What Is the Current Situation?
As of November 4, 2012, the Vietnam Ministry of Health has confirmed that approximately 134,929 people in 63 provinces have had hand, foot, and mouth disease (HFMD) since the beginning of 2012; 43 people in 15 provinces have died. Slightly more than half of the HFMD cases and 91% of the deaths have occurred in the southern region. The Vietnam Ministry of Health is working with World Health Organization to control the outbreak.

Large outbreaks of severe HFMD occur frequently in some countries in Asia. Thousands of people may get infected during these outbreaks. Some people, particularly young children, may have severe disease requiring hospitalization or even causing death. Maintaining good hygiene, including hand washing, can help lower the risk of getting sick.

What Is HFMD?
HFMD is a common viral illness that usually affects infants and children under 5 years of age. Adults can also get the disease.

Symptoms of hand, foot, and mouth disease include fever, blister-like sores in the mouth (often painful), and a rash. HFMD is spread from person to person by direct contact with the saliva, nasal secretions, blister fluid, and stool of an infected person. The virus can also be spread when an infected person touches objects and surfaces that are then touched by others.

An infected person is most contagious during the first week of the illness. However, the virus can stay in the stool for weeks after symptoms go away. In addition, people with HFMD do not always show signs of infection, but still could have the potential to spread the disease.

How Can Travelers Protect Themselves?
There is currently no vaccine or medicine to prevent HFMD. However, you can protect yourself from HFMD by practicing healthy personal hygiene.

• Wash your hands often with soap and water, especially before eating and after going to the bathroom or changing a diaper.
• Disinfect dirty surfaces and soiled items by washing items with soap and water; then disinfect them with a solution of chlorine bleach.
• Avoid close contact such as kissing, hugging, or sharing eating utensils or cups with people who have HFMD.

There is no specific treatment for HFMD. If you do develop mouth sores:

• Take over-the-counter medications to relieve pain and fever. (Caution: Aspirin should not be given to children.)
• Use mouthwashes or sprays that numb mouth pain.
• Drink plenty of liquids to stay hydrated.

What is the Current Situation?
Dengue virus is present in all tropical and many subtropical areas worldwide. The mosquitoes that carry dengue bite most often in the morning and evening and during hot, wet times of the year. However, they can bite and spread infection all year long and at any time of day.

Africa and the Indian Ocean Islands
As of August 2012, cases of probable dengue continue to occur in Mogadishu, Somalia. As of May 2012, probable dengue cases have been reported in eastern Kenya, and cases have been confirmed in Mandera, Kenya. The Kenyan Ministry of Health and local health officials are working with local hospitals and clinics to monitor the situation.

Atlantic Islands
According to the European Centre for Disease Prevention and Control1,148 cases of dengue (517 cases laboratory confirmed) have been reported as of November 4, 2012, on the Portuguese island of Madeira. Fifty-seven people have been hospitalized. No deaths have been reported.

South Pacific and Southeast Asia
From September 2011 to April 2012, an outbreak of dengue in the Federated States of Micronesia resulted in more than 1,200 cases and two deaths. Starting in July 2012, cases have increased on Yap Main Island. Cases of probable dengue are also being reported in the Yap Outer Islands.

Confirmed dengue cases have been reported in US travelers returning from destinations in Asia, specifically the Philippines and Thailand. Singapore, Malaysia, Cambodia, Taiwan, the Philippines, Vietnam, India, Sri Lanka, and Thailand are among the countries reporting dengue activity in 2012.

Australia also continues to report sporadic dengue activity in areas of northern Queensland.

The Americas and the Caribbean
In 2012, dengue cases have been reported in most countries in Latin America. Confirmed dengue cases have been reported in US travelers returning from Brazil, Cuba, the Dominican Republic, Ecuador, Haiti, Jamaica, and Puerto Rico.

Middle East
Dengue activity is reported occasionally throughout the Middle East, including areas popular with travelers, such as Jeddah in Saudi Arabia. Currently, dengue cases are being reported in Pakistan and Yemen.

What is Dengue?
Dengue fever is the most common cause of fever in travelers returning from the Caribbean, Central America, and South Central Asia. This disease is spread through the bites of infected mosquitoes and cannot be spread person to person.

Severe dengue can be fatal, but with good treatment, less than 1% of patients die from dengue.

Symptoms of dengue include:

• fever
• headache
• pain behind the eyes
• joint and muscle pain
• rash
• nausea/vomiting
• mild bleeding, such as nose or gum bleeding or easy bruising

People who have had dengue before may get severe dengue if they are infected again. Anyone with dengue who experiences the following warning signs should go to a doctor or emergency room immediately:

• Severe abdominal pain or persistent vomiting
• Red spots or patches on the skin
• Bleeding from nose or gums
• Vomiting blood
• Black, tarry stools (feces, excrement)
• Drowsiness or irritability
• Pale, cold, or clammy skin
• Difficulty breathing

How Can Travelers Protect Themselves?
Travelers can reduce their risk of dengue infection by protecting themselves from mosquito bites:

• Stay in hotels that are well screened or air conditioned.
• Use insect repellent on uncovered skin.
  • Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535.
  • Always follow the instructions on the label when you use the repellent.
  • If sunscreen is needed, apply before applying insect repellent.
• Wear loose, long-sleeved shirts and long pants when outdoors.
  • For more protection, clothing may be sprayed with a repellent containing permethrin. (Don’t use permethrin on skin.)

