Travel Health Alert. Argentina Over 79,400 probable cases (10 deaths) of dengue fever have been reported from 21 provinces during 2016.

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1 1 st February 2017 Various strains of avian influenza have affected humans in. An increase in cases of H7N9 has been reported since Dec 16. Several provinces have reported cases, including: Liaoning (NE), Guangdong (S), Guizhou (S), Anhui, Hubei (SE), Shandong, Hunan, Jiangxi, Fujian and Zhejiang (E) during 2016/17. Over 1,000 cases have been reported to date from Other strains of avian influenza (H5N1, H5N6 and H9N2) have also been detected. Avian influenza is a serious viral infection usually transmitted to humans by contact with infected poultry. The risk to travellers is low. Travellers should avoid contact with poultry (e.g. visiting live animal markets) and wash their hands regularly. Argentina Over 79,400 probable cases (10 deaths) of dengue fever have been reported from 21 provinces during Australia 74 confirmed cases of dengue fever have been reported, Jan 17. 1,900 cases of dengue fever were reported Jan-Oct 16. Cases are reported each year on the NE coast of Queensland especially around Cairns and Townsville. Belize 192 suspected cases of dengue have been reported, Jan 17. Over 3,000 suspected cases were reported nationally during Bolivia Over 31,700 probable cases of dengue fever were reported during Brazil Dengue fever is a continuing problem throughout Brazil with over 1,496,000 probable cases (629 deaths) reported during Many cases are reported from Pernambuco, Minas Gerais and Parana. Over 2,000 cases of dengue fever were recorded during 2016.

2 Colombia Dengue fever is a continuing problem, over 103,800 probable cases (199 deaths) were reported during Valle de Cauca and Antioquia departments (W) are most affected. Costa Rica Over 22,600 cases of dengue fever have been reported during % of cases recorded from the pacific coastal provinces of Guanacaste and Puntarenas. Ecuador Dengue fever is a continuing problem, over 14,100 probable cases were reported during French Polynesia 21 confirmed cases of dengue fever have been reported, Dec 16-Jan 17. Laos Health authorities have reported 235 cases of dengue fever from 12 out of 18 provinces. Over 5,600 cases (10 deaths) were reported in Many cases are reported from Champasak province (SW) and Vientiane (W). Malaysia Dengue fever is a continuing problem in Malaysia. 5,592 cases (13 deaths) have been reported, Jan 17. Over 101,000 cases (237 deaths) were reported during Selangor (SW) reported at least 40,000 of these cases. Johor (S), Perak (W), and Kuala Lumpur (E) were also affected. Mexico Dengue fever is a continuing problem, over 130,000 probable cases (34 deaths) were reported during States most affected: Guerrero, Chiapas, Veracruz and Michoacán. New Caledonia There has been an increase of dengue fever, with 360 cases reported, Jan 17. Noumea (S) is most affected. Nicaragua Dengue fever is a continuing problem, over 88,300 probable cases (16 deaths) were reported in 2016.

3 Panama Over 7,000 probable cases of dengue fever (14 deaths) were reported during Most affected regions: Metro Panama City, Panama Oeste (E) and Bocas del Toro (N). Peru Over 31,800 probable cases (41 deaths) of dengue fever were reported during Regions most affected: Lambayeque (NW), La Libertad (N), Ayacucho (S), Piura, and Loreto (W). Puerto Rico Over 71,700 probable cases of dengue fever have been reported during Singapore 296 cases of dengue fever have been recorded in Singapore, Jan 17. Over 12,600 cases were reported, Jan-Nov 16. Solomon Islands Over 8,500 suspected cases of dengue fever have been reported by the Ministry of Health, with Honiara, Guadalcanal, Malaita, Isabel, Choiseul, Makira, Temotu, Western, Central and Renbell reporting the largest numbers, Aug-Dec 16. Dengue fever is a viral infection spread by day-time biting mosquitoes. It is widespread across over 110 countries with large outbreaks reported in many regions including South East Asia and South/Central America. Dengue fever commonly causes flu-like symptoms including fever, joint pain and rash. Severe forms of the disease are rare in travellers but can lead to excessive bleeding and organ failure. Over 2,468,000 cases (220 deaths) of hand, foot and mouth disease were reported during This follows the previous seasonal pattern. Japan 515 cases of hand, foot and mouth disease have been reported, Jan 17. Over 69,000 cases were reported during Singapore 501 cases of hand, foot and mouth disease have been reported, Jan 17. Over 42,000 cases were reported during 2016.

