World travel health alerts 24 November 2021

World travel health alerts for 24th of November 2021.

COVID-19 update

The rise in new weekly COVID-19 case numbers reported in the WHO Nov 23 epi update was mainly due to the European Region’s surge (up 11 percent, with three countries logging just over a third of all new cases: Germany, the UK and Russia), while large increases in deaths were recorded in the regions of the Western Pacific and the Americas (29 percent and 19 percent respectively). The Americas’ largest proportionate increases in new deaths were reported by Ecuador, Mexico and the Bahamas, while in the Western Pacific, the Philippines and Vietnam had the highest number of deaths.

The WHO advised that surveillance limitations should be taken into account when assessing the global distribution of variants of concern (VOCs), but of the more than 845,000 sequences uploaded over the past two months, 99.8 percent were Delta. The agency also noted that there is considerable variation on sub-regional and country levels, ‘most notably within some South American countries, where the progression of the Delta variant has been more gradual’.

In related news:

- The Dept. of Home Affairs has information on Preparing to leave Australia, Preparing to travel to Australia from overseas, as well as COVID-19 testing and treatment.

- From The Conversation, Taking your first rapid antigen test? 7 tips for an accurate result

- Nature writes that ‘Cuba’s bet on home-grown COVID vaccines is paying off’

Alert over bird flu outbreaks, regional flu update

Late last week the WHO published an assessment on the risk posed to humans by the highly pathogenic avian influenza strain A(H5N6) (HPAI), which has this year been responsible for 26 infections (25 in China and one in Laos) - almost all had exposure to poultry. The H5N6 strain is one of several HPAI viruses which has been reported in up to 40 countries, following wild bird migration patterns. An AFluDiary post observed that, ‘Given the continual evolution of avian flu viruses - and their ability to reassort amongst themselves - new threats can always arise with little warning’. In other news on flu, the ECDC released its first influenza report this season for the European region: ‘86% type A viruses, with A(H3N2) 97%) dominating’, as detections increased steeply compared to last year and are now ‘close to the more usual number of detections seen in earlier seasons’. And in the USA, an uptick in flu activity has been reported by the CDC, mainly due to H3N2 infections in children and young adults (ages five years to 24).

Advice for travellers

There are several strains of bird flu and while the high pathogenic strains can be fatal, infection generally poses a low risk for travellers – even for those heading to a region where the disease is present or an outbreak is occurring. Travellers should avoid contact with birds or poultry in marketplaces, wash hands thoroughly before and after preparing food, and observe strict personal hygiene. Read more on bird flu and how to avoid it.

Zero new Ebola cases; Yellow fever in south-central province

No new Ebola cases have emerged in North Kivu province since Oct 30 but the WHO has expressed the same concerns over the outbreak, ‘inadequate EVD surveillance in communities poses risk for further spread’, together with insufficient resources needed for response measures. Read more

PROVINCIAL authorities in Kasaï have declared an outbreak of yellow fever (YF) in Mweka territory (Bulape health zone). According to local media, a suspected YF case was first identified on Oct 1 and later laboratory-confirmed. 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.

Reports of YF in 2 more regions

The WHO regional bulletin this week has revised up the number of suspected yellow fever cases in the Savannah region to 89 and 16 deaths, all from 14 nomadic communities in North Gonja and West Gonja districts. The update also provides more background on the location: bordering ‘Cote d’lvoire and hosts Mole National Park, Ghana’s largest wildlife sanctuary that is frequented by tourists. The community is made up of a predominantly mobile population that migrated from Nigeria in 2019 and currently live at the base of the park’. The yellow fever vaccine is routinely given to babies at 9 months of age in Ghana (88 percent coverage), however rates are unknown (and likely sub-optimal) in the mobile population affected in this outbreak. Local media are also reporting YF cases (not all are confirmed) in the regions of Upper West (Sissala West and Wa East Districts) and Bono (Wenchi Municipality and Tain and Banda Districts).

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.

Dengue prevails, Zika ‘under control’ in UP

Post-monsoon viral illnesses prevail in a number of localities, with news reports on dengue fever outbreaks over the past week coming from the states of Haryana, Karnataka and Rajasthan, and the cities of Delhi, Pune and Mumbai (also chikungunya). In Uttar Pradesh, the Zika outbreak is said to be under control after a total of 143 cases were detected, but the state’s dengue fever case count has been the highest in the country this year. 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 accessed through smartraveller (DFAT).  

Chikungunya suspected in coastal county

An outbreak of what is suspected to be chikungunya has hit the northern coastal county of Lamu. To date, people suffering symptoms typical of the mosquito-borne infection have been presenting at health centres in Lamu Island, Witu, Mpeketoni and Faza, according to local media. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by day-time feeding Aedes mosquitoes. 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.

Legionella cases reported near Barcelona

In Catalonia, 26 cases of legionellosis were reported in the two weeks to Nov 18, 16 of whom required hospitalisation and more infections may emerge in the coming days. Investigations are underway into the source/s of infection in two municipalities - Montmeló and Montornès del Vallès – situated some 20kms north of Barcelona. And in the Netherlands, legionella infections have been confirmed in Schijndel in the province of North Brabant. At least 15 cases have been detected, resulting in one death. The cause is still under investigation, however authorities are focussing ‘on a source in the open air’. Read more

Advice for travellers

Legionnaire’s disease occurs worldwide and outbreaks have been associated with cruise ships, hotels, and resorts. The bacteria that cause Legionnaires’ disease are found in the airborne droplets of warm, fresh water, such as from fountains, spas, showers and the cooling towers of buildings. Over 50s, current or former smokers, those with a chronic lung condition, and the immunocompromised are at higher risk of developing illness after exposure. Read more.

VD polio cases continue to mount; 2nd imported monkeypox case in US

The vaccine-derived polio case total this year has risen to 280 (cf. eight last year), with another six cVDPV2 infections reported by the GPEI (in the states of Bauchi, Gombe, Katsina, and Yobe), plus positive environmental samples were detected from 26 sites from seven states in all.

FOUR MONTHS after the first imported case of monkeypox was reported in the US (Texas) in a person arriving from Nigeria, there has been another – this time into Maryland. While fellow travellers and close contacts are being followed up for 21 days, the mask mandate on flights means the risk of onward transmission is considered low. The CDC advised that the imported strain in this instance matches the one ‘that has been re-emerging in Nigeria since 2017’. Read more

Advice for travellers

Advice for travellers: Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox.

Late season flu wave

A surge in influenza infections that was first reported in late August continues, as the NICD announced that numbers spiked early this month, with ‘clusters of influenza cases in schools and workplaces’. The agency’s alert notice said that influenza B Victoria made up almost 40 percent of samples tested, followed by just over 23 percent of A (H1N1)pdm09 and influenza A (H3N2), 10.6 percent.

Advice for travellers

In most years, seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Whether you are travelling within Australia or overseas, vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol-based hand sanitiser is a convenient alternative if soap and water is not available.

Cholera confirmed in Isingiro district

An outbreak of cholera has been declared in seven villages of Isingiro district, a refugee settlement area in the far south. To Nov 17, there have been seven confirmed infections and 163 suspected cases (including 11 in the capital city of Kampala). No deaths have been recorded. 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.