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Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

 

Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

 

Health Advice for Travellers
Swiss Expert Committee for Travel Medicine

Latest News

The Swiss Expert Committee for Travel Medicine (ECTM) - a body of the Swiss Society for Tropical and Travel Medicine (FMH) - has revamped the Safetravel® website and renamed it to HealthyTravel.ch. The website continues to offer basic travel medicine recommendations for laypersons free of charge. Professionals can also subscribe to additional travel medicine information and recommendations such as in-depth country-specific information, vaccination recommendations with expert opinions, detailed maps (including malaria recommendations), fact sheets (including e.g. dosage information for malaria prophylaxis) and other important travel medicine content. These can be used during travel medicine consultation of patients and clients and can be individually compiled for the traveller, printed out or sent electronically.

 

The recommendations and content on HealthyTravel.ch reflect the recommendations of the Swiss Expert Committee for Travel Medicine. They are developed in cooperation with the Federal Office of Public Health (FOPH). The website is under construction and will be continuously expanded with additional content and updates. Please note that all content available on the website HealthyTravel.ch is protected by copyright and may not be passed on to third parties.

 

Further information can be found in the flyer (LINK). The Swiss Expert Committee for Travel Medicine will be happy to answer any questions at info@healthytravel.ch !

ECTM_Flyer_HealthyTravel_PRO_EN_October_2022.pdf

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.
Via ProMED 2.9.2023, ProMED 21.9.2023
The number of reported tick-borne encephalitis (TBE) cases in Sweden has risen sharply this year. According to the health authority, 170 cases were confirmed in the month of August alone. In Sweden, the ticks had favourable conditions this year, as the weather alternated between high temperatures and a lot of precipitation.

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.

Via ProMED 20.9.2023

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.

Via ProMED, 15.9.2023
Five cases of Nipah virus infection, including two deaths, have been reported in Kozhikode, Kerala, since late August. The index case was hospitalized in Kozhikade district on August 28, 2023; the other four cases are either family members or hospital contacts of the index case.
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%).
Risk to travelers is low. Follow local instructions. Avoid eating raw fruit juices and unwashed, especially bitten, tree fruits or vegetables. Avoid contact with sick persons and with animals or their excrement. Seek medical attention if symptoms occur. There is neither a vaccination for humans nor a specific treatment.
Via ProMED 14.9.2023
In Bordeaux, in southwestern France, fifteen people were diagnosed with suspected botulism, including 1 death. At least ten persons were hospitalized and eight were treated in intensive care. Type B botulism toxin was detected in serum samples from some of the affected individuals, and sardines tested were positive for Clostridium botulinum type B. All patients reported eating at the same restaurant that served locally produced canned sardines, which were confirmed as the source of infection. The patients were individuals of U.S., British, Canadian, English, French, German, Irish, and Spanish nationality. The product was immediately withdrawn from circulation and control measures are being implemented in the restaurant.
Based on current knowledge, the risk of infection to EU/EEA citizens is considered low, although additional cases related to this event may occur in the coming days. The public is urged to contact their healthcare provider if symptoms occur.
ECDC CDTR, 15.9.2023
Since the first week of August and until September 11, 2023, 14 cases of locally acquired (autochthonous) dengue fever infection have been registered in the Italian regions of Lombardy and 5 cases in the region of Lazio, including Rome. All cases were laboratory-confirmed, and all patients have recovered or are on the road to recovery. Since the beginning of the year, 146 imported dengue cases have been registered in Italy.
It is not uncommon for autochthonous dengue cases to occur in parts of southern Europe during the summer months. Carry out optimal mosquito protection, especially during the day (see factsheet Mosquito and tick bite protection). In case of fever: take paracetamol preparations and ensure sufficient fluid intake. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®), as these increase the risk of bleeding during a dengue infection.
ECDC CDTR, 15.9.2023
In August 2023 alone, 15 cases of leptospirosis were registered in the Lviv region. This is five times more than in the first half of 2022, and 21 cases have been reported since the beginning of the year. According to epidemiological investigations, the infections occurred in the following ways: during contact of damaged skin with infected objects, surfaces (12 cases), through water contact (swimming in reservoirs, fishing) (8 cases) and during consumption of infected food (1 case).
Wear protective waterproof clothing/boots when wading through water! Cut or scratch wounds should be covered with waterproof bandages.
Via ProMED, 13.9.2023

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.

Further autochthonous cases may occur in the affected regions, and in Italy overall.

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.
ECDC CDTR, 15.9.2023
Between late July and early September, 10 autochthonous (locally acquired) dengue cases were reported in Italy. The affected regions are Lombardy (7 cases, province of Lodi and Lake Garda) and Lazio (1 case in Rome, 2 cases in Latina). According to media reports, an autochthonous dengue case in Parma is also under investigation. A total of 122 imported dengue cases have been diagnosed in Italy since the beginning of the year.
According to the Italian health authority, the situation described is in line with expectations for this season, as international travel has increased following the COVID 19 emergency and climatic conditions favor the proliferation of Aedes albopictus mosquitoes (also known as tiger mosquitoes), which can transmit dengue virus. Optimal mosquito protection especially during the day. In case of fever: take paracetamol preparations and ensure sufficient fluid intake. Do not take medications containing acetylsalicylic acid (e.g. Aspirin®), as these increase the risk of bleeding during a dengue infection.
ECDC, 4.9.2023 | BASG 1.9.2023 | | Insituto Superiore di Sanità, 6.9.2023 | Media 7.9.2023
Since January 2023, a total of 8'455 diphtheria cases (2'507 confirmed; 5'948 suspected) and 230 deaths have been recorded in four African countries: Algeria: (80 cases, 10 deaths), Guinea (90 cases, 22 deaths), Niger (272 cases, 8 deaths), and Nigeria (8,013 cases, 190 deaths). Immunization rates in the region are low, and this is in an environment where mining causes large population movements. In addition, the local health system is fragile and has limited resources to respond to this outbreak. Other ongoing outbreaks in the region, particularly pertussis, polio, and rabies, are straining the limited resources available.
In addition to full basic immunization against diphtheria, persons traveling to or working in a country with diphtheria outbreaks should receive booster vaccinations every 10 years.
Africa CDC, 27.8.2023 | WHO AFRO, 27.8.2023

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).

Optimal mosquito protection especially during the day. In case of fever, take paracetamol preparations and ensure sufficient fluid intake. Do not take medications containing acetylsalicylic acid (e.g. Aspirin®), as these increase the risk of bleeding in the event of a dengue infection.
Santé publique France, 4.9.2023
Virginia state health officials are reporting an outbreak of meningococcal disease. Since June 2022, a total of 27 cases of meningococcal disease caused by the bacterium Neisseria meningitides, type Y, have been reported in adults aged 30 to 65 years. 5 patients have died. A total of 26 patients were not vaccinated. The strain associated with this outbreak is known to be common in the United States.
This is a reminder that exchange students and individuals at risk for meningococcal disease should refresh their meningococcal meningitis vaccination.
Outbreak News Today, 4.9.2023
Since the beginning of the year, 1,785 hepatitis A cases have been registered in Lebanon, 204 of them in the Baalbek district in the east of the country. Last year, there were fewer than 600 hepatitis A cases nationwide.
Optimal food and drinking water hygiene and personal hygiene. Vaccination against hepatitis A is recommended for all travelers.
Via PromMED 27.8.2023
Globally, nearly 1.5 million new COVID-19 cases and over 2500 deaths have now been reported from 10 July to 6 August 2023, representing an 80% increase and a 57% decrease, respectively, from the previous 28 days. By 6 August 2023, over 769 million confirmed cases and over 6.9 million deaths have been reported globally. The current reported cases do not accurately reflect infection rates as the number of tests and reports have decreased worldwide.
Although the international health emergency was declared to have ended on 5 May 2023, COVID-19 remains a major threat. WHO continues to urge Member States to maintain and not dismantle their existing COVID-19 infrastructure. It is critical to maintain early warning, surveillance and reporting, variant tracking, early clinical care, administration of booster vaccines to high-risk groups, improved ventilation and regular communication.
WHO, 10.8.2023 | WHO risk assessment, 9.8.2023 | ECDC 11.8.2023
The Democratic Republic of Congo (DRC) is facing its worst cholera epidemic in six years due to an increase in conflict and displacement in the east of the country. The United Nations Children's Fund (UNICEF) warns The UN agency reports that 31,342 suspected or confirmed cases of cholera and 230 deaths were reported across the country in the first seven months of this year, many of them children. North Kivu is the most affected province.
Despite these numbers of cases, infections through travellers are very rare. Ensure careful personal hygiene and only consume food and drinks from safe sources. Cholera vaccination is only recommended for humanitarian missions.
Outbreak News Today, 20.8.2023
According to media reports, 47 chikungunya cases were reported in the Kedougou region of southeastern Senegal in the first half of August. The last chikungunya outbreak in Senegal occurred in 2015.
Optimal 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). In case of fever, take paracetamol preparations and make sure to drink enough fluids. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®), as these increase the risk of bleeding. In case of fever, malaria should always be ruled out by a blood test.
Crisis 24, 18.8.2023
A mumps outbreak has been reported from health centers and community schools in Zimbabwe.
A review of mumps protection should always be part of a travel medical consultation. All persons born after 1963 who do not have documented protection against the infection should be vaccinated twice with MMR vaccine. Because of the insufficient efficacy of the Rubini vaccine strain (Triviraten®), persons vaccinated with this vaccine should receive additional MMR doses (i.e., 1 or 2 MMR doses, aiming for a total of 2 effective mumps vaccine doses).
Via ProMED, 15.8.2023
Since the beginning of 2023, 88 hepatitis A cases have been registered in the Zhetysu region of Kazakhstan, including 20 in children under 14 years of age. This is more than 7-fold increase compared to last year.
Optimal food and drinking water hygiene. All travelers to Kazakhstan, including children, should be vaccinated against hepatitis A.
Via ProMED, 17.8.2023
On August 4, 2023, two autochthonous (locally acquired) cases of dengue virus infection were reported in patients residing in Gardanne, in the Bouche-du-Rhône department and in the Provence Alpes-Côte d'Azur region. None of the two cases had traveled abroad recently. These are the first autochthonous dengue virus infections in France in the 2023 transmission season.
Optimal protection against mosquito bites during the day against dengue. In case of fever, paracetamol preparations and hydration. Do not take medications containing acetylsalicylic acid (e.g. Aspirin®), as these increase the risk of bleeding in the event of a dengue infection.
ECDC CDTR, 11.8.2023
A measles outbreak in Kyrgyzstan resulted in the deaths of two children, aged three and one. Both deaths were due to parental refusal to vaccinate. The Ministry of Health reported a total of 1,704 confirmed cases this year. The increase in cases extends to other former Soviet republics, with Russia reporting more than 5,000 cases, Kazakhstan at least 3,000, and Tajikistan 528 cases since the beginning of the year. Recently, a traveler brought measles to Chile after visiting Armenia and Georgia.
Verification of measles protection should always be part of a travel medical consultation. All persons born after 1963 who do not have documented protection against infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In case of an epidemic in the region or contact with a measles case, vaccination is recommended from 6 months of age.
Via ProMED 15.8.2023

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.

Optimal mosquito bite protection 24/7, also in cities (during the day and dusk against dengue, chikungunya, Zika and other viruses). 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 in the event of a dengue infection.
Outbreak News Today, 28.7.2023

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.

The risk for travellers is very low. Do not eat rodents! Use repellents and clothing impregnated with permethrin to protect against fleas. Contact with rats and dead or sick animals, as well as sick persons, should be avoided. In case of fever, painful lymph nodes and/or breathing difficulties, quick medical consultation.
Via ProMED 8.8.2023

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.

Seasonal vaccination is recommended for all persons at risk. Of note, in Europe, vaccination against influenza will only be available from September on. Persons at risk might consider vaccination on site.
Via ProMED, 6.8.2023

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!

