Travel Health Alerts

Alert over fever cases, deaths

More than 65 Crimean-Congo haemorrhagic fever (CCHF) cases and 13 deaths have been recorded this year – 23 of the infections were from the province of Dhi Qar, followed by Basra with 10. Officials with the health ministry have stressed the need to prevent tick bites, but the primary message has been to butchers who are at highest risk of infection through contact with infected animals. Also on CCHF, 466 suspected infections have been logged this year in 26 provinces of Afghanistan; there were 23 associated deaths. In the most recent reporting week, Kandahar and Helmand provinces recorded seven cases each. 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 majority of cases have occurred in people involved in the livestock industry, so infection is a low risk to travellers. Read more about the virus.

MVE in Big Rivers region

Last week, the Northern Territory Health Department reported Murray Valley encephalitis (MVE) had been confirmed in two infants from the Big Rivers region, one has died of the infection. These latest cases take the YTD total to four (others were in Barkly and Top End districts), but this represents a substantial increase on the Territory’s two cases in the past five years. (The Big Rivers region occupies a large swathe of the Territory and includes Katherine and numerous remote communities.) The highest risk of MVE infection is reported to be from February to July and mosquito bite prevention measures are the only defence against infection. Read more

Advice for travellers

While the risk of contracting MVE is low if insect bite avoidance measures are employed, 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 and recently flooded areas of Australia should take all measures to prevent bites. Apply an insect repellent containing DEET, picaridin, or citriodiol (PMD) to exposed skin when outdoors. Read more about MVE.

Lymphatic filariasis eliminated

On May 13, the SE Asian regional WHO office announced a ‘commendable’ achievement: the elimination of lymphatic filariasis from Bangladesh’s 19 endemic districts. A national strategy was put in place in 2001, employing transmission assessment surveys and mass drug administration to achieve the goal (joining Maldives, Sri Lanka and Thailand in lymphatic filariasis elimination). Read more

Advice for travellers

Travellers are at low risk of lymphatic filariasis, a parasitic disease caused by thread-like roundworms spread by the bite of an infected mosquito. It is found in sub-Saharan Africa, Egypt, southern Asia, the western Pacific Islands, the north-eastern coast of Brazil, Guyana, Haiti, and the Dominican Republic. While most infections have no symptoms, acute infection can lead to painful swelling of an affected limb, fever, or chills due to bacterial superinfection. Avoiding mosquito bites is the best form of prevention. Read more.

Fewer vaccinations, more measles

Interruptions to routine immunisation programs during the pandemic have led to a spike in measles cases, with a health ministry official announcing at least 3,945 cases between June last year and early May 2023. DTP3 vaccination coverage has declined to just over 80 percent. In other news on measles, a vaccination campaign is planned to run through June and July in Cameroon in response to a ‘worrisome’ epidemiological situation which has produced more than 4,600 measles cases and 18 deaths. Japan’s health minister has announced two locally acquired measles cases in Tokyo, the first in three years. Both cases were in adults who were seated in the same train carriage as an infectious individual who had returned from overseas. Lastly, new measles case numbers have declined in Mumbai, India, and there are fewer serious infections due to immunisation drives launched after the spike in cases last year. 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.

STI increase in central province

Local media report that an extended interruption to condom supplies has led to an increase in STIs in the province of Artemisa. While the prophylactics can be bought on the ‘informal market’, the higher price is prohibitive for many locals, especially those aged 19 to 24 years. Rates of HIV, syphilis and gonorrhoea have all risen in the province. Visitors are advised not to rely on local supplies and to BYO condoms and lubricants. Read more

Advice for travellers

Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.

Rains, flooding escalate disease threats

Leptospirosis cases in the province of Chincha, Ica Department, are now more than four times the entire 2022 total, compounding the strain on the public health system which is already dealing with a health emergency from dengue fever epidemics in 20 of the 25 departments. Near constant rains and resulting flooding have hit the area – roughly mid-way between Lima and Nazca - in recent months. While Ica has recorded a total of 406 leptospirosis cases this year, that figure is dwarfed by Loreto’s 3,645 infections. To the north, in Ecuador’s Guayas province, leptospirosis cases are still being confirmed two months after a health emergency was declared in the city of Durán. A second leptospirosis death was announced last week, while 126 cases have been recorded in all after extensive flooding hit the area in February. Read more

Advice for travellers

Leptospirosis is spread through the urine of infected animals, typically rats. The bacterium enters the body through the mucous membranes of the eyes, nose, or mouth, as well as through broken skin. Outbreaks are typically associated with exposure to floodwaters, making leptospirosis a low risk for most travellers. Read more about leptospirosis.

Cholera cases reported

A WHO update on cholera last week named Eswatini as the 24^th country this year to report a cholera outbreak. One of the cases was infected through cross-border transmission and the other locally acquired. The agency recognised the multiple challenges involved in responding to the outbreaks, including ‘a lack of resources, limited oral cholera vaccine, and overstretched public health personnel who are juggling multiple outbreaks and emergencies’. 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.

