World travel health alerts 14 October 2020

World travel health alerts for 14th of October 2020.

WPV1 cases top 50 in 2020, African update

Both wild (WPV) and circulating vaccine-derived polio cases (cVDPV) were recorded in the last week – four WPV1 cases from the provinces of Khost, Badghis and Hilmand and eight cVDPV2 infections from across six provinces, while in Africa, Burkina Faso registered six new cVDPV2 cases (no locations cited) and Chad’s three cases were from Logone Occidental and Oriental provinces. 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 resurgence

For four weeks in a row now the global weekly COVID-19 incidence has hit record highs, with one million cases recorded over a recent 3-day period. Read more. Late last week, a CIDRAP post described Europe ‘exhibiting exponential growth’, as the Johns Hopkins newsletter of the same day noted that the region’s epidemic ‘is now more than more than twice as large as during its first peak in early April’, however fatality rates are not as high as during March/April. More details on the current situation for the Netherlands, France, Russia,  UK,  Germany and Poland. Also, India’s total has passed seven million cases but overall numbers have declined since the mid-September peak, and the PAHO issued an update on the situation in the Americas on Oct 7.  

Closer to home, Auckland moved onto the same alert footing as the rest of New Zealand (level 1) on Oct 7 - 179 cases were recorded during the outbreak that started on Aug 11. In Australia, the fortnightly CDI report for the period ending Sept 27 showed ‘the largest number of cases occurred in those aged 20–29 years (64 cases), with the highest rate of infection for this period again occurring in those ≥90 years old’. Meanwhile the Solomon Islands government has suspended repatriation flights for students in the Philippines after 2 cases were detected from an inbound flight last week.

In related news:

Virus that causes COVID-19 survives up to 28 days on surfaces, Australian scientists find: ABC news

This week, two clinical trials have been paused pending investigation of possible safety concerns and unexplained illness - the Eli Lilly antibody therapy, LY-CoV555, and the Johnson & Johnson Covid-19 vaccine.

Dengue at 10-year high

On Oct 9, the ECDC gave notice that Martinique’s year-long dengue fever outbreak has reached a 10-year peak after the island registered 7,800 of the French Antilles’ 10,6023 suspected cases in the latest update. Guadeloupe has the next highest count – 2,430 additional suspected cases – however all islands in the group are said to be in an epidemic phase. To the south, in Barbados, authorities are watchful of the outbreaks in the region but say that the slight increase in dengue cases this year is not ‘beyond what is expected’.

Advice for travellers

Dengue occurs both in urban and rural areas, around human habitation. The virus is spread by Aedes mosquitoes which breed in shady places close to dwellings and bite mainly during the daylight hours, making them difficult to avoid when 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 (or PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Rare local malaria cases in non-travellers

In a tragic example of what is thought to be ‘airport malaria’, an elderly couple from a town located outside Brussels, and 6kms from two airports, died of malaria last month. They had not travelled overseas and details of the cases remain under investigation, however P. falciparum was found to be the cause of infection. No further cases were detected in the area and cold weather would now prevent any mosquitoes on arriving aircraft from surviving. Read more

Advice for travellers

More on airport malaria from Medscape.

Hep E hits North-Central region

Hepatitis E infection has been confirmed in almost all of 71 jaundice cases under investigation, most of which are in the Centre-Nord region. Ten deaths have been recorded in pregnant or post-partum women. According to the regional WHO bulletin, ‘one sample tested IgM positive for yellow fever …, awaiting confirmation from the Institut Pasteur in Dakar in Senegal’. Read more

Advice for travellers

The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Infection during the latter stages of pregnancy carries a higher rate of severe disease and mortality. Unlike the Hep A and B viruses, there is no vaccine for this strain in Australia, which is especially common in communities with lower levels of sanitation and hygiene. Read more about the virus and how to prevent it.

Peaks and troughs of protracted cholera outbreak

More on the nearly seven months-long cholera outbreak with the WHO regional bulletin concluding that it ‘is showing little signs of being controlled, with fluctuating case numbers and moving geographical areas’. The regions of Littoral and Central have reported most cases in the outbreak that has now caused 79 deaths from the 1,848 infections (to Sept 30). 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.

Response measures continue in challenging environment

The absence of new confirmed Ebola cases and deaths in the NW outbreak since Sept 28 is a welcome development, however according to the WHO, the persistent issues (contacts lost to follow up, confirmed cases remaining in the community and challenges with safe and dignified burials) mean that the news must be interpreted with caution. 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.

Oropouche virus confirmed in central region

Investigations into a spike of dengue-like illnesses last month in the country’s central rainforest region has instead led to the first confirmed presence of Oropouche virus (OROV) in French Guiana. Currently 37 confirmed and probable cases have been recorded from a population of 50 to 80 in the commune of Saül, a popular destination for hikers and entomologists that is only accessible by air. Other countries in the region have reported cases of Oropouche fever and the principle vectors, the Culicoides midge and a Culex spp mosquito, are present hence the advice from the WHO to include OROV ‘ in the clinical differential diagnosis for other common vector-borne diseases in the region of the Americas (e.g., malaria, dengue, chikungunya, Zika, yellow fever)’.  More on Oropouche fever in WHO Disease outbreak news.

Dengue toll climbs to 12

The capital Vientiane and the provinces of Bolikhamxay (central) and Bokeo (NW) have logged most dengue fever cases this year as the national total rose this month to 7,031 cases and 12 related deaths. While in Thailand, the remote NW province of Mae Hong Son has seen a 4-fold increase in dengue fever reporting which has hit hardest in young people aged 10-24 years, many of whom are students and farmers. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. Both 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. Read more about dengue fever.

RVF outbreak widens to 9 regions

The Rift Valley fever outbreak (previously posted on Sept 30) has now spread from five to nine regions - Adrar, Assaba, Brakna, Hodh Elchargui, Hodh El Gharby, Tagant, Trarza, Gorgol and Noukchott Sud – and as cases have climbed, so have related deaths, now numbering 13 (from at least 36 confirmed cases). Read more

Advice for travellers

Rift Valley fever (RVF) is an acute viral disease that typically infects domesticated herd animals. It is generally found in eastern and southern Africa where sheep and cattle are raised, as well as in West Africa, Madagascar, and more recently Saudi Arabia and Yemen. People are infected after exposure to blood, body fluids, or the tissue of RVF-infected animals, or from the bite of an infected mosquito. The virus presents a low risk to travellers, but is another reason to use personal insect repellent and take other steps to minimise insect bites in places where it occurs. Read more about RVF.