Via ProMED, 7.8.2023
Since the beginning of the year and through the end of June, 54,139 suspected dengue cases have been reported in Malaysia, compared with 21,688 cases during the same period in 2022. The increase was expected. Dengue outbreaks occur in Malaysia in cycles of about 4 years. Most infections come from the state of Selangor, which surrounds the capital city of Kuala Lumpur.t

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.

WHO/PRO Dengue update
Health authorities in Palawan report an increase in malaria cases in the barangay (district) of Irawan. From April 26 to June 30, 31 cases were registered. More detailed information is not yet available. The number of malaria cases nationwide has decreased by 87% since 2003. Malaria transmission occurs on the islands of Palawan, Mindoro and Mindanao and smaller islands nearby.

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.

Government of the Philippines, February 2023

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.

Protect yourself optimally around the clock (24/7) against mosquitoes (see factsheet mosquito protection):. 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).
Government of Western Australia, 14.7.2023

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.

In addition to full basic immunization against diphtheria, persons traveling to or working in a country with diphtheria outbreaks should receive booster vaccinations at 10-year intervals.
Via ProMED 8.7.2023
According to Pakistani media, there have been a total of 75 laboratory-confirmed cholera cases in Sindh province so far in 2023. This is just the tip of the iceberg, as over half a million cases of acute watery diarrhea were reported in the province in the first six months of this year, according to the Communicable Disease Control Department.
Be sure to practice careful personal hygiene and consume only food and beverages from safe sources. Cholera vaccination is recommended for humanitarian missions only.
Outbreak News Today, 10.7.2023
French authorities confirmed a total of 61 cases of locally acquired tick-borne encephalitis (TBE) between May 2021 and May 2023. The Auvergne-Rhône-Alpes region has become an important TBE distribution area, with the Haute-Savoie department reporting the most cases during this two-year period. Cases have also been recorded in the department of Ardèche.

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.

NathNac, 12.7.2023

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.
PAHO, 7.7.2023
Many enjoy hot weather, but intense heat can be dangerous. In hot weather, our bodies work harder to maintain internal core temperatures, putting additional stress on the heart and lungs. Combined with the fluid and salt loss that occurs from sweating, this can lead to specific heat-related health problems such as dehydration, overheating, heat exhaustion and heat stroke. Excessive heat can also worsen existing health conditions. The elderly, people with underlying conditions, infants, and young children are especially sensitive to higher temperatures. However, adverse health effects from hot weather are largely preventable if reasonable precautions are taken.

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

NaTHNaC, WHO Heatwaves
Health authorities in Ethiopia report increased malaria activity nationwide, with 1,251,910 cases reported since the beginning of the year, compared with 13,136 cases reported in 2022 over a similar period. The Afar region is most at risk, followed by the Gambella region.
Optimal mosquito protection around the clock (at dusk and at night against malaria, during the day against dengue and other arboviruses) is of great importance! In addition, chemoprophylaxis against malaria is recommended throughout the country at altitudes below 2500 m, including in the city of Labilela. If you are only in the city of Addis Ababa: Mosquito bite prophylaxis is recommended. 

Important: In case of fever (>37.5°C) malaria should always be excluded immediately by a blood test!
Via ProMED 6.7.2023
On June 11, 2023, the Ministry of Health reported a confirmed case of yellow fever in the Oussouye health district in the Ziguinchor region. The case was an 11-year-old boy who presented to the Oussouye district hospital with fever, abdominal pain, and bleeding. A confirmatory test conducted at the Institut Pasteur in Senegal was positive for yellow fever. The last yellow fever outbreak in Senegal, with 7 confirmed cases, occurred in December 2020.
Vaccination against yellow fever is strongly recommended for Senegal and is mandatory when entering the country within 6 days from a yellow fever endemic area (including airport transit).
Africacdc.org 24.6.2023
According to Mexican health authorities, 841 cases of cutaneous leishmaniasis have been reported nationwide as of June 17, 2023. Of these, 91.4% occurred in the 3 states of the Yucatan Peninsula. This is an unusual increase compared to the last 4 years.
Transmission of the disease occurs mainly during the night, in Mexico mainly between November and March, through the bite of the infected female sandfly. Prevention: Apply insect repellent to exposed skin and under the ends of sleeves and pant legs. Seek medical attention if skin lesions do not heal.
Outbreak News Today, 3.7.2023
A significant increase in pertussis cases has been recorded in Israel, especially among the ultra-Orthodox "Haredi" population in Jerusalem. Between the beginning of May and the end of June, 326 cases were counted. A 10-week-old infant died as a result of the disease. Both the infant and the mother had not been vaccinated.
After basic immunization against pertussis, booster vaccinations are recommended for adolescents (11-15 years) and adults (25-29 years). Booster vaccination is also indicated for any pregnancy. In addition, adolescents and adults should be vaccinated against pertussis if there is regular occupational or family contact with infants under 6 months of age and the last vaccination against pertussis was 10 years ago or more.
Via ProMED 29.6.2023

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.

Optimal food and drinking water hygiene: avoid drinking unboiled water and eating raw or inadequately heated foods. The clinical course of hepatitis E is usually mild, but pregnant women have a high risk of death (10-30%). Boiling through or heating to ≥ 71°C for at least 20 minutes inactivates the virus. A vaccine against hepatitis E is licensed in China but not available in Switzerland.
Outbreak News Today 2.7.2023
The number of cases of tick-borne encephalitis (TBE) has increased in Slovakia in recent years. At the end of June 2023, 17 people were hospitalized with the disease in Banská Bystrica. They had become infected after eating mountain products made from unpasteurized sheep and goat milk. 

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.
Protect yourself from ticks during outdoor activities (see Factsheet Mosquito and Tick Bite Protection). Vaccination against TBE is recommended during (planned) stays in endemic areas. 


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.
Via ProMED, 7.7.2023
The Pasteur Institute in Dakar confirmed a yellow fever case in the Republic of Côte d'Ivoire. The patient is a 35-year-old man from Cocody-Bengerville in Abidjan. His vaccination status against yellow fever is unknown.
Yellow fever is endemic in the Republic of Côte d'Ivoire, including in the cities. Proof of vaccination is mandatory when entering the country.
Outbreak News Today, 29.5.2023
The infection season for West Nile virus (WNV) is mainly between June and November. For up-to-date information on cases and spread, see the European Centre for Disease Control and Prevention (ECDC) dashboard West Nile Virus Infection.

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.
Protect yourself from mosquito bites during the day and at night. 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.
ECDC | ECDC Dashboard for WNV
More than 20% of the ticks analyzed in all Latvian laboratories tested positive for Borrelia this year. The early summer meningoencephalitis (TBE) virus has been detected in only a few ticks so far in 2023.
Protect yourself from ticks during outdoor activities (see Factsheet Mosquito and Tick Protection). For stays in endemic areas, vaccination against TBE is recommended.

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.
Via ProMED 27.5.2023
There is an ongoing risk for measles worldwide. Many international destinations, including European ones, are reporting increased numbers of measles cases. This is often due to low vaccination rates and vaccination refusal, but in some countries also to challenges in maintaining the cold chain for vaccines.
Before a planned trip, have it checked whether you are adequately protected against measles. Swiss recommendations: All persons born after 1963 who do not have documented protection against infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In case of an epidemic in the region or contact with a measles patient, vaccination is recommended from 6 months of age.
CDC, WHO, other

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.

Good personal hygiene. Avoid close contact with sick persons, especially including skin or genital lesions and with contaminated materials used by sick persons. Avoid contact with sick animals. Safer sex is recommended, including prevention of other sexually transmitted diseases. 

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.
ECDC 1.6.2023 | WHO 17.3.2023 | CDC 17.5.2023
The Australian Health Service of New South Wales (NSW) is urging the public to be vigilant for symptoms of meningococcal disease following the death of one man and 3 new cases. Since the beginning of the year, 19 cases of meningococcal disease have been recorded in New South Wales, with the majority due to the meningococcal B strain of infection. As early as December 2022, NSW reported 29 cases of meningococcal meningitis, also primarily due to meningococcal serogroup B.
Students spending an academic year in Australia, in particular, should have a current meningococcal meningitis vaccination. Swiss recommendation: see Swiss vaccination schedule.
Via ProMED 5.6.2023

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.

Leishmaniasis is transmitted by the bite of infected female sandflies, mainly at night. Prevention: Apply insect repellent to exposed skin and under the ends of sleeves and pant legs.
Via Promed 16.5.2023
There have been 9 human rabies deaths reported from the Malaysian state of Sarawak, located on the island of Borneo, since the beginning of the year. Out of 181 dogs tested for rabies in the state, 42 were infected.
Avoid contact with animals ( do not feed them in any case!). 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), see also factsheet rabies. 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.
Outbreak News Today, 23.5.2023
A dengue fever outbreak in the Afar Region in Northeastern Ethiopia has been reported. It is estimated that over 1'000 suspected dengue cases have been registered. The large number of displaced people due to conflict and ongoing flooding are aggravating the epidemic situation.
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 Paracetamol 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.
OCHA, 11.05.2023
According to reports from South African health authorities, there is a significant increase in malaria cases in the endemic provinces in the north and northeast of the country. Early detection and treatment are essential for malaria cases. Untreated malaria rapidly develops into a severe disease with a potentially fatal outcome.
Optimal mosquito protection at dusk and at night in the north/northeast of the country. From September to May, northeast and east of Mpumalanga Province (including Kruger and neighboring national parks) and north and northeast of Limpopo Province, taking antimalarial medication before, during and after travel is recommended.
Outbreak News Today 11.05.2023
Colombia reports a higher than usual number of dengue cases this year. A total of 32'206 cases have been registered through April, including 108 deaths. The majority of cases are from the following regions: Meta, Tolima, Cundinamarca, Barranquilla, Sucre, Cartagena, Santander, Cali, Cesar, Northern Santander, Atlantic, Cordoba and Guajira.
Dengue fever is transmitted by Aedes mosquitoes: Optimal mosquito protection during the day, also in cities. In case of fever, take paracetamol preparations and ensure sufficient fluid intake. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®), as these increase the risk of bleeding. In case of fever, malaria should always be ruled out by a blood test.
Outbreak News Today 15.05.2023
The Federal Office of Public Health (FOPH) has reported the first Zika virus infection in Switzerland since 2019. It is an imported case. In Switzerland itself, no locally acquired Zika virus infection has been detected so far. Globally, Zika transmissions have been at low levels since 2018. Since the start of mandatory reporting in Switzerland in 2016, the FOPH has registered a total of 75 Zika cases.
For information on Zika and prevention, see the Zika factsheet at www.healthytravel.ch.
Swissinfo.ch, 16.05.2023
Since the beginning of the year and until mid-April, a total of 1'053 suspected yellow fever cases have been reported from Uganda.
For stays in Uganda, vaccination against yellow fever is strongly recommended.
WHO Afro Weekly Bulletin
So far this year, 35 chikungunya cases have been registered in Uruguay; 18 of them were locally transmitted and originated in the department of Paysandú.
Optimal mosquito protection during the day, even in cities. Treatment consists of reducing fever with paracetamol-based products and relieving joint pain with anti-inflammatory medication and rest. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®).
Subrayado, 30.4.2023
According to health officials in Galveston County in Texas, USA, murine typhus (R. typhi) is on the rise. Four cases have been reported so far this year, and they are likely to increase as temperatures rise. Since 2014, the number of cases has been cumulative. In 2014, there was only one reported case; last year, there were 54, according to the health district; in fact, the number is likely higher.

