China: Dengue Fever Update
Epidemiological News 10/24/2006
In southern China (primarily Guangdong Province), 502 cases of dengue were reported in September, 2006.
Consequences for the Traveler: All travelers to affected areas should take standard mosquito precautions during the day and night and in urban centers.
Ref.: ProMED-mail, no. 477, 10-24-06.


India and Indian Ocean Islands: Chikungunya Fever Update
Epidemiological News 10/24/2006
The outbreak of chikungunya fever in India, on-going since April, 2006, involves the following states: Andhra Pradesh, Andaman and Nicobar Islands, Tamil Nadu, Karnataka, Maharashtra, Gujarat, Madhya Pradesh, Kerala and Delhi. As many as 1.25 million cases may have occurred thus far, primarily in Karnataka and Maharashtra. Illness in other states is also being investigated. The large outbreak since March, 2005 on the Indian Ocean islands of Mayotte, Mauritius, Reunion and the Seychelles is waning.

Consequences for the Traveler: All travelers to affected areas should take standard mosquito precautions during the day and night and in urban centers.
Ref.: CDC Travelers' Health Outbreak Notice, 10-24-06, and WHO Disease Outbreak News, 10-17-06.


Nepal, India, Pakistan and Cuba: Dengue Fever Update
Epidemiological News 10/24/2006
New cases of dengue in southern Nepal have raised concern about spread of infection from northern India. As of October 8, 2006, 3407 cases have been reported from India, including 886 in Delhi. In Pakistan, there is a substantial, on-going outbreak of dengue in Karachi (1000 suspected cases), and reports from Cuba indicate current outbreaks in several provinces.

Consequences for the Traveler: All travelers to affected areas should take standard mosquito precautions during the day and night and in urban centers.
Ref.: ProMED-mail, no. 452, 10-16-06, and no. 477, 10-24-06.

Democratic Republic of the Congo (DRC): Plague Outbreak 10/23/2006
There is an apparent outbreak of pneumonic plague in Haut-Uele district, Oriental Province, DRC. As many as 626 suspected, not yet confirmed cases have been recorded. A previous outbreak occurred in a different district in Oriental Province in June, 2006.

Consequences for the Traveler: U.S. travelers seldom visit this regions. In general, the risk of plague infection in travelers is low, especially for those staying in hotels in cities, unless they are exposed to infected fleas of animals or to a patient ill with pneumonic plague.
Ref.: CDC Travelers' Health Outbreak Notice, 10-23-06, and WHO Disease Outbreak News,10-13-06.

Kenya: Poliomyelitis
Epidemiological News 10/19/2006
A case of polio has been reported in a young child from a Somali refugee camp in northeastern Kenya. The camp is in the region bordering an area of Somalia in which 216 cases of polio have been reported since July, 2005.
Consequences for the Traveler: CDC continues to recommend polio vaccination for all travelers to polio-endemic or epidemic regions which include Africa, South Asia, Southeast Asia and the Middle East. For previously immunized individuals who received a full, four-dose primary series, a single booster sometime as an adult is thought to confer lifetime immunity. For adult travelers who have not received a primary series (at least three doses of vaccine), immunization with inactivated polio vaccine (IPV) should be completed before travel. Live polio vaccine (OPV) is no longer manufactured in the U.S. Standard precautions should also be taken to avoid water- and food-borne infection.
Ref.: WHO Disease Outbreak News, 10-19-06.

Indonesia: Avian Influenza
Epidemiological News 10/16/2006
With three additional new cases, Indonesia has now recorded a total of 72 confirmed cases of human infection by avian influenza virus (H5N1) with 55 deaths.
Ref.: WHO Disease Outbreak News, 10-16-06.

WHO Web Sites on Infectious Diseases
Epidemiological News 10/13/2006
WHO has updated its list of web sites related to a wide range of infectious diseases.
Ref.: WHO Weekly Epidemiologic Record 2006; 81:396, October 13, 2006.

Egypt: Avian Influenza
Epidemiological News 10/11/2006

The first case of avian influenza (H5N1) since May, 2006 was recently reported by Egypt. To date, 15 cases have occurred in Egypt (6 deaths).
Ref.: WHO Disease Outbreak News, 10-11-06.

Fiji, India, Taiwan and Trinidad and Tobago: Dengue Fever Update
Epidemiological News 10/06/2006
The Health Ministry of Fiji has issued a dengue warning based upon recent, new cases. The last major outbreak of dengue fever on Fiji was in 1997-98 (24,000 cases). In India, 3000 cases have been recorded in 2006, including from the capital city, Delhi, and there is concern that the infection is spreading. In Taiwan, nearly 300 cases of dengue have been reported in 2006, mostly from the southern Kaohsiung region. Increased numbers of patients with dengue are also being reported from Trinidad and Tobago.
Consequences for the Traveler: All travelers to affected areas should take standard mosquito precautions during the day and night and in urban centers.
Ref.: ProMED-mail, no. 452, 10-6-06.

United States: Imported Chikungunya Virus Infection, 2005-06
Epidemiological News 09/29/2006
CDC has reported that 12 travelers arriving in the U.S. from regions known to be epidemic or endemic for chikungunya fever were diagnosed serologically and virologically in 2005-06 with this infection. The report summarizes several cases, reviews clinical and epidemiologic information and provides management guidance for U.S. clinicians faced with a traveler from a chikungunya-reporting region who has fever, headache, malaise, arthralgias or arthritis, myalgias and low back pain and skin rash (50% of cases). The report also indicates that public health officials should be alert to the possibility of secondary, local transmission if the virus is introduced through infection of local mosquitoes.
Ref.: MMWR 55:1040-1042, 29 Sept 2006.