TRAVEL HEALTH PROVIDER INITIATIVE
APRIL 2018 NEWSLETTER
PREP: An Interactive Tool For The Clinician

YELLOW FEVER ALERT


There is a large, ongoing outbreak of yellow fever in multiples states of Brazil. Since early 2018, several unvaccinated travelers to Brazil have contracted yellow fever; many of these travelers were infected on the island of Ilha Grande (Rio de Janeiro State). Several have died. The World Health Organization has expanded the list of areas where yellow fever vaccination is recommended. In addition to areas in Brazil where vaccination is already recommended, it is now also recommended for people who are traveling to or living in all of Espirito Santo State, all of Rio de Janeiro State, including the city of Rio de Janeiro, all of São Paulo State, including the entire city of São Paulo, and a number of cities in Bahia State. Because of a yellow fever vaccine shortage in the United States, travelers should contact a yellow fever vaccine provider well in advance of travel. People who have never been vaccinated against yellow fever should avoid traveling to areas of Brazil where yellow fever vaccination is recommended.

Updates, Outbreaks & Security Concerns

Africa
  • The Nigeria Center for Disease Control has reported an ongoing outbreak of Lassa fever in Nigeria that began in early 2018. The outbreak has been confirmed in at least 17 states with over 40 deaths reported. Most cases have been found in Edo and Ondo in southwest Nigeria states. Lassa fever is spread through contact with rat feces and urine, and the bodily fluids of people seriously ill with the virus. Travelers to Nigeria should avoid contact with rats, especially rat urine and feces, and take precautions to keep their accommodations or campsites clean. Travelers should also wash hands often, and avoid contact with people who are sick.
  • Public health officials in South Africa have reported an ongoing, severe outbreak of listeriosis that began in early 2017. Most cases have been reported in Gauteng, Western Cape, and KwaZulu-Natal provinces. Over 180 people have died. The source of the listeriosis outbreak has been identified in a variety of processed, ready-to-eat meat products, including “polony”. Listeriosis primarily affects pregnant women and their newborns, older adults, and people with weakened immune systems. Travelers to South Africa should avoid all ready-to-eat processed meat products to reduce their risk of listeriosis.
  • Health officials have reported several cases of measles in the Democratic Republic of the Congo. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • The Nigeria Centre for Disease Control has reported an ongoing outbreak of yellow fever that began in September 2017. Laboratory-confirmed yellow fever cases have been reported in at least seven states, and multiple people have died. CDC recommends anyone 9 months or older who travels to any part of Nigeria should be vaccinated against yellow fever. In addition, Nigerian authorities require proof of yellow fever vaccination from all people one year of age or older who are traveling to Nigeria and are arriving from a country with risk of yellow fever virus transmission. Because of current limitations in the availability of yellow fever vaccine in the United States, travelers should contact a yellow fever vaccine provider well in advance of travel.
  • In early October, World Health Organization and the Madagascar Ministry of Health responded to an unusual outbreak of plague pneumonia in widespread areas of Madagascar, including in heavily populated cities of Antananarivo (the capital city and its suburbs) and Toamasina. In late November 2017, it was declared that the urban outbreak had been contained. However, bubonic plague occurs nearly every year in Madagascar, so travelers to the area should continue to take precautions to protect their health including prevention of flea bites and avoiding contact with dead animals.
  • Health officials in Cape Verde have reported a substantial increase in malaria in the capital city of Praia on São Tiago Island (also known as Santiago Island). CDC now recommends that travelers to the city of Praia on São Tiago Island take prescription medicine to prevent malaria before, during, and after their trip. 
  • Health officials in South Africa have reported limited cases of locally transmitted malaria in Gauteng Province, where Johannesburg and Pretoria are located. Malaria is not usually found in Gauteng Province, but rare outbreaks have been reported in the past. Because malaria is spread by mosquito bites, travelers to Gauteng Province should prevent mosquito bites by using insect repellent when outdoors, wearing protective clothing, and sleeping in an air-conditioned or well-screened room or under an insecticide-treated bed net. 
  • Cases of polio have been reported in Nigeria and the Democratic Republic of the Congo. The CDC recommends that all travelers to these countries be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.
  • Check the World Map of Areas with Risk of Zika to find out about countries in Africa with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Asia
  • Health officials have reported several cases of measles in Indonesia, including the island of Bali. CDC recommends that all travelers to Indonesia protect themselves by being fully vaccinated against measles prior to departure.
  • The Malaysian state of Sarawak has declared parts of three divisions to be rabies infectious areas. Five human rabies cases and almost 800 cases of people being bitten by rabid animals have been reported in Serian, Sri Aman, and Kutching divisions as of July 2017. All people infected with rabies have died. Travelers who anticipate contact with animals such as dogs, cats, bats, or other carnivores should consider rabies vaccination before travel. Even if the pre-exposure rabies vaccine has been received, travelers should still get immediate medical treatment if bitten or scratched by an animal during travel.
  • Check the World Map of Areas with Risk of Zika to find out about countries in Asia with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Caribbean, Central and South America
  • See 'Yellow Fever Alert' above for details regarding the current yellow fever outbreak in Brazil.
  • Public health officials in Brazil have reported an outbreak of locally transmitted malaria in the town of Wenceslau Guimarães in Bahia State. At this time, CDC recommends that all travelers to Wenceslau Guimarães take medication to prevent malaria. Travelers should also take precautions to avoid mosquito bites.
  • Hurricanes Irma and Maria crossed the Caribbean in September 2017 causing severe damage in multiple countries and territories. The extent of destruction varies, with many areas flooded and inaccessible. Significant damage has caused problems with water supplies, sanitation, food supply, electricity, transportation, shelter, communications, security, medical care, and mosquito control. Post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among persons in or recently returned from hurricane-affected areas. Contaminated drinking water and reduced access to safe water, food, and shelter in some areas may create conditions for outbreaks of infectious diseases. Potential visitors should postpone travel to severely affected.
  • Check the World Map of Areas with Risk of Zika to find out about countries in the Caribbean, Central and South America with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Europe
  • Officials have reported an outbreak of measles in Italy, Ukraine, Greece, England, Romania and SerbiaCDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles. Before departure from the United States, infants (6 through 11 months of age) should have 1 dose of MMR vaccine, and adults and children over 1 year of age should have 2 doses of MMR vaccine separated by at least 28 days.
  • Three cases of Plasmodium vivax malaria have been reported in UK residents who traveled to Esentepe (also known as Agios Amvrosios) in the Kyrenia District in Northern Cyprus. CDC recommends that travelers to Esentepe (Agios Amvrosios) take medicine to prevent malaria.
Middle East
  • Cases of vaccine-derived polio have been reported in Syria. Most cases have been reported in Mayadeen District, in Dayr az Zawr Province. CDC recommends that all travelers to Syria be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine.

