WORLD TRAVEL HEALTH ALERTS – March 30, 2011

– Latin America gripped by dengue
– New outbreak in Cairns
– Dengue makes for a blue Hawaii
– Hunt for clues goes on in Chiang Mai mystery
– More Chikungunya cases in Noumea
– Rash of travel-related measles in USA, Australia
– Measles epidemic sweeps through DRC
– UK students learning about measles and mumps
– Bird flu fears in Bali
– Lingering Norovirus closes UK hospital wards, nursing home
– Cholera raging in Africa, Caribbean, PNG
– Legionnaires’ outbreak in Dundee
– Floodwaters bring leptospirosis deaths
– Young adults bear pertussis burden in Spain
– Polio eradication proving elusive

Latin America gripped by dengue
Latin American countries have recorded 206,097 cases of dengue in the first quarter, including 2744 cases of severe dengue and 223 fatalities, according to figures released this week. Many of the cases are from Brazil.
BRAZIL: Hundreds of people a day are being treated for dengue fever in metro areas of Rio de Janeiro, with the year-to-date tally now passed 10.000 cases – an 8-fold increase on the same period last year. Eight Brazilian states (Rio de Janeiro, Sao Paulo, Rio Grande do Sul, Minas Gerais, Acre, Ceara, Alagoas, and Pernambuco) are experiencing epidemics or major outbreaks. More details.
BOLIVIA: Santa Cruz department (state) has declared a state of emergency to deal with a growing epidemic of 4000 confirmed or suspected cases.
PARAGUAY: Paraguay’s second largest city, Ciudad del Este (Alto Parana state) has had 1557 cases (22 deaths) this year.
ARGENTINA: There hav e been 90 recent cases in Romang (Santa Fe province).
Meanwhile, SRI LANKA recorded 2159 dengue cases (24 deaths) island-wide to early March.
More details.
Advice to travellers: Epidemics in Brazil and other Latin America countries may pose a significant risk for Australians, even short-stay travellers staying in cities such as Rio de Janeiro. Recent outbreaks in Asia, as well as North Queensland and Hawaii (see below), highlight the need for travellers to take all measures to avoid mosquito bites when visiting tropical areas. The mosquitoes that transmit the dengue virus inhabit urban areas, including up market hotels and resorts. Travellers should cover up at dusk and apply an insect repellent containing DEET or Citriodiol regularly to exposed skin at all times when outdoors.

New outbreak in Cairns
AUSTRALIA: Dengue cases have been confirmed in two Cairns suburbs. Testing is underway to determine if the outbreak is linked to one in nearby Innisfail, where 55 cases have now been recorded. More details.

Dengue makes for a blue Hawaii
HAWAII: There has been 4 cases of locally acquired dengue fever in Pearl City, near Honolulu (Oahu). Authorities say a wider outbreak is unlikely, although neighbours of the four have been tested for the virus. The four cases are the first locally acquired cases since a serious outbreak (153 cases) in 2001. More details.

Hunt for clues goes on in Chiang Mai mystery
THAILAND: While investigations are continuing into the death of seven people in Chiang Mai in January and February, health authorities have found no common link to restaurants, water, food, or travel. With no further deaths reported, they say the risk to tourists and locals is now ‘low or minimal’. Hotels and guesthouses in Chiang Mai are under orders to report episodes of severe vomiting among guests. More details.

More Chikungunya cases in Noumea
NEW CALEDONIA: Five more residents of a Noumea suburb have now contracted Chikungunya fever after the disease was imported from Indonesia by a returned traveller last month. More cases are expected. More details.
Advice to travellers: With more cases anticipated in Noumea, Travelvax advises Australians visiting New Caledonia to cover up at dusk and apply an insect repellent containing DEET or Citriodiol regularly to exposed skin at all times when outdoors. Chikungunya is prevalent in Asia and Africa, and there is no vaccine or preventative medication.

Rash of travel-related measles in USA and Australia
USA: Travel–related measles is causing concern in 3 US states. In Minnesota, an outbreak that began with an unvaccinated child who had travelled to Kenya, has now grown¬¬ to 11 confirmed cases. Two New Yorkers contracted measles in Romania and India, respectively, while in California a 27-year-old man contracted measles in either the Philippines or Thailand. More details.
In Australia , 7 of 24 measles cases in northern New South Wales in the last month involved travellers recently returned from overseas, according to NSW Health. Residents of the far northern Tweed region have been urged to check their vaccination status, especially those planning to travel abroad. More details.
Across the border, a second measles case has been confirmed on Queensland’s Gold Coast, following the first case involving a worker at the Westfield shopping centre at Helensvale. More details.
Advice to travellers: Commenting this week, Travelvax Australia’s medical director, Dr Ed Bajrovic, said travel-related measles has become a common theme in recent alerts: “Measles is a highly mobile and highly contagious airborne disease. Aircraft passengers are at risk of infection, especially if seated near a contagious person. Travellers who have not had measles or have not received two documented doses of live virus vaccine should consider a booster as part of their pre-travel vaccination regime.”
Travelvax recommends all travellers check their immunisation status for measles and other childhood diseases, including whooping cough, diphtheria, mumps and polio, as part of their pre-travel medical preparations.

