Guide Imported infectious diseases : the impact in developed countries

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Infectious diseases not only cause loss of health and, eventually, life but generally also lead to economic consequences. Serious challenges oppose current efforts to stem and limit epidemics in these countries, requiring urgent collaboration with adjacent and global countries through shared experience, financial support, multisector intervention, professional healthcare delivery, and technical innovation.

Promoted by the BRI, with the Health Silk Road as a priority, opportunities will be provided for combating infectious disease epidemics based on technical experience communication, financial investment, cooperative organisation, and future collaborative programmes.

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Appropriate management and treatment are essential to achieving the elimination of infectious diseases [ 12 ]. However, such efforts will have to be tailored to local settings. In , China successfully passed the validation of its LF elimination strategy after having followed a plan of control and surveillance for nearly 60 years [ 29 ]. The work towards elimination of LF in China has relied on the implementation of three schemes: 1 surveys using repeated blood testing followed by treatment when needed; 2 mass drug administration MDA with diethylcarbamazine-fortified salt to disrupt infectious microfilaria; and 3 target treatment of carriers using the same drug.

Cambodia has improved its healthcare capacity and also managed to eliminate LF as a public health problem using a similar approach along with parallel interventions against other vector-borne diseases [ 30 ]. Turkmenistan and the United Arab Emirates have achieved zero indigenous cases of malaria [ 31 ], whereas China had no indigenous cases in [ 32 ]. The Chinese government has scheduled the elimination of this disease by [ 33 ]. As for the national malaria elimination programme, the surveillance and response strategy reporting cases within one day, investigating cases within three days, and targeting control measures within seven days has benefitted from conducting interventions at the provincial, municipal, and county levels, ensuring a nationwide effect [ 34 ].

This successful rapid response to cases of malaria in returning overseas workers and the engagement of private-sector employers have recently been implemented in other Asia-Pacific countries [ 34 ]. Using the antimalarial drug artemisinin, developed from herb-based Chinese traditional medicine, has proved vital for malaria treatment [ 35 ].

In addition, the use of mosquito nets is suggested for implementation during the transmission season [ 29 ]. The Chinese government now schedules schistosomiasis elimination by [ 36 ] by using the successful, multisectoral national strategy that has reduced Schistosoma japonicum infection in cattle, humans, and snails, which is based on MDA with praziquantel for snails combined with the removal of cattle from the grasslands where the snails reside [ 37 ].

With regard to TB, dengue, and cystic echinococcosis, the plan is to end these epidemics, and there has already been success in reaching this goal. However, the effective strategy to end TB also requires high-level political commitment, community engagement, social protection, funding support, and innovation of drug delivery and rapid diagnostics.

For dengue, the timely reporting of cases also relies on a notification system, and the approach to controlling mosquito reproduction has provided a solution to dengue epidemics elsewhere [ 40 ].


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In China, the control and treatment of echinococcosis integrates large-scale surveys, control of the transmission source deworming definitive hosts , and detection plus treatment of patients free of charge, supported by domestic funding [ 41 ]. The successful interventions in China are implemented in line with the Chinese health system, which is vital for delivering healthcare to less developed regions and responds effectively to health crises by coordinated action [ 12 ].

Apart from the above interventions, political support, regulation guidance, and financial investment are paramount. It has been proposed by WHO to tailor some feasible aspects to local health systems to achieve disease elimination and UHC [ 42 ]. The Health Silk Road concept encourages regional cooperation and extensive participation from governments, international and regional organisations, universities, private sectors, civil society, and the general public. China is a positive initiator and has, together with related countries, jointly published a series of agreements.

Nongovernmental exchange and cooperation activities in various fields are complementary to governmental projects, as they build public support for the BRI.

China has also worked to strengthen think-tank cooperation and initiated the International Silk Road Think Tank Association [ 1 ]. Building the Silk Road for health by combating infectious diseases cannot be achieved without multisector engagement and expert involvement. The platforms created are well suited to take on current opportunities in collaboration with organisations such as WHO collaborating centres and existing South—South networks, linking them with similar units in Belt and Road countries Table 1.

Current platforms have significantly contributed to achieving first control and later elimination of some diseases and are now turning to the global level, providing opportunities to assist building a health approach within the BRI. For example, trilateral collaboration between China providing technical support , Australia a major donor , and Papua New Guinea a country close to holoendemic for malaria is dedicated to improving local staff capacity for malaria diagnosis and disease control.

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This programme highlights the regional health security agenda of a malaria-free Asia Pacific by The Belt and Road Network for Elimination and Control of Echinococcosis and Cysticercosis, involving institutions from Asia and Europe, has established the importance of technical cooperation and health education, and regional collaborating control activities are on the way. In the — Five-Year Plan of Action on Lancang—Mekong Cooperation, infectious disease control is achieved by strengthening collaboration on dengue fever and malaria and establishing and improving the mechanism for joint surveillance, prevention, and control of cross-border emerging and reemerging infectious diseases.

