Japanese encephalitis vaccination

Sunray

They are advising having this before you travel to Indias effected regions, which of course I am.

I'm in Bangkok, so its easy to get here. Has anyone had this? Did it make them sick? Its not actually licenced in the UK but you can have it if you ask.

Have to stay in Thailand and near Bangkok for 10 days incase of delayed allergic reaction which is a right pain in the arse. 80-97% effective so not perfect.

OzThumper

General information has tended to indicate that vaccination is not required unless you are going to specific (limited) region involved, AND you are staying for an extended period.

Refer to the World Health Organisation site that deals with this issue, for further info.

__________________
Dave
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I started with nothing and still have most of it left.

Sunray

Hmmm, thats not very conclusive. 25% mortatility rate of infection and mental retardation for survivors. That makes me want the vaccination.

OzThumper

Might I suggest you follow the link on the above-listed url and have a look at the specifics in more detail.

You will then find that there are some specific guidelines and recommendations, one of which indicates that there should be no restriction in travel, etc.

GoanCanuck

My advice would be to only take the vaccination if you are going to a place which has an outbreak of this disease. You don't need this vaccination if you are mainly going to be in Goa.

OzThumper

A quote from the online website of the Travel Doctor (Australia):

thaneb

Yeah, I have been wrestling with this as well, when I got my shots they didn't recommend it, but my girlfriend went after this announcement and they did recommend it. I'm not one for the sciences but my friend who is tells me this one is a particularly bad one to get due to the brain damage so I am a little concerned. Malaria I could deal with, brain damage worries me a bit more. I will definitely have to look into it more.

shanthi

From the Government website:http://www.cdc.gov-Destinations:SouthAsia


Recommended Vaccinations and Preventive Medications

The following vaccines may be recommended for your travel to South Asia. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need.

• Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
• Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
• Japanese encephalitis, if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis.
• Malaria: your risk of malaria may be high in these countries, including cities. See your health care provider for a prescription antimalarial drug. For details concerning risk and preventive medications, see Malaria Information for Travelers to South Asia.
• Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
• Typhoid. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors Vaccination is particularly important because of the presence of S. typhi strains resistant to multiple antibiotics in this region. There have been recent reports of typhoid drug resistance in India and Nepal.
• As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults.

Required Vaccinations

• None.

kiemhwa

I am going in Late November...to Delhi, Rajasthan, and Dharamsala.... do I have any chance of moqsuito exposure in these locations at this time of year?

OzThumper

Re #8... on the Jap E website, the follwoing is listed:

..indicating that for most travellers then there really should not be a problem.

I think the term "unprotected" really needs to be highlighted though. If you are not using some kind of spray (e.g. DEET-based), covering up with long sleeves and pants, etc. in most of these regions then you are plain silly anyway and deserve whatever you get.

ammadas

i just came back from my travel doctor and he told me that since 1957 only 200 US travelers have gotten jap-e,he also told me that side effects are pretty bad a percentage of the time so he only suggests getting it if going to be in high risk areas for an extended amount of time.if i were you i would find a travel doctor and find what is good for you.good luck
Namaste ammadas

Blueskiesgirl

Hi
After reading about the latest Jap E outbreak and the fact that I will be in rural Rajasthan doing voluntary work for 3 months I decided last week to have it just to be safe even though it is not cheap. I am having three injections (£30 each) with one week between each and then I cannot fly for a further 10 days after the last one in case of reaction.
I was advised not to drink alcohol for a couple of days after the jab but apart from that I feel fine. My boyfriend felt quite lightheaded and not quite with it for a day or so after his.
The nurse did have to get authorisation from a local doctor because it is unregulated and we had to sign a disclaimer but it was still easy.
I had originally decided against it when the nurse discussed it at my first meeting but that was before I read about the most recent outbreak. I thought it wise not to take chances especially as I am a novice traveller and will be in the affected areas so still learning how best to avoid bites etc.
She strongly drilled home the main importance of care against being bitten at all - the usual long sleeves, legs and feet covered, regular reapplication of repellent etc etc.
Whatever you decide I hope you have a safe and happy trip

Sunray

Thanks for that, very informative.

Thats 31 days total. Hmmm, shit. I dont have that sort of time. I'm not going to get it more out of cost/time. I am only going to go to towns and cities, I have a mozzie net, deet and rarely get bitten so should be ok.

shanthi

The Public Health Agency of Canada (PHAC) is monitoring a large outbreak of Japanese encephalitis (JE) in India. Between July 29 and August 30, 2005, 1145 cases of JE have been reported in an on-going outbreak affecting 14 of 70 districts in the state of Uttar Pradesh; additional cases have also been reported in the neighbouring state of Bihar. Of the 1145 reported cases, 296 were fatal.

Source: WHO

Japanese encephalitis, a flavivirus, is a mosquito-borne viral disease that is primarily transmitted to humans through the bite of an infected mosquito. Wild and domesticated animals, such as pigs and birds, are the principal hosts for JE virus. The majority of infections are mild with little or no symptoms. In cases where severe infection occurs and illness develops, approximately 30% of cases are fatal and between 33% to 50% of survivors are left with permanent psychologic and neurologic effects. In Asia, more than 50,000 cases of JE are reported annually. Children under the age of ten years and the elderly are most at risk.

