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Accessible travel for all passengers is considered a fundamental right in Europe, addressing both physical and digital accessibility needs. Public transportation must cater to a diverse range of passengers with varying physical conditions, cognitive abilities, and cultural backgrounds. The European Sustainable and Smart Mobility Strategy (2020) underscores the necessity of making mobility accessible and affordable for all, including better connectivity for rural and remote regions. This study examines the importance of considering universal design (UD) in public transport, emphasizing the need for inclusive solutions that benefit as many passengers as possible without requiring specialized adaptations. Research material on the effect of UD measures in accessible travel chains was collected during the planning and implementation phases of the travel chain. The usability and content of travel information sources related to accessibility were examined in these phases. The key findings highlight significant travel chain accessibility challenges in both digital and physical aspects. The planning phase findings show that the digital information about infrastructure accessibility was fragmented, creating difficulties for passengers with low digital literacy to identify, book, purchase, and obtain tickets for accessible transport. The implementation phase revealed inadequately designed physical environments, a lack of multi-sensory guidance, and gaps in the provided digital information. Various accessibility challenges in the physical environment and insufficient digital accessibility information prevent a seamless travel experience for persons with disabilities. While the built environment was initially designed using UD principles, maintenance and functionality have deteriorated over time. Providing accurate digital information about the functionality of infrastructure in advance could enable passengers to make more suitable route choices.

Aim: To explore activities performed by community nurses in community health centre clinics and during home visits., Design: Cross-sectional, observational using time and motion technique. Data collected during lockdown in 2020., Methods: Community nurses' work in clinics and during home visits were observed and recorded. The purposefully designed data collection tool covered six categories (Administration, Communication, Direct care, Documentation, Indirect care and Other) and 35 activities relative to community nurses' work., Results: Eight hundred and ten complete timings were obtained. Community nurses' time was most often (86.5%) spent on Direct care, Communication, Documentation and Other activities. Patient education occurred more often in the home., Conclusions: The type, frequency and time taken to complete community nursing activities provides insight into the community nurse role. Addressing inefficient practices such as documentation and travel could serve to improve workload., Reporting Method: Adheres to EQUATOR guideline STROBE for cross-sectional studies., Patient or Public Contribution: No patient or public contribution., (© 2024 John Wiley & Sons Ltd.)

While globally hepatitis A (hepA) infections occur in 150 million people annually, European high-income countries now have a low endemicity. However, this results in a more susceptible adult population which is prone to severe illness. To determine current epidemiological characteristics, we performed a systematic literature review to assess the severity of hepA disease in the past two decades in 11 European countries (i.e., Denmark, France, Germany, Greece, Hungary, Italy, the Netherlands, Spain, Sweden, Switzerland and the United Kingdom). Literature search was performed using PubMed and Embase between 1 January 2001 and 14 April 2021. Search terms included the disease (hepA), the 11 selected countries, the term 'outbreaks' and its synonyms, outcomes and terms for hepA virus circulation. In total, 43 records reported data on hepA disease outcomes. Hospitalisation rates varied between the countries, with annual rates exceeding 50% at least once in seven countries. The lowest hospitalisation rates were reported for the Netherlands (≤ 32%) and the highest for Greece (≥ 81%). Liver failure, haemorrhagic and other complications were rarely reported, and case fatality rates were low (0.03%-0.26%). Our findings are consistent with the trends observed globally. This systematic literature review highlights the need to increase awareness of hepA risks and to strengthen prevention strategies. Continuous monitoring of epidemiological data is crucial to assess which populations would most benefit from prevention, mainly with respect to future vaccination recommendations., (© 2024 GSK PLC. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.)

Tourism plays a key role for gay people, as it is not only a way to escape from work, but also a source of liberation and self-embracement. This role can be particularly valued in societies and political environments that are perceived as hostile toward this group. The present study examines the travel motivations and habits of gay and lesbian people, based on a questionnaire sample of 1473 respondents. The results show that for this group, but especially for women, acceptance and an open culture are of paramount importance when choosing a destination. In contrast, services and events specifically targeted at this sector, which are popular in the Western world, do not typically influence decision-making (they tend to be more attractive to women). Sex per se is not a travel motivator for this group, but is an important feature of travel for men. In addition to gender, the services and activities that an individual engages in while traveling are influenced by the degree of their sexual embracement, the place of residence and the company with which the individual travels.

The global dynamics of seasonal influenza viruses inform the design of surveillance, intervention, and vaccination strategies. The COVID-19 pandemic provided a singular opportunity to evaluate how influenza circulation worldwide was perturbed by human behavioral changes. We combine molecular, epidemiological, and international travel data and find that the pandemic's onset led to a shift in the intensity and structure of international influenza lineage movement. During the pandemic, South Asia played an important role as a phylogenetic trunk location of influenza A viruses, whereas West Asia maintained the circulation of influenza B/Victoria. We explore drivers of influenza lineage dynamics across the pandemic period and reasons for the possible extinction of the B/Yamagata lineage. After a period of 3 years, the intensity of among-region influenza lineage movements returned to pre-pandemic levels, with the exception of B/Yamagata, after the recovery of global air traffic, highlighting the robustness of global lineage dispersal patterns to substantial perturbation.

Background and Objectives: Donor selection questions differentially impacting ethnic minorities can discourage donation directly or via negative word-of-mouth. We explore the differential impact of two blood safety questions relating to (i) sexual contacts linked to areas where human immunodeficiency virus (HIV) rates are high and (ii) travelling to areas where malaria is endemic. Epidemiological data are used to assess infection risk and the need for these questions., Materials and Methods: We report two studies. Study 1 is a behavioural study on negative word-of-mouth and avoiding donation among ethnic minorities (n = 981 people from National Health Service Blood and Transplant (NHSBT) and the general population: 761 were current donors). Study 2 is an epidemiology study (utilizing NHSBT/UK Health Security Agency (UKHSA) surveillance data on HIV-positive donations across the UK blood services between1996 and 2019) to assess whether the sexual risk question contributes to reducing HIV risk and whether travel deferral was more prevalent among ethnic minorities (2015-2019). Studies 1 and 2 provide complementary evidence on the behavioural impact to support policy implications., Results: A high proportion of people from ethnic minorities were discouraged from donating and expressed negative word-of-mouth. This was mediated by perceived racial discrimination within the UK National Health Service. The number of donors with HIV who the sexual contact question could have deferred was low, with between 8% and 9.3% of people from ethnic minorities deferred on travel compared with 1.7% of White people., Conclusion: Blood services need to consider ways to minimize negative word-of-mouth, remove questions that are no longer justified on evidence and provide justification for those that remain., (© 2024 The Author(s). Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)

