World travel health alerts 2 September 2020

World travel health alerts for 2nd of September 2020.

More states with VDPV polio

In a further update on the newly declared vaccine-derived poliovirus (cVDPV2) outbreak, 11 more suspected cases have been reported, all of which are said to be genetically linked to circulating strains in Chad. According to a Sept 1 WHO Disease Outbreak News post, the 13 confirmed and suspected cases originated from six states (Red Sea, West Darfur, East Darfur, White Nile, River Nile and Gezira), plus three positive environmental samples were taken from separate sites in Khartoum in late March. The WHO assessed the risk of further spread across central Africa and the Horn of Africa to be high. In other cVDPV2 news, the GPEI reports two cases in Afghanistan’s Nangahar province; one case each in Benin (Zou province), Chad (Longone Occidental province) and Somalia (Banadir province), and two more cases in the DRC (Equateur province). The July 2020 WHO Country List now contains a section on poliovirus with the temporary recommendations listed for those States with wild or vaccine-derived poliovirus outbreaks.

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.

Spike in west’s leishmaniasis burden

The incidence of cutaneous leishmaniasis has soared in several western provinces (wilayas) with the greatest burden in Saïda, where it is estimated to be at 26.5 per 100,000 inhabitants, and Tiaret (10.5/100,000). Males aged under 14 years are most affected. Read more

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is 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. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

COVID-19 cases pick up pace

Accelerating case numbers culminated in a record high in daily incidence of almost 80,000 on Aug 30 as total cases near #2 ranking Brazil on a global scale; India now sits third in reported deaths after overtaking Mexico. The Americas has six countries in the top 10 of global cases while per capita daily incidence is highest in the Maldives, Peru, Bahrain, Argentina and Colombia, according to the Aug 31 Johns Hopkins newsletter. In the WHO Epidemiological Update of the same date, it was noted that global mortality rates had declined in the previous week, however cases were up by one percent.

In more local news, Samoa’s state of emergency has been extended to Sept 27 as the nation strives to remain COVID-free. Other measures put forward by the Prime Minister include increasing managed quarantine for arrivals from two to three weeks ‘as well as a move to change a 2m social distance policy to 10m’.

In Africa, the WHO weekly bulletin’s lead article concerns the rising rates of serious cases COVID-19 in Ethiopia, particular in the setting of other outbreaks.

In other COVID-19 news:

- Evidence mounts on airborne transmission of SARS-CoV-2, supporting the importance of ventilation: The results of two studies, one from China and the other the Netherlands, were summed up by CIDRAP – ‘One study found that patients can exhale millions of viral RNA particles per hour in the early stages of disease, and the second tied an outbreak affecting 81% of residents and 50% of healthcare workers at a Dutch nursing home to inadequate ventilation.’

- An editorial in The Lancet on ‘Air travel in the time of COVID-19’ notes ‘aeroplanes benefit from air-conditioning systems with far more sophisticated and effective filters than those generally found on the ground.’ Measures we may have to adapt to include: limiting touchpoints through reduced service offerings, rapid testing of passengers and crew, enhanced cleaning and the use of PPE. Firstly though, an effective vaccine to inspire the confidence of travellers.

- IATA issued a statement this week on the need to re-open international borders, putting forward a 3-point plan which includes ‘testing measures that will enable the re-opening of borders by reducing the risk of COVID-19 importation to what is acceptable to public health authorities with accuracy, speed and scalability that also meet the exacting requirements for incorporation into the travel process’.

- Updated Q&A page from the WHO: Staying at hotels and accommodation establishments and COVID-19

New YF certificate requirement

In the latest update of yellow fever recommendations and country entry requirements, a valid ICVP is now ‘required for all travellers aged 9 months or over’ arriving in Burundi. Other changes to the updated WHO Country List and Annex (available to download) as summarised by NaTHNaC: New requirement for ICVP: Burundi, Cape Verde, Kazakhstan; Removal of requirement for ICVP: Kyrgyzstan, Laos, Lesotho; Addition or removal of transit information: Barbados, Chad, Eritrea, Gambia, Guyana, Panama, Seychelles; Changes to lower age limit for ICVP: Algeria, Benin, Burkina Faso, Cameroon, Mali, Nepal, Niger, Thailand. 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.

