Ultime notizie
On 27 September 2024, Rwanda reported its first Marburg virus disease outbreak (see EpiNews as of 3 Oct 2024). Updates as of 18.10.2024:
- As of 16 October 2024, 62 cases of MVD have been reported, including 15 deaths (case fatality rate: 24%); 9 patients are in isolation. So far, 38 patients have recovered. For updates, see LINK. Cases are reported from eight of the 30 districts. Health care workers continue to be disproportionately affected.
- Treatment trial: WHO announced the commencement of a randomized, controlled trial to test remdesivir and a monoclonal antibody designed specifically against MARV (derived from antibodies from a MVD survivor). Link to study with NHP model. Gilead donates remdesivir for emergency use to Rwanda.
- Vaccination: On 6 October 2024, vaccinations (provided by Sabin Vaccine Institute) for healthcare workers and high risk contacts started as part of a Phase 2 rapid response open-label study; as of 16.10.2024 a total of 856 doses have been administered. Link to phase 1 study of the cAd3-vector based vaccine (single-dose i.m.). Link to the Marburg virus vaccine consortium, MARVAC. Link to GAVI, Marburg-page.
- Rwanda continues implementing a number of control measures including: entry and exit screening at the airport, see EpiNews of 10.10.2024,
- Link to history of Marburg Outbreaks via CDC webpage, see LINK.
- CDC has put Rwanda on alert level 3 (Reconsider nonessential travel to the Republic of Rwanda).
- As of 14 October 2024, the US Department of Health and Human Services started public health entry screening for those entering the country after having been to Rwanda the past 21 days, see LINK.
Marburg virus disease (MVD) is a rare but severe hemorrhagic fever, caused by Marburg virus (MARV). Although MVD is uncommon, MARV has the potential to cause outbreaks with significant case fatality rates (up to 88%). All recorded MVD outbreaks have originated in Africa.
Transmission: Fruit bats are the natural reservoir of MARV. The majority of MVD outbreaks have been connected to human entry into bat-infested mines and caves. Humans can also get infected by direct contact with an infected animal (e.g., non-human primate).
Person-to-person transmission occurs by direct contact (through broken skin or mucous membranes) with infected blood, secretions, and body fluids or by indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment. MVD is not an airborne disease, and a person is not contagious before symptoms appear. As a result, if proper infection prevention and control precautions are strictly followed, the risk of infection is regarded as minimal.
Incubation period: usually five to ten days (range 2-21 days).
Symptoms: The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhea. In severe cases, a rash may develop, along with bleeding from various body areas.
Treatment: There are several experimental drugs and vaccines for Marburg, but none has been licensed to date.
Further information, see ECDC Factsheet Marburg Virus, CDC
WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.
ECDC assess the overall risk for EU/EEA citizens visiting or living in Rwanda as low. This is because the likelihood of exposure to MVD – considering the low number of cases reported and the mode of transmission – and the impact are both assessed as low. For details, see LINK.
Follow media and official reports! Follow all the recommendations of the local health authorities!
Travellers should be made aware of the ongoing outbreak. The risk for travellers to Rwanda is assessed as low, but it is high for family members and caregivers who have contact with sick people.
Preventive measures:
- Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
- Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
- Avoid contact with blood and other body fluids.
- Avoid visiting healthcare facilities in the MVD-affected areas for nonurgent medical care or non-medical reasons.
- Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial.
- Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
- Wash and peel fruit and vegetables before consumption.
- Avoid visiting mines or bat caves and contact with all wild animals, alive or dead, particularly bats.
- If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks and eye protection.
- Practice safer sex.
Upon return from Rwanda:
- Watch your health for symptoms of Marburg while in the outbreak area and for 21 days after leaving the outbreak area (no quarantine is required if there are no symptoms).
In case of symptoms
If you develop fever and nonspecific symptoms such as chills, headache, muscle pain or abdominal pain:
- you should separate yourself from others (isolate) immediately and
- directly contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
- alert the healthcare providers of your recent travel to an area with a Marburg outbreak.
For clinicians:
- Consider Marburg as a possible diagnosis in patients with epidemiologic risks factors, especially in people with possible exposure of Marburg cases in Rwanda.
- Further information on evaluation and diagnosis: see LINK and ECDC risk assessment.
In urban districts of Hong Kong further cases of melioidosis were confirmed. Melioidosis is endemic in Hong Kong, though case numbers are low (18 so far in 2024). This serves as a reminder that this infection – though commonly associated with out-door and rural environments – is indeed also endemic in metropolitan surroundings.
Melioidosis is an endemic disease in Asia and Northern Australia. Cases have also been reported from Africa, the Caribbean basin, and the Americas. Cases may increase after hurricanes, heavy rain, typhoons, and other severe weather events.
Melioidosis mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal and liver disease, and others. Information on melioidosis: see CDC.
On 27 September 2024, Rwanda reported its first Marburg virus disease outbreak (see EpiNews as of 3 Oct 2024).
- As of 10 October 2024, 58 cases of MVD have been reported, including 13 deaths (case fatality rate: 22%); 30 patients are in isolation. So far, 12 patients have recovered. For updates, see LINK.
- The cases are reported from eight of the 30 districts in the country. Among the confirmed cases, over 80% are health care workers from two health facilities in Kigali. Contact tracing is underway and follow-up of more than 300 contacts is ongoing.
- On 6 October 2024, vaccinations for healthcare workers and high risk contacts started as part of a Phase 2 rapid response open-label study; vaccines have been provided by Sabin Vaccine Institute.
- Rwanda has been implementing a number of control measures including: entry and exit screening at the airport, measures in education settings and conferences, ban on patient visits to hospitals, strengthening infection prevention and control protocols in hospitals, and measures to limit contact with dead bodies.
- CDC has put Rwanda on alert level 3 (Reconsider nonessential travel to the Republic of Rwanda).
- On 7 October 2024, the US Department of Health and Human Services announced that on the week of 14 October 2024 US CDC will start public health entry screening for those entering the country after having been to Rwanda the past 21 days, see LINK.
Marburg virus disease (MVD) is a rare but severe hemorrhagic fever, caused by Marburg virus (MARV). Although MVD is uncommon, MARV has the potential to cause outbreaks with significant case fatality rates (up to 88%). All recorded MVD outbreaks have originated in Africa.
Transmission: Fruit bats are the natural reservoir of MARV. The majority of MVD outbreaks have been connected to human entry into bat-infested mines and caves. Humans can also get infected by direct contact with an infected animal (e.g., non-human primate).
Person-to-person transmission occurs by direct contact (through broken skin or mucous membranes) with infected blood, secretions, and body fluids or by indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment. MVD is not an airborne disease, and a person is not contagious before symptoms appear. As a result, if proper infection prevention and control precautions are strictly followed, the risk of infection is regarded as minimal.
Incubation period: usually five to ten days (range 2-21 days).
Symptoms: The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhea. In severe cases, a rash may develop, along with bleeding from various body areas.
Treatment: There are several experimental drugs and vaccines for Marburg, but none has been licensed to date.
Further information, see ECDC Factsheet Marburg Virus, CDC.
WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.
ECDC assess the overall risk for EU/EEA citizens visiting or living in Rwanda as low. This is because the likelihood of exposure to MVD – considering the low number of cases reported and the mode of transmission – and the impact are both assessed as low. For details, see LINK.
Follow media and official reports! Follow all the recommendations of the local health authorities!
Travellers should be made aware of the ongoing outbreak. The risk for travellers to Rwanda is assessed as low, but it is high for family members and caregivers who have contact with sick people.
Preventive measures:
- Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
- Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
- Avoid contact with blood and other body fluids.
- Avoid visiting healthcare facilities in the MVD-affected areas for nonurgent medical care or non-medical reasons.
- Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial.
- Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
- Wash and peel fruit and vegetables before consumption.
- Avoid visiting mines or bat caves and contact with all wild animals, alive or dead, particularly bats.
- If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks and eye protection.
- Practice safer sex.
Upon return from Rwanda:
- Watch your health for symptoms of Marburg while in the outbreak area and for 21 days after leaving the outbreak area (no quarantine is required if there are no symptoms).
In case of symptoms
If you develop fever and nonspecific symptoms such as chills, headache, muscle pain or abdominal pain:
- you should separate yourself from others (isolate) immediately and
- directly contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
- alert the healthcare providers of your recent travel to an area with a Marburg outbreak.
For clinicians:
- Consider Marburg as a possible diagnosis in patients with epidemiologic risks factors, especially in people with possible exposure of Marburg cases in Rwanda.
- Further information on evaluation and diagnosis: see LINK and ECDC risk assessment.
In 2024, as of 06 October 2024, 16 countries have reported 7’524 confirmed cases (+770 new confirmed cases within 1 week), including 32 deaths. The three countries with the majority of the cases in 2024 (all clades) are Democratic Republic of the Congo (6’169), Burundi, (n = 987), and Nigeria, (n = 84).
(Note: A significant number of suspected mpox cases that are clinically compatible with mpox remain untested due to limited diagnostic capacity in some African countries and therefore never got confirmed.)
In 2024, 15 countries have reported both 31’527 suspected and laboratory tested cases (+5’160 within 1 week, all clades), including 998 suspected and confirmed deaths (+2 within 1 week).
According to WHO, in 2024 as of 29 Sept 2024 the cumulative confirmed mpox cases (+ cases since last update 29 Sep 2024) were reported in the below mentioned countries (for updates, details, suspected cases, epidemic curves, see WHO LINK):
Clade Ia and b:
- D.R. Congo: according to WHO: 5’610 (+559 cases since 29 Sept 2024; note OV: in the week before the reported number was not conclusive)
Clade Ib
- Burundi: 987 confirmed cases (+134 cases since 29 Sept 2024, stable increase of confirmed cases) (plus hundreds of suspected cases)
- Uganda: 69 cases (+47 cases since 29 Sept 2024)
- Kenya: 12 cases (+4 since 29 Sept 2024)
- Rwanda: 6 cases (+0 cases since 29 Sept 2024)
- Outside Africa: Sweden (1 case, imported from Burundi), Thailand (1 case, imported from DRC), India (1 imported case)
Clade Ia:
- Republic of the Congo: 21 confirmed cases (+0)
- Central African Republic: 57 confirmed cases (+2)
- Cameroon: 6 cases (+0), including unknown number of cases with clade IIa and IIb
Clade II (a and/or b):
- Côte d’Ivoire: 67 cases (+15)
- Cameroon: 6 cases including unknown number of cases with clade 1a
- Ghana: 1 case
- Guinea: 1 case (+0)
- Morocco: 3 case (+1)
- Nigeria: 84 cases (+6)
- South Africa: 25 cases (+0)
In addition, mpox cases have been reported in Africa in 2024 without specification of the clade:
- Gabon: 2 cases (+0)
- Liberia: 14 cases (+1)
Epicurve for Ib clade cases as 6 October 2024:
Follow local media and local health authority advice. The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic (see also Factsheet Mpox).
General precautions
- Worldwide:
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- Wash your hands often with soap + water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- Avoid touching potentially contaminated personal items such as bedding/clothing, towels or sharing eating utensils/cups, food or drink with a person who has, or may have mpox.
- Avoid sex with sick persons; use of condoms for up to 12 weeks if you sexual partner have had mpox.
- Follow advice of local authorities.
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- When travelling to endemic / epidemic areas in Africa, in addition to above mentioned general precautions:
- Avoid contact with and animals in areas where mpox regularly occurs.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
Vaccination
A vaccination against mpox is available (Jynneos®, manufactured by Bavarian Nordic). The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, as of 3 October 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi in case of:
- Clinical, research or laboratory work
- Working with animals
(a broader indication is still under discussion)
2. People staying outside of Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi (worldwide) in case of:
- Increased risk (e.g. laboratory workers handling mpox virus, men who have sex with men, trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine against mpox (e.g. Jynneos®) is also effective against clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms
- Seek medical attention immediately
If you are diagnosed with mpox:
- Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox.
- People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
Wash your hands often with soap /water or an alcohol-based hand sanitizer containing at least 60% alcohol. - You should not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- For more information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries in the previous 21 days.
- Further information on evaluation and diagnosis: see CDC LINK.
Information about rabies and what to do if exposed is important for all travellers!
Prevention: Avoid contact with animals and do not feed them! Pre-exposure vaccination is particularly recommended for travellers with increased individual risk (working with animals, travel on two-wheelers, to remote areas, young children, cave explorers, possible contact with bats, etc.).
Behavior after exposure: After an animal bite/scratch: immediately wash the wound with water and soap for 15 minutes, then disinfect and in any case visit a medical center for post-exposure vaccination as soon as possible! For more information: see Flyer rabies.
On 13 September 2024, the IHR NFP for Barbados notified WHO of one confirmed human infection with West Nile Virus (WNV) in a child. This marks the first detected human case of WNV reported from Barbados.
Additionally, no infections have been previously documented in birds or horses in this country, making this case both unusual and unexpected. However, the WNV has spread throughout the Caribbean, likely via infected migratory birds. It is possible that the virus is circulating in birds and horses undetected.
West Nile viruses belong to the flavivirus family and are transmitted by Culex mosquitoes. The main hosts are birds; humans are false hosts. Most cases are asymptomatic; clinically symptomatic cases develop fever and meningitis or encephalitis. Elderly persons, pregnant women and immunosuppressed persons are at higher risk for a neuroinvasive form of the disease.
The following precautions are recommended:
- Protect yourself against mosquito bites during the day and at night (see factsheet mosquito and tick bite protection).
- Do not touch sick or dead birds, as they may also be infected.
- If you have visited a West Nile fever transmission area, do not donate blood for at least 28 days after returning.
The number of people affected by leptospirosis and related deaths in Kerala is increasing. In the first 4 days of October 2024 alone, 45 people were diagnosed with the disease.
According to the Health Department, from 1 Jan to 4 Oct 2024, a total of 2’512 people have been diagnosed with leptospirosis, including 155 confirmed deaths. Additionally, 1’979 people sought treatment for symptoms related to the illness. Similarly, 131 deaths suspected to be caused by leptospirosis symptoms were also reported.
Health officials warn that the disease is now spreading during all seasons.
Leptospirosis: Leptospires are transmitted via the urine of rodents (especially rats), e.g. in water residues (rivulets, puddles, etc.) or mud. Transmission to humans occurs through direct or indirect contact with rodent urine via small skin lesions or mucosal surfaces. The clinical picture ranges from flu-like general symptoms to aseptic meningitis and sepsis. Vaccination is not available.
Prevention: Wear waterproof protective clothing/boots when wading through water! Cuts or scratches should be covered with waterproof bandages. Vaccination is not available for travelers.
As of 3 October, 130 locally acquired dengue cases have been reported by the Italian National Public Health Authority. These are 63 more cases than reported in the previous week's update. The newly reported cases were from Marche (51 cases), Emilia Romagna (14 cases) and Lombardy (one case). According to local authorities in the Marche Region, there is a decreasing trend in case numbers reported from Fano.
For 129 cases NUTS2 regions were reported:
- Marche (102 cases)
- Emilia Romagna (19 cases)
- Lombardy (six cases)
- Tuscany (one case)
- Veneto (one case).
An additional case (onset of symptoms 18 August, DENV 2) was reported by the Abruzzo region. However, the place of infection is currently under investigation as the infection may have occurred in another region.
Prevention: Optimal mosquito bite protection during the day, also in cities.
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
In 2024 and as of 2 October 2024, 18 countries in Europe have reported 1’202 locally acquired human cases of West Nile Virus (WNV) infection with known place of infection. The earliest and latest date of onset were respectively on 1 March 2024 and 26 September 2024.
Locally acquired cases were reported by Italy (422), Greece (202), Spain (114), Albania (102), Hungary (101), Romania (71), Serbia (53), Austria (34), Türkiye (30), France (27), Croatia (20), Germany (8), Slovenia (5), Kosovo (4), Slovakia (4), Bulgaria (2), North Macedonia (2) and Czechia (1).
In Europe, 88 deaths were reported by Greece (31), Italy (16), Albania (13), Romania (10), Spain (10), Bulgaria (2), Serbia (2), Türkiye (2), France (1) and North Macedonia (1).
Case numbers reported this year are above the mean monthly case count for the past 10 years. During the same period in 2023, 681 cases had been reported. However, numbers are lower than in 2018, when 1 728 cases had been reported by this time of year.
Distribution of locally acquired human West Nile virus infections in 2024 till 2 October 2024:
Of note, further regions of infection were reported in 2023.
The following precautions are recommended:
- Protect yourself against mosquito bites during the day and at night (see factsheet mosquito and tick bite protection).
- Do not touch sick or dead birds, as they may also be infected.
- If you have visited a West Nile fever transmission area, do not donate blood for at least 28 days after returning.
On 2 October 2024, Germany reported that two travellers returning from Rwanda were isolated at the University Medical Center Hamburg (UKE) on suspicion of Marburg virus disease (MVD). Both tested negative on 3 October. One of the cases is a medical student who worked in a hospital in Rwanda, where he was exposed to a patient infected with MVD around 25 September, while wearing appropriate protective equipment. He will continue to be monitored for his own safety until the end of the incubation period of up to 21 days. In the coming days, he is to remain in quarantine at the UKE's special unit for highly contagious infectious diseases, followed by home quarantine under the supervision of the responsible public health department.
The companion also tested negative and is showing mild symptoms of another disease. The companion had no contact with MVD-infected persons in Rwanda. The accompanying person will also continue to be monitored at the UKE over the weekend.
See news above.
The negative test result and the absence of symptoms during the returning trip rule out any risk to third parties. Thus, there was no risk of infection with the Marburg virus for either the air or rail travellers at any time.
On 27 September 2024, the Rwanda Ministry of Health announced the confirmation of Marburg virus disease in patients in health facilities in the country. As of 3 October, 36 cases of MVD have been reported, including 11 deaths (Case fatality rate: 31%). The cases are reported from seven of the 30 districts in the country (Gasabo, Gatsibo, Kamonyi, Kicukiro, Nyagatare, Nyarugenge and Rubavu districts). Among the confirmed cases, over 70% are health care workers from two health facilities in Kigali. Contact tracing is underway with 410 contacts under follow-up. The source of the infection is still under investigation.
One contact travelled to Belgium from Rwanda. WHO was made aware of this by the public health authorities in Belgium. They shared detailed information on the contact's situation, that they remained healthy, completed the 21-day monitoring period, did not present with any symptoms, and are not a risk to public health.
This is the first time MVD has been reported in Rwanda. The Government of Rwanda is coordinating the response with support from WHO and partners. The Ministry of Health of Rwanda announced several control measures including a ban on patient visits to hospitals, strengthening protocols in hospitals, and measures to limit contact with dead bodies.
Rwanda will start cinical trials of experimental vaccines and treatments for MVD in the next few weeks.
Marburg virus disease (MVD) is a rare but severe hemorrhagic fever, caused by Marburg virus (MARV). Although MVD is uncommon, MARV has the potential to cause outbreaks with significant case fatality rates (up to 88%). All recorded MVD outbreaks have originated in Africa.
Transmission: Fruit bats are the natural reservoir of MARV. The majority of MVD outbreaks have been connected to human entry into bat-infested mines and caves. Human can also get infected by direct contact with an infected animal (e.g., non-human primate).
Person-to-person transmission occur by direct contact (through broken skin or mucous membranes) with infected blood, secretions, and body fluids or by indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment MVD is not an airborne disease, and a person is not contagious before symptoms appear. As a result, if proper infection prevention and control precautions are strictly followed, the risk of infection is regarded as minimal.
Incubation period: usually five to ten days (range 2-21 days)
Symptoms: The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhea. In severe cases, a rash may develop, along with bleeding from various body areas.
Treatment: There are several experimental drugs and vaccines for Marburg, but none has been licensed to date.
Further information, see ECDC Factsheet Marburg Virus. CDC.
WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.
Follow media and official reports. The risk for travellers is usually very low, but it is high for family members and caregivers who have contact with sick people.
Preventive measures:
- Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
- Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
- Avoid contact with blood and other body fluids
- Avoid visiting healthcare facilities in the MVD-affected areas for nonurgent medical care or non-medical reasons.
- Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial.
- Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
- Wash and peel fruit and vegetables before consumption.
- Avoid visiting mines or bat caves and contact with all wild animals; alive or dead, particularly bats.
- If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks.
- Practice safer sex.
Upon return from Rwanda:
- Watch your health for symptoms of Marburg while in the outbreak area and for 21 days after leaving the outbreak area (no quarantine is required if there are no symptoms).
In case of symptoms
If you develop fever and nonspecific symptoms such as chills, headache, muscle pain or abdominal pain:
- you should separate yourself from others (isolate) immediately and
- directly contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
- alert the healthcare providers of your recent travel to an area with a Marburg outbreak.
For clinicians:
- Consider Marburg as a possible diagnosis in patients with epidemiologic risks factors, especially in people with possible exposure of Marburg cases in Rwanda.
Further information on evaluation and diagnosis: see LINK.
According to WHO, between 29 to 1 September 2024 (week 31 to 35), 19 countries shared their meningitis epidemiological data.
Epidemic:
- Benin: Zoe region (Abdomey health district, crossed epidemic threshold on weeks 33 and 34)
- D.R. Congo: Province Sud-Ubangui and province Sankuru
Alert:
- Benin: Bargou region, Collines region
- D.R. Congo: Haut – Lomami province, Ituri province, Lomami province, Maindombe province
- Ghana: Savannah region
- Mali: Bamako region
For previous epidemics and alerts, see EpiNews or news at www.healthytravel.ch.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended:
- During epidemics or alerts, vaccination is recommended for stays > 7 days or in the case of close contact with the population.
If no alert or epidemic is reported, vaccination is recommended for travel to the ‘meningitis belt’ during the dry season (typically occurring from December to June) across sub-Saharan Africa if
- Travelling for >30 days or
- For shorter stays, depending on the individual risk (e.g. close personal contacts, work in health care facilities, stay in heavily occupied accommodation, risk of epidemics).
As of 27 September 2024, a total of 294 Zika virus cases across 40 provinces have now been reported for 2024.
More than 750 Zika cases were reported in the whole of 2023. Due to an increased number of imported Zika cases in returning travellers (n=25), particularly with exposure in the second half of 2023 (n=21), ongoing transmission of Zika virus in Thailand was assumed, leading the Swiss ECTM to issue special recommendations in February 2024 (EpiNews 2 February 2024).
Zika is endemic in Thailand. The current numbers do not indicate an increasing ongoing transmission. CDC does not classify Thailand as an area with a current outbreak (see CDC map). As a result, the Swiss Expert Committee for Travel Medicine updates its ZIKA prevention recommendations for travellers to Thailand as follows:
Optimal mosquito bite protection 24/7, also in cities (during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria).
For detailed ECTM recommendations on Zika, see link. In case of fever, malaria should always be ruled out by blood test.
Die Zahl der in den USA im Jahr 2024 bisher gemeldeten Pertussis- oder Keuchhustenfälle ist nach den neuesten Daten der Centers for Disease Control and Prevention (CDC) mehr als viermal so hoch wie zum gleichen Zeitpunkt des letzten Jahres. Bis zum 14. September wurden 14’569 Pertussis-Fälle gemeldet. Dies entspricht einem Anstieg von 319 %.
Auch Australien verzeichnet einen deutlichen Anstieg der Pertussisfälle. Laut den dortigen Gesundheitsbehörden und Stand vom 21. September dieses Jahres wurde insgesamt 29’648 Fälle, die höchste Zahl seit 2011, als 38’748 Fälle gemeldet wurden, registriert.
Dies ist eine Erinnerung daran, dass eine reisemedizinische Beratung eine Gelegenheit ist, den Pertussis-Impfstatus zu überprüfen. Schweizer Empfehlungen: Nach der Grundimmunisierung gegen Keuchhusten werden Auffrischungsimpfungen bei Jugendlichen (11-15 Jahre) und Erwachsenen (25-29 Jahre) empfohlen.
Eine Auffrischungsimpfung ist auch bei jeder Schwangerschaft angezeigt. Zusätzlich sollten sich Jugendliche und Erwachsene jeden Alters gegen Keuchhusten impfen lassen, wenn beruflich oder familiär regelmässiger Kontakt mit Säuglingen unter 6 Monaten besteht und die letzte Impfung gegen Keuchhusten 10 Jahre oder länger zurückliegt.
Between epidemiological week (EW) 1 and EW 35 of 2024, 38 confirmed human cases including 19 deaths of yellow fever (YF) have been reported in 5 countries of the Americas Region: Bolivia (7 cases, including 4 with history of YF vaccination), Brazil (3 cases, including 1 case with history of YF vaccination in 2017), Colombia (8 cases, including 1 cases with history of YF vaccination), Guyana (2 cases), and Peru (18 cases). For details, see LINK.
Geographical distribution of municipalities with occurrence of yellow fever cases in humans in Bolivia, Brazil, Colombia, Guyana, and Peru, years 2022, 2023, and 2024 (as of EW 35):
Mozambican health authorities have detected measles outbreaks in 4 districts of the northern province of Cabo Delgado, and warned that the outbreaks have worsened over the past 2 months.
Neighbouring Malawi has also issued an alert after detecting measles cases.
This is a reminder that all travelers should be updated with measles vaccination.
Swiss recommendations: all persons born after 1963 who have no documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine.
In the event of an epidemic in the region or contact with a measles case, vaccination is recommended from the age of 6 months.
The number for Zika cases in Pune have increased to more than 100 cases, including 5 deaths. All deaths were in elderly people with co-morbidities.
End of August 2024, the US CDC issued an alert on a Zika outbreaks in the state of Maharashtra.
There is currently an increased risk of transmission of the Zika virus in the state of Maharashtra, India. Please note that the Zika virus can also be transmitted sexually!
Prevention: Optimal mosquito protection 24/7: during the day against Zika, dengue and other arboviruses, at dusk and at night against malaria.
When travelling to areas with a Zika outbreak, as is now the case in the state of Maharashtra, India, the Swiss Expert Committee for Travel Medicine recommends using a condom/femidom during the trip and for at least 2 months after returning home to prevent possible sexual transmission of the virus.
Due to the risk of malformations in the unborn child, pregnant women are currently advised not to travel to the state of Maharashtra in India. If travelling is absolutely necessary, it is recommended that you speak to a specialist in travel medicine before departure.
Women planning to become pregnant should wait at least 2 months after their return (or that of their partner) from India before starting family planning. In the case of medically assisted reproduction, this period should be extended to at least 3 months. Please also read the Zika information sheet, especially if you are pregnant or if you or your partner are planning a pregnancy.
In 2024 and as of 4 September 2024, 15 countries in Europe have reported 715 locally acquired human cases of WNV infection. The earliest and latest date of onset were respectively on 1 March 2024 and 29 August 2024. Locally acquired cases were reported by Italy (287), Greece (138), Albania (74), Spain (54), Hungary (43), Romania (42), Serbia (27), Austria (18), France (15),
Türkiye (7), Croatia (3), Bulgaria (2), Germany (2), Kosovo (2) and North Macedonia (1).
In Europe, 51 deaths were reported by Greece (17), Albania (13), Italy (10), Spain (4), Romania (3), Bulgaria (2), France (1) and Serbia (1).
In addition, Slovenia reported three human cases of WNV infection through EpiPulse in the Pomurska and Podravska regions. These cases had not been reported through TESSy by 4 September and are therefore not included in this monthly WNV report.
Case numbers reported this year are above the mean monthly case count of the past 10 years. For instance, during the same period in 2023, 445 cases had been reported. Numbers are, however, lower than in 2018, when 1 048 cases had been reported by this time of year.
Distribution of locally acquired human West Nile virus infections in 2024 till 11 September 2024:
The following precautions are recommended:
- Protect yourself against mosquito bites during the day and at night (see factsheet mosquito and tick bite protection).
- Do not touch sick or dead birds, as they may also be infected.
- If you have visited a West Nile fever transmission area, do not donate blood for at least 28 days after returning.
- Ensure good hand hygiene: wash your hands with soap and water or a disinfectant alcohol gel before cooking or eating and after using the toilet.
- Consume only well-cooked/fried foods that are served hot. Avoid salads, unpeeled fruits, foods with raw eggs, soft ice cream and similar products.
- Drink water only from bottles that have been properly sealed. Ice cubes should be avoided.
Avoid bathing, washing, or walking in fresh water.
Consult a general practitioner or a specialist in travel and tropical medicine after suspected skin contact with fresh water during your trip.
