World travel health alerts 15 May 2019

World travel health alerts for 15th of May 2019.

Local, global measles round-up

A WHO Disease Outbreak News post provides a situation update for Tunisia – up to Apr 30 there had been more than 3,100 suspected measles cases from the governates of Kasserine and Sfax; also, to a lesser extent, in Kairouan, Tunis, Sousse and Nabeul. Routine measles vaccinations were administered to infants at 12mo, however in view of the outbreak, the age limit has now been lowered to 6 months of age. The WHO considers the risk of spread within the region to be moderate due to high levels of cross-border travel between Tunisia and Algeria. The agency’s African region weekly bulletin provides details on measles cases in Ethiopia, Guinea (10 epidemic areas) and Angola (Lunda Sul and Moxico provinces, but now said to be under control), Mali (recent increases in Babamba and Koutiala health districts) and Uganda (rural areas most affected). In a separate news article, six of the 48 measles cases reported to date this year in Reunion stemmed from two doctors who were infected with the virus and worked at a hospital in Saint-Denis. In 2018 Reunion reported a total of four measles cases.

The WHO’s report for the Western Pacific provides a summary of the situation in our region, while a more recent update from New Zealand notes that Auckland’s infection count now sits at 53.

In Singapore, this year has seen a 3-fold increase in cases over the same four month period in 2018. Other regional information comes from Hong Kong and in a release from Taiwan’s CDC (computer-translated).

And an ECDC update for the European region states that 11 countries have ‘ongoing or new outbreaks: Austria, Bulgaria, the Czech Republic, France, Italy, Lithuania, Luxembourg, Poland, Romania, Slovakia and Spain. Most of the cases were reported from Romania (1 027), France (852), Poland (554), Lithuania (569) and Italy (557). In 2019, five deaths were reported in the EU in Romania (4) and France (1).’ From an agency infographic, ‘most EU/EEA cases are in teenagers and adults’. More details are provided in the Communicable Disease Threats Report, May 5-11.

Advice for travellers

Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. In general the infection is relatively benign, but complications 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.

Legionella infections near NW city

Cooling towers located near a canal linking the city of Ghent to Terneuzen in the Netherlands are being tested in the search for the source of up to 16 legionellosis cases in Evergem and nearby Oostakker. To date, one person has died and 11 remain in hospital. Read more

Advice for travellers

Legionnaire’s disease occurs worldwide and many of the increasing number of cases reported in Australia in recent years have been linked to overseas travel. Outbreaks have been associated with cruise ships, hotels, and resorts. The bacteria that causes Legionnaires’ disease is found in airborne droplets of warm, fresh water, such as from fountains, spas, showers and the cooling towers of buildings. Over 50s, current or former smokers, those with a chronic lung condition, and the immunocompromised are at higher risk of developing illness after exposure. Read more

Mozzie pest detected in north

Peru, Bolivia and Argentina all host the Aedes aegypti mosquito (a vector of yellow fever, dengue fever, chikungunya and Zika virus), so authorities in neighbouring mainland Chile carefully monitor any potential insect breeding sites for signs of the insect. A report released in late March has revealed Ae. aegypti larvae were detected in one such site in the northern coastal city of Iquique, situated to the west of the Atacama Desert. Clean-up activities have been carried out in the area and authorities state there has been no local transmission of any of these viruses. Read more

New affected area in Ebola outbreak

Alimbongo is the latest health zone to be affected in the Ebola virus disease outbreak, reporting one of the 15 cases announced in the Ministry of Health’s newsletter of May 14 – the others were Beni, Katwa, Butembo, Mandima, Musienene and Lubero. The death toll from the epidemic is now 1,136 from 1,720 confirmed and probable cases. More from the WHO here.

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.

Dengue cases top 137

The number of suspected dengue fever cases in an outbreak first reported in late March has mounted to 137, with DENV-1 identified in those samples sent for testing. Read more. While in Tahiti, the count of locally-transmitted DENV-2 infections has risen to 20 (Mahina, Arue, Papeete (Taunoa), Faa’a, Papearii and Papetoai (on Moorea). Nearly 50 confirmed or suspected DENV-1 infections have also been reported (in Tahiti, Moorea, Raiatea, Tahaa, Nuku Hiva and Rangiroa).

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.

