World travel health alerts for 11th of November 2020.
Polio update, first VDPV for Congo
The first case of circulating vaccine-derived polio (cVDPV2) has been identified in the coastal department of Kouilou and it has been linked to an outbreak in Angola’s SW province of Huila. Also on cVDPV2, other countries reporting cases to the GPEI were Afghanistan (20 cases), Burkina Faso, Central African Republic, Chad, Côte d’Ivoire and South Sudan. While in Pakistan, a single WPV1 case was reported in Punjab province, taking the YTD total to 80.
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.
70pc drop in malaria
Malaria cases have declined for the year to October, falling from more than 25,000 in 2019 to 7,668 and for a second consecutive year, no related deaths were recorded. Read more
Advice for travellers
Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.
H5N1 case in south
Eighteen months after the last notification of an H5N1 avian influenza infection in humans (in Nepal), details have emerged of one new case in the southern province of Saravane. Taiwan’s CDC reported the case, along with a new H9N2 infection in a young girl from China’s Guangdong province (Zhuhai City) – this is Mainland China’s 38th since 2013. In both cases, there was ‘a history of poultry exposure or live poultry near their homes before the onset’. Read more
Advice for travellers
There are several strains of bird flu and while the virus can be fatal, infection generally poses a low risk for travellers – even for those heading to a region where the disease is present or an outbreak is occurring. Travellers should avoid contact with birds or poultry in marketplaces, wash hands thoroughly before and after preparing food, and observe strict personal hygiene. Read more on bird flu and how to avoid it.
Dengue outbreak ongoing
An update of the dengue fever outbreak (DENV-3) that has been active since May last year with confirmed cases now nearing 2,000 from 3,817 suspected cases, and two deaths. Better news in the Cook Islands with the declaration of the end of their dengue outbreak which began in February 2019. 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.
Plague emerges in NE again; Countdown to Equateur’s Ebola outbreak continues
Bubonic plague is suspected as the cause of an outbreak in Mahagi territory of the NE province of Ituri, some 50kms from the Ugandan border. In a ProMED post, a doctor with the NGO EcoHealth Alliance said the affected area ‘is located in the most active endemic plague focus in continental Africa’ which has now reported eight outbreaks this year. Read more
AS OF Nov 9, 40 days had lapsed since the last confirmed Ebola virus disease case was reported and so the two incubation period (42-day) countdown continues. If the situation remains unchanged with zero positives, the outbreak would be declared over on Nov 18, to be followed by a 90-day period of heightened surveillance in Equateur province. Read more from ReliefWeb.
Advice for travellers
Plague poses a low risk to most travellers. The majority of plague cases are due to bubonic plague following the bite of an infected flea carried by rats. If left untreated, infection of the lungs causes the pneumonic form of plague, a severe respiratory illness, which can progress rapidly to death. Read more on the plague.
COVID-19 infections still to peak
With the peak in COVID-19 infections still to come according to the Director-General of Health, by Nov 9 France had taken over #2 spot for total daily incidence and is placed fourth overall in case numbers (per Johns Hopkins tracking dashboard). The Nov 8 PAHO update noted that ‘ the WHO Region of the Americas and the WHO European Region, represent 70% of the total confirmed cases and 78% of the total deaths’, with the European region reporting the highest relative increase in cases and deaths since mid-October. It took just three weeks for the global case count to jump from 40 to 50 million (20 to 30 million in 37 days and 30 to 40 million in 31 days).
In related news:
-Strongly positive early results from the Pfizer/BioNTech mRNA-based vaccine candidate, BNT162b2, phase III trial involving more than 43,000 participants will be followed up with more data due in the third week of November and emergency use authoritisation in the US won’t be sought until ‘half of the patients in their study have been observed for any safety issues for at least two months following their second dose’ - two doses are administered three weeks apart. STAT news reports that data is still lacking on asymptomatic carriage of SARS-CoV-2 and the vaccine’s efficacy in preventing severe COVID-19 infection. Some eventual distribution challenges are anticipated in view of the temperature (-70°C) at which the vaccine must be stored. More from Pfizer.
-The WHO issued a Disease outbreak news post on Nov 6 relating to coronavirus infections in Denmark that were associated with a mink variant. The agency reported on 214 human cases ‘with SARS-CoV-2 variants associated with farmed minks, including 12 cases with a unique variant, reported on 5 November. All 12 cases were identified in September 2020 in North Jutland’. The ECDC added that there are many unknowns relating to any potential implications of the five different clusters of mink variants that have been identified, one of which ‘showed less sensitivity to neutralising antibodies from people with previous COVID-19 infection’. More from GAVI.
