key: cord-0008195-6xnnbtqt authors: Sahin, Mustafa Kursat; Sahin, Gulay title: Emerging and re-emerging infectious disease training needs in Turkey date: 2018-06-05 journal: Travel Med Infect Dis DOI: 10.1016/j.tmaid.2018.06.004 sha: f7910b1a20abb1f50036d47366d54c2465358d68 doc_id: 8195 cord_uid: 6xnnbtqt nan Travel Medicine and Infectious Disease journal homepage: www.elsevier.com/locate/tmaid Emerging and re-emerging infectious disease training needs in Turkey We read the paper of unusual microorganisms and antimicrobial resistances in a group of Syrian migrants in Italy [1] and we believed that it is an important problem for Turkey, too. And Turkey harbors several risk factors for the development and spread of emerging and reemerging infectious diseases (ERID). Issues such as climate change, globalization, migration, environmental damage, improper urbanization, social inequalities, wars and antibiotic resistance are risk factors for the development and spread of ERID. The Center for Disease Control and Prevention describes emerging infectious diseases (EID) as: "Infectious diseases whose incidence in humans has increased in the past 2 decades or threatens to increase in the near future have been defined as 'emerging'. These diseases, which respect no national boundaries, include: new infections resulting from changes or evolution of existing organisms, known infections spreading to new geographic areas or populations, previously unrecognized infections appearing in areas undergoing ecologic transformation, old infections reemerging as a result of antimicrobial resistance in known agents or breakdowns in public health measures." [2] . Based on that definition, Turkey harbors several risk factors for the development of ERID. According to Turkish Statistical Institute data for 2016, the level of urbanization in Turkey has reached 92.3% [3] . Urbanization involves several problems for global health and the epidemiology of infectious diseases. According to Cook et al., the Mediterranean region, which includes Turkey, is going through the most arid period for the last 900 years [4] . Climate change is another factor creating a suitable environment for ERID. Turkey is also receiving intense migration due to the wars near its borders. Mass migrations clearly play a major role in the development of new infections. The war in Syria has cost many lives since 2011. The surviving, but defenseless people have had to face a wide range of difficulties. Health is one of the most important of these. The destruction of health infrastructure, mass migrations, deaths among health workers, interrupted vaccination programs, malnutrition, housing problems and defective sanitation have all prepared the ground for infectious diseases. 7.65 million Syrians seeking to escape their predicament have had to abandon their homes, and nearly 4.8 million have sought shelter in neighboring countries. In the framework of its 'Open Door Policy' Turkey has not turned any Syrians away, and has given them 'Temporary Protected Status.' The number of Syrians who have come to Turkey has risen on a continuous basis. 3.1 million Foreigners are seeking international pro-tection in Turkey, including 2.75 million Syrians with temporary protected person status. Some 250,000 of these live in temporary accommodation centers. However, the remaining 2.5 million Syrians are trying to meet their own accommodation needs in Turkey. Various infectious diseases are increasing as a result. Countries are reporting cases of polio, measles, tuberculosis, cutaneous leishmaniosis and cholera [5] . The antibiotic resistance caused by excessive antibiotic use in Turkey is another problem, and one which is growing as more Syrians enter the country [1] . Such a large number of risk factors combining together in this way of course make it essential for ERID to be reviewed and to be included in medical training in Turkey. Many foreign students from Asia, Europe, Africa, and the Middle East receive training in Turkey. It therefore needs to have an international up-to-date curriculum. The absence of this subject on medical faculty curricula represents a serious deficiency. ERID needs to be assed to Turkey's Undergraduate Medical Core Curriculum as a matter of urgency. A list of the main EID capable of causing outbreaks was published at a conference in 2015. These diseases were identified as Crimean Congo hemorrhagic fever, Ebola virus disease and Marburg, Lassa fever, MERS and SARS coronavirus diseases, Nipah and Rift Valley fever. Chikungunya, severe fever with thrombocytopenia syndrome and Zika were described by the WHO as 'serious' diseases, the identification of which was encouraged. Diseases not on the list but with a high outbreak potential, such as HIV/AIDS, tuberculosis, malaria, Avian influenza and Dengue fever, were not included since significant disease control and research networks were already in place [6] . Priority should therefore be attached to diseases on this list in training sessions to be planned about ERID. Unusual microorganisms and antimicrobial resistances in a group of Syrian migrants: sentinel surveillance data from an asylum seekers centre in Italy What are "emerging" infectious diseases Address Based Population Registration System Results in Spatiotemporal drought variability in the Mediterranean over the last 900 years Syrian refugees and infectious disease challenges WHO publishes list of top emerging diseases likely to cause major epidemics All authors declare that they have no conflicts of interest. No funding was received for this study.