Health Alerts

CHOLERA in Cameroon, Central African Republic, Chad, Congo, Democratic Republic of Congo, Dominican Republic, Ghana, Guinea, Haiti, India, Malawi, Mozambique, Nigeria, Philippines, Sierra Leone, Somalia, Uganda
May '12- An estimated 3 to 5 million cases and over 100,000 deaths occur each year around the world. Cholera is common in many Sub-Saharan African countries. According to the CDC, an ongoing outbreak of cholera in Haiti has resulted in a total of 534,647 cases, 287,656 hospitalizations, and 7,091 deaths over the past 2 years. According to the Haitian government an average of 77 new sufferers are appearing each day. In Dominican Republic to date, 21,000 cases and more than 360 deaths have been reported. Dominican health authorities confirmed the death of 6 people due to cholera in Tamboril, province of Santiago; 19 patients with symptoms of cholera are currently hospitalized. In West and Central Africa cholera epidemics hit 85,000 people and killed 2,466 during 2011; the most significant increases were in Chad, Cameroon, and in western Democratic Republic of Congo (DRC). According to a UN humanitarian spokesman case rates in Congo DR are already at 40% of the totals reported last year. So far, nearly 8,000 cases and 120 deaths have been reported during 2012. The cholera problem is especially bad in the Eastern DRC with South Kivu province reporting more than 2,200 cases so far. Central African Republic (CAR) has reported at least 2 deaths so far this year. An outbreak in western Guinea caused at least 14 deaths and more than 80 cases in February. Outbreaks in Ghana’s Greater Accra and Eastern Regions has resulted in more than 1550 cases and more than 160 cases respectively. During the first two months of 2012, Nigeria reported 40 cases and 1 death in Kaduna and Gombe states. In the Republic of Congo an outbreak in Brazzaville has resulted in 10 confirmed cases so far. An outbreak in Sierra Leone’s northern region has resulted in more than 2000 cases and at least 34 deaths recently. A cholera outbreak in Blantyre, Malawi has killed 11 people in the last few months; according to health officials matters are worse due to an acute economic crisis, which has contributed to the contamination of water supplies and the hospitals inability to buy medicines. Uganda's Nebbi district has reported at least 11 fatalities and over 550 cases since the beginning of April. In addition, more than 250 cases have been reported in the districts of Kasese, Mbale, Sironko, Bududa, and Buliisa according to Health officials. In India's cities of Bangalore and Mysore (located in Karnataka state) 5 cases and 34 cases have been reported respectively. In Albay and Mindanao Philippines 5 deaths have already been reported this year. The humanitarian situation in Somalia remains highly critical. Since September 2011 cholera has claimed at least 200 lives. Passport Health offers products for water purification and electrolyte replacement; precautions for food and water are covered in the travel consultation. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

MALARIA in Angola, Bahamas, Democratic Republic of Congo, Greece, Honduras, India, Madagascar, Nigeria, Pakistan, United Arab Emirates, Venezuela
May '12- Each year, more than 250 million cases of malaria are reported worldwide, killing between one and 3 million people. In March this year, one case of malaria was reported in a U.S. traveler returning from the island of Great Exuma, Bahamas; CDC no longer recommends malaria prophylaxis for Great Exuma, Bahamas since no new cases have been reported since this one. About 90% of malaria-related deaths take place in Sub-Saharan Africa. Democratic Republic of Congo is currently experiencing outbreaks in Monieka, Mbandaka, Bolenge and Ikengo with over 1200 cases and more than 400 deaths reported so far this year. Malaria is endemic in Angola; over 2 million cases were registered in 2011. In India, malaria is endemic in Rajasthan and parts of Chhattisgarh, Orissa, West Bengal, Gujarat and Jharkhand. In Jharkhand 2 deaths have been reported already this year and an average of 15 cases are being seen in the hospitals daily. Karnataka, India has reported 28 cases so far. Due to the 20 cases reported in Greek citizens without reported travel history between May and September 2011 the CDC now recommends a malaria prophylaxis when traveling to the Lakonia region of Greece. Malaria is endemic in Colon, Honduras; so far this year at least 100 cases have been reported in the area. According to Madagascar’s health ministry, a severe outbreak of malaria has resulted in 7 fatalities and at least 60 others needing hospitalization since the beginning of May. Malaria is endemic in Nigeria. According to the Ministry of Health, Nigeria has the highest number of malaria cases in the world and currently contributes to about 23% of the world's malaria cases. The last outbreak reported in Pakistan’s Sindh province was toward the end of 2011, with about 12,000 cases reported. More than 2000 cases were reported in Abu Dhabi, United Arab Emirates (UAE) last year, more than double the number in 2010; they all came from outside the UAE, maintaining the country's malaria-free status, which it has held since 2007. About 94% of cases reported from Venezuela so far this year have come from Bolivar state; nearly 1,000 cases have been reported nationally from Venezuela this year. Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. When traveling to these areas it is recommended to use mosquito repellents containing DEET on exposed skin and Permethrin on outer clothing, mosquito netting and bedding. Travelers should also speak with a Travel Health specialist to find out if a prophylactic anti-malarial medication is needed. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

