World travel health alerts 27 February 2019

Mozzie-borne viruses in Sydney’s west, East Kimberley

Health authorities in Sydney have issued warnings after Ross River virus was detected in mosquitoes in three western locations – Deepwater Park, Sydney Olympic Park and Bankstown. From a NSW Health media statement, the ‘Director of Environmental Health Dr Richard Broome said while Ross River infection was relatively rare in Sydney, high numbers of mosquitoes at this time of year mean people should be cautious.’ Read more. On the other side of the country, the Murray Valley encephalitis virus has been found for the first time this year in sentinel chickens in Western Australia’s East Kimberley. While the risk of contracting the virus is still considered low during the current wet season, visitors to the area and residents have been alerted to the need for using mosquito bite precautions. 

Advice for travellers

Cases of Ross River occur throughout Australia, including more temperate southern states. Travellers visiting areas of Australia affected by recent flooding or continuing rain should take measures to prevent mosquito bites. Use a personal effective insect effective ingredient such as DEET, Picaridin or oil of lemon eucalyptus (PMD) when outdoors and wear long, loose-fitting, light coloured clothing – especially at dawn and dusk, the times of day when RRV-carrying insects are most active. Read more on RRV from NSW Health.

All four dengue serotypes circulating

Brazil is one of three countries in the Americas that were reporting all four dengue serotypes in circulation in 2018 (together with Guatemala and Mexico), while Bolivia, Colombia, Honduras and Venezuela reported three serotypes co-circulating. Details can be found in the PAHO’s 2018 summary of dengue in the Americas with global updates on dengue and chikungunya in the ECDC’s Communicable Disease Threats Report (February 17-23).

Advice for travellers

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. 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.

Measles cases near 70,000

The latest WHO figures show the shocking extent of the measles outbreak in Madagascar – over 68,000 cases and 900 deaths. Vaccination campaigns have been underway to improve the estimated 60 percent national immunisation coverage. Read more. The latest report from the Philippines is that measles outbreaks are occurring in 17 regions with the tally as of Feb 24 at more than 12,700 cases and 203 associated deaths. Over one-quarter of all cases were in the National Capital Region comprising Metropolitan Manila. Poland has reported an 8-fold rise in measles cases this year. Of the 46 cases, more than one-quarter were aged 30-39 years, while Bulgaria has recently announced 46 cases with 10 of those in Sofia districts. In Vietnam, Ho Chi Minh City’s measles case count exceeded 1,000 for the first eight weeks of the year, with cases reported in all 24 districts. Other reports from around the globe can be found here.

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.

Dengue cases exceed 1,000

According to a local news source, Phnom Penh and the provinces of Siem Reap, Kandal and Kampong Speu have reported the highest incidence of dengue fever infections this year with the national total climbing to over 1,000 cases. A government report cited in the article also announced a 41 percent rise in Plasmodium vivax malaria infections in 2018 compared with the previous year, while P. falciparum cases decreased. Last year, over three-quarters of malaria infections were reported during the months of June and July. 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.

Measles epidemics in 39 districts

Measles case numbers have risen sharply this year and the focus of response measures is on epidemics underway across 39 districts, with six of those reporting over half of all cases - Amtiman, N’Djamena East, Abéché, N’Djamena Center, Dourbali and N’Djamena South. More than 3,000 suspected cases have already been reported this year, a figure more than half the 2018 total (5,336 suspected cases). 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.

Small dengue cluster in capital

The removal of potential mosquito breeding sites is a priority for the government after four cases of locally-acquired dengue fever were reported in Raratonga last week. The notification of the infections, the first local cluster in three years, comes three weeks after a traveller infected with dengue arrived from French Polynesia. As noted in the health ministry’s media release, ‘dengue is not endemic to the Cook Islands’. Read more

Advice for travellers

Don’t get bitten 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.

Ebola outbreak update

A comprehensive summary of the current Ebola virus disease outbreak in the provinces of North Kivu and Ituri issued by ProMED includes an outbreak summary, response and news on research. The latest newsletter from the Ministry of Health gives the situation as: ‘the cumulative number of cases is 875, of which 810 are confirmed and 65 are probable; 196 suspected cases under investigation. In total, there were 551 deaths (486 confirmed and 65 probable)’.

