No abstract

Leptospirosis is a worldwide zoonosis and common in tropical and subtropical areas with high rainfall. It should be noted as an imported infectious disease although it is sporadic in Japan. Some imported cases already have been reported in Japan and these cases occurred mainly in Southeast Asia. The case discussed in this article is the first reported Japanese case infected in Vietnam. Four days after returning back to Japan after a two-week stay in the mountain area near Hue, in the middle part of Vietnam, the patient suddenly experienced chills, a high fever, sore throat, gastrocnemius pain, and headache. Conjunctival jaundice, renal function disorder, and proteinuria were observed on the third day of onset. Significant increase in antibody titers against serovar Australis and Autumnalis strains was observed in paired serum samples by microscopic agglutination test (MAT). Consequently we recognized this case as a diagnosis of severe leptospirosis (Weil’s disease). Finally, renal function disorder did not deteriorate further, and then the patient recovered after the tenth day of onset with the administration of antibiotics and supportive care without sequelae. We experienced the first imported Japanese case of severe human leptospirosis infection from Vietnam that was successfully treated with ceftriaxone and minocycline.

Background Awareness of pre-travel consultations (PTCs) and prevention methods for overseas travel-related diseases, and the understanding of PTCs among Japanese travelers and medical professionals remains low in Japan. A multicenter registry was established to examine PTCs in Japan. This study assessed the PTC implementation rate and examined the indicators of PTCs that can be used as criteria for evaluating quality. Methods Clients who presented for their PTCs at 17 facilities and were registered between February 1, 2018, and May 31, 2020, were included. Medical information was extracted retrospectively via a web-based system. Correlations between vaccination risk categories and advice/intervention proportions by the facility were evaluated using Spearman’s ordered phase relations (α = 0.05). Results Of the 9700 eligible clients (median age, 32 years; 880 [9.1%] aged < 16 years and 549 [5.7%] aged ≥65 years), the most common travel duration was ≥181 days (35.8%); higher among younger clients. The most common reason for travel was business (40.5%); the US (1118 [11.5%]) and Asia (4008 [41.3%]) were the most common destinations and continents, respectively. The vaccine number (median three per person) increased after the PTCs except for the tetanus toxoid. Only 60.8% of the clients recommended for malaria prophylaxis received anti-malarial agents. The gross national income; the incidence of human rabies, typhoid fever, falciparum malaria; and dengue risk category were associated with the percentage of hepatitis-A vaccines; explaining rabies post-exposure prophylaxis, typhoid-fever vaccinations, malaria-prophylaxis prescriptions; and mosquito repellants, respectively. Conclusions Although the characteristics of the travelers differed, the quality of the PTCs should be improved to address, for example, the lower rate of acceptance of malaria prophylaxis in Japan.

BackgroundAwareness of pre-travel consultation (PTC) and prevention methods of overseas travel-related diseases is low in Japan, and understanding of PTC among Japanese travelers and medical professionals remains low. A multicenter registry was established to examine PTC in Japan. This study assessed the PTC implementation rate and examined indicators to be used as criteria for data-quality evaluation.MethodsClients who presented for PTC at 17 facilities registered between February 1, 2018, and May 31, 2020, were included. Medical information was retrospectively extracted via a web-based system. Correlations between vaccination risk categories and advice/intervention proportions by facility were evaluated by Spearman’s ordered phase relations (α=0.05).ResultsOf 9,700 eligible clients (median age, 32 years; 880 (9.1%) aged <16 years and 549 (5.7%) aged ≥65 years), the most common travel duration was ≥181 days (35.8%), higher among younger clients. The most common reason for travel was business (40.5%); the US (1,118 [11.5%]) and Asia (4,008 [41.3%]) were the most common destination and continent, respectively. Vaccine number (median 3 per person) increased after PTC except for tetanus toxoid. Only 60.8% of clients recommended for malaria prophylaxis received anti-malarial agents. The gross national income, incidence of human rabies, typhoid fever, and falciparum malaria, and dengue risk category were associated with the percentage of hepatitis-A vaccine, explaining rabies post-exposure prophylaxis, typhoid-fever vaccination, malaria-prophylaxis prescription, and mosquito repellants, respectively.ConclusionsAlthough the characteristics of travelers differ, the quality of PTC should improve to address, for example, the lower rate of acceptance of malaria prophylaxis in Japan.