LASSA FEVER in Nigeria
May '12- According to the CDC, the Nigerian Federal Ministry of health has reported an increased number of cases of Lassa Fever. More than 800 cases (131 have been laboratory confirmed), including 84 deaths have been reported from 19 of Nigeria’s 36 states since the beginning of 2012. The number of Lassa virus infections per year in West Africa is estimated at 100,000 to 300,000, with about 5,000 deaths. Lassa fever is a viral illness that is spread through direct contact with rat droppings or urine and through touching objects or eating food contaminated with rat droppings or urine. Lassa fever may also spread though person-to-person contact. Symptoms include, fever, headache, sore throat, a cough, nausea, vomiting, diarrhea, and muscle pain. A common complication of Lassa Fever is deafness. Lassa Fever can occur all year long, but most cases occur from January to May. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

DENGUE FEVER in Argentina, Bolivia, Brazil, Cambodia, Colombia, Cook Islands, Dominican Republic, Ecuador, El Salvador, Fiji Islands, India, Indonesia, Malaysia, Mexico, Niue, Pakistan, Paraguay, Peru, Philippines, Sri Lanka, Taiwan, Yemen
May '12- Dengue Fever cases have been on the rise worldwide. According to WHO over 2.5 billion people are now at risk of dengue and there are about 50-100 million dengue infections worldwide every year. Outbreaks last year (2011) from Paraguay, Panama and the non-Hispanic Caribbean countries, such as Aruba, the Bahamas, and Saint Lucia reported cases and deaths totaling more than any historical data on file. In Argentina more than 50 cases have been confirmed in Salvador Mazza, located in Salta province near the border of Bolivia. More than 100,000 cases have been reported this year from the following states in Brazil: Alagoas, Bahia, Ceara, Mato Grosso, Mato Grosso do Sul, Parana, Paraiba, Rio de Janerio and Sao Paulo. More than 75% of these cases have come from Rio de Janerio state alone. In Bolivia, near Yacuiba, there have been more than 1,000 suspected cases, with 75 confirmed so far. According to the Ministry of Health, by the end of March (this year) nearly 1,400 cases including 8 deaths had been reported in Cambodia. According to the WHO the trend of dengue activity is continuing to increase gradually. So far in 2012, the departmental Secretariat of Health reported nearly 2,000 cases in Colombia’s Huila department. According to health officials 3 cases have been confirmed from Rarotonga in the Cook Islands. These cases are the first to be recorded in the Cook Islands since 2009. The Dominican Republic has reported more than 350 cases and 2 deaths so far this year from the following provinces: Puerto Plata, Monsenor Nouel, Santo Domingo, Distrito Nacional, Maria Trinidad Sanchez, Espaillat, Valverde, and Duarte. According to the Ministry of Public Health more than 6,000 cases and 14 fatalities have been reported from Ecuador; 4 of these cases were reported from the Galapagos Islands. El Salvador has reported more than 700 cases and 1 death so far this year. According to the Health Ministry, more than 300 cases have been reported in Fiji since January; more than half of the cases were recorded in the Western Division. In India more than 1700 cases have been reported this year from the following states: Gujarat, Haryana, Jakarta, Karnataka, Kerala, Maharashtra, Orissa, Puducherry and Tamil Nadu. So far this year Indonesia has reported at least 370 cases cumulatively from Jambi, North Jakarta, West Java and East Java. During the first four months of the year, more than 8,000 cases and 18 deaths were reported from Malaysia. Selangor topped the list with more than 3,600 and 9 deaths, followed by Kuala Lumpur and Putrajaya reporting more than 860 cases with 3 deaths, and Perak with at least 560 cases with one death. In Mexico so far this year, at least 160 cases have been reported. Niue Island health authorities reported 3 cases in early March, 2 of the people were hospitalized. In Pakistan, outbreaks have been reported in Karachi (Sindh province) and Khyber Pakhtunkhwa so far this year. Paraguay’s health system has registered 30 dengue deaths while another 39 are under investigation for confirmation. So far this year, more than 10,000 cases have been confirmed; most of these cases were detected in the Asuncion area. In Peru more than 2,000 cases have been confirmed while another 6500 are still under investigation. The majority of cases reported by district health agencies came from Ucayali, Jaen, Loreto, Junin and San Martin. In Philippines, more than 1,400 cases have been reported from Bataan, Mindanao, and Zamboanga City so far this year. According to health officials Dengue Hemorrhagic Fever (DHF) cases have reached “high alert” level in Zamboanga City. According to health authorities 10 cases have been reported on Reunion Island so far this year. More than 10,000 dengue cases and 42 deaths were reported in Sri Lanka during the 1st four months of 2012, most of which have been from the Western Province. According to the CDC, Taiwan has confirmed it’s first indigenous case in this year’s dengue epidemic season from North District in Greater Tainan. Dengue fever has been confirmed in 4 cases from Hodeida governorate in Yemen. Dengue fever causes the same symptoms as flu and other kinds of fever and then develops in critical conditions such as hemorrhage, vomiting, or faster heartbeats. Travelers going to areas where dengue is present should promptly seek medical care if illness occurs when they return home and inform their health care provider of their recent travel. Persons traveling to areas where dengue is endemic should use insect repellents, wear protective clothing, and reside in facilities with screens and air conditioning when available. No vaccine is available for preventing dengue infection. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

