Travel Health Alerts

JEV found in more areas; Ross River virus detected in Sydney mozzies

It is expected that autumn will bring about a reduction in mosquito numbers, but until then the advice from health departments is to continue taking measures to avoid insect bites. Two new (historic) cases of Japanese encephalitis (JE) were announced by NSW Health during the week - both male patients were from the Riverina region (Lockhart and Carrathool Shires). In Victoria, JE virus-infected pigs have now been detected in farms across eight local government areas (to Apr 5). The national total of human JE cases now sits at 35 (24 confirmed and 11 probable). Read more

MONITORING of mosquitoes in Sydney’s Northern Beaches has detected Ross River virus in some of the specimens collected recently at Narrabeen Lagoon. An alert has been issued to residents on the need for extra precautions in avoiding mosquito bites. 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.

Large towns reporting cholera outbreaks

Health authorities are enforcing quarantine on people infected with cholera in the SW region and outbreaks are now being reported in ‘the capital, Yaounde, the economic capital, Douala, and western commercial towns like Buea, Limbe and Bafoussam’. News reports advise that more than 40 percent of major towns are now affected, while case numbers are likely to be an underestimate as many of the sick visit traditional healers instead of seeking medical advice. 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.

Oyster recall after norovirus detected

Oysters farmed at one British Columbia location have been recalled in both Canada and the USA after some were found to be contaminated with norovirus. Public Health Canada launched an enquiry when the first cases appeared in January and now infections have been reported from four provinces, while the US CDC advised this week that at least 13 states have identified gastrointestinal illnesses related to the consumption of the oysters. Read more

Advice for travellers

While it is extremely contagious, norovirus infection is generally short-lived, causing nausea, vomiting and diarrhoea, which may lead to more serious complications among young children, the elderly, and the sick. To minimise the risk, wash your hands after using the toilet and before eating, and practice good hygiene. Read more on norovirus.

COVID-19 update

The Apr 5 WHO epi update advised that ‘All regions reported decreasing trends both in the number of new weekly cases and new weekly deaths’ with the usual disclaimer that fewer tests are being performed in many areas so data should be interpreted with caution. In the Western Pacific region there was a 16 percent decline in new case numbers, however seven countries did report an increase of 20 percent or more – the top three: Mongolia (new cases up 162 percent), Solomon Islands (up 56 percent) and Cook Islands (up 49 percent). Read more

Related articles:

- From a CIDRAP summary of the results of a human challenge trial carried out in the UK in which 36 healthy young adults aged 18 to 30 years were exposed to SARS-CoV-2. ‘Most participants who contracted the virus did so within 2 days of exposure, and viral shedding was highest on day 5. By that day, the virus was found most abundantly in the nose.’

Plague resurfaces in NE

A ProMED report has related the details of a suspected outbreak of bubonic plague in Djugu Territory, Ituri province late last month. Three health centres (Rassia, Lokpa and Kpandroma) have been treating the sick and so far two deaths have been recorded. Read more

Advice for travellers

Plague poses a low risk to most travellers. The majority of plague cases 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.

Meningitis alerts in several regions

The response to multiple outbreaks of suspected meningitis is being hampered by a lack of laboratory and technical means in the country. With limited local capacity to determine the disease aetiology and treatment required, epidemic thresholds have now been surpassed in Oromia, Somali, SNNPR and Amhara regions, according to the WHO weekly regional bulletin. An alert has also been raised for Walikale district in the D R of Congo’s NE province of North Kivu after more than 1,600 suspected meningitis cases were reported to mid-March. Read more.

Advice for travellers

Meningococcal meningitis is an acute bacterial disease transmitted from person-to-person through close (kissing, sharing eating utensils) or extended contact. Risk factors include extensive travel in crowded conditions, extended contact with local people in crowded places and travel to sub-Saharan Africa’s ‘meningitis belt’ where meningitis outbreaks occur in the dry season (Dec-April) and just prior to the rainy season (May-June). Read more about Men. meningitis.

