Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 15, Number 11—November 2009

Globally Mobile Populations and the Spread of Emerging Pathogens

Author affiliations: Centers for Disease and Prevention, Atlanta, Georgia, USA (P.M. Arguin, N. Marano); University of Alabama at Birmingham, Birmingham, Alabama, USA (D.O. Freedman)

Cite This Article

During the past decade, the global public health community has been challenged by the emergence and rapid worldwide spread of novel influenza strains, severe acute respiratory syndrome, chikungunya virus, drug-resistant tuberculosis, and other conditions and pathogens. Modern transportation and increased tourism, business travel, and immigration contributed to dissemination of these high-impact pathogens. The effectiveness of interventions such as airport screening, travel restrictions, and other community mitigation measures remains uncertain. However, human migration has occurred for centuries and will continue, despite the threats posed by microbes.

Medicine and public health traditionally have focused on the individual pathogens. Today, however, we should look more closely at globally mobile populations that move pathogens across international borders. In addition, we should consider what travelers’ behaviors, demographics, or geographic origins tell us about the microbial hitchhikers they might bring with them.

Travel and migration medicine are unique disciplines because of their dual focus on protecting the health of the individual and protecting the community in which that individual lives, works, or travels. Articles in this issue highlight globally mobile populations and stimulate thought about a recurring theme in travel and migration medicine: better identification and definition of at-risk travelers. We need to be able to identify these populations of travelers and characterize them appropriately so we can better identify modifiable risk factors and target interventions to keep travelers safe and healthy during and after their journeys.

Globally mobile population is a fairly broad, intentionally inclusive term. The fields of travel and tropical medicine usually are associated with preparing tourists for international journeys or evaluating such travelers when they return sick. Articles in this issue demonstrate a much broader concern because of the existence of many different types of globally mobile populations. This issue features articles on some of those populations: refugees, immigrants (legal and not), long-term travelers, pregnant travelers, guest workers, soldiers, cruise ship passengers, and imported animals (16). These extremely different populations share a characteristic: they travel from one part of the world to another, placing themselves or others at risk for exposure to novel conditions and pathogens that can adversely affect their health.

In addition to articles about host populations are articles about populations of microbes for which epidemiologic niches have been shifted by our globally mobile populations. For example, travel and migration affect the spread of antimicrobial drug resistance, vaccine-preventable diseases, multidrug-resistant tuberculosis, novel influenza viruses, and dengue virus serotypes (79). The risks of travel in developing countries are known; however, imported infection also can originate in wealthy countries and on luxury cruise ships (5,10). These observations, although perhaps intuitive, help establish the foundation of the evidence base for recommendations for travel and migration medicine.

Travel and migration medicine are still fairly young fields. Much of the medical literature, including the articles in this issue, still focus on defining populations and describing diseases and conditions associated with certain groups or activities. Relatively few of these articles recommend or evaluate new interventions to keep globally mobile populations safer and healthier. Investigators and public health authorities need to start making this shift towards scientific evaluation of interventions that can lead to using this evidence to begin shifting toward recommendations for efficient, cost-effective methods to prevent illness in refugees, immigrants, and travelers. At the same time, all disease- or pathogen-specific guidelines from national and supranational bodies should explicitly address globally mobile populations. Studies that measure the impact of pretravel guidance, vaccines, and prescription of prevention or self-treatment medications will then follow.

We have many lessons to learn from the increasing number of communicable diseases associated with transportation and travel. The traveling public is our teacher; let us take this opportunity to focus on the intersection between the travel and migration medicine and public health communities to improve the control and prevention of infectious diseases in globally mobile populations.

Paul M. Arguin
Paul M. Arguin

Dr Arguin is chief of the domestic malaria unit in the Division of Parasitic Diseases at the Centers for Disease Control and Prevention.

Nina Marano
Nina Marano

Dr Marano is chief of the Quarantine and Border Health Services Branch in the Division of Global Migration and Quarantine at the Centers for Disease Control and Prevention.

David O. Freedman
David O. Freedman

Dr Freedman is professor of medicine and epidemiology at the University of Alabama at Birmingham and a founding director of the GeoSentinel Surveillance Network. Trained in clinical tropical medicine and parasitology, he is also director of the Gorgas Course in Clinical Tropical Medicine in Lima, Peru.



  1. Leslie T, Kaur H, Mohammed N, Kolaczinski K, Ord RL, Rowland M. Epidemic of Plasmodium falciparum malaria involving substandard antimalarial drugs, Pakistan, 2003.Emerg Infect Dis. 2009;15:17539.PubMedGoogle Scholar
  2. Nadjm B, Van Tulleken C, Macdonald D, Chiodini PL. East African trypanosomiasis in a pregnant traveler[letter]. Emerg Infect Dis. 2009;15:18667.PubMedGoogle Scholar
  3. Chen LH, Wilson ME, Davis X, Loutan L, Schwartz E, Keystone J, Illness in long-term travelers visiting GeoSentinel clinics.Emerg Infect Dis. 2009;15:177381.PubMedGoogle Scholar
  4. Song J-W, Moon S-S, Gu SH, Song K-J, Baek LJ, Kim HC, Hemorrhagic fever with renal syndrome in 4 US soldiers, South Korea, 2005.Emerg Infect Dis. 2009;15:18336. DOIPubMedGoogle Scholar
  5. Said B, Ijaz S, Kafatos G, Booth L, Thomas HL, Walsh A, Hepatitis E outbreak on cruise ship.Emerg Infect Dis. 2009;15:173844.PubMedGoogle Scholar
  6. Pavlin BI, Schloegel LM, Daszak P. Risk of importing zoonotic diseases through wildlife trade, United States.Emerg Infect Dis. 2009;15:17216.PubMedGoogle Scholar
  7. MacPherson DW, Gushulak BD, Baine WB, Bala S, Gubbins PO, Holtom P, Population mobility, globalization, and antimicrobial drug resistance.Emerg Infect Dis. 2009;15:172732.PubMedGoogle Scholar
  8. Forshey BM, Morrison AC, Cruz C, Rocha C, Vilcarromero S, Guevara C, Dengue virus serotype 4, northeastern Peru, 2008.Emerg Infect Dis. 2009;15:18158.PubMedGoogle Scholar
  9. Gavín P, Iglesias MJ, Jiménez MS, Herrera-León L, Rodríquez-Valin E, Rastogi N, Multidrug-resistant Mycobacterium tuberculosis strain from Equatorial Guinea detected in Spain[letter]. Emerg Infect Dis. 2009;15:185860.PubMedGoogle Scholar
  10. Tamminga N, Bierman WFW, de Vries PJ. Cutaneous larva migrans acquired in Brittany, France[letter]. Emerg Infect Dis. 2009;15:18568.PubMedGoogle Scholar


Cite This Article

DOI: 10.3201/eid1511.091426

Table of Contents – Volume 15, Number 11—November 2009

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.



Please use the form below to submit correspondence to the authors or contact them at the following address:

Paul M. Arguin, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F22, Atlanta, GA 30341, USA;

Send To

10000 character(s) remaining.


Page created: December 09, 2010
Page updated: December 09, 2010
Page reviewed: December 09, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.