World travel health alerts 8 May 2019

World travel health alerts for 8th of May 2019.

Late season dengue update

On a national level, the number of probable dengue infections this year has risen by more than 300 percent compared with the same 3-month period in 2018, with over 450,000 cases recorded. Alerts have been posted in several states, including São Paulo, Minas Gerais (Centre, Northwest, North, West and Triângulo Mineiro), Pernambuco (a near 4,000 percent increase year-on-year in Belém do São Francisco, Cedro, Mirandiba, Salgueiro, Serrita, Terra Nova and Verdejante with smaller increases seen in Zika virus and chikungunya infections), Paranà and Piauí. Read more

Advice for travellers

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. 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 PMD when outdoors to all exposed skin. Read more about dengue fever.

Measles updates for 4 regions

A WHO Disease Outbreak News post on the situation in Europe cautions that 10 countries remain measles-endemic: Belgium, Bosnia and Herzegovina, France, Georgia, Germany, Italy, Romania, Russian Federation, Serbia and Ukraine. In Jan/Feb this year 34,300 measles cases were reported from 42 European countries (more than 70 percent in the Ukraine) and, as noted in the post, ‘Even with implementation of outbreak response measures, measles continues to circulate in the European Region as a result of suboptimal vaccination coverage and population immunity gaps.’ Switzerland has experienced over seven times the number of measles cases this year (compared to 2018) and last week announced the deaths of two men from measles-related complications (one 30yo, the other 70 years of age). In other measles reports from around the globe, the Philippines recorded 31,056 measles cases including 415 deaths between Jan 1 and Apr 13 - over half of all cases were in the National Capital Region, Calabarzon and Central Luzon. Health authorities in New Zealand say there have now been 42 measles cases in Auckland and one in a visitor to Wellington. Additional reports from the Western Pacific region are summarised in a WHO update issued on May 7. Three districts in Nepal have outbreaks of measles (Morang, Dang and Kapilvastu) while epidemics have been declared in numerous districts of Chad and Guinea.

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.

Dengue count rises to 40

A comprehensive campaign has been put in place to limit the spread of dengue fever with the current total sitting at 40 (37 from Rarotonga, 3 from Aitutaki). A Ministry of Health report dated Apr 30 states that 18 cases have been confirmed as DENV-1 and ‘ the first confirmed DENV-1 case was a German visitor who arrived from French Polynesia’. Read more Last week NZ health authorities confirmed a dengue fever infection in a recent arrival from the Cook Islands (also 10 imported cases with travel history to Fiji).

Advice for travellers

Avoid mosquito bites and you won’t get 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.

Ebola, one of many ongoing outbreaks

According to the latest WHO weekly bulletin, ‘multiple outbreaks of epidemic-prone diseases continue, mainly measles, cholera, EVD, poliomyelitis, yellow fever, monkey pox and bubonic plague’ are occurring in the DRC. Besides EVD, other outbreaks of concern relate to those due to cholera (in the provinces of North Kivu, Tanganyika, Upper Katanga and South Kivu) and measles (Tshopo, Lualaba and Upper Lomami).

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.

Link with rare infections

A rare food-borne infection reported in a post on Sweden last week has also been responsible for 18 cases ‘from all over Denmark’ since March. A co-operative effort is underway between health agencies in both countries to trace the source of the Yersinia enterocolitica infections. Read more

July start for Klang Valley’s dengue campaign

A local news source reports dengue fever cases in the first four months of the year almost doubled those of the same period in 2018 with Selangor topping the list. The current case count (as at May 7) shows Selangor’s total at 26,485 while Kuala Lumpur has reported almost 4,000 cases. The release of Wolbachia-infected mosquitoes is to get underway in Selangor’s Klang Valley in July. 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.

Plague deaths in western district

Passengers arriving in Ulaanbaatar on a flight from the western province of Bayan-Ölgii were quarantined due to fears they may have had contact with two people who had succumbed to bubonic plague; it is believed the couple contracted the infection from eating raw meat from a type of squirrel (marmot) – ‘thought to be a folk remedy for good health’. A period of quarantine (since lifted) was also instituted in the provincial capital, Ölgii, stranding a number of foreign tourists. Read more.  More on plague infections (WHO).