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.
Avoid contact with fleas. Use veterinarian-approved flea control products for cats and dogs, such as flea collars, oral medications or spot-ons. Keep rodents and animals (such as opossums) out of your home, workplace and recreational areas.
The Daily News, 26.4.2023 | CDC, Flea-borne (murine) typhus
Hajj, the annual pilgrimage to Mecca in the Kingdom of Saudi Arabia (KSA), is one of the largest gatherings of its kind in the world. This year, Hajj begins on 26 June 2023. Normally, about three million Muslims from all over the world gather in Mecca. For Hajj 2023, the KSA Ministry of Health has announced that regulations have been restored to the pre-pandemic situation; there are no longer COVID-19 precautions and age restrictions for pilgrims. 
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.
Performing the rituals of Hajj and Umrah is demanding and often requires long distances in hot weather. Pilgrims must make sure that they are as physically fit as possible.
 
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!)
Ministry of Healthy KSA | NaTHNac | HealthyTravel
Nigeria reports 1'686 suspected meningitis cases (124 fatal) since early October 2022. The majority of cases have been recorded in the north of the country, but other regions are also affected (see map).

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.

ECTM_weekly_EpiNews_EN_2023_04_30_image_1.jpg

Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended for stays >30 days or even for shorter stays, depending on the individual risk (e.g., close contact with people, work in health care facilities, heavily occupied accommodation, risk of epidemics). In the case of alerts and epidemics, vaccination is recommended for stays >7 days or close contact with the population.
WHO DON, 27.4.2023
Since the start of the chikungunya outbreak in Paraguay in October 2022, there have been 77'790 confirmed and probable chikungunya cases. All regions of the country reported cases. Nearly 6'000 cases have been identified in the last three weeks, mainly concentrated in Central, Asunción, and Alto Paraná, but expansion of the epidemic is also observed outside the metropolitan region.
Optimal mosquito protection during the day, even in cities. Treatment consists of reducing fever with paracetamol based products and relieving joint pain with anti-inflammatory medication and rest. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®).
Outbreak News Today, 28.4.2023
Since 2022, Indonesia has seen an increase in suspected and confirmed measles cases compared to previous years. Since the beginning of 2023, a total of 2'161 suspected measles cases have been reported in 18 of Indonesia's 38 provinces, mainly from West Java, Central Papua, and Banten.
Given the large worldwide incidence and high transmissibility of the disease, travelers may be exposed to the virus in almost any country they visit. Get your measles protection checked, for example, as part of a travel medicine consultation! All persons born after 1963 who do not have documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In case of an epidemic in the region or contact with a measles case, vaccination is recommended from the age of 6 months.
WHO, 28.4.2023
As of 31 March 2023, it is no longer possible to trek on your own in Nepal. Travelers must use the services of a licensed trekking guide and obtain a TIMS card (for a fee) through authorized trekking agencies registered with the government of Nepal. This (binding!) decision was made to avoid risks and accidents that have occurred in the past with tourists traveling alone.
Nepal official trade website of Nepal Tourism Board, 9.3.2023
Since the beginning of 2023, 47 cases of tick-borne encephalitis have been confirmed in Poland, which is more than a 3x increase compared to the same period in 2022.
Lyme disease cases have also increased (2'753 cases).
Protect yourself against ticks during outdoor activities. Vaccination is recommended when staying in endemic areas. Complete basic immunization requires three doses of vaccination. Temporary protection is available 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 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.
Via ProMED, 25.4.2023 | Outbreak News today, 26.4.2023
The Bolivian Minister of Health and Sports reported a yellow fever case from the municipality of San Borja, El Beni Department, on 3 April 2023. A case was already reported at the end of March from the municipality of Puerto Suárez, department of Santa Cruz (in southeastern Bolivia, 1400 km from the other case).
Yellow fever is endemic in Bolivia. Vaccination recommendations: see country page Bolivia on www.healthytravel.ch.
Via ProMED, 3.4.2023 | via ProMED, 30.3.2023
Although measles is almost non-existent in the Netherlands, a girl has died from the virus. This is the first measles death in the Netherlands since 2019.
Given the large worldwide incidence and high transmissibility of the disease, travelers can be exposed to the virus in almost any country they visit! All persons born after 1963 who do not have 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. Have your measles protection checked, e.g. as part of a travel medicine consultation!
NL Times, 17.4.2023 | BAG Bulletin, 17.4.2023 | RKI, 1.3.2023
The Ministry of Health of Costa Rica reports 139 cases of malaria from the Caribbean region of Huerta. Most cases were registered in Pococí and Limón. According to the U.S. Centers for Disease Control and Prevention (CDC) and other sources, the malaria species found is P. falciparum, one of the most dangerous forms of the parasite.
All travelers 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 may be considered for travelers to the affected areas. Note that there is also a malaria risk in the provinces of Alajuela, Heredia, and the Puntarenas region (see Malaria at www.healthytravel.ch). Optimal mosquito protection 24/7 (at dusk and night against malaria, during the day against dengue, chikungunya and other arboviroses). In case of fever >37.5° C always remember that this can be caused by malaria and immediately take a blood test for malaria!
MoH Costa Rica, 20.4.2023 | MoH Costa Rica, 18.4.2023 | MoH Costa Rica, 14.4.2023 | MoH Costa Rica, 13.4.2023 | MoH Costa Rica, 7.4.2023 | CDC, 17.4.2023 | CDC Alert Travel Notice, 17.4.2023
The National Department of Health reported 41'257 dengue cases by mid-April, of which 37'914 were locally acquired. In 27 cases, the infection was fatal. Four regions of the country are particularly affected: the central region with Buenos Aires, the northeastern region, the northwestern region and the province of San Luis in Cuyo.
Optimal mosquito protection during the day. In case of fever, paracetamol products and hydration. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®), as this increases the risk of bleeding.
Outbreak News Today, 15.4.2023
According to data from the Health Surveillance Directorate of the Ministry of Health, as of 18 April 2023, a total of 116 positive malaria cases have been identified in the Huerta Caribbean region, with of 57 cases in Pococí (in particular in the areas of Ticabán, El Jardín, Las brisas and El rótulo), 55 cases in the canton of Limón (areas Moín, Villa del Mar, Limón 2000 and the Miles sector), two in Matina, one in Guácimo and one case in Siquirres. Most cases have been reported during the first two weeks of April. The latest information on the outbreak can be found on the Ministry of Health’s website of Costa Rica.
 
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
 

ECTM_weekly_EpiNews_EN_2023_04_20_image_1.jpg

The dynamics of this outbreak are currently unclear and are being closely followed.
 
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!
MoH Costa Rica, 18.4.2023 | MoH Costa Rica, 14.4.2023 | MoH Costa Rica, 13.4.2023 | MoH Costa Rica, 7.4.2023 | CDC 17.4.2023 | CDC Alert Travel Notice 17.4.2023
Between the beginning and middle of March 2023, the following countries reported meningitis outbreaks:
 
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.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended for stays >30 days or even for shorter stays, depending on the individual risk (e.g., close contact with people, work in health care facilities, heavily occupied accommodation, risk of epidemics). In case of alerts and epidemics, vaccination is recommended for stays >7 days or close contact with the population.
WHO Meningitis Bulletin | Meningitis Dashboard
After initial reports of Marburg virus cases and deaths in Bukoba district in the Kagera region of northwestern Tanzania, they were confirmed by laboratory tests on 21 March 2023. Five of the eight cases died, including one health worker. A total of 161 contacts are being monitored.

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.
The risk for travelers is low. Every traveler in Africa should consult a doctor in case of fever to clarify the cause and especially to exclude malaria.
WHO, 21.3.2023
In October 2002, an outbreak of measles was reported in Limpopo Province, South Africa. Confirmed cases were then recorded in all provinces in mid-March 2023. Most cases (86%) affected children under 14 years of age.
Review of measles protection should always be part of a travel medical consultation. All persons born after 1963 who do not have documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In case of an epidemic in the region or contact with a measles case, vaccination is recommended from 6 months of age.
WHO DON, 21.3.2023
On 21 March 2023, the Peruvian health authority reported a confirmed vaccine poliovirus type 1 (VDPV1) case. It involved a 16-month-old boy with acute flaccid paralysis who belongs to an indigenous community in the district of Manseriche in the province of Datem del Marañón in the department of Loreto and who had not been vaccinated or traveled before the onset of symptoms.
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).
PAHO, 23.3.2023 | Outbreak News Today, 23.3.2023
Austria reports an outbreak of measles with 89 cases. The outbreak is mainly confined to the region of Styria, with cases also reported in Upper Austria, Vienna, and Carinthia.
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.
Review of measles protection should always be part of a travel medical consultation. All persons born after 1963 who do not have documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In case of an epidemic in the region or contact with a measles case, vaccination is recommended from 6 months of age.
ECDC, 24.3.2023

 

  • 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.

