World travel health alerts 3 July 2019

World travel health alerts for 3rd of July 2019.

6 VDPV outbreaks this year; EVD hotspots in 3 health zones

In the latest WHO African region report, concern is raised over ‘the fifth and sixth outbreaks of genetically-distinct cVDPV2 in the country in 2019’ adding to the ‘continuous risk of further spread of the cVDPV2 within the country and to neighbouring countries, as is the case with the current outbreak in Angola’. In other news from the GPEI, there are reports of one cVDPV2 case from Kwara State in Nigeria and three cVDPV2 cases isolated from healthy community contacts in Somali State, Ethiopia. With respect to wild poliovirus type 1 cases reported during the same period, two have been confirmed in Afghanistan (Tirinkot district, Uruzgan province) and three in Pakistan (Lakki Marwat, Torghar and Bannu districts in Khyber Pakhtunkhwa province).

RENEWED Ebola virus disease activity (EVD) in low transmission areas and the movement of a case from Beni to an area ‘towards the borders with Uganda and South Sudan’ are two of the issues raised in the WHO External Situation Report of July 2nd. The latest details of the outbreak in North Kivu and Ituri provinces are updated in the Ministry of Health newsletter of the same date.  

Advice for travellers

Polio 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.

Flu season update

The death toll resulting from this influenza season has climbed to more than 220 and advice from health authorities to anyone suffering typical flu symptoms is to stay home and don’t risk spreading the infection further. Data from the Immunisation Coalition reveals that by July 1 there had been 114,656 laboratory confirmed notifications across the country – NSW, Victoria and Qld have had most cases. According to the latest WHO global flu update, ‘activity continued to increase across countries in the temperate zone of the southern hemisphere’ with influenza A(H3N2) viruses predominating in Oceania and South Africa, and influenza A(H1N1)pdm09 viruses in temperate South America.

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. 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 wipes are a convenient alternative if soap and water is not available.

YF update - 82 cases from 3 states

Confirmation that 2019 has been a much milder season for yellow fever infections with 82 cases compared to more than 1,300 in 2018. The Secretariat of Health Surveillance summary noted that the cases had been reported from São Paulo (68 cases), Paraná (13) and Santa Catarina (1) and were mainly ‘rural workers or those exposed in forested areas’. Epizootics were confirmed to a greater extent in southern regions - Paraná, São Paulo, Rio de Janeiro, Pará and Santa Catarina. Read more

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.

Dengue rates set to worsen

This rainy season is expected to inflame the dengue fever outbreak that has already caused cases to surge by 70 percent over the 2018 figures for the same period. An ECDC report on dengue across the Americas notes that 80 percent of the nearly 750,000 suspected and confirmed cases to mid-June were in Brazil (more than 4-fold increase), ‘followed by Colombia (49,000), Nicaragua (33,000) and Mexico (20,000).’ Honduras also gets a mention as last year’s total has been topped by around 5,000 cases already – dengue emergencies were declared in 12 departments in mid-June. Brazil and El Salvador have also recorded an increase in chikungunya cases over last year. 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.

Dengue season updates

The ECDC notes substantial year-on-year increases in dengue fever reporting across the SE Asian region. In more recent updates, according to the director of Cambodia’s National Centre for Parasitology, Entomology and Malaria Control, dengue infections have struck 13,000 people across the Kingdom this year and 24 children have died from dengue-related causes. In Singapore, the NEA reported almost 500 dengue cases in the week to June 29 (a 3-year high in weekly rates) and announced a 56 percent increase in Aedes mosquito populations between March and May this year, heightening the risk of dengue transmission. While in Vietnam, Ho Chi Minh City residents are facing a similar rise in the incidence of dengue fever with one hospital admitting 70 dengue cases daily; Colombo district in Sri Lanka has recorded over 5,000 cases for the first half of the year (followed by Gampaha, Jaffna and Kalutara); and Tainan now joins Kaohsiung (Taiwan) in reporting locally-acquired dengue fever cases this year – a total of 31.

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.

Water woes in Gujarat’s capital; Diphtheria rates in Delhi

Water infrastructure failures and illegal tapping of supplies in Gujarat’s capital, Ahmedabad, last month led to cholera cases doubling and a near-50 percent increase in typhoid fever (compared with 2018 figures). Read more

A HOSPITAL in Delhi’s north has reported one death resulting from the 14 diphtheria cases treated in the last month. Doctors at the facility have requested further supplies of diphtheria antitoxin as they believe more cases are likely to occur during the current wet season.

