World travel health alerts 10 April 2019

Flu, measles imports cause local infection spikes; NT mozzie-borne virus advice

Influenza cases brought back by travellers have fueled infection trends resulting in more than 26,000 cases reported nationwide this year – ‘South Australia is leading the per capita trend’, according to an ABC article. With 92 measles infections confirmed across the country this year (only 11 fewer than the entire 2018 total), the federal Health Minister has announced a campaign aimed at travellers, advising those born after 1966 to check their immunisation status before departure to ensure they have received two doses of the (free) vaccine. Read more (See more measles news under UK post)

MOSQUITO bite avoidance measures are recommended for travel to the Greater Darwin region and east Arnhem land after ‘widespread Kunjin virus activity’ was detected. A Mar 29 health department media release noted that ‘the high risk period for Kunjin virus is from February to the end of July, and mosquito numbers are expected to increase following this week’s rain’. This is also the season when Murray Valley encephalitis (MVE) virus activity is present. 

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, when available, for all travellers over 6 months of age. Read more about influenza.

Measles outbreaks expand

Rates of measles infections have spiked among an Orthodox Jewish community in London’s NE, mirroring the outbreak in New York’s Rockland county which was sparked by unvaccinated travellers arriving from Israel (and more recently in Brooklyn and Queens with health authorities declaring on Apr 9 that every adult and child without a medical exemption who lives, works or resides in Williamsburg, Brooklyn, and has not received the measles-mumps-rubella (MMR) vaccine to be vaccinated or face a $1,000 fine). Over 320 cases have been reported in Hackney and Haringey since October. More on the current situation in the US, with four more states reporting their first cases for the year - Florida, Indiana, Massachusetts and Nevada. While in Europe, Bulgaria has seen a 2-fold increase in cases over the past month with highest incidence reported in Blagoevgrad and Sofia; and in the Czech Republic, Prague has experienced a year-on-year rise in measles infections. Outbreaks continue in the Asian region with news from Vietnam that this year’s total of measles cases in Ho Chi Minh City is almost double that of 2018 with the current tally of suspected cases now at 3,316. There have been no further updates from the Philippines since Mar 26 when reports showed there had been 25,676 measles cases and 355 deaths – the median age was 3yo, 54% of cases were under 5 and 53% of cases were male. In South Korea, one measles infection imported from Vietnam by an unvaccinated young girl in Daejeon (South Chungcheong province) has spread to seven other children who were in the same hospital ward, while over 4,000 people who had come into contact with 25 measles-infected healthcare workers in a hospital in Anyang (Gyeonggi Province) are being monitored for signs of measles infection. Of Hong Kong’s 62 confirmed measles infections this year (aged from 8 months to 49yo), 28 are from a cluster associated with airline workers or people who worked at the HKG airport. In other regions, the majority of Tunisia’s 2,000 measles cases have been in the states of Kasserine and Sfax. Four measles infections have been diagnosed in Mt Maunganui on New Zealand's Bay of Plenty while Auckland’s total has risen to 15; there has been no further increase in reported measles cases in Christchurch. Other updates have been summarised by ProMED.

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.

Ebola outbreak fatality rate exceeds 60%

More high-risk community deaths were notified in the past recording week - a total of 26. According to the latest WHO External Situation Report, ‘the enduring transmission of Ebola virus disease in the Democratic Republic of the Congo, with eight health zones reporting new confirmed cases in the past three days along with the continuing infection of healthcare workers, is of particular concern’ however the agency ‘advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information’. 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.

Unknown source of miners’ illnesses

Two men from a group of 18 miners who became ill while working in a NW manganese mine have died in hospital. Ten of the survivors, all Chinese nationals, are to be repatriated for treatment. A news article states that several of the miners ‘came into contact with bat droppings while cleaning one of four tunnels’ in the Matthew's Ridge mine. Read more

Dengue, chikungunya updates

The number of dengue fever infections has escalated in the regency of East Sumba (East Nusa Tenggara province) with 875 diagnosed to date and 12 deaths recorded. Meanwhile it’s the chikungunya virus, also transmitted by Aedes mosquitoes, that has sickened residents in Depok, part of Greater Jakarta. 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.

