World travel health alerts for 13th of June 2019.
West Nile fever reports to start
The ECDC is set to commence Europe's West Nile fever monitoring (in both humans and equids) this week. Information on 2018 data was re-posted by the agency last week: ‘2,083 human cases were reported by EU Member States and EU neighbouring countries’. Weekly updates will include current data and maps. Read more
Advice for travellers
West Nile virus is endemic in Eastern Europe and the Mediterranean basin, with epidemics regularly reported in summer and autumn since the 1950s. 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 reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Europe’s outbreaks are not as severe or widespread as in other regions where the virus occurs, notably North America. Read more on WNV.
Dengue spike in 20 states; Tick-borne infection deaths in MG
Local news sources report that dengue fever cases have undergone a four-fold increase this year, striking 20 states as well as the Federal District. Deaths related to dengue infection have also risen, up to 222 from 88 a year ago - many of those in the state of São Paulo. Read more
WHILE in Contagem, a satellite city of Minas Gerais’ capital Belo Horizonte, spotted fever and its vector, the lone star tick, are responsible for the deaths of at least three people and sickened at least 30. The state has recorded five deaths related to the tick-borne infection this year. 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.
Malaria increase troubling
The steadily increasing number of malaria infections in 2019, now nearly twice last year’s total for the same period, has local and international agencies concerned. A WHO report attributes the rise to an undersupply of treated mosquito nets, low population immunity (‘especially for the people living in the mountains where malaria transmission is usually very low’), changes in climate conditions ‘and vector ecological and behavioural changes (increased vector density and feeding habits – biting both indoors and outdoors as well as higher vector aggressiveness)’. Up to week 21 of 2019, there have been in excess of three million ‘clinical malaria cases, including 1,273 malaria-related deaths’ and 40 of the 46 health districts are reporting epidemics. Read more
Advice for travellers
Sub-Saharan Africa presents a significant malaria risk for travellers so they should discuss their itinerary and the need for anti-malaria medication with a medical practitioner. For details call 1300 360 164. Read more about malaria.
Dengue upswing across region
Six countries in the WHO Western Pacific region are experiencing high rates of dengue fever for this time of year, with Cambodia’s levels ‘higher than expected’ and those in Laos representing a 5-year high. Both Malaysia and the Philippines report levels that are double or higher year-on-year, while Vietnam’s are triple the 2018 figures. In Singapore, an upward trend in dengue reporting has occurred over the past two months amid 28 current high risk clusters - 4,720 is the national YTD total. The WHO Regional Director noted that ‘even more worrying is the increase in the rate of people dying from dengue, especially children’. Separate reports provide details on the situation in Thailand (central and NE regions most affected) and Myanmar (Yangon). 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.
SE’s polio case
The country’s first cVDPV2 for 2019 was reported on June 3 from the SE region of Diffa region. Investigations are underway, however Niger’s 10 cVDPV2 cases in 2018 were genetically linked to virus isolated in the Nigerian states of Jigawa and Katsina. Read more. While in the Central African Republic, a second VDPV2 case has been identified in Bimbo (Ombella-M'poko prefecture, under 30kms SW of Bangui and adjacent to DRC border). Testing reveals the case is not genetically linked to one reported late last month in Bambari (Ouaka prefecture).
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 polio.
Local, global measles update
The number of measles cases in Auckland has climbed to 108 - most infections have been reported from West Auckland (48), followed by South (25) and Central Auckland (21). Read more. Elsewhere, the Comoros has recorded 66 probable measles infections (only 16 confirmed to date), which is a substantial escalation of an earlier reported outbreak largely centred on Grand Comoros (Ngazidja), in Moroni District, site of the capital. Health and other infrastructure was damaged when Cyclone Kenneth struck the nation almost two months ago. In Madagascar, a series of vaccination campaigns have slowed the measles epidemic that had up to May 26 produced almost 150,000 cases and 910 deaths. Updates are also available for measles in Ethiopia, Chad and Niger from the regional WHO Weekly Bulletin. The DRC has suffered a massive 700 percent year-on-year hike in measles cases with 23 provinces affected up to mid-May. At that time, there were an estimated 87,000 suspected measles cases. The WHO Eastern Mediterranean region is experiencing a rise in measles reports, namely in Somalia, Sudan, Saudi Arabia, Pakistan, Tunisia and Lebanon.
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.
Ebola confirmed in western Uganda
The International Health Regulations Emergency Committee is to meet again tomorrow following news that Ebola virus disease (EVD) infections have now been confirmed in western Uganda. A 5yo boy was taken by his extended family of 14 from an EVD hotspot (Mabalako) into Uganda on June 10 to seek treatment. He has since succumbed to the infection and 2 more of the group have confirmed EVD. Neighbouring countries of the DRC have been on the alert for Ebola-infected people crossing their borders, taking the precaution of vaccinating many healthcare workers – fortunately this includes frontline staff at the facility where the family members are undergoing treatment or monitoring. The Emergency Committee will ‘assess if changes warrant declaring a public health emergency of international concern (PHEIC) under International Health Regulations, and to update any earlier recommendations’. An update of the situation in the DRC is available in the latest Ministry of Health newsletter. Read more
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.
