Travel Alerts

Shoreland’s Travax News Alert Service

Travax News Alert – Apr. 19, 2019

Democratic Republic of the Congo: Ebola Virus Disease Remains Uncontrolled in North Kivu and Ituri Provinces
According to WHO and international health authorities, more than 97 cases of Ebola virus disease (EVD; caused by EBOV-Zaire strain) per week are occurring almost exclusively in the North Kivu Province health zones of Katwa (60), Butembo (10), Vuhovi (4), Beni (3), Mabalako (2), Kalunguta (2), Masereka (2), Kyondo (1), Musienene (1), and Oicha (1); 11 of the cases occurred in Mandima Health Zone, Ituri Province. The majority of recent cases are linked to known chains of transmission. In the past 3 weeks, 93% of the confirmed new cases have occurred in the current main hot spots of Katwa and Butembo health zones (which contain the large city of Butembo; population nearly 1 million) and in Beni, Mandima, and Vuhovi health zones, with no new cases reported in 9 of the 21 affected health zones during this same period. See Ebola Virus Disease Outbreak Map. New cases are continuing due to civil unrest, community resistance, and distrust of the response campaign, delays in detection and isolation of new cases, transmission within family and community networks, unsafe burial practices, and inadequate infection prevention and control practices in health care settings (mainly informal facilities). Weekly incidence trends must be interpreted cautiously due to some reporting lags.

Approximately 1,317 cases of EVD (including 1,251 laboratory-confirmed and 66 probable cases and 821 deaths) have been reported since mid-July 2018 from 21 health zones in North Kivu Province (mainly in Katwa [443 cases] and Beni [260 cases]) and Ituri Province (117 cases), making this the second largest EVD outbreak ever. Over the past week, contact follow-up rates ranging from 83% to 89% per day of the more than 10,900 current known contacts (including health care workers [HCWs]) were achieved. More than 62,500 contacts are beyond the 21-day incubation period. International health authorities have expressed extreme concern that the outbreak, now in its tenth month, will not be controlled in the foreseeable future.

The highest risk of spread is to Uganda and South Sudan; both countries have implemented heightened surveillance. Exit screening is ongoing at Goma International Airport, and entry screening of incoming internal flights from the Ebola-affected areas is also in place. Surveillance is ongoing in 72 of 80 key international ports of entry and points of control in affected provinces. Of the 50 million travelers screened to date, only 8 have been confirmed positive for EVD, and no cases have been reported in neighboring countries. A ring vaccination strategy (health care and front-line workers, case contacts, and contacts of contacts, including pregnant and lactating women and children under 1 year) using Ebola vaccine (rVSV-ZEBOV; Merck) has included more than 102,500 people (including > 29,700 HCWs) since August 8, 2018, in all affected health zones. Preliminary data indicate an estimated vaccine efficacy of 97.5%. Vaccination of HCWs and front-line responders is ongoing in 12 districts in Uganda; Rwanda (> 170 HCWs); and Nimule, Tambura, Yambio and Yei, South Sudan (> 15,000 HCWs) and will soon begin in Burundi. Laboratories with rapid molecular diagnostic capabilities are currently operational in Beni, Bunia, Butembo, Goma, Mangina, Katwa, Kinshasa, and Komanda. Twelve ETCs and transit centers have been established in Beni, Bunia, Butembo, Goma, Katwa, Kayina, Komanda, Mangina, and Oicha. Preliminary uncontrolled, unrandomized data indicate reduced mortality after compassionate-use treatments with remdesivir, mAb114, ZMapp, or REGN-3470-3471-3479 in this ongoing program at all ETCs. Separately, a randomized controlled trial began in November 2018 (only in the Beni, Butembo, and Katwa ETCs) to compare mAb114, remdesivir, and ZMapp. WHO considers the public health risk to be very high at the national and regional level and low at the global level. Travelers returning from Democratic Republic of the Congo should self-monitor for 21 days after return and telephone ahead before presenting to any medical facility if they become ill.

Tafenoquine: Malaria Information
Tafenoquine has been commercially available in Australia since March 2019 and will be available in the U.S. no earlier than August 2019. The Malaria article, the applicable Destinations pages, and all malaria maps were updated in Nov. 2018 to include tafenoquine as a first-line chemoprophylaxis option, thus allowing users time to become familiar with the properties of and indications for this first new chemoprophylaxis drug in almost 20 years. A version of the Malaria article with extensive tafenoquine-related content highlighted in yellow is available here, and it is also accessible from a link in the standard Malaria article.

