World travel health alerts for 25th of September 2019.
First polio cases in close to 2 decades
On Sept 19, the Dept. of Health confirmed the first of two vaccine-derived poliovirus 2 (VDPV2) cases from opposite ends of the country: a 3yo girl from the province of Lanao del Sur in Mindanao and the second case, a 5yo boy from Laguna, SE of Manila on the island of Luzon. A Sept 20 media release revealed that in 2018 ‘12 out of the 17 regions in the country were identified as high-risk areas for polio reemergence’. Recently VDPV2 had been detected in environmental samples taken in Manila and Davao regions, and the Sept 24 WHO Disease Outbreak News post states that VDPV1 was also isolated from several environmental samples collected in Manila since July. Due to sub-optimal polio vaccination coverage and AFP surveillance, the WHO assesses the the risk of further spread within the Philippines [to be] high and ‘recommends that all travellers and residents in polio-affected areas be fully vaccinated against polio’ .Three catch-up vaccination campaigns are now planned for millions of children under 5yo across the Philippines. In other polio news, with seven more cVDPV2 cases detected in Angola (provinces of Huambo, Lunda Norte, Bie and Luanda), the YTD total has climbed to 15. Nigeria reported one more cVDPV2 infection (from Ibaji district, Koji province).
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.
Hep A source identified
Investigations carried out by the Korea Centers for Disease Control and Prevention have uncovered the source of a large hepatitis A outbreak that had also spread to the state of NSW, Australia. Hep A genes were found in over half of the salted clams (fermented shellfish) samples tested by the agency. The product has been recalled and advice issued not to consume the two affected brands. NSW Food Authority has also published information on the pickled or salted clams and details of hepatitis A symptoms for consumers to be aware of. Read more
Advice for travellers
Hepatitis A (HAV) is one of the more common infections for overseas travellers. It is a significant risk in countries where sanitation and hygiene are lacking. The virus is transmitted by faecally contaminated food and water, or through some types of sexual contact. A course of hepatitis A vaccine offers immunity that’s highly effective and long-lasting. Travellers should also follow safe food and water guidelines.
Dengue cycle upswing across region
In endemic or hyperendemic dengue fever regions, large outbreaks can run in 3-5 year cycles and this year Cambodia is just one of the countries in the SE/South Asian regions experiencing an upsurge in cases. The ECDC’s latest Communicable Disease Threats Report contains a digest of dengue fever and chikungunya reporting around the globe and advises that most countries ‘are observing a spike in the number of cases, with Thailand, the Philippines, Cambodia and Vietnam ‘particularly affected’ in 2019. While in Bangladesh, the dengue epidemic is relentless after more than 14,000 cases were recorded this month and the death toll rose to at least 75 to date; more infections are anticipated in dengue-affected parts of Pakistan before the peak season ends with the arrival of cooler weather; and in Sri Lanka the dengue case count is nearing 49,000 with almost half of those in western districts. Read more
Advice for travellers
Dengue is spread by 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.
39 million measles vaccines to halt outbreak
With most of the 4,476 measles infections recorded this year registered in the past three months (the majority in São Paulo state), the health ministry plans to provide catch-up vaccines to 39 million residents aged from 12 months to 49 years. 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. In general the infection is relatively benign, but complications 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.
Mixed progress in EVD outbreak response
When stringent public health measures can be applied, there is progress in the NE’s Ebola virus disease outbreak, however, as stated in this week’s WHO African region weekly bulletin, ‘persistence of hot spots and the shift in transmission intensity between the main hotspots remains of grave concern, as does continued sporadic transmission in other health areas’. Current case counts are listed on the WHO Ebola dashboard. In other news, after the UN asked for clarification over unofficial reports of a suspected Ebola death in the capital Dar es Salaam earlier this month, the Tanzanian government is now seeking details of ‘reports circulating in the media’ while reaffirming its stance that there is no evidence of Ebola disease in the country.
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.
Rising pertussis incidence causes concern
The Statens Serum Institut (SSI) has declared an outbreak of pertussis in response to a 3-fold increase in infections reported across a wide range of age groups. The 1,323 cases registered this year exceeds the combined total for the last two years. Read more
Advice for travellers
Travelvax Australia recommends that all travellers ensure they are current for whooping cough (pertussis) and all childhood vaccinations, including, diphtheria, measles, chickenpox and tetanus for travel to any destination – be it a developed or developing country. Read more about pertussis.
