Scientific Data DocumentationDisease Outbreak BulletinsABSTRACT A current list of outbreaks significant to travelers follows. This information was recorded in August 1991 by the CDC and will be updated whenever the list is revised.CHOLERA OUTBREAK INFORMATION Travelers to South America should be aware that an epidemic of cholera is occurring in several countries including Peru, Ecuador and Columbia. Cholera has been reported in most coastal cities and inland areas of all three countries. Cholera has also been reported in Cuzco in Peru and in the Galapagos Islands of Ecuador. In addition, a small number of cases have been reported from Santiago, Chile, and from an area of the Brazilian jungle bordering Peru, in rural areas of Central Mexico and on the Pacific Coast of Guatemala. Cholera cases were first recognized in Peru in the last week of January 1991 and by August had affected over 280,000 in the affected countries. Cholera has been reported in a small number of U.S. residents traveling to Peru and Ecuador. Epidemiologic investigations in Peru have indicated that the principal means of transmission are through municipal water supplies, ice made from that water, foods and beverages bought from street vendors, and vegetables irrigated with fresh sewage. Previous experience in other cholera epidemics and recent epidemiologic investigations in Ecuador during this epidemic also suggest that raw and undercooked seafood are important in the transmission. Some cases of cholera have occurred in the United States after people brought back crabs in their luggage from South America. Travelers should not bring back perishable crabs or seafood when they return to the United States. Cholera causes watery diarrhea and vomiting and in severe cases can lead to dehydration and death if not properly treated. Cholera is transmitted through contaminated food and water. It is particularly important to avoid raw or undercooked seafood, potentially contaminated water and ice made from that water. Travelers should not assume municipal water in affected areas is safe to drink, even if the local information is reassuring. Food and beverages sold by street vendors should be avoided. The usual precautions to avoid travelers' diarrhea should be observed carefully. The basic rule is "boil it, cook it, peel it or forget it." Since cholera is associated with areas of poor sanitation, the risk of cholera in travelers who follow the normal tourist itineraries has been exceedingly low in other cholera epidemics. The vaccine confers only brief and incomplete protection and is not recommended. In the unlikely event a traveler develops severe watery diarrhea, or watery diarrhea and vomiting, medical attention should be sought immediately. Treatment with oral rehydration, or, in severe cases, intravenous rehydration is highly effective. There are no cholera vaccine requirements for entry into or exit from South American Countries or the United States.DIARRHEAL ILLNESS Several people have returned from trips to Mexico in 1989 with severe diarrheal illness caused by bacterium Shigella dysenteriae type 1. The CDC has received fewer reports of illness in 1989 than occurred in 1988. The risk is small for any one individual, but because the illness can be severe, travelers to this area should take extra precautions with regard to food and beverages. Travelers should avoid uncooked vegetables and fruits which cannot be peeled. No food should be eaten raw. Although the water in Cancun is purified, it may be prudent to drink bottle water, carbonated water, or water that has been boiled or treated with iodine. Other beverages should be drunk without ice. Preventive antibiotics are not advised.EPIDEMIC MENINGOCOCCAL DISEASE Epidemic meningococcal disease has been reported in Nairobi, Kenya and the Arusha area on northern Tanzania. Control measures have been instituted and the number of reported cases appear to be decreasing. There have been no reports of meningococcal disease in travelers. Because of the potential risk for exposure in Kenya and northern Tanzania, CDC recommends that U.S. travelers to Kenya and northern Tanzania receive the meningococcal polysaccharide vaccine. Quadrivalent polysaccharide vaccine containing serogroup A,C,Y, and W135 is available from local distributors or by calling Connaught Laboratories at 1-800-VACCINE.YELLOW FEVER OUTBREAK IN BENDEL STATE, NIGERIA A suspected yellow fever outbreak has been reported from Bendel State in southern Nigeria. The illness is characterized by fever, muscle aches, bleeding from the gastrointestinal tract, jaundice, and clinically is consistent with yellow fever. However, laboratory confirmation of the diagnosis still is lacking. The outbreak began in April and apparently peaked in July. Sporadic cases still are occurring in Bendel State and also from JOS. Since 1986, several major yellow fever outbreaks have occurred in Nigeria, leading to tens of thousands of cases. Yellow fever can be prevented by immunization. Yellow fever vaccine is recommended for travellers to Nigeria and other areas of West and Central Africa.
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