Health Alerts
Angola: Rabies vax shortfall

In the southern province of Cunene de Janeiro a lack of rabies vaccines is forcing people with potentially rabid dog bites to travel across the border into Namibia in order to source the life-saving treatment. Nine people died from rabies infections in early July in the province. Read more

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 – especially dogs, the main source of infection. If bitten, urgent post-exposure treatment is required. Vaccination recommendations are itinerary-specific but include those travellers planning to live in, or travel extensively or repeatedly through, endemic countries. Read more on rabies

Bahamas: Gastropod causing gastro illness

A bacterium from the Vibrio family, related to cholera, has sickened up to 40 people on the island of New Providence (location of the capital Nassau), after they consumed improperly prepared conch meat. According to the US Centers for Disease Control & Prevention (CDC): ‘Vibrio bacteria naturally live in certain coastal waters and are present in higher concentrations between May and October when water temperatures are warmer. Read more
The European Centre for Disease Control (ECDC) monitors and reports on ‘estuaries and enclosed water bodies with moderate salinity’ in the region over the warmer months, providing locations with current ‘environmental suitability for Vibrio growth in the Baltic Sea’. Read the latest report here

Cambodia: Cycle of dengue

Dengue fever cases increased more than two-fold in the first half of the year compared to 2017, and dengue related deaths also climbed, up from one last year to seven. The rainy season has hit now and infection rates are rising faster, but health ministry officials are not declaring an alert as yet. 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.

Central African Republic: Monkeypox outbreak continues in SW

Described by the WHO regional office as an annual occurrence, the outbreak of monkeypox, now in its fifth month, continues with the most recent cases in the SW district of Mbaïki. Two other southern districts have reported cases this year: Bambari and Bangassou. Read more

Advice for travellers: Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox

Costa Rica: Hep A source unknown

Authorities are investigating a number of hepatitis A cases in an eastern district of the capital San José. A public awareness campaign focusing on preventing further spread of the viral infection is being carried out in the canton of Goicoechea. 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.

Democratic Republic of Congo: New Ebola outbreak in east

A new outbreak of Ebola virus disease (EVD) has been declared in the province of Nord-Kivu, on the opposite side of the country to Equateur, the location of the outbreak declared over last week. Authorities were notified on July 28 of 20 deaths resulting from 26 cases of haemorrhagic fever; testing on six of the cases gave positive findings to Ebola virus from four samples. A team of experts from the DRC health ministry is being sent to the area to organise the necessary response. In the health minister’s press release (in French), it is noted that EVD is endemic in many equatorial forest regions of the country.

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.

El Salvador: Typhoid uptick in most areas

Four of the country’s 14 departments (San Miguel, San Salvador, La Paz & Sonsonate) have experienced a surge in typhoid cases in the first six months of the year compared with the same period last year - up to 937 from 675. All provinces apart from Cabañas, a mainly agricultural region in the north, have reported the increase. 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.

Europe: West Nile season underway

Concerning the current situation on West Nile Virus (WNV), the ECDC notes that ‘the 2018 transmission season started earlier than usual and higher case numbers have been reported compared with the same period in the previous years’. It goes on, ‘as of 26 July 2018, 56 human cases have been reported in EU/EEA Member States by Greece (22), Italy (24), Romania (5) and Hungary (5). Forty-one human cases have been reported in EU neighbouring countries, all by Serbia, including three deaths'. Read more. A UK news site reports on ten of the WNV cases in Italy, in the NE region of Veneto, including towns and cities near Venice and this week two additional cases have been reported in Central Macedonia, Greece. Read more. In the USA, the CDC monitors outbreaks of WNV each year. See current surveillance data here

Advice for travellers: Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuro-invasive disease. The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites

India: Disease counts generally lower; Vaccine import ban, recall

There’s been a much slower start to the peak season for mosquito-borne infections in New Delhi compared to last year – the cumulative total of cases for 2018 sits at: malaria 88, dengue 49, and chikungunya 35. Telangana’s capital Hyderabad is reporting fewer malaria cases this year, but dengue and chikungunya infections have increased by more than two-fold. There’s been a decline in some common monsoon season infections (dengue, chikungunya) and an increase in others that are less typical (leptospirosis, Japanese encephalitis) in Kozhikode, Kerala state. While in Maharashtra, chikungunya case numbers are lower than in 2017, but one local doctor has pointed out that testing is more likely to be carried out on suspected dengue fever cases, resulting in fewer chikungunya infections reported. In a new development, babies under one year of age in the city of Pune are being diagnosed with dengue fever – according to doctors, this is a sign of more mosquito vectors in the community. Read more
A CHINESE company’s safety protocol breaches in the production of rabies vaccines have led to a ban on its importation by the drug controller general. After an investigation to determine how many doses of the vaccine have been distributed in both private and government centres is completed, a recall will be announced. Rabies vaccines used in India are both locally produced and imported. 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.

