World travel health alerts 8 January 2020

Measles digest – local, regional, global

Following the measles vaccination campaign there has been marked improvement in the outbreak with 30 new cases reported in the week to Jan 5 – they take the total to 5,697 and 83 deaths. A Jan 6 govt. update notes that ‘There are currently no travel restrictions or vaccination requirement for those travelling to Samoa. Additionally, proof of MMR vaccination is not currently required for Samoans travelling to Australia, New Zealand, or the United States. Only travelers to American Samoa are required to provide proof of vaccination for MMR.’ Elsewhere in the South Pacific, to Jan 3 Fiji had reported 27 measles cases in Central Division with the govt. advising ‘non-essential travel to Sakoca in Tacirua, Naikorokoro Village in Lami, Saumakia Village in Naitasiri, Nasilai Village in Nakelo Rewa, and Serua/Namosi … is strongly discouraged’, while Tonga registered 612 confirmed or suspected cases to Dec 31 – Tongatapu and Vava’u Island have been most affected. In a Dec 27 report, authorities in Kiribati advised there had been two confirmed measles cases and 18 more were suspected. American Samoa had recorded 10 confirmed and four suspected measles infections to Dec 30 – all from the island of Tutuila. On Dec 23, the WHO International Travel and Health site published ‘Additional health measures in relation with measles outbreaks in the Pacific Island Countries’, comprising travel advisories under Article 43 of the IHR (2005) for American Samoa, Solomon Island, Marshall Island, and Tokelau. Read the NaTHNaC post on the requirements. In other regions, measles cases in Turkey this year have hit a 10-year high with more than 2,700 cases to the end of October, many of those infected were unvaccinated. A WHO summary of measles in the European region from Jan-Oct 2019 attributes the more than 100,000 cases in 49 of 53 countries to ‘immunization gaps’. Since late August, Argentina’s capital, Buenos Aires and four regions of the province have recorded 88 measles cases – the highest count since 2000. More on measles reports from the African region – Cameroon, CAR, Chad, Comoros, Ethiopia, Kenya, Liberia, Niger and South Sudan.

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.

Local measles transmission in Sydney

A Jan 4 press release from NSW Health advised that five people had recently been infected with measles in Sydney, becoming symptomatic in the last week of December – none had travelled outside the city. A number of locations are listed in the release where people who are not immune to measles may have had exposure to the virus with advice to monitor their health.

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.

Malaria count now exceeds 8.7 million

Malaria cases recorded in 2019 (to Dec 22) almost doubled over those for the previous year, soaring to more than 8.7 million with 3,233 deaths from 46 districts (eastern regions most affected). Burundi’s population is approximately 11.5 million. 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.

Hep E in KP; Polio & PHEIC updates across the globe

Hepatitis E infections have sickened more than 60 people, mainly women, in the last month in Almas, Upper Dir district of the northern province of Khyber Pakhtunkhwa and the outbreak is still uncontained – most families in the area have been affected. Read more

FIVE more wild poliovirus cases have taken the 2019 total to 128, however that figure is expected to rise with multiple tests still to be completed. The recent cases were from the provinces of Sindh, Balochistan and Khyber Pakhtunkhwa. In other polio news, no further updates since Dec 27 on the 3mo baby found to be infected with cVDPV2 in early December in the Malaysian state of Sabah or on results of tests that were pending on 20 people who had contact with the child, however it was revealed that more than 2,200 children had been checked at that time and none had signs of acute flaccid paralysis. An extensive immunisation campaign has commenced in the state and in mid-December some news sources claimed that overseas visitors would also be vaccinated. From Africa: Angola’s most recent cVDPV2 cases were in the provinces of Benguela, Moxico, Cuanza Sul, Bie, Luanda, Bengo, Uige and Huambo - they take the 2019 total to 71 cases; cVDPV2 cases were also recorded in Chad. Ghana, Togo (Plateaux province) and Zambia (Kalabo District, Western Province). Lastly, the report from the 23^rd meeting of the IHR Emergency Committee Regarding the International Spread of Poliovirus held last month cited multiple factors in the decision to continue the temporary recommendations for a further three months. From the NaTHNaC summary of the meeting: Malaysia and the Philippines have been added to the list of countries infected with WPV1, cVDPV1 or cVDPV3 with the potential risk of international spread - these countries have a certificate requirement for polio vaccination under IHR (2005); Chad, Côte d’Ivoire, Nigeria, Somalia, Togo and Zambia are now also categorised as states infected with cVDPV2, with potential or demonstrated risk of international spread and, while there is no certificate requirement under IHR (2005) for these countries, travellers are encouraged to carry proof of polio vaccination; Papua New Guinea is no longer infected by WPV1 or cVDPV, but remains vulnerable to re-infection by WPV or cVDPV; and Iran and Syria are no longer polio-virus infected, but at high risk of outbreaks.

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.

