WORLD TRAVEL HEALTH ALERTS May 18, 2011

–  Girl’s death sparks fears of Ebola outbreak
–  Rio state wracked by dengue – 700 cases a day
–  As rains begin, Thailand braces for dengue spike
–  UK sees sharp rise in mozzie diseases
–  2014 launch planned for dengue vaccine
–  Measles marches on
–  Latter-day ‘Typhoid Mary’ behind typhoid cluster
–  Typhoid in migrant worker sees crop canned
–  Cockfighting spreading bird flu in Indonesia
–  Children bear burden of chickenpox in India
–  Early rains speed cholera in Yaounde
–  Fresh cholera outbreak in Dominican Republic

Girl’s death sparks fears of Ebola outbreak
UGANDA: The WHO is bracing for more cases of a deadly Ebola virus following the death of a 12-year-old girl on May 6. Another 30 people are being monitored for signs of the haemorrhagic disease as the medical personnel and supplies are rushed to the central Ugandan district of Luwero, 50km north of the capital, Kampala. Further cases are likely to lead to border restrictions. The strain has been identified as Sudan ebolavirus, which has a 60% mortality rate. Ebola killed 37 people in western Uganda in 2007 and at least 170 in the country’s north in 2000. More details. 
Advice to travellers: Ebola viruses are highly contagious and symptoms include fever, vomiting, diarrhoea and, in many cases, internal and external bleeding. The virus is spread by direct contact with blood and body secretions. There is no vaccine.

Rio state wracked by dengue – 700 cases a day
BRAZIL: Four states continue to battle dengue epidemics and outbreaks. Hard hit Rio de Janeiro State is recording almost 700 cases each day, with 85,425 official cases this year. There have been 66 deaths since January - 14 last week alone – and 18 municipalities have epidemics. In Ceara State, the number of cities with dengue epidemics has risen from 27 to 32 in the last month, with 17,066 cases and 70 suspected or confirmed deaths this year. In Alto Floresta (Mato Grosso), high mosquito infestations in parts of the city indicate epidemic conditions, although to date cases are down on the same period in 2010. The dengue toll is also rising in Sao Caetano (Sao Paulo).
Also in this week’s dengue report, Paraguay’s hot spot is the Alto Parana (11,546 cases, 47 deaths), although the epidemic show signs of declining with fewer recent cases and hospital admissions. More details.

Advice to travellers: The WHO estimates there are 50 million cases of dengue worldwide each year and around two-fifths of the world’s population (2.5 billion people) are at risk. As always, our advice to Australians travelling to Latin America and any tropical region is to cover up when outdoors and apply an insect repellent with an effective active ingredient, such as DEET (30-50%), Picaridin, IR3535, or oil of lemon eucalyptus.

As rains begin, Thailand braces for dengue spike
THAILAND: With the rainy season underway, health authorities warn a sharp rise in the number of dengue fever cases is likely. There have been 9418 cases (7 deaths) nationwide to May 10, significantly lower than the 16,110 cases and 20 deaths last year. Thai provinces most prone to dengue include Krabi, Samut Sakhon, Satun, Songkhla, Ratchaburi, Nakhon Pathom, Nakhon Sawan, Chon Buri, and Trat. More details.

UK sees sharp rise in mozzie diseases
British travellers have been warned of the dangers of mosquito-borne dengue fever and Chikungunya fever, particularly in Asia. Britons brought home 406 cases of dengue last year compared to 166 in 2009, the majority from India (21%) and Thailand (16%), while the incidence of imported Chikungunya rose by 34%. More details.

2014 launch planned for dengue vaccine
FRANCE: French vaccine manufacturer, Sanofi-Pasteur hopes to launch its dengue fever vaccine by 2014 in unnamed ‘priority countries’. Sanofi’s vaccine, which entered Phase 3 clinical testing in Australia last November, is the most clinically advanced of the vaccines under development. The company said it could produce 100 milli on doses a year. More details.

Measles marches on
The list of countries with measles outbreaks continued to grow last week as the WHO put back its target date for global measles eradication to 2015. In light of the current epidemics, experts say it’s unlikely the ambitious target can be met. The latest global measles update included:
EUROPE: The Continent’s epidemic is spreading, with significant outbreaks in the UK, France, Belgium, Germany, Romania, Serbia, Spain, Macedonia and Turkey. France has had more than 7000 cases and the disease has now been imported into French-controlled Reunion Island by a traveller.
ASIA: Bangladesh (Bandarban), India (Uttar Pradesh).
NORTH AMERICA: USA (California, Florida, Massachusetts, New York).
AFRICA: Congo DR, Zambia (Eastern province).
The disease is ‘spreading like wildfire’ in Congo DR, according to aid group Medecins sans Frontieres (MSF), the some 16,000 cases and 107 deaths have been recorded this year. Without emergency funding from the WHO and UNICEF, MSF warns it will be impossible to stem the epidemic.
UNITED KINGDOM: With 275 laboratory-confirmed cases this year (compared with 33 to May 2010), health authorities across England and Wales are warning parents to ensure their children have received two doses of the MMR vaccine before travelling to mainland Europe for the summer holidays.
Read the global round-up.
Advice to travellers: Measles is highly contagious and can cause severe illness. Regardless of their destination, all Australian travellers should consider a booster if they have not had m easles or received two documented doses of live virus vaccine. As part of pre-travel medical preparations, we also recommend travellers check their immunisation status for whooping cough, diphtheria, mumps, and polio 4-6 weeks before departure.

