Travel Health Alerts

COVID-19 update

The WHO reports there are more than 500 sub-lineages of Omicron currently in circulation; BA.2 has over 218 descendent sub-lineages, while BA.4 and BA.5 combined have more than 260. In its weekly update, the agency also said that ‘BA.5 and its descendent lineages continue to be dominant globally, with dominance differing by country’. In Europe, the ECDC reported new COVID-19 cases among the 65 years and over cohort fell over the week to Nov 20 (down 13 percent), while for all age groups ‘case and death rates also continue to decrease and are at low levels compared to the pandemic maximum (6% and 7% respectively).’ Read more

In related news:

- Last week the WHO published the article ‘One year since the emergence of COVID-19 virus variant Omicron’ detailing the changes ‘and why there hasn’t been a new variant of concern’. Read more

- The Conversation: Paxlovid is Australia’s first-line COVID antiviral but Lagevrio also prevents severe disease in over-70s

- An article in Insight+ outlines the results of research into the long term sequelae of COVID-19 infection: ‘More proof COVID is a multi-system cluster bomb’. Read more  

Dengue, ‘a significant public health concern’

The ongoing dengue outbreak, now the country’s second largest since the year 2000, is described in a WHO Disease Outbreak Notice as ‘unusual in its scale and seasonality’. Prevailing high rainfall, temperatures and humidity have allowed mosquitoes to proliferate, particularly in the capital Dhaka where nearly 65 percent of all dengue cases have been recorded. Limited tested has so far detected two circulating dengue virus strains: ‘DENV-3 has been consistently predominant since 2019 but DEN-4 has not been reported for several years’, according to the WHO. Read more

Advice for travellers

Dengue is spread by Aedes mosquitoes which breed in shady areas close to habitations 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 an effective 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.

Monkeypox disease, now mpox

Late last week, the Africa CDC provided an update on monkeypox cases (WHO-preferred name is now mpox, to be phased in over a year), advising that within the region Nigeria accounted for 624 confirmed cases and seven deaths from the continent’s total of 996 cases and 198 deaths in the eight endemic countries. In the most recent reporting week, ‘26 new confirmed cases and 24 new deaths of monkeypox were reported from Cameroon, DRC, Mozambique and Nigeria’. On a global level, mpox case numbers declined by nearly 50 percent in the week to Nov 27, down from 1,090 to 588. The Region of the Americas remains the most affected. Read more

Advice for travellers

Closely related to the smallpox virus, monkeypox was 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. More information on the 2022 global outbreak of monkeypox (mpox) from the WHO. Read more on monkeypox.

More VD polio cases in Aceh, global digest

Three more VDPV2 cases have been detected in the week since a single symptomatic infection was announced in Aceh – all three are aged under five years, live in the same district (Pidie) and are reported to be without symptoms. Vaccination campaigns have already started in Sigli, on the north coast of Sumatra, and the aim is to reach around 1.2 million children in the province. In other polio news, the GPEI reported new cVDPV2 cases in Chad (one each in Mayo Kebbi Est, Logone Oriental, Wadi Fira and Tandjile prefectures), D R of Congo (three in total from the provinces of Tanganyika, Nord Kivu and Tshopo) and Nigeria (four cases from Sokoto, Kwara and Zamfara states). 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.

Disease uptick following rains

The Ministry of Health and Medical Services advised last week that recent heavy rainfall have seen dengue fever and leptospirosis rates increasing ‘despite the fact that for most of this year our reported case numbers had remained near or slightly above the outbreak level’. Hospitalisations and deaths are low fortunately, due to community and healthcare worker efforts. The department is also responding to an outbreak of typhoid fever in Vanua Levu (Raranibulubulu community) ‘and sporadic cases in Navosa’. Read more

Advice for travellers

Typhoid occurs at times in Pacific countries, although it presents a low risk for travellers staying in hotels or resorts. Travellers should follow safe food and water guidelines, and personal hygiene practices. Vaccination is generally recommended for travellers staying in rural areas, as well as for adventurous eaters. Read more about typhoid.

Flu levels increasing

In the week ending Nov 19, the CDC reported high to very high flu activity in 35 states; those with low to moderate levels were largely in the north. The viruses included in this season’s vaccines have so far been shown to be ‘in the same genetic subclade as and antigenically similar’ to the majority of viruses sub-typed by the CDC. In Europe, in the week to Nov 20 the ECDC noted ‘seasonal influenza activity above 10% positivity in sentinel primary care, with A(H3) being the dominant virus’ in France, Greece, Germany, the Netherlands, Portugal and Spain. 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

Rare human viral infection in SW

Another rare human infection with Usutu virus (USUV) has been detected - this time in an individual living in the west/SW region of Nouvelle-Aquitaine. The patient had no recent travel history and so the likely culprit (virus reservoir) would be migratory birds from Africa. A ProMED moderator commented that following the first human USUV case in France (Hérault, Occitanie) in 2016, studies have proposed ‘that the prevalence of USUV infection in humans could be higher than West Nile virus infection (estimated to range between 0.3% and 3%) in areas where both viruses co-circulate’. Read more

Cholera peak passed in early November

New cholera cases have been trending downwards since Nov 8, while another 28 cases were confirmed in the MSPP update provided earlier this week. Children aged from one to four years have the highest number of suspected infections, followed by the 20-29 and 30-39 years age groups. Of the 10 departments reporting suspected cases, Ouest has around 10,000 of the almost 11,000 registered nationally to Nov 27. In other news on cholera, Lebanon’s health department update for Nov 28 shows the cumulative total of confirmed and suspected cases has climbed to 4,455 but no new deaths have been recorded over the past week. 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.

