World travel health alerts 10 July 2019

World travel health alerts for 10th of July 2019.

Polio now detected in central province

Less than a month after the first case of circulating vaccine-derived polio (cVDPV2) was detected in the NE province of Lunda Norte, another outbreak has been identified more than 1,000 kms away - one cVDPV2 case and four health community contacts who tested positive for cVDPV2 in the central province of Huambo. As reported by the WHO, ‘the virus isolated in stool specimens from a community contact was genetically linked to the VDPV2 isolated from an acute flaccid paralysis (AFP) case, indicating circulation’. In the first six months of the year there have been 167 cases of acute flaccid paralysis in Angola, yielding these ‘two genetically-distinct outbreaks of cVDPV2’. Reactive vaccination programs are planned or already underway in the two provinces. More on polio this week summarised by ProMED.

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.

WHO updates vaccination requirements

On July 1, the WHO released the updated vaccination requirements for all member countries and for anyone arriving on our shores within six days of being in a designated yellow fever risk area there are no changes to the previous position. Australia’s entry requirements state: a yellow fever vaccination certificate is required for travellers aged 1 year or over arriving from countries with risk of yellow fever transmission (with the exception of Galápagos Islands in Ecuador) and for travellers having transited for more than 12 hours through an airport of a country with risk of yellow fever transmission (with the same exception as mentioned above). WHO Country List and Annex.

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.

Measles: Some good news…

On a more positive note than most of the measles news we have posted lately, the WHO SE Asian regional office announced that Sri Lanka has interrupted measles transmission ‘at a time when globally measles cases are increasing’ -  May 2016 was the last time an indigenous measles case was recorded. Read more. In other news: Chad – nine fewer districts are reporting measles epidemics however in the last week of June there were still 555 suspected cases and four related deaths, taking the YTD total to more than 22,000 and 215 deaths. While Ethiopia’s measles infections are nearing the 7,000-mark with many of those reported from Oromia, Amhara and Solami regions. The International Federation of Red Cross and Red Crescent Societies has reported on vaccination campaigns underway in response to the Ukraine’s continuing high rates of measles - the YTD total at the end of May reached 52,034 cases. Among the most affected regions there has been marked improvement in Lviv, however high monthly case numbers in Kharkiv and Kyiv are of concern to the agency. According to a 2019 public health report, for the past three years, the uptake of the the first dose of MMR vaccine in Ireland for children at their second birthday has been 92 percent (target 95 percent), with one area south of Dublin recording only 84 percent in 2018. Sixty measles cases have been reported in the republic to June this year. New Zealand’s total of measles cases rose to 280 on July 5, with the highest incidence of infections in the 20 to 29yo age group (71 cases) followed by 10–19yo (54) and under 15 months (51). The Counties Manukau Health Board of southern Auckland has reported most cases this year (76). The International Federation of Red Cross and Red Crescent Societies has reported on the vaccination campaigns underway in response to the Ukraine’s continuing high rates of measles - the total at the end of May reached 52,034 cases. Among the most affected regions, there has been marked improvement in Lviv, however high monthly case numbers in Kharkiv and Kyiv are concerning to the agency. According to a 2019 report from Ireland’s Dept of Health, for the past three years the uptake of the first dose of MMR vaccine for children reaching their second birthday has been 92 percent (target of 95 percent), with one area south of Dublin recording only 84 percent in 2018. Sixty measles cases were reported to June this year. In Australia, the health departments in Qld (Brisbane, Gold Coast) and NSW (Sydney) have issued alerts relating to several measles cases reported over the past week.

Advice for travellers

Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. 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. Read more about measles.

Dengue update for Abidjan

The earlier reported dengue fever outbreak continues with the majority of cases in the former capital of Abidjan (upmarket districts of Cocody-Bingerville and Abobo East of note); two dengue serotypes are in circulation. Case numbers peaked in late June with 280 infections reported over a 7-day period. 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.

Dengue outbreaks worsened by apathy

A senior public health official has stated that several dengue fever outbreaks are occurring across the country without providing details, however a separate news article from July 2 commented on the up to 30 suspected dengue cases reported each day in San Cristóbal (Artemisa province), to the west of Havana. The outbreaks are being blamed on rainfall, high temperatures and landfills. Read more

Advice for travellers

Avoid mosquito bites to protect against 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.

More high-risk community EVD deaths

The latest WHO Situation Report notes that ‘EVD case incidence rates remained largely unchanged in the past week’ and no further cases have been discovered in Ariwara Health Zone, near the Ugandan and South Sudan borders, since the first one was identified on June 30. Five more high-risk deaths occurred in the community in the last day, three of those in Beni which is re-emerging as a hotspot. The cumulative total of suspected and confirmed cases is now 2,428 and 1,641 deaths – see Ebola dashboard here. 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.

