World travel health alerts 2 June 2021

World travel health alerts for 2nd of June 2021.

Human rabies death in BA province

Health authorities announced the country’s first human rabies death since 2008, a woman from Coronel Suarez in Buenos Aires province. The victim died in April after incurring a cat bite in early March – she had not received any treatment for the injury. Subsequent testing has determined that a bat variant of the rabies virus was the cause of death. 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.

Residents warned to get ready for dengue surge

With the forecast of more rain throughout June and July, dengue infections are expected to accelerate, adding to the more than 7,600 suspected cases recorded to the end of May. Authorities report that just under 30 percent of dengue cases were from Western Province, which includes the capital Colombo. Elsewhere, better news on the dengue outbreak in the Cook Islands as the latest figures showing infections starting to slow, following the seasonal pattern of the past two years. To date, 200 confirmed or suspected cases have been reported and young people under 20yo have been most impacted. Flooding in Guyana’s south (Region Nine or Upper Takutu-Upper Essequibo) is hampering efforts to carry out mosquito fumigation after a dengue fever outbreak was declared in the area. This is an added burden for the region’s existing public health challenge, endemic malaria. More dengue and chikungunya news from across the globe as reported by the ECDC in an update on data since April 24: Brazil and India have reported the majority of new chikungunya cases, while highest numbers of dengue fever infections were in Brazil, Peru, Vietnam, Philippines and Nicaragua. 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.

3 more cVDPV1 cases, global update

The count of circulating vaccine-derived poliovirus type 1 (cVDPV1) cases for 2021 has risen to four with three new infections reported to the GPEI (two in Boeni and one in South East). Relating to cVDPV2, the D R of Congo recorded five more cases from three provinces (South Ubangi, North Ubangi and Mongala) and there was one case each in Burkina Faso (Dori), Republic of Congo (Niari department), Guinea and Mali (Kayes).

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.

3 provinces with most chikungunya cases

An update on the chikungunya outbreak in the province of Ratanakiri outlines plans for a mosquito control program in eight villages of O'Chum and Bakeo districts where between 40 and 70 percent of residents are symptomatic. On a national level, 230 suspected chikungunya infections have been recorded in 11 provinces - more than 90 percent were in Ratanakiri, Kampong Chhnang and Prey Veng. The rainy season, which runs until October, has just begun. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by day-time feeding Aedes mosquitoes. 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.

Endemic rubella wiped out in Hong Kong; First confirmed transmission of rare bird flu strain

On May 21, the WHO Western Pacific office officially declared the interruption of rubella virus transmission in Hong Kong SAR. The achievement follows concerted efforts in disease prevention and control including ‘99% of pre-school children in Hong Kong have received rubella vaccine over the past decade’. Read more

A MAN from Zhenjiang in the eastern province of Jiangsu has been diagnosed with the low pathogenic avian influenza strain, H10N3, the first such case in humans. Health authorities have not released any details on how he acquired the infection, ‘an accidental cross-species transmission’, and no onward spread has been detected. Read more

Advice for travellers

There are several strains of bird flu and while the high pathogenic strains can be fatal, infection generally poses a low risk for travellers – even for those heading to a region where the disease is present or an outbreak is occurring. Travellers should avoid contact with birds or poultry in marketplaces, wash hands thoroughly before and after preparing food, and observe strict personal hygiene. Read more on bird flu and how to avoid it.

Cholera suspected in North Kivu

Aid agencies are working quickly to provide clean drinking water in two North Kivu health districts where people from the city of Goma are sheltering from the volcanic eruption of Mount Nyiragongo. Suspected cholera infections have already surfaced in Kirotshe and Sake health districts. Read more

Advice for travellers

While the risk of infection with cholera is low for short-stay travellers, Australians travelling to regions where an outbreak is occurring should adhere to strict personal hygiene and choose food and beverages with care. Read more about cholera.

Guinea worm test results pending

Testing is yet to confirm a diagnosis of dracunculiasis in a man from North Tongu District in Volta Region after reports ‘a whitish worm’ emerged from a blistered area on his ankle in early May. According to a WHO article, Ghana’s elimination of dracunculiasis transmission was certified in early 2015 and the last case had been reported in 2010 (down from almost 180,000 in 1989). Active community case finding is underway in the district. More about guinea worm disease (dracunculiasis) from the CDC. Read more

Countdown to June 19 continues, Lassa fever update

Just under three weeks left in the countdown to the end of the Ebola outbreak and no new confirmed cases to report. Issues remain, with suspected Ebola infections followed up in many, but not all, cases and some refusing to be transferred to hospital. Read more. On the fatal Lassa fever case reported in the same region last month, surveillance continues as the regional WHO office reports 12 community deaths without safe and dignified burials, ‘the prefecture of Bheeta is regarded as active, with the prefectures of Yomou-Centre, Péla, Yomou and Bignamou on alert’. 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 most 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, chikungunya, leptospirosis alerts

Following the recent landfall of two cyclones and now the imminent onset of the SW Monsoon, residents in many of the districts already affected by heavy rains have been alerted to the heightened risks of dengue fever, chikungunya and leptospirosis. Kerala and Jharkhand are two of the states where local officials were warned to be prepared to control these new threats while also supporting pandemic responses. Read more

Advice for travellers

Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

Villager deaths in Rakhine state

A diarrhoeal disease has sickened more than 200 people and caused the deaths of seven infants in Minbya township, 50kms west of the capital of Rahkine State, Sittwe. Nearby villages have also recorded cases, a development noted by ProMED that points ‘to a major food or water source that might be contaminated’ and warrants a proper epidemiological investigation.

