Travel Health Service Year 2013

Travel Health News Digest (15 October 2013 - 21 October 2013)

Advice for pilgrims visiting Mecca, Saudi Arabia (Hajj)

Pilgrims are advised to note the followings:

Vaccination against meningitis

The Saudi Arabia government requires all pilgrims on entry to produce a certificate of vaccination against the meningococcal disease using the quadrivalent vaccine (serogroups A, C, W135 and Y). The certificate should be not more than 3 years and not less than 10 days before arrival.

Vaccination against seasonal influenza

The Saudi Ministry of Health recommends that international pilgrims be vaccinated against seasonal influenza before arrival into the Kingdom of Saudi Arabia, particularly those at increased risk of severe influenza diseases, including pregnant women, children under 5 years, the elderly, and individuals with underlying health conditions such as HIV/AIDS, asthma, and chronic heart or lung diseases.

Be Vigilant against Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Travellers should take note of MERS-CoV (formerly known as novel coronavirus). Most of the cases reported to date originated or returned from the Middle East and subsequently became ill. The most common symptoms observed include fever, cough, and breathing difficulties. Approximately half of the patients have died.

In view of the severity and possibility of spread of the illness among human through close contact, if you are travelling to the Middle East for vacation or pilgrimage, please observe personal and environmental hygiene strictly at all times such as avoiding undercooked meats, raw fruits and vegetables, unless they have been peeled, or unsafe water. Travellers should also avoid direct contact with animals, birds, poultry or sick people during the journey and should wear face masks in crowded places.

Pilgrims should be reminded that pre-existing major medical conditions can increase the likelihood of medical problems, including MERS-CoV infection, during travel; thus, pilgrims should consult a health care provider before travelling to review the risk and assess whether making the pilgrimage is medically advisable. For further advice from the Saudi Ministry of Health, please see ( http://www.moh.gov.sa/en/Hajj/Pages/HealthRegulations.aspx )

Travellers who develop symptoms during travel or up to 14 days after their return from affected areas should put on face masks, seek medical attention and inform doctor of their travel history. Before departure, if you feel unwell, such as having fever, sore throat, muscle pain or cough, you are advised to seek medical attention and delay the trip until recovery. For further information on MERS, please visit Centre for Health Protection (CHP) website （http://www.chp.gov.hk）。

Other infectious diseases

Updating immunization against vaccine-preventable diseases in all travellers is strongly recommended. With the recent resurgence of measles and rubella cases, special attention is needed for both of these vaccines to avoid widespread outbreaks with this virus during Hajj and Umra this year.

Men are required to shave their heads after Hajj, and unclean blades can transmit disease. Male pilgrims should go to officially designated centers to be shaved, where barbers are licensed and use disposable, single-use blades.

Food hygiene

Fresh food carried by visitors and pilgrims are banned and not allowed into the country. Only properly canned food in very small amount which is enough for one person to the end of his or her trip is allowed. In addition, diarrhea is common during Hajj, so eat only food that is cooked and served hot and drink only beverages from sealed containers.

Injury

Try to avoid the most densely congested areas and always be aware of the location of emergency exits. Pilgrims can perform rituals during non-peak hours to avoid crowds.

Heat stroke

Temperatures in Mecca can exceed 37.8 ºC (100°F) in October. Heat exhaustion and heatstroke are leading causes of illness during Hajj. Pilgrims should drink plenty of water (bottled), wear sunscreen, rest, and seek shade as much as possible. Symptoms of heat-related illness can include profuse sweating, chills, headache, dizziness or confusion, and nausea. Travelers who develop these symptoms should move to a cool area and seek medical attention.

Observe personal and environmental hygiene strictly at all times. For more information, please read the section on Travel Health Advice.

(Source: World Health Organization, Centers for Disease Control and Prevention & Ministry of Hajj, Kingdom of Saudi Arabia)

Take precautions against dengue fever when travelling abroad

Dengue fever is an endemic disease in most Southeast Asian countries including Singapore, Malaysia, Indonesia, Laos, Thailand, Cambodia, Vietnam and the Philippines. Travellers visiting these places are advised to protect themselves against mosquitoes all year round.

The recent dengue fever activity in Asia has been more severe than that of last year. Various popular tourist attractions among Hong Kong people including Thailand, Singapore, Taiwan and Indonesia, observed recent persistent increase in the number of dengue fever cases. Other neighbouring Asian countries such as Laos, Cambodia, Vietnam, Malaysia, the Philippines, Pakistan and India, also recorded rising dengue fever activities.

Outbreaks of dengue fever were observed in Guangdong province in China, Brazil, Costa Rica, Columbia, Paraguay and the Dominican Republic this year. It was expected that dengue fever activities will continue to rise in coming months in Central America, Mexico and the Caribbean.

Travellers planning to travel in these areas should take precautions against the disease.

Cumulative reported number of dengue cases in 2013 *

	Cumulative reported no. of cases in 2013	Source of information and date of report
America North, Central & South	2,024,034	World Health Organization, 2 October 2013
Australia	1,434	World Health Organization, 16 October 2013
Cambodia	15,193	World Health Organization, 16 October 2013
China Guangdong province	753	Department of Health of Guangdong Province, 15 October 2013
India	38,179	Ministry of Health & Family Welfare, India, 30 September 2013
Lao PDR	42,779	World Health Organization, 16 October 2013
Malaysia	23,829	World Health Organization, 16 October 2013
New Caledonia	10,536	World Health Organization, 16 October 2013
Philippines	138,055	World Health Organization, 16 October 2013
Singapore	18,065	Singapore National Environment Agency, 18 October 2013
Sri Lanka	25,230	Ministry of Health, Sri Lanka, 15 October 2013
Taiwan	409	CDC, ROC (Taiwan), 19 October 2013
Thailand	135,344	Ministry of Public Health, Thailand, 16 October 2013
Vietnam	44,085	World Health Organization, 16 October 2013

Remark:
* Dengue reporting systems vary by country.

