World travel health alerts 31 July 2019

World travel health alerts for 31st of July 2019.

Hantavirus in NW

Wild rats are flourishing in the many rubbish dumps that have sprung up near San Salvador in the NW province of Jujuy, in turn leading to a rise in hantavirus infections which are transmitted to humans through contact with infected rodents or their urine/droppings. There have been more than 370 suspected infections in the state, 18 confirmed and one death. More comments on ProMED. Read more

Advice for travellers

Hantavirus is passed on to humans through contact with hantavirus-infected rodents or their urine and droppings. Eliminating rats in and around living quarters is the main way of preventing hantavirus infection. Cases have been documented in Argentina, Brazil, Canada, Chile, Panama, Paraguay, and Uruguay, making HPS a pan-hemispheric disease. Read more about hantavirus.

Drought triggers disease alert

NSW Health has warned of the increased risk of contracting Q fever in rural regions ‘as drought and high winds may increase the risk of the disease spreading’. Precautions include vaccination for people working with livestock and also for those aged 15 years and above with risk of exposure through ‘inhaling dust particles contaminated by infected animal secretions’. The department’s website lists other measures that are advised for the prevention of infection. Read more

Dengue death toll climbs to 9

With over half of the annual dengue fever season still to run, infections are widespread across the island-state and have now exceeded 8,800 this year with nine associated deaths. Fifty high risk clusters are concerning the NEA which stated that ‘60% of mosquito breeding are found in homes’ and acknowledged that the entire region is experiencing a rise in dengue reporting. (More reports from the Philippines, Bangladesh, Vietnam, the Maldives, Nepal and Sri Lanka) Meanwhile, another infection transmitted by Aedes mosquitoes, chikungunya has been diagnosed in a resident of New Taipei City in Taiwan – the first such report by the country’s CDC, which summarises chikungunya activity in the region and across the globe on its website. 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.

Frontier cholera spread

Cross-border people movements have enabled cholera outbreaks occurring in northern regions of Cameroon to spread into neighbouring districts of Chad with small outbreaks hitting two villages of the SW province of Mayo Kebbi East. The WHO is calling for a rapid response as the wet season is imminent. 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.

Abidjan’s yellow fever outbreak

Soon after news that the dengue fever outbreak affecting Abidjan (mainly in Cocody-Bingerville, Abobo East & Marcory-treichville) appeared to be subsiding, the health ministry has announced 89 yellow fever cases and one death, also in Abidjan. As both infections are transmitted by the same mosquito vector in urban areas, Aedes aegypti, measures to remove mosquito breeding areas and kill adult insects are being carried out together with ring vaccination of people living near the yellow fever cases. 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.

3 provinces report VDPD cases; 2nd EVD case in Goma

As reported by the GPEI, the country ‘is currently affected by eight separate cVDPV2 outbreaks; one each originated in Haut Katanga, Mongala, Sankuru, two in Haut Lomami and three in Kasai provinces’. A further four cVDPV2 cases were reported this week from Kalonda-Ouest (two cases), Nyanga, Kasai province and Tshumbe, Sankuru province (one case each).

A FATHER of 10 from Ituri province has become the second Ebola virus disease case to be detected in the populous city of Goma, near the Rwandan border. A news report, quoting a senior official, indicates the man arrived in Goma some 18 days ago after travelling the 600kms from his home town. Current details on the outbreak which has now been running for 12 months can be found on the Ebola Dashboard.

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.

