World travel health alerts 4 September 2019

Another 3 countries no longer measles-free

Four countries in the region have now lost their measles-free status – Greece, the Czech Republic and Albania have joined the ranks along with the UK after a review of 2018 data from 53 member countries. The European Regional Verification Commission for Measles and Rubella Elimination (RVC) did however award elimination status to Austria and Switzerland. Last year’s spike in cases across the region continued its momentum with nearly 90,000 new measles notifications (& 37 deaths) this year – already more than the 2018 total of just under 84,000. Other measles reports this week from Brazil (YTD total of almost 2,500 cases - São Paulo state is the epicentre), the USA (Brooklyn, NY, outbreak has ended) and New Zealand (Auckland’s measles case numbers now 812). In other related news, mumps notifications in England hit a 10-year high from April-May this year with high rates noted in particular among university students. Read more.  

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.

West Nile in 34 regions

The asymptomatic nature of most West Nile virus (WNV) infections suggests that the 96 cases currently registered represent a substantial under-reporting of the true situation. Doctors from the Athens Medical Association want ‘the public to take all the necessary precautions’ to avoid the infection which is being reported in 34 regions and caused the deaths of at least 10 people this year. Read more. The ECDC has published EU data up to Aug 29; in the US, WNV data is published by the CDC.

Advice for travellers

Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuroinvasive disease.  The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Read more on WNV.

RVF in SW prefecture

Twelve cases of Rift Valley fever (five confirmed, the remainder suspected) have been reported in the western sub-prefecture of Boali in what is described as ‘the first time such an event has been formally reported in the country’. In the latest WHO African region situation summary, concern was expressed that ‘The ongoing rainy season, running from May to October, may result in increased vector density, constituting another risk factor for escalation of RVF’. Read more

Advice for travellers

Rift Valley fever (RVF) is an acute viral disease that typically infects domesticated herd animals. It is generally found in eastern and southern Africa where sheep and cattle are raised, as well as in West Africa, Madagascar, and more recently Saudi Arabia and Yemen. People are infected after exposure to blood, body fluids, or the tissue of RVF-infected animals, or from the bite of an infected mosquito. The virus presents a low risk to travellers, but is another reason to use personal insect repellent and take other steps to minimise insect bites in places where it occurs. Read more about RVF.

Dengue outbreak on way out

According to a local news report, the Islands’ health secretary admitted that the dengue fever outbreak which began in January is ”on its way out but it's not gone”. Only two new cases were registered last month and, of the outbreak total, all but three were in Raratonga. Read more. In an update of the dengue outbreak (DENV-2) in French Polynesia, authorities registered a sharp increase in new case reporting over the 2-week period from Aug 12 – over half were aged under 20 years. Since the virus was introduced by an infected traveller arriving from New Caledonia in February, 582 dengue fever cases have been reported – the NW of Tahiti remains the area most affected.

Advice for travellers

Dengue is mainly 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.

Another Ebola case identified at Ugandan border

There has been another Ebola virus disease death in Uganda, occurring in young girl who had travelled with her mother from North Kivu to the border district of Kasese and then admitted to the Ebola treatment centre in Bwera, Uganda. The girl’s mother has now been repatriated and no onward transmission has been confirmed in Bwera to date. Read the latest WHO External Situation Report.

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.

Chikungunya cases rise 5-fold

The chikungunya outbreak in the country’s second largest city, Dire Dawa, continues unabated, lifting the case count to 20,000 from the nearly 4,000 cases initially reported in mid-August. Measures have been introduced to stem the tide of new infections – insecticides, public awareness campaigns and free testing for the virus. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.

Diphtheria spreads in student hostel

Twenty-five young women living in a student hostel in the city of Kalaburagi in northern Karnataka state have been diagnosed with diphtheria. The initial source of infection is believed to be a patient who was being treated by one of the medical students. 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.

Active cholera, leishmaniasis outbreaks ongoing

Cholera outbreaks remain active in six of the 10 counties which have reported cases this year - Garissa, Kajiado, Mandera, Nairobi, Turkana and Wajir. The national YTD total now exceeds 3,750 (suspected) cases. From the same WHO regional report, more visceral leishmaniasis infections have been registered in Marsabit and Garissa counties. Together with those reported previously in Mandera and Wajir, suspected cases have climbed to more than 2,300 this year. 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.

Lassa fever emergency announced

Since the beginning of the year a total of 92 suspected Lassa fever cases, including 21 deaths, have been reported in four counties (Nimba, Grand Bassa, Bong, Grand Kru). The persistence of new cases into the usual low (rainy) season and one reported death in a health worker has led to a health emergency being declared. As contact with the excreta of infected rats is the main mode of transmission to humans, personal hygiene measures are advised, as is having a cat around the house. Read more

Advice for travellers

Lassa fever is an acute viral illness that occurs in West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5000 deaths occur each year. However, Lassa is a remote risk for travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Read more about Lassa fever.

Flu activity remains high

The two countries highlighted in the latest WHO global influenza surveillance report due to increased (or increasing) flu notifications were Myanmar and Madagascar (however in ‘Eastern Africa, influenza detections continued to be reported across reporting countries’). Positive results on tests carried out by WHO GISRS laboratories for a 2-week period from the end of July revealed almost two-thirds of samples were influenza A - >60 percent were A(H3N2) and of the influenza B detections, >92 percent were B-Victoria lineage.

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 wipes are a convenient alternative if soap and water is not available.

Urban, rural outbreaks of skin infection reported

A mass treatment program has been instituted after a surge of scabies cases hit the capital Lilongwe and the districts of Kasungu, Mchinji, Dowa, Ntcheu and Machinga. People in both towns and rural areas have been affected. Read more  

Advice for travellers

More on scabies from SA Health.

Scrub typhus hits the hills

Scrub typhus infections are not usually common outside the lowland areas of the Terai, but this year, in the far western province of Sudurpaschim Pradesh, authorities have seen the disease transmitted by mites spread from Dadeldhura to nearby hilly districts. Read more

Advice for travellers

Scrub typhus is a bacterial disease passed on to humans by mites, or chiggers, that normally live on rats infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus is endemic throughout the Asia-Pacific region and more than a million cases occur annually. There is no vaccine or prevention medication: the best way to avoid scrub typhus is to avoid being bitten by mites. Protective measures include the use of an effective personal insect repellent, wearing protective long clothing, and a thorough end-of-day self-examination after visits to rural areas. Due to the disease’s 5- to 14-day incubation period, travellers may only experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Treatment involves taking antibiotics and should begin as quickly as possible. Always see a doctor as soon as possible if you develop a fever after the trip and remember to discuss any recent overseas travel. Read more about rickettsial diseases.

VDPV found in Manila sewage; Dengue toll mounting in 11 regions

Vaccine-derived poliovirus has been detected in two samples taken from a Manila sewage pump station. With polio immunisation rates among the city’s under 5 population less than 50 percent currently (the oral polio vaccine is used in the early childhood schedule), local and international health agencies are assisting in response measures which include heightened surveillance for acute flaccid paralysis. Read more. See all polio news from the GPEI.  

DENGUE FEVER alerts or epidemics hold sway in 11 of the country’s 17 regions with highest infection rates recorded in the Western Visayas, Calabarzon, Northern Mindanao and Zamboanga peninsula. For the year to mid-August the WHO Philippines Office reports there have been 229,736 cases and 958 associated deaths across the country.

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.