MEASLES in Afghanistan, Angola, Australia, China, Congo, Democratic Republic of Congo, Ecuador, France, Germany, India, Ireland, New Zealand, Pakistan, Russia, Spain, Switzerland, Uganda, Ukraine, United Kingdom, USA, Yemen
May '12- About 30 million people are diagnosed with measles annually. Presently Songo, Angola is experiencing an outbreak. In western Afghanistan at least 20 children have died. More than a dozen cases have already been reported this year from the Australian Capital Territory (ACT) and South Australia. China reported more than 300 cases in January. In Ecuador a total of 203 cases have been reported from Tungurahua, Pichincha, Guayas, Pastaza and Chimborazo Cotopaxi. England has reported more than 110 cases so far this year in and around Liverpool and Wales. In India, Arunachal Pradesh (30 cases), Himachal Pradesh (more than 100 cases) and Nalkheda Village (50 cases) have reported outbreaks so far this year. Wellington, New Zealand has reported 3 cases so far this year. Swabi, Pakistan has reported at least 4 cases and 1 death recently. In the last 3 months there have been more than 1000 cases and 27 deaths reported from the Equateur province in Democratic Republic of Congo. The Republic of Congo has reported at least 200 cases, in Brazzaville, since the beginning of February. An outbreak in Kiruhura, Uganda has resulted in at least 1 fatality and 38 others hospitalized recently. Outbreaks across Russia, 47 regions so far, have affected more than 600 people and caused at least one death so far this year. In Spain nearly 400 cases have been reported in Alicante and Valencia provinces since the beginning of the year. Ukraine has reported more than 2,800 cases mostly from the Lviv region. Since mid-2011 measles has killed more than 150 children, under the age of 5 years, in Yemen. 2011 was the worst year for measles cases in the United States since 1996; by the end of October 220 cases were reported. Most of these cases were people who traveled overseas to Western Europe, Africa or Asia and were not vaccinated. The increased trend in Measles cases has a few contributing factors, including increased number of infections in Americans returning from travel abroad. The U.S. Centers for Disease Control and Prevention has urged Americans traveling overseas to make sure they are vaccinated against measles—especially if traveling with children. In children complications may lead to bronchitis and pneumonia and in more severe cases, the disease can cause central nervous system damage. Measles is an acute, highly communicable disease, transmitted by direct contact with infectious droplets or by airborne spread. Symptoms of measles include fever, runny nose, and sore eyes followed about 2 days later by a red blotchy rash. It is recommended that you receive an adult booster if you haven't had measles and you have only had your childhood immunizations, especially when traveling internationally. Young children can complete their MMR vaccination schedule early if they are traveling abroad. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

