World travel health alerts 30 September 2020

World travel health alerts for 30th of September 2020.

First cVDPV cases recorded, global update

The country’s first vaccine-derived polio cases, which are linked to Chad's outbreak, have been reported (three total – from the provinces of Warrap and Western Bahr El Ghazal), and in further developments on cVDPV2 in Africa, two other nations registered three cases each: Chad (Logone Oriental and Mayo Kebbi East provinces) and Guinea (Kankan and N'zerekore). In Asia, Afghanistan recorded a new wild poliovirus type 1 case (WPV1) in Kandahar province and another cVDPV2 infection (Kunar province) and Pakistan’s three new WPV1 cases were from the provinces of Balochistan and Punjab, plus two cVDPV2 cases in Sindh province. 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.

2021 flu vaccine composition posted

On Sept 25, the WHO announced the recommended influenza strains for the 2021 southern hemisphere season for both egg and cell/recombinant-based vaccines. Accompanying the release is a full report and Q&A. The agency reports that fewer viruses were available for characterisation this year due to decreased influenza activity, which ‘was very low in reporting countries in Oceania with co-circulation of influenza A and influenza B viruses and predominance of influenza A(H1N1)pdm09’. Read more

Advice for travellers

Seasonal flu is the most common vaccine-preventable travel-related illness because it is a potential risk during every stage of the journey. Whether you are travelling within Australia or overseas, Travelvax recommends vaccination for all travellers over 6 months of age. Read more about influenza.

COVID-19 2nd waves

The ECDC reported on Sept 24 that ‘available data from seroprevalence studies suggest that the level of immunity in the population is <15% in most areas within the EU/EEA and the UK’ and has now included nine countries in its list of those which now report <120 infections per 100,000 population. Denmark, Iceland, Hungary and the Netherlands have most recently crossed the threshold. Read more. Targeted restrictions have been suggested over lockdowns in Europe as hospitalisations and ICU admissions climbed. Read more. The Sept 28 WHO epi update noted that a nine percent increase in cases over the previous week occurred in the Eastern Mediterranean region, while the rise in deaths in the European region was also nine percent.

Elsewhere, the Sept 28 Johns Hopkins newsletter reported that India’s daily incidence had continued ‘to decline from its peak in mid-September, down 10% over the past 2 weeks. Peru fell out of the top 10 in terms of total daily incidence, and it was replaced by Indonesia.’

Australian data for the fortnight to Sept 13 from the CDI was based on a 61 percent reduction in new cases over the previous reporting period. The report includes a section - In focus: Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS).

In related news -

-Some airlines in the US and Europe are proposing pre-flight coronavirus tests at airports to promote confidence in returning to the skies.

-An informative tweetorial on SARS-CoV-2 vaccines by Prof. Florian Krammer, Dept. of Microbiology, Icahn School of Medicine at Mount Sinai.

-The first ship to return to the Greek islands since March in a re-launch of local cruises has been ordered into Piraeus after several crew tested positive for COVID-19 among a random sampling. A news article stated that negative tests were received from passengers on embarkation.

Chikungunya, local and global

Late last week, the WHO published a Disease outbreak news update on the chikungunya epidemic centred on the country’s fourth largest city, Abéché, noting that the risk at a national level is moderate in this first outbreak for Chad. The case count listed in the Sept 27 weekly regional bulletin had climbed again to 30,220 (with one death in a young man with a history of sickle cell disease and asthma). And in Cambodia, the chikungunya outbreak continues and is now affecting 21 provinces, however more than three-quarters of the nearly 6,000 cases have been in Preah Vihear, Siem Reap and Takeo. Meanwhile, the ECDC is reporting two other countries which have also registered chikungunya cases since the August update - Brazil and Thailand. The agency’s Sept 20-26 report gives a summary of both dengue fever and chikungunya across the globe.

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by day-time feeding Aedes mosquitoes. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.