Individuals who have received intragastric injections of botulinum neurotoxin in Turkey between 3 February and 1 March 2023 are encouraged to seek medical advice from their healthcare provider, especially if they experience symptoms such as weakness, difficulty with breathing and/or swallowing.
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.
ECDC, 24.3.2023 | WHO DON, 24.3.2023
The Minas Gerais State Health Secretariat confirmed a death from yellow fever in Monte Santo de Minas on 14 March 2023. The victim is a 41-year-old agricultural worker. Information on his vaccination status is not provided. There will be an epidemiological investigation to determine the probable site of infection. 
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.
The WHO recommends yellow fever vaccination for most regions of Brazil. Due to the increasing prevalence even in areas previously declared free of yellow fever, the Swiss Expert Commission for Travel Medicine (ECTM) recommends yellow fever vaccination for all regions in 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.
Via ProMED, 15.3.2023
According to media quoting Panamanian health authorities, a total of 1'922 malaria cases have been registered in the country since the beginning of the year and up to 7 March. Guna Yala province reported the most cases, followed by Ngäbe Buglé, Darien and Panamá Este. Since 2020, there has been an increase in malaria cases, likely due to the disruption of various services during the COVID 19 pandemic. The eastern part of the country is the most affected.
Optimal mosquito protection 24/7 (at dusk and at night against malaria, during the day against dengue, chikungunya and other arboviroses). In case of fever >37.5° C always think of malaria and rule it out by blood test. In some regions it is recommended to carry a standby emergency treatment or to take a chemoprophylaxis, for detailed information see country page Panama at www.healthytravel.ch 
Via ProMED, 15.3.2023
From 1 to 3 March 2023, two destructive category 4 tropical cyclones and a magnitude 6.5 earthquake affected over 80 percent of Vanuatu's population. To address this emergency, the United Nations, together with Pacific Member States, deployed personnel on the ground to coordinate humanitarian assistance and prepare post-disaster damage assessments.
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.
Pay attention to official reports and those of the media. Postpone non-essential travel to affected areas. The risk of mosquito-borne diseases, gastrointestinal infections, leptospirosis, etc. usually increases after major floods.
Relief, 9.3.2023
The Philippine Department of Health reports the death of 55 persons from rabies by 25 February 2023.
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 consult a high-quality medical facility (post-exposure vaccination), see also factsheet rabies. 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.
Outbreak News Today, 12.3.2023
Between the end of November 2022 and mid-March 2023, a total of 690 measles cases, including one death, were reported from seven districts in western Nepal. Almost half of the cases were from Banke district in Lumbini province, which borders India. The majority of cases involved children under the age of 15.
Measles is very contagious! A trip offers an ideal opportunity to check the protection against measles (2x vaccinated or passed measles disease) and if necessary to update the vaccination protection. This is especially important during humanitarian missions.
Outbreak News Today, 15.3.2023
As of February 2023, over 4.8 million new cases and over 39'000 deaths have been reported worldwide. Since the beginning of the pandemic, over 758 million confirmed cases and over 6.8 million deaths have been reported.
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.
Country-specific COVID-19 entry requirements and travel restrictions, see:
- IATA (with interactive map). The websites are constantly updated.
- HUG (practical and user-friendly summary of entry requirements by country, in French, updated weekly based on IATA and WFP).
WHO, 1.3.2023
Health authorities in the city of Pergamino, in the Argentine province of Buenos Aires, report 19 cases of chikungunya. These are the first locally acquired cases ever reported in this city.
Optimal mosquito protection, especially during the day against chikungunya, dengue, Zika, etc. In case of fever, paracetamol preparations and hydration. Do not take acetylsalicylic acid-containing medications (e.g. Aspirin®), as these increase the risk of bleeding in the event of a dengue infection.
Outbreak News Today, 6.3.2023
The Municipal Health Secretariat of Caxias do Sul reports a yellow fever case in a howler monkey. This is the first suspected and then confirmed yellow fever case in 2023. The animal was found dead in Parada Cristal, a peri-urban area (transition between rural and urban areas), about 140 km north of Porto Alegre.
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.
Yellow fever vaccination is recommended by the WHO for most regions of Brazil. Due to the increasing prevalence even in areas previously declared free of yellow fever, the Swiss Expert Committee for Travel Medicine (ECTM) recommends yellow fever vaccination for all regions in 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.
An outbreak of leptospirosis has been reported in East Java: 249 cases have been registered since the beginning of the year, including 9 deaths. The majority of cases occurred in Pacitan. During all of last year (2022), there were 606 cases of leptospirosis in East Java province. Leptospirosis cases have also been recently reported in Central Java, Yogyakarta, and West Java.
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.
Wear protective clothing/boots when wading in water! Cut or scratch wounds should be covered with waterproof bandages. Vaccination is usually not available for travelers.
Via ProMED, 7.3.2023
Following the massive earthquakes of 6 February 2023 and numerous severe aftershocks, 44'218 deaths and 108'068 injuries were reported in Turkey and over 5'914 deaths and 10'857 injuries in northwestern Syria.
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.
Travelers should avoid nonessential travel to southeastern Turkey and northwestern Syria. Foodborne and waterborne illnesses, respiratory infections, and vaccine-preventable infections, as well as other health threats, are expected to be of concern in the coming weeks. Humanitarian workers should have their routine vaccinations (diphtheria-tetanus-polio, measles-mumps-rubella, chickenpox) up to date or, if necessary, refreshed, and be vaccinated against hepatitis A and B, covid-19, influenza, rabies, typhoid, and cholera (for assignments in Syria).
ECDC CDTR, 3.3.2023 | Reliefweb - OCHA, 28.2.2023
From early October 2022 to the end of January 2023, 18 states reported 315 suspected meningitis cases, including 54 confirmed and 50 deaths. Most cases originated in northern Jigawa State.
For a stay in Nigeria, vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended.
WHO AFRO, 5.2.2023
The diphtheria outbreak in Nigeria continues, with 523 suspected cases reported in the 5 states of Kano, Yobe, Katsina, Lagos, and Osun by early February.
In addition to the basic diphtheria immunization, persons traveling to or working in a country with diphtheria outbreaks should receive a booster 10 years after their last diphtheria vaccination.
Via ProMED, 14.2.2023 | NCDC EW 5/2023
A 7.8-magnitude earthquake struck southeastern Turkey and northwestern Syria on 6 February 2022, bringing the number of people killed by the earthquake in Turkey and Syria to more than 50'000. Turkey alone recorded 44'218 dead, the Turkish Disaster Agency said. The latest death toll from Syria was 5'900. Aftershocks are still shaking the region. According to the Turkish government, 20 million people in the country have been affected by the earthquake. For Syria, the United Nations estimates that 8.8 million people have been affected.
Travelers should avoid nonessential travel to southeastern Turkey and northwestern Syria.
Divers
The authorities in Equatorial Guinea on Monday declared the first outbreak of Marburg virus, a highly infectious disease from the same family of viruses that causes Ebola. Nine people are believed to have died from this viral hemorrhagic fever in the western province of Kie Ntem. The World Health Organization says 16 people have now been quarantined as suspected contact cases. The country's health minister said preliminary investigations linked the deaths to people who had attended a funeral ceremony. Movement was restricted around two villages where most of the cases were reported. This was the first recorded outbreak in the country and the third in sub-Saharan Africa. Ghana had confirmed a case last year and Guinea the year before as well.

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.
The risk for the traveler is low. Every traveler in West Africa should consult a doctor in case of fever in order to clarify the cause and especially to exclude malaria.
WHO, 13.2.2023
During week 05 (01/28/2023 - 02/03/2023), physicians in the Sentinella reporting system recorded 14 consultations for influenza-like illness per 1000 physician consultations, an increase from the previous two weeks. Predominantly circulating virus A(H3N2).
All travelers should be vaccinated against influenza, especially persons at risk.
BAG, 8.2.2023
The World Health Organization (WHO) has reported meningococcal meningitis outbreaks in "meningitis belt" countries. Since December 2022 and through mid-February, the epidemic threshold has been exceeded in Niger in the Zinder region and in Nigeria in Jigawa state. Other countries issue an alert (increase in cases without reaching the epidemic threshold): Benin: Borgou Region (Bembereke District and Sinende District), Aliboro Region (Gogounou District), Burkina Faso: Southwest Region (Batié District), Chad: Ennedi Province, (Amdjarasse District), DR Congo: Maindombe Province, Kiri Health Zone, and South Ubangi Zone, Zongo Health Zone, Nigeria: Akwa Ibom State, Senegal: Dakar Region (Dakar Centre District), South Sudan: Unity State (in the north of the country), Togo: Savannas Region (Oti South District), Ghana: Upper West Region (Nandom District), Côte d'Ivoire: Goutougo Region (Tanga District).

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.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended for stays >30 days or even for shorter stays, depending on the individual risk (e.g., close contact with people, work in health care facilities, heavily occupied accommodation, risk of epidemics). In the case of alerts and epidemics, vaccination is recommended for stays >7 days or close contact with the population.
WHO Meningitis Bulletin, EW 2/2023 | Meningitis Dashboard | This day Live, 24.1.2023
After reassessment by a committee, the WHO advised that the COVID-19 pandemic remains a Public Health Emergency of International Concern (PHEIC).
Country-specific COVID-19 entry requirements and travel restrictions, see:
- 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).
WHO, 30.1.2023
During 2022, several countries in South America recorded an increase in the number of dengue, Zika, and chikungunya cases. A total of 3'110'442 cases of arboviral diseases were reported. Of the total cases, 90.1% were dengue cases, 8.7% were chikungunya cases, and 1.2% were Zika cases.
Optimal mosquito bite protection around the clock (during the day against dengue, Zika, Chikungunya, etc., at dusk and at night against malaria). In case of fever, paracetamol products and hydration. Do not take medications containing acetylsalicylic acid (e.g., Aspirin®), as this increases the risk of bleeding from dengue infection. When staying in malaria areas, always rule out malaria if you have a fever.
PAHO, 25.1.2023
According to media reports, the Santa Fe Provincial Department of Health has issued a warning about a recent trichinellosis outbreak in several locations in the territory. To date, 26 suspected cases and 8 confirmed cases of this parasitic disease have been registered. The source is unknown; generally homemade sausages are responsible. Trichinella infections are frequently reported in Argentina.
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.
Refrain from eating artisanal, non-certified or street-sold sausages. Cook pork and game thoroughly before eating. Trichinae are killed by heating above 70°C for more than 1 minute. Smoking, curing and drying are not safe measures to kill larvae.
MinutAR, 24.1.2023
In the last 2 weeks, 10 confirmed and 2 suspected cases of scrub typhus have been reported from the Los Lagos region in southern Chile. This represents a significant increase from previous years (with 1-2 cases in January). 
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.
There is an increased risk during outdoor activities (e.g. camping, trekking). Prevention: Apply mosquito repellent to skin, wear insecticide-impregnated clothing during outdoor activities. Consult a physician if symptoms occur to quickly initiate antibiotic therapy (doxycycline).
Via ProMED, 31.1.2023
In the last three weeks of January 2023, more than 8'440 chikungunya cases were reported in Paraguay, compared with 2'443 cases in all of 2022.
In early February 2023, a chikungunya infection was also diagnosed in a returning traveler to Switzerland.
Optimal mosquito bite protection, especially during the day against dengue, Zika, Chikungunya, etc.. In case of fever, paracetamol preparations and hydration. Do not take medications containing acetylsalicylic acid (e.g. Aspirin®), as these increase the risk of bleeding during a dengue infection.
MoH, 3.2.2023 | personal communication Gilles Eperon, HUG, Geneve, Switzerland
The Victorian Health Authority in Australia is warning people in northern Victoria to take extra measures to avoid mosquito bites after a person contracted mosquito-borne Japanese encephalitis virus (JEV) while in the Buloke Shire and Swan Hill area. This is the second locally acquired JEV case this mosquito season.
In 2022, more than 40 human JEV cases were reported in the states of News South Wales, Queensland, South Australia and Victoria.
Optimal protection against mosquito bites, especially at dusk and at night. Vaccination is recommended especially for:
- 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.
Australian Govt. Dept. of Health, 7.6.2022
Malawi is currently experiencing the worst cholera epidemic in 20 years. As of 22 January 2023, more than 29'000 cholera cases and more than 900 deaths have been reported. According to the Swiss Red Cross, the epidemic began in March 2022 but recently escalated. The country is now entering the rainy season, which typically results in higher cholera transmission. The outbreak has occurred in three waves so far, first in the south (March-June), then in an atypical dry season wave in the north (August-September), and now throughout the country. Cholera now puts more than 10 million people at risk, including more than five million children.
Despite these numbers of cases, imports from travelers are very rare. Maintain careful personal hygiene and consume only food and beverages from safe sources. Cholera vaccination is recommended only for humanitarian missions.
IFRC, 25.1.2023 | Swiss Red Cross | pers. Communication
According to a recent article published by Emerging Microbes & Infections, 16% of fever cases in some Colombian cities are due to the Oropouche virus (OROV).
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.
Optimal mosquito protection around the clock (also against other mosquito-borne diseases such as dengue, Zika, chikungunya and malaria).
In case of symptoms after a stay in an endemic area, think of Oropouche fever.
Emerging Microbes and Infections, 8.12.2022 | WHO
The World Health Organization (WHO) has reported meningococcal meningitis outbreaks in countries within the "meningitis belt." Since December 2022 through mid-January, the epidemic threshold has been exceeded in Niger, Zinder Region and Nigeria, Jigawa State. Other countries provide an alert (increase in cases without reaching the epidemic threshold): Benin: Borgou region (Bembereke district and Sinende district), Aliboro region (Gogounou district), Burkina Faso: Sud-Ouest region (Batié district), Chad: Ennedi province, (Amdjarasse district), DR Congo: Maindombe province, Kiri health zone, and Sud-Ubangi zone, Zongo health zone, Nigeria: Akwa Ibom state, Senegal: Dakar region (Dakar Centre district), South Sudan: Unity State (in the north of the country), Togo: Savane region (district of Oti Sud). 

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.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended for stays >30 days or even for shorter stays, depending on the individual risk (e.g., close contact with people, work in health care facilities, heavily occupied accommodation, risk of epidemics). In case of alerts and epidemics, vaccination is recommended for stays >7 days or close contact with the population.
WHO Meningits Bulletin
On 20 November 2022, a suspected yellow fever case was reported from Dabola Health District, Faranah Health Region, in Guinea. The case is a 9-year-old child who died and whose yellow fever vaccination status is unknown. Two tests confirmed the yellow fever infection.
Vaccination against yellow fever is highly recommended for stays in Guinea.
WHO AFRO, 15.1.2023
The Kano State government in northern Nigeria has confirmed an outbreak of diphtheria in 13 local government areas of the state, with more than 100 suspected cases and at least three deaths. There have also been reports from Lagos, Osun and Yobe states.

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.
In addition to the basic immunization against diphtheria, persons traveling to or working in a country with diphtheria outbreaks should receive a booster 10 years after the last dose of diphtheria vaccine.
Outbreak News Today, 22.1.2023
The Thailand Bureau of Epidemiology reported a 61% increase in melioidosis cases last year compared to 2021 reports. According to disease surveillance data, 3'559 melioidosis patients were reported from 70 of Thailand's 77 provinces.
 
