World travel health alerts for 22nd of May 2019.
Flu threshold revisited for 2019 season
The threshold that determines the official start of the flu season in NSW has had to be revised this year after high rates of infections were recorded over the summer and autumn months (also in other regions across the country). Rates of five percent and above have been the trigger in the past, however that figure has been exceeded each month this year. Currently South Australia is leading the tally in flu cases with 14,018 cases to May 20, followed by NSW (13,043) and Qld (10,900), from a national total of 51,523 laboratory confirmed notifications. Read more
Advice for travellers
The 2019 flu season is now underway in the southern hemisphere and Travelvax Australia recommends vaccination for all travellers over 6 months. Seasonal flu is the most common vaccine-preventable travel-related illness, posing a risk aboard aircraft, in crowded airport terminals, and at your destination. 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. Hand sanitiser is a convenient alternative if soap and water is not available. Read more on seasonal influenza.
Measles count climbs to 880, global round-up
The CDC reported another 41 measles cases up to May 17, taking the total this year to 880 in 24 states. Elsewhere in the Americas, the PAHO has updated 2019 data from Apr 18, noting that nine countries have reported cases in the most recent 4-week period, Brazil (70 cases), Venezuela (63), Colombia (27), Canada (12 cases), Uruguay (6 cases) and one case each in Chile, Costa Rica and Peru.
In New Zealand, Auckland’s case count has risen to 65 with the highest incidence in the west and central areas of the city. Health authorities in La Louvière, Belgium, have seen an increase in measles infections over the past three weeks (30-35 per week compared to 1-2 per year). Ukraine’s YTD total is nearing 50,000 cases. Across Asia, there are updates for the Philippines, Hong Kong, Vietnam and India (Kerala and in particular, the capital Thiruvananthapuram). In the African region, outbreaks have been reported in Nigeria (2,157 suspected cases from 34 States and FCT), Madagascar (from Sept 2018 – 11 May, 909 deaths from 145,136 cases) and Ethiopia (Oromia, Amhara and Solami regions) has recorded over 5,600 suspected cases.
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.
Local Mayaro fever near Rio; Dengue, chikungunya spike
Concerning news that locally-transmitted Mayaro virus has been identified in the city of Niterói, under 10kms from Rio de Janeiro, across Guanabara Bay. Only three cases have been confirmed to date, however a local news report states that the virus has been present in Rio since 2016 and abundant mosquito vectors are present. Read more
CASES of chikungunya have been on the rise in the city and state of Rio de Janeiro, while as a whole, Brazil has seen dengue fever cases increase by up to six times over 2018 data (586,000 cases). Across the Americas, other nations reporting substantial dengue totals are Colombia (32,000), Nicaragua (21,000) and Mexico (13,000) to May 4.
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.
Wet season warnings
Health warnings have been issued after the arrival of the rainy season last week. Effective hygiene and mosquito-bite prevention measures are advised to prevent water-borne infections (including cholera, dysentery and leptospirosis) and insect-borne diseases such as dengue and malaria. Read more
Advice for travellers
Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative medication with their healthcare provider. For advice, call Travelvax on 1300 360 164. More on malaria.
Rapa Nui’s dengue
There have been at least 22 confirmed DENV-1 dengue fever cases on Easter Island and a further 10 are suspected. A health alert has been declared in order to manage the outbreak as authorities express some concern over the DENV-2 cases occurring in Tahiti. Read more. Radio New Zealand is reporting that DENV-2 infections have now spread beyond Tahiti, with one each in Taiohae (the Marquesas) and Bora Bora. In New Caledonia, new dengue cases (DENV-2) are slowing with the YTD total now at 3,367 cases and in the Cook Islands the outbreak total remains at 50 (DENV-1), however ‘while health authorities anticipate more victims, extensive efforts are being made to ensure the spread is minimised’.
Advice for travellers
Avoid mosquito bites and you won’t get 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.
Dengue strikes Abidjan’s young
The capital Abidjan and nearby Cocody-Bingerville health district are reporting a rise in dengue fever cases, with the highest incidence of infections among children aged under 15 years. More than 560 suspected infections were recorded up to week 20. 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.
