Cholera warning for travellers

5 minute read

While Australia hasn’t seen any cases, numbers are exploding overseas.

The WHO has declared the global risk of cholera to be “very high” as the disease spreads to 24 countries. 

And while Australia is yet to report a case of cholera this year and had only three cases last year according to national disease surveillance data, travellers are still at risk, a University of Queensland infectious diseases expert has warned. 

Associate Professor Paul Griffin, also director of infectious diseases at Mater Health, said many of the countries affected by the current outbreak were popular with Australian travellers.  

People at the most risk were those returning home to one of these countries to visit friends and relatives, he told The Medical Republic

“That’s because they often reside in a high diversity country for things like cholera, typhoid and malaria. When they move away, their immunity does decline over time, in the absence of ongoing exposure. 

“And then when they return home [to the country where they are visiting friends and family], they are susceptible as a traveller but behave like a local who does have immunity. So they’re the ones that are at greater risk of all of these [cholera, typhoid and malaria] and particularly cholera at the moment.” 

According to WHO’s latest 20 March data, 24 countries have reported cases of cholera. There have been almost 340,000 cases reported overall and nearly 3300 deaths.  

Countries and regions with the largest case numbers include Pakistan (77,000 cases), north-west Syria (58,000), Malawi (55,000), Haiti (37,000) the Democratic Republic of the Congo (25,000), Afghanistan (23,000) and the Syrian Arab Republic (21,000). 

“The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including shortages of the oral cholera vaccine, as well as overstretched public health and medical personnel, who are dealing with multiple disease outbreaks and other health emergencies at the same time,” the WHO said in a statement. 

“Based on the current situation, including the increasing number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO assesses the risk at the global level as very high.” 

Professor Griffin said the global cholera outbreak had been “bubbling away” for a couple of years, however the latest WHO advice highlighted the challenges of the disease against the covid backdrop. 

“There’s been so many contributing factors, not least the fact that public health systems and health care personnel are overwhelmed with so many other things that this has really been allowed to really take off,” he said. 

“This is what happens when we focus on something else – those other things come back.” 

In Australia, covid stymied overseas travel for two years, but that had all changed about a year ago when international borders reopened. 

“I think that’s something else that probably lapsed a little bit is our recognition and management of people that need travel advice,” said Professor Griffin. 

“It was obviously something that we didn’t have to consider for such a long time. But people are moving around again and visiting family and doing all those things. 

“And this is something that I think people that may be considering travelling, certainly need to know about.” 

He said with more people moving around overseas, it was important for doctors to offer travel advice around vaccines and the importance of fundamental hygiene practices, especially around being cautious about what travellers eat and drink while they’re away. 

“We’re starting to see more cases of people who have picked things up while travelling,” he said. 

“This week I’ve had a patient with malaria and a patient with dengue. I think a lot of our systems of recognising people who are travelling high risk areas, and making sure they got the right advice has maybe just become a little less of a focus because people didn’t travel and all the focus has been on covid.” 

Professor Griffin said it was a good idea for doctors to refocus on travel medicine to ensure that patients were protected. 

“I think because the focus has solely been on covid, we have lost sight of other infectious diseases. And perhaps just getting that that basic travel consultation,” he said. 

“So the simple advice [for GPs] would be to make sure you inquire about prospective travel and go through all the things that you used to because if you didn’t, the risks are greater now than they perhaps were before,” he said. 

“The interesting thing was all the things we did for covid actually reduced to a lot of these types of infections, even things like gastrointestinal things. But of course, they’re all undone now. And we are seeing the, the resurgence of a lot of them as a result.” 

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