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 13th of September 2018
Argentina: Sand fly infection strikes southern Yungas
Last year the Yungas region of the remote NW province of Jujuy recorded 30 cases of the sand fly-borne parasitic infection leishmaniasis, this year there have been more than 100 cases and a provincial legislator is describing it as an epidemic. Four towns (Caimancito, Yuto, Calilegua and Fraile pintado) have been hard hit in the area which forms part of a popular tourist circuit, the Southern Andean Yungas. Read more (translate from Spanish).
Advice for travellers
Leishmaniasis is a parasitic disease spread by infected sand flies and is found in the tropics and subtropics, as well as in southern Europe. There are two main forms – cutaneous and visceral. The former causes skin ulcers, the latter a severe systemic disease that is usually fatal without treatment. Read more on the disease, where it’s found and how prevent it.
Brazil: Measles remains in Manaus
The measles outbreak in the capital of Amazonas state, Manaus, is ongoing with suspected cases since February now numbering more than 7,700. Over half of the unconfirmed cases are aged 15 to 29 years of age, however infants under one year form the majority of the confirmed infections. Read more (translate from Portuguese).
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.
Chile: Port city’s hep A cases
Every fortnight another five new hepatitis A cases are reported in the northern port city of Antofagasta and authorities are putting the blame squarely on food stalls which lack hygiene checks. More than 200 cases of the viral infection have been identified to date. Read more (translate from Spanish).
Advice for travellers
Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is highly effective and protects for 20-30 years. Travellers should also follow these guidelines for safe food and water.
China: No new dengue cases since 4/9
It’s been a week since any new dengue fever cases have appeared in Hong Kong and the decision on when to re-open Lion Rock Park (where 19 of the 29 confirmed cases originated) is pending. Mosquito surveillance and control measures have been carried out in nearby Wong Tai Sin district. 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.
Democratic Republic of Congo: Ebola toll rises to 92
Since the last WHO situation report which was released on Sept 5th, cases of Ebola Virus disease (EVD) have increased from 129 (98 confirmed and 31 probable), including 89 deaths (58 confirmed and 31 probable) to 133 cases (102 confirmed, 31 probable) and 92 deaths – these include new cases in the large urban centres of Beni and Butembo. Eight health zones in the provinces of North Kivu and Ituri have reported confirmed and suspected EVD cases. Read more
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.
India: Peak mosquito season arrives
City authorities in Delhi have warned residents that the peak months for dengue fever are here – September and October – so careful mosquito bite-avoidance measures must be taken. While in Ahmedabad (Gujarat), it’s malaria that is having the greatest impact after 345 cases were diagnosed in just over a week this month. There has also been a rise in the number of water-borne illnesses in the city. In the city of Nagpur (Maharashtra), three vector-borne infections have struck - malaria, dengue and scrub typhus – but the highest fatality rates have come from scrub typhus. Twelve deaths have been recorded to date.
Advice for travellers
Scrub typhus is a bacterial disease passed on to humans by mites that normally live on rodents infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus occurs throughout the Asia-Pacific region, where more than a million cases occur annually. There is no vaccine or prevention medication: avoidance hinges on minimising insect bites. Due to the disease’s 5- to 14-day incubation period, travellers often experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Read more about rickettsial diseases.
Italy: Legionella suspected in Lombardy; WNV along Po
It is thought that Legionella bacteria are behind a spate of pneumonia cases in Brescia and Mantua, in the province of Lombardy. Currently over 190 people are hospitalised and legionellosis has been confirmed in 12 cases, according to a local news source. Authorities believe that the drop in numbers of people presenting at local hospitals indicates the worst of the outbreak may be over. Read more
NATIONAL data on neuro-invasive West Nile virus infections up to Sept 5th reveal that most of the 365 recorded cases were from regions in the Po valley - Emilia-Romagna, Veneto, Lombardy, Piedmont and Friuli Venezia Giulia. There are suggestions from some quarters that the intense surveillance carried out in these areas is more effective in identifying new cases. Highest case numbers were in Emilia-Romagna (87 cases, 14 deaths). Read more. More on WNV in Europe from the European Centre for Disease Control (ECDC) which notes that ‘since it is currently a particularly intense transmission season for West Nile fever, precautionary measures for travellers and residents, mainly elderly and immunocompromised individuals, to affected areas must be highlighted’. Read more
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.
Japan: Rubella case numbers climb again
According to the National Institute of Infectious Diseases, another 172 rubella infections were recorded in the two weeks to Sept 2nd, taking the total since January to 362 –a nearly four-fold increase over 2017. A local news report indicated that many of those infected are ‘men in their 30s and older’. Of the recent cases, Tokyo had 28, with other cases in the prefectures of Chiba (11 cases), Kanagawa (8) and Aichi (7). Read more
Advice for travellers
Rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine, one of the routine immunisations which should be current for prior to overseas travel. Travellers should also check their immunisation status for tetanus, diphtheria, and whooping cough. Read more about rubella.
