Travel changes people and places. The traveler can be the target and sufferer from microbial threats; the traveler can also provide the microbial transport system. Traveling humans alter infectious diseases patterns by introducing pathogenic microbes or resistance or virulence factors into new populations. The movement of pathogenic microbes through history has been intimately linked to the capacity of humans to travel and to migrate to new locations. Today, humans have the capacity to reach virtually any city in the world within a day or two. Travel to tropical and developing countries is increasing more rapidly than travel to developed countries, and all projections suggest that human travel will continue to increase in the foreseeable future. Infectious diseases influence decisions about travel and trade; and travelers change the epidemiology of infectious diseases.

Travel has played an essential role in the movement of HIV/AIDS throughout the world. Rapid international air travel moved the virus that causes SARS to multiple countries within weeks. Travel has been and will continue to be important in the movement of human influenza.

Recent experiences with SARS and avian influenza underscore several observations:

• travel and trade are major forces in the global economy

• movement of humans and animals influences the biogeography of infectious diseases

• many important human pathogens originate from related microbes in animals

• interactions between humans and animals are common and widespread

• animal populations (for food) are growing even faster than human populations

• animals and birds can migrate

• humans have some control over animal trade (though illegal movement and marketing is huge)

• humans cannot control movement of microbes through bird migration

• surveillance is critical and must be global and linked to response capability

• communication among scientists must be frequent and open

• isolates of microbes must be made available to scientists

• international collaboration is essential and must be multidisciplinary

• communication about risks must be timely and accurate

• poverty and ignorance are risk factors for infectious diseases

• poverty limits choices.

Travel consists of sequential shared environments, often with people from diverse regions of the world. It should be considered a loop, and not just an origin and destination. Travel has created one, extensively interconnected world in terms of microbial threats. Approaches must consider the global community.

Swine Influenza

Swine Influenza

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