World travel health alerts 29 January 2020

World travel health alerts for 29th of January 2020.

16 polio cases, by region and by strain

A UNICEF/WHO report released this week outlines the current polio situation, with a total of 16 cases detected since the outbreak was declared in September last year: ‘13 cases with cVDPV2, one case with cVDPV1; one case with VDPV1 [not genetically linked to the Basilan and Malaysia cases]; and one case with immunodeficiency-related VDPV type 2 (iVDPV2).’ By region, the cases were from Maguindanao province (8), Sultan Kudarat Province (3), one each in the provinces of Cotabato, Lanao Del Sur province and Laguna, and also one from both Basilan Island and Metropolitan Manila. In other polio news, the GPEI’s weekly update dated Jan 22 reported on WPV1 cases in Afghanistan (Herat province) and Pakistan (Khyber Pakhtunkhwa province, which also reported three cVDPV2 cases & three from the Tribal Districts), while from the WHO African region bulletin, there were new details of cVDPV2 cases contracted in 2019 in Angola (12 cases from the provinces of Benguela, Moxico, Cuanza Sul, Bie, Luanda, Bengo, Uige and Huambo), Chad (a second case), Ghana (two more cases) and Togo (one case in Plateaux province).

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.

Flu activity high in Israel

This week the influenza round up describes a gradual increase in case reporting with group A viruses responsible for 78 percent of confirmed infections. Israel was the only jurisdiction to report high activity in FluNewsEurope, while medium levels were seen in Latvia, Austria, Switzerland, Slovenia, Georgia, Albania, North Macedonia and Greece. The ECDC report also advised that ‘Circulating viruses remain susceptible to the neuraminidase inhibitors’. While in the USA, the CDC reported moderate to high levels of influenza-like illness in all but nine states (Alaska, Delaware, Indiana, Michigan, Montana, Nevada, New Hampshire, Ohio and Idaho) – testing has seen two flu viruses detected at similar rates - B/Victoria and A/H1N1pdm09.

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. 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.

Measles, both near and far

Thirty-four measles cases have been confirmed in people with no history of travel – they were from two districts on Praslin island: Grand Anse Praslin and Baie Saint Anne Praslin. Read more. Elsewhere in the Indian Ocean, India has donated 30,000 measles vaccines to the Maldives for a vaccination campaign aimed at both Maldivians and foreign workers. Six measles infections have been recorded to date. In the Central Africa Republic, a national measles epidemic has been declared – at least 11 health zones have been impacted and more than 3,650 cases recorded since Feb 2019. And in our region, American Samoa’s case count is now 15 after three more cases were confirmed this week. Samoa reported two measles infections in the week to Jan 20, taking the outbreak total to 5,707 and 83 deaths. A govt. post advised that they have no vaccination requirements for inbound travellers, however travellers from Samoa to American Samoa do require proof of MMR vaccination. An update for Tonga to Jan 22 reveals no new measles cases on the islands of Eua and Niuas, however active transmission continues on Tongatapu and Vava’u. More than 42,700 vaccines have been administered in response to the outbreak. Fiji’s health minister announced last week that all 28 measles patients had recovered and, while no new cases have arisen so far, measures to raise vaccination coverage will continue.

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.

Sudden dengue spike in eastern department

Dengue fever infections have surged in the tropical eastern lowlands with cases in Santa Cruz already exceeding the department’s entire total for 2019. There have also been several deaths reported – three or eight, according to different sources. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which 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.

Rabies risk rises in north

The district health officer in the northern tourist town of Maun issued an alert to residents and visitors after two people succumbed to rabies infection following dog bites. Rabies vaccinations have now been administered to thousands of domestic pets in the region in an effort to check the rising incidence which has been blamed on recent drought conditions. Maun is the main entry point for visits to the Okavango Delta. Read more

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 – especially dogs, the main source of infection. In the event of an at-risk exposure, urgent first aid and post-exposure treatment is required. Vaccination recommendations are itinerary-specific but include those travellers planning to live in, or travel extensively or repeatedly through, endemic countries. Read more on rabies.

Measles outbreak showing no signs of slowing; 2020’s first YF case in southern state

In the six weeks to Jan 24, Brazil reported a further 3,669 measles cases and it has now contributed nearly 90 percent of all the measles infections recorded in the Americas since January 2019. It was one of five countries notifying cases during the 6-week period, also Argentina (29 cases), Chile (1), Colombia (12) and the USA (6). Read more  

AUTHORITIES in the southern state of Santa Catarina have confirmed the first human yellow fever case this year, a man from the northern city of São Bento do Sul, not far from the sites of the state's two cases detected in 2019 - Itaiópolis and Joinville.  

