The Travel Doctor TMVC Health Alerts

Rabies on Bali update

Fri, 3 September 2010 09:30:00 +1100

The rabies situation in Bali does not appear to be improving.

The total number of deaths officially reported since the outbreak began at the end of 2008 is now 78. So far no tourist has been involved. The number of dog-bites has increased steeply in the last several months; 36,000 dog-bite incidents in Bali so far this year, this compares with 24,000 for the whole of 2009.

Travellers to Bali should be aware of the rabies risk, and the frequent lack of rabies immunoglobulin (used for treatment following a bite) on the island as well as a shortage of rabies vaccine. Rabies pre-exposure vaccination may be considered. This will require three vaccinations over a period of a month before travel. Animal contact should be avoided. If bitten the wound must be immediately cleansed preferably with antiseptic . If already vaccinated booster vaccination is still required but there is time to arrange this. If bitten and not vaccinated immunoglobulin plus vaccination is needed and when there is doubt about the supply immediate evacuation to Singapore or Australia should take place.

Malaysian Parks Closed Following Fatal Infections

Tue, 24 August 2010 09:30:00 +1100

Malaysia has closed parks and warned the public about swimming and dumping trash in rivers after up to 10 people died from a disease spread by rats. Several parks throughout the country have been closed since the first deaths were reported last month. The latest reported death from the bacterial disease leptospirosis was Saturday, 21st August. The 17-year-old boy in northern Kedah state had swam in a river and had a picnic with friends at a recreational park last month.

Health officials said the number of leptospirosis deaths has more than tripled in the past six years with 20 deaths in 2004, 62 deaths last year and 95 deaths between January 1 to August 15 this year. The recent spate began in July when eight people, who were among a search and rescue group looking for a drowning victim in a recreational area in eastern Pahang state, died of the disease and another water-borne bacteria.

Leptospirosis, which produces fever, vomiting, severe muscle aches and headaches, is mostly spread through the urine of infected rats, which can contaminate water in lakes and rivers, but also in flooded areas and wells. Infection is acquired by swallowing contaminated water or through open cuts or abrasions in the skin.

Plague in Peru

Mon, 16 August 2010 09:30:00 +1100

As of 30 July 2010, the Ministry of Health in Peru confirmed a total of 17 cases of plague in Ascope province of Department La Libertad. The onset of symptoms for the last reported case of pneumonic plague was on 11 July 2010. During the investigations strains of Yersinia. pestis the plague organism were isolated from humans, rodents and domestic cats. The World Health Organisation is working with the Ministry of Health in assisting La Libertad with the outbreak investigation and response activities in affected areas and the surrounding districts.

Plague is transmitted usually by flea bites Ascope in La Libertad province is in the coastal jungle area of northern Peru and has not been a tourist destination, but it is wise for anyone entering visiting remote villages to use insect repellent regularly.

Dog vaccination plans for Bali

Mon, 9 August 2010 09:30:00 +1100

Since the first case of rabies on Bali was reported at the end of 2008 there have been over 70 deaths in the epidemic, the latest report being of a 43 year old Balinese woman who died on 3rd August. Indonesian authorities have announced plans for vaccinating the island’s dogs deploying about 200 teams in 700 villages. Starting in late September they hope to vaccinate all dogs by the end of the year. Culling of stray dogs is already taking place but this strategy has been criticised by world health experts as likely to be ineffective and vaccination is much more likely to achieve control.

Some media reports have given dramatic accounts of the horrendous nature of the disease and such reports are not exaggerated. Rabies is a vaccine preventable disease but because the vaccine is expensive and requires a series of three inoculations over the period of a month few tourists are being vaccinated. The supply of vaccines on the islands is unpredictable because of the demand so reliance on getting effective treatment after a bite is a dubious proposition. Until the epidemic is finally brought under control travellers to Bali must give serious thought to vaccination against rabies.

For further information on rabies see the Fact Sheet on this website.

Disease carrying mosquitoes found in the Netherlands

Wed, 4 August 2010 09:30:00 +1100

The English language newspaper and website DutchNews has reported that three species of tropical mosquitoes capable of transmitting yellow fever, dengue fever or West Nile fever have been found in Brabant province. One of these, the tiger mosquito (Aedes albopictus), has become established in the Mediterranean coast of Europe, and as climate change occurs, is predicted to spread farther north.

All 3 species can breed in water in tires, and eggs can be transported in them to other continents in shipments of tires. Dutch public health authorities are aware of the danger and have been stepping up inspections of other possible sources of imported mosquitoes such as bamboo since 2006, and warning residents in affected areas.

Measles in Greece

Mon, 2 August 2010 11:30:00 +1100

Measles is still present in Europe, causing severe complications and deaths in children. Despite a large decline in measles incidence in the past decade, the World Health Organization (WHO) target to eliminate measles in Europe by 2010 is unlikely to be reached. A measles outbreak with more than 20 000 reported cases has been taking place in Bulgaria since April 2009, and clusters of cases have been reported from several countries in Europe - Poland, Slovenia, Ireland, Italy, Germany - in 2009 and 2010.

Overall, measles incidence has been steadily declining in Greece during the past 25 years, but this year 126 measles cases have so far (by July 25th ) been reported to the Hellenic Centre for Disease Control and Prevention through the mandatory notification system (rate 1.1 cases per 100 000 population). Although most of the cases have occurred in the Roma population there have been many cases in the non-minority group where the disease has affected young adults rather then children.

Travellers from Australasia should confirm that they have had the recommended two mumps-measles-rubella vaccinations. If there uncertainty it is worthwhile having a blood test or having a booster dose, bearing in mind also that the vaccination was introduced into Australia only in 1980.

Mumps by the sea – UK update

Tue, 27 July 2010 10:00:00 +1100

Health Officials have predicted a rise in the number of mumps cases during the summer months in Brighton and Hove as thousands of holidaymakers and daytrippers visit the area. There have been 112 confirmed cases across the county of Sussex so far in 2010; this compares with 139 for the whole of 2009. The worst affected area of the county is Brighton and Hove with 52 cases. East Sussex has 39 cases and West Sussex 21 cases.

Source: http://www.fitfortravel.scot.nhs.uk/news/newsdetail/3018.aspx

Travellers from Australasia should confirm that they have had the recommended two mumps-measles-rubella vaccinations. If there uncertainty it is worthwhile having a blood test or having a booster dose, bearing in mind also that the vaccination was introduced into Australia only in 1980.

Rabid Cow Attacks Crowd in Goa, India

Thu, 22 July 2010 11:00:00 +1100

The Herald newspaper published in Goa, India carries the report that 15 people were attacked and injured by a cow at a bus stand in the outer Goa suburb of Bicholim a week ago. The cow has subsequently been found to have rabies. Apparently the cow had been bitten by a rabid dog though the report does not give the time interval between the bite and the cow’s symptoms.

There are some 20,000 deaths from rabies annually in India. Although the virus is mostly carried by dogs this report highlights the fact that any mammal is capable of transmitting the disease and all bites or even scratches that break the skin must be regarded as potentially rabid and, after cleansing of the wound, medical attention must be sought.

Dengue update Caribbean and Central America

Thu, 15 July 2010 13:00:00 +1100

The dengue fever virus is continuing to circulate in the Caribbean and Central American region at a high level. For example the President of the Dominican Republic College of Physicians has requested the Minister of Public Health to ask the President to declare a state of emergency in face of the overwhelming number of cases.

The high incidence of dengue in Honduras has seriously impaired the ability to care for the sick in public and private hospitals, and in the Honduran army an average of 50-60 troops on a weekly basis are obliged to be relieved from duty after showing symptoms of dengue. Puerto Rico's top health official has warned that the US island could face its worst-ever dengue fever outbreak if people don't act quickly to destroy breeding areas for disease-spreading mosquitoes.

In Venezuela the Ministry of Health has reported that dengue cases climbed 81.8 percent this year. Taken with previous reports and concurrent reports from Brazil and other South American countries it is clear that dengue poses a significant threat in the entire region and travellers must ensure that they take every possible precaution to prevent being bitten by mosquitoes.

Sensible Precautions for Delhi Commonwealth Games

Wed, 14 July 2010 13:30:00 +1100

For any travel to India it is wise to be fully vaccinated against the food-borne diseases Hepatitis A and Typhoid Fever, and immune status for tetanus, polio, measles and chicken pox should be checked. More detailed advice on these and other vaccinations plus reminders about malaria and dengue fever can be found on the India Destination Sheet available on the Traveldoctor website. It is also very important to consider vaccinating against influenza.

Early October is a high risk time for seasonal influenza in Delhi according to the records, and the Pandemic H1N1 flu is still circulating currently in parts of India although at a low level; but it is reasonable to assume that a mixture of the seasonal and pandemic forms of flu will pose a very real threat to visitors to the Games. We strongly recommend that if, not already vaccinated this year, all intending participants and spectators going to the Commonwealth Games 2010 be vaccinated with one of the Influenza vaccines currently available in Australasia.

Avian influenza Indonesia new human case

Mon, 12 July 2010 09:30:00 +1100

5 July 2010 -- The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 34-year-old female from South Jakarta District, DKI Jakarta Province developed symptoms on 25 May, was hospitalized on 27 May and died on 1 June. Laboratory tests were positive for H5N1 virus infection. The case was possibly infected from environmental exposure to manure in her plant nursery.

Of the 166 cases confirmed to date in Indonesia, 137 have been fatal.

Dengue fever Bali update

Fri, 2 July 2010 12:30:00 +1100

Health authorities are warning that Denpasar remains under threat from Dengue and dengue haemorrhagic fever, the serious and sometimes even fatal form of the mosquito-borne disease. This season's dengue outbreak in Bali is the worst in years because extended rains have left a lot of standing water around Denpasar. While the official rainy season had ended this did not mean mosquitoes are no longer a threat. Sanglah Hospital, the chief treatment centre for serious cases, continues to remain busy with dengue patients.

Since there is currently no vaccine against dengue fever prevention is dependent on personal anti-mosquito measures as outlined in our Fact Sheet on Insect Avoidance Measures.

Raw Pork Alert in Thailand

Wed, 30 June 2010 12:00:00 +1100

An alert has been issued by Thailand health authorities in Phetchabun province because of a number of fatal cases of human infection by an organism which causes pig disease. Streptococcus suis infection is a zoonosis which can cause severe systemic infection with a mortality of about 30% in humans exposed to infected pig tissue. To date there have been relatively few reports of S. suis infection in humans, with around 700 cases reported worldwide, most of them in the last few years in Thailand, Vietnam and Laos. It is an occupational disease of slaughterers and abbatoir workers but the infection can be transmitted by ingestion of raw pork in dishes such as Larb and Lu Mu (Lao meat salad made with raw pork.)

This alert emphasises and reinforces advice to all travellers – especially adventurous ones - to avoid eating raw meats ( or indeed raw molluscs, fish or other seafood), and to avoid unidentifiable dishes which may contain raw foods.

Dengue Fever in Brazil update

Thu, 24 June 2010 13:30:00 +1100

Dengue fever,transmitted by day-biting mosquitoes of the Aedes genus is still very prevalent in many of Brazil's provinces. For example the epidemic in Sao Paulo state is now reported as being the worst in its history, 121,270 cases of the disease were notified in 2010, compared with over 92,000 in 2007, until then the worst epidemic year. In the state of Minas Gerais with over 190,000 cases this year the municipality with the greatest number of confirmed cases is Belo Horizonte. Although the numbers vary there are significant problems in Espirito Santo and Roraima as well as in parts of the Rio de Janeiro state. Encouragingly though there has been a decrease in the number of cases in Piaui.

There is no vaccination available for the prevention of dengue fever and prevention depends on prevention of mosquito bites as described in our Fact Sheet.

Japanese Encephalitis in Vietnam

Tue, 22 June 2010 11:00:00 +1100

The Vietnamese Ministry of Health has reported a total of 120 cases of Japanese encephalitis (JE) in the last month. The distribution of patients infected is widespread in 15 provinces and cities including Ha Noi, Ho Chi Min City, Nam Dinh, Bac Giang, Nghe An, Thanh Hoa, Dak Lak and Dong Nai.

JE is a viral illness, the organism being transmitted by mosquitoes, and is most common in Vietnam from May to August. The northern provinces are currently reporting the highest incidence of infection.

There is a vaccine available for protection in Australia but it involves two inoculations a month apart, is expensive and is not currently licensed for children under 17 years of age. Travellers along the standard tourist route are at low to negligible risk and the World Health Organisation recommends vaccination only for people living and working in endemic areas for periods exceeding one month. Nevertheless risks must be discussed in consultation with an experienced health professional and personal protection against mosquito bites must be used at all times.

Dengue Update India and Sri Lanka

Thu, 17 June 2010 09:30:00 +1100

In 2010, a total of 45 people have suffered from dengue in the Kerala district of India, an area much visited by tourists. This is part of a general state of increasing dengue infections in tropical regions throughout the world. Health officials are stepping up their efforts to avert a dengue outbreak in the Sri Lankan capital, Colombo. The city is now on high alert given prevailing weather conditions. Incessant rains beginning in mid-May are continuing.

Dengue virus infection is carried by day-biting mosquitoes of the Aedes species which can also transmit the virus of chikungunya fever, a similar disease to dengue fever.

There is no dengue vaccine as yet available and prevention depends on strict attention to the avoidance of mosquito bites with the help of an effective personal insect repellent containing DEET or Picaridin

Bird flu death in Hubei , China

Mon, 7 June 2010 09:30:00 +1100

A 22-year-old pregnant woman died from a bird flu infection in central China's Hubei Province early Thursday, the Ministry of Health (MOH) said in a website report Friday.

The woman was four months pregnant when she began to show symptoms and was hospitalized in Hubei's Ezhou city on May 23. She died on Thursday 3rd June hours after she tested positive for the H5N1 strain of avian influenza by local disease prevention authorities.

According to the MOH report, Chen had contact with sickened birds before she became sick. The Health Ministry said it has reported the case to the World Health Organization (WHO) as well as informed health authorities in China's Hong Kong and Macao special administrative regions.

Source: Xinhua

Influenza Cases in Singapore Soar

Mon, 31 May 2010 11:00:00 +1100

The epidemic season has hit Singapore as the number of flu cases surged through the roof, local newspaper The Straits Times reported Thursday 27 May 2010. Although this has been a traditionally high season for influenza and colds the number of people with respiratory symptoms has been at epidemic, or near-epidemic levels for the past 6 weeks according to newspaper reports. From Ministry of Health figures it appears that some 29% of patients with flu-like symptoms have involved the pandemic A H1N1 strain.

Also worrying is the higher number of patients turning up with pneumonia, a potentially fatal complication of influenza infection.

Although the H1N1 flu pandemic has proved to be milder in its consequences than first thought there is a significant death rate, and the pandemic has not gone away. The 2010 Australian flu vaccine is an effective protection against both pandemic and seasonal flu and no one should travel without prior vaccination.

Rift Valley Fever South Africa Warning

Fri, 14 May 2010 09:30:00 +1100

The World Health Organisation has advised travellers to South Africa to take precautions against insect bites and contact with raw meat, after an outbreak of Rift Valley fever killed 18 people. Rift Valley fever is a viral disease in livestock such as cattle, sheep and camels, but can also infect humans through indirect or direct contact with infected animal blood or organs and have also resulted from the bites of infected mosquitoes. Most human cases of the disease, which is prevalent in east and north Africa, are mild but it has been deadly in an average of less than one percent of cases with a more severe haemorrhagic form. The South African government had confirmed 186 cases of the viral fever in humans by May 10, including 18 deaths, in five provinces: Free State, Eastern, Western and Northern Cape, as well as North West Province.

Visitors to South Africa, especially those intending to visit farms and/or game reserves, should avoid coming into contact with animal tissues or blood, avoid drinking unpasteurized or uncooked meat or eating raw meat. All travellers should take appropriate precautions against bites from mosquitoes and other blood sucking insects.

Fatal human Avian influenza case in Cambodia

Thu, 6 May 2010 10:30:00 +1100

The Ministry of Health of Cambodia has announced a new confirmed case of human infection with the (H5N1) avian influenza virus.

The 27-year-old male, from Prey Veng Province, developed symptoms on [13 Apr 2010], was admitted to the hospital on [16 Apr 2010] and died the following day [17 Apr 2010]. The presence of the H5N1 virus was confirmed by the National Influenza Centre, the Institute Pasteur in Cambodia. The patient prepared and consumed sick poultry in the 7 days before onset of symptoms.

To date, Cambodia has reported 10 laboratory confirmed cases with 8 deaths since 2005.

