World travel health alerts 23 October 2019

World travel health alerts for 23rd of October 2019.

Progress in tackling measles, global measles news

The measles outbreak is now into its 11th month and suspected cases have risen above 8,500 (with 57 deaths), however vaccination campaigns implemented in the four most affected regions – Oromio (over half of all cases), Somali, Amhara and Afar – have produced a gradual decline in new cases since the March peak. Elsewhere in the region, 16 of Chad’s regions report measles epidemics as the YTD total of suspected cases climbed to more than 25,000 (with 242 deaths). And in Europe, measles rates have soared in Switzerland this year, expanding more than 6-fold over those reported in 2018. Five cantons have recorded highest numbers (Geneva, St Gallen, Zurich, Bern and Neuchâtel) and over half of all cases have been in adults aged 20 years or older. While in Lebanon, four governates have borne the brunt of the increase in measles cases since November last year - Aakar, Baalbek-El-Hermel, Bekaa North and Mount Lebanon. The WHO has assessed the risk of the infection spreading to be high within the country and moderate for the region. Regarding the situation in Oceania: after UNICEF last month warned of the increased risk of measles spreading to Pacific island nations due to sub-optimal vaccination rates in some areas, health authorities in Samoa have called for New Zealand to check its ongoing outbreak, believed to be the original source of the now seven confirmed cases there. Onward transmission has now also been confirmed in Tonga, with a health alert issued following 15 confirmed and suspected measles cases associated with schoolboy rugby players who had recently returned from playing in NZ. 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.

VDPV identified in north, plus reports from Chad, Togo

There has been a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in the far northern district of Chienge, adjacent to the border with the DRC. Testing on healthy contacts of the initial case, a two year-old child, revealed two positive samples genetically linked to the VDPV2, confirming the cause was a circulating virus. One of the child’s parents lives in the DRC but no link between the current outbreaks in the DRC and the incident in Zambia has been established. Response measures have been instituted ‘which include surveillance in all health facilities, communities, and points of entry among others’. Two more notifications regarding detections of cVDPV2 were published in the WHO weekly bulletin with single cases identified in Chad (SW province of Chari Baguirmi, near the Cameroon border) and Togo (in Plateaux province, bordering Benin and Ghana). Both are considered ‘part of the Jigawa emergence’ in Nigeria. Read more. With regards to new wild poliovirus infections reported in Pakistan, three cases of WPV1 were registered in the most recent reporting week – two in Khyber Pakhtunkhwa province and one in Balochistan. 

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.

PHEIC to remain

With the Public Health Emergency of International Concern (PHEIC) set to continue for a further three months, two disturbing trends were noted by the WHO in its latest update ‘a decline in the proportion of confirmed cases listed as contacts (from 57% to 13%) and an increase in the proportion of cases dying outside of Ebola treatment centers (from 14% to 27%) this past week’. The new cases reported on Oct 22 by the DRC’s response committee (CMRE): one each from Kalunguta, Mabalako, Mambasa, and Mandima health zones. Read this week’s External Situation Report here.

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.

2nd Zika case in south, ECDC assessment published

News this week of a second Zika virus case in Var department, identified in the same neighbourhood as the earlier case announced on Oct 9 - a ‘localized focus’. Both infections were acquired via bites of infected Aedes albopictus (tiger) mosquitoes and the two affected individuals have now recovered. In the meantime, the ECDC risk assessment on the probability of more Zika virus infections in the Var notes that environmental conditions are no longer favourable and ‘ongoing vector-borne local transmission in Hyères (and surrounding areas) is considered very low because current evidence does not indicate the existence of a more extensive cluster of ZIKV cases’. Read more

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).  

Post-monsoon dengue burden mounts

Across the nation, Karnataka has topped the list of states with high dengue burdens, followed by Maharashtra, Uttarakhand, Gujarat, Kerala, Bihar (a spike following severe flooding in the capital Patna) and Delhi. At least two major cities have also reported dengue-related challenges, with at least 2,000 people requiring treatment in Mumbai hospitals in early October, while health authorities in Chennai report shortages of blood products needed to treat dengue fever patients. Read more

Advice for travellers

Dengue is spread by 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.

Dengue confirmed in 2 students

A local news agency reports that dengue fever was confirmed in two students from Tokyo on return from an excursion to Kyoto and Nara in mid-September. The infections were confirmed last week; they are the first autochthonous cases since 2014 when a localised outbreak caused the closure of part of Yoyogi Park in Tokyo’s Shibuya district. 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.

Sand fly-borne infection strikes in NW

Since mid-2018, the number of people presenting at Tawergha’s health facility for treatment of leishmaniasis infections has risen to at least 500. The town is located inland of the large NW city of Misrata. Read more

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

One game reserve, 2 sleeping sickness cases

From a report published in ProMED on Oct 18: in the previous week two people from the same northern game reserve - Vwaza Marsh Wildlife Reserve - have been diagnosed with East African trypanosomiasis and are undergoing treatment in South Africa. Read more

Advice for travellers

Human African trypanosomiasis is rare in travellers, however the tsetse fly, which spreads the disease, is found in 37 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.

Terai district ranks highest in dengue reports

Evidence of this year’s severe dengue season, comparing the 542 dengue fever cases reported in the first week of October with only eight for the same period in 2018. Rupandehi in the Outer Terai topped the count, followed by Kathmandu, Lalitpur and Kaski. Read more. While in Singapore, the NEA has asked the public to continue their efforts in eradicating mosquito breeding sites, stating that the decline in new dengue cases (down from a peak for more than 660 in July to 239 last week) could reverse with a second potential surge in cases later in the year -  16 high risk dengue clusters are being monitored by the NEA.

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.

Unusual uptick in rabbit fever this year

A Eurosurveillance report on the exceptional tularaemia outbreak this year highlights the surge in cases in central districts – 13 of the 15 hardest-hit municipalities were in the region. The 979 cases registered up to Oct 6 represent a 4-fold increase over the previous 18 years’ averages and almost 75 percent of infections were contracted through insect bites. The report also noted that the current 2019 total ‘is higher than what has been reported in any single year since the end of the 1960s and it is more than are reported from the whole of Europe during a normal year’.

Advice for travellers

The main hosts of tularaemia bacteria in Europe are rabbits, hares and rodents and the majority of infections contracted there are through tick or mosquito bites, or by ingesting contaminated food or water. It is described as often being 'a long and debilitating disease' that can affect the eyes, lymph nodes, skin and lungs. Prevention measures include avoiding insect bites and the ingestion of surface water. Read more on tularaemia.