World travel health alerts 28 October 2020

World travel health alerts for 28th of October 2020.

Polio update, Temporary Recommendations extended again

Plenty of polio news (and cases) this week, coinciding with World Polio Day on Oct 24: Pakistan reported two more WPV1 cases (Balochistan province) and Afghanistan registered a single WPV1 case (Kandahar province) but 14 more cVDPV2 infections from nine provinces. In Africa, seven countries added to their cVDPV2 counts: 21 in Burkina Faso, 16 in Sudan, 15 in Côte d’Ivoire, six in Mali, five in Somalia, four in Ethiopia and one in Nigeria, and lastly, in the Middle East, Yemen recorded two cVDPV1 cases in Saadah district. At the Oct 22 meeting of the Polio IHR Emergency Committee, it was remarked that with a 42 percent increase in WPV1 global incidence in 2020 over 2019 and more cVDPV infections in 2020 than in all of 2019 (409 cf 378), ‘the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC)’ so the Temporary Recommendations will be extended for a further three months. A number of factors have contributed to the current very high risk of international spread of WPV1, while there is frequent cross-border spread of cVDPV2, both in Asia (Pakistan to Afghanistan) and Africa – as evidenced by new outbreaks in Guinea, South Sudan and Sudan (and with the same virus also ‘detected in sewage in Cairo, Egypt but with no evidence of local circulation’). Of note however, is the reduction in sub-types / lineages and newly emerged viruses, which is down on last year. 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.

Dengue first, now chikungunya

Along with a rise in confirmed dengue fever cases, health authorities have announced they have also detected chikungunya infections. Over one-third of those with dengue have required hospitalisation which is possibly due to the introduction of a strain of the virus that hasn’t circulated in the islands in recent years. Read more and an update on the dengue epidemics in the French Antilles.

Advice for travellers

Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Applying an effective repellent to all exposed skin and covering up are your best defences. Read more about chikungunya.

28 days with no new Ebola cases detected in NW

Twenty-eight days have now lapsed since any confirmed Ebola virus disease (EVD) cases were detected and on Oct 7 the last EVD patient was discharged from the Makanza treatment centre. The Oct 27 situation update signalled that, without new infections reported, the outbreak could be declared over on Nov 18. In the interim the search for previously identified contacts who absconded continues as do community engagements focusing on disease prevention measures. The outbreak total is 130 confirmed cases (119 confirmed, 11 probable) 55 deceased & 75 recovered). More from ReliefWeb.  

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.

Preparing for cyclone season

While reinforcing residents’ responsibilities on preparing for disasters ahead of the cyclone season, the health minister gave an update on year-to-date infections due to dengue fever (4,000+ cases), leptospirosis (1,259 cases with half in Central division) and typhoid (203 cases) and a combined death toll of 23. 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.

COVID-19: 2nd consecutive week of ‘greatest proportion’ of new cases

The ECDC issued its latest update to the Rapid Risk Assessment on COVID-19 in the region on Oct 23, with both France and Spain now reporting more than 1 million cases (and ranking fifth and sixth globally in total case numbers). More restrictions and even nationwide lockdowns are under consideration in many European nations. The Oct 27 WHO epidemiological update noted Europe’s ‘33% increase in cases compared to the previous week – contributing nearly half of all new cases reported worldwide this week’ as the global total closes in on 44 million, according to Johns Hopkins tracking. The only week-on-week declines were seen in the WHO SE Asian and Western Pacific regions. Highest case numbers in the African region were reported in South Africa, Kenya and Ethiopia while in the Eastern Mediterranean region, the top three countries are Iran, Jordan and Bahrain. Also this week, the Oct 26 JH newsletter flagged French Polynesias’s per capita daily incidence which had increased by more than 80 percent, taking it to #4 globally, just behind Andorra, the Czech Republic and Belgium. A view of the epidemic curve of confirmed cases for the duration of the pandemic by WHO region can be found here.

In related news:

-The US CDC’s definition of close contact with a COVID-19 infected individual has been updated and is now characterised as 1.5 metres for 15 minutes’ exposures cumulative over a 24-hour period. Read more

-Published in the journal Clinical Infectious Diseases on Oct 17, a study based on a formal, placebo-controlled trial involving the use of hydroxychloroquine to protect healthcare workers caring for COVID-19 patients from becoming infected found that pre-exposure prophylaxis with once or twice weekly hydroxychloroquine ‘did not significantly reduce laboratory-confirmed Covid-19 or Covid-19-compatible illness among healthcare workers’.

-A Stat News video shows how messenger RNA (mRNA) vaccines work.

-In Japan, PCR tests are to be offered (for a fee) to travellers departing from Narita airport next month with results in around two hours. Read more

More virus news

Just under two weeks after a WHO Disease outbreak news post on Oropouche virus cases in the central rainforest region, the agency has published another article, this time relating to Mayaro virus (MAYV). Investigations into dengue fever-like illnesses reported since mid-July has uncovered 13 confirmed Mayaro virus disease cases, most of which were (unusually) from urban coastal areas (Cayenne, Kourou, and Montsinery-Tonnegrande), while two lived in a more typical rural/sylvatic setting (Roura). MAYV was first detected in French Guiana in 1998 and in the past three years, one to three cases were confirmed annually. It is from the same virus complex as the chikungunya and Ross River viruses and is characterised as an endemic and emerging pathogen in the Caribbean and Central/South America. With access to French technical and research capabilities, French Guiana is a ‘sentinel territory’ in the region, effecting the detection of other pathogens such as Tonate virus.

Rabies death toll mounts; Dengue cases down this year

Sarawak has recorded its fourth rabies death this year – a woman in her 30s from Sibu who was bitten by her pet dog but had not sought treatment. The state has now recorded 26 rabies cases since mid-2017. Read more

DENGUE cases for the year to date are roughly 25,000 fewer than last year, coming in at 80,000 with 133 related deaths. The trend of new infections is declining and, as with most countries in the WHO Western Pacific region (exception Singapore), this year has seen a significant reduction in the incidence of dengue fever. Read more. Meanwhile a Pacific community organisation’s (SPC) report of Oct 26 provides updates on dengue fever outbreaks in the Marshall Islands, Wallis and Futuna (both ongoing) and the Cook Islands, and the ECDC has summarised global outbreaks of both dengue fever and chikungunya in 2020.

Advice for travellers

Rabies is present in most countries and all travellers should be aware of the importance of avoiding contact with wild and domestic animals, including bats. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is generally recommended for longer stays, especially travellers planning to live in, or travel extensively through, rural areas and also for children; however the final recommendation is itinerary-specific. Read more on rabies.

HFMD hits urban kids

Southern districts of Ho Chi Minh City have seen the largest increase in hand, foot and mouth disease cases in the last week with one paediatric hospital is admitting up to 50 cases a day and 200 treated as outpatients. Dengue cases are also climbing as the country enters its peak rainy season. Read more

Advice for travellers

HFMD mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection. Read more about HFMD.