World travel health alerts 16 June 2021

World travel health alerts for 16th of June 2021.

Polio outbreak officially over, global polio news

The GPEI has announced the launch of a new polio eradication strategy which ‘clearly outlined how to overcome the final barriers to securing a polio-free world’. Actions planned from 2022-2026 include ‘further integrating polio activities with essential health services … and building closer partnerships with high-risk communities’. Read more. In other polio news, the WHO has declared the end of Philippines’ outbreak after 16 months of response measures, including mass vaccination campaigns. Read more. Last week the GPEI reported one new case each of circulating vaccine-derived poliovirus type 2 (cVDPV2) in Afghanistan (Badghis) and Burkina Faso (Kaya).  Further clarification of the cVDPV2 situation in Senegal has revealed a total of 12 cases reported this year from Touba, Diourbel, Tivaouane, Sokone, Thies and Mbao (Dakar), with a national vaccination program planned for later this week. And lastly, an ABC article of interest relating to polio in our wider region: ‘Polio was eliminated in the Asia-Pacific. Then it suddenly came back’.

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 data to be released

Over the past seven days, all WHO regions recorded declines in new COVID-19 case numbers except Africa which saw its fifth consecutive week of increases. The WHO Director-General this week said that ‘the steep increase in Africa is especially concerning’. Namibia, Uganda, South Africa and Zambia are flagged in the latest regional weekly bulletin for their rising infection rates, while ‘Botswana, Namibia, Cape Verde and Seychelles are all exhibiting uncontrolled community transmission’. The government in Tanzania is set to start releasing COVID-19 data ‘soon’ in response to pressure from the UN and international financial institutions – there have been no disease updates since April 2020 when the official count was 509 cases and 21 deaths. Read more

In related news:

- The WHO has designated a new variant of interest (VOI) first detected in Peru in Aug 2020. Lambda is the seventh VOI and has become increasingly prevalent in several South American countries. Read more in the June 15 WHO epi update.

- On June 9 the RANZCOG and ATAGI released a joint statement on COVID-19 vaccination for pregnant women, recommending they are ‘routinely offered Pfizer mRNA vaccine (Cominarty) at any stage of pregnancy. This is because the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby.’ 

- Public health measures introduced for this year’s Hajj pilgrimage (17-22 July) will limit attendance to people from within Saudi Arabia and numbers are restricted to 60,000 pilgrims between the ages of 18 and 65 years. Read more

- Data released by Public Health England suggests high efficacy against hospitalisation with the Delta variant for two vaccines (following two doses): 96 percent for Comirnaty and 92 percent for COVID-19 Vaccine AstraZeneca.

- Four countries are hosting trials of the Pfizer vaccine in children, with the Phase 2/3 using lower doses for the age group of five to 11 years, followed at a later date by children of two to four years and then under two years. News reports state that the trial will be carried out over two years. Read more

- Human subjects are being sought by Brisbane-based researchers for trials of a COVID-19 vaccine delivered by nasal spray. Read more

- Germany’s new CovPass app, which provides digital proof of COVID-19 vaccination, is expected to be available to fully vaccinated residents by the end of this month. According to a VOA article, ‘the yellow paper WHO-issued vaccination certificates will still be honored as well’. The app is aligned with the EU certificate which is planned to be in use for a period of 12 months from July 1.  Read more

- The UEFA European Football Championship is underway in 11 host countries until July 11. The reduced number of spectators (around 460,000) must ‘comply with border entry restrictions, including COVID-19 restrictions, and requirements that will be in force at the time of the games in the hosting country as well as COVID-19 restrictions to access the stadiums, which may necessitate, for some venues, proof of negative COVID-19 test, and/or vaccination, and/or proof of COVID-19 diagnosis within certain period’. The ECDC is monitoring the events and will release weekly reports on any significant health-related incidents. Read more

Most chikungunya cases in 4 provinces

More on this year’s chikungunya outbreaks in the kingdom, with reports of 550+ infections already logged and increases forecast during the current rainy season when the heaviest falls generally occur in August-September. Provinces recording most of the cases are Ratanakiri, Mondulkiri, Battambang and Kratie. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by day-time feeding Aedes mosquitoes. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.

