World travel health alerts 20 July 2022

World travel health alerts for 20th of July 2022.

Vaccine-derived polio in southern province, global update

Algeria has become the latest country to detect circulating vaccine-derived polio type 2 (cVDPV2), in an individual from the southern province of Tamanghasset in the Ahaggar Mountains. The GPEI advised that a link has been found between this case and others infected with a strain originating in Zamfara, Nigeria. In other news from the update, all relating to cVDPV2: four cases in Niger (Maradi and three in Tillaberi), two in Benin (Atlantique and Oueme), and one each in Eritrea (Gashbarka) and Ghana (Savannah). Lastly, the US CDC has updated its travel advice in relation to polio, advising ‘Before any international travel, anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series.’ Level 2, Practice Enhanced Precautions alerts have been placed over a number of countries in Africa, Asia and Eastern Europe. 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.

JE surveillance and vaccinations continue

While the risk of Japanese encephalitis (JE) infection has mostly abated with winter’s cold temperatures in southern regions, response measures to the unprecedented outbreak continue in Victoria. News media have reported the lifting of quarantine on affected piggeries, while the vaccination program targeting farm workers and residents is still underway. In NSW, residents of several inland towns are undergoing blood tests to determine the levels of exposure to the JE virus in those areas. Read more

Advice for travellers

A mosquito-borne virus, JE is generally found in many parts of Asia, the Indian subcontinent, Southeast Asia, China, Indonesia and PNG, and more recently, in areas of southern and eastern Australia. In Asia, it is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to large urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

New measles outbreaks in 3 countries

Three new disease posts relating to measles were added to the WHO regional bulletin this week: In Kenya, measles outbreaks have been declared in the counties of Marsabit and Wajir; the Central African Republic has four districts reporting outbreaks – Bimbo, Kouango-Grimari, Alindao Haute-Kotto; and 16 districts of Senegal are said to have crossed the epidemic threshold. 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.

Dengue makes a comeback in 2022

This year’s peak dengue fever season is still to materialise, but more than 3,000 cases have already been reported nation-wide to June 10 after a lull in infections last year. Seven provinces have confirmed virus transmission - Havana, Sancti Spíritus, Camagüey, Las Tunas, Holguín, Santiago de Cuba and Guantánamo, while three dengue serotypes are currently circulating. In related news from the USA, a dengue advisory has been issued in Florida’s Miami-Dade County after confirmation of the first locally-acquired dengue fever case in 2022. 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.

COVID-19 update

Last week’s WHO epi update noted the greatest regional increases in new COVID-19 cases in the Western Pacific (up 28 percent with the largest proportional increases observed in Vanuatu and French Polynesia) and the Eastern Mediterranean (up 25 percent, Iran and Tunisia). Data from the Office for National Statistics in the UK reveals that for the week ending July 6/7, around one in 19 people in England and one in 16 in Scotland returned positive tests (more details here). Meanwhile the WHO European Region office has issued guidance on appropriate interventions recommended for the upcoming autumn and winter seasons in view of the spike in cases over summer as people socialised more, and the anticipated co-circulation of ‎COVID-19 and other respiratory viruses. Read more  

National monkeypox cases top 3,000

Global monkeypox case numbers have now passed the 14,500 mark, with a change in the order of the top four – Spain (3,125 cases), UK (2,137), USA (2,108) and Germany (2,033) according to the US CDC. The UKHSA has just updated its guidance for close contacts of monkeypox cases in the UK, being ‘proportionate to the latest transmission risks identified’. In Africa, the latest Nigerian CDC summary stated that the 2017 peak in monkeypox (MPX) cases – the year the virus re-emerged - has already been exceeded in 2022, perhaps partly or wholly due to increased surveillance, awareness, risk communication and community engagement.  Read more

Advice for travellers

Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People travelling in endemic countries can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk in those regions. Read more from the WHO on the current outbreaks of monkeypox in non-endemic countries. 

‘Baggage malaria’ strikes 2 airport workers

ProMED reports on two cases of airport malaria, contracted by workers from different parts of the international airport in Frankfurt – neither had travelled to a malarial area recently/ received blood transfusions. The article went on to say that both individuals became symptomatic on July 5 and were subsequently diagnosed with Plasmodium falciparum malaria – one is receiving critical care in hospital. The airport is situated some 8kms SW of Frankfurt’s main railway station. Read more

WHO confirms viral haemorrhagic fever

The WHO has confirmed that the two cases of haemorrhagic fever from Ashanti province reported last week were infected with Marburg virus, the first such detections in Ghana. Both patients, unrelated male farmers living in separate forested areas of the region, died from their illnesses. The first outbreak of Marburg virus disease in West Africa took place in Guinea in August of 2021. Read more

