Travel in the Time of COVID: A Review of International Travel Health in a Global Pandemic

Fright of Long-Haul Flights: Focus on Travel-Associated Thrombosis

Travel-related thrombosis (TRT), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant health risk associated with long-haul travel. Prolonged immobility, dehydration, and cabin pressure changes during flights contribute to venous stasis, hypoxia, and hypercoagulability, collectively increasing the risk of venous thromboembolism (VTE). While the absolute risk of TRT is relatively low in the population overall, it rises significantly among high-risk groups, including individuals with a history of VTE, thrombophilia, pregnancy, or recent surgery. This review explores the epidemiology, pathophysiology, clinical presentation, and diagnostic evaluation of TRT while highlighting the importance of early recognition and prevention. Risk assessment models can provide guidance for identifying at-risk travelers. Preventive strategies include pharmacological prophylaxis with low-molecular-weight heparin (LMWH) for high-risk individuals and nonpharmacological measures such as compression stockings, intermittent pneumatic compression, mobility exercises, and hydration. Guidelines from international societies recommend tailored interventions based on individual risk profiles, as randomized controlled trials are scarce. Given that long-haul travel dramatically expands, this review critically analyzes the available TRT management strategies in various clinical settings, aiming to increase awareness of this global health issue.

Italian Medical Professionals' Practices, Attitudes, and Knowledge in Travel Medicine: Protocol for a National Survey

BACKGROUND

The evolving global health landscape highlights the importance of travel medicine, making it necessary for health care professionals to understand the epidemiologic profiles among varied traveler populations and keep themselves updated in this rapidly changing field. However, in Italy, travel medicine clinics have significant gaps in resource allocation, staff training, and infrastructure.

OBJECTIVE

This protocol of a cross-sectional study aims to create and validate a questionnaire to assess the knowledge, attitudes, and practices of health care professionals in travel medicine in Italy. The final goal is to provide a tool to evaluate the state of travel medicine, guide training initiatives, and be able to monitor trends over time.

METHODS

The study population consists of health care professionals who practice travel medicine in Italy. The questionnaire will be developed by adapting an existing English survey and conducting a scoping review to align the questionnaire with contemporary scientific discourse. The validation process includes face validity, content validity, and expert evaluation. The sample size, determined through power analysis, ranges from 218 to 278 participants. The questionnaire will undergo a pilot test on a smaller sample size (10% of the total) to identify and address any issues. Statistical analysis will include central tendency and dispersion measures, categorical summaries, group comparisons, and regressions. This research received ethical approval, and informed consent will be obtained from all participants.

RESULTS

As of July 2024, we completed the questionnaire validation involving 9 experts. The validated version of the questionnaire includes 86 items. Furthermore, we conducted a pilot test on 53 individuals during the SIMVIM (Italian Society of Travel Medicine and Migrations) course on travel medicine held in Lucca, Italy, on June 14, 2024.

CONCLUSIONS

This cross-sectional study will guide strategic planning and targeting training and awareness activities in areas deemed most critical or lacking. The study's structured approach and periodic assessments will facilitate the identification of educational gaps, the dissemination of best practices, and the overall improvement of health care services for travelers in Italy.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59511.

Lifting of travel restrictions brings additional noise in COVID-19 surveillance through wastewater-based epidemiology in post-pandemic period

