key: cord-1026488-m06xneol authors: Leong, Wei-Yee title: COVID-19’s impact on travel medicine surpasses that of all other emerging viral diseases date: 2020-11-27 journal: J Travel Med DOI: 10.1093/jtm/taaa221 sha: 2e6a24925a5c06bb3d28c566328dc0eac8fd35e6 doc_id: 1026488 cord_uid: m06xneol COVID-19 has devastated economies, led to widespread lockdowns and an extent of travel restrictions that the world has not seen for decades. high disability). 7 It was declared a PHEIC because the endgame of polio eradication was at stake due to international travel. The other diseases declared PHEIC before COVID-19 were Zika and H1N1. Zika was declared a PHEIC because of its case fatality rate (it basically does not lead to death) but because of the unusual cluster of birth defects and Guillain-Barre syndrome. 8 The Zika PHEIC did not lead to massive travel restrictions, although pregnant women were advised not to travel to Zika endemic countries, and post-travel guidance on preconception advice was given. 9 The first PHEIC to be declared by the revised International health regulations (2005) was the H1N1 pandemic in 2009. An estimated 62 million illnesses, 274 000 hospitalizations and 12 400 deaths were associated with the 2009 H1N1 virus occurred in the USA, 10 far lower than the now 250 000 deaths due to COVID-19 reported in the USA. Influenza did not lead to travel restrictions, and although influenza outbreaks were reported on cruise ships, 11 the cruise ship industry continued during the H1N1 pandemic, whereas it stalled during the COVID-19 pandemic. Ebola was declared a public health emergency in 2014 in West Africa and again in 2018 in the Democratic Republic of Congo. 12 About 14 000 Ebola deaths were recorded, which now in hindsight pales against the 1.4 million deaths due to COVID-19, although at the time, it led to widespread panic and undue travel warnings. 12 Spread of Ebola via air travel has only rarely occurred, 13 the main reason being that connectivity between the worst-affected Ebola countries is relative low and the fact that Ebola patients are too symptomatic to board a plane or are picked up at entry screening, whereas a large proportion of COVID-19 are asymptomatic. COVID-19 has plummeted air travel and the tourism industry. The pandemic will change the way we do travel medicine, both before travel, 14 risks during travel 15 and how we assess fever in returning travellers. There is hope though: travel and travel medicine will recover from this crisis once effective vaccines and therapeutics are widely available. Revised recommendations for rabies preexposure prophylaxis in travellers: avoid bumpy roads, select the highway Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination, openlabel, cluster-randomised trial (Ebola Ca Suffit!) Call to action for improved case definition and contact tracing for MERS-CoV Severe yellow fever in Brazil: clinical characteristics and management Monkeypox transmission among international travellers-serious monkey business? Estimation of the basic reproduction number, average incubation time, asymptomatic infection rate, and case fatality rate for COVID-19: meta-analysis and sensitivity analysis Potential for international spread of wild poliovirus via travelers Zika virus and microcephaly: why is this situation a PHEIC? Zika virus and sexual transmission: updated preconception guidance Chapter 31: Inactivated Influenza Vaccines. Plotkin's Vaccines 7th edition Influenza on cruise ships Travel restrictions and infectious disease outbreaks Ebola virus outbreak in North Kivu and Ituri provinces, Democratic Republic of Congo, and the potential for further transmission through commercial air travel Factors affecting pre-travel health seeking behaviour and adherence to pre-travel health advice: a systematic review Travel vaccine preventable diseases-updated logarithmic scale with monthly incidence rates