MASTA Travel Health Alert- 22nd December 2016
At least 108 cases of acute flaccid myelitis (AFM) have been recorded across 36 states, Jan-Nov 16. The majority of cases have been in children 3-14yrs old.
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, Fujian and Zhejiang (E) during 2016. 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.
A large outbreak of chikungunya has been reported in Sindh province, especially Karachi, Dec 16. Up to 30,000 suspected cases have been recorded.
Chikungunya (CHIK) is a viral infection spread by day-time biting mosquitoes. Symptoms may include fever and muscle/joint pain. Some people experience persistent joint pain and fatigue lasting weeks or months.
Outbreaks of cholera have been reported from at least 15 governorates, including the capital Sana'a, Oct-Dec 16. Over 10,100 suspected cases have been recorded with many in Taiz, Al-Bayda, Al Hudaydah and Aden.
Cholera is 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.
At least 18 suspected cases of Haff disease have been recorded in eastern state of Bahia, Dec 16. Many of the victims had eaten a local fish called ‘bull’s eye fish’.
Haff Disease is a rare illness thought to be caused by ingesting unidentified toxins in fish. It results in ‘rhabdomyolysis’ where muscle cells break down causing dark urine and severe muscle pain.
Medical experts are investigating an outbreak of hepatitis in Kothamangalam, Kerala (SW), Dec 16. A number of deaths have been recorded. The hepatitis strain has not been confirmed but is suspected to be either A or E. Take care with food/water hygiene.
Hepatitis E infection affects the liver and is usually transmitted through contaminated food and water in areas with poor sanitation. Symptoms include fever, fatigue and jaundice. It is especially dangerous in the latter stages of pregnancy when fatality rates can reach 20%. There is currently no vaccine.
Hepatitis A 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.
The Ministry of Health have reported 560 cases (41 deaths) of leptospirosis, during 2016. Cases have increased following Hurricane Matthew and continuous rains since Oct.
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 state of Maine has reported an increased incidence of Lyme disease during 2016 with Over 1,300 cases. The disease is considered endemic in many north eastern and Midwestern states.
Lyme Disease is a bacterial infection spread by ticks, primarily in the forests of the northern hemisphere. A ‘bull’s eye’ rash typically develops around the bite site. Other symptoms can include joint/muscle pain, heart problems and neurological issues. Lyme disease is usually treated with antibiotics. Travellers should take steps to avoid tick bites with insect repellents and protective clothing. Any ticks found on the skin should be removed promptly and carefully with tweezers.
Health authorities report a continuing increase in malaria, with almost 200,000 cases, Jan-Nov 16. Cases have been reported from over half of Venezuelan states, though 75% are from Bolivar State (S); with others in Amazonas (S), Sucre (N) and Delta Amacuro (NE). The majority of cases are P.vivax which is rarely life-threatening.
Malaria is a serious and sometimes fatal disease common in many tropical countries. It is spread by the bite of infected mosquitoes which bite between dusk and dawn. Symptoms can vary and include fever and a flu-like illness. More serious forms can be fatal and progress to organ failure and coma within 24 hours of symptoms first appearing.
Measles cases are frequently reported in Somalia. UNICEF have reported an outbreak in Kismayo, Lower Juba (S) with at least 419 cases (mostly children), Dec 16.
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.
At least 31 cases of meningitis C have been reported in children in Tuscany during 2016. The most recent case was a child in Pisa, Dec 16. Meningitis C vaccinations are now given in the UK as part of the childhood immunisation schedule.
Meningococcal meningitis is a bacterial infection affecting the brain usually spread by respiratory droplets (coughing/sneezing). Highest infection rates usually occur during the dry season in the ‘meningitis belt’ of sub-Saharan Africa. The risk is highest for long-stay travellers and those mixing closely with the local population. There are a number of different strains of meningococcal meningitis and the vaccine used for traveller purposes contains 4 of these (A, C,W135 and Y). This vaccination is mandatory for pilgrims travelling to Hajj or Umrah in Saudi Arabia.
The Saudi Ministry of Health continue to report additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV), Dec 16. 1,511 cases (629 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.
Media sources have reported that at least 41 people have died in the city of Irkutsk (S) after drinking bath lotion containing methanol, Dec 16. The lotion is thought to be sold locally as an alternative to vodka.
Methanol (wood alcohol) is a commonly used industrial solvent found in products such as antifreeze. It is highly toxic if ingested causing neurological problems, blindness, organ failure and in many cases death. It is sometimes found in locally produced, unregulated moonshines/alcoholic beverages.
An outbreak of plague has been reported in Befotaka Atsimo district (S), Dec 16. 31 deaths have been recorded. The WHO states that Madagascar is the country most severely affected by plague worldwide.
Plague is spread from animals, usually through flea bites or by handling infected animals. Rarely the disease is spread by close contact with an infected person or swallowing infected materials. Most travellers are at low risk with outbreaks mainly occur in areas of poor housing and sanitation. Infected persons usually start with flu-like symptoms. Prompt antibiotic treatment is required to prevent serious illness or death.
707 cases (14 deaths) of scrub typhus have been reported from 47 different districts of the country, Jul-Dec 16. The majority of cases are from Chitwan district (C) and Kailali (W).
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.