World travel health alerts 14 July 2021

World travel health alerts for 14th of July 2021.

VD polio in 5 states; Cholera outbreaks flare up

In the last week of June the GPEI reported a total of 10 polio cases all involving circulating vaccine-derived poliovirus type 2 (cVDPV2) from five different states (Jigawa, Yobe, Borno, Kano and Zamfara), while from the most recent update there were single cVDPV2 cases in Afghanistan and the DRC, plus one cVDPV1 infection in Saadah, Yemen. Egypt has also recorded its 10th cVDPV2 positive environmental sample this year - in Qena north of Luxor.

THERE HAS been further deterioration in the cholera outbreaks that were affecting numerous states in late June, with media reports singling out Bauchi, Kano, Plateau and Ebonyi.  On the other side of the continent, cholera vaccinations are being rolled out to residents of the islands off Tanzania’s coast, Zanzibar (Unguja) and Pemba. The WHO is supporting the program which aims to halt the outbreaks that frequently affect the Isles by 2028.

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.

Rabies risk from stray dogs

A local news source has reported three recent human rabies deaths in the district of Kavre district, SE of Kathmandu. The fatal infections occurred over a one-month period and follow another rabies death earlier this year. Warnings have been issued to residents on the risks associated with stray dogs, while veterinary services are commencing vaccination and sterilisation programs for the canine population. Read more. In other news on rabies, a rise in the number of rabies infections has been noted among jackals in northern regions of Israel near border zones, and the animals have been involved in attacks on travellers. Two further ProMED reports cover incidents of rabies risk and exposures in Canada, the USA and Brazil (Foz do Iguaçu in Paraná state and Rio Grande do Sul).

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.

COVID-19 – Delta variant moving ‘at a scorching pace’

The spread of the Delta variant into at least 111 countries across all six WHO regions has seen COVID-19 case numbers increase by 10 percent in the last week – the only region not experiencing a rise in incidence is the Americas. Indonesia and the UK reported significant increases in new cases – 40 percent and 33 percent respectively – while Africa recorded the largest spike in deaths, up 50 percent on the previous week. Fiji was fifth overall on reported new cases per 100,000 population (after British Virgin Islands, Seychelles, Cyprus and Jersey). Read more in July 13 WHO epi update and the WHO director-general’s media briefing on July 12.

Related news:

- In view of the outbreak of community acquired cases of the Delta variant in the Greater Sydney region, this week the Australian Technical Advisory Group on Immunisation (ATAGI) has issued updated clinical advice on vaccine use during these events.

- A July 8 NPR article provides more detail on the VOC expected to become the dominant variant globally over the coming months: ‘The Delta Variant Isn't Just Hyper-Contagious. It Also Grows More Rapidly Inside You’.  

-CIDRAP has reported on a study that found that people who had received a flu vaccination two weeks to six months prior to contracting COVID-19 ‘had less risk of sepsis, stroke, deep vein thrombosis (DVT), and disease requiring emergency or intensive care’. It also stated that ‘Flu vaccine was not linked with reduced risk of death’ and does not remove the need for COVID-19 vaccinations. More from EurekAlert.            

-Also from CIDRAP, a summary of findings from an Israeli study published in JAMA this week, in which two doses of the Pfizer/BioNTech vaccine, Comirnaty, had a 78 percent efficacy in preventing infection of pregnant women.

- Europe's Digital COVID Certificate came into use on July 1st. The certificate, which is free of charge and comes in paper or digital format, features a QR code to show proof of vaccination, testing negative or recovery from COVID-19 and is valid in all EU countries. Read more

-The Scientist publishes tracking details of COVID-19 vaccines that are currently in clinical trials, plus efficacy data and side effects for those that have been approved.

- To date, COVID-19 vaccines have mostly been known by their developers’/manufacturers’ names, however to avoid confusion in the future, the trademarked vaccine names are to become more prominent on the vial labels: Comirnaty (Pfizer/BioNTech), Vaxzevria (AstraZeneca) and Spikevax (Moderna). Read more

Malaria-free status at last

China has become the 40th country to achieve malaria elimination status, reducing infections from 30 million in the 1940s to zero by 2017. The announcement was made on June 30 by the WHO Director-General who said that China had joined ‘the growing number of countries that are showing the world that a malaria-free future is a viable goal’. Read more

More plague in NE province

The latest WHO regional bulletin describes an outbreak of plague in Fataki health zone of Ituri province in the country’s endemic NE: In the two months since the first case was identified on April 22, there have been 117 suspected plague cases (bubonic and pulmonary) and 13 deaths from eight health zones in the province. The bulletin notes that 'more cases occur in the rainy seasons (from March-May then July-November), harvest seasons, and its peri-forest environment'.  

