Factors Influencing the Health of Participants in Religious Mass Gathering Ceremonies in Iraq: A Systematic Review

Introduction: In the last decade, the number of religious mass gathering ceremonies, which take place in Iraq, has increased considerably. Millions of participants visit the country annually from across the world to reach Karbala on foot or by other vehicles for participation in a religious ritual called Arbaeen, which lasts about 20 days. Unlike the Hajj mass gathering, another important annual religious mass gathering event of Muslims, an evidence-based review of scientific literature about influential factors on the health of participants in these ceremonies in Iraq has not been done.Methods: Using PRISMA guidelines and searching PubMed, Scopus, ISI_Web of Science, Cochrane Library, ProQuest, and Google Scholar databases, original English language studies focused on participants' health in religious ceremonies of Iraq until October 2021 were selected. The methodological quality of the studies and the risk of bias were checked using the Joanna Briggs Institute (JBI) checklists. In addition, the data from the Iraqi Ministry of Health and other organizations, including WHO and CDC, about Iraq's health condition and other resources were used to describe the related findings better and make health recommendations for the participants.Results: Thirty-two studies passed our criteria and were included for analysis. There was not any clinical trial. All of them were observational (cross-sectional) or qualitative (interview) research;the majority had low to moderate quality scores. Considering the limitations, the leading health risks of participants in religious ceremonies in Iraq include road accidents, insufficiency of Iraq's health system, cardiovascular disease, respiratory tract (including Covid-19) infections, unhealthy food and drink, gastrointestinal infections (including hepatitis), and zoonotic infections(leishmaniasis).Conclusion: Regarding the grandeur of Iraqi-related mass gatherings, preparation must begin before the events. Pre-participation examination, vaccination of high-risk individuals, and training of pilgrims and authorities on the health hazards are critical.

Public Health Importance of Emporiatrics: A Review.

People travel all around the world to explore, trade, sojourn, etc. Millions of individuals cross national and international borders. Travel medicine services are offered by general practitioners, specialized travel clinics, or immunization centers. Epidemiology, illness prevention, and travel-related self-treatment are all included in the interdisciplinary field of travel medicine. The main objective is to keep travelers alive and in good health, by reducing the effects of illness and accidents through preventative measures and self-care. The danger to a traveler's health and well-being must be understood, and the travel medicine practitioner's job is to help their patient or client recognize and manage those risks. The absence of any disease or symptom does not always indicate good health. Chronic illness sufferers, including those with cancer, diabetes, and hypertension, can maintain a reasonable level of health and mobility. Travel medicine is a rapidly developing, extremely dynamic, multidisciplinary field that calls for knowledge of a range of travel-related illnesses as well as current information on the global epidemiology of infectious and non-infectious health risks, immunization laws and requirements around the world, and the shifting trends in drug-resistant infections. Pre-travel consultation aims to reduce the traveler's risk of disease and harm while on the road through preventive counseling, education, recommended drugs, and essential vaccines. Specialized medical guidance can help reduce the potential health risks of travel. Emporiatrics is not only used for traveling advice or things to be done during the period of the journey but it also creates room in implementing the interdisciplinary subject with new methods or development of new policies, technologies, and various programs to reduce unnecessary problems of the travelers, which will boost tourism.

Lessons from the Lab: SARS-CoV-2 Detection Rate amongst the Vaccinated Travel Lane and Non-Vaccinated Travel Lane Travellers into Malaysia.

