The Swiss Expert Committee for Travel Medicine (ECTM) - a body of the Swiss Society for Tropical and Travel Medicine (FMH) - has revamped the Safetravel® website and renamed it to HealthyTravel.ch. The website continues to offer basic travel medicine recommendations for laypersons free of charge. Professionals can also subscribe to additional travel medicine information and recommendations such as in-depth country-specific information, vaccination recommendations with expert opinions, detailed maps (including malaria recommendations), fact sheets (including e.g. dosage information for malaria prophylaxis) and other important travel medicine content. These can be used during travel medicine consultation of patients and clients and can be individually compiled for the traveller, printed out or sent electronically.  The recommendations and content on HealthyTravel.ch reflect the recommendations of the Swiss Expert Committee for Travel Medicine. They are developed in cooperation with the Federal Office of Public Health (FOPH). The website is under construction and will be continuously expanded with additional content and updates. Please note that all content available on the website HealthyTravel.ch is protected by copyright and may not be passed on to third parties. Further information can be found in the flyer (LINK). The Swiss Expert Committee for Travel Medicine will be happy to answer any questions at info@healthytravel.ch !

In the beginning of May 2022, one case of monkeypox was detected in England, which had occurred after travel to Nigeria. In the course of this, 6 further cases of monkeypox were diagnosed in England in people with no previous travel and no contact with known travel-associated cases. These are two cases in one family and four cases in men who have sex with men (MSM). The latter apparently got infected in London. Apart from the family and two of the MSM cases, there are no known links between the cases. Further 2 cases have been reported in the meantime. Investigations into the sources of infection and other suspected cases are in progress.Additional cases are reported by GeoSentinel and various media reports from the following countries:France: 1 suspected case (Île-de-France region).Italy: 3 cases, one confirmed, 1 case with travel history Canary Islands (link)Canary Islands: 1 suspected casePortugal: 14 confirmed cases, another 6 suspected cases (link), Lisbon Region and Tagus Valley RegionSpain: 7 confirmed, 23 suspected cases, (link)Sweden: 1 confirmed case, 1 suspected caseCanada: 17 suspected cases (link)USA: 1 confirmed case with travel history to Canada (link) Description: Monkeypox is a zoonosis caused by an orthopoxvirus, a DNA virus genetically related to the variola and vaccinia viruses. Monkeypox is endemic in West and Central Africa. Increased cases have been recorded in Nigeria since September 2017, and imports by returning travellers to England and the USA have also been recorded more frequently in recent years. There are two types of monkeypox virus: the West African type and the Central African type (Congo Basin).Transmission: Monkeypox is transmitted from infected animals by a bite or by direct contact with blood, body fluids or lesions of the infected animal. It can be transmitted via abrasions in the mouth to people who eat infected animals. It can also be transmitted from person to person via the respiratory tract, through direct contact with body fluids of an infected person or with virus-contaminated objects. The incubation period is 5-21 days, usually about 7 to 17 days.Symptoms: Symptoms of monkeypox include fever, headache, muscle aches, swollen lymph nodes and chills. 1- 3 days after the onset of symptoms, a rash develops that may look like chickenpox or syphilis and spreads from the face to other parts of the body, including the genitals. The disease is usually mild. In immunocompromised individuals, the disease can be severe. The mortality rate is about 1% for the West African type and up to 10% for the Central African type. For further details, see WHO factsheet, ECDC and CDC.

Since the beginning of the year, more than 7'300 dengue cases have been registered in Singapore, including 1'005 in the last week of April alone. Dengue is mainly transmitted by Aedes aegypti mosquitoes. In March 2022, the incidence of these mosquitoes in Singapore was about 48% higher than in the same period last year.

According to media reports citing the Ministry of Health of São Tomé and Príncipe, more than 40 cases of dengue fever (30 of which were laboratory-confirmed) have been reported nationwide since 11 April 2022.

The number of measles cases reported globally increased by 79% in the first 2 months of 2022, to 17'338 cases, compared to the same period in 2021. WHO and UNICEF warn that ideal conditions prevail for severe measles outbreaks (and outbreaks of other vaccine-preventable diseases). Pandemic-related disruptions, inequalities in access to immunisation and the redistribution of resources have severely affected routine childhood immunisation in many places.