If you return from a trip abroad and get sick with a fever, seek medical care right away. Tell the doctor about your recent travel.

Beware of walking barefoot on some beaches. You could become infected with dog or cat hookworms (a Parasite). I recently diagnosed a patient who came to the office with unusual marks on her foot.  They were painful and red. She had been vacationing on the beaches of Costa Rica two weeks previously. My diagnosis was Cutaneous Larva Migrans.  As shown in this photograph worms can be seen in the skin of her foot.

Cutaneous Larva Migrans is a parasitic infection caused by the larval phase of hookworms that are frequently found in the feces of cats and dogs.  The eggs of the worm are shed in the feces, pass into the sand or soil, and develop into larvae which can penetrate bare skin.

Symptoms:

– The main symptoms are pain, itching and red marks on the skin.

– Lesions are typically found on feet or buttocks that have been in direct contact with contaminated soil or sand.

– The skin shows worm shaped patterns at the site of penetration.

– Symptoms typically develop 1 to 5 days after infection but may occur as long as 4 weeks 4 weeks after infection.

Treatment:

Administration of an antiparasitic drug by mouth for 1 to 3 days.  The drugs most commonly prescribed are Albendazole, Mebendazole, or Pyrantel pamoate.

Precautions:

Reduce contact with contaminated soil by wearing shoes and protective clothing.

Use towels when seated on the ground.

What Is the Current Situation?

From April 2012 to March 2013, a total of 17 people in Saudi Arabia, Qatar, Jordan, the United Kingdom (UK), and the United Arab Emirates were confirmed to have respiratory illness caused by a novel (new) coronavirus. Eleven of these 17 people died.

In the UK, an infected man likely spread the virus to two family members. He had recently traveled to Pakistan and Saudi Arabia and got sick before returning to the UK. This cluster of cases provides the first evidence of person-to-person transmission. The UK’s Health Protection Agency is continuing to investigate this. Also, clusters of cases in Saudi Arabia and Jordan are being investigated.

CDC does not recommend that anyone change their travel plans because of these cases of the novel coronavirus. CDC recommends that US travelers to countries in or near the Arabian Peninsulamonitor their health and see a doctor right away if they develop fever and symptoms of lower respiratory illness, such as cough or shortness of breath. They should tell the doctor about their recent travel.  

What Is a Coronavirus?

Coronaviruses are a cause of the common cold. A coronavirus also was the cause of the severe respiratory illness called SARS (severe acute respiratory syndrome). SARS caused a global epidemic in 2003, but there have not been any known cases of SARS since 2004. This novel coronavirus is not the same coronavirus that caused SARS.

What Is Known About Novel Coronavirus?

The novel coronavirus is different from any other coronavirus that has been previously found in people. In the UK, the virus likely spread from an infected person to two family members. Symptoms of novel coronavirus infection have included fever, cough, and shortness of breath. CDC is working with WHO and other partners to understand the public health risks from this virus.

How Can Travelers Protect Themselves?

Taking these everyday actions can help prevent the spread of germs and protect against colds, flu, and other illnesses:

• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth. Germs spread this way.
• Avoid close contact with sick people.
• Be sure you are up-to-date with all of your shots.
  • Cover your mouth with a tissue when you cough or sneeze, and throw the tissue in the trash.
  • Avoid contact with other people to keep from infecting them.

What is the Current Situation?
An outbreak of cholera has been ongoing in the Dominican Republic since November 2010. According to the Dominican Ministry of Health (Ministerio de Salud Publica y Asistencia Social [MSP]), as of December 16, 2012, 7,766 suspected cholera cases and 62 suspected cholera-related deaths have been reported for 2012.

This information is current as of today, March 04, 2013 at 14:40 EST Updated: January 16, 2013

What Is the Current Situation?
The Federal Ministry of Health (FMOH) of Sudan and the World Health Organization (WHO) recently announced that there is an outbreak of yellow fever in Sudan. This ongoing outbreak started in early September and has affected 35 localities in Greater Darfur. A total of 849 suspected cases, including 171 deaths, have been reported as of January 9, 2013. Most suspected cases have been reported from Central, South, and West Darfur. WHO is assisting the FMOH of Sudan in the response activities. An emergency mass vaccination campaign to protect people at risk and to stop the spread of yellow fever in the affected areas is currently ongoing with support from international partners.

Yellow fever is always a potential health risk in areas south of the Sahara Desert in Sudan. However, this outbreak of human cases suggests a higher than usual risk of infection for travelers to the Greater Darfur region. Travelers to this area of Sudan are advised to get vaccinated against yellow fever and to take steps to prevent mosquito bites.

This information is current as of today, March 04, 2013 at 14:47 EST Updated: January 16, 2013