Travellers should stay vigilant against dengue fever and adopt the following personal preventive measures against mosquito bite:

*	Always wear long-sleeved clothing and trousers;
*	Stay in air-conditioned residence or places with mosquito screens;
*	If mosquito screen or air-conditioning is absent, aerosol insecticide and bed nets are advised;
*	Use insect repellents containing DEET on exposed skin and clothing;
*	Use insect repellents containing DEET apart from applying sunscreen while staying in beaches;
*	Carry a portable bed nets and apply permethrin on it as well as to clothes if travelling to rural areas where dengue fever is prevalent.

Travellers returning from areas where dengue fever is prevalent should seek medical advice as soon as possible if they feel unwell and provide travel details to their doctors.

Qatar: Middle East Respiratory Syndrome [Update]

The Department of Health is monitoring an additional Middle East Respiratory Syndrome case in Qatar reported to the World Health Organization. The case involves a 61-year-old man with underlying medical conditions who was admitted to a hospital on October 11. He is currently hospitalised and is in stable condition.

This brings the latest global number of confirmed cases of Middle East Respiratory Syndrome to 139, including 60 deaths.

(Source: The Centre for Health Protection of the Department of Health 18 October 2013)

Mexico: Cholera [Update]

Health authorities in Mexico reported a total of 171 cases of cholera. Of the 171 confirmed cases, two are from the Federal District, 157 cases from the state of Hidalgo, nine from the state of Mexico, one from the state of San Luis Potosi and two from the state of Veracruz.

(Source: World Health Organization 19 October 2013)

Syria: Poliomyelitis

The World Health Organization received reports of a cluster of acute flaccid paralysis cases in Deir Al Zour province in the Syrian Arab Republic. Initial results from the national polio laboratory in Damascus indicate that two of the cases could be positive for polio. Syria is considered at high-risk for polio.

(Source: World Health Organization 19 October 2013)

Australia: Avian Influenza, poultry

An outbreak of highly pathogenic H7N2 Avian Influenza was reported in Australia. Of 435 000 susceptible birds, 18 000 were found dead and the remaining birds were destroyed.

(Source: World Organisation for Animal Health 16 October 2013)

Vietnam: Avian Influenza, poultry

An outbreak of highly pathogenic H5N1 Avian Influenza was reported in Vietnam. Of 1 175 susceptible birds, 370 were found dead and the remaining birds were destroyed.

(Source: World Organisation for Animal Health 14 October 2013)

Mainland: Avian Influenza, human

The Centre for Health Protection (CHP) of the Department of Health (DH) was notified on 15 October by the National Health and Family Planning Commission (NHFPC) of a human case of avian influenza A(H7N9) in Zhejiang. The case involves a 35-year-old man who is receiving treatment in hospital. His current condition is serious.The sample from the patient tested positive for the avian influenza A(H7N9) virus in testing by the Centre for Disease Control and Prevention of Zhejiang Province and the case was subsequently confirmed by the Health Bureau of Zhejiang Province.

To date, a total of 135 human cases of avian influenza A(H7N9) have been laboratory confirmed in the Mainland, including Zhejiang (47 cases), Shanghai (33 cases), Jiangsu (28 cases), Jiangxi (six cases), Fujian (five cases), Anhui (four cases), Henan (four cases), Shandong (two cases), Hunan (two cases), Beijing (two cases), Hebei (one case) and Guangdong (one case).

(Source: The Centre for Health Protection of the Department of Health 15 October 2013)

Kingdom of Saudi Arabia: Middle East Respiratory Syndrome [Update]

World Health Organization has been informed of an additional two laboratory-confirmed cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection in the Kingdom of Saudi Arabia.

The patients, both men, aged 55 and 78, were from Riyadh region. They became ill at the end of September 2013 and died in the beginning of October 2013. Both the patients were reported to have had no contact to a known laboratory-confirmed case with MERS-CoV.

Globally, from September 2012 to date, WHO has been informed of a total of 138 laboratory-confirmed cases of infection with MERS-CoV, including 60 deaths.

(Source: World Health Organization 14 October 2013)

Nigeria: Cholera

A cholera outbreak in Rini Village and Bakura town in the Zamfara State of Nigeria has caused 2 deaths and 130 persons were hospitalized.

(Source: ProMED-mail 14 October 2013)

Iran: Cholera

On 9 October 2013, a total of 214 cholera infection cases have been reported in Iran and 6 patients died from the infection.

(Source: ProMED-mail 14 October 2013)

Mexico: Cholera [Update]

Health authorities in Mexico reported a total of 157 cases of cholera and 145 of them were reported from the central state of Hidalgo.

(Source: ProMED-mail 14 October 2013)

Australia: Measles

West Australia reported four imported cases of measles in the past week and those travelers have been to Bali, Indonesia.

(Source: ProMED-mail 13 October 2013)

Singapore: Chikungunya Fever [Update]

In Singapore, cases of Chikungunya Fever continued to increase. As of 5 October 2013, 752 cases were reported, compared with 10 cases reported in the same period last year.

(Source: Ministry of Health, Singapore 10 October 2013)

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