–  Rare case of Japanese encephalitis in Bali
–  New Typhoid outbreak in Fiji
–  Caribbean cholera count set to rise
–  Dengue: the news could get worse for Rio
–  Acute diarrhoea strikes in Germany: 80 hospitalised
–  Baby injured by airline food, mother claims
–  Pesticide suspected in Chiang Mai deaths
–  Rabies toll rises in major cities in India, Russia
–  Low condom use behind Bali’s rising HIV/AIDS rates
–  Correction: No Chikungunya in the Seychelles

Rare case of Japanese encephalitis in Bali
A 54-year-old German woman is being treated in hospital for Japanese encephalitis (JE) after contracting the mosquito-borne disease during a two-week holiday in Bali late last month. The woman and her husband “visited many tourist sites and went upcountry, but did not stay in particularly low budget accommodations”, according to the tropical diseases specialist who reported the case. The woman is expected to make a full recovery. More details.
Advice to travellers: JE infection is extremely rare among travellers. Generally, vaccination is not recommended for short-stay travel to urban areas of Indonesia and other parts of Asia where the disease occurs. For expats and people staying for prolonged periods in rural areas of Asia, the risk of JE is similar to that of local people (0.1-2 cases per 100,000 persons per week). Dengue fever remains the main mosquito-borne risk in Bali, although this case highlights the need for all travellers to use an effective insect repellent for personal protection while travelling in the tropics. Read more on JE and the risk to travellers.

New Typhoid outbreak in Fiji
Typhoid is again widespread in Fiji, according to a media report quoting a Ministry of Health spokesman. The epicenter of the outbreak is a mining operation at Bau (Vanua Levu island) where there have been 42 cases. More details.
Advice to travellers: Typhoid is a recurring problem in Fiji, however the disease presents a low risk for travellers in hotel or resort accommodation. The disease is spread by contaminated food and beverages and vaccination is more likely to be recommended for those staying in homes or budget accommodation in rural areas, or those with adventurous eating habits. We advise all travellers to follow safe food and water guidelines.

Caribbean cholera count set to rise
There is no end in sight to the Caribbean’s worst humanitarian disaster in a century, with cholera case numbers expected to rise sharply with the onset of the hurricane season next month.
In Haiti, 4 deaths and an average 560 cases a day have raised the death toll to 5200 people from more than 300,000 cases over the last 7 months. In neighbouring Dominican Republic, hundreds of new cholera cases have been recorded throughout the country, raising the total to 1143 cases (14 deaths) since the outbreak began there in November. More details.

Dengue: the news could get worse for Rio
As if 2011 hasn’t been bad enough, experts warn Rio de Janeiro could face an even bigger epidemic of dengue fever next year. The prediction follows news that types 1 and 4 are now circulating in the city and other areas of Rio state. Type 4 is new to the region, while Type 1 hasn’t been seen for more than 20 years, which would make the young particularly susceptible.
South America again dominates this week’s global dengue roundup. Included are reports from Brazil (Sao Paulo state - Ribeirao Preto, Bauru, Rio Claro, Sorocaba; Rio de Janeiro state – south regions, Niteroi, Rio de Janeiro city, statewide; Ceara state; Andradas Minas Gerais state; and Mato Grosso do Sul state), as well Paraguay, and Venezuela (Ciudad Guayana, Bolivar state). More details.
CAMBODIA: As the peak dengue season (Jun e-July) approaches, there are signs the country could be heading for a major epidemic, the head of the National Dengue Control Program has warned. There have been high case numbers during recent months when dengue is usually rare, and outbreaks are occurring in 4 of Cambodia’s 24 provinces. More details.
HONG KONG: Two men have contracted dengue while holidaying in Phuket (Thailand) last month, bringing to 8 the number of imported cases in Hong Kong this year. Last year, there were 79 imported, and 4 local cases. More details.
QUEENSLAND: Aedes egypti mosquitoes, which carry dengue fever, have been found in Gin Gin, near Bundaberg for the first time. Queensland Health says they probably hitched a ride south with people who had visited the state’s far north. More details.
Advice to travellers: Dengue remains arguably the most significant travel health risks for Australians visiting urban or rural areas in tropical regions. The mosquitoes that transmit the dengue virus inhabit urban areas, including leading hotels and resorts, and bite during the day. We advise travellers to adopt personal measures to avoid mosquito bites, including applying an insect repellent containing an effective active ingredient, such as DEET, Picaridin, IR3535, or oil of lemon eucalyptus at all times when outdoors. Clothing that covers arms and legs, and footwear, is also advisable at times of high mosquito activity, especially at dusk.