The Los Angeles County Public Health Department has confirmed a case of locally acquired dengue from a resident who has no history of travel to areas where dengue fever is endemic. According to a release from the health department, the infected person resides in Baldwin Park.
It is the third case of locally acquired dengue in California and the first reported by the Los Angeles County Department of Public Health. Cases of locally acquired dengue were previously confirmed by Long Beach and Pasadena in fall 2023.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
The number of cases in 2024 period already cross those of the entire 2023 (n= 19’300).
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
In two weeks (19 – 21 Sep 2024) the "Conference on Tropical Medicine and Global Health 2024" starts in Düsseldorf!
We would like to draw your attention once again to the exciting and varied programme with numerous national and international speakers (see www.dtg-conferences.de)!
The hosting societies German Society for Tropical Medicine, Travel Medicine and Global Health e.V. (DTG) and Swiss Society of Tropical and Travel Medicine (SSTTM) are delighted to welcome you to the conference!
Please note:
- For registration, see LINK
- Conference language is English, except for session on Saturday afternoon (in German)
- Annual assembly will take place for DTG and SSTTM
In 2024, as of 01 September 2024, 15 countries have reported 3’891 confirmed cases, including 32 deaths. The three countries with the majority of the cases in 2024 are The Democratic Republic of the Congo, (n = 3’361), Burundi, (n = 328), and Nigeria (n = 48).
Note: a significant number of suspected cases, that are clinically compatible with mpox are not tested due to limited diagnostic capacity and never get confirmed. WHO efforts on integrating these data is currently ongoing and will be included in future updates. Not all countries have robust surveillance systems for mpox, so case counts are likely to be underestimates.
According to WHO, in 2024 as of 1 Sept 2024, mpox due to monkeypox virus clade I were reported in (for updates, details, epidemic curves, see WHO LINK):
Clade Ia and b:
- D.R. Congo: According to WHO: 3’361 cases. Increasing trend in number of cases.
According to Africa CDC, update 31 Aug 2024: Since the last update (23 August 2024 ), the MoH reported 1’838 confirmed, 1’095 suspected and 35 deaths (CFR: 2.2%) of mpox from 16 provinces. This is a 137% increase in the number of new cases reported compared to the last update. Cumulatively, 4’799 confirmed, 17’801 suspected and 610 deaths (CFR: 3.4%) of mpox have been reported from all 26 provinces in DRC. Children <15 years accounted for 66% of cases and 82% of deaths. Of the confirmed cases, 73% were males. Clade Ia and Ib was isolated from the confirmed cases.
Clade Ib
- Burundi: 328 confirmed cases (plus more than 700 cases suspected cases), including more than 190 hospitalized patients. Increasing trend in cases (+8 % within one week).
The majority of case are from North Bujumbura, Kayanza and South Bujumbura district. A total of 29 districts out of 49 districts) have reported at least one positive mpox case. - Rwanda: 4 cases
- Uganda: 10 cases
- Kenya: 4 cases
- Outside Africa: Sweden (1 case, imported from Burundi), Thailand (1 case, imported from DRC)
Clade Ia:
- D.R. Congo: 23 cases
- Republic of the Congo: 49 confirmed cases
- Central African Republic: 45 confirmed cases
- Cameroon: 5 cases including unknown number of cases with clade IIa and IIb
Mpox due to monkeypox virus clade II (a and b) reported in 2024 (for updates, details, epidemic curves, see WHO LINK):
- Côte d’Ivoire: 28 cases
- Nigeria: 48 cases
- South Africa: 24 cases
- Marocco: 1 case
- Cameroon: 5 cases including unknown number of cases with clade 1a
In addition, mpox cases have been reported in Africa without specification of the clade in 2024:
- Gabon: 2 cases
- Guinea: 1 case
- Liberia: 7 cases
Clades globally detected (1 Jan 2022 to 01 Sept 2024), Link Outbreak status (active transmission = red), Link
WHO conducted the latest global mpox risk assessment in August 2024. Based on the available information, the risk was assessed as:
- In eastern Democratic Republic of the Congo and neighbouring countries, the overall risk is assessed as high.
- In areas of the Democratic Republic of the Congo where mpox is endemic, mpox risk is assessed as high.
- In Nigeria and other countries of West, Central and East Africa where mpox is endemic, mpox risk is assessed as moderate.
WHO risk assesment, see LINK.
Follow local media and local health authority advice. The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic (see also Factsheet mpox).
General precautions
- Worldwide:
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- Wash your hands often with soap + water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- Avoid touching potentially contaminated personal items such as bedding/clothing, towels or sharing eating utensils/cups, food or drink with a person who has, or may have mpox.
- Avoid sex with sick persons; use of condoms for up to 12 weeks if you sexual partner have had mpox.
- Follow advice of local authorities.
- When travelling to endemic / epidemic areas in Africa, in addition to above mentioned general precautions:
- Avoid contact with and animals in areas where mpox regularly occurs.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid contact with and animals in areas where mpox regularly occurs.
Vaccination
A vaccination against mpox is available (Jynneos®, manufactured by Bavarian Nordic). The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, status 30 August 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Eastern D.R. Congo and Burundi in case of:
- Clinical, research or laboratory work
- Working with animals
(of note: broader indication is under discussion)
2. People staying outside of Eastern D.R. Congo and Burundi (worldwide) in case of
- Increase risk (e.g. laboratory workers handling mpox virus, men who have sex with men or trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine against mpox (e.g. Jynneos®) is also effective against the new clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms
- Seek medical attention immediately
If you are diagnosed with mpox:
- Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
- Wash your hands often with soap /water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- You should not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- For more information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries in the previous 21 days.
- Further information on evaluation and diagnosis: see CDC LINK.
The State Department of Health confirmed a case rabies in a 56-year-old man who was bitten by a marmoset in the rural area of Piripiri, 166 km north of Teresina. The agency reported that the last cases of human rabies in the state occurred more than 10 years ago, in 2013, in the cities of Parnaíba and Pio IX.
In Brazil, rabies transmitted by the common marmoset primate is emerging and causing unpredictable human deaths. This primate, once endemic to the northeast of the country, has now invaded regions in the south through human-mediated introductions. However, the dynamics of rabies in this primate and the extent of spillover risk to humans remain unknown. Researchers found that outbreaks of rabies in marmosets reported to the Ministry of Health are continuously reported in new areas, including three new states since 2012, for details see publication.
Marmoset:
Prevention: Avoid contact with animals and do not feed them! Pre-exposure vaccination is particularly recommended for travelers with increased individual risk (working with animals, travel on two-wheelers, to remote areas, young children, cave explorers, possible contact with bats, etc.).
Behavior after exposure: After an animal bite/scratch: immediately wash the wound with water and soap for 15 minutes, then disinfect and in any case visit a medical center for post-exposure vaccination as soon as possible! For more information: see Flyer rabies.
Between early June and 15 August 2024, the Ministry of Health and Family Welfare of the Government of India reported 245 cases of acute encephalitis syndrome (AES) including 82 deaths (CFR 33%). Of these, 64 are confirmed cases of Chandipura virus (CHPV) infection. CHPV is endemic in India, with previous outbreaks occurring regularly, especially during the monsoon season. However, the current outbreak is the largest in the past 20 years.
The Chandipura virus (Vesiculovirus chandipura, CHPV) is a zoonotic arbovirus in the family Rhabdoviridae. The virus is endemic in several regions of India and has been detected in other countries in the South Asian subcontinent. Sporadic cases and limited outbreaks have been reported in India since 1965. The virus has also been detected in animals in some African countries (e.g. Nigeria, Senegal, Tanzania) without reported human cases.
The principal vector of CHPV in India is the sand fly Phlebotomus papatasi, which is also present in several regions of Europe. Other sand fly, mosquito and tick species are also potential vectors of the virus. A broad range of animals are suspected as vertebrate hosts of CHPV; however, little information is available on the natural ecological cycle of the virus.
The incubation period is typically short, ranging from 3 to 6 days.
CHPV infection may manifest in rapid course as a general febrile disease with meningitis and/or encephalitis (Acute Encephalitis Syndrome). Predominantly children below the age of 15 years are affected. The case fatality rate can reach 55–75%. Serological data indicate asymptomatic human infections.
There is no specific treatment or vaccine available.
WHO assessed the risk as moderate at the national level. The risk assessment will be reviewed as the situation of the outbreak evolves.
Prevention: Optimal insect bite protection 7/24 is of great importance. In case of symptoms: see medical advice immediately.
Sexually transmissible infections (STIs) represent some of the most prevalent infections globally, with an estimated 375 million new infections with one of the curable STIs each year. About 300’000 new diagnoses of bacterial STIs are reported annually by the European Union (EU)/European Economic Area (EEA) Member States to The European Surveillance System, the main source of epidemiological data for the region.
On World Sexual Health Day (4 September 2024), the European Centre for Disease Prevention and Control (ECDC) published a comprehensive review that underscores the urgent need to improve monitoring data and enhance targeted prevention interventions across Europe, see LINK
Swiss recommendations: all persons born after 1963 who have no documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine.
In the event of an epidemic in the region or contact with a measles case, vaccination is recommended from the age of 6 months.
At least 6 people have died and more have been hospitalized in intensive care unit due to methanol intoxication after consumption of punched alcohol.
According to the police in Bangkok, samples of homemade liquor from the 18 stalls contained hazardous levels of methanol.
Two suspected Nipah cases have been reported from the state of Kerala. The case are hospitalized and isolated. Investigations are ongoing.
The Nipah virus (NiV) is a viral disease that can cause a severe clinical picture. It was first detected in 1999 during an outbreak in Malaysia and Singapore. Since then, several outbreaks have been reported in South and Southeast Asia.
NiV is most commonly transmitted via fruit bats through direct or indirect contact with their faeces. Tree fruit or sap made from it that is contaminated with bat faeces is often considered a source of infection. Human-to-human transmission has been reported when caring for infected patients. In addition, pigs can also be infected. The disease spectrum ranges from (mostly) asymptomatic courses to flu-like symptoms with high fever, headache and muscle pain to encephalitis with severe neurological or other complications. Mortality is high (40-70%).
The oropouche virus outbreak in Cuba is still ongoing and the detection of cases in returning travelers continuous.
The U.S. Centers for Disease Control and Prevention (CDC) reported on 27 Aug 2024 the detection of 21 cases of oropouche fever in people who returned from Cuba, 3 of whom required hospitalization. These cases were recorded up to 16 Aug 2024, and most of those affected presented symptoms between May and July 2024.
Canary islands: In August three cases of oropouche virus infection have been confirmed on Canary islands among travelers returning from Cuba.
According to WHO, as of 20 July 2024, a total of 8’078 confirmed oropouche cases, including two deaths, have been reported in the Region of the Americas, across five countries: Bolivia, Brazil, Colombia, Cuba, and Peru.
Oropouche fever is a viral disease that is transmitted by mosquito bites. The virus is found in several regions of the Americas, particularly in Brazil, Colombia, Cuba, Ecuador, French Guiana, Panama, Peru and Trinidad and Tobago.
The clinical picture includes dengue-like symptoms with sudden onset of high fever, headache, myalgia, skin rash, joint pain and vomiting. The disease usually lasts 3-6 days. A short-term recurrence of symptoms can occur in up to 60% of cases. Rare complications include inflammation of the brain. In 2024, a small number of cases of transmission from mother to unborn child (vertical transmission) were reported for the first time.
Prevention: Optimal mosquito protection 24/7 (also against other mosquito-borne diseases such as dengue, Zika, Chikungunyaand malaria).
Given its clinical presentation, Oropouche fever should be included in the clinical differential diagnosis for other common vector-borne diseases in the region of the Americas (e.g., malaria, dengue, chikungunya, Zika, yellow fever.
The occurrence of vertical transmission of OROV adds a new dimension to the pathogenicity of the virus. The extent of possible foetal malformations or death in the context of an OROV outbreak situation is currently still unclear and is being investigated. Until further data is available, pregnant women and women planning to be pregnant should be provided with comprehensive information during pre-travel consultation on the OROV outbreak and the potential of miscarriage, fetal malformation or death. The current outbreaks occur in regions where Zika virus is also endemic, and travel advice for pregnant women related to ZIKV can also adequately address the potential risk associated with Oropouche virus disease; for detailed ECTM recommendations on Zika prevention, see LINK.
WHO Director-General Dr Tedros has determined that the upsurge of mpox (formerly monkeypox) in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR). The PHEIC will help to take further coordinated international action to support countries in combating disease outbreaks.
This PHEIC determination is the second in two years relating to mpox. Mpox was first detected in humans in 1970, in the DRC. The viral disease is caused by the Monkeypox virus (MPXV), which is present in the wildlife (in certain small mammals) and the disease is considered endemic in countries in central and west Africa. In July 2022, the multi-country outbreak of mpox was declared a PHEIC after an outbreak occurred in Europe and spread rapidly via sexual contact across a range of countries where the virus had not been seen before. That PHEIC was declared over in May 2023 after there had been a sustained decline in global cases.
Since November 2023, the Democratic Republic of the Congo (DRC) has seen a significant increase in mpox cases and the emergence of a new mpox clade I. The country has reported over 16’000 new cases and more than 500 deaths in 2024. Mpox outbreaks are caused by different clades, clades 1 and 2. Historically, clade 1 has been associated with a higher percentage of people with mpox developing severe illness or dying, compared to clade 2. The clades are now subdivided into clade 1a, 1b and clade 2a, 2b.
- Clade 1a is the clade endemic in DRC and other central and East African countries (e.g. the Central African Republic and the Republic of Congo) for decades, it affects mostly children and is spreading through multiple mode of transmission (including animal-to human transmission, close nonsexual contact, sexual contact).
- Clade 1b, identified since September 2023, is currently causing the outbreak in eastern DRC and neighboring countries (Burundi, Rwanda, Kenya, and Uganda; and more recently in a returning traveler from Burundi to Sweden), it affects mostly adults of both sex and is spreading predominantly through intimal contact (sexual networks). Nonsexual transmission is also happening to a lesser extent. At present, there is no evidence that it is more transmissible or more severe than the clade 1a.
- Clade 2a is endemic in various countries of West Africa for decades with low incidence and is spreading through multiple modes of transmission like clade 1a.
- Clade 2b is the clade at the origin of the 2022/2023 global outbreak (116 countries), it affects mostly men (>96%) and is spreading primarily through sexual contact (particularly men having sex with men). It is still ongoing and could affect people with risk factors in all countries around the world, including African countries.
Details to Mpox, see LINKs of Swiss FOPH, Robert Koch-Institute Germany, ECDC, CDC.
Countries where mpox virus clade I and/or clade II have been detected:
Follow local media and local health authority advice.
The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic:
General precautions:
- Refrain from sexual or other close contact with people who are sick with signs and symptoms of mpox, including those with skin lesions or genital lesions.
- Avoid contact with wild animals (alive or dead) in areas where mpox regularly occurs.
- Avoiding contact with contaminated materials used by people who are sick (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with wild animals.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid sex with sick persons and use of condoms for up to 12 weeks after the convalescence of the sexual partner.
A vaccination against mpox is available (Jynneos®, manufacture Bavarian Nordic). There is an increased demand worldwide with risk of vaccine shortage. The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, status 16 August 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Eastern D.R. Congo and Burundi in case of:
- Clinical or research or laboratory work
- Working with animals
2. People staying outside of Eastern D.R. Congo and Burundi (worldwide) in case of:
- Increase risk (e.g. laboratory workers handling mpox virus, men who have sex with men or trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine (Jynneos®) is also effective against the new clade I. This vaccine is considered safe and highly effective in preventing severe Mpox disease.
In case of symptoms:
- Please stay at home (isolate) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should clean and disinfect the spaces they occupy regularly to limit household contamination.
- Wash hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
- You should not have sex while symptomatic and while lesions are present. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- Further information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries (ROC, CAR, Rwanda, Burundi, Uganda, Zambia, Angola, Tanzania, and South Sudan) in the previous 21 days.
- Further information on Evaluation and Diagnosis: see CDC LINK.
The European Center for Disease Control (ECDC) has issued a risk assessment on 16 August 2024 with specific advice, for details see LINK.
- Following the report of an imported Monkeypox virus (MPXV) clade Ib case in Sweden on 15 August 2024 in a returning traveler from Burundi, Thailand reported a confirmed imported case due to MPXV clade Ib on 22 August 2024. The case is a European man, with travel history to the Democratic Republic of Congo.
- On August 22, 2024, Gabon reported a suspected case of mpox clade Ib in a person with a travel history to Uganda (LINK).
Epidemiological situation: Mpox outbreaks are caused by different clades, clades 1 and 2, see EpiNews as of 16 August 2024. Historically, clade 1 has been associated with a higher percentage of people with mpox developing severe illness or dying, compared to clade 2 (responsible for the global spread in 2022). D.R. Congo (DRC) has been the most affected country, with a large increase of mpox cases due to MPXV clade I being reported since November 2023. In April 2024, sequencing of mpox cases from Kamituga in South Kivu province in eastern DRC, within the context of an observational study, identified a subtype of clade I, clade Ib. Both MPXV clade Ia and clade Ib have been circulating in DRC, while clade Ia has been detected in Congo and Central African Republic.
Geographical spread of the new MPXV clade Ib variant occurs via transport routes through sexual contact (e.g. sex workers), and then local transmission is observed in households and other settings (which are becoming increasingly important).
In recent weeks, confirmed mpox cases due to MPXV clade Ib have been reported by countries neighbouring DRC, such as:
- Burundi (highest number of cases outside DRC): As of 17 August 2024, there had been 545 alerts of mpox cases since the outbreak declaration, of which 474 suspected cases (86.9%) had been investigated and validated. Of 358 suspected cases tested, 142 (39.7%) tested positive for MPXV. Genomic sequencing analysis has confirmed clade Ib MPXV. About 37.5 cases % are among children <10 years old.
- Kenya. 1 case confirmed, for details see LINK. As of 13 August, a total of 14 suspected cases had been identified, one case had tested positive for MPXV Clade Ib, 12 suspected cases had tested negative, and the test result for one case was pending.
- Rwanda: 2 confirmed cases in July and 2 confirmed cases in August.
- Uganda: 2 confirmed cases
On 14 August 2024, WHO declared the current clade I monkeypox virus outbreak a public health emergency of international concern (PHEIC).
The type of exposure reported by cases in DRC includes sexual contact, non-sexual direct contact, household contact and healthcare facility contacts. The cases reported in Rwanda had travel history to DRC and Burundi, investigation showed that the cases reported by Uganda took place outside the country, while the case reported in Kenya was detected at a point of entry. For clade Ib (reported in Eastern DRC, Burundi, Rwanda, Uganda and Kenya), close physical contact (sexual contact) has been documented as the predominant mode of transmission, while for clade Ia (in endemic areas of DRC, Congo and CAR) multiple modes of transmission have been documented including zoonotic transmission.
For details of the cases, epidemiology, public health response and WHO advice, see WHO LINK.
Follow local media and local health authority advice. The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic:
General precautions:
- Refrain from sexual or other close contact with people who are sick with signs and symptoms of mpox, including those with skin lesions or genital lesions.
- Avoid contact with wild animals (alive or dead) in areas where mpox regularly occurs.
- Avoid contact with contaminated materials used by people who are sick (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with wild animals.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid sex with sick persons and use of condoms for up to 12 weeks after the convalescence of the sexual partner.
A vaccination against mpox is available (Jynneos®, manufacture Bavarian Nordic). There is an increased demand worldwide with risk of vaccine shortage. The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, status 30 August 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
People staying or travelling to Eastern D.R. Congo and Burundi in case of:
- Clinical or research or laboratory work
- Working with animals
- (of note: broader indication is under discussion)
People staying outside of Eastern D.R. Congo and Burundi (worldwide) in case of
- Increase risk (e.g. laboratory workers handling mpox virus, men who have sex with men or trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine (Jynneos®) is also effective against the new clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms:
- Seek medical attention immediately
If you are diagnosed with mpox:
- Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
- Wash your hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
- Youshould not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- For more information: see Factsheet Mpox.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries (ROC, CAR, Rwanda, Burundi, Uganda, Zambia, Angola, Tanzania, and South Sudan) in the previous 21 days.
- Further information on Evaluation and Diagnosis: see CDC LINK.
According to the media, the Nigerian government has mandated that incoming passengers to the country (through the airports), fill out a health declaration form to ensure safety against infectious diseases.
The reintroduction of the protocols by the Nigerian government through the Port Health Services under the Federal Ministry of Health and Social Welfare is connected to the recent outbreak of mpox (former ‘monkeypox’) in the Democratic Republic of Congo (DRC) and other African countries.
Following the massive flooding at the end of July, the number of leptospirosis cases is rising at an alarming rates.
The Philippine Department of Health on Saturday ordered all hospitals in the capital to ‘activate’ their leptospirosis capacity plan.
On 8 August 2024, three additional autochthonous cases of dengue have been reported in the Pyrénées, Orientales, Lozère and Gard departments.
On 2 August 2024, an autochthonous case of dengue in a person living in La Colle-sur-Loup, Alpes-Maritimes department, Provence-Alpes-Côte d'Azur region. This is the first locally acquired dengue case in the region in 2024. Recently, a second case was reported from the same region.
Overall, France has reported six locally acquired dengue cases in 2024.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
- The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
At the end of July 2024, Swissmedic authorised the Qdenga vaccine from manufacturer Takeda Pharma AG. The vaccine is licensed for people aged four and over.
The Swiss Expert Committee for Travel Medicine (ECTM) assessed the published and unpublished data for the Qdenga® vaccine. In line with the recommendation of WHO and other European countries, the Swiss ECTM issues the following recommendation:
- Vaccination with Qdenga® can be recommended for travellers from 6 years old and older who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission.
- Vaccination against dengue fever virus with Qdenga® in persons with no evidence of previous dengue fever infection is not recommended.
Previous dengue infection is defined as i) a laboratory confirmed dengue infection (PCR, antigen or seroconversion) or ii) a compatible history of dengue infection with a positive IgG serological test.
This is a precautionary decision, since the current data also include the possibility that people who are vaccinated with Qdenga® before a first dengue infection may experience a more severe course of the disease when infected after vaccination. A consultation with a specialist in tropical and travel medicine is recommended.
Travel medicine advisors should provide concise communication in accessible language on the complexity and risk/benefit evaluation for the use of dengue vaccines in travellers.
The full ECTM statement including background information is available at LINK.
Information on Dengue, including Factsheets: Vaccinations – HealthyTravel.
Swissmedic, 2.8.2024 | WHO 3.5.2024 position paper on dengue vaccine
Vaccination against Dengue fever for Travellers – Statement of the Swiss Expert Committee for Travel Medicine, an organ of the Swiss Society for Tropical and Travel Medicine, August 2024, LINK.
Information about rabies and what to do if exposed is important for all travelers.
Prevention: Avoid contact with animals! Do not feed animals either! Pre-exposure vaccination is particularly recommended for travelers with increased individual risk (working with animals, travel on two-wheelers, to remote areas, young children, cave explorers, possible contact with bats, etc.).
Behavior after exposure: After an animal bite/scratch: immediately wash the wound with water and soap for 15 minutes, then disinfect and in any case visit a medical center for post-exposure vaccination as soon as possible! For more information: see factsheet Rabies.
In June and July 2024, 19 imported cases of Oropouche virus (OROV) disease were reported for the first time in EU countries: Spain (12), Italy (5), and Germany (2), eighteen of the cases had a travel history to Cuba and one to Brazil.
The principal vector of OROV (Culicoides paraensis midge) is widely distributed across the Americas, but absent in Europe. To date, there has been a lack of evidence as to whether European midges or mosquitoes could transmit the virus. To date, no secondary transmission has ever been reported. Therefore, the risk of locally acquired OROV disease in the EU/EEA is low.
According to ECDC, the likelihood of infection for travellers to, or residing in epidemic areas in South and Central America is currently assessed as moderate. Further imported cases to Europe are likely.
Prevention: Optimal mosquito protection 24/7 (also against other mosquito-borne diseases such as dengue, Zika, Chikungunya and malaria).
Given its clinical presentation, Oropouche fever should be included in the clinical differential diagnosis for other common vector-borne diseases in the region of the Americas (e.g., malaria, dengue, chikungunya, Zika, yellow fever.
The occurrence of vertical transmission of OROV adds a new dimension to the pathogenicity of the virus. The extent of possible foetal malformations or death in the context of an OROV outbreak situation is currently still unclear and is being investigated. Until further data is available, Pregnant women and women planning to be pregnant should be provided with comprehensive information during pre-travel consultation on the OROV outbreak and the potential of miscarriage, fetal malformation or death. The current outbreaks occur in regions where Zika virus is also endemic, and travel advice for pregnant women related to ZIKV can also adequately address the potential risk associated with Oropouche virus disease; for detailed ECTM recommendations on Zika prevention, see LINK.
Due to heavy rainfalls and flooding, the risk for leptospirosis may be increased.
Wear waterproof protective clothing/boots when wading through water! Cuts or scratches should be covered with waterproof bandages. Vaccination for travelers is not available.
On 31 July 2024, France reported a confirmed, autochthonous case of chikungunya virus (CHIKV) disease in Île-de-France with suspected exposure in Paris (Paris Department) and Gennevilliers (Hauts-de-Seine Department). The case had the onset of symptoms on 18 July 2024. Since 1 May and as of 30 July 2024, nine imported chikungunya cases have been reported in France.
On 2 August 2024, the Alpes-Maritimes department reported its first locally acquired case of dengue in France for the 2024 season.
Oropouche fever is transmitted by insects and mosquitoes and was first detected in the blood of a sloth in Brazil in 1960. Since then, cases have been reported repeatedly, particularly in the Amazon region and other Latin American countries. According to the Brazilian government, at least 7,236 cases have been reported nationwide.
The disease has symptoms similar to those of dengue fever, albeit milder. Brazilian health authorities are also investigating six possible cases of vertical transmission of the disease, i.e. between a pregnant mother and her child.
These first deaths reported by Brazil coincide with a dengue outbreak that has been raging in the country this year and is the worst in the country's history, with at least 4,824 confirmed deaths since January 1, 2024.
The health authorities are warning against the consumption of buffer fish products that have reached the markets. The buffer fish has migrated from the Indian Ocean via the Red Sea and the Suez Canal into the waters of the Mediterranean and is an invasive species. It can grow to more than one metre in length. It has been found in coastal waters from Turkey, Syria, Cyprus and Egypt to Gibraltar. The takifugu (fugu) or pufferfish can contain the toxin tetrodotoxin, which it absorbs and accumulates in the food chain via toxic microorganisms. The toxin is heat-resistant and odourless.
Tetrodotoxin is an extremely strong toxin that is mainly found in the liver and gonads of some fish such as pufferfish, hogfish and toadfish as well as in some amphibian, octopus and shellfish species. Poisoning in humans occurs when the muscle meat of fish is improperly prepared and consumed. Tetrodotoxin interferes with the transmission of signals from the nerves to the muscles and causes progressive muscle paralysis. The symptoms can lead to paralysis, unconsciousness, respiratory arrest and death within a few hours of consumption. There is no antidote.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
- The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
General precautions:
- Mass events can favor gastrointestinal and respiratory infections, therefore: careful personal and food hygiene.
- The risk of accidents can also be increased (beware of binge drinking!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhea, chlamydia, mpox, etc.): Safer sexual practices (condoms).
- COVID-19: Control, entry and return regulations, see IATA LINK.
Recommended vaccinations and other health risks:
- See country page France.
- Important! Due to several measles outbreaks in Europe: All visitors should be immune to measles!
- Vaccination against meningococcal disease may be considered.
Diseases transmitted by mosquitoes and ticks:
- Dengue fever: In 2023, locally acquired dengue cases were reported for the first time in the greater Paris area (Ile de France). Local dengue cases have been recorded in the southern departments of France for a few years now.
- West Nile virus, leishmaniasis (Mediterranean region) and tick-borne encephalitis are endemic in some parts of the country.
- It is strongly recommended to protect yourself against mosquito and tick bites around the clock throughout the country, including the cities.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
- The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
Performing the rituals of Hajj and Umrah is strenuous and often involves long walks in hot weather. Pilgrims must ensure that they are as physically fit as possible.
Ideally, pilgrims should see their doctor at least four to six weeks before the Hajj for advice on vaccinations, food and water precautions, risks from insect bites, heat exhaustion and how to avoid injury.