Second cyclone exacerbates existing cholera, malaria

A second cyclone hit Mozambique (and the Comoros Islands) at the end of April, this time to the north of the country, with the WHO African regional office advising that a ‘cholera outbreak has been reported in the town of Pemba and Mecufi district, northern Mozambique, with 14 cases confirmed. Pemba is particularly affected by endemic cholera and malaria is also prevalent.’ 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.

Filariasis in peninsula district

ProMED reports on an undisclosed number of filariasis infections among people of Yebyu township and onward spread to the regional capital of Tanintharyi, Dawei, and other nearby municipalities. Tanintharyi region lies on the Malay Peninsula (adjacent to the Thai province of Kanchanaburi). More on lymphatic filariasis (WHO).

Advice for travellers

Travellers are at low risk of lymphatic filariasis, a parasitic disease caused by thread-like roundworms spread by the bite of an infected mosquito. It is found in sub-Saharan Africa, Egypt, southern Asia, the western Pacific Islands, the north-eastern coast of Brazil, Guyana, Haiti, and the Dominican Republic. While most infections have no symptoms, acute infection can lead to painful swelling of an affected limb, fever, or chills due to bacterial superinfection. Avoiding mosquito bites is the best form of prevention. Read more.

Khumbu flu; Human avian influenza death in Bhaktapur District

A National Geographic article published on Apr 30 documents a six month rise in influenza cases that is impacting climbers in the Everest region, ‘originating from the high-altitude trekking lodges’. The medical director of the CIWEC Clinic, Dr Prativa Pandey, is quoted as saying that she hadn’t seen ‘flu outbreaks like this’ in her time at the clinic.    

THE WHO has confirmed that the death of a 21yo man in late March was due to complications of H5N1 avian influenza infection. The agency advised that ‘This is the first reported human case of Influenza A (H5N1) in Nepal. No additional case of infection with this virus has been reported by NPHL since then.’ The man lived in Bhaktapur District (~20kms SE of Kathmandu), the site of an outbreak of H5N1 bird flu in poultry announced early last month.

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 wipes are a convenient alternative if soap and water is not available.

Rare rabies death

A Norwegian woman, who had been travelling in SE Asia (Philippines) two months ago, has died of rabies in a hospital in her home county of Sogn og Fjordane. According to a news article, this was the first such death on the Norwegian mainland in more than 200 years. The young woman was bitten by a puppy she rescued and was caring for during her travels. Fellow travellers have been advised and are under medical care. 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. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is normally recommended for longer stays, especially travellers planning to live in, or travel extensively through, rural areas and also for children; however the final recommendation is itinerary-specific. Read more on rabies.

Chikungunya now in 8 of 12 departments

Almost half of all suspected chikungunya cases reported since early January have been from the coastal health department of Kouilou (others are Bouenza, Pointe Noire, Plateaux, Pool, Niari, Lékoumou and Brazzaville). The WHO now considers the risk of further spread to be ‘moderate at both the national and regional levels.’ Read more

Advice for travellers

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

Dengue in largest city, northern region

There has been no let-up in new dengue fever cases with many of the now 1,122 infections reported in Dar es Salaam (Ilala, Temeke, Kinondoni and Ubungo) and the northern region of Tanga. Read more

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.

Warning over fake meds

Counterfeit medications, believed to be sold as ‘corticosteroids, erectile dysfunction-treating medicine and sleeping pills’ were discovered during a raid on one Bangkok premise after investigations uncovered the use of fake or mislabelled medications at a number of ‘illegal clinics’. Read more

Hep A news from 4 states; World Jamboree advice

Four updates this week in the multi-state hepatitis A outbreak first identified in 2016 among the homeless and illicit drug users and now totaling 15,000 cases and 140 deaths: Florida (1,585 cases for the year to May 4), Arizona (10-year high), Virginia and Louisiana.  

RECOMMENDED vaccinations for travellers to the World Scouting Jamboree being held in West Virginia from 22 July 22 to Aug 2 this year include most of the Australian Immunisation Program routine immunisations, with the exception of the hepatitis A vaccine. The UK’s fitfortravel website provides some relevant history of the event: ‘Following the 2015 jamboree in Japan, five scouts and one parent developed meningococcal infection’. Further, ‘USA is considered to be low risk for rabies, however wild animals such as foxes, skunks and racoons are high risk. You should avoid contact with wild animals including bats. A bite, lick or scratch from an animal whilst in the US should be reported and medical assessment sought immediately.’

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.