World travel health alerts for 11th of March 2020.
Polio digest – SE region off outbreak country list, Malaysia’s 4th case announced
Around 10 months after wild poliovirus type1 (WPV1) was detected in sewage tested in the SE province of Sistan & Balochistan, the GPEI reported this week that ‘the event has now been declared closed therefore eliminating Iran from the list of outbreak countries’. In other polio news, WPV1 infections were reported in Afghanistan (the first two this year, from Helmand and Zabul provinces) and Pakistan (four total i.e. one each from Punjab, Khyber Pakhtunkhwa, Sindh and Balochistan provinces). Pakistan also reported six cVDPV2 cases (Khyber Pakhtunkhwa Tribal Districts, Khyber Pakhtunkhwa province and Punjab). In Africa, cVDPV2 cases were registered in Angola (one in Benguela province), Chad (one each from Ouaddai, Chari Baguirmi, Batha and Logone Oriental provinces), Democratic Republic of the Congo (one each from Lualaba and Tshopo provinces) and one case from Oromyia province in Ethiopia. Malaysian authorities have announced the country’s fourth polio case, in an ‘undocumented three-year-old boy in Sandakan, Sabah’. The GPEI weekly report of Mar 4 stated that testing in the state of Sabah had detected three cVDPV1 positive environmental samples. 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.
COVID-19 responses, relevant articles
As confirmed COVID-19 cases continue to rise, the federal government has announced the introduction of measures to protect the population, including up to 100 pop-up fever or respiratory clinics to allow for the more serious cases to be treated at hospitals and GP clinics. It is expected that the clinics will manage those people who have mild or moderate symptoms. Govt. funding will also provide for phone hotlines, telehealth consultation services and some home medicines services. Read more
More on local and global cases in the Mar 10 WHO Sitrep and the Australian Dept. of Health’s dedicated COVID-19 online resources.
Details of conditions inside just one Italian hospital dealing with the extensive outbreak, now the second largest outside mainland China, offer compelling reasons behind the countrywide lockdown now in place. Read more
In other news:
A STAT news article summarising a recent (pre-print) German study suggests the rapid spread of COVID-19 is due to ‘very high levels of virus emitted from the throat of patients from the earliest point in their illness —when people are generally still going about their daily routines’. Read more
The Mar 6 WHO Situation Report contained a section on Q&A: Similarities and differences – COVID-19 and influenza.
An informative series of tweets by a professor at the UNSW School of Chemistry explains ‘Why does soap work so well on SARS-CoV-2, the coronavirus and in fact most viruses?’
While SARS-CoV-2 can survive on surfaces from two hours to nine days, it is vulnerable to heat, changes in pH, and common disinfectants.
The Chair of the Coalition for Epidemic Preparedness Innovations (CEPI) has said that a COVID-19 vaccine won’t be available for at least 12 months; and in the US, the NIH has commenced Phase 2 studies of the investigational antiviral remdesivir to test its effectiveness in hospitalised adults diagnosed with COVID-19, including 295 patients in South Korea.
Flu lingering in east
Flu season continues in the Northern Hemisphere. In the week to Mar 1, six countries were still reporting high rates of influenza (Luxembourg, Bosnia and Herzegovina, Montenegro, Kosovo, North Macedonia and Moldova) while medium intensity was recorded in a further 14 countries (several eastern European nations among them). The 2020/21 northern flu season vaccine recommendations have now been released by the WHO. 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 (>60% alcohol) is a convenient alternative if soap and water is not available.
First 2020 YF death in southern state
Santa Catarina’s first yellow fever (YF) fatality for the year, a man in his 40s, travelled frequently between the coastal resort city of Balneário Camboriú and nearby Camboriú. A local news report stated that while yellow fever vaccines are now provided free of charge by the state, the man had not been vaccinated. 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.
Seafood source suspected in Hep A outbreak
Recent reporting of sporadic hepatitis A cases in the NE province of Liaoning has been attributed by the health authorities in one coastal city as consistent ‘with the seasonal epidemic trend of hepatitis A’. Local social media posts focussed on seafood consumed in Dalian and Dandong as possible sources of infection. Read more
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.
