World travel health alerts for 13th of March 2019.
Measles continues its momentum
The current measles situation according to the ECDC: ‘case numbers continued to increase compared with the previous two months. Romania, Italy, Poland and France had the highest case counts with 261, 165, 133 and 124 cases, respectively. Notable increases were reported in Italy, Poland, France and Austria.’ In the year to Jan 31, 2019, France and Italy recorded 23 and 22 percent of all cases respectively. Further, referring to 2017 data, only Hungary, Portugal, Slovakia and Sweden had optimal immunisation coverage (at least 95 percent). Elsewhere Kasserine in Tunisia and Guerrara & Ouargla in central Algeria have reported measles outbreaks this year.
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.
Hantavirus update
The updated hantavirus case count from the Andes virus outbreak that originated in Chubut province in February is now 34, with the last infection reported in early February. This week ProMED has reported that genetic testing has revealed further ‘evidence of person to person transmission of the virus in this unusual outbreak’. Read more
Advice for travellers
Hantavirus is passed on to humans through contact with hantavirus-infected rodents or their urine and droppings. Eliminating rats in and around living quarters is the main way of preventing hantavirus infection. Cases have been documented in Argentina, Brazil, Canada, Chile, Panama, Paraguay, and Uruguay, making HPS a pan-hemispheric disease. Read more about hantavirus.
Mozzie-borne infection a rarity for Tasmania
The east coast of Tasmania is the focus of investigations into two confirmed cases (and three more suspected) of Barmah Forest virus, a rare event for the island state. Read more
Advice for travellers
Related to Ross River virus, Barmah Forest virus is transmitted from infected animals to humans via mosquito bites. Symptoms include a rash and joint pain, but there is no specific treatment or vaccine so supportive therapy and pain relief (with Paracetamol) is most often recommended. Travellers visiting areas of Australia affected by recent flooding or continuing rain should take measures to prevent mosquito bites. Use a personal effective insect effective ingredient such as DEET, Picaridin or oil of lemon eucalyptus when outdoors and wear long, loose-fitting, light coloured clothing – especially at dawn and dusk, the times of day when BFV-carrying insects are most active.
Fever’s southerly trend
Rates of yellow fever infection have been significantly lower during the current high transmission season (December–May) when compared to the past two years (2016/7: 778 cases, 262 deaths; 2017/8: 1,376 cases, 483 deaths). PAHO reports that of the 50 cases this season, the majority of São Paulo’s 46 cases were recorded in the south of the state while the four cases in Paraná were from eastern districts. The agency also noted that the location of the cases and epizootics ‘indicates the progression of transmission towards the Southeast and South regions of the country, with the possibility of reaching bordering countries such as Argentina and Paraguay.
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.
Reports of dengue, cholera, measles
Kenya is the source of a number of communicable disease reports in the region published this week: Dengue fever in Mombasa County (also Dar Es Salaam and Tanga in Tanzania and 53 districts of Uganda); cholera in Kajiado county, south of Nairobi; and active measles transmission in Wajir, Tana River and Kwale (plus other reports from Chad, Guinea and South Sudan). 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.
Epidemic measles in 104 of 114 districts; 2018/9 a milder plague season
The health department is tasked with bringing a halt to the extensive measles outbreak and, as the end of the annual dry (plague) season approaches, it has also announced a total of 93 bubonic plague cases and a further 14 of the pneumonic type, with 31 resulting deaths since August last year. A news report states that the cities of Antananarivo and Toamasina have not been affected, unlike last season. Read more. A confirmed case of pneumonic plague and another considered probable, who were taken across the border for treatment in the district of Zombo in Uganda’s NW, are related to several reported deaths in the DRC’s neighbouring province of Ituri. More than 50 high-risk contacts of the infected women are under treatment. Read more
Advice for travellers
Plague occurs annually in Madagascar, but poses a low risk to most travellers. Most cases of plague are due to bubonic plague following the bite of an infected flea carried by rats. If left untreated, infection of the lungs causes the pneumonic form of plague, a severe respiratory illness, which can progress rapidly to death. Read more on the plague.