Measles epidemic sweeps through DRC
DR CONGO: Measles is spreading like wildfire into northern provinces (Bandundu, Kasaï Oriental, and Maniema), with high mortality rates among the 21,000 cases recorded since last September. Medecins Sans Frontieres (MSF) is calling for concerted action from the international community to halt the epidemic. More details.

UK students learning about measles and mumps
UNITED KINGDOM: Measles is circulating among unvaccinated students in the northern English city of Leeds, with 15 confirmed and 5 suspected cases since February. More details.
In Southampton, mumps is spreading among local university students, prompting authorities to urge young adults to get vaccinated. More details.

Bird flu fears in Bali
BALI: Authorities fear bird flu (H5N1) has resurfaced on the island. Testing is underway to confirm the virulent disease caused the death of chickens on farms in Denpasar, Badung and Tabanan. No human cases have been reported. More details.
Advice to travellers: Indonesia has now had 175 cases (144 deaths), mainly in West Java and Sumatra, since the bird flu outbreak began in 2005. Last week we reported a large outbreak in Bengkulu province (southwest Sumatra). While bird flu is low risk for travellers, Australians visiting affected areas should avoid eating poultry from street stalls, and avoid handling chickens or caged birds in live animal markets and poultry farms. Read more on bird flu.

Lingering Norovirus closes UK hospital wards, nursing home
UNITED KINGDOM: Norovirus has caused a recent spate of hospital ward and nursing home closures across the country, despite the change of season. The winter illness forced hospital ward closures in Birmingham and Dorset (England), and in Wrexham, Chirck, and Mold (Wales).
On the Isle of Mann, a nursing home was closed after an outbreak lasting two weeks. More details.
Advice to travellers: While these outbreaks are out of season, Norovirus is the most common cause of infectious gastroenteritis in Britain year round. Although generally short-lived, it causes nausea, severe vomiting and diarrhoea, which may lead to more serious complications among young children, the elderly, and the sick. The best form of prevention is good hygiene and regular hand-washing.

Cholera raging in Africa, Caribbean, PNG
DR CONGO: A growing cholera epidemic in the Kisangani region (Orientale Province) has now claimed 33 lives among 537 cases, with under-resourced health authorities unable to contain the outbreak. More details.
GHANA: The death toll from a cholera epidemic centered on the capital, Accra has risen to 67 (5200 cases), with the Greater Accra and Central regions hardest hit. More details.
HAITI: Despite international efforts to control the outbreak, cholera has now killed 4737 among 261,985 cases since last October. More details.
DOMINCAN REPUBLIC: Haiti’s neighbour is also struggling to contain its widespread cholera outbreak. More than 650 cases (7 deaths) have been reported. More details.
PAPUA NEW GUINEA: PNG’s cholera smoldering cholera epidemic has hit nearby Bougainville, with more than 65 cases and 2 deaths. The outbreak began in Haku and has spread to Gogohe and Hutj. and has mainly effected young teenagers. More details.
Advice to travellers: For most short-stay travellers, the risk of cholera is low. However, the disease spreads rapidly and travellers heading to infected regions should adhere to strict personal hygiene guidelines and choose only safe food and beverages. Travelvax can offer advice on the risks for a journey, and whether vaccination should be considered. Contact Travelvax on 1300 360 164.

Legionnaires’ outbreak in Dundee
SCOTLAND: One man is in hospital with Legionnaires' disease, while another 66 guests and staff have flu-like symptoms after using the leisure centre at the 4-star Landmark hotel in Dundee. More details.
Advice to travellers: Legionnaires’ disease is not contagious and presents a low risk to most travellers. Initial symptoms may include a high fever, chills, a cough, muscle aches and headaches. Legionella bacteria thrive in warm water, usually in air-conditioning systems of large buildings, but also hot water tanks, heated pools, spas etc. It is transmitted by breathing in contaminated mist or vapour. More on Legionnaires disease.

Floodwaters bring leptospirosis deaths
SRI LANKA: The cities of Kurunegala and Anuradhapura have been hardest hit by an epidemic of Leptospirosis spread by floodwaters. There have been 1883 cases (20 deaths), mainly among farming communities. Sri Lanka experiences monsoonal outbreaks from March to May, with a larger peak from October to December. More details.
Advice to travellers: Typically, leptospirosis is associated with exposure to floodwaters, so it presents a low risk for most travellers. The bacteria that cause the disease are spread through the urine of infected animals, entering the body through skin or mucous membranes (eyes, nose, or mouth) – especially if the skin is broken. While it occurs worldwide, the disease is most common in temperate or tropical regions.

Young adults bear pertussis burden in Spain
SPAIN: The northern city of Girona has recorded 53 cases of whooping cough (pertussis) since January, many of them among young adults. The yearly average is 70. More details.

Polio eradication proving elusive
The goal of eradicating polio is proving elusive. While international efforts are gaining ground in the four remaining endemic countries, poor neighboring countries are unable to prevent wild poliovirus spreading after it is re-introduced. This global p olio bulletin gives insights into the challenges of achieving a polio-free world.
In Sierra Leone, hundreds of vaccine-carrying health workers trekked to far-off villages and hamlets last week to begin vaccinating over one million children against polio. More details.

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.