World travel health alerts 21 October 2020

World travel health alerts for 21st of October 2020.

6 countries with polio cases

Globally, a total of 26 polio cases were registered in the past week, with three WPV1 cases in Pakistan (Balochistan and Punjab provinces) and a single case in Afghanistan (Khost province), while in Africa the mounting tally of cVDPV2 infections continues: four cases in Côte d’Ivoire (Gbokle-Nawa-San-Pedro, Loh-Djiboua, Poro-Tchologo-Bagoue and Tonkpi provinces), 11 in Guinea (Kankan, N'zerekore, Conakry, Faranah and Kindia provinces), four in Mali (regions of Bamako, Mopti and Sikasso) and three in Niger (Dosso, Niamey, and Tahoua provinces). 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.

COVID-19, 40 million and counting; Flu reporting season begins

Global COVID-19 case numbers rose above 40 million this week, led by surges in both the USA (31 states are now ‘red zone’) and Europe. Read more. The ECDC has published the first in a new series of weekly maps showing the 14-day notification rates of new confirmed cases at the sub-national level, weekly testing rates and test positivity. This comes as the region’s weekly cases spiked by 25 percent with an even higher increase in death rates. Read more in the Oct 18 WHO epi update.

In other news, Argentina has recorded a surge in daily incidence becoming only the fifth country with more than a million infections (from a population of only 45 million) after cases started to rise in regional areas, including Ushuaia. Meanwhile, Belgium, Iran and Russia have all recorded daily increases in cases in the past week.

Related news:

-In planning for a safe resumption of normal activities, the Ministry of Health in Singapore is introducing a pilot program running through to December which will provide free ‘pre-event [antigen rapid] COVID-19 testing for larger-scale and higher-risk activities’, with events selected including ‘business-to-business events, wedding receptions, live performances, and sports events’.

-One news source has reported on extensive SARS-CoV-2 transmission that stemmed from a spin studio in Hamilton, Ontario, despite the facility following Canadian public health protocols. Read more

THE INFLUENZA reporting season in Europe has begun and, along with the USA and Canada, flu activity is pegged as very low, low or below average. According to the WHO global flu update (data to Sept 29), only two countries reported increased influenza detections - Cambodia and Laos. CIDRAP reported on the southern hemisphere’s 2020 flu season, noting that Australia’s 315 cases in winter were ‘down 99.8% from the 130,000 cases seen in most years’. Read more

Dengue cases up ahead of peak season

The American embassy in Lima has warned US citizens in the country of the heightened risk of dengue fever with the start of the peak season due next month. Prevalence has been elevated in high risk departments (including Loreto, Ica, Ucayali, San Martín, Junín, and Madre de Dios) during the cooler months as ‘normal prevention measures’ were put on hold during pandemic restrictions. News sources in Peru claim a 5-fold increase in dengue fever cases this year compared to the same period in 2019 and also increased dengue reporting in Bolivia and Ecuador.  Read more

Advice for travellers

Dengue is spread by 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. Read more about dengue fever.

Fever, malaria outbreaks in northern states

An outbreak of a Rift Valley fever in Northern State has had the greatest impact on Merowe and Ed Debba residents and caused thousands of deaths and miscarriages in their livestock. Disagreement exists between local and state actors on the extent of the outbreak which as sickened at least 1,490 people and killed at least 63. Read more. In the neighbouring state of North Darfur, floods have given rise to intensive mosquito-borne disease activity - up to 60,000 people are now said to be infected with malaria. Meanwhile, across the western border into Chad, the chikungunya outbreak in the eastern provinces of Ouaddai, Biltine and Sila has shown some decline following the gradual introduction of mosquito fumigation systems and the distribution of insecticide-treated nets. The WHO has also expressed some concern in its measles risk assessment for Chad, finding a ‘very high risk of transmission during the next measles season, expected in the fourth quarter of 2020 to June 2021’ due to lapses in disease monitoring and vaccine coverage/funding.

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.

‘Cautious optimism’ over Equateur’s outbreak

While the last confirmed Ebola case was reported back on Sept 28, there remains concern over positive cases known to be in the community and other challenges relating to funding. Protests, at times violent, have paused response measures in some locations, however on Oct 17, the Congolese virologist who was a co-discoverer of the Ebola virus in 1976 tweeted that the situation is under control after 16 days with no new cases and no patients in treatment centres. Read more

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.

Typhus vectors move ‘close to home’

While scrub typhus case numbers declined during lockdown with most residents confined to their homes, doctors in the city of Chennai (eastern state of Tamil Nadu) are now reporting an uptick in infections that are affecting children. More cases are being detected in urban areas with the probability the vectors, larval mites or chiggers, ‘have adapted to the city environment and are close to home’. Read more

Advice for travellers

Scrub typhus is a bacterial disease passed on to humans by mites that normally live on rodents infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus occurs throughout the Asia-Pacific region, where more than a million cases occur annually. There is no vaccine or prevention medication: avoidance hinges on minimising insect bites. Due to the disease’s 5- to 14-day incubation period, travellers often experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Read more about rickettsial diseases.

Source of south’s malaria cases

As the country closes in on malaria eradication certification by the WHO - provided there are no indigenous cases again this year - health officials announced that the 363 infections recorded in the SE province of Sistan-Baluchestan since March were in cross-border travellers from neighbouring Pakistan or Iranians who had visited Pakistan. 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.

Epidemics strike in north

Heavy rains that fell in northern desert regions over winter have helped boost the numbers of malaria parasite-carrying mosquitoes, resulting in recent epidemics. Currently, the situation in Gao and Ménaka is described as alarming, but cases are also being recorded in Tombouctou et Taoudéni. Read more

Advice for travellers

Sub-Saharan Africa presents a significant malaria risk. Travellers should discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. Read more about malaria.

Human WNV case confirmed

Coming a matter of weeks after the first detection of West Nile virus in birds in Utrecht region, a human infection has now been confirmed in the area. This year in Europe, almost 300 WNV cases have been reported – Greece with the most (137 and 20 deaths), followed by Spain (75, seven deaths) and Italy (65, five deaths). The ECDC also announced the first locally-acquired human WNV cases for previously unaffected areas of Bulgaria (Pazardzhik province), Spain (Badajoz province) and Germany (regions of Barnim, Ostprignitz-Ruppin, Saalekreis, Halle and Meissen).

Advice for travellers

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 during the peak transmission season should take measures to avoid mosquito bites. Read more on WNV.

New Taipei’s dengue cases top 46

Locally-acquired dengue fever cases have risen to 66 for the year, with roughly three-quarters of them in New Taipei (Sanxia, Luzhou, Tucheng, Banqiao, Zhonghe, Shulin and Linkou), while the remainder are from Taoyuan. And in Singapore, mosquito populations measured through traps placed in residential areas have stayed high since late August while weekly cases exceeded those for the same period in the past four years. The YTD total of dengue cases has now passed 32,000 and 45 clusters are currently characterised as high-risk (10 or more cases). 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.

JE cases for heavily populated province

Health authorities have confirmed one case of Japanese encephalitis (JE) and two more are suspected in Gyeonggi province, which surrounds the capital Seoul - all three reported the onset of symptoms last month. Peak JE season in the country is from Aug – Nov. Read more

Advice for travellers

A mosquito-borne virus, JE is usually found in many parts of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. 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.