Abstract
We report two cases of Ross River virus (RRV) infection in Dutch travellers who visited Australia during February to April 2015. These cases coincided with the largest recorded outbreak of RRV disease in Australia since 1996. This report serves to create awareness among physicians to consider travel-related RRV disease in differential diagnosis of patients with fever, arthralgia and/or rash returning from the South Pacific area, and to promote awareness among professionals advising travellers to this region.
Highlights
RRV, an alphavirus transmitted by mosquitoes, is endemic in Australia and Papua New Guinea, with occasional epidemics in island countries in the Asia-Pacific region
Diagnosis of RRV disease in travellers returning to Europe is very rare [8,9,10,11]
Only three cases of RRV disease have been confirmed between 1 January 2009 and 30 June 2015 in the Netherlands, including the two cases in 2015 reported here, who had additional confirmation by gold-standard serology
Summary
RRV, an alphavirus transmitted by mosquitoes, is endemic in Australia and Papua New Guinea, with occasional epidemics in island countries in the Asia-Pacific region. Figure Rash in a traveller (Case 2) returning from Australia with Ross River virus disease, 19 May 2015, 29 days post symptom onset transmission has been described in epidemic situations, and viraemic travellers from Australia have been linked to epidemics in the Cook Islands, Fiji, New Caledonia and Samoa [3]. Mosquitoes belonging to the genera Aedes and Culex are considered the main vector species and vertical transmission has been described as a way for the virus to persist during adverse conditions in desiccation-resistant eggs [6]. RRV is endemic in tropical and subtropical Australia (Northern Territory and Queensland) with year-round notification of human cases, while in temperate Australia (New South Wales and Victoria) human cases occur seasonally and in epidemics [3,6]. Symptomatic disease typically includes arthralgia, myalgia and fatigue. Serology is complicated by putative cross-reactivity with other alphaviruses, especially CHIKV, which belongs to the same serogroup [1,3,8]
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