World travel health alerts 30 October 2019

World travel health alerts for 30th of October 2019.

Measles news for region and globally

Confirmed measles cases, updated on Oct 24, advised a further 44 suspected infections had been reported since Oct 21, mostly on Upolu Island.  Of the 213 suspected and 15 confirmed cases, the highest incidence has been in children under 10yo and adults aged 20 to 30. Read more. While in Tonga there are now 68 confirmed or probable cases; the first infections originated among school rugby players who had travelled to New Zealand. Other regional countries are on the alert for measles-infected visitor arrivals: In American Samoa, border surveillance has been introduced at the airport and ocean terminal; and in Fiji, the government is offering free measles vaccines to residents travelling overseas and has plans to provide vaccinations for workers with a higher risk of exposure: including airport and airline workers, and those working in hotels and in healthcare. In Asia, Singapore’s 149 cases recorded this year is the highest count since the 2-dose measles vaccine schedule was introduced in 1998. And in Japan (includes a rubella update), for the year to Oct 16, there have been 719 measles cases (majority reported in Osaka, Tokyo and Kanagawa) while rubella infections, mostly among adult males, rose to 2,228 from all but two prefectures (Aomori and Kochi). Measles outbreaks continue in several African countries, including Angola and Ethiopia.

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.

Maguindanao’s polio case takes national total to 3, global polio news, WPV3 is no more

The country’s third polio case was announced this week by the Dept. of Health – an unvaccinated 4yo child from the SW province of Maguindanao, on the southern island of Mindanao. Testing has revealed that the child’s illness was vaccine-derived poliovirus 2 (VDPV2), ‘genetically linked to the VDPV2 from the confirmed Polio case in Morogong, Lanao del Sur’. Another case is under investigation. Last week (Oct 24), the WHO announced the detection of genetically-related cVDPV1 in samples taken between July and September ‘from one sewage collection site and its tributary pumping stations in Manila’, facilities that service more than 600,000 people. In other polio news, one case each of VDPV2 were reported in Benin (Borgou province), DRC (Kasai Oriental province), Ghana (Northern province) and Ethiopia (Somali province). From a separate ProMED post which requests more information, the Ukraine Ministry of Health announced that at 2yo child from Volyn Oblast had been diagnosed with cVDPV infection. The region is in NW Ukraine and shares borders with Belarus and Poland. Lastly, welcome news from the WHO with the declaration on Oct 24 (World Polio Day) that WPV3 has been eradicated, leaving only WPV1 (WPV2 was declared eradicated in 2015).

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.

Presence of dengue/Zika in Paraná; Spotted fever in SP

As peak season for mosquito-borne infections nears, health authorities in the state of Paraná have registered an increasing number of dengue fever cases and, in Foz do Iguaçu, a city which is the gateway for visiting the famed Falls, three locally-acquired Zika virus disease cases. Read more

IN THE weeks since early September, health agencies in the inland city of Piracicaba (São Paulo state) have confirmed seven cases of Spotted fever, resulting in two deaths. The source is believed to be infected ticks found along the Piracicaba River. The area is endemic for spotted fever and the ticks are sustained by the bacteria’s amplifying host in Brazil, the capybara. 

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 on smartraveller (DFAT).  

Malaria strikes over half the population

According to the latest WHO African region weekly bulletin, more than 7 million of the country’s near 12 million population have contracted malaria this year -  140,000 in the last reporting week – and the death toll has exceeded 2,600 (60 more each week). As many as 14 districts in eastern regions report ‘a malaria prevalence of more than 90% among the tested patients since the beginning of the outbreak’.   

Advice for travellers

Sub-Saharan Africa presents a significant malaria risk. Travellers should discuss their itinerary and the need for anti-malaria medication with their travel health professional. Read more about malaria.

Slow increase in malaria cases

With malaria ranked as low risk and the country posed as a possible candidate for the elimination of the parasitic infection by 2020, the steady rise in local cases over the past four years is unwelcome news -  comparing the 37 cases recorded in 2019 with 70 last year, 12 in 2017, 4 cases in 2016 and none in the previous three years. The WHO notes that ‘This upsurge in cases has been related to illegal gold mining in the north of the country, which draws migrant workers from neighbouring malaria-endemic countries’, (Nicaragua).

Advice for travellers

Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, with their healthcare provider. More on malaria.