Pacific Islands

  • Check the World Map of Areas with Risk of Zika to find out about Pacific Islands with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.

Traveler Health & Safety Tips

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The CDC recommends all travelers:

  • Visit a health care provider, ideally, 4 to 6 weeks before their trip for personalized health advice, vaccines, and medications.
  • Avoid bites from mosquitoes and other bugs by using an insect repellent and wearing long-sleeved shirts, long pants, closed shoes, and hats as much as possible.
  • Stay safe around animals. Do not pet, handle, or feed unfamiliar animals, even pets.
  • Be safe on international roads. Avoid overcrowded buses and cars, always wear a seat belt, and wear a helmet when riding a bike or motorcycle.
  • Wash their hands often with soap and water and use a hand sanitizer, as needed.

Current Zika Virus Recommendations

  • Check the World Map of Areas with Risk of Zika before you travel.
  • The recommendations for travelers to areas with risk of Zika are:
    • CURRENT PREGNANCY: Women who are pregnant (in any trimester) should not travel to areas with risk of Zika. Men who have traveled to an area with risk of Zika who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sexual intercourse for the duration of the pregnancy. 
    • MOSQUITO AVOIDANCE: Prevent mosquito bites while traveling to areas with Zika virus transmission, and for three weeks after returning to the U.S.
    • PLANNING PREGNANCY: If you or your partner are trying to get pregnant, consider avoiding travel to areas with a CDC Zika travel notice. Women should wait at least eight weeks after travel before trying to get pregnant. Men should either consistently and correctly use condoms during sexual intercourse or not have sexual intercourse for at least six months after travel to an area with Zika virus transmission. 
    • SYMPTOMS AFTER TRAVEL: Zika virus testing should be offered to people with symptoms of Zika virus disease, including pregnant women and others who develop symptoms during or following travel.

Resources

This email distribution tool is supported by funding from grant U01CK000175 of the U.S. Centers for Disease Control and Prevention (CDC) to the Massachusetts General Hospital. The tool attempts to capture up-to-date notices and alerts at the time of posting; however, components of this information are constantly changing. By using this tool, you agree that the Massachusetts General Hospital and tool developers/supporters are not liable for any adverse outcomes, including those relating to travel.

 

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