Health Alerts INFLUENZA WorldwideApr. '18 – According to the CDC, annual vaccination against seasonal influenza is recommended for all people 6-months of age and older. Globally, influenza activity is low in most regions. In North America, influenza activity continues to decrease. In Europe, influenza activity continues to decrease in most countries. In northern Africa and the Middle East, influenza activity continues to decrease or remained low in most countries; however activity remained high in Jordan and Turkey. In the temperate countries of Asia, influenza activity continued to decrease, but continues to remain high in the Republic of Korea. In tropical countries of the Americas, influenza activity remains low in most countries. In tropical Asia, influenza activity began to decline in India but continued to decrease in southern China and Hong Kong SAR. In tropical Africa, influenza activity increased in western Africa, however Madagascar reported declining influenza activity. Lastly, in the southern hemisphere influenza activity remains at inter-seasonal levels. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization. YELLOW FEVER in Argentina, Brazil, Nigeria, Peru, Suriname, UgandaApr. '18 - 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 worldwide per year, with 30,000 deaths; 90% of these cases occur in Africa. According to WHO, yellow fever is endemic in tropical areas of Africa and Latin America. WHO also notes, the number of yellow fever cases has increased over the past two decades due to declining population immunity to infection, deforestation, urbanization, population movements and climate change. In early 2017, the Brazilian Ministry of Health reported outbreaks of yellow fever in several eastern states, including areas where yellow fever was not traditionally considered to be a risk. Although virus spread decreased by mid-2017, yellow fever cases have reappeared in several states since the end of 2017, especially in São Paulo State, including areas close to the city of São Paulo. In early 2018, the GeoSentinel Surveillance System reported a case of yellow fever in an unvaccinated Dutch traveler who had stayed near the São Paulo metropolitan region. In Nigeria, the local Centre for Disease Control has reported an ongoing outbreak of yellow fever that began in September 2017. Laboratory-confirmed yellow fever cases have been reported in at least seven states, and a number of people have died. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization. MALARIA in Brazil, Cape Verde, Costa Rica, South AfricaApr. '18 - Malaria is a potentially deadly mosquito-borne disease found in many countries throughout the the world. Cases of malaria have been reported in parts of South Africa, Costa Rica and Brazil. Public health officials in Brazil have reported an outbreak of locally transmitted malaria in the town of Wenceslau Guimarães in Bahia State. Local transmission means that mosquitoes in the area may be infected with malaria and spreading it to people. Although mosquitoes that spread malaria are present in Bahia State, malaria is not usually found there; this outbreak is believed to have started with an infected person who traveled from Pará State, where malaria is known to spread. In South Africa, as of March 2018, multiple cases have been reported in travelers to Limpopo Province. CDC now recommends that travelers to the western Waterberg district of Limpopo Province take prescription medicine to help prevent malaria. CDC previously recommended these medicines only for people traveling to Vembe or Mopane cities in Limpopo province. A malaria epidemic has been declared by the Burundi Ministry of Health. All of the country’s 18 provinces are reporting higher numbers of malaria cases than expected and nine provinces—Gitega, Kirundo, Muyinga, Karusi, Kayanza, Ngosi, Ruyigi, Cankuzo and Cibitoko—have been especially hard-hit. CDC continues to recommend that travelers to Burundi take prescription medicine to prevent malaria. Sources Include: Center for Disease Control and PreventionCHOLERA in Chad, Cote d'Ivoire, Cuba, Democratic Republic of Congo, Dominican Republic, Ghana, Haiti, India, Iraq, Kenya, Malawi, Mozambique, Namibia, Nigeria, Somalia, Syria, Tanzania, Uganda, Zambia, ZimbabweApr. '18 – Cholera is a bacterial disease that can cause diarrhea and dehydration. Cholera is most often spread through the ingestion of contaminated food or drinking water. Although cholera is preventable, 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. Passport Health offers products for water purification and electrolyte replacement; precautions for food and water are covered in the travel consultation. Recently, the following places have reported cases and/or deaths due to cholera: In Africa: Cote d'Ivoire, Democratic Republic of Congo, Ghana, Kenya, Malawi, Mozambique, Nigeria, Tanzania, and Uganda. Tanzania alone has seen 4,835 cases, including 68 deaths in its most recent outbreak. In Asia: India and Syria. In the Americas: The last confirmed cholera case in Cuba was reported in a Canadian Traveler returning from Cuba in January 2015. In the Dominican Republic, since