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Horizon 2020 Horizon 2020 Dr Dipti Patel RCN Public Health Forum and NaTHNaC Travel Health Conference February 2020 By the end of this presentation …you will be able to: • Identify the current/future challenges facing the international traveller and those advising travellers • Highlight key new and anticipated changes/articles in travel medicine • Consider expected developments in travel medicine in 2020 and beyond • Travel patterns • Traveller type • Vaccine related • Non vaccine related • Outbreaks Travel Patterns https://www.e-unwto.org/doi/pdf/10.18111/9789284421152 Where in the world? https://www.e-unwto.org/doi/pdf/10.18111/9789284421152 UK travelling patterns UK residents' visits abroad by purpose, 1998 to 2018 https://www.ons.gov.uk/peoplepopulationandcommunity/leisureandtourism/articles/traveltrends/2018 The challenges • Changing disease patterns in over 220 countries • Preventive/therapeutic interventions/guidance change • An online world allows for frequent, detailed dissemination information • Brits like to travel….and they are: • going to more exotic locales • online and research widely • older, younger, have co-morbidities, are immunosuppressed…. …their judgement can be poor.. https://www.theguardian.com/artanddesign/2015/dec/28/selfies-danger-death-2015 Gerard T. Flaherty, Joonkoo Choi; The ‘selfie’ phenomenon: reducing the risk of harm while using smartphones during international travel, Journal of Travel Medicine, 2016 Advising the traveller - the reality • Travellers get information from various sources • Many do not seek pre-travel advice • They don’t do what they say they will • They have their own perception and tolerance of risk • Cost of interventions may be prohibitive • Practitioner beliefs can affect perception • They have great expectations…. And they watch/read/listen to the news… https://www.nytimes.com/2020/02/06/world/asia/coronavirus-cruise-ship.html https://www.youtube.com/watch?v=Kk6tYHVaWww The older traveller • …60, 65, 70…..? • Co-morbidities • Mobility • Polypharmacy • Severe infections • Immunosenescence • YF vaccine adverse events https://travelhealthpro.org.uk/factsheet/70/older-travellers Travel destinations • 75% planned to travel alone • 34.5% planned to travel to the one or more countries with risk of yellow fever transmission • 29.4% were planned cruises which involved complex itineraries with multiple locations and environmental conditions Del Prete V, et al Malaria prevention in the older traveller: a systematic review, Journal of Travel Medicine, Volume 26, Issue 7, 2019 Lee TK et al. Guidelines for the prevention of travel-associated illness in older adults. Trop Dis Travel Med Vaccines. 2017 https://www.gov.uk/drug-safety-update/yellow-fever-vaccine-stamaril-and-fatal-adverse-reactions-extreme-caution-needed-in-people-who-may-be-immunosuppressed-and-those-60-years-and-older Immunosuppression • Since April 2013 NICE have positively appraised 29 new immunomodulating agents • Between 2013 and 2018, expenditure increased on 9 of the top 10 immunomodulating drugs • Rates of chronic immunosuppressive conditions are on the rise too, including all cancers • Rise in the proportion of calls involving immunocompromised travellers (12.2% vs. 8.1% in 2013) Immunosuppression Hall V et al. Travel and biologic therapy: travel-related infection risk, vaccine response and recommendations, Journal of Travel Medicine 2018 Chang C et al. Travel vaccination recommendations and infection risk in HIV-positive travellers, Journal of Travel Medicine, Volume 26, Issue 6, 2019 https://travelhealthpro.org.uk/factsheet/66/immunosuppression Special risk travellers https://travelhealthpro.org.uk/fact-list.php?list=5 Vaccine issues • Measles • Polio • Yellow fever Measles https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/ Measles • Measles remains endemic in many parts of the world • It takes only one non-immune person travelling to area with lower vaccination rates to cause an outbreak • The pre-travel appointment is an ideal time to ensure individual is up to date with MMR vaccine • Increasing awareness in higher risk groups requires a tailored approach Measles Polio – the endgame https://travelhealthpro.org.uk/news/423/polio-public-health-emergency-of-international-concern Donaldson LJ. Eradicating Polio. BMJ 2018 https://www.who.int/news-room/feature-stories/detail/two-out-of-three-wild-poliovirus-strains-eradicated Yellow fever vaccine associated adverse events https://www.gov.uk/government/news/strengthened-recommendations-for-the-yellow-fever-vaccine https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/860666/yellow_fever_inadvertent_vaccination_guidance.pdf Improving vaccine uptake Non vaccine related • Malaria • Zika • Pollution • Medical tourism Malaria…same old issues? https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/812824/Malaria_imported_into_the_United_Kingdom_2018.pdf Calls to NaTHNaC advice line? Kay N et al. Pre-travel malaria enquiries to the United Kingdom national travel advice line 