WORLD TRAVEL HEALTH ALERTS – March 9, 2011

– Dengue gains ground in Europe as epidemics rage in Brazil
– Thais probe tourist deaths in Chang Mai hotel
– Flu cases continue to decline in Europe
– Rabies alerts for Indonesia, South Africa, Ukraine
– Major rubella outbreak in North Vietnam
– Saudis fear deadly Yemen outbreak
– Hepatitis B claims 4 in Uganda
– A decade on, polio returns to Gabon
– NSW and Guam wracked by whooping cough
– Malaria now at home in Tanzania’s high country

Dengue gains ground in Europe as epidemics rage in Brazil
Local transmission of dengue fever is now possible in two European countries, with Croatia joining France. This follows recent confirmation that the Aedes albopictus mosquito, a species capable of transmitting both the dengue and Chikungunya viruses, has spread throughout Croatia’s coastal regions. Experts say locally acquired cases are now likely when the viruses are introduced into areas with mosquito populations.
In Brazil’s north, Amazonas state is in the grip of one of its worst-ever dengue epidemics, with 10,798 cases reported this year – more than two thirds of the national tally (15,548). An average 230 people are seeking treatment each day, mainly in the state capital Manaus, and Tefe. Outbreaks are also occurring in other parts of Brazil, including Sorocaba, Bauru, Araraquara, and Itu (Sao Paulo state), Cambe (Parana), Volta Redonda (Rio de Janeiro), Ceara, and Rio Grande do Sul.
Elsewhere, alerts are current for Philippines (Pangasinan), Indonesia (Jakarta), Saudi Arabia (Jeddah), USA (Miami, Florida), and Honduras.
More details.
Advice to travellers: Dengue is a significant health issue for Australians travelling to infected regions of Brazil, particularly the Amazon. Dengue’s continued presence in South and Central America, the Caribbean, Asia, and unlikely locations, such as Saudi Arabia, highlights the need for travellers to take all measures to avoid mosquito bites. The mosquitoes that transmit the virus inhabit urban areas. Cover up at dusk and apply an insect repellent containing DEET or Citriodiol to exposed skin regularly.

Thais probe tourist deaths in Chang Mai hotel
THAILAND: Authorities are investigating the mysterious deaths of 3 tourists and Thai women who stayed at the Downtown Inn in the northern city of Chiang Mai last month. The tourists included two British pensioners and a 23-year-old New Zealand women, who died after she and two friends became ill while staying at the hotel. More details.

Flu cases continue to decline in Europe
Europe saw fewer Influenza cases last week, with activity declining in 24 countries of the 53 in the region. Only 5 countries reported high-intensity influenza activity compared with 9 the previous week. More details.
Advice to travellers: The latest flu vaccine is now available in Australia. Influenza is the most common vaccine preventable illness and Travelvax recommends vaccination for overseas travellers due to the risk of infection in planes, airports, public transport, restaurants and other high-traffic areas.

Rabies alerts for Indonesia, South Africa, Ukraine
INDONESIA: Rabid dogs have infected at least 242 residents of Sikka, East Nusa Tenggara province, this year. Stocks of vaccine are at critically low levels, the Jakarta Post reports. More details.
SOUTH AFRICA: A rabies outbreak in Lenasia, a densely populated urban area just south of Johannesburg, has prompted a large-scale vaccination program this week. More details.
UKRAINE: Unlike the previous two posts, three separate rabies outbreaks in the Kharkov region have been associated with cats. More details.
Advice to travellers: Australians visiting I ndonesia should be aware of ongoing outbreaks of rabies. While the disease remains a low risk for short-stay visitors, those visiting remote regions or planning extended stays should consider vaccination. While dogs are the most common carriers, a variety of animals can transmit the disease. All travellers to Indonesia should avoid contact with wild and domestic animals, and seek urgent post-exposure treatment if bitten or scratched. As stated previously, rabies immunoglobulin, which is required for rapid post-exposure treatment for unvaccinated travellers, remains in short supply throughout Indonesia. It is expensive and hard to obtain in many countries where the disease is present. More on rabies.

Major rubella outbreak in North Vietnam
VIETNAM: An average 75 people a day – many aged 20-35 – sought medical treatment for rubella (German measles) last week as a severe epidemic continues in northern provinces. There have been almost 1000 cases this year. More details.
Advice to travellers: Spread by airborne droplets, German measles is a particular risk for pregnant women. Travellers should check their immunisation status for all childhood diseases, including whooping cough, diphtheria, mumps, and polio as part of their pre-travel medical preparations. Live attenuated viral rubella vaccine is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine.

Saudis concerned over deadly Yemen outbreak
SAUDI ARABIA: Authorities fear an undiagnosed haemorrhagic-like disease causing fatalities in border regions of neighbouring Yemen will enter the kingdom. The disease has killed at least 65 people and hundreds more have been treated in hospitals recently. More details.

Hepatitis B claims 4 in Uganda
UGANDA: An outbreak of Hepatitis B which began last year has now killed 4 people in the northern Moyo District. This year, there have been 24 cases, bring the outbreak total to 74. More details.
Advice to travellers: Hepatitis B is a blood-borne disease typically transmitted through unprotected sex, IV drug use, unscreened blood products, and unsterile needles used in tattooing, medical or dental procedures, body piercing, acupuncture etc. This risk is accentuated for younger tr avellers engaging in adventure-style activities, which carry a higher risk of injury.

A decade on, polio returns to Gabon
GABON: After a 10-year absence, polio has returned, prompting a mass immunisation campaign. The wild poliovirus type 1 infection follows recent cases in neighbouring Congo and Democratic Republic of Congo.
Advice to travellers: We recommend all travellers check their immunisation status for polio and other childhood diseases, including whooping cough, diphtheria, measles, and mumps, prior to travel.

NSW and Guam wracked by whooping cough
AUSTRALIA: Whooping cough (pertussis) continues to be a risk for international and domestic travellers in NSW, with more than 9000 cases diagnosed this year. Clusters have been reported in places like Broken Hill, which has had a 100% increase on last year. More details.
GUAM: Parents have been urged to vaccinate their children after 20 confirmed or suspected cases of whooping cough in the Pacific island nation since January. More details.

Malaria now at home in Tanzania’s high country
Climate change has been blamed for the spread of malaria to the southern highlands of Tanzania. Up until 1960, Rungwe, Mbeya, Mufindi, Njombe, Makete, Iringa, and other southern highland regions near the Malawi and Zambia borders were outside Tanzania's traditional lowland malarial zones. Today, there's a high prevalence of the disease. More details.
Advice to travellers: As this article confirms, malaria is widespread throughout Tanzania and travellers should consider taking malaria prevention medication. For further advice, contact Travelvax Australia’s travel health advisory service on 1300 360 164.

Travelvax Australia compiles this weekly bulletin of global travel health alerts, risk assessments and advice for the information of Australian travellers and the travel industry. Please contact our travel health advisory service on 1300 360 164 for broad destination-specific advice and vaccination recommendations. Recommended vaccines, travel medication, trip-specific advice and accessories are available during a medical consultation with a travel health professional at any of Travelvax Australia’s 32 clinics. Visit our website or call 1300 360 164 for details.