MENINGITIS in Australia, Benin, Brazil, Burkina Faso, Chad, Cote d'Ivoire, Ghana, Uganda, Vietnam
May '12- Sub-Saharan Africa is plagued yearly during the dry season (December to June) by large epidemics of meningococcal meningitis. Outbreaks have been reported in Benin (381 cases and 38 deaths), Burkina Faso (1966 cases and 212 deaths), Chad (1043 cases and 67 deaths), Cote d’Ivoire (281 cases and 39 deaths), Ghana (369 cases and 37 deaths) and Uganda (33 cases and 14 deaths) so far this year due to increased surveillance in the African Meningitis Belt. A meningitis epidemic in the Brazilian state of Bahia resulted in at least 1,500 bacterial meningitis cases (the most serious form of the disease) and left more than 100 dead during 2011. In Queensland, Australia 16 cases have been confirmed so far this year. Ho Chi Minh City, Vietnam has reported 5 cases and Hanoi has reported 4 deaths so far this year. Vaccination prior to travel is recommended. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

TYPHOID FEVER in Fiji Islands, India, Indonesia, Philippines, Samoa, Tonga, Zambia, Zimbabwe
May '12- Typhoid affects 21.5 million people each year. Fiji has one of the highest rates for typhoid fever in the world; After flooding in January at least 30 cases were reported. In Harapanahalli, India over 360 cases have been reported so far this year. In Punjab, India about 40-45 people are being diagnosed with cholera daily. In Indonesia cases have been on the rise; the First Lady of Indonesia was hospitalized for treatment earlier this year. Pakistan currently experiences an average of 1000 cases per year. In and around Leyte province Philippines notable rises in cases are being reported. Samoa's Upolu Island has reported several cases in Malie and 1 infant death in Upolu. Tongatapu, Tonga has reported it's first 2 cases this year. In Zambia's Mupambe township 2,094 cases and 2 deaths have been reported since the outbreak started in December 2011. In the town of Kabwe, Zambia, 204 cases have been reported since the the start of the outbreak in the beginning of April. Zimbabwe is in the midst of an outbreak, with more than 4000 cases and 1 death reported since October 2011; on average about 50 cases are being reported daily. Travelers are encouraged to get the Typhoid vaccine prior to traveling to these and other endemic regions and to exercise food and water precautions. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

PERTUSSIS in Argentina, Australia, Canada, Chile, New Zealand, Spain, USA
May '12- According to the WHO there are 50 million pertussis cases including 350,000 deaths annually worldwide. The disease is contagious and known for uncontrollable, violent coughing which often makes it hard to breathe. After fits of many coughs, someone with pertussis often needs to take deep breaths, which result in a "whooping" sound. Pertussis most commonly affects infants and young children and can be fatal. Since the beginning of the year Argentina has confirmed more than 560 cases. Western Australia is in the midst of a pertussis epidemic that began in mid-2011. According to the Health Department's diseases register, 1505 cases have been recorded so far in 2012. Nearly 200 cases have been reported from Yukon, New Brunswick, British Columbia's Fraser Valley and Ontario Canada so far this year. In Londonderry Northern Ireland 1 child has been diagnosed with pertussis. The prevalence of pertussis cases in Chile remains higher than in neighboring countries; so far this year more than 640 cases, double the cases from last year this time, and 5 fatalities have been recorded. The South Island of New Zealand, particularly the Nelson Marlborough region, has reported more than 200 cases so far this year. Spain reported about 1,700 cases in 2011. So far this year in the USA, Arizona, California, Colorado, Florida, Idaho, Illinois, Iowa, Massachusetts, Missouri, Montana, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Washington and Wisconsin states have experienced outbreaks of whooping cough. Children should be vaccinated against the disease and parents, family members and caregivers of infants need a booster shot. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

