Health Alerts
Brazil: YF toll still rising

The May 2nd Pan American Health Organization (PAHO)/WHO yellow fever (YF) update notes that in the states of Espírito Santo, Minas Gerais, and Rio de Janeiro, there has been no further spread into new urban areas. As with previous statements, the Aedes aegypti mosquito has not been a vector in the YF virus transmission cycle in towns and cities to date; however the presence of infected primates in major cities such as Vitoria in Espírito Santo and Salvador in Bahia adds to the potential for urban transmission. Overall figures up to April 27th now show: ‘3,131 cases of yellow fever reported (715 confirmed, 827 suspected under investigation, and 1,589 discarded), including 392 deaths (240 confirmed, 113 discarded, and 39 under investigation). The case fatality rate is 34% among confirmed cases.’ The European Centre for Disease Control (ECDC) has published a map showing the locations of locally acquired YF cases and the expanded areas of Brazil now presenting a risk of yellow fever transmission (up to April 26, 2017).

Advice for travellers: Yellow fever virus is a mosquito-borne disease found in tropical and subtropical areas in Central/South America and Africa. While it can be severe, yellow fever infection is a very rare in Australian travellers. However, under the International Health Regulations (IHR), proof of vaccination may be required of any traveller entering or leaving an area at risk of yellow fever transmission. Read more about yellow fever

Canada: Manitoba’s mumps slowing

Health officials in the province of Manitoba are hoping that the most recent 3-week total of 55 new mumps cases is the beginning of the end of the outbreak that has produced 345 cases over nearly 8 months. The average yearly rate of mumps notifications in the state is usually between 4 and 8. Other provinces reporting mumps cases, but with comparatively lower year-to-date figures, are Alberta (65) and Saskatchewan (34). Read more.

Advice for travellers: This ongoing outbreak of mumps highlights 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.

China: More bird flu cases, another province affected

More news on human H7N9 avian influenza cases on the mainland, with a further 17 reported in the week from April 23-29, according to the Hong Kong Centre for Disease Control (CHP) update. The highest weekly total was in Sichuan (5 cases), followed by Beijing, Guangdong & Shandong (2 cases each) and one case each from Chongqing, Fujian, Gansu, Henan, Hunan and Jiangsu. Yesterday, authorities in Shaanxi province reported their first local case of H7N9 avian influenza. Read more in an Afludiary post. As with previous reports, the CHP has advice for travellers to regions with bird flu outbreaks, including: ‘Avoid touching birds, poultry or their droppings and visiting poultry markets or farms when travelling outside Hong Kong. Travellers returning from affected areas with avian influenza outbreaks should consult doctors promptly if they have flu-like symptoms, and inform the doctor of the travel history and wear a mask to help prevent spread of the disease.’ 

Dominican Republic: Spike in leptospirosis

New figures released last week indicate an almost doubling of the number of leptospirosis cases over the same 3-month period last year. Of the 200 cases reported between Jan 1 and Mar 31 this year, there have been 20 deaths. Poor sanitation and garbage/waste collection issues leading to the proliferation of rodents are considered likely causes. 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.

Europe: Hep A cases increasing

According to the latest ECDC assessment, the ongoing hepatitis A outbreak in the region is not yet contained and more cases are to be expected. The 675 confirmed cases (June 2016 to April 28, 2017) are thought to be an under-reporting of the actual numbers of infections. Since the last update in February, 387 new cases were reported from 10 countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Portugal, Sweden and the UK). Over 80 percent of confirmed cases have been in men who have sex with men (MSM). Read more on outbreak and the increased risk of infection among MSM. 

Advice for travellers: Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans by faecally contaminated food and water, or by handling everyday items. 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.

Liberia: Unidentified illness under investigation

Ebola and Lassa fever have been ruled out by local health agencies, as investigations continue into the cause of a mystery illness that has sickened 25 people and killed 11 (according to the WHO) since April 23rd. The first cases were reported in Sinoe County, on the southern coast, and were initially believed to relate to rites conducted at a funeral. Symptoms included vomiting & diarrhoea, fever and headaches. One of the fatalities occurred in the capital Monrovia after a man returned to the city following the funeral; his fiancée has since succumbed to the same illness. Testing of samples taken from victims is underway in the US. Read more.

