With what seems to be a new virus in the news every week, it’s difficult to know what is (and isn’t) relevant to your travels. On Call’s Chief Medical Officer, Dr. Michelle Nathan, shares her latest insights on the most common infectious diseases on our travelers’ radars right now – as well as her advice for preventing these diseases while traveling.
Mpox
We’ll start with the mpox endemic – what is it what are the main symptoms? Are there any locations with more mpox prevalence?
Dr. Nathan: Mpox is a viral illness that is caused by the orthopoxvirus. The main symptoms of an infection are fever, muscle aches, sore throat, and a rash. The current outbreak of Clade 1 mpox is centered in the Democratic Republic of Congo and has spread to surrounding countries including Burundi, Rwanda, and Uganda. The very few cases reported outside of Africa were imported cases, meaning those patients were recently in one of the countries with an outbreak.
How does mpox spread? Are there any populations more susceptible to contracting mpox?
Dr. Nathan: Mpox is spread mainly by direct contact with the rash, and less commonly, by close contact with respiratory secretions. Other much less common ways of spread include contact with contaminated objects or infected animals and through needles, including tattoos. The CDC and WHO note that gay men, bisexual men and other men who have sex with men make up the majority of the cases in the current mpox outbreak. But it’s important to know that anyone who has been in close personal contact with someone who has mpox is at risk.
If someone tests positive for mpox, what are the available treatment options?
Dr. Nathan: Most patients recover with supportive care and pain control. Tecovirimat is an antiviral that is not yet approved by the FDA , but is available for mpox treatment. Antiviral therapy is used for patients with complicated/severe mpox. Antiviral treatment can also be used for patients who are at increased risk for severe disease, including those with weakened immune systems, and with skin conditions such as eczema and psoriasis.
Aside from getting vaccinated if you are a higher risk population, what are your top tips for preventing mpox while traveling?
Dr. Nathan:
1) Avoid close contact with people who are sick and have skin or genital lesions.
2) Avoid contact with or eating meat from wild animals.
3) Avoid contact with contaminated clothing/bedding from people who are sick.
Mosquito-borne Ilnesses: West Nile & EEE
We know both of these diseases are caused by mosquito bites, but what are the main symptoms of West Nile and EEE? How do they differ?
Dr. Nathan: Most people with West Nile virus have no symptoms. Those who develop symptoms have fever, headache, body aches, joint pain, vomiting, and diarrhea. Most of these people recover completely, but can have fatigue that lasts for several weeks.
Like West Nile virus, most people infected with Eastern Equine Encephalitis (EEE) virus have no symptoms. Less than 5% develop severe EEE with high fever, headache, neck stiffness, confusion, seizures, and coma. EEE is rare but is a more serious illness than West Nile virus; many patients who recover from EEE have long-term neurologic damage.
In what locations are these diseases more prevalent?
Dr. Nathan: West Nile virus is commonly found in Africa, Europe, the Middle East, North America, and West Asia. European countries reporting West Nile virus infections in 2024 include Albania, Austria, Bulgaria, Croatia, France, Germany, Greece, Hungary, Italy, Kosovo, North Macedonia, Romania, Serbia, Spain, and Turkiye. West Nile virus is endemic in sub-Saharan Africa, with cases seen in Morocco, Tunisia, and South Africa.
Eastern equine encephalitis is found in North and South America; including the United States, Canada, the Caribbean, and Argentina. In the United States, EEE is most common in the eastern and Gulf Coast states. In Canada, the Caribbean, and Argentina, EEE occurs mainly in the eastern coastal areas of each country.
With mosquito bite prevention being key to preventing these diseases – what are your top 3 tips for mosquito bite prevention for travelers?
Dr. Nathan:
1) Use an EPA-registered insect repellent with one of the following active ingredients: DEET, Picaridin (KBR 3023 or icaridin), IR 3535, oil of lemon eucalyptus (OLE), para-menthane diol (PMD), or 2-undecanone.
2) Wear protective, loose-fitting long-sleeved shirts and pants, preferably treated with permethrin.
3) Control mosquitoes indoors by using window screens, fans, and air conditioning if available.
Respiratory Illnesses: COVID-19 and Flu
Right now, it appears as if the FLiRT variant is most prominent on a global level – how does it differ from other variants?
Dr. Nathan: The FliRT variant is a subvariant of the Omicron strain that’s been with us since 2021. It is more contagious than other variants, but generally causes less severe illness than previous strains. The good news is that the FLiRT variant can still be treated with the same medication (Paxlovid) as other variants, and the latest COVID vaccines still lower the risk of severe illness from infection.
With flu season peaking soon, can you explain the difference in symptoms between flu and COVID?
Dr. Nathan: Flu and COVID symptoms are very similar, and you can’t tell the difference between the two illnesses by symptoms alone. Both illnesses have symptoms such as fever, cough, muscle aches, shortness of breath, and fatigue. COVID infections tend to have symptoms for a longer time- up to 14 days after infection.
Are there any locations of the world that are experiencing higher case volumes in these infections?
Dr. Nathan: There has been an uptick in cases in North America, Europe, and Australia over the summer months. No single country is identified as having particularly higher cases, but the global increase is noted.
Aside from getting vaccinated, what are your top 3 tips for travelers to avoid these infections while traveling?
Dr. Nathan:
1) Practice good travel health hygiene: handwashing/sanitizing, covering your mouth and nose when coughing or sneezing, and cleaning frequently-touched items such as phones and passports.
2) Avoid people who are sick; minimize time in closed spaces by moving activities outdoors whenever possible.
3) Take steps to keep yourself healthy by getting enough sleep, staying hydrated, eating a balanced diet, and engaging in regular exercise.
For more travel health resources and information contact us today:
From 24/7 emergency medical transportation, referrals for medical facilities abroad, and even prescription assistance, On Call can provide medical assistance support to travelers anywhere in the world. Visit www.oncallinternational.com learn more.
About On Call International:
When traveling, every problem is unique–a medical crisis, a political threat, even a common accident such as a missed flight. But every solution starts with customized care that ensures travelers are safe and protected. That’s why for over 25 years, On Call International has provided fully-customized travel risk management and emergency assistance services protecting millions of travelers, their families, and their organizations. Visit www.oncallinternational.com and follow us on LinkedIn to learn more.