HEPATITIS A in Malaysia, Mexico, Netherlands, New Zealand, Pakistan
May '12- About 1.4 million cases of Hepatitis A occur annually worldwide. It is transmitted when a person ingests food or drink contaminated by an infected person's feces. The risk of contracting hepatitis A virus infection is high in certain regions, in particular Eastern Europe, Africa, Asia, and South America. So far this year, New Zealand has reported 19 cases in Auckland. During the end of 2011 an outbreak due to contaminated water supply infected more than 800 people in Terengganu, Malaysia. Hepatitis A infection is common in many small communities throughout Mexico due to seasonal factors, inadequate sanitation and lack of clean water. During the last half of 2011 more than 20 cases were acquired in Netherlands. In Pakistan Hepatitis A is thought to infect almost all persons living in Pakistan by the age of 15 years. Travelers should vaccinate prior to travel. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

HEPATITIS B in Bangladesh, Bhutan, East Timor, India, Indonesia, Korea (North), Maldives, Myanmar (Burma), Nepal, Pakistan, Sri Lanka, Thailand, Uganda
May '12- About 600,000 people die each year due to Hepatitis B. More than 130 million people from eleven Asian countries carry Hepatitis B and/or C, out of 520 million people who have the disease globally. Chronic Hepatitis B and C are among the leading causes of preventable deaths in Bangladesh, Bhutan, Myanmar(Burma), East Timor, India, Indonesia, Maldives, Nepal, North Korea, Sri Lanka and Thailand. In Pakistan 10.8% percent of all viral Hepatitis cases reported from June 2010 to March 2011 were Hepatitis B. Hepatitis B cases are increasing in Pathanamthitta villages, located in Kerala state, with health officials reporting at least 2 deaths since the beginning of the year. In Punjab and Gujarat, India at least 140 cases and 92 deaths were reported respectively in the past year, most were between 15 and 45 years old. In India at least 1 in every 25 people living in North Chennai, in Tamil Nadu, have tested positive for hepatitis. In Uganda more than 35 cases were reported last year; 4 deaths were reported out of the 74 cases reported in 2010. Hepatitis B is a liver disease. It can range in severity from a mild illness to a serious long-term (chronic) illness that can lead to liver disease or liver cancer. Vaccination is recommended. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

LEPTOSPIROSIS in Fiji Islands, Peru
May '12- Since Fiji’s flooding in January, more than 250 people have contracted leptospirosis. The majority of all cases have been from the Western Division. So far 7 fatalities have been confirmed and 13 still under investigation. In Iquitos, Peru an outbreak of leptospirosis is causing concern after river water levels have reached higher than they have in the past 25 years. Nationally, Peru has reported more than 300 cases. These case totals are close to the number of leptospirosis cases reported during the entire year of 2011, which was 404 cases. Leptospirosis is spread through contact of urine from infected animals and/or contact with water, soil or food contaminated with the urine of infected animals. According to the CDC, leptospirosis can cause a wide range of symptoms, including fever, vomiting, jaundice, diarrhea, rash, abdominal pain, muscle and head aches. However, some may not exhibit symptoms at all. If not treated, Leptospirosis can lead to kidney damage, meningitis, liver failure, respiratory distress, and even death. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