the beginning of the epidemic (November 2010), more than 32,200 suspected cholera cases have been reported, including more than 480 deaths. Since the beginning of 2015, more than 180 suspected cases, including 9 deaths, have been reported; this is an increase of cases compared to the same period last year. In Haiti, since the beginning of the epidemic (October 2010), more than 734,000 cholera cases have been reported, of which more than 50% were hospitalized and more than 8,700 have died. Since the beginning of 2015, there have been more than 10,300 cases, including 106 fatalities; the number of cases and deaths reported in 2015 are already higher than those reported during the same period last year. Sources Include: International Society for Infectious Diseases, Center for Disease Control, Pan American Health Organization and World Health Organization.DENGUE FEVER in Argentina, Australia, Belize, Bolivia, Brazil, British Virgin Islands, Brunei, Cambodia, Cayman Islands, Chile, China, Colombia, Cook Islands, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Egypt, El Salvador, Ethiopia, Fiji Islands, France, French Guiana, French Polynesia, Guadeloupe, Guatemala, Honduras, India, Indonesia, Jamaica, Japan, Kenya, Malaysia, Martinique, Mauritius, Mayotte, Mexico, Mozambique, Myanmar (Burma), Nauru, Nepal, New Caledonia, Nicaragua, Pakistan, Panama, Paraguay, Peru, Philippines, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Samoa (USA), Saudi Arabia, Singapore, Solomon Islands, Sri Lanka, St. Martin, Sudan, Taiwan, Tanzania, Thailand, Tonga, Turks & Caicos Islands, Tuvalu, U.S. Virgin Islands, USA, Vanuatu, Venezuela, VietnamApr. '18 - Dengue Fever cases have been on the rise worldwide. According to WHO, incidence of dengue has increased 30 fold in the past 50 years. WHO estimates over 2.5 billion people are now at risk of dengue and there are about 50-100 million dengue infections worldwide every year. According to the CDC, dengue fever is the most common cause of fever in travelers who return from South Central Asia, Central America and the Caribbean. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.MEASLES WorldwideApr. '18 - Health officials in Italy, the Ukraine, New Zealand, Romania, Indonesia, England, Greece and the Democratic Republic of the Congo have reported an outbreak of measles. You can get measles primarily by breathing in airborne particles that contain the virus. Symptoms of measles are rash, high fever, cough, runny nose, and red, watery eyes. The best protection against measles is through vaccination. SOURCES: CDCLASSA FEVER in NigeriaApr. '17 - According to the CDC, the Nigerian and Benin health officials have reported 302 cases and 134 deaths form the virus. According to the International Society for Infectious Diseases, Lassa fever is known to be endemic in Guinea (Conakry), Liberia, Sierra Leone, and parts of Nigeria, but probably exists in other West African countries as well. 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.MUMPS in Australia, Canada, Scotland, United Kingdom, United States of AmericaApr. '18 - Mumps outbreaks have been reported in the following locations: USA, Australia (Western Australia), and UK: Scotland. 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. A mumps outbreak is currently ongoing in Canada. While the source of the outbreak is unknown, some previous outbreaks have been traced to international travelers. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.POLIO in Afghanistan, Cameroon, Democratic Republic of Congo, Guinea, Laos, Madagascar, Myanmar (Burma), Nigeria, Pakistan, Somalia, South Sudan, Syria, UkraineApr. '18 - CDC and WHO recommend that all international travelers be fully vaccinated against polio. Additionally, adults should receive a one-time booster dose of polio vaccine if traveling to a polio-affected country. The following countries have reported polio cases in recent years: Afghanistan and Pakistan. The following countries reported polio cases in the past year: Afghanistan, Cameroon, Guinea, Laos, Madagascar, Myanmar, Nigeria, Pakistan, Somalia, South Sudan and Ukraine. According to the CDC, as of May 5, 2014, anyone staying in any of the polio-affected countries for more than 4 weeks may be required to show proof of polio vaccination when departing the country; in these instances polio vaccine must be received between 4 weeks and 12 months prior to departure from the polio-affected country and should be documented in the yellow International Certificate of Vaccination in order to avoid delays in transit or forced vaccination in country. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.RABIES in Algeria, Bangladesh, China, Ghana, Haiti, India, Indonesia, Israel, the West Bank and Gaza, Malaysia, Nepal, Pakistan, Philippines, Tunisia, USA, VietnamApr. '18 - Although the CDC says that rabies is a preventable viral disease, there are more than 55,000 human deaths per year from rabies worldwide. Canine rabies is most prevalent in South East Asia and Africa, while bat rabies predominates in South America. 