The post-pandemic world still faces ongoing COVID-19 infections, although international travel has returned to pre-pandemic conditions. Wastewater-based epidemiology (WBE) is considered an efficient tool for the population-wide surveillance of COVID-19 infections during the pandemic. However, the performance of WBE in post-pandemic era with travel restrictions lifted remains unknown. Utilizing weekly county-level wastewater surveillance data from June 2021-November 2022 for 222 counties in 49 states (covering 104 million people) in the United States of America, we retrospectively evaluated the correlations between SARS-CoV-2 RNA (CRNA) and reported cases, as well as the impacts of international air travel, demographics, socioeconomic aspects, test accessibility, epidemiological, and environmental factors on reported cases under the corresponding CRNA. The lifting of travel restrictions in June 2022, shifted the correlation between CRNA and COVID-19 incidence in the following 7-day and 14-day from 0.70 (IQR: 0.30-0.88) in June 2021-May 2022 (pandemic) to 0.01 (IQR: -0.31-0.36) in June-November 2022 (post-pandemic), and from 0.74 (IQR: 0.31-0.90) to -0.01 (IQR: -0.38-0.45), respectively. Besides, after lifting the travel restrictions, under the same CRNA, the reported case numbers were impacted by many factors, including the variations of international passengers, test accessibility, Omicron prevalence, ratio of population aged between 18 and 65, minority vulnerability, and healthcare system. This highlights the importance of demographics, infection testing, variants and socioeconomic status on the accuracy and implication of WBE to monitor COVID-19 infection status in post-pandemic era. Our findings facilitate the public health authorities to dynamically adjust their WBE-based tools/strategies to the local contexts to achieve optimal community surveillance.

Impact of COVID-19 on a medium-sized travel medicine clinic in eastern Pennsylvania, USA

BACKGROUND

The COVID-19 pandemic (COVID) disrupted international travel. We sought to determine the impact of the COVID-19 pandemic on patient volume, traveler demographics, and income of our medium-sized travel clinic in Pennsylvania, USA.

METHODS

We extracted de-identified pre-travel data on 3,510 pre-travel consultations for adults during: Pre-COVID-19 (January 2018-December 2019), Early COVID-19 (April 2020-March 2022) and Late COVID-19 (April 2022-March 2023). We compared traveler demographics, destinations, purpose of travel, medical conditions, and number of vaccinations administered over time, and our clinic's revenue obtained from our financial database (TruSource) for the Pre, Early and Late COVID-19 periods.

RESULTS

We observed 84% and 85% relative decreases in traveler volume and revenue respectively from the Pre-COVID-19 to the Early COVID-19 period. The decrease (16-11%) in volume was highest for travelers over 65 years of age. Of those that sought care during Early COVID-19, a fewer proportion of travelers had multiple co-morbid conditions and were taking chronic medications. Trip length increased and there was a significant increase in travel to Africa. Travel to visit friends or family and for service work also increased during Early-COVID-19 (32.9%) versus Pre-COVID-19 (19.8%). Clinic volume and revenue began to increase in Late COVID-19 but did not return to Pre-COVID levels.

CONCLUSIONS

The COVID pandemic resulted in a large reduction in patient volume and revenue in our academic-based Pennsylvania travel clinic. We saw substantial changes in our traveler demographics, destinations, as well as reasons and durations of travel. Smaller travel clinics will need to have plans in place in order to survive the next pandemic and better serve their pre-travel populations.

Air Passengers' Risk of SARS-CoV-2 Infection With a 14-Day Quarantine and Accuracy Assessment of a Symptom-based Screening System at an Airport

OBJECTIVES

This study aimed to validate the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, identify infection risk factors among air passengers subject to a 14-day mandatory quarantine, and evaluate the accuracy of mass symptom-based screening criteria at an airport.

METHODS

This retrospective cohort study analyzed data from 116 004 air passengers who entered Thailand through Suvarnabhumi Airport in Bangkok from April 2020 to September 2020. The incidence of SARS-CoV-2 infection, risk characteristics, and accuracy indices of symptom-based screening were calculated.

RESULTS

The overall incidence of SARS-CoV-2 was 0.5%, or 540 infections per 100 000 air passengers. Identified risk factors included sex, nationality, continent of departure, on-arrival screening results, and month of travel. Positive screening results indicated a higher risk and positive likelihood ratio for SARS-CoV-2 infection. However, the on-arrival screening criteria demonstrated low sensitivity and area under the receiver operating characteristic curve.

CONCLUSIONS

The current study confirms previous findings that the risk of SARS-CoV-2 infection during air travel is low. However, this might result from strict pre-departure screening and the SARS-CoV-2 test requirement for arriving passengers. The symptom-based screening criteria used upon arrival showed a low probability of identifying positive cases, suggesting that incorporating additional criteria could help detect asymptomatic infections. The integrated screening and quarantine model proved effective in preventing the spread of the virus into local communities.