Background: The vaccinated travel lane (VTL) between Malaysia and Singapore was implemented to facilitate travelling between countries without the need for quarantine. Objectives: i) Observe the rate of positive SARS-CoV-2 test results amongst inbound international travellers; ii) Explore possible factors associated with the outcome of test results between VTL and non-VTL travellers. Method: This is a retrospective cross-sectional study involving air travellers arriving in Malaysia via the Kuala Lumpur International Airport (KLIA) or Kuala Lumpur International Airport 2 (KLIA2) who were tested for SARS-CoV-2 by reverse transcriptase polymerase chain reaction (RT-PCR) from 29 November 2021 to 15 March 2022. Subject demographics and RT-PCR results were retrieved from the laboratory information system and statistically analysed. Results: Out of 118,902 travellers, mostly were Malaysian nationals (62.7%) and VTL travellers (68.2%) with a median age of 35 years old. A total of 699 (0.6%) of travellers tested positive on arrival, out of which 70.2% had cycle threshold (Ct) values > 30 (70.8% of VTL and 70.0% of non-VTL cohorts). Non-VTL travellers were 4.5 times more likely to test positive compared with VTL travellers (1.25% versus 0.28%; P < 0.001). Conclusion: Tighter entry requirements including vaccination status and testing frequency, the use of sensitive detection methods on arrival and similar public health policies between countries may have contributed to the VTL being a safe and cost-effective mode of travel.

Mediterranean spotted fever with multiorgan involvement.

A previously well man in his 50s returned to the UK after a trip to the Mediterranean. The day after returning he developed malaise, fevers, rigors and severe headache. He was hospitalised with sepsis, multiorgan involvement, a maculopapular rash and an eschar on each hip. Serology was positive for Rickettsia spp (spotted fever group) with a rise in titre from 1:64 to 1:1024 eight days later. Blood and tissue PCR were also positive for Rickettsia spp. He had cardiac, pulmonary, renal, ocular and neurological involvement. He completed a 14-day course of doxycycline and recovered well. This is a case of likely Mediterranean spotted fever (MSF) caused by Rickettsia conorii, which is endemic to the Mediterranean basin. We highlight the need for awareness and early treatment to prevent severe complications. This case is also the first to describe Purtscher-like retinopathy in the context of likely MSF.

Types and outcomes of pharmacist-managed travel health services: A systematic review.

BACKGROUND AND AIM: Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services. METHODS: A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services. RESULTS: Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94-100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%-94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted. CONCLUSION: Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations.

Special Issue: One health. (Special Issue: One health.)

This special issue consists of 17 papers dealing with issues animal health (captive and wild primates), environmental health (rain forests and mountain areas), and human health (the role of religion in One Health, lessons from the Hanuman langur (Semnopithecus entellus) and other human-non-human primate interactions,and Covid-19).

Travel in the Time of COVID: A Review of International Travel Health in a Global Pandemic.

Purpose of Review: This review critically considers the impact of the COVID-19 pandemic on global travel and the practice of travel medicine, highlights key innovations that have facilitated the resumption of travel, and anticipates how travel medicine providers should prepare for the future of international travel. Recent Findings: Since asymptomatic transmission of the virus was first recognized in March 2020, extensive efforts have been made to characterize the pattern and dynamics of SARS-CoV-2 transmission aboard commercial aircraft, cruise ships, rail and bus transport, and in mass gatherings and quarantine facilities. Despite the negative impact of further waves of COVID-19 driven by the more transmissible Omicron variant, rapid increases of international tourist arrivals are occurring and modeling anticipates further growth. Mitigation of spread requires an integrated approach that combines masking, physical distancing, improving ventilation, testing, and quarantine. Vaccines and therapeutics have played a significant role in reopening society and accelerating the resumption of travel and further therapeutic innovation is likely. Summary: COVID-19 is likely to persist as an endemic infection, and surveillance will assume an even more important role. The pandemic has provided an impetus to advance technology for telemedicine, to adopt mobile devices and GPS in contact tracing, and to apply digital applications in research. The future of travel medicine should continue to harness these novel platforms in the clinical, research, and educational arenas.

Travel-Related Monkeypox Outbreaks in the Era of COVID-19 Pandemic: Are We Prepared?

Several neglected infectious pathogens, such as the monkeypox virus (MPXV), have re-emerged in the last few decades, becoming a global health burden. Despite the incipient vaccine against MPXV infection, the global incidence of travel-related outbreaks continues to rise. About 472 confirmed cases have been reported in 27 countries as of 31 May 2022, the largest recorded number of cases outside Africa since the disease was discovered in the early 1970s.

