ECDC: Communicable Disease Threats -Week 23

 

 

# 6378

 

With the EUR02012 underway in Poland and the Ukraine, and the London Olympics set to begin in a little over a month, a lot of attention will be paid to public health surveillance and reporting out of Europe this summer.

 

On Friday, in How The ECDC Will Spend Your Summer Vacation, I described some of these monitoring efforts.  One of the products of this surveillance effort is the ECDC’s weekly Communicable Disease Threat Report.

 

We’ve the latest version of this report available this morning, which includes reports on multistate outbreaks of measles in the EU, an update on the Legionnaires outbreak in Scotland (see my blog Legionella Update From NHS Lothian), and a new section on enhanced surveillance for the EURO2012 games ( described below):

 

New! UEFA EURO 2012 - MG enhanced surveillance  (weekly update)

Opening date: 7 June 2012

From 8 June, the CDTR includes a section on threats related to the UEFA Euro 2012. It contains information gathered through epidemic intelligence activities concerning health events or public health measures relevant for the football tournament. The information is classified regarding host countries (Poland and Ukraine), other participating countries (Croatia, Czech Republic, Denmark, England, France, Germany, Greece, Italy, the Netherlands, Portugal, Republic of Ireland, Russian Federation, Spain and Sweden) and other bordering countries (Belarus, Hungary, Lithuania, Moldova, Romania and Slovakia).   

 

 

This report also contains information on non-EU threats, such as H5N1, polio, dengue, malaria, and other diseases around the globe.

 

Surveillance reports - 08 Jun 2012

Available as PDF in the following languages:

 

The World Health Organization today released a 5-page FAQ (Frequently Asked Questions) document providing health information to people traveling to the EURO2012 games.

 

This PDF covers a wide range of topics, including the signs and symptoms of measles and rubella, how to survive a stampede, and how call for emergency services in Poland and the Ukraine on your cell phone. 

 

 

Questions answered: health advice for travellers to EURO 2012

11-06-2012

WHO/Europe has produced detailed health advice for those attending the 2012 UEFA European Football Championship (EURO 2012). It includes information on how to prepare before leaving home, stay safe in crowds, seek emergency health care, and avoid, recognize the symptoms of and treat common travellers’ illnesses.

More information

• Frequently asked questions (FAQ): EURO 2012

 

 

 

While there are some legitimate public health threats involved anytime hundreds of thousands of people from around the world congregate in a small region, the individual risks to one’s health and safety are generally quite small.

 

Perhaps the best advice to anyone planning a holiday, regardless of the destination, is to make sure their immunizations are up-to-date. Many of the health threats one might encounter in their travels are vaccine-preventable.

 

That and being smart about consumption of local food and water, the prevention of tick and mosquito bites, and knowing about specific health threats that may exist along your route, will go a long ways towards making any trip a safe and healthy one.

 

The CDC maintains an extensive Traveler’s Health Website, which includes the 2012 Yellow Book, and travel health information to more than 200 international destinations.

»» Read More

CDC Issues HFMD Travel Notice For Vietnam

 

Photo Credit University of Iowa

#6349

 

In terms of threat levels, the CDC issues several different types of travel notices, with the lowest threat belonging to the category called `In The News’. 

 

Essentially, this is an acknowledgement there are reports of sporadic cases of a disease in a specific country or region, but that they pose `No increased risk over baseline for travelers observing standard recommendations’.

 

On Friday, the CDC issued an `In The News’ travel notice on the ongoing outbreak of HFMD in Vietnam.

 

HFMD (Hand Foot Mouth Disease) is a relatively common, and usually mild, viral illness seen mainly in children under the age of 10 (although adults are vulnerable as well) and may be caused by several of the non-polio enteroviruses.

 

The 60+ non-polio enteroviruses identified to date are among the most prevalent viral infections in the world, probably only second to the myriad and ubiquitous variants of Rhinovirus (`common cold’) that circulate every year.

