World travel health alerts 16 October 2019

World travel health alerts for 16th of October 2019.

5 countries with 1,000+ measles cases, Samoa’s outbreak announced

The Oct 12 ECDC summary of EU measles notifications reveals that most cases this year have been reported in Romania, France, Italy, Poland and Bulgaria - data is provided for all countries, both within and outside the EU/EEA. The agency notes that measles remains ‘a serious cross-border threat to health’ and the risk of ‘continued widespread circulation of measles in EU/EEA in the near future is high. In other news, a measles epidemic was declared in Samoa today after the infection was confirmed in seven adults and children. Results on other probable cases have been sent to Melbourne and are pending, as is the cause of death of an infant last weekend, suspected to be from measles complications.   

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.

Dengue’s death toll mounts

Ten people succumbed to (suspected or confirmed) dengue fever-related causes last month alone, taking the 2019 death toll to 88. One of the parishes hit particularly hard by the virus is St Elizabeth in the country’s SW, with more than 220 suspected cases this year. Read more. Around 400kms to the NW, authorities in the Cayman Islands have confirmed one locally acquired dengue fever infection in a resident with no history of travel.

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.

More suspected polio cases, vaccination recommendations for travellers

Tests are underway on samples taken from three siblings living in Marawi City, Lanao del Sur on the island of Mindanao, after they were found to be suffering from symptoms described as being ‘polio-like’. A polio vaccination campaign targeting children under 5yo in the high-risk region is due to start this week in Davao City, Davao del Sur and Lanao del Sur (Mindanao) and the second phase is underway in the NCR (including Metro Manila). Read the vaccination recommendations for foreign nationals and returning Filipinos intending to stay for four or more weeks, published in the Oct 10 Dept of Health advisory. More polio news: in view of the rise in the 12-month tally of polio-affected countries (both WPV and VDPV) to 20 - Africa (12), Asia (5) and the Western Pacific (3), the IHR Emergency Committee has continued the Public Health Emergency of International Concern with vaccination recommendations for residents and long-term travellers to these areas. In the most recent reporting week, cVDPV infections were registered in the Central African Republic (from RS1, RS4, RS5, and RS7 provinces) and the DRC (one from Sankuru province and two from Haut Lomami province). 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.

Dengue epidemic phase in 11 islands, other regional dengue news

Dengue activity is continuing to increase – the capital Papeete has recorded the highest number of dengue fever cases (DENV2) with 341 of the national total of 1,488 – all since early February. Eleven islands are currently categorised as being in an epidemic phase with a further five on alert. Type 1 dengue is also circulating in Tahiti, Moorea and Rangiroa. Read more. Also in the region, an update issued by the health ministry of the Cook Islands shows a slight increase in dengue fever cases (type 1) from the five recorded in August, to nine in September - Raratonga’s north is ‘still the hot spot, with 70% of the total cases reported on Rarotonga’; the districts of Tamil and Weloy on the island of Yap (FSM) have borne the brunt of the outbreak of DENV3 this year. 

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.

Cholera at 25-year high; EVD returns to Ituri health zone

Five provinces have reported most of the recent cholera cases with the YTD national total now exceeding 20,000 suspected infections. North Kivu, South Kivu, Tanganyika, Haut Lomami and Kasai Oriental, located near Kivu and Tanganyika Lakes, have all experienced a recent jump in cases and are considered the cholera hotspots. Read more

WHILE the number of health zones affected by Ebola virus disease (EVD) is now low compared to the 207 implicated during the height of the outbreak, news this week that a case has been registered in Ituri province’s Maroro health area after nearly 10 months is a set-back. Read the latest CMRE report here.

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.

Zika case in SE

A single locally-acquired Zika case has been registered in the town of Hyères, on the Mediterranean coast between Marseilles and Cannes - the only autochthonous infection registered in France this year. The woman has now recovered and authorities acted promptly to fumigate the immediate residential area and instigate a public awareness campaign. The ECDC will issue a rapid risk assessment next week. Read more. This week, a news report stated that Malaysian health authorities have also confirmed a single Zika virus infection, in a man from the NW peninsular state of Perak. The last clinical cases confirmed in Malaysia were in 2016 – eight in all.

