World travel health alerts 27 March 2019

World travel health alerts for 27th of March 2019.

Measles on both islands

Canterbury district’s measles count increased by one to 35 this week after an infectious passenger arrived in Christchurch on a flight from Melbourne on Mar 19. Read more. Auckland’s case count has risen to nine with four of the five most recent measles infections considered close contacts of an earlier case. In Australia, the state of Victoria has reported another measles case in the past week, an infection stemming from an outbreak in the Northern Territory. There are separate alerts for both NSW and QLD, while in Western Australia, the state government announced a program providing free measles vaccines for residents born in or after 1966 who are not fully vaccinated against measles’. The media release noted that ‘while the vaccine is free, there may be a fee for the consultation’.

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.

BRAZIL: Southern state’s fever uptick

Yellow fever cases reported this year in the southern state of Paraná have risen to 12 with a local news source stating there have been 224 notifications overall and 61 cases are under investigation. Confirmed cases were in the municipalities of Antonina, Morretes, Adrianopolis, Campina Grande do Sul, Curitiba, Piraquara and São Jose dos Pinhais (this last town is the site of a new YF epizootic, together with Paranagua). Vaccination campaigns are being carried out across the 22 health zones of the state. 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 surges across 11 departments

New dengue fever cases are currently presenting at a rate of around 2,000 per week with highest rates occurring in the departments of Putumayo, Amazonas, Meta, Norte de Santander, Guaviare, Boyacá, Huila, Cesar, Tolima, Magdalena and Córdoba. Read more. A PAHO dengue summary shows the cumulative total in Colombia nearing 20,000 (to week 11). Other substantial data from the summary: Brazil (185,934 cases to week 10), Nicaragua (11,574 to week 8) and Mexico (7,131 to week 10).

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.

Regional dengue reports

The Mar 14 WHO Dengue Situation Update notes that ‘dengue activity has increased since week 7, and is higher compared to the same period in previous five years’ with the latest count at 978 cases and four deaths. Elsewhere in the Western Pacific region, Cambodia’s weekly total remains above the threshold, while year-on-year increases have been experienced in Singapore, Malaysia, the Philippines, Thailand, China and Vietnam.

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.

Ebola outbreak – 9 months, 1022 cases, 639 deaths

The Ministry of Health newsletter (Mar 26) announced the latest figures in this challenging outbreak – there are 161 cases under investigation, more cases in Katwa, Mandima and Vuhovi and news that four high-risk community deaths had occurred in Katwa and Mandima. Read more

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.

Local dengue 2 infection detected

Last month a level two health alert was instituted after an imported DENV-2 infection was diagnosed in a new arrival from New Caledonia; the reason being that over 80 percent of the local population has never been exposed to this strain. The alert remains in operation and will continue to do so after authorities confirmed a locally acquired DENV-2 infection in the area of Patuto'a, near the port and main shopping precinct. Read more. And in Palau it is DENV-3 that is the newcomer, with advice from the Ministry of Health that ‘the whole population is potentially vulnerable to infection’. Eight new infections were diagnosed in the most recent reporting week, taking the total since early December to 124. The majority of the cases have been in the southern states of Koror and Airai.

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, IR3535, or oil of lemon eucalyptus, 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.

Rise in measles reports

Measles cases were recorded at a 4-year high for the year to mid-March and many of the infections were in unvaccinated adults (15 of 24 cases). Immunisation rates in Singapore are high and the requirement for measles immunisation was recently extended to include foreign children applying to reside in the city-state long term. While in Hong Kong, public health authorities have moved quickly to limit onward measles virus transmission after several recent cases were reported among airport workers, including a flight attendant who was incubating the infection while working on a number of regional flights. The CHP has already provided over 800 measles vaccinations to workers onsite at Hong Kong International Airport. Last year’s measles total has been surpassed (20 compared with 15 in 2018). The extensive outbreak in the Philippines continues with the latest figures from the NDRRMC update on Mar 26: for the year to Mar 21 there have been 23,563 measles cases and 338 deaths from 17 regions. On Mar 23, ProMED published a summary of other outbreaks both within the Asian region (including Pahang in Malaysia and Macau), and also Africa and the USA.

Advice for travellers

A highly contagious virus, measles occurs in developing and developed countries. 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 6 weeks before departure.

Update on polio in Papua

From the GPEI weekly report on the current situation in Papua province: ‘In total, three genetically-linked circulating vaccine-derived poliovirus type 1 (cVDPV1) isolates were detected from Papua province. In addition to the above-listed isolate, cVDPV1 was isolated from an acute flaccid paralysis (AFP) case, with onset of paralysis on 27 November 2018, and from a sample of a healthy community contact, collected on 24 January 2019.  This outbreak is not linked to the cVDPV1 currently affecting neighbouring Papua New Guinea.’ Investigations into the occurrence and the necessary response measures are continuing. In the same report, more on Nigeria’s situation: ‘One case of circulating vaccine-derived poliovirus type 2 has been reported this week in Kaiama LGA, Kwara State. This is third case in Kwara State and the second in 2019 in Nigeria.’

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.

Cyclone lifts disease risk

Following damage to water infrastructure and health facilities caused by Cyclone Idai, response measures planned by aid agencies will tackle the anticipated rise in cases of acute watery diarrhoea, cholera, typhoid and malaria infections across the affected central regions, but centred on the port city of Beira in Sofala province. Authorities in Zimbabwe and Malawi, which were also severely impacted by the cyclone, are also on alert for the emergence of these same flood-related issues. The CDC has issued a level 3 alert – avoid non-essential travel – to the three affected countries while DFAT’s smartraveller also has current warnings for the region.

Clampdown on medication compounds

Authorities are cracking down on the practice by some pharmacies of pulverising medications (including analgesics, cough suppressants, steroids and antibiotics) and combining them in one sachet. The drugs involved may not even be registered or have passed their expiry dates. Of the many concerns over this practice, such as antibiotic resistance, there is a heightened risk of interactions and of side effects being intensified. A local news source claims the sachets are being sold at low cost in ‘convenient shops and beauty stores’. Read more

Lassa fever update

A second case of Lassa fever has been identified in the endemic zone of Eastern province. The child, who has succumbed to the infection, lived in Kenema District, near the Liberian border. And the Nigerian states of Edo and Ondo continued to be the highest reporting among those with new Lassa fever infections in the week Mar 11-17. Over half of the 23 new confirmed cases were from those states (others were Bauchi, Taraba, Imo, Enugu, Benue and Kebbi). In this outbreak, the infection has proved fatal in 23 percent of confirmed cases. 

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 5000 deaths occur each year. However, Lassa is a remote risk for 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.

Move over measles

A local news source in Nottinghamshire is reporting mumps outbreaks in the county’s two universities - the current count is 40 confirmed cases and 223 suspected infections. Both institutions are located in the city of Nottingham. Read more. In the US state of Pennsylvania, reports of mumps infections at Philadelphia’s Temple University climbed sharply in the past eight weeks with the current count now exceeding 100 cases.  

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.

Zika export

From a March 20 ProMED summary on Zika virus infection in the Americas and SE Asia, news that a young Taiwanese boy was diagnosed with Zika infection late last month after returning from a 10-day trip to Ho Chi Minh City. Read more  

Advice for travellers

Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information on smartraveller (DFAT).  

Cholera surges again

Stamping out the cholera outbreak remains one of the major health challenges during the last four years of conflict with children most impacted. According to Save the Children, ‘40,000 new cases were reported in just the last two weeks, a spike of 150% compared to the same period last month. More than a third were children under the age of fifteen – an average of 1,000 cases every day’.

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.