World travel health alerts 29 May 2019

World travel health alerts for 29th of May 2019.

Measles risk continues in region

The ECDC has published an assessment on the extensive measles outbreak in the region. ‘Who is at risk for measles in the EU/EEA?’ includes a warning that ‘there is a high risk of the continued widespread circulation of measles in EU/EEA in the near future’ driven largely by: A large pool of individuals susceptible to measles and high burden of measles among infants and adults, the groups at the highest risk of complications, as well as the continued potential of importations. France has reported an increase in cases recently with more than 100 new infections per week taking the YTD (May 22) toll to 1,184. And in Malta, MMR vaccination coverage of 95 percent has again been reached amid reports of more than 20 local cases this year. Nearly 1,500 new measles cases were recorded last week alone in the Ukraine (from late Dec to May 23 there were 50,749 and 17 deaths). In North America, the CDC now advises there have been 940 cases in the USA (Jan 1 to May 24) from 26 states; and in Canada, most of the nine measles cases reported in Saint John, New Brunswick are linked to a local high school. The Philippines recorded nearly 35,000 cases (and 477 associated deaths) between Jan 1 and May 11 and Hong Kong’s total has climbed to 75 for the year, up from 15 recorded for all of 2018. In the African region, there are updates from Algeria (provinces of Naama and Batna), Angola, Nigeria (Borno state) and Chad; while in our region, Auckland has now recorded 74 measles cases. 

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.

Malaria-free certification

Argentina is one of two countries declared malaria-free this month by the WHO and they were only the second to do so in their respective regions – Algeria is the other. The last malaria cases recorded in Argentina was in 2010, in Algeria, 2013. Read more

Rare dengue on Qld’s Central Coast; Flu season updates

Health authorities in Qld will use all measures required to halt further spread after a locally-acquired case of dengue fever was diagnosed in a resident of the northern suburbs of Rockhampton - no history of travel was recorded. The Central Queensland Public Health Unit director was quoted as saying that the mosquito vector was not abundant and the case was ‘located in areas with low population density’, reducing the likelihood of local transmission. Read more

THE SOUTHERN hemisphere flu season is underway with the WHO’s latest update (to May 12) noting that influenza reports are increasing in temperate zones: Australia and New Zealand (predominantly influenza A(H3N2) and influenza B viruses), South Africa (predominantly A(H3N2)) and South America (A(H1N1)pdm09). The case count in Australia was 58,974 on May 27 – highest figures from SA (15,554 cases), NSW (14,942), Qld (11,799) and Victoria (11,163).

Advice for travellers

The 2019 flu season has arrived in the southern hemisphere and Travelvax Australia recommends vaccination for all travellers over 6 months. Seasonal flu is the most common vaccine-preventable travel-related illness, posing a risk aboard aircraft, in crowded airport terminals, and at your destination. 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. Hand sanitiser is a convenient alternative if soap and water is not available. Read more on seasonal influenza.

Capital district’s mumps doubles

The Federal District, location of the capital Brasília, has seen a doubling of mumps infections this year with 632 cases recorded to date. Read more

Advice for travellers

Outbreaks of mumps serve to highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps.

Dengue upsurge

Children have borne the brunt of the increase in dengue fever cases, after health officials announced the number of infections rose to 8,000 this year (compared to just over 5,000 in the first half of last year). 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.

Disease risks rise from humanitarian crises

Ongoing security issues have only added to the number of ‘epidemic-prone diseases [that] continue to complicate the humanitarian situation, including hepatitis E (Bocaranga-Koui), measles, meningitis and poliovirus type 2 (Bambari health district). There are also sporadic reports of rabies and monkeypox.’ Read more

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.

Ebola situation update

Attacks on health facilities have ramped up over the past five months, hindering the response to the Ebola virus disease outbreak in North Kivu and Ituri provinces - the hotspots are still Katwa and Butembo. At the end of last week MSF issued concerns that actual cases are much higher than those being reported due to surveillance shortfalls. 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.

