Health Alerts
  • Brazil: States battle mosquito-borne illnesses

    Mosquito-borne infections have maintained a strong presence in the state of Minas Gerais. Chikungunya case numbers have now topped 10,000 and suspected dengue fever infections have risen even further, to 23,265 with at least seven deaths attributed to the illness; another nine under investigation. Read more. And in the central-western state of Mato Grosso, chikungunya infections have surged by more than 200 percent over last year’s figures - Várzea Grande, a city adjacent to the capital Cuiabá recorded almost 10,000 cases this year. 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.

    Canada: Measles alert for cruise passengers

    Passengers on board a ship that cruised from Vancouver to Seward in Alaska, departing on August 6th, have been advised to be alert for measles symptoms. A teenager who was infected with measles was promptly isolated after boarding in Vancouver, so the risk of infection to others was said to be low. Read more

    Advice for travellers: Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. While generally benign, infection can result in severe illness or death. Travelvax Australia recommends travellers check their immunisation status for measles and other childhood diseases such as diphtheria, whooping cough (pertussis) and mumps at least 6 weeks before departure. Read more about measles.

    China: Local dengue investigated

    Hong Kong health authorities reported the first four locally acquired dengue fever cases this week. As investigations continue into the locations where each person was infected, the Centre for Health Protection has issued a map of the sites of distribution and information on each case. Read more

    Advice for travellers: Dengue is spread by two types of Aedes mosquitoes. Both breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid. Travellers should cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active. Apply repellent containing an active ingredient, such as DEET, Picaridin, or PMD when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

    Democratic Republic of Congo: NE region Ebola update

    The World Health Organization (WHO) has declared the public health risk to other countries in the region presented by the Ebola Virus disease (EVD) outbreak in the highly populous North Kivu area to be high. Enhanced screening is planned for entry points on a local level, but also in the neighbouring countries of Burundi, Central African Republic, Rwanda, South Sudan, Zambia and Uganda. To August 14, there have been 73 cases of haemorrhagic fever of which 46 are confirmed as EVD. A further 27 are considered probable and 40 others are undergoing testing. Several new cases were diagnosed at Mabalako; all are contacts of previously identified cases. Of the 43 deaths recorded, 16 were confirmed EVD. Read more. An experimental treatment for EVD using monoclonal antibodies, still in early clinical trials, is to be employed in the area. Read the FAQs.

    Advice for travellers: Ebola Virus disease is a severe viral haemorrhagic fever found in humans and other primates (such as monkeys, gorillas, and chimpanzees). It spreads through families and friends in close contact with blood and infectious secretions of people with obvious symptoms and, as such, presents a low risk to tourists to the affected countries. Read more about Ebola virus disease.

    El Salvador: Towns in 4 departments on dengue alert

    Six towns have been placed under a yellow (moderate) alert for dengue fever while authorities have also announced an increase in severe dengue fever cases. The towns on alert are in four regions (departments): Santa Ana, Chalatenango, La Libertad and San Salvador. Read more (translate from Spanish).

    India: Monsoon season outbreaks

    Monsoon-associated illnesses including dengue fever, leptospirosis and gastro intestinal infections are surging in Mumbai. Dengue fever is also a mounting concern elsewhere in Maharashtra state (Kolhapur, Nashik and Pune), while in Odisha, there’s been a jump in cases in a commercial district of the capital Bhubaneswar, and villages in the district of Kalahandi. Other locations reporting dengue outbreaks this week: Durg (Chhattisgarh),  Hyderabad (Telangana), Parmanoo (Himachal Pradesh) and Andhra Pradesh. In the SW state of Karnataka, malaria case numbers are climbing in the district of Dakshina Kannada that includes the commercial port city of Mangaluru. In Assam, the death toll caused by the Japanese encephalitis virus (JEV) this year has reached 66 among more than 320 confirmed infections. The latest death occurred in Dibrugarh, a city surrounded by tea estates. JE is endemic in Assam and is considered a major public health issue. Four JE cases have been reported in Bhopal (Madhya Pradesh); the infection was identified in the city for the first time last year. Contaminated drinking water has sickened more than 900 people in two villages of Kupwara district in the state of Jammu and Kashmir. A local news source cites a government report which claims that ‘74 percent of drinking water samples tested from Kashmir have been found contaminated’. Read more