The aim of this study is to reveal the spatial-temporal characteristics and influencing factors of the static and dynamic distribution of global cruise ships, against the backdrop of the COVID-19 pandemic, which has transformed the global cruise network from "lines" to "points". This study collected trajectory data for 292 cruise ships and data for 789 cruise ports worldwide from March 2020 to July 2021. Based on the relationship between port and navigation, port management rights research, and port geography theory, we analyzed the spatial distribution and spatiotemporal migration of cruise ships with ArcGIS tools. It was found that, compared with normal times, the distribution of cruise ships in regional markets, countries, and ports showed stronger spatial agglomeration characteristics and formed four types, which were mainly influenced by differences in cruise operators' fleet scale, positioning, and itinerary. With the improvement of the epidemic, cruise ships trended to gather at the cruise home port. During the COVID-19 pandemic, there was an obvious separation between the epidemic prevention country, flag country, and operator country. Operators were inclined to berth their cruise ships in the countries where cruise ships were registered, countries of operators, and ports with high integration. Rather than simply emphasizing the static state of the cruise shipping network, the global cruise geography under the COVID-19 pandemic reflects the right relationship between ports, cruise ships, and companies. This study provides a methodological framework for analyzing the cruise shipping network at the port level and has practical implications for micro-interpretation of the dotted cruise shipping network during the COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xumao Li. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The Zika virus epidemic of 2015-16, which caused over 1 million confirmed or suspected human cases in the Caribbean and Latin America, was driven by a combination of movement of infected humans and availability of suitable habitat for mosquito species that are key disease vectors. Both human mobility and mosquito vector abundances vary seasonally, and the goal of our research was to analyze the interacting effects of disease vector densities and human movement across metapopulations on disease transmission intensity and the probability of super-spreader events. Our research uses the novel approach of combining geographical modeling of mosquito presence with network modeling of human mobility to offer a comprehensive simulation environment for Zika virus epidemics that considers a substantial number of spatial and temporal factors compared to the literature. Specifically, we tested the hypotheses that 1) regions with the highest probability of mosquito presence will have more super-spreader events during dry months, when mosquitoes are predicted to be more abundant, 2) regions reliant on tourism industries will have more super-spreader events during wet months, when they are more likely to contribute to network-level pathogen spread due to increased travel. We used the case study of Colombia, a country with a population of about 50 million people, with an annual calendar that can be partitioned into overlapping cycles of wet and dry seasons and peak tourism and off tourism seasons that drive distinct cyclical patterns of mosquito abundance and human movement. Our results show that whether the first infected human was introduced to the network during the wet versus dry season and during the tourism versus off tourism season profoundly affects the severity and trajectory of the epidemic. For example, Zika virus was first detected in Colombia in October of 2015. Had it originated in January, a dry season month with high rates of tourism, it likely could have infected up to 60% more individuals and up to 40% more super-spreader events may have occurred. In addition, popular tourism destinations such as Barranquilla and Cartagena have the highest risk of super-spreader events during the winter, whereas densely populated areas such as Medellín and Bogotá are at higher risk of sustained transmission during dry months in the summer. Our research demonstrates that public health planning and response to vector-borne disease outbreaks requires a thorough understanding of how vector and host patterns vary due to seasonality in environmental conditions and human mobility dynamics. This research also has strong implications for tourism policy and the potential response strategies in case of an emergent epidemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lieberthal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We report a suspected case of acute pulmonary coccidioidomycosis contracted in Peru, where the disease is not known to occur, in a patient from Switzerland. Although not confirmed by direct diagnostic testing, the clinical manifestations and serologic testing results of this case are highly suggestive of coccidioidomycosis.

We describe the case of a returned traveler to the United States from Ecuador who had an acute febrile illness, initially diagnosed as Oropouche fever. This illness was later confirmed to be a rare infection with Iquitos virus, a related bunyavirus that shares 2 of 3 genome segments with Oropouche virus.

Millions of pilgrims travel annually to Makkah and Madinah, Saudi Arabia, for the Hajj, posing unique challenges for public health management and disease control. The large influx of pilgrims from diverse backgrounds traveling to a confined geographic area, coupled with the close proximity and interactions among them, create significant pressure on the healthcare system and heighten the potential for the spread of communicable diseases. This review examines current trends in communicable diseases and their impact, drawing insights from expert perspectives on the required (i.e., meningococcal meningitis, polio, and yellow fever) and recommended vaccinations (influenza, COVID-19) for Hajj participants. The updated COVID-19 vaccine is mandatory for local pilgrims and is strongly recommended for international visitors, with ongoing discussions on adapting protocols to address emerging variants. The timing and strain coverage of influenza vaccination, along with quadrivalent meningococcal vaccination, are also emphasized as critical preventive measures. Diseases such as cholera and yellow fever are addressed underscoring the need for rigorous surveillance and targeted vaccination strategies to mitigate the risk of transmission during the Hajj. By providing up-to-date information on mandated and recommended vaccinations, this review aims to empower pilgrims and healthcare professionals to make informed decisions regarding public health and disease prevention during this significant event., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In visual foraging, foragers collect multiple items from a series of visual displays (or "patches"). When the goal is to maximize the total or the rate of collection of target items, foragers must decide when to leave a depleted patch given that "traveling" from one patch to another incurs a temporal cost. In three experiments, we investigated whether the interposition of a secondary task during travel between patches in visual foraging altered patch-leaving behavior. Over the course of 10- or 30-minute experiments, participants foraged in simulated "berry patches" and traveled to the next patch at will. While they traveled, they either actively performed a secondary task or simply observed passing visual stimuli. Travel time was varied across conditions. The addition of a secondary task, regardless of its relevance to visual foraging, to traveling, or to both, did not impact patch-leaving times in the primary visual foraging task. In Experiment 1 and more weakly in Experiment 2, the patch-leaving decision was based on how long the travel took as predicted by the Marginal Value Theorem (MVT). In Experiment 3, however, patch-leaving did not depend on travel time. Participants 'overharvested' in a manner that suggests that they may have adopted rules different from those of MVT. Across all three experiments, patch-leaving did not depend on the nature of the travel., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Malaria keeps on being a serious global health threat, especially in many tropical countries, where it is endemic. Also in non-endemic countries, like Spain, malaria is an issue that requires attention due to the presence of imported cases., Methods: This is a retrospective study, including all patients diagnosed with malaria at Severo Ochoa University Hospital from 2006 to 2022, being classified according to: (I) their type of stay in an endemic area as visiting friends and relatives (VFR), migrants of recent arrival (MRA), or tourism and business (T&B), and (II) the mode of presentation as microscopic (MM) or submicroscopic (SMM) malaria., Results: In this study, 132 patients (23.7% of all suspected) were diagnosed with malaria. The PCR was the most sensitive technique (99.2%), followed by antigen detection (78.8%) and microscopy (75%), with Plasmodium falciparum being the predominant species (94.7%). VFR was the largest group infected with malaria (69.7%), mostly symptomatic (98.2%) and presenting MM (90.2%). Instead, MRA patients (25%) presented milder (47.4%) or no symptoms (31.6%) and higher cases of SMM (42.4%). Coinfection with another imported pathogen was present in 19 patients (14.4%), being MRA more frequently coinfected (30.3%) CONCLUSION: This study shows the need for establishing systems for VFRs to attend pre-travel consultations to reduce malaria imported risk. In the case of MRA, screening for imported diseases should be conducted upon their arrival. Finally, we highlight two cases of co-infection with imported viruses, showing that presence of symptoms resembling malaria from another imported pathogen does not exclude malaria., (© 2024. The Author(s).)

