World travel health alerts 4 November 2020

World travel health alerts for 4th of November 2020.

Wallis and Futuna: Dengue epidemic shifts to Futuna

Futuna’s dengue outbreak continues with a further 14 confirmed and probable cases registered in the latest update, 13 of which were locally-acquired. There have now been more cases on Futuna after transmission on Wallis slowed in June this year. The dengue virus responsible for the epidemic is stated as DENV-2. 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.

Flu update, low activity overall

Flu activity has further increased in Cambodia and, also the case with Laos, influenza A(H3N2) predominated, while in Africa, influenza notifications were received by the WHO for Côte d’Ivoire and Mali. Argentina has registered flu activity above the epidemic threshold (AH3N2 and influenza B in co-circulation), but in Europe, flu levels for early October were described as being similar to the low season over summer. The WHO does warn in its global update that some countries’ influenza-like illness notifications could reflect SARS-CoV-2 transmission. 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.

Gastro strikes Qld coast

Gold Coast health officials have issued an alert relating to a spate of infectious gastrointestinal infections that sickened at least 330 people from 20 different facilities in the fortnight to Oct 29. Children, childcare/school staff members and aged care residents make up those with reported gastro symptoms. Read more

Advice for travellers

Extremely contagious, norovirus infection is typically intense but generally short-lived, causing nausea, vomiting and diarrhoea, which may lead to more serious complications among young children, the elderly, and the sick. To minimise the risk, wash your hands after using the toilet and before eating, and practice good hygiene. Read more on norovirus.

Indications of virus activity near 4 Goias cities

While some details are missing from a local news report, it is claimed that a number of dead monkeys found near cities in the central state of Goias (Goiania, Abadia de Goias, Aragoiania and Aparecida de Goiania) succumbed to yellow fever, with concern mounting over the potential for onward transmission of the virus to humans in a region where vaccination coverage for both adults and children/infants is lower than required. 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.

Weekly update, vaccine-derived polio prevails

All polio cases reported by the GPEI last week were cVDPV type 2 (cVDPV2) - Pakistan registered three cases (Balochistan, Punjab, and Sindh provinces), while in Africa, Cameroon’s two cases were from Extreme Nord region; of Chad’s eight cases, seven were from Logone Oriental and the last from Moyen Chari; Côte d’Ivoire logged three more cases (Gontougo, Nawa and Tonkpi ); the DRC’s four cases were from Equateur, Kinshasa and Maindombe; and three of Mali’s 15 cases were from the capital, Bamako and the remainder in Sikasso, Menaka, Mopti and Gao; and lastly, in South Sudan, nine infections were registered in Warrap and Northern and Western Bahr El Ghazal. In other polio news, emergency use approval of a vaccine specifically for cVDPV is pending while the results of phase 2 trials are awaited. The vaccine is already being produced at an Indonesian facility. 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.

Ebola outbreak slows

More than 33 days now without a confirmed Ebola case detected in Equateur province, and while the outbreak appears to be under control, as asserted by the ECDC in its week 44 update, ‘there is evidence that it is still ongoing as the response remains challenging’. More in a Nov 3 MSF post.

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.

COVID-19 regional surge

Weekly COVID-19 incidence across the globe has been increasing rapidly over the past six weeks and it was Europe’s steep rise in new cases that contributed almost one-quarter of the week’s 3.3+ million cases registered (WHO Epi Update Nov 3). Switzerland has now entered the top 10 countries for per capita incidence, according to the Nov 2 JH newsletter, after it recorded a 43 percent increase in new cases for the week and France reported a new high of more than 52,500 daily cases on Nov 3. While in the US, which ranks #1 globally for new cases, the biggest rise in confirmed cases among children occurred at the end of October, with the total for the month nearing 200,000. Read more.

The WHO’s IHR committee met last week, determining that ‘the COVID-19 pandemic continues to constitute a PHEIC’ and issued advice to States Parties as Temporary Recommendations under the IHR (2005). Read more 

In related news:

-Analyses of COVID-19 infection fatality ratios (IFR) published by Imperial College, London, found ‘the risk of death doubling approximately every eight years of age’. An IFR of 1.15 percent was estimated for high income countries, but in low income countries (which tend to have a younger population), the ratio was estimated to be 0.23 percent.

-Kenya has vaccinated 40 frontline health workers in Kalifi County with the ChAdOx1 nCoV-19 vaccine candidate (developed by the University of Oxford in partnership with AstraZeneca) in the first local trial.