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.
Avoid contact with soil/surface water, especially on minor wounds. Skin injuries should be disinfected. Wear protective clothing when wading through water.
Outbreak News Today, 23.1.2023
During the week of the 2 to 8 January 2023, nearly 2.9 million new cases and more than 11'000 deaths were reported worldwide. This represents a 9% and 12% decrease in weekly cases and deaths, respectively. However, these trends must be considered taking into account the decline in testing and reporting delays in many countries during the year-end vacation season. Since the beginning of the pandemic, more than 659 million confirmed cases and more than 6.6 million deaths have been reported worldwide.
For travelers returning from China, please note that there are entry restrictions for many countries. For travelers with Chinese passports, it is advised to check the restrictions in the destination country. Most European countries require a PCR test for travelers from China.
WHO, Weekly epidemiological update on COVID-19 - 11 January 2023
Uganda's Ministry of Health has declared the recent Ebola outbreak caused by the Sudan virus (SVD) to be over. This declaration follows a period of 42 days (twice the maximum incubation period for Sudan virus infections) since the last patient tested negative for the second time and no new cases have been reported. Since the outbreak declaration on 20 September 2022, a total of 164 cases with 77 deaths have been reported from nine districts.
Although the outbreak was successfully contained despite the lack of specific therapeutics and vaccines, surveillance and detection capabilities need to be strengthened.
WHO AFRO, 8.1.2023
A sharp increase in reports was observed last year in La Réunion, with 165 cases of leptospirosis. A total of 3 people have died from the disease. Usually, an accumulation of cases is observed from November to April. 
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.
Wear waterproof protective clothing/boots when wading through water! Cuts or scratches should be covered with waterproof bandages. Vaccination for travelers is not available.
Clicanoo, 6.1.2023
There is currently a very high rate of COVID-19 transmission in China. The actual number of COVID-19 cases and deaths in China is unclear to date, and underreporting is assumed.
Reconsider traveling to China, Hong Kong, and Macao due to the rapid increase in COVID-19 cases and limited healthcare resources. If you do travel, follow the COVID-19 prevention measures (link FOPH) to protect yourself and others from COVID-19 infection.
WHO, 14.1.2023
Chinese New Year officially starts on 22 January 2023, with celebrations culminating with the Lantern Festival on 5 February 2023. The festival is likely to attract big crowds and international visitors, with movement of people within China expected to increase. Large crowds in small areas increase risk of accidents and spread of infectious diseases such as COVID-19 and flu (influenza).
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

NaThNAC
No WHO region achieved and/or maintained the 95% elimination target. During the COVID-19 pandemic, measles-containing vaccine coverage decreased significantly. The U.S. CDC has identified the 10 countries with the most measles outbreaks last year. It is led by India, with 9'489 reports, followed by Yemen, Somalia, Zimbabwe, Pakistan, Ethiopia, Liberia, Indonesia and Nigeria.
A trip is an ideal opportunity to check the protection against measles (vaccinated twice or had measles) and if necessary to update the vaccination protection.
CDC Global Measles Outbreaks | WHO, 23.11.2022
A suspected case of yellow fever in an unvaccinated 67-year-old farmer from Kono District, Eastern Province in Sierra Leone tested positive for yellow fever at the Institut Pasteur in Dakar, Senegal. No other cases have been found in the region.
Protect yourself 24/7 against mosquitoes. Vaccination against yellow fever is strongly recommended. Proof of vaccination is mandatory for all travelers entering Sierra Leone, except for airport transit passengers.
WHO AFRO Bulletin, 18.12.2022
According to media reports, health authorities have released an epidemiological alert due to an outbreak of malaria in the state of Oaxaca in southern Mexico. So far, a total of 20 confirmed malaria cases have been identified. Of these, 16 cases are indigenous and 4 are imported. Prior to the onset of this outbreak, the state of Oaxaca was considered malaria-free.
Optimal mosquito bite protection 24/7 (at dusk and at night against malaria, during the day against dengue, chikungunya and other arboviruses). In case of fever >37.5° C, malaria should always be considered and ruled out through a blood test (see also factsheet Malaria).
ECDC/CDTR, EW 49
The HealthyTravel team wishes you a Merry Christmas and a happy 2023 with travel in good health.
According to the Indian Ministry of Health, nearly 250 rabies deaths have been reported from 18 states since the beginning of the year, with Karnataka having the highest number with 32 deaths, followed by Maharashtra and West Bengal with 24 deaths each. In fact, the number is estimated to be much higher (WHO estimate: 18'000-20'000). In the first 7 months of the year, about 1.45 million people were bitten by animals in India (97% by dogs, 2% by cats). Jackals, wolves, mongooses, and monkeys are other vectors. Rabies is present throughout the country.
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), see also factsheet rabies. 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 highly recommended.
The New Indian Express, 9.12.22
The World Health Organization (WHO) has reported outbreaks of meningococcal meningitis in "meningitis belt" countries. Since late October and through the end of November, the epidemic threshold has been exceeded in the Nandom District, Upper West Region, in Ghana. Other countries provide an alert (increase in cases without reaching the epidemic threshold): Benin: Borgou Region (Bembereke District, Sinende), Alibori (Gogounou District), Ghana: Upper West Region (Lawra District), Mali: Koulikoro Region (Kati District), Niger: Zinder Region (Dungass District), Senegal: Dakar Region (Diamniadio District), South Sudan: Northern Bahr El Ghazal State (Awiel Centre County), Eastern Equatoria State (Ikotos County).
 
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.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended for stays >30 days or even for shorter stays, depending on the individual risk (e.g., close contact with people, work in health care facilities, heavily occupied accommodation, risk of epidemics). In case of alerts and epidemics, vaccination is recommended for stays >7 days or close contact with the population.
WHO Meningitis Weekly bulletin 31.10. - 27.11.2022 EW 44-47 | WHO Meningitis EW 47
Hepatitis E cases continue to be reported in Bentiu refugee camp in South Sudan. Since the beginning of 2019, 3'592 cases and 26 deaths have been recorded.
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%).
Optimal food and drinking water hygiene: Avoid drinking unboiled water and consuming raw or insufficiently heated food. A vaccine against hepatitis E is licensed in China but not available in Switzerland.
WHO Africa Epidemiological Bulletin Week 44
According to health authorities, 9.4 million malaria cases were diagnosed in Mozambique in the first nine months of this year, 20% more than in the same period last year. Malaria is endemic in Mozambique, and the entire population is at risk of infection. In most parts of the country, malaria is transmitted throughout the year, with a seasonal peak during the rainy season, which is usually from December to April.
Optimal protection against mosquito bites 24/7 (at dusk and at night against malaria, during the day against dengue and other arboviruses) and taking a chemoprophylaxis against malaria are strongly recommended. Detailed information can be found on the Mozambique country page at www.healthytravel.ch. In case of fever, malaria should always be ruled out by a blood test, even if a chemoprophylaxis has been taken.
AllAfrica, 29.11.2022
9 suspected Chagas cases (caused by Trypanosoma cruzi) were reported from the Pratinha neighborhood in Belem, Brazil. All patients reported eating acai fruit before the onset of symptoms. Across the city of Belém, 11 cases of the disease have been reported, according to city officials.
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.
Chagas is very rare in travelers. The disease can be transmitted by predatory bugs and through food. Other transmissions include through blood/blood products, during pregnancy from mother to child (congenital), through organ transplantation, and laboratory accidents.
Avoid eating pressed acai berries, which are a known source of infection for Chagas (pressed predatory bugs in fruit juice).
Globo Noticias, 12.11.2022 | SESPA, 17.11.2022
Yellow fever: Between July 2021 and June 2022, 485 suspected yellow fever cases were recorded in primates in Paranà, Brazil. During the same period, 123 suspected cases were reported in humans. The peak season for yellow fever transmission in Brazil is from December to the end of May. 
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).
Gov.Br, Boletim Epidemiológico Vol.53 Nº44
Since the beginning of the year, a total of 6'788 suspected measles cases with 6'320 confirmed cases and 57 deaths have been reported in Ethiopia. There are currently confirmed measles outbreaks in 16 districts (woredas): Hadelela, Mecha North, Sekela, Dehana, Fedis, Ginir, Doba, Tulo, Basketo, Doyogena, Fik, Jigjiga City, Jigjiga Zuria, Dagah Bur, Gashamo, Sagag.
Review of measles protection should always be part of a travel medicine consultation. All persons born after 1963 who do not have documented protection against infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In case of an epidemic in the area or contact with a measles case, vaccination is recommended from 6 months of age.
WHO EW 45
The National Department of Health has recorded a total of 4'109 malaria cases and 34 deaths across South Africa for the period from January to October 2022. These numbers are slightly lower than for the same period last year in 2021, but are expected to increase due to delays in data collection in the Malaria Information System.
 
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).
Optimal mosquito bite protection 24/7 (at dusk and at night against malaria, during the day against arboviruses). From September to May: It is recommended to take medication against malaria for stays in the northeast and east of Mpumalanga province (including Kruger and neighboring national parks) and in the north and northeast of Limpopo province, see also country page South Africa.
IOL News, 7.11.2022 | NICD, Malaria Oct 2022
Circulating type 2 vaccine poliovirus was reported from Zambia in mid-November 2022 from an environmental sample collected in Copperbelt on 4 October. Botswana also reported circulating type 2 vaccine poliovirus in early November.

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).
GPEI, as of 9.11.2022
In 2022, 14 measles infections were imported in Minnesota by unvaccinated children/teens. Of them, 7 cases had to be hospitalized. Nationwide, 33 measles infections have been reported since the beginning of the year. From 2001 to 2016, 553 imported measles infections were recorded in the United States.
Review of measles protection should always be part of a travel medicine consultation. All persons born after 1963 who do not have documented protection against infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In case of an epidemic in the area or contact with a measles case, vaccination is recommended from 6 months of age.
Minnesota Department of Health | CDC, Measles Cases and Outbreaks
Since November 2021, a multi-country Shigella outbreak in Europe has been associated with stays in some hotels in Cape Verde. So far, confirmed cases of Shigella sonnei have been reported in the Netherlands, Denmark, France, Germany, Portugal, and the United Kingdom.
Optimal food and drinking water hygiene (see factsheet diarrhea) and personal hygiene (regular hand washing and disinfection).
ECDC/CDTR EW 45, 6-12 November 2022
Since the beginning of 2022, almost 100 dengue cases have been registered in Senegal; 52 cases in the Matam region and 13 in the Kaffrine district. Only the regions of Saint-Louis, Ziguinchor, Kedougou, Sédhiou and Kolda have not reported any cases.
Optimal mosquito bite protection 24/7 (during the day against dengue, Zika, Chikungunya and other arboviruses). If you have a fever, take paracetamol products and drink plenty of fluids. Do not take any medicines containing acetylsalicylic acid (e.g. Aspirin®), as these can increase the risk of bleeding. After a stay in a malaria endemic area, malaria should also be considered if you have a fever and should always be ruled out by a blood test.
SENE News, 18.11.2022
As of 17.11.2022, a total of 141 confirmed Ebola cases and 55 confirmed deaths have been reported. At least 19 health workers have been infected and 7 of them have died. Currently 9 Ugandan districts are affected by this outbreak: Bunyangabu, Jinja, Kagadi, Kampala, Kassanda, Kyegegwa, Masaka, Mubende and Wakiso.
 
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.

