Travel Health Alerts

More JE cases reported

Thirty-three Japanese encephalitis cases made up the Current Status on the Dept of Health website as of March 28 – 22 are confirmed and 11 probable (either epidemiologically linked or testing was strongly indicative). No more fatal cases have been recorded so the death toll remains at three. Late last week, ABC News posted articles on new cases detected in Qld and an increase in the piggeries with JEV-infected animals in South Australia. Read more

Advice for travellers

Japanese encephalitis (JE) is the most important cause of viral encephalitis in Asia. It usually occurs in rural or agricultural areas, often associated with rice growing and pig farming. JE virus is transmitted to humans through the bite of infected Culex mosquitoes. Most JE virus infections are mild (fever and headache) or symptomless, but around 1 in 250 infections results in severe and potentially fatal disease characterised by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and death. The risk to short-stay travellers and those who confine their travel to urban centres and use insect bite avoidance measures is low. Expatriates, repeat travellers and travellers living for prolonged periods in agricultural areas where Japanese encephalitis is endemic or where seasonal epidemics occur should consult their travel health provider about recommendations for vaccination. Read more.

Cholera erupts as weather heats up

A rise in temperature and the consumption of street food and juices are contributing to a spike in cholera cases in the capital Dhaka, as well as in Cumilla district and Barishal division. Many of the patients admitted to the International Centre for Diarrhoeal Disease Research in Dhaka’s Mohakhali Hospital have been from the city’s Jatrabari, ShonirAkhra, Kadamtali, Dakshinkhan and Uttara areas. Read more

Advice for travellers

Cholera is usually spread in contaminated water. For most short-stay travel, the risk of infection is low. Travellers 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.

Influenza activity up in Central-West region

THE ECDC reports increased influenza activity in the region which had peaked in week 10. Five countries have signalled flu activity of 50 percent or above: ‘Hungary (79 percent), France (71pc), Belgium (63pc), the Netherlands (62pc) and Slovenia (52pc), while influenza A(H3) viruses continue their dominance in most jurisdictions. The same report provides details of three new avian influenza H5N6 cases in China, one each from the provinces of Jiangsu, Jiangxi and Sichuan. All patients had confirmed exposure to poultry. More flu news in the March 21 WHO global flu update. Read more

Advice for travellers

In most years, 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. Whether you are travelling within Australia or overseas, 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-based hand sanitiser is a convenient alternative if soap and water is not available.

Peak dengue season underway

Data from a Mar 21 Ministry of Health bulletin reveals that dengue fever cases risen by almost 45 percent this year compared to the same period in 2021, and dengue’s peak season is just hitting now. The mid-West recorded a large increase, while of the cities, Goiânia and Brazilia had the highest rates of infection. Dengue monitoring has demonstrated that more areas likely to experience outbreaks, including ‘the northwest of São Paulo, the region between Goiânia and Palmas (TO), passing through the Federal District, and some isolated municipalities in Bahia, Santa Catarina and Ceará‘. 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.

Typhoid death toll rises

The village of Togovere in Rakiraki district, located on the northern coast of Viti Levu, was placed into lockdown last week as health authorities worked to stem an outbreak of typhoid fever through screening and containment measures. News had emerged earlier that typhoid infections had tragically claimed the lives of a mother and her two children from the village. Read more

Advice for travellers

Typhoid occurs sporadically in some Pacific countries, although it presents a low risk for travellers staying in hotels or resorts. Travellers should follow safe food and water guidelines, and personal hygiene practices. Vaccination is generally recommended for travellers staying in rural areas, as well as for adventurous eaters. Read more about typhoid fever.

Vax campaign to target measles

The regional WHO office attributes the community’s general lack of awareness of the need to vaccinate against measles as behind the mounting numbers of infections and deaths reported this year. While the majority of the nearly 11,000 suspected measles cases have been in Conakry, all eight regions have been affected. A reactive vaccination campaign was planned for this month. A warning has also been issued in Ghana after a number of suspected measles and rubella cases were registered in the Greater Accra Region, while Congo’s extended outbreak continues and has spread into new health districts despite a ‘targeted outbreak response implemented’. Read more

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.

