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Travel Medicine News August 2019. Volume 5. Climate change-related catastrophes, such as cyclones leave large populations of displaced people, who can be at risk of waterborne diseases. 9 How can the environment impact travel medicine? PAX-US-0290 References 1. Morens DM, Fauci AS. Emerging Infectious Diseases: reats to Human Health and Global Stability. PLoS Pathog. 2013;9:e1003467. 2. National Academies of Sciences, Engineering, and Medicine. 2018. Urbanization and slums: Infectious diseases in the built environment: Proceedings of a workshop. Washington, DC: e National Academies Press. 3. ECDC news report. Cyclone Idai: ECDC joins emergency response as more cases of cholera and waterborne diseases expected. Available at: https://ecdc.europa.eu/en/news-events/cyclone-idai-ecdc-joins-emergency-response-more- cases-cholera-and-waterborne-diseases; Accessed August 2019. 4. United Nations. World urbanization prospects: e 2018 revision. Available at: https://population.un.org/wup/ Publications/Files/WUP2018-KeyFacts.pdf; Accessed August 2019. 5. Bivins AW, Sumner T, Kumpel E, et al. Estimating Infection Risks and the Global Burden of Diarrheal Disease Attributable to Intermittent Water Supply Using QMRA. Environ Sci Technol. 2017;51:7542−51. 6. Luby SP. Urban Slums: A Supportive Ecosystem for Typhoidal Salmonellae. J Infect Dis. 2018;218(Suppl 4):S250–54. 7. N’cho HS, Masunda KP, Mukeredzi I, et al. Typhoid Fever Outbreak — Harare, Zimbabwe, October 2017– February 2018. MMWR Morb Mortal Wkly Rep. 2019;68:44–5. 8. Date KA, Newton AE, Medalla F, et al. Changing Patterns in Enteric Fever Incidence and Increasing Antibiotic Resistance of Enteric Fever Isolates in the United States, 2008–2012. Clin Infect Dis 2016;63:322–29. 9. Wu Z, Lu Y and Zhou S, et al. Impact of climate change on human infectious diseases: Empirical evidence and human adaptation. Environ Int. 2016;86:14–23. Environmental factors as well as microbes and the humans that are affected, all influence and impact upon the emergence of infectious disease. 1 Environmental factors potentially involved in emerging/remerging human infections 1 ▲ Climate/weather 1 ▲ Economic development and land use 1 ▲ Technology/industry 1 ▲ Poverty 1 ▲ Lack of public health services 1 ▲ Animal populations 1 ▲ War 1 ▲ Famine 1 ▲ Lack of political will 1 Urban slums are one example where environmental factors combine to provide ideal settings for the emergence and spread of infectious disease. 2 How does the growth of urban slums influence travel health? Increasing populations in neighborhoods with poor water and sanitary infrastructure increases the number of people at risk of emerging infectious disease. 2 In 2016, approximately one in eight people around the world lived in slums. 2 % of the world’s population residing in urban areas 1950 2018 2050 Evolution of urban and rural populations 1950–2050 4 80 0 20 40 60 30% 55% 68%* *projected The world’s urban population will increase by 2.5 billion people by 2050 with almost 90% of this growth happening in Asia and Africa. 4 Intermittent water supply is a risk for disease Intermittent water supply is prevalent throughout low and middle-income countries and is associated with increased microbial contamination and potentially elevated risk of waterborne illness. 5 Specifically, intermittent water supply in low-income cities provides for efficient transmission of Salmonella Typhi and Paratyphi 6 Recently, the combination of poor water quality and sanitation and urban overcrowding was shown to be the driver of a large: typhoid fever outbreak Harare, Zimbabwe, Oct 2017 – Feb 2018 191 confirmed cases 7 In the US, and other developed countries, incidence of enteric fever is primarily associated with travel to typhoid-endemic areas. Foreign travel preceding illness onset was reported by 86% patients. 8 2008–2012 2341 enteric fever cases were reported in the USA 80% were typhoid cases 20% were paratyphoid A Mozambique Zimbabwe Malawi Tropical cyclone Idai hit southern Africa on March 15, 2019... ... displacing thousands of people in Mozambique, Malawi, and Zimbabwe, and causing hundreds of fatalities as well as an upsurge of infectious diseases such as cholera. 3 How does climate change affect travel health? Intermittent water supply may account for: 17.2 million infections causing 4.52 million cases of diarrhea 109 thousand diarrheal DALYs 1560 deaths each year 5 DALYs, Disability Adjusted Life Years © 2019 Emergent BioSolutions Inc. All rights reserved. Emergent BioSolutions ® and any and all Emergent BioSolutions Inc. brands, products, services and feature names, logos and slogans are trademarks or registered trademarks of Emergent BioSolutions Inc. or its subsidiaries in the United States or other countries. All other brands, products, services and feature names or trademarks are the property of their respective owners. This newsletter has been developed by Emergent BioSolutions ® for information only and does not constitute medical advice or recommendations.
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