A high proportion of the earlier published cases of JE have been in the United States and allied military personnel stationed in SEA regions. From 1945 to 1972, 131 cases of JE were reported in military personnel. In the years 1978 to 1992 and 1992 to 2008, 24 cases and 21 cases were reported, respectively. Rates of 0.1–2.1 per 10,000 per week have been observed in nonimmunized US military personnel in Asia. JE vaccination is recommended for this group of travelers. JE infection has been reported in short-term travelers who selleck products have traveled outside of the rainy season with minimal travel to rural
locations.[3, 8-10] This has raised concerns about the limits in our current understanding of the risk of JE infection in short-term travelers. Characterizing http://www.selleckchem.com/products/INCB18424.html the current risk of JE in general travelers and the uncertainty limits around this risk provides valuable information to travel medicine practitioners advising prospective travelers. In our cohort of predominantly short-term travelers, travel was more common in periods of the year where JE transmission is higher and whilst nearly half of the
travelers visited or stayed in a rural area overnight, only a small proportion of travel-days were spent on “outdoor” activities. The risk of JE infection is linked to outdoor exposure in the dusk or evening times in rural destinations where JE transmission occurs. In terms of adherence to pre-travel advice, most travelers utilized some form of mosquito preventive behavior, although consistency of use was not documented. Only a small proportion of travelers (9%) were vaccinated for JE, which probably reflects the current recommendations for JE vaccine, in that a majority were short-term travelers and not spending a great amount of time in rural areas. Low-level antibodies at baseline were noted in 2.8% of travelers with possibilities
of previous JE, given the presence of JE in Northern Australia, or other flavivirus vaccination or Morin Hydrate infection as possible explanations. A limitation of this study is the potential impact of a small sample size on the likelihood of observing an infrequent infection such as JE (clinical or subclinical) in travelers. A further limitation is the generalizability of the findings from a travel-clinic attendee cohort who may be different to general travelers. Data were also incomplete for the travelers who did not complete the study. Although unlikely, it is also possible that some seroconversions were missed given the timing of the second bleed (day 10). Several considerations relating to risk factors for infection, adverse effects and costs of vaccine, and individual personal preference regarding vaccination, need to be considered when discussing indications for or against vaccination. The threshold for JE vaccination is generally still based on historical risk-benefit considerations that may no longer be valid now as we have a safer vaccine.