4 Vietnam Over 48,800 cases of hand, foot and mouth disease have been reported from all provinces during Hand, foot and mouth disease is a viral infection which affects mainly young children and causes fever, mouth ulcers and blisters on hands and feet. It is transmitted by person to person contact. The majority of cases are mild but serious complications are occasionally reported. Chad The WHO have reported over 600 cases of suspected hepatitis E, Sep 16 - Jan 17. The majority of cases have been reported in the Am Timan area (SE). Hepatitis E infection affects the liver and is usually transmitted through contaminated food and water in areas with poor sanitation. Symptoms include fever, fatigue and jaundice. It is especially dangerous in the latter stages of pregnancy when fatality rates can reach 20%. There is currently no vaccine. Namibia Health authorities have reported 102 cases of malaria in Omuthiya, Oshikoto Region (N), Jan 17. Malaria is a serious and sometimes fatal disease common in many tropical countries. It is spread by the bite of infected mosquitoes which bite between dusk and dawn. Symptoms can vary and include fever and a flu-like illness. More serious forms can be fatal and progress to organ failure and coma within 24 hours of symptoms first appearing. Saudi Arabia The Saudi Ministry of Health continue to report additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV), Jan 17. 1,544 cases (641 deaths) have been reported since MERS-CoV is a viral infection which affects the respiratory system and can be fatal. Human to human transmission has been reported including amongst healthcare workers. There is evidence that camels/bats may also transmit the disease. Travellers returning from the Middle East who develop a significant respiratory illness with fever and cough should seek medical advice. There are no travel restrictions.

5 Germany There has been a large increase in numbers of norovirus cases in 11 out of 16 federal provinces, Dec 16. Over 14,800 cases were recorded in Nov 16. Outbreaks of gastroenteritis, caused by the norovirus, occur occasionally in hotels and cruise ships around the world. It commonly causes vomiting and sometimes diarrhoea. The virus is highly infectious and can be transmitted in contaminated food or via contact with the vomit of an infected individual e.g. air-borne particles or on inanimate objects such as door handles. Maintain good personal hygiene such as hand washing. Myanmar Media sources have reported more than 50 cases of food poisoning in students who had consumed castor seeds, Jan 17. Ricin poisoning is caused by consumption of castor beans or inhalation of ricin containing material. Consumption can lead to gastrointestinal or respiratory symptoms and in severe cases can lead to death. There is no cure and treatment is by supportive medical care. Brazil As of 26th Jan 2017 the yellow fever risk area has been extended to include parts of the SW states of Bahia, Espírito Santo and Rio de Janeiro. A state of emergency has been declared in Minas Gerais (SE). 598 confirmed and suspected cases (46 confirmed deaths) have been reported from Minas Gerais, Espírito Santo, Bahia and São Paulo, Jan 17. Local vaccination campaigns have begun. Suspected cases have also been reported in Mato Grosso do Sul. Yellow fever is a viral disease, found in tropical regions of Africa and the Americas. It principally affects humans and monkeys, and is transmitted by the bite of an infected mosquito. The risk is highest in rural areas % of those infected will develop severe disease with organ failure, jaundice and bleeding. An effective vaccine is available but may not be suitable for everyone. International regulations are in place to prevent the spread of the disease and as such the vaccine must be administered in a registered Yellow Fever Centre and a certificate of vaccination issued.

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