Outbreak Information and News
2009 H1N1 Influenza (Swine
Flu) Update
Swine Flu is circulating in essentially every country. In
the Northern Hemisphere, the current wave of influenza
activity is at or above epidemic threshold in most
countries. The percentage of influenza that is NOT swine flu
in the Northern Hemisphere is negligible, except for China
and Kenya.
CDC in US reports the disease remains widespread in 46
states...From April to October 2009, there were estimated
14-34 million cases and between 500
to 6,000 deaths related to 2009 H1N1 flu.
Travellers to the northern hemisphere are strongly
recommended Panvax - the vaccine against the 2009 H1N1
Influenza (swine flu). The vaccine is available free from
your local TMA clinic.
Thailand: Chikungunya
As of September, 29, 2009, a large outbreak of chikungunya
fever has affected the country, particularly the southern
region including some tourist destinations, such as Phuket.
According to the Ministry of Public Health in Thailand, over
42,300 cases have been documented this year in 50 provinces.
Reports from Thailand show that chikungunya virus continues
to circulate throughout the country.
Chikungunya fever is nothing to do with chickens. It is a
disease caused by a virus that is spread to people through
the bite of infected mosquitoes. Symptoms can include sudden
fever, joint pain with or without swelling, chills,
headache, nausea, vomiting, lower back pain, and a rash.
USA: Mumps Outbreak
New York, New Jersey, Quebec, 2009.
An outbreak that began in a summer camp in New York has
grown to become the largest U.S. mumps outbreak since 2006,
when a resurgence of mumps produced 6,584 cases. As of
October 30, a total of 179 cases had been identified in New
York and New Jersey, and an additional 15 cases had been
reported from Canada. The outbreak primarily has affected
members of a tradition-observant religious community; median
age of the patients is 14 years, and 83% are male. Three
persons have been hospitalized.
Iran: Crimean-Congo Hemorrhagic
fever
According to a posting on ProMED,
at least 63 cases of Crimean-Congo hemorrhagic fever (CCHF)
have been reported in Iran so far this year.
Transmission is
via tick bite or through direct contact with the blood of
infected animals and birds or ingestion of infected meat. Travellers are advised to avoid tick bites and tick-infested
areas and animals. (Shoreland's Travax Alert Service)
Vietnam: Fascioliasis
Fascioliasis is a disease caused
by an infestation of parasitic liver flukes - is affecting
more people in the central and central highlands regions,
with some 3000 cases recorded this year [2009], according to
the health ministry's Institute of Mariology, Parasitology
and Entomology in Quy Nhon.
Trieu Nguyen Trung, the institute's director general, said
the latest figure was 45 percent more than the number a year
ago.
Fascioliasis is spread by cattle that are allowed to wander
freely in the region and disperse larvae into water
environments. Since the local people are in the habit of
eating water vegetables and drinking water without boiling
it first, it's easy for them to be infected, Trung
explained.
It is estimated that 40 to 70 percent of local cattle are
infected with the disease, he said. Communicated by ProMED-mail.
Philippines: Leptospirosis
According to the Philippines'
Department of Health, approximately 1,000 cases of
leptospirosis, a significant increase over the average
incidence, have been reported in metro Manila hospitals
since October. Most cases are from flooded areas of metro
Manila and Rizal Province caused by tropical storm Ketsana.
Travellers to flooded regions who anticipate extensive
outdoors exposure, including disaster relief workers and
adventure travellers, should consider prophylaxis with 200
mg of doxycycline once a week.
Dengue Update
Since early 2009, an increased number of dengue cases have
been reported from countries throughout several regions of
the world.
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Africa: The country of Cape Verde reported its first outbreak of
dengue fever. As of November 8, 2009, over 12,000 suspected
cases of dengue and 6 deaths have been reported to the
Ministry of Health.
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Middle East:
Throughout 2009, Saudi Arabia reported dengue cases in areas
popular with travelers, including Jeddah and Mecca. Those
planning to participate in the Hajj should take extra
precautions to prevent dengue.
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Mexico: According to Jalisco's
Department of Health, a significant increase in dengue fever
incidence has occurred this year, mostly since August.
Approximately 1,500 cases have been reported in Jalisco,
primarily from the city of Guadalajara. Travellers are
advised to practice daytime insect precautions.