Other programmes, such as the Cooperation in Control of Infectious Diseases in Central Asia, cooperates with central Asian countries on the control of echinococcosis and other zoonoses, and LF and TB control are being proposed to enlarge, enforce, and deepen cooperation worldwide. Regional cooperation will be increased through health infrastructure work by building joint laboratories and research and knowledge translation centres [ 44 ].

China will upgrade 50 medical and health aid programmes for Africa, such as the headquarters of the African Center for Disease Control and Prevention and China—Africa Friendship Hospitals [ 45 ].

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China has also donated drugs and equipment as well as helped to build health facilities [ 35 ]. For example, responding to the Ebola epidemic, the Aucma Company Qingdao, China has facilitated the delivery of the Ebola vaccine to West Africa using the Arktek Qingdao, China portable cold-storage devices. The diverse and vibrant private sectors in China, such as those dealing with data systems and mobile phone—based technologies, will potentially provide much-needed assistance for combating infectious diseases [ 46 ].

This not only provides technical guidance, establishes the mechanism for disease control and prevention, and improves local staff capacity to sustain interventions but also produces open platforms and innovative new models for global health collaboration. Ending infectious disease epidemics demands intensified funding, preferably delivered at the international level, to strengthen advocacy, research, and the global control effort.

Besides being a sincere collaborator in the area of global health and a board member of UNAIDS and the Global Fund [ 11 ], China is creating its own multilateral funds and banks, e. The multilateral funds are substantial, adding up to USD billion, with China securing major pledges, mainly from the two banks and the Silk Road Fund. Part of the financial aid is supposed to contribute to research and innovation with respect to medical products and diagnostic skills. The initiative also encourages discovery and production of new drugs and vaccines [ 4 , 44 ].

In addition, China will cancel the debt of the least developed countries, launch specific projects to end poverty, and support better health services [ 11 ]. In this way it can alleviate regional poverty so that the income of local people will increase and their living standards will improve, and it can reduce the risk and burden of infectious diseases caused by poverty. Apart from funding infrastructure construction, which supplies delivery and research, the BRI also advocates improved professional and organisational capabilities targeting specific diseases [ 4 ].

As one of the WHO Emergency Medical Teams, China has distributed medical supplies and will, together with WHO, take on infectious disease control, implementing professional support, training of medical staff, and healthcare delivery. For instance, during the Ebola pandemic, China sent 1, medical experts and committed an additional USD million for training more than 13, local medical workers in response to Ebola infections in West Africa [ 11 ].

China will assist in training more medical personnel for Africa and continue to send medical teams to meet Africa's requirements [ 45 ]. More global health human resources and specific medical workers will be brought in, together with global health departments being established in universities and institutions [ 47 ].

China is pursuing discussions about cooperation with multilateral initiatives at the highest level, aligning relevant health agreements under the BRI theme. Compared with other initiatives, this initiative stands out because of its political commitment, which advances the health SDGs and solves current constraints to the progress of UHC [ 5 , 48 ].

However, the situation is changing, as the Belt and Road multilateral funding initiative is substantial, with a total planned to reach USD billion, exceeding the USD billion capitalisation of the World Bank [ 4 ]. As an ambitious, long-term initiative that is extremely open and inclusive, the BRI meets the great challenges of cultural differences and economic risks and has questioned the viability of some infrastructure investments.

However, with the goal of a shared benefit for all humankind, an increasing number of countries have engaged in building the initiative. Enhanced interconnectivity will bring about not only international health risks but also, more importantly, new opportunities for global health cooperation and development.

So far there is a lack of specific indicators for each disease and detailed procedures regarding cooperation with respect to disease control and elimination. The current study is expected to result in recommendations to policy makers on an overall policy plan and a road map for the imminent future. All aforementioned experiences, platforms, and programmes as well as financial and personnel resources provide useful opportunities for cooperation among involved countries with respect to the threat of infectious diseases.

More importantly, pilot research and demonstration projects in line with the BRI have been proposed and, in some cases, have already started.

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China has demonstrated strong and sustained political leadership to ensure its core role of global health collaboration in economic development. For these patients, diagnoses were counted. The visits were evenly distributed during the calendar year, with no seasonal abnormities or significant associations. Appendix Figure. Illness rates in persons whose purpose of travel was visiting friends and relatives VFR versus traditional travelers travelers. Points indicate number of illnesses per 1, ill returned travelers. Our analysis included traditional travelers and VFR travelers.

For traditional travelers, the reason for most recent travel was tourism or business.

Summary and Assessment

The basic demographic pattern was comparable Table 1. VFR travelers traveled on average for a longer period than traditional travelers, were slightly older, were more likely to have inpatient status, and were less likely to seek pretravel advice. Traveled regions were also comparable Table 2. Fever and gastrointestinal disorders were the most frequent reasons for seeking treatment Table 2. Traditional travelers had more gastrointestinal symptoms The proportionate illness patterns are shown graphically in the Appendix Figure. In contrast, traditional travelers were more likely to receive a diagnosis of diarrhea OR 2.

