Weekly round-up of the world's travel health news from Nomad including E-coli in Europe, Ebola in Uganda, Rabies in India and Bubonic Plague in the US
An increased number of cases of haemolytic uraemic syndrome (HUS) and bloody diarrhoea caused by enterohaemorrhagic Escherichia coli (EHEC) infection have been reported in Germany. As of 31 May 2011, a total of 373 cases of HUS have been reported in Germany. Six people have died. There have also been 796 reported cases of EHEC (bloody diarrhoea). The majority of cases have been reported in northern Germany, but there are also reports of cases in southern and eastern Germany. This outbreak of HUS is unusual in that there has been a large number of cases in a short space of time, and most cases are adults and predominantly women. In 2010, 65 cases of HUS were reported for the whole year in Germany of whom only six were adults. Cases of HUS and bloody diarrhoea have been reported in other European countries including Denmark, France, the Netherlands, Sweden and the United Kingdom, all of which are associated with travel to Germany.
Transmission of these bacteria usually occurs through contaminated food or water, following contact with animals, and occasionally from person to person. German authorities believe that a food source of infection is likely and early studies implicate raw tomatoes, cucumbers and lettuce.
Advice for travellers
EHEC is transmitted via the faecal-oral route. There is no vaccine available for travellers to prevent EHEC infection. Travellers to Germany should practise food and water and hygiene precautions. The Robert Koch Institute are advising their local population, in addition to the usual food and hygiene measures concerning the handling of fruits and vegetables, that consumption of raw lettuce, tomatoes and cucumber should be avoided in Germany until further notice. Travellers to Germany should follow the advice of the German authorities. Returning travellers with symptoms indicative of EHEC infection (i.e. bloody diarrhoea, cramping abdominal pain) should seek medical assistance as soon as possible and make sure they mention any recent travel history. (NaTHNaC).
Ross River virus
As of 31 May, a total of 3,791 cases of Ross River virus infection have been reported in 2011. The majority of cases were reported from the departments of Victoria (1,208), South Australia (875), and Queensland (701). A peak in cases occurred in February (1,185 cases) and March (964 cases); this compared with 451 and 929 cases during the same period in 2010 throughout the entire country.
Barmah Forest virus
As of 31 May 2011, a total of 1,083 cases of Barmah Forest virus infection have been reported since the beginning of 2011. The majority of cases were from Queensland (447), New South Wales (276) and Victoria (150), however smaller number of cases have also occurred in all other states.
On 25 February 2011, the Department of Western Australia advised residents and holiday makers in the Kimberley, Pilbara, Gascoyne and Murchison regions of Western Australia to avoid mosquito bites following the detection of Kunjin virus. As of 31 May 2011, one human case of Kunjin virus has been confirmed in Northern territory.
Murray Valley encephalitis
New South Wales: On 1 April 2011, the first human case of Murray Valley encephalitis (MVE) since 2008 was reported.
Western Australia: As of 16 May 2011, six confirmed MVE cases and one suspected case (including one death) have been reported. Residents have been warned against mosquito bites north or east of the capital Perth.
South Australia: Two confirmed cases of MVE have been reported this year.
Northern Territory: As of 25 May 2011, a total of three cases of MVE have been reported. The most recent was a 19-year-old Canadian traveller who died after contracting MVE whilst on holiday in the Northern Territory during the first two weeks of May.
As of 31 May 2011, a total of 415 cases of dengue have been reported in Australia since the beginning of January. Local outbreaks have been reported in several north Queensland towns following the floods and cyclone Yasi .
Advice for travellers
Each of these diseases is transmitted to humans by the bite of a mosquito. Therefore practising insect bite avoidance measures will help to prevent them. Barmah Forest and Ross River virus infections are febrile illnesses associated with headache, rash, joint pains and sometimes arthritis. MVE and Kunjin virus are rare infections that can be associated with encephalitis (inflammation of the brain). Physicians who see travellers with a febrile illness, who have returned from risk areas in Australia, should be alert to the possibility of mosquito borne disease.