Advice for travellers

Marburg virus disease is a rare but severe viral haemorrhagic fever, related to the Ebola virus, and there is no treatment. Found in the African fruit bat, Marburg typically appears in sporadic outbreaks and laboratory-confirmed cases have occurred in Uganda, Zimbabwe, the Democratic Republic of the Congo, Kenya and Angola. Preventive measures are not well defined, as study in how it is spread continues, but travellers should avoid contact with fruit bats and sick primates in central Africa. Read more

Monsoon influence on disease trends

From media reports, the rise in seasonal infections has centred mostly on dengue fever, however health authorities in Pune (Maharashtra state) this week confirmed the first Zika virus case this year, in Palghar (70kms north of Mumbai). Cholera outbreaks have been reported in the state’s NE, in Amravati district and on the east coast in Odisha (Rayagada District). The cities of Hyderabad and Secunderabad (Telangana) are seeing rising rates of malaria, typhoid, chikungunya and diarrhoea; while dengue fever notifications have flowed from across the state. And in West Bengal, several districts have recorded leishmaniasis infections – among those named were Darjeeling, Malda, Uttar Dinajpur, Dakshin Dinajpur and Kalimpong. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travel, the risk of infection is low. Travellers to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care. Read more about cholera.

West Nile fever cases reported

The first cases of West Nile fever this year have been reported by the Istituto Superiore di Sanità: Two of the three cases - from Padua and Modena - remain in hospital with neurological complications, while the third, a fatal infection, was from Veneto. The presence of infected mosquitoes has been confirmed in the provinces of Vicenza, Venice, Verona, Rovigo and Padua. Read more

Advice for travellers

West Nile virus is endemic in Eastern Europe and the Mediterranean basin, with sporadic outbreaks reported in summer and autumn since the 1950s. 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. Europe’s outbreaks are not as severe or widespread as in other regions where the virus occurs, notably North America. Read more on WNV.

Malaria cases spike in 10 provinces

The WHO regional bulletin updated the local malaria situation, advising that for the year to June 5 there had been more than 540,000 malaria cases. Nineteen health districts from across 10 provinces have crossed the epidemic threshold since the end of May. 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.

Carrying the burden of malaria risk

A senior health official announced the malaria case-count for the first six months of 2022: 1,447 cases ‘involving 1,311 cases of zoonotic malaria and 136 of locally infected human malaria’. Companies working in mining, forestry and construction were recommended to provide suitable care for their workers, many of them foreign, as they carry a higher risk of infection. Six malaria deaths have also been recorded this year - from Terengganu, Sabah, Sarawak and Pahang; while a death attributed to ‘local human malaria’ occurred in Johor. Read more

Advice for travellers

The P. knowlesi strain of malaria is spreading in humans throughout Asia due to factors such as deforestation – its natural host is the macaque. As well as local cases, infections are increasingly being reported among international travellers who have visited Thailand, Vietnam, Cambodia, Malaysia and the Philippines. Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Efforts towards rabies eradication

The aim is to eradicate rabies in Sri Lanka by the end of 2025, but a senior government veterinary official said that for that to happen more work has to be done to vaccinate dogs, while people who have sustained a bite from a dog or puppy (the main source of rabies infections in humans in Sri Lanka) must be aware of the need to seek urgent treatment. Twelve people have succumbed to rabies infections in the past six months according to health ministry data. 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.

Test results confirm cause of illnesses, deaths in south

Medical teams responded to an outbreak of an unknown illness in Lindi region, finding more than a dozen people suffering from fever, fatigue and nosebleeds and three deceased patients. Initial concerns were for the emergence of a viral haemorrhagic fever, such as Ebola, however test results have now showed leptospirosis to be the cause. The health ministry has provided guidance to residents of Ruangwa District on the prevention and treatment of the bacterial infection. 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.

Peak dengue season sets in

Almost 5,200 dengue cases and six deaths were reported for the first half of 2022 and now the wet season has arrived, the risk of infection is higher. Government messaging covers reporting dengue symptoms promptly and ensuring stagnant water (used by mosquitoes as breeding sites) is removed from around the home. 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.

Severe unexplained hepatitis investigations continue

The WHO provided another update on the severe paediatric hepatitis cases of unknown aetiology last week, with the total of probable cases now exceeding 1,000 and 22 deaths. Through a global survey, the agency is now gauging this year’s incidence of cases and liver transplants to compare them with rates over the past five years. Thirty-five countries from five regions have reported cases, with the earliest dating back to October 2021. The WHO warned the recent drop in new cases may be due to ‘reporting delays and limited surveillance in many countries’ and it assessed risk on a global level as moderate. Read more

Product recalled over safety issues

Food Safety News reports that the FDA has issued warning letters to four companies selling honey-based products in the USA due to the undeclared presence of active drug ingredients, including two used as treatments for erectile dysfunction (tadalafil and sildenafil). One product has subsequently been recalled. Read more