Effect of Omicron on the prevalence of COVID-19 in international travelers at the Mexico city international airport. December 16th, 2021 to January 31st, 2022.

INTRODUCTION: SARS-CoV-2 continues to have a high rate of contagion worldwide. The new variant of concern, Omicron, has mutations that decrease the effectiveness of vaccines and evade antibodies from previous infections resulting in a fourth wave of the pandemic. It was identified in Mexico in December 2021. METHODS: The Traveler's Preventive Care Clinic from the Faculty of Medicine UNAM at Mexico City International Airport has performed rapid antigen and PCR SARS CoV2 tests since January 2021 to comply with the new travel requirements. Demographic and clinical characteristics were collected from each passenger and the fourth wave of the pandemic in Mexico mainly caused by Omicron was analyzed in the travelers. RESULTS: A total of 5176 travelers attended the clinic between the second half of December 2021 and January 2022. Ten percent of all the tests performed were positive (13% of PCR and 9.3% of antigens, p = 0.001). Most of the SARS CoV2 positive cases were asymptomatic (78%), with a ratio of 3.5:1 over the symptomatic. By age groups, this ratio was higher for those under 20 years old (8.7:1). DISCUSSION: This study shows the rapid escalation of positivity that occurred in Mexico, detected in travelers, from the second half of December 2020 and throughout the month of January 2021. The incidence of COVID-19 was extremely high in travelers who were mostly asymptomatic for the period under study.

Current Status of Foreign Patients in a Hospital over the Past 6 Years and the Impact of COVID-19.

Purpose: As it becomes difficult to move between countries due to the spread of COVID-19, it can be expected that the number of foreign patients entering Korea for treatment will decrease significantly. The purpose of this study is to investigate the current status of hospitalization of foreign patients over the past 6 years and the impact of COVID-19. Methods: The sex, age, nationality, and histories of foreign patients who visited the International Medical Center from 2016 to 2021 were collected. A total of 25,569 subjects were analyzed. Results: For six years from 2016 to 2021, the number of foreign patients increased steadily before COVID-19 but decreased significantly after COVID-19. Overall, it was analyzed that the average annual growth rate of foreign patients from 2016 to 2019 was about 6%. However, due to the impact of COVID-19, the number of patients in 2020 decreased by about 57% compared to the previous year and by about 1% in 2021 compared to the previous year. Conclusion: It is believed that the decrease in foreign patients in a situation such as Corona 19 is due not only to the risk of infection, but also to the difficulty of moving between countries. In other words, it can be said that the driving force for the movement due to the medical skill gap still exists. Therefore, if this situation improves, it is judged that the phenomenon of moving abroad in search of medical care is inevitable. [ FROM AUTHOR] Copyright of Korean Journal of Aerospace & Environmental Medicine is the property of Aerospace Medical Association of Korea and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Underestimation of travel-associated risks by adult and paediatric travellers compared to expert assessment: A cross-sectional study at a hospital-based family pre-travel clinic.

BACKGROUND: Travellers' perception of their risk for acquiring travel-related conditions is an important contributor to decisions and behaviors during travel. In this study, we aimed to assess the differences between traveller-perceived and expert-assessed risk of travel-related conditions in children and adults travelling internationally and describe factors that influence travellers' perception of risk. METHODS: Children and adults were recruited at the Hospital for Sick Children's Family Travel Clinic between October 2014 and July 2015. A questionnaire was administered to participants to assess their perceived risk of acquiring 32 travel-related conditions using a 7-point Likert scale. Conditions were categorized as vector-borne diseases, vaccine-preventable diseases, food and water borne diseases, sexually transmitted infections and other conditions. Two certified travel medicine experts reviewed each patient's chart and assigned a risk score based on the same 7-point Likert scale. Traveller and expert risk scores were compared using paired t-tests. RESULTS: In total, 207 participants were enrolled to participate in this study, 97 children (self-reported, n = 8; parent-reported, n = 89), and 110 adults. Travel-related risk for adults and parents answering for their children were significantly underestimated when compared to expert-assessed risk for 26 of the 32 assessed conditions. The underestimated conditions were the same for both adults and parents answering for children. Travel-related risk was not over-estimated for any condition. CONCLUSIONS: Adults underestimated their children's and their own risk for most travel-related conditions. Strategies to improve the accuracy of risk perception of travel-related conditions by travellers are needed to optimize healthy travel for children and their families.