 

The most common causes of HFMD are the Coxsackie A16 virus, and the Enterovirus-71 (EV-71), and more rarely the Coxsackie A10 virus. In recent years, we’ve also seen the emergence of the Coxsackie A6 virus as a cause, first in Finland, and this past year, even in the United States (see MMWR: Coxsackievirus A6 Notes From The Field).

 

HFMD in the United States is most often due to the Coxsackie A16 virus, which is generally mild, rarely causes serious illness, and outbreaks of which are not uncommon in childcare facilities.

 

EV-71 HFMD is most commonly found in the Asia, with serious outbreaks recorded over the past dozen years in places like China, Malaysia, Hong Kong and most recently, Vietnam.

 

This version of the HFMD can sometimes be quite serious, with viral meningitis - and less commonly, encephalitis – complicating matters.

 

Two major genotypes of EV-71, EV-71 B and EV-71 C, have been identified as being responsible for a number of severe outbreaks in Australia, Japan, China, Malaysia, and Taiwan since 1997.

 

A couple of years ago, the Virology Journal, published an analysis of an EV-71 HFMD virus that caused a major disease outbreak in Fuyang City, China in 2008 that showed it was due to an emerging recombinant virus (see China: A Recombinant EV-71).

 

A reminder that viruses are always changing, evolving, looking for an evolutionary advantage.

 

Yesterday, the Thanh Nien Daily carried a story indicating that the number of HFMD cases in Vietnam this year is 10 times greater than last year, and that researchers are looking to see if the virus has mutated.

 

 

Cases of HFMD in Vietnam increase more than tenfold year on year

Saturday, May 26, 2012 04:20:00

The number of hand, foot and mouth disease (HFMD) cases in Vietnam is 10.2 times higher over the first five months of 2012 than it was for the same period last year.

 

According to the Ministry of Health’s report on Friday, 46,277 HFMD cases have been recorded across Vietnam since the beginning of this year.

 

Twenty-seven deaths have also been reported, 1.7 times more than last year, it said.

 

(Continue . . . )

 

 

With that in mind, here are some excerpts from the CDC’s Travel Notice, and some resources on HFMD from the CDC Website.

 

 

In the News
Hand, Foot, and Mouth Disease in Vietnam

This information is current as of today, May 27, 2012 at 15:03 EDT

Released: May 25, 2012

What Is the Current Situation?

As of April 29, 2012, the Vietnam Ministry of Health has confirmed nearly 40,000 cases of hand, foot, and mouth disease (HFMD) since the beginning of 2012. Cases have occurred in 63 provinces, and 20 deaths (all in children under 5) have occurred in 10 provinces. Hai Phong in the North has the highest number of cases, followed by Bac Can, Yen Bai, Lao Cai, Hoa Binh, Da Nang, Vinh Phuc, Quang Tri, Dong Thap, and Binh Dinh Provinces in the Center and Southern Regions. The Vietnam Ministry of Health is taking steps to control the outbreak.

 

Large outbreaks of severe HFMD occur frequently in some countries in Asia. Thousands of people may get infected during these outbreaks. Some people, particularly young children, may have severe disease requiring hospitalization or even causing death. To learn more outbreaks occurring around the world, visit the World Health Organization’s website.

<SNIP>

How Can Travelers Protect Themselves?

There is currently no vaccine or medicine to prevent HFMD. However, you can protect yourself from HFMD by practicing healthy personal hygiene.

• Wash your hands often with soap and water, especially before eating and after going to the bathroom or changing a diaper. If soap and water are not available, use an alcohol-based hand cleaner with at least 60% alcohol. Consider packing alcohol-based hand cleaner in your carry-on luggage to ensure you have it when needed.
• Disinfect dirty surfaces and soiled items. If you are able, first wash the items with soap and water; then disinfect them with a solution of chlorine bleach (made by mixing 1 tablespoon of bleach with 4 cups of water) or a cleaning product that contains bleach.
• Avoid close contact such as kissing, hugging, or sharing eating utensils or cups with people who have HFMD.

There is no specific treatment for HFMD. If you do develop mouth sores:

• Take over-the-counter medications to relieve pain and fever. (Caution: Aspirin should not be given to children.)
• Use mouthwashes or sprays that numb mouth pain.
• Drink plenty of liquids to stay hydrated.

