Climate Change and Travel: Harmonizing to Abate Impact.

Purpose of Review: With climate change being the single biggest health threat facing humanity, this review aims to identify the climate-sensitive health risks to the traveler and to recognize the role that travel plays in contributing to the detrimental effects of climate change. With this understanding, adaptations for transformational action can be made. Recent Findings: Travel and tourism, including transportation, food consumption, and accommodation, is responsible for a large percentage of the world's carbon emissions which is contributing to the climate change crisis at an alarming rate. Climate change is a health emergency that is resulting in a rise of significant health impacts to the traveler including increased heat illnesses; food-, water-, and vector-borne diseases; and increasing risk of exposure to emerging infectious diseases. Patterns of future travel and destination choices are likely to change due to climactic factors such as temperature and extreme weather events, forced migration, degradation, and disappearance of popular and natural tourist destinations. Summary: Global warming is and will continue to alter the landscape of travel medicine with expansion of transmission seasons and geographic ranges of disease, increased risk of infections and harmful marine toxins, and introduction of emerging infections to naïve populations. This will have implications for pre-travel counseling in assessing risk and discussing the environmental influences on travel. Travelers and stakeholders should be engaged in a dialogue to understand their "climate footprint," to innovate sustainable solutions, and be empowered to make immediate, conscientious, and responsible choices to abate the impact of breaching critical temperature thresholds.

COVID-19 transmission and the safety of air travel during the pandemic: a scoping review.

PURPOSE OF REVIEW: To examine the literature assessing safety of air travel relating to coronavirus disease 2019 (COVID-19) transmission from January 2020 to May 2021. The COVID-19 pandemic has had an unprecedented impact on air travel and global mobility, and various efforts are being implemented to determine a safe way forward. As the pandemic evolves, so do the challenges that force various stakeholders, including the aviation industry, health authorities, and governments, to reassess and adapt their practices to ensure the safety of travellers. RECENT FINDINGS: The literature was reviewed for multiple aspects of air travel safety during the COVID-19 pandemic. Recurring themes that surfaced included the pivotal role of commercial air travel in the geographic spread of COVID-19, the efficacy of travel restrictions and quarantines, inflight transmission risk and the role of preventive measures, the utility of pre and post flight testing, the development of effective vaccines and subsequent challenges of vaccine passports, and the ongoing threat of novel highly transmissible variants. SUMMARY: Much uncertainty lies ahead within the domains of these findings, and ongoing research, discourse and review will be necessary to navigate and determine the future direction and safety of air travel. Recovery will be slow, necessitating innovative, multipronged and collaborative solutions.

Navigating the risks of flying during COVID-19: a review for safe air travel.

RATIONALE FOR REVIEW: With air travel restarting, there has been much discourse about the safety of flying during the pandemic. In travel medicine, risk assessment includes estimating baseline risk to the traveller, recognizing factors that may modify that risk, considering the role of interventions to decrease that risk and accounting for a traveller's perception and tolerance of risk. The goals of this review are to identify the in-flight transmission risks of commercial air travel, provide recommendations about the risks of flying during the pandemic and propose strategies to mitigate the spread of COVID-19. KEY FINDINGS: The airline industry has taken a layered approach to increase passenger safety through effective onboard ventilation, extended ventilation at the gate, boarding and deplaning strategies, improved aircraft disinfection and pre-flight screening such as temperature checks and COVID-19 testing. Proximity to an index case may contribute to the risk of transmission more than the seat type or location. The use of face masks has significantly reduced onboard transmission, and mandatory in-flight mask-wearing policies are being enforced. Innovations such as digital health passports may help standardize screening entry requirements at airports and borders, allowing for a safer return to travel. RECOMMENDATIONS: In-flight transmission of SARS-CoV-2 is a real risk, which may be minimized by combining mitigation strategies and infection prevention measures including mandatory masking onboard, minimizing unmasked time while eating, turning on gasper airflow in-flight, frequent hand sanitizing, disinfecting high touch surfaces, promoting distancing while boarding and deplaning, limiting onboard passenger movement, implementing effective pre-flight screening measures and enhancing contact tracing capability. Assessing risk is a cornerstone of travel medicine. It is important to evaluate the multiple factors contributing to the cumulative risk of an individual traveller during the COVID-19 pandemic and to employ a multi-pronged approach to reduce that risk.

Treatment of soil-transmitted helminth infections in pregnancy: a systematic review and meta-analysis of maternal outcomes.

BACKGROUND: Gestational helminth infections are correlated to adverse outcomes including maternal anaemia; as such, treatment is recommended. However, little published high-quality data exist around the efficacy, safety and tolerability of anti-helminthics in pregnancy. We therefore conducted a systematic review and synthesized the available data on maternal outcomes following gestational treatment of intestinal nematodes to help guide clinical decision-making. METHODS: Five electronic databases were searched for studies reporting the efficacy, safety or tolerability of anti-helminthic drugs for gestational treatment of intestinal nematodes. Studies were systematically screened followed by data extraction. Trial quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. We conducted a narrative synthesis followed by meta-analyses using random effects models as appropriate. Data were summarized using qualitative and quantitative measures for specific parasitic infections as well as efficacy and safety of anti-parasitic agents. Outcomes of interest included maternal anaemia, minor adverse outcomes, pregnancy loss, pre-mature delivery, prevalence of infection and cure rate. RESULTS: Twenty-three studies were included. Gestational treatment with albendazole had cure rates up to 90% for hookworm and Ascaris, but only 50% for Trichuris. Mebendazole had an overall cure rate of ≤ 70% for Ascaris, hookworm and Trichuris. Pooled relative risk reduction of hookworm prevalence at delivery with albendazole compared to placebo was 90% (95% confidence interval, 0.09-0.15; n = 2; I2 = 0%). Rate of pregnancy loss and haemoglobin concentration did not differ between albendazole or mebendazole vs placebo, and rates of pre-term delivery were similar in albendazole-treated pregnant women vs controls. Ivermectin demonstrated a cure rate of 29% for hookworm and 56% for Trichuris in pregnant women. No serious adverse events were attributable to any drug studied. CONCLUSIONS: With increased international travel and migration of vulnerable populations, practitioners will encounter nematode infections in pregnant patients. Our analysis supports that albendazole in pregnancy has high cure rates for soil-transmitted helminths and is safe for the mother.

2018 in review: five hot topics in tropical medicine.

The year 2018 heralded many new developments in the field of tropical medicine, including licensure of novel drugs for novel indications, licensure of existing drugs for existing indications but in novel settings, and globalized outbreaks of both vector-borne and zoonotic diseases. We herein describe five top stories in tropical medicine that occurred during 2018, and illuminate the practice-changing development within each story.

Zika Virus-Associated Aseptic Meningitis and Guillain-Barre Syndrome in a Traveler Returning from Latin America: a Case Report and Mini-Review.

ZIKV-associated Guillain-Barré syndrome presents with an accelerated clinical course compared to classic post-infectious Guillain-Barré syndrome. Clinicians should anticipate and screen patients with ZIKV infection for neurologic complications bearing in mind that these may manifest during the acute viremic phase or during early convalescence.