World travel health alerts 3 February 2021

World travel health alerts for 3rd of February 2021.

Typhoid targeted in Punjab; Polio digest

This week a typhoid vaccination campaign gets underway in high-burden districts of Punjab, aimed at protecting children aged from nine months to 15 years using a conjugate vaccine. The state also plans to include the vaccine in the paediatric immunisation schedule from next year with the objective to reduce the incidence of resistant strains of typhoid in the region. Read more

TWO weeks of polio notifications to report on: Pakistan logged 10 wild poliovirus1 cases and six more vaccine-derived poliovirus type 2 (cVDPV2) cases (in Sindh, Punjab and Balochistan provinces) while Afghanistan registered 15 cVDPV2 cases. In Africa, additional cVDPV2 cases were reported in Burkina Faso, Chad, Guinea, Mali and Sudan. Read more. The WHO’s Executive Board met last month and aims to keep ‘polio eradication in its sights’. 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.

Regional measles, diphtheria reports

According to the Feb 1 PAHO report on measles across the Americas in 2020, Brazil reported 97 percent of all cases, followed by Argentina and Mexico. The peak of Brazil’s outbreak was early in 2020 and case numbers gradually dropped to around 30 per week by the end of the year. Pará, Rio de Janeiro, São Paulo and Amapá continue to report ongoing outbreaks. The same PAHO report outlines regional data on diphtheria, with 80 confirmed cases overall - Haiti recorded most with 66 confirmed, including 16 deaths.

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.

NSW district reports uptick in RRV cases

The Murrumbidgee Local Health District in southern NSW issued a warning about the risk of Ross River virus (RRV) towards the end of January after a more than four-fold increase in cases was recorded to Jan 22 (compared to the same period in 2020). This was despite lower numbers of mosquitoes in evidence. Read more. And more on the ‘bad year’ for RRV on Victoria’s Surf Coast and Bellarine Peninsula.

Advice for travellers

Cases of Ross River fever occur throughout Australia, including more temperate southern states. Travellers visiting areas of Australia affected by recent flooding or continuing rain should take measures to prevent mosquito bites. Use a personal effective insect effective ingredient such as DEET, Picaridin or oil of lemon eucalyptus (PMD) when outdoors and wear long, loose-fitting, light coloured clothing – especially at dawn and dusk, the times of day when RRV-carrying insects are most active. More on RRV in NSW.

Peak malaria season approaches

Local authorities in the NW region of Ngamiland are concerned because districts such as Okavango and Ngami are experiencing more malaria. February is the peak of the Oct-May malaria season and there are added challenges as the local health workforce is having to manage the pandemic and prepare for an anticipated increase in clinical malaria cases. Read more

Advice for travellers

Malaria is endemic in many areas of southern Africa. Travelvax recommends that travellers visiting this region discuss their itinerary and preventative medication at their nearest Travelvax clinic, or with their healthcare provider. More on malaria.

Monkeypox in 2020

There was a marked downward trend in monkeypox reporting in the latter part of 2020, however the yearly total still exceeded 2019 figures. The WHO reports that 17 of the 26 provinces logged more than 6,200 suspected cases and 229 deaths last year. Read more

Advice for travellers

Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox.

Cyclone season risks continue

A health official has declared the risk for dengue fever, typhoid and leptospirosis is elevated in those areas with deteriorating conditions following Tropical Cyclone Yasa in December and another storm system of lesser intensity this week. Authorities in the city of Lautoka had already announced several dengue cases on the weekend and last week other news sources advised that a further two typhoid cases had been reported on Vanua Levu, with one of the infections recorded in a new location, Bua. Read more

Advice for travellers

Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

Dengue reporting returns to seasonal levels

The Jan 28 WHO Western Pacific region dengue fever update had Singapore’s current weekly trends within expected seasonal levels, as the NEA advised there had been just over 650 cases in the first four weeks of 2021. More than 35,000 dengue cases and 32 related deaths were recorded in 2020, a record high for the island-state. Low or reduced dengue case reporting occurred in other countries within the region that provided updates. The ECDC has also published a global summary of both dengue and chikungunya in its Jan 23 weekly report, with a separate post on the continuing dengue epidemic in the French Antilles.

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.

Hindu pilgrimage health measures

Millions of pilgrims will perform a bathing ritual in the holy waters of the Ganges at the Hindu festival of Kumbh Mela, taking place this year from January to April in Haridwar in the hill state of Uttarakhand. Strict COVID-19 health measures are outlined in the standard operating procedures (SOPs) for the event, including a requirement for a negative RT-PCR test taken at least 72 hours before the visit as well as public/personal hygiene precautions.

