Global Health Risks - Updated WEEK 24, 2019

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Stay vigilant & healthy as you journey Perpetual Traveller's

Health Risks for...

---------- Week 24. 2019 ----------

Belgium
Legionnaires' Disease in East Flanders
Latest update: additional cases confirmed, likely source of illness from a cooling tower. Cases of Legionnaires' disease have been confirmed in Evergem municipality, East Flanders. Investigations into the potential source are underway, with water cooling towers suspected. Legionnella bacteria is naturally present in the environment at low levels and the majority of people exposed do not become ill. Older people, smokers, and those with underlying health problems are at higher risk of developing symptoms such as fever, cough and difficulty breathing. Overall the risk to travellers is low. Anyone with symptoms who has been in the affected area should seek medical attention.

Congo (DRC)
North Kivu, Ituri: ongoing Ebola outbreak 
More than 1,900 confirmed probable Ebola cases and at least 1,200 fatalities have been reported. The response to the outbreak has been hindered by an escalation in violence in affected areas, prompting some health organisations to temporarily suspend operations. The security forces are supporting medical staff at entrance/exit points, where travellers are screened prior to entering/exiting affected zones.

Congo (DRC)
Increase in cholera cases
Latest update: further cases reported. Cholera cases have been increasing across several provinces. The disease spreads via contaminated food and water. Symptoms include vomiting and profuse, watery diarrhoea which can lead to severe dehydration. Travellers staying in quality accommodation with access to safe food and water are at low risk. Ensure food and water for consumption are safe, and consider vaccination if likely to encounter unsanitary conditions.

North Macedonia
Increase in measles cases
An increase in measles cases have been reported nationwide including capital, Skopje. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. Measles can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure that they are fully immunised against measles.

Pakistan
Latest update: new cases confirmed, more environmental samples test positive.
Polio cases have been detected in parts of Khyber Pakhtunkhwa (including the Tirbal Districts), Punjab and Sindh provinces. Environmental samples have tested positive in several provinces, including Khyber Pakhtunkhwa (including in the Tribal Districts), Balochistan, Punjab and Sindh. Some of these samples were collected in major cities including Islamabad, Faisalabad, Karachi, Lahore and Peshawar. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date. 

Saudi Arabia
MERS-CoV
Latest update: outbreak ongoing. Sporadic human cases of Middle East Respiratory syndrome (MERS-CoV) continue to occur in Saudi Arabia. Transmission within hospitals sometimes occurs. The virus is present in camels and can be transmitted to people who have direct contact or consume raw camel products. Overall the risk to travellers is low if precautions are taken. Avoid contact with sick people and practice good general hygiene. Avoid contact with camels and do not eat or drink raw camel products. If you require medical attention, call International SOS and we will arrange an appropriate referral.

Thailand
Chikungunya outbreak continues
An outbreak of chikungunya has been ongoing since the beginning of the year. Cases have been reported in travellers. Chikungunya can cause severe illness, particularly in newborn babies, older adults and people with underlying health issues (such as diabetes, heart disease, weakened immune system). There is no specific treatment and no vaccine. Prevent infection by avoiding mosquito bites.

Uganda
Cases of Ebola linked to outbreak in Democratic Republic of Congo
Latest update: Ebola case repatriated to DRC, along with four suspected cases. No confirmed cases of Ebola remain in Uganda. In Uganda there are three suspected cases awaiting test results, and 27 contacts under monitoring. Three people who arrived with their family in Kasese district from the Democratic Republic of the Congo on 10 June tested positive for Ebola. Two have subsequently died. A Rapid Response Team has been mobilised to the district. International SOS is monitoring the situation closely. Ebola is spread by contact with the blood or other bodily fluids (including vomit and diarrhoea) of infected or dead people. Healthcare workers, household members and people participating in traditional funeral practices (touching the body) are at high risk. Prevent infection by paying strict attention to hygiene, and avoiding contact with blood and body fluids. Do not participate in traditional funerals. Do not go to health facilities where Ebola patients are being treated.

