Travel Health Alerts

5 more cVDPV2 cases, global digest

Two African countries each reported five more cVDPV2 cases from four provinces this week - Sudan and Burkina Faso, while the DRC recorded three cases (Maindombe and Equateur provinces) and Nigeria’s single infection was in Sokoto. Across the globe, Afghanistan reported one wild poliovirus 1 (WPV1) case in Kandahar province and Pakistan’s total for the week was a single WPV1 case (Punjab province) and three more cVDPV2 infections (Sindh and Punjab provinces). 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 retains its hold on the region

Dengue fever data for the Americas this year, published in an ECDC bulletin, ranks Brazil, Paraguay, Mexico, Bolivia and Colombia in the top five places, while all four dengue serotypes are in circulation. From the same ECDC report: Singapore’s dengue peak passed in July but the weekly total is still high – roughly twice the average over the past three years for the same period; while on Reunion Island the dengue epidemic is described as of medium intensity with more than 16,000 cases recorded this year. Mosquito control measures are operational day and night in order to curb the outbreak. More on the global dengue fever situation in a ProMED post and for our region from the SPC.  

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close homes and other accommodation. They bite mainly during the daylight hours and can be found indoors, 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 repellent containing an active ingredient, such as DEET, Picaridin, or oil of lemon eucalyptus (PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.

Variant influenza A case in central Alberta

Health authorities have confirmed a human case of influenza A(H1N2) variant virus of pig origin in the province of Alberta, the first such detection in Canada and the 27^th worldwide since 2005. After developing mild flu-like symptoms in mid-October, the individual was ‘tested for COVID-19 and influenza and quickly recovered’. No further cases have emerged among contacts, residents of the province and slaughterhouse workers. Read more

11th Ebola outbreak over; Cholera surfaces in Lomani

November 18 saw the end of the DRC’s 11^th Ebola outbreak declared – the last confirmed case, in Makanza health zone, was on Sept 28. A WHO summary noted that the logistical challenges were enormous as the ‘outbreak took place in communities scattered across dense rain forests as well as crowded urban areas’. Surveillance activities continue. Read more

SEVERAL provinces have experienced cholera outbreaks this year – in particular Haut-Katanga and Kasaï-Oriental – but the most recent reports have related to 55 cases and eight deaths which occurred over a 3-week period in Kalambayi, in the south-central province of Lomani. In other news on cholera outbreaks in Africa: there have been reports of infections in the busy port area of Togo’s capital city, Lomé, and an update on the situation in Banadir, Somalia. Read more

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.

Dengue finally trending downwards

Finally some decline seen in new dengue cases across the island groups with news, attributed by the ECDC to French authorities, that numbers started to fall in the first week of October. Regardless, ‘Guadeloupe, Saint-Martin, Saint-Barthélemy and Martinique are all in an epidemic phase’ after a further 3,778 dengue cases were recorded in the fortnight to Nov 12. 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.

COVID-19 cases top 500k

Actual infection numbers are estimated to be much higher than the 4,000+ reported each day due to low rates of testing and high positives as the country’s total rose above half a million – the highest in SE Asia. Read more. Japan’s third wave is gaining pace with five days of 2,000 or more infections registered recently. Elsewhere, 13 European countries are reporting a decline in new cases after the introduction of public health measures, according to the Nov 20 JH newsletter, and now the ECDC has released its projections for each country in the region up to Dec 25. More on the global situation in the Nov 24 WHO epi update.

In related news:

-The results from phase 2 of the AstraZeneca vaccine’s Phase 2/3 clinical trial were published in The Lancet last week. CIDRAP reported that ‘WHO officials said they have been in talks with Oxford and AstraZeneca about the vaccine being submitted for WHO prequalification, and they hope for a formal assessment at the beginning of the new year’.