Polio found in Tajikistan

Mon, 3 May 2010 10:30:00 +1100

Travel Doctor TMVC recommends that you review your polio immunisation status.

171 cases of acute flaccid paralysis) have been reported to the World Health Organisation by the Ministry of Health of the Republic of Tajikistan from January 2010 to present. 32 of these cases are confirmed wild poliovirus type ; results are pending for the remaining cases. The majority of these cases have an onset of paralysis within the past 3 weeks. There have been 12 deaths. This is the first outbreak of polio in this region this decade.

Of the 32 confirmed wild poliovirus cases, 17 are under the age of 2 years, 14 are between the ages of 2 and 5 years, and one is between the ages of 6 and 15 years. All cases are reported from the southwest of the country, including the capital city Dushanbe. This region borders Afghanistan and Uzbekistan. Genetic sequencing has now determined that the poliovirus is most closely related to virus from Uttar Pradesh, India.

In response to the outbreak, the government of Tajikistan confirmed they are planning 3 supplementary rounds of immunization targeting every child less than 5 years (approx. 1.1 million children).

Neighbouring countries are responding to the outbreak by heightening surveillance at all health care facilities and reporting sites while reviewing immunization status of children.

It is important that international travellers to and from polio affected areas are adequately immunized against polio. The live polio vaccine given by mouth is no longer being used in Australasia. The inactivated virus vaccine given by intramuscular injection conveys a high degree of immunity and is part of the infant and pre-school protocol. Provided the full course has been received one polio booster for adults is regarded as sufficient.

Bird flu spreading in Vietnam

Thu, 29 Apr 2010 09:30:00 +1100

Bird flu is occurring in the central province Quang Tri of Viet Nam, raising the total number of affected provinces in the country to 4, said a report of the Department of Animal Health under the Viet Nam's Ministry of Agriculture and Rural Development on Tuesday [27 Apr 2010].

The bird flu struck a local farm of Quang Tri province, causing 250 ducks out of 1500 to die, said the department.

The local animal health bureau and authorities have been taking measures to prevent the spread of the H5N1 virus to nearby areas. These measures include slaughtering infected animals and sterilizing the affected areas and their neighborhood.

Currently, Viet Nam reports 4 provinces nationwide hit by avian flu including 2 northern provinces, namely Bac Kan and Quang Ninh, and 2 central provinces of Quang Ngai and newly reported Quang Tri, said the department.

Cholera in Ho Chi Minh City

Mon, 12 Apr 2010 16:30:00 +1100

Three cases of cholera have been confirmed in Ho Chi Minh City at the Tropical Disease Hospital, prompting the city Health Department to call for measures to prevent a possible epidemic.

The latest patient is a 22 year old man. The other 2 confirmed cases a week ago were a mother and child who had no personal connection with the 3rd case. The source of exposure of all these cases has not been confirmed but newspaper reports mention all of them had consumed street food before falling sick, and street food is considered as a potential source. At a meeting between the Health Department and health officials from 24 city districts, experts said that the prolonged hot weather could be a contributing factor to the disease, as food is more prone to spoilage if not properly refrigerated.

Although there is a cholera vaccine available, cholera prevention in tourists also involves care in eating and drinking. "Street food" if cooked in front of your eyes and comes to you piping hot is probably safe. Otherwise it should be avoided.

Measles continues in South Africa's Western Cape

Fri, 9 Apr 2010 11:00:00 +1100

The number of measles cases in Western Province has almost doubled in the past month. Up to February there had been 517 cases confirmed and there are now reports of over 1000 cases with 12 deaths including one adult. The City of Cape Town is regarded as the epicentre of the outbreak Travellers intending to visit the province, and Cape Town in particular, should ensure that their vaccination status is appropriate. This applies importantly to World Cup tourists who will inevitably be in crowded situations where the measles virus is easily spread.

Meningococcal Meningitis in Chad

Tue, 6 Apr 2010 12:00:00 +1100

From 4 January to 28 March the Ministry of Health of Chad reported 1531 suspected cases of meningococcal disease including 151 deaths (case-fatality rate: 10%). So far, seven districts have crossed the epidemic threshold (Bébidja, Bédjondo, Béré, Doba, Dono-Manga, Goundi and Laï) while five others crossed the alert threshold (Bénoye, Laokassi and Sarh).

Sixty seven specimens of cerebral spinal fluid have been found positive for Neisseria meningitidis serogroup A by latex test while 14 specimens were found positive for Neisseria meningitidis serogroup W135, by latex, and culture. This indicates that some areas are experiencing mixed epidemics (Dono-Manga), while others are being predominantly affected by either serogroup A (Doba, Bébidja district ) or serogroup W135 (Goundi district).

Meningococcal disease outbreaks occur regularly in sub-Saharan Africa at this time of the year. The Menigococcal C Vaccine used widely now in Australia for infants and teenagers is not sufficient for protection in this region. The quadrivalent vaccine against the A,C,Y and W135 strains is required and this is available at all Travel Doctor-TMVC clinics.

Rift Valley fever in South Africa

Thu, 1 Apr 2010 15:45:00 +1100

As of Sat 27 Mar 2010, the Ministry of Health South Africa has reported 63 human cases infected with Rift Valley fever (RVF), including 2 deaths. There is an ongoing outbreak of RVF virus infection affecting sheep, goats, cattle and wildlife on farms within Free State, Eastern Cape, Northern Cape, Western Cape, Mpumalanga, North West, and Gauteng provinces. Almost all cases result from direct contact with infected animals and therefore occur in farm workers or veterinarians but the virus can be transmitted by mosquitoes. Travellers are unlikely to be affected but care should be exercised in visiting farm areas.

Dengue fever in Ecuador (Galapagos)

Thu, 18 Mar 2010 15:45:00 +1100

There has been a re-emergence of dengue fever in the Galapagos Islands.

A small outbreak has been reported with 6 cases of dengue fever in San Cristobal and one in Santa Cruz. Dengue fever was first detected in the Galapagos in 2002, when 215 cases were confirmed. The health authorities eradicated the infection by 2004, when no cases were reported.

It is thought that the large number of visitors to the Galapagos and the intense rains in recent weeks may have contributed to the re-emergence of the infection.

Further human bird flu cases in Vietnam and Egypt

Tue, 16 Mar 2010 10:45:00 +1100

A fourth case of H5N1 infection (avian influenza) has been confirmed in Vietnam bringing the total number to date 116. The patient is from the Ha Noi area and is currently under treatment. The Egyptian Ministry of Health has reported 2 new cases one in a pregnant woman and another in an 18 month old child. The total number of cases in Egypt is now 106.

All the above cases have been identified as having direct exposure to sick poultry.

Hepatitis A in France

Thu, 11 Mar 2010 10:45:00 +1100

A small outbreak of Hepatitis A has occurred in France probably resulting from the importation of contaminated sun-dried tomatoes form Turkey. As of March 1st 55 case of the disease had been reported the highest number from the departments of Hautes-Pyrenees and Pyrenees-Atlantiques (19 cases), and Lot (15 cases). The suspect batch of tomatoes is no longer available, and so should not pose an ongoing risk but the outbreak illustrates the fact that the virus causing Hepatitis A is easily spread and since the vaccine against Hepatitis A is highly effective in prevention all tourists even to low risk destinations, should consider vaccination.

Fiji Typhoid Alert

Thu, 11 Mar 2010 10:43:00 +1100

The Fiji Ministry of health has declared an outbreak of typhoid fever in the Northern Division of the island group which includes the island of Vanua Levu where there are a number of tourist resorts. Typhoid outbreaks have occurred sporadically over many years in Fiji almost always affecting villages with poor water supplies although some cases have occurred now and then in town areas. Typhoid vaccination is recommended but the vaccine is not completely protective and tourists must exercise care when visiting villages and settlements; in fact the Ministry of Health recommends that tourists take their own supplies of drinking water when visiting such areas.

Measles in Ireland (Mar 10)

Tue, 9 Mar 2010 17:30:00 +1100

The measles outbreak in the Republic of Ireland which first began in Aug 2009, is ongoing and the total number of cases notified is now 320; two thirds of whom were unvaccinated.

The outbreak began mainly among the Traveller and Roma [gypsy] communities and others who refused vaccination, however by Feb 2010, the spread to the general population has been considerable.

It should be confirmed that children have received their recommended doses of MMR in infancy with a second dose pre-school (or at school in some cases.) Unimmunised adults who have not had the disease themselves may consider vaccination if thought to be at risk .Two doses of MMR vaccine is required to give adequate protection.

Rabies in Israel

Tue, 9 Mar 2010 17:30:00 +1100

Twelve children from Beit She'an in the north of the country were treated for rabies last week, after a rabid dog they'd been in contact with bit 2 other people in the town. The small, long-haired dog, whose owner neglected to vaccinate, lived near the school; children used to pet and play with her. When the dog was diagnosed with rabies, the Health Ministry asked anyone who may have touched her to report to the nearest health clinic. This is the 11th rabies case - 7 involving pet dogs - diagnosed in the Galilee and Golan since the beginning of the year. Last year, 58 cases of rabies in animals were recorded compared to 9-12 annually before that.

Polio in Senegal

Tue, 9 Mar 2010 17:30:00 +1100

Although poliomyelitis is regarded as being endemic in 4 countries only- Afghanistan, India, Nigeria and Pakistan - there has been spread over the past few years to neighbouring countries particularly in Africa. Senegal is the latest of these countries to report cases of polio.

The polio virus is mainly spread by ‘faeco-oral' contamination – a common problem in countries with poor water and sanitation infrastructure – or by direct contact with an active case or carrier. A polio vaccination booster is recommended for all adults at least once for travellers to African countries or to the Indian sub-continent. This can be given separately or added to the tetanus/diphtheria/pertussis booster in one injection. The oral polio vaccination “drops” are no longer available in Australia.

Dengue risk in Brazil doubles

Thu, 4 Mar 2010 15:00:00 +1100

Brazil's Health Ministry announced that the number of dengue fever cases registered from Jan. 1 to Feb. 13 in the country reached 108,640, up 109 percent from the same period in 2009.

The number of deaths by dengue fever was 31 in 2009, and 21 in the period of 2010.

About 70 percent of the cases are concentrated in only five states, which are Mato Grosso, Mato Grosso do Sul, and Goias, in the midwestern region, and Acre and Rondonia, in the northern region. The ministry has attributed the rise in cases to the high temperatures and heavy rains registered in the first six weeks of 2010 which increase the breeding areas for the Aedes mosquito which transmits the infection

Dengue fever must now be considered as a constant health threat to visitors to tropical and sub-tropical areas of South and Central America. Personal protective measures against mosquito bites are essential.

Fatal Human avian influenza case in Vietnam

Mon, 1 Mar 2010 13:00:01 +1100

A 38 year old woman in the southern province of Tien Giang has become the 1st fatal case of bird flu in Viet Nam in 2010, bringing the country's toll from avian influenza to 58, the health ministry said on Friday 26 Feb 2010. The victim had killed and cooked sick waterfowl. A 3 year old girl in the central province of Khanh Hoa was previously reported with confirmed flu earlier this month. According to Viet Nam's Department of Animal Health (DAH) update on Highly Pathogenic Avian Influenza dated 23 Feb 2010, an avian influenza H5N1 outbreak was reported from Nghe An province among 500 affected ducks, of which 50 died. Currently, 7 provinces -- Ca Mau, Dien Bien, Soc Trang, Kon Tum, Quang Tri, Nghe An, and Nam Dinh -- have reported avian influenza outbreaks within the last 21 days.

Chikungunya fever on Madagascar

Mon, 1 Mar 2010 13:00:00 +1100

A district in the south east of the Indian Ocean island of Madagascar is battling a outbreak of the mosquitoborne chikungunya. Chikungunya virus, which is transmitted by a bite from an infected mosquito, causes high fever, headaches, and severe joint pain that can last several weeks. Around 44,000 families in and around Mananjary, a small port town on the Mananjary River (Fianarantsoa Province), have been affected by the outbreak. There is no vaccine against chikungunya fever and prevention involves measures to prevent mosquito bites.

Dengue update for Bali

Tue, 23 Feb 2010 14:00:00 +1100

Dengue fever outbreak is expected to reach its peak this month. Data at the Sanglah Hospital, the island's largest medical facility, shows that the daily average number of dengue fever patients is growing, a 50 percent increase from January. Spread by the Aedes mosquito, there is no vaccine to prevent the disease. Tourists should use repellents containing DEET or Picaridin on exposed skin and Permethrin on clothing, bedding and mosquito netting and wear light-weight long sleeve shirts and pants when outdoors. Unlike the malaria mosquito the dengue-carrying mosquito feeds during the daytime

Human cases of Avian Influenza exceed 100 in Egypt

Mon, 22 Feb 2010 10:30:00 +1100

A statement released by the Ministry of Health on Friday 19 Feb 2010 confirmed 2 new bird flu cases in Egypt, bringing the total number to 102. The 101st case is a 13-year-old boy from Kafr El-Sheikh governorate. The 102nd case is a 30-year-old woman from Qellin city, Kafr El-Sheikh governorate. So far the identity and place of residence of the 100th case has not been announced. According to the Flu Trackers web-site the 100th case may have occurred in the Dakahlia governorate, but the details are unknown

Rabies situation deteriorating on Bali

Wed, 17 Feb 2010 11:30:00 +1100

The government of Bali is struggling to contain a rabies outbreak among the island's dogs which has now killed at least 30 people. Rabies is spreading out of control among Bali's 500,000 dogs, prompting the government to try vaccinations and culls in an effort to contain the virus. Rabies is thought to have been brought to Bali 14 months ago by an infected dog owned by a fisherman from nearby Flores, and is now spread to all but one corner of the island.

A spokesman from the Sanglah Hospital in Denpassar says every day around 300 dog bite victims come to the hospital seeking treatment, however it is known that vaccine and immunoglobulin is scarce, and many bites are not being treated according to WHO standards. Bali is known to have very limited access to rabies immunoglobulin, an important part of treatment for people who get bitten by dogs.

The focus of the local Government is on dog-culling. Balinese usually let their dogs roam free and the local government believes that this is why it is difficult to control the disease. In December laws requiring all dogs to be kept inside or leashed, or they would be impounded, and eventually killed, were enacted. Government figures show 40,000 dogs have been culled in the past year, the aim to halve the island's dog population.

However, dog-culling alone is not supported by international advisers, including WHO. Experts and animal rights activists say Bali's culling campaign is a waste of time, because dog numbers will quickly bounce back, and have launched their own vaccination program. Animal rights activist Janice Giraldi says vaccination is the only way to eradicate the disease and without an effective program, no solution will stop the spread of rabies on the island. The Bali Government has been doing it own vaccination program and they say 190,000 dogs have been reached in the past year, but there are concerns as the locally-made vaccine has only a temporary effect and may be ineffective. Mass vaccinations are planned for June, using an internationally approved vaccine, but the Bali government admits it is short of funding for the program.

Travellers should be aware of the risk of dog-bites, and carefully avoid contact with animals on Bali, as in most other parts of Indonesia. Vaccination against rabies before travel , while expensive, should be considered for travellers at high-risk of exposure.

Dengue Fever warning for Port Vila

Mon, 15 Feb 2010 14:30:00 +1100

Local Health Ministry has this warned of a possible upswing in dengue cases in and around Port Vila. Since the beginning of January 2010, suspected cases of dengue have been reported in Vanuatu which could indicate that a larger outbreak is imminent. Physicians in Vila Central Hospital have confirmed several cases of dengue fever. The Ministry of Health had sent their blood samples to the Pasteur Institute in Noumea for virus isolation and serotyping to confirm the type of dengue virus.

The last outbreak of dengue fever in Vanuatu occurred between October 2008 and March 2009 in which 136 cases were confirmed. For the remaining period of 2009 only 3 suspected cases were reported in Port Vila.

A response team was deployed this week to conduct case investigation as soon as the residences of suspected dengue patients were located. The team also conducted focal Indoor Residual Spraying targeting the residence of the individuals suspected with dengue.

Dengue fever is caused by a virus which has 4 sub-types and is not thought to be endemic in Vanuatu. The virus is spread by the Aedes aegypti mosquito which bites during the day, with increased biting activity for 2 hours after sunrise and several hours before sunset. The symptoms are sudden onset fever, intense headache, body aches and pains, joint pains, pain behind the eyes, loss of appetite, bowel disturbances and rash. They can easily be mistaken for other diseases which cause acute febrile disease.

