Travel Health Service Year 2009

Travel Health News Digest (16 November 2009)

Advice for Travellers Planning to Visit Human Swine Influenza Affected Areas

Human Swine Influenza (Influenza A / H1N1)

The World Health Organization has declared the human swine influenza (swine flu) outbreak a global pandemic. Confirmed cases of swine flu have been reported in many parts of the world, including Hong Kong.

Human-to-human transmission has occurred in the present swine flu outbreak. The symptoms of swine flu include fever, cough, sore throat, runny nose, muscle pain and headache. Some people infected with swine flu may also have vomiting and diarrhoea.

Advice

Strict adherence to personal and environmental hygiene is essential for prevention of swine flu. Department of Health reminds travellers to watch out for the latest developments in the swine flu outbreak when planning travel. Travellers should prepare adequate face masks and alcohol-based handrub and take the following precautionary measures:

During the trip: maintain good personal hygiene, wash hands or use handrub frequently and avoid contact with sick people.
Before returning: do not get on board an airplane when influenza-like symptoms develop. Put on a mask and seek medical attention where you are.
After returning: avoid going to crowded places and pay close attention to your health. Seek medical consultation from public clinics or hospitals right away if influenza-like symptoms appear.

The Government of the HKSAR requires each arriving passenger to complete a Health Declaration Form and return it to designated collection points.

Use of Anti-viral Drugs

According to interim testing result performed by Centers for Disease Control and Prevention, USA, human swine influenza virus is sensitive to two antiviral drugs, namely Oseltamivir (Tamiflu) and Zanamivir (Relenza). You should consult your doctor before taking these anti-viral drugs.

(Source: Department of Health, HKSAR, 22 June 2009)

Advice for Inbound Travellers/Returnees to Hong Kong on Prevention of Human Swine Influenza (Influenza A/H1N1)

Advice

The Hong Kong Special Administrative Region Government appeals to all inbound travellers/returnees to Hong Kong to observe the following:

While overseas, exercise good personal hygiene, e.g. observe hand hygiene and cough manners, and -
- pay attention to announcements from the local government
- follow local public health guidelines, including any movement restrictions and preventive recommendations
- avoid contact with sick people
Before returning, do not get on board an airplane when influenza-like symptoms develop. Put on a mask and seek medical attention where you are.
If you develop symptoms while on board, put on a mask and notify the crew right away. The crew will in turn follow established procedures and alert ground control. Port health team will board the airplane to assess and follow up on landing.
Upon landing, accurately and honestly complete the health declaration form; or present yourself to the port health post stationed at all border crossings if you have a health concern.
After returning, avoid going to crowded places and pay close attention to your health. Seek medical consultation from public clinics or hospitals right away if influenza-like symptoms appear.

(Source: Department of Health, HKSAR, 25 June 2009)

Worldwide: Pandemic Influenza (H1N1) 2009

As of 8 November 2009, worldwide more than 206 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6250 deaths.

The winter influenza season, which began unusually early across much of the Northern Hemisphere, shows early signs of peaking in parts of North America but is intensifying across much of Europe and Central and Eastern Asia.

In North America, Canada reported sharp increases in rates of influenza-like-illness (ILI), detections of pandemic H1N1 virus, and school outbreaks over the past three weeks as pandemic activity continues to spread west to east. In the United States, influenza transmission remains geographically widespread and intense but largely unchanged since the previous reporting week. In Mexico, influenza activity remains geographically widespread with a significant wave of cases reported since early September, most notably from central and southern Mexico.

In Europe and Central Asia, overall influenza transmission continues to intensify throughout the continent as pandemic activity spreads eastward. At least 10 countries of Western Europe (Iceland, Poland, Romania, Belgium, Germany, the Netherlands, Norway, Spain, Sweden and the United Kingdom) now report that the proportion of sentinel samples testing positive for influenza exceeded 20% consistent with active circulation of pandemic influenza viruses. High to very high intensity of respiratory diseases with concurrent circulation of pandemic H1N1 2009 was also reported in the Netherlands, Italy, much of Northern Europe, Belarus, Bulgaria, and in the Russian Federation (particularly in the Urals). Disease activity may be peaking in a few countries, notably Iceland, Ireland, and parts of the UK (Northern Ireland) that experienced intense transmission during early autumn.

