World travel health alerts 11 August 2021

Seven more VD polio cases

This year has seen a marked decrease in wild poliovirus detections, with just two WPV1 cases recorded (one each in Pakistan and Afghanistan reported in January), compared to 87 for the same period in 2020. Cases of circulating vaccine-derived poliovirus (cVDPV) are also lower this year (160 cf. 206). Over the past fortnight only cVDPV2 infections were announced by the GPEI: Nigeria had 34 cases, Tajikistan’s seven were mostly from Khatlon (one case in Districts of Republican Subordination), while Afghanistan (Wardak) and the D R of Congo (Mongala) each reported a single case. Additionally, the first reports of positive cVDPV2 environmental samples detected in two more African countries: two in Uganda’s capital, Kampala (linked to the N’Djamena outbreak in Chad) and two in Western Region, Gambia (linked to Nigeria’s Jigawa outbreak).  

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.

Varicella rates rise in QLD; Contaminated dates linked to NSW Hep A cases

Chickenpox cases have spiked in Queensland this year, with confirmed infections already exceeding average yearly totals. Almost 5,750 cases have been recorded to date (annual average is 5,100). Read more

FRESH Medjool dates imported from Jordan were subject to a recall in the UK in April after around 30 hepatitis A infections were traced to them, and now the same strain has been linked with three Hep A infections in NSW. More details on the batches involved can be found on the NSW Food Authority website. Read more

Advice for travellers

Chickenpox (varicella) is a highly contagious disease caused by the varicella-zoster virus. Mainly passed from person to person by coughing or sneezing, it causes a blister-like rash, itching, tiredness, and fever. While the illness is generally mild in children, it can be more severe in young babies, adults, and people with weakened immune systems. Read more about chickenpox.

Dengue on Efate Island

The Ministry of Health has advised that 18 dengue fever cases have been confirmed since mid-April and they were reported from Erakor Area, Freshwota, Pango, Nambatu Area, Namburu, Bladinear, Beverly Hills, Tebakor and Havannah Area, which are all located in Port Vila and its peri-urban areas. Read more. In other dengue news, almost three-quarters of all dengue fever cases in Sri Lanka this year have been in Western Province, with an overall rise in infections compared to the same period in 2020. The ECDC has published an update on dengue fever numbers since July 2: More than 141,600 new cases across the globe, the majority from Brazil, Philippines, Vietnam, Peru and Mexico, while high rates of chikungunya were reported by Brazil, India, Belize, Malaysia and Peru.

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.

Central province’s chikungunya outbreak

Local media are reporting an outbreak of chikungunya in Kandal province, which surrounds the capital Phnom Penh. More than 80 people are said to have contracted the infection in three districts of Ponhea Leu district. Across the country this year more than 1,300 chikungunya cases have been recorded, with the incidence generally higher in the provinces of Battambang, Kampong Chhnang, Ratanakiri, Mondulkiri and Kratie. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by day-time feeding Aedes mosquitoes. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.

First local dengue infection in 2021

Health authorities in the Provence-Alpes-Côte d'Azur region have confirmed the first case of locally-acquired dengue fever in France (and Europe) this year. The infected individual, who had no history of travel, lives in the city of Toulon and has since recovered. The risk of dengue transmission in the region is dependent on imported infections and the presence of the Aedes albopictus mosquito, which is well-established in many European countries. 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 after CCHF death

A woman from the southern region of Samtskhe-Javakheti succumbed to Crimean-Congo haemorrhagic fever last month while health authorities have warned that the disease vector, adult Hyalomma spp. ticks, are found throughout the country. According to sources quoted by ProMED, ‘the seroprevalence in Georgia is approximately 2.8 percent’. Within the wider region, Turkey is the country most affected by CCHF.

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.