Acute diarrhoea strikes in Germany
An outbreak of life-threatening diarrhoea has infected around 80 people in Germany, put ting many of them in intensive care. While a strain of E.coli is suspected, the source remains unknown as victims have been too ill to talk to health authorities. More details.

Baby injured by airline food, mother claims
In-flight food is under the spotlight after a woman claimed Listeria bacteria was present in a chicken roll she consumed during a flight, causing developmental delays and other injuries to her unborn child, court documents allege. Renee Cherry has launched legal action in the Supreme Court on behalf of her son Zayd Fokeera, now aged almost two, seeking compensation from Virgin Australia. Her solicitors, Slater and Gordon said they are investigating several cases of food poisoning arising from airline travel. More details.

Pesticide suspected in Chiang Mai deaths
Thailand is anxiously awaiting the results of tests by the WHO, hoping they will identify what caused the death of seven people, 6 of them tourists, in Chiang Mai. The victims died mysteriously in the northern province between January and February. Four of them had stayed at the Downtown Inn, which a WHO team has tested exhaustively. Surasing Visaruthrat, Chiang Mai's head of public health, said the team suspects an unnamed pest-control substance, but had now ruled out a bedbug spray containing chlorpyrifos. More details.

Rabies toll rises in major cities in India, Russia
In India, a shortage of rabies vaccine for post-exposure treatment has been blamed for a spate of deaths in Rajahmundry and Kakinada , in the southern coastal state of Andhra Pradesh. Several victims reportedly approached local hospitals after being bitten by dogs, only to be sent away without treatment. More details.
Rabies also remains a problem in Moscow and surrounding regions, in particular the Krasnogorsky, Leninsky and Odintsovsky regions. There have been several recent deaths in the city’s suburbs, and more than a dozen people have received post-exposure treatment. More details.

Low condom use behind Bali’s rising HIV/AIDS rates
Concerned at ‘skyrocketing’ rates of HIV/AIDS in Bali, health authorities want more of the island’s sex workers to insist that their clients use condoms, local online news site BaliDiscovery reported this week. Only 1-in-4 sex workers require condoms be used, according to local health authorities, who said an estimated 4000 people contracted the disease in 2010. Many Balinese see the use of condoms as condoning ‘free sex’, despite growing rates of pregnancy among school-aged girls and rising HIV/AIDS rates. More details.

Correction: No Chikungunya in the Seychelles
The Seychelles government has advised Travelvax Australia that an item in our newsletter of April 27 stating that there had been an outbreak of Chikungunya fever in the country was incorrect. We based the alert on a posting on ProMED, which took the information from a local media report, which gave details of outbreaks in both the Seychelles and Madagascar. This week, disease surveillance network, ProMED stated: “The error was one of inaccurate reporting in the original article, not one of an inaccurate translation. ProMED frequently has to rely on the popular press for timely disease outbreak information. Unfortunately, in this case, although the Madagascar information was probably accurate, the Seychelles information was not.”
Travelvax Australia’s National Operations Manager, Tonia Buzzolini commented: “We are delighted that there is no Chikungunya outbreak in the Seychelles and happy to correct the error. Like ProMED, we published the item in good faith and regret any inconvenience it may have caused.”

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.