Health Alerts INFLUENZA WorldwideJan. '17 – 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 Angola, Argentina, Brazil, Chad, China, Democratic Republic of Congo, Peru, Rwanda, UgandaJan. '17 - 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. A recent outbreak in Angola has claimed nearly 200 lives. Travelers to the country have been affected as well including Chinese and regional travelers. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization. MALARIA in Brazil, Cambodia, Democratic Republic of Congo, Dominican Republic, India, Laos, Malaysia, Myanmar (Burma), Nigeria, Thailand, Venezuela, VietnamJan. '17 - According to WHO, about 200 million cases of malaria are reported worldwide, killing between 600,000 and 800,000 people. About 90% of malaria-related deaths take place in Sub-Saharan Africa. Increased prevention and control measures have led to a reduction in malaria mortality rates by 47% globally since 2000 and by 54% in the WHO African Region. According to the WHO, malaria still killed more than 580,000 people in 2013, most of them in sub-Saharan Africa, despite the drop in death rates recorded. According to some reports, in July multiple cases of of imported malaria were diagnosed in travelers having gone to the Punta Cana and Puerto Plata regions in the Dominican Republic. Reuters has reported, drug-resistant malaria fever spread in Myanmar and other countries in the Mekong River basin, including Cambodia, Laos, Thailand, and Vietnam. Additionally, other countries that have reported malaria outbreaks during 2015 include (note that malaria cases are often underreported): India, Malaysia Democratic Republic of Congo, Venezuela, and Brazil. In March Brazil reported locally transmitted malaria in the states of Goias and Rio de Janeiro. Since then, there have been no other reports of local transmission of malaria in these two states. According to the CDC, the central mountainous forested areas of Rio de Janeiro state have reported an average of 6 cases of locally-transmitted malaria annually therefore CDC recommends that travelers to the central, mountainous forested areas of Rio de Janeiro state use mosquito avoidance measures. Malaria is also a major public health concern in Nigeria where it accounts for over 60% outpatient visits and 30% of hospital admissions across the country. A malaria epidemic has been claiming lives in the South Kivu province of the Democratic Republic of Congo. A significant increase in malaria cases in Venezuela has recently been reported, corresponding to an accumulated case toll of more than 30,000 affected people across the country; the majority of recent cases have been from Bolivar and Amazonas States, and some are thought to have been imported cases from Colombia, Brazil, and Guyana. 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.EBOLA in Guinea, Liberia, Nigeria, Senegal, Sierra LeoneJan. '17 - The 2014-2015 Ebola outbreak is the largest in history. On August 8th (2014), the World Health Organization (WHO) declared that the current Ebola outbreak is a Public Health Emergency of International Concern (PHEIC). The CDC is now screening at five U.S. airports that receive over 94% of travelers from Guinea, Liberia, and Sierra Leone. New cases continue to be reported from Guinea and Sierra Leone. According to WHO, the Ebola virus outbreak in Liberia was declared over after 42 days had elapsed since the burial of the last confirmed case in the country but are still in a period of heightened vigilance. Senegal, Sierra Leone Nigeria have been declared Ebola free by WHO. Guinea is the only country with active Ebola cases per the CDC. According to the CDC, travelers headed to an area affected by Ebola should do the following for prevention: practice careful hygiene do not handle items that could have come into contact with an infected person's blood or body fluids avoid burial rituals that require handling the body of someone who has died from Ebola avoid contact with bats and non-human primates, including blood, fluids, and raw meat prepared from these animals avoid hospitals in West Africa where Ebola patients are being treated after returning, monitor health for 21 days and seek medical care promptly if you experience Ebola symptoms: fever headache muscle pain weakness diarrhea vomiting abdominal pain unexplained bleeding or bruising Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.CHOLERA in Cote d'Ivoire, Cuba, Democratic Republic of Congo, Dominican Republic, Ghana, Haiti, India, Iraq, Kenya, Malawi, Mexico, Mozambique, Nigeria, Syria, Tanzania, Uganda, Zambia, ZimbabweJan. '17 – 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. During 2015, 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. In 2014, Mexico reported 14 cases from two states (Hidalgo and Querétaro). Since the beginning of 2015, there have been no new cholera cases registered. Sources Include: International Society for Infectious Diseases, Center for Disease Control, Pan American Health Organization and World