World travel health alerts 1 December 2021

Polio update, PHEIC to continue

Last week the GPEI reported two new WPV1 infections in Aghanistan (Kunduz), taking its YTD total to three, as well as cVDPV2 cases in Yemen (two cases from Taiz and Marib governorates) and nine cases in Nigeria from six states (plus eight other states returned 25 cVDPV2 positive environmental samples). In the latest meeting of the WHO’s polio emergency committee, it was agreed that the declared PHEIC must remain in place. Concern was expressed over the extent and spread of the cVDPV outbreaks in Nigeria and the delays in response measures in Senegal and vaccine shortages in Guinea Bissau, while in the Ukraine, rapid vaccination efforts are needed to protect groups and local areas with ‘pockets of missed children’. The report listed Mauritania, Guinea Bissau and the Ukraine as the latest (newly) infected countries affected by the international spread of cVDPV2. Thirty countries in all have reported cVDPV cases this year (in Africa, Europe and the Eastern Mediterranean region), with 452 recorded to Nov 23 (289 of those in Nigeria).

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.

NW province’s paratyphoid spike

Nearly two-thirds of paratyphoid infections recorded in the NW state of Salta this year have been in children aged under 15 years. An alert has been posted by health authorities relating to the increase in serotype Paratyphi B cases in and around the capital, Salta, which arose during warmer weather early in the year and again as summer approaches. An increasing trend in paratyphoid B infections has been observed in Salta since 2017. Read more

Advice for travellers

Paratyphoid, like typhoid fever, is an enteric fever which can develop into a severe and even fatal illness. There are three paratyphoid serotypes bacteria – A, B and C, and humans are the only reservoirs. Infection is acquired through consuming food or water contaminated with the faeces of an infected individual (acute or chronic) and so the risk is deemed to be highest in lower and middle income countries. Food and water precautions are advised as there is no specific vaccine for paratyphoid (although the oral typhoid vaccine may confer some protection). Read more  

Rabies reports across region

ProMED has published a summary of recent rabies cases and exposures in the Americas, with three separate incidents in the US (Alabama, Delaware and South Carolina) involving human contact with rabid animals (dog, raccoon and kitten respectively). In Brazil, a young boy from the northern state of Maranhão succumbed to rabies infection last month following a bite from an infected fox. His is the first confirmed rabies case in the state for eight years. Elsewhere, South Africa’s NICD has confirmed 17 human rabies cases this year and an alert has been sounded in eThekwini Metropolitan Municipality, which includes the city of Durban (KwaZulu-Natal province), after an increase in the number of rabid animals was observed recently.

Advice for travellers

Rabies is present in most countries and all travellers should be aware of the importance of avoiding contact with wild and domestic animals, including bats. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is generally recommended for longer stays, especially travellers planning to live in, or travel extensively through, rural areas and also for children; however the final recommendation is itinerary-specific. Read more on rabies.

COVID-19 update

While new COVID-19 cases over the past week have been stable overall, there have been upticks in the African, Western Pacific and European regions according to the latest WHO epi update, which also noted that the African increase ‘was largely due to batch reporting of antigen tests by South Africa last week’ and therefore a trend to be interpreted with caution. The Western Pacific’s rise in new case numbers included increases in ‘Viet Nam (70%), Brunei Darussalam (40%), Republic of Korea (28%)’. The epi update includes a summary of the new variant of concern, Omicron, and a link to a technical brief outlining priority actions for Member States. The agency’s risk assessment on Omicron in the context of the pandemic is rated as very high, however it is noted that ‘The evidence for this assessment contains considerable uncertainty and will be updated as more information becomes available’. On Nov 30, the WHO published ‘WHO advice for international traffic in relation to the SARS-CoV-2 Omicron variant (B.1.1.529)’ providing recommendations to countries while ‘scientific research is underway to understand how the variant behaves’. More on the Omnicron variant from the WHO, Africa CDC and ECDC.  

In related news:

- 'Patience is crucial': Why we won't know for weeks how dangerous Omicron is’ as detailed by the journal Science.

- Only 1 in 4 African health workers fully vaccinated against COVID-19 Read more

- Victoria Makes Australia’s First mRNA Vaccine Candidate, as explained by the Doherty Institute.

