Health Alerts
Brazil: Unusual malaria cases in south; Measles kills 5

In the towns of Vila Pavão and Barra de São Francisco in NW districts of Espírito Santo state, as many as 106 malaria cases and one death have occurred in just over a week. Testing has revealed Plasmodium falciparum to be the malaria type causing the infections and as this is not the predominant malaria parasite in the state (P. vivax), doctors are assuming that onward transmission occurred at a local level from an imported case. Read more (translate from Portuguese). 
THE DEATH toll from measles infections in the states of Amazonas and Roraima has reached five, while there have been a total of 1,100 confirmed cases and over 5,600 more are under investigation. A vaccination drive has been initiated across the country, targeting measles and polio. Read more

Advice for travellers: Malaria is considered a risk for western states in the Amazon basin, rare cases occur in rural areas of several others. Travellers visiting Brazil should discuss their itinerary and the required and recommended vaccinations and medications during a pre-travel medical consultation. For details call 1300 360 164. Read more about malaria

Democratic Republic of Congo: NE Ebola situation report

By the latest count, there have been a total of 44 Ebola virus disease cases (17 confirmed, 27 probable & 47 suspected), including 36 deaths in the new outbreak areas of the (neighbouring) provinces of Nord-Kivu and Ituri. While the Zaire outbreak strain of Ebola virus is the same as in Equateur province, testing has not shown a close genetic link. Preparations have already been underway ahead of the start of the ring vaccination campaign which begins today. The logistics of this outbreak are made worse as the affected region is the site of a longstanding conflict with a large population which includes many internally displaced people travelling through seeking shelter in nearby countries. Read more 

Advice for travellers: Despite the latest development, the risk of Ebola infection for travellers is still considered to be low. A severe viral haemorrhagic fever found in humans and other primates (such as monkeys, gorillas, and chimpanzees), Ebola spreads through families and friends because they come in close contact with blood and infectious secretions when caring for ill persons. Read more about Ebola virus disease.

Europe: Spate of viral infections

A rise in Echovirus 30 enterovirus infections occurring in Denmark, Latvia, the Netherlands, Norway, Sweden and the UK is mentioned in the latest ECDC Communicable Disease Threats Report. The mostly faecal-orally transmitted virus causes an aseptic meningitis which lacks a specific treatment, only supportive measures are used. As noted by the ECDC, prevention includes: ‘High hygienic practices such as frequent hand washing, avoidance of shared utensils, bottles or glasses and disinfection of contaminated surfaces (e.g. with diluted bleach solution) are recommended to prevent the spread of E30 from person-to-person.’ Read the ECDC report here.

India: Nipah outbreak summary; Food & water-related illnesses; Insects prevail

From a summary published by the WHO on the May/June Nipah virus (NiV) outbreak in Kerala: 19 confirmed cases and 17 deaths were recorded in the districts of Kozhikode and Malappuram. Although there have been no further cases and ‘no evidence of NiV infection in humans in Kerala State,’ surveillance is to be continued. ‘NiV infection can be prevented by avoiding exposure to bats and sick pigs in endemic areas, and by avoiding consuming fruits partially-eaten by infected bats or drinking raw date palm sap/toddy/juice.‘ 
CASES of the food and water-borne viral illnesses, hepatitis A and E, are surging in Nagpur, the winter capital of Maharashtra state. Despite the rise, the current outbreak is not considered an epidemic due to the increased incidence reported each year during the monsoon season. Read more
REPORTS of mosquito-borne infections this week came from Kerala, Jaipur in Rajasthan, Karnataka and Assam, where more than 220 of the country’s provisional count of 523 Japanese encephalitis (JE) cases have been reported. Read more

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

Ireland: Measles risk for the masses

People, both young and old, are advised to check their vaccination status before attending a large outdoor mass during the Pope’s visit to Dublin later this month. There are concerns that local and imported cases of measles, influenza and other pathogens could spread within the large audience, expected to be around 500,000. 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.

Kiribati: Dengue numbers on the decline

The dengue fever outbreak that started in February is gradually settling after having produced more than 1,700 cases. A ReliefWeb report on the region also notes that the spread of dengue fever continues in Wallis and Futuna. 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.

Malaysia: HFMD outbreak continues

More on the hand, foot and mouth disease outbreak affecting most states, with Sabah recording more than 400 new cases over the past week, and a further 230 cases in the peninsular state of Negri Sembilan.

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.

