World travel health alerts 11 December 2019

World travel health alerts for 11th of December 2019.

Measles update, global situation and WHO report

Conditions of the ongoing State of Emergency include orders for no children or young adults under 19yo to be present at organised public gatherings or medical facilities (unless undergoing treatment/assessment). The latest measles figures issued by the government today: 4,898 cases and 71 deaths; measles vaccines have now been provided to approx. 91 percent of the population. Read more. American Samoa has extended its state of emergency and advised the closure of all schools and child-minding centres, cancelled public gatherings and put a hold on entry permits for travellers arriving from Samoa and Tonga. Currently, of the nine reported cases, four are locally-acquired. Fiji’s measles cases have risen to 19 as the latest govt. press briefing announced a continuation of the vaccination campaign that has targeted high risk groups across the nation and more specifically in the affected Central Division (that occupies the eastern part of Viti Levu and includes the capital, Suva). Almost 90 percent of Tonga’s measles cases have been on the main island of Tongatapu and local media say there’s been no new cases on other islands since the November update. It was also noted that over two-thirds of the 440 individuals with confirmed and suspected infections have now recovered. In the African region, measles vaccinations are planned for all regions of Cameroon in response to the ongoing outbreak. Most recently it’s been the northern regions that have been hard-hit, those bordering Nigeria and Chad in particular. And in South Sudan, 20 counties have suffered measles outbreaks this year, most recently a surge in cases has been seen in Ikotos County, Eastern Equatoria. Lastly, from the Dec 6 MMWR: between 2000 and 2018 there was a 65 percent drop in the estimated number of measles cases and a 75 percent decrease in measles deaths; and the six countries with the most unvaccinated infants were Nigeria, India, Pakistan, Ethiopia, Indonesia and the Philippines.

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.

VD polio case in Sabah, all polio news

A case of circulating vaccine-derived poliovirus type 1 (cVDPV1) has been detected in a 3mo boy from the West Coast Division, Tuaran district in Sabah; tests are currently being conducted on family, community contacts and environmental samples. The virus has been genetically linked with a strain detected in southern Philippines this year. Malaysia’s last reported polio case occurred in 1992. In other polio news, the WHO African region weekly bulletin advised that ‘outbreaks of cVDPV2 appear to be gaining a foothold in the African region, with the events spreading from conflict-affected countries (initial hotspots) to relatively stable countries’; the comment accompanied the announcement of new cVDPV2 cases in the DRC, Ghana, Benin and Togo. Also in Africa, the process culminating in verification of wild poliovirus eradication commenced this week in Nigeria with a result due mid-2020. An expert review committee recently stressed the need ‘to address the circulating Vaccine Derived Polio Virus (cVDPV2) transmission in the context of zero WPV1 status in the country’. While in the European region, the ECDC reports that three countries have been designated by the WHO as having a high risk of sustained polio outbreaks due in part to low vaccination coverage – Romania, Bosnia and Herzegovina, and Ukraine, while a further 14 have an intermediate risk. 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 waning

The latest update from the Ministry of Health reveals a drop in new dengue fever cases, down from 20 in October to seven last month (five confirmed, two suspected). Of the 120 cases recorded in the 10 months to Nov 30, all but four were in Raratonga. 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.

Abrupt, severe start to flu season

A Croatian news site, quoting a local virologist’s comments on the early start to the flu season, advised that up to one quarter of their flu patients have suffered severe complications (pneumonia, encephalitis, myocarditis), so much so that ‘We are getting calls from other European countries and colleagues are asking us what is happening in Croatia’. Influenza A/H1N1 has predominated to date. Read more

Advice for travellers

Seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol-based hand sanitiser is a convenient alternative if soap and water is not available.

