Travel Health Alerts

Elevated risk post-floods

A reminder to residents and visitors from the Victorian health department that the risk of mosquito-borne infections is elevated in the wake of recent floods. A Dec 8 alert advised that both the Ross River and Barmah Forest viruses are endemic in the state, and they have recently ‘been detected in mosquitoes in the Campaspe, Horsham and Loddon local government areas’. There is a generally lower risk of other mosquito-borne diseases (Japanese encephalitis, Kunjin virus and Murray Valley encephalitis), so effective prevention measures are paramount. Read more

Advice for travellers

Cases of Ross River occur throughout Australia, including more temperate southern states. Travellers visiting areas of Australia affected by recent flooding or continuing rain should take measures to prevent mosquito bites. Use a personal effective insect effective ingredient such as DEET, Picaridin, or oil of lemon eucalyptus (PMD) when outdoors and wear long, loose-fitting, light coloured clothing – especially at dawn and dusk, the times of day when RRV-carrying insects are most active.

Global polio digest

According to the latest GPEI update, Madagascar logged another three circulating vaccine-derived poliovirus type 1 (cVDPV1) cases (in Analamanga, Ihorombe and Sava), which has taken the yearly total to 13, while Mozambique’s two infections were from Zambezia.  On cVDPV2, Benin recorded three cases in Bourgou, Niger’s two patients were in Tillaberi, and single infections were reported by both Ghana (Northern province) and Togo (Plateaux region). Relating to the vaccine-derived polio case confirmed in New York, USA earlier this year, sequencing carried out by the CDC has determined that, at this time, seven of the 94 positive samples collected from five counties ‘have not been genetically linked to the individual case in Rockland County’. In a statement, the NY health department said the ‘environmental findings provide evidence that the unvaccinated individual Rockland County resident with paralytic polio contracted the virus through local—not abroad or international—transmission and provide evidence of expanding community spread’. The source of the index case’s infection is still under investigation and the department stressed that residents should ensure their polio vaccinations are up to date. 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, 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 poliomyelitis.

World’s 2021 malaria report card

With the release last week of the WHO World Malaria Report 2022, we learn that Nigeria accounted for more than one quarter of all global malaria cases in 2021 (27 percent), followed by the D R of Congo, Uganda and Mozambique (another 19 percent combined). In all, 96 percent of the world’s malaria infections occurred in 29 countries, while four countries in the WHO African Region - Nigeria, DRC, Niger and Tanzania – had just over half of 2021’s global malaria deaths. In the other regions, those countries accounting for the majority of malaria cases in 2021 were Papua New Guinea (87 percent) in the Western Pacific,  India (79 percent) in the SE Asian region, and Venezuela, Brazil and Colombia (more than 79 percent) in the Americas. The report also noted that in SE Asia, Malaysia in particular had experienced ‘a notable rise’ in human Plasmodium knowlesi infections. Lastly, Azerbaijan, Belize, Cabo Verde, Iran and Tajikistan have all ‘submitted an official request for malaria free certification’. Read more

Advice for travellers

Travellers visiting malarious regions should discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. Read more about malaria.

Child flu rates soar

The flu season hit early this year and six weeks in, activity caused mostly by influenza A(H3N2) is high. Adults 65 years and over and children aged under five have accounted for the highest hospitalisation rates, while influenza-associated admissions for all paediatric age groups (16 years and under) are up 10-fold compared to this stage of the season in most years. Read more   

Advice for travellers

In most years, seasonal flu is the most common vaccine-preventable travel-related illness: it’s likely to be found aboard aircraft, in crowded airport terminals, and at your destination. Vaccination is highly recommended and travellers should also avoid close contact with people showing flu-like symptoms, and thoroughly washing hands using soap and water after using the toilet and before eating. Alcohol wipes are a convenient alternative if soap and water is not available. Read more