Pilgrims with pre-existing medical conditions should discuss with their doctor whether traveling is an option. If they are taking medication, they should ensure that they have a sufficient supply for the time abroad and that they have a copy of their prescription with them.
The following vaccinations are recommended or mandatory (see the website of the Ministry of Health of the Kingdom of Saudi Arabia for details).
- All pilgrims should have up-to-date routine vaccinations (diphtheria/tetanus/pertussis/poliomyelitis/measles, mumps, rubella, chickenpox, etc.).
- The meningococcal vaccination (quadrivalent conjugate vaccine, Menveo®) is mandatory for all persons aged 1 year and over and must be administered at least 10 days before departure.
- Poliomyelitis vaccination: In addition to the basic immunization, a polio booster vaccination is mandatory if you are traveling from countries where wild polioviruses or circulating polioviruses have been reported.
- Hepatitis A vaccination
- Hepatitis B vaccination (especially for men due to the frequent shaving of the head on site)
- A yellow fever vaccination is mandatory when entering Saudi Arabia from countries or areas at risk of yellow fever.
- COVID-19 vaccination is recommended by the ministry of Health of the Kingdom of Saudi Arabia for people ≥12 years of age.
- Influenza vaccination, especially for risk groups.
- For other vaccinations depending on risk: see country page at www.healthytravel.ch
Recommended precautions:
- Disposable razor blades recommended for the obligatory head shave
- Good personal hygiene (hand washing, disinfection, etc.), handkerchiefs when coughing or sneezing and disposal of used handkerchiefs in a waste bin.
- Wear a face mask in large crowds.
- Avoid contact with people who appear ill and do not share their personal belongings.
- Avoid visiting and coming into contact with camels on farms, markets or in stables, and avoid drinking unpasteurized milk or eating raw meat or animal products that have not been thoroughly cooked.
- Good food and drinking water hygiene to prevent food and waterborne diseases
- Drink plenty of fluids!
- Avoid direct sunlight
- Mosquito repellent, especially during the day (dengue!)
According to the WHO, 18 countries shared their epidemiological data on meningitis between March 4 and 10, 2024.
Epidemics:
- Niger: Niamey region
- Nigeria: Bauchi state
- D.R. Congo: North Kivu province
Warnings:
- Benin: Collines region and Dinga region
- Central African Republic: Region 3 and Region 6
- Chad: Mandoul region
- D.R. Congo: Haut-Uelé Province and Bas-Uelé Province and North Ubangui Province
- Ghana: Upper West Region and Ahafo Region and North East Region
- Guinea: Conakry region (Ratoma district)
- Nigeria: Gombe State
- South Sudan: Northern region of Bahr El Ghazal
- Togo: Kara region
Previous epidemics and warnings can be found under News at www.healthytravel.ch.
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important strains of meningitis is available as prophylaxis for adults and children over 1 year of age.
According to the WHO, 18 countries submitted their epidemiological data on meningitis between February 18 and March 3, 2024 (week 7 to 9).
Epidemics:
- Nigeria: Gombe State
- D.R. Congo: North Kivu province
Warnings:
- D.R. Congo: Province of Haut-Uele
- Ghana: Upper West Region and Savannah Region
- Guinea: Conakry region (Ratoma district)
- Niger: Niamey region
- Senegal: Dakar region (Dakar Centre district)
- Nigeria: Bauchi State, Gombe State
- Togo: Kara region (Doufelgou district)
Further information:
- Nigeria: according to media reports, an outbreak of meningitis in Yobe state has resulted in 636 cases.
Previous epidemics and warnings can be found under News on www.healthytravel.ch
Seasonal meningitis epidemics in sub-Saharan Africa occur mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important strains of meningitis is available as a prophylaxis for adults and children over 1 year of age.
The number of dengue patients in Thailand has reached 17,783 cases so far in 2024, more than twice as many as in the corresponding period in 2023.
Optimal protection against mosquito bites around the clock, even in cities (during the day against dengue, chikungunya, Zika). In case of fever: paracetamol products and hydration. Avoid taking medication containing acetylsalicylic acid (e.g. Aspirin®) if you have a fever, as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medicines containing acetylsalicylic acid if they are already part of your regular treatment for an underlying condition.
Based on the available data, many European countries and the Swiss Expert Committee for Travel Medicine (EKRM) currently recommend vaccination with Qdenga® only for certain travelers and in special situations. Advice from a specialist in tropical and travel medicine is therefore recommended.
La febbre dengue, endemica in molti Paesi tropicali e subtropicali, è una delle principali cause di malattia nei viaggiatori, ma la febbre dengue grave e le conseguenti ospedalizzazioni o morti sono rare in questa popolazione. Esistono due vaccini contro la febbre dengue, Dengvaxia® e Qdenga®. Mentre non esiste alcuna raccomandazione per l'uso di Dengvaxia® nei viaggiatori, Qdenga® è stato approvato per i viaggiatori in molti Paesi europei dal dicembre 2022. L'approvazione di Swissmedic per l'uso in Svizzera è prevista per la seconda metà del 2024.
Il Comitato svizzero di esperti in medicina dei viaggi (EKRM) ha valutato i dati pubblicati e non pubblicati sul vaccino Qdenga® e formula la seguente raccomandazione:
- La vaccinazione contro il virus della febbre dengue con Qdenga® in persone senza una precedente infezione da febbre dengue non è raccomandata.
- La vaccinazione con Qdenga® può essere raccomandata per i viaggiatori di età pari o superiore a 4 anni se hanno avuto una precedente infezione confermata da dengue E saranno esposti in una regione con una significativa trasmissione di dengue.
I consulenti sanitari di viaggio devono fornire informazioni in un linguaggio semplice sulle complessità e sui compromessi rischi-benefici dell'uso del vaccino contro la dengue nei viaggiatori.
Details of the position statement can be found at LINK.
According to the WHO, 18 countries submitted their epidemiological data on meningitis between January 29 and February 18, 2024 (week 5 to 7).
Epidemics:
- Ethiopia: SNNP region (Jinka Town and Leku Town)
- D.R. Congo: North Kivu province and Ituri province
Warnings:
- Benin: Zou region (Abomey district), Collines region (Bante district) and Borgou region (Nikki district)
- Cameroon: Est region (Lomie district)
- D.R. Congo: Bas-Uele province and Equateur province
- Ghana: Upper West Region
- Guinea: Conakry region (Ratoma district)
- Nigeria: Bauchi State, Gombe State
- Togo: Kara region (Doufelgou district)
Previous epidemics and warnings can be found under News at www.healthytravel.ch
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important strains of meningitis is available as prophylaxis for adults and children over 1 year of age.
Between January 22 and 28, 2024 (week 4), 18 countries reported their meningitis epidemiological data.
Epidemics:
- Mali: Gao region
- Nigeria: Jigawa State
Warnings:
- Benin: Littoral region (Cotonou district)
- Ghana: Upper West Region
- Nigeria: Yobe State and Bauchi State
Previous epidemics and warnings can be found at www.healthytravel.ch.
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important meningitis strains is available as prophylaxis for adults and children over 1 year of age.
According to Médecins Sans Frontières (MSF), 3,965 patients were treated for measles in Borno State in Nigeria from October to December 2023. The increase in the number of cases could be due to the fact that public health actors were unable to achieve the 95% vaccination rate due to the uncertain situation in the region. In addition, the interruption of routine childhood vaccinations during the COVID-19 pandemic contributed to the increase in cases.
On February 12, 2024, the Centres for Disease Control and Prevention (CDC) published the top 10 countries with measles outbreaks (data refer to the period July - December 2023):
- Yemen 18,464
- Azerbaijan 13,721
- Kazakhstan 13,195
- India 12,301
- Ethiopia 10,060
- Russian Federation 7,720
- Iraq 7,601
- Pakistan 7,027
- Kyrgyzstan 5,777
- Indonesia 3,205
Measles outbreaks are reported when the number of reported cases in an area is higher than the expected number of cases.
In the 2nd and 3rd week of 2024, 21 countries have reported their epidemiological data on meningitis:
Epidemic:
- Ethiopia: Jinka Town (since week 1/2024)
Warning:
- Benin: Littoral Region (Cotonou District)
- Ghana: Upper West Region (Jirapa and Nandom districts) and Northern Region (Zabzugu district)
- Nigeria: Bauchi State (Damban District) and Jigawa State (Biriniwa District)- D.R. Congo: Haut-Uele and North Kivu
- Chad: Mandoul region (Goundi district)
Previous epidemics and warnings can be found at EpiNews or at www.healthytravel.ch.
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of rainfall. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important meningitis strains is available as prophylaxis for adults and children over 1 year of age.
In 2023, 171 cases of leptospirosis were recorded in Reunion Island, more than 70% of which occurred between January and June.
Leptospirosis is a bacterial disease that occurs worldwide, particularly frequently in tropical countries during the rainy or flooding season. It is transmitted through contact between small skin lesions and water contaminated with urine (mainly from infected rats, dogs, pigs, cows, etc.). The risk of infection increases when camping or during water-related activities (swimming, kayaking, wading through watercourses). The disease can be treated with antibiotics if diagnosed in time.
The following precautions are recommended:
General:
- Mass events can favour gastrointestinal and respiratory infections, therefore: careful personal and food hygiene.
- The risk of accidents can also be increased (CAVE alcohol!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhoea, chlamydia, etc.): Safer sex practices (condoms).
- COVID-19: Check, entry and return regulations, see IATA LINK.
- Observe strict personal hygiene and adhere to the recommendations and regulations of your host country
Recommended vaccinations and other health risks: See the relevant country page at www.healthytravel.ch/countries/. Vaccination against meningococcal disease may be considered.
It is strongly recommended that you protect yourself against mosquitoes around the clock throughout the country, including in cities, to prevent diseases such as
Dengue, Chikungunya and Zika. The city of Rio de Janeiro is malaria-free, but the disease is endemic in the Atlantic rainforest of the state of Rio de Janeiro. Further malaria risk areas and
recommended prevention measures can be found on the Brazil country page www.healthytravel.ch .
Since the beginning of 2023 and up to January 11, 2024, a total of 777 Zika virus infections (ZIKV) have been reported in Thailand. These have been registered in 36 provinces, with the central and northern regions being the most affected. According to the government, 758 people tested positive (including 33 pregnant women), compared to only 190 in 2022 and 63 in 2021. It is currently unclear whether the case numbers in 2023 are due to an increase in awareness and/or diagnostic capacity or an increase in ZIKV circulation.
In December 2023, three Zika cases were imported to Europe after a stay in Thailand.
Optimal measures to prevent mosquito bites around the clock, see factsheet Protection against mosquito and tick bites.
Although the US CDC map (last updated December 8, 2023) does not yet show Thailand as a country with a current Zika outbreak, an increased risk of Zika transmission in Thailand cannot be ruled out. As soon as more data is available, the Expert Committee on Travel Medicine (ECRM) will reassess the situation.
Until further information is available, the EKRM recommends that
- Travelers to Thailand should be informed about the situation, the possible risk of congenital infection by ZIKV and its sexual transmission.
- To prevent possible sexual transmission of the virus, it is recommended to use a condom/femidom during the trip and for at least 2 months after return.
- Due to the risk of fetal malformations, pregnant women should postpone planned trips to Thailand at any time during pregnancy (in case of unavoidable travel, a consultation with a specialist in travel medicine is recommended before departure).
- Women who wish to become pregnant should wait at least 2 months after their return (or that of their partner) from an area with an increased risk of Zika transmission.
For details, see the Swiss ECRM recommendation from 2019: LINK
The following precautions are recommended:
General:
- Mass events can favour gastrointestinal and respiratory infections, therefore: careful personal and food hygiene.
- The risk of accidents can also be increased (CAVE alcohol!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhoea, chlamydia, etc.): Safer sex practices (condoms).
- COVID-19: Check, entry and return regulations, see IATA LINK. Observe strict personal hygiene and follow the recommendations and regulations of your host country
- Avian influenza is particularly widespread in China. Avoid contact with poultry and their droppings. Do not visit bird and poultry markets/farms and do not import poultry meat from China. Travellers should also wash their hands frequently with soap and water.
Recommended vaccinations and other health risks: See the respective country page at www.healthytravel.ch/countries/.
The outbreak of Streptococcus suis infections in Thailand continues: 137 infections and 8 deaths have been reported within the last three weeks. The increase in infections is linked to the consumption of raw or undercooked pork, sausages and raw pork blood salad.
Infection with Streptococcus suis is usually asymptomatic in pigs. Humans can become infected by eating contaminated raw or undercooked pork and fresh blood or through direct contact with infected pigs or pork products. Symptoms include high fever, severe headache and dizziness, vomiting, diarrhea, neck stiffness, intolerance to light, decreased level of consciousness and hearing loss.
Health authorities are warning people to protect themselves after a case of Japanese encephalitis virus (JEV) infection was detected in New South Wales (NSW). Following the persistently wet and warm weather over the vacation period, mosquito populations in NSW are currently thriving.
In 2022, there was one outbreak of JEV in Australia with 45 cases detected mainly in the Murray Valley in New South Wales.
Optimal protection against mosquito bites, especially at dusk and at night. In addition, the Swiss Expert Commission for Travel Medicine (EKMT) recommends vaccination against JE for travelers to Australia for high-risk travelers such as:
- Work / extensive outdoor activities in rural areas
- Long-term stays (>4 weeks) or during an ongoing outbreak.
According to the Thai Ministry of Health, there has been a significant increase in Zika virus cases, with around 100 new cases are reported every month.
Around 660 cases have been registered since June 2023, mainly in the northern and central areas. Cases of Zika virus have also been detected in people who had recently returned from Thailand. Zika is endemic in Thailand and other parts of the world, but a current outbreak (epidemic) is not currently recorded in Thailand, according to the US Center of Disease Control and Prevention (CDC) (see CDC map).
Optimum protection against mosquito bites around the clock, even in cities (during the day against chikungunya, dengue, Zika and other viruses, at dusk and at night against malaria). Detailed information on Zika can be found in the Zika information sheet.
If you have a fever, take paracetamol preparations and make sure you drink enough fluids. Do not take medicines containing acetylsalicylic acid (ASA) (e.g. Aspirin®) if you have a fever, as these increase the risk of bleeding. (Note: Do not stop taking medication containing ASA if it is part of a long-term medication for an underlying illness.
In the case of fever, malaria should always be ruled out by means of a blood test.
After a three-week trip to southern Thailand (Krabi, Khao Sok, Koh Phangan, Koh Samui), two German tourists in Tübingen were diagnosed with Zikainfection.
Although the CDC does not classify Thailand as a country with a current outbreak (see CDC map), Zika is endemic in Thailand.
The WHO's annual malaria report highlights the growing threat of climate change. In 2022, there were an estimated 249 million malaria cases worldwide in 85 malaria-endemic countries and territories - significantly more than the estimated number of cases before the COVID-19 pandemic. The main countries contributing to the increase in 2022 were Pakistan, Ethiopia, Nigeria, Uganda and Papua New Guinea. The WHO African region accounted for about 94% of cases worldwide. The number of deaths amounted to an estimated 608,000. In addition to the disruption caused by COVID-19, the global malaria response is facing a growing number of threats: Drug and insecticide resistance, humanitarian crises, resource scarcity, climate change impacts and delays in program implementation, particularly in countries with a high burden of the disease.
Details can be found at WMR LINK.
In October 2023, the following countries reported meningitis outbreaks:
Epidemic:
- Nigeria: Nangere LGA (Yobe State)
Warning:
- Nigeria: Machina LGA (Yobe State), Garawa LGA and Gumel LGA (Jigawa State)
- Ghana: Bole District (Savannah Region)
- Chad: Goundi district (Manoul region)
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important meningitis strains is available as prophylaxis for adults and children over 1 year of age.
Prevention: Good personal hygiene. Avoid close contact with sick people, including those with skin lesions or genital lesions. Avoid contact with sick animals. Avoid contact with contaminated materials used by sick people. Safer sex is recommended to prevent other sexually transmitted diseases. Do not eat bush meat.
Vaccination against Mpox is available and recommended for people at increased risk. Talk to your doctor about whether such a vaccination is recommended for you. Swiss recommendations: see LINK.
In case of symptoms: If you are diagnosed with Mpox, you should not have sex while you have symptoms and lesions. Use condoms for 12 weeks after infection. This is a precautionary measure to reduce the risk of transmitting the virus to a partner. Wash your hands frequently with soap and water or an alcohol-based hand sanitizer containing at least 60% alcohol.
On the World AIDS Day on December 1, here is a look back at the extent of the pandemic:
In 2022:
- 39 million people are living with HIV worldwide
- 1.3 million people were newly infected with HIV
- 630,000 people died from AIDS-related illnesses
- 29.8 million people received access to antiretroviral therapy
Since the beginning of the epidemic:
- 85.6 million people have been infected with HIV and 40.4 million people have died from AIDS-related illnesses.
In Denmark, whooping cough (pertussis) cases have increased significantly during the spring and summer, with the authorities now reporting a figure more than ten times higher than normal. In the 37th week alone (up to September 16), 200 cases of whooping cough were detected (normally an average of around 20 cases per week).
Whooping cough is a respiratory infection that is characterized by a course lasting up to three months with severe coughing fits, often accompanied by howling breathing and vomiting immediately after the attacks.
An 8-year-old girl died of rabies in Agra, Uttar Pradesh, on October 25, 2023, after being bitten by a stray dog two weeks earlier. The child did not inform anyone in her family except her mother about the incident, and she was only given some home remedies instead of the necessary rabies vaccine. The family only contacted the Community Health Center when the girl developed symptoms after 15 days.
According to officials, as many as 5000 cases of dog bites are reported every month in both rural and urban Agra.
Prevention: Avoid contact with animals! Do not feed animals either! Vaccination before exposure (2 injections and a booster after 1 year) is particularly recommended for travelers with increased individual risk (travel on two-wheelers, to remote areas, long-term stays, small children, spelunkers, contact with bats, etc.).
What to do after exposure: After an animal bite/scratch: Immediately wash the wound with running water and soap for 15 minutes, then disinfect and in any case visit a good medical facility for vaccination/revaccination as soon as possible!
Ethiopia has faced malaria outbreaks in numerous regions since early 2023. The regions most affected include Gambela, Southwest Ethiopia (SWEPR), Afar, and Ahmara.
In addition to malaria, Ethiopia faces other health crises, including cholera, measles, dengue fever, and COVID-19, as well as a variety of natural disasters such as droughts, recurrent floods, food insecurity, and locust infestations, as well as man-made challenges such as conflict, internal displacement, and the effects of the Sudan conflict. These factors combined have significantly increased the country's need for health and humanitarian assistance.
The Ministry of Health documents can be downloaded at www.healthytravel.ch.
Although the Tanzania Ministry of Health document is of poor quality and was issued in 2016, travelers with this document have had no problems entering mainland Tanzania. To emphasize the timeliness of this document, the Swiss EKRM recommends that it be stamped by your travel clinic and dated and signed by you.
This tragic case demonstrates the importance of being informed about rabies and acting quickly in the event of a bite or scratch by a mammal in a rabies-endemic country.
Prevention: Avoid contact with animals! Do not feed animals either! Pre-exposure vaccination (2 injections and a booster after 1 year) is recommended especially for travelers with increased individual risk (traveling with two-wheelers, to remote areas, long-term stays, small children, cave explorers, contact with bats, etc.).
Behavior after exposure: After an animal bite/scratch: Immediately wash the wound with running water and soap for 15 minutes, then disinfect and in any case visit a good medical facility as soon as possible for follow-up vaccination!
For more information: see flyer rabies.
In the Indian state of Assam (north-eastern part of the country), 432 cases of Japanese encephalitis (JE) were reported by the end of August, 24 of which were fatal. Cases have increased almost tenfold since the beginning of August 2023.
Ranchi district in Jharkhand state in northern India has also reported an increase in JE cases, although the numbers are still modest, with 12 cases in recent weeks.
The risk for travellers is low. Optimal protection against mosquito bites, especially at dusk and at night.
The indication for vaccination against Japanese encephalitis should be discussed individually and is recommended for:
- Long-term (>1 month) stay in endemic rural areas during the transmission period.
- Short-term travel (<1 month) to endemic areas during the transmission period, outside urban areas and when activities are planned that increase the risk of JE virus exposure.
- Travel to an area with an ongoing outbreak.
Protect yourself against ticks during outdoor activities (see Factsheet Mosquito Protection). Vaccination is recommended when staying in endemic areas. Complete basic immunisation requires three vaccination doses. Protection for a limited period of time already exists after two vaccination doses. These first two vaccinations are usually given one month apart. The third vaccination is given 5-12 months after the second dose, depending on the vaccine. A booster vaccination is indicated after 10 years.
After recreational activities: Always check your body for ticks or tick bites. If redness occurs after a tick bite: Consult a doctor to rule out Lyme disease, which would require antibiotic treatment.
According to media reports, a case of canine rabies has been reported in the city of São Paulo in Brazil. The infection was confirmed by the Pasteur Institute. This is the first case of canine rabies since 1983.
The case is still under investigation and has already led to surveillance measures in the region and 367 animals have been vaccinated with rabies vaccine.
Information about rabies and what to do in case of exposure is important for all travelers!
Prevention: Avoid contact with animals! Do not feed animals either! Pre-exposure vaccination (2 injections and a booster after 1 year) is recommended especially for travelers with increased individual risk (traveling with two-wheelers, to remote areas, long-term stays, small children, cave explorers, contact with bats, etc.).
Post-exposure behavior: After an animal bite/scratch: Immediately wash the wound with soap and water for 15 minutes, then disinfect and in any case visit a quality medical center for post-exposure vaccination as soon as possible! For more information: see factsheet rabies.
Restrictions such as lockdowns were announced to prevent the spread of the virus. Some schools, colleges and offices have been closed and 7 villages have been declared a containment zone. Wearing masks and using disinfectants were made mandatory in the containment zone. The source of the infection is still under investigation. The last documented case of NiV infection in India occurred in 2021, also in Kozhikade district.
Nipah virus (NiV) is a highly pathogenic virus belonging to the family Paramyxoviridae, genus Henipavirus. It was first isolated and identified in 1999 during an outbreak in Malaysia and Singapore. Since then, several outbreaks have been reported in South and Southeast Asia.
NiV is most commonly transmitted via fruit bats, a species of bat that is the natural reservoir, through direct or indirect contact with their excreta. Tree fruits or sap produced from them contaminated with bat droppings are often considered a source of infection. Human-to-human transmission has been reported during the care of infected patients. In addition, pigs may also be infected. The spectrum of disease ranges from (usually) asymptomatic courses to flu-like symptoms with high fever, headache, and muscle pain to encephalitis with severe neurologic or even pulmonary complications. Mortality is high (40-70%).
Since the first week of August and as of 11 September 2023, 19 locally acquired dengue fever cases have been detected in the Lombardy (14) and Lazio (5) regions in Italy. The cases are grouped in three clusters:
- in the province of Lodi, Lombardy region (14 cases)
- in the metropolitan city of Rome (3 cases) and
- in the province of Latina (2 cases), Lazio region (Circero).
All cases were laboratory confirmed by PCR and all cases have recovered or are improving.
A DENV-1 serotype virus was identified in the cases in Lombardy and in the metropolitan city of Rome, Lazio region. Epidemiological investigations have not identified any link between the cases in Lombardy and the cases identified in the Lazio region.
A DENV-3 serotype was detected in the cluster of cases in the province of Latina, Lazio region, indicating that this outbreak is independent from the other two in Italy.
Response and control measures are being implemented by Italian public health authorities. These include case finding, vector control activities, information to healthcare providers and the general public, and preventive measures for donors of substances of human origin (e.g. blood and organs).
So far, 146 imported dengue cases have been registered in Italy in 2023, most of them in the Lombardy region (50 imported cases) and Lazio region (28 imported cases).
For more details of the outbreak in Italy, see Rapid Communication of Eurosurveilance.
It is not unusual that autochthonous dengue cases occur during the summer months in parts of southern Europe.
Prevention: Optimal mosquito bite prevention during the day, also in cities.
An outbreak of 4 autochthonous (locally transmitted) cases of dengue fever was detected in Gardanne in the department of Bouches-du-Rhône. Symptoms of the cases occurred between the second half of July and early August 2023.
At least 47 autochthonous cases were recorded in France in 2022. The affected regions were Occitania (9 cases) and Provence-Alpes-Cote d'Azur (36 cases).
Officials observe that the downward trend in terms of chikungunya continues, with a weekly average of about 40 cases per week in the last 3 weeks, dengue cases still remaining at an average of 100 weekly cases. The high dispersion of the cases is also maintained, covering practically the entire national territory.
The head of Health Surveillance, Guillermo Sequera, stated that it is striking that at the end of July we still have cases of dengue and chikungunya (usually there are no cases at this time). He expressed his concern about this scenario, considering that the rainy season is approaching -in October-, to this is added the phenomenon of El Niño, which could portend a complicated epidemiological scenario for the next season.
A man has been hospitalized in Ulan Bator with bubonic plague after eating marmot meat. This was reported by the National Center for the Study of Zoonotic Infections of Mongolia. According to Xinhua News Agency, the hospitalized man and 5 other people who were in close contact with him have been isolated.
While hunting marmots is illegal in Mongolia, many Mongolians regard the rodent as a delicacy and ignore the law. Of all the 21 Mongolian provinces, 17 are still at risk of the bubonic plague, urging the public not to hunt marmots or eat marmot meat.
According to the media, 8.64% of respiratory specimens handled by public laboratories tested positive for flu, higher than 8.57% recorded the week before, but below the baseline threshold level of 9.2%. The latest fatal case involved a 2-year-old boy who tested positive for influenza A and died on 28 July 2023.
Hong Kong has 2 flu seasons, one beginning in April and the second starting in August.
The ministries of health and agricultural development of the province have declared an epidemiological alert after the detection of cases of suspected trichinosis in the interior of Buenos Aires. So far, 29 people have been reported to have been exposed, 15 of whom developed symptoms; from the municipalities of Adolfo Alsina and Sallikelo, and the products included bacon and dried chorizo.
Samples of both products analyzed by the Applicant's laboratory tested positive for Trichinella spiralis. The sausages came from the plant "AGROINDUSTRIA LOS ANDRES SRL", with the trademark "Don Andrés" RPE No. 122-5 PAMS Exp No. 22500-39417/17 found in salami.
According to preliminary information, these products were distributed in the municipalities of Dayro, Hipólito Yrigoyen, Coronel Suárez, Saavedra, Tres Lomas, Trenque Lauquen, Puan, Rivadavia and Adolfo Alsina. Faced with this, medical teams were called in to strengthen the epidemiological surveillance of cases of trichinosis in the said municipalities, and the secretariats of health and food science departments of these areas were urged to continue the investigation.
- Do not consume products from the pork factory in the Sallikelo area, AGROINDUSTRIA LOS ANDRÉS" CUIT 30-71205283-6 with the trademark "Don Andrés".
- Promptly seek medical attention if you experience symptoms such as swelling of the eyelids or face (facial and/or periorbital edema), fever, muscle pain, diarrhea after several days, and other gastrointestinal symptoms.
Trichinellosis is a food-borne helminth infection caused by Trichinella spiralis. Homemade jerky and sausage are often the cause of many cases of trichinellosis. Salting, drying, freezing, smoking or microwaving meat alone does not consistently kill infective worms.
Therefore: Consume only well-cooked meat!
Optimal mosquito protection 24/7 (during the day against dengue, Zika, Chikungunya and other arboviroses, in the evening and at night against malaria). If you have a fever, take acetaminophen products and make sure you drink enough fluids. Do not take medications containing acetylsalicylic acid (e.g., Aspirin®), as they may increase the risk of bleeding. During and after a stay in a malaria endemic area, malaria should also be considered in case of fever and should always be ruled out by a blood test.
Optimal mosquito protection 24/7 (at dusk and at night against malaria, during the day against dengue, chikungunya and other arboviroses). Drug prophylaxis is recommended for parts of Palawan, see detailed information on the Phiilippines country page.
In case of fever >37.5° C, malaria should always be considered and excluded by blood tests.
So far this season (2023), 6 cases of Murray Valley Encephalitis (MVE) have been recorded, two of which were fatal. The Kimberley region has been particularly affected. This has been the worst season for MVE since 2012. Other arboviruses are also transmitted in Western Australia: dengue virus, Ross River virus, Japanese encephalitis virus, Barmah Forest virus, Kunjin virus, etc.
Murray Valley encephalitis virus is transmitted by mosquitoes. The risk of contracting and becoming ill is low, but the illness caused by the virus can be severe and possibly fatal.
