World travel health alerts 15 July 2020

World travel health alerts for 15th of July 2020.

WPV total rises to 58

Afghanistan and Pakistan were both reported to have detected wild poliovirus 1 and cVDPV cases in the July 7 GPEI update: in the former there were three WPV1 cases and eight of cVDPV2, in the latter, one WPV1 case and three cVDPV2. Rounding out the weekly cVDPV2 digest, Chad registered four cases and Côte d’Ivoire, one.

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 coincides with monsoon-related infections

The pressure is on health services as they contend with COVID-19 upsurges (cases have passed 937,000 and more than 24,000 deaths) and the annual surge in vector-borne infections during monsoon season.  This week there have been reports on malaria from Mumbai (Maharashtra) and Bareilly (Uttar Pradesh), while in the SW state of Kerala, dengue fever cases are steadily increasing in several panchayats of Kottayam district. In other regional news, despite an early arrival of the monsoon this year in Bhutan, the uptick in dengue and malaria cases has arrived late in the southern border dzongkhag (district) of Sarpang. 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.

Tick-borne infection kills 5 in Anhui

Severe Fever with Thrombocytopenia Syndrome (SFTS) cases have been trending upwards in China since first officially reported almost 10 years ago, and the range of the tick vector has broadened – the provinces now considered SFTS-endemic for are Liaoning, Shandong, Henan, Hubei, Anhui and Jiangsu. Last week, health authorities in Anhui confirmed that 23 SFTS cases have required hospitalisation in Lu'an since April, resulting in five deaths, while also warning the local population of the risk of other tick-borne infections. Read more

Advice for travellers

SFTS causes symptoms including high fever, vomiting, diarrhoea, blood test abnormalities and multiple organ failure. There is no effective vaccine and deaths rates among those infected can be as high as 30 percent. Read more about SFTS in China.

‘… still a very active outbreak’

A further expansion of Equateur’s Ebola outbreak has health agencies concerned, made worse by the remoteness of some affected areas and their locations near to international borders and a major transport route, the Congo River. Six health zones have now reported cases and the WHO weekly bulletin notes several people with confirmed infections remain in the community. From the July 13 update, there had been 48 confirmed (plus three probable) cases and 18 deaths among the confirmed cases. More than 11,600 people have been vaccinated (rVSV-ZEBOV-GP) since the beginning of the outbreak.  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.

STI update

Syphilis cases have reportedly doubled from Jan-June this year compared to 2019 figures, with highest rates overwhelmingly among males. While the increase in gonorrhoea notifications wasn’t as great, it’s chlamydia that is most often reported. According to a local news source, ‘about 1 in every 440 Icelanders has tested positive for Chlamydia so far this year’. Finland's data from 2019 also revealed a rise in STI reporting with a new record in chlamydia cases for the year, which may be explained by more testing undertaken. 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.

Measles hike in western county

Local news sources are reporting a recent rise in measles cases in West Pokot County, adjacent to the Uganda border. There have been as many as 40 cases among both children and adults (and one death in a child) over the past month in the area, which is known to have low immunisation rates among its nomadic farmers. 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.

JE now in 2 Penang locations

Health authorities have announced more Japanese encephalitis (JE) cases in the state of Penang. There have been six in total now - the most recent were children from the same district as previous cases, Sungai Bakap, but also in Balik Pulau, a town on Penang Island. Read more. More on JE with Taiwan registering its youngest case, a 3mo baby from Changhua County, taking the country’s YTD total to 13.

Advice for travellers

A mosquito-borne virus, JE is usually found in many part 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.

Local measles, rubella no more

With the declaration last week of the end of endemic rubella transmission in Sri Lanka and the Maldives, the two countries are the first in the WHO SE Asian region to have eliminated both measles and rubella – well before the 2023 target set last year. The WHO statement also advised that all countries in the region now have measles and rubella vaccines in their immunisation programmes: ‘First-dose coverage of measles-containing vaccine is now 88% and the second-dose coverage 76%’. 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.

TBE cases on the up and up

The Federal Office of Public Health has announced a surge in medical visits for tick bites up to June that has surpassed the previous record in 2018, with tick-borne encephalitis (TBE) cases more than double those reported last year. The agency suggests this might be the result of ‘favourable weather’, more people visiting forests in response to social distancing restrictions or the failure of residents to be vaccinated for the same reason. 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.

Reasons for rise in Zanzibar’s malaria cases

According to the region’s malaria evaluation officer, the spike in Zanzibar‘s malaria cases may in part be due to recent rains and residents’ incorrect use of mosquito nets - almost 9,000 cases have been detected this year. Overall the country has made significant inroads in tackling malaria, posting a 50 percent fall in cases between 2016 and 2018. Read more

Advice for travellers

Many countries in Africa present a significant malaria risk. Travellers should discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. Read more about malaria.

COVID-19 total nearing 3.5 million

Globally, COVID-19 cases have risen another million - to 13 million - in just five days and CIDRAP reports that the Americas have ‘more than half of the world's cases and nearly two-thirds of the deaths’. According to the Johns Hopkins July 13 newsletter, new cases reported daily in the USA are ‘accelerating’ fastest in the South (approx. 13 percent test positivity), but with marked increases in the Southwest (18 percent), West and Midwest regions. More indepth global and national data on variations in positive results from the Stat News dashboard.

In other COVID-19 news, on July 9 the WHO updated its scientific brief on ‘Transmission of SARS-CoV-2: implications for infection prevention precautions’, in one section noting that in some circumstances, ‘short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out’.  

The Therapeutic Goods Administration (TGA) announced on July 10 that Remdesivir ‘has received provisional approval for use in adults and adolescent patients with severe COVID-19 symptoms who have been hospitalised’.

The New York Times publishes a Coronavirus Vaccine Tracker that is regularly updated to provide the latest insights into the search for an effective COVID-19 vaccine – this week’s news includes links for Phase III trials for Moderna and the launch of Phase I trials for Medicago and the University of Queensland.