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Don't let anything spoil your trip. The adventure of your travel should come from being well prepared, not from the lack of it.

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AVIAN INFLUENZA in CAMBODIA, CHINA, EGYPT, INDONESIA, VIETNAM

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March '10- In Cambodia 9 cases and 7 deaths have been confirmed to date. In China 7 cases and 4 deaths were confirmed in 2009. In Hong Kong the 7th case of H9 viruses were found in humans. These H9 infections occurred in 1999, 2003, 2007, 2008 and 2009. Infection in humans is rare and appears to present as a mild disease. In Egypt the number of cases confirmed since the beginning of 2006 is 104, so far 30 have been fatal. In 2009 alone 39 cases and 4 deaths were reported. In Indonesia 163 cases have been confirmed to date, with 135 of them being fatal. In Vietnam 112 cases and 58 deaths have been confirmed to date. Avian influenza viruses do not normally infect humans. However, there have been instances of certain highly pathogenic strains causing severe respiratory disease in humans. In most cases, the people infected had been in close contact with infected poultry or with objects contaminated by their faeces.

CHIKUNGUNYA in INDIA, INDONESIA, MADAGASCAR, MALAYSIA, MALDIVE ISLANDS, MYANMAR, REUNION ISLAND, SINGAPORE, THAILAND

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March '10- In Indonesia (Lampung) almost 20,000 cases were reported from January to February [2010]. In Malaysia more than 5044 cases were reported in 2009. The latest outbreak in Madagascar has spread rapidly since mid-February 2010; there have been 1507 cases reported. In the Maldive Islands 3 confirmed cases have been documented since 2006. In Myanmar (Burma) chikungunya has been spreading rapidly. In Thailand 123 cases have been reported in 13 provinces so far this year. In India cases have been reported from most districts. In Tamil Nadu 63 cases have been confirmed and more than 100 cases in the South Goa district have been reported. In Saint-Gilles-Les-Bains, a tourist zone of Reunion Island [Indian Ocean], 4 cases were confirmed between 18 Jul 2009 and Aug 2009. In Hanoi Vietnam 6750 people have been admitted to hospitals since the beginning of 2009. Chikungunya occurs during the rainy season in parts of Africa, Southeast Asia, southern India, and Pakistan. Chikungunya fever is a disease caused by a virus that is spread to people through the bite of infected mosquitoes. Symptoms can include sudden fever, joint pain with or without swelling, chills, headache, nausea, vomiting, lower back pain, and a rash. Travelers should use mosquito nets when sleeping and apply mosquito repellents.

CHOLERA in AFGHANISTAN, ANGOLA, BENIN, DEMOCRATIC REPUBLIC OF THE CONGO, ETHIOPIA, IRAQ, KENYA, MOZAMBIQUE, NAMIBIA, NEPAL, NIGER, NIGERIA, PAPUA NEW GUINEA, SENEGAL, SOUTH AFRICA, SUDAN, TANZANIA, THAILAND, ZAMBIA, ZIMBABWE

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March '10- In Afghanistan at least 673 cases and 28 deaths have been reported since July 2009. In Angola a total of 31 cases, which resulted in 1 death, were reported from October to December 2009 in the district of Ganda. In Benin 66 cases and 4 deaths were reported this year. The D.R. of Congo reports 5483 cases and 120 deaths to date. In Ethiopia cholera is killing hundreds of people in West Arsi, East Shewa, West Hararghe and North Shewa and Arsi zones. Iraq reports 892 cases and 11 deaths to date. In Kenya a total of 16 people were hospitalized this year. In Mozambique (Cabo Delgado) 966 cases and at least 13 deaths have been reported so far this year. Namibia reports 2168 cases with 13 deaths to date. Nepal had 301 deaths last year [2009]. Niger has had 13,276 cases with 6 deaths reported to date. In Nigeria (South Central) 78 have been hospitalized and 6 deaths have been confirmed in 2010 so far. In Papua New Guinea 1900 cases and about 40 deaths have been reported to date. Senegal has had 2231 cases with 12 deaths reported to date. South Africa reports 720 cases with 22 deaths to date. Sudan reports over 6000 cases and over 44 deaths to date. In Tanzania at least 60 deaths have been reported in the Mwanza Region since October 2009. In Thailand 80 cases have been reported since the beginning of 2010. Zambia has reported 264 cholera cases since October 2009. Zimbabwe has reported 156 cases and 5 deaths since September 2009. Follow the food and water precautions covered in the travel consultation.

