An outbreak of Legionnaires's disease has been reported among travelers who stayed at an unidentified hotel in Calpe, Costa Blanca. Any traveler to Calpe who develops fever, cough, or trouble breathing should seek immediate medical attention.

Three cases of yellow fever have been reported from reported from Kedougou and Saraya Health districts, near the border with Mali and Guinea Conakry. Yellow fever vaccine is recommended for all travelers to Senegal.

An outbreak of hepatitis C infections related to unsterilized needles has been reported from eastern Anhui province. Transfusions and injections should be avoided in China if at all possible.

An outbreak of Chikungunya fever has been reported from Bangladesh. Travelers should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

New cases of cholera contintue to be reported from the Dominican Republic. Travelers should be sure not to ingest tap water.

Several outbreaks of hepatitis A have been reported from West Java. Hepatitis A vaccine is recommended for all travelers to Indonesia.

An outbreak of sarcocystosis has been reported among travelers who visited Tioman Island off the east coast of peninsular Malaysia between June and August 2011. The main symptoms are fever and muscle aches. The disease is generally acquired by comsumption of undercooked pork or beef.

An outbreak of hepatitis A has been reported from southern Estonia, chiefly Viljandi county. Hepatitis A vaccine is recommended for all travelers to Estonia.

An outbreak of dengue fever has been reported from the Marshall Islands, chiefly affecting the capital of Majuro. Travelers should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

Because of a recent malaria outbreak, the CDC is now recommending malaria pills for all travelers to Laconia. For Evia/Euboea, Eastern Attiki, Voitia, and Larissa, anti-malarials are not recommended because there have only been a limited number of cases.

Twelve cases of Legionnaires' disease have been reported among UK travelers who visited the island of Corfu. Any traveler to Corfu who develops fever, cough, chest pain, or difficulty breathing should seek immediate medical attention.

A toxoplasmosis outbreak has been reported from Cuiaba, Brazil, probably from contaminated water. Pregnant women especially should be sure not to drink unfiltered water.

Because of recent polio cases in China near the Pakistan border, the CDC is now advising that all travelers to China should be fully immunized against polio. Any adult who received polio vaccine as a child but not as an adult should be given a single dose of polio vaccine.

South Africa is now requiring proof of yellow fever vaccination for travelers arriving from Tanzania, Zambia, Somalia, or Sao Tomé and Principe, even though the risk of yellow fever in those countries is low.

A measles outbreak has been reported from Quebec, causing more than 700 cases. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity.

Eleven cases of Legionnaires' disease have been reported among travelers who stayed in Lazise, Italy. Any traveler to Lazise who develops fever, cough, chest pain, or difficulty breathing should seek immediate medical attention.

Four cases of polio, probably imported from Pakistan, have been reported from Hetian prefecture, Xinjiang Uygur autonomous region. The risk to travelers is not thought to be significant.

A mumps outbreak has been reported from Bosnia-Herzegovina, particularly affecting cantons of Central Bosnia, Zenica-Doboj, Sarajevo, and Herzegovina-Neretva. All travelers born after 1956 should make sure they are fully immunized against mumps.

A leptospirosis outbreak has been reported from the state of Gujarat. Leptospirosis is acquired by exposure to water contaminated with urine from infected animals. Those who might be exposed should consider taking doxycycline prophylactically.

Six cases of malaria have been reported from southern Greece, including one in a traveler. Travelers to southern Greece should protect themselves from mosquito bites by applying repellent and keeping covered. Malaria pills are not recommended.

An outbreak of dengue fever has been reported from the Bahamas, but the island of Grand Bahama has been spared to date. Travelers to Nassau should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

An outbreak of hand, foot and mouth disease has been reported from Viet Nam, causing the death of 81 children. The virus is transmitted by exposure to fecal material from infected children. Most travelers are at low risk.

A rubella (German measles) outbreak has been reported from Fiji, mainly Suva. All travelers born after 1956 should make sure they have been fully immunized against rubella. Those born before 1957 are presumed to be immune.

A measles outbreak has been reported from Auckland. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity.

An increasing number of hantavirus infections are being reported from Chile, chiefly in the region from Maule to Aysen. Hantavirus infections occur in those who live in close association with rodents. Campers in forest areas may be at risk.

A mumps outbreak has reported from the Lower Mainland of British Columbia, including Vancouver, following an outbreak in Whistler earlier this spring. Travelers born after 1956 should have either two documented MMR immunizations or a blood test showing mumps immunity.

