World travel health alerts for 13th of February 2019.
Lassa escalation prompts WHO alert
The European Civil Protection and Humanitarian Aid Operations commented this week on the Lassa fever outbreak that the WHO has declared a level two emergency: ‘Though Lassa fever is endemic in the West Africa region, there has been a sharp increase in the number of cases this year. In four weeks, the number of cases has already reached two thirds of the total cases reported last year. Nigeria is the most affected country, reporting 275 confirmed cases with 57 deaths. Four other countries (Benin, Guinea, Liberia and Togo) report 12 confirmed cases, including two deaths. More suspected cases are under investigation.’ 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 5000 deaths occur each year. However, Lassa is a remote risk for 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.
YF heading south; advice for Carnival tourists
The WHO’s Feb 11 Disease Outbreak News outlines the current situation regarding yellow fever in Brazil: ‘From December 2018 through January 2019, 36 confirmed human cases, including eight deaths, have been reported in 11 municipalities of two states of Brazil’. The majority of cases were in the state of São Paulo, however two cases were reported from eastern districts of Paraná. Paraná, which shares borders with Sao Paulo state to the north and Argentina and Paraguay in the west has not recorded any human YF cases for four years. The WHO notes that while it is early, this could ‘mark the beginning of what could be a third wave and a progression of the outbreak towards the Southeast and South regions of the country … there is indication that the virus transmission is continuing to spread in a southerly direction and in areas with low population immunity.’
THE ECDC has published health advice for travellers heading to the Carnival in Rio de Janeiro which is taking place from March 1-9.
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.
Dengue strikes in 8 departments
The departments of Norte de Santander, Meta, Antioquia, Tolima, Córdoba, Cesar, Huila and Santander have been hard hit by dengue fever this year and the national count is nearing 4,500 infections with 22 associated deaths. Furthermore, it’s reported that some highland areas, including those near the capital Bogotá (Cundinamarca and Boyacá departments) also have dengue transmission occurring. Read more
Advice for travellers
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. 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.
More community Ebola deaths
This week the case count in the Ebola virus disease outbreak rose again, to 819 with 516 deaths. Local resistance to the containment measures continues – the three most recent cases reported by the health ministry occurred in Katwa, Butembo & Komanda – all three subsequently died in the community with a high risk of onward transmission. Read more
2018 measles summary and update
The 2018 WHO measles summary for the EU reveals the extent of the outbreak: A 10-year high in cases – 82,596 measles infections reported from 47 of the region’s 53 countries, 72 deaths (children and adults) and, in countries that reported hospitalisation data, 61 percent of cases were admitted to hospital. In France this week, news that 24 young people, most of whom are seasonal workers, have been diagnosed with measles in Val-Thorens, a ski resort in the Auvergne-Rhone-Alpes region near the Italian border. All were unvaccinated. According to the Copenhagen Post, onward transmission has already been reported after two Danish tourists who had visited the resort were diagnosed with measles. Madagascar’s extensive outbreak has now claimed over 300 lives from the 53,459 cases recorded (to Feb 5). (Other measles reports can be found here and see separate posts for Ireland and the Philippines below). Read more
Advice for travellers
A highly contagious virus, measles occurs in developing and developed countries. 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 6 weeks before departure.
Govt. aid helps to contain outbreak; Leptospirosis kills 4
Reporting of new typhoid infections in the districts of Naitasiri and Namosi (SE Viti Levu) is on the decrease according to a local news source, after government assistance improved sanitation in the affected areas. The same news report summarised the outbreak: ‘since September 2018 there were 53 reported cases of typhoid fever, 30 confirmed and 15 suspected in Naitasiri while in Namosi there were a total of 22 reported cases, 10 confirmed and 12 suspected typhoid fever cases’. Read more
THE DEATH toll among people infected with leptospirosis in Central Division (comprised of the provinces of Naitasiri, Namosi, Rewa, Serua and Tailevu) has risen to four from 98 cases. Read more
Advice for travellers
Typhoid 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 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.
Mumps, measles upsurge
Just over 575 mumps cases were recorded by the Health Protection Surveillance Centre last year, but it has taken only six weeks to reach almost half that number in 2019 – 278 cases, with 15 requiring hospitalisation. Areas with highest rates of infections are ‘Northeast (83 cases), followed by the East (58 cases), the West (50 cases), Northwest (43 cases)’. Read more
A RISE in the number of measles infections has been reported in Donegal, in the NW province of Ulster. To date there have been two confirmed cases however there are several more that are probable or under investigation.