KP location reports hundreds of CL cases

‘Hundreds’ of people in Lachi tehsil, Khyber Pakhtunkhwa province, are reported to be suffering from the sand fly-borne cutaneous leishmaniasis (CL) and up to 150 are currently undergoing intensive treatment for the infection. One doctor was quoted by media as saying that the government lacked resources to control sand fly populations and some affected people were hesitant about submitting to the rigours of the prescribed CL treatment. Read more

Advice for travellers

Leishmaniasis is a parasitic disease 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. The former causes skin ulcers and the latter a severe systemic disease that is usually fatal without treatment. India, Bangladesh, Nepal, Sudan, South Sudan, Ethiopia and Brazil account for 90% of visceral leishmaniasis, while 90% of cutaneous leishmaniasis cases occur in Afghanistan, Algeria, Iran, Saudi Arabia, and Syria, as well as the South American countries of Brazil, Colombia, Peru, Bolivia and Argentina. Read more on the disease and prevention.

COVID-19’s third wave, more news

The June 1 WHO epi update notes that ‘cases and deaths remain at the highest levels since the beginning of the pandemic in the Western Pacific region, and while most other regions reported stable or decreasing numbers of new cases and deaths, Africa recorded increases in both, with a 24 percent hike in case incidence in South Africa and a near-200 percent rise in Uganda.  

In related news:  

- To avoid disparaging, discriminatory language and misreporting, the WHO suggests that, outside of scientific purposes, emerging SARS-CoV-2 variants no longer be known by the country where they were first detected but by letters of the Greek alphabet in date order i.e. B.1.1.7 (UK) – Alpha; B.1.351 (South Africa) – Beta; P.1 (Brazil) – Gamma; and B.617.2 (India) – Delta etc. etc. The WHO lists of Variants of Concern (VOCs), Variants of Interest (VOIs, currently Epsilon to Kappa) and their labels are available here.   

- Europe’s medicines regulator has approved the use of the Pfizer/BioNTech vaccine Comirnaty for use in adolescents aged 12 to 15 years. Read more

- Seven Pacific Island countries have now received supplies of COVID-19 vaccines through the COVAX facility - Fiji, Solomon Islands, Tonga, Nauru, Tuvalu, Samoa and most recently, Vanuatu. Read more

ABC News is reporting a new directive in the Northern Territory that means that ‘anyone who returns from overseas, quarantines interstate and then travels soon afterwards to the NT to get a coronavirus test three days after they complete their fortnight of quarantine’.

- The WHO has approved the inactivated Sinovac-CoronaVac vaccine for emergency use listing (the eighth COVID-19 vaccine with EUL), recommending its use in adults 18 years and older in a two-dose schedule with a two to four week interval between doses. The validation gives ‘countries, funders, procuring agencies and communities the assurance that it meets international standards for safety, efficacy and manufacturing’.  

CCHF toll climbs to 13

Crimean-Congo haemorrhagic fever (CCHF) cases registered in 2021 now total 243 with 13 deaths but fatality rates are down compared to last year. Most cases are reported in the agricultural areas of the country’s north. Read more

Advice for travellers

Sporadic cases of CCHF virus occur in Turkey. The disease, which has a fatality rate of 10-40%, is more common in Africa, the Balkans, the Middle East, and Asia, as well as countries south of the 50th parallel north. CCHF virus presents a low risk for most traveller as it is transmitted either directly by tick bites or through contact with the blood or tissue of infected animals during and immediately after slaughter. Read more about the virus.

ICVP now required on arrival from YF risk countries

As noted in our May 26 post, the WHO has published the 2021 updates for its vaccination and malaria recommendations in the Country List and Annex 1. One of the major changes was the new requirement for a yellow fever vaccination certificate (ICVP) on entry into Uruguay for travellers aged one year or over arriving from countries with risk of yellow fever transmission. A complete list of the update changes have been summarised by NaTHNaC.

TCV on board for routine immunisations

Zimbabwe has become the second country in Africa (after Liberia) to include a typhoid conjugate vaccine (TCV) in its routine immunisation program. The roll-out will commence with a vaccination campaign targeting children aged from 9mo to 15 years, after which TCV will be given to infants at nine months of age as a routine immunisation. 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.