There is mounting evidence that the the source of the E. coli outbreak was bean and seed sprouts, including fenugreek, mung beans, lentils, adzuki beans, and alfalfa. The number of new cases is rapidly falling.

A schistosomiasis outbreak has been reported from Palo, Leyte. Travelers should avoid swimming in bodies of fresh water, such as lakes, ponds, streams, or rivers in the Philippines.

An outbreak of severe intestinal E. coli infections has been reported from Germany, possibly related to sprouts. Travelers should avoid eating sprouts, raw tomatoes, cucumbers, and leafy salads and should see a doctor immediately if diarrhea occurs.

An isolated case of Ebola has been reported from Luwero district, central Uganda, about 25 miles from Kampala. No travel restrictions are recommended for Uganda at this time.

A measles outbreak has been reported from the Canary Islands, apparently caused by unvaccinated travelers from the UK and Germany. All travelers born after 1956 should make sure they have had either two measles immunizations or a blood test showing measles immunity.

Mumps outbreaks continue to be reported from the UK, most recently from the Universities of Central Lancashire and Manchester. Travelers born after 1956 should make sure they have had either two documented MMR immunizations or a blood test showing mumps immunity.

Two cases of tularemia have been reported in travelers to Central Anatolia. Travelers should protect themselves from ticks by applying repellent and keeping themselves and should drink only bottled or boiled beverages.

A measles resurgence has been reported in France and Belgium. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity.

A rabies outbreak has been reported from Chennai, India. Travelers should avoid stray dogs. Anyone bitten by a dog should seek immediate medical attention.

A small number of cases of Chikungunya fever has been reported from the Seychelles, raising the possibility of a new outbreak. Travelers should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

An outbreak of visceral leishmaniasis (kala-azar) has reported from Al Qadarif state in Sudan. Travelers should protect themselves from sandflies, which transmit the disease, by applying repellent and keeping themselves covered.

An upsurge in cholera cases has been reported from Haiti, related to the onset of the rainy season. Travelers should drink only bottled or boiled beverages.

An increased number of cases of melioidosis has been reported from the Northern Territory. Travelers should wear waterproof gloves and shoes or boots whenever coming into contact with soil, especially during the rainy season.

An outbreak of St. Louis encephalitis has been reported from San Juan. All travelers should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

Sporadic cases of hantavirus pulmonary syndrome continue to be reported from Chile. Most cases occur in those who have had contact with rodents or rodent excrement. Campers in forest areas may be at risk.

A measles outbreak has been reported from Seville. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity.

An alert for Murray Valley encephalitis, which is transmitted by mosquitoes, has been issued for New South Wales. Travelers to New South Wales should protect themselves from bites by applying repellent and keeping themselves covered.

Two cases of yellow fever have been reported from Jahun village in Bonthe district, Southern province,Sierra Leone. Yellow fever vaccine is recommended for all travelers to Sierra Leone.

An outbreak of meningococcal meningitis has been reported from Chad, killing people. Meningococcal vaccine is recommended for all travelers to Chad during the dry season (November through June).

A leptospirosis outbreak has been reported from North Central province after flooding. Leptospirosis is acquired by exposure to water contaminated with urine from infected animals, especially rodents. Those who might be exposed should consider taking doxycycline prophylactically.

An outbreak of visceral leishmaniasis has been reported from Corrientes in northeastern Argentina. Leishmaniasis is transmitted by sandflies, which are about 1/3 the size of mosquitoes. Travelers should protect themselves from bites by applying repellent and keeping themselves covered.

A measles outbreak has been reported from Turkey. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity.

A tularemia outbreak has been reported from More og Romsdal and Sor-Trondelag in central Norway. Most cases are caused by direct contact with infected rodents or hares or by ingesting contaminated water or snow.

An alert for Murray Valley encephalitis, which is transmitted by mosquitoes, has been issued for Victoria. Travelers to Victoria should protect themselves from bites by applying repellent and keeping themselves covered.

An outbreak of rabies caused by vampire bats has been reported among native communities in the Amazonas region, near the Ecuadoran border. Travelers should not sleep in open areas without mosquito netting and should consider getting rabies vaccine.

A leptospirosis outbreak, transmitted by infected rat urine, has been reported from the Bantul regency in Java. Those who might be exposed to contaminated water may consider taking doxycycline prophylactically.

