World travel health alerts for 15th of January 2020.
4 measles cases – regional, global digest
Four measles infections have now been confirmed – two in Port Moresby and one each in the provinces of New Ireland and Gulf – however no onward spread of the infection has been detected as yet. A Solomon Islands news source last week stated that from Jan 20 travellers from PNG will require proof of measles vaccination when arriving in the Islands – the other countries for which this applies were listed (including Australia) in a Dec 20 post. ReliefWeb has posted a summary of the current situation in the South Pacific with updates for Samoa, Fiji, Tonga, Australia, New Zealand and Kiribati, and on Jan 9 the regional WHO office issued an update on the situation and response measures. The public health emergency declared by authorities in American Samoa in November will now continue until Feb 6 – 12 measles cases have been confirmed to date and vaccinations have been extended to include ‘undocumented immigrants’ in the territory. Elsewhere, the ECDC has published a summary of EU and global cases; there have been three confirmed cases in the Maldives and seven more are under investigation; 24 laboratory-confirmed cases of measles and two 2 deaths were reported in the Gaza Strip; the Nigeria Centre for Disease Control updated the 2019 data for Jan-Nov advising there had been almost 59,000 suspected cases in 36 states and the FCT, resulting in 289 deaths; and lastly, measles has killed at least five children in the SW province of Balochistan in Pakistan. Read more
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.
Onset of meningococcal season
The WHO is calling for collaboration and heightened surveillance from neighbouring countries after an outbreak of bacterial meningitis hit Banikoara in the northern Alibori Department, near the borders of Burkina Faso, Niger and Nigeria. In the month to Jan 8, 77 meningococcal infections (and 17 deaths) were recorded - the predominant pathogens isolated were serogroup C (10) and X (4). The WHO notes that ‘[A]lthough Benin is not fully part of the meningitis belt in sub-Saharan Africa, the current outbreak is being reported at the time of the usual seasonal increase in cases of meningitis in sub-Saharan Africa.’ Read more
Advice for travellers
Meningococcal meningitis is an acute bacterial disease transmitted from person-to-person through close (kissing, sharing eating utensils) or extended contact. Risk factors include extensive travel in crowded conditions, extended contact with local people in crowded places and travel to sub-Saharan Africa’s ‘meningitis belt’ where meningitis outbreaks occur in the dry season (Dec-April) and just prior to the rainy season (May-June). Read more about Men. meningitis.
Surge in arboviral infections
Infections transmitted by Aedes mosquitoes increased markedly from 2018-19, with one news source’s summary claiming a 488 percent hike in dengue fever notifications (1,544,987 cases), 52 percent for Zika virus infections (10,708) and 30 percent for chikungunya (132,205). The health department has warned that summer is the peak season for mosquito-borne infections and is encouraging a national mobilisation against the mosquito. Read more. And Paraguay is currently experiencing a dengue epidemic – more than 1,700 suspected cases each week are reported from the metropolitan region of Asunción alone, and with the weather favouring mosquito breeding to continue, there are fears this year could top the previous peak recorded in 2013.
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.
Unfolding details of novel coronavirus
A novel coronavirus (nCoV-2019) has been confirmed as the cause of death in one person and of illness in another 40 – six severe – in Wuhan, Hubei province, and one other in a tourist from Wuhan visiting Thailand. On Jan 14, the acting head of the WHO’s emerging diseases unit said that, while there has been no sustained transmission among humans, it’s possible there has been limited transmission among families. Read more. In a separate post on the same day the agency said that more information is needed on ‘modes of transmission, common source of exposure and the presence of asymptomatic or mildly symptomatic cases that are undetected’, and travellers should be provided with the measures necessary to reduce the risk of respiratory infections. They should also practise strict hand hygiene and avoid close contact with farm or wild animals – living or dead. An analysis of the potential for spread of nCoV-2019 through air travel corridors has been published in the Journal of Travel Medicine (PDF only). While investigations continue, the US CDC has issued a level one travel health notice while an ECDC update stated that ‘Neighbouring territories such as Hong Kong, Malaysia, Myanmar, the Philippines, Singapore, Taiwan, Thailand, Russia and Vietnam implemented entry screening activities to all incoming travellers from Wuhan in their transport hubs such as airports and train stations.’ As the Lunar New Year festival (Jan 25-Feb 8) approaches, in China the great exodus of relatives heading home for family reunions (Chunyun) has already begun and will continue until Feb 18.