Respiratory diseases and viral syndromes were significantly associated with VFR travelers only in the univariate analysis Table 3. Traditional travelers were significantly more likely to seek pretravel advice compared with VFR travelers Table 1. Percentage of disease diagnoses in travelers visiting friends and relatives VFR and traditional travelers trav who reported illnesses after returning to Switzerland, classified by geographic region visited.

A different infectious disease spectrum and a trend toward a distinct pattern in both VFR and traditional travelers were also found when selecting different travel regions Figure. Malaria cases were almost exclusively imported from the sub-Saharan Africa region; Of these, 22 cases were imported from sub-Saharan Africa and 1 from Turkey; for 4 case-patients, no specified travel region or no information on place of exposure was available. When data were stratified by VFR versus traditional traveler, the risk for malaria in sub-Saharan Africa was twice as high in the VFR traveler group than in the traditional traveler group data not shown.

However, GeoSentinel is a health facility—based surveillance system and does not actively screen for certain diseases. Patients included in the database do not necessarily represent the whole population or the epidemiology or frequency of the disease. Besides the unknown number of ill returned travelers going to general practitioners or nonspecialized clinics, the number of travelers returning in good health is also unknown.

Incidence rates or relative risks therefore cannot be estimated. Similarly, patients with mild or self-limiting disease are likely to see a general practitioner rather than to go to a specialized center, although many VFR travelers do not have a regular general practitioner. A limitation of the study is the relatively small number of patients included in the database during the month period, which made it necessary to form summary diagnoses and regions.

Traditional travelers mainly tourists were significantly more likely to seek advice before traveling and to have a posttravel diagnosis of acute diarrhea. This is consistent with previous studies from European migrants returning to their home countries 16 , as well as a recent review of the global GeoSentinel database 5. Malaria is most likely to be acquired in the sub-Saharan Africa region, according to our data and those of others 13 , The protective effect in VFR travelers could reflect immunity due to recent exposure or exposure in childhood.

Acute or chronic viral hepatitis was also significantly associated with VFR travel, which correlates with a recent study of hepatitis A virus infections in Swiss travelers during a period of 12 years that identified VFR travelers as a high-risk group, especially children of immigrants Other significant associations of disease between VFR and traditional travelers were not found; however, this does not necessarily mean that no such relationship exists. Systemic febrile illnesses, including malaria and typhoid fever, tuberculosis, and respiratory syndromes, are more frequently diagnosed among VFR travelers 5.

In our study, respiratory diseases contributed to the relatively high rate of illness in both VFR and traditional travelers vs. No significant association could be established between influenza, long trip duration, and travel involving visiting friends and relatives as described before 14 , probably because of small numbers and very few cases of influenza.

Viral syndrome, a rather loosely defined summary diagnosis with unspecific viral symptoms, was also frequently diagnosed and can be interpreted as a flulike syndrome. Other typical tropical infectious diseases, such as typhoid fever, leishmaniasis, dengue fever, or brucellosis, were rarely diagnosed. This study shows that VFR travelers are at greater risk for certain infectious diseases and have a disease spectrum distinct from that of traditional travelers. Malaria is the most important, life-threatening imported disease for both nonimmune and VFR travelers, and malaria acquisition is even more likely in VFR travelers.

VFR travelers are vulnerable because they may visit more rural destinations, live under poor sanitary conditions, and stay away for longer periods 3 , 4. The impact of mega agricultural production on populations as they relate to infectious disease also must be considered. For example, Salinas Valley, Calif. He described the spinach outbreak, during which isolates from cows and wild boars were matched to water in systems around the spinach fields. As the developed world moves to importing more food from developing countries, problems with infectious disease related to food are anticipated.

Good animal health strategies are public health strategies, although they are often considered separate entities, according to King.

A major concern is health disparities in resource-limited countries. Women and children will get infected at the highest levels because they traditionally care for livestock in developing nations, according to King. Shifts from rural livestock to farms closer to urban areas or the fringe of forests also have major implications for infectious disease. Fruit bats, which can have 4-foot wing spans and may cover miles in 10 days, flourish in Southeast Asia. Working in large groups, they descend on the fruit at the edge of the jungle, where the swine are raised to increase production.

Fruit bat saliva dropping on the hogs leads to entire herds being killed from infectious disease. Livestock production is moving closer into urban areas, creating another perfect scenario for infectious disease endemics. In Bangkok, the growth of poultry and livestock has already moved into the city. Tell us what you think about Healio. Login Register My Saved. Demand-driven agriculture and livestock production predicted to increase spread and dangers of zoonotic diseases. Infectious Disease News, August