World travel health alerts for 2nd of October 2019.
Polio lingers in Kayin, global update
Two more circulating vaccine-derived poliovirus type 1 (cVDPV1) cases reported this week in Kayin province take the national YTD total to six, while Angola has registered 19 cVDPV2 cases at the latest count, with the four most recent cases from the provinces of Huambo, Kwanza Sul and Uige. (See separate post for Philippines update.) In Pakistan, six WPV1 cases in Khyber Pakhtunkhwa province and one in Sindh take its 2019 total to 69 – in 2018 there were only 12. 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.
FNQ’s dengue in decline
A research articlepublished on Sept 26 in Gates Open Research describes how the World Mosquito Program plan to tackle dengue fever in Far North Queensland has proved a success after eight years of Wolbachia-carrying mosquitoes release in the region, achieving ‘near-elimination of local dengue transmission over the past five years in locations where Wolbachia has been established’.
Ryan PA, Turley AP, Wilson G et al. Establishment of wMel Wolbachia in Aedes aegypti mosquitoes and reduction of local dengue transmission in Cairns and surrounding locations in northern Queensland, Australia [version 1; peer review: awaiting peer review]. Gates Open Res 2019, 3:1547 (https://doi.org/10.12688/gatesopenres.13061.1).
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.
Elevated hospitalisation rates among Auckland’s measles cases
A higher incidence of measles infections in children under 4 observed during Auckland’s outbreak has resulted in hospitalisation rates of between 35 and 40 percent (usually around 10 percent). The regional health service (ARPHS) report issued on Oct 1 notes that ‘Around 52 percent of children under 5 years with measles have been hospitalised in this outbreak, and Maori and Pacific children and adults are more likely to be in hospital with measles, with Maori rates at 41 percent and Pacific rates at 37 percent.’ To date the agency has registered complications including pneumonia, encephalitis and two miscarriages. Auckland’s measles case count has risen to 1,329. A measles alert for the Perth suburb of Rockingham, Western Australia is believed to be associated with a recent visitor from New Zealand who was infectious during his stay - five cases have been linked with the report to date. Last week UNICEF issued a health advisory warning of the heightened risk of the spread of measles in the Western Pacific as ‘some Pacific island countries and areas have not reached the 95% immunization coverage target for measles, making them more vulnerable to outbreaks’.
Advice for travellers
Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. In general the infection is relatively benign, but complications 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.
WNV mosquito transmission confirmed
A year after West Nile virus was first detected in a small number of birds and horses, Germany has reported its first human WNV case (contracted via a native mosquito species) after a man from Saxony, who was being treated for encephalitis, tested positive to the virus. This may prove a forewarning for residents to be aware of the potential risk of WNV over the warmer months in years to come. Elsewhere in the region in the last reporting week: WNV cases were recorded in Greece, Hungary, Romania, Serbia and North Macedonia. Other WNV posts were from the US CDC and Bangladesh, where the first appearance of another mosquito-borne infection would be most unwelcome in light of the current dengue fever outbreak. The Institute of Epidemiology Disease Control and Research is carrying out investigations into a single case of West Nile virus fever identified in a man living near the capital, Dhaka. 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.
New weapon in Ebola arsenal, UK considering Tanzania travel advice
A second vaccine (Janssen Pharmaceuticals) will be used to tackle the Ebola virus disease (EVD) outbreak in the NE provinces: two doses are to be administered in pre-exposure settings, as opposed to the Merck investigational vaccine which has been in use since last year and is given as pre- and post-exposure. The Merck vaccine has proved to be over 95 percent effective in the DRC outbreak so far. The total number of cases since the outbreak began in August 2018 has risen to 3,194 cases and 2,133 deaths.
More on the post last week regarding the unofficial report of an EVD death in Dar es Salaam, Tanzania early last month: the United Kingdom Foreign and Commonwealth Office (FCO) yesterday stated that the death was due to Ebola virus is now ‘probable’ - the office will issue updates as new information arrives. The US CDC amended their advice for travellers to Tanzania on Sept 27 and will also provide updates. The Oct 1 WHO External Situation Report notes that the ‘current situation in Tanzania requires further investigation’.
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.
More local dengue found in SE
Following further investigations, public health authorities in the SE department of Alpes-Maritimes have now confirmed a total of five local cases of dengue fever, all from a 100m radius in the town of Vallauris. As noted by the ECDC, ‘the occurrence of autochthonous transmission of dengue in the southern part of France in the late summer months is expected as Ae. albopictus is established and the environmental conditions at that time are suitable for vector activity’. The risk of further transmission is expected to taper off soon as the temperature drops however measures to avoid insect bites are advised nonetheless. And in Spain, another report of locally acquired dengue fever was published this week although the infections occurred in August. Two family members who had stayed in the cities of Cádiz and Murcia were diagnosed with dengue and a third relative is also suspected to have contracted the infection. 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.
Peak dengue season starts
High levels of dengue infections are currently being reported in a line running through the states of Tamil Nadu and Karnataka, SW from Chennai to Coimbatore and also up into Andhra Pradesh. Other dengue and malaria reports this week came in from Goa, Punjab and Delhi. Read more
Advice for travellers
Malaria is widespread in India and can occur in both rural and urban areas, including major cities. Travellers visiting India should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. Read more on malaria in India.
Malaria uptick in NW
A concerning spike in malaria infections has been reported from the Kerio Valley, SW of Lake Turkana. Officials with the local health department also claimed that a shortage of treatment medications is curbing their ability to manage the 5-fold increase in cases. While far to the north, in Sudan’s western province of North Darfur, new malaria cases have risen by almost 8,000 over the past four weeks. Read more
Advice for travellers
Sub-Saharan Africa presents a significant malaria risk. Travellers can discuss their itinerary and the need for anti-malaria medication with a trained travel health professional at their nearest Travelvax clinic. For details call 1300 360 164. Read more about malaria.
YF warning for Ebonyi’s high-risk foreign workers
A WHO Disease Outbreak News post on Sept 26 notes that the risk of yellow fever spreading from the current outbreak in Ebonyi state and adjacent to the borders of Cross River and Benue states ‘represents a moderate risk at regional level’ but, as one case has already occurred in an overseas worker (who worked in Izzi LGA but lived in (urban) Abakiliki LGA , ‘there is risk to national and international workers in high-risk extractive industries like open pit mining and forestry, underscoring the importance of ensuring all international travelers and workers are vaccinated according to International Health Regulations (IHR) recommendations’. More information is also available on the outbreak in Bauchi state.
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.
Polio vaccinations planned for the under 5s
A global advisory panel has recommended the Dept of Health concentrate on polio vaccinations targeting type 2 ‘because circulating VDPV2 (cVDPV2) is highly contagious and expected to spread rapidly among unvaccinated children’ according to a UNICEF report. There have been no further reports of cVDPV2 infections following the two cases in Mindanao and Luzon. The vaccination campaigns aimed at children under 5 will commence this month and extend to January 2020. VDPV1 was detected in Manila sewage samples in July, August and September so immunisation against this type will also be strengthened. 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.
Air quality takes a dive
Air quality in both Hanoi and Ho Chi Minh City has been sitting in the ‘unhealthy’ range for much of the past fortnight and local residents have taken to wearing face masks with activated charcoal in an attempt to screen out the smog’s PM2.5 particles – the ones that can be breathed deep into the lungs. News reports from Thailand earlier this week blamed the poor air quality in Bangkok on prevailing weather systems trapping local smog over the city. Read more