Health Alerts
American Samoa: Fresh surge of Chikungunya on Tutuila

Almost 50 new cases of Chikungunya virus infection in the 3 days to August 8 have taken the total to 390 in the past 5 weeks. Most cases have been on the main island of Tutuila. Seven people have been hospitalised. Read more

Advice for travellers: The symptoms of Chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of Chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication: Using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about Chikungunya

Argentina: Chikungunya cases linked to travel

Two imported Chikungunya infections – one each in the capital, Buenos Aires, and the city of Florencia Varela – involved travellers infected in the Dominican Republic. Read more

Australia: Cases double, but flu peak still to come

Women – particularly young women – have dominated the 21,000 lab-confirmed flu cases this year, with the majority of infections involving A(H1N1) or swine flu. With doctors generally testing to confirm more severe illness, many more cases go unreported. The case tally is double last year’s figure, while the traditional September flu spike is still to come, a flu expert has warned. Read more

Bhutan: Rabies fear prompts vaccination

There’s been a rabies scare in the border town of Samtse, with around 170 people vaccinated after they ate beef thought to contain the deadly virus. Read more

Advice for travellers: Rabies is present in most countries and all travellers should be aware of the importance of avoiding contact with wild and domestic animals – especially dogs, whose bites are the main source of infection. However, rabies can also be transmitted by eating the flesh of animals, such as cattle and deer, which are typically infected through contact with wildlife. Read more on rabies

Cameroon: Cholera toll mounts in north

A cholera epidemic in the north continues to be fanned by rains and the movement of refugees. The 1400 cases since April have included 75 deaths. Read more

Advice for travellers: Cholera is usually spread in contaminated water. For most short-stay travellers, the risk of infection is low. Australians travelling to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care.

Caribbean: Chikungunya intensifies in Dom. Republic, Puerto Rico; Under-reporting of epidemic; Caymans’ tally grows

With the official total now standing at 576,000 and 32 deaths, almost all of the 62,000 new Chikungunya cases recorded in the region in the week to August 8 were reported in the Dominican Republic. Martinique, Guadeloupe, and St. Martin (where the epidemic began), reported no new cases. The mosquito-borne virus surfaced for the first time in Canada and Curacao, which announced 8 and 9 imported cases respectively. Meanwhile, Jamaica confirmed 2 locally acquired infections soon after 2 imported cases. Read more (PAHO update, Aug 8). 
(This PAHO report shows that just 5 nations or territories of 43 are current with reporting of the epidemic, with Dutch St Martin 20 weeks behind. Of the 43, 10 are reporting only travel-linked illnesses, indicating that local cases are either being not reported or downplayed to avoid losing vital tourism revenue.)
IN the Cayman Islands, 3 new suspected cases in the Grand Cayman Island’s tourist precinct of West Bay have taken the total to 13, including at least one locally acquired infection. Read more

Cuba: Dengue outbreak 'worst ever'

A Spanish-language media outlet has reported dengue epidemics in Camaguey province (1200 cases) and the island of Juventud (600 cases), describing them as ‘the worst outbreak in its history’. Municipalities most affected include Sibanicu, Florida, and Vertiente. Read more

Ethiopia: Hep E adds to refugees' plight

Contaminated water is behind an outbreak of Hepatitis E which has spilled across the border from South Sudan into 3 refugee camps in the western region of Gambella. The camps are sheltering many of the estimated 250,000 displaced South Sudanese who’ve fled fighting. The UN is working with Ethiopian authorities to contain the outbreak, which has led to 367 cases and 13 deaths since April. Read more

Advice for travellers: The hepatitis E virus is usually transmitted through faecal contamination of drinking water, as well contaminated food and infected blood products. Over 60 percent of all hepatitis E infections and 65 percent of all hepatitis E deaths occur in East and South Asia, with 3.4 million cases resulting in 57,000 deaths each year. Read more about hepatitis E.  

