WORLD TRAVEL HEALTH ALERTS – April 13, 2001
– Antibiotic-resistant gene discovered in New Delhi’s water
– Mumbai’s malaria rates reach record highs
– Rio’s dengue outbreak surges to epidemic levels
– Second dengue outbreak in Hawaii
– Heat and rain increase dengue danger in Sri Lanka
– Solomons at risk from PNG cholera outbreak
– Toxic sardines kill 14 in Madagascar
– Malaria resurfaces in Torres Strait
– Hand-foot-mouth outbreak worsens in Vietnam
– Lack of resources hampers Zimbabwe’s cholera battle
– Leishmaniasis reaches pandemic levels in Sudan
– Namibia braces for floods and disease
– Swaziland’s north records first malaria outbreak
– Swine flu kills 8 in Venezuela
– Low vaccination rates behind polio resurgence

Antibiotic-resistant gene discovered in New Delhi’s water
INDIA: A gene that makes bacteria highly resistant to almost all antibiotics has been found in bacteria in public water supplies in India’s capital, New Delhi. The water is used by local residents for drinking, washing, and cooking. Worryingly, the New Delhi metallo-ß-lactamase (NDM) 1 gene has spread to bacteria that cause cholera and dysentery, according to a study published online in the Lancet last week. More details.

Advice to travellers: This development highlights the importance of travellers adopting strict personal hygiene, and safe food and water practices. Tap water in New Delhi should be boiled or effectively treated before drinking. Read more on safe food and water.

Mumbai’s malaria rates reach record highs
INDIA: Malaria rates in Mumbai have been at a 7-year high in the last 12 months, with the capital accounting for 137 of Pune State’s 185 deaths. There has been a sharp increase in reported cases statewide in recent years: 138,605 from May 2010 to April this year, compared with 85,000 the previous year, and an average 67,590 in both 2009 and 2008. Efforts to halt a sharp rise in cases have met with little success and this report quotes one of the state’s leading doctors as saying: "The number of malaria, dengue and chikungunya cases reported by the state health department is just the tip of the iceberg. A majority of the cases remain under-reported." More details.

Advice to travellers: Travelvax recommends anti-malaria medication to Australians travelling to India, including major cities. Malaria is present year-round in rural and urban areas of India and the number of potentially fatal Plasmodium falciparum cases is increasing. Travellers to India or elsewhere in Asia should discuss their itinerary, preventative medications, and the available options at a Travelvax clinic, or with their healthcare provider.

Rio’s dengue outbreak surges to epidemic levels
In Rio de Janeiro, the number of official dengue cases rose from 10,000 on April 1 to 18,890 (11 deaths) on April 9 as the disease reaches epidemic proportions in the city. This week’s dengue bulletin also includes the latest figures from 7 states of Brazil, and news of ongoing outbreaks in Bolivia (Santa Cruz) and Paraguay. More details.

Advice to travellers: Australian travellers heading to Latin America and Asia should take measures to avoid mosquito bites as epidemics and outbreaks continue in these regions. The daytime-feeding Aedes mosquitoes that transmit the dengue virus inhabit urban areas, including hotels and resorts. Travellers should cover up and apply an insect repellent containing effective active ingredients, such as DEET, Picaridin, IR3535, or oil of lemon eucalyptus, to exposed skin any time they are outdoors.

Second dengue outbreak in Hawaii
USA: In Hawaii, there have been two suspected cases of dengue on Maui Island. It is not known if the virus was acquired locally or ‘imported’ from overseas or Oahu, where case numbers are rising. There are now 29 suspected and 2 confirmed cases in Pearl City. More details.

Heat and rain increase dengue danger In Sri Lanka
Health authorities predict a surge in dengue cases this month as high daytime temperatures and nighttime rain create ideal mosquito breeding conditions. Nationwide there have been 3215 cases and 31 deaths this year – a third of the cases (12 deaths) in the Colombo district. The health ministry says high-risk districts include Colombo, Ratnapura, Kegalle, Gampaha, Kalutara, Hambantota, Batticaloa, Trincomalee, Puttalam, and Kurunegala. More details.

