Meningococcal Disease in Travelers - A review

Purpose of review: Invasive meningococcal disease is a rare but potentially devastating disease in travelers. In the past 5 years, significant progress in vaccine development has been made. The purpose of this review is to provide up-to-date information on the current status of risk of meningococcal disease in travelers and vaccine recommendations. 

Recent findings: More evidence on cases of meningococcal disease in travelers is now available. The main areas of highest risk for travelers continue to be the Hajj pilgrimage and travel to the meningitis belt. Two new tetravalent conjugate vaccines against serogroups A, C, W135 and Y have been licensed in North America, Europe and other countries. Significant progress has been made in the development of serogroup B vaccines. 

Summary: The vaccine of choice for travelers at risk of invasive meningococcal disease is a tetravalent conjugate meningococcal vaccine. Data on the need for re-vaccination schedules are still lacking, and so are data on immunogenicity in very young children and the elderly. The first vaccine against serogroup B may become available in early 2013 thus expanding the options of broadening the protection against more serogroups for travelers. Furthermore, the development of pentavalent vaccines will increase the uptake of meningococcal vaccines in the future.
For more information read at Medscape News
Comments: Given the soon to be available Meningococcal conjugate vaccine in India (Menactra) it is important for doctors (especially travel medicine specialist) to know about this excellent update

Yellow fever shots begin in Sudan's Darfur

Health workers in Sudan's Darfur region have begun vaccinating more than two million people against a rare yellow fever outbreak suspected of killing 124 since late September, medics said on Thursday.
The campaign began on Tuesday in West Darfur state and is expected to continue in other affected areas by Saturday, said a joint report from the Sudanese health ministry and the World Health Organisation (WHO). "As of 20 November, the total number of cases has reached 497, including 124 deaths," it said, adding that most cases are in Central Darfur state. This is the first yellow fever outbreak in Darfur in 10 or 20 years, WHO country representative Anshu Banerjee told AFP last week, adding that cases were concentrated in rural areas among the nomad population. Sudan's impoverished western Darfur region has been plagued by conflict since ethnic minority rebels rose against the Arab-dominated Khartoum government in 2003. The yellow fever virus normally circulates among monkeys but could be linked to more mosquitoes breeding this year after heavy rains and flooding in the region. Mosquitoes can become infected from the primates and transfer the virus to humans, Banerjee said. There is no specific treatment for the illness found in tropical regions of Africa but it can be contained through the use of bed nets, insect repellents and long clothing. Vaccination is the most important preventative measure.
(c) 2012 AFP

Read more at: http://medicalxpress.com/news/2012-11-yellow-fever-shots-sudan-darfur.html#jCp

CDC / Malaria Cases: Greece Update

Center for Disease Control and Prevention: updated November 20, 2012

 

The Centers for Disease Control and Prevention (CDC) has received information that there have been five additional P. vivax malaria cases identified in Greece; four that are locally-acquired cases in Greek residents with no previous travel, and one case in an immigrant.

 

Between January 1 and October 22, 2012, Greece has reported a total of 75 cases of malaria.  Of those 75 cases, 47 were caused by P. vivax (16 are locally acquired, 2 are relapses, and the remainder occurred in immigrants). Cases among immigrants from P. vivax-endemic countries, could have either been imported or acquired locally. The immigrants reported being in Greece from as short as a few days before onset of symptoms to as long as 4 years before the onset of symptoms, therefore these cases could have been either locally transmitted or imported.

The four new locally-acquired cases occurred in locations where malaria had been previously identified.  Three new cases were identified in an agricultural area of Evrotas, Lakonia.  Another case was reported in Sofades, Karditsa.

No new cases have been reported in Markopoulo and Marathon, two areas were cases had been identified during June through August.  No locally transmitted malaria cases have been reported in Athens.

Given that there continues to be new cases of locally transmitted malaria in Lakonia, CDC will continue to recommend preventive antimalarial drugs for travel to the agricultural areas of Evrotas in the Lakonia region.  

With the approach of winter in the coming month, it is fully anticipated that this recommendation will change in the near future.

 

If traveling to the affected areas, discuss the benefits and risks of taking malaria prophylaxis based on your itinerary, duration of travel, and activities--as well as your other medications and health conditions--with a health care provider knowledgeable about travel medicine.

 

Mosquito avoidance measures are also recommended, such as insect repellant and sleeping in either an air conditioned or well-screened setting or under a treated bed-net, to prevent malaria infection. Malaria prophylaxis is not currently recommended for travelers to the affected areas of Karditsa, Marathon, Markopoulo, Viotia, and Xanthi.

 

Travelers to these areas should rely on mosquito avoidance measures to prevent malaria infection.

 

Source: CDC / Malaria cases: Greece update

WHO / Yellow fever in Sudan

World Health Organization: GAR : Global Alert and Response

 

The Federal Ministry of Health (FMOH) in Sudan has notified WHO of a yellow fever outbreak affecting 23 localities in Greater Darfur. As of 11 November 2012, a total of 329 suspected cases including 97 deaths were reported from this outbreak. Central and South Darfur have reported most of the suspected cases.

 

Laboratory confirmation was conducted by WHO regional reference laboratory for yellow fever, the Institut Pasteur in Dakar, Senegal, on two samples which tested positive for yellow fever by IgM ELISA test and RT-PCR Differential diagnosis for other flavivirus was negative.

The government of Sudan has requested the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) to provide support for a reactive mass vaccination campaign. The YF-ICG has approved of 2.4 million doses of vaccine, which is expected to arrive in the country shortly. Sudan, with support from WHO is expected to start the emergency mass vaccination campaign in the affected areas in order to protect the at risk populations and stop the spread of the disease.

 

Source: WHO / Yellow fever in Sudan