-  Deadly start to JE season in India’s north
-  Malaria flares in India; Small outbreak in Sabah
-  Dengue alerts for India, Brazil, Australia
-  Measles reaches new places, new faces on global march
-  Cholera epidemics hit Africa, Asia, Caribbean
-  Measles and Chikungunya: Double trouble for Republic of Congo
-  Whistler’s mumps reaches Vancouver

Deadly start to JE season in India’s north
A media report says Japanese encephalitis (JE) has caused the deaths of 26 people, mainly children, in India’s far northeast in the last fortnight. Another 30 are in intensive care. The outbreak has occurred at the beginning of Bihar state’s JE season. More details.
Advice to travellers: JE infection is extremely rare among travellers. Generally, vaccination is not recommended for short-stay travel to Asia, where the disease occurs. However, travellers should discuss their individual risk based on their itinerary at their nearest Travelvax Clinic or with their healthcare provider. 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). Malaria and dengue fever remain the main mosquito-borne risks in India and all travellers should use an effective insect repellent for personal protection. We advise travellers to consider taking malaria prevention medication. Read more on JE and the risk to travellers.

Malaria flares in India; Small outbreak on Sabah
Further south in India, there have been 145 recent cases of malaria in Hyderabad (Andhra Pradesh state), the majority in Banjara Hills and Bholakpur (Musheerabad). More details.
In Mumbai (Maharashtra), there’s been an outbreak of malaria in Arthur Road Jail. More details.
Cases are also rising in the coastal city of Mangalore (Karnataka). More details.
In Malaysia, malaria has been reported in Kampung Kionsom (Sabah). More details.
Advice to travellers: There have been regular reports of malaria in India. It is present year-round in rural and urban areas, including major cities. Malaria is considered a year-round risk in rural areas of Sabah and Sarawak. Travelvax recommends travellers discuss their itinerary and preventative malaria medication at their nearest Travelvax clinic, or with their healthcare provider. For advice, call Travelvax on 1300 360 164.

Dengue alerts for India, Brazil, Australia
INDIA: The onset of the monsoon has brought dengue fever to many parts of Thiruvananthapuram city (Kerala state). Meanwhile, Mumbai (Maharashtra state) has recorded the first death of the year from dengue haemorrhagic fever (DHF).
SOUTH AMERICA: In Brazil’s Parana state new epidemics have occurred in the cities of Jaguapita and Quinta do Sol. Of the state’s 399 municipalities, 38 have epidemics, and 136 outbreaks.
In Rio de Janeiro state, the dengue death toll has risen to 99 (131,604 cases) – a third of them in Rio de Janeiro city. In Sao Goncalo, cases have slowed dramatically in June after 947 in May.
In neighbouring Sao Paulo state, the northern city of Ribeirao Preto is again experiencing record cases (14,257) and deaths (8). Closer to the coast, low temperatures are expected to slow the outbreak in Sorocaba city.
Bolivia fears this year’s outbreak in Santa Cruz department may surpass its 2009 outbreak. To date, there have been 21 deaths from 21,550 confirmed and suspected cases.
In Peru’s sparsely populated far north, several cases and rising mosquito numbers have prompted fears of a more serious outbreak.
AUSTRALIA:It’s been 3 months since the last dengue cases in Innisfail, Cairns, or Townsville, signaling an official end to outbreaks in North Queensland. Innisfail had 47 of the region’s 69 cases – half of them requiring hospital treatment.
More details.
Advice to travellers: While there have been fewer reports of dengue in recent weeks, Australians heading to the tropics should continue 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.

Measles reaches new places, new faces on global march
In the USA, virtually all of the 118 people infected with measles this year were unvaccinated, with around 50 requiring hospital treatment.
It is the country’s largest outbreak in 15 years and most cases have been linked to overseas travel. North Dakota, South Dakota, and Massachusetts are the latest of 23 states to see outbreaks, the CDC announced this week.
Elsewhere, measles was reported in:
SPAIN: The disease has been imported into the Alicante region, an autonomous territory in southern Spain.
KYRGYZSTAN: Doctors have appealed to the WHO to initiate a vaccination campaign after the country registered its 83rd case, 66 in Osh oblast.
CANADA: Quebec’s tally has jumped to 330. The outbreak has been traced to a traveller infected in France.
PHILIPPINES: There’s been a suspected measles outbreak in 2 evacuation centres housing 8000 families made homeless when floodwaters hit Cotabato City on Mindanao.
AUSTRALIA: WA Health has again warned the public to be on the alert for measles after 2 travellers recently returned to Perth with the disease from the Philippines and Thailand.
NEW ZEALAND: There have now been 17 cases of measles in Auckland, most in unimmunised people. Three required hospitalisation. Another 200 people may have been exposed and some of those contacted have been instructed to isolate themselves.
More details.
Advice to travellers: Australian travellers 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 – regardless of their destination. Measles is a highly contagious a irborne disease that can cause severe illness. Travelvax recommends travellers check their immunisation status for childhood diseases such as whooping cough, diphtheria, mumps, and polio, as part of their pre-travel medical preparations.

Cholera epidemics hit Asia, Africa, Caribbean
Cholera has claimed the lives of dozens of young children under 5 in war-torn Kandahar Province of southern Afghanistan. Thousands more are beyond the reach of medical personnel.
In Cameroon, the death toll has risen to 256 from 7718 cases as cholera rages in 9 of the country’s 10 regions.
In Nigeria’s Adamawa state, cholera has claimed more than 30 lives, mostly women and children in the Mubi South and Maiha regions, while 200 are receiving intensive treatment.
A small outbreak (8 cases) has been confirmed in the Hoima district of Uganda.
With more than 100 deaths already recorded, the toll in Chad is likely to increase now annual rains have begun.
Chipinge is the new epicentre of Zimbabwe's latest cholera outbreak in the eastern Manicaland province. Two thirds of the country’s 936 cases have occurred in the province this year.
More details.
In the Caribbean, there has been a new wave of cholera in the Dominican Republic. More than 1500 cases and 46 deaths have been recorded since last November. More details.
Advice to travellers: Travellers heading to areas where outbreaks are occurring should adhere to strict personal hygiene and choose only safe food and beverages. For most short-stays in a cholera-endemic region, the risk to travellers is low. Call Travelvax on 1300 360 164 for advice on the risks for a particular journey, and whether vaccination should be considered.

Measles and Chikungunya: Double trouble for Republic of Congo
Measles has infected 800 people and claimed 32 lives in Pointe-Noire, the Republic of Congo’s economic hub. Poor vaccination coverage has been blamed for the outbreak, malnutrition for the deaths – mainly among young children. The measles outbreak comes at a time when the country’s health services are trying to deal with an epidemic of Chikungunya fever, which has infected more than 4000 people in the southern districts of the capital, Brazzaville. More details.
Advice to travellers: As with dengue fever, there is no vaccine or preventative medication for Chikungunya fever, which is spread by daytime-feeding 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.

Whistler’s mumps reaches Vancouver
In Canada, an outbreak of mumps that began on Whistler’s ski fields in recent months has now reached Lower Mainland areas of British Colombia, including the capital, Vancouver. As mentioned last week, the outbreak has effected young adults, mainly males, aged 18-35. More details.
Advice to travellers: Mumps is among the pre-travel vaccinations Travelvax routinely 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.

Travelvax Australia compiles this weekly bulletin of globa l 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.