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Abstract Rationale The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations. Key findings Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013–2015, outbreak in Democratic Republic of Congo 2018–2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. Recommendations The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.

Air travel during the COVID-19 pandemic is challenging for travellers, airlines, airports, health authorities, and governments. We reviewed multiple aspects of COVID peri-pandemic air travel, including data on traveller numbers, peri-flight prevention, and testing recommendations and in-flight SARS-CoV-2 transmission, photo-epidemiology of mask use, the pausing of air travel to mass gathering events, and quarantine measures and their effectiveness. Flights are reduced by 43% compared to 2019. Hygiene measures, mask use, and distancing are effective, while temperature screening has been shown to be unreliable. Although the risk of in-flight transmission is considered to be very low, estimated at one case per 27 million travellers, confirmed in-flight cases have been published. Some models exist and predict minimal risk but fail to consider human behavior and airline procedures variations. Despite aircraft high-efficiency filtering, there is some evidence that passengers within two rows of an index case are at higher risk. Air travel to mass gatherings should be avoided. Antigen testing is useful but impaired by time lag to results. Widespread application of solutions such as saliva-based, rapid testing or even detection with the help of “sniffer dogs” might be the way forward. The “traffic light system” for traveling, recently introduced by the Council of the European Union is a first step towards normalization of air travel. Quarantine of travellers may delay introduction or re-introduction of the virus, or may delay the peak of transmission, but the effect is small and there is limited evidence. New protocols detailing on-arrival, rapid testing and tracing are indicated to ensure that restricted movement is pragmatically implemented. Guidelines from airlines are non-transparent. Most airlines disinfect their flights and enforce wearing masks and social distancing to a certain degree. A layered approach of non-pharmaceutical interventions, screening and testing procedures, implementation and adherence to distancing, hygiene measures and mask use at airports, in-flight and throughout the entire journey together with pragmatic post-flight testing and tracing are all effective measures that can be implemented. Ongoing research and systematic review are indicated to provide evidence on the utility of preventive measures and to help answer the question “is it safe to fly?“.

The absence of large numbers of published in-flight transmissions of SARS-CoV-2 is not definitive evidence of safety. All peer-reviewed publications of flights with possible transmission are categorized by the quantity of transmission. Three mass transmission flights without masking are contrasted to 5 with strict masking and 58 cases with zero transmission.

Abstract Rationale for review The increasing mobility of populations allows pathogens to move rapidly and far, making endemic or epidemic regions more connected to the rest of the world than at any time in history. However, the ability to measure and monitor human mobility, health risk and their changing patterns across spatial and temporal scales using traditional data sources has been limited. To facilitate a better understanding of the use of emerging mobile phone technology and data in travel medicine, we reviewed relevant work aiming at measuring human mobility, disease connectivity and health risk in travellers using mobile geopositioning data. Key findings Despite some inherent biases of mobile phone data, analysing anonymized positions from mobile users could precisely quantify the dynamical processes associated with contemporary human movements and connectivity of infectious diseases at multiple temporal and spatial scales. Moreover, recent progress in mobile health (mHealth) technology and applications, integrating with mobile positioning data, shows great potential for innovation in travel medicine to monitor and assess real-time health risk for individuals during travel. Conclusions Mobile phones and mHealth have become a novel and tremendously powerful source of information on measuring human movements and origin–destination-specific risks of infectious and non-infectious health issues. The high penetration rate of mobile phones across the globe provides an unprecedented opportunity to quantify human mobility and accurately estimate the health risks in travellers. Continued efforts are needed to establish the most promising uses of these data and technologies for travel health.

COVID-19 provides an opportunity to review travel health advice priorities. Infectious and non-infectious diseases are key for travel medicine, Research is warranted to stimulate an evidence-based balance in what travel medicine experts communicate to their clients

Based on notification data the impact of the COVID-19 lockdown in Switzerland was assessed. While the incidence of tick-borne encephalitis almost doubled as compared to 2016-2019, a reduction in all other infectious diseases was recorded. The lowest reduction rates (<25%) were noted for legionellosis, hepatitis A, chlamydia infection and gonorrhoea.