Initial symptoms include fever, drowsiness, headache, stiff neck, nausea and dizziness. People who experience these symptoms should seek medical attention as soon as possible.
The Blitar District Health Office in East Java, Indonesia, reported 11 suspected diphtheria cases in the past 2 months, all of which required a stay in the intensive care unit of a hospital.
Diphtheria is caused by bacteria that are common worldwide. The pathogen produces a powerful toxin that can permanently damage organs such as the heart and liver. There are two types of the disease: respiratory (breathing) and cutaneous (skin) diphtheria. The pathogen primarily affects the upper respiratory tract and produces a toxin that can lead to dangerous complications and late effects. Person-to-person transmission occurs through droplet infection (close physical contact, coughing, sneezing). It originates from a sick person or from someone who carries the bacterium without symptoms. Less commonly, infection occurs through contaminated objects or, in the case of cutaneous diphtheria, through direct contact. Effective vaccination protects against the disease.
Protect yourself against ticks during outdoor activities (see Mosquito Protection Factsheet). Vaccination is recommended when staying in endemic areas. Complete basic immunization requires three doses of vaccine. Temporary protection exists after only two doses of vaccination. These first two vaccinations are usually given one month apart. The third vaccination is given 5-12 months after the second dose, depending on the vaccine. A booster vaccination is indicated after 10 years.
After recreational activities: Always examine their body for ticks or tick bites. If redness occurs after tick bite: Consult a physician to rule out Lyme disease, which would require antibiotic treatment.
In recent years, the world, and the Americas region in particular, has seen an exponential increase in international travel in search of medical care. While most patients seek this in the country in which they reside, there is a growing proportion of individuals who change countries for medical, dental or surgical treatment. This practice is referred to as medical and health tourism. For example, millions of Americans travel to other countries each year for medical care, especially to Mexico, Canada, and other countries in Central America, South America, and the Caribbean.
While there are few published studies on the number of people seeking medical care outside their country of residence, it is estimated that the annual number in the United States alone has increased from 750,000 to 1.4 million over a 10-year period (2007 to 2017). This number is expected to increase by 25% each year, both in the United States and globally. The main motivations for seeking outsourced medical care include lower costs, avoiding long waiting lists, the ability to access procedures that are not available in the country of residence, and the ability to combine health care with a vacation stay. Procedures related to cosmetic and aesthetic surgery account for the largest percentage of procedure types, followed by organ transplants, cardiac surgery, dental procedures, cancer treatment, joint treatments, bariatric surgery, and assisted artificial insemination techniques.
This type of medical care can pose a risk to both public health and the life of the person receiving that type of care. Public health risks include the occurrence and spread of outbreaks caused by resistant microorganisms. As for the patient, the most common complications are surgical wound infections and bacterial sepsis.
The risk of health care in other countries is related to the following factors, among others:
- The quality of health care: Requirements for accreditation of healthcare professionals and facilities may differ from those in the country of origin. In addition, there is a risk of using counterfeit drugs and unapproved medical equipment.
- Air travel: The change in air pressure during a flight increases the risk of blood clots forming and complications such as deep vein thrombosis following certain surgeries.
- Continuity of care: After returning to their home country, patients may need treatment for complications of the procedure performed, which can be costly and not covered by their health insurance.
- Communication difficulties: If a different language is spoken at the destination, this can lead to communication difficulties with medical staff and misunderstandings about the treatment, the instructions to be followed, the treatment prescribed, etc.
People with chronic diseases who take daily medications are at higher risk for complications and death during a heat wave, as are the elderly, children, pregnant women and outdoor workers!
- Drink water regularly, avoid alcohol.
- Try to stay out of the sun between 11 a.m. and 3 p.m., avoid physical exertion during the hottest hours of the day, and try to walk in the shade
- Wear light and loose clothing.
- Wear a hat or cap and sunglasses.
- Take cool showers and foot baths.
- Eat small meals more often.
- Keep indoors cool: open windows when the air outside is cooler than indoors; darken windows exposed to direct sunlight; go to a cooler part of the house, especially for sleeping.
If you feel dizzy and weak, or have severe thirst and headache, go to a cool, shady place to rest and drink water or fruit juice. Seek medical attention if you experience unusual symptoms such as confusion or vomiting. If you develop painful muscle cramps or other symptoms such as a persistent headache, you should also seek medical attention.
Some symptoms of heat-related illness, such as high fever, headache, loss of appetite, dizziness, or shortness of breath, may resemble symptoms of other illnesses. If you or someone else is uncomfortable in hot weather with a high temperature, you should consider the possibility of motion sickness and/or heat-related illness
Important: In case of fever (>37.5°C) malaria should always be excluded immediately by a blood test!
Health authorities in the Czech Republic report an increase in hepatitis E cases in the Moravian-Silesian region and throughout the country. In 2022, a total of 319 cases of hepatitis E were reported, and by the end of May 2023, 221 new cases had already been reported.
Doctors assume that it could be contamination from insufficiently cooked meat, especially pork.
The disease is most commonly transmitted by ticks. The second possible route of transmission is the consumption of unpasteurized dairy products, especially from sheep and goats. In Slovakia, mountain products are traditionally made and consumed from unpasteurized milk. However, since tick-borne encephalitis vaccination coverage is low, (<10%), up to 20% of annual TBE cases in the country involve individuals infected by consumption of risky products. This is unique in Europe.
After recreational activities: Always examine your body for ticks or tick bites. If redness occurs at least 3 days (on average 7-10 days) after the tick bite: see a doctor to rule out erythema migrans (Lyme disease), which requires antibiotic treatment.
WNV affects countries in southern, eastern, and western Europe. The virus is transmitted by the bite of infected mosquitoes among birds and can also infect humans and other mammals. About 80% of WNV infections in humans are asymptomatic. The elderly and immunocompromised are at higher risk for complications. There is no specific prophylaxis or treatment against the disease in humans.
After recreational activities: Always examine your body for ticks or tick bites. If redness occurs at least 3 days (7-10 days on average) after the tick bite: Consult a doctor to rule out Lyme disease, which would require antibiotic treatment.
Although monkeypox (MPOX) cases have declined significantly in recent months, it is important to remember that the virus is still circulating at low levels. Some WHO member states continue to report new cases, and the possibility of reintroduction, either from endemic areas or newly affected countries, is likely.
Based on the findings of the current outbreak and the low number of new infections, the overall risk for MPOX remains moderate for men who have sex with men and very low for the general population. However, ECDC has warned of the possibility of an increase in cases next summer due to a series of celebrations such as Pride events and increased travel.
To kick off the summer festival season and Pride month, ECDC is releasing an updated fact sheet for health professionals. In addition, ECDC and the WHO Regional Office for Europe have provided a series of new infographics and social media maps on personal protective measures to consider for those at increased risk.
- Social media cards: learn more about MPOX before Pride events: LINK.
- Social media cards: MPOX - what you need to know: LINK
- Editable poster: Learn more about MPOX: LINK
MPOX is transmitted primarily through skin contact, including during sex, with someone who has Mpox, even before symptoms appear.
Vaccination against MPOX is available and recommended for those at increased risk. Consult your doctor about whether vaccination is an option for you.
In case of symptoms:
If you are diagnosed with mpox, you should not have sex while you have symptoms and lesions are present. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of transmitting the virus to a partner. Wash your hands frequently with soap and water or an alcohol-based hand sanitizer with at least 60% alcohol.
An increase in leishmaniasis cases in the north of the country has been reported in Honduras. In May of this year alone, 20 cases were registered. For the full year 2022, the number of cases was 84 (2021: 112 cases).
An increase in cutaneous leishmaniasis was also observed in Nicaragua in the first months of the year, with 306 cases.
Murine typhus is caused by rickettsiae (organisms found worldwide and classified as bacteria), which are transmitted to humans by fleas. Symptoms include chills, headache, fever and rash. There is no vaccine; the disease can be treated with antibiotics.
As a precaution, the KSA recommends that pregnant women and young children postpone performing Hajj and Umrah.
Umrah is a shorter pilgrimage for Muslims that is performed as part of the Hajj ritual, but can also be undertaken at any time.
Ideally, pilgrims should see their doctor at least four to six weeks before performing the Hajj so that recommended and mandatory vaccinations can be administered, health status checked, and recommended precautions for the pilgrimage discussed.
In particular, pilgrims with pre-existing conditions should discuss with their doctor whether the trip can be made and under what precautions. If you are taking prescribed medication, make sure you have a sufficient supply to cover your stay abroad and have some extra in case of delays, and carry a copy of your prescription with you. See also instructions on the factsheet Hajj-Umrah.
The following vaccinations are recommended or mandatory according to the KSA:
• All pilgrims should have valid routine vaccinations (diphtheria/tetanus/pertussis/poliomyelitis/measles, mumps, rubella, varicella).
• Meningococcal vaccination (quadrivalent conjugate vaccine, Menveo®) is mandatory for all persons 1 year of age and older and must be administered at least 10 days prior to departure.
• Poliomyelitis vaccination: In addition to the basic immunization, a polio booster vaccination is mandatory if you are entering from countries where wild or circulating polioviruses are reported or positive environmental samples are available
• Vaccination against COVID-19 is mandatory
• Influenza vaccination
• Hepatitis A vaccination
• Hepatitis B vaccination (especially for men because of head shaving)
• Yellow fever vaccination, if entering from a yellow fever endemic area
• Other vaccinations depending on risk: see Saudi Arabia country page at www.healthytravel.ch.
Recommended precautions:
• Disposable razor blades are recommended for the obligatory head shave
• Good personal hygiene (hand washing, disinfecting, etc.), use tissues when coughing or sneezing, and dispose of used tissues in the wastebasket.
• Wear a face mask in large crowds.
• Avoid contact with persons who appear to be ill and their personal belongings.
• Avoid visits and contact with camels at farms, markets, and avoid drinking unpasteurized milk or eating raw meat or uncooked animal products.
• Good food and drinking water hygiene
• Drink plenty of fluids!
• Avoid direct sunlight
• Mosquito repellent, especially during the day (dengue fever!)
Seasonal meningitis epidemics occur in sub-Saharan Africa primarily during the dry season, usually from December to June. They decline rapidly with the onset of rains. Generally, meningococcal serogroups A, C, W, and X are responsible for these outbreaks. The disease spreads by droplets from person to person. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. As a prophylaxis, vaccination against the main meningitis strains is available for adults and children over 1 year of age.
Lyme disease cases have also increased (2'753 cases).
After recreational activities: Always examine your body for ticks or tick bites. If redness occurs after tick bite: Consult a doctor to rule out Lyme disease, which would require antibiotic treatment.
According to US CDC and other sources the species found is P. falciparum.
As part of the containment actions established by the Ministry of Health in conjunction with the Costa Rican Social Security Fund, since the first case was detected, a series of preventive and control measures have been implemented to prevent the disease from spreading. Among the actions being carried out are the exhaustive tracking of all persons who have been in contact with confirmed cases, to detect possible new infections and provide timely medical care, as well as delivery of prophylactic treatment in different locations to patients positive for the disease living with them, to prevent the disease from spreading and becoming an epidemic, monitoring of control of thick drops to determine the effectiveness of medical treatment and detect possible relapses.
After having reported no documented local transmission in Costa Rica from 2012–2014, cases have been gradually increasing since 2015 with 189 locally acquired cases reported in 2021, mostly in Alajuela Province (near the border with Nicaragua), In 2022, according to the 'Dirección de Vigilancia de la Salud', a total of 332 malaria cases were reported in EW 34 (ending 28 August 2022), with the North Huetar region the most affected with a total of 300 cases, followed by the Caribbean Huetar region with 24 cases, P. falciparum being the most prevalent parasite.
Map Source: LINK
Recommendation: All travellers to Limon Province and adjacent provinces should be made aware of the malaria outbreak; until there is clarity on the dynamics of the outbreak, chemoprophylaxis can be considered for travelers to the affected areas. Optimal mosquito protection 24/7 (at dusk and at night against malaria, during the day against dengue and other arboviruses) is of great importance! Be aware, that there also is a malaria risk in the provinces of Alajuela, Heredia, area around Puntarenas, see map at www.healthytravel.ch.
Important: In case of fever (>37.5°C), malaria should always be immediately ruled out by blood tests!
Epidemics:
- Togo: Savane region (Oti Sud district).
- Niger: Zinder region (Mirriah district)
- Nigeria: Jigawa State
Alerts:
- Benin: Borgou region (Bembereke district), Zoe region (Agbangnizoun district), Donga region (Djougou district), and Atacora region (Toucountouna district).
- Chad: Mandoul region (Bekourou district)
- Ghana: Upper Region (Nadom District)
- Niger: Zinder Region (Mirriah District)
- Nigeria: Jigawa State (Sule Tankakar district)
- Senegal: Dakar Region (Diamniadio District)
For previous epidemics and alerts, visit www.healthytravel.ch.
Seasonal meningitis epidemics occur in sub-Saharan Africa primarily during the dry season, usually from December to June. They decline rapidly with the onset of rains. Generally, meningococcal serogroups A, C, W, and X are responsible for these outbreaks. The disease spreads by droplets from person to person. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. As a prophylaxis, vaccination against the main meningitis strains is available for adults and children over 1 year of age.
Marburg virus disease is a hemorrhagic fever with a mortality rate of up to 88%. The disease begins abruptly with high fever, severe headache, and severe discomfort. Many patients develop severe hemorrhagic symptoms within seven days. The virus is transmitted to humans by fruit-eating bats and spreads among people through direct contact with the body fluids of infected persons, surfaces, and materials. There are no approved vaccines or antiviral therapies to treat the virus. However, supportive care - oral or intravenous rehydration - and treatment of specific symptoms improve survival.
Polio vaccination coverage in the country is insufficient.
While the official WHO declaration is still pending, Peru formally falls under category 1 of the WHO temporary poliomyelitis vaccination recommendations:
- At departure from Peru, persons staying in the country for more than 4 weeks must have received a booster polio vaccination (IPV) not more than 12 months ago and documented in the "International Certificate of Immunization."
- For stays <4 weeks: In addition to the basic immunization against polio, a booster vaccination is recommended every 10 years (recommendation of the Swiss Expert Committee for Travel Medicine (ECTM).
The outbreak in Austria is the first significant measles outbreak reported in the EU/EEA since the start of the COVID-19 pandemic. Measles activity in the EU/EEA currently remains low.
- As of 23 March 2023, 30 cases of botulism have been reported in Europe in Germany (27 cases), Austria (1 case), France (1 case), and Switzerland (1 case). All of the affected individuals underwent medical intervention in the form of injection of botulinum neurotoxin into the stomach to treat obesity in Turkey in February 2023.
- In addition, the National Focal Point for Turkey has reported 53 cases of botulism in individuals who underwent the same procedure at two private clinics in Istanbul (50 cases) and Izmir (3 cases).
- In 65 known cases, the procedure was performed at a single clinic in Istanbul, Turkey.
- At this time, it is unclear whether this event is a therapeutic or procedural problem at the affected hospitals or a problem with the product administered.
Outbreaks of botulism are very rare and may be associated with a natural, accidental, or possibly intentional source of infection.
ECDC strongly encourages EU/EEA citizens to avoid intragastric treatments with botulinum neurotoxin for obesity in Turkey, as this is currently associated with a significant risk of developing botulism.
On 27 January 2023, the state of São Paulo recorded the 1st confirmed case of yellow fever since 2020, involving a 73-year-old man living in a rural area in the inland municipality of Vargem Grande do Sul.
Vanuatu is located in the Pacific "Ring of Fire" and experiences frequent volcanic and seismic activity. Along with the other small island developing states in the Pacific, Vanuatu faces existential threats due to rising sea levels, ocean acidification, and the increasing frequency and severity of natural disasters, and is at the forefront of the climate crisis.
According to the latest update from the Chinese CDC, the COVID-19 situation in mainland China has stabilized between 10'000 and 15'000 cases per day, with fluctuations within this range. The downward trend in hospitalizations and deaths continues.
In South America, deaths in monkeys often precede cases of yellow fever in humans and thus are an indicator of the spread of the virus. In Brazil, the peak season for yellow fever infections is between December and May.
Leptospirosis spreads more easily during the rainy season. It is transmitted through the urine of rodents (especially rats), e.g., in water residues (rivulets, puddles, etc.) or mud. Transmission to humans occurs via small skin lesions or mucosal contacts through direct or indirect contact with infected rodent urine. The clinical picture ranges from flu-like general symptoms to encephalitis or blood poisoning.
In northwestern Syria, there have been 506 cholera cases and 21 related deaths as of 27 February 2023, according to a report published by the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA). In addition, the number of suspected cholera cases in the region is estimated at 50'000.
Marburg virus disease is a hemorrhagic fever with a mortality rate of up to 88%. The disease begins abruptly with high fever, severe headache, and severe malaise. Many patients develop severe hemorrhagic symptoms within seven days. The virus is transmitted to humans by fruit-eating bats and spreads among people through direct contact with the body fluids of infected persons, surfaces, and materials. There are no approved vaccines or antiviral therapies to treat the virus. However, supportive care - oral or intravenous rehydration - and treatment of specific symptoms improve survival.
Seasonal meningitis epidemics occur in sub-Saharan Africa primarily during the dry season, usually from December to June. They decline rapidly with the onset of rains. Generally, meningococcal serogroups A, C, W, and X are responsible for these outbreaks. The disease spreads by droplets from person to person. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. As prophylaxis, vaccination against the main meningitis strains is available for adults and children over 1 year of age.
- IATA (with interactive map). The websites are constantly updated.
- HUG (practical and user-friendly summary of entry requirements by country, updated weekly based on IATA and WFP).
Trichinellosis is caused by the larvae of an intestinal worm when eating inadequately cooked meat (mainly pork, but also game and other animals such as bear). Symptoms vary widely: muscle pain, inflammation of the eyelids and eye pain, diarrhea, and fever. Cardiac and neurological complications are possible and the disease is sometimes fatal.
In South America, scrub typhus, a rickettsial disease, has only recently been detected. It is now endemic in a wide geographic area in southern Chile (from the Biobío region in the north to Tierra del Fuego in the south). The infection is caused by a bacterium of a novel Orientia species and is transmitted by mites. The disease exhibits marked seasonality, with cases occurring during the Australian summer months (December to March). After an incubation period of 6-21 days, a typical blackish skin lesion (scab) may appear, as well as fever, headache, muscle pain, swollen lymph nodes, and sometimes exanthema. If scrub spotted fever is suspected, antibiotic treatment (doxycycline) should be started as soon as possible to avoid possible neurologic (encephalitis) and cardiac complications, which can be fatal.
In early February 2023, a chikungunya infection was also diagnosed in a returning traveler to Switzerland.
In 2022, more than 40 human JEV cases were reported in the states of News South Wales, Queensland, South Australia and Victoria.
- Persons who work with pigs or live near or visit pig farms.
- People who work with mosquitoes or the virus itself (laboratory).
The Australian Department of Health recommends vaccination for stays in the Torres Strait region of Australia for:
- Travelers to rural areas.
- Stays in the region of one month or longer.
Oropouche fever is caused by the Oropouche virus (OROV) and is transmitted to humans through mosquito bites. To date, there is no evidence of direct human-to-human transmission. It is endemic in several regions of the Americas. Human cases have been documented in rural and urban communities in Brazil, Peru, Ecuador, French Guiana, Panama, and Trinidad and Tobago. The symptoms are dengue-like with sudden onset of high fever, headache, muscle pain, rash, joint pain, and vomiting. The illness usually lasts 3-6 days. A brief return of symptoms may occur in up to 60% of cases. A rare complication is aseptic meningitis.
In case of symptoms after a stay in an endemic area, think of Oropouche fever.
Seasonal meningitis epidemics occur in sub-Saharan Africa primarily during the dry season, usually from December to June. They decline rapidly with the onset of rains. Generally, meningococcal serogroups A, C, W, and X are responsible for these outbreaks. The disease spreads through droplets from person to person. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. As prophylaxis, vaccination against the main meningitis strains is available for adults and children over 1 year of age.
Diphtheria is a bacterial, highly contagious infection that usually manifests with sore throat and can be fatal without immediate administration of diphtheria antitoxin and antibiotics. Vaccination is extremely effective in preventing this disease. The disease is more common in developing countries where the population is insufficiently vaccinated.
Melioidosis is a disease caused by the bacterium B. pseudomallei. It lives in soil and surface water, especially in Southeast Asia and northern Australia. You can become infected when the bacterium enters through a break in your skin or when you inhale or swallow it. Melioidosis is a life-threatening disease that requires immediate medical attention.
Leptospires are transmitted through the urine of rodents (mainly rats), for example, in water residues (rivulets, puddles, etc.) or mud. Transmission to humans occurs via small skin lesions or mucosal contacts through direct or indirect contact with rodent urine. The clinical picture ranges from flu-like general symptoms to aseptic meningitis and sepsis.
China is currently experiencing a large COVID-19 outbreak. The World Health Organization (WHO) is monitoring this evolving situation very closely and there are increasing reports of severe disease in the country.
If considering a visit despite COVID-19 pandemic, the following precautions are recommended:
General:
- COVID-19: Observe current situation, entry and return travel regulations, and precautions regarding COVID-19 in the country! Follow strict personal hygiene.
- Mass events may favor gastrointestinal and respiratory infections, therefore: follow good personal and food hygiene.
- The risk of accidents may also be increased (CAVE alcohol!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhea, chlamydia, etc.): follow safer sex practices (condoms).
- Avian influenza is particularly prevalent in China. Contact with poultry and their droppings should be avoided. Do not visit bird and poultry markets/farms, do not import poultry meat from China. Travelers should also wash their hands frequently with soap and water.
Recommended vaccinations and other health risks: see country page China
Seasonal meningitis epidemics occur in sub-Saharan Africa primarily during the dry season, usually from December to June. They decline rapidly with the beginning of rains. Generally, meningococcal serogroups A, C, W, and X are responsible for these outbreaks. The disease spreads by droplets from person to person. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. As prophylaxis, vaccination against the main meningitis strains is available for adults and children over 1 year of age.
Hepatitis E is a viral disease and is transmitted directly from one person to another through contaminated water/food or by feco-oral route. Symptoms include abdominal pain, yellowing of the skin (jaundice) and are flu-like (fever, muscle and joint pain). Pregnant women are particularly at risk, with a significantly increased mortality rate (10-30%).
Since the beginning of the year, 164 Chagas cases and two deaths have been registered in the state of Pará, according to authorities (2021: 285 cases, 2 fatal; 2020: 230 cases, 2 fatal). The city of Belém (capital of Pará) is considered the Brazilian municipality with the most acute Chagas cases in Brazil.
Avoid eating pressed acai berries, which are a known source of infection for Chagas (pressed predatory bugs in fruit juice).
Dengue fever: 1'390'673 probable dengue cases occurred in Brazil by the end of November. Compared to 2021, there was a 175.1% increase in cases this week.
Chikungunya: 170'199 probable chickungunya cases were reported by the end of November, an increase of 80.4%.
Zika: By mid-November, there were 9'256 probable cases (47.1% increase).
- Protect yourself optimally 24/7 against mosquitoes (see factsheet mosquito protection): during the day against yellow fever, dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria.
- Vaccination protection against yellow fever is recommended for all regions in Brazil. Consult a specialist in tropical and travel medicine to obtain this!
- For information on Zika, see the Zika factsheet at www.healthytravel.ch.
- If you should have a fever: take medication containing the active ingredient paracetamol and make sure you drink enough fluids. Do not use any medication containing the active ingredient acetylsalicylic acid (e.g. Aspirin®), as this can increase the bleeding tendency in the event of a dengue infection (see also factsheet dengue). When staying in malaria regions, malaria should always be ruled out by means of a local blood test in the event of a fever >37.5 °C. Visit a medical facility for this purpose (see also factsheet malaria).
Malaria transmission in South Africa is seasonal, with the number of cases increasing in October, peaking in January and February, and decreasing again towards May. Therefore, with the onset of summer in the southern hemisphere, malaria cases in South Africa are expected to increase (higher temperatures and heavier rainfall in endemic areas).
While the official WHO IHR statement is still pending, Botswana and Zambia formally fall under category 2 of the WHO temporary poliomyelitis vaccination recommendations:
- On departure from Botswana or Zambia, persons with residence or staying in the country for >4 weeks are strongly recommended to have received a polio booster vaccine (IPV) no longer than 12 months ago with documentation in their 'International Certificate for Vaccination'.
- For Stays <4 weeks: Basic immunisation and booster vaccination every 10 years (recommendation of the Swiss expert Committee for Travel Medicine).
WHO estimates the public health risk to be low at the global level, high at the regional level and very high at the national level.
Travelers are usually at low risk of contracting Ebola if you follow these precautions:
- Avoid contact with infected/deceased persons or their body fluids, and all wild animals, alive and dead.
- Avoid handling or eating bush/wild meat.
- Wash and peel fruit and vegetables before eating.
- Wash hands regularly and thoroughly with soap and water (or use a sanitizer if soap is not available).
- Practice safe sex, see LINK.
Vaccination against Ebola is not available to travellers.
For humanitarian missions, it is recommended to consult a travel medicine specialist.
If you have symptoms of illness (fever >38 °C, headache, diarrhea, bleeding symptoms, etc.) during travel until 21 days after being in the affected area:
Isolate yourself and immediately contact the hotline in the country by phone or contact a tropical institute or a university hospital infectious disease unit. Always state that you may have had an exposure to Ebola.
While the official WHO declaration is still pending, Indonesia formally falls under category 2 of the temporary WHO poliomyelitis vaccination recommendations:
- On departure from Indonesia, persons staying in the country for >4 weeks are strongly recommended to have received a polio booster vaccine (IPV) no longer than 12 months ago with documentation in their 'International Certificate for Vaccination'.
- For stays <4 weeks: In addition to the basic immunisation against polio, a booster vaccination is recommended every 10 years (recommendation of the Swiss Expert Committee for Travel Medicine (ECTM).
Nepal: In the early morning of 9 November 2022, an earthquake of magnitude 6.6 struck Doti district in far western Nepal, killing at least 6 people. The epicentre was in the rural community of Khaptad Chhanna in Doti district. According to the Nepalese government, six people were killed and eight injured. On the evening of 12 November, another strong earthquake occurred in Bajhang district. Since 14 November, those affected have been living in the open and are in urgent need of emergency shelter.
Solomon Islands: On 22 November 2022, an earthquake of magnitude 7.0 occurred in Solomon Islands, followed by several aftershocks. The epicentre was located 18 km southwest of Malango and 57.4 km southwest of the capital Honiara. There are reports of widespread damage to infrastructure, including water and power outages.
While the official WHO IHR statement is still pending, Botswana formally falls under category 2 of the WHO temporary poliomyelitis vaccination recommendations:
- On departure from Botswana, persons with residence or staying in the country for >4 weeks are strongly recommended to have received a polio booster vaccine (IPV) no longer than 12 months ago with documentation in their 'International Certificate for Vaccination'.
- For Stays <4 weeks: Basic immunisation and booster vaccination every 10 years (recommendation of the Swiss expert Committee for Travel Medicine).
In Kenya, an estimated 2'000 people die each year from rabies caused by bites from rabid dogs.
Follow the official and media reports.
Since 1 November 2022, WHO considers the public health risk to be very high at the national level, high at the regional level and low at the global level.
Travelers are usually at low risk of contracting Ebola if you follow these precautions:
- Avoid contact with infected/deceased persons or their body fluids, and all wild animals, alive and dead.
- Avoid handling or eating bush/wild meat.
- Wash and peel fruit and vegetables before eating.
- Wash hands regularly and thoroughly with soap and water (or use a sanitizer if soap is not available).
- Practice safe sex, see LINK.
Vaccination against Ebola is not available to travellers.
For humanitarian missions, it is recommended to consult a travel medicine specialist.
If you have symptoms of illness (fever >38 °C, headache, diarrhea, bleeding symptoms, etc.) during travel until 21 days after being in the affected area:
Isolate yourself and immediately contact the hotline in the country by phone or contact a tropical institute or a university hospital infectious disease unit. Always state that you may have had an exposure to Ebola.
The National Influenza Vaccination Day will take place on Friday, 25 November 2022. People interested in being vaccinated can spontaneously get vaccinated against influenza on this day at one of the participating medical practices or vaccination pharmacies for a recommended flat rate of CHF 30.
Nationwide, 224'771 dengue fever cases with 92 deaths have been recorded this year through the end of September.
