WORLD TRAVEL HEALTH ALERTS – October 12, 2011

- SE Asia braces for severe flooding
- Bird flu kills two boys in Bali
- DENGUE ALERTS: Cambodia, Philippines, India,   Pakistan, El Salvador, Costa Rica, Brazil
- Water may be source of India’s deadly AES
- Cholera epidemics among Africa’s worst, says UNICEF
- Caribbean rains bring new surge of cholera
- Legionnaires’ outbreaks in Greece and Italy
- Measles continues in both hemispheres
- Mumps hits UC’s Berkeley campus
- Malaria the latest torment for southern Pakistan
- Bihar is India’s leishmaniasis ‘capital’
- Rise in rabies deaths in central Angola

SE Asia braces for severe flooding
THAILAND, CAMBODIA: Flooding in SE Asia has killed 252 people in Thailand and another 200 in Cambodia. Floodwaters have inundated 59 of Thailand’s northern provinces and are expected to reach Bangkok this weekend.
The Thai government says it is unlikely the 7000 million cubic metres of water flowing down the Central Plains can be diverted before it reaches the capital on Saturday or Sunday. More details.
In neighbouring Cambodia, the flooding has affected 1.2 million people, displacing tens of thousands of families. More details.
Advice to travellers: Floodwaters will inevitably bring gastro infections and other water-borne diseases, such as leptospirosis, to affected areas. A rise in insect-borne diseases also can be expected as waters subside. Tra velvax advises Australian travellers visiting flood-effected regions to avoid wading in floodwater. Those travelling in coming weeks should follow food and water guidelines, and avoid insect bites by covering up and using an insect repellent at all times when outdoors.

Bird flu kills two boys in Bali
INDONESIA: Authorities in Bali are on alert for bird flu (H5N1) following the deaths of brothers aged 10 and 5 in the northern Bangli Regency on Monday. Tests are expected to confirm bird flu as the cause of death, however the boys had been in direct contact with dead poultry around their home. The WHO has confirmed bird flu killed a one-year-old girl from DKI Jakarta province on August 25. More details.
Advice to travellers: Indonesia has now had 181 cases (149 deaths), mainly in West Java and Sumatra, since the bird flu outbreak began in 2005. The disease is a low risk to travellers; however, Australians visiting affected areas should avoid eating poultry from street stalls, and handling chickens or caged birds in live animal markets. Read more on bird flu.

DENGUE ALERTS: Cambodia, Philippines, India, Pakistan, El Salvador, Costa Rica, Brazil
In Asia, dengue activity has intensified in flood-effected regions in the past week, notably in Cambodia and the Philippines. In Latin America, El Salvador and Costa Rica feature in this week’s dengue roundup.
CAMBODIA: Recent rains and flooding have pushed the year’s dengue toll to record levels. In the first nine months, 54 children have died with 5497 infected, compared to 37 fatalities and 5497 cases for all of 2010. Cambodia’s rainy season runs from May to October. More details.
PHILIPPINES: Dengue cases in Metro Manila have risen by 32% and are expected to go higher following massive floods caused by back-to-back typhoons last week. I n the first 9 months, the nation officially recorded 19,432 dengue cases (108 deaths), compared to 14,751 cases (106) in the same period last year. More details.
INDIA: This week's bulletin includes last month’s cumulative state totals, when 6098 cases and 2245 deaths were officially recorded. Andhra Pradesh, Gujarat, Karnataka, and Tamil Nadu were among the states worst effected. More details.
Read more on outbreaks in Punjab state and Hyderabad (Andhra Pradesh state).
PAKISTAN: Dengue activity continues to intensify across the country as medical facilities in major cities such as Islamabad, Lahore, Faisalabad, and Karachi are swamped with cases from metro and rural areas.
EL SALVADOR: 63 cases were registered last week, with public alerts current for 8 departments. This year there have been 4592 cases (5 deaths).
COSTA RICA: Of this year’s 6650 cases, 4000 have been on the Atlantic Coast. Limon province has 3 of the 4 dengue serotypes, making it difficult to curb the disease.

BRAZIL: Figures from the first 6 months reveal the highest intensity in Brazil’s southeast. Three quarters of the 715,000 official cases (131 deaths) occurred in 8 states: Rio de Janeiro, Sao Paulo, Amazonas, Ceara, Parana, Minas Gerais, Espirito Santo, and Bahia. Rio de Janeiro state has recorded 159 052 cases (131 deaths) in the year to September 24.

Advice to travellers: Travellers visiting tropical countries 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.

Water may be source of India’s deadly AES
INDIA: In the far northern states of Bihar and Uttar Pradesh, more than 400 people have died in the last month from mosquito-borne Japanese encephalitis (JE), and acute encephalitis syndrome (AES).
While AES remains undiagnosed, there is now speculation that contaminated water may be the source. More details.
New Delhi has recorded its fifth case of Japanese encephalitis. More details.
Advice to travellers: AES and seasonal JE, along with other insect-, food- and water-borne diseases, continue to be a risk to Australians travelling in the north states during India’s post-monsoon months (October – December). They should discuss their itinerary and risk of exposure with a travel health professional. For advice on whether JE vaccination should be considered, call Travelvax on 1300 360 164. As always, we also advise travellers to cover up and use an effective insect repellent at all times when outdoors.

