World travel health alerts 20 November 2019

World travel health alerts for 20th of November 2019.

Measles toll rises – travel advice issued; Regional update

The measles outbreak is expanding: government social media posts announced there have been 1,174 cases and 16 deaths. A 30-day State of Emergency is now in place and a mass vaccination campaign commenced. The Nov 19 govt. press release revealed that approximately ‘98% of measles cases are in Upolu, and notably concentrated in the Vaimauga West and Faleata West District with about 92% admission rates highest in children below the age of 5 years.  Travel advice includes the following recommendations ‘ALL travellers to Samoa to ensure their vaccinations are up to date before travelling. If uncertain of your immunization status, seek the advice of your healthcare providers before travelling; - Visitors who are already in Samoa and uncertain of immunization status, visit one of the vaccination clinics including the National Hospitals; - ALL travellers who have recently returned from Samoa to report to healthcare providers immediately if experiencing any of these symptoms - high fever, runny nose, cough, red and watery eyes and a rash.’

WITHIN the region, American Samoa declared a public health emergency on Nov 13 with warnings that ‘ALL visitors entering American Samoa through the Independent State of Samoa or the Kingdom of Tonga must provide proof of MMR (measles) ImmunizatIon or proof of MMR (Measles) Immunity as a condition of entry’. Failure to do so will result in denial of entry and return by the same vessel to the point of origin. Fiji now has seven confirmed measles cases and two more are suspected (from Navunikabi Namosi, the location of one of the most recent cases, a 19yo male). Measles vaccination is available free of charge for four groups most at risk of infection. There hasn’t been an update on the situation in Tonga since Nov 13 when suspected or confirmed cases numbered 251 – ‘86% are in the island of Tongatapu and 14% in Vava’u’. According to a Nov 19 UNICEF press release, measles vaccine coverage in 2018 for Samoa ‘was 40 per cent for the first dose and 28 per cent for the second dose’, Fiji’s was 81 percent for the first dose (based on available data), while ‘Tonga had a 99 per cent coverage’. New Zealand’s weekly measles case count dropped to 39 in week 46 from a peak in mid-September. In view of the regional outbreaks, the government of the Solomon Islands has launched a measles vaccination campaign for children under 6yo and has heightened surveillance at all points of entry.

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 tetanus at least 6 weeks before departure. Read more about measles.

Wild and vaccine-derived polio digest

More on the circulating vaccine-derived poliovirus 2 (cVDPV2) cases detected in July in north Pakistan with the GPEI pinpointing their locations  - the provinces of Gilgit Batistan and Khyber Pakhtunkhwa, as well as Islamabad. Also in Pakistan, two more WPV1 cases were detected in Khyber Pakhtunkhwa province take the national YTD total to 82 – compared with just 12 last year. The Nov 15 MMWR notes that there has been ‘a 31% increase in the proportion of WPV1-positive sites under environmental surveillance’ and sewage samples taken in in non-reservoir areas in other districts and provinces ‘have indicated wide WPV1 transmission’. Other cVDPV2 polio news from Africa: three new cases from Huambo, Uige and Moxico provinces in Angola; 10 cases from the DRC provinces of Haut Lomami, Kwilu and Kwango; and a single case this week from Nigeria (Kogi province).

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.

Cholera-hit districts, malaria cases continue to increase

After six months, cholera continues to spread and has moved beyond the most populous city, Bujumbura into rural areas – in all, four western and NW provinces are affected. Read more. The Nov 17 WHO African region update added a further 150,000 malaria cases in the week to Oct 27, taking the Burundi outbreak total to almost 7.4 million cases. In Angola, there have been fewer malaria deaths this year compared to 2018, however cases have doubled over the same 9-month period, averaging 700 new infections ever hour.

Advice for travellers

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

Smarter smartraveller website

The new smartraveller website will be launched on Nov 21 and the enhancements are outlined on the current DFAT site: ‘Our travel advisories will be easier to read and navigate. You’ll be able to receive all travel advice updates simply, just by using your email address to subscribe. We’ll offer a new option to get SMS ‘critical alerts’ in a crisis. Please note, current subscribers will need to resubscribe when we launch our new website. We know that’s an extra step but we think you’ll like how easy our new service is to use.’ Read more

A bad year for dengue locally, and in the region

The capital, Vientiane, and southern provinces have recorded most of the recent dengue fever cases with health authorities announcing infections have surged to more than 37,500 cases and 74 associated deaths (cf. 5,600 cases and 15 deaths in 2018). Read more. Also in the region, Malaysia's national dengue fever case total has risen above 115,000 with more than half of them from Selangor. WP Kuala Lumpur has recorded more than 13,000 cases. Elsewhere in the region, the Maldives has experienced a surge in cases this year - Male', Hulhumale' City, Shaviyani, Noonu, and Lhaviyani atoll are most affected. In Vietnam a significantly larger dengue outbreak is on the cards after cases this year tripled and deaths increased 5-fold over 2018 figures. More than 50,000 cases were recorded in Ho Chi Minh City and all 63 provinces are reporting cases. Earlier this month, an Indonesian public health official said that between them, Java and Bali had most of the 61,071 cases reported up to the end of October, followed by Sumatra with almost 22,000 cases. Almost half of Nepal’s 14,400+ dengue cases registered between July and early this month were from Chitwan and Kathmandu. See more reports from Nepal, including updated dengue, leishmaniasis, scrub typhus and malaria from the EWARS Nov 17 Weekly Bulletin. Pakistan’s dengue case count since early July has exceeded 47,000 from four provinces and two territories (KP, Punjab, Balochistan, Sindh, Islamabad and AJK). The WHO has assessed the risk of spread at a national level to be high and moderate for the region. Phuentsholing in Bhutan remains the centre of that outbreak after nearly five months and 4,300 cases. There has been a decline in new reporting; all but one of the 20 districts (dzongkhags) have recorded infections.   