    Advice for travellers: A mosquito-borne virus, JE is usually found in many part of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE

    Libya: Measles on the march

    ProMED reports on the increase in measles cases occurring in many Libyan cities, noting that the outbreak is spreading fast. Read more

    Malaysia: KL's dengue uptick

    There has been a recent surge in dengue fever cases in Kuala Lumpur, with the greatest impact felt in three northern districts – Batu, Kepong and Segambut. Read more

    New Caledonia: Hep A cases linked to Vanuatu

    Health authorities reported on seven hepatitis A cases that occurred in travellers returning from Vanuatu. The infections were acquired during an 18-day visit dating from June 10th. Read more 

    Advice for travellers: Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is 99%-plus effective and protects for 20-30 years. Travellers should also follow these guidelines for safe food and water.

    New Zealand: Mumps outbreak slows, but not over

    Auckland’s mumps outbreak is finally slowing, down from the peak of the epidemic in October 2017. In the 18 months to the end of June, almost 1,300 mumps cases were recorded in the city’s health region – the highest incidence has been among children and adults aged 10 to 29 years. Read more

    Advice for travellers: These outbreaks of mumps highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps.

    Pakistan: Resistant typhoid cases mounting

    During a local news interview, an Assoc. Professor of Pathology and Consultant Microbiologist in Islamabad has put the number of extensively drug-resistant typhoid fever cases recorded during the first half of this year at ‘around 2,000’. The US Centers for Disease Control and Prevention (CDC) issued a travel advisory for Pakistan in early July. Read more

    Advice for travellers: Typhoid is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is generally recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.

    Papua New Guinea: Another polio case confirmed

    The Eastern Highlands province is the latest to report a case of polio, the fourth in the country since late July. The WHO considers the risk of further spread is high. Immunisation campaigns are underway and are being offered to all children under five years of age. Surveillance of reported acute flaccid paralysis continues – 65 cases are under investigation. Read more

    Advice for travellers: Polio is a potentially serious viral illness that is spread through contact with infected faeces or saliva. The risk to travellers is generally low, however vaccination is recommended for travel to affected regions and is a requirement for travel to/from some countries. If at risk, adults should have a booster to the childhood series. More on polio

    Philippines: Monsoon-related illnesses spike in highlands

    A spike in cases of dengue fever and leptospirosis cases has been reported in the Cordillera region of northern Luzon - the provinces of Benguet, Kalinga and Apayao have reported most of the dengue cases. The cooler weather of the highlands means the area is a popular destination during summer. Read more

    Advice for travellers: The Philippines averages almost 7000 leptospirosis cases and 40 fatalities a year, with the seasonal peak occurring during the rainy months from July to October. Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

    Serbia: Measles cases soar to over 5,700

    While Slovakia’s spate of measles is waning, the epidemic in Serbia continues with the case count for confirmed and suspected infections now over 5,700 (and 15 associated deaths) for the past 10 months. Read more. The latest report on the extensive outbreaks across many EU countries can be found here

    Singapore: HFMD incidence on the rise

    There has been a surge in cases of hand, foot and mouth disease (HFMD), with nearly 1,250 for the week to Aug 4th. While there have been more reports than usual of the EV71 strain, it is not the predominant cause. Two Malaysian children have died this year from complications of infection with EV71. Read more

    Advice for travellers: Parents of young children should be aware of that seasonal epidemics of HFMD occur throughout Asia. The virus mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection.

    Sweden: E Coli flare up

    Investigations are being carried out to determine the origin of an outbreak of E Coli infections that has spread countrywide. According to a Xinhuanet news article, two cities have been hardest hit – Uppsala and Gotaland. Read more 

    Switzerland: Tick season in full swing

    In an update on the current tick-borne encephalitis (TBE) season, there are new record highs – a slight increase in cases, more serious infections – almost four times the 2015 rate - and more doctor’s visits for tick bites and bacterial infections. Vaccination is recommended for at-risk areas in Switzerland and may be extended to cover most of the country next year. Read more. In the Czech Republic, the SE region of South Moravia is reporting a three-fold increase in new TBE cases when compared to the last two years. While the TBE vaccine is recommended for Czech nationals, it is not funded by the government and so uptake is low, around 25 percent. Read more