United States
Multistate E. Coli Outbreak
Latest update: outbreak ongoing. Twomulti-state outbreaks of Escherichia coli are under investigation. Ground beef has been identified as the source of one outbreak, while contaminated flour is the source of the other. E. coli spreads through contaminated food, as well as from one person to another. It can cause gastroenteritis, with symptoms of abdominal cramping, diarrhoea, fever and vomiting typically occurring about three days after exposure. Most people recover in about ten days without treatment. Some people, especially young children and the elderly, can develop serious complications, including haemolytic uraemic syndrome (HUS). Prevent infection by paying attention to hygiene and following safe food practices.

---------- Week 23. 2019 ----------

Afghanistan
Polio cases
Latest update: new case in Kunar province. Polio remains an ongoing risk. New cases continue to be reported.Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date, including a booster. Travellers who will be in Afghanistan for 4 or more weeks may be required to show proof of vaccination within the 12 months prior to departing the country.

Belgium
Legionnaires' Disease in East Flanders
Latest update: additional cases confirmed, likely source of illness from a cooling tower. Cases of Legionnaires' disease have been confirmed in Evergem municipality, East Flanders. Investigations into the potential source are underway, with water cooling towers suspected. Legionnella bacteria is naturally present in the environment at low levels and the majority of people exposed do not become ill. Older people, smokers, and those with underlying health problems are at higher risk of developing symptoms such as fever, cough and difficulty breathing. Overall the risk to travellers is low. Anyone with symptoms who has been in the affected area should seek medical attention.

Congo (DRC)
North Kivu, Ituri: ongoing Ebola outbreak 
More than 1,900 confirmed probable Ebola cases and at least 1,200 fatalities have been reported. The response to the outbreak has been hindered by an escalation in violence in affected areas, prompting some health organisations to temporarily suspend operations. The security forces are supporting medical staff at entrance/exit points, where travellers are screened prior to entering/exiting affected zones.

Cook Islands
Dengue cases
Latest update: outbreak ongoing. Cases of dengue fever have been reported after a gap of about two years. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Fiji
Leptospirosis outbreak
An outbreak of leptospirosis has been declared in Central Division. The bacterial disease is mainly spread through contaminated water entering the body through the skin or mucous membranes (eyes, nose, or mouth). Symptoms are often mild and flu-like, but the infection can be severe. Untreated, it can cause organ failure which can be fatal. Prevent infection by avoiding contact with contaminated waters.

India
Nipah virus in Kerala state
Latest update : several suspected cases negative for Nipah. A case of Nipah virus (NiV) has been confirmed in Kerala and is undergoing treatment. Nipah is a potentially fatal viral disease. People get infected through direct contact with infected bats, animals or other people, or through consuming fruit / unpasteurised fruit juice which has been contaminated by bats. There is no specific treatment and no vaccine for NiV. Prevent illness by avoiding contact with sick people, infected animals (particularly bats) and selecting safe food and beverages. International SOS is monitoring the situation closely and if you should require medical attention, call International SOS.

Pakistan
Latest update: new cases confirmed, more environmental samples test positive.
Polio cases have been detected in parts of Khyber Pakhtunkhwa (including the Tirbal Districts), Punjab and Sindh provinces. Environmental samples have tested positive in several provinces, including Khyber Pakhtunkhwa (including in the Tribal Districts), Balochistan, Punjab and Sindh. Some of these samples were collected in major cities including Islamabad, Faisalabad, Karachi, Lahore and Peshawar. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date. 

Réunion (France)
Dengue outbreak
Latest update: activity increasing in the West and North. Health authorities have declared an outbreak of dengue fever. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Saudi Arabia
MERS-CoV
Latest update: outbreak ongoing. Sporadic human cases of Middle East Respiratory syndrome (MERS-CoV) continue to occur in Saudi Arabia. Transmission within hospitals sometimes occurs. The virus is present in camels and can be transmitted to people who have direct contact or consume raw camel products. Overall the risk to travellers is low if precautions are taken. Avoid contact with sick people and practice good general hygiene. Avoid contact with camels and do not eat or drink raw camel products. If you require medical attention, call International SOS and we will arrange an appropriate referral.

