Brazilian Public Health Policy for Cruise Ships - A Review of Morbidity and Mortality Rates - 2009/2015

Introduction: For 10 years, Brazil has presented a significant flow in cruise ships with 597 011 travelers in 2015. Cruise ships represent a major mass gathering capacity, generating more risk of outbreaks and epidemics. Moreover, visiting several places presents travelers with the possibility of contact with some tropical diseases, which demands the development of specific policies for public health surveillance. Methods: In this study, case reports on transmissible diseases, accidents and deaths on board of cruise ships in the Brazilian coast during 2009 to 2015 were reviewed and correlated with the development of public health surveillance policies implemented by ANVISA, which established the mandatory communication of infectious diseases in 2009 and of deaths onboard in 2011. Results: Norovirus was the major etiologic agent of outbreaks, though the rate of outbreak has been declining in recent years. The lethality rate last season was 0.67:100 000, mostly because of preexisting conditions (75%); the remaining cases were caused by accidents. The mandatory reporting of outbreaks and deaths is an important tool in the planning of preventive actions for the safety and health of travelers in Brazil. The continuous evolution of hygiene surveillance may reduce outbreaks; the adoption of transparency policies and fast communication of deaths has contributed to the significant reduction in accidents. Conclusion: The effectiveness of specific public policies for the safety and security of travelers established for cruise ships in Brazil is indicated by the quantitative reduction in outbreaks and deaths. New destinations such as Cuba and China may adopt the same strategy of surveillance and protection against potential outbreaks of infectious diseases provided by cruise ships

Public policies with minimum cost for health insurance in inbound tourism at Schengen area : causes and consequences

