WORLD TRAVEL HEALTH ALERTS – April 20, 2011

– Measles blazes across Europe, North America
– In-flight measles causes alarm in Victoria and Tasmania
– Sun, surf, sand… and measles
– Dengue: epidemics continue in South America, Caribbean, Maldives
– Manila heads list of Philippines’ dengue hotspots
– Soil, water disease on the rise in Northern Territory
– Chikungunya tally rising on New Caledonia
– Typhoid fever widespread in Philippine province
– Whistler’s skiers watch for bumps and mumps
– Weekly cholera bulletin: Haiti figures continue to climb
– Malaria forges new territory in Zimbabwe
– Bilharzia prevalent around Lake Victoria
– Dengue and malaria follow in wake of Jeddah flooding
– Sindh is Pakistan’s polio hotspot
– Now, if only the caterpillars would eat the garbage…

Measles blazes across Europe, North America
EUROPE: Measles outbreaks show no sign of slowing as 24 countries on the Continent continue to battle large outbreaks that are spreading across borders, as well as to and from overseas countries.
NORTH AMERICA: Outbreaks are occurring in Canada (Saskatchewan), and the USA (Utah, and Rhode Island-ex Italy). This week’s global measles bulletin contains detailed reports on current outbreaks.
Read more details of outbreaks in Europe and North America.
Advice to travellers: Measles continues to go global. Australian travellers who have not had measles or have not received two documented doses of live virus va ccine should consider a booster as part of their pre-travel vaccination regime. Measles is a highly contagious airborne disease that can cause severe illness. Passengers on planes, boats, trains and buses are at higher risk of infection – especially if seated near a contagious person. 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.

In-flight measles causes alarm in Victoria and Tasmania
In Victoria, health officials have contacted passengers aboard an Air Asia flight from Malaysia to Melbourne on April 1 after 4 passengers were diagnosed with measles. They have also contacted people who were at Austin Hospital's emergency department on April 14 after one of the passengers sought treatment. Symptoms usually appear 10 days after exposure. More details.
Tasmania is also on alert for measles after one of the measles-infected Air Asia passengers travelled aboard the Spirit of Tasmania from Melbourne to Devonport, and then went to the emergency department of a Burnie hospital for treatment. More details.

Sun, surf, sand… and measles
In Queensland, health authorities have warned thousands of competitors and spectators at the Australian Surf Life Saving Championships on Queensland’s Gold Coast (April 2-10) to watch for measles symptoms after an infected person attended the competition and a local McDonalds restaurant. More details.

Dengue: epidemics continue in South America, Caribbean, Maldives
Dengue fever continues to plague South America, with ongoing epidemics in Brazil, Bolivia and Paraguay, and a worrying outbreak in Argentina. This week’s dengue bulletin also included reports from Maldives, Barbados, and the Hawaiian island of Maui, where another 6 confirmed or suspected cases were recorded last week. More details.
The Maldives is battling a growing epidemic, with 300 cases (5 deaths) in the first three months of 2011 – many in the capital, Male – compared to 737 cases (2 deaths) last year. Mosquitoes are breeding in pools of stagnant water on building sites across the city, according to one expert. More details.
Advice to travellers: Worsening epidemics in Latin America and Asia pose a significant risk for all travellers, whether visiting urban or rural areas. The mosquitoes that transmit the dengue virus inhabit urban areas, including leading hotels and resorts, and bite during the day. All travellers should take measures to avoid mosquito bites when visiting any tropical country. Cover up, especially at dusk, and regularly apply an insect repellent containing an effective active ingredient, such as DEET, Picaridin, IR3535, or oil of lemon eucalyptus, to exposed skin at all times when outdoors.

Manila heads list of Philippines’ dengue hotspots
PHILIPPINES: There have b een slightly fewer dengue fever cases nationwide in the first quarter of 2011 - 14,837 compared to 15,493 in 2010 – the worst year in the past decade with a 12-month total of 135,355 cases. First quarter figures revealed the highest number of cases in Metro Manila, Llocos Region (San Fernando City, La Union) and Cagayan Valley Region (Tuguegarao City). The country’s latest Disease Surveillance Report listed Davao, Pasig, and Valenzuela City as dengue hotspots. More details.

Soil, water disease on the rise in Northern Territory
AUSTRALIA: Melioidosis, a potentially deadly soil- and water-borne disease, has infected 56 people in the Northern Territory during the current wet season. Melioidosis causes several deaths in the Territory each year and there have been a record number of cases in the last two years, authorities say. More details.
Advice to travellers: Melioidosis is predominately a disease of tropical climates, especially in Southeast Asia and northern Australia, where it is endemic. The bacteria (Burkholderia pseudomallei) that cause melioidosis are found in contaminated water and soil. Wear shoes or boots (not thongs) and avoid direct contact with soil and standing water, especially if you have open skin wounds. People with diabetes or chronic renal disease are at higher risk of infection. Read more on Melioidosis.

Chikungunya tally rising on New Caledonia
NEW CALEDONIA: There are now 17 confirmed or suspected Chikungunya fever cases in Noumea. The outbreak is the first ever in New Caledonia, introduced by a resident returning from Indonesia on March 3. Further cases are expected. More details.
Advice to travellers: As with dengue fever, there is no vaccine or preventative medication for Chikungunya fever, which is prevalent throughout Asia. Both diseases are spread by Aedes mosquitoes. 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.