-As summarised in a The Lancet communication, findings from a study undertaken in Singapore reported ‘Among non-household contacts, exposure to more than one case, being spoken to for 30 min or longer by an index case, and sharing a car with an index case were associated with SARS-CoV-2 transmission; whereas sharing a bedroom and being spoken to by an index case for 30 min or longer was associated with SARS-CoV-2 transmission among household contacts.’

-UK health authorities are developing guidelines on the treatment of ‘long covid’ which will be the subject of frequent review/update as more data are received. The post-covid syndrome will apply to symptoms that appear during, or just after the infection, and persist for at least 12 weeks with no alternate diagnosis. Read more

-COVID-19 Antibodies may last longer than researchers thought Read more

-Mock voyages are part of the US CDC’s framework to recommence cruises once initial measures are tackled: demonstrated ‘adherence to testing, quarantine and isolation, and social distancing requirements to protect crew members while they build the laboratory capacity needed to test crew and future passengers’. The agency ‘will help ships prepare and protect crew members’ in the early phases of the Framework for Conditional Sailing Order.  

2nd river implicated in schistosomiasis transmission

GeoSentinel has reported on a case of urogenital schistosomiasis diagnosed in a German man who most likely contracted the infection while visiting Corsica in 2019. He presented with symptoms in June this year and it is believed he was infected while swimming in the Solenzara River. The site of previous infections with the same S. haematobium/S. bovis hybrid in Corsica, the Cavu River does not communicate with the Solenzara. Read more

Advice for travellers

Schistosomiasis or bilharzia is caused by a parasite which is released into fresh water by host snails. It burrows into the skin of people who swim or wade in rivers, streams and lakes containing the snail. With the rise in eco-tourism and adventure travel, increasing numbers of tourists are contracting schistosomiasis, according to a WHO fact sheet. Around 10% of travellers exposed to contaminated water will be infected. No vaccine or prevention medication is available, but schistosomiasis is treatable – especially if diagnosed early. Read more on the risk for travellers and how to prevent infection.

Diphtheria rise for 2nd year

A spike in diphtheria cases has been reported among children in the northern districts of Gujarat. At least 11 cases have been recorded, as well as three deaths, in six of the western state’s villages. The same region experienced a local outbreak of diphtheria last year. Read more

Advice for travellers

Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.

Filariasis eradication achieved

A milestone has been reached in the battle to eradicate lymphatic filariasis, with the WHO formally announcing Malawi as only the second sub-Saharan country to achieve this validation – Togo was the first. 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. Read more.

Diphtheria case in Lima sparks health alert

The subject of a health alert, a confirmed case of diphtheria has been reported in Lima some 20 years after the disease was considered eradicated in Peru. The patient, a 5yo girl from the populous district of La Victoria died this week after her condition worsened from the complication diphtheria myocarditis. A news report claimed the child had only received one of the three primary doses of her early childhood vaccines. Read more

Advice for travellers

Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.

MERS cases persist

Circulation of MERS Co-V continues with the case count for this year rising to 57 and 20 related deaths; highest numbers were in Riyadh, followed by Asir, Eastern Province and Makkah. The three infections registered outside the kingdom early this year were in the UAE (two cases) and Qatar. Contact with camels was confirmed in 16 cases overall and 11 infections were in healthcare workers. Read more, plus information on MERS from the WHO.

Dengue outbreaks, ‘most severe in recent history’

IFRC assessments of the dengue fever crises in St Vincent & the Grenadines and St Lucia addressed the increase in cases as ‘a clear indicator’ of larger imminent outbreaks. Both island groups are experiencing outbreaks described as their most severe in recent history. All health districts of St Vincent are affected, however most cases have been in Pembroke, Kingstown, Calliaqua and Georgetown, while in St Lucia, the north has borne the brunt of the outbreak. Read more

Advice for travellers

Dengue is spread by 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. Read more about dengue fever.

Typhoid resurfaces in Glen View

Health authorities have confirmed four cases of typhoid fever in the high-density suburb of Glen View in Harare’s SW, amid a water shortage in the area. Glen View’s residents were severely affected in a major typhoid outbreak at the end of last year. Read more. Also on the local front, a WHO article cites sources who have estimated that more than three-quarters of yellow vaccination cards issued to travellers in Zimbabwe are fake, presenting a potential public health issue for their destination countries. 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.