Namibia: Hep E outbreak slowing, but not over yet
The WHO has updated its information on the hepatitis E outbreak, noting some improvement but also admitting that this has happened previously and was followed by another resurgence in cases: for the 12 months to the end of August, there have been ‘a total of 2554 suspected hepatitis E cases and 24 deaths’ (11 were in women who were either pregnant or post-delivery). The region of Khomas has been hardest hit, followed by Erongo, while active transmission is also being reported in Omusati, Oshana, Oshikoto, Ohangwena, and Kavango.
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, which is especially common in communities with lower levels of sanitation and hygiene. The majority of hepatitis E infections occur in East and South Asia. Read more about the virus and how to prevent it.
Nigeria: Cholera again on the rise in NE
Almost 900 cholera cases (and 19 related deaths) have been recorded in the NE state of Borno, the count jumping by more than one-third over the weekend. An outbreak has now been declared after the initial cases were first identified in mid-August. Highly populous central regions with ‘poor water, sanitation and hygiene conditions’ have been most impacted. Read more. A Nigeria Centre for Disease Control (NCDC) weekly report reveals the extent of the spike in cholera cases this year compared to 2017: ‘Between weeks 1 and 34 (2018), 14,762 suspected Cholera cases with 389 laboratory confirmed and 258 deaths from 23 States were reported compared with 1198 suspected cases and 32 deaths from 16 States during the same period in 2017’.
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.
Papua New Guinea: 10th polio case is first for capital
In a concerning development, a six-year old boy from 5-Mile Settlement in the capital Port Moresby has been diagnosed with polio infection (circulating vaccine-derived poliovirus, cVDPV). This latest case, the tenth, is the first for the National Capital District - the remaining cases were in Morobe (3) and two each in the Eastern Highlands, Enga and Madang. According to a WHO representative, the agency is working with partners to aid the government in surveillance and a comprehensive vaccination program which has now been expanded to include children up to 15 years of age. Read more
Advice for travellers
Polio 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 poliomyelitis.
Republic of the Congo: Outbreak response underway
The World Health Organization (WHO) is assisting in planning a vaccination campaign in response to the recently declared yellow fever outbreak in the large southern city of Pointe-Noire, noting that the risk of local spread is high due to the ‘suboptimal immunization coverage in the affected community’. Moreover, there is the ‘potential risk of spread within the Congo, especially to the capital city of Brazzaville’. 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.
Reunion Island: No hibernation for dengue
New dengue fever cases have continued during the cooler months, albeit in much lower numbers – 15 in the last reporting week, taking the year-to-date total to 6,553. Authorities are concerned that the persistence of the viral illness during winter could herald a much larger outbreak during summer. A campaign focusing on anti-dengue measures was carried out this week in schools. Read more (translate from French).
South Korea: MERS infection ex-Kuwait
A businessman returning to Seoul from a 3-week trip to Kuwait has been diagnosed with MERS Co-V and is receiving treatment in hospital. Close contacts, including family members and passengers seated nearby on his arriving flight are under quarantine, and a further 435 people are under ‘passive surveillance’. A rapid response system has been in place in South Korea since 2015 when a 7-month outbreak of MERS killed 38 people infected with the virus. Read more from the WHO.
Sudan: NE state’s chikungunya outbreak
Mosquitoes are spreading chikungunya in the NE state of Kassala, with ReliefWeb reporting high rates of infection in the capital Kassala, while state-wide case numbers now exceed 6,200. 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: Not one, but two, monkeypox cases
A visiting naval officer from Nigeria has been diagnosed with monkeypox while in the UK; it is believed he was infected in Nigeria. Up to 50 people who had contact with him while he was infectious are being followed up. Read more. Within a few days of the first case being announced, a second, unrelated case, also contracted during a stay in Nigeria, was confirmed by English health authorities. The NCDC is assisting public health authorities in England with investigations into the cases. Since September last year Nigeria has reported 262 suspected monkeypox infections, with many of those from southern states. Read more
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.
United States of America: Vax campaign to intercept Hep A
Illicit drug users and homeless people are the focus of a hepatitis A vaccination campaign in Illinois aimed at preventing outbreaks such as those occurring the adjacent states of Michigan, Indiana and Kentucky. Read more
Zimbabwe: Harare’s cholera emergency
Another water-borne illness has struck the country. This time it’s the capital, Harare where at least 20 deaths have resulted from more than 2,000 cholera infections in an area centred on three south-western suburbs (Glen View, Mbare and Budiriro); it has now also spread to a further four provinces resulting in the declaration of an emergency. Residents often have to use ground or bore water due to poor infrastructure and in this case, it appears that a fractured sewage pipe has contaminated water sources in the affected areas. Authorities have advised the use of water purification tablets and enhanced personal hygiene for all residents. Read more