World travel health alerts 3 November 2021

World travel health alerts for 3rd of November 2021.

Low COVID-19 vaccination rates, global digest

The region with the highest weekly case incidence was again Europe, and globally, the five countries reporting the most cases over the week were the USA, UK, Russia, Turkey and Ukraine. The latter has one of Europe’s lowest COVID-19 vaccination coverage rates - 16 percent but Armenia’s is around seven percent. SE Asia recorded the largest increase in new deaths – a rise of 50 percent – due largely to a new surge in India (up 83 percent). In our region, over half of all new cases (58 percent) were logged by Malaysia, the Philippines and Vietnam. Read more

The timeline for vaccinating at least 70 percent of the world’s population was set at the G20 meeting this week: mid-2022, with at least 40 percent receiving a dose by the end of this year. As things stand, only five African countries will meet this year’s 40 percent goal due to supply issues relating to vaccines and auto-disable syringes - Seychelles, Mauritius, Morocco, Tunisia, and Cape Verde. Read more.

In related news:

- ‘COVID vaccines for 5 to 11 year olds are inching closer. Here’s what we know so far’ is explained in The Conversation. In the Middle East this week, Bahrain and the UAE gave emergency use approval for the Pfizer vaccine in children aged five to 11 years and now the US CDC (ACIP) has unanimously endorsed it for US kids in the same age group. Final approval from the CDC director is pending. More countries are expected to follow this recommendation.

- ATAGI has provided advice to the Chief Medical Officer on vaccination status, testing and quarantining for Australian children returning from overseas. Read more 

- Findings from the largest real-world study of third dose of COVID-19 vaccine effectiveness summarised by EurekAlert and ATAGI’s recommendations on the use of a booster dose of COVID-19 vaccine in Australia, published on Oct 28.  

- At the end of last week Novavax filed a submission for provisional approval of its protein sub-unit COVID-19 vaccine to the TGA (also in Canada and the UK), while this week Indonesia’s medical regulator granted emergency use status to the NVX-CoV2373 vaccine which will be manufactured in India and distributed under the name Covovax. Read more

- Two more vaccines currently in use overseas, but not in Australia, have been ‘'recognised' by the TGA for the purposes of establishing a traveller's vaccination status’ - Covaxin (Bharat Biotech, India) and BBIBP-CorV (Sinopharm, China).

- Smartraveller advised last week that its travel advice levels were changing, with the Do Not Travel notice replaced by four levels: Exercise normal safety precautions (Level 1), Exercise a high degree of caution (Level 2), Reconsider your need to travel (Level 3) and Do not travel (Level 4).

RRV risk for some Bay residents

Increasing urban development near coastal wetland areas of SE Qld could place residents at risk of infection with Ross River fever after a QIMR Berghofer Medical Research Institute study ‘found more than 80 per cent of koalas in the Moreton Bay region have been infected with Ross River virus in their lifetime’. Competent mosquito vectors are also abundant in the wetlands. While Ross River fever cases are reported in all states, Qld has the highest incidence nationally (Qld Health data: 3,407 cases reported in 2020). Read more

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 Qld.

Diphtheria in UP; JE count up in Assam; Top ranking for dengue, chikungunya

Thirteen diphtheria cases, resulting in at least two deaths, have been reported this year from several areas in the city of Ghaziabad, a suburb of Delhi and New Delhi in Uttar Pradesh. In announcing the cases last month, WHO officials blamed ‘Vaccine hesitancy, lack of awareness and illiteracy’. Read more

OF THE 447 Japanese encephalitis (JE) cases (and 51 deaths) recorded nationwide to September this year, Assam reported 212 of the cases (and 39 of the deaths). While vaccination programs have been aimed at children in the past, the focus is now to offer the protection of the JE vaccine to people aged between 15 and 65 years of age. States with a lower incidence of both JE cases and deaths than Assam this year are Uttar Pradesh, West Bengal and Jharkhand. Read more.

THE LATEST ECDC update on dengue and chikungunya reports around the globe rank India number one for both diseases over the four previous weeks. Other countries with high dengue numbers were Brazil, Pakistan, Colombia and Vietnam.

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.