Dengue haemorrhagic fever and dengue shock syndrome (DSS) are severe forms of the disease which may be fatal due to extensive bleeding in the body. This is recognized principally in young children. Parents should be warned to observe the early symptoms of dengue fever. If their children suffer from a high fever, headache, vomiting or bloody stools, they should seek hospitalization without delay. Prolonged self-medication, including consuming an overdose of anti-fever medication or similar, may cause complications for subsequent hospital treatment. Use of pain killers – including Asprin – should be avoided.

The Ministry of Health will continue to monitor the situation and provide regular updates on the dengue situation.

Imported Measles Alert in Queensland

Thu, 11 Feb 2010 11:30:00 +1100

An alert has been issued following the diagnosis of measles in a foreign tourist who spent time in the Whitsunday Islands until February 4th. Symptoms usually occur within 10 days of contact but the incubation period of measles can be up to 17 or 18 days. Previous outbreaks of measles in Australia have usually been traced to foreign visitors or to Australians returning from a country where measles is prevalent. This emphasise the need to follow State recommendations for infant and childhood vaccinations, and also to have booster vaccination before overseas travel where there is doubt about immunity.

Avian Influenza Update – Egypt, Cambodia, Myanmar

Wed, 10 Feb 2010 18:30:00 +1100

The Ministry of Health of Egypt has announced two new cases of human H5N1 avian influenza infection. Both are in hospital receiving oseltamivir treatment, Investigations into the source of infection indicated that both cases had exposure to sick and dead poultry. Of the 96 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 27 have been fatal. Most cases have resulted from infected backyard poultry.

In Cambodia an outbreak involving ducks started last month in Pralay village, Romenh commune, Koh Andeth district. All ducks within 5 kilometres of the village are to be incinerated, sales of duck meat have been stopped, and local officials within 10 kilometres of the area have been instructed to monitor both ducks and humans for signs of infection.

After being declared free of A(H5N1) infection in April 2008 Myanmar has reported a new case detected in Yangon's Mayangong township at the beginning of this month and control measures are being implemented.

Tourists are unlikely to be infected even in areas of high incidence but precautions as outlined in our Fluthreat website should be observed.

Measles in South Africa Feb 2010

Thu, 4 Feb 2010 18:30:00 +1100

The city of Cape Town on 1 Feb 2010 issued a warning about a measles outbreak. More than 100 cases of measles had been reported in Cape Town since October. In the Western Cape Province health authorities say they are on high alert after receiving reports that nearly 250 people around the province have contracted measles in the past 5 months.. Both Gauteng (which includes Johannesburg) and KwaZulu-Natalprovinces were hit by measles outbreaks late last year. More than 1000 children in Gauteng contracted measles in the space of 3 months. The Eastern Cape province has also experienced a surge in measles cases during the past month. A 25-year-old man from Tshezi village outside Mthatha died on 3 Jan 2010 after contracting the virus from a two-year-old who came to visit during Christmas holidays from Gauteng. By mid-January there were 50 suspected measles infections reported from villages.

Measles appears now to be prevalent throughout South Africa with both adults and children at risk, indicating incomplete vaccine coverage. Visitors to South Africa should ensure that they have adequate protection. Measles infection, although usually mild, can have serious consequences for non-immunised or partially immunised children and adults.

Increased bird flu activity

Mon, 1 Feb 2010 10:45:00 +1100

The northern hemisphere winter has seen a number of new reports of Highly Pathogenic Avian Influenza H5N1 appearing. In Egypt the problem has been recognised as being endemic and only human cases are being notified to international organisations. Six new cases have been notified since early November with the latest being reported on 23rd January. Press articles continue to report extensive bird outbreaks in Indonesia while 2 human cases were reported from Pekanbaru earlier this month. There is continuing activity in poultry in Vietnam but only one human case in November. In Cambodia there was a single outbreak in December with no human cases resulting. A new outbreak in domestic poultry has occurred this month in West Bengal, India and in neighbouring Bangladesh there have been two outbreaks in the Joypurhat district this month – the first since September last. In Israel an outbreak was discovered on 26 January in Kibbutz Ein Shemer near Haifa.

Rabid raccoons in N.Y. Central Park

Tue, 26 Jan 2010 16:01:37 +1100

Rabid raccoons have been increasingly infesting Central Park, with 8 of the mad animals found there in the past 2 weeks, according to the Department of Health. The 8 cases, along with 12 reported in 2009, are a dramatic increase over years past, when only a single rabid raccoon was reported from 2003 to 2008. Most of the rabid raccoons were found in the northern portions of Central Park from 79th Street to 110th Street, the Health Dept said. The Health Dept has posted fliers in the park and nearby subway stations and plans to bait raccoons with oral rabies vaccine in and around Central Park, Morningside Park, and Riverside Park in an attempt to slow the spread of the disease. Park workers have increased surveillance for sick animals. Visitors are encouraged to be on the lookout for strange animal behaviour and to call an emergency number if they notice animals that may be infected

Central park is located in New York City. Central Park's 341 hectares include 55 ha of woodlands, 101 ha of lawns, and 61 ha of water in 7 water bodies. The park's 10 kilometre perimeter extends from Central Park West to Fifth Avenue and 59th Street to 110th Street. More than 25 million visitors visit Central Park each year. With a park this size, and this many visitors and activities, it is easy to see why this many rabid raccoons would warrant concern.

Rats and Bats and Rabies

Thu, 8 Jan 2009 17:00:00 +1100

Three holidaymakers attacked and bitten by a sick "little red flying fox" in Queensland remind us that though Australia is free of rabies we are still vulnerable to infection with the rabies-related Lyssavirus; and the uncharacteristically aggressive red flying fox has proved to be affected by the virus. Fortunately the rabies vaccine is very effective in preventing development of the disease. Currently it is not thought that bats outside the Queensland area are infected but sick bats anywhere must be handled with caution to avoid bites. A bat that behaves uncharacteristically must also be suspected of carrying Lyssavirus.

The situation is very different and much more serious in Africa, Asia and South America. For instance on the same day as Australian press were reporting the Queensland incident there has been an account of seven deaths in children bitten by bats in Peru. Any mammal, not just roaming dogs and picturesque monkeys, can carry the virus. Bats are increasingly recognised as transmitters and even rats have been implicated. Travellers must consult a travel health professional to discuss the question of being immunised against rabies before travel

New bird flu case in Cambodia

Tue, 22 Dec 2009 15:00:00 +1100

The Ministry of Health of Cambodia has announced a new confirmed case of human infection with the H5N1 avian influenza virus.

The 57-year-old male, from Ponhea Kreak district, Kampong Cham province, developed symptoms on [11 Dec 2009]. The case was admitted to Kampong Cham Provincial Hospital on [16 Dec 2009], where he received treatment. He is in a stable condition.

The presence of the H5N1 virus was confirmed by the National Influenza Centre, the Institut Pasteur du Cambodge. A team led by the Ministry of Health is conducting field investigations into the source of his infection.

Of the 9 cases confirmed to date in Cambodia, 7 have been fatal. This is the 1st diagnosed case in Cambodia during 2009.

Cholera in PNG still spreading

Tue, 22 Dec 2009 14:00:00 +1100

Government inaction is contributing to the spread of cholera in Papua New Guinea (PNG), health workers say in a report by IRIN the United Nations humanitarian news and analysis agency.
Since the first case reports in July, more than 1,000 have been reported in the Pacific island nation, fuelled largely by poor sanitation practices and an acute lack of access to potable water.
Of the 1,356 cases to date, 608 have occurred in the provinces of Madang, 462 in Morabe, 281 in East Sepik and five in the Eastern Highlands Province, reported the World Health Organization (WHO), with at least 35 confirmed deaths.

In September the government declared a public health emergency and committed more than US$4 million to combating the disease - none of which has been released, leaving local health authorities and NGOs struggling to cope. Since the first case in Morabe and a subsequent outbreak in Lae, the provincial capital, the disease has travelled westward by road along the coastline, with outbreaks now in both Madang and East Sepik provinces, as well as the country's Eastern Highlands.

Added to that is its movement now by water down the Sepik River - PNG's second-largest and a primary source of water for both drinking and washing. And with the Christmas season fast approaching, as thousands prepare to return home, mainly by air as many villages are inaccessible by road, the disease could likely become airborne if it has not already.

Dengue Fever in Florida-USA

Wed, 9 Dec 2009 21:06:49 +1100

Health Officials have reported three confirmed cases of dengue fever in Key West, Florida. One of the cases; a tourist from New York, is the first locally acquired case of dengue fever in the state in more than forty years. Dengue fever is rare in Florida but not unknown. The Centers for Disease Control and Prevention (CDC) are investigating the outbreak and mosquito eradication has been stepped up in the area.

Dengue fever is a disease that is spread by the day biting mosquito, Aedes aegypt and is prevalent in Central and South America and the Caribbean islands. The disease can cause an acute flu-like illness that affects infants, young children and adults. There are no specific medications available to prevent or treat dengue fever. Travellers must ensure that they use measures to avoid mosquito bites including the regular use of personal insect repellants.

Measles in South Africa

Mon, 30 Nov 2009 14:27:29 +1100

An outbreak of measles, first recognised in August, continues to worry authorities.

An immunisation campaign was launched in Sep 2009, as a result of more than 131 measles cases being reported by 30 Aug 2009. The worst affected area was Gauteng province the majority of cases being in the Pretoria health district. Random cases were reported from other parts of the country. An immunisation campaign was launched in September but the number of laboratory confirmed cases of measles increased during the month. Most of these patients were from the Gauteng province, with the majority from the Tshwane district. (Tshwane includes the Pretoria municipal area). However, there were also confirmed cases in Ekurhuleni and Johannesburg. The ages of the patients ranged from 2 months to 54 years. The number of new cases continues to increase. Gauteng province remains the worst affected area with 188 new cases registered since 17 Nov 2009. The total number of cases reported in 2009, is 2656 (2292 from Gauteng province).

Travellers should confirm that children and young adults born after 1980 have received their recommended doses of Mumps –Measles-Rubella vaccine. Unimmunised adults who have not had the disease themselves may consider vaccination if thought to be at risk. Two doses of MMR vaccine is required to give adequate protection.

Cholera Update PNG East Sepik province

Thu, 26 Nov 2009 19:48:07 +1100

Cholera in Papua New Guinea was reported for the first time in 50 years in Morobe province in late August 2009. [See our Health Alerts of 6th, 16th and 21st September.] It spread to Madang, where an outbreak was declared in October 2009and the number of people suspected to be infected there has risen to 400. Now, in a statement released on November 19th the East Sepik provincial administration and health authorities have confirmed a new outbreak in Angoram district. The worst affected areas are Kambaramba village, the Biwat area, Angoram town, and the Gavien Resettlement area. People from these areas are frequent travellers to Madang province via the Sepik River and they may have contracted the disease there.

Mumps in Israel

Wed, 25 Nov 2009 22:45:52 +1100

Since the beginning of September, 105 people have been diagnosed with mumps in Israel. Most between the ages of 10 and 24. During the same period in 2008, only 4 people were diagnosed with the disease. Only 13 cases were reported for the entire year. In 2007, only 6 mumps cases were reported. Of the current cases, 82 are people from Jerusalem, but the disease has also been found in the central region (12 cases), Tel Aviv (5), the south (4), and Haifa (2). One of the patients developed testicular infection, a complication of mumps, and is hospitalized in a Jerusalem hospital.

The outbreak is thought to have occurred because of low vaccine coverage, particularly among some ultra-orthodox religious groups who decline vaccination.
Travellers must ensure that they have had the mumps-measles-rubella vaccinations according to the Australian schedule or have a blood test to determine immunity to mumps.

Queensland sees dengue return

Thu, 19 Nov 2009 18:34:47 +1100

Dengue fever has returned to north Queensland. During the last outbreak, which ended only three months ago, more than 1000 people were infected. Early summer rain has created conditions ideal for the dengue-carrying mosquito to breed. Three Cairns residents have been diagnosed with dengue after travelling to Malaysia, India and Viet Nam. In the Townsville suburb of Garbutt dengue has been diagnosed in someone who has not travelled implying that mosquitoes have been infected by a person with unrecognised illness. GPs in Cairns and Townsville have been alerted to dengue's return. Quarantining is not mandatory but the infected patients have been asked to self-quarantine. Residents are being asked to report to a doctor for blood testing if a fever with aches and pains develops.

Dengue in Cape Verde and Senegal

Thu, 19 Nov 2009 18:34:10 +1100

Medecins Sans Frontieres emergency teams are responding to the 1st ever dengue fever outbreak in Cape Verde , just off the West African coast. The Cape Verde Ministry of Health has reported 13 187 suspected cases of dengue fever in 4 islands within the archipelago between 1 Oct - 9 Nov [2009]. The outbreak is the 1st ever in Cape Verde and is the biggest recorded in Africa. The number of cases has increased sharply since the beginning of November 2009, reaching 1000 cases per day. 93 cases of DHF have been reported, and 6 people have already died.

On the West African mainland in Senegal dengue has been reported for the first time in at least two decades.

Reports of dengue outbreaks from sub-Saharan Africa have been extremely rare

Bali Rabies Situation

Thu, 5 Nov 2009 12:00:00 +1100

Although there has been no further official reports since our update published on 19th October many major travel websites have been publicising the problem in recent days.

Our emphasis now has to be that for practical purposes post exposure vaccination is not available in Bali, or at least the availability is unpredictable.

Activities that are particularly risky include: - Working closely with animals of unknown vaccination history. - Spending a lot of time in a rural area or doing outdoor activities such as bicycling, camping, or hiking. - Touching or playing with animals.

If you are bitten or scratched by a dog or any other mammal, cleanse the wound thoroughly with soap and water and apply an antiseptic like Betadine if available. Then do not take any chances but, since daily flights are available, get the first flight to Australia (or Singapore) to start rabies "post exposure" vaccination course including immunoglobulin.

Despite the cost. (approximately equivalent to 4 dinners in a good restaurant) and very low overall risk vaccination before travel is well worth considering. It is highly efficient but bear in mind that it involves a course of three inoculations over a four week period.

Rabies in Ghana

Thu, 5 Nov 2009 11:00:00 +1100

Six children have died in the past week and two are in a critical condition in the town of Bolgataga in Ghana's Upper East Region. (Bolgataga is at the southern terminus of the Trans-Sahara trade route and is known as the crafts centre of northern Ghana). A Senior Nursing Officer at the Bolgataga hospital is quoted as saying that even cases that were reported in a timely manner could not be treated because of lack of the anti-rabies vaccine in the hospital.

Information from Ghana indicates an increase in the number of cases of rabies recently probably because of an increase in the number of stray dogs. In Africa in general there are something like 24,000 deaths from rabies annually. While anti-rabies vaccine may be available in larger centres there is no guarantee that there will always be a sufficient supply and availability in rural areas is even more questionable. We advise that it would be wise for travellers who go off the beaten track to be vaccinated before travel.

PNG Cholera update

Wed, 28 Oct 2009 09:31:09 +1100

Following strenuous efforts to control the cholera outbreak there has been a disappointing report of a further 6 cases seen in one day at the cholera centre in Lae. Dr Likei Theo, chairman of the Morobe cholera outbreak task force, says the emergence of a large number of cases in one day showed that the people were returning to their old ways and were not as fastidious over hygiene as they had been.
The development comes as most of the aid agencies and organizations that were assisting the task force have left Morobe.
Visitors and workers with development projects should be immunised with the oral Dukoral vaccine but the most important preventive measures are careful attention to personal hygiene and drinking safely sterilised water.

Mumps in the United Kingdom

Mon, 19 Oct 2009 21:36:53 +1100

The Health Protection Agency of the United Kingdom is recommending that college and university students ensure that they are protected against mumps due to an increase in mumps cases in Bedfordshire in the English midlands. In the first half of 2009, 61 cases were reported; this compares with only two cases reported in the county in 2008. In the east of England, 467 confirmed mumps cases were reported up to July 2009; this compares with a total of 136 cases in 2008. The age group most affected in the area is 15-24 years, accounting for 73% of all cases reported in 2009.

This recommendation is of importance to young travellers to the United Kingdom for holiday, work or study. It applies particularly to those who may be in dormitory accommodation. Since the early eighties children in Australia have had two inoculations with the combined mumps-measles-rubella vaccine (MMR)one at the age of 12 months and one in early adolescence at school. Some may have missed out on one or other of these immunisations and if in doubt a simple blood test will determine whether another MMR inoculation is required.

Rabies on Bali Update

Mon, 19 Oct 2009 21:36:25 +1100

New cases have been confirmed at Kubu on the Bali east coast and at Petang north of Ubud. So far no cases have been identified within the major cities of Ubud and Gianyar, and only a few on the outskirts of Denpasar the capital city, but cases now have occurred on all sides of these densely populated communities. So far seventeen people have died from rabies since the outbreak started at the end of last year.

