World travel health alerts 13 January 2021

1st hantavirus case for the year in Patagonia

Residents spending more time indoors during the pandemic is likely to be a major factor behind the low incidence of reported hantavirus infections. News emerged recently of a single case in a young man who first fell ill at the end of December in the tourist hub of Bariloche, in Río Negro province. His source of infection is still being investigated but authorities are focusing on areas around two nearby lakes - Gutiérrez and Mascardi. The man is said to be in a stable condition but is being treated in a local intensive care unit. Residents have been warned to ensure they avoid any contact with the local vector of hantavirus, the long-tailed mouse. Read more

Advice for travellers

Hantavirus is generally spread from various rodent species to people, through aerosols shed in excreta, urine or saliva, but to a lesser extent via the bite of an infected animal. The syndromes resulting from infection vary by region - in Europe and Asia, the 'Old World' hantaviruses may cause haemorrhagic fever with renal syndrome (HFRS), while the New World' hantaviruses in the Americas can result in hantavirus pulmonary syndrome (HPS). Read more on hantavirus from the US CDC.

Flu activity remains low overall

Influenza activity across the globe remains low, however in its Jan 4 update, the WHO did note that notifications of predominately influenza A(H3N2) were still be received from both Laos and Vietnam. In West Africa, there were ‘detections of influenza A(H3N2) and B in Burkina Faso and Ghana, influenza B (Victoria lineage) in Guinea and influenza A(H1N1)pdm09 in Togo’. In summary, the WHO advised that influenza activity remained at lower levels than expected for this time of the year, ‘despite continued or even increased testing for influenza in some countries’.

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. 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, 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.

More polio cases to add to 2020 totals; Measles deaths rise in the Sindh

Pakistan recorded one WPV1 case in Balochistan province to the GPEI last week, while in news on cVDPV2 in Africa, Chad’s single case in Mandoul took its 2020 total to 94 (cf. 11 in 2019), the three cVDPV2 cases in Côte D’Ivoire were in Gbeke, Belier and Agneby-Tiassa, and the DRC’s only case was in the western province of Mai-Ndombe.

A MEASLES outbreak in Garhi Yasin, near the city of Jacobabad in NW Sindh province, has hospitalised least 20 local children and led to the deaths of two. 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.

COVID-19 taking its toll

South Africa is experiencing a major surge in COVID-19 cases following the end-of-year holidays and remains the hardest-hit across the African continent, while Ethiopia's infection numbers are rising, exacerbated by conflict and humanitarian crises in Tigray, Amhara and Afar (which also report malaria, dysentery and typhoid). Ethiopia now ranks second for cumulative cases in Africa. In the Jan 10 WHO regional bulletin, South Africa, Ethiopia, Algeria, Nigeria and Kenya ‘account for 82% of total cases and 83% of total deaths’. Overall however, Africa has fared better than most other WHO regions, reporting 2.5 percent of both global cases and deaths to date. More in the Jan 12 WHO epi update with the latest on emerging variants, including the SARS-CoV-2 variant within lineage B.1.1.28 detected in four travellers arriving in Japan from Brazil.

In related news:

-A STAT News article looks at the results of a non-peer reviewed study into the effectiveness of the Pfizer-BioNTech vaccine on the N501Y mutation found in recent SARS-CoV-2 variants.  

-The European Medicines Agency believes it may be able to complete its review of COVID-19 Vaccine AstraZeneca by Jan 29. Read more

-Our World in Data uses diverse resources to monitor the progress of country-by-country COVID-19 vaccination programmes, with many of the countries most affected by the pandemic already vaccinating their population.

-England and Scotland have updated their conditions for international arrivals. From 04:00 on Jan 15, boat, plane and train passengers (including UK nationals) must ‘present a negative COVID-19 test taken up to 72 hours prior to departure’. Those people arriving from countries not on the government’s travel corridor list are still required to self-isolate for 10 days, regardless of test results and all passengers must also complete a passenger locator form and ‘be subject to national lockdown restrictions’.

Alerts in cyclone’s aftermath

Health authorities were on high alert for cases of leptospirosis, typhoid, dengue and diarrhoea in the wake of last month’s category 5 cyclone, Yasa, as nearly 40 areas of the Northern Division were designated as hotspots. Following reports of six typhoid cases on Vanua Levu, those infected and their local communities are receiving support and a medical response team sent to the island has now completed its work. 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 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.

Bat Lyssavirus confirmed in 2019 death

Over a year after the death of a man in Limoges from an unspecified encephalitis, a programme of genetic analysis of post-mortem samples by the Institut Pasteur has confirmed the cause as European Bat Lyssavirus (EBLV-1), the first such case in metropolitan France. Those who knew the man said he had regular contact with the bats which nested in the attic of his house. 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.

Dengue, down but not out in Jalisco

Dengue fever cases in the Pacific coastal state of Jalisco were down by around half in 2020 compared to 2019’s record year, but they were still the highest across the country. Four towns, all inland, reported the highest incidence of infections and two dengue serotypes were circulating. 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.

Cholera strikes 6th northern district

Confirmation that cholera has spread to a sixth district in the northern province of Cabo Delgado after 11 cases, and including one death, were reported in Montepuez. The outbreak that began a year ago on the island of Ibo (Quirimbas Island group) before spreading to the provincial capital Pemba and beyond has sickened more than 2,100 people and caused 37 deaths. Read more. Meanwhile, the relatively small flare-up of cholera in Golfe 1 and Golfe 6 districts of Togo’s capital, Lomé, has remained active as the country moves into its first epidemic peak period for the year over the dry months of Jan-Mar. The affected districts are ‘in an area that attracts large numbers of people from different areas of Lomé and from neighbouring towns to buy fish’.

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.