World Travel Health Alerts – August 3, 2011

– Outbreak of German measles in Fiji
– Hand-foot-mouth disease ‘spreading in Asia’
– Dengue activity centred on Asia, Americas
– E.coli outbreak officially over
– Measles Update: Cases still rising in New Zealand
– Mumbai gets tough on malaria
– Bird flu death confirmed in Cambodia
– South Africa combines resources to contain Hep A
– Bali on track to eradicate rabies
– Calls for Pakistan to address rabies
– Bolivia fears rabies epidemic is looming
– Search goes on for cross-border GBS
– Mumps: Now it’s Toronto’s turn

Outbreak of German measles in Fiji
Falling vaccination levels have been blamed for an outbreak of German measles (Rubella) in Fiji’s capital, Suva. After 3 initial cases last week, the number had risen to 11 yesterday. More details.
Advice to travellers: German measles is spread by airborne droplets. It is a particular risk for pregnant women. Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine. Travellers should check their immunisation status for all childhood diseases, including measles, whooping cough, diphtheria, mumps, and polio as part of their pre-travel medical preparations.

Hand-foot-mouth disease ‘spreading in Asia’
Hand-foot-mouth disease (HFMD) is not only spreading in Vietnam, but also in Singapore, Brunei, Taiwan, and Japan, Nguyen Van Binh, head of Vietnam’s General Department of Preventive Medicine (GDPM), said last week.
In Vietnam, July saw a sharp increase in cases. The 9700 (21 deaths) recorded bring the year’s total to 23,350 (70 deaths) in 49 provinces and cities. Almost all fatalities were in the south, especially in Ho Chi Minh City. Hanoi, Thanh Hoa and Vinh Long were among other cities with high case numbers.
Meanwhile, Dengue continues to plague Vietnam. Dr Nguyen said more than 23,000 cases (22 deaths) had been recorded this year – with 5000 (8 deaths) in July alone.
More details.
Advice to travellers: HFMD is spread by direct contact with infected persons, or with virus-contaminated surfaces. The disease mainly occurs in children and good hygiene practices will greatly reduce the risk of infection. There is no vaccine or preventative medication.

Dengue activity centred on Asia, Americas
While most dengue activity continues to be reported from Asia, outbreaks in the Americas made news in the past week, notably in the Bahamas and Panama.
The latest dengue bulletin includes reports from:
Sri Lanka – 3697 cases in July was the highest monthly tally for the year, raisng the tally to 13,975 cases and 1112 deaths. Worst affected has been the Colombo district (5454 cases,51 deaths), along with Gampaha (2031,16), Kalutara (767,6), Kandy (461,2), Galle (453,1), Matara (298,4), Batticaloa (651,9), Kurunegala (528,4), Puttalam (322,6), and Ratnapura (551,3). More details.
Sri Lanka will soon get a dengue early warning system, courtesy of the European Union. More details.
Philippines – Outbreaks are occurring in Mabalacat (Pampanga province), Cordillera Administrative Region (Abra, Apayao, Benguet, Ifugao, Kalinga, Mountain, and Baguio City provinces). More details.
Cambodia – With 3 months of its rainy season (May-October) remaining, Cambodia has officially recorded 4626 cases and 23 deaths, mostly children under 5. More details.
Bahamas – The number of cases more than doubled to 90 in just 2 days last week. The outbreak is the first since 2003. More details.
Panama – A fresh outbreak has raised the year’s tally to 1608 cases. There have been 2 recent fatalities among 13 cases of more severe dengue haemorrhagic fever. More details.
Brazil – In Parana state, there has been a record 7371 cases in the northern city of Londrina this year. In comparison, Alagoas state has had 7923 cases to date, compared to 42,343 last year. More details.
Advice to travellers: Seasonal rains in Asia are creating ideal conditions for dengue and other mosquito-borne disease, although limited activity persists in Latin America and the Caribbean. In the tropics, 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 reso rts, and bite mainly during the day.

E.coli outbreak officially over
Germany has declared the E. coli outbreak which killed more than 50 people is now over after no cases were reported in the past three weeks. More than 4400 people in Europe and North America were infected in two outbreaks: the major one centered in the northern German city of Hamburg, and a smaller cluster in the French city of Bordeaux.
Germany's national disease control agency shut down its monitoring centre last week, but intensified surveillance will continue in case the pathogen resurfaces. Fenugreek seeds imported from Egypt are the likeliest source of the outbreak. More details.
Measles Update: Cases still rising in New Zealand
In New Zealand, 14 new cases last week saw Auckland’s measles tally climb to 90. Frustrated health officials say there appears to be no end in sight. As feared, the outbreak has now spread outside Auckland, with Waikato announcing an outbreak.
The latest measles update provides details of outbreaks in the following regions:
Europe – UK (Sussex), Ukraine (Western)
Africa – Angola (KS), Congo DR (multi province)
Americas – USA (Indiana, Pennsylvania)
More details.
Philippines: A vaccination campaign will be ramped up to stop an outbreak (43 cases) in Roxas City, Capiz (Western Visayas). More details.
Advice to travellers: Given ongoing epidemics in many parts of the world, Australian travellers should ensure they are protected against measles. Those who have not had measles or have not received two documented doses of live virus vaccine should consider a booster, regardless of their destination. We also advise travellers to check their immunisation status for childhood diseases such as whooping cough, diphtheria, mumps, and polio, as part of their pre-travel medical preparations.

