World travel health alerts for 10th of August 2022.
JE vaccine recommendations widen
NSW Health has recently revised its advice regarding Japanese encephalitis vaccination for residents of nine LGAs in the state’s south to include those ‘aged between 50-65 AND are employed in an occupation that is largely or totally outdoors (defined as spending at least 4 hours per day outdoors).’ Read more
Advice for travellers
A mosquito-borne virus, JE is generally found in many parts of Asia, the Indian subcontinent, Southeast Asia, China, Indonesia and PNG, and more recently, in areas of southern and eastern Australia. In Asia, 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.
COVID-19 update, other news
In its COVID-19 update last week, the WHO said that the global incidence of new cases had fallen slightly, but the upward trend in deaths since mid-June has continued. In the Western Pacific region, cases and deaths both rose – up 20 percent and 44 percent respectively, and the greatest proportional increases were observed in the Federated States of Micronesia (up 4,503 percent) and the Cook Islands (up 491 percent). Read more. While new cases and deaths declined over the reporting period in Europe, the German government has plans in place for the cooler seasons as it works to avoid further strain on the health system. From Oct 1 to April 7 next year, the wearing of masks will be mandated on long-distance public transport and during air travel, with additional testing and masking requirements for access to institutions with vulnerable people i.e. hospitals and care homes. State authorities have the option to introduce their own restrictions. Read more.
In other news:
- The European Medicines Agency (EMA) is conducting rolling reviews of the HIPRA bivalent recombinant protein vaccine (to be used as a booster in people aged 16 years and above) and an updated Pfizer/BioNTech vaccine which targets the original SARS-CoV-2 and Omicron subvariants BA.4/5. Deliveries could begin in October, pending the results of clinical trials. Read more
- From Oct 1, Thailand’s Department of Disease Control (DDC) will downgrade COVID-19 into the category ‘communicable diseases under surveillance’ which requires the same degree of monitoring as dengue fever and influenza. Read more in the Bangkok Post.
Bumper dengue season in progress
Regional media are reporting a 15-year high in infestations of the dengue fever vector, the Aedes aegypti mosquito, resulting in a spike of human infections across most provinces. Recent dengue activity was noted in the provinces of Pinar del Río, Havana, Matanzas, Villa Clara, Camagüey, Las Tunas, Holguín and Guantánamo. A shortage of tests means that many cases are not being confirmed and treatment is said to be hard to access due to pandemic pressures on the health system. Read more
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.
Monkeypox cases highest in 5 provinces
The WHO weekly bulletin update on monkeypox (MPX) has Sankuru, Tshopo, Maniema, Tshuapa and Sud-Ubangi as the provinces with most cases this year. Nationally, more than 2,200 suspected cases had been reported to July 28. The same publication has more data on Congo Basin and West African clades of MPX in other endemic countries. Lastly, officials from the WHO provided more background on monkeypox in Africa, with confirmation that transmission of the virus in the region primarily occurs through household transmission and around 40 percent of cases are in women. Read more
Advice for travellers
Closely related to the smallpox virus, monkeypox has its origins in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People travelling in endemic countries can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk in those regions. More recently, monkeypox has spread person-to-person around the globe, primarily through large respiratory droplets, but also via direct contact with skin lesions or body fluids (i.e. close or intimate contact) and indirect contact by way of contaminated bedding, clothes etc. Read more from the WHO on the current outbreaks of monkeypox.
Vax campaigns to tackle measles, rubella
A supplementary vaccination campaign is underway after suspected measles cases were reported last month in Rewa, Nasinu and Labasa. On Aug 4, the Ministry of Health and Medical Services update ‘reported suspected cases of measles (8) and rubella (2) wherein the initial tests done were positive’. 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 used here which should be current prior to overseas travel. Travellers should also check their immunisation status for tetanus, diphtheria, and whooping cough. Read more about rubella.
Monkeypox spreads to 89 countries
More than 80 countries that had not previously reported monkeypox (MPX) cases are now part of the extensive outbreak in which cases are nearing 32,000, rising by almost 10 percent in the week to Aug 7. The US total has topped 9,400, while Spain, Germany and the UK round out the top 4. In related news, the B.1 lineage of the MPX virus has been detected most frequently in non-endemic countries, however, as reported in the JH Outbreak Alerts on Aug 3, the A.2 lineage has been sequenced from cases in the three US states, Thailand and India, suggesting ‘there could be an additional cluster of human-to-human transmission that has potentially been unrecognized for years’. Read more
Advice for travellers
Closely related to the smallpox virus, monkeypox has its origins in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People travelling in endemic countries can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk in those regions. More recently, monkeypox has spread person-to-person around the globe, primarily through large respiratory droplets, but also via direct contact with skin lesions or body fluids (i.e. close or intimate contact) and indirect contact by way of contaminated bedding, clothes etc. Read more from the WHO on the current outbreaks of monkeypox.