Dengue and malaria in NE region

Malaria infections were already rife in the NE region of Afar following heavy rains and flooding, and by late April a dengue fever outbreak was also unfolding. An estimated 1,000 suspected cases were reported in Mile and Ada’ar. 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.

Lassa outbreak over

The Lassa fever outbreak that was first declared in late February in the Greater Accra Region has been declared over. In all, 27 people were infected and one died, however, as the WHO acknowledged, ‘rapidly implemented public health measures clearly played a key role in the effective control of this Lassa fever outbreak’. Read more

Advice for travellers

Lassa fever is an acute viral illness that occurs in West Africa, notably in Nigeria, Guinea, and Liberia. As many as 300,000 cases and 5,000 deaths occur each year. However, Lassa is a remote risk for travellers. Rodents shed the virus in urine and droppings and it is spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of an infected person. Read more about Lassa fever.

Leishmaniasis in mountainous north

Leishmania data have only recently been added to health ministry reporting and the latest epidemiological bulletin reveals an 11 percent increase in cutaneous leishmaniasis (CL) cases for the year to early March, compared to 2022 numbers. Prevalence is highest in two northern departments, Jinotega and Matagalpa. Nationally, more than 2,400 cases were reported last year. In Honduras, there has been a rise in CL cases in the rural area around the northern city of Villanueva in Cortés Department. 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.

STI rate increases

On a national level, more than 20,700 syphilis cases were detected last year through early diagnostic testing programmes, with highest infection numbers in the 25 to 49 years age group. Of the population groups where infection was more prevalent, men who had sex with men (MSM) made up 28 percent of cases, followed by pregnant women (27 percent). The country has seen a 70 percent increase in syphilis reporting since 2016 when 12,000 cases were registered. Read more

Advice for travellers

Syphilis is a sexually transmitted infection (STI) caused by a bacterium that enters through wounded skin or mucous membranes. You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Infections can cause long-term complications if not treated correctly with an effective antibiotic. Read more about syphilis and other STIs.

Rabies toll rises to 9

Authorities in the state of Sarawak announced that human rabies deaths this year have climbed to nine from a total of 11 cases. According to the health ministry, Sibu and Serian have each reported four patients, while Kuching has had two and the remaining case is from Bintulu. Dog bites were the source of infection in eight of the 11 cases, while exposure through cat bites or scratches occurred in two others (unknown in the 11^th case). 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.

3 Zika cases in Hougang area

Three people who either lived or worked in the residential Kovan neighbourhood (within the NE town of Hougang) have been diagnosed with Zika virus disease. In a joint statement issued on May 12, the NEA and health ministry said the cases were locally acquired and none of the three is pregnant. The confirmation of more Zika infections cannot be discounted so the use of an effective insect repellent is strongly advised. 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 more about Zika virus through healthdirect.  

Malaria surge in endemic provinces; Mumps cases spike

An official with Limpopo’s health department has announced a surge in malaria infections over the past month, with many of the cases in “Vhembe (northern & eastern lowveld areas) and the east part of the Mopani region”. The NICD has also observed ‘a significant increase in malaria cases’ centred on the endemic provinces (Limpopo, KwaZulu-Natal and Mpumalanga), as well as Gauteng. Read more

TEST POSITIVITY for mumps has risen this year, with ‘steady increases’ seen in KwaZulu-Natal, Mpumalanga and Gauteng. According to the NICD, rates have been highest in children aged one to nine years (83-84 percent), followed by adults in their early 30s (67 percent). The ‘unexpected, sudden increase in mumps IgM and PCR test positives, in the absence of other data, constitutes an outbreak’. Read more  

Advice for travellers

Travelvax recommends that travellers visiting malarious regions discuss their itinerary and the possible need for anti-malaria medication during a pre-travel medical consultation. More on malaria.

Bird flu in 2 farm workers

Asymptomatic avian influenza H5N1 infections have been detected in two poultry workers during routine testing. Both had worked at a farm in England which had experienced an outbreak of the disease in its flock. Investigations are underway into one of the cases in question where a positive result may have been due to environmental contamination as opposed to infection, mirroring similar incidents in Spain and the US since early last year. Read more

Advice for travellers

There are several strains of bird flu and while the virus 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.

Mpox emergency over

The WHO director-general accepted the determinations of the IHR Emergency Committee on the Multi-Country Outbreak of mpox meeting held last week and announced the end of the emergency phase (PHEIC) of the response. The committee listed a number of long-term challenges and issued revised Temporary Recommendations for the transition period. Meanwhile the US CDC, through its Health Alert Network (HAN), said that the outbreak is not over and it ‘continues to receive reports of cases that reflect ongoing community transmission in the United States and internationally’. Social gatherings during the warmer weather have the potential to lead to a resurgence in mpox infections. Read more

Advice for travellers

Closely related to the smallpox virus, mpox (monkeypox) was mainly found in Central and Western Africa, with rodents the suspected reservoir, and 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 in the affected African countries. An outbreak of mpox in countries without previously documented transmission began in 2022. Read more information on the 2022 global outbreak from the WHO. Read more on mpox.