Solomons at risk from PNG cholera outbreak
PAPUA NEW GUINEA: Cholera experts warn Bougainville’s outbreak may spread to the Solomon Islands. A task force is attempting to rein in an outbreak that has killed 2 people and infected 159. 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.

Toxic sardines kill 14 in Madagascar
MADAGASCAR: While plague is widespread in the north, in the island nation's south 14 people have died and 120 are seriously ill after eating sardines contaminated with a toxin discovered in seaweed that now proliferates on local reefs. The deaths occurred in the southwestern town of Toliara. The government blames global warming and changed sea conditions for the event. More details.

Malaria resurfaces in Torres Strait
AUSTRALIA: In Torres Strait, the fifth recent case of malaria was reported last week, following four on Saibai and Dauan islands last month. Whether the vivax or falciparum strain is responsible has not been confirmed. More details.
Advice to travellers: Because of the islands' proximity to Papua New Guinea, there is a continuous risk of malaria transmission in the Torres Strait. Both vivax and falciparum strains have been responsible for past cases, the latest in 2001.

Hand-foot-mouth outbreak worsens in Ho Chi Minh City
VIETNAM: An average 20 children a day are being hospitalised with hand, foot and mouth disease (HFMD) in Ho Chi Minh City. The cases represent a dramatic escalation of an epidemic that has seen 600 cases and 3 deaths this year. More details.
Advice to travellers: HFMD infection mainly occurs in children. It is spread by direct contact with infected persons, or with virus-contaminated surfaces. Good hygiene practices reduce the risk of infection. There is no vaccine or preventative medication.

Lack of resources hampers Zimbabwe’s cholera battle
ZIMBABWE: Under-resourced health officials are battling to control cholera in Manicaland and Masvingo provinces, with 36 fatalities in the last month. Cholera claimed 4200 lives in Zimbabwe in 2008-09 and officials are concerned about the persistence of the water-borne disease in a number of parts of the country. More details.

Leishmaniasis reaches pandemic levels in Sudan
SUDAN: There are fears visceral leishmaniasis may soon reach pandemic proportions in eastern Al Qadarif state. The case tally has reached 5550, with 142 deaths – one every second day. More details.
Advice to travellers: Leishmaniasis is widespread in the tropics, subtropics and southern Europe. For short-stay travellers, it generally presents a low risk. However, they should use an effective repellent to avoid sand fly bites. Read more on leishmaniasis.

Namibia braces for floods and disease
NAMIBIA: Health officials have warned of the risk of cholera, polio and malaria in the country’s north as flooding intensifies in regions bordering Angola. More details.

Swaziland’s north records first malaria outbreak
SWAZILAND: An outbreak of malaria (20 cases) was reported last week in the Sidvwashini area of Northern Hhohho and nearby Masutaneni, Nya-katfo, and Ngonini. It is the first time malaria has been recorded in the region. More details.

Advice to travellers: Swaziland has a climate and mosquitoes to transmit malaria and imported cases can easily start local transmission. The region is located close to Mozambique, which reported 4.3 million suspected and 94,000 confirmed cases in 2009. Travellers should cover up and apply an insect repellent containing effective active ingredients, such as DEET, Picaridin, IR3535, or oil of lemon eucalyptus, to exposed skin any time they are outdoors.

Swine flu kills 8 in Venezuela
An outbreak of A/H1N1 influenza in Venezuela has claimed 8 lives among 712 cases in the past 3 weeks. More details.

Advice to travellers: Influenza is the most common vaccine-preventable illness and Travelvax recommends vaccination for all travellers. The new southern hemisphere seasonal flu vaccine protects against both the swine flu (H1N1) and B strains.

Low vaccination rates behind polio resurgence
More polio cases have been reported in Pakistan (4) and Nigeria (4). This bulletin provides recent global figures that reflect the challenges ahead in eradicating polio. Wild polio virus is being ‘imported’ across borders into African and Asian countries that had previously interrupted transmission, but have not kept up vaccination rates in recent years. More details.

Advice to travellers: Travelvax recommends all travellers check their immunisation status for childhood diseases, including polio, measles, whooping cough, diphtheria, and mumps. If required, we advise primary vaccination or a booster as part of their pre-travel medical preparations.

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.