Travel Health News

Nomad Travel Health News is edited by Rebecca Swadling, Clinic Nurse Trainer, Nomad Travel Clinics. All outbreak information is sourced from Promed.

Visit one of our clinics for a 10 minute travel vaccination consultation with a specialist travel health medical professional  for £20 or free when you pay for any travel vaccination. Contact your nearest Nomad Travel Clinic

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Sri Lanka – Dengue Fever

So far this year, there have been 8 deaths and 2449 cases of Dengue. In 2011, there were 28 140 cases of Dengue of which 185 people died. Of this number, 55.9 percent of incidents were reported from the Western Province.

Malaysia – Dengue Fever

A total of 459 cases of Dengue Fever, with 2 deaths, were reported during the week between 15-21 January.

Suriname – Dengue Fever

Up to now more than 300 Dengue cases have been registered. With the Dengue outbreak now a month old, health authorities said they believe cases of the mosquito-borne disease are peaking. Due to overcrowding in hospitals, patients were being treated in the army's health facilities.

Brazil (Rio de Janeiro) – Dengue Fever

The Secretariat of Health and Civil Defense of Rio presented the total of Dengue in the municipality, 6 new Dengue cases registered in the last week, totaling 532 reported cases this year.

Paraguay – Dengue Fever

Up to now, 36 confirmed Dengue cases have been reported in Paraguay. There are a total of 453 reports, of which 36 were confirmed, 54 were discarded, and 363 are registered as suspicious.

Peru – Dengue Fever

An outbreak of Dengue virus type 2 is affecting the urban areas of Pucallpa, capital of Ucayali region. Cases have been reported since November 2011 but they have increased over the last weeks. 1753 individuals with Dengue symptoms have been attended to. Also, 3 people died because they did not go to a medical centre in time.

Mexico – Dengue Fever

There have been 316 confirmed cases of Dengue in Yucatan, which is 86 percent of the total cases in the country.

Advice to travellers
Dengue Fever is spread by daytime biting mosquitoes normally from sunrise to sunset and is more common in urban areas. It causes a high ‘breakbone’ fever (pain all over), accompanied with headache, rash. It lasts a few days and will resolve itself. If caught a second time it has approximately 2% chance of developing into Dengue Haemorrhagic Fever which can be fatal.  There is currently no vaccine available and therefore insect bite avoidance is essential.

Mexico – Swine ‘flu

An ongoing swine 'flu [Influenza A/H1N1pdm09 virus infection] outbreak in Mexico has left at least 29 people dead and nearly 1500 others infected, health officials confirmed.
Thousands more are also ill as the country faces several types of influenza this season.
Since the start of the ongoing winter season, at least 7069 people have reported suffering from symptoms similar to those of swine flu. Lab tests are still underway and have so far confirmed 1456 cases of the disease.
According to Mexico's Health Ministry, at least 29 people have died of swine flu so far this season. While no health emergency has been declared, officials expect the death toll will rise in the coming weeks.

Japan – Influenza

One person has died and 2 are in a critical condition after 39 people were infected by a 'flu outbreak in a Saitama hospital, officials said.
In total, 20 patients and 19 staff members are believed to have contracted the virus, TV Asahi reported. 31 of those stricken have tested positive for influenza type A virus. The deceased is believed to have been a woman in her 80s.

Advice to travellers
Influenza is spread by droplet infection. You are at higher risk in crowded situations such as on public transport, markets etc.  Ensure good hand washing and consider vaccination before you travel to an area especially if you are in the high risk groups (defined by your GP) or if travelling into an outbreak situation.


Fiji – Floods

A severe flood warning remains in place for low lying areas of Western Viti Levu island. Flooding has caused road closures, power cuts and left people cut off from their homes or destinations. Ra, Tavua/Nadarivatu, Ba, Lautoka, Nadi and Nadroga/Navosa districts are the most severely impacted. Local authorities have also imposed a 12-hour curfew (restriction of movement) order for certain towns and cities in these affected areas. Heavy rains forecast to continue for several days. Travellers should continue to monitor the latest situation on the Fiji Meteorological Service website. (FCO).

Vietnam – Meningitis

Deputy Minister of Health Nguyen Viet Tien said that 3 cases of Meningococcal Disease have been reported nationwide in the past week. None of the cases were fatal, he said.
One case of Meningococcal Disease was reported in Ha Noi and the other 2
in Ho Chi Minh City; the 3 patients are in stable condition.

