World travel health alerts 17 April 2019

Infected rodents spread viral illness

Eleven people from the NW province of Jujuy (municipalities of San Pedro, Palma Sola, Libertador General San Martín and Calilegua) have been found to have contracted hantavirus; most acquired the infection after coming into contact with aerosolised virus shed by the vector, a species of wild mouse, while hunting or fishing. Despite the current case count representing an increase of more than half compared to last year, it is a substantial reduction on figures from two decades ago. Read more. Also in the region, eight hantavirus infections have been recorded among rural workers in Bolivia’s central department of Cochabamba with one death resulting.

Advice for travellers

Hantavirus is passed on to humans through contact with hantavirus-infected rodents or their urine and droppings. Eliminating rats in and around living quarters is the main way of preventing hantavirus infection. Cases have been documented in Argentina, Brazil, Canada, Chile, Panama, Paraguay, and Uruguay, making HPS a pan-hemispheric disease. Read more about hantavirus

Dengue, Zika increase, decline in chikungunya

Over 90 percent of São Paulo’s towns and cities have reported dengue fever this year; least affected is the SW region while the NW has been hardest hit. In Minas Gerais, high rates of dengue infections have been recorded in 128 municipalities, with the total now exceeding 100,000 cases. Country-wide reporting revealed a 300 percent increase in dengue fever infections compared to 2018, with the SE and central western regions most affected. Read more

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.

Elevated flu activity

The WHO global flu update (with data to Mar 31) notes that while most regions are experiencing decreasing or low influenza activity, Thailand, northern China and South Korea reported elevated levels or a second wave of infections with influenza B most common followed by influenza A(H3N2) viruses. Read more

Advice for travellers

Seasonal flu is the most common vaccine-preventable travel-related illness because it is a potential risk during every stage of the journey. Whether you are travelling within Australia or overseas, Travelvax recommends vaccination for all travellers over 6 months of age. Read more about influenza.

Dengue’s upswing continues

There has been a gradual upward trend in the number of confirmed or suspected dengue fever cases recorded since March with the latest count at 30 (18 confirmed, 12 probable). Read more

Advice for travellers

Avoid mosquito bites and you won’t get 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.

Ebola vaccinations reach 101,000 at-risk

A WHO emergency committee has again decided that as the ongoing Ebola virus disease outbreak remains limited to the provinces of North Kivu and Ituri it does not constitute a Public Health Emergency of International Concern, resulting in no changes in surveillance, travel, and trade recommendations. Read more. Good news on active prevention measures in place as the V920 vaccine that is being administered to ring contacts of Ebola patients (& healthcare workers) has proven to be 97.5% effective. More on the current outbreak situation as advised by the WHO and the Ministry of Health.

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.

8 dengue serotype 2 cases prompt outbreak declaration

On April 11 authorities in Tahiti declared an outbreak of type 2 dengue fever (DENV-2) after the eight case of locally-transmitted dengue fever was identified (since mid-March). The areas affected are Papeete (Taunoa), Mahina and Faa’a. The concern is that it has been nearly two decades since serotype 2 has been in circulation adding to the risk of a larger outbreak and one that is more likely to affect those residents under 20 years of age. Currently, no other islands in the group have reported DENV-2 cases however DENV-1 is circulation in Tahiti, Moorea, Raiatea, Bora Bora and Rangiroa. Read more  

Advice for travellers

Dengue is spread by two types of 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.

Measles, rubella updates

Sixteen of the 17 rubella cases reported this year to the region’s authorities occurred in the last fortnight and they number among them several hotel employees. Further news on reported measles cases in Macau – current case count is 32 for the YTD and almost one-third of infections were diagnosed in health workers. 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 which should be current for prior to overseas travel. Travellers should also check their immunisation status for tetanus, diphtheria, and whooping cough. Read more about rubella

Global measles situation

Summaries of measles infections in the news across the globe this past week: European region (additional data for rubella taking in 12 months to the end of Feb 2019), Madagascar, the Philippines, USA and South Korea. Australian recommendations regarding MMR vaccination have recently changed, lowering the minimum age from nine months to six months if infants are ‘travelling to countries where measles is endemic, or where measles outbreaks are occurring’ (after an individual risk assessment). The two routine doses must still be given. The health dept. advice also includes the following: ‘Travellers are strongly recommended to have received 2 doses of measles-containing vaccine. Measles importation after international travel is the most significant source of measles cases in Australia.’