Iran: Tick-borne infection kills 7

Deaths from the tick-borne infection Crimea-Congo Haemorrhagic fever (CCHF) have increased this (Iranian calendar) year, reaching seven – from 56 cases. Most of those who succumbed to the infection had compromised immune systems caused by pre-existing medical conditions. CCHF is endemic in Iran. Read more

Advice for travellers: CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

Malaysia: Dengue, HFMD updates

More than one half of all dengue fever cases and one quarter of dengue-related deaths have been recorded in the state of Selangor this year. Residents have been urged to monitor their local environment for anything that could become a mosquito breeding site. Read more. See dengue counts across all states here. At a meeting to discuss the dengue fever situation, the health minister also commented on the extensive hand, foot and mouth disease (HFMD) outbreak affecting most states; the greatest effect has been felt by Selangor which has reported over 11,000 cases (from a national total of almost 41,000 on Aug 1). 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.

Mexico: Duo of mosquito-borne infections in Jalisco

The mosquito-borne infections, dengue fever and Zika virus, are in the news in the Pacific coastal state of Jalisco. Overall numbers are down, but authorities are urging residents to remove mosquito breeding sites. Both infections have been reported in the main tourist centre of Puerto Vallarta as well as several inland towns. 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).

Pakistan: Virulent typhoid’s victims mainly kids

Children under 10 years of age in the cities of Karachi and Hyderabad have been most impacted by infections caused by multi-drug resistant strains of typhoid fever. In a news article, a local paediatrician disclosed that ‘thousands of children have been infected’ in Karachi. Read more

Philippines: Dengue, chikungunya news

In the northern archipelago province of Batanes, authorities are requesting top tier governmental assistance to deal with a dengue fever outbreak that has caused two deaths so far. Read more. On the island of Panay, the incidence of dengue fever has risen this year - the capital Kalibo, Batan and Altavas have recorded the highest figures. Read more. And in the province of Biliran, chikungunya cases have surged in Maripipi. 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.

Reunion Island: Weekly dengue case numbers decline

Just under 60 new dengue fever cases were confirmed in the most recent reporting week - a decline from previous weekly totals was expected due to the cooler winter temperatures. The year-to-date situation in this extensive outbreak: 6,345 cases (134 required treatment in hospital) with most from the western and southern districts. Vector control measures will be carried out this month in Le Port, Saint Leu, La Possession and Saint-louis. Read more (translate from French). 

Taiwan: JE cases climb to over 30

Japanese encephalitis infections in the 2018 season have risen to 31 with the notification of a recent case, the first for the year, in Yunlin County. While most Taiwanese residents have been vaccinated against JE, the latest case was not. He had an additional risk factor, also present in several other recent cases: pigs housed nearby. Read more

Advice for travellers: On average, 24 cases are recorded each year in Taiwan, mainly in the south from May to October, but peaking in June and July. Cases typically occur in rural, rice-growing areas where people live near the host animals, pigs and wading birds. While it is a low risk for most travellers staying in urban areas, expats and travellers spending extended periods in agricultural areas of Asia should consult their travel doctor about recommendations for vaccination. Read more about JE.

United Kingdom: ‘French letter’ recall

Several batches of two brands of latex-free condoms have been recalled in the UK, Ireland and Australia due to concerns they may split if used near their expiry dates (between late 2020 and early 2021). Read more

United States of America: Mumps cases top 1,000

Since the first cases of vaccine-preventable mumps infections were reported in Hawaii in March last year, over 1,000 cases have been recorded in the state. The health department states that around 60 percent of cases are in the 18+ years’ age group and ‘32 reports of complications due to mumps infection (e.g., orchitis, hearing loss)’. Most confirmed cases have been in Honolulu (813) - other affected counties are Hawaii (134), Kauai (49) and Maui (7). 

Advice for travellers: These consequences of mumps outbreaks 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.

Vietnam: Measles threat in north; Dengue cases mount in HCMC

With the memory of a 2014 measles outbreak that killed 14 of the 1,700 individuals infected, doctors in the capital Hanoi have warned the current surge in cases could foreshadow a much larger outbreak if the large cohort of unvaccinated children is not immunised. Read more
A RISE in the incidence of dengue fever cases is expected in Ho Chi Minh City with the onset of the rainy season. While there have been fewer cases this year, a senior doctor puts the weekly number of people requiring hospitalisation for dengue at between 350 and 450. Read more

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.