World travel health alerts 18 May 2022

Measles vax rates fall

National coverage for measles vaccination (first dose) fell from 100 percent to 88 percent in the years between 2018 and 2020 and now authorities report cases have more-than doubled in January/February this year compared to the same period in 2021. In other measles reports, at least 20 children have died from measles complications in Manicaland province, Zimbabwe and hundreds more have been infected. A mass vaccination campaign is planned for Mutasa District. On a regional level, the WHO has called for routine immunisation programmes to be restored after a 400 percent year-on-year increase in measles cases was registered in the African region and outbreaks were confirmed in 20 countries from Jan-March this year. In Afghanistan, while the number of new suspected measles cases declined in five regions, they increased in the remaining three - the West, Central West and East. Read more

Advice for travellers

A highly contagious virus, measles occurs in developing and developed countries. 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.

Dengue infections double

The number of suspected dengue fever cases reported in the first four months of this year is at least double those of the same period in 2021. Of the regions, the West-Central region fared the worst, while Goiânia ranks first among the most affected municipalities. Also in the Americas, health authorities in Honduras’ capital Tegucigalpa are racing to avert a dengue epidemic and have declared an alert for the city. At least 1,700 dengue cases have been recorded this year. 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.

‘Unexpected and rare’ typhoid cases

Five locally-acquired cases of typhoid fever reported in Ottawa reported between Oct 2018 and February this year are thought to result from spread in the community from imported infections. The transmission events are described as being ‘unexpected and rare’ as, in most years, only four imported typhoid cases are registered by the city’s public health department. Read more

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.

Gastro illnesses spike in western province

A period of drought followed by heavy rains earlier this month has put immense pressure on the water supply infrastructure in the western province of Pinar del Río, resulting in contamination of drinking water supplies. A spike in gastrointestinal illnesses in the district of Hermanos Cruz in the provincial capital is presumed to be due to E. coli after cholera was discounted. Read more

Polio update, new WPV1 case in Pakistan

A single case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was confirmed in the northern province of Nampula in the latest GPEI update, the second to be reported in the province this year. Also in Africa, the D R of Congo logged 11 cVDPV2cases (10 in Maniema province, one in Sud-Kivu), while a single case was recorded in Nigeria’s Bauchi state. And in Pakistan, the country’s third wild poliovirus type 1 (WPV1) case this year was announced in local media – in an unvaccinated child living in the same North Waziristan district of Khyber Pakhtunkhwa province as the previous two cases. 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.

No new Ebola cases detected

In the latest situation update on Equateur’s Ebola outbreak, May 17 was the 13^th consecutive day with no new cases - the last was confirmed on May 4. Vaccination of the 800+ contacts of the three fatal cases continues. 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.

COVID-19 update

The WHO Director-General’s opening remarks at the May 17 briefing included expressing concern over the risk COVID-19 presents for severe disease and death in North Korea and Eritrea as neither country has started public vaccination programs. Read more. On a global level, case numbers have increased in the American, Western Pacific and African regions, fuelled by Omicron sub-variants. Last week, the ECDC categorised BA.4 and BA.5 as Variants of Concern, with the agency noting that indications are that ‘that the presence of these variants could cause a significant increase in COVID-19 cases in the EU/EEA in the coming weeks and months’. In South Africa, tracking of the BA.4 and BA.5 sub-variants to May 13 showed they comprised ‘96% of May sequences, but more data is needed to determine prevalence’.

In related news:

- On global vaccination rates, Our World in Data reports that almost two-thirds of the world’s population has received at least one dose of a COVID-19 vaccine, however that figure for low-income countries is only 15.9 percent. Read more

- A May 13 ABC News article on Australia’s high rates of infection: ‘COVID-19 infections in Australia hit worldwide highs — and experts predict another Omicron variant spike is coming’.

