Travel Clinic London – Outbreak Summary 2013

Daily Travel Health Update’s for 2013 fromLondon Vaccination Clinic: Travel Clinic London: A summary of our travel health advice from 2013 into one post below for quick reference.


The first confirmed case of Polio has been reported in Kenya since 2011. The case originates North East of Narobi, in the Dadaab – near the Somalian border, where refugee camps are established. An emergency vaccination campaign is being planned in response. Polio is unfortunately on the rise again and travellers are reminded to ensure that they are up-to-date with their routine vaccination schedule including the combined Tetanus, Diphtheria and Polio vaccination.

India – Typhoid

More than 300 cases of Typhoid Fever have been reported in North Eastern India, in the Wagoora area of Barmulla, North Kashmir. Travellers to India should ensure they are adequately vaccinated before travel, either with injectable typhoid or oral typhoid (vivotiff) the vaccine can last up to three years, but immunity wanes over time, employ good hygiene practices and drink bottled water.

India – Rabies

Six cases of Rabies has been reported from regions in the North East of India. All cases resulted in death. Manipur state from where the cases originated is estimated to have 182,000 dogs. 80,000 dogs were vaccinated as part of control measures implemented by the state department, with 30,000 more planned. Travellers must be aware of the risks associated with the bite or scratch of a mammal in a rabies endemic country. A vaccination is available and commonly advised to travellers. Rabies is a very serious disease with a 100% fatality rate for people contracting the disease without vaccination. The vaccination is a course of 3 injections over 21-28 days.

India – Japanese Encephalitis

Cases of Japanese Encephalitis recorded in Kokrajhar in India. Japanese Encephalitis is a viral infection spreads from the bite of a mosquito mostly during the daylight hours. Bite avoidance such as using DEET 50% insect repellent and bed net use is essential. Japanese Encephalitis is a potentially fatal disease which causes inflammation of the brain. Many households in this region keep pigs which are the host for Japanese Encephalitis. June and July are peak transmission for the disease. Travellers are advised to consider vaccination if travelling to this area of India, and other rural areas.

India – Cholera

A total of 52 confirmed cases of Cholera reported from Mumbai in recent months. In the state of Orissa, in the Rayagada area, 90% of samples collected have been tested positive for the cholera bacteria. In Gujurat over 300 suspected cases have been confirmed in two villages Boria and Silvai in Petland tehsil. Travellers should take measures to ensure they are drinking only from reliable bottled water sources and following strict hygiene precautions. A vaccine is available before travel. A course of 2 doses taken 1-6 weeks apart. Cholera causes severe diarrhoea and vomiting that can be life threatening. It is extremely contagious and often originates from local population water sources.


There have been 16 deaths reported in Vietnam from Dengue Fever since June 2013, over 25,000 cases reported nationally which is an increase of 25% since the previous year. The most cases have been reported from the Phu Yen area north of Nha Trang, a very popular tourist destination on the East coast. Dengue Fever is transmitted by the bite of a mosquito more commonly in daylight hours. It is common in tropical and subtropical areas of the world including Vietnam. After an incubation period of about a week, those infected usually experience a fever (high temperatures) followed by other flu-like symptoms and a rash.

Dengue Fever usually clears up after about a week, however in some severe cases this will develop into Dengue Haemorrhagic Fever which results in bleeding and high blood pressure. If left untreated this can have a mortality rate of up to 40%, however with proper treatment fatality rates are around 1%-2%. Bite avoidance and prevention precaution must be taken which includes covering up exposed skin and using insect repellent such as DEET 50%. There is no vaccination fro dengue fever.

India – Dengue Fever

Over fifteen thousand cases of Dengue Fever have been reported in India at the start of August 2013, nearly double the number in the same period of 2012. To date there have been 56 deaths reported. The South of India has reported the highest numbers. Delhi has only confirmed 12 cases. Dengue Fever is a viral illness that is spread by mosquitoes in tropical and subtropical regions of the world including India. It causes flu-like symptoms in those infected including a high temperature (fever) and a rash. In most cases Dengue Fever clears up in about a week. However, some severe cases will develop into Dengue Haemorrhagic Fever which is characterised by high blood pressure and bleeding. If left untreated this can be fatal in around 40% of cases. However, with proper treatment mortality rates is around 1%-2%. There is no vaccination for dengue fever, travellers must protect themselves against mosquito bites whilst travelling in India, we recommend DEET 50% repellent spray which can be obtained at our clinics as well as making sure that they are properly covered with protective clothing and sleeping under a mosquito net.


A Spanish tourist who spent six weeks travelling in Thailand has contracted Japanese Encephalitis. The tourist was not vaccinated for Japanese Encephalitis and did not receive pre travel advice. Although Japanese Encephalitis is considered relatively low risk for travellers to Thailand, it is a very serious disease which can cause long-term neurological issues and can also be fatal in a third of those who contract the disease. There is a vaccine available – Ixiario a two dose course which will help protect travellers against this disease. Travellers are also advised to take measures to avoid getting bitten by mosquitoes including wearing DEET 50% insect repellent, sleeping under a mosquito net and covering any exposed skin with long sleeves and trousers.

