World travel health alerts 23 June 2021

World travel health alerts for 23rd of June 2021.

6 more polio cases reported, global digest

All polio cases reported to the GPEI last week involved circulating vaccine-derived poliovirus type 2 (cVDPV2): a single case in Afghanistan (Ghanzi), while in Africa, Ethiopia recorded six cases (Oromiya, Tigray and the SNNP region), Senegal’s five cases (as mentioned in last week’s post - Louga, Diourbel, Thies, Fatick and Dakar), two cases in Burkina Faso  (Dori and Banfora), and single cases from each of Benin (Couffo), DRC (Sud-Ubangi province) and Niger (Zinder).

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.

Malaria situation ‘critical and challenging’

A senior health official has said the two million malaria cases and more than 5,500 related deaths reported in 2021 are evidence of ‘a critical and challenging’ situation facing the nation. The majority of the cases, recorded in the first five months of the year, were in Luanda, Lunda Norte, Malanje, Huambo, Uige, Benguela, Bie and Huila. Read more. And in Malawi, the government has set 2030 as the target to achieve the elimination of malaria. Last year more than one-third of the population was infected with malaria and it caused an average of six deaths every day.

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.

Cholera toll nears 300

More than 10,000 suspected cholera cases and 289 related deaths have been reported by the NCDC this year, with a sharp rise in new infections over the past month. The states of Plateau, Bauchi, Gombe, Kano, Zamfara, Bayelsa and Kaduna are most affected. Read more. The WHO has recently published an update on the situation in Somalia, noting that floods and the ongoing cholera outbreak have added to the strain placed on health services by the pandemic. The latest reports on suspected cholera cases came from Banadir, Bay and lower Shabelle regions. In other cholera news, the ECDC reports that the majority of suspected cholera infections reported since late April have been in Yemen and Bangladesh.

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.

Recent surge in CFP cases

Fish poisonings caused by ciguatera toxin are reported intermittently across most tropical and subtropical regions, however a sudden spike in cases in the Caribbean territory earlier this month has prompted an alert from health authorities. The national BVI epidemiologist warned against ‘eating the head, skin, intestines and roe of coral reef fish’ due to their ‘higher concentrations of toxins’. Earlier this year, a similar CFP alert was issued in Saipan. Food Safety News reports that ‘researchers at the Institute of Natural Products and Agrobiology (IPNA-CSIC) are working on a Ciguatera vaccine’. Read more and further information on CFP here.

Dengue rates down again this year

Sabah has recorded the fourth highest dengue fever case count this year after Kuala Lumpur, Putrajaya and Johor, and rates of infections continue the decline first seen in 2020, which is at least partly due to restricted population movements. Read more. In other dengue news, the situation in the Cook Islands has improved with a welcome decline in new dengue cases. Local news sources report that Aitutaki, Mauke, and Mangaia in the Pa Enua have recorded cases since February and, in Raratonga, the virus had been ‘most active on the south-eastern side of the island, particularly in the villages of Ngatangiia’. In South Asia, the recent passage of cyclones and now the SW Monsoon are further taxing the health system in India’s Kerala state (Ernakalum), as mosquito breeding sites proliferate and dengue infections mount. Colombo district is the epicentre of Sri Lanka’s dengue outbreak (particularly Kurunegala, Maharagama, Dehiwala, Battaramulla, Ratmalana, and Homagama) and the government has responded by closely monitoring high risk areas and launching public awareness campaigns. In Guam, it takes just three cases confirmed over a 2-week period for a dengue outbreak to be declared, so the single case reported on Monday - the first since Feb 2020 - has authorities calling for vigilance from residents.

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. They bite mainly during the daylight hours and can be found indoors, 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 oil of lemon eucalyptus (PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

COVID-19 updated, related news

The June 22 WHO COVID-19 epi update notes that the ‘African Region recorded a marked increase in the number of weekly cases as compared to the previous week. Globally, mortality remains high with more than 9000 deaths reported each day over the past week, however, the number of new deaths reported in the past week decreased across all Regions except for the Eastern Mediterranean and the African Regions. In the Western Pacific region, overall case numbers were stable, however Mongolia, Fiji and Singapore all recorded weekly rises in new cases. 

Earlier this week it was reported that the Russian health minister advised a booster dose for those in their population who were vaccinated more than six months ago. The Russian Federation has recorded a 31 percent weekly increase in case numbers, driven by the Delta variant.

In related news:

- June 21 COVID-19 news in the New Scientist: UK to announce plans for booster shots in coming weeks.