Central Highlands: According to a Ministry of Health report, more than 7'400 dengue fever cases have been reported in Gia Lai, Dak Lak, Dak Nong, and Kon Tum provinces since the beginning of the year through August, accounting for about 15% of cases registered nationwide.
If considering a visit, the following precautions are recommended:
General Precautions:
- Follow entry requirements and precautions regarding COVID-19 in the country.
- Mass events may favor gastrointestinal and respiratory infections, therefore: follow good personal and food hygiene.
- The risk of accidents may also be increased (CAVE alcohol!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhea, chlamydia, etc.): follow safer sex practices (condoms).
- Mosquito-borne diseases: Optimal mosquito protection mainly during the day against dengue, zika, chikungunya and other arboviruses. In case of fever, paracetamol products and hydration. Do not take medication containing acetylsalicylic acid (e.g. Aspirin®), as this increases the risk of bleeding.
- Middle East Respiratory Syndrome Coronavirus (MERS-CoV): People with an underlying disease such as diabetes should consult a doctor before travelling. WHO advises that travellers to the Arabian Peninsula should avoid contact with dromedaries, as well as visiting farms and markets where the animals are present. They should also avoid eating raw or incompletely heated camel products. In addition, the usual rules of everyday hygiene should be followed (same as for COVID-19).
- It is strongly recommended that you take out health and travel insurance.
- For further information: see www.healthytravel.ch.
The following vaccinations are recommended:
- For all visitors: COVID-19, MMR, varicella (if infection not passed), influenza, tetanus, diphtheria, pertussis, poliomyelitis (basic immunization), hepatitis A and B, meningitis (MenACWY).
Country requirements:
- Vaccination against polio is compulsory for entry from the following countries (with documentation in the International Certificate for Vaccination): Afghanistan, Pakistan
WHO estimates the public health risk to be low at the global and regional levels and high at the national level.
Travelers are generally at low risk of contracting Ebola if you follow these precautions:
- Avoid contact with sick/dead persons or their body fluids, and with all live and dead wildlife.
- Avoid handling or eating bush/wild meat.
- Wash and peel fruits and vegetables before eating.
- Wash hands regularly and thoroughly with soap and water (or use a sanitizer if soap is not available).
- Practice safer sex, see LINK.
Vaccination against Ebola is not available to travelers.
For humanitarian missions, it is recommended to consult a travel medicine specialist.
If you have symptoms of illness (fever >38°C, headache, diarrhea, bleeding symptoms, etc.) during travel until 21 days after being in the affected area:
Isolate yourself and immediately contact the hotline by phone or contact a tropical institute or university hospital infectious disease department. Always state that you may have had an exposure to Ebola.
Proper disease surveillance is impossible in this situation.
Humanitarian organizations have increased their precautions and outreach in response to the emergency situation following the flooding in Pakistan. MSF-Switzerland is active in the southwest mainly as a mobile clinic in Sindh with a base in Karachi in the malaria zone and on hills between the flooded areas.
On 4 October 2022, the Nigerian Center for Disease Control and Prevention warned of the high risk of Ebola introduction into Nigeria due to increased travel between the two countries. So far, no cases of Ebola have been detected in Nigeria.
Three experimental vaccines against the Sudanese Ebola virus have been tested in human trials, but because outbreaks with this species are so rare, they have not yet been tested in the field. Testing will begin in October.
According to ECDC, the risk of infection to EU/EEA citizens associated with this event is currently considered very low, despite uncertainty about the extent of the outbreak.
Travelers are generally at low risk of contracting Ebola if you follow these precautions:
- Avoid contact with sick/dead persons or their body fluids, and with all live and dead wildlife.
- Avoid handling or eating bush/wild meat.
- Wash and peel fruits and vegetables before eating.
- Wash hands regularly and thoroughly with soap and water (or use a sanitizer if soap is not available).
- Practice safer sex, see LINK.
Vaccination against Ebola is not available to travelers.
For humanitarian missions, it is recommended to consult a travel medicine specialist.
If you have symptoms of illness (fever >38°C, headache, diarrhea, bleeding symptoms, etc.) during travel until 21 days after being in the affected area:
Isolate yourself and immediately contact the hotline by phone or contact a tropical institute or university hospital infectious disease department. Always state that you may have had an exposure to Ebola.
Authorities had reported resurgence of the virus in Beni, North Kivu province, on 22 August 2022. Genome sequencing of the virus confirmed that the case was a flare-up of the previous EVD outbreak in the region in 2018 - 2020.
Vaccination again played an important role in the response. 51 direct contacts of the Ebola victim and 303 contacts of contacts were vaccinated. This contrasts with the current EVD outbreak in Uganda, where responders are facing the Sudan strain (SDV) of the virus, for which there is no vaccine.
Malaria is transmitted by mosquitoes in the evening at dusk and at night. Symptoms of the disease include fever >37.5° C, chills, headache and flu symptoms, and occasionally diarrhea. The disease is potentially fatal and is a medical emergency! See also factsheet Malaria.
According to WHO, there have been 63 cases (confirmed and probable) and 29 deaths so far. They have been reported in Mubende, Kyegegwa and Kassanda districts. At least 10 health workers have been infected, and four of them died. So far, no confirmed cases have been reported in the capital, Kampala.
Travelers are generally at low risk of contracting Ebola if you follow these precautions:
- Avoid contact with sick/dead persons or their body fluids, and with all live and dead wildlife.
- Avoid handling or eating bush/wild meat.
- Wash and peel fruits and vegetables before eating.
- Wash hands regularly and thoroughly with soap and water (or use a sanitizer if soap is not available).
- Practice safer sex, see LINK.
Vaccination against Ebola is not available to travelers.
For humanitarian missions, it is recommended to consult a travel medicine specialist.
If you have symptoms of illness (fever >38°C, headache, diarrhea, bleeding symptoms, etc.) during travel until 21 days after being in the affected area:
Isolate yourself and immediately contact the hotline by phone or contact a tropical institute or university hospital infectious disease department. Always state that you may have had an exposure to Ebola.
Formally, D.R. Congo thus falls under the WHO temporary polio vaccination recommendations category 1 ("States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread"), but the official WHO declaration is still pending:
- Persons staying in the country for > 4 weeks must have received a polio booster vaccination (IPV) with documentation in the international vaccination certificate at the time of departure, which must not be older than 12 months. This is important to prevent the spread of poliomyelitis virus from the country and can be checked upon departure.
- Stays < 4 weeks: In addition to the basic immunization against polio, a booster vaccination is recommended every 10 years (recommendation of the Swiss expert Committee for Travel Medicine (ECTM).
Avoid contact with animals (never feed them!). After an animal bite/scratch, wash the wound with running water and soap for 15 minutes, disinfect and in any case visit a high-quality medical center (post-exposure vaccination). For long-term travelers and travelers with increased individual risk (travel with two-wheelers, to remote areas, long-term stays, small children, work with animals, cave explorers, etc.), a pre-exposure vaccination before the stay (2 injections and a booster after 1 year) is recommended.
Travelers are generally at low risk of contracting Ebola if you follow these precautions:
- Avoid contact with sick/dead persons or their body fluids, and with all live and dead wildlife.
- Avoid handling or eating bush/wild meat.
- Wash and peel fruits and vegetables before eating.
- Wash hands regularly and thoroughly with soap and water (or use a sanitizer if soap is not available).
- Practice safer sex, see LINK.
Vaccination against Ebola is not available to travelers.
For humanitarian missions, it is recommended to consult a travel medicine specialist.
If you have symptoms of illness (fever >38°C, headache, diarrhea, bleeding symptoms, etc.) during travel until 21 days after being in the affected area:
Isolate yourself and immediately contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease department. Always state that you may have had an exposure to Ebola.
So far, more than 110 schools in Bangkok have been fully or partially closed for several days after the virus spread there. Children aged ≤ 4 years are affected in 85% of cases.
HFMD is a highly contagious viral disease with a worldwide distribution that primarily affects children. It is caused by various enteroviruses, In most cases, HFMD is benign and self-limiting, but severe neurological and even fatal courses have been repeatedly reported in Southeast Asia.
The rabies situation in 2022 is as follows: Since the beginning of the year, authorities reported 222 human rabies deaths in 16 of the country's 17 regions. This is a 17% increase from the previous year.
The Central Luzon region (including Metro Manila) reported the most cases, followed by Calabarzon, Davao, and Soccsargen (Region XII, Mindanao).
Behavior after exposure: After an animal bite/scratch: Immediately wash the wound with running water and soap for 15 minutes, then disinfect and in any case visit a high quality medical center for revaccination as soon as possible! See also the factsheet rabies.
Legionella multiply especially in hot water systems, humidifiers, whirlpools and hydrotherapeutic facilities at water temperatures below 50°C. Particularly at risk of severe illness are older people, immunocompromised persons, such as transplant recipients and tumour patients, diabetics and persons with chronic lung diseases (smokers).
El Ministro anunció los nuevos criterios de inclusión para la detección del brote de legionella, 5.9.2022
WHO Legionellosis - Argentina, 5.9.2022 | Cases of pneumonia due to unknown cause - Tucumán Argentina, 1.9.2022
DSWD-DROMIC Preparedness for Response Report #13 on the Typhoid Fever Cases in Region VII as of 11 July 2022
In case of fever, take paracetamol products and drink plenty of fluids. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®), as these may increase the risk of bleeding. After a stay in a malaria endemic area, malaria should always be ruled out by blood tests.
Lassa virus is endemic in West Africa. Outbreaks from Nigeria are consistently reported. The virus is transmitted via rodent excreta (Mastomys sp.), e.g., through contaminated food, or it is inhaled. Human-to-human transmission occurs through contact with body fluids of infected individuals. Lassa belongs to the group of hemorrhagic fevers. Symptoms of illness range from mild flu-like symptoms to fever with bleeding. The infection is often fatal.
At least eight people living in a Bern asylum center contracted the disease but did not have respiratory problems. The infected group of people has been isolated, and more than 170 other asylum seekers, mostly unaccompanied minors, are in quarantine at the center. All residents have since been vaccinated against diphtheria.
Diphtheria is caused by bacteria that are spread worldwide. The pathogen produces a powerful toxin that can permanently damage organs such as the heart and liver. There are two types of the disease: respiratory and cutaneous (skin) diphtheria. The pathogen primarily affects the upper respiratory tract and produces a toxin that can lead to dangerous complications and long-term effects. Person-to-person transmission occurs through droplet infection (close physical contact, coughing, sneezing). It originates from a sick person or from someone who carries the bacterium without symptoms. Less commonly, infection occurs through contaminated objects or, in the case of cutaneous diphtheria, through direct contact. Effective vaccination protects against the disease.
Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne virus. The disease is prevalent in Eastern Europe, particularly in the former Soviet Union, throughout the Mediterranean region, northwest China, Central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.
Clinical presentation: The clinical picture is characterised by lesions that are atypical of the clinical picture in endemic countries. Currently, there are mainly very few, non-grouped, painless pustular lesions on the genitals, perianally and orally. Whether transmission occurs through genital secretions or primarily only through close skin-to-skin contact is not yet clear. The draining lymph nodes are sometimes massively swollen, and fever usually occurs for a few days. The general condition is often only slightly reduced.
Transmission: The virus can 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 7-17 days. Monkeypox is transmitted from infected animals through a bite or through direct contact with blood, body fluids or lesions of the infected animal. They can be transmitted to people who eat infected animals via abrasions in the mouth.
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.
MANDATORY REPORTING: In Switzerland, every suspected case must be reported within 2 hours to the respective cantonal doctor and to the FOPH (tel. +41 58 463 87 06)! Specialist laboratories, such as the Reference Laboratory for Imported Viral Diseases (HUG) or the Spiez Laboratory or the ZBS1 at the Robert Koch Institute (RKI; consiliary laboratory for smallpox), offer molecular diagnostics for the identification of monkeypox infections (material: crust or vesicular fluid).
Geosentinel requests confirmed and suspected cases to be reported at: geosennel@geosentinel.org
ECDC: Monkeypox multi-country outbreak. Situation Updates
WHO: Monkeypox
WHO: Meeting of the IHR (2005) Emergency Committee regarding the multi-country monkeypox outbreak, 25.6.2022
WHO: Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin, 17.6.2022
CDC: Monkeypox. Global Map
Global Health (GH): Map Monkeypox
Johns Hopkins: Center for health security. Monkeypox
Mumbai: The local health department had already registered 397 malaria cases by mid-July. Within a week, malaria cases increased by 63%. The number of dengue cases is also on the rise.
Trichinellosis is caused by the larvae of an intestinal worm when eating insufficiently cooked meat (mainly pork, but also game and other animals such as bear). Symptoms vary widely: muscle pain, inflammation of the eyelids and eye pain, diarrhea, and fever. Cardiac and neurological complications are possible and the disease is sometimes fatal.
Marburg is transmitted to humans by bats (fruit bats) and spreads in humans through direct contact with body fluids of infected persons, surfaces, and materials. The disease begins abruptly with high fever, severe headache, and malaise. Many patients develop severe hemorrhagic symptoms within seven days. Mortality rates have varied from 24% to 88% in previous outbreaks, depending on the strain of virus and case management.
West Nile fever (WNV) is transmitted by mosquitoes during the day and at night. Only about 20% of those infected show symptoms, which can range from flu-like symptoms with fever, headache, and aching limbs. In rare cases, encephalitis (inflammation of the brain) and meningitis may occur. This more severe form of the disease can include headaches, neck stiffness, visual disturbances, paralysis, and other neurological symptoms, and can lead to a very long duration of illness, permanent paralysis, or death.
The risk is low. People who are over 60 years of age, have an underlying disease, or have a weakened immune system are at higher risk for the more severe form of West Nile virus.
The following precautions are recommended:
- Protect yourself against mosquito bites during the day and at night (see factsheet mosquito and tick bite protection).
- Do not touch sick or dead birds, as they may also be infected.
If you have visited a West Nile fever transmission area, do not donate blood for at least 28 days after your return.
After an animal bite/scratch: immediately wash the wound with running water and soap for 15 minutes, then disinfect and in any case visit a high-quality medical center for post-exposure vaccination as soon as possible!
Leptospires are bacteria that can be transmitted through the urine of rodents (especially rats). This can happen, for example, when wading through contaminated rivulets, puddles or mud. In this case, 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. Treatment requires antibiotic therapy.
Formally, this means Algeria falls again under the WHO temporary polio vaccination recommendations (category 2: "States infected with cVDPV2, with potential or demonstrated risk of international spread"), confirmation by the IHR committee is still pending. Meaning: Persons staying in the country for > 4 weeks are strongly recommended to have a min. 4 weeks and a a max. 12 months old polio booster vaccination (IPV) with documentation in the international vaccination certificate when leaving Algeria. This is important to prevent the spread of poliomyelitis virus from the country and can be checked upon departure. Persons staying in the country for <4 weeks are recommended to have a booster vaccination every 10 years in addition to a basic polio immunization.
In case of fever > 37.5°C: consult a doctor or go to a clinic immediately and take a blood test for malaria (see also factsheet Malaria)!
Preliminary analysis of samples revealed two positive Marburg virus cases. The two patients from the southern Ashanti region - both deceased and unrelated - presented symptoms of diarrhea, fever, nausea and vomiting. Preparations for a possible outbreak response are being made rapidly as further investigations are in progress.
Marburg is transmitted to humans by bats (fruit bats) and spreads in humans through direct contact with bodily fluids of infected persons, surfaces, and materials. The disease begins abruptly with high fever, severe headache and discomfort. Many patients develop severe hemorrhagic symptoms within seven days. Mortality rates have varied from 24% to 88% in previous outbreaks, depending on the strain of virus and case management.
Most of the laboratory-confirmed cases (2933/3413; 86%) were reported from the WHO European Region. In Switzerland, there have been 81 confirmed cases since May 21 and up to June 29.
Clinical presentation: The cases so far have been mild, there have been no deaths yet. Hospitalised patients have mostly been admitted for local isolation orders. The clinical picture is characterised by lesions that are atypical of the clinical picture in endemic countries. Currently, there are mainly very few, non-grouped, painless pustular lesions on the genitals, perianally and orally. Whether transmission occurs through genital secretions or primarily only through close skin-to-skin contact is not yet clear. The draining lymph nodes are sometimes massively swollen, and fever usually occurs for a few days. The general condition is often only slightly reduced.
Transmission: The virus can 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 7-17 days. Monkeypox is transmitted from infected animals through a bite or through direct contact with blood, body fluids or lesions of the infected animal. They can be transmitted to people who eat infected animals via abrasions in the mouth, source, NCDC.
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.
If the clinical picture is suggestive, individuals should also be isolated, tested, and screened for monkeypox.
MANDATORY REPORTING: In Switzerland, every suspected case must be reported within 2 hours to the respective cantonal doctor and to the FOPH (tel. +41 58 463 87 06)! Specialist laboratories, such as the Reference Laboratory for Imported Viral Diseases (HUG) or the Spiez Laboratory or the ZBS1 at the Robert Koch Institute (RKI; consiliary laboratory for smallpox), offer molecular diagnostics for the identification of monkeypox infections (material: crust or vesicular fluid).
Geosentinel requests confirmed and suspected cases to be reported at: geosennel@geosentinel.org
ECDC: Monkeypox multi-country outbreak. Situation Updates
WHO: Monkeypox
WHO: Meeting of the IHR (2005) Emergency Committee regarding the multi-country monkeypox outbreak, 25.6.2022
WHO: Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin, 17.6.2022
CDC: Monkeypox. Global Map
Global Health (GH): Map Monkeypox
Johns Hopkins: Center for health security. Monkeypox
- Do not eat raw oysters or other raw shellfish.
- Cook shellfish (oysters, clams and mussels) thoroughly.
- Consume seafood immediately after cooking and refrigerate leftovers.
- Avoid contact of open wounds or injured skin with warm salt or brackish water or with raw shellfish originating from such waters.
Globally, extreme temperature events are observed to be increasing in frequency, duration, and magnitude. Between 2000 and 2016, the number of people exposed to heat waves increased by about 125 million.
Heat waves can strain health care and emergency services and increase stress on water, energy, and transportation supplies, which can lead to power shortages or even blackouts. Food and nutrition security can also be affected if crops or livestock are destroyed by extreme heat.
Direct impacts: Heat illness (dehydration, heat cramps, heat stroke), accelerated death from respiratory illness, cardiovascular disease, kidney disease, and other chronic diseases), stroke, diabetes, etc. Indirect effects: Impacts on health services, increased risk of accidents (drowning, workplace accidents, etc.). Disruption of infrastructure (electricity, water, etc.). Increased transmission of foot and water borne diseases, algal blooms.
The risk is higher for the disabled, pregnant, already fragile, poor, displaced, homeless, children, elderly, and outdoor workers!
- Keep your living space cool.
- Stay away from heat.
- Drink water regularly, avoid alcohol.
- Wear light and loose clothing.
- Wear a hat or cap and sunglasses.
- Take cool showers and foot baths.
- Eat small meals more often.
During stays in regions with high risk (link risk areas), it is also strongly recommended to take preventive medication (medicinal prophylaxis).
If you have a fever > 37.5°C: go to a doctor or clinic immediately and have a blood test for malaria! This applies regardless of whether you have taken prophylactic medication or not (see also factsheet malaria).
According to the ECDC (as of June 8, 2022), a total of 1'177 cases have been confirmed worldwide (including EU/EEA). Cases occurred mainly in gay, bisexual and other men who have sex with men (GBMSM), though not exclusively. Most of the cases outside the UK, Canada and US are reported to be linked to travel. However, cases with no known travel history, contact with other cases, animals or specific events are also reported.
Clinical presentation: The cases so far have been mild, there have been no deaths yet. Hospitalised patients have mostly been admitted for local isolation orders. The clinical picture is characterised by lesions that are atypical of the clinical picture in endemic countries. Currently, there are mainly very few, non-grouped, painless pustular lesions on the genitals, perianally and orally. Whether transmission occurs through genital secretions or primarily only through close skin-to-skin contact is not yet clear. The draining lymph nodes are sometimes massively swollen, and fever usually occurs for a few days. The general condition is often only slightly reduced.
Transmission: The virus can 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 7-17 days. Monkeypox is transmitted from infected animals through a bite or through direct contact with blood, body fluids or lesions of the infected animal. They can be transmitted to people who eat infected animals via abrasions in the mouth, source, NCDC.
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.
Prevention: Good personal hygiene. Avoid close contact with sick people, including those with skin lesions or genital lesions, and animals at all costs. Avoid contact with contaminated materials used by sick people. During stays in West and Central Africa: Do not consume bushmeat.
The individual risk of contact with a patient with monkeypox depends on the type and duration of contact. In case of very close contact with a case (e.g., family members, aeroplane neighbours, medical staff, sexual partners), the risk of infection is moderate, otherwise low.
If the clinical picture is suggestive, persons should also be isolated, tested and reported for monkeypox.
MANDATORY REPORTING: In Switzerland, every suspected case must be reported within 2 hours to the respective cantonal doctor and to the FOPH (Tel. +41 58 463 87 06) ! Special laboratories, such as the Reference Laboratory for Imported Viral Diseases (HUG) or the Spiez Laboratory or the ZBS1 at the Robert Koch Institute (RKI; consiliary laboratory for smallpox), offer molecular diagnostics for identifying monkeypox infections (material: crust or vesicular fluid).
Geosentinel asks to report confirmed and suspected cases at: geosennel@geosentinel.org
The spread of Zika is known in Thailand.
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 case
- Portugal: 14 confirmed cases, another 6 suspected cases (link), Lisbon Region and Tagus Valley Region
- Spain: 7 confirmed, 23 suspected cases, (link)
- Sweden: 1 confirmed case, 1 suspected case
- Canada: 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.
Further cases must be expected. Persons showing symptoms as described above should contact a doctor, ideally in advance by telephone. Persons who have several sexual partners or practice casual sex should be particularly vigilant!
Prevention: Good personal hygiene, avoid contact with infected persons and animals at all costs. During stays in West and Central Africa: No consumption of bushmeat. The individual risk of contact with a patient with monkeypox depends on the type and duration of contact. In the case of very close contact with a case (e.g. family members, aeroplane neighbours, medical personnel), the risk of infection has so far been classified as moderate; in the case of sexual / intimate contact, it is probably high.
In case of corresponding clinic, persons without travel history should also be isolated, tested and reported for monkeypox.
MANDATORY REPORTING: In Switzerland, every suspected case must be reported within 2 hours to the respective cantonal doctor and to the FOPH (Tel. +41 58 463 87 06) ! Special laboratories, such as the Reference Laboratory for Imported Viral Diseases (HUG) or the Spiez Laboratory or the ZBS1 at the Robert Koch Institute (RKI; consiliary laboratory for smallpox), offer molecular diagnostics for identifying monkeypox infections (material: crust or vesicular fluid).
Geosentinel asks to report confirmed and suspected cases at: geosennel@geosentinel.org
Source image: NCDC
WHO 18.5.2022, RKI 19.5.2022, UK GOV, 16.5.2022, Outbreak News Today, 18.5.2022, CDC, Labor Spiez
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.
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.
Travelers are usually at low risk of contracting Ebola if you follow these precautions:
- Avoid contact with infected/deceased persons or their body fluids, and all wild animals, alive and dead.
- Avoid handling or eating bush/wild meat.
- Wash and peel fruits and vegetables before eating.
- Wash hands regularly and thoroughly with soap and water (or use a sanitizer if soap is not available).
- Practice safe sex, see LINK.
Vaccination against Ebola is not available to travelers.
For humanitarian missions, it is recommended to consult a travel medicine specialist.
If you have symptoms of illness (fever >38 °C, headache, diarrhea, bleeding symptoms, etc.) during travel until 21 days after being in the affected area: Isolate yourself and immediately contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit. Always state that you may have had an exposure to Ebola.
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.
The vaccination rate against yellow fever is insufficient in the region.
Protect yourself against ticks during outdoor activities (see factsheet mosquito and tick bite protection). Vaccination against TBE is recommended for (planned) stays in endemic areas (CH: throughout Switzerland except cantons of Geneva and Ticino).
After recreational activities: Always examine your body for ticks or tick bites. If redness appears at least 3 days (7-10 days on average) after tick bite: consult a physician to rule out erythema migrans (Lyme disease), which would require antibiotic treatment.
Il Comitato svizzero di esperti per la medicina di viaggio (CEMV) - un organo della Società svizzera di medicina tropicale e dei viaggi (FMH) - ha ridisegnato il sito web Safetravel® e lo ha rinominato HealthyTravel.ch. Il sito web continua a offrire gratuitamente raccomandazioni di base di medicina di viaggio per i viaggiatori. I professionisti possono anche abbonarsi a informazioni e raccomandazioni addizionali sulla medicina di viaggio, come informazioni approfondite specifiche per paese, raccomandazioni di vaccinazione con opinioni di esperti, mappe dettagliate (incluse le raccomandazioni sulla malaria), fogli informativi (incluse, per esempio, informazioni sul dosaggio della profilassi della malaria) e altri importanti contenuti sulla medicina di viaggio. Questi possono essere utilizzati per le consultazioni di medicina di viaggio con pazienti e clienti e possono essere compilati individualmente per i viaggiatori, stampati o inviati elettronicamente.
Le raccomandazioni e i contenuti di HealthyTravel.ch corrispondono alle raccomandazioni del Comitato svizzero di esperti per la medicina di viaggio. Sono sviluppati in collaborazione con l'Ufficio federale della sanità pubblica (UFSP). Il sito è in costruzione e sarà continuamente ampliato con contenuti e aggiornamenti addizionali. Si prega di ricordare che tutti i contenuti disponibili sul sito web HealthyTravel.ch sono protetti da copyright e non possono essere ceduti a terzi.
Maggiori informazioni possono essere trovate nel volantino (LINK). Il Comitato svizzero di esperti per la medicina di viaggio sarà lieto di rispondere a qualsiasi domanda su info@healthytravel.ch!
- Brazil, Bolivia, Peru and Venezuela.
Exempt from this entry requirement are: Persons >60 years old and children <1 year old.
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.
Protect yourself optimally around the clock (24/7) against mosquitoes (see factsheet mosquito and tick bite protection): at dusk and at night against malaria, during the day against dengue and other arboviruses.
If you should have a fever > 37.5°C: visit a medical facility immediately and take a blood test for malaria (see also factsheet malaria).
Protect 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 should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this can increase the bleeding tendency in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria).
After an animal bite/scratch: immediately wash the wound with running water and soap for 15 minutes, then disinfect and in any case visit a high-quality medical centre as soon as possible for a post-exposure vaccination (see also factsheet on rabies) !
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.
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.
The dengue virus also occurs in Africa! The spread on the African continent is probably underestimated due to a lack of diagnostics.
Protect yourself optimally around the clock (24/7) against mosquitoes (see factsheet mosquito and tick bite protection): during the day against dengue, chikungunya, and other viruses, at dusk and at night against malaria. If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this can increase the bleeding tendency in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria).
- Guinea-Bissau
- Mauritania
- Ukraine
In 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.
On departure from Israel, persons with residence in the country for >4 weeks must have received a polio booster vaccine (IPV) no longer than 12 months ago with documentation in their 'International Certificate for Vaccination'. This is important to avoid the spread of poliomyelitis viruses from the country and can be checked on departure.
Stays < 4 weeks: In addition to the basic immunisation against polio, a booster vaccination is recommended every 10 years (recommendation of the Swiss Expert Committee for Travel Medicine (ECTM).
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 travelers
Protect 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).
References
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 travelers
Wash 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.
References
The World Health Organisation (WHO) reported four cases of monkeypox in the last week of February, including 2 deaths in the Central African Republic. At least one monkeypox epidemic is recorded in the country every year.
Consequences for travelers
Monkeypox is endemic in countries in West and Central Africa. The individual risk of contact with a patient with monkeypox depends on the type and duration of contact. Transmission occurs from animal to human through contact with infected material (usually "bush meat" preparation). In case of very close contact with a patient (e.g. family members, neighbours on an plane, medical staff), the risk of infection is moderate, otherwise low.
References
In India, two women from Vemulamada village in the southern state of Andhra Pradesh died of rabies on the same day, two months after being bitten by a cat. According to the villagers, the cat had contracted rabies because it had previously been bitten by a rabid dog. The cat also died later on. According to the report, the women received tetanus toxoid injections and medication for the cat bite, but no mention was made of post-exposure prophylaxis (PEP) against rabies.