More polio cases emerge, global digest

Updated information on circulating vaccine-derived poliovirus type 3 (cVDPV3) cases in children residing in Jerusalem and the surrounding area, with the total climbing to seven (unvaccinated) cases and one probable infection in a partially vaccinated child. Testing has determined all infections had genetic links to strains found in environmental samples taken from the Jerusalem and Bethlehem regions over Sept 2021 to Jan this year. A catch up vaccination program is underway. Read more. In other polio news, the GPEI reported more cVDPV2 cases last week: six from the D R of Congo (Maniema province), three in Nigeria (two in Bauchi state and one in Gombe state), and 16 in Yemen (Alhudaidah, Aljawf, Amran, Marib and Saadah governorates). Egypt also reported two positive environmental samples from the city of Qena, 50kms north of Luxor. 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.

Western Division’s typhoid outbreak

The typhoid fever epidemic threshold was crossed this week in the Western Division as more confirmed cases emerged. Most were from Lautoka, while all other divisions reported ‘below the average or at the average numbers expected for this time of the year’, (apart from a localised outbreak in the North Division’s Cakaudrove province). Read more on the current situation for typhoid, leptospirosis, dengue fever and COVID-19 in the Apr 4 Ministry of Health and Medical Services update.

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.

Malaria report card published

A summary of annual malaria parasite incidence lists 24 high burden districts with rates that are ‘concerning’ from areas of the states of Chhattisgarh, Odisha, Mizoram, Tripura, Jharkhand, Meghalaya, West Bengal and Maharashtra. Of the last three states listed, each had only one district of consequence: Maharashtra’s was Gadchiroli which lies in a heavily forested area in the east. Read more

Advice for travellers

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.

Measles in southern district

Hospitals in Aden’s Sirah district are reported to be treating dozens of children presenting with suspected measles infections. Health services in the southern city, which is under the control of militia, are said to be in a state of ‘collapse’. Read more. In related news, in some parts of New Zealand, vaccination rates for measles, mumps and rubella are below the recommended levels, and health authorities are already on alert as the opening of international borders adds the risk of these viruses being introduced by travellers.

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.

Blood-borne hazards in Sindh

There have been calls for guaranteed safe blood supplies in the Sindh after 40 percent of mainly male teenage haemophiliac patients tested on one day recently were found to be infected with HIV, hepatitis B or hepatitis C. Substandard blood screens and therapies used in unregistered facilities were blamed for the rise in blood-borne disease incidence. Read more

Advice for travellers

Hepatitis C is a viral infection of the liver which is most commonly contracted through intravenous drug use, but transmission has also has been reported infrequently through modes such as unsafe MSM sex with an HCV-infected person (a higher risk if that person is also HIV-infected), sharing personal care items (i.e. razors) contaminated with blood and unregulated tattooing. For up to 30% of infections, it is a short-term illness and the individual may not have symptoms; but for the majority it can become a chronic infection which can produce long-term health issues and potentially lead to death. Antiviral medications have been developed which have been shown to successfully treat the majority of Hep C infections. Read more on hepatitis C from the WHO.

Confirmed yellow fever case in capital

This week’s WHO regional bulletin reported a confirmed yellow fever case in Talangai district of the capital, Brazzaville. The post included an alert that ‘the context is concerning as preventive mass vaccination campaigns are not yet completed outside of Pointe Noire’, the location of two other yellow fever cases. 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.

Q fever clusters in NW

The source of several apparently unlinked Q fever cases is under investigation in the NW province of Asturias. Five cases were initially treated in the town of Avilés from a cluster that doctors say is now contained. Since then, another three cases have been confirmed. Local authorities have expressed concern, not that Q fever cases are being diagnosed in this farming area, but over the number and their distribution. Read more

Dengue infections climb in NE

Dengue fever infections are increasing in four NE (Isaan) provinces - Nakhon Ratchasima, Chaiyaphum, Buriram and Surin, with the 10 to 14 years’ cohort bearing the brunt of the outbreaks. The districts of Non Thai, Non Sung and Chokchai in Nakhon Ratchasima have recorded the highest rates of infection. 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.