China

Various strains of avian influenza have affected humans in China. A large increase in cases of H7N9 has been reported Dec 16-Jun 17. Most recent cases confirmed from Beijing, Hebei and Tianjin (NE), Gansu (C), Hubei (SE), Sichuan (S), Henan, Jiangxi, Fujian, Shaanxi and Zhejiang (E). Over 1,500 confirmed cases (558 deaths) have been reported to date from 2013. Other strains of avian influenza (H5N1, H5N6 and H9N2) have also been detected.

Avian influenza is a serious viral infection usually transmitted to humans by contact with infected poultry. The risk to travellers is low. Travellers should avoid contact with poultry (e.g. visiting live animal markets) and wash their hands regularly.

Yemen

The WHO has reported over 65,000 suspected cases of cholera in 19 provinces, with Al Hudaydah (W), Al Bayda (SW), Hajjah (NW), Sana'a (W) and Ta'izz (SW) Governates most affected, Oct 16-May 17.

Sudan

Outbreaks of ‘acute watery diarrhoea'/cholera have been reported in the eastern states of White Nile, Kosti, El Geriza Aba, El Obeid and Sennar, May 17. At least 2,755 suspected cases have been recorded.

Kenya

Media sources have reported 146 cases of cholera (4 deaths) from Nairobi, Mombasa and Vihiga, May 17. At least 15,000 cases were reported from 30 counties during 2016.

Somalia

The number of cases of acute watery diarrhoea/cholera continues to increase with over 36,000 cases (697 deaths) reported in 13 regions, Jan-May 17. Bay, Bakol, Lower Shabelle, Gedo and Middle Juba regions in the south are most affected. Large outbreaks were recorded during 2016 with at least 15,600 cases (548 deaths).

South Sudan

An outbreak of cholera has been reported from 19 counties with over 8,100 cases (248 deaths), Jun 16-May 17.

Nepal

Over 118 cases of acute watery diarrhoea/suspected cholera have been reported from Kathmandu valley, May 17.

Cholera is a bacterial infection usually spread through contaminated food and water in areas with poor sanitation. The risk is highest for those with limited access to safe water and medical care such as aid workers and travellers to remote areas with reported outbreaks. Symptoms include watery diarrhoea and dehydration. An oral vaccine is available for those at particular risk.

Iran

Health authorities report a death from Crimean Congo haemorrhagic fever in Sistan-Baluchestan Province (SE), May 17. 2 more cases have been unofficially reported in the provinces of Isfahan (C) and Kermanshah (W).

Spain

Spanish health authorities report that Crimean-Congo haemorrhagic fever is present in ticks in Extremadura (W), Castilla-La Mancha(C), Castilla/Leon (N) and Madrid, May 17. The first 2 cases (1 death) were in the country, Sept 16.

Crimean Congo haemorrhagic fever is an unpleasant viral disease which can be fatal. It is usually transmitted by infected tick bites or direct contact with the blood of infected individuals. Travellers should take steps to avoid bites by covering exposed skin and using an effective repellent.

Seychelles

9 Israeli tourists have been diagnosed with dengue fever following a tour of the Seychelles, Apr 17. 388 cases were confirmed by the Ministry of Health during 2016.

Thailand

Health authorities have reported over 11,000 cases of dengue fever from 77 provinces, Jan-May 17. Over 60,000 cases were reported during 2016.

India

Dengue fever is a widespread problem with outbreaks reported in Karnataka, Kerala, Andhra Pradesh and Delhi, May 17. Over 97,300 cases were reported during 2016.

Bangladesh

Dhaka has reported at least 126 cases of dengue fever, May 17. 2016 saw the largest dengue fever outbreak in Bangladesh for 10 years with nearly 6,000 cases reported, Jan-Nov 16.

Myanmar

Dengue fever is a continuing problem throughout Myanmar, with over 1,000 cases reported in Rakhine State (W) and Yangon (S), May 17. Over 9,800 cases were recorded during 2016.

Fiji

Dengue fever is a continuing problem in Fiji. 913 cases have been confirmed, Jan-May 17. Central Division is most affected.