Floods bring disease threats
Another 347 cases were added to Assam’s tally of Japanese encephalitis (JE) cases in the past 40 days, with many of the infections from three districts – Nagaon, Jorhat and Golaghat. The JE death toll since the start of the monsoon season sits at 63. In other monsoon-related news, health officials in the cities of Pune and Mumbai in Maharashtra state say that contact with the contents of overflowing drains infested with rodents has caused a sharp increase in the number of people requiring treatment for leptospirosis. Read more
Advice for travellers
Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.
Higher WNV intensity reported
This year’s West Nile virus (WNV) season started early in Italy; the case count has already climbed to 94 and there have been seven related deaths. The ECDC noted the high proportion of cases suffering West Nile neuroinvasive disease (58 percent) is possibly due to under-reporting of mild infections that may be confused with COVID-19 symptoms. It also advised that during the current peak holiday season, which is expected to be busier than usual, travellers to WNV transmission areas (in the endemic areas in Europe) must be advised of ‘the risk of exposure and the importance of the use of personal protective measures to avoid mosquito bites’. Read more
Advice for travellers
West Nile virus is endemic in Eastern Europe and the Mediterranean basin, with sporadic outbreaks reported in summer and autumn since the 1950s. 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. Europe’s outbreaks are not as severe or widespread as in other regions where the virus occurs, notably North America. Read more on WNV.
2nd NY county reports polio in wastewater, global polio news
More evidence of a wider circulation of poliovirus in New York State, with seven positive environmental samples in total collected in June/July from Rockland County and two separate locations in adjacent Orange County. The Orange County government issued a press release on Aug 2 advising, the ‘virus is circulating in the community according to wastewater analysis reports’. While no cases have been confirmed in the county, there however there are pockets of low immunisation rates ‘in certain areas’. In other polio news, last week the GPEI advised a single wild poliovirus case in Pakistan’s Khyber Pakhtunkhwa province – its 14th this year, while more than two dozen cVDPV1 positive environmental samples were detected in Madagascar (18 in Analamanga, five in Boeni, two in Diana, and single collections in Sud-Ouest and Anosy). Read more
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.
Dengue cases in 59 districts
Dengue fever infections are on the rise around the country, and at least 100 cases have been reported from three districts in Kathmandu Valley, particularly Lalitpur. Nearly 60 districts in all have recorded cases, including Jumla and Kalikot in the mountains.
Advice for travellers
Dengue occurs both in urban and rural areas, around human habitation. The virus is spread by Aedes mosquitoes which breed in shady places close to dwellings 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 oil of lemon eucalyptus (or PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.
High death toll in suspected measles outbreak
A government team has been dispatched to the southern state of Rivers to establish the extent of a measles outbreak in the Kugbo clan. Requests for assistance were sent to authorities after 50 children from three communities were reported to have succumbed to the infection. Read more
Advice for travellers
Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. In general the infection is relatively benign, but complications 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.
Diphtheria in 4 non-travellers
Regional health authorities suspect local circulation of diphtheria in the territory after the confirmation of four cases this year in residents with no history of travel. On average, two cases are detected per year among people who have visited endemic countries. The local population has been asked to ensure they are up-to-date with routine vaccinations, one of which includes the diphtheria toxoid. In related news, eight diphtheria infections have been diagnosed among asylum seekers residing at a facility in Bern, Switzerland. Read more
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.
Southern counties report most JE cases
Sixteen cases of Japanese encephalitis (JE) have been recorded this year according to CDC data, with all but one case in the south. Tainan City has reported four cases, while the counties of Taitung, Yunlin, Changhua and Chiayi each logged two JE infections. Read more
Advice for travellers
On average, 24 cases are recorded each year in Taiwan, mainly in the south from May to October, but peaking in June and July. Cases typically occur in rural, rice-growing areas where people live near the host animals, pigs and wading birds. While it is a low risk for most travellers staying in urban areas if they avoid insect bites, expats and travellers spending extended periods in agricultural areas of Asia should consult their travel health provider about recommendations for vaccination. Read more about JE.