World travel health alerts 17 November 2021

Increase in Vibrio food-borne illness

Health authorities in South Australia have issued an alert relating to a rise in gastrointestinal illness due to a naturally-occurring bacterium in coastal waters, Vibrio parahaemolyticus. Media outlets have reported on 36 cases in South Australia (and several in both Western Australia and Victoria), some of whom had eaten raw or partially cooked oysters. Last year, SA recorded zero V. parahaemolyticus cases. Advice from SA Health: ‘Raw unshucked oysters should be stored at less than 10°C and shucked oysters at less than 5°C to minimise the risk of _Vibrio parahaemolyticus_ infection’. Additionally, the elderly and pregnant or immunocompromised people should ‘refrain from eating raw or undercooked seafood’. Read more

Cholera cases surpass 100,000

The cholera outbreak peaked over three months ago and the NCDC is now reporting around 80 new suspected cases per week instead of the 7,500 seen in July. The outbreak total has now exceeded 100,000 cases, with four northern states recording just over half of all infections – Bauchi, Jigawa, Kano and Zamfara. In neighbouring Cameroon, cholera infections reported in and around the SW district of Bamusso have authorities on alert, with the area affected by ‘insecurity and humanitarian crisis’. And a cholera outbreak recently declared in Togo has implications for Benin as the site in the Lacs health district boasts a large market frequented by border communities.  

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travel, the risk of infection is low. Travellers 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.

COVID-19 update

Europe and the Americas have reported surges in new COVID-19 cases, both up eight percent on last week’s numbers. In the former, the Nov 16 WHO epi update noted that just over 45 percent of countries ‘which were widely distributed across the Region reported increases of over 10% in new cases in the past week, including Germany’, while in the latter, the USA and Brazil recorded the largest rises. Fifteen of the 49 countries in the African region saw new cases go up by more than 10 percent over the week, however a recent study conducted by the WHO estimated that as few as one in every seven infections were being detected. Read more

In related news:

- A study carried out by the UK Health Security Agency (UKHSA) has found that following a booster dose of the Pfizer vaccine, Comirnaty, at least six months after a primary course of either the same vaccine or AZ’s Vaxzevria, ‘protection against symptomatic infection in adults aged 50 years and over was 93.1% in those with AstraZeneca as their primary course and 94.0% for Pfizer-BioNTech’. Read more in the GOV.UK press release.

- Also in the UK, November 22 marks the day when WHO Emergency Use listed vaccines will all be recognised in arriving travellers. There are also changes relating to the under 18s arriving in England – see more here.

- STAT News writes on ‘8 lingering questions about the new Covid pills from Merck and Pfizer’.

Confirmed polio case in Transcarpathia, global digest

A second, unlinked, case of cVDPV1 has been reported in the Ukraine, in an unvaccinated girl from the region of Transcarpathia; further investigations did not uncover any more cases among her contacts. The Ukraine is one of three countries in the region (also Romania and Bosnia and Herzegovina) ‘at high risk of a sustained polio outbreak following importation of WPV or emergence of circulating VDPV, due primarily to suboptimal population immunity’. Read more. In Africa, cVDPV2 cases were logged in six countries over the past fortnight, as advised by the GPEI: Nigeria (eight cases, five states), Niger (five from Diffa, Agadez and Zinder regions) and a single case each in Cameroon (its first in 2021, from Far North region), Côte d’Ivoire (Marahoue) and the D R of Congo (Maniema province). In other news, concern over Namibia's high risk for the introduction of vaccine-derived polio has prompted local health authorities to intensify surveillance for acute flaccid paralysis. Priority has been given to areas with ‘a high number of un and under vaccinated children along the Namibian- Angolan and Namibia-Zambia border … and other health districts that are considered high risk such as Windhoek, Okahandja, Otjiwarongo, Tsumeb, Oshakati and Onandjokwe districts’.

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.

5 provinces on alert over Salmonellosis

The source of a salmonella outbreak that has sickened 46 people across five provinces remains under investigation. According to the PHAC, residents of British Columbia, Alberta, Saskatchewan and Manitoba have been advised on safe food handling practices in order to avoid more infections while the source of contamination is identified. Read more

Advice for travellers

Salmonella is a bacterium typically found in food, such as poultry, that causes diarrhoea, fever, and abdominal cramps between 12 and 72 hours after infection. Illness usually lasts 4 to 7 days, and most people recover without treatment, although diarrhoea may be so severe as to require hospital treatment. Young children and the elderly are at highest risk of severe illness. As there is no vaccine to prevent salmonellosis, it is best to avoid raw or undercooked eggs, poultry, or meat. Read more

Dengue warning issued

More than 50 municipalities have reported dengue outbreaks, prompting authorities to declare an epidemiological alert in areas that include the districts of Barranquilla, Buenaventura, Santa Marta and Cartagena. Read more. And in Cuba, health services are responding to a build-up in dengue activity since September, with Camagüey, La Habana, Ciego de Ávila, Santiago de Cuba and Holguín reporting many of the cases.  