-Some countries are requiring proof of negative COVID-19 test results from arriving passengers but the validity of the proof may in some cases be questionable after the discovery of counterfeit digital certificates in the UK, France and Brazil. Two apps in development should stymie this black market trade - CommonPass (Commons Project & World Economic Forum) and IATA’s Travel Pass are digital platforms where a traveller’s health status and test results can be uploaded from verifiable sources in order to satisfy country requirements. Read more

-The US CDC has updated its advice for cruise travel, now including it in its Level 4 advisory: Very high level of COVID-19.

TB prevalence underestimated

The release of a study measuring the annual TB prevalence reveals that the true figure is up to 1.6 times higher than previously estimated, at 415 per 100,000 (117,000 cases). Data provided in a news report shows the death rate is also greater – more than 17,000 TB-related deaths each year is three times higher than the previous calculation of 5,500, a rate of 46 people per day losing their lives to tuberculosis. Moreover, lockdown restrictions are likely to have exacerbated the situation, prompting calls for immediate public health measures. Read more

20 more yellow fever cases; Malaria uptick following floods

From an overview of yellow fever (YF) cases reported to the NCDC this year: More than 1,550 suspected cases were recorded from across all 36 states and the Federal Capital Territory. The agency’s latest update revealed another 20 confirmed cases in Enugu (14), Benue (3), Delta (2) and Ebonyi (1) and two associated deaths. In other YF news, vaccinations are planned for nearly 1 million residents of three of the badly affected council areas in Enugu, and investigations are underway after more than 50 people died of unknown causes in the neighbouring state of Kogi. Meanwhile the YF outbreaks in five states are the subject of a WHO Disease outbreak news post of Nov 24.

THE ANNUAL rains that hit the central savanna state of Jigawa have caused floods and subsequent loss of shelter to thousands of people, and now a surge in malaria cases which has caused overcrowding in local hospitals.

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.

Legionella in northern counties

Investigations are continuing into the source of 72 Legionnaire’s disease infections logged since late October in the northern counties of Póvoa de Varzim, Vila do Conde and Matosinhos. To date there have been nine associated deaths among the cases (average age of 75 years). An environmental source is considered likely and the ECDC reports that two buildings’ cooling towers have been shut down. Read more

Advice for travellers

: Legionnaire’s disease occurs worldwide and many of the increasing number of cases reported in Australia in recent years have been linked to overseas travel. Outbreaks have been associated with hotels, resorts and cruise ships. The bacteria that cause Legionnaires’ disease are found in 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

NE state’s virus cases ‘concerning’

Last week a senior New Hampshire health official declared that cases of Jamestown Canyon virus (JCV) were rare – five reported this year - but the fact that the state is seeing more of them is concerning. The most recent case, a man from Newport, remains in hospital, suffering ‘left side weakness, unresponsiveness and multiple seizures’. JCV infection is transmitted to humans by mosquitoes that have fed on infected deer and generally results in a mild illness presenting with fever, headache, dizziness and fatigue. In rare instances, the infection can cause encephalitis and meningitis. US CDC information on JCV notes that most cases are in the upper Midwest and around ‘half of patients reported with Jamestown Canyon virus disease are hospitalized’, but deaths are rare. Read more

Flood-related infection spikes in central provinces

A series of typhoons and storms have hit the central region in the past month, leading to widespread flooding. News sources are now reporting that around half of the patients presenting with melioidosis at a hospital in the central city of Huế are from the flood-affected central provinces of Nam Dinh, Thanh Hoa, Quang Binh, Ha Tinh and Quang Tri. As many as 28 patients have been admitted to the facility since October, many of them in the late stages of the infection. Read more

Eastern province’s malaria cases ‘raised a red flag’

Over the past three weeks, malaria case numbers in the province of Manicaland have surged, ranging between 800 and 1,000 per week and ringing alarm bells for the national government. The death toll has also increased this year in the province, which lies along with the border with Mozambique and has three districts that rank in the national top 10 for their malaria burden. 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.