Although the risks to tourists are very small, and the cost of anti-rabies vaccination is high, vaccination before travel should be considered as there is a shortage of vaccines on the island for post-exposure vaccination and supplies of the rabies immunoglobulin, which forms part of the emergency first treatment, are virtually non-existent

Philippines floods - hazards for aid workers

Mon, 19 Oct 2009 21:35:56 +1100

The Philippines including metropolitan Manila and central and northern Luzon have been badly affected by a series of typhoons - yet another is on its way – resulting in extensive flooding. There has been an inevitable rise in the usual infectious diseases associated with flooding but rescue workers and aid personnel involved in helping the population in flood-affected areas face yet another hazard. The Philippine government on Friday 16th October expressed concern over the growing number of cases of leptospirosis, a deadly disease obtained by wading in flood waters that contain the urine and waste of infected rats. The germs (leptospira) can invade through any cuts, sores or abrasions on the skin and then affect the liver causing jaundice and bleeding, or the nervous system causing a form of meningitis. Precautions include using wading boots and covering any break in the skin with suitable waterproof dressings. The disease responds to antibiotics if detected early.

The antimalarial drug doxycycline is effective . Anyone who is likely to be involved in aid or rescue work should discuss the possibility of taking doxycycline prophylactically with a health professional.

Rabies threat in Israel

Mon, 19 Oct 2009 21:35:40 +1100

According to Ministry of Agriculture's information, a steep rise in the number of rabies cases in animals has been recorded in recent months, becoming an "almost daily" event. Since the beginning of this year 36 rabies cases have been detected in animals, 22 of them in dogs, mostly in the Galilee and Golan Heights. Last month 9 people were bitten during one night by infected jackals in the Afula-Nazareth area [northern Israel]. In another incident a group of boys found 3 female donkeys roaming the hills of Jerusalem and brought them to a school-farm nearby the village Sedot Micha. One of the boys was bitten by a donkey and was taken to the hospital. The donkey was transferred to the Veterinary Service and found positive for rabies.

Japanese encephalitis seasonal resurgence in Uttar Pradesh, India

Tue, 13 Oct 2009 20:48:00 +1100

With another 4 deaths reported this week, the toll of Japanese encephalitis virus victims has now been raised to 379 in the northern Indian state of Uttar Pradesh, a senior Indian Health official was quoted as saying. "A total of 2182 patients suffering from the deadly vector-borne disease were admitted to Baba Raghav Das Medical College in the recent past in Gorakhpur in the eastern part of the state. According to latest reports, 379 patients have died so far this year. The condition of some patients are also serious and the toll may mount," the official said.

The main area of spread at present of this mosquito-borne disease is in the Gorakhpur area of Uttar Pradesh. It is common at this time of year for the disease to resurge, and efforts are being made to vaccinate children where possible. Travellers should be aware of increased risk, and those spending time in this region should be vaccinated against the disease. Vaccination consists of two injections 4 weeks apart and is safe and available from Travel Doctor-TMVC.

Dengue Fever in Florida USA

Sun, 27 Sep 2009 13:05:48 +1000

PNG Cholera Update 21st September

Mon, 21 Sep 2009 20:37:36 +1000

THE quarantine centre at Angau Memorial Hospital in Lae has reported a total of 22 deaths from cholera.

The figure includes the casualties from Morobe province's outbreak areas of Wasu in Tewai-Siassi and Lae districts, and Goroka in Eastern Highlands province.

These figures were presented in the provincial outbreak task force meeting that was held yesterday at the provincial malaria office.

It was also revealed by Medecins Sans Frontieres (MSF) staff during the meeting that West Taraka ( in Lae) is fast becoming a "hotspot".

Travellers to Morobe and adjacent Eastern Highlands provinces should consider being vaccinated against cholera. Cholera vaccination is provided by the oral vaccine, Dukoral, which requires 2 doses ( drinks) taken one week apart. This can provide good protection (approx 80%) for about 2 years. Vaccine is available at Travel Doctor-TMVC clinics.

PNG Cholera Update

Wed, 16 Sep 2009 22:12:08 +1000

12 people have died from the 1st outbreak of cholera in 50 years in
Papua New Guinea (PNG), and the disease must be urgently contained
before it spreads further, the World Health Organization (WHO) says.

Eigil Sorensen, WHO's representative in Papua New Guinea, said
cholera appeared in 2 coastal villages in northern Morobe Province at
the end of July 2009 and gradually spread to 4 districts in the
province, but was not identified until a month later.

Of the 130 reported cases so far, there had been 12 deaths, Sorensen
said, and the disease appeared to be spreading through low level
transmission. "Since there is low level transmission and the number
of cases remains relatively low, we think there is no contamination
of any major water sources," he said. However, the disease has
appeared in Lae, the provincial capital, which Sorenson attributed to
people traveling from rural areas into the city.

Medical NGO Medecins Sans Frontieres (MSF) said on 7 Sep 2009 that
Angau Hospital in Lae was on high alert over the cholera outbreak and
that it had helped the Ministry of Health establish a cholera
treatment center there. MSF's emergency team has sent 7 additional
staff, including 3 nurses and a water and sanitation specialist, to
assist in the urgent response.

Morobe Province has also been hit by unrelated outbreaks of
shigellosis, a bacterium that causes bloody diarrhea. Sorenson said
about 40 people might have died from shigella in the last month in
remote districts in Morobe.

Care with Yellow Fever certificates and Brazil

Mon, 14 Sep 2009 00:05:19 +1000

Travellers who are travelling to Brazil and returning to Australia within 6 days are required to have valid International Certificate of Vaccination against Yellow Fever to show on re-entry. This applies to travellers just going to spend a few days in large cities and around the popular tourist sites like Iguassu falls. This is an Australian health requirement.

Some travellers who have sought advice from the Brazilian consulates have been advised that yellow fever vaccination is not required- but this is only reflecting the Brazilian authorities' policy, which is that the Brazilian government does not care about the vaccine status of travellers.

If you are re-entering Australia from Brazil within the last 6 days, you are expected to show a valid certificate (or valid official medical exemption.)

Public Health Alert in PNG- cholera, dysentery, influenza

Mon, 14 Sep 2009 00:04:42 +1000

Local papers yesterday reported that the National Government yesterday officially declared a public health emergency for disease-stricken Menyamya, Wasu in Tewai-Siassi, Lae and affected parts of Gulf and Eastern Highlands provinces.
The move follows a visit by representatives of the Government, Health Department, World Health Organisation and AusAID to Lae this week to obtain first hand situation reports from the provincial health command post about surveillance and containment of the outbreaks. The public health emergency, which was announced by Health and HIV/AIDS Minister Sasa Zibe yesterday, will give more powers to health authorities to carry out a full-scale containment exercise
All schools and prepared food markets in Lae have been ordered closed as a precautionary measure, in an attempt to contain the spread of the outbreaks.
Health secretary Dr Clement Malau said that an environmental health inspection survey was currently being conducted in villages along the Bumbu River.
After his visit to Lae, Dr Malau praised health teams working in the area and for the support of the World Health Organisation, AusAID, Medecins San Frontieres and other private bodies.
As of yesterday morning, figures obtained for Menyamya showed there have been 393 known cases of dysentery, with 29 deaths reported.
There have been 242 cases of cholera so far with 18 deaths, while 3,099 cases of influenza have been reported, with 51 deaths.

Bali rabies update

Mon, 14 Sep 2009 00:04:00 +1000

Until November last year Bali was regarded as free from rabies but since then confirmed cases have occurred with the latest, as yet unconfirmed, case being reported from a village in Tabanan. . Three of the islands eight regencies Badung, Denpasar and now Tabanan, all adjacent, must now be considered confirmed or probable rabies epidemic areas.

Vaccinations against rabies are available at Travel Doctor-TMVC clinics, although are not generally recommended for short-term holiday stays.

Any animal bite or possible rabies exposure should be managed appropriately with post-exposure prophylaxis (PEP), which consists of the administration of rabies vaccines on days 0,3,7,14,28 and the use of rabies immunoglobulin in those people who are not previously immunised, and only 2 booster does of vaccine in those who are already vaccinated.

Travellers who experience an animal bite on the island of Bali, should wash the wound immediately and report the bite to medical services for PEP usually, but not always, available on the island. In Australia, those bitten travellers should attend their closest Travel Doctor-TMVC clinic.

Measles Alert for Angola, Namibia and South Africa

Sun, 6 Sep 2009 21:24:28 +1000

Spreading from Angola, where last week there were 99 cases of measles diagnosed in the southern Cunene province, a measles outbreak has occurred in northern Namibia. This has led to cross-border talks on how to prevent and respond effectively to the outbreak.

At the same time the health department in South Africa has urged the public and medical practitioners to be aware of measles symptoms and for parents to get their children vaccinated after a reported outbreak in Gauteng (which includes the Johannesburg/Pretoria areas).Random cases have been reported in other parts of the country. Vigorous efforts are being made to immunise or re-immunise schoolchildren.
These are serious outbreaks in southern Africa which appear to be
spreading, as elsewhere, as a consequence of localised resistance to
vaccination and incomplete coverage of the population.

Travellers to southern Africa should make sure that immunisation is complete.

Cholera reported in PNG for first time

Sun, 6 Sep 2009 21:24:00 +1000

According to a news report on the Australian Broadcasting Commission authorities in Papua New Guinea have confirmed cases of cholera in the northeast coastal province of Morobe. This is the first time cholera has been reported in the country. The situation is a little confusing as an outbreak of dysentery and many cases of a flu-like illness (probably seasonal influenza) have also been reported from the area – the Menyama district of Morobe province. World Health Organisation delegates are assisting the PNG government in the investigation of the outbreak(s).

It is uncertain as to how cholera entered the country but in areas where safe water supply and sanitation occur it can easily be spread. Travellers and expatriate workers must ensure that attention is paid to safe hygienic principles.

At this point in time vaccination against cholera with Dukoral is not routinely recommended. The Travel Doctor-TMVC will continue to closely monitor the situation and provide updates via our website.

Rabies (animal) in New York

Tue, 1 Sep 2009 22:24:04 +1000

In recent weeks, two racoons have been identified as being infected with rabies virus in Manhattan.
The Health Department has warned the public of New York to stay away from racoons, skunks, bats, stray dogs and cats and other wild animals that can carry the rabies virus. Twelve animals have been identified with rabies in New York City this year (2009). Eight were found in the Bronx, two in Manhattan (most recently in Central Park), one in Queens and one in Staten Island.
Racoons are the most commonly reported animals in New York City; in 2008, nineteen animals tested positive for rabies virus. They included four racoons, seven skunks, one bat and one cat from the Bronx, four racoons from Staten Island, a bat from Brooklyn and a racoon from Queens.

Suspected Methanol Poisoning in Uganda

Tue, 1 Sep 2009 22:23:24 +1000

An outbreak of cases - with so far 9 deaths - characterised by severe respiratory symptoms and blindness in a Kampala suburb has prompted a police investigation on the basis of suspected methanol intoxication.

There were related reports, 3 months ago, of 5 deaths in the Western Uganda town of Kasese following consumption of liquor packed locally in the town. In 2007, 40 people with a presentation similar to the symptoms of the current deaths died in Kampala and nearby districts after drinking a toxic local gin. The investigation into those cases by the Ministry of Health revealed that the cases had been exposed to a local gin that contained too much methanol . Methanol toxicity remains a common problem in many parts of the developing world, where methanol is often a component of bootleg alcohol, which is made in rural regions. Because of its low cost, it is often consumed by those in lower socioeconomic classes.

In June we reported on cases of methanol poisoning (including deaths in two tourists)in Bali caused by adulteration of local arak, so we repeat the warning note to tourists that whilst it may seem exotic to partake of cheap home-made “traditional” drinks it is a whole lot safer to stick to established if more expensive brands.

Austrian woman reports otter attack in Wisconsin

Thu, 13 Aug 2009 17:35:53 +1000

A posting on the International Society for Infectious Diseases ProMED newsite carries the report that an Austrian woman on vacation in Wisconsin, USA is getting rabies shots after she was bitten by otters while swimming in a lake near Duluth. The 51 year old was swimming on Lake Owen last Wednesday [3 Aug 2009] when 3 otters suddenly appeared. She said they swam off when she shook her legs, but not before biting her 8 or 9 times. Although the victim says the bites didn't hurt much, she did go to a hospital, where doctors started a series of rabies shots.

Otters, like the majority of mammals, are susceptible to rabies virus infection, but attacks on humans are rare although not unknown. The ProMED-mail archive records attacks on humans in Florida and Vermont in recent years.

Yet another virus fever in Brazil

Mon, 10 Aug 2009 22:01:55 +1000

More than 650 cases of Oropouche virus infection were confirmed in the municipalitiy of Mazagao, located in the south of the Amazonia state. The cases have attracted attention not just for the high number of patients of this disease, but also because it has been at least 5 years since there has been an epidemic of Oropouche fever in Amazonia. The prefecture has initiated cleanup action in areas that are foci of the virus carrier which are biting midges (Culicoides spp.) The 1st cases of Oropouche fever occurred in the state in March this year [2009], but have intensified in the last 3 months. Acute fever, intense headache, skin rash, joint and muscle pain are symptoms that can appear in the course of a patient's disease. The duration of Oropouche fever in the human body can last up to 7 days.

The oropouche virus is the 2nd most frequent cause of arbovirus fever in Brazil,and there are records of events in Panama, Peru, Suriname and Trinidad and Tobago.

From a practical point of view oropouche fever is very similar to dengue fever and prevention relies on the liberal use of insect repellents.

Plague outbreak in northern China

Mon, 3 Aug 2009 22:32:14 +1000

AP - reported yesterday ( Sunday 2nd) that thousands of people have been placed under quarantine in a town in northwest China after a man died of pneumonic plague and 11 others were confirmed infected with the deadly lung infection, according to local health authorities.

The 32-year-old herdsman died in Ziketan in Qinghai province, the provincial health bureau said in a statement posted on its Web site Saturday. It did not say when he died. Most of the others infected are relatives of the deceased and are in stable condition in a hospital, the bureau said. The town of 10,000 people has been placed under quarantine and a team of experts has been sent to the area, it said.

Pneumonic plague is spread through the air and can be passed from person to person through coughing, according to the World Health Organization. It is caused by the same bacteria that occurs in bubonic plague — the Black Death that killed an estimated 25 million people in Europe during the Middle Ages. While bubonic plague — which is usually transmitted by flea bite — can be treated with antibiotics if diagnosed early, pneumonic plague is one of the deadliest infectious diseases. According to the WHO, humans can die within 24 hours of infection.

The Qinghai health bureau statement warned that anyone who has visited Ziketan and surrounding areas since July 16 and has developed a fever or a cough should seek treatment at a hospital.

Typhoid fever in Ethiopia

Tue, 28 Jul 2009 21:15:23 +1000

An outbreak of typhoid fever has killed one person and affected more than 100 in the northern Tigray region of Ethiopia the United Nations Office for the Co-ordination of Humanitarian Affairs said on 27 July, adding that 11 others have also died of acute watery diarrhoea across the country.

Tigray is in the north-eastern part of the country.

Dengue haemorrhagic fever in Belize

Mon, 27 Jul 2009 17:43:08 +1000

Belizean health authorities have confirmed an outbreak of dengue hemorrhagic fever in western Belize.

The outbreak was confirmed in the Cayo district, which is 70 miles from Belize City, on the western border with Guatemala. The neighboring town of Melchor de Mencos, Guatemala is considered a hotspot for the disease.

Of the 114 confirmed dengue cases, the Ministry of Health says that 17 cases were clinically diagnosed as Dengue Hemorrhagic Fever, the majority of which came from the Cayo District.

Haemorrhagic fever is a serious complication of dengue infection and overall is estimated to occur in about 3% of cases so a 15% incidence is unusually high. This emphasises the need for personal protection against mosquito bites in the form of insect repellants and the use of permethrin-impregnated outer clothing when travelling anywhere in the Central American/Caribbean area.

Dengue in French Polynesia

Mon, 20 Jul 2009 22:53:22 +1000

Radio New Zealand International has carried a report from the French Polynesia health ministry that a dengue outbreak has affected more than 2,100 people and has spread to all island groups. Half the people who contracted type-4 dengue are in the 10- to 19-year age group.

The ministry said so far 40 people needed hospital care, with one patient falling seriously ill before recovering.

It warned that in the months to come, there is a risk that dengue could spread on islands where the illness has been recently introduced.