Travax News Alert – Apr. 12, 2019

Belgium: Significant Measles Increase, Mainly in Brussels-Capital and Flemish Regions
According to regional health authorities, more than 80 cases of measles (a significant increase over average incidence) were reported from January 1 through February 22, 2019, throughout the country, mainly in Brussels-Capital and Flemish regions. Shoreland continues to make the following recommendations for travelers: All individuals ≥ 12 months of age born in 1957 or later (1970 or later in Canada and the U.K.; 1966 or later in Australia) without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6-11 months should receive 1 dose of MMR vaccine. All those born before 1970 (in Canada) without evidence of immunity or previous vaccination with 1 countable dose of measles-containing vaccine need 1 dose of MMR vaccine.

France: Significant Measles Increase
According to France’s Ministry of Health, more than 75 cases of measles per week (a significant increase over average incidence) are being reported throughout most of the the country (including Paris). More than 630 cases have been reported since January 2019 throughout the country, mainly in Occitanie (> 140 cases), Auvergne-Rhône-Alpes (> 110 cases), and Île-de-France (> 85 cases) regions. The outbreak has yet to peak. Shoreland continues to make the following recommendations for travelers: All individuals ≥ 12 months of age born in 1957 or later (1970 or later in Canada and the U.K.; 1966 or later in Australia) without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6-11 months should receive 1 dose of MMR vaccine. All those born before 1970 (in Canada) without evidence of immunity or previous vaccination with 1 countable dose of measles-containing vaccine need 1 dose of MMR vaccine.

Tanzania: Dengue in Dar es Salaam and Tanga Regions
According to WHO’s regional office and Tanzania’s Ministry of Health, more than 300 cases of dengue fever (including > 25 confirmed) have been reported since August 2018 in Dar es Salaam (> 250 cases) and Tanga (> 50 cases) regions. MOH officials have confirmed to local media that outbreaks are currently occurring in both cities. Travelers should observe daytime insect precautions.

Democratic Republic of the Congo: Ebola Virus Disease Remains Uncontrolled in North Kivu and Ituri Provinces
According to WHO and international health authorities, more than 103 cases of Ebola virus disease (EVD; caused by EBOV-Zaire strain) per week (the highest weekly incidence since the outbreak began) are occurring almost exclusively in the North Kivu Province health zones of Katwa (54), Vuhovi (19), Butembo (9), Beni (7), Komanda (2), Mabalako (2), Masereka (1), and Oicha (1); 8 of the cases occurred in Mandima Health Zone, Ituri Province. The majority of recent cases are linked to known chains of transmission. In the past 3 weeks, 91% of the confirmed new cases have occurred in the current main hot spots of Katwa and Butembo health zones (which contain the large city of Butembo; population nearly 1 million) and in Beni, Mandima, and Vuhovi health zones, with no new cases reported in 9 of the 21 affected health zones during this same period. See Ebola Virus Disease Outbreak Map. New cases are continuing due to civil unrest, community resistance, and distrust of the response campaign, delays in detection and isolation of new cases, transmission within family and community networks, unsafe burial practices, and inadequate infection prevention and control practices in health care settings (mainly informal facilities). Weekly incidence trends must be interpreted cautiously due to some reporting lags.

Approximately 1,220 cases of EVD (including 1,154 laboratory-confirmed and 66 probable cases and 764 deaths) have been reported since mid-July 2018 from 21 health zones in North Kivu Province (mainly in Katwa [378 cases] and Beni [259 cases]) and Ituri Province (108 cases), making this the second largest EVD outbreak ever. Over the past week, contact follow-up rates ranging from 83% to 87% per day of the more than 8,600 current known contacts (including health care workers [HCWs]) were achieved. More than 60,300 contacts are beyond the 21-day incubation period. International health authorities have expressed extreme concern that the outbreak, now in its ninth month, will not be controlled in the foreseeable future. Response capabilities are gravely threatened by insecurity in the current epicenters of Katwa and Butembo and recurrent temporary suspensions and delays of case investigation and response activities.

