Outbreak Information and News
Guinea: Yellow Fever
According to WHO, 1 confirmed
and 6 suspected human cases of yellow fever have been
reported since December 2009 in Mandiana Prefecture (Kankan)
in the eastern part of the country, near the border with
Cote d'Ivoire (where an outbreak has also been confirmed).
Vaccination is available and
recommended.
Guadeloupe: Dengue
According to the French Ministry
of Health, approximately 900 suspected cases of dengue
fever, a significant increase over the average incidence,
have been reported from the Caribbean islands of St. Martin
(700 cases) and St. Barthelemy (200 cases) since December
2009. The islands of St. Martin and St. Barthelemy are part
of the chain of islands that comprise Guadeloupe. Travelers
are advised to practice daytime
insect precautions.
Israel: Mumps
According to the Israeli
Ministry of Health, approximately 250 cases of mumps were
reported in Israel between mid-September and December 2009.
The cases were mostly in 15-22 year-old males attending
Yeshivas in several Jerusalem neighborhoods and nearby
cities. All travelers should be up
to date with MMR vaccination.
Mount Kenya: Malaria
transmission increasing
According to a team of
researchers funded by the UK Government's Department for
International Development (DfID),
global warming is to be blamed for the 7-fold increase in
the malaria cases on Mount Kenya. This has placed
an extra 4 million people at risk of malaria, as the disease
creeps into the higher altitude areas.
According to the researchers, the average temperature in the
Kenyan Central Highlands has risen 2-degrees Centigrade over
last 20 years; from 17 deg C in 1989 to 19 deg C today.
Since the malaria parasite matures only in temperatures
above 18 deg C, it was absent from the region prior to the
1990s. However, with average temperatures now above 18 deg
C, malaria epidemics have increased in the past decade,
malaria-carrying anopheles mosquitoes discovered in Naru
Moro, which is over 1900 m above sea level in 2005.
Limpopo Province South
Africa: Malaria
The numbers of malaria
cases started to increase in December, in the usual
malaria transmission areas of Vhembe and Mopane,
bordering the Kruger National Park. Although the
numbers were well below the alert
thresholds for this time of the year, there were 4
deaths, so a media release was sent to heighten
awareness and remind people of symptoms and need for
early presentation and treatment.
The usual recommendations for malaria prevention
remain for tourists visiting the area. Tourists are
advised to use personal
preventive measures for prevention of mosquito bites
and take effective malaria pills.
Lucille Blumberg, National Institute for
Communicable diseases, Garth Brink, SASTM |
MAP OF PROVINCES OF SOUTH AFRICA |
Relief
Workers Going to Haiti
Consider the following:
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Haiti will be hot and humid
-
Poor infrastructure for
water and sanitation - almost non-existent in many
locations
-
Food/water-borne illnesses
will be prevalent - food/water precautions are critical!
-
Power lines are down -
assume any wire is live
-
Sun exposure will be
significant - precautions are essential
-
Availability of medical
support is limited- even for responders - carry a
personal medical kit
-
Immunizations always
important for Haiti
-
Mosquito-borne illnesses are
a risk in Haiti - includes dengue and malaria
-
Rabies is always present in
Haiti
-
Snakes will be displaced
into uncommon areas - increased risk of encounters
-
Violent crime should be
expected - even against relief workers
-
Toxins and/or irritants
likely in air and water
-
Haiti has amongst the
world's highest TB rates
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HIV is prevalent
Prospective
relief workers should be in good
health with no predictable need for medical support
during any relief-work travel. Anyone who is de-conditioned
("out-of-shape") or has musculo-skeletal conditions that may
flare with poor sleeping environments or significant
physical requirements should think twice. Travax
Swine
Flu Update
As of 3 January 2010, worldwide
more than 208 countries and
overseas territories or communities have reported laboratory
confirmed cases of pandemic influenza (H1N1)
2009, including at least 12799 deaths.
WHO is actively monitoring the progress of the pandemic. The
most active areas of pandemic influenza transmission
currently are in parts of central, eastern and southeastern
Europe, North Africa, and South Asia. In Europe, pandemic
influenza transmission remains geographically widespread
throughout the continent and there continues to be intense
virus circulation in several countries of central, eastern,
and southeastern Europe - particularly in Poland, Serbia,
Ukraine, Georgia.
...Prepared by Dr Deborah Mills, Brisbane, Travel Medical Alliance
Leptospirosis
Leptospirosis - from water
contaminated with animal urine -
is a serious but potentially avoidable disease that is
becoming more common in travellers. Infection has been
associated with recreational activities such as freshwater
swimming, rafting, kayaking, canoeing, fishing, hunting,
caving, hiking, and trail bike riding. Other risk factors
include walking barefoot, swimming, contact with floodwater,
drinking river water, and having skin wounds.
Globally, there have been many cases of lepto reported after
severe flooding. Extreme climate events such as flooding are
on the rise, potentially leading to an increase in
leptospirosis.
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Essential
information on how to avoid Lepto:
-
Travellers
should avoid flood waters.
-
If participating
in nature - based tourism, outdoor
recreation, or wildlife viewing, travellers
should wear protective clothing and boots,
and most definitely cover cuts and abrasions
on their skin with waterproof dressings.
