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JAPANESE ENCEPHALITIS in INDIA - September '08 -- There have been 254 deaths and 1510 cases in children up to 15 years of age since June of 2008 in the Uttar Pradesh state. Travelers are encouraged to consider JE vaccination prior to travel and to use mosquito repellents containing DEET on exposed skin and Permethrin on outer clothing.

YELLOW FEVER in COTE D'IVOIRE / ECUADOR / TANZANIA / PERU / ARGENTINA / PARAGUAY / BRAZIL / CAMEROON / SUDAN - September '08 -- Cote D'Ivoire reports 19 cases since Aug. '08, Ecuador, the CDC recommends a Yellow Fever vaccine in the following areas; Amazon Basin, Morana-Santiago, Napo, Orellana, Pastaza, Sucumbios, and Zamora-Chinchipe. Tanzania has just re-instated a requirement for Yellow Fever Vaccination prior to entry into the country as of 21 Apr. 2008. Peru reports 20 cases and 3 deaths in the Amazonas & Picota Departments so far this year. Argentina has one death and 6 confirmed cases in the Misiones province. In Paraguay there have been 24 cases and 8 deaths since the beginning of 2008. Brazil has 112 confirmed cases and 55 deaths so far in 2008, the government of Brazil is recommending all travelers to; Brasilia DF, or the states of Maranhao, Piaui, Minas Gerais, Bahia, Espirito Santo, Sao Paulo, Parana, Santa Catarina and Rio Grande de Sul; get the Yellow Fever vaccine prior to travel. Yellow Fever is a mosquito born disease found in Sub-Saharan Africa and the Amazon region of South America. This disease can be prevented with vaccination. Anyone traveling to a yellow fever zone needs to be protected, so get vaccinated.

CHOLERA in IRAQ / GUINEA-BISSAU / CONGO / SUDAN / NAMIBIA / KENYA / DEMOCRATIC REPUBLIC OF THE CONGO / NIGER / SENEGAL / ANGOLA - September '08 -- Iraq reports 500 cases and 8 dead in the Babil Province. Guinea-Bissau reports 3915 cases with 90 dead and a declared country wide epidemic during July and August of '08. The Congo reports 630 cases and 26 dead in '08. Sudan reports over 6000 cases and over 44 deaths so far in '08. Namibia reports 2168 cases with 13 dead so far in '08. Kenya has had 1217 cases and 59 deaths so far in '08. The Congo, D.R., reports 5483 cases and 120 dead in the 1st 7 weeks of '08 with increasing numbers through to June. Senegal has had 2231 cases with 12 dead in '08. Niger has had 13,276 cases with 6 dead in '08. Angola has had 4500 cases with 150 dead so far in '08. Follow the food and water precautions covered in the travel consultations.

TYPHOID FEVER in PAKISTAN - September '08 -- Health officials confirmed a recent outbreak of Typhoid Fever in Pakistan where currently they experience 1000 cases per 100,000 of population per year. Travelers are encouraged by local health officials to get the Typhoid vaccine prior to traveling to these and other endemic regions and to exercise food and water precautions.

MALARIA in JAMAICA / MALAYSIA / INDIA / ANGOLA / DOMINICAN REPUBLIC - September '08 -- Jamaica reports its first case in St. Catherine this year. A new outbreak of 21 cases of P. vivax malaria has occured in Malaysia, Sarawak in the Bario highlands region (deep in the interior fo Sarawak). India reports 286,000 cases and 154 deaths so far in '08. Angola reports that since the beginning of '08, they have had 4992 cases of malaria and 117 deaths. The Dominican Republic continues to have cases among both the local and tourist population (Punta Cana). The CDC is recommending that travelers to malaria areas of the world take prophylactic antimalarial medications. Visitors should also use mosquito repellents containing DEET on exposed skin and Permethrin on outer clothing, mosquito netting and bedding.

MUMPS in CANADA / MOLDOVA - September '08 -- Canada reports 200+ cases in the Fraser Valley, mostly among a religious group that refuses vaccinations. Moldova reports an epidemic with more than 2000 cases so far in 2008 with most of those in the 12 to 19 year old age group. So, if you haven't had mumps and you have only had your childhood immunizations, you need a booster!

