World travel health alerts for 20th of March 2019.
Dengue cases surge
Dengue cases in Rio de Janeiro have risen by almost half this year compared with the same period in 2018 – with many of the more than 1,000 infections from the western districts of Santa Cruz and Campo Grande. Read more. And in the state of São Paulo, the city of Araraquara is recording up to 50 new dengue cases on a daily basis and 18 cities of NW regions have received warnings that epidemics may be imminent. While in the Caribbean, rates of both dengue fever and malaria have risen substantially in the Dominican Republic. Read a summary of dengue in the Americas here.
Advice for travellers
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. 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 PMD when outdoors to all exposed skin. Read more about dengue fever.
Local measles reports and further afield
Measles cases have reached a 10-year high in Lithuania’s largest county outside Vilnius, Kaunas. Nearly two-thirds of those infected were in the 35 to 44 years age group and hospitalisations for treatment of complications have been as high as 65 percent of cases. Almost half of Russia’s 872 measles cases this year have been in Moscow and its surrounding region (oblast). While the situation in the Ukraine remains grim - 17,000 children and 13,000 adults have contracted measles this year and 12 have died. Western regions have been hardest hit, including the capital Kiev and also Lviv, Rivné, Vinnytsya and Khmelnytsky. Nearly 100 of the Czech Republic’s 298 measles cases recorded to Mar 17 have been in Prague and the highest weekly total was recorded in the last epiweek. Thirteen locations have been affected in the outbreak this year. In other regions, New Zealand has a declared outbreak in the district of Canterbury with 30 confirmed cases to date; Auckland and Dunedin have also reported cases. The Mar 16 update from the Philippines agency managing that measles outbreak (NDRRMC) announced there had been more than 21,000 measles and 315 deaths – over half of all cases have been in young children and infants under four years of age. Read more measles updates here.
Advice for travellers
Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. While generally benign, infection 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.
Ebola outbreak toll exceeds 600
As the Ebola case count climbed beyond 960 this week, yesterday’s WHO update noted that ‘while Katwa and Butembo remain major hotspots, clusters of cases with onward transmission have been reported in other health zones such as Mandima, Masereka and Vuhovi, which is concerning’. More in the Ministry of Health’s newsletter here.
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.
Diphtheria update
The latest PAHO Epidemiological Update on diphtheria reveals a recent drop in the incidence in Haiti which it says may be due to late reporting. Two municipalities in Nord department have the highest rates of infection (Acul du Nord and Trou du Nord). The number of suspected cases in Venezuela’s almost three year-long outbreak is now 2,726 with 164 of those reported this year (including 10 deaths). PAHO advice: ‘it is recommended that national authorities remind travelers going to areas with diphtheria outbreaks to be properly vaccinated prior to travel in accordance with the national vaccination scheme established in each country. If more than five years have passed since their last dose, a booster dose is recommended.’
Advice for travellers
Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.
North’s dengue outbreak lingers
The northern region of Cortes (in particular the towns of Choloma, San Manuel, Pimienta, Villanueva, San Francisco de Yojoa and Omoa) continues to suffer an outbreak of dengue fever with children hardest hit. Over 4,000 cases of dengue and 1,131 of severe dengue have resulted, including 14 deaths. The last major outbreak was four years ago and the cycles of dengue infections run every four to five years. Read more
Advice for travellers
Dengue is spread by two types of 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.
Elevated flu reports; Low season dengue
High levels of influenza infections are being reported in India according to the WHO Global Influenza Update (Mar 18), ‘with influenza A(H1N1)pdm09 virus most frequently detected followed by influenza A(H3N2) viruses.’ In North America, influenza A(H3) viruses are predominating, while in Europe ‘although influenza A(H1N1)pdm09 was the most frequently detected virus overall, influenza A(H3N2) viruses co-circulated and predominated in some countries’ and for SE Asia, ‘few countries reported in this reporting period. A sharp increase of influenza activity was reported in Thailand, with influenza B most frequently detected followed by influenza A viruses.’ Read detailed reports for the US, Canada, Europe and Hong Kong.