Dengue fever is a viral infection spread by day-time biting mosquitoes. It is widespread across over 110 countries with large outbreaks reported in many regions including South East Asia and South/Central America. Dengue fever commonly causes flu-like symptoms including fever, joint pain and rash. Severe forms of the disease are rare in travellers but can lead to excessive bleeding and organ failure.

Niger

Health authorities have reported an outbreak of hepatitis E in Diffa region (SE), with 664 cases (30 deaths), Dec 16-May 17.

Iraq

An outbreak of viral hepatitis has been reported in Al-Saqlawiyah city (C), May 17. The strain has not been confirmed but is suspected to be hepatitis E.

Hepatitis E infection affects the liver and is usually transmitted through contaminated food and water in areas with poor sanitation. Symptoms include fever, fatigue and jaundice. It is especially dangerous in the latter stages of pregnancy when fatality rates can reach 20%. There is currently no vaccine.

UAE

At least 60 cases of Legionnaires' disease have been reported in European travellers returning from Dubai, Oct 16-May 17. The source of the infection is unknown.

Legionnaires’ disease is a bacterial infection which can cause a life-threatening pneumonia. Outbreaks are often associated with communal water facilities such as spas, showers and cooling towers.

Qatar

Qatar health authorities have reported an additional case of Middle East respiratory syndrome coronavirus (MERS-CoV), May 17, bringing the total to 21 since 2012. Cases have been reported in many Middle East countries with the majority in Saudi Arabia.

Saudi Arabia

The Saudi Ministry of Health continue to report additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV), May 17. 1,612 cases (665 deaths) have been reported since 2012.

MERS-CoV is a viral infection which affects the respiratory system and can be fatal. Human to human transmission has been reported including amongst healthcare workers. There is some evidence that camels may also transmit the disease. Travellers returning from the Middle East who develop a significant respiratory illness with fever and cough should seek medical advice. There are no travel restrictions.

Democratic Republic of Congo

WHO have confirmed 4 cases of vaccine derived polio virus in Haut Lomami(S) and Maniema (E), May 17.

Polio is a viral infection which can sometimes cause long term paralysis. It is usually spread by contaminated food and water in areas with poor sanitation. Polio has been successfully eliminated from many countries. Vaccination is part of the standard UK immunisation schedule and boosters are given in combination with tetanus and diphtheria.

Bolivia

2 children have died from rabies in Santa Cruz, May 17. Bolivia has one of the highest incidence of human rabies transmitted by dogs in the Western hemisphere.

Rabies is a viral infection spread by the saliva of infected animals. Human cases are usually due to dog bites but any mammals can be infected. Rabies is fatal once symptoms begin. Pre-exposure vaccinations are recommended for long-stay travellers; those remote from medical help (>24 hours) and animal handlers. All travellers must know how to treat a wound and seek prompt post-exposure vaccines if bitten/scratched.

Zambia

An outbreak of typhoid has been reported in the Kalingalinga district of Lusaka, May 17.

Typhoid fever is a bacterial infection usually spread by contaminated food and water. It can cause fever, headaches, digestive disturbances and less commonly, serious complications. Vaccination can be given alone or in combination with hepatitis A. An oral vaccine is also available but is not suitable for everyone.

India

The first 3 locally acquired cases of Zika virus disease have been reported in Ahmedabad District, Gujarat State (W), May 17.

Zika virus (ZIKV) is transmitted by daytime biting mosquitoes and is similar to dengue fever. Symptoms include rash, conjunctivitis, muscle or joint pain. Neurological complications have been reported. There is consensus that ZIKV infection during pregnancy may cause some birth defects such as microcephaly. There is a low risk of sexual transmission of the disease. Countries/territories/areas with active or past Zika transmission have now been classified into 4 risk categories: high, moderate, low and very low, based on the current and potential epidemiological situation. These categories ensure travel advice is appropriate and proportionate to the defined ZIKV transmission risk.  See current national advice from Public Health England for more details, including that for pregnant travellers, who are advised to postpone non-essential travel to high risk countries and also regarding condom use for preventing sexual transmission of the disease.https://www.gov.uk/government/collections/zika-virus-zikv-clinical-and-travel-guidance