World travel health alerts 16 September 2020

World travel health alerts for 16th of September 2020.

Polio update for Asia, Africa

More WPV1 cases were reported to the GPEI this week from Pakistan (three cases from the provinces of Balochistan and Punjab) and Afghanistan (four cases – equal numbers from Kandahar and Zabul provinces), while in Africa, the DRC’s total of cVDPV2 cases rose sharply this week with a further 15 cases reported (13 in Equateur and one each in Kinshasa and Mai Ndombe provinces). Chad also recorded three more cVDPV2 infections (Logone Oriental and Tandjile provinces) and lastly, Sudan registered another eight cases from across five provinces (Blue Nile, Kassala, River Nile, East Darfur and Khartoum).  

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 cases set to pass 5 million

News sources are reporting almost half of all active COVID-19 cases are in just three states - Maharashtra, Andhra Pradesh and Karnataka. The national outbreak total is close to 5 million (with over 80,000 deaths) and a record 97,654 cases were added on Sept 11, however a research paper published this week estimated that millions of cases may have been missed earlier in the year when testing was limited. Read more

In the Sept 14 Johns Hopkins newsletter, it was noted that Bahrain, Israel and Montenegro are all experiencing rapidly increasing incidence, while from a separate news source, Argentina’s rate of positive tests climbed further to 50 percent, after polling 40 percent since early last month. Elsewhere, the WHO Middle East region’s director is concerned by the rising case numbers, particularly in Iraq, Morocco, Tunisia and the UAE. More on the global situation in the Sept 14 WHO weekly epi update.

In other COVID-19 news:

A 2-dose Chinese COVID-19 vaccine, which is still undergoing phase III testing, has been approved for emergency use in the UAE’s first responders. Read more

A stark warning of the impact of SARS-CoV-2 on global health is contained in the 2020 Bill & Melinda Gates Foundation’s Goalkeepers Report, with just one indicator – vaccine coverage - ‘dropping to levels last seen in the 1990s. In other words, we’ve been set back about 25 years in about 25 weeks.’

Ebola striken areas widespread

More on Equateur province’s Ebola outbreak as currently only 10 of 39 health areas are reporting active transmission, however a new name was added to the list this week – Bontole. Cases have now risen to 121 (confirmed and probable) with recorded deaths static since last week at 48. Almost 28,500 people have been vaccinated since the outbreak began in June. In an earlier WHO news release, concerns were raised over the potential for the outbreak to spread and ‘reach neighbouring Republic of Congo and even the capital, Kinshasa’. 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 activity revived by flood conditions

Recent flooding is certain to worsen the cholera outbreak which had shown signs of improvement lately after affecting ‘nine regions, including Addis Ababa and Dire Dawe city’. Damage to infrastructure and drinking water supplies is predicted to sweep active disease transmission into more widespread areas. The summer monsoon season has also affected East Darfur state in neighbouring Sudan, with a reported rise in malaria cases coinciding with an ‘acute shortage’ in malaria treatment medications. Further south in Kenya, cholera outbreaks have been controlled in four of the five affected counties (Wajir, Murang’a, Marsabit and Garissa), leaving Turkana which is now experiencing its fourth wave of infections this 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.

Probe into possible dengue cluster in Nice

Health authorities in the Alpes-Maritimes department are investigating a possible cluster of locally-acquired dengue fever cases in Nice, with two confirmed cases and up to 10 more suspected. Read more. Also in the region, a Sept 10 Eurosurveillance post describes the first instance of locally acquired dengue fever in Italy which took place last month in Vicenza, west of Venice in the Veneto region. An Italian national arrived from the island of Pulau Weh in West Sumatra via Jakarta in late July and five household members who had not travelled with the index case later tested positive for dengue (DENV-1).

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. Both bite mainly during the daylight hours, making them difficult to avoid outdoors. 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 oil of lemon eucalyptus (PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites. Read more about dengue fever.

2nd schisto species detected

UK researchers have confirmed the emergence of intestinal schistosomiasis cases in Mangochi District, on the southern shores of Lake Malawi. The appearance of a new snail species in the area coincided with the detection of Schistosoma mansoni parasites among local schoolchildren, in some cases outnumbering cases of the endemic urogenital form (caused by S. haematobium). There is concern that the parasite ‘has transitioned from emergence to outbreak, and could perhaps eventually become the dominant form locally’. Read more

Advice for travellers

Schistosomiasis or bilharzia is caused by a parasite which is released into fresh water by host snails. It burrows into the skin of people who swim or wade in rivers, streams and lakes containing the snail. With the rise in eco-tourism and adventure travel, increasing numbers of tourists are contracting schistosomiasis, according to a WHO fact sheet. Around 10% of travellers exposed to contaminated water will be infected. No vaccine or prevention medication is available, but schistosomiasis is treatable – especially if diagnosed early. Read more on the risk for travellers and how to prevent infection.

Sarawak’s 3rd rabies death in 2020; 4 districts with Kelantan’s malaria burden

A man from Kuching’s south succumbed to rabies infection last week, taking the death toll in Sarawak’s 3-year outbreak to 24 - three this year. Investigations are continuing into how and when he contracted the viral infection as he had not reported any animal bites and his own pets remained healthy. Read more

HEALTH department records for the NE peninsular state of Kelantan that detailed the 65 Plasmodium knowlesi malaria infections registered from Jan-Aug this year indicated they were located in the districts of Gua Musang, Kuala Krai, Jeli and Tanah Merah. There were no fatalities among those affected. 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.

Is dengue in for the long haul?

After a 3-month drop in dengue reporting, cases are starting to climb again in Majuro, with a few also in the Outer Atolls. More than 3,500 suspected and confirmed cases were recorded across the islands from May 2019 to late August and Majuro hospital hasn’t had a dengue patient-free week during this period. There is now some concern that the virus may become endemic. Read more 

More dengue news from across the Western Pacific in the latest WHO update (Sept 10): most countries, with the notable exception of Singapore, have reported substantially fewer cases than for the same timeframe in 2019. Recent news from Futuna, where a dengue epidemic has been declared after 17 cases were recorded over the past eight weeks. And in the SE Asian region, Thailand has experienced a severe dengue season after ideal weather conditions boosted vector numbers – 126 dengue-related deaths and more than 136,000 cases, with hardest hit areas centred on Bangkok and its environs and Chiang Mai province.   

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.

Pandemic hampers malaria initiatives

Malaria cases reported last year were already 50,000 higher than for 2018 (greatest burden in Binga, Gokwe North, Beitbridge, Hwange, Mbire, Rushinga, Mudzi, Nyanga, Mutasa and Chimhanimhani), and are likely to rise again this year due to disruptions to control programs during the pandemic. According to recent figures, more than 306,000 malaria cases and 279 related deaths have been registered nationwide this year. Read more

Advice for travellers

Malaria is endemic to many areas of southern Africa. Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.