ECDC, 18.11.2022 | WHO Afro, SitRep 49, 13.11.2022 | Ministry of Health Uganda, 12.11.2022 | WHO, 10.11.2022
According to media reports, there has been a significant increase in dengue cases in the eastern part of the Yucatan. In the Merida region, in the south of the state, and to a lesser extent in western and central Mexico, there has also been an increase in dengue cases. By the beginning of November 2022, 10'411 cases had been confirmed nationwide. This represents an increase of over 108% compared to the same period last year.
Optimal mosquito bite protection 24/7 (during the day against dengue, Zika, Chikungunya and other arboviruses). If you have a fever, take paracetamol products and drink plenty of fluids. Do not take any medicines containing acetylsalicylic acid (e.g. Aspirin®), as these can increase the risk of bleeding. After a stay in a malaria endemic area, malaria should also be considered if you have a fever and should always be ruled out by a blood test.
The Yucatan Times, 21.11.2022
In November 2022, a case of acute flaccid paralysis caused by a vaccine-derived polio virus was reported from Indonesia. The case is a 7-year-old unvaccinated child in Aceh (Pidie district) in Sumatra. The child had symptoms of paralysis of the left leg and was hospitalised on 18 October. Polio vaccination coverage in Indonesia has been insufficient for decades.

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).
Antara News, 19.11.2022 | Head Topics Indonesia, 19.11.2022 | CNBC Indonesia, 19.11.2022 | ECDC
Indonesia: On 21 November 2022, an earthquake of magnitude 5.6 occurred in West Java. The epicentre was located about 10 km southwest of Cianjur district (West Java province). Thousands of houses, schools, infrastructure facilities, roads and more were severely damaged. More than 270 people were killed and more than 150 are missing.
 
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.
Follow the instructions of the authorities and the media.
ABC News, 23.11.2022 | ReliefWeb, Nepal: Earthquake | USGS, Earthquake Hazards Program, Solomon Islands
On 4 November 2022, circulating vaccine poliovirus type 2 (cVDPV2) was detected in an environmental sample in Botswana. The isolated virus is closely related to a case from Haut Lomami (D.R. Congo).

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).
WHO, Global Polio Eradication Initiative
Eight counties in Kenya have recorded rabies cases, with the highest number reported in Nairobi, followed by Nakuru, Kwale, Kilifi, Wajir, Narok and Isiolo counties.
In Kenya, an estimated 2'000 people die each year from rabies caused by bites from rabid dogs.
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), see also rabies factsheet. For long-term travellers and travellers with increased individual risk (travelling with two-wheelers, to remote areas, long-term stays, small children, working with animals, cave explorers, etc.), a pre-exposure vaccination before the stay (2 injections and a booster after 1 year) is highly recommended.
Nation Africa, 05.11.2022 | Frontiers in Public Health, 10.03.2022
The National Institute for Communicable Diseases of South Africa reports measles outbreaks in the Greater Sekhukhune and Mopani districts of Limpopo Province. Twenty-three people have fallen ill, of whom 20 were <15 years old.
Review of measles protection should always be part of a travel medicine consultation. All persons born after 1963 who do not have documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In case of an epidemic in the region or contact with a measles case, vaccination is recommended from the age of 6 months.
National Institute for Communicable Diseases South Africa, 3.11.2022
As of 13 November, a total of 140 confirmed Ebola cases and 55 confirmed deaths have been reported. The most affected district remains Mubende with 64 confirmed cases and 22 declared probable cases, followed by Kassanda. Two districts, Bunyangabu and Kagadi, have not reported any cases for more than 40 days. Uganda will close schools nationwide on 25 November after 23 Ebola cases were confirmed in school children; 8 children have died. On 5 November 2022, Uganda extended the three-week lockdown of Mubende and Kassanda, the two epicentres of the outbreak.

ECTM_weekly_EpiNews_EN_2022_11_18_image_3.jpg

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.

WHO Afro, SitRep - 49 | Ministry of Health Uganda, 12.11.2022 | WHO, 10.11.2022
The spread of influenza (flu) is currently increasing in the cantons of Graubünden and Ticino. The most frequently detected viruses by the National Reference Centre for Influenza (NZI) this week were rhinoviruses and Sars-CoV-2. Among the influenza viruses, influenza A(H3N2) was the most common.
 
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.
All persons at risk are recommended to be vaccinated against influenza every year. This applies to persons over 65 years of age, persons with pre-existing chronic diseases and/or immunodeficiency, pregnant women, premature babies, residents of old people's or nursing homes and contact persons of these risk persons, including caring contact persons of infants under 6 months of age. Influenza vaccination is also recommended for all medical and nursing staff, for persons working in the paramedical field, as well as for the staff of kindergartens, day-care centres and old people's and nursing homes.
BAG Lagebericht Schweiz: Saisonale Grippe
Ho Chi Minh City: according to the Center for Disease Control of Ho Chi Minh City, more than 62'000 dengue cases (25 deaths) have been reported in the city this year through early October, a sharp increase from last year (about 8'600). 75% of dengue deaths in the city involved adults. 
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.
Optimal mosquito bite protection 24/7 (during the day against dengue, Zika, Chikungunya and other arboviroses). If you have a fever, take paracetamol products and drink plenty of fluids. Do not take medications containing acetylsalicylic acid (e.g., Aspirin®), as they may increase the risk of bleeding. If you have a fever after a stay in a malaria endemic area, malaria should also be considered and always ruled out by a blood test.
Bloomberg, 6.10.2022
he 2022 recommendations are the same as in previous years since 2013. They are aimed at all adults and children with an increased risk of flu complications, as well as all persons who have regular close contact with persons at particular risk in their private or professional environment. These include people 65 years of age and older, people with pre-existing conditions, pregnant women, and health care workers. The vaccination recommendations are published in detail on the website www.schutzvordergrippe.ch. Vaccination is also recommended for all travelers.
FOPH, Protection against flu
Qatar will host the World Cup from 20 November to 18 December 2022. Regardless of the reason for their stay, visitors and fans will need a "Hayya" card to enter Qatar from 1 November to 23 December 2022, which will only be issued after booking a suitable accommodation.

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
Ministère de l’Europe et des Affaires étrangères France, 3.10.2022 | FIFA World Cup 2022™ | FIFA Hayya
According to the World Health Organization (WHO), 54 confirmed cases and 20 probable cases of Ebola virus disease, including 39 deaths, have been recorded in Uganda since the outbreak was declared on 20 September. Among them were 11 health workers; four among them have died. The cases were mainly from Mubende. In addition, cases have been reported from Kampala, Bunyangabu, Kagadi, Kassanda, and Kyegegwa; they are epidemiologically linked to the cases reported from Mubende. 

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.

WHO media briefing, 12.10.22 | Uganda officials 12.10.22 | UNICEF, 7.10.2022 | Reliefweb, 11.11.2022 | BBC News
In the first eight months of this year, the country reported 40 human rabies deaths in 16 cities and provinces, with most cases coming from Ben Tre, Kien Giang and Gia Lai. Annually, approximately 400'000 people in Vietnam are vaccinated against rabies after being bitten by a dog or cat.
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), see also rabies information sheet. 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 highly recommended.
VietnamPlus, 28.9.2022 | WHO, Rabies in Vietnam
The heavy monsoon rains, which have been ongoing since mid-July 2022, have affected many parts of the country, with 75% of all districts and more than 33 million people affected, most severely in Sindh and Balochistan provinces. More than 420'000 were forced to flee, at least 1'638 people died, and 12'865 were injured. Numerous houses, schools and roads were destroyed or damaged. Unprecedented highs of dengue fever and malaria (P. vivax and P. falciparum) have been recorded in the flooded areas, with hundreds of thousands of patients. Thousands of diarrheal cases and skin diseases were also recorded.
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.
Non-essential travel to affected areas should be avoided. Persons who are or will be involved in humanitarian missions should consult a specialist in tropical and travel medicine regarding vaccinations, malaria prophylaxis and other precautions prior to their mission.
TheNews Pakistan, 27.9.2022 | WHO, 17.9.2022 | MinuteMirror, 1.10.2022 | Reuters, 22.9.2022 | Reuters, 16.9.2022 | Open Access Government Pakistan, 17.9.2022 | UNICEF, 5.10.2022
Following the devastation caused by Hurricane Fiona, 72 suspected cases of leptospirosis have been reported to date.
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. Vaccination is not generally available.
Gobierno de Puerto Rico, 28.9.2022
As of 5 October 2022, there have been 63 confirmed and probable cases of Ebola virus disease in Uganda, including 29 deaths, according to WHO data. At least 10 health workers have contracted Ebola and four have died. 

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.

WHO, 26.9.2022 | WHO TWITTER, 6.10.2022
The 15th EVD outbreak in the Democratic Republic of Congo - ended on 27 September 2022, 42 days after the burial of the outbreak's only EVD victim.
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.
ReliefWeb, 27.9.2022
According to the report of the Judicial Committee, 21 people have already died of rabies in Kerala this year. In addition, 196'000 dog bites in humans have been documented. Six deceased had not received post-exposure prophylaxis (PEP) against rabies. In 2019, there were 289'000 stray dogs in Kerala.
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), see also rabies factsheet. 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 highly recommended.
East Coast Daily, 25.9.2022
According to the Ministry of Health, a total of 332 malaria cases have been reported in Costa Rica since the beginning of the year, with the North Huetar region the most affected with a total of 300 cases, followed by the Caribbean Huetar region. P. falciparum is the most common parasite.
 
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.
Optimal mosquito protection 24/7 (at dusk and at night against malaria, during the day against dengue, chikungunya and other arboviruses). In case of fever >37.5° C, malaria should always be considered and ruled out by blood test.
San Carlos Digital, 21.9.2022 | Ministerio de Salud Costa Rica, 1.9.2022
The number of cases is increasing because the original patient who was diagnosed with the disease was not diagnosed immediately, exposing other people to the virus. In addition, the outbreak is occurring in areas with (illegal) gold mines and refugee camps, making it difficult to manage. The source of infection is unknown.
 
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.

WHO, 26.9.2022 | WHO TWITTER, 6.10.2022
For the first time, 4 cases of circulating type 1 vaccine-derived poliovirus have been confirmed in the Democratic Republic of Congo. The cases occurred in Haut-Lomami province. In addition, 28 vaccine-derived poliovirus type 2 cases have been confirmed in Bas-Uele, Maniema, South Kivu, and Tanganyika provinces, bringing the total number of cases in 2022 to 110, which is already significantly more than in the entire year 2021.

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).
GPEI, 14.9.2022
Ghana has declared the end of the Marburg virus disease outbreak that was confirmed in July 2022. It was the first outbreak of Marburg virus in the country. No new infections have been reported for 42 days. A total of three cases (including two deaths) have been confirmed in the Ashanti, Savannah, and West Ghana regions since the outbreak began on 7 July 2022.
WHO, 16.9.2022
According to media reports, in southern Ghana, the Ashanti Region Health Directorate reports an increase in human rabies cases in three districts in the region. As of 12 September 2022, a total of four confirmed cases and one probable case have been reported in the region. The cases are from Asante Akim South, Bosomtwe and Kwabre East.
Information about rabies and what to do in case of exposure is important for all 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 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.
Ghana News Agency, 15.9.2022
On 20 September 2022, the Uganda Virus Research Institute confirmed a fatal Ebola virus infection in a 24-year-old man from Mubende district in central Uganda. The national rapid response team had previously investigated six suspected Ebola deaths in the same district. There are currently eight suspected cases. The source is not known. This is the first time since 2012 that there has been an outbreak in Uganda with the rare "Sudan" strain of Ebola virus. In 2019, there was an outbreak of the "Zaire" strain of Ebola. The virus was imported from neighboring D.R. Congo, where a large epidemic was then raging in the northeast. To date, there have been seven known outbreaks of the "Sudan" strain of Ebola virus: four in Uganda and three in Sudan.

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.

