World travel health alerts 15 December 2021

World travel health alerts for 15th of December 2021.

2nd VD polio strain circulating, global update

A new emergence of cVDPV2 in Yemen has been reported by the WHO, with two young unvaccinated girls found to be infected (one from each of the non-contiguous governates of Taiz and Marib). The viruses are unrelated to other known strains globally and are the first cVDPV2 detections since 2016 in Yemen (35 cVDPV1 cases have been reported since 2019). The agency reiterated the assessment from the latest Emergency Committee meeting that ‘the risk of international spread of cVDPV2 is currently high’. Read more. In other polio news, from the weekly GPEI update, Afghanistan recorded its fourth WPV1 case this year (in Kunduz province), while cVDPV2 infections were logged by Cameroon (single case in Extreme Nord province) and Nigeria (18 cases from seven states).  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.

Outbreak yet to peak

More on the marked increase in paratyphoid B cases recorded in the NW state of Salta this year, with children aged between five and 14 years comprising over 530 of the 1,283 cases confirmed (there are another 200 suspected cases). Almost two-thirds of the latest infections, averaging between 90 and 100 per week, were from the capital, Salta, and the remainder in the districts of Cerrillos, Chicoana, Cafayate, Rosario de Lerma, Los Andes, Metán, La Caldera, Molinos and Cachi. Read more

Advice for travellers

Paratyphoid, like typhoid fever, is an enteric fever which can develop into a severe and even fatal illness. There are three paratyphoid serotypes bacteria – A, B and C, and humans are the only reservoirs. Infection is acquired through consuming food or water contaminated with the faeces of an infected individual (acute or chronic) and so the risk is deemed to be highest in lower and middle income countries. Food and water precautions are advised as there is no specific vaccine for paratyphoid (although the oral typhoid vaccine may confer some protection). Read more 

Seasonal flu news

Flu activity has been increasing across the region and the ECDC reports that six countries ((Armenia, Israel, Kazakhstan, Kyrgyzstan and Russia) have so far seen positivity rates climb above 10 percent - influenza A(H3) viruses predominated.

Advice for travellers

In most years, seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Whether you are travelling within Australia or overseas, vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol-based hand sanitiser is a convenient alternative if soap and water is not available.

Wet weather mosquito bonanza

Measures used to control mosquito populations have reportedly proved effective in lowering the risk of Ross River fever for residents of the City of Mandurah (WA), and should continue to do so in the face of high (La Niňa-boosted) rainfall. Read more. The same weather phenomenon is likely to cause swarms of biting mozzies on the East Coast, with an ABC News article reporting ‘more than 200 cases of Barmah Forest virus, and more than 770 cases of Ross River virus’ in Qld this year. In the same post, CSIRO scientist Brendan Trewin expressed concern over the possibility that the Asian Tiger mosquito (Aedes albopictus) could become established in Australia, particularly as the species is known for its ‘habit of constant biting – between 20 and 100 times an hour’.

Advice for travellers

Cases of Ross River fever occur throughout Australia, including more temperate southern states. 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 (PMD) when outdoors and wear long, loose-fitting, light coloured clothing – especially at dawn and dusk, the times of day when RRV-carrying insects are most active. More on RRV in Western Australia and in Qld.

Southern state’s YF update; Moths causing skin irritation

With yellow fever vaccine coverage sitting just under 80 percent in Santa Catarina, the state government’s announcement of eight yellow fever (YF) cases and three resulting deaths in 2021 was used to remind the population to get vaccinated if they hadn’t already done so. Surveillance of monkey deaths caused by YF infection have so far uncovered more than 600 suspected cases, with the latest reported from the municipality of Pedras Grandes. Peak YF season runs from December through to May. Read more

INVESTIGATIONS into bouts of severe dermatitis suffered by large numbers of residents in 21 Pernambuco cities since October have found the cause to be Hylesia moths. The insects fly towards lights in unscreened homes and on contact ‘release tiny body bristles that penetrate deep into human skin and cause the intense dermatitis observed’. 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.

Plans for safe, healthy Winter Games

Health guidelines for participants and attendees at the February 2022 Beijing Winter Olympics and Paralympics are detailed in two ‘Playbooks’, which have been designed to assure that both visitors and the local population ‘stay safe and healthy for the Games’. Read more

Certified malaria-free

El Salvador and China have both received malaria-free certification in an announcement by the WHO that coincided with the release of the 2021 World Malaria Report. Estimates on the global burden of malaria in 2020 contained in the report revealed there had been ‘241 million malaria cases and 627,000 deaths in 85 malaria endemic countries’, representing a rise of 14 million cases and 69,000 deaths compared to the previous year. Around two-thirds of those deaths were ‘linked to disruptions in malaria prevention, diagnosis, and treatment’, however it was not as severe as initially predicted earlier in the pandemic in its worst case scenario. The highest burden of malaria is carried by sub-Saharan Africa, with close to 95 percent of global cases and 96 percent of deaths in 2020. The report also advised that the ‘six countries of the Greater Mekong subregion continue to achieve impressive declines in their malaria caseload.  By the end of 2020, there were approximately 82 000 cases of malaria in the subregion, down from a peak of 650 000 cases in 2012 and about 100 000 cases in 2019’. In other malaria news, several agencies working together in Costa Rica are maintaining an ‘epidemiological fence operation’ around seven communities of the Northern Zone following an uptick in malaria cases over the past few weeks. Read the World Malaria Report here.