Thailand
Chikungunya outbreak continues
An outbreak of chikungunya has been ongoing since the beginning of the year. Cases have been reported in travellers. Chikungunya can cause severe illness, particularly in newborn babies, older adults and people with underlying health issues (such as diabetes, heart disease, weakened immune system). There is no specific treatment and no vaccine. Prevent infection by avoiding mosquito bites.

---------- Week 22. 2019 ----------
Afghanistan
Polio cases

Latest update: environmental sample tests positive in Hilmand province. Polio remains an ongoing risk. New cases continue to be reported. A new case has been reported in Hilmand province. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date, including a booster. Travellers who will be in Afghanistan for 4 or more weeks may be required to show proof of vaccination within the 12 months prior to departing the country.

Australia
Dengue in Queensland

Dengue fever cases have been reported in Rockhampton, Queensland. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Cameroon
Polio

An environmental sample has tested positive for polio. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date, including a booster, and selecting safe food and water.

Honduras
Increased dengue activity

Latest update: outbreak continues. An increase in dengue activity has been reported. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

India
Heat related health risks

Very hot weather conditions have been reported in most parts of the country with unusually high temperatures being recorded in some locations. Exposure to excessive temperatures for a sustained period can pose health risks ranging from relatively mild rashes and sunburn up to heat stroke, a medical emergency. To prevent heat-related illnesses, keep yourself hydrated and avoid exposure to heat.

Nigeria
Lassa fever

Cases of Lassa fever continue to be reported. Lassa fever is a viral haemorrhagic fever. Transmission to humans mostly occurs through ingestion or inhalation of excretions from infected rodents, especially rats. The disease can also spread through direct contact with the body fluids of an infected person. Prevent infection through observing strict hygiene and avoiding contact with sick people. Risk to the business traveller is low.

Nigeria
Polio in some states

Polio cases due to a strain of "circulating vaccine-derived poliovirus type 2" (cVDPV2) have been detected in Borno, Jigawa, Katsina, Kaduna, Kwara, Niger, Ogun, Taraba and Yobe states. The cVDPV strain can emerge in under-vaccinated populations. Polio is a contagious viral illness that causes paralysis and death. The infection is spread through ingestion of contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date.

Pakistan
Additional Polio cases confirmed, further environmental samples test positive.

Polio cases have been detected in parts of Khyber Pakhtunkhwa, Punjab and Sindh provinces. Additionally, environmental samples have tested positive in several provinces, including Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh. Some of these samples were collected in major cities including Islamabad, Faisalabad, Karachi, Lahore and Peshawar. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Ensure your polio vaccination is up to date.

United States
Measles outbreaks

Latest update: further cases reported. Measles outbreaks have been reported in several states. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. The illness can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure they are fully immunised against measles.

Wallis and Futuna (France)
Dengue fever

Dengue fever cases have been reported in the island. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

---------- Week 21. 2019 ----------
Afghanistan
Polio cases

Latest update: environmental sample tests positive in Kandahar. Polio remains an ongoing risk. New cases continue to be reported. A new case has been reported in Hilmand province. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date, including a booster. Travellers who will be in Afghanistan for 4 or more weeks may be required to show proof of vaccination within the 12 months prior to departing the country.

Congo
Outbreak of Ebola virus

With the Ebola epidemic in the Democratic Republic of the Congo now in its tenth month and the number of new cases increasing in recent weeks, the United Nations announced measures to strengthen its response and end the outbreak. The Ebola epidemic has claimed more than 1,200 lives and the risk of spread to other provinces in the eastern Congo as well as neighbouring countries remains very high. A third of those who have fallen ill are children, which is a higher proportion than in previous outbreaks. International SOS is monitoring the situation closely. Ebola is spread by contact with the blood or other bodily fluids (including vomit and diarrhoea) of infected or dead people. Healthcare workers, household members and people participating in traditional funeral practices (touching the body) are at high risk. Continue to defer non-essential travel to affected areas. Prevent infection by paying strict attention to hygiene, and avoiding contact with blood and body fluids. Do not participate in traditional funerals. Do not go to health facilities where Ebola patients are being treated.

Nigeria
Outbreak of measles

Latest update: Outbreak continues, Borno state heavily affected. There is a measles outbreak in Nigeria. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. The illness can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure they are fully immunised against measles.

