Nomad travel health blog
Blog Words : Wanderlust health advice | 20 October

Wanderlust travel health update: flooding in South East Asia

This week's travel health news including advice for travellers affected by the widespread flooding in South East Asia

This health advice is provided by Nomad, who offer Wanderlust visitors 10% off equipment online and in store including 10% off vaccinations. See the Nomad website for more details.

Thailand – flooding

Widespread flooding is reported in north, north-east and central Thailand. The worst affected provinces are Ayutthaya, Phitsanulok and Sukhothai. As of 13 October 2011, a total of 283 deaths have been reported in the country since July.

Flood warnings have been issued in Bangkok to communities living near the Chao Phraya river which runs through the city. Road and rail networks, particularly north of Bangkok are reported to be disrupted (NaTHNaC).

Cambodia, Laos, Vietnam – flooding

Greater than average rain and typhoons have caused flooding in the Mekong river basin (affecting Cambodia, Laos and Vietnam) since August 2011. As of 13 October, 203 people have been killed in Cambodia following flooding of the Mekong and Tonle Sap rivers. A further one million people have been affected and over 180,000 evacuated to higher ground. In the Mekong Delta in southern Vietnam, 34 people have been killed, nearly 70,000 homes damaged and 250,000 people affected. A total of 30 people in Laos are reported to have died and a further 430,000 affected. The heavy rains are expected to continue in the area for several more weeks (NaTHNaC).

Philippines – flooding

The northern Philippines has been affected by flooding and landslides following two consecutive typhoons. A total of 90 people have died and over four million affected. Tropical storm Banyan passed over the Philippines on 12 October causing a further eight deaths and 24,000 people affected (NaTHNaC).

Advice for travellers

Flooding increases the risk of diseases transmitted by food, water and insect vectors, as well as accidents and injuries. Travellers should check with the Foreign and Commonwealth Office for current travel advice. Travelling independently, without adequate preparation, is likely to put a strain on the area’s already challenged emergency and medical services (NaTHNaC).

India – malaria

The number of malaria cases in Bikaner, Rajasthan has hit record levels with around 1,400 patients being admitted to hospital in the last fortnight, with six deaths. In September 2011, the average weekly number of patients detected with the disease was around 400 cases.

Advice to travellers

Travellers to the affected area should seek expert advice before they travel regarding the most suitable form of malaria tablets for their trip and medical history. Travellers should ensure they take the tablets as advised by their doctor or health advisor or they will not work as effectively. Malaria tablets are approximately 90–95% effective when taken properly, so bite avoidance should also be adhered to. Always wear 20-50% DEET on all exposed skin, sleep under a mosquito net and wear long clothing to protect you. Malaria-carrying mosquitoes generally bite between sunset and sunrise.

Vietnam – dengue fever

Ho Chi Minh City is gearing up to stop the spread of dengue fever. Since early 2011, the city has experienced 9,000 cases of dengue fever, up 1.6 times from a year earlier, including six deaths.

Pakistan (Punjab) – dengue fever

Dengue fever has claimed four more lives, with the death toll reaching 211 in the provincial metropolis and 231 in the Punjab, in Pakistan. According to official data, the number of dengue victims is increasing and the total has now reached 14,470 in Lahore, after 221 more people tested positive.

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 and rash. It lasts a few days and will resolve itself. If caught a second time it has a 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.

Ecuador – measles

There are already 86 confirmed cases of measles in Ecuador; 83 have been reported in the province of Tunguragua and three in Quito. According to the Minister of Health, the outbreak was provoked by a virus that arrived from Minnesota in the United States and that the virus has not been endemic in Ecuador since 1997. In Minnesota, there was an outbreak of measles earlier this year in May. Last week, Ecuador began a national vaccination campaign in response to this outbreak.

New Zealand – Measles

The measles outbreak which began in early 2011, in Auckland is ongoing. To date, more than 300 cases have been recorded nationwide. A measles epidemic in New Zealand in 1997 resulted in more than 2,000 cases. The most recent increase in cases has been focused in the inner suburbs of Auckland and has affected individuals aged 20-30 years. The majority of cases have been in unimmunised individuals.

It has also been reported that an individual (unknowingly) suffering from measles in Wellington was working over the weekend in several catering establishments used by those attending the Rugby World Cup quarter-final games.

Advice to travellers

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

Mexico – hepatitis A

The Ministry of Health of the state government of Chihuahua, has reported a new outbreak of hepatitis A in the state. Forty suspected cases have been reported in the town of Hidalgo del Parral, the majority of who are in educational institutions. In order to prevent the disease from spreading out of the colonies (neighbourhoods/housing developments), a coordinated operation has been implemented.

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 just close proximity with an infected person. It affects the liver and adults can take many months to fully recover. Travellers should ensure they eat ‘safe’ food and drink ‘safe’ water and be vaccinated prior to travel. Vaccination consists of two injections, the first lasts approximately one year and the second at least 20 years.

Madagascar – pneumonic plague

A pneumonic plague epidemic has been declared in the district of Miarinarivo, located in the province of Antananarivo. One person has died of this disease and five other persons are being treated at hospital.

Advice to travellers

In plague-endemic areas, travellers should avoid contact with rats and should be advised on how to store and dispose of food to prevent the attraction of rodents. Avoid flea bites where possible by using DEET on skin and premethrin on clothing.

Travellers should also be discouraged from camping and handling rodents both dead and alive. Pneumonic plague can also be spread via the respiratory route so travellers should avoid close contact with people in affected areas especially in crowded situations. Consider taking an anti-bacterial handwash such as H2ONO.

India – Japanese encephalitis (JE)

Bihar: JE has killed 61 children, while more than 50 have been diagnosed with the disease in Bihar's Gaya district, health officials said on Monday 10 October 2011. 

Uttar Pradesh: More than 400 people, mainly children, have died in an outbreak of viral encephalitis in northern India, health officials say. So far, 2,300 patients have been admitted to a hospital in the affected Gorakhpur area of Uttar Pradesh state. One doctor told the BBC that it was a, "tragedy beyond imagination" with children dying every day. Nearly 6,000 children have died of encephalitis in the hospital since the first case was detected in 1978. Most of the deaths this year have happened since July 2011, doctors say. 

Advice to travellers

JE is spread by night-biting mosquitoes in certain parts of Asia. Outbreaks occur mainly during or just after monsoon time, however can happen year round. The risk to short-term travellers is very low, particularly if they are only visiting urban areas, with overall estimates of one case per million travellers. The risk becomes greater for persons who intend to live or travel in risk areas for long periods of time, and have rural trips during transmission seasons. The majority of cases of JE are asymptomatic or non-specific. Travellers to affected areas should seek advice prior to their trip. Vaccination is available and consists of two or three injections over a four to six week period. Bite avoidance is essential.

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