World travel health alerts 28 April 2021

Positive VD-polio sample in south

The GPEI weekly report on Apr 21 revealed no cases of either WPV1 or circulating vaccine-derived polio over the reporting period, however six countries did register positive environmental samples. Iran’s cVDPV2 result, from Zahedan in Sistan and Baluchestan Province, was the first for the year (following three in 2020), while two cVDPV2 positive samples were retrieved from Tajikistan’s capital of Dushanbe. The other countries mentioned in the report were Afghanistan, Pakistan, Benin and Sierra Leone.

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.

Malaria elimination pending, ‘Draw the Line against Malaria’

After three years without local malaria transmission, the WHO will consider Cape Verde’s application for certification of elimination and, if successful, it will be the third time. In the past, failure to ensure vector control measures led to disease resurgences after certification was granted in 1968 and again in 1983. Read more. Coinciding with World Malaria Day on Apr 25, which had the theme ‘Zero Malaria – Draw the Line Against Malaria’, a number of endemic countries have published their malaria report cards: Namibia recorded a substantial reduction in cases (and deaths) from 2017 to 2019, however an increase was recorded in 2020; Zambia saw malaria cases rise from 5.3 million in 2019 to 7.6 million in 2020; In Pakistan around 60 per cent of the population (or 123 million people) are at high risk for malaria and it kills 50,000 every year; and in the Americas, the PAHO has called for urgent measures to keep Belize on track for malaria elimination in 2022. In other news on malaria, there has been good news on the vaccine front, with promising findings from a Phase IIb trial of the candidate vaccine R21/Matrix-M on 450 children in Burkina Faso. After 12 months of follow-up, vaccine efficacy was rated at 77 percent, over and above the WHO’s goal of 75 percent. Read more

Advice for travellers

Travelvax recommends that travellers visiting malarious regions discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. More on malaria.

Dengue outbreak showing no sign of decline

Reports of new confirmed and suspected dengue fever cases (DENV-2) have climbed by more than 40 percent this month as the outbreak total rose to 317 infections. More afflicted residents have required hospitalisation - 35 by the last count, and Raratonga continues to bear the brunt of the outbreak. Read more. In other dengue news, the ECDC’s latest update reveals the top five dengue reporting countries in the Americas – more than 270,000 suspected, probable, and confirmed cases in total from Brazil, Peru, Nicaragua, Colombia and Paraguay, with all four serotypes circulating. In more encouraging news, health authorities in the French Antilles are moving to declare the end of the dengue outbreak.

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. They 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 outbreaks claim 20 lives

A measles outbreak is ongoing in the eastern region of Yokadouma, adding to the national total for the year to Apr 4 which already sits at 843 cases and 20 deaths. In a media release this week, the WHO announced that up to 50 countries face a high risk of outbreaks of vaccine-preventable disease such as measles, yellow fever and polio after the disruption of immunisation programs due to the pandemic – over half of countries at-risk are in Africa. Read more

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 at least 6 weeks before departure.

Ebola countdown resumes

The last Ebola patient was discharged from a treatment centre in N’Zérékoré on Apr 24 and so the 42-day countdown to the end of the outbreak has restarted. There is still concern over surveillance and follow-up activities, a confirmed case remaining in the community and the identity of an early source of infection in Gouécké. In related news, with no new Ebola cases in North Kivu, there is just over a week to go before the D R of Congo’s 12^th outbreak can be declared over. 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.

COVID-19 update

On a global level, SE Asia recorded the largest weekly increase in daily incidence of new cases last week, largely driven by India’s surge in infections - reporting seven consecutive days of 300,000+ cases, and now more than 3,000 deaths in one day (both figures likely an undercount). The SE Asian region recorded a 49 percent week-on-week rise in new cases, according to the latest WHO epi update. In neighbouring Nepal, the peak climbing season has kicked off amid reports that several climbers had been evacuated from Everest Base Camp suffering from COVID-19. Nepal requires a negative PCR test no later than 72 hours before arrival in the country and also on entry. Seven day hotel quarantine is mandatory, but not necessarily enforced, for those with positive results. Read more

In related news:

• The WHO is considering emergency use approval for three vaccines – Moderna, Sinopharm and Sinovac, with a positive outcome expected to allow for their wider distribution. Read more
• CIDRAP summarised three real-world studies carried out on COVID-19 vaccines where it was found they reduced the number of both infections and hospitalisations.  
• Updated advice for women to seek advice on deferring a planned mammogram or breast ultrasound for six weeks following evidence that, as part of the normal immune response in some people, the two mRNA vaccines given in the US had induced a temporary swelling of the armpit lymph nodes that could interfere with the interpretation of the scan. Read more 
• The Australian government has published information to help patients make informed decisions on COVID-19 vaccinations - Weighing up the potential benefits against risk of harm from COVID-19 Vaccine AstraZeneca

Outdoors time brings hike in diarrhoeal illness

Parents have been warned to ensure their children wash their hands properly after spending time outdoors, following contact with animals, particularly on farms, as well as before eating and after toileting. The advice comes after a spike in cryptosporidiosis cases, a parasitic gastrointestinal infection which is often spread person-to-person and from animals through inadvertent contact with manure. Cases reported over the past few weeks, many of them in young children under 4yo, have hit more than twice the average. Read more

Advice for travellers

Outbreaks of ‘Crypto’ in holiday resorts are well documented – mainly the result of swimming in swimming pools and water parks harbouring the parasite. While the parasite can be spread in several ways, swallowing contaminated drinking or recreational water is the most common. Cryptosporidium is a leading cause of water-borne disease in most developed countries, including Australia. Read more from heathdirect.

Dengue cases rise amid long rains

All six sub-counties in the city of Mombasa report increased numbers of fever cases, with almost half of the tests performed returning positive results for dengue fever. Public health officials are warning that more cases should be expected as the seasonal ‘long rains’ run through to the end of May, boosting mosquito populations. 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.

Hep A cases still increasing

An update on the hepatitis A outbreak this year, with the case count rising to 180 by Apr 25, an increase of nearly 80 since March 29. In 2020 the territory recorded 100 Hep A infections. 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.