COVID-19 update

This week’s WHO COVID-19 epi update advises that ‘decreasing trends in the number of new weekly cases and four regions reported a decreasing trend in new weekly deaths’, although changes in definition in the Americas and retrospective adjustments in India resulted in a substantial rise in the death toll. The agency expressed concern that the rise in cases earlier this month came about despite reduced testing across all regions. Significantly reduced testing by some countries means that ‘data is less representative, less timely, and less robust’. South Korea recorded the highest number of new cases in the week and infections are on the rise again after five days of downturn, up by just over 347,000 on Mar 29. Some of the largest increases in new cases in the Western Pacific region were in Vanuatu (up 251 percent), Guam (up 243 percent) and Laos (up 149 percent). Read more

Related articles:

- An editorial in the journal Nature writes that ‘This is no time to stop tracking COVID-19’.

-  Selected population groups in Australia are recommended to receive an additional booster dose of COVID-19 vaccine to increase vaccine protection before winter: ATAGI

- CIDRAP summarises a study published recently on co-infection of COVID-19 and influenza, ‘an especially dangerous pair’.

- From April 17, 2022 Australia’s biosecurity emergency pandemic measures will come to an end. With this, negative pre-departure tests for travellers entering Australia will no longer be required. International travellers into and out of Australia will still be required to provide proof of double vaccination against COVID-19 and masks must be worn on international flights. Restrictions on the entry of cruise vessels into and within Australian territory will also lapse on that date. Read more

Risk of yellow fever spread ‘high’

A further WHO update on the yellow fever outbreak in Isiolo County assesses the risk presented to public health ‘as high at the national and regional levels’. Figures provided cover the situation from Jan 12 to March 15: a total of 53 suspected yellow fever cases and six deaths from 11 wards of the county. As noted in the March 16 alerts, routine yellow fever vaccinations are not part of the national immunisation program (except for four NW counties considered high risk), so ‘at the national level, the overall estimated coverage through routine immunization is 7% of the target population’. The WHO rated the risk level through a number of factors: mass refugee migration and the movements of pastoralists through the area, population increase due to informal mining and a national park in the adjacent county.  Read more   

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.

South’s cholera surge

Flooding, the legacy of recent weather events that passed over the country’s south, has resulted in an outbreak of cholera that was first detected in Machinga district, but has now spread to Nsanje in the far south. International aid agencies are assisting with the chlorination of water supplies and procuring cholera vaccines for the affected areas. Read more. To the south, in Mozambique, cholera has been reported in Caia district of Sofala province. Response activities are said to be ongoing.

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.

Polio update, immunisation rates down in the Americas

Of the seven most recent circulating vaccine-derived poliovirus type 2 (cVDPV2) cases reported by the GPEI, two were logged by both Niger (Diffa and Tillabery regions with a 2021 date of illness onset) and Nigeria (Niger and Nasarawa states, added to the 2022 total), while Yemen’s three infections were in Lahaj, Marib and Sa'dah governates. Elsewhere, the Pan-American Health Organization (PAHO) has warned that the region’s current low levels of vaccination against childhood diseases such as diphtheria, measles and polio risk outbreaks occurring. Almost three decades of progress have been lost during the pandemic, with immunisation levels falling back to those recorded in 1994. Read more

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.

Leishmaniasis rife in Balochistan

Cutaneous leishmaniasis cases have soared in the province of Balochistan, with more than 8,000 infections reported over ‘a few days’ and Quetta, Qilla Abdullah, Qilla Saifullah, Jaffarabad, Zhob, and Kech named as high risk districts. Requests have been made to international agencies for treatment medications as local stocks are in short supply. Read more

Advice for travellers

Leishmaniasis is generally a low risk for travellers. The parasitic disease is found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. There is no vaccine or preventative medication: avoiding infection relies on minimising sand fly bites. Read more on the disease and prevention.