Risk of COVID-19 transmission on long-haul flights: During the COVID-19 pandemic

This study aimed to determine the possibility of COVID-19 transmission through in-flight contact during flights for many patients with confirmed COVID-19 during the COVID-19 pandemic and explore infection prevention and control (IPC) methods for overseas infectious diseases. A retrospective cohort study was conducted on flight with a large number of confirmed case among. Delhi- Incheon flights in 2020. This flight was selected to confirm transmission through close contact with the cabin, with a total of 14 confirmed cases out of 190 passengers (including 10 flight attendants). After confirming COVID-19 test results for those entering Korea, we conducted an epidemiological investigation on confirmed patients to determine their general characteristics and epidemiological relevance. We analyzed the epidemiological relevance, occupational information, incubation period, and COVID-19 variation and genotype among confirmed patients who were in close contact with confirmed cases, and analyzed the possibility of transmission according to the distance of close contact in the flight. One confirmed patient was found to be highly likely to be infected due to close contact with the cabin. However, it occurred within two rows, not within 1 meter. In addition, considering the aerodynamics in the cabin and local incidence rate, infection in an unspecified number of local people could not be excluded. It was analyzed that the reason for reducing infection from close contact on board for a long time in a flight with a large number of confirmed cases was the effective IPC method. In order to prevent overseas infectious diseases caused by flights, autonomous IPC management of airlines and passengers is necessary in addition to national quarantine management such as symptom screening before boarding, wearing passenger masks while boarding, food and beverage restrictions, disinfection of public spaces, distancing between passengers, close contact management after boarding, and self-quarantine.

International Travel for Organ Transplantation: A Survey of Professional Experiences and Attitudes Toward Data Collection and Reporting

Background

Lack of data regarding international travel for organ transplantation (ITOT) hampers efforts to evaluate, understand, and respond to trends in ITOT activities, such as those suggestive of organ trafficking or "transplant tourism." This study aimed to assess transplant professionals' experience of ITOT and their attitudes toward reporting ITOT data to a global registry.

Methods

An international cross-sectional anonymous survey of transplant professionals was conducted online (from October to December 2022). The English language questionnaire assessed professional experiences in providing care to individuals who had traveled to or from a country for living donation or transplantation, and attitudes toward reporting of ITOT data. Data were analyzed with descriptive statistics.

Results

Two hundred thirty-nine individuals from 68 countries completed the entire questionnaire, of whom 79% had provided care for ≥1 patient who had traveled internationally for donation or transplantation. Of these, 60.8% of individuals (n = 115) had cared for ≥1 person who engaged in ITOT between 2019 and 2022, with the most recent case experiences involving 89 countries and 157 unique routes of international travel. Predominant concerns regarding reporting of ITOT data to a global registry related to prevention of harm and protection of patient privacy; most (52.7%; n = 126) respondents expressed a preference for anonymous reporting of ITOT data.

Conclusions

ITOT is a global phenomenon and transplant professionals' experience with ITOT cases is more common than anticipated. Systems for the collection of ITOT activity data should be carefully designed to address potential ethical concerns of transplant professionals which may influence reporting practices.

Contraction of Respiratory Viral Infection During air Travel: An Under-Recognized Health Risk for Athletes

Air travel has an important role in the spread of viral acute respiratory infections (ARIs). Aircraft offer an ideal setting for the transmission of ARI because of a closed environment, crowded conditions, and close-contact setting. Numerous studies have shown that influenza and COVID-19 spread readily in an aircraft with one virus-positive symptomatic or asymptomatic index case. The numbers of secondary cases differ markedly in different studies most probably because of the wide variation of the infectiousness of the infector as well as the susceptibility of the infectees. The primary risk factor is sitting within two rows of an infectious passenger. Elite athletes travel frequently and are thus prone to contracting an ARI during travel. It is anecdotally known in the sport and exercise medicine community that athletes often contract ARI during air travel. The degree to which athletes are infected in an aircraft by respiratory viruses is unclear. Two recent studies suggest that 8% of Team Finland members traveling to major winter sports events contracted the common cold most probably during air travel. Further prospective clinical studies with viral diagnostics are needed to understand the transmission dynamics and to develop effective and socially acceptable preventive measures during air travel.

