World travel health alerts 20 April 2022

World travel health alerts for 20th of April 2022.

More parasitic infections from pork products

Another trichinosis outbreak has been reported in the central province of Córdoba just six months after nearly 250 people acquired the infection from consuming pork products contaminated with the parasite Trichinella. This time the infections were detected in the capital city, Córdoba, and in Santa Rosa de Calamuchita and Deán Funes. Advice from public health officials includes: check produce is from a reputable brand (and not homemade), kept under optimum conditions, used within the date of expiry, and cooked to the required temperature. Read more

Top End’s bacterial uptick

Above average rainfall this year has seen the number of melioidosis cases in the Northern Territory surge by 50 percent, with health warnings now issued. Melioidosis is most common during the Top End’s wet season and presents a higher risk for people with underlying predisposing conditions. Recommendations include ensuring any injuries or abrasions are covered with impermeable dressings, wear waterproof footwear and avoid the outdoors during storms (risk of inhaling contaminated soil and dust).  Read more

Pre-monsoonal diarrhoea cases mount

An early start to the first of two annual peak periods for diarrhoeal infections has taken case numbers over the 170,000-mark and killed 30 people, according to the the International Centre for Diarrhoeal Disease Research, Bangladesh’s chief. Oral vaccines have been distributed in five hotspot areas of the capital Dhaka, although cases have been reported from across the country. Read more  

Tourist succumbs to yellow fever

A yellow fever death has been recorded in the central state of Tocantins; it was also the state’s first human case in four years. According to a local news source, the infection occurred in an unvaccinated tourist who was participating in recreational fishing in the area of Tocantins River and Lagoa do Peixe. 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.

COVID-19 update

Six African countries reported a rise of 20 percent or more in new COVID-19 infections over the past week (Cape Verde, Mali, Mozambique, Niger, Uganda and Zambia) but, on a regional level, numbers have been declining for around three months. Global data will be released by the WHO in its weekly epi update to be published later today (Apr 20). Read more

In related news:

- CIDRAP summarised a meta-analysis published in the Journal of Infectious Diseases titled ‘Global data reveal half may have long COVID 4 months on’ in which it was estimated just under 50 percent of people suffered lingering symptoms in the four months post-COVID-19 infection.  

- Estimates of the protection against severe infection and death conferred from seven to 30 days after a fourth dose of the Pfizer/BioNTech vaccine: 62 percent and 74 percent respectively. These were the findings from an Israeli study carried out on people aged 60 years and over from Jan 3 to Feb 18 during an Omicron surge. Read more

- In the wake of the Easter long weekend, an ABC News article covers ‘When is COVID-19 most contagious? How long after an exposure does it take to test positive?’.  

-  An Apr 19 STAT News article discusses ‘Covid hasn’t given up all its secrets. Here are 6 mysteries experts hope to unravel’.

- This week, Australia’s Smartraveller published an update of the changes to international travel: ‘Easing restrictions for Australians travelling overseas’, with a reminder that ‘Foreign governments, transport providers and Australian states and territories can have their own requirements for COVID-19 testing and vaccination.’ Read more in Smartraveller

- The second Global COVID-19 summit will be held next month, aiming to ‘redouble our collective efforts to end the acute phase of the COVID-19 pandemic and prepare for future health threats’. Read more

80 zones at very high risk of measles epidemics

An update on measles outbreaks for the year to Apr 13 reveals that 77 health zones have reported epidemics and the four provinces with highest (suspected) case numbers are Sankuru, Tanganyika, Haut-Lomani and Sud-Ubangi. Just over 34,000 cases and 564 deaths have been recorded on a national level this year and, of the laboratory-confirmed cases, less than one quarter had received any measles-containing vaccines. And in Chad, there has been an upward trend in measles cases in the past three weeks and epidemics are unfolding in five health districts of the capital N’Djamena and to the south, in Bongor. The WHO warns that the risk of outbreaks continues due to low routine 2-dose vaccination coverage and poor measles surveillance, however the trends are markedly better than in 2019-20 after extensive vaccination campaigns were carried out in 2021. Read more

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.