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. China averages more than 2,400 human deaths from rabies annually. According to China’s Ministry of Health, rabies is a huge problem in China and has the 2nd highest incidence rate in the world after India. Many human rabies deaths are attributed to the consumption of rabid dog meat in China. Roughly 36% of the world’s rabies deaths occur in India each year. India reports an estimated 25,000-30,000 human deaths from rabies annually. Rabies is a known issue in Indonesia, even in popular tourist destinations. Rabies is endemic in Nepal and Algeria. In Pakistan about 5,000 deaths are reported annually. This year human cases and/or deaths due to rabies have been reported from the following countries: Ghana, India, Indonesia, Israel (Northern Golan), Haiti, Nepal, Philippines, Tunisia, Vietnam, and USA. 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.TUBERCULOSIS in China, Estonia, India, Indonesia, Latvia, Lithuania, Myanmar (Burma), United KingdomApr. '18 - According to the European Centre for Disease Prevention and Control (ECDPC) and WHO, 1000 people throughout Europe develop tuberculosis every day and multidrug-resistant TB continues to increase in the region; health officials are concerned that multi-drug resistant TB continues to be most prevalent in the 3 Baltic countries - Estonia, Latvia, and Lithuania. About 25 percent of the world’s multidrug-resistant tuberculosis (MDR-TB) cases occur in China. According to the Chinese Center for Disease Control and Prevention, it is estimated that nearly 120,000 new cases occur on Mainland China every year. Ranking second after China, 20 percent of the world's multidrug-resistant tuberculosis (MDR-TB) cases occur in India. For the first time ever 2 cases of extensively drug-resisitant (XDR-TB) tuberculosis were detected in India's Pune district last year. Indonesia and Myanmar follow China and India with the next highest figures of MDR-TB cases annually. 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.TYPHOID FEVER in Australia, Brazil, Fiji Islands, France, Germany, Italy, Nepal, Pakistan, Zambia, ZimbabweApr. '18 - According to the CDC, typhoid affects 21.5 million people worldwide each year. Fiji has one of the highest rates for typhoid fever in the world. Since 2015, Fiji has reported more than 2 dozen cases in Bua (Northern Division). Pakistan currently experiences an average of 1000 cases per year. Typhoid fever is endemic in Nepal; cases usually peak in July and August, when the highest annual precipitation occurs. According to health officials, incidence of typhoid fever in Australian travelers returning home have increased in recent years and failure to get vaccinations prior to travel may be to blame. Additionally, an increasing number of Australian travelers are bringing typhoid home with them, prompting a reminder for people to get pre-travel vaccinations. In Zimbabwe outbreaks were reported in and around Harare last year; typhoid outbreaks also occurred in these areas in almost every year of the last decade. 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.JAPANESE ENCEPHALITIS in China, India, Malaysia, Nepal, Taiwan, VietnamApr. '18 - According to the CDC, Japanese Encephalitis (JE) is the leading cause of viral encephalitis in Asia with an estimated 67,900 cases reported annually. It is transmitted to humans by mosquitoes that become infected with JE virus; mosquitoes become infected by feeding on domestic pigs and wild birds infected with the JE virus. Mild JE infections can occur without apparent symptoms other than fever and/or headache. Severe cases are marked by a quick onset of headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions and spastic paralysis. Southeast Asia is endemic for Japanese Encephalitis virus. Malaysia and Taiwan reported several cases last year. The CDC estimates between 20 and 40 cases of JE are reported annually in Taiwan. Vietnam reported several hundred cases, including more than 30 fatalities, due to JE last year. China and Nepal also reported cases and/or deaths due to JE last year. Eastern China is endemic for JE. In India several cases have been reported this year in Gaya, including six deaths and more than 21 infections in children alone. According to health experts, cases of JE have increased about 5-fold in 5 years in India's northeast Assam state as a result of warming weather and changing rainfall. It's interesting to note, that in 2009 JE was recorded in only half of Assam's districts but is now seen in all of them. 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.AVIAN INFLUENZA (H7N9) in ChinaApr. '18 - According to the World Health Organization (WHO), several hundred cases of human infection with influenza A(H7N9) have been confirmed in China's mainland since March 2013, when the first human case was observed. Since then, cases have also been reported in Canada, Taiwan, and Malaysia where travelers had recently returned from China. Symptoms include fever, cough, and shortness of breath. So far human infection with avian influenza (H7N9) has resulted in severe respiratory illness and in some cases death. Sources Include: International Society for Infectious Diseases, Center for Disease Control, Pan American Health Organization and World Health Organization.PLAGUE in MadagascarApr. 