World travel health alerts 18 November 2020

Wallis and Futuna dengue update

A Nov 17 health bulletin reports another eight locally-acquired dengue fever cases (DENV-2) on Futuna, most of which were in Alo district, and an uptick in varicella infections that was first detected early last month.

Advice for travellers

Avoid mosquito bites to protect against 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.

15 more VDPV cases, global polio update

The 15 cVDPV2 cases recorded this week included two infections in Kabul (the remainder across six provinces) and in Pakistan there were no infections to report, however positive environmental samples were detected for both WPV and cVDPV2. And in Africa, Chad’s single cVDPV2 case was from Logone Oriental region (the risk of further virus spread across the Lake Chad subregion remains high), while Somalia reported three cVDPV2 cases (Banadir and Galbeed). South Sudan’s government has partnered with international agencies in a polio and measles vaccination drive for children across several states – five have reported VDPV cases recently. More on measles from a WHO release which expanded on the global burden of the disease – cases rose by 50 percent in the three years to 2019 when more than 207,000 lives were lost to the infection. The surge was attributed by the authors to ‘a failure to vaccinate children on time with two doses of measles-containing vaccines’; on a global level coverage with the second dose sits at only 71 percent. 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.

WA’s Ross River virus warning

The West Australian health department has warned locals as well as visitors to be extra careful in avoiding mosquito bites in view of a hike in Ross River virus (RRV) activity. The risk of Ross River fever infection is said to be greatest in ‘South West of WA, and along the coastal Midwest and Gascoyne regions, from Jurien Bay to Denham’. Australia-wide, RRF notifications for the year to date have been highest in NSW (3,293 cases) and Qld (1,922 cases), according to the National Notifiable Diseases Surveillance System (NNDSS).

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 RRV-carrying insects are most active. More on RRV in Western Australia

Regional diphtheria digest to Nov 11

The Nov 17 PAHO update on diphtheria includes the four recent cases in Peru, however the majority of the region’s 56 cases were in Haiti, where the disease is endemic (42 cases and 11 deaths). Also reporting cases were Brazil, the Dominican Republic and Venezuela. The update provided more information on the cases in Peru, noting they were from a family cluster and ‘belong to an indigenous community in the eastern part of the country, and for the past year, have resided in a densely populated district of the Lima City in Peru’.

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.

Outbreak end nears

In a Nov16 post showing two days to run till the anticipated end of Equateur’s Ebola outbreak, the government released some details of the plans for the 90-day surveillance period that it is currently finalising. During the outbreak that was declared on June 1, 130 Ebola cases were reported from 41 health areas, 55 people died and more than 40,000 doses of the rVSV-ZEBOV-GP vaccine were administered. 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.

Rabies death toll rises to 5

The source of infection in Sarawak’s latest fatal rabies case remains unknown after authorities were unable to link the man’s exposure to the virus to any of his pets. This was the state’s fifth fatal case this year which has prompted the Health director-general to remind residents to ‘seek immediate medical treatment if bitten’ and ensure all pets are vaccinated. 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.

RVF spread updated

A WHO update on the Rift Valley fever (RVF) outbreak in Tagant, Assaba and Adrar regions that was first advised in September reveals that the initial eight cases (and seven deaths) had risen to 75 with 25 fatalties by Nov 7. Cases have been recorded in 11 of the country’s 15 regions, however Tagant has just over half of all cases ‘with principal hotspot districts being Tidjikja and Moudjeria’. The WHO assessed the risk level to be high at a national level in view of the widespread nature of the infection among herd animals, but moderate for the region.

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.

COVID-19 cases top 1 million

Mexico is the latest country to pass 1 million COVID-19 cases, while across the globe, the WHO reported nearly 4 million cases for the ninth consecutive week of increases and a second week-on-week rise in deaths. New infections in Europe have slowed slightly ‘following the strengthening of public health and social measures across the region’, but in the Americas there was a ‘sharp upward trend’ in the past week. The USA’s 7-day average of daily new infections is rising, now at more than 150,000. Read more

In other news:

-South Africa is to open the country to all foreign visitors, subject to strict health protocols which include a valid certificate showing a negative PCR test ‘obtained not more than 72 hours before the date of travel’. While travellers from some designated ‘low risk’ countries were able to enter the country from the beginning of last month, the lifting of restrictions is now across the board.   

-Following the release of the US CDC’s framework for recommencing cruising that focuses on mitigating the risk of COVID-19 spread onboard, one company has received thousands of messages from people requesting a berth on the required test cruises that must be undertaken to ensure the new procedures are effective. Read more

- A summary of the two vaccines for which preliminary results from Phase 3 trials have shown 90+ percent efficacy – ‘Moderna, Pfizer Shots Look Strong. Here’s How They Stack Up’ Read more

2nd region to report WNV

Dutch health authorities have added another West Nile virus case to this year’s total (now six): a more recent infection which occurred during the cooler month of October and in a new region, Arnhem. Plans will soon be made on WNV preventive actions needed to be in place for the 2021 peak mosquito season. Read more

Advice for travellers

Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuroinvasive disease.  The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions during the peak transmission season should take measures to avoid mosquito bites. Read more on WNV.

Yellow fever now confirmed or suspected in 4 states; Lassa fever in 19 states this year

Suspected yellow fever infections have been reported in three new local government areas (LGAs) of Enugu state - testing of blood samples taken from the sick in Nsukka, Isi-Uzo, and Igbo-Etiti LGAs is being carried out in Abuja. A total of 222 suspected cases and 76 related deaths were recorded from Nov 1 to 11 from three states (Enugu, Delta and Bauchi), while in Enugu’s NE neighbouring state of Benue, a flare-up of yellow fever has been confirmed in Ogbadibo LGA after investigations into 20 recent deaths. Read more

A NCDC update on the Lassa fever outbreak declared in late January notes that almost three-quarters of cases were reported from just three states - Ondo (35%), Edo (32%) and Ebonyi (7%). An analysis of the 2020 Lassa fever situation undertaken by the IFRC found that when compared to 2019’s, it is ‘more alarming, fast and widespread’. 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.