Travel Health Alerts

Legionnaires’ alert for Sydney CBD

NSW Health has issued an alert for anyone who has been in Sydney’s CBD in the past fortnight after six cases of Legionnaires’ disease were confirmed in visitors to the area. The source of the infections is under investigation and the department has advised that the cases, in people aged from their 40s to 70s, may not be related. Cooling towers in the affected area are being tested for the presence of Legionella bacteria. Elsewhere, almost a year since Legionnaires’ disease was identified in a guest at a hotel in Waikiki, Hawaii, four more cases have been confirmed at the same hotel, occurring between early March and May 23, 2022. Read more

Advice for travellers

Legionnaires’ disease occurs worldwide and outbreaks have been associated with cruise ships, hotels, and resorts. The bacteria that cause Legionnaires’ disease are found in the airborne droplets of warm, fresh water, such as from fountains, spas, showers and the cooling towers of buildings. Over 50s, current or former smokers, those with a chronic lung condition, and the immunocompromised are at higher risk of developing illness after exposure. Read more.

COVID-19 update

New COVID-19 case numbers continued their decline since the January peak, although weekly trends rose in the Americas and the Western Pacific. Highest week-on-week increases were logged by the USA (up by 18 percent), China (up 39 percent) and Australia (up 8 percent). In a more positive sign for China however, some of the restrictions put in place in Beijing and Shanghai are being relaxed this week. Read more. In the Western Pacific region, the WHO epi update of May 25 announced proportional increases ‘in Guam (238 vs 36 new cases; +562%), Fiji (116 vs 26 new cases; +346%) and Tonga (444 vs 246 new cases; +80%)’. Read more

Related articles:

- Published by The Conversation last week, ‘COVID-19 in babies – here’s what to expect’.

- ABC News wrote about the rising incidence of repeat COVID-19 infections in Australia.

Dengue spread speeding up; Regional yellow fever summary

The article, ‘Fast expansion of dengue in Brazil’, published recently in The Lancet provides details on the expanding reach of the dengue virus into new areas of Brazil that are characterised by high elevation and sparse population. Over the past five years, more than 480 municipalities have seen their first local dengue infections, while from Jan-March this year, around half of all new detections were in the south, particularly in the states of Santa Catarina and Rio Grande do Sul. The spread is said to be driven by climate change, population movements and urbanisation. Read more

A PAHO summary on yellow fever (YF) in the region has revealed the pandemic’s impact on vaccine coverage, causing an overall decline in 2019-20 - ‘11 of the 13 endemic countries/territories did not achieve coverage of 95% or greater, and in 7 countries, the coverage was less than 80%’. In 2022 (to the first week of May), confirmed YF cases had been reported from Bolivia (5 cases in the north of La Paz Department), Brazil (3 cases in Pará and Tocantins states), and Peru (2 cases in Junín and Ucayali Departments). 

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.

Global polio digest

This year’s count of wild poliovirus type 1 (WPV1) cases has risen to six, with the latest infections confirmed in 18mo twins living in North Waziristan district of Khyber-Pakhtunkhwa province. In other news, the WHO regional bulletin has detailed Mozambique’s recent WPV1 case in Tete province which borders on Malawi, Zambia and Zimbabwe. From the GPEI update last week, circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported by Chad (two cases - Batha department and N'Djamena), the D R of Congo (10 cases, mostly in Maniema province), Niger (a single case in Tillaberi) and lastly, Yemen (12 cases from nine districts). 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.

2nd H3N8 avian influenza case on mainland

Hong Kong’s Centre for Health Protection has announced another avian influenza H3N8 case on the mainland – a 4yo boy living in Changsha, Hunan Province. He was known to have visited a live poultry market. This detection comes just over a month after the first case, also in a young child who had contact with poultry, from Zhumadian City in Henan Province. Read more

Advice for travellers

There are several strains of bird flu and while the high pathogenic strains can be fatal, infection generally poses a low risk for travellers – even for those heading to a region where the disease is present or an outbreak is occurring. Travellers should avoid contact with birds or poultry in marketplaces, wash hands thoroughly before and after preparing food, and observe strict personal hygiene. Read more on bird flu and how to avoid it.

Sankuru hunters risk monkeypox; New probable Ebola case

More than 450 suspected monkeypox cases and nine related deaths have been reported from the central province of Sankuru this year and local health authorities say that the virus is most commonly spread from animal hosts to people when they hunt for bushmeat in rainforest habitats. The WHO is assisting seven African nations that have reported monkeypox cases this year to boost surveillance and response measures. Monkeypox transmission has moved into wider areas of the countries reporting outbreaks, however it has not spread into new non-endemic countries in Africa. Read more  

ANOTHER EBOLA case in the Equateur province epicentre, described as probable due to links with a previous case, has been identified in Mama Balako Health Area, giving the outbreak a total of five cases (four confirmed and one probable) from Mbandaka and Wangata 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.

More than 1,500 HFMD outbreaks reported

Hand, foot and mouth disease infections have soared this year after numbers declined earlier in the pandemic. Overall, cases are higher than pre-COVID-19 - up from nearly 30,000 to 65,500 (to May 28). Most infections have been reported in Selangor, Kuala Lumpur and Putrajaya, Perak, Kelantan and Sabah, with more clusters in Kuala Lumpur and Putrajaya. Read more

Advice for travellers

HFMD 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 about HFMD.

