Faculty of Medicine. Lecture 25

Transcription

1 Faculty of Medicine الصحة العامة ( ) Health Public Lecture 25 Migration and Travelers' health By Hatim Jaber MD MPH JBCM PhD

2 1. The global health impact of mental health and mental diseases. Drug abuse and Addictive substances 2. Global overview of communicable diseases 3. Global overview Non- Communicable Diseases(NCDs) 4. The global health impact of Hepatitis, Tuberculosis and HIV/AIDS 5. The global health impact of Cardiovascular Diseases, Diabetes and Obesity 6. Health policy and management, Health priorities 7. Health policies and management within a global health perspective 8. Healthcare service delivery in developed and developing countries 9. Healthcare systems and financing 10. Quality of care and effectiveness in different health services systems 11. Violence and Injuries 12. Migration and Travelers' health 13. Traditional Medicine

3 Presentation outline Time Migration and Health 09:15 to 09:25 Global Compact in Migrants and Refugees 09:25 to 09:35 Travelers Medicine 09: 35 to 09:40 Travelers Health Risks 09:40 to 09:50 Infectious Disease Risks to the Traveler 09:50 to 10:15

4 Globalization of health and safety Affects Health of local populations Health determinants Safety and security Results in Global impacts Emerging and re-emerging infectious disease Terrorism Commerce and Health Influenza Tsunami SARS Pathogens travel as fast as transportation: borders are not respected

5 Global Migration Trends 1 billion Migrants The six Ds driving migration: 2014: S-S 37%: S-N 35%; N-N 23%; N-S 5% 1. DEMOGRAPHY: pop. replacement rates in industrialized world; & birth rates in developing countries; 2. DEMAND: labour shortage in industrialized world; labour surplus in developing countries; 3. DISTANCE shrinking due to technology and travel; 4. DIGITAL REVOLUTION: real-time info on mobility/migrant networks; 5. DISPARITY: Between North South (economic and social); 6. DISASTERS: Natural, man-made, climate-changes,slow-onset => displacement;.6

6 International Organization for Migration (IOM) Migration Health Division H1 Migration Health Assessment & Travel Health Assistance H2 Health Promotion & Assistance for Migrants H3 Migration Health Assistance for Crisis Affected Populations

7 Migration Health Addresses the physical, mental and social needs of migrants, and the public health needs of hosting communities, as well as communities of origin, through policies and practices corresponding to the emerging challenges facing mobile populations today (IOM, MC/INF/275, 8 Nov IOM COUNCIL DOCUMENT IOM Governing Body 8

8 Operational framework to guide Member States and stakeholders in implementing the strategies of Operationalizing the Resolution WHA WHA set at 1 st Global Consultation on health of migrants, March 2010 Monitoring Migrant Health Identify key indicators Ensure standardization and comparability of data on migrant health Migrant sensitive Health Systems Policy & Legal Frameworks Develop and implement policies that promote equal access to health services for all migrants Extend social protection in health and improve social security for all migrants and family members Partnerships, Networks, multicountry frameworks Ensure health services are culturally, linguistically and epidemiologically appropriate Address migrant health in global and regional processes

9 Challenges in implementation of the WHA Migrants too often remain invisible, marginalized and excluded from HEALTH SYSTEMS/PLANS 2. Migration health absent/poorly described within global health initiatives (eg. UHC,NCD, etc.) and migration & development (GFMD, etc.) 3. migrants still seen as burden on health system and carriers of disease 4. No unit/focal point on migration health at MOH etc

10 The impact on the health of low skilled migrant workers and their families have been largely neglected. Such research evidence is needed for policy formulation and developing interventions to ensure a safe, dignified and healthy labour migration experience for millions of migrant workers and their families globally Academia have a critical role in this endevour

11 Increasing political and global attention on migrants as a result of the European Migrant crisis and Syrian conflict with its mixed migration flows. Some political science commentators said it took a crisis at the doorstep of Europe for world leaders to galvanize action Global Compact around migrants and refugees three-year-old Syrian boy of Kurdish ethnic background whose image made global headlines after he drowned on 2 September 2015 in the Mediterranean Sea

12 Global Compact in Migrants and Refugees Member States have committed themselves to negotiate Clearer leadership structures are needed within the UN to forge a system that can; i) anticipate and react quickly to movements in a crisis; ii) deliver political messages with a consistent voice; Iii) assist member states to deliver the migration-related Sustainable Development Goals, and monitor their success in doing so; iv) formulate common standards for the handling of migration, and develop these into soft international law; and v) where member states are ready, negotiate binding treaties on specific migration issues. It further contends that functioning international cooperation on migration depends on restoring an atmosphere of trust, which at present is alarmingly absent in many aspects of international relations Special Representative of the UN Secretary-General for International Migration, Mr. Peter Sutherland