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 and their partners, should seek medical advice before travel to Zika-affected areas. Read information on smartraveller (DFAT).  

Anthrax suspected in 2 northern districts

The infection anthrax is suspected as the cause of illness among 115 people in the northern regions of Kunene and Zambezi – they are all believed to have consumed meat contaminated with the bacterial spores. The Zambezi region cases probably stem from local villagers eating meat from a hippo – one of many in a recent die-off in Liambezi Lake. Read more  

Advice for travellers

The anthrax bacterium is transmitted to people in the form of spores which are can produce disease through consuming contaminated meat, through inhalation or via contact with the wool, hair or hide of infected animals. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about anthrax.

More fatalities in Bauchi’s YF outbreak; E-yellow card set-back

There have been more deaths related to the yellow fever outbreak in the northern state of Bauchi. An official with the state’s Primary Health Care Development Agency revealed that 10 of the 22 deaths ‘were rangers working with the Yankari Games Reserve’. Read more. In other news, one source is reporting the theft of thousands of e-yellow cards, recently introduced as a means to prevent the sale of counterfeit yellow fever vaccination certificates. According to, ‘top officials’ from the health ministry are behind the theft and have subsequently sold them on the black market.

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.

Timely advice for summer visitors to NE

In September, just ahead of the peak season, and following a year-on-year decline in its reporting, the NICD has published an update on malaria for the warmer months to come: ‘Visitors to northern KwaZulu-Natal Province, the lowveld areas of Mpumalanga Province, including the Kruger National Park and areas bordering the park, north-eastern Limpopo Province, and especially those visiting Mozambique, must take precautions against mosquito bites by using effective insect repellent applied to exposed skin areas after sunset, and use mosquito coils, fans and airconditioning, and even mosquito nets, in high-risk areas. Visitors should consider taking prophylactic drugs if visiting high-risk areas.’ Travellers are also advised to be aware of the non-specific nature of malaria symptoms which can mimic a number of other illnesses. Read more

Advice for travellers

Malaria is endemic in many areas of southern Africa. Travelvax recommends that travellers visiting this region discuss their itinerary and preventative medication at their nearest Travelvax clinic, or with their healthcare provider. For advice, call Travelvax on 1300 360 164. More on malaria.

2 NE states with RVF; Risk of cholera spread downstream concerning

Rift Valley fever cases and associated deaths have recently been reported in humans and domesticated animals in the northern state of River Nile and its easterly neighbour, Red Sea State. And more on the cholera outbreak affecting the SE with a WHO situation assessment indicating that ‘the risk of spread is of more concern in the areas situated down the river Nile (including Khartoum)’. 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.

Local dengue, JE, enterovirus digest

Japanese encephalitis cases have risen to 21 this year with the latest infection reported in the western county of Yunlin. Highest numbers to date have been in Kaohsiung, Taoyuan and Taichung. Also this week, the country’s CDC Deputy Director-General advised that ‘enterovirus is still in its epidemic season, so parents and people who work with children should take preventive measures and be on the look out for symptoms’. Read more. The first dengue fever case for the year in Taichung takes the national total to 97 – mostly from Kaohsiung (57), followed by Tainan (31), New Taipei (5), Taipei (2) and Taoyuan and Taichung (1 each).

Advice for travellers

On average, 24 cases are recorded each year in Taiwan, mainly in the south from May to October, but peaking in June and July. Cases typically occur in rural, rice-growing areas where people live near the host animals, pigs and wading birds. While it is a low risk for most travellers staying in urban areas, expats and travellers spending extended periods in agricultural areas of Asia should consult their travel doctor about recommendations for vaccination. Read more about JE.

STI in the news

National data on sexually transmitted infections in 2018 published by the CDC shows new primary and secondary syphilis cases, as well as gonorrhoea have risen to a near-30 year high. One reason contributing to the rise is ‘Decreased condom use among vulnerable groups, including young people and gay and bisexual men’. Separate news reports relate to the rates of STIs in California and Hawaii.