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i) Update on GeoSentinel ii) Interventions to increase travel health
awareness among VFR travellers Associate Professor Karin Leder
Director of Travel Medicine and Immigrant Health, Royal Melbourne Hospital, Victoria, Australia
Head of Infectious Disease Epidemiology Unit Monash University, Victoria, Australia
The Global Surveillance Network of the ISTM and CDC
A worldwide communications and data
collection network of travel/tropical medicine
clinics
www.geosentinel.org
Provider-based surveillance of international travelers & migrants
56 travel/tropical medicine clinics, 24 countries, 6 continents
Approx 200,000 patient records (since 1996) >250,000 final diagnoses
Rationale for GeoSentinel
• Travel & migration continue to increase
• Travelers & immigrants = key elements in spread of emerging ID
• Travelers as sentinels
• Value of central aggregation of global data
• Functions
1. Surveillance – response (alarming sentinel events)
2. Surveillance – ongoing trends
3. Analysis of morbidity and risk factors – Diagnosing ill-returnees, advising prospective travelers, defining
associations b/n demographic or itinerary characteristics and disease
Assessing risk using GeoSentinel data
Risk
All incident cases
All travelers to a destination
Proportionate Morbidity
No. of patients with diagnosis (or group of diagnoses)
All ill travelers to a destination
• Sentinel surveillance among “ill” travelers ‒ Don’t describe all travelers or all illness in
• Over-representation of “risky” destinations
• 47 GeoSentinel publications, >1,500 citations
• 24% of VFRs had pre-travel encounter vs 67% of tourists
• VFRs should be targeted for pre-travel health interventions
CID 2006
Systemic Febrile Illnesses Proportionate morbidity (%)
35%
23%
1.50% 0.90%
19%
10%
0.90%2%
12%
3%
0.30%2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Systemic febrile illness Malaria Typhoid Dengue
Immigrant-VFR Traveler-VFR Tourist-traveler
26% of VFRs managed as inpatients vs 6% of tourists
• Initiative supported by unrestricted educational grant from Sanofi Pasteur
• Communications consultancy firm engaged – Devised ways to encourage pre-travel advice for VFRs – Identified GPs in high VFR communities and alert re need for
opportunistic/proactive advice
– Identified priority communities (Chinese, Vietnamese, Indian)
• Engaged Drs from 3 major ethnic grps as spokesmen • Established combination of methods to convey travel-related
messages
Media outreach
• Over 5 months: – Publication of 64 media
items on travel health in 4 languages
• Estimated audiences for media outlets: 1.1 M
Multilingual printed educational materials
• Posters, fold out z-cards, tear-sheets
Hotspot identification
• 100 businesses identified across Sydney and Melbourne – GP practices
– Non-medical businesses
• Posters and tear-sheets distributed to GPs
• Posters distributed to non-medical businesses via bilingual taskforce
Ethnic community events • Hosted information stalls
conveying travel-related public health messages at ethnic community events – 2 Autumn Moon Festivals (18th
& 19th Sep ‘10) – 2 Diwali Festivals (31st
Oct & 7th Nov ‘10) • Over 5,000 z-cards distributed
– 2,500 in Chinese, 2,000 in English, 700 in Vietnamese
Conclusions and Limitations
• Multi-dimensional campaign for community education
• Novel initiatives specifically targeted to ethnic groups contributing large numbers of VFRs
• Opportunistic dissemination of linguistically and culturally appropriate information
• Simple health messages • Formal evaluation of impact of interventions
unable to be performed
Improving health of international students: Promoting awareness of TB and VFR-travel
• >557,000 international students enrolled in Australia in 2011; ~1/3 based in Victoria
• Students originate from >160 countries – China and India most common
• Timing of travel usually at end-of-year breaks
Aims and Methods • Determine feasibility and acceptability of establishing
appropriate health education materials targeted at international students
• Identify and engage interested parties – Student Services at Education Institutions
– GP’s & Health Clinics, community Centres
– International Student Organisations
– Health Insurance Providers
• 2 health messages: I. Early presentation for TB
II. Pre-travel visit for international students travelling as VFRs
‘Toolbox’ of Materials Generated
Sample pack
Social media Text for Facebook, Twitter, newsletters
Postcards Pamphlets
PowerPoint slides
Poster
Key Travel Health Messages
Seek pre-travel advice
Consider vaccination and preventive medication as recommended by your doctor
If sick during travel or on return to Australia
→ See a doctor and tell them that you have recently been overseas
Materials Distributed Education institution
Medical facility Other Total
VFR travel postcard 9,740 1,500 250 11,490
VFR travel pamphlet 7,540 680 250 8,470
Electronic media 26 4 3 33
Sample text for twitter
International students - UR @ risk 4 infections when U travel home. See a Dr b4 U travel. Visit traveldoctor and
smartraveller
Postcard
Pamphlet
Presentation title 22
Conclusions • International student support services & health care
providers willing to disseminate health education messages
• Established database of relevant facilities (specific contacts)
• Determined optimal methods for information delivery
• Developed and distributed materials
• Limitations – Unable to determine how many students saw message or whether
any changes in behaviour occurred
– Unsustained
Discussion
• Short term educational VFR initiatives possible but efficacy in changing behaviour is unknown
• Few improvements in last decade