Endemic in China, Japan, Korea, and eastern areas of Russia Outbreaks now occur in previously nonendemic countries including islands in the Torres Strait and northern Australia1,2 Can lead to death in 30% of cases and neuropsychiatric sequelae in 50% of survivors3 Increased travel, increased exposure Since the late 1980s, tourism to Asia has increased 64%4 Japanese encephalitis is the leading cause of viral encephalitis in Asia and is a considerable public health problem, with at least 50,000 cases per year1 Risk for travelers to rural areas can reach 1 per 5000 during a 1-month period5   CDC recommends vaccination for5: Persons spending 30 days in endemic or epidemic areas (especially rural) during transmission season Persons spending <30 days in endemic areas during epidemics or if performing extensive outdoor activities in rural areas   References: 1. World Health Organization Position Paper. Japanese encephalitis. Available at: http://www.who.int/vaccines-diseases/diseases/je.shtml. Accessed December 10, 2001. 2. National Health and Medical Research Council. Japanese encephalitis vaccine added to immunisation schedule. Available at: http://www.health.gov.au/nhmrc/media/98releas/japan.htm. Accessed December 7, 2001. 3. Centers for Disease Control and Prevention (CDC). Health Information for International Travel 2001-2002. Atlanta, Ga: US Dept of Health and Human Services; 2001:74-80. 4. Tourism Industries, International Trade Administration. U.S. resident travel to Canada, Mexico and overseas countries historical visitation—outbound 1987-1997 (one or more nights). Available at: http://www.tinet.ita.doc.gov/view/f-1997-11-001/index.html. Accessed December 14, 2001. 5. CDC. Inactivated Japanese encephalitis virus vaccine: recommendations of the Advisory Committee on Immunization Practices (AClP). MMWR Morb Mortal Wkly Rep. 1993;42(RR-01):1-11.