World travel health alerts 11 May 2022

Buruli ulcer alert in Melbourne’s inner north; More SA piggeries report JE virus

The Victorian health department has issued an alert notice after the bacteria that cause Buruli ulcer were detected in new areas of Melbourne’s inner north – ‘Pascoe Vale South and Strathmore, expanding the inner-Melbourne areas of interest which previously included Essendon, Moonee Ponds and Brunswick West’. More detail is provided in the department’s news post, including the state’s high and moderate risk locations, as well as emerging risk areas. Read more

THE NUMBER of South Australian piggeries reporting Japanese encephalitis infections in their animals has risen to nine, with two facilities from the Mid Murray and Loxton Waikerie Local Government Areas added to the list. The federal health department May 4 status update flagged a total of 38 confirmed or suspected human JEV cases and the death toll has risen to four. Read more

Advice for travellers

A mosquito-borne virus, JE is generally found in many parts of Asia, the Indian subcontinent, Southeast Asia, China, Indonesia and PNG, and now areas of southern and eastern Australia. In Asia, 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 large urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

Cholera reports from 6 African countries

Cholera infections have been confirmed in residents of an informal settlement area east of Nairobi’s central business district. Two deaths have been reported in Kamukunji Constituency and several children have been hospitalised for treatment. A May 10 ProMED report covers more cholera outbreak news from Cameroon (Centre, Littoral, South, Southwest, and North regions), South Sudan (Unity state), Malawi (Blantyre, Nsanje, Neno, Chikwawa and Machinga districts) and Somalia (Southwest and Hirshabelle states and Banadir region. From another news source, teams from Nigeria’s Centre for Disease Control (NCDC) are working to control cholera outbreaks in 15 states ahead of the rainy season in the far north. 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.

3rd fatal Ebola case in Equateur

A high-risk contact of the index case has become the third infection of the Ebola outbreak in the city of Mbandaka, Equateur province – all three cases were fatal. Surveillance and vaccination of contacts continues with the support of the WHO. 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.

2nd flu peak now receding

An update on flu news from the EU, with the highest rates of influenza positivity in sentinel primary care reported last week by Finland (80 percent), Netherlands (60 percent) and Poland with 50 percent. The ECDC registered a downward trend in new flu cases over the past two weeks after a second peak of activity late in the season - influenza A(H3) viruses predominated in most countries. Read more

Advice for travellers

In most years, 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. Whether you are travelling within Australia or overseas, vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms. 

Rural governates report tick-borne infections

The death toll from tick-borne infection Crimean-Congo haemorrhagic fever (CCHF) has risen to seven since early 2021 and cases are three times higher than in previous years. The governate of Dhi Qar has reported the majority of both infections and deaths from among the endemic regions of the country’s rural south over the period; all confirmed cases occurred in people working in the livestock industry. The same ProMED CCHF alert reports that warmer weather in Tokat and Kelkit Valley in Turkey’s north has prompted doctors to warn that tick bites are a seasonal risk for people venturing into the countryside. While in Georgia, three people are receiving treatment for CCHF in a Tbilisi hospital. 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 disease, which has a fatality rate of 10-40%, is more common in Africa, the Balkans, the Middle East, and  Asia, as well as countries south of the 50^th parallel north. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to most travellers. Read more about the virus.

2 unlinked Lassa fever cases in southern province

A second Lassa fever case has been confirmed in Guéckédou province and there are no apparent epidemiological links to the first infection diagnosed last month. While both patients are from the same province, they reside in different sub-provinces (Kassadou and Tekoulo). The WHO regional office’s situation summary notes that ‘the newly declared Lassa fever outbreak in Guinea is of grave concern in the context of a country with a fragile health system that has faced multiple disease outbreaks such as Ebola, Marburg, Lassa fever, yellow fever, and the ongoing COVID-19 pandemic’. Read more

Advice for travellers

Lassa fever is an acute viral illness that occurs in sub-Saharan 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. For 80% of people infected, Lassa fever is mild or has no observable symptoms. The remaining 20% can experience severe, often fatal, multisystem disease. Read more about Lassa fever.

