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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.

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.

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.

Patients who will be traveling internationally should be advised to schedule dedicated pretravel assessments with their primary care physicians. The pretravel consultation is a vital opportunity for physicians to review preventive and risk-reduction strategies with travelers. Critical components of the patient interview include travel itinerary, anticipated high-risk activity, and medical history. This information affects subsequent recommendations for immunizations, malaria chemoprophylaxis, personal protective measures, and risk-reduction measures. Physicians should review whether routine and seasonal immunizations, including those for COVID-19 and influenza, are up to date and determine whether location-specific immunizations are warranted. Malaria prophylaxis and counseling on personal protective measures, including minimizing skin exposure and using insect repellant, permethrin-treated clothing, bed nets, and screens, are recommended for travelers visiting endemic areas. A single dose of antibiotics may be considered for self-treatment of traveler’s diarrhea without features of dysentery. Travelers with chronic medical conditions, such as diabetes, should carry documentation of medical issues and enough medications and supplies to last for the duration of travel. Activity-specific concerns include sunburn, motor vehicle crashes, water safety, altitude sickness, and risks associated with sexual behaviors.

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.

Abstract Background The coronavirus pandemic (COVID-19) has spread worldwide via international travel. This study traced its diffusion from the global to national level and identified a few superspreaders that played a central role in the transmission of this disease in India. Data and methods We used the travel history of infected patients from 30 January to 6 April 6 2020 as the primary data source. A total of 1386 cases were assessed, of which 373 were international and 1013 were national contacts. The networks were generated in Gephi software (version 0.9.2). Results The maximum numbers of connections were established from Dubai (degree 144) and the UK (degree 64). Dubai’s eigenvector centrality was the highest that made it the most influential node. The statistical metrics calculated from the data revealed that Dubai and the UK played a crucial role in spreading the disease in Indian states and were the primary sources of COVID-19 importations into India. Based on the modularity class, different clusters were shown to form across Indian states, which demonstrated the formation of a multi-layered social network structure. A significant increase in confirmed cases was reported in states like Tamil Nadu, Delhi and Andhra Pradesh during the first phase of the nationwide lockdown, which spanned from 25 March to 14 April 2020. This was primarily attributed to a gathering at the Delhi Religious Conference known as Tabliqui Jamaat. Conclusions COVID-19 got induced into Indian states mainly due to International travels with the very first patient travelling from Wuhan, China. Subsequently, the contacts of positive cases were located, and a significant spread was identified in states like Gujarat, Rajasthan, Maharashtra, Kerala and Karnataka. The COVID-19’s spread in phase one was traced using the travelling history of the patients, and it was found that most of the transmissions were local.

Background. Diagnosis of malaria relies on parasite detection by microscopy or antigen detection; both fail to detect low-density infections. New tests providing rapid, sensitive diagnosis with minimal need for training would enhance both malaria diagnosis and malaria control activities. We determined the diagnostic accuracy of a new loop-mediated amplification (LAMP) kit in febrile returned travelers. Methods. The kit was evaluated in sequential blood samples from returned travelers sent for pathogen testing to a specialist parasitology laboratory. Microscopy was performed, and then malaria LAMP was performed using Plasmodium genus and Plasmodium falciparum-speciñc tests in parallel. Nested polymerase chain reaction (PCR) was performed on all samples as the reference standard. Primary outcome measures for diagnostic accuracy were sensitivity and specificity of LAMP results, compared with those of nested PCR. Results. A total of 705 samples were tested in the primary analysis. Sensitivity and specificity were 98.4% and 98.1%, respectively, for the LAMP P. falciparum primers and 97.0% and 99.2%, respectively, for the Plasmodium genus primers. Post hoc repeat PCR analysis of all 15 tests with discrepant results resolved 4 results in favor of LAMP, suggesting that the primary analysis had underestimated diagnostic accuracy. Conclusions. Malaria LAMP had a diagnostic accuracy similar to that of nested PCR, with a greatly reduced time to result, and was superior to expert microscopy.

Recent years have seen unprecedented growth in international travel. Travellers are at high risk for acquiring infections while abroad and potentially bringing these infections back to their home country. There are many ways to mitigate this risk by seeking pre-travel advice (PTA), including receiving recommended vaccinations and chemoprophylaxis, however many travellers do not seek or adhere to PTA. We conducted a systematic review to further understand PTA-seeking behaviour with an ultimate aim to implement interventions that improve adherence to PTA and reduce morbidity and mortality in travellers. We conducted a systematic review of published medical literature selecting studies that examined reasons for not seeking PTA and non-adherence to PTA over the last ten years. 4484 articles were screened of which 56 studies met our search criteria after full text review. The major reason for not seeking or non-adherence to PTA was perceived low risk of infection while travelling. Side effects played a significant role for lack of adherence specific to malaria prophylaxis. These data may help clinicians and public health providers to better understand reasons for non-adherence to PTA and target interventions to improve travellers understanding of potential and modifiable risks. Additionally, we discuss specific recommendations to increase public health education that may enable travellers to seek PTA.

Background. International travel poses a risk of destination-specific illness and may contribute to the global spread of infectious diseases. Despite this, little is known about the health characteristics and pretravel healthcare of US international travelers, particularly those at higher risk of travel-associated illness. Methods. We formed a national consortium (Global TravEpiNet) of 18 US clinics registered to administer yellow fever vaccination. We collected data regarding demographic and health characteristics, destinations, purpose of travel, and pretravel healthcare from 13 235 international travelers who sought pretravel consultation at these sites from January 2009 through January 2011. Results. The destinations and itineraries of Global TravEpiNet travelers differed from those of the overall population of US international travelers. The majority of Global TravEpiNet travelers were visiting low- or lower-middle-income countries, and Africa was the most frequently visited region. Seventy-five percent of travelers were visiting malaria-endemic countries, and 38% were visiting countries endemic for yellow fever. Fifty-nine percent of travelers reported ≥ 1 medical condition. Atovaquone/proguanil was the most commonly prescribed antimalarial drug, and most travelers received an antibiotic for self-treatment of travelers' diarrhea. Hepatitis A and typhoid were the most frequently administered vaccines. Conclusions. Data from Global TravEpiNet provide insight into the characteristics and pretravel healthcare of US international travelers who are at increased risk of travel-associated illness due to itinerary, purpose of travel, or existing medical conditions. Improved understanding of this epidemiologically significant population may help target risk-reduction strategies and interventions to limit the spread of infections related to global travel.