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Blog Words : Wanderlust health advice | 27 October

Wanderlust travel health update: Kenya, Turkey, Bolivia and more

This week's travel health news, including random attacks in Kenya, earthquake advice in Turkey, a rabies outbreak in Bolivia and more

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.

Indonesia – chikungunya

At least 94 people – adults and children under five – fell ill during a chikungunya virus outbreak. The cases are from central Java. It is predicted that the toll will reach hundreds of people in the near future.

Advice to travellers

Chikungunya is spread by daytime biting mosquitoes normally from sunrise to sunset and is more common in urban areas. There is no vaccine available and therefore insect bite avoidance is essential.

Spain – measles

So far this year, the Community of Madrid has reported 360 confirmed cases of measles. Last year, 31 cases were confirmed (out of 50 reported). This means that measles infections in the capital have multiplied by at least 12-fold in one year. The Spanish average shows six times more infections this year than in 2010, according to the National Epidemiology Center.

Ecuador – measles

The Ecuadorian health minister said that the province of Tungurahua has been worst hit by the measles outbreak, as it has confirmed 93 cases. Nationwide, the measles outbreak has reached 99 confirmed cases.

New Zealand – measles

The measles outbreak, which has infected more than 200 Aucklanders, has now spread to Waiheke Island. A 17 year old resident on the island recently tested positive for the disease. It is not known where the teenager contracted measles, but because of the school holidays, his contact with others had been limited. There were no other suspected cases on Waiheke. Since the measles outbreak began in May 2011, there has been 229 confirmed cases of the disease in Auckland.

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, two vaccines given ideally one month apart will provide cover.

Haiti / Dominican Republic border – cholera

More than 480 people have died of cholera and 1,800 others have suffered from the disease in 2011 on the Haitian-Dominican border, where a new outbreak of cholera has been reported. The new outbreak has affected the bordering region and cases are increasing, in a zone where there is no drinking water or centres for the control of the disease.

Democratic Republic of Congo – cholera

Cholera remains a major health issue in the Democratic Republic of Congo (DRC). Almost 17,000 cases have been recorded in 2011. Cholera is endemic in four provinces; Katanga, Maniema, North Kivu and South Kivu.

Around 9,357 cholera cases and 77 deaths have been recorded in these areas in 2011. Cholera is particularly common in areas like the town of Goma where the local population use water from Lake Kivu (sourced from Travax).

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 two drinks given one to six weeks apart.

Australia – influenza

Doctors have reported a significant rise in influenza cases across Australia, with 25,000 confirmed cases reported to state and territory health authorities to the end of September 2011. It is the highest number this decade, aside from the swine flu epidemic two years ago.

Queensland is the worst-affected state with more than 10,000 cases, while New South Wales followed, with around 5,000 cases. Per-capita infection rates have been highest in Queensland, South Australia, and the Northern Territory.

Of all flu cases reported nationally this year, 15% have been in children younger than four, the highest rate in any age group.

Advice to travellers

Influenza is spread by droplet infection. You are at higher risk in crowded situations such as on public transport or in markets. 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.

Madagascar – polio

While no cases of polio have been detected in Madagascar since the late 1990s, the authorities announced that they had identified six new cases in the south of the country, raising fears of a new resurgence of the epidemic of polio.

The low immunisation rates combined with the health problems and malnutrition may well contribute to a recurrence of this disease. A study conducted by the Pasteur Institute has indicated that the virus involved in these cases is derived from a vaccine virus and therefore would be less virulent causing a slight paralysis, while the wild-type virus usually causes severe paralysis.

China – polio

Seven new cases of poliomyelitis were reported in the last week, bringing the total number of cases to 17. All the cases have been identified in Xinjiang Uygur autonomous region in north-west China; however four of the new cases are from Kashgar district which had not previously reported any polio cases (source from Travax).

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 cause of 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 ten years.

Indonesia – avian influenza

Two children aged five and ten from Jehem, Bali province, have died from a case of bird flu at Sanglah hospital. The children had reportedly come into direct contact with dead birds near their house.