In a published opinion piece, the WHO director general and UNICEF executive director have declared that ‘We are in the middle of a global measles crisis’ ... ‘In just the first three months of 2019, there have been more than 110,000 measles cases reported worldwide, a figure that is up nearly 300% from the same period last year. And these numbers will represent just a fraction of all the cases that occur.’  

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.

Peak dengue season nears

Dengue fever cases recorded for the year to April 16 climbed to 13,619 (and 11 deaths). While more than 3,000 cases were from Colombo and its environs, Gampaha and Jaffna also reported high numbers of infections. Peak dengue season is yet to start – last year June and July were the high season months. Read more. Also in the region, this week health authorities in the Maldives stated that the recent upsurge in mosquito-borne infections is likely to continue, adding to the 1,493 cases of dengue and 660 cases of chikungunya reported to date. The hike in dengue cases is an almost 4-fold increase on 2018 notifications for this period. Areas affected include the capital, Malé and outlying islands. Read more

Advice for travellers

Avoid mosquito bites and you won’t get 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.

Dengue spikes in southern, central regions

Zamboanga peninsula, on the southern island of Mindanao, has experienced a recent rise in dengue fever cases and related deaths that constitutes a two-fold increase on the same period in 2018. Hardest hit have been Zamboanga, Zamboanga del Norte, Zamboanga del Sur, Zamboanga Sibugay, and Isabela City on the island of Basilan. Read more

The Western Visayas region (provinces of Aklan, Antique, Capiz, Guimaras, Iloilo, and Negros Occidental) has also seen a spike in dengue reporting; cases are up by more than 150 percent year-on-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, to exposed skin when outdoors during the day. In addition, cover up with long-sleeved tops, long pants, and shoes and socks a

Dengue epidemic’s 14,000 cases

While southern districts continue to report heightened dengue fever activity (recent surges in Saint Joseph, Le Tampon and Les Avirons), in all, 23 communes are said to have concerning levels of dengue infections. In the most recent reporting week, more than 1,000 new cases were identified, taking the YTD total to over 6,000. Read more   

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.

Port city, coastal region report dengue

Authorities declared a dengue fever outbreak last week in Dar es Salaam and the coastal region of Tanga after more than 300 people were admitted to hospital for treatment of the viral illness. Recent rains have been blamed for the sudden spike in cases. 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, 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.

World Pride preparations; Salmonella outbreak source determined; Hep A outbreak update

The UK’s fitfortravel website is recommending that people travelling to New York in June to celebrate World Pride consider that vaccination against ‘MMR, Hepatitis A and Hepatitis B may be advised’; also of importance, pre-travel health advice should be sought on other possible health risks.  

PRE-CUT melon from a single supplier is the ‘likely source’ of a multi-state Salmonella outbreak (S. enterica serotype Carrau) that has sickened 93 people from nine states to date. More cases may emerge due to potential delays in reporting systems. Read more 

THE CDC continues to monitor and respond to the widespread hepatitis A outbreak that first appeared in 2016 and has had the greatest impact on illicit drug users and the homeless. News this week that Broward County in Florida joins with Palm Beach and Martin counties in becoming high risk zones after reaching the Hep A outbreak threshold.

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.

Local diphtheria cases announced

According to a NZ news source two children, 11 and 13 years of age, have been diagnosed with diphtheria; this has occurred as part of an increased trend in vaccine-preventable infections reported this year. Read more

Advice for travellers

Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis, or whooping cough. Read more on diphtheria.