World travel health alerts for 1st of May 2019.
Measles and more measles…
Another week and more reports on (vaccine-preventable) measles outbreaks: Over half of the 557 measles cases reported in Italy in the first three months of the year were from Lombardy and Lazio (18 regions overall and the median age of those infected was 30). Austria has confirmed cases in Styria, Carinthia, Salzburg, Tyrol and Vienna (76 overall which is one fewer than the entire 2018 total). Malta, which boasts high immunisation rates, has reported 15 cases this year – a trebling of 2018 notifications. In other regions, there are reports from Nepal (Dang district in Inner Terai), the Philippines (case count climbed to 31,056 by mid-April with 415 deaths; regions hardest hit by the outbreak, National Capital Region (6075 cases and 106 deaths), Calabarzon (6075;106) and Central Luzon (5091;73)), USA (704 cases from 22 states and a 25-year high), Japan (two cases among Narita airport workers), New Zealand (Auckland), Ukraine (43,783 cases and 16 deaths to Apr 25), South Sudan and Angola.
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 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.
Dengue in 21 municipalities
Arbovirus surveillance activities have been intensified in the six provinces endemic for dengue fever (Misiones, Jujuy, Salta, Santa Fe, Formosa and Buenos Aires) with 21 towns reporting cases. Read more. While Argentina has reported almost 1,000 cases through week 14, Brazil’s total has exceeded 439,000 for the same period according to the PAHO.
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.
2019’s flu notifications expected to surpass 2018
The flu season is off to a bad start this year with notifications well over those reported early in 2018 – more than 35,000 confirmed cases so far. NSW and QLD have both had over 9,000 cases and South Australia nearly 8,500 to April 29. Read more
Advice for travellers
Seasonal flu is the most common vaccine-preventable travel-related illness because it is a potential risk during every stage of the journey. Whether you are travelling within Australia or overseas, Travelvax recommends vaccination for all travellers over 6 months of age. Read more about influenza.
More high risk community deaths in NE’s Ebola outbreak; 5 cVDPV2 outbreaks
From the WHO’s latest assessment of the Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces: ‘The increasing number of new EVD cases in the Democratic Republic of the Congo is deeply concerning. However, geographic spread is still limited to two provinces and there is no spread to neighbouring countries.’ During the week to Apr 28 another 126 new confirmed cases were reported; Butembo and Katwa are the hotspots. Of the 83 deaths reported in the past week, over half were in the community i.e. high risk for onward transmission. Read more
UPDATES on vaccine-derived polio cases from a bulletin produced by the WHO’s African regional office: ‘DRC is affected now by five separate cVDPV2 outbreaks, in the provinces of Haut Katanga; Mongala, Maniema; Haut Lomami/Tanganika/Haut Katanga/Ituri and Kasai.’ And for Nigeria, two recent cases, ‘one from Ilorin West in Kwara State and one from Mashegu in Niger State… The country is now affected by three separate cVDPV2 outbreaks, the first centered in Jigawa State with subsequent spread to other states as well as to neighbouring Republic of Niger, the second in Sokoto State and the third one in Bauchi State.’ More polio news here.
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.
Upswing in dengue cases
The capital Santo Domingo has reported most of the country’s dengue fever infections with YTD figures exceeding those for the same period in 2018. Within the region, there are updates from Mexico (highest incidence in Veracruz, Chiapas, Jalisco and Quintana Roo) and Panama (507 cases, provinces hardest hit are Colón, Herrera, Panamá Norte, Coclé, Panama Metro and San Miguelito). While measures introduced to reduce mosquito numbers in Jamaica appear to be working after rates of new infections in one district, St Ann, declined. More updates from across the Americas were published by ProMED on Apr 25.
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.
Dengue widespread
Dengue fever outbreaks have been reported across the country but are having the greatest impact in the capital Dili and the districts of Liquica, Viqueque, Covalima and Baucau. While there have been 542 cases YTD (and five deaths), an upward trend has been noted. Infections are expected to peak at the end of June. Read more
Advice for travellers
Avoid mosquito bites and you won’t get 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.
