braz j infect dis 2 0 1 6;20(5):513–515
w w w . e l s e v i e r . c o m / l o c a t e / b j i d
The
Brazilian
Journal
of
INFECTIOUS
DISEASES
Letter
to
the
Editor
The
fast
transmission
of
infectious
diseases
around
the
world
–
a
new
concern
to
the
public
health
DearEditor,
The high number of people traveling around the world (1,184,000,000tripsin2015)with∼45%participationof emerg-ingcountriestourists,alliedtotheirhostageofinternational sportive mass gatherings events (Fig. 1A and B), increase thepotentialriskforinfectiousdiseasestransmissiondueto emergingcountriesrecentlychallengedpublichealthsystems stilldevoted toendemicdiseasesissuesassociatedtoolder policy.1
Internationaltravelersfromemergingcountries,likeBrazil, seemstobedifferent tomostcountrypeople withdistinct socialstatusandbetterhealth,shownbytravelexpenditure andtravelinsuranceclaims(Fig.1CandD),corroboratingto the“healthyimmigranteffect”.2
Importedinfectiousdiseasesrepresentanewproblemfor theseinternationaltravelers,whereweseeoutbreakscaused bypeoplevisitingendemicorriskyareas,includingdeveloped countries,andbringbackpreviouslycontrolleddiseaseslike measlesandmumpsinBrazil–2014/2015.3
Theinfectiousdiseasecontrolimposedbysomenations, duetoincreasedtravel,leadstorethinkingpublichealthas alargerphenomenon.Thecurrentmodelsofborder surveil-lance,eitherbyentryvisa,limitedlengthofstayormandatory travel insurance (Schengen Convention), do not seem as effectiveinpreventing themigrationofinfectious diseases transportedbothbyforeignvisitorsorreturningtravelers.As anexample,therecentZikaVirusepidemicinBrazilandfast worldwidespread,possiblyalarge-scalepandemic,promoted a global mobilization to control and study a new emerg-ingdisease,4denotingthediscussionofanimportanttopic:
infectiousdiseasesarenolongerlimitedtogovernmental bor-dersorpoornations,theyareaworldwideproblem,especially theneglectedones.
Emergingcountrieswithrecentlyestablishedpublichealth systemsare exquisitelyexposed tonewdiseases outbreaks due to the recent increasing international travel, requir-ing morepreventivemeasures bothforborder surveillance or control of their returning travelers, in a challenge for their endemic diseases dedicated systems. The full imple-mentationofWHO’s2005International HealthRegulations, which includes the International Certificate of Vaccina-tion and Prophylaxis, is mainly oriented to developed countries. RevisionoftheseRegulationsisrequiredbothto includethisnewcomeremergingsystemsbut also vaccine-preventablediseasestransferredfromdevelopedcountries.5
Travel Insurance should be an important tool due to the possibility of travelers to receive medical treatment that wouldpreventbringingbackinfectiousdiseasestotheirhome countries.
Webelievethatitismandatorytocreateauniqueglobal networkinordertoimprovethenotificationofeasily trans-mitteddiseasesandalsounknowndiseases,whereeveryone shouldadoptrigidprotocolstoprovideinformationregarding neworcurrentoutbreaks.Inaddition,alldatamustbe avail-ableforallnations,whichcouldultimatelyleadhealthpolicy makersaroundtheworldtogetfullaccessregardingall uni-fiedoutbreakalerts.Probably,wecouldtackleH1N1,Ebola,and Zikavirusepidemicsmoreeffectivelyandmayberesearchers could gather more information to eventually help Health Authoritiestopreventfutureepidemics,andspeedup treat-mentofsickpeople.
514
braz j infect dis.2016;20(5):513–515Year
% participation in
international to urism arrivals
1990 1995 2000 2005 2010 2015 20 40 60 80 Advanced Emerging
B
Year Arrivals (Millions) 1990 1995 2000 2005 2010 2015 0 200 400 600 800 1000 1200A
World Advanced economies Emerging economies 1000 6000 Year YearC
D
Expenditure (US milions)
Br
azilian tour
ists (`000)
Insur
ance finances (BRL milions)
4000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2003 2004 2005 2006 2007 2008 0 800 80 Insurance claim, % C\P, % Yield, %
Total expenditure overseas (USD milions) Total of outbound flow from brazil (`000) Travel insurance expenditure (USD milions)
60 40 20 0 600 400 200 0
Fig.1–A–Internationaltourismintheworld(triangles)/advanced(dots)oremerging(squares)countries,expressedas millionsofarrivals(closedsymbols).B–Percentageofworldarrivalsfromeachorigin.Dottedlinesrepresentthe95% confidenceintervalofregressionlines.p-Valuesarethecomparisonofslopesbetweenregressions.C–Expenditureof
Braziliantouristsabroad.D–TravelinsuranceindexesofBraziliantouristsabroad.Straightlinesrepresentregressionlines andcorrespondentinterruptedlinesrepresentthe95%confidenceintervals.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
Acknowledgments
Theauthorswishtoacknowledgetheassistancefrom Insti-tutodeMedicinaTropicaldeSãoPaulo–USP,LIM–49/LIM– 52–HCFMUSP,FAPESPandCAPES.
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1.HunterP.Tropicaldiseasesandthepoor:neglectedtropical diseasesareapublichealthproblemfordevelopingand developedcountriesalike.EMBORep.2014;15:347–50.
2.KwakK.Anevaluationofthehealthyimmigranteffectwith adolescentsinCanada:examinationsofgenderandlengthof residence.SocSciMed.2016;157:87–95.
3.NaliLH,daS,FujitaDM,etal.Potentialmeaslestransmission riskinmassgatherings:arewesafefortheOlympicgames-Rio 2016?JTravelMed.2016;23.
4.DeCockKM,SimonePM,DavisonV,SlutskerL.Thenewglobal health.EmergInfectDis.2013;19:1192–7.
5.SteffenR,BehrensRH,HillDR,GreenawayC,LederK. Vaccine-preventabletravelhealthrisks:whatistheevidence– whatarethegaps?JTravelMed.2015;1:1–12.
DennisMinoruFujitaa,∗,LuizHenriquedaSilvaNalib, PauloRobertoUrbanob,DéboraMaringoniSoeiroa,
brazj infect dis.2016;20(5):513–515
515
aUniversidade de São Paulo (USP), Instituto de Medicina
TropicaldeSãoPaulo,LaboratóriodeProtozoologia,SãoPaulo,SP, Brazil
bUniversidadedeSãoPaulo(USP),InstitutodeMedicinaTropicalde
SãoPaulo,LaboratóriodeVirologia,SãoPaulo,SP,Brazil
∗Correspondingauthor.
E-mailaddress:dmfujita@usp.br(D.M.Fujita).
Received23May2016 Accepted27June2016 Availableonline26July2016
1413-8670/©2016SociedadeBrasileiradeInfectologia. PublishedbyElsevierEditoraLtda.Thisisanopenaccess articleundertheCCBY-NC-NDlicense(http://
creativecommons.org/licenses/by-nc-nd/4.0/).