Typhoid fever widespread in Philippine province
PHILIPPINES: There have been almost 200 cases of typhoid across cities and towns of Negros Occidental province (Negros Island) this year. More details.
Advice to travellers: Typhoid is spread by contaminated food and beverages and presents a low risk for short-stay visitors in hotel or resort accommodation. Vaccination is more likely to be recommended for those visiting rural areas or those with adventurous eating habits. We advise all travellers to follow safe food and water guidelines.

Whistler’s skiers watch for bumps and mumps
CANADA: Competitors and fans arriving for the Telus World Ski and Snowboard Festival in Whistler (British Colombia), which began last week, received an unusual offer – free vaccination against mumps. After 15 recent cases, health authorities were keen for young people to take up the offer. More details.
Advice to travellers: Mumps is among the pre-travel vaccinations Travelvax recommends to all travellers, particularly young adults. They should also check their immunisation status for measles, whooping cough, diphtheria, and polio 4-6 weeks before departure.

Weekly cholera bulletin: Haiti figures continue to climb
AMERICAS: In the Caribbean, the cholera count in Haiti had reached a staggering 415,765 cases with 4766 deaths to the end of March.
ASIA: A 29-year-old Taiwanese woman who contracted cholera during a 4-day trip to Sabah (Malaysia) may have been infected after eating grilled fish and shrimp. This bulletin provides details of the outbreak in Sabah, along with others in Asia, including India (Haryana State), Myanmar (Shan State), and the Philippines (Palawan province).
More details from these two regions.
AFRICA: The WHO fears a cholera epidemic to match the death toll of 2008 may be looming after 431 confirmed and 373 suspected cases (22 deaths) in 9 of the country’s 62 districts this year. There are significant outbreaks in Congo DR (Orientale), Nigeria (Taraba), Chad (Mayo-Kebbi Est), and Namibia. More details.
Advice to travellers: For most short-stay travellers, the risk of cholera is low. Australians heading to infected regions should adhere to strict personal hygiene guidelines and choose only safe food and beverages. Call Travelvax on 1300 360 164 for advice on the risks for a particular journey, and whether vaccination should be considered.

Malaria forges new territory in Zimbabwe
ZIMBABWE: There have been more than 900 cases of malaria and 11 deaths in a major outbreak in Goromonzi West, 20km from Harare. The area had previously been considered malaria-free. More details.
Advice to travellers: Areas above 1500 meters, including Harare, are usually malaria free; below 900ms [2953 feet] the risk is high, particularly in the north at altitudes of 900-1500 meters. There have been 60,000 cases of malaria nationwide already this year.

Bilharzia prevalent around Lake Victoria
UGANDA: Three-quarters of the Ugandans living in the Jinja district on the shores of Lake Victoria are infected with bilharzia (schistosomiasis), according to the local tropical diseases officer. A program to control the disease has met with only limited success. More details.
Advice to travellers: The parasites that cause bilharzia live in certain types of freshwater snails and emerge to infect people who swim or wade in the infected water. All fresh water in southern and sub-Saharan Africa – including the great lakes, rivers and smaller bodies of water – pose a risk of schistosomiasis. Transmission also occurs in the Mahgreb region of North Africa and the Nile River valley in Egypt and Sudan. It also occurs in South America (Brazil, Suriname, Venezuela), the Caribbean (Antigua, Dominican Republic, Guadeloupe, Martinique, Montserrat, Saint Lucia), the Middle East (Iran, Iraq, Saudi Arabia, Yeme n), southern China, and Southeast Asia, including the Philippines and Laos. Avoid swimming or wading in freshwater in schistosomiasis-endemic countries. Swimming in the ocean and in chlorinated swimming pools is safe.

Dengue and malaria follow in wake of Jeddah flooding
SAUDI ARABIA: Jeddah is grappling with outbreaks of dengue fever (6 confirmed, 26 suspected) and malaria (4 cases) following March flooding. Malaria is seasonal and most cases in the capital are ‘imported’, however dengue is endemic and spraying is underway in the city’s south, where the worst of the flooding occurred. More details.

Sindh is Pakistan’s polio hotspot
PAKISTAN: Sindh province last week recorded Pakistan’s seventh polio case of 2011, despite a recent WHO-backed vaccination campaign aimed at eradicating the disease. There were 144 polio cases in Pakistan in 2010 and it remains one the last remaining endemic countries, along with Afghanistan, India, and Nigeria. More details.

Now, if only the caterpillars would eat the garbage…
INDONESIA: Caterpillars and garbage are threatening to overwhelm Bali, according to local news site, Bali Discovery.
Three varieties of caterpillars, which cause skin irritations for humans, are devouring fruit trees and their crop in 6 of Bali's 9 regencies, including Denpasar, Buleleng, Gianyar, Jembrana, Karangasem and Klungkung. More details.
Meanwhile, Bali’s ‘clean and green’ motto is under threat from garbage, with authorities drafting new laws and urging communities to adopt t he ‘3Rs’ – reduce, reuse and recycle. The capital, Denpasar alone produces 1.8 million cubic meters of trash a year. 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.