Holiday Traveller

Returning to your country of origin to visit family and friends may seem like a ‘safe’ travel option. However, these ‘homecoming holidays’ often involve much higher health risks than other types of leisure travel – both for the traveller and the community they return to after their trip. That’s especially true when young children travel, as the community of Ashburton found to its cost in 2013.

Early that year, a young family visited relatives in Samoa. They had no vaccinations before leaving. The timing of their visit wasn’t ideal: they arrived soon after Cyclone Evan had damaged basic infrastructure, including local sewage treatment systems, compromising sanitation and hygiene.

On their return home to Ashburton, in New Zealand’s Canterbury district, the parents probably weren’t even aware that their toddler had been infected with the viral liver disease, Hepatitis A. Very young children often show no signs of infection, but can pass on the highly contagious virus to those around them for up to 2 months.
Unlike infants, hepatitis A virus (HAV) in older children and adults can cause potentially severe illness that may linger for weeks – even months. It has an average death rate of 2 in 100 adults over 50 years of age.
It soon became clear that the child and other toddlers it had infected were spreading the disease beyond local day care facilities.
In the weeks following, 28 people in the Ashburton community were diagnosed with the disease. Five needed hospital treatment, one required intensive care.

Virus crossed the Tasman to Sydney
Almost every case was traced back to infected toddlers. Co-incidentally, the few exceptions were linked to a second unimmunised local traveller who was also infected during an overseas holiday. (Authorities refused to disclose his/her destination so as not to reveal their identity.)
Six months later, it was still not known just how far the outbreak of HAV had spread beyond Ashburton and New Zealand. However, tests confirmed that an infected resident sparked an outbreak in Sydney while visiting Australia in May.
To halt the New Zealand outbreak, local health authorities arranged free vaccination of the district’s 1500 children aged under 4. Without the intervention, the outbreak could have continued for years, according Canterbury district medical officer, Dr Alistair Humphrey.
“We decided we had to get ahead of this because with the prospect of summer holidays kids will be going all over the country,” Dr Humphrey said last week.
“We don't want to see ourselves chasing this across New Zealand or possibly even the world. Without a mass vaccination it is possible the current epidemic could grumble on for several years.”

Group who most need protection don’t take it
The Ashburton outbreak is a graphic example of how an infection picked up overseas by an unimmunised traveller can have a profound effect on their community. It also highlights the increased risk of infection facing travellers like the young family visiting relatives in Samoa.
Travel doctors refer to people ‘visiting friends and relatives’ overseas as VFRs. Statistically, they are at much higher risk of picking up infectious diseases because they often reside in rural areas, stay for longer periods, and are in close contact with family members of all ages.
According to Travelvax Australia’s Medical Director, Dr Eddy Bajrovic, that combination of factors alone makes it difficult for VFRs to avoid infectious diseases circulating in the community they are visiting.
“VFRs mistakenly think that their cultural heritage somehow protects them from the local diseases that can pose a risk for other travellers,” Dr Bajrovic said.
“That’s wrong. Even VFR travellers born in the country quickly lose any immunity to food-, water- and insect borne diseases soon after they leave.
“Unfortunately, VFRs also tend to dismiss the potential for infection during their stay. They tend not to get vaccinated or take malaria-prevention medication.”
What heightens the health risks for VFRs is that often they must eat and drink what’s provided in the family home, while their accommodation may also provide little protection against disease-carrying insects.

A common vaccine-preventable health risk
As well as being transmitted by eating or drinking faecally contaminated food or beverages, HAV can also be passed from hand to mouth by touching common, everyday items such as hand rails, door handles – even money. In fact, virtually anything local people may have handled can transfer the virus.
HAV is extremely common in many of the world’s most popular holiday destinations. To date, 151 Australians have been infected in 2013 – virtually every case originating overseas or linked to international travel.
That makes the virus a significant risk for travellers visiting regions where it’s most commonly found: The Indian sub-continent (especially India, Pakistan, Bangladesh, and Nepal), Africa, the Middle East, parts of the SE Asia (excluding Japan), Central and South America, and Mexico.
“Hepatitis A is one of the most common vaccine-preventable diseases for Australian travellers,” Dr Bajrovic said.

Hep A more severe in older people
“And, the older you are, the more severe the illness is likely to be.
“Anyone travelling to a high-risk country should consider having the vaccine as well as taking other simple precautions to avoid infection.
“There are several hepatitis A vaccines available in Australia. Children as young as 12 months can be vaccinated.”
He added that it’s particularly important for travellers to know how hepatitis A is transmitted and to follow simple guidelines to ensure they consume only safe food and water.
Simple measures such as washing your hands thoroughly after using the toilet and before eating will also help travellers to not only avoid HAV, but also other food- and water-related illness like traveller’s diarrhoea – another common pitfall for travellers visiting a developing country.

To find out more about the risk of hepatitis A for your next overseas travel destination, call Travelvax Australia on 1300 360 164 (toll-free from landlines). You can also book an appointment to obtain recommended vaccinations, medication, and personalised, country-specific health advice during a pre-travel medical consultation.