Occupational Infectious Agents and Travel Medicine

Background:   The H1N1 pandemic in 2009 highlighted the need for the ICOH Working Group on Occupational Infectious Agents (WGOIA) to consider the interface of occupational medicine with travel medicine which “seeks to prevent illnesses and injuries occurring to travellers and manages problems arising in returning travellers home or those coming from elsewhere”.  .   Integrating travel medicine into occupational health services:   The WGOIA "Risk assessment", "Fitness for work" and "Health surveillance" focus has an additional dimension when people travel for work; the destination and length of deployment affect all these issues. Workers who travel require individual prioritisation of risks and intervention from preventive immunisation through prophylaxis and stand-by treatment. The occupational physician needs access to real-time information on destination risks, including distribution of infectious agents, likelihood of exposure, personal health characteristics predisposing to or protective against infections, and geographical drug resistance. The occupational history and examination must assess risks of infection, while preventive measures and individualised advice must address the risks. Disease management during travel and post-deployment medical surveillance are vital aspects of occupational health services for travellers.     Prioritising Travel-related Occupational Infectious Diseases:  Although infectious diseases account for <1% of mortality in recreational travellers, deployment in rural, developing countries increases the risk of morbidity and requirement for emergency repatriation for conditions such as malaria and dengue fever. The revised International Health Regulations guide the obligatory measures to be taken to minimise global spread of infectious diseases and a useful framework for prioritising public health problems. Vaccines administered in the workplace (e.g.  hepatitis A and B, meningococcal meningitis, and tetanus) have had significant impact as has chemoprophylaxis. However, administration of live vaccines (e.g. yellow fever) poses challenges in immunosuppressed and older workers as does long-term malaria chemoprophylaxis. The presentation will illustrate experience with different worker populations that travel for work.