This update is being sent to members of the Wisconsin Travel Health Network.
Global Health Update
Oropouche
There have been several travel health alerts for Oropouche virus disease (Oropouche) since summer 2024. At this time, countries reporting low levels of Oropouche cases include Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guyana, and Peru. Additionally, there is currently an outbreak of Oropouche in Cuba, with multiple cases of Oropouche having recently been reported in U.S. and European travelers returning from travel to Cuba.
Oropouche virus is spread through biting midges and mosquitoes. Illness can occur in people of any age, and Oropouche symptoms are often mistaken for dengue. Oropouche virus has been found in semen, but it is unknown if it can be spread through sex. At the time of writing, there have been no reported cases of sexually-transmitted Oropouche.
Individuals planning to travel to affected areas should take steps to prevent bug bites and should consider using condoms or not having sex during travel and for six weeks after returning from travel. Pregnant people should reconsider non-essential travel to Cuba. The potential risks of Oropouche during pregnancy are unclear, though there are concerns that Oropouche virus being passed from a pregnant person to their fetus is associated with fetal deaths and congenital abnormalities.
CDC Travel Health Notices for International Travelers
Level 4 – Avoid All Travel
None at this time.
Level 3 – Reconsider Nonessential Travel
None at this time.
Level 2 – Practice Enhanced Precautions
Chikungunya in the state of Telangana, India
The CDC (Centers for Disease Control and Prevention) has issued a level 2 travel health notice for chikungunya in Telangana. Telangana is a state in south-central India, and chikungunya is a disease spread by mosquitoes. Symptoms of chikungunya include fever, joint pain, headache, muscle pain, joint swelling, or rash. The CDC has seen higher-than-expected chikungunya cases in U.S. travelers returning from Telangana. Travelers can protect themselves from chikungunya by using insect repellant and wearing long-sleeved shirts and pants. Additionally, individuals 18 years and older traveling to areas with a current chikungunya outbreak should be vaccinated against the virus. The chikungunya vaccine should not be given to people with weakened immune systems or to people who have had a serious allergic reaction to a vaccine component. Advise pregnant people to reconsider travel to Telangana, as vaccination generally should be deferred until after delivery.
Marburg in Rwanda
The CDC has downgraded the Marburg travel health notice in Rwanda from a level 3 to a level 2. On December 4, the U.S. government ended public health entry screening at three U.S. airports for people coming from Rwanda. There have been no new cases of Marburg reported in Rwanda since October 30. The risk of Marburg in the U.S. is extremely low, though the CDC continues to recommend that people traveling to Rwanda avoid all possible exposure to ill people and watch for the development of Marburg symptoms until 21 days after leaving Rwanda.
Level 1 – Practice Usual Precautions
Global Dengue (Updated November 15)
Global Measles (Updated November 21)
Holiday Travel Safety
Over a million Wisconsinites traveled for Thanksgiving, and many more will be traveling for the holidays between December and January. Remind travelers about safety practices, like ensuring children have proper booster seats on car trips and following winter driving safety recommendations. If individuals are traveling to warm climates that have current warnings for vector-borne diseases, such as Cuba, Telangana, and countries at risk of dengue, counsel them to bring long sleeves and pants to avoid mosquitos.
As COVID-19 and influenza rates continue to increase, travelers should take steps to protect themselves and their families. Regular handwashing is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. If soap and water are not available, travelers should use hand sanitizer containing at least 60% alcohol. COVID-19 and influenza vaccinations are particularly important during the holidays as large gatherings become more frequent. Remind travelers that vaccination takes two weeks to reach full efficacy, and they should plan accordingly.
For those traveling internationally, travelers should check their destination for country-specific health risks and safety concerns. Travelers should ensure they have a plan to get care overseas if needed, especially if their health insurance does not cover medical care abroad. Counsel people traveling to low- or middle-income countries with potential sanitation risks to choose safe food and drink. Travelers can use the Wisconsin Department of Health Services (DHS) safe travel checklist to ensure they are prepared for upcoming trips.
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Sexual Health Guidance: Travel and Bacterial STIs
The U.S. has higher rates of sexually transmitted infections (STIs) than most other developed nations. Common curable, bacterial STIs include Chlamydia trachomatis infection, gonorrhea, and syphilis. As many STIs can be asymptomatic, travelers can easily be unknowingly exposed to an infected individual since the other person may be unaware of their STI status.
The CDC estimates that one in three travelers will have sex with a new partner while on a trip. Providers should give safer sex guidance and supplies to help prevent infections to individuals who plan on having sex with new or multiple partners while traveling. Accessing care for an exam and diagnosis may be cumbersome for travelers, so prevention is key.
Counsel travelers to seek STI testing prior to their departure. Provide risk reduction items like condoms, information on safer sex practices, and medication that can prevent STIs from developing in case of an exposure, such as doxycycline post-exposure prophylaxis (Doxy-PEP) (see CDC recommendations). Additionally, encourage travelers to protect themselves against viral STIs by getting the hepatitis A, B, and HPV vaccines. If a traveler is concerned about HIV, PrEP (HIV pre-exposure prophylaxis) may also be recommended. Find more information on the CDC yellow book and DHS STI webpage.
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International Students
International students returning home for the holidays or students participating in a study abroad program over the winter break should check the CDC’s destination pages for travel health information. If necessary, travelers should schedule destination-specific vaccines at least 4–6 weeks before departure and should inform their provider of health concerns they may have, as well as their itinerary and planned activities.
Traveling students should always follow security and safety guidelines, such as carrying a copy of their passport or visa. As students adjust to their environment, they should seek support from their institution and health provider as needed if they experience changes in their physical or mental health. Advise students to continue their routine medications while abroad and ensure traveling students have a plan to obtain medical and mental health care, if necessary, as their domestic health insurance may not extend to other countries.
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Disease Spotlight: Pertussis
Pertussis (whooping cough) is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. It’s known for the “whoop” noise when someone gasps for air after a coughing fit, a symptom that affects about a third of those who get this infection.
In the United States, as of November 9, 2024, more than five times as many pertussis cases have been reported in 2024 compared to the same time in 2023. Additionally, as of December 13, 2024, Wisconsin has 2,245 confirmed cases of pertussis statewide. Cases have also risen in several countries, including Brazil, Mexico, Peru, and the developing world. Before traveling, individuals should check for any travel health notices related to pertussis for their destination. Travelers should also protect themselves, their family, and their community by getting the pertussis vaccine.
What are the symptoms?
It usually takes five to 10 days for symptoms to appear after exposure to the bacteria that causes pertussis. Sometimes symptoms do not develop for as long as three weeks. At first, a person with pertussis may seem like they have a cold. Early symptoms include low-grade fever (less than 100.4°F), slight cough, and runny or stuffed up nose.
After one or two weeks, the cough progresses to rapid, violent, and uncontrollable coughing fits. These coughing fits usually last one to six weeks but can last for up to 10 weeks. The cough generally gets worse and becomes more common as the illness continues. The cough causes other symptoms, such as:
- Difficulty breathing.
- Needing to take a deep breath that makes a “whoop” sound.
- Vomiting during or after coughing fits.
- Having difficulty sleeping at night.
Babies may not have a cough. Instead, they may stop breathing for several seconds (apnea), or they may look like they are gasping for air. The apnea may cause cyanosis (turning blue). Babies are at greatest risk for getting pertussis and can have serious complications from it, including death. That is why it’s important that pregnant people and everyone who regularly comes into contact with the baby are up to date with their pertussis vaccines. Pertussis vaccines are effective but vaccinated people can still get pertussis; people who have been vaccinated but still get pertussis generally experience a milder illness.
More information about the signs and symptoms of pertussis can be found on the DHS pertussis web page.
How is it spread?
The bacteria that cause pertussis can spread easily from person to person through the air. When a person with pertussis sneezes or coughs, they release small particles of the bacteria that other people can then breathe. These bacteria can spread when people spend a lot of time together or share breathing space.
How is it treated?
It’s very important to treat pertussis early, before coughing fits begin. Health care providers generally treat pertussis with antibiotics. Further treatment in the hospital may be required if symptoms are serious.
Travel recommendations
The best way to prevent pertussis is by getting vaccinated with the Tdap or DTaP vaccines. These vaccines provide protection against tetanus, diphtheria, and pertussis. For the best protection against pertussis, travelers should plan to be fully vaccinated at least two weeks before they depart.
If their trip is less than two weeks away and they are not protected against pertussis, they should still get a dose of the pertussis vaccine.
Travelers should contact their health care provider, local or Tribal health department, or locate a pharmacy or clinic near them to schedule an appointment for the pertussis vaccine. The CDC recommends vaccines for the following groups:
DTaP for young children:
- 2, 4, and 6 months
- 15 through 18 months
- 4 through 6 years
Tdap for preteens:
Tdap for pregnant people:
- During the 27th to 36th week of each pregnancy
Tdap for adults:
- Anytime for those who have never been vaccinated
- Every 10 years
All travelers should follow the CDC’s routine recommended vaccine schedule.
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