Food safety alert over Salmonella

A string of Salmonella Enteritidis infections linked to fresh peaches, which has spread across 12 US states as well as two Canadian provinces, has now impacted sales of some lines of the fruit sold in New Zealand and Singapore – recalls have been issued in all affected areas. Read more

Advice for travellers

Salmonella is a bacterium typically found in food, such as poultry, that causes diarrhoea, fever, and abdominal cramps between 12 and 72 hours after infection. Illness usually lasts 4 to 7 days, and most people recover without treatment, although diarrhoea may be so severe as to require hospital treatment. Young children and the elderly are at highest risk of severe illness. There is no vaccine to prevent salmonellosis so careful hand hygiene and food preparation techniques are recommended. Read more

Chikungunya outbreak in east

More than 9,000 people in the eastern region of Ouaddai have contracted chikungunya since mid-August with two health districts - Abéché (the regional capital) and Adré – reporting most cases. Response measures such as vector control as planned by the government are 2-fold: to contain the epidemic and prevent its spread to other areas of the country. 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.

Ebola’s reach widens

A further increase in Ebola cases and deaths reported in the week to Aug 31 has taken the outbreak total to 109 cases (103 confirmed, 6 probable), 47 deaths and the addition of a newly affected area, Monieka Health Zone in Equateur province’s east (one confirmed case lost to follow-up). Read more. (Also see cVDPV post under SUDAN)

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.

Search for contaminated food sources

An unknown imported food source is thought to be responsible for around 50 gastro-intestinal infections reported in different parts of the country. To date, testing of victims has detected cases of hepatitis A and two rare strains of Salmonella. While investigations continue, advice from health authorities is to follow good kitchen hygiene measures. Read more

Advice for travellers

Salmonella is a bacterium typically found in food, such as poultry, that causes diarrhoea, fever, and abdominal cramps between 12 and 72 hours after infection. Illness usually lasts 4 to 7 days, and most people recover without treatment, although diarrhoea may be so severe as to require hospital treatment. Young children and the elderly are at highest risk of severe illness. As there is no vaccine to prevent salmonellosis, it is best to avoid raw or undercooked eggs, poultry, or meat. Read more

Several districts reporting scrub typhus

Summer temperatures have driven scrub typhus transmission rates up with infections recently reported across widespread districts. Nationally, cases of the infection which is transmitted by larval mites (chiggers) have doubled this year compared to those recorded in 2019 while there has been a downward trend in other vector-borne infections such as dengue fever and malaria. Read more

Advice for travellers

Scrub typhus is a bacterial disease passed on to humans by mites that normally live on rodents infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus occurs throughout the Asia-Pacific region, where more than a million cases occur annually. There is no vaccine or prevention medication: avoidance hinges on minimising insect bites. Due to the disease’s 5- to 14-day incubation period, travellers often experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Read more about rickettsial diseases.

Hep A spike recorded

Hepatitis A infections reported this year among some family clusters, as well as sporadic cases, have seen the low notification rates of the past four years (19 cases in total) climb to 35 as at Aug 13. Statistics published by DASS give a breakdown of the three clusters: Maré (13 cases), Montravel (eight cases) and Dumbéa (five cases). The agency also stated that several of the isolated cases were known to have consumed raw and cooked seafood. A large hepatitis A outbreak affecting almost 800 individuals (mostly children under 15yo) occurred in 2005. 

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 consuming contaminated food and water, by handling everyday items and through some types of 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.

Strep B source search

No link has yet surfaced between a rise in bacterial food poisonings, particularly among the elderly, reported in July and another in 2015 that was caused by the same organism. In the earlier outbreak, invasive group B _Streptococcus_ (GBS) sickened more than 160 people after they consumed contaminated raw freshwater fish. ProMED reports that GBS ST283 ‘was subsequently reported to be widespread in humans and aquaculture in South East Asia’. The health ministry has alerted doctors to the spike in cases in view of the infection’s early symptoms which are similar to those of both COVID-19 and dengue fever. Read more