World travel health alerts 11 September 2019

Polio news in Asia, Africa

Vaccine-derived poliovirus information updated this week by the GPEI: Myanmar (one cVDPV1 case in Kayin province), Angola (one cVDPV2 case each from Cuanza Sul and Lunda Sul provinces), the Democratic Republic of the Congo (six cVDPV2 cases in total from the provinces of Kasai, Haut Lomami and Sankuru), and Ethiopia (one cVDPV2 case from Somali province). The latest WHO African region report advised that in Ghana, ‘ongoing investigations appear to indicate a wider geographical diffusion of the poliovirus [cVDPV2] across the country and an elevated potential for further spread.’ The second detection of an environmental sample of cVDPV2 in Ghana occurred last month in Accra city. Elsewhere, two new WPV1 cases in Afghanistan (Uruzgan province) lift its YTD total to 15 cases.

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.

Gastro hits alpine city

Norovirus has sickened at least 850 people in the popular tourist destination city of San Carlos de Bariloche in the country’s Patagonia region. Over a 3-week period, the virus spread quickly among a (mostly) student population and on to the general community, however in recent days there has been a decline in new cases, from 300 per day at the peak down to less than five. Read more

Advice for travellers

While it is extremely contagious, norovirus infection is generally short-lived, causing nausea, vomiting and diarrhoea, which may lead to more serious complications among young children, the elderly, and the sick. To minimise the risk, wash your hands after using the toilet and before eating, and practice good hygiene. Read more on norovirus.

Local health costs to vary by visa; Regional dengue digest

The costs of hospitalisation and associated procedures will change on Sept 29 for people staying in the kingdom under several different visa categories. Thai nationals, residents of neighbouring countries, working foreigners on non-immigrant visas, and tourists/retirees will find themselves paying a sliding scale of prices at Thai public hospitals. A local news sources states that, while the fees will generally rise, they will still represent a substantial saving over those charged by private hospitals. Previously, charges at public hospitals were not set, leading to a wide variation in costs paid by non-Thais. Read more

NEARLY 5,000 Bangkok residents have been infected with dengue this year and local authorities are continuing to monitor the situation in those areas most affected: Huay Kwang, Nong Chok, Phyathai, Yannawa and Chatuchak (site of popular weekend market). Elsewhere in the region, more dengue fever cases are arriving for treatment in the SW town of Phuentsholing in Bhutan (flu activity has also increased across the country); in Vietnam, Da Nang has experienced a trebling of dengue cases this year as the city heads into the dengue high season. A WHO regional dengue update reveals that the national situation mirrors Da Nang’s: ‘a total of 124,751 cases with 15 deaths reported, a 3.3-fold increase compared to the same period in 2018’; and Sri Lanka has now recorded more than 45,000 cases this year with highest incidence in Colombo – all areas, Gampaha, Galle and Kalutara.

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.

‘Most complex Ebola outbreak’

Reporting on the Ebola virus disease (EVD) outbreak this week, the WHO advised that ‘While the intensity of the outbreak shows signs of easing in some areas and total case numbers are decreasing, it is too soon to tell if this trend will continue.’ The problem being that there has been improvement at other times in this outbreak, but security ‘events’ turned the tide again, causing yet another uptick in new case numbers. Several US health officials and experts are travelling to the region this week for meetings.

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.

Mosquito-borne infections reporting highest in south

High rates of dengue fever have been reported in four southern states (Karnataka, Tamil Nadu, Telangana and Kerala) and in Uttarakhand in the north. Malaria is proving to be an added concern for Delhi, Bangalore and in Gujarat, following the seasonal path that sees most cases reported in the last four months of the year, while insect population control measures appear to be working in Mumbai (Maharashtra). Also in the news, Gujarat’s largest city, Ahmedabad, reported a year-on-year rise in typhoid cases during August. Read more

Advice for travellers

Typhoid fever is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and, importantly, for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.

Disease-causing mosquitoes, sand flies in west

After seven children died of suspected malaria in Tiaty sub-county (in the western county of Baringo), more testing was carried out which has also confirmed dengue and kala-azar (visceral leishmaniasis) infections circulating in the area. Results are pending on other possible causes of the deaths - chikungunya virus, Rift Valley Fever, yellow fever and West Nile fever. 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, HFMD in high season

This year, the state of Selangor has recorded almost five times as many dengue fever cases as the two next highest states/territories, Kuala Lumpur and Johor. Across the country, the incidence of hand, foot and mouth disease (HFMD) has risen by two-thirds this year in Sabah and by more than 40 percent in Sarawak (compared to the same period in 2018). Other states with significant YTD totals are Selangor (8,080 cases), Kuala Lumpur (3,297), Perak (2,961) and Penang (2,311). Fortunately, most cases have been mild (due to Coxsackie A16). 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.

