Travel Bug Infectious

The Travel Bug Can Be Infectious

Pathogens and People: The travel bug can be infectious

By EDWARD McSWEEGAN, For The Capital

Published 05/03/09

Summer is approaching and that means it's time to start planning vacations to the far side of the Chesapeake Bay,

and the far side of the world. Travel is a seasonal migration worth $1.6 trillionto the U.S. travel and tourism industry.

Worldwide, some 2 million people cross internationalborders every day. At peak times, there are 5,000 planes

crisscrossing U.S. skies. In 2007, 458million people were traveling on vacations.

Long-distance travel is a relatively new phenomenon. A few years ago, London epidemiologist

David Bradley used four generations of his family to illustrate the expansion of personal travel.

His great-grandfather was confined to a 40-kilometer corner of southeast England. His

grandfather stretched those boundaries to about 400 km. His father reached the continent

(courtesy of the British Army) and wandered over 4,000 km. David, the son, has since extended

his own range across six continents and 40,000 km. Great-grandpa would be shocked.

Technology has made David's kind of long-distance travel easy. Not surprisingly, the ease and

scope of modern travel has created new economic and social consequences. There are also

infectious disease consequences because when we pack for a trip we also pack along our

microbes. When we arrive, we unpack those germs and pick up new ones as if they were tiny

souvenirs. Travel - especially international travel - often encourages a laissez faire exchange of

microbes. Usually the exchange is harmless. Sometimes it causes illness (e.g., traveler's

diarrhea). Sometimes it sparks an epidemic.

During the age of sail, sick passengers usually got better - or died - before their ships ever

reached port. The vagaries of wind and tide helped to slow the spread of many infectious

diseases. (Four of my ancestors died of "ship fever" (typhus) sailing from Ireland in 1847.)

The steam engine changed patterns of disease transmission by quickly moving passengers

between ports while some of them were still contagious. A 19th-century sailing trip from India to

Fiji took 70 days, but insured any passengers with measles either died or recovered before the

ship made landfall. Steamships made the same journey in half the time and carried more

passengers. Enough sick passengers survived the trips to ignite devastating measles epidemics in

Fiji.

Steamships also carried plague-infected rats and fleas around the world in the late 19th century.

Bubonic plague from China reached Hawaii in 1899 and San Francisco in 1900. (Plague is still

in the U.S. today, having found a comfortable home among the squirrels and prairie dogs of the West.)

Modern jets have made the problem of travel and infections much worse. Many long-range

planes can now reach almost any part of the globe in 24 hours. That means visitors to West

Africa can be exposed to deadly viruses such as Lassa and Marburg, and fly home to the U.S. or

Europe before they show symptoms of infection. Eco-tourists can bring home water-borne

illnesses such as leptospirosis or amoebic dysentery, rabies or H5N1 influenza from wildlife,

encephalitis viruses from ticks and mosquitoes, and rare but deadly hemorrhagic viruses from

bats and rodents.

In 2003, jets spread the SARS virus from China to 29 other countries, causing 800 deaths and

economic losses of $40-54 billion. In 2007, a U.S. lawyer infected with multidrug-resistant

tuberculosis (MDR-TB) created an international panic as he hopped planes, crossed borders and

breezed past customs officials.

Back on the high seas, modern cruise ships can bring a few thousand passengers together for

extended trips. On board, they may be exposed to Legionella in the water systems, influenza in

the air, and that bane of all cruises, the highly contagious norovirus, which contaminates food

and persists on surfaces. Last year, half a dozen cruise lines experienced outbreaks of norovirus.

Bugs like to travel. Should you plan a "staycation" and hide out at home? Well, don't forget the

infected ticks and mosquitoes lurking in the backyard. And just because you're not traveling

doesn't mean other people won't be. The world is crowded with immigrants, migrants, refugees

and foreign tourists.

But a little planning and guidance can make for a safer and healthier trip. The Centers for

Disease Control and Prevention, for example, has a Web site for traveler's health issues

(www.cdc.gov/Travel). ProMED mail (www.promedmail.org) has daily listings of potential

disease outbreaks collected from all over the world. HealthMap (www.healthmap.org) collects

outbreak reports and displays them on a map. The map can be searched by disease, country and

news source. Travel medicine clinics such as Baltimore-based Passport Health

(www.passporthealthusa.com) also provide information about overseas disease threats, suggest

appropriate medicines and vaccinations, and even sell traveler's insurance against overseas

accidents and medical evacuations.

Bon voyage.

Dr. Edward McSweegan has a Ph.D. in microbiology and lives in Crofton. He works on and

writes about infectious disease issues. He may be contacted atmcsweegan@nasw.org.

http://www.scribd.com/doc/14898738/The-Travel-Bug