Pakistan
Additional polio cases have been detected in parts of Khyber Pakhtunkhwa (including the Tirbal Districts), Punjab and Sindh provinces.

Additionally, environmental samples have tested positive in several provinces, including Khyber Pakhtunkhwa (including in the Tribal Districts), Balochistan, Punjab and Sindh. Some of these samples were collected in major cities including Islamabad, Faisalabad, Karachi, Lahore, Peshawar. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date.

Réunion (France)
Dengue outbreak

Latest update: activity increasing in the West and North; decreasing in the South; expanding in the East. Health authorities have declared an outbreak of dengue fever. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.


---------- Week 20. 2019 ----------


Brazil
Dengue fever
Outbreak continues to rapidly expand. A sharp increase in dengue fever activity has been reported, with fatalities reported. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Congo
Outbreak of Ebola virus in North Kivu and Ituri provinces

Latest update: increased cases, new area affected. An outbreak of Ebola continues to grow in the provinces of North Kivu and Ituri. Key response activities continue to be challenged but have progressively resumed despite ongoing security issues. International SOS is monitoring the situation closely. Ebola is spread by contact with the blood or other bodily fluids (including vomit and diarrhoea) of infected or dead people. Healthcare workers, household members and people participating in traditional funeral practices (touching the body) are at high risk. Continue to defer non-essential travel to affected areas. Prevent infection by paying strict attention to hygiene, and avoiding contact with blood and body fluids. Do not participate in traditional funerals. Do not go to health facilities where Ebola patients are being treated.

Kenya
Cholera outbreak

Outbreak ongoing. An outbreak of cholera has been reported in several counties. Cholera spreads via contaminated food and water. Symptoms include vomiting and profuse, watery diarrhoea which can lead to severe dehydration. Travellers staying in quality accommodation with access to safe food and water are at low risk. Ensure food and water for consumption are safe, and consider vaccination if likely to encounter unsanitary conditions.

Maldives
Increase in dengue cases

A surge in cases of dengue have been reported across the island including capital Male. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Nigeria
Monkeypox ongoing risk

Travellers are reminded of the ongoing risk of monkeypox following the confirmation of a traveller from Nigeria diagnosed with the disease in Singapore. There have been 'sporadic' cases of monkeypox identified in Nigeria since an outbreak in 2017. People can contract the virus from an infected animal. They may be bitten or come into contact with an infected animal's skin, blood or body fluids. Infected people can pass on the disease to others. Prevent infection by observing hygiene and avoiding contact with animals.

Pakistan
Polio cases

Latest update: four more cases confirmed, further environmental samples test positive. Polio cases have been detected in parts of Khyber Pakhtunkhwa (including the Tirbal Districts), Punjab and Sindh provinces. Additionally, environmental samples have tested positive in several provinces, including Khyber Pakhtunkhwa (including in the Tribal Districts), Balochistan, Punjab and Sindh. Some of these samples were collected in major cities including Islamabad, Faisalabad, Karachi, Lahore and Peshawar. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date.

Philippines
Measles outbreak

Latest update: outbreak ongoing. An outbreak of measles is underway across the country. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. Measles can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure that they are fully immunised against measles.

Réunion (France)
Dengue outbreak

Additional cases; new area affected. Health authorities have declared an outbreak of dengue fever. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Saudi Arabia
Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak

National International Health Regulations Focal Point of Saudi Arabia reported 45 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Of the 45 cases reported, 9 cases, including 1 death, were linked to the outbreak in Wadi Aldwasir city. Of the 36 cases reported in Saudi Arabia, 10 cases were reported in Alkhafi city and 6 cases in Riyadh city.

Singapore
Imported case of monkeypox from Nigeria

Latest update: Contacts have no symptoms. A visitor from Nigeria has been diagnosed with monkeypox, and is being treated under isolation at the National Centre for Infectious Diseases. Health officials have placed 22 of his contacts in quarantine for 21 days, and others under active surveillance. Monkeypox is a rare viral disease and is not usually present in Singapore. Infection can spread from person to person through direct contact with skin lesions, blood or other body fluids, and contaminated objects. As the patient is isolated, and his contacts are in quarantine or under surveillance, the risk of spread is considered low.