The highest risk of spread is to Uganda and South Sudan, and both countries have implemented heightened surveillance. Exit screening is ongoing at Goma International Airport, and entry screening of incoming internal flights from the Ebola-affected areas is also in place. Surveillance is ongoing in 76 of 80 key international ports of entry and points of control in affected provinces. Of the 48 million travelers screened to date, only 7 have been confirmed positive for EVD, and no cases have been reported in neighboring countries. A vaccination ring strategy (health care and front-line workers, case contacts, and contacts of contacts, including pregnant women and children aged younger than 1 year) using Ebola vaccine (rVSV-ZEBOV; Merck) has been implemented. Since August 8, 2018, more than 97,900 people (including > 27,000 HCWs) have been vaccinated in all affected health zones. Vaccination of HCWs and front-line responders is ongoing in 12 districts in Uganda and in Nimule, Tambura, Yambio and Yei, South Sudan (> 15,000 HCWs), and will soon begin in Burundi and Rwanda. Laboratories with rapid molecular diagnostic capabilities are currently operational in Beni, Bunia, Butembo, Goma, Mangina, Katwa, Kinshasa, and Komanda. ETCs and transit centers have been established in Beni, Bunia, Butembo, Goma, Katwa, Kayina, Komanda, Mangina, and Oicha. Preliminary uncontrolled, unrandomized data indicate reduced mortality after compassionate-use treatments with remdesivir, mAb114, ZMapp, or REGN-3470-3471-3479 in this ongoing program at all ETCs. Separately, a randomized controlled trial began in November 2018 (only in the Beni, Butembo, and Katwa ETCs) to compare mAb114, remdesivir, and ZMapp. WHO considers the public health risk to be very high at the national and regional level and low at the global level. Travelers returning from Democratic Republic of the Congo should self-monitor for 21 days after return and telephone ahead before presenting to any medical facility if they become ill.

Travax News Alert – Apr. 8, 2019

Australia: Significant Measles Increase, Mainly in New South Wales State and Northern Territory
According to Australia’s Department of Health and regional health authorities, more than 5 cases of measles per week (a significant increase over average incidence) are being reported in New South Wales and Queensland states and Northern Territory. More than 90 cases have been reported since January 1, 2019, throughout the country, mainly in New South Wales (> 30 cases) and Northern Territory (mainly in the city of Darwin; > 20 cases). The outbreak has yet to peak. Shoreland continues to make the following recommendations for travelers: All individuals ≥ 12 months of age born in 1957 or later (1970 or later in Canada and the U.K.; 1966 or later in Australia) without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6-11 months should receive 1 dose of MMR vaccine. All those born before 1970 (in Canada) without evidence of immunity or previous vaccination with 1 countable dose of measles-containing vaccine need 1 dose of MMR vaccine.

Ireland: Significant Measles Increase, Mainly in Dublin
According to Ireland’s Health Protection Surveillance Centre, approximately 5 cases of measles per week (a significant increase over average incidence) are being reported in eastern and midwestern counties, mainly in the city of Dublin. More than 40 cases (including 22 laboratory-confirmed) have been reported since January 1, 2019, in eastern (28 cases), midwestern, and northwestern counties. The outbreak has yet to peak. Shoreland continues to make the following recommendations for travelers: All individuals ≥ 12 months of age born in 1957 or later (1970 or later in Canada and the U.K.; 1966 or later in Australia) without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6-11 months should receive 1 dose of MMR vaccine. All those born before 1970 (in Canada) without evidence of immunity or previous vaccination with 1 countable dose of measles-containing vaccine need 1 dose of MMR vaccine.

Northern Hemisphere: Influenza Season Almost Over in the U.S.
In the U.S., the proportion of outpatient visits for influenza-like illness (ILI) has decreased for the sixth consecutive week to 3.2% (just slightly above the national baseline of 2.2%), indicating the end of the main influenza season, which (at 19 weeks) has been exceptionally long. Influenza A(H3N2), now 71% of all isolates, remains the predominant strain and typically results in more severe illness (especially in older adults).

In Europe, overall influenza intensity continues to decrease, with the majority of countries reporting baseline or low intensity levels across the region. Influenza A(H3N2) has been predominating over A(H1N1) since early March 2019. ILI rates in Canada were 1.6% (just below baseline) this past week, with A(H3N2) predominating over A(H1N1) since late February.

No significant neuraminidase inhibitor resistance has been detected in the U.S., Canada, or Europe. Shoreland continues to recommend seasonal influenza vaccination for all travelers and oseltamivir or baloxavir as standby therapy, especially for those who are at high risk for complications from influenza or who are inadequately vaccinated. Travelers who were vaccinated with the current formulations more than 6 months earlier should consider revaccination because immunity may have declined.

