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Background: The towering peaks of the Himalayas lie in troves of captivating hill destinations, especially in India. Each destination aims to provide tourists with unique experiences and breath-taking landscapes. Understanding the tapestry of factors that weave the allure of these destinations and draw visitors from diverse backgrounds remains intriguing. Method: This study delves into the socio-demographic tapestry of Himalayan hill destination selection, unraveling the complex interplay of demographic characteristics, social influences, and individual motivations that shape tourists' choices. Results: This study aims to answer why different tourists have different travel choices and what factors are the drivers behind such choices. The results show that destination selection factors are similar irrespective of respondents' socio-demographic variabilities; however, for a few factors, the results are reversed. Conclusion: The study has implications for policymakers and the limitations of the research discussed at the end.

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Beginning in late 2023, Oropouche virus was identified as the cause of large outbreaks in Amazon regions with known endemic transmission and in new areas in South America and the Caribbean. The virus is spread to humans by infected biting midges and some mosquito species. Although infection typically causes a self-limited febrile illness, reports of two deaths in patients with Oropouche virus infection and vertical transmission associated with adverse pregnancy outcomes have raised concerns about the threat of this virus to human health. In addition to approximately 8,000 locally acquired cases in the Americas, travel-associated Oropouche virus disease cases have recently been identified in European travelers returning from Cuba and Brazil. As of August 16, 2024, a total of 21 Oropouche virus disease cases were identified among U.S. travelers returning from Cuba. Most patients initially experienced fever, myalgia, and headache, often with other symptoms including arthralgia, diarrhea, nausea or vomiting, and rash. At least three patients had recurrent symptoms after the initial illness, a common characteristic of Oropouche virus disease. Clinicians and public health jurisdictions should be aware of the occurrence of Oropouche virus disease in U.S. travelers and request testing for suspected cases. Travelers should prevent insect bites when traveling, and pregnant persons should consider deferring travel to areas experiencing outbreaks of Oropouche virus disease.

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BACKGROUND: Japan implemented strict border control measures and all incoming passengers were subject to entry screening with reverse transcription-polymerase chain reaction or antigen testing. From late 2020, exit screening within 72 h of departure to Japan also became mandatory. In this study, we evaluated the effectiveness of the exit screening policy in Japan by analyzing airport screening data from October 2020 to April 2022. METHODS: In addition to assessing entry screening data over time of passengers from the United Kingdom, we examined the prevalence of coronavirus disease 2019 (COVID-19) in the United Kingdom based on the Office of National Statistics infection survey. We constructed a statistical model that described entry screening positivity over time using Office of National Statistics prevalence data as the explanatory variable. Ideally, the time-dependent patterns of entry screening and Office of National Statistics prevalence data should resemble each other; however, we found that, sometimes, they were different and regarded the difference to statistically partly reflect the effectiveness of exit screening. RESULTS: The average proportion positive in one month before mandatory exit screening was implemented among Japanese passengers was 0.67% (95% confidence interval [CI]: 0.45, 0.98), whereas the proportion positive decreased to 0.49% (95% CI: 0.21, 1.15) in the first month of exit screening. Adjusting for time-dependent prevalence at the origin, we concluded that exit screening contributed to reducing passenger positivity by 59.3% (95% CI: 19.6, 81.3). The overall positivity values among passengers during the Delta and Omicron variant periods were 3.46 times and 1.46 times that during the pre-Delta variant period, respectively. CONCLUSIONS: We used a simplistic statistical model and empirical data from passengers arriving in Japan from the United Kingdom to support that exit screening helped to reduce the proportion positive by 59%. Although the proportion positive later increased considerably and precluded preventing the introduction of imported cases, submitting a certificate for a negative test result contributed to reducing the positivity among travelers.

