World travel health alerts 25 August 2021

World travel health alerts for 25th of August 2021.

Polio recommendations to continue

The Aug 20 meeting of the IHR Emergency Committee on polio has extended the PHEIC Temporary Recommendations again, but did acknowledge the marked reduction in wild poliovirus cases and positive environmental samples in both Pakistan and Afghanistan, as well as lower case numbers of circulating vaccine-derived poliovirus (cVDPV) globally. There were however eight instances of international spread of cVDPV, including to the two countries which had most recently detected the virus: Gambia and Uganda. The meeting also advised ‘an outbreak of cVDPV3 due to local emergence’ in China, dating from late Jan 2021. While in the latest GPEI summary, Nigeria reported 26 new cVDPV2 cases - 13 in Jigawa, three in Borno and Yobe, two in Kano, and a single case each in Bauchi, Gombe, Kaduna, Sokoto and Zamfara. Another cVDPV1 positive environmental sample was detected in Madagascar’s NW region of Boeny.

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.


Widespread measles outbreaks

The WHO regional office has provided an update on measles outbreaks across the country with new data on active transmission occurring in 11 provinces this year. Other countries also reporting ongoing outbreaks or epidemics include Cameroon, the Central African Republic, Chad, Ethiopia, Mali and Sudan.

Advice for travellers

A highly contagious virus, measles occurs in developing and developed countries. While generally benign, infection can result in severe illness or death. Travelvax Australia recommends checking immunisation status to ensure protection against measles and other childhood diseases such as diphtheria, whooping cough (pertussis) and mumps. 

Alert over more bird flu cases

Hong Kong’s Centre for Health Protection (CHP) has urged residents to ‘maintain strict personal, food and environmental hygiene both locally and during travel’ after confirmation of the 17th human H5N6 avian flu infection on the mainland this year, and the fifth this month. The most recent case is a farmer from Liuzhou in Guangxi province who is confirmed to have had contact with live poultry. Read more

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.

A second Ebola case suspected

More information has emerged on the Ebola case reported last week, as relief agencies report an improvement in the condition of the patient hospitalised in Abidjan, an 18-year old female. Her travel from Guinea earlier this month took five days and included a night in Nzérékoré, the epicentre of this year’s Ebola outbreak. More than 200 contacts, including fellow bus passengers, are being monitored; the woman’s spouse is suspected to be infected also. The reports notes that the infected traveller was symptomatic when she crossed into Côte d’Ivoire, suggesting that infection could have occurred before leaving her home in Labe and therefore, potentially, the existence of unknown chains of transmission. 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.

Plague in border region

A UNICEF report released this week details the concerns surrounding the incidence of plague in Ituri province and its effect on local children in the health zones of Biringi, Rethy and Aru. The emergence of bubonic and the highly virulent pneumonic forms of plague in new areas near borders shared with South Sudan and Uganda adds to the ‘considerable risk of cross-border transmission’. The agency is trying to garner support for control measures: rat and flea eradication and rodent-resistant housing.

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.

Leptospirosis warning in SW locale

A halt to canyoning activities was expected to be announced early this week for Ariège, in the SW region of Occitanie, following confirmation of leptospirosis in a person who had descended the Argensou canyon. Test results for two fellow canyoners also suspected to have contracted the bacterial infection are pending. The popular tourist area is located in an area of pastures and rugged mountains near the French borders with Spain and Andorra. Read more

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.

Seasonal surge in infections

Monsoon-related diseases are adding pressure to the health systems of several large cities, with malaria and cholera cases surfacing in Kolkata (West Bengal), and dengue fever infections in Bhubaneswar (Odisha) and in Hyderabad (Telangana) - some cases co-infected with COVID-19. Read more

Advice for travellers

Malaria is widespread in India and can occur in both rural and urban areas, including major cities. Travellers visiting India should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. Read more on malaria in India.