Travax News Alert – Apr. 3, 2019

Maldives: Significant Dengue Increase, Including in Male
According to Maldives’ Ministry of Health and press sources, more than 400 locally acquired cases of dengue fever per month (a significant increase over average incidence) are being reported throughout the country. More than 1,300 cases have been reported since January 1, 2019, throughout the country, including in the city of Male (> 390 cases). The outbreak is past peak. Travelers should observe daytime insect precautions.

Uganda: Tourist Kidnapped in Queen Elizabeth National Park
On April 2, 2019, an American tourist was kidnapped in Queen Elizabeth National Park. Extreme vigilance is recommended. Travelers should maintain a high level of security awareness, follow the advice of local authorities, and monitor the situation through local media and embassy communications.

Travax News Alert – Apr. 1, 2019

Northern Hemisphere: Seasonal Influenza Remains Elevated in the U.S.; Mismatched A(H3N2) Continues
In the U.S., the proportion of outpatient visits for influenza-like illness (ILI) has decreased slightly from the previous week to 3.8%, making 18 straight weeks above the national baseline of 2.2% and the highest level recorded this late in the season since monitoring began in 2000-01. Significant influenza activity is expected to continue for several more weeks. Influenza A(H3N2), now 65% of all isolates, has replaced A(H1N1) as the predominant strain and will predominate from now on. A(H3N2), which typically results in more severe illness (especially in older adults), was predominant during the very severe 2017-18 season, where A(H3N2) vaccine strains exhibited viral mutations during growth in embryonated chicken eggs used in the manufacturing process of most available vaccines. A(H1N1) vaccine strains do not exhibit this same viral mutation. Influenza B accounts for 5% of all isolates, with B/Victoria (in both trivalent and quadrivalent vaccines) predominating over B/Yamagata (only in quadrivalent vaccines). Pneumonia and influenza mortality is currently 7.4%, which is above the national baseline. Influenza-associated hospitalizations are currently 52.5 per 100,000 population, compared to record-high rates of 102.9 per 100,000 population at the end of the 2017-18 season. Midseason monitoring of vaccine effectiveness (VE) in the U.S. against all influenza illness is 47%, compared to a VE of 25% during the A(H3N2) predominant 2017-18 season.

In Europe, overall influenza intensity continues to decrease, with the majority of countries reporting baseline or low intensity levels across the region. Influenza A(H3N2) has been predominating over A(H1N1) since early March 2019, with relatively little influenza B reported across the region. ILI rates in Canada increased to 1.6% (still within the 5-year average) with A(H3N2) predominating over A(H1N1) since late February; influenza B accounts for approximately 21% of all isolates. In Canada, midseason monitoring of VE against all influenza illness is 72%.

The current vaccine formulations are well matched to the majority of circulating strains, but 42.6% of recent A(H3N2) strains in the U.S. and 32.9% of recent A(H3N2) strains in Canada reacted poorly to anti-sera raised against the current A(H3N2) vaccine strain. No significant neuraminidase inhibitor resistance has been detected in the U.S., Canada, or Europe. Shoreland continues to recommend seasonal influenza vaccination for all travelers and oseltamivir or baloxavir as standby therapy, especially for those who are at high risk for complications from influenza or who are inadequately vaccinated. Travelers who were vaccinated with the current formulations more than 6 months earlier should consider revaccination because immunity may have declined.

Mozambique: Significant Cholera Increase, Mainly in Beira
According to international health authorities and press sources citing Mozambique’s Ministry of Health, more than 200 suspected cases of cholera per day (a significant increase over average incidence) are being reported in Sofala Province, mainly in Beira as well as in Nhamatanda. More than 550 confirmed cases have been reported since March 27, 2019, mainly in Beira (> 90% of cases). The outbreak is attributed to contaminated water sources secondary to damage from Cyclone Idai on March 14, 2019. Cholera vaccination is recommended for all travelers to Sofala Province. Strict food and beverage precautions and hand-hygiene measures are recommended for travel to affected areas. Travelers should carry oral rehydration salts in case of severe, watery diarrhea.

United States: Artesunate Now Sole Intravenous Drug Available for Treatment of Severe Malaria
Artesunate is now the sole intravenous (IV) drug available for treatment of severe malaria. Artesunate is not FDA-approved and is only available from CDC through an expanded access investigational new drug (IND) protocol. CDC human subjects approval has been obtained for use, but some local regulations may still require an emergency human subjects use approval for an investigational drug at some hospitals.