COVID-19 update

Three consecutive weeks of declines in new COVID-19 cases around the globe were reported in the latest WHO epidemiological update, and last week’s total was the lowest since October. Of the different WHO regions, only SE Asia recorded an increase in cases overall and the largest rise in deaths occurred in the Western Pacific (Japan, the Philippines and Malaysia). Japan’s government is prolonging the states of emergency in 10 prefectures until March 7, however they could be lifted ‘if COVID-19 infections are brought under control'. Read more

In other COVID-19 news:

-Loss of sense of taste and smell was less likely to be reported by people participating in the UK Office for National Statistics' Jan 27 Coronavirus (COVID-19) Infection Survey when they had positive tests compatible with the new UK variant. They were also ‘more likely to report any symptoms and the classic symptoms’. (The survey was conducted in the community and symptoms were self-reported.)

-CIDRAP reports on ‘New variant COVID findings fuel more worries about vaccine resistance’.

-This week the TGA revealed the outcome of its review into the reported deaths of some elderly people in Norway after they were administered the Pfizer/BioNTech vaccine: Investigation reveals no specific risk of COVID-19 vaccinations in elderly patients. Read more

-Europol has issued a warning relating to fake COVID-19 test certificates after recent criminal activity was uncovered in the UK, France and Spain. The agency notes that specialised printers and software mean that ‘fraudsters are able to produce high-quality counterfeit, forged or fake documents’ and requests that relevant information is shared with Europol. The falsification racket doesn’t just run to certificates, with an article this week on counterfeit COVID-19 vaccines discovered in Jiangsu, Beijing and Shandong. Saline was used instead of vaccine to fill syringes. Read more

- Good news for the COVAX facility with 190 countries set to receive advice on their vaccine allotments. Read more. However an AP News article on Tanzania, one of the countries listed for vaccine procurement with the facility, cited the health ministry stating ‘it has no plans in place to accept COVID-19 vaccines’. Mainland Tanzania last reported COVID-19 cases in late April 2020 and Zanzibar on 7 May 2020 for a total of 509 cases and 21 deaths. Read more

-The Democratic Republic of Congo has been using drones to deliver immunisation resources, PPE and lab samples to and from health facilities in remote areas of Equateur province since December. The Drones for Health will also be employed as ‘an additional mechanism in place for the upcoming COVID-19 vaccine distribution’. Read more

RVF surfaces in neighbouring counties

The rainy season has boosted mosquito numbers and exacerbated the outbreak of Rift Valley fever that first emerged in humans back in November when a number of male herders were found to be infected. The current situation comprises four confirmed cases, 17 more are suspected and nine deaths in Isiolo and Garissa counties. The vaccination of livestock is in the pipeline and surveillance has been intensified at the animal level; also the movement of herds has been limited to prevent RVF spread both nationally and within the region. 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.

Uptick in Hep A & leptospirosis

After recording 100 hepatitis A cases last year, the local health service reports circulation of the Hep A virus with a further 23 cases diagnosed in January – 13 from Maré, six in Noumea and one each from Dumbéa and Canala. Increasing numbers of leptospirosis infections have also been identified – 36 cases just last month, of which 28 were from Province Nord and six from Province Sud. Read more (Bulletin épidémiologique N°55 /29 janvier 2021)

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.

2 states with suspected cholera outbreaks; Lassa cases trend upwards

Outbreaks of what is suspected to be cholera have been reported in four local government areas (LGA) of Benue state as well as Burutu LGA and its surrounds in the state of Delta. The WHO regional office declared that ‘the occurrence of two outbreaks of acute watery diarrhoea, with vomiting, in two geographically separated states, is of concern’, particularly with the country’s ‘history of cholera outbreaks, usually associated with unsafe drinking supplies and poor sanitation’. Read more

THE RECENT increase in Lassa fever cases is following the trend of the last four years, when Jan-Mar became the disease’s peak season. To date, most cases have been reported from the states of Ondo, Ebonyi and Edo. Public awareness campaigns are underway to educate the masses on mitigating risk factors such as contact with the virus’ rodent reservoirs and their excreta. 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.

MERS update - testing rates low

The WHO issued an update on MERS-CoV infections in the kingdom in a Feb 1 Outbreak Disease News post. Details of four cases from the second half of last year from the regions of Riyadh, Taif and Al-Ahsaa were shared together with a risk assessment. The agency also noted that testing for MERS has been severely affected during the pandemic in Saudi Arabia and elsewhere. Further, the ‘WHO expects additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to dromedaries, animal products (for example, consumption of camel’s raw milk), or humans (for example, in a health care setting or household contacts).’

Virus contaminated oysters detected

Local health authorities this week warned the public not to consume oysters from two large batches imported from Vietnam after one was found to be contaminated with norovirus, and the other with hepatitis A virus. Read more

Advice for travellers

Norovirus infection is generally short-lived, causing nausea, vomiting and diarrhoea, however these symptoms can lead to more serious complications among the sick, young children, and the elderly. To minimise the risk, wash your hands after using the toilet and before eating, and practice good general hygiene. Read more on norovirus