Travel health news provided by Nomad
Blog Words : Wanderlust health advice | 28 September

Wanderlust travel health update: Bali, Greece, France and more

This week's world health news from Nomad including: rabies in Bali, malaria in Greece, measles in France 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.

Sri Lanka – Rabies

About 31 people have died so far this year of rabies, as opposed to 59 deaths last year.

Indonesia (Bali) – Rabies

Rabies continues to be a risk in the resort island's capital, Denpasar, and its neighbouring regency Gianyar, underlining the persistence of the deadly epidemic that has haunted Bali since late 2008. Provincial health agency head I Nyoman Sutedja said that as of August (2011), the epidemic had killed 18 people, far less than last year, when 86 people died of rabies.

"The number of bite cases is still very high; up to 150 cases per day. Yet, most of the bites do not result in fatalities because a large number of the dogs have been inoculated and the bite victims have managed to immediately get proper medical treatment, including anti-rabies vaccines," he said.

Bolivia – Rabies

The city of Oruro, capital of Oruro department in the west of Bolivia has a problem with stray dogs and an estimated 30,000 populate the city. There have been ten cases of canine rabies (laboratory confirmed) in the capital and around ten individuals a day report dog bites. In 2010, a total of 1,598 dog bites were registered in Oruro. The vaccination of stray dogs was carried out in August 2011; in an effort to contain the rabies outbreak however, culling of unvaccinated stray animals is due to begin in September 2011. (Travax)

Advice to travellers

Travellers are advised to consider a pre-travel Rabies vaccination; 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.

India – Leptospirosis

In the past two months, nearly 130 people have been killed by the dangerous disease leptospirosis in south Gujarat. Those affected by the disease have mainly been farmers, who work in sugarcane and paddy fields.

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.

Greece – Malaria

A new case of malaria has been reported in Greece in a patient who lived in Greece for the last three years and returned to Romania three weeks ago. He worked in the south, in the Leimonas village, near Skala and Elos. The traveller had no history of travel to any malaria-endemic areas.

Since June 2011, 16 cases of Plasmodium Vivax malaria, without previous history of travel to an endemic country, have been reported from Greece. Ten of the cases are residing in the municipality of Evrotas (Lakonia Prefecture), two in Chalkida (Evoia Prefecture), two in Eastern Attiki Prefecture, one in Agia (Larissa Prefecture) and one in Orchomenos (Viotia Prefecture).

Advice to travellers

Travellers visiting a malaria-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 they will not work as well. 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.

Africa – Cholera

Cameroon: Nine of the country's ten provinces have reported outbreaks of cholera, with a total of 10,582 cases and 379 deaths as of mid-August 2011.

Congo DR: A cholera epidemic that started in the east of the country has spread along the Congo River to the west, with 5,171 cases and 301 deaths as of mid-August 2011.

Mali: Health authorities said there have been cholera outbreaks in three regions of the country, leaving 880 people infected and 36 dead as of mid-August 2011.

Niger: There have been outbreaks in about ten districts in the south and south-east districts of the country, leading to 1,008 people being infected and 26 deaths as of mid-August 2011.

Nigeria: Reports say there have been cholera epidemics in 23 of the country's 36 states, with 13,551 cases and 353 deaths as of mid-August 2011.

Republic of Congo: There have been cholera outbreaks in four provinces in the country, Brazzaville, Cuvette, Likouala and Plateaux, with 341 people said to have been infected and 20 deaths.

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.

India – Japanese Encephalitis

In a potential epidemic, at least 61 people have died and 662 hospitalised due to encephalitis in the last ten days in Uttar Pradesh, around 125km north-east of Lucknow. Cases in India have reached 4,458 with 584 deaths. Of these, Uttar Pradesh reported 1,782 cases, Assam (1,308), Tamil Nadu (404), West Bengal (341) and Bihar 288 cases.

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.

Bahamas – Dengue Fever

A total of 3,200 cases of dengue fever have been reported in the Bahamas.

Thailand – Dengue Fever

The Ministry of Public Health reports there have been 48,760 people infected with dengue fever in Thailand since the beginning of this year (2011), including 35 deaths. The majority of patients are in the central region, followed by the north-east, the north and the south.

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.

France – Measles

The Institute for Public Health and the National Academy of Medicine report that since 2008, more than 20,000 measles cases have been recorded, with 14,500 of these cases being reported during the period January to June 2011, compared with 5,000 (two deaths) during the whole of 2010. (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, two vaccines given ideally one month apart will provide cover.

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