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WORLD TRAVEL HEALTH ALERTS - AUGUST 25, 2010

- Delhi's dengue danger rises as Games draw closer
- Rabies claims two young lives in Bali
- NT dengue case a bit(e) of a mystery
- Dengue deaths at five-year high in Laos
- High cholera death rate may be linked to global warming: WHO
- Fears grow over water-borne diseases in Pakistan
- Ten-fold rise in Nigeria as deadly measles sweeps Africa
- Travellers warned after measles outbreak on NSW North Coast
- Three more deaths from swine flu in New Zealand
- West Nile claims another life in Greece
- Sharp rise in malaria in Seoul
- Leptospirosis deaths close parks in Malaysia
- No tourist deaths from sleeping sickness

Delhi's dengue danger rises as Games draw closer
Dengue fever is looming as a real threat to Commonwealth Games athletes and spectators as case numbers continue to rise in New Dehli. Fuelled by incessant monsoon rains, the capital has recorded 322 cases - although media reports put the unofficial figure much higher. With the Games due to begin in 41 days (October 3), Games organisers are worried: the dengue-transmitting Aedes mosquito has a life-span of 45 days. Indian doctors say foreigners will have far lower resistance to dengue than local people. More details.
Advice to travellers: Australians visiting tropical countries, especially in the Caribbean, Latin America and SE Asia should be aware that dengue fever continues to pose a significant travel health risk due to widespread outbreaks. There is no vaccine for dengue: Preventing mosquito bites is the only sure way to avoid the risk. Using an effective insect repellent containing DEET or Citriodiol is essential. Repellent should be applied regularly to exposed skin when outdoors at any time of the day in any setting, including resorts and hotels.

Rabies claims two young lives in Bali
In Bali, the death of two children from rabies on the weekend has raised the official death toll from an island-wide epidemic to 78. As authorities struggle to control the disease, tourists have been warned to avoid any contact with domestic or wild animals, especially dogs. More details.
Advice to travellers: As stated previously, the risk of rabies for most short-stay travellers to Bali is low. While dogs are the most common carriers of rabies, cats, m onkeys and many other animals can also transmit the disease. Rabies is present in most countries and all travellers should be aware of the importance of avoiding contact with wild and domestic animals. If bitten, urgent post-exposure treatment is required. More on rabies.

NT dengue case a bit(e) of a mystery
Australia's Northern Territory has recorded its first case of dengue fever in 70 years, but the source of the disease remains a mystery. The dengue-carrying Aedes egypti mosquito does not exist in the Territory, and the infected man had not travelled overseas. The mozzie may have arrived by ship or in cargo, according to a spokesperson for NT Health. More details.

Dengue deaths at five-year high in Laos
Dengue fever has killed 36 people in Laos this year, the worst epidemic in at least five years. More details.

High cholera death rate may be linked to global warming: WHO
The WHO says a global warming may be a factor in the surge of cholera epidemics around the world. Higher temperatures create ideal conditions for the disease to flourish in water and, combined with poor hygiene, may be contributing to above average fatality rates. Outbreaks are occurring in Nigeria and Cameroon, as well as Democratic Republic of Congo, Laos, Uganda, Djibouti, Afghanistan, Nepal and Papua New Guinea. Cholera kills some 120,000 people each year, according to WHO estimates. More details.
Advice to travellers: For most travellers the risk of cholera is low - even when visiting countries where the disease is endemic. However, cholera spreads rapidly and people heading to regions with cholera outbreaks should adhere to strict personal hygiene guidelines and choose food and beverages with care. Travelvax can advise travellers if cholera is a sign ificant risk for their journey and recommend vaccination against cholera if appropriate. Regardless of their destination, all travellers should avoid drinking unchlorinated water, adding ice to drinks, and eating unrefrigerated food from street stalls.

Fears grow over water-borne diseases in Pakistan
Outbreaks of cholera, dysentery and acute diarrhoea are occurring in Africa and Asia, including flood-ravaged Pakistan's Khyber-Pakhtunkhwa regions. Other affected regions include: ASIA - Laos (Attapeau), Indonesia (East Java), China (Gansu), and Nepal (Midwestern Region); AFRICA - Cameroon (north regions) and Nigeria (Borno, Bauchi). More details.
In India, cholera has been confirmed in Kartarpur (Punjab state). More details.
In Kenya, cholera has killed five people in Kuria West District (Masaba and Mabera divisions) after water shortages forcing residents to drink contaminated water from the polluted Ragana River. More details.

