EFFECT OF GLOBAL TRAVEL ON HEALTH:

the case of infectious diseases

By

NCHANJI GORDON T.

BUMPSA 2015

OUTLINE

Introduction

Conceptual Framework

Why travel?

Infectious diseases and travel

CASES: TYPHOID MARY: CHOLERA:

MALARIA: SARS; EBOLA

How is this issue handled?

CONCLUSIONS

2

INTRODUCTION

Today, there is growing recognition that an outbreak anywhere can potentially

represent an emergency of international public health concern.

“The movement of populations shapes the patterns and distribution of

infectious diseases globally” (Wilson, 2003).

During travel, humans carry their genetic makeup, immunologic sequelae of

past infections, cultural preferences, customs, and behavioral patterns

(Wilson, 1995).

3

~Conceptual Framework~

4

GLOBAL TRAVEL

Geographical location

 

Route of Transmission

- Foodborne and waterborne diseases

- Vector-borne diseases

- Zoonoses (diseases transmitted by animals)

- Sexually transmitted diseases

- Blood borne diseases

- Airborne diseases

- Diseases transmitted via soil / formites

Economic Tourism Social

NON-INFECTIOUS DISEASES

-NCDs/Genetics

-Toxins (chemical and biological))

INFECTIOUS DISEASES

-Virus

-Bacteria

-Fungi

-Protozoa

How do we handle this problem?

-Sensitization

-Prevention

-Vaccination

-Quarantine

ConflictsNatural Disasters

Figure 1: Conceptual flow of ideas (with inspiration from WHO’s International Travel and Health guide, 2012 )

ENVIRONMENTAL RISKS-Altitude-Heat/humidity-UV radiation

INJURY AND VIOLENCE-Road traffic injuries-Recreational waters-Interpersonal violence

PSYCHOLOGICAL HEALTHStress

5

Why do we travel?

Social

Natural disasters

Conflicts

Figure 2: Tourism and commerce: cornerstones for “A World of Movement.”

Figure 3: Tourism is the fastest growing industry worldwide, and the number of in-country arrivals is projected to double by the year 2020 (Source: Hurley and Friend, 2006)

6

INFECTIOUS DISEASES

AND

TRAVEL

7

8

Selected pecific infectious diseases involving potential health risks for travellers(WHO, 2007)Disease Agent Risk

ANTHRAX Bacillus anthracis Very low for most travellers.

BRUCELLOSIS Brucella bacteria Generally low, but higher in rural/agricultural areas

LISTERIOSIS Listeria monocytogenes Low. consumption of unpasteurized milk and milk products and prepared meat products

VIRUSES

Chikungunya Chikungunya virus Risk in endemic areas/those affected by epidemics

Yellow fever virus Yellow fever virus Risk in endemic area; greater for visitors who enter forest and jungle areas

DENGUE Dengue virus Significant risk in endemic areas/those affected by epidemics

PROTOZOA

GIARDIASIS Giardia intestinalis Significant risk in recreational waters

Parasitic

LEISHMANIASIS Leishmania sp Visitors to rural and forested areas in endemic countries are at risk.

TRYPANOSOMIASIS Trypanosoma brucei sp Risk in endemic regions if they visit rural areas for hunting, fishing, safari trips, sailing or other activities in endemic areas.

Risk varies geographically and with lifestyle (Toovey et al., 2007a)

Routes of transmission

Figure 4: Common routes for potential transmission of infectious diseases between animals and humans and vice versa (Hurley and Friend, 2006).

Waterborne diseases

Sexually transmitted diseases

Bloodborne diseases

Diseases transmitted via soil

• MRSA lives for a week on seat-back

pockets in Airplanes; E. coli O157:H7

persisted for 96 hours on armrests

and 72 hours on tray tables (ASM,

2014).

• Windshield washer fluid as potential

source of Legionella pneumophila; 84%

of samples at a high concentration of

8.1×104 CFU/mL (Schwake, 2015).

9

CASES

10

Typhoid Mary: Mary Mallon~ Cook: 1900-1907

Asymptomatic carrier of typhoid fever

The work of a chronic typhoid germ distributor (SOPER, 1907).

First quarantine (1907–10); Mary Brown

Release and second quarantine (1915–38)

Death 1938 (68 years)

Blamed for 51 Cases and 3 Deaths

(The New York Times, 1938). http://upload.wikimedia.org/wikipedia/

11

CHOLERA: Haiti 2010

-START: October 21,

2010

-Nov. 16: + cases in the

neighboring Dominican

Republic and in Florida.

-Nov. 19: had reached

every department of

the country

-Several confirmed

cases in the Dominican

Republic (3) and all

confirmed U.S. cases

(5) were among

travelers from Haiti

(CDC, 2010).

12

13

MalariaPopulation movement

contributes to the spread of

malaria (Martens and Hall,

2000)

Risk is dependent upon the

entomological inoculation

rate faced by the long-term

traveler.

Risk is cumulative,

increasing with duration of

exposure, greatest in rural

and periurban areas, and

least in urban centers (Toovey

et al., 2007b).

SARS

(Source: Hurley and Friend, 2006)

-February 2003, a Canadian and a US

resident were both infected when they and

the index SARS patient stayed at the same

hotel in Hong Kong

--The US (symptomatic) resident returned

as a suspect case; was treated with caution;

so, she did not cause a SARS outbreak.

--The Canadian resident returned to Canada

as an asymptomatic case and caused a

SARS outbreak in Toronto (Ruin et al.,

2003).

14

Global spread of EBOLA (March 2014 outbreak)

15

How is this issue handled???

16

Global Outbreak Alert and Response Network-(GOARN)

-Creation: April 2000. W.H.O

-Presently monitoring:

Middle East respiratory syndrome coronavirus (MERS-CoV) -United Arab

Emirates, Qatar, Saudi Arabia, Korea, Germany and The Philippines: 1118

laboratory-confirmed cases of infection with MERS-CoV, including at least 423

related deaths

Meningococcal disease -Niger: 6,179 suspected cases of meningococcal

meningitis, including 423 deaths (WHO, 2015).

17

CREATING AWARENESS!!!

-Infographics-News-Communiques-SMS (Senegal)…

Creating

awareness

particularly

strengthens

PREVENTIO

N

CAMPAIGNS

18

19

Prevention/control of spread

The most effective measure and needs to be prompt

Hygiene (Faecal-Orally Transmitted Diseases)

Prophylaxis (Malaria)

Cure all disease humans and/animals

Quarantine (Ebola, Swine and bird flu,)

Vaccination (Yellow fever, Polio,)

Due to better hygienic standards at travel destination, Faeco-orally transmitted diseases among travellers is decreasing (Baaten et al., 2010)

20

CONCLUSIONS Travel is very much linked to infectious diseases???

Knowledge of transmission routes and putting in place of proper disinfection protocols, and personal hygiene is invaluable to keeping travelers safe.

Rapid response in case of outbreaks, to establish source and transmission mechanism(s), so as to prevent spread and thus control the disease.

Are we doing enough? (Ebola outbreak 2014).

21

THANK

YOU

IMMENSELY

FOR

YOUR

ATTENTION

22

BUMPSA2015