-
On return if
illness develops, especially with a fever
... seek prompt medical attention from
doctors experienced in travel medicine.
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Symptoms of Leptospirosis
After an incubation period of
2-30 days, the most common symptoms are
fever, chills, headache, muscle aches,
and yellow/bloodshot eyes.
Although it often presents as a mild flu-like illness and
goes away by itself, leptospirosis can be responsible for
more serious illness (Weil's disease) including sudden
kidney or liver failure, bleeding into lungs, or swelling or
infection of the heart of brain. The death rate for severe
cases is up to 30%.
Leptospirosis - under electron microscope
How common is Lepto in
travellers?
There is limited information
about this. Experts estimate infection rates of 1-100 per
100,000 persons per year, with an
estimated 300,000-500,000 severe cases occur each year
worldwide. Lepto is often not diagnosed, as
doctors either do not have facilities to do the right tests,
or do not think to look for it!
In developed countries such as Australia, leptospirosis used
to be only an occupationally acquired disease, predominantly
affecting males working in farming and livestock industries.
However, over the last 10 years, recreational exposure and
international travel have emerged
as important sources of infection. In 2008,
approximately 35% of cases reported to the enhanced
surveillance system at the WHO Collaborating Centre for
Reference and Research on Leptospirosis in Brisbane,
Australia, were related to international travel and/or
recreation. About one fifth were acquired overseas. Most of
the cases acquired internationally over the past decade were
related to travel to Asia,
but cases also came from New
Zealand, the Pacific Islands, and South America.
Some international visitors caught leptospirosis in
Australia - about one third of these were young European
travellers who had worked in the fruit growing industries of
Northern Queensland.
The Eco- Challenge-Sabah was a 10-day multi-sport, endurance
competition held in Borneo, involving 304 athletes from 26
countries and 29 states of the USA. Activities included
jungle trekking, caving, outrigger sailing, kayaking,
climbing, scuba diving, mountain biking, and swimming in
rivers in the jungle. The leptospirosis attack rate for
competitors in the event was 42% among 189 interviewed
athletes (62% of all participants), with 36% of these
requiring hospital admission despite being young and
extremely fit.
A study in Cambodia in 2007 found leptospirosis was the most
likely cause of fever presenting to health centres,
accounting for 14% of all cases, and MORE common than
dengue, malaria, influenza, or typhoid.
...From Lau C, et al.,
Leptospirosis: An emerging disease in travellers, Travel
Medicine and Infectious Disease (2010),
doi:10.1016/j.tmaid.2009.12.002. Dr Colleen Lau is a
sessional doctor at Brisbane and Perth TMA clinics.
Hand
Sanitiser - easy to forget?
How quickly we forget? A recent
study aimed to measure rates of hand sanitiser use in a
hospital entrance foyer four months after a baseline study
during New Zealand's influenza pandemic. Of the 743 people
observed over one (summer) day in December 2009,
8.2% used the hand sanitiser, which
was significantly lower (p<0.0001) than the 18.0%
reported in the August (winter) study (during the swine flu
epidemic!).
Blood
Donations Following Receipt of Live Vaccines
Recently there was a case of
transfusion-related transmission of yellow fever vaccine
virus! This is the first time such a case has been reported
but it underscores the need for temporary deferral of blood
donations after receipt of a live vaccine.
Persons receiving live vaccines should
defer blood donations for a minimum of 4 weeks
following receipt of live vaccines ( i.e. yellow fever, mmr,
chickenpox).
TMA MEMBER CLINIC NEWS
Travel Health App soon
to be available for the iPhone
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Dr Deb, in conjunction
with a team of clever computer people has developed
an iPhone app based on her
book Travelling Well. Dr Deb's book has
sold over 140,000 copies and is very popular with
travellers - especially the section on "what to
do if you get sick". The drawback is that the
paper book is bulky when luggage space is at a
premium, so now travellers who take an iPhone can
carry all the information they need in a
technologically friendly format.
It is almost ready
for the Apple iTunes store, but
if you have an iPhone and
would like a pre-release copy to help test this app,
send in your email to Dr Deb care of
list@drdeb.com.au. All you need to do is spend a
little time reviewing it and send us a few comments.
The test app will be provided to the first 15
persons who reply. |
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Japanese Encephalitis (JE)
Trial
Dr Deb Mills and one of her
nursing staff (Jennifer Hickey), have just returned from an
investigator meeting in Frankfurt. The Brisbane TMA clinic
is participating in a multi centre trial that will
help make the Japanese Encephalitis
(JE) vaccine available for Australian children.
This will be very useful as JE is more severe in children
and these days Australians are visiting Asia in great
numbers. Currently there is no licensed vaccine for
Australian children. Watch this space for more information
when the trial officially begins ...
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Have you any really
interesting travel photos?
We would love to publish them in our
newsletter. Not only will you win fame and glory
with your name published ... if the photo is
published in our newsletter,
you will win a first aid kit valued at $35.
If you do have an interesting travel photo,
(especially those with a health theme) send it
to TMA care of
info@travelmedicine.com.au. |
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