Over 99% of subtyped influenza A viruses in the Europe were pandemic H1N1 2009 with the exception of the Russian Federation where <10% of viruses subtyped were seasonal influenza subtypes, H3N2 and seasonal H1N1.

In Western Asia, increasing activity has been observed in several countries. In Israel, sharp increases in rates of ILI and pandemic virus detections have been observed over the past 3 weeks. In Afghanistan, the proportion of sentinel visits for acute respiratory infections (ARI) has increased over the past 3-4 weeks, but more dramatically in the last 1-2 weeks.

In East Asia, very intense and increasing influenza activity continues to be reported in Mongolia with a severe impact on the healthcare system. In China, the proportion of sentinel hospital visits for ILI and the proportions of respiratory samples testing positive for influenza, continued to increase over the past 3-4 weeks. More than 80% of influenza viruses isolated in China were pandemic H1N1 2009. In Hong Kong SAR, rates of ILI have returned baseline after a recent wave of predominantly pandemic H1N1 influenza in September and October. In Japan, sharp increases in influenza activity continue to be reported nationally. On northern island of Hokkaido, which to date has been the most heavily affected, disease activity may have recently peaked.

Although active, predominantly pandemic influenza transmission persists in the Caribbean region, disease activity may have recently peaked in some places as evidenced by recently declining rates of ARI and severe acute respiratory infections (SARI) in the Caribbean Epidemiology Centre (CAREC) countries. Most other countries in the tropical region of Central and South America continue to report declining influenza activity.

With the exception of Nepal and Sri Lanka, overall transmission continues to decline in most parts of South and Southeast Asia.

In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported in recent weeks. Of note, a cluster of pandemic influenza cases been reported in Argentina in the capital area.

(Source: World Health Organization 13 November 2009)

Ukraine: Pandemic Influenza (H1N1) 2009 [update 1]

Because of a sharp rise in pandemic influenza cases one week ago in Ukraine, the Ministry of Health requested assistance from WHO European Regional Office to evaluate and respond. The initial analysis of information indicates that the numbers of severe cases do not appear to be excessive when compared to the experience of other countries and do not represent any change in the transmission or virulence of the virus. Preliminary tests reveal no significant changes in the pandemic (H1N1) 2009 virus based on investigations of samples taken from patients in Ukraine.

(Source: World Health Organization 13 and 17 November 2009)

Cape Verde Islands: Dengue fever [update 1]

In Cape Verde Islands, the outbreak of Dengue Fever continued to affect the country with 13 187 suspected cases and 6 deaths reported since the outbreak began in September this year.

(Source: ProMED-mail 15 November 2009)

Democratic Republic of the Congo: Ebola Hemorrhagic Fever

In Democratic Republic of the Congo, 13 cases of Ebola Haemorrhagic Fever with 9 deaths have been reported in Kasai Occidental province since December last year.

(Source: ProMED-mail 13 November 2009)

Indonesia: Dengue Fever

As of October this year, more than 26 500 suspected cases of Dengue Fever with 33 deaths were reported in Jakarta, Indonesia.

(Source: ProMED-mail 11 November 2009)

Mexico: Dengue Fever

In Mexico, more than 35 000 cases of Dengue Fever were reported in the country so far this year. This figure represented a 40 percent increase as compared with the same period last year.

(Source: ProMED-mail 11 November 2009)

Senegal: Dengue Fever

In Senegal, 19 suspected cases of Dengue Fever have been reported since October this year. This is the first Dengue Fever outbreak in Senegal.

(Source: ProMED-mail 15 November 2009)

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