Professor Lyn Gilbert1
1University of Sydney, Marie Bashir Institute for Emerging Infections and Biosecurity,
Westmead Institute for Medical Research, Hawkesbury Rd, Westmead, 2015. lyn.Gilbert@sydney.edu.au
People who travel, for whatever reason, often develop infection. It may originate from exposure to an exotic, rare (in Australia), or (even) previously unknown pathogen in an Asian, African, Middle Eastern or South American wet market, luxury resort, boutique private hospital, village, city or rain forest. But it is more likely acquired in a crowded European shopping mall, an airport or the aeroplane on the way home. Whatever the source, the symptoms are usually nonspecific: diarrhoea, cough, headache, myalgia, rash and/or fever.
Most illnesses are mild and self-limiting; a minority need medical attention, even fewer need hospital admission. Some present within a few days of return, others weeks or months later; sometimes they first present for an unrelated condition.
The challenge, especially in a hospital setting, is to recognise the patient with the potential to transmit a significant exotic pathogen, to a healthcare worker or patient, and start a hospital or community outbreak. Plenty of recent examples show that even the best hospitals in high-income countries do not always meet the challenge: SARS, Toronto; Ebola, Dallas; MERS, Seoul; Clostridium difficile 027, Melbourne (among others) are almost certainly the very pointy tip of the iceberg. How can we ensure that the risk and potential consequences of transmission are assessed and mitigated simultaneously with – or even before – the initial clinical assessment, resuscitation and investigation? If the risk is significant it will be too late when a diagnosis is confirmed and high-level transmission-based precautions implemented. Standard precautions, properly observed, should do the trick.