World travel health alerts 6 February 2019

World travel health alerts for 6th of February 2019.

School contacts aid measles spread

Yet more on the measles spread across Europe, this time the city of Graz in the southern province of Styria where up to 50 suspected infections were reported at a children’s hospital over a recent 3-week period. Further measles cases are expected as the province’s MMR vaccine coverage is 79 percent for the two dose schedule. A ProMED update of worldwide measles reporting can be found here. Read more

Advice for travellers

A highly contagious virus, measles occurs in developing and developed countries. 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 6 weeks before departure.

Updated YF map; Rio’s chikungunya spike

On Jan 31, the ECDC published its updated map on Brazil’s yellow fever risk areas which is based on the WHO’s 2018 Yellow Fever Vaccination Recommendations in the Americas.  

HEALTH authorities are calling for measures to tackle the rise in chikungunya cases in Rio de Janeiro after the city experienced a five-fold increase in 2018 compared with the previous year. More than 10,000 cases were recorded last year and the current weather conditions are expected to add to the burden of disease – there were another 197 cases last month. 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.

Season heightens risk in cholera outbreak

The ongoing wet season is expected to prolong the cholera outbreak affecting districts on the eastern shores of Lake Tanganyika. Spread beyond the currently affected areas of Rumonge and Bujumbura to neighbouring areas under these conditions is also a risk. 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.

Flu update – 23 states with high rates; West, East coast measles update

It is mid-flu season with reports 23 states and New York City were experiencing high rates of influenza-like illnesses (ILI) up to the end of week 4 and a further 10 states and Puerto Rico reported moderate ILI rates. According to the CDC’s FluView, ‘the majority of influenza viruses characterized antigenically and genetically are similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses’. Influenza A viruses predominate. In Canada, the influenza vaccine has been 72% effective this season against the predominant circulating virus, influenza A(H1N1)pdm09, offering “substantial” protection, researchers said. See more at Influenza reporting in Japan has spiked with record numbers of flu diagnoses – more than 7.6 million cases this season. As with North America, influenza A viruses are most common.

WASHINGTON State health department is now reporting 49 confirmed measles cases and a further 11 are probable - at least 42 of the confirmed cases were unimmunised. Read more. On the east coast, Rockland County’s reported measles cases have risen to 130 since October while in Brooklyn, 64 cases have emerged among the Orthodox Jewish community living in four neighbourhoods. This local outbreak began after several unvaccinated children returning from Israel and the virus then spread locally.

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, when available, for all travellers over 6 months of age. Read more about influenza.

Ebola outbreak into 7th month

The latest WHO External Situation Report, published yesterday, provided details on 12 of the 18 affected health zones in the provinces of North Kivu and Ituri which continue to report ongoing active Ebola virus transmission. The Health Ministry’s daily newsletter puts the case count as of Feb 5 at 788 cases (734 confirmed and 54 probable), 191 suspected cases under investigation and the locations of three new confirmed cases - Katwa, Kyondo and Oicha. Read the update here.

Dengue increasing locally, and in region

The rise in the number of suspected and confirmed dengue fever cases in the first three weeks of the year (339 cases and 6 deaths) follows 12 months of increased reporting – over four times the 2017 case count. The highest incidence of dengue (circulating strain is DENV3) is in Saint Catherine Parish, location of the former capital, Spanish Town. A WHO Disease Outbreak News post also notes that ‘some countries and territories in the Caribbean region, such as Guadeloupe, Martinique, and Saint Martin, reported an increase in dengue cases. Of note, in Saint Martin and Guadeloupe, serotype DENV1 is currently circulating.’

Advice for travellers

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. 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.

WHO assistance with Lassa outbreak, Guinea’s Lassa death

The Lassa fever outbreak continues with 213 confirmed and two probable cases from 16 states up to Jan 27, according to a NCDC Situation Report. In response to the outbreak, the WHO is now ‘mobilizing experts to intervene in investigations, contact-tracing, risk communication and plans are underway to strengthen efforts to further assist Nigeria in controlling the Lassa fever outbreak’. In an assessment of the situation, the WHO notes that ‘the trend in the current outbreak has already exceeded those in any of the previous years … This changing trend is worrying’. Read all outbreak news in the region in the WHO Weekly Bulletin (Feb 1) here. Authorities in Guinea have announced a rare case of Lassa fever in the town of Mamou, NE of the capital Conakry. The victim, who died late last month was from Kissidougou prefecture. ProMED is reporting that one year ago, a Guinean national from the SE prefecture of Youmou died of Lassa in Liberia. 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 on Lassa fever.

Kids sent to rusticate while smog affects city

With the Real-time Air Quality Index for the capital Ulaanbaatar showing ‘very unhealthy’ levels of PM2.5 smog particles, schools will remain closed into the new term and some residents have dispatched their children to stay in outlying areas where the air is clearer. Read more

Dengue fever cases top 700

Of the 707 dengue fever cases reported since September last year ((99% were DENV2), 435 were recorded over January and almost half of those in the capital Noumea - an epidemic alert was declared by the DASS on Dec 21, 2018. The neighbourhoods of Rivière Salée and Vallée des Colons have been hardest hit. Read more. And in an update of Palau’s dengue outbreak: from Dec 1 to Feb 3 there were 77 cases – the southern state of Koror recorded 75 percent of all cases.

Advice for travellers

Dengue is 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.

‘Falsified’ rabies vaccine alert; Manila’s measles upswing

Two batches of falsified rabies vaccine (Verorab®) have been found to be in circulation, leading to notification of the WHO and its subsequent release of Medical Product Alert N° 1/2019. A falsified medical product is one that ‘deliberately/fraudulently misrepresents their identity/composition/source. The WHO-approved cell culture vaccine is used for both pre- and post-exposure vaccinations to prevent rabies, an infection that kills between 200 and 300 Filipinos every year. The Philippines is in the top 10 of rabies incidence countries worldwide.

ONE major hospital in Manila has been treating large numbers of measles infections, resulting in overcrowding of wards and patients having to share beds. More than 1,000 measles admissions were recorded last month and there have been a number of associated deaths in children. 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. 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.

TBE risk present in all but 2 cantons

More on the increasing incidence of tick-borne encephalitis with authorities now advising that only two cantons, Geneva and Ticino, are outside the risk areas. Vaccination is recommended for residents and visitors who will be participating in outdoor activities, with an emphasis placed on grassy areas, hedges and clearings on forest edges where ticks are found. There is no specific drug therapy for TBE infection so vaccination is the best option, starting the vaccine course in the cooler months of winter. Insect bite prevention measures are advised regardless as Lyme disease is also present. Read more

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, vaccination can be obtained by doctors through a Special Access Scheme.

South facing more dengue, chikungunya

Phuket and four southern provinces are the top five reporting chikungunya currently - Pattalung, Pattani, Songkla and Narathiwat. A Disease Forecast issued by the Department of Disease Control in late January advised that recent rainfall was expected to maintain dengue fever transmission in the south in particular, mentioning Sonkhla, Pattani, Phuket, Nakhon Pathom and Nakhon Si Thammarat as having the highest incidence rates. 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.