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 31st of August 2022
Monkeypox focus shifts to the Americas
On a global level the rate of rise in new monkeypox (MPX) cases has slowed, while the epicentre of the outbreak has moved from Europe to the Americas, with the WHO director-general noting that intense transmission is continuing in the region, particularly Latin America. Read more. This week the WHO Regional Director for Europe said that encouraging early signs of the MPX outbreak slowing in Europe must be followed up with urgent steps towards its elimination. Read more. In the updated Interim Guidance on Vaccines and Immunization for Monkeypox, the WHO stated that, ‘Control of monkeypox outbreaks primarily relies on public health measures including surveillance, contact-tracing, isolation and care of patients. While smallpox vaccines are expected to provide some protection against monkeypox, efficacy data are limited.’ More information from the WHO in its External situation report #4 and 2022 Monkeypox Outbreak: Global Trends and the current situation in Africa.
Advice for travellers
Closely related to the smallpox virus, monkeypox has its origins in Central and Western Africa. Rodents are the suspected reservoir, with monkeys and humans as secondary or ‘spill-over’ hosts. People travelling in endemic countries can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk in those regions. More recently, monkeypox has spread person-to-person around the globe, primarily through large respiratory droplets, but also via direct contact with skin lesions or body fluids (i.e. close or intimate contact) and indirect contact by way of contaminated bedding, clothes etc. Read more from the WHO on the current outbreaks of monkeypox.
Dengue activity remains high
From the latest ECDC summary, the 1.9 million dengue fever cases recorded by Brazil this year far exceed the caseloads of the next four countries: Vietnam (145,536), Philippines (82,597), Indonesia (68,903) and Peru (57,469). The update includes dengue and chikungunya activity from all regions. Read more
Advice for travellers
Dengue fever is common in most tropical or sub-tropical regions of the world. The virus is spread by daytime-feeding Aedes mosquitoes and to avoid it and other insect-borne diseases, travellers should apply an insect repellent containing an effective active ingredient, such as DEET, Picaridin or oil of lemon eucalyptus (PMD), to exposed skin when outdoors during the day. In addition, cover up with long-sleeved tops, long pants, and shoes and socks around dawn and dusk, as well as other times when the mosquitoes are active.
5th wild poliovirus case reported, global digest
Tête province has recorded another wild poliovirus type 1 (WPV1) case, the country’s fifth since May amid strengthened surveillance activities. In other polio news, last week the GPEI announced circulating vaccine-derived poliovirus type 2 cases (cVDPV2) in Chad (five cases across Guera, N’djamena and Mayo Kebbi Est provinces), one case in Somalia (middle Juba) and 10 cases from five provinces of Yemen. Read more. Pakistan has recorded its 15th wild poliovirus case this year, a 17mo child from North Waziristan (the location of all but one of the cases – the other in Lakki Marwat). In the USA, another worrying development related to the confirmed vaccine-derived polio case detected in Rockland County in July, with four positive samples in wastewater samples collected in July/August in Sullivan County, some 100kms NW of New York City. Authorities have stated that the polioviruses are linked to the Rockland County polio case. In an Aug 26 update, the NY Health Department stated, ‘Wastewater Samples in Rockland County, Orange County, and New York City Had Already Provided Additional Evidence of Local Transmission and Circulating Polio That Can Cause Paralysis’ and has strongly urged both adults and children to ensure they are immunised or are up to date with their vaccinations. 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.
No new Ebola cases; High measles toll in southern province
The WHO country office provided an update on Ebola virus disease (EVD) on Aug 29 in which it stated that no new cases have emerged in Beni, North Kivu since the index case on Aug 15. A ring vaccination campaign is currently underway among family and healthcare contacts. In an Aug 25 Disease Outbreak News post, the agency assessed the EVD risk as high on a national level and moderate over the region. Read more
HEALTH ZONES right across the southern province of Kasaï-Oriental are reporting measles cases as the outbreak that started in Miabi back in February gathers pace. More than 6,000 cases and at least 50 deaths have been recorded, while vaccination campaigns have been carried out in less than half of the health zones. 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.
WNV cases comparable to 2018 epidemic year
The season’s total of West Nile virus (WNV) cases has risen to 301 with 15 deaths after another 71 infections were announced in an Aug 24 ISS report - this is almost three times the second-ranking EU country, Greece (123 cases from Thessaloniki, Imathia, Kilkis, Pella, Pieria, Halkidiki, Serres, Trikala and Larissa, 11 deaths). In Italy, over half of the patients suffering neuro-invasive complications have been from the Veneto region. A recent ECDC update lists Serbia as logging 81 cases, six were fatal. Lastly, WNV cases have been reported from four areas which had not previously documented cases – Harz in Germany, Lucca and Pistoia in Italy, and Moravicki in Serbia. Read more
Advice for travellers
West Nile virus is endemic in Eastern Europe and the Mediterranean basin, with sporadic outbreaks reported in summer and autumn since the 1950s. Most human WNV infections (70-80%) are mild, subclinical or asymptomatic, but around 1-in-150 cases involve potentially severe neuroinvasive disease. The virus is transmitted by Culex mosquitoes, which feed mainly around dawn and dusk. While the risk of infection for most travellers is generally low, those visiting regions reporting human cases, particularly the peak transmission season, should take measures to avoid mosquito bites. Europe’s outbreaks are generally not as severe or widespread as in other regions where the virus occurs, notably North America. Read more on WNV.
