World travel health alerts for 19th of February 2020.
Another polio case on Luzon, weekly polio digest
The country’s 17th polio case was announced last week by the Dept. of Health – a 1-year old boy from Cabanatuan City, 110 kms north of Metro Manila. He was diagnosed with cVDPV2 infection after undergoing testing during routine acute flaccid paralysis surveillance. In the region of Central Visayas, authorities in Mandaue City have prohibited residents from using the local waterways after the detection of poliovirus in some samples. The Butuanon, Mahiga, and Tipolo Rivers all run through the city that sits to the north of Cebu City and is considered part of Metro Cebu. Read more. In other polio news, Pakistan has now recorded 12 WPV1 cases this year with the addition of a further five (three from Sindh province and two from Khyber Pakhtunkhwa province) listed in this week’s GPEI report. While in the African region, cVDPV2 cases were reported in Angola (one each from Bié, Huambo and Namibe provinces), Nigeria (one from Anambra province), DRC (two from Kwilu and Sankuru provinces) and seven cases in Ethiopia (Oromiya province and the SNNPR).
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.
COVID-19 digest: reports, articles
On Feb 15th, the WHO reported a COVID-19 case in Egypt, the first for Africa, taking the number of countries outside China with confirmed cases to 25 (and 14 with transmission occurring outside China). A day prior (Feb 14), the agency announced that 1,716 Chinese healthcare workers had been infected with the novel coronavirus, resulting in six deaths. The Feb 19 National Health Commission (NHC) update reported the total number of confirmed cases had risen to 74,185 and there had been 2,004 deaths from 31 provincial-level regions (Hubei accounted for over 61,000 of the cases and 1,921 deaths). The large increase in cases seen in the WHO Sitrep on Monday this week reflected a change in reporting to include all confirmed cases and those that are clinically diagnosed.
A number of countries have introduced enhanced screening procedures and travel restrictions that apply to arrivals from some SE Asian countries – information is listed by destination on the Smartraveller website.
Thailand’s daily update of Feb 17 noted that ‘The Ministry has added to its definition of a Person Under Investigation (PUI) for COVID-19 infection, by including anybody who presents with fever and symptoms and with travel history to Japan and Singapore (in addition to mainland China, Hong Kong SAR, Macau SAR and Taipei and environs) within 14 days prior to the onset of illness.’
In Japan, the birthday celebrations for Japan’s Emperor Naruhito, and some local and regional sporting events have been cancelled due to concerns that the public gatherings could lead to spread of the novel coronavirus.
A range of recent journal and other articles/resources on COVID-19:
COVID-19: what is next for public health? Read article here.
Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. Read article here.
Coronavirus up to 20 times more likely than Sars to bind to human cells, study suggests. Read more
Lastly, the WHO updates the Database of publications on coronavirus disease (COVID-2019) on a daily basis, and its Technical Guidance webpage provides information on the the management of mass gatherings, for ill travellers via air, ground and sea as well as public health preparedness and response for aviation and maritime companies.
Ebola cases dip amid ‘cautious optimisim’; Cholera hits hard in lake communities, monkeypox in 4 provinces
Cautious optimism for the NE's Ebola virus outbreak was signalled in the Feb 16 WHO regional bulletin after a single case and no new deaths were reported over the past week. More details in the CMRE newsletter dated 17 Feb and this week’s WHO Ebola SitRep. Also in news from the WHO last week, Ervebo, the Ebola vaccine, is now licensed in Burundi, Zambia and Ghana, as well as the DRC.
CHOLERA continues to impact as many as 14 provinces with areas surrounding Lakes Kivu and Tanganyika in the east bearing the brunt - North Kivu, South Kivu, Haut-Katanga and Tanganyika have been the hotspots this year. From the same source, the Feb 16 regional WHO bulletin, new suspected monkeypox cases escalated from the second week of 2020 - almost three-quarters of the 222 cases recorded to the end of January were from the provinces of Sankuru, Bas-Uele, Equateur and Mai-Ndombe.
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.
Arboviral uptick in region
There was an uptick in new dengue fever cases over January affecting Guadeloupe, Saint Martin, Saint Barthélemy and Martinique with reports of three different serotypes circulating in the region, according to an ECDC report. Epidemics have been declared in Guadeloupe (DENV-2 predominant) and Saint Martin (DENV-1), while ‘Saint Barthélemy remains in an inter-epidemic phase and Martinique [DENV-3] is at risk of an epidemic’. Read more. And in the Indian Ocean, the island of Reunion’s dengue outbreak is well into its second year. Another 353 cases have been reported since the beginning of the year and weekly rates are climbing. The south continues to have most cases, with many of those living in the SW commune of Saint-Louis (also active transmission in Saint-Paul, Saint-André, Etang-Salé and L’Entre-Deux). Last year, more than 18,000 dengue cases were confirmed on Reunion.
Advice for travellers
Dengue is spread by Aedes mosquitoes which breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid. 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 PMD when outdoors to all exposed skin. Read more about dengue fever.
Typhoid in NE commune
Rainwater collected by residents in home-made ponds is believed to be the source of contaminated drinking water that caused an outbreak of typhoid fever, and also provided mosquito breeding sites leading to a surge in malaria cases in the NE commune of Mont-Organisé, near the Dominican Republic border. 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.
Measles lingers on Praslin, more measles news
Over the two weeks from Jan 28, measles cases increased from 34 to almost 80 (both confirmed and suspected cases) and were seen in all age groups from the islands of Praslin and Mahé. Read more. In our region, in the reporting week to Feb 12, Tonga registered three more measles cases, all from the island of Tongatapu. And encouraging measles stats in New Zealand after it registered the second week without cases since the outbreak began in March last year. For this public health event to be closed, two 28-day incubation periods must lapse without new cases.
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.
Dengue surge triggers emergency
A health emergency has been declared to manage the country’s largest dengue fever outbreak in several years. Figures released last week showed there had been 3,500 confirmed cases - including the president and his wife - and a further 57,000 suspected infections (plus 16 confirmed deaths and 87 more under investigation). Read more. Elsewhere, more on the dengue situation in Peru as reported on last week (Loreto, Madre de Dios, San Martín provinces) with a health alert also issued for the Cusco region and the provinces of La Convención and Quispicanchi. Dengue fever cases have been increasing and were also detected in the town of Quincemil, located on the Interoceanic Highway that runs between San Juan de Marcona in Peru and Rio de Janeiro, Brazil.
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.
Widespread dengue clusters
Dengue cases continue to run at a 3-year high with 300-400 recorded each week this year, totalling more than 2,650 to Feb 18. Dengue serotype 3 hasn’t circulated in Singapore for several decades but last month, it was the cause of more cases than DENV-2 (more common since 2016), however, according to the NEA, ‘it is still too early to deem that a switch in the predominant dengue virus serotype has occurred’. Of the current active clusters, 21 are high risk areas with 10 or more cases. 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.
NE mumps cases
Mumps has sickened over 100 people in the Catalan regions of Gironès and Pla de l'Estany that lie between Barcelona and the French border. According to a local news report, most of those infected have been aged from 16 to 30 years. Read more
Advice for travellers
These outbreaks of mumps highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to all destinations. Read more about mumps.