Advice to travellers
Ebola viruses are highly contagious and cause a range of symptoms including fever, vomiting, diarrhea, generalized pain or malaise, and in many cases, internal and external bleeding. They are transmitted through excreta from rodents and from infected patients in conditions of poor hygiene. Travellers should avoid visiting an area affected by an Ebola outbreak, however if it is unavoidable, should follow Government guidelines.
World Health Organisation (WHO) experts suspect that a pest-control substance could be the cause of the mysterious deaths at a Chiang Mai hotel. Chiang Mai's head of public health Surasing Visaruthrat, who joined the WHO investigation team in examining the Downtown Inn on Friday (20 May 2011), said the world body's experts agreed with his team that it was unlikely that New Zealand tourist Sarah Carter died of a bedbug spray containing chlorpyrifos as had been suggested.
"We are looking into a toxic substance other than chlorpyrifos," Dr Surasing said. He refused to name the substance, saying only that it was "a pest control chemical." Carter was one of seven people who died mysteriously in the northern province between January and February (2011). Four of them had stayed at the Downtown Inn.
A man died of rabies in Andhra Pradesh on Wednesday, taking the toll due to dog bites to five in ten days, officials have said. The daily-wage laborer died of rabies at a government hospital in Kakinada in East Godavari district of coastal Andhra Pradesh, doctors said. The 45-year-old bit his wife before his death, and she too has been admitted to the hospital.
The victim had been bitten by a stray dog four months ago, but he did not receive anti-rabies vaccines. According to the health authorities, there are close to 67,000 stray dogs in the urban areas of East Godavari district alone, while their number is over 20 lakh (2 million) across the state.
Rabies virus infection was confirmed in a 14-year-old boy who was bitten by a dog in Vhembe district of Limpopo Province in the north of the country. This is the second human case of rabies infection to be confirmed in 2011; both in Limpopo Province. Mpumalanga and Gauteng Provinces also report confirmed human rabies infections annually. In June 2010, rabies was established in domestic dogs in south western Johannesburg, since then almost 50 cases of canine rabies have been confirmed in Johannesburg Metro.
A 16-year-old youth was reported to have died of suspected rabies-related disease at Buleleng Regional Hospital, adding to the island's 147 victims of rabies since the deadly disease emerged in November 2008. The victim was rushed to the hospital, when he exhibited symptoms of rabies such as difficulty breathing, hydrophobia, and a sore throat.
The hospital director said that the patient's family stated the boy had been bitten by a dog in his village in Banjar about a year ago. I Nyoman Sutedja, head of the province's Health Agency, said that dog bite cases in Bali remained high, with 130 cases per day despite the province's ambitious target to eliminate its rabies outbreak by the end of 2012.
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.
Sertaozinho, Sao Paulo state: 885 dengue cases have been registered in the first five months of 2011, almost double that of last year.
Sorocaba, Sao Paulo state: From the beginning of the year, Sorocaba recorded 1,034 dengue cases.
Rio de Janeiro city, Rio de Janeiro state: The Rio de Janeiro municipality registered 4,330 new dengue cases in the last seven days, for a total of 34,734 confirmed cases.
Natal, Rio Grande do Norte state: The Natal municipality recorded 2,859 dengue cases.
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 a headache and a 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.
A 58-year-old man in New Mexico was recently treated for bubonic plague, the first case of the disease to surface in 2011. Doctors said the man was most likely bitten by a flea carrying the plague bacteria, the most common method of transmission to humans. Only about 10 to 15 people in the USA catch the illness each year, typically in western states. It is particularly prevalent in New Mexico because the state has a high population of both rodents and fleas.
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 product to prevent attraction to 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 or alive. Pneumonic plague can also be spread via the respiratory route so travelers should avoid close contact with people in affected areas especially in crowded situations. Consider taking an anti bacterial handwash such as H2ONO.
The government has dispelled fears over the presence of yellow fever in Baringo and the country in general. Public health minister Beth Mugo said on Wednesday (4 May 2011) that currently there are no laboratory-confirmed cases of the disease, allaying fears on the prevalence of the fever-disease.
"I assure the general public and those intending to visit the country that there are no known cases that meet the case definition standard or are laboratory confirmed to be yellow fever," she told journalists at a media briefing at her Afya House office.
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