World travel health alerts 18 September 2019

World travel health alerts for 18th of September 2019.

Total of VDPV cases now 6, other polio reports

Two cVDPV2 cases have been reported from Ombella-M'Poko prefecture (Mbaiki and Bimbo districts), SW of the capital Bangui, taking the country’s YTD total to six. The D.R. of Congo has also reported another cVDPV2 case in Haut Lomami province, one of nine current outbreaks. Afghanistan registered one WPV1 case, however in Pakistan there was news of another four WPV1 cases and 28 positive environmental samples. According to the GPEI, ‘So far 2019 has had much higher WPV1 activity than last year, with 78 cases to date, compared with 2018's total of 33 cases’.

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.

XDR typhoid import; Flu notifications decline overall

A letter published this month in the Medical Journal of Australia describes the country’s first case of XDR typhoid. The infection was diagnosed earlier this year in a 20mo child who returned to Sydney following a 3-month trip to Karachi, Pakistan. It was also stated that ‘This case was one of 12 travel‐associated, culture‐positive enteric fever cases managed at our hospital in the first 3 months of 2019. This continues a trend toward a higher incidence of enteric fever, as previously reported at our hospital from 2003 to 2015’. Read more in the Medical Journal of Australia.

FLU notifications to Sept 8 continued to slow following ‘an apparent peak’ in July, according to the Australian Influenza Surveillance Report (AISR). The latest WHO Influenza Update (with data to Sept 1) notes that flu activity in New Zealand was ‘below seasonal baseline threshold’ while Chile has recorded a second wave of influenza (mostly B viruses). Small increases in activity were seen in El Salvador, Honduras, Nicaragua and Senegal, while ‘influenza A(H1N1)pdm09 and B viruses continued to be reported in Myanmar and Thailand. The report advised also that Bhutan’s influenza percent positivity stayed above the alert threshold.

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.

West Nile virus, measles updates

Weekly reporting by the ECDC on West Nile virus infections in the EU and neighbouring countries registered cases in Greece, Italy, Romania, Hungary, Austria, Cyprus, Serbia, North Macedonia and, for the first time, in Slovakia. The Communicable Disease Threats Report also contains information on measles both in the region and globally.

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 reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Read more on WNV.

Dengue in half of districts, regional update

Three of the country’s six districts (Orange Walk, Stann Creek and Cayo) have borne the brunt of the dengue fever outbreak that is currently expanding across the region. With wet weather set to continue, authorities are warning the public of the risk fearing many more cases than the 3,115 already recorded. Other Central American countries with current high rates of dengue are El Salvador, Honduras, and Nicaragua while in South America, Brazil is the hot spot. The risk of severe dengue is heightened in Brazil, Guatemala and Mexico with co-circulation of the four dengue serotypes. Other countries with multiple serotypes circulating are Colombia, Guadeloupe, Martinique, Panama, and Venezuela (DENV 1, DENV 2, DENV 3) and in Paraguay and Peru (DENV 1, DENV 2, DENV 4). The latest PAHO Epidemiological Update for dengue notes that the region’s final 2019 total ‘will likely exceed the total reported in the epidemic year of 2015’. More on Mexico’s dengue fever rates. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. Both bite mainly during the daylight hours, making them difficult to avoid outdoors. Travellers should cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active. Apply repellent containing an active ingredient, such as DEET, Picaridin, or oil of lemon eucalyptus (PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Fast-growing measles outbreak; Ebola update

The measles outbreak which has spread across all 26 provinces and described by the WHO as ‘one of the world’s largest and fastest-growing measles outbreak this year’ is having the greatest toll on children under 5 years of age who make up over three-quarters of cases. A second spike in the rate of suspected infections occurred late in August, taking the YTD total to a staggering 179,477 cases and 3,559 deaths. Four provinces have had almost half of all cases - Kwilu, Kasai, Kasai Central and Kinshasa.

THE WEEKLY WHO situation report on the Ebola virus disease outbreak in the three NE provinces notes that most of the 149 cases in the previous 21 days came from ‘Mambasa, Kalunguta, Mandima and Beni. Fourteen health zones that have previously reported cases of EVD since the beginning of the outbreak have not reported a case in more than 21 days.’ Read more

Advice for travellers

Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. 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. Read more about measles.

Fever outbreak ramps up, regional dengue news

The dengue fever outbreak continues with heightened intensity – a further 254 cases of DENV-2 were recorded in the two weeks from Aug 25 with Tahiti, Bora-Bora, Moorea, Nuku Hiva and Raiatea in epidemic phase and a further nine islands on alert. Dengue type 1 is also circulating, although to a lesser extent (277 cases since early Feb cf. 834 of type 2). Elsewhere in the region, the Pacific Syndromic Surveillance System Weekly Bulletin reports ‘the first locally acquired dengue case detected and reported on Guam in the last 75 years’ and updates on the outbreaks in Palau and the Marshall Islands. Read more

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.

