Health Alerts
Brazil: Chikungunya, dengue in various states; Hep A incidence rises

The municipality of Campos dos Goytacazes, which is around 290kms north of Rio de Janeiro, has been placed under a state of emergency due to the ongoing chikungunya outbreak. The declaration allows for a raft of measures aimed at reducing mosquito infestations to be instituted. Read more (translation required). Ministry of Health data on mosquito-borne infections recorded in the state of Alagoas up to June 9 this year: 818 cases of dengue were confirmed, 62 of zika and 51 of chikungunya.  Over 12,000 suspected dengue fever cases have been reported this year from the NE state of Rio Grande do Norte – this represents an almost 3-fold increase over last year’s figures for the same period. Read more. In Foz do Iguaçu (Paranà), with over 1,000 suspected dengue fever cases already recorded this year and the presence of large numbers of mosquitoes capable of transmitting dengue, chikungunya and Zika virus, the announcement of a ‘state of attention’ will enable city authorities to tackle mosquito-borne diseases, leishmaniasis and bat rabies. Read more
YEAR-on year, hepatitis A notifications climbed by over 70 percent in 2017 and over half were reported in the state of São Paulo. The state capital recorded a three-fold increase in cases from July last year, with 156 in that month alone. Read more (translation required). 

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.

China: Rubella rates rise

In the city of Wuzhou – Guangxi Zhuang Autonomous Region, bordering Guangdong province – cases of rubella (German measles) have been increasing among unvaccinated teenagers and adults. According to a local news source, there is a risk of a larger outbreak due to low rubella vaccination rates. Read more 

Advice for travellers: Rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine, one of the routine immunisations which should be current for prior to overseas travel. Travellers should also check their immunisation status for tetanus, diphtheria, and whooping cough. Read more about rubella.

Democratic Republic of Congo: Polio outbreaks in 3 regions; Ebola ‘largely contained

Over four months after the declaration of a national health emergency over outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2), the World Health Organization (WHO) reported on two separate strains infecting residents of five provinces (Haut Lomami, Tanganyika, Haut Katanga, Ituri and Mongala) this year. Surveillance is being carried out in Zambia, Tanzania and Uganda, as they share borders with the affected provinces. The WHO considers the risk of spread both nationally and internationally to be high as it ‘is magnified by known population movements between the affected area of Democratic Republic of the Congo, Uganda, Central African Republic and South Sudan, and the upcoming rainy season which is associated with increased intensity of virus transmission.’ Further, the agency ‘recommends that all travelers to polio-affected areas be fully vaccinated against polio.’ Read more
IN THE latest update on the Ebola virus disease (EVD) situation in Equateur Province, the WHO states that the outbreak ‘has largely been contained’ but that there ‘remains a risk of resurgence from potentially undetected transmission chains and possible sexual transmission of the virus by male survivors’. Surveillance and contact tracing is to continue. 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. 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 vaccine-derived poliovirus.

India: Surge in rain-related infections

Dengue fever rates have risen across a number of cities (Bilaspur & nearby towns in Himachal Pradesh, Indore in Madhya Pradesh, Kolkata in West Bengal,  Cuttackin  Odisha) and also rural districts of the states of Andhra Pradesh and Goa. In neighbouring Bangladesh, Dhaka South City has seen a rise in dengue cases. Read more  

Advice for travellers: Dengue occurs throughout India – both in urban and rural areas. The virus is spread by two types of Aedes mosquitoes. Both breed in shady places close to dwellings and bite mainly during the daylight hours, making them difficult to avoid when 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 oil of lemon eucalyptus (or PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Japan: Large spike in STI

A local news post reported on the gradual rise in syphilis cases, with a more than 3-fold increase in cases between 2014 and 2017, reaching almost 6,000 for the year. According to the article, ‘the rise last year was especially notable among people living in provincial cities and young women’. One doctor puts the reason partly down to increased promiscuity ‘especially with the prevalence of dating and hookup apps’. Read more 

Advice for travellers: Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.

Libya: Measles cases top 80

ProMED reports on a measles outbreak involving over 80 cases from most of the country’s 22 districts. A state of emergency has been declared covering all medical facilities. 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.

Malaysia: HFMD in peninsula state

Hand, foot and mouth disease (HFMD) notifications in Penang have risen by more than half over 2017 figures, with 1,675 cases recorded so far this year. Parents have been asked to seek prompt medical treatment for their children at the first signs of the infection’s typical symptoms. 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.