THE CITY of Jaipur, in Rajasthan, is reporting dengue fever cases year-round with an increased number of infections presenting well after the monsoons - more than 90 cases have been recorded during the cooler ‘low season’ months this year. Read more
Advice for travellers
Seasonal flu is the most common vaccine-preventable travel-related illness because it is a potential risk during every stage of the journey. Whether you are travelling within Australia or overseas, Travelvax recommends vaccination, when available, for all travellers over 6 months of age. Read more about influenza.
Measles, rubella updates
The US CDC has updated their travel advisory for Japan in view of the ongoing rubella outbreak and offers particular advice for pregnant women who may be contemplating travelling there. The most recent data (Mar 13) from the National Institute for Infectious Diseases shows highest infection rates this year have been in Tokyo (245 cases), Kanagawa (124), Chiba (86) and Osaka (84). There is a separate travel notice regarding measles with the 2019 case count at 304 (Osaka 106 cases, Mie 51, Aichi 29 & Tokyo 28) - a number of the cases were acquired in Asian destinations including Philippines, Vietnam, Myanmar, Maldives, Republic of Korea, Cambodia, Sri Lanka and Malaysia.
Advice for travellers
Rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine, one of the routine immunisations which should be current for prior to overseas travel. Travellers should also check their immunisation status for tetanus, diphtheria, and whooping cough. Read more about rubella
Dry season alert
The quadrupling of dengue fever cases in the country’s NE during January, coming well before the usual high (wet) season, has public health authorities concerned. More than 9,000 cases and seven deaths were recorded up to Mar 5. Read more. Highest rates of dengue fever and severe dengue this year have been in the south, followed by the central and NE regions. While Malaysia has also recorded a year-on-year rise in the incidence of dengue fever and related deaths with almost 33,000 cases and 57 deaths in the year to Mar 19. Selangor has been hardest hit with almost 200 new cases daily.
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, IR3535, or oil of lemon eucalyptus, 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.
Capital district’s dengue spike
Recent heavy rains may escalate a dengue fever outbreak occurring near Port Louis. Forty cases in total have been reported, 35 in Vallée-des-Prêtres which situated on the eastern side of the capital. Read more. Just over 200kms away in Reunion Island, the dengue epidemic continues unabated with more than 500 new cases reported weekly. As of Mar 19, more than 2,300 cases have been reported this year with southern districts most affected.
Advice for travellers
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. 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 PMD when outdoors to all exposed skin. Read more about dengue fever.
MERS update
A summary of MERS in 2019 (to Mar 12) as published by the ECDC: ‘112 MERS-CoV cases have been reported in Saudi Arabia (99) and Oman (13). There were also 22 deaths in Saudi Arabia (18) and Oman (4). In Saudi Arabia, 36 cases were primary (20 of whom reported contact with camels), 31 were healthcare-acquired, 18 were household contacts and 14 cases are under investigation. The majority of cases in Saudi Arabia (76%) were reported in Wadi Aldwasir (56) and Riyadh (19). Six regions are affected with cases from the last 21 days and 10 of 13 regions in Saudi Arabia have reported cases in 2019’. Read more
NE region, Lima dengue
One district to the east of Lima has reported 34 dengue fever cases and health authorities say conditions in the area are optimal for the mosquito vectors. Insecticide spraying is to be carried out in Lurigancho-Chosica (which includes the Peruvian Union University) and across districts of east Lima. Read more. And in the NE region of Lambayeque, Ferreñafe is one of several towns reporting dengue cases. Read more
Advice for travellers
Avoid mosquito bites to prevent infection with 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.
Hospitals in crisis
Senior doctors have walked out of hospitals in protest over the lack of essential supplies needed to treat their patients. Emergency cases are still being cared for but that situation cannot continue for much longer before all the necessities have been depleted. One news source cites the doctors’ concerns on the ‘shortages of painkillers and syringes and … nurses had to wash and reuse bandages, increasing the risk of infection’. Read more