World travel health alerts 5 February 2020

World travel health alerts for 5th of February 2020.

Another cVDPV1 case in south, global summary

A second cVDPV1 case has been reported, this time in Southern Mindanao province, taking the 2019 total to two. The GPEI weekly summary also updated WPV1 cases in Pakistan – six in total, but four categorised as 2020 cases - (Sindh, Balochistan and Khyber Pakhtunkhwa provinces) and positive WPV1 environmental samples in both Afghanistan and Pakistan (plus four cVDPV2 cases and one cVDPV2 positive environmental sample). In Africa, cVDPV2 infections were recorded in Angola (15 from eight provinces in all) and two in the DRC (Sankuru and Kwilu provinces), while the virus was also found in environmental samples in Nigeria, Somalia and Ethiopia; the risk of further cVDPV2 spread across the affected regions remains high. 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.

Flu season ramping up

Flu infections during in late January were reported as widespread with activity described as very high in Slovenia and high in Luxembourg, Bulgaria and Turkey. Influenza A strains were dominant with the exceptions of Georgia and Romania, while both A and B strains prevailed in Russia, Luxembourg, Kosovo and Albania. Read more. In the USA, much of the country was reporting high levels of influenza-like illness. The CDC advised that for the week ending Jan 25, B strains were more common in people aged 24 years and under, while influenza A(H1N1)pdm09 viruses predominated in adults aged over 25 years.  

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.

Caution over low levels of Ebola virus transmission; Measles update

Ebola virus (EVD) infections dropped to a new weekly low, however health agencies remain wary that the situation could quickly change – Beni is the latest hotspot and violence has flared again near Mandima. More in-depth information can be found in the Feb 4 WHO Sitrep and CMRE newsletters of Feb 2 and Feb 3.  

A JANUARY 31 Médecins Sans Frontières article outlines their current work in the western province of Kongo Central, assisting at a measles hotspot. All 26 provinces have been impacted in the outbreak and the 12-month national death toll from measles infections has now exceeded 6,100 from almost 320,000 cases (WHO data). In other measles news, Tonga recorded a further five measles cases in the week to Jan 29, all from Tongatapu and the public health emergency will continue in American Samoa until the end of this month – of the 15 measles cases reported, the most recent onset was Jan 17.

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.

YF vax urged for Paraná citizens, dengue alerts

Residents in the southern state of Paraná have been urged to get their yellow fever (YF) vaccinations as authorities announced that 16 people are undergoing testing for the infection amid a rising number of monkey deaths (YF virus reservoirs) in areas that include within the metropolitan region of the capital, Curitiba. Read more. Dengue fever cases have been increasing also – more than 3,800 cases were reported last week and much of Paraná is now on alert as the peak Feb/Mar season gets underway. The three municipalities reporting the highest number of suspected dengue cases were Londrina, Paranavaí and Foz do Iguaçu, according to a Feb 4 state health dept report.

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.

WHO’s 2019-nCoV regional and global level risk assessment: high

The first 2019-nCoV deaths outside mainland China have been reported: the first, a 44yo man hospitalised in the Philippines after travelling from Wuhan is said to have been co-infected with Streptococcus pneumoniae and influenza B, while the second, in Hong Kong, was a man with diabetes who had recently visited Wuhan – no information was provided on whether his chronic illness contributed to his death. More than 20 countries, including Australia, have now introduced travel restrictions relating to the outbreak.

Doctors at a hospital in Bangkok, Thailand, have declared some success after using oseltamivir in combination with lopinavir and ritonavir on several seriously ill 2019-nCoV patients (Feb 3 article in The Scientist). Trials are underway on other drug combinations and treatments, as reported in Science and Cell Research.

Regular or daily situation updates issued by the WHO, ECDC, the US CDC, Johns Hopkins Center for Health Security are listed together with resources collated in real time on The Global Health Network’s Knowledge Hub. The Feb 1 CDC HAN update delivers a situational update and interim guidance. The Australian Dept. of Health’s Coronavirus update at a glance summary included the latest case numbers: ‘As of this morning, 5 February 2020, 13 cases of 2019-nCoV have been confirmed in Australia: 4 in New South Wales, 4 in Victoria, 3 in Queensland, and 2 in South Australia. Of the 12 previously reported cases, 3 have recovered. The others are in a stable condition. Australian health authorities are testing another 213 people who show symptoms of the virus.’

Strong start for dengue

Six states have reported the majority of January’s 441 confirmed dengue fever cases (Veracruz, Quintana Roo, Tabasco, Guerrero, Jalisco and Yucatán) and a further 6,000 suspected cases were recorded. Both these figures represent a year-on-year increase from Jan 2019. Read more. Elsewhere in the Americas, a big clean-up of likely mosquito breeding grounds has been underway in dengue-affected areas of Paraguay – all locations of Central Department and the capital have been affected, but some areas more so (Barrio Obrero, San Vicente, Saxony, Zeballos Cué, Holy Trinity and Republican).

Advice for travellers

Dengue is spread by Aedes mosquitoes which 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.

'Monkey' malaria in SE island location

ProMED this week published a communication describing a malaria infection contracted by a German tourist who had spent just under four weeks on the island of Koh Chang Noi (Little Koh Chang) during late Dec/early Jan - the traveller was diagnosed with Plasmodium knowlesi infection on his return to Germany. As a similar case was described at this same time of year in 2016-7, the author of the post stressed that the currently defined low-risk destination is ‘as an area of potential _P. knowlesi_ infections’.

Advice for travellers

The P. knowlesi strain of malaria is spreading throughout Asia due to factors such as deforestation. As well as local cases, infections are increasingly being reported among international travellers who have visited Thailand, Vietnam, Cambodia, 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 yellow fever cases suspected

The Feb 2 WHO African region weekly bulletin updated the situation on Moyo district’s yellow fever cases we reported on last week: two more probable YF cases and tests results are pending on eight more suspected infections. There are several factors that present the potential for international spread of the outbreak - the presence of the mosquito vector and high population movements in an area which is adjacent to both the DRC and South Sudan. Outbreaks in ‘high-risk’ Uganda (EYE strategy) have occurred most recently in 2016 and 2019 among mostly rural communities ‘with documented sylvatic transmission’. 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.

Hep A outbreak tops 30,000 cases

Five states have reported most of the cases in the hepatitis A (HAV) outbreak, now almost into its fourth year - Kentucky, Florida, Ohio, Tennessee, and West Virginia. The outbreak total has climbed past 30,000 cases and more than 60 percent of those infected have required hospitalisation. As noted by the CDC, while Hep A is usually recognised as a food and water-borne infection, in the US it ‘is more commonly spread from person to person’ with infection rates and risk of complications highest among the homeless, people who use illicit drugs, MSM and those with chronic liver disease.

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.