World travel health alerts 19 June 2019

World travel health alerts for 19th of June 2019.

Flu updates following season’s early start

As previously posted, high influenza rates hit most states and territories over the summer this year and, according to the latest WHO global influenza update, New Zealand, Chile and South Africa also had an early start to their flu seasons. The update advised that the most frequently detected virus in Australia has been influenza A(H3N2), followed by influenza B, while in New Zealand, both influenza A(H3N2) and B (Victoria-lineage) viruses were ‘detected in similar proportions’. Influenza A(H3N2) viruses predominate in South Africa, while Chile has seen more infections due to influenza A(H1N1)pdm09 viruses. Read more

Advice for travellers

The 2019 flu season has arrived in the southern hemisphere and Travelvax Australia recommends vaccination for all travellers over 6 months. Seasonal flu is the most common vaccine-preventable travel-related illness, posing a risk aboard aircraft, in crowded airport terminals, and at your destination. 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. Hand sanitiser is a convenient alternative if soap and water is not available. Read more on seasonal influenza.

Ongoing, new measles outbreaks

The ECDC’s latest report highlights nine countries across the region with current measles outbreaks: Romania, France, Poland, Bulgaria, Italy, Lithuania, the Czech Republic, Slovakia and Spain. Epidemiological summaries for EU/EEA countries are available in the ECDC Communicable Disease Threats Report Week 24 (along with other relevant data for non-EU/EEA countries). Late last week, the Governor of New York signed into law an end to non-medical vaccination exemptions for the state’s schoolchildren as health authorities attempt to stem new measles cases. The US CDC reported a further 22 cases to June 13 with 28 states reporting cases this year. In New Zealand, of the 215 cases recorded to June 14, 115 (now 117) have been in Auckland. As many as 112 measles infections and 15 related deaths have been reported recently among Malaysia’s Orang Asli people of Gua Musang (Kampung Kuala Koh) – their immunisation coverage for the second MMR vaccine is believed to be only 30 percent. The WHO regional weekly bulletin for Africa outlines the current situation in the DRC (the peak in measles cases occurred in early May however, even in the most recent reporting week, the burden of infections remains high with 3,439 suspected cases and 52 measles-associated deaths), Cameroon (outbreaks in twenty-four districts) and Chad (Am Timan, N’Djamena East, N’Djamena South, Bongor, Bousso and N’Djamena Centre districts all exceeding 1 000 suspected cases)

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.

YF certificate changes proposed

The East African Community Secretariat is considering re-introducing a policy which would require East Africans to show proof of yellow fever vaccination when crossing into Kenya, Tanzania, Uganda, Rwanda, Burundi or Sudan, or be denied entry. This measure is partly due to ‘the recent increase in outbreaks in the region’; two yellow fever infections were reported from separate districts in Uganda (Koboko and Masaka) in early May. The policy would dictate that the vaccination certificate must show the date of validity to be at least 10 days before travel. According to the news article, ‘Travellers with an exemption certificate due to medical reasons will be allowed entry, but will be placed under quarantine and/or will be required to report any fever or other symptoms to health authorities.’ 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.

Local, regional dengue update

National dengue fever data for 2019 (57,975 cases and 88 deaths) split into regions reveal the extent of the outbreak in the state of Selangor (33,215 cases), followed by Kuala Lumpur (5,790), Johor (4,758), Pulau Pinang (2,924) and Sabah (2,470). In Sarawak, authorities announced a three-fold increase in dengue reporting for the year to June compared to the same period in 2018 – of the 807 cases, more than 260 were in the state capital, Kuching. While in the Philippines, dengue cases have doubled in Eastern Visayas region which takes in the islands of Samar, Leyte and Biliran. Punitive measures could be used against residents in Thailand who do not keep their immediate environment clear of mosquito larvae after authorities declared a dengue fever outbreak. To June 11 this year there had been 28,785 cases and 43 deaths. And in Myanmar, Yangon’s dengue fever cases have risen to 630, however serious infections have also increased leading to eight deaths. With the current peak season now in progress, warnings have been issued in high-risk dengue endemic states – Yangon, Mandalay and Taninthayi. Cambodia’s wet season is also in full swing and this year had already proved more severe for dengue fever compared to last year. According to the dengue control programme manager, six provinces (Kandal, Siem Reap, Battambang, Kampong Speu, Kampong Thom and Preah Sihanouk) as well as the capital, Phnom Penh, are reporting dengue infections. Kaohsiung, a large port city in Taiwan’s south, is the site of 21 locally-acquired dengue fever cases of which 20 are part of a cluster. The most recent case, a woman from Sanmin District, is reported to be infected with DENV-4 serotype whereas most indigenous dengue in Taiwan is caused by types 1 or 2. Singapore’s NEA is reporting ‘the number of weekly reported dengue cases have more than quadrupled in the past 3 months’ and ‘active dengue clusters have also more than doubled in the past month’ as the YTD case total climbed past 5,300 on June 18. Thirty-three clusters are considered high risk, producing 10 or more cases. Ten of the 16 states in Palau have reported dengue

