World travel health alerts 23 September 2020

World travel health alerts for 23rd of September 2020.

Polio count rises again

One wild poliovirus1 (WPV1) case was reported by the GPEI in both Balochistan and Sindh provinces and there were seven cVDPV2 cases (Punjab and Sindh), however plans are in place, and optimism expressed by the Polio Eradication Initiative’s national coordinator, that the disease will be eradicated from Pakistan next year. Read more. Also on WPV1, Afghanistan has recorded a single case in the provinces of Khost and Paktika, plus nine cVDPV2 cases from seven provinces. While Africa’s cVDPV2 cases continue: DRC (seven in Equateur and one in both Kwilu and Mai Ndombe) and a single case each in Somalia (Banadir district), Sudan (Kassala province) and the Central African Republic (Region Sanitaire 3).

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.

Chikungunya in capital region; Some flu activity reported

Recent news of a spate of chikungunya cases in two villages located in Kandal province, surrounding the capital Phnom Penh. Last month almost 2,000 infections were recorded across 15 provinces, however the health ministry now states the situation is under control. Elsewhere, Chad’s outbreak has spread into two other provinces (Wadi Fira and Sila) as cases continued to climb towards 25,000. Biltine in Wadi Fira province has reported the greatest rise in infections of late. Read more

IN OTHER local news, Cambodia was one of the few countries to report influenza activity in the Sept 14 WHO update – predominately A(H3N2) and sporadic influenza B detections were recorded in Argentina and Côte d’Ivoire. Also in the WHO’s summary was the comment that the flu season in the southern hemisphere’s temperate zones is yet to start, while also cautioning that the update’s data may be affected by pandemic hygiene precautions, health-seeking behaviours and lower testing rates/capabilities.

Advice for travellers

Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Applying an effective repellent to all exposed skin and covering up are your best defences. Read more about chikungunya.

Regional diphtheria update

Diphtheria remains endemic in Haiti, however data for the year to mid-August reveals a downward trend since 2018 when 253 cases were reported for the same period (and 139 last year). From the 92 suspected cases in 2020 there were five deaths and the highest cumulative incidence rates were in Mont Organisé, Nord Est Department. Other countries reporting diphtheria cases in the Sept 22 PAHO Epidemiological Update were Brazil, the Dominican Republic and Venezuela.

Advice for travellers

Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.

Western province sees STI spike

Alberta's syphilis outbreak, described as the largest in more than 70 years, is now into its second year and forms part of a nationwide trend that has seen cases increase over the last six years. The Edmonton area has borne the brunt of the rise in cases, which has resulted in a number of stillbirths and several infants acquiring congenital syphilis infection. Read more

Advice for travellers

Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.

Brucellosis arising from contaminated waste gas

A report published last week outlined a veterinary vaccine manufacturing process failure in December 2019 that led to Brucella bacteria-containing aerosols released into the air in Lanzhou, Gansu Province. While more than 21,000 residents have been tested for brucellosis, just over 3,200 people returned positive results and will be provided with health assessments and compensation. Read more. More on brucellosis in the NSW Health factsheet

Children among latest Ebola cases, alert for neighbouring province

Two more Ebola-related deaths in the past week have taken the total to 50 and the number of confirmed and probable infections to 124, as lingering issues such as inadequate surveillance of community deaths fuel the spread of the virus to new areas. Two of the infections confirmed in the past week were in young children. Also in the past week, agencies responded to reports of four suspected Ebola cases in a remote location in Mai Ndombe province (to the south of Equateur), taking blood samples and documenting contacts. Read more

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.

‘Unlucky’ dengue fever patient

Dutch media are reporting a case of dengue fever in a citizen who contracted the infection last month while in southern France. The woman, who was described by health officials as unlucky, was staying in the commune of La Croix-Valmer in the Provence-Alpes-Côte d'Azur region. No further details were given on her condition. The dengue vector in France, the Aedes albopictus mosquito, is established in 58 mainland departments – see map. 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. Read more about dengue fever.

Confirmed WNV cases in 3 locations

Investigations are underway to determine the extent of West Nile virus activity after nine human infections were recently confirmed - Leipzig has reported seven to date, while both Meissen and Berlin recorded one each. In related news, Dutch authorities have confirmed the presence of WNV in a bird caught in Utrecht, saying the infection was most probably acquired in the Netherlands which ‘corroborates the further expansion of WNV circulation in Europe’. Elsewhere, Spain has recorded its fourth WNV-related death (from 49 confirmed cases) this year in an 87yo woman from Puerto Real in the province of Cadiz. Read more

Advice for travellers

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. Read more on WNV.

Duo of infections strike central province

People suffering from dengue fever or scrub typhus are presenting at medical centres in Gandaki province on a daily basis – Mygadi district has been hardest hit by both infections. Read more. Elsewhere, health authorities in the far NE Indian state of Nagaland, adjacent to the Myanmar border, have reported up to 600 cases of scrub typhus, resulting in five deaths. Read more

Advice for travellers

Scrub typhus is a bacterial disease passed on to humans by mites that normally live on rodents infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus occurs throughout the Asia-Pacific region, where more than a million cases occur annually. There is no vaccine or prevention medication: avoidance hinges on minimising insect bites. Due to the disease’s 5- to 14-day incubation period, travellers often experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Read more about rickettsial diseases.

COVID-19 levels climbing again

Transmission levels are rising fast ‘and probably exponentially in significant parts’ of England, Scotland, Wales and Northern Ireland, leading the CMOs to recommend upgrading the national COVID-19 alert level from 3 to 4. To ease pressure on health services and prevent excess deaths over the coming months, the advice is for everyone ‘to follow the social distancing guidance, wear face coverings correctly and wash their hands regularly’. Case numbers have also jumped in Russia, Iran and many European nations, however even with India’s new cases on Sept 21 representing an almost 4-week low (74,493), it retained #1 global ranking for daily new cases. Read more. In the latest weekly WHO epi update the agency advised that new cases reported last week were the highest to date for the pandemic. It was also noted that in the Western Pacific, the Philippines and Japan accounted for both the region’s greatest number of new cases and new deaths.

In related news:

Two major cruise lines have submitted plans for the resumption of services to the US CDC. Read more

CIDRAP summarised three studies into transmission of the novel coronavirus on international flights, two of which related to index cases among business class passengers.

Campaign to end outbreak

A cholera vaccination campaign is underway in Cabo Delgado province’s capital, Pemba, and the districts of Mocimboa da Praia, Macomia, Ibo and Metuge to end the 8-month long outbreak which has sickened 1,627 people and killed 27. 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.

Vax campaigns to continue during pandemic

Children under 5yo at risk of measles infection (and polio) are being targeted in a vaccination campaign set to start late next month. Of the 3,500 measles cases recorded to August this year in this age group, 36 infections proved fatal. 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.

Rains boost dengue reporting

While dengue fever activity has been lower this year compared to 2019, the onset of rains has brought an uptick in cases which has had the greatest impact on the south, particularly Ho Chi Minh City and the provinces of Dong Nai, Long A and Khanh Hoa. 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.