Seek medical care:

• If you are sick and unsure if you have HFMD.
• If you cannot swallow liquids to stay hydrated.

 

 

You obviously don’t have to travel to Vietnam, or other parts of Asia, to be exposed to HFMD. 

 

For that reason, everyone should learn about the virus, and how it is spread.  To that end, we’ve a couple of multimedia products related to hand, foot, and mouth disease from the CDC.

 

• CDC Feature: Hand, Foot, & Mouth Disease
  An article that provides the basics about hand, foot, and mouth disease, who is commonly affected, symptoms, how it spreads, and ways to prevent it.
• Podcast: Hand, Foot, and Mouth Disease
  A CDC pediatrician and dad talks about hand, foot, and mouth disease, its symptoms, and tips to prevent your family from getting this disease.

»» Read More

The Pathogen Less Taken

 

 

# 6320

 

 

While the United States, Canada, and much of Europe remains free of most of the exotic diseases one might encounter in Africa, South America, or Asia – each year thousands of people infected with diseases like dengue, malaria, yellow fever, or cholera return from travels abroad.

 

These imported diseases not only pose a health risk for the unlucky traveler, they also have the potential to be spread locally.

 

A few examples of internationally imported infectious diseases include:

 

• The 2009 influenza pandemic spread rapidly, in large part, due to the heavy spring break air travel in and out of Mexico during the initial outbreak.
• Starting in 2010, Florida reported their first cases of locally acquired dengue fever in more than half a century – no doubt imported by someone who had visited a country where that virus is endemic.
• I told the story in It's A Smaller World After All, but in 2007 a traveler returning from India brought the Chikungunya virus back to northern Italy which led to more than 290 cases being reported in the province of Ravenna.
• The ongoing epidemic of Cholera in Haiti has been identified as an Asian strain, and is widely believed to have been brought into the country by UN Peacekeeping personnel.
• And almost every year we see warnings issued from Australia (see A Message Of Import) to vacationers returning from Bali who may have been exposed to a `range of infectious diseases, including mosquito borne diseases like Dengue fever, gastroenteritis, sexually transmissible infections, and rabies.’

 

Since you can literally travel from just about any two cities (with airports) anywhere in the world in 24 hours or less, no longer are the oceans, or distance, a protection against diseases normally seen only in remote areas of the world.

 

All of which makes it imperative that travelers know what diseases they might be exposed to when globe-trotting and what precautions (including inoculations) they should take.

 

To that end, the World Health Organization has published their 2012 edition of the International Travel and Health book, and while if you want the entire book you’ll have to purchase it, there are sample chapters and a number of illuminating maps posted online for your consideration.

 

 

2012 Edition

More than 900 million international journeys are undertaken every year. Global travel on this scale exposes many people to a range of health risks. Many of these risks, can be minimized by precautions taken before, during and after travel. This report provides information on health risks for travellers.

 

• View or download selected chapters
• ITH clinic poster
• Order in hardcopy
• Order in PDF format
• ITH Promotion Flyer

For individual queries about travel, refer to national or specialised websites, ministries of health, travel clinics or practitioners.

Links to national travel and health websites

Some of the updated disease distribution maps that are available online include:

• Chikungunya
• Cholera
• Crimean Congo HF
• Dengue
• Hepatitis A
• Hepatitis B
• HIV infection
• Japanese encephalitis
• Malaria
• Meningococcal disease
• Poliomyelitis
• Rabies
• Schistosomiasis
• Tuberculosis
• Yellow Fever Africa
• Yellow Fever Americas Yellow Fever Risk Maps
  pdf, 1.44Mb

 

 

Many of the diseases one is likely to encounter are vectored by mosquitoes, ticks, fleas, or biting flies.

 

While rare, some – like West Nile, Lyme Disease, or EEE – may even be acquired here in the United States. Which is why the State of Florida strongly recommends that locals and visitors follow the `5 D’s’ of mosquito protection.

 

 

Good advice, whenever you are in mosquito territory.

