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Background: Japanese encephalitis (JE) and rabies are serious vaccine preventable diseases which are an important consideration for travelers to Asia.Methods: Five Boston-area travel clinics collected demographic data, trip information, and interventions for travelers to Asia seen at pre-travel consultations from March 1, 2008, through July 31, 2010. We evaluated travelers for proportion vaccinated for JE and rabies, those traveling for >1 month, and whether travelers had adequate time to complete the JE series (clinic visit ≥28 days before departure) and rabies pre-exposure prophylaxis (clinic visit ≥21 days before departure).Results: Among 15,440 travelers from five Boston Area Travel Medicine Network travel clinics, Asia was the most common destination region, visited by 5,582 (36%) of travelers. Among these travelers, 4,810 (86%) planned to travel to only one Asian subregion. Median trip duration was 17 days, with more than 20% traveling for >1 month. The most common destinations were South (41%), Southeast (26%), and East (23%) Asia. Of those traveling to South, Southeast, or East Asia, over one-third with trips >1 month had insufficient time to complete a series for either JE or rabies vaccine. Overall, only 10% of travelers were vaccinated (past and pre-travel visit) for either JE or rabies, with lowest percentages among travelers visiting friends and relatives. Most travelers received advice on vector precautions (96%) and rabies prevention, which included avoiding animal contact, washing wounds, and obtaining appropriate post-exposure prophylaxis (88%).Conclusion: Given the insufficient time for completion and relatively low vaccination rates, greater awareness of earlier pre-travel consultations, at least 4-6 weeks before travel, and accurate risk assessment for travelers are important. Effective counseling about vector avoidance, rabies, and animal bite prevention and management remains critical. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 55-year-old man from Massachusetts who was diagnosed with Zika virus infection in January 2016. It mentions that the patient has brought at the Mount Auburn Hospital in Cambridge after he suffered from conjunctivitis, rash, and arthralgia after his travel in Costa Rica. It discusses the circulation of the virus in the Americas and suggests that travelers were the potential source of expansion.

Jamestown Canyon virus (JCV) is a neuroinvasive arbovirus that is found throughout North America and increasingly recognized as a public health concern. From 2004 to 2012, an average of 1.7 confirmed cases were reported annually in the United States, whereas from 2013 to 2018 this figure increased over seventeen-fold to 29.2 cases per year. The rising number of reported human infections highlights the need for better understanding of the clinical manifestations and epidemiology of JCV. Here, we describe nine patients diagnosed with neuroinvasive JCV infection in Massachusetts from 2013, the year of the first reported case in the state, to 2017. Because current diagnostic testing relies on serology, which is complicated by cross-reactivity with related orthobunyaviruses and can be negative in immunosuppressed patients, we developed and evaluated an RT-qPCR assay for detection of JCV RNA. We tested this on the available archived serum from two patients, but did not detect viral RNA. JCV is transmitted by multiple mosquito species and its primary vector in Massachusetts is unknown, so we additionally applied the RT-qPCR assay and confirmatory RNA sequencing to assess JCV prevalence in a vector candidate, Ochlerotatus canadensis . We identified JCV in 0.6% of mosquito pools, a similar prevalence to neighboring Connecticut. We assembled the first Massachusetts JCV genome directly from a mosquito sample, finding high identity to JCV isolates collected over a 60-year period. Further studies are needed to reconcile the low vector prevalence and low rate of viral evolutionary change with the increasing number of reported cases.

We queried hospital patients about international travel in the previous 30 days to assess potential importation of emerging infections. We used 12 months of deidentified data to analyze patient demographics, travel destinations, and diagnoses for exposure to Zika virus. Our approach could be used to analyze potential infectious disease exposures.

Immigrants to the United States from developing countries have a higher probability of previous infection with hepatitis A virus (HAV) and/or hepatitis B virus in their countries of origin. Prior knowledge of hepatitis A and B seroprevalence in this population may aid in determining the need for pretravel immunizations when these individuals travel to endemic regions. We conducted a retrospective analysis of hepatitis A and B serologies in a travel clinic population (from March 1999 through September 2002) to determine the seroprevalence in our predominantly highly educated foreign-born subjects. All our patients who had immigrated from China and India and who were older than 60 years (born on or before 1940) were immune to hepatitis A. The Indian and Chinese subjects who were anti-HAV positive were also significantly older than the anti-HAV negative group. In addition, in our Indian study group, the hepatitis A-seropositive individuals first left India at a significantly older age than the hepatitis A-seronegative group (mean age 22.7 years vs 11.4 years, p < 0.05). Our small sample size of Chinese subjects may not have permitted a statistically significant difference to be detected for hepatitis A seroprevalence and age at departure from their country of origin. These results have helped tailor our recommendations for pretravel immunizations for our groups of foreign-born individuals planning to visit endemic areas. Individuals born in China or India on or before 1940 are likely to have preexisting antibody to hepatitis A and probably do not need the vaccine when they travel. Younger individuals may elect to have a hepatitis A antibody titer checked before getting the vaccine.