Leptospirosis, dengue reports; JE in NE state

With the arrival of the monsoons and a corresponding uptick in associated infections such as leptospirosis, surveillance has been heightened in an area known as the Konkan belt, a coastal fringe which includes parts of Maharashtra, Goa, and Karnataka. Particular emphasis has been placed on Mumbai where many of Maharashtra’s leptospirosis cases and deaths have been reported over the past five years. People considered at high risk of the infection in areas that have recently been inundated with floodwaters have been administered prophylactic antibiotics. Read more. Dengue fever cases are on the rise in Karnataka (Bengaluru), while authorities in Delhi are preparing for the dengue outbreaks that normally eventuate between July and November.

THE state of Assam is in active Japanese encephalitis season with several districts (four in Upper Assam and one in Lower Assam) reporting many of the cases. As many as 57 deaths have resulted from the more than 230 JE cases over the past three months.   

Advice for travellers

A mosquito-borne virus, JE is usually found in many part 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 urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

CCHF in 6 provinces

Six provinces hold the highest burden of Crimean-Congo haemorrhagic fever (CCHF) cases - 54 cases and five deaths have been recorded countrywide since late March. Prevalence of CCHF virus infection, which is tick-borne or acquired through contact with infected animal blood or tissues during and immediately after slaughter, is highest in the province of Sistan-Baluchestan, but also significant in Khorasan Razavi, Kerman, Isfahan, Fars and Mazandaran. Read more

Advice for travellers

CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

Dengue toll climbs to 27

A nationwide call to eradicate breeding sites of the dengue virus-carrying Aedes mosquito has been issued by the government in one measure aimed at kerbing ongoing outbreaks. There have been more than 11,500 dengue fever cases this year and 27 related deaths, with the capital Vientiane and southern regions most affected. 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.

Wolbachia mosquitoes to tackle dengue

The state of Selangor has reported over half of the country’s dengue fever cases this year (almost 67,000) and virtually double last year’s figures. Deaths are approaching the 100-mark, again an increase on the 2018 half-year total of 53. Measures to curtail the momentum of new dengue cases include the release of Wolbachia-infected mosquitoes in Penang, Selangor, Kuala Lumpur and Putrajaya. 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.

Alert over fake rabies vax

Last week the country’s Food and Drug Administration notified the public that another two batches of counterfeit rabies vaccines had been found in regular distribution chains, the third such alert over the past 18 months and the second regarding counterfeit batches of the GSK product, Rabipur. Read more

Good news on MERS front

The decline in the reporting of new MERS Co-V infections has been attributed to ‘addressing knowledge gaps with regard to transmission, enhancing surveillance, and strengthening the ability to detect cases early and contain outbreaks through improved infection prevention and control measures in hospitals’, in a Research Letter published in the CDC’s Emerging Infectious Disease journal on July 8 and summarised by the WHO. The case count since MERS-CoV was first identified in 2012 until May 31 this year rose to 2,442 infections and it has claimed 842 lives. The article also notes that the virus ‘is currently circulating in dromedary camels in Africa, the Middle East, and southern Asia; however, most cases of human infection have been reported in the Arabian Peninsula’. Read more

Tick-borne infections rise in summer months

Summer is peak tick season and the advice from the government for anyone venturing outdoors is use repellent and cover up. This advice is particularly important in provinces such as Gangwon-do which has reported the highest rates of a viral infection transmitted by the arachnids, Severe Fever with Thrombocytopenia Syndrome. Countrywide this year there have been 46 cases and 11 deaths due to SFTS. SFTS is an emerging infection in the region with increasing reports in South Korea since it was first identified there in 2012. Read more

Advice for travellers

SFTS causes symptoms including high fever, vomiting, diarrhoea, thrombocytopenia, leukopenia, and multiple organ failure. The virus has a 6%–30% case-fatality rate and there is no effective vaccine. Read more about SFTS.

Rabies risk up in summer

Warmer weather means more humans interacting with wildlife and a rise in potential rabies exposures. ProMED this week summarised reports from four states (Pennsylvania, Florida, New Jersey and South Carolina) involving rabid foxes, raccoons and stray cats. Read more

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. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is normally 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.

Cholera toll mounts

The humanitarian crisis is into its fourth year and cholera continues to be a major public health issue after recent floods. According to OCHA, there have already 460,000 cholera cases this year with almost half of those in children. More than 700 deaths have resulted; the governates reporting high case numbers are Amanat Al Asimah, Sana’a, Al Hudaydah, Hajjah, Ibb, and Dhamar. 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.

Fly-blown infection

A second case of East African trypanosomiasis has been reported in the area of South Luangwa National Park this year. ProMED reports that the latest case, a young woman, had been bitten on the leg by a tse tse fly during a wildlife viewing drive one afternoon ‘but was told there had not been any cases of trypanosomiasis for years in this area’. An earlier case was reported in March. Read more  

Advice for travellers

Human African trypanosomiasis is rare in travellers, however the tsetse fly, which spreads the disease, is found in 37 African countries. The aggressive flies are attracted to moving vehicles and bright, dark colours and can bite through light-weight clothing. Travellers should cover up and apply a personal insect repellent containing DEET (30-50%), Picaridin, IR3535, or oil of lemon eucalyptus at all times when outdoors. Read more on African trypanosomiasis and how to avoid infection.