World travel health alerts 31 March 2021

World travel health alerts for 31st of March 2021.

Wet season hazards in FNQ

Health authorities in tropical north Qld have alerted GPs working in the area to an increase in melioidosis and leptospirosis cases which have spiked above the wet season average. Of the 17 melioidosis cases recorded this year, ABC News advised late last week that there have been two deaths and ‘four required treatment in intensive care’, with infections reported in Cairns, including Clifton Beach and Mount Sheridan. People spending time outdoors and in the garden are advised to ensure any open wounds are covered. The warning on leptospirosis infections noted that the majority of cases have been reported ‘in the Cassowary Coast and Tablelands areas’.

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.

COVID-19 update

The Mar 30 WHO epi update outlines a further rise in new COVID-19 cases and deaths in Brazil, but also a 55 percent weekly increase in new cases in India which comprised almost 85 percent of the new infections reported in the SE Asian region. While in the Philippines, more regions of the country have been placed under varying levels of community quarantine to curb rising rates of new cases.

In other COVID-19 news:

-This year’s Hindu religious festival of Kumbh Mela, to be held in the northern Indian city of Hardiwar, has been pared back to one month (April) in response to India’s accelerating case numbers and attendees are required to show a negative COVID-19 RT-PCR test taken within the previous 72 hours. Read more

-The European Medicines Agency granted conditional authorisation to the AstraZeneca vaccine in late January and has now announced its new name – Vaxzevria. Read more 

-Thai news media report that plans are under consideration to allow vaccinated tourists to fly directly into Phuket from July without having to submit to quarantine requirements– a so-called tourism ‘sandbox’. There are likely to be conditions attached to entry, such as testing and the use of an official app, but the scheme will probably be extended at a later date to other resort areas such as Pattaya, Chiang Mai, Krabi, Phang Nga and Surat Thani.

-Counterfeit vaccines for sale on the dark web and also on the clearnet has led to a warning for Australians to avoid third party suppliers at all costs. Falsified products have been found in South Africa, South America, the USA, Europe and the UK. Together with law enforcement agencies, the TGA is actively monitoring for evidence of the ‘illegal import, supply and advertising of COVID-19 vaccines’ and the vaccine companies also ‘have measures in place’. AstraZeneca is only supplying vaccines to the government in Australia. Read more

-The WHO has released its findings from the global study into the origins of SARS-CoV-2. In response, 14 countries (including Australia) have issued a joint statement.    

Chikungunya, dengue digest

Brazil took top ranking for both chikungunya and dengue fever notifications (confirmed and suspected cases) since Feb 26 in the ECDC’s latest global update. The four other countries that made up the majority of dengue cases reported during this period were Vietnam, the Philippines, Nicaragua and Peru (note: a separate report on a rise in dengue, chikungunya and Zika virus cases). The situation in the French Antilles has improved, with low levels of dengue recorded in Martinique, Saint Martin and Saint Barthelemy – Guadaloupe is said to be in a ‘stable’ epidemic phase of its outbreak. On the island of Reunion, the dengue outbreak is accelerating across 21 communes: the West (Le Port - more than half of all cases this year, La Possession and Saint Paul) and South (Saint-Joseph, Tampon and Etang-Salé) most affected.

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.

More measures to curb dengue outbreak

A clean-up campaign is likely to be brought forward to help tackle the ongoing dengue fever outbreak. Local media report 32 confirmed cases (DENV-2) but ‘there are also 53 probable cases along with 98 suspected cases, revealing a slight uptick from official numbers released earlier this month’. One of the suspected cases is in the Pa Enua (outer island of Mauke). Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. They bite mainly during the daylight hours and can be found indoors, making them difficult to avoid. 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.

TBE rates hit 8-year high in 2020

An overview of tick-borne encephalitis (TBE) cases reported in 2020 signals an 8-year high in infections. The 854 cases recorded last year represented a more than 2-fold increase since 2015, however Lyme disease cases declined during the same period. In related news, an article recently posted in the journal Emerging Infectious Diseases details an increase in Lyme disease infections on treeless islands in the Western Isles of Scotland. 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.

