World travel health alerts for 6th of March 2019.
Regional dengue warning
Dengue fever is the subject of a media release from the Pan American Health Organization (PAHO) stressing the need for Caribbean and Latin American countries to adequately prepare in view of the region’s history of ‘cyclical outbreaks and epidemics every three to five years’. As noted in the release, ‘The first dengue epidemic with over one million cases occurred in the Region in 2010. Three years later, in 2013, the first epidemic with more than two million cases occurred. At the beginning of 2019, there was an increase in cases compared to the same period of 2018.’ Read more
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.
Dengue risk in Falls area
With higher rainfall, more abundant mosquitoes and an increased incidence of dengue fever already occurring in the tourist hotspot of Foz do Iguaçu, a combined effort to eradicate the vectors ahead of the peak dengue season is underway. Representatives from municipalities in the three countries with borders at the Falls – Brazil, Paraguay and Argentina – are all involved. Read more
Advice for travellers
Don’t get bitten and you won’t get 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.
More local dengue reported
Eleven dengue fever cases are now either confirmed or suspected in Raratonga, all but one of the confirmed cases were locally-acquired DENV-1 serotypes. The four most recent cases include a visitor from Fiji. The outer islands, or Pa Enua, remain unaffected. There are separate reports of dengue cases in Vanuatu and an update of the situation on Palau.
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.
Regional and international measles reports
Multiple reports emerge when conducting searches on the internet regarding measles. This week, news from the Czech Republic that fewer than 10 measles cases were recorded in 2016, but that figure has increased at least 10-fold in the first two months of this year after authorities announced 100 cases (70 of those in Prague). While the extensive outbreak continues in the Ukraine, Macedonia has reported more than 250 cases recently and the resulting deaths of three children. In Asia, the latest data from the Philippines shows the current national total at 16,349 cases and over 260 deaths, with more than 20 percent of cases from each of Calabarzon and the National Capital Region (Metro Manila) - outbreaks have been declared across six regions. Four towns in Myanmar’s Yangon district have reported most of the country’s measles cases this year – 1,300 to mid-February and at least one child from Mandalay district died as a result of measles complications. In the African region, the death toll in Madagascar has now exceeded 1,100 as the case count surpassed 79,000 by the end of February and Nigeria’s year-to-date total is almost double that for the same period in 2018 (4,838 suspected measles cases and 13 deaths). There are also summaries of measles cases in the USA and across the Americas. Read more
Advice for travellers
Measles is a highly contagious virus and can cause serious illness in people of all ages. Most cases reported in Australia are linked to overseas travel - both developing and developed countries. 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.
Violence continues to hamper Ebola response
The two health zones of Butembo and Katwa are said to be ‘fuelling this epidemic’ in a Mar 4 health ministry newsletter reporting on the Ebola virus disease outbreak. Setbacks experienced during the week include the torching of two treatment centres in the worst affected health zones. Latest information on the epidemiological situation can be found here. 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.
Progress of tick-borne disease season
Deaths from Kyasanur Forest disease (KFD) during Karnataka’s current dry season have risen to 12, while in late February more than 1,500 suspected KFD cases were reported from just three districts - Shivamogga, Uttara Kannada and Chikkamagaluru. Risk of KFD infection is highest for people who work in rural or forested areas inhabited by ticks, the vector of KFD, or who have contact with infected animals (usually a monkey). A locally produced vaccine is said to be >80 percent effective after the third dose. More on KFD from the CDC. Read more
Feb 20 polio report updated; Jakarta’s dengue menace
More on the vaccine-derived polio (cVDPV) cases reported in Papua province last month: one child with acute flaccid paralysis due to infection with cVDPV1 and an asymptomatic community contact were identified in remote Yahukimo district, near the PNG border (but not associated with the outbreak in PNG). The WHO reports that the ‘exact extent and timing of the outbreak response is being finalized’ and more than 5,000 local children have now been immunised with bivalent oral polio vaccine. The agency has categorised the risk as moderate ‘at the national level due to the sub-optimal polio vaccination coverage and surveillance quality’ in the province. As such, the Temporary Recommendations extended under the continuing Public Health Emergency of International Concern (see below) apply: ‘persons of all ages residing in polio-infected countries and long-term visitors to such countries (i.e. persons who spend more than four weeks in the country) should have completed a full course of vaccination against polio in compliance with the national schedule. In addition, they should receive an additional dose of OPV or IPV within four weeks to 12 months of travel to boost intestinal mucosal immunity and reduce the risk of poliovirus shedding, which could lead to reintroduction of poliovirus into a polio-free area.’ See the CDC travel health notice here. At the Feb 19 meeting of the Twentieth IHR Emergency Committee, it was decided that in view of the increase in WPV1 cases experienced globally last year and an unprecedented number of outbreaks of cVDPV in recent years, the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus will be extended for a further three months.
