The aim of the presentation was to create awareness about the interaction between health and travel. Here, particular emphasis is on infectious diseases. Read and digest. Comments are welcomed.

1. EFFECT OF GLOBAL TRAVEL ON HEALTH:
the case of infectious diseases
By
NCHANJI GORDON T.
BUMPSA 2015

2. OUTLINE
 Introduction
 Conceptual Framework
 Why travel?
 Infectious diseases and travel
 CASES: TYPHOID MARY: CHOLERA:
MALARIA: SARS; EBOLA
 How is this issue handled?
 CONCLUSIONS
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3. 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).
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4. ~Conceptual Framework~
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5. 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
HEALTH
Stress
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6. 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)
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7. INFECTIOUS DISEASES
AND
TRAVEL
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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)
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9. 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).
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10. CASES
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11. 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/
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12. 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).
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13. Malaria
Population 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).
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14. 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).
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15. Global spread of EBOLA (March 2014 outbreak)
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16. How
is
this
issue
handled???
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17. 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).
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18. CREATING AWARENESS!!!
-Infographics
-News
-Communiques
-SMS (Senegal)…
Creating
awareness
particularly
strengthens
PREVENTION
CAMPAIGNS
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19. 19

20. 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)
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21. 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).
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22. THANK
YOU
IMMENSELY
FOR
YOUR
ATTENTION
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