MASTA Travel Health Alert- 24th November 2016
At least 89 cases of acute flaccid myelitis (AFM) have been recorded across 33 states, Jan-Nov 16. The majority of cases have been in children 3-14yrs old.
Acute flaccid myelitis (AFM): 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 or other viral infections.
Various strains of avian influenza have affected humans in China. Cases of H7N9 have been identified in several provinces including: Liaoning (NE), Guangdong (S), Anhui, Hunan, Jiangxi and Zhejiang (E), Dec 15-Nov 16. At least 800 cases have been reported to date from 2013. Other strains of avian influenza (H5N1, H5N6 and H9N2) have also been detected, 2014-16.
Avian influenza is a serious viral infection usually transmitted to humans by contact with infected poultry. The risk to travellers is low. Travellers should avoid contact with poultry (e.g. visiting live animal markets) and wash their hands regularly.
Health authorities have reported a large outbreak of campylobacteriosis related to contaminated local water supplies in Hawke's Bay (North Island), Oct-Nov 16. It is estimated that over 5,500 local residents suffered from gastro-intestinal symptoms with 45 needing hospitalisation. Local water supplies have been treated.
Campylobacter are the most common bacteria that cause gastroenteritis worldwide. Occasionally infection can lead to serious neurological complications.
Following Hurricane Matthew in Oct 16, over 7,000 additional cases of cholera have been recorded. Over 28,500 cases, (267 related deaths) were reported, Jan-Sep 16. The departments of West, North, Artibonite and Centre are most affected. 36,045 cases (179 deaths) were reported in 2015.
16 cases and 3 deaths of cholera have been reported on Mbamou Island, Brazzaville, Nov 16.
Cholerais a bacterial infection usually spread through contaminated food and water in areas with poor sanitation. The risk is highest for those with limited access to safe water and medical care such as aid workers and travellers to remote areas with reported outbreaks. Symptoms include watery diarrhoea and dehydration. An oral vaccine is available for those at particular risk.
The World Health Organisation has reported a large outbreak of dengue fever in the capital city Ouagadougou, Nov 16. Sahel region (N) and Hauts-Bassins region (W) have also recorded a small number of cases. Over 1,061 cases have been confirmed including 15 deaths.
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.
Media sources have reported large outbreaks of diphtheria amongst children living in internally displaced person camps in South/North Waziristan, Federally Administered Tribal Areas (NW), Nov 16. 30 deaths have been recorded. Vaccine coverage in this area is extremely low and access to treatment very limited.
137 suspected cases of diphtheria have been recorded in Umm Keddada (North Darfur), Aug-Nov 16.
Diphtheria is a bacterial infection affecting the respiratory tract usually spread through respiratory droplets such as coughing. The risk is increased risk 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.
At least 114 deaths from encephalitis have been reported in Odisha, Oct-Nov 16. About 1/3 have been confirmed as Japanese encephalitis whilst the rest as acute encephalitis syndrome (AES). The causes of AES are still under investigation. The majority of reported cases countrywide are from Uttar Pradesh, West Bengal, Assam, Odisha, Jharkand and Tamil Nadu. India reported over 1,700 cases (290 deaths) of Japanese encephalitis and nearly 10,000 cases (1,200 deaths) of acute encephalitis syndrome (AES) in 2015.
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.
The Saudi Ministry of Health continue to report additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV), Nov 16. 1,484 cases (617 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.
An outbreak of mumps has been reported in NW Arkansas, Nov 16. At least 1,028 confirmed and suspected cases have been recorded. The Marshallese community (originally from the Marshall Islands) has been especially affected. Outbreaks have also been reported at a number of US universities including Harvard (Boston), New York and University of Missouri, Nov 16.
Mumps is a viral disease which causes painful swelling of the salivary glands. 2 doses of the MMR vaccine are recommended but protection against the disease sometimes wanes over time.
6 people have become ill with tularemia after harvesting grapes in the northern part of Mainz-Bingen district (W), Oct 16.
Tularemia is a serious bacterial infection which can affect many different organs. It is transmitted by direct or indirect contact with infected animals, usually rabbits and rodents, and is a particular risk to hunters. It can also be acquired by contaminated soil/water or infected tick bites.
At least 4 deaths from rabies have been reported in Hurungwe district (N), Nov 16.
Since July 2013, 549 animal rabies cases have been confirmed. Most have been in wild animals (mainly ferret-badgers and palm civets) but one dog has also been affected. During 2016, at least 9 people have been bitten by ferret-badgers thought to have had 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.
127 cases (2 deaths) of trypanosomiasis (Chagas disease) have been reported in Para state (N) during 2016. The cases are thought to be related to the consumption of contaminated acai (a species of palm tree).
South American Trypanosomiasis (Chagas` Disease) is a potentially fatal parasitic disease spread by “cone nose” or “kissing” bugs. These live in cracks in the roofs/walls of houses in rural areas. Outbreaks are occasionally associated with contaminated fruit juices. Symptoms include eyelid swelling, enlarged liver/spleen and swollen glands. More serious complications can affect the brain, heart and bowel.
6,642 locally acquired cases of Zika virus have been confirmed, mainly from Chiapas, Oaxaca and Guerro states (S), Jan-Nov 16.
Since Zika virus was first reported in the country over 32,000 cases have been reported, Jan-Nov 16.
Cases of Zika virus have been reported from 12 provinces including Chiang Mai, Chanthaburi, Phetchabun, Bung Kan and the Sathon district of Bangkok, Nov 16. At least 686 cases have been recorded including some suspected cases of Zika-related microcephaly.
Media sources have reported the first locally acquired case of Zika virus infection in Kompong Siem District in the eastern province of Kompong Cham, Nov 16.
Since it was first recorded in the country in 2015, over 70,000 suspected cases of Zika virus have been reported to Nov 16. Most affected departments: Cortés, Francisco Morazán, Yoro, and Choluteca.
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