Health Alerts
  • Brazil: Chikungunya climbs in NE; Second YF death in SP

    Of Cearà’s 184 districts, only 4 in the NE state haven’t reported suspected or confirmed cases of chikungunya, while dengue, chikungunya or Zika virus infections have been recorded in all bar one district in what is being described in the media as an epidemic situation. The state’s death toll from chikungunya sits at 136 - 105 occurring in the capital Fortaleza. Read more (translate from Portuguese)

    A SECOND man from São Paulo state has been diagnosed with yellow fever – he lived in the same district where up to 90 monkeys were recently found to have died from the viral infection. In October we reported on the death of an elderly man due to yellow fever in the same region - Itatiba/Jundiaí. Read more (translate from Portuguese).

    Advice for travellers: Yellow fever virus is a mosquito-borne disease found in tropical and subtropical areas in Central/South America and Africa. While it can be severe, yellow fever infection is a very rare in Australian travellers. However, under the International Health Regulations (IHR), proof of vaccination may be required of any traveller entering or leaving an area at risk of yellow fever transmission. Read more about yellow fever

    Democratic Republic of Congo: Cholera now in multiple health zones

    More districts in the southern region of Grand-Kasaï and neighbouring Lomani have been hit in the cholera outbreak that began in late July. A Congo River Basin news source claims there have been 600 recent suspected cases and 45 deaths. Read more (translate from French). 

    Advice for travellers: Cholera is usually spread in contaminated water. For most short-stay travellers, the risk of infection is low. Australians travelling to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care. Read more about cholera.

    Fiji: Plans to counter rise in dengue

    It was unusual that the peak of the dengue fever season this year occurred in the cooler drier month of May, producing a 3-fold increase in cases over the first 10 months of the year and resulting in 9 deaths. Local authorities have instituted a clean-up campaign to ensure the rainy season that starts mid-November doesn’t bring with it another outbreak. Read more.

    Advice for travellers: Dengue is spread by two types of Aedes mosquitoes. Both breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid outdoors. Travellers should cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active. Apply repellent containing an active ingredient, such as DEET, Picaridin, or PMD when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites

    Finland: Pneumonia strikes SE

    At least 50 people – both young and old - have contracted pneumonia in the SE border region around the town of Virolahti. The local news source stated that the infection ‘is thought to be caused by the mycoplasma bacteria… also known as walking- or atypical pneumonia...’ Read more.

    Greece: Measles cases top 360

    The measles outbreak first reported in May has now produced 368 cases (& 1 death), 152 infections in the last month alone. Since January 2016, across the EU region, there have been over 19,000 measles cases and 46 deaths – countries most affected are Romania (7,759 cases), Italy (4,775) and Germany (898). Of the European Centre for Disease Control (ECDC) analysis of cases from ‘1 October 2016 – 30 September 2017 with known vaccination status, 86% were not vaccinated. Measles increasingly affects all age groups across Europe; in 2017, 47% of measles cases with known age were aged 15 years or older.’ Read more from the ECDC. 

    Advice for travellers: A highly contagious virus, measles occurs in developing and developed countries. While generally benign, infection can result in severe illness or death. Travelvax Australia recommends travellers check their immunisation status for measles and other childhood diseases such as diphtheria, whooping cough (pertussis) and mumps 6 weeks before departure.

    India: Dengue risk remains; Delhi’s smog danger persists

    Data from the agency overseeing the prevention and control of vector borne diseases reveals the states with the highest dengue fever case count this year: Kerala (19,445 cases), Tamil Nadu (19,116), Karnataka (15,303) and Punjab (12,614). Read more. Meanwhile New Delhi continues to report cases – 705 in a recent week, while in Bengal, sales of insect repellents have risen sharply in response to the dengue stats for the year to October: 10,697 cases and 19 deaths. Rainfall received this week is considered likely to increase the risk of dengue infections yet again.

    DELHI’S pollution rating remains at severe while there are reports that a plan to use a helicopter to settle the smog by spraying water cannot proceed as the aircraft is unable to fly in the current hazy conditions. Read more.

    Madagascar: Plague epidemic waning

    The World Health Organization (WHO) issued an update on the plague epidemic, noting that the appearance of new cases is now declining: ‘The last confirmed bubonic case was reported on 24 October and the last confirmed pneumonic case was reported on 28 October. Since plague is endemic to parts of Madagascar, WHO expects more cases to be reported until the end of the typical plague season in April 2018.’ Read more from the WHO. 

