Shifting disease patterns and outbreaks affect the recommendations and information we provide to travellers during a pre-travel consultation. Each week Travelvax updates the current travel health alerts to reflect those issues which could affect travellers heading to a particular region or country. We do this by scanning the websites of health agencies such as the World Health Organization and the European and US Centers for Disease Control, as well as international news media. Simply click on the point on the map of your area of interest for more details on the current health alert. We also include Advice for Travellers which gives background information and tips. If you have any further questions, of course you can give our Travelvax infoline a call during business hours on 1300 360 164.
World travel health alerts for 17th of May 2018
More states added to YF risk area
Three more southern states (Paraná, Santa Catarina and Rio Grande do Sul) are now included in the designated yellow fever (YF) risk areas after a recent assessment. Further: ‘the World Health Organization (WHO) expects that the yellow fever virus will continue to spread along the Atlantic Forest ecosystem in Sao Paulo State, towards Paraná State and the south of the country in the coming months’. See the report from UK TravelHealthPro. On May 9th, the health ministry updated official YF figures to 1,261 cases and 409 – mostly from south-eastern states.
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.
Ebola outbreak situation, response
The case count in the Ebola outbreak affecting Bikoro, Iboko and Wangata health zones in the country’s west is now 44: 3 confirmed cases, 21 suspected infections and a further 20 that are probable. A new development was a recently confirmed death reported over the weekend that took place in an area close the provinicial capital of Mbandaka, home to one million people. Read more. An unlicensed vaccine that had proved to be effective when used in the late stages of the Guinea outbreak in 2016 is to be employed on a voluntary basis in the remote area, targeting ‘contacts, contacts of contacts, international and local healthcare and frontline response workers in the hot spots, and healthcare and frontline responders in areas at risk’. Read more
Advice for travellers
Ebola 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.
Men. meningitis vax campaign kicks off
A meningococcal meningitis C vaccination campaign began this week in the Central Division (Ra subdivision), the location of 39 of the 65 cases since Jan 1 this year. The May 7 Ministry of Health update notes that of the 65, ‘25 are laboratory confirmed, 7 probable, and 33 suspected ... an average of 3.6 suspected cases per week in the last 4 weeks.’ To date, all those infected have been under 19 years of age. Read more
Advice for travellers
Advice on the prevention of meningococcal infection, as stated on the Fiji Ministry of Health and Medical Services website, includes: Practicing good hygiene such as covering mouth and nose when coughing or sneezing and washing hands; don’t share utensils, cups/glasses, drinks at social gatherings, cigarettes, or kava bowls. If planning travel to Fiji, discuss whether vaccination against meningococcal meningitis would be appropriate for your itinerary with your doctor or travel clinic. Read more about Men. meningitis.
Dengue, JE, malaria and more
Dengue reports this week from Alandi in Maharashtra state, a renowned pilgrimage destination, as well as Kasargod in Kerala. In the NE town of Kushinagar (Uttar Pradesh), up to 10 patients are being admitted on a daily basis for treatment of Japanese encephalitis, well ahead of the peak season for the illness. High temperatures in Ahmedabad (state of Gujarat) early this month are being blamed for a rise in the incidence of food-and water-borne infections such as hepatitis and typhoid, as well as malaria.
Advice for travellers
A mosquito-borne virus, JE is usually found in many part 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 urban centres and use effective mosquito bite avoidance measures is very low. The recommendations for vaccination are itinerary-specific. Read more on JE.
Measles checks initiated
As the number of measles cases in Okinawa climbed to over 90, the government took steps to ensure that hospital workers and infants attending nursery school are fully vaccinated i.e. they have received two doses of a measles-containing vaccine. A local news source also revealed that the outbreak has spread beyond Okinawa and Aichi prefectures to Tokyo and Kanagawa prefecture.
Advice for travellers
Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, during travel, 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.
Cholera hits south
Drinking water contaminated with sewage during flood conditions or damage to infrastructure has caused an outbreak of cholera, with many patients from Nairobi county seeking treatment in adjacent Kiambu county. 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. For general advice on vaccination options for your trip, call Travelvax Australia’s travel health advisory service (1300 360 164).
Rabies deaths climb to 4
Just a week after notification of the third rabies death this year, there is news of a fourth, a child in Sandong (13km SW of Kuching CBD, in Sarawak). The child, who was bitten by a stray dog late in April and did not receive the appropriate post-exposure rabies treatment according to a Health Ministry report, is currently in hospital in a critical condition. Read more (translation required).
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. If bitten or scratched, urgent post-exposure treatment is required. Vaccination is normally recommended for longer stays, especially travellers planning to live in, or travel extensively through, rural areas and also for children; however the final recommendation is itinerary-specific. Read more on rabies.
