MASTA Travel Health Alert- 6th October 2016
Dengue fever is a continuing problem throughout Myanmar, over 7,300 cases (40 deaths) have been recorded, Jan-Oct 16. Mandalay(C) reports many cases.
Dengue fever is a viral infection spread by day-time biting mosquitoes. It is widespread across over 110 countries with large outbreaks reported in many regions including South East Asia and South/Central America. Dengue fever commonly causes flu-like symptoms including fever, joint pain and rash. Severe forms of the disease are rare in travellers but can lead to excessive bleeding and organ failure.
A resurgence of diphtheria has been reported in Bolivar (C), Oct 16. 22 deaths have been reported, many in the Sifontes region.
Diphtheria is a bacterial infection affecting the respiratory tract usually spread through respiratory droplets such as coughing. The risk is increased in conditions of overcrowding and poor hygiene. It can cause serious throat symptoms and also affect the skin. Vaccination is part of the standard UK immunisation schedule and boosters are given in combination with tetanus and polio.
An outbreak of hepatitis A has been reported on Oahu with 284 cases recorded, Jul-Oct 16. The source of the outbreak has been traced to imported frozen scallops served raw at sushi restaurants.
Hepatitis A is a viral infection which affects the liver and occasionally causes severe disease. It is usually spread by contaminated food and water. Symptoms include fever, digestive disturbance and jaundice. Effective hepatitis A vaccines are available and can be given on their own or in combination with hepatitis B or typhoid.
At least 27 deaths from Japanese encephalitis have been reported in Odisha, Oct 16. 360 cases (78 deaths) were reported in Assam (NE), 600 cases (250 deaths) in Uttar Pradesh (N), and over 80 cases in Bihar (N), Aug 16. Over 1,600 cases of encephalitis were reported in Uttar Pradesh, 100 in West Bengal and 200 in Assam, during 2015. Some cases are confirmed as Japanese encephalitis whereas others are attributed to acute encephalitis syndrome (AES).
Japanese encephalitis is a viral infection affecting the nervous system spread by mosquitoes. There is no treatment and around a third of those who develop encephalitis will die. It is found in parts of Asia, particularly in rural areas where there are rice fields and pig farms. The risk is highest during the rainy season. Vaccination should be considered for long stay or rural travellers.
There has been an increasing number of Lassa fever cases, with over 823 suspected cases (96 deaths) reported from 28 states, Jan-Sep 16. Lassa fever is a serious problem in many of the 36 states in Nigeria.
Lassa fever is a viral infection which occurs in West Africa. It is primarily transmitted by contact with infected rodent excreta but can also occur following direct contact with the blood or secretions of infected individuals. It is especially dangerous if contracted during pregnancy. The risk is low but it would be wise to avoid rodent infested areas.
An outbreak of visceral leishmaniasis has been reported in Morang (S), Oct 16. At least 115 cases were reported in the region during 2015.
Leishmaniasis is a parasitic disease spread by infected sand flies that bite between dusk and dawn. The disease occurs in three forms of varying severity affecting the skin and/or internal organs. Treatment can be prolonged with skin ulcers taking a long time to heal. Travellers should avoid sand fly bites by using effective repellents and sleeping under insecticide treated bed nets.
An outbreak of leptospirosis has been reported in the Okuma River, northern Okinawa Prefecture, Oct 16.
Leptospirosis is transmitted by contact with the urine of infected animals usually in water. Outbreaks often occur after natural disasters and flooding. About 10% of those infected progress onto a severe form known as Weil’s disease which can involve multiple organs. Avoid swimming or wading in potentially contaminated fresh water. It is treated with antibiotics.
The Saudi Ministry of Health continue to report additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV), Sept 16. 1,457 cases (611 deaths) have been reported since 2012.
MERS-CoV is a viral infection which affects the respiratory system and can be fatal. Human to human transmission has been reported including amongst healthcare workers. There is some evidence that camels may also transmit the disease. Travellers returning from the Middle East who develop a significant respiratory illness with fever and cough should seek medical advice. There are no travel restrictions.
49 human rabies deaths have been reported across 20 cities/provinces, Oct 16. On average 400,000 people are bitten by cats and dogs in the country each year with the northern mountainous regions considered high risk for rabies.
Rabies is a viral infection spread by the saliva of infected animals. Human cases are usually due to dog bites but any mammals can be infected. Rabies is fatal once symptoms begin. Pre-exposure vaccinations are recommended for long-stay travellers; those remote from medical help (>24 hours) and animal handlers. All travellers must know how to treat a wound and seek prompt post-exposure vaccines if bitten/scratched.
An outbreak of Rift Valley fever has reportedly affected 64 people (23 deaths) in Tahoua (W), Sept-Oct 16. Most cases have been reported in nomadic herders.
Rift Valley fever is a potentially fatal viral infection causing fever, headaches and liver problems. It is usually reported in southern and eastern Africa, often affecting domesticated animals such as cattle and sheep. Around 8-10% of people who contract the virus will have severe, potentially life threatening symptoms. It is transmitted by infected mosquitoes or by direct contact with blood, bodily fluids or milk of infected animals. Take steps to avoid mosquito bites.
An outbreak of rotavirus has affected a lake town resort in Perak (NW), Sept 16. 46 suspected cases have been reported.
Rotavirus infection is the most common cause of severe diarrhoea in children worldwide. It can also cause vomiting and nausea. Exercise good hand hygiene and stay well hydrated. A vaccine is given routinely to babies in the UK.
Cases of Zika virus infection, locally acquired via mosquito bites have been reported from Florida State (S). 119 locally acquired cases have been reported which includes 92 pregnant women, Sept 16. Affected areas are: South Beach/Miami Beach area and Wynwood district in Miami-Dade County. Sporadic cases have been reported from Pinella, Broward and Palm Beach counties, Aug 16.
416 cases of Zika virus have been reported, including on Caye Caulker Island, Apr-Sep 16.
17 locally acquired cases of Zika virus have been confirmed, Aug-Sep 16.
British Virgin Islands
18 locally acquired cases of Zika virus have been reported, Aug-Sep 16.
A German tourist has been diagnosed with Zika virus after visiting the Maldives in Jun 16. The first case of Zika virus in the country was reported, Jan 16. This is a retrospective case, the traveller had spent several months in the Maldives and was diagnosed after returning to Finland in 2015.
Cases of Zika virus have been reported from the provinces of Chiang Mai, Chanthaburi, Phetchabun, Bung Kan and the Sathon district of Bangkok, Sep 16. At least 392 cases have been recorded including some suspected cases of Zika-related microcephaly.
Zika virus (ZIKV) is transmitted by daytime biting mosquitoes and is similar to dengue fever. Symptoms include rash, conjunctivitis, muscle or joint pain. Neurological complications have been reported. There is consensus that ZIKV infection during pregnancy may cause some birth defects such as microcephaly. There is a low risk of sexual transmission of the disease. Countries/territories/areas with active or past Zika transmission have now been classified into 4 risk categories: high, moderate, low and very low, based on the current and potential epidemiological situation. These categories ensure travel advice is appropriate and proportionate to the defined ZIKV transmission risk. See current national advice from Public Health England for more details, including that for pregnant travellers, who are advised to postpone non-essential travel to high risk countries and also regarding condom use for preventing sexual transmission of the disease. https://www.gov.uk/government/collections/zika-virus-zikv-clinical-and-travel-guidance
32 cases of acute flaccid myelitis (AFM) have been recorded across 17 states, Jan-Oct 16. The exact cause of this limb weakness/paralysis is uncertain but is thought to be related to a viral respiratory illness caused by enterovirus D68.