World travel health alerts 8 September 2021

World travel health alerts for 8th of September 2021.

Rabies exposures up in Cochabamba

From a ProMED summary on rabies reports around the globe: Bolivia’s central department of Cochabamba has been the site of 45 human exposures to rabid animals this year, resulting in four deaths. The 2-fold increase in rabies infections in dogs and cats has caused particular alarm in the municipalities of Tarata, Arbieto, Cliza and Sipe Sipe, leading to a state of emergency being declared in those areas. The same summary covers rabies reports from the USA (North & South Carolina and Illinois), while a separate entry expands on cases recorded in South Africa, Zimbabwe, Ghana and Morocco. 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, including bats. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is generally 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.

Elevated YF risk

A report compiled by the WHO has highlighted the rising number of confirmed and suspected yellow fever (YF) cases this year, exacerbated by high densities of Aedes aegypti mosquitoes in northern regions as well as the large cities of Douala and Yaoundé. Another consideration is the country’s sub-optimal YF immunisation coverage - only 57 percent. The WHO advised that local and regional violence, ‘the low vaccination coverage, a favourable environment for vector breeding, logging and mining activities, and uncontrolled urbanization also poses a risk of rapid spread of YF in Cameroon’.

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.

WHO discards Ebola diagnosis

Further analysis of tests on a Guinean woman traveller believed to have contracted Ebola last month have now confirmed that she was not in fact infected with the Ebola virus. No further infections have been detected among her contacts and the woman herself has now recovered. Read more

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.

23 VD polio cases reported

The GPEI published its latest weekly news on new polio cases on Sept 2, all of which involved cVDPV2 infections. Nigeria’s case count was the largest – 23 from the states of Borno, Jigawa, Kaduna, Kebbi and Kano, while the two cases recorded in Ethiopia were both in Oromiya, and a single case each came from Mali (Koulikoro) and Sierra Leone (Northern Province). Outside Africa, there was one case from Khatlon in Tajikistan. In other news, on Aug 27 MMWR published ‘Progress Toward Polio Eradication — Worldwide, January 2019–June 2021’.

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.

Tiger mozzies detected in Brittany

Health authorities in the NW region of Brittany have confirmed the first detection of Aedes albopictus mosquitoes in Domagné, situated approx. 20kms east of the capital Rennes (Ille-et-Vilaine). Insecticide fumigation was planned for last week and advice offered to residents on avoiding mosquito bites. The range of the ‘tiger’ mosquito has been extending northwards since it first arrived in France in 2004; the species is now established in at least 64 departments of Metropolitan France. Read more

COVID-19 update, related news

According to the Sept 7 WHO weekly epi update, global COVID-19 case incidence has been relatively stable for the past month, with the exception of the Americas which did see a 19 percent increase over the last week. The region was also one of two to report a rise in deaths, together with Europe (17 and 20 percent increases respectively). The agency’s Aug 31 update made mention of ‘substantial increases in case incidence’ in French Polynesia, Japan and Vietnam (up 86, 53 and 36 percent).   

In related news:

- A BBC article on the results of a study of COVID-19 infections caused by Alpha and Delta variants in more than 43,000 Britons between March and May this year: 'Covid: Delta variant patients twice as likely to need hospital care'.

- The Mu variant of interest (VoI), first detected in Colombia in January, is one to watch according to the WHO as it has some similarities to the Beta variant which demonstrated some immune escape capabilities. Detection of the Mu variant has been highest in North America, followed by South America and Europe. Read more

- ‘mRNA COVID vaccines not tied to serious side effects’ is a CIDRAP summary of US data obtained from monitoring more than six million people post-vaccination.

- Chilean health authorities have approved the use of the Sinovac vaccine, known as Coronavac, in children over six years of age. Read more

- Moving towards digital documentation of COVID-19 status, the WHO has published its ‘Digital documentation of COVID-19 certificates: vaccination status’ which offers guidance ‘for countries and implementing partners on the technical requirements for developing digital information systems for issuing standards-based interoperable digital certificates for COVID-19 vaccination status, and considerations for implementation of such systems, for the purposes of continuity of care, and proof of vaccination’. Read more  

- Three US states have already started using so-called vaccine passports to check the use of counterfeit vaccination cards and limit new COVID-19 cases. The SMART Health Cards, which are not part of a national scheme, are currently in use in California, New York and Louisiana, with more states expected to participate in the coming months. Read more

- The WHO has established the Hub for Pandemic and Epidemic Intelligence in Berlin, Germany ‘to provide the world with better data, analytics and decisions to detect and respond to health emergencies’.

