World travel health alerts for 23rd of January 2019.
High Aedes count bad news for 500 cities
After gauging Aedes mosquito densities in over 5,500 municipalities, authorities now state that up to 500 of them are at risk of outbreaks of diseases such as dengue, Zika virus, chikungunya and yellow fever, and nearly 2,000 more cities are on alert. Highest rates were in the Central West, followed by the southeast. Read more. Recent dengue fever reports have come from Goiás, São Paulo, Minas Gerais, Mato Grosso do Sul, Paraná and Tocatins. And since Jan 15, there have been several confirmed and suspected yellow fever cases in El Dorado and one report from São Sebastião, both in the state of São Paulo.
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.
Little kids hard-hit in flu outbreak
More than 300 of Hong Kong’s 1,000 pre-schools and kindergartens have been closed for a week in an effort to contain their flu outbreaks. Kowloon City, Sha Tin and Tuen Mun were worst hit in recent days, however all areas are reporting cases. The closures were ordered to manage the ‘critical stage’ of the outbreaks. Read more
Advice for travellers
Seasonal flu is the most common vaccine-preventable travel-related illness because it is a potential risk during every stage of the journey. Whether you are travelling within Australia or overseas, Travelvax recommends vaccination, when available, for all travellers over 6 months of age. Read more about influenza.
Hep A on Gulf of Nicoya coast
Contaminated food is believed to be responsible for 33 hepatitis A infections reported over an 11 day period this month in the communities of Barranca, Chacarita and El Roble, in the west coast province of Puntarenas. Poor hygiene used in food preparation was implicated after testing of local water supplies cleared it as a source of infection. Read more
Advice for travellers
Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is highly effective and offers long term protection.
Cholera in SE; Ebola update
Cholera has struck eastern parts of the country’s second largest city, Lubumbashi, and other districts of Haut-Katanga Province, with nearly 1,200 people falling ill and 64 deaths resulting. Contaminated river water used for drinking is believed to be the cause of the outbreak, now into its sixth month. Read more
NEWS on the Ebola Virus disease outbreak in the NE provinces of North Kivu and Ituri is contained in the Jan 18 update by Médecins Sans Frontières and the Jan 22 Ministry of Health newsletter.
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 alert in 3 provinces, forecast for Jakarta
Jakarta is likely to be under a dengue alert during February and March as calculations based on the current humid weather indicate ideal breeding conditions for Aedes aegypti mosquitoes. In the first 17 days of 2019, ten provinces have recorded rises in the incidence of dengue and three ‘have declared a dengue fever emergency’ - North Sulawesi, East Nusa Tenggara and Central Kalimantan. Read more
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.
Regional dengue warning issued
It’s been 10 years since the region experienced a large outbreak of dengue fever (there have been extensive outbreaks of Zika virus and chikungunya in the interim however). Increased dengue case numbers in Latin America last year, the recent spike in cases in Jamaica and disease modelling undertaken by the Caribbean Public Health Agency triggered its announcement ‘that another regional outbreak of Dengue may occur in the near future’, and so regional countries must employ measures ‘to reduce mosquito breeding and prevent the spread of disease’. Read more
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.
Measles count nears 20,000
The measles outbreak is now approaching the four month mark and it has been reported that almost two-thirds of cases have occurred in children under 14. The case count to Jan 7 exceeded 19,500 and there had been 39 deaths in hospitals (and an unspecified number of community deaths). All 22 regions have recorded cases including ‘densely populated urban cities including Toamasina, Mahajanga, Antsirabe, Toliara and the capital city Antananarivo. As noted by the WHO’s Dr Peter Salama in his twitter feed, the outbreak is ‘occurring concurrently with resurgence of seasonal #plague, straining the public health response’. Read the WHO report. With recent and ongoing measles outbreaks in the region, health authorities are urging residents of the island of Reunion to ensure their measles vaccinations are current. The Director of Health Surveillance and Security for the regional health agency (ARS) cited outbreaks in Madagascar and Mauritius, and several cases in Mayotte and Comoros. Thirteen cases have been reported in southern districts of Reunion since last week, with vaccination coverage at around 80 percent, according to Dr François Chieze who was quoted in a local news article.
Advice for travellers
Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. In general the infection is relatively benign, but complications 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.
Unchecked dengue in parts of Penang
Penang has experienced a two-fold rise in dengue fever cases early in the year with over 500 cases and two deaths reported. There are several dengue hotspots in Penang and a local news source is reporting four mainland areas with ‘uncontrolled epidemics’. Read more. Selangor’s outbreak continues with the city of Klang, west of Kuala Lumpur, recording almost 1,000 cases up to Jan 18.
Advice for travellers
Don’t get bitten 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.
RVF in circulation again
Cases of Rift Valley fever have been on the rise in this overseas department of France, situated in the Indian Ocean to the NW of Madagascar. Twelve human cases were reported on the archipelago in the six years following the first detection of the virus in 2007, however there have been five more cases since late November last year, ‘a new circulation of the virus’. Read more
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.
