Travel Health Alerts

2 years into COVID-19 pandemic

This week’s WHO epi update announced the greatest increases in new COVID-19 cases stemmed from the Western Pacific and African Regions (up 29 and 12 percent respectively). On a country level, highest case numbers were registered by South Korea (up by 44 percent to more than 2 million), ‘Vietnam (1,670,627 new cases; +65%), Germany (1,350,362 new cases; +22%), Netherlands (475,290 new cases; +42%), and France (419,632 new cases; +20%)’.

In our region, the update placed the largest percentage increases over the past week ‘in Vanuatu (146 vs 3 new cases; +4767%), Tonga (685 vs 280 new cases; +145%), and American Samoa (257 vs 112 new cases; +121%)’.

A change in the classification of variants dependent on current epidemiological trends occurred last week, with the WHO designating Alpha, Beta and Gamma as ‘previously circulating VOCs’ and Delta and Omicron as ‘currently circulating VOCs. 

In related news:

- Studies will continue into a new variant (detected in some EU countries and the US) that combines features from both the Delta and Omicron VoCs. Read more

- More about how SARS-CoV-2 has mutated since early 2020 Read more

- ‘The Pandemic After the Pandemic’ in The Atlantic looks into the pandemic’s ‘looming spectre’, Long Covid.

More JE cases confirmed; New STI spike in Victoria

Another Japanese encephalitis case has been registered in NSW, the seventh to date and the patient, a woman in her 40s who has been discharged from hospital, is from the Riverina (Berrigan area). It is expected more infections will be confirmed as testing continues in the affected districts. And in Victoria, on March 11 the health department announced a total of seven confirmed and two probable JE cases and advised anyone with concerning symptoms ‘particularly if they’ve visited northern and north-west Victoria or southern New South Wales, along the Murray River and its surrounds, or been in contact with pigs, [to] seek urgent medical attention’. Read more

THERE HAS been an expansion of the sexually transmitted infection outbreak reported in May 2021 in Melbourne, with cases of gonorrhoea surging ‘among women apparently in the same demographic group that was affected by syphilis’ and in the same outer suburbs (Casey, Melton and Brimbank). Assoc. Professor Eric Chow, Alfred Health epidemiologist and biostatistician, said in a news article that the 5-fold increase in gonorrhoea cases over recent years shows ‘heterosexual gonorrhoea was now endemic in 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.

Visceral leishmaniasis in lowlands

The discovery of visceral leishmaniasis (VL) cases in Villa Montes (Tarija department) is concerning health authorities. According to information in a ProMED post, cutaneous leishmaniasis has previously been detected in the lowland Chaco town, however not VL, the more severe form of the sand fly-borne infection. Seven VL cases have now been confirmed in the town and investigations revealed that the mother of the child index case had travelled from Beni department. Read more

Advice for travellers

Leishmaniasis is a parasitic disease 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. The former causes skin ulcers and the latter a severe systemic disease that is usually fatal without treatment. India, Bangladesh, Nepal, Sudan, South Sudan, Ethiopia and Brazil account for 90% of visceral leishmaniasis, while 90% of cutaneous leishmaniasis cases occur in Afghanistan, Algeria, Iran, Saudi Arabia, and Syria, as well as the South American countries of Brazil, Colombia, Peru, Bolivia and Argentina. Read more on the disease and prevention.

Young girl diagnosed with bird flu

A one-year-old girl has been hospitalised with pneumonia in Siem Reap province after contracting avian influenza A/H9. A health ministry team has been dispatched to the area to manage the situation and provide risk awareness to residents. Over the past six months, 16 cases of H9N2 avian influenza have been reported in mainland China (CHP report), and the agency is currently monitoring another human H5N6 infection – a woman from Nanchang in Jiangxi Province who had a history of contact with poultry and is now in a critical condition in hospital. Read more

Advice for travellers

There are several strains of bird flu and while the high pathogenic strains can be fatal, infection generally poses a low risk for travellers – even for those heading to a region where the disease is present or an outbreak is occurring. Travellers should avoid contact with birds or poultry in marketplaces, wash hands thoroughly before and after preparing food, and observe strict personal hygiene. Read more on bird flu and how to avoid it.