    Mozambique: Rise in cholera for NE province

    In the province of Nampula, cholera has struck killing at least 10 people and infecting over 400. Four districts of the north-eastern province have been hardest hit: Memba, Liúpo, Mogovolas and Malema. Read more (translate from Portuguese).

    Nigeria: Yellow fever update

    The number of suspected yellow fever cases resulting from the outbreak first recognised in early September has now reached 179 from a total of 7 states - Kogi, Kwara, Zamfara, Abia Borno, Kebbi and Plateau (confirmed cases from the first 3 states only). Read more from the Nigeria Centre for Disease Control (NCDC).

    Tanzania: Cholera spikes near Zambia/Malawi border

    In the country’s south-west, cholera continues to pose a public health threat in 2 adjacent border regions, Mbeya and Songwe - between them they reported over 90 percent of the weekly total of cases. The WHO assessment of the situation notes that the ‘continuous propagation of cholera in Tanzania mainland remains a concern and could result in another upsurge affecting the whole country. Read more.

    United States of America: Legionnaire’s source investigated; Hep A in 5 states; Mumps persists in Hawaii

    Fifteen people have been diagnosed with Legionnaire’s disease – 11 of them had spent time in Disneyland in Anaheim between August and October. As a result of testing 2 cooling towers at the theme park were closed down, however investigations into the exact source of the infections are still underway. Read more

    ALSO in California, the hepatitis A outbreak that initially affected mainly homeless people and those who use illicit drugs has spread to other parts of the community, with an increase seen in gay and bisexual men. Cases have been recorded across 5 states – California, Michigan, Utah, Arizona and Colorado. Limited supplies of Hep A vaccines have curbed the reactive vaccination campaign put in place to tackle the outbreak. Read more

    IN a further update of the mumps outbreak affecting Hawaii, cases reported since late July now number 557: Honolulu (450 cases), Hawaii (61), Kauai (44) & Maui (2). The State Health Dept advises that ‘The disease has been confirmed in children and adults, both vaccinated and unvaccinated.  Nearly 60% of cases have been in adults aged 18 years and older.  There have been 16 reports of complications due to mumps infection (e.g., orchitis, hearing loss).’ 

    Advice for travellers: Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is 99%-plus effective and protects for 20-30 years. Travellers should also follow these guidelines for safe food and water

    Vanuatu: Mumps for capital’s kids

    A mumps outbreak has been ongoing for several months and continues to affect mainly children of school age in Port Vila. Read more.

    Advice for travellers: This lingering outbreak of mumps highlights the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps. 

    Venezuela: Disease burden climbing

    Over 500 measles cases were identified in 6-week period from August to October in the state of Bolivar (chiefly in Caroní municipality), over three-quarters were infants under 12 months of age. The burden of diseases that were once eradicated is growing – measles now added to the existing list of malaria, diphtheria and tuberculosis. Read more.

  • Brazil: Uptick in mosquito-borne viruses

    The state of Minas Gerais has recorded an almost 20 percent rise in dengue fever cases during October compared with the same month last year. It takes the year-to-date figures for dengue infections to 27,045 (13 deaths + 11 under investigation). Chikungunya has also continued to be a public health issue: 17,403 suspected cases and at least 10 related deaths; while there were over 700 suspected Zika virus cases. Read more (translate from Portuguese).

    Advice for travellers: Dengue is spread by two types of Aedes mosquitoes. Both breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid outdoors. Travellers should cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active. Apply repellent containing an active ingredient, such as DEET, Picaridin, or PMD when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

    Burkina Faso: Surge in dengue causes alarm

    The latest World Health Organization (WHO) weekly bulletin from its African office provides an update on the dengue fever outbreak (reported in our Oct 26 alerts), describing the rise in cases as exponential ‘particularly in the Central Region of the country, around the capital city, Ougadougou.’  

    Cuba: Zika risk now high

    Travellers to Cuba are being warned that the risk of Zika virus infection is now high after 20 Europeans were confirmed to have contracted the virus during travel over the past 3 months. Increased precautions relating to pregnancy – current and planned – are among those being advised if travelling to the region. Read more.

    Advice for travellers: Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information on smartraveller (DFAT).