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.

Drought hampers Hep E response

After a short downward trend, a resurgence in new hepatitis E infections occurred in the second week of June as drought conditions compromised water safety and supplies in the affected informal settlement communities. During the 18 month-long outbreak ‘Khomas region remains the most affected, with 3,529 (65%) of confirmed cases, followed by Erongo with 1,267 (23%). The remaining [7] regions account for 12% of total cases’. Almost half of all 45 fatalities have been maternal deaths. 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.

Plan to tackle STI

The Ministry of Health’s National Syphilis Action Plan is aimed at stemming the rising number of syphilis infections reported annually; they increased from 82 to 543 over six years. A senior official in the department has spoken out about ‘the rise of congenital syphilis’, however the plan also targets the most affected groups – MSM (70% of cases), ‘Asian and Mâori men, and Mâori women’. Programs to be implemented include public awareness, education, STI testing and promotion of correct condom use. Read more

Advice for travellers

Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.

Typhoid, XDR typhoid outbreaks in Sindh

A vaccination campaign is to be carried out in Karachi in response to typhoid fever outbreaks and the deaths of two young girls from an extensively drug resistant strain (XDR). According to ProMED, there have been more than 150 suspected typhoid cases in Malir district since mid-June. Sindh province has reported high rates of XDR typhoid – from November 2016 to May 5 this year, ’10,677 people were tested positive for typhoid in the province, of which 7109 were infected with XDR typhoid. Of these, 7947 cases of typhoid were reported from different areas of Karachi, of which 4973 were XDR typhoid’.

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.

Rabies death toll rises in Region VI

With 17 human rabies deaths this year in the Western Visayas region (equal to the cumulative total for 2018) and adequate supplies of vaccine on hand, authorities have expressed concern that many people are unaware of the need for post-exposure treatment following a bite or at-risk contact. According to a local news report, ‘Negros Occidental recorded eight death cases, the highest in the region followed by Iloilo and Aklan with three cases, Capiz (2) and Iloilo City with one death’. 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.

5 rabies cases from 2 provinces YTD

The NICD has published details on a probable fifth rabies infection this year, the latest being a young girl from Eastern Cape Province. According to the report, the girl’s post-exposure prophylaxis consisted of four doses of rabies vaccine, but no immunoglobulin. She succumbed to the infection in May. The five cases this year were located in two provinces - Eastern Cape and Limpopo. 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 – especially dogs, the main source of infection. If bitten, urgent post-exposure treatment is required. Vaccination recommendations are itinerary-specific but include those travellers planning to live in, or travel extensively or repeatedly through, endemic countries. Read more on rabies.

Dengue outbreak hardest on kids under 10

A June 26 update on the dengue fever outbreak declared at the end of March: 211 confirmed infections from 476 dengue-like illnesses with ‘21 hospitalisations and two deaths in cases with severe dengue. Majority of the cases (45%) are in children <10 years.’ ReliefWeb reports that one quarter of the suspected cases ‘are from Fakaifou district, 18% from Senala, 12% from Alapi. These areas are the most densely populated areas on Funafuti.’ 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.

Measles update; Papaya link to Salmonella infections; West Nile on the West Coast

This week 18 more measles infections have been recorded by the CDC – 13 are related to ongoing outbreaks in the New York boroughs of Brooklyn and Queens. The national total now sits at 1,095 cases from 28 states – ‘the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated in 2000’. Read more

NEW Yorkers make up 24 of the 62 Salmonella (Uganda) infections nationally that have been linked to papayas imported from Mexico – the remaining cases are in Connecticut, Massachusetts, New Jersey, Pennsylvania, and Rhode Island. While investigations continue, advice to consumers from the CDC is to avoid ‘whole, fresh papayas from Mexico’.

WEST Nile virus activity in California (and across many parts of the US) is at forecast levels but expected to rise, ‘influenced by many factors, including climate, the number and types of birds and mosquitoes in an area, and the level of WNV immunity in birds’. The California Department of Public Health is advising residents ‘to take every possible precaution to protect against mosquito bites’.

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