More polio positives, global digest

Two more positive poliovirus stool samples have been detected – one in a close contact of the unvaccinated index case and the other from wider Jerusalem obtained through random testing. The GPEI last week said that the first case ‘confirms an outbreak of cVDPV3 in both Israel and the occupied Palestinian territory’ as it is the same strain collected in environmental samples from both areas between Sept 2021 and Jan 2022. In other polio news, both the D R of Congo and Nigeria reported a single cVDPV2 case last week. And from the Feb 28 meeting of the Polio IHR Emergency Committee, a warning that the risk of international spread of wild poliovirus (WPV) remains, demonstrated by the recent case in Malawi, ‘particularly as the route from Pakistan to Africa is currently unknown both in time and place’. On cVDPV2, genetic testing suggests ‘cross border spread continues to occur, with spread from Nigeria into Cameroon, CAR, Chad and Niger and from Yemen into Djibouti and Egypt’. The GPEI has listed the following countries as ‘Key At-Risk’ for the reintroduction of the virus due to low levels of immunity and surveillance: Angola, Myanmar, Malaysia and the Philippines. 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.

Dengue cases on the rise

Dengue fever cases are up by more than 150 percent over the same seven week period last year and seven dengue-related deaths have been registered. Half of the most recent reporting week’s cases were from Santiago, Santo Domingo de Guzmán, Santo Domingo Norte, Santo Domingo Este and San José de Ocoa. The same news source reports that malaria case numbers are lower when compared to the same period over the previous two years – San Juan and Los Tres Brazos are considered the foci. More global dengue fever data here. 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.

Regional flu update

The European Centre for Disease Prevention and Control (ECDC) reports widespread flu activity/ medium flu intensity in Estonia, France, Hungary, Ireland, Luxembourg, Netherlands, Norway, Slovenia, Turkey and United Kingdom (Scotland), and influenza A(H3) viruses have dominated across the region. Overall, flu activity in the EU is lower than pre-pandemic levels (as also noted by the CDC for the current US flu season). 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.

Flu, leptospirosis cases climbing

Flu-like illnesses have been increasing according to the March 15 Pacific Syndromic Surveillance Report, almost doubling in the most recent week. The same report also advised that dengue fever outbreaks are ongoing in the ‘Western Division (Nadi, Tavua, Ba) and the Eastern Division (Levuka)’. The number of Fiji’s leptospirosis infections is nearing 1,000 for the year with 25 deaths, while New Caledonia’s case count has risen to 78 and one death from 27 municipalities (mainly in the north).

Advice for travellers

Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

Update on Isiolo County’s yellow fever cases

More on the yellow fever (YF) outbreak in Isiolo County, a sparsely populated area in the country’s centre approximately 270 kms north of Nairobi. The latest WHO weekly bulletin notes that 15 suspected cases (two now confirmed) and four deaths have been reported from eight villages in the sub-counties of Chari, Cherab and Garba Tulla. Routine YF vaccination programs are only carried out in four counties of Kenya’s NW which are not close to the affected area, leading to the WHO’s assessment that due ‘to minimal population immunity, there is high risk of outbreak amplification’. Yellow fever has not been reported in Isiolo County before according to the bulletin. The WHO recommends vaccination against YF for all international travellers aged nine months and above going to Kenya. Mosquito bite avoidance measures will also be necessary. 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.

Meningococcal meningitis uptick

A ProMED post reports on a spike in meningococcal meningitis infections affecting young children, but no further details are provided on the serogroup involved or the distribution of cases. Parents and carers have been advised to seek vaccination for their charges. 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 or extended contact with local people in crowded places. If planning to travel to any region experiencing an outbreak, discuss whether vaccination against meningococcal meningitis would be appropriate for your itinerary with your doctor. Read more about Men. meningitis.

Public’s help to curb dengue surge

The National Environment Agency has alerted residents to an increase in dengue fever cases, up by more than 100 over the week ending March 5. Currently there are 11 red clusters (≥10 dengue cases), with the less common Dengue virus type 3 (DENV-3) circulating in eight of them. Pockets of Aedes aegypti mosquito populations had been identified last month prompting the agency to warn that current conditions ‘may lead to a surge in dengue cases in the coming months’. 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.

Emerging disease threat

A recent publication brings to light three human cases of rat hepatitis C (Orthohepevirus C) infection in Spain, detected through retrospective analysis of hepatitis patients from 2018 to 2021. The ECDC’s weekly Communicable Disease Threats Report of Mar 12 notes that one of the patients, who was immunosuppressed, had died. Two were known to have consumed undercooked pork while the third worked as a cleaner. The agency’s assessment of risk: ‘Orthohepevirus C is circulating in rodents worldwide, including Spain, thus the risk of zoonotic transmission is plausible globally and not restricted to a specific area. The study suggests that Orthohepevirus C can be an emerging infectious disease and more sporadic human cases can be expected also in the EU/EEA countries.’ Read more