    Advice for travellers: A viral infection, tick-borne encephalitis (TBE) can cause fever, vomiting, cramps and paralysis, which can be prolonged. In rare instances, infection can be fatal. Travellers who spend time in regions where TBE is endemic – mainly forested areas of Central and Eastern Europe, Russia, Northern China, and Mongolia – may be at risk. The highest risk is during the warmer months from April to November, especially when hiking or camping in areas below 1500m. While safe and effective vaccines are available in Europe, none are licensed in Australia; however, vaccination can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE

    Taiwan: More dengue for New Taipei City

    Several more dengue fever cases have been added to the cluster in an inner district of New Taipei City, with authorities urging the use mosquito bite avoidance measures and the removal of insect breeding sites in the immediate area. Of the 14 locally acquired cases this year, 10 have been from Xinzhuang district. Read more

    Zimbabwe: Typhoid in Midlands

    A national youth sporting competition which was to take place this week in the midlands capital of Gweru has been deferred due to an outbreak of typhoid fever. According to reports, there have been up to 350 confirmed cases and five resulting deaths; most areas of the city are affected. As contaminated drinking water is believed to be the cause of the outbreak, the government is to provide water tankers and water purification tablets. Read more

  • Brazil: Unusual malaria cases in south; Measles kills 5

    In the towns of Vila Pavão and Barra de São Francisco in NW districts of Espírito Santo state, as many as 106 malaria cases and one death have occurred in just over a week. Testing has revealed Plasmodium falciparum to be the malaria type causing the infections and as this is not the predominant malaria parasite in the state (P. vivax), doctors are assuming that onward transmission occurred at a local level from an imported case. Read more (translate from Portuguese). 
    THE DEATH toll from measles infections in the states of Amazonas and Roraima has reached five, while there have been a total of 1,100 confirmed cases and over 5,600 more are under investigation. A vaccination drive has been initiated across the country, targeting measles and polio. Read more

    Advice for travellers: Malaria is considered a risk for western states in the Amazon basin, rare cases occur in rural areas of several others. Travellers visiting Brazil should discuss their itinerary and the required and recommended vaccinations and medications during a pre-travel medical consultation. For details call 1300 360 164. Read more about malaria

    Democratic Republic of Congo: NE Ebola situation report

    By the latest count, there have been a total of 44 Ebola virus disease cases (17 confirmed, 27 probable & 47 suspected), including 36 deaths in the new outbreak areas of the (neighbouring) provinces of Nord-Kivu and Ituri. While the Zaire outbreak strain of Ebola virus is the same as in Equateur province, testing has not shown a close genetic link. Preparations have already been underway ahead of the start of the ring vaccination campaign which begins today. The logistics of this outbreak are made worse as the affected region is the site of a longstanding conflict with a large population which includes many internally displaced people travelling through seeking shelter in nearby countries. Read more 

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

    Europe: Spate of viral infections

    A rise in Echovirus 30 enterovirus infections occurring in Denmark, Latvia, the Netherlands, Norway, Sweden and the UK is mentioned in the latest ECDC Communicable Disease Threats Report. The mostly faecal-orally transmitted virus causes an aseptic meningitis which lacks a specific treatment, only supportive measures are used. As noted by the ECDC, prevention includes: ‘High hygienic practices such as frequent hand washing, avoidance of shared utensils, bottles or glasses and disinfection of contaminated surfaces (e.g. with diluted bleach solution) are recommended to prevent the spread of E30 from person-to-person.’ Read the ECDC report here.

    India: Nipah outbreak summary; Food & water-related illnesses; Insects prevail

    From a summary published by the WHO on the May/June Nipah virus (NiV) outbreak in Kerala: 19 confirmed cases and 17 deaths were recorded in the districts of Kozhikode and Malappuram. Although there have been no further cases and ‘no evidence of NiV infection in humans in Kerala State,’ surveillance is to be continued. ‘NiV infection can be prevented by avoiding exposure to bats and sick pigs in endemic areas, and by avoiding consuming fruits partially-eaten by infected bats or drinking raw date palm sap/toddy/juice.‘ 
    CASES of the food and water-borne viral illnesses, hepatitis A and E, are surging in Nagpur, the winter capital of Maharashtra state. Despite the rise, the current outbreak is not considered an epidemic due to the increased incidence reported each year during the monsoon season. Read more
    REPORTS of mosquito-borne infections this week came from Kerala, Jaipur in Rajasthan, Karnataka and Assam, where more than 220 of the country’s provisional count of 523 Japanese encephalitis (JE) cases have been reported. Read more

