World travel health alerts 10 February 2021

World travel health alerts for 10th of February 2021.

Early response to positive virus samples; Global polio digest

A month after the detection of vaccine-derived poliovirus 2 in environmental samples at two sites of the capital Monrovia, the Liberian government has advised that it has ‘spread throughout the country’ and declared a National Public Health Emergency. The pronouncement was made to allow for decisive measures as ‘swift intervention is needed to curtail its further spread’. The WHO warns that Liberia risks the the importation of COVID-19 and VDPV from refugees fleeing the continuing insecurity in Côte d’Ivoire. In other parts of the globe, the GPEI advised that Afghanistan’s first WPV1 case in 2021 was reported in Ghazni and there were also 14 more cVDPV2 cases from eight provinces. Pakistan recorded another eight cVDPV2 cases (Sindh and Balochistan provinces), while two African countries registered cVDPV2 cases – a single case each in Benin (Oueme) and Nigeria (Bayelsa state). 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.

Flu ticking along at low levels

Low levels of flu were recorded across most of the globe according to the latest WHO update, but a number of countries did have sporadic activity: Bangladesh, India, Iran, Laos, Oman, Saudi Arabia, Armenia, and the UAE. In the first two weeks of 2021, almost 80 percent of laboratory-tested positive flu samples were found to be influenza B. The advice on interpreting the flu data is to use caution - healthcare-seeking behaviour, provision of healthcare services, and testing practices and capacities have been impacted by the pandemic in many jurisdictions.

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.

Acre’s dengue spike; YF epizootics in 2 states

Dengue fever cases in Rio Branco, capital of the NW state of Acre, topped 1,300 in January, a figure almost 1,000 percent higher than the same period last year. This marked surge in infections has led to a health emergency declaration which grants the local government extra powers to manage the outbreak. Read more

IT IS high transmission season for yellow fever and in Palmeira, due west of Santa Catarina’s capital of Florianopolis, the first monkey deaths due to YF in four years have led to a vaccination drive for the local human population. Epizootics of YF have also been reported from 23 municipalities in the state of Paraná since July last year. More from the BBC on stopping the next YF outbreak in monkeys before it spreads to humans. 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.

Dengue surge starts the year

The islands have already reported 19 probable and confirmed dengue cases this year, while another news source puts the number of suspected cases at 60 - this compares with a total of 140 confirmed infections in 2020. The government has plans for a widespread program of mosquito reduction and habitat clearing, starting later this week in Raratonga and then moving out to the Pa Enua. 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.

Ebola death in NE; Measles cases rise in North, South Ubangi

On the weekend reports emerged that the wife of a surviving Ebola virus disease (EVD) case had succumbed to Ebola at what had been one of the North Kivu hotspots in the DRC’s largest Ebola outbreak (ending in June 2020). Contact tracing and disinfection of the local environment are underway and WHO epidemiologists are already in the area. Virus samples have been sent for genetic sequencing to see if they match the circulating virus from 2019-20 or if it is new. Sporadic cases have emerged in the past after being transmitted from individuals who had harboured the virus in immune-privileged sites such as the testes. Read more

MEDECINS sans Frontières has reported an upsurge in measles cases in the NE provinces of North and South Ubangi. Since mid-December the organisation has treated around 4,500 cases - the majority were children under 5yo and many of those under care had complications due to malnutrition. 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.

Rabies risk on the rise

Managing stray dog populations is complex, but curbing their numbers is becoming more important from a public health perspective, with ProMED reporting that around 60 people die from rabies infections each year in Egypt and the number of dog bites has been rising in recent times. The same post has details on the rabies risk from jackals in Israel, and also reports on several child deaths from rabies last year in South Africa (KwaZulu-Natal and Limpopo). Meanwhile in Peru, veterinarians in Lima are warning that rabies surveillance has lagged, with the risk that the disease could be reintroduced into the capital. One concerning national statistic quoted was that 10 rabid animals were detected in Arequipa last month alone. 

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.

Dengue adds to burdens in Somali state

Several health agencies are working to tackle a dengue fever outbreak in two woredas of the eastern regional state of Somali. The WHO notes that the area has previously reported outbreaks in 2017 and 2018, with drought, malnutrition and population displacement exacerbating the situation this time.

Advice for travellers

Dengue is spread by Aedes mosquitoes which 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 insect repellent containing an active ingredient, such as DEET, Picaridin or PMD when outdoors to all exposed skin. Read more about dengue fever. Read more about dengue fever.

COVID-19 update and news

In its Feb 9 epi update, the WHO noted four consecutive weeks of falling new case numbers and two weeks in a row of declining death rates, finding the trend at a global level ‘encouraging’, despite ‘many countries with increasing numbers of cases’. All six WHO regions registered a decline in new cases overall – in our region Malaysia had the greatest increase in new cases for the week, followed by Japan and the Philippines. The update includes a ‘Summary of emerging information on key variants of concern, as of 8 February 2021’.    

The WHO also announced this week that the results of a review by the Strategic Advisory Group of Experts on Immunisation (SAGE) were being presented to the director-general on Feb 9. SAGE will focus on ‘evidence on the AstraZeneca/Oxford vaccine, including emerging evidence on performance against viral variants, and to consider the demonstrated impact of the product and the risk-benefit assessment for use cases with limited data’. Read more

In other news:

-Four COVID-19 vaccines are currently in advanced stages of evaluation with the WHO – Britain's AstraZeneca (announcement expected Feb 15), South Korea's SK Bioscience and two from China (Sinovac and Sinopharm). Read more

-Last week the UK government announced it was funding a ‘world-first COVID-19 alternating dose vaccine study’, using different COVID-19 vaccines for first or second dose. A summary from CIDRAP: ‘The 13-month study, conducted across eight sites among 800 patients, will also explore the effect of different vaccination intervals on immune response.’

-GovUK: Coronavirus vaccine - summary of Yellow Card reporting.

-Vaccines Versus the Mutants. Read more in The Scientist

-Some EU countries have plans for vaccination passports in the pipeline, Iceland already has its in place. Read more

-A CIDRAP summary on the four main theories outlined in the first briefing of the WHO team investigating the pandemic's origins.

-WHO has launched EARS, an AI-powered public-access social listening tool Read more

Diarrhoeal diseases rife in northern province

The cholera outbreak in the northern province of Cabo Delgado continues, with seven districts now affected, after Montepuez and Chiure also recorded infections (and in Chiure’s case, one death); cases of acute watery diarrhoea are being reported in Ancuabe, Namuno, Balama and Macomia districts. Read more

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.

Hep E outbreak responses falter

An update from the WHO African office on the prolonged hepatitis E outbreak that began in December, 2017, with welcome news of a ‘strong declining trend’. The agency expressed concern that the need for health authorities to focus on pandemic responses occurs while ‘the conditions that led to the outbreak are still in place, with challenges around inadequate water, sanitation and hygiene interventions to improve access to safe drinking water and proper sanitation in affected urban informal settlements, along with inadequate risk communication activities’. 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.

Report into yellow fever cases in 2020

Health authorities have announced the results of an investigation into the yellow fever cases reported in the country’s east at the end of last year - a total of eight cases and two deaths were detected in two regions, Tambacounda and Kédougou. The outbreak is said to be controlled now and plans are underway to ramp up anti-mosquito measures in the area.  A YF vaccination campaign will begin next week targeting a population of 800,000 people in the most exposed areas. 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.