A dengue outbreak caused by a particularly aggressive strain of the virus has been reported from Peru's northern Amazon jungle region. Travelers should protect themselves from mosquitoes by applying repellent and keeping themselves covered.

Human cases of Q fever continue to be reported from the southern part of the Netherlands. Travelers should avoid farms in affected areas and should not drink unpasteurized milk or eat products made from unpasteurized milk.

An outbreak of rubella (German measles) has been reported from Lviv oblast. All travelers born after 1956 should make sure they have had two doses of MMR vaccine.

An upsurge in cases of Ross River and Barmah Forest virus infections, transmitted by mosquitoes, has been reported from the Riverland area in South Australia. Travelers should protect themselves from mosquitoes by keeping covered and applying repellent.

Clusters of Nipah virus infections have been reported from Lalmonirhat, Rangpur, Faridpur and Rajbari, killing at least 25 people. Travelers should avoid consuming fruit or fruit juices possibly contaminated by bats.

A yellow fever outbreak has been reported from Cote d'Ivoire, chiefly affecting the center-north departments of Seguela, Mankono, Katiola, and Beoumi. Yellow fever vaccine is recommended for all travelers to Cote d'Ivoire.

Cases of leptospirosis are being reported from central Queensland after the recent flooding. Travelers should avoid beaches, lakes, rivers, creeks, and other bodies of fresh water.

An outbreak of H1N1 influenza (swine flu) has been reported from Israel. Flu vaccine is recommended for everyone 6 months of age or older.

An outbreak of Legionnaires' disease has been reported among Australians who had vacationed in Bali. All but one had stayed at stayed at the same hotel in the central area of Kuta. Travelers who develop fever, cough, or difficulty breathing should promptly seek medical attention.

A mumps outbreak has been reported from Oban, on the western coast of Scotland. All travelers born after 1956 should make sure they have had either two documented MMR or mumps immunizations or a blood test showing mumps immunity.

The number of severe and fatal cases of H1N1 influenza (swine flu) is continuing to increase in the UK. 25% of intensive care beds in the UK are currently occupied by influenza patients. Flu vaccine is recommended for everyone 6 months of age or older.

An outbreak of Legionnaires’ disease has been reported from the Regency Club Vacation Resort and Wyndham Cozumel Resort and Spa (formerly Reef Club Cozumel) on Cozumel, Mexico. Legionnaires' is usually transmitted by airborne droplets from contaminated water sources. Travelers should consider staying elsewhere.

Health officials in Puerto Rico have announced the end of the dengue outbreak, which caused more than 12,000 cases and cost 31 lives this year.

An outbreak of dengue fever has been reported from Acapulco. Dengue is a flu-like illness transmitted by mosquito bites. Until further notice, travelers to Acapulco should apply insect repellent and keep themselves covered when outdoors.

An outbreak of yellow fever has been reported from northern Uganda. Yellow fever vaccine is recommended for all travelers to Uganda.

A plague outbreak has been reported from an area bordering the government forest reserve at the edge of the Rift Valley in Manyara Region, Tanzania. The plague is transmitted by rodent fleas. Travelers should avoid areas containing rodent burrows or nests.

Human cases of H5N1 avian influenza (bird flu) continue to be reported from Egypt. No travel restrictions are advised, but travelers should avoid exposure to live poultry, including visits to poultry farms, and should make sure all poultry and egg products are thoroughly cooked.

An outbreak of dengue fever has been reported from Townsville in northern Queensland. Dengue is a flu-like illness transmitted by mosquito bites. Travelers to northern Queensland should apply insect repellent and keep themselves covered when outdoors.

A mumps outbreak has been reported from northern Bavaria. All travelers born after 1956 should make sure they have had either two documented MMR or mumps immunizations or a blood test showing mumps immunity.

A measles outbreak has been reported from Granada in southern Spain. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity.

An increased number of cases of H1N1 influenza (swine flu) has been reported across the UK, similar to the H1N1 outbreak last spring. Flu vaccine is recommended for everyone 6 months of age or older.

An outbreak of hepatitis A has been reported from Azad Jammu and Kashmir, related to consumption of contaminated water caused by defects in the sewage system. Hepatitis A vaccine is recommended for all travelers to Pakistan.

An increased number of cases of Streptococcus suis infections have been reported from northern Thailand. Most cases are related to consumption of raw pork in dishes such as Larb and Lu Mu, which should be avoided.