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.

Year-on-year rise in varicella infections

More than 3,100 cases of chickenpox have been reported already this year, representing a rise of 700 on the same period in 2019. While the varicella vaccine is recommended for children in Bulgaria, it is not included in the national immunisation program. Read more

Advice for travellers

Chickenpox (varicella) is a highly contagious disease caused by the varicella-zoster virus. Mainly passed from person to person by coughing or sneezing, it causes a blister-like rash, itching, tiredness, and fever. While the illness is generally mild in children, it can be more severe in young babies, adults, and people with weakened immune systems. Read more about chickenpox.

Conflict intensifies public health crises

The WHO is supporting national and international agencies in providing response measures to the humanitarian crisis as ongoing conflict escalates existing disease risks such as cholera and malaria while the country enters into ‘the epidemic seasons of meningitis and measles’. Read more

Advice for travellers

Meningococcal meningitis is an acute bacterial disease transmitted from person-to-person through close (kissing, sharing eating utensils) or extended contact. Risk factors include extensive travel in crowded conditions, extended contact with local people in crowded places and travel to sub-Saharan Africa’s ‘meningitis belt’ where meningitis outbreaks occur in the dry season (Dec-April) and just prior to the rainy season (May-June). Read more about Men. meningitis.

Novel CoV travel advice, resources

More details are emerging on the global spread of 2019-nCoV and confirmed human-to-human transmission outside China, amid predictions by academics in Hong Kong that infections in five mainland ‘megacities’ will reach their ‘peak between late April and early May’. Read more. Control measures introduced by the govt. now include a country-wide extension of the Lunar New Year holiday to Feb 2 and school closures up to a date to be decided. Last week the Emergency Committee convened by the WHO concluded that the outbreak did not constitute a PHEIC at that time - the next meeting is planned for Jan 30. Advice for travellers to China from Australia’s DFAT is to ‘reconsider your need to travel’ to China overall and ‘do not travel’ to Hubei Province, reflecting similar warnings from the UK Foreign Office and the US CDC. More resources: a GIS Dashboard with global cases (Johns Hopkins CSSE); US FDA landing page with links to more information, including Information for Healthcare Professionals, FAQs and Guidance for Travelers; The BMJ's latest coverage of the outbreak, including Best Practice; ‘Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China’: Huang et al, The Lancet;  ECDC, including a Rapid Risk Assessment published on Jan 26; Fitfortravel (update 4); today’s CIDRAP digest; STAT news article ‘The coronavirus questions that scientists are racing to answer’; ABC News (Aust.) story: ‘Australian lab first outside of China to re-create coronavirus, helping vaccine push’ and lastly, a Jan 26 article on the subject by the former director of the US CDC, Dr Tom Frieden, on LinkedIn.

Ebola virus claims more than 2,200 lives

Beni and Mabalako health zones in North Kivu province were the locations of the latest Ebola virus disease cases, as the total of confirmed and suspected cases rose to 3,420 and more than 2,200 deaths - 600 cases are currently under investigation. More in-depth information is available in the WHO Situation Report 77, with data to Jan 26. 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.

Lassa fever cases in 3 districts

The latest WHO African region bulletin reports on nine suspected Lassa fever cases (and five deaths) from the districts of Tonkolili (central), Kenema (east) and Kono (SE), none of which are linked to outbreaks in Nigeria (experiencing a ‘significant upsurge’ in cases this year) and Liberia. Read more

Advice for travellers

Lassa fever is an acute viral illness that occurs in West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5,000 deaths occur each year. However, Lassa is a remote risk for travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Read more about Lassa fever.

YF entry requirement details

A Ministry of Health statement published this week on the department's Twitter feed and through a local news site offers clarification of Rwanda’s entry requirements from yellow fever endemic countries or those with active outbreaks, for arriving travellers with an invalid, or no vaccination certificate, or for people found to have a fever (≥38.5°). 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.

Latest YF cases pave the way for routine immunisation

Yellow fever infections have been confirmed in five people from two NW districts (Moyo in West Nile region and Buliisa in Hoima region) – three of the cases have since died. The two (fatal) cases in Moyo had travelled from South Sudan prior to becoming symptomatic, the third death occurred in a cross-border cattle trader. The WHO is now working with the government to provide vaccinations in the affected regions and, with this latest outbreak, ‘Uganda now qualifies to introduce Yellow Fever vaccine as a long term measure to prevent Yellow Fever outbreaks’. 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.