World travel health alerts 4 December 2019

World travel health alerts for 4th of December 2019.

Results for women in 2018 HIV report

From Eurosurveillance, a report on HIV in Europe during 2018 revealed that heterosexual sex constituted the main mode of transmission for women and almost two-thirds of their diagnoses were in those between the ages of 30 and 49. Further, more than 50 percent of women’s HIV diagnoses occurred late, ‘partly a result of relatively low HIV testing coverage and uptake in the Region, and are an indication that sexual risks, including HIV and other sexually transmitted infections, are not being adequately addressed with older adults’.

Advice for travellers

More on HIV transmission, risk factors and prevention from the WHO.

Update for WPV/VDPV infections

Only 12 WPV1 cases were reported across Pakistan in 2018 but this year’s total is many times higher - an update from the GPEI tells of a further five polio infections from two provinces, Sindh and Khyber Pakhtunkhwa, taking the YTD figure to 91. Better news from neighbouring Afghanistan which had 21 WPV1 cases last year and 21 to date this year. Updates published in the African region WHO weekly bulletin reveal that both Benin and Ghana reported four more cVDPV2 cases: Ghana’s cases were widespread, from the regions of Northern, Bono, Oti and Savannah (also positive environmental samples taken in the Greater Accra Region), while in Benin they were in Atacora, Borgou, Collines, and Donga provinces. Other countries in the region reporting cases: Togo with two cases from Savanes province, and one new case in the DRC’s Haut Lomani province. More from two separate WHO Disease Outbreak News posts on cVDPV2 in Pakistan and the African region. 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.

Dengue to top 2015 record

Dengue fever cases reported to Dec 3 are close to exceeding the record of 120,836 infections registered in 2015 – more than half this year have been in the state of Selangor. Read more. Elsewhere in the region, Myanmar recorded more than 23,200 cases of dengue for the year to Nov 23 and unusually high numbers of haemorrhagic fever among children have resulted in a year-on-year rise in dengue-related deaths; worst affected regions were Kachin, Yangon, Ayeyarwady and Mandalay. The dry season has finally arrived in Bangladesh, bringing a drop in dengue infections although new cases continue to be reported. A summary of the YTD situation shows how bad a season it has been: more than 100,000 people hospitalised for treatment of dengue – the worst month was August, averaging 2,500 admissions daily. An article on this year’s severe dengue fever outbreak in Nepal notes that all but 10 districts were affected and infections occurred at altitudes of up to 2,000m; the nationwide case count of almost 14,500 is also likely to be an underestimate of the true figure.  

Advice for travellers

Dengue is spread by Aedes mosquitoes that breed close to dwellings, are found in shady areas and bite mainly during the daylight hours, 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 PMD when outdoors to all exposed skin. Read more about dengue fever.

Ulanqab, site of 4th plague infection

A shepherd from Ulanqab in Inner Mongolia has become the fourth person infected with the plague - in this case, the bubonic form. The area where he lives is several hundred kilometres from Xilingol League, site of the earlier plague cases. Read more   

Advice for travellers

Plague poses a low risk to most travellers. The majority of plague cases are due to bubonic plague following the bite of an infected flea carried by rats. If left untreated, infection of the lungs causes the pneumonic form of plague, a severe respiratory illness, which can progress rapidly to death. Read more on the plague.

Rains add to health crises

The worst floods in 25 years have struck seven provinces but had the greatest impact in three - North and South Ubangi and Mongala, causing a spike in cases of malaria, acute respiratory infections and typhoid fever and adding to the disease outbreaks already suffered this year - Ebola virus disease (EVD), measles, cholera, monkeypox, bubonic plague and rabies. On the EVD outbreak in the NE: there will be delays in relief efforts in Mangina and Biakato after attacks on healthcare workers led to several deaths and injuries to others; a 2-day general strike has also been declared in North Kivu. The latest daily update (Dec 3) announced 367 suspected cases under investigation but no new confirmed cases or (high-risk) community deaths (10 were recorded late last week however). Overall there have been 3,133 confirmed and probable EVD cases and more than 2,200 deaths. Read more  

Advice for travellers

Sub-Saharan Africa presents a significant malaria risk. Travellers should discuss their itinerary and the need for preventive measures including anti-malaria medication during a pre-travel consultation. For details call 1300 360 164. Read more about malaria.