Tanzania
Dengue outbreak in ongoing in Dar es Salaam and other areas

Health authorities have declared an outbreak of dengue fever. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Tunisia
Measles outbreak in several areas including Tunis

An increase in cases of measles have been reported from several parts of the country. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. The illness can result in serious complications, particularly when very young children, elderly people or pregnant women are infected. All travellers should ensure they are fully immunised against measles.

United Kingdom
Measles cases continued to be reported from several areas.
Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Common symptoms include fever, cough and a characteristic rash. Measles can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure that they are fully immunised against measles.


---------- Week 19. 2019 ----------

Brazil
Dengue fever
Outbreak continues to rapidly expand. A sharp increase in dengue fever activity has been reported, with fatalities reported. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Congo
Outbreak of Ebola virus in North Kivu and Ituri provinces

Increased cases, ongoing security incidents. An outbreak of Ebola continues to grow in the provinces of North Kivu and Ituri. Key response activities continue to be challenged but have progressively resumed despite ongoing security issues. International SOS is monitoring the situation closely. Ebola is spread by contact with the blood or other bodily fluids (including vomit and diarrhoea) of infected or dead people. Healthcare workers, household members and people participating in traditional funeral practices (touching the body) are at high risk. Continue to defer non-essential travel to affected areas. Prevent infection by paying strict attention to hygiene, and avoiding contact with blood and body fluids. Do not participate in traditional funerals. Do not go to health facilities where Ebola patients are being treated.

Kenya
Cholera outbreak

Outbreak ongoing. An outbreak of cholera has been reported in several counties. Cholera spreads via contaminated food and water. Symptoms include vomiting and profuse, watery diarrhoea which can lead to severe dehydration. Travellers staying in quality accommodation with access to safe food and water are at low risk. Ensure food and water for consumption are safe, and consider vaccination if likely to encounter unsanitary conditions.

Maldives
Increase in dengue cases

A surge in cases of dengue have been reported across the island including capital Male. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Nigeria
Monkeypox ongoing risk

The ongoing risk of monkeypox following the confirmation of a traveller from Nigeria diagnosed with the disease in Singapore continues. There have been 'sporadic' cases of monkeypox identified in Nigeria since an outbreak in 2017. People can contract the virus from an infected animal. They may be bitten or come into contact with an infected animal's skin, blood or body fluids. Infected people can pass on the disease to others. Prevent infection by observing hygiene and avoiding contact with animals.

Pakistan
Polio cases

3 more cases confirmed, further environmental samples positive for polio. Polio cases have been detected in parts of Khyber Pakhtunkhwa (including the Tirbal Districts), Punjab and Sindh provinces. Additionally, environmental samples have tested positive in several provinces, including Khyber Pakhtunkhwa (including in the Tribal Districts), Balochistan, Punjab and Sindh. Some of these samples were collected in major cities including Islamabad, Faisalabad, Karachi, Lahore and Peshawar. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date.

Réunion (France)
Dengue outbreak

Additional cases; new area affected. Health authorities have declared an outbreak of dengue fever. The disease is spread by mosquitoes, and is present in both rural and urban areas. Dengue can cause a range of symptoms and has no particular treatment. Some people, especially those who have been infected before, get a more severe form that can lead to fatal complications. Although a vaccine is available in several locations, it is only recommended for people who have been infected with dengue in the past and are living or travelling in areas with high levels of dengue transmission. Prevent infection by avoiding mosquito bites.

Saudi Arabia
Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak

National International Health Regulations Focal Point of Saudi Arabia reported 45 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Of the 45 cases reported, 9 cases, including 1 death, were linked to the outbreak in Wadi Aldwasir city. Of the 36 cases reported in Saudi Arabia, 10 cases were reported in Alkhafi city and 6 cases in Riyadh city.