2018- From Aug. 23 through Jan. 11, over 500 cases of plague have been reported in Madagascar. Nearly 11% of those infected have died. Bubonic plague occurs annually in Madagascar. But, this outbreak of plague pneumonia is occurring in geographically widespread areas, including in heavily populated cities. These include Antananarivo and Toamasina. New cases continue to be reported with over 300 cases of plague pneumonia and 135 of bubonic plague. Bubonic plague is spread through bites of infected fleas while plague pneumonia (or pneumonic plague) spread through inhaling contaminated droplets from untreated plague sources. Symptoms of both include headache, fever and chills. Bubonic plague is characterized by painful, swollen lymph nodes. Pneumonic causes pneumonia and potentially shock and respiratory failure. Both plague types can lead to death. In response to the outbreak, the local government is working to control fleas and is canceling mass gatherings. Be sure to use insect repellent and avoid contact with ill individuals, especially those with a cough or pneumonia. Soucre: CDCMIDDLE EAST RESPIRATORY SYNDROME (MERS) in Bahrain, Egypt, Iran, Iraq, Israel, the West Bank and Gaza, Jordan, Kuwait, Lebanon, Malaysia, Oman, Qatar, Saudi Arabia, Syria, Tunisia, Turkey, United Arab Emirates, YemenApr. '18 - Since June 2017, nearly 2,000 cases of MERS (Middle East Respiratory Syndrome) have been identified in multiple countries in the Arabian Peninsula, including in travelers to the region. This has lead to some small outbreaks outside the Arabian Peninsula. In about one-third of the cases, the patients have died. It is not clear how people contract MERS. However, evidence of transmission to humans from direct contact with camels has been steadily increasing. Most instances of person-to-person spread have occurred in healthcare workers and other close contacts (such as family members and caregivers) of people sick with MERS. CDC does not recommend that travelers change their plans because of MERS. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.ZIKA VIRUS in Anguilla, Antigua & Barbuda, Argentina, Aruba, Bahamas, Barbados, Belize, Bolivia, Bonaire, Brazil, British Virgin Islands, British West Indies, Cape Verde, Cayman Islands, Chile, Colombia, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, Fiji Islands, French Guiana, Grenada, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Indonesia, Jamaica, Marshall Islands, Martinique, Mexico, Montserrat, New Caledonia, Nicaragua, Palau, Panama, Papua New Guinea, Paraguay, Peru, Puerto Rico, Sabah, Saint Barthelemy, Saint Kitts and Nevis, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Samoa, Samoa (USA), Sao Tome & Principe, Singapore, Sint Maarten, St. Martin, Suriname, Tonga, Trinidad & Tobago, Turks & Caicos Islands, U.S. Virgin Islands, United States of America, USA, VenezuelaApr. '18 - Zika fever was originally detected in Africa, however an increasing number of cases have been detected in the Americas. Brazil, Colombia, and the Caribbean have been the hardest hit so far, but the disease is spreading rapidly. On Dec. 31 2015, Puerto Rico reported its first case of the disease in a resident who had not traveled outside of the island. Multiple cases have been detected in the United States in travelers from other regions. A few instances of local transmission are under investigation in Florida. Multiple cases of infant microcephaly have been reported in the U.S. Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to continue to change over time. Zika fever is a viral illness similar to dengue fever, yellow fever, and Japanese encephalitis. It is spread though mosquito bites and mosquitoes carrying the virus can bite during the day and at night. Symptoms of zika fever include high temperature, headache, red eyes, skin rash, muscle aches, and joint pains. Those traveling to the South or Central America or the Caribbean should take extra precautions in order to avoid the mosquito-borne disease including using mosquito repellents, mosquito netting and protective clothing. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.LISTERIOSIS in South AfricaApr. '18 - Public health officials in South Africa have reported an ongoing outbreak of listeriosis that began in early 2017. Most cases have been reported in Gauteng, Western Cape, and KwaZulu-Natal provinces. While the current condition of most people who have reported illness is unknown, over a third of those patients with known outcomes have died. The source of the outbreak is unknown. Listeriosis is a disease primarily affecting pregnant women, newborns, individuals over 65 and those with weakened immune systems. The disease is spread through contaminated foods like unpasteurized milk, ready-to-eat meats (like hotdogs or cold cuts) and raw or uncooked vegetables. Common symptoms include diarrhea, fever. If the infection spreads to the gut symptoms can worsen and lead to life-threatening infection in pregnant women. Source: CDC Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.