World travel health alerts 24 February 2021

Temporary polio recommendations extended, new case round-up

A further three month extension of the Temporary Recommendations was confirmed last week at the 27^th meeting of the Polio IHR Emergency Committee. Issues raised included: WPV transmission remains in core reservoirs of Pakistan (Karachi and Quetta Block) and in Southern Afghanistan. It has also ‘expanded to previously polio-free areas such as North Sindh and South Punjab in Pakistan and the Western and Northern regions in Afghanistan’; and a 254 percent increase in cVDPV2 cases in 2020 compared to 2019, but with fewer lineages and newly emerging viruses detected. Several strategies were proposed for countries such as Egypt, which has now had four positive cVDPV2 environmental samples – one last year and three in 2021 – through sewage testing in Giza, Alexandria, and Aswan and Qena in the south (all linked to Sudan). They include undertaking ‘urgent and intensive investigations to determine if there has been local transmission of the imported cVDPV2’, ensuring early poliovirus detection and intensifying immunisation efforts and national and international/cross-border surveillance. Kenya has recorded its second cVDPV2 positive environmental sample for 2020/1 in Mombasa, related to the outbreak in Somalia. In other polio news last week, more cVDPV2 cases to add to 2020 totals were reported in Afghanistan (one case in Khost province), Ethiopia (three cases from Oramiya and Amhara regions), two from Sud-Ubangi province in the DRC and one case each from Côte d’Ivoire (Kabadougou), Mali (Gao region) and Sudan (originating in South Sudan). Read more

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.

ABLV-infected bat found in southern Qld park

Another reminder for the general public of the dangers of handling bats, even if they appear sick or injured, after a red flying fox found in a Gold Coast park earlier this month was confirmed to be infected with Australian bat lyssavirus (ABLV). People who had contact with the bat before trained handlers arrived on the scene have been asked to urgently follow up with their doctor and local public health unit to assess the need for rabies vaccinations. Read more

Advice for travellers

Australian bat lyssavirus (ABLV) infections in humans is a very rare occurrence, but there have been fatal cases. The advice is to avoid handling any bat in Australia, or overseas. If bitten or scratched, urgent first aid and post-exposure treatment is required. Read more on ABLV. 

East coast Salmonella outbreak reported

Investigations are continuing into a recent Salmonella outbreak in Newfoundland and Labrador, and Nova Scotia. Initial enquiries undertaken by health agencies in the Atlantic provinces suggested that eggs may be the source of the infections, but updates will be issued in the event of any new findings. Recent details of case numbers point to 57 confirmed infections with 19 people requiring hospitalisation. 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. As there is no vaccine to prevent salmonellosis, it is best to avoid raw or undercooked eggs, poultry, or meat. Read more

Dengue case count rises

The dengue fever (DENV-2) outbreak continues as the number of probable and confirmed cases climbed to 48, according to a Feb 19 update from the health ministry. All cases have been in Rarotonga and to date, 21 people have required hospitalisation. New Zealand has plans to open up a travel bubble with the Cook Islands at the end of next month. Read more

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.

NE province’s plague update

The latest account of the plague outbreak in the NE province of Ituri now has the total at more than 520 cases, of which all but seven were the bubonic form. At least seven deaths have been recorded and the majority of cases have been in children under 17 years of age. Read more

Advice for travellers

Plague poses a low risk to most travellers. The majority of plague cases are due to bubonic plague following the bite of an infected flea carried by rats. If left untreated, infection of the lungs causes the pneumonic form of plague, a severe respiratory illness, which can progress rapidly to death. Read more on the plague.

Ebola outbreak evolves

The Ebola outbreak in N'Zerekore prefecture has now claimed six lives and the latest tally of cases is four confirmed and five probable – another suspected case in Kankan region has tested negative. Vaccinations for healthcare workers started today in the SE and Conakry, to be followed by ring contacts and frontline workers. A Feb 17 WHO Disease outbreak news post provides more details of response measures and a risk assessment. While in the Democratic Republic of Congo, fatalities in the North Kivu Ebola outbreak have risen to four from eight cases, and infections have spread from Biena health zone to two others – Katwa and Musienene. Challenges remain – gaps in community surveillance, contacts refusing to cooperate ‘and poor communication and logistics’. Vaccinations are continuing. 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.

Diphtheria cases in south

Three diphtheria cases have been reported in children this year in the southern cities of Neiba, Baní and San Cristóbal, but the Ministry of Public Health is not declaring an outbreak as they were detected ‘in time’. In 2020 a total of three diphtheria infections were recorded. Read more

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.

COVID-19 cases up 10%, global news

The Feb 23 WHO epi update reports six consecutive weeks of decline in new COVID-19 cases, with deaths down for three weeks in a row. Of the five countries which recorded the highest weekly case numbers, only India and France saw increases (up by 10 percent and three percent respectively). In the Western Pacific region, overall new case numbers were down but fatalities rose by six percent – the Philippines reported a 41 percent increase in new deaths.

In other COVID-19 news:

-Pfizer/BioNTech has progressed its global study on the use of Comirnaty vaccine in healthy pregnant women aged 18 and over into Phase 2/3.

-In an about-turn on his previous stance, Tanzania’s president has asked citizens to protect themselves from “this respiratory disease” by respecting preventive measures including wearing masks (locally made versions only). On the weekend, the WHO Director-General called for Tanzania to start reporting COVID-19 cases, share data and prepare for vaccinations. Read more

- The first AstraZeneca vaccines produced in India under the COVAX program have been shipped to Africa. Read more

-Food Safety News reports that ‘U.S. officials say there’s nothing to suggest food or food packaging spread of COVID-19’.

2 counties hot spots for malaria

A council established to tackle malaria elimination is to focus on the counties of Busia and Siaya, near the northern shores of Lake Victoria. The health minister last week remarked that the malaria rates in the two western counties were six times the national average. While malaria incidence has reduced across the country by nearly 75 percent since the year 2000, there are still around 36 million people considered to be at a high risk of infection. 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.

More of Sarawak designated rabies-affected

The number of Sarawak’s rabies-affected areas has risen to 67 after a positive rabies result was obtained from a pet dog which had bitten its owner earlier this month in Kampung Hilir, Sri Aman. Twenty-eight human fatalities have resulted from the rabies outbreak first declared in mid-2017. Of the rabies-affected areas, Serian has 22 sites, followed by Kuching, Miri, Mukah and Sri Aman. Read more

Advice for travellers

Rabies is present in most countries and all travellers should be aware of the importance of avoiding contact with wild and domestic animals, including bats. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is generally recommended for longer stays, especially travellers planning to live in, or travel extensively through, rural areas and also for children; however the final recommendation is itinerary-specific. Read more on rabies.

Surge in leptospirosis infections

Leptospirosis case numbers have shot up – from 36 in January to 80 by February 21. The three most affected areas were in the neighbouring communes of Ponérihouen and Poindimié on the east coast, and Païta, north of Nouméa. Leptospirosis is classified as a notifiable disease in the territory - last year DASS recorded 69 cases and four related deaths.

Advice for travellers

Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.