Barcelona CISTM15 May 2017

Bits, bites and bytes takes flight

SALIM PARKERSASTM

Opening Acts

Global Air travel• In 2016 there were 3.7 billion air travellers

• Forecast 4 billion 2017

• International passenger: 1.5 billion passengers in 2016

http://www.iata.org/pressroom/pr/Pages/2017-02-02-01.aspx

• The longest flight:

• Dallas-Sydney: 17 hours 13 730 km

• Dubai-Auckland 17 hours 14 120 km

• New Delhi- San Francisco 14.5 hours 15 300 km

• Airbus 380 carries up to 853 pax

http://www.iata.org/pressroom/pr/Pages/2016-10-18-02.aspx

Global Air Passenger Forecast

Taking Flight: The final frontier

PROF. Gerard Flaherty

PROF. Gerard Flaherty

There is a market!

FutronCorporation survey (2002)

• Suborbital market could exceed 15,000 passengers by 2021

• Orbital market could reach 60 passengers per year.

• Total annual revenue >US$1 billion

Elon Musk: SpaceX to Mars 2020

PROF. Gerard Flaherty

PROF. Gerard Flaherty

The Bits…….

Children are not ‘bit’ adults!

More than a bit of safety needed

• Children 4% of travellers but 25% of hospitalisations

• MVA leading cause of death in travelling children

• Car restraints decrease deaths by >70%

• Drowning second commonest cause of deaths

• Safety!!!

Rabies Vaccine in Children

• No lower age limit

• Prolonged stay

• Rural stay

• Other high risk exposure (monkeys/bats)

• Intradermal NOT for immunocompromised or if on mefloquine

CISTMatic Review of the Evidence

• Travellers’ Diarrhea: Consensus and Controversy

I used to be indecisive, but now I’m not so sure!

Antibiotic Resistance

• Antibiotic resistance is a global problem.

• It affects multiple types of bacteria.

• It is getting worse.

• Rates and types of resistance vary by geographic area and change over time.

• Travellers are part of the global conveyor belt that moves bacterial genetic material around the world.

Mary E. Wilson, MD

Antibiotic Resistance

• Persistence at 1 year (up to 11%)

• May vary by resistance type

• Most resistant bacteria do not cause infection

• Carriage usually silent

• Spread to close contacts

• Studies underestimate extent of spread

• Multidrug resistant UTI are more likely to have history of international travel

• Patients infected with multidrug resistant bacteria have poorer outcome (higher mortality)

Mary E. Wilson, MD

Barcelona: Fun and work

UK 18-33yo

•Check their device 85 times a day

•Total 5 hours browsing the web/ using apps

•a third of time awake

•Twice as often as persons realize

Nottingham Trent university : Dr De Frey

Life’s essentials… & smartphones?

•40% check phone within 5 mins waking

•18-24 yo : Check 82 times per day

•Average: 47 times a day

Deloitte 2016 Global mobile consumer survey: Dr A de Frey

Deloitte 2016 Global mobile consumer survey: Dr A de Frey

Pre-travel consultation: Using Tech

A wide range of simulated travellers showed a

high level of acceptance of a

telehealth portal, and a preference for using

telehealth for travel medicine consults.

Stuart R. Framm Abstract 37

Tech during travel

mHealth using smartphone

technology has the potential to

revolutionize our understanding of health

during travel by creating an almost real-time

timeline of health events and behaviours

during travel.

A Farnham: Abstract 129

The Advent of the SELFIE

Our Dangerous World

• Climate change

• Air pollution

• Extreme events

Air Pollution and Travel

This pilot study shows that travel to cities withsignificantly higher pollution than one's homecity can have acute impacts on thecardiopulmonary system. This supports aconcern for potential adverse health effectsdue to air pollution while traveling abroad.

• M.J.R. Vilcassim PO 12.02

Air Pollution• 09 Oct 2017

• Breathing New Delhi’s air right now is the equivalent of smoking 45 cigarettes a day

• Air quality index 999

• WHO: <25

• Globally roughly 7 million people will die prematurely each year

https://qz.com/1124049/air-pollution-in-new-delhi-has-the-health-effect-of-smoking-45-cigarettes-a-day/

Humans taking flight

Aspiration vs Desperation

Aspiration vs Desperation

Malaria

The late Professor Desowitz

famously stated that: ‘When I

got my PhD in 1951 my

supervisor said that malaria is dead

and that I’ll never make a living out

of it.’

Malaria

The malaria parasite is

however no pushover! It is

estimated to have killed nearly

half of all humans that have

so far graced the earth!

Malaria cases are still high!!

Malaria Endemic countries

Although these numbers are

decreasing, the numbers of

cases of malaria in travellers

has been increasing.

https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/malaria

Total Malaria Cases in High Reporting Areas of South Africa, 2015 - 2017

49

Summary of Malaria Cases in South Africa, 2016 and 2017▪ Total of 945 malaria cases in August 2017 as

compared to 246 malaria cases in August 2016

▪ Total 438 of imported cases in August 2017 as

compared to 227 imported cases in August

2016

▪ Total of 507 local cases in August 2017 as

compared to 11 local cases in August 2016

▪ Total of 1 unknown malaria cases in August

2017 as compared 8 to unknown malaria cases

in August 2016

▪ Total of 4 deaths due to malaria in August 2017

as compared to 2 malaria deaths in August 2016

50

Prof Helen Rees: PHEIC

IHR Chapter 12- “Public Health Emergency of International Concern”(PHEIC)

• Means an extraordinary event which is determined, as provided in these regulations:

• To constitute a public health risk to other States through international spread of the disease and

• To potentially require a coordinated international response

IHR Emergency committee Status

1. Pandemic influenza A (H1N1) April 2009 ‐ August 2010. Closed

2. Middle East Respiratory Syndrome‐ Coronavirus (MERS‐CoV)July 2013 ‐ September 2015. Closed

3. International spread of poliovirus May 2014 ‐ On‐going

4. Ebola Virus August 2014 ‐ March 2016. Closed

5. Zika virus and neurological disorders February 2016 ‐ November 2016. Closed

6. Yellow Fever May 2016 and August 2016. Closed

Public Health Emergencies of International Concern CISTM15 Barcelona, 2017 Prof Helen Rees

Rumi Chunara, PhD

Assistant Professor

Computer Science & Engineering, College of Global Public Health

New York University

Disease Surveillance and Digital Disease Detection

Japan Scout Jamboree 2015

• 34 000 attendees

• 3 Scottish scouts and one parent infected

• 2 Swedish scouts

• Couple seated close to scouts Japan-Germany flight

• Wife developed invasive disease, husband carrier

• Serogroup W

http://www.promedmail.org/direct.php?id=20171019.5391253

Measles• 2010 Soccer World Cup in

South Africa

• Journalist: Europe import

• Unvaccinated Australians acquired local SA genotype

• Cape Town 2015

• 2 oncology patients, same hospital

• Both contract measles

• Same genotype as found in Europe

• Munich Airport employee had same genetic sequence

• An oncologist based at the same CT hospital travelled from a conference in Europe via Munich airport. He had measles symptoms. So did his wife

Travel is not only from first world to third world countries!Diseases obey no boundaries and restrictions

2015 measles outbreak in USA DisneylandMost current USA cases travel related

3000 cases in Italy 2017 http://www.promedmail.org/direct.php?id=20171017.5384584

News just in…….

• Top of the priority list for emergent new issues in UK

• A vaccine that can prevent 29% of MI’s…….

• Just as effective as smoking cessation….

• Even more effective than statins…….

• It has been around a while……..

• ?????????????