World travel health alerts for 9th of October 2019.
Regional dengue round-up
The peninsular state of Selangor continues to report most dengue infections this year. While all regions are affected, only two provinces (Perlis and Terengganu) have registered fewer than 500 cases this year; the national YTD total now sits at 103,650 dengue cases. Across the region, most countries have reported a recent, slight decline in the number of new cases, however overall, infection rates have been higher than last year: Myanmar (highest rates in Kachin and Ayeryarwady), a particularly severe dengue season for Pakistan and Bangladesh and added reports from Sri Lanka, the Philippines, Cambodia and Laos. 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.
Dengue maintains presence over winter
Even before peak dengue season hits, infections and related deaths reported over the cooler months were registered at above average levels. According to PAHO data, in the year to the end of September Brazil had recorded 2 million suspected dengue fever cases and 634 deaths. Within the region, a news source claims that the Cuban provinces of Santa Clara and Santiago de Cuba have been particularly hard hit by dengue this year. 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.
Two new EVD cases in last 2 days
Only two new Ebola virus disease (EVD) cases this week (one each on Monday and Tuesday) – from Oicha and Mandima health districts - but hope that this represents a turning point in the outbreak is guarded in view of the continuing security issues in the NE provinces. 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.
Local, Pacific islands dengue digest
The health emergency declaration has kept the dengue fever outbreak, which first affected the island of Ebeye and then spread to Majuro, from spreading to the outer islands. The measure is said to have had an impact on tourism but will remain in place till at least next month. More regional dengue news from ReliefWeb. 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.
Lengthy monsoon season to end
It’s over a month late and has been wetter than usual, but the monsoon is finally set to retreat, starting in the country’s NW, according to the India Meteorological Dept. The effects of mosquito-borne infections fuelled by the rainfall will remain for some time. This past week they have included dengue fever reports from Telangana, Tamil Nadu (Chennai) and Bihar (Patna), while it’s dengue and chikungunya in Maharashtra (Pune) and malaria in the states of Uttar Pradesh (Bareilly, Budaun) and Punjab. Scrub typhus also continues to trouble the north-central state of Himachal Pradesh (Bilaspur district) – first reported in the news this season in early August.
Advice for travellers
Malaria is widespread in India and can occur in both rural and urban areas, including major cities. Travellers visiting India should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. Read more on malaria in India.
Public health success heralded
The WHO this week announced a public health success: the elimination of lymphatic filariasis in Kiribati. In the Western Pacific WHO region 12 endemic countries remain from the original 24 (American Samoa, Brunei Darussalam, Fiji, French Polynesia, Laos, Malaysia, Micronesia, New Caledonia, PNG, the Philippines, Samoa and Tuvalu). Read more
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.
Exceptional dengue rates reported
Unseasonably warm weather and recent floods are exacerbating the dengue fever situation which is now affecting 67 of the country’s districts - the director of the Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu was recently quoted as saying that they had “never had an outbreak like this before”. Highest rates of infection have been in Chitwan (2,416 cases) followed by 2,183 in the district of Kaski (which includes Pokhara) and more than 1,500 in Kathmandu. The national count from mid-July to the end of September neared the 11,000-mark with six deaths. Read more
Advice for travellers
Dengue is spread by 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.
Potential for national YF spread ‘high’
With all states (including the Federal Capital Territory) reporting at least one suspected case of yellow fever this year and the WHO risk assessment rating high on a national level for the ‘potential for ongoing local transmission and amplification’, the US CDC updated its travel health notice level 2 on Oct 7.
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.
Resistant typhoid extends its reach
A level 1 CDC travel notice was posted last week in relation to more isolated cases of extensively drug-resistant (XDR) typhoid fever reported in travellers returning from Pakistan. The media has covered recent cases in Australia, Taiwan and Texas (USA), while in Ireland, this month’s HSE Epi-Insight report refers to three Pakistan-associated XDR typhoid cases registered this year.
Advice for travellers
Typhoid fever is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.
Moderate risk of polio spread in region
Results of tests performed on the two September cases’ VDPV2 samples were published in the latest UNICEF polio report released yesterday, revealing ‘the AFP case from Laguna is not genetically linked with any other known type 2 poliovirus, indicating new emergence’ - the environmental samples of VDPV1 taken in Manila were also found to be a new emergence. No further transmission has been detected within the contacts and local communities associated with the cases in Lanao del Sur and Laguna. The report also assessed the potential risk of spread within the region ‘to be moderate considering the large number of Overseas Filipino Workers’. In other polio news, the IHR Emergency Committee has extended the measures employed under the Public Health Emergency of International Concern at its latest meeting citing ‘the significant further increase in WPV1 cases’ and the ‘unprecedented levels’ of cVDPV2 outbreaks in Africa which must be considered as public health emergencies. Read the GPEI’s Oct 2 update.
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.
Miami-Dade’s mozzie alert
As Florida’s local dengue case count rose to nine, with all but one residing in Miami-Dade County, the local health department has invoked a mosquito-borne illness alert – Drain (standing water) and cover (skin with repellent or clothing). 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.