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.

Ups and downs of the regional malaria update

From a Nov 18 PAHO report on malaria in the Americas (taking in YTD data to weeks 40-44), Colombia is one of several countries in the region with outbreaks occurring: almost 75 percent of all cases were in the departments of Chocó, Nariño, Córdoba and Antioquia. In Brazil, the state of Amazonas continues to have the highest burden of malaria this year, followed by Pará and Roraima. For the third year in a row, Venezuela reported more than 320,000 malaria infections. Overall, compared to 2018 data, increased malaria activity was reported in Panama and the Dominican Republic, but has decreased in Ecuador, Guatemala, Haiti, Honduras, Nicaragua and Peru.

Advice for travellers

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

Another plague case from northern region

A third plague infection has been reported from Inner Mongolia and, while the first two were the pneumonic type, the latest case was the bubonic form and said to be contracted through the consumption of wild rabbit meat. Twenty-eight contacts of the patient have been placed in isolation. No link has been determined between this and the earlier cases, however drought conditions across the region have led to a surge in rodent populations – a reservoir of the plague bacterium. Read more

Advice for travellers

Plague poses a low risk to most travellers. The majority of plague cases are due to bubonic plague following the bite of an infected flea carried by rats. If left untreated, infection of the lungs causes the pneumonic form of plague, a severe respiratory illness, which can progress rapidly to death. Read more on the plague.

Ebola update

In the regional weekly bulletin, the WHO is calling for intensification of contact tracing and case identification in Ebola virus hotspots such as Mandima, Mabalako and Beni. More from the Nov 19 epidemiological update. Late last week the DRC president was quoted as saying he believed the outbreak should be over by the end of this year.

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.

Hunt for Salmonella source

Investigations are underway in five European countries following the detection of (mostly non-travel related) Salmonella Mikawasima infections since the end of summer, according to the ECDC. The UK accounted for the majority of cases (138), followed by Sweden (31), France (18), Denmark (2) and Ireland (1) – a rise in reports has also been seen in Portugal. Genomic testing ‘indicates association with a common source. The lack of travel history for the cases and the recent identification possibly points to a vehicle of infection simultaneously distributed in different EU countries’. Sweden has also experienced a rise in the incidence of cryptosporidiosis. 

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. Read more

Act passed to require measles vaccination

Children enrolling in school or kindergarten from March next year must be vaccinated against measles or risk exclusion, and their parents may be fined up to €2,500 under the recently passed Measles Protection Act. The requirement for vaccination also includes, ‘Medical staff, daycare workers, teachers and workers at community facilities’. 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 dengue confirmed

More on dengue transmission in the Caribbean with a Jamaican news source reporting that cases continue (the west-central parish of Manchester has had 524 in the last month), taking the YTD total to over 6,400 at the start of November. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. They 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.

Hep A sparks vaccination campaign

After the source of a hepatitis A outbreak in the SE port city of Cartagena was tracked to a local restaurant, around 4,000 diners, staff and relatives of the 21 people diagnosed with the infection have been vaccinated by the Murcia health service. The timeframe for exposure to the virus was between Oct 30 and Nov 6. Read more

Advice for travellers

Vaccine-preventable Hepatitis A (HAV) is one of the most common infections affecting travellers. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and some types of sexual contact. A course of hepatitis A vaccine offers immunity that’s 99%-plus effective and long lasting. It is also important to follow safe food and water guidelines.

Risk to region from low vaccination rates

The ECDC warns that sub-optimal vaccination rates for diseases currently posing ‘public health events’, such as measles, diphtheria and pertussis, present a risk for the region due to the high cross-border flow of people from the Ukraine into Poland, Slovakia, Hungary, Romania and beyond. Overall, however, the risk of transmission for travellers is low ‘provided they are fully vaccinated in accordance with national recommendations’.

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.

Flu season’s early start in SE

CDC influenza reporting for the week to Nov 9 notes early season, high influenza-like illness (ILI) activity in Louisiana and moderate in five other SE states (Georgia, Alabama, Mississippi, Texas, South Carolina), plus Puerto Rico. Overall, ILI activity is described as being below baseline levels. The CDC notes ‘significant cocirculation of influenza A(H3N2), A(H1N1)pdm09 and B/Victoria viruses with the predominant virus varying by region and age group’. NSW Health earlier this month recommended travellers heading into the Northern Hemisphere winter consider having a (second) flu vaccination for the year – particularly for high risk groups. The northern flu vaccine may not be available here so, as ‘the best option to protect yourself prior to travel’, have our current vaccine at least two weeks before departure. Read more

Advice for travellers

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. 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.