Travel Health Alerts

Flu activity up

As flu season advances, two countries logged influenza test positivity of more than 40 percent over the latest reporting period (Armenia and Israel) and 23-25 percent in three others (Serbia, Slovenia and Hungary). Flu News Europe advised that flu activity was widespread in Norway, Moldova and Sweden and A(H3) viruses continue to be dominant across all monitoring systems.

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.

COVID-19 update

On Feb 1, the WHO Director-General warned of a start in ‘a very worrying increase in deaths’ in most regions of the world and since ‘Omicron was first identified just 10 weeks ago, almost 90 million cases have been reported to WHO - more than were reported in the whole of 2020’. Read more

While the Omicron variant BA.1 (including lineage BA.1.1) has accounted for over 96 percent of sequences submitted to GISAID to Jan 31, the WHO is pressing for prioritised investigations into the characteristics of BA.2, including transmissibility, immune escape properties and virulence’ after a relative increase of the variant was observed in multiple countries. Late last week, the UKHSA reported in its Technical Briefing 35 that in early analysis, the apparent growth advantage of BA.2 over the original Omicron variant ‘is currently substantial’.

In the latest WHO weekly update, on a regional level, the largest increase (up 37 percent) in new COVID-19 case numbers was reported by the Western Pacific, driven by a rise of 73 percent in Japan and 65 percent in Australia (which also recorded a 31 percent increase in deaths).

In related news –

- According to Our World in Data, in just over a year, more than 10 billion COVID-19 vaccine doses have been administered around the globe and 61.1 percent of the world’s population has had at least one dose of an approved vaccine. But, ‘only 10% of people in low-income countries have received at least one dose’.

- Two articles from the journal Nature:  ‘COVID-19: endemic doesn’t mean harmless’ Read more and 'Where did Omicron come from? Three key theories' Read more

- The national vaccine safety system AusVaxSafety data on children aged five to 11 years receiving the Pfizer vaccine.

- An ABC News article sums up ‘What it might mean to be COVID-normal’.

Mosquito-borne disease threat in east

The wet spring late last year followed by a wetter-than-usual summer has, as expected, boosted mosquito populations on the east coast, and brought with it the increased risk of mosquito-borne diseases. One such infection, caused by the Kunjin virus, has recently been detected in horses in NSW's northern and southern districts, but there is also concern over the potential for cases of Murray Valley encephalitis to emerge among residents and visitors. Mosquitoes can transmit the Kunjin virus if they have fed from an infected bird (but can be an animal such as a horse), and then bite a human. The species of mosquito involved is most active around dawn and dusk. Read more

Advice for travellers

The Kunjin virus (a subtype of the West Nile virus) is related to Murray Valley encephalitis but is more likely to cause a milder infection. Incubation times are shorter (2-14 days) and symptoms, if they occur, can include fatigue, rash, muscle weakness, enlarged lymph nodes and swollen, painful joints. Of the infections that do produce symptoms, some can result in encephalitis which requires treatment in hospital. Fatalities are rare. There is no specific treatment or cure for Kunjin virus infections, so avoid mosquito bites by covering up, refraining from outdoor activities during peak insect activity hours and using an effective repellent. Read more

WHO update on cholera outbreaks

In a summary of Benin’s latest cholera outbreak, one of several periodic surges of the disease since 2016, the WHO has advised that the risk of spread remains high both within the country and in the region. While this latest wave originated in the department of Borgou, it has since seeded to Alibori, Atacora, Atlantique, Collines, Donga, Littoral, Mono and Oueme. The WHO reports that the epicentre, Parakou district in Borgou department funnels high levels of commercial traffic to the capital, Cotonou. Read more. Last week’s WHO regional bulletin provided an update on the ongoing cholera outbreak in Cameroon. The disease has remained active in South-West, Littoral and South regions since October last year and there is now fear that it has spread to Fotokol and Far North region. In addition, large public gatherings for the ongoing 2022 African Cup of Nations football competition, comprising teams from 24 countries and being held in Cameroon, add to the risk of further spread.

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.

Suspected leishmaniasis cases investigated

Investigations have begun in the city of Villa Montes, Tarija department, after suspected cases of cutaneous leishmaniasis (CL) were reported there for the first time. The city is north of the municipalities where CL cases have been confirmed since 1997 – Bermejo, Padcaya, Caraparí, Entre Ríos and Yacuiba (all located near Tariquía Flora and Fauna National Reserve and the Bolivian-Argentine border). Read more. In other news on leishmaniasis, Iranian health authorities have reported more than 10,500 CL cases in 18 of the country’s 31 provinces (highest rates in Isfahan, Fars, Khuzestan, Semnan, Khorasan Razavi and Golestan); they also include parts of the capital Tehran. And in Pakistan, a health official has attributed the movements over several years of sheep herders infected with leishmaniasis for the spread of the sand fly-borne infection from Afghanistan, Balochistan and some Khyber-Pakhtunkhwa (KP) districts to all of KP’s western districts. Karak is the latest district to see a hike in leishmaniasis cases after vector control measures stalled during the pandemic.

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.