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BACKGROUND: The increasing prevalence of falsified and counterfeit medicines globally poses risks to international travellers. This narrative literature review examines the global challenge of falsified and counterfeit medicines, with a specific focus on risks for travellers. The aim is to provide a comprehensive understanding of this multidimensional issue, exploring potential solutions for effective intervention. METHODS: A comprehensive search of databases, including PubMed, MEDLINE, and Scopus, as well as relevant reports from international organisations, was undertaken. There was a focus on extracting information pertaining to the prevalence, types, and geographical patterns of falsified and counterfeit medicines encountered by international travellers. Synthesising this information helped to identify overarching trends and patterns. This narrative review utilised a thematic analysis approach to synthesise the findings. RESULTS: The findings revealed a diverse range of counterfeit drug categories, spanning from antibiotics to lifestyle medications, posing unique risks to travellers navigating the global pharmaceutical landscape. The review emphasises the geographical distribution of these drugs, with varying consequences for both high- and low-income nations. The inadequate formulations and inconsistent drug release arising from these practices pose severe threats to public health, especially for individuals travelling abroad. The review also highlights the significance of international collaboration in addressing this global challenge, as pharmaceutical supply chains seamlessly cross borders, necessitating a collaborative approach for effective regulation and enforcement. CONCLUSIONS: This review underscores the need for targeted research, collaborative interventions, and technological innovations to address the complexities associated with falsified and counterfeit medicines, ensuring the safety and well-being of international travellers.

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Introduction: Community-level changes in population mobility can dramatically change the trajectory of any directly-transmitted infectious disease, by modifying where and between whom contact occurs. This was highlighted throughout the COVID-19 pandemic, where community response and nonpharmaceutical interventions changed the trajectory of SARS-CoV-2 spread, sometimes in unpredictable ways. Population-level changes in mobility also occur seasonally and during other significant events, such as hurricanes or earthquakes. To effectively predict the spread of future emerging directly-transmitted diseases, we should better understand how the spatial spread of infectious disease changes seasonally, and when communities are actively responding to local disease outbreaks and travel restrictions. Methods: Here, we use population mobility data from Virginia spanning Aug 2019-March 2023 to simulate the spread of a hypothetical directly-transmitted disease under the population mobility patterns from various months. By comparing the spread of disease based on where the outbreak begins and the mobility patterns used, we determine the highest-risk areas and periods, and elucidate how seasonal and pandemic-era mobility patterns could change the trajectory of disease transmission. Results and discussion: Through this analysis, we determine that while urban areas were at highest risk pre-pandemic, the heterogeneous nature of community response induced by SARS-CoV-2 cases meant that when outbreaks were occurring across Virginia, rural areas became relatively higher risk. Further, the months of September and January led to counties with large student populations to become particularly at risk, as population flows in and out of these counties were greatly increased with students returning to school.

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This study employs a mathematical model to analyze and forecast the severe outbreak of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), focusing on the socio-economic ramifications within the Thai population and among foreign tourists. Specifically, the model examines the impact of the disease on various population groups, including susceptible (S), exposed (E), infected (I), quarantined (Q), and recovered (R) individuals among tourists visiting the country. The stability theory of differential equations is utilized to validate the mathematical model. This involves assessing the stability of both the disease-free equilibrium and the endemic equilibrium using the basic reproduction number. Emphasis is placed on local stability, the positivity of solutions, and the invariant regions of solutions. Additionally, a sensitivity analysis of the model is conducted. The computation of the basic reproduction number (R0) reveals that the disease-free equilibrium is locally asymptotically stable when R0 is less than 1, whereas the endemic equilibrium is locally asymptotically stable when R0 exceeds 1. Notably, both equilibriums are globally asymptotically stable under the same conditions. Through numerical simulations, the study concludes that the outcome of COVID-19 is most sensitive to reductions in transmission rates. Furthermore, the sensitivity of the model to all parameters is thoroughly considered, informing strategies for disease control through various intervention measures.

