Travel Health Alerts

Global polio digest; Cholera alert in NE

Four African countries reported circulating vaccine-derived polio type 2 (cVDPV2) cases dating from 2022 to the GPEI last week: Chad (two cases in the departments of Chari-Baguirmi and Logone Occidental), Algeria (one patient in El Oued province), Mali (a single case in Taoudenit region) and the DRC, which also recorded cVDPV1 infections - a combined total of 30 type 1 and type 2 cases from eight provinces. Read more

ON FEB 10, the WHO published an Outbreak News post on the cholera outbreak underway in two health zones of North Kivu province (Nyiragongo and Karisimbi). Onward spread of cholera from the internally displaced populations (IDPs) camps into surrounding communities has been confirmed and the WHO suggests that conflict in the affected areas and the current rainy season could trigger the seeding of infections into neighbouring countries. The North Kivu outbreak is one of the cholera events contributing to a deteriorating global situation for the disease as outlined in a Feb 11 WHO update. 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.

Mosquito risk in the Top End; Health recommendations for Pride festival

Mosquito bite warnings are again being issued, this time in the Northern Territory, after the health department announced the death of a woman from Murray Valley encephalitis (MVE) last month. The department advised that her infection was probably acquired in Darwin, and the ‘virus is present from February to July in the Top End of the NT, north-west of Western Australia and inland North Queensland during most years, and can extend into the Barkly and Central Australia in wet years.’ Read more

WORLDPRIDE celebrations commence in Sydney on Feb 17 and a number of useful resources for participants have been made available by NSW Health, including vaccinations (routine and mpox), accessing medical help, and staying safe.

Advice for travellers

While the risk of contracting MVE is generally low, the virus can cause severe illness, even death in very rare cases. The vector mosquitoes are active at dawn and dusk, particularly in the first two hours after dark. They pass on the virus to humans after feeding on infected birds attracted to flooded wetlands. Travellers to wetland areas of Australia should take all measures to prevent bites. Apply an insect repellent containing DEET, picaridin, IR3535, or oil of lemon eucalyptus to exposed skin when outdoors. Read more about MVE.

Norovirus cases surging

Norovirus cases, also known as winter vomiting bug, have spiked in England, having risen 66 percent above the average for this time of year. The UKHSA advised that the highest rates of infection are amongst the over 65s and in aged care facilities. The public has been reminded to practice good personal hygiene, including hand washing with soap and water (not alcohol hand sanitiser) to prevent infection. And in the US positive results from norovirus testing have shown an upward trend in the past few weeks, and of the 14 states experiencing a surge in cases since mid-January, most have been in the mid-West. Elsewhere, Chinese provincial health authorities in Guangdong, Jiangsu and Henan have warned that peak norovirus season has arrived and cases are expected to increase as students return to schools and campuses. Read more

Advice for travellers

While it is extremely contagious, norovirus infection is generally short-lived, causing nausea, vomiting and diarrhoea, which may lead to more serious complications among young children, the elderly, and the sick. To minimise the risk, wash your hands with soap and water after using the toilet and before eating, and practice good hygiene. Read more on norovirus.

Regional Strep A reporting; Tracking flu activity

The ECDC provided an update on group A streptococcal (GAS) infections across the region, noting for scarlet fever cases ‘an exceptional level of activity at this early point in the season’. There has been an overall decline in new invasive GAS (iGAS) infections cases since the end of 2022, however notifications had increased in France, Ireland, the Netherlands and Denmark. In all areas, the age groups of those most affected are children under 10 years and adults 65 years and older. Read more

FLU ACTIVITY in Europe peaked in the second last week of 2022, however there was an uptick due to influenza B virus circulation in the week ending Feb 5. In the same week, seven countries reported greater than 40 percent test positivity in sentinel care (France, Israel, Netherlands, Romania, Slovenia, Slovakia and Ukraine). Read more

Advice for travellers

Scarlet fever is a low risk for most travellers. A mild bacterial infection, it generally causes strep throat or, less commonly, streptococcal skin infections. It affects people of any age, but is most common among children. The classic symptom is a sandpaper-like red rash. Scarlet fever is treatable with antibiotics which helps clear up symptoms faster, reduces spread to other people and prevents rare but serious long-term health problems. Read more on group A streptococcal infections.

