World travel health alerts 8 July 2020

Polio infections detected in Sabah, Labuan

After a 7-month pause polio infections have been detected again, this time in both Sabah and the Federal Territory of Labuan (a group of islands off the NW coast of Sabah). News sources are reporting that only one of the four children found to be infected was ‘local’ - their ages ranged from 4mo to 11 years. Read more. In other polio news, it has been a grim week for both wild poliovirus (WPV1) and circulating vaccine-derived cases (cVDPV) reported to the GPEI:  Afghanistan, seven WPV1 cases and Pakistan, two. For cVDPV2 in Africa: the DRC, 13 cases; Burkina Faso, five and Côte d’Ivoire, eight cVDPV2 cases. And in the Ukraine, only 30 percent of infants aged under 12mo are receiving their primary series of polio vaccines, sparking a health department warning the country is at high risk of an outbreak. Lastly, at the 25^th meeting of the IHR Emergency Committee on June 23, it was noted that ‘the global situation remains of great concern’ and so the Temporary Recommendations under the PHEIC will be extended for a further three months. Mixed news with regards to WPV1 as the YTD case numbers in Afghanistan and Pakistan rose to 83 compared with 60 for the same period in 2019, but Nigeria has been declared WPV-free. Of the States no longer infected by cVDPV, but which remain vulnerable to re-infection (Mozambique, Papua New Guinea, Indonesia and China), there are no specific vaccination requirements for residents, long-term visitors and travellers but these countries must enhance surveillance activities and intensify vaccination efforts before reporting back to the committee after 12 months.

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.

Cholera in 4 regions puts pressure on response measures

Cholera outbreaks are compounding the strain on health services during the pandemic, particularly in hard-hit Littoral Region, but also South West, South and Central. The WHO warns of ‘a risk of spread to other areas of the country and escalation within already-affected regions’. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travellers, the risk of infection is low. Australians travelling to regions where a cholera outbreak is occurring should adhere to strict personal hygiene guidelines and choose food and beverages with care. Read more about cholera.

Equateur Ebola outbreak evolving; Ituri’s plague cases mount

The WHO’s weekly bulletin reports that Equateur’s Ebola virus disease (EVD) outbreak is continuing to evolve and spread into new health zones – there are now 41 confirmed and probable cases, which includes 17 deaths – of the most recent, two were high-risk community deaths. The plan has been for ‘community engagement and education [to] cover both EVD and COVID-19, with the risk communication strategy for both outbreaks working in tandem’. Bikoro and Mbandaka have been the sites of 27 of the EVD cases and 14 deaths, according to the latest CMRE newsletter.

AN UPDATE on the bubonic plague outbreak in Ituri province now reveals a rise in Rethy health area’s cases to 34 including seven deaths in the three weeks since the first reports emerged; and this week ProMED has posted reports of clusters from a second health area, Odranyi, and Djugu region. Read more. While in northern China’s Inner Mongolia Autonomous Region, a herdsman who had been active in the plague epidemic zone is under isolation in hospital after being diagnosed with the bubonic form of the infection. The WHO is monitoring the situation as authorities stress local measures needed to prevent and control plague, including taking personal protection if going to the epidemic areas, no camping in grasslands and don’t eat wild animals.

Advice for travellers

Plague poses a low risk to most travellers. The majority of plague cases are due to bubonic plague following the bite of an infected flea carried by rats. If left untreated, infection of the lungs causes the pneumonic form of plague, a severe respiratory illness, which can progress rapidly to death. Read more on the plague.

COVID-19 update

India’s COVID-19 cases now exceed Russia’s, taking third place in global rankings (#8 for deaths however), and the reporting of new infections and deaths have hit a 3-month high – according to data from the Ministry of Health and Family Welfare, there have been almost 720,000 cases and 20,160 deaths; the worst-hit areas are Maharashtra, Tamil Nadu and Delhi. The lockdown is being relaxed in some areas which haven’t shown high case numbers and domestic travel has re-started (no international flights however). Read more. More on the global situation from the WHO July 7 sitrep, Johns Hopkins dashboard and Al Jazeera live updates.

In other related news, the two authors of a research letter published in The Lancet, and co-signed by more than 230 scientists from 32 countries, have appealed to the medical community and health agencies to acknowledge the potential for airborne spread of COVID-19 as ‘Studies by the signatories and other scientists have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air and pose a risk of exposure at distances beyond 1 to 2 m from an infected individual ‘. The WHO has replied that it recognised the emerging evidence and is working on a scientific brief which ‘consolidates growing knowledge about respiratory pathways, including the possible role of airborne spread in settings such as poorly ventilated indoor areas’.  

Rare lyssavirus confirmed in Tuscan cat

In an isolated event, a bat-related Lyssavirus, detected only once before in the Caucasus Mountains of southern Russia in 2002, was confirmed from tests taken on a cat in Arezzo, eastern Tuscany. The cat had died after exhibiting neurological symptoms. The ECDC notes that the ‘transmissibility and pathogenicity of the virus to humans are unknown’ as is the effectiveness of the rabies vaccine against this virus; ‘the public health risk for Europe is considered to be low’. 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. Read more on rabies.

Dengue upsurge in Pacific coastal state

Dengue fever cases are surging in the Pacific coast state of Jalisco, even after extra funds were provided for control measures. In the last week of June, 875 new infections were recorded. The state had ranked highest in dengue cases last year with nearly 12,000 cases reported. 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.

Most recent MERS cases in Riyadh

Riyadh reported seven of the country’s nine MERS-CoV cases confirmed over April and May – five were fatal – with most of the cases linked to an outbreak at one of the city’s hospitals. This year, there have been 61 cases in total – all from the Arabian Peninsula: 57 from Saudi Arabia (10 regions), plus two in the UAE and one in Qatar. The WHO advises people with high-risk medical conditions (diabetes, renal failure, chronic lung disease, immunocompromised state) to ‘avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating’ and adhere to general hygiene measures. Read more

Dengue record in the making

While Cambodia, Laos, Malaysia, the Philippines and Vietnam have all experienced substantial year-on-year falls in dengue reporting, Singapore has moved in the opposite direction and now looks like it’s headed for the worst year for dengue fever on record. Intensive dengue transmission is underway in the 369 clusters currently identified – 118 are high-risk red zones with 10 or more cases. The dengue season generally runs until October. 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.

JE total jumps to 9

A further five Japanese encephalitis (JE) infections have been confirmed since mid-June, taking the total to nine this year from Taoyuan, Kaohsiung, Pingtung, Changhua, Chiayi and Tainan. The JE season lasts until October, but June and July are the peak transmission months. Read more

Advice for travellers

A mosquito-borne virus, JE is usually found in many part of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to large urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

Diphtheria hits Central Highlands

Local media have reported 65 confirmed diphtheria cases over the past month from four provinces of the Central Highlands - Dak Nong (25 cases), Kon Tum (23), Gia Lai (16) and Dak Lak (1); three deaths have been recorded to date. Government health sources say the Central Highlands are vulnerable to outbreaks due to its low vaccination rates of 48-50 percent for diphtheria. Read more

Advice for travellers

Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.