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 outbreak not a PHEIC

No declaration of a Public Health Emergency of International Concern (PHEIC) was the upshot of the WHO Emergency Committee meeting on June 14 regarding the Ebola virus disease (EVD) outbreak in the NE, but the situation remains concerning, particularly in view of the recent spread to the western region of Uganda. It was found that all ‘three criteria for a PHEIC under the IHR’ were not met at the time. Current information on the outbreak from the Ministry of Health shows there have now been 2,187 confirmed or suspected EVD cases and 1,459 deaths. The Ugandan government announced yesterday that two members of the extended family that had travelled from the DRC seeking treatment had succumbed to Ebola and those remaining had been repatriated, including a young boy who has since died of the infection. Two new suspect cases are under isolation at Bwera Ebola Treatment Unit in Kasese District; test results are pending.

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.

Chickenpox spikes in eastern departments

Eleven regions, comprising almost half the country, are reporting moderate to high levels of chickenpox (varicella) infections with eastern departments among those most affected: Pays de la Loire, Ile-de-France, Grand Est, Hauts-de-France and Occitanie. Among the departments with moderate levels of activity are ProvenceAlpes-Côte d'Azur, Normandy and Corsica. Read more

Advice for travellers

Chickenpox 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.

West Nile warnings for tourists

Following an unusually high number of West Nile infections recorded in 2018, advice to UK residents travelling to Greece during the warmer months now includes the need to take precautions against insect bites. Similar warnings appear on the Australian government’s smartraveller website. 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 reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Read more on WNV.

100+ deaths in Bihar children under investigation; Monsoon season dengue, chikungunya count begins

More than 100 children from Muzaffarpur in the NE state of Bihar have died from what is described as acute encephalitis syndrome (AES). ProMED provides comments on some of the recently proposed aetiologies (including Reye syndrome-like disease, enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus). Read more

THE south-west monsoon may have crossed the coast, making progress over the rest of the country but pre-monsoon rains have been enough to kick-start dengue notifications in Mumbai (Maharashtra) and Bengaluru (Karnataka).  

Advice for travellers

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. 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.

Rubella update

According to Japan’s National Institute of Infectious Diseases (NIID), rubella cases reported this year have climbed to 1,718 (to week 23) with a sharp increase for the previous month recorded in the week 22 report - an additional 300 cases confirmed. Highest rates have been in the prefectures of Tokyo, Kanagawa, Gunma and Saitama. Since December and for a 3-year period, the government is providing free rubella vaccines to men aged 36 to 59 who missed out on earlier public vaccination campaigns. Read more 

Advice for travellers

Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine. Highly contagious, rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Travellers should also check their immunisation status for all childhood diseases, including measles, mumps, tetanus, whooping cough and diphtheria as part of their pre-travel medical preparations.

Warnings for capital’s residents as rains near

Kathmandu’s capacity as a transit hub and its suitable weather conditions both increase the risk of dengue fever infections being introduced from regions reporting outbreaks - such as Dharan, Sunsari, Morang and Itahari, as well as international destinations. Residents are encouraged to employ measures needed to avoid mosquito bites and remove the insects’ breeding sites ahead of the upcoming warmer, wet season. Read more

Advice for travellers

Avoid mosquito bites and you won’t get 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.

Two serotypes escalate dengue risks

There has been a marked downturn in new dengue fever cases with the arrival of winter conditions in the territory - weekly cases dropped to fewer than 400 compared with 1,300 during the epidemic’s peak. Northern and western districts have taken over from southern regions in the reporting of new dengue cases. The recent appearance of 19 DENV-1 infections (DENV-2 has been dominant to date) is of concern to health agencies; this could extend the outbreak as DENV-1 is not endemic to the island and most of the local population will lack immunity. Read more

Advice for travellers

Dengue is spread by two types of 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.

Chikungunya souvenir for 3 tourists

Three Icelandic tourists have contracted chikungunya during their stay on the Costa Blanca, in the SE province of Alicante; a possible fourth case is under investigation. While chikungunya was first identified in Europe in 2007, its local vector, the Aedes albopictus mosquito is now established along the northern Mediterranean coast from Spain to Greece, and also around the Black Sea coast (Bulgaria, Georgia, Romania, southern Russian Federation and Turkey). 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 Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Apply an effective repellent when outdoors to all exposed skin. Read more about chikungunya.

Hep A outbreak cases top 20,000

New Hep A cases in Florida are still increasing and are now more than 12-times higher than in 2016. Highest incidence has been in counties located in central Florida, particularly Pasco, Pinellas, Orange and Volusia Counties. National data for the outbreak that started in 2016 available from the CDC: 23 states have reported cases now totalling 20,133 cases and 191 deaths. Read more

Advice for travellers

Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is highly effective and offers long term protection.