World travel health alerts 21 April 2021

Ebola response continues; Polio in 10 countries

Figures to Apr 16 point to another three suspected Ebola cases in N’Zérékoré and Gouécké admitted to the treatment centre as surveillance continues in the region; Lola is one of three sub-prefectures on alert. The WHO is maintaining communications with health authorities in the porous border areas shared with Liberia and Sierra Leone. And in the D R of Congo, with no new Ebola cases emerging, it will be another two weeks before the outbreak in North Kivu can be declared over. Read more

IN AFRICA, eight countries reported circulating vaccine-derived poliovirus type 2 (cVDPV2) to the GPEI last week: Burkina Faso, Republic of Congo, Côte d’Ivoire, the DRC, Guinea, Mali, Senegal and Sierra Leone. Guinea logged five cases, and Mali and Sierra Leone had two new cases, while the remaining five countries registered one case each. Over in the Middle East, Afghanistan recorded four cVDP2 cases and Yemen added another three cVDPV1 cases, all in Saadah.

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.

Mosquito-borne virus activity in Top End

The NT health department has reported widespread Murray Valley encephalitis and Kunjin virus activity in the Top End and it is expected to continue through to late July. In a department news release, a medical entomologist said that higher mosquito numbers would prevail ‘in rural areas, especially those close to swamps and wetlands’, so the public is advised to use protective measures when the insects are most active, ‘at night and in the early morning’.

Advice for travellers

While the risk of contracting MVE is generally low, the virus can cause severe illness, even death in very rare cases. The vector mosquitoes are active at dawn and dusk, particularly in the first two hours after dark. They pass on the virus to humans after feeding on infected birds attracted to flooded wetlands. Travellers to wetland areas of Australia should take all measures to prevent bites. Apply an insect repellent containing DEET, picaridin, or oil of lemon eucalyptus [PMD] to exposed skin when outdoors. More about MVE and Kunjin viruses.

COVID-19 related lockdown in Viti Levu’s west, global digest

The Ministry of Health and Medical Services in Fiji has established containment areas, door-to-door screening, contact tracing and enhanced testing around Nadi and Lautoka and in Naicabecabe Village on Moturiki Island after a hotel quarantine breach resulted in three locally acquired COVID-19 cases. More positive cases are expected as two of the infected individuals were among 500 mourners attending a recent funeral in Lautoka. Read more. Also in our region, a NZ news source reported that the SARS-CoV-2 positive body of a Filipino crewman had washed up on Vanuatu’s Efate island, near Port Vila on Apr 11. Outbound travel from the island has been paused for three days in order to allow contact tracing from first responders to the scene and further investigations to take place. On the global level, the WHO DG said late last week that new COVID-19 cases had almost doubled in the past two months as the highest rates of the pandemic edge nearer. Infections and hospitalisations are increasing alarmingly among the 25 to 59 years age groups, ‘possibly as a result of highly transmissible variants and increased social mixing among younger adults’. Concerns were also raised over the situation in Papua New Guinea, with positive cases recorded in 22 provinces. According to the health minister, ‘half of all cases and deaths were reported in the last month alone, and health workers are increasingly among those infected‘. Read more.  More information in the Apr 20 WHO epi update.

In related news:

- Air travel from India to Hong Kong have been paused for two weeks after a flight originating in Delhi reportedly led to up to 47 positive infections among the passengers after arrival in Hong Kong - most were apparently detected late in mandatory quarantine. A negative test taken 72 hours before departure is required of all passengers heading to Hong Kong. A similar ban has been instituted for travel from Pakistan and the Philippines. Read more

- At the Apr 13 IHR Emergency Committee meeting on the coronavirus pandemic, Temporary Recommendations to States Parties covered topics including vaccination, variants and international travel. The latter included the points: countries should not require proof of vaccination as a condition of entry, prioritisation of vaccination for seafarers and air crews, the implementation of ‘coordinated, time-limited, risk-based, and evidence-based approaches for health measures in relation to international traffic in line with WHO guidance and IHR provisions’, and reducing ‘the financial burden on international travelers for the measures applied to them for the protection of public health (e.g. testing, isolation/quarantine, and vaccination), in accordance with Article 40 of the IHR’. Read more

- According to findings released by the US CDC, 5,800 COVID-19 break-through infections diagnosed in fully vaccinated individuals represented less than one percent of the 77 million people who have received both vaccine doses. Further, the infections were seen ‘among people of all ages eligible for vaccination’, 45 percent were in the 60 years and over cohort, and ‘3,752 (65%) of the people experiencing a breakthrough infection were female’. It was acknowledged that there were likely to be considerably more asymptomatic infections than the 29 percent detected. Read more

- The COVID-19 vaccine tracker, developed at the London School of Hygiene & Tropical Medicine’s Vaccine Centre, has been around for the past year, providing real-time information on the vaccine landscape, clinical trials database, efficacy trial map, living review and implementation.