A national state of emergency has been declared due to severe flooding and landslides that have caused devastating damage in KwaZulu-Natal and parts of the Eastern Cape.According to the South African government, 435 people have died and over 48 are still missing as of 19 April 2022. In addition, more than 40'000 people have been displaced and thousands of homes destroyed or damaged, including health centres. Electricity and water supplies have collapsed.

According to the WHO, a 31-year-old man from Mbandaka who had been vaccinated against Ebola was confirmed to be infected with Ebola; the man died on 21.4.2022. The source of infection is not known. The virus of this outbreak appears to be different from that of previous outbreaks in this province (2018 and 2020). A second Ebola case, a close patient contact, was confirmed on 25.4.2022.Ebola is a viral, haemorrhagic, very severe or fatal disease. It is transmitted through direct contact with body fluids and excretions of an infected person (blood, saliva, vomit, stool, sweat, semen, urine, etc.) or with infected animals (especially monkeys, antelopes, rodents, bats). The symptoms are sudden high fever, muscle pain, fatigue, sore throat or headache, followed by diarrhoea, vomiting and internal and external bleeding. Early hospitalisation with supportive care (hydration, maintenance of normal blood pressure) can improve the prognosis.

A 41-year-old man from ElSalto/Jalisco in Mexico has died of rabies. He had been bitten on the right hand by a bat in January 2022. He had a medical consultation on 9.4.2022 due to pain in his arm, received a rabies vaccination for the first time on 13.4.2022 and died on 18.4.2022.In Jalisco, the last humane rabies case from dog bites occurred in 1995. From 1996 to 2021, there were only seven cases associated with wild animals.

A 45-year-old man from the village of Bagayiri, Boussé district, Plateau Central region, died of yellow fever in Ouagadougou on 20 March 2022. The man had not been vaccinated against the disease.

An unvaccinated tourist (country of origin unknown) died of yellow fever in the state of Tocantins. In March 2022, the deceased had gone sport fishing on Lago Peixe/Angical, between Peixe, São Salvador, and Parana.The vaccination rate against yellow fever is insufficient in the region.

Sweden experienced a record year for TBE in 2021 with 553 cases. The warm summer of 2020, with an increase in the population of the small rodents, as well as Covid-19-related reduced foreign travel, are cited as factors for the increase in TBE infections in 2021.

According to IATA (International Air Transport Association), Paraguay has adjusted the entry requirements for yellow fever (see bold). Vaccination against yellow fever is mandatory for entry within 6 days (not for airport transit there) from:- Brazil, Bolivia, Peru and Venezuela.Exempt from this entry requirement are: Persons >60 years old and children <1 year old.

According to IATA (International Air Transport Association), Nicaragua has adjusted the entry requirements for yellow fever for children (see below). Yellow fever vaccination is mandatory for entry from the following countries (not for airport transit there): Angola, Argentina, Benin, Bolivia, Brazil, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Colombia, Congo, Côte d'Ivoire, Ecuador, Equatorial Guinea, Ethiopia, Franz. Guyana, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Guyana, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Panama, Paraguay, Peru, Rwanda, Senegal, Sierra Leone, Sudan, South Sudan, Togo, Trinidad and Tobago, Uganda and Venezuela.Exempt from this entry requirement are: Persons >60 years old and children <9 months old.

Health authorities report continued malaria transmission in the region of Zona Norte in the country. Since September 2021, increased numbers of malaria cases have been reported in Medio Queso, San Gerardo, Cuatro Esquinas, Isla Chica, La Trocha, Las Delicias, Coquita, Santa Cecilia and San Francisco.

In certain information sheets (French version, not English version) of the Embassy of Mozambique in Geneva, proof of a yellow fever vaccination is still required for visa applications. After personally contacting the embassy in Geneva, the ECTM (Expert Committee on Travel Medicine) was assured that this does not apply to people entering from Europe.

A Chikungunya outbreak is reported in Wajik County (located in the north of the country). The dengue outbreak of 2021 in Mombasa and Mandera continues in 2022.

According to authorities, 18 deaths from rabies were reported last year, compared to seven deaths in 2020. Bukidnon province was responsible for the most deaths. According to the authorities, one reason for the increase could be that it was difficult to get vaccinated against rabies due to the pandemic.