Consequences for travelers
Avoid contact with animals (never feed them!). After an animal bite/scratch, wash the wound with running water and soap for 15 minutes, disinfect and in any case visit a high-quality medical centre (post-exposure vaccination). For long-term travellers and travellers with increased individual risk (travelling with two-wheelers, to remote areas, long-term stays, small children, etc.), a pre-exposure vaccination is recommended before the stay.
References
A yellow fever outbreak has been confirmed in Isiolo district (see map). So far, 4 people have died and investigations are pending for another 15 people. The first case was apparently already confirmed in January.
The outbreak takes place in a sparsely populated and not very attractive area for tourists. Nevertheless, the epidemic potential of yellow fever is evident with very low vaccination coverage nationwide.
Vaccination campaigns are planned. The last local cases of yellow fever occurred in the early 1990s.
Consequences for travelers
Yellow fever vaccination is now recommended by the Swiss Expert Committee for Travel Medicine (ECTM) for all travellers to Kenya (whole country) until further data becomes clear. For immunocompetent persons, a yellow fever vaccination with a one-time second vaccination after 10 years (i.e. a maximum of 2 vaccinations in a lifetime) is recommended. In the case of travellers returning from Kenya from this region who exhibit fever, a yellow fever infection must be considered and ruled out by means of laboratory analyses (incubation period typically 3-6 days).
References
Kenya on alert as it reports outbreak of yellow fever – MINISTRY OF HEALTH
https://promedmail.org/ - Archive Number: 20220309.8701889
Health authorities in Malawi declare an outbreak on 17 Feb 2022 after a case of wild poliovirus type 1 is confirmed in Malawi/Lilongwe (disease began in Nov 2021). The pathogen is related to a strain from Pakistan (Sindh), where wild polio is still circulating.
Africa was declared free of indigenous wild polio in August 2020 after all forms of wild polio were eliminated in the region. In Malawi, the last clinically confirmed case of wild polio was reported in 1992.
Polio is transmitted through water or contaminated food and can cause permanent, disabling paralysis. There is no treatment, but vaccination prevents the disease.
Consequences for travelers
The vaccination reliably protects against infection: 4 doses during childhood or 3 doses during adulthood and a booster vaccination every 10 years for all countries in sub-Saharan Africa and for countries that are classified as vulnerable to polio outbreaks.
References
Two cases of circulating poliovirus type 2 have been reported, one in each of the provinces of Nampula and Cabo Delgado. These cases occurred already in December 2021.
Consequences for travelers
Formally, Mozambique is again included in the temporary polio vaccination recommendations of the WHO (category 2: "States infected with cVDPV2, with potential or demonstrated risk of international spread"), a confirmation by the IHR committee is still pending. This means:
Persons who are staying in the country for > 4 weeks are strongly recommended to have a minimum of 4 weeks and a maximum of 12 months of recent polio vaccination (IPV) with documentation in the international vaccination card when leaving Mozambique. This is important to avoid the spread of poliomyelitis viruses from the country and can be checked upon departure.
Persons staying in the country for < 4 weeks are recommended to receive a booster vaccination every 10 years in addition to a basic immunisation against polio.
References
According to media citing the National Institute of Communicable Diseases of South Africa, at least 160 cases of typhoid fever have been reported since 16 February 2022, a significant increase over the average incidence. Cases have been recorded in 8 of the 9 provinces, with the highest number of cases recorded so far in Guateng (45 cases) and Western Cape (64 cases, including in Cape Town and Garden Route N.P.). The source of infection is still under investigation; in the Western Cape, well water has been ruled out as a source.
Consequences for travelers
Optimal food and drinking water hygiene is recommended. In case of poor sanitary conditions, vaccination against abdominal typhoid may be considered. In case of fever, a doctor should be consulted.
References
According to IATA (International Air Transport Association), Egypt has adjusted the entry requirements (new countries marked in bold): Vaccination against polio is mandatory for entry from the following countries (with documentation in the 'International Certificate for Vaccination'):
Afghanistan, Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, China, Côte d'Ivoire, D.R. Congo, Ethiopia, Gambia, Ghana, Guinea, Iran, Kenya, Liberia, Madagascar, Mali, Niger, Nigeria, Pakistan, Republic of Congo, Senegal, Sierra Leone, Somalia, Sudan, South Sudan, Tajikistan, Togo, Uganda and Yemen.
Consequences for travelers
The vaccination must be administered at least 4 weeks before entry and must not date back more than 1 year.
References
IATA, Travel International Manual, February 2022
The Rio Carnival will take place from 20 to 30 April 2022. The events will be held throughout the city of Rio de Janeiro.
Consequences for travelers
Mass events can promote gastrointestinal and respiratory infections. Good food and personal hygiene and plenty of hydration are recommended. The risk of accidents may also be increased. To avoid sexually transmitted diseases (HIV, syphilis, gonorrhoea, chlamydia, etc.): be sure to follow safe sex practices!
Recommended vaccinations: COVID-19 vaccination (see also entry regulations!), yellow fever, MMR varicella (if infection has not been passed), tetanus, diphtheria, pertussis, poliomyelitis (basic immunisation only), hepatitis A and B, influenza and meningococcal ACWY. Further vaccinations depending on travel style and destination, see country page Brazil www.healthytravel.ch.
Mosquito protection 24/7 is strongly recommended throughout the country, including cities, to avoid various arboviruses such as dengue, chikungunya, Zika. The city of Rio de Janeiro is malaria-free, but malaria is endemic in the Atlantic rainforest of Rio de Janeiro state. For more malaria risk areas and recommended prevention measures, see country page Brazil www.healthytravel.ch.
References
Various
Timor-Leste has been reporting an outbreak of dengue cases since the end of 2021. In the month of January 2022 alone, a total of 1,286 cases were registered. This compares to 901 cases in the whole of 2021 and 1'451 cases in the whole of 2020. More than half of the cases were reported from the capital region of Dili.
Consequences for travelers
Protect yourself optimally around the clock (24/7) against mosquitoes (see factsheet mosquito and tick bite protection): during the day against dengue, at dusk and at night against malaria. If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this can increase the bleeding tendency in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria)
References
Dengue infections in the state of Minas Gerais in Brazil are increasing sharply after heavy rains. According to the health department, a 224% increase was observed with a total of 577 cases at the beginning of February.
Consequences for travelers
Protect yourself optimally around the clock (24/7) against mosquitoes (see factsheet mosquito and tick bite protection). If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this can increase the bleeding tendency in the event of a dengue infection (see also factsheet dengue).
References
Outbreaknewstoday, 7.2.2022
According to official sources, at least 74 children have died of measles in Badakhshan province in northern Afghanistan.
Since the end of July 2021, measles cases and deaths have increased in all provinces, with the highest weekly number observed in the last four weeks in January 2022. Measles vaccination uptake rates are very low among the population. The World Health Organisation warned of many measles deaths in Afghanistan as early as November 2021.
Measles is a highly contagious viral disease transmitted through the respiratory tract. It is spread all over the world. The disease can be prevented very effectively with a vaccine.
Consequences for travelers
A trip offers an ideal opportunity to check the protection against measles (2x vaccinated or passed measles infection) and if necessary to update the vaccination protection. This is especially relevant for humanitarian missions.
References
Via ProMED 11.2.2022
In 2021, a total of 21'030 malaria cases were registered by 21.11.2021, compared to 27'573 cases in the same period in 2020. The reporting figures have increased compared to previous years.
In addition, Nicaragua is the country in Central America with the highest increase in Plasmodium falciparum malaria. This type of malaria is a severe form of malaria that can quickly become fatal if left untreated.
Consequences for travelers
Protect yourself optimally against mosquitoes around the clock (see factsheet mosquito and tick bite protection): during the day against dengue fever, chikungunya, Zika and other viruses, at dusk and at night against malaria. In addition, if you are staying in high-risk areas (north-eastern Nicaragua), it is recommended that you take medicinal malaria prophylaxis. If you have a fever >37.5 °C, you should consult a local doctor to rule out malaria. Visit a medical facility for this purpose (see also factsheet malaria).
References
Outbreaknewstoday.com, mesvaccins.net, 31.1.2022
Health authorities in South Africa reported the first case of human rabies in 2022. The diagnosis was confirmed in a four-year-old child in Gqerberha (Port Elizabeth) of the Eastern Cape province. He was bitten on the lip by a dog he was playing with on 1 December 2021. Post-exposure prophylaxis (PEP) against rabies was not arranged. One month later, the child was admitted to hospital with rabies symptoms.
In 2021, a total of 19 confirmed human rabies cases were reported in the Eastern Cape provinces.
Consequences for travelers
Avoid contact with animals (never feed them!). After an animal bite/scratch, wash the wound with running water and soap for 15 minutes, disinfect and in any case visit a high-quality medical centre (post-exposure vaccination). For long-term travellers and travellers with increased individual risk (travelling with two-wheelers, to remote areas, long-term stays, small children, etc.), a pre-exposure vaccination before the stay (2 injections and a booster after 1 year) is recommended.
References
Outbreaknewstoday.com, mesvaccins.net, 3.2.2022
2022 is the Year of the Tiger; Chinese New Year falls on Feb. 1, 2022, and a highlight will be the Lantern Festival on Feb. 15, 2022. In addition, the Olympic and Para-Olympic Games in Beijing, Yanqing, in Zhangjiakou and in Hebei Province are scheduled for February 4-20 and March 4-13, 2022, respectively.
Consequences for travelers
If considering a visit despite COVID-19 pandemic, the following precautions are recommended:
General:
- COVID-19: Observe current situation, entry and return travel regulations, and precautions regarding COVID-19 in the country! See also advice FOPH Coronavirus/Travel.
- Mass events may favor gastrointestinal and respiratory infections, therefore: follow good personal and food hygiene.
- The risk of accidents may also be increased (CAVE alcohol!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhea, chlamydia, etc.): follow safer sex practices (condoms).
- Avian influenza is particularly prevalent in China. Contact with poultry and their droppings should be avoided. Do not visit bird and poultry markets/farms, do not import poultry meat from China. Travelers should also wash their hands frequently with soap and water.
Recommended vaccinations and other health risks:
See China country page
References
Diverse. Olympische Spiele, Bejing 2022
In 2021, a total of 1,567 cases with West Nile virus (WNV) infection were recorded in the state of Arizona, with 110 cases being fatal. This is by far the highest number of reported cases in recent decades. As a possible cause for the huge increase in 2021, it could have been the extremely wet summer, which led to an increased mosquito population, as well as very warm temperatures still in November to early December, which could have extended the transmission season.
West Nile viruses belong to the flavivirus family and are transmitted by Culex mosquitoes. The main hosts are birds. Most cases are asymptomatic; clinically symptomatic cases present fever and flu-like symptoms. In severe cases, the disease can cause meningitis or encephalitis. Recovery from severe disease may take several weeks or months, and some of the neurological problems may be permanent. In rare cases, death may occur. Elderly people, pregnant women, and immunosuppressed individuals are at higher risk for severe disease progression.
Consequences for travelers
Optimal mosquito bite protection especially at dusk and dawn. Sick and dead birds should not be touched.
References
Due to an increase in leptospirosis cases, the Department of Antioquia has issued a warning. So far, the municipalities most affected are Medellín, with 70 confirmed cases, Apartadó (54 cases), Turbo (29 cases) and Puerto Berrío (18 cases). Large accumulations of waste in some areas (especially in the city of Medellín) favor the presence of rodents.
In 2021, the total number of leptospirosis cases registered nationwide was 2269, including 14 deaths. The cities of Cali, Bogotá and Medellín were particularly affected.
Consequences for travelers
Wear protective clothing/boots when wading through water! Leptospires are transmitted via the urine of rodents (especially rats), e.g. in water residues (rivulets, puddles, etc.) or mud. Transmission to humans occurs via small skin lesions or mucosal contacts through direct or indirect contact with rodent urine. The symptoms range from flu-like general symptoms to meningitis (aseptic meningitis) to sepsis. The disease can be treated with antibiotics. Vaccination is not generally available.
References
In Andresito, Misiones province in northeastern Argentina, two people have died from botulism and six affected persons are still in intensive care. The source of infection is believed to be homemade sausages that the affected persons had consumed.
Botulism, caused by toxins from the bacterium Clostridium botulinum, is usually associated with home-canned food, be it home-canned vegetables, meat or fish. Botulinum toxin cannot be smelled, nor does it have a specific taste. Botulinum toxins are among the most potent poisons known and are on the list for potential bioweapons agents.
Consequences for travelers
Consumption of home-made sausages should be avoided. Food botulism is prevented by proper preparation of canned food and industrial controls. Bombed canned foods are considered suspect and must be destroyed.
References
Five Americans died from rabies in 2021, the highest number in a decade. According to health officials, some of these people did not know they were at risk of infection or refused life-saving vaccinations.
- The first was an 80-year-old Illinois man who refused to receive the vaccines after a bat contact out of fear of vaccinations in general.
- The next were an Idaho man and a Texas boy who had refused vaccination because they mistakenly assumed they would not be injured after contact with a bat.
- The fourth was a Minnesota man who had been bitten by a bat.
- The last had been bitten by a rabid dog during a trip to the Philippines and died on his return to New York.
Consequences for travelers
Avoid contact with animals! Do not feed animals either! For long-term travelers and travelers with increased individual risk (travel with two-wheelers, to remote areas, small children, work with animals, cave explorers, etc.) a pre-exposure vaccination before the stay (2 injections and a booster after 1 year) is recommended.
Behavior after exposure:
After an animal bite/scratch: immediately wash the wound with running water and soap for 15 minutes, then disinfect and in any case visit a high-quality medical center for post-exposure vaccination as soon as possible!
For more information: see factsheet rabies
References
According to the World Health Organization (WHO), 1'380'955 clinical cases of typhoid fever have been reported in the DRC since the beginning of 2021 and up to December 12, including 502 deaths.
Consequences for travelers
Follow optimal food and drinking water hygiene ("cook it, boil it, peel it or forget it"). Vaccination against typhoid fever is especially recommended for persons visiting friends and relatives (VFRs) and for travelers where sanitary conditions are poor during their stay. For more details, see factsheet typhoid fever
References
In 2021, nine countries in the WHO African Region (Cameroon, Chad, Central African Republic (CAR), Côte d'Ivoire, Democratic Republic of Congo (DRC), Ghana, Niger, Nigeria, and Republic of Congo) reported human yellow fever cases that were confirmed in the laboratory. The number of cases in these outbreaks is increasing compared to previous years. Yellow fever cases classified as probable have also been reported in Benin, Burkina Faso, Gabon, Mali, Togo, and Uganda.
Some of the affected countries are classified as fragile, conflict-affected, or vulnerable, where population immunity to yellow fever is low.
Consequences for travelers
Yellow fever vaccination is strongly recommended when traveling to yellow fever endemic areas, see country pages www.healthytravel.ch/countries/ or 'Reisemedizinischen Tabellen' of the FOPH: LINK.
References
WHO DON, 23.12.2021
A 13-year-old girl contracted rabies after being bitten by her own dog, according to the head of the Zoonosis Program of the Departmental Health Service (SEDES) in Potosí, southeastern Bolivia. A few days after the bite, she had a series of health problems for which she was admitted to the intensive care unit of a medical center. The rabies diagnosis was confirmed by laboratory tests.
Consequences for travelers
Avoid contact with animals (never feed them!). After an animal bite/scratch, wash the wound with running water and soap for 15 minutes, disinfect and in any case visit a quality medical center (post-exposure vaccination). For long-term travelers and travelers with increased individual risk (travel with two-wheelers, to remote areas, long-term stays, small children, work with animals, cave explorers, etc.), a pre-exposure vaccination before the stay (2 injections and a booster after 1 year) is recommended.
References
The epidemiological authority of the state of Santa Catarina has reported 8 human cases of yellow fever this year, including three deaths. None of the victims were vaccinated. In addition, monkey deaths continue to be observed in Santa Catarina State: In 2021, there were a total of 625 cases in monkeys, and yellow fever infection was confirmed in 137 cases.
Yellow fever is a life-threatening viral disease transmitted by mosquitoes. There is no specific therapy, but there is a very effective vaccination. It is the best way to protect yourself from yellow fever. In addition, optimal mosquito protection is important. For children under 9 months, pregnant women, nursing mothers, people with immunodeficiency or thymus disease who want to travel to Brazil, we recommend to consult a specialist in travel and tropical medicine.
Consequences for travelers
In Brazil, the main season for yellow fever infections is between December and May. Yellow fever vaccination is recommended by the WHO for most regions in Brazil. Due to the increasing spread even in areas previously declared to be free of yellow fever, the Swiss Expert Committee for Travel Medicine (ECTM) recommends yellow fever vaccination for all of Brazil. For immunocompetent persons, a yellow fever vaccination with a one-time second vaccination after 10 years (i.e. a maximum of 2 vaccinations in a lifetime) is recommended.
References
A yellow fever outbreak occurred in Ghana in October 2021. The following regions are affected: Savannah, Upper West (in the northwest), Bono (in the center), and Oti (in the east). Of approximately 600 clinical cases, 102 laboratory-confirmed cases and 46 deaths have been reported.
Consequences for travelers
Vaccination against yellow fever is mandatory for traveling to Ghana.
References
Das «Center for Disease Control and Prevention» (CDC) hat ganz Indien als Land mit einer aktuellen Zika-Epidemie eingestuft, wobei der Ausbruch hauptsächlich in Uttar Pradesh stattfindet. Seit Oktober 2021 wurden 109 bestätigte Fälle gemeldet. Wie in früheren Nachrichten berichtet, wurden auch in anderen Teilen Indiens (Kerala, Maharasthra) Zika-Fälle registriert.
Das Zika-Virus wird v.a. von Mücken übertragen, die tagsüber stechen und in vielen tropischen Regionen vorkommen. Etwa 80% der Infektionen verlaufen asymptomatisch. Die klinischen Symptome sind in der Regel nicht schwerwiegend und dauern zwischen 5 und 7 Tagen: Fieber, roter Hautausschlag (Rash) mit Juckreiz, Gelenkschmerzen, Bindehautentzündung (rote Augen), manchmal Kopf- und Muskelschmerzen. Es kann zu neurologischen (Guillain-Barré-Syndrom) und immunologischen Komplikationen kommen. Es gibt keinen Impfstoff und keine spezifische Therapie gegen das Zika-Virus. Eine besondere Situation besteht für schwangere Frauen, da ein Risiko schwerer Missbildungen beim ungeborenen Kind besteht.
Folgen für Reisende
Aktuell besteht ein erhöhtes Übertragungsrisiko für das Zika-Virus in Indien. Beachten Sie, dass das Zika-Virus auch sexuell übertragen werden kann! Prävention: Optimaler Mückenschutz 24/7: Tagsüber gegen Zika, Dengue und andere Arbovirosen, in der Dämmerung und nachts gegen Malaria.
Bei Reisen in Gebieten mit einem Zika Ausbruch, wie dies in Indien nun der Fall ist, empfiehlt das Schweizerische Expertenkomitee für Reisemedizin während der Reise und mindestens 2 Monate nach der Rückkehr ein Kondom/Femidom zu verwenden, um eine mögliche sexuelle Übertragung des Virus zu verhindern.
Wegen des Risikos für Fehlbildungen beim ungeborenen Kind wird schwangeren Frauen derzeit davon abgeraten, nach Indien zu reisen. Bei unbedingt notwendigen Reisen wird empfohlen, vor der Abreise mit einem Facharzt für Reisemedizin zu sprechen.
Frauen, die planen, schwanger zu werden, sollten nach ihrer Rückkehr (oder der des Partners) aus Indien mindestens 2 Monate mit der Familienplanung abwarten. Im Falle einer medizinisch unterstützten Fortpflanzung sollte dieser Zeitraum auf mindestens 3 Monate verlängert werden. Lesen Sie auch das Informationsblatt Zika, insbesondere wenn Sie schwanger sind oder Sie oder Ihre Partnerin eine Schwangerschaft planen.
Referenzen
CDC Travel News, 9.12.2021, ECDC 13.11.2021, EKRM statement 2019
In den letzten vier Wochen wird ein Anstieg der Malariafälle in der Nordzone (Gemeinden Medio Queso, San Gerardo, Cuatro Esquinas, Isla Chica, La Trocha, Las Delicias und Coquital) beobachtet. Bis zum 27.11.2021 wurden 138 Fälle registriert. Nachdem in den Jahren 2013-2015 keine lokal erworbenen Fälle in Costa Rica registriert wurden, kommt es seit 2016 wieder zu vermehrten Meldungen von lokal erworbenen Malariafällen, wobei die Anzahl pro Jahr jedoch unter 100 Fällen blieb.
Malaria wird abends und nachts durch Mücken übertragen. Die Symptome der Erkrankung sind Fieber >37,5° C, Schüttelfrost, Kopfschmerzen und Grippesymptome sowie gelegentlich Durchfall. Die Krankheit ist potenziell tödlich und stellt einen medizinischen Notfall dar!
Folgen für Reisende
Optimaler Mückenschutz 24/7 (in der Dämmerung und nachts gegen Malaria, tagsüber gegen Dengue, Chikungunya und andere Arbovirosen). Bei Fieber >37.5° C sollte immer an eine Malaria gedacht und diese mittels Blutuntersuchung ausgeschlossen werden.
Referenzen
Outbreak News Today, 4.12.2021, Ministerio de Saude, 3.12.2021
In Queensland, the number of cases with Ross River Virus (RRV) infections is increasing, with over 150 people tested positive on the Sunshine Coast. Due to rainfall and the associated increase in the mosquito population, more people are expected to become ill in the coming weeks.
Ross River virus disease is the most common mosquito-borne infectious disease in Australia; it occurs throughout of the country but is found primarily in Queensland, Victoria, and Western Australia. Transmission occurs through Culex and Aedes mosquitoes. After an acute phase with fever, skin rash, and joint pain, RRV can sometimes cause long-lasting pain in various joints (polyarthritis).
Consequences for travelers
Optimal mosquito protection is recommended around the clock (24/7) (see factsheet mosquito and tick bite protection). There is neither a specific medication nor a vaccination.
References
According to the WHO, more than 200 suspected cases of yellow fever infection were reported between Oct. 15th and Nov. 27th, 2021, of which 70 cases were laboratory-confirmed. The number of deaths has risen to at least 40. Yellow fever was likely introduced into the region by nomads from Nigeria who moved into Savannah region of Ghana. At least 8 regions are now affected by the outbreak, including tourist areas. A vaccination campaign and further investigations have been initiated.
Consequences for travelers
Vaccination against yellow fever is strongly recommended for all travelers. Proof of yellow fever vaccination is mandatory upon entry.
References
According to media reports, seven people have died in Zanzibar after eating turtle meat; three people are still being treated in hospital.
Turtle meat is a popular delicacy among residents. In rare cases, turtle meat can be toxic due to a biotoxin called chelonitoxism. Symptoms include nausea, vomiting, dysphagia, and abdominal pain. Severe cases can lead to coma and multiple organ failure.
Consequences for travelers
Refrain from consuming the meat of sea turtles! It is prohibited in most countries due to conservation efforts!
References
According to media reports, malaria cases in Limpopo province have doubled from 206 to over 400 cases in two weeks. The districts Vhembe and Mopani are most affected. Authorities expect a further increase in malaria cases during the rainy season in the coming weeks.
Consequences for travelers
Optimal mosquito protection is necessary at dusk and at night in the north/northeast of the country. In addition, from September to May, the use of chemoprophylaxis against malaria is recommended for stays in the high-risk areas (northeast and east of Mpumalanga Province, incl. Kruger & neighboring parks, as well as north and northeast of Limpopo Province.).
References
Between October 8th and November 11th, 2021 86 cases of dengue fever infections were registered in the district of Richard Tol, Saint Lois region. So far, Dengue virus serotypes 1 and 3 (DENV 1 and DENV 3) have been reported.
Dengue is endemic in Africa. The exact extent of its spread on the African continent is unclear, as a diagnosis is often not made and epidemiological surveillance is poor.
Consequences for travelers
Protect 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 should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this can increase the bleeding tendency in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria).
References
(source image: PAHO Zika weekly report, accessed 19.11.2021) The high incidence in Guatemala compared to the other countries is striking. However, these numbers need to be interpreted with caution, as epidemiological surveillance may be limited due to the COVID-19 pandemic. Case numbers in the Caribbean are incomplete, see link for details.
Consequences for travelers
Currently, none of the above countries is classified as an area with a current outbreak (see CDC map). Prevention: Optimal mosquito protection is necessary around the clock (24/7): during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria. If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this may increase the risk of bleeding in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria). Detailed information on Zika can be found in the Zika factsheet.
References
PAHO Zika weekly report, accessed 19.11.2021
According to media reports, at least 80 fishermen have fallen ill with an unclear skin disease in the suburbs of Dakar. Already, in 2020 several hundred fishermen in Senegal were affected by an unclear vesicular, highly itchy skin affliction, which was accompanied by fever and had occurred after returning from the sea (incubation period of several days). Close contacts, such as family members, were not affected at that time. Images of skin disease 2020 (source image: AFRIK.COM, 20.11.2021):
Consequences for travelers
Very likely low risk for travelers. For information, follow current media reports. In case of unclear skin symptoms after contact with seawater, consult a physician.
References
A person in Maryland, USA, has contracted monkeypox after a stay in Nigeria. Laboratory tests revealed that it is the same strain that has been circulating in Nigeria since 2017. The person is currently in isolation. Investigations regarding possible contacts have been initiated.
Monkeypox is endemic in Nigeria and other countries in West and Central Africa. An increase in cases in Nigeria has been recorded since September 2017. 88 cases have been reported in 2021 (through the end of October 2021).
Consequences for travelers
Prevention: Follow good personal hygiene, avoid contact with infected people and animals, do not consume bushmeat. The individual risk of contracting monkeypox from an infected patient depends on the type and duration of contact. If there is very close contact with a case (e.g., family members, airplane neighbors, medical personnel), the risk of infection is considered to be moderate, otherwise low.
References
The Beijing Olympic and Paralympic Games are scheduled for February 4-20 and March 4-13, 2022, respectively. About 3,000 athletes from 80 countries are expected. The competitions will be held in Beijing, Yanqing, Zhangjiakou, and the Hebei province.
According to current regulations, international spectators are not allowed to attend. Local spectators will be allowed to attend the Games; information on additional conditions is still pending.
Consequences for travelers
If considering a visit, the following precautions are recommended:
General:
- Follow entry requirements and precautions regarding COVID-19 in the country.
- Mass events can favor gastrointestinal and respiratory infections: follow good personal and food hygiene.
- Accident risk may also be increased (be cautious with alcohol!).
- Follow safer sex practices (i.e., the use of condoms) to avoid the transmission of sexually transmitted diseases (HIV, syphilis, gonorrhea, chlamydia, etc.).
- Avian influenza is prevalent in China. Contact with poultry and their droppings should be avoided. Do not visit bird and poultry markets/farms, do not import poultry meat from China. Travelers should wash hands frequently with soap and water.
Recommended vaccinations:
- COVID-19, MMR, varicella (for people with no chickenpox infection in the past), influenza, tetanus, diphtheria, pertussis, poliomyelitis (basic immunization and booster every 10 years if stay < 4 weeks or annually if stay > 4 weeks), hepatitis A and B.
- Depending on individual risk: pre-exposure rabies vaccination.
References
Diverse. Olympische Spiele, Bejing 2022
Diphtheria cases were reported in four countries in 2021:
Dominican Republic: A total of 56 suspected diphtheria cases were reported between week 1 and 42 in 2021, of which 18 were confirmed (14 by laboratory testing and 4 by epidemiologic investigation), including 12 confirmed deaths. Regarding other cases: 31 of the total reported in 2021 were discarded, one was classified as probable, and 6 remain under investigation.
Haiti: A sustained diphtheria outbreak has been ongoing since 2014 (over >1,300 suspected cases). In 2021 (week 1-38), the number of suspected cases reported (164 cases) is similar to the number reported in the same period in 2019 (165 cases), although higher than the number of suspected cases reported in the same period in 2020 (110 cases).
Colombia: 7 suspected diphtheria cases were reported between week 1 and 41 (2021), of which 1 was laboratory-confirmed, 5 cases were excluded, and 1 case is still under investigation.
Brazil: 1 diphtheria case
The WHO Americas Region has seen a steady decline in vaccination coverage against diphtheria since 2010. The coverage rate for the third dose of diphtheria, tetanus, and pertussis (DTP3) vaccine in the Americas Region declined from 94% to 84% between 2010 and 2020. In addition, the COVID-19 pandemic has also affected epidemiologic and laboratory surveillance systems for vaccine-preventable diseases.