COVID-19 news and update

Last week’s WHO COVID-19 epi update showed a general decline in new global COVID-19 cases and deaths, however the African and American regions did report an increase in cases (by 31 and 13 percent respectively). Africa’s surge was driven by a 67 percent hike in new infections in South Africa fuelled by the BA.4 and BA.5 sub-variants, while in the Americas, the USA logged a 27 percent increase, with BA.2.12.1 sub-lineage detections rising. In the SE Asian region, highest numbers of new cases were reported by Thailand and India. The WHO Director-General gave a briefing yesterday in which he said that cases are now rising in more than 50 countries, highlighting the volatility of SARS-CoV-2. Read more

In related news:

- A May 9 article by The Conversation covered the current advice on COVID-19 vaccine timings in Australia following the latest ATAGI meeting: ‘COVID vaccination recommendations evolve over time. Who is due for which dose now?’

Dog attacks in Bali

A spate of rabid dog attacks on villagers has been reported in Tabanan Regency, in SW Bali and local officials have said there are several risk hotspots in the area. And on the eastern side of the island, more than 40 people have been bitten by rabies-infected dogs in Karangasem. A mass rabies vaccination program is planned this year for at least 80 percent of Tabanan’s dog population. 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, including bats. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is generally 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.

HFMD spikes in 3 states

Children aged under six made up the majority of the nearly 22,500 hand, foot and mouth disease (HFMD) cases recorded to the end of April this year. The states registering most cases were Kuala Lumpur and Putrajaya, Selangor and Perak, however news media report 767 outbreaks across the nation. Read more

Advice for travellers

Parents of young children should be aware of that seasonal epidemics of HFMD occur throughout Asia. The virus mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection. Read more on HFMD.

Preparations for dengue season

Plans for suppressing dengue fever outbreaks are underway as the pre-monsoon rains arrive in Kathmandu Valley. A UN report on the impacts of climate change warned that it has already resulted in six vector-borne infections becoming endemic in Nepal and their distribution has widened, with Anopheles, Culex and Aedes mosquitoes now found above 2,000 metres in altitude. 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.

Polio update

Last week the GPEI announced three new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases in Nigeria (Niger, Katsina and Zamfara states), bringing its YTD total to 20. Pakistan’s second wild poliovirus type 1 (WPV1) case this year, which was detailed in our May 4 alerts, was also mentioned in the update. 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.

2nd imported monkeypox case in 2 years; Paediatric hepatitis update

Late last week health authorities confirmed an imported case of monkeypox in a traveller from Nigeria; the patient is currently receiving treatment at a London hospital and contacts are being followed up. It has been stressed that the risk of transmission to others is low and the overall risk to the general public very low. A single imported case was reported this time last year (also from Nigeria) and resulted in onward spread of the infection to two family members. The reporting of monkeypox in Nigeria is sporadic: a recent governmental situation update advised that positive cases had been detected in four states in April - Lagos, Federal Capital Territory, Kano and Delta. Read more

THE LATEST information emerging on the paediatric hepatitis of unknown aetiology delivered at a WHO briefing on May 10 is that there are now 348 probable cases from 20 countries in five global regions, and a further 70 cases in 13 countries ‘are pending confirmation’. In the UK, health authorities are investigating six working hypotheses that include the cause due to normal or variant adenoviruses; post-infectious SARS-CoV-2 syndrome; a drug, toxin or environmental exposure; a novel pathogen either acting alone or as a coinfection; and a new SARS-CoV-2 variant. 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.

Cholera strikes in 2 western regions

An outbreak of cholera was declared late last month in the neighbouring regions of Kigoma and Katavi in Tanzania’s west. The majority of the suspected cases were in Kigoma and children aged under five years made up just under half of all cases. Read more

Advice for travellers

While the risk of infection with cholera is low for short-stay travellers, Australians travelling to regions where an outbreak is occurring should adhere to strict personal hygiene and choose food and beverages with care. Read more about cholera.

Cutaneous leishmaniasis uptick in Anzoátegui

Residents of the municipality of Sabana de Uchire in the coastal province of Anzoátegui blame the failure by authorities to fumigate insect breeding habitats for the rise in cases of cutaneous leishmaniasis. With at least 66 infections reported, there are urgent calls for control measures against the sand fly vector. Read more

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is 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. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.