Risk of EVD spread ‘very high’
Words of caution from the WHO Director-General this week on the NE’s Ebola virus disease outbreak. In a keynote address to the 72nd World Health Assembly, Dr Tedros Adhanom Ghebreyesus admitted they were ‘fighting one of the world’s most dangerous viruses in one of the world’s most dangerous areas’, with a very high risk of spread beyond the two provinces. Recent case details can be found in the Ministry of Health newsletter of May 21, WHO dashboard and External Situation Report (May 21).
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.
Post-cyclone cholera update
Cholera outbreaks continue in the wake of the March/April cyclones, affecting Beira, Buzi, Dondo and Nhamatanda in Sofala Province and Pemba city and surrounding districts of Metuge and Mecufi in Cabo Delgado province. In Kenya, UNICEF’s regional update to May 17 reports that ‘new cases emerged from the following five Counties: Mandera (64), Garissa (34), Nairobi (25), Embu (6) and Kajiado (1)’ while authorities in Mombasa have banned the sale of food and beverages from unlicensed vendors as part of a suite of control measures aimed at preventing cholera infections. 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.
Chikungunya at 13-year high, dengue cases top 2,100
As the number of chikungunya cases this week climbed over 925, the highest since 2006, it was revealed that almost half were from the capital Malé and Hulhumalé, and another 291 from Gaaf Alif atoll. Dengue fever is also impacting the archipelago with many cases in northern and central atolls – across the republic this year there have been 2,102 cases (520 in April). Read more
Advice for travellers
Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever and Zika virus. 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.
Tick-borne fever reports from region
The NICD reports that three provinces have each confirmed one case of Crimean-Congo Haemorrhagic fever (Free State, Northern Cape and North West) this year, adding that cases are rare and ‘mostly reported in farmers, veterinarians, abattoir workers, hunters and other individuals who are at higher risk of exposure to the hyalomma ticks’. The WHO African regional bulletin (week 20) states that up to May 15, in Namibia, ‘seven suspected cases of CCHF were reported from five regions, including one laboratory confirmed case out of seven samples tested and one death (case fatality ratio 14%). Forty-five close contacts, including healthcare workers and family members are being followed up’. There are concerns that drought conditions could ‘intensify the risk of transmission and geographical spread of the disease, with livestock movements from arid to less dry areas’. More in a report from the ECDC.
Advice for travellers
CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.
Polio count rises
Four more wild poliovirus infections (WPV1) were reported by the GPEI this week, three from Khyber Pakhtunkhwa province (Bannu and North Waziristan districts) and one from Sindh (Larkana District), taking the national YTD total to 15 (17 via a local news source on May 21). A positive environmental sample was also detected in the SE province of Sistan-Baluchistan in Iran, near the Afghanistan/Pakistan borders. 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.
WHO issues dengue update
On May 20 the WHO issued a Disease Outbreak News post on the nation’s ongoing dengue fever outbreak, outlining possible causes for the unprecedented ‘upsurge’ in confirmed and probable cases: ‘an increase in the viral load of asymptomatic cases over the threshold values of infectivity for mosquito vectors; lack of herd immunity in the local population for the prevailing serotype, but also for other co-circulating serotypes, thus favoring further transmission of the virus; co-circulation of different serotypes (since 2014) may result in more severe hemorrhagic fever cases and increase in deaths, in particular among secondary cases.’ The island’s popularity with tourists suggests that the ‘current outbreak increases the likelihood of exporting dengue virus to other countries’ and for the introduction of other strains through arriving passengers.
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.
JE season starts
The large southern municipality of Kaohsiung is the location of the country’s first Japanese encephalitis case this year. According to a local news source, during the incubation period the man had been to the districts of Daliao and Fengshan where risk factors are present (pig farm and rice paddies). The report notes that JE occurs in Taiwan from ‘May to October, with June and July the peak period’. Read more
Advice for travellers
A mosquito-borne virus, JE is usually found in many part 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 urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.
YF cases in 2 locations
The WHO African regional office has reported two confirmed yellow fever cases dating from March: one from Masaka (Central region) and the other from Koboko (Northern region). Read more
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.
Anthrax warning for Zambezi valley
Members of the public has been warned against consuming ‘biltong from unknown sources’ after a surge in suspected anthrax deaths among wildlife in endemic zones of the Zambezi Valley (sections of Matetsi Safari Area). Read more
Advice for travellers
The anthrax bacterium is transmitted to people in the form of spores which are can produce disease through consuming contaminated meat, through inhalation or via contact with the wool, hair or hide of infected animals. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about anthrax.