International Journal of Travel Medicine and Global Health
Volume:9 Issue: 1, Winter 2021

As countries worldwide are beginning to end their lockdowns due to the coronavirus disease 2019 (COVID-19) pandemic, travel and tourism are again becoming possible. However, pre-pandemic travel practices are not likely to resume for some time, at least until a COVID-19 vaccine becomes available. The current time is a crucial one that requires us to reconsider our strategies to protect health and prevent travel-related diseases. This article therefore addresses various considerations for the resumption of tourist activities and the near future of travel, such as pre-travel medical counseling, personal hygiene, luggage handling, food safety, and measures to ensure safety on airplanes and in hotels. These considerations may aid in delineating a way forward for the travel industry and for travelers alike. Author believes that this article is especially timely and of interest not only for travel medicine specialists but all participants in the field of travel business.

COVID-19, a severe respiratory disease mediated by SARS-CoV-2 virus, is an extremely infectious. This virus was a recant outbreak from Wuhan City of China in late December 2019, but no remedy has been found yet. The coronavirus can spread mainly from person to person when they come in close contact with each other. Respiratory droplets from an infected person’s infect any nearby people. Furthermore, asymptomatic person can also infect others. Data and information were searched from Web Science, Google Scholar, and PubMed databases, and the articles published before June 2020, using relevant keywords. WHO, CDC and other Govt. Agencies have published a protective measure for better prevention of the COVID-19 disease until vaccines or any other antivirals become available. “Stay at home”, “Uses of Mask”, and “Wash hands frequently for 20 sec” are some of the general strategy for precaution. However, it is not possible for the ‘must travellers’ and/or “front-line workers” to “stay at home”. The concerns of the must-travellers and front-line workers to avoid any unwanted consequences that may arise from their travelling issues were discussed in this review.

Cruise ship linked COVID-19 outbreaks have been identified as a potential source of community transmission of COVID-19 in Australia and worldwide. The risk factors and potential mitigation around COVID-19 infections on cruise ships and communities is a research gap. A correlation and regression analyses for risk factors for COVID-19 attack rates oncruise ships worldwide with reported COVID-19 from January 1, 2020 to May 11, 2020 were performed, with a more detailed analysis done for Australia. Geospatial emerging hot spot analysis during key time periods was used to assess temporal trends in spatial clustering of COVID-19 cases related to two cruise ship events in NSW, Australia. For 36 cruise ships with global COVID-19 cases, available cabins had a moderate inverse correlation with the attack rate (-0.4154; 95% CI [-0.0002, -0.00003], P < 0.0118). The number of cabins, the number of decks with cabins, and passenger-to-space ratio were significantly associated with attack rate, however, the duration at sea was not. By May 2020, cruise ship passengers made up 14.9% of COVID-19 cases in Australia and 27% of the COVID-19 related deaths. Emerging hot spots of community transmission in Sydney occurred during 1-2 incubation periods of two cruise ship events. Mitigation of risk on cruise ships should focus on spatial design and reducing crowding, including rapid surveillance and on-board testing. To mitigate this risk during the era of COVID-19, all passengers disembarking an infected ship should be quarantined for at least the 14-day window period and tested for COVID-19, regardless of symptoms. Vaccination should be a pre-requisite for travel of any kind once available.

As the coronavirus disease 2019 (COVID-19) pandemic rapidly sweeps across the world, it is inducing a considerable degree of psychological problems, which can affect everyone in the community. This study aimed to compare the severity of the psychological distress in the general population and patients during the COVID-19 epidemic in an Iranian population. In this cross-sectional study, the mental health status of 221 COVID-19 infected patients and 241 participants from general population were investigated by the self-report questionnaire of Depression, Anxiety, and Stress Scale (DASS). The DASS-21 questionnaire and sociodemographic data sheet were filled out by the participants. All statistical analyses were performed using SPSS software version 21. The results indicated higher scores of DASS in patients than the population simultaneously (Wilks Lambda = 0.934, F (3, 440) = 10.44, p <0.001) and individually (Mean difference [MD] = 2.55, 95% CI = 1.48 to 3.62 for depression, MD = 1.48, 95% CI = 0.39 to 2.57 for anxiety, and MD = 1.41, 95% CI = 0.32 to 2.49 for depression score). The present study revealed a high prevalence of mental health problems among patients with COVID-19 and gaps in providing them with mental health services. We call for systematic screening of mental health status for all patients and developing specific psychological interventions for this vulnerable population. Psychosocial assessment and monitoring should be developed in the community to support aspects of COVID-19.

