World travel health alerts 28 August 2019

World travel health alerts for 28th of August 2019.

1st VDPV case, all polio news

A cVDPV2 case has been reported in the Northern Province (Chereponi district) – the first for 2019, however the virus was detected in an environmental sample taken some 140kms to the SW in the same province in June. The GPEI advised that ‘Both the isolates are linked to [the] Jigawa cVDPV2 outbreak in Nigeria’. It also announced another cVDPV2 case in Angola (Amboim district, Kwanza Sul State).  Pakistan’s latest polio case count shows a further five cases were detected in the past week (Khyber Pakhtunkhwa – 3, Sindh – 2), representing an almost 400 percent rise on last year and taking the YTD figure to 58 across 20 districts. In other news, the WHO has provided details on the cVDPV1 cases detected in June in Hpapun township of Kayin state, Myanmar and the US CDC has issued a series of travel notices (Alert Level 2, Practice enhanced precautions) in relation to polio.

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.

Link in Hep A infections sought

NSW Health has advised South Korean community members to be aware of the symptoms of hepatitis A infection after up to eight cases were diagnosed among people with that background across three Sydney health districts and the ACT since June. Investigations are underway to determine the source of the infections – most of those infected had no recent history of overseas travel. The health department’s news release also stated that ‘South Korea, where hepatitis A is usually uncommon, is experiencing a large outbreak of hepatitis A with over 11,000 cases reported so far this year.’  

Advice for travellers

Vaccine-preventable Hepatitis A (HAV) is one of the most common infections affecting travellers. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and sexual contact. A course of hepatitis A vaccine offers immunity that’s 99%-plus effective and long lasting (20-30 years). It is also important to follow safe food and water guidelines.

Infection caused by rodents spikes

The ECDC reports that both Slovenia and Croatia have recorded significant increases in cases of viral haemorrhagic fever with renal syndrome related to hantavirus infections, while in Austria, 200 Puumala virus infections have been registered, mostly from regions bordering Slovenia. Peaks in the cycles of infections occur when food is plentiful for the rodent hosts; transmission to humans is via ‘the inhalation of infected rodent urine, droppings, or saliva’. More about hantavirus from the ECDC. Read more

Advice for travellers

Hantavirus is passed on to humans through contact with hantavirus-infected rodents or their urine and droppings. Eliminating rats in and around living quarters is the main way of preventing hantavirus infection. Cases have been documented in Argentina, Brazil, Canada, Chile, Panama, Paraguay, and Uruguay, making HPS a pan-hemispheric disease. Read more about hantavirus.

Dengue epidemics raging, regional updates

Dengue fever remains at epidemic proportions in nine of the country’s regions, over-reaching last year’s figures for the same period by over 75 percent – in the last reporting week, more than 14,000 cases and 46 deaths were recorded. And dengue isn’t the only infection proliferating during the wet season: warnings have been issued by Calabarzon health authorities on the risk of leptospirosis through contact with polluted water – there have already been 75 cases and 12 deaths in the region. Elsewhere in the region, the NEA in Singapore is advising that 156 dengue clusters are active (as of Aug 26) and the YTD case total now sits at 10,750 cases. Bangladesh is experiencing its most severe dengue epidemic – more than 5,500 people are currently receiving treatment for dengue infection in Dhaka hospitals. In related news, a second locally-acquired case of chikungunya has been reported in New Taipei City, Taiwan, one month after the country’s first ever case was detected in a man from the same northern city.  And in Thailand’s south, the highest burden of chikungunya is claimed by the provinces of Tak, Pattani, Phitsanulok, Surat Thani and Songkhla. On a national level, the more than 6,000 cases represent ‘a ratio of 9.52 persons for every 100,000, which is the highest in five years’. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.

Dengue in east, Bhutan’s outbreak persists

Dengue fever continues to rage in Dharan in the country’s east with estimates of 5,000 infections recorded since mid-May. Testing carried out on cases in four cities of Province 1 (Kakkdabhitta, Damak, Dharan and Biratnagar) found DENV-2 predominated. Relief is not likely to be felt until the effects of the monsoon end in October. While in SW Bhutan, the dengue fever outbreak in Phuentsholing that has killed one person and infected more than 1,200 shows no signs of letting up. 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.

Malaria strikes half the population

The 9-month long malaria epidemic is the basis of an Aug 22 CDC travel notice (level 1, Practice Usual Precautions). The WHO African region bulletin reports that there have been almost six million cases, resulting in 2,192 deaths (Burundi’s population is estimated to be around 12 million).

Advice for travellers

Sub-Saharan Africa presents a significant malaria risk. Travellers can discuss their itinerary and the need for anti-malaria medication with a trained travel health professional at their nearest Travelvax clinic. For details call 1300 360 164. Read more about malaria.

Ebola toll nears 2,000

Some positive news with no new Ebola virus disease cases in the city of Goma and the WHO noted a ‘small declining trend seen in the past three weeks [which] must be interpreted with caution’. In other news, a fourth EVD case was detected in Mwenga, South Kivu. Read more in the WHO External Situation Report Aug 27 and the Ebola dashboard.

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.

