World travel health alerts 29 July 2020

7 new wild poliovirus cases in 2 endemic countries

The country’s year to date count of WPV cases is now 60 with the addition of one case each from the provinces of Balochistan and Punjab. Afghanistan’s cases have risen to 34 after five more infections were reported by the GPEI (in Hirat, Kandahar and Uruzgan provinces), while the only cVDPV2 reports were from Chad – a single case in each of three provinces (Logone Occidental, Tandjile, and Wadi Fira).

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.

Six months into pandemic emergency

It is almost six months to the day since the WHO declared a public health emergency (PHEIC) over COVID-19 and the global total has soared to more than 16.6 million with 657,686 deaths. Currently five countries in the Americas rank in the top 10 for confirmed cases (US, Brazil, Mexico, Peru and Chile) – Mexico has moved into second place after Brazil for overall case totals in Latin America. Outbreaks in India (ranking 3^rd globally) and South Africa (#5) are accelerating. Read more

Authorities in Vietnam have announced the first cases of COVID-19 community transmission detected since April - 22 cases in the central resort city of Da Nang. Tourists in the area, most of whom are local, are being evacuated and social distancing precautions have been restored. While a major humanitarian network has urged Indonesians to ‘exercise greater caution’ as the country became ‘the hardest hit in South East Asia’. And in Hong Kong, a third wave of infections has led to a new swathe of public health measures to start today. News reports out of Papua New Guinea shed light on the local situation, saying on July 27 that ‘80% of PNG’s Covid cases have been recorded in the past 10 days’, amid shortages of PPE and concerns over the capacity to respond. More news in the latest CIDRAP summary and the July 28 WHO sitrep’.

In other related news, most members of an expert panel with the UN World Tourism Organization ‘expect international tourism to recover by the second half of 2021’. Read more

Chikungunya confirmed in one province, suspected in another

A mystery illness that sickened dozens of people in the western province of Banteay Meanchey has been confirmed as chikungunya. More than 160 residents of Poipet, a city on the highway connecting Bangkok and Siem Reap, sought medical advice after suffering from fever, rash and joint pain. Read more. And results are pending on tests taken from up to 20 residents of a Sihanoukville village suspected of having either chikungunya or rubella. Read more

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.

Hunt for source of outbreak

The source of a salmonella outbreak that has spread across 23 states remains unknown while genetic links have been identified in Salmonella Newport infections reported within the same timeframe in five Canadian provinces. Cases first started emerging in late June and have risen to 59 in Canada and 212 in the US. No deaths have been recorded to date. The CDC advises that no ‘specific food item, grocery store, or restaurant chain’ has yet been identified in the search for a source which is being carried out in collaboration with Canadian health agencies. 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

Seafood behind February Hep A increase

An investigation into the rise in hepatitis A infections in Liaoning province in February found that consumption of seafood in a raw or undercooked state was the cause in most cases. The coastal cities of Dalian and Dandong reported the majority of cases and authorities have now mounted an information campaign and encouraged hepatitis A vaccination for residents. 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.

Ongoing dengue outbreak

The dengue outbreak continues and is now into its second year, with at least 3,500 suspected cases registered so far. In other dengue news, the latest Cook Islands dengue update reveals an increase in cases reported in June, at least half of which were DENV-2. The outbreak of type 1 dengue was declared in February 2019. Read more

Advice for travellers

Dengue occurs both in urban and rural areas. The virus is spread by Aedes mosquitoes which breed in shady places close to dwellings and bite mainly during the daylight hours, making them difficult to avoid when 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 (or PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Plague, Ebola and measles updates

Concern has been raised over Ituri province’s plague outbreak which has now spread across five health zones, infected 64 people and killed 14 – last year only one health zone was involved and recorded 10 cases and five deaths. The WHO has determined the risk of spread on a national level to be moderate. Read more

NINE more Ebola cases and the same number of deaths have been reported over the past week in Equateur province as health agencies contend with public resistance to their efforts and the presence of confirmed cases in the community. Read more. A long term follow-up study has described the severe immune dysfunction suffered by Ebola survivors and ‘identifies a set of biological and genetic markers that could be used to define a signature of “chronic Ebola virus disease (CEVD)’.

FOUR provinces (Sankuru, Maindombe, North Kivu and North Ubangi) have recorded most of the measles cases logged in June with Sankuru reporting over five times more than the next highest (Maindombe). Read more

Advice for travellers

Plague poses a low risk to most travellers. The majority of plague cases are due to bubonic plague following the bite of an infected flea carried by rats. If left untreated, infection of the lungs causes the pneumonic form of plague, a severe respiratory illness, which can progress rapidly to death. Read more on the plague.

JE cases, deaths surge in NE

Only four of Assam’s 33 districts haven’t reported a Japanese encephalitis this year and cases have started to increase, climbing from 38 cases and 5 deaths earlier this month to almost 200 with 29 deaths. Two districts of Upper Assam have been hardest hit - Kamrup and Jorhat. Read more  

Advice for travellers

A mosquito-borne virus, JE is usually found in many parts of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to large urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

Mozzie uptick sees disease risk rise

A surge in Culex mosquito populations capable of transmitting the Japanese encephalitis virus has prompted health authorities in the SE city of Busan to alert residents to the need for preventive measures, including vaccination. Read more

Advice for travellers

Japanese encephalitis (JE) is the most important cause of viral encephalitis in Asia. It usually occurs in rural or agricultural areas, often associated with rice growing and pig farming. JE virus is transmitted to humans through the bite of infected Culex mosquitoes, particularly Culex tritaeniorhynchus. Most JE virus infections are mild (fever and headache) or symptomless, but around 1 in 250 infections results in severe and potentially fatal disease characterised by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and death. The risk to short-stay travellers and those who confine their travel to urban centres and use insect bite avoidance measures is low. Expatriates, repeat travellers and travellers living for prolonged periods in agricultural areas where Japanese encephalitis is endemic or where seasonal epidemics occur should consult their travel health provider about recommendations for vaccination. Read more.

More diphtheria cases in central regions, and now south

In a further update on the diphtheria outbreak, the number of cases in central regions (the Central Highlands and Quang Tri) has risen to 124, including three deaths, while two new infections have been detected in the south (Ho Chi Minh City and the province of Binh Phuoc). Government officials are proposing more public health measures in the Central Highlands to also manage a rise in rabies-related deaths and the diagnosis of tetanus in two residents this year. Read more

Advice for travellers

Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.