Tick-borne virus spreads north

An article published in Eurosurveillance in October details three cases of tick-borne encephalitis contracted in or adjacent to the large forest of Tisvilde Hegn, ‘an acute, new, high-risk TBEV micro-focus in Northern Zealand’. Additional comments were made on the increasing incidence of TBEV in the region ‘which mirrors the increased abundance of ticks, the increased geographic spread and potentially climate changes’.  

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.

171 more measles cases since yesterday, global update

In response to the extraordinary measles outbreak affecting Samoa, all state-owned/Public Service enterprises (excepting some essential services) and private businesses will close on Dec 5 and 6 to allow for more people to access the ongoing mass vaccination campaign. Door-to-door vaccination is to be provided to everyone aged from six months to 60yo (non-pregnant women only). Some inter-island and all road travel is restricted, as outlined in a local news article. The Samoan government’s facebook page today announced a further 171 measles infections and five deaths reported in the last 24 hours, taking the total to 4,052 cases and 60 deaths. Fiji’s measles cases have increased to 15, from the subdivisions of Serua/Namosi (11 cases), Suva (2) and Rewa (2). The latest case is a 38yo man from Nasilai Village, according to a Dec 3 Ministry of Health and Medical Services press release. A vaccination campaign has reached almost 100,000 Fijians, with the next phase prioritising Central Division from today (Dec 4). In Auckland, by Dec 3 the measles count had risen to 1,708 (and 2,144 for all New Zealand). Last week the WHO published a global update on measles confirming there had been more than 440,000 cases this year from 187 member states (to Nov 5).  

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.

Care for Depok’s Hep A cases

An outbreak of hepatitis A among older students at one school and on to the general community in the city of Depok (southern Jakarta metropolitan area) has been declared a ‘full-blown extraordinary occurrence’ which will allow the local health agency to ensure those infected receive treatment as needed. Read more

Advice for travellers

Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through consuming contaminated food and water, by handling everyday items and through some types of sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is highly effective and offers long term protection.

Warnings of dengue upsurge

Authorities are warning of the possibility of a severe dengue fever outbreak, based on fast-rising case numbers over the last month and high densities of mosquito breeding sites. It is hoped that assistance from the public in removing standing water around residences could prevent the current epidemic from becoming much worse in areas including Central and Capital departments. 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.

MERS case in Abu Dhabi region

The Emirate’s second MERS case in just over 18 months has been reported, this time in a farmer from Al Ain city in Abu Dhabi region; he was known to have close contact with dromedary camels and sheep, a MERS infection risk. His case takes the UAE’s total since 2012 to 88. Saudi Arabia reported a further 12 MERS cases last month, from the regions of Riyadh, Al Madinah, Makkah and Al Qasim. Read more

Advice for travellers

Read more on Middle East respiratory syndrome coronavirus (MERS-CoV) in a WHO factsheet.

Lassa fever advice for travellers

On Nov 28 both the WHO and ECDC published summaries with more details on the Lassa fever infections contracted last month by healthcare workers in Northern province’s Tonkolili district. One of the recommendations from the ECDC’s Rapid Risk Assessment is for travellers to Sierra Leone to seek advice on Lassa fever prior to departure. The risk of infection is considered greater during the dry season (Nov-Apr) and more so for people who are visiting family and friends in rural areas than for tourists or business travellers. Advice includes avoiding ‘consumption of food and drink which may have been contaminated with rodent droppings, exposure to rodents or dust contaminated by rodents or to people presenting with haemorrhagic fever’. Read more

Advice for travellers

Lassa fever is a low risk for most travellers. Rodents shed the virus in urine and droppings and it’s then passed on to humans through direct contact, touching objects or eating food contaminated with these materials, or through cuts or sores. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease. Read more about Lassa fever.

STI rates climb; Flu activity up in south and west

Surveillance conducted by the CDC established a fifth consecutive year of increases in sexually transmitted infections (syphilis, gonorrhea and chlamydia). Chlamydia was most common and ‘nearly two-thirds of those cases were among young adults aged 15 to 24 years and the reported rate of cases in women was nearly two times the rate in men’, according to the report. Rates of syphilis infections (primary and secondary) also rose.

IT’S STILL early in the flu season and the CDC reports low activity overall, with the exception of the south and some western regions. Testing has revealed influenza B/Victoria to be most common, however A(H1N1)pdm09 and A(H3N2) viruses have been detected ‘with the predominant virus varying by region and age group’. The ECDC also notes low activity across Europe with ‘early signs of increased influenza B activity in some countries’.  

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.