World travel health alerts 22 September 2021

World travel health alerts for 22nd of September 2021.

Round up of post-monsoon dengue & malaria reports

Over the past fortnight various news media have reported on increasing numbers of dengue infections in Delhi and, more specifically for DENV-2, across 11 states (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Uttar Pradesh, Maharashtra, Odisha, Rajasthan, Tamil Nadu, and Telangana). Read more. Other articles focused on rising cases of malaria in Uttar Pradesh (Bareilly) and Maharashtra (Gadchiroli and Mumbai). Authorities in Maharashtra said that the spike in confirmed dengue and malaria cases at this time may be due in part to testing facilities returning to more normal functioning after the pandemic peak earlier this year. Elsewhere, Dhaka has reported most of the dengue cases during Bangladesh’s peak season, with fewer than 1,700 infections of the national total of 16,000 from outside the capital. And in Pakistan, surges in dengue infections have been seen in Peshawar, Punjab and the Sindh.

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.

Cholera ravages regions

Heavy rainfall, lack of access to clean water and sanitation, and a health system strained by the pandemic have further aggravated the cholera outbreaks affecting numerous states. Just over half of all cases have been recorded by Bauchi, Kano and Jigawa. Read more. In neighbouring Niger, the regional WHO office reports that the situation regarding the cholera outbreak is ‘rapidly worsening’ amid the rainy season, with six of eight regions now affected including the capital, Niamey. Onward spread has now also been reported in Burkina Faso and Mali.

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.

In advance of malaria elimination plan

A local news article on the reported 62 percent decline in malaria cases this year compared to the same period in 2020 observed that this would place the National Strategic Plan for Elimination of Malaria in Cambodia (2011-2025) three years ahead of schedule. The post added that there had been no malaria-related deaths since 2018. 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.

Bird flu case in southern city

A woman from Youngzhou city (Hunan province) has become the country’s 19th H5N6 avian influenza case in 2021 after she contracted the illness at a poultry market earlier this month. CIDRAP reports that ‘H5N6 is known to circulate in poultry, mainly in Asia. Human infections typically occur in people who had poultry exposure and are often severe or fatal. China and Laos are the only countries to report human cases’. The Sept 18 ECDC update includes reports on human cases of avian influenza A(H9N2) and swine flu A(H1N1 and H1N2) variant viruses.

Advice for travellers

There are several strains of bird flu and while the high pathogenic strains can be fatal, infection generally poses a low risk for travellers – even for those heading to a region where the disease is present or an outbreak is occurring. Travellers should avoid contact with birds or poultry in marketplaces, wash hands thoroughly before and after preparing food, and observe strict personal hygiene. Read more on bird flu and how to avoid it.

Meningococcal meningitis outbreak in north; Measles cases top 33,000

An outbreak of meningococcal meningitis in Banalia territory, Tshopo Province, announced by the WHO on Sept 8 remains active and the latest update puts the current case count at 608 suspected cases (12 confirmed) and 161 deaths - 16 of 20 health areas in the Banalia health zone have reported at least one suspected case. Analysis of samples taken from several of the earliest confirmed cases detected Neisseria meningitidis serogroup W. The affected area, a mining zone along the Aruwimi River, is situated some 200kms NE of the provincial capital of Kisangani.  

THE NUMBER of suspected measles cases reported to the end of July this year have passed the 33,000 mark, with 505 associated deaths. An ECDC summary of the situation notes that this represents an increase since the extensive outbreak of 2018-20.

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.

COVID-19 cases spike, global digest

After last week’s WHO epi update announced the ‘first substantial decline in weekly cases in more than two months’, the Sept 21 post has reported another seven days of falling new COVID-19 case numbers and deaths - the greatest decreases were in the regions of the Eastern Mediterranean and South East Asia. In our Western Pacific region, notable falls in the incidence of new case reporting applied to both Japan and French Polynesia. Singapore’s COVID-19 cases have surged to levels last seen in April 2020 after some restrictions were relaxed - approx 82 percent of the population is fully vaccinated. Read more  

The Sept 14 epi update also contained a summary of ‘the current knowledge around SARS-CoV-2 infection acquisition and transmission and COVID-19 disease in children’ from the ages of under five years up 19. The older adolescent and young adult cohorts (15-19 yo and 20-24 yo respectively) ‘had the highest proportion of the global cases’, however deaths across all groups covered in the focus ‘represented less than 0.5% of the proportion of global deaths’.  

