Travel Health Alerts

Cholera confirmed in central province

An outbreak of cholera has been confirmed in the central province of Sofala, with at least 160 cases recorded in Caia district since August. Read more. Elsewhere in the region, Benin’s usual cholera hot spots are implicated in the latest outbreaks dating from early August. Most cases have been reported in the coastal departments of Atlantic and Littoral.

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.

Regional yellow fever update

A PAHO regional update on yellow fever (YF) has identified new corridors of transmission in the southern region of Brazil, resulting in more routes and municipalities as the focus for disease surveillance and immunisation activities. Epizootics reported through the 2020-2021 seasonal period have been predominantly in the South Region, with confirmed outbreaks among non-human primates in the states of Minas Gerais, Rio Grande do Sul and Santa Catarina. The same report covers YF data for Peru: 14 confirmed or probable cases and seven deaths recorded this year (to Sept 18) from the departments of Puno, San Martín and Loreto. None of those infected were vaccinated. The country is also contending with dengue outbreaks in 51 districts of 15 departments, including Piura, San Martín, Loreto, Huánuco, Junín, Cajamarca, Cusco, Madre de Dios, Ayacucho, Lima, Amazonas, Ucayali, Pasco, Tumbes and Ica. A state of emergency has been declared in the affected regions. 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.

Group B strep uptick; Avian flu case in Hunan Province

Hong Kong’s health department (CHP) is investigating a spike in invasive Group B Streptococcus infections after confirming 79 cases since early last month. The agency ‘considers that handling raw freshwater fish with hand wounds or consumption of undercooked freshwater fish may be associated with the infection’ and has alerted the public to the need for personal, food and environmental hygiene measures. Read more

A OCT 18 CHP press release announced another avian influenza A(H5N6) infection has been detected on the mainland (Changde in Hunan Province), the 24^th human case this year. The patient, who is confirmed to have had exposure to dead poultry, has been hospitalised in a critical condition. 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.

Polio case in NW region, global digest

In the past fortnight, the GPEI has reported Madagascar’s second cVDPV1 case in two weeks (in Boeni), while Nigeria logged a total of 35 cVDPV2 cases (in Adamwa, Bauchi, Jigawa, Katsina, Borno, Gombe, Kano, Taraba and Yobe) and Côte d’Ivoire’s single cVDPV2 infection was from Guemon province. Elsewhere, the ECDC announced that a cVDPV2 infection had been confirmed in an unvaccinated 18mo girl from the Ukraine’s Rivne oblast. The virus strain has been linked with those circulating in Pakistan. Polio vaccination rates in the Ukraine’s north-west are reported to be under 49 percent. In other polio news, the Strategic Advisory Group of Experts on immunization (SAGE) has endorsed the transition to the next use phase for the novel oral polio vaccine type 2 (nOPV2) vaccine.

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.

New COVID-19 records

The WHO epi update this week notes a stabilisation in new global cases and mortality, and all regions except Europe experienced an overall decline in numbers. The latest Johns Hopkins report provided more details: in the past fortnight ‘16 European countries have reported increases in daily incidence of 25% or greater, including Czechia (+102%), Latvia (+118%), and Poland (+123%) with greater than 100%’. Most of the countries reporting increases are in Central and Eastern Europe (except for Ireland, Iceland and the UK). Russia’s daily case and death incidences are at record highs with just under one third of the country fully vaccinated. According to a WHO study, only one in seven COVID-19 cases in Africa are detected, so actual numbers are more likely to be 59 million cases and not the more than eight million recorded. Eight countries are to participate in a program of ramped-up screening and preventive measures initially funded by the agency - Burundi, Cote d’Ivoire, Democratic Republic of the Congo, Guinea-Bissau, Mozambique, Republic of the Congo, Senegal and Zambia. In our region, overall both new cases and deaths are lower, but notably, Papua New Guinea has reported a 481 percent rise in the weekly reporting of new deaths.

