Mary E Wilson

• MD
• Professor at University of California, San Francisco

Every dollar spent on food in the United States produces two dollars of negative impact on public health and the environment. Today’s food system feeds people but harms the environment and the health of humans, animals, and plants globally (The Rockefeller Foundation, 2021). The authors of this commentary explore how food systems have arrived at th...

Purpose of review: The current article will review how the coronavirus disease 2019 pandemic has changed travel and travel medicine. Recent findings: Travelers spread severe acute respiratory syndrome coronavirus 2 globally and continue to spread variants. The characteristics of the virus, the place, and time created a perfect storm that allowed...

Travel, a major contributor to global economy, needs to adapt to the COVID-19 pandemic. Restarting business and travel share convergent considerations. Travel health preparation will require detailed assessment to specifically address COVID-19: the individual’s personal risk stratification, elements of travel, and policies imposed on each traveler...

A novel coronavirus, probably of bat origin, has caused an outbreak of severe respiratory infection in humans in Wuhan, China and has been dispersed globally by travelers. The WHO has declared the spread of the infection a Public Health Emergency of International Concern.

Abstract Yellow fever (YF) outbreaks continue, have expanded into new areas and threaten large populations in South America and Africa. Predicting where epidemics might occur must take into account local mosquito populations and specific YF virus strain, as well as ecoclimatic conditions, sociopolitical and demographic factors including population...

Antibiotics have an afterlife. They remain biologically active and affect microbial ecosystems in and outside the body. Antibiotics used by humans and animals are excreted and reach the environment through multiple pathways causing widespread contamination of soil and water globally. Wastewater treatment plants to not eliminate all antibiotic resid...

What is the difference between an allergic reaction and an adverse reaction? What are the signs and symptoms of an allergic reaction? All allergic reactions to a drug are adverse drug reactions, but adverse drug reactions also include many other kinds of reactions. Every antibiotic...

What are the Most Important Consequences of having Infections Caused by Antibiotic-Resistant Bacteria? Several major consequences stand out. Infections caused by antibiotic-resistant bacteria lead to more deaths and disability than infections caused by antibiotic-sensitive bacteria. They cause more suffering through longer hospitalizations and more...

What is antibiotic resistance? Antibiotic resistance describes the survival of bacteria when exposed to a concentration of an antibiotic that would normally kill them or stop their growth. Although we call it antibiotic resistance, resistance is an attribute or characteristic of the bacteria. It is...

What are the uses of Antibiotics other than to Treat Infections in Humans? Antibiotics are used widely in human medicine, in many other species—food animals, work and recreational animals, pets, fish, and honeybees—and on plants. They are also used in research laboratories to prevent the...

Are there Ways to Reduce the Risks of Infections so that we do not Need Antibiotics? We have many tools available to reduce the need for antibiotics by reducing infections. It is worth examining several of these—keeping in mind that using antibiotics drives the appearance...

How are Antibiotics Administered? What are the Routes of Administration Besides by Mouth and by Injection? What Determines how they Should be Given? How an antibiotic is administered depends on the type and location of the infection and the characteristics of the antibiotic. Some antibiotics...

What is an Antibiotic? The word “antibiotic” comes from the terms “anti,” meaning “against” or “opposing,” and “bios,” meaning “life,” and refers to a substance that works against bacterial life. Originally the term was used to describe substances, such as penicillin or streptomycin, produced by...

How Common is Inappropriate Prescribing of Antibiotics? Many studies have tried to estimate what percentage of antibiotic use in people is unnecessary or inappropriate. Most estimates come up with about a quarter to a third of all use. For some specific types of infections like...

Purpose of review: Zika virus (ZIKV) swept through the Americas and led to recognition of its neurotropism. Zika circulation elsewhere in the world, nonvector transmission including maternal-fetal/sexual/transfusion routes, and additional reports on congenital Zika syndrome (CZS) and Guillain-Barré syndrome (GBS) have been published. Recent findi...

A STIRRING EXAMINATION OF A LOOMING CRISIS Virtually everyone has taken antibiotics. They can be lifesavers -- or they can be useless. But what are they? How are they used? And what happens as the effectiveness of antibiotics begins to decline? Antibiotics: What Everyone Needs to Know® examines the personal and societal implications of our planet's...

Malaria chemoprophylaxis is probably the most complex area of pretravel advice. The travel medicine advisor must have in-depth knowledge of all available chemoprophylactic drugs as well as detailed knowledge of the current epidemiology of malaria at travelers’ destinations. The current priority antimalarials are atovaquone/proguanil, doxycycline, a...