    Advice for travellers: A mosquito-borne virus, JE is usually found in many part of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE

    Ireland: Measles risk for the masses

    People, both young and old, are advised to check their vaccination status before attending a large outdoor mass during the Pope’s visit to Dublin later this month. There are concerns that local and imported cases of measles, influenza and other pathogens could spread within the large audience, expected to be around 500,000. Read more

    Advice for travellers: A highly contagious virus, measles occurs in developing and developed countries. While generally benign, infection can result in severe illness or death. Travelvax Australia recommends travellers check their immunisation status for measles and other childhood diseases such as diphtheria, whooping cough (pertussis) and mumps 6 weeks before departure.

    Kiribati: Dengue numbers on the decline

    The dengue fever outbreak that started in February is gradually settling after having produced more than 1,700 cases. A ReliefWeb report on the region also notes that the spread of dengue fever continues in Wallis and Futuna. Read more

    Advice for travellers: Dengue is spread by two types of Aedes mosquitoes. Both breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid outdoors. Travellers should cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active. Apply repellent containing an active ingredient, such as DEET, Picaridin, or PMD when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

    Malaysia: HFMD outbreak continues

    More on the hand, foot and mouth disease outbreak affecting most states, with Sabah recording more than 400 new cases over the past week, and a further 230 cases in the peninsular state of Negri Sembilan.

    Advice for travellers: Parents of young children should be aware of that seasonal epidemics of HFMD occur throughout Asia. The virus mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection.

    Mexico: Food-borne parasite persists

    UK health authorities are warning of yet another summertime rise in the incidence of the food- and water-borne parasite, Cyclospora, in travellers to Mexico. Most of the cases (46 of 57 cases) stayed in all-inclusive hotel accommodation in two popular areas of the Yucatan Peninsula: Cancun and the Riviera Maya. Infection usually occurs through consuming foodstuff contaminated with human faeces containing the parasite. Read more 

    Advice for travellers: A single-celled coccidian parasite, Cyclospora cayetanensis may be a risk for travellers to tropical or subtropical regions where it is found. The microscopic parasite causes watery diarrhoea, nausea, anorexia, abdominal cramps, weight loss and, occasionally, fever that can last for several days – and reoccur - if not treated effectively. Most cases result from consuming food or water containing the parasite, or swallowing contaminated water while swimming. Fruits and vegetables such as raspberries, basil and lettuce washed with contaminated water are common culprits, especially those imported from developing nations. Read more about Cyclospora.

    Namibia: Hep E toll now 20

    Oshana, in the country’s central-north, is the fourth region with an outbreak of hepatitis E, but another six regions have reported sporadic infections this year. A regional WHO statement announced 2,435 suspected Hep E cases and 20 deaths up to July 29 – around half of those were pregnant women or post-delivery (a high risk category for complications of the infection). Almost 80 percent of cases have been from informal settlements of the capital, Windhoek (Havana and Goreangab). Read more 

    Advice for travellers: The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Infection during the latter stages of pregnancy carries a higher rate of severe disease and mortality. Unlike the Hep A and B viruses, there is no vaccine for this strain, which is especially common in communities with lower levels of sanitation and hygiene. Read more about the virus and how to prevent it.

    Nepal: Sand flies and chiggers carrying infections

    Four deaths from 127 confirmed cases of Kala-Azar, or visceral leishmaniasis, have been recorded in residents of Kathmandu, Palpa, Jumla and Bajura this year. Read more. Palpa is also named as one of the affected areas in a report on scrub typhus - over the last two months there have been more than 100 cases from across 27 districts. Read more

    Advice for travellers: Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

    Papua New Guinea: New polio case - in central province

    A third case of circulating vaccine-derived poliovirus (cVDPV) has been identified and it’s in a different province to the two earlier infections. According to the World Health Organization (WHO), ‘the new case is genetically linked to the other two cases from Morobe Province’. The 3 year-old child, from Laigam district in Enga province (approx. 130kms NW of Mt Hagen), became ill in late June and suffered paralysis on July 2nd. The WHO expanded on the case by noting his ‘vaccination history is unknown due to unavailability of the baby clinic book, and his travel history is being established.’ Risk of further spread is high due to low vaccination coverage in many provinces. Read more
    Local and international health agencies are managing human cVDPV type 2 infections and positive environmental samples in several Nigerian states. The WHO recommends full polio vaccination for travel to and from affected countries. Read more

