World travel health alerts 4 May 2022

World travel health alerts for 4th of May 2022.

COVID-19 update

After more than one million COVID-19 deaths and estimates of between 60 and 80 percent of the population infected over the past 2+ years, the European Commission last week announced its next plan for managing the pandemic in the region – ‘while transitioning out of the acute COVID-19 phase’. They include increasing vaccination/boosting, testing and routine disease surveillance systems that will detect new variants, and supporting the development of vaccines and therapeutics. Read more. For more COVID-19 data from the regions, the latest WHO global epidemiological update will be published later today.

In related news:

- Last week CIDRAP covered the results of observational studies carried out in Luxembourg, Sweden and Ireland which revealed long COVID risk and recovery.  

- An app, MySejahtera, developed by the Malaysian government to help manage COVID-19 outbreaks, including a ‘traveller’ option for returning residents and visitors, will now also allow users to track cases of other infectious diseases in their vicinity (dengue, rabies, measles, and Hand, Foot and Mouth Disease (HFMD)). Read more

- On Omicron-specific boosters: Moderna forecasts large amounts of its mRNA vaccine booster will be available in the northern hemisphere autumn. And according to the May 3 Johns Hopkins COVID-19 update, boosters developed by two different Chinese manufacturers are in clinical trials or about to commence testing – one is inactivated, the other mRNA. Read more  

Measles outbreaks loom from low vax rates

Both the WHO and UNICEF have cautioned that conditions are ripe for large outbreaks of measles in numerous areas suffering humanitarian crises and conflicts. Countries with the largest outbreaks in the past year include Somalia, Yemen, Nigeria, Afghanistan and Ethiopia, however vaccination programs have been interrupted due to the pandemic in many other nations, putting 73 million children at risk of measles infections. Read more. Over the past week, reports of measles outbreaks have been confirmed by governments of the Republic of the Congo and Liberia.

Advice for travellers

Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both in transit and during their stay. In general the infection is relatively benign, but complications 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.

Hantavirus in Los Lagos province

The region of Los Lagos has recorded its sixth hantavirus infection this year, in a man from the Rio Negro commune of Osorno province. While the type of hantavirus has not been specified, the Andes virus is endemic in Chile and can cause a respiratory disease, Hantavirus Pulmonary Syndrome (HPS). Other recent reports on hantavirus cases have been posted in Bolivia (Palos Blancos) and Argentina (Entre Rios). Read more

Advice for travellers

Hantavirus is generally spread from various rodent species to people, through aerosols shed in excreta, urine or saliva, but to a lesser extent via the bite of an infected animal. The syndromes resulting from infection vary by region - in Europe and Asia, the 'Old World' hantaviruses may cause haemorrhagic fever with renal syndrome (HFRS), while the New World' hantaviruses in the Americas can result in hantavirus pulmonary syndrome (HPS). Read more on hantavirus from the Taiwan CDC. Read more on hantavirus from the US CDC.

WHO outbreak notice on JEV in 4 states

The World Health Organisation (WHO) posted a Disease Outbreak News item late last week relating to the outbreaks of Japanese encephalitis virus (JEV). As of April 27, the virus has been identified in 73 pig farms located in four states, while the federal health department’s tally of locally acquired human cases shows that 26 infections have been confirmed, 11 are considered probable and there have been three deaths. The agency’s assessment of risk is categorised at low on a regional and global level, and recommendations include vector control, surveillance and personal protective measures. Additionally, it says consideration should be given to vaccination strategies for endemic and outbreak areas, plus integration of the JE vaccine ‘into national immunization schedules in all areas where JE is recognized as a public health priority’. Read more

Advice for travellers

A mosquito-borne virus, JE is generally found in many parts of Asia, the Indian subcontinent, Southeast Asia, China, Indonesia and PNG, and now areas of southern and eastern Australia. In Asia, 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.

Dengue surge in Paraná city

The incidence of dengue fever in Foz do Iguaçu (Paraná state) was tracking on an average for most non-outbreak years, however recent heavy rains and hot weather have led to a surge in reported cases. Health authorities are said to be concerned that they could be facing a fourth consecutive year of dengue epidemics in the city, which is a base for visiting the Iguaçu Falls. On a national level, the number of dengue cases this year in Brazil is closing in on the total for all of 2021, with the incidence highest in the central and western regions. Read more. Meanwhile in Bolivia, the circulation of a different dengue serotype to the one seen in recent years in the city of Cochabamba is causing more severe cases; two fatal infections have been recorded to date. 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.

Hep A surge in capital’s schools

A spike in hepatitis A cases has been reported in ‘multiple locations’ of the capital Zagreb over the past two months, with many of the infections among school students, some of whom were hospitalised. Treating doctors say that there are no in-patients at present, but due to the viral infection’s long incubation period, more cases may emerge. Read more

Advice for travellers

Vaccine-preventable Hepatitis A (HAV) is one of the most common infections affecting travellers. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and some types of sexual contact. A course of hepatitis A vaccine offers immunity that’s 99%-plus effective and long lasting. It is also important to follow safe food and water guidelines.

Ebola response underway in Equateur

No further Ebola cases have been detected in Equateur province’s outbreak and response measures are well underway according to the latest update of May 1. Ring vaccination of contacts of the two (fatal) cases, as well as frontline healthcare workers, has commenced in the densely populated city of Mbandaka, however concerns over onward spread of the virus persist in view of the transport links of the river port (along domestic transport routes and connecting to the Congo and the Central African Republic). 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.

