World travel health alerts 12 February 2020

World travel health alerts for 12th of February 2020.

Tongatapu’s active measles transmission

Four more measles were reported between Jan 31 and Feb 5 taking the total of confirmed and suspected cases to 656. Ongoing transmission is occurring on the main island of Tongatapu with the last onset of illness occurring there on Feb 1. Read more. Also in the region, American Samoa’s 16th measles case was reported this week and was said to be local transmission. The last three cases were confirmed in late January.

Advice for travellers

Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. In general the infection is relatively benign, but complications 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.

Beni, focus of Ebola control measures; Polio case in megacity, global news

A review of the current Ebola virus disease (EVD) outbreak undertaken by the WHO has Beni health zone as the current hotspot but there are indications that ‘Butembo and Mabalako are preferred destinations for potential contacts’. Of the 29 health zones that have reported cases during the outbreak, ‘23 health zones have not reported cases for more than 42 days. However, surveillance is still ongoing in these health zones.’ There have been no new confirmed cases reported in the four CMRE newsletters to Feb 11, but 440 remain under investigation. More indepth information is contained in the WHO SitRep #79 (data to Feb 9) and on Feb 12 a decision will be made on whether the outbreak remains a PHEIC.

ONE CASE of circulating vaccine-derived poliovirus 2 (cVDPV2), linked to a strain producing cases in Angola, has been reported in the megacity of Kinshasa, home to more than 11 million people. The wasn’t formally recorded in the current statistics listed by the GPEI (a further five genetically-distinct cVDPV2 viruses from Kwilu, Kongo Central, Kinshasa and Sankuru provinces have however), but the organisation voiced concern over the news due to the risk of spread both within the city and on to the two million inhabitants of Brazzaville, the capital of the Republic of the Congo which sits on the opposite bank of the Congo River. The GPEI documented cVDPV2 cases in Angola (eight from the provinces of Bié, Malanje and Cuanza Norte and also from the capital, Luanda) and Burkina Faso (Centre-Est administrative region) – all date from 2019. In other polio news, Pakistan’s 2020 total of WPV1 cases rose to seven, and a Feb 6 UNICEF update on the situation in the Philippines noted no new polio cases since Jan 27 while vaccination campaigns continue in affected regions.

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.

Health emergency in Amazon states; Regional dengue hit record in 2019

A change in the dominant dengue serotype circulating in the departments of Loreto, San Martín and Madre de Dios and a sharp increase in cases in the same jungle regions has led to the proclamation of a health emergency. There are reports of 2,500 dengue infections and seven related deaths since the beginning of the year. Read more. And across the Americas, the Pan American Health Organization’s regional epidemiological dengue update for 2019 revealed that the previous highest case total recorded in the epidemic period of 2015-6 was upped by 30 percent last year, with more than 3 million cases reported. Also, year-on-year increases from 2018 were experienced in 34 countries and territories – from three to as much as ten times higher in some cases - while incidence rates were highest in Nicaragua, Belize, Honduras, Brazil and El Salvador. As 2020 begins, the update stated that Bolivia, Honduras, Mexico, and Paraguay had already ‘reported an increase of two to three times more dengue cases in 2020 compared to the same period in 2019’.

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.


Elevated flu levels in 9 countries, more flu news

In the week to Feb 2, nine countries reported high or very high levels of influenza activity and flu-like illnesses were widespread across the region. Almost two-thirds of viruses detected were type A - over 60 percent of those were A(H1N1)pdm09 viruses. Only four jurisdictions were reporting type B dominance – Georgia, Romania, Ireland and Northern Ireland. Read more. Flu activity in Canada was reported as increasing in the week to Feb 1 with influenza A(H1N1) dominant, while for the US in the same period, activity was low, minimal or moderate in five states as well as District of Columbia and the U.S. Virgin Islands, while the rest of the country reported high rates. Detections of influenza A(H1N1) viruses were rising.

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.

Measles continues its march

More districts are now reporting measles cases as the outbreak moves into its second year – new weekly cases (suspected) rose by over 900 and five more districts have been impacted. The Feb 9 WHO bulletin also provides updates on other measles outbreaks in the African region, including the DRC (Maidombe, Equateur, Bas-uele, Kongo central and Mongala provinces), Chad (Beboto, Korbol and Kelo) and Ethiopia (Oromia region). Read more

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.

