Tropical diseases are no longer uncommon

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Acceleration and improvement of diagnostics in hospitals, development of molecular techniques - all this means that we start talking about tropical diseases in a tame way and stop treating them as something extraordinary. And that is good, because thanks to this we can better prepare for the trip, and thanks to vaccines we can avoid diseases with very serious consequences for health and even life - says the Chief Sanitary Inspector Dr. Paweł Grzesiowski.

Do we have a problem in Poland with infectious diseases imported from exotic expeditions?

From the point of view of the Sanitary Inspection, diseases imported to Poland from various climate zones are a real threat. This is important because importing a pathogen can pose a threat to the environment. We have such cases every year, which is why we need to improve both diagnostics and therapy in this area.

But health problems related to travel and people traveling outside our climate zone are very diverse and concern not only infectious diseases.

For example, malaria, which is not transmitted between people, will not cause an epidemic, but due to delayed diagnostics and lack of awareness, patients often end up in hospital in a very advanced condition, and sometimes it is not even possible to save them because it is too late for treatment.

Broad-based education is necessary, especially since Poles are increasingly emigrating.

And this is both in society and among doctors of various specialties, because not only preparation and prevention are important for tourists who travel to new and exotic regions, but also what happens after returning, i.e. early and effective diagnosis of diseases that can be acquired during such a trip. And then their treatment here, with us. Many people think of travel medicine mainly through the prism of vaccinations, repellents and such interventions, and that is not all - a comprehensive approach is what counts.

How to decide what we should get vaccinated against when planning an exotic vacation?

We start with a risk assessment, we look at who is going - whether it is a child or an adult, whether it is a sick or healthy person. It is important where they are going and what they will be doing there - we protect someone who plans to lie on a beach lounger differently than someone who is going trekking in the jungle. And only then do we adapt the preventive program to them and propose appropriate protection. The first will receive a basic set of vaccinations, i.e. against viral hepatitis A, and we are interested in whether they have had booster vaccinations against diphtheria and tetanus. But the second, who is going to wild areas, must think about getting vaccinated against Japanese encephalitis, rabies, and perhaps typhoid fever. Because these are diseases that may appear there. Vaccinations for travelers are currently the main mechanism of protection against typhoid fever, foodborne jaundice, yellow fever, and mosquito-borne diseases.

What happens next is also important - the doctor's task is to make the patient aware that if any disturbing symptoms appear after returning from abroad, especially fever, they should definitely see a specialist.

We often think about vaccinations when we travel to exotic places. But what about when we travel to Europe?

It is also worth mentioning that travel medicine is changing its image not only because Poles travel to other, often very exotic areas, but also because many people from outside our climate zone come to Poland and other European countries. And they also bring diseases with which they infect us. Tourist traffic has also begun to intensify in the other direction. And if in Spain or Italy - where Poles like to travel - visitors from exotic regions appear, the threat of diseases that have not previously occurred in our country potentially increases.

If we like to travel, if we have such plans, it is worth going to a travel medicine doctor , because there we talk about broadly understood prevention . And we must also mention the threat that does not necessarily depend on humans, namely vector diseases, i.e. those in which pathogens or disease-causing organisms are transmitted by fleas, ticks and mosquitoes, such as dilofilariosis, Chikungunya malaria, Zika, West Nile virus, where we do not even have to have a live patient, a mosquito is enough, which can transfer the disease from an animal to a human and infection can occur, even without leaving Poland, which has already happened. And since vector diseases are becoming more and more common, it is worth knowing how to reduce the risk associated with them.

These are diseases that were already there before…

Now, more is being said about them, because we are starting to diagnose better - we have increasingly better virological diagnostics, we know much more about encephalitis and many other symptoms, and thanks to this, it is easier to associate certain things and diagnose faster. In the past, we simply said: unknown cause of encephalitis and that's it. The subject is closed. Today, when we receive information about an arbovirus transmitted by arthropods, mainly mosquitoes and ticks, or another virus in the cerebrospinal fluid, we start looking for the source of the infection, we wonder where it could have come from.

Improved diagnostics in hospitals, development of molecular techniques, acceleration of diagnostics - all this means that we start talking about tropical diseases in a familiar way and stop treating them as something completely unusual. Because if we have 50-60 cases of malaria in Poland every year, then we have to realize that there is certainly a group of patients who are not diagnosed.

Are there any plans to expand the vaccination schedule in this regard?

The vaccination schedule, when it comes to travel, is actually flexible, because these are recommended vaccinations and systemic intervention is not needed here. It is just a matter of new registrations and recommendations.

Something else would be a systemic approach, where if someone buys an exotic trip, they have a discount on vaccinations in their insurance package, for example. At the moment, there is nothing like that, patients cover the full cost of vaccinations and they are often much more expensive than the trip itself.

And it's discouraging...

Yes, although it must be said that some vaccines - such as against yellow fever - are taken once in a lifetime and we already have protection for all trips, so it is a one-time expense. And it is an investment for life.

But there is indeed a big gap in this area, because people buy travel insurance, but it often does not cover health and preventive services, and in my opinion this is an issue that needs to be addressed.

Have you considered introducing mandatory vaccinations for children, e.g. against tick-borne diseases?

No, ticks are not our priority, we are now more focused on smallpox or meningococci , they are currently higher in the category of possible health effects. We do not have good data on tick-borne encephalitis , in this area diagnostics are not as efficient as in the case of meningococci . And since relatively few of them are detected, there is no epidemiological basis for introducing vaccinations on a large scale.

So what about the flu, which is also much talked about - also in the context of travel?

We are not thinking about mandatory vaccination for everyone for the sake of traveling - unless international health regulations require some kind of vaccine . First of all, because there is huge variability in terms of destination, people go to different places when they want. The obligation to vaccinate results from risk, and so, for example, to enter Bolivia, you must have a vaccination against yellow fever and this must be done at least 10 days before arrival. Or when going on a pilgrimage to Mecca, due to the fact that the pilgrimage route is demanding, high dustiness has an adverse effect on the respiratory system, and in a crowd of people it is easy to transmit microorganisms through droplets - the traveler must be vaccinated against meningococci. The ACWY meningococcal vaccination certificate is necessary when applying for a visa. Without it, there is no way to enter the country. But establishing that, for example, if you are going to Asia in the fall, you must get vaccinated against influenza would only be possible if the countries reached an agreement on this matter.

Which infectious diseases are the biggest problem right now?

Hepatitis A and seasonal diseases - although now, fortunately, the season for COVID, flu and RSV is ending. We do have a whole spectrum of year-round diseases such as pneumococci and meningococci.

Is there any idea on how to prevent people from avoiding vaccinations?

We certainly cannot exclude a group of people just because they have different views. That is why I believe it is more important to ensure that their influence on society is as small as possible. But not by attacking them - because these people usually have already established views and it is impossible to convince them - but by limiting their influence on undecided people. Because this indecision sometimes results in bad decisions, for example, waiting for a better moment to get vaccinated. And sometimes - as the recent example of a child who returned from Zanzibar with diphtheria showed - we have a problem.