Update on wild poliovirus, global news; Response to cholera outbreak ramped up

A government press release of Apr 29 announced the detection of a second wild poliovirus type 1 (WPV1) case this year in North Waziristan. The WPV1 infection has been genetically linked to the first case and both young children are reported to be suffering paralysis. Vaccination campaigns were commenced in the affected area after the initial case was confirmed. In other polio news, the GPEI last week announced a number of circulating vaccine-derived poliovirus type 2 (cVDPV2) cases in its weekly update: the Democratic Republic of Congo reported four cases (Maniema and South Kivu provinces), while one case each was logged by Nigeria (Bauchi state), and Somalia (Lower Shabelle). Read more

DESIGNATED wards have been set up in Karachi hospitals to manage the cholera outbreak currently affecting the Central, East and South districts of the city. Public awareness campaigns on disease prevention are to be broadcast in the Sindh and the WHO has donated water purification tablets to the effort. Another news source claims there has also been an upswing in hepatitis A cases and a single report of a Naegleria fowleri infection in Karachi, the first this year. 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.

 

Protracted cholera outbreak in central province

In March, public health challenges from substandard sanitation were further compounded by severe weather events and damage to infrastructure, resulting in an outbreak of cholera in the central province of Zambezia. Local health authorities claim the situation is under control despite a recent uptick in cases in Mopeia district (Chimuara). Read more. Also on cholera, last week the WHO published an update on the outbreak among displaced persons in southern Malawi, noting that all but two of the 78 reported infections were in Nsanje; the district also registered four deaths. The agency assessed the risk of transmission as ongoing in ‘the hotspot of the recurrent cholera outbreaks’, with the added concern of frequent cross-border population movements to Mozambique. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travel, the risk of infection is low. Travellers 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.

Dengue spikes ahead of peak season

Dengue fever cases are continuing to mount well ahead of the annual peak season which starts next month – more than 6,400 infections have been logged this year and the NEA has currently identified 45 high-risk clusters of 10 or more cases. In order to prevent a major outbreak, the agency has warned of ‘Strong Enforcement Action’ for those people who fail to remove mosquito breeding sites around their premises. Read more. In other regional news on dengue, health authorities in Zamboanga City in the Philippines (Mindanao) have responded to the dengue outbreak declared last month by intensifying vector control operations and raising public awareness on disease prevention. To Apr 23, the city had registered more than 1,400 dengue cases and 14 related deaths. 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.

Recognition of public health achievement

A tweet posted by the health ministry last week announced that the WHO regional office had declared the elimination of rhodesiense human African Trypanosomiasis (sleeping sickness) as a public health problem in Rwanda. The decision was based on evidence provided by the ministry to an expert panel. The WHO advised that disease surveillance should be maintained and results reported to the agency. Read more

Advice for travellers

Human African trypanosomiasis is rare in travellers, however the tsetse fly, which spreads the disease, is found in many African countries. The aggressive flies are attracted to moving vehicles and bright and dark colours; they can also bite through light-weight clothing. Travellers should cover up well with neutral-coloured, medium weight clothing and apply an effective personal insect repellent at all times when outdoors. Read more on African trypanosomiasis and how to avoid infection.

Malaria risk elevated for forest areas

A marked increase in human Plasmodium knowlesi infections between October last year and March has sparked a warning from the Disease Control Centre. According to one news report, around 10 P. knowlesi malaria cases are confirmed in most years - mainly in the provinces of Ranong, Songkhla and Trat – however 70 were registered over the six months in question. Those considered most at risk of infection live near, or work in, forests or are involved in raising macaques, the P. knowlesi reservoirs. Read more

Advice for travellers

The P. knowlesi strain of malaria is spreading in humans throughout Asia due to factors such as deforestation – its natural host is the macaque. As well as local cases, infections are increasingly being reported among international travellers who have visited Thailand, Vietnam, Cambodia, Malaysia and the Philippines. Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

More acute hepatitis cases reported

The UK Health Security Agency announced in its Apr 29 update that cases of hepatitis of unknown aetiology had risen to 145 – ‘108 are resident in England, 17 are in Scotland, 11 are in Wales and 9 are in Northern Ireland’; 10 have received liver transplants. This week a WHO representative said at least 228 probable cases have now been reported from 20 countries in Europe, the Americas, the Western Pacific and Southeast Asia, while 50 more cases are under investigation. Causative agents of the acute hepatitis infections continue to be explored, with adenovirus and possible infectious or environmental contributing factors among the hypotheses. Read more

Human bird flu first in western state

A Colorado man who was involved in culling poultry is the first person in the US to be diagnosed with avian influenza H5N1; 10 of his contacts are under surveillance. The patient is being treated in isolation and apart from suffering fatigue, is reported to be asymptomatic. Read more

Advice for travellers

There are several strains of bird flu and while the high pathogenic strains can be fatal, infection generally poses a low risk for travellers – even for those heading to a region where the disease is present or an outbreak is occurring. Travellers should avoid contact with birds or poultry in marketplaces, wash hands thoroughly before and after preparing food, and observe strict personal hygiene. Read more on bird flu and how to avoid it.

More severe dengue cases in HCMC

The early onset of the wet season, which saw mosquito swarms proliferate, has caused a surge in dengue fever cases affecting children living in Ho Chi Minh City. Doctors have also noticed higher rates of serious outcomes of the infection in the young, largely from parents delaying medical care due to confusing early symptoms of dengue for COVID-19 or other viral infections. 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.