Mexico: Food-borne parasite persists

UK health authorities are warning of yet another summertime rise in the incidence of the food- and water-borne parasite, Cyclospora, in travellers to Mexico. Most of the cases (46 of 57 cases) stayed in all-inclusive hotel accommodation in two popular areas of the Yucatan Peninsula: Cancun and the Riviera Maya. Infection usually occurs through consuming foodstuff contaminated with human faeces containing the parasite. Read more 

Advice for travellers: A single-celled coccidian parasite, Cyclospora cayetanensis may be a risk for travellers to tropical or subtropical regions where it is found. The microscopic parasite causes watery diarrhoea, nausea, anorexia, abdominal cramps, weight loss and, occasionally, fever that can last for several days – and reoccur - if not treated effectively. Most cases result from consuming food or water containing the parasite, or swallowing contaminated water while swimming. Fruits and vegetables such as raspberries, basil and lettuce washed with contaminated water are common culprits, especially those imported from developing nations. Read more about Cyclospora.

Namibia: Hep E toll now 20

Oshana, in the country’s central-north, is the fourth region with an outbreak of hepatitis E, but another six regions have reported sporadic infections this year. A regional WHO statement announced 2,435 suspected Hep E cases and 20 deaths up to July 29 – around half of those were pregnant women or post-delivery (a high risk category for complications of the infection). Almost 80 percent of cases have been from informal settlements of the capital, Windhoek (Havana and Goreangab). Read more 

Advice for travellers: The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Infection during the latter stages of pregnancy carries a higher rate of severe disease and mortality. 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. Read more about the virus and how to prevent it.

Nepal: Sand flies and chiggers carrying infections

Four deaths from 127 confirmed cases of Kala-Azar, or visceral leishmaniasis, have been recorded in residents of Kathmandu, Palpa, Jumla and Bajura this year. Read more. Palpa is also named as one of the affected areas in a report on scrub typhus - over the last two months there have been more than 100 cases from across 27 districts. Read more

Advice for travellers: Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

Papua New Guinea: New polio case - in central province

A third case of circulating vaccine-derived poliovirus (cVDPV) has been identified and it’s in a different province to the two earlier infections. According to the World Health Organization (WHO), ‘the new case is genetically linked to the other two cases from Morobe Province’. The 3 year-old child, from Laigam district in Enga province (approx. 130kms NW of Mt Hagen), became ill in late June and suffered paralysis on July 2nd. The WHO expanded on the case by noting his ‘vaccination history is unknown due to unavailability of the baby clinic book, and his travel history is being established.’ Risk of further spread is high due to low vaccination coverage in many provinces. Read more
Local and international health agencies are managing human cVDPV type 2 infections and positive environmental samples in several Nigerian states. The WHO recommends full polio vaccination for travel to and from affected countries. 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, however 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 poliomyelitis

Philippines: Rise in dengue noted for half-year

Year-on-year there has been a modest increase in dengue fever cases at a national level – up by over 1,600 cases to 62,000, according to the health minister. Ilocos Norte has reported substantial rates of infections, while in the province of Biliran, there has been a surge in chikungunya cases. Read more 

Saudi Arabia: WHO: MERS summary published

The WHO has published an extensive summary on MERS Co-V, noting there had been 189 more cases since the last update in July 2017. The report outlines the need for more information on ‘how humans become infected from animal or environmental source(s) in the community [and] identification of risk factors for infection from humans or the environment in occupational settings and health care settings’. 

South America: Scattered patterns of flu activity

From the latest global flu update: Chile and Paraguay are reporting increasing influenza activity and in Peru there has been a drop in new cases but the situation is still regarded as ‘elevated’. Activity is generally below seasonal thresholds in Oceania with the exception of Western Australia where activity is trending upwards - ‘Influenza A(H1N1)pdm09 was the most frequently detected virus’. 

Advice for travellers: Seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol wipes are a convenient alternative if soap and water is not available. Read more

Taiwan: More local dengue cases

More dengue fever infections have been identified in a cluster of cases occurring in New Taipei’s, inner city district of Xinzhuang. One person classified as a recent infection resides approx. 500 metres away from previous cases, while in Taipei itself, a new case has been identified in Neihu District. Read more 

Thailand: Dengue cases in seasonal climb

Following the pattern of every rainy season, dengue fever reports are on the rise, however this week a senior government minister stated that ‘the epidemic was at a high level from the beginning of the year’. Read more. Cases of more severe dengue disease – dengue haemorrhagic fever (DHF) – were highest in Phichit, Nakornpathom and Phuket. Read the current reports for dengue fever and DHF from the Bureau of Epidemiology.