Marburg case a first for Guinea, West Africa

Guinea, and West Africa, have now reported their first Marburg virus case (and death) in the Koundou area of the southern prefecture of Gueckedou. The prefectures lies in Nzérékoré Region, near the borders with Sierra Leone and Liberia, and was the site of Ebola outbreaks this year and the epidemic of 2014-16. More than 150 contacts are being monitored for signs of the viral haemorrhagic fever. The WHO has praised Guinea’s rapid response to the confirmed case and is assisting in ‘risk assessment, disease surveillance, community mobilization, testing, clinical care, infection prevention as well as logistical support’. Countries that have reported outbreaks and sporadic cases in the past include Angola, the D R of Congo, Kenya, South Africa and Uganda. Read more

Advice for travellers

Marburg virus disease is a rare but severe viral haemorrhagic fever, related to the Ebola virus, and there is no treatment. Found in the African fruit bat, Marburg typically appears in sporadic outbreaks and laboratory-confirmed cases have occurred in Uganda, Zimbabwe, the Democratic Republic of the Congo, Kenya, Angola, and South Africa. Preventive measures are not well defined, as study in how it is spread continues, but travellers should avoid contact with fruit bats and sick primates in central Africa. Read more

COVID-19 deaths climb, global digest

While it took 12 months for COVID-19 cases across the globe to reach 100 million, it has taken only six months for the 200 million milestone to be hit. The latest WHO weekly epi update noted that the largest proportionate increases in new cases were in the Region of the Americas (largely driven by Peru and the USA) and Western Pacific Region (Malaysia, Japan and the Philippines), which also reported a 46 percent rise in new deaths (Vietnam recorded a 108 percent increase in deaths this week on top of the 576 percent rise last week).

In related news:

- ATAGI has issued ‘Guidance on Myocarditis and Pericarditis after mRNA COVID-19 vaccines’. Read more

- Spikevax (elasomeran), a mRNA vaccine produced by Moderna, has now been granted provisional approval by the TGA for individuals 18 years of age and older, with a 28-day interval between doses.

- COVID-19 in Australia: Live tracking of Coronavirus Cases, Active Cases, Tests, Recoveries, Deaths, ICU and Hospitalisations at https://covidlive.com.au/

- Due to a technicality, vaccinations of the Australian-made AstraZeneca COVID-19 vaccine are not currently recognised in Europe. The ABC reports on the rebranding of the vaccine to 'Vaxzevria' before international travel gets underway again.

- Information on the African Union's Digital Vaccination Platform which features: ‘Information about the latest travel restrictions and entry requirements applicable to the entire stretch of your journey … a Database of authorised laboratories and vaccination compliance information … and Africa CDC “mutual recognition protocol” for COVID-19 testing and test results, and vaccination certificates (including yellow fever and a future COVID-19 vaccine)’. Read more

Lassa fever in 4 counties

The August 1 WHO regional bulletin provided an update on a Lassa fever outbreak that has affected four counties this year - Bong, Grand Bassa, Montserrado and Nimba. Contact tracing is underway in Bong and Nimba counties for the most recent confirmed (fatal) case early in July. Lassa fever is endemic in Liberia, Sierra Leone, Guinea and Nigeria.

Advice for travellers

Lassa fever is an acute viral illness that occurs in West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5,000 deaths occur each year. However, Lassa is a remote risk for most travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Read more about Lassa fever.

Cholera outbreaks increasing

Outbreaks of cholera are escalating around the country, with confirmed reports from the Federal Capital Territory and 22 states so far this year. Suspected cases now exceed 31,000 and more than 800 people have died, while there have also been reports of spread to the neighbouring regions of Maradi and Zinder in southern Niger. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travel, the risk of infection is low. Travellers 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.

Hepatitis C update

Following World Hepatitis Day, which was observed on July 28, local health officials released a hepatitis C report card for Pakistan: almost 14 million people are infected with the virus and disease prevalence in the provinces of Punjab, Sindh, Balochistan and KPK ranges from 6.7 percent down to just over one percent. Read more

Advice for travellers

Hepatitis C is a viral infection of the liver which is most commonly contracted through intravenous drug use, but transmission has also has been reported infrequently through modes such as unsafe MSM sex with an HCV-infected person (a higher risk if that person is also HIV-infected), sharing personal care items (i.e. razors) contaminated with blood and unregulated tattooing. For up to 30% of infections, it is a short-term illness and the individual may not have symptoms; but for the majority it can become a chronic infection which can produce long-term health issues and potentially lead to death. Antiviral medications have been developed which have been shown to successfully treat the majority of Hep C infections. Read more on hepatitis C from the WHO.

Tick warning over relapsing fever

Tourists staying in cabins in California’s El Dorado County (Lake Tahoe, Sierra Nevada) are asked to be alert for the presence of rodents after two cases of tick-borne relapsing fever were detected recently. A local news source advised that the bacterial infection is carried by ticks that commonly live in rodents’ nests and ‘can cause recurring bouts of fever, headache, muscle and joint aches, and nausea’. Read more