3 further rat Hep E infections announced

Hong Kong’s Centre for Health Protection (CHP) is investigating another three cases of rat hepatitis E infection - in elderly residents of Kowloon City, Southern District and Tuen Mun. While the source and routes of infection are investigated, advice from the CHP is for ‘members of the public to be vigilant against hepatitis E infection and to strictly observe good personal, food and environmental hygiene’. Read more

Monkeypox diagnosed in overseas visitor

Twenty-two contacts of a Nigerian man diagnosed with monkeypox after his arrival in Singapore have been put into isolation for the duration of the 21-day incubation period. The man, who is from Delta state, is said to be in a stable condition - his diagnosis was confirmed on May 8. In late April he had attended a wedding in Nigeria’s Ebonyi State (200kms NE of Port Harcourt) and it is believed he may have contracted the virus by consuming bush meat, a recognised source of transmission. 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.

Human LPAI case in northern governate

ProMED reports on a positive human infection with H9N2 bird flu in a young child from Al Batinah South Governorate, noting that currently, ‘information on the clinical details of the case or potential exposure source of the case is not available’. Read more

3,500 suspected dengue cases per week

The dengue fever epidemic maintains its momentum with the YTD confirmed case count now exceeding 10,000, however cases that are clinically suggestive of dengue infection actually number more than 30,000 (3,500 per week). Early in the epidemic, the south was most affected but now northern and western areas of the island are reporting an increase in cases – North (Saint Denis, Sainte Marie and Sainte Suzanne); West (Saint-Paul and La Possession). Read more (Measles outbreak news below)

Advice for travellers

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. 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.

Leptospirosis, dengue updates

The incidence of leptospirosis has risen this year with the country recording 1,600 cases to date – highest rates have been in the departments of Ratnapura, Kalutara, Moneragala and Galle (Colombo has reported 76 cases). ProMED comments that ‘Sri Lanka might have one of the highest incidence of leptospirosis and needs to be considered as a leptospirosis high endemic country.’ Meanwhile, almost 17,000 dengue cases have been registered countrywide with 3,718 from all areas of Colombo, followed by Gampaha, Jaffna, Kalutara and Kandy. Read more

Advice for travellers

Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

Capital, national dengue; STI hike in young adults; UK ups Zika warning for pregnant women

A series of public campaigns planned to take place throughout the year in Bangkok are aimed at stemming new dengue fever cases. The city reported a total of 1,500 infections (with one death resulting) between Jan 6 and Apr 27. Read more. Countrywide, up to May 1, there had been at least 18,000 cases of dengue with 27 deaths; authorities have forecast there will be up to 95,000 cases this year.

THE 15-24 YEAR age group is now contributing a substantial proportion of the rising number of syphilis infections, with as many as 30 percent admitting to practicing unsafe sex. An official with the Department of Disease (DDC) control has also said that ‘citizens are becoming sexually active at a younger age (averaging about 13 to 15 years old)’. Read more

PUBLIC health authorities in the UK have reassessed their advice for pregnant travellers to Thailand. From information available on the Travelhealthpro website: ‘Following recent reports of Zika cases in travellers to Thailand [1] and review of available evidence, the advice for pregnant women travelling to Thailand has been upgraded. Pregnant women are advised to avoid travelling to Thailand until after the pregnancy.’

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 on smartraveller (DFAT).  

Hep A vaccine recommendation boosted

Late last week, the UK’s Travelhealthpro website advised that the ‘country-specific hepatitis A vaccine recommendation for Turkey has been upgraded from "some" to "most" travellers’, based on the review of ‘reports of Hepatitis A infection including reports in travellers. Vaccine guidance is updated in consultation with Public Health England.’ Read more

Advice for travellers

Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is highly effective and offers long term protection.

Next measles outbreak locations?

A study published in the journal Lancet Infectious Diseases on May 9 lists 25 US counties with the greatest risk of measles outbreaks this year – the top four were named as Cook (Illinois), Los Angeles (California), Miami-Dade (Florida) and Queens (New York). Honolulu (Hawaii) is tenth on the list. Vaccine exemptions, travel data and current outbreaks were used in determining the degree of risk. The CDC announced the YTD total for 23 states (up to May 10) as 839 measles cases, with 66 of the most recent 75 infections from New York.

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.