Purpose: Research has demonstrated negative environmental impacts from in-person conferences. Nonetheless, there are benefits to in-person meetings. The 2023 American Pediatric Surgical Association (APSA) meeting was mostly attended in-person. To understand the environmental impact, this study quantifies the travel emissions generated from that meeting., Methods: The 2023 APSA meeting was held in Orlando, FL. Using a de-identified list of attendees, the distance between the attendee's home city and Orlando was determined. If ≤ 200 miles, it was assumed the attendee drove. If > 200 miles, the distance between the closest airport and Orlando International Airport was determined. Travel emissions factors represent emissions per person-mile traveled. The Environmental Protection Agency (EPA) Greenhouse Gas Inventory emissions factors for carbon dioxide (CO 2 ), methane (CH 4 ), and nitrous oxide (N 2 O) were multiplied by travel distances to determine the emissions generated from each attendee. These were aggregated to determine the total meeting travel emissions. The EPA Greenhouse Gas Equivalencies Calculator was used to convert the emissions to a relatable outcome., Results: There were 757 in-person and 135 virtual attendees. Fifty attendees drove and 707 attendees flew. This generated 267,279 kg CO 2 , 1222 gm CH 4 , and 8486 gm N 2 O; equivalent to the emissions generated from the average annual use of 60 gasoline-powered passenger vehicles in the United States., Conclusion: Based on attendance to the 2023 APSA meeting, there is a preference for meeting in-person, though the associated environmental cost should be recognized. Based on these results, APSA should consider strategies to mitigate the environmental impact of its annual meeting., Levels of Evidence: N/A., Competing Interests: Conflicts of interest The authors have no conflicts of interest relevant to this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Proximity to mental health services is a predictor of timely access to services. The present study sought to investigate whether travel time was associated with engagement in coordinated specialty care (CSC) for early psychosis, with specific attention to whether the interaction of travel time by race and ethnicity had differential impact., Data Source/study Setting: Data collected between 2019 and 2022 as part of the New Journeys evaluation, the CSC model in Washington State., Study Design: This cross-sectional study included a sample of 225 service users with first episode psychosis (FEP) who had received services from New Journeys., Data Collection: Service users' addresses, and the physical location of CSC were geocoded. Spatial proximity was calculated as travel time in minutes. Scheduled appointments, attendance and program status were captured monthly by clinicians as part of the New Journeys measurement battery., Principal Findings: Proximity was significantly associated with the number of appointments scheduled and attended, and program status (graduation/completion and disengagement). Among Hispanic service users with spatial proximity further away from CSC (longer commutes) was associated with a lower likelihood of graduating/completing CSC compared to non-Hispanic service users (p = .04). Non-white services users had a higher risk of disengagement from CSC compared to white service users (p = .03); additionally, the effects of spatial proximity on disengagement were amplified for non-White service users (p = .03)., Conclusions: Findings suggest that proximity is associated with program engagement and partially explains potential differences in program status among ethnoracial group., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Objectives: Pregnant women living in rural areas considering their preferred place of birth may have to 'trade-off' travel time/distance and other attributes of care (e.g. the full choice of birthplace options is rarely available locally). This study assesses the preferences and trade-offs of recent mothers who live in remote and rural areas of Great Britain., Methods: An online survey, informed by qualitative research, was administered to women living in rural areas who had given birth in the preceding 3 years. The survey included a discrete choice experiment (DCE) to elicit women's preferences and trade-offs for place of birth. The DCE presented women with a series of eight choice tasks in which place of birth was defined by four attributes: (1) type of facility, (2) familiarity with staff, (3) understanding options and feel relaxed and reassured and (4) the travel time to the place of intrapartum care. DCE data were analysed using an error components logit model to identify preferences., Results: Across 251 survey responses, holding everything else equal, respondents preferred: intrapartum care in locations with more specialist staff and equipment, locations where they understood their options and felt reassured and where travel time was minimal. Women were willing to travel (92-183 min) to a well-staffed and equipped facility if they understood their options and felt relaxed and reassured. Willingness to travel was reduced if the care received at the specialist facility was such that they did not understand their options and felt tense and powerless (41-132 min)., Conclusion: These insights into the preferences of recent mums from remote and rural areas could inform future planning of rural intrapartum care., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Australia rapidly developed COVID-19 quarantine programs to reduce the adverse outcomes of a novel pathogen imported by visitors and returned travellers. Different quarantine pathways were utilised over the pandemic, yet no definitive cohort map exists to guide future preparedness. We created a whole-of-system cohort journey map of Australian quarantine cohorts to inform future pandemic preparedness activities., Methods: Australian parliamentary websites and Google were searched for publicly available grey literature from 2019 to 2023. Data about quarantine cohorts, pandemic plans and documents, journey activities, viral escape events, and quarantine recommendations were extracted and plotted to produce a whole-of-system cohort journey map., Results: The system mapping process identified 22 distinct quarantine cohort journeys during COVID-19, yet few of the cohorts were mentioned in pandemic and emergency plans. Viral escape events were documented 27 times, and COVID-19 reviews and inquiries produced 282 quarantine-specific recommendations. Cohorts included international and domestic travellers who experienced home, hotel, and facility quarantine iterations. Other cohorts, such as humanitarian evacuations, diplomats, airline crews, community close contacts, and people experiencing homelessness, had distinctive quarantine journeys., Conclusions: This whole-of-system quarantine cohort map furthers the case for governments and policymakers to update pandemic plans to include the 22 identified cohorts and test plans through pandemic exercises. Recommendations from inquiries should be acquitted to reduce the risk of viral escape and to strengthen national preparedness if quarantine systems are required in future pandemic responses., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: This study examined the relationship of precamp match exposure, travel demands, perceptual wellness, and musculoskeletal screening with ensuing training load (TL) during national-team (NT) duties for international footballers (soccer)., Methods: Match minutes and days since last match prior to NT arrival were collected for match exposure. Travel duration and time-zone difference were included as travel demands. Perceptual fatigue, soreness, sleep quality, and stress scores were collected via self-report questionnaire on arrival to NT. Musculoskeletal testing on day 1 of NT included knee to wall and hip internal and external rotation. Relative TL across the first 3 days of NT camp was measured via total distance, high-speed running distance, very high-speed running distance, and accelerations and decelerations per minute. Linear mixed models determined the influence of independent variables on respective TL metrics, with the player included as a random effect., Results: Total distance, high-speed running, very high-speed running, and decelerations per minute were all highest on day 3 (P < .001). Small relationships existed (R2 < .15) between decreased total distance per minute and increased soreness (P = .037), while decreased high-speed running per minute was associated with increased fatigue (P = .017). Small associations existed between decreased accelerations per minute, increased hip internal rotation (P < .001), fatigue (P = .033), and knee to wall (P = .016), while decreased decelerations per minute were associated with increased soreness (P = .001), knee to wall (P = .024), and days between recent match and arrival (P = .003)., Conclusions: Very small relationships existed between fatigue, soreness, musculoskeletal screening, and prior match exposure with TL. The larger influence of camp day suggests that deliberate periodization of training is a major factor for prescription on arrival into NT duties.