Advice to travellers
Meningitis is spread via the respiratory route (the nose or mouth) – predominantly through coughing and sneezing. It can cause a high fever, headache, nausea, vomiting, photophobia and stiff neck and can be fatal if left untreated.  Travellers planning to mix closely with the local population e.g. travel on buses, visit markets or work and who are going to endemic areas, or areas with an outbreak should consider vaccination (one injection). Speak to your travel health Specialist before departure.


Vietnam – Hand Foot and Mouth (HFMD)

72 cases of Hand-Foot-Mouth Disease have been reported nationwide since 21 Jan 2012. None of the cases were fatal. The northern city of Hai Phong has reported 48 cases of Hand-Foot-Mouth patients since 21 Jan.

Advice to travellers
HFMD is viral illness that most commonly affects children under 10 years of age however older children and adults are sometimes affected. It causes a fever, sore throat quickly followed by small spots that develop inside the mouth. These soon progress into small mouth ulcers, and sometimes also develop on the skin. It is spread via direct contact with nose and throat secretions and faeces from an infected individual and by aerosol droplet spread. Contact with infected children should be limited and crowded situations avoided; personal hygiene and handwashing is essential.


Changes to Pet travel scheme – UK

On 1 January 2012 the Department for Environment, Food and Rural Affairs (Defra) introduced changes to the UK Pet Travel Scheme to bring it in line with the rest of the European Union (EU). All pets can now enter the United Kingdom (UK) from any country in the world without quarantine, provided they meet the rules of the scheme. These vary, depending on the country or territory the pet is arriving from.
All pets must be vaccinated against Rabies before entering the UK. However, under the new scheme, pets travelling from the EU and countries such as Australia only have to wait 21 days after vaccination before entering the UK. Pets from other countries must have a blood test to confirm immunity, followed by a three month wait, before they are allowed into the UK

Bangladesh – Nipah Encephalitis

A young man has died in Joypurhat with symptoms of Nipah virus infection, taking the toll of such deaths in the district to 6.

Advice to travellers
Travellers are advised caution while drinking raw date juice as bats, which are the
natural hosts of the disease, usually drink date juice at night. The virus is spread through contaminated body tissue or bodily fluids from infected animals. It causes ‘flu like symptoms which can develop into Encephalitis (swelling of the brain), convulsions and coma. Up to 50% of persons infected will die. There is no vaccination.

Update 26th January 2012 

WORLD MALARIA REPORT

Just before Christmas the World Health Organisation released their annual report on Malaria from information mainly collected in 2010.

• There were an estimated 216,000,000 cases worldwide with the deaths of an estimated 655,000 people in 2010
• 86 percent of victims were children aged under 5
• Africa accounted for 91 percent of deaths and 81 percent of the total cases
• Six countries account for 60 percent of deaths from Malaria: Nigeria, Democratic Republic of Congo, Burkina Faso, Mozambique, Ivory Coastand Mali
• Europe had an estimated 176 cases of malaria in 2010 with no reported deaths.

Whilst appearing quite unbelievable on the face of it, the figures actually represent a 5 percent drop in deaths from 2009 and a 26 percent fall in mortality rates since 2000. The WHO has hailed these numbers as a "major achievement".

The UN health agency aims to eradicate malaria deaths altogether by the end of 2015 and reduce the number of cases by 75 percent on 2000 levels. International funding for the fight against malaria peaked at USD 2 billion (1.5 billion euros) last year [2011], but the WHOestimates USD 5 billion will be needed each year until 2015 if its
 targets are to be reached.

The cash has funded a big increase in the number of households with insecticide-treated mosquito nets, particularly in sub-Saharan Africa, where 50 percent now have the nets compared with just 3 percent in 2000.

To finance the fight, the WHO suggested a tax on airline journey schemes or tourist taxes

Advice to travellers
Antimalarial medication is very effective when taken properly, but for increased protection and to prevent other mosquito borne diseases, high levels of bite avoidance should also be adhered to. This will include the use of an effective insect repellent such as 50% DEET on all exposed skin, sleeping under a treated mosquito net and wearing long sleeves and trousers during risk times. Malaria carrying mosquitoes generally bite between sunset and sunrise.

