OBJECTIVES: The authors examine the rationale and efficacy of pre-travel hepatitis B immunization strategies based on itinerary and presumed on-travel risk behaviour. METHODS: A large survey among 26,640 Danes survey provided data on journey lengths and destinations, immunization coverage, risk behaviour and knowledge. RESULTS: The estimated cumulative lifetime stay in endemic areas outside Europe is 4.3 months. The majority of risk situations are involuntary and unforeseeable. The majority of risk situations occur on short-term journeys. 5% nonimmune and 5% short-term travellers experienced at least one risk situation such as injections/operations/tattoos on their journey. The level of knowledge of hepatitis A and B is low. CONCLUSIONS: The rationale and efficacy of current immunization strategies are challenged. Based on the results presented here and the availability of vaccines with long-lasting coverage, the authors find that recommendations of immunization should be based on lifetime risk instead of single journey itineraries. The authors find that a recommendation and/or cost-benefit discussion would be relevant in the pre-travel counselling of most - especially younger - travellers to endemic areas.