2016: Advice mainly needed on malaria maps and risk groups.Travel Med Infect Dis. 2019 What’s new in malaria Chiodini PL, Patel D, Whitty CJM and Lalloo DG. Guidelines for malaria prevention in travellers from the United Kingdom, 2018. London: Public Health England; November 2018 Tan KR et al. Tafenoquine receives regulatory approval in USA for prophylaxis of malaria and radical cure of Plasmodium vivax. J Travel Med. 2018 Schlagenhauf P et al. Complex choices: Which malaria chemoprophylaxis can be recommended for the pregnant traveller? [published online ahead of print, 2019 Nov 20]. Travel Med Infect Dis. 2019;101525. doi:10.1016/j.tmaid.2019.101525 Zika • More than 4,800 pregnancies in the US territories had confirmed or possible Zika 2016-2018. • About 1 in 7 (or 14%) had one or more health problems possibly caused by Zika • Some of these problems were not apparent at birth • The full range of long-term health problems caused will remain unknown until these babies mature Rice ME et al. Vital Signs: Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection — U.S. Territories and Freely Associated States, 2018. MMWR Morb Mortal Wkly Rep 2018;67:858-867. Poor air quality Annual mean ambient PM2.5 (ug/m3) - from measurements, 2018 update http://maps.who.int/airpollution/ Air pollution and travel Ruzmyn Vilcassim MJ et al, Exposure to air pollution is associated with adverse cardiopulmonary health effects in international travellers. Journal of Travel Medicine 2019 Guindi MN et al, Every breath you take: how does air pollution affect the international traveller? Journal of Travel Medicine 2018 In the news Information on country pages http://aqicn.org/city/australia/canberra/monash/ Medical tourism Foley BM et al. Patient care without borders: a systematic review of medical and surgical tourism, Journal of Travel Medicine, Volume 26, Issue 6, 2019 EU exit ….again Outbreaks Changing climate Public health emergencies of international concern (PHEIC) • Since 2009 WHO) has declared PHEICs for 5 disease outbreaks: • 2009 H1N1 (or swine flu) pandemic • 2014 polio • 2014 Ebola in West Africa • 2015 Zika • 2019 Kivu Ebola epidemic • On January 30, 2020, (2019-nCoV) in the People's Republic of China A rapidly evolving situation • 31st December 2019: WHO informed of 44 cases of pneumonia associated with Wuhan City • Link to large seafood and live animal market suggesting zoonotic origin • 9th January 2020: WHO announced that novel coronavirus detected: 2019-nCoV • Person-to-person spread confirmed in community and health settings in China, as well as Vietnam, Japan, Thailand, Germany, and the US • Transmission dynamics in first 425 cases found that 55% of cases before 1st January 2020 were linked to Seafood Market; only 8.6% of cases after this date were linked to market confirming person-to-person spread among close contacts since mid Dec 2019 • Uncertain how easily virus spreads - possible that asymptomatic carriers may be able to infect people Coronavirus – situation as of 7th February http://who.maps.arcgis.com/apps/opsdashboard/index.html#/c88e37cfc43b4ed3baf977d77e4a0667 https://www.thesun.co.uk/news/10896117/coronavirus-thirty-staff-hong-kong-cruise-ship/ Current UK travel advice • Risk to UK population to China, considered to be moderate • FCO advises against all travel to Hubei province, China and all but essential travel to rest of mainland China • Post travel recommendations for China, Hong Kong, Japan, Macao, Malaysia, Singapore South Korea, Taiwan, Thailand What should you be advising travellers • Be aware of latest official departing country advice about travel and impact this may have on travel insurance coverage and medical repatriation costs • Contact travel agents or airlines to get latest advice on travel restrictions or local public health advice • Vulnerable travellers should be aware of possibly increased risk of severe infection • Keep up to date with local or departing country advice during trip • Be aware that there may be enhanced screening/monitoring at entry and exit ports • Be aware of returning country advice on self-isolation When abroad On return Hubei Province Mainland China (not Hubei), Hong • Regardless of symptoms self- Kong, Japan, Macao, Malaysia, isolate for 14 days South Korea, Singapore, Taiwan or • Stay indoors and avoid contact Thailand with others • Do not need to self-isolate if no • If symptoms call: symptoms • NHS 111 (England and Wales) • If symptoms, self-isolate and call: • 0300 200 7885 (Northern Ireland) • NHS 111 (England and Wales) • Your GP or NHS24 111 (Scotland) • 0300 200 7885 (Northern Ireland) • Your GP or NHS24 111 (Scotland) Coronavirus resources https://www.gov.uk/government/collections/wuhan-novel-coronavirus https://www.bmj.com/coronavirus https://www.thelancet.com/coronavirus What next…. • More 2019-nCoV • More measles, polio, air pollution…. • Improving EVD situation in DRC? • ….less travel? Thank you for your time 0845 602 6712 https://travelhealthpro.org.uk www.nathnac.org [email protected].
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