    Fiji: Dengue season underway

    A senior government official has called on residents to ensure that mosquito breeding sites are cleared as the rainy season begins. The highest dengue figures this year were recorded in the northern province of Macuata on Vanua Levu island, however the official went on to warn that ‘there have been confirmed cases of chikungunya and Zika virus in Fiji that is also caused by mosquitoes.’ Read more.

    India: Some states get respite from mozzie diseases; Delhi takes pollution title

    Relief is on the way for northern states with the anticipated arrival of the cool, dry season that brings to an end the dengue (& other mosquito-borne infections) season. While to the south, in Punjab, persistent reports of dengue fever cases have led authorities to carry on insect fogging in Ludhiana into December – normally this would come to an end in October. Other regions continuing to report dengue outbreaks include Kolkata, Haryana and Maharashtra. And it’s not just dengue that’s causing concern in Delhi, malaria cases hit a 4-year high in 2017 with over 550 cases recorded. Coastal parts of the city of Kozhikode in Kerala have also reported higher numbers of malaria cases. In Chennai a local news source gives details of a rise in bacterial infections, even while dengue fever cases are on the decline. The incidence of diarrhoea, ENT infections, paratyphoid, conjunctivitis and upper & lower respiratory tract infections have risen in the city. Read more.

    THE smog which settled on Delhi this week caused a public emergency to be declared. Conditions in the city are described as being the equivalent of smoking at least 50 cigarettes a day – a ‘gas chamber’ according to the chief minister. Fine particles suspended in the air (PM2.5) reached a level 11 times higher than the recommended standard on Tuesday. Read more

    Advice for travellers: Malaria is widespread in India and occurs year-round in both rural and urban areas, including major cities. Travellers visiting India should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. Read more on malaria in India.

    Kenya: Rains trigger rise in infections

    Recent heavy rains in many regions has caused a rise in cases of diarrhoea with some residents of Mombasa County suffering cholera-like symptoms. Testing is underway to confirm the diagnosis. Read more.

    Advice for travellers: Cholera is usually spread in contaminated water. For most short-stay travellers, the risk of infection is low. Australians travelling to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care. Read more about cholera.

    Madagascar: Outbreak showing improvement

    The numbers of people requiring hospitalisation for treatment of plague infection has dropped further as the outbreak’s toll becomes apparent. ReliefWeb expands on the figures: ‘From 1 August to 3 November 2017, a total of 1,947 confirmed, probable and suspected cases of plague, including 143 deaths, have been reported from 51 of 114 districts in the country. Of these, 1,437 (74%) were clinically classified as pulmonary plague, 295 (15%) were bubonic plague, one was septicaemic, and 211 were not yet classified…’. Over two-thirds of cases were reported in the area of the capital Antananarivo (Analamanga Region). 

    Nigeria: Updates on monkeypox & yellow fever outbreaks

    Twenty states and the Federal Capital Territory (FCT) have reported suspected cases of monkeypox and, as of Nov 2nd, 38 infections were confirmed (with 106 more suspected) from 8 of those states. Read more. In an update on the yellow fever (YF) outbreak reported last month in Kwara state, the WHO details how a widespread follow up resulted in diagnosing a total of 166 YF cases from 6 states (Abia, Borno, Kwara, Kogi, Plateau & Zamfara). ‘Reactive’ vaccination campaigns are planned for those areas identified as having sub-optimal vaccination rates.  

    Advice for travellers: Yellow fever virus is a mosquito-borne disease found in tropical and subtropical areas in Central/South America and Africa. While it can be severe, yellow fever infection is a very rare in Australian travellers. However, under the International Health Regulations (IHR), proof of vaccination may be required of any traveller entering or leaving an area at risk of yellow fever transmission. Read more about yellow fever.

    Serbia: Capital records measles spike

    Authorities have declared a measles outbreak in Belgrade with 5 cases reported in the city from a total of 65 across the region – all since the beginning of October. Read more.

    Advice for travellers: A highly contagious virus, measles occurs in developing and developed countries. While generally benign, infection can result in severe illness or death. Travelvax Australia recommends travellers check their immunisation status for measles and other childhood diseases such as diphtheria, whooping cough (pertussis) and mumps 6 weeks before departure.

