Health Alerts
Australia: Measles imports from Asian hotspots

Four West Australian residents have returned from holidays in SE Asia infected with measles in the past month. All cases are unconnected and had recorded travel to either Bali, Thailand or Malaysia. Read more. NSW Health also recorded four measles cases in March following travel that included Pakistan, India and The Philippines. As two of those reported were infants, the department’s Director of Communicable Diseases proffered the advice: ‘“Families taking young infants to Asia are also urged to discuss vaccination with their GP before they travel, as the measles vaccine can be given earlier than the first birthday if they are likely to be exposed to measles while travelling.”

Advice for travellers: Measles is a highly contagious virus and can cause serious illness in people of all ages. Most cases reported in Australia are linked to overseas travel - both developing and developed countries. 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.

Brazil: YF vaccine for entire country

From a Mar 28 Ministry of Health news update, ‘yellow fever virus now circulates in metropolitan regions of the country with the largest population, reaching 35.8 million people who live in areas that have never had a recommendation of vaccine. In the past seasonality, for example, the outbreak reached a population of 9.8 million people.’ In response and as a preventive measure, the government has plans to vaccinate the entire population against yellow fever by April next year.

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

Fiji: Men. meningitis outbreak; Floods post-cyclone

On April 2, the Ministry of Health & Medical Services updated information on the ongoing meningococcal meningitis C outbreak: 38 confirmed and suspected cases for the year to Mar 29, averaging 2 cases per week for the past month. Six cases were in a school situated in the north of Tailevu province (east coast of Viti Levu); antibiotics have been administered to students and they will be given serotypes ACWY vaccines today. Read more. Kiribati has been screening international air passenger arrivals from Fiji as a precaution due to the meningococcal outbreak. Read more. EXTENSIVE flooding has resulted from the recent cyclone and towns and roads have been flooded across many areas, with Ba on Viti Levu particularly hard hit. Read more

Guinea: Alert for inland districts

Eight inland prefectures have been put on alert for outbreaks of meningococcal meningitis as the number of cases recorded this year reached 95. Sentinel sites have been established in the 17 prefectures that are located within the African ‘meningitis belt’. Read more (translate from French).

Advice for travellers: Meningococcal meningitis is an acute bacterial disease transmitted from person-to-person through close (kissing, sharing eating utensils) or extended contact. Risk factors include extensive travel in crowded conditions or extended contact with local people in crowded places. Guinea lies in North Africa’s ‘meningitis belt’, where meningitis outbreaks occur in the dry season (Dec-April) and just prior to the rainy season (May-June). If you plan to visit this region, call Travelvax Australia’s free travel health advisory service (1300 360 164 - toll-free for landlines) for further advice. Read more about Men. meningitis.

India: Water-borne illnesses surge in Guntur

Leaking water pipelines are believed to be the cause of a sudden spike in cases of hepatitis A and diarrhoeal disease in Guntur, in the SE state of Andhra Pradesh. To date there have been at least 17 deaths and over 200 people have sought medical assistance for symptoms. 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.

Kenya: Vaccine scam in capital

Several Nairobi city health officials have been arrested after they were found to have substituted water for the yellow fever vaccine given as a requirement to travellers heading overseas, including the international certificate of vaccination; the fake vaccines were offered at a discounted, cash price. Read more

Malaysia: Dengue tops 15,000

In the year to April 4, the nation’s dengue fever case count neared 15,200 infections. While all provinces are reporting cases, highest numbers are in Selangor, W P Kuala Lumpur, Penang, Johor and Sabah. 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.

Micronesia: Mumps in 2 states

Following last week’s report on an increase in mumps cases in the island state of Chuuk, ReliefWeb this week has posted news of cases on Yap; the outbreak also continues in Vanuatu.

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.

Mozambique: Cholera set to worsen

An uncontrolled cholera outbreak in the province of Cabo Delgado could deteriorate further with rains due soon. Drinking water shortages in the province and in the capital, Maputo, may further ‘exacerbate poor hygiene and sanitation practices,’ according to the World Health Organization (WHO). 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. Read more about cholera

Myanmar: ‘Snail fever’ in west coast town

Testing carried out after a number of residents reported symptoms of schistosomiasis in the coastal town of Sittwe (Rakhine state) has confirmed the presence of the parasitic infection. ProMED surmises that ‘rather than the emergence of a new infection … it might have existed in the area but had never been tested before’. (Archive 20180329.5717098) 

Advice for travellers: Schistosomiasis or bilharzia is caused by a parasite which is released into fresh water by host snails. It burrows into the skin of people who swim or wade in rivers, streams and lakes containing the snail. With the rise in eco-tourism and adventure travel, increasing numbers of tourists are contracting schistosomiasis, according to a WHO fact sheet. Around 10% of travellers exposed to contaminated water will be infected. No vaccine or prevention medication is available, but schistosomiasis is treatable – especially if diagnosed early. Read more on the risk for travellers and how to prevent infection (Travelvax, WHO, CDC).

Nigeria: Cholera in 2 states; Lassa fever update

Dual cholera outbreaks have struck Bauchi state and its north-east neighbour, Yobe. The outbreak in Bauchi is the largest – almost 560 people have been sickened, many are under the care of Médecins Sans Frontières. LASSA fever cases continue to be reported: six more in the week to Apr 1 from five states, taking the total of suspected cases to 1,706 for the year. The Nigeria Centre for Disease Control update notes that: ‘81% of all confirmed cases are from Edo (42%) Ondo (23%) and Ebonyi (16%) states’.