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.

Tiger mosquito spreads further north

The reach of Aedes albopictus mosquitoes across France is expanding, with the species now detected in 64 departments. The most recent incursion has been in Loiret, in the Centre-Val de Loire region where the species was first identified in 2017 (in Indre, followed by Cher and Indre-et-Loire). Read more. In publishing details of the mosquito’s spread throughout the region, the ECDC includes a map (March 2021) showing where the species is established or introduced. The ECDC also notes that no locally acquired cases of dengue fever or chikungunya have been detected in the EU this year. On a global level, in 2021 the majority of chikungunya cases were reported by Brazil, India, Belize, Malaysia and Cambodia, while highest case numbers of dengue fever were in Brazil, Peru, Vietnam, Réunion and the Philippines

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by day-time feeding Aedes mosquitoes. 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 and dengue fever.

Success against JE in Assam district; Zika infections in Kerala

Public awareness campaigns and targeted vaccination for children at risk have resulted in a marked decrease in Japanese encephalitis (JE) infections this season in Dibrugarh district, Assam. A single JE case has been recorded this year, to July 9. The district encompasses a large city on the banks of the Brahmaputra River and tea plantations. Read more

IN THE southern state of Kerala, at least 18 Zika virus infections have been detected in Thiruvananthapuram district, and they include a pregnant woman. Health teams have been sent to the state, which is now on alert, and testing facilities expanded.  Read more

Advice for travellers

A mosquito-borne virus, JE is usually found in many parts 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 large urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

Syphilis cases surge

Syphilis infection rates had been rising steadily before the restrictions imposed last year but the limited diagnostic services available in 2020 now has authorities fearing the potential for ‘a large reservoir’ of cases yet to be confirmed. In June this year a national outbreak of early infectious syphilis was declared, with more than three-quarters of cases recorded in Dublin, Kildare and Wicklow; 90 percent of infections were reported in men. Read more

Advice for travellers

Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.

WNV strikes in new area

No human cases of West Nile virus (WNV) infection had been recorded this year across the EU and neighbouring countries until last week when Italian authorities reported a single case in Calice al Cornoviglio in La Spezia. The province, which is in the region of Liguria, has not previously reported a human WNV case. Also on WNV, the July 9 ECDC update advised that the media report of a suspected case in Seville in mid-June has been discounted after further testing by Spanish authorities. Read more

Advice for travellers

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 during the peak transmission season should take measures to avoid mosquito bites. Read more on WNV.

Kala-azar reported from at least 11 counties

Plans are underway to manage the increasing incidence of visceral leishmaniasis which has spread beyond six endemic counties and is now confirmed in at least 11 and probably more. Arid and semi-arid areas have been hardest hit. 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. Read more on the disease and prevention.

RSV rates soar

Health authorities are reporting a surge in respiratory syncytial virus infections across the country, with a recent week-on-week increase of almost 30 percent. 688 new cases were logged in the ESR’s July 4 report, taking this year’s total to 1,680 cases. Some paediatric and maternity hospitals have imposed restrictions on visitors and delayed elective procedures so as to leave bedspace for respiratory infection admissions. Read more and more information on RSV from healthdirect.

CCHF in endemic SW

At least 14 Crimean-Congo haemorrhagic fever (CCHF) infections have been reported in and around the city of Stavropol in the country’s SW. As the region in a known endemic zone for CCHF, residents have been advised to use insect repellent before venturing outdoors and regularly check themselves for ticks. Read more

Advice for travellers

CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

TBE cases double

Tick-borne encephalitis (TBE) infections have increased 2-fold this year compared to the same period in 2020. While tick populations have been growing due to favourable environmental conditions, fewer TBE vaccinations have been administered in the country, both this year and last. The Swedish Public Health Agency advises a 7-day interval between receiving a COVID-19 vaccine and one for TBE. TBE cases generally peak in the warmest months of July and August and Sweden reports between 200 and 300 cases each year, with highest incidence in central and southern areas. 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 most infections are contracted through the bites of infected ticks, food-borne transmission through untreated dairy products is a known mode of transmission. Safe and effective vaccines are available in Europe, but none are licensed in Australia, however the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.

Tick-borne illnesses steadily increasing

Residents of New York State heading out of urban areas have been warned of the risk of tick-borne illnesses such as Lyme disease, and now also anaplasmosis. Media reports say the percentage of ticks in the area which carry the bacteria that cause Lyme disease, Borrelia burgdorferi, ranges from 30 to 50 percent, and for anaplasmosis the estimate is around 5 percent, although testing for the infection is rare. According to the CDC, anaplasmosis ‘is most frequently reported from the upper midwestern and northeastern United States’. Read more