World travel health alerts 26 August 2020

World travel health alerts for 26th of August 2020.

Delayed reporting of polio

This week the GPEI advised that 15 cVDPV1 cases (aged 8mo to 13 years) have been detected in Saada Governorate. The infections were dated between late January and mid-June, however ongoing conflict has interrupted testing. Investigations suggest the virus has been circulating undetected in the country for up to 2 years. In other polio news, new wild poliovirus 1 cases have been recorded in Afghanistan (one each in Uruzgan, Kandahar and Hilmand provinces) and two in Pakistan (Balochistan and Punjab provinces), while in Africa, circulating type 2 virus (cVDPV2) cases were reported in Côte d'Ivoire (four cases from Gbokle-Nawa-San, Poro-Tchologo-Bagoue, Tonkpi), one in Nigeria (Sokoto province) and two in Somalia (Banadir province) – Sudan’s cases were listed in last week’s post.

And after four years without wild polio cases across the continent, yesterday the independent Africa Regional Certification Commission (ARCC) for Polio Eradication declared Africa to be wild polio-free. As the GPEI noted, global polio eradication is closer with over 90 percent of the world’s population now living wild polio-free.

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.

Measles spreads to 15 provinces

In an update of the measles outbreak spreading across 15 of the 18 provinces this year, children under five years have borne the brunt recording 80 percent of all infections. Hardest hit provinces and case counts as reported in the WHO weekly regional bulletin: Cabinda (436), Malanje (108), Bie (184), Luanda (88), Huambo (54) and Uige (45). The bulletin also provides recent details of the measles outbreaks in Burundi, Cameroon, CAR, Chad, Kenya and Liberia. The health minister of the DRC this week declared the end of their measles epidemic which over 25 months was responsible for the deaths of more than 7,000 children aged under five.

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.

COVID-19 update

Confirmation this week of a 33yo Hong Kong man re-infected with SARS-CoV-2. The IT worker had tested positive in March for COVID-19 and was cleared of the infection in April, however after he recently returned from Spain, he was diagnosed with a virus which through sequencing showed noticeable differences to the first. This second infection is also said to be asymptomatic, as opposed to the first which resulted in hospitalisation. Read more. Two more apparent re-infections have since been reported in Belgium and the Netherlands.

India has claimed the highest global daily incidence for the last 18 days and has now recorded more than 3.1 million cases and 58,000 deaths.

In the Americas, the PAHO director this week called for the strengthening of public health measures as deaths ‘have doubled and the number of new COVID-19 infections reported has more than doubled’ over the past six weeks. Dr Etienne said people aged 20 to 59 were behind the spread of infections but ‘almost 70% of deaths occur in individuals over 60 years old’.

Globally, over 1.7 million new COVID-19 cases and 39 000 new deaths were reported to the WHO for the week ending 23 August

In other COVID-19 news:

WHO: How to report misinformation online covering seven social media platforms Read more

On Aug 19 the WHO provided an update on ‘Considerations for quarantine of contacts of COVID-19 cases’ for the first time in five months. The interim guidance contains ‘updated guidance for the implementation of quarantine, as well as additional guidance on ventilation and on the care of children in quarantine’.

Long-Haulers Are Redefining COVID-19 Read more

The CDC no longer recommends 14-day quarantine for travellers arriving in the USA Read more

A Chinese COVID-19 vaccine has been in use since early July Read more  

UQ vaccine scientists report positive results from pre-clinical testing Read more

NW Ebola cases pass 100; Monkeypox, plague updates

The Ebola case count in Equateur province climbed to 104 with 44 deaths on Aug 24, double the tally six weeks ago. Concerns continue over the wide area affected and easy connections to large cities including Kinshasa and Brazzaville. The two cases reported on Aug 23 were in a health zone located near the DRC/Congo border. Read more

IN OTHER disease reports, monkeypox cases continue to emerge, now totalling more than 3,500 (suspected) cases and 132 deaths for the year to Aug 9, and plague infections in Ituri province are nearly 2-fold those recorded in 2019, with 91 cases and 17 deaths from five health zones (Aungba, Linga, Rethy, Aru, Logo and Kambala).