Warnings re gastro infection
A steady annual increase in the number of UK travellers contracting the parasitic infection Cyclospora in Mexico has their public health authorities advising the need for suitable precautions. As stated by Travelhealthpro, the infections is usually ‘acquired from food or water contaminated by human faeces’. Advice is to ‘maintain good food and water hygiene at all times when abroad even if staying in high-end, all-inclusive resorts’, ‘choose recently prepared, thoroughly cooked food that is served piping hot’ and ‘avoid fresh uncooked berries/unpeeled fruit and salads that have not been washed in safe water’. The authorities have also recorded recent Cyclospora infections in travellers to the Dominican Republic and Indonesia, however the risk exists in all tropical regions. Read more
Advice for travellers
A single-celled coccidian parasite, Cyclospora cayetanensis may be a risk for travellers to tropical regions where it is found. The microscopic parasite causes watery diarrhoea, nausea, anorexia, abdominal cramps, weight loss and, occasionally, fever that can last for several days – and reoccur - if not treated effectively. Most cases result from consuming food or water containing the parasite, or swallowing contaminated water while swimming. Fruits and vegetables such as raspberries, basil and lettuce washed with contaminated water are common culprits, especially those imported from developing nations. Read more about Cyclospora.
Dengue cases top 10,000
Dengue fever cases have soared past 10,000 this year with more than 30 dengue-related deaths recorded across six regions (Atlantida, Cortes, Yoro, Choluteca, Olancho and Santa Barbara). Read more. In eastern El Salvador, close to the Honduran border, authorities are emphasising the need for insect (sand fly) bite avoidance measures following a five-fold rise in the incidence of cutaneous leishmaniasis in one of two communities reporting cases - Concepción de Oriente and Anamorós. 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.
Cholera in 5 regions
Contaminated water is believed to be the source of the more than 420 cholera infections reported over a 6-week period to June 6. Five regions have been affected – almost half of all cases in Amhara, but also Oromia, Addis Ababa, Somali and Tigray. Read more
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.
Bottled water bacterial contamination
The country’s food safety authority (SFA) has recalled several batches of a brand of bottled water imported from Malaysia after routine testing revealed the presence of the bacterium Pseudomonas aeruginosa in some samples. The bacteria are widely found in the environment and infection is usually mild, however it can be severe in people with compromised immune systems. Read more
Local dengue after 4 years
The regional health authority (ARS Océan Indien) has announced that three of the nine cases of dengue reported since the end of March involved no recent history of travel so were probably locally-acquired. Further testing is underway. The agency’s press release also notes that the last local dengue infections were in 2015 so the three cases may be the first signs of a new cycle of dengue circulation on the island. Read more
Advice for travellers
Avoid mosquito bites 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.
Sudden spike in GB syndrome
Ninety day health emergencies have been declared in the departments of Piura, Lambayeque, La Libertad, Junín and Lima after authorities were notified that more than 150 people had been diagnosed with the auto-immune disorder, Guillain-Barré syndrome. The declaration boosts measures needed to manage the sudden increases in cases – usually six to 10 per week, however in week 21 there were 33 cases. The health minister acknowledged that the incidence of Guillain-Barré generally rises during the winter season and may follow respiratory or diarrhoeal illness (there is also some association with Zika virus infection). Read more
Correction to January Zika report
New information has overturned the diagnosis of Zika virus disease in a resident of Samoa with no history of travel (published in a ReliefWeb post on Jan 22) as a probable false positive result: ‘The Ministry of Health would like now to officially correct the previous information, and confirm that this was NOT a case of Zika’. Read more
Wet season ups dengue risk
The arrival last month of the SW monsoons is expected to bring an upswing in dengue fever cases which are already sitting at more than 20,000 for the year to date. All areas of Colombo have recorded 4,510 cases in total – plus at least 28 deaths - and western districts overall have been hardest hit (Gampaha, Kalutara, Galle), but also Jaffna in the north. 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.
JE count rises to 12
Less than a month after the first Japanese encephalitis case of the year was announced in Kaohsiung (mid-May), authorities have advised there have been a further seven infections – one each from Taichung City, Changhua County, Chiayi County and Tainan City, and three in Kaohsiung City – taking the YTD total to 12. Read more
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 urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.
Bats leading cause of rabies in US; Hep A outbreaks worst in Kentucky, Ohio, West Virginia
A June 12 CDC Vital Signs report names bats as the source of almost three-quarters of all human rabies cases in the US, with many people unaware of the risk. The report also notes that the ‘large percentage of deaths tied to bats is particularly striking since bats account for just a third of the 5,000 rabid animals reported each year in the U.S’. Read more
THE SCALE of the Hep A outbreak in Ohio is concerning authorities after it was revealed that cases had doubled over the past four months, with one-third in four counties of the greater Cincinnati area (Butler, Mongomery, Hamilton and Claremont). Read more. Information from the CDC on the Hep A epidemic, now into its 28th month, reveals that Kentucky, Ohio, West Virginia, Florida, Tennessee, and Indiana have suffered the highest number of infections and deaths of the 20 states currently reporting outbreaks.
Advice for travellers
Vaccine-preventable Hepatitis A (HAV) is one of the most common infections affecting travellers. It is a significant risk in most developing countries where sanitation and hygiene are lacking, with an estimated 1.4 million cases occurring worldwide each year. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and with some sexual practices. 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.