More countries reported child hepatitis cases

More on the paediatric hepatitis cases reported last week, with the USA, Spain Denmark, Ireland and the Netherlands now also registering infections in children. Further investigations into the 13 cases in Scotland found that of the 11 children tested for adenovirus, five returned positive results; two pairs of cases had epidemiological links. Read more from the WHO. In the US, nine hepatitis cases have been identified in Alabama since November (four testing positive to type 41 adenovirus) and there have been three in Spain (from Ciudad Real, Madrid and Aragon). The ECDC writes that ‘an infectious aetiology is considered more likely given the epidemiological picture and the clinical features of the cases’.  Read more

Dengue, typhoid, leptospirosis updates

Dengue fever activity recorded over the week to Apr 18 was at a seasonal average in all areas except the Western Division, where cases surpassed the outbreak alert threshold. The Ministry of Health and Family Services website included updates on typhoid fever cases (now below alert threshold in Western Division and at average levels or below elsewhere) and leptospirosis (‘slight upward trend in cases is noted approaching the outbreak alert threshold nationally … driven by the Western Division'). 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.

Targeting malaria elimination

Nepal is aiming to gain malaria elimination status by 2025, and with the majority of imported malaria infections in Nepal reported to be in arrivals from India, malaria test kits are now in use at border crossings. The two countries are now also sharing information on malaria cases and introducing control measures. India’s goal is to achieve malaria elimination in 2030. Read more

Advice for travellers

Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Polio recap

On Apr 15 the WHO published a summary of Israel’s circulating vaccine-derived polio type 3 (cVDPV3) outbreak that was first announced in early March: seven confirmed cases, with further testing underway on two more suspected infections. A vaccination campaign for children aged six weeks to 17 years was initially focused on Jerusalem and has now been expanded to include all areas. The agency’s risk assessment notes that due to ‘the high immunization coverage and robust surveillance system in the country, the risk of national spread is considered moderate’. In the latest reporting week, a further four cVDPV3 positive environmental samples were detected in Jerusalem. In other polio news, a single case of cVDPV2 was reported by the GPEI last week in Nigeria’s province of Niger. 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.

’Urgent and immediate action’ to tackle rising dengue cases

After National Environmental Agency (NEA) surveillance in March found populations of the Aedes aegypti mosquito to be almost 50 percent higher than for the same period last year, there has been a corresponding rise in dengue cases and it has occurred early in the season. More than 5,000 cases have been recorded this year (1,888 of them in the three weeks to April 17) and the less common DENV-3 type was identified in 26 of the 33 hotspots (clusters of 10-plus 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.

Tick season commences

After 2021 proved to be a record year for tick-borne encephalitis (TBE) cases, the public health agency, Folkhalsomyndigheten, has warned residents and travellers to risk areas to take all precautions necessary to avoid infection. TBE activity has spread in many areas – from Gävle municipality to the south and to the west and vaccinations are advised as per ‘the recommendations from the regions' infection control units’. Read more

Advice for travellers

A viral infection, tick-borne encephalitis (TBE) can cause fever, vomiting, cramps and paralysis, which can be prolonged. In rare instances, infection can be fatal. Travellers who spend time in regions where TBE is endemic – mainly forested areas of Central and Eastern Europe, Russia, Northern China, and Mongolia – may be at risk. The highest risk is during the warmer months from April to November, especially when hiking or camping in areas below 1500m. While most infections are contracted through the bites of infected ticks, food-borne transmission through untreated dairy products is a known mode of transmission. Safe and effective vaccines are available in Europe, but none are licensed in Australia, however the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.

Flu cases trending upwards

A peak in influenza cases was recorded at the very end of last year, however the CDC is now reporting rising flu case numbers which are ’highest in the central and south-central regions of the country and is increasing in most regions’ compared with the previous week. Influenza A(H3N2) viruses are predominating. Read more

Advice for travellers

In most years, seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Whether you are travelling within Australia or overseas, vaccination is highly recommended and 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. Alcohol-based hand sanitiser is a convenient alternative if soap and water is not available.