The cholera outbreak in Haiti continues to spread. Almost 70,000 cases and more than 1600 deaths have been reported nationwide. Thousands of cases have now been reported from Port-au-Prince and environs. Travelers should drink only bottled or boiled beverages.

Two cases of cholera have been reported from the Dominican Republic, related to a major cholera outbreak in neighboring Haiti. More cases of cholera are expected in the Dominican Republic, due to the number of people regularly crossing the border.

An outbreak of Legionnaires' disease has been reported from Madrid, causing 51 cases, five of them fatal. Legionnaires' is usually transmitted by airborne droplets from contaminated water sources, such as cooling towers or air conditioners. The source of the Madrid outbreak has not been determined.

More cases are being reported from Cite Soleil, a slum on the outskirts of Port-au-Prince, plus some cases in Port-au-Prince itself, leading to concerns that the outbreak could spread to heavily-populated tent camps in Port-au-Prince. Travelers should drink only bottled or boiled beverages.

Influenza activity remains low worldwide, except in parts of the tropics, most notably in Southeast Asia, and to a lesser extent in the tropical areas of the Americas. Influenza vaccine is recommended for everyone aged 6 months and older.

Several cases of sleeping sickness have recently been reported among visitors to game parks in Zambia, especially Luangwa River Valley in eastern Zambia. Sleeping sickness is transmitted by tsetse flies. Travelers should keep themselves covered, since insect repellents don't work against tsetse flies.

An outbreak of Crimean-Congo hemorrhagic fever has been reported from Pakistan. CCHF is transmitted by ticks which have fed on infected animals. Most cases occur in farm workers. Most travelers are at low risk.

Because of a polio outbreak that started in Tajikistan and has spread elsewhere, the CDC now recommends a single polio booster for any adult who is visiting the following countries and never had a polio booster as an adult: Armenia, Azerbaijan, Georgia, Karakhstan, Kyrgyzstan, Russia, Tajikistan, Turkmenistan and Uzbekistan.

An outbreak of dengue fever has been reported from St. Maarten. Dengue fever is a flu-like illness transmitted by mosquito bites. Travelers should protect themselves from mosquito bites with insect repellent.

A cholera outbreak has been reported from a rural area in central Haiti and may be spreading to Port-au-Prince. Travelers should drink only bottled or boiled beverages. Cholera vaccine is available in Canada, Australia, and the European Union, but not the United States.

An outbreak of chikungunya fever, a mosquito-borne illness characterized by fever and incapacitating joint pains, has been reported from Guangdong Province in southern China. Travelers to southern China should apply insect repellent and keep themselves covered to avoid mosquito bites.

An outbreak of meningococcla meningitis has been reported from Namibia. Travelers should consider getting meningococcal vaccine before departure.

A small outbreak of dengue fever has been reported from St Thomas-St John District of the U.S. Virgin Islands. Dengue fever is transmitted by mosquitoes and may be complicated by hemorrhage or shock. Insect protection measures are advised.

An outbreak of dengue fever has been reported from New Delhi, causing more than 3000 cases and 5 deaths. Dengue fever is transmitted by mosquitoes and may be complicated by hemorrhage or shock. Insect protection measures are advised.

An outbreak of Lassa fever has been reported from the Northern region. Lassa fever is a life-threatening viral infection generally acquired by contact with the excreta of infected rodents, but may also be transmitted person-to-person. The risk to travelers is low, unless they are medical providers.

An outbreak of pneumonic plague has been reported from Laduo, a remote village in southwestern Tibet. The plague is usually transmitted by the bite of rodent fleas or, less commonly, by inhalation of infected droplets, which may be coughed into the air by an infected person. Most travelers are at low risk.

All pilgrims over 2 years old must receive meningococcal vaccine no more than 3 years and no less than 10 days before arrival and must show proof of vaccination. Also, all pilgrims must show proof of vaccination for H1N1 flu 2 weeks or more before applying for the Hajj visa.

An outbreak of conjunctivitis ("pink-eye") has been reported from the states of Guerrero and Tamaulipas. Conjunctivitis is a viral infection which usually clears in a few days. Careful handwashing is recommended to prevent transmission.

An outbreak of leptospirosis, related to flooding, has been reported from the department of Leon. Leptospirosis is transmitted to humans by exposure to water contaminated by the urine of infected animals. Those at risk should wear protective clothing and consider taking doxycycline once weekly.

