World travel health alerts 7 August 2019

World travel health alerts for 7th of August 2019.

Mixed flu reporting

The WHO global flu update of Aug 5 indicated that for Australia there were ‘increases reported in some states and decreases reported in others. Influenza A(H3N2) viruses were most frequently detected, followed by influenza B viruses. The national case count is nearing 200,000 – over half of those were in NSW (69,225) and VIC (40,406) – see annual statistics since 2014 here. Elsewhere, high or increasing flu activity was recorded in Thailand, Myanmar, French Polynesia, Cuba, Côte d'Ivoire, Guinea, Nigeria and Mauritius.

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

Dengue in NE, regional updates

Nearly 140 suspected cases of dengue fever are being investigated in the town of Doksum in the NE district of Trashiyangtse; one death has been registered to date. The town lies close to the sacred Buddhist site of Gomphu Kora. Read more. There are separate reports for smaller outbreaks in Hetauda in south, central Nepal and Taiwan (first autochthonous case this year in Taoyuan City), as well as the large outbreaks underway in the Philippines (July’s dengue alert now upgraded to national epidemic after more than 660 deaths this year), Sri Lanka (more than 35,000 cases, 47 deaths; high risk districts - Colombo, Gampaha, Kalutara, Ratnapura, Galle), Bangladesh (2,000 new cases in one 24-hour period this week taking total of dengue hospitalisations to more than 27,000), Laos (early start to the season this year – now more than 20,000 cases and 48 related deaths) and Malaysia (more than 500 cases daily country-wide; 80,000+ cases, 113 deaths).

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 dengue spike

Central American countries have reported a relative increase in dengue fever infections this year – see PAHO data. While dengue has had the greatest impact in Honduras based on case numbers and related deaths, updates for Belize, Nicaragua, Guatemala and Costa Rica demonstrate the general rise in notifications for the region. Read more

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.

Malaria count exceeds 5 million

From a WHO African region report quoting malaria data for the year to Aug 4: ‘week 1 (week ending 5 January 2019) to week 29 of 2019, a cumulative total of 5,738,661 cases and 1,801 deaths (CFR 0.03%) have been reported’. Starting in early December last year, the epidemic’s peak was reached in the first week of May across 46 districts. Cholera outbreaks have more recently been reported in the provinces of Bujumbura Mairie (Bujumbura-South health district) and Cibitoke (Cibitoke health district).  

Advice for travellers

Central Africa presents a significant malaria risk. Travellers can discuss their itinerary and the need for anti-malaria medication with a trained travel health professional at their nearest Travelvax clinic. For details call 1300 360 164. Read more about malaria.

US CDC travel notice update, second Ebola vaccine trial

At the end of last month the US CDC updated its advice for travellers to the DRC, issuing a level 2 alert - Practice Enhanced Precautions. (See Smartraveller advice here.) This week, two relatives of the most recent Ebola virus disease (EVD) case detected in Goma are receiving treatment in hospital – no link has been found between the initial two cases in the city. For more on the current situation, see the latest WHO External Situation Report. In other news, a second experimental Ebola vaccine is set to be trialled in a western district of Uganda over the next two years.

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.

VDPV in eastern zone, regional update

The first case of circulating vaccine-derived poliovirus type 2 (cVDPV2) for 2019 was announced this week – from the extreme eastern zone of Dollo in Somali State. Read more. More cVDPV2 reports from across the African region were compiled by the WHO in a July 31 Disease Outbreak News post: Nigeria - 17 states affected; Niger’s 22 cVDPV2 cases in Magaria, Tanout, Dungass, and Bosso since July 2018, linked to the outbreak in Borno state, Nigeria; an environmental sample detected in last month in Ghana was linked to the outbreaks in Kwara state of Nigeria; a total of 31 cases of cVDPV2 have been reported from seven provinces across the Democratic Republic of the Congo. Elsewhere, Pakistan’s wild poliovirus (WPV1) count for the year has risen to 48 after a five month old baby in Balochistan province was diagnosed with the infection - he had not been vaccinated.

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.

Dengue surge for five states; JE update for Assam; Scrub typhus warnings for Himalayan state

As the monsoon season progresses, dengue fever has hit hard in the states Karnataka, Tamil Nadu, Telangana and Kerala, while  Gujarat and Rajasthan are also registering a rise in reports. In Karnataka’s capital, Bengaluru, nearly 3,400 cases were recorded in the last week alone. Read more.

AN UPDATE of Assam’s Japanese encephalitis cases with nearly 600 cases now reported and 139 deaths – casualty rates have been high in the western districts of Goalpara, Kamrup and Manipur.

THE DISTRICTS of Bilaspur, Hamirpur and Kangra have borne the brunt of scrub typhus infections recorded this year in Himachal Pradesh; the bacterial infection spread by larval mites is endemic in the north-central state.

Advice for travellers

Scrub typhus is a bacterial disease passed on to humans by mites that normally live on rodents infected with the disease. Most travel-acquired cases occur when travellers camp, hike, or go river rafting in rural areas in endemic countries. Scrub typhus occurs throughout the Asia-Pacific region, where more than a million cases occur annually. There is no vaccine or prevention medication: avoidance hinges on minimising insect bites. Due to the disease’s 5- to 14-day incubation period, travellers often experience symptoms (fever, headache, malaise, and sometimes nausea, vomiting and a rash) after their trip. Read more about rickettsial diseases.