A case of locally acquired (autochthonous) mosquito-transmitted Plasmodium vivax malaria was diagnosed in Arkansas in September 2023. This represents the 10th autochthonous case identified nationally in 2023, after 20 years without recorded local mosquitoborne malaria transmission in the United States. The public health response included case investigation, active case surveillance, mosquito surveillance and control, assessment of medical countermeasures, and clinical and public outreach. Prompt diagnosis and appropriate treatment of malaria can improve clinical outcomes and, in addition to vector control, minimize risk for local transmission. Clinicians should consider malaria among patients who have traveled to countries where malaria is endemic, or with unexplained fever regardless of travel history. Although the risk for autochthonous malaria in the United States remains very low, its reemergence highlights the importance of vectorborne disease preparedness and response. Examples of such efforts include improving awareness among clinicians, access to diagnostics and antimalarial medications, and capacity for mosquito surveillance and control. Collaboration and communication among CDC, health departments, local jurisdictions, clinicians, hospitals, laboratories, and the public can support rapid malaria diagnosis, prevention, and control. Before traveling internationally to areas where malaria is endemic, travelers should consult with their health care provider regarding recommended malaria prevention measures, including chemoprophylaxis and precautions to avoid mosquito bites, to reduce both personal and community risk., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Alison D. Ridpath reports ownership of stocks in the following companies: Johnson & Johnson, BioNtech SE, Protagonist Therapeutics, Imminic, Inc., Infinity Pharmaceuticals, Inc., Pfizer, Inc., Merck and Co., Inc., Amgen. Inc., and IQVIA Holdings, Inc. Bobby L. Boyanton Jr. reports receipt of consulting fees from Guidepoint Global, MedAvers, and QuidelOrtho, payment or honoraria from QuidelOrtho, and application for a patent from Siemens Atellica Instruments. No other potential conflicts of interest were disclosed.

Skin problems are common in returning travellers, despite the fact that vaccination, insect repellent techniques, adequate clothing and footwear are all ways to prevent skin disease. When travelling to unusual areas, the traveller can still expect to pick up diseases that are common across the world, such as lice, scabies, and staphylococcal or streptococcal infections. What can differ are the different arthropods and the diseases they can spread. Given the plethora of dermatoses in returning travellers, a methodological approach is necessary. We attempted such an approach by creating a practical guide that includes a diagnostic flowchart alongside a world map presenting common skin problems by continent. Additional information regarding possible investigations, along with tables presenting common infectious skin diseases and their corresponding presentations, is also included in our study. Our aim is to help clinicians approach skin dermatosis in patients returning from holidays, acknowledging the diagnostic difficulties that this might entail., Competing Interests: Conflicts of interest ARS was Editor in Chief of Clinical and Experimental Dermatology at the time of writing this article., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Since the first reported traveler case of Dengue in Tehran in 2008, the virus has gradually spread across Iran, driven by factors including international travel, climate change, and Aedes mosquito vectors. The disease has manifested in various forms, ranging from mild fever to severe dengue, with notable cases identified in Sistan and Baluchistan Province. Despite the increasing prevalence, Iran faces significant challenges in surveillance, diagnosis, and vector control. This perspective comprehensively analyzes dengue virus epidemiology in Iran, emphasizing the need for enhanced public health strategies, including genomic surveillance, targeted interventions, and health education. The findings highlight the critical importance of addressing these challenges to mitigate the potential for large-scale dengue epidemics and protect public health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Heydarifard, Heydarifard, Mousavi and Zandi.)

Background: The purpose of this exploratory study was to evaluate different accelerated tick-borne encephalitis (TBE) vaccine schedules for last-minute travellers., Methods: In a single-centre, open-label pilot study, 77 TBE-naïve Belgian soldiers were randomized to one of the following five schedules with FSME-Immun®: group 1 ('classical accelerated' schedule) received one intramuscular (IM) dose at Day 0 and Day 14, group 2 two IM doses at Day 0, group 3 two intradermal (ID) doses at Day 0, group 4 two ID doses at Day 0 and Day 7 and group 5 two ID doses at Day 0 and Day 14. The last dose(s) of the primary vaccination scheme were given after 1 year: IM (1 dose) or ID (2 doses). TBE virus neutralizing antibodies were measured in a plaque reduction neutralization test (PRNT90 and 50) at Days 0, 14, 21, 28, Months 3, 6, 12 and 12+21 days. Seropositivity was defined as neutralizing antibody titres ≥10., Results: The median age was 19-19.5 years in each group.Median time to seropositivity up to Day 28 was shortest for PRNT90 in ID-group 4 and for PRNT50 in all ID groups. Seroconversion until Day 28 peaked highest for PRNT90 in ID-group 4 (79%) and for PRNT50 in ID-groups 4 and 5 (both 100%). Seropositivity after the last vaccination after 12 months was high in all groups. Previous yellow fever vaccination was reported in 16% and associated with lower geometric mean titres of TBE-specific antibodies at all-time points.The vaccine was generally well tolerated. However, mild to moderate local reactions occurred in 73-100% of ID compared with 0-38% of IM vaccinations, and persistent discolouration was observed in nine ID vaccinated individuals., Conclusion: The accelerated two-visit ID schedules might offer a better immunological alternative to the recommended classical accelerated IM schedule, but an aluminium-free vaccine would be preferable., (© The Author(s) 2023. Published by Oxford University Press on behalf of International Society of Travel Medicine.)

