Health Alerts
Brazil: Measles surge in 2 states; Chikungunya, dengue reports

Vaccine supplies are being sent to the states of Amazonas and Roraima to stem the spread of measles. The majority of Amazonas’ confirmed cases have been the capital, Manaus; there are a further suspected 1,368 cases in the state. To the north in Roraima, there have been 200 confirmed measles notifications and 177 more suspected. Read more
UP TO 9,000 residents of the state of Rio de Janeiro have been infected with chikungunya this year and despite the arrival of the cooler months the number is increasing. While all areas of the state have been affected, it’s the northern city of Campos dos Goytacazes that has borne the brunt of the outbreak. Separate reports on mosquito-borne infections in other states have also been published, including Paraná, Minas Gerais, Maranhão and Bahia. Read more (translation required). 

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: HFMD cases mount in capital

Beijing’s 4,014 hand, foot and mouth disease (HFMD) infections in June represent an almost 90 percent increase over last year’s figures for the same month. June is also the start of the city’s peak HFMD season which is likely to extend until November. Read more (translation required).

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.

Democratic Republic of Congo: Measles epidemics; Ebola updates

The World Health Organization (WHO) regional update for various reporting dates in June notes that cumulative suspected measles cases for the DRC climbed to 14,031 (149 deaths), Liberia 3,025 (15 deaths, epidemics in 22 health zones) and Ethiopia 2,244 suspected cases.
MORE than three weeks have lapsed (June 12) since the last confirmed Ebola virus disease (EVD) case was released from a treatment centre and in the latest sitrep, the WHO notes on July 3 that ‘13 suspected EVD cases were reported in Bikoro (10), Iboko (2) and Wangata (1) health zones. Of the 13 suspected cases, 11 tested negative, while two suspected cases reported on 30 June 2018 are awaiting collection of the second specimens for a repeat test after the first specimens tested negative.’ Surveillance will continue in the interim: ‘The 12 June 2018 marked the start of the countdown towards the end of the EVD outbreak, which requires 42 days (two maximum incubation periods) without notifying new confirmed EVD cases.

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.

Guatemala: Dengue surge in west

There has been a two-fold increase in dengue fever cases over 2017 figures in some areas of Quetzaltenango department, situated in the SW near the Mexican border (Chiapas state). The towns of Coatepeque, Colomba, Genoa, Flores, and El Palmar have been hardest hit. 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.

India: Dengue, JE, leptospirosis reports; Nipah outbreak source update

THIS week, there have been news reports on dengue fever in Visakhapatnam (Andhra Pradesh) and Patna (Bihar); 30 cases of Japanese encephalitis infection and five associated deaths in Dibrugarh district, Assam; and the Municipal Corporation of Greater Mumbai has advised of the rise in a number of monsoon-related illnesses. Read more
NO further Nipah virus disease cases have been reported since May and testing has confirmed that almost 20 percent of the fruit bats caught in the two affected districts of Kerala (Mallapuram and Kozhikode) during the outbreak carried the virus. 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.

Ireland: Gastro illness upswing

VTEC (verocytoxin producing E. coli) gastrointestinal illness has spiked recently, causing health authorities to issue a warning with particular mention of young children and the elderly who are more at risk of severe complications. Infections like VTEC (aka STEC or Shiga toxin-producing E. coli) are more common in the warmer months and are acquired through contamination of foods with faecal material. Advice from the Health Protection Surveillance Centre, ‘Always wash your hands before and after handling food, wash your fruit and vegetables thoroughly before eating them and always ensure minced meats are cooked all the way through.’ Read more

Kenya: RVF in 3 counties, 8 more at risk

Wajir, Marsabit, and Siaya counties have all reported human RVF cases although a further eight counties are considered risk areas. The situation as outlined by the WHO on June 29 – 90 cases and 10 deaths. Most cases were acquired through contact with blood or tissues of infected animals (livestock); but recent flooding in one district led to an increase in cases acquired through bites from infected mosquitoes, a less common mode of transmission. Read more 

Advice for travellers: Rift Valley fever (RVF) is an acute viral disease that typically infects domesticated herd animals. It is generally found in eastern and southern Africa where sheep and cattle are raised, as well as in West Africa, Madagascar, and more recently Saudi Arabia and Yemen. People are infected after exposure to blood, body fluids, or the tissue of RVF-infected animals, or from the bite of an infected mosquito. The virus presents a low risk to travellers, but is another reason to use personal insect repellent and take other steps to minimise insect bites in places where it occurs. Read more about RVF.

