Geographical Pattern of Infectious Diseases and Infection Prevention for Travellers

2019 ◽  
Author(s):  
Desmond Hsu ◽  
Zahir Osman Eltahir Babiker
Keyword(s):  
Infectious Diseases ◽  
Migratory Birds ◽  
Sunshine Duration ◽  
The United States ◽  
International Travel ◽  
Travel Health ◽  
Health Advice ◽  
Visiting Friends And Relatives ◽  
Main Determinants ◽  
Key Aspects

Infectious diseases are transmitted either directly from person to person via direct contact or droplet exposure, or indirectly through a vector organism (mosquito or tick) or a non-biological physical vehicle (soil or water). Vector-borne infectious diseases are highly influenced by climate factors such as temperature, precipitation, altitude, sunshine duration, and wind. Therefore, climate change is a major threat for the emergence and re-emergence of infectious diseases, e.g. re-emergence of dengue fever in some parts of southern Europe. The natural reservoirs of infectious diseases are either humans (anthroponoses) or animals (zoonoses). Population movement due to travel or civil unrest risks introducing non-immune populations to regions that are endemic for certain infectious diseases. By contrast, global trade contributes to the movement of animals or arthropods across the world and this poses a major risk for introducing infectious diseases to previously non-endemic settings, e.g. rats on board commercial ships and the global spread of hantaviruses; international trade in used car tyres and the risk of introducing flavivirus-infected mosquitoes into non-endemic settings; and the contribution of migratory birds to the introduction and the spread of West Nile virus in the United States. The unprecedented growth of international travel facilitates the swift movement of pathogens by travellers from one region to another. The main determinants of travel-related infections are destination country, activities undertaken during travel, and pre-existing morbidities. Therefore, the pre-travel consultation aims to assess potential health hazards associated with the trip, give advice on appropriate preventative measures, and educate the traveller about their own health. Attitudes towards seeking pre-travel health advice vary by the type of traveller. For example, those visiting friends and relatives (VFRs) in their country of origin are less likely to seek pre-travel health advice compared to tourists and therefore stand a higher chance of presenting with preventable infections such as malaria. The key aspects of a pre-travel consultation include: ● comprehensive risk assessment based on the demographic and clinical background of the traveller as well as the region of travel and itinerary.

Factors Affecting Pre-Travel Health Seeking Behaviour and Adherence to Pre-Travel Health Advice: A Systematic Review

2019 ◽  
Vol 26 (6) ◽  
Author(s):  
Dylan Kain ◽  
Aidan Findlater ◽  
David Lightfoot ◽  
Timea Maxim ◽  
Moritz U G Kraemer ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Public Health Education ◽  
International Travel ◽  
Health Providers ◽  
Health Seeking ◽  
Factors Affecting ◽  
Travel Health ◽  
Health Advice ◽  
Full Text Review

Abstract Background Recent years have seen unprecedented growth in international travel. Travellers are at high risk for acquiring infections while abroad and potentially bringing these infections back to their home country. There are many ways to mitigate this risk by seeking pre-travel advice (PTA), including receiving recommended vaccinations and chemoprophylaxis, however many travellers do not seek or adhere to PTA. We conducted a systematic review to further understand PTA-seeking behaviour with an ultimate aim to implement interventions that improve adherence to PTA and reduce morbidity and mortality in travellers. Methods We conducted a systematic review of published medical literature selecting studies that examined reasons for not seeking PTA and non-adherence to PTA over the last ten years. 4484 articles were screened of which 56 studies met our search criteria after full text review. Results The major reason for not seeking or non-adherence to PTA was perceived low risk of infection while travelling. Side effects played a significant role for lack of adherence specific to malaria prophylaxis. Conclusions These data may help clinicians and public health providers to better understand reasons for non-adherence to PTA and target interventions to improve travellers understanding of potential and modifiable risks. Additionally, we discuss specific recommendations to increase public health education that may enable travellers to seek PTA.

scholarly journals The COVID-19 pandemic offers a key moment to reflect on travel medicine practice