Alert over respiratory illnesses

Health authorities report a rise in respiratory illnesses in people of all ages which has been greatest in children under five years of age (who have tested negative for both SARS-CoV-2 and influenza viruses). The same update revealed new leptospirosis cases continue above the outbreak threshold, with higher than expected seasonal rates in the Western and Northern Divisions. Dengue fever cases are at, or below, expected levels for the time of year, while typhoid fever infections are ‘at the average level expected at this time of the year for this endemic disease’; five new cases were reported in the update. Read more

National rise in syphilis rates

A recent ProMED post provided an in-depth situation national update on syphilis. Since 2014, the burden of syphilis has shifted from being most common among men (primarily men who have sex with men – MSM) to the heterosexual community. While the increase has been seen in all areas, high case numbers are being reported from Tokyo amid a rising trend. Read more

Advice for travellers

Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.

Dengue fever, HFMD case numbers increasing

A senior health official has warned of continuing outbreaks of hand, foot and mouth disease (HFMD) among young children, with nearly 900 events recorded over a recent week. Selangor, Kuala Lumpur and Putrajaya, Sabah, Perak and Kelantan reported highest case numbers. An update on dengue fever cases shows infections are trending upwards – rising by more than 50 percent in the second week of May. Read more

Advice for travellers

HFMD mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection. Read more about HFMD.

Rabies death in western state

A man from El Salto, a municipality SE of Guadalajara, has become Jalisco’s first rabies death in 13 years. According to news reports, he was bitten on the arm by a bat in January while in the nearby town of Chapala, but did not seek treatment until early April when he was symptomatic. In other rabies news, recent reports from the USA on animal (fox, dog, bats and skunk) and human exposure to the rabies virus in the states of South Carolina, Virginia, Missouri and Alabama. 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.

Two MERS cases, one fatal

Following advice from Qatari authorities, the WHO published a Disease Outbreak News post late last week relating to two MERS cases from late March/early April. The two men, one aged 50 years and the other 85yo, had confirmed high risk exposure to dromedary camels which included consuming raw camel milk in the two weeks before becoming ill. The older man, who had a number of co-morbidities, succumbed to the infection in mid-April. Also this week, the WHO announced a MERS case in Oman - a man whose family farm in the NW governate of Al Dhahira kept animals, including dromedaries. In all, more than 2,500 MERS infections and 894 deaths have been recorded across the globe since 2012 - the majority in the Arabian Peninsula. Read more

Cholera outbreaks amid heat waves

With no let-up in the circulation of cholera in Dera Bugti district, Balochistan province, local media report protests over delays in controlling an outbreak in Pirkoh tehsil. In related news, early season weather systems that produced heat waves in Pakistan and India have also impacted Bangladesh and Sri Lanka. The May 13 Johns Hopkins Global Now newsletter reported that April was ‘India’s hottest in 122 years and Pakistan’s hottest in 61 years’, resulting in dozens of deaths. Read more

Uptick in leishmaniasis cases

Above average numbers of cutaneous leishmaniasis cases have been recorded this year according to the health minister. The district of Cerro Azul was flagged as an area with high disease incidence due to its remoteness, while 31 cases were recorded in the Metropolitan region (from the townships of Las Garzas, Ancón, December 24, Las Mañanitas, San Francisco and Veracruz). Read more

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

7 monkeypox cases, local transmission involved

More monkeypox cases have been confirmed over the past week - none had a history of travel to an endemic country and no link was found to the travel-related case announced on May 7. The first two cases lived in the same London household, while the four most recent cases (three in London and one linked case in NE England) ‘self-identify as gay, bisexual or other men who have sex with men (MSM)’; common contacts have been found in two of the four. Urgent investigations continue, however a quote from the UKHSA’s Chief Medical Advisor in the May 16 update includes, “…evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact. We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay.’ The agency also advised that the infections were with the West African clade of the virus, a milder form than the Central African clade. 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.

Investigations continue into paediatric hepatitis

On May 13 the ECDC and WHO issued a joint surveillance bulletin on the 232 probable cases of hepatitis of unknown origin reported in the EU. An increase in cases was observed from early March (week 9) and most patients were aged under five years. In the UK, the last update published on May 12 stated that case numbers had risen to 176 - investigations continue into the cause. Read more