World travel health alerts 21 August 2019

World travel health alerts for 21st of August 2019.

First cVDPV case

Benin joins Nigeria (Kogi State), the Democratic Republic of the Congo (Haut Lomami) and Angola (Lunda Norte) in reporting circulating vaccine-derived poliovirus (cVDPV) cases this week after announcing its first cVDPV2 case, detected in Kalalé district in the NE department of Borgou, which shares borders with Nigeria. Benin’s polio vaccine coverage last year was estimated to be 60 percent. Pakistan also recorded five more wild poliovirus type 1 cases (Khyber Pakhtunkhwa province) taking its YTD total to 53. 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.

Measles status downgrade, WHO global update

Measles elimination was declared in 2017 in the UK but a Public Health England blog dated Aug 19 explains how considerations such as increased numbers of infections and the detection of the B3 Dublin measles strain ‘for more than 12 months across 2017 and 2018’ has resulted in it losing that status. Of concern for the agency has been the importation of measles infections from regions reporting outbreaks, as well as a lower-than-required vaccine coverage for the second MMR vaccine (87.4 percent). The WHO has released provisional data based on monthly reports for the year to August noting that major outbreaks continue in Angola, Cameroon, Chad, Kazakhstan, Nigeria, Philippines, South Sudan, Sudan and Thailand. Together with news that the first half of this year saw more measles reported than in any year since 2006, the agency announced that in July this year, ‘86% [of] children have received the first dose of measles vaccine and 69% the second. This means that around 20 million children in 2018 received no measles vaccine through their routine vaccination programmes. Furthermore, 23 countries have yet to introduce the second measles vaccine dose into their national schedule’. Other measles news this week from Malta and Brazil.

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.

Reasons for early flu season, global update

A report by Barr et al., 2019, ‘Intense interseasonal influenza outbreaks, Australia, 2018/19. Euro Surveill. 019;24(33):pii=1900421 published this month in Eurosurveillance explains that the pre-season surge in flu cases this year was ‘complex and due to multiple factors’ that included an extensive influenza outbreak occurring during the tropic's rainy season and a mild but lengthy preceding flu season in 2018 which produced ‘a larger susceptible population’. In other flu news, the latest WHO global influenza update (data to Aug 4) notes that activity has peaked in most countries in the southern hemisphere’s temperate zones, however in ’Queensland, activity had not peaked yet. Western Australia reported ILI activity higher than that of the 2017 season.’ Elsewhere, influenza A(H1N1)pdm09 viruses predominated in Myanmar (detections remained high) and in Uruguay (minor increase).

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 for all travellers over 6 months of age. Read more about influenza.

Dengue epidemic cycle uptick

According to the PAHO, the region is ‘experiencing a new epidemic cycle of dengue, with a notable increase in cases’ mostly affecting children under 15 years of age. More than two million people have been infected this year and the death toll has already exceeded 720. Dengue outbreaks are currently having the greatest impact in ten countries - Nicaragua, Brazil, Honduras, Belize, Colombia, El Salvador, Paraguay, Guatemala, Mexico and Venezuela. 

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.

3 EVD cases in South Kivu

A third NE province is now implicated in the Ebola virus disease outbreak with three cases this week reported in South Kivu – all three are linked to the hotspot city of Beni in North Kivu. More information on the outbreak and response measures can be found in the latest WHO situation report and the DRC’s Ebola response committee’s newsletter for Aug 19.

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.

Eastern city’s chikungunya spike

More than 4,000 chikungunya infections have been recorded in the industrial city of Dire Dawa in the country’s east; authorities announced the outbreak two weeks ago in the area which is home to around 2.5 million people. Read more

Advice for travellers

Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Apply an effective repellent when outdoors to all exposed skin. Read more about chikungunya.

Ticks, bacterial infection they transmit increase

Research carried out this year following the detection of a probable case of spotted fever in a horse owner living near Siegen in the central west also revealed that the vector, the hyalomma tick, is becoming more prevalent in Germany. Further, rickettsial bacteria have been found in around half of the ticks tested. ProMED notes that ‘[i]n Eurasia, both _Hyalomma_ species are considered transmitters of the Crimean Congo hemorrhagic fever virus and the Arabic hemorrhagic fever virus (Alkhumra virus). They also transmit the bacterium _Rickettsia aeschlimannii_, which causes a form of spotted fever’. More on the epidemiology of rickettsioses from the ECDC.