2020 ◽  
Vol 27 (8) ◽  
Author(s):  
Christoph Hatz ◽  
Silja Bühler ◽  
Andrea Farnham
Keyword(s):  
Infectious Diseases ◽  
Travel Medicine ◽  
Evidence Based ◽  
Medicine Research ◽  
Travel Health ◽  
Health Advice

COVID-19 provides an opportunity to review travel health advice priorities. Infectious and non-infectious diseases are key for travel medicine, Research is warranted to stimulate an evidence-based balance in what travel medicine experts communicate to their clients

scholarly journals The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance

2016 ◽  
Vol 144 (16) ◽  
pp. 3554-3563 ◽  
Author(s):  
A. E. HEYWOOD ◽  
N. ZWAR ◽  
B. L. FORSSMAN ◽  
H. SEALE ◽  
N. STEPHENS ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Disease Control ◽  
Communicable Disease ◽  
Control Strategies ◽  
Hepatitis E ◽  
International Travel ◽  
Foreign Born ◽  
South Wales ◽  
Increased Risk ◽  
Visiting Friends And Relatives

SUMMARYImmigrants and their children who return to their country of origin to visit friends and relatives (VFR) are at increased risk of acquiring infectious diseases compared to other travellers. VFR travel is an important disease control issue, as one quarter of Australia's population are foreign-born and one quarter of departing Australian international travellers are visiting friends and relatives. We conducted a 1-year prospective enhanced surveillance study in New South Wales and Victoria, Australia to determine the contribution of VFR travel to notifiable diseases associated with travel, including typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya. Additional data on characteristics of international travel were collected. Recent international travel was reported by 180/222 (81%) enhanced surveillance cases, including all malaria, chikungunya and paratyphoid cases. The majority of cases who acquired infections during travel were immigrant Australians (96, 53%) or their Australian-born children (43, 24%). VFR travel was reported by 117 (65%) travel-associated cases, highest for typhoid (31/32, 97%). Cases of children (aged <18 years) (86%) were more frequently VFR travellers compared to adult travellers (57%,P< 0·001). VFR travel is an important contributor to imported disease in Australia. Communicable disease control strategies targeting these travellers, such as targeted health promotion, are likely to impact importation of these travel-related infections.

scholarly journals 918. Typhoid Fever in the US Pediatric Population, 1999–2015, and the Potential Benefits of New Vaccines

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S26-S26
Author(s):  
Jarred McAteer ◽  
Gordana Derado ◽  
Michael Hughes ◽  
Amelia Bhatnagar ◽  
Felicita Medalla ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Typhoid Fever ◽  
Pediatric Population ◽  
The United States ◽  
Multidrug Resistant ◽  
International Travel ◽  
Illness Onset ◽  
Current Vaccine ◽  
Visiting Friends And Relatives ◽  
Resistance Data

Abstract Background In the United States, typhoid fever is rare. About 300 typhoid cases are reported to CDC annually through the National Typhoid and Paratyphoid Fever Surveillance (NTPFS) system. Most are acquired during international travel and while visiting friends and relatives. CDC recommends pretravel vaccination of at-risk children with one of two currently available vaccines: oral (age ≥6 years) or injectable (age ≥2 years). In anticipation of licensure of new protein-conjugate typhoid vaccines that could be administered to children ≥6 months old, we characterized clinical, epidemiologic, and antimicrobial resistance data of pediatric typhoid fever cases reported to CDC. Methods We reviewed laboratory-confirmed Salmonella enterica serotype Typhi infections reported to NTPFS and antimicrobial resistance data on Typhi isolates in the National Antimicrobial Resistance Monitoring System (NARMS) from 1999 to 2015. Results Of 2,051 pediatric (≤18 years) cases of typhoid fever, 80% had traveled internationally within 30 days of illness onset (most frequently to South Asia [82%]), 81% were hospitalized (median duration 6 days; range 0–77 days), and none died. Eight hundred twenty-seven (40%) were &lt;6 years old; 219 (26%) were 6 months–2 years old. While 76% of pediatric cases were vaccine eligible (travelers ≥2 years old), only 6% were known to be vaccinated. Of 2,020 isolates tested for antimicrobial susceptibility, 1,211 (60%) had decreased susceptibility or resistance to ciprofloxacin, of which 277 (23%) were also resistant to ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole (multidrug-resistant [MDR]). None were resistant to ceftriaxone or azithromycin. MDR isolates were more likely in children than adults (16% vs. 9%, P &lt; 0.05) and in travel-associated than domestically acquired cases (16% vs. 6%, P &lt; 0.05). Conclusion Among pediatric cases of typhoid fever, 94% of currently vaccine-eligible travelers were unvaccinated. Emphasis on current vaccine indications and an effective pretravel typhoid vaccine for children between 6 months and 2 years old available during routine immunization visits could begin to reduce the burden of disease, and help prevent drug-resistant infections, in this vulnerable age group. Disclosures All authors: No reported disclosures.