SARS-CoV-2 variant introduction following spring break travel and transmission mitigation strategies

BACKGROUND

University spring break carries a two-pronged SARS-CoV-2 variant transmission risk. Circulating variants from universities can spread to spring break destinations, and variants from spring break destinations can spread to universities and surrounding communities. Therefore, it is critical to implement SARS-CoV-2 variant surveillance and testing strategies to limit community spread before and after spring break to mitigate virus transmission and facilitate universities safely returning to in-person teaching.

METHODS

We examined the SARS-CoV-2 positivity rate and changes in variant lineages before and after the university spring break for two consecutive years. 155 samples were sequenced across four time periods: pre- and post-spring break 2021 and pre- and post-spring break 2022; following whole genome sequencing, samples were assigned clades. The clades were then paired with positivity and testing data from over 50,000 samples.

RESULTS

In 2021, the number of variants in the observed population increased from four to nine over spring break, with variants of concern being responsible for most of the cases; Alpha percent composition increased from 22.2% to 56.4%. In 2022, the number of clades in the population increased only from two to three, all of which were Omicron or a sub-lineage of Omicron. However, phylogenetic analysis showed the emergence of distantly related sub-lineages. 2022 saw a greater increase in positivity than 2021, which coincided with a milder mitigation strategy. Analysis of social media data provided insight into student travel destinations and how those travel events may have impacted spread.

CONCLUSIONS

We show the role that repetitive testing can play in transmission mitigation, reducing community spread, and maintaining in-person education. We identified that distantly related lineages were brought to the area after spring break travel regardless of the presence of a dominant variant of concern.

Pulmonary infections in the returning traveler

PURPOSE OF REVIEW

The recent COVID-19 pandemic has shaped the epidemiology of other infectious diseases globally. International tourist arrivals are increasing and recovering to prepandemic levels. This review focuses on respiratory infections in travelers, highlighting the characteristics of the main imported viral, bacterial, fungal, and parasitic infections with pulmonary involvement.

RECENT FINDINGS

A recent systematic review estimated a prevalence of respiratory symptoms in travelers of around 35%, increasing to nearly 65% in the context of mass gatherings. Common viral and bacterial pathogens account for the majority of respiratory infections with an identified cause; however, recent data focus on the need for surveillance of emerging infections such as MERS-CoV, henipaviruses and multidrug resistant bacteria, which may be spread through travel. Fungal and parasitic respiratory infections are less common, and acquisition is usually associated with specific risk factors or exposure in endemic areas. Special risk groups, such as immunocompromised travelers, may be particularly vulnerable, presenting with severe disease or reactivation of latent infections.

SUMMARY

The next significant international epidemic could involve another new infectious agent causing respiratory disease and spreading via mobile populations. Official protocols should be adhered to, and public health interventions implemented for effective control. Continued and globally coordinated investments in research for new vaccines, therapeutic agents, disease modeling, and digital tracking strategies are essential.

Evaluating infection risks in buses based on passengers' dynamic temporal and typical spatial scenarios: A case study of COVID-19