Positive VD polio case in Garissa County, global digest

Ongoing surveillance of acute flaccid paralysis cases has led to the detection of a case of circulating vaccine-derived polio 2 (cVDPV2) in Dadaab, Garissa county in the country’s NE region – symptom onset was in May. Sequencing revealed that the strain was very similar to one that had been circulating in the area seven years previously. Positive environmental samples have also been obtained from Nairobi and Mombasa this year, so two rounds of reactive polio vaccinations have been carried out in 13 counties using the novel oral polio vaccine type 2 (nOPV2). In other polio news, the GPEI update reported cVDPV2 cases in Nigeria (42 from 13 states and the FCT, taking the YTD total to 266), and a single case each in Cameroon (Extreme Nord province) and Senegal (Matam, and a positive environmental sample in Dakar), while Madagascar has recorded another cVDPV1 infection, its 10th this year, from Sud-Ouest province. Of note, Guinea-Bissau has confirmed its first cases of cVDPV2 - three in total from Bissau and Biombo. 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.

Bird flu cases rise to 26

Hong Kong’s health agency, the CHP, has emphasised the need for residents to ‘maintain strict personal, food and environmental hygiene both locally and during travel’ after another human H5N6 avian influenza case, was confirmed on the mainland the 26th this year. The patient, a man who runs a live poultry stall at a local market from Dongguan in Guangdong Province, is in a critical condition. Dongguan in under 100kms NW of Hong Kong. The US CDC is preparing an updated risk assessment on H5N6 in view of the rise in cases this year, with concerns over the virus’ pandemic potential. Read more

Advice for travellers

There are several strains of bird flu and while the high pathogenic strains can be fatal, infection generally poses a low risk for travellers – even for those heading to a region where the disease is present or an outbreak is occurring. Travellers should avoid contact with birds or poultry in marketplaces, wash hands thoroughly before and after preparing food, and observe strict personal hygiene. Read more on bird flu and how to avoid it.

13th Ebola outbreak update; Measles moves into capital city

Two more Ebola virus disease cases have been reported from North Kivu province’s Beni health zone and, of greater concern, they were located in different health areas to the first six - Ngilinga and Bundj. Half of all infections to date have been in children under five years of age. The six fatal cases included four that were high risk, occurring outside secure treatment centres. Read more

A SECOND wave of measles infections hit in mid-August, affecting 23 provinces and it has now spread to at least four districts of the densely populated capital, Kinshasa ((Kingabwa, Police, Nsele and Masina 2). Overall case numbers are lower than last year, however the ‘risk of the rapid spread of the outbreak in Kinshasa is high given its high population density and high chronic malnutrition rates among children under five (43%) years. 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. In general the infection is relatively benign, but complications 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.

Food-borne illness at resort hotel

Media have reported on a food poisoning incident at a hotel in the Red Sea resort city of Hurghada. Some 47 foreign tourists were hospitalised as a result, however all are now said to be in a stable condition. Three hotel employees have been arrested and the resort closed pending investigations into the source of the outbreak. Read more

YF deaths suspected in Savannah region

Eight deaths, suspected to be due to yellow fever (YF) infection, have been reported among (unvaccinated) nomadic people in the West and North Gonja of the Savannah region. Initial results, which excluded other haemorrhagic fevers, indicated yellow fever, however confirmation will have to wait for the final analysis of samples at an overseas laboratory. The last confirmed YF report in Ghana was five years ago.

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.

Cholera persists in border town

Authorities are planning the next move as they attempt to control the cholera outbreak in Krishnanagar Municipality of Kapilvastu district we reported on last month. The death toll has now risen to at least four from more than 1,250 cases. A ring vaccination campaign is considered to be the most effective strategy for halting the spread of cholera in the community, however supplies must be sourced from aid agencies. 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.

Prolonged WNV season

It’s been an extended season for West Nile virus (WNV) in New York, with media outlets flagging higher vector numbers this year - almost triple the 2020 count across all five boroughs. And in Queens, which had most confirmed WNV cases, infected mosquitoes were still being detected in late October. The CDC describes West Nile virus as ‘the leading cause of mosquito-borne disease in the continental United States. It is also found in Africa, Europe, the Middle East and West Asia. Read more

Advice for travellers

Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuroinvasive disease.  The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions during the peak transmission season should take measures to avoid mosquito bites. Read more on WNV.