Background: Acute gastroenteritis (AGE) is a major medical condition for travellers worldwide, particularly travellers to low- and middle-income countries. Norovirus (NoV) is the most common cause of viral AGE in older children and adults, but data on prevalence and impact amongst travellers is limited., Methods: Prospective, multi-site, observational cohort study conducted 2015-2017, amongst adult international travellers from the US and Europe to areas of moderate to high risk of travel-acquired AGE. Participants provided self-collected pre-travel stool samples and self-reported AGE symptoms whilst travelling. Post-travel stool samples were requested from symptomatic subjects and a sample of asymptomatic travellers within 14 days of return. Samples were tested for NoV by RT-qPCR, genotyped if positive and tested for other common enteric pathogens by Luminex xTAG GPP., Results: Of the 1109 participants included, 437 (39.4%) developed AGE symptoms resulting in an overall AGE incidence of 24.7 per 100 person-weeks [95% confidence interval (CI): 22.4; 27.1]. In total, 20 NoV-positive AGE cases (5.2% of those tested) were identified at an incidence of 1.1 per 100 person-weeks (95% CI: 0.7; 1.7). NoV-positive samples belonged mostly to genogroup GII (18, 85.7%); None of the 13 samples sequenced belonged to genotype GII.4. Clinical severity of AGE was higher for NoV-positive than for NoV-negative cases (mean modified Vesikari Score 6.8 vs 4.9) with more cases classified as severe or moderate (25% vs 6.8%). In total, 80% of NoV-positive participants (vs 38.9% in NoV-negative) reported at least moderate impact on travel plans., Conclusions: AGE is a prevalent disease amongst travellers with a small proportion associated with NoV. Post-travel stool sample collection timing might have influenced the low number of NoV cases detected; however, NoV infections resulted in high clinical severity and impact on travel plans. These results may contribute to targeted vaccine development and the design of future studies on NoV epidemiology., (© International Society of Travel Medicine 2023. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Text classification, as an important research area of text mining, can quickly and effectively extract valuable information to address the challenges of organizing and managing large-scale text data in the era of big data. Currently, the related research on text classification tends to focus on the application in fields such as information filtering, information retrieval, public opinion monitoring, and library and information, with few studies applying text classification methods to the field of tourist attractions. In light of this, a corpus of tourist attraction description texts is constructed using web crawler technology in this paper. We propose a novel text representation method that combines Word2Vec word embeddings with TF-IDF-CRF-POS weighting, optimizing traditional TF-IDF by incorporating total relative term frequency, category discriminability, and part-of-speech information. Subsequently, the proposed algorithm respectively combines seven commonly used classifiers (DT, SVM, LR, NB, MLP, RF, and KNN), known for their good performance, to achieve multi-class text classification for six subcategories of national A-level tourist attractions. The effectiveness and superiority of this algorithm are validated by comparing the overall performance, specific category performance, and model stability against several commonly used text representation methods. The results demonstrate that the newly proposed algorithm achieves higher accuracy and F1-measure on this type of professional dataset, and even outperforms the high-performance BERT classification model currently favored by the industry. Acc, marco-F1, and mirco-F1 values are respectively 2.29%, 5.55%, and 2.90% higher. Moreover, the algorithm can identify rare categories in the imbalanced dataset and exhibit better stability across datasets of different sizes. Overall, the algorithm presented in this paper exhibits superior classification performance and robustness. In addition, the conclusions obtained by the predicted value and the true value are consistent, indicating that this algorithm is practical. The professional domain text dataset used in this paper poses higher challenges due to its complexity (uneven text length, relatively imbalanced categories), and a high degree of similarity between categories. However, this proposed algorithm can efficiently implement the classification of multiple subcategories of this type of text set, which is a beneficial exploration of the application research of complex Chinese text datasets in specific fields, and provides a useful reference for the vector expression and classification of text datasets with similar content., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xiao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Total hip arthroplasties (THAs) are increasingly being performed at high-volume centers, causing some patients to travel further distances to receive care. Concerns remain that increased travel distance limits follow-up, which may impact outcomes and early return to the hospital. The purpose of this study is to evaluate the impact of travel distance on 90-day patient-reported outcomes (PROs) and 90-day complication rates., Methods: Patients undergoing inpatient primary THA at a single center by one of three surgeons between 2017 and 2021 were retrospectively reviewed. Patients whose local and distant medical records were available were included. Patients who lived ≥ 40 miles from the location or follow-up were labeled as "travelers," and those < 40 miles were "locals." Primary outcomes included PROs as measured by Veterans Rand 12 Item Health Survey, Harris Hip Score, and Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement. Secondary outcomes included rates of 90-day medical complications, emergency department visits, unplanned readmissions, and reoperations., Results: A total of 413 patients were analyzed at a mean of 897.1 days (range, 92 to 2,196) including 96 travelers. Travelers averaged 96.1 miles for follow-up (range, 40.1 to 678 miles), and locals averaged 14.1 miles for follow-up (range, 0.3 to 39.8 miles). There were no differences in the percentage of patients achieving minimal clinically important difference in PROs. There was no difference in the rate of 90-day medical complications, 90-day readmissions, and reoperations. Local patients were significantly more likely to have unplanned postoperative emergency department visits (travelers = 0%, locals = 7.4%, P = 0.003)., Conclusions: Travelers did not demonstrate any significant differences with respect to rates of achieving minimal clinically important difference in PROs or 90-day complication rates. These data suggest that increased travel distance to treatment centers does not impact outcomes following primary THA., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Ensuring equitable access to health services is crucial for public welfare and social equity, and is a key objective of the United Nations' Sustainable Development Goals (SDGs). However, existing datasets often define hospital accessibility using travel time to hospitals in geographic dimension only, without considering the supply (hospital capacity) and demand (population distribution) dynamics. To overcome this limitation, we developed and validated a national-scale 1 km map of both hospital travel time and hospital accessibility in China. We used the Gaussian two-step floating catchment area (Ga2SFCA) model to calculate hospital accessibility, incorporating hospital capacity and service population. Various file types and statistical indicators are provided, making the dataset highly accessible for non-specialists. The dataset fills the gap in publicly available nationwide hospital accessibility data for China and can serve as a critical tool in optimizing resource allocation and developing targeted strategies to improve healthcare equity., (© 2024. The Author(s).)

Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. Both authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

The imminent climate crisis has been labeled as the biggest health threat humanity must deal with. Vector-borne disease distribution and transmission as well as the population at risk are influenced to a great degree by environmental and climactic factors affecting both the vectors themselves and the causative pathogens. Paired with an increase in worldwide travel, urbanization, and globalization, along with population displacements and migration, elucidating the effects of anthropogenic climate change on these illnesses is therefore of the essence to stave off potential negative sequelae. Outcomes on different vector-borne diseases will be diverse, but for many of them, these developments will result in a distribution shift or expansion with the possibility of (re-)introduction of vector and pathogen species in previously nonendemic areas. The consequence will be a growing likelihood for novel human, vector, and pathogen interactions with an increased risk for infection, morbidity, and mortality. Wilderness medicine professionals commonly work in close relationship to the natural environment and therefore will experience these alterations most strongly in their practice. Hence, this article attempts to bring awareness to the subject at hand in a wilderness medicine context, with a focus on malaria, the most burdensome of arthropod-borne diseases. For prevention of the potentially dire consequences on human health induced by climate change, concerted and intensified efforts to reduce the burning of fossil fuels and thus greenhouse gas emissions will be imperative on a global scale.

Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This QES aims to address the following question: What are the lived experiences and perceptions of abortion seekers (i.e. pregnant women, transgender men, and non-binary people of any gender) traveling to obtain care? The review objectives are to: synthesize the qualitative evidence to address the review question; identify factors that influence abortion travel experiences and perspectives, which may include the specific abortion regulatory and care delivery context (e.g. legal restrictions, unavailability) and abortion seekers' personal circumstances (e.g. age, race/ethnicity, gender, partnership status, gestational duration, social/family support, income/wealth)., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Objective: To analyze the epidemiological characteristics of imported malaria cases from 2019 to 2023 after the elimination of malaria in Shanxi Province, and provide reference for formulating scientific and effective malaria prevention and control strategies in Shanxi Province. Methods: The data of imported malaria cases were collected China Information System for Disease Control and Prevention and National Parasitic Disease Control Information Management System in Shanxi Province, from 2019-2023. Descriptive epidemiological method and SPSS 26.0 statistical software were used for descriptive epidemiological statistical analysis. Results: A total of 51 malaria cases were reported in Shanxi Province in 2019-2023, all imported from abroad. Among them, there were 38 cases of falciparum malaria (74.51%), 6 cases of plasmodium ovale (11.77%), 5 cases of plasmodium vivax (9.80%), 1 case of plasmodium triticum malaria (1.96%), and 1 case of mixed infections (1.96%), with nodeaths; cases were predominantly males (94.12%, 48/51) and workers who went abroad for work (84.31%,43/51); the median age of onset was 37 years old; and there were imported cases every month, with no obvious peak of incidence; Taiyuan City reported the most cases, accounting for 72.55% (37/51) of the total number of cases,the source of infection of cases was mainly from Africa (96.08%), with the Democratic Republic of the Congo (16 cases), Nigeria (6 cases), Equatorial Guinea (5 cases), Mozambique (3 cases), and Republic of the Congo (3 cases) in that order; the median time between the onset of disease and first diagnosis, and the median time between first diagnosis and confirmation, were two times longer than that of first diagnosis, and the median time between first diagnosis and confirmation was two times longer than that of first diagnosis. The M ( Q 1 , Q 3 ) intervals from onset to first diagnosis and from first diagnosis to confirmed diagnosis were 2(0,4) days and 1(0,3) days, respectively, with statistically significant differences between different years from onset to first diagnosis ( H =17.41, P =0.048), and from first diagnosis to confirmed diagnosis ( H =20.82, P =0.010). A total of 101 146 blood tests for febrile patients were conducted in the province during the five years, with the minimum number of blood tests in 2020 (19 867 person-times) and the maximum number of blood tests in 2023 (20 778 person-times). Conclusions: After the elimination of malaria in Shanxi Province from 2019 to 2023, all malaria cases were imported from abroad, and it is still necessary to strengthen the surveillance of people traveling to and from malaria-endemic areas, implement the combination of medical treatment and prevention, and jointly prevent and control the occurrence of imported malaria.

We investigate the emergence, mutation profile, and dissemination of SARS-CoV-2 lineage B.1.214.2, first identified in Belgium in January 2021. This variant, featuring a 3-amino acid insertion in the spike protein similar to the Omicron variant, was speculated to enhance transmissibility or immune evasion. Initially detected in international travelers, it substantially transmitted in Central Africa, Belgium, Switzerland, and France, peaking in April 2021. Our travel-aware phylogeographic analysis, incorporating travel history, estimated the origin to the Republic of the Congo, with primary European entry through France and Belgium, and multiple smaller introductions during the epidemic. We correlate its spread with human travel patterns and air passenger data. Further, upon reviewing national reports of SARS-CoV-2 outbreaks in Belgian nursing homes, we found this strain caused moderately severe outcomes (8.7% case fatality ratio). A distinct nasopharyngeal immune response was observed in elderly patients, characterized by 80% unique signatures, higher B- and T-cell activation, increased type I IFN signaling, and reduced NK, Th17, and complement system activation, compared to similar outbreaks. This unique immune response may explain the variant's epidemiological behavior and underscores the need for nasal vaccine strategies against emerging variants., (© 2024. The Author(s).)

Weight and skin-fold measurements were made at five-day intervals during a 47-day expedition by six men and three women from the edge of the sea ice to the South Pole. From these, together with detailed manual records of the nutrition for individual participants, the average daily energy expenditure was determined before and after a resupply at approximately mid-point of the expedition. For all participants body weight fell during the expedition with the overall loss being much smaller for the three female participants (-4.0, -4.0, -4.4kg) than for the male participants, (mean±sd) -8.6±2.0kg. Fat weight fell approximately linearly during the expedition with a total loss of (-4.1, -6.5 and -2.5kg) for the three female participants and -6.8±1.7kg for the male participants. Individual fat-free weight changed by a smaller amount overall: (0.13, 2.5 and -1.8kg) for the three female participants; -1.8±2.0kg for the male participants who, with one exception, lost fat-free tissue All participants showed a substantial variation in fat-free tissue weight during the expedition. Analysis of the daily energy expenditure showed adequate nutrition but the intake fell for the second part of the expedition although the reasons for this are unclear, but adaptation to the cold, altitude and workload are possible explanations. The validity of this time-averaged measurement for individual participants was determined from analysing moments about the mean of time-series actigraphy data from wrist worn devices. The mean and autocorrelation function of the actigraphy data across subjects were analysed to determine whether measures could be compared between participants. The first, second and third moment about the mean of the day-to-day activity was found to be time-invariant for individual subjects (χ2, p>0.05) and the normalized mean and autocorrelation measured over a day for each participant indistinguishable from the mean of the group (χ2, p>0.05) allowing both longitudinal and cross-sectional analysis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wilson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

A 74-year-old man, previously healthy, presented at the Dermatology department with an asymptomatic hand lesion persisting for two months. The general practitioner initially treated the lesion with betamethasone and fusidic acid cream. Examination revealed a 3 cm livid plaque with central crusts. A biopsy confirmed cutaneous leishmaniasis tropica. The patient travelled to Greece, Spain, and Southern France before the lesion occurred, which is consistent with the endemicity of leishmaniasis in the Mediterranean. Treatment involved cryotherapy and antimony injections, resulting in lesion resolution after two sessions. This case underscores the importance of considering travel history and endemic diseases in diagnosing and managing dermatological conditions, especially in regions prone to specific infections.