Multiple disease outbreaks complicate EVD response

The Ebola virus disease (EVD) outbreak in the NE is just one of the many the country is dealing with this year: Other outbreaks include malaria (over 14 million suspected and confirmed cases), measles (Kwilu, Kasai Central, South Kivu and Ecuador are the hotspots – national YTD total of suspected cases/deaths is 209,211/ 4,149), cholera (North Kivu, South Kivu, Tanganyika and Haut Lomami currently affected), poliomyelitis (see separate post), rabies, monkey pox and bubonic plague. 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 count climbs again; Flu news

MERS cases continue to arise – 11 so far this month (one was a 10yo child) from the regions of Riyadh, Taif, Aseer and Qaseem. As noted in the WHO September Situation Update, the 50–59 years’ age group is at the greatest risk for acquiring infection and for death among primary cases. Saudi Arabia has had the highest burden of MERS infections since the coronavirus was first detected in 2012. Read more.

ALSO in the region, the Oct 28 WHO global influenza update notes that flu activity is rising in the Arabian Peninsula ‘with influenza A(H3N2) viruses predominating in Qatar and all seasonal influenza subtypes co-circulating in Kuwait and Oman’; while in other zones, influenza activity increased in Laos and the Philippines in SE Asia; and El Salvador and Nicaragua in Central 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-based hand sanitiser is a convenient alternative if soap and water is not available.


Additional WNV infections, hundreds more suspected

In what could be a forewarning for the local population and visitors in coming years, news last week that two more human cases of West Nile virus (WNV) infection have been diagnosed – one each in Wittenberg (Saxony-Anhalt province) and in Berlin – both are situated near Leipzig, site of the country’s first case detected in September. As approximately one in five WNV infections are asymptomatic, there are concerns that the actual count may be ‘in the hundreds’. More on WNV from the ECDC. Read more  

Advice for travellers

West Nile virus is endemic in Eastern Europe and the Mediterranean basin, with epidemics regularly reported in summer and autumn since the 1950s. 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 reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Europe’s outbreaks are not as severe or widespread as in other regions where the virus occurs, notably North America. Read more on WNV.

Delhi’s 5-year malaria spike, monsoon’s ebb and flow

Relief in the north after the arrival of autumn temperatures in the state of Uttarakhand cooled the large dengue outbreak. Elsewhere, a local news source is reporting that while dengue fever numbers are generally down in Delhi, malaria cases are at a 5-year high with Rohini, Keshavapuram, Mukherjee Nagar, Narela and South Delhi hardest hit. Rainfall is set to continue in the south – govt. meteriological reports note that ‘the southwest monsoon has withdrawn from the entire country and simultaneously Northeast monsoon rains have commenced over Tamilnadu and adjoining areas of Andhra Pradesh, Karnataka’. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. Both bite mainly during the daylight hours, making them difficult to avoid outdoors. 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 oil of lemon eucalyptus (PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Dengue surge impacts blood supplies

After a reported rise in dengue fever cases early in the year, numbers have started to climb again, with children under 15yo most affected. The surge has led to increased demand on blood products used to treat the more severe infections. Read more. And in Mexico, dengue infections have trebled this year compared to 2018 and resulting deaths have increased two-fold, leading to the declaration of a national health emergency. Five states are carrying the highest burden of infections - Veracruz, Jalisco, Chiapas, Oaxaca and Quintana Roo.

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.

Floods and diseases

A UN Office for the Coordination of Humanitarian Affairs (OCHA) report published on Oct 24 summarises current health concerns, many of which have been exacerbated by recent floods affecting 17 of the 18 states: Dengue fever cases in the states of Kassala, Red Sea, North Darfur, South Darfur and West Darfur; Rift Valley Fever (RVF) infections reported in Red Sea, River Nile and Khartoum states; and suspected cholera in Blue Nile, Sennar and Khartoum states.

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.

Measles slows, diphtheria uptick

Weekly measles case numbers have decreased markedly more than two years into the outbreak that has sickened over 115,000 people and killed more than 40, down to 23 in a recent 7-day period. Now however, an outbreak of another vaccine-preventable disease is looming with 18 diphtheria cases diagnosed already this month and vaccination coverage for adults sitting around 27 percent. (Addit. see post under Philippines)  Read more

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.

TBEV’s first sighting in UK

The BBC is reporting the first detection of ticks infected with the tick-borne encephalitis virus (TBEV) in two areas: on the Hampshire-Dorset border and in Thetford Forest, the UK’s largest man-made forest which spans from the south of Norfolk to the north of Suffolk. The risk to the general public is considered ‘very low’ however precautions are recommended for people moving through areas of long grass. Read more

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 safe and effective vaccines are available in Europe, none are licensed in Australia; however the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.