DENGUE FEVER in AMERICAN SAMOA, ARGENTINA, ARUBA, AUSTRALIA, BARBADOS, BOLIVIA, BRAZIL, CAMBODIA, COLOMBIA, COSTA RICA, EL SALVADOR, FRENCH GUIANA, GUADELOUPE, HONDURAS, INDIA, INDONESIA, MALAYSIA, MEXICO, NICARAGUA, PUERTO RICO, SAINT MARTIN, SAINT BARTHELEMY, SRI LANKA, USA, VENEZUELA

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March '10- In American Samoa there has been a resurgence of dengue fever with 42 cases in January 2010. In Argentina 465 cases have been confirmed so far this year. In Aruba 612 suspected cases were reported in 2009. In Cairns Australia 900 cases were reported in 2009. In Barbados one death was reported from co-infection with pandemic influenza and dengue-3 in 2009. In Bolivia there have been about 532 suspected cases in 2010 so far. In Brazil (nationwide) since the beginning of this year there have been 12,666 cases and 8 deaths confirmed for the disease. In Sao Paulo state 2787 cases and 2 deaths have been reported this year. In the state of Mato Grosso (Brazil) 1346 cases, 26 of them reported as serious dengue cases, and 4 deaths have been reported so far this year. In Cambodia 11,652 cases and 37 deaths were reported in 2009. In Colombia 14,801 cases and 18 deaths have been confirmed this year. In Costa Rica 426 cases have been confirmed so far this year. In El Salvador there have been 1294 cases of classical dengue fever and 28 of DHF reported this year. In French Guiana more than 1200 cases have been recorded since December 2009. In Guadeloupe there has been a rapid rise in the number of cases clinically suggestive of dengue virus infections since the beginning of this year. In Honduras 87 cases and 1 death have been confirmed so far this year. In Gujarat India the total number of patients treated for dengue fever was 55 with 1 death reported in 2009. In Goa India 49 cases and 1 death were reported in 2009. In Indonesia (East Kalimantan) 2 people have died, and 176 others have been treated in hospitals since December 2009. In East Java Indonesia, 103 cases have been reported since the beginning of 2010. In West Java Indonesia around 90 cases were reported during the first 2 weeks of February 2010. In January about 170 cases were reported. In Malaysia 4579 cases were reported between last year and January 2010. In 2009 Jalisco Mexico reported a total of 4697 cases, of which 776 are the DHF form of the disease. In Nicaragua 180 confirmed cases have been reported this year. In Puerto Rico 210 cases have been confirmed since the beginning of this year. In Saint Martin and Saint Barthelemy the dengue epidemic continues. In Sri Lanka 6638 cases and 42 deaths have been reported since the beginning of 2010. In Key West Florida USA 20 cases of locally transmitted dengue were confirmed in 2009. In Venezuela 729 cases have been confirmed to date. Vietnam had more than 77,000 cases and 58 deaths confirmed last year (2009). Dengue fever causes the same symptoms as flu and other kinds of fever in the first 3 days and then developing in critical conditions such as hemorrhage, vomiting, or faster heartbeats.

EARTHQUAKE RELIEF in HAITI

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March '10- Volunteers traveling to Haiti to help with earthquake relief efforts should be aware and properly protected against diseases that arise after a disaster. Diseases such as Typhoid, Polio, Hepatitis A & B, Meningitis, Tuberculosis as well as Measles, Mumps, Rubella are increased. With water supplies being stalled and contaminated, the risks of waterborne disease outbreaks are likely. People who do not have a clear history of having had their routine childhood immunizations are at risk for vaccine-preventable diseases that are uncommon in the United States, but common in Haiti. The potential new mass of displaced persons could create crowded, unsanitary conditions that facilitate the spread of contagious infections. Haiti has the highest tuberculosis rate in the Americas, and health experts say it is about to drastically increase. In normal times, Haiti sees about 30,000 new cases of tuberculosis each year. There is risk of Dengue Fever and Malaria outbreaks as well. Malaria is endemic in Haiti. Thus, displaced persons living outdoors or in temporary shelters and thousands of emergency responders in Haiti are at substantial risk for malaria. So far, CDC received reports of 11 laboratory-confirmed cases malaria acquired in Haiti. Most patients with malaria will present with fever, chills, and headache. Dengue, another mosquito-borne infection, presents with similar signs and symptoms as malaria, along with severe myalgias.

