i) Update on GeoSentinel ii) Interventions to increase travel health

awareness among VFR travellers Associate Professor Karin Leder

Director of Travel Medicine and Immigrant Health, Royal Melbourne Hospital, Victoria, Australia

Head of Infectious Disease Epidemiology Unit Monash University, Victoria, Australia

The Global Surveillance Network of the ISTM and CDC

A worldwide communications and data

collection network of travel/tropical medicine

clinics

www.geosentinel.org

Provider-based surveillance of international travelers & migrants

56 travel/tropical medicine clinics, 24 countries, 6 continents

Approx 200,000 patient records (since 1996) >250,000 final diagnoses

Rationale for GeoSentinel

• Travel & migration continue to increase

• Travelers & immigrants = key elements in spread of emerging ID

• Travelers as sentinels

• Value of central aggregation of global data

• Functions

1. Surveillance – response (alarming sentinel events)

2. Surveillance – ongoing trends

3. Analysis of morbidity and risk factors – Diagnosing ill-returnees, advising prospective travelers, defining

associations b/n demographic or itinerary characteristics and disease

Assessing risk using GeoSentinel data

Risk

All incident cases

All travelers to a destination

Proportionate Morbidity

No. of patients with diagnosis (or group of diagnoses)

All ill travelers to a destination

• Sentinel surveillance among “ill” travelers ‒ Don’t describe all travelers or all illness in

• Over-representation of “risky” destinations

• 47 GeoSentinel publications, >1,500 citations

• 24% of VFRs had pre-travel encounter vs 67% of tourists

• VFRs should be targeted for pre-travel health interventions

CID 2006

Systemic Febrile Illnesses Proportionate morbidity (%)

35%

23%

1.50% 0.90%

19%

10%

0.90%2%

12%

3%

0.30%2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Systemic febrile illness Malaria Typhoid Dengue

Immigrant-VFR Traveler-VFR Tourist-traveler

26% of VFRs managed as inpatients vs 6% of tourists

• Initiative supported by unrestricted educational grant from Sanofi Pasteur

• Communications consultancy firm engaged – Devised ways to encourage pre-travel advice for VFRs – Identified GPs in high VFR communities and alert re need for

opportunistic/proactive advice

– Identified priority communities (Chinese, Vietnamese, Indian)

• Engaged Drs from 3 major ethnic grps as spokesmen • Established combination of methods to convey travel-related

messages

Media outreach

• Over 5 months: – Publication of 64 media

items on travel health in 4 languages

• Estimated audiences for media outlets: 1.1 M

Multilingual printed educational materials

• Posters, fold out z-cards, tear-sheets

Hotspot identification

• 100 businesses identified across Sydney and Melbourne – GP practices

– Non-medical businesses

• Posters and tear-sheets distributed to GPs

• Posters distributed to non-medical businesses via bilingual taskforce

Ethnic community events • Hosted information stalls

conveying travel-related public health messages at ethnic community events – 2 Autumn Moon Festivals (18th

& 19th Sep ‘10) – 2 Diwali Festivals (31st

Oct & 7th Nov ‘10) • Over 5,000 z-cards distributed

– 2,500 in Chinese, 2,000 in English, 700 in Vietnamese

Conclusions and Limitations

• Multi-dimensional campaign for community education

• Novel initiatives specifically targeted to ethnic groups contributing large numbers of VFRs

• Opportunistic dissemination of linguistically and culturally appropriate information

• Simple health messages • Formal evaluation of impact of interventions

unable to be performed

Improving health of international students: Promoting awareness of TB and VFR-travel

• >557,000 international students enrolled in Australia in 2011; ~1/3 based in Victoria

• Students originate from >160 countries – China and India most common

• Timing of travel usually at end-of-year breaks

Aims and Methods • Determine feasibility and acceptability of establishing

appropriate health education materials targeted at international students

• Identify and engage interested parties – Student Services at Education Institutions

– GP’s & Health Clinics, community Centres

– International Student Organisations

– Health Insurance Providers

• 2 health messages: I. Early presentation for TB

II. Pre-travel visit for international students travelling as VFRs

‘Toolbox’ of Materials Generated

Sample pack

Social media Text for Facebook, Twitter, newsletters

Postcards Pamphlets

PowerPoint slides

Poster

Key Travel Health Messages

Seek pre-travel advice

Consider vaccination and preventive medication as recommended by your doctor

If sick during travel or on return to Australia

→ See a doctor and tell them that you have recently been overseas

Materials Distributed Education institution

Medical facility Other Total

VFR travel postcard 9,740 1,500 250 11,490

VFR travel pamphlet 7,540 680 250 8,470

Electronic media 26 4 3 33

Sample text for twitter

International students - UR @ risk 4 infections when U travel home. See a Dr b4 U travel. Visit traveldoctor and

smartraveller

Postcard

Pamphlet

Presentation title 22

Conclusions • International student support services & health care

providers willing to disseminate health education messages

• Established database of relevant facilities (specific contacts)

• Determined optimal methods for information delivery

• Developed and distributed materials

• Limitations – Unable to determine how many students saw message or whether

any changes in behaviour occurred

– Unsustained

Discussion

• Short term educational VFR initiatives possible but efficacy in changing behaviour is unknown

• Few improvements in last decade