Committee to Advise on Tropical Medicine and Travel

Committee to Advise on Tropical Medicine and Travel (CATMAT) April 2008 Pierre J. Plourde, M. D. , FRCPC Medical Officer of Health, Winnipeg Regional Health Authority Medical Director, Travel Health and Tropical Medicine Program, WRHA Medical Consultant, Journeys Travel Health Clinic Associate Professor, Medical Microbiology (Clinical Parasitology), University of Manitoba Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) CATMAT reports to. . . Public Health Agency of Canada, Chief Public Health Officer of Canada, Assistant Deputy Minister, Migration and International Health, Travel Health Program Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Mandate u u u provides recommendations on prevention and treatment of infectious diseases and other health hazards for Canadian travellers; suggests mechanisms for wide dissemination and use of recommendations and other travel medicine-related information; and advises on priorities for epidemiological research and other activities related to travel or tropical medicine. Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Structure u 10 members (4 -year terms): Canadian expertise in travel medicine, tropical medicine, parasitology, infectious diseases, public health, and epidemiology u liaison members: CPS, CPHA, CSIH, AMMI Canada (formerly CIDS), NACI, IDRC, CAEP u ex-officio members: HC, DND, CIC, DFA, US CDC Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Summary: u u Future statements/guidelines Yellow fever Update CDC Update Travel Health in the Canadian Health Care System Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Upcoming Published Statements: 2007/2008 Ø Ø High altitude (April 2007) Immunocompromised hosts (April 2007) Ø Ø Ø Hepatitis (in press) Japanese encephalitis (final edits) Malaria guidelines (final edits) Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Future Updated Statements: 2008/2009 Ø Ø Ø Tuberculosis Typhoid Dengue fever Guidelines for TM practice Meningococcal meningitis Fever in the International Traveller Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Future New Statements: 2009 Ø Ø Ø Ø Yellow fever Long term traveller International adoption Elderly travellers Pregnancy and travel Pediatric traveller Accidents and injuries VFRs Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Yellow fever Update: u Case Report (Calgary): § § § 5 week old male born March 2007 (normal delivery) presented with 2 wk history of URTI and fever for 2 days, “seizure activity” for 1 day Admitted and treated with antibiotics, acyclovir, and anti-seizure medications Dx: encephalitis Normal CT head, CSF negative PCR Baby completely recovered Arboviral serology positive (Yf 1: 5120 Ig. M!!) Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Yellow fever Update: u Case Report (Calgary): § § § Arboviral serology positive (Yf 1: 5120 Ig. M!!) Mother had travelled to Caracas, Venezuela for 7 days, when baby was 13 days old Mother had received yellow fever vaccine when baby was 10 days old (no need for vaccine!) Baby was breastfed only; no rural travel Was baby infected with endemic yellow fever (no evidence of current outbreak) or was baby infected with vaccine strain via breast milk (has never been documented)? Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) CDC Update: u Interactive “live” malaria maps online Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Travel Health in the Canadian Health Care System: Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Travel Health in the Canadian Health Care System: u u ~2, 000 Canadian travellers to developing countries 20% VFRs; “voluntourism” 75% travellers develop travel-related illness (GI, dengue, malaria, typhoid) But true cost of travel-related illness in Canada unknown Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Travel Health in the Canadian Health Care System: u u <15% travellers visit travel clinic Primary care practitioners often provide incorrect advise*: Ø Ø 37% accuracy for immunizations (vs 76% THNs) 69% accuracy for antimalarials (vs 78% for THNs) Public Health Agency of Canada * Keystone JS, et al. J Travel Med 1994; 1: 72 -78 Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Travel Health in the Canadian Health Care System: u u u “Why don’t provincial health care plans cover travel medicine? ” “if one can afford to travel, one can afford to pay” ? VFRs, students, missionaries, altruistic volunteers Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Travel Health in the Canadian Health Care System: u u Covering cost of pre-travel consultation fees – encourage travellers to seek advice from the right places Correct the misconception that travel medicine is a “luxury item” Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Haiti Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) Contacts… www. travelhealth. gc. ca www. catmat. gc. ca Public Health Agency of Canada Agence de santé Publique du Canada

Committee to Advise on Tropical Medicine and Travel (CATMAT) April 2008 Pierre J. Plourde, M. D. , FRCPC Medical Officer of Health, Winnipeg Regional Health Authority Medical Director, Travel Health and Tropical Medicine Program, WRHA Medical Consultant, Journeys Travel Health Clinic Associate Professor, Medical Microbiology and Community Health Sciences, University of Manitoba Public Health Agency of Canada Agence de santé Publique du Canada