MEASLES in JAPAN / INDIA / SUDAN / FRANCE / USA / ENGLAND / AUSTRIA / SWITZERLAND / ITALY / GERMANY - September '08 -- Japan reports 9651 cases up to 22 June '08. India reports dozens of cases with 5 children dead in a very rural area of Jumma and Kashmir. Sudan reports 80 cases and 22 dead during mid-August '08. France reports 142 cases that originated in a holiday camp at Faye d'Anjou. The United States has had 127 cases in 15 states so far in '08. The United Kingdom declares Measles endemic to the country with 461 cases reported so far in '08, mostly due to poor vaccination rates in the preceeding two decades. Austria, Saltzburg area, 180 cases this year (2008) with cases being reported in the Bavaria area of Germany, usually in persons who were unvaccinated. Switzerland reports 414 cases and Italy reports large ongoing outbreaks in '08. Measles and Mumps outbreaks continue to be a problem in many areas of the world. Vaccination with MMR is recommended at least 2 weeks prior to traveling to these regions. So, if you haven't had the diseases and you have only had your childhood immunizations, you need a booster!

CHIKUNGUNYA in MALAYSIA / SINGAPORE / INDIA (Gujarat, Bangalore, Kerala) - September '08 -- Malaysia reports 1703 cases in the last week of Aug. '08. Singapore reports 117 cases so far this year. India reports over 70,740 cases in '08, a 19% increase over last year; healthcare experts are on red alert due to unusually high numbers of breeding mosquitoes. Chikungunya is a viral disease spread to humans by the aggressive daytime biting Aedes Aegypti mosquito. Travelers are advised to use insect repellents containing DEET for exposed skin and Pemethrin on outer clothing.

MENINGITIS in BRAZIL / SUDAN / INDIA - September '08 -- Brazil in the Sao Paulo area reports 29 cases in '08, twice as many as last year. A recent outbreak of meningitis in Southern Sudan has infected more than 11,786 people killing 704. Meningitis is endemic to most countries in Sub-Saharan Africa. This has been a long standing problem in India, especially in the Calcutta, Nadia and Murshidabad districts. Vaccination prior to travel is recommended for travelers to these areas. (Note: current vaccines are extremely effective.)

POLIO in CAMEROON / INDIA / NIGERIA / NAMIBIA / PAKISTAN / AFGANISTAN - September '08 -- There has been a dramatic increase in Polio in the central African countries this year and the WHO is warning all that this coming Haj to Saudi Arabia could present problems, so if you are going on Haj, be sure you have your Polio booster. WHO officials confirmed 25 new cases of paralytic polio in Cameroon. India confirms that the provinces of Bihar and Uttarakhand have experienced 331 new cases in '08. Nigeria reports 792 cases so far in 2008. Namibia had been polio free for 10 years until a recent outbreak involving 19 cases and 6 deaths. The Centers for Disease Control recommend a Polio booster for all adults going to Namibia. Pakistan reports 55 cases so far in '08 and Afganistan reports 17 cases so far this year. Polio is a highly contagious viral disease involving the brain and spinal cord that can cause paralysis within hours. Adults should receive a one-time polio booster and all children should be current with their vaccinations prior to traveling. New Guideline: Saudi Arabia now requires proof of current vaccination for all persons less than 15 years of age entering the country, including travelers for Hajj and Umrah.

RABIES in VIETNAM / INDIA / RUSSIA / ANGOLA / CHINA (Beijing/Shanghai) - September '08 -- World wide there are approximately 55,000 deaths per year. Vietnam reports 81 dead so far in '08 and 5.9 million exposure cases over the past ten years. Health officials in India continue to report thousands of dog bites and a lack if HRIG (a portion of the post exposure treatment) in most health care facilities. With nearly a million unvaccinated stray dogs and cats, Hunan Province, Beijing and Shanghai (China) are under a threat of a rabies epidemic. There have been 3380 deaths in China during 2007. Travelers to these areas should consider the pre-exposure rabies prophylaxis vaccination series.

TUBERCULOSIS in NAMIBIA / BOTSWANA / UGANDA / SOUTH AFRICA - September '08 -- Namibia reports 15,244 cases in 2007 with 254 cases of multi-drug resistant TB (MDR-TB) and 24 cases of extreme drug resistant TB (XDR-TB). Both Uganda and So. Africa have reported a disturbing appearance and spread of both MDR-TB and XDR-TB, 400++ cases in So. Africa alone, also, the spread of the disease from human to animals has been reported in August '08. The animals diagnosed so far are springbok, mongooses, baboons, chimpanzees, a Maltese poodle and dassies (a guinea pig like animal). Botswana now reports 2 cases of XDR-TB and 100 cases of MDR-TB for 2008. Be sure you are TB tested prior to and following your return from these areas.

HEPATITIS A in MEXICO - September '08 -- The state of Queretaro, Mexico reports 290 cases so far in '08 with a potential of 26,000 exposures.

