Health Alerts
Brazil: YF update; More mozzie worries for Rio

In the most recent reporting week (Apr 17-24), another 61 human yellow fever (YF) cases and 22 associated deaths were recorded in the states of Rio de Janeiro (36), Minas Gerais (14) and São Paolo (11). YF outbreaks among non-human primates were also occurring in those states, with 16 of the 18 epizootics in São Paulo. A vaccination campaign aimed at immunising the entire population of 77 million inhabitants continues. Read more. IN THE first quarter of the year, the state of Rio de Janeiro has experienced a three-fold increase in chikungunya cases, almost reaching the 2017 total of 4,305. The city of Rio recorded over 850 cases, mostly from the western districts of Campo Grande, Guaratiba and Santa Cruz. Read more (translation required).

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

Chile: Rapa Nui dengue

Following reports in mid-April of four dengue fever cases on Easter Island, an Apr 27 update announced that number has risen to 14. Health Ministry response has been to declare a health warning which allows for the necessary powers to manage the outbreak and halt it – assembling teams to fumigate the island and distribute mosquito nets and repellents. Up to 80 percent of the population was infected with dengue in 2002, the first major outbreak recorded after the virus was introduced in 2000. Read more (translation required).

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.

Europe: Measles woes continue

Lower than required vaccination rates in many EU countries, compounded by the highly infectious nature of measles, and there is more news on expanding outbreaks: This week, from the Czech Republic, 70 of the more than 100 measles cases notified to authorities this year were in the capital, Prague. A news report stated that the situation has necessitated the closure of the emergency dept. of ‘Prague's largest hospital Motol … until next weekend’. Also updates from Estonia, Ukraine and Portugal.

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.

Fiji: Vaccine set-back

The government has announced there will be a delay in the provision of meningococcal vaccines to all individuals under 19 years of age. The World Health Organization (WHO) and UNICEF had been approached for assistance in procuring the more than 300,000 doses needed. Read more

France: Chickenpox cases mount in 5 departments; Dengue-transmitting mozzie hits new areas

The rate of chickenpox infections is more than double the seasonal norm in Burgundy-Franche-Comté (SE of Paris), while increases have also been seen in Brittany, and to a lesser extent in Hauts-de-France, Nouvelle-Aquitaine and Normandy. Around one-third of those infected are under five years of age. Read more (translation required). THE MOSQUITO vector behind the 2017 chikungunya outbreak in Provence-Alpes-Côte d'Azur is now present across 42 of the 96 departments - up from six in 2010 (see map). Warnings have been issued ahead of the warmer months, with real concerns that imported viruses from countries experiencing outbreaks (i.e. dengue in Reunion) could spread to local communities. Read more

Advice for travellers: Chickenpox is a highly contagious disease caused by the varicella-zoster virus. Mainly passed from person to person by coughing or sneezing, it causes a blister-like rash, itching, tiredness, and fever. While the illness is generally mild in children, it can be more severe in young babies, adults, and people with weakened immune systems. Read more about chickenpox.

Mexico: Mumps infections intensify in 5 states

Mumps notifications reached 2,619 by the second week of April with nearly one-third of infections in the 25 to 44 years age group (20 percent were 20-24yo). Most affected states have been: Tamaulipas, Nuevo Leon, Quintana Roo, Jalisco and Chihuahua. Outbreaks have occurred involving university students in Mexico City, Sonora and Chihuahua. Read more (translation required).

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.

Nepal: Varicella in valley; Al fresco malaria

A media release from a Kathmandu hospital states that it is treating three to four children for symptoms of chickenpox every day, and there has been a rise in cases across the valley. Read more. LOCAL health officials in Nawalparasi District - within the Terai and lying to the west/north-west of Chitwan National Park – have attributed at least some of the 21 malaria cases they have recorded to people sleeping outdoors during hot weather. It is hoped through the actions of the National Malaria Control Program to eradicate malaria by 2016. Read more

Advice for travellers: Travellers visiting this lowland region of Nepal should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. For details call 1300 360 164. Read more about malaria

Nigeria: Lower intensity of Men. meningitis season

Forty-six of the 713 people with suspected meningococcal meningitis have succumbed to the infection in the NW state of Katsina, a significantly lower figure than during last year’s devastating outbreak when there was a ~10 percent death rate from the more than 4,600 cases. The outcome was attributed to an extensive vaccination campaign and prompt antibiotic treatment. Read more

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. Nigeria 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.