WHO, 20.9.2022 | EMA, ERBEVO - Summary of Product characteristics | Health Policy Watch, 20.9.2022 | CIDRAP, 15.9.2022
Media reports from the Indian state of Kerala have described cases of "tomato flu" in young children. An investigation of 2 symptomatic children in the United Kingdom who had recently returned from Kerala with corresponding symptoms revealed that they had hand-foot-mouth disease (HFMD). HFMD is a common illness of young children with fever and rash mainly on the palms of the hands, soles of the feet, and in the mouth. The main causative agents are enteroviruses.
Optimal personal hygiene (often washing or disinfecting hands). Avoid touching your eyes, nose, and mouth. Clean and disinfect frequently touched surfaces and shared items, including toys and doorknobs. Avoid close contact with sick people.
The Pediatric Disease Journal, 19.8.2022 | CDC Prevention HFMD
According to the ministry's communicable disease control department, the number of cases of hand-foot-mouth disease (HFMD) has doubled compared to last year, with more than 26'000 cases reported nationwide by the end of July, significantly higher than the same period last year.
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.
Optimal personal hygiene (often washing or disinfecting hands). Avoid touching your eyes, nose, and mouth. Clean and disinfect frequently touched surfaces and shared items, including toys and doorknobs. Avoid close contact with sick people.
Thailand warns public to be cautious of dengue fever, hand-foot-mouth disease, 29.8.2022
Hand-foot-and-mouth disease cases rise to over 6,000 this year, 5.9.2022
The Philippine Food and Drug Administration (FDA) warns against counterfeit immunoglobulins against rabies (Equirab 200ml). Immune sera should only be purchased from FDA approved facilities.
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).
Considering the counterfeit immunoglobulins in circulation, travelers are advised to get vaccinated against rabies BEFORE traveling (2 doses). Avoid contact with animals and do not feed them.
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.
Philippines FDA warns of fake anti-rabies serum, 4.9.2022 | Philippines reports increase in rabies cases/deaths in 2022, 4.9.2022
A magnitude 6.6 earthquake occurred in Sichuan, China, on 5 September 2022, and the epicenter was located about 43 km southeast of Kangding. Most of the casualties and damage occurred near the epicenter in Luding County. Authorities reported at least 65 fatalities. Hundreds of people are cut off from the outside world. Nearly 250 houses collapsed and more than 13'000 were partially damaged. Power outages and interruptions to the water supply were also reported from the affected area.
Observe information from the authorities and the media.
China: Disruptions ongoing in Sichuan Province as of Sept. 6 following magnitude-6.6 earthquake
As of 5 September 2022, a total of 19 cases have been identified, including six deaths. Among the reported cases are eight health care workers (3 deaths) from a private clinic in the city of San Miguel de Tucumán. All cases occurred in the same health center.
Follow local indications. Other cases may still occur. In case of symptoms, especially coughing and shortness of breath, consult a doctor.

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).
Legionella identified as cause of cluster of pneumonia cases in Tucuman, Argentina. PAHO, 3.9.2022
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
A measles outbreak has been ongoing in Tanzania since June 2022. As of 23 August 2022, a total of 223 suspected cases have been reported. Almost half of the cases involved children under five years of age. Most cases are reported from Magharibi B, Magharibi A, and Wete districts (west coast of Zanzibar Island).
Any person born after 1963 who does not have documented protection against infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. This is also important for Switzerland! In case of an epidemic in the area or contact with a measles case, vaccination is recommended from 6 months of age.
WHO, EW 35
The Niger Ministry of Health has reported a case of dengue fever in Niger for the first time. The patient is a 47-year-old man from Niger who entered from Cuba on 13 August 2022. Numerous dengue cases are currently registered on this Caribbean island.
Optimal mosquito bite protection 24/7 (during the day against dengue, Zika, Chikungunya and other arboviroses). If you have a fever, take Paracetamol products and drink plenty of fluids. Do not take medications containing acetylsalicylic acid (e.g., Aspirin®), as they may increase the risk of bleeding. 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.
WHO Africa, 4.9.2022
In 2022, an increase in cases of typhoid fever has been registered in various provinces (especially Negros Oriental / Central Visayas). Nationwide, there have been 7'681 suspected cases so far this year, twice as many as last year.
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.
Philippines: Negros Oriental reports a near doubling of typhoid fever, 25.8.2022
DSWD-DROMIC Preparedness for Response Report #13 on the Typhoid Fever Cases in Region VII as of 11 July 2022
The heavy monsoon rains, which have been ongoing since mid-July 2022, have affected many parts of the country; 75% of all districts have been impacted, most severely in Sindh and Balochistan provinces. The floods have affected more than 33 million people; more than 420'000 have been forced to flee and more than 1'000 people have died as a result of the disaster so far.
Follow the advice of the media and authorities. Non-essential travel to affected areas should be avoided. Large floods usually increase the risk of mosquito-borne diseases and gastrointestinal epidemics.
WHO/EMRO Situation reports on the flooding in Pakistan, 30.8.2022
Nepal has been seeing a rapid rise in the number of dengue cases in the past few weeks. In Kathmandu Valley, hundreds of patients have been admitted into hospitals, and the number of cases diagnosed in hospitals has surpassed 1'000 - more than in the previous outbreak in the summer 2019. In Kathmandu, CIWEC Hospital and Travel Medicine Center has also been seeing increasing cases of travelers, expatriates, and locals with dengue fever in the past week.
Optimal mosquito protection 24/7 (during the day against dengue, Zika, Chikungunya etc). Travelers are advised to bring good quality mosquito repellents from their home country while traveling to Nepal as there is a shortage of good quality repellents.
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.
Nepali Times, 30.8.2022; pers. Communication P. Schlagenhauf
Nigerian authorities report 894 cases of Lassa fever in 25 states so far this year. Seventy percent of the confirmed cases are from Ondo, Edo and Bauchi states.
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.
Wash or disinfect hands regularly and maintain optimal food hygiene. Mouse-infested places should be avoided. Avoid contact with ill or deceased persons suspected of having Lassa fever.
OCHA Services, 27.8.2022
During the past few weeks, acute chikungunya infection was identified in 4 European travelers who had visited Bali. All 4 cases traveled to Bali as tourists between March and June 2022 and had the first symptoms either during the trip or shortly after returning to their home countries in Europe (the Netherlands, France, Germany, and Spain).
Optimal mosquito protection 24/7 (during the day against dengue, Zika, Chikungunya etc., at dusk and at night against malaria). In case of fever, paracetamol products and hydration. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®), as these may increase the risk of bleeding. After traveling to a malaria area, malaria should always be considered and ruled out by blood tests in case of fever.
David Hamer. GeoSentinel. Via ProMED, 19.8.2022
The Cuban Ministry of Health (Minsap) recorded 4'776 clinical cases of dengue fever in the third week of July, more than the 3'036 recorded in the entire first half of the year. The numbers are particularly high in Isla de la Juventud and in the provinces of Havana, Guantánamo, Camagüey, and Holguín. Since the beginning of the year, 29 confirmed cases in returned travelers to Europe have been reported.
Optimal mosquito protection 24/7 (during the day against dengue, Zika, Chikungunya etc). In case of fever, paracetamol products and hydration. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®), as these may increase the risk of bleeding.
Presentan en comisión de salud situación epidemiológica del país, 20.7.2022 | GeoSentinel, pers. communication
Several asylum seekers have contracted pharyngeal diphtheria at an asylum seekers' center - the first known cases in Switzerland in almost 40 years.
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.
There is no increased risk for the general population. Vaccination should be given to children at 2, 4, and 12 months of age and at ages 4 to 7 and 11 to 15 years. Additional booster vaccinations are recommended at ages 25, 45, and 65 years (i.e., every 20 years) and every 10 years thereafter. For high-risk persons, such as health care workers or contact persons etc., an interval of 10 years is recommended.
SwissInfo, 3.8.2022; BAG - Fälle von Diphtherie, 3.8.2022
On August 5, 2022, the Spanish Ministry of Health published two cases of Crimean-Congo hemorrhagic fever (CCHF) in Bierzo, in the province of León in the north of the country. The first case was a 49-year-old hunter with a known history of tick bites; his condition is stable. The second patient was a 51-year-old man who worked in forestry. He died on June 19, 2022, and was diagnosed with CCHF postmortem on July 20, 2022. Between 2013 and 2022, a total of 12 cases (including 4 deaths) were confirmed in Spain.
 
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.
Tick protection through clothing and insecticides. Insect repellents should contain DEET. Also, avoid contact with blood and body fluids of animals or people with symptoms of infection in endemic areas. In the latter, gloves should be worn for tick removal.
ECDC, Crimean-Congo Haemorrhagic Fever; Infosalus, 8.8.2022; ECDC, Cases of CCHF (2022)
A case of yellow fever in a 67-year-old man has been confirmed in Pará de Minas, Minas Gerais state. Since the patient is a person who travels a lot, the location of the infection is unknown.
Vaccination against yellow fever is strongly recommended for all stays in Brazil.
Atualização Epidemiológica – Febre Amarela, July 2022
On July 23, 2022, the WHO Director-General declared the spreading global outbreak of monkeypox a Public Health Emergency of International Concern (PHEIC). According to the U.S. Centers for Disease Control and Prevention (CDC), a total of more than 25'000 cases have been reported to date in 76 non-endemic countries. The U.S. has the highest total with 6'325 cases, followed by Spain, Germany and the United Kingdom. In the past week, five deaths were recorded in non-endemic countries: two in Spain and one each in Brazil, Peru and India. The two fatal cases in Spain were unrelated and occurred in previously healthy men aged 31 and 44 years who died of encephalitis. According to the WHO Director-General, about 10% of infected persons are hospitalized for treatment of pain symptoms.
 
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.
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.
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: Epidemiological update: Monkeypox multi-country outbreak, 15.6.2022
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
Delhi: In the capital, 169 dengue cases were registered by July 30, the highest number in the city since 2017. In addition, 33 malaria infections were reported.
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.
Optimal mosquito protection around the clock (at dusk and at night against malaria, during the day against dengue and other arboviruses). In case of fever, paracetamol preparations and hydration. Do not take medications containing acetylsalicylic acid (e.g., Aspirin®), as they may increase the risk of bleeding. Malaria should always be ruled out in cases of fever.
WION News, 1.8.2022; The Hindu; Mid-day, 27.7.2022
The Florida Department of Health in Miami-Dade County is warning of dengue infections after dengue was confirmed in one resident. This is the second local case this year. Dengue cases have also been reported in Miami-Dade in previous years.
Optimal mosquito protection 24/7 (during the day against dengue, Zika, Chikungunya, etc.). In case of fever: paracetamol products and hydration. Do not take medications containing acetylsalicylic acid (e.g., Aspirin®) as they may increase the risk of bleeding.
Florida Department of Health, 29.7.2022
The Santa Fe Health Department in Argentina confirms cases of trichinellosis. An outbreak with five cases was reported from the area of Granadero Baigorria and another outbreak with 35 cases was registered in the department of General López (various towns: Venado Tuerto, Wheelwright, Hughes, San Gregorio and Rufino). The source is unknown, mostly homemade sausages. Trichinella infections are frequently reported in Argentina.
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.
Refrain from consuming artisanal or non-certified sausage. Cook pork and game well before consumption. Trichinae are killed by heating above 70°C (>1 min). Smoking, curing, and drying are not safe measures to kill larvae.
La Tribuna del Sur, 22.7.2022; Santa Fe Provincia, 21.7.2022; Argentina.gob.ar
The Ghana Health Service reported a third and fourth suspected Marburg virus case (wife and child of the index case). The child died on 21. July 2022. Local tests were positive, and results from the Pasteur Institute are pending. Forty contacts remain under surveillance, including 11 health care workers.
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.
Avoid contact with sick people and eating bushmeat or bats. Avoid caves that may harbor bats. See a doctor if you have a fever, also to rule out malaria.
REUTERS, 27.7.2022; Vidal France, 26.7.2022; Graphic Online, 24.7.2022
Since the start of the 2022 transmission season and through the end of July, EU/EEA countries have recorded 55 human West Nile fever infections in Italy (42), Greece (12), and Slovakia (1), and five deaths in Italy.
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.

