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Wanderlust travel health update: Sweden, Greece, Cambodia and more

This week's world health news from Nomad including: tick borne encephalitis in Sweden, an update of the malaria outbreak in Greece and dengue fever in Cambodia

Wanderlust health news supplied by Nomad

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.

Cambodia – Dengue Fever

A total of 40 Cambodian children died of dengue fever in the first seven months of 2011, an increase from 37 such deaths in all of last year. From January to July this year, some 7,867 cases of dengue fever had been reported, exceeding the 2010 total of 5,497 cases.

Latin America – Dengue Fever:

El Salvador – 5,644 cases; 2,195 laboratory confirmed.

Panama – 390 cases; 249 laboratory confirmed; 2 deaths.

Mexico – 25,307 cases; 2,476 laboratory confirmed; 382 classed as severe; 10 deaths.

Aruba – 1,573 cases; 674 laboratory confirmed; 1 death.

St Lucia – more than 150 cases; 1 death.

Bolivia – 26,019 cases; 6,270 laboratory confirmed; 36 classed as 'severe'; 36 deaths.

Peru – 33,888 cases, 8,827 laboratory confirmed; 234 classed as 'severe'; 28 deaths.

Colombia – 1,9482 cases; 4,070 laboratory confirmed; 819 severe.

Paraguay – 35,027 cases; 5,933 laboratory or epidemiologically confirmed; 95 classed as 'severe'; 62 deaths.

Brazil – 715,666 cases; 8104 severe; 3120 deaths.

Pakistan – Dengue Fever

Punjab province – The number of dengue cases in the province has reached 762, while the confirmed number of dengue cases in Lahore has reached 681. The recent spell of heavy rainfall has led to the increase in the number of 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 headache, 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.

Venezuela – Malaria

So far 139 cases of malaria have been confirmed in the state of Zulia from an outbreak of malaria which originated in the Colombian Guajira region. Of these 139 cases only one occurred locally and the remainder were infected while visiting Colombia.

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. They should ensure that they take the tablets as advised or may not be as effective. 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.

Greece – Malaria

Greece has been malaria free since 1974; however according to Greek health authorities, since June 2011, a total of six malaria cases have been reported in persons with no history of travel to a malaria-endemic area. All cases were confirmed to be P vivax and occurred in the southern region (Peloponnesus) of the country, specifically in Laconia and Evoia districts.

Advice to travellers

Travellers to the affected area should seek expert advice before they travel. There are currently no recommendations to take malaria tablets for travel to Greece although travellers should ensure good bite avoidance. 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.

Sweden – Tick Borne Encephalitis

The number of people infected by tick-borne diseases, such as tick-borne encephalitis, has gone up this year.

So far in August 2011, 66 cases of the deadly disease have been reported, which is more than during any other month in the past four years. In total this year, 144 cases of tick-borne encephalitis have been reported already compared to the total of 174 for the whole of 2010.

Advice to travellers

Tick-borne encephalitis is transmitted to humans via the bite of an infected tick. Less commonly, the disease is spread by the ingestion of unpasteurised milk from infected animals especially goats. Travellers to rural tick infested areas who plan to camp or walk during the tick season should consider vaccination. This consists of two injections ideally one month apart with a booster 5-12 months later. Travellers should treat their clothing with premethrin which will kill ticks on contact and should always check for embedded ticks and remove them immediately.

India – Japanese Encephalitis

More than 350 cases of Japanese encephalitis and nearly 90 deaths due to the viral disease have been reported in Assam so far this year.

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 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.

Bulgaria – Hepatitis A

The Regional Health Inspectorate in Bulgaria's southern city of Plovdiv has registered a total of 144 cases of hepatitis in August 2011. According to the report, 34 of the 144 cases were located in the city's Roma ghetto, Stolipinovo. The majority of patients were of Roma ethnic origin and were children, the watchdog announced. Most of the cases were of hepatitis A infection, but 10 of the probes raised suspicions of hepatitis B and C.

India (Gujurat) – Leptosporosis

With two more deaths due to leptospirosis, one each in Valsad and Navsari, the total number of deaths due to the deadly disease has reached 46. The number of patients has reached 228 with the addition of six new patients on Saturday (27 August). In south Gujarat, leptospirosis cases are reported in rural areas among those working in farms. The cases are reported during monsoon and in the three months of the rainy season. The disease kills more than 100 people of working age every year.

Advice to travellers

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.

All outbreak information has been sourced from Promed.

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For more travel health stories see our health news pages

For travel health articles check our Dr Jane Wilson-Howarth's features here

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