World travel health alerts 6 October 2021

World travel health alerts for 6th of October 2021.

Rabies death in Illinois; COVID-19 cases in children ‘exceptionally high’

The state of Illinois has reported its first human rabies case (and death) in nearly 70 years after an 80yo man who was bitten by a rabid bat last month succumbed to the infection after he refused treatment (the reason for this is not given). A 2018 WebMD article highlights the potential cost of surviving rabies in the US, explaining that for the uninsured, patients can be up for tens of thousands of dollars. Read more

NEW COVID-19 cases have been decreasing among the USA’s adult population, however according to the American Academy of Pediatrics (AAP), children made up over one quarter of new cases (26.7 percent) in the week to Sept 30. With nearly 850,000 child cases added over the past month the AAP notes that ‘the available data indicate that COVID-19-associated hospitalization and death is uncommon in children’ but more study is needed into the effects of the pandemic on ‘the long-term physical health of infected children, as well as its emotional and mental health effects’. (The AAP states that the data is preliminary and subject to change). On a global level, the WHO advised that the downward trend seen in new case reporting since August continues. The Oct 5 epi update notes that all regions except Europe (relatively stable) had experienced a decline in new case numbers over the previous week - UK, Turkey and Russia had Europe’s highest numbers of new cases. Africa logged a 43 percent drop in weekly cases - Angola, Benin, Gabon, Equatorial Guinea, Ethiopia, Mauritius, and Sao Tome and Principe reported an upward trend in the past week. South Africa continues to report more than half of all new cases in the region. Read more  

In related news:

- The NCIRS has published reliable and accurate information in 'COVID-19 and children: Frequently asked questions'.

- AusVaxSafety data indicates that the 12 to 19 years of age cohort is reporting similar short term side effects to the COVID-19 vaccines as older Australians.

- TGA advice on recognition of COVID-19 vaccines not registered in Australia but used internationally now allows for the Sinovac and Covishield to be recognised as acceptable for "incoming international travellers to be regarded as appropriately vaccinated".

- On Oct 1, a media release issued by the Prime Minister outlined plans to re-open Australia’s borders, starting with the return of fully vaccinated citizens and permanent residents (approved vaccines and quarantine measures required); foreign travellers will follow at a later date. Timing of the end of border closures will be dependent on the vaccination rates in the individual States and Territories.

- On Oct 4 the WHO published the interim guidelines on booster doses of COVID-19 vaccines, also noting that ‘introducing booster doses should be firmly evidence-driven and targeted to the population groups in greatest need’ (and distinguished between booster and additional doses).                                                                                                           

- A STAT News article outlines ‘What we know — and don’t know — about Merck’s new Covid-19 pill’ and about other Covid-fighting pills in development.

- Guidance from the Australian Red Cross for those people who plan to donate blood, plasma or platelets to wait seven days after receiving a COVID-19 vaccine. Read more

- Air New Zealand has joined Qantas in mandating full COVID-19 vaccination for its international passengers. The requirement will be enforced from Feb 1, 2022. Read more

Health warning over pork products

Sporadic reporting of trichinellosis cases from several towns and cities in two provinces have led health agencies to warn the public that only pork meats bought from authorised facilities which correctly label their products should be consumed. Cases of the parasitic disease contracted through eating undercooked or raw pork meat have been registered in the provinces of Buenos Aires and Córdoba, according to Food Safety News.

Measles report for the Americas

The PAHO measles summary for the Americas this year up to early Sept has Brazil’s count of 552 confirmed cases and two deaths as highest for the region. States with the greatest cumulative incidence rates were Amapá, Pará, Ceará and Alagoas, while outbreak activity continues in Amapá, Pará and Alagoas. Measles vaccination rates fell in 2020 and again this year by between 18 and 22 percent compared to 2019.  

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 at least 6 weeks before departure.