Namibia: Hep E toll swells to 17

A health official stated this week that the hepatitis E outbreak, which started in the informal settlements of Windhoek in December before spreading to other areas, has now produced 1,867 suspected cases and caused 17 deaths. Read more

Advice for travellers: The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. The virus is found worldwide, mainly in communities with low levels of sanitation and hygiene. There is no vaccine. More than 60% of all hepatitis E infections and 65% of deaths occur in East and South Asia. Read more about the virus and how to prevent it.

Papua New Guinea: Response to polio underway

Response activities planned by the WHO to address the outbreak of circulating vaccine-derived polio virus in a district of Lae include widespread monitoring of non-polio Acute Flaccid Paralysis (AFP) cases and the collection of stool samples from contacts of AFP cases. Surveillance will be more intense in the highest risk provinces of Morobe, Madang, Eastern Highlands Province, Jiwaka, Chimbu, Western Highland Province and National Central District. Read more from ReliefWeb. The government plans to increase polio vaccination rates from 30 to 80 percent by the year 2020. Read more

Philippines: Manila’s dengue spike

Compared to the first six months of 2017, this year in Metro Manila there have been 1,500 more dengue fever cases, with 7,200 infections recorded up to July 7. The rainy season extends from June until the end of October. Read more

Reunion Island: Dengue cases near 6,000

Local and regional authorities have raised the level of response to the dengue epidemic (now categorised as Level 4 - moderate intensity) with efforts planned for the control of the virus during the cooler months. For the year to July 10, there have been 5,970 dengue fever cases – over 3,000 of those from the large municipality of Saint-Paul. Read more (in French). In a European Centre for Disease Control (ECDC) assessment on the risk of spread to southern EU areas with the competent mosquito species, the agency notes ‘vector abundance is currently considered sufficient to permit autochthonous transmission of dengue virus and potentially generate local outbreaks’. The ECDC recommends travellers heading to dengue fever-affected regions use mosquito bite avoidance measures, doctors should be aware of the potential for dengue cases in returning travellers, and travellers must report ‘symptoms compatible with dengue fever in the first two weeks after return’. 

Saudi Arabia: June MERS update; Dengue in Mecca region

Another four MERS Co-V cases were reported in June and one succumbed to the infection, according to the WHO situation update for June. The update also notes that the ‘age group 50–59 years continues to be at highest risk for acquiring infection of primary cases’. Read the June situation update here
THREE cases of dengue fever have been confirmed in the city of Al-Taif city, Al-Taif Governate (Mecca region). Read more 

Sweden: Frozen fruit hep A risk

Frozen strawberries imported from Poland have been identified as the source of 13 confirmed or suspected hepatitis A cases reported in the counties of Skane, Blekinge, Kalmar and Gavleborg. A recall of the products, sold by a wholesaler and used in smoothies or desserts by caterers or restaurants, is under way, however the risk of new cases appearing remains as some of the product may still be in the marketplace and hepatitis A infection has a long incubation period – ranging from 15 to 50 days, but averaging 28 days. Read more 

Switzerland: Tick season’s hike in related infections

The incidence of tick-borne encephalitis (TBE) infections has climbed sharply this year. The Federal Office of Public Health reported 73 early-summer meningoencephalitis infections last month alone, a significant increase from 46 to 109 cases per year for the period 2000-2017. But TBE is not the only tick-borne disease occurring in areas of the country below 1,500metres, there have also been 6,900 cases of Lyme disease. Vaccination against TBE is recommended for residents of TBE endemic areas, and for those visitors who plan activities that put them at risk of tick bites. 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. VACCINE: 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.

Uganda: Changes to proof of vaccination

Four African countries have been added to the list of WHO state members requiring mandatory proof of yellow fever vaccination at entry; the others are Cameroon, Chad and South Sudan. The UK’s National Travel Health Network and Centre website travelhealthpro lists the main changes to the yellow fever vaccination requirements for all countries in 2018. Read more 

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

United Kingdom: Bacterial infection strikes

There has been plenty of publicity about the spread of measles in England resulting from travellers returning home from EU countries reporting large outbreaks, but Public Health England is also highlighting a steep rise in scarlet fever infections, with almost 27,000 cases for the year. Read more

Advice for travellers: A mild bacterial infection, scarlet fever generally causes strep throat or, less commonly, streptococcal skin infections. It affects people of any age, but is most common among children. The classic symptom is a sandpaper-like red rash. Scarlet fever is treatable with antibiotics which helps clear up symptoms faster, reduces spread to other people and prevents rare but serious long-term health problems. Read more on scarlet fever.

Vietnam: Capital’s measles threat

Measles cases reported in the capital Hanoi have reached 200 this year, which is 140 more than the total for 2017. At the end of last year there were concerns of a looming outbreak due to the large cohort of unvaccinated children. Read more