In wastewater-based epidemiology, normalization of experimental data is a crucial aspect, as emerged in the recent surveillance of COVID-19. Normalization facilitates the comparison between different areas or periods, and it helps in evaluating the differences due to the fluctuation of the population due to seasonal employment or tourism. Analysis of biomarkers in wastewater (i.e. drugs, beverage and food compounds, microorganisms such as PMMoV or crAssphage, etc.) is complex to perform, and it is not routinely monitored. This study compares the results of alternative normalization approaches applied to SARS-CoV-2 loads in wastewater using population size calculated with conventional hydraulic and/or chemical parameters (i.e. total suspended solids, chemical oxygen demand, nitrogen forms, etc.) commonly used in the routine monitoring of water quality. A total of 12 wastewater treatment plants were monitored, and 1068 samples of influent wastewater were collected in urban areas and in highly touristic areas (summer and/or winter). The results indicated that both census and population estimated with ammonium are effective and reliable parameters with which to normalize SARS-CoV-2 loads in wastewater from urban sewersheds with negligible fluctuating populations. However, this study reveals that, in the case of tourist locations, the population calculated using NH 4 -N loads can provide a better normalization of the specific viral load per inhabitant., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To describe the adoption of international travel measures during the first year of the COVID-19 pandemic., Methods: To comprehensively analyze the measures adopted, we constructed a dataset based on the WHO's Public Health and Social Measures (PHSM) database, which covered 252 countries, territories, or other areas (CTAs), including all 194 WHO Member States, from December 31, 2019, to December 31, 2020. We examined the adoption of measures by type, over time, and by the implementing and targeted CTA, including their levels of income., Findings: We identified 11,431 international travel measures implemented during the first year of the pandemic. The adoption of measures was rapid and widespread: over 60% of Member States had adopted a travel measure before the WHO declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020. Initially, health screening and travel restrictions were the most adopted measures; however, quarantine and testing became more widely adopted over time. Although only a small portion of the total measures adopted constituted full border closure, approximately half of all Member States implemented this measure. Many travel measures targeted all CTAs but were unlikely to have been adopted universally enough to provide public health benefits. Low-income countries relied more on more universal measures, including full border closure, and were slower in scaling up testing compared to higher-income countries., Conclusion: The adoption of international travel measures during the first year of the COVID-19 pandemic varied across jurisdictions and over time. Lower-income countries used a different mix and scaled-up measures slower than higher-income countries. Understanding what measures were used is crucial for assessing their effectiveness in controlling the spread of COVID-19, reviewing the usefulness of the International Health Regulations, and informing future pandemic preparedness and response activities., (© 2024. The Author(s).)

We reviewed all diagnoses of Shigella species notified to the UK Health Security Agency from January 2016 to March 2023. An overall increase in notifications of shigellosis was seen between 2016 ( n = 415/quarter) and 2023 ( n = 1 029/quarter). However, notifications dramatically declined between March 2020 and September 2021 during the COVID-19 pandemic ( n = 208/quarter) highlighting the impact of travel and social distancing restrictions on transmission. S. sonnei diagnoses were more affected by lockdown restrictions than S. flexneri , most likely due to a combination of species-specific characteristics and host attributes. Azithromycin resistance continued to be associated with epidemics of sexually transmissible S. flexneri (adult males = 45.6% vs. adult females = 8.7%) and S. sonnei (adult males = 59.5% vs. adult females = 14.6%). We detected resistance to ciprofloxacin in S. sonnei from adult male cases not reporting travel at a higher frequency (79.4%) than in travel-associated cases (61.7%). Extensively drug-resistant Shigella species associated with sexual transmission among men almost exclusively had ESBL encoded by bla CTX-M-27 . Given the increasing incidence of infections and AMR, we recommend that enhanced surveillance is used to better understand the impact of travel and sexual transmission on the acquisition and spread of MDR and XDR Shigella species.bla CTX-M-15 . Given the increasing incidence of infections and AMR, we recommend that enhanced surveillance is used to better understand the impact of travel and sexual transmission on the acquisition and spread of MDR and XDR Shigella species.

Background: Indigenous Peoples living on the land known as Canada are comprised of First Nations, Inuit, and Métis people and because of the Government of Canada's mandatory evacuation policy, those living in rural and remote regions of Ontario are required to travel to urban, tertiary care centres to give birth. When evaluating the risk of travelling for birth, Indigenous Peoples understand, evaluate, and conceptualise health risks differently than Eurocentric biomedical models of health. Also, the global COVID-19 pandemic changed how people perceived risks to their health. Our research goal was to better understand how Indigenous parturients living in rural and remote communities conceptualised the risks associated with evacuation for birth before and during the COVID-19 pandemic., Methods: To achieve this goal, we conducted semi-structured interviews with 11 parturients who travelled for birth during the pandemic and with 5 family members of those who were evacuated for birth., Results: Participants conceptualised evacuation for birth as riskier during the COVID-19 pandemic and identified how the pandemic exacerbated existing risks of travelling for birth. In fact, Indigenous parturients noted the increased risk of contracting COVID-19 when travelling to urban centres for perinatal care, the impact of public health restrictions on increased isolation from family and community, the emotional impact of fear during the pandemic, and the decreased availability of quality healthcare., Conclusions: Using Indigenous Feminist Methodology and Indigenous Feminist Theory, we critically analysed how mandatory evacuation for birth functions as a colonial tool and how conceptualizations of risk empowered Indigenous Peoples to make decisions that reduced risks to their health during the pandemic. With the results of this study, policy makers and governments can better understand how Indigenous Peoples conceptualise risks related to evacuation for birth before and during the pandemic, and prioritise further consultation with Indigenous Peoples to collaborate in the delivery of the health and care they need and desire., (© 2024. The Author(s).)

Leishmaniasis is a rare disease in the United States, with an estimated annual incidence of dozens of cases occurring primarily in travelers, migrants, and military personnel. True disease incidence is unknown, since leishmaniasis is not a nationally notifiable condition. Here, we describe the results of molecular leishmaniasis over a 1-year interval (September 2021 to August 2022) when our laboratory served as the primary national reference laboratory for molecular diagnosis of civilian leishmaniasis. We tested 218 specimens submitted from 36 states yielding 94 of the 186 (50.5%) positive cases with species or species complex-level identification and 18 novel mini-exon alleles. Most species belonged to subgenus Viannia (75.6%) and associated with cutaneous or mucocutaneous disease. Cases were associated with recent travel (18.1%), travel timing unspecified (7.4%), migration (7.4%), remote travel (2.1%), military (1.1%), or unknown history (63.8%). These data illustrate the clinical utility of molecular testing for leishmaniasis and provide unique insight into disease epidemiology., Importance: Leishmaniasis is a disfiguring, neglected parasitic infection endemic to the Southern United States and the Americas. Despite significant populations at risk-travelers, military and foreign service members, and migrating persons-the epidemiology of the disease in the United States is poorly understood. Moreover, few clinical laboratories in the United States can test for the disease. Here, we present results from 1 year of testing for this disease at a major reference laboratory. These findings are particularly relevant because they coincide with a temporary "pause" on all clinical testing at the CDC. Our findings suggest at least several hundred cases occur each year in the United States. In particular, mucosal leishmaniasis may be more common than previously reported. We also highlight greater genetic diversity in Leishmania species endemic to the Americas than has been previously sampled, with implications for diagnostic specificity., Competing Interests: The authors declare no conflict of interest.

