Travel Health Alert- 7th September 2016
Democratic Republic of Congo
Over 16,800 cases (446 deaths) of cholera have been reported Jan-Aug 16. Equateur remains the province with the highest transmission rate. The WHO reported over 19,000 cases across the country, including the provinces of Katanga, Maniema, North Kivu and Oriental, 2015.
At least 12,000 people have been affected by outbreaks of cholera across the country, with over 50% of cases being in Addis Ababa, Jul-Aug 16. This outbreak coincides with the peak of the rainy season.
Over 200 suspected cases of cholera have been recorded in the Pyay district, Bago region (S), Jul 16. This outbreak is linked to stalls selling a traditional 'mohinga' breakfast.
Over 13,000 cases (490 deaths) of acute watery diarrhoea/cholera have been reported by UNICEF, Jan-Aug 16. This is a marked rise in numbers as 5,250 cases were reported in 2015.
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.
Spanish health authorities report the first 2 cases (1 death) of Crimean-Congo haemorrhagic fever in the country, Sept 16. The second case is in a nurse who was caring for the first person with the disease.
Crimean-Congo haemorrhagic fever is an unpleasant viral disease which is fatal in 20-35% of cases. It is usually transmitted by infected tick bites or direct contact with the blood of infected individuals. Take steps to avoid tick bites by covering exposed skin and using an effective repellent.
Afghanistan is one of the few countries still reporting polio cases. 8 cases have been reported from Paktika, Kabul, Kandahar, Kunar & Helmand Provinces, Mar-Aug 16. 19 cases were reported in 2015. Most were from the Eastern Region close to the Pakistan border. May 2014: International Health Regulations have come into force requiring certification of polio vaccination within the 12 months prior to departing Afghanistan for residents and travellers staying >4wks.
Health authorities have reported 3 cases of wild polio virus (WPV) in Gwarzo, Monguno and Jere Local Government Areas of Borno State (NE), Aug-Sep 16.
Polio is a viral infection which can sometimes cause long term paralysis. It is usually spread by contaminated food and water in areas with poor sanitation. Polio has been successfully eliminated from many countries. Vaccination is part of the standard UK immunisation schedule and boosters are given in combination with tetanus and diphtheria.
Cases of tularaemia have been reported from several states, including Colorado and New Mexico, Jul-Aug 16. 100 cases were reported in Colorado, Nebraska, South Dakota and Wyoming, Jan-Oct 15. This represented an increase compared to previous years.
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, rodents and is a particular risk to hunters. It can also be acquired by contaminated soil/water or infected tick bites.
Health authorities report the current outbreak of yellow fever is declining, with no new confirmed cases since 23 Jun 16. At least 3,984 suspected cases (369 deaths) have been reported, Dec 15-Sep 16. All 18 provinces have reported cases but Luanda (N) and Huambo (C) were most affected. Vaccine campaigns have taken place in affected parts of the country. Yellow fever is endemic in Angola, but this is the first outbreak in 28 years.
Yellow fever is a viral disease, found in tropical regions of Africa and the Americas. It principally affects humans and monkeys, and is transmitted by the bite of an infected mosquito. The risk is highest in rural areas. 15-25% of those infected will develop severe disease with organ failure, jaundice and bleeding. An effective vaccine is available but may not be suitable for everyone. International regulations are in place to prevent the spread of the disease and as such the vaccine must be administered in a registered ‘Yellow Fever Centre’ and a certificate of vaccination issued.
The first cases of Zika virus have been reported from Sabah, Aug 16.
At least 97 cases of Zika virus have been reported from the provinces of Chiang Mai, Chanthaburi, Phetchabun, and Bung Kan, Jun- Aug 16.
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