Singapore
Imported case of monkeypox from Nigeria

A visitor from Nigeria has been diagnosed with monkeypox, and is being treated under isolation at the National Centre for Infectious Diseases. Health officials have placed 22 of his contacts in quarantine for 21 days, and others under active surveillance. Monkeypox is a rare viral disease and is not usually present in Singapore. Infection can spread from person to person through direct contact with skin lesions, blood or other body fluids, and contaminated objects. As the patient is isolated, and his contacts are in quarantine or under surveillance, the risk of spread is considered low.

Tunisia
Measles outbreak in several areas including Tunis

An increase in cases of measles have been reported from several parts of the country. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. The illness can result in serious complications, particularly when very young children, elderly people or pregnant women are infected. All travellers should ensure they are fully immunised against measles.

---------- Week 18. 2019 ----------

Afghanistan
Polio remains an ongoing risk - new cases continue to be reported
A new case has been reported in Hilmand province. Polio is a contagious viral illness that can cause paralysis and death. It is spread through contaminated food or water, or directly from an infected person. Prevent infection by ensuring polio vaccination is up to date, including a booster. Travellers who will be in Afghanistan for 4 or more weeks may be required to show proof of vaccination within the 12 months prior to departing the country.

Congo (DRC)
Outbreak of Ebola virus in North Kivu and Ituri provinces
Record number of new cases in April. An outbreak of Ebola continues to grow in the provinces of North Kivu and Ituri. Key response activities continue to be challenged but have progressively resumed despite ongoing security issues. International SOS is monitoring the situation closely. Ebola is spread by contact with the blood or other bodily fluids (including vomit and diarrhoea) of infected or dead people. Healthcare workers, household members and people participating in traditional funeral practices (touching the body) are at high risk. Continue to defer non-essential travel to affected areas. Prevent infection by paying strict attention to hygiene, and avoiding contact with blood and body fluids. Do not participate in traditional funerals. Do not go to health facilities where Ebola patients are being treated.

France
The tiger mosquito colonized France. Its presence is official in 51 departments and is detected in 8.
The fight is organized, but it is almost impossible to eliminate it. The health authorities are also worried about the arrival in Réunion of the metropolitan tourists. In 2004 the first implantation of tiger mosquitoes is detected in the Alpes-Maritimes. Fifteen years later, the insect is installed in fifty-one departments and has been detected in eight others. This rapid colonization worries the health authorities who fear an epidemic of dengue, zika or chikungunya. The daily newspaper Le Monde invites metropolitan tourists traveling to Reunion, to use repellents, as the dengue epidemic department has warned about the potential risk for tourists to be infected.

Mozambique
Cholera outbreak and health implications following cyclones
Travel can resume, rising malaria cases. Two serious cyclones struck the nation within a five-week time span in March-April. Heavy rains led to extensive damage and flooding across parts of the country. A state of emergency has been declared. Thousands of people are affected. The provinces of Cabo Delgado, Inhambane, Manica, Sofala (especially the city of Beira) and Zambezia have been impacted with damage to infrastructure including power, communications and health facilities. Malaria and cholera cases have been reported. Cholera is spread via contaminated food and water and safe food and drinking water may be limited. Further health risks posed by the flood waters include injury, skin infections and other insect-borne diseases. Monitor this alert and the Travel Security Online advisory.

Nepal
First human case of H5N1
A fatal human case of H5N1 bird flu has been confirmed in Nepal. This is the first human infection detected in the country. Bird flu is consistently present in birds in Nepal, with frequent outbreaks in poultry. H5N1 infections are serious and can be fatal. Early treatment is critical. Most infections occur in people who have direct contact with poultry. Prevent infection by paying attention to hygiene and avoiding contact with birds and their environment.


---------- Week 15. 2019 ----------

China
Measles vaccination continued at the Hong Kong International Airport
Authorities have established vaccination stations for airport staff. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. Measles can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure that they are fully immunised against measles.


India
Seasonal flu outbreaks continue
Influenza is a viral illness, causing a sudden fever, cough, headache, weakness and muscular pains. Most cases are mild although some can be severe or even fatal. Pregnant women, adults over 65 and young children are at higher risk of severe illness. Prevention is through vaccination and attention to hygiene.