HEPATITIS B in INDIA

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March '10- In Gujarat India there were 92 deaths reported, most between 15 and 45 years old. In the Sabarkantha district cases climbed to 43 with the report of 5 new deaths. From Modesa town and nearby villages 6 new cases of hepatitis have been registered to date.

JAPANESE ENCEPHALITIS in AUSTRALIA, BANGLADESH, CAMBODIA, CHINA, INDIA, INDONESIA, KOREA, LAOS, MALAYSIA, MYANMAR, NEPAL, PAPUA NEW GUINEA, PHILIPPINES, SINGAPORE, SRI LANKA, TAIWAN, THAILAND, VIETNAM

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March '10- Japanese encephalitis is the leading cause of viral encephalitis in Asia with 30-50,000 cases reported annually. In the Uttar Pradesh state of India there were around 4000 cases of Japanese encephalitis and acute encephalitis syndrome reported last year (2009) and 567 deaths. In India's northern state of Bihar at least 30 deaths occurred last year (2009). In Assam 78 deaths have been reported in 8 districts since April(2009). According the the CDC, countries which have had major epidemics in the past, but which have controlled the disease primarily by vaccination, include China, Korea, Japan, Taiwan and Thailand. Other countries that still have periodic epidemics include Vietnam, Cambodia, Myanmar, India, Nepal, and Malaysia. 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.

MALARIA in CAMBODIA, DOMINICAN REPUBLIC, GEORGIA, INDIA, KENYA, SOUTH AFRICA

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March '10- In Cambodia 279 deaths occurred last year (2009) -- an increase of one-third on 2008. The Dominican Republic continues to have cases among both the local and tourist population (Punta Cana). In [the Republic of] Georgia 6 tropical malaria cases have been registered to date. In Mizoram India an estimated 119 deaths were reported in an outbreak between January and October last year (2009). Malaria transmission has increased on Mount Kenya. In the past 20 years, the average temperature on the mountain has risen by 2-degrees Centigrade, allowing the disease to crop up in the higher altitude areas, with the local population having no or little immunity to the disease. In Limpopo South Africa more that 947 people have been diagnosed with malaria since the start of the rainy season, and numbers are expected to soar. Tropical malaria manifests with flu-like symptoms and high fever. The CDC is recommending prophylactic anti-malarial medications as well as mosquito repellents containing DEET on exposed skin and Permethrin on outer clothing, mosquito netting and bedding.

MEASLES in ANGOLA, AUSTRALIA, BOSNIA, BURKINA FASO, ENGLAND, IRELAND, NAMIBIA, NIGERIA, PHILIPPINES, SOUTH AFRICA, ZIMBABWE

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March '10- In Angola at least 99 cases of measles were diagnosed between July 2009 and Aug 2009. Victoria, Australia experienced its largest measles outbreak in years in February 2009; 12 cases total were reported. In Western Bosnia 161 cases were reported in 2009. In Burkina Faso a measles outbreak infected more than 19,000 people, with 150 deaths reported between January 2009 and April 2009. In England 99 cases had been reported last year [2009], and more than 100 suspected cases were being investigated. In Ireland, since January 2009, over 60 cases of measles have been reported nationally. In Namibia there have been 1081 cases and 13 deaths reported. In Nigeria 25 deaths have been confirmed. The Philippines have already recorded a total of 669 cases this year. In South Africa, the number of measles cases in Western Cape has increased dramatically, and now stands at 447. In Eastern Cape there have been 314 total cases and 3 deaths. More than 100 cases of measles had been reported in Cape Town since October [2009]. In Zimbabwe 10 infants have died of measles since the beginning of this year. An estimated 1052 cases have been reported countrywide although confirmed cases number only 161. At least 41 people have died from the disease. Vaccination with MMR is recommended at least 2 weeks prior to traveling to these regions. It is recommended that you receive an adult booster if you haven't had measles and you have only had your childhood immunizations.