Cholera epidemics among Africa’s worst, says UNICEF
With 85,000 cases and 2466 deaths, Central and West Africa is in the grip of cholera epidemics that are among the worst the continent has ever seen, according to the United Nations Children’s Fund (UNICEF). While smaller cholera epidemics in Benin, Cote d’Ivoire, Ghana, Guinea, Liberia, and Togo are under control, the agency has appealed for international assistance to combat three major cross-border epidemic outbreaks. These include: the Lake Chad Basin, taking in Chad, Cameroon, Nigeria and Niger; the We st Congo Basin (Democratic Republic of the Congo, the Republic of the Congo, and the Central African Republic); and Lake Tanganyika (the DRC and Burundi). More details.

Caribbean rains bring new surge of cholera
HAITI: The rainy season in Haiti has a seen a new surge in cholera cases, with weekly numbers spiking from 250 last month to 850 last week. A year after the epidemic began, there have been 456,000 cases and 6435 deaths. More details.

Legionnaires’ outbreaks in Greece and Italy
CORFU (GREECE): Nine cases of Legionnaires’ disease among British travellers who visited various areas of the island in the past six weeks are being investigated by Greek, UK, and European health authorities. Situated in the Ionian Sea, Corfu is northwest of mainland Greece, off the coast of Albania. More details.
ITALY: In the Italian lakeside resort town of Lazise, there have been 17 cases of Legionnaires’ among travellers from 5 European countries since mid-August. Testing at 3 hotels and 2 camping grounds has failed to locate the source of the disease. More details.
Advice to travellers: Initial symptoms of Legionnaires' disease may include a high fever, chills, a cough, muscle aches and headaches. Transmitted by breathing in contaminated mist or vapor, Legionnaires disease is not contagious and presents a low risk to most travellers. As reported previously, there have been significant increases in rates of Legionnaires' disease in Italy and surrounding countries since 2000. Travel-related cases have almost tripled in the last decade in Italy. Read more on Legionnaires' disease.

Measles continues in both hemispheres
Ten months after 5 students caught measles on a flight from Singapore, nearly 300 New Zealanders have been infected – 44 requiring hospital treatment. There is no end in sight to Auckland’s outbreak. More details.
To September 20, Europe has recorded 26,025 measles cases (11 deaths). The majority has come from France – 14,600 this year alone, and almost 22,000 since the first wave of the epidemic began in January 2008.
AFRICA: Large outbreaks are being reported by the Democratic Republic of the Congo (DRC), which has recorded 103,00 cases (1100 deaths), followed by Nigeria (17 428), Zambia (5397), and Ethiopia (2902).
AMERICAS: Most of the region’s outbreaks in 2011 have been linked to travel to Europe. In Canada, Quebec has had 742 cases, the USA (213 cases), Ecuador (41), Brazil (18), Columbia (7), Mexico (3), and Chile (6).
The WHO has renewed its advice to people travelling overseas to have a primary or booster course of measles vaccine before departure, as required.
Advice to travellers: Measles is extremely contagious and Australian travellers who have not had the disease or two documented doses of live virus vaccine should consider a booster, regardless of their age or destination. We also advise travellers check their immunisation status for childhood diseases such as whooping cough, diphtheria, mumps, and polio, as part of their pre-travel preparations.

Mumps hits UC’s Berkeley campus
USA (California): Mumps ‘imported’ from the UK continues to spread repidly on the University of California’s Be rkeley campus, with 44 confirmed or suspected cases – 41 during last 2 weeks alone. More details.
Advice to travellers: Mumps is among the pre-travel vaccinations that Travelvax routinely recommends to all travellers, particularly young adults.

Malaria the latest torment for southern Pakistan
PAKISTAN: In the wake of widespread flooding which have brought food-, water- and insect-borne diseases to southern regions, 12,000 cases of malaria have also been recorded in Sindh province, according to this media report. More details.
Malaria is endemic across Pakistan. During 2008 (the latest reported year), it recorded 1.5 million malaria cases – 25% the severe P. falciparum strain. More details.
Advice to travellers: Malaria is endemic year-round in rural and urban areas of Pakistan, including its cities. The risk is higher during and immediately after the monsoon rains. Travellers to Pakistan should discuss their itinerary, and whether or not preventative malaria medication should be considered, at their nearest Travelvax clinic, or with their healthcare provider. For more advice, call Travelvax on 1300 360 164.

Bihar is India’s leishmaniasis ‘capital’
INDIA: With 56 of the nation’s 60 deaths from 24,231 cases this year, the northern state of Bihar has been hit hardest by leishmaniasis. Other states affected by the sand fly-borne disease include Assam (5 cases, 0 deaths), Himachal Pradesh (1, 0), Jharkhand (4264, 3), Sikkim (3, 0), Uttar Pradesh (8, 1), and West Bengal (1431, 0). More details.
Advice to travellers: Leishmaniasis is widespread in the tropics, subtropics and southern Europe. There is no vaccine and travellers can greatly reduce the risk of infection by using an effective repellent to avoid sand fly bites. Read more on leishmaniasis.

Rise in rabies deaths in central Angola
ANGOLA: There has been a significant increase in rabies deaths in central Huambo province this year, mainly in the municipalities of Huambo, Tchicala-Tcholohanga, Caala, and Londuimbali. Stray dogs are the main source of the virus. More details.

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.