Recent reports of Japanese encephalitis (JE) activity belie the fact that disease rates in Vietnam have decreased in recent years. [1,2]

Time and Place:
- Japanese encephalitis was first reported in Vietnam in 1960.
- Most cases of Japanese encephalitis in Vietnam occur in the South during the rainy and early dry season; and in the north during late summer and autumn.
- 61,729,000 persons (73% of the population) live in areas of risk.

Vaccine Schedule:
BCG – birth
DTwP – 2, 3, 4 months
HepB – birth; 2, 4 months; [since 2003]
Japanese encephalitis – 12, 13, 25 months; Part of country [selected HRD]
Measles (monovalent) – 9 months
OPV – 2, 3, 4 months
TT – pregnant women; CBAW (15-35) in some areas
Typhoid – 3-10 years; Part of country [selected HRD]
Vitamin A – 6-11, 12-17, 18-24, 31-36 months

WHO estimates for vaccine coverage decreased slightly from 95% in 2006, to 88% in 2008 (see graph).

The incidence of Japanese encephalitis has decreased dramatically during the past three decades – from a peak of 4,935 cases in 1985, to only 558 cases in 2000.
– 9,574 cases were reported during 1986 to 1990; 6,981 during 1991 to 1996.
– 68 cases were officially reported in 2009.
– Annual mortality from the disease has varied from 60 to 150 cases.

Incidence and Prevalence:
- Japanese encephalitis accounted for 67% of acute childhood encephalitis in Hanoi during the summer of 1995.
- The annual incidence among children in Southern Vietnam is 4.6% (2007 publication)
- A recent outbreak was centered in Ha Bac and Hai Hung.
- Eight children died of presumed Japanese encephalitis in Kien Giang Province in 1999.
- 200 cases were reported in the northern region during May to June, 2005.

Exported cases
- An Australian soldier acquired Japanese encephalitis in Vietnam (reported in 1975).
- In 2006, an Italian traveler developed Japanese encephalitis (nonfatal) after returning from Vietnam.
- In 2008, an American tourist contracted Japanese encephalitis (nonfatal) while in Vietnam and Cambodia.

Related diseases:
- A new arbovirus, tentatively named “Nam Dinh virus,” was implicated in several cases of encephalitis in Ha Noi and Ha Tay in 2003, and in Bac Giang Province in 2004.

References:
1. Berger SA. Infectious Diseases of Vietnam, 2010, 382 pp. Gideon e-book series, http://www.gideononline.com/ebooks/country/infectious-diseases-of-vietnam/
2. Berger SA. Japanese Encephalitis: Global Status, 2010, 51 pp. Gideon e-book series, http://www.gideononline.com/ebooks/disease/japanese-encephalitis-global-status/

Update: Posted in ProMED

Virtually everything that we humans do for pleasure could place us at risk for illness, or even death. In recent years, a growing variety of medical conditions has been reported among travelers. The ‘top-ten’ from this list follow:

1. Diarrhea – Not the most serious, but certainly the most common. Roughly 40% of travelers to less-developed countries will develop diarrhea within 48 hours of arrival. Much of the next few days of touring will be seriously damaged by searching for a clean bathroom … or even toilet paper. In recent years, scores of ocean voyages have been cut short by mass outbreaks of vomiting and diarrhea – related to Norovirus infection.
2. Skin disorders due to sun, heat, humidity and insect bites. Like diarrhea, not life threatening – but no fun while touring.
3. Insect-borne fevers. Dengue and Chikungunya are becoming increasingly common and are no longer limited to “local natives.” Both diseases are characterized by headache, high fever, muscle and joint pain. The incubation periods are short – meaning that the traveler is likely to still be on the road, with no chance for continued tourism and the risk of exposure to sub-standard health care.
4. (more…)

A recent outbreak among American missionaries in El Salvador is the latest in a growling list of histoplasmosis outbreaks acquired during travel to endemic areas. The following chronology is abstracted from GIDEON (primary references available on request) Additional cases of travel-related African histoplasmosis (caused by Histoplasma capsulatum var. duboisii ) appear at the bottom of the list :

1984 (publication year) – A case of imported infection (from India) was reported in Scotland.
1986 (publication year) – Disseminated histoplasmosis has been reported in an immigrant to the United States from the Dominican Republic.
(more…)

In October, 2008 an American tourist in Tanzania acquired trypanosomiasis. At least 40 such cases have been reported since 1970. The following chronology is abstracted from Gideon. Note that the country of disease acquisition was reported in 37 cases – of which Tanzania accounted for 18 and Malawi 11.