A rabies outbreak caused by vampire bats has been reported from the Awajun and Wampis indigenous in northeastern Peru. Most travelers are at low risk.

A measles resurgence has been observed in France, leading to almost 5000 cases over the past 3 years. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity.

A case of African trypanosomiasis (sleeping sickness) has been reported in an American traveler who had been on a hunting safari in the South Luangwa river valley, south of the South Luangwa National Park. All travelers should protect themselves from tsetse flies, which transmit the disease.

An outbreak of Legionnaires' disease has been reported from the Heads of the Valleys corridor in South Wales, causing 19 deaths. Legionnaires' disease is usually transmitted by airborne droplets from contaminated water sources, such as cooling towers or air conditioners. The source of the South Wales outbreak has not been determined.

An anthrax outbreak has been reported from Bangladesh, causing more than 500 cases. Anthrax occurs in those who have direct contact with infected farm animals, such as buffalo, cattle or goats, or who consume infected meat. Most travelers are at low risk.

An outbreak of acute encephalitis has been reported from Uttar Pradesh and Bihar. Some of the cases have been caused by Japanese encephalitis virus, but the cause of others is unknown. Japanese encephalitis vaccine is recommended for those with extended outdoors exposure in rural areas.

An outbreak of West Nile virus infections has been reported from Volgograd, central Russia. West Nile virus is carried by Culex mosquitoes, which breed in stagnant water and are most active after dusk. Travelers should protect themselves from mosquitoes by applying insect repellent and covering up, especially after dusk.

An outbreak of melioidosis has been reported from Thailand, mostly among farmers in the northeastern part of the country. Melioidosis is caused by a soil bacterium which enters the body through cuts or other breaks in the skin. Travelers should wear waterproof gloves and shoes or boots whenever coming into contact with soil, especially during the rainy season.

An outbreak of bubonic plague has been reported from northern La Paz department. The plague is usually transmitted by the bite of rodent fleas. Those who may have contact with rodents or their fleas should bring along a bottle of doxycycline, to be taken if exposure occurs.

An increase in leptospirosis has been reported from Malaysia. Leptospirosis is acquired by exposure to water contaminated by the urine of infected animals. Travelers should avoid exposure to lakes, rivers, and other bodies of fresh water.

Fresh cases of rabies continue to be reported from Bali. The outbreak has been caused by bites from infected dogs. Travelers should avoid touching all animals, including pet dogs and cats and wild animals such as monkeys. Rabies vaccine is recommended for travelers at risk for animal bites.

The World Health Organization has declared that the H1N1 influenza pandemic is over, though H1N1 transmission remains locally intense in parts of India and New Zealand. All travelers should receive the influenza vaccine, which will include protection against H1N1 influenza, when available this fall.

An outbreak of West Nile virus infections has been reported from Greek Central Macedonia. All travelers to Central Macedonia should protect themselves from mosquito bites by applying insect repellent and keeping themselves covered.

An outbreak of human plague has been reported from the district of Chocope, department La Libertad. The plague is usually transmitted by the bite of rodent fleas, and less commonly by inhalation of infected droplets coughed into the air by an infected person. Most travelers are at low risk.

A mumps outbreak has been reported from Israel, chiefly involving religious boarding schools in the Jerusalem area. All travelers born after 1956 should make sure they have had either two documented MMR or mumps immunizations or a blood test showing mumps immunity.

Cases of Chikungunya fever continue to be reported from India, most recently Karnataka and Maharashtra. Chikungunya fever is a viral infection, transmitted by mosquito bites, which causes fever and joint pains. Travelers should apply insect repellent and keep themselves covered to prevent mosquito bites.

Worldwide, overall influenza activity is low at this time, except in South Africa, where winter influenza activity appears to have peaked, and in Australia and New Zealand, where influenza activity remains low but is increasing. All travelers should receive the influenza vaccine, which will include protection against H1N1 influenza, when available this fall.

Major outbreaks of dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, have been reported from Puerto Rico, the Dominican Republic, Trinidad and Tobago, and other Caribbean islands. Travelers should apply insect repellent and keep themselves covered to prevent mosquito bites, which transmit the disease.

A mumps outbreak has been reported from Brighton and Hove, Sussex, UK. All travelers born after 1956 should make sure they have had either two documented MMR immunizations or a blood test showing mumps immunity. This does not apply to people born before 1957, who are presumed to be immune.

