Travel Medicine and Infectious Diseases: Global Health Challenges

This report examines the significant increase in international travel and its correlation with the spread of infectious diseases and antimicrobial resistance (AMR). It highlights how travelers can be exposed to various pathogens and risks, leading to health complications and the potential for global dissemination of resistant microorganisms. The report emphasizes the role of human migration in fostering infectious disease development, facilitated by air transportation and the movement of disease vectors. It discusses the importance of risk assessment for travelers, pre-travel preventive care, and the need for improved sanitation and responsible antibiotic use in low- and middle-income countries. Furthermore, the report addresses specific diseases like measles, Ebola, and traveler's diarrhea, underscoring the crucial role of travel medicine practitioners in research, surveillance, and advocating for AMR recognition on the global health agenda. The report concludes that travel is a potent force in the evolution and spread of infectious diseases, necessitating ongoing research and intervention strategies.

Running head: TRAVEL MEDICINE AND INFECTIOUS DISEASE 1
Travel Medicine and Infectious Disease
Westmead Institute for Medical Research

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International travelling has increased significantly in the past few decades, attributed to
globalization. More than 3 billion individuals travel across borders. Many people travel for
vacations, business, and visiting relatives and friends (Aw et al., 2014). Additionally, many
uncounted travellers' cross borders to evade prosecutions or in search of better opportunities.
Travellers are likely to be exposed to numerous risks and pathogens, at least 20%-60% of
travellers report of having health complications during their travel (Aw et al., 2014). During
international travel, individuals are likely to seek medical attention; some may require
emergency medical evacuations, while others may die (Morens & Fauci, 2013).
Globally the increase in antimicrobial resistance (AMR) is a threat not only to
contemporary medicine but also a significant challenge to the practice of travel medicine. The
rise in international travel contributes to the spread of antimicrobial resistance (Frost, Van-
Boeckel, Pires, Craig & Laxminarayan, 2019). Resistant microorganisms and infections have
increased mortality and morbidity. In addition, they place a significant burden on health care
systems than other diseases brought about by susceptible microorganisms.
Travellers visiting regions with a high prevalence of AMR are likely to be exposed to
resistant bacteria and are likely to carry the bacteria's back to their origin. The AMR bacteria are
located in different regions across the globe however the difference between areas is attributed to
various factors including the level of antibiotic consumption, availability of sanitation and clean
water, vaccination coverage and presence of quality medical care and access to high-quality
medical supplies (Frost et al., 2019).
Human migration favors the development of infectious diseases through numerous
channels. During travel, individuals transfer their genetic makeup and accumulated immunologic
characteristics. Travellers can carry the microorganisms in or on their bodies and are likely to

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transfer disease vectors, for instance, lice. Technological applications in the economic activities,
methods of disease treatment, traditions, and behavioral patterns may contribute to their risk for
contamination in a new environment and the ability to introduce diseases into a new area.
Recently various outbreaks have indicated contemporary epidemics, and large-scale
infectious outbreaks occur and spread significantly. (Tseng & Chan, 2015). Air transportation is
a significant vehicle for the fast dissemination and spread of infectious diseases with several
reported epidemics of major airborne diseases aboard commercial flights, for instance, severe
acute respiratory syndrome, smallpox, tuberculosis, influence, and measles (Connor & Riddle,
2013). More than 3.2 billion travellers and 50 million metric tons of cargo were transported
through air from 41,000 airports and 50,000 routes across the globe (Ericsson & Riddle, 2018).
With the increased number of travellers through the air around the world, the threat of infectious
disease transmission is a significant concern for its implication on the spread of contagious
diseases.
The healthcare providers identify travellers who are at significant risk of the travellers
including the usual tourist routes, long-term travellers as well as foreign borne individuals going
back home from a different destination as they are more likely than others to acquire different
types of diseases (Morens & Fauci, 2013). Each traveller undergoes a comprehensive risk
assessment that is critical in precisely assess traveller, itinerary, and destination-specific risk and
recommend the most appropriate risk management intervention to prevent adverse health
outcomes and enhance health during travel (Nelson et al., 2013). However, even with increased
surveillance, treatment, and vaccination, incidences of infections are still recorded in different
regions across the globe due to antibiotic resistance.