Conventional buses, as an indispensable part of the urban public transport system, impose cross-infection risks on passengers. To assess differential risks due to dynamic staying durations and locations, this study considered four spatial distributions (i = 1-4) and six temporal scenarios (j = 1-6) of buses. Based on field measurements and a risk assessment approach combining both short-range and room-scale effects, risks are evaluated properly. The results showed that temporal asynchrony between infected and susceptible individuals significantly affects disease transmission rates. The Control Case assumes that infected and susceptible individuals enter and leave synchronously. However, ignoring temporal asynchrony scenarios, i.e., the Control Case, resulted in overestimation (+30.7 % to +99.6 %) or underestimation (-15.2 % to -69.9 %) of the actual risk. Moreover, the relative difference ratios of room-scale risks between the Control Case and five temporal scenarios are impacted by ventilation. Short-range risk exists only if infected and susceptible individuals have temporal overlap on the bus. Considering temporal and spatial asynchrony, a more realistic total reproduction number (R) can be obtained. Subsequently, the total R was assessed under five temporal scenarios. On average, for the Control Case, the total R was estimated to be +27.3 % higher than j = 1, -9.3 % lower than j = 2, +12.8 % higher than j = 3, +33.0 % lower than j = 4, and + 77.6 % higher than j = 5. This implies the need for a combination of active prevention and real-time risk monitoring to enable rigid travel demand and control the spread of the epidemic.

Injuries and medical emergencies among international travellers

BACKGROUND

Tropical infectious diseases and vaccine-preventable emergencies are the mainstay of pre-travel consultations. However, non-communicable diseases, injuries and accidents that occur during travel are not emphasized enough in these settings.

METHODS

We performed a narrative review based on a literature search of PubMed, Google Scholar, UpToDate, DynaMed and LiSSa and on reference textbooks and medical journals dedicated to travel, emergency and wilderness medicine. Relevant secondary references were extracted. We also aimed to discuss newer or neglected issues, such as medical tourism, Coronavirus Disease 2019, exacerbations of co-morbidities associated with international travel, insurance coverage, health care seeking abroad, medical evacuation or repatriation and tips for different types of travellers' emergency medical kits (personal, group, physician handled).

RESULTS

All sources reviewed led to the selection of >170 references. Among epidemiological data on morbidity and deaths while abroad, only retrospective data are available. Deaths are estimated to occur in 1 in 100 000 travellers, with 40% caused by trauma and 60% by diseases, and <3% linked to infectious diseases. Trauma and other injuries acquired during travel, such as traffic accidents and drowning, can be reduced by up to 85% with simple preventive recommendations such as avoiding simultaneous alcohol intake. In-flight emergencies occur on 1 in 604 flights on average. Thrombosis risk is two to three times greater for travellers than for non-travellers. Fever during or after travel can occur in 2-4% of travellers, but in up to 25-30% in tertiary centres. Traveller's diarrhoea, although rarely severe, is the most common disease associated with travel. Autochthonous emergencies (acute appendicitis, ectopic pregnancy, dental abscess) can also occur.

CONCLUSIONS

Pre-travel medicine encounters must include the topic of injuries and medical emergencies, such as the risk-taking behaviours and foster better planning in a comprehensive approach along with vaccines and infectious diseases advices.

Effectiveness of testing, contact tracing and isolation interventions among the general population on reducing transmission of SARS-CoV-2: a systematic review

