South Africa

SOUTH AFRICA

NEW HIGH RISK MALARIA REGION IN SOUTH AFRICA – MARCH 2017

Areas with malaria: Present along the border with Zimbabwe and Mozambique. Specifically in Vembe and Mopane district municipalities of Limpopo Province; Ehlanzeni district municipality in Mpumalanga Province; and Umknanyakude in Kwazulu-Natal Province. Present in Kruger National Park. Note: As of March 2017, new recommendations are in place for parts of Gauteng, Limpopo, and North West Provinces. See travel notice and map at https://wwwnc.cdc.gov/travel/notices/alert/malaria-south-africa.

Estimated relative risk of malaria for US travelers: Low.

Drug resistance: Chloroquine.

Malaria species: P. falciparum 90%, P. vivax 5%, P. ovale 5%.

Recommended chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine.

CHIKUNGUNYA IN THE WORLD – JANUARY 16, 2015

TRAVEL HEALTH NOTICE

The first cases of infection with chikungunya have been reported in the Caribbean in December 2013. The disease has since significantly spread in the neighboring regions and in other areas in the world. In 2014, the number of travel-related infections of chikungunya has increased in Canada. Chikungunya is transmitted through the bite of a contaminated mosquito. The Public Health Agency of Canada advises thus the travelers intending to go to a country at risk to protect themselves efficiently against mosquitoes. 

WHAT IS CHIKUNGUNYA ?

Chikungunya is a viral mosquito-borne disease. The symptoms of chikungunya usually include a fever, arthritis-like joint pain and skin rash. The signs of chikungunya can sometimes be similar to those of dengue fever, but chikungunya is a completely different virus. There is currently no effective vaccine or specific treatment for chikungunya. 

WHAT ARE THE COUNTRIES AT RISK FOR CHIKUNGUNYA ?

Many areas in the Americas, in Africa, in Asia, in the Pacific Islands and on the Indian subcontinent are regularly affected by outbreaks of chikungunya. For more information concerning the evolution of the disease in the world, travelers can consult the website of the WHO. 

In the Americas and especially in the Caribbean islands, the local health authorities have reported several confirmed cases of chikungunya in December 2013. Local outbreaks have notably occurred in Central America, in South America, in Mexico and in Florida in the United States. More than one million of victims have already been infected (or suspected of being infected) with chikungunya within these regions since the beginning of the outbreaks. Eleven locally transmitted confirmed cases of chikungunya have been reported in Montpellier, in the South of France, during October 2014. New Caledonia, French Polynesia, Samoa, American Samoa and the Cook Islands are currently facing outbreaks of chikungunya. 

RECOMMENDATIONS FOR TRAVELERS

All the travelers intending to go to a country at risk for chikungunya are advised to see a doctor or to go to a travel health clinic six weeks before their departure.

While traveling, they ought to protect themselves efficiently against mosquito bites, especially during the sunset and the sunrise hours, as mosquitoes are more active during these periods. They must wear protective clothes like long pants and long sleeves, use insect repellents as well as insecticide aerosols and mosquito coils, and sleep under a mosquito net.

If they experience symptoms of chikungunya while traveling or after their return to their home country, travelers must see a doctor immediately and inform him/her of the countries they have visited. They should see preferably a physician specialized in travel medicine.

HAITI EPIDEMIC OF CHOLERA (OCT 2016)

Due to recent natural disasters (2016), there is currently an epidemic of cholera in Haiti. As such, the recommendations for pre-travel vaccination against cholera have been expanded to include all travelers:
 -who may potentially be exposed to unsanitary conditions
 -who may have difficulty to access clean water or adequate medical resources
 -with underlying gastrointestinal conditions or taking medications that may make them more susceptible to Cholera infection
Visit with one of our travel health professionals to see if these updated recommendations apply to you and to receive information on how to prevent and treat Cholera and various other travel-related illnesses.

MEASLES IN THE WORLD – JANUARY 29, 2015

TRAVEL HEALTH NOTICE

Measles is a highly contagious viral disease. It affects numerous people all around the globe and it is one of the major cause of death among children worldwide. Although the number of cases of measles has significantly decreased within the last 10 years, the disease is still spreading in some areas, especially in Africa and in Europe. Some countries in the Americas, like Canada, have been affected by outbreaks of measles after the virus was imported from other regions of the world. 