In the first three months of 2022, 99 probable cases of leptospirosis were registered in Petrópolis, compared to only three reports in the same period of 2021. The region was hit by heavy rains and flooding in February 2022, which increased again in recent days.Leptospires are bacteria that can be transmitted via the urine of rodents (especially rats). This can happen, for example, when wading through contaminated rivulets, puddles or mud. Transmission to humans occurs via small skin lesions or mucosal contacts through direct or indirect contact with rodent urine. Symptoms of the disease range from flu-like general symptoms, headache, high fever to blood poisoning. Antibiotic treatment is necessary to prevent complications and accelerate healing.

The Ugandan Ministry of Health reports an outbreak of yellow fever with a total of 8 cases from the districts of Wakiso and Masaka on Lake Victoria. Four of the cases are reported to have not been vaccinated against yellow fever, there is no information on the vaccination status of the others.

On 23 March 2022, the Ministry of Health of Côte d'Ivoire reported 11 confirmed dengue cases to the WHO, including 1 death. Nine cases originated from Abidjan (particularly from the districts of Cocody Bingerville and Treichville Marcory), and 2 cases from the hinterland districts of Adiaké and Daloa.A traveller returning to Switzerland who had been in Côte d'Ivoire was also recently diagnosed with dengue infection.Dengue outbreaks have been recorded repeatedly in Côte d'Ivoire in recent years.

According to the World Health Organisation (WHO), a chikungunya outbreak was detected in Dolo Ado district in Somali Region on 17 January 2022. A total of 311 suspected cases were reported, three of them confirmed.

According to IATA (International Air Transport Association), Egypt has adjusted its entry requirements. Vaccination against polio is now mandatory for entry from the following countries (with documentation in the 'International Certificate for Vaccination'):- Guinea-Bissau- Mauritania- UkraineIn addition, polio vaccination is still mandatory from the following countries: Afghanistan, Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, China, D.R. Congo, Republic of Congo, Côte d'Ivoire, Ethiopia, Gambia, Ghana, Guinea, Iran, Kenya, Liberia, Madagascar, Mali, Niger, Nigeria, Pakistan, Senegal, Sierra Leone, Somalia, Sudan, South Sudan, Tajikistan, Togo, Uganda and Yemen.

At the beginning of March, an almost 4-year-old girl from Jerusalem was diagnosed with acute flaccid paralysis. Circulating vaccine poliovirus type 3 (cVDPV3) was detected in the stool. In the course, another 5 persons were diagnosed with cVDPV3 and one suspected case is still awaiting test results. All 7 persons had not been vaccinated against polio.Further testing revealed genetic links to VDPV3 strains detected in environmental samples collected from sites in Jerusalem and Bethlehem between September 2021 and January 2022. Health authorities are currently conducting epidemiological and virological investigations on site to further determine the source and origin of the isolated virus and the associated potential risk of further spread.

The Brazilian Ministry of Health reports a 35.4% increase in dengue cases in the first two months of this year compared to 2021, with 30 deaths and 128,379 cases registered, according to the report. The municipalities with the most probable dengue cases were Goiânia, Brasília, Palmas, Sinop and Aparecida de Goiânia. Consequences for travelersProtect yourself optimally around the clock (24/7) against mosquitoes (see factsheet mosquito and tick bite protection): during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria if you are in a risk area. If you have a fever: take medication containing the active ingredient paracetamol and make sure you drink enough fluids. Do not use any medicines containing the active ingredient acetylsalicylic acid (e.g. Aspirin®), as this can increase the tendency to bleed in the case of a dengue infection (see also factsheet dengue). During stays in malaria areas, malaria should always be ruled out by means of a blood smear if the fever is >37.5 °C. Visit a medical facility to do so (see also factsheet malaria). ReferencesOutbreak News Today, 25.3.2022

Since the beginning of 2022, 33 suspected Lassa cases have been recorded in Liberia, 17 confirmed and 5 fatal. The cases come from Bong County, Grand Bassa Counte and Nimba County. In Togo, 1 case was confirmed in the north of the country at the end of February.Lassa virus is transmitted via rodent excretions, e.g. through contaminated food, or it is inhaled. Human-to-human transmission occurs through contact with body fluids of infected persons. Lassa belongs to the group of haemorrhagic fevers. The symptoms of the disease range from mild flu-like symptoms to fever with bleeding. Consequences for travelersWash or disinfect hands regularly and maintain optimal food hygiene. Mouse-infected places should be avoided. Avoid contact with ill or deceased persons suspected of having Lassa fever. ReferencesOutbreak News Today, 18.3.2022