World travel health alerts 3 June 2020

World travel health alerts for 3rd of June 2020.

Measles hits 2 largest cities, 4 regions

Infants 12mo and under have made up just over half of the 717 measles cases recorded this year, however new infections are now said to be declining. Hardest-hit areas included the capital and the second largest city – Bishkek and Osh – and the regions of Jalal-Abad, Chui, Osh and Batken. In other measles news, eight children have died of measles complications since March in the north-central province of Malanje in Angola - 285 infections were recorded in the first three months of the year. Read more

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.

COVID-19 update

It took 12 days for global COVID-19 cases to jump from 3 to 4 million and also from 4 to 5 million, but just nine days for the next million as South America becomes the region with most intense virus transmission. In the past week the Americas as a whole reported almost half of the world’s 732,000 new cases. CIDRAP posted that ‘Countries seeing the biggest increases include Brazil, Colombia, Chile, Peru, Haiti, Mexico, Argentina, and Bolivia’ and most have not as yet reached their peak, with Peru’s total daily incidence sitting in fourth place globally and trending upwards. Also new information on the situation in the African region, where the WHO advised that the ‘trajectory of the pandemic in the region is on the rise, both in terms of case incidence and mortality’. More in the June 2 WHO Sitrep.

In other COVID-19 news:

At the end of the recently concluded extensive testing campaign carried out in Wuhan, China, a total of 300 asymptomatic cases were identified from nearly 10 of the city’s 11 million population. Read more

The Australian Health Dept now offers a factsheet ‘Use of masks by the public in the community’ with instructions on how to put on a disposable mask, if you choose to wear one. Late last week the CMO, Prof. Brendan Murphy, stated that "in a public transport situation, people may choose to wear masks when up close to other people” is recognised “as not an unreasonable thing to do”.

In other local news, the TGA has published a list of ‘Disinfectants for use against COVID-19 in the ARTG [Australian Register of Therapeutic Goods] for legal supply in Australia’.

NW Ebola outbreak announced

WHO response teams have rushed to the NW province of Équateur after confirmation of Ebola virus infections in the provincial capital of Mbandaka, on the banks of the Congo River. By June 2, surveillance had detected ‘a total of eight EVD cases, including three confirmed and three probable and two suspected cases’ with four deaths among them (updated to nine cases and five deaths, according to a UNICEF news release). The WHO continues to oversee the ‘final phase’ of the EVD outbreak 1,000kms away in North & South Kivu/Ituri provinces, amid a nationwide measles epidemic. Équateur recorded an Ebola outbreak two years ago in Bikoro (85kms south of the capital), which led to 33 deaths. 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.

Two local polio cases, 11 in Africa

Two wild poliovirus1 cases reported this week by the GPEI are from Khyber Pakhtunkhwa and Punjab provinces. In Africa, Ethiopia reported 4 cVDPV2 cases (one in Oromiya province, three in the SNNP region); three cases each in Niger (Dosso, Niamey and Tillaberi provinces) and Ghana (one in Ashanti province, two in Western province ); and one in Togo’s Lomt province. The DRC updated its figures to retrospectively register a case from late last year.

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.



Surge in dengue, malaria recorded

Year-on-year rises in both dengue fever and malaria up to late April have had the greatest impact in the provinces of Pedernales, Santiago and Santo Domingo for dengue and Los Tres Brazos for malaria. 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.

Unpasteurised cheese suspect in encephalitis cases

Health authorities in the SE region of Auvergne-Rhône-Alpes have issued a recall of a locally produced raw milk cheese after its consumption was found to be a common factor in at least half of 26 cases of tick-borne encephalitis (TBE) detected in Ain department, near the Swiss border. The infection has been confirmed in at least 10 of the 26 people. The post’s ProMED moderator notes that ‘No evidence of TBE virus infection in cows and goats of the region is presented, nor if ticks are active in the area and are infected and can be ruled out as vectors there’.

Advice for travellers

A viral infection, tick-borne encephalitis (TBE) can cause fever, vomiting, cramps and paralysis, which can be prolonged. In rare instances, infection can be fatal. Travellers who spend time in regions where TBE is endemic – mainly forested areas of Central and Eastern Europe, Russia, Northern China, and Mongolia – may be at risk. The highest risk is during the warmer months from April to November, especially when hiking or camping in areas below 1500m. While most infections are contracted through the bites of infected ticks, food-borne transmission through untreated dairy products is a known mode of transmission. Safe and effective vaccines are available in Europe, but none are licensed in Australia; however the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.

Dengue on the scene as rains arrive

The SW monsoons have arrived on time in the southern state of Kerala and will spread countrywide over the next six or so weeks. Dengue fever reports have already been increasing in Ernakulam, a coastal district of Kochi, and are said to be double those tabled in the same period last year. And in Sri Lanka, the onset of the monsoon rains is expected to cause an uptick in dengue and leptospirosis cases, both common seasonal diseases of ‘significant public health importance’. Myanmar has recorded four dengue-related deaths in Yangon region this year; of the nearly 250 cases, the highest count was observed in South Dagon and Hlaing Tharyar. 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.

Rabies risk via bite from pet dog

A 5yo boy from Sibu in central Sarawak is receiving post-exposure treatment for rabies after being bitten by his pet dog which later tested positive for the virus. A local news source is reporting that the state’s rabies outbreak ‘has now entered its fourth year’. 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. In the event of an at-risk exposure, urgent first aid and 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.

Northern region’s dengue spike

Authorities have announced an uptick in dengue fever cases in the NW town of Zouérat, capital of Tiris Zemmour region. The ProMED moderator comments that ‘it is possible that such acute febrile illness of dengue may come as a co-infection with COVID-19 in some cases’. In the week to May 26, Mauritania was one of seven African countries reporting the highest percentage increase in COVID-19 cases.

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.

Side effect of lockdown benefits mosquitoes

Local health authorities on the island of Ibiza have warned that mosquito populations, including the tiger mosquito (Aedes albopictus), are currently 4-times the norm due to lack of swimming pool maintenance during the lockdown. Collaborative action from owners and managers of all pools is needed to head off the risk of mosquito-borne disease outbreaks during the upcoming tourist season. The tiger mosquito, a vector of the dengue, Zika and chikungunya viruses, is established along the Mediterranean coast of Spain. Read more

NE posts most dengue cases

A further update on dengue fever reporting as early rains provide ideal breeding conditions for mosquitoes - cases for the year to May 25 surpassed 14,100 with 11 related deaths. The states with highest case numbers were Rayong, Chaiyaphum, Khon Kaen, Mae Hong Son and Nakhon Ratchasima. 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.

Single Zika infection emerges in coastal city

Three years after the last Zika virus case was reported in Vietnam, a single infection has been confirmed in a man from the coastal city of Da Nang. Previous outbreaks, in 2016-7, were concentrated in southern and central districts and the Central Highlands during the rainy season. Read more

Advice for travellers

Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information accessed through smartraveller (DFAT).