World travel health alerts for 24th of July 2019.
YF factsheet update; WHO flu report
The Dept. of Health has updated its yellow fever – general fact sheet to reflect the addition of Argentina’s Corrientes province to its list of yellow fever risk countries and areas. As advised in the fact sheet, vaccination is ‘strongly recommended for travellers who have never been vaccinated for yellow fever and who intend to travel to countries where there is a risk of transmission’. Unvaccinated travellers will be subjected to border biosecurity processes, however ‘entry to Australia will not be refused on the basis of non-compliance with yellow fever monitoring and control requirements’.
IN THE southern hemisphere, Australia is one of three countries reporting increased influenza activity (with Argentina and Uruguay) from information applicable to July 7. Elsewhere, flu reporting activity was high or increasing in Bangladesh, Myanmar, Thailand, Costa Rica, Panama, Cuba and French Guiana. More details in the WHO Influenza Update N° 346.
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.
Regional, global measles
ECDC measles data for the region reveals ongoing or new outbreaks in Belgium, Bulgaria, the Czech Republic, France, Poland, Italy, Lithuania, the Netherlands, Poland, Romania and Spain with most cases in Romania (2,152), France (2,125), Poland (1,290), Italy (1,096), Bulgaria (1,053), and Lithuania (787). Published in the CDTR, data is also provided for the African region, the Americas and the Western Pacific Region. The tally for reported measles cases across the globe for the year to July 10 compiled by the WHO: 270,000 cases (epidemiologically linked, clinically/laboratory-confirmed).
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.
SW’s dengue and chikungunya
Dengue fever infections are mounting in the SW town of Phuentsholing with up to 100 cases reported this month. There have also been a small number of chikungunya cases in the town and in the neighbouring district of Samtse. The current rainy season and population movements in the border region are thought to be contributing factors to the outbreak. 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.
Rio reports rise in chikungunya infections
Chikungunya cases in the city of Rio de Janeiro have increased almost 2-fold compared to 2018 – the city has recorded over 24,000 cases (Campo Grande has been hardest hit) while state-wide that figure is 60,000 to July 9 (NW districts most affected). Read more. The ECDC monitors chikungunya and dengue outbreaks across the globe, summarising them in the weekly Communicable Disease Threats Report (CDTR).
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.
Fatality rates high in cholera outbreak
The wet season and ongoing conflict are challenging response measures in the country’s north with high fatality rates reported among the increasing number of cholera cases in the region since late last month. The North and Far North regions are affected. While in Kenya, cholera outbreaks continue to be reported in the counties of Nairobi, Garissa, Kajiado, Wajir, Mombasa and Machakos. Nearly 3,500 suspected cases have been recorded in the country this year. 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.
BC rabies death reported; STI spike in Alberta
Reminders to avoid any contact with bats as they may be infected with rabies follow the death of a young man from Vancouver Island earlier this month. It is believed he acquired the viral infection in May while outdoors during the day when a bat ‘ran into his hand’ - he started suffering typical rabies symptoms some six weeks later. A rare occurrence, his is only the second death from rabies in the province since recording began 95 years ago. More on rabies in Canada. Read more
ALL FIVE health zones in the province of Alberta have recorded steep rises in infectious syphilis with some districts recording increases up to 10 times the 2014 figures. New infections are now at a 60-year high. Recent, smaller outbreaks have also been registered in Quebec, Ontario and Manitoba.
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. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is normally 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.
Polio identified in Sichuan, global news
Last week the GPEI advised that a single case of circulating vaccine-derived poliovirus type 2 (cVDPV2) had been detected in a person with acute flaccid paralysis from Liangshan Yi Autonomous prefecture, Sichuan province and noted that the virus ‘is genetically linked to a VDPV2 isolated from an environmental sample from Xinjiang province, collected on 18 April 2018’. A rapid response has been instituted by the government ‘strengthening disease surveillance, investigating the origin of the virus and planning an appropriate outbreak response’. Meanwhile this week the agency announced two circulating vaccine-derived poliovirus type 1 (cVDPV1) cases from the eastern state of Kayin in Myanmar (onset of paralysis was on 22 May 22 and June 14) and two cVDPV1 positive contacts in the same northern district (Papun). Routine immunisation in Myanmar (including bivalent OPV) is around 89 percent and neighbouring countries have been notified of the situation.
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.
Dengue outbreak continues on 2 islands
From a July 10 Ministry of Health report on the dengue fever outbreak first announced in late February: 22 confirmed and 47 probable cases, with 66 of the total on the main island of Rarotonga and 3 in Aitutaki. Peak months were April and May however new infections continued into June (10 cases).
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.
