Japanese Encephalitis

Dr Tu Khai Huynh – TMA Member Ipswich

Japanese Encephalitis (JE) occurs in practically all Asian countries and is also now considered endemic in the Torres Strait region and Papua New Guinea. The incidence of JE in humans varies by season, usually coinciding with the rains and is mainly passed through the bite of the Culex mosquito. Country Peak transmission Korea, Japan May to September Temperate South East Asia (Thailand,Vietnam, Cambodia) April to October Nepal, Northern India September to December Malaysia, Indonesia and Philippines and tropical regions of South East Asia All year round

Humans are infected by the virus (JEV) when living in close proximity its natural hosts (pigs and wading birds). This usually occurs in rural areas where there is breeding of the vectors in flooded rice fields. Nearly 3 billion people are believed to be at risk for JE virus infection and approximately 20,000 clinical cases with 6,000 deaths are reported annually. Infection is characterized by sudden onset of fever, chills, muscle aches, and confusion. It is recognised, however, that most infections are asymptomatic; published estimates of the symptomatic to asymptomatic infection ratio vary in different populations from 1:25 to 1:1000.. The case fatality rate ranges from 5-30% but approximately 30-50 % of the surviving patients have permanent brain damage and complete recovery occurs in only one-third of patients.

Culex mosquito – Females bite usually during the day time but peak at dawn and at dusk. All travellers to Asia (and other tropical regions) must be fully aware of the need to take appropriate measures to avoid mosquito bites, such as effective insect repellent and appropriate clothing.

Risk for travellers The risk to short term travellers to Asia is very low, particularly if they are only visiting urban areas, with overall estimates of one case per million travellers. The risk becomes greater for persons who intend to live or travel in risk areas for long periods of time, and have rural trips during transmission seasons. Certain activities may increase the risk such as fieldwork, camping, or cycling in rural areas. The risk amongst rural travellers has been estimated to be in the range of 1 case per 5,000 travellers to 1 per 20,000 per week. Treatment There is no specific treatment, but rather supportive management. Prevention Apart from personal protective measures to avoid being bitten, vaccination of humans is the most effective means of preventing JE. Two different vaccines are available for use in Australia – these would be discussed with your doctor. JE vaccination is recommended for: Travellers (≥12 months of age) spending 1 month or more in rural areas of high-risk countries in Asia and Papua New Guinea (see 4.8.3 Epidemiology above); however, should be considered for shorter-term travellers, particularly if the travel is during the wet season, or anticipated to be repeated, and/or there is considerable outdoor activity, and/or the accommodation is not mosquito-proof. All other travellers spending a year or more in Asia (except Singapore), even if much of the stay is in urban areas. Please consult your travel doctor for timely advice about Japanese encephalitis if you are going to Asia or PNG, especially those times listed above, and especially if your travel will involve a lot of rural activity.