Mumps case numbers swell

The Health Protection Surveillance Centre reports a spike in mumps cases for the first eight weeks of the year with 381 cases, over half were from areas covered by the Eastern Regional Health Authority and North Eastern Health Board. Read more  

Advice for travellers

These outbreaks of mumps highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps.

Chagas disease uptick in February

Notifications of Chagas disease rose sharply earlier this month in the east coast peninisular state of Yucatán after 24 cases were recorded. With 62 cases reported last year, authorities put the rising incidence down to improvements in surveillance and testing. A ProMED moderator commented that the state ‘has some of the highest levels of Chagas in the country. Read more

Advice for travellers

Although widespread in Mexico, Central America, and South America, Chagas disease presents a low risk to Australians travelling to the Americas. Travellers who sleep indoors in air-conditioned or screened hotel rooms are at low risk for exposure to infected triatomine bugs (aka kissing or assassin bugs), which infest poor-quality dwellings and are active mainly at night. However, as has become more common, the disease can also be transmitted through food and freshly pressed juice contaminated with the faeces of insects attracted to ripening fruit. Read more on Chagas disease.

XDR typhoid cases top 5,800

In an update of information on extensively drug-resistant (XDR) typhoid fever infections in Sindh province, EMRO’s Weekly Epidemiological Monitor sums up the situation from November 1, 2016 to February this year: 5,853 XDR typhoid cases across 19 districts - 68 percent in Karachi and 27 percent in Hyderabad. Concerns expressed in the bulletin include the ‘number of knowledge gaps which is hindering effective control of this outbreak’ and ‘the number of reported MDR cases are increasing and also reported from areas other than initially affected’. Read more

Advice for travellers

Typhoid is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.

Whooping cough deaths in west

An outbreak of pertussis (whooping cough) that began late last year in the indigenous comarca of Ngäbe Buglé has now produced 95 cases and 11 deaths, while across the country there have been 11 cases this year – seven of those in the Metropolitan region. 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.

Polio response update

A Feb 20 WHO report detailed the response to last year’s circulating vaccine-derived poliovirus type 1 (cVDPV1) outbreak – ‘the last laboratory-confirmed case reported having experienced the onset of paralysis in late October 2018’. Five immunisation campaigns were completed by December and ‘AFP surveillance continues to be enhanced and all provinces are now reporting cases of suspected AFP’. In its risk assessment, the WHO notes that ‘the risk of international spread of poliovirus from Papua New Guinea to be low… there remains a need for additional SIAs/NIDs in areas of low-coverage to strengthen routine immunization programmes. The risk of further spread of cVDPV1 within the country remains a great concern due to poor routine immunization coverage’. Read more

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.

Malaria spike after rains in Limpopo

Officials from the Malaria Institute warn that recent rains in the NE province of Limpopo have led to a spike in malaria cases; two high risk areas were mentioned - Mopani and Vhembe. Read more

Advice for travellers

Malaria is endemic in many areas of southern Africa. Travelvax recommends that travellers visiting this region discuss their itinerary and preventative medication at their nearest Travelvax clinic, or with their healthcare provider. For advice, call Travelvax on 1300 360 164. More on malaria.

Weekly chickenpox cases near 1,000

In the most recent reporting week, varicella (chickenpox) rates climbed to a 5-year high, with 981 cases recorded mostly among children aged five to 14 years. As the varicella vaccine is included in the immunisation schedule in Taiwan, it is suspected the infections are due to waning immunity in a small percentage of children. Read more. A similar rise in varicella reporting has also occurred in South Korea, with more than 13,500 cases for the year to date. Read more

Advice for travellers

Chickenpox is a highly contagious disease caused by the varicella-zoster virus. Mainly passed from person to person by coughing or sneezing, it causes a blister-like rash, itching, tiredness, and fever. While the illness is generally mild in children, it can be more severe in young babies, adults, and people with weakened immune systems. Read more about chickenpox.

Increase in western district’s leishmaniasis

Cases of leishmaniasis reported in the town of Metlaoui have increased 3-fold in two years. The town is located in the western region of Gafsa and is known for phosphate mining. Read more

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.