Mumbai measles situation reflected across the globe

Health authorities in Mumbai are racing to control the expanding measles outbreak, with 20,000 children at risk of infection after missing out on timely routine vaccinations. The situation is the same in Bihar, Gujarat, Haryana, Jharkhand and now Kerala, leading to vaccination drives in all areas. Cases in Mumbai have climbed to 233 since late October and 12 children have died. In related news, measles outbreaks are occurring in at least 20 countries and a joint study by the WHO and CDC estimated that nearly 40 million children missed measles vaccines in 2021: ‘25 million children missed their first dose and an additional 14.7 million children missed their second dose’. The agency describes the situation as grave; ‘an imminent threat in every region of the world’ as a consequence of low vaccine coverage, ‘weakened measles surveillance, and continued interruptions and delays in immunization activities due to COVID-19, as well as persistent large outbreaks in 2022’. 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.

Cholera outbreak active in 7 counties

The cholera outbreak that spread out from a wedding celebration in Kiambu County in early October in still active in seven counties (Garissa, Kajiado, Kiambu, Machakos, Meru, Muranga and Nairobi). More than one-third of the 568 confirmed and suspected cases occurred in the county of Machakos, followed Nairobi and Kiambu. The outbreak death toll was 15 as of Nov 13. Read more

Advice for travellers

While the risk of infection with cholera is low for short-stay travellers, Australians travelling to regions where an outbreak is occurring should adhere to strict personal hygiene and choose food and beverages with care. Read more about cholera.

26 districts remain in the grip of cholera

A spike in cholera infections was recorded in October and, with the wet season is due to commence soon, only three of the 29 districts reporting cholera since March have controlled their outbreaks. Those with the highest case numbers are Nkhata Bay, Mangochi, Nkhotakota, Rumphi and Karonga, according to an ECDC update (with more on multi-country (World) cholera outbreaks). The latest WHO African regional bulletin puts Malawi’s cumulative confirmed cases at 8,627 with 262 deaths. 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.

Spike in malaria cases in southern border state

Doctors on both sides of the Myanmar/Thai border at Mae Sot district have observed a sharp increase in malaria cases among people fleeing conflict and the situation is set to worsen during the next monsoon season. Along with the refugees at risk of malaria are young city-dwellers who have joined rebel fighters in Karen state; they also lack any degree of resistance to malaria, unlike those born and bred in the malarial areas. Read more

Advice for travellers

Travelvax recommends that travellers visiting this region discuss their itinerary and preventative medication with their healthcare provider. For advice, call Travelvax on 1300 360 164. More on malaria.

Search for outbreak source

The Institute of Public Health and related agencies are conducting investigations into the source of an outbreak of salmonella (Salmonella Agona) which has infected more than 30 people from across eight regions, including the capital Oslo. To date, 13 people have required hospitalisation. Food Safety News reports that the incidence of Salmonellosis is low in Norway and most cases in the past have stemmed from overseas travel or imported foodstuff. 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

Dengue cases up 2-fold; Rabies elimination targeted

Dengue fever infections almost doubled for the year to Nov 5 compared to 2021 data and the death toll has now passed 640. News sources report that most cases have been in and around Metro Manila on the island of Luzon. Read more

HUMAN RABIES deaths are more than a third higher this year than 2021 figures to Nov 5, up from 235 fatal cases to 322, and there are calls for renewed effort to achieve both human and animal rabies elimination – a target which had previously been set for 2020. 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. Read more on rabies.

Leishmania range spreads

One local vet has suggested that the expanding range of Leishmania infantum, which has resulted in more dogs testing positive for the parasite, should serve as a warning to health authorities to manage the infection risk for humans. While leishmaniasis is endemic in Spain, the main areas of prevalence are Ourense, Lleida, Girona, Cáceres, Valencia, Alicante, Murcia and Andalusia, and a recent spike in canine cases has been seen in the NW region of Galicia. Read more

Advice for travellers

Leishmaniasis is a parasitic disease 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. The former causes skin ulcers and the latter a severe systemic disease that is usually fatal without treatment. India, Bangladesh, Nepal, Sudan, South Sudan, Ethiopia and Brazil account for 90% of visceral leishmaniasis, while 90% of cutaneous leishmaniasis cases occur in Afghanistan, Algeria, Iran, Saudi Arabia, and Syria, as well as the South American countries of Brazil, Colombia, Peru, Bolivia and Argentina.

Ebola lockdown to continue in 2 districts

The Sudan ebolavirus outbreak appears to be slowing, with a single case in Kassanda reported in the past 12 days – that of a stillborn baby born to a woman who survived the infection. The lockdown has been extended until mid-December in the two central districts of Mubende and Kassanda, while the president described the current situation as fragile, worsened by the challenges of misinformation and a faltering health system. 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.

Response to rising diarrhoea case numbers

Health authorities are reporting 250–270 diarrhoea cases and around five typhoid fever infections each week in Harare; the incidence is highest in the most populous districts where sanitation infrastructure and clean water supplies are inadequate. A local health official said that response measures have been put in place as a matter of urgency to avoid the repeat of past serious outbreaks and against the spread of cholera from Mozambique and Malawi. Read more