World travel health alerts 17 February 2021

World travel health alerts for 17th of February 2021.

First vaccine-derived polio report, global digest

The central Asian country is reporting its first vaccine-derived polio case, one that is said to be linked to an outbreak in Pakistan. The cVDPV2 infection was detected in Khatlon province. In other cVDPV2 news, Afghanistan recorded 34 more cases from eight provinces (noted as dating from 2020), Chad and the DRC each had one case, and South Sudan logged two more cases (Unity province). Lastly, Yemen registered a cVDPV1 case Saadah 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.

Hantavirus cases, 1 death in Salta

Five hantavirus infections have been reported from the northern province of Salta since the beginning of the year, and one person has subsequently died. Residents of rural communities have been warned by health authorties to maintain a clean environment to discourage the presence of rodents, the hantavirus vectors. Additional advice for people who plan to camp in these areas includes choosing sites with little vegetation, ‘do not sleep directly on the ground, and consume safe water’. Read more

Advice for travellers

Hantavirus is generally spread from various rodent species to people, through aerosols shed in excreta, urine or saliva, but to a lesser extent via the bite of an infected animal. The syndromes resulting from infection vary by region - in Europe and Asia, the 'Old World' hantaviruses may cause haemorrhagic fever with renal syndrome (HFRS), while the New World' hantaviruses in the Americas can result in hantavirus pulmonary syndrome (HPS). Read more on hantavirus from the US CDC.

NSW’s high RR fever cases in 2020

The ABC is reporting that Ross River fever cases were at record-high levels last year in many NSW regions, as the state recorded almost 2,000 infections - only QLD fared worse, with just over 3,400 cases according to the National Notifiable Diseases Surveillance System. Councils in some badly affected northern districts of NSW have established an SMS-based program, Tackling Mosquitoes Together.

Advice for travellers

Cases of Ross River fever occur throughout Australia, including more temperate southern states. Travellers visiting areas of Australia affected by recent flooding or continuing rain should take measures to prevent mosquito bites. Use a personal effective insect effective ingredient such as DEET, Picaridin or oil of lemon eucalyptus (PMD) when outdoors and wear long, loose-fitting, light coloured clothing – especially at dawn and dusk, the times of day when Ross River virus-carrying insects are most active. More on RRV in NSW.

Highest Zika case count in region

The PAHO has published an update on Zika virus across the Americas in 2020, advising that Brazil reported just under 16,000 of the more than 17,400 suspected cases. Guatemala, Paraguay and Bolivia were the next highest, however each recorded fewer than 1,000 cases.

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 more information accessed through smartraveller (DFAT).  

Ebola returns after 4 years, DRC cases rise

On Feb 14 the WHO declared an outbreak of Ebola virus disease (EVD) - Zaire subtype - in the SE prefecture of N’Zerekore (Guinée forestière), after confirmation was received through samples taken from a deceased nurse in the rural community of Gouecké. The outbreak currently totals 17 cases with five deaths, plus there are 125 contacts from the immediate region as well as in the capital Conakry. This is the first outbreak in Guinea since the 2014-2016 West African epidemic that spread to neighbouring Sierra Leone and Liberia. The WHO is mobilising Ebola vaccine supplies for Guinea while also assisting authorities in North Kivu, DRC in launching a vaccination campaign for Butembo’s recent outbreak. The case count in that resurgence rose this week to four and more cases are anticipated in known patient contacts, some of whom attended an unsecured burial. The UN has placed six countries on ‘urgent alert’ in response to the two outbreaks. 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.

Dengue, typhoid, leptospirosis update

A Feb 13 Ministry of Health & Medical Services update on LTD (dengue, typhoid and leptospirosis) across the islands: more than 330 dengue cases have been recorded and northern districts risk a surge in infections after heavy rainfall, rates of leptospirosis are currently above the threshold (160 confirmed cases, five deaths) and the 53 typhoid fever cases, with one death and two people admitted to ICU, is ‘ below the expected level- except for some clusters in Wainikoro and Naduri medical areas in the North’.

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.

COVID-19 update, news

The Feb 16 WHO epi update announced a global week-on-week decline in new COVID-19 cases of 16 percent and a 10 percent reduction in deaths, however one region, the Eastern Mediterranean, did log a 7.5 percent increase in new cases - highest numbers were from Iran, the UAE and Lebanon. In the Feb 15 ECDC risk assessment update, the agency said that the B.1.1.7 is now the dominant strain circulating in Ireland ‘and, based on growth trajectories observed, several other countries are expecting a similar situation in the coming weeks. The variant B.1.351 has also been increasingly reported in EU/EEA countries … and the variant P.1 is so far being reported at lower levels’.

Just under 178 million vaccine doses had been administered in at least 86 countries/territories as of Feb 15, according to Our World in Data.

In other COVID-19 news:

-In the UK, 300 children aged from six to 17 years will get their first dose of the Oxford-AstraZeneca vaccine later this month in a new trial to determine the efficacy in a younger population. BBC News

-This week the WHO granted Emergency Use Listing (EUL) for two versions of the AstraZeneca/Oxford COVID-19 vaccine - AstraZeneca-SKBio (Republic of Korea) and the Serum Institute of India – which makes way for their distribution to low- and middle-income countries through COVAX.

HAN advisory over drug-resistant typhoid cases

The CDC is investigating nine cases of extensively-resistant (XDR) typhoid fever in US residents who had no history of travel (eight were from 2020). Surveillance of the strain was initiated in 2018 and since then, 71 cases have been recorded – 58 involved travel to Pakistan in the preceding 30 days. The HAN report also noted that an ‘unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq has been reported in the United States and the United Kingdom’. 

Advice for travellers

Typhoid fever is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.

Northern counties’ RVF situation

The WHO issued a Disease outbreak news post on human Rift Valley fever (RVF) cases in the northern counties of Isiolo and Mandera as cases rose to 32 (14 confirmed) and 11 deaths. A total of four counties are affected after RVF infections were detected in livestock in flood-affected and swampy areas of Isiolo, Mandera, Murang’a and Garissa counties. The agency notes that ‘there is an increased risk of disease spreading to other parts within Kenya and to neighbouring countries’ and specified a number of public health messages for risk reduction.

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.

Search for typhoid source

A food outlet at a Clemenceau Avenue shopping centre was closed by health authorities last week as investigations were mounted into the source of typhoid fever infections in two of its regular patrons. Both victims required hospitalisation after suffering from fever, headache, diarrhoea and cough. A public health alert has been issued for anyone who has reported symptoms after eating at the establishment between Jan 2 and Jan 18. Read more

Advice for travellers

Typhoid fever generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.

Dengue update, outbreak continues

Data released by the Ministry of Health, Wellness, and the Environment in late January show an 11 percent increase in dengue infections since October, with infants and children aged under 15 years bearing the brunt of the rise. The parishes of St. Georges, Charlotte and St. Andrews have reported the highest number of suspected dengue infections, however all health districts have been affected. 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 (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.