Stock is prepositioned at select quarantine stations at major airports across the country. Drug is often obtainable within several hours in select cities during regular business hours, but delays of up to 24 hours may occur in more peripheral areas or during off-hours. Hospitals may contact the CDC Malaria Hotline (770-488-7788; 770-488-7100 after hours). The requesting hospital must arrange for pick-up from the destination airport or releasing quarantine station (if local delivery). Health care providers may consider administering an oral antimalarial (artemether-lumefantrine, quinine, atovaquone-proguanil) orally or via the nasogastric route while waiting for the IV artesunate to arrive.

IV quinidine gluconate is no longer available, and all existing stock has expired. The artesunate IND protocol has been in place since 2007; no indication of a date for any formal application for FDA approval is available.

Travax News Alert – Mar. 29, 2019

Mozambique: Significant Cholera Increase in Beira

According to press sources, more than 100 suspected cases of cholera per day (a significant increase over average incidence) are being reported in Beira, Sofala Province. More than 130 confirmed cases have been reported since March 27, 2019. The outbreak is attributed to contaminated water sources secondary to damage from Cyclone Idai on March 14, 2019. Risk to travelers is minimal. Cholera vaccination is recommended for aid and refugee workers. Strict food and beverage precautions and hand-hygiene measures are recommended for travel to affected areas. Travelers should carry oral rehydration salts in case of severe, watery diarrhea.

Democratic Republic of the Congo: Ebola Virus Disease Remains Uncontrolled in North Kivu and Ituri Provinces

According to WHO and international health authorities, more than 66 cases of Ebola virus disease (EVD; caused by EBOV-Zaire strain) per week are occurring almost exclusively in the North Kivu Province health zones of Katwa (25), Vuhovi (17), Beni (7), Oicha (5), Butembo (3), and Lubero (2). Seven of the cases occurred in Mandima Health Zone, Ituri Province. The majority of recent cases are linked to known chains of transmission. In the past 3 weeks, 83% of the confirmed new cases have occurred in the current main hot spots of Katwa and Butembo health zones (which contain the large city of Butembo; population nearly 1 million) and in Mandima, Masereka, and Vuhovi health zones, with no new cases reported in 8 of the 21 affected health zones during this same period. New cases are continuing due to civil unrest, community resistance, and distrust of the response campaign, delays in detection and isolation of new cases, transmission within family and community networks, unsafe burial practices, and inadequate infection prevention and control practices in health care settings (mainly informal facilities). Weekly incidence trends must be interpreted cautiously due to some reporting lags.

Approximately 1,059 cases of EVD (including 993 laboratory-confirmed and 66 probable cases and 652 deaths) have been reported since mid-July 2018 from 21 health zones in North Kivu Province (mainly in Katwa [306 cases] and Beni [245 cases]) and Ituri Province (86 cases), making this the second largest EVD outbreak ever. Over the past week, contact follow-up rates ranging from 79% to 89% per day of the more than 5,000 current known contacts (including health care workers [HCWs]) were achieved. More than 57,000 contacts are beyond the 21-day incubation period. International health authorities have expressed extreme concern that the outbreak, now in its ninth month, will not be controlled in the foreseeable future. Response capabilities are gravely threatened by insecurity in the current epicenters of Katwa and Butembo, recurrent temporary suspensions and delays of case investigation and response activities, and the closure of the Ebola treatment center (ETC) in Katwa.

The highest risk of spread is to Uganda and South Sudan, and both countries have implemented heightened surveillance. Exit screening is ongoing at Goma International Airport, and entry screening of incoming internal flights from the Ebola-affected areas is also in place. Surveillance is ongoing in 73 of 80 key international ports of entry and points of control in affected provinces. Of the 46 million travelers screened to date, only 7 have been confirmed positive for EVD, and no cases have been reported in neighboring countries. A vaccination ring strategy (health care and front-line workers, case contacts, and contacts of contacts, including pregnant women and children aged younger than 1 year) using Ebola vaccine (rVSV-ZEBOV; Merck) has been implemented. Since August 8, 2018, more than 92,500 people (including > 27,000 HCWs) have been vaccinated in all affected health zones. Vaccination of HCWs and front-line responders is ongoing in 12 districts in Uganda and in Yambio and Yei, South Sudan (> 12,000 HCWs), and will soon begin in Burundi and Rwanda. Laboratories with rapid molecular diagnostic capabilities are currently operational in Beni, Bunia, Butembo, Goma, Mangina, Katwa, Kinshasa, and Komanda. ETCs have been established in Beni, Bunia, Butembo, Goma, Kayina, Komanda, Mandima, Mangina, and Tchomia. Preliminary uncontrolled, unrandomized data indicate reduced mortality after compassionate-use treatments with remdesivir, mAb114, ZMapp, or REGN-3470-3471-3479 in this ongoing program at all ETCs. Separately, a randomized controlled trial began in November 2018 (only in the Beni, Butembo, and Katwa ETCs) to compare mAb114, remdesivir, and ZMapp. WHO considers the public health risk to be very high at the national and regional level and low at the global level. Travelers returning from Democratic Republic of the Congo should self-monitor for 21 days after return and telephone ahead before presenting to any medical facility if they become ill.