Gastro illness warning for tourists; TB on the rise

Against the background of almost 600 Cyclospora infections reported in British travellers to the Riviera Maya over the past five years – 14 of those already this year – UK health authorities have issued advice to ‘maintain a high standard of food, water and personal hygiene even if staying in luxury resorts’. The popular tourist destination, which is located on the Yucatán Peninsula and includes the resort towns of Cancun and Playa de Carmen, offers many all-inclusive hotels. Read more

A LOCAL news source reported that the Ministry of Health advised a year-on-year doubling of tuberculosis cases with this year’s total nearing near 19,000 TB infections (Veracruz, Baja California and Guerrero states most affected). 

Advice for travellers

A single-celled coccidian parasite, Cyclospora cayetanensis may be a risk for travellers to tropical or subtropical regions where it is found.  The microscopic parasite causes watery diarrhoea, nausea, anorexia, abdominal cramps, weight loss and, occasionally, fever that can last for several days – and reoccur - if not treated effectively. Most cases result from consuming food or water containing the parasite, or swallowing contaminated water while swimming. Fruits and vegetables such as raspberries, basil and lettuce washed with contaminated water are common culprits, especially those imported from developing nations. Read more about Cyclospora.

Hep A prevention for Pride attendees

Amsterdam’s Public Health Agency organised a series of hepatitis A vaccination clinics during Gay Pride celebrations last week in response to an increase in cases registered both locally and nationally this year. The ECDC is also promoting health measures for Pride events which are taking place from ‘May to November in various cities across Europe, involving millions of participants’. Advice includes ensuring routine and recommended vaccinations are current, pre-travel education on preventing STIs & HIV pre-exposure prophylaxis, post-travel testing for STIs, ‘and healthcare provider evaluation among those experiencing symptoms or those who engaged in unprotected sexual activity with casual partners is advised’. Read more

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 contaminated food and water, by handling everyday items and 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.

No let-up in Lassa

According to the latest NCDC Sitrep (July 14), new Lassa fever cases continue to be reported even after the annual peak season ended. The states of Edo, Ondo and Bauchi registered seven more cases, taking the country’s YTD total to almost 640 with 140 deaths. 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.

Northern districts’ dengue, Zika alerts

Dual outbreaks of dengue fever and Zika virus have hit the northern region of Cajamarca, with the districts of Jaen and Bellavista most affected. This year the districts have recorded almost 900 Zika infections, a substantial increase on the 65 registered last year, as well as over 1,500 dengue cases. A 90-day health emergency has been declared in response. Read more. Last month the WHO updated its ‘Information for travellers visiting countries with Zika virus transmission.

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).  

European agency’s advice to returning travellers

In the wake of the alert last month relating to falsified rabies vaccines and immunoglobulin found ’at patient level’, the ECDC is recommending that its ‘Travellers and tourists returning from the Philippines, and who have recently received rabies post-exposure prophylaxis, should seek advice from a health care professional. Any possible adverse event should be reported to the national medicines regulatory authorities’. To date there have been no reported adverse events regarding these counterfeit products. Read more

Advice for travellers

Despite efforts to control rabies through canine immunisation in several provinces of the Philippines, rabies remains a major problem in many regions. However, 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. If bitten, urgent post-exposure treatment is required. Read more on rabies.

Circumstances indicate more rabies possible

A local news source identified four areas in KwaZulu-Natal province (Ugu District, eThekwini, iLembe, and Zululand) which officials from the Dept. of Agriculture consider to present a higher risk for rabies virus exposure in the human population; four deaths have already been reported in a recent 2-month period. The belief is that not enough domestic animals are being vaccinated against rabies and the need for people who are exposed to the virus to seek treatment is not widely known. Public awareness campaigns on rabies prevention are ongoing. 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. If bitten, urgent 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.

Tick bite prevention advisable for hikers

A new study on the prevalence of Lyme disease in the UK suggests the actual number of infections is in excess of 7,000 per year, as opposed to the current estimate of 2,000 to 3,000 cases. The incidence of Lyme disease has been rising since 2001 and is now reported in all regions ‘with Scotland reporting the highest incidence rates and most cases, followed by South West and South England’. Read more

Advice for travellers

Ticks can attach to any part of your body but are often found in hard-to-see areas such as the groin, armpits, and scalp. Infected ticks must be attached for 36-48 hours or more before Lyme transmission can occur, so it is important to check yourself each day after outdoor activities. The CDC’s Lyme disease fact sheet offers plenty of other good advice.

Update to Florida’s Hep A outbreak

With more than 2,100 new hepatitis A infections reported just this year in Florida, state health officials have declared a Public Health Emergency to raise the profile of the outbreak among the local population and promote vaccination as the best way of preventing infection. Currently, 17 counties are considered ‘critically impacted’ by the outbreak. On a national level, 27 states are reporting Hep A infections as reported by the CDC; the greatest toll has been on homeless people and illegal drug users. The outbreak is now into its third year.

Advice for travellers

Vaccine-preventable Hepatitis A (HAV) is one of the most common infections affecting travellers. The virus is transmitted by the oral-faecal route, such as through contaminated food and water, and sexual contact. A course of hepatitis A vaccine offers immunity that’s 99%-plus effective and long lasting (20-30 years). It is also important to follow safe food and water guidelines.

Lingering impact of cyclone

Flooding following Cyclone Idai has added to the malaria burden in one province, with authorities announcing Manicaland has recorded more than 77,000 cases this year and 66 deaths. Read more

Advice for travellers

Malaria is endemic in many areas of southern Africa. Travelvax recommends that travellers visiting this region discuss their itinerary and preventative medication at their nearest Travelvax clinic, or with their healthcare provider. For advice, call Travelvax on 1300 360 164. More on malaria.