Northern European Conference of Travel Medicine in Edinburgh "a Smashing Success"

Karl Neumann, MD, FAAP

Can a medical society - or, for that matter, any society - continue indefinitely to maintain a record in which each successive conference is judged superior to the one immediately preceding it, especially when each preceding one was rated "outstanding?" Apparently, yes. The International Society of Travel Medicine is on a remarkable winning streak; all wins - and by ever bigger margins.

The recently concluded Northern European Conference of Travel Medicine (NECTM) in Scotland continued this amazing streak. The meeting attracted about 1,000 attendees from more than 40 countries, a record for an ISTM regional meeting. NETCM was the collaborative effort of the Travel Medicine societies of nine northern European countries and the ISTM. Having so many societies of any type working in harmony is by itself a monumental feat. Much credit goes to a slew of dedicated people headed by Fiona Genasi of the NETCM Organizing Committee and Eric Walker and Randi Hammer Boggi of the Scientific Committee.

The opening ceremony, a rousing Scottish welcome, held in the fabled Royal Museum of Scotland, in the old part of the city, set the tone (with bagpipes, of course) for the entire meeting. A band of bagpipers, about ten of them, in full Scottish regalia, assisted by other musicians provided an evening of music to accompany the excellent local food and drink. A few of the local travel medicine practitioners wore their kilts for the occasion, something they will long be remembered for by their foreign colleagues.

The Conference was a perfect blend of host city, conference hall, program and audience. Edinburgh is one of the more picturesque cities of Europe, if not the world. It is just the right size for walking, if you don't mind steep hills or outdoor stairs. There are lots of interesting attractions to explore, including castles, historic buildings and parks with the greenest lawns and brightly colored flowers; the lawns and flowers thanks to the legendary weather, rain. However, only a few drops of rain dared to fall during the Conference - as had been cautiously predicted by the organizers — who were also responsible for providing good weather. Fog did descend one evening, covering the hills in and around the city. The fog half engulfed the huge Edinburgh Castle, high on a hill in the middle of the City, a memorable eerie vision.

The Edinburgh Conference Center is state-of-the-art with unusually large and comfortable upholstered seats. It was a tribute to the quality of speakers that they were able to keep the audience alert and involved, when dozing off was an inevitable option. And it was also a tribute to the speakers that the audience, the bulk of them Europeans, did not stray from the sessions despite all the hoopla surrounding the beginning of the World Cup Football (soccer) tournament. (One of the first questions during an interactive travel medicine quiz was to name the opponent of the United States in the first round of play. Most of the Americans refused to answer the question, claiming that the question had nothing to do with travel medicine or on constitutional grounds against self incrimination, not wanting to show their ignorance regarding football in the midst of football frenzy. The answer: Czechoslovakia. The U.S. lost the match. No wonder).

The scientific sessions - obviously, the main attraction at conferences, especially at ISTM-sponsored ones — gave an overview of travel medicine, geographically, scientifically and chronologically, starting in the past, exploring the present and predicting the future if, indeed, there will be a future.

The speakers at the opening session were quite somber about the future. "If civilization finds a way of surviving it seems certain that the greed, profligacy and shortsightedness of our generation will come to be viewed with disgust and incredulity," said James Willis (UK) in his talk, Climate Changes and Its Implication for Travel. "The short-term interests of any particular group, the travel industry is a good example, are trivial in comparison with mankind's shared interests. In a frighteningly real sense we are all in the same boat, the same cruise liner, the same jumbo jet. And we are being warned in the strongest possible terms that our current course is heading to disaster."

"The implications of climate change for tourism and travelers are complex," said the second speaker, Sari Kovats, also from the UK (Climate change and Human Health: Early and Late Effects.) Many resorts will be directly affected by changes in climate factors, such as snowfall, storms and coastal dynamics. In the longer term, climate change will affect the suitability of certain places as tourist destinations. The UK is likely to benefit, as domestic tourism increases the result of warmer weather.

Human health will be affected by a range of mechanisms. The most important of these for travelers are: heat waves and heat stress, infectious intestinal diseases, vector-borne diseases, and floods/storm events. The heat wave of 2002 in Western Europe, an extreme event, was associated with over 14,000 excess deaths in France, albeit, information on deaths in tourists due to the heat wave are not available. Age and illness are strong predictors of heat related mortality as age highly correlates with increasing illness, disability, drug use and reduced fitness. This is especially significant as more elderly people are traveling routinely.

Climate changes will cause summer conditions in large towns and cities, particularly in southern Europe, to become less pleasant and more stressful as the number of hot days will increase, exacerbated by the urban heat island affect. Climate changes may cause an increase in the geographic distribution and transmission intensity of vector-borne diseases. There is some evidence of the northward expansion of important vector species in Europe due to observed climate change. Environmental temperature is an important factor in the transmission of bacterial agents causing enteritis, particularly for pathogens such as salmonella. Reported infections with salmonella increase by 5-10 % for each degree in ambient temperature. The effects of climate change on health have important implications for surveillance and on the advice given to travelers.

One of the highlights of the meeting was an address by Her Royal Highness, Princess Anne, who "came up from London" for the occasion. The Princess has had a long association with groups that advocate for the health and wealth of poor children in the developing world. She has been President of the Save the Children Fund since 1970, an organization that "fights for children who suffer from poverty, disease, injustice and violence." The Fund "works with the children to find lifelong answers to the problems they face." She spoke about what has been done, what is being done and what needs to be done in the future to help the children. The Princess was charming, making a very positive impression on the audience.