Monsoon-related infections persist
The state of Karnataka is experiencing high rates of dengue fever infections, with the capital Bengaluru registering more than 1,100 cases, and in Punjab, the dengue case count is almost twice the entire 2021 total - the peak is not expected until October. Paediatricians in Mumbai (Maharashtra) are reporting an uptick in children presenting with hand, foot and mouth disease, while the city’s Municipal Corporation announced a month-on-month increase in cases of influenza, dengue fever and malaria. Read more
Advice for travellers
Parents of young children should be aware of that seasonal epidemics of HFMD occur throughout Asia. The virus mainly affects young children and symptoms include fever, oral lesions, and rash on the hands, feet and buttocks. There is no vaccine or preventative medication, but good hand hygiene will greatly reduce the risk of infection. Read more on HFMD.
COVID-19 update
New COVID-19 case numbers remained stable or declining across all six WHO regions, as reported in last week’s WHO epi update and Japan continues to record most new cases. Death rates have also been fairly constant or decreasing in most regions, with the exceptions of Africa (following batch reporting from South Africa) and the Western Pacific. On variants of concern, BA.5 descendent lineages were still dominant; BA.5.1 and BA.5.2 are reported to be increasing in prevalence, although this comes against the background of less surveillance and fewer tests/sequencing being carried out. Read more
In related news:
- Last week the WHO director-general announced that the ‘tragic milestone’ of one million COVID-19 deaths this year has been passed. It is estimated that one-third of the world’s population has not received a vaccine, ‘including two-thirds of health workers and three-quarters of older adults in low-income countries’. Read more
- Australia’s TGA has provisionally approved the Moderna bivalent COVID-19 vaccine for use as a booster dose in adults.
Inaction over dengue transmission
The lack of concerted efforts by local authorities to tackle the increasing numbers of dengue fever cases has prompted calls for the government to expedite the passage of a bill establishing a central health agency with enforcement powers. With more than 2,500 dengue cases from 70 districts this year, there have been no counter measures to remove mosquito breeding grounds and educate the public on prevention. Read more
Advice for travellers
Avoid mosquito bites to protect against dengue fever. To avoid biting insects, apply repellent containing an active ingredient, such as DEET, Picaridin, or oil of lemon eucalyptus (PMD) to all exposed skin when outdoors. 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 also cover up with long-sleeved tops, long pants, and shoes and socks when mosquitoes are most active.
Uptick in dengue and typhoid in central region; Gastro outbreak on Panay
Last week local authorities in the Central Visayas province of Negros Oriental announced that typhoid fever infection rates have almost double compared to last year – locations with most cases include Guihulngan City (and three deaths), Bayawan City, Ayungon and Dumaguete City. Dengue fever cases have also spiked according to the Provincial Health Office - six regions in all crossed the dengue epidemic threshold in the four weeks to Aug 13. In related news, a 9yo Australian boy died of dengue shock syndrome last week in the Philippines, two weeks into a 5-week trip. ABC News reported that his parents ‘are now warning travellers to take extra care following their son's tragic death’. Read more
ON THE island of Panay in Western Visayas region, an outbreak of gastro-intestinal (GI) illness has been declared in Iloilo City, with several cases of cholera also detected. Clusters of GI cases have been reported from the densely populated City Proper district and residents have been advised to boil water for drinking. Read more
Advice for travellers
Typhoid fever is endemic in many developing regions, although it generally presents a low risk for short-stay travellers staying in western-style accommodation. Vaccination is itinerary specific, but is usually recommended for those staying or travelling extensively in rural areas, as well as for adventurous eaters and for travel to areas reporting drug-resistant typhoid. All travellers visiting endemic areas should follow safe food and water guidelines, and adopt strict personal hygiene practices. Read more about typhoid fever.
Viral fever in arid north
Public health measures have been implemented after Crimean-Congo haemorrhagic fever (CCHF) was confirmed in two linked residents of Podor health district in the country’s north. The response includes enhanced surveillance and educating the public on preventing tick bites and virus transmission from infected animals. Read more
Advice for travellers
CCHF virus is transmitted to people either directly by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The disease, which has a fatality rate of 10-40%, is more common in Africa, the Balkans, the Middle East, and Asia, as well as countries south of the 50th parallel north. The majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to most travellers. Read more about the virus.
Dengue case on Florida’s west coast
Residents of Florida’s south have been advised to protect themselves from mosquito bites and remove any standing water that could be used as breeding sites for the insects after the detection of six locally-acquired dengue fever cases. The first five occurred in June/July in Miami-Dade County, while the latest was on the west coast, in Collier County and is its first in 20 years. Read more
Advice for travellers
Dengue occurs both in urban and rural areas, around human habitation. The virus is spread by Aedes mosquitoes which breed in shady places close to dwellings and bite mainly during the daylight hours, making them difficult to avoid when 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 (or PMD) when outdoors to all exposed skin. Read more about dengue fever and preventing insect bites.