Dengue outbreak continues, Western Pacific updates

The dengue fever outbreak (DENV-2) continues with all but three communes on Tahiti in epidemic phase (NW is hardest hit) and also on Moorea (Afareaitu, Haapiti and Paopao) and Bora Bora (districts of Vaitape and Faanui). In total, a further six islands are on alert: Nuku-Hiva (Taiohae), Fakarava, Raiatea, Rangiroa, Huahine and Hiva Oa (Atuona). To date there have been more than 350 locally-acquired dengue type 2 cases. Dengue type 1 is also circulating on Tahiti and Moorea. While in the Marshall Islands, authorities fear the expanding outbreak of DENV-3 infections on Ebeye and now Majuro could prove severe to many of the population who were infected with type 4 virus during the last major epidemic eight years ago. A domestic travel ban has been instituted to prevent the spread of dengue to the outer islands. Type 3 dengue is also behind an outbreak on the island of Yap (Federated States of Micronesia), with 16 percent of people tested presenting with dengue/leptospirosis co-infections. Read the Aug 27 CDC travel notice on Dengue in Asia and the Pacific Islands. 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.

Monsoon-related infections update

News of a monsoon-related surge in diseases in Telangana: typhoid cases topped the 10,000-mark in the period from early June to last week while acute diarrhoeal disease sickened more than 86,000 of the state’s population. Vector-borne infections are also expanding in the state with dengue fever and malaria detections increasing in Hyderabad and Secunderabad; similar seasonal hazards in Goa have led authorities to eradicate mosquito breeding sites by fogging with insecticide around schools. Odisha recorded a 3-fold rise in malaria cases in July compared with June – Malkangiri and Rayagada were most affected. Local preparations are in progress in Rajasthan to stem an early rise in dengue, malaria and scrub typhus notifications. Flutrackers lists reported dengue fever data by state.  

Advice for travellers

Typhoid fever is endemic in many developing regions - vaccination is itinerary specific, but is usually recommended for those people who are 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.

Health promotion for rugby fans

The ECDC has summarised travel health recommendations for rugby fans heading to Japan for the 2019 Rugby World Cup to be held from Sept 20 to Nov 2 at 12 venues. In view of the half million or so visitors expected, the ECDC warned that ‘Gastrointestinal and respiratory infections, including meningococcal infection, are the most common communicable diseases reported at mass gatherings’, but also stressed the need for routine vaccinations to be current due to recent or ongoing outbreaks of measles and rubella in Japan. Other advice includes the use of insect bite avoidance measures, safe sex practices and enhanced respiratory and hand hygiene habits. Read more

Advice for travellers

Rubella is the 'R' component in the triple MMR (measles, mumps, rubella) vaccine. Highly contagious, rubella is spread by airborne droplets and can cause serious birth defects if infection occurs during early pregnancy. Travellers should also check their immunisation status for all childhood diseases, including measles, mumps, tetanus, whooping cough and diphtheria as part of their pre-travel medical preparations.

Measles travels to OC and beyond

An alert has been sparked after a teenager who had travelled from Auckland to various tourist favourites in California (including Disneyland, Universal Studios, Hollywood, Santa Monica) was diagnosed with measles on her return. The Orange County Health Care Agency and LA County Public Health have advised members of the public who were at specified sites between Aug 11 and 15 to monitor their health for signs of measles infection. 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.

GI infections hammer Karachi’s kids

Waters polluted in recent rains and accumulating waste in the streets of Karachi have caused a big spike in gastrointestinal infections among the city’s children – ‘more than 10,000 cases of diarrhea, gastroenteritis, hepatitis A and E have been reported in various hospitals in the city and it has been increased by 300-fold’, according to a ReliefWeb report.

Advice for travellers

The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Infection during the latter stages of pregnancy carries a higher rate of severe disease and mortality. Unlike the Hep A and B viruses, there is no vaccine for this strain in Australia, which is especially common in communities with lower levels of sanitation and hygiene. Read more about the virus and how to prevent it.

Dengue surge in east/north

There has been a nearly 2-fold increase in dengue fever cases up to mid-August, from 4,698 in 2018 to 8,325 this year. Six regions in the north and east have borne the brunt of the increase - Loreto, Cajamarca, Madre de Dios, Lambayeque, San Martín and Tumbes. Read more

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.

Confirmation of 3 vaccines for visa

Travellers from Australia who wish to apply for a visa to enter Sierra Leone are required to have evidence of yellow fever, cholera and hepatitis A vaccinations. According to the visa application accessed on the Republic’s Australian Consulate General’s website, information to supply includes ‘a copy of a certificate showing proof of compulsory vaccinations: cholera, yellow fever and Hepatitis A. 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.

Pork product recalled with listeria alert

Listeria-contaminated pork products from a facility in Seville, Andalusia have been identified as the source of nearly 200 confirmed listeriosis infections and two resulting deaths. EU health agencies and the WHO were alerted to the products in question (now recalled) amid concerns that cases may emerge outside Spain (Andalusia is popular with tourists) – one infection has already been confirmed in a British visitor to Seville this month. Read more

Advice for travellers

Read more about listeriosis in an Australian government Dept. of Health factsheet.

Dengue in Sunshine State; More rats, fleas in LA ups disease risk

Three apparently unrelated dengue fever cases have now been recorded in Florida’s Miami-Dade County with the local health agency advising the public to ‘remain diligent in their personal mosquito protection efforts’. Read more

A ProMED moderator has summarised murine typhus data from the Los Angeles area (rising incidence attributed to the mounting number of homeless people and rubbish/faecal matter littering the streets) as, ‘in 2018 over 85% of murine typhus cases in LA County occurred outside of the downtown area and about 95% occurred in non-homeless individuals’.  

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.