Outbreak Information and News
Tick Borne Encephalitis (TBE)
has been found on Zealand
Tick Borne Encephalitis (TBE)
has been found on Zealand as opposed to New Zealand ...
Zealand is the largest island in Denmark ... the capital of
Denmark, Copenhagen, is partly located on the eastern shore
of Zealand.Tick Borne Encephalitis causes fever,
influenza-like symptoms, headache, myalgia, and arthralgia.
Long-lasting or permanent brain
damage has been observed in 10-20% of infected patients.
There is no specific treatment. The forests in northern
Zealand are visited by more than 2.3 million people
annually. Following these 2 cases of TBE, all forest workers
have been offered vaccination against TBEV.
Travellers to Europe need to be
mindful of avoiding tick bites.
More information.
Northern Hemisphere Flu
The composition of the Northern
hemisphere flu vaccine for their autumn season is the same
as our current southern hemisphere seasonal flu vaccine. I
think that is good reason for extra encouragement to our
travelers to have flu vaccination
before they travel. Dr Christine Aus, TMA
Newcastle.
Germany - Hantavirus
According to state health
authorities, 85 cases of hantavirus infection, a significant
increase over the average incidence, have been confirmed in
Baden-Wurttemberg's Stuggart District so far this year.
Hantavirus is transmitted by rodents and, although risk to
the typical traveler is minimal,
contact with rodent droppings and rodent urine should be
avoided.
Fiji - Cyclone Tomas
On March 14, Cyclone Tomas hit
Fiji with heavy rainfall and very strong winds.
Northern and eastern areas of Fiji
have been declared emergency zones. Power,
telecommunication systems, and local infrastructure have
been affected. Travelers should monitor local weather
forecasts and follow the advice of local authorities.
Turkey - Earthquake
On March 8, 2010, a
6.0-magnitude earthquake struck Elazig Province. Casualties
and damage to infrastructure have been reported. Landslides
and strong aftershocks are possible.
Travelers should avoid affected areas and
monitor local media reports.
Kenya, Rwanda, Uganda -
Flooding
Heavy rains have caused flooding
and mudslides throughout the country. Evacuations,
casualties, and damage to infrastructure have been reported.
Provision of essential services has been disrupted.
Travelers should monitor local news
and weather reports and follow the advice of local
authorities.
Sri Lanka - Dengue
According to Sri Lanka's
Ministry of Health, approximately 8,600 suspected cases of
dengue fever, a significant increase over the average
incidence, have been reported so far this year, primarily
from the districts of Jaffna, Gampaha, and Colombo.
Travelers are advised to practice
daytime insect precautions.
Honduras - Dengue
According to the Honduran
Ministry of Health, approximately 2,500 suspected cases of
dengue fever, a significant increase over the average
incidence, have been reported so far this year. Areas most
affected include the metropolitan areas of Central District
and Atlantida, Olancho, and Yoro Departments. Travelers are
advised to practice daytime insect
precautions.
Argentina - Dengue
According to the Argentine
Ministry of Health, more than 500 cases of dengue fever, a
significant increase over the average incidence, have been
reported from Misiones Province so far this year. Travelers
are advised to practice daytime
insect precautions.
...Prepared by Dr Campbell Crilly, Cairns, Travel Medical Alliance
Lhasa to
Kathmandu via mountain bike
In September October 2009 I
undertook a cycling challenge in aid of the Oncology
Children's Foundation with the aim of raising funds for gene
therapy research and we succeeded above all expectations in
raising over $90,000. The three Toowoomba riders from a
group of fourteen raised over half the amount.
We flew into Lhasa and had a few
days acclimatising and getting supplies and bikes in order.
The trip covered the Frienship Highway with a side trip to
Everest Base Camp and Rongbok Monastery. We passed several
peaks over 5000 metres with some super descents. My
descending skills were a little hesitant at first as last
April I had a minor bingle involving fractured collar bone
and four ribs. Luckily I recovered well and was able to get
the necessary training hours in to undertake the trip.
We camped and used some "guest houses" over the journey and
after a week the tents were the preferred option even if it
was minus seven in the mornings. Some towns we stayed in had
the noisiest dogs on the planet. The group bonded very well
together, it never ceases to amaze me how Aussies all stick
together through the most trying conditions. Our leader from
Raw travel did an absolutely superb job on keeping morale
high as everyone had an off day here or there. Altitude
issues were quite minimal due to our initial four days in
Lhasa as cycling over 5000 metres is not for the faint
hearted but everybody succeeded at their own tempo. The
scenery on the Himalayan Plateau while stark is equally
stunning and we were rewarded with some amazing vistas at
the various peaks we crossed. Having been in Bhutan the year
before it was interesting looking South over the range and
realising we were generally a 1000 metres higher.
The Tibetan people were naturally very inquisitive about us
and we had lots of school kids high five us along the way.
The most arduous part was when we left the highway for Base
Camp. Riding through someone's rock garden springs to mind.
One of our group, a fit 35 year old tri-athlete had cerebral
oedema at Base Camp oxygen sats 72%, but responded well to
dexamethasone and we descended next day anyway.
Once we reached Nyalem we were
on the last leg and the next day we descended 4000 metres
over 60 kilometres to the Nepalese border and the crossing
itself was a surreal experience between the two countries.
We had a few days rest at The Last Resort just inside the
Nepalese border where the house red was Jacob's Creek!
Overall the cycling was almost the easy part as the camping
and low temperatures were a bit of a shock even coming from
Toowoomba.
To use the old cliche "it was a
life changing experience" and feel very privileged to have
gotten so close to Everest at 5300 metres but have no
desires to climb it.
