International Journal of Travel Medicine and Global Health
Volume:6 Issue: 1, Winter 2018

Medical tourism emerged when people were challenged with high costs and slow service in medical care. As a consequence of these issues, people started to look for medical treatment in other countries. Globalization accelerated the growth of medical tourism. Several “push” and “pull” factors play roles in the motivation of patients to become a medical tourist. This review addresses the different aspects of medical tourism in general, describes the development of medical tourism in Turkey, and describes experiences with medical tourism in the Bone Marrow Transplantation Center (BMTC) at Erciyes University, Kayseri, Turkey. Since January 2016, an international collaboration has existed between BMTC and the King Hamed University Hospital (KHUH) in Bahrain. Ten allogeneic stem cell transplantations (SCTs) have been performed on patients from Bahrain with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin lymphoma, and myelofibrosis. Furthermore, ten autologous SCT have been conducted on patients from Bahrain with multiple myeloma (MM), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL). In 2016, transplant-related mortality (TRM) at 100 days among Bahrain patients was 0% compared to 2.6% in all patients. Although these numbers are small, the first results show that the outcomes of international patients are similar to those of non-international patients. In our experience, the key to a successful collaboration between international hospitals is having close communication regarding the treatment of the international patient. The outcome of a large group of international compared with non-international patients should be further studied.

Rotaviruses are the most common cause of severe diarrhea in children under 5 years of age worldwide with a higher prevalence in developing countries. In accordance with the World Health Organization (WHO) recommendations for the global use of rotavirus vaccines, it is important to review trends of rotavirus epidemiology, distribution and diversity of rotavirus strains in the pre-vaccine period. In Iran, the average rotavirus positivity rate is 40.04% in all patients under 5 years of age hospitalized for acute gastroenteritis (AGE). Studies have shown a substantial increase in the rotavirus detection rate over time from 1986 to 2013. Moreover, there has been continued predominance of G (G1) and P (P[8]) genotypes, although the peak prevalence of G1 appeared to decline in 2007-2011 compared to 2001-2006. The data presented in this review, which suggests a change in the pattern of rotavirus genotypes in the Iranian population, further highlights the important role of continuous monitoring of rotavirus genotypes before starting any national rotavirus vaccination program.

For 10 years, Brazil has presented a significant flow in cruise ships with 597 011 travelers in 2015. Cruise ships represent a major mass gathering capacity, generating more risk of outbreaks and epidemics. Moreover, visiting several places presents travelers with the possibility of contact with some tropical diseases, which demands the development of specific policies for public health surveillance.

In this study, case reports on transmissible diseases, accidents and deaths on board of cruise ships in the Brazilian coast during 2009 to 2015 were reviewed and correlated with the development of public health surveillance policies implemented by ANVISA, which established the mandatory communication of infectious diseases in 2009 and of deaths onboard in 2011.

Norovirus was the major etiologic agent of outbreaks, though the rate of outbreak has been declining in recent years. The lethality rate last season was 0.67:100 000, mostly because of preexisting conditions (75%); the remaining cases were caused by accidents. The mandatory reporting of outbreaks and deaths is an important tool in the planning of preventive actions for the safety and health of travelers in Brazil. The continuous evolution of hygiene surveillance may reduce outbreaks; the adoption of transparency policies and fast communication of deaths has contributed to the significant reduction in accidents.

The effectiveness of specific public policies for the safety and security of travelers established for cruise ships in Brazil is indicated by the quantitative reduction in outbreaks and deaths. New destinations such as Cuba and China may adopt the same strategy of surveillance and protection against potential outbreaks of infectious diseases provided by cruise ships.

Travel health practice and research in Egypt lag behind both needs and demands. This study was done in two parts to assess travel health knowledge, attitude, and practice (KAP) among Egyptian travelers.

This survey was conducted at the departure halls of Cairo International Airport and included 1500 travelers to Africa (excluding North Africa), Southeast Asia, and Latin America. An interview questionnaire was used to measure the KAP of travelers inquiring about different aspects of pre-travel health. Subjective evaluations of travel health services and suggestions for improvement were also solicited.

Travelers in this study were mainly males (89.3%), less than 40 years of age (82%), living in urban residences (89.1%), married (65.9%), university educated (83.3%), traveling for work (69.1%) with destinations of Africa (61.3%), Asia (28.4%), and Latin America (10.3%). They had poor travel-associated risk perception, and only 13.4% had risk management plan. Less than half (42.4%) sought information about their destination, and 11.9% sought health information; their source of information was mainly the internet (98.7%). The majority had poor scores on various travel-related practices, including seeking pre-travel health services (87.9%), receiving pre-travel vaccines (91.3%), and using malaria chemoprophylaxis (90.6%). The travel health services were rated good by 0.5% of travelers and bad, very bad, or undetermined by 11.4%, 61.3%, and 26.9% respectively.

Egyptian travelers, although mostly educated, had poor travel health perceptions and practices and are unsatisfied with the travel health services in Egypt.

Wilderness or backcountry diarrhea is a type of travelers’ diarrhea commonly caused by Cryptosporidium and Giardia, which can survive freezing temperatures. Campsites pose additional risks worldwide, irrespective of developing or developed regions, due to inadequate hygiene. In a first of its kind, an outbreak of wilderness diarrhea at a semi-permanent Himalayan Base Camp at 4000 m/13,125 ft in Uttarkashi, India, was investigated and managed by empirical antimicrobials. Return of normal bowel function was considered as primary outcome, and return to routine training at Base Camp was considered secondary outcome. Sixty-two personnel presented with wilderness diarrhea of 5.58 days mean duration with onset after mean stay of 10.26 days, despite provisions for adequate camp hygiene and sanitation. Both primary and secondary outcomes were reached by all except three students who were evacuated on foot to the district referral hospital 56 km downhill from Base Camp. Hygiene was compromised due to cold weather/water. Epidemiological surveillance was not contributory. Wilderness diarrhea can present in outbreak proportions from formerly safe water sources due to variable microbial contamination. On-site diagnostics and management are required to control outbreaks of wilderness diarrhea. Traveler risk management strategies and traveler awareness/education can be a targeted mandatory intervention to enhance preparedness and resilience capital in outdoor and mountain environments.

According to the World Health Organization (WHO), helminth control could contribute to achieving 7 Millennium Development Goals (MDGs). The present study evaluated the impact of deworming on the infection rate of schistosomiasis in Sumidouro, Brazil and the consequences for the MDGs. The whole population of this area was invited to participate in the 2 stages of the study, the baseline from 2002 to 2003 and the follow-up from 2005 to 2006. Within this interval, no improvements to sanitation or access to safe water were undertaken. The statistical investigation was confined to the 164 people who were tested in both surveys. The diagnosis of parasitosis was based on coproscopy by Kato-Katz smears. Infected people were treated with a single oral dose of praziquantel. The infection rate of schistosomiasis dropped from 28.7% (n=47) to 6.7% (n=11). Among women of childbearing age, this rate decreased was from 27.8% (n=10) to 5.6% (n=2), and among children, it dropped from 14.6% (n=6) to 3.3% (n=1). As there was no improvement in sanitation, deworming might have led to the reduced transmission of schistosomiasis. The drop in infection rate of schistosomiasis in children and women of childbearing age supports the argument that deworming would allow for the reduction of child mortality and the promotion of gender equality. A better future can also be foreseen, as no girl under 15 years of age was infected.