Background After being eliminated during the 1950s, dengue reemerged in Brazil in the 1980s. Since then, incidence of the disease has increased, as serotypes move within and between cities. The co-circulation of multiple serotypes contributes to cycles of epidemic and interepidemic years, and a seasonal pattern of transmission is observed annually....

Plots of first two principal components of data with selected clustering groups (2011–2015). Outlying single- and multi-bairro clusters are labeled. (PDF)

Average and range annual values for parameters considered in the hierarchical clustering analysis, by year (2011–2015). (PDF)

Standardized principal component loadings and squared loadings of variables used for hierarchical clustering. (PDF)

Dengue incidence rates and covariates used in the study, by year and bairro. (ZIP)

Bairro and regional identification numbers in Fortaleza (ordered by regional). (PDF)

Gap statistic values calculated from parameters used for hierarchical clustering analysis, by year (2011–2015). Range is bounded at seven clusters. Selected number of clusters identified by vertical dotted line. (PDF)

Vector‐borne infections make a substantial contribution to the global burden of disease. Among mosquito‐borne infections dengue infections are expanding in distribution and intensity of transmission and severity; malaria remains an ongoing challenge in many areas. At the same time, previously unfamiliar mosquito‐borne viruses such as chikungunya an...

Leptospirosis is a potentially fatal emerging zoonosis with worldwide distribution and a broad range of clinical presentations and exposure risks. It typically affects vulnerable populations in (sub)tropical countries but is increasingly reported in travelers as well. Diagnostic methods are cumbersome and require further improvement. Here, we descr...

Background: Analysis of a large cohort of business travelers will help clinicians focus on frequent and serious illnesses. We aimed to describe travel-related health problems in business travelers. Methods: GeoSentinel Surveillance Network consists of 64 travel and tropical medicine clinics in 29 countries; descriptive analysis was performed on...

Whilst there is a global effort towards measles elimination, and even eradication [1], spatial and temporal analysis of virus transmission between 1954 and 2017 demonstrates ongoing virus transmission in many countries and all world regions to date. Transmission, in fact, does not only occur within countries but is exported across boundaries, with...

Background: Travel medicine needs are changing. New patterns of travel, including greater travel by individuals from emerging economies with different values in costs, risks and benefits, must be considered. This review aims to (1) highlight selected studies that have been published that address previously identified gaps in knowledge; (2) propose...

Objective To inform future interventions for advising travelers. Patients and Methods We prospectively collected data on travelers seen at the Boston Area Travel Medicine Network, a Boston area research collaboration of 5 travel medicine clinics. Data from 15,440 travelers were collected from March 1, 2008, through July 31, 2010. We compared trave...

This prospective cohort study describes travelers' diarrhea (TD) and non-TD gastrointestinal (GI) symptoms among international travelers from the Boston area, the association of TD with traveler characteristics and dietary practices, use of prescribed antidiarrheal medications, and the impact of TD and non-TD GI symptoms on planned activities durin...

Response to question about possible unintended consequences of massive infrastructure project reconnecting Asia.

Purpose of review: While mosquitoes have been primarily responsible for outbreaks of Zika virus worldwide, most prominently in the Americas during 2015 and 2016, there has been increased recognition of the importance of sexual transmission. We review human reports and animal model studies of Zika sexual transmission and summarize potential therape...

The burden of dengue is large and growing. More than half of the global population lives in areas with risk of dengue transmission. Uncertainty in burden estimates, however, challenges policy makers' ability to set priorities, allocate resources, and plan for interventions. In this report, the first in a Series on dengue, we explore the estimations...

Many factors can contribute to the emergence of new microbial threats, often working synergistically. This chapter focuses on infections that are new or newly recognized in the human population. The biological characteristics of microbes (abundant, diverse, ubiquitous, resilient, able to survive in extreme environments (extremophiles), capacity to...

Background: The Boston Area Travel Medicine Network surveyed travelers on travel-related health problems. Methods: Travelers were recruited 2009-2011 during pre-travel consultation at three clinics. The investigation included pre-travel data, weekly during-travel diaries, and a post-travel questionnaire. We analyzed demographics, trip characteri...

Human dengue virus infection without mosquito vector has been reported to occur as a result of mucocutaneous transmission, needlestick in patient care and laboratory accident, blood transfusion, bone marrow transplant, organ transplant, intrapartum and perinatal transmission, and breastfeeding. The emergence of Zika virus, another mosquito-borne fl...

We conducted a prospective study to measure dengue virus (DENV) antibody seroconversion in travelers to dengue-endemic areas. Travelers seen in the Boston Area Travel Medicine Network planning to visit dengue-endemic countries for ≥ 2 weeks were enrolled from 2009 to 2010. Pre- and post-travel blood samples and questionnaires were collected. Post-t...