Zimbabwe – Anthrax

An Anthrax outbreak that began in November 2011 has affected 4 provinces in Zimbabwe. By the end of 2011, 149 human cases of Anthrax had been reported, although there were no deaths. Affected areas are Centenary, Mbire, and Mt Darwin in Mashonaland Central, Mutoko in Mashonaland East, Nkayi in Matabeleland North, and Chirumhanzu and Gokwe North in the Midlands provinces. In some places like Mbire, the outbreak was attributed to consumption of meat from infected dead animals.
There have been multiple outbreaks of Anthrax amongst animals in Zimbabwe over recent years with Mana Pools currently investigating the deaths of many hippos, buffaloes and elephants.

Advice to travellers
Anthrax is a bacterial illness that usually affects the skin, but may also affect the gastrointestinal tract or lungs. It is spread by infected animals either through eating infected animals or contact with their hides, wool, hair, bone or carcasses. Anthrax does not spread from person to person. Depending on the type, symptoms can include lesions, nausea, vomiting, and altered mental state and can be fatal. Prevention of Anthrax is dependent upon the control of the disease in livestock and on disinfecting, washing and scouring imported animal products. Vaccination is available but normally only considered for those at risk from inhalation of spores in an occupational or military setting. Travellers should avoid contact with animals and potentially contaminated meat in affected areas.

Update 18th January 2012

Indonesia - Avian Influenza (Bird Flu)

A 23 year old man has died in Jakarta after being admitted to hospital 24 hours earlier. It is believed that the gentleman kept pidgeons and had recently been nursing a sick one. There have been 183 cases of Bird Flu (H5N1) in Indonesia, 151 of which have been fatal

Cambodia – Avian Influenza (Bird Flu)

A 2 year old child has been admitted to hospital with the H5N1 strain of Avian Influenza. He is on a ventilator and is being given Tamiflu. He is only the 19th case to be confirmed in Cambodia, however of the previous 18, 16 have been fatal.


Advice to travellers
The most important thing for travellers to be aware of is the risk areas and whether there is an outbreak or recent cases in the area of travel. Travellers should also avoid spending time in areas where they may be in close proximity to poultry as many of the reported cases have been in individuals that either work with infected animals or keep them as pets. Poultry and eggs should always be well cooked. Good levels of personal hygiene such as frequent hand washing using soap and water can be an important preventative measure. If soap and water is unavailable, alcohol hand gel is a good alternative.


Western Australia – Pertussis (Whooping Cough)

The Health Authorities of Western Australia are warning that the state may be facing an epidemic of Whooping Cough. A record number of more than 3500 cases were reported in the state last year (2011); more than double the number of cases in 2010. Pertussis notifications peaked in the month of November 2011, with 704 cases. Four babies have died from Pertussis in the last four years and the Health Department is urging parents to be prepared for more cases and have their children immunised.
Pertussis epidemics tend to occur every 3-4 years and the last epidemic in Western Australia was in 2004.

Advice for travellers
Whooping Cough (is spread by the respiratory route – people coughing and sneezing). Children in the UK are routinely immunised as babies.  If travelling into an outbreak situation, non immune travellers should practice routine respiratory precautions such as good hand hygiene and avoid persons known to be infected. Check with your GP that you have received all routine vaccinations.  If travelling long term into affected areas, or if planning to mix closely with young babies, and you are not immune, you may wish to consider getting vaccinated at your destination. Seek advice.

Uganda (Acholi) – Nodding Disease

There have been 1800 deaths and another 1000 affected by a mysterious disease that affects children and causes them to nod (sometimes violently) themselves to death
The first cases of the disease were reported in 2003, and some locals thought it was witchcraft. Unfortunately little progress has been made since then and both parents and doctors are still baffled as not a single child has been cured since 2003.
The disease, which has remained a puzzle to many medical experts, is characterised by mental and physical retardation, head nodding and drooling, many are also malnourished because eating food seems to spark bouts of nodding and seizures.
Research is ongoing but with children being withdrawn for schools, fathers abandoning homes with infected children and a general sense of government inactivity it cannot progress quick enough.

Update 12th January 2012

Zambia – Typhoid

An outbreak in Central Zambia that started last month is still ongoing, with over 2,000 suspected cases and several deaths. The ministry of health says that the situation is slowly stabilising and measures to reduce the spread of the disease such as water chlorination have been intensified.

Zimbabwe – Typhoid

As of just before Christmas, an outbreak of Typhoid in Harare had killed one individual and affected over 600. It was thought that the outbreak was centred around  groups of individuals drinking from contaminated wells following a prolonged dry spell.