SW malaria cases

Local health authorities in the country’s south-west have declared an outbreak of malaria after 11 cases were confirmed in the area over the past three months. A member of the local health management team is reported to have said that the SW has not been an endemic malaria zone ‘historically’. The WHO has advised countries in the African region not to weaken malaria control measures during the pandemic. 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.

Lassa response ramped up; Polio update

The  Emergency Operations Centre will respond to the recent increase in Lassa fever cases now affecting 11 states - Bauchi, Edo, Ondo, Oyo, Benue, Taraba, Kaduna, Plateau, Kogi, Cross River and Ebonyi. NCDC teams will be assigned to coordinate ‘outbreak investigation, contact tracing, response coordination, case management, psychosocial care for infected people, risk communication, and infection prevention and control activities’. The annual peak in cases generally occurs during the November to May dry season. Read more

ALL NEW polioviruses reported to the GPEI over the past fortnight involved cVDPV2 infections with a date of onset in 2021. They include two cases in the DR of Congo (Maniema province), eight in Nigeria (Bauchi, Borno, Gombe, Kano, Katsina and Plateau states) and a single cVDPV2 case in the Ukraine (Zakarpattia, an oblast in the country’s west). The last case was in an unvaccinated child and linked to samples identified in the region of Rivne in October last year.

Advice for travellers

Lassa fever is an acute viral illness that occurs in sub-Saharan West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5,000 deaths occur each year. However, Lassa is a remote risk for most travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. For 80% of people infected, Lassa fever is mild or has no observable symptoms. The remaining 20% can experience severe, often fatal, multisystem disease. Read more about Lassa fever.

Hike in dengue cases

The capital Dili has borne the brunt of a dengue fever outbreak, reporting 466 of the nearly 650 cases confirmed across the country this year and six of the 14 deaths. The remaining eight fatal cases were in the municipalities of Ermera, Covalima, Ainaro and Bobonaro. This year’s case numbers represent just over 70 percent of the total recorded for all of 2021, with children aged under 14 years most affected. 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 alert sounded in East Java

Dengue fever cases have topped 1,220 in East Java this year and are still rising, with highest numbers in the regencies of Bojonegoro, Nganjuk, Malang District, Ponorogo and Tuban. Children aged between five and 14 years made up the majority of the 21 fatal cases. The current situation is a substantial increase in both deaths and infections reported for the same period last year. 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.

Dengue cases on the rise

Dengue types 1 and 2 are both circulating in Asunción, and suspected cases have been trending upwards in both the capital and in Central department over the past three weeks, according to the Arbovirus Surveillance Report. The highest cumulative dengue fever incidence rates are in Alto Paraguay and Presidente Hayes, with the national YTD total of confirmed dengue infections now exceeding 2,000 cases from nearly 17,000 notifications. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which 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 insect repellent containing an active ingredient, such as DEET, Picaridin or PMD when outdoors to all exposed skin. Read more about dengue fever. Read more about dengue fever.

Malaria uptick in NE; Rabies death in Eastern Cape

Last week the National Institute for Communicable Diseases (NICD) cautioned that early non-specific symptoms shared by both malaria and COVID-19 have led to an increase in late-presenting malaria infections, which are then harder to treat. Malaria cases have risen recently in KwaZulu-Natal, Limpopo and Mpumalanga as pandemic travel restrictions were relaxed, allowing more travel to risk areas of neighbouring countries. Read more

RABIES has claimed the first human life this year, a young girl who lived in the Eastern Cape where nine of the 19 fatal cases recorded last year were located. Of the remaining ten cases, six were in the province of KwaZulu-Natal and four in Limpopo. News sources report no post-exposure prophylaxis was sought for the young girl after she was bitten on the lip by a dog.  Read more

Advice for travellers

Rabies is present in most countries and all travellers should be aware of the importance of avoiding contact with wild and domestic animals – especially dogs, the main source of infection. If bitten or scratched, urgent first aid and post-exposure treatment is required. Vaccination recommendations are itinerary-specific but include those travellers planning to live in, or travel extensively or repeatedly through, endemic countries. Read more on rabies.

Kyotera deaths investigated

Investigations continue into the cause of death and illness among some members of Kyotera District communities (Central Region). Initial tests have excluded several haemorrhagic fevers which were under consideration due to the presenting symptoms – ‘fever, swellings, abdominal and chest pain, vomiting, and general body weakness and [death] within a week. Read more

MenB spike in late 2021; Shigella alert for MSM community

Health authorities have confirmed a rise in invasive meningococcal disease cases that took off in the 15 to 24 years cohort in September last year. According to UKHSA data, the increase followed ‘easing of COVID-19 containment measures’ and involved mainly meningococcal group B (MenB). Low or zero numbers of infections due to other serogroups (<6 percent for Group W and zero for Groups Y and C) reflects the benefits of the 2015 introduction of the MenACWY conjugate vaccination for adolescents (the same year a 3-dose course of MenB vaccines was introduced for infants, with no catch up for teenagers). Read more

WARNINGS on the heightened risk of extremely antibiotic-resistant Shigella sonnei infections have been directed primarily to the MSM (men who have sex with men) community, after a marked increase in cases was reported, mainly among that cohort, over a 4-month period from late last year and into January 2022. 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.