Mexico: Tick-borne disease on the rise

Warnings have been issued on the increase in tick-borne infections known as rickettsioses on the Yucatan peninsula – the location of the popular tourist resorts of Cancun & Playa del Carmen and the famous Mayan ruins of Chichen Itza and Tulum. According to a news report, there were 110 cases last year, with 2 deaths in children; this year there have been 10 cases to date. The exact nature of the infections is not identified. Read more about rickettsial infections

New Caledonia: Dengue count tops 3,200

New dengue fever cases reduced by nearly one-quarter in April over the March figures (863 vs 1138). The tally for the epidemic that started in early September last year has now hit 3,206 cases. Read more (translate from French). 

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 an effective 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.

Nicaragua: Chikungunya updated, Peru’s double hit

Reporting of chikungunya figures to the PAHO has been intermittent for many countries in the region this year, but in the latest update Nicaragua advised that it has had 317 cases this year, followed by Panama (305 new cases) and Peru (69). Also in Peru, recent flooding has caused a wave of dengue fever cases in Piura, La Libertad, Ica, Lambayeque, Ayacucho, Ucayali, Cusco and Áncash. More than 4,700 people have contracted the mosquito-borne virus but there are another 11,000+ suspected cases across various lowland areas of the country. 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 egypti 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.

Nigeria: Lassa active in 9 states

The states of Bauchi, Ondo, Edo, Taraba, Nasarawa, Kaduna, Kano, Kogi and Enugu continue to report Lassa fever cases as the outbreak heads into its fifth month. From the 164 confirmed and suspected cases, there have been 68 associated deaths. Read more.

Advice for travellers: Lassa fever is an acute viral illness that occurs in West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5000 deaths occur each year. However, Lassa is a remote risk for travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Read more about Lassa fever.

Singapore: 2017 Zika cases rise to 30

Four Zika virus cases with onset over the past 2 weeks have been added to data on the NEA website. They are among the 11 cases reported from 3 sites in the eastern Hougang/Serangoon areas. The 2017 total now sits at 30. 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).

South Africa: Late Limpopo malaria season

Recent heavy rains adding to mosquito numbers has in turn caused an uptick in malaria at the end of the peak season in Limpopo province. This year there’s been a surge in cases, with 624 reported since January. Read more.

Advice for travellers: Malaria is endemic in many areas of southern Africa. Travelvax recommends that travellers visiting this region discuss their itinerary and preventative medication at their nearest Travelvax clinic, or with their healthcare provider. For advice, call Travelvax on 1300 360 164.

Taiwan: Planning for dengue-free Universiade

August is high summer season when locally transmitted dengue fever cases are usually more common, but this year authorities are already planning their preventive measures and responses to any outbreaks during this time as the capital Taipei prepares to host a multinational university athletic event. Athletes from 150 nations will descend on the city to participate in the Summer Universiade and spectator numbers are expected to reach 160,000. Read more.

Uganda: Rubella spike in north

Primary school children make up most of the 49 rubella (German measles) cases reported from Kalongo town in the northern Uganda district of Agago. Adults have not so far been affected in the outbreak, however surveillance has been stepped up to prevent the infection spreading to pregnant women, with the added potential for serious complications (foetal death, premature delivery and serious birth defects). Read more.

Advice for travellers: Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine. Highly contagious, rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Travellers should also check their immunisation status for all childhood diseases, including measles, mumps, tetanus, whooping cough and chickenpox as part of their pre-travel medical preparations.

United States of America: Aloha to mumps; Imported tuna brings Hep A risk

Many states on the US mainland have been hit by mumps outbreaks recently and now it appears to be Hawaii’s turn, with 16 cases reported this year on Oahu - 2 of those in the last week. A local news site quotes a health official as saying: ‘It would seem that mumps has been introduced into our community and is potentially circulating more widely.’ Read more.
ALSO in Hawaii, some portions of raw fish salad, or poke, sold in several supermarkets and convenience stores are believed to contain tuna contaminated with hepatitis A virus. The frozen fish had been imported from Indonesia; the dates of sale of the tainted food are April 28 to May 1st. The Department of Health is advising those people who may have consumed the raw tuna to seek vaccination and monitor their health for symptoms of Hep A infection for 50 days. No confirmed cases have been reported thus far. Read more, including a list of the stores where the salad may have been sold.