Health Organization.CHIKUNGUNYA in Anguilla, Antigua & Barbuda, Argentina, Aruba, Bahamas, Bangladesh, Barbados, Belize, Benin, Bhutan, Bolivia, Bonaire, Brazil, British Virgin Islands, British West Indies, Burundi, Cambodia, Cameroon, Cayman Islands, Central African Republic, China, Colombia, Comoros, Congo, Republic of the, Cook Islands, Costa Rica, Curacao, Democratic Republic of Congo, Dominica, Dominican Republic, Ecuador, El Salvador, Equatorial Guinea, Fiji Islands, France, French Guiana, French Polynesia, Gabon, Grenada, Guadeloupe, Guatemala, Guinea, Guyana, Haiti, Honduras, India, Indonesia, Jamaica, Kenya, Kiribati, Laos, Leeward Islands, Madagascar, Malawi, Malaysia, Maldives, Marshall Islands, Martinique, Mauritius, Mayotte, Mexico, Micronesia, Montserrat, Myanmar (Burma), New Caledonia, Nicaragua, Nigeria, Pakistan, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Puerto Rico, Reunion, Saint Barthelemy, Saint Kitts and Nevis, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Samoa, Samoa (USA), Saudi Arabia, Senegal, Seychelles, Sierra Leone, Singapore, Sint Maarten, South Africa, Sri Lanka, St. Martin, Sudan, Suriname, Tahiti, Taiwan, Tanzania, Thailand, Tokelau-Islands, Tonga, Trinidad & Tobago, Turks & Caicos Islands, U.S. Virgin Islands, Uganda, USA, Venezuela, Vietnam, Yemen, ZimbabweJan. '17 - Chikungunya is known to occur during the rainy season in parts of Africa, Southeast Asia, southern India, and Pakistan. More recently the disease has also been reported in the Americas and South Pacific for the first time. According to the CDC, most people in the Americas are not immune to chikungunya so further spread is likely. Once infected people can infect and spread the virus to other mosquitoes. Chikungunya is often confused with Dengue fever, as the symptoms are similar, although chikungunya symptoms are less severe compared to dengue. Local transmission of chikungunya has been reported in the following countries: AFRICA: Benin, Burundi, Cameroon, Central African Republic, Comoros, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Guinea, Kenya, Madagascar, Malawi, Mauritius, Mayotte, Nigeria, Republic of Congo, Reunion, Senegal, Seychelles, Sierra Leone, South Africa, Sudan, Tanzania, Uganda, and Zimbabwe. AMERICAS: Anguilla, Antigua, Argentina, Aruba, Bahamas, Barbados, Belize, Bolivia, Bonaire, Brazil, British Virgin Islands, Cayman Islands, Colombia, Costa Rica, Curaçao, Dominica, Dominican Republic, Ecuador, El Salvador, French Guiana, Grenada, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Montserrat, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Saint Barthelemy, St. Kitts & Nevis, St. Lucia, Sint Maarten (Dutch), Saint Martin (French), Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, Turks and Caicos Islands, U.S. Virgin Islands, U.S.A (several states - travel related), and Venezuela. ASIA: Bangladesh, Bhutan, Cambodia, China, India, Indonesia, Laos, Malaysia, Maldives, Myanmar (Burma), Pakistan, Philippines, Saudi Arabia, Singapore, Sri Lanka, Taiwan, Thailand, Timor, Vietnam, Yemen. EUROPE: France. OCEANIA/PACIFIC ISLANDS: American Samoa, Cook Islands, Fiji, Kiribati, Samoa, Marshall Islands, Federal States of Micronesia, French Polynesia, New Caledonia, Papua New Guinea, Tokelau Islands, and Tonga. 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.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, VietnamJan. '17 - 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 WorldwideJan. '17 - According to the CDC, measles kills more than 100,000 children each year worldwide and is common in parts of Europe, Asia, the Pacific, and Africa. Domestic travelers are just as likely, as international travelers, to be exposed on airplanes or in airports. Measles is one of the most contagious diseases and the CDC advises that all travelers be up to date on their vaccinations. Significant outbreaks have been reported in the following countries so far this year (2015): Angola, Australia, Bermuda, Bosnia and Herzegovina, Canada (Manitoba, Ontario, Quebec), China, Croatia, Congo DR, Egypt, Ethiopia, France (Alsace region), Georgia, Germany, Guinea, Guinea-Bissau, Hong Kong SAR, Italy, Kazakhstan, Kyrgyzstan, Liberia, Mexico, New Zealand, Nigeria, North Korea, Papua New Guinea, Philippines, Russia, Serbia, Sierra Leone, Slovenia, South Africa, South Sudan, Sudan, Sweden, United Kingdom, USA (several states), and Vanuatu. The U.S. Centers for Disease Control and Prevention urges 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.HEPATITIS A in Australia, Belize, Canada, China, Hong Kong SAR, Mexico, Nepal, Russia, United KingdomJan. '17 – According to the WHO, 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. Travelers should vaccinate prior to travel. During 2015, so far, the following countries have reported outbreaks of Hepatitis A: Australia, Belize, Canada, China (Hong Kong SAR), Mexico, Nepal (earthquake related), Russia, and the United Kingdom. It's interesting to note, that among the outbreaks that have occurred in Mexico, the CDC reports more than 25 hepatitis A cases in US travelers, who traveled to Tulum, Mexico. Hepatitis A can be spread through contaminated food or water. Travelers can protect themselves by receiving the vaccine and by practicing frequent handwashing with soap and water. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.PERTUSSIS in Australia, Brazil, Canada, Guam, Liberia, New Zealand, Pakistan, USAJan. '17 - According to the WHO, about 50 million pertussis cases, including 350,000 deaths, occur 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. According to International Society for Infectious Diseases, 1 to 3 deaths from pertussis occur each year in Canada, usually in infants too young to have begun their immunization and in partially immunized infants. An outbreak of whooping cough is ongoing in central Alberta, Canada; the outbreak began in early December 2014 and has resulted in more than 120 confirmed cases by the end of 2014 and 1 case so far in 2015. Over the past couple decades there has been a dramatic increase in pertussis cases in Australia and New Zealand. In Australia whooping cough cases have increased by more than 50% in the past year; more than 4600 cases were reported throughout 2014. Pertussis cases in Australian Capital Territory (ACT) have more than doubled during the last year; so far this year, more than 110 cases have been reported in ACT. Additionally, pertussis cases in Ballarat (located in Victoria) have skyrocketed in recent years, having recorded more than 200 cases during 2014, compared to 27 cases in 2013; 9 whooping cough cases have already been reported so far in 2015. In Brazil more than 10 indigenous children, of the Rio Breu area in Acre State, died from suspected pertussis between June and September last year. Guam has reported 2 cases so far this year. In Balochistan, Pakistan a pertussis outbreak has resulted in more than 10 deaths during January this year. In southern Liberia (Maryland County) more than 500 children have been infected with pertussis; health officials are calling this an alarming outbreak of cases. In the USA there has been an increase in pertussis cases and deaths; states that have reported outbreaks so far this year include: AK, CA, KS, MI, NE, and WA. 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.LASSA FEVER in Benin, Liberia, Nigeria, TogoJan. '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, Scotland, United Kingdom, United States of AmericaJan. '17 - Since the beginning of 2015, mumps outbreaks have been reported in the 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. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.HEPATITIS B in Australia, Bangladesh, Bhutan, Bulgaria, China, East Timor, India, Indonesia, Korea (North), Kuwait, Maldives, Myanmar (Burma), Nepal, Pakistan, Romania, Sri Lanka, Thailand, Tibet, UgandaJan. '17 - According to the WHO, two billion people worldwide have been infected with Hepatitis B and about 600,000 people die each year because of it. 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. According to health officials in Tibet, 61% of Tibetans living in Nepal are infected with Hepatitis B. According to a Chairperson of the National Association for Hepatitis Prevention (Hepasist), Bulgaria and Romania produce about 60% of hepatitis cases in Europe. According to to the National Health and Family Planning Commission nearly 1/3rd of the world's 350 million hepatitis B carriers are Chinese. According to the Chinese Center for Disease Control and Prevention, about 100,000 people in China are infected every year and vaccination has proven to be the most effective way to prevent hepatitis B virus infection. In India at least 1 in every 25 people living in North Chennai, in Tamil Nadu, have tested positive for hepatitis. According to the head of the Indonesia Liver Research Association (PPHI) only about 10 -20% of all hepatitis cases are detected. According to a Health Ministry study (in 2007), 9.4% of Indonesians (about 30 million people) were found to be positive for hepatitis B or C. According to the Victorian Infectious Diseases Service, Hepatitis B affects about 200,000 Australians. According to the Ministry of Health, more than 700 cases of hepatitis B and at least 1000 cases of hepatitis C were detected among Kuwait’s citizens and residents in 2012. The prevalence of Hepatitis B virus infection in Pakistan is one of the highest rates in the world. According to health officials there has been a recent rise in Hepatitis B infections in Uganda's northern Nwoya district (as of April 2015). 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. Hepatitis B is spread by contact with blood and other body fluids of an infected person. According to WHO, common methods of Hepatitis B virus transmission include, from mother to baby at birth, early childhood infections through close interpersonal contact with infected household contacts, unsafe injection practices, blood transfusions and unprotected sexual contact. Vaccination is recommended. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.POLIO in Afghanistan, Cameroon, Guinea, Laos, Madagascar, Myanmar (Burma), Nigeria, Pakistan, Somalia, South Sudan, UkraineJan. '17 - 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 the last year (2015): 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, Nepal, Pakistan, Philippines, Tunisia, USA, VietnamJan. '17 - 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 KingdomJan. '17 - 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, Nepal, Pakistan, Zambia, ZimbabweDec. '16 - 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 the beginning of 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 again last year; typhoid outbreaks also occurred in these areas in 2011, 2012 and 2013. 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, VietnamJan. '17 - 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 (H5) in Cambodia, China, Egypt, Indonesia, VietnamJan. '17 - Influenza A(H5) viruses of various subtypes, such as influenza A(H5N1), A(H5N2), A(H5N6), A(H5N8) and A(H5N9) have been detected in birds in Africa, Asia, and Europe according to reports. Although influenza A(H5) viruses have the potential to cause disease in humans, so far no human cases of infection with these viruses have been reported, with exception of the human infections with influenza A(H5N1) viruses and the four human infections with influenza A(H5N6) virus detected in China since 2014. In most cases, the people infected had been in close contact with infected poultry or with objects contaminated by their feces. WHO reports that globally since 2003, there have been more than 800 confirmed cases, including more than 450 fatalities overall. Since the beginning of 2015, confirmed cases and/or fatalities have been reported from China, Egypt, Indonesia, and Vietnam. Countries that confirmed cases and/or fatalities during 2014 include: Cambodia, China, Egypt, Indonesia and Vietnam. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.AVIAN INFLUENZA (H7N9) in ChinaJan. '17 - 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.MIDDLE EAST RESPIRATORY SYNDROME (MERS) in Algeria, Austria, Bahrain, Egypt, Iran, Iraq, Israel, the West Bank and Gaza, Italy, Jordan, Kuwait, Lebanon, Malaysia, Oman, Qatar, Saudi Arabia, Syria, Thailand, Tunisia, Turkey, United Arab Emirates, YemenJan. '17 - According to the CDC, countries located in or near the Arabian Peninsula that have reported lab-confirmed cases include Saudi Arabia, the United Arab Emirates, Qatar, Oman, Jordan, Kuwait, Yemen, Lebanon, and Iran. Countries that have confirmed travel-associated cases include the United Kingdom, France, Tunisia, Italy, Malaysia, Philippines, Greece, Germany, Eqypt, Netherlands, Turkey, Algeria, Austria, Thailand and USA to date. documented multiple confirmed cases in 2015 that were traced back to a traveler to the Middle East, however, the majority of these cases involved healthcare workers or those in very close contact with the initial victims. Coronaviruses are a cause of the common cold and can cause severe respiratory illnesses. According to the CDC, risk of the new coronavirus is thought to be low for travelers. Symptoms include coughing, breathing difficulties, and fever. The CDC recommends that travelers to countries on the Arabian Peninsula or neighboring countries (Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates, and Yemen) monitor their health and see a doctor right away if the above symptoms develop. Travelers to the Middle East for Hajj or other such public events may be at additional risk. 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, Cook Islands, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, Fiji Islands, French Guiana, French Polynesia, Grenada, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Indonesia, Jamaica, Kosrae, Marianas, Marshall Islands, Martinique, Mexico, Micronesia, 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, Tahiti, Tonga, Trinidad & Tobago, Turks & Caicos Islands, U.S. Virgin Islands, United States of America, USA, Vanuatu, VenezuelaJan. '17 - 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.VARICELLA (CHICKENPOX) in France, India, Nepal, Thailand, VietnamJan. '17 - According to health officials in France, varicella (chickenpox) is usually prominent annually in the winter and spring; during April this year there were signs of high varicella activity. In Nepal, after the earthquake earlier this year, at least 3 cases have been confirmed in Kathmandu shelters and hospitals. Additionally, beginning in November 2014, a chickenpox outbreak affected at least 10 children in Odisha state, India. Early last year, chickenpox outbreaks were reported in Vietnam, Thailand, and India. Chickenpox is a highly contagious disease caused by the varicella-zoster virus. It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. The chickenpox vaccine is the best protection against chickenpox. 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.