    Uganda: Marburg kills 3

    Marburg Virus Disease (MVD) in Kween district has claimed the lives of the 3 cases previously identified and a high risk contact of one of the cases has been hospitalised following the onset of symptoms. The WHO update issued on Nov 7th noted that the appropriate public health response is being carried out by the Dept of Health with the support of the WHO and partners, and cross-border meetings are planned with Kenyan authorities. As a further note the update offered the following: ‘Uganda has previous experience in managing recurring Ebola and Marburg virus (MVD) disease outbreaks. MVD cases have historically been reported among miners and travellers who visited caves inhabited by bat colonies in Uganda.’ 

    Vietnam: Measles surges in north

    Hanoi and surrounding districts have reported up to 5 new measles cases per week for the last 2 months, prompting authorities to plan a vaccination campaign aimed at children under 5 years of age. One-third of the recent cases were unvaccinated. Read more.

    New Zealand: Mumps cases top 757

    A Public Health doctor in Auckland has described how the largest outbreak of mumps since 1994 in the city has spread largely due to unimmunised segments of the community, and the country is, ‘importing mumps, as well as probably exporting it as well.’ Read more. There have been 757 suspected and confirmed cases during the current outbreak.

    Advice for travellers: This lingering outbreak of mumps highlights the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps.

  • Cambodia: Flu on the rise

    The latest World Health Organization (WHO) global influenza update notes an increase in flu cases in Cambodia (mainly A(H3N2) viruses) and Oman (A(H1N1)pdm09), while on Réunion Island flu activity ‘remained elevated, with influenza A and B viruses co-circulating’. Most other regions recorded declining or low numbers. 

    Advice for travellers: The 2017 flu season is almost over in Australia, however in the tropics it’s year-round. Travelvax Australia recommends vaccination for all travellers over 6 months. Seasonal flu is the most common vaccine-preventable travel-related illness, posing a risk aboard aircraft, in crowded airport terminals, and at your destination. Travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Hand sanitiser is a convenient alternative if soap and water is not available.

    Cape Verde: Capital’s malaria cases continue

    The Plasmodium falciparum malaria outbreak in the capital Praia reported in early August shows no sign of tapering, with 40 more confirmed cases in the most recent reporting week (taking the yearly total to 343 with one death). The WHO’s review of the current situation cites concern that, among other local issues, ‘vector control measures appear to be at its weakest point.’ Read more

    Advice for travellers: Travellers can discuss their itinerary and the need for anti-malaria medication with a trained travel health professional at their nearest Travelvax clinic. For details call 1300 360 164. Read more about malaria.

    India: Late season disease surge

    Dengue fever outbreaks persist in Chandigarh and Noida (Uttar Pradesh), as well as in the states of Tamil Nadu, Punjab, Jammu and Kashmir. States in the SE have been particularly hard hit by dengue this year. Read more. According to a local news article, malaria cases and deaths for 2017 have been highest in West Bengal (also reporting a rise in scrub typhus), followed by Odisha and Maharashtra. 

    Advice for travellers: Scrub typhus is a bacterial disease passed on to humans by mites that normally live on rodents infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus occurs throughout the Asia-Pacific region, where more than a million cases occur annually. There is no vaccine or prevention medication: avoidance hinges on minimising insect bites. Due to the disease’s 5- to 14-day incubation period, travellers often experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Read more about rickettsial diseases.

    Kenya: Malaria spikes in north

    Over 1,000 malaria cases and 26 associated deaths have occurred over the past month in the central/north region of Marsabit, during what is considered the low season for the mosquito-borne illness. A number of factors are thought to be responsible for the increase, including recent heavy rains. Read more

    Advice for travellers: For most travellers, Africa presents a significant malaria risk. If you’re visiting this region, Travelvax advises that you discuss your itinerary and malaria prevention with your travel health provider. 

    Madagascar: Some relief after decline in plague numbers

    Schools in previously plague-affected areas are to be reopened on Nov 6th, as the response to the outbreak produces some results - 12 districts have reported no new cases in the last few weeks. September/October marks the beginning of the ‘plague season’ in Madagascar, however the recent outbreak has been of concern for a number of reasons, including: Two-thirds of cases reported in the outbreak have been the more virulent pneumonic form, and cases have been recorded in large urban centres, including the capital. Read more from ReliefWeb. More on the plague from the US CDC.  

    Nigeria: Monkeypox confirmed in 5 areas

    A total of 9 confirmed cases of monkeypox have so far been reported in the states of Bayelsa, Akwa Ibom, Enugu and the Federal Capital Territory, while 94 suspected case cases are under investigation from 12 states in all. More information on outbreak locations and the government’s response can be found on the Nigeria Centre for Disease Control website.  