An increase number of malaria cases is being reported from Mumbai, India, chiefly from Central Mumbai, where many large construction projects are in progress. All travelers to India should take malaria prophylaxis (Malarone, mefloquine, or doxycycline) to prevent infection.

Major outbreaks of dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, have been reported from Mexico, Costa Rica, Honduras, Belize, El Salvador, and other Central American countries. Travelers should apply insect repellent and keep themselves covered to prevent mosquito bites, which transmit the disease.

An outbreak of Pontiac fever, which is caused by the same bacteria that cause Legionnaire's disease, has been reported from the Barcelona area. The outbreak is thought to have been spread by irrigation systems. Any traveler to Barcelona who develops a fever should seek immediate medical attention.

An outbreak of Rift Valley fever (RVF) has been reported from South Africa, chiefly the Free State, but also Eastern Cape Province, Northern Cape Province, Western Cape, and North West Province. RVF is a viral infection usually transmitted by mosquitoes, but also acquired by direct exposure to infected animals. Insect protection measures are strongly advised for South Africa.

A polio outbreak has been reported from from the southwestern part of Tajikistan, on the border with Afghanistan and Uzbekistan. Any adult who received the recommended childhood immunizations but never received a booster as an adult should be given a single dose of inactivated polio vaccine before travel to Tajikistan.

Measles outbreaks have been reported from a number of African countries, most recently Malawi, Mozambique, and Zambia. All travelers to Africa born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune.

A rabies outbreak has been reported from the southern and eastern parts of Bali, caused by bites from infected dogs. Travelers should avoid touching all animals, including pet dogs and cats and wild animals such as monkeys. Rabies vaccine is recommended for travelers at risk for animal bites.

A series of mumps outbreaks have been occurring in the United Kingdom, chiefly involving schoolchildren and university students. All travelers to the U.K. born after 1956 should make sure they have had either two documented mumps immunizations or a blood test showing mumps immunity. This does not apply to people born before 1957, who are presumed to be immune.

Thousands of cases of Q fever have been reported from the Netherlands, chiefly the province of Noord-Brabant in the south. Q fever is primarily a disease of ruminants such as cattle, sheep, and goats, which shed the Q fever bacteria in their body fluids, especially birth products. Humans become infected by inhaling dust or aerosols contaminated by body fluids from infected animals.

An increase in the number of cases of pertussis (whooping cough) has reported from several states, including New South Wales, Queensland, and Victoria. Pertussis is a highly contagious respiratory infection, spread by exposure to an infected person who is coughing or sneezing. All travelers to Australia should be fully immunized against pertussis. The vaccine is generally given in combination with the vaccines for tetanus and diphtheria.

More than 30 cases of yellow fever have been reported from the states of Rio Grande do Sul and Sao Paulo since October 2008. A single case has also been reported from Minas Gerais. Yellow fever vaccine is strongly recommended for all travelers to these states. Travelers should also protect themselves from mosquito bites by applying insect repellent and keeping themselves covered.

An outbreak of Chagas disease has been reported from Chichiriviche de la Costa, in the western part of the state of Vargas. The outbreak appeared to have been caused by contaminated guava juice. Travelers to Venezuela and other countries in South America should avoid consuming homemade juice or wine, especially from roadside stands.

A small number of human cases of avian influenza (bird flu) continue to be reported, mostly from Egypt, Indonesia, and Viet Nam. Almost all human cases have occurred in those who have had direct contact with infected poultry. As before, travelers should not hesitate to visit countries affected by avian influenza, but should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked.

An outbreak of hand, foot, and mouth disease has been reported from China, chiefly affecting young children. The northeastern provinces of Henan and Shandong have been especially affected. Hand, foot, and mouth disease is characterized by fever, oral blisters, and a rash or blisters on the palms and soles, usually occurring in young children. Most cases resolve uneventfully, but a small percentage are complicated by encephalitis (inflammation of the brain), myocarditis (inflammation of the heart muscle), or pulmonary edema (fluid in the lungs). The disease is caused by enteroviruses, which are transmitted by exposure to fecal material from infected individuals. There is no vaccine. The key to prevention is good personal hygiene and scrupulous hand-washing, especially after defecation and before handling food. No travel restrictions are recommended.

