World travel health alerts 13 November 2019

World travel health alerts for 13th of November 2019.

Measles news for Pacific Islands, Europe, Africa

The measles outbreak declared by the Fijian Ministry of Health and Medical Services involves four cases (three confirmed, one suspected) who are all linked – two adults, one child and an infant from Wailali Settement in Wainadoi in the Serua/Namosi Subdivision near Suva. Vaccinations are being carried out on a local level, as well as for all children (and people who will be travelling overseas or to the outbreak area) who haven’t had two doses of MR vaccine. Read more. While in Samoa, the measles outbreak has claimed more lives with news reports of seven deaths and at least 638 cases. An Echo Flash Daily report on Nov 13 included the comment, 'A vaccinologist from Auckland University said the disease was at the stage where it was now difficult to stop'. Two Samoan children visiting American Samoa have been admitted to hospital with suspected measles. In Tonga, a Nov 5 update revealed the outbreak at that time comprised 177 confirmed or suspected measles cases, many of whom were students of schools in Tongatapu and Vava͛u High School and linked to the first cases associated with travel to New Zealand. More measles news: Reports from across the European region - Romania, the UK, Italy (more than half of cases in Lazio & Lombardy) and Croatia (Zagreb) have recorded the highest increases in recent cases, however the ECDC notes that the ‘majority of the countries have reported less than 10 cases in the past month’. The agency has published a global summary of measles reports and a separate African region update provides more details on the extensive outbreak in the D.R. of Congo, where a further 53,000+ suspected cases were identified in the last eight weeks taking the 2019 total to more than 233,000 and 4,723 deaths (to Oct 27).

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.

Rabies risk rises in Sindh; cVDPV2 detected in north, all polio news

A local news source has reported on the alarming rise in dog attacks in Karachi and across the Sindh – over 200,000 this year – blamed on the soaring rabid dog population. The situation has been exacerbated by shortages of rabies vaccines and the lack of public awareness on the required treatment for rabies exposure. There have been 22 human rabies deaths in the province this year. Read more

LAST WEEK the Minister of Health confirmed in a statement that seven children from northern districts had been infected with cVDPV2 in July (type 2 oral polio vaccine hasn’t been used since 2014). Reactive vaccinations will be carried out in Rawalpindi and Islamabad and 11 northern districts starting this week. More in-country and global polio news: two more WPV1 cases were reported in Khyber Pakhtunkhwa take Pakistan’s YTD total to 82; while in Africa, cVDPV2 infections were reported in Angola (seven in total from the provinces of Luanda, Malange, Huambo and Moxico); the Central African Republic (one case in RS2 province); six more cases in the DRC (from Sakuru, Kwilu and Haut Lomami provinces); and two in Ghana (Northern province).

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.

Flu update to Oct 27

Malaysia was one of two tropical Asian countries with existing or increasing flu activity (also Laos), as noted in the WHO global influenza update which included data to Oct 27. Other flu reporting singled out the Arabian Peninsula, Iran, Cuba, Jamaica, El Salvador, Nicaragua, Côte d’Ivoire, Ghana and Reunion Island as having elevated influenza activity. Almost 70 percent of all specimens tested by WHO GISRS laboratories were influenza A strains – over half of those were A(H3N2) viruses.

Advice for travellers

Seasonal flu is the most common vaccine-preventable travel-related illness because it is a potential risk during every stage of the journey. Whether you are travelling within Australia or overseas, Travelvax recommends vaccination for all travellers over 6 months of age. Read more about influenza.

Regional dengue fever update

Summarising 2019 in the November 11 dengue update, the PAHO disclosed that the case count to mid-Oct was ‘the largest recorded in the history of dengue in the Americas, exceeding by 13% the number of cases reported in the epidemic year of 2015’. Severe dengue cases were also higher than reported in that year. All four dengue serotypes have been circulating in Brazil, Guatemala and Mexico; a further seven countries report the presence of three serotypes. Overall, highest incidence rates across the region were in Belize, El Salvador, Honduras, Nicaragua and Brazil (most probable cases - 2,069,502 and 702 deaths).

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. They 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.

Dengue adds to crisis in 2 regions

High dengue fever rates are adding to the humanitarian crisis besetting the country. The more than 5,500 suspected cases and 24 deaths this year have been reported from all areas, including those enduring recent armed conflict – North-centre and Sahel. 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.