Azithromycin-resistant shigellosis is increasing globally. This retrospective analysis of Shigella flexneri serotype 2a isolates from 2016 to 2018 in Ontario found nearly half were azithromycin (47.7%, 72/151) and ciprofloxacin (50.7%, 77/152) resistant. Moreover, 34.7% (25/72) of azithromycin-resistant isolates were also ciprofloxacin-resistant. Four isolates were ceftriaxone-resistant, although all azithromycin-resistant isolates were ceftriaxone-susceptible. Overall, 83.6% (127/152) of all S. flexneri 2a isolates were recovered from males and 97.2% (70/72) of the azithromycin-resistant cases were males. Among the azithromycin-resistant cases, some (8/72) reported international travel. Phylogenetic analysis of azithromycin-resistant isolates revealed two large male-dominated clusters, and one cluster may have been due to importation of resistant strain. Comparison of plasmids isolated from the clusters in Ontario revealed the presence of incFII plasmid with high percentage of similarity to plasmids present in global outbreaks affecting mostly males including men who have sex with men (MSM). These two large azithromycin-resistant clusters are suggestive of an outbreak among MSM, though disease exposure or sexual orientation of patients was unknown. The presence of plasmid-borne azithromycin resistance in ciprofloxacin-resistant isolates is a public health concern. Antimicrobial surveillance is important for patient management, understanding the spread of novel resistance types in local communities which sometimes is introduced by travel. We found ongoing multidrug-resistant outbreaks spanning multiple years affecting males. Reduction of future outbreaks in high-risk communities like MSM requires consorted information flow between laboratory, public health, and physicians. We impart genomic and antimicrobial characteristics of multidrug S. flexneri 2a which may serve as reference by clinicians and public health.IMPORTANCEOral ciprofloxacin and azithromycin are generally considered as the first-line therapy of shigellosis. Here, we report the emergence and transmission of azithromycin and ciprofloxacin-resistant S. flexneri serotype 2a among male adults in Ontario during 2016-2018. The percentage of azithromycin and ciprofloxacin resistance among S. flexneri 2a is higher compared to previous reports from Canada and United States. Here, we show the genetic basis of the antimicrobial resistance among these unique groups of S. flexneri 2a isolates. We describe a domestically acquired azithromycin-resistant and ciprofloxacin-resistant S. flexneri 2a lineage in Ontario. Combining whole-genome sequencing (WGS) data with travel-associated data helped in understanding dissemination and transmission. We employed WGS, which not only helped us in understanding the genetic-relationship between isolates but also mine information regarding plasmids. In the future, linking WGS, travel-related data, and clinical data can provide enhanced contact tracing and improve public-health management., Competing Interests: The authors declare no conflict of interest.

Mayaro virus is endemic to the tropical Americas, where the incidence is currently increasing. Like other viruses of the Semliki Forest virus serocomplex, such as Alphavirus chikungunya , symptomatic infections are typically characterised by an acute febrile disease followed by long-lasting arthralgia. Cases in travellers are rarely reported but may be underdiagnosed. We report on four people who diagnosed with Mayaro fever after working in remote areas of Suriname as members of a film team.

RISK OF ACQUIRING ANTIBIOTIC-RESISTAN. BACTERIA AND TRAVEL. The continuing expansion of international tourism increases the opportunities of contact with diverse epidemiological environments, leading to both a risk of bacterial acquisition or infection for the traveler and the circulation of the micro-organisms around the world. With the disparate increase in antibiotic resistance worldwide, the traveler becomes a microbiological sentinel for resistance surveillance. Travel has been associated with the acquisition of digestive carriage of multidrug-resistant Enterobacterales, most frequently associated with travel to South Asia, enhanced by diarrhea and/or antibiotic use. But travel has also been the cause of authentic infections caused by multi- or extensively resistant bacteria, such as shigellosis, typhoid fever caused by Salmonella typhi, sexually transmitted infections caused by gonococci, or skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA), for which worry is the low number of antibiotics remaining effective. It is therefore necessary to advise travelers during pre-travel consultations on how to reduce the risk of acquisition., Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts.

In response to the increasing number of mpox cases caused by monkeypox virus (MPXV) clade I in the African continent and the first reported travel-related clade Ib case of mpox in EU/EEA, the European Centre for Disease Prevention and Control surveyed national capability for detection and characterisation of MPXV in the EU/EEA. The results showed high level of capability for case confirmation by PCR, alongside molecular typing methods for identification of MPXV clades and/or clade I subclades within the EU/EEA.

Vibrio cholerae is a Gram-negative bacterium found in aquatic environments and is the aetiological agent of cholera, characterized by acute watery diarrhoea and severe dehydration. Cholera presents a significant global health burden of an estimated 1.3-5 million annual cases, with the current pandemic caused by a toxigenic lineage of the O1 El Tor biotype called seventh pandemic El Tor (7PET) that is still ongoing. Whilst it is known that non-7PET lineages can cause sporadic disease, little is known about the transmission of these non-epidemic lineages. Thirty-four V. cholerae isolates were obtained from travellers returning from Indonesia to Australia between 2005 and 2017. These were whole genome sequenced, placed into a global phylogenetic context with 883 isolates, and screened for known genes associated with antimicrobial resistance and virulence. This analysis revealed that 30 isolates fell within non-7PET lineages and four within the 7PET lineage. Both 7PET and non-7PET isolates carried genes for resistance to antibiotics that are commonly used in cholera treatment such as tetracyclines and fluoroquinolones. Diverse virulence factors were also present in non-7PET isolates, with two isolates notably carrying toxin-coregulated pilus genes, which are primarily responsible for intestinal colonization in 7PET V. cholerae . This study demonstrates the role of travel in long-range carriage of epidemic and non-epidemic lineages of V. cholerae, and how sentinel travel surveillance can enrich our knowledge of V. cholerae diversity, reveal new biology about the spread of diverse lineages with differing disease potential and illuminate disease presence in endemic regions with limited surveillance data.

Active travel is a widely recognised strategy for promoting active living but its co-benefits beyond increasing physical activity, such as broader health, environmental, and social benefits, have rarely been synthesised. We conducted a systematic review to examine the co-benefits of active travel interventions. Following a preregistered protocol (PROSPERO CRD42022359059), we identified 80 studies for the search period from Jan 1, 2000, to Sept 13, 2022. Across studies, there was consistent evidence that active travel interventions offered co-benefits beyond physical activity. Particularly, 25 (71%) of 35 studies favoured improved safety outcomes, 20 (67%) of 30 showed improved health, 17 (85%) of 20 supported economic benefits, 16 (84%) of 19 highlighted improved transport quality, 12 (92%) of 13 showed environmental benefits, and four (80%) of five documented social benefits. Despite the overall low-certainty evidence, mostly limited by the quasi-experimental design and natural-experimental design of many of the studies, active travel interventions offer unique opportunities to engage stakeholders across sectors to jointly address major societal issues, such as physical inactivity, traffic safety, and carbon emissions. This evidence can inform the design, implementation, and evaluation of active travel interventions., Competing Interests: Declaration of interests DS received royalties for a textbook from the publisher Human Kinetics and speaker honoraria for a keynote presentation in Chile; travel funds to teach a methods course at the National Institute of Public Health of Mexico; is an executive board member of the International Society of Behavioral Nutrition and Physical Activity; and is chair of The Council on Environment and Physical Activity. BZ-D received consulting fees from Public Health England. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)