scholarly journals Retrospective analysis of older travellers attending a specialist travel health clinic

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Milad Darrat ◽  
Gerard T. Flaherty
Keyword(s):  
Medical Condition ◽  
Travel Medicine ◽  
Significant Proportion ◽  
Antihypertensive Agents ◽  
Health Clinic ◽  
Travel Health ◽  
Wide Range ◽  
Health Advice ◽  
Visiting Friends And Relatives ◽  
The Mean

Abstract Background Older people represent a significant proportion of overseas travellers. The epidemiology of older international travellers is not well described in the literature. This study aims to identify demographics, travel characteristics and the medical profile of older travellers seeking pre-travel health advice in a specialist travel medicine clinic. Methods Records of travellers aged 60 years and older attending the Tropical Medical Bureau clinic in Galway, Ireland between 2014 and 2018 were examined. Descriptive and inferential analysis of data was performed. Results A total of 337 older travellers sought pre-travel health advice during the study period. The mean age of the cohort was 65.42 (±10) years. Most of the travellers (n = 267, 80%) had at least one travelling companion. Nearly half of older travellers (n = 155, 46.8%) were travelling with a single companion. Tourism was the main reason for travel for the majority (n = 260, 77.6%), followed by visiting friends and relatives (VFR) (n = 23, 6.9%) travellers. The mean interval remaining before the planned trip was 4.36 (±2) weeks, and the mean duration of travel was 3.16 (±1) weeks. The most popular single country of destination was India with 33 (9.8%) visitors, and South East Asia was the most popular region with 132 (39.2%) older travellers. The majority of travellers (n = 267, 79.2%) had a documented pre-existing medical condition. The most commonly reported medical conditions were hypertension (n = 26, 7.7%), dyslipidaemia (n = 18, 5.3%), diabetes mellitus (n = 12, 3.5%), insect bite sensitivity (n = 11, 3.3%), and hypothyroidism (n = 9, 2.6%). Antihypertensive agents (n = 32, 9.4%) and statins (n = 24, 7.1%) were the most frequently used medications. Typhoid (n = 112, 33.2%) and hepatitis A (n = 84, 24.9%) were the most common vaccinations administered to older travellers at the clinic. Conclusions This study provides an insight into the demographics, travel characteristics, and medical profile of elderly travellers seeking advice at a large travel clinic in Ireland. A wide range of travel destinations, diseases and medication use was reported among this group of travellers, which may enable travel medicine physicians to provide more tailored advice and to more appropriately counsel older travellers.

scholarly journals 966. Infectious Diseases among US Resident Student Travelers after Return to the United States: A GeoSentinel Analysis, 2007–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S36-S36
Author(s):  
Kristina M Angelo ◽  
Jean Haulman ◽  
Anne Terry ◽  
Daniel Leung ◽  
Lin H Chen ◽  
...  
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
The United States ◽  
International Travel ◽  
Sub Saharan Africa ◽  
Global Network ◽  
Vaccine Preventable Diseases ◽  
Common Diagnosis ◽  
Vector Borne ◽  
Few Data

