TRAVEL ASSOCIATED DISEASES:
EBOLA, DENGUE, MALARIA, AND
Napa County Public Health receives reports of malaria, dengue, and measles in persons with a history of international travel. Ebola Virus Disease (EVD) has also re-emerged in an outbreak in the Democratic Republic of the Congo. As the early symptoms of these diseases are non-specific, travel history is essential for timely diagnosis. Patients may not be aware of pre-travel recommendations for measles immunization or malaria chemoprophylaxis. Proactive questioning about planned or recent travel assists with prevention, appropriate infection control, and diagnosis. Please refer to the table in full advisory below (red button) for features of EVD, dengue fever, malaria, and measles.
EVD: The World Health Organization (WHO) has declared the ongoing Ebola outbreak in the Democratic Republic of the Congo to be a Public Health Emergency of International Concern. As of 7/28/2019, 2687 confirmed and probable cases and 1803 deaths were reported. The WHO does not currently recommend closure of borders, restrictions on travel or trade, or entry screening at airports or other ports of entry. Although the risk of importation of EVD to Napa County is low, health care providers should institute protocols to obtain travel history to ensure early consideration of EVD and immediate infection control. If there is suspicion of EVD in a patient based on travel history and clinical presentation, immediately isolate the patient in a private room with in-room bathroom or a covered bedside commode and rapidly report to Napa County Public Health.
DENGUE: The incidence of dengue in the US has increased in recent decades. Most cases in the US are imported, although dengue is endemic in some parts of the US, including Puerto Rico and the US Virgin Islands. From 2013-2018, there was 1 confirmed and 4 probable cases in Napa County. Dengue can be caused by four related viruses (dengue virus 1-4).
MALARIA: Malaria transmission typically occurs in tropical and subtropical regions where Anopheles mosquitoes are found. Although the risk of malaria to Napa County is low, health care providers should institute protocols to ask about recent or planned travels to ensure early consideration of malaria and immediate infection control. Malaria can be prevented through chemoprophylaxis and by avoiding mosquito bites.
MEASLES: Measles is a highly contagious disease that has caused several outbreaks in Europe, the Philippines, and parts of Africa in 2019. As of 7/25/2019, 1164 cases have been confirmed in the US in 2019, the greatest number of cases reported in this country since 1992. Several outbreaks have occurred in California this year, and while there has not been a confirmed case in Napa County, there is ongoing risk and need for clinician vigilance and immediate reporting of suspected cases to Napa County Public Health before the patient leaves the health care facility. Before international travel, clinicians should confirm that patients are up to date on measles immunizations; infants 6-11 months old should receive one dose of MMR, and persons 12 months of age and older should receive 2 doses of MMR. Infants who get one dose before 12 months of age should receive two more doses of MMR at 12-15 months and another separated by at least 28 days.