Christchurch New Zealand measles outbreak

Wed, 15 Jul 2009 14:40:32 +1000

As at 14 Jul 2009 there [were] 26 reported cases in the Christchurch outbreak, with 16 confirmed serologically and confirmation awaited for a further 8 (2 cases have refused blood tests).

14 of the cases are related to one high school for boys (this includes 2 pairs of siblings) and 3 of these were in the same class. The remainder of the cases are spread over the city with no obvious geographical connections.

A few have social connections to the boys high school pupils. It is currently the 2nd week of school winter vacation here in New Zealand and many families will have travelled out of town, so other public health units elsewhere in New Zealand have been advised of the outbreak and an alert notice was placed on PacNet as the Pacific Islands (particularly Fiji) are popular destinations for New Zealand holidaymakers in the winter.

source:www.promedmail.org

Pandemic (H1N1) 2009 - Current situation in Australia

Wed, 15 Jul 2009 14:39:32 +1000

Today Australia will exceed 10,000 confirmed cases of Pandemic (H1N1) 2009 virus, and this is despite a policy where only persons at high-risk are being tested. Most cases, like people who are otherwise healthy, and those with mild symptoms, are not tested at all.

It is expected that many more will be diagnosed as the winter season progresses. The Commonwealth's chief medical officer, Jim Bishop, warned yesterday that the spread of the disease would start to peak next month, increasing the pressure on hospitals. He said hospitals would be under rising pressure "in the next six weeks".

The total number of Australian deaths associated with Pandemic (H1N1) 2009 is currently 19, with eleven reported in Victoria, four in New South Wales, one in Western Australia, one in South Australia, one in the Northern Territory and one in Tasmania.

There are currently 123 people in hospital around Australia with Pandemic (H1N1) 2009 and 32 of these are in Intensive Care Units. There are 38 patients in hospital in NSW, 29 in Victoria, 18 in Queensland, 15 in the Northern Territory, 15 in South Australia, 4 in Tasmania, 2 in the ACT and 2 in Western Australia. ICU admissions: Of the 32 people currently in Intensive Care Units, 16 are in Victoria, 6 in NSW, 5 in Queensland, 3 in the NT, 1 in South Australia and 1 in Western Australia.

The total number of hospitalisations in Australia since Pandemic (H1N1) 2009 was identified is 1029. Professor Bishop said that many of these were short stays and numbers were similar to what had been experienced in previous bad flu years such as 2007. The number of flu cases being seen by general practitioners in the community was similar to 2007. But numbers going to hospital emergency departments were "a little higher" than previously, apparently because of higher public awareness.

Australia is expecting to get the first of 21 million doses of swine flu vaccine by October, when the worst of the epidemic is expected to have passed, although overseas cases had continued into summer.

(It should be noted that the WHO officially changed the name of this new infection to “Pandemic (H1N1) 2009”.)

Mosquito-borne problems on Phuket

Mon, 6 Jul 2009 22:10:33 +1000

Dengue fever virus disease, now present in most parts of the tropical world, has long been prevalent in Thailand including Phuket. This year, however, a similar mosquito-borne virus illness – chikungunya fever – has added emphasis to the need for visitors to the resort island to be obsessive about avoiding mosquito bites. According to recently released figures from the Phuket Public Health Office there have been 2155 confirmed cases of Chikungunya Fever in the province in the 1st half of this year (with no deaths.) Only 31 of these cases were among foreigners, mainly migrant labourers. Most tourists are fortunately by now aware of the need for personal protection from mosquito bites and the need to use effective insect repellents which partially accounts for the low numbers among visitors. However, the Public Health Office report refers only to confirmed notified cases so the figures may not reflect the true incidence One can expect more cases to occur in the next few months of the year so we remind visitors to Phuket that insect repellent must be an essential part of your luggage.

Mumps outbreak in Cumbria, England

Wed, 1 Jul 2009 23:55:59 +1000

A mumps outbreak has been reported last week in Cumbria, (which embraces the English Lake District) and a general increase in cases has been seen across the county. In the last few years there has been a noticeable increase in the number of cases of mumps, particularly in teenagers and young adults. This is of concern as mumps is easily spread. .Mumps virus infection causes fever, headache, and painful swollen glands in the face neck and jaw and although most cases are mild some people can experience complications, for example meningitis, which can be serious. It may in some cases also affect fertility. The incomplete acceptance of the triple MMR vaccine in the UK which occurred some years back because of a subsequently disproved theory of association with autism, has allowed continued circulation of mumps virus in the community and leaves a cohort of young adults vulnerable to infection.

Young adults in Australasia should have been protected by MMR immunisation in infancy and during the school years. If in doubt before travel either have a blood test to determine immunity or simply have a booster dose of mumps-measles-rubella vaccine.

Swine Flu Traps for Travellers

Wed, 24 Jun 2009 20:53:11 +1000

Australia's response to the “swine flu” pandemic has been to move to the PROTECT phase where medical efforts are now directed at protection and treatment of people in whom the disease could be severe. This recognises the facts that the illness in general is a mild although infectivity is high, and that major isolation tactics have not succeeded in stopping the spread of the infection. Other countries have remained in the “Contain” phase which poses a potential problem for international travellers. For example Venezuela has quarantined a visiting cruise ship following an outbreak of swine flu on board. In Shanghai 80 airline passengers have been under compulsory quarantine in a Chinese hotel and have had their passports confiscated because of a suspected swine flu case on their flight from Australia. In South Korea members of Australia's under-21 lacrosse team were locked in their hotel rooms this week because of swine flu concerns. The United Arab Emirates are employing another tactic by arranging for Emirate students abroad to be screened where they are studying before returning home for term holidays. The use of Tamiflu to prevent swine flu has been advocated but is only properly indicated where there is a major underlying medical condition, and in any case does not protect the traveller from being quarantined when someone else on the plane or ship has been identified with the disease! All one can do until other countries move into the “Protect” phase is to factor in such possible delays when arranging overseas business (or pleasure) trips.

BUBONIC PLAGUE, - LIBYA: (AL BUTNAN)

Sun, 21 Jun 2009 22:51:42 +1000

Promed has reported that Libyan authorities have reported an outbreak of bubonic plague in the Mediterranean coastal town of Tubruq, and the World Health Organization (WHO) was sending a team to investigate, a WHO official said on Tuesday [16 Jun 2009].

The cases, approximately 16 to 18 have been reported, would be the 1st in more than 2 decades in Libya of the disease known in medieval times as the Black Death, according to John Jabbour, a Cairo-based emerging diseases specialist at WHO. "It is reported as bubonic plague," Jabbour said, adding WHO still didn't have "a full picture" of the situation. "It is officially reported by Libya... Tomorrow [17 Jun 2009], the WHO is deploying a mission to Libya to investigate the whole situation, to see how many of the cases are confirmed, or not confirmed." He said preliminary information from Libyan authorities showed 16 to 18 reported cases including one death, and that Tripoli had asked for assistance from the global health body.

Tubruq, where the new cases were reported, is approximately 125 km [78 miles] from the Egyptian border and was the scene of previous plague cases decades ago, Jabbour said. Globally the WHO reports about 1000 to 3000 plague cases each year, with most in the last 5 years occurring in Madagascar, Tanzania, Mozambique, Malawi, Uganda and the Democratic Republic of Congo.

Tick-borne encephalitis areas in Germany

Thu, 18 Jun 2009 04:32:34 +1000

Tick-borne encephalitis (TBE) is a virus disease prevalent between May and October in many parts of Europe including Russia. The Robert Koch Institute in Germany has published an updated map of risk areas in that country indicating that the states of Baden-Wurttemberg and Bavaria show the highest risk. Other states in which there is some risk are Hesse, Rhineland-Palatinate and Thuringia.
Ticks, which can also spread another infection called Lyme Disease, largely occur in forested areas and tourists who might be at risk are those who are going on camping or hiking holidays. However, the infection can also be acquired through drinking unpasteurised milk, particularly goat's milk. A Fact Sheet on TBE can be found on this website. Tourists are usually at minimal risk but for those who are likely to spend some time involving camping or hiking through forested areas a vaccination course is available in Europe. If there is sufficient time the vaccine can be made available in Australia under a Special Access Scheme on formal application.

Up to one-third of Victorians could be infected with Swine Flu

Mon, 15 Jun 2009 04:31:38 +1000

It is being suggested that up to one-third of Victorians could now be infected with swine flu, an expert said yesterday, as the Federal Government announced it was preparing to ramp up its response to the virus in coming days. Last night Health Minister Nicola Roxon said all states and territories would move to the "sustain" phase of the Government's pandemic plan this week, bringing them into line with Victoria's strategy to manage the virus. The shift would mean fewer testing and quarantine measures to contain the H1N1 virus and a greater focus on those most at risk of serious illness, such as the elderly, the very young, and those with existing health conditions. "As we see the numbers gradually increasing in other jurisdictions there will be steps over the coming days to move to a consistent alert level," Ms Roxon said.

In Australia, more than 1500 cases have been officially reported, with more than 1000 in Victoria. The actual number is probably much higher than this, as testing for the virus has now restricted to specific cases, and high-risk persons. As routine testing has ceased, the official numbers will be more and more irrelevant.

On the basis of available evidence and expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met. The Director-General of WHO therefore decided to raise the level of influenza pandemic alert from phase 5 to phase 6. "The world is now at the start of the 2009 influenza pandemic," said Dr Margaret Chan late last week. Globally, 74 countries have officially reported about 30,000 cases of influenza A(H1N1) infection, including 145 deaths. The first death of a person outside the Americas was reported from Scotland overnight, the person having pre-existing medical problems.

There is no need for travel restriction in Australia at present, as all states move to sustain, a reflection that the risk of acquiring the disease is in all states.

Potential problems for international travellers remain, and although no official travel restrictions exist, travellers from pandemic “hot-spots” may be placed in quarantine at destination if they present with symptoms of the disease. For travellers going to other parts of the world, it may be wise to seek specific advice at a Travel Doctor-TMVC clinic, and discuss the use of tamiflu medication prevention, available through Travel Doctor-Travellers flu kits.

Deaths from contaminated alcohol drinks in Bali

Wed, 10 Jun 2009 22:38:07 +1000

A recently reported series of fatalities (including two tourists) in Bali from drinking rice wine (arak) contaminated with methanol serves as a reminder to a warning which we posted some 10 years ago about the dangers of drinking cheap local alcoholic brews. At that time the deaths that occurred were in Turkey but there have been similar outbreaks in Bali in the past for the same reasons. The price of imported alcohol is high and small local manufacturers operate in a poorly controlled environment. Profits are increased for the local manufacturer if the drink is adulterated but even unadulterated drinks may become contaminated In this instance the drink was stored in old containers used previously for storing antifreeze solution. Whilst it may seem exotic to partake of cheap home-made “traditional” drinks it is a whole lot safer to stick to established if more expensive brands.

Measles epidemic in Bosnian Serb towns

Mon, 1 Jun 2009 23:12:37 +1000

A measles epidemic has been declared in the municipalities of Prijedor, Bosanska Dubica, and Kotor Varos [western Bosnia], as 161 people, mainly young people aged 15 to 19 years, have been registered as having measles. This was confirmed by a spokeswoman for the Bosnian Serb Republic Health Institute, Milka Mrdja. The infected were born during the Balkans war and were not immunized against measles.

Travellers to this region should ensure that they are immune to measles either by having a booster MMR vaccination or having a blood test to check.

Polio in Kenya

Mon, 25 May 2009 22:07:08 +1000

Kenya, which eradicated polio 25 years ago, has recorded 13 new cases of the virus in three months. The new cases were reported in northern Turkana district which borders Ethiopia and Somalia. In 2006 Kenya reported a case after two decades of freedom from the disease. This case was confirmed to have originated in Somalia. The country issued an alert in February this year after a case of a rare wild polio was confirmed suspected to have been imported from southern Sudan.

Polio remains endemic in just four countries in the world, the hotbed being Nigeria, followed by India, Afghanistan, and Pakistan but the International Red Cross last month warned that a polio outbreak now affects 15 African countries and could threaten efforts to eradicate the disease.

Most Australians and new Zealanders will have had polio vaccination as a routine childhood vaccination but may not have had a further dose as an adult which boosts antibody response for life. Travellers to Africa in general are strongly advised to update polio vaccination.

Thailand and Malaysia report Chikungunya (CHIK) fever

Mon, 18 May 2009 22:56:42 +1000

Chikungunya fever is caused by a virus carried by mosquitoes. The mode of transmission is the same as that for dengue fever and the symptoms of the illness are similar except that CHIK fever seldom develops the more serious haemorrhagic state that can occur occasionally with dengue fever. Distinguishing between the two requires blood testing but symptomatic treatment for both infections is the same involving adequate fluid intake and painkillers. Paracetamol is preferred to aspirin or non-steroidal anti-inflammtories like ibubrofen which could aggravate any tendency to bleeding.

Currently there are reports of CHIK fever in southern Thailand including Phuket as well as in Malaysia both in peninsular Malaysia and Sarawak. Since there is no vaccine and no specific antiviral treatment personal anti-mosquito measures are essential for tourists during the day as well as evenings.

First Australian swine flu tested positive

Sun, 10 May 2009 13:33:56 +1000

The first Australian to test positive for swine flu has been identified in Queensland, but she is no longer infectious.Four other persons being tested for the virus have returned negative results, health authorities say. Officials say there have been no more cases of swine flu in Queensland after Australia's first case was confirmed in Brisbane this morning.

A New South Wales woman, aged in her 20s tested positive after she flew into Brisbane on a flight from Los Angeles on Thursday.Queensland Health says it is unlikely she was infectious when she boarded the flight in the US because she returned a "weak positive" test for the disease.

The woman had had a mild infection while overseas, and essentially is non-infectious and already in the normal recivery stage of her illness. This means that she is not a risk to other persons, and unable to infect other people.

Federal Health Minister Nicola Roxon says the woman had fully recovered by the time she returned to Australia. As a precaution Ms Roxon said authorities were contacting other passengers who were on the woman's flight from Los Angeles.

Bottled water not always safe

Mon, 27 Apr 2009 16:36:15 +1000

Monday, 27 April, 2009 In early 2009 tests by health officials in Vietnam showed widespread contamination of municipal tap and bottled water. In recent years, as incomes have risen, more people have been buying bottled water. Twenty-litre jugs that sell for around 50 US cents are affordable for most Vietnamese. However, tests on hundreds of brands across the country reveal that bottled water cannot be trusted either. Dozens of samples failed safety standard tests in Ho Chi Minh City in March 2009. "We detected bacterium in our samples, mainly coliform and Pseudomonas aeruginosa," said Le Truong Giang, deputy director of the city's health department. At the last count 38 water-bottling firms had been ordered to close in Ho Chi Minh City, 12 in central Quang Ngai Province, and at least a dozen in Hanoi. An official of Ho Chi Minh City's health department has advised that consumers shouldchoose reliable brand names only but even then it is safer to boil the bottled water as well. Source: United Nations IRIN news

Swine flu illness in the United States and Mexico

Mon, 27 Apr 2009 16:35:37 +1000

Monday, 27 April, 2009 The World Health Organization has declared the swine flu outbreak in North America a "public health emergency of international concern". The decision means countries around the world will be asked to step up reporting and surveillance of the disease implicated in dozens of human deaths in Mexico and at least 8 non fatal cases in the US. WHO fears the outbreak could spread to other countries and is calling for a coordinated response to contain it.At least 62 people have died from severe pneumonia caused by a flu-like illness in Mexico, WHO says. Some of those who died are confirmed to have a unique flu type that is a combination of bird, pig, and human viruses. The virus is genetically identical to one found in California. US authorities said 8 people were infected with swine flu in California and Texas, and all recovered. Health authorities in Nova Scotia are confirming 4 cases of swine flu in the province. The province's public health officer, Dr Robert Strang, says the 4 infected people in the Windsor area are recovering from the illness. All of them had what he describes as "mild" cases of the flu. As of 26 April 2009, the United States Government has reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California, 2 in Texas, 2 in Kansas and 1 in Ohio). All 20 cases have had mild Influenza-Like Illness with only one requiring brief hospitalization. No deaths have been reported. All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans. Also as of 26 April, the Government of Mexico has reported 18 laboratory confirmed cases of swine influenza A/H1N1. Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspect clinical cases have been reported in 19 of the country's 32 states. WHO and the Global Alert and Response Network (GOARN) are sending experts to Mexico to work with health authorities. WHO and its partners are actively investigating reports of suspect cases in other Member States as they occur, and are supporting field epidemiology activities, laboratory diagnosis and clinical management. On Saturday, 25 April, upon the advice of the Emergency Committee called under the rules of the International Health Regulations, the Director-General declared this event a Public Health Emergency of International Concern. WHO is not recommending any travel or trade restrictions.

