**12. Way forward in curbing HBV as a traveler's infection**

#### **12.1 Early screening and treatment**

Early screening and treatment will help mitigate frequent transmission of the viral agent and curb morbidities and mortalities in infected persons [85]. The first line should be to give the exact medical advice and start antiviral treatment, if available. Sadly, undergoing this step is often a problem in developing regions where there is lack of access to good healthcare facilities, and antiviral treatment is often exorbitant [6, 86].

#### **12.2 Advocacy of immunization exercise**

Advocacy of immunization exercise for HBV infection should be key in eliminating the viral agent worldwide which is central to WHO's agenda [6, 10]. To maximize implementation of the WHO agenda, provision of technical guidance and support to reduce transmission of the disease such as adhering to safer blood transfusion and disposable needles among others. The virus vaccine is very effective in preventing disease progression. It has been reported that only 27% of newborn babies had receive a birth dose of hepatitis B vaccine globally [86]. Birth dose vaccination of the viral agent is fundamental to halting mother-to-child transmission as late immunization is not fully effective in destroying the chain of mother-to-child transmission. Coordination between maternal health services and immunization should be effectively established [88].

#### **12.3 Self-protection measures**

Self-protection measures are one of the pre-travel counseling given to potential travelers to HBV and other blood-borne pathogen endemic regions [7, 8, 43]. Persons should be guided from contaminated items or equipment used in medical or cosmetic procedures, blood products, injection drug use or any exercise that involve piercing the skin or mucosa, or unprotected sexual activity. Travelers should be advised properly against the use of equipment that is not properly sterilized or disinfected on medical or beautification tourism (such as tattooing or piercing) [8]. The viral agent can be disseminated to others if tools are not sterile or if personnel do not follow proper infection control protocols [89].

#### **12.4 Educational awareness**

Educational awareness and programs that will be targeted towards HBV awareness lowers transmission of the infection [90, 91]. There is a large pool of persons suffering from chronic HBV infection in Sub-Saharan Africa that are not aware of their situation. Educational awareness and implementation of local health measures are pertinent in eradicating the scourge of the infection [2]. These should include training local communities on how to perform safe blood transfusion and establishing efficient screening methods for transfusion of donated bloods. Health education programs should include administration of safe injections (intravenous drug users and healthcare settings) and implementation of safer sex practices (especially the use of condoms). More so, occupational safety trainings should be advocated for health workers [92]. It is also worthy to note that effective communication and emphasizing the role of the virus testing, follow-up visits, and monitoring therapy will help eliminate HBV infection [43].

## **12.5 Socioeconomic condition enhancement**

Enhancing the socioeconomic conditions of a particular population has shown reduction in the rate of HBV infection. Government and non-governmental organization (NGO) bodies should ensure that there is a universal access to portable water and encourage food handling that is safe and hygienic [92]. They should also implement good sanitation systems. Safe disposal practice of medical waste should be advocated in the health settings [43].