Ten-fold rise in Nigeria as deadly measles sweeps Africa
To add to its cholera woes, Nigeria has had 4771 cases of measles this year, a 10-fold increase on the same period last year. Along with Zimbabwe and Chad, Nigeria is one of 30 African countries with widespread measles outbreaks. There were 64,000 cases (1100 deaths) in the first five months of the year. More details.
Advice to travellers: Childhood diseases are common in both developing and developed countries and outbreaks like those occurring in Africa are usually associated with sub-optimal immunisation levels. Regardless of their destination, we recommend all travellers to check their immunisation status for measles, diphtheria, pertussis (whooping cough), mumps and polio as part of their pre-travel medical preparations.

Travellers warned after measles outbreak on NSW North Coast
A traveller who contracted measles overseas has infected five locals on the NSW North Coast. NSW Health has urged people to check their immunisation history, especially if they intend to travel overseas. More details.

Three more deaths from swine flu in New Zealand
A second wave of swine flu in New Zealand claimed three more lives last week, bringing the number of death to nine this year. There have been widely differing levels of infection, with some badly affected provincial areas reporting hundreds of schoolchildren absent with influenza-related illness. More details.
The WHO reports swine flu activity also remains intense in India's Maharashtra state. More details.
Advice to travellers: We recommend that all overseas travellers, particularly those heading to countries where swine flu persists, consider receiving the seasonal flu vaccine. The vaccine currently available in Australia protects against swine flu and this season's local B/Brisbane and A/Perth (H3N2-like) strains.

West Nile claims another life in Greece
In Greece, eight people have now died from West Nile Virus as the mosquito-borne disease continues to spread in the country's northern states. Culex pipiens mosquitoes, the virus' usual vector, have now been confirmed as the carriers. More details.
Advice to travellers: WNV generally causes only mild flu-like symptoms. However, in a small number of cases - particularly elderly patients - the virus can cause meningitis or encephalitis, a potentially fatal inflammation of the brain or spinal cord. Travellers should take precautions to avoid mosquito bites.

Sharp rise in malaria in Seoul
Seoul (Korea) has seen a sharp rise in the incidence of Plasmodium vivax malaria this year - up 50% on average. Malaria-carrying Anopheles mosquitoes have been found in Incheon City, and Gyeonggi and Gangwon provinces. More details.

Leptospirosis deaths close parks in Malaysia
In Malaysia's northern Kedah state, authorities have closed parks to swimmers after a teenager died of leptospirosis last week, the tenth recent death. Case numbers have increased sharply in Malaysia in the last decade: from 263 (20 deaths) in 2004, to 1400 (62) last year. More details.
Advice to travellers: Leptospirosis is a parasitic infection found in and around rivers, lakes and other fresh water in many warm-climate countries. The disease is caused by exposure to water contamina ted with urine of infected animals, mainly rats. Leptospires enter the body through open sores or wounds in the skin, or through mucous membranes following exposure to contaminated water. For most patients, the illness is mild, however 10 percent develop a more severe illness of the heart, kidneys or liver. A recent study revealed the disease is fatal in one-in-five patients admitted to hospital. Prompt treatment is crucial. More on leptospirosis.

No tourist deaths from sleeping sickness
A construction site manager, not a tourist, died of sleeping sickness in Nkhotakota Wildlife Reserve in Malawi (Africa).
Mr John Dickson, who has lived and worked at Bua River Lodge for almost two years, wrote to correct last week's Travelvax alerts item.
Our item referred to a local news report, which stated one tourist had died and others were infected with sleeping sickness (Human African Trypanosomiasis or HAT) in the reserve. The disease is transmitted by the bite of infected Tsetse flies.
Mr Dickson wrote: "The person who died was not a tourist, but the man in charge of construction of a new lodge in the centre of the reserve. He had been exposed to Tsetse over many months, and it is likely he died from incorrect hospital treatment."
The only other person infected, the lodge manager, also was exposed to bites over several months. He has now recovered following treatment in South Africa.
Mr Dickson said no tourists had been infected recently.
"Not all parts of the reserve are infested with Tsetse," he said.
"Recently new Tsetse traps were installed in the reserve and areas previously infested are now clear."
Editor's note: We thank Mr Dickson for his clarification and have forwarded his comments to ProMED, which carried the media report last week.