Mosquitoes that commonly transmit JE are most heavily concentrated in rural, rice growing areas and feed most actively in the late afternoon and early evening. Transmission may occur year-round, but epidemics usually begin during the rainy season when mosquito populations are at their highest levels. In the temperate regions of China, Japan, Korea, and the eastern areas of the Russian Federation, transmission tends to be between May and September. In sub-tropical and tropical areas, transmission periods are extended and vary with the rainy season. Agricultural irrigation is also an important factor, as flooded rice fields are excellent breeding grounds for mosquitoes.

JE is endemic in parts of China, India, Korea, Japan, the South East Russian Federation, Islands in the Torres strait Australia, Nepal, Thailand, Vietnam, Cambodia, Lao PDR, the Philippines, Taiwan, Indonesia, Malaysia, and Sri Lanka. Large outbreaks are known to occur in India and Nepal.

The incubation period for JE ranges from 5 to 15 days and presents with a range of symptoms depending on the severity of infection. Minor infections may only result in fever and headache, while the symptoms associated with sever infections include quick onset, headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions (especially in infants) and spastic paralysis. Acute encephalitis; can progress to paralysis, seizures, coma and death.

Although there is no cure or treatment, an inactivated vaccine is available for use in Canada to protect against the development of symptomatic disease.

Recommendations:

Canadians traveling to the state of Uttar Pradesh, India are advised to obtain an individual risk assessment with a travel medicine physician or their family physician four to six weeks prior to their departure, to determine both the risk of exposure to and the need for vaccination against JE, as determined by their travel itinerary and medical history.

Furthermore, the personal insect protective measures that follow are very effective at preventing arthropod-borne diseases and are recommended for all travellers to JE endemic and/or epidemic areas.

• stay in well-screened or completely enclosed, air-conditioned accommodation;
• sleep under insecticide-treated bed nets;
• wear clothing that reduces the amount of exposed skin; wear long-sleeved shirts (tightly weaved material, sleeves down, buttoned/zipped up, tucked into pants) and long pants (tucked into socks or footwear);
• light-coloured clothing may be less attractive to some mosquitoes and make mosquitoes more noticeable;
• use DEET-based products as repellents on exposed skin. The higher the concentration of DEET in the repellent formulation, the longer the duration of protection. However, this relation reaches a plateau at about 30% to 35%. DEET formulations that are "extended duration" (ED), such as polymers, are generally considered to provide longer protection times, and may be associated with less DEET absorption. Formulations over 30% are not currently available in Canada, although they are available internationally, including in the United States. It should be noted, however, that products sold outside Canada have not been evaluated by Health Canada's Pest Management Regulatory Agency (PMRA). Most repellents containing "natural" products are effective for shorter durations than DEET and for this reason are not considered the preferred products for protecting against mosquito bites.

Note: Regulatory agencies in western nations may differ regarding the recommended maximum concentration and application rates of DEET, especially for children. The Committee to Advise on Tropical Medicine and Travel (CATMAT) is satisfied that, for travel outside of Canada where the risk of mosquito-borne diseases (malaria, JE, dengue) outweighs the risk of any important adverse reaction to DEET, the threshold for use of DEET should be low.

CATMAT recommends that concentrations of DEET up to 35% can be used by any age group.

For children, alternative personal protective measures, such as mosquito nets treated with insecticide, should be the first line of defence, especially for infants less than 6 months of age. Portable mosquito nets, including self-standing nets, placed over a car seat, a crib, playpen, or stroller help protect against mosquitoes. However, as a complement to the other methods of protection, the judicious use of DEET should be considered for children of any age. Recent medical literature from Canada suggests that DEET does not pose a significant or substantial extra risk to infants and children.

DEET/sunscreen combination products are not generally recommended, because DEET can decrease the efficacy of sunscreens. As well, sunscreens should be used liberally and often while DEET should be used sparingly and only as often as required. If application of both is necessary, the Canadian Dermatology Association recommends that the sunscreen be applied first and allowed to penetrate the skin for 20 minutes, prior to applying DEET.

Although the state of Uttar Pradesh in India is experiencing an outbreak of JE, travellers are reminded that JE occurs in many areas in the regions of east, southeast and middle south Asia, the far eastern Russian Federation, and some of the Pacific islands and that outbreaks of JE in these areas, are not uncommon.

As a reminder…

The Public Health Agency of Canada routinely recommends that Canadian international travellers consult their personal physician or a travel clinic prior to international travel, regardless of destination, for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication, and personal protective measures.

The Public Health Agency of Canada recommends, as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been.