NGO assists in Kwango province; Cholera hotspots in 2 provinces; Measles in capital

A Médecins Sans Frontières’ (MSF) team has treated nearly 2,200 people for typhoid fever in Popakabaka district, Kwango province, and the downward trend in new cases is likely to come to an end after the rainy season set in last month. The organisation has also tended to 3,500 people suffering from malaria. Read more

CHOLERA is endemic in the east of the country (North and South Kivu, Tanganyika, Haut Katanga and Haut Lomami) but sporadic outbreaks become more widespread during the wet season. The latest hotspots according to the WHO regional bulletin are in Tanganyika and South Kivu which ‘have reported almost all cases notified in week 36 (week ending 12 September 2021)’. The agency does note however that the outbreaks this year are of ‘a much lower intensity compared to the same period in the previous four years’. Read more

MEASLES outbreaks have been declared in four health zones of the capital, Kinshasa (Kingabwa, Police, Nsele and Masina 2). Vaccination campaigns are now planned for the affected health zones and those nearby, aimed at protecting children aged from six months to 14 years. 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.

Dengue adds to pandemic pressures

Health authorities in Lahore, Punjab are still grappling with COVID-19 cases and now an upsurge in dengue fever infections is further straining their resources. Plans have been made to convert a field hospital into a facility to treat dengue patients. Read more. While in the neighbouring state of Punjab in India, dengue cases are reported to have doubled over a 7-day period. 

Advice for travellers

Dengue fever is common in most tropical or sub-tropical regions of the world. The virus is spread by daytime-feeding Aedes mosquitoes and to avoid it and other insect-borne diseases, travellers should apply an insect repellent containing an effective active ingredient, such as DEET, Picaridin or oil of lemon eucalyptus (PMD), to exposed skin when outdoors during the day. In addition, cover up with long-sleeved tops, long pants, and shoes and socks around dawn and dusk, as well as other times when the mosquitoes are active.

Whooping cough spike in late Sept

A Pacific community report published this week advised that a total of 41 pertussis cases were recorded in the period between Sept 20 and Oct 1 – they were confirmed as Bordetella pertussis (36 cases) and B. parapertussis (five cases). Read more

Advice for travellers

Travelvax recommends Australians travelling overseas check their immunisation status for childhood diseases such as whooping cough (pertussis), diphtheria, measles and mumps at least 6 weeks before departure. Read more about whooping cough.

Plague in 2 districts; Polio update

An update on the plague outbreaks was provided by the WHO on Oct 1, with two known endemic areas reporting cases - Itasy (Arivonimamo district) and Haute Matsiatra (Ambalavao district). The agency noted that between 200 and 400 cases of plague are reported most years, with the majority of the bubonic form - most of the cases to date this year have been the more virulent pneumonic form. While the country has extensive experience in managing these outbreaks, the WHO advises that current economic conditions and the famine crisis make a comprehensive response strategy doubtful. Read more

MADAGASCAR was one of two countries reporting circulating vaccine-derived poliovirus cases in the Sept 30 GPEI update (there were no cases to report last week), with a cVDPV1 infection logged in both Boeni and Menabe. Elsewhere, Senegal’s single cVDPV2 case was registered in Kaolack. The global polio situation to Sept 21: Wild poliovirus cases in 2021 (2020) - 2 (116) and circulating vaccine-derived poliovirus in 2021 (2020) - 305 (381).

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.

Yellow fever activity ongoing

An Oct 1 WHO news release expressed concern over the ‘documented gaps in population immunity against yellow fever’ (YF) after Nigeria reported 1,312 suspected YF cases from 36 States and the Federal Capital Territory (FCT) to the end of August – national YF vaccination coverage estimates in 2020 were 54 percent. Upsurges in YF activity were reported in 2017 but the states with highest infection rates at present are Bauchi, Benue, Delta, Ebonyi and Enugu. The risk of further spread of YF is said to be high and likely to be exacerbated by loosening of pandemic restrictions. Another country to report recent yellow fever cases is Venezuela, where a NGO (Doctors Unidos de Venezuela) announced seven human cases from Carapal del Tigre and El Merey de Amana in the eastern state of Monagas, plus several cases in howler monkeys. YF vaccination coverage for infants of 12 months was estimated to be 35 percent back in 2018.

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.