MENINGITIS in BRAZIL, CHAD, INDIA, NIGERIA, RUSSIA, SUDAN, UGANDA, USA

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March '10- In Bahia Brazil 2218 cases and 138 deaths were reported to the Directorate of Health Information by the Secretary of Health of the State as of 10 Dec 2009. In Southern Chad 517 cases and 56 deaths have been reported in only a two week period. More than 40,000 people have been vaccinated and the situation is now under control. The Ministry of Health of the Federal Republic of Nigeria has reported 5323 suspected cases, including 333 deaths. In India, at least 257 people have died in the north eastern states of Tripura, Meghalaya, and Mizoram. A recent outbreak of meningitis in Southern Sudan has infected more than 11,786 people, killing 704. In Russia an outbreak of serous meningitis has occured in the Chelyabinsk Oblast. Since the beginning of this year [2009] 200 preschool children have fallen ill with this disease. Vaccination prior to travel is recommended for travelers to these areas.

MUMPS in CANADA, MACEDONIA(FYROM), MOLDOVA, UNITED KINGDOM, USA

03/11/2010 11:29 AM

March '10- In Israel 600 cases of mumps have been reported in the Jerusalem district and over 850 nationally in Israel. In England there were 315 confirmed cases in Greater Manchester in 2009, compared with 36 in 2008. Across Cumbria and Lancashire the number rose from 97 to 341 confirmed cases and in Merseyside and Cheshire the numbers rose to 304 from 111. In Macedonia-FYROM (Former Yugoslav Republic of Macedonia) there were 234 cases of mumps reported. Canada reports 200+ cases in the Fraser Valley. America's largest mumps outbreak in years, continues to spread in suburban New York. So far 2336 cases have been reported. Mumps is caused by a virus that usually spreads through saliva and can infect many parts of the body, especially the salivary glands. It can lead to inflammation and swelling of the brain and other organs. It can cause deafness and leave men sterile. It is recommended that you receive an adult booster if you haven't had mumps and you have only had your childhood immunizations.

POLIO in AFGHANISTAN, ANGOLA, BENIN, BURKINA FASO, CAMEROON, CHAD, CONGO, COTE D'IVOIRE, GUINEA, HAITI, INDIA, KENYA, MALI, NAMIBIA, NIGER, NIGERIA, PAKISTAN, SUDAN, TOGO, UGANDA

03/11/2010 11:29 AM

March '10- 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. Adults should receive a one-time polio booster and all children should be current with their vaccinations prior to traveling. In Afghanistan 1 case has been reported so far this year. The total number of cases for 2009 was 38. In Angola 29 cases were confirmed in 2009. In Kenya there were 18 cases total in 2009. In Burkina Faso 15 cases were confirmed in 2009. In Benin 21 cases were confirmed in 2009. In Chad 66 cases were confirmed in 2009. In Cote d'Ivoire 27 cases were confirmed in 2009. In Guinea 41 confirmed cases were reported in 2009. In India 724 cases were confirmed in 2009. In Liberia 11 cases were confirmed in 2009. In Nigeria 388 cases were confirmed in 2009. In Pakistan a 9-month-old child is the 1st polio case this year. In Uganda 8 cases were confirmed in 2009.

RABIES in ANGOLA, BRAZIL, CHINA, INDIA, INDONESIA, RUSSIA, THAILAND, USA, VIETNAM

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March '10- In Luanda Angola 93 children died in the beginning of 2009. A Brazilian boy died (in January 2009), this brings the numbers of patients to at least 3 who received treatment and died. China averages more than 2400 deaths from rabies infections annually. Indonesia (Bali) reports 25 deaths due to bites from wild dogs since the outbreak started in 2008. Since November 2008, a total of 31,000 dog bite injuries have occurred in Bali with 28,000 people being given anti-rabies serum. There is a shortage of vaccine. Consequently, travelers to Bali should vaccinate prior to departure. Otherwise, if bitten, they will need to fly home, or to an Asian center such as Bangkok, Singapore, or Hong Kong to get proper post-exposure treatment. In Israel (Galilee & Golan) 11 cases have been reported since the beginningof this year. So far this year at least 14 people in Moscow have been bitten by a rabid dog. In Thailand 6 people have died from rabies so far this year. Vietnam reports 81 dead in '08 and 5.9 million exposure cases over the past ten years. Travelers to these areas should consider the pre-exposure rabies prophylaxis vaccination series. World wide there are approximately 55,000 deaths per year.