Chile - Typhoid

Since the start of January there have been 64 cases of Typhoid reported which is more than would be expected. There has been a mini outbreak in Santiago with 19 cases in the last 2 months. This mini outbreak has been linked to vegetables being sold at a local market. It is believed that they had been irrigated using a contaminated water source.

Bangladesh – Emerging Drug Resistant Typhoid

Recent years have seen an increase in the number of Typhoid cases in Bangladesh. On analysis, nearly 50% of those tested in a suburb of Dhaka were resistant to 4 different drugs that would usually be expected to kill the Typhoid bacteria.


Advice to travellers
Typhoid is spread through contaminated food and water such as shellfish, raw fruit or vegetables. The source of the contamination is often human faeces that have been used to fertilise the crops or been pumped from sewage pipes, untreated, into the sea. Symptoms commence 1-3 weeks after infection and include fever, headache, constipation, diarrhoea and an enlarged liver or spleen. It is also possible to be a carrier without exhibiting any symptoms.
Travellers should seek specialist advice before they travel and if required, should be vaccinated. A single vaccination provides protection for 3 years. Good food and water hygiene including water purification is also essential.


Flu Update – Northern Hemisphere

Influenza activity in the temperate regions of the northern hemisphere remains below seasonal threshold levels, though notable increases in activity have been reported in some areas of Canada, Europe (Spain and Turkey), northern Africa (Tunisia and Algeria), and the Middle East (Iran). The persistence of the increased activity over the last few weeks in these areas likely represents the start of the influenza transmission season.

Advice to travellers
Crowded conditions encourage spread of infection and travellers can be exposed, for example in those attending pilgrimages (e.g. the Hajj), in aircraft, waiting rooms, buses, bars, hotels and on cruises. Those individuals at particular risk and fall outside of the usual UK vaccination groups should consider vaccination before travel. Outside of the UK 'flu season, access to vaccine may be impossible before travel and therefore if travelling to the southern Hemisphere, information regarding vaccination on arrival at destination should be sought.


Cambodia – Dengue Fever

Cambodia's Ministry of Health has reported that at least 72 Cambodian children had been killed by Dengue Fever in 2011, an increase of 89 percent, compared with the 2010's deaths of 38 children. It said that there were 15,805 Dengue Fever cases reported in 2011, up 26 percent from 12,500 cases in a year earlier [2010].
This can be attributed to several factors including the floods that engulfed much of the country towards the end of the year as well as the fact that Dengue Fever tends to have a much higher impact once every 3-5 years and 2011 was that year.


Marshall Islands – Dengue Fever

Medical authorities in Marshall Islands report that the Dengue Fever outbreak that began in October 2011, has now peaked. With a population around 70,000, these small islands North East of The Solomon Islands, Papua New Guinea and Australia have recorded 1,400 cases of Dengue Fever. Fortunately new cases reported are now down to just a few each day.

Bolivia (Santa Cruz, Cochabamba departments ) – Dengue Fever

In the past 30 days 5 people have died from Dengue in Bolivia. According to the Health Department there are 5000 confirmed Dengue cases with 300 serious infections. The areas most affected by the disease are eastern Santa Cruz and central Cochabamba.

Advice to travellers
Dengue Fever is spread by daytime biting mosquitoes and is more common in urban areas. It causes a high ‘breakbone’ fever (pain all over), accompanied with headache and rash. It lasts a few days and will usually resolve by itself. If caught a second time it has approximately 2% chance of developing into Dengue Haemorrhagic Fever which can be fatal.  There is currently no vaccine available and therefore insect bite avoidance is essential.

India (Rajesthan) – Malaria

Prolonged spells of rain in 2011 lead to 53,000 cases of Malaria, an increase of 2,000 on 2010. However, the main cause of concern was the increase in the cases of fatal Plasmodium Falciparum_ (PF) cases. It increased by almost 30 percent in 2011 as compared to the corresponding period in 2010.

Advice to travellers
Much of India is considered too low a risk for Malaria to warrant taking antimalarials tablets, however travellers to the affected area should seek expert advice before they travel to see if Malaria tablets are required and regarding the most suitable form for their trip and medical history.

Antimalarial medication is very effective when taken properly, but for increased protection and to prevent other mosquito borne diseases, high levels of bite avoidance should also be adhered to. This will include the use of an effective insect repellent such as 50% DEET on all exposed skin, sleeping under a treated mosquito net and wearing long sleeves and trousers during risk times. Malaria carrying mosquitoes generally bite between sunset and sunrise.