Travelers can be at high risk for measles if they are not immunized against the virus. They are immunized if they have been previously infected with the disease or if they are fully vaccinated. They could be contaminated while traveling in a country at risk or when transiting in large international airports for example.

The Public Health Agency of Canada advises all the Canadian and foreign travelers to make sure their vaccination against measles is up to date before they leave their country. 

WHAT ARE THE COUNTRIES THE MOST AT RISK FOR MEASLES ?

Measles is occurring worldwide, but the disease is more present in some regions of the globe. Travelers can find the complete list of the countries at risk for measles on the website of the WHO. 

Measles has been eradicated in North America, in South America, in Central America and in the Caribbean. But some cases are intermittently reported in these areas after the importation of the virus from another region of the world. A sudden outbreak of measles has notably started in December 2014 in the United States, especially in California. Related cases have since been recorded in Mexico. Another outbreak is currently ongoing in Brazil since 2014.

Measles is endemic in Africa, in Asia, in Europe and in Oceania, where periodic large outbreaks occur. The travelers who are not immunized against the disease are at high risk for measles in these areas. Several travelers have notably been affected by the disease after their return to Canada. Most of them had recently visited the Philippines, where a measles outbreak is currently ongoing, especially in the Manilla region. Vietnam and China are other countries that are highly affected by the disease and which have seen an increase in the number of local cases of measles since 2014. 

RECOMMENDATIONS FOR TRAVELERS

All the travelers intending to go to a country at risk for measles should see a doctor or go to a travel health clinic six weeks prior to their departure. If they are not fully vaccinated and have never been infected with the disease, they ought to get vaccinated or to get a booster dose of vaccine to protect themselves against measles. Infants and young children must get two doses of vaccine. The first one should be administrated between the ages of 12 and 15 months and the second one at the age of 18 months or anytime after. Infants below the age of 12 months traveling to a region affected by the virus can get one dose of vaccine as early as 6 months of age. They will later have to get two more doses after their first birthday. The teenagers and the adults born in 1970 or after should check if they have been fully vaccinated before they travel. The persons born before 1970 must get vaccinated, unless they have a certificate of vaccination attesting that they have been administrated the two doses of vaccine after their first birthday, or the positive lab test results of a serologic screening for measles immunity. For more information on the vaccine against measles, Canadian travelers can consult the national recommended routine vaccination schedule. 

While in a country at risk, travelers must always have good hygiene practices. They must frequently wash their hands with soap and clean water during at least 20 seconds. If no water is available, an alcohol-based hand sanitizer can be used. They should always carry this kind of product. When sneezing or coughing, they must cover their nose and their mouth with a disposable tissue and wash their hands right after.

The persons experiencing symptoms of measles while traveling or after their return to their home country must see a doctor immediately and inform him/her of the regions they have visited. They must remain isolated and avoid any contact with other people in the four days following the appearance of skin rash to avoid the spread of the disease. If they are experiencing symptoms of measles while traveling back home, they ought to notify the flight crew about their health status, as well as a border services officer or a quarantine officer upon arrival. 

POLIOMYELITIS IN THE WORLD – FEBRUARY 12, 2015

TRAVEL HEALTH NOTICE

Although the number of cases of poliomyelitis in the world is decreasing and the disease has been eliminated from numerous countries, polio is still significantly affecting some areas of the planet. The Public Health Agency of Canada advises the travelers intending to go to a country at risk for polio to make sure that their vaccination against the virus is up to date. The regions at risk are the territories where polio is endemic and the countries where cases of polio have been reported after the importation of the virus from another part of the world, as well as the neighboring areas. 

The WHO has published temporary recommendations for travelers concerning the vaccination against polio, to stop the spread of the virus in the world. For more information regarding the countries affected by polio, travelers can consult the website of the WHO.

WHAT IS POLIOMYELITIS ?

