Health Alerts
Botswana: Diarrhoeal illness kills 38 children

Rotavirus is believed to be responsible for a large outbreak of diarrhoeal illness among children that started in September. To date 38 children have died and 30,000 cases recorded. A senior health official stated that the peak of the outbreak was in mid to late September and only three of the 28 affected districts continue to report cases - Jwaneng, Gaborone and Chobe. Read more. More about rotavirus infection from healthdirect.gov.au

Chad: Alert on measles epidemics

A measles outbreak occurring in 11 provinces is now into its ninth month and has killed 79 people from over 3,000 suspected infections; epidemics have been declared in 41 health districts. 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.

Democratic Republic of Congo: New hot zone in Ebola outbreak, Uganda vaccinates frontline HCWs

Ebola virus disease (EVD) cases in a new health zone and another chain of transmission to follow are two more barriers in the control of the outbreak in North Kivu and Ituri provinces. The US CDC Director has warned that this outbreak may not be contained, leading to EVD becoming endemic in the region. The current situation can be found in the DRC Ministry of Health report here. Ebola vaccines are to be supplied to Ugandan healthcare workers, particularly those that would be in a front line position in the event of a local EVD case arising from the outbreak in the neighbouring DRC. Read more

Advice for travellers: Ebola Virus disease 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.

Egypt: Clean-up campaign for Red Sea resort hotels

Hotels in the popular diving resort town of Hurghada on the Red Sea are to have their hygiene standards assessed in the wake of the deaths of two tourists from the UK. According to Egyptian authorities, the couple died from E.coli infections in August while staying at a local hotel. Read more

Ethiopia: Yellow fever in SW

A yellow fever (YF) vaccination campaign has been carried out in the districts of Gamo Gofa and Wolaita in the SW Southern Nations, Nationalities, and Peoples region following the reporting of 35 suspected YF cases and 10 deaths since late August. The WHO regional office situation assessment notes that the ‘outbreak is of concern since the population of Ethiopia is highly susceptible to yellow fever due to absence of recent exposure and lack of large-scale immunization’. Inclusion of the YF vaccine in the routine immunisation schedule is not planned until 2020. 

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

India: Zika cases identified in third state; Delhi’s toxic air; Dengue in Punjab

The number of Zika virus cases in Rajasthan has risen to 159 and surveillance activities continue, however the focus is now on the state of Madhya Pradesh where eight Zika cases have been found, including in the capital Bhopal and two nearby districts, Sehore and Sironj. Madhya Pradesh lies in central India and is adjacent to the two states also reporting Zika – it is SE of Rajasthan and east of Gujarat. Read more
THIS WEEK Delhi’s air pollution has peaked at 20 times recommended levels (as dictated by the WHO) and are set to worsen during the upcoming festival of Diwali. In the past, the firecrackers that are set off during the Hindu celebration exacerbate pollution levels, so this year authorities are limiting the times of use for the fireworks. Read more. See Delhi’s real time Air Quality Index here.
CHILDREN have been hardest hit in a large outbreak of what is suspected to be dengue fever in the NW state of Punjab. The sudden increase to more than 5,000 cases has occurred in the city of Kotkapura. 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).

Israel: Measles count exceeds 1,300

The 2018 national measles case count has now exceeded 1,300 with over half in Jerusalem’s ultra-Orthodox communities, known to have low immunisation rates. The country’s first measles-related death in 15 years occurred last week in an unvaccinated young child from Jerusalem. Read more. An outbreak of measles in New York State, USA is believed to have stemmed from infected (unvaccinated) travellers returning to the US from Israel (and the Ukraine). Read more

Japan: Rubella outbreak nears 1,700 cases

The German measles (rubella) outbreak continues with 100 or more new cases per week reported over the past two months and there are now concerns that cases could continue to emerge during large upcoming sporting events, such as next year’s Rugby World Cup. In the most recent reporting week (week 43), a total of 170 cases were reported from Tokyo (60), Kanagawa (24), Chiba (19), Osaka (7) and Fukuoka (6). The National Institute of Infectious Diseases (NIID) is urging women planning pregnancy and their close contacts to ensure they are vaccinated; this advice is reflected in a US CDC travel notice for anyone heading to Japan. 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.