An alert for Murray Valley encephalitis has been issued for the Kimberley and the Pilbara in Western Australia after blood tests showed the disease was found in sentinel chickens. The increase in viral activity occurred after weeks of flooding. Murray Valley encephalitis is transmitted by "common banded" mosquitoes, which breed in grassy and reed swamps and pools and bite after sundown. Murray Valley encephalitis may cause fever, headaches, neck stiffness, confusion, seizures, nausea, vomiting, tremors, and dizziness. Severe cases may progress to coma and death. There is no vaccine. Travelers to Western Australia should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

An outbreak of dengue fever has been reported from northern Argentina, especially affecting the province of Chaco. Dengue fever is a mosquito-borne viral infection which is sometimes complicated by hemorrhage or shock. There is no vaccine. Travelers to northern Argentina should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

A major outbreak of dengue fever has been reported from Bolivia, chiefly affecting the department of Santa Cruz. Cases have also occurred in Beni, Pando, Cochabamba, Chuquisaca and La Paz. Dengue fever is a mosquito-borne viral infection which is sometimes complicated by hemorrhage or shock. There is no vaccine. Travelers to Bolivia should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

Although no human cases of yellow fever have been reported from Trinidad since 1979, recent yellow fever cases in monkeys indicate that the virus is continuing to circulate in forested areas of the island. Yellow fever vaccine is recommended for travelers who will be going to Trinidad, except for cruise ship passengers who do not disembark from the ship or travelers visiting only Port of Spain, who may consider foregoing vaccination. Yellow fever vaccine is not recommended for those visiting only Tobago.

An outbreak of meningococcal meningitis has been reported from the states of Meghalaya, Tripura and Mizoram in northeastern India. Meningococcal infections are spread person-to-person by exposure to secretions from the nose or throat, and may lead to meningitis, marked by the abrupt onset of fever, headache, stiff neck, and lethargy, frequently with a rash. Meningococcal vaccine is recommended for all travelers to Meghalaya, Tripura and Mizoram.

A series of mumps outbreaks have been reported from the United Kingdom, chiefly affecting schoolchildren and university students. Mumps is a viral infection which is spread by direct contact with or inhalation of oral or nasal secretions from an infected person. All travelers born after 1956 should make sure they have had either two documented MMR immunizations or a blood test showing mumps immunity. This does not apply to people born before 1957, who are presumed to be immune.

A measles outbreak has been reported from the canton of Vaud. Measles outbreaks occur regularly in Switzerland, due to low vaccination rates among Swiss2/8/2009 children. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity. Those born before 1957 are presumed to be immune. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to Switzerland.

An outbreak of leptospirosis has been reported from Fiji after massive flooding caused by torrential rains. Leptospirosis is transmitted to humans by exposure to water contaminated by the urine of infected animals. Symptoms may include fever, chills, headache, muscle aches, conjunctivitis (pink eye), light sensitivity, and rash. Most cases resolve uneventfully, but a small number may be complicated by meningitis, kidney failure, liver failure, or hemorrhage. There is no vaccine. Travelers exposed to potentially infected water can lower their risk of becoming ill by taking 200 mg of doxycycline.

A case of Marburg hemorrhagic fever has been reported in a U.S. citizen who had visited “the python cave” in the Maramagambo Forest in western Uganda (at the southern edge of Queen Elizabeth National Park). This cave contains large numbers of fruit bats, which can harbor Marburg virus. In July 2008, a fatal case of Marburg hemorrhagic fever occurred in a Dutch tourist who had visited the same cave. Travelers should avoid these caves until further notice

A rabies outbreak related to infected dogs has been reported from the southern tip of Bali. Travelers to Bali should avoid touching all animals, including pet dogs and cats and wild animals such as monkeys. Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites.

An outbreak of dengue fever has been reported from the northern suburbs of Cairns. Dengue fever is a mosquito-borne viral infection which is sometimes complicated by hemorrhage or shock. There is no vaccine. Travelers to northern Queensland should protect themselves from mosquito bites by applying repellent and keeping themselves covered.

A nationwide cholera outbreak caused by contaminated drinking water has been reported from Zimbabwe, causing tens of thousands of cases. The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most travelers are at low risk for infection, as long as they drink and use only bottled water. Cholera vaccine, which is available in many countries but not the United States, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care.

An outbreak of dengue fever has been reported from St. Maarten, causing hundreds of cases. Dengue fever is a mosquito-borne viral infection which is sometimes complicated by hemorrhage or shock. There is no vaccine. Travelers to St. Maarten should protect themselves from mosquito bites by applying repellent and keeping themselves covered.