Advice for travellers
These outbreaks of mumps highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps.
Hazards from communing with nature
Over the past month, kicks and bites inflicted by wild deer that live in Nara Park have resulted in injuries to more than 200 park visitors. Interacting with the animals has in some cases resulted in fractures. More than 1,000 wild deer inhabit the park and the risk of injury is generally considered to be higher during the deer’s autumn mating season. Read more
Cholera in 3 counties
A regional report on cholera for Eastern and Southern Africa highlights Kenya as faring the worst this year with three neighbouring counties, including Nairobi, reporting infections. Almost half of the 572 cases were in Kajiado County, with 166 in Narok County and the remainder in Nairobi. Read all cholera outbreak news from the region here.
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.
RVF infections climb to 31
The Rift Valley fever outbreak is now into its third month and the number of human cases has risen to 31, while more than 20 outbreaks have been identified in animals, mostly in central districts of Grande-Terre. Read more
Advice for travellers
Rift Valley fever (RVF) is an acute viral disease that typically infects domesticated herd animals. It is generally found in eastern and southern Africa where sheep and cattle are raised, as well as in West Africa, Madagascar, and more recently Saudi Arabia and Yemen. People are infected after exposure to blood, body fluids, or the tissue of RVF-infected animals, or from the bite of an infected mosquito. The virus presents a low risk to travellers, but is another reason to use personal insect repellent and take other steps to minimise insect bites in places where it occurs. Read more about RVF.
Hep E outbreak widespread
The hepatitis E outbreak has now spread to all but two of the country’s 14 regions, with only Zambezi (NE) and //Kharas (south) spared. In just over 13 months there have been more than 4,400 cases and 40 deaths, with almost half of the fatalities in pregnant women. Read more
Advice for travellers
The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Infection during the latter stages of pregnancy carries a higher rate of severe disease and mortality. Unlike the Hep A and B viruses, there is no vaccine for this strain in Australia, which is especially common in communities with lower levels of sanitation and hygiene. Read more about the virus and how to prevent it.
First dengue death in 2019
The first dengue-related death was announced last week, a gendarme in her 40s who had only been working in the territory since October last year. The latest figures published by DASS show there have now been 554 dengue fever cases this year – all those tested were DENV-2 viruses. Read more
Advice for travellers
Dengue is spread by two types of 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.
Second polio case in KP
After environmental samples detected the presence of wild poliovirus in the populous city of Faisalabad in Punjab, it is to be included in an immunisation campaign planned for Lahore and Rawalpindi. Two confirmed wild polio cases have been reported from the province of Khyber Pakhtunkhwa so far this year. Read more
Advice for travellers
Polio 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 poliomyelitis.
More red flagged measles locations
Luzon, Central and Eastern Visayas have been added to the ‘red flag’ list of locations where outbreaks of measles are currently occurring. More than 4,300 cases were reported across the country in January and the death toll in Manila has now climbed to 55 – all were children under four. 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. 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.
Chikungunya reported in east and west
Two chikungunya outbreaks have recently been declared. With more than 1,000 cases recorded in the coastal district of Diosso, north of Pointe-Noire, it has the highest burden of infections, while the other affected district, Mindouli, is in the eastern department of Pool. Read more
Advice for travellers
The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.
More than 1,200 dengue cases, 2 deaths
In the last week two dengue-related deaths were reported from areas currently listed among the high risk dengue clusters on the NEA website. The latest count of dengue infections for the first six weeks of the year is 1,209. Read more
Advice for travellers
Don’t get bitten and you won’t get 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.
Dengue post retraction
A ProMED post reported on last week concerning two Japanese tourists apparently infected with dengue fever in the UAE has been updated with new information after it was revealed the travellers had also been to the Maldives and it was there that the infection was contracted, not the UAE. Read more
Hep A cases, death toll mount
In a follow-up on the hepatitis A outbreak affected several states, case counts have been updated by state health departments in Kentucky (3,997 cases, 40 deaths to Feb 2), Ohio (1657 cases, 5 deaths) and West Virginia (2,324; 12). The CDC has a dedicated webpage for details of the outbreak, now almost into its third year, with state-specific information. 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 contaminated food and water, by handling everyday items and 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.