Cholera, chikungunya updates
According to the latest WHO weekly bulletin, reports of suspected cholera infections have been intensifying since early August; eight regions are now impacted with highest rates in Oromia, Amhara and Addis Ababa city. The bulletin also posted an update on Dire Dawa’s chikungunya outbreak: all neighbourhoods have been affected and limited spread has been confirmed in neighbouring Somali region.
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.
Isolated dengue case in Catalonia, France reports two
Autumnal weather is likely to prevent any further transmission after a single locally-acquired case of dengue fever was reported in the Barcelonès region of Catalonia. Authorities have commenced vector control measures – a vector of dengue fever, the Aedes albopictus mosquito, was first identified in Spain in 2004 and it is now established along the Mediterranean coast. Read more
This week a single dengue infection has also been reported in a suburb of Lyon, Caluire-et-Cuire, in the Rhône-Alpes region of France. It is the first time a locally-acquired dengue infection has been reported so far north and comes not long after another (also autochthonous) case was announced in the SE town of Vallauris in the Alpes-Maritimes region, near Antibes.
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.
Viral infection in southern states
One local news source is reporting a sharp rise in hantavirus infections in two southern states. Since early August, 202 cases have been recorded in Bavaria (Freyung-Grafenau district in particular) compared with 12 during those same weeks last year. The neighbouring state of Baden-Württemberg has also experienced an increase in cases. More on hantavirus from the ECDC. Read more
Local dengue recurrence, 7 cases reported
Health authorities have advised that the count of confirmed autochthonous dengue fever infections has risen to seven, with authorities acting on clean-up or fumigation activities in Dededo and Mangilao. No new cases had been identified according to yesterday’s Special Bulletin. Also in the Western Pacific region, in Yap there are reports of new dengue cases with highest rates in Tomil and Weloy. 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.
Dengue impacting several states: Hep A, E in Punjab
Dengue fever reporting this week has come from several states: Uttarakhand (dengue more prevalent in southern areas but highlands also affected), Telangana (Hyderabad, Khammam and Medchal districts), Delhi, Tamil Nadu, Maharashtra and Gujarat (Ahmedabad) and West Bengal (Kolkata). Read more
INVESTIGATIONS are underway into outbreaks of food or waterborne hepatitis A and E in the city of Bathinda in southern Punjab, however authorities now claim that the situation is contained. Flood damage to sewage infrastructure is thought to be responsible for the spate in cases.
Advice for travellers
Vaccine-preventable Hepatitis A (HAV) is one of the most common infections affecting travellers. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and some types of sexual contact. A course of hepatitis A vaccine offers immunity that’s 99%-plus effective and long lasting. It is also important to follow safe food and water guidelines.
Cholera outbreaks persist in 4 counties
There have already been several reports this year on cholera outbreaks that have troubled 10 counties - Garissa, Wajir Mandera, Nairobi, Turkana, Embu, and Makueni, Narok, Kajiado, and Machakos, and remaining active in the first four. More than 4,000 cholera cases have been reported in 2019 and 28 people have succumbed to the infection. 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.
YF cluster now involves 5 states
The NCDC has released details of the yellow fever cases connected with Alkaleri Local Government Area (LGA) in the northern state of Bauchi. From Aug 1 to 18 Sept, 243 suspected and confirmed cases with epidemiological links to the LGA were identified in Bauchi and four other states (Borno, Kano, Gombe and Katsina). The week 37 Situation Report notes that 28 cases are presumptive or confirmed and 34 deaths have resulted. A ProMED report contains further analysis of the outbreak.
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’s repeat pattern over Austral winter
The course of the dengue fever outbreak, now into its second year, is following that of winter in 2018. There has been a decline in the number of cases but active transmission continues (mostly in Saint-Pierre and Saint-Leu). For this year alone, up to Sept 17, nearly 18,000 cases had been confirmed, however another 50,000 infections were clinically presumed to be dengue. Read more
Advice for travellers
Dengue is spread by Aedes mosquitoes. They breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, making them difficult to avoid. 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 PMD when outdoors to all exposed skin. Read more about dengue fever.
Chikungunya alerts for 5 provinces
The provinces of Pattani, Ranong, Tak, Phuket and Songkhla have reported the highest rates of chikungunya infections this year and health authorities are pressing residents to avoid mosquito bites and keep their neighbourhoods clear of mosquito breeding sites. The national total up to Sept 16 was 7,481 cases reported from 49 provinces. Read more
Advice for travellers
Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Apply an effective repellent when outdoors to all exposed skin. Read more about chikungunya.