Swine Flu Update

Mon, 27 Apr 2009 16:33:57 +1000

Monday, 27 April, 2009 International health authorities are responding to the emerging threat of swine flu, which has the potential to become a pandemic. Reports of spread to the US, Scotland, Canada, and New Zealand have been noted and Australian authorities are on alert. There apparently have been several deaths in Mexico, where media reports suggest that the virus may have been circulating for 2-3 weeks. Cases in the US and elsewhere appear to be milder, and all have recovered. This is a new influenza A virus, deriving from swine strains, and the viruses isolated to date are sensitive to the anti-flu drugs, oseltamivir ( Tamiflu), and zanamivir (Relenza). The current human vaccines for seasonal influenza are unlikely to offer any protection. Travellers who have been in Mexico within the last 10 days should consider having a medical check-up, and should certainly report any flu-like illness. Influenza is characterised by the rapid-onset of high fever, headache, muscle ache, tiredness and respiratory symptoms. Travel Doctor-TMVC clinics have instituted their pandemic response, and Tamilflu is available in Travel Doctor-TMVC clinics

Imported Measles

Mon, 20 Apr 2009 21:49:13 +1000

Monday, 20 April, 2009 A case of measles imported from India into the United States is the latest in a growing list of cross-border measles episodes. Apart from this case 2009 has seen cases in California traced to a case infected in England, a cluster of sick children with measles in Taiwan traced to an unvaccinated child travelling from Vietnam and 2 other outbreaks related to cases who had visited mainland China. Over the past decade there have been more than 30 documented outbreaks in various countries both "developing" and "developed" (including Australia) where the source has clearly been a visitor or returning resident who had not been vaccinated. Measles is highly infectious and given the frequency of international travel introduction of cases from offshore is difficult to avoid, but the disease can be effectively prevented through vaccination.

Dengue fever in Argentina

Thu, 9 Apr 2009 00:00:00 +1000

Thursday, 9 April, 2009 A major outbreak of dengue fever has been reported from northern provinces in Argentina. Health Officials say that it is more serious than previous years due to the number of individuals and provinces affected. The Health Ministry reports 4147 registered dengue fever cases, which is more than double the number reported in the last serious outbreak in 2007. Unofficial figures are much higher. The worst affected area is the northern province of Chaco where the local authorities recorded 4000 dengue fever cases in Charata alone. The areas affected are not on the usual tourist routes but all tropical and sub-tropical areas should be regarded as potentially affected by dengue fever and the use of personal insect repellants is essential.

Yellow fever in Brazil update

Mon, 6 Apr 2009 20:07:39 +1000

Monday, 6 April, 2009 The outbreak of yellow fever in Sao Paulo state which began on 27 Feb 2009, is ongoing. On 31 Mar, two more cases were reported bringing the total number of confirmed cases of yellow fever in the state to 15, including 8 deaths from the infection. The 8 deaths were registered in the cities of Piraju, Sarutaia and Itatinga in the Botucatu region, southern part of the state. So far all those affected had been living in rural areas. A mass vaccination campaign is still in operation. The outbreak of yellow fever in Rio Grande do Sul state which began in Dec 2008, is ongoing. To date there have been 21 suspected cases of yellow fever; the Secretariat of Health has confirmed 13 cases including 6 deaths. The worst affected area is the Vale do Rio Pardo, 155 km from Porto Alegre .The immunisation campaign targeting the local population is to be extended. Although there appears to be no risk in the cities of Sao Paolo and Porte Alegre dengue fever is a major risk here (as well as in Rio de Janeiro)and anti-mosquito precautions are of prime importance. Vaccination is advised for travellers where there is any doubt about itinerary, and is required if returning from a yellow fever area to Australia within a period of 6 days.

Meningococcal Disease situation in West Africa

Fri, 27 Mar 2009 00:00:00 +1100

Friday, 27 March, 2009 During the first 11 weeks of 2009 (January 1- March 15), a total of 24 868 suspected cases have been reported to WHO by countries of the meningitis belt. More than 85% of the cases have occurred in one epidemic focus encompassing Northern Nigeria and Niger. So far 20 of Niger's 42 districts have crossed the alert or the epidemic threshold. In Nigeria cases originate from 16 Northern states, with states of the North East (Bauchi, Gombe and Yobe) being the most affected in the final week of the period but Katsina and Jigawa states are seriously affected as well. WHO is supporting the Nigerian Federal and National Ministry of Health to strengthen disease surveillance, laboratory diagnosis, case management and in defining adapted vaccination strategies. Technical experts from WHO have been supporting the Federal Ministry of Health in Nigeria since mid February 2009. Meningococcal meningitis occurs in epidemic form in the sub-Saharan states of Africa during the dry season. The predominant type in this particular outbreak is serotype A which is preventable by vaccination with the quadrivalent vaccine available at all TravelDoctor-TMVC clinics but not by the meningococcal C vaccine offered to infants and schoolchildren in Australia. Vaccination is strongly recommended to all travelers and tourists to countries extending in the line from Senegal to Ethiopia.

Third death from avian influenza in Vietnam

Mon, 23 Mar 2009 00:00:00 +1100

Monday, 23 March, 2009 A three-year-old Vietnamese boy died 19th March from bird flu, becoming the country's third human victim of the disease this year. The boy was admitted to the city's Tropical Diseases Institute on 16th where he tested positive for the H5N1 strain of the avian influenza virus. His condition worsened yesterday morning and he died in the afternoon. Vietnam has the world's second-highest bird flu death toll after Indonesia, with 55 deaths.

United Nations Cholera Update Report

Thu, 12 Mar 2009 00:00:00 +1100

United Nations Cholera Update Report Thursday, 12 March, 2009 Zimbabwe remains the worst affected country in a regional cholera outbreak, but in nine southern African countries surveyed, case numbers and fatalities are rising, according to a UN report released on 6 March. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) said as of 4 March, 124,404 cholera cases and 4,320 deaths from the waterborne disease had been reported in Angola, Botswana, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe since August 2008. Apart from Zimbabwe's 3,948 deaths, Malawi reported 95 deaths, Zambia 68 deaths, Mozambique 77 deaths, Angola 60 deaths and South Africa 59 fatalities from cholera, at a regional case fatality rate average of 3.5 percent. Zimbabwe's cumulative cholera caseload was 86,867 cases, followed by South Africa's 11,979 cases, Mozambique's 9,405 cases - although this does not include data from 2008 - Zambia's 5,763 cases, Angola's 5,368 cases and Malawi's 4,171 cases. [Cholera is almost entirely a water borne infection and tourists are very unlikely to be affected. For those like aid workers who might be at risk because of lack of access to safe water a course of the oral vaccine Dukoral is available.]

New polio cases in Kenya

Fri, 27 Feb 2009 00:00:00 +1100

Friday, 27 February, 2009 According to newspaper reports Polio has been detected in Kenya for the first time in 20 years. The infection has been confirmed in a 4 year-old girl and suspected in an infant, both from the Turkana District of northern Kenya. Last year the disease was detected in Sudanese refugees and it is suspected that the indigenous cases are a spillover from southern Sudan. Immunisation campaigns in Kenya had been disrupted by the political problems of 2007/8. The government, in collaboration with WHO and UNICEF, will carry out an emergency polio immunisation campaign targeting 96,000 children aged five years and below in the district. Travellers and tourists should ensure that polio immunisation is up to date. Provided that the primary course of vaccination has been carried out in early childhood one booster dose in adult life is considered sufficient.

Yellow Fever warning for Trinidad

Mon, 23 Feb 2009 00:00:00 +1100

Monday, 23 February, 2009 Following the detection of yellow fever in howler monkeys (see our Health Alert of January 29) the American Centers for Disease Control have recommended vaccination for visitors to Trinidad. Although no human cases of yellow fever have been reported since 1979, these monkey deaths suggest that yellow fever virus is circulating in the forested areas of Trinidad. People traveling outside Port of Spain, especially those who visit rural or forested areas of Trinidad, are at risk for infection with yellow fever virus, especially if they have not been vaccinated. Over 90% of the local population in Trinidad is vaccinated against yellow fever, thus human cases of yellow fever are rare despite the presence of disease risk.

Meningococcal meningitis in Nigeria

Fri, 20 Feb 2009 00:00:00 +1100

Friday, 20 February, 2009 As of 8 February 2009, the Ministry of Health of the Federal Republic of Nigeria has reported 1364 suspected cases of meningococcal disease including 108 deaths in 19 out of 35 states and Abuja. So far 30 Local Government Areas (LGA) in 8 states have crossed the alert or the epidemic threshold. In the last week, 11 LGAs crossed the epidemic threshold, and 600 suspected cases including 40 deaths were reported across the country. Cerebrospinal fluid specimens collected from Jigawa state have tested positive for Neisseria meningitidis serogroup A by latex test. The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control has approved the release of 268 750 doses of polysaccharide vaccine for a mass vaccination campaign in two affected LGAs in Jigawa state.

Human infections with Avian Influenza Egypt and Vietnam

Mon, 9 Feb 2009 00:00:00 +1100

Monday, 9 February, 2009 The Ministry of Health and Population of Egypt has announced a new human case of avian influenza A(H5N1) virus infection. The case is a 2-year-old male from Suez Governorate, Ganain District. His symptoms began on 2 February and he was hospitalized at the Suez Fever Hospital on 3 February. He remains in a stable condition. Of the 54 cases confirmed to date in Egypt, 23 have been fatal. The State-run online Lao Dong newspaper on 7th February has quoted health officials as saying that a 23-year-old man from Dam Ha district in the northern province of Quang Ninh, about 150 km from Hanoi had fallen ill and tests showed he carried the bird flu virus. This is the 2nd case of avian A/H5N1 influenza virus infection recorded in Viet Nam in 2009, bringing the total number of cases since 2003 to 108 (with 52 fatalities).

Avian influenza situation in China update

Wed, 4 Feb 2009 00:00:00 +1100

Wednesday, 4 February, 2009 2 February 2009 -- The Ministry of Health in China has announced a new confirmed human cases of H5N1 infection. The case is a 21-year-old female from Xupu County, Hunan province. She had onset of symptoms on 23 January and remains in hospital in a clinically stable condition. Investigations into the source of her infection indicate possible exposure to sick and dead poultry. Of the 38 cases confirmed to date in China, 25 have been fatal.

Marburg Fever acquired in Uganda

Mon, 2 Feb 2009 00:00:00 +1100

Monday, 2 February, 2009 The United States Centers for Disease Control has recently determined that a US citizen who became ill in January 2008 contracted Marburg hemorrhagic fever after a trip to Uganda. The patient developed illness 4 days after returning to the U.S., was hospitalized and is now fully recovered . No other cases have been identified in the United States at this time and there is no evidence that this traveler infected other people. Marburg hemorrhagic fever is a serious and sometimes fatal disease caused by the Marburg virus. The main ways that travellers may get Marburg virus are through direct contact with a patient suffering from Marburg hemorrhagic fever or through direct contact with infected bats, monkeys, or other wild animals that may be infected. During her trip to Uganda, the traveler visited “the python cave” in the Maramagambo Forest in western Uganda (at the southern edge of Queen Elizabeth National Park). A popular tourist destination, this cave contains large numbers of fruit bats. In July 2008, a Dutch tourist visited this same cave and died from infection due to Marburg virus after she returned home. [see our Health Alert of 22 July 2008] Travelers should be aware of the serious health risks associated with visiting caves in the Maramagambo Forest in Uganda and in other areas of Africa as well visiting old mines where bats may live. Apart from Marburg fever these risks include rabies, and histoplasmosis.

Additional Yellow Fever Alerts South America

Thu, 29 Jan 2009 00:00:00 +1100

Thursday, 29 January, 2009 The detection of Yellow Fever in monkeys may presage an outbreak in humans. In Argentina an alert has been issued for a number of northern provinces bordering Brazil and Paraguay. For tourists this essentially means Missiones Province and the Iguacu Falls. In Venezuela an outbreak “of great magnitude” in monkeys in the states of Aragua and Guárico has resulted in a National Alert recommending vaccination for anyone coming into Venezuela. The Caribbean islands of Trinidad and Tobago which have been free of the disease for decades have now issued a similar alert after detecting the disease in howler monkeys .

Avian influenza – situation in China - update

Thu, 29 Jan 2009 00:00:00 +1100

Avian influenza – situation in China - update Thursday, 29 January, 2009 27 January 2009 -- The Ministry of Health in China has announced three new confirmed human cases of H5N1 infection. The first, a 31-year-old female from Urumqi, Xinjiang Autonomous Region had onset of symptoms on 10 January. She received treatment in hospital but died on 23 January. Investigations into the possible source of her infection indicate recent visits to a live poultry market. The local authorities are currently conducting epidemiological investigations and close contacts are being monitored. To date, no clinical symptoms have been reported among the contacts. The second case is a 29-year-old male from Guiyang city, Guizhou. He had onset of symptoms on 15 January and remains in a critical condition. Investigations into the source of his infection indicate possible exposure at poultry market. The third case is an 18-year-old male from Beiliu City, Guangxi Province. He had onset of symptoms on 19 January and died on 26 January. Investigations into the source of his infection indicate a recent history of exposure to sick and dead poultry. Close contacts of the case are being monitored and to date all remain well. Of the 37 cases confirmed to date in China, 25 have been fatal. © WHO 2009

Malaria acquired in Goa

Tue, 27 Jan 2009 00:00:00 +1100

Tuesday, 27 January, 2009 Two cases of falciparum malaria ( the kind that can cause cerebral malaria) - one in Berne,Switzerland and the second in Manchester,UK - acquired in Goa have been reported in the past week by the International Society for Infectious Diseases. Because reports of P. falciparum_ malaria in visitors to Goa have appeared at regular intervals since autumn 2006 this popular tourist destination should be regarded as a risk area requiring the use of anti-malarial medication. Consultation with a travel health professional at one of our clinics will provide information, advice and the appropriate anti-malarials

Hepatitis A in Europe

Tue, 27 Jan 2009 00:00:00 +1100

Tuesday, 27 January, 2009 This vaccine- preventable virus disease, causing inflammation of the liver, is spread by contaminated food or water or by person-to-person contact. Therefore within a good public health system as in European countries the risk of acquiring it is increasingly low, but in such a situation very few people have natural immunity and when the virus is brought in it spreads rapidly. Recently Latvia, the Czech Republic and Slovakia have had serious outbreaks and many cases have been identified in Germany, Belgium and France. The virus had been brought in by unvaccinated travellers and the victims were all unvaccinated. The implications of the European experience are clear – all travellers to any country should be vaccinated against Hepatitis A.

More Human Bird Flu in Indonesia

Thu, 22 Jan 2009 00:00:00 +1100

Thursday, 22 January, 2009 An Indonesian Health Ministry statement on 21 January 2009 reports on two deaths after apparent contact with sick chickens. A 6-year-old girl in Bekasi, West Java, got sick after buying a chicken with her parents at a market and was hospitalized for a week. She died on 2 Jan 2009. In Tangerang just outside Jakarta a 29-year-old woman developed flu-like symptoms after visiting a market and died in a hospital 5 days later on 16 Dec 2008 .Double laboratory testing confirmed they had the H5N1 strain of avian influenza. These cases bring the total for Indonesia to 141 cases of whom 115 have died. Because Indonesia has declared itself to be endemic for avian influenza new outbreaks in poultry are only reported six-monthly and are not posted on our Health Alerts unless human cases are reported.

Fiji After the Deluge

Wed, 21 Jan 2009 16:00:59 +1030

Wednesday, 21 January, 2009 Despite the inconveniences and delays caused by the recent severe floods in the areas near Nadi Airport Fiji is still a relatively safe destination from the health point of view. On the Coral Coast and offshore island resorts the rainy season extends from October to April and while some flooding does occur this year's has been a one-in-ten-year event. Reports are that the Nadi water supply is rapidly being restored and supplies in resorts should be safe within days. Nevertheless visitors must take precautions until assured by the appropriate hotel or resort management; when in doubt drink only water that has been boiled or treated with water purifying tablets. This would apply also when visiting villages. Diarrhoeal diseases can occur but are usually not very common amongst tourists. Medical services are good, but anti-diarrhoeal medication as included in one of our packs is a good safety measure for adults and older children. Young children need fluid and electrolyte replacement but medical consultation should be sought if there is no improvement. Immunisation against Hepatitis A and Typhoid fever – both problems being related to contaminated food or water – is strongly recommended. Dengue fever is a constant hazard during the rainy months and with much water standing around after the floods mosquito breeding will be even greater than usual. Use insect repellants containing DEET or Picaridin extensively for adults as well as for children. Lower strength ‘paediatric' insect repellants will not work as well nor last as long as the higher strengths and are safe to use in toddlers. There is no malaria on Fiji.

