World travel health alerts 27 July 2022

Gastro cases on the rise

In Granada, cases of a gastro-intestinal illness have been on the rise over the past couple of weeks. The nature and cause of the illness were not specified but local health authorities have said that they expect more cases ‘in the coming days and weeks as the Carnival celebrations intensify’. To date most cases have been in the parishes of St. George and St. Andrew. Read more

Tick-borne infections in season

Local media reports on Crimean-Congo haemorrhagic fever (CCHF) notifications this year have the national total at 33 confirmed cases and four deaths. In Afghanistan, CCHF incidence is higher, with 115 suspected and confirmed cases registered in 22 provinces. Eight fatal cases were recorded in the provinces of Herat, Kapisa, Nangarhar and Kabul. Surges in infections occur annually, particularly around religious festivals. Lastly, in Europe, Spain’s first case of CCHF this year has been confirmed in a man from the NW province of León who is reported to have contracted the disease through a tick bite. The infection remains a relatively rare event in Spain, with sporadic cases reported since 2106, mostly from the Castile and León region. Read more

Advice for travellers

CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The disease, which has a fatality rate of 10-40%, is more common in Africa, the Balkans, the Middle East, and Asia, as well as countries south of the 50^th parallel north. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to most travellers. Read more about the virus.

Cholera infections persist in southern regions

Cholera outbreaks in Banadir region and the adjacent states of South-West and Hirshabelle were the subject of a WHO Disease Outbreak News post after nearly 8,000 cases and 37 fatalities were reported for the six months of the year. The numbers have passed the 2021 total for the same drought-stricken areas which house Internally Displaced Populations (IDP) camps. The first stage of a cholera vaccination campaign was conducted in mid-June in nine high-risk districts. Also on cholera, ProMED reports on outbreaks in Afghanistan (Jawzjan, Helmand and Kandahar provinces) and Iran (Kordestan, Kermanshah and West Azerbaijan provinces). Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travel, the risk of infection is low. Travellers to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care. Read more about cholera.

Alert over parasitic infections in Santa Fe city

An upsurge of cases of trichinellosis has been reported in the province of Santa Fe, west of Buenos Aires. The epicentre is in the city of Rufino where an alert was issued after eight people were confirmed to have the parasitic infection – that has now climbed to 23 cases. The infection is generally acquired through consuming undercooked meat (often pork) infected with Trichinella roundworms. As there can be a lag time between infection and symptoms appearing, more cases are expected. More about trichinellosis from the US CDC. Read more

Malaria incidence declines, dengue cases up

The first half of 2022 saw a three percent decline in malaria notifications, down to just over 2,000 cases and no associated fatalities, according to one media report. The declining incidence was attributed by Cambodia’s director of the National Centre for Parasitology, Entomology and Malaria Control to ‘better awareness, adequate equipment such as malaria testing devices, insecticide-treated mosquito nets, and anti-malarial drugs’. The local situation regarding dengue fever is not as positive, with heavy rainfall from an early wet season seeing cases rising 3-fold compared to last year and seven deaths have been recorded. The peak season will run till October. Read more

Advice for travellers

Dengue fever is common in most tropical or sub-tropical regions of the world. The virus is spread by daytime-feeding Aedes mosquitoes and to avoid it and other insect-borne diseases, travellers should apply an insect repellent containing an effective active ingredient, such as DEET, Picaridin or oil of lemon eucalyptus (PMD), to exposed skin when outdoors during the day. In addition, cover up with long-sleeved tops, long pants, and shoes and socks around dawn and dusk, as well as other times when the mosquitoes are active

Measles spreads to all 10 regions

The measles outbreak that first erupted in 2021 shows no signs of letting up, with all 10 regions now affected. The WHO weekly bulletin update names Far-North region as having most cases, followed by the Centre region, Littoral and South region. Over 74 percent of confirmed cases had no history or proof of measles vaccination. The agency noted that the health system is already burdened by the COVID-19 pandemic, yellow fever and cholera. Funding support is being sought for reactive vaccination campaigns planned for next month. Read more

Advice for travellers

Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. While generally benign, infection can result in severe illness or death. Travelvax Australia recommends travellers check their immunisation status for measles and other childhood diseases such as diphtheria, whooping cough (pertussis) and mumps at least 6 weeks before departure. Read more about measles.