In related news:

- An ABC article elaborates on the two COVID-19 treatments recently approved in Australia - Ronapreve and PF-07321332.  

- ‘Why easing COVID restrictions could prompt a fierce flu rebound’, as other respiratory viruses return in unexpected ways: Nature

- The WHO and SAGE have recommended that people aged over 60 who received either the Sinovac or Sinopharm COVID vaccines receive a third dose of the same or another vaccine to ensure sufficient protection as ‘the immunity from two doses of either vaccine wanes rapidly, and the protection offered to older people is limited’. Read more

- In the US, the FDA is scheduled to consider amending ‘Pfizer-BioNTech’s Emergency Use Authorization (EUA) for administration of their COVID-19 mRNA vaccine to children 5 through 11 years of age’ on Oct 26.

-  International COVID-19 vaccination certificates are now available to download through MyGov. They are linked to a physical passport and are compatible with IATA's Travel Pass. Read more  

- Each week the ECDC publishes updated maps through which ‘a coordinated approach to the restriction of free movement in response to the COVID-19 pandemic’ is outlined through the use of colour-coding.

- A Strategy to Achieve Global Covid-19 Vaccination by mid-2022 and 40 percent by the end of 2021, as planned by the WHO.

- The TGA has approved several self-test kits for use at home from the beginning of next month Read more

- CIDRAP commentary articles: What can masks do? Part 1: The science behind COVID-19 protection and Part 2: What makes for a good mask study — and why most fail.

Ebola again in NE; Measles in 23 provinces

Five new Ebola virus disease cases, three of them fatal, have been reported among neighbouring families in Butsili health area, North Kivu province. Sequencing suggests this is a flare-up of the 2018-2020 Ebola epidemic, the country’s 10^th, which centred on the NE provinces of North Kivu and Ituri. Contact tracing and ring vaccinations are underway in the commercial hub of Beni. The WHO believes sporadic cases will continue to emerge in areas of previous outbreaks as the Ebola virus has been shown to persist for months in immune-protected parts of the body. Read more

MORE THAN 41,000 suspected measles cases and 609 deaths have been registered for the year to Sept 26. The WHO weekly bulletin reports that 23 provinces, including the capital Kinshasa, have confirmed cases, while children aged under five years have been hardest hit.

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.

Having a “Pogosta year”

2021 is turning out to be a peak in the roughly seven year cycle of Pogosta disease, a mosquito-borne Sindbis virus (SINV) infection, and this year’s total of 467 cases is the highest in nearly 20 years. Most cases have been reported from North Savo in Eastern Finland, followed by Central Finland, North Ostrobothnia and the Pirkanmaa region. Disease incidence is highest during autumn and infections are characterised by ‘a rash, mild fever and other flu-like effects — but in more extreme cases can lead to a painful arthritis’. Read more

Zika risk ‘moderate’; Dengue & chikungunya late in season

The WHO has assessed the level of risk from confirmed Zika cases reported in Kerala and Maharashtra this year as moderate due to the established presence and densities of the mosquito vector, likely interruption of insect control measures during the pandemic, plus ‘ecological conditions are favourable for ZIKV transmission and potential endemicity’. The initial case confirmed in Kerala led to a further 89 detected through screening in the local area – all either resided in, or had travelled to, Trivandrum district. In Maharashtra (Belsar, Pune district), no more Zika infections have been identified to date from the single confirmed case, however some results are pending.  

THE PROLONGED monsoons have produced later surges in seasonal illnesses and they could continue well into next month. Dengue cases have been rising in the states of Haryana, Punjab (Amritsar and Chandigarh Tricity) and to the north in Jammu and Kashmir (Kathua), while chikungunya rates are at 4-year high in Mumbai (Maharashtra). In neighbouring Pakistan, dengue is added to the public health burden in the cities of Lahore and Islamabad.

