World travel health alerts 29 September 2021

World travel health alerts for 29th of September 2021.

2022 flu vaccine composition announced

The WHO’s advisory body on flu vaccination has determined the vaccine composition for our next influenza season, making changes to two of the strains – the H3N2 and influenza B/Victoria lineage components. It will also mean that two strains will be different when comparing the Southern Hemisphere formulation to the one for use in the Northern Hemisphere’s flu season this year. The WHO has provided a Q&A document covering ‘Recommended composition of influenza virus vaccines for use in the southern hemisphere 2022 influenza season and development of candidate vaccine viruses for pandemic preparedness’. More testing of influenza specimens have been performed this year compared to last, but overall there were few viruses to analyse. More flu news in the Sep 27 WHO global flu update. Read more

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. Whether you are travelling within Australia or overseas, 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.

Rapid response to border zone malaria

Agencies in Nicaragua and neighbouring Costa Rica have been working together to stem an outbreak of malaria in La Trocha on the southern (Costa Rican) side of the border. Surveillance has detected a total of 15 cases from both nationalities in the area which experiences high population movement. Read more  

Advice for travellers

Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Northern meningitis outbreak report

An update on the meningitis outbreak which is ongoing in Banalia territory (Kisangani district) since late July has the case count at 777 cases and 167 deaths, with serogroup W identified from 12 tests performed. In related news, a WHO press release this week announced a new meningitis strategy which aims ‘to eliminate epidemics of bacterial meningitis – the most deadly form of the disease – and to reduce deaths by 70% and halve the number of cases’ by 2030. While outbreaks of meningitis occur throughout the globe, the burden is greatest in Africa where ‘more than half a billion Africans are at risk of seasonal meningitis outbreaks’. 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.

COVID-19 update

The WHO African regional office announced that there had been a slowing of COVID-19 cases in the last eight weeks, but the trend was ‘slower than in previous waves due to the persistent effects of variants. South Africa continues to report more than half of all new cases in the region, followed by Ethiopia’.  Read more. Elsewhere, Russia has just logged its highest daily death count since the start of the pandemic, largely due to the effect of the Delta variant and sub-optimal vaccination rates, while in Japan, a gradual easing of restrictions will occur with the end of the state of emergency for 19 prefectures later this week. Vaccination rates across the globe have been falling: It’s estimated that just under 45 percent of the world’s population has received one dose of a COVID-19 vaccine and around one-third are considered fully vaccinated. Africa’s vaccination coverage is sitting at just over four percent. See more from Our World in Data.

In related news:

- On Sept 23, ATAGI published a statement about the need for additional doses of COVID-19 vaccines.

- The Federal Health Minister last week requested that Pfizer present its data on vaccinating children aged between five and 11 years of age with the Comirnaty vaccine ‘at the earliest possible time’. Read more

- The Novavax COVID-19 vaccine has been presented to the WHO for consideration of Emergency Use Listing by the company and its partner, Serum Institute India. The Australian govt. has a supply agreement in place for the Novavax COVID-19 vaccine, however it has not been granted regulatory approval in any country as yet. The partners have completed some of the steps required by regulatory agencies in India, Indonesia and the Philippines as one of their priorities is to enable vaccine access in low- and middle-income countries. Read more

- On rapid antigen testing for COVID-19: the TGA announced this week that a change will be made in a regulation ‘that will allow companies to formally apply for TGA regulatory approval after 1 October to legally supply their self-tests for use at home in Australia after 1 November 2021’. More about rapid antigen tests in The Conversation.

Dengue, chikungunya news; Summary of Nipah virus case; Mumbai’s flood-related disease risk

Authorities in the state of Maharashtra report a rise in chikungunya cases over the past three months which has been greatest in Nashik, Kolhapur and Nagpur - most recent case numbers show a 2-fold increase compared to the same period last year. Read more. A similar trend has also been seen in Jharkhand, with a higher incidence of chikungunya cases than dengue fever being reported. In Gujarat’s Ahmedabad district, dengue cases are four times higher than in 2020 and chikungunya infections have doubled. The number of typhoid fever cases reported has also climbed, up by half compared to last year with 1464 infections registered.

