Health Alerts
Afghanistan: Global polio update

From the Oct 3rd global round up of polio: one case of wild poliovirus type 1 (WPV1) from Kandahar province, and in Pakistan, reporting of 7 WPV1-positive environmental samples. The 2018 year-to-date WPV count is now 19 - 15 in Afghanistan and 4 in Pakistan. No new circulating vaccine-derived poliovirus (cVDPV) cases were recorded in Papua New Guinea, Niger, the DRC and Syria in the previous week, however three more cases of cVDPV2 were reported in Nigeria (Jigawa). 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 polio

Central African Republic: Two disease alerts

Outbreaks of both hepatitis E and monkeypox are ongoing: hepatitis E in the NW region (five localities in Bocaranga-Koui Health District) has international agencies on the alert due to the risk of further extension; while three southern regions have reported monkeypox - ‘in the rural district of Mbaiki, located 107 km from the capital, Bangui, and at the border with the Democratic Republic of the Congo and the Republic of Congo’. Read more. The CAR is just one of several countries in the region reporting monkeypox cases since 2016: Cameroon, Democratic Republic of the Congo, Liberia, Nigeria, Republic of the Congo, and Sierra Leone. Read the WHO disease outbreak news on monkeypox in Nigeria dated Oct 5 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

Democratic Republic of Congo: Ebola-affected areas ‘now cover hundreds of kilometres’

Community resistance continues in some areas in response to the measures required to limit the spread of Ebola – vaccination, contact tracing, 21 day monitoring and safe burials. This has allowed new cases and deaths to increase substantially this week, with 14 more cases reported over a 3-day period. Read more. The health ministry’s Ebola Surveillance Dashboard puts the confirmed and suspected cases at 188 with 118 deaths. The latest WHO situation report notes that ‘Beni, Butembo and Mabalako continue to report an increasing number of new cases, indicating the persistence of Ebola virus transmission in these areas.’ 

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.

Fiji: Typhoid in 2 Viti Levu provinces

From early August until Sept 20th, a total of 26 typhoid fever infections were reported from two provinces on the largest island, Viti Levu. In a regional update, ReliefWeb posted that the affected provinces were ‘Naitasiri (in three villages and one settlement) and Navosa (Naveyago village)’, situated in the island’s centre and south-west. Investigations into the source/s of infection are ongoing. 

Advice for travellers: Typhoid occurs in some Pacific countries, although it presents a low risk for travellers staying in hotels or resorts. Travellers should follow safe food and water guidelines, and personal hygiene practices. Vaccination is generally recommended for travellers staying in rural areas, as well as for adventurous eaters. Read more about typhoid.

India: Zika in Rajasthan; Mozzies persist due to end of season rains

From Jaipur’s first Zika virus infection, which was confirmed in the Rajasthan capital on Sept 23rd, further testing has identified a total of 29 cases - the largest count in India to date. All confirmed infections have been in a northern area of Jaipur, Shahstri Nagar. A team of experts has been sent to the city to assist with control measures while the NCDC (National Centre for Disease Control) monitors the outbreak. Read more
INTERMITTENT rain is allowing disease-carrying mosquitoes to breed, adding to the number of dengue fever, chikungunya and malaria cases being reported in Delhi. The city has also experienced a sharp rise in flu infections.  A recent rise in chikungunya infections in the city of Vadodara, in the western state of Gujarat has officials concerned. The end of the monsoons will bring about a reduction in the number of leptospirosis infections which have killed 12 people in Mumbai this year, but dengue fever is likely to affect the city until November. Scrub typhus has killed more people than dengue fever in Himachal Pradesh – Shimla reported 12 deaths due to the mite-borne disease. In neighbouring Bangladesh, this year has proved to be a record for dengue fever infections – the highest tally since the virus was first detected in the country in the year 2000. Dhaka has recorded most cases. Read more

Advice for travellers: Dengue occurs throughout India – both in urban and rural areas. The virus is spread by two types of Aedes mosquitoes. Both breed in shady places close to dwellings and bite mainly during the daylight hours, making them difficult to avoid when outdoors. 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 oil of lemon eucalyptus (or PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Ireland: Mumps in western counties

As many as 45 teenagers and adults up to 29 years of age have been infected with mumps over a 7-week period in three western counties - Galway, Mayo, and Roscommon. Read more

Advice for travellers: These outbreaks of mumps highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps.

Japan: Rubella cases top 770

The outbreak of rubella (German measles) continues, with a further 104 cases recorded at the end of September taking the year-to-date total to 770 – an 8-fold increase on 2017 figures. While Tokyo is reporting most cases, according to a news report, rubella infections occurred in 40 of the 47 provinces in the week. 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.

Mauritania: Dengue following rains

A dengue fever outbreak is underway in the iron ore mining centre of Zourate, with one local news source claiming there are up to 20 new cases every day. Read more

Mexico: Dengue in south, alert for north

Almost half of all dengue fever cases recorded in Mexico have been in the southern state of Chiapas, bordering Guatemala. The state has also had 15 of the 19 deaths reported nationwide this year. Read more. While in Baja California, dengue alerts have been issued for four localities - Mexicali, San Felipe, El Rosario and Isla de Cedros – following recent flooding. Read more

Spain: Locally-acquired dengue reported

Health authorities reported on two locally-acquired dengue fever infections, and another which is suspected, from August. The confirmed cases live in the SE province of Murcia and had no history of travel. One of the dengue fever vectors, Aedes albopictus mosquitoes, has an established presence along Spain’s Mediterranean coastline. Read more

United States of America: Flea-borne infection in LA County

Up to 57 cases of murine typhus have been reported in parts of Los Angeles County over the past months – Pasadena, Long Beach and downtown LA. The Pasadena Health Department news item outlining the epidemic notes that ‘Flea-borne typhus is found regularly in Los Angeles County, especially Pasadena, with most cases occurring in the summer and fall months. Read more. The flea-borne infection is contracted when people come into contact with fleas infected with Rickettsia typhi – most commonly when an infected flea’s faeces are rubbed into broken skin. More on murine typhus from the US Centers for Disease Control and Prevention (CDC).

Zimbabwe: Cholera outbreak deepens, first round of vaccinations in Harare

In a further worsening of the cholera outbreak, the WHO reported at the end of last week that nearly 5,000 new cases have been identified since Sept 20th, taking the total number of cases to over 8,500 with 50 deaths. South-western districts of Harare remain those most affected, in particular Glen View and Burdiriro, but 135 cases have been reported in other provinces. The WHO assessment also notes that ‘available response capacities are overstretched as authorities are already responding to a large typhoid outbreak which started in August 2018’. Read more. A regional cholera update includes information on Tanzania (Arusha, Manyara and Rukwa regions) and Somalia (regions of Banadir and Lower Jubba).

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