Another country issues gastro warnings

In a follow up to the July 17 post regarding Public Health England’s updated advice for travellers to Egypt, health authorities in Germany have been alerted to a rise in the number of Enterohaemorrhagic E. coli (EHEC) cases associated with travel to Egypt - 31 cases compared with 21 last year and 9 in 2017, and five people with haemolytic uremic syndrome (HUS). The source of the cases in Germany is unknown as yet as those infected had ‘stayed at different hotels in separate places’. Advice from the PHE’s Deputy Director of the National Infection Service included ‘ensuring meat is cooked thoroughly, not drinking tap water or ice made from tap water and trying to avoid swallowing water when swimming’. Read more

Syphilis infections now outpacing HIV

Syphilis data comparing infection rates in EU/EEA countries between 2010 and 2017 reveal a rise of 70 percent in notifications with highest rates ‘primarily among men who have sex with men (MSM) living in urban areas’. Five countries recorded the sharpest rise - Iceland, Ireland, the UK, Germany and Malta. The Head of the ECDC’s programme on HIV, STI and viral hepatitis attributed the rise to being ‘a result of several factors such as people having sex without condoms and multiple sexual partners combined with a reduced fear of acquiring HIV’. 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.

Pacific coast dengue

The dengue fever outbreak has spread to new areas with media reports that as many as 26 of the country’s 32 public hospitals have been swamped with cases – now totalling 28,000 and 54 related deaths and the highest figure in five decades. Dengue cases in Guatemala have exceeded 6,000 this year and the resulting death toll has risen to 27. Hardest hit has been the SW municipality of Coatepeque, however several other southern towns have also been affected. Read more

Advice for travellers

Dengue is spread by two types of 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.

Monsoon rains and disease rates

The monsoon rains falling in the central state of Telangana and Kerala in the SW have produced a rise in water-borne infections and those transmitted by insects. Authorities are advising that the number of typhoid and gastro illnesses and also malaria and dengue fever cases are increasing. Each year Telangana’s two largest cities, Hyderabad and Warangal, report over one-third of the state’s malaria cases. To the north in Tamil Nadu, incorrect vaccine scheduling has led to an outbreak of diphtheria in a town 70kms from Coimbatore – to date two children have died and a further 10 are receiving treatment in hospital. Assam’s death toll from Japanese encephalitis (JE) infections has risen to 126, while in India’s most north-easterly state, Arunachal Pradesh, which shares international borders with Bhutan, Myanmar and Tibet, there have been at least 55 JE cases and one death.

Advice for travellers

Malaria is widespread in India and can occur in both rural and urban areas, including major cities. Travellers visiting India should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. Read more on malaria in India.

Measles reports top 400; regional, global news

The country reported its highest weekly measles count this year with a further 54 cases taking the YTD total to 407. Most infections are still being reported in Auckland’s Counties Manukau, however other areas with new infections include Waikato, Hawke's Bay, Capital and Coast and Canterbury. Public Health Surveillance data includes information that almost 40 percent of people suffering measles infections this year have required hospitalisation and around one-quarter of all cases were in the 20 to 29 year’s age group. Read more. ProMED summarised recent measles data from around the globe – Turkey has recorded nearly 1,500 cases this year with vaccine refusals driving the trend, also updates for the USA, Taiwan and Singapore.

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.

CCHF risk increased with livestock movement

Crimean-Congo haemorrhagic fever has already killed six people this year and the risk of infection is likely to increase in urban areas as (potentially tick-infested) livestock are brought in from the countryside ahead of the Eid al-Adha religious holiday (celebrated this year in the third week of August). Health authorities are promoting public awareness messages on preventing CCHF transmission. Read more

Advice for travellers

CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

Stinger season in gulf

In the Gulf of Thailand, warning signs have been placed on Koh Samui, Koh Pha-Ngan, and Koh Tao beaches as water and tidal conditions bring jellyfish towards the shore, upping the risk of box jellyfish stings to unwary swimmers. Read more

Harare’s suburbs hit by more gastro infections

Failing water supply infrastructure is said to be behind a surge in typhoid and diarrhoeal illness in the capital, Harare. SW suburbs that were at the centre of the 2018 cholera outbreak, Budiriro and Glen View, were among others reporting gastrointestinal infections which included typhoid fever (858 cases from Jan-June). Read more

Advice for travellers

Typhoid fever 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.