Yellow fever vax campaigns launched

A yellow fever (YF) vaccination program targeting residents aged from 9 months to 60 years is being held in Isiolo County and in Lagdera and Balambala in the neighbouring county of Garissa. The health department arranged the campaign in response to a outbreak that was first announced in March. To date there have been 71 YF cases and seven related deaths; Merti and Garbatulla sub-counties have been hardest-hit. Also on yellow fever, a round of reactive vaccinations is planned for nine districts in southern and central Chad to stem an outbreak of yellow fever which has been active since November last year. Read more

Advice for travellers

Yellow fever virus is a mosquito-borne disease found in tropical and subtropical areas in Central/South America and Africa. While it can be severe, yellow fever infection is a very rare in Australian travellers. However, under the International Health Regulations (IHR), proof of vaccination may be required of any traveller entering or leaving an area at risk of yellow fever transmission. Read more about yellow fever.

Challenging monkeypox outbreak now a global emergency

Global cases of monkeypox (MPX) had passed the 19,000-mark by July 26 and Spain continues to have the highest total with 3,738 cases, while the order of the next three has changed to USA (3,590), UK (2,432) and Germany (2,410). The UKHSA announced this week an update on the case definition of MPX to ’help both individuals and clinical professionals identify monkeypox symptoms’. The widespread outbreaks of monkeypox have now been declared a Public Health Emergency of International Concern (PHEIC) by the WHO after the director-general cast a deciding vote when the committee could not reach a consensus. His reasons for doing so included concern over the dearth of knowledge on new modes of transmission in a global outbreak with rising case numbers (and likely many more undiagnosed). It was therefore gauged that ‘the risk of monkeypox is moderate globally and in all regions, except in the European region where we assess the risk as high … There is also a clear risk of further international spread’. The monkeypox PHEIC is the third in place currently, along with COVID-19 and polio. Temporary recommendations based on each country’s epidemiological situation have been set by the WHO and it has now established a live dashboard with monkeypox data. In related news, a CIDRAP post summarises the findings from a large international study on the MPX virus which is likely to lead to an expansion of ‘the current international case definitions … to add symptoms that are not currently included’. Read more

Advice for travellers

Closely related to the smallpox virus, monkeypox has its origins in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People travelling in endemic countries can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk in those regions. More recently, monkeypox has spread person-to-person around the globe, primarily through large respiratory droplets, but also via direct contact with skin lesions or body fluids (i.e. close or intimate contact) and indirect contact by way of contaminated bedding, clothes etc. Read more from the WHO on the current outbreaks of monkeypox.

Reports of 3rd Marburg virus case

According to local media reports, preliminary results taken from a now-deceased relative of one of the two confirmed Marburg virus disease (MVD) cases indicate that he too was infected with the viral haemorrhagic illness. The individual is said to have developed MVD symptoms sometime after the maximum incubation period of 21 days. The health of 40 contacts is being monitored. On July 22, the WHO published a Disease Outbreak News article relating to the outbreak, advising that the source of the initial infections had not been determined as yet, and the risk of spread within Ghana is high and moderate on a regional level. The latter decision was based on the fact that the first case was in the Western Region before developing symptoms and was subsequently given an unsafe burial in an area of Savannah adjacent to the borders with Côte d’Ivoire and Burkina Faso.  Read more

Advice for travellers

Marburg virus disease is a rare but severe viral haemorrhagic fever, related to the Ebola virus, and there is no treatment. Found in the African fruit bat, Marburg typically appears in sporadic outbreaks and laboratory-confirmed cases have occurred in Uganda, Zimbabwe, the Democratic Republic of the Congo, Kenya and Angola. Preventive measures are not well defined, as study in how it is spread continues, but travellers should avoid contact with fruit bats and sick primates in central Africa. Read more

Monsoon season disease update

Health authorities in the NE state of Assam have announced a sharp increase in the number of Japanese encephalitis cases since the beginning of July - fatalities have also risen to 41. At least 17 districts have reported JE cases during the peak season which runs until October. In Chhattisgarh, reports have emerged of dengue fever and JE cases and deaths in Bastar Division, home to several tribal groups. Over on the west coast, a viral haemorrhagic infection transmitted to humans through tick bites or contact with an infected monkey, Kyasanur Forest Disease (KFD), has sickened nine people in Sindhudurg district, Maharashtra. As a ProMED moderator noted, ‘herders, forest workers, farmers, and hunters are particularly at increased risk of contracting the disease’. And in Goa, paediatricians are reporting a spike in cases of hand, foot and mouth disease (HFMD), known locally as ‘tomato fever’. Read more

Advice for travellers

A mosquito-borne virus, JE is generally found in many parts of Asia, the Indian subcontinent, Southeast Asia, China, Indonesia and PNG, and more recently, in areas of southern and eastern Australia. In Asia, it is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to large urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

More regions reporting West Nile virus infections

On a regional level, West Nile virus (WNV) case numbers are reported to be within the norms of previous years at this stage of the transmission season, whereas Italy’s current tally of 15 cases and four deaths is the highest since 2018. ECDC data to July 20 reveals WNV infections in several northern regions (five cases in Padova, two in Modena and one each in Vercelli, Novara, Brescia, Mantova, Verona, Venezia, Ferrara and Ravenna). Greece has recorded four WNV cases this season (Thessaloniki). Read more

Advice for travellers

West Nile virus is endemic in Eastern Europe and the Mediterranean basin, with sporadic outbreaks reported in summer and autumn since the 1950s. Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuroinvasive disease.  The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Europe’s outbreaks are not as severe or widespread as in other regions where the virus occurs, notably North America. Read more on WNV.

COVID-19 update

The WHO global update last week advised that new case numbers had been stable after several weeks of increases, In a separate EU update, a 4.4 percent decline in new cases was registered but deaths rose by twice that figure and were mostly in the 65 years and over age group. The Western Pacific logged the greatest increase in new cases on a regional level (up 37 percent), largely driven by 100 percent or more rises in Japan and South Korea. BA.5 subvariants made up just over 50 percent of samples tested. After more than two years of zero COVID-19 infections in the Federated States of Micronesia, the government announced the first positive cases in the community in Pohnpei and Kosrae on July 19. A week later, case numbers have soared to more than 2,000 and one death has been recorded. According to the July 26 update, ‘Both Yap and Chuuk remain COVID-19 free in their communities’. Read more

In related news:

- Science Daily published an article on July 25 providing details from a UK study on the broad range of symptoms being experienced by sufferers of long covid: ‘Hair and libido loss join fatigue and brain fog among wider list of Long COVID symptoms’.

- A Burnet Institute article explains ‘Why upgrading your face mask is a crucial defence against new COVID-19 variants’.

Another wild poliovirus case, vaccine-derived infections in US, Africa, Middle East

The country’s 13^th wild polio case has been announced – a young child from Lakki Marwat in Bannu Division. All cases in this year have been in tribal districts of southern Khyber Pakhtunkhwa province. In other news, in the US state of New York, an unvaccinated Rockland County resident has been diagnosed with vaccine-derived polio. Further testing indicated the infection was acquired from a recipient of an oral polio vaccine type 2, which has not been used in the US since 2000. According to the ECDC, the patient is ‘a 20-year-old male who travelled to Poland and Hungary this year and was hospitalised in the US in June’. He resides in the same district affected by a large measles outbreak in 2018-19. US polio vaccination coverage in children at two years of age is estimated to be 92.6 percent. NY health authorities are requesting that residents who are unvaccinated complete the primary polio vaccination course, and for those who have been vaccinated in the past, have a booster. Read more. The last VDPV case diagnosed in the US was in 2013. From the weekly GPEI update, circulating vaccine-derived polio type 2 (cVDPV2) infections were logged by Nigeria (three cases from Katsina, Taraba and Zamfara states) and Yemen (five cases in Amran, Lahaj, Dhamarfour governorates and Sanaa city). Read more

Advice for travellers

Poliomyelitis is a potentially serious viral illness that is spread through contact with infected faeces or saliva. The risk to travellers is generally low, however vaccination is recommended for travel to affected regions and is a requirement for travel to/from some countries. If at risk, adults should have a booster to the childhood series. More on polio.

Dengue outbreak now waning

There has been more positive news on the dengue fever outbreak with fewer cases being reported now that the rainy season is over. The outbreak, the country’s first, was announced in early May and the majority of cases have been in Água Grande health district. A dengue response plan has now been developed and ‘national and local-level capacity has been built in response’. Read more

Advice for travellers

Avoid mosquito bites to protect against dengue fever. To avoid biting insects, apply repellent containing an active ingredient, such as DEET, Picaridin, or oil of lemon eucalyptus (PMD) to all exposed skin when outdoors. Dengue is spread by two types of aedes mosquitoes. Both breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid outdoors. Travellers should also cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active.

Managing Hep E outbreak

A resurgence in hepatitis E infections in a large displaced persons camp just outside the southern city of Bentiu is being tackled jointly by the health department and Médecins Sans Frontières using a Chinese-developed vaccine, Hecolin. The large scale vaccination campaign is the first using Hecolin, which is currently not prequalified by the WHO. In 2015 the agency advised its use ‘should be considered in special situations to mitigate consequences in pregnant women’. Read more. Two doses of the three-dose schedule have already been administered and the final round is planned for October. Read more

Advice for travellers

The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Infection during the latter stages of pregnancy carries a higher rate of severe disease and mortality. Unlike the Hep A and B viruses, there is no vaccine for this strain in Australia, which is especially common in communities with lower levels of sanitation and hygiene. Read more about the virus and how to prevent it.