 

For more information, the United States CDC maintains a full featured website just for travelers, with updates, travel advisories, and advice.

 

Travelers' Health

 

Hot off the press! Explore Travel Health with the new 2012 Yellow Book!

See Travelers' Health site FAQ and Useful Links.

 

 

None of this should dissuade you from making that long awaited trip to some exotic locale. If you take the proper precautions, the odds of contracting a serious illness are small.

 

But it should spur you to investigate – before you depart – what types of diseases threats you might encounter and what steps you need to take to avoid contracting them.

»» Read More

U.S. Issues Dengue Warning For The Bahamas

 

 

# 5749

 

A couple of weeks ago in Dengue Roundup: Puerto Rico, Florida, Bahamas, I wrote about the rise in Dengue fever cases being reported in the Bahamas.  Those numbers have continued to climb, and this week the United States Embassy in Nassau issued the following email alert.

 

 

 

Emergency Message for U.S. Citizens: Bahamas, Dengue Fever Warning

Disease Outbreak

Western Hemisphere > Bahamas

8/9/2011

U.S. Embassy Nassau released the following Emergency Message for U.S. Citizens on August 9, 2011:

U.S. citizens should be aware of the recent dengue fever outbreak in The Bahamas.   In the past few weeks, over 200 cases have been reported and almost 1,000 cases have been reported of individuals suffering from symptoms that match dengue.

 

The Ministry of Health has begun spraying local communities, especially the more densely populated areas, and they have stressed to the public the importance of prevention.

 

The local government continues to combat this outbreak through greater public awareness of dengue and the importance of mosquito control.

(Continue . . . )

 

The lengthy email then goes into detail on the causes, transmission, symptoms, and treatment of the illness.

 

The email offers the following advice:

 

How Can I Prevent Dengue?

The best way to prevent dengue virus infection is to take special precautions to avoid being bitten by mosquitoes. Several dengue vaccines are being developed, but none is likely to be licensed by the Food and Drug Administration in the next few years.

When outdoors in an area where dengue fever has been found, use a mosquito repellent containing DEET, Picaridin, and oil of lemon eucalyptus are less effective than DEET so are not recommended as a substitute unless there is an allergy or a contraindication to DEET or it is unavailable. Dress in protective clothing-long-sleeved shirts, long pants, socks, and shoes.

Because Aedes mosquitoes usually bite during the day, be sure to use precautions especially during early morning hours before daybreak and in the late afternoon before dark.

Other precautions include:

Keep surrounding areas free from free standing water.

 

Wear long sleeves and light colored clothes.

 

Use insect repellent when outside.

 

Unscreened windows should be kept closed to prevent the mosquitoes from entering.

 

Carefully inspect your environment to detect and eliminate all areas with standing water where mosquitoes can breed, such as flower pots, containers, birdbaths, discarded tires, etc.

»» Read More

MMWR: Dengue Among Travelers Returning from Haiti

 

 

# 5697

 

 

Last summer, the CDC issued a Health Advisory via their HAN (Health Alert Network) in order to inform health care providers of the possibility of seeing Dengue Fever in returning visitors from areas where the virus is being seen.

 

This is an official
CDC HEALTH ADVISORY

Distributed via Health Alert Network
Sunday, July 25, 2010, 22:35 EDT (10:35 PM EDT)
CDCHAN-00315-2010-07-25-ADV-N

Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas

Summary

Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF).

 

The return of locally acquired dengue fever to Florida in 2009 - after an absence of 6 decades - was no doubt due to repeated introductions of the virus by travelers coming from countries where the virus is endemic.

 

You can find the CDC MMWR report on the reemergence of Dengue in Key West HERE.

 

In Travel-Associated Dengue Surveillance --- United States, 2006—2008, also published last summer, the MMWR came out with a new report on Travel Associated Dengue in the United States.

 

This surveillance pre-dates the Key West outbreak, and as the study reports, `Clinically recognized cases of travel-associated dengue likely underestimate the risk for importation because many dengue infections are asymptomatic or mildly symptomatic’.

 

 

Worldwide, the explosive growth of Dengue – when combined with our highly mobile society – provides ample opportunities for this mosquito borne virus to travel to new regions.

