World travel health alerts 29 June 2022

COVID-19 update

Last week’s WHO COVID-19 epi update noted that the ‘rise in prevalence of BA.4 and BA.5 has coincided with a rise in cases in several WHO regions’, with UK public health advising that the two Omicron sub-variants are now dominant in the country, making up 61 percent of the total between them, and that the latter will likely become most prevalent due its growth advantage which has been gauged at ‘35.1% faster than Omicron BA.2’. According to the WHO update, ‘In some countries, the rise in cases has also led to a surge in hospitalizations and ICU admissions; however, the current evidence available does not indicate a change in severity associated with any of the three Omicron descendent lineages BA.2.12.1, BA.4 and BA.5’. On a regional level, increases in new cases were observed in SE Asia (highest case numbers were India, Thailand, Indonesia), Eastern Mediterranean (UAE, Morocco, Bahrain), and Europe (Germany, France, Italy), although the disclaimer for caution interpreting the data due to variable testing rates and surveillance affecting actual numbers applies. Read more

In related news:

- A June 25 ABC News article recounted, ‘COVID cognitive decline more widespread than thought, say researchers at Australia's first long-COVID clinic’ and another reported on the risks of COVID-19 re-infection. Read more

- A study conducted by Imperial College London estimates that nearly 20 million lives were saved by COVID-19 vaccines in one year. Read more

Tick season underway

Following last week’s post on severe fever with thrombocytopenia syndrome (SFTS) in Japan, reports have emerged of the tick-borne infection causing several deaths among older residents in Xinyang, Henan Province (known as a ‘high incidence area’). SFTS peak season occurs during times of high tick activity, from April to October. Read more

Advice for travellers

SFTS causes symptoms including high fever, vomiting, diarrhoea, blood abnormalities and multiple organ failure. There is no effective vaccine and deaths rates among those infected can be as high as 30 percent. Read more about SFTS in China

Cholera lingers in 2 provinces; Polio digest

There has been an overall decline in new cholera cases in Sofala and Zambézia provinces, however the outbreaks are not yet controlled according to the WHO. The hardest-hit districts have been Caia and Morrumbala in Sofala, and Mopeia in Zambézia Province. Response measures continue in the affected regions, but the WHO has stressed the need for ‘longterm investment in sustainable access to clean water, sanitation, and hygiene for the population’. Read more

DURING THE past week, the WHO has published more details on the wild poliovirus type 1 (WPV1) case detected in May near the Zimbabwe and Malawi borders in Mozambique, assessing that onward spread of the virus ‘particularly across the South East region of Africa remains high, due to persisting sub-optimal immunity and surveillance gaps, and large-scale population movements.’ In other polio updates posted by the GPEI, the D R of Congo logged 15 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases (Maniema, Sud-Kivu and Tanganyika), while Yemen’s two cases were in Saadah, Dhamar and Hajjah governorates and in Sanaa City. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travel, the risk of infection is low. Travellers to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care. Read more about cholera.

End of latest Ebola outbreak nears

The end of Equateur province’s Ebola outbreak should become official later this week, once 42 days (or two consecutive incubation periods) have lapsed with no new cases. The challenges remain however – healthcare worker strikes, community resistance and sub-optimum disease surveillance, but the WHO has hailed ‘the swift response of national authorities and partners [that] has paid off in controlling this outbreak so far’. 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.

Dengue epidemic brewing

Six municipalities recorded just over half of all dengue fever cases notified over a seven day period in late May - Santiago, Santo Domingo Norte, Santo Domingo de Guzmán, San Cristóbal, Santo Domingo Este and Los Alcarrizos. To date, the majority of dengue-related deaths have been in men, while most cases have been in the five to 19 years cohort. Authorities recently warned of a looming dengue epidemic after cases increased 3-fold compared to 2021 data. 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.