AVIAN INFLUENZA in Azerbaijan, Bangladesh, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Laos, Myanmar (Burma), Nigeria, Pakistan, Thailand, Turkey, Vietnam
May '12- In Azerbaijan 8 cases and 5 deaths have been confirmed to date. In Cambodia 20 cases and 18 deaths have been confirmed to date. Of the 41 cases confirmed to date in China, 27 have been fatal. In Egypt 167 cases and 60 deaths have been confirmed to date. In Indonesia 157 deaths out of 189 cases have been confirmed to date. Of the 3 cases confirmed to date in Iraq, 2 have been fatal. In Laos 2 cases, both resulting in deaths have been confirmed. In Nigeria 1 case resulting in death has been confirmed to date. Pakistan confirms 3 cases and 1 death to date. In Thailand 25 cases resulting in 17 fatalities have been confirmed to date. Of the 12 cases confirmed in Turkey to date, 4 have been fatal. In Vietnam 123 cases and 61 deaths have been confirmed to date. Countries that have reported cases but no fatalities since 2003 include, Bangladesh (6 cases), Djibouti (1 case) and Myanmar (1 case). Avian influenza viruses do not normally infect humans. However, there have been instances of certain highly pathogenic strains causing severe respiratory disease in humans. In most cases, the people infected had been in close contact with infected poultry or with objects contaminated by their feces. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

MUMPS in Canada, Scotland, Serbia and Montenegro, Spain
May '12- An ongoing mumps outbreak has resulted in more than 100 cases so far this year in Novi Sad, Serbia. One school in Winnipeg, Canada has already experienced an outbreak this year, resulting in at least 11 cases. Scotland's Glasgow University has reported an outbreak totaling 30 cases since start of February. An ongoing outbreak, in northern Spain since December last year, has affected more than 100 people in Girona. Mumps is caused by a virus that usually spreads through saliva and can lead to inflammation of the brain and other organs. It is recommended that you receive an adult booster if you haven't had mumps and have only had your childhood immunizations. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

POLIO in Afghanistan, Angola, Central African Republic, Chad, China, Congo, Cote d'Ivoire, Gabon, Guinea, Kenya, Mali, Niger, Nigeria, Pakistan
May '12- Many countries worldwide report cases of Polio each year. So far in 2012, Afghanistan (4 cases), Chad (1 case), Nigeria (5 cases) and Pakistan (12 cases) have reported cases. WHO removed India from it’s list of endemic countries (Feb 25th) after the country passed one year without registering any new cases. The milestone is a major victory in the global effort to eradicate polio and leaves only three countries endemic with polio — Pakistan, Nigeria and Afghanistan. India must pass another two years without new cases to be declared polio-free. In 2009, India accounted for half of all cases in the world, but cases plummeted to 42 in 2010 and none in the last 12 months. Globally 620 cases were reported in 2011. Case totals during 2011 are as follows: Afghanistan (80 cases), Angola (5 cases), Central African Republic (4 cases), Chad (132 cases), China (21 cases), Cote d'Ivoire (36 cases), Republic of Congo (1 case), DR Congo (93 cases), Gabon (1 case), Guinea (3 cases), Kenya (1 case), Mali (7 cases), Niger (5 cases), Nigeria (61 cases), and Pakistan (198 cases). Adults should receive a one-time polio booster and all children should be current with their vaccinations prior to traveling. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

CHIKUNGUNYA in Benin, India, Indonesia, Malaysia, Mauritius
May '12- Chikungunya is known to occur during the rainy season in parts of Africa, Southeast Asia, southern India, and Pakistan. A number of travelers that returned from Benin and Indonesia last year (2011) were diagnosed with Chikungunya. Chikungunya is endemic in India; therefore sporadic outbreaks occur throughout the country frequently. So far this year, India's Kerala and Orissa states have reported about 30 cases cumulatively. Malaysia has reported 23 cases so far this year. Mauritius reported its 1st chikungunya case for the year in January. Chikungunya fever is a disease caused by a virus that is spread to people through the bite of infected mosquitoes. Symptoms can include sudden fever, joint pain with or without swelling, chills, headache, nausea, vomiting, lower back pain, and a rash. In case of these symptoms people are strongly advised to see their doctor. Travelers should use mosquito nets when sleeping and apply mosquito repellents. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