Patients with Chronic Diseases Who Travel: Need for Global Access to Timely Health Care Data.

Despite the Covid-19 pandemic, international travel is expected to increase in the future. Before the pandemic, the United Nations World Tourism Organization estimated that by 2030 nearly 2 billion people would travel internationally each year. This raises the risk of unavailable medical record information if a complication or an emergency occurs in another country (particularly problematic for the growing numbers of older travelers with multimorbidity). We propose that an international medical record containing current health information be developed to allay this additional risk of traveling.

Aviator Occupational Behavior Surrounding COVID-19 Infection and Vaccination in the United States: A Cross-Sectional Population-Based Survey.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has precipitated change across the aviation industry, including aeromedical standards. U.S. pilot occupational behavior regarding COVID-19 infections and vaccinations have not been well-studied. Methods We conducted an anonymous survey of 661 U.S. pilots from September 1, 2021, through December 15, 2021. Results We found 23.8% of pilots reported a history of COVID-19 infection but only 20.5% of infected pilots reported this history to an aeromedical examiner (AME)/flight surgeon. Of uninfected pilots, 50.5% reported being either extremely unlikely or somewhat unlikely to disclose a new infection to an AME/flight surgeon. Seventy-nine point six percent (79.6%) of pilots received at least one dose of any COVID-19 vaccine and 89.6% of those who received a vaccine complied with the 48-hour no-flying policy. Of the unvaccinated pilots, 74.5% reported being either extremely unlikely or somewhat unlikely to receive a vaccine.

COVID-19, a litmus test on travel medicine, global surveillance and international health regulations? A critical review

A failure in the timely surveillance of domestic and international travelers transformed the 27 cases of pneumonia in China to an epidemic and then to the fifth pandemic of the 21st century. It is ever evident that travel and outbreak are strongly correlated. An imported outbreak compromises global health security, devitalizes economy and strains political relationships among nations. 'World Health Organization' advocated 'International Health Regulations'(IHR), to improve international surveillance and public health reporting mechanisms for events that are global health risks. Travel medicine does exist as a specialty in most nations. Despite all these instruments, there was a gap evident from the failure in the surveillance of travelers at times of CoVID-19, even by the better prepared and ever-alert developed nations, led to the pandemic. An overview on the travel and infectious disease outbreaks, existing policies and protocols and nations' ability in pandemic preparedness and the WHO's response to COVID-19 outbreak is drawn.

Mathematical Modeling for Removing Border Entry and Quarantine Requirements for COVID-19, Vanuatu.

The Pacific Island country of Vanuatu is considering strategies to remove border restrictions implemented during 2020 to prevent imported coronavirus disease. We performed mathematical modeling to estimate the number of infectious travelers who had different entry scenarios and testing strategies. Travel bubbles and testing on entry have the greatest importation risk reduction.

Medical students from German-speaking countries on abroad electives in Africa: destinations, motivations, trends and ethical dilemmas.