Advice for travellers

Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

No new Ebola cases; Monkeypox in eastern province

Beni health zone in the province of North Kivu has less than five days before the end of its latest Ebola outbreak can be declared, however concerns remain over a number of contacts who have been lost to follow-up. More than 1,500 vaccinations have been administered as part of the response using the rVSV-ZEBOV-GP and ERVEBO vaccines. Read more

AN OUTBREAK of monkeypox in the Eastern province of Maniema has to date caused 191 cases and 24 related deaths, and comes on top of a recent surge in measles infections. Read more

Advice for travellers

Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox.

Yellow fever cases in more districts

Up to Dec 10, the yellow fever outbreak had claimed 46 lives from the 600 suspected cases (102 confirmed). While the situation is now stable in the areas where the first cases were detected, news reports now state that suspected cases are still emerging in Central Gonja, Bole, and Sawla-Tuna-Kaba districts. Reactive vaccination campaigns continue. 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.

Mixed reports on insect-borne infections, one Zika case in Delhi

Various reports on insect-borne infections have filtered through over the past fortnight, with new dengue infections finally trending down in the central state of Madhya Pradesh, while news out of Delhi is that a single Zika virus case has been confirmed in a man from the city’s NE (Shadipur) – surveillance has been increased in the area. Read more. A report into Japanese encephalitis (JE) infections registered in the eastern state of Assam to September puts its YTD total at 212 cases and 39 deaths. Lastly, in Patna (Bihar), the risk of JE and other mosquito-borne infections is said to be increasing due to continuing rains, and Odisha has reported nearly 500 scrub typhus cases in 2021. Read more

Advice for travellers

Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information accessed through smartraveller (DFAT).

COVID-19 update

According to the Dec 14 WHO weekly epi update, the African region experienced the biggest increase in new COVID-19 cases over the past seven days (up 111 percent), while the highest weekly case and death incidences per 100,000 population were in Europe, followed by the Americas. Thirty of the 49 countries that make up the African region reported new case increases of 25 percent or more – the top three in rank were South Africa, Zimbabwe and Mauritius, however the number of deaths registered was relatively stable. Only six African nations have reached the target of fully vaccinating at least 40 percent of their population before the end of the year – Seychelles, Mauritius, Morocco, Cape Verde, Tunisia and Botswana. Eritrea is yet to start its vaccination program. Read more.

In related news:

- ATAGI issued a statement on the Omicron variant and timing of COVID-19 booster vaccination on Dec 12, advising that the booster ‘is particularly important for people with increased exposure risk (e.g. occupational risk or outbreak areas) or who have risk factors for severe disease’ using either of the mRNA vaccines. The Group issued a reminder to people with immunocompromise to have their third (primary) dose of COVID-19 vaccine a minimum of two months after their second dose.

- A Dec 10 Technical Briefing published by the Health Security Agency in the UK advised that ‘Omicron is projected to reach parity with Delta (equal proportion of cases) in mid-December’, with estimates that a person with the Omicron variant is about 3 times as likely as someone infected with the Delta variant to pass the virus on to a household member.

- Three people in their 20s from one Melbourne household are the first in Australia to have contracted COVID-19 twice, after being infected by two different SARS-CoV-2 variants roughly a year apart – they were ineligible for vaccination at the time of second infection. Read more

- Imperial College, London published ‘Omicron - latest findings and commentary from Imperial experts’.

- Our World in Data provides a 12-month rolling total of vaccine doses administered globally, by region, country and high/medium/low income status. The same information is also available for the past six and nine months.

- CIDRAP summarises the most recent data on the Omicron variant of concern.

Dengue cases persist into winter

An increase in new dengue infections has persisted since October and news sources are still reporting dengue-related deaths in both Karachi and Hyderabad. It is hoped that cooler temperatures will arrive soon in the Sindh and bring relief from the disease threat posed by mosquitoes. 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.

RVF emerges in 2 medical zones

The Dec 14 WHO weekly bulletin issued an update on an outbreak of Rift Valley fever (RVF) that was first reported in early November, with a single case detected in three health districts of Fatick and Matam medical zones. The agency notes that RVF outbreaks have occurred in Senegal in the past and response measures to these cases must include community education on the use of mosquito nets and correct handling of body tissues of potentially infected animals. 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.

AWD in the under 5s

Children under five from communities that include some on the Guadalcanal Plain make up most of the acute watery diarrhoea cases that have surged in recent weeks. While investigations are underway into the causative organism/s, parents have been reminded of the need for personal as well as food and water hygiene, also to ensure the routine rotavirus vaccination is administered to their infants as scheduled. Read more

Flooding link to deaths investigated

Cholera has apparently been ruled out as the cause of death in 89 people in Fangak, located in the north of Jonglei State. Extensive flooding has isolated the area and WHO response teams have had to be flown in to investigate and perform testing. Read more

Local MERS case

The WHO this week announced a single MERS case in a camel farmer dating from mid-November in Abu Dhabi region. The man, who had several co-morbidities, has since recovered. There have been 93 MERS cases in the Emirates since 2013. Read more, also WHO factsheet on MERS.