Year:
1970 – A case of trypanosomiasis was reported in Switzerland.
1970 – Two American tourists acquired trypanosomiasis while in Kenya and Rwanda.
1975 – A Swedish tourist acquired trypanosomiasis in Gambia.
1977 – A case of trypanosomiasis was reported in Switzerland.
1981 – An American acquired trypanosomiasis in Tanzania.
1990 (publication year) – Two Swiss nationals acquired trypanosomiasis in Rwanda.
1997 – A Brazilian acquired trypanosomiasis in Angola.
1998 – An Australian acquired trypanosomiasis in Tanzania.
2000 – One American and one British national acquired trypanosomiasis in Tanzania.
2001 – Eleven persons acquired trypanosomiasis in Tanzania: three Dutch, two Italians, and one each Swedish, Norwegian, Belgian, South African, American and British.
2001 – A British national acquired trypanosomiasis in Zambia.
2004 – Two British brothers acquired trypanosomiasis in Tanzania.
2004 – Two Italians acquired trypanosomiasis, in Gabon and Central African Republic.
2005 – An American acquired trypanosomiasis in Tanzania.
2005 – Two South Africans acquired trypanosomiasis in Malawi.
2007 – A British national, 5 South Africans, 1 Canadian and two Australians acquired trypanosomiasis in Malawi.

As quoted by Steve in ProMED:

Travel-related episodes of endemic typhus are relatively uncommon.
The following chronology is abstracted from GIDEON

1997 (publication year) – Three Norwegian tourists acquired endemic typhus – in Guinea-Bissau, Crete and Thailand
1998 (publication year) – Three European travelers acquired endemic typhus in Indonesia.
1998 – Two Norwegians acquired endemic typhus – in China and Crete.
1999 – A Norwegian acquired endemic typhus in Malta
2001 (publication year) – A German tourist acquired murine typhus in Thailand.
2002 (publication year) – A traveler from Hong Kong acquired endemic typhus in China.
2003 – A Czech tourist acquired endemic typhus in Egypt.
2003 – A Japanese national developed endemic typhus in Vietnam.
2008 – Two Japanese nationals acquired endemic typhus overseas – one in Indonesia.

Health travel tips from Dr. Steve Berger, GIDEON‘s medical advisor:

1. If you are planning a trip to any country, become aware of the local health situation, ongoing disease outbreaks, weather, emergency telephone numbers, availability of medicines you may be taking.
2. If you will be traveling to a tropical or developing country, consult a Travel Medicine Clinic for advice, vaccines and preventive medications.
3. Eat only well cooked foods, preferably in “clean” or “modern” facilities. Avoid eating fresh vegetables, exotic plants and animals and non-bottled water.
4. In areas where mosquito-borne diseases (malaria, dengue, etc) are endemic, use insect repellents and wear long-sleeved clothing appropriate to local weather.
5. Things to avoid: high-risk trauma which might result in “local” health care (injections, blood), unsafe sex, contact with animals.
6. If you feel ill following return home, consult an expert in Travel Medicine – bring a written itinerary which details dates of travel and return, exact places visited, foods eaten, health status of accompanying persons, vaccines and drugs received.

A sample of the new enhanced content for the Travel tab, was provided on ProMED related to an outbreak of Measles in New Mexico:

Travel and measles
——————
1982 – An outbreak (7 cases) among patients in a pediatrician’s office in the United States was related to an imported case from Korea.
1998 – An outbreak (69 cases, 2 hospitalized, 0 fatal) in Tuvalu was ascribed to introduced cases among workers from Nauru.
1998 – An outbreak (33 cases) was linked to an infected visitor arriving in Alaska, United States, from Japan.
1999 – An outbreak (75 confirmed cases) in Australia was traced to an index case from Indonesia.
2000 – Outbreaks (78 cases, total) in Canada were linked to travel in Mexico (6 cases), Bolivia (19 cases), and Belgium (25 cases).
2000 – An outbreak (992 cases, or 57 percent of all cases for the Americas region) in Haiti was thought to have originated with imported cases from the Dominican Republic.
2000 to 2001 – An outbreak (1062 cases, 0 fatal) was reported in Tanzania among refugees from Burundi.
2001 – An outbreak (37 cases) in Venezuela was ascribed to a case imported from Europe.
2001 – An outbreak (14 cases) in the United States was reported among internationally adopted children.
2002 – An outbreak (1334 suspect cases; 128 confirmed) in Colombia was traced to index patients who had acquired the disease in Venezuela.
2002 – An outbreak (13 cases) in the United States resulted from a case imported from the Philippines.
2002 – An outbreak (6380 suspect cases; 2397 confirmed) in Venezuela was traced to measles imported from Europe.
2003 – An outbreak (107 cases) in an unvaccinated religious community in Israel followed introduction of an index patient from Switzerland.
2003 – An outbreak (22 cases) was reported in Mexico following importation of measles from either Japan or Korea.
2004 – An outbreak (59 cases) was reported in Mexico following importation of an index case from Asia.
2004 – 10 confirmed cases were identified among Chinese children (from Hunan) arriving in the United States, and 3 Chinese children arriving to Norway.
2005 – An outbreak (34 cases) in the United States was related to an index case who contracted measles in Romania.
2005 to 2006 – An outbreak (27 cases) in Mexico was related to index cases who had worked at an international airport.
2006 – An outbreak (7 cases) in Australia was related to an imported index case.
2006 – An outbreak (15 cases) in an office building in the United States was associated with an index case, which had arrived from India.
2006 – An outbreak (3 cases) was reported among members of an adoption group returning to the United States from China.
2006 – An outbreak (44 cases) in Venezuela was ascribed to an index case arriving from Spain.
2006 to 2007 – An outbreak (213 cases) in Spain followed importation of a case from Eastern Europe.