Mass gatherings at major international sporting events put millions of international travelers and local host-country residents at risk of acquiring infectious diseases, including locally endemic infectious diseases. The mosquito-borne Zika virus (ZIKV) has recently aroused global attention due to its rapid spread since its first detection in May 2...

Fevers in individuals with recent tropical travel require rapid assessment because many of the potential causes are treatable and/or have important public health implications. History and clinical findings are essential to identify the likely causes of the fever and, thus, recognize those that require urgent intervention.This review outlines obtain...

We conducted a prospective cohort study to assess adherence to malaria chemoprophylaxis, reasons for nonadherence, and use of other personal protective measures against malaria. We included adults traveling to malaria-endemic countries who were prescribed malaria chemoprophylaxis during a pretravel consultation at three travel clinics in the Boston...

Background: Japanese encephalitis (JE) and rabies are serious vaccine preventable diseases which are an important consideration for travelers to Asia. Methods: Five Boston-area travel clinics collected demographic data, trip information, and interventions for travelers to Asia seen at pre-travel consultations from March 1, 2008, through July 31,...

A few decades ago, travel medicine, or travel health as labelled by WHO, had to be developed from scratch as an interdisciplinary field to protect travelers from illness and accidents, and ultimately death. A variety of surveys have shed some light on travel health risks. However, much remains to be done to improve the reliability of the evidence o...

Travel abroad for healthcare has increased rapidly; interventions include organ transplant; cardiac surgery; reproductive care; and joint, cosmetic, and dental procedures. Individuals who receive medical care abroad are a vulnerable, sentinel population, who sample the local environment and can carry home unusual and resistant infections, documente...

A fully updated version of this popular, clinically oriented, user-friendly text on infectious disease, with even more helpful graphics, tables, algorithms and images. It is packed full of information on diagnosis, differential diagnosis and therapy. In addition to the traditional organization of organ-system and pathogen-related information, this...

The epidemiology of dengue fever has undergone major shifts in recent decades. The global distribution has expanded to include more geographic areas. The intensity of transmission and the severity of infections have increased in areas where infection was already endemic. Multiple studies provide a clearer picture of the epidemiology and allow mappi...

Background Yellow fever (YF), a potentially fatal mosquito-borne infection, is preventable with a live-attenuated vaccine, rarely associated with severe adverse events. We surveyed travelers to assess their reasons for pre-travel medical consultation, information they considered important regarding YF disease and vaccination, whether they recalled...

Parasitic infections are an important cause of illness among returned travelers, and can lead to considerable morbidity and, in some cases, mortality. The complexity of parasitic life cycles and geographic specificities can present diagnostic challenges, particularly in non-endemic settings to which most travelers return for care. Clinical manifest...

Background As international travel increases, many health care professionals are being asked to provide pre-travel advice. We designed an anonymous web-based survey to assess the extent to which primary care providers (PCPs) provide travel medicine advice and how their understanding and delivery of itinerary-specific advice and management compare w...

We describe travelers who were evaluated pre-travel to Brazil from March 2008 through July 2010 in the Boston area. Of 599 Brazil travelers, 71%, 58%, and 50% received vaccines for yellow fever (YF), typhoid, and hepatitis A, respectively. Fewer received influenza and hepatitis B vaccines (14%, 11%). A total of 60% traveled during Brazil's peak inf...

BACKGROUND: Brazil will host the 2014 FIFA World Cup and the 2016 Olympic and Paralympic Games, events that are expected to attract hundreds of thousands of international travelers. Travelers to Brazil will encounter locally endemic infections as well as mass event-specific risks. METHODS: We describe 1586 ill returned travelers who had visited Bra...

Dengue viruses have spread widely in recent decades and cause tens of millions of infections mostly in tropical and subtropical areas. Vaccine candidates are being studied aggressively and may be ready for licensure soon. We surveyed patients with past or upcoming travel to dengue-endemic countries to assess rates and determinants of acceptance for...

Dengue virus (DENV) infections may occur in travelers. To determine prevalence of anti-DENV IgG antibody in travelers who lived in or visited dengue-endemic countries and to describe risk factors and characteristics associated with infection and subsequent anti-DENV IgG antibody presence. Participants were enrolled from travel clinics of the Boston...

To describe the medical conditions, travel plans, counseling, and medications prescribed for high-risk international travelers. This cross-sectional study was conducted from March 1, 2008, through July 31, 2010, in 5 clinics in the greater Boston area. We assessed all travelers seen for pretravel care and compared demographic characteristics, trave...