Monitoring over for last Ebola contacts
Another landmark event as the last Ebola contacts - 46 people from Beni – successfully completed their 21-day observation period. ReliefWeb reports that vigilance is being maintained until the outbreak is over: ‘Ebola response operations remain in full force. Critical ongoing activities include validating alerts, testing suspected cases and confirming the cause of death of people who pass away in communities’. More news from the WHO Sitrep with data to Mar 8.
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.
Dengue downturn at last
There was a further decline in new dengue fever cases reported during the fortnight ending Feb 22, although 14 islands are still considered to be in an epidemic phase (and six more on alert). Nearly 2,700 cases have been recorded since the outbreak began at the beginning of 2019, with the NW districts of Tahiti most affected. And on Wallis and Futuna, sporadic dengue infections persist – the three most recent cases were in Malae (Hihifo district), Mata-Utu and Akaaka (Hahake). Read more
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 repellent containing an active ingredient, such as DEET, Picaridin, or PMD when outdoors to all exposed skin. Read more about dengue fever.
Diphtheria digest for region
A PAHO update on diphtheria infections reveals the highest burden among children aged from one to 14 yo – in the first eight weeks of this year there were nine confirmed cases (and two deaths), plus a further 25 cases were considered probable. Highest disease incidence was in two southern departments, in the communes of La Vallée and Port à Piment. In 2019 there were 250 confirmed and suspected cases. Elsewhere in the region, in the first eight weeks of 2020 Venezuela had reported 25 confirmed cases in ‘2 federal entities and 2 municipalities’ in an outbreak that has simmered since mid-2016. The PAHO reports that last year in Venezuela, ‘the highest age-specific case-fatality rates are among 5 to 9- year-olds (33%), followed by 1-year-olds (25%), and 40 to 49-year-olds (20%)'.
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 and to protect their infant. Read more on diphtheria.
Selangor’s dengue cases surge
Selangor’s 18,000+ dengue fever cases since late Dec 2019 eclipse all other states, making up over half of the national total of 29,766 cases (and 43 deaths). In the same period, Kuala Lumpur recorded just over 2,100 cases and Sabah had 1,688. While in Indonesia, authorities announced 14,716 confirmed and suspected cases – the highest case count and death toll occurred in the province of Nusa Tenggara. 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.
Curbing sand fly vector not on checklist
Cutaneous leishmaniasis infections have soared in Misratah district, east of Tripoli. More than 1,000 infections have been reported, however control of the sand fly that transmits the protozoan parasite is not reported to be one of the strategies in the local response to the surge in cases. Read more
Advice for travellers
Leishmaniasis is a parasitic disease found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. The former causes skin ulcers and the latter a severe systemic disease that is usually fatal without treatment. India, Bangladesh, Nepal, Sudan, South Sudan, Ethiopia and Brazil account for 90% of visceral leishmaniasis, while 90% of cutaneous leishmaniasis cases occur in Afghanistan, Algeria, Iran, Saudi Arabia, and Syria, as well as the South American countries of Brazil, Colombia, Peru, Bolivia and Argentina. Read more on the disease and prevention.
Dengue in Lima’s north
A widening of the dengue fever outbreak affecting the country has been reported, with a small number of cases now being recorded in parts of the capital, Lima. Fumigation has been underway in the two northern districts – the highly populous Comas and nearby Puente Pedra – to halt transmission. More on dengue across the Americas in a ProMED report. 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.
Local dengue case in Florida’s southernmost county
Quoting Key West health authorities, a local news source announced the first case of locally-acquired dengue fever infection for 2020 in the Florida Keys. 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.
Yet more bad cholera news
Extensive outbreaks of cholera were recorded during 2107 and 2019, and the outlook for this year is also looking bad as suspected cases rose above 56,000 in the first seven weeks of last year. There are particular concerns for five northern governates (Sana’a, Hajjah, Hudaydah, Taiz and Dhamar) and the impact of the upcoming wet season. 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.