• Posted on August 17, 2013
• Posted in Vaccine
• Tags: Japanese Encephalitis

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Singapore Traffic Adventure

by Diana Gillatt, TMA Member Tanunda Despite your travel doctor’s warnings about exotic illnesses like typhoid, malaria and rabies, the fact is that the most common health problems suffered by travellers are much more mundane things like diarrhoea, coughs and colds and accidents / injuries. Abroad as at home, motor vehicle injuries are a major cause of trauma and for travellers there are the added hazards of unfamiliar traffic rules and often quite different general attitudes to traffic safety in foreign countries. In fact for travellers in developing countries it is more often as pedestrians, cyclists or on public transport that we are injured, rather than as the driver or passenger in a car. This was brought home to me recently during a short visit to Singapore. Now Singapore is one of the more developed countries in Asia, with good roads and appearances in the city not so different from at home. But even here travellers need to be aware that they are not at home. Walking back to my motel along the paved footpath beside the river, I was offered a ride on a Trishaw by a pleasant elderly gentleman. The price was reasonable and it seemed like the chance for a quiet easy ride along the leafy Esplanade and a rest for my feet after a day exploring Chinatown. Unbeknownst to me, however, there was apparently one section of this Esplanade with some steps that the Trishaw couldn’t negotiate, so once I had agreed the price and climbed aboard, my charming host headed off in the opposite direction! After he assured me he really was taking me to the correct motel, he proceeded to ride out to the main road and to my horror left the footpath to take up position in the middle of a busy major intersection! While waiting for the traffic lights to change, I held on to the hope that we were going to cross with the pedestrians to the other side, but no. In fact he didn’t even wait for the lights, but decided that the time was ripe for us to launch out into the main thoroughfare, do a U-turn and carry on down the road ignoring the rushing vehicles all around us! Being overtaken by a bus and a truck while we were in the right hand turning lane didn’t phase him at all, and of course he gently guided us around a corner and eventually back on to the quiet riverside esplanade again. I had just about stopped quaking enough to pay him the fare by the time we arrived at the motel. Needless to say there was no opportunity of a bicycle helmet on a trip like this, and the risk taking that was obviously an every day event for my driver left this Australian quaking and looking for the nearest Singapore Sling to calm her nerves. I can look back on this little episode and laugh now, but many travellers aren’t so lucky. And these roads in Singapore are rather tame when compared to some other countries… Hiring a motorbike to get around a beach resort in Indonesia or Thailand may seem fun, but is there a helmet provided? Do you know which side of the road you are meant to ride on? Are the road rules different from at home, and does anyone pay them any attention? It’s great to have a some adventure on your travels, but don’t leave all your common sense behind! Here are a few tips: Be aware of the local road rules – for instance, which side of the road are vehicles meant to drive on? Take extra care as a pedestrian – don’t expect the traffic to try to avoid you! Ask for a helmet if cycling or riding a motor bike. If you hire a car, ask for one that has seat belts and air bags. Avoid driving at night. Take a first aid kit with you on your travels so you can manage minor injuries yourself.

• Posted on August 17, 2013
• Posted in Tanunda
• Tags: accidents, Singapore

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Japan and Your Medications

… Prepared by TMA Member Maitland NSW:Dr Puru Sagar Chromis Sept 2012

It is generally well known that you can’t take certain medications into Middle Eastern countries but did you know that there are restrictions on medications imported into Japan, even for personal use? It is illegal to bring into Japan some over-the-counter medications including cough and cold, sinus, and allergy medications containing stimulants or codeine. Did you know that your body (specifically, your liver) can convert a 30mG tablet of codeine into as much as about 5mG of actual morphine? In Japan, codeine is thus considered a narcotic and its importation is prohibited. An illegal or backyard chemist can distil as much as 23mG of morphine out of a 30mG tablet.

Japan will generally allow up to a month’s supply of your personal medication as long as it is not a prohibited substance (such as narcotics and stimulants). However, you will still need to declare your medication at customs. Quantities larger than a month’s supply, including syringes, pumps, and CPAP machines, may still be allowable provided you have pre-arranged an import certificate called the “Yakkan Shoumei”. You will need two copies of an Import Report of Medications, a signed Declaration, an Explanation of the Products, a copy of a doctor’s Prescription or Direction, your travel documents listing arrival date and port, and a return envelope with Japanese postal stamps. Only when the Pharmaceutical Inspector “can confirm that your application documents are complete and he admits that you speak the truth, he will send you a ‘Yakkan Shoumei’ by post”. The Japan Ministry of Health lists an example form filled out by one Sherlock Holmes trying to import morphine for personal use during a conference in Japan!

The US Government warns its citizens that “some US prescription medications cannot be imported into Japan, even when accompanied by a customs declaration and a copy of the prescription” and that Japanese officials have detained travellers carrying prohibited items “sometimes for several weeks”. Apparently, Japanese officials do not make on-the-spot humanitarian exceptions.

If you are going longer than a month, please note that Japanese doctors can prescribe similar, but not identical, medications to yours (the generic will be the same but the brand name will be different). You can generally find a list of English-speaking doctors and medical facilities on the web, noting that medical treatment in Japan is world class but expensive. Buying drugs such as Viagra or Prozac on the black market in Japan can lead to arrest and imprisonment.

Prior to travelling overseas, it is wise to undertake some preliminary research well in advance of your travel date about medication importation, even if that medication is for personal use. A good place to start is atwww.smartraveller.gov.au but more comprehensive information is generally available from the embassy/high commission websites or that country’s Ministry of Health website. If in doubt,  ask your TMA doctor.

• Posted on September 27, 2012
• Posted in Maitland
• Tags: Japan, Medications

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