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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 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.
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 (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).
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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