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BACKGROUND: The 2018 UNOS allocation policy change deprioritized geographic boundaries to organ distribution, and the effects of this change have been widespread. The aim of this investigation was to analyze changes in donor transplant center distance for organ travel and corresponding outcomes before and after the allocation policy change. METHODS: The UNOS database was utilized to identify all adult patients waitlisted for heart transplants from 2016 to 2021. Transplant centers were grouped by average donor heart travel distance based on whether they received more or less than 50% of organs from >250 miles away. Descriptive statistics were provided for waitlisted and transplanted patients. Regression analyses modeled waitlist mortality, incidence of transplant, overall survival, and graft survival. RESULTS: Centers with a longer average travel distance had a higher mean annual transplant volume with a reduction in total days on a waitlist (86.6 vs. 149.2 days), an increased cold ischemic time (3.6 vs. 3.2 h), with no significant difference in post-transplant overall survival or graft survival. CONCLUSIONS: The benefits of reducing waitlist time while preserving post-transplant outcomes extend broadly. The trends observed in this investigation will be useful as we revise organ transplant policy in the era of new organ procurement and preservation techniques.

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BACKGROUND: Encouraging alternatives to the car such as walking, cycling or public transport is a key cross-sector policy priority to promote population and planetary health. Individual travel choices are shaped by individual and environmental contexts, and changes in these contexts - triggered by key events - can translate to changes in travel mode. Understanding how and why these changes happen can help uncover more generalisable findings to inform future intervention research. This study aimed to identify the mechanisms and contexts facilitating changes in travel mode. METHODS: Prospective longitudinal qualitative cohort study utilising semi-structured interviews at baseline (in 2021), three- and six-month follow up. Participants were residents in a new town in Cambridgeshire, UK, where design principles to promote walking, cycling and public transport were used at the planning stage. At each interview, we followed a topic guide asking participants about previous and current travel patterns and future intentions. All interviews were audio recorded and transcribed. Data analysis used the framework approach based on realist evaluation principles identifying the context and mechanisms described by participants as leading to travel behaviour change. RESULTS: We conducted 42 interviews with 16 participants and identified six mechanisms for changes in travel mode. These entailed increasing or reducing access, reliability and financial cost, improving convenience, increasing confidence and raising awareness. Participants described that these led to changes in travel mode in contexts where their existing travel mode had been disrupted, particularly in terms of reducing access or reliability or increasing cost, and where there were suitable alternative travel modes for their journey. Experiences of the new travel mode played a role in future travel intentions. IMPLICATIONS: Applying realist evaluation principles to identify common mechanisms for changes in travel mode has the potential to inform future intervention strategies. Future interventions using mechanisms that reduce access to, reduce reliability of, or increase the financial cost of car use may facilitate modal shift to walking, cycling and public transport when implemented in contexts where alternative travel modes are available and acceptable.

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PURPOSE OF REVIEW: The goal of this review is to summarize the potential causes of anaphylaxis in the different holiday contexts, providing practical suggestions aimed to mitigate the stress challenged by allergic patients because of unfamiliar situations. RECENT FINDINGS: A regard was reserved to potential food triggers, particularly uncommon ones and typical of certain destinations, and to arthropods responsible for anaphylaxis. SUMMARY: This review highlights the potential risk of anaphylaxis due to the unusual contexts more experienced during holidays (i.e., travels, outdoor activities and eating out). Moreover, it underlines the need for a further allergological education in these cases, in order to prepare allergic patients to avoid and manage undesired situations.

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BACKGROUND: Assessment of the effective use of international travel measures during the COVID-19 pandemic has focused on public health goals, namely limiting virus introduction and onward transmission. However, risk-based approaches includes the weighing of public health goals against potential social, economic and other secondary impacts. Advancing risk-based approaches thus requires fuller understanding of available evidence on such impacts. METHODS: We conducted a scoping review of existing studies of the social impacts of international travel measures during the COVID-19 pandemic. Applying a standardized typology of travel measures, and five categories of social impact, we searched 9 databases across multiple disciplines spanning public health and the social sciences. We identified 26 studies for inclusion and reviewed their scope, methods, type of travel measure, and social impacts analysed. RESULTS: The studies cover a diverse range of national settings with a strong focus on high-income countries. A broad range of populations are studied, hindered in their outbound or inbound travel. Most studies focus on 2020 when travel restrictions were widely introduced, but limited attention is given to the broader effects of their prolonged use. Studies primarily used qualitative or mixed methods, with adaptations to comply with public health measures. Most studies focused on travel restrictions, as one type of travel measure, often combined with domestic public health measures, making it difficult to determine their specific social impacts. All five categories of social impacts were observed although there was a strong emphasis on negative social impacts including family separation, decreased work opportunities, reduced quality of life, and inability to meet cultural needs. A small number of countries identified positive social impacts such as restored work-life balance and an increase in perceptions of safety and security. CONCLUSIONS: While international travel measures were among the most controversial interventions applied during the COVID-19 pandemic, given their prolonged use and widespread impacts on individuals and populations, there remains limited study of their secondary impacts. If risk-based approaches are to be advanced, involving informed choices between public health and other policy goals, there is a need to better understand such impacts, including their differential impacts across diverse populations and settings.