Malaria in 5 states: Kissing bug disease rates on Peninsula
A local news source cites the National Epidemiological Surveillance System in reporting malaria cases from Chiapas, Chihuahua, Tabasco, Campeche, and a new addition, Quintana Roo. Other information disclosed in the article included the potential for malaria in the tourist hotspot Cancun due to the presence of the Anopheles mosquito vector.
THE SURVEILLANCE System has also posted an update on Chagas disease (American trypanosomiasis) in the Yucatan – 15 cases for the year. ProMED notes that ‘The Yucatan region has some of the highest levels of Chagas in the country.’
Advice for travellers
Although widespread in Mexico, Central America, and South America, Chagas disease presents a low risk to Australians travelling to the Americas. Travellers who sleep indoors in air-conditioned or screened hotel rooms are at low risk for exposure to infected triatomine bugs (aka kissing or assassin bugs), which infest poor-quality dwellings and are active mainly at night. However, as has become more common, the disease can also be transmitted through food and freshly pressed juice contaminated with the faeces of insects attracted to ripening fruit. Read more on Chagas disease.
Lassa fever eases
Surveillance for further Lassa fever cases continues during the current season, but case numbers have dropped over the past six weeks and so some response activities have been eased. Read more. In Liberia, Margibi became the fourth county to report Lassa fever cases after two deaths were confirmed last week. Many of the previously suspected cases proved negative – 67 of the 81 - after laboratory testing. The death toll now sits at 22. 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 on Lassa fever.
Polio risk persists
The upshot of a WHO meeting on the global polio situation was commendation for Pakistan on the low disease count this year, however it noted: ‘environmental surveillance continues to detect WPV1 (wild poliovirus 1) transmission in many high risk areas of the country such as Karachi, Peshawar and the Quetta Block.’ There was also a comment on ‘the stagnation in progress in Afghanistan and the ongoing risks to eradication posed by the number of inaccessible and missed children, particularly in the southern and eastern regions’. In conclusion, it was decided to extend the Temporary Recommendations for a further three months as ‘the risk of international spread of poliovirus remains a Public Health Emergency of International Concern’. Read more
Advice for travellers
Polio is a potentially serious viral illness that is spread through contact with infected faeces or saliva. The risk to travellers is generally low. 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 poliomyelitis.
Dengue fever toll now 13
While there are nearly 3,000 confirmed dengue fever cases, the number of suspected infections is over seven times higher and the death count has risen to 13. Five of the country’s departments are reporting cases. Read more(translation required).
Advice for travellers
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 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 PMD when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.
Luzon’s first JE cases this year; Dengue deaths rise in Eastern Visayas
The first Japanese encephalitis cases for 2018 have been recorded on Luzon, with two in Benquet, one from Baguio City and five others ‘from outside the Cordillera region’. Read more
EASTERN Visayas has experienced a sharp rise in dengue fever-related deaths this year – 13 of the 1,066 cases succumbed to the mosquito-borne infection; last year the annual death toll was five. The two provinces that are most affected are Leyte and Northern Samar. Read more
Dengue escalates
Weekly dengue fever case numbers rose to 388, with the year-to-date total now at 2,980. The western districts remain those with most cases. Read more (translation required). Dengue is reported as being widespread in the Seychelles, according to a Russian Foreign Ministry travel warning issued this week. Read more (translation required).
Dengue warning for travellers
The British Foreign Office has added a link to the local Epidemiology Unit dengue fever update in its advice to travellers. The dengue case count has climbed to over 18,500 for the year to date and the Western Division continues to report most cases. See Smartraveller advice for Australian travellers.
Vax campaign brings hope for outbreak end
Rates of measles immunisation (2 doses) plummeted from a high of 95 percent in 2008 down to just over 30 percent in 2016, leading to an extensive outbreak – 12,000+ cases this year with nine fatalities. In a turnaround, a campaign is underway to restore the 95 percent rate by the end of the year. ReliefWeb notes that: ‘Ukraine is facing the largest outbreak in the Region, but high case numbers (100 or more per month) are also being reported by France, Georgia, Greece, Italy, Romania, the Russian Federation and Serbia.’
Measles imports
Regular travel between Europe and the UK has fanned the spread of measles across England: Up to May 9th, London has recorded 164 of the national total of 440 confirmed cases, followed by the Southeast, West Midlands, Southwest and West Yorkshire. Like the ongoing outbreaks across many parts of Europe, the majority of those infected were unvaccinated, or undervaccinated. Read more
More than half mumps cases over 18yo
Hawaii’s mumps outbreak continues with a new case on Maui, infected while visiting Oahu. This latest case takes the total to 985 since March last year. The Hawaii Health Dept. website notes that ‘nearly 60% of cases have been in adults aged 18 years and older. There have been 30 reports of complications due to mumps infection (e.g., orchitis, hearing loss).’ Read more
Advice for travellers
These consequences of mumps infections highlight the importance of current immunisation against contagious childhood diseases, such as whooping cough (pertussis), diphtheria, rubella and measles for travel to any destination – be it a developed or developing country. Read more about mumps.