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.

Ebola case numbers stable; Monkeypox suspected in southern province

There have been no more new Ebola virus disease cases since Oct 30 in the outbreak site near Beni in North Kivu province. The latest WHO update  expressed concern over the risk of further spread from ‘inadequate EVD surveillance in communities’.

AN OUTBREAK of suspected monkeypox infections in Kimbombo district of Maniema province is said to have killed 10 people over a 2-week period, while actual case numbers has not been disclosed. Nationwide to the end of Oct in 2021, the WHO regional bulletin reports there have been 2780 cases of monkeypox, with 72 deaths. Read more

Advice for travellers

Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox.

Declining routine vaccine coverage

The PAHO reports a steady decline in diphtheria vaccination coverage across the region since 2010, with rates for the third DTP vaccine dose falling from 94 to 84 percent during that time. The latest update on diphtheria in the Americas reveals that Haiti and the Dominican Republic have confirmed 18 cases this year – 12 of the cases were fatal in the Dominican Republic and three in Haiti. 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. Read more on diphtheria.

Hazards emerge after storms

The damaging storms which hit the Red Sea and Aswan governates recently cut power supplies and caused extensive flooding, and also stirred scorpions from their nests and into residences in some cases, resulting in more than 500 people being stung and three deaths. Read more

More suspected YF cases in Savannah region

Enhanced surveillance in West Gonja Municipality and the North Gonja District has uncovered more suspected yellow fever cases and local news sources are saying that by Nov 12 ‘the death toll had increased to 16 with others in critical condition’. YF vaccinations have been carried out in the two affected areas. Read more

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.

Zika update in UP; Dengue surge in 9 northern states

Since the first Zika virus cases were detected in Uttar Pradesh’s Kanpur district late last month, infections have now spread to Kannauj, Unnao and the state capital, Lucknow. The current case total sits at 123, although they are not all still active infections. This is the state’s first Zika outbreak. Read more

DENGUE response teams have been sent to nine northern states which have experienced sharp rises in infections which make up the majority of reports nationwide. Rainfall in the affected areas, which include Uttar Pradesh, Punjab and Delhi has been higher than average. Read more

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 information accessed through smartraveller (DFAT).  

Medium flu intensity reported

Global flu detections have remained low overall, however medium intensity activity was reported in Uzbekistan according to the ECDC. In other regions, the latest WHO global influenza update stated that South Asia’s season has been similar to previous years, with India, the Maldives and Nepal recording mostly influenza B/Victoria lineage recently. The update noted that ‘Globally, among influenza detections, influenza B viruses predominated’.

Advice for travellers

In most years, seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Whether you are travelling within Australia or overseas, vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol-based hand sanitiser is a convenient alternative if soap and water is not available.

Border province targeting malaria hotspots

The Limpopo districts of Vhembe and Mopani are the focus of malaria testing and awareness campaigns to stem the elevated rates of infection (Waterberg, Capricorn and Sekhukhune Districts are also of concern to authorities). Zero malaria is the goal, however this year Limpopo province has recorded more than 400 malaria cases, two of which were fatal. And in Namibia, residual insecticide spraying has commenced ahead of the rainy (peak malaria) season in December in the most affected regions of Kavango East, Kavango West, Ohangwena and Zambezi.  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.

Varicella in NW city

Local media have reported on an outbreak of chickenpox in the city of Arua which has drawn the assistance of the WHO. The first case was detected in Ayiforo cell in Ayivu division three weeks previously and infections then spread to Dadamu and Tanganyika cells within the same division. Arua is located in the country’s NW, close to the border with the D R of Congo. Read more

Advice for travellers

Chickenpox (varicella) is a highly contagious disease caused by the varicella-zoster virus. Mainly passed from person to person by coughing or sneezing, it causes a blister-like rash, itching, tiredness, and fever. While the illness is generally mild in children, it can be more severe in young babies, adults, and people with weakened immune systems. Read more about chickenpox.

Rare human rabies death in NW state; Hep B vaccination recommendation

Earlier this month, health authorities in Idaho announced the first human rabies death in the state since 1978. A man from the county of Boise reportedly had contact with a bat at his property in August but did not think he’d been injured and so didn’t seek post-exposure treatment. Onset of rabies symptoms occurred in October and he subsequently died. Read more

THE ADVISORY Committee on Immunization Practices (ACIP) has recommended hepatitis B vaccination for all US adults under 60 years of age to counter the slow progress towards achieving the elimination of viral hepatitis by 2030. CDC surveillance data show that cases increased among adults aged 40 to 49 years in 2017, driven by ‘injection drug use and having multiple sex partners, combined with lack of protection by vaccination’. The ACIP move to recommend Hep B vaccination to a wider group of US adults must be signed off by the director of the CDC. 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.