Ghana: Cholera hits coastal city

On the southwest coast, cholera has been reported in the twin cities of Sekondi-Takoradi. The 9 confirmed and 14 suspected cases include patients from the nearby towns of Kojokrom, Adiembra, Kwesimintsin, and Effia-Kuma. Read more

Guinea, Liberia, Nigeria, Sierra Leone: Ebola deaths pass 1000 mark

In the week since the WHO declared the Ebola virus disease epidemic an international public health emergency, the totals have risen to 1848 cases and 1013 deaths. According to WHO figures (Aug 11), Sierra Leone heads the count with 730 cases and 315 deaths, followed by Liberia (599, 323), Guinea (506, 373), and Nigeria (13, 2).
In other Ebola news:
– A Spanish missionary infected in Liberia has died – the first fatality outside Africa. Read more
– Guinea closed its border with Sierra Leone and Liberia in a bid to control the disease, while Liberia put a third northern province under quarantine.
– A number of arriving/returning travellers, mainly African nationals, tested negative for Ebola infection in Benin, Canada, Germany, Hong Kong, India, Mexico, Morocco, Romania, Rwanda, Saudi Arabia, Senegal, and Sierra Leone.
– Several African countries have banned entry to nationals from outbreak countries, or closed borders. Outside Africa, numerous countries have followed the lead of the USA in advising against non-essential travel and urging those intending to travel to outbreak areas to avoid exposure by avoiding contact with sick people displaying symptoms and following strict personal hygiene guidelines.
– Saudi Arabia has reportedly rejected visa applications from more than 7000 pilgrims from Guinea, Liberia and Sierra Leone. Saudi Arabia’s Ministry of Health has advised pilgrims from Ebola-affected countries not to perform Umrah or Hajj this year, stating that visas will not be issued. Read more.
– The WHO conceded that rapid containment of the Ebola outbreak faced significant barriers, particularly widespread fear in the community and a lack of capacity in local health systems, which makes difficult to implement standard control measures.
– In weighing ethical considerations for the use of unregistered Ebola treatments and (future) vaccines, WHO experts recommended that they be used only under strict guidelines, including: Transparency about all aspects of care, informed consent, freedom of choice, confidentiality, respect and preservation of dignity of the individual, and community involvement. (It’s been reported that GlaxoSmithKline's experimental Ebola vaccine may move forward into human tests this year and may be available by 2015.)
Read a comprehensive timeline summarising the past week’s Ebola outbreak news. 

Advice for travellers: Despite the latest development, the risk of Ebola infection for travellers is still considered to be low (see today’s feature article). A severe viral haemorrhagic fever found in humans and other primates (such as monkeys, gorillas, and chimpanzees), Ebola spreads mainly through families and friends who come into close contact with blood and infectious secretions when caring for ill persons. Read more about Ebola

India: Encephalitis claims 350 in north; Malaria on the rise; Diphtheria surfaces in Hyderabad

In the states of Assam and neighbouring West Bengal, Japanese encephalitis has killed more than 350 people in recent weeks, with Sivasagar among the worst affected area. The two northern states are prone to outbreaks of JE. Another mosquito-borne disease, West Nile, is also endemic to the region and may be responsible for some of the encephalitis deaths, experts say. Read more
THE malaria epidemic gripping the small north-eastern state of Tripura has now claimed 79 lives in the past 2 months, mainly children. Unofficial sources say the toll may be twice that number, while more than 46,000 cases have been recorded. Read more.  
GENERALLY a lower-risk region for malaria, Mangalore City (Karnataka State) has seen 400 cases this year, including 1500 in July alone. The spike has prompted authorities to prepare an action plan to control the disease and raise public awareness regarding prevention. Read more
IN Jharkhand, almost 1000 cases of malaria have been reported in villages in the Bokaro district. Read more
AT least 15 cases of diphtheria have been reported among unvaccinated children in poorer districts of Hyderabad. Read more.

Israel: Fewer West Nile cases this year

Mosquito-borne West Nile virus (WNV) has been diagnosed in a region stretching from the northern Haifa district to southern Ashkelon. The health ministry advised 2 confirmed and 13 suspected cases were scattered across a dozen communities. There have been fewer cases in 2014 than in recent years: Last year, Israel had 71 WNV cases, 4 of them fatal. Read more.

Advice for travellers: WNV is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk to most travellers is generally low, those visiting regions which have reported human cases during the peak transmission season should take measures to avoid mosquito bites

Malaysia: New JE cases in Penang

In Penang State, authorities have belatedly reported 3 cases of Japanese encephalitis which occurred last month in George Town and Bagan Jermal in north Seberang Perai, and Tasek Gelugor. Earlier in July, JE cases were reported in Sarawak (8 cases), Sabah (4), and Penang (3), and one each in Selangor and Kelantan, of which 4 had been fatal. Read more.

