World travel health alerts 17 June 2020

World travel health alerts for 17th of June 2020.

COVID-19 digest

In Beijing, more than 100 new cases have been reported in the latest virus flare-up. One local news source, which publishes real-time updates on the outbreak stemming from one of Beijing’s markets, said that school-based classes have now been suspended and travel restrictions imposed across designated risk areas of the city. Read more

Meanwhile, in India, the drain on health resources resulting from the annual monsoon season is being compounded by the waves of COVID-19 cases in cities such as Mumbai. The state of Maharashtra has recorded around one-third of the 343,000 confirmed coronavirus cases across the country to date.  

Taken from the June 12 Johns Hopkins newsletter, the Eastern Mediterranean region has five of the top 11 countries with the highest per capita daily incidence – ‘ Qatar (#1), Bahrain (#2), Oman (#4), Kuwait (#7), and Saudi Arabia (#11)’. However it’s the Americas that make up almost one half of all cases across the globe – 3.8 million of 8 million – ‘and the epidemic is still accelerating in the region’: PAHO Director, June 16.  

In the June 11 ECDC risk assessment, the agency noted that Sweden and Poland are the only two countries in the region where infections had not as yet peaked.

More detailed information on COVID-19 for other regions can be found in the WHO dashboards for the African and Western Pacific zones, plus the June 16 global WHO sitrep.  

A study by Imperial College, London suggests that the epidemic is still at a relatively early stage and the decline in cases in parts of the European, Asian and North America are ‘a result of lockdowns, behavioural shifts, social distancing and other interventions’.

In other news:

In the US, the FDA this week cancelled the Emergency Use Authorization of hydroxychloroquine (and chloroquine) as new evidence does not support their effective use in treating COVID-19.

Statnews: Major study finds common steroid reduces deaths among patients with severe Covid-19

As some countries start to open their borders to international travel, on June 14 the WHO’s director of emergencies, Dr Michael Ryan, said that in order to make travel as safe as possible, ‘in a few days a series of guidelines will be published in collaboration with the International Civil Aircraft Organization and the International Air Transport Association’. Read more

ReliefWeb has published a detailed list of Airport Restrictions Information for the Pacific region (updated June 15)

Cholera in 4 regions

Four regions continue to report cholera infections – coastal Littoral has had the highest numbers, followed by South Ouest, South and Centre. While Mozambique’s outbreak is now into its sixth month after logging more than 2,600 cases and 21 deaths. Active cases persist in several districts of the two provinces still affected: Nampula (Monapo and Nampula city) and Cabo Delgado (Mocimboa de Praia, Macomia, Ibo and Pemba city). 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.

Malaria, arbovirus update for the Americas

The June 10 PAHO report on ‘Malaria in the Americas in the context of COVID-19 pandemic’ ranks the NE town of Puerto Cabezas as ‘the principal focal point of malaria infection in Central America’. Nicaragua is one of eight countries reporting more malaria cases this year (also Haiti, Panama, Dominican Republic, Honduras, Costa Rica, and Suriname), however amid an overall regional reduction, some countries have seen infections increase only in selected regions i.e., Amazonas and Tumbes departments in Peru, three Brazilian states (Mato Grosso, Rondônia, and Roraima) and eight departments in Colombia. It is acknowledged that the COVID-19 pandemic will adversely impact the burden of malaria and resulting mortality through limiting access to health services and interruption of vector control and surveillance activities. On the same date, the PAHO also published a separate regional epidemiological update on dengue, chikungunya, and Zika viruses for the year to mid-May – Brazil reported highest case numbers for all three infections.

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.



NW Ebola outbreak ‘continues to evolve’

In new developments on Equateur’s Ebola outbreak, more cases (five confirmed EVD cases and five deaths) have emerged and two new health zones (Bolomba and Iboko) are also involved, bringing the current total to 17 cases and 11 deaths from five health zones. The WHO regional office expressed concern over the combined impact of several ongoing health crises, local resistance to response measures and the location of the outbreak’s epicentre - ‘Mbandaka is a large town with a population of 1.2 million people with air and river links to Kinshasa and Boende, and there has already been local spread to Bolomoba, which is 240 km away’. Meanwhile testing of suspected Ebola cases continues in the NE provinces with no positive results in the past week – June 25 is the end date of the 42-day countdown for the outbreak’s close (June 16 Sitrep). 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.

TBE food transmission confirmed in SE

Confirmation this week of food-borne transmission in the tick-borne encephalitis (TBE) infections reported in Auvergne-Rhone-Alpes department last month. To date there have been 28 confirmed and nine suspected cases suffering from TBE or ‘attenuated flu-like forms’ which relate to the consumption of (now-recalled) unpasteurised milk cheeses (goat and others). Read more

Advice for travellers

A viral infection, tick-borne encephalitis (TBE) can cause fever, vomiting, cramps and paralysis, which can be prolonged. In rare instances, infection can be fatal. Travellers who spend time in regions where TBE is endemic – mainly forested areas of Central and Eastern Europe, Russia, Northern China, and Mongolia – may be at risk. The highest risk is during the warmer months from April to November, especially when hiking or camping in areas below 1500m. While most infections are contracted through the bites of infected ticks, food-borne transmission through untreated dairy products is a known mode of transmission. Safe and effective vaccines are available in Europe, but none are licensed in Australia; however the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.

Imported rabies case fatality

A foreign national who became Japan’s first rabies case in 14 years has died in a central Honshu hospital. He arrived in the country in February and relatives had reported he had sustained a dog bite on the leg when in the Philippines late last 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.

Haemorrhagic fever case confirmed in western region

The health minister of the NW region of Castile and León has cautioned anyone planning a visit to local forests to avoid tick bites following the confirmation of a case of Crimean-Congo haemorrhagic fever (CCHF) in Salamanca. The man was said to be in a critical condition and several contacts are being monitored. The viral tick-borne infection was first identified in Spain 10 years ago in Extramadura, another western region bordering Portugal, but cases have been limited. Read more

Advice for travellers

CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

19 year-high in viral infections

The year’s tally of hantavirus cases has risen again, now at a near 20-year high, after the infection was confirmed in a Kaohsiung City restaurant worker who sustained a rat bite in mid-April. Kaohsiung and New Taipei City have between them recorded over two thirds of all hantavirus cases since 2001 (21 of 30 confirmed cases). 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 Taiwan CDC.