Abstract Background The number of US students studying abroad has more than tripled over the past 20 years. As study abroad programs diversify their destinations, more students are traveling to developing regions, increasing their risk of infectious diseases. Few data exist describing infections acquired by US students while traveling internationally. We describe the spectrum of disease among students who have returned from international travel and suggest how to reduce illness among these travelers. Methods GeoSentinel is a global network of travel and tropical medicine providers that monitors travel-related morbidity. Records of US resident student travelers, 17–24 years old, who returned to the United States and were given a confirmed travel-related diagnosis at one of 15 US GeoSentinel sites during 2007–2017. Those without ascertainable exposure regions were excluded. Records were analyzed to describe demographic and travel characteristics and diagnoses. Results There were 432 students included. The median age was 21 years; 69% were female. Over 70% had a pretravel consultation with a healthcare provider. The most common exposure region was sub-Saharan Africa (112 travelers; 26%); the most common exposure countries were India (44 students; 11%), Ecuador (28; 7%), Ghana (25; 6%), and China (24; 6%). Students presented to a GeoSentinel site a median of 8 days (range: 0–181) after travel; 98% were outpatients. The most common diagnosis categories were gastrointestinal (45%) and dermatologic (17%). Of 581 confirmed diagnoses, diarrheal illnesses were most common (165; 28%). Thirty-one (7%) students had a vector-borne disease; 14 (41%) of these were diagnosed with malaria (13 had a pretravel consultation) and 11 (32%) with dengue. Two students were diagnosed with acute HIV. Three had a vaccine-preventable disease (two typhoid; one hepatitis A). Conclusion Students experienced travel-related infections despite a large proportion receiving pretravel consultations. Students (especially those traveling to a less developed region) should receive specific pretravel instructions (including suggestions for behavioral modification, vaccination, and medication prophylaxis when applicable) to prevent gastrointestinal, vector-borne, sexually transmitted, and vaccine-preventable diseases. Disclosures All authors: No reported disclosures.

scholarly journals A Quarter Century of Emerging Infectious Diseases – Where Have We Been and Where Are We Going?

2018 ◽  
Vol 47 (1) ◽  
pp. 117
Author(s):  
James W. Le Duc ◽  
Teresa E. Sorvillo
Keyword(s):  
Public Health ◽  
Infectious Diseases ◽  
Emerging Infectious Diseases ◽  
The United States ◽  
International Travel ◽  
Emerging Infections ◽  
Quarter Century ◽  
Public Health Programs ◽  
National Public Health ◽  
Societal Changes

<p>A quarter century ago the landmark report from the U. S. National Academies of Sciences, Engineering, and Medicine entitled <em>“</em><em>Emerging Infections, Microbial Threats to Health in the United States” </em>was released. This classic study captured the societal changes then underway in our rapidly growing world: The growth of the world’s population and changing human behavior; the advances and globalization of technology and industry; the changes in economic development and land use; the dramatic increase in speed and frequency of international travel and commerce; the adaptation of microbes and the appearance of never before seen pathogens; and the breakdown of traditional public health measures. This societal evolution has only increased and the growing frequency of outbreaks foretold in the report has come to pass. Each new disaster has precipitated changes and adaptations in our global response to infectious diseases designed to reduce risks and avoid future outbreaks. We discuss these past events and how each led to change in an effort to mitigate future threats. We also look to the future to consider what challenges might lay ahead.</p><p><strong>Conclusion. </strong>Major outbreaks over the past quarter century validated the concept of emerging infectious diseases and led to improvements in global policies and national public health programs; however, there will likely always be new diseases and the threat of reemergence of diseases once thought controlled leading to a constant need for vigilance in public health preparedness.</p>

scholarly journals Pre-travel health care attendance among migrant travellers visiting friends and relatives (VFR): a 10-year retrospective analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Pietro Ferrara ◽  
Cristina Masuet-Aumatell ◽  
Josep Maria Ramon-Torrell
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Travel Medicine ◽  
Health And Safety ◽  
Malaria Prevention ◽  
Prevention Measures ◽  
Vaccination Rates ◽  
Travel Health ◽  
Health Advice ◽  
Visiting Friends And Relatives

