The World of Travel, Immunisations and Preventable Diseases

Fifty years ago, the cost of travel to far and abroad places was out of reach of the ordinary person. Today, nearly every person has traveled either intrastate, interstate or internationally. We use many forms of transport from our cars, to trains and buses and airplanes. In particular, airplanes carry us to far off destinations, where we experience life and culture and we return home with sometimes more than we bargained for, writes Marija Juraja.
With increasing travel we have seen a rise in the spread of particular diseases, some new diseases (Middle East Respiratory Syndrome (MERS), some old including vaccine preventable diseases (i.e. Measles and Influenza), food borne diseases (i.e. Salmonella typhimurium) and vector borne diseases (i.e. Dengue Fever and Ross River Virus).
There are two vaccine preventable diseases we need to focus on – Measles and Influenza; new diseases we need to watch, that currently have no vaccine available include MERS.
[caption id="attachment_7405" align="alignright" width="200"] Measles outbreaks in 2013. Source:www.cfr.org/interactives/GH_Vaccine_Map[/caption]
Measles is a viral respiratory infection that attacks the immune system; children are especially vulnerable to this deadly infection. Exceptionally contagious, children who are not immunised are more likely to suffer from the disease when they are exposed. Most people see measles as a disease that causes temporary illness, requiring time off from school or work. Complications from measles can leave some children with lifelong disabilities, such as blindness, deafness, and brain damage. It can also lead to death. Prior to the availability of measles vaccine, measles infected over 90 per cent of children before they reached 15 years of age. These infections were estimated to cause more than two million deaths and between 15,000 and 60,000 cases of blindness annually worldwide. Unvaccinated children under the age of five are most at risk of death. WHO recommends that every child receive two doses of measles vaccine ⁽¹⁾.
Over the past few months we have seen several outbreaks of measles in Australia related to overseas travel. For the Communicable Diseases Control Branch and the Infection Control Practioner (ICP), these measles cases create an enormous amount of work. It requires confirming the location and travel of the sick person, their exposure points (within the healthcare facility and community) and then following up with each potential contact that was exposed, ensuring they meet the criteria of low risk of contracting measles and subsequently following up with preventative measures for those at high risk with either immunisation or administration of normal human immunoglobulin. Contact tracing can range from a small cluster of less than 50 people to well and truly over 300 people or more which adds additional workloads for both the ICPs and public health staff. The hysteria and confusion that this creates also in the community and healthcare facilities is another complicated issue with these outbreaks, but it also brings wealth of awareness and highlights the importance of vaccinations.
Another new disease threatening Australia is MERS. MERS has spread now across 12 countries and the virus has killed almost 40 per cent of the people it’s infected. And, even though it may currently be confined to one region of the world, with air travel between the Middle East and Australia increasing, the chance that it could find its way here is still a large threat. Of the cases 181 reported cases internationally, 54 per cent of the confirmed cases had underlying conditions (in some cases multiple underlying conditions) that may have made them more susceptible to the virus. Especially important to note is that scientists still don’t fully understand how it spreads, and there is no treatment for it or vaccine to prevent against it ^{(2, 3)}.
With winter comes Influenza, again a preventable disease. Recent examples of major flu pandemics include the 2009 H1N1 outbreak; where recent studies indicate the swine flu may have killed more than 200,000 people ⁽⁴⁾. The new H7N9 is also notable because of its high mortality rate. According to the Center for Disease Control, the geographic spread of influenza in 24 states is widespread, with the 2009 H1N1 virus the predominant strain. The death toll is also an indication of the importance of immunisation, where in California alone they have doubled their death rate to 243, in comparison to the 106 influenza related deaths the state reported in the previous year. The highest hospitalisation rates are also among people 65 and older (50.9 per 100,000), followed by people 50-64 years (38.7 per 100,000) and children younger than 5 years (36.0 per 100,000). Again as in most seasonal influenza events, children 0-4 years and adults 65 years and older have the highest hospitalisation rates. ^(5).
It’s extremely important that healthcare workers, who are the first point of contact are immunised. It is also important that healthcare workers educate their patients/clients and/or residents on the importance of vaccinations, and the hospital avoidance that an immunisation can provide. They also need to educate on good hand hygiene practices, cough etiquette and social distancing if they are unwell. There is no point in being a martyr and returning to work/school to then become the germ transporter and potentially cause an outbreak ⁽⁶⁾.

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References :
1. “Measles Deaths Decline, But Elimination progress stalls in some regions”, January 2014.[Accessed 16/2/2014 www.MeaslesRubellaInitiative.org]
 2. World Health Organization. Middle East respiratory syndrome coronavirus (MERSCoV) - updates 23 September 2012 to 4 February 2014. [Accessed 16/2/2014. https://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-mers-cov.htm]
 3. World Health Organization. WHO statement on the Fourth Meeting of the IHR Emergency Committee concerning MERS-CoV. 2013. Accessed on 4 December 2013. Available from the WHO website: http://www.who.int/mediacentre/news/statements/2013/mers_cov_20131204/en/index.html 4. 2009 H1N1: Overview of a Pandemic. Centers for Disease Control and Prevention [Accessed 16/2/2014 http://www.cdc.gov/h1n1flu/yearinreview/yir3.htm]
 5. Summary of Flu Update: Centers for Disease Control and Prevention, Feb 2-8 2014. [Accessed 16/2/2014 http://www.cdc.gov/flu/weekly/summary.htm]
 6. Influenza Consumer Information. Influenza Specialist Group [Accessed 16/2/2014 http://www.isg.org.au/index.php/publications-/brochures-andposters-/]
FluView
A Weekly Influenza Surveilance Report Prepared by the Influenza Division. Weekly Influenza Activity Estimates Reported by State and Territorial Epidemiologists*
Week Ending February 08, 2014 - Week 6
Marija Jane Juraja
RN, Grad Certificate IC, CICP
ACIPC President
Marija currently holds the position of Coordinator, Infection Prevention & Control at The Queen Elizabeth Hospital, SA. She is a registered nurse, with extensive experience in infection prevention, surveillance and control. She has a Graduate Certificate in Infection Control from Adelaide University and is currently an Adjunct Lecturer at The University of South Australia. She is the current president of the Australasian College for Infection Prevention and Control. She has published and coauthored several articles and guidelines and presented at national and international conferences. Marija is the college representative on the Healthcare Associated Infection’s Implementation Advisory Committee at the Australian Commission on Safety & Quality in Health Care and a council/board member of the National Coalition of National Nursing Organisations.