Marburg virus disease confirmed in NE

The first reports of an outbreak of haemorrhagic fever in the NE province of Kie Ntem Province emerged last week, and the WHO has now confirmed Marburg virus disease (MVD) in one person. There are a further 16 suspected cases and nine deaths among people who at recently attended a funeral. Across the border in Cameroon, two suspected MVD cases have been identified in Olamze health district. The agency is assisting Equatorial Guinean authorities in their response to the country’s first MVD outbreak and an urgent meeting of the WHO R&D Blueprint committee was called ‘to discuss vaccine and therapeutic candidates’. Read more

Advice for travellers

Marburg virus disease (MVD) is a severe viral haemorrhagic fever, related to the Ebola virus, and there is no treatment. Found in the African fruit bat, Marburg typically appears in sporadic outbreaks and laboratory-confirmed cases have occurred in Uganda, Zimbabwe, the Democratic Republic of the Congo, Kenya, Angola, and South Africa. Preventive measures are not well defined, as study in how it is spread continues, but travellers should avoid contact with fruit bats and sick primates in central Africa. Read more on MVD

Potential listeria risk prompts recall

More than two dozen cheeses produced by a company in the central department of Allier have been voluntarily recalled as a precaution after a routine check detected listeria at one of its manufacturing facilities. The recalled products (made from goat, sheep or cows’ milk) are widely distributed in France. Read more

Advice for travellers

Infection with listeria (listeriosis) is a rare but serious bacterial disease. The organisms grow on certain high risk foods and are unusual in that they will grow in cold conditions, such as in the refrigerator. They produce a flu-like illness with symptoms of fever, chills, nausea, diarrhoea and muscle aches. Complications such as meningitis and septicaemia are more common in the elderly and in immunocompromised people, and infection during pregnancy is associated with miscarriage or stillbirth. Read more about listeriosis.

Recent human and animal rabies reports

Local media reported on rabies exposures to two tourists in Bali, dating from December after they sustained bites from rabid dogs while in Legian. A separate, more recent, article related to a suspected rabies fatality in a female resident of Bali’s Jembrana regency. No details were provided on the outcome of the incident involving the foreign tourists as they were lost to follow-up, however it was known that the woman from Mendoyo district had been bitten by a dog but had not sought medical treatment. 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, urgent 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 and also for children. Read more on rabies.

Disease risk in storm’s aftermath

Local and regional aid agencies are on the alert for disease outbreaks following the passage of a severe cyclone last month. According to the WHO, ‘There is crucial need to increase surveillance activities in affected areas due to the increased risk of water-borne (cholera, typhoid fever, shigellosis, etc.) and vector-borne (malaria, plague) disease outbreaks, as well as vaccine-preventable disease outbreaks (measles, meningitis, poliomyelitis).’ Read more

Measles risk sites listed

A five day window of potential measles exposures is being managed by the health department, with advice provided to people who may have been in contact with an infected individual from Feb 5 to 11 across several locations in Auckland, Waikato and Tauranga. According to the department, the individual, who acquired the infection overseas, had attended a popular music festival as well as a hotel, supermarket, pharmacy and more. All potential exposure sites are listed on the department’s website. On a national level, routine immunisation coverage for New Zealand children aged two years in the 12 months to Dec 2022 was just over 82 percent (and 66.4 percent for Māori children). 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.

SW region’s leishmaniasis burden

The number of people seeking treatment for cutaneous leishmaniasis in Balochistan province has increased significantly in recent years, with many of those affected travelling to Quetta from impoverished rural areas for treatment provided by Médecins Sans Frontières in conjunction with local authorities. Read more  

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 avoiding sand fly bites. Read more on the disease and prevention.

Worsening impact of chikungunya

An increase in chikungunya cases in the Americas throughout 2022 has carried forward into the new year, and the PAHO is warning that countries, particularly those in the Southern Cone sub-region, could experience a greater drain on their health systems if weather conditions favour the spread of mosquito-borne diseases (including dengue fever and Zika virus). Paraguay’s number of suspected chikungunya cases had already climbed past 40,000 by Feb 2 and 15 deaths were recorded. The epidemic in areas including Asunción and Central is not expected to improve until early next month. Read more

Advice for travellers

Chikungunya virus is spread by the same daytime-feeding mosquitoes that transmit dengue fever. There is no approved vaccine as yet and preventing infection relies on avoiding mosquito bites. Apply an effective repellent when outdoors to all exposed skin. Read more about chikungunya.

Measles outbreak in west

A measles outbreak has been reported in Bunyoro sub-region in the country’s Western Region. To date only 12 cases have been confirmed, however there are another 144 suspected infections, according to the WHO regional bulletin. In neighbouring South Sudan, two measles outbreaks that first started in Jan 2022 in Eastern Equatoria and Upper Nile States have spread into all 10 states and three administrative regions. Sub-optimal vaccination rates and the large scale movement of people across borders has elevated the regional risk to moderate. And in South Africa, the NICD updated its measles outbreak information on Feb 10 – a total of 506 cases had been confirmed by Feb 4. Read more

Advice for travellers

A highly contagious virus, measles occurs in developing and developed countries. While usually relatively 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.

High dengue virus transmission forecast

Health agencies are forecasting a peak in the dengue transmission cycle this year after an early surge in cases affecting mainly Bangkok and central regions. According to the Disease Control Department, dengue fever infections could surge to four times the 2022 figures of 45,145 cases and 29 deaths, with the peak expected during the wet season which starts in May. Read more

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, 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 oil of lemon eucalyptus (PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.