Travel Health Alerts

COVID-19 update

The public health emergency of international concern, or PHEIC, declared on the COVID-19 pandemic was ended last week after the 15^th meeting of the WHO’s International Health Regulations Emergency Committee. Even so, as the agency’s director-general noted that the global health threat is not over: “This virus is here to stay. It is still killing, and it’s still changing. The risk remains of new variants emerging that cause new surges in cases and deaths.” Read more

Early rise in measles cases; Ticks are about

In 2022 the UK Health Security Agency (HSA) recorded 54 measles cases, however this year there had already been 49 cases up to April 20 (some linked to overseas travel). The situation is even more concerning with vaccination coverage for the first dose of the measles, mumps, rubella (MMR) vaccine in children aged two years currently at 89 percent. Elsewhere, measles reports have been posted from Armenia, D R of Congo, Ethiopia, Lesotho, Mauritania and New Zealand. Read more  

NEWS MEDIA reporting on the incidence of Lyme disease have incorporated a map which reveals England’s south and south-west to be most affected. According to Lyme Disease UK, around 1,000 laboratory-confirmed cases are registered each year in England and Wales, while actual numbers are likely to be much higher. Of the confirmed cases, the top four counties with the highest incidence were Somerset, Dorset, Bristol and Wiltshire. And in the USA, where around 475,000 people are infected with Lyme disease each year, an oral vaccine targeting the rodent reservoirs of Borrelia burgdorferi has been conditionally approved. Read more

Advice for travellers

Ticks can attach to any part of your body but are often found in hard-to-see areas such as the groin, armpits, and scalp. Infected ticks must be attached for 36-48 hours or more before Lyme transmission can occur, so it is important to check yourself each day after outdoor activities. The CDC’s Lyme disease fact sheet offers plenty of other good advice.

Another MVE case in the West; Hep A alert in Victoria; Flu cases top 32,000

A second Murray Valley encephalitis (MVE) case has been reported this year from Western Australia. The health department confirmed the infection on Monday, advising the person ‘was potentially exposed to infected mosquitoes while travelling in the West Kimberley and the Northern Territory’ - the virus has been detected in the area through Western Australia’s surveillance system. The state’s Managing Scientist stressed the need to avoid mosquito bites to prevent infections such as MVE, Japanese encephalitis and Kunjin virus. Read more

THE VICTORIAN health department issued an alert late last week after linking two hepatitis A infections to a café in Springvale, in Melbourne’s SE. The stated potential exposure timeframe for patrons of the café was from March 25 until April 8, however monitoring for symptoms of Hep A infection should be continued for the extended range of its incubation period of 50 days. Read more  

NATIONAL FLU infection rates have soared this year, with more than 32,000 cases (and 32 associated deaths) recorded; 6,000 in the most recent reporting fortnight. Over three-quarters of infections were due to influenza A (most not sub-typed) and 22 percent of influenza B. On a global level, a WHO update taking in data around early April showed activity sharply up in Peru and Hong Kong, while infection levels were elevated in Chile and Australia. 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.

Dengue activity in 2 regions

A 2-week fumigation program to eradicate mosquito breeding sites is underway in the NE canton of Sarapaquí after the health ministry confirmed the circulation of all four dengue serotypes in the area of Puerto Viejo, La Guaria, Palmitas, Tucán, Rojo Maca and Cuatro Esquinas. The ministry also advised that the highest dengue case numbers reported in recent weeks were in the regions of Huetar Caribe and Central Sur, and has reminded residents not to self-medicate and to seek medical assistance early for any concerning symptoms such as fever, aches, malaise, vomiting or abdominal pain. 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.

Global polio digest

Only one country had a polio case to report to the GPEI last week – the first circulating vaccine-derived polio type 2 (cVDPV2) case this year for Côte d’Ivoire and it was located in Bounkani. Elsewhere, eight positive cVDPV1 environmental samples were collected in Madagascar, all in Analamanga (mentioned in last week’s post as the site of three cVDPV1 cases). 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.

Mpox reports continue; Cholera in SE border province

In the WHO African region, 106 of the 11 mpox cases reported in the two weeks to April 23 were in the DRC (also two each in Nigeria and Liberia, and one in Ghana), taking its YTD total to 277 laboratory-confirmed infections. Cases have been reported each week this year from both the DRC and Nigeria. In regions without previously documented mpox transmission, 17 new cases were detected over the past month in the EU (Spain, France, the UK, Netherlands, Austria, Ireland, Poland and Greece) and South Korea announced the detection of 16 new cases last week, while in Australia, the first mpox infection since November was announced by NSW Health last week – a Sydney resident with no recent history of travel ‘so there may be some local transmission of the virus occurring’. Read more

IN THE SPACE of two weeks, cholera has caused the deaths of 11 people and sickened 329 in Lubumbashi, a mining hub near the Zambian border and capital of the SE province of Haut-Katanga. The outbreak has hit two areas in the city’s SW, Katuba and Annexe. 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.

Marburg virus outbreaks update

This week, the WHO provided a summary of the first outbreaks of Marburg virus disease (MVD) in Equatorial Guinea and Tanzania, making recommendations on case and alert management, contact tracing, and surveillance within each country and at border crossings. Concern remains over unlinked chains of transmission in the former and a still unknown virus source in Tanzania. It will not be possible to commence discussions on the start of the 42-day countdown to the end of the outbreaks until ‘all listed contacts of confirmed or probable cases have completed their 21-day follow-up period with no symptoms’. Read more

Advice for travellers

Marburg virus disease (MVD) is a severe viral haemorrhagic fever, related to the Ebola virus, and there is no treatment. Found in the African fruit bat, Marburg typically appears in sporadic outbreaks and laboratory-confirmed cases have occurred in Uganda, Zimbabwe, the Democratic Republic of the Congo, Kenya, Angola, and South Africa. Preventive measures are not well defined, as study in how it is spread continues, but travellers should avoid contact with fruit bats and sick primates in central Africa. Read more on MVD

Intense heat over region

Heat records have been equalled or broken in Vietnam, Laos and Thailand as extreme temperatures continue their weeks-long effect on the region. Daytime readings of 43 degrees or more have seen workers start earlier in the day so they can be indoors once the heat builds from 10am. The annual hot season lasts until June when the monsoon season arrives. Read more

More diphtheria this year; Rabies in Ilicos Norte dogs

A spike in diphtheria infections this year was announced by the department of health, with cases up 775 percent and 35 deaths. Metro Manila and the National Capital Region recorded the highest number of cases and deaths, respectively. Read more

THE DETECTION of rabies in 30 dogs found in the area of Batac City in the NW province of Ilicos Norte this year is being attributed to a pause in canine vaccinations during the pandemic. Veterinary and agricultural officers are planning a catch-up immunisation campaign for local dogs and a public awareness program for their owners. Read more

Advice for travellers

Despite efforts to control rabies through canine immunisation in several provinces of the Philippines, rabies remains a major problem in many regions. However, 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. Read more on rabies.

Enterovirus threshold reached

The peak season for enterovirus infections has officially started after the weekly threshold of 11,000 cases was passed last week. The CDC announced a 10 percent rise in cases over the previous week and has stressed the need for enhanced hygiene measures to prevent the highly infectious illness. Read more

Rabid foxes in Alaska’s west

Government veterinary officials in western Alaska have warned that the number of red foxes testing positive to rabies around the Nome area has increased this year, posing a risk to humans directly and also through their dogs if they have been in contact with an infected fox. A ProMED post has outlined other recent rabies exposures to humans and dogs in the USA: Death Valley, California; Suffolk, Virginia; and Larimer County, Colorado. 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.