Cholera spikes in 3 states

Sixteen states have now recorded cholera cases this year and new infections increased by 180 percent from March to April. The NCDC announced the outbreaks had claimed 54 deaths and the states of Taraba, Cross River and Katsina have been most affected. 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.

First dengue outbreak reported

Last week the WHO declared a dengue fever outbreak, the first to hit the island nation; it follows extensive flooding earlier this year which damaged infrastructure and allowed mosquitoes to proliferate. Most cases have been reported from northern and eastern districts of São Tomé (Água Grande, Mézochi, Lobata and Cantagalo health districts) and from the Autonomous Region of Principe. The agency assessed the risk of dengue transmission to be high, complicated by ‘limitations to the capacity to conduct surveillance and diagnose cases’. 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.

Malaria alert in southern provinces

People living in or visiting three southern provinces - Trat, Songkhla, and Ranong - have been asked to remain vigilant after several human cases of malaria caused by Plasmodium knowlesi were confirmed near forested areas. In the SW province of Trat, nine of 11 recent infections were recorded in the tourist destination island of Koh Chang, known to be home to large colonies of macaques, the natural host of the P. knowlesi parasite. Read more

Advice for travellers

The P. knowlesi strain of malaria is spreading in humans throughout Asia due to factors such as deforestation – its natural host is the macaque. As well as local cases, infections are increasingly being reported among international travellers who have visited Thailand, Vietnam, Cambodia, Malaysia and the Philippines. Travelvax recommends that travellers visiting malarious regions discuss their itinerary and preventative measures, including medication, during a pre-travel medical consultation. More on malaria.

Gambiense sleeping sickness eradicated; Heavy malaria transmission season

Last week the WHO announced the eradication of the gambiense form of sleeping sickness (human African trypanosomiasis or HAT) in Uganda. It also reaffirmed the country’s goal of tackling the rhodiense parasite sub-species which remains endemic in central and southern regions. Uganda joins Benin, Côte d’Ivoire and Togo in gaining validation of gambiense eradication (Rwanda has eliminated rhodiense HAT). Read more

MALARIA outbreaks have been reported in several districts, with news sources reporting 28 deaths in Arua, Kagadi and Mbale over a one-week period. Ten districts in all are said to be experiencing a heavy malaria transmission season. Read more

Advice for travellers

Human African trypanosomiasis is rare in travellers, however the tsetse fly, which spreads the disease, is found in many African countries. The aggressive flies are attracted to moving vehicles and bright and dark colours; they can also bite through light-weight clothing. Travellers should cover up well with neutral-coloured, medium weight clothing and apply an effective personal insect repellent at all times when outdoors. Read more on African trypanosomiasis and how to avoid infection.

Monkeypox cases now in at least 26 non-endemic countries

Investigations continue into how to contain the monkeypox outbreaks afflicting non-endemic countries, with research underway to determine if an under-recognised transmission mode is involved or if the virus has undergone genetic changes. More than 600 confirmed or suspected cases have now been reported (according to Our World in Data) in what is the largest outbreak outside Africa, and while the majority of cases to date have self-identified as MSM, the WHO reminds us: ‘Anyone can get or pass on monkeypox, regardless of their sexuality’. No deaths have been recorded to date. The agency’s assessment of risk to global public health is ‘moderate considering this is the first time that monkeypox cases and clusters are reported concurrently in widely disparate WHO geographical areas, and without known epidemiological links to non-endemic countries in West or Central Africa’. A higher risk level could eventuate ‘if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease such as young children and immunosuppressed persons’. 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 travelling in endemic countries can be infected by eating undercooked ‘bushmeat’ or handling infected animals, making infection a low risk in those regions. Read more from the WHO on the current outbreaks of monkeypox.

Investigations into paediatric hepatitis continue

The WHO advised that 650 probable cases of paediatric hepatitis of unknown origin (and 99 additional cases pending classification) had been reported from 33 countries in five WHO Regions to May 26, with just under 60 percent of those in the WHO European Region (374 cases). The Americas had recorded 240 cases, ‘far outpacing the Western Pacific (34 cases), Southeast Asia (14), and the Eastern Mediterranean (5).’ In the UK, case totals had risen to 222 by May 26, while in the US, the CDC has 216 ‘Persons Under Investigation’ centred on children with Acute Hepatitis of Unknown aetiology. The WHO acknowledges that the ‘source and mode of transmission of the potential aetiologic agent(s) has not yet been determined, and so the likelihood of further spread cannot be fully assessed’. Read more

Steps to manage dengue outbreak

High rates of dengue fever and severe dengue seen this year in Ho Chi Minh City have spurred local authorities to mount a prevention campaign ahead of the annual ASEAN Dengue Day on June 15. District officials in Binh Tan, Tan Phu, Binh Chanh, Cu Chi, District 12 and Hoc Mon districts have been asked to institute vector control and provide public education to manage their particularly high dengue case numbers. News sources also report hand, foot and mouth disease (HFMD) outbreaks in the city, although proactive responses from the health sector has seen a fall in new infections. 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.