World travel health alerts 6 November 2019

World travel health alerts for 6th of November 2019.

Positive VDPV environmental sample in Abidjan, global polio update

The environmental sample of circulating vaccine-derived poliovirus type 2 (cVDPV2) that was detected late last month from Jacob city in Abidjan has been linked to a virus belonging to the (Nigerian) Jigawa emergence group (also previously isolated in Cameroon, Chad, Niger, Benin, Ghana and Togo). In other polio news, a GPEI report summarises the weekly count: ‘Afghanistan— one WPV1 case; Pakistan— one WPV1 case and 12 WPV1-positive environmental samples; Central African Republic— three cVDPV2 cases [RS6, RS4 and RS1 provinces] and one cVDPV2 positive environmental sample. Angola— 11 cVDPV2 cases [Kwanza Sul, Huambo, Benguela and Luanda provinces]; Philippines— one cVDPV2 case, one cVDPV1 and two cVDPV2 positive environmental samples’. In the latest update from the Philippines, a Nov 5 Dept. of Health press release announced ‘the fourth confirmed polio case in the country from Mindanao’. 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.

Schools to close early in response to measles outbreak, measles in other regions

A Nov 4 ECHO Daily Flash post reported that the government has Cabinet approval ‘for all primary schools to be closed from 15 November and all high schools as of 29 November’ as one of the measures needed to stem the measles outbreak which has so far led to more than 300 suspected infections and three resulting deaths. Restrictions have also been imposed on visits to hospitals and clinics. And in Tonga, the Ministry of Health update of Oct 29 announced that suspected and confirmed cases had climbed to 107. Global measles news: the PAHO update for the Americas revealed that Brazil has reported most of the recent cases and is leading the tally of regional countries this year with more than 9,300 cases to Oct 31. The state of São Paulo, which has 2-dose measles vaccine coverage of under 77 percent, has had the highest infection count by far to date (and 13 of the 14 measles-related deaths this year). In the African region: this year Ethiopia has recorded more than 8,500 suspected measles cases and 57 deaths from Oromio, Afar, Amhara and Somali regions. While in Lesotho, a measles outbreak has been declared in the district of Qacha’s Nek, adjacent to the South African border in the country’s SE. The WHO African region weekly bulletin commented that Lesotho reports high vaccination coverage overall, however rates are sub-optimal in some ‘hard to reach areas’ such as Qacha’s Nek (65% coverage for the first vaccine dose only).

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.

Dengue uptick, more dengue news

Northern and eastern districts of Raratonga have been the focus of dengue eradication efforts with cases now totalling 109 for the year (and four in Aitutaki) - type 1 dengue - as ‘probable’ cases slowly start to climb again after a lull over mid-year. Across the WHO Western Pacific region, many countries are starting to see a decline in new dengue fever cases, however for most, numbers this year have exceeded those reported in the last one or more years (as with Central America where incidence rates are at a 5-year high). Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. They 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.

Ebola campaign update

The latest WHO Ebola situation report suggests the lower case numbers identified this past week may be due to access and security issues in reaching remote areas. The total number of confirmed and probable cases is now 3,282 with more than 2,100 deaths (to Nov 5).

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.

Var’s 3rd Zika case in August

Active case-finding in Hyères, the site of two locally-acquired Zika virus (ZIKV) infections in August, has detected a third in the same neighbourhood dating from that period – all have since recovered. The ECDC published a summary late last week which also proposed that ‘To ECDC’s knowledge, this event was the first report of vector-borne transmission of ZIKV by Aedes albopictus in Europe’. Read more

Advice for travellers

Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information on smartraveller (DFAT).  

Delhi’s air a ‘health emergency’

As reported by the news media this week, much of Delhi has been shrouded in smog; NE districts and the city of Meerut recorded the highest PM2.5 rates (atmospheric particulate matter [PM] of <2.5 micrometres diameter), categorised as ‘hazardous’. On Nov 1 a public health emergency was declared and several flights were unable to land due to reduced visibility caused by the pollution, however by Nov 6, there had been some improvement with most areas of the city recording ‘unhealthy’ readings, according to the Read more

Highlands malaria risk heats up

A ProMED moderator suggests that the warming climate may be the reason behind recent malaria cases and deaths in the normally low risk county of Nakuru, designated as such due to its altitude (1,850m). Three deaths last week occurred in Solai which is higher still at 1,952m. Read more

Advice for travellers

Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Early start to malaria’s high season

The rise in malaria notifications ahead of the peak November-May season has concerned authorities after a review of activity over recent months showed cases in the NW and SE already surpassing the epidemiologic threshold. Interventions are planned for the five districts reporting high transmission rates (Ihosy, Sakaraha, Ampanihy, Toliara and Betioky). Read more

Advice for travellers

Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Tests on another human rabies death pending

Health authorities in Sarawak are awaiting results of tests on a young child who died on the weekend to find out if rabies was the cause – it would be the 21st human rabies death since July 2017 if confirmed. The local news report also issued an update on a young boy from Sarawak who survived rabies infection in August 2017, saying he has been ‘left with severe neurological damage and is currently on life support’. 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 – especially dogs, the main source of infection. In the event of an at-risk exposure, urgent first aid and post-exposure treatment is required. Vaccination recommendations are itinerary-specific but include those travellers planning to live in, or travel extensively or repeatedly through, endemic countries. Read more on rabies.

Hep E outbreak almost into 3rd year

After nearly two years, there is no quick end in sight for the hepatitis E outbreak - the central region of Khomas continues to have the highest burden of infections with almost two-thirds of cases, however 10 of the country’s 14 regions are affected. The Nov 3 WHO bulletin assessed that the ‘major drivers of the hepatitis E outbreak in Namibia remain the limited access to safe drinking water, inadequate sanitation and poor personal and food safety practices’. Read more

Advice for travellers

The hepatitis E virus is transmitted mainly through faecal contamination of drinking water. Infection during the latter stages of pregnancy carries a higher rate of severe disease and mortality. Unlike the Hep A and B viruses, there is no vaccine for this strain in Australia, which is especially common in communities with lower levels of sanitation and hygiene. Read more about the virus and how to prevent it.

Kids to get protective typhoid vaccine

The conjugate typhoid vaccine (TCV) is being introduced into the childhood vaccination schedule, starting this month in the Sindh with a later roll-out to the entire country to be completed by 2021. A catch-up campaign is planned for Nov 18-30, when more than 10 million children aged between 9mo and 15 years living in urban areas of the Sindh will be vaccinated with the TCV. Reports of travellers returning from Pakistan with extensively drug-resistant typhoid infections have been recorded by Australia, the US, UK, Canada, Spain, Denmark, Taiwan and Ireland. 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.

High chikungunya rates in 5 provinces

The provinces of Pattani, Rayong, Tak, Phuket, and Songkhla have reported the country’s highest chikungunya infection rates this year with notifications exceeding the average for the past five years. The national count for the year to Oct 30 was 8,774 cases and adults ‘aged 25-34 years are the most affected’ according to the translation posted by ProMED.

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.

Forged YF certificates a public health danger

In mid-October we posted an alert on the sale of stolen e-yellow cards in Nigerian markets; last week a Ugandan news service exposed a scam that has been underway for some time in which forged yellow fever vaccination certificates are being sold on the streets to unvaccinated travellers for around A$24 (compared to around $40 for the actual vaccine + certificate). A yellow fever vaccination certificate is required for all travellers aged 1 year or over arriving into Uganda (and for residents departing). 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.