RABIES in Bangladesh, Brazil, China, Dominican Republic, India, Indonesia, Pakistan, Paraguay, Peru, Philippines, Romania, Russia, South Africa
May '12- Although the CDC says that rabies is a preventable viral disease, there are approximately 70,000 deaths per year from rabies worldwide. Cases are often under-reported. Bangladesh has the highest per capita rate of human deaths from rabies, which is 1 death in every 30,000 people. In Ceara, Brazil a child was the first fatality reported this year. China averages more than 2400 deaths from rabies annually.In the most recent report from China: more than 700 dogs were put down earlier this month in Sichuan, after a woman died from rabies, due to the bite of a neighbor’s dog. Chinese officials imprisoned 8 people in 2011 after accusing them of selling a fake rabies vaccine. Toronto has reported its first human rabies case in over 80 years. The person is reported to have contracted the rabies strain, previously seen in dogs on Hispaniola, in the Dominican Republic. Roughly 36% of the world’s rabies deaths occur in India each year. Rabies is a known issue in Indonesia, even in popular tourist destinations; Bali, Nusa Penida District, East Nusa Tenggara and Central Kalimantan reported a total of 27 deaths from rabies last year. So far this year cases have been reported from Jakarta and Maluku provinces. In Pakistan about 5000 deaths are reported annually. Reports of at least 9 bats attacking humans have happened this year in Paraguay, in which at least 1 of these was a rabid bat. A child has died due to the bite of a rabid bat in Cusco, Peru so far this year. As of late 2011 the Philippines were estimated to be among the top 10 rabies hotspots in Asia; so far during this year 2 people have been reported dead due to rabies in Cotabato. In eastern Romania the death of a 5 year old was reported in early March. In Russia's Moscow region 2 residents were hospitalized after coming into contact with a rabid moose in February. Also in February, an outbreak in Limpopo South Africa resulted in the hospitalization of 2 people. There is a shortage of vaccine. Consequently, travelers should vaccinate prior to departure. Otherwise, if bitten, they will need to fly home, or to an Asian center such as Bangkok, Singapore, or Hong Kong to get proper post-exposure treatment. Travelers to these areas should consider the pre-exposure rabies prophylaxis vaccination series. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

YELLOW FEVER in Cameroon, Cote d'Ivoire, Ghana, Peru, Senegal, Sierra Leone, Uganda
May '12- Since December an outbreak has been occurring in the upper-east and mid-western regions of Ghana. In Peru 3 deaths have been reported so far this year. An outbreak in Cameroon has resulted in at least 20 cases, including 7 deaths so far this year. In August 2011 Senegal ‘s Kedougou and Saraya Health districts reported 76 cases and 10 deaths; a vaccination campaign is currently underway. Outbreaks were reported earlier last year (2011) from Northern Uganda (over 200 cases and 53 deaths), Cote d'Ivoire (35 deaths in about 5 months) and Sierra Leone (2 cases in Southern Province). Case numbers for Yellow Fever are thought to be greatly under-reported; the World Health Organization (WHO) estimates that there are approximately 200,000 cases of yellow fever per year, with 30,000 deaths. In Africa, alone, WHO estimates 508 million people in 32 countries are at risk. Yellow Fever is a mosquito born disease found in Sub-Saharan Africa and the Amazon region of South America. Early signs of yellow fever are muscle pain and backache, headache, fever, shivering, loss of appetite and vomiting. In the later stages, patients can develop yellow eyes, abdominal pain, bleeding from the mouth, nose, eyes and stomach. This disease can be prevented with vaccination. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

RUBELLA in Romania, Solomon Islands, Spain
May '12- People preparing for travel to Solomon Islands, especially the Festival of Pacific Arts in July, are being urged by health officials to vaccinate against Rubella. This warning comes after 6 cases were reported in two days(May 8th and 9th). According to Spain's Health and Sanitation Department of Aragon Government, more than 15 cases have been reported since the end of February in Alcaniz and Zaragoza. A rubella outbreak has been ongoing in Salaj, Romania since September 2011 involving more than 1,800 cases. Rubella, also known as German measles, is highly contagious. The symptoms of rubella include a mild fever, rash, runny nose, sore throat and often swollen lymph nodes with aching joints. Rubella infection in pregnant women can cause serious birth defects or miscarriage. It is recommended that you receive an adult booster if you haven't had rubella and have only had your childhood immunizations. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

