World travel health alerts 25 October, 2023

World travel health alerts for 25th of October 2023.

New dengue hotspots emerge in capital

Dengue fever transmission continues at a fast pace in Hanoi and new outbreak areas are still being reported. The districts of Hoang Mai, Phu Xuyen and Ha Dong all registered more than 1,500 cases over the past week. Elsewhere, Sri Lanka’s western and Kandy regions have seen an uptick in dengue cases as the national total passed 66,600 for the year. The wet weather is also likely to cause an upswing in diarrhoeal and eye infections. Lastly, the Burkina Faso cities of Ouagadougou and Bobo Dioulasso are at the centre of a deadly dengue epidemic that has so far killed more than 200 people. Read more

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.

Cholera in 3 regions

Mara region is now the hotspot in a cholera outbreak underway since July, however active transmission is still occurring in Arusha and Kigoma. Response measures have been introduced by the health ministry, but the regional WHO office expressed concern that the outbreak ‘continues to escalate both in case numbers and geographic spread’. Meanwhile in Burundi, the health districts of Isare, Cibitoke Kabezi continue to report cholera cases in an outbreak now into its 11th month. 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. For those at higher risk, an oral cholera vaccine is available. Read more about cholera.

Global polio digest

Local media have announced a wild poliovirus type 1 (WPV1) case in a two year-old child from Karachi, and positive WPV1 environmental virus samples have recently been collected from sewage in the city as well as in Peshawar, Rawal­pindi, and Chaman. In other news on polio from the GPEI weekly update, circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were logged by the Central African Republic, Côte d’Ivoire, Mali and Yemen, while the DR of Congo recorded both cVDPV1 and cVDPV2 cases. 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.

Dengue patients filling hospitals

According to local media, public hospitals and private clinics are all full with dengue fever patients - the majority of cases are children caught up in the upsurge in infections dating from late July. Within the wider region, suspected dengue fever case numbers continue to rise in Martinique and Guadaloupe, and Jamaica has now recorded more than 2,100 confirmed or suspected dengue infections (highest rates in St Thomas, Portland and St Mary). Lastly, Costa Rica’s nationwide preventive health alert announced in early September in response to the hike in dengue cases continues, with case totals now exceeding 14,400. Incidence has been greatest in the provinces of Limón (Huetar Caribe region), Puntarenas (North Central region), Alajuela (Central Pacific region) and Heredia (Chorotega region), according to an IFRC report. 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.

4 regions with malaria upsurge

Malaria cases have exceeded epidemic thresholds in Gambela, Southwest Ethiopia Peoples’ Region (SWEPR), Afar, and Ahmara, further straining relief efforts which are already dealing with high rates of cholera, measles, dengue fever, plus COVID-19. Plasmodium falciparum infections comprised just over 60 percent of reported cases. Read more

Advice for travellers

Travellers visiting malarious regions should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. Read more about malaria.

Spread from imported measles case in SE department

An outbreak of measles first reported in the SE department of Ardèche in mid-September was sparked by an unvaccinated returned traveller who had been to Bali and then participated in a local sports camp. At the latest update, the regional health office said that 61 people have now been infected – the majority were children and included some who had received their first measles vaccine before the age of 12 months. In more news of measles, there are updates on outbreaks in Ethiopia, Kyrgyzstan and Kazakhstan, plus a new outbreak in Uganda’s Kiryandongo District. 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. 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.

Dengue, WNV update

Late last week the ECDC updated the season’s count of locally acquired dengue fever cases reported in both Italy and France, with Italy’s total sitting at 58 - ‘four clusters in the province of Lodi, Lombardy region (30), the metropolitan city of Rome (25) and in Anzio (1), in the province of Latina (2), in the Lazio region’, and in France, seven clusters have led to 36 cases in the regions of Île-de-France (first report), Provence-Alpes-Côte d’Azur, Occitania and Auvergne Rhône-Alpes. The most northerly detection of autochthonous dengue in Europe is the one that occurred in Limeil-Brévannes, Île-de-France region, a SE suburb of Paris. The transmission season ends next month. From the same ECDC update, two new locations reported human West Nile virus (WNV) cases for the first time - Verbano-Cusio-Ossola in Italy and Timiş in Romania. Italy and Greece between them have recorded nearly three-quarters of the region’s confirmed WNV infections, repeating last year’s high rates. 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.

