World travel health alerts 22 June 2022

World travel health alerts for 22nd of June 2022.

Measles toll still climbing

New measles case numbers are said to be stabilising overall, however an increase in infections was logged by both the East and North regions last week. All provinces have been affected by outbreaks, but the hardest-hit are Badakhshan, Kunduz, Nangarhar, Kabul, Helmand and Takhar. To date this year there have been almost 55,000 suspected measles cases and 321 deaths. 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.

COVID-19 update

The WHO epi update of June 15 announced the highest regional increases in new COVID-19 cases in the Eastern Mediterranean and SE Asia, while the five countries with most new infections were the USA, China, Germany, Brazil and Australia. Read more

In related news:

- In Europe, the agency charged with ‘scientific evaluation, supervision and safety monitoring of medicines’, the EMA, is conducting a rolling review of Moderna’s bivalent vaccine which targets both the original SARS-CoV-2 strain and Omicron. Read more  

- A CIDRAP article this week outlines why ‘Women more likely to have long COVID, different symptom profile’. Researchers looked at long-term data on post-infection sequalae, finding ‘that women mount a more robust and rapid response, which helps with initial infection but might increase vulnerability to prolonged autoimmune-related diseases’. Read more

- The journal Nature writes on ‘How common is long COVID? Why studies give different answers’

Measles is back; Weekly average of flu cases rises

The country’s first measles cases in more than two years has been diagnosed in Victoria – in a returned traveller residing in the Geelong area who had visited the UK and Italy. Read more

THE MOST recent WHO update on global flu activity revealed Australia’s influenza A detections had increased since mid-April, with the rise currently exceeding the weekly 5-year average for this time of year. Also reported, elevated respiratory syncytial virus (RSV) activity in NSW, Qld and South Australia. In other flu news, Qatar reported a rise in flu activity, mainly due to influenza A(H3N2) and Chile saw moderate levels of influenza-like illnesses, ‘higher than is usual for this time of year’, with RSV detections also up across most countries in the sub-region.

Advice for travellers

In most years, 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. Whether you are travelling within Australia or overseas, 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.

Polio digest, cases in Africa, Pakistan

Two more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were announced in the latest GPEI update (in N'djamena) while three historic cases were added to the 2020 total for Burkina Faso – from Bobo and Ouagadougou. Pakistan media have reported another two wild poliovirus cases in North Waziristan – unvaccinated infant boys from Dosali and Mir Ali. 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.

Meningococcal meningitis outbreak suspected in NE

Laboratory results are pending to confirm an outbreak of what is suspected to be meningococcal meningitis in the NE province of Haut-Uélé. Four residents of the village of Konzokonvu were first to fall ill with symptoms suggestive of meningitis in late May, and by June 9, the total had risen to 45 and 19 deaths (from Apodo, Kossia, Akpandau and Tangi health areas). Testing is still being carried out, but early analysis of one sample detected Neisseria meningitidis type C. The area sits within the Meningitis belt of sub-Saharan Africa and is subject to frequent outbreaks. Read more

Advice for travellers

Meningococcal meningitis is an acute bacterial disease transmitted from person-to-person through close (kissing, sharing eating utensils) or extended contact. Risk factors include extensive travel in crowded conditions, extended contact with local people in crowded places and travel to sub-Saharan Africa’s ‘meningitis belt’ where meningitis outbreaks occur in the dry season (Dec-April) and just prior to the rainy season (May-June). Read more about Men. meningitis.

Public health achievement validated

More positive news on the elimination of human African trypanosomiasis (HAT), or sleeping sickness, after the WHO this week announced it had validated Equatorial Guinea’s public health achievement in eradicating the gambiense form within its borders, joining Benin, Côte d’Ivoire, Togo and Uganda. In the 20 years to 2021, cases of the gambiense form declined by 95 percent – from 26,095 to 750 in the 11 endemic countries. Read more

Advice for travellers

Human African trypanosomiasis is rare in travellers, however the tsetse fly, which spreads the disease, is found in many African countries. The aggressive flies are attracted to moving vehicles and bright and dark colours; they can also bite through light-weight clothing. Travellers should cover up well with neutral-coloured, medium weight clothing and apply an effective personal insect repellent at all times when outdoors. Read more on African trypanosomiasis and how to avoid infection.