Counting down to outbreak end

With no further Ebola cases confirmed, Guinea began the 42-day countdown to the end of its outbreak on Mar 24 (and a start date of Mar 22 for the end of the D R of Congo outbreak). Vaccinations have been provided to healthcare workers, people who had contacts with Ebola cases and contacts of the contacts in the regions of Conakry, Kindia, and N’Zerekore. Read more. The ECDC reports that the ‘WHO considers the risk of spread in the country as very high, given the unknown size, duration and origin of the outbreak, the potentially large number of contacts, the potential spread to other parts of Guinea and neighbouring countries, and the limited response capacity currently on the ground’. The WHO director-general last week said that the agency ‘is strongly encouraging Ebola-affected countries to implement national survivor care programmes, to support survivors and to advance our understanding of long-term latency of the virus’, as ‘recent cases in Guinea and DRC were linked to body fluids of survivors’. 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.

More infections in post-cyclone period

In the wake of cyclones Ana and Yasa that struck the islands over the summer months the health ministry has reported a total of 1,747 dengue cases as well as 99 typhoid fever infections (one fatal case). 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.

NTDs rebound

Health authorities in Ashanti have warned that the upward trend in neglected tropical diseases (NTDs) reported in the southern region, such as Buruli ulcer, yaws, onchocerciasis and filariasis, warrants new strategies to reduce the burden on public health. Read more

Advice for travellers

Travellers are at low risk of lymphatic filariasis, a parasitic disease caused by thread-like roundworms spread by the bite of an infected mosquito. It is found in sub-Saharan Africa, Egypt, southern Asia, some areas of the western Pacific, the north-eastern coast of Brazil, Guyana, Haiti, and the Dominican Republic. While most infections have no symptoms, acute infection can lead to painful swelling of an affected limb, fever, or chills due to bacterial superinfection. Avoiding mosquito bites is the best form of prevention. Last year the WHO launched its road map for responding to NTDs for 2021-2030. Read more.

Raw mussels off the menu

The presence of Vibrio parahaemolyticus bacteria, which occur naturally in estuarine environments and grow in number during the warmer months, led to a warning from New Zealand Food Safety on Mar 24 for residents to ensure raw mussels are cooked thoroughly before consuming them - above 65 degrees Celsius for one minute. The agency said that in the last two years, there had been between four and 14 cases during the first quarter, this year there were 22. Read more

One outbreak over, many more remain

Three years after it started, Somalia’s cVDPV3 polio outbreak has been declared over by the WHO (without resulting in any international spread), however the agency warns that the ‘cVDPV2 outbreak continues to paralyse children, and environmental samples – sewage water – consistently show that virus moving through Somali communities’. In other VDPV news, a WHO global update issued on Mar 26 showed a sharp rise in both cVDPV cases and environmental samples in 2020 compared to 2019. Twenty-one of the 27 affected countries are in the African region and there are several genetically-distinct cVDPV2 strains causing outbreaks. The agency assessed the risk of cVDPV spread to be very high in the African region and high in the Eastern Mediterranean region. In the latest weekly polio news, two countries reported cVDPV2 infections: South Sudan - 3 cases in the states of Unity, Jonglei and Equatoria; and two more cases in Tajikistan (Khatlon province).

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.

Spring fever for ticks

The arrival of springtime raises the risk of tick bites for people venturing outdoors in many areas of the country’s east and also on the west coast. Several species of ticks found in the US are responsible for the transmission of diseases such as Rocky Mountain spotted fever, Lyme disease, Powassan virus, tularemia and ehrlichiosis, and bites can also trigger mammalian meat allergy. More details can be found on the TickEncounter website. Read more

Advice for travellers

Although its incidence has increased in the past two decades, Rocky Mountain spotted fever is a low risk for most travellers visiting North America, where over 50 percent of cases occur in 5 US states – Arkansas, Missouri, North Carolina, Tennessee, and Virginia. However, it is advisable to take preventive measures to avoid tick bites when outdoors, particularly in warmer months (April-September) when ticks are most active. RMSF can be a severe or even fatal illness if not treated in the first few days of symptoms. Typical symptoms include fever, headache, abdominal pain, vomiting, and muscle pain – with or without a rash. Read more about RMSF.