Majuro’s dengue cases mount

Majuro’s dengue case count is fast catching up to the numbers already recorded on the island of Ebeye after a 2-fold increase over one recent week took the total to 124 (suspected and confirmed). A further extension of the health emergency, which affects domestic travel, has been ordered to prevent spread to other islands. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. Both bite mainly during the daylight hours, making them difficult to avoid outdoors. 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 oil of lemon eucalyptus (PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Chihuahua’s spotted fever

Of the 50 tick-borne rickettsial infections reported in the northern state of Chihuahua this year, 27 were from the capital and another 16 in Cuidad Juárez, on the border with Texas at El Paso. So far 17 deaths have been caused by spotted fever with highest rates in the 25-44 years age group. More on tick-borne rickettsial infections in Mexico and globally. Read more

Advice for travellers

More on spotted fever and other rickettsial infections from the US CDC.

Dengue, scrub typhus spread during rains

One Kathmandu hospital is reporting up to 400 people per day presenting with dengue-like symptoms with calls by some doctors for a public health emergency to be declared. Fifty-six districts are now impacted ‘including mountainous districts like Manang’ (in the Annapurna Conservation Area), and several have recorded dengue associated deaths - Sindhupalchowk, Sunsari, Chitwan and Doti. Read more. In a follow-up on last week’s scrub typhus post in the western province of Sudurpaschim Pradesh, the Epidemiology and Disease Control Division notified 72 cases of the rickettsial infection in Kathmandu in the months from June to August and another 162 from the districts of Banke, Palpa, Dhading, Morang, Chitwan, Kaski, Rupandehi, Dadeldhura, Kailali, Ilam, Kavrepalanchowk and Makawanpur. Read more

Advice for travellers

Scrub typhus is a bacterial disease passed on to humans by mites that normally live on rodents 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 occurs throughout the Asia-Pacific region, where more than a million cases occur annually. There is no vaccine or prevention medication: avoidance hinges on minimising insect bites. Due to the disease’s 5- to 14-day incubation period, travellers often experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Read more about rickettsial diseases.

Measles flies in from the snow

While most measles news has concentrated on the large outbreak in Auckland, this week NSW Health issued an alert after three cases in as many weeks occurred in people arriving from Queenstown in the South Island. The media release revealed that there had been ‘15 recent cases in Queenstown and nearby snowfields’.

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.

YF confirmed in Bauchi, Ebonyi states; E-Yellow Card; Floods worsen cholera outlook

Four yellow fever (YF) cases reported over the past month in the state of Bauchi have been confirmed to date, however, according to a NCDC media release, tests results are pending on eight of 10 cases (7 fatal) which occurred in people who visited Yankari Game Reserve in August and who are suspected to have contracted YF. While in the SW state of Ebonyi, 9 of more than 55 suspected YF infections recorded in Izzi district have been laboratory-confirmed amid a rising death toll (currently 20) – a reactive vaccination campaign is planned.

IN OTHER YF news: information on the e-Yellow Card, which since July 1 this year must be used by Nigerian citizens and residents when they require proof of yellow fever vaccination, is detailed on the UK’s travelhealthpro website.

AID RESPONSES to cholera outbreaks still active in the states of Adamawa, Borno and Yobe have been compromised by recent heavy rains and flash floods with the situation made worse by damage to sanitation infrastructure. According to ReliefWeb, the likelihood of more outbreaks is heightened as a result.

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.

Mozzies behind tularaemia uptick

New tularaemia cases are now on the decline after reaching a peak of 150 per week in the first half of August (now around 100). The adjacent counties of Dalarna and Gävleborg in middle Sweden have recorded many of the recent cases, however dispersal of tularaemia infections has also become more widespread in the north (Norrland). While the Swedish Public Health Agency has registered almost 800 cases to date, September is the peak month according to the ECDC, due to ‘greater exposure to contaminated water and mosquito activity during the summer and early autumn months… Farmers and people involved in hunting, wildlife management, hiking and camping are at higher risk of infection’. During this season’s outbreak, almost three-quarters of infections have been acquired through mosquito bites. Read more

Advice for travellers

The main hosts of tularaemia bacteria in Europe are rabbits, hares and rodents and the majority of infections contracted there are through tick or mosquito bites, or by ingesting contaminated food or water. It is described as often being 'a long and debilitating disease' that can affect the eyes, lymph nodes, skin and lungs. Prevention measures include avoiding insect bites and the ingestion of surface water. Read more on tularaemia. 

Enterovirus infections soar

A local news source reported that 19,254 people sought treatment for enterovirus infections in the first week of this month alone, representing a 5-year high for the week in question. More than 300 cases caused by the EV-A71 strain, which in rare cases can cause neurological disease, have been detected this year. Following an April-June peak season, the incidence of enterovirus infections in Taiwan usually spikes again when the school term starts in September. The virus is found in the respiratory secretions, faeces and blisters (in the case of hand, foot and mouth disease) of infected people. More about enterovirus in Taiwan. Read more

Hep A count in multiple states exceeds 25k

The case count in the 30 month-long hepatitis A outbreak that has spread person-to-person across 30 states (two have declared an end to theirs) has risen above 25,000 (25,484 according to the CDC on Sept 6) – almost two-thirds of people infected have required hospitalisation. The death toll now sits at 254.

Advice for travellers

Vaccine-preventable Hepatitis A (HAV) is one of the most common infections affecting travellers. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and sexual contact. A course of hepatitis A vaccine offers immunity that’s 99%-plus effective and long lasting (20-30 years). It is also important to follow safe food and water guidelines.