World travel health alerts 27 November 2019

Risk of polio spread high nationally, moderate for region

In the past week, the Dept. of Health has announced another four poliovirus cases – from Mindanao and the first on the island of Basilan, south of Zamboanga. In addition, a Nov 26 WHO/UNICEF report confirmed VDPV2 circulation in Maguindanao province after four healthy children also tested positive for cVDPV2. The agency’s risk assessment notes that, in view of the rise in cases and environmental samples of VDPV 1 and 2, ‘the risk for further polio transmission continues to be assessed as high at the national level, because of chronically suboptimal immunisation coverage, sub-optimal performance of AFP surveillance, and poor sanitation and hygiene conditions. The regional risk of potential spread across international borders is still assessed as moderate considering the large number of Overseas Filipino Workers (OFW). Although many OFW work globally, the risk of international spread is still considered low, but not negligible, further influenced by dynamic migratory patterns (particularly the USA).’ In other polio news, the GPEI reported a wild poliovirus (WPV) case in Afghanistan’s NW province of Badghis, bordering Turkmenistan; three WPV and two cVDPV2 cases from Pakistan’s Khyber Pakhtunkhwa province and one cVDPV2 in Sindh; and in Africa, cVDPV2 cases in Nigeria (one in Oyo State), DRC (three cases from Haut Lomami province), Central African Republic (one each in RS3 and RS4 provinces) and Angola (one in Huambo province and two in Kwanza Sul).

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.

249 more measles cases over 24 hours, regional update

The Samoan government’s efforts to rein in the measles outbreak continue with more than 65,000 people vaccinated either before or during the current mass vaccination campaign. The outbreak has now caused 33 deaths, mainly children under 4yo, and sickened 2,686 – in the Nov 27 update, the govt. advised 249 more cases in the previous 24 hour period. The seven cases reported last week in Fiji has risen to 13 – mostly from the same area of Viti Levu, Serua/Namosi and Wainadoi. The update from Tonga on Nov 20 put the confirmed and suspected measles case count at 310 – Tongatapu (272 cases), Vava’u (38), ‘Eua (2), Ha’apai (1) and one suspected case in Niuatoputapu. There have been no fatalities recorded to date, a fact attributed to the 99 percent measles, rubella vaccination rates in the kingdom. More on measles in the region from WHO/UNICEF. Recent measles alerts issued by QLD, NSW & VIC state health departments stem from infected individuals arriving from overseas destinations including Samoa and New Zealand. On Nov 26 the WHO issued a summary of measles across the globe in a Disease Outbreak News post.

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.

A weathervane for our dengue imports

Research undertaken at QUT directly links weather conditions ideal for mosquito breeding in Bali with a rise in imported dengue into Australia, brought back by infected tourists; so it is very good news that the Wolbachia-treated mosquitoes introduced into countries, including Australia, through the World Mosquito Program have been found to drastically cut dengue transmission in those areas.  

Advice for travellers

While most of Australia’s dengue cases are contracted overseas, outbreaks have occurred in tropical and sub-tropical regions of North Queensland during summer months. Dengue fever is spread by daytime-feeding Aedes mosquitoes and travellers should apply an insect repellent containing an effective active ingredient, such as DEET, Picaridin, or oil of lemon eucalyptus/PMD to exposed skin during the day. In addition, cover up with long-sleeved tops, long pants, and shoes and socks around dawn and dusk, when the mosquitoes are most active.

Violence escalates as new Ebola cases decline

Reporting of new Ebola virus infections has dipped markedly – 12 days this month without a new case - so the impact of the suspension of aid agencies’ efforts caused by violence in the city of Beni and in Butembo, and Oicha health zones ‘couldn’t have come at a worse time’. More news on the outbreak’s latest case count, the Nov 26 WHO situation update and results of a study into Ebola viral RNA shedding in survivors. 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

HCWs infected with Lassa

It started earlier this month in the central district of Tonkolili with two Dutch health workers (one of whom has since died) contracting Lassa fever and being repatriated to the Netherlands (no barrier nursing employed in transit for the first, fatal case). The ERCC portal said that by Nov 25 there had been seven cases and three deaths, ‘including 3 laboratory confirmed, 2 probable (deceased) and 2 suspected’. According to the WHO African region bulletin, ‘a total of 48 contacts have been identified and are being monitored in Denmark, Germany, Sierra Leone, The Netherlands, Uganda and United Kingdom.’ Read more

Advice for travellers

Lassa fever is a low risk for most travellers. Rodents shed the virus in urine and droppings and it’s then passed on to humans through direct contact, touching objects or eating food contaminated with these materials, or through cuts or sores. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease. Read more about Lassa fever.

Dengue epidemic declared, more regional dengue

Following two years of dengue virus type 1 circulating, the appearance and then increase in both local and imported cases of type 2, plus the upcoming cyclone season, a dengue fever epidemic has been declared in Wallis and Futuna (centred mainly on Hihifo district in Wallis’ north). With this the public is being asked to ramp up anti-dengue measures and promptly report symptoms of dengue fever. Read more. Also in the region, an update on the dengue situation in the Marshall Islands reveals the total count has risen to 1,165 suspected and confirmed cases from four locations - Ebeye, Majuro, Utrik and Aur. While in French Polynesia, the type 2 dengue outbreak continues – more than 2,000 cases have been detected since April and 13 islands are in epidemic phase, a further five are on alert.