Malaysia: Fifth JE case in Sarawak: Tinned fish recall

Sri Aman, situated in the east of Sarawak state, is the latest district to report a Japanese encephalitis case this year, the others being Kota Samarahan, Lawas, Julau, Kuala Baram. The health department now categorises the infection as endemic to the state. Read more. Sri Aman is also included in the list of districts containing 31 rabies-declared zones, together with Serian, Kuching, Samarahan, and Sarikei. Read more
EIGHT brands of tinned sardines and mackerel have been recalled from sale after they were found to contain Anisakis species roundworms. None of the worms were alive, having been killed in the cooking process. Read more. More on Anisakiasis, the parasitic infection contracted through eating some types of uncooked or undercooked seafood.  

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

Namibia: New Hep E hotspot

Hepatitis E infections, four confirmed and 32 under investigation, have been reported in the central coastal city of Swakopmund. Many of the cases are in the Democratic Resettlement Community (DRC), an informal township in the NE of the city. Read more. In a separate news report, the Hep E outbreak in the informal settlements of the capital city, Windhoek, continues to spread to new areas. Read more

Advice for travellers: The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. 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. The majority of hepatitis E infections occur in East and South Asia. Read more about the virus and how to prevent it.

Nigeria: Cholera in northern state

Eleven of 132 people suffering from cholera infections have perished in the northern state of Katsina. Six districts in the state, which shares borders with Niger, are affected. Read more. Cameroon is also being impacted by cholera outbreaks in Nigeria after the infection spread from the NE state of Adamawa to some border districts. 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

Pakistan: Travel warning due to resistant typhoid

The US Centers for Disease Control and Prevention (CDC) has issued a Level 2, Practice Enhanced Precautions travel advisory for travellers to Pakistan, in particular those who are visiting friends and relatives, relating to the presence of an extensively drug-resistant (XDR) strain of typhoid fever. One tourist from the UK and two from the US have returned home infected with the virulent bacteria this year. First identified in Hyderabad in late 2016, it has since spread to Karachi and beyond. 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.

Papua New Guinea: Morobe Province polio update

From a ReliefWeb post on the circulating vaccine-derived polio case reported last week, ‘In response to the detection of poliovirus in the index case, mop-up vaccination was undertaken in Lae where the case lives and in Eastern Highlands Province where the case had stayed prior to onset of paralysis… Prior to the detection of VDPV1 in contacts of the index case, preparation is underway for implementation of broader polio supplementary immunization activities as well as surveillance system strengthening in the affected province and surrounding provinces.’ From the WHO’s risk assessment: ‘Given substantial vaccination coverage gaps across the country and suboptimal surveillance for AFP and poliovirus, the risk of further spread of cVDPV within the country is deemed to be high.’ 

Advice for travellers: Read more on vaccine-derived polio from the WHO. 

Philippines: Infections from contaminated water rise

Health authorities are directing money and resources towards tackling this year’s climb in leptospirosis cases – they have risen by more than 30 percent compared with 2017. To date there have been 1,040 cases and eight resulting deaths. The capital Manila and Bacolod City (Western Visayas) are two of the areas affected by the increased incidence. 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.

Sri Lanka: Dengue fever cases top 25,000

Nationwide, dengue fever cases have now topped 25,000 for the year, with the Western Province recording almost one-third of all cases (including the districts of Colombo, Gampaha & Kalutara). The peak of last year’s dengue season occurred at this time of year - June and July. Read more

Taiwan: Southern city’s dengue case

Until this week, all dengue fever cases recorded this year have been imported, but the first locally-acquired infection, a man from the large southern city of Kaohsiung, has been announced by the Centers for Disease Control. The man’s contacts and neighbours have been tested for dengue infection but all proved negative. Read more

Ukraine: Weekly measles count drops, to 935

New measles infections have decreased in number over the past week, but they remain high – 935 cases in the 7-day period. Country-wide, the year-to-date total has climbed to 24,027 cases, the death toll remains at 12. Read more. While eastern districts of Slovakia are also experiencing a measles epidemic, with cases reaching a 20-year high. Eighteen towns and villages have reported cases; around half of the 101 suspected measles infections have been confirmed to date. Read more

Vietnam: Dengue season onset

A Russian health agency, Rospotrebnadzor, has warned travellers of the heightened risk of dengue fever infection in areas including Da Nang, Hanoi , Ho Chi Minh City and southern provinces. According to Russian news reports, there have been more than 21,000 dengue infections and four related deaths this year in Vietnam. Read more (translation required).