More Human Bird Flu Cases in China

Wed, 21 Jan 2009 16:00:23 +1030

After the lapse of almost one year without a case, there have been 4 human cases of avian A/H5N1 influenza reported from China since beginning of 2009: A 19-year-old woman living in Beijing; a 2-year-old girl contracting infection in Hunan province and treated in Shanxi province, now critically ill; a 27-year-old woman in Shandong province who died; and now a 16-year-old student in Guizhou province, who remains in a critical condition. None of these cases are connected, and there has been no spread so far to contacts. In 3 of the cases, exposure to diseased poultry has been confirmed. The Chinese authorities have stepped up their monitoring of the sale of live poultry in the run-up to the Lunar New Year holiday, which begins on Mon 26 Jan 2009. The government has warned that the approach of the holiday -- and an increase in the sale and movement of poultry -- brings a higher risk of the emergence of an epidemic. The total number of confirmed bird flu cases recorded in China is now 35.

Meningitis in Uganda

Wed, 21 Jan 2009 15:59:40 +1030

Recent outbreaks of meningococcal meningitis are currently being reported from the Arua and Hoima districts of Uganda. Arua is to the north and Hoima to the east of Lake Albert. Meningococcal meningitis occurs sporadically or as epidemics in sub-Saharan Africa, which is known as the "Meningitis Belt", an area that stretches from Senegal in the west to Ethiopia and Eritrea in the east and that includes northern Uganda. Numerous cases of meningococcal meningitis are reported in this region of Africa each year during the dry season, between December and June, and every 6-12 years a large outbreak occurs. Travellers “on the beaten path” to tourist areas in East Africa in general are at low risk of acquiring meningococcal infection but if travel involves touring or working in remoter areas vaccination is advised Previous outbreaks have proven in this area to be due to the A strain of the meningococcus organism which is not prevented by the Men C vaccine given to pre-school children and teenagers in Australia. There is currently a shortage of the polyvalent vaccine but this is expected to be resolved shortly.

Yellow Fever threat Argentina

Wed, 21 Jan 2009 15:56:16 +1030

The first cases of Yellow Fever in Argentina were reported last year in the north-eastern province of Missiones. The patents involved were rural workers in the forested areas bordering on Rio Grande do Sol in Brazil and were presumed to have acquired the sylvan form of the disease which is transmitted by the Hemogogus species of mosquito from infected monkeys to humans. There is now suspicion that yellow fever has caused the death of a 36 year-old woman in Posadas City in Missiones province who had not been outside the city during the duration of the incubation period of Yellow Fever. If confirmed, the case raises the possibility of transmission human-to-human through the urban Aedes mosquito. Posadas City is close to the Paraguay border where there was a serious outbreak at the beginning of last year. Although Argentina is not yet a designated Yellow Fever country it is strongly recommended that anyone visiting the northern area including particularly the Iguacu Falls be vaccinated against Yellow Fever

Egyptian girl infected with avian influenza

Wed, 14 Jan 2009 15:45:43 +1030

Egyptian girl infected with avian influenza Wednesday, 14 January, 2009 An Egyptian girl of 21 months has contracted bird flu [avian A/H5N1 influenza virus] and is in hospital in a stable condition, a health ministry official said on Monday [12 Jan 2009]. She is the 52nd human case of bird flu in Egypt and the 2nd of this winter [2008/2009] season. The girl showed the 1st symptoms on Friday [9 Jan 2009] and was admitted to a specialist hospital on Saturday [10 Jan 2009], said assistant health minister Nasr el-Sayed, quoted by the state news agency MENA. The other Egyptian to contract the deadly virus this year [2008], a woman near the southern town of Assiut, died on 15 Dec 2008. From the 52 human cases in Egypt over almost 3 years, 23 have died, but the number of cases seems to be diminishing. The girl, from the village of Kerdasa on the western edge of Cairo [in the 6th October Governorate], had been in contact with infected birds and showed the usual 1st symptoms -- a high temperature, vomiting, and diarrhea, Sayed said. She is receiving the antiviral drug Tamiflu [oseltamivir], which has proven effective against bird flu if treatment starts early.

Rabies outbreak in Vietnam

Mon, 12 Jan 2009 15:45:11 +1030

Monday, 12 January, 2009 The Thanh Nien News in Vietnam has carried a report on 10th January that 19 people from a commune in the province of Binh Thuan have been hospitalized after being attacked by rabid dogs. All the victims, from Binh Thuan's Tan Phuc Commune, were listed as being in critical condition. A hospital doctor is quoted as saying that this was the first time the hospital had received so many people from one place bitten by rabid dogs in separate attacks. The affected area is inland situated roughly midway between Ho Chi Minh City and Da Lat. Rabies is unfortunately endemic in Vietnam and can be present in metropolitan as well as rural areas. The risk to short-term tourists is very small and because the cost of vaccination is high it is not widely used. However, for anyone working in Vietnam for any length of time vaccination is well worth while. Any animal bite or scratch, however trivial, must be suspected of transmitting rabies and cannot be ignored. The wound must be thoroughly cleansed and immediate medical attention sought. This applies whether you have been vaccinated or not. If vaccinated a booster is recommended. If not vaccinated then a full post exposure course of vaccination is needed together with an injection of rabies antiglobulin (not always available everywhere).

Human cases of bird flu China and Vietnam

Wed, 7 Jan 2009 15:44:36 +1030

Wednesday, 7 January, 2009 A confirmed case of human infection with the avian influenza H5N1 virus has occurred in Beijing. A 19 year old woman was admitted to hospital on 24 Dec 2008 and died on 5 January 2009. Chinese media report that she had bought a duck at a market outside Beijing. She is thought to have become unwell after slaughtering the bird. This is the 31st case of human infection in China. An 8-year-old Vietnamese girl from the country's northern Thanh Hoa Province has been infected with bird flu and hospitalized at the Viet Nam National Institute of Hygiene and Epidemiology and currently is reported to be in a stable condition. According to press reports the girl ate chicken before being hospitalized, and specimens from poultry raised in Dien Chung town, where the girl is from, have recently tested positive for bird flu virus. This is the 1st human case of H5N1 avian influenza to have occurred in Viet Nam since March 2008. Prior to the current case, there had been 106 human cases.

Australian Tourists Catch Chikungunya Fever

Fri, 2 Jan 2009 15:43:40 +1030

Friday, 2 January, 2009 Australian Tourists Catch Chikungunya Fever The Public Health Virology Laboratory in Queensland has confirmed in a report to the International Society for Infectious Diseases that two Australian travellers recently returned to Brisbane from Sibu Island off the east coast of Malaysia have been diagnosed with chikungunya virus infection. They both fell ill within 5 days of arriving in Sibu, Johor province for a holiday. Both were exposed to mosquito bites and contracted similar symptoms of fever, joint pain and rash. Our Alert of 24th December refers to the increase of this mosquito-borne disease in peninsular Malaysia.

Rabies in Central Asia

Fri, 2 Jan 2009 15:43:01 +1030

Friday, 2 January, 2009 Government authorities have reported that three people have died from rabies in Chimkent, southern Kazakhstan since October 2008. While rabies is a risk throughout the country Chimkent, near the border with Kirghistan, is the worst affected area. At the same time Tajik medical authorities are concerned over increasing number of rabies cases in that country. According to Navrouz Jaffarov, head of the center for sanitary and epidemiologic supervision within the Ministry of Health 13 cases of rabies have been registered in the country over the first 10 months of this year [2008], which is 7 cases more than in the same period of last year. Rabies is transmitted by the bite – or scratch – of an infected mammal, most frequently a canine but other mammals including bats can carry the disease. The risk is very small for short-tem travellers to main centres but it must be noted that the availability of vaccines cannot be relied on in smaller areas. Those who are going to work in these countries should consider having the course of preventive vaccination before travelling.

Cholera in Zimbabwe - update

Mon, 29 Dec 2008 15:42:16 +1030

Cholera in Zimbabwe - update Monday, 29 December, 2008 © WHO 2008 26 December 2008 -- As of 25 December 2008, a total of 26 497 cases, including 1 518 deaths, have been reported by the Ministry of Health in Zimbabwe. Cases are now being reported from all 10 of the country's provinces. Harare, particularly Budiriro suburb in the south west, accounts for the majority of cases, followed by Beitbridge in Matabeleland South and Mudzi in Mashonaland East. The current outbreak is the largest ever recorded in Zimbabwe and is not yet under control. In fact, the epidemiological week ending 20 December saw over 5 000 new cases - an increase in the number of weekly cases relative to previous weeks - and an increase in deaths outside treatment/health centres. The overall Case Fatality Rate (CFR) has risen to 5.7% - far above the 1% which is normal in large outbreaks - and in some rural areas it has reached as high as 50%. Mortality outside of healthcare facilities remains very high. This is a clear indication that better case management and access to healthcare is needed - in particular an increased use of oral rehydration therapy with Oral Rehydration Salts in communities very early after onset of the disease. The outbreak has taken on a subregional dimension with cases being reported from neighboring countries. In South Africa as of 26 December, 1 279 cumulative cases and 12 deaths (CFR of 0.9%) had been recorded, with the bulk of the cases (1 194) in the Limpopo area. Cases have also been reported in Botswana (Palm Tree). The current situation is closely linked to the lack of safe drinking water, poor sanitation, declining health infrastructure, and reduced numbers of healthcare staff reporting to work. Other current risk factors include the commencement of the rainy season and the movement of people within the country, and possibly across borders, during the Christmas season. WHO, together with the Ministry of Health and partners from the health and Water and Sanitation clusters, has established a cholera outbreak response coordination unit in order to strengthen the reporting and early detection of cases, improve the response mechanism and access to healthcare and ensure proper case management. WHO has also deployed experts in public health, water and sanitation, logistics and social mobilization. In light of the extent and pace of expansion of the outbreak, reinforcing all control activities across the country is critical. Given the current dynamic of the outbreak and the context of the collapsed health system, a cholera vaccination is not recommended. Moreover, the use of the internationally available WHO prequalified oral cholera vaccine is not recommended once an outbreak has started due to its 2-dose regimen and the time required to reach protective efficacy, high cost and the heavy logistics associated to its use. The use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the occurrence of severe adverse events. In controlling the spread of cholera WHO does not recommend any special restrictions to travel or trade to or from affected areas. However, neighboring countries are encouraged to reinforce their active surveillance and preparedness systems. Mass chemoprophylaxis is strongly discouraged, as it has no effect on the spread of cholera, can have adverse effects by increasing antimicrobial resistance and provides a false sense of security.

Chikungunya fever spreads in Malaysia

Wed, 24 Dec 2008 11:15:48 +1030

Wednesday, 24 December, 2008 Further to our Alert of December 17th - the Malaysian National News Agency Bernama on December 18th posted a statement from Minister Datuk Liow Tiong Lai that the number of reported cases of chikungunya fever throughout peninsular Malaysia has reached about 4000. The disease which was first detected in Johor had spread to Negeri Sembilan, Melaka, Perak, Selangor and the latest reports come from Kedah. Chikungunya fever is a virus infection transmitted by Aedes day-biting mosquitoes. The symptoms of fever, headache, nausea and severe joint pains are similar to those of dengue fever but it does not have the possible, though unusual, complication of life-threatening haemorrhages. Nevertheless chikungunya can be dangerous where there are pre-existing medical conditions and at the extremes of life, and any fever is undesirable to a woman in the first three months of pregnancy. There is currently no vaccine and prevention is dependent on preventive measures against mosquito bites.

Rabies in Irish woman ex South Africa

Wed, 24 Dec 2008 11:15:21 +1030

Rabies has been confirmed in a woman admitted to hospital in Belfast, Northern Ireland.The patient had worked as a volunteer with animals in South Africa for short periods during the past 2 years, and had close contact with various animals including dogs. Rabies is endemic in South Africa where bites from infected dogs are the main source of rabies in humans. Rabies is almost totally preventable by vaccination. Because the vaccine is expensive and has to be given as a series of three injections it is usually not thought necessary for short term travellers where the risk is extremely low. This woman worked with animals and therefore the risk was definitely not low. Rabies vaccination must be considered for anyone who by the nature of their work – whether professional or voluntary – are at risk of contact with animals in a rabies endemic area. It should also be considered for travellers to such areas for more than a month unless there is reliable access to prompt, safe medical care, as well as anyone even over shorter periods who cannot get access to prompt (within 24 hours) medical attention

Malaysia dengue and chikungunya fevers update

Fri, 19 Dec 2008 15:11:39 +1030

A Health Ministry statement issued on Tuesday (16th December) stated that 44,494 case of dengue fever had been reported over the year in peninsular Malaysia with 1,273 being reported in the week Nov 30 to Dec 6 . A total of 98 people have died of the disease . Chikungunya fever, another virus illness transmitted by mosquitoes has also been present in Malaysia this year and in the past fortnight there has been an outbreak in villages with 32 cases being admitted to the Sungai Petani Hospital. The increase has been attributed to , the rainy weather and the public's lack of awareness of keeping their premises and surrounding free of aedes mosquito breeding grounds.

Possible Rabies on Bali - Update

Tue, 16 Dec 2008 15:24:57 +1030

The reports of rabies cases on Bali, have been accepted by the public health authorities as being correct, it appears that laboratory confirmation has been done in Indonesia. We now consider that rabies exists on Bali, and any animal bite or possible rabies exposure should be managed appropriately with post-exposure prophylaxis (PEP), which consists of the administration of rabies vaccines on days 0,3,7,14,28 and the use of rabies immunoglobulin in those people who are not previously immunised, and only 2 booster does of vaccine in those who are already vaccinated. Vaccinations against rabies are available at Travel Doctor-TMVC clinics, although are not generally recommended for short-term holiday stays. Historically Bali has been considered rabies-free, but rabies is an extremely serious disease, and control efforts (vaccination of dogs) will need to be introduced. Travellers who experience an animal bite on the island of Bali, should wash the wound immediately and report the bite to medical services. In Australia, those bitten travellers should attend their closest Travel Doctor-TMVC clinic.

South African death in Brazil update

Wed, 10 Dec 2008 16:25:17 +1030

Wednesday, 10 December, 2008 Investigations have now shown that the cause of the haemorrhagic fever causing the death of a South African businessman in Rio was not the arenavirus recently reported in Johannesburg ex-Zambia; the infection was due to tick-bite spotted fever. This is a severe form of South African tick-bite fever which usually is not life-threatening and responds well to antibiotic therapy. Tick bites are usually sustaining when walking through grassland areas but also when camping on the ground in the open The use of insect repellants will reduce the chances of tick bites and camping gear such as groundsheets should be impregnated with permethrin. Fever, with headaches and nausea are early symptoms and a fine rash may occur after 2 or 3 days. In all such cases the presence of the tick or the small black area left by its bite must be sought. When in doubt seek medical attention as an antibiotic such as doxycycline will cure the infection.

Contaminated pork products Ireland Tuesday, 9 December, 2008

Tue, 9 Dec 2008 16:24:47 +1030

Ireland has launched an intensive investigation to establish the source of a toxic substance that forced the recall of all Irish pork products. The Irish government ordered the recall on Saturday [6 Dec 2008] of all pig meat products made in the Republic of Ireland after dioxins were discovered in slaughtered pigs thought to have eaten contaminated feed. The recall included products sold in Ireland and abroad. Contaminated Irish pork was found in France and Belgium, but the Food Safety Authority of Ireland (FSAI) said the problem was restricted to "Irish pig meat related to an Irish feedstuff." The FSAI said it was almost certain that the source of the contamination was oil which mistakenly found its way into pig feed made at an Irish factory. Dioxins are toxic chemicals that can have serious health effects, including causing cancers, if there is long-term exposure to them at high levels. FSAI deputy chief executive Alan Reilly said dioxin levels found in meat samples were "between 80 and 200 times" above the legal limit. But he said the risk to public health was "very, very low. "You would have to be eating products containing these chemicals for 40 years before you would show any signs of illness." The recall involves pork meat, bacon, pork sausages, sausage meat, gammon steaks, offal from pigs, salami, ham, sausage rolls, black pudding and white pudding. The products concerned were all made since September 2008, because scientific evidence suggests the contamination was recent.Ireland is a major exporter of pork with products sent to Britain -- the main destination -- and countries including Japan, Germany, Russia, France and the United States. Laboratory tests in Britain had confirmed the presence of dioxins in both pig meat and pig feed samples. Tests in France and Belgium had also revealed contaminated Irish pork products. Both countries had received products from a processing plant in the Netherlands where sides of pork from Ireland were boned and processed before being shipped on. The European Commission said in a statement it was "closely following up this contamination incident and the actions taken to withdraw any potentially contaminated pork meat and pork meat products from the market."