Sporadic detections of influenza variants

The ECDC has reported on three swine-origin influenza A variant virus infections: one A (H1N2)v case in Taiwan and two A(H1N1)v cases – one in the USA (Iowa) and the other in Germany (Mecklenburg-Western Pomerania). All three cases were known to have had exposure to pigs prior to the infections have since recovered and no onward transmission was detected among contacts. More on variant influenza viruses from the US CDC. 

Ebola outbreak countdown to end within days

No further confirmed Ebola cases in Nzérékoré Prefecture, but issues remain as some people with suspected infections refuse testing or transfer to treatment centres. Barring any new developments, the end of the outbreak is expected to be declared later this week. 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.

Cholera alert issued

Health authorities in the NE governate of Sulaymaniyah are warning there is a risk of a large cholera outbreak as reports of diarrhoeal illnesses soar just ahead of the upcoming peak season. Support from international agencies has been requested. 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.

Another rabies death reported

Sarawak’s fourth human rabies death in 2021 has been announced, a man from Stapang, NE of Sibu, who succumbed to the infection last month following dog bites sustained in February and March. He had not sought treatment at the time and didn’t receive any post-exposure care. In other news on rabies, authorities in the Pakistani province of Khyber Pakhtunkhwa report that rabies vaccines are in short supply even as the incidence of dog bites soars. It is estimated that Pakistan’s human rabies toll is between 2,000 and 5,000 deaths each year. Read more

Advice for travellers

Rabies is present in most countries and all travellers should be aware of the importance of avoiding contact with wild and domestic animals, including bats. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is generally recommended for longer stays, especially travellers planning to live in, or travel extensively through, rural areas and also for children; however the final recommendation is itinerary-specific. Read more on rabies.

Dengue uptick in southern state

There are reported to be up to 200 residents of Mon state undergoing treatment for dengue fever and numbers are expected to rise as the monsoon season progresses. News reports state that most cases have been recorded in the townships of Mawlamyine (Moulmein) and Ye. 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 insect repellent containing an active ingredient, such as DEET, Picaridin or PMD when outdoors to all exposed skin. Read more about dengue fever. Read more about dengue fever.

Hep A, leptospirosis cases climb

According to the latest hepatitis A notifications, 277 cases have been confirmed this year and just over three-quarters of infections were in children under 15yo; highest case numbers were in Maré, Nouméa and Lifou. Also reported in the May Bulletin epidémiologique, leptospirosis cases recorded to June 11 have exceeded the 206 cases seen in the previous peak year, 1997. Of the 210 confirmed cases to date in 2021, three were fatal and highest disease incidence overall has been in Province Nord. Read more (Bulletin épidémiologique - N°58 / mai 2021)

Advice for travellers

Hepatitis A (HAV) is one of the more common infections for overseas travellers. The virus is transmitted by faecally contaminated food and water, or through some types of sexual contact. A course of hepatitis A vaccine offers immunity that’s highly effective and long-lasting. Travellers should also follow safe food and water guidelines.

Another monkeypox importation

A man who had been working in the Nigerian state of Delta before travelling to the UK in early May has been diagnosed with monkeypox, as has a fellow quarantined family member – this takes to five the number of cases imported since 2018. The index patient developed a facial rash two days after arrival and sought medical advice later in the month. Contact tracing has been carried out and those exposed will be monitored for 21 days, however the risk to the public is low. The WHO advises that the disease resulting from infection with the West African clade of monkeypox virus ‘sometimes leads to severe illness in some individuals’ but ‘is usually self-limiting’. According to the NCDC, there have been 446 suspected monkeypox cases from 30 states in Nigeria between Sept 2017 and May 2021, 32 were recorded this year. 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.

Cholera in 16 states this year

Suspected cholera cases from outbreaks in both rural and urban areas of 16 states this year have already exceeded the totals for each of the past two years, as summarised in the latest weekly WHO regional bulletin. The states of Kano, Zamfara, Bayelsa and Delta have reported most cases. Resources needed to control the outbreaks are limited due to the pandemic response, and ‘a global shortage of oral cholera vaccine [is] making a large reactive vaccine campaign impossible’. Read more

Advice for travellers

While the risk of infection with cholera is low for short-stay travellers, Australians travelling to regions where an outbreak is occurring should adhere to strict personal hygiene and choose food and beverages with care. Read more about cholera.

RVF deaths in western district

Four fatal cases of Rift Valley fever have been confirmed in an outbreak in the western district of Kiruhura. It comes two years after the region last reported 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.