-Resulting from news of the SARS-CoV-2 variants in Denmark, the UK instituted a travel ban for visitors from Denmark on Nov 7 (to be reviewed after seven days) and UK residents returning from there must self-isolate for two weeks, with no exceptions (except ‘freight and hauliers’).
-A global dashboard of wastewater monitoring sites for SARS-CoV-2 RNA has been established as monitoring ‘has been shown effective to predict outbreaks of COVID-19 by 2-14 days’. The stated goal of COVIDPoops19 is ‘to provide a global map of SARS-CoV-2 wastewater testing so the public can easily see where testing is happening in their area’. Read more.
-Outbreaks of vaccine-preventable infections such as polio, measles, yellow fever, cholera and typhoid are forecast over the next two years unless immunity gaps caused by loss of vaccination services during the pandemic are addressed. Read more
Invasion of ticks in southern city
Residents in the city of Luxor have reported the arrival of a new, exotic species of tick in their streets. ProMED noted that ‘the recent climatic changes in the region favour the increase of many tick species populations’ with the potential risk for infections which they can transmit (i.e., ‘including rickettsia and other types of bacteria, viruses, and protozoa’). Read more
Dengue down but scrub typhus up in Chitwan
Health authorities in the Terai district of Chitwan have reported 165 scrub typhus cases and 33 dengue fever infections affecting both local residents and others from surrounding areas who have sought treatment there. These numbers represent a rise in scrub typhus notifications and a drop in dengue cases. Read more
Advice for travellers
Scrub typhus is a bacterial disease passed on to humans by mites, or chiggers, that normally live on rats infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus is endemic throughout the Asia-Pacific region and more than a million cases occur annually. There is no vaccine or prevention medication: the best way to avoid scrub typhus is to avoid being bitten by mites. Protective measures include the use of an effective personal insect repellent, wearing protective long clothing, and a thorough end-of-day self-examination after visits to rural areas. Due to the disease’s 5- to 14-day incubation period, travellers may only experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Treatment involves taking antibiotics and should begin as quickly as possible. Always see a doctor as soon as possible if you develop a fever after the trip and remember to discuss any recent overseas travel. Read more about rickettsial diseases.
More WNV in Utrecht
Less than a month after its first locally-acquired case of West Nile virus infection was confirmed, five more people from the central province of Utrecht have tested positive for the virus. The ECDC reports that in the past, Europe’s WNV season has ended by the second week of November. Read more
Advice for travellers
Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuroinvasive disease. The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions during the peak transmission season should take measures to avoid mosquito bites. Read more on WNV.
Yellow fever cases confirmed in 3 states; River blindness risk for millions
Yellow fever (YF) outbreaks have been reported in the southern states of Delta and Enugu, as well as the NE state of Bauchi. To date, Bauchi’s Ganjuwa Local Govt. Area has recorded eight deaths and another eight people are receiving treatment, while the death toll in the two other affected states is higher – 22 in Delta and 50 in Enugu. ProMED commented that the high number of fatalities in these two states is perhaps a sign of spread ‘to new frontiers’ and the current toll means there are now ‘more fatalities than what was reported across Nigeria in the whole of 2019’. Read more
FUNDING shortfalls and security concerns are two of the reasons why the risk of contracting Onchocerciasis (river blindness) persists for 50 million Nigerians living in 27 states and the Federal Capital Territory. 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.
Summer, rains and more dengue
Under eight months after the end of an extensive dengue epidemic that claimed 53 lives from more than 177,000 suspected cases, the director of Health Surveillance has warned that infections are rising again, currently around 90 per day with many from Asunción and Central. While dengue is present year-round in Paraguay, summer rains are expected to cause an uptick in reporting. 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.
More diphtheria cases in Lima
A further four diphtheria cases have been detected in the week since news that a 5yo girl from La Victoria in Lima had succumbed to the infection. Three are close contacts of the girl and the fourth, a fatal case in a 69yo woman with comorbidities from nearby San Martín de Porres. A vaccination drive was planned for approximately 80,000 people living in the immediate area last week. 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.
Umrah to recommence
Authorities have announced details of the stages which will gradually allow a limited resumption to Umrah pilgrimages from both within and outside the kingdom. The Saudi Press Agency reports that the regulation of approved health standards and controls for pilgrims, worshippers and visitors is to be delivered through the Eatmarna app. Read more
Caution to holiday travellers on malaria risk
During the Southern African Development Community’s recognition of Malaria Week, a reminder on the risk of malaria ahead of the festive season from the Gauteng health department for people travelling to malaria endemic areas both outside the country and to South Africa’s NE provinces of Limpopo and Mpumalanga. More from the NICD. Read more
Advice for travellers
Malaria is endemic to many areas of southern Africa. Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.