Public health emergencies of international concern: a historic overview.

RATIONALE: The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations. KEY FINDINGS: Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. RECOMMENDATIONS: The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.

GeoSentinel: past, present and future†.

RATIONALE FOR REVIEW: In response to increased concerns about emerging infectious diseases, GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine in partnership with the US Centers for Disease Control and Prevention (CDC), was established in 1995 in order to serve as a global provider-based emerging infections sentinel network, conduct surveillance for travel-related infections and communicate and assist global public health responses. This review summarizes the history, past achievements and future directions of the GeoSentinel Network. KEY FINDINGS: Funded by the US CDC in 1996, GeoSentinel has grown from a group of eight US-based travel and tropical medicine centers to a global network, which currently consists of 68 sites in 28 countries. GeoSentinel has provided important contributions that have enhanced the ability to use destination-specific differences to guide diagnosis and treatment of returning travelers, migrants and refugees. During the last two decades, GeoSentinel has identified a number of sentinel infectious disease events including previously unrecognized outbreaks and occurrence of diseases in locations thought not to harbor certain infectious agents. GeoSentinel has also provided useful insight into illnesses affecting different traveling populations such as migrants, business travelers and students, while characterizing in greater detail the epidemiology of infectious diseases such as typhoid fever, leishmaniasis and Zika virus disease. CONCLUSIONS: Surveillance of travel- and migration-related infectious diseases has been the main focus of GeoSentinel for the last 25 years. However, GeoSentinel is now evolving into a network that will conduct both research and surveillance. The large number of participating sites and excellent geographic coverage for identification of both common and illnesses in individuals who have traversed international borders uniquely position GeoSentinel to make important contributions of travel-related infectious diseases in the years to come.

Tracking the spread of COVID-19 in India via social networks in the early phase of the pandemic.

BACKGROUND: The coronavirus pandemic (COVID-19) has spread worldwide via international travel. This study traced its diffusion from the global to national level and identified a few superspreaders that played a central role in the transmission of this disease in India. DATA AND METHODS: We used the travel history of infected patients from 30 January to 6 April 6 2020 as the primary data source. A total of 1386 cases were assessed, of which 373 were international and 1013 were national contacts. The networks were generated in Gephi software (version 0.9.2). RESULTS: The maximum numbers of connections were established from Dubai (degree 144) and the UK (degree 64). Dubai's eigenvector centrality was the highest that made it the most influential node. The statistical metrics calculated from the data revealed that Dubai and the UK played a crucial role in spreading the disease in Indian states and were the primary sources of COVID-19 importations into India. Based on the modularity class, different clusters were shown to form across Indian states, which demonstrated the formation of a multi-layered social network structure. A significant increase in confirmed cases was reported in states like Tamil Nadu, Delhi and Andhra Pradesh during the first phase of the nationwide lockdown, which spanned from 25 March to 14 April 2020. This was primarily attributed to a gathering at the Delhi Religious Conference known as Tabliqui Jamaat. CONCLUSIONS: COVID-19 got induced into Indian states mainly due to International travels with the very first patient travelling from Wuhan, China. Subsequently, the contacts of positive cases were located, and a significant spread was identified in states like Gujarat, Rajasthan, Maharashtra, Kerala and Karnataka. The COVID-19's spread in phase one was traced using the travelling history of the patients, and it was found that most of the transmissions were local.

Travel-screening documentation to enable the "Identify-Isolate-Inform" framework for emerging infectious diseases: It's all in the details.

The early phase of the coronavirus disease 2019 (COVID-19) pandemic and ongoing efforts for mitigation underscore the importance of universal travel and symptom screening. We analyzed adherence to documentation of travel and symptom screening through a travel navigator tool with clinical decision support to identify patients at risk for Middle East Respiratory Syndrome.

Travel Health Implications for Women Traveling Abroad.

International travel is increasing each year, and many travelers are female. Travel-related health risks include diseases, accidents, and other safety concerns. Whether traveling for business or pleasure, women should practice appropriate measures that minimize the impact travel can have on their health and well-being. Female travelers can have unique health risks related to pregnancy, lactation, and infectious disease. A large part of pretravel health preparation is often performed by nurses and should include a comprehensive health risk assessment, education, and vaccinations, all of which can help mitigate potential health risks for travelers.

Expanding travel medicine in the 21st century to address the health needs of the world's migrants.

HIGHLIGHT: The body of knowledge needed to effectively practice travel medicine has expanded since the 1990s, as migrants begin to comprise an increasing proportion of the world's population. We describe the unique needs of migrants and provide resources available to migration health practitioners. As the number of the world's migrants grows, collaboration across disciplines is key to achieving high-quality migration health practices.