Pacific: Regional dengue, mumps reports

The dengue fever outbreak that began late last year in Wallis and Futuna has worsened with a news report stating ‘it has spread to the centre of the island’. The situation has prompted meetings of interest groups including government and local officials. THE MOST recent post from ReliefWeb outlines health issues in regional countries: ongoing outbreaks of dengue fever in New Caledonia, Fiji and Vanuatu; mumps in Vanuatu and two states of Micronesia (Chuuk, Yap) and an Apr 19 update on the meningococcal outbreak in Fiji (see separate post).

Pakistan: Province's malaria upswing

An announcement this week from the director of malaria control in the province of Balochistan disclosed that 29 of the districts are reporting malaria and the incidence is increasing. Currently up to 7,000 children are infected with malaria each year. On a national level, annually more than 1.6 million people are infected with the malaria parasite. Read more

Reunion Island: ‘Unprecedented’ dengue outbreak, over 2,100 cases

According to the WHO, the risk of exportation of the dengue virus from the current ‘unprecedented’ outbreak to other countries with a competent mosquito vector is ‘heightened’. It also notes that studies established ‘in previous years asymptomatic cases contributed to the transmission cycle and since the proportion of asymptomatic cases was high, the virus has continued to spread unnoticed until now’. While the advice is not to restrict travel, the recommendations include: the use of personal protection measures (effective insect repellents, suitable clothing etc) and ‘Insecticide-treated mosquito nets afford good protection for those who sleep during the day (e.g. infants, the bedridden and night-shift workers), but also during the night to prevent mosquito bites, if the lights are kept on.' As of Apr 29, there have been 2,119 cases across the island, with western districts hardest hit. Read more

Singapore: HFMD for month tops 12,000

More than 3,800 cases of hand, foot and mouth disease (HFMD) have been notified to authorities over the last four weeks, taking the cumulative yearly total to 12,309. Case numbers started to climb in early March. Read more. Reports of HFMD in China show a drop from last year’s figures for the same period – nearly 142,000 cases and six associated deaths to Apr 20. Read more. And in Taiwan, HFMD infections climbed by 20 percent last week taking the yearly total to more than 5,000 cases - not classified as an epidemic as yet however. Read more. Thailand had recorded over 10,000 HFMD cases to Apr 30. 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.

Thailand: Measles update

Bureau of Epidemiology data on measles cases across the kingdom this year: over 700 cases with the majority in the central, NE, north and southern provinces. One-quarter of cases were aged 15 to 24 years of age, followed by 25-34 years cohort. Last week the health department in Victoria (Australia) advised of an imported case of measles originating in Thailand (mirroring the outbreaks underway in Okinawa & Aichi Prefectures, Japan, and in Taiwan).

United States of America: Spring increase in rabies reports

With the warming of the weather people spend more time outdoors, wild animals become more active and so the rabies risk increases. This week, ProMED posted details of four separate incidents of human exposure to rabid animals that took place over the last seven days in the states of Alabama, Massachusetts, New York and South Carolina.

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. If bitten or scratched, 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.

Venezuela: Measles, malaria among the multiple health troubles

A paediatric hospital in the capital Caracas is treating between five and seven children for measles infections every day; in total over 450 since the end of last year. Lack of isolation facilities has led to children who are in-patients becoming infected with measles during their stay. The outbreak has spread beyond the Capital District to seven other states. Read more (translation required). And measles is not the only health issue hammering the country, malaria cases increased by almost 70 percent in 2017 – the greatest increase of any country. Read more