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.

WNV claims 2 lives in Seville

In a further update of the West Nile virus cases in Seville, news this week of two deaths among the 38 cases identified in Coria del Río and La Puebla del Río (as of Aug 21). The largely asymptomatic nature of most WNV infections means actual case numbers are likely to be much higher than the 38 reported. (More on WNV in Andalucia, Spain) And across Europe, the ECDC Aug 21 WNV update registered 66 cases for the region from ‘Greece (39, including 6 deaths), Italy (19), Spain (6), and Romania (2)’ and a single case from a newly affected area, the northern Italian province of Verbano-Cusio-Ossola, bordering Lake Maggiore. 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.

More viral threats for Delhi

Warnings for residents of Delhi as a surge in monsoon-related illnesses has the potential to further stress the health system which is already dealing with COVID-19 infections. One news source reports a sharp rise in viral illnesses (flu, dengue, chikungunya), plus malaria in the capital. 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.

CCHF toll rises to 5

Crimean-Congo haemorrhagic fever (CCHF) has proved fatal for five of the 38 infections reported since late March. Each year since CCHF was first detected in Iran in 1999, between 100 and 150 people are diagnosed with the infection and now most provinces report cases. Read more

Advice for travellers

CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

Cholera active again in Turkana

The WHO African region weekly bulletin reports the fourth wave of cholera infections this year to hit Turkana - Kenya’s largest county which is situated in the NW. Earlier outbreaks in Garissa, Wajir, Murang’a and Marsabit counties are now said to be controlled. 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.

Cholera outbreak in northern province

Conflict in Cabo Delgado province’s Macomia district is impacting response measures to a cholera outbreak. To date nearly 80 people have succumbed to cholera in the northern province with health workers unable to access those afflicted. Read more

Advice for travellers

While the risk of infection with cholera is low for short-stay travellers, Australians travelling to regions where an outbreak is occurring should adhere to strict personal hygiene and choose food and beverages with care. Read more about cholera.

YF infection in central district

A single case of yellow fever has been confirmed in a young girl living in Darou Marnane Ndia area, about 150kms NE of Dakar. The child, who was unvaccinated and lived in a district known to have sub-optimal vaccination rates, is recovering ‘with symptomatic treatment as an outpatient’ – no further cases were detected during follow up surveillance in the local area. The WHO has advised catch up immunisation campaigns (severely impacted by the pandemic) as well as vector control after surveys detected mosquito infestation rates above 22% with a ‘high proportion identified as a yellow fever vector, Aedes aegypti ‘. Read more

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 cases top 25,000

Dengue fever cases are expected to surge again in the wake of the SW monsoon season; health authorities have recently announced an increase in infections in Kandy, Ratnapura and Colombo districts. The YTD total has now exceeded 25,000 cases and there have been more than 20 dengue-related deaths. More on dengue and chikungunya across the globe in the ECDC week 34 update. Read more

Advice for travellers

Dengue occurs both in urban and rural areas, around human habitation. The virus is spread by Aedes mosquitoes which breed in shady places close to dwellings and bite mainly during the daylight hours, making them difficult to avoid when 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 (or PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

SW state with rising rates of CL

ProMED reports on the increasing incidence of cutaneous leishmaniasis affecting residents of the eastern part of Jabal Marra area in South Darfur state (one of the many endemic areas in Sudan).

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

Anthrax suspected in 3 deaths

An outbreak of anthrax affecting animals in Queen Elizabeth National Park (Ankole sub-region in SW) is presumed to have filtered into the local human population living on the shores of Lake Edward, killing three. As the infection is most often acquired through the consumption of infected meat, livestock in the area will be immunised and meat sales temporarily suspended. Read more

Advice for travellers

The anthrax bacterium is transmitted to people in the form of spores which are can produce disease through consuming contaminated meat, through inhalation or via contact with the wool, hair or hide of infected animals. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about anthrax.