Travel medicine (TM) focuses on preventing and managing travel-related issues. Evidence has become more important than expert opinions in the development of TM standards. This study aimed to evaluate the training and experience of TM among Primary Care Physicians (PCPs) in Qatar and their associated factors. A cross-sectional study design was employed. A structured questionnaire was utilized to gather data from all PCPs working in publicly funded primary health centers. The study involved 360 PCPs (response rate: 89.5%). Of these, 42.3% reported postgraduate training (15.1%) or experience (27.5%) in TM, with common training forms including workshops (67%), postgraduate programs (24%), and short courses (15%). About 81.8% expressed interest in TM training. Regarding confidence in practicing TM, 20% felt very confident, while 50% felt moderately confident. In practice, 25.8% conducted comprehensive pre-travel risk assessments, and 22.5% responded to traveler queries without formal consultations. Multivariable logistic regression analysis showed that PCPs who graduated from medical schools in Arab countries, conducting more than ten TM consultations per month, performing comprehensive pre-travel assessments, and those expressing high confidence were more likely to be associated with TM training or experience. Many PCPs in Qatar lack prior training and experience in TM, raising concerns about their ability to provide adequate care to traveling patients. There is a significant need for targeted TM training for PCPs, especially since the majority express a keen interest in receiving such training.

Travel medicine has virtually stopped in light of the coronavirus pandemic. It is worth contemplating how travel medicine will be affected by the ongoing pandemic when international travel starts to become more possible. How will we advise patients and use the coming vaccines that may be available? Travel medicine practices are well-suited to play a major role in advising travellers in the pandemic era.

Background Despite the World Health Organization certifying China malaria-free in 2021, the risk of local transmission caused by imported malaria cases remains a significant clinical and public health issue. It is necessary to present the changing trends of malaria in China and discuss the role of travel medicine services in consolidating malaria elimination. Methods This study systematically reviewed articles and reports related to human malaria from 2013 to 2022 published in international and Chinese databases. Data on malaria (i.e. number of cases, Plasmodium spp., diagnostic method, country of acquisition, provinces with high risk of re-introduction and transmission) were collected and synthesized, then summarized using descriptive statistics. Results Overall, 24 758 cases of malaria (>99.5% laboratory confirmed, > 99.2% imported, 0.5% fatal) were reported in China from 2013 to 2022, with a downward trend over the years (4128 cases in 2013 compared to 843 cases in 2022; χ2 trend P = 0.005). The last locally acquired case was reported in 2017. Plasmodium falciparum (65.5%) was the most common species identified, followed by P. vivax (20.9%) and P. ovale (10.0%). Two P. knowlesi cases were also identified in 2014 and 2017 in returned travellers from Malaysia and Indonesia, respectively. The most common countries for malaria acquisition were Ghana, Angola and Myanmar. Plasmodium vivax was mainly detected in returned travellers from Myanmar, while P. falciparum and P. ovale were detected in travellers from sub-Saharan Africa. Imported cases were mainly reported in Yunnan, Jiangsu, Sichuan, Guangxi, Shandong, Zhejiang and Henan provinces, where large numbers of Chinese people travel overseas for work. Conclusion Returned travellers from malaria-endemic countries pose a significant risk of malaria re-introduction to China. Travel medicine should be strengthened to improve the capacity and accessibility of both pre- and post-travel services, including malaria prophylaxis and prompt diagnosis of illness in returned travellers.

Travellers with recognised disabilities or the dis-ability to function as required during a trip have been overlooked in the travel medicine literature. This paper provides a starting point for further discussion and research into this neglected traveller population. In contrast, tourism research has explored travel with a disability for some time in order to understand the travellers' needs and to improve services accordingly. The contemporary bio-psycho-social understanding of disability serves as the framework for exploring motivations to travel as well as barriers, such as inter and intrapersonal, economic, structural and attitudinal obstacles. The demands of complex travel planning are acknowledged. Attention is also drawn to the particular issue of acquired disability. The theoretical discussion is complemented by travellers' own accounts using as examples mobility impairment on aeroplanes, sensory impairments, and obesity. These insights should inform high quality travel health care starting with an exploration of the health professionals' own views on such endeavours. Important are appropriate communication skills, an understanding of the travellers'/carers' views, wishes and judgment of abilities, as well as the appreciation of the reason for the trip, destination and planned activities. Challenging may be the need to accept that the traveller/carer will be more knowledgeable about the disability, needs, potential problems and solutions than the health professional. Finally, medical requirements for destination and activity need to be combined with the medical requirements for the dis-abling condition. Scarce literature and increasing numbers of travellers with disabilities should make this field a research priority in travel medicine. Unless there is an absolute medical contraindication, travel health professionals should encourage and support travellers for whom travel is a challenge.