Mumbai gets tough on malaria
Maharashtra State accounts for 13.4% of India’s malaria cases, more than half of them occurring in it’s capital, Mumbai. The city recorded 24,973 official cases between January and June, according to figures released to the state Assembly. The government says the hundreds of high-rise construction sites in Mumbai are a breeding ground for mosquitoes. It has drafted a raft of new measures to address the malaria menace, including blood testing and treatment for construction workers, and making it compulsory for companies to appoint a doctor to treat workers on building sites. More details.
Advice to travellers: Malaria is highly endemic in India and is present throughout the year in rural and urban areas, including major cities. The risk is higher during and immediately after the monsoon rains. Travelvax recommends that 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.

Bird flu death confirmed in Cambodia
Cambodia has had another rare, but lethal case of bird flu. The WHO has confirmed a 4-year-old girl from north-western Banteay Meanchey province is the seventh person to die from the H5N1 strain of avian influenza this year. Worldwide, there have been 563 human cases of avian A/H5N1 influenza virus infection, including 330 fatalities, since the first case was recorded in 2003. The 47 cases this year have occurred in Bangladesh (2), Cambodia (7), Egypt (31), and Indonesia (7) – 23 of them fatal. All were associated with exposure to diseased poultry, with no human-to-human transmission. More details.
Advice to travellers: For travellers the risk of infection by avian influenza is low. The virus is excreted in the droppings of infected birds. Travellers should avoid contact with chickens and birds in live animal markets and poultry farms, and any free-ranging or caged poultry. Read more on H5N1.
http://www.who.int/csr/disease/avian_influenza/travel2005_11_3/en/index.html

Sou th Africa combines resources to contain Hepatitis A
In South Africa, at least 17 cases of hepatitis A have been confirmed in Tshwane district (Gauteng province). National and local health officials have joined forces to halt the outbreak, which began in nearby Pretoria. More details.
Advice to travellers: Typically, the Hepatitis A virus (HAV) is contracted by eating or drinking food or water contaminated by the faeces of an infected person, or from contaminated items such as crafts, money, door-handles etc. It is a common vaccine-preventable infection in travellers to developing countries and the degree of risk can be seen on this CDC map. Vaccines offers high-level, long-term protection, but good personal hygiene is also important. Read more on Hepatitis A.

Bali on track to eradicate rabies
Indonesia says it is on track to rid Bali of rabies. The number of villages to have recorded cases has now dropped from 266 to 44, while more than 80% of the island’s estimated 360,000 dogs have now been vaccinated. The national government is optimistic that by 2012 there will be no new cases, and that the island can be declared officially rabies-free by 2015. More details.
Advice to travellers: Generally, rabies presents a low risk to most travellers, but the potential for exposure rises for longer stays – especially for children. Dog bites cause 99% of human fatalities and rabies immunoglobulin for rapid post-exposure treatment is in short supply globally. India has the highest incidence of rabies. Tr avellers should avoid any contact with wild and domestic animals, and seek urgent post-exposure treatment if bitten. To discuss the risk of rabies for your itinerary, call Travelvax on 1300 360 164.

Calls for Pakistan to address rabies
More than 5000 rabies deaths – almost one in every 10 worldwide – occurs in Pakistan each year, according to new figures. Experts have called for a decisive plan of action to tackle the disease. More details.

Bolivia fears rabies epidemic is looming
Bolivian authorities fear a rabies epidemic following a marked increase in human cases recently. They say there have been 4 deaths and cases are up in 3 departments (states). More details.

Search goes on for cross-border GBS
Experts believe 24 cases of Guillain-Barre Syndrome (GBS) in a small area on the US-Mexico border may be due to bacterial contamination of food or water. The outbreak is centred on Yuma County (Arizona) and neighboring San Luis Rio Colorado (Sonora). As a joint team searches for the source, locals and visitors have been urged to wash their hands thoroughly after using the toilet, as well as before cooking and eating. In rare cases, GBS can cause paralysis or death.