We conducted a systematic literature review of general population testing, contact tracing, case isolation and contact quarantine interventions to assess their effectiveness in reducing SARS-CoV-2 transmission, as implemented in real-world settings. We designed a broad search strategy and aimed to identify peer-reviewed studies of any design provided there was a quantitative measure of effectiveness on a transmission outcome. Studies that assessed the effect of testing or diagnosis on disease outcomes via treatment, but did not assess a transmission outcome, were not included. We focused on interventions implemented among the general population rather than in specific settings; these were from anywhere in the world and published any time after 1 January 2020 until the end of 2022. From 26 720 titles and abstracts, 1181 were reviewed as full text, and 25 met our inclusion criteria. These 25 studies included one randomized control trial (RCT) and the remaining 24 analysed empirical data and made some attempt to control for confounding. Studies included were categorized by the type of intervention: contact tracing (seven studies); specific testing strategies (12 studies); strategies for isolating cases/contacts (four studies); and 'test, trace, isolate' (TTI) as a part of a package of interventions (two studies). None of the 25 studies were rated at low risk of bias and many were rated as serious risk of bias, particularly due to the likely presence of uncontrolled confounding factors, which was a major challenge in assessing the independent effects of TTI in observational studies. These confounding factors are to be expected from observational studies during an on-going pandemic, when the emphasis was on reducing the epidemic burden rather than trial design. Findings from these 25 studies suggested an important public health role for testing followed by isolation, especially where mass and serial testing was used to reduce transmission. Some of the most compelling analyses came from examining fine-grained within-country data on contact tracing; while broader studies which compared behaviour between countries also often found TTI led to reduced transmission and mortality, this was not universal. There was limited evidence for the benefit of isolation of cases/contacts away from the home environment. One study, an RCT, showed that daily testing of contacts could be a viable strategy to replace lengthy quarantine of contacts. Based on the scarcity of robust empirical evidence, we were not able to draw any firm quantitative conclusions about the quantitative impact of TTI interventions in different epidemic contexts. While the majority of studies found that testing, tracing and isolation reduced transmission, evidence for the scale of this impact is only available for specific scenarios and hence is not necessarily generalizable. Our review therefore emphasizes the need to conduct robust experimental studies that help inform the likely quantitative impact of different TTI interventions on transmission and their optimal design. Work is needed to support such studies in the context of future emerging epidemics, along with assessments of the cost-effectiveness of TTI interventions, which was beyond the scope of this review but will be critical to decision-making. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

Supplemental findings of the 2021 National Blood Collection and Utilization Survey

BACKGROUND

The Department of Health and Human Services' National Blood Collection and Utilization Survey (NBCUS) has been conducted biennially since 1997. Data are used to estimate national blood collection and use. Supplemental data from the 2021 NBCUS not presented elsewhere are presented here.

METHODS

Data on survey participation, donor characteristics, blood component cost, transfusion-associated adverse reactions, and implementation of blood safety measures, including pathogen-reduction of platelets, during 2021, were analyzed. Comparisons are made to 2019 survey data where available (2013-2019 for survey participation).

RESULTS

During 2021, there were 11,507,000 successful blood donations in the United States, a 4.8% increase from 2019. Persons aged 45-64 years accounted for 42% of all successful blood donations. Donations by persons aged 65 years and older increased by 40.7%, while donations among minorities and donors aged <25 years decreased. From 2019 to 2021, the median price hospitals paid per unit of leukoreduced red blood cells, leukoreduced and pathogen-reduced apheresis platelets, and fresh frozen plasma increased. The largest increase in price per unit of blood component in 2021 was for leukoreduced apheresis platelets, which increased by ~$51. Between 2019 and 2021, the proportion of transfusing facilities reporting use of pathogen-reduced platelets increased, from 13% to 60%. Transfusion-related adverse reactions declined slightly between 2019 and 2021, although the rate of transfusion-transmitted bacterial infections remained unchanged.

CONCLUSION

During 2021, blood donations increased nationally, although donations from those aged <25 years and minorities declined. The prices hospitals paid for most blood products increased, as did the use of pathogen-reduced platelets.

Robots in travel clinics: building on tourism's use of technology and robots for infection control during a pandemic

The arrival of COVID-19 impacted every aspect of life around the world. The virus, whose spread was facilitated overwhelmingly by people's close contact at home and by travelling, devastated the tourism, hospitality, and transportation industry. Economic survival depended largely on demonstrating to authorities and potential travellers the strict adherence to infection control measures. Fortunately, long before the pandemic, the industry had already employed digital technology, artificial intelligence, and service robots, not to keep the world safe, but to either bridge staff shortages or save costs, reduce waiting times, streamline administration, complete unattractive, tedious, or physical tasks, or use technology as marketing gimmicks. With COVID-19, offering social distancing and touchless service was an easy step by extending quickly what was already there. The question arose: could travellers' acceptance of technology and robots for infection control be useful in travel medicine? COVID-19 fostered the rapid and increased acceptance of touchless technology relating to all things travel. The public's expectations regarding hygiene, health and safety, and risk of infection have changed and may stay with us long after the pandemic is 'the new normal', or a new one approaches. This insight, combined with the current experience with robots in health and medicine, is useful in exploring how robots could assist travel medicine practice. However, several aspects need to be considered in terms of type of robot, tasks required, and the public's positive or negative attitudes towards robots to avoid known pitfalls. To meet the crucial infection control measures of social distancing and touch avoidance, the use of robots in travel medicine may not only be readily accepted but expected, and implications for management, practice, and research need to be considered.