13 2016 Timeline of events leading up to 2 nd GC: global health diplomacy

14 What to do 1. Adopt a participatory, inter-sectoral and multidisciplinary approach 2. Adopt an inclusive approach covering all migrant flows 3. Adopt an evidence-based approach and develop a national research agenda 4. Adopt a pragmatic and responsive approach 5. Embed a regular reporting and accountability framework 6. Ensure advocacy and engagement at regional and international level

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16 Travellers from industrialised areas to developing areas 1999 (WTO) 2.8 USA / Canada 35.2 million Europe 25.0 million Japan 11.4 mio AUS / NZ 3.3 million Total: n million travelers million travelers ~ 80 million travelers

17 What is travel medicine? It is that part of health professional practice that: seeks to prevent illnesses and injuries occurring to travellers going abroad manages problems arising in travellers coming back or coming from abroad is concerned about the impact of tourism on health and also advocates for improved health and safety services for tourists is increasing concerned about refugee and migrant health (Primer of Travel Medicine 3 rd Ed)

18 What is travel medicine the art of travel medicine is selecting the necessary prevention strategy without unnecessary adverse events, cost or inconvenience (Steffen, 1994) Travel medicine is a new multidisciplinary specialty emerging in response to the needs of the travelling population worldwide.

19 What is travel medicine? Travel and aviation medicine have many linkages, especially in terms of fitness to fly and dealing with problems that may arise in travelers due to physiological and psychological stresses of travel. Increasingly, the discipline of refugee and migrant medicine is also being included in the specialty area of travel medicine.

20 Travellers are exposed to a variety of hazards

21 The Importance of Travel Health Measures 100,000 travelers to the developing world for 1 month.. 50,000 will become ill 8,000 will see a physician 5,000 will stay in bed 1 will die Steffen, 1994

22 The Importance of Travel Health Measures. Per 100,000 travellers that have travel insurance will make a claim (8%) 2000 will use emergency assistance (2%) 400 ER or clinic referrals (0.4%) 200 Hospital admissions (0.2%) 50 Aeromedical evacuations (0.05%) Leggat et al. Travel Med Inf Dis 2005;3:9-17.

23 The Importance of Travel Health Measures... Mortality Cardiovascular Disease (50 to 70%) Accidents/Trauma (20-25%), Infectious diseases (2.8-4%) (Reid and Cossar, BMBull. 1993; ; Prociv, MJA. 1995;163:27-30; Baker et al., PHR 1992;107: ; MacPherson et al, JTM. 2000; 2000: ; Steffen, Trans RSTM&H 1991;85: )

24 Deaths Related to International Travel Cardiovascular Medical Injury Homicide/Suicide Infectious Disease Other N = 2463 Hargarten S et al, Ann Emerg Med, :

25 Travel medicine is a continuum Travellers do get sick or injured abroad or when they come back The commitment to travel health can therefore be regarded as a continuum

26 The Continuum of Travel Medicine Pre-Travel Preventive Medicine Visitors Contingency During Travel Planning Treatment & Rehabilitation Post-Travel

27 Travelers Health Risks It is conservatively estimated that 30% 50% of travelers become ill or are injured while travelling. The main health complaints of returned Australian travelers reported in a recent survey of travel insurance claims were: - respiratory (20%), - musculoskeletal (17%), - gastrointestinal (14%), - ear, nose and throat (12%), - and dental conditions (7%)

28 The Patient: Medical Issues Age-specific issues Underlying illness, immunosuppression Systems review Medical history Medication use Vaccination history Allergies Contraindications to vaccines and medications 28

29 The Patient: Other Issues Reproductive Pregnant Breastfeeding Preconception Risk-taking behaviors 29

30 Infectious Disease Risks to the Traveler Malaria Diarrhea Leishmaniasis Rabies Dengue Meningococcal Meningitis Schistosomiasis Tuberculosis Leptospirosis Polio Yellow Fever Measles JEV ETC. 30

31 Injury Deaths and International Travel Motor Vechicle Drowning Air Crash Homicide/Suicide Poisoning Other N = 601 Hargarten S et al, Ann Emerg Med, :

32 Other Risks to the Traveler Accidental injury Environmental hazards Crime and assault Psychiatric problems Animal bites, stings and envenomations Dermatologic disorders Altitude. ETC. 32