Unpasteurised cheese recall
Batches of two different cheeses (Saint-Félicien and Saint Marcellin), sold under at least 10 brand names, have been recalled while investigations continue into the cause of up to 13 cases of haemolytic uraemic syndrome (HUS) in children since the end of March. A number of the children developed HUS, a complication of STEC infections which they are believed to have acquired through consuming the unpasteurised cheese. Read more
Advice for travellers
Read more on STEC infection and haemolytic uraemic syndrome on the HealthyWA website.
Second wave of flu hits
The week 15 WHO Western Pacific region and global flu updates report the Republic of Korea’s ‘influenza activity continued to increase with influenza B most frequently detected followed by influenza A(H3N2) viruses, after a first wave …predominated by influenza A(H1N1)pdm09 virus’. While in Malaysia, ‘increased detections of all seasonal influenza subtypes were reported … in recent weeks’. General increases in influenza-like illness reporting were detected in French Polynesia, Kiribati, Northern Mariana Islands, New Caledonia, Tonga and Vanuatu. In other regions the advice is that flu activity declined in North America, Europe, North Africa, and most of West Asia, with the exception of Saudi Arabia.
Advice for travellers
Seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol wipes are a convenient alternative if soap and water is not available.
Mumps cases top 1,000
Latest data on mumps notifications reveal the count already double the 2018 total with 1,015 cases to week 17 – over 650 were in the 15 to 24 years age group. Across the country, highest rates of infections were in the area covered by the Eastern Regional Health Authority. The director of the HSE has also warned that measles vaccination coverage rates are ‘up to 8% below what they should be in some parts of the country’, so a spike in cases is likely during the peak summer travel period. 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.
Regional dengue news
A Western Pacific Region dengue fever update issued by the WHO on Apr 25 shows a marked rise in cases (up 3.4 times) when compared to the same period in 2018. Over half of the 63 provinces are reporting cases. Elsewhere Singapore, Laos, Malaysia and the Philippines all show year-on-year increases while Cambodia’s notifications are sitting above the threshold.
Advice for travellers
Avoid mosquito bites and you won’t get 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.
Increasing dengue and chikungunya reports
A local news site is reporting a hike in chikungunya cases with the greatest impact on Thaa, Gaaf Alif and Kaafu atolls. However it’s the dengue virus that has infected significantly more of the population this year (particularly when compared to 2018) with 1,700 dengue fever cases – many of those in the capital Malé and on the atolls of Alif Alif and Laamu. 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.
Food-borne illnesses in the news
Consumption of fresh Iranian dates is the common denominator among 8 confirmed (and one suspected) hepatitis A cases across seven counties over the past two months. Investigations are continuing into the source but, according to the Public Health Authority, ‘There is currently no trademark of dates that are specifically designated or suspected and no joint producer has been identified’. Read more. A separate outbreak of another food-borne infection is being investigated by the agency: Yersinia enterocolitica type O3 with 23 confirmed and a further 30 suspected cases. It is reported that of those affected, ‘60 percent are women and they live in different areas from the county of Halland in the south to Västerbotten in the north’.
Diphtheria doubles
Updated information on diphtheria from the Dept. of Disease Control reveals there have been two deaths among the nine diphtheria cases reported from six provinces this year – Uttaradit, Tak, Suratthani, Sonkhla, Satun and Yala - representing a doubling of cases over 2018 figures and an increase on the 5-year average.
Advice for travellers
Spread by coughing and sneezing 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.
Third parasitic infection for Hawaii
A resident of east Hawai’i has been revealed as the third case of angiostrongyliasis (or rat lungworm disease) in 2019. The source of the infection remains unknown but guidelines introduced last year recommend: ‘Control snail, slug, and rat populations around homes, gardens and farms’, ‘Inspect, wash and store produce in sealed containers, regardless of whether it came from a local retailer, farmer’s market, or backyard garden’ and ‘Wash all fruits and vegetables under clean, running water to remove any tiny slugs or snails.’ More on angiostrongyliasis in Hawaii.
Dengue uptick in two districts, diphtheria update
Over 200 dengue fever cases have been reported this year (to Apr 16) – most recently from the capital, Port Vila and Luganville (on Espiritu Santo). And more on the two diphtheria cases reported on April 15, with news that the bacteria were isolated from three of the 30 patient contacts. Read more
Advice for travellers
Dengue is spread by two types of Aedes mosquitoes which breed in shady areas close homes and other accommodation. Both bite mainly during the daylight hours, making them difficult to avoid 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 (PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.