Vector-borne disease update

A health ministry update announced the 2022 dengue case count had passed the 7,000-mark (most affected regions Metropolitan, North Panama, West Panama, Bocas del Toro and San Miguelito), while Guna Yala, Darién and Panama East registered most of the 5,710 malaria cases recorded. It was also noted that malaria infections were double 2021 figures. In addition, there have been 53 hantavirus cases from five provinces: Santos, Herrera, Coclé, Panamá Oeste and Veraguas. Elsewhere, Chilean health authorities have warned people working in the rural sector and those undertaking treks off established trails to be aware of symptoms that could indicate hantavirus infection (fever and muscle pain). To date, there have been 27 hantavirus cases this year, seven fatal, from the regions of Nuble, Los Ríos, and Los Lagos. Read more

Advice for travellers

Hantavirus is passed on to humans through contact with hantavirus-infected rodents or their urine and droppings. Eliminating rats in and around living quarters is the main way of preventing hantavirus infection. Cases have been documented in Argentina, Brazil, Canada, Chile, Panama, Paraguay, and Uruguay, making HPS a pan-hemispheric disease. Read more about hantavirus.

Ticks found to have new virus

Researchers in Zurich tested ticks from several regions, finding that ‘numerous specimens were infected with the Alongshan virus (ALSV), a virus that first discovered in China five years ago. According to a university news item, “ALS viruses were detected in the tick samples far more frequently than TBE viruses” and “since the symptoms of an infection with ALS viruses are similar to those of an infection with TBE viruses, the Alongshan virus could already pose a public health concern in Switzerland, albeit hitherto unrecognized.” The next step is to develop tests to detect the virus in human sera. Read more

Group A Strep spike in 4 EU countries

An increase in invasive Group A Streptococcus (iGAS) infections affecting children aged under 10 years has been reported by Ireland, France, the Netherlands and Sweden since September, according to the ECDC. The agency also said that several iGAS-related deaths have occurred in Ireland, France and the UK, with the latter two countries recording rates that are ‘several-fold higher than pre-pandemic levels for the equivalent period of time’. It was noted that the increase is associated with lower rates of Type A streptococcal infections earlier in the pandemic, together with ‘the recent increased circulation of respiratory viruses, including seasonal influenza and respiratory syncytial virus (RSV)’. Group A Streptococcus infections are not notifiable to health authorities in all EU countries. Read more

Cholera outbreak reported to be easing

Twenty of the 26 districts are still weathering the cholera outbreak, but Akkar, Mennieh-Donnieh and Tripoli have had the highest case numbers and a recent spike in infections in Bekaa, east of Beirut, is being monitored. Vaccines have been administered to 80 percent of the at-risk population and the government claims that the outbreak is now under control. In related news, Haiti has been supplied with more than one million cholera vaccine doses from the global stockpile to stem the outbreak with more than 14,700 suspected cases. The first areas to be targeted in the coming days are those most heavily impacted: Cité Soleil, Delmas, Tabarre, Carrefour and Port-au-Prince in the Ouest Department and Mirebalais in Centre Department. 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.

Tropical infection sickens 42 in 2022

Hong Kong’s Centre for Health Protection (CHP) confirmed four more melioidosis cases late last week in people ‘who developed symptoms during the period from mid-August to early November’, however it also said the reporting of new infections has eased this month. There have been 42 melioidosis cases this year; 26 of those diagnosed since August were from Sham Shui Po district in Kowloon. Read more. And in Sarawak, Malaysia, the State Health director confirmed two fatal melioidosis cases from at least 15 infections reported in Samarahan, a satellite town of Kuching. More about melioidosis from the US CDC. 

2 Zika cases reported last month

Local news media have reported two cases of Zika virus infection identified last month: the first a 67 yo man from Maharashtra who had travelled to Pune from Nashik, and the other a young girl residing in Raichur district, Karnataka. The latter case is the first Zika infection for Karnataka and to date, her close contacts have tested negative. Read more  

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 Zika virus through healthdirect.