SCRUB TYPHUS in INDIA

03/11/2010 11:29 AM

March '10- Scrub typhus, a disease caused by the bites of ticks or mites [usually mites, also called "chiggers"], has claimed 5 lives in Meghalaya India and affected more than 80 people, particularly in the rural areas of the state. Soon after the bite of the mites or ticks, the patients develop fever. The portions where the mites or ticks bite initially become reddish and then change into black spots. It is important to apply repellents containing permethrin and/or deet when in rural areas.

SWINE FLU in WORLDWIDE PANDEMIC

03/11/2010 11:29 AM

March '10- The Pandemic Level is currently a 6 out of 6. Worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15,292 deaths. WHO says the actual death toll is probably much higher. Though 2,498 confirmed American deaths had been reported to the CDC as of January 30, the agency estimates that between 8,330 and 17,160 people have actually died. Due to the circulation of 2009 H1N1 influenza in the United States and many other countries, airport staff in some foreign countries may check the health of arriving passengers. If you are sick with symptoms of flu-like illness, you should not travel. In other countries that are conducting entry screenings, travelers may be checked for fever and other symptoms of H1N1, and their travel may be delayed. Consult the embassy of the country, or countries, in your travel itinerary for information about entry screening procedures. These outbreak-related delays, which could include several days of quarantine, may affect planned activities and lead to unexpected costs. Swine Influenza is a respiratory disease of pigs caused by type A Influenza Viruses. There is no evidence to show that swine flu can be transmitted through food. Eating properly handled and cooked pork and pork products is safe. Travelers should receive an H1N1 vaccine.

TYPHOID FEVER in FIJI, INDONESIA, NEPAL, PAKISTAN, UGANDA

03/11/2010 11:29 AM

March '10- In Fiji the typhoid outbreak continues to rise, bringing the total number of cases to 112. The Centre for Health Protection urges travelers to Indonesia to guard against typhoid fever due rising cases of the disease in people arriving from the country recently. In Nepal 40 Israeli travelers who were traveling in the [Russian] Far East became ill with Typhoid Fever. Pakistan currently experience 1000 cases of Typhoid Fever per 100,000 of population per year. Uganda reports 90 cases with 20 dead in the Kasese area since July '08. 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.

WEST NILE VIRUS in CANADA, ITALY

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March '10- Two people in British Columbia Canada contracted West Nile virus in Aug 2009. The two people had travelled only within the Okanagan. In Italy 16 human cases of West Nile neuroinvasive disease (WNND) were reported in 2009, in the 3 regions: Veneto, Emilia-Romagna, and Lombardy. The geographical distribution indicates spread of the West Nile virus from east to west. People over 50 and those with a weakened immune system are more likely to be more seriously affected by West Nile virus. A new study shows that people who have been infected with West Nile virus may have persistent virus in their kidneys for years after initial infection, potentially leading to kidney problems.

YELLOW FEVER in BRAZIL, CAMEROON, CENTRAL AFRICAN REPUBLIC, COTE D'IVOIRE, LIBERIA

03/11/2010 11:29 AM

March '10- In Brazil, at least 4 cases of yellow fever were confirmed in Rio Grande do Sul in 2009. In Sao Paulo state, 25 cases and 9 deaths were reported in 2009. In Cameroon 3 cases of yellow fever in Banjoun and Fantun districts of the country's Western Region were reported last month (February 2010). Central African Republic [CAR] have reported 4 suspected cases of yellow fever, including 3 deaths. In Cote d'Ivoire's northern province of Ordienne local health officials have reported 37 suspected cases and a total 21 deaths since the disease was detected in November 2009. The WHO and Ivorian authorities have declared an epidemic in the Denguele region (in the far north, bordering on Mali) with 36 suspected cases and 19 deaths. In Liberia the total number of confirmed cases was 2 including 1 death in 2009. 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.