...Prepared by Dr Cormac Carey, Toowoomba, Travel Medical Alliance
Close To
Home - Lessons From A Dengue Epidemic In North Queensland
In late 2008 and early 2009
North Queensland experienced its worst epidemic of dengue
fever infections for 50 years. In total 1025 people were
confirmed to be infected with one fatality recorded of an
infected individual. Dengue fever is not naturally occurring
in North Queensland and the cause of the outbreak was from
infected international travellers with local transmission
occurring thereafter. Dengue fever viral infection has been
increasing globally since the 1970's and it is estimated
that between 50 and 100million people are infected annually
with 250,000 people affected by Dengue haemorrhagic fever.
Dengue fever is the most common mosquito borne viral disease
affecting humans globally.
Dengue Fever
|
Dengue is a virus
belonging to the flaviviridaea family of viruses
that includes Yellow fever, Japanese
encephalitis, Nile valley fever and Chikagunya
fever. Infection with one of four serotypes of
dengue confers lifetime immunity to that
serotype but no protection against the other
serotypes. Clinically significant infection
occurs in an urban - endemic cycle between
humans and mosquitoes only.
Transmission occurs via the
female Aedes aegypti
mosquito biting an unsuspecting
human. The Aedes mosquito is a lazy mosquito and
enjoys the comforts of human habitation. It is a
daytime biting mosquito
and prefers to rest indoors feeding early
morning or mid to late afternoon but may feed
all day. The mosquito is a prolific
breeder in discarded tyres, pot plants, blocked
gutters and drains and other water bearing
receptacles. |
 |
Dengue occurs
worldwide in all tropical and subtropical areas
but is increased during hot, humid and wet seasonal weather
where conditions favour breeding. Dengue transmission is
more intense in urban areas and the risk of infection is
highest in South East Asia and South America. Transmission
rates of one in 1000 travellers have been suggested but are
dependant on many factors. Any traveller is at risk when
visiting an endemic urban area. The risk of Dengue
haemorrhagic fever is one hundred times greater for
individuals who have been previously infected with a
different serotype. Travellers who have a history of
infection need specific advice in regard to the risk of DHF.
Clinically symptoms of dengue fever occur
2-7 days after infection
and notable for the abrupt onset of fever with headache,
retro-orbital pain, backache, myalgia, arthralgia, weakness,
nausea and vomiting. Approximately 50% of individuals will
develop a rash initially on the
trunk but it may spread to the extremities and
the face. The initial infection is usually self-limiting and
the illness resolves after one week. Fatalities are not
associated with a typical primary infection.
Dengue haemorrhagic fever occurs
when an individual who has been previously infected by the
dengue virus is re-infected with a different dengue
serotype. The clinical presentation is the same
but severe thrombocytopaenia develops with easy bruising,
petechiae, effusions and hypo-proteinaemia. Severe shock may
develop with specific organ impairment i.e. kidneys and DIC
in rare cases.
The diagnosis of Dengue fever should be suspected in all
travellers returning from endemic regions with a fever.
Clinical symptoms are not dissimilar to many viral mosquito
borne disease and if suspected early enough a Dengue RT- PCR
blood test will detect the presence of the virus. Specific
Dengue IgM and IgG should also be performed and repeated if
necessary along with a full blood count, electrolytes, renal
and liver function tests.
Treatment is symptomatic and supportive. Early detection of
more severe disease symptoms requires hospitalisation.
Advice on avoiding the spread of the disease to uninfected
individuals where Aedes aegypti mosquitoes are present is
crucial to avoiding a local epidemic.
Prevention of Dengue fever in travellers is about education
on insect protective measures and the occurrence and spread
of the disease. Specific travel advice is required to take
into consideration the regions travelled and the mode of
accommodation used. Public health measures in infected
countries do help reduce the incidence of the disease but
are hampered by cost, population apathy and weak enforcement
of public health measures. A
tetravalent Dengue vaccine is in development stage
but is mooted to be many years away from clinical use.
The University of Queensland is conducting research into
Wolbachia pipientis an intra-cellular bacterium that occurs
naturally in many insects including mosquitoes. The bacteria
is of interest in the control of dengue fever because a
particular strain of the Wolbachia bacteria shortens the
lifespan of the mosquito and appears to interfere with the
mosquitoes capacity to transmit the disease. However the
transmission of the infection does not readily occur between
mosquitoes and is spread vertically from the female parent
to the offspring. The Wolbachia research continues and if
successful will have implications for other insect borne
diseases such as malaria.
Bibliography: 1. Harrison's Principles of
Internal Medicine 17th Edition (2008) Part 7- Infectious
diseases, Section 15- Infections Due to RNA Viruses; Chapter
189 Infections Caused by Arthropod and Rodent borne
Viruses-Clarence J. Peters introduction; 2. Queensland
Government Tropical Public Health Unit Media releases
2008-2010 Updated 9th March 2010 3. Travax Medical Library
2010 4.
www.eliminatedengue.org 5.
www.who.int
Dr. W.J.H.McBride; "Deaths associated with dengue
haemorrhagic fever: the first in Australia in over a
century" eMJA; 183(1): 35-37
...Prepared by Dr Campbell Crilly, Cairns, Travel Medical Alliance
Interesting
travel photo - fish catches the fisherman
This is a photo of Ben a patient
of mine who travelled to Peru for his honeymoon last year.
He and his wife where on a river cruise approximately 150km
east of Iquitos in the Amazon Tributaries when they noticed
a large number of fish jumping around the boat. One of the
fish struck him in the throat catching a spike in his neck.
He also drove a spike into his thumb attempting to retrieve
the fish. Neither the patient or the fish was harmed in the
photo!
...Prepared by Dr Campbell Crilly, Cairns, Travel Medical Alliance
|
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. |
|