YTD mumps notifications top 800

In the week ending Apr 6, a further 100 mumps cases were identified across the country, taking the yearly total to 824. Details provided by the HPSC’s April Epi-Insight publication indicate highest notification rates were in the east, NE and west health services, while ‘most cases are among the 15-24 year age group’. 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.

Sand fly infection strikes pastoralists

A health official in Laisamis, located in Kenya’s largest county, Marsabit, has called for a public awareness campaign to counter the spread of sand flies and the infection they can transmit, visceral leishmaniasis or kala-azar. Twenty-seven people have required hospitalisation for treatment recently, with high rates of infection among pastoral workers. Read more

Advice for travellers

Leishmaniasis is a parasitic disease found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. The former causes skin ulcers and the latter a severe systemic disease that is usually fatal without treatment. India, Bangladesh, Nepal, Sudan, South Sudan, Ethiopia and Brazil account for 90% of visceral leishmaniasis, while 90% of cutaneous leishmaniasis cases occur in Afghanistan, Algeria, Iran, Saudi Arabia, and Syria, as well as the South American countries of Brazil, Colombia, Peru, Bolivia and Argentina.

Fungal infection suspected in spelunkers

A number of foreign cave specialists who spent four nights in a cave in the southern state of Chiapas are suspected to have contracted histoplasmosis. Bats and bat droppings were in evidence near the cave – they can be the source of fungal spores that produce the infection’s typical symptoms when inhaled - fever, shortness of breath, dry cough, fatigue and headache. The cave in question, La Cueva del Rio La Venta, is popular with speliologists and exploring it requires many hours underground. Read more

Warning for GoT series fans

British tourists visiting locations made famous through filming of the Game of Thrones series are being warned of the risk of the sand fly-borne infection leishmaniasis which is endemic to the country. As described by the WHO, ‘Morocco comprises several vegetation zones which reflect varied climate and topography and influence the distribution and density of sandfly species and consequently of Leishmania species’ and ‘recent studies have found new focus of anthroponotic cutaneous leishmaniasis and the emergence of cutaneous leishmanaisis is a current public health problem in Morocco.’  Read more

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites.

Domestic, regional malaria advice

The NICD has issued an alert for travellers to be aware of the risk of malaria both in endemic provinces (NE Limpopo, eastern Mpumalanga and northern KwaZulu-Natal) and in the wider region, particularly in the wake of the devastation wreaked by Cyclone Idai. The agency warns that as a result of conditions produced by the cyclone, ‘there may be an increase of malaria cases within the next two months locally and within the southeast African region’. (In other news relating to Cyclone Idai, cholera cases in Mozambique’s Beira and Dondo towns and Buzi and Nhamatanda districts (Sofala) rose to ‘nearly 3,600 with six deaths up to April 8’) Read more

Advice for travellers

Malaria is endemic in many areas of southern Africa. Travelvax recommends that travellers visiting this region discuss their itinerary and preventative medication at their nearest Travelvax clinic, or with their healthcare provider. For advice, call Travelvax on 1300 360 164. More on malaria.

Dengue continues in east

More than two-thirds of the 1,675 dengue fever cases recorded this year have been in the province of Alto Paraná, bordering Brazil, while across the country there have been more than 6,000 suspected arbovirus infections – these include dengue fever, Zika virus and chikungunya. Read more

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).  

Risk of chikungunya countrywide

The chikungunya outbreak that began in Pointe-Noire in January has spread to all southern regions and there are fears that its range will soon extend to the country as a whole. More than 4,000 people have been infected so far, with women most affected. As a senior public health official explained, the risk of mosquito bites is greatest when women are performing housework activities - in the early morning and late afternoon. Read more

Advice for travellers

Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Apply an effective repellent when outdoors to all exposed skin. Read more about chikungunya.

MERS case numbers climb again

Khafji, Riyadh and Najran were the locations of the most recent confirmed MERS cases and they take the year-to-date total to 126, including a large cluster of 57 cases in Wadi ad-Dawasir and a smaller one in Khafji. Read more

Smoggy conditions for north

The combination of illegal forest burning and drought conditions have caused high levels of pollution across nine northern regions. The focus has been on Chiang Rai due to a recent ASEAN meeting; some parts of the city were still recording very unhealthy levels of PM2.5 particles. These are of a size that can be breathed in, causing symptoms such as wheezing, difficulty breathing and chest tightness. Read more