    Advice for travellers: Polio is a potentially serious viral illness that is spread through contact with infected faeces or saliva. The risk to travellers is generally low, however vaccination is recommended for travel to affected regions and is a requirement for travel to/from some countries. If at risk, adults should have a booster to the childhood series. More on poliomyelitis

    Philippines: Rise in dengue noted for half-year

    Year-on-year there has been a modest increase in dengue fever cases at a national level – up by over 1,600 cases to 62,000, according to the health minister. Ilocos Norte has reported substantial rates of infections, while in the province of Biliran, there has been a surge in chikungunya cases. Read more 

    Saudi Arabia: WHO: MERS summary published

    The WHO has published an extensive summary on MERS Co-V, noting there had been 189 more cases since the last update in July 2017. The report outlines the need for more information on ‘how humans become infected from animal or environmental source(s) in the community [and] identification of risk factors for infection from humans or the environment in occupational settings and health care settings’. 

    South America: Scattered patterns of flu activity

    From the latest global flu update: Chile and Paraguay are reporting increasing influenza activity and in Peru there has been a drop in new cases but the situation is still regarded as ‘elevated’. Activity is generally below seasonal thresholds in Oceania with the exception of Western Australia where activity is trending upwards - ‘Influenza A(H1N1)pdm09 was the most frequently detected virus’. 

    Advice for travellers: Seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol wipes are a convenient alternative if soap and water is not available. Read more

    Taiwan: More local dengue cases

    More dengue fever infections have been identified in a cluster of cases occurring in New Taipei’s, inner city district of Xinzhuang. One person classified as a recent infection resides approx. 500 metres away from previous cases, while in Taipei itself, a new case has been identified in Neihu District. Read more 

    Thailand: Dengue cases in seasonal climb

    Following the pattern of every rainy season, dengue fever reports are on the rise, however this week a senior government minister stated that ‘the epidemic was at a high level from the beginning of the year’. Read more. Cases of more severe dengue disease – dengue haemorrhagic fever (DHF) – were highest in Phichit, Nakornpathom and Phuket. Read the current reports for dengue fever and DHF from the Bureau of Epidemiology.

  • Angola: Rabies vax shortfall

    In the southern province of Cunene de Janeiro a lack of rabies vaccines is forcing people with potentially rabid dog bites to travel across the border into Namibia in order to source the life-saving treatment. Nine people died from rabies infections in early July in the province. 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, the main source of infection. If bitten, urgent post-exposure treatment is required. Vaccination recommendations are itinerary-specific but include those travellers planning to live in, or travel extensively or repeatedly through, endemic countries. Read more on rabies

    Bahamas: Gastropod causing gastro illness

    A bacterium from the Vibrio family, related to cholera, has sickened up to 40 people on the island of New Providence (location of the capital Nassau), after they consumed improperly prepared conch meat. According to the US Centers for Disease Control & Prevention (CDC): ‘Vibrio bacteria naturally live in certain coastal waters and are present in higher concentrations between May and October when water temperatures are warmer. Read more
    The European Centre for Disease Control (ECDC) monitors and reports on ‘estuaries and enclosed water bodies with moderate salinity’ in the region over the warmer months, providing locations with current ‘environmental suitability for Vibrio growth in the Baltic Sea’. Read the latest report here

    Cambodia: Cycle of dengue

    Dengue fever cases increased more than two-fold in the first half of the year compared to 2017, and dengue related deaths also climbed, up from one last year to seven. The rainy season has hit now and infection rates are rising faster, but health ministry officials are not declaring an alert as yet. Read more

    Advice for travellers: Dengue is spread by two types of Aedes mosquitoes. Both breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid outdoors. Travellers should cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active. Apply repellent containing an active ingredient, such as DEET, Picaridin, or PMD when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

    Central African Republic: Monkeypox outbreak continues in SW

    Described by the WHO regional office as an annual occurrence, the outbreak of monkeypox, now in its fifth month, continues with the most recent cases in the SW district of Mbaïki. Two other southern districts have reported cases this year: Bambari and Bangassou. Read more

    Advice for travellers: Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox

    Costa Rica: Hep A source unknown

    Authorities are investigating a number of hepatitis A cases in an eastern district of the capital San José. A public awareness campaign focusing on preventing further spread of the viral infection is being carried out in the canton of Goicoechea. Read more

    Advice for travellers: Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is 99%-plus effective and protects for 20-30 years. Travellers should also follow these guidelines for safe food and water.