THE WHO has released a summary on the Nipah virus infection and subsequent death of a 12yo boy in Kozhikode district of Kerala earlier this month, noting that this was the fifth outbreak recorded in India. The last reported incident was in Kochi district, also in Kerala in 2019. In its risk assessment the agency stated that the ‘event is an isolated case and the risk is low at national level and low at the regional level’ as the country has demonstrated its ability to control outbreaks in the past.

DATA released by health agencies in Maharashtra highlight the burden of leptospirosis in the city of Mumbai, revealing that since 2015 the infection had been more deadly than both dengue and malaria. Fatal cases resulted most often when infected people presented late for treatment. Read more

Advice for travellers

Fruit bats (flying foxes) are the natural hosts of Nipah virus, and females shed the virus when pregnant or lactating. The fruit-eating bats perch on the jars used for collecting juice from palm or date trees, contaminating the juice with infected saliva and droppings.  People are infected when they drink the raw juice, although it is also spread through person-to-person contact. Read more about Nipah virus.

Rabies uptick in SE region

Amid a rise in rabies infections among local dogs and cats, Nelson Mandela Bay Municipality in Eastern Cape Province last month reported the death of a young boy following a bite from a rabid dog. Responding to concerns the outbreak could spread to other areas, a rabies vaccination campaign has been targeting the municipality’s domestic pets. Read more. And in Lebanon, rabies is now said to be a risk on the streets of Beirut after unvaccinated dogs abandoned by their owners due to the economic downturn were left to roam free.

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.

Plague season continues

A local news source reported last week that the pneumonic plague outbreak in Arivonimamo has been declared over. The district recorded around 20 cases and seven associated deaths, however no new infections have been detected for several weeks. The same outlet also announced the death of a young man from bubonic plague in Ankazobe (Analamanga Region, Central Highlands of Madagascar) and another case in one of his close contacts. Read more

Advice for travellers

Plague occurs annually in Madagascar, but poses a low risk to most travellers. Most cases of plague 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.

Cholera in NE region

A cholera outbreak linked to Niger’s Tillabery region and affecting Gao in NE Mali is centred on Ansongo health district, an area which shares borders with both Niger and Burkina Faso. The regional WHO office assessed the risk of further cholera spread from its current localised focus to wider areas of the country as high – previous outbreaks have expanded along the Niger and Senegal River systems. Read more

Advice for travellers

While the risk of infection with cholera is low for short-stay travellers, Australians travelling to regions where an outbreak is occurring should adhere to strict personal hygiene and choose food and beverages with care. Read more about cholera.

Typhoid cases highest in 2 coastal states

The number of typhoid fever cases recorded in the eastern coastal state of Tamaulipas this year has passed the 3,400 mark and is the highest in the nation, according to a local news source, while Sinaloa in the country’s NW ranks second with 3,381 cases. 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.

Hep A outbreak ongoing

A Pacific Community report advises that the outbreak of hepatitis A is ongoing in the territory, with a total of 447 cases logged for the year to Sept 24. In other regional news, the 78 leptospirosis infections recorded in Vanuatu this year have mostly been in Sanma (70 cases), with the remainder in Shefa, Malampa, Penama and Torba Province.

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.

Dengue cases spike in KP

Local media have reported a rise in dengue fever cases in the districts of Peshawar, Noushera, Buner and Khyber in the NW province of Khyber Pakhtunkhwa. A total of 22 districts have recorded an increase in recent weeks. 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.

Disease risks rise in 2 states

The arrival of the rainy season has brought with it a surge in malaria and pneumonia cases among the children of Lakes state, while in Warrap State, malaria rates have been high for the past two months against a background of shortages in treatment medications and hospital beds. Read more

Advice for travellers

Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Alert over resistance to malaria treatment

Summarised by CIDRAP, concerning news from a study conducted at a northern hospital between 2017 and 2019, as just under six percent of people diagnosed with malaria who were administered an artemisinin derivative ‘had evidence of slow parasite clearance, which can be a sign of partial resistance to artemisinin. Further analysis of parasite DNA samples from patient blood samples identified genetic mutations associated with delayed parasite clearance and artemisinin resistance’. Resistance to artemisinin is well-recognised in parts of SE Asia (Greater Mekong Subregion), but the implications for Africa, which has the greatest malaria burden, have the potential to be disastrous.