World travel health alerts 22 January 2020

World travel health alerts for 22nd of January 2020.

More polio cases, one within Metro Manila

On Jan 16, the Dept. of Health reported that the number of polio cases had risen to 16 since the outbreak was declared in September 2019. Details were published on four new cases: one in Quezon City (located in Metro Manila, the National Capital Region) which occurred in a fully vaccinated, but immunocompromised, 3yo child; and the remaining three, all in boys aged three years or under, on the southern island of Mindanao. More information is provided in a Jan 16 ProMED report which also includes a global digest of wild and vaccine-derived polio cases.  

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 outbreaks stabilising in region

A Jan 17 government report advised that six more measles cases were reported in Tongatapu and ongoing transmission was also occurring on the island of Vava'u. The outbreak total was announced as 639 confirmed or suspected cases. In Fiji, good news with the spread of measles infections halted in Serua/Namosi, but not quite as upbeat for the rest of Central Division, however numbers are down and there have been no more notifications since the Jan 9 update. While in New Zealand, the 2019 measles case total had climbed to 2,174 by the week 51 update but the ESR has reported fewer than 15 since then; and NSW’s case count rose to nine last week with two more cases in Sydney – adults aged between 20-55 years. A joint WHO-UNICEF statement on Pacific measles situation released on Jan 20 summarises the recent/ ongoing outbreaks and the responses and continuing measures needed to ensure their align with the IHR requirements. Their advice includes: ‘ In the Pacific, all individuals travelling between Pacific Island countries and areas, or to and from the Pacific are strongly advised to ensure they are up to date with their vaccinations at least two weeks prior to departing’.

Advice for travellers

A highly contagious virus, measles occurs in developing and developed countries. 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.

Yellow fever vax prompt to residents of S/SE; High dengue, chikungunya burden

Residents of south and SE regions have been urged to get the yellow fever vaccination as peak season for the mosquito-borne infection arrives amid reports of deaths among monkeys, YF forest reservoirs, in the states of Paraná, São Paulo and Santa Catarina. The southern regions are mentioned specifically in view of ‘a large population and a low number of vaccinated people’. The January Epidemiological Bulletin lists by region the number of suspected and confirmed YF cases between July 2019 and Jan 2020, as well as epizootics. Read more

GLOBAL monitoring of chikungunya and dengue fever published in the week 3 ECDC Communicable Disease Threats Report (CDTR) named Brazil as one of four countries recording the most chikungunya cases since the Dec 20 update – the others were Thailand, India and Malaysia. The summary of dengue in 2019 revealed that Brazil’s dengue cases were 10 times higher than the previous year and accounted for more than 70 percent of dengue in the region – 2,201,000 cases. Notable upticks in dengue reporting were also seen in most SE Asian and Asian countries.  

Advice for travellers

Yellow fever virus is a mosquito-borne disease found in tropical and subtropical areas in Central/South America and Africa. While it can be severe, yellow fever infection is a very rare in Australian travellers. However, under the International Health Regulations (IHR), proof of vaccination may be required of any traveller entering or leaving an area at risk of yellow fever transmission. Read more about yellow fever.

STI ‘widespread’

Against the background of a general rise in the incidence of STIs across Canada, the province of Nova Scotia has declared an outbreak of syphilis. The infection is now widespread and more women are becoming infected. 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.

2019-nCov on the move

An emergency meeting convened under the IHR will take place today (Jan 22) to decide if the 2019-nCoV outbreak constitutes a Public Health Emergency of International Concern and to decide the measures needed to control it – a virtual press conference will then be streamed through the agency’s facebook and twitter accounts at 19:00 hours (Geneva time). Details of the virus, transmission and new cases are emerging every day – an update was communicated in the Jan 20 WHO sitrep but since then a case has been identified in both Taiwan and the USA; also infections in 15 healthcare workers in Wuhan indicate some human-to-human transmission. Live updates of the case count (in Chinese) can be found here.’ A leading medical research centre in the US, the NIH, is said to be in the very early stages of developing a vaccine against 2019-nCoV. DFAT’s Smartraveller website offers the following advice: ‘exercise a high degree of caution if you are travelling to Wuhan. If you are in Wuhan avoid live animal (or ‘wet’) markets, contact with living or dead animals, and contact with sick people’ and seek medical attention promptly if respiratory symptoms develop within two weeks of travel; advise the doctor of recent travel history. The US CDC has issued a Level 2, Practice enhanced precautions travel alert for travel to China and a HAN Update and Interim Guidance (on Jan 17). Afludiary, a Flutrackers discussion thread and virologydownunder.com offer updates on the evolving situation.

Dengue outbreak surges again

New dengue cases had dropped by late November but they are on the rise again with up to 41 people seeking treatment at a hospital in the capital, Majuro, on one day last week and 162 cases recorded for the 7-day period, a new high in reporting. Following the lifting of a travel ban, some outer islands have also confirmed dengue fever infections. Read more. And more on dengue in the Pacific with a Cook Islands govt. update on their 2019 cases advising that the six infections recorded in December took the total to 126 (confirmed and probable) – 122 on Raratonga and four on Aitutaki. Updates on dengue in the region have also been published in the Jan 12 Pacific Syndromic Surveillance System Weekly Bulletin.

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.

Ebola outbreak update

The latest CMRE newsletter advised that almost 400 Ebola virus disease cases were under investigation while a vaccinated healthcare worker was among the most recent confirmed cases in Beni. In the two affected provinces, new confirmed cases have been reported in Beni, Mabalako and Butembo (North Kivu), and Mambasa health zone in Ituri. Read the Jan 21 WHO Ebola Situation Report.

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.