In related news:

- A Pfizer news release this week announced the outcome of a trial of the Comirnaty vaccine for children aged five to 11 years in which the vaccine was found to be ‘safe, well tolerated and showed robust neutralizing antibody responses’. The vaccine was administered in a two dose regimen of 10µg doses with a 21 day interval. The next step is to present data to regulatory bodies such as the FDA and EMA ‘as soon as possible’. Meanwhile, children as young as two years old in the Cuban province of Cienfuegos are being given the locally produced vaccine Soberana-2. Both Cuban vaccines, Soberana-2 and Abdala, are yet to be submitted to the WHO for prequalification and emergency use listing (EUL). The Sinopharm vaccine is in use, or proposed (non-mandated), for children as young as six years in El Salvador and Chile, and three years of age in the UAE and China, according to the Sept 17 JH situation report. Read more

- November 2021 is to be the timeline for when fully vaccinated non-residents will be able to enter the USA, subject to enhanced contact tracing orders, a negative COVID-19 test and full vaccination – the vaccines deemed to be acceptable are still to be announced. Read more

- 14 of 54 African countries have reached the WHO target of fully vaccinating more than 10% of its population against COVID-19 by the end of September.

- Nobel Laureate Professor Peter Doherty explains what we know about the SARS-CoV-2 virus so far, why it is so different to the flu, and why the vaccines are incredibly effective, despite some transmission in fully vaccinated people: Setting it straight video edition

Marburg outbreak over

After two incubation periods (42 days) elapsed without any new Marburg virus cases emerging in Gueckedou (N'Zerekore region), the outbreak, the first for Guinea, was declared over last week. The primary case was the only one identified despite monitoring of more than 150 high-risk contacts. The southern region of N'Zerekore was also the site of outbreaks of Ebola virus this year and in 2014-16. Read more

Advice for travellers

Marburg virus disease is a rare but severe viral haemorrhagic fever, related to the Ebola virus, and there is no treatment. Found in the African fruit bat, Marburg typically appears in sporadic outbreaks and laboratory-confirmed cases have occurred in Uganda, Zimbabwe, the Democratic Republic of the Congo, Kenya, Angola, and South Africa. Preventive measures are not well defined, as study in how it is spread continues, but travellers should avoid contact with fruit bats and sick primates in central Africa. Read more

Polio outbreak resolved but risk remains, global news

While no more polio infections have been detected since March 2020, health authorities have pledged to maintain high immunisation rates and continue enhanced surveillance ‘to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations’. A review will take place in 12 months, with Malaysia one of several countries designated in the most recent IHR Emergency Committee report as remaining vulnerable to reinfection (also Myanmar, Zambia, Philippines and Angola). Read more. In other polio news, northern and NE states of Nigeria were the sites of the 10 new circulating vaccine-derived (cVDPV2) infections announced in the latest GPEI update. These 10 are on top of last week’s 18 cases reported from seven states and take the YTD total to 151 (cf. eight in 2020). The only other cVDPV2 detection logged in the GPEI post was in Mali (Bamako).

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.

Typhoid vaccine added to immunisation program

Positive news, with a vaccination campaign recently underway in schools on the island of Upolu, administering a conjugate typhoid vaccine (TCV) to students. Plans are to extend the reach of the vaccine to all Samoans aged from one year up to 45 years. A trial conducted in Malawi on children aged nine months to 12 years estimated the efficacy of the TCV to be 84 percent and it presented a strong safety profile. TCV has been introduced recently into routine immunisation programs in Pakistan, Liberia and Zimbabwe. Read more

Advice for travellers

Typhoid fever is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.