Health Alerts INFLUENZA WorldwideJuly '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 Argentina, Brazil, Peru, Suriname, UgandaJuly '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. The Brazilian Ministry of Health has reported an ongoing outbreak of yellow fever. The first cases were reported in the State of Minas Gerais in December 2016, but confirmed cases have since been reported in the neighboring states of Espirito Santo, São Paulo, and Rio de Janeiro (not Rio de Janeiro City). Cases have occurred mainly in rural areas, with most cases being reported from Minas Gerais state. Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization. MALARIA in South AfricaJuly '17 - Malaria is a potentially deadly mosquito-borne disease found in many countries throughout the the world. Two outbreaks are currently ongoing, one in South Africa and the other in Burundi: Cases of malaria have been reported in parts of three provinces in South Africa where transmission of the disease does not usually occur. As of March 12, 2017, 53 cases have been reported, most of them in the cities of Thabazimbi and Lephalale in Limpopo Province. Two of the cases were reported in Swartruggens, North West Province, and two more cases in the Doornpoort neighborhood north of Pretoria in Gauteng 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 Cote d'Ivoire, Cuba, Democratic Republic of Congo, Dominican Republic, Ghana, Haiti, India, Iraq, Kenya, Malawi, Mexico, Mozambique, Nigeria, Syria, Tanzania, Uganda, Zambia, ZimbabweJuly '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. 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. 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, ZimbabweJuly '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, VietnamJuly '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 WorldwideJuly '17 - Health officials in France 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: CDCHEPATITIS A in Belize, Canada, China, Hong Kong SAR, Mexico, Nepal, Russia, United KingdomJuly '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. The following countries have recently 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 hand washing 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, USAJuly '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. 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%. 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. In Brazil more than 10 indigenous children, of the Rio Breu area in Acre State, died from suspected pertussis between July 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.MENINGITIS in NigeriaJuly '17 - As of 19 March 2017 (epidemiological week 11), a total of 1407 suspected cases of meningitis and 211 deaths (case fatality rate: 15%) have been reported from 40 local government areas (LGAs) in five states of Nigeria since December 2016. Zamfara, Katsina and Sokoto account for 89% of these cases. Source: World Health OrganizationMUMPS in Australia, Canada, Scotland, United Kingdom, United States of AmericaJune '17 - 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.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, UgandaJuly '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, 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 recent years. 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. 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, UkraineJuly '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 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, Nepal, Pakistan, Philippines, Tunisia, USA, VietnamJuly '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 KingdomJuly '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, ZimbabweJuly '17 - 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, VietnamJuly '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 (H7N9) in ChinaJuly '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 Bahrain, Egypt, Iran, Iraq, Israel, the West Bank and Gaza, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, Tunisia, Turkey, United Arab Emirates, YemenJuly '17 - As of 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, Cook Islands, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, Fiji Islands, French Guiana, 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, VenezuelaJuly '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.ROSS RIVER DISEASE in AustraliaJuly '17 - The Australian Ministry of Health has reported 3,086 cases of mosquito-borne Ross River virus infection in 2017, most of them occurring in southern states near large population centers. This includes 1,528 cases in the state of Victoria, including the city of Melbourne. CDC recommends that travelers to Australia protect themselves from Ross River virus by preventing mosquito bites. SOURCE: Centers for Disease Control and PreventionHAJJ AND UMRAH IN SAUDI ARABIA in Saudi ArabiaJuly '17 - The annual Hajj, or pilgrimage to Mecca, Saudi Arabia, is among the largest mass gatherings in the world. In 2017, Hajj will take place from approximately August 30 to September 4. Umrah is a similar pilgrimage that can be undertaken at any time of the year but is likely to be more crowded during the month of Ramadan (approximately May 27 to July 24). Saudi Arabia requires meningitis (meningococcal disease) vaccine if you are traveling to take part in a pilgrimage. Saudi Arabia may require or recommend additional vaccinations, including yellow fever or polio vaccine. Please consult the Saudi Arabia Ministry of Health’s Hajj regulations, the Embassy of Saudi Arabia in the United States, or your travel provider for more information. SOURCE: Centers for Disease Control and Prevention Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.