? Novel viral infection in central province

In the city of Wuhan (Hubei province), 59 people are ill, seven of them critically, suffering from what is suspected to be an infection of animal origin – SARS, MERS and avian influenza have been ruled out. Chinese authorities notified the WHO on Dec 31 and the agency stated that invasive lesions in both lungs are evident in those infected (some of whom worked at a seafood/wild animal meat market – now closed for disinfection). Read the WHO Jan 5 Disease Outbreak News post. Up to 30 people with respiratory symptoms following travel to Wuhan have been under surveillance in Hong Kong since Dec 31, however test results released by the Centre for Health Protection (CHP) to date do not show a ‘novel infectious agent’ as the cause. The CHP has issued travel advice. In view of the cluster of cases in China, the US CDC has issued a level 1 Travel Notice for travellers to the country. Lunar New Year in 2020 takes place over 16 days from Jan 25. Some countries in the region are performing thermal screening on people arriving from China. Read more

Ebola, measles outbreaks update

The Ebola virus disease situation in the NE has deteriorated again amid conflict and resistance to response measures. The Jan 7 WHO Situation Report noted a further 28 cases from five health zones since Dec 24 and the latest CMRE post added more cases from Mambasa health zone (Ituri) which had until this week gone 66 days without a case. Read more from CIDRAP. The Jan 5 WHO African region report provides updates on the Ebola virus disease, measles, cholera, monkeypox, bubonic plague and cholera outbreaks that have impacted the country throughout 2019. Yesterday the WHO called for more funding to tackle the measles outbreak that has now killed more than 6,000 of the more than 310,000 people with suspected infections since January last year.

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.

Dengue outbreak steadies at onset of rains

The dengue epidemic that began in Tahiti in April has finally stabilised, however the arrival of the rainy season in the collectivity has sparked concerns of a resurgence as weather conditions will favour mosquito breeding. Thirteen islands remain in epidemic phase (including Tahiti, Bora Bora and Moorea), while a further six are ‘on alert’. DENV2 has predominated, causing more than 2,400 infections since April. 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.

Mumbai’s uptick in Hep A/E; Rabies risk rises in UP city

Authorities in Mumbai reported a spike in both hepatitis A and E infections during 2019, blamed by doctors on ‘roadside stalls, which use unhygienic water to cook food. They wash dishes and cups in the same contaminated water’. Read more

IN THE NORTHERN state of Uttar Pradesh, residents of the city of Lalitpur are up in arms over the large population of stray dogs and the resulting increase in dog bites - more than 500 people required rabies exposure treatment in a 1-month period recently. 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 consuming contaminated food and water, by handling everyday items and through some types of 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.

Legionella advice for Bali

A WA health dept. media release on Dec 23 reported confirmed legionella infections in four Western Australians (plus two more from other states), all of whom had stayed at or near a hotel in Central Kuta, Bali between February and November 2019 – ‘the exact source of the disease remained unknown’. As a result, the dept. issued advice for travellers planning on staying or spending time in the vicinity of the hotel, as well as advice for recent visitors to that area of Bali, to monitor their health. Read more

Advice for travellers

Legionnaire’s disease occurs worldwide and many of the increasing number of cases reported in Australia in recent years have been linked to overseas travel. Outbreaks have been associated with hotels, resorts and cruise ships. The bacteria that cause Legionnaires’ disease are found in airborne droplets of warm, fresh water, such as from fountains, spas, showers and the cooling towers of buildings. Over 50s, current or former smokers, those with a chronic lung condition, and the immunocompromised are at higher risk of developing illness after exposure. Read more

YF transmission intensifies

Further to a Dec 17 WHO Disease Outbreak News update on the intensification of yellow fever (YF) transmission affecting all states, there are reports of 13 confirmed YF cases (and three deaths) from Jos North, Bassa, Riyom and Wase in Plateau state. In the update, the WHO notes the elevated risk for spread of the YF virus ‘into densely populated urban areas where preventive mass vaccination campaigns have not been conducted so far’, such as Kano and Lagos. In other YF news, suspected yellow fever cases continue to be reported from Sikasso and Koulikoro regions in Mali, now numbering 41 with five deaths. The WHO assessment places the proximity of the affected regions to the capital Bamako and the Côte d’Ivoire border, plus low immunity and high population movements as presenting ‘a risk of amplification’ which is high on a national level and moderate for the region. Read more. Level one travel notices have been issued by the US CDC regarding Nigeria’s ongoing outbreaks of monkeypox and Lassa fever.

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.

3 MERS cases reported

A single fatal MERS infection was announced in a resident of Doha last month – there was no history of travel or contact with dromedary camels – and a further two asymptomatic cases were found through contact-tracing. The WHO continues to recommend extra measures for travellers to regions reporting MERS: ‘people with … underlying medical conditions should avoid close unprotected contact with animals, particularly dromedary camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.’ In related news: already this month MERS cases have been reported from Medina and Riyadh in Saudi Arabia and a vaccine trial is currently underway in the kingdom. Read more

Efforts to curb dengue

Dengue prevention campaigns will get underway this week after the country recorded more than 102,000 cases last year – many of those in the Western Division. Read more

Advice for travellers

Avoid mosquito bites to protect against 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.

Flu season underway

The CDC’s FluView site, reporting data for the week to Dec 28, notes rising influenza activity with, unusually for this time of year, Influenza B/Victoria viruses predominating, followed by A(H1N1)pdm09 viruses. Low or minimal flu activity was reported in only seven states (Hawaii, Michigan, Missouri, Montana, Nevada, Delaware and Idaho). While information from Flu News Europe outlines rising activity across the region during the last week of 2019 with type A viruses detected most often. More in the WHO global influenza update (with info to Dec 8, 2019).

Advice for travellers

Seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol-based hand sanitiser is a convenient alternative if soap and water is not available.