- Scenarios on the probability of booster shots for COVID-19 in the US are discussed in The Scientist.

RVF spreads to 5 regions

Investigations are continuing into at least five deaths in residents of Mananjary district (Vatovavy Fitovinany region), with Rift Valley fever suspected to be the cause. Several hundred cattle have died in the area since late March according to veterinarians sent to manage the epidemic and there are reports of viral spread to the regions of Analamanga, Atsimo Andrefana, Atsinanana and Diana. Read more

Advice for travellers

Rift Valley fever (RVF) is an acute viral disease that typically infects domesticated herd animals. It is generally found in eastern and southern Africa where sheep and cattle are raised, as well as in West Africa, Madagascar, and more recently Saudi Arabia and Yemen. People are infected after exposure to blood, body fluids, or the tissue of RVF-infected animals, or from the bite of an infected mosquito. The virus presents a low risk to travellers, but is another reason to use personal insect repellent and take other steps to minimise insect bites in places where it occurs. Read more about RVF.

Leptospirosis cases spike in south

High rainfall and localised flooding in some parts of the southern provinces has seen attack rates of leptospirosis rise, with the worst affected named by health officials as Ranong, Yala, Songkhla, Phatthalung and Phang Nga. To early April, 219 leptospirosis infections and three deaths had been reported, with farmers making up over one-third of cases. Also on leptospirosis, the number of cases reported in New Caledonia has risen further with 135 infections for the year to Apr 9 (cf. a total of 69 cases in 2020). 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.

MERS update

The WHO has published an update on MERS in the kingdom this year, with four cases from Riyadh and one case each from Jeddah, Al-Ahsaa and Makkah which resulted in three deaths. The agency forecasts more cases in the Middle East ‘and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to dromedaries, animal products (for example, consumption of camel’s raw milk), or humans (for example, in a health care setting)’.

Rising TB rates affect the young

Funding shortfalls and the lack of patient support and public awareness are said to be hampering TB control measures as disease rates continue to climb, particularly among the young. The eight states which had the highest prevalence of TB infections in the period 2015-19 were Khartoum, El Gezira, Red Sea state, Kassala, El Gedaref, Sennar, Blue Nile state, and White Nile state, however, on a national level, more than one third of active cases remain undiagnosed due to problems accessing testing. Read more

Tracking food source linked to Hep A cases

Health authorities are searching for the source of at least 28 non-travel related hepatitis A infections reported in England and Wales this year. Batches of dates imported from Jordan have been recalled from one supermarket chain as a precaution while investigations continue. Food Safety News reports that ‘genomic sequencing has identified three closely related strains of the Hepatitis A virus and investigations continue into a possible common source’. Further analysis may result in other food recalls or new advice.

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.

6 years of rising STI rates; 3rd variant flu case detected

The report is in for three STIs registered during 2019, with the CDC advising that chlamydia, gonorrhea & syphilis cases were at record levels for a sixth year in a row. Findings included the reportable STIs rose by almost 30 percent between 2015 and 2019, while congenital syphilis ‘nearly quadrupled’ during the same period, and gay and bisexual men made up nearly half of all syphilis cases. The agency also noted contributing factors to the rise in the incidence of STIs were dating apps which ‘made sex more anonymous—and contact tracing much harder’, and the decline in the use of condoms after HIV PrEP medications became available.

A YOUNG child has become the third case of an influenza A variant infection reported during the USA’s flu 2020-21 season – there have now been two A(H1N1)v viruses and one A(H3N2)v virus. No human-to-human transmission was linked to the infection and the child, who lived in Wisconsin and had contact with pigs, has since recovered. Read more

Advice for travellers

Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.