World travel health alerts 27 October 2021

World travel health alerts for 27th of October 2021.

AWD rife in Kabul's children

Aid agencies are assisting in the treatment of hundreds of cases of acute watery diarrhoea located in and around the capital, Kabul. The situation has been exacerbated by concurrent outbreaks of measles and the malnutrition that has hit hardest among children aged under five. Read more

Potential indicators of flu season to come

The ECDC has warned that the region could be heading for a severe influenza season this year, borne out by an early increase in flu detections in Croatia. As the A(H3N2) subtype has been dominant to date, the agency’s programme chief said that the effects of the pandemic combined with a bad flu season “could have serious consequences for the elderly and those with weak immune systems and could place an additional burden on health systems already strained by COVID-19”. The 2020-2021 flu season was exceptionally mild due to non-pharmaceutical interventions, however in general, ‘approximately 20% of the population become infected with influenza each year and one in four infected people will develop symptoms’. More on the global flu situation from the Oct 25 WHO update.

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. Whether you are travelling within Australia or overseas, 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.

Ebola count rises; Typhoid spike in southern province

The count of Ebola virus disease (EVD) cases at Butsili health zone, near Beni (North Kivu) has risen to six and four deaths, two of which are high risk as they occurred in the community. Nearly 600 contacts have been identified but not all of them are being monitored for follow up. Read more. The Oct 24 WHO regional bulletin expressed concern that ‘COVID-19, as well as cholera, meningitis, and measles outbreaks may jeopardize the country’s ability to rapidly detect and respond to the EVD outbreak’. On the other public health challenges, meningitis cases (Neisseria meningitidis serotype W) continue to emerge in Banalia district of Tshopo Province, but a reactive vaccination campaign is underway and mortality rates have declined thanks to improved case management.

MORE THAN 380 typhoid fever cases have been confirmed in Kalonda health zone in the southern province of Kasai since mid-September. Local media say that many of the cases have been in the communes of Mbumba and Mabondo. Nationwide there have been more than 1.1 million suspected typhoid fever cases reported this year. 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.

Zika, dengue and malaria reports

There has been a confirmed Zika virus infection in the city of Kanpur in the northern state of Uttar Pradesh (UP). A specialist response team has been dispatched to Chakeri area for the provision of ‘anti-larvae spray, identification of fever patients, screening of seriously ill people and pregnant women’. Read more. Also in UP, some districts of Lucknow have been experiencing a surge in dengue fever cases, while in Agra, media outlets are reporting a shortage in treatment options for people suffering from dengue and malaria. Nearby, in Delhi, hospitals are also reporting a spike in both dengue and severe dengue infections.

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 accessed through smartraveller (DFAT).  

Rising incidence of resistant typhoid

A study conducted on children living in informal settlements near Nairobi has found high rates of multidrug-resistant (H58) typhoid fever present. Some degree of resistance to antibiotics was identified in more than 95 percent of S. typhi infections, while MDR typhoid was seen in just over three-quarters of positive cases. Read more

Advice for travellers

Typhoid fever 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.

Scabies alert in southern district

Health authorities in Blantyre district have alerted the both residents and the administrators of large public venues to a spike in scabies cases. At least 10 towns in the southern district have recorded cases between June and September. Read more

Raw onions linked to Salmonella outbreak

Imported onions have been the link in an extensive outbreak of Salmonella Oranienburg infections that have sickened more than 650 people from 37 states and led to hospitalisation of 129. The red, white and yellow onions, traced to the State of Chihuahua in Mexico, have since been recalled. Read more

Advice for travellers

Salmonella is a bacterium typically found in food, such as poultry, that causes diarrhoea, fever, and abdominal cramps between 12 and 72 hours after infection. Illness usually lasts 4 to 7 days, and most people recover without treatment, although diarrhoea may be so severe as to require hospital treatment. Young children and the elderly are at highest risk of severe illness. As there is no vaccine to prevent salmonellosis, it is best to avoid raw or undercooked eggs, poultry, or meat. Read more

Hep A cases rise again

The epidemic of hepatitis A continues in the territory, with case numbers recorded since the beginning of the year now sitting at 487 – this figure is more than four times higher than in 2020. An earlier news report noted highest Hep A case numbers were on Maré (Loyalty Islands) and, in Province Sud, the commune of Mont-dore in Nouméa, Children aged under 15 years make up almost two-thirds of cases this year. Read more

Advice for travellers

Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through consuming contaminated food and water, by handling everyday items and through some types of sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is highly effective and offers long term protection.

Summary of polio reports; African Medicines Agency launched

From the GPEI’s weekly report on polio cases, Nigeria logged 37 cVDPV2 cases from 12 states (14 cases in Kebbi), while both Senegal (Diourbel) and Somalia (Middle Juba region) detected a single case each. Following World Polio Day earlier this week, the WHO has published ‘Pursuing the endgame: novel polio vaccine rollout in Africa’, providing details of the campaign to tackle the rising numbers of vaccine-derived polio cases through the use of the novel oral polio vaccine type 2 (nOPV2). In other news, next month the newly minted African Medicines Agency will begin its role in coordinating ‘national and regional regulatory efforts, support local manufacturing and pharmacy, and act against substandard and falsified medicines’. Read more

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.

COVID-19 pandemic ‘far from over’

THE WHO European region was again the stand-out in the WHO epi update, being the only region with increased new case numbers this week, up 18 percent on last week and a 14 percent rise in deaths. Forty-two of the EU’s 61 countries saw a rise in new cases, but the Ukraine’s was the largest, up 43 percent and deaths up 51 percent. A WHO statement this week on the latest meeting of the IHR Emergency Committee declared that the pandemic remains a public health emergency of international concern (PHEIC) and identified 10 Temporary Recommendations to States Parties.

In related news:

- In Australia, the TGA has approved booster doses of the Pfizer COVID-19 vaccine, COMIRNATY for individual 18 years of age and older to be given at least six months after completion of a primary course of COVID-19 vaccines.

- Fully vaccinated Australians will be able to travel overseas without a Dept. of Home Affairs exemption from Nov 1. Read more. And for those people, Smartraveller has advice on obtaining the necessary International COVID-19 Vaccination Certificate (ICVC).

- Discussions are being held between airlines and the federal govt. on the differences in the accepted vaccination status of children in the UK compared with Australia. Read more

- The US CDC has published the requirements for air travellers entering the country from Nov 8. They include a list of the accepted COVID-19 vaccines and proof of vaccination. Read more

- CIDRAP offered its perspective in ‘FDA panel green-lights Pfizer COVID vaccine for young kids’, after the independent panel that advises the agency approved the use of the Comirnaty vaccine in children aged between five and 11 years (with a dosing of two 10-microgram doses given 3 weeks apart). Data supplied by Pfizer stated that Comirnaty was 91 percent effective against symptomatic COVID-19 in this age group.

- The Immunisation Coalition has launched the CoRiCal Covid Risk Calculator that ‘aims to help people make informed decisions about the risks versus benefits of COVID-19 vaccines’.

- The AY.4.2 Delta variant sub-lineage (“Delta plus”) has been designated a Variant Under Investigation (VUI-21OCT-01) in the UK. Currently VUI-21OCT-01 accounts for around 6 percent of overall Delta cases in the UK. Read more in Technical Briefing No. 26.

- ‘COVID doesn’t need to run rampant. Here are 6 ways to keep cases low in the next year’: The Conversation

- ‘Fake, substandard vaccines and medicines spell trouble for controlling Covid-19’: STAT News