World travel health alerts 26 June 2019

Polio virus isolated in 2 provinces

News this week of a vaccine-derived polio case discovered in Lunda Norte province. According to the GPEI, the location is ‘at high-risk for further transmission of the isolated cVDPV2’ as it borders the DRC which has reported circulating VDPV2 outbreaks for the past two years. A second case, apparently unrelated to the first (‘and any other VDPV2 isolated elsewhere’), has been identified in Huila province, in an individual suffering from acute flaccid paralysis. As noted by the GPEI, this ‘further underlines the risk of cVDPV2 across Africa’. In other news from the GPEI, there have now been three positive environmental samples of WPV1 detected in the SE Iranian province of Sistan and Balochistan – ‘genetic sequencing confirms they are linked to WPV1 circulating in Karachi, Pakistan’.

Advice for travellers

Polio 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 doubles in Dhaka, regional news

Dengue fever cases have doubled in Dhaka in the past month amid reports that many areas of the capital were found to have large infestations of the Aedes mosquito vector. In Singapore, the NEA notes that the ‘persistently high Aedes aegypti mosquito population increases the risk of transmission of the dengue virus’ with active clusters more than doubling over the past five weeks. This year, dengue fever cases have tripled those recorded in Vietnam’s capital, Hanoi, for the same period in 2018 with weather conditions proving favourable for mosquito proliferation. Nepalese authorities are to conduct dengue awareness campaigns for residents of Kathmandu and the nearby districts of Lalitpur and Bhaktapur after Aedes mosquito populations were discovered in the area – several dengue cases were reported from one township in west Kathmandu last year. Read more

Advice for travellers

Dengue is spread by two types of 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.

Flu rates surge

According to the latest WHO global flu update, influenza activity was low over most parts of SE Asia, with the ‘exception of Cambodia where influenza detections of influenza A(H1N1)pdm09 and B (Victoria-lineage) increased in recent weeks’. Bangladesh is also experiencing a rise in activity, with ‘influenza B (Victoria-lineage) being the predominant detected virus, followed by A(H1N1)pdm09’.

Advice for travellers

The 2019 flu season has arrived in the southern hemisphere and Travelvax Australia recommends vaccination for all travellers over 6 months. Seasonal flu is the most common vaccine-preventable travel-related illness, posing a risk aboard aircraft, in crowded airport terminals, and at your destination. 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. Hand sanitiser is a convenient alternative if soap and water is not available. Read more on seasonal influenza.

Heat warnings for region

Heatwave conditions are expected to peak later this week across most districts and are likely to continue until at least the end of the month. High humidity is compounding the effect of the heat, with similar conditions occurring in Spain, Germany, Switzerland, Italy, Belgium and the Czech Republic (see ERCC map here). According to a BBC report, parts of Paris have been designated as ‘"cool places" that have lower temperatures than the surrounding city streets - such as parks, air-conditioned public halls, and areas where temporary fountains and mist machines have been set up’. Read more

New Ebola hotspots emerging

In the latest Ebola virus disease (EVD) update from the WHO issued earlier today it was stated that there had been some easing of transmission in hard-hit areas such as Butembo and Katwa, however ‘concerns remain over the concurrent increase in the number of new cases occurring in areas that previously had lower rates of transmission, such as the Komanda, Lubero, and Rwampara health zones’. CIDRAP has also reported a resurgence of EVD in the capital of Ituri province, Bunia. The June 25 Ministry of Health newsletter records the situation as 2,265 cases (confirmed and probable) with 1,522 deaths. According to a study published in PLOS journal, it has been estimated that since the Ebola virus was first identified in 1976, ‘at least half of EVD outbreaks’ have gone undetected.  

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.

Double dose of dengue

Two dengue serotypes continue to circulate in the territory with the health department advising an epidemic (of DENV-2 and also circulation of type 1) on Tahiti and alerts for Moorea (types 1 & 2), Bora Bora (1,2), Nuku Hiva (2), Raiatea (1) and Tahaa (1). Thirteen communes on Tahiti are affected by the DENV-2 outbreak and concerns persist that it could extend due to a lack of immunity among the local population. The cumulative total of locally-acquired type 2 dengue infections is now 104. 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.

Early monsoon disease reports

The rise in mosquito-borne infections reported during the annual monsoon season is being seen in some areas already, with local medical facilities in Pune on alert for an influx of dengue fever cases, along with warnings that conditions are ideal for the spread of malaria in parts of Maharashtra. In the country’s north-east, there are reports of Japanese encephalitis cases in the district of West Garo Hills in Meghalaya and malaria in Tripura. Read more

Advice for travellers

A mosquito-borne virus, JE is usually found in many part of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

Parasitic gastro illness in Lamu; Sand fly-borne infection rife in 3 counties

Food and water hygiene advice has been provided to people living in the town of Lamu after more than 100 cases of amoebic dysentery were reported. Cases in the area, the location of a UNESCO world heritage site, have been increasing over the past few weeks as the rainy season set in. Read more

IN THE village of Gilgil, just over 100kms NW of Nairobi, the mounting number of leishmaniasis infections among the local human population has been attributed to sand fly bites acquired during activities such as gathering firewood in nearby forests, the habitation of the rock hyrax, a leishmania parasite host. Separate outbreaks continue in the northern counties of Marsabit and Wajir with the WHO regional office now reporting more than 1,500 cases and seven deaths between them for the year.

