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……..
• ?????????????