Update 7th January 2012

Angola – Cholera

A Cholera outbreak has been reported in Lucapa Municipality, north-eastern Angola. More than a hundred Cholera cases were recorded in the first two weeks of December 2011. The source of the infection has not been mentioned but the government is taking steps to contain the outbreak.

Advice to travellers
Precautions should be taken to ensure good food, water and personal hygiene. Hand washing is very important and the use of an alcohol based hand gel is recommended where soap and water are not readily available. If planning to visit for a long time or travelling into affected areas, travellers should consider vaccination.  Vaccination involves 2 drinks given 1-6 weeks apart.

Indonesia (BALI) – Rabies

Following a four month period of no reports of Rabies cases, a new case of Human Rabies virus infection has been identified in Bali. The case was a young man from a village in central Bali who was bitten on the arm by a stray dog six months ago. Unfortunately he did not seek treatment of the bite and he died shortly after being admitted to hospital on 11 December 2011.

A total of 133 human deaths from Rabies have been recorded since the outbreak began in 2008. This figure does not take in to account the unconfirmed, suspected deaths from Rabies in isolated areas.

USA (Massachusetts) – Rabies

A man in Massachusetts has contracted Rabies, the first time a human has contracted the disease in Massachusetts in 75 years. Public health officials said they believe the Barnstable County man who is over the age of 60 contracted the virus from a bat at his home.

USA (South Carolina) – Rabies

A woman in Sumter County, South Carolina has died from Rabies virus infection. This is the first human case of rabies in the state in 50 years and it is thought that the woman was bitten by a bat which entered her home a few months ago.

Advice to Travellers
Rabies is a viral disease that infects the central nervous system, ultimately causing disease in the brain and death. It can be fatal if treatment is not administered prior to the onset of symptoms. Early-stage symptoms include fatigue, headache and fever. It can progress to acute pain, violent movements, uncontrolled excitement, depression and hydrophobia. Travellers to Rabies endemic counties where access to adequate medical care may be limited, are advised to consider pre travel Rabies vaccine, this consists of a course of 3 vaccines administered over the course of 21 to 28 days; this removes the need for Rabies Immunoglobulin in the event of an injury. Animal contact should be avoided wherever possible and in the event of contact with animal saliva any wound should be thoroughly washed with soap and water, then Iodine or Alcohol applied. Medical advice should be sought as soon as possible even if vaccinated with a full course of Rabies vaccine.

RABIES VACCINE IN STOCK AT ALL NOMAD TRAVEL CLINICS

Australia (NSW State) – Mosquito Borne Diseases

NSW [New South Wales state] Health is warning residents and visitors in southern and western NSW to take extra precautions to protect themselves against mosquitoes now that Summer has arrived, specifically following the detection of not only the Murray Valley Encephalitis virus(usually found in Northern Australia) but also several other mosquito borne diseases across the state.

Advice to Travellers
There are no specific vaccine to protect against the mosquito borne diseases transmitted in Australia so travellers should be aware of the advice given by the local Health authorities and know how to protect themselves from mosquito bites by covering up and using insect repellents containing DEET or an effective alternative recommended for use in areas where disease is spread by mosquitos


Australia (Western State) – HIV contracted from tattoo in Bali

A case of HIV (human immunodeficiency virus) infection where all the evidence points to a tattoo received recently in Bali as being the source of the infection has been reported.

Advice to Travellers
HIV is transmitted through sexual activity and, as in this case, blood to blood contact. It appears as though the equipment may not have been sterile and the items used were previously contaminated with blood containing the human immunodeficiency virus.
WA Department of Health Communicable Disease Control Director Dr Paul Armstrong said getting body art and piercings done overseas, particularly in developing countries, was not recommended. "This case demonstrates the very real health risk in having this type of procedure done overseas,"

All travellers to developing countries are recommended to travel with a minimal sterile kit containing needles and syringes in case they need medical treatment whilst away

Ghana – Lassa Fever

The Public Health Directorate at the Ghana Health Service (GHS) has set up a committee to investigate an outbreak of a disease known as Lassa fever in the Eastern and Ashanti regions. The severity of the outbreak is unknown at this time

Advice to Travellers
Lassa fever is a viral illness caused by the Lassa Haemorrhagic Fever Virus. It is transmitted to humans through contact with food or household items that have in turn been contaminated with rodent excreta. The disease is characterised by fever, muscle aches, sore throat, nausea, vomiting, and chest and abdominal pain, but in its severest (haemorrhagic) form it can progress to facial swelling, fluid in the lung cavity, bleeding from mouth, nose, vagina or gastrointestinal tract and is responsible for approximately 500,000 cases and 5,000 deaths across Western Africa. Good food storage and preparation precautions should be used to prevent infection in the rural communities that the rodent responsible for transmission usually lives.