BACKGROUND: International medical electives are one the highlights of medical training. Literature about international electives is scarce, and understanding what made a student choose one destination over another is unclear. Many medical students based in Europe travel to Africa each year for their elective, however, students' expectations and motivations are yet largely unexplored. METHODS: To gain insights into the factors driving students to travel to Africa, we analyzed two large international elective databases based in Germany. We reviewed elective testimonies and extrapolated geographical data as well as the choice of discipline for electives completed in Africa. Based on pre-defined categories, we also investigated students' motivations and expectations. RESULTS: We identified approximately 300 elective reports from medical students from German-speaking countries who chose to travel to Africa for their elective. Students commonly reported destinations in Southern and East Africa, with the Republic of South Africa and Tanzania being the most frequently selected destinations. Surgical disciplines were the most commonly reported choice. Diverse motivations were identified, including the desire to improve knowledge and clinical examination skills. A large proportion of students reported a link between destination choice and the potential to partake in surgical procedures not feasible at home; whether these surgeries were not or no longer practiced at home, or whether students could not partake due to level of training, was not ascertainable from the data. A trend-analysis revealed a growing interest in travelling to Africa for electives within the last 15 years. We observed a sharp decline in reports in 2020, a phenomenon most likely related to SARS-CoV-2-related travel restrictions. CONCLUSIONS: This study suggests that medical electives in Africa are commonly reported by medical students from German-speaking countries, with diverse motivations for the choice of destination. A non-neglectable proportion of students identified the possibility to engage in surgical procedures as one of the main reasons for choosing Africa. This poses a series of ethical dilemmas, and well-structured pre-departure trainings may be a solution to this. The recent dip in overseas electives should be seen as a unique opportunity for medical schools and universities to restructure their international elective programs.

Multiple introductions of SARS-CoV-2 B.1.1.214 lineages from mainland Japan preceded the third wave of the COVID-19 epidemic in Hokkaido.

BACKGROUND: The third wave of the COVID-19 epidemic in the island of Hokkaido, the second largest island in Japan, began abruptly in October 2020. METHODS: We conducted a phylodynamic analysis of the SARS-CoV-2 genome sequences obtained from tertiary medical centers in the Greater Tokyo Area and Sapporo, the largest city in the island of Hokkaido, and genome sequences published by GISAID, an international SARS-CoV-2 genome database. We also analyzed the statistics on the person-nights of travelers in the island of Hokkaido from the Greater Tokyo Area in 2019 versus 2020. RESULTS: At least eight sub-lineages belonging to the B.1.1.214 lineage were introduced to the island of Hokkaido from the island of Honshu, the mainland of Japan from late July to November 2020, during the governmental travel promotion program. Five of the eight sub-lineages originated from the Greater Tokyo Area. Comparison of the monthly ratios of the person-nights of travelers in the island of Hokkaido from the Greater Tokyo Area in 2019 and 2020 revealed that the highest value occurred in October 2020. CONCLUSION: We contend that the Japanese governmental travel promotion program contributed to the introduction of the B.1.1.214 sub-lineages from the main island of Honshu to the island of Hokkaido, and drove the third wave in Hokkaido, even if we are unable to establish the causality.

No time to die: An in-depth analysis of James Bond's exposure to infectious agents.

Global travelers, whether tourists or secret agents, are exposed to a smörgåsbord of infectious agents. We hypothesized that agents pre-occupied with espionage and counterterrorism may, at their peril, fail to correctly prioritize travel medicine. To examine our hypothesis, we examined adherence to international travel advice during the 86 international journeys that James Bond was observed to undertake in feature films spanning 1962-2021. Scrutinizing these missions involved ∼3113 min of evening hours per author that could easily have been spent on more pressing societal issues. We uncovered above-average sexual activity, often without sufficient time for an exchange of sexual history, with a remarkably high mortality among Bond's sexual partners (27.1; 95% confidence interval 16.4-40.3). Given how inopportune a bout of diarrhea would be in the midst of world-saving action, it is striking that Bond is seen washing his hands on only two occasions, despite numerous exposures to foodborne pathogens. We hypothesize that his foolhardy courage, sometimes purposefully eliciting life-threatening situations, might even be a consequence of Toxoplasmosis. Bond's approach to vector-borne diseases and neglected tropical diseases is erratic, sometimes following travel advice to the letter, but more often dwelling on the side of complete ignorance. Given the limited time Bond receives to prepare for missions, we urgently ask his employer MI6 to take its responsibility seriously. We only live once.