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The following information has been published on the Travel Health Pro website by NaTHNaC:
Confirmed cases of Nipah virus infection(NiV) including fatalities and hospital admissions, have been reported in the southern state of Kerala. As of 25 May 2018, the Government of Kerala Directorate of Health Services has reported a total of 36 cases across 6 health districts: 14 confirmed and 22 suspected, including 11 confirmed deaths and one unconfirmed death. Confirmed cases have been reported from Kozhikode and Malappuram districts only.
NiV is an emerging virus that spreads to humans from animals (a zoonosis) and most human infections result from direct contact with sick animals, particularly bats and pigs, or their contaminated environments. NiV can cause a range of illnesses from asymptomatic infection to acute respiratory illness and fatal encephalitis. Treatment is limited to supportive care.
Eating or drinking fruit or fruit products (such as raw date palm juice) contaminated with urine/saliva from infected fruit bats is a likely source of infection. Transmission also occurs from direct exposure to infected bats, and limited human to human transmission of NiV has also been reported among family and care givers of NiV patients, including in hospital settings.
Advice from Travel Health Pro for travellers
The risk to tourists to southern India is currently very low if standard precautions are taken, but the risk to other UK travellers (such as those visiting friends and family) in Kerala may be higher, depending on activities undertaken.
There is currently no licenced vaccine to protect against NiV. If you are travelling to risk areas, pay careful attention to personal hygiene, and avoid contact with animals, especially bats and pigs, as much as possible. Gloves and other protective clothing should be worn if handling sick animals or their tissues, and during slaughtering and culling procedures.
Raw or partially fermented date palm juice should be boiled and all fruit should be thoroughly washed with clean water and peeled before consumption. Close, unprotected physical contact with people with NiV infection should be avoided. Regular hand washing should be carried out after caring for or visiting sick people.
In 2010 a case of locally acquired chikungunya virus infection was reported in the Var department of the Provence-Alpes-Cote d’Azur region of southern France. In 2014 a case was reported in Montpellier in the Herault region. In August 2017 a third case has been reported, again in the Var department. Travellers should be aware of the possibility of chikungunya infection in southern France and should take precautions against bites from daytime biting Aedes mosquitoes. Travel health advisers should be aware of the possibility of chikungunya infection in travellers returning from southern France with symptoms typical of chikungunya such as fever, headache, myalgia arthralgia and rash.
HEPATITIS B VACCINE SHORTAGE: IMPLICATIONS AND ADVICE FOR CLINICAL PRACTICE
Public Health England publishes hepatitis B vaccine recommendations and dose sparing advice for pre and post exposure immunisation and boosting
Currently, hepatitis B vaccine is in short supply in the United Kingdom (UK); until normal vaccine supply resumes, health professionals should consider alternative vaccines, prioritisation and dose sparing.
Public Health England provides additional advice for healthcare workers providing information on hepatitis B vaccination for adults and children who travel abroad:
Public Health England. Hepatitis B vaccination in adults and children: temporary recommendations
Health Professionals are advised that this temporary advice is not absolute and requires some clinical judgement and a detailed individual risk assessment.
Advice is subject to change and will be updated as further information becomes available.
In addition, health professionals should note that the hepatitis B chapter of Immunisation against infectious disease (the Green Book) has been updated in light of the introduction of hexavalent combination vaccine (diphtheria/tetanus/acellular pertussis/ inactivated polio vaccine/Haemophilus influenzae type b/hepatitis B) into the routine infant immunisation programme from autumn 2017.