Public health and travel medicine: intricately intertwined

Abstract

Just over a century ago, Orville and Wilbur Wright achieved the first powered flight, which lasted 12 seconds, having travelled 120 feet; less than the length of a Boeing 747. This was the shape of things to come and between 1950 and 2011 the number of international arrivals has grown from 25 million to 980 million. With continued growth predicted to continue in 2012, albeit at a somewhat slower rate, international tourist arrivals are on track to reach the milestone one billion mark later this year. Despite various terrorist attacks and natural disasters, such as the aftermath of the Indian Ocean tsunami, travellers' confidence to explore the world continues unabated. Growth in travel occurred in particular to Africa by 7%, Asia and the Pacific by 6%, and international tourist arrivals worldwide are expected to grow by a further 3 to 4% in 2012, reaching the historic one billion mark by the end of this year. The specialty of travel medicine has evolved rapidly as a result of the massive increase in international travel facilitated by the introduction of economical and fast air transport across the world, the construction of transcontinental road and rail connections, giant ship cruisers, travel to and exploration of regions and areas that were previously inaccessible or remote, and the explosive increase in tourism. Concomitant with the predicted increase in international travel, this also means exposure of travellers to genes, bacteria, viruses, fungi and parasites and other health hazards in the new environment, and the transfer of genes and microorganisms across continents to the host population. This can result potentially, in public health concerns in host countries as exemplified by the transmission and subsequent spread of the infectious diseases, SARS and H1N1. Travel medicine extends well beyond diseases of warm climates and the exigencies of travel and tropical life. It includes exposure to new environments and new cultures, and new hazards ranging from high-altitude and deep-sea environments to medical problems of cosmic radiation and space travel; emerging and re-emerging infections; safe food, safe water, safe clothing; natural and accidental disasters; issues such as jet lag and tourist risk of violence and importantly, the avoidance of accidents which is the most common cause of morbidity and mortality in travellers. Extensive knowledge of current and new vaccines and of prophylactic and therapeutic drugs is essential. These include malaria chemoprophylaxis, strategies for emergency standby treatment for malaria and drugs for the treatment of travellers' diarrhoea. The re-emergence of infections such as diphtheria and syphilis in parts of Eastern Europe, the epidemiology of drugresistant malaria, extensive outbreaks of dengue fever and antigenic shifts of influenza leading to pandemic influenza, are examples of the imperative need for rapid access to accurate information in order to protect the health of those who travel. …