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Author: M.S.c. M.D. Ivan

Juan Padrón Rendón The growth of travel and tourism, and the emergence of new emerging and re-emerging diseases, has caused diseases that were once a local problem to now be of global concern. Consequently, tourists and travelers can be the means of transmission of contagious diseases.
In recent decades, the world has experienced rapid changes that included population displacement, increased trade, tourism and international travel, as well as the emergence of new pathogens and re-emerging diseases. The World Health Organization (WHO) indicates that since the 1970, one or more emerging diseases have been identified each year.1
The arrival of millions of tourists constitutes a challenge for tourism providers and the health security of citizens of the United States, whose health system is more effective when state governments and their health authorities have collaborators for early detection and timely response to these threats.
The sources of information that can be used for early warning go far beyond traditional surveillance based on disease indicators, therefore, the early warning and response mechanism must be sensitive, detecting and responding quickly to signals and alerts coming from formal and informal sources, within and outside the health sector.
The tourism sector, in its role as recipient of these millions of tourists and travelers from around the world, is called to become a strategic ally of epidemiological surveillance, thus consolidating the important binomial Health-Tourism, whose results are mutually beneficial for these sectors and society in general.
The negative situation created in tourism by the COVID-19 pandemic is of great proportions. Globalization and the growth of international tourism generate economic dependence on this sector in several countries; in this sense, the pandemic has conditioned economic activity, which directly affects the foundations of the tourism system.2
Consequently, tourists can be the means of transmission of contagious diseases between territories, a situation that directly affects tourists and generates negative impacts in countries that send and receive tourists, since it is possible to cause a public health emergency.3
Infectious diseases drastically affect tourism, this is one of the reasons why governments must make efforts to prevent their arrival and subsequent spread in their territories through early warning systems and epidemiological surveillance in its different variants, especially in the sector itself and at the same time guarantee the health of residents and visitors.4
This work aims to provide basic elements for managers and workers in the tourism sector, which allows us to sensitize them in the role they can play as collaborators in epidemiological surveillance.

What is an emerging and re-emerging disease?
The World Health Organization (WHO) defines emerging and re-emerging diseases as follows:

Emerging diseases
These are those that have recently appeared or whose incidence has increased considerably in recent years. Examples include HIV/AIDS, the Ebola virus and SARS-CoV-2.5

Re-emerging diseases
These are those that, after having decreased in incidence, have reappeared with greater frequency or in new geographic areas and that once again constitute a health threat and that frequently reappear in epidemic proportions. Examples include tuberculosis and malaria.6
In 1992, the United States Institute of Medicine defined emerging diseases as those whose incidence has increased over the past 2 decades or threatens to increase in the future. Among them we can find:

By virus:
➢ HIV/AIDS infection.
➢ Ebola hemorrhagic fever.
➢ Hepatitis C, Delta, E, GB.
➢ Influenza A (H5N1) virus.
➢ Hantavirus pulmonary syndrome.
➢ Acute diarrheal disease due to Rotavirus.
➢ Erythema infectious.
➢ Hemorrhagic fevers due to arenavirus (Argentine, Venezuelan, Bolivian hemorrhagic fever).

By bacteria:
➢ Ehrlichiosis.
➢ Acute diarrheal disease due to Campylobacter jejuni and Escherichia coli 0157 H7.
➢ Legionellosis.
➢ Gastritis due to Helicobacter pylori.
➢ Toxic shock syndrome caused by Staphylococcus aureus.

Due to protozoa:
➢ Cryptosporidiasis.

Due to spirochetes:
➢ Lyne’s disease.

Re-emerging diseases
Re-emerging diseases refer to the resurgence of diseases that had apparently been eradicated or their incidence had decreased. They are all those known infectious diseases, which after not constituting a health problem, often appear taking on epidemic proportions. The following are well-known examples:

Virus:
➢ Dengue.
➢ Rabies disease.
➢ Yellow fever.

Bacterial:
➢ Cholera.
➢ Diphtheria.
➢ Necrotizing fasciitis.
➢ Leptospirosis.
➢ Plague.
➢ Tuberculosis.

Parasites:
➢ Malaria.
In future articles we will discuss each of the emerging and re-emerging diseases, as well as the hygienic-sanitary measures to prevent their contagion and transmission.

References:
1 Early detection, assessment and response to acute public health events: Implementation of Early Warning and Response with a focus on Event-Based Surveillance. World Health Organization, 2014.
2 Palomo, G., Navarro, E., Cerezo, A., & Torres, E. J. (2020). Turismo poscoronavirus, ¿una oportunidad para el poscrecimiento? En R. Simancas, R. Hernández, & N. Padrón (Coords), Turismo pos-COVID-19: reflexiones, retos y oportunidades (pp. 161-173). Cátedra de Turismo
3 Fernández M, B., Martínez, E., Díaz, O., Gómez, D., Sierra, M. J., Cano, R., Pérez, M., Durán, E., Cebollada, A. D., Vergara, A., Huerta, I., Grau, P., Cataliba, I., Rojo, M. L., Pla, A., Blasco, A., Javier Viloria, L., Ruiz S, C., Fernández, S., … Villatoro, K. (2019). Zika virus disease in Spain. Surveillance results and epidemiology on reported cases, 2015-2017. Medicina Clínica (EnglishEdition), 153(1), 6-12. https://revistas.uexternado.edu.co/index.php/tursoc/article/view/8828/14809
4 Matos, V. & Barcellos, E. C. (2010). Relações entre turismo e saúde: abordagens metodológicas e propostas de ação. Revista Panamericana de Salud Pública, 28(2), 128-134. https://www.scielosp.org/pdf/rpsp/2010.v28n2/128-134/pt
5 Emerging infections. Microbial threats to health in the Unites States. Washington, DC: National Academy, 1992.
6 Emerging and re-emerging infectious diseases: who responds to a global threat? Washington, DC: OPS,1994; vol 4:26-37.