Suspected viral contamination of seafood

Investigations are continuing into whether French live oysters sold in France, as well as Sweden, Italy, the Netherlands and Denmark may be behind their outbreaks of norovirus infections since the beginning of the year. Farming areas in seven French regions have been closed pending the results. Read more

Advice for travellers

Extremely contagious, norovirus infection is typically intense but generally short-lived, causing nausea, vomiting and diarrhoea, which may lead to more serious complications among young children, the elderly, and the sick. To minimise the risk, wash your hands after using the toilet and before eating, and practice good hygiene. Read more on norovirus.

Cholera outbreak now into 3rd year

Active cholera transmission, which has mostly affected young children, continues in Banadir and Lower Shebelle regions in the outbreak that has been underway for more than two years, producing 10,113 cases and 51 associated deaths. While in South Sudan, recent floods have caused a spike in water- and vector-borne infections, including acute watery diarrhoea and malaria; and in Ethiopia, South Omo and Gofa zones have reported most of the 1,000 or more cholera infections and 24 associated deaths since mid-December. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travellers, the risk of infection is low. Australians travelling to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care. Read more about cholera.

Dengue after-effect from cyclones

Following the recent passage of two cyclones, Vanua Levu’s main town, Labasa, recorded 10 dengue fever cases, but the Minister for Health has reassured residents that no other flood-related public health issues had arisen. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which 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.

Flu updates for the region, globally

Influenza detections across the region have risen since the beginning of the year however, according to Flu News Europe, for the week Jan 6-12 they largely remained at baseline or low levels – the exceptions being high activity in Turkey and Israel, and medium in Ireland, Wales, Latvia and some eastern Mediterranean countries. On a global level, the WHO update which takes in data to Jan 5 stated that ‘seasonal influenza A viruses accounted for the majority of detections’, however more than one third of all infections were due to B viruses (mostly B-Victoria lineage). Flu activity was on the increase in North America (all subtypes circulating), Central (B viruses predominate) and East Asia (overall increase with 3-year high for this time in China and Japan), Western Asia (elevated overall), Central/South America (increased detections in Mexico, Ecuador, Colombia) and SE Asia (continued or increasing levels in Laos, Malaysia and Singapore).

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.

Chickenpox alert for SW city

A health warning has been issued in Kerala after a rise in chickenpox cases was reported in the city of Alappuzha, known as the Venice of the East and for the houseboats sailing its backwaters. Read more

Advice for travellers

Chickenpox is a highly contagious disease caused by the varicella-zoster virus. Mainly passed from person to person by coughing or sneezing, it causes a blister-like rash, itching, tiredness, and fever. While the illness is generally mild in children, it can be more severe in young babies, adults, and people with weakened immune systems. Read more about chickenpox.

Mumps outbreak widens

After an upward trend in mumps cases last year, the country’s health agency has announced that infections are now widespread. 2019 finished with more than 2,700 cases recorded and a further 253 have already been registered this year – more than half of those in the 15 to 24 years age group. The MMR vaccine is being offered free of charge for those aged 11-30 years. Read more

Advice for travellers

These outbreaks of mumps highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to all destinations. Read more about mumps.

Lassa reported in Grand Bassa

Confirmed Lassa fever infections have risen to 20 and three deaths have resulted after an outbreak was declared in the coastal county. Read more

Advice for travellers

Lassa fever is an acute viral illness that occurs in West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5,000 deaths occur each year. However, Lassa is a remote risk for travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Read more about Lassa fever.

Increase in YF cases in central state; Lassa outbreak in Ondo

In an update on the yellow fever outbreak reported in Plateau state in late December, the number of affected local govt. areas health zones has risen from four to five and there are now 25 confirmed cases and 141 more are suspected. Read more

LASSA fever has killed 18 people and a further 28 are seriously ill in the SW state of Ondo - last year Edo, Ondo and Ebonyi reported most cases of the viral haemorrhagic fever. 

Advice for travellers

Yellow fever virus is a mosquito-borne disease found in tropical and subtropical areas in Central/South America and Africa. While it can be severe, yellow fever infection is a very rare in Australian travellers. However, under the International Health Regulations (IHR), proof of vaccination may be required of any traveller entering or leaving an area at risk of yellow fever transmission. Read more about yellow fever.

Leishmaniasis burden set to increase

A local news source has reported on a caution from the WHO which relates to an ‘impending outbreak’ of cutaneous leishmaniasis in the next two months, with the province of Khyber Pakhtunkhwa and tribal areas likely to bear the brunt. Read more

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

Switch in dominant dengue virus strain

More on Sri Lanka’s ongoing dengue outbreak this week with a local news article ascribing the rise in cases to a ‘previously latent’ strain of the virus (DENV-3), combined with intermittent rains since August. Surges in the incidence of dengue are occurring in alternate years as a latent strain becomes dominant - a general increase in dengue cases has been seen over the past 10 years. Read more. Singapore is also experiencing a resurgence of the same DENV-3 strain, one that has been relatively uncommon in the country for the past three decades, and so immunity among the population is low. The NEA is warning that high mosquito densities and dengue cases, plus the presence of the DENV-3 strain may lift the weekly case count above the current 300-400.

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.

Watch out when medusas are about

Each month, just over a week after the full moon, the risk of being stung by box jellyfish when spending time in the waters off Oahu’s south-facing beaches rises. A Hawaiian news source reports that the popular snorkelling site Hanauma Bay was closed after 30 reported stings on Jan 19 and further review was planned for the following three days of peak conditions. The Waikiki Aquarium publishes an online calendar estimating days of high probability for the presence of jellyfish while also warning that the creatures ‘may be present on any day of the year. Always obey warning signs posted on beaches.’ Read more