Advice for travellers
More on coronaviruses from the WHO.
EVD outbreak total tops 3,400
The WHO Situation Report on Ebola virus in the NE dated Jan 14 notes that most of the recent cases are not unexpected and are related to a known chain of transmission. The outbreak total is now 3,403 cases and 2,235 deaths, according to the latest CMRE newsletter. More details in the WHO dashboard.
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.
Two additional polio cases in Sabah, global update
Surveillance for acute flaccid paralysis uncovered two more polio infections in the state of Sabah; they come just over a month after the first case of VDPV1 was identified in an infant from Tuaran district (West Coast Divison). That virus was found to be genetically linked to one circulating in the southern Philippines. The newly confirmed cases were in boys aged eight and 11 years from Kinabatangan and Sandakan (in the NE division of Sandakan) and their diagnoses have prompted a review of the mass vaccination campaign which was originally planned just for children aged under 5yo. Read more. More polio news in a global update from the GPEI dated Jan 9. Also, three more cVDPV2 have been reported in Ghana (Bono, Bono East and Ahafo Regions). In Pakistan, six more wild poliovirus infection were recently confirmed in Khyber Pakhtunkhwa, taking the province’s 2019 total to 97 and 141 for the country as a whole.
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.
Dengue off to a strong start
The Central District, comprising the capital Tegucigalpa and the city of Comayagüela, has seen a slight increase in dengue fever cases over the past few weeks, however it’s a near 3-fold rise on the first week of 2019 – a rise reflected on a national level (286 cf. 1048). More than 112,000 cases and 180 related deaths were recorded last year. 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.
Highest rubella rates in men
Nearly 2,300 rubella cases were reported last year (to Dec 25), down from the 2,946 recorded in 2018, and the burden of infections remains high among men - in fact, more than three times higher than in women. Prefectures recording most cases for 2019 (to week 51) were in Tokyo, Kanagawa, Chiba and Saitama. Read more
Advice for travellers
Rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine, one of the routine immunisations used here which should be current prior to overseas travel. Travellers should also check their immunisation status for tetanus, diphtheria, and whooping cough. Read more about rubella.
Updates on cholera, measles, kala-azar
Three diseases continue to trouble the country. News this week of another measles outbreak, this time in Alale, Pokot North sub-county. Cholera cases are persisting in Garissa, Mandera, Turkana and Kirinyaga counties while Garissa, Mandera, Marsabit and Wajir are still reporting visceral leishmaniasis (kala-azar) infections – adding to the nearly 2,900 recorded last year. 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.
Malaria spikes again in Betroka
Just eight months after an epidemic of malaria swept through the south-central distict of Betroka, several children have succumbed to the infection. Local health authorities are working to raise public awareness of malaria, prevention measures and the need to seek prompt medical attention at the first symptoms. Read more
Advice for travellers
Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.
Chikungunya cases in travellers
Information gathered by GeoSentinel and published this month in Eurosurveillance provides details on 18 chikungunya cases in travellers (13 European, four Asian and one from the Americas) believed to have been contracted between Aug-Oct last year. Twelve different locations are listed as being possible exposure sites. Officially there had been no reported chikungunya cases in Myanmar since 2010.
Advice for travellers
Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Applying an effective repellent to all exposed skin and covering up are your best defences. Read more about chikungunya.
No end-of-year break for dengue
The new year has started with two weeks of increased dengue reporting – more than 780 cases up to Jan 14 and the number of active dengue clusters is also rising – 107 to date. The NEA has advised residents celebrating the Lunar New Year to ensure that decorative plants around the household do not become mosquito breeding sites. Read more
Advice for travellers
Dengue is spread by Aedes mosquitoes which breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid. 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 PMD when outdoors to all exposed skin. Read more about dengue fever.
Pack your repellent
There is no mention of the species or of any diseases transmitted, but a local news article has warned of the nuisance caused by the annual surge in Dubai’s mosquito population, accompanying lower temperatures and plentiful standing water. The post mentions the areas of Jumeirah, The Lakes, Meadows, Springs and Emirate Hills however authorities are said to be ‘carrying out pest control across 10 different sections of the city. Read more