    Advice for travellers: Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox.

    Pakistan: Chikungunya in Sindh

    The number of suspected chikungunya cases in Karachi rose to 243 for the month of October, from a province-wide total of 4,600. Read more

    Advice for travellers: The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.

    Samoa: Outbreak declared

    While not stating actual numbers, a senior official with the Ministry of Health has declared a dengue fever outbreak. Leausa Dr. Take Naseri ‘asked the public not to panic but take immediate action to eliminate mosquito-breeding places.’ He went on to say that the current cases were dengue type 2 strain, which hasn’t been circulating in recent years, so the potential for more severe complications were higher. Read more

    Advice for travellers: Dengue is spread by two types of Aedes mosquitoes. Both breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid outdoors. Travellers should cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active. Apply repellent containing an active ingredient, such as DEET, Picaridin, or PMD when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

    Saudi Arabia: MERS reports persist well into 6th year

    The 2 most recently diagnosed MERS Co-V cases both had a recent confirmed risk factor for infection: either direct or indirect contact with camels. They take the 5-year total of cases to 1,738 (703 deaths). Read more

    Senegal: Dengue in NW

    In the country’s northwest, dengue fever has been confirmed in Louga and the smaller town of Dahra (90kms to the east). To date 36 of the 232 suspected cases have been laboratory-confirmed. Read more

    Spain: Legionnaire’s warning for Mallorca

    English health authorities have issued a warning for travellers to Mallorca (or Majorca) who have recently stayed, or are planning on staying, in the town of Palmanova (15km SW of the capital, Palma) after 18 tourists fell ill with Legionnaire’s disease on their return to the UK. Public Health England has advised: ‘people who have travelled or are planning to travel to Palmanova in Mallorca to be aware of the signs and symptoms of Legionnaires’ disease, which are initially flu-like. This is particularly important if you are in a group at increased risk of infection such as those with underlying medical conditions, smokers or people aged 50 or over.'

    St Kitts and Nevis: HFMD spike

    Authorities are warning residents to be on the alert for symptoms of hand, food & mouth disease (HFMD) following a rise in the incidence of the viral infection across the federation. Read more

    Advice for travellers: HFMD mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection. Parents should be aware that seasonal epidemics of HFMD are common across Asia. Read more about HFMD.

    St Lucia: Post-Maria water-borne disease rise

    Cases of leptospirosis have risen in the wake of the flooding produced by Hurricane Maria, leading authorities to order a Rodent Reduction Programme aimed at lowering the risk of transmission from the most common vectors. Read more

    Advice for travellers: Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

    Sudan: Cholera cases decreasing

    There has been a decline in newly diagnosed acute watery diarrhoea cases after a concerted drive by local and international agencies. Regional countries continuing to report cholera are: Kenya – Embu County, DR Congo -  North & South Kivu, Chad - Salamat and Sila regions, & South Sudan are the others. ProMED provides a situation update. 

    Advice for travellers: Cholera is usually spread in contaminated water. For most short-stay travellers, the risk of infection is low. Australians travelling to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care. Read more about cholera.

    Uganda: MVD update for 2 districts

    The regional WHO office this week updated the Marburg virus disease (MVD) situation, stating that as of Oct 29th,’a total of six cases (2 confirmed, 1 probable and 3 suspected) have been reported in Kween and Kapchorwa Districts’. ‘Two weeks after initial detection, the MVD outbreak remains localized and the case count is still low. However, there are concerns around the number of contacts who have potentially been exposed in the community...’ Read more

    United States of America: Hep A burden for more states

    With no let-up in Michigan’s hepatitis A outbreak that has been underway since August last year, authorities have instituted an emergency response plan. Detroit is one of many cities that have reported cases.of the faecal-oral transmitted infection. The case count sits at 457 confirmed cases, with 18 associated deaths. Meanwhile in NY State, diners who ate at a restaurant in Westchester County between Oct 16 & 23 are being advised to seek vaccination against hepatitis A after a food worker was diagnosed with the viral illness - over 3,000 people have already been given the post-exposure vaccine. 

    Advice for travellers: Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is 99%-plus effective and protects for 20-30 years. Travellers should also follow these guidelines for safe food and water