Seasonal infections surge in several states; More Nipah virus surveillance in Kerala

The city of Ahmedabad in Gujarat state has experienced a surge in both chikungunya and dengue fever cases for the year to date, with news sources reporting a 10-fold increase compared to last year. Read more. Other states with surges in vector-borne infections include Telangana (Hyderabad), Maharashtra (Nashik) and Madhya Pradesh (Bhopal). In related news, health teams were sent to Uttar Pradesh last week in response to reports of more than 50 child deaths from an unspecified viral fever. Results of tests carried out in the districts of Firozabad, Mathura and Mainpuri found the majority had succumbed to complications of dengue fever, but some were also due to scrub typhus and leptospirosis infections. More recent news reports indicate that dengue cases are now increasing in eastern districts of Uttar Pradesh, including the cities of Varanasi and Basti. Read more

CONTACT tracing and testing continues after the weekend death of a 12yo boy died from Nipah virus infection in the northern Kerala district of Kozhikode. More than 250 people have been quarantined and neighbouring districts placed on alert. A bat habitat was found near the boy’s house – fruit bats (Pteropodidae family) are the Nipah virus’ natural host. 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.

Start of plague season

The peak plague season in Madagascar is generally during the dry weather experienced from September/October to April and authorities have already announced seven deaths and 22 pneumonic plague infections in the Central Highlands district of Miandrandra Arivonimamo - the first death was recorded on Aug 23. The affected area has now been quarantined.

Advice for travellers

Plague occurs annually in Madagascar, but poses a low risk to most travellers. Most cases of plague 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.

Varicella reports on the rise

An update from the health ministry notes an increase in chickenpox cases seen recently – nine in Majuro, eight in Ebeye and two on Lib. In other regional news, New Caledonia’s hepatitis A outbreak continues with the YTD total now at 422, compared to 100 last year and only five in 2019. The same ReliefWeb post confirms dengue fever serotype DENV-2 circulating in Vanuatu.

Advice for travellers

Chickenpox (varicella) is a highly contagious disease caused by the varicella-zoster virus. Mainly passed from person to person by coughing or sneezing, it causes a blister-like rash, itching, tiredness, and fever. While the illness is generally mild in children, it can be more severe in young babies, adults, and people with weakened immune systems. Read more about chickenpox.

Warning to avoid chigger bites

A 10-fold increase in scrub typhus infections has been reported by doctors working in the hill district of Baitadi in the country’s west. Local residents have been advised to avoid bites from the vector, infected chiggers or mites, and to present early for medical help if experiencing fever symptoms. Scrub typhus activity escalates during the monsoon season, however the current surge is the largest since 2015, following the devastating earthquakes. Read more

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.

WNV cases likely to rise

After the warmer temperatures and above-average rainfall experienced this past summer, authorities have warned of the potential for more West Nile virus cases than usual, and a likely spread to previously unaffected areas. Media reports note that SW regions generally record most WNV cases each year. Read more

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.

Hep E spikes in northern camp

Hepatitis E cases are reported to have risen sharply since mid-May in a camp for displaced persons in the north of the country, and to date the number of infected individuals is some 10 times higher than for the same period in 2019 and double the 2020 cases. The outbreak started in early 2018. The Bentiu camp lies in Unity State, near the border with Sudan, leading the WHO regional office to express concern that the highly porous border and mobile population could seed the infection across state lines. Read more

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 uptick in crisis zone

Dengue fever infections have surged in the western governate of Taiz, site of ongoing conflict. According to local news sources, more than 4,700 cases have been reported since the beginning of the year. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which 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 insect repellent containing an active ingredient, such as DEET, Picaridin or PMD when outdoors to all exposed skin. Read more about dengue fever. Read more about dengue fever.

Seasonal alert over malaria

The national government has warned citizens, particularly those living in Mashonaland (Central, East and West), to prepare for the peak malaria season. The alert was prompted by cases increasing from 2019-2020 by more than 50 percent. Deaths also rose during that period. Read more

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.