Another MERS case emerges

The country’s first MERS Co-V case since 2020 has been reported by the Ministry of Health, which confirmed that a man who had confirmed contact with camels had been diagnosed with the illness. He remains in hospital and all contacts are under monitoring Read more and the Feb 2022 WHO regional update.

Yellow fever outbreak in 2 southern districts; Malaria uptick in east

A yellow fever outbreak has been declared in Wakiso and Masaka districts. The four initial cases were detected in Jan/Feb and that total has now risen to eight. The WHO weekly bulletin notes that ‘Masaka is located close to the greater Kampala area and Wakiso encircles Kampala. Wakiso also includes Entebbe, where the international airport is located’. The agency recommends close monitoring of the situation in view of the occurrences being close to major population centres and negligible population immunity in Uganda as well as in neighbouring countries, D R of Congo and South Sudan. The yellow fever vaccine is not included in Uganda’s routine immunisation schedule as yet and ‘the exact prevalence and incidence of yellow fever in Uganda is not known’. Read more

MALARIA cases have been trending upwards in the eastern district of Kibuku since last year. According to local health officers, case numbers have been highest in the towns of Kibuku, Pallisa, Butebo, Budaka, Butaleja, Tororo and Busia. There has been some local resistance to measures introduced to tackle malaria in the area, with news reports claiming that insecticide-treated nets have been used for ‘poultry shelters, garden boundaries and … ropes to tether livestock’. Read more

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.

Imported haemorrhagic fever case; Resistant Shigella cases investigated

A woman who had travelled from Central Asia has become the third case of Crimean-Congo haemorrhagic fever (CCHF) to be confirmed in the UK. The two previous incidents were in 2012 and 2014 and did not result in onward transmission of CCHF. No details of the departing country have been provided and the patient is receiving specialised care in a London hospital. Read more

HEALTH authorities are investigating a cluster of extensively drug-resistant (XDR) Shigella sonnei infections which have been identified from all regions of England, Scotland and Northern Ireland, as well as several European countries, since the latter part of 2021. Transmission occurred through direct, person-to-person transmission and included sexual transmission between men who have sex with men (MSM). Sequencing carried out on many of the cases in Austria, Belgium, Denmark, France, Germany, Ireland, Italy, Norway and Spain have found similar resistance profiles to the UK infections. The WHO published an assessment of the situation suggesting the emergence of these clusters ‘may represent an increase in reporting activities following the COVID-19 pandemic and resumption of social contact, especially in MSM exposed to high-risk sexual practices and in immunocompromised adults’, but also adds that public health could be seriously impacted due to elevated case numbers and ‘the mechanism of antimicrobial resistance by which this S. sonnei strain has gained XDR characteristics is unusual’. Read more

Advice for travellers

CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to most travellers. Read more about the virus.

Legionella infections in island hotel

Legionnaire’s disease has been confirmed in two guests of the same hotel in Waikiki, Hawaii, but their stays were several months apart. The state’s health department is investigating the cases, the first of which was identified in June last year and the most recent, earlier this month. Health officials have advised that the risk of infection is low, but “cases of Legionnaires’ disease are on the rise nationwide”. The State Epidemiologist has requested that “Individuals who stayed at the Hilton Grand Islander in the last two weeks who develop symptoms or individuals who were diagnosed with Legionnaires’ disease after a stay at the Grand Islander are encouraged to seek medical attention and contact DOH.” Read more

Advice for travellers

Legionnaire’s disease occurs worldwide and outbreaks have been associated with cruise ships, hotels, and resorts. The bacteria that cause Legionnaires’ disease are found in the airborne droplets of warm, fresh water, such as from fountains, spas, showers and the cooling towers of buildings. Over 50s, current or former smokers, those with a chronic lung condition, and the immunocompromised are at higher risk of developing illness after exposure. Read more.