More countries reporting monkeypox cases

This week the WHO-convened IHR committee decided against declaring a Public Health Emergency of International Concern (PHEIC) over the multi-country outbreaks of monkeypox, however it has called for intensive surveillance ahead of the next review in a few weeks. On a global level, cases remain highest in the UK (1,076 as of June 26), while Germany is ranked second and Spain third with 756 and 736 cases respectively, according to the global.health database. Meanwhile in Africa, there have been 1,715 confirmed/suspected cases and 73 deaths this year from 10 countries. The latest WHO update lists a number of atypical presentations of monkeypox infections that have been observed and more outbreak news is provided in the Johns Hopkins Center for Health Security update. Read more

Chikungunya cases in Bali

Health authorities in Bali have requested cooperation from residents in helping to eradicate mosquito breeding sites following an uptick in chikungunya and dengue fever cases. Most recently, an increase in chikungunya infections was recorded in Karangasem on the east coast of the island and there has been at least one report of chikungunya diagnosed in a foreign tourist who had stayed in Ubud and Canggu. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by day-time feeding Aedes mosquitoes. 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 hotspots tagged

Residents of Kyaikhto Township, in the SW state of Mon, have been urged to clear mosquito breeding sites from around their homes after dengue fever claimed the lives of two children in the growing outbreak which has also seen more than 110 people diagnosed with severe dengue. In related news, areas of southern and central Vietnam have been named as dengue hotspots, with 10,000 new infections in the latest reporting week and news that the 2022 death toll had climbed to 30. And in Laos, the capital Vientiane registered the highest number of dengue fever cases in recent weeks, with the provinces of Saravan, Attapeu and Sekong also recording cases. Read more

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.

Typhoid in Cebu municipality

In the wake of Cebu health authorities announcing they had registered a total of 98 typhoid fever infections and two related deaths this year, media sources are reporting that hospitals in Barili are barely able to manage case numbers. Many of the patients admitted recently are said to be from Mantayupan and Gunting barangays. 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.

Scabies incidence on the rise

More time spent at home, together with delays in accessing medical care during the pandemic, are possible contributing factors to a step-up in scabies cases that has been observed in Spain since 2014. There are reports of doctors seeing significantly more patients with scabies or with more serious infestations, as well as a rise in anti-parasitic treatments being sold at pharmacies. On the same topic, hundreds of residents in Uganda’s far west district of Hoima who are infected with scabies have been advised to adhere to strict personal hygiene while waiting for medical assistance to arrive on the scene. Read more

Zoonosis plaguing SW district's residents

Residents of several villages in the SW district of Sheema have been afflicted by outbreaks of tungiasis, a parasitosis caused by female jiggers - the parasitic sand fleas burrow into the skin of humans (and animals) to feed on the blood meals necessary for incubating their eggs. The fleas become enlarged, causing irritation and pain, and can result in ‘abscesses, secondary infections, gangrene and disfigurement’, according to a WHO factsheet. Tungiasis is found most commonly in areas of poverty in tropical and sub-tropical regions, where people go barefoot and live in sub-standard housing with dirt floors. Read more

Poliovirus in London sewage - national incident declared

London residents have been put on notice to check polio vaccinations, particularly for children aged under five years who may have missed their routine vaccinations, following the detection of vaccine-derived poliovirus type 2 (VDPV2) in samples taken from the London Beckton Sewage Treatment Works, the largest such facility in Europe. No known active cases of polio have been reported to date. According to the UKHSA, ‘several closely-related viruses were found in sewage samples taken between February and May … and the virus has continued to evolve and is now classified as a ‘vaccine-derived’ poliovirus type 2 (VDPV2), which on rare occasions can cause serious illness, such as paralysis, in people who are not fully vaccinated.’ It is possible the transmission has occurred among a closely connected group of unvaccinated people. The GPEI advised that ‘Recent coverage for the primary course of DTaP/IPV/Hib/HepB vaccination, which protects against several diseases including polio, in London suggests immunization coverage of 86.6%.’ 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.

Meningococcal alert for Florida remains

The US CDC is maintaining its advice to men who have sex with men (MSM) to speak to their healthcare provider about vaccination against meningococcal disease as more serogroup C infections emerge in what is described as ‘one of the worst outbreaks’. At least 26 cases and seven deaths have been recorded in Florida outbreak. Vaccination is recommended for MSM who are residents of Florida, as well as those travelling to the state and anyone in the USA who is living with HIV. Pride events have added urgency to the advice on prevention. 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 or extended contact with local people in crowded places. If planning to travel to any region experiencing an outbreak, discuss whether vaccination against meningococcal meningitis would be appropriate for your itinerary with your doctor. Read more about Men. meningitis.