STI outbreak declared

A spike in syphilis infections that has overwhelmingly affected males is now officially a national STI outbreak. Health agencies advised that the majority of cases have been in Dublin (75 percent), while Cork, Kildare, Wicklow and Kerry were also noted to be locations of concern. More effort is called for to detect what could be ‘a potentially large undiagnosed reservoir of syphilis infection in Ireland’. 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.

COVID-19 digest

The WHO epi update this week noted that ‘the number of new cases reported globally seems to be plateauing after increasing for nearly two months (since mid-June)’, however a rise was seen in the Western Pacific (up 20 percent, mainly due to sharp increases in case incidence in Malaysia, Vietnam, Japan and the Philippines) and the Americas (up 8 percent, with USA contributing the most).

In related news:

- A ‘milestone’ has been achieved in the US, with the FDA granting approval to the Pfizer/BioNTech COVID-19 vaccine – Comirnaty. Emergency Use Authorisation (EUA) will still apply for adolescents aged 12 to 15 years.

- According to Our World in Data estimates, a point will be reached during the next week when one-quarter of the world’s population will be fully vaccinated. This will come at a time when fewer than five percent of people in Africa and 1.5 percent of people in low-income countries will have received at least one dose. Read more. Meanwhile the WHO has issued an alert on the detection of falsified doses of the COVISHIELD vaccine in Asia (India) and Africa (Uganda). COVISHIELD is the Indian manufactured formulation of Vaxzevria (AstraZeneca).  

A CIDRAP summary of findings from a US study published in MMWR this week showed that ‘unvaccinated people were 5 times more likely to get COVID-19 than vaccinated peers and 29 times more likely to be hospitalized for their infections’. The study was carried out in Los Angeles County from May to June when transmission of the Delta variant was increasing.  

Cholera outbreaks escalate

Deteriorating conditions caused by flooding during the country’s June-Oct rainy season have rapidly intensified the cholera outbreaks in six regions. Cases and associated deaths have now also been recorded in the capital Niamey, and the WHO regional office has cautioned that cross-border spread has the potential to lead to a wider regional outbreak. 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.

MERS cases climb to 11

The WHO has published an update on MERS-CoV in the Kingdom, announcing four more cases in the 20 weeks to July 31 and one death. Two of the cases were in Riyadh, and the others in Hafar Albatin and Taif - they take the YTD total to 11. The agency judged that more MERS cases will emerge in Saudi Arabia (or any country where the virus is circulating among its natural hosts, dromedary camels) from contact with infected camels, raw products obtained from them (i.e. raw camel’s milk), or in a healthcare setting. People who have underlying chronic medical conditions (i.e. diabetes, renal failure, chronic lung disease) and the immunocompromised are more likely to develop serious disease.   

WNV cases near Seville

Health authorities in Andalucia have reported the first West Nile virus (WNV) cases for the year, three people who live near the regional capital, Seville. Surveillance and control of mosquito populations the Lower Guadalquivir area is planned and nearby residents have been advised to avoid insect bites from dusk till dawn. Read more

Advice for travellers

West Nile virus is endemic in Eastern Europe and the Mediterranean basin, with epidemics regularly reported in summer and autumn since the 1950s. 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. Europe’s outbreaks are not as severe or widespread as in other regions where the virus occurs, notably North America. Read more on WNV.

Capital, 4 provinces with most dengue

Almost 10,000 dengue infections have been reported across the country for the year to July, with Bangkok and the provinces of Ranong, Rayong, Nakhon Pathom, and Mae Hong Son most affected. The situation in Bangkok, where cases have climbed to over 1,000, was described as ‘unprecedented’ and has been compounded by surging COVID-19 infections. 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.

NE state’s 2nd Salmonella outbreak

Contaminated drinking water is thought to be the cause of more than 570 Salmonella infections and two deaths in the NE state of Anzoátegui - the coastal municipality of Simón Bolívar has reported most of the cases. A similar outbreak was reported earlier this year in two of the areas currently dealing with the outbreak, El Carmen and San Cristóbal. Read more