Update 29th December 2011

Canada – Hepatitis A

This week health officials confirmed 91 cases of Hepatitis A have been reported to the Vancouver Island Health Authority (VIHA) in a continuing outbreak.
Since November one to 3 new cases per week have been identified, the majority of whom are centered in the Port Alberni/West Coast region, with some cases in other parts of Vancouver Island.

India – Hepatitis A

Kerala -  Compared to last year when only 36 cases of Hepatitis A were reported,
this year the number of confirmed cases were 237, with another 726 cases reported as suspected, making it about a thousand cases of jaundice.

Advice to travellers
Hepatitis A is spread via the faecal-oral route; by people not washing their hands before preparing food, contaminated food (especially shellfish), water or close personal contact with an infected person.  It affects the liver and adults can take many months to fully recover.  Travellers should ensure they eat ‘safe’ food, drink ‘safe’ water and be vaccinated prior to travel.  Vaccination consists of 2 injections, the first lasts approx 1 year and the second at least 20 years.

China – Hepatitis C

The Health Authorities in Henan province will continue to investigate a clinic, located in the suburbs of the city of Yongcheng, where 103 people have become infected with Hepatitis C [virus] after allegedly receiving intravenous injections at the clinic. The outbreak was 1st reported in late October (2011) in the neighboring province of Anhui. A new source of infection has been traced to Yongcheng, where scores of new cases
were found after the local government launched a screening program in the city's suburbs.

Advice to travellers
This blood borne infection is spread by contaminated blood and body fluids through unprotected sex, blood transfusion, dirty needles, dried blood etc. It can cause chronic liver problems leading to increased risk of liver cancer or cirrhosis. There is no current vaccination available for Hepatitis C, however travellers should consider vaccination against Hepatitis B before travelling to countries where the medical facilities are unknown or if travelling for long periods, working with children etc. Speak to your local Travel Clinic or GP for more information. Travellers should always carry their own sterile needle kit with them, this can be given to the Doctor to use in case of emergency.

Indonesia – Dengue Fever

The Kebayoran Lama district recorded 235 dengue fever cases this year to date -- the most in South Jakarta. There have been 1194 Dengue Fever cases recorded in South Jakarta this year to date.

Sri Lanka – Dengue Fever

A staggering 23,260 Dengue cases and 160 deaths have been reported in Sri Lanka.
The worst affected have been young adults more than children. Last year, the total number of cases stood at 34 105 with 246 deaths by end of December 2010.

India – Dengue Fever

Manipur state: Declared by the State Government as an outbreak, the cases of Dengue in Churachandpur district stands at 202.

Delhi : Dengue cases in the capital went up to 1111 as 3 more people tested positive for the disease.

Advice to travellers
Dengue Fever is spread by daytime biting mosquitoes normally from sunrise to sunset and is more common in urban areas. It causes a high ‘breakbone’ fever (pain all over), accompanied with headache, rash. It lasts a few days and will resolve itself. If caught a second time it has approximately 2% chance of developing into Dengue Haemorrhagic Fever which can be fatal.  There is currently no vaccine available and therefore insect bite avoidance is essential.

Updated 22nd December 2011

All information has been sourced from Promed unless otherwise stated.

Brazil – Meningitis
A Meningitis epidemic has killed 109 people in the north eastern Brazilian state of Bahia since the start of the year. A total of 1670 people have been hit by bacterial meningitis, the most serious form of the disease, officials said. In the tourist resort of Costa do Sauipe, dozens of tourists have canceled their bookings as a result of the epidemic, hotel staff told the media.

Advice to travellers
Meningitis is spread via the respiratory route (the nose or mouth) – predominantly through coughing and sneezing. It can cause a high fever, headache, nausea, vomiting, photophobia and stiff neck and can be fatal if left untreated.  Travellers planning to mix closely with the local population e.g. travel on buses, visit markets or work and who are going to endemic areas, or areas with an outbreak should consider vaccination (one injection).