Measles cases in 22 counties

Measles infection rates have been on the rise for several months and cases are now widespread, prompting the health ministry to declare an outbreak. More than 30 deaths have been recorded to date and there have been almost 2,500 cases. Also on measles, drought conditions in seven Kenyan counties has forced families to move in search of water and food and disrupted routine childhood vaccinations. As many as 90 percent of children have missed a second measles vaccination, resulting in outbreaks in those areas. The health ministry vaccination drive targeting children from nine months to five years is planned to conclude early next week. In other news, an extensive campaign to vaccinate Zimbabwean children against measles has achieved 95 percent coverage in high risk districts, including Mutasa, Buhera, Chimanimani, Mutari and Nyanga. Between April and early October this year, a measles outbreak caused 744 deaths from more than 7,500 suspected and confirmed cases. And lastly, in the US, of the 73 measles cases recently confirmed in the area of Columbus, Ohio, the majority were unvaccinated, while the remainder had incomplete or no vaccination status recorded. Twenty-six children required hospitalisation for the management of their measles symptoms. 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.

Human rabies death in Sibu

Sarawak has recorded its 11^th human rabies death this year, in a man who is said to have handled dog carcasses prior to becoming symptomatic. Residents have been reminded that rabies is endemic in the state so all contact with stray dogs and cats should be avoided, and in the event of an at-risk exposure, to attend any of the 26 government facilities that offer the appropriate follow-up care. 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, including bats. 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.

Timeline to eradicate elephantiasis

The eradication program for the neglected tropical disease (NTD) lymphatic filariasis has been extended to 2028 so districts with low rates of medication uptake can be targeted in new campaigns. Baglung district (Dhaulagiri Zone), around 40kms west of Pokhara, is one such location. An increase in cases observed last year in the village development committees of Kushmisera, Dagatumdada and Gwalichour prompted a special medication distribution drive, while testing of residents has also confirmed symptomatic infections in Narayansthan, Galkot and Badigad. Read more

Meningococcal advice for parents

Parents are asked to monitor their children for early symptoms of meningococcal disease after infections increased over levels reported in the last two years. Of the 56 cases tested (69 in total), serogroup B (MenB) was identified in 45. Read more. Currently MenB vaccines are not part of the routine immunisation schedule, but that will change in March next year when they will be available for children under five years (with a catch-up campaign). Read more

Advice for travellers

Meningococcal meningitis is an acute bacterial disease transmitted from person-to-person through close (kissing, sharing eating utensils) or extended contact. Risk factors include extensive travel in crowded conditions or extended contact with local people in crowded places. If planning to travel to any region experiencing an outbreak, discuss whether vaccination against meningococcal meningitis would be appropriate for your itinerary with your doctor. Read more about Men. meningitis.

Search for contaminated food source

A salmonellosis outbreak that first emerged in early November is still infecting people and now Sweden has identified cases also caused by Salmonella Agona. Norway’s case numbers have risen to 58 (23 in hospital) from across 10 regions, while its neighbour has so far recorded 26 cases from 12 regions. The search is underway for a common, contaminated food source. Read more  

Advice for travellers

Salmonella is bacteria typically found is food, such as poultry, that causes diarrhoea, fever, and abdominal cramps between 12 and 72 hours after infection. Illness usually lasts 4 to 7 days, and most people recover without treatment, although diarrhoea may be so severe as to require hospital treatment. Young children and the elderly are at highest risk of severe illness. As there is no vaccine to prevent salmonellosis, it is best to avoid raw or undercooked eggs, poultry, or meat. Read more

Ebola vaccine trials to begin

The first 1,200 vaccines to be used in the Sudan ebolavirus (SUDV) clinical trials have arrived: the Sabin Vaccine Institute’s single-dose ChAd3-SUDV (chimpanzee adenovirus vector) candidate which had been shown ‘to elicit rapid, robust, and durable immunity’ in early trials. The WHO cited the 79 days from outbreak declaration to vaccines arriving onsite as ‘a historical milestone in the global capacity to respond to outbreaks’. The randomised trials are being co-sponsored by the WHO and the Ugandan health ministry and conducted by Kampala’s Makerere University. No new SUDV cases have been identified since the stillborn baby on Nov 27, however contact tracing from earlier chains of transmission is continuing. 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.