Latter-day Typhoid Mary behind typhoid cluster
TAIWAN: A 60-year-old cook with asymtomatic typhoid fever was the source of 4 recent cases and another 6 sporadic cases since 2007, according to Taiwan’s Centers for Disease Control (CDC). Three young IT workers who ate noodles in an Indonesian restaurant in the Hsinchu Science Park (Hsinchu City) are undergoing treatment in hospital, along with the fourth person. The female cook, an Indonesian woman who carried the disease but showed no symptoms, is also being treated in quarantine. More details.
Advice to travellers: Mary Mallon, an immigrant cook from Ireland, was the first known asymptomatic carrier of typhoid in the USA early last century. She infected 53 people (3 of whom died) in New York. With no way to treat the disease, ‘Typhoid Mary’ was forcibly quarantined for 30 years before her death. Read her story. As reported in last week’s Travelvax Alerts, the Taiwanese government plans to get tough on foreign workers and exchange students by making immunisation certificates a condition of entry.
Spread by contaminated food and beverages, typhoid presents a low risk for short-stay visitors in hotel or resort accommodation. Vaccination offers high levels of protection and 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.

Typhoid in migrant worker sees crop canned
NEW ZEALAND: An $800,000 kiwifruit crop will be destroyed after a migrant worker who came to Tauranga (Bay of Plenty region) to pick the fruit under the country’s seasonal employee scheme was found to have typhoid. Test are underway on co-workers and close contacts. Public health officials believe the worker, whose nationality was not released, had the illness before entering New Zealand. Local health authorities are also investigating how a Te Puke High School student was infected with tuberculosis. More details.

Cockfighting spreading bird flu in Indonesia
The slaughter of poultry in religious ceremonies and during cockfighting is fuelling bird flu (H5N1) in Indonesia, according to animal activists. The latest global update on bird flu details outbreaks in Egypt, South Africa, Bangladesh, South Korea, Vietnam, and Indonesia, including a suspected outbreak in Klungkung (Bali). More details.
Advice to travellers: Bird flu is a low risk for travellers, but those visiting areas where outbreaks are occurring should maintain high levels of personal hygiene and wash hands before and after food preparation. They should also avoid: live animal markets, poultry and pig farms; handling sick or dead birds or animals, including cats; touching any surfaces that may be contaminated by poultry droppings; swim in any body of water that is used by birds; eating poultry products, eggs and pork products not thoroughly cooked; consume raw poultry products, such as raw duck blood. Read more on bird flu.

Children bear burden of chickenpox in India
INDIA: Chickenpox is widespread in India’s Assam state, including it’s largest city Guwahati, with a large number of children among those infected. In India, children are not routinely vaccinated against the disease. More details.
Advice to travellers: Chicken pox (varicella) is highly contagious and is typically spread by coughing and sneezing, or direct contact with an infected pers on. It can cause severe illness with serious complications in adults, infants, adolescents, and people whose immune systems have been weakened because of illness or long-term steroid treatment. Currently, two doses of vaccine are usually administered, usually in combination with the MMR (mumps, measles and rubella) vaccine.

Early rains speed cholera in Yaounde
CAMEROON: Cholera has claimed more than 250 lives in an unprecedented epidemic that is spreading rapidly through Cameroon’s capital, Yaounde. Only around 65,000 of the city’s 2 million-plus inhabitants have access to treated water, while a local study of 50 wells in the capital and the city of Douala found all were contaminated with sewage. The city council has banned the sale of bottled drinking water on the streets, a popular source of income among the growing ranks of unemployed youths. More details.
Advice to travellers: Cholera is a low risk for most short-stay travellers. Australians heading to infected or endemic regions should adhere to strict personal hygiene guidelines and choose only safe food and beverages. Call Travelvax for advice on the risks for a particular journey, and whether vaccination should be considered. Contact Travelvax on 1300 360 164.

Fresh cholera outbreak in Dominican Republic
DOMINICAN REPUBLIC: There have been at least 8 deaths in a fresh outbreak of cholera in La Cienaga, a crowded neighborhood in Santo Domingo. It’s the latest outbreak in Haiti’s near neighbour. More details.
 

Travelvax Australia compiles this weekly bulletin of global travel health alerts, risk assessments and advice for the information of Australian trav ellers 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.