- The World Health Assembly is holding a special meeting to discuss mechanisms for an ‘international instrument on pandemic preparedness and response’.

Fungal infection kills in Ontario

Health authorities have confirmed blastomycosis as the cause of death of two First Nation people in the Lake Constance area of NE Ontario. The infection is contracted by inhaling fungal spores ‘found in soil and rotting wood in certain parts of North America’. A dozen more cases in the community required hospitalisation for treatment of the infection which can produce pulmonary, cutaneous or disseminated disease. Read more

Hep E confirmed in southern region

Ongoing strains on the health system due to COVID-19, measles, visceral leishmaniasis, floods and humanitarian crises have been compounded by a surge in hepatitis E cases in Tandjilé region. The first reports of Hep E infections emerged in late August and, by mid-November, the cluster had grown to 377 and two deaths from six villages. The WHO notes that ‘Hepatitis E is endemic in Chad, particularly in the Tangile region, which previously experienced large-scale outbreaks in 2017 and 2018’. 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.

Cause of child deaths investigated; 29 days with no new Ebola cases in NE

Results from malaria testing are still to be confirmed in Gungu and Mukedi (Kwilu province), however the provincial health minister has stated that 80 percent of the territories’ population has the infection. Since late August the death toll has climbed past 340 from the more than 10,000 symptomatic children aged under 10 years. The minister explained that entomological surveys carried out by the National Malaria Control Program captured ‘100 percent’ Anopheles mosquitoes, most of which carried two or three species of Plasmodium parasites. Read more

ANOTHER week with no new Ebola cases during North Kivu’s second outbreak this year, one that has been unusual in that half of all cases have been in children aged under 5 years. Vaccination activities continue in the affected area. Read more

Advice for travellers

Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Measles confirmed in Viti Levu’s south

A single case of measles has been confirmed in each of two villages in Serua province on the island of Viti Levu, with reports they were acquired at a gathering held in Serua/Namosi. The local medical sub-division has started MMR vaccinations for eligible children in the area, which lies in the south of Viti Levu, between Suva and Sigatoka. Read more

Advice for travellers

A highly contagious virus, measles occurs in developing and developed countries. While generally benign, infection can result in severe illness or death. Travelvax Australia recommends checking immunisation status to ensure protection against measles and other childhood diseases such as diphtheria, whooping cough (pertussis) and mumps. 

YF infections in more regions

Eight regions have now reported yellow fever cases according to one news outlet. Northern, Oti and Bono regions are among those recording infections as vaccination efforts ramp up in the affected areas. Forty deaths have so far been registered, however most have been in Savannah region. Intensified vaccination campaigns are also being run in Cameroon in response to 38 new YF cases and 13 deaths from at least nine regions, ‘with only the South-West yet to present a case’. 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.

JE outbreak in Kedah district

Two fatal cases of Japanese encephalitis have been reported in Kota Setar district, in the northern peninsular state of Kedah. According to local media, an outbreak was declared after JE cases rose to 10 with three deaths. Kedah, which includes the Langkawi archipelago, shares borders with the state of Perlis and two southern Thai provinces (Satun and Songkhla). Read more

Advice for travellers

A mosquito-borne virus, JE is usually found in many parts of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. 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.

Peak passed in dengue outbreak

Dengue fever case numbers have been declining since the end of October after peaking earlier the same month. By Nov 11, there had been more than 235,000 suspected dengue cases across the country and 197 associated deaths, with Punjab province recording most of the confirmed cases, followed by Khyber Pakhtunkhwa, Sindh and Balochistan. The highest death count was in the district of Lahore which logged half of all fatal cases registered in the country. Read more. The ECDC update of Nov 21-27 contains a run-down of dengue and chikungunya across the globe, and there are more dengue reports from ProMED.  

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.

River blindness vector in abundance

Seasonal rains and delays in larvacide spraying have seen a jump in black fly populations in areas of the Northern Region. A local medical officer, as well as some Gulu district residents, have expressed concern that this may lead to a resurgence in onchocerciasis, or river blindness. Female black flies, which thrive near fast-moving rivers, transmit microfilariae of Onchocerca volvulus parasite worms into the host which eventually cause severe itching, rash, skin nodules and eye lesions with eventual vision loss. The US CDC notes that, generally ‘many bites are needed before becoming infected’. Read more