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.

Dengue in French Antilles

Following on from last week’s post on dengue in Jamaica, the latest ECDC update notes substantial increases in dengue fever reporting for the islands of Guadeloupe, Saint Martin and Martinique islands compared to last year.

Advice for travellers

Following on from last week’s post on dengue in Jamaica, the latest ECDC update notes substantial increases in dengue fever reporting for the islands of Guadeloupe, Saint Martin and Martinique islands compared to last year.

Mumps infections increasing

Mumps infections are on the rise in England, climbing from the 795 cases confirmed in the first quarter of 2019 to more than 2,000 between April and June. The increase in cases has also been seen in Ireland, with more than 2,000 infections recorded this year; the 15-24 years’ age group has been most affected. 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.

Small rise in tick-borne infections this year

This year there's been the highest number of cases of tick-borne severe fever with thromobocytopenia (SFTS or Huaiyangshan banyangvirus) since the virus was first detected in the country in 2013 – 96 in all, which may in part be due to better recognition of the symptom complex. In Japan the elderly are considered most at risk of acquiring the infection through contact with their pets. Taiwan’s CDC last week confirmed their first case of SFTS in an elderly man who took regular hikes in the mountains; people with outdoor exposure, including farmers and hikers are considered most at risk of the infection. Read more

Advice for travellers

SFTS causes symptoms including high fever, vomiting, diarrhoea, thrombocytopenia, leukopenia, and multiple organ failure. The virus has a 6%–30% case-fatality rate and there is no effective vaccine. Read more about SFTS in Japan.

Both Hep A & E circulating

Since December 2017 most hepatitis reporting has been related to the hepatitis E virus, however a news source last week highlighted the increase in the incidence of hepatitis A infections, with more than 2,200 cases reported in June/July - most cases from Khomas, Oshikoto, Oshana and Omusati regions. Hepatitis E continues to circulate – a Oct 20 update announced ‘a cumulative total of 1,608 laboratory-confirmed, 4,141 epidemiologically linked, and 855 suspected’ cases from 12 of the 14 regions. Read more

Advice for travellers

Vaccine-preventable Hepatitis A (HAV) is one of the more common infections affecting travellers. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and some types of sexual contact. A course of hepatitis A vaccine offers immunity that’s 99%-plus effective and long lasting. It is also important to follow safe food and water guidelines.

Mumps returns to Auckland

It’s not only measles infections causing concern to Auckland health authorities (now 1,692 for the year), the numbers of mumps cases has been increasing with the ARPHS reporting ‘clusters of mumps cases in Howick and Pakuranga and in the CBD and Ponsonby areas. The clusters include instructors working in community fitness centres and gyms across Auckland.’ Read more in the 22.11.19 news post.

Advice for travellers

Vaccine-preventable measles and mumps are highly contagious infections that can cause serious illness in people of all ages. Travelvax Australia recommends travellers check their status for these and other routine childhood immunisations, such as tetanus, diphtheria and whooping cough (pertussis) ahead of departure.

Bangkok, Chiang Mai lead dengue count

A local news source quoting health authorities revealed that this year’s dengue outbreak is the largest in more than 20 years with Bangkok and its environs, as well as Chiang Mai province accounting for many of the cases - there have been more than 136,000 cases and 126 related deaths to date this year. Read more. In Singapore, increased detection of the dengue vector, Aedes mosquitoes, and their larvae in October indicate a potential increase in dengue reporting in the coming weeks. The YTD count sits at more than 14,700 and 20 related deaths, and currently clusters are widespread across the island.

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.

RVF toll high in farmers; Dengue count tops 2,500 cases

Farmers have borne the brunt of the Rift Valley fever outbreak, with over one-third of the 319 cases since late Sept. from six states: River Nile (186 cases), followed by Red Sea (128 cases/11 deaths), Kassala (2 cases) and one each in El Gedaref, Khartoum and White Nile state. Read more

KASSALA has topped the case count in the dengue fever outbreak that began over three months ago – there have now been more than 2,500 cases according to a local news report which also drew attention to a rising number of malaria (and dengue) cases in North Darfur.  

Advice for travellers

Rift Valley fever (RVF) is an acute viral disease that typically infects domesticated herd animals. It is generally found in eastern and southern Africa where sheep and cattle are raised, as well as in West Africa, Madagascar, and more recently Saudi Arabia and Yemen. People are infected after exposure to blood, body fluids, or the tissue of RVF-infected animals, or from the bite of an infected mosquito. The virus presents a low risk to travellers, but is another reason to use personal insect repellent and take other steps to minimise insect bites in places where it occurs. Read more about RVF.

YF case confirmed in eastern state

The WHO has confirmed the first locally-acquired yellow fever infection in 14 years, occurring in a man with sylvatic exposure from a risk area of the eastern state of Bolivar, bordering Guyana and Brazil. 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.

Disease woes continue

The years-long war continues to compound ongoing public health crises, which include the cholera outbreak that has carried through into this year, and now a surge in dengue fever and malaria cases has been reported in the main port of Hodeidah and in Taiz governate. 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.