Next in line for malaria vaccine

Ghana, Malawi, and now Kenya are phasing in the malaria vaccine, RTS,S. It is planned to be given to thousands of children every year in areas of the country reporting high levels of malaria transmission (including the SW counties of Homabay, Kisumu, Migori, Siaya and Busia). The WHO announced that three doses will be administered between 6 months and 9 months of age, and the fourth dose at the age of 2 years. Read more

JE, malaria, dengue digest

Assam’s death toll from Japanese encephalitis infections has reached a 5-year high but the outbreak is now on the wane. Most fatalities occurred in lower Assam. A vaccination campaign targeting adults in the state is planned to run from November to March. Intensive testing of fever patients in the city of Barielly, Uttar Pradesh, have seen the number of Plasmodium falciparum malaria cases diagnosed over a 20-day period rise to 3,500. Overall, the incidence of P. vivax is around five times higher in the area. Authorities in Delhi have started to see a rise in malaria and dengue fever cases, while dengue reporting in Bhopal (Madhya Pradesh) this season tops the notifications for the last 10 years. Read more

Advice for travellers

A mosquito-borne virus, JE is usually found in many part of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

Resistant bacterial infection in Tuscany

In Tuscany the number of people infected with New Delhi metallo-beta-lactamase (NDM)-producing carbapenem-resistant Enterobacteriaceae (CRE) since November continues to mount. There has been substantial spread in NW regions of the province, including Pisa, and cases have now been detected in 17 hospitals. An ECDC Rapid Risk Assessment published in early June stated that ‘Outbreaks such as the one in Tuscany present a risk for cross-border transmission and further spread to other EU/EEA countries, especially since the affected area is a major tourist destination’. Read more

Lassa fever spreads to non-endemic regions

From the Sept 15 WHO African region weekly bulletin: the traditional Lassa fever belt appears to be expanding with confirmed autochthonous cases reported from the SE, previously not part of the endemic region. This year the counties of Bong, Nimba, Grand Bassa and Grand Kru have all had confirmed cases. Peak season for lassa fever starts with the dry weather in November. Read more

Advice for travellers

Lassa fever is an acute viral illness that occurs in West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5,000 deaths occur each year. However, Lassa is a remote risk for travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Read more about Lassa fever.

Dengue in 56 districts, BYO repellent

An update on the dengue fever outbreak which continues to expand across the country, now in 56 of 77 districts. As dengue hasn’t been a major public health issue in Kathmandu Valley (unlike lowland areas), residents are unfamiliar with the need to avoid mosquito bites, further exacerbating the outbreak. Also, local sources advise that DEET products are not available and there has been a run on other types of insect repellent; tourists and trekkers are advised to take their own supplies. Autumn is a popular time of year for trekking in Nepal. 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.

Update on YF in Bauchi state

The NCDC has issued a Situation Report with more details on the recent yellow fever cases in Bauchi: Four other states (Borno, Kano, Gombe, Katsina) have registered YF cases with epidemiological links to Alkaleri Local Government Area and overall, as of Sept 11, there had been a total of 169 suspected cases and 23 deaths

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, dengue reports; ‘Unhealthy’ air from smoke haze

Three locally-acquired Zika virus disease cases were detected in the first two weeks of this month – 2019’s first cluster. While they take the YTD total to 10, there may be, or have been, asymptomatic cases which were not reported. The cluster occurred in one of the locations reporting dengue fever infections – both are transmitted by Aedes mosquitoes. Read more. The NEA continues to monitor the dengue fever outbreak, now totalling 11,809 cases and 15 deaths in 2019 – the highest death toll in 12 years. The active clusters currently concerning authorities are in Choa Chu Kang, Ang Mo Kio, Jalan Eunos, Flora Dr and Commonwealth Ave. Read more

ILLEGALLY lit forest fires burning across Sumatra and Borneo in Indonesia are producing hazardous smoke haze that has drifted to Singapore and Malaysia. Air quality index rating for parts of both Singapore and Kuala Lumpur have been shown to be in the ‘unhealthy’ range at times, while in other areas it has become ‘very unhealthy’.

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 on smartraveller (DFAT).  

Cholera in 2 eastern states

Cholera, first confirmed in Blue Nile state has now also been detected in Sennar, to its north. The risk of more cholera and other diarrhoeal diseases occurring remains following recent floods in many parts of the country. 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.

Chikungunya count rises

More locally-acquired cases of chikungunya have been reported from New Taipei City. The three cases all have links to Zhonghe District, the site of a recent cluster of cases. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.

Locally-acquired dengue in Florida

Four apparently unrelated dengue fever cases have now been recorded in Florida’s Miami-Dade County - the local health department ‘is under a mosquito-borne illness alert’. And in Miami-Dade’s northerly neighbour, Broward County, one dengue fever infection has been detected in a southern district. Read more

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.