Alcohol seized in methanol poisonings
Methanol poisoning that killed 19 people in the past few weeks has prompted the government to issue an alert to the public while also seizing up to 30,000 bottles of alcohol (different brands) that were found to be adulterated. The deaths occurred across several districts. Read more
TBE season heats up
Warmer weather and more human outdoor activity brings on the risk of tick-borne infections with authorities advising that a further eight cases of tick-borne encephalitis has taken the YTD total to 27 in the NE Moravian-Silesian Region (which shares borders with Poland and Slovakia). The more-than 700 infections reported across the country last year gave the Czech Republic the highest burden of TBE in the region. Read more. Switzerland’s rates of TBE infections have returned to the averages reported prior to last year’s peak. As noted in a ProMED post, ‘the Swiss government has had a proactive tick-borne encephalitis (TBE) vaccination program this year’ and is promoting vaccination for those at risk including people hiking in forested areas.
Advice for travellers
A viral infection, tick-borne encephalitis (TBE) can cause fever, vomiting, cramps and paralysis, which can be prolonged. In rare instances, infection can be fatal. Travellers who spend time in regions where TBE is endemic – mainly forested areas of Central and Eastern Europe, Russia, Northern China, and Mongolia – may be at risk. The highest risk is during the warmer months from April to November, especially when hiking or camping in areas below 1500m. While safe and effective vaccines are available in Europe, none are licensed in Australia; however, vaccines can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.
Escalation prompts PHEIC
The Ebola virus disease outbreak which has been ongoing for almost 12 months in two NE provinces has now been declared a Public Health Emergency of International Concern (PHEIC) by the WHO. This escalation came about in response to new developments including a confirmed EVD case in the city of Goma (pop. almost 2 million) which is situated on the border with Rwanda and has an international airport. On July 17 an International Health Regulations Emergency Committee made specific recommendations, but advised that ‘It is important that the world follows these recommendations. It is also crucial that states do not use the PHEIC as an excuse to impose trade or travel restrictions, which would have a negative impact on the response and on the lives and livelihoods of people in the region.’ Read more. The July 23 WHO Situation Report can be found 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.
Two dengue serotypes circulating
The July 22 health bulletin provides details of the continuing dengue fever (DENV-2) outbreak, with epidemics underway on Tahiti since early April and on Bora Bora since July 12; there are also alerts for Moorea (Papetoai) and Nuku-Hiva (Taiohae). The count of locally-acquired DENV-2 cases has risen to 200, while type one is also circulating in Tahiti, Moorea and Raiatea. Read more.
Yesterday, ReliefWeb published a report on dengue fever in the Pacific: Dengue fever: A constant threat to Pacific health security.
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.
JE in more eastern states
Following recent news of Japanese encephalitis cases in Assam, infections are now being reported in the neighbouring states of Manipur (SW district of Churachandpur) and Nagaland (Dimapur district). National JE data is listed on the Flutrackers website.
Advice for travellers
A mosquito-borne virus, JE is usually found in many part of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.
New dive-related facility in Bali
A new hyperbaric chamber now operating at Kasih Ibu Hospital in Bali offers capacity for six people with scuba diving-related conditions at the same time; previously the only option on the island was a single chamber at nearby Sanglah General Hospital. The new facility, the Hyperbaric & Diving Medicine Center, is located in Denpasar and, according to a local news report, provides 24-hour services to those in need. Read more
JE reports from Sarawak, Sabah
One month after reports of five Japanese encephalitis (JE) cases in Sarawak, authorities in Sabah have confirmed their fourth human case, in the district of Tambunan. The other three cases were in Kota Kinabalu, Ranau and Papar – in 2018, a total of five JE cases were recorded in the state. Read more
Advice for travellers
A mosquito-borne virus, JE is usually found in many part of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.
Rabies medical product alert
Two weeks after news of the detection of counterfeit rabies immunobiologics, the WHO has issued a Medical Product Alert following ‘confirmation that falsified batches of Verorab, Speeda, Rabipur and Equirab were available at patient level in the Philippines. Investigations are ongoing, and laboratory analyses are being facilitated for available samples to determine their contents and better assess the risk to public health.’ This is occurring against the backdrop of rabies vaccine shortages in the country. Advice from the WHO is not to use any of the ‘falsified products, or if you suffer an adverse event having used these products, please seek immediate advice from a qualified healthcare professional, and ensure’ it is reported to the appropriate authority. 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. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is normally 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.
Dengue outbreak tops 6,500 cases
The dengue fever outbreak is continuing to produce new cases - Dar es Salaam (164 cases), Tanga (26), Lindi (3), and Arusha (1). For the year to July 14 there have been more than 6,500 confirmed cases and four related deaths. 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.
Measles, rubella vaccines for 18m children
Eighteen million children are to be immunised against measles and rubella in campaigns planned for late September as local and international agencies assert control over measles outbreaks that have been occurring in 62 districts and rubella in 25. Read more
Advice for travellers
Rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine, one of the routine immunisations used here which should be current prior to overseas travel. Travellers should also check their immunisation status for tetanus, diphtheria, and whooping cough. Read more about rubella.