 

Dengue’s success is well illustrated by the following graph from the World Health Organization.

 

What this graph doesn’t indicate is another doubling of dengue cases has taken place over the past 5 years.  

 

 

All of which serves as prelude to Friday’s MMWR release, which looked at the incidence of Dengue fever in travelers returning from Haiti last fall.  You can read the entire report at the link below.

 

 

Dengue Virus Infections Among Travelers Returning from Haiti --- Georgia and Nebraska, October 2010

Weekly

July 15, 2011 / 60(27);914-917

 

The gist, however, is that of 28 travelers who had recently returned from spending 7-11 days in Haiti, 7 (25%) showed laboratory evidence of recent DENV infection.

 

As the report explains:

 

All 28 travelers were asked to participate in a survey using a 53-item questionnaire to collect information regarding demographics, medical and travel history, pretravel preparations and knowledge, mosquito-avoidance practices while in Haiti, and illnesses during and after travel. Twenty-five (89%) travelers participated: 21 by telephone or in-person interviews, two by proxy, and two by self-administration.

 

Based on this questionnaire, 90% had a pre-travel health care appointment and 57% researched travel advice on the Internet. 95% reported having pre-travel knowledge about infectious diseases in Haiti, and 48% stated they were aware of the dangers of Dengue.

 

Despite these opportunities for awareness, only 24% reported using mosquito repellent several times a day.

 

Moreover, no statistically significant association was found between acquiring a dengue infection and pre-travel knowledge or mosquito-avoidance practices.

 

The editorial note concludes by saying:

 

All travelers to Haiti should seek pretravel health counseling, preferably 4--6 weeks before travel, receive information about risks for DENV infection, and employ recommended mosquito-avoidance practices.

 

Clinicians evaluating travelers with febrile illness who recently have returned from Haiti or other DENV-endemic areas are encouraged to consider dengue in their differential diagnosis, submit specimens for laboratory testing, and report cases of dengue expeditiously to local or state health departments

 

Whether you are tramping through the tropics where Dengue is endemic, or simply strolling through your neighborhood when mosquitoes are active, this advice from the Florida health department remains worth heeding.

 

»» Read More

China: Spring Festival - High Risk Individuals Should Not Travel Home

 

 

# 4251

 

 

Returning home in Asia during the time of the lunar New Year is practically a cultural imperative, particularly in countries like China, Vietnam, Malaysia, and Korea.  

 

Chunyun – or China’s Spring Festival Travel Season - is often described as the largest yearly human migration on the planet.

 

While the actual date varies each year (it is based on the Lunar Calendar), Chinese New Year falls between late January and mid-February.

 

This year, the Chinese Lunar New year falls on February 14th, and with it comes a cultural ethic for millions who have moved to the big cities or away to school to return home to visit with their families.

 

These travelers will spend a few days in their home village or town, and then travel back to the city where they work or live.

 

With an influenza pandemic ongoing, this is an opportunity for the virus to hitch a ride to remote areas of China and other parts of Asia that have been relatively untouched by the illness. 

 

And that has authorities in Beijing worried.

 

Today, China’s state run media has announced the following advice from the Chinese government regarding travel during this pandemic.

 

China advises less travel ahead of Spring Festival amid flu fear

 

www.chinaview.cn  2010-01-14 01:03:24
 

    BEIJING, Jan. 13 (Xinhua) -- China's Ministry of Health on Wednesday advised children, old people and other vulnerable groups to stay put for the upcoming Spring Festival in a bid to prevent an A/H1N1 outbreak.

 

Usually a large number of Chinese people, mostly migrant workers and students, travel back home for family reunions in time of the Lunar New Year, which falls on Feb. 14, resulting in a highpeak of mass transportation.

 

Pregnant women, children, the elderly, obese people and those with chronic diseases were advised not to frequent crowded places and see doctors as soon as possible if experiencing respiratory symptoms, the ministry said on its official website.

 

The Chinese mainland reported 51 deaths from the A/H1N1 influenza in the week from Jan. 4 to Jan. 10, with 2,173 new cases confirmed.