Consequences for travelers
A booster vaccination against diphtheria (together with tetanus) is necessary in addition to a basic immunization. The optimal time for the booster vaccination for stays in areas with a diphtheria epidemic is unclear. Travelers to countries with diphtheria outbreaks should receive a booster vaccination if the previous booster vaccination is more than 10 years old, as the diphtheria protection is shorter-lasting than the tetanus protection. For high-risk individuals, such as those on humanitarian missions, a shorter interval (e.g., 5 years) should be considered.
References
Forty-two suspected cases of yellow fever (YF) were reported between October 15th, 2021, and November 3rd, 2021. Infection was proven by PCR at least in three blood samples collected from suspected cases.
The cases occurred primarily amongst nomadic settlers from the two districts of West Gonja and North Gonja in the Savannah region of northwestern Ghana (bordering Côte d'Ivoire). Eleven of the 42 suspected cases, including all three PCR-positive cases, died.
Consequences for travelers
Yellow fever is endemic in Ghana. The last outbreak was in 2016. The current outbreak once again emphasizes the importance of a yellow fever vaccination when staying in Ghana. Proof of a yellow fever vaccination is required upon entry into Ghana.
References
More than 1.1 million cases of typhoid fever have been reported from the beginning of the year (2021) until the end of September, including 19,734 confirmed cases and 411 deaths. This is a significant increase compared to 2020 (total 715,920 suspected cases, 178 deaths). These figures should be interpreted with caution because bacterial cultures are not usually possible and the test used in most cases (Widal test) is not very sensitive and specific for the diagnosis of typhoid fever.
Consequences for travelers
Maintain optimal food and drinking water hygiene. Vaccination against typhoid fever is recommended especially for people visiting friends and relatives (VFRs) and for people traveling with poor hygienic conditions.
References
Ukrainian health officials report a polio case in an unvaccinated 12-year-old child with acute flaccid paralysis from Transcarpathia (southwest of the country) in a new report on the current polio situation in Ukraine. There is no information yet regarding the type of polio.
An epidemiological investigation was conducted after this case was reported. No further person was found to be infected with the poliovirus. The previously detected cVDPV2 cases in Ukraine in the Rivne region are not connected to the current case.
Consequences for travelers
Ukraine is now considered a category 2 in the WHO temporary poliomyelitis vaccination recommendations ("States infected with cVDPV2, with or without evidence of local transmission"):
- On departure from Ukraine, persons with residence in the country for >4 weeks are strongly recommended to have received a polio booster vaccine (IPV) no longer than 12 months ago with documentation in their 'International Certificate for Vaccination' (according to WHO, 20.8.2021).
- Stays < 4 weeks: in addition to the basic immunisation against polio, a booster vaccination is recommended every 10 years (recommendation of the Swiss Expert Committee for Travel Medicine (ECTM).
References
India, Delhi: Health authorities in Delhi have reported 531 additional dengue fever cases in one week, bringing the total number of cases in the city to over 1,500. This is the highest number of reported cases since 2018, with over 46,000 cases recorded in India, which now ranks second in the world after Brazil (60,000 cases). According to media reports, this sharp increase in dengue fever cases has led to a shortage of hospital beds in both government and private hospitals.
Consequences for travelers
Optimal mosquito protection measures 24/7: during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria. If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this may increase the risk of bleeding in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria).
References
Outbreak News Today, 1.11.2021, Outbreak News Today, 23.10.2021
More than 23,000 dengue cases (including 89 deaths) have been recorded since the beginning of 2021, with the majority of cases (20,000) reported in Dhaka.
Consequences for travelers
Optimal mosquito protection measures 24/7: during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria. If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this may increase the risk of bleeding in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria).
References
Outbreak News Today, 1.11.2021, Outbreak News Today, 23.10.2021
Diphtheria bacteria were detected in three people in the Ky Son district in the Huu Lap commune (northwest of the country).
Consequences for travelers
A booster vaccination is necessary in addition to a basic immunization against diphtheria (together with tetanus, etc.). The optimal time for the booster vaccination for stays in areas with a diphtheria epidemic is unclear. Travelers to countries with diphtheria outbreaks should receive a booster vaccination if the previous booster vaccination is more than 10 years old, as the diphtheria protection is shorter-lasting than the tetanus protection. For high-risk individuals, such as those on humanitarian missions, a shorter interval (e.g., 5 years) should be considered. Please talk to your doctor if you belong to this group.
References
Outbreak News Today, 27.10.2021, Outbreak News Today, 23.10.2021
In the district of Ghaziabad in the state of Uttar Pradesh, 13 diphtheria cases were registered until October 2021, compared to 14 cases in the entire 2020.
Consequences for travelers
A booster vaccination is necessary in addition to a basic immunization against diphtheria (together with tetanus, etc.). The optimal time for the booster vaccination for stays in areas with a diphtheria epidemic is unclear. Travelers to countries with diphtheria outbreaks should receive a booster vaccination if the previous booster vaccination is more than 10 years old, as the diphtheria protection is shorter-lasting than the tetanus protection. For high-risk individuals, such as those on humanitarian missions, a shorter interval (e.g., 5 years) should be considered. Please talk to your doctor if you belong to this group.
References
Outbreak News Today, 27.10.2021, Outbreak News Today, 23.10.2021
In Ernakulam district, Kerala state, the number of confirmed leptospirosis cases have continued to increase in October 2021 (now 29 confirmed cases and 48 suspected cases) compared to September 2021 (18 confirmed 51 suspected cases). Since the beginning of 2021, 304 suspected cases have been reported in Ernakulam (confirmed: 133 cases).
Monsoon-related flooding occurs regularly between June and September, with October and November constituting the post-monsoon season. As a result, outbreaks of leptospirosis are common during this period.
Consequences for travelers
Wear protective clothing/boots when wading through water! Leptospira are transmitted through the urine of rodents (mainly rats), which can contaminate small bodies of water (creeks, puddles, etc.) and mud. Transmission to humans occurs through small skin lesions or mucosal contacts through direct or indirect contact with the rodent urine. Symptoms range from flu-like symptoms, aseptic meningitis to sepsis. Vaccination is not generally available.
References
The 'Pan American Health Organization' (PAHO) has reported 122,203 chikungunya fever cases in the Americas in the year 2021, compared to 103,000 cases reported for the entire year of 2020. Brazil accounts for the majority of cases (97%).
Chikungunya fever is a viral infection transmitted by Aedes mosquitoes. The disease is typically manifested by severe joint pain in the hands and feet, which can last for weeks or months in some patients.
Consequences for travelers
Optimal mosquito protection measures 24/7: during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria. If you should have a fever: take medication containing the ingredient paracetamol and make sure you drink enough fluids. Do not take any medication containing the ingredient acetylsalicylic acid (e.g. Aspirin®), as this may increase the risk of bleeding in the event of a dengue infection (see also factsheet dengue). If you have visited a malaria area and have a fever >37.5 °C, you should always exclude malaria by taking a blood smear on the spot. Visit a medical facility for this (see also factsheet malaria).
References
According to WHO, three laboratory-confirmed cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported in the Biombo and Bissau regions on October 26, 2021. The most recent date of symptom onset was July 15, 2021. The detected cVDPV strain is genetically linked to a strain circulating in Nigeria. cVDPV had not previously been detected in Guinea-Bissau.
Consequences for travelers
Guinea-Bisseau is now considered as category 2 of the WHO temporary poliomyelitis vaccination recommendations ("States infected with cVDPV2, with or without evidence of local transmission"):
- On departure from Guinea-Bisseau, persons with residence in the country for >4 weeks are strongly recommended to have received a polio booster vaccine (IPV) no longer than 12 months ago with documentation in their 'International Certificate for Vaccination' (according to WHO, 20.8.2021).
- Stays < 4 weeks: in addition to the basic immunisation against polio, a booster vaccination is recommended every 10 years (recommendation of the Swiss Expert Committee for Travel Medicine (ECTM).
References
Over 120 cases of salmonella have been reported since 2019 in Germany (68 cases), Sweden (37 cases), Norway (5 cases), Denmark (9 cases), and the Netherlands (2 cases). Cases have also been reported in the United States and Canada. The salmonella outbreak is linked to sesame products (tahini and halva) imported from Syria. Fourteen batches have tested positive for one or more of the Salmonella-outbreak strains. Tahini is a paste made from raw sesame seeds. Halva is a confectionery product that contains a high percentage of sesame seeds.
The recurrent occurrence of cases and the repeated discovery of positive samples since 2019 indicate that contaminated sesame-based products have been circulating in the EU market for more than two years.
Consequences for travelers
Considering the limited information on the production and distribution of the sesame products from Syria, there is still a risk of new salmonella infections in the EU/European Economic Area. Caution should be shown when consuming these products (tahini, halva).
References
In the Punjab province, cases of dengue infections are increasing significantly, with more than 300 cases per day. Between January and October 76th, 2021, 5’700 infections have been recorded in the province, including 18 deaths. All four dengue virus strains are circulating (DENV-1, DENV-2, DENV-3, and DENV-4).
Consequences for travelers
Optimal mosquito protection is necessary around the clock (24/7) (Daytime risk: Dengue, Zika, Chikungunya, etc.; Dusk / nighttime risk: Malaria). Dengue fever is transmitted in urban areas. In case of fever, fever-reducing medications containing paracetamol should be favored, as well as hydration. Do not take fever-reducing medications containing acetylsalicylic acid (e.g., Aspirin ®), as they increase the risk of bleeding. For travelers staying in regions with malaria risk, a malaria infection should always be excluded in the case of fever.
References
The Minister of Health declared a health emergency on the 10th of October (2021) for 51 districts in 15 regions in Peru due to a dengue fever outbreak. The affected regions are Piura, San Martín, Loreto, Huánuco, Junín, Cajamarca, Cusco, Madre de Dios, Ayacucho, Lima, Amazonas, Ucayali, Pasco, Tumbes and Ica. The health emergency is expected to last 90 days and is intended to prevent and control the dengue outbreak. 36’000 dengue fever infections have been registered since January 2021, which corresponds to an incidence rate of 111 infections per 100’000 inhabitations. The current incidence rate and number of cases are significantly higher than the previous three years.
Consequences for travelers
Optimal mosquito protection is necessary around the clock (24/7) (Daytime risk: Dengue, Zika, Chikungunya, etc.; Dusk / nighttime risk: Malaria). Dengue fever is transmitted in urban areas. In case of fever, fever-reducing medications containing paracetamol should be favored, as well as hydration. Do not take fever-reducing medications containing acetylsalicylic acid (e.g., Aspirin ®), as they increase the risk of bleeding. For travelers staying in regions with malaria risk, a malaria infection should always be excluded in the case of fever.
References
Outbreak News Today, 11.10.2021, MoH Peru, Epid. Bulletin, KW 40, 2021
Two hundred cases of schistosomiasis and diarrhea have been reported in children due to drinking contaminated water from pools and rivers in the Boni forest (Garissa district) in eastern Kenya, a region threatened by Al Sahab terrorism. Boni residents have been forced to drink untreated, dirty water as their water sources have dried up due to a devastating drought.
Consequences for travelers
Avoid all contact with freshwater, especially bathing and wading near the shore and drinking untreated drinking water. Bathe only in chlorinated pool water and in the ocean (saltwater), as this does not pose a risk in regards to schistosomiasis infections. A schistosomiasis infection should be ruled out after possible exposure.
For more information: see HealthyTravel: Factsheet Schistosomiasis
References
In der Provinz North-Kivu wurde ein neuer, im Labor bestätigter Fall mit einer Ebola-Virus-Infektion festgestellt. Es handelt sich dabei um ein 3-jähriges Kind, welches Anfang Oktober erkrankte. Nachbarn des erkrankten Kindes (2 Kinder und deren Vater) waren bereits Mitte bzw. Ende September an Ebola verdächtigen Symptome verstorben, eine Labordiagnose wurde jedoch nicht gestellt. Inzwischen wurde ein weiterer Fall in der Stadt Beni bestätigt.
Am 3. Mai war der Ebola Ausbruch in der Nort Kivu Provinz erst als beendet erklärt worden.
Ebolafieber ist eine virale, hämorrhagische, äusserst virulente Krankheit. Sie wird durch direkten Kontakt mit Körperflüssigkeiten und -ausscheidungen einer erkrankten Person (Blut, Speichel, Erbrochenes, Stuhl, Schweiss, Sperma, Urin usw.) oder mit infizierten Tieren (v. a. Affen, Antilopen, Nagern, Fledermäuse) übertragen. Die Symptome sind plötzliches hohes Fieber, Muskelschmerzen, Müdigkeit, Hals- oder Kopfschmerzen, gefolgt von Durchfall, Erbrechen und innerlichen und äusserlichen Blutungen. Eine frühzeitige Hospitalisierung mit unterstützender Pflege (Hydratation, Erhaltung eines normalen Blutdrucks) kann die Prognose verbessern.
Folgen für Reisende
Das Risiko einer Ebola-Infektion besteht für Personen, die in das Ausbruchsgebiet reisen, bei engem, ungeschütztem Kontakt mit einer an Ebola erkrankten oder verstorbenen Person (und deren Körperflüssigkeiten) sowie bei ungeschütztem Geschlechtsverkehr mit einem Ebola-Patienten oder Überlebenden (12 Monate). Es wird empfohlen, sich regelmäßig die Hände zu waschen und zu desinfizieren (insbesondere vor dem Berühren der Augen, der Nase und des Mundes, nach dem Umgang mit potenziell kontaminierten Gegenständen und nach dem Toilettengang) sowie den Kontakt mit einem möglicherweise infizierten Tier zu vermeiden und kein Buschfleisch zu essen. Bei humanitären Einsätzen wird empfohlen, einen Spezialisten für Reisemedizin zu konsultieren.
Referenzen
Das ukrainische Gesundheitsministerium meldet einen Fall von akuter schlaffer Lähmung verursacht durch das Poliovirus. Es handelt sich dabei um ein ungeimpftes 18 Monate altes Mädchen aus der Oblast Rivne im Nordwesten des Landes. Die Eltern hatten die Impfung aufgrund religiöser Überzeugungen abgelehnt. Auch bei 6 Kontaktpersonen wurde das Virus gefunden. Die Durchimpfungsrate gegen Polio ist in der Bevölkerung sehr gering.
Polio wird durch Wasser oder verunreinigte Nahrungsmittel übertragen und kann bleibende, invalidisierende Lähmungen verursachen. Es gibt keine Behandlung, aber die Impfung ist ein wirksames Mittel zur Vorbeugung der Krankheit.
Folgen für Reisende
Personen, die sich > 4 Wochen im Land aufhalten, wird dringend empfohlen, bei Ausreise aus der Ukraine eine mind. 4 Wochen und max. 12 Monate zurückliegende Polio-Auffrischimpfung mit Dokumentation im internationalen Impfausweis zu haben. Bei Aufenthalten < 4 Wochen: Grundimmunisierung und Auffrischimpfung alle 10 Jahre.
Referenzen
Polioeradication (accessed 14.10.2021)
Seit Jahresbeginn 2021 wurden in Peru insgesamt 14 Fälle von Gelbfieber gemeldet, von denen 10 bestätigt wurden. Die Betroffenen waren nicht gegen Gelbfieber geimpft.
Gelbfieber ist eine hämorrhagische, virale Krankheit und wird durch Mücken übertragen. Sie beginnt mit hohem Fieber, Schüttelfrost, Muskel- und Kopfschmerzen und Verdauungsstörungen und kann bei gewissen Patienten zu Blutungen und Gelbsucht führen, die tödlich sein können. Es gibt keine spezifische Therapie, die Impfung ist das beste Mittel, sich vor dieser Krankheit zu schützen. Nicht geimpfte Personen (bei Kontraindikation) müssen sich unbedingt gegen Mückenstiche schützen. Für Kinder unter 9 Monaten, Schwangere, Stillende und Personen mit schwerer Immunschwäche oder Thymus Krankheiten, wird eine Zuweisung zu einem Spezialisten in Reise- und Tropenmedizin empfohlen.
Folgen für Reisende
Ein Impfschutz gegen Gelbfieber wird bei Aufenthalten in Gebieten die unter 2’300m östlich der Anden liegen empfohlen (nicht für Aufenthalte in Cusco, Lima, Machu Picchu und für den Inca Trail).
Referenzen
Seit September 2017 besteht ein Gelbfieberausbruch in Nigeria. Seit Jahresanfang 2021 und bis Ende August wurden insgesamt 1’312 Verdachtsfälle registriert.
Gelbfieber ist eine hämorrhagische, virale Krankheit und wird durch Mücken übertragen. Sie beginnt mit hohem Fieber, Schüttelfrost, Muskel- und Kopfschmerzen und Verdauungsstörungen und kann bei gewissen Patienten zu Blutungen und Gelbsucht führen, die tödlich sein können. Es gibt keine spezifische Therapie, die Impfung ist das beste Mittel, sich vor dieser Krankheit zu schützen. Nicht geimpfte Personen (bei Kontraindikation) müssen sich unbedingt gegen Mückenstiche schützen. Für Kinder unter 9 Monaten, Schwangere, Stillende und Personen mit schwerer Immunschwäche oder Thymus Krankheiten, wird eine Zuweisung zu einem Spezialisten in Reise- und Tropenmedizin empfohlen.
Folgen für Reisende
Eine Impfung gegen Gelbfieber ist bei Aufenthalten in diesem Land obligatorisch und muss in einem offiziellen Impfzentrum (oder von einem zugelassenen Arzt) durchgeführt werden und spätestens 10 Tage vor Einreise erfolgt sein, damit ein Schutz gewährleistet ist. Bei immunkompetenten Personen ist eine Gelbfieberimpfung mit einer einmaligen Auffrischimpfung nach 10 Jahren (d. h. maximal 2 Impfungen im Leben) empfohlen.
Zwischen Ende August und Mitte September 2021 wurden insgesamt 20 Verdachtsfälle und 22 bestätigte Fälle von Pest (19 Lungenpest Fälle, 3 Beulenpestfälle) gemeldet. Die gemeldeten Fälle befinden sich in zwei nicht benachbarten Regionen: Itasy und Haute Matsiatra. Beide Regionen sind als Pest-Endemiegebiete bekannt.
Die Pest ist auf Madagaskar endemisch, die Hauptübertragungszeit findet zwischen September und April statt. Jedes Jahr werden 200-700 Fälle gemeldet, hauptsächlich die Beulenpestform. 2017 gab es einen großen Ausbruch mit v. a. Lungenpest.
Die Pest wird durch Bakterien (Yersinia pestis) verursacht und durch Flöhe von Nagetieren (vor allem Ratten) oder auch Haustieren übertragen. Es gibt die sogenannte Beulen (Bubonen)-Pest und die seltener auftretende systemische (Pestsepsis) und Lungenpest. Letztere wird von Mensch zu Mensch über Tröpfchen über die Atemwege von Patienten mit Lungenpest übertragen. Diese Form ist äußerst ansteckend. Symptome der Lungenpest sind neben Fieber vor allem Lungenbeschwerden wie Brustschmerzen, Atemnot und Husten. Eine Antibiotikatherapie muss innerhalb von 24 Stunden nach Beginn der Symptome begonnen werden. Die Bubonenpest äussert sich durch Fieber, Schüttelfrost und Grippesymptome (Kopf-, Muskel- und Halsschmerzen) und oft eine Schwellung der Lymphdrüsen (Beulen).
Folgen für Reisende
Das Risiko für Reisende ist sehr gering. Schützen Sie sich vor Flöhen, in dem Sie regelmässig Repellentien auftragen und Permethrin imprägnierte Kleidung tragen. Vermeiden Sie Kontakt mit Ratten und toten oder kranken Tieren, sowie erkrankten Personen. Konsultieren Sie bei Fieber, schmerzhaften Lymphknoten und/oder Atembeschwerden rasch einen Arzt.
Referenzen
Laut Medienberichten wurde bis Anfang Oktober bei sieben Personen in Venezuela eine Gelbfieberinfektion festgestellt. Die Fälle traten in den Bundestaaten Monagas und Anzoategui auf. Die Durchimpfungsrate gegen Gelbfieber ist in der Bevölkerung von Venezuela ungenügend. Aufgrund der politischen Lage ist die medizinische Infrastruktur eingeschränkt.
Gelbfieber ist eine hämorrhagische, virale Krankheit und wird durch Mücken übertragen. Sie beginnt mit hohem Fieber, Schüttelfrost, Muskel- und Kopfschmerzen und Verdauungsstörungen und kann bei gewissen Patienten zu Blutungen und Gelbsucht führen, die tödlich sein können. Es gibt keine spezifische Therapie, die Impfung ist das beste Mittel, sich vor dieser Krankheit zu schützen. Nicht geimpfte Personen (bei Kontraindikation) müssen sich unbedingt gegen Mückenstiche schützen. Für Kinder unter 9 Monaten, Schwangere, Stillende und Personen mit schwerer Immunschwäche oder Thymus Krankheiten, wird eine Zuweisung zu einem Spezialisten in Reise- und Tropenmedizin empfohlen.
Folgen für Reisende
Ein Impfschutz gegen Gelbfieber wird bei Aufenthalten in den meisten Bundesstaaten von Venezuela, einschliesslich Monangas und Anzoategui dringend empfohlen.
Referenzen
Masernausbrüche werden aus mindestens 14 Ländern Afrikas berichtet mit einigen Hundert bis mehreren Tausend Fällen seit Jahresbeginn 2021.
Masern sind eine hoch ansteckende Viruserkrankung, die über die Atemwege übertragen wird. Sie ist in der ganzen Welt verbreitet. Mit einem Impfstoff lässt sich die Krankheit sehr wirksam verhindern.
Folgen für Reisende
Eine Reise bietet eine ideale Gelegenheit, den Schutz vor Masern zu kontrollieren (2x geimpft oder durchgemachte Masern) und wenn nötig den Impfschutz zu aktualisieren.
Referenzen
Seit Jahresanfang 2021 wurden 5 Fälle von humaner Tollwut bekannt und 234 Fälle bei Tieren. Betroffen waren Personen aus allen Landesteilen.
Tollwut kann durch Speichel von infizierten Säugetieren (vor allem Hunden, Katzen, Affen, Fledermäusen) übertragen werden. Durch rasche Behandlung – Wunde unter fliessendem Wasser und mit Seife mindestens 15 Minuten lang ausgiebig waschen und spülen, Immunglobulin und 4 Impfdosen - kann verhindert werden, dass sich die Infektion zur tödlichen Tollwut entwickelt. Immunglobuline und moderne, hoch gereinigte Impfstoffe sind in vielen Regionen nicht erhältlich. Kinder sind besonders gefährdet, da Expositionen häufig unbemerkt erfolgen.
Folgen für Reisende
Kontakt mit Tieren vermeiden (auf keinen Fall füttern!). Nach einem Tierbiss/-kratzer, die Wunde mit fliessendem Wasser und Seife 15 Minuten lang waschen, desinfizieren und in jedem Falle ein qualitativ hochwertiges medizinisches Zentrum aufsuchen (post-expositionelle Impfung). Für Langzeitreisende und Reisende mit erhöhtem Individualrisiko (Reisen mit Zweirädern, in entlegene Gebiete, Langzeitaufenthalte, Kleinkinder, Arbeiten mit Tieren, Höhlenforscher usw.) ist eine prä-expositionelle Impfung vor dem Aufenthalt (2 Injektionen und eine Auffrischimpfung nach 1 Jahr) empfehlenswert.
Referenzen
Outbreak News today, 23.9.2021
Bei einem 18 Monate alten, gegen diese Krankheit nicht geimpften Kind aus dem Dorf Mala im Distrikt Kemo in der Zentralafrikanischen Republik wurde eine Gelbfieberinfektion bestätigt.
Gelbfieber ist eine hämorrhagische, virale Krankheit und wird durch Mücken übertragen. Sie beginnt mit hohem Fieber, Schüttelfrost, Muskel- und Kopfschmerzen und Verdauungsstörungen und kann bei gewissen Patienten zu Blutungen und Gelbsucht führen, die tödlich sein können. Es gibt keine spezifische Therapie, die Impfung ist das beste Mittel, sich vor dieser Krankheit zu schützen. Nicht geimpfte Personen (bei Kontraindikation) müssen sich unbedingt gegen Mückenstiche schützen. Für Kinder unter 9 Monaten, Schwangere, Stillende und Personen mit schwerer Immunschwäche oder Thymus Krankheiten, wird eine Zuweisung zu einem Spezialisten in Reise- und Tropenmedizin empfohlen.
Folgen für Reisende
Eine Impfung gegen Gelbfieber ist bei Aufenthalten in diesen Ländern obligatorisch und muss in einem offiziellen Impfzentrum (oder von einem zugelassenen Arzt) durchgeführt werden und spätestens 10 Tage vor Einreise erfolgt sein, damit ein Schutz gewährleistet ist. Bei immunkompetenten Personen ist eine Gelbfieberimpfung mit einer einmaligen Auffrischimpfung nach 10 Jahren (d. h. maximal 2 Impfungen im Leben) empfohlen.
Referenzen
Am 13. August 2021 wurden im Institut Pasteur in Dakar fünf aus der Côte d’Ivoire stammende Gelbfieberfälle bestätigt.
Gelbfieber ist eine hämorrhagische, virale Krankheit und wird durch Mücken übertragen. Sie beginnt mit hohem Fieber, Schüttelfrost, Muskel- und Kopfschmerzen und Verdauungsstörungen und kann bei gewissen Patienten zu Blutungen und Gelbsucht führen, die tödlich sein können. Es gibt keine spezifische Therapie, die Impfung ist das beste Mittel, sich vor dieser Krankheit zu schützen. Nicht geimpfte Personen (bei Kontraindikation) müssen sich unbedingt gegen Mückenstiche schützen. Für Kinder unter 9 Monaten, Schwangere, Stillende und Personen mit schwerer Immunschwäche oder Thymus Krankheiten, wird eine Zuweisung zu einem Spezialisten in Reise- und Tropenmedizin empfohlen.
Folgen für Reisende
Eine Impfung gegen Gelbfieber ist bei Aufenthalten in diesen Ländern obligatorisch und muss in einem offiziellen Impfzentrum (oder von einem zugelassenen Arzt) durchgeführt werden und spätestens 10 Tage vor Einreise erfolgt sein, damit ein Schutz gewährleistet ist. Bei immunkompetenten Personen ist eine Gelbfieberimpfung mit einer einmaligen Auffrischimpfung nach 10 Jahren (d. h. maximal 2 Impfungen im Leben) empfohlen.
Referenzen
Der Bundesstaat Tamaulipas an der Ostküste Mexikos, der an Texas grenzt, hat Medienberichten zufolge in diesem Jahr bisher 3’407 Abdominaltyphus Infektionen gemeldet. Damit steht Tamaulipas an der Spitze der gemeldeten Fälle in Mexiko, dicht gefolgt vom Bundesstaat Sinaloa (3'381 Fälle).
Abdominaltyphus ist eine bakterielle Erkrankung, die durch kontaminierte Nahrungsmittel und Wasser übertragen wird. Symptome sind Fieber, Bauchschmerzen, Durchfall oder Verstopfung. Antibiotika sind wirksam und eine vorbeugende Impfung ist verfügbar (um die 60% Schutzwirkung).
Folgen für Reisende
Nur gekochte Nahrungsmittel und abgekochte Getränke oder Mineralwasser konsumieren. Je nach Reiseart und Hygienestandard kann eine Impfung empfohlen werden. Sie sollte spätestens 2-3 Wochen vor der Abreise erfolgen.
Referenzen
Laut Medienberichten nimmt die Anzahl der gemeldeten Tollwutfälle bei Hunden in Tema, Region Greater Accra zu: über 115 Tollwut-Verdachtsfälle wurden gemeldet. Auch andere Regionen scheinen eine Zunahme zu verzeichnen. So ist erst kürzlich eine 23-jährige Frau nach einem Hundebiss in Techiman, nördlich von Kumasi, an Tollwut gestorben, sowie zwei kleine Kinder.