Measles, Zika imports
Health authorities in Waikato and the Bay of Plenty on the North Island have reported several measles infections related to travel. In a separate post, as published by ReliefWeb from Epidemic and emerging disease alerts, ‘One (1) imported case of Zika virus infection with travel history to Samoa was reported by New Zealand ESR for the period 12/01/19 to 18/01/2019’.
Advice for travellers
Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information on smartraveller (DFAT).
YF outbreak continues, US travel notice updated; Lassa fever outbreak declared
The US CDC has updated its travel notice (level 1) regarding the yellow fever outbreak advising that ‘the outbreak has expanded throughout the country’. Currently, ‘all 36 states and the Federal Capital Territory had reported more than 3,500 suspected cases and a number of deaths. Edo State had reported a large number of suspected cases, several of them laboratory-confirmed as yellow fever’. The key point of the notice: ‘Those never vaccinated against yellow fever should avoid travel to Nigeria during the outbreak.’
FOLLOWING recent trends of increases in Lassa fever cases during the dry season, 60 confirmed cases and 16 deaths have been reported in the year to Jan 13 from eight states (Edo, Ondo, Bauchi, Nasarawa Ebonyi, Plateau, Taraba and the Federal Capital Territory). An outbreak has been declared and a response mounted in conjunction with international agencies. 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 5000 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.
Sand fly-borne infection in NW province
Hilly areas of Karak district have been hardest hit in an outbreak of cutaneous leishmaniasis in the NW province of Khyber Pakhtunkhwa, however cases have also been recorded other parts of the province including Nowshera, Mardan, and Peshawar. Read more
Advice for travellers
Leishmaniasis is a parasitic disease spread by infected sand flies and is found in the tropics and subtropics, as well as in southern Europe. There are two main forms – cutaneous and visceral. The former causes skin ulcers, the latter a severe systemic disease that is usually fatal without treatment. Read more on the disease, where it’s found and how prevent it.
MERS update, new cases in Riyadh and Makkah
MERS cases reported in the first three weeks of this year have totalled six, with four in Riyadh region and two in Jeddah. In the most recent MERS situation update (Dec 2018), the WHO advised that the ‘age group 50–59 years continues to be at highest risk for acquiring infection of primary cases’ and ‘30–39 years is most at risk for secondary cases’. Advice on preventing infection is included in the latest Disease Outbreak News post.
What not to bring home from your travels
Timely advice for South African travellers heading to other countries in the region, as well as overseas, as provided by the National Institute for Communicable Diseases. Much of the information focuses on insect-borne diseases - malaria, African tick bite fever, East African trypanosomiasis, dengue fever, chikungunya & West Nile fever - but it also includes food and water-borne infections, flu and measles. Read more
Advice for travellers
Read more about rickettsial infections which include African tick bite fever.
Measles alerts for 2 provinces
At least 400 people - young children and babies at childcare centres, family members and hospital staff - in Ansan (Gyeonggi Province) are all being monitored after they potentially came into contact with some of the eight recent measles cases. Other unrelated cases (16 in total) were notified in Daegu and North Gyeongsang province. Measles was declared eliminated from South Korea in 2006. 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. In general the infection is relatively benign, but complications 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.
Chikungunya in 12 provinces
People infected with chikungunya while in Bangkok are thought to have spread the virus to their local communities after returning to their villages in the NE province of Surin. Over 120 chikungunya cases have been recorded to date. Read more. Bureau of Epidemiology data for Jan 1 to 14 advises that of the 12 provinces reporting chikungunya cases, the highest rates of infection were in Phuket (21.44 / 100,000 population), Songkla (18.49), Pattani (11.16) Satun (1.27) and Yala (0.97).
Advice for travellers
The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.
Scarlet fever peaks
Along with a rise in measles reporting, predominantly associated with travel to Europe, there has been a sharp increase in the incidence of scarlet fever. Public Health England were notified of 31,865 cases in 2018, the highest recorded figure and up from 17,813 in 2017. Peak occurrence is during winter and spring each year. Read more
Advice for travellers
Scarlet fever is a low risk for travellers. A mild bacterial infection, it generally causes strep throat or, less commonly, streptococcal skin infections. It affects people of any age, but is most common among children. The classic symptom is a sandpaper-like red rash. Scarlet fever is treatable with antibiotics which helps clear up symptoms faster, reduces spread to other people and prevents rare but serious long-term health problems. Read more on scarlet fever.
Measles on 2 coasts
In addition to the measles outbreak affecting several counties in the state of New York, a public health emergency was declared late last week in Clark County, Washington state, after a number of measles cases were identified in the Vancouver area. Currently, there are 25 confirmed and suspected cases with onward spread to the Portland metropolitan area. Read more
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 6 weeks before departure.