VARICELLA (CHICKENPOX) in Guinea, India, Liberia
May '12- Over 90 cases, mostly adults, were admitted to Mumbai's only hospital for infectious diseases in late February. In Chennai, India an increase in cases has been reported recently, mostly in pregnant women and newborns. An outbreak is occurring along the border between Guinea and Liberia. Chickenpox causes a blister-like rash, itching, tiredness and fever. It spreads easily from infected people to others who have never had chickenpox or never received the chickenpox vaccine. Chickenpox can be prevented through vaccination. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

TUBERCULOSIS in India, Korea (North), Nigeria
May '12- Doctors in Mumbai, India identified more than 20 patients infected with Drug Resistant Tuberculosis earlier this year. Since March this year, more than 70 new MDR-TB (multidrug resistant tuberculosis) cases have been reported in Pune district. North Korea has one of the highest rates of tuberculosis outside of sub-Saharan Africa. In Gombe state Nigeria, 30 suspected cases of drug-resistant tuberculosis have been reported recently. Tuberculosis (TB) is an infectious bacterial disease, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. In healthy people, infection with TB often causes no symptoms. However, the most common symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Tuberculosis is usually treatable with a six-month course of antibiotics. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

JAPANESE ENCEPHALITIS in India
May '12- Japanese Encephalitis is the leading cause of viral encephalitis in Asia with 30-50,000 cases reported annually. India reported more than 840 deaths in 2011; Uttar Pradesh and Assam each reported death tolls in the hundreds. According the CDC, countries which have had major epidemics in the past, but which have controlled the disease primarily by vaccination, include China, Korea, Japan, Taiwan and Thailand. Other countries that still have periodic epidemics include Viet Nam, Cambodia, Myanmar, India, Nepal, and Malaysia. Travelers are encouraged to consider JE vaccination prior to travel and to use mosquito repellents containing DEET on exposed skin and Permethrin on outer clothing. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

WEST NILE VIRUS in Albania, Greece, Israel, Italy, Romania, Russia, USA
May '12- During the last half of 2011, Albania (2 cases), Greece (31 cases), Israel (6 cases), Italy (7 cases) and Romania (1 case) all reported cases. In Volgograd Russia 61 cases were reported in 2011. People over 50 and those with a weakened immune system are more likely to be seriously affected by West Nile virus. A new study shows that people who have been infected with West Nile virus may have persistent virus in their kidneys for years after initial infection, potentially leading to kidney problems. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

CRIMEAN-CONGO HEMORRHAGIC FEVER in Oman, Pakistan
May '12- Crimean-Congo hemorrhagic Fever is endemic in many countries in Africa, Europe and Asia. In Oman at least 1 person has died in recent weeks and 1 other death is suspected. In Pakistan at least 2 deaths were reported in the last three months of 2011. Crimean-Congo Hemorrhagic Fever is transmitted to humans through infected ticks or from direct contact with blood/infected tissues of livestock. Signs and symptoms of the disease include: sudden onset of high fever, headache, backache, abdominal pain, small hemorrhages of the eyes, and a type of rash in the mouth and on the trunk of the body. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.

E. COLI in Austria, Canada, Czech Republic, Denmark, France, Germany, Greece, Luxembourg, Netherlands, Norway, Poland, Spain, Sweden, Switzerland, United Kingdom
May '12- An outbreak of E. Coli in New Brunswick, Canada has left more than 25 people ill in at least 3 communities since the beginning of May. During 2011 almost 4000 cases, including more than 40 deaths were reported worldwide. The European Union, consisting of 27 member states in Europe, reported more than 900 cases; about 28% of the total cases turned into hemolytic uremic syndrome (HUS), a serious complication that can cause kidney failure. The following countries reported cases during the outbreak: Austria, Czech Republic, Denmark, France, Germany, Greece, Luxembourg, Netherlands, Norway, Poland, Spain, Sweden and the United Kingdom. Switzerland also reported 23 cases during the year; normally Switzerland sees about 60 cases annually. E. Coli is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat products and raw milk. Symptoms include severe stomach cramps, diarrhea, vomiting and mild fever. Most people get better within 5-7 days, but some patients go on to develop HUS—usually about a week after the diarrhea starts. Symptoms of HUS include decreased frequency of urination, feeling very tired, and losing pink color to skin and membranes due to anemia. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.