– Europe’s E. coli death toll climbs to 16
– Uganda dodges Ebola ‘bullet’
– Rare mozzie disease kills Canadian traveller
– Fiji’s typhoid tally soars to 149
– Finally, Rio gets some respite from dengue
– Pacific on alert as Chikungunya smolders in Noumea
– Low vaccination rates fuel measles epidemics
– Bali winning rabies battle – but slowly
– Polio continues to plague Pakistan.

Europe’s E. coli death toll climbs to 16
With 16 people dead and more than 1150 infected in 10 countries, Europe’s E. coli outbreak is looming as one of the world’s largest ever cases of food poisoning. Until the source of the contamination is confirmed, travellers have been warned to avoid eating salad vegetables – especially in northern Germany. EU health officials suspect organically grown cucumbers from Spain as the source of the outbreak. Cases have also been reported among German tourists and returning travellers in France, Sweden, Denmark, Britain, Switzerland, Austria, Spain, The Netherlands, and the USA. More details.

Uganda dodges Ebola ‘bullet’
Ugandans breathed a collective sigh of relief when no new Ebola cases emerged last week. WHO and government medical teams had been on high alert since a lone fatality on May 6. A second suspected case proved negative. The Sudan strain of Ebola is highly contagious and virulent, and relieved observers are amazed that there was no widespread outbreak. More details.
Advice to travellers: Ebola viruses are spread by direct contact with blood and body secretions. Symptoms include fever, vomiting, diarrhoea and, in many cases, internal and external bleeding. There is no vaccine.

Rare mozzie disease kills Canadian traveller
A 19-year-old Canadian tourist has died in Calgary (Alberta province) after contracting Murray Valley encephalitis (MVE) during a 10-day holiday in the Northern Territory in May. More details.
Meanwhile, the rare mosquito-borne disease has left several West Australians fighting for their lives in hospital. Among 9 MVE cases this year are a toddler from the Kimberley area and a 29-year-old Perth police officer who contracted the disease while working in a rural Aboriginal community. More details.
Advice to travellers: MVE virus is transmitted by the common banded mosquito (Culex annulirostris), which bites in the 2 hours after sundown. Heavy rains and flooding in January and February led to a significant increase in mosquito breeding habitats in wetland areas of Victoria, South Australia and the Northern Territory. There have been two other MVE deaths in Australia this year, along with hundreds of cases of Ross River fever. With no vaccine, avoiding bites is the only sure way to avoid infection. While most people infected with MVE experience only mild symptoms, if any, in rare cases symptoms can worsen to include neck stiffness, tremors, and seizures.

Fiji’s typhoid tally soars to 149
The number of typhoid cases in Fiji has risen to 149 cases, according to a lo cal media report. Following last week’s report of 42 cases Bua (Vanua Levu), there have now been 107 new cases, including 71 in Northern division and 6 in Central, FijiLive reports, quoting a Ministry of Health spokesman, Peni Namotu. More details.
Advice to travellers: Typhoid is spread by contaminated food and beverages and presents a low risk for visitors staying for short periods in hotels or resorts. Vaccination is more likely to be recommended for people staying rural areas and those with adventurous eating habits. We advise all travellers to follow safe food and water guidelines.

Finally, Rio gets some respite from dengue
BRAZIL – With significantly fewer cases in late May compared to April’s peak, the dengue epidemic in Rio de Janeiro state is declining, despite localised outbreaks in Volta Redonda and Angra dos Reis. The state has recorded 107,227 official cases and 80 deaths this year – more than a third of them in Rio de Janeiro city.
In Brazil’s Sao Paulo state, the virus is at near epidemic levels in the cities of Sorocaba, Tambau, and Campinas. In Alagoas state, 24 municipalities are on dengue alert, although infection rates have declined statewide in recent weeks. Parara state has had 21,902 confirmed cases this year, the majority in northern municipalities. Authorities say the epidemic in Ceara state is now under control, despite a fresh outbreak in Fortaleza city.
This week’s dengue round-up also includes Puerto Rico, Sri Lanka and India. More details.
Advice to travellers: The continuing presence of dengue fever in Latn America and Asia highlights the need for Australian travellers heading abroad to be aware of the risk and avoid mosquito bites. Travellers should cover up and regularly apply an insect repellent containing effective active ingredients, such as DEET, Picaridin, IR3535, or oil of lemon eucalyptus, to exposed skin at all times when outdoors. The mosquitoes that transmit the dengue virus inhabit urban areas, including leading hotels and resorts, and bite mainly during the day.

Pacific on alert as Chikungunya smolders in Noumea
With 26 cases of Chikungunya fever now recorded in New Caledonia, authorities have introduced new measures to eradicate mosquito-breeding sites in and around the capital, Noumea. While it remains localised, regional authorities are watching the Pacific’s first outbreak closely. 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.

Low vaccination rates fuel measles epidemics
Europe’s measles epidemic continues unabated with low vaccination rates blamed for the dramatic impact across the Continent.
France has had more than 10,000 cases (78%), with Spain (5%) a distant second, followed b y Germany (3%), Italy (2%), Romania (2%), and Switzerland (2%). In Switzerland, almost 1 in every 10 of the 486 measles cases this year has required hospital treatment.
Across the Channel, cases continue to rise sharply in England and Wales where there have been 334 cases since January, compared to 374 for all of 2010. Many cases in the UK and USA have been travel-related.
In the USA, which normally sees 50 cases a year, thee have now been 118 cases – the highest tally since 1996. Of the 118 victims, 105 had not been vaccinated and 4-in-10 wee hosptialised.
In Africa, new figures reveal 3022 cases (8 deaths) in Nigeria this year compared to 464 last year, and 4 deaths from an unknown number of cases in Somalia.
More details.
Mozambique is leading the way in an ambitious WHO campaign to reduce measles deaths by 98% by 2012 in sub-Saharan African countries. More than 3.6 million children were vaccinated last week at a cost of $US4.5 million. After recording 197,000 cases in 2007, Mozambique recorded only 434 last year.
Advice to travellers: Australians heading overseas 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. Passengers on planes, boats, trains and buses are at higher risk of infection from a contagious person. We recommend 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.

Bali winning rabies battle – but slowly
Bali may push back its rabies eradication deadline from 2012 to 2015, as the island’s administrators concede the difficulties in achieving the ambitious goal. However, as a new dog vaccination drive gets underway there are positive signs: only 100 dogs tested for rabies to date this year compared to 500 last year, and fewer villages have reported cases, the Jakarta Post reports. More details.
Advice to travellers: This news is encouraging, travellers should remain alert to the risk of rabies in Bali, and on other Indonesian islands. As stated previously, the risk of rabies for most travellers to Bali is low. However, travellers should avoid contact with wild and domestic animals, and seek post-exposure treatment urgently if bitten. Rabies immunoglobulin for rapid post-exposure treatment continues to be in short supply on the island.

Polio continues to plague Pakistan
A new case of polio in Karachi last week brings the number in the city this year to 4 and the total in Singh province to 12. Pakistan has had 43 cases of polio this year – the highest rate in the world. 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.