Travel Health Service Year 2013

Travel Health News Digest (6 August 2013 - 12 August 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	1,370,004	World Health Organization, 28 July 2013
Australia	1,087	World Health Organization, 7 August 2013
Cambodia	8,796	World Health Organization, 7 August 2013
China Guangdong province (Zhongshan)	63	Department of Health of Guangdong Province, 22 July 2013
India Maharashtra	727	ProMED-mail, 7 July 2013
Indonesia East Jakarta	1,826	ProMED-mail 1 July 2013
Lao PDR	30,166	World Health Organization, 7 August 2013
Malaysia	15,400	World Health Organization, 7 August 2013
Myanmar	6,448	ProMED-mail 1 July 2013
New Caledonia	10,488	World Health Organization, 7 August 2013
Pakistan Sindh	555	ProMED-mail, 5 August 2013
Philippines	76,354	World Health Organization, 7 August 2013
Singapore	14,109	Singapore National Environment Agency, 8 August 2013
Solomon Island	6,591	World Health Organization, 7 August 2013
Sri Lanka	15,777	ProMED-mail 1 July 2013
Taiwan	217	CDC, ROC (Taiwan), 5 August 2013
Thailand	81,763	ProMED-mail, 5 August 2013
Vietnam	18,934	World Health Organization, 7 August 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.

Mainland: confirmation of suspected human case of Avian Influenza

The Centre for Health Protection of the Department of Health has been notified by the Department of Health of Guangdong Province on 10 August that the suspected human case of avian influenza A(H7N9) in Guangdong has been confirmed. The CHP received the notification from the Department of Health of Guangdong Province on 9 August that a 51-year-old woman living in Henghezhen, Boluo, Huizhou, Guangdong, presented with fever since 27 July. She sought medical consultation at Huizhou Municipal Central Hospital on 3 August and was admitted on the same day. She was transferred to the First Affiliated Hospital of Guangzhou Medical University last night. The review test on the patient's sample by the Chinese Center for Disease Control and Prevention confirmed this case as a human case of avian influenza A(H7N9). The patient is currently in critical condition.

(Source: The Centre for Health Protection of the Department of Health 10 August 2013)

Mainland: suspected human case of Avian Influenza

The Centre for Health Protection of the Department of Health has been notified by the Department of Health of Guangdong Province of a suspected human case of avian influenza A(H7N9) on 9 August affecting a 51-year-old woman in Huizhou in Guangdong Province. The sample of the patient tested positive for the avian influenza A(H7N9) virus by the Centre for Disease Control and Prevention of Guangdong Province and has been sent to the Chinese Center for Disease Control and Prevention for confirmation by a review test. According to the preliminary information, the patient is a poultry worker and has a history of exposure to live poultry. No abnormality was found among the 36 close contacts of this case so far.

(Source: The Centre for Health Protection of the Department of Health 9 August 2013)

Taiwan: Rabies [Update]

In Taiwan, as of 7 August, there were 49 cases of confirmed rabies cases in animals.

(Source: ProMED-mail 7 August 2013)

Kenya: Poliomyelitis [Update]

Ten cases of Poliomyelitis have been reported from Kenya in 2013. These are the first wild poliovirus cases confirmed in Kenya since July 2011.

(Source: Centers for Disease Control and Prevention U.S.A. 1 August 2013)

USA: Cyclosporiasis

As of August 5, 2013, 466 cases of Cyclospora infection have been reported from the following 16 states: Arkansas, Connecticut, Florida, Georgia, Iowa, Illinois, Kansas, Louisiana, Minnesota, Missouri, Nebraska, New Jersey, New York, Ohio, Texas, and Wisconsin, USA.

(Source: Centres for Disease Control and Prevention 6 August 2013)

USA: Hepatitis A

As of August 1, 2013, 158 people have been confirmed to have become ill from hepatitis A after eating ‘Townsend Farms Organic Antioxidant Blend’ in 10 states: Arizona, California, Colorado, Hawaii, New Hampshire, New Jersey, New Mexico, Nevada, Utah, and Wisconsin, USA.

(Source: Centres for Disease Control and Prevention 2 August 2013)

India: Avian Influenza, poultry

2 outbreaks of highly pathogenic H5N1 Avian Influenza were reported in India. Of 8 442 susceptible birds, 2 856 were found dead.

(Source: World Organisation for Animal Health 5 August 2013)

Taiwan: Rabies [Update]

In Taiwan, as of 5 August, 5 more ferret-badgers were confirmed with rabies.

(Source: CDC, ROC (Taiwan) 6 August 2013)

Taiwan: Avian Influenza, poultry

Taiwan reported an outbreak of low pathogenic H5N3 Avian Influenza in Hua-Lien County. Out of 13400 susceptible birds, 20 cases were reported.

(Source: World Organisation for Animal Health 2 August 2013)

Asia: Hand, Foot and Mouth Disease [Update]

Regional hand, foot and mouth disease (HFMD) is variable. Japan, Macao and Republic of Korea have reported more cases in 2013 than in 2012 for the same time period. The recent trend is showing an increase in cases in China and Japan. As of 24 July, 606 354 and 80 296 cases of HFMD were reported in China and Japan respectively.

(Source: World Health Organization, Western Pacific Region Office 24 July 2013)

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