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.

Philippines: Vaccine scarcity strikes; Measles cases, deaths climb

Compelling advice to dog owners on the need to vaccinate their animals against rabies as the country copes with a shortage of rabies vaccine for humans, used to prevent the fatal infection as both pre- and post-exposure measures. Read more. THE incidence of measles has risen this year with nearly 600 cases recorded till mid-March and 12 resulting deaths (from Davao Region, Soccsksargen, Central Luzon, and the National Capital Region (NCR)). Read more

Advice for travellers: Despite successful efforts to control rabies through canine immunisation in several provinces of the Philippines, rabies remains a major problem in many regions. However, 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 is normally recommended for those staying for more than a month, especially travellers planning to live in, or travel extensively through, rural areas; however the final recommendation is itinerary-specific. Read more on rabies.

Portugal: Measles count now 82

A measles outbreak continues in the northern city of Oporto. Healthcare workers at a local hospital make up over three-quarters of the number of infected individuals, however more cases have been identified at other hospitals in Gaia, São João, Matosinhos and Braga. Up to Mar 30, 82 cases have been confirmed and a further 20 are under investigation. One of the initial cases had travelled from France, the epicentre of a large outbreak. Read more. More on the outbreak in Greece here.

Reunion Island: Dengue numbers rise

The dengue fever outbreak underway in the island’s western and southern districts could spread to the north after two cases were identified in Sainte-Clotilde, a neighbourhood of the capital, Saint-Denis. There have now been 755 dengue infections for the year; 167 more in the last week. Read more (translate from French).

Russia: Flu season lingers

The WHO influenza update of Apr 2 notes that or most of Europe flu activity has declined, however Eastern Europe has rising rates of predominantly influenza A. The Russian Federation is most affected, showing high rates ‘with all seasonal influenza subtypes co-circulating’.

Advice for travellers: Seasonal flu is the most common vaccine-preventable travel-related illness because it is a potential risk during every stage of the journey. Whether you are travelling within Australia or overseas, Travelvax recommends flu vaccination for all travellers over 6 months of age.

South Korea: New meaning for ‘spiked’ drink

As fads go, this one definitely lacks medical endorsement: mixing Soju, the nation’s favourite distilled alcoholic beverage, with wasps. Supposedly of benefit for diabetes and hypertension, the Ministry of Food and Drug Safety cites the risk of allergic reactions and choking for cracking down on the retail and online sales of the drink. Read more

Sri Lanka: Dengue toll now 15

The districts of Colombo and Gampaha on the west coast and Batticaloa in the east have reported the highest number of dengue fever cases this year – between them they have had over one-third of the nation’s 14,000 cases (to Mar 28). Fifteen deaths have resulted. Read more

Taiwan: Outdoor pursuits carry risks; Measles flies in

At a time when the population is outdoors enjoying the Spring weather and participating in the rituals of Qingming Festival when ancestors are honoured and tombs are swept, the Centers for Disease Control (CDC) has warned of the risk of chigger bites and scrub typhus. Ahead of the June/July peak season, there have already been 67 scrub typhus cases, including 20 in Taitung County and 15 in the county of Hualien. Read moreTWO flight attendants with the airline Tigerair Taiwan have been diagnosed with measles after coming into contact with a passenger who became infected while in Thailand. Contact tracing is under way for all 852 passengers on the flights worked by one of the attendants – mainly between Taiwan and Japan or Macau. Read more

Advice for travellers: Scrub typhus is a bacterial disease passed on to humans by mites, or chiggers, that normally live on rats infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus is endemic throughout the Asia-Pacific region and more than a million cases occur annually. There is no vaccine or prevention medication: the best way to avoid scrub typhus is to avoid being bitten by mites. Protective measures include the use of an effective personal insect repellent, wearing protective long clothing, and a thorough end-of-day self-examination after visits to rural areas. Due to the disease’s 5- to 14-day incubation period, travellers may only experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Treatment involves taking antibiotics and should begin as quickly as possible. Always see a doctor as soon as possible if you develop a fever after the trip and remember to discuss any recent overseas travel. Read more about rickettsial diseases.

Uganda: Cholera persists in west; Measles infects northern kids

The cholera outbreak that had first struck Congolese refugees in the western district of Hoima continues unabated and has now spread to the local population – 500 more cases have occurred in the past fortnight and the death toll has reached 40. Read more. IN the northern district of Amuru, over 40 children aged under 14 years have been diagnosed with measles infections. Vaccination rates in the area are low. Read more

United Kingdom: Highly resistant STI ex-SE Asia

Public Health England (PHE) has issued warnings on the importance of safe sex practices after a resident returned from South-East Asia infected with a highly resistant form of gonorrhoea. The man had reported having sexual contact with a woman while overseas. The infection was resistant to the 2 first-line antibiotics (& others); further tests are due in the middle of this month to determine the efficacy of his current treatment. The common sense advice from PHE: ‘It is better to avoid getting or passing on gonorrhoea in the first place and everyone can significantly reduce their risk by using condoms consistently and correctly with all new and casual partners.’ Read more

Advice for travellers: Read more about sexually transmitted infections here. Fit for Travel, NHS (Scotland).