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El Salvador: According to El Salvador's
Ministry of Health, approximately 9,800 suspected cases of
dengue fever, a significant increase over the average
incidence, have been reported so far this year, mostly since
September. Departments most affected include Chalatenango,
Cabanas, Sonsonate, Ahuachapán, and San Salvador. Travellers
are advised to practice daytime insect precautions.
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Nicaragua: According to WHO, more than
1,800 cases of dengue fever, a significant increase over the
average incidence, have been reported this year, mostly
since September. The highest number of cases is reported
from Managua. Travellers are advised to practice daytime
insect precautions.
More information on Dengue here.
Travel
and Oral Anticoagulation
Every year, over 1 billion
people travel by air, and this figure is predicted to double
over the next 2 decades. Air travel is a comfortable and
safe means of travel and is available and is accessible to
all sectors of the population. The global increase in
travel, together with the aging population, means that there
will be a significant increase in older passengers and those
will illness who will wish to travel.
One subgroup of patients who are increasingly considering
travel are those individuals on permanent or temporary oral
anti coagulation treatment with vitamin K antagonists (VKAs).
Most relevant are those on primary or secondary prevention
of venous thromboembolism, the prevention of systemic
embolism in patients with prosthetic heart valves, or atrial
fibrillation. For well-trained and informed patients
performing a sufficient patient self-management (PSM) test
with a stable INR, travel while being on oral anticoagulants
is possible!
Below is a check list for patients and their travel medical
physicians to work though for the safety of the travelling
patient.
Travel Risk Assessment
Risk Of Underlying Disease
Self-Management Of The Patient:
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Do you perform a sufficient PSM?
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Is your anticoagulation stable in the targeted INR
range?
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Can you manage problems with the INR-self-testing
device?
Risk Of Complications:
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Do you know what to do in case of INR-variations?
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Intake of vitamin K? Administration of heparin?
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What will you do in case of diarrhoea and /or
vomiting? Or other infectious diseases ( use of
antibiotics)
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Any new activities planned during the journey? Risk
of injury? Alcoholic beverages?
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Do you know what to do in case of bleeding or
clinical signs of thromboembolism?
Risk Of Destination
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What about the climatic risks?
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Will you be travelling
through different time zones?
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Are you acutely aware of
the potential of unknown vitamin K content in exotic
foods/changes in dietary habits?
Infectious Diseases And
Malaria
Medical Facilities
Communication
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Do you have multilingual
or at least English customs
declaration/certification for the INR-self-testing
device, equipment and medication?
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For carriers of
mechanical heart valves, a leaflet with information
to prevent endocarditis?
Information about current health status including
latest ECG/Echo
Transport
Insurance
...Prepared
by Dr Julie Burke TMA Yeppoon, Travel Medical Alliance
Good
preparation for Kokoda is essential
The recent months have seen
another two Australians die while walking the Kokoda trail
in PNG. This brings this year's tally to four and again has
focused attention onto adequate preparation for this
demanding 96km trek which sees approximately 50 people each
year requiring medical evacuation.
The number of Australians attempting the Kokoda trail has
risen from less than 100 per year in 2001 to nearly 6000 per
year in the past couple of years. A medical clearance is
required of participants by many trekking companies although
the Kokoda Track Authority has not made this mandatory for
tour operators to obtain a licence. Whilst a medical
clearance is a sensible step in preparation for the trek, it
is unlikely that a medical examination alone would
accurately predict a person's ability to undertake this
trip.
The PNG government recommends a minimum three months
preparation for the Kokoda trail and this timeframe is
echoed by most trekking companies. More reputable companies
will provide specific training programs and some include
supervised training in the tour package.
Ultimately the responsibility for adequate preparation lies
with the traveler regardless of the destination or type of
trip planned. The frequency of deaths and serious illnesses
on the Kokoda trail highlights the importance of travelers
seeking appropriate advice well in advance of travelling.
...Prepared
by Dr Paul Paterson TMA Yeppoon, Travel Medical Alliance
A picture tells a thousand words
A good reason to avoid hospital in some parts of the world
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Do you have a holiday story to
tell, especially one with a medical event?
Send it to
info@travelmedicine.com.au, and we will send
you one of our mini TMA torches to put on your
key ring - a great help when finding your lock
at night. |
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