Indonesia has been hardest hit by the virus, with 148 deaths since 2003. The last was in March 2011. The World Health Organization says Indonesia accounts for nearly half the 333 human fatalities worldwide.

Advice to travellers

Avian Flu is spread through close contact with infected poultry. Avoid contact with poultry and wild birds (eg markets, farms). Wash your hands frequently and well, consider carrying a hand sanitiser gel with you, avoid eating undercooked or uncooked poultry or eggs.

India – Japanese encephalitis (JE)

Bihar: At least ten-12 cases of the disease are being reported at Patna Medical College and Hospital (PMCH) everyday. Dr Nigam Prakash Narayan a senior doctor at the paediatrics ward of the hospital said, "About 250 patients of encephalitis have been admitted to the hospital so far. Of them, around 100 are down with JE (virus infection).

Uttar Pradesh: In the last 24 hours, ten of 18 patients with JE virus infections have died. Overall, from January 2011 until the last patient arrived for treatment, 449 have died.

Advice to travellers

Japanese encephalitis 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 travel to rural areas 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.

Bolivia – Rabies

The death of a seven year old child, 78 confirmed canine rabies cases, and 11 children bitten by a rabid dog recently, demonstrates the vulnerability of Cochabamba department to rabies. Throughout this year, Cochabamba department has been one of the areas most affected by rabies virus.

Advice to travellers

Travellers are advised to consider pre-travel Rabies vaccine, this consists of a course of three 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 and Iodine or Alcohol applied. Medical advice should be sought as soon as possible, even if vaccinated with a full course of Rabies vaccine.

Philippines – Leptospirosis

From January to September, the Department of Health recorded at least 2,061 cases of Leptospirosis with 156 casualties. This number is 195% higher than the number of cases in the same period of last year (699 cases).

Advice to travellers

Leptospirosis is a bacterial infection spread by rodents mainly rats or small mammals through contaminated water. The infection comes from the urine or other secretions of the mammal and enters the human via open skin lesions and/or mucous membranes.

Travellers should avoid contact with potentially contaminated water (rivers, flooded areas etc). They should shower well after any possible exposure and protect any open cuts/lesions with waterproof plasters.

Vietnam – hand, foot and mouth disease

Hand, foot and mouth disease (HFMD) is spreading throughout all 63 Vietnamese cities and provinces, with more than 71,470 people affected, of whom 130 have died, a local Thanh Nien newspaper reported.

Advice to travellers

HFMD is viral illness that most commonly affects children under ten 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 hand washing are both essential.

South eastern Turkey – earthquake

On 23 October 2011, an earthquake measuring 7.2 on the Richter scale occurred around nine miles from the south eastern city of Van and 73 miles from Hakkari.

The earthquake and strong aftershocks affected the cities of Van and Ercis and the neighbouring provinces of Vitlis and Hakkari. There are confirmed reports of 461 people killed, around 1,000 injured and hundreds missing or homeless; the death toll is expected to rise.

There has been severe damage to buildings in the cities of Van and Ercis and disruption to electricity, water, telecommunication and transport services in the region. Further disruption to these services is anticipated. Much of affected area is remote and mountainous. This is the most powerful earthquake to hit Turkey in the last ten years.

Advice for travellers

The infrastructure and communications networks have been severely disrupted; there is an increased risk of food and waterborne disease, as well as a risk of accidents and injuries. There are no travel restrictions in place for Turkey; however flights to Van Province may be disrupted and subject to cancellations. Travellers should check the Foreign and Commonwealth Office (FCO) website for current travel advisories (sourced from NaTHNaC).

Kenya – random attacks

On 24 October, there were reports of attacks at several places within Nairobi. The first incident involved an explosive device thrown at a bus stop in central Nairobi. One person was reportedly killed and several injured. The second incident occurred near Nairobi's business district. Several people were reported to have been injured after a grenade was detonated in a bar.

Advice for travellers

We advise British nationals to take extreme caution and avoid any unnecessary travel around the affected areas of the city. Full travel advice to Kenya can be found on the FCO website.

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