World travel health alerts 9 September 2020

World travel health alerts for 9th of September 2020.

Wallis and Futuna: Dengue outbreak persists

A dengue outbreak (DENV-2) that began in July continues with virus activity over the past fortnight in the villages of Taoa, Ono and possibly Alofi. The total of confirmed and suspected cases this year is now 59 with 46 of those in Wallis. 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.

Three countries cited in polio update

In the latest GPEI update on global polio cases, one new wild poliovirus type 1 case (now 37 total in 2020) was reported in each of three provinces - Hilmand, Kandahar and Khost – while the 13 cVDPV2 infections registered across six provinces took the YTD total to 54. Africa’s cVDPV2 cases continue to rise: Chad (3 cases from Logone Oriental province) and another case in the DRC’s Equateur province.

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.

Q fever spike in FNQ district

Local health authorities in Far North Qld have reported a rise in Q fever notifications in the Atherton Tablelands, with most of the 23 recent cases around Mareeba. A senior public health doctor suggested the situation may have arisen due to ‘greater numbers of wildlife, close to residential areas’ and warned that animal droppings (livestock and wildlife) may harbour the bacteria and contaminate soil or dust for long periods of time. Vaccination is recommended for people working with animals and in high risk settings, while the public is warned to wear a mask if performing tasks such a lawn mowing. Read more  and information on Q fever from healthdirect

High mosquito numbers driving east’s outbreak

The chikungunya outbreak centred in Ouaddaï Region’s capital, Abéché (adjacent to the Sudanese border), is intensifying with more than 10,000 cases now recorded. The WHO weekly bulletin raised concerns that the sharp rise in cases in this urban area suggested ‘a heavy vector load’.

Advice for travellers

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

Search for Hep E source

The strict observance of ‘good personal, food and environmental hygiene’ is advised by Hong Kong’s CHP after another case of rat hepatitis E virus (HEV) was detected in mid-August; this time in an elderly woman from Ngau Chi Wan. The source of infection is still to be determined but the patient, who is now recovering, had no recent travel history and no known contact with rodents. Preventive measures are listed in the CHP press release of Sept 4. More than 10 Hong Kong residents have tested positive for rat HEV since it was first identified in humans in 2018.

Barriers to Ebola response measures

After just over three months of Equateur’s second outbreak in three years, the case count has risen again to 113 (107 confirmed and six probable) and 48 fatalities. The WHO attributes the steady rise in cases to resistance among community members to vaccination and ‘safe and dignified burials’, together with insufficient funds and human resources. 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.

TBE risk through staycation

A surge in tick-borne encephalitis (TBE) infections occurring in altitudes of 550 to over 600 metres is driving case numbers this year into record territory. The states of Baden-Wurttemberg and Bavaria have reported most cases. ‘Unusually high numbers’ of TBE-infected ticks were observed early this year which augured a spike in human TBE cases during summer. This event has been further exacerbated by the pandemic travel restrictions which meant more Germans taking domestic holidays in the south’s ‘mountainous recreational areas’. Read more

Advice for travellers

A viral infection, tick-borne encephalitis (TBE) can cause fever, vomiting, cramps and paralysis, which can be prolonged. In rare instances, infection can be fatal. Travellers who spend time in regions where TBE is endemic – mainly forested areas of Central and Eastern Europe, Russia, Northern China, and Mongolia – may be at risk. The highest risk is during the warmer months from April to November, especially when hiking or camping in areas below 1500m. While safe and effective vaccines are available in Europe, none are licensed in Australia; however the vaccine can be obtained by a medical practitioner through a Special Access Scheme. Read more about TBE.

Late season malaria; Knowlesi malaria in northern states; COVID-19 cases pass 4.2 million

Late onset of the monsoon and insufficient resources directed towards mosquito control have led to a surge in malaria cases in Mumbai, however health authorities predict the numbers should start dropping soon followed by an uptick in dengue reporting. Five districts of South Mumbai have recorded almost three-quarters of all  the city's malaria cases this year. Read more  

RESEARCHERS have confirmed the presence of Plasmodium knowlesi malaria among the population of the northern states of Uttar Pradesh, Haryana, and Delhi as a result of testing on acute febrile illness cases in the region in 2017-8. The healthsite post also notes that the same institute (AIIMS) had previously detected the presence of the parasite in the Andaman and Nicobar Islands.