Thailand
Air Pollution in Northern Thailand
High levels of air pollution ongoing in Chiang Mai. High levels of air pollution have been recorded in the northern parts of the country including Chiang Mai and Chiang Rai. Polluted air can cause symptoms such as wheezing, coughing, shortness of breath, and irritation of the eyes and nose. Young children, the elderly, pregnant women and people with underlying heart and lung disease (high-risk groups) are particularly vulnerable. To lessen the risk of potential health problems, reduce exposure by decreasing time and physical activity outdoors. For more information visit the International SOS Air Pollution website.


United States
Measles clusters in New York State
New York City declares public health emergency and mandates vaccination in some areas. Cases reported in Westchester County. Ongoing measles cases are being reported in areas of New York State including parts of New York City and Rockland and Westchester Counties. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. Measles can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure that they are fully immunised against measles.



---------- Week 13. 2019 ----------


India
Seasonal flu

Seasonal flu outbreaks continue.Influenza season continues, with many due to an A(H1N1) strain. Influenza is a viral illness, causing a sudden fever, cough, headache, weakness and muscular pains. Most cases are mild although some can be severe or even fatal. Pregnant women, adults over 65 and young children are at higher risk of severe illness. Prevention is through vaccination and attention to hygiene.

Lithuania
Measles outbreak

An increase in measles cases has been reported nationwide including in Kaunas and the capital, Vilnius.Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. Measles can result in serious complications, particularly when very young children, the elderly or pregnant women are infected.



---------- Week 12. 2019 ----------

Malawi
Health implications following Cyclone Idai
Cyclone Idai and associated heavy rains have led to extensive damage and flooding in parts of the country. Hardest hit are Chikwawa, Machinga, Mangochi, Nsanje and Phalombe districts in the Southern region.Infrastructure damage has occurred including power, communications and health facilities. Food and safe drinking water may be limited. Increased health risks posed by the flood waters include injury, diarrhoeal diseases, skin infections, insect-borne diseases. Defer non-essential travel to affected areas. Monitor this alert and the Travel Security Online advisory.


Zimbabwe

Health implications following Cyclone Idai

Cyclone Idai and associated heavy rains have led to extensive damage and flooding in parts of the country. A state of disaster has been declared in parts of Manicaland province (Chimanimani, Chipinge, Mutare and Nyanga districts.) The number of injuries and fatalities is expected to rise. Infrastructure damage has occurred including power, communications and health facilities. Food and safe drinking water may be limited. Increased health risks posed by the flood waters include injury, diarrhoeal diseases, skin infections, insect-borne diseases. Defer non-essential travel to affected areas. Monitor this alert and the Travel Security Online advisor



---------- Week 11. 2019 ----------

Malaysia
Hazardous Gases in Pasir Gudang area, Johor Bahru

Low levels of hydrogen cyanide detected in air samples. Potentially hazardous gases, possibly related to a chemical spill, have been detected in the Pasir Gudang area of Johor Bahru. Thousands of people have suffered ill health requiring hospitalisation. All schools, kindergartens and nurseries in the district have been closed. International SOS is monitoring the situation and will update this alert as information becomes available. Anyone within five kilometres of the affected area should follow the advice of local authorities. Avoid clean-up areas and any recreational activities around the Kim Kim River. If you develop symptoms, seek medical help.

Philippines
Measles outbreak

Outbreak ongoing.An outbreak of measles is underway across the country. Measles is caused by a highly contagious virus that spreads from person-to-person via infected droplets. Outbreaks occur frequently in under-vaccinated populations. Common symptoms include fever, cough and a characteristic rash. Measles can result in serious complications, particularly when very young children, the elderly or pregnant women are infected. All travellers should ensure that they are fully immunised against measles.

Thailand
Air Pollution in Northern Thailand

High levels of air pollution have been recorded in the northern parts of the country including Chiang Mai and Chiang Rai. Polluted air can cause symptoms such as wheezing, coughing, shortness of breath, and irritation of the eyes and nose. Young children, the elderly, pregnant women and people with underlying heart and lung disease (high-risk groups) are particularly vulnerable. To lessen the risk of potential health problems, reduce exposure by decreasing time and physical activity outdoors. For more information visit the International SOS Air Pollution website.

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