Likely infection source found

Spinach imported from Italy is believed to be the source of more than 50 Yersinia enterocolitica infections reported in various areas of Sweden and Denmark in March. Testing of the suspect batches was not carried out but other investigations implicated the imported spinach. Advice from authorities: wash leafy greens before consumption. Read more

Seasonal rise in rodent-borne infection

There has been a year-on-year increase in (Puumala) hantavirus reporting in areas of the SW state of Baden-Württemberg, coinciding with abundant food for bank voles, a virus host. A spike in cases has been seen in the capital, Stuttgart, in particular. According to the UK’s Fitfortravel website, risk of infection is low for most travellers, however it ‘is increased in those living or working close to rural - forested areas/rodent infested buildings (including cleaning garages, cellars and sheds); campers, agricultural workers, building workers, soldiers are among those most likely to be exposed.’  Read more

Advice for travellers

Hantavirus is passed on to humans through contact with hantavirus-infected rodents or their urine and droppings. Eliminating rats and rodents in and around living quarters is the main way of preventing hantavirus infection. Read more about hantavirus.

Malaria case’s long lag time

Investigations into a single malaria infection (P. vivax) reported from Thessaly Region (Trikala) in late April have determined it was ‘more likely that the patient was infected during the previous transmission season in 2018 by a P. vivax strain with a long incubation period (temperate strain).’ Between six and nine P. vivax cases were reported in Greece in 2017-8. Appropriate follow-up measures have been advised. Read more

Unconfirmed rabies report in Bali

A local news site is reporting an unconfirmed death due to rabies in eastern Klungkung regency. According to the source, a 22yo man died last week, three months after he was bitten on the foot by a dog. If the diagnosis is confirmed, this would be the first rabies-related death since 2016 on the island. 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. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is normally 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.

Festival’s potential to boost RVF risk

Optimal Rift Valley fever transmission conditions are set to weaken with the end of the rainy season, but warnings have again been issued to residents on the need to take precautions when slaughtering animals and consuming their meat and curdled milk as the end of Ramadan approaches. Since the end of November there have been 134 human RVF cases and more than 100 animal clusters. Recent activity has been seen in the east and south of the island. Read more

Advice for travellers

Rift Valley fever (RVF) is an acute viral disease that typically infects domesticated herd animals. It is generally found in eastern and southern Africa where sheep and cattle are raised, as well as in West Africa, Madagascar, and more recently Saudi Arabia and Yemen. People are infected after exposure to blood, body fluids, or the tissue of RVF-infected animals, or from the bite of an infected mosquito. The virus presents a low risk to travellers, but is another reason to use personal insect repellent and take other steps to minimise insect bites in places where it occurs. Read more about RVF.

YF update; Monkeypox infections prompt travel warning

In the year to Apr 20, 12 yellow fever infections were confirmed from the 930 suspected cases reported – the majority in the state of Edo (7 confirmed, 1 inconclusive), followed by Ondo (2), Imo (1) and Osun (1). Preventive mass vaccination campaigns are planned this year in Edo, Ekiti, Katsina and Rivers States for those areas not previously covered. Read more

THIS MONTH the US CDC issued a travel notice level one (practice usual precautions) bases on Nigieria’s monkeypox outbreak that first started back in 2017. Four cases originating in Nigeria have now been diagnosed in other countries (UK, Israel and Singapore).

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.

Sindh’s resistant typhoid

The country’s most populous city, Karachi, has recorded more than 1,760 typhoid fever cases for the year to mid-May, of which 1,217 were (Ceftriaxone) resistant infections. All areas of the city are affected with the cause ascribed to ‘consumption of contaminated water and poor sanitation conditions’. Read more

Advice for travellers

Typhoid 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.

Central, southern provinces’ dengue burden

Dengue fever is hitting children under 10 hard on Panay’s largest province, Iloilo, with authorities announcing cases have risen by almost 500 percent this year (over 2018 data) – and the wet season is just beginning. Read more. While on the Zamboanga peninsula, there has also been an increase, but not been as steep - 1,145 cases from Jan to April last year, this year there have been 2,767.

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.

School, and HFMD, resume

Hand, foot and mouth disease infections have soared as children return to school after holidays. The Ministry of Public Health’s Department of Disease Control reports highest incidence in Surat Thani, Chiang Mai, Phuket, Chumphon and Prachuap Khiri Khan. Ranking at number three, Phuket has had 143 cases, mostly among children under four years of age. Read more


Advice for travellers

Parents of young children should be aware of that seasonal epidemics of HFMD occur throughout Asia. The virus 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 on HFMD.

Cholera in north

The first of many reports of cases of acute watery diarrhoea and cholera started in April, stemming from the shores of Lake Tanganyika in Zambia’s north. The latest WHO update notes that five new cases are still being treated each day, however this does represent a decreasing trend in case numbers. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travellers, the risk of infection is low. Australians travelling 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.