Travel Health Alerts

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 October 2018

Inadequate vax coverage in at-risk YF cities

From an Oct 8 Ministry of Health update with yellow fever data for 12 months from July 1 last year: 1,376 confirmed cases of yellow fever, 770 still under investigation and 483 deaths. In a computer translation of the release, the ministry ‘warns the population for the arrival of summer, the period of greatest risk of transmission of the disease. This concern is due to the fact that recently affected areas with large populations, such as the metropolitan areas of Rio de Janeiro, Minas Gerais and São Paulo, still have large numbers of unvaccinated people, i.e., those at risk of infection.  It should be noted that these states, since the beginning of this year, are already areas with vaccine recommendation (ACRV).’ Regarding YF vaccine usage, the release also notes ‘at present, fractional doses are not being applied, but rather the standard ones’.

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

Decision pending on raised Ebola alert

A decision will be made this week by a gathering of experts from the World Health Organization (WHO) on whether to escalate the Ebola outbreak in North Kivu and Ituri provinces to a Public Health Emergency of International ConcernRead more. The Oct 16 Ministry of Health update announced that there have been 216 cases of haemorrhagic fever, of which 181 are confirmed, 35 are probable and 32 suspected cases are under investigation. Of the 181 confirmed, 104 have died. It also notes that ‘The number of alerts in Beni has risen sharply indicating an improvement in the surveillance system and better collaboration of the community that uses emergency services’. Read more

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.

Single Côte d'Azur dengue case

Reports last week of the first locally-acquired dengue fever infection in mainland France for 2018 – a resident of Saint-Laurent-du-Var in the Provence-Alpes-Côte d'Azur region, <10kms west of Nice. Surveillance has been increased in the area, but more cases are unlikely due to the onset of cooler weather. Isolated cases of dengue fever have been reported in the area in previous years; the Aedes albopictus mosquito was first detected there in 2004. Read more

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. 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.

Zika cases rise to 72; Dengue, malaria persist

There are some concerns for the upcoming tourist season in the northern state of Rajasthan as Jaipur’s Zika virus disease cases rose to 72. The health minister commented on the outbreak this week, stating that it was localised, monitoring and insecticide fogging are underway and quarantine measures have been applied to the area. Read more 
ELSEWHERE, there has been a late rise in dengue and malaria cases in DelhiKotkapura and Jalandhar in the state of Punjab, Lucknow (Uttar Pradesh) and  in areas of Telangana state.

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 on smartraveller (DFAT). 

Flu season update

A 5-year peak in influenza infections (predominantly A(H1N1)pdm09) affecting mainly children under 5yo has been reported in the latest WHO global flu update, while elsewhere in the region the same strain is behind a rise in flu notifications in India and Thailand. See the full WHO update here

Advice for travellers

Seasonal flu is the most common vaccine-preventable travel-related illness because it is a potential risk during every stage of the journey. Whether you are travelling within Australia or overseas, Travelvax recommends vaccination, when available, for all travellers over 6 months of age. Read more on influenza.

Measles circulating

The number of measles infections is climbing, with Jerusalem reporting over half of all cases (341) this year. One local news source quotes one doctor who claims there are five to 10 new cases per day in the city. An expansion of the outbreak to other towns and cities is on the cards due to low vaccination rates in some areas. Read more

Advice for travellers

Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both 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.

Monkeypox export

A third monkeypox infection originating in Nigeria but diagnosed outside the country has been reported, this time in Israel. The infected man, an Israeli working in Port Harcourt, Nigeria, is believed to have contracted the disease while in Rivers state. This is also where the two recent UK cases were infected (a third UK infection was healthcare-related). Read more

Advice for travellers

Closely related to the smallpox virus, monkeypox is mainly found in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk for travellers. Read more on monkeypox

Polio case count rises to 15

As reported by the GPEI, a fifteenth case of polio (cVDPV1) was reported this week from the province of East Sepik and ‘two VDPV1 positive environmental samples, both collected on 5 September, were reported from Port Moresby’. Vaccination campaigns targeting all children under 15yo continue, while the WHO has released a report: ‘The First 100 Days of the Polio Outbreak Response in Papua New Guinea: A Summary’. 

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, 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

Chikungunya spreads to 7 states

During the current chikungunya outbreak, the WHO has categorised the risk of further spread to other states to be very high due to the widespread presence of the mosquito vector. ‘From 31 May through 2 October 2018, seven States (Kassala, Red Sea, Al Gadaref, River Nile, Northern State, South Darfur and Khartoum) have been affected with a total of 13,978 cases of chikungunya, 95% of which are from Kassala State’. Read more

Advice for travellers

The symptoms of chikungunya fever are similar to dengue fever and both are transmitted by the same mosquitoes – the day-time feeding Aedes aegypti and Aedes albopictus. Acute joint pain with a rash is typical of chikungunya and while fatal cases are rare, painful joints may persist for weeks or months after the acute phase has ended. There is no vaccine or prevention medication; using an effective, tropical-strength repellent to avoid insect bites is the best form of protection. Read more about chikungunya.

Measles outbreak in south kills 5

A measles outbreak has struck the landlocked province of Yala in southern Thailand killing five children and infecting nearly 350 people since last month. Highest rates of infection have been recorded in Yaha district, Bannangsata and Than Toh. Other provinces reporting outbreaks were Prachuap Khiri Khan, Samut Sakhon, Chiang Mai and Amnat Charoen. Read more

Advice for travellers

Measles occurs in developing and developed countries and unvaccinated travellers are at particular risk, both 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.

Hep A toll continues to rise

Hepatitis A cases, primarily among the homeless and illicit drug users, continue to mount, however, as noted by a ProMED moderator, ‘Spillover into other portions of the population, such as restaurant diners affected through infected food handlers will continue’. Kentucky (2,050 cases, 14 deaths since Aug “17) and West Virginia (1527 cases & 5 deaths since Mar ‘18) have been hardest hit among the 11 states cited in the ProMED post on Oct 16 (Archive Number: 20181016.6094878).

Advice for travellers

Hepatitis A (HAV) is a vaccine-preventable viral disease passed on to humans primarily through oral contact with faeces of an infected person. This can occur through contaminated food and water, by handling everyday items and sexual contact. It is a significant risk in travellers to developing countries where sanitation and hygiene are lacking. A course of hepatitis A vaccine offers immunity that is highly effective and protects for 20-30 years. Travellers should also follow these guidelines for safe food and water.

Diphtheria returns to Central Highlands province

Two deaths resulting from diphtheria infection, and a further five suspected cases, have been reported in the central highlands province of Kon Tum, adjacent to the borders with Laos and Cambodia. These are the first diphtheria cases in 11 years in the province which has pockets of low immunisation in some communities. Read more

Advice for travellers

Spread by coughing and sneezing or by direct contact with wounds or items soiled by infected persons, diphtheria is one of the infectious diseases prevented through routine childhood vaccination. It is also a component in the vaccine given to pregnant women for the prevention of pertussis. Read more on diphtheria.

New cholera cases slowing

The death toll in the cholera outbreak has climbed to 54 with five fatalities reported in the village of Buhera, around 220kms south of Harare - all five were related. A second round of vaccinations is due to start this week aimed at halting the spread of cholera – with more than 9,000 cases now recorded. Read more. Harare has borne the brunt of the outbreak. As stated in a ReliefWeb post on Oct 12, ‘The ten hot spot areas in Harare are: Glenview, Budiriro, Mbare, Epworth, Glen Norah, Granary, Mabvuku, Mufakose, Stoneridge, and Kambuzuma'. 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