    Democratic Republic of Congo: New Ebola outbreak in east

    A new outbreak of Ebola virus disease (EVD) has been declared in the province of Nord-Kivu, on the opposite side of the country to Equateur, the location of the outbreak declared over last week. Authorities were notified on July 28 of 20 deaths resulting from 26 cases of haemorrhagic fever; testing on six of the cases gave positive findings to Ebola virus from four samples. A team of experts from the DRC health ministry is being sent to the area to organise the necessary response. In the health minister’s press release (in French), it is noted that EVD is endemic in many equatorial forest regions of the country.

    Advice for travellers: Ebola is a severe viral haemorrhagic fever found in humans and other primates (such as monkeys, gorillas, and chimpanzees). It spreads through families and friends in close contact with blood and infectious secretions of people with obvious symptoms and, as such, presents a low risk to tourists to the affected countries. Read more about Ebola virus disease.

    El Salvador: Typhoid uptick in most areas

    Four of the country’s 14 departments (San Miguel, San Salvador, La Paz & Sonsonate) have experienced a surge in typhoid cases in the first six months of the year compared with the same period last year - up to 937 from 675. All provinces apart from Cabañas, a mainly agricultural region in the north, have reported the increase. Read more

    Advice for travellers: Typhoid is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is generally recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.

    Europe: West Nile season underway

    Concerning the current situation on West Nile Virus (WNV), the ECDC notes that ‘the 2018 transmission season started earlier than usual and higher case numbers have been reported compared with the same period in the previous years’. It goes on, ‘as of 26 July 2018, 56 human cases have been reported in EU/EEA Member States by Greece (22), Italy (24), Romania (5) and Hungary (5). Forty-one human cases have been reported in EU neighbouring countries, all by Serbia, including three deaths'. Read more. A UK news site reports on ten of the WNV cases in Italy, in the NE region of Veneto, including towns and cities near Venice and this week two additional cases have been reported in Central Macedonia, Greece. Read more. In the USA, the CDC monitors outbreaks of WNV each year. See current surveillance data here

    Advice for travellers: Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuro-invasive disease. The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites

    India: Disease counts generally lower; Vaccine import ban, recall

    There’s been a much slower start to the peak season for mosquito-borne infections in New Delhi compared to last year – the cumulative total of cases for 2018 sits at: malaria 88, dengue 49, and chikungunya 35. Telangana’s capital Hyderabad is reporting fewer malaria cases this year, but dengue and chikungunya infections have increased by more than two-fold. There’s been a decline in some common monsoon season infections (dengue, chikungunya) and an increase in others that are less typical (leptospirosis, Japanese encephalitis) in Kozhikode, Kerala state. While in Maharashtra, chikungunya case numbers are lower than in 2017, but one local doctor has pointed out that testing is more likely to be carried out on suspected dengue fever cases, resulting in fewer chikungunya infections reported. In a new development, babies under one year of age in the city of Pune are being diagnosed with dengue fever – according to doctors, this is a sign of more mosquito vectors in the community. Read more
    A CHINESE company’s safety protocol breaches in the production of rabies vaccines have led to a ban on its importation by the drug controller general. After an investigation to determine how many doses of the vaccine have been distributed in both private and government centres is completed, a recall will be announced. Rabies vaccines used in India are both locally produced and imported. Read more

    Advice for travellers: Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

    Iran: Tick-borne infection kills 7

    Deaths from the tick-borne infection Crimea-Congo Haemorrhagic fever (CCHF) have increased this (Iranian calendar) year, reaching seven – from 56 cases. Most of those who succumbed to the infection had compromised immune systems caused by pre-existing medical conditions. CCHF is endemic in Iran. Read more

    Advice for travellers: CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

    Malaysia: Dengue, HFMD updates

    More than one half of all dengue fever cases and one quarter of dengue-related deaths have been recorded in the state of Selangor this year. Residents have been urged to monitor their local environment for anything that could become a mosquito breeding site. Read more. See dengue counts across all states here. At a meeting to discuss the dengue fever situation, the health minister also commented on the extensive hand, foot and mouth disease (HFMD) outbreak affecting most states; the greatest effect has been felt by Selangor which has reported over 11,000 cases (from a national total of almost 41,000 on Aug 1). Read more

    Advice for travellers: HFMD mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection. Read more about HFMD.