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The COVID-19 pandemic provoked a large impact on tourism because of the enforcement of harsh travel restrictions and the increased global health risks caused by international mobility. This paper utilizes a longitudinal analysis to tests the impact of COVID-19 on tourists' health risk perceptions, and their relationships with destination image perception and visiting intentions. Tourists are surveyed at two different points of time, before and after the COVID-19 pandemic. Multi-group structural equation modeling is utilized for the comparison of the relationships at the two points of time. The results show that the negative influence of health risk perceptions on destination image perception and visiting intentions are significantly larger after the COVID-19 pandemic while there are no significant differences in the impact of destination image perception on visiting intentions. Thus, not only are tourists more sensitive to health risk perceptions after COVID-19, but this higher sensitivity has larger impacts both on their perceptions of destination image and on the behavioural implication. The results have useful implications in terms of the need to dedicate more efforts for the management of health conditions of destinations after COVID-19.

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In wastewater-based epidemiology, normalization of experimental data is a crucial aspect, as emerged in the recent surveillance of COVID-19. Normalization facilitates the comparison between different areas or periods, and it helps in evaluating the differences due to the fluctuation of the population due to seasonal employment or tourism. Analysis of biomarkers in wastewater (i.e. drugs, beverage and food compounds, microorganisms such as PMMoV or crAssphage, etc.) is complex to perform, and it is not routinely monitored. This study compares the results of alternative normalization approaches applied to SARS-CoV-2 loads in wastewater using population size calculated with conventional hydraulic and/or chemical parameters (i.e. total suspended solids, chemical oxygen demand, nitrogen forms, etc.) commonly used in the routine monitoring of water quality. A total of 12 wastewater treatment plants were monitored, and 1068 samples of influent wastewater were collected in urban areas and in highly touristic areas (summer and/or winter). The results indicated that both census and population estimated with ammonium are effective and reliable parameters with which to normalize SARS-CoV-2 loads in wastewater from urban sewersheds with negligible fluctuating populations. However, this study reveals that, in the case of tourist locations, the population calculated using NH4-N loads can provide a better normalization of the specific viral load per inhabitant.

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Online travel agency (OTA) platforms frequently engage in unfair behaviors that infringe on the legitimate rights and interests of consumers and airlines in the ticket sale market. Effective governance of the OTA platforms' misconduct has become an urgent topic. In order to address the governance dilemma of OTA platforms' misconduct, a tripartite evolutionary game model considering the collaborative supervision between airlines and consumers is constructed. This study analyzes the evolutionary path and stable strategy of the three participants, airlines, platforms and consumers by numerical simulation. The results show that some actions, such as airlines' strict control of ticket sales resources and high fines on the platform, reducing the cost of customers' rights protection, and effectively guiding online public opinion, can benefit airlines and consumers and enhance their willingness to cooperate in supervision. Legitimate consumer rights protection not only brings negative public opinion and image loss to airlines, but also to platforms, which can force airlines to impose stricter constraints on platforms and force platforms to strengthen self-restraint. Therefore, a market mechanism instead of government regulatory that can effectively suppress platforms misconduct should be established to promote platforms self-regulation through a collaborative effort between airlines and consumers. Some special measures that guide the interests of three participators are also provided.

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