New health zone reports Ebola
Now into its eighth month, the Ebola virus disease outbreak continues at a moderate intensity with violence directed at response measures still occurring. There has been spread of the virus to a new health zone (Lubero) while the WHO’s latest situation update states that ‘nine of the 20 health zones (45%) that have reported at least one case of EVD to date have active virus transmission’. Read more from the Ministry of Health newsletter (Mar 12).
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.
Canterbury district measles; Dengue imports
As the number of measles cases climbed to 25 on March 11, the Canterbury District Health Board advised that ‘it can now be assumed that measles is circulating widely in our community’ and more cases are expected ‘over the coming days and weeks’. The first infections were reported in late February from Christchurch and nearby Rangiora.
IN THE first week of this month, seven travellers who had been in Fiji were diagnosed with dengue fever. According to a report published by ReliefWeb, ‘5 cases are DEN 1 and 2 are unknown serotype’.
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.
Rare report of local malaria
Public health authorities are investigating how a baby girl who lived in the Abu Salim neighbourhood of Tripoli contracted malaria – hers is the first local case since 1973. Checks for the presence of the malaria vector are being carried out near Abu Salim and also at the city’s immigration detention centres which house people mostly from sub-Saharan African nations. Read more
Advice for travellers
Malaria is not endemic in North Africa, but for many travellers, sub-Saharan Africa presents a significant malaria risk. Travellers can discuss their itinerary and the need for anti-malaria medication with a trained travel health professional at their nearest Travelvax clinic. For details call 1300 360 164. Read more about malaria.
Dengue tops 1,500 cases
The capital Noumea has recorded more than 500 of the territory’s 1,535 dengue cases this year (in particular the districts of Rivière Salée, Magenta and Vallée des Colons), next highest reporting locations are Dumbea, Montdore and Païta. A separate ReliefWeb report gives an outline of the 4 confirmed and 31 suspected dengue cases in Vanuatu this year.
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.
Vaccine-derived polio in west
Last week the GPEI published information on the presence of vaccine-derived polio (cVDPV2) in the western state of Kwara. This is the first cVDPV2 report for the year across the globe, but follows two separate outbreaks in Nigeria last year that occurred in Sokoto and Jigawa; the latter resulted in spread both domestically and into Niger.
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.
Official malaria-free certification
The WHO has certified both Paraguay and Uzbekistan to be malaria-free after they complied with the requirements of the status – three consecutive years without local transmission and surveillance/response systems in place. Read more
Advice for travellers
Travelvax recommends that travellers visiting declared malarious regions discuss their itinerary and preventative medication with their healthcare provider. For advice, call Travelvax on 1300 360 164. More on malaria.
Dengue, measles epidemics
The health department is urging dengue awareness as the number of people infected in the first 54 days of the year rose by more than two-thirds over the same period in 2018. The epidemic threshold has been topped in four regions (Cagayan Valley, Mimaropa, Cordillera Administrative Region and Caraga). Read more. Up to Mar 11, the number of measles infections nationwide had climbed to more than 18,500 and 286 deaths. The most affected regions have been in Central and south Luzon, including Metro Manila, Central Visayas and northern Mindanao. Read more in updates from the Philippine NDRRMC and UNICEF.
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.
Rabies in a NYC park’s raccoons
Testing carried out recently on several raccoons from a park in Manhattan’s north established they were infected with rabies - the first such finding since 2011 for the borough.
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 – especially dogs, the main source of infection. If bitten, urgent post-exposure treatment is required. Vaccination recommendations are itinerary-specific but include those travellers planning to live in, or travel extensively or repeatedly through, endemic countries. Read more on rabies.
Measles cases to surge
More than 70 measles infections were reported from Mar 4-10 in Hanoi and further increases are expected over the coming weeks; the capital’s year to date total now sits at 412. On a national level, there have been 7,727 measles cases (& more than 35,000 cases of dengue fever). 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.