Plague in northern region

Two people from Inner Mongolia, an autonomous region of in northern China, are undergoing treatment in Beijing after being diagnosed with pneumonic plague infections. Read more

Advice for travellers

Plague poses a low risk to most travellers. The majority of plague cases 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.

2nd dengue transmission through sexual contact reported

A rare case of dengue infection acquired through sexual contact was reported in Madrid in September: a man whose male partner had recently returned from Cuba and the Dominican Republic, both of which have ongoing dengue outbreaks. Testing confirmed both men had been infected with an identical dengue strain, one that is circulating in Cuba. Probable dengue fever sexual transmission was last recorded in 2013, in South Korea. 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.

Another zero EVD case day, Goma’s vaccine campaign, Ervebo pre-qualified

There have now been six days this month, and eight for the year, when no new Ebola virus disease (EVD) cases have been posted in a hopeful sign for health agencies involved in the NE’s outbreak. Read more. In other news, Janssen’s investigational 2-dose Ebola vaccine will be used in a vaccination campaign to start this week in the city of Goma for ‘individuals at some risk of Ebola infection who live in areas close to the current outbreak zone’. It was announced this week that Merck’s Ebola vaccine, known as Ervebo, has been pre-qualified by the WHO and gained approval in Europe. For more news and information on the outbreak, the WHO has established an Ebola response website.

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.

Canine-transmitted rabies-free; Zika news

The WHO has declared Mexico to have eliminated human rabies transmitted by dogs after it completed a validation process initiated by the WHO/PAHO in 2016. Rabies-free status involves zero transmission for two years and, while there have been no cases since 2006, according to the PAHO, ‘In order to sustain elimination, PAHO/WHO recommends continuing all rabies prevention, surveillance and control actions, particularly as rabies virus continues to circulate among wild animals such as bats’. Read more

THE STATES of Jalisco, Morelos and Sinaloa have recorded more than 80 of the 98 Zika virus infections detected this year. In other Zika news, ProMED has summarised worldwide reports since August and included related journal articles here.

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 normally 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.

3 states with most of recent YF cases

Mass yellow fever vaccination campaigns have been carried out in a number of Local Government Areas in 13 states and the Federal Capital Territory in response to a rise in both suspected and confirmed cases this year. Multi-agency Rapid Response Teams have been deployed to the three states currently reporting the highest burden of infections - Katsina, Bauchi and Benue. Read more

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.

Measures to prevent a summer kick-start to dengue

New dengue fever case numbers have stabilised recently but they remain higher than for the same period last year. With the approaching summer and peak mosquito breeding season, health authorities are asking the population to maintain personal protection measures in order to prevent another severe dengue season. More than 18,000 cases have been recorded this year and south/western areas have been hardest hit. Read more

Advice for travellers

Avoid mosquito bites to protect against 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’s late year uptick

Warnings from the government on the current dengue fever outbreak after October saw the highest monthly count for the year and the death toll exceeded 80; the greatest share of dengue patients was in Colombo district. The public has been advised to present for blood tests in the event of fever (and treat said fever with paracetamol only). Read more

Advice for travellers

Avoid mosquito bites to protect against 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.

3 peak TBE seasons in a row

November brings the end of the annual tick season and this year 251 Early Summer Meningo-encephalitis (ESME) cases have been registered, well down from last year’s peak of 353 but still maintaining a high 5-year average. Preventive TBE vaccinations have been encouraged by the government for people living in all districts except the cantons of Geneva and Ticino. Read more

Advice for travellers

A viral infection, tick-borne encephalitis (TBE) can cause fever, vomiting, cramps and paralysis, which can be prolonged. In rare instances, infection can be fatal. Travellers who spend time in regions where TBE is endemic – mainly forested areas of Central and Eastern Europe, Russia, Northern China, and Mongolia – may be at risk. The highest risk is during the warmer months from April to November, especially when hiking or camping in areas below 1500m. While safe and effective vaccines are available in Europe, none are licensed in Australia; however the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.

Diphtheria diagnosis on return home

Details are lacking, but news sources have reported on two (related) overseas travellers who were diagnosed with diphtheria on their return to the Lothian region of SE Scotland; they are receiving treatment in an Edinburgh hospital. Health officials have reminded parents to ensure children have up-to-date routine vaccinations, which provide protection against diphtheria, and for travellers to seek information on disease risks at their destination. Read more

Advice for travellers

Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.