Diphtheria in Hyderabad; Upward trend in insect-borne infections

The 240 diphtheria infections reported in Hyderabad, capital of Telangana state, over the past eight weeks occurred in young babies right up to adults 60 years of age, killing as many as 4 patients each week recently. Read more

MOST PARTS of the country are entering the peak season for infections related to monsoon conditions: Substantial dengue virus transmission is occurring in the northern state of Uttarakhand (Dehradun district) while there has been increased reporting in the southern states of Karnataka (Bengaluru) and Tamil Nadu (Chennai). Assam’s Japanese encephalitis toll has climbed to 147 from the 618 cases recorded to date this year. Finally, in the Himalayan state of Himachal Pradesh, scrub typhus has killed five people this year in the districts of Shimla and Mandi.

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.

Caution on eating undercooked pork

The Health Protection Surveillance Centre has again issued warnings on eating undercooked pork products due to the risk of hepatitis E infection. According to the ECDC, in developed countries the hepatitis E virus (HEV) ‘is a zoonosis mainly transmitted to humans through consumption of contaminated, not-properly-cooked pork or game meat or other meat products, but also through shellfish or contaminated vegetables’. Consuming barbecued pork meat is of particular concern as the product’s internal temperature may not reach the required minimum to kill the virus (75°C) during cooking. HEV-3 (20 subgenotypes) is the most common hepatitis E genotype in Europe. The ECDC also states that in’ the last 10 years a 10-fold increase in reported cases was observed in EU/EEA countries with more than 5,500 cases in 2015’. Genotypes 1 and 2 (human only infection mainly transmitted through the faecal-oral route) are more prevalent in developing countries. Read more

Preparations for annual plague season

Three villages have undergone disinfection processes following the detection of 13 (as yet unconfirmed) cases of the plague - Amboana Arivonimano, Ambatomirahavavy and Faratsiho – as the peak plague season approaches. Clean-up campaigns are already underway and rat traps with added insecticide (used for both rat and flea control) have been placed in high risk areas of the capital Antananarivo. Two years ago plague killed more than 200 and sickened 2,000 over an 8-month period. Read more

Advice for travellers

Plague occurs annually in Madagascar, but poses a low risk to most travellers. Most cases of plague 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.

Dengue spread to capital to be confirmed

The dengue fever outbreak that sparked a state of emergency on the eastern Kwajalein Atoll is thought now to have spread to the archipelago’s capital of Majuro. Test results on two suspected cases who had travelled from Ebeye Island to Majuro before becoming ill are pending. Read more

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.

Hep E cases top 6,000

Central provinces remain those most affected in the hepatitis E outbreak that first began in Windhoek in December 2017 before spreading to a total of nine regions. Almost three-quarters of all cases have been in the 20 to 39 years of age group with men making up slightly higher numbers (60 percent) – overall the outbreak has resulted in 6,151 suspected hepatitis E cases. Read more

Advice for travellers

The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Infection during the latter stages of pregnancy carries a higher rate of severe disease and mortality. Unlike the Hep A and B viruses, there is no vaccine for this strain in Australia, which is especially common in communities with lower levels of sanitation and hygiene. Read more about the virus and how to prevent it.

Measles count’s sharp rise

A local news source has reported a surge in measles reports over a recent 10-day period with 126 new infections across the Auckland region. On Aug 21 the YTD total had risen to 585 - Manukau health district has the highest incidence with 400 confirmed cases, followed by Waitemata and Auckland (115 and 69 respectively). 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. 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.

Rabbit fever uptick

Five counties have reported the majority of the country’s tularemia cases this year (Dalarna, Gävleborg, Örebro Västerbotten and Norrbotten) as the overall incidence is noted to have risen this year ahead of the usual reporting season (peaks in September). Insect bite avoidance measures are recommended in risk areas. Read more

Advice for travellers

The main hosts of tularaemia bacteria in Europe are rabbits, hares and rodents and the majority of infections contracted there are through tick or mosquito bites, or by ingesting contaminated food or water. It is described as often being 'a long and debilitating disease' that can affect the eyes, lymph nodes, skin and lungs. Prevention measures include avoiding insect bites and the ingestion of (untreated) surface water. Read more on tularaemia.