Global 2004). Brower et al (2005) linked that

Global Perspective of Infectious Disease, Surveillance, and Prevention PolicyIntroduction to Global Infectious Diseases and Travel PolicyGlobalization has facilitated the spread of diseases beyond national borders. The public health issues are no longer contain within boundaries as it impacts the global community (WHO, 2005). A part of globalization impacts the health status of the individual directly and indirectly. However, Saker et al., (2004) stated that globalization has the more negative impact than positive on health due to the spread of infectious diseases. The global burden of infectious disease has remained a priority health concern as it is a leading cause of mortality and morbidity all over the world. Although non-communicable diseases (NCD) has also contributed, still infectious diseases account for the large proportions of morbidity and mortality (Saker et al., 2004). In 2000, the global burden of disease study projected that infectious disease was responsible for 22 percent of all deaths and 27 percent of all disability-adjusted life years (DALYs), which increased to 52 percent and 50 percent of all deaths and DALYs respectively in 2002 (Saker et al., 2004). Infectious diseases like HIV/AIDS, tuberculosis, and respiratory infections have an intense effect on individual lives in both developed and developing countries. However, the burden of infectious diseases remains higher in poor countries due to several factors (Saker et al., 2004). Brower et al (2005) linked that “disease has a profound negative impact on state’s social order, functioning, and psyche, and therefore infectious disease can act as a catalyst for regional instability” (p, 1165).  MacPherