Shifting disease patterns and outbreaks affect the recommendations and information we provide to travellers during a pre-travel consultation. Each week Travelvax updates the current travel health alerts to reflect those issues which could affect travellers heading to a particular region or country. We do this by scanning the websites of health agencies such as the World Health Organization and the European and US Centers for Disease Control, as well as international news media. Simply click on the point on the map of your area of interest for more details on the current health alert. We also include Advice for Travellers which gives background information and tips. If you have any further questions, of course you can give our Travelvax infoline a call during business hours on 1300 360 164.
World travel health alerts for 27th of September 2018
Bangladesh: Late dengue peak for capital
Dhaka’s dengue fever cases have exceeded 5,200 this year but authorities are admitting there will be many more that go unreported – southern districts have been hardest hit. In a bad year for dengue, related deaths have risen to a 15-year high. Read more
Advice for travellers
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. Travellers should cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active. Apply repellent containing an active ingredient, such as DEET, Picaridin, or PMD when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.
Chile: Cholera in 3 regions
Since June more than 30 people with no recent history of travel have been diagnosed with cholera, and investigations continue as to the causes of infection. The three regions reporting cases are La Florida, Valparaiso and Atacama. Read more
Advice for travellers
Cholera is usually spread in contaminated water. For most short-stay travellers, the risk of infection is low. Australians travelling 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.
Colombia: Port city’s dengue alert
Health alerts have been issued for eight localities due to a rise in dengue fever cases. Included in the alert is the northern department of Atlántico which has experienced a 50 percent rise in dengue infections. Around half of cases have been in the municipality of Soledad in the popular port city of Baranquilla. Read more
Cuba: Fever cases in east and west
Stronger mosquito control measures have been called for in the eastern province of Holguín after reports of dengue fever cases in eight provincial towns. In a (computer translated) local news report, a public health official confirmed that ‘fever cases related to Dengue and Zika, arboviruses transmitted by Aedes Aegypti, have increased’. Earlier this month, local media reported isolated Zika virus cases in Pinar de Rio, the westernmost province of Cuba.
Advice for travellers
Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information on smartraveller (DFAT).
Democratic Republic of Congo: Latest update, response meets conflict
The WHO has recommended caution while delivering news that control measures are working in the Ebola virus disease (EVD) outbreak. Updates from this week include information on a confirmed EVD case in a new area - Tchomia Health Zone in Ituri Province, bordering Uganda. It has also been reported that the Tchomia case had ‘actively avoided [WHO] teams and refused care. Read more. Violence in the response centre’s base of Beni is limiting treatment and surveillance measures, leading a senior WHO official to caution of ‘a "perfect storm" of active conflict and traumatized communities [which] could enable the deadly disease to spread’. Read more. Latest figures indicate there have been 120 confirmed and 30 probable Ebola virus disease cases and almost 12,000 people have been vaccinated.
Advice for travellers
Ebola virus disease is a severe viral haemorrhagic fever found in humans and other primates (such as monkeys, gorillas, and chimpanzees). It spreads through families and friends in close contact with blood and infectious secretions of people with obvious symptoms and, as such, presents a low risk to tourists to the affected countries. Read more about Ebola virus disease.
Europe: More than 1,100 cases this WNV season
In the latest reporting week, 186 new West Nile Virus (WNV) cases were reported in the region. Of those over 90 were in Italy, ‘Greece (32), Romania (33), Hungary (12) and Croatia (11)’. This WNV season has been more severe and started earlier in the year. Read more. All details are outlined in the Sept 22 update from the European Centre for Disease Control (ECDC).
Advice for travellers
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.
India: Zika in Rajasthan; Diphtheria cases treated in Delhi; Dengue peaking
A single case of Zika virus disease has been confirmed in a resident of Jaipur in Rajasthan this month. The state’s health minister has cancelled leave for all medical providers to deal with this and other seasonal illnesses, including dengue fever, malaria and scrub typhus. Further investigations into Rajasthan’s Zika case are being carried out by a medical team that includes the director of the National Centre for Disease Control (NCDC) – this is the first case of Zika identified in Rajasthan, the previous (4) confirmed infections were in Gujarat and Tamil Nadu. Read more
A CHILDREN'S hospital in Delhi treated 147 children aged nine years or under for diphtheria over a 17 day period this month, 18 of them died from the infection. According to a news report, only 14 of the children were from Delhi, the remainder were from Uttar Pradesh (122) and Haryana (11). Read more
SEPTEMBER has proved to be the peak month for dengue fever infections in Delhi, however the total is less than one quarter of that reported in the city last year. While in eastern Maharashtra state, the region of Vidarbha is experiencing a surge in dengue fever and scrub typhus cases.
Advice for travellers
Spread by coughing and sneezing or or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.
Japan: STI rate increases
Rates of the sexually transmitted infection syphilis have been climbing across the country for the past seven years, but it’s Tokyo, Osaka and Okayama Prefecture that have the highest incidence. As outlined in a news report, the rise has been particularly noticeable among young Japanese women, increasing by as much as ten times over three years. Last year’s national total of more than 5,800 syphilis cases was a 44-year peak in infections but year-to-date, this year is higher.
Advice for travellers
Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.
Laos: Dengue surges in 3 provinces
The highest rates of dengue fever infections and dengue-related deaths this year have been recorded in the central province of Savannakhet, followed by Attapeu and Champassak in the south – the national count to Sept. 14 is 4,600 infections and 14 deaths (the capital Vientiane has reported 585 dengue cases but no associated deaths). The government has said it is committed to reducing the burden of dengue fever by using public awareness campaigns and promoting clean-ups in local areas. Read more
Mauritius: Measles cases exceed 1,000
A local news site reports on a further increase in measles infections, climbing to 1,022 cases since the outbreak began in March. The most affected age group is adults from 20 to 49 years of age and the districts, Port-Louis, Rivière-Noire and Plaines-Wilhems. The death toll remains at 3 (immunocompromised women aged 29-31 years) and occurred in June .
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.
Niger: Cholera persists in southern border areas
More cholera cases have been recorded in the central south, bordering areas of Nigeria which are also experiencing outbreaks. The regional WHO update notes that ‘The ongoing rainy season and the increase in cholera cases in Katsina State in Nigeria provide the potential for further spread of the disease both within Niger and across the border with Nigeria’. In the 12 weeks since the outbreak was first announced, there have been over 3,400 cases and 67 deaths in the affected region of Niger. Read more
Sudan: Kassala outbreak worsens
The outbreak of what is suspected to be chikungunya that is affecting the eastern district of Kassala, as reported on Sept 13, has expanded significantly with the case count now totalling over 11,000. Chikungunya may not be the only virus circulating, with some reports of dengue fever transmission also. Read more
Advice for travellers
The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.
United Kingdom: Secondary case of monkeypox
A healthcare worker who was caring for one of the recent monkeypox cases after his arrival in the UK from Nigeria has been diagnosed with the infection. It appears that strict personal protective measures were not used by those staff members having close contact with the patient prior to the confirmation of the diagnosis. As a result their health was being closely monitored for the maximum duration of the incubation period, 21 days. Read more. More on the current situation regarding monkeypox in Nigeria can be found here.
Advice for travellers
Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox.
Venezuela: Local and regional impacts of 2 vaccine-preventable diseases
The spread of measles both within Venezuela and to regional countries is highlighted in a Sept 21 PAHO (Pan American Health Organization) report. Venezuela has recorded more than 4,600 measles infections and 61 deaths this year (to Sept 1) from ‘all states and the Capital District’. Brazil, Peru, Ecuador and Colombia have all confirmed imported or import-related infections. As a result, advice to national authorities provided to Member States by the PAHO includes ‘all travelers aged 6-months and older who cannot show proof of vaccination or immunity, receive the measles and rubella vaccine, preferably the triple viral vaccine (measles, mumps and rubella - MMR), at least two weeks before traveling to areas where measles transmission has been documented. The recommendations for advice for travelers are available in the 27 October 2017 PAHO/ WHO Epidemiological Update on Measles‘.
ALSO from the PAHO, a regional update on the current situation on diphtheria: The bacterial infection has spread to 22 of Venezuela’s states and capital district – 660 cases and 81 deaths this year, with the highest incidence in children from 10 to 14 years. Among those countries reporting to the PAHO, Haiti is also experiencing high rates of diphtheria – this year there have been 281 probable cases and 22 deaths. Nearly two-thirds of cases were in children under 14 years of age. PAHO advice is for going to countries with outbreaks to be ‘properly vaccinated prior to travel’ while noting they ‘don’t have ‘a special risk for diphtheria infection’.
Zimbabwe: Response to cholera outbreak as death toll rises to 49
A multi-drug resistant strain of cholera is continuing to produce cases - mainly from Harare, but also in Makoni and Masvingo. The death toll has climbed to 49 from nearly 6,645 suspected cases and with the assistance of the WHO, a vaccination campaign has been announced for the worst hit districts. Read more. The Sept 20 WHO Disease Outbreak News can be read here.