Polio is a contagious viral disease affecting the nervous system, which can be prevented by vaccination. It can be transmitted through close contact with an infected person, or through the consumption of water and raw or under cooked food that have been contaminated with the feces of an infected person. In some cases, the virus reaches the central nervous system and destroys the nervous cells which are playing a role in the proper functioning of muscles. This can result in the permanent paralysis of the arms and legs or in the death of the victim.

WHAT ARE THE COUNTRIES AT RISK FOR POLIOMYELITIS ?

Poliomyelitis is endemic in three countries : in Afghanistan, in Nigeria and in Pakistan. Several cases of infection with the virus have been reported since the beginning of 2014 in Cameroon, in Equatorial Guinea, in Ethiopia, in Iraq, in Somalia and in Syria. In Kenya, confirmed cases have been recorded in 2013 (these were the first cases of polio in the country since 2011). In Israel, the wild polio virus type 1 has been detected in samples of waste water in 2014, but no cases of paralytic poliomyelitis were recorded. The same situation occurred in Sao Paulo, Brazil, in March 2014. Although Brazil is not among the countries at risk, as the last known case of polio on the territory dates back to 1989, the local authorities urge the travelers and the local population to get vaccinated.

RECOMMENDATIONS FOR TRAVELERS

All the travelers intending to go to a country at risk for polio should see a doctor or go to a travel health clinic six weeks prior to their departure, in order to review their medical history, to evaluate their potential risk of exposure to the virus and to check their vaccination status. Before leaving their country, travelers must make sure that they are fully vaccinated against polio. Infants, children and teenagers below the age of 18 years old in Canada should be vaccinated according to the protocol specified in the national routine vaccine schedule for children. The children who didn’t get the adequate doses of vaccine before traveling in a country at risk for polio must be fully vaccinated before their departure. Adults above the age of 18 years old must make sure that they are fully vaccinated against the virus. If they didn’t get a booster dose of vaccine since their 18th birthday, they must complete their vaccination before they travel. 

While in a country at risk for polio, travelers must have good hygiene practices and wash their hands frequently with clean water and soap during at least 20 seconds, or with an alcohol-based hand sanitizer. It is a good idea to always carry this kind of product. They should always be sure that the water they drink and use is safe, and they ought to avoid consuming raw or under cooked food.

DENGUE FEVER, GLOBAL SITUATION – JANUARY 19, 2015

TRAVEL HEALTH NOTICE

According to health organizations, the number of cases of dengue fever has significantly increased in the world during the past 25 years. Dengue fever is a viral disease caused by one of the 4 strains of dengue viruses. The disease is transmitted through a contaminated mosquito bite. The symptoms of dengue fever are similar to those of seasonal flu. In some cases, the infection can lead to a fatal hemorrhagic fever. There is currently no vaccine and no effective treatment against dengue fever. 

The Public Health Agency of Canada advises travelers to protect themselves efficiently against mosquito bites if they are going to a country at risk for dengue. 

THE AREAS AND THE COUNTRIES AT RISK FOR DENGUE FEVER

Dengue fever is occurring in most of the tropical and subtropical regions in the world, notably in urban and semi-urban zones. Africa, Central America, South America, the Caribbean, South Asia, South East Asia, Eastern Mediterranean and Oceania are all at risk for dengue fever. An increased number of cases of the disease is noted during the rainy season.

Compared to 2013, Malaysia has seen a strong increase in the number of cases of dengue fever in 2014. The first cases of the disease have been reported in Fiji in 2014. In France, cases of dengue fever due to local contamination have been recorded in the region of the Var in August 2014. The disease had already been observed in the South of France in 2010 and in 2013. In Japan, the virus is present all across the country, but most of the affected people have been infected in the Yoyogi Park in Tokyo. These are the first cases of the disease in Japan since more than 70 years. In 2014, China has been significantly affected by dengue fever, especially in the Guangdong province. 

RECOMMENDATIONS FOR TRAVELERS

The travelers intending to go to a country at risk for dengue fever should see a doctor or go to a travel health clinic prior to their departure. While traveling, they ought to protect themselves efficiently against mosquitoes, especially during the sunset and the sunrise hours, as mosquitoes are more active during these periods. If they experience flu-like symptoms while traveling or after their return to their home country, they must see a doctor as soon as possible and inform him/her of the places they have visited.