India – Chikungunya

53 cases of Chikungunya Virus were reported in Thiruvananthapuram city – Kerala, India in August 2013, nearly double from the previous month. Kerala is a very popular destination for travellers especially to the famous backwaters, where people can spend a number of days exploring the area on houseboats. Travellers to this area are advised to take mosquito avoidance measures. Chikungunya Virus is similar to dengue fever, symptoms include high temperature and severe joint pain, rashes, headache, nausea. It is a virus spread by the bite of a mosquito mostly during daylight hours. There is no treatment or vaccination. Bite avoidance and prevention is advised to all travellers. Use Deet 50% repellent during the days and cover extremities and sleep under a mosquito net.


Since May this year there have been over 40,000 cases of Dengue Fever reported in Brazil, a sharp rise on the numbers reported last year. Sao Paulo is reporting cases and Baixada Santista on the Southern Coast. Dengue Fever is an illness spread by mosquitoes in tropical and sub-tropical regions of the world. The mosquitoes that spread the disease bite mainly during the daytime and especially during dusk and dawn. Signs and symptoms of Dengue Fever are similar to the flu and include high temperature (fever) and a rash. In sever cases Dengue can develop into Dengue haemorrhagic fever which is a sudden change in blood pressure and bleeding. If left untreated this can be fatal in around 40% of cases but is closer to 1%-2% if treated properly. Travellers must take bite prevention measures to avoid mosquito bites predominantly during daylight hours in the case of dengue fever. We recommend using DEET 50% repellent and bed nets.

Thailand – Dengue Fever

Since July 2013 there have been over 81,700 cases of Dengue Fever with 80 deaths confirmed across Thailand. The most prevalent area is Chang Mai in the North of the country with over 6,200 cases reported in the 2nd week of August 2013 alone. Dengue Fever is a viral illness that is spread by mosquitoes in tropical and sub-tropical regions of the world. After an incubation period of about a week it causes fever in those infected as well as a number of flu-like symptoms and rash. Most cases clear up after a week or so but some cases may develop into dengue haemorrhagic fever which causes a sudden high blood pressure and bleeding. Dengue haemorrhagic fever can be fatal and if not treated has a mortality rate of around 40% but is closer to 1%-2% if treated. Travellers must take bite prevention measures to avoid mosquito bites predominantly during daylight hours in the case of dengue fever. There is no vaccination for dengue fever, travellers are advised to take bit prevention measures. We recommend using Deet 50% repellent, sleeping under bed nets and wearing protective clothing including long sleeves and long trousers to avoid any exposed skin.

Middle Eastern Respiratory Syndrome

The World health Organisation has confirmed 18 new cases of MERS CoV infection in Saudi Arabia. This brings the total case number from initial reporting in September of this year to 132. The disease has a high case fatality rate with a total of 58 deaths so far to date. The majority of cases are originating in Saudi Arabia with one case being reported from Qatar.


There are reports of an increase in the number of cased of Measles being reported in the Philippines during 2013 including a number of deaths. Eduardo C. Janairo the Director of the Department of Health in Manila advised of the rise in cases of measles being reported in Manila as well as in other cities including Las Piñas, Muntinlupa, Caloocan, Manila, and Paranaque. Travellers are advised to ensure that they are up-to-date with all of their routine vaccinations including MMR (Measles, Mumps and Rubella). Please speak to one of our travel nurses for further information and a thorough risk assessment prior to your departure.

South Africa

A male in his twenties has reportedly been infected by the Rabies Virus in South Africa and sadly died in October 2013. The report was made from Msogwaba in Mpumalanga Province to the west of Johannesburg. This area is reportedly a high at risk area for rabies, with seven people contracting the virus since 2008. Mpumalaga is a popular destination for tourists travelling to Kruger National Park. Travellers are advised to have a full risk assessment prior to their travels to South Africa to assess their risk to contracting this and other deadly diseases. Contact with mammals, especially dogs should be avoided. Any animal bites need to be reported immediately for assessment.


Almost 1000 cases of Chikungunya Virus have been reported in Singapore this year. According to The Straights Times the outbreak is mainly centred around the industrial area of Sungei Kadut and Bukit Timah Road. The Chikungunya Virus is spread to humans by infected mosquitoes and symptoms include high fever, headache, nausea, stiffness and sore joints. It is most common in lush tropical areas that provide good breading grounds for mosquitoes. Travellers to Singapore are advised to take mosquito avoidance measures, especially during dusk and dawn, including avoiding bites by using insect repellents such as DEET 50%, sleeping under mosquito nets and wearing long sleeves and trousers.


The World Health Organisation is reporting over 6,000 incidents of Measles in Indonesia during 2013. A number of tourists have been diagnosed with measles after returning from their journey. Travellers are advised to ensure that they are fully up to date with their routine vaccinations prior to travel to Indonesia, including Bali and Borneo.

For further information and travel health advice, please contact one of our travel nurses at either of our Travel Clinics in London.