Madagascar: Measles in capital region

Measles vaccinations are to be carried out in the capital Antananarivo as well as in the neighbouring districts of Avaradrano, Atsimondrano and Ambohidratrimo after a large number of suspected measles cases were reported – over 1,000 in one location alone. Read more. While in Mauritius the case count has now risen to 1,226 and many of those infected are aged 20 to 49 years, followed by young children under four. New cases appear every day and so a vaccination campaign is planned targeting the adult cohort. Read more

Malawi: Suspected typhoid in north

Typhoid fever is assumed to be the cause of ‘some’ hospital admissions and related deaths in Mzuzu in the country’s north - the source of the illnesses is still unknown. The city is described as the gateway to Lake Malawi. 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 against typhoid fever is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices.

Papua New Guinea: Added measures to tackle polio

As reported by the GPEI, new polio cases in the provinces of Jiwaka, Gulf and Southern Highlands take the total number of cases of vaccine-derived poliovirus to 21. A fourth round of polio vaccinations is planned as part of the response to the outbreak, with completion due early next month. All details of the response are outlined in an ifrc.org update. In other polio news this week (from a local news source), four children aged from five to eight years from the district of Mastung in NW Balochistan province, Pakistan, have become the country’s latest cases for 2018, taking the total to 10. 

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 and vaccine-derived polio

Peru: Mosquito-borne virus alert; Measles in south

With conditions considered ideal for the transmission of viral illnesses transmitted by the Aedes aegypti mosquito (i.e. dengue fever, Zika virus and chikungunya), a health emergency has been declared in the SW province of Madre de Dios. The initiative will allow the government to employ measures ‘to provide the necessary health services and protect public health’. Read more
OVER 70 suspected measles cases have been reported in the neighbouring province of Cusco; the national health agency (MINSA) is planning a vaccination campaign in response. 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. 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.

Spain: Local dengue cases updated

Updated information on the locally-acquired dengue fever infections reported last month brings news that two other cases with identical sequencing have since been recorded in Murcia and the region is now considered to be the origin of all five infections. Read more

Sri Lanka: Dengue risk rising

Recent rains are likely to boost the number of dengue fever-carrying mosquitoes with the health ministry warning that ‘the density of mosquito larvae has significantly risen in the Western, Wayamba, Nothern and Eastern provinces’. The year-to-date total of dengue fever cases is 41,000 and 45 deaths. Read more

United Kingdom: Hep A spike among homeless, drug users

Bearing similarities to the hepatitis outbreak occurring in several US states since last year, the Middlesex-London Health Unit has advised that 15 non-travel related hepatitis A cases have been reported since the start of October ‘mostly among under-housed or homeless Londoners, and those who inject drugs’. On average, the unit reports ‘about three cases of hepatitis A per year, most of them travel-related’. Read more

Advice for travellers: Vaccine-preventable Hepatitis A (HAV) is one of the most common infections affecting travellers. It is a significant risk in most developing countries where sanitation and hygiene are lacking, with an estimated 1.4 million cases occurring worldwide each year. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and with some sexual practices. A course of hepatitis A vaccine offers immunity that’s 99%-plus effective and long lasting (20-30 years). It is also important to follow safe food and water guidelines.

Zimbabwe: Cholera situation easing

New cholera cases have dropped by almost 70 percent in the most recent reporting week, part of the 6-week ‘downward trend’ - 59 more infections were reported in Harare for the last full week of October. In the same UNICEF report on cholera in Eastern and Southern Africa, in Tanzania an ‘increase in the epidemic trend has been noted… All new cases emerged from Ngorongoro district in Arusha region’.

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. For general advice on vaccination options for your trip, call Travelvax Australia’s travel health advisory service (1300 360 164).