»» Read More

International Travelers At Risk Of Isolation

 

# 3925

 

 

Although told in hyperbolic tabloid style, the cautionary tale below is a reminder that travelers to a number of countries should keep in mind. 

 

When you arrive in some countries, you may be screened for fever or flu-like symptoms, and if they suspect influenza you could be separated from your group and forcibly placed into isolation.

 

 

British children rounded up at airport in Egypt over swine flu fears

By Lesley Yarranton 1/11/2009

Families rounded up at the airport

Forty British children have been rounded up under draconian swine flu regulations as they arrived in to start holidays in Egypt.

 

Officials with heat-monitoring equipment are forcibly holding anyone with temperatures of more than 38C.

 

Horrified parents, taking half-term breaks, have had to watch helplessly as their tearful children are frogmarched off by armed guards to a squalid makeshift hospital at the Sharm el Sheikh resort.

 

Eight-year-old Ellie Kemp and her father, Chris, 36, of Wellingborough, Northants, were taken to a "hellhole" hospital where they had to share a bed and were fed rice and water along with at least 30 other British families. It meant they missed their week-long allinclusive holiday, for which the family paid £3,000. Mum Sarah insists Ellie had no symptoms. Sarah said: "This bloke just grabbed my daughter who was screaming. It was the most frightening experience of my life. She and her dad were stuck in a room you wouldn't leave your dog in."

 

Eleven-year-old Millie Powell, of Rochester, Kent, was also taken from her parents by force. Her worried aunt, Claire Harvey said: "Her parents were terrified Millie would catch something in the hospital."

 

A Foreign Office spokesman said: "There is little we can do as these measures have been put in place by the Egyptian authorities."

 

These measures have also been reported in India, Japan, China and other nations.   The CDC reminds US Travelers:

 

 

Possible 2009 H1N1 Flu Screening for International Travelers

Updated: October 15, 2009

Current Situation

Due to the circulation of 2009 H1N1 influenza in the United States and many other countries, airport staff in some foreign countries may check the health of arriving passengers. Many other countries, including Japan and China, are screening arriving passengers for symptoms of the flu.

 

If you are sick with symptoms of flu-like illness, you should not travel. These symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu and have respiratory symptoms without a fever.

 

The United States is not screening travelers who arrive from other countries or depart for other countries.

 

In other countries that are conducting entry screening for 2009 H1N1 flu, travelers may be checked for fever and other symptoms of 2009 H1N1 flu, and their travel may be delayed. Consult the embassy of the country, or countries, in your travel itinerary for information about entry screening procedures (see Websites of U.S. Embassies, Consulates, and Diplomatic Missions for contact information).

 

When you travel internationally from the United States, officials in other countries may ask you to:

• Pass by a scanning device that checks your temperature. (The device may look like an airport metal detector, a camera, or a handheld device.) In some countries this may be done before you disembark at your destination.
• Have your temperature taken with an oral or ear thermometer
• Fill out a sheet of questions about your health
• Review information about the symptoms of 2009 H1N1 flu
• Give your address, phone number, and other contact information
• Be quarantined for a period of time if a passenger on your flight is found to have symptoms of 2009 H1N1 flu
• Contact health authorities in the country you are visiting to let them know if you become ill

If you have a fever or respiratory symptoms or are suspected to have 2009 H1N1 flu based on screening, you may be asked to:

• Be isolated from other people until you are well
• Have a medical examination
• Take a rapid flu test (which consists of a nasal swab sample)
• Be hospitalized and given medical treatment, if you test positive for 2009 H1N1 flu

Please note that the U.S. Department of State usually cannot interfere with the rights of other countries to screen airline passengers entering or exiting their countries, nor can it influence the number of days a traveler is placed in quarantine.

 

Because these outbreak-related delays, which could include several days of quarantine, may affect planned activities and lead to unexpected costs, CDC strongly recommends that travelers consider purchasing travel insurance. To find a list of possible travel health and medical evacuation insurance companies, visit Medical Information for Americans Abroad (U.S. Department of State).

»» Read More