ECDC/CDTR EW 30, 24-30 July 2022
According to the Ministry of Health, there have been 157 rabies-related deaths in the country since the beginning of the year. 119 victims had not received post-exposure prophylaxis (PEP). Many were infected from their own unvaccinated pets. The regions with the most cases are Central Luzon, followed by Calabarzon, Western Visayas, and Davao/Mindanao.
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.
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!
DOH reports 5% drop in rabies cases in first half of 2022
The 20 cases (3 deaths) of a previously unknown disease from the Lindi area in southern Tanzania have now been identified as leptospirosis.
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.
Wear protective clothing/boots when wading through water! No vaccination is available for travelers.
Tanzania confirms outbreak of leptospirosis, 18.7.2022
One case of circulating poliovirus type 2 has been reported in Tamanghasset, Algeria. The virus is associated with cases in Zamfara, Nigeria, and had not previously been detected in Algeria.

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.

GPEI, 13.7.2022
To protect your health, your family, and others, FDRE Ministry of Health, Ethiopian Public Health Institute (EPHI) requires you to complete this form before boarding and present the hard/soft copy of the certificate/QR code or google form response summary to the health desk at arrival. The form is available at: LINK. Your information will be held confidential and used only for public health purposes.
A Zika infection was diagnosed in 5 tourists from Germany, Israel, and the United Kingdom who had recently returned from Thailand. They visited the following areas: Phuket, Phi Phi Island, Koh Samui, Khao Lak, Bangkok, and Chang Mai. The country is not classified as an area with a current outbreak at this time (see CDC map).
Optimal mosquito protection around the clock (during the day against dengue, Zika, Chikungunya, etc., at dusk and at night against malaria). In case of fever, paracetamol supplements and hydration. Do not take acetylsalicylic acid-containing medications (e.g., Aspirin®), as they may increase the risk of bleeding. During stays in malaria areas, a differential diagnosis should always be made in case of fever in order to exclude malaria. Detailed recommendations on Zika can be found here.
Geosentinel via ProMED, 4.7.2022
Since the beginning of the year, the Costa Rican Ministry of Health has reported 256 cases of malaria. The trend has been increasing for 5 years. The three regions with the most cases are Huetar Norte with 226 cases, Huetar Caribe with 22 cases and Central Pacific with 8 cases.
Protect yourself optimally around the clock (24/7) against mosquito bites (see factsheet mosquito and tick bite protection): at dusk and at night against malaria, during the day against dengue and other arboviruses. 
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)!
Ministerio de Salud Costa Rica, 30.6.2022

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.

Avoid contact with sick people and the consumption of bushmeat or bats. Avoid caves that may contain bats. Consult a doctor if you have a fever, also to exclude malaria.
WHO, 7.7.2022

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.

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.

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: Epidemiological update: Monkeypox multi-country outbreak, 15.6.2022
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
As of June 24, 2022, the Florida Department of Health confirmed 13 cases (2 deaths) of Vibrio vulnificus infection. In 2021, Florida reported 34 cases and 10 deaths. Vibrio vulnificus is a bacterium that normally lives in warm seawater. Infections with Vibrio vulnificus are rare. If saltwater is swallowed or shellfish or mussels are eaten, the bacteria can be ingested and lead to gastroenteritis. If the bacteria enter the body through small skin lesions (e.g., injuries to coral or fish spines), there is a risk of fulminant sepsis, especially in immunocompromised individuals or those with chronic liver or kidney disease, diabetes, or iron storage disease. The bacterium is inactivated by cooking or freezing.
  • 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.
Florida Health, Vibrio vulnificus
An outbreak of meningococcal serogroup C disease in gay and bisexual men is reported in Florida, USA. So far, 24 cases and 7 deaths have been reported.
In response to this outbreak, the U.S. Centers for Disease Control and Prevention (CDC) recommends gay, bisexual, and other men who have sex with men to get vaccinated against meningococcal disease (MenACWY) if they live in, or travel to, Florida. CDC also stresses the importance of routine MenACWY vaccination for people with HIV.
CDC Assists with Meningococcal Disease Outbreak Investigation in Florida, 22.6.2022
Florida Department Of Health In Orange County Advises On Meningococcal Disease and Vaccines in Florida, April 2022
CDC Meningococcal Disease in Florida, 2022
Since the beginning of 2022, there have been 1'715 cases and 73 deaths of monkeypox reported from eight endemic and two non-endemic countries in the African Union. According to WHO, these countries are Benin, Cameroon, Central African Republic, Republic of Congo, D.R. Congo, Ghana, Nigeria, and South Africa. From February 2020 until today, 12'141 cases and 363 deaths of monkeypox have been documented in Africa. The number of cases continues to increase in Africa.
Good personal hygiene. Avoid close contact with sick people at all costs. Also avoid contact with people who have skin or genital lesions. Avoid contact with contaminated materials used by sick people. Contact with sick animals should also be avoided. During stays in West and Central Africa: Do not consume bushmeat.
Africa CDC, 27.6.2022
Heat waves can have significant impacts, including an increase in heat-related deaths. They are among the most dangerous natural events, but rarely receive proper attention because resulting deaths and damage are not always immediately visible. From 1998 to 2017, more than 166'000 people died as a result of heat waves, including more than 70'000 during the 2003 heat wave in Europe.
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.
WHO Heatwaves
WHO Public health advice on preventing health effects of heat
WHO Heat and Health
The "Pride Season" begins and events will take place all over the world. Participants will be primarily lesbian, gay (MSM), bisexual, transgender and queer (LGBTQ) people. It is important to take protective measures against sexually transmitted infections (STIs), including COVID-19 and other infections transmitted through close human-to-human contact, such as monkeypox, HIV, gonorrhea, etc.
MSM are at increased risk of monkeypox infection in non-endemic countries such as Europe or the USA, etc. Safer sex and abstinence from contact with infected persons are important.
CDC, 8.7.2022, CDC (factsheet), 8.7.2022, ECDC, 8.7.2022
Since the end of December 2019, there have been 535'143'050 reported cases of COVID-19 worldwide, including 6'328'694 deaths. In the EU/EEA, 1'112'088 deaths have been recorded. As of mid-June 2022, the total number of weekly reported cases in the EU/EEA increased by 9.2% compared to the previous week. The countries with the highest 14-day reporting rates per 100'000 inhabitants are: Portugal, Luxembourg, Iceland, Germany and France. 
Since the beginning of the year, 755'014 suspected cases of typhoid fever, including 376 deaths, have been reported in the Democratic Republic of Congo.
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.
WHO Bulletin on Outbreaks, EW 24
Since the beginning of the year, 555 clinical cases of yellow fever have been reported from all ten regions of Cameroon. In Uganda, 199 clinical cases were registered during the same period.
Vaccination against yellow fever is recommended for all travelers to these countries. It is mandatory for entry within 6 days from a yellow fever endemic area (also for airport transit there).
WHO Africa 5.6.2022, WHO EW 24
Since the beginning of the year, 17'497 dengue cases have been registered in Malaysia (10 deaths). This is an increase of more than 57% compared to the reported cases in the same period in 2021.
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.
WHO, 2.6.2022
More than 100 cases of anisakiasis have been reported in Japan, caused by fish contaminated with parasites. Mackerel, bonito and sashimi are most likely the source. People experience reactions such as severe abdominal pain and vomiting after eating contaminated fish. Several supermarkets have stopped selling fish products and closed the markets for fresh fish.
Do not eat raw or undercooked fish. Raw fish is a common dish in Japan and infections with Anisakis parasites are known.
Global Food Mate, 9.6.2022
So far this year, more than 13'000 cases of dengue fever have been reported in Singapore. The weekly number of dengue cases is expected to increase and reach another historic high. The start of the traditional peak of the dengue season is June.
Optimal mosquito protection 24/7: during the day against dengue, Zika, chikungunya etc. (see factsheet mosquito and tick bite protection). In case of fever: paracetamol products and hydration. 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).
NEA Singapore, accessed 7.6.2022
Malaria cases in the north-eastern Kavango East region of Namibia continue to increase. By the end of April 2022, the most affected district was Andara with 249 cases, followed by Rundu (146) and Nyangana (104). With the emergence of COVID-19, an increase in malaria cases has been observed worldwide.
Protect yourself optimally around the clock (24/7) against mosquito bites (see factsheet mosquito and tick bite protection): at dusk and at night against malaria, during the day against dengue and other arboviruses).
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).
The Namibian, 26.4.2022, WHO AFRO, 26.5.2022
Since the beginning of the year, a total of 7,394 Zika cases have been reported in the Americas region. The countries particularly affected are Guatemala, Paraguay, Brazil, El Salvador and Bolivia. Currently, none of the above countries is classified as an area where an epidemic is taking place (CDC map).
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). Detailed information on Zika can be found in the factsheet zika.
PAHO, accessed 7.6.2022

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

ECDC, 9.6.2022, WHO, 4.6.2022, others
Besides an increase in syphilis infections among men who have sex with men (MSM), the continuous rise since 2014 is attributed rather to heterosexual transmissions.
Follow Safer Sex practices at all costs! Sexually transmitted diseases are on the rise worldwide!
Via ProMED, 13.5.2022
An Israeli traveler contracted the Zika virus during a stay in northern Thailand. An English couple who had travelled to Thailand in March 2022 also contracted Zika. They had visited Phuket, some islands and an elephant sanctuary.
The spread of Zika is known in Thailand.
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). Detailed information on Zika can be found in the factsheet zika.
GeoSentinel Personal Communication
News_HealthyTravel_22_05_20_Monkeypox.JPG

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

Since the beginning of the year, more than 7'300 dengue cases have been registered in Singapore, including 1'005 in the last week of April alone. Dengue is mainly transmitted by Aedes aegypti mosquitoes. In March 2022, the incidence of these mosquitoes in Singapore was about 48% higher than in the same period last year.
Optimal mosquito protection during the day, also in cities. In case of fever, take paracetamol products and drink fluids. Do not take medicines containing acetylsalicylic acid (e.g. Aspirin®), as these increase the risk of bleeding.
Outbreak News Today, 7.5.2022
According to media reports citing the Ministry of Health of São Tomé and Príncipe, more than 40 cases of dengue fever (30 of which were laboratory-confirmed) have been reported nationwide since 11 April 2022.
Dengue is also endemic in African countries, although the extent of its spread is unclear due to lack of surveillance and diagnostics. Optimal mosquito protection 24/7 (at dusk and at night against malaria, during the day against dengue and other arboviruses). In case of fever, malaria should always be considered and excluded by a blood test.
RFI, 23.4.2022
The number of measles cases reported globally increased by 79% in the first 2 months of 2022, to 17'338 cases, compared to the same period in 2021. WHO and UNICEF warn that ideal conditions prevail for severe measles outbreaks (and outbreaks of other vaccine-preventable diseases). Pandemic-related disruptions, inequalities in access to immunisation and the redistribution of resources have severely affected routine childhood immunisation in many places.
Measles are highly contagious and can lead to severe symptoms of the disease with a potentially fatal outcome, especially for immunocompromised patients. They can also cause serious secondary damage. Therefore, a medical consultation should always be used to also review the measles vaccination status: Persons born after 1963 who do not have documented protection against infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. When travelling to an epidemic area, vaccination is recommended for infants as early as 6 months of age.
WHO, 27.4.2022
A national state of emergency has been declared due to severe flooding and landslides that have caused devastating damage in KwaZulu-Natal and parts of the Eastern Cape.
According to the South African government, 435 people have died and over 48 are still missing as of 19 April 2022. In addition, more than 40'000 people have been displaced and thousands of homes destroyed or damaged, including health centres. Electricity and water supplies have collapsed.
Follow current information from the authorities and the media. Tourist travel to the affected areas is not advised. After large floods, the risk of mosquito-borne and gastrointestinal diseases usually increases.
WHO Afro, 24.4.2022