33 Immunizations to Consider for Adult Travelers Routine Diphtheria* Tetanus* Pertussis* Measles + Mumps+ Rubella + Varicella Pneumococcus Influenza Travel related Hepatitis A Hepatitis B Typhoid Rabies Meningococcal disease Polio Japanese encephalitis Yellow Fever * Td or Tdap + MMR 33

34 Travel Medications: Prophylaxis & Self Treatment Malaria chloroquine, atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), primaquine Diarrhea quinolone, azithromycin Altitude acetazolamide Motion sickness scopolamine, dimenhydrinate (Dramamine) 34

35 Patient Counseling Sufficient time for patient education Tailored to suit traveler Fitness for travel Understanding impact on existing conditions Advisability of destinations 35

36 Travel Preparation Travel health insurance Medical care Hospitalization Evacuation Obtaining medical care abroad Awareness of travel notices Hand washing and hygiene 36

37 Environmental Precautions Air Travel Jet Lag Sun Protection Extreme Heat and Cold dehydration, heat stroke hypothermia, frostbite Altitude Water recreation Drowning, boating & diving accidents Risk of schistosomiasis or leptospirosis Biological and chemical contamination 37

38 Food and Water Precautions Bottled water Selection of foods well-cooked and hot Avoidance of salads, raw vegetables unpasteurized dairy products street vendors ice 38

39 Vector Precautions Covering exposed skin Insect repellent containing DEET 25 50% Treatment of outer clothing with permethrin Use of permethrin-impregnated bed net Use of insect screens over open windows Air conditioned rooms Use of aerosol insecticide indoors Use of pyrethroid coils outdoors Inspection for ticks 39

40 Bloodborne and STD Precautions Prevalence of STDs Hepatitis B Hepatitis C HIV Unprotected sexual activity Commercial sex workers Tattooing and body piercing Auto accidents Blood products Dental and surgical procedures 40

41 Animal Precautions Animal avoidance Rabies Specific animal threats Medical evaluation of bites/scratches Post exposure immunization and immunoglobulin Envenomations Snakes, scorpions, spiders Maritime animals 41

42 Vehicles Injury and Crime Risk of road and pedestrian accidents Night travel Seat belts and car seats Use of drugs and alcohol Understanding local crime risks Scam awareness Situational awareness Location avoidance 42

43 Travel Emergency Kit Copy of medical records and extra pair of glasses Prescription medications Over-the counter medicines and supplies Analgesics Decongestant, cold medicine, cough suppressant Antibiotic/antifungal/hydrocortisone creams Pepto-Bismol tablets, antacid Band-Aids, gauze bandages, tape, Ace wraps Insect repellant, sunscreen, lip balm Tweezers, scissors, thermometer 43

44 Post-Travel Care Post-travel checkup Long term travelers Adventure travelers Expatriates in developing world Post-travel care Fever, chills, sweats Persistent diarrhea Weight loss 44

45 Communicable Diseases of Public Health Significance Vaccine-Preventable Diseases Mumps Measles Rubella Polio Tetanus Diphtheria Pertussis Haemophilus influenzae Type B Rotavirus Hepatitis A Hepatitis B Meningocococcal disease Varicella Pneumococcal pneumonia Influenza Source: Centers for Disease Control and Prevention (accessed in July 2013)

46 Quarantinable Diseases Designated by Presidential Executive Order Cholera Diphtheria Infectious tuberculosis Plague Smallpox Yellow Fever Viral Hemorrhagic Fevers Severe Acute Respiratory Syndrome (SARS) Pandemic Influenza viruses Source: Centers for Disease Control and Prevention (accessed in July 2013)

47 Events that are reportable as a public health emergency of international concern (PHEIC) to WHO A PHEIC is defined as an extraordinary event which is determined: (i) to constitute a public health risk to other States through the international spread of disease and (ii) to potentially require a coordinated international response. 1 Examples include: Smallpox, Severe Acute Respiratory Syndrome (SARS), Pandemic Influenza and Other public health emergencies of international concern 1 Source: World Health Organization, (accessed July 2014)

48 Giving the correct advice to travellers Giving the correct health advice to travellers needs: Information Training Experience Documentation Travellers

49 Giving the correct advice to travellers Giving the correct health advice to travellers needs: Information Training Experience Documentation Travellers

50 Take home points More people are traveling to more destinations, becoming exposed to the health and safety of that destination and also having the potential to impact on the health and safety of that destination, especially through emerging infectious disease Travelers health is a continuum and includes the pretravel health, contingency planning while abroad and caring the traveler after travel Travel health advice needs information (including a capacity to undertake a risk assessment), training, experience, documentation and travelers

51 Challenge of travel medicine Sea of global migration of people More people travelling People travelling further a field Rapid movement of travellers