Advice for travellers

Leishmaniasis is a parasitic disease 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. The former causes skin ulcers and the latter a severe systemic disease that is usually fatal without treatment. India, Bangladesh, Nepal, Sudan, South Sudan, Ethiopia and Brazil account for 90% of visceral leishmaniasis, while 90% of cutaneous leishmaniasis cases occur in Afghanistan, Algeria, Iran, Saudi Arabia, and Syria, as well as the South American countries of Brazil, Colombia, Peru, Bolivia and Argentina.

Chikungunya in peninsula state

In Alor Setar, the capital of the peninsular state of Kedah, up to 23 chikungunya infections have been confirmed and several others are suspected. Within the region, southern provinces of Thailand have experienced a surge in chikungunya cases this year with many of nationwide total of more than 3,500 reported from the south. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. 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.

Popular tourist spot’s dengue

Dengue infections are being reported from several townships located within the municipality of Puerto Vallarta, a Pacific coast resort town in Jalisco state. No outbreak has been declared as yet but officials are monitoring a rise in cases from El Pitillal. Read more

Advice for travellers

Avoid mosquito bites and you won’t get 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 again in NE

Cholera has again broken out in the NE state of Adamawa, several months after an outbreak that sickened more than 2,700 people and killed 45. The onset of the wet season is a potential obstacle to response measures. Yola North, Girei and Yola South are the three local government areas currently affected – almost two-thirds of cases have been women. Read more. Cholera vaccination campaigns are planned for two high-risk states in Somalia this week in response to the year’s 1,000-plus cases. 

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.

Health emergencies declared in 5 regions

More on the rise in Guillain-Barre syndrome cases, with the government declaring a state of emergency in the regions of Junín, La Libertad, Lambayeque, Lima and Piura. Almost 400 cases were reported in the two weeks to mid-June, according to an ECDC report which also commented that ‘Guillain-Barré is known to be triggered by bacterial infections, respiratory viruses, enteroviruses and arboviruses such as dengue and Zika’. Investigations are continuing.

1440 Hajj, Umrah health guidelines

The Ministry of Health has published its guidelines for ‘visitors traveling to Saudi Arabia for the purposes of Umrah, Hajj, or seasonal works in Hajj and Umrah areas’ which include the requirement for proof of quadrivalent meningococcal meningitis vaccination for anyone aged over two years. Also proof of vaccination is required for travellers arriving from designated risk areas for yellow fever and polio, as outlined by the MoH. Other recommendations include seasonal flu vaccination while promoting advice on food and water- and insect-borne infections and heat-related illnesses.

Advice for travellers

Meningococcal meningitis is an acute bacterial disease transmitted from person-to-person through close (kissing, sharing eating utensils) or extended contact. Risk factors include extensive travel in crowded conditions or extended contact with local people in crowded places. If planning to travel to any region experiencing an outbreak, discuss whether vaccination against meningococcal meningitis would be appropriate for your itinerary with your doctor. Read more about Men. meningitis.

Tourists’ chikungunya diagnoses in doubt

A June 21 release from Iceland’s Directorate of Health placed doubt on whether chikungunya infections had in fact been contracted by four of their nationals in the Alicante region of Spain recently. A follow-up local Spanish news report updated the situation, stating that the results were in fact false positives and that no other chikungunya cases or mosquito vectors were found in the immediate area. Read more

Dengue update, 4,000+ infections

Further on the dengue fever outbreak that has had the greatest impact on the city of Dar es Salaam, with confirmed cases now exceeding 4,200 and four related deaths (national total). Other affected regions include Tanga, Morogoro and Dodoma. (Dar es Salaam and Tanga regions have also reported cholera infections in the past 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 general advice on vaccination options for your trip, call Travelvax Australia’s travel health advisory service (1300 360 164).

Strep A infections surging

Since March, public health agencies have been tackling an outbreak of Strep A infections in Essex which, in 32 cases, progressed to cause invasive Group A streptococcal (iGAS) infections; 12 deaths have resulted. Many of those with complications were elderly and needed ‘care for chronic wounds in the community and care homes’. The outbreak is believed to be slowing but is not contained as yet. PHE data for England and Wales reveals a steadily increasing trend over the five years from 2013 with new cases almost doubling over the period. Mild infections are usually characterised by a sore throat (strep throat) or skin infection. Read more