Travel abroad for healthcare has increased rapidly; interventions include organ transplant; cardiac surgery; reproductive care; and joint, cosmetic, and dental procedures. Individuals who receive medical care abroad are a vulnerable, sentinel population, who sample the local environment and can carry home unusual and resistant infections, documente...

Longitudinal data examining travel-associated illness patterns are lacking. To address this need and determine trends and clusters in travel-related illness, we examined data for 2000-2010, prospectively collected for 42,223 ill travelers by 18 GeoSentinel sites. The most common destinations from which ill travelers returned were sub-Saharan Africa...

Illness in business travelers is associated with reduced productivity on the part of the employee as well as the employer. Immunizations offer a reliable method of preventing infectious diseases for international business travelers. The authors review the travel patterns of business travelers, available data on illnesses they encounter, their poten...

Chinese translation International travel continues to increase, particularly to Asia and Africa. Clinicians are increasingly likely to be consulted for advice before travel or by ill returned travelers. To describe typical diseases in returned travelers according to region, travel reason, and patient demographic characteristics; describe the patter...

Persons born in countries with hepatitis B surface antigen (HBsAg) prevalence ≥2% have increased risk for unrecognized hepatitis B virus (HBV) infection. Testing at pre-travel consultations is a strategy to identify previously undiagnosed HBV infections. Using records of travelers seen at the Boston Area Travel Medicine Network (BATMN) sites, we as...

The study objective was to assess differences in demographics and travel health challenges between youths ≤18 years old traveling internationally to visit friends and relatives (VFRs) compared with those traveling for other purposes (non-VFR). The Boston Area Travel Medicine Network consists of 5 clinics collecting anonymous data from international...

Dengue virus (DENV) and chikungunya virus (CHIKV) cause significant morbidity in many world regions and their epidemiology, pathogenesis, vector issues, and control and prevention continue to fascinate researchers. This review focuses on the progress in these areas in the past 2 years. Recent studies have highlighted the features of the epidemiolog...

Providers must counsel travelers to yellow fever (YF)-endemic areas, although risk estimates of disease and vaccine serious adverse events (SAEs) may be imprecise. The impact of risk information and patients' requests for participation in vaccine decisions on providers' recommendations is unknown. Vaccine providers were surveyed regarding decisions...

Antimicrobial resistance is a growing problem globally. The appearance and spread of bacteria that are resistant to most or all commonly available antibiotics has raised the specter of untreatable bacterial infections. The New Delhi metallo-beta-lactamase-1 (NDM-1) has received wide attention because of the extreme resistance it confers, its presen...

Vaccine recommendations for travellers are based on individual risk assessments of multiple factors, most importantly the destination and duration of the impending trip. Many people undertake frequent trips, but existing WHO, CDC and national advisory board recommendations do not explicitly consider cumulative travel-associated risks. Given the per...

Influenza is a common vaccine-preventable disease among international travelers, but few data exist to guide use of reciprocal hemisphere or out-of-season vaccines. We analyzed records of ill-returned travelers in the GeoSentinel Surveillance Network to determine latitudinal travel patterns in those who acquired influenza abroad. Among 37,542 ill-r...

Introduction How Vectors Move Summary References

[This corrects the article on p. e939 in vol. 5.].

Infectious diseases are dynamic and can be expected to continue to change in the foreseeable future. Characteristics of the world today including extensive interconnections via travel, trade, and migration; human population size, density, and location; expansion of food animal populations and increasing contact with wild animal populations; changes...

megacities continue to expand rapidly in number and size globally. Several characteristics of megacities make them vulnerable to new and resurgent microbial threats. Megacities can serve as a source of microbes, a site of amplification, and a place in which introduced microbes can spread and disperse to other places. The global connectedness of meg...

Education, training, and a broad understanding of the social, political, economic, and environmental factors underlying poor health and health disparities are key elements in dealing with neglected tropical diseases (NTDs). We have now completed 3 years of the Harvard-Brazil Collaborative Public Health Field Course, and we believe this model is eff...

Vaccine preventable diseases (VPDs) threaten international travelers, but little is known about their epidemiology in this group. We analyzed records of 37,542 ill returned travelers entered into the GeoSentinel Surveillance Network database. Among 580 (1.5%) with VPDs, common diagnoses included enteric fever (n=276), acute viral hepatitis (n=148),...

Dengue and chikungunya are arboviruses that have caused major outbreaks and infected travelers, and both can be associated with fever and rash. We review the recent epidemiology of dengue and chikungunya infections and discuss their clinical presentations, diagnosis, treatment, and prevention. We highlight the findings in travelers. Globally dengue...