Kiwis escaping the winter to catch the rays in Fiji are being warned to be vigilant as the Pacific nation grapples with an outbreak of meningococcal disease.
The Ministry of Health is advising New Zealanders to vaccinate against the strand plaguing the country, meningococcal C, if they are planning a long trip and especially children and teenagers.
More than 30 cases of the disease have been reported in Fiji this year. Tens of thousands of New Zealanders are expected to travel there between May and August and most Kiwis aren't immunised against the strand.
The Government's Safe Travel website issued a warning in March, "though the risk for travellers to Fiji is low".
"People staying in local communities or for longer periods of time should be vigilant and aware of the symptoms of meningitis following an outbreak of meningococcal disease."
The most common form of meningococcal in New Zealand is type B, for which a vaccine was funded for babies, children and teenagers between 2004 and 2008, after an epidemic in the early 2000s.
After rates of infection declined during the mid to late 2000s the vaccine was pulled from the national immunisation programme.
But Elizabeth Hayes, co-founder and director of the Meningitis Foundation Aotearoa New Zealand, said most Kiwis didn't realise a vaccine for the A, C, Y and W types could be bought and administered at medical centres around the country.
Cases of meningococcal here increased by 55 per cent year on year from 75 during 2016 to 116 last year, according to the ESR's latest Public Health Surveillance Report.
Cases of meningococcal type W - which has proved to be particularly deadly in the UK and Australia where it is more common - jumped from eight to 12 annually in that period.
Between 2012 and 2015 the Ministry of Health was notified of two to three cases of meningococcal W on average each year.
A quarter of people who contracted meningococcal W last year died. Between 2012 and 2016 the fatality rate had been 5 per cent.
A Ministry of Health spokesman said any increase in cases of meningococcal was concerning and it was unfortunate the W type of the disease was becoming more prevalent.
"The Ministry of Health constantly monitors the numbers of meningococcal cases and adjusts its advice accordingly."
Public health units also investigated each time they were notified of a new case and provided the patient's close contacts with advice about vaccination and antibiotics to prevent the spread of the disease.
The Meningitis Foundation Aotearoa New Zealand is urging the ministry to make the vaccine against B available to all children again.
In September 2015, Britain became the first country to immunise all newborn babies against meningococcal B, and Australia has recently moved to roll out a similar scheme.
Hayes said she hoped New Zealand would do the same and also review treatment practices so meningococcal was diagnosed and treated more quickly.
The vaccine used in the UK offered kids some protection against meningococcal W as well as type B, she said.
University of Otago public health researcher Dr Amanda Kvalsvig said although rates of meningococcal disease fluctuated from year to year the latest increase was larger than expected.
"It's too early to say whether we're seeing the start of a new epidemic, but this finding is a prompt for us to consider how we should respond and what further action may be needed."
Kvalsvig said vaccination could help curb the spread of meningococcal but wasn't 100 per cent effective.
Crowded, poor-quality housing also contributed to the extent of the disease and a co-ordinated response from governments was needed to solve this issue.
What is meningococcal disease?
• Meningococcal disease is an infection caused by the bacteria Neisseria meningitidis.
• It causes two very serious illnesses: meningitis - inflammation of the brain and spinal chord - and septicaemia (blood poisoning), which can lead to loss of limbs, brain damage, deafness and blindness.
• Meningococcal is spread through secretions from the nose or throat, often passed on by coughing or sneezing, kissing and sharing eating or drinking utensils, toothbrushes or pacifiers.
• More information is available on the Ministry of Health website.
• High fever (more than 38.5C) – possibly with cold hands and feet
• Headache and joint and muscle pain
• Neck stiffness and/or inability to touch chin to chest
• Drowsiness and sensitivity to bright lights
• A rash (may look like tiny bloody spots or dark bruises) that doesn't fade when pressed
For a full list of symptoms go to the Meningitis Foundation's website.
Contact a doctor or call Health Line immediately if you think you or someone else may have meningococcal. If a doctor reassures you but you're still unsure get a second opinion.
Who is most at risk?
• Anyone can contract meningococcal but children younger than 5, teenagers and young people - particularly those living in shared accommodation - are particularly susceptible.
How to stop the spread
• Get vaccinated against meningococcal A, C, Y and W
• Cover your mouth and nose when you sneeze or cough
• Wash your hands before eating, after using the toilet and after sneezing or coughing