As áreas tropicais são consideradas propensas a doenças infecciosas e recentemente apresentaram desenvolvimento econômico com aumento do turismo doméstico e internacional de seus habitantes. Há um aumento de viagens internacionais com maior risco potencial para a importação de doenças, particularmente nos últimos 10 anos, e o novo quadro de surtos globais no século 21. A promoção de viagens seguras destes turistas no destino é um novo desafio para os governos receptores. Alguns países desenvolvidos com tradição turística, como os signatários da Convenção Schengen, implementaram políticas para lidar com o eventual custo de saúde de viajantes de áreas tropicais. Outros destinos, como os Estados Unidos, mantiveram suas políticas de saúde para turistas. Visando identificar a real condição de saúde destes novos turistas de países emergentes, estudamos os problemas de saúde dos turistas brasileiros no exterior, comparando o fluxo de viagens, o custo de saúde antes e depois da implantação da Convenção Schengen, a exposição potencial para algumas doenças infecciosas no intuito de sugerir medidas para proteção e prevenção desses viajantes brasileiros. Não há evidência de transporte de doenças por viajantes brasileiros para seus destinos turísticos. Países que adotaram seguro saúde obrigatório para os turistas brasileiros não apresentaram maiores custos de saúde, tendo queda relativa do fluxo turístico do Brasil, em comparação a países sem restrições. Além disso, o transporte aéreo e eventos internacionais de massa, como a Copa do Mundo e os Jogos Olímpicos, permitiram a transmissão de doenças para o Brasil, com introdução do vírus Zika e reintrodução do vírus do sarampo. A rápida transmissão mostra a importância das medidas preventivas que incluem o reforço da vacinação de grupos específicos, o alerta de higiene pessoal adequada e outras ações para evitar possíveis surtos devido ao elevado tráfego de viajantes nos eventos. No turismo doméstico, o potencial risco de transmissão de doenças infecciosas negligenciadas, como Leishmaniose Visceral, cuja disseminação se intensificou por deslocamento de animais de estimação; e da esquistossomose humana pelo aumento das mudanças climáticas e de atividades de lazer em áreas naturais, promovem maior exposição dos viajantes internacionais e nacionais. A rede atual de prevenção e proteção para viajantes no Brasil, composta por clínicas de medicina de viagem, mídias com recomendações para viajantes e centros de imunização tornam-se importantes na prevenção de contágio dos turistas e reduzem consideravelmente o número de atendimentos pós-viagem. Quando usada, fornece aos viajantes brasileiros proteção para as principais doenças infecciosas preveníveis ale de orientação para se evitar situações de risco em viagem, sendo um modelo de política pública interessante. Alguns protocolos para a entrada dos viajantes demonstram ser uma atitude adequada para melhorar a segurança dos viajantes e de seus países, bem como novas medidas preventivas são necessárias para evitar a disseminação de surtos de doenças infecciosas.Tropical areas are considered prone to infectious diseases and have recently presented economic development with increased domestic and international tourism of its inhabitants. There is an increase in international travel with greater potential risk for diseases importation, particularly in the last 10 years, a new global outbreak chart in the 21st century. The promotion of safe travel of these tourists at destination is a challenge for recipient governments. Some developed countries with a tourist tradition, such as the Schengen Convention, have implemented policies to deal with the possible cost of health of travelers from tropical areas. Other destinations, as the United States, have maintained their health policies for tourists. Aiming to identify the real health condition of new tourists from emerging countries, we studied the health problems of Brazilian tourists abroad, comparing flow, health cost before and after the implementation of the Schengen Convention, their potential exposure to some infectious diseases, to suggest measures for protection and prevention of these Brazilian travelers. There is no evidence of diseases\' transport by Brazilian travelers to their destinations. Countries that adopted mandatory health insurance for Brazilian tourists did not present higher health costs, only a relative drop in Brazil\'s tourism flow compared to unrestricted countries. In addition, with air transport and international mass events, such as the World Cup and the Olympic Games, allowed the importation of diseases into Brazil, with the introduction of the Zika virus and the reintroduction of the measles virus. The rapid transmission shows the importance of preventive measures that include reinforcing of vaccination, adequate personal hygiene alert, and other actions to avoid possible outbreaks due to the high traffic of travelers at events. In domestic tourism, the potential risk of transmission of neglected infectious diseases, such as Visceral Leishmaniosis, whose spread was intensified by displacement of pets; and human schistosomiasis by increasing climate change and leisure activities in natural areas, promoting greater exposure of international or national travelers. The current network of prevention and protection for travelers in Brazil, composed of travel medicine clinics, media with recommendations for travelers and immunization centers is effective in preventing infection of tourists and greatly reduces the number of post-trip visits. When used, it provides Brazilian travelers with a protection for the major preventable infectious diseases and education to avoid risky travel situations, an interesting model of public police. Some protocols for travelers\' entry prove to be an appropriate attitude to improve the safety of travelers and countries, as well as new preventive measures are needed to prevent the spread of infectious disease outbreaks

Reemergence of mumps in São Paulo, Brazil - the urgent need for booster shot campaign to prevent a serious infectious disease

Abstract INTRODUCTION: Neglected infectious diseases like mumps may be opportunistic in controlled areas with low vaccine coverage, particularly in developed and emerging countries. METHODS: A retrospective analysis of mumps-related data from 2001 to 2016 for São Paulo State, Brazil was conducted. RESULTS: From 2014 to 2015, there was an increase of 82% in reported mumps cases in São Paulo, with prevalence of n=49 and 297, respectively in young adults aged 15-29 years. CONCLUSIONS: A booster-shot campaign on MMR vaccination is recommended to prevent the spread of mumps in unvaccinated children and recipients of only the first dose

Dengue and climate changes: Increase of DENV-1 in São Paulo/Brazil – 2023

Dengue is a vector borne disease caused by virus serotypes DENV-1, DENV-2, DENV-3, and DENV-4, representing a significant public health concern in the Region of the Americas (2,997,097 cases in 2023). This study explores the relationship between dengue incidence and climate changes in the city of São Paulo-Brazil. During the first semester of 2023, Brazil reported the highest number of dengue cases in Americas’ Region. Our data reveals a correlation between the high temperature and rainfall season persistence and the extension of dengue incidence into the winter season. The findings highlight the importance of understanding the relationship between climate change and disease transmission patterns to develop effective strategies for prevention and control