World travel health alerts for 26th of February 2020.
Flu season past peak
In the week to Feb 16, high or very high rates of influenza activity were reported in several countries in the Balkan region and medium for most others. FluNewsEurope noted that on a regional level, the flu season started earlier than in most years and appears to have peaked in late Jan/early Feb. Influenza type A viruses predominated.
Advice for travellers
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. 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.
Potential for COVID-19 pandemic
An update by the WHO’s Director-General on Feb 24 included the following information: the epidemic in China has been declining since a peak and subsequent plateau from Jan 23-Feb 2; with mild infection recovery takes ~two weeks but three to six weeks in the event of severe/critical illness; and ‘the fatality rate is between 2% and 4% in Wuhan, and 0.7% outside Wuhan’.
The number of countries outside China reporting COVID-19 cases has risen to at least 40. Within the last few days, five more Middle Eastern nations reported cases linked to the outbreak in Iran, taking to eight those in the region recording COVID-19 infections (Afghanistan, Bahrain, Iran, Iraq, Kuwait, Lebanon, Oman and the UAE); and Africa has its second case (first was in Egypt), with Algeria confirming an infection in an arrival from Italy. While in Europe, infections related to contact with travellers from Italy have been confirmed in four countries - Croatia, Austria, Switzerland and Spain (including Canary Islands).
Public health measures are in place in Australia in the event of further escalation of the epidemic – they include the Australian Health Sector Emergency Response Plan For Novel Coronavirus (COVID-19). The federal health department has a number of resources available for the general public, health professionals and industry. Advice for Australians travelling overseas is to check the Smartraveller website and subscribe for updates.
Update on polio, plus African cases; Measles strikes in KP
In the last week, the GPEI reported on five more wild poliovirus (WPV1) cases (provinces of Khyber Pakhtunkhwa [4] and Balochistan [1]), and provided details on cVDPV2 cases in three African nations (Luanda in Angola [1], Oromyia province in Ethiopia [1] and Ashanti province in Ghana [2]).
THE NW province of Khyber Pakhtunkhwa has also been in the news due to a spike in measles cases – 104 cases have already been confirmed this year and a further 218 are suspected, however this is likely to be an under-reporting of the true situation. One hospital in Peshawar has recorded six deaths among children with measles over the past 12 weeks.
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.
Caution over measles, plus dengue near Iguazú Falls
Health authorities are on alert over two outbreaks: 465 measles cases have been reported in Argentina since July last year, and a dengue epidemic in progress immediately to the north in Paraguay. As a result, vaccination recommendations have been updated following discussions with stakeholders from the provinces and Buenos Aires, and a dengue prevention campaign has already been set in motion in Iguazú, near the Triple Frontier of Argentina, Brazil and Paraguay. On the Brazilian side of the Falls, a dengue emergency has been declared in Foz do Iguaçu after nearly 7,000 cases were recorded since August last year. Read more
Advice for travellers
Dengue is spread by Aedes mosquitoes which 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.
More YF reported in Santa Catarina
Cases of yellow fever cases in the state of Santa Catarina have risen to four – one each from the towns of Pomerode and Blumenau in the NE Vale do Itajaí (or ‘European Valley’) and Jaraguá do Sul and São Bento do Sul further north near the border with Paraná. 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.
Local dengue cases on Rapa Nui
Early this month testing confirmed the presence of three locally-acquired DENV-2 dengue fever infections on Easter Island. Last year 28 cases (DENV-1) were recorded in the territory and five more were imported (two of which were type 2). The Feb 22 WHO outbreak news post notes that, ‘Since 2009, no other serotypes besides DENV 1 have been identified in autochthonous cases until the beginning of 2020’. And in Colombia, a spike in dengue fever cases in the southern department of Huila prompted authorities to declare a health emergency on Feb 10.
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.
Ebola outbreak ‘stable’; Measles cases decline, situation remains serious
Five new confirmed Ebola virus disease (EVD) cases were reported in the three weeks to Feb 23, all from Beni health zone – only one of those cases was in the most recent 7-day reporting period. However the risk of resurgence remains despite the ‘overall trend and reduced geographic spread of the outbreak’. More in WHO Sitrep 81. In the Feb 24 CMRE newsletter, the trend continued with no new confirmed cases (377 suspected cases under investigation).
THE REGIONAL WHO office has expressed some optimism over the devastating measles outbreak with a decline in new cases over the past 10 weeks, but it reaffirmed that the situation remains serious. More than 20,000 suspected cases and 252 deaths were recorded in the first six weeks of the year with highest rates of infection and death in the provinces of Maindombe, Congo Central, Equateur, Bas-Uele and Mongala.
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.
Malaria uptick in west
Recent downpours have led to a surge in the number of malaria cases in the western county of Bomet. In a recent four-day period, more than 130 people required treatment for malaria and that number is rising – the greatest impact has been felt in the town of Sotik, but also in Longisa and Tenwek. Read more
Advice for travellers
Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.
Plague season in central district
Following recent Ministry of Health investigations, there’s been no new reporting of bubonic plague infections over the past fortnight in Ambositra district, an endemic region of the country’s interior. The district had recorded 18 cases and seven resulting deaths since August last year. The country last experienced a large outbreak of (mostly pneumonic) plague in 2017. Read more
Advice for travellers
Plague occurs annually in Madagascar, but poses a low risk to most travellers. Most cases of plague 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.
No let-up in Lassa reports
More than 2,100 suspected Lassa fever cases (586 confirmed) and 103 deaths were reported up to Feb 16 – the number of suspected case is almost double those for the same period last year. Sixteen states registered cases in the most recent reporting week and over half of the confirmed cases this year were from the southern states of Edo and Ondo. Read more (Week 7 update)
Advice for travellers
Lassa fever is an acute viral illness that occurs in West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5,000 deaths occur each year. However, Lassa is a remote risk for most travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Read more about Lassa fever.
MERS count rises again
The Ministry of Public Health announced last week that another MERS infection had been detected – three cases were reported in December last year. No details were provided by the on the recent case other than the 65yo man had chronic medical conditions. The previous infections were an older woman from Doha who had no history of contact with dromedary camels or recent travel, and two of her relations who were found to be infected (but asymptomatic) following contact tracing and have since recovered. Read more
Review of yellow fever cases in north
A WHO Disease Outbreak News post provides background on the recent yellow fever (YF) infections in Moyo, Buliisa and Maracha – eight in all, four fatalities among them and involved new localities. As two of the Moyo district cases were traders moving between Uganda and Kajo-Keji County in South Sudan, investigations are being carried out in that region (which is also suffering outbreaks of malaria, acute watery diarrhoea, measles and bloody diarrhoea). YF vaccination coverage in Uganda is negligible at 4.2 percent (planned to be added to the routine immunisation schedule, but not in force as yet). Entry conditions for travellers arriving in Uganda dictate that proof of yellow fever vaccination is required for all those aged one year and above.
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.
Round one of the dengue fight
The World Mosquito Program will begin releasing the first Wolbachia-infected mosquitoes in Colombo next week with the aim to drive down the burden of dengue fever. Countrywide, almost 15,000 dengue infections have been recorded this year – just under 2,200 of those in Colombo, with January’s total over 90 percent higher than in the same month last year. 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.