Morbidity of Returning Travelers Seen in Community Urgent Care Centers throughout Israel

Information regarding post-travel morbidity is usually reported via dedicated post-travel clinics and mainly relates to travelers returning from low-middle-income countries (LMIC), however, the spectrum of morbidity seen within the community setting is scarcely reported. This prospective observational study among visitors to 17 community Urgent Care Centers (UCC) was designed to evaluate the reasons for post-travel community clinic visits and to compare travelers returning from LMIC to high-income countries (HIC). All visitors within one-month post-travel to all destinations were included. A total of 1580 post-travel visits were analyzed during 25 months. Travelers to LMICs were younger (mean 36.8 years old vs. 41.4 in the HIC group) and stayed longer periods abroad (30.1 ± 41.2 vs. 10.0 ± 10.6 in the HIC group) but more of them had pre-travel vaccines (35.5% vs. 6.6%). Travel-related morbidity was significantly more common in the LMIC group 58.3% (253/434) vs. 34.1% (391/1146) in the HIC group, (p < 0.001). Acute diarrhea was the leading cause of morbidity after visiting LMIC (28.8%) and was significantly more common than in the HIC (6.6%, p < 0.001). Other common morbidities in the LMIC cohort were respiratory (23.3%), cutaneous (15.8%), and injuries (9.9%). In the HIC group, the common morbidities were respiratory (37.3%), and diarrhea composed only 6.6% of the complaints. Our study group represents a less biased sample of travelers to LMIC as well as HIC, therefore, data from the UCC setting and at the specialized travel clinics complete each other in understanding the true extent of morbidity in travelers.

Emotion Regulation and Mood during the COVID-19 Pandemic

The 2019 coronavirus disease (COVID-19) pandemic has had a significant negative impact on health, mood, and well-being [...].

Types and outcomes of pharmacist-managed travel health services: A systematic review

BACKGROUND AND AIM

Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services.

METHODS

A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services.

RESULTS

Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94-100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%-94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted.

CONCLUSION

Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations.

Is standby therapy for Covid-19 a practical option for travellers?

International travel has resumed while the risk of SARS-CoV-2 persists, leading to consideration of medications that can treat or prevent Covid-19 when travellers become ill abroad. Nirmatrelvir-ritonavir, molnupiravir and tixagevimab-cilgavimab are available under Emergency Use Authorization or conditional approval. We discuss the potential application of these medications to protect travellers.

Mesenchymal Stem Cells and MSCs-Derived Extracellular Vesicles in Infectious Diseases: From Basic Research to Clinical Practice

Mesenchymal stem cells (MSCs) are attractive in various fields of regenerative medicine due to their therapeutic potential and complex unique properties. Basic stem cell research and the global COVID-19 pandemic have given impetus to the development of cell therapy for infectious diseases. The aim of this review was to systematize scientific data on the applications of mesenchymal stem cells (MSCs) and MSC-derived extracellular vesicles (MSC-EVs) in the combined treatment of infectious diseases. Application of MSCs and MSC-EVs in the treatment of infectious diseases has immunomodulatory, anti-inflammatory, and antibacterial effects, and also promotes the restoration of the epithelium and stimulates tissue regeneration. The use of MSC-EVs is a promising cell-free treatment strategy that allows solving the problems associated with the safety of cell therapy and increasing its effectiveness. In this review, experimental data and clinical trials based on MSCs and MSC-EVs for the treatment of infectious diseases are presented. MSCs and MSC-EVs can be a promising tool for the treatment of various infectious diseases, particularly in combination with antiviral drugs. Employment of MSC-derived EVs represents a more promising strategy for cell-free treatment, demonstrating a high therapeutic potential in preclinical studies.