Travel Health Network: January 2023

Global Health Update

COVID-19 testing recommendations for those who recently traveled from China, Hong Kong, or Macau

On January 5, 2023, new COVID-19 testing requirements were enacted for all travelers 2 years and older, regardless of citizenship, flying into the United States from China, Hong Kong, or Macau. The Wisconsin Department of Health Services (DHS) encourages health care providers to obtain travel history for patients presenting with COVID-19 symptoms. Patients who recently returned from China, Hong Kong or Macau should receive a viral test as soon as possible. Nucleic Acid Amplification Tests (NAAT) are preferred to allow for follow-up whole genome sequencing (WGS) at the Wisconsin State Lab of Hygiene. The criteria for sending positive COVID-19 molecular samples are outlined in Health Alert #25 Surveillance for New Genetic Variants of SARS-CoV-2: Information for Clinicians. 

Ebola outbreak over in Uganda 

On January 11, 2023, the Government of Uganda and the global public health community celebrated the end of the Ebola outbreak in Uganda. The Centers for Disease Control and Prevention (CDC) has recommended an end to U.S. travel-related measures, including public health monitoring of travelers who have been to Uganda in the prior 21 days. DHS no longer receives alerts for individuals who have traveled in Uganda and has discounted public health follow-up and monitoring of previous travelers. 

World Health Organization urges travelers to wear masks as new COVID-19 variant spreads

The World Health Organization (WHO) updated their mask recommendations to continue to combat the spread of COVID-19. WHO recommends masks to be worn following a recent exposure to COVID-19, when someone suspects they have COVID-19, when someone is at high-risk for severe COVID-19, or for anyone in a crowded, enclosed, or poorly ventilated space. Prior to this update, mask recommendations were based on the current epidemiological situation of a locality. This update reflects the current situation characterized by global transmission of omicron subvariant XBB.1.5 and China’s COVID-19 surge.

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Travel Health Highlight

Tuberculin testing of travelers

Leisure travel to most countries in the world poses little risk of Tuberculosis (TB) infection. However, TB can be a serious threat to travelers who plan to spend an extensive amount of time in clinics, hospitals, prisons, or homeless shelters within TB endemic countries. TB can also be spread by consuming unpasteurized dairy products such as milk, cheese, or yogurt from countries where TB is found in cattle, goats, and sheep. 

All travelers who anticipate possible close or prolonged exposure to people with TB should have a TB skin test or TB blood test before leaving the United States. Annual testing may be recommended for those who anticipate repeated or prolonged exposure to TB or plan to stay abroad for a period of years. Additionally, any traveler who suspects a potential or probable exposure should be tested for TB eight to 10 weeks after returning to the United States.

Disease Spotlight: Japanese Encephalitis 

In 2021 and early 2022, a Japanese encephalitis (JE) outbreak occurred in parts of Australia. In November 2022, JE virus was detected in pigs in the Murray River region, confirming risk for JE in humans during the current Australian summer season.

What is it? 

Japanese encephalitis virus is spread by mosquitoes. Most people infected with the JE virus experience no or very mild symptoms. However, a small percentage, about 1%, of people develop severe neurologic illness.  

Who is at risk? 

Most people who travel internationally are not at increased risk for JE. However, travelers who spend long periods of time in an endemic country, travel during the transmission season,  spend time in rural areas and/or on farms, participate in extensive outdoor activities, or stay in accommodations without air conditioning, screens, or bed nets are at increased risk for JE.

What are the symptoms? 

In people who develop symptoms, the time from infection to onset of illness is typically five to 15 days. Initial symptoms of JE include fever, headache, and vomiting. Over the subsequent days, people may experience mental status changes, neurologic symptoms, weakness, and movement disorders. Seizures are common, especially among children. Among those who experience symptoms and develop encephalitis (infection of the brain), 20%–30% will die.

Reporting and follow-up

Japanese encephalitis should be considered in a patient with evidence of a neurologic infection (e.g., meningitis, encephalitis, or acute flaccid paralysis) who has recently traveled to or resided in an endemic country in Asia or the western Pacific region. Learn more about clinical and laboratory evaluation and diagnostic testing for Japanese encephalitis.

Prevention

The best way to prevent JE is to protect yourself from mosquito bites by using insect repellent, wearing long-sleeved shirts, treating clothing and gear with 0.5% permethrin, and getting vaccinated before traveling. Vaccination is recommended for anyone planning on spending more than one month in the main risk areas in Australia (areas surrounding the Murray River and Outer Torres Strait Islands). Learn about JE vaccination recommendations for travelers.

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