Abstract Background Travellers visiting friends and relatives (VFR) define a specific population of travellers exposed to higher risks for health and safety than tourists. The aim of this study was to assess differentials in pre-travel health care in VFR travellers compared to other travellers. Methods A retrospective cohort study was performed including attendees of the Travel Medicine Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, between January 2007 and December 2017. Results Over the 10-year period, 47,022 subjects presented to the travel clinic for pre-travel health care, 13.7% of whom were VFR travellers. These showed higher rates of vaccination against yellow fever and meningococcus, but lower rates for hepatitis A, hepatitis B, influenza, rabies, cholera, polio, typhoid IM vaccine and tetanus vaccine boosters. Regarding malaria prevention measures, results highlighted that VFR travellers, when compared with tourists, were more likely to be prescribed with chemoprophylaxis, particularly with mefloquine, than with atovaquone/proguanil. Conclusions Findings from this large-scale study indicated differences in vaccination rates and completion, as well as in chemoprophylaxis for malaria, between VFR and non-VFR travellers, fostering specific interventions for promoting adherence to pre-travel health advice among migrant travellers.

scholarly journals Pharmacy-Based Travel Health Services in the United States

Pharmacy ◽  
2018 ◽  
Vol 7 (1) ◽  
pp. 5 ◽  
Author(s):  
Keri Hurley-Kim ◽  
Jeffery Goad ◽  
Sheila Seed ◽  
Karl Hess
Keyword(s):  
United States ◽  
Health Services ◽  
Pharmacy Practice ◽  
State Level ◽  
The United States ◽  
International Travel ◽  
Travel Health ◽  
Training Clinic ◽  
Immunization Services ◽  
Care Outcomes

The aim of this paper is to review pharmacy laws and regulations, pharmacist training, clinic considerations, and patient care outcomes regarding pharmacy-based travel health services in the United States. Pharmacists and pharmacies in the United States are highly visible and accessible to the public, and have long been regarded as a source for immunization services. As international travel continues to increase and grow in popularity in this country, there is a pressing need for expanded access to preventative health services, including routine and travel vaccinations, as well as medications for prophylaxis or self-treatment of conditions that may be acquired overseas. In the United States, the scope of pharmacy practice continues to expand and incorporate these preventable health services to varying degrees on a state-by-state level. A literature review was undertaken to identify published articles on pharmacist- or pharmacy-based travel health services or care in the United States. The results of this paper show that pharmacists can help to increase access to and awareness of the need for these services to ensure that patients remain healthy while traveling abroad, and that they do not acquire a travel-related disease while on their trip. For those pharmacists interested in starting a travel health service, considerations should be made to ensure that they have the necessary training, education, and skill set in order to provide this specialty level of care, and that their practice setting is optimally designed to facilitate the service. While there is little published work available on pharmacy or pharmacist-provided travel health services in the United States, outcomes from published studies are positive, which further supports the role of the pharmacist in this setting.

scholarly journals Pharmacy-Based Travel Health Services in the United States

2018 ◽  
Author(s):  
Keri Hurley-Kim ◽  
Jeffery Goad ◽  
Sheila Seed ◽  
Karl Hess
Keyword(s):  
United States ◽  
Health Services ◽  
Pharmacy Practice ◽  
State Level ◽  
The United States ◽  
International Travel ◽  
Travel Health ◽  
Preventative Health ◽  
Immunization Services ◽  
Care Outcomes

Pharmacists and pharmacies are highly visible and accessible to the public and have long been regarded as a source for immunization services in the United States. As international travel continues to increase and grow in popularity in this country, there is a pressing need for expanded access to preventative health services including routine and travel vaccinations and medications for prophylaxis or self-treatment of conditions that may be acquired overseas. In the United States, the scope of pharmacy practice continues to expand and incorporate these preventable health services to varying degrees on a state-by-state level. As a result, pharmacists can help to increase access to and awareness of the need for these services to insure that patients remain healthy while traveling abroad and that they do not acquire a travel-related disease while on their trip. For those pharmacists interested in starting a travel health service, considerations should be undertaken that ensures that they have the necessary training, education, and skill set in order to provide this specialty level of care and that their practice setting is optimally designed to facilitate this service. Outcomes from studies that have evaluated pharmacy-based travel health services are positive, which further supports the role of the pharmacist in this setting. Therefore, the purpose of this paper is to highlight United States pharmacy laws and regulations, pharmacist training, travel clinic considerations, and patient care outcomes from pharmacy-based travel health services.

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