Advice for travellers

Zika’s symptoms include a rash, pain in the joints, and the eye condition, conjunctivitis lasting 4-7 days. Long-term ill-effects are rare, although the joint pain may linger for weeks, even months. Like dengue and chikungunya, Zika is spread by Aedes mosquitoes which bite by day and are found in urban setting, including leafy gardens and outdoor restaurants – even in upmarket hotels and resorts. Transmission of Zika virus has also occurred during pregnancy, breastfeeding, sexually and also through blood or blood products. Travellers should take particular care to avoid being bitten just after sunrise and just before sunset, the main feeding time for Aedes mosquitoes. All travellers, but particularly pregnant women or those planning pregnancy, should seek medical advice before travel to Zika-affected areas. Read information accessed through smartraveller (DFAT).  

JE death in southern island

A rare death due to Japanese encephalitis has been reported in Kunisaki City in the NE prefecture of Ōita on Kyushu Island. Local news sites say the fatal case, a woman aged over 80, is the first such instance in the area since statistics were started in 2006. Read more

Advice for travellers

A mosquito-borne virus, JE is usually found in many parts of Asia, the Indian subcontinent, Southeast Asia and China, although cases also occur in Indonesia and PNG. It is mainly found in rural areas around rice paddies where pigs, wading birds and humans live closely together, however it does also occur in or near cities. The risk to short-stay travellers who confine their travel to large urban centres and use appropriate mosquito bite avoidance measures is low. The recommendations for vaccination are itinerary-specific. Read more on JE.

Protracted Kala azar outbreaks

According to the latest WHO weekly bulletin, the outbreak of visceral leishmaniasis that was declared in January 2020 remains active in four counties - Kutui, Tharaka Nithi, West Pokot and Wajir. The case count now sits at 1,120 with 10 deaths. In Panama, it’s cutaneous leishmaniasis that has sickened some members of the indigenous Ngäbe communities of Charco La Pava, Guayabal and Valle del Rey.

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.

Terai town reports cholera

Cholera has sickened nearly 900 people and led to the deaths of four in the southern border municipality of Krishnanagar in Lumbini province (western Terai). The presence of cholera was confirmed from testing undertaken in response to a surge in diarrhoeal illnesses, while analysis of drinking water supplies has also detected E coli bacteria. The town sits on the border with India at Barhani Bazar and nationals from both countries cross the border with no restrictions. Read more

Advice for travellers

While the risk of infection with cholera is low for short-stay travellers, Australians travelling to regions where an outbreak is occurring should adhere to strict personal hygiene and choose food and beverages with care. Read more about cholera.

Cholera death toll mounts; Most Lassa fever cases in 2 states

The widespread cholera outbreak is ongoing and the death toll continues to rise, now estimated to be exceed 3,200 from almost 90,000 suspected cases. While 31 states and the Federal Capital Territory have all reported cases, almost half have been in the states of Bauchi, Kano and Jigawa. Children between five and 14 years have been hardest hit in the outbreak. Read more

THE NCDC update on Lassa fever has two states accounting for around 80 percent of all suspected cases recorded this year - Edo and Ondo. Other details from the update: the most affected age group is people from 21 to 30 years and the national death count has climbed to 78. Read more  

Advice for travellers

Lassa fever is a low risk for most travellers. Rodents shed the virus in urine and droppings and it’s then passed on to humans through direct contact, touching objects or eating food contaminated with these materials, or through cuts or sores. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease. Read more about Lassa fever.

DENV-3 re-emerges after decades’ absence

The NEA has warned that the dengue virus serotype 3 detected in two large clusters recently has not circulated in the country in the past 30 years, so ‘the population immunity for DENV-3 is low, and people are therefore more susceptible to transmission of the virus’. Surveillance and trapping has seen areas of high density of the vector and the NEA warns that people working from home provide ‘more blood meals for the day-biting Aedes aegypti mosquito’.

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 suspected in capital’s informal settlements

At least two news outlets are reporting an outbreak of what is suspected to be typhoid fever in informal settlements of the capital, Lusaka. Testing has detected faecal contamination in some local water samples. Read more

Advice for travellers

Typhoid fever is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.