- New Zealand’s medical regulatory body, Medsafe, has approved the use of the Pfizer vaccine for teenagers aged 12 to 15 years. Read more

- In response to emerging SARS-CoV-2 variants, the WHO has established two bodies: the Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) to provide advice on the characterisation of VOIs and VOCs and ‘continue assessing the available evidence on impacts on therapeutics, diagnostics and the impact on current and future COVID-19 vaccines’; and the Technical Advisory Group on vaccine composition (TAG-CO-VAC) ’to interpret available evidence and provide recommendations for adapting COVID-19 vaccine composition, if needed’. Read more

SE’s Ebola outbreak over

On June 19th, the WHO declared the end of the Ebola outbreak after just over four months, ‘a total of 16 confirmed and seven probable cases … in which 11 patients survived and 12 lives lost’. Lessons learned in fighting outbreaks in the DRC and the 2014-16 epidemic in Guinea resulted in ‘rapid, coordinated response efforts, community engagement, effective public health measures and the equitable use of vaccines’. Support from the WHO, which was also provided to neighbouring countries, will continue in Guinea to enhance surveillance and build capacity for response measures. Read more. And in other news, another Lassa fever case has been detected in the country’s SE forested region – this time in Beyla, Konyan region.

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 most 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.

Goa’s good news on rabies front

Authorities in the western state of Goa have declared the area to be rabies-controlled six years after introducing a vaccination and sterilisation program for dogs. While 17 rabies-related human deaths were recorded in 2014, the state has now gone three years without a single fatality. Read more

Advice for travellers

Rabies is a significant public health issue throughout India. For most short-stay travellers the risk is generally low if remaining aware of personal safety. Vaccination recommendations are itinerary-specific but include those travellers planning to live in, or travel extensively.  However, all Australians visiting India and other endemic countries should be aware of the importance of avoiding contact with wild and domestic animals – especially dogs, the main source of infection. If bitten, urgent post-exposure treatment is required. Read more on rabies.

Hantavirus in central provinces

Targeted surveillance has detected 11 New World hantavirus cases to date this year – six were the more serious complication, cardiopulmonary syndrome (HCPS) and the remainder, hantavirus fever. Several central provinces have reported the infections: Los Santos (Tonosí), Herrera (Parita), Coclé (Aguadulce) Veraguas (Soná) and Panama East region. A larger outbreak of hantavirus infections was reported in 2018 and was likely related to environmental impacts on the rodent host. Read more

Advice for travellers

Hantavirus is generally spread from various rodent species to people, through aerosols shed in excreta, urine or saliva, but to a lesser extent via the bite of an infected animal. The syndromes resulting from infection vary by region - in Europe and Asia, the 'Old World' hantaviruses may cause haemorrhagic fever with renal syndrome (HFRS), while the New World' hantaviruses in the Americas can result in hantavirus pulmonary syndrome (HPS). Read more on hantavirus from the US CDC.

Possible early WNV activity; First CCHF case in León

Confirmation is pending on a possible case of West Nile fever that was detected in the province of Seville. There were concerns it may be a false positive - the individual in question had tests for meningitis symptoms that emerged after a COVID-19 illness. The ECDC notes that if this case is confirmed, it would be ‘a relatively early start of the WNV season ‘.

IN THE NW, health authorities in the province of Castile and León have reported a second case of Crimean-Congo haemorrhagic fever (CCHF) this year. The woman, from El Bierzo, is thought to have had exposure to tick bites. Hers is the first CCHF case registered in the region of León. Read more

Advice for travellers

West Nile virus is endemic in Eastern Europe and the Mediterranean basin, with epidemics regularly reported in summer and autumn since the 1950s. Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuroinvasive disease.  The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Europe’s outbreaks are not as severe or widespread as in other regions where the virus occurs, notably North America. Read more on WNV.

Melons implicated in widespread Salmonella infections

The number of people who have become ill from eating Salmonella-tainted melons has risen to 99 since April. Investigations are continuing into whether Galia, cantaloupe, and honeydew melons imported from Honduras and Costa Rica may be implicated. The same strain – Salmonella enterica serovar Braenderup - has been reported recently in infections found in Denmark, Belgium, Czech Republic, Finland, France, Germany, Ireland, Luxembourg, the Netherlands, Norway, Sweden, Canada, and Switzerland. Read more

Advice for travellers

Salmonella is a bacterium typically found in food, such as poultry, that causes diarrhoea, fever, and abdominal cramps between 12 and 72 hours after infection. Illness usually lasts 4 to 7 days, and most people recover without treatment, although diarrhoea may be so severe as to require hospital treatment. Young children and the elderly are at highest risk of severe illness. There is no vaccine to prevent salmonellosis. Read more

Tick season alert

In the eastern state of Connecticut there have been warnings over tick bites which bring with them the risk of Powassan virus (POW) infection after two cases were reported from Fairfield and New Haven counties. ProMED advises that POW is a rare infection, however the virus has been identified ‘in recent years from one or more of the eastern and northeastern or midwestern states’, with authorities advising that ticks must be removed promptly to prevent transmission. More on Powassan virus from the CDC.