 Travax News Alert – Mar. 25, 2019

According to Hong Kong’s Department of Health and press sources, 10 locally acquired cases of measles (a significant increase over average incidence) have occurred since March 1, 2019; half the cases occurred in staff members at Hong Kong International Airport. Shoreland continues to make the following recommendations for travelers: All individuals ≥ 12 months of age born in 1957 or later (1970 or later in Canada and the U.K.; 1966 or later in Australia) without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6-11 months should receive 1 dose of MMR vaccine. All those born before 1970 (in Canada) without evidence of immunity or previous vaccination with 1 countable dose of measles-containing vaccine need 1 dose of MMR vaccine.

Travax News Alert – Mar. 21, 2019

Democratic Republic of the Congo: First Chikungunya Cases Since 2012

According to WHO’s regional office, approximately 17 suspected cases of chikungunya fever per week (a significant increase over average incidence) are being reported in Kinshasa Province (including the city of Kinshasa). Approximately 330 cases (including > 45 laboratory-confirmed) have been reported since late September 2018 in Kinshasa and Kongo Central provinces. The last chikungunya fever case was reported in 2012. Travelers should observe daytime insect precautions.

Travax News Alert – Mar. 18, 2019

Nigeria: Measles Increase, Mainly in Borno State

According to Nigeria’s Ministry of Health and international health authorities, more than 1,200 cases of measles per week (a significant increase over average incidence) are being reported throughout the country. More than 7,400 cases (including > 530 laboratory-confirmed) have been reported in all 36 states and Federal Capital Territory, mainly in Maiduguri, Borno State (primarily in children aged less than 5 years). The outbreak has yet to peak. All individuals ≥ 12 months of age born in 1957 or later (1970 or later in Canada and the U.K.; 1966 or later in Australia) without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6-11 months should receive 1 dose of MMR vaccine. All those born before 1970 (in Canada) without evidence of immunity or previous vaccination with 1 countable dose of measles-containing vaccine need 1 dose of MMR vaccine.

Taiwan: Significant Measles Increase, Mainly in Taipei and Surrounding Areas

According to Taiwan’s Ministry of Health, approximately 19 locally acquired, confirmed cases of measles have occurred since early January 2019 in the northern areas of the country, mainly in Taipei (6 cases) and the special municipality of New Taipei (8 cases). The outbreak appears to be past peak. Shoreland continues to make the following recommendations for travelers: All individuals ≥ 12 months of age born in 1957 or later (1970 or later in Canada and the U.K.; 1966 or later in Australia) without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6-11 months should receive 1 dose of MMR vaccine. All those born before 1970 (in Canada) without evidence of immunity or previous vaccination with 1 countable dose of measles-containing vaccine need 1 dose of MMR vaccine.

Mozambique: Aftermath of Cyclone Idai

On March 14, 2019, Cyclone Idai struck near Beira, Sofala Province. Significant casualties and widespread infrastructure damage have been reported throughout 90% of the city. Disruptions to transportation (including road travel and air travel via Beira Airport), mobile and internet services, and basic services (including power outages and access to potable water) should be expected. Travelers should avoid the affected areas and monitor the situation through local media and embassy communications.

Zimbabwe: Aftermath of Cyclone Idai

On March 15, 2019, Cyclone Idai struck eastern areas of the country, mainly Chimanimani and Chipinge districts, Manicaland Province. Significant casualties and infrastructure damage have been reported. Disruptions to transportation (including road travel) and basic services (including power outages) should be expected. Travelers should avoid the affected areas and monitor the situation through local media and embassy communications.

START TYPING AND PRESS ENTER TO SEARCH