Progress in EVD response halted

As expected there has been an uptick in new Ebola virus disease (EVD) reporting following the cessation of response activities due to the recent violence - the cumulative case total in the Dec 9 update was ‘3,324, of which 3,206 are confirmed and 118 are probable. In total, there were 2,209 deaths (2091 confirmed and 118 probable) and 1087 people healed’. Read more from CIDRAP including a second possible instance of relapse/re-infection with EVD. The (Bavarian Nordic/Janssen) investigational Ebola vaccine is to be used in a vaccination campaign for Rwandan citizens living in Rubavu, adjacent to the DRC border and considered high risk for EVD spread.

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.

PAHO update on diphtheria

The diphtheria outbreak that started over three years ago has persisted throughout 2019. Within the region Venezuela continues to have the highest burden of infections (albeit with fewer locations involved compared to last year), followed by Haiti with 169 suspected cases from four different departments: Nord, Centre, Sud Est and Nippes. 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.

Mumps heading for big finish in 2019

More news on the expanding mumps outbreak with news sources reporting a weekly increase of more than 100 cases – Greater Dublin (ERHA) is most affected, registering around half of the almost 2,500 cases this year (Dec 9 Health Protection Surveillance Centre report). Read more

Advice for travellers

These outbreaks of mumps highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to all destinatios. Read more about mumps.

Lassa fever season starts

Sanniquellie Mahn, Saclepea, and Tappita districts in Liberia’s north-eastern Nimba County have reported confirmed and suspected Lassa fever cases recently, signalling the start of the peak, dry season. Six counties in all have recorded suspected cases this year - Grand Bassa, Bong, Nimba, Montserrado, Grand Kru and Margibi. The WHO African region office outlines potential factors contributing to ‘the yearly increasing trend of Lassa fever cases reported’ - climate and improved surveillance. Meanwhile updates from the NCDC on Lassa fever infections in Nigeria indicate that of the 23 states recording cases in 2019, prevalence has been highest in Edo and Ondo, followed by Ebonyi, Bauchi, Taraba and Plateau. Read more

Advice for travellers

Lassa fever is a low risk for most travellers. Rodents shed the virus in urine and droppings and it’s then passed on to humans through direct contact, touching objects or eating food contaminated with these materials, or through cuts or sores. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease. Read more about Lassa fever.

YF notification from health ministry

The WHO has been advised of three yellow fever (YF) cases from widespread locations – one each in the districts of Kato (near the capital, Bamako) and Sikasso (SE, bordering Côte d’Ivoire), and also one in the Côte d’Ivoire itself (Kérégouana village). While the YF vaccine was introduced into the national schedule in 2002, there has not been a vaccination campaign in the affected areas (or nationally) since 2008. The WHO regional report noted that ‘10 cases were detected in Mali in 2015’. 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.

Another traveller diagnosed with monkeypox; Scarlatina season

Last week the PHE announced the UK’s fourth monkeypox case, in a traveller arriving from Nigeria. The person is undergoing treatment in hospital and all contacts are being monitored. In September 2018 England reported two unrelated monkeypox infections, with subsequent onward transmission to a healthcare worker. Read more. The most recent update on monkeypox in Nigeria dates from September 2019 – two states recorded more than half of all confirmed cases (Delta and Lagos).

LOCAL news sources are reporting a rise in the number of scarlet fever notifications, following the seasonal pattern of peak incidence between December and April. Between 400 and 500 cases are being recorded each week but numbers for the YTD are around half of those in 2018 (14295 cf. 30950) according to the week 49 NOIDs Weekly Report. Scarlet fever, which is a highly contagious bacterial infection, is most common among children aged between two and eight years – it is treated with antibiotics. More on scarlet fever from PHE. 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.

Hep A update with cases nearing 29k

Total case numbers in the multi-state hepatitis A outbreak that began in March 2017 are approaching 29,000, with the spread of the virus enabled mainly through person-to-person contact. Those affected most have been people who use illicit drugs, the homeless and men who have sex with men (MSM). Complications of Hep A infection have been more common, resulting in more than 60 percent requiring hospitalisation and nearly 300 deaths. Read more from the CDC.

Advice for travellers

Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through consuming contaminated food and water, by handling everyday items and through some types of sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is highly effective and offers long term protection.