South African death from Haemorrhagic Fever in Brazil

Mon, 8 Dec 2008 16:24:00 +1030

Monday, 8 December, 2008 An official statement has been issued by the Superintendent of Health Surveillance for the Secretary of Municipal Health of the city of Rio de Janeiro, Brazil regarding the death of a South African traveller to Rio who died on December 2nd after displaying symptoms of a haemorrhagic fever. The patient first showed signs of illness on 27th November having arrived from Johannesburg on 23rd November. 15 days prior to his arrival in Rio de Janeiro, he had an orthopedic surgical procedure performed at Morningside hospital, Johannesburg, South Africa. At this time there was an outbreak of an arenavirus [infection] in that hospital which originated with a patient who came to that hospital from Zambia. There were a resultant 4 additional hospital-acquired cases of the same disease. The statement goes on to say; “ We are investigating arenavirus, hantavirus, hepatitis, rickettsia, yellow fever, dengue fever, and leptospirosis. We have a list of all his contacts at the 2 hospitals in Rio de Janeiro where he was seen, the hotel where he stayed and his job. They will be monitored for 21 days following his death.” Experts in South Africa have expressed doubts that the cases were connected but further tests should give an answer. .

Possible Rabies on Bali

Thu, 4 Dec 2008 16:23:13 +1030

Thursday, 4 December, 2008 Unconfirmed reports about a cluster of rabies cases in south Bali area of Ungasan have appeared in the local press in Bali. While denials have been made by the local hospital, other reports quote a local veterinarian as saying rabies virus was the cause. These reports are unreliable at this time, as the diagnostic tools to diagnose rabies formally are not generally present locally, so we will continue to monitor the situation and sek reports from the Indonesian Health authorities. Officially, Bali is considered rabies-free, but rabies was introduced to Flores in recent years by dogs accompanying fishermen, and more than 100 persons have died there in the last 10 years. In the meantime, travellers who experience an animal bite on the island of Bali, should wash the wound immediately and report the bite to medical services. In Australia, those bitten travellers should attend their closest Travel Doctor-TMVC clinic.

Malawi possible rabies exposure alert

Wed, 10 Dec 2008 16:22:10 +1030

Tuesday, 25 November, 2008 The Health Protection Agency of the United Kingdom has been made aware of a case of confirmed rabies in a puppy that may have been in contact with travellers at the Mabuya Camp backpacker lodge near Lilongwe (the capital of Malawi). Anyone who stayed at the lodge between 28 Oct - 14 Nov 2008, and who had contact with the puppy to seek medical advice.

Dengue update South Pacific - New Caledonia adopts visitor screening.

Mon, 24 Nov 2008 16:21:32 +1030

Monday, 24 November, 2008 The Australian Broadcasting Commission reports that Pacific passengers arriving in New Caledonia are now being screened for possible dengue fever symptoms. Oceania Flash reports that local health services are using a state of the art, heat-sensitive camera filming device to screen passengers, particularly those arriving from Fiji.The camera picks up unusually high body temperature. New Caledonia is currently facing a dengue type1 epidemic, with over a thousand cases reported while Fiji is dealing with a type 4 epidemic with more than 2000 people affected. America Samoa is also reporting a large number of dengue cases. On the basis of past history of outbreaks visitors to any of the South Pacific islands must assume that there is a risk and must use personal mosquito repellants containing DEET or Picaridin

Meningitis in Ghana

Wed, 19 Nov 2008 16:20:30 +1030

Wednesday, 19 November, 2008 Ten people have been confirmed dead and two are hospitalised following an outbreak of meningitis in the Yaw Bronya farming community in the Ashanti Region, 250km north of the capital Accra. Local authorities have closed down schools and banned all public gatherings. Health workers from Accra have travelled to Yaw Bronya and are on standby to attend to new cases. Ghana is a country in the “meningitis belt' stretching across sub-Saharan Africa from Senegal to Ethiopia and epidemics can be expected to break out anywhere especially during the drier months. The germ is spread by ‘droplet' infection from person to person. Vaccination with the quadrivalent vaccine will provide protection and it is wise for all travellers to any of these countries to be immunised but note that the Meningitis C vaccine widely used now in Australasia is insufficient to provide protection for international travellers

Cholera severe and widespread in Zimbabwe

Wed, 19 Nov 2008 16:19:43 +1030

Wednesday, 19 November, 2008 In Zimbabwe's capital, Harare, Medecins Sans Frontieres (MSF) is responding to a cholera outbreak which the local Ministry of Health has declared "the biggest ever in Harare". MSF has set up cholera treatment centres in Budiriro Polyclinic and Harare Infectious Diseases Hospital, where on average 38 new patients are admitted every day. About 78 percent of the patients come from 2 densely populated suburbs in the south west of Harare, Budiriro and Glen View, which have a combined population of approximately 300 000 people but the outbreak has also affected people from the neighbouring suburbs. Up to 1.4 million people are endangered if the outbreak continues to spread. The disease broke out 3 weeks ago in Harare, and health authorities have been battling to contain it but city health director Stanley Mungofa admitted Monday [17 Nov 2008] the cholera outbreak in the city was getting worse and claiming more lives. Much of the recent cholera activity in Zimbabwe has been in the capital Harare and other northern areas of the Mashonaland province. However, in the southern Matabeleland province bordering South Africa the district medical officer for Beitbridge has confirmed an outbreak in the district. The first case was detected on 14 November and by 17 November 431 cases had been admitted to Beitbridge Hospital which because of inadequate personnel and resources has been forced to close the hospital to non-cholera related cases. Medecins Sans Frontieres and the International Organisation for Migration have deployed their staff to assist in fighting the epidemic. The two organisations also supplied the hospital with medical kits such as gloves, tablets, and protective garments for the health staff. Travellers passing through the border post have also been put on high alert. Beitbridge border post is reported to be the busiest point of entry in sub-Saharan Africa with a huge volume of both human and motor traffic passing through everyday. In some of the rural areas of Zimbabwe cholera is endemic and occurs every year. However, until recent years cholera was relatively rare in urban areas of the country where treated piped water and flush toilets exist in most homes. With the ongoing economic crisis and the constantly deteriorating living conditions these urban areas are more and more affected. Travellers and tourists cannot rely on the safety of water supply and although bottled water may be available and safe in some areas boiling is the most reliable way of sterilising water. The oral vaccine Dukoral may provide an extra level of protection for anyone working in the area.

Botswana First report of Unusual Parasitic Disease

Mon, 17 Nov 2008 16:19:09 +1030

Monday, 17 November, 2008 Scientists at the National Institute for Communicable Diseases National Health Laboratory Service in Johannesburg, South Africa have identified 2 separate clusters of gnathostomiasis acquired in the Okavango Delta, Botswana, with a total of 8 confirmed or probable cases. Both outbreaks (one in August, one in November 2008) occurred in groups of people who ate raw, marinated bream (_Tilapia_ species). After non-specific malaise and/or gastrointestinal discomfort, some exposed individuals presented with recurrent episodes of painful migratory skin nodules and transient urticaria. Several small worms were extracted from localised skin lesions, which were identified as larvae of a _Gnathostoma_ species. These nematode parasites have a complicated life cycle involving a variety of hosts. Humans become infected when they eat raw or undercooked fish, crabs or crayfish, but also rarely from undercooked poultry and reportedly by drinking water containing Cyclops – microscopic creatures – infected with larvae. Gnathostomiasis is well-known in Southeast Asia and Central and South America and is regarded as an emerging imported disease resulting from increasing international travel and adventurous eating. This is the first description of the disease from Botswana; the only other recognised outbreak in the region occurred on the Zambezi River in western Zambia.

Dengue in South America update

Mon, 10 Nov 2008 16:18:08 +1030

Wednesday, 12 November, 2008 ProMED has reported (4th November) that in Brazil, Rio de Janeiro state has registered 250,026 cases of dengue in 2008 through 29 Oct 2008, including 181 confirmed deaths, with 143 more deaths awaiting confirmation; 56 confirmed deaths were from DHF. Half the cases (125,988) and 105 of the confirmed deaths were in the capital, Rio de Janeiro itself. The age group with the largest number of cases (44 per cent) was 20-49 years. In Peru, health authorities have reported that a fast-growing outbreak of dengue fever, aggravated by heavy rain and torrid heat, might lead to the reappearance of the more serious dengue hemorrhagic fever in Iquitos, a city of about 300,000 residents in Peru's northern Amazon region. According to Loreto's Regional Health Office, 4348 people have contracted dengue fever since January 2008. In St. Maarten, as authorities scramble to stem the dengue outbreak in St Maarten, the number of confirmed cases continues to climb. The Dengue Action Response Team (DART) announced that 90 laboratory-confirmed cases of dengue had been recorded 1-25 Oct. The results of 48 lab tests are pending, and DART said the figure was expected to surpass 100 this month. There is a dengue outbreak on the island of Curacao. In September 2008, there were 23 registered cases; in October 2008, there were 32. That is more than usual for this time of year, when there is always an increase in dengue cases due to rainfall. The rising trend has been established since July of this year.

Mumps cases in UK University

Mon, 10 Nov 2008 11:11:47 +1030

Monday, 10 November, 2008 Students at the University of Gloucestershire in the west of England are on alert following a mumps outbreak. A total of 10 students in Cheltenham and Gloucester have been diagnosed with the infection and the number is expected to rise. Health officials are now working at the university's 4 campuses in Cheltenham and Gloucester, which house more than 9500 full and part time students, in an effort to contain the outbreak. The United Kingdom Health Protection Agency is working with the university and is checking all suspected cases of the illness that have been reported in the past 2 weeks. Mumps virus infection in young adults is likely to be a consequence of incomplete or absence of MMR vaccination in their earlier years.

Cholera in south China

Mon, 10 Nov 2008 11:07:25 +1030

Monday, 3 November, 2008 Cholera has been identified as the cause of an outbreak of severe diarrhoeal disease among students at Hainan University in the provincial capital city of Haikou. According to Xinhua News Agency the university has been placed under quarantine. The source of the outbreak has not yet been determined but a similar outbreak in the nearby city of Danzhou has been attributed to contamination of the water supply following widespread flooding in mid-October. Hainan is an island off the south mainland coast and is not on the regular tourist route. However, it is increasing in popularity and has several tourist hotels and resorts. Water-bourne cholera can be totally avoided by consumption of safe water and it is always best to assume (unless assured otherwise) that local tap water and ice are potentially unsafe.

Animal Rabies in north-east Italy

Mon, 10 Nov 2008 11:06:48 +1030

Tuesday, 28 October, 2008 The Ministry of Health has confirmed that a fox which attached a man walking in the forests of Resia district was infected with rabies. Rabies was laboratory confimed on 21 Oct 2008. Resia district is located in the Friuli-Venezia Giulia Regin of north-eastern Italy, close to the borders with Austria and Slovenia. This area of north-east Italy has been known for animal rabies in the past; this is the first case in thirteen years and the infection may have been introduced to Italy from the east This area is not a popular tourist destination in Italy, however visitors to this region should be aware of the rabies risk. This awareness must apply to all of Europe except the United Kingdom. Animal contact should be discouraged but in the event of a bite or scratch from any animal including bats the wound must be thoroughly washed and immediate medical attention should be sought.

Dengue update South Pacific Islands

Mon, 10 Nov 2008 11:06:21 +1030

Tuesday, 28 October, 2008 Dengue fever transmitted by day-biting mosquitoes has been reported regularly from various island states in the South Pacific over the past decade. Currently there is a definite upsurge throughout the region Fiji reporting nearly 2000 cases – predominantly in the Central and Western regions - and American Samoa reporting a year's supply of cases in September alone. Samoa, Tonga, New Caledonia, Kiribati, and Palau are also reporting unusually high levels of the infection. The months of highest incidence are September to March coinciding with the heaviest rainfall, but in recent years cases have occurred at other times of the year as well. Putting this into perspective anecdotal evidence suggests that there is not a very high incidence among short term tourists to the South Pacific probably because by now travelers have become educated in the liberal use of mosquito repellants, and because resort proprietors are aware of the need to exercise mosquito control strategies. Nevertheless dengue can spoil a holiday and occasionally, especially in young children, it can be life-threatening. Mosquito repellants are an essential part of travel luggage and using the repellant must be part of the daily routine.

Dengue update Malaysia

Mon, 10 Nov 2008 11:05:55 +1030

Monday, 20 October, 2008 Malaysia is considering imposing a quarantine in a small northern town in the state of Perak as part of efforts to stem a dengue fever outbreak, a news report said 10 Oct 2008. Health Minister Liow Tiong Lai said 175 people in the northern Manjung town were treated for suspected dengue fever from 18 Aug-4 Oct this year [2008], more than double the 77 patients recorded during the same period last year [2007]. A total of 4 patients have died from the mosquito-borne disease this year, he said. "We are seriously considering imposing a quarantine," Liow was quoted as saying by the New Straits Times daily. The government has been holding campaigns to educate the public as well as conduct checks for mosquito-breeding sites on residential and construction sites to try to stem dengue cases. Despite the efforts, the number of cases and deaths continues to rise each year. While this report refers to one small area dengue fever has been reported in most parts of Malaysia including Kuala Lumpur and visitors must be vigilant in the use of mosquito bite protective measures.

Typhoid in PNG

Mon, 10 Nov 2008 11:05:30 +1030

Monday, 20 October, 2008 There are reports of an outbreak of typhoid fever in the northern coastal province of Morober. Typhoid fever is a serious and potentially fatal disease in which there has been an increasing resistance to antibiotic treatment. The usual cause of such outbreaks is contamination of the water supply but it an also be spread by contaminated food. Vaccination is partially effective but although it is recommended for visits to rural PNG (including the Kokoda trail) this does not preclude taking particular care about ensuring safe water supply.

Outbreak of a possible new acute disease, West Africa

Mon, 10 Nov 2008 11:04:58 +1030

Outbreak of a possible new acute disease, West Africa Wednesday, 15 October, 2008 Promed has reported today that the results of tests conducted at the Centers for Disease Control in Atlanta (CDC), USA, and at the National Institute for Communicable Diseases of the National Health Laboratory Service in Johannesburg, provide preliminary evidence that the causative agent of the disease that has resulted in the recent deaths of 3 people in hospitals in Johannesburg, is a rodent-borne arenavirus related to the Lassa fever virus of West Africa. Further tests, to confirm the diagnosis by growing the virus in culture and to characterize it further, are in progress. It needs to be determined whether it is a previously unrecognized member of the arenaviruses, and what its distribution and reservoir host are. Arenaviruses cause chronic infection in wild rodents (multimammate mice) with excretion of virus in urine, which can contaminate human food or house dust. Arenaviruses have been found in southern African rodents in the past, but there has been no previous association with human disease. The virus associated with the present outbreak may prove to be a new member of the group. In the current outbreak there have been 3 deaths, the index case ex-Zambia and 2 persons who acquired disease after close contact in the nosocomial setting. A 4th patient, a nurse, who had close contact with the 2nd patient, has developed a febrile illness and thrombocytopenia, and has tested positive by PCR [polymerase chain reaction] for arenavirus. She is currently being treated with ribavirin. The efficacy of ribavirin has been documented in Lassa fever, but is unknown for the current virus. The incubation period for cases in the present cluster ranges from 7-13 days. There is a prodromal illness of about 7 days with myalgia, headache, diarrhoea, and a severe pharyngitis. This is followed by a more severe illness with moderate thrombocytopenia but no bleeding. Hepatic dysfunction with raised transaminases has typically occurred late in the course of disease. [Source: Centers for Disease Control and Prevention, Atlanta, USA National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa Department of Pathology, University of the Witwatersrand, Johannesburg, South Africa]

Measles again - Perth WA, Thailand and Netherlands

Mon, 10 Nov 2008 11:04:19 +1030

Thursday, 9 October, 2008 Press reports indicate that one of the students returning from Thailand following the tragedy of the lightning strike has developed measles which would have been acquired in Thailand. The student had apparently not been vaccinated against measles. The West Australia health authorities are tracing his contacts at the school and on the airline flight from Thailand in case any of them had not been previously vaccinated. On the same day as this report comes another international report from Utrecht, Holland of 16 cases among children of a group who oppose vaccination on religious grounds. Measles still has a considerable morbidity with deafness or neurological problems as a possible result of the infection. Rarely it can even be fatal. Vaccination prevents infection. Traveldoctor TMVC recommends checking up on vaccination status before any travel.