Travel Health Service Year 2013

Travel Health News Digest (24 December 2013 - 30 December 2013)

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
Australia	1,665	World Health Organization, 25 December 2013
Brazil	1,451,432	World Health Organization, 13 December 2013
Cambodia	16,722	World Health Organization, 25 December 2013
China Guangdong province	753	Department of Health of Guangdong Province, 15 October 2013
India	55,063	Ministry of Health & Family Welfare, India, 28 October 2013
Lao PDR	44,098	World Health Organization, 25 December 2013
Malaysia	39,222	World Health Organization, 25 December 2013
Mexico	221,271	World Health Organization, 13 December 2013
New Caledonia	10,548	World Health Organization, 25 December 2013
Philippines	166,107	World Health Organization, 25 December 2013
Singapore	22,094	Singapore National Environment Agency, 29 December 2013
Sri Lanka	31,007	Ministry of Health, Sri Lanka, 27 December 2013
Taiwan	835	CDC, ROC (Taiwan), 29 December 2013
Thailand	150,934	Ministry of Public Health, Thailand, 25 December 2013
Vietnam	60,588	World Health Organization, 25 December 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.

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 provide a proof of vaccination against the meningococcal disease using the quadrivalent vaccine (serogroups A, C, W135 and Y). The vaccine should have been received 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)

Caribbean: Chikungunya Fever [Update]

Cases of Chikungunya Fever infection were detected in Caribbean with 66 confirmed cases in St. Martin, 11 suspected cases in St. Barthelemy, 1 confirmed case in Guadeloupe, 3 confirmed cases in Martinique and 1 confirmed case in Guyana.

(Source: ProMED-mail 28 December 2013)

India: Japanese Encephalitis

In Uttar Pradesh, India, three fatal cases of Japanese Encephalitis were reported.

(Source: ProMED-mail 27 December 2013)

Kingdom of Saudi Arabia: Middle East Respiratory Syndrome

The Department of Health is closely monitoring four additional cases of Middle East Respiratory Syndrome reported to the World Health Organisation (WHO) by the Kingdom of Saudi Arabia (KSA). According to the WHO, the four patients are from the KSA's capital. Two of them are female health workers who are asymptomatic. The third case is a man aged 53 with underlying illnesses who is currently under intensive care. He had no exposure to animals or travel history, but had contact with a confirmed patient. The remaining case is a man aged 73 with underlying illnesses who died on December 18. He reported exposure to animals but no travel history.

This brings the latest global number of confirmed cases of Middle East Respiratory Syndrome to 170, including 72 deaths.

(Source: The Centre for Health Protection of the Department of Health 28 December 2013)

Syria: Poliomyelitis

As of November 25, 17 cases of poliomyelitis have been reported from Syria.

(Source: Centres for Disease Control and Prevention 20 December 2013)

Cameroon: Poliomyelitis

As of November 29, 4 cases of poliomyelitis have been reported from Cameroon.

(Source: Centers for Disease Control and Prevention 20 December 2013)

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