Diphtheria in eastern region

From an Oct 18 WHO update on the diphtheria outbreak affecting four of five prefectures in Kankan region, the total has climbed to 538 suspected and confirmed cases and 58 deaths from early July to mid-October. Just over 80 percent of cases have occurred in young children aged between 12 months and four years and none were vaccinated (36 percent DTP3 vaccination coverage). The agency advised that the region is also suffering outbreaks of pertussis, poliomyelitis and rabies. 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.

Weather ups parasitic diarrhoea risk

The UK is one of four countries (also Ireland, Luxembourg and the Netherlands) which has seen an increased incidence in cryptosporiasis reports, which the ECDC suggested may be attributed to ‘favourable environmental conditions (heat waves, heavy rainfall and flooding) in southern Europe and summer travel patterns towards these countries’. Ireland’s Health Protection Surveillance Centre (HPSC) noted that many of the infections reported to them by travellers were linked to stays in Catalonia, Spain (particularly Salou). Read more

Urban risk of scrub typhus

Nearly 4,000 people have been diagnosed with scrub typhus this year and authorities admit concern over an increasing number being reported from urban areas. Among the hardest hit areas have been the provinces of Sudurpaschim (Kailali and Kanchanpur) and Bagmati (Nuwakot and Dhading). Read more

Advice for travellers

Scrub typhus is a bacterial disease passed on to humans by mites, or chiggers, 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.

TBE advice for the outdoors

There has been a slight fall in tick-borne encephalitis (TBE) cases this year after the record numbers of 2022, however the risk of tick bites will continue until the weather cools considerably. Residents have been reminded to take precautions when undertaking outdoor activities such as mushroom picking, and to consider TBE vaccination over the winter months to prepare for next year’s peak season. Read more

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 the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE

Rubella uptick in Western Cape

Sporadic reporting of measles infections continue in Mpumalanga and North West, and the NICD has now announced an increase in rubella reports from the City of Cape Town (Khayelitsha sub-district) in Western Cape Province. Due to public health measures, fewer rubella infections were reported during the first three years of the pandemic, however the agency has now warned that as ‘the country has not experienced the usual seasonal rubella outbreaks, we are likely to see a large number of cases in 2023’. Read more

Advice for travellers

Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine. Highly contagious, rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Travellers should also check their immunisation status for all childhood diseases, including measles, mumps, tetanus, whooping cough and diphtheria as part of their pre-travel medical preparations. Read more about rubella.

More domestic malaria

The Korea Disease Control and Prevention Agency (KDCA) provided an update on local transmission of malaria up to the second week of October, announcing that 657 cases had been confirmed, plus another 62 imported malaria infections. Read more

Advice for travellers

Travellers visiting malarious regions should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. Read more about malaria.

Whitmore's disease in 4 provinces

At least 10 farmers from the provinces of Buri Ram, Nakhon Ratchasima and Songkhla have succumbed to melioidosis, sparking a warning from health authorities. News sources report almost 600 cases from the same provinces this year, with many of those infected aged over 65 years. Advice for the prevention of the bacterial infection centres around avoiding contact and the inhalation of contaminated soil, and not drinking dirty water. Read more

Local dengue a first

A resident of Pasadena in southern California has been diagnosed with locally-acquired dengue fever, the first such instance in the state. The individual had no history of travel outside the US this year and California is not dengue-endemic. Local authorities have said the dengue virus had not been isolated from any mosquito populations (including the Aedes vector) in the area and the risk of infection is very low. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. They 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.