Epicentre of widespread outbreak

The WHO last week proposed a unified response to the monkeypox outbreak, ‘removing the distinction between endemic and non-endemic countries’ and, going forward, issuing reports together from all five global regions. Europe has recorded most cases to date – 84 percent of the total. ( database has the number of confirmed and suspected cases at 3,246 from 55 countries and territories). Preliminary sequencing of samples from newly affected countries have detected the West African clade of the virus. The WHO has assessed the risk of infection spread in the EU as high and moderate elsewhere. In the UK, the public health agency is working towards interrupting transmission beyond managing contacts and occupations with exposure to the virus, and is now offering doses of the MVA-BN vaccine to higher risk groups such as those with multiple sex partners. Read more

Dengue warning to residents

With an average of 800 dengue fever cases recorded each week, authorities are warning that an epidemic is not far off unless people start taking measures to prevent infection and remove mosquito breeding sites. Read more

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.

Dengue spikes in early monsoon season

With the SW monsoon advancing across the country and dengue fever a year-round risk, Tamil Nadu and Karnataka have already been named as 2022’s top two states for dengue infections. Rajasthan is ranked third and the monsoon still to arrive over southern districts of the state - due later this week. In related news, peak rainy season has hit Sri Lanka and dengue fever cases have now topped 22,000 for the year, with highest rates in the Western Division and in particular the districts of Colombo, Gampaha, Kalutara, Kandy, Galle, Jaffna, Kegalle and Ratnapura. 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.

Cholera and gastrointestinal illnesses soaring

There have been dozens of confirmed and suspected cholera cases in the province of Sulaimaniyah in northern Kurdistan region, according to press reports, and thousands of people are receiving treatment for gastrointestinal illnesses in the province. While in Pakistan, the WHO reported a ‘significant increase in cholera cases’ in Sindh province (mostly in Karachi) and between 25 and 31 cases in the provinces of Punjab (including the city of Lahore) and in three districts of Balochistan. The agency assessed the situation as, ‘with ongoing transmission in close proximity to border areas and transportation hubs, the risk of international spread cannot be ruled out’. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travel, the risk of infection is low. Travellers 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.

Tick-borne infection moving into new areas

Compared to the same period last year there’s been a slight increase in cases of severe fever thrombocytopenia syndrome (SFTS), however an article posted in ProMED notes that 2021 was in fact a record year for SFTS. There has also been a geographic expansion of vector (tick) activity from western regions into two eastern prefectures - Aichi and Shizuoka. Read more

Advice for travellers

SFTS causes symptoms including high fever, vomiting, diarrhoea, blood abnormalities and multiple organ failure. There is no effective vaccine and deaths rates among those infected can be as high as 30 percent. Read more about SFTS in Japan

Cholera confirmed in capital

Doctors at the capital’s infectious diseases hospital have confirmed cholera in two residents of Bagbazaar in Kathmandu, and two more in Sanepa and Kapan in the Valley, leading to fears of a larger outbreak emerging. The onset of diarrhoeal illnesses comes at a time of wet weather and interruptions to household waste collection which have both contributed to the contamination of water supplies. 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.

High dengue attack rates in northern district

The dengue fever outbreak first announced in mid-April is not yet under control and cases are still being reported – mostly from the district of Água Grande, followed by Mézôchi, Lobata and Lemba. Read more

Advice for travellers

Dengue occurs both in urban and rural areas, around human habitation. The virus is spread by Aedes mosquitoes which breed in shady places close to dwellings and bite mainly during the daylight hours, making them difficult to avoid when 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 (or PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Diphtheria in SW city

An extensive diphtheria vaccination campaign is underway in the city of Al-Zabadani, in Rif Dimashq Governorate, after several confirmed and suspected cases were detected – the first in three decades. The bivalent vaccine (combined with tetanus antigen) is mandated for all residents of the city, which is located near the main Damascus-Beirut transport route. Read more

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.

1st JE case reported

A man aged in his 50s from Beimen District in Tainan City, who developed fever symptoms on June 7, has since been diagnosed with Japanese encephalitis, the first in the country this year. Read more

Advice for travellers

On average, 24 cases are recorded each year in Taiwan, mainly in the south from May to October, but peaking in June and July. Cases typically occur in rural, rice-growing areas where people live near the host animals, pigs and wading birds. While it is a low risk for most travellers staying in urban areas, expats and travellers spending extended periods in agricultural areas of Asia should consult their travel health provider about recommendations for vaccination. Read more about JE.