    Mexico: Duo of mosquito-borne infections in Jalisco

    The mosquito-borne infections, dengue fever and Zika virus, are in the news in the Pacific coastal state of Jalisco. Overall numbers are down, but authorities are urging residents to remove mosquito breeding sites. Both infections have been reported in the main tourist centre of Puerto Vallarta as well as several inland towns. Read more

    Advice for travellers: Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information on smartraveller (DFAT).

    Pakistan: Virulent typhoid’s victims mainly kids

    Children under 10 years of age in the cities of Karachi and Hyderabad have been most impacted by infections caused by multi-drug resistant strains of typhoid fever. In a news article, a local paediatrician disclosed that ‘thousands of children have been infected’ in Karachi. Read more

    Philippines: Dengue, chikungunya news

    In the northern archipelago province of Batanes, authorities are requesting top tier governmental assistance to deal with a dengue fever outbreak that has caused two deaths so far. Read more. On the island of Panay, the incidence of dengue fever has risen this year - the capital Kalibo, Batan and Altavas have recorded the highest figures. Read more. And in the province of Biliran, chikungunya cases have surged in Maripipi. Read more

    Advice for travellers: Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Apply an effective repellent when outdoors to all exposed skin. Read more about chikungunya and avoiding insect bites.

    Reunion Island: Weekly dengue case numbers decline

    Just under 60 new dengue fever cases were confirmed in the most recent reporting week - a decline from previous weekly totals was expected due to the cooler winter temperatures. The year-to-date situation in this extensive outbreak: 6,345 cases (134 required treatment in hospital) with most from the western and southern districts. Vector control measures will be carried out this month in Le Port, Saint Leu, La Possession and Saint-louis. Read more (translate from French). 

    Taiwan: JE cases climb to over 30

    Japanese encephalitis infections in the 2018 season have risen to 31 with the notification of a recent case, the first for the year, in Yunlin County. While most Taiwanese residents have been vaccinated against JE, the latest case was not. He had an additional risk factor, also present in several other recent cases: pigs housed nearby. Read more

    Advice for travellers: On average, 24 cases are recorded each year in Taiwan, mainly in the south from May to October, but peaking in June and July. Cases typically occur in rural, rice-growing areas where people live near the host animals, pigs and wading birds. While it is a low risk for most travellers staying in urban areas, expats and travellers spending extended periods in agricultural areas of Asia should consult their travel doctor about recommendations for vaccination. Read more about JE.

    United Kingdom: ‘French letter’ recall

    Several batches of two brands of latex-free condoms have been recalled in the UK, Ireland and Australia due to concerns they may split if used near their expiry dates (between late 2020 and early 2021). Read more

    United States of America: Mumps cases top 1,000

    Since the first cases of vaccine-preventable mumps infections were reported in Hawaii in March last year, over 1,000 cases have been recorded in the state. The health department states that around 60 percent of cases are in the 18+ years’ age group and ‘32 reports of complications due to mumps infection (e.g., orchitis, hearing loss)’. Most confirmed cases have been in Honolulu (813) - other affected counties are Hawaii (134), Kauai (49) and Maui (7). 

    Advice for travellers: These consequences of mumps outbreaks highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps.

    Vietnam: Measles threat in north; Dengue cases mount in HCMC

    With the memory of a 2014 measles outbreak that killed 14 of the 1,700 individuals infected, doctors in the capital Hanoi have warned the current surge in cases could foreshadow a much larger outbreak if the large cohort of unvaccinated children is not immunised. Read more
    A RISE in the incidence of dengue fever cases is expected in Ho Chi Minh City with the onset of the rainy season. While there have been fewer cases this year, a senior doctor puts the weekly number of people requiring hospitalisation for dengue at between 350 and 450. Read more

    Advice for travellers: A highly contagious virus, measles occurs in developing and developed countries. While generally benign, infection can result in severe illness or death. Travelvax Australia recommends travellers check their immunisation status for measles and other childhood diseases such as diphtheria, whooping cough (pertussis) and mumps 6 weeks before departure.