Malaysia – Sarcosporidiosis
A cluster of Sarcocystosis among travellers returning from Malaysia have been reported. These travelers reported visiting Tioman Island on the east coast of Peninsular Malaysia before their illnesses occurred.

Advice to travellers
This disease usually affects animals but can also rarely cause disease in humans. Two forms of the disease can occur, one which causes diarrhoea, and the other which causes muscle pain, fevers, and other symptoms. Most people infected with
Sarcocystis do not have symptoms. Muscle sarcocystosis is spread through the ingestion of food, water, or soil contaminated with infected animal faeces. There is currently no vaccine or treatment for sarcocystosis; most infected people get better on their own. Ensure while traveling, you follow food and water precautions and practice good hygiene, including washing your hands before eating.

Ecuador – Rabies
The deaths of 11 people confirmed as sylvan rabies (from Vampire Bats) have been registered in 3 communities.  In Ecuador, no cases of urban [dog-origin] rabies have been registered since 2001 due to campaigns for vaccination of dogs and cats; however, small outbreaks or isolated cases of sylvan rabies have been documented.
The population of bats that feed on blood has increased in recent years mainly due to deforestation and introduction of cattle, which has provoked an increased risk of [bat] attacks on humans.

Measles – Uganda
The Ministry of Health yesterday announced that there is a national measles outbreak in eastern, central, and western Uganda, warning the public to report suspected cases early. The contagious disease was first suspected in Namayingo in November
after a total of 112 children were admitted with measles symptoms. To curb the airborne disease, Dr Aceng said they had opened up a measles unit at the National Referral Hospital, Mulago, and other upcountry hospitals and health centres to attend to any reported cases.
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Ukraine – Measles
Transmission of measles has continued in Ukraine since cases were first reported in July 2011. A total of 193 measles cases were recorded up until October this year; this is a six-fold increase on 2010. The regions reporting measles cases include Lviv, Ivano-Frankivsk, Zakarpattia and Rivne. (Travax).

Advice to travellers
Measles is easily spread through coughing and sneezing.  Ensure you have been fully vaccinated prior to visiting affected areas.  If no history of vaccination or if you are unsure, in adults, 2 vaccines given ideally 1 month apart will provide cover.

Ghana – Yellow Fever
The International Federation of Red Cross and Red Crescent are supporting the Ghana Health Services to contain an outbreak of yellow fever. An increasing number of cases have been identified in the past six weeks. As of 18 November 2011, 8 cases and one death have been recorded in three regions; Upper west and Northern in the north of the country and Greater Accra in the south. (Travax).

Advice to travellers
Yellow Fever is spread by the bite of an infected aedes aegypti mosquito that generally bites during the day. It is an untreatable acute viral disease which can vary in severity and can be fatal. Travellers should avoid infection by avoid getting bitten by mosquitoes.  Apply 50% DEET to all exposed skin regularly, treat clothing with premethrin or apply 100% DEET to collars and cuffs.  Remember when wearing sunscreen to apply the cream first and the DEET on top. Always sleep under premethrin treated mosquito net. When vaccinated you will be provided with a Yellow Fever Certificate which you should keep with your passport and will have 10 years cover.

Pakistan – Polio
There have been a total of 45 cases of polio reported in Pakistan so far this year.

Afghanistan – Polio
One case was reported in the past week from Nahri Sarraj district in Hilmand province -- bringing the total number of cases for 2011 to 59.

Nigeria – Polio
The total number of cases of Polio reported in Nigeria for 2011 is 45.

Advice to travellers
Transmission of polio occurs primarily through person to person contact and is spread mainly through the faecal-oral route.  It is found in areas where sanitation is poor. In rare cases milk, and other food stuffs, contaminated with faeces have been reported as the vehicle for infection. Travellers should ensure good food and water hygiene – seek advice before you travel.  Travellers to affected areas should also ensure their vaccinations are in date prior to travel. Boosters last 10 years.

Fiji – Typhoid
There have been 39 confirmed cases of Typhoid in Fiji.

Advice for travellers
Typhoid is spread through contaminated food and water such as shellfish, raw fruit or vegetables fertilized by ‘night soil’ (human faeces). Symptoms commence 1-3 weeks after infection and include fever, headache, constipation, diarrhoea and enlarged liver or spleen. It is also possible to be a carrier without exhibiting symptoms. Travellers should seek specialist advice before they travel and if required should be vaccinated. A single vaccine provides protection for 3 years.