Additional Information

The Public Health Agency of Canada's Committee to Advise on Tropical Medicine and Travel Statement on Japanese Encephalitis Vaccine provides comprehensive information on Japanese encephalitis, including information on immunization and geographic regions where transmission is a risk; it can be accessed through the following link: Canada Communicable Disease Report

shanthi

Table 1 Risk of Japanese Encephalitis by Country, Region, and Season*

COUNTRY

AFFECTED AREAS/JURISDICTIONS

TRANSMISSION SEASON

COMMENTS

Bangladesh

Few data, probably widespread

Possibly July-December as in northern India

Outbreak reported from Tangail district, Dacca division, sporadic cases in Rajshahi division

Bhutan

No data

No data

Not applicable

Brunei

Presumed to be sporadic, endemic as in Malaysia

Presumed year-round transmission



Cambodia

Endemic, hyperendemic countrywide

Presumed to be May-October

Highly prevalent in rural areas near Phnom Penh

Hong Kong

Rare cases in new territories

April-October

Vaccine not routinely recommended

India

Reported cases from all states except Arunachal, Dadra, Daman, Diu, Gujarat, Himachal, Jammu, Kashmir, Lakshadweep, Meghalaya, Nagar Haveli, Orissa, Punjab, Rajasthan, and Sikkim

South India: May-October in Goa, October-January in Tamil Nadu, August-December in Karnataka; second peak (April-June in Mandya district)
Andrha Pradesh: September-December
North India: July-December

Outbreaks in West Bengal, Bihar, Karnataka, Tamil Nadu, Andrha Pradesh, Assam, Uttar Pradesh, Manipure, and Goa, urban cases reported e.g. Lucknow

Indonesia

Kalimantan, Bali, Nusa Tenggara, Sulawesi, Mollucas, and western Irian Jaya**, Lombok

Probably year-round risk; varies by island; peak risks associated with rainfall, risk cultivation and presence of pigs; peak periods of risk, November-March, June-July in some years

Human cases recognized on Bali and Java only, four cases among tourists to Bali reported

Japan+

Rare, sporadic cases on all islands, except Hokkaido

June-September except Ryukyu Islands (Okinawa) April-October

Vaccine not routinely recommended for travel to Tokyo and other major cities, enzootic transmission without human cases observed on Hokkaido

Korea

No data from North Korea; South Korea sporadic, endemic with occasional outbreaks

July-October, most cases August and September1***

Last major outbreaks in 1982-1983

Laos

Presumed to be endemic, hyperendemic countrywide

Presumed to be May-October

No data available

Malaysia

Sporadic, endemic in all states of Peninsula, Sarawak, and probably Sabah

No seasonal pattern, year-round transmission

Most cases from Penang, Perak, Salangor, Johore, and Sarawak

Myanmar (formerly Burma)

Presumed to be endemic, hyperendemic countrywide

Presumed to be May-October

Repeated outbreaks in Shan State in Chiang Mai Valley

Nepal

Hyperendemic in southern lowlands (Terai), Kathmandu Valley outbreak reported recently

July-December
Most cases mid August-early November***

Vaccine not routinely recommended for travellers visiting high altitude areas only

People's Republic of China

Cases in all provinces except Xizang (Tibet), Xinjiang, Quinghai, hyperendemic in southern China, endemic - periodically epidemic in temperate areas

Northern China: May-September
Southern China: April-October
(Guangshi, Yunnan, Gwangdong, and Southern Fujian, Szechuan, Guizhou, Hunan, Jiangsi provinces)

Vaccine not routinely recommended for travellers to urban areas only

Pakistan

May be transmitted in central deltas

Presumed to be June-January

Cases reported near Karachi, endemic areas overlap those for West Nile virus

Philippines

Presumed to be endemic on all islands

Uncertain, speculations based on locations and agroecosystems; West Luzon, Mindoro, Negro Palowan: April-November; Elsewhere: year round, greatest risk April-January

Outbreaks described in Nueva Ecija, Luzon, and in Manila

Russia

Far eastern maritime areas south of Khabarousk

Peak period July-September

First human cases in 30 years recently reported

Singapore

Rare cases

Year-round transmission - April peak

Vaccine not routinely recommended

Sri Lanka

Endemic in all but mountainous areas, periodically epidemic in northern and central provinces

October-January, secondary peak of enzootic transmission May-June

Recent outbreaks in central (Anuradhapura) and northwestern provinces

Taiwan+

Endemic, sporadic cases island wide

April-October, June peak

Cases reported in and around Taipei

Thailand

Hyperendemic in north; sporadic, endemic in south

May-October

Annual outbreaks in Chiang Mai Valley, sporadic cases in Bangkok suburbs

Vietnam

Endemic, hyperendemic in all provinces

May-October

Highest rates in and near Hanoi

Western Pacific & Australia & Papua New Guinea

Discrete epidemics reported on Guam, Saipan (Northern Mariana Islands) and in the Torres Strait, Australia; sporadic cases reported on west coast of Cape York Peninsula, Australia, and western province of Papau, New Guinea

Uncertain, possibly September-January in the Pacific, March-April in the Torres Strait

Enzootic cycle may not be sustainable on islands, epidemics may follow introductions of the virus