PLAGUE in CONGO, D.R. / UGANDA - September '08 -- The Congo, D.R. reports 20 cases with 5 dead in the northeast region so far in '08. Uganda reports 160 cases with 19 dead in '08. This is a disease spread primarily through flea bites, so don't forget to use your insect repellents.

SCHISTOSOMIASIS in YEMEN - September '08 -- Yemen reports approximately 3 million cases per year, mostly in 6 to 18 year olds. This is a parasite found in fresh water. So follow the swimming rules, only in chlorinated pools or the ocean.

DENGUE FEVER in YEMEN / PERU / NEW CALEDONIA / VENEZUELA / INDIA / THAILAND / CAMBODIA / COOK ISLANDS / EL SALVADORE / COSTA RICA / HONDURAS / JAMAICA / BARBADOS / NICARAGUA / INDONESIA / MALAYSIA / BRAZIL / SINGAPORE / BURMA / PARAGUAY / TAIWAN / PAKISTAN / CUBA / PUERTO RICO / PHILIPPINES / VIETNAM / LAOS / SOUTH PACIFIC - September '08 -- Brazil is currently experiencing a Dengue Fever epidemic, primarily in the state of Rio de Janeiro where there are 230,860 cases and 512 dead, the rest of the country has experienced 473,000 cases with 49 deaths so far in 2008. Two of the more deadly forms of dengue fever and DHF (Den 2 & Den 3) have resurfaced in Malaysia with 29,942 cases and 71 deaths in '08. Record numbers of dengue cases are occurring globally in all tropical and sub-tropical regions; Yemen with 3000+ cases and 5 dead in '08, Peru with 10,318 cases in '08; New Caledonia with 320 cases and Fiji with 815 cases in '08; Mexico, 67,562 cases; Jamaica, 1770 cases, 50 in the past few weeks with 4 deaths; Barbados, 592 cases; Paraguay 28,000 confirmed cases and 13 deaths; Venezuela 100,000+ cases with 40+ deaths; Costa Rica with 25,000 cases and 8 deaths; Honduras with 29,112 cases and 15 dead; Puerto Rico with 2343 cases; Thailand 43,911 cases and 48 dead in '08; Philippines 19,658 cases with 195 dead in '08; Dominican Republic 6000 cases and 30 dead; Indonesia 14,729 + cases and 60 dead in '08; Singapore 2472 cases with 2 deaths; Taiwan, 511 cases; Burma with 8,445 cases and 98 dead; Vietnam with 36,900 cases and 33 dead and Laos with 1900+ cases and 18 dead so far in '08. Now the South Pacific region is experiencing epidemic levels, the countries involved include Fiji, Tonga, Kiribati, Palau, Somoa and American Samoa . Spread by the daytime biting Aedes Aegypti mosquito, there is no vaccine to prevent the disease. Visitors are strongly urged to use repellents containing DEET on exposed skin and Permethrin on clothing, bedding and mosquito netting and to wear light-weight long sleeve shirts and pants when outdoors.

MOSQUITO BORNE VIRAL DISEASES in AUSTRALIA, NEW SOUTH WALES - September '08 -- There has been a tremendous increse in the number of insect borne viral diseases in the tropical areas of New South Wales, Australia. There are no vaccinations for these diseases, so be sure to wear your insect repellents as directed.

HEPATITIS E in UGANDA / CHINA - September '08 -- Uganda reports 6000 cases with 98 dead so far this year with 175 new cases in the last few weeks of Aug. '08. Hong Kong reports 45 cases so far this year. Care with food and scrupulous hand washing is essential.

RIFT VALLEY FEVER in MADAGASCAR - September '08 -- Madagascar reports 418 suspected cases (59 confirmed) and 17 deaths so far in 2008. This disaese is spread via contact with blood or internal organs of infected animals either through ingestion, inoculation via openings in the skin, or through inhalation of aerosolized body fluids. Also, it can be spread by the bite of infected mosquitos or blood feeding flies. Remember, follow the safe food rules and always use your insect repellents as directed.

PNEUMONIA in NICARAGUA - During 2008 there have been 7000+ cases and 260 deaths with 302 cases reported in the first two weeks of August. Most of these cases are attributal to Influenza A (H1).

VISCERAL LEISHMANIASIS in INDIA - September '08 -- India reports 17,637 cases and 75 deaths so far in '08. This is a sand fly borne, parasitic disease acquired by a bite from the fly. So, be sure to use your insect repellents as prescribed.