Children are frequent international travelers and may acquire serious infectious diseases during travel. We undertook a retrospective 10-year review examining children admitted to hospital with infectious diseases associated with international travel at a Canadian tertiary care pediatric hospital.
Retrospective chart review was performed on select travel-related infectious diseases in children ranging in age from birth to <18 years who were admitted at the Hospital for Sick Children in Toronto between January 1st, 2009 and December 31st, 2018. Cases were identified using ICD-10 discharge codes. Patient demographics, travel history, epidemiological data, disease, and prophylaxis history were documented.
A total of 154 children were hospitalized with a travel-related infection over a 10-year period. The most common diagnoses were typhoid or paratyphoid fever (n = 58, 38%), malaria (n = 57, 37%), and hepatitis A (n = 14, 8%). The median age of those infected was 8 years (IQR 3-12). There were 120 (78%) children who were Canadian born, 31 (20%) immigrants and 3 (2%) who were visiting Canada. Of those who lived in Canada, 112 (90%) travelled for the purpose of visiting friends and relatives (VFR), 6 (5%) for tourism and 2 (2%) for humanitarian work. India was typically known for the acquisition of infection for typhoid or paratyphoid fever, and Nigeria for malaria. Hepatitis A was most commonly acquired in Pakistan.
Imported infectious diseases continue to be a significant issue in travelers returning from trips suggesting improved preventative pre-travel care. VFR children are a group that should, in particular, be targeted for appropriate pre-travel advice and care.

Perceived discrimination is one of the reasons behind ethnic health disparities. However, less is known about racial and ethnic groups differ in social determinants of discrimination. This study was aimed to compare the association between household income and perceived discrimination among American children of different racial groups. The Adolescent Brain Cognitive Development (ABCD) study, a national longitudinal study, followed 4383 children 9-10 years old who were either European American, African American, Asian American, or mixed/other race for one year. We compared racial groups for the association between baseline household income and perceived discrimination at the end of one year follow up. We used ANOVA and linear regression for data analysis. The outcome was perceived discrimination. The predictor was household income. Covariates were age, gender, and parental marital status. The moderator was race. In the total sample, high household income was associated with less perceived discrimination. There was an interaction between race and household income, suggesting a difference in the association between household income and perceived discrimination between African American and European American children. The inverse association between household income and perceived discrimination was weaker for African American than European American children. High-income African American children are not well protected against perceived discrimination. High exposure to perceived discrimination may explain the worse expected health and development of middle-class African American children. As discrimination is a major social determinant of health, the results have considerble implications for public health policy.

Typhoid fever is a potential febrile illness caused by Salmonella enterica serovar Typhi. It is mainly transmitted through contaminated food and water, and spreads from infected persons and chronic carriers. Humans are the only reservoir host. There were many multi-drug resistant S. Typhi cases reported in many parts of South Asia and Africa. However, since 2016there were reported case series of extended drug resistant S. Typhi from Pakistan (resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones and third generation cephalosporines). Genomic sequencing analysis of this organism was of haplotype H58 transmitted by a plasmid.

This is the first reported case of ceftriaxone-resistant typhoid fever in the Middle-East, who travelled from Pakistan to Qatar in September 2019. He recovered completely with injection meropenem and oral azithromycin.

A detailed travel history and early diagnosis and treatment with appropriate drugs are inevitable in the management of such cases. Safe drinking water, improved sanitation and effective public health infrastructure will play a key role in the control of the disease.