World travel health alerts 7 October 2020

World travel health alerts for 7th of October 2020.

Sharp rise in wild, cVDPV cases this year

On Sept 30 the GPEI reported Pakistan’s single case of WPV1 (Punjab province) and three cVDPV2 cases in Sindh. While in Africa, two countries reported one cVDPV2 infection each - Cameroon (Est province) and Sudan (Red Sea province); the DRC registered six cases (three each in Equateur and Mai Ndombe provinces) and Guinea, seven from the provinces of Faranah, Kankan and N’zerekore. On a global level, 120 wild poliovirus cases were reported to Sept 22 (82 for the same period last year), however the increase is many times higher for cVDPV which rose to 406 from 90 in 2019.

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.

Rains bring chikungunya, malaria uptick

A spike in chikungunya cases has prompted authorities in the province of West Darfur to declare a health emergency after heavy rains caused an increase in mosquito numbers - malaria infections are also on the rise. West Darfur lies immediately to the east of Chad’s Biltine and Ouaddaï prefectures which are experiencing extensive outbreaks of chikungunya. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by day-time feeding Aedes mosquitoes. 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.

Monkeypox, one of ‘multiple disease outbreaks’

Cases of monkeypox cases are mounting again after the outbreak’s first peak in March and the current status is now the subject of a WHO Disease Outbreak News notice. More than 4,500 suspected cases (and 171 deaths) have been recorded from across 17 provinces – highest counts in Sankuru, Mai-Ndombe, Equateur, Tshuapa and Mongala. But it is the situation in Mai-Ndombe that is causing the most concern: active outbreaks have continued throughout this year and in one affected health zone, a quarter of the territory is involved. The post notes that the outbreak is ‘reported in health zones which are also experiencing multiple disease outbreaks, including measles, polio due to cVDPV, malaria, cholera, and COVID-19, in addition to an ongoing Ebola virus disease outbreak in Equateur Province which continues to experience armed conflict and violence.’ Meanwhile, response measures to Equateur’s Ebola outbreak continue to face obstacles such as confirmed cases lost to follow-up and the inability to manage community deaths. Latest report here (OCHA Oct 5).

Advice for travellers

Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox.

Home-based control to manage malaria upsurge

The 31 districts in Nampula and Zambezia provinces which report more than half of all malaria cases are to be the focus of home-spraying activities to curb infection rates – a further 18 districts in Inhambane, Gaza and Maputo will be included in the program. Authorities report that while fatalities from malaria have declined over the first eight months of the year, infections have actually risen. Read more. In other regional malaria news, almost 18 months after the launch of the malaria vaccination campaign, over one million doses of the RTS,S/AS01 malaria vaccine have been administered to children in Kenya, Ghana and Malawi.  

Advice for travellers

Malaria is endemic to many areas of southern Africa. Travelvax recommends that travellers planning a visit to malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Hep E outbreak shows improvement

The latest WHO African region weekly bulletin provides an update on the protracted hepatitis E outbreak underway since Dec 2017. A relatively steady decline in new cases since April is described by the organisation as ‘welcome’, however challenges remain and ‘until water, sanitation and hygiene issues across all informal settlements in regions are fully addressed, transmission remains a risk’.

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.

Dengue adds to public health burden

A local news source is reporting a near-tripling in dengue fever cases in the northern region of Loreto, which has been particularly hard hit during the pandemic. The rise has been attributed to infections caught during lockdown, with most people at home and untended water containers in the immediate surroundings providing ample numbers of mosquito vectors. With the onset of rains in the Amazon region this month, rates of malaria and leptospirosis infections are also expected to rise. Read more

Advice for travellers

Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

WNV report and risk profile

Health authorities published a risk assessment report following the ‘unprecedented’ rise in West Nile virus-related meningoencephalitis cases this year. The risk of infection is determined to be ‘moderate in areas where WNV infections have been detected in mosquitoes, equids, birds and/or humans during the current or previous seasons, especially in western Andalusia in the surroundings of the Guadalquivir marshes and the Janda region in Cádiz, Extremadura and the wetlands of the Ebro Delta in the province of Tarragona’, particularly from late summer through early autumn, but ‘very low in the rest of Spain and between December and March’.

Advice for travellers

Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuroinvasive disease.  The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions during the peak transmission season should take measures to avoid mosquito bites. Read more on WNV.

Spate of dengue in eastern Caribbean continues

Yet another Caribbean island to report an uptick in dengue reporting with most cases located in the island’s north - northern Castries, Bexon and Central Babonneau. Two serotypes are said to be circulating and highest rates of infection are among males and in the 15-24 years cohort. 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.

COVID-19 cases up 3-fold in 2 weeks

More than 14,500 new positive cases were recorded on Oct 6 with the BBC stating that the ‘daily figure has trebled in a fortnight’; a different indicator of the state of affairs is the hospitalisation rate, which in England on Sunday rose to rates last seen in June. Read more. In global news, the Oct 4 WHO epi update notes that new cases per week have hovered around two million over the past three weeks – the highest since the onset of the pandemic. The agency’s head of emergencies estimated that roughly one in 10 people worldwide may have been infected with SARS-CoV-2 (depending on country, group and urban/rural settings), a number over 20 times the confirmed total. Overall, the African and the Western Pacific regions are said to be in a ‘rather more positive’ situation, SE Asian countries are facing a surge in cases, and deaths are rising in Europe and the eastern Mediterranean regions - a difficult period is ahead for the world. Read more

According to the Johns Hopkins tracking data, Turkey has recorded more than 327,000 COVID-19 cases, however a news source has quoted the health minister admitting ‘all official figures released since 29 July referred only to “patients”— meaning those exhibiting coronavirus symptoms’ and do not include asymptomatic infections. Read more

HFMD rates highest in 4 urban districts

Last week, Ho Chi Minh’s tally of hand, foot and mouth disease infections peaked for the year to date with 640 new cases recorded. Highest rates were in Districts 9, 12, Tan Phu and Binh Chanh; more cases are expected now that the new school term has started. In other news, a senior health official has admitted that challenges persist in attaining adequate vaccination coverage for diseases such as measles and diphtheria in remote, disadvantaged regions. On diphtheria, cases have increased markedly this year - of the 198 cases, there were ‘172 cases in the Central Highland region, 22 cases in central provinces and four cases in southern provinces’. Read more

Advice for travellers

HFMD mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection. Read more about HFMD.