MASTA Travel Health Alert- 29th September 2016
The Pan-American Health Organisation (PAHO) and the WHO have announced that the Americas have become the first region of the world to be declared free of measles. The last local measles outbreak was reported in Venezuela in 2002 although imported cases are still seen into the region. Be aware that some countries request documented proof of prior measles vaccination for certain visas in order to protect their measles-free status.
675 cases of measles have been recorded, Jan-Sept 16. This is a large increase on the 7 cases confirmed during 2015.
Measles is a viral infection which causes a red blotchy rash and occasionally more serious disease. 2 doses of the MMR vaccine are recommended to provide protection against the disease. The travel consultation is good opportunity to ensure 9
20 cases of anthrax have been reported from Rajshahi (W), Sept 16. Media sources report continuing outbreaks, with over 100 cases from several districts of Sirajganj province(C), May-Aug 16. Cases are being attributed to the eating of infected meat.
Anthrax is a bacterial infection which can affect the skin, lungs and gastro-intestinal tract. It is generally transmitted via infected livestock. Travellers should ensure that all meat is well cooked and from a safe source.
A total of 90 cases of Crimean-Congo haemorrhagic fever have been reported, with most from Balochistan and Karachi, Jan-Sept 16. Cases have been also been recorded in Punjab (N), Khyber Pakhtunkhwa, Islamabad and Jammu/Kashmir.
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.
Media sources have reported an increased incidence of hand, foot and mouth disease (HFMD).
HFMD is a viral infection which usually affects young children and causes fever, mouth ulcers and blisters on hands and feet. It is transmitted by person to person contact. The majority of cases are mild but serious complications are occasionally reported.
The Saudi Ministry of Health continue to report additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV), Sept 16. 1,456 cases (610 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.
Central African Republic
Health authorities report an outbreak of monkeypox in Basse-Kotto prefecture (S) affecting 14 people, Sept 16. Mbomou (S), suffered a similar outbreak in Jan 16.
Monkeypox is a viral infection which causes a rash similar to chickenpox. It only occurs in rural areas in central/west Africa. Monkeypox can affect all ages but is most common in children. Infection is transmitted by direct contact with primates, squirrels or other infected humans.
Afghanistan is one of the few countries still reporting polio cases. 9 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.
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.
Rabies is a continuing problem in virtually all provinces of the Philippines with around 350 human deaths each year. The province of Pangasinan (N) has reported over 14,300 dog bites and 14 rabies deaths, Jan-Aug 16.
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 52 people (21 deaths) in Tahoua (W), Sept 16.
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.
Media sources have reported over 700 cases (20 deaths) of scrub typhus from Himachal Pradesh, Sept 16. Cases were also reported from Rajasthan, May 16.
Scrub typhus is an illness caused by a Rickettsia bacteria that is spread by mites on rodents. Symptoms vary but often include headache, fever and rashes. Travellers should minimize exposure by avoiding rodents and using insect repellents.
77 cases (8 deaths) of West Nile fever have been reported from a number of regions, May-Sept 16. The most affected regions have been Braila (SE) and Bucharest (S).
868 cases (25 deaths) of West Nile fever have been recorded, Jan-Sep 16. Most affected states so far have been Texas, California. Colorado, Arizona and South Dakota. 2,060 cases (119 deaths) were reported during 2015.
West Nile fever is a viral infection spread by the bite of mosquitoes. It usually causes flu-like symptoms, but can rarely cause fatal brain infection. The elderly are at higher risk of complications. There is no specific treatment.
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 349 cases have been recorded including some suspected cases of Zika-related microcephaly.
Health authorities have reported 393 cases of Zika virus since the first confirmed cases were reported in Aug 16.
Cases of Zika virus infection, locally acquired via mosquito bites have been reported from Florida State (S). 93 cases have been reported in South Beach/Miami Beach area, Sept 16. Wynwood district in Miami-Dade County has not reported new cases since early Aug 16. Sporadic cases have been reported from Pinella, Broward and Palm Beach counties, Aug 16.
Over 5,135 suspected cases of Zika virus have been reported, Jan-Sept 16.
Since Zika virus was first reported in the country in Jan 16 the number of cases have been rising. Nearly 20,000 cases have been reported, Jan-Sept 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