FIVE sub-districts of Jakarta have been hardest hit by dengue fever infections with almost 2,300 cases recorded city-wide to date this year; they are Kalideres, Pasar Rebo, Cipayung, Matraman and Jagakarsa. Up to Feb 8, more than 16,500 cases and 176 deaths have been reported. Highest rates of infection have been in East and West Java and East Java and East Nusa Tenggara. Read more
Advice for travellers
Polio 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.
Rabies hike in north
Authorities have announced a 10-fold increase in the number of rabid wild jackals found in northern districts after the virus spread from border areas. There is now concern that the animals’ movements could raise the risk of rabies in settled areas. ProMED reports that ‘the situation has led the State Veterinary Services to declare large parts of northern Israel as "high risk" and to apply more severe control measures’. Read more
Advice for travellers
Rabies is present in most countries and all travellers should be aware of the importance of avoiding contact with wild and domestic animals. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is normally recommended for longer stays, especially travellers planning to live in, or travel extensively through, rural areas and also for children; however the final recommendation is itinerary-specific. Read more on rabies.
Concerns over immunisation rates
National MMR vaccination rates have dropped to 89 percent according to a news report (which also refers to a practice employed by some Hajj pilgrims to avoid the compulsory meningococcal immunisation by having the certificates falsified). The government is considering making immunisation mandatory for all schoolchildren, a move which comes one week after the death of an unimmunised 2yo boy in Bohor from diphtheria – a further four contacts, all children living in the same household, have also been infected and are receiving treatment. 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.
Dengue count tops 800
More than 500 dengue fever cases were reported in January and the latest data for Feb showed a further 368 cases, while the 2-month case total for chikungunya infections was 206. Read more
Advice for travellers
Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no vaccine and preventing infection relies on avoiding mosquito bites. Apply an effective repellent when outdoors to all exposed skin. Read more about chikungunya.
RVF cases mount, local agriculture affected
French media has announced that the sale of unpasteurised milk on Mayotte has been banned for three months as health authorities deal with the outbreak of Rift Valley fever that has now produced 82 human cases since November last year. Infections in humans remain concentrated on the centre and NW of the island and numbers have remained stable for the past three weeks, however nearly 40 clusters have been identified among local animals – cattle, sheep and goats. 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.
Update on medical tourists’ resistant bacterial infections
The WHO has updated information on the antibiotic-resistant Pseudomonas aeruginosa (VIM-CRPA) infections acquired by 20 medical tourists at facilities in Tijuana, Mexico. Investigations at one particular hospital ‘identified reusable equipment that was not being appropriately processed, which poses a small but potential risk of transmission for bloodborne infections among patients’, leading to advice for all previous surgical patients of the hospital to seek testing for hepatitis B and C viruses and HIV. Read more
More Lassa fever in 8 states
More than 20 new Lassa fever infections emerged from eight states during week 8 taking to the year-to-date total of suspected fever cases to 1,279 and 83 deaths, however the general trend is decreasing case numbers. The states of Edo and Ondo have reported almost two-thirds of all confirmed cases this year. 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.
MERS now in 2 governates
Eight new MERS cases have been identified in recent days from two governates – South Sharquia and North Batinah, the latter reported five cases last month. The sources of infection are under investigation currently. Read more. Recent reports from Saudi Arabia are summarised by Afludiary.
Flu season update
Influenza-like illness rates are elevated across New York City and 33 states according to Fluview with ‘influenza A(H3) viruses … reported more frequently than influenza A(H1N1)pdm09 viruses’. The WHO global flu report released on Mar 4 notes high influenza intensity in six countries of SW Europe and elevated levels in Southern Asia, while ‘increased influenza activity was reported in Thailand, with detections of all seasonal influenza subtypes’.
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.
South coast dengue surges
Dengue fever cases in the south central coastal city of Nha Trang have risen by more than 800 percent compared with last year, rising to nearly 2,000 cases with a slightly lower increase experienced at a province level. Read more
Advice for travellers
Don’t get bitten and you won’t get 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.