Cholera risk elevated in region

Over 1.6 million people living in parts of Western and Central Africa have been impacted by extensive flooding which has brought with it the potential for the spread of cholera from several hotspots as well as new outbreaks. Countries with regions at risk as outlined by a ReliefWeb document are Nigeria, Niger, Cameroon, Mali, Chad, Burkina Faso, Gambia and Guinea.

Advice for travellers

While the risk of infection with cholera is low for short-stay travellers, Australians travelling to regions where an outbreak is occurring should adhere to strict personal hygiene and choose food and beverages with care. Read more about cholera.


Ebola update for NW

There have been no new confirmed Ebola cases since Sept 19 in Equateur province, however ‘positive cases at large in the community and challenges around safe and dignified burials’ persist together with personnel and communication problems. The rainy season is underway, which is further aggravating issues caused by the region's difficult terrain as response teams seek out contacts of infected patients. 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.

WNV spreads to new regions

More on West Nile virus (WNV) infections emerging in Germany with the ECDC this week reporting three new regions with first-time locally-acquired cases - Barnim, Ostprignitz-Ruppin and Saalekreis. While in Spain, the first autochthonous WNV case for the western province of Badajoz was confirmed last week. Five locally-acquired WNV cases were reported in Spain from 2010-19, however this year the national total has risen to 67 cases and six deaths. More on WNV in Europe in the weekly ECDC report.

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 reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Read more on WNV.

Dengue uptick, epidemics rage in the French Antilles

The parishes of St David, St George’s and St Andrew are to be the focus of vector control measures after an increase in dengue fever cases in the area. The national YTD total is nearing the count for all of 2019. A similar rise in dengue cases since July has occurred in nearby St Vincent and the Grenadines, which has also recorded four dengue-related deaths. Elsewhere, a Santé Publique France update on the French Antilles’ epidemics confirms activity is intensifying in Martinique and Guadeloupe; Saint Martin and Saint Barthélemy are also in an epidemic phase. And Mexico’s dengue cases are down on last year but still number more than 11,000 with highest reports from the states of Jalisco, Michoacán, Veracruz and San Luis Potosí.

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.

JE count lower in NE state

Assam’s Japanese encephalitis cases to Sept 9 are considerably lower this year compared to 2019 figures, with 318 infections and 51 deaths. One health official has attributed the fall to less time spent outdoors and other pandemic restrictions rather than ‘rigorous awareness activities’. The decline in JE cases has been greatest in the endemic districts of Sivasagar, Dibrugarh and Lakhimpur. Read more

Advice for travellers

A mosquito-borne virus, JE is usually found in many parts of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to large urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

RVF kills 3

Authorities have confirmed three human deaths from five cases of Rift Valley fever in the wilayas of Tagant and Assaba, but five regions in total are reported to have animals infected with the zoonosis - Tagant, Assaba, Hodh El Gharbi, Brakna and Trarza. Recommendations for residents of the affected areas, which are in the country’s southern and central regions, include the use of mosquito nets and enhanced precautions for contact with potentially infected animals. 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.

Pet vax campaign to counter rabies hike

A local news source reports that over the past three months the NE state of KwaZulu-Natal has recorded at least four human deaths from rabies and a fifth case is considered probable. Vaccinations are planned for the region’s animals to check the high rates of rabies infections and cut transmission to humans. The article quotes the NICD: ‘over the past two decades, 41.9% of human rabies cases in South Africa were reported from KZN’. While in the Americas, a PAHO official commented on the region’s achievement in reducing dog-mediated rabies in humans from ‘from a record of 300 cases in 1983 to just 3 cases in 2019’. The planned elimination date for rabies transmitted by dogs in the Americas is 2022. 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, including bats. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is generally 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.

Western province’s leishmaniasis uptick

Cutaneous leishmaniasis cases are increasing in the North Darfur locations of Kutum, Tawila, and Almosalha – almost 100 cases have recently been reported. Read more

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

Local dengue count rises again

The count of locally-acquired dengue fever cases has climbed to 32 after two new infections were reported, stemming from a bamboo shoots farm in the New Taipei district of Sanxia – 16 cases have now been implicated with this cluster. Overall, Taoyuan has reported 17 cases and 15 in New Taipei. 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.