THE 90,000+ COVID-19 infections added to India’s total on Monday took the country to #2 in global ranking and played a major part in the SE Asian region recording the largest increase in new COVID-19 cases in the past week, compared to the previous (in the Sept 6 WHO weekly epi update). It was also noted that the Americas ‘continues to carry the highest burden of the disease globally’. In Australia, the Dept of Health’s COVID-19 Epidemiological Report for the fortnight to Aug 30 noted that children up to 9yo ‘continue to have the lowest rate of infection (39.4 cases per 100,000 population), with testing rates comparable to other age groups’ while highest case numbers were among the 20–29 years cohort.    

Advice for travellers

The P. knowlesi strain of malaria is spreading in humans throughout Asia due to factors such as deforestation – its natural host is the macaque. As well as local cases, infections are increasingly being reported among international travellers who have visited Thailand, Vietnam, Cambodia, and the Philippines. Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

40 malaria deaths recorded

The national malaria death toll has climbed to 40 from more than 12,500 cases this year as planned control measures were put on hold due to the pandemic. Cases are also higher than last year when dry conditions kept numbers low. 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.

Public health milestone achieved

Late last month the WHO announced it had granted validation for the elimination of human African trypanosomiasis (HAT or sleeping sickness) caused by Trypanosoma brucei gambiense in Togo after 10 years without cases. The West African nation is the first of the 36 endemic countries in the sub-Saharan region to do so. The gambiense spp ‘is found in 24 countries in west and central Africa and accounts for more than 98% of cases’ while the remainder, caused by the rhodesiense spp, occur in 13 eastern and southern African countries.  Benin, Burkina Faso, Cameroon, Cote d’Ivoire and Ghana have also started the WHO validation process. Read more and information on HAT from the US Centers for Disease Control and Prevention. 

Mumps hike curbed

A surge in Scotland’s mumps cases late in 2019 and early this year was effectively checked by pandemic lockdown measures, dropping from 853 for Jan-Mar down to 10 for the next quarter. Low uptake of the MMR vaccine is suggested as the reason for the increased incidence of mumps in the 17 to 34 years cohort. Read more

Advice for travellers

Largely preventable through vaccination, measles and mumps are highly contagious diseases that can cause serious illness in people of all ages. Travelvax Australia recommends travellers ensure these and other routine childhood immunisations, such as tetanus, diphtheria and whooping cough (pertussis) are current.

Tick-borne infections up in Midwest state; Plague risk mitigation in Lake Tahoe

Nebraska’s Department of Health and Human Services has given notice of a rise in tick-borne infections this year, even as it announced the death of a man from the West Central district from Rocky Mountain spotted fever - the first fatality in five years. Read more

SOME sites around South Lake Tahoe were shut to visitors recently after testing in the area detected fleas that were carrying plague bacteria. The testing followed last month’s confirmation of the first human plague infection in five years. Insect control measures were being deployed to enable all facilities to re-open by Labor Day. Advice from the Forest Service for anyone visiting the area includes staying on the marked trails, using insect repellent, suitable clothing and avoiding all contact with rodents. Read more. Elsewhere, Mongolia’s bubonic plague death toll has risen to three with another fatal case this week – in western Zavkhan province. The man was known to have eaten marmot meat – the animals are a significant reservoir of plague bacteria in the region. There have been 18 suspected bubonic plague infections this year in Mongolia with 17 of the 21 provinces currently considered risk areas.

Advice for travellers

Although its incidence has increased in the past 2 decades, Rocky Mountain spotted fever is a low risk for most travellers visiting North America, where over 50 percent of cases occur in 5 US states – Arkansas, Missouri, North Carolina, Tennessee, and Virginia. However, it is advisable to take preventive measures to avoid tick bites when outdoors, particularly in warmer months (April-September) when ticks are most active. RMSF can be a severe or even fatal illness if not treated in the first few days of symptoms. Typical symptoms include fever, headache, abdominal pain, vomiting, and muscle pain – with or without a rash. Read more about RMSF.