World travel health alerts for 10th of June 2020.
Local and African polio cases updated
No wild poliovirus cases were reported to the GPEI this past week, but unfortunately not so for circulating vaccine-derived poliovirus type 2 (cVDPV2): in Afghanistan (six cases in Nangarhar province), Burkina Faso (Centre-Nord and Ouagadougou provinces – one each), Ethiopia (one in SNNP province) and Côte d’Ivoire (three in Gbokle-Nawa-San-Pedro province and one in Goh province). The onset of the June-August peak transmission season in Pakistan and the suspension of the polio immunisation programme in late March due to the COVID-19 pandemic have sparked concerns over a resurgence of the disease, particularly for the 40 million children under 5 years targeted in the campaign and for residents of high risk districts.
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 reporting at 'historic lows'
Social distancing and enhanced hygiene measures continue to have a beneficial effect on influenza activity - confirmed infections in May dropped from 30,372 in 2019 to 197 this year (monthly May average over the previous five years was ~2,400), according to stats published by the Immunisation Coalition. This picture is reflected on a global level: Of the influenza samples obtained from 62 reporting countries through FluNet in the week to May 10, only 0.084 percent tested positive compared with 9.6 percent for a similar period in 2019. A ProMED post’s moderator questions whether ‘influenza surveillance [is] being impacted by the intense demands of the COVID-19 pandemic? Or more importantly, are the influenza circulation patterns being displaced by SARS-CoV-2?’. Overall, low or no influenza detected were reported in most regions and activity was at or below inter-seasonal levels in temperate regions of the southern hemisphere. More in the WHO summary.
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.
Dengue cases top 10,000
Another warning from the NEA on dengue fever as cases surpassed 10,000 for the year, evoking memories of similar numbers recorded in 2013, ‘the largest outbreak year recorded in Singapore’s recent history’. Peak transmission season is expected to last until October, leading the agency to call for urgent community support ‘to do their part in preventing dengue’. Read more. Malaysia is also anticipating a more active dengue transmission to take place until September, worsened by populations of mosquitoes which have boomed during lockdowns. However many countries in the region, including Malaysia, have to date experienced a reduction in dengue cases compared to the same period in 2019 (Cambodia, Laos, Philippines and Vietnam).
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.
The scourge of measles
While the large measles epidemic in the DRC gains some media coverage, there is much less on the outbreaks in two countries to its north. Suspected cases in Chad this year now total 8,200 and 39 deaths (in Beboto, Kyabe, Goundi, Korbol, Kelo and Guelao) and there has been further spread of the outbreak in the Central African Republic into seven new districts. 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. 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.
Update on NW Ebola outbreak, monkeypox impact highest in 5 provinces
More Ebola cases have emerged in the NW province of Equateur – there have now been 9 confirmed and 3 probable infections, six of the cases proved fatal. Three health zones have reported cases – Mbandaka, Wangata and Bikoro (site of the last Equateur outbreak); vaccinations are already underway in the first two zones. A post in virological.org suggests that the source is likely ‘a new spillover from animals to humans' and genetic sequencing suggests there is no link between the Ebola outbreaks in the NE and NW, the country’s 10th and 11th. Equateur is one of five provinces with most of this year’s reported monkeypox cases, the others are Sankuru, Bas-Uele, Mongala and Tshopo. To mid-May, across the country, there have been 1,702 suspected cases and 47 deaths. Read more
Advice for travellers
Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox.
More dengue, US travel notice issued
In a further update of the dengue fever outbreak affecting the four territories, the ECDC reports an additional 1,700+ cases over the four weeks to May 31 – Martinique and Guadeloupe recorded 1,340 between them. The ECDC went on to note that ‘environmental conditions are favourable for continuous transmission. The concurrent circulation of several dengue serotypes may increase the risk of more severe clinical presentations.’ A May 21 CDC travel notice was issued for 14 countries in Central and South America, Mexico, and the Caribbean due to ‘higher-than-usual numbers of dengue cases’.
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.
Tick numbers, risk of infections soar
News media have reported a huge surge in tick populations following the mild winter, with one region in Siberia (already known for its high incidence of tick-borne infections such as tick-borne encephalitis - TBE - and Lyme disease) registering the arachnids’ numbers at 400 times greater than usual. Novosibirsk and Tomsk regions are also said to have been plagued by ‘a mutant tick’, a fertile hybrid that ‘is capable of carrying infectious agents associated with both parent species’. Read more
Advice for travellers
A viral infection, tick-borne encephalitis (TBE) can cause fever, vomiting, cramps and paralysis, which can be prolonged. In rare instances, infection can be fatal. Travellers who spend time in regions where TBE is endemic – mainly forested areas of Central and Eastern Europe, Russia, Northern China, and Mongolia – may be at risk. The highest risk is during the warmer months from April to November, especially when hiking or camping in areas below 1500m. While safe and effective vaccines are available in Europe, none are licensed in Australia; however the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.
Cholera infections likely to surge
No end to the cholera outbreak which has been underway since January with aid agencies anticipating a doubling of cases by the end of this month. The regions of Middle Juba and Bakool have been hardest-hit. 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.
No additional YF cases in Oti district
A June 5 WHO Disease Outbreak News post updated information on surveillance and response measures for the confirmed yellow fever case in the northern region of Savanes in early February. ‘No additional cases of acute febrile jaundice were identified’ in Galangashie health area and a reactive yellow fever vaccination campaign was instituted last month to improve coverage in the region. The last YF outbreak to hit Togo occurred in 2006-7. 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.
COVID-19 update
News this week that June’s 7-day averages of confirmed cases in some 14 states are the highest yet, ‘fueled by rural outbreaks in southern and western states, many of which were quick to reopen on or around May 1’. Read more. According to the Johns Hopkins COVID-19 tracker, the US has had just over 1.985 million confirmed cases (2.045 million per worldometers), however it’s South America’s contributions that have grown and are now making up around one-third of the global total (7.238 million today). More in the June 9 global WHO Sitrep and for Africa.
In other COVID-19 news:
The WHO has revised its Interim Guidance on wearing face masks - the recommendation is for their use in countries with widespread transmission and in those situations where physical distancing is not possible.
A new Google maps feature available in some countries, including Australia, will show relevant alerts from local transit agencies when searching ‘public transit directions for a trip that is likely to be affected by COVID-19 restrictions’; they also include whether it is a requirement to wear a mask on the transport, as well as mandated driving alerts.
Rainy season set to worsen cholera outbreak
Cholera infections are mounting, with reports of more than 150,000 cases registered since the beginning of the year - the capital Sana'a and governates of Sanaa, Ibb, Al Mahwit, Hajjah and Dhamar have been hit the hardest. It is likely that the worst is still to come, with the arrival of the rainy season predicted to widen the outbreaks. 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.
More anthrax cases
Reports of anthrax infections first emerged in week 36 last year and continue into May, having spread into new districts. Of the 303 cases reported for the year to May 15, highest case counts have been in in Masvingo, Midlands and Mashonaland west provinces. Read more
Advice for travellers
The anthrax bacterium is transmitted to people in the form of spores which are can produce disease through consuming contaminated meat, through inhalation or via contact with the wool, hair or hide of infected animals. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about anthrax.