COVID-19 update

Coupled with the re-designation of the nCoV-2019 illness as COVID-19, has been the naming of the virus which causes it, a sister virus of SARS-CoV. The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses used ‘phylogeny, taxonomy and established practice’ to name it severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Read more.

The Feb 11 WHO Situation Report notes that 24 countries in all have reported COVID-19 cases, but there had been no new countries over the previous 24 hours. Not so for new cases with the global total climbing to 43,103 confirmed (+2,560 from yesterday) and 1,018 deaths (+108) – 42,708 of the confirmed cases and 1,017 deaths were in China. Also on Feb 11, the Director-General of the WHO announced the formation of a Crisis Management Team which will ‘coordinate the whole UN response’ to the outbreak and defined the expected outcomes of a meeting this week of more than 400 scientists from around the globe.

Additional resources and articles on COVID-19 this week:

Clinical characteristics of 2019 novel coronavirus infection in China – an analysis of data to Jan 30 from 1,099 patients with confirmed COVID-19 in more than 550 hospitals throughout 31 provinces/provincial municipalities. 

Coronavirus Expert Reality Check (The Global Health Network Feb 4) aims to ’help improve understanding of an emerging outbreak’s complex dynamics’.

The US CDC issued an Interim Guidance for Ships on Managing 2019 Novel Coronavirus.

An ASEAN Briefing article which offers ‘a running live update service to keep businesses involved in ASEAN and Asia updated with the latest relevant regional news’.  

Dengue uptick in January

Suspected dengue fever cases increased from the six reported in December to 11 in January and all but four of the 137 confirmed and probable cases registered since late Feb 2019 have been on Raratonga. A Pacific Community post on Feb 10 reported a single dengue fever case (DENV-1) in a traveller arriving in New Zealand from the Cook Islands in the first week of this month. Updates were also given on the dengue outbreaks in the Marshall Islands (now more than 2,500 cases and three dengue-related deaths), Palau and French Polynesia. 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.

Outbreaks carry over into 2020

Updates on four different outbreaks that have persisted since last year are listed in the Feb 9 WHO weekly bulletin and they include the counties that are currently affected: Cholera (Garissa, Wajir and Turkana), measles (Pokot North sub-county), chikungunya (Garissa) and visceral leishmaniasis (Marsabit, Wajir and Garissa). 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.

Lassa fever’s intensification

The Feb 9 WHO weekly bulletin summarised the troubling Lassa virus situation as cases continue to increase in an ‘unprecedented manner’ and four states with no history of cases are now affected (Kano, Federal Capital Territory, Kebbi and Anambra); the peak season continues until April. Three states have recorded over three-quarters of Lassa virus cases – Edo, Ondo and Ebonyi. Of note, the outbreaks in Liberia and Sierra Leone are not linked to those in Nigeria. Read more

Advice for travellers

Lassa fever is an acute viral illness that occurs in 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. Read more about Lassa fever.

Proof of tick-borne virus

The virus that causes Crimean-Congo Haemorrhagic fever (CCHF) is known to have been circulating in Mali over the last 10 years, but no active cases were identified until the beginning of this month when an outbreak was reported in the SE district of Mopti near the Burkina Faso, an area with limited access due to insecurity. Of the 14 suspected CCHF cases to date, seven have died. 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 majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

5 more MERS cases this month

This year the Ministry of Health has reported on 20 MERS cases from across the kingdom, including what is thought to be a cluster of six among healthcare workers in Abha in January. The five cases recorded this month are all categorised as ‘primary’. In the latest WHO update (Dec 2019), almost 2,500 cases had been reported world-wide since 2012 with more than 2,100 of those in Saudi Arabia. WHO MERS factsheetRead more

JE in short-term tourist

ProMED this week published a report on a Japanese encephalitis (JEV) infection in a 14yo Belgian girl who had travelled to Khao Lak in Phang Nga province on Dec 20. Eleven days after arriving in the country, she developed initial symptoms of JEV (fever, headache, fatigue and dysphagia) which progressed during her return flight home. Early in Jan, she was confirmed to have Japanese encephalitis and admitted to an intensive care unit in Belgium for treatment and has since recovered enough to be moved to a ward but will require long-term rehabilitation. The seven other family members travelling with her were not infected.

Advice for travellers

A mosquito-borne virus, JE is usually found in many part of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. 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 however. Read more on JE.