Tollwut kann durch Speichel von infizierten Säugetieren (vor allem Hunden, Katzen, Affen, Fledermäusen) übertragen werden. Eine rasche Behandlung – Wunde unter fliessendem Wasser und mit Seife mindestens 15 Minuten lang ausgiebig waschen und spülen, Gabe von Immunglobulinen und insgesamt 4 Impfdosen - kann verhindern, dass sich die Infektion zur tödlichen Tollwut entwickelt. Leider sind hochwertige Tollwutimpfstoffe, insbesondere Immunglobuline in vielen Ländern nicht immer verfügbar. Kinder sind besonders gefährdet, da Expositionen häufig unbemerkt erfolgen.
Folgen für Reisende
Kontakt mit Tieren vermeiden (auf keinen Fall füttern!). Nach einem Tierbiss/-kratzer, die Wunde mit fliessendem Wasser und Seife 15 Minuten lang waschen, desinfizieren und in jedem Falle ein qualitativ hochwertiges medizinisches Zentrum aufsuchen (post-expositionelle Impfung). Für Expatriierte und Reisende mit erhöhtem Individualrisiko (Reisen mit Zweirädern, in entlegene Gebiete, Langzeitaufenthalte, Kleinkinder usw.) ist eine prä-expositionelle Impfung vor dem Aufenthalt (2 Injektionen und eine Auffrischimpfung nach 1 Jahr) empfehlenswert.
Referenzen
Sieben bestätigte und weitere sechs Verdachtsfälle von Leptospirose wurden bei Personen gemeldet, die im Fluss Argensou in Auzat und Vicdessos in Ariege (Südfrankreich) Wassersportaktivitäten wie Canyoning betrieben haben.
Leptospirose ist eine bakterielle Erkrankung, die weltweit vorkommt, besonders häufig in tropischen Ländern während der Regen- oder Überschwemmungszeit. Sie wird bei Kontakt von kleinen Hautverletzungen mit durch Urin verunreinigtem Wasser (v. a. von infizierten Ratten, Hunden, Schweinen, Kühen usw.) übertragen. Das Ansteckungsrisiko erhöht sich beim Campen oder bei Aktivitäten im Zusammenhang mit Wasser (Schwimmen, Kajakfahren, Durchwaten von Wasserläufen). Die Krankheit kann, wenn rechtzeitig diagnostiziert, mit Antibiotika behandelt werden.
Folgen für Reisende
Die französischen Gesundheitsbehörden rufen Personen, die im obengenannten Bereich gebadet oder geangelt haben, dazu auf, beim Auftreten von Symptomen schnell ihren Arzt aufzusuchen.
Referenzen
Via ProMED 12.9.2021, ARS
In einer Tierklinik in Niedersachsen ist ein Hund an Tollwut gestorben. Der Welpe war Anfang September aus dem Mittelmeerraum ohne die vorgeschriebene Tollwutimpfung importiert worden. Post-mortem Tollwutteste fielen positiv aus. Über 50 Kontaktpersonen mussten sich einer post-expositionellen Impfung unterziehen.
Folgen für Reisende
Eine Tollwut-Impfung ist u.a. Voraussetzung für den Import eines Tieres. Der illegale Import von Hunden und anderen Tieren ist ein ernst zunehmendes Problem und gefährdet Mensch und Tier! Bitte halten Sie sich an die Vorschriften.
Referenzen
Tierklinik Posthausen – Facebook, 11.9.2021
Südafrika: Innerhalb einer Woche (23.-31.8.2021) wurden 7 im Labor bestätigte humane Fälle in den Provinzen Limpopo, KwaZulu-Natal und Eastern Cape sowie zusätzlich 3 als wahrscheinlich beurteilte Fälle gemeldet.
Tollwut kann durch Speichel von infizierten Säugetieren (vor allem Hunden, Katzen, Affen, Fledermäusen) übertragen werden. Durch rasche Behandlung – Wunde unter fliessendem Wasser und mit Seife mindestens 15 Minuten lang ausgiebig waschen und spülen, Immunglobulin und 4 Impfdosen - kann verhindert werden, dass sich die Infektion zur tödlichen Tollwut entwickelt. Immunglobuline und moderne, hoch gereinigte Impfstoffe sind in vielen Regionen nicht erhältlich. Kinder sind besonders gefährdet, da Expositionen häufig unbemerkt erfolgen.
Folgen für Reisende
Kontakt mit Tieren vermeiden (auf keinen Fall füttern!). Nach einem Tierbiss/-kratzer, die Wunde mit fliessendem Wasser und Seife 15 Minuten lang waschen, desinfizieren und in jedem Falle ein qualitativ hochwertiges medizinisches Zentrum aufsuchen (post-expositionelle Impfung). Der Zugang zu hochwertigen Tollwutimpfstoffen ist in Südafrika nicht immer gewährleistet! Für Langzeitreisende und Reisende mit erhöhtem Individualrisiko (Reisen mit Zweirädern, in entlegene Gebiete, Langzeitaufenthalte, Kleinkinder usw.) ist eine prä-expositionelle Impfung vor dem Aufenthalt (2 Injektionen und eine Auffrischimpfung nach 1 Jahr) empfehlenswert.
Referenzen
Bolivien: Die Fälle von Hunde- und Katzentollwut haben sich in diesem Jahr in Cochabamba gegenüber dem gleichen Zeitraum des Vorjahres verdoppelt; vier Gemeinden haben den Notstand ausgerufen. Laut Angaben des offiziellen Tollwutprogrammes von Bolivien wurden 2021 bereits 45 Fälle bei Tieren registriert, 4 Personen sind verstorben. Massen-Impfkampagnen für Tiere wurden angekündigt.
Tollwut kann durch Speichel von infizierten Säugetieren (vor allem Hunden, Katzen, Affen, Fledermäusen) übertragen werden. Durch rasche Behandlung – Wunde unter fliessendem Wasser und mit Seife mindestens 15 Minuten lang ausgiebig waschen und spülen, Immunglobulin und 4 Impfdosen - kann verhindert werden, dass sich die Infektion zur tödlichen Tollwut entwickelt. Immunglobuline und moderne, hoch gereinigte Impfstoffe sind in vielen Regionen nicht erhältlich. Kinder sind besonders gefährdet, da Expositionen häufig unbemerkt erfolgen.
Folgen für Reisende
Kontakt mit Tieren vermeiden (auf keinen Fall füttern!). Nach einem Tierbiss/-kratzer, die Wunde mit fliessendem Wasser und Seife 15 Minuten lang waschen, desinfizieren und in jedem Falle ein qualitativ hochwertiges medizinisches Zentrum aufsuchen (post-expositionelle Impfung). Der Zugang zu hochwertigen Tollwutimpfstoffen ist in Bolivien nicht immer gewährleistet! Für Langzeitreisende und Reisende mit erhöhtem Individualrisiko (Reisen mit Zweirädern, in entlegene Gebiete, Langzeitaufenthalte, Kleinkinder usw.) ist eine prä-expositionelle Impfung vor dem Aufenthalt (2 Injektionen und eine Auffrischimpfung nach 1 Jahr) empfehlenswert.
Referenzen
Die Demokratische Republik Kongo hat einen Meningokokken-Meningitis Ausbruch in der nordöstlichen Provinz Tshopo gemeldet, in der mindestens 261 Verdachtsfälle und 129 Todesfälle aufgetreten sind. Die Sterblichkeitsrate ist mit 50 % sehr hoch.
Saisonale Meningitis-Epidemien kommen in Subsahara-Afrika vor allem während der Trockenzeit vor. Im Allgemeinen sind die Serogruppen der Meningokokken A, C, W und X für diese Ausbrüche verantwortlich. Die Krankheit verbreitet sich durch Tröpfchen von Mensch zu Mensch. Falls Symptome (hohes Fieber, starke Kopfschmerzen und Erbrechen) auftreten, sollte sofort ein Arzt konsultiert und mit einer Antibiotikatherapie begonnen werden, da die Krankheit innert Stunden zu lebensbedrohlichen Zuständen führen kann. Als Prophylaxe steht für Erwachsene und Kinder über 1 Jahr eine Impfung gegen die wichtigsten Meningitisstämme zu Verfügung.
Folgen für Reisende
Aufgrund der aktuellen Epidemie wird eine Impfung gegen Meningokokken empfohlen.
Referenzen
Laut Medienberichten wurden zwischen Ende August und Anfang September 30 Verdachtsfälle mit Lungenpest gemeldet, von denen 12 Fälle bestätigt wurden. Sieben Personen verstarben. Die Fälle traten in Itasy, einer in der Nähe der Hauptstadt Antananarivo gelegenen Region im Zentrum des Landes auf.
Die Pest ist auf Madagaskar endemisch, die Hauptübertragungszeit findet zwischen September und April statt. Jedes Jahr werden 200-700 Fälle gemeldet, hauptsächlich die Beulenpestform. 2017 gab es einen großen Ausbruch mit v. a. Lungenpest.
Die Pest wird durch Bakterien (Yersinia pestis) verursacht und durch Flöhe von Nagetieren (vor allem Ratten) oder auch Haustieren übertragen. Es gibt die sogenannte Beulen (Bubonen)-Pest und die seltener auftretende systemische (Pestsepsis) und Lungenpest. Letztere wird von Mensch zu Mensch über Tröpfchen über die Atemwege von Patienten mit Lungenpest übertragen. Diese Form ist äußerst ansteckend. Symptome der Lungenpest sind neben Fieber vor allem Lungenbeschwerden wie Brustschmerzen, Atemnot und Husten. Eine Antibiotikatherapie muss innerhalb von 24 Stunden nach Beginn der Symptome begonnen werden. Die Bubonenpest äussert sich durch Fieber, Schüttelfrost und Grippesymptome (Kopf-, Muskel- und Halsschmerzen) und oft eine Schwellung der Lymphdrüsen (Beulen).
Folgen für Reisende
Das Risiko für Reisende ist sehr gering. Schützen Sie sich vor Flöhen, in dem Sie regelmässig Repellentien auftragen und Permethrin imprägnierte Kleidung tragen. Vermeiden Sie Kontakt mit Ratten und toten oder kranken Tieren, sowie erkrankten Personen. Konsultieren Sie bei Fieber, schmerzhaften Lymphknoten und/oder Atembeschwerden rasch einen Arzt.
Referenzen
Innerhalb einer Woche wurden von den Gesundheitsbehörden in Hongkong drei Fälle mit einer Gelflügelinfluenza (H5N6) gemeldet. Der jüngste Fall betrifft einen 55-jährigen Mann, der in Liuzhou, Guangxi, lebt. Er ist Landwirt und hatte Kontakt mit lebendem Geflügel. Er entwickelte am 17. August Symptome und wurde noch am selben Tag zur Behandlung eingeliefert. Der Zustand des Patienten ist kritisch.
Im Allgemeinen ist das Vogelgrippe Infektionsrisiko für Menschen äusserst gering und kommt fast ausschliesslich bei engem Kontakt mit infiziertem Geflügel (Atemsekrete und Fäkalien) vor.
Folgen für Reisende
Optimale persönliche Hygiene, welche auch im Rahmen der COVID-19 Pandemie wichtig ist. Kontakt mit Geflügel und deren Ausscheidungen sollte vermieden werden. Kein Besuch von Vogel- und Geflügelmärkten/ -farmen.
Referenzen
Laut Medienberichten wurden in der Region Chuvisca, Bundesstaat Rio Grande do Sul, 4 tote Brüllaffen aufgefunden. Bei einem der Affen konnte eine Gelbfieberinfektion bestätigt werden. Die betroffene Region, in denen die toten Affen gefunden wurden, liegt zwischen Porto Alegre und der Grenze zu Uruguay.
Todesfälle bei Affen gehen in Südamerika häufig humanen Gelbfieberfällen voraus und sind damit ein Indikator für eine (vermehrte) Zirkulation von Gelbfieberviren.
Gelbfieber ist eine hämorrhagische, virale Krankheit und wird durch Mücken übertragen. Sie beginnt mit hohem Fieber, Schüttelfrost, Muskel- und Kopfschmerzen und Verdauungsstörungen und kann bei gewissen Patienten zu Blutungen und Gelbsucht führen, die tödlich sein können. Es gibt keine spezifische Therapie, die Impfung ist das beste Mittel, sich vor dieser Krankheit zu schützen. Nicht geimpfte Personen (bei Kontraindikation) müssen sich unbedingt gegen Mückenstiche schützen. Für Kinder unter 9 Monaten, Schwangere, Stillende und Personen mit schwerer Immunschwäche oder Thymus Krankheiten, wird eine Zuweisung zu einem Spezialisten in Reise- und Tropenmedizin empfohlen.
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Die Gelbfieberimpfung wird von der WHO für die meisten Regionen in Brasilien empfohlen. Aufgrund der zunehmenden Ausbreitung auch in bisher als gelbfieberfrei erklärten Gebieten sollte die Indikation für aktuell noch als gelbfieberfreie deklarierte Regionen ebenfalls großzügig gestellt werden (Hauptsaison für Gelbfieber ist Dezember bis Mai)! Empfehlung des Schweizerischen Expertenkomitees für Reisemedizin (EKRM): bei immunkompetenten Personen wird eine Gelbfieberimpfung mit einer einmaligen Zweitimpfung nach 10 Jahren (d. h. maximal 2 Impfungen im Leben) empfohlen.
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Am 6. August 2021 wurde die WHO über einen bestätigten Fall mit einer Marburg-Virus-Infektion in der Präfektur Guéckédou, Region Nzérékoré, im Südwesten Guineas informiert. Das Dorf, in dem der Fall auftrat, liegt sowohl in der Nähe der Grenze zu Sierra Leone als auch zu Liberia. Dies ist der erste bekannte humane Fall mit einer Marburg-Virus-Infektion in Guinea. Inzwischen wurde ein zweiter Fall bestätigt; beide Fälle kommen aus Temessadou.
Das Marburg-Virus ist ein dem Ebola-Virus verwandter Erreger, welcher ein sogenanntes hämorrhagisches Fieber auslösen kann. Das Virus wird bei Kontakt mit Blut und anderen Körperflüssigkeiten von Infizierten übertragen. Nach einer Inkubationszeit von 5-10 Tagen treten Symptome mit plötzlichem hohem Fieber, Muskelschmerzen, Müdigkeit, Hals- oder Kopfschmerzen auf, gefolgt von Durchfall, Erbrechen und innerlichen sowie äusserlichen Blutungen, welche meist zum Tod führen. Es gibt weder ein spezifisches Medikament noch eine Impfung. Bisher wurden sporadische Fälle insbesondere aus Uganda, Kenia und D.R. Kongo gemeldet. 2018 wurde das Marburg Virus erstmals in Sierra Leone bei Frucht-Fledermäusen identifiziert, ein Hinweis, dass das Virus auch in West Afrika zirkuliert.
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Das Risiko für Reisende ist sehr gering, für Familienangehörige und Pflegepersonen, die mit Erkrankten Kontakt haben, allerdings gross. Vermeiden Sie Kontakt mit kranken Personen. Konsumieren Sie kein Buschfleisch (bushmeat) oder Fledermäuse. Ebenso sollten Höhlen, die Fledermäuse beherbergen können, gemieden werden. Bei Fieber konsultieren Sie bitte sofort einen Arzt, dies ist auch wichtig um andere Erkrankungen wie z.B. eine Malaria auszuschliessen.
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Die griechischen Gesundheitsbehörden haben die ersten drei West-Nil-Fieber Fälle der Saison aus der Region Pella in Zentralmazedonien gemeldet.
West Nil Fieber (WNF) ist eine virale Krankheit (Flavivirus), die in zahlreichen Regionen Europas, Zentralasiens, Nordamerikas und Afrikas durch Stechmücken auf den Menschen übertragen wird. Sie verläuft meist ohne Symptome (80%) oder wie eine Grippe. Selten (< 1 %) kommt es zu neurologischen Störungen oder zu einer Gehirnentzündung mit möglichem tödlichem Ausgang. Ältere Personen, Schwangere und Immunsupprimierte haben ein höheres Risiko für einen schweren Krankheitsverlauf. Es gibt keine spezifische Behandlung.
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Schützen Sie sich gegen Mückenstiche tagsüber und nachts (lange Hosen, langärmlige Kleider, Mückenschutzmittel). Berühren Sie keine erkrankten oder toten Vögel, da diese ebenfalls infiziert sein können. Wenn Sie ein West Nil Fieber Übertragungsgebiet besucht haben, sollten Sie mindestens 28 Tage nach ihrer Rückkehr kein Blut spenden.
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Aktuell besteht ein Dengue-Ausbruch (Typ 3) in Mombasa (Januar bis Juni 2021: über 710 Fälle) und Mandera County (52 Fälle, eine hohe Dunkelziffer wird vermutet). In Kenia kommt es seit fünf Jahren jedes Jahr zu Ausbrüchen von Dengue-Fieber.
Dengue Fieber ist eine virale Krankheit, die durch tagaktive Mücken v. a. in den Städten während und kurz nach der Regenzeit übertragen wird. Die Symptome sind hohes Fieber, Kopf-, Gelenk- und Muskelschmerzen und ein Hautausschlag. Die Krankheit verläuft meist gutartig und heilt normalerweise nach 10 Tagen aus. Seltener kann sie zu Blutungen führen.
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Optimaler Mückenschutz 24/7 (in der Dämmerung und nachts gegen Malaria, tagsüber gegen Dengue und andere Arbovirosen. Bei Fieber: Paracetamol-Produkte und Flüssigkeitszufuhr. Keine Medikamente einnehmen die Acetylsalicylsäure (z. B. Aspirin®) enthalten, da diese die Blutungsgefahr erhöhen. Bei Fieber >37,5 °C muss auch an eine Malaria gedacht und diese vor Ort mittels Blutausstrich ausgeschlossen werden (eine medikamentöse Malariaprophylaxe wird neben der Durchführung eines Mückenschutzes unbedingt empfohlen!).
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WHO Africa, 11.7.2021
Laut WHO wurden in diesem Jahr 2 Gelbfieberfälle bestätigt: Bei dem ersten Fall handelt es sich um einen 34-jährigen Mann aus der Provinz Nord und beim zweiten Fall um eine 47-jährige, nicht gegen Gelbfieber geimpfte Frau aus der Provinz Bas Uele. Drei weitere Verdachtsfälle aus der Provinz Equateur, Kinshasa und Nord-Ubangi werden noch untersucht.
Gelbfieber ist eine hämorrhagische, virale Krankheit und wird durch Mücken übertragen. Sie beginnt mit hohem Fieber, Schüttelfrost, Muskel- und Kopfschmerzen und Verdauungsstörungen und kann bei gewissen Patienten zu Blutungen und Gelbsucht führen, die tödlich sein können. Es gibt keine spezifische Therapie, die Impfung ist das beste Mittel, sich vor dieser Krankheit zu schützen. Nicht geimpfte Personen (bei Kontraindikation) müssen sich unbedingt gegen Mückenstiche schützen. Für Kinder unter 9 Monaten, Schwangere, Personen mit schwerer Immunschwäche oder Thymus Krankheiten, wird eine Zuweisung zu einem Spezialisten in Reise- und Tropenmedizin empfohlen.
Folgen für Reisende
Eine Impfung gegen Gelbfieber ist bei Aufenthalten in der D.R. Kongo obligatorisch und muss in einem offiziellen Impfzentrum (oder von einem zugelassenen Arzt) durchgeführt werden und spätestens 10 Tage vor Einreise erfolgt sein, damit ein Schutz gewährleistet ist. Bei immunkompetenten Personen ist eine Gelbfieberimpfung mit einer einmaligen Auffrischimpfung nach 10 Jahren (d. h. maximal 2 Impfungen im Leben) empfohlen.
Referenzen
WHO Africa, 25.7.2021
Im Bundesstaat Amapa ist ein 21-jähriger Mann an Gelbfieber verstorben. Der Mann stammte aus dem Staat Pará (Rio Tambaqui do Vieira, in Afua), wo er laut Behörden sehr wahrscheinlich auch die Infektion erworben hatte.
Gelbfieber ist eine lebensbedrohliche virale Erkrankung, die durch Mücken übertragen wird. Es gibt keine spezifische Therapie, jedoch eine sehr wirksame Impfung. Sie ist das beste Mittel, sich vor Gelbfieber zu schützen. Daneben ist ein optimaler Mückenschutz wichtig. Für Kinder unter 9 Monaten, Schwangere, Stillende, Personen mit Immunschwäche oder einer Thymus-Krankheit, die nach Brasilien reisen möchten, empfehlen wir einen Spezialisten in Reise- und Tropenmedizin zu konsultieren.
Folgen für Reisende
Die Impfung gegen Gelbfieber wird von der WHO für die meisten Regionen Brasiliens empfohlen. Seit ein paar Jahren breitet sich Gelbfieber zunehmend auch in bisher gelbfieberfreie Gebiete aus. Auch nicht geimpfte Reisende sind bereits nach einem Aufenthalt in Brasilien gestorben. Das Schweizerische Expertenkomitee für Reisemedizin empfiehlt deshalb einen Gelbfieberimpfschutz für Aufenthalte in allen Gebieten Brasiliens. Die Impfung muss in einem offiziellen Impfzentrum oder von einem dafür zugelassenen Arzt mindestens 10 Tage vor der Einreise nach Brasilien durchgeführt werden, um einen ausreichenden Schutz gegen Gelbfieber zu gewährleisten. Bei immunkompetenten Personen wird eine einmalige Auffrischung nach 10 Jahren empfohlen (d.h. maximal 2 Impfstoffdosen im Leben).
Referenzen
Outbreak News Today, 26.7.2021
China wurde von der Weltgesundheitsorganisation (WHO) als malariafrei zertifiziert. Das Land hat in der Bekämpfung der Malaria innerhalb der letzten 70 Jahre eine bemerkenswerte Leistung erbracht: in den 1940er Jahren wurden landesweit jährlich 30 Millionen Malaria-Fälle gemeldet. Ab den 1950er Jahren wurde eine nationale Malaria-Eliminationsstrategie entwickelt. Die Zertifizierung der Malaria-Eliminierung wird von der WHO erteilt, wenn ein Land nach eingehender Prüfung nachgewiesen hat, dass landesweite Übertragungen für mindestens die letzten drei aufeinander folgenden Jahre unterbrochen wurden. Das Land muss ausserdem nachweisen, dass es in der Lage ist, ein Wiederaufflammen von Übertragungen zu verhindern.
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Auch wenn nun keine spezifische Malaria-Prävention mehr indiziert ist, sollten Mückenschutzmassnahmen weiterhin 24/7 durchgeführt werden: tagsüber gegen Mücken, die z.B. Dengue, Chikungunya und Zika übertragen können und nachts gegen mückenübertragene Erkrankungen wie die Japanische Enzephalitis.
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Aus den USA und Kanada werden verschiedene Expositionen gegenüber tollwütigen Tieren gemeldet (Waschbären, Fuchs, eigene Hunde). In allen Fällen konnten die Tiere identifiziert und getötet werden (inkl. Diagnosesicherung) und die exponierten Menschen erhielten eine korrekte postexpositionelle Prophylaxe (PEP) gegen Tollwut.
Tollwut kann durch Speichel von infizierten Säugetieren (vor allem Hunden, Katzen, Affen, Fledermäusen) übertragen werden. Durch eine rasche Behandlung – Wunde unter fliessendem Wasser und mit Seife mindestens 15 Minuten lang ausgiebig waschen und spülen, Gabe von Immunglobulin und 4 aktiven Impfdosen - kann verhindert werden, dass sich die Infektion zur tödlichen Tollwut entwickelt. Immunglobuline und moderne, hoch gereinigte Impfstoffe sind in vielen Regionen nicht erhältlich. Kinder sind besonders gefährdet, da sie häufig Bissen im Gesicht ausgesetzt sind und das Virus nur einen kurzen Weg zurücklegen muss, um das Gehirn zu erreichen bzw. auch kleine Wunden unbemerkt geschehen können.
Folgen für Reisende
Kontakt mit Tieren vermeiden (auf keinen Fall füttern!). Nach einem Tierbiss/-kratzer, die Wunde mit fliessendem Wasser und alkalischer Seife 15 Minuten lang waschen, desinfizieren und in jedem Falle ein qualitativ hochwertiges medizinisches Zentrum aufsuchen (post-expositionelle Impfung). Für Reisende mit erhöhtem Individualrisiko (Reisen mit Zweirädern, in entlegene Gebiete, Langzeitaufenthalte, Kleinkinder, Höhlenforscher, Kontakt mit Tieren / Fledermäuse etc.) empfiehlt das Schweizerische Expertenkomitte für Reisemedizin eine prä-expositionelle Impfung vor der geplanten Reise (2 Injektionen und eine Auffrischimpfung nach 1 Jahr).
Referenzen
Outbreak News Today; via ProMED-mail
In Kolumbien ist ein junger Mann im Departement Huila, im Südwesten des Landes an Tollwut verstorben. Weitere Informationen sind nicht bekannt. Letzten September war im gleichen Departement eine 26-jährige Frau nach einem Biss durch ihre Hauskatze verstorben.
Tollwut kann durch Speichel von infizierten Säugetieren (vor allem Hunden, Katzen, Affen, Fledermäusen) übertragen werden. Durch eine rasche Behandlung – Wunde unter fliessendem Wasser und mit Seife mindestens 15 Minuten lang ausgiebig waschen und spülen, Gabe von Immunglobulin und 4 aktiven Impfdosen - kann verhindert werden, dass sich die Infektion zur tödlichen Tollwut entwickelt. Immunglobuline und moderne, hoch gereinigte Impfstoffe sind in vielen Regionen nicht erhältlich. Kinder sind besonders gefährdet, da sie häufig Bissen im Gesicht ausgesetzt sind und das Virus nur einen kurzen Weg zurücklegen muss, um das Gehirn zu erreichen bzw. auch kleine Wunden unbemerkt geschehen können.
Folgen für Reisende
Kontakt mit Tieren vermeiden (auf keinen Fall füttern!). Nach einem Tierbiss/-kratzer, die Wunde mit fliessendem Wasser und alkalischer Seife 15 Minuten lang waschen, desinfizieren und in jedem Falle ein qualitativ hochwertiges medizinisches Zentrum aufsuchen (post-expositionelle Impfung). Für Reisende mit erhöhtem Individualrisiko (Reisen mit Zweirädern, in entlegene Gebiete, Langzeitaufenthalte, Kleinkinder, Höhlenforscher, Kontakt mit Tieren / Fledermäuse etc.) empfiehlt das Schweizerische Expertenkomitte für Reisemedizin eine prä-expositionelle Impfung vor der geplanten Reise (2 Injektionen und eine Auffrischimpfung nach 1 Jahr).
Referenzen
Outbreak News Today; via ProMED-mail
Seit Anfang Jahr wurden im mexikanischen Bundesstaat unmittelbar südlich des US-Bundesstaates Kalifornien 23 Fälle von Rocky Mountain Spotted Fever (RMSF) diagnostiziert, davon sind acht Personen verstorben. Die Verstorbenen waren alles Kinder und Jugendliche; Gründe dafür sind am ehesten die engeren Kontakte mit ihren Hunden, die die infizierten Zecken nach Hause bringen und die grundsätzlich erhöhte Mortalität bei Kindern und Jugendlichen.
RMSF wird durch Rickettsia rickettsii verursacht, eine durch Zecken übertragene Infektion. Entsprechend werden die meisten Fälle im Sommer gemeldet. Die Infektion zeigt sich anfänglich mit unspezifischen Symptomen. Der typische Ausschlag zeigt sich häufig erst nach wenigen Tagen, so dass die Diagnose bei Symptombeginn nicht leicht zu stellen ist. Die Infektion lässt sich mit einer raschen Doxyzyklin-Therapie gut behandeln. Kinder < 10 Jahren haben ein 5-fach erhöhtes Risiko an RMSF zu versterben.
Folgen für Reisende
Schützen Sie sich gegen Zecken (gut abschliessende Kleidung und die Socken über den Hosen tragen, Applikation von Insektiziden auf der Kleidung) und untersuchen sie Körper und Haare regelmässig. Manchmal kann ein Zeckenstichbiss unbemerkt bleiben. Finden Sie eine Zecke, entfernen Sie sie mit Hilfe einer Pinzette, indem Sie sie so nah wie möglich an der Haut fassen und allmählich rausziehen. Vermeiden Sie es, die Zecke zu zerdrücken (Kontaminationsrisiko), niemals mit einem Streichholz verbrennen oder verschiedene Flüssigkeiten anzuwenden. Waschen und desinfizieren Sie die Bissstelle und Ihre Hände. Konsultieren Sie bei Fieber oder Hautrötung für eine eventuelle Behandlung einen Arzt.