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Travel medicine practitioners offer travel advice to travellers, especially in areas that are
likely to have a high prevalence of infectious diseases (Aw et al., 2014). Different travellers have
a different extent of risk depending on the region they hail from. For instance, a member of
immigrant populations in western countries mainly from the Indian subcontinent and West
African countries are highly vulnerable to endemic diseases, for example, typhoid and malaria
when they return to their country of origin (Savini et al., 2013). The medical professionals offer
advice on the importance of carrying details of immunization, allergies, and regular medication
in addition to adequate insurance in case of emergencies. Vaccinations might also be needed and
should be offered according to each traveller's immunization history, travel itinerary, and the
available time before take-off. However, incidents are still recorded due to AMR; the standard
treatments available becomes ineffective, and infections persist and may spread.
Measles is one of the common diseases across the globe, including Asia, Europe, middle
east America, and Africa. More than 10 million get measles across the globe, and approximately
110,000 of the infected population die due to measles (Angelo et al., 2019). Many nations
ranked as popular destinations, including Israel, Thailand, and japan experience measles
outbreak. Reports indicate most of the measles cases across the globe emanate from international
travel (Savini et al., 2013). Measles is spread by unvaccinated individuals who get infected in
different nations (Angelo et al., 2019). The measles spread to other individuals who are not
vaccinated against measles, which may lead to disease outbreaks. Measles is highly contagious
and can spread to the environment through sneezing and coughing, which affects the people
around the environment. Measles is highly contagious, especially in an enclosed setting, as one
individual can infect more than 90% of the individuals surrounding them who are not immune

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(Angelo et al., 2019). Consequently, individuals infected with measles can spread the diseases
four days before the rash is visible.
Ebola is a rare and deadly disease that is spread through direct contact with the body
fluids of individuals infected with the Ebola virus. Ebola is also spread through contact with
contaminated surfaces or infected animals. Ebola can spread through sex or getting into contact
with semen and other fluids of individuals who have recovered from the disease(Tseng & Chan,
2015). Individual caring for Ebola patients is significantly at risk of developing the virus (Tseng
& Chan, 2015). Travellers from different regions, especially in Africa, should take precautions to
avoid infection. They should avoid contact with sick people, animals, and enhance hygiene to
prevent the risk of infection.
Diarrhoea is one of the most prevalent diseases affecting travellers. Many people
travelling to developing countries have diarrhoea with a significant number being bedridden
during their trip diarrhoea is mainly transmitted through consumption of contaminated water and
food (Ericsson & Riddle, 2018). Travel medical practitioners recommend individuals travelling
to developing nations with a high prevalence of diarrhoea should carry antibiotics and
antimotility agents for the treatment of diarrhoea. Also, strict water and food hygiene are critical
in nations with relatively poor sanitation. Hence, travellers should carry water, purification
tablets, and other portable water filters (Ericsson & Riddle, 2018) Pretravel preventive care,
including the assessment injury and risk of travellers, is a crucial element towards infection
prevention and control among travellers. Travel healthcare providers should consider the
traveller's medical condition and their planned journey including the exact itinerary, the length of
stay in the new region, accommodation type and the activities likely to be carried out during the
visit in the area of destination (Nelson, Marienau, Schembri & Redd, 2013).

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Therefore, individuals travelling in regions with high levels of AMR vaccines up to date
and be educated on ways of preventing and treating infectious diseases in addition to safe
practices to prevent infections (Frost et al., 2019). In low- and middle-income nations, there is a
need to decrease the transmission of resistant strains of infections by enhancing access to
sanitation facilities, clean water, and vaccines. There is also the need to curb the inappropriate
use of antibiotics accrues the globe in order to decrease cases of antimicrobial resistance.
In conclusion, travel is a potent force in the development of infectious diseases.
Movement of people across the globe is the way for dissemination infectious diseases and
continues to control the emergence, incidence, and spread of pathogens in geographic
populations and regions. New infections are projected to emerge, and the presently known
diseases will change in severity, distribution, and frequency. The profound change in the
physical environment and the combination of movements at numerous levels can lead to
unanticipated disease spread through numerous channels. Through research and surveillance,
travel medicine practitioners across the globe can map the worldwide movement and evolution
of microbes and develop interventions to the infectious conditions. Pretravel consultation,
traveller specific risk factors, destination-specific risks, and containing the identified risk is of
importance to the travel medicine practitioners. Travel medicine practitioners have a significant
role in advocating for the recognition of AMR as of importance to the global health agenda.

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