Myanmar: Dengue kills 12 in Rangoon

Dengue is on the rise in the former capital Yangon (Rangoon), where more than 1200 people – most of them children – have been hospitalised and 12 deaths reported. Most of the cases have been in the nearby townships of Dagon Myothit (south), Hlaingthaya, Thaketa, Dagon Seikkan, Seikkyi Kanaungto, Tamwe, Dala, Mingalar Taungnyunt, Insein, and Hlaing. Read more

Nepal: Hills district gripped by typhoid, gastro

As many as 200 people a day are being treated for typhoid, viral fever, and acute diarrhoea in Pyuthan, a hills district 250km west of Kathmandu. The spike in gastro cases is due to contaminated water following heavy rain. Read more

Nigeria: Cholera claims 3

Plateau State’s cholera outbreak has claimed 3 lives among 34 cases reported in in the Gumbur ward of Wase Local Government Area. Read more. 

Philippines: Caraga provinces battle dengue

With more than 3000 cases and 12 deaths, dengue fever activity continues to increase in Mindanao Island’s Caraga region. The provinces hardest include Agusan del Sur (752 cases) and Butuan (732). Read more

Samoa: Island-hopping Chikungunya arrives

The first ever outbreak of Chikungunya fever has been reported, involving 21 cases. Four people have been hospitalised, while 2 deaths involving fever are also under investigation. The outbreak comes a month after the disease was reported on nearby American Samoa (see separate alert). Read more

Saudi Arabia: MERS resurfaces – 2 new cases

After a month-long break in cases of MERS-CoV (Middle East respiratory syndrome coronavirus), the health ministry reported 2 cases on successive days this week, and the death of an existing patient. The country has now confirmed 723 cases, including 299 deaths, while the WHO has confirmed 838 cases and 292 deaths worldwide. Read more

South Korea: Busan on alert for Japanese encephalitis

An upsurge in Culex tritaeniorhynchus mosquitoes in the Busan region has prompted a nationwide warning of an outbreak of Japanese encephalitis (JE). Authorities have urged immunisation against the virus, especially for children and the elderly living in the country’s second most populous area. Read more

Advice for travellers: JE is usually found in many part of Asia – including the Korean peninsula – the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia, the Torres Strait and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it can occur in or near cities. The risk to short-stay travellers and those who confine their travel to urban centres is very low. Expatriates and travellers living for prolonged periods in agricultural areas where Japanese encephalitis is endemic or where seasonal epidemics occur are at greater risk and should consider vaccination.

United States of America: Chikungunya ‘imports’ soaring; California battles whooping cough, West Nile; Plague case in Colorado

The number of travel–linked Chikungunya cases has risen to 484 – a rise of 86 in the past week – in 40 states, according to national figures. Florida has reported 127 cases, followed by New York (72), New Jersey (25), Tennessee (23), and Massachusetts (22). US territories have also been hit – Puerto Rico (201 local, 16 imported) and the US Virgin Islands (2,2). In Harris County (Houston, Texas) a media report stated that the virus had been detected in tests on mosquitoes, raising the possibility of local transmission.
CALIFORNIA reported 760 new cases of whooping cough (pertussis) in the two weeks to August 4, with 2-in-3 in kids aged 7 to 16. However, 60% of the children hospitalised were under 4 months – too young to be fully immunised. The latest cases take the state’s 2014 total to 6930. Read more
ALSO in California, West Nile virus is on the rise. Two deaths were among 35 recent cases reported in 10 counties. New Jersey has reported its first human case of West Nile virus of the year in Gloucester County, while the virus has been detected in mosquitoes tested in 16 others. 
In Colorado, a La Plata County resident has tested positive for bubonic plague, the county’s first case since 2006. Read more

Vietnam: HCMC on cholera alert

Cholera bacteria found during testing of snails sold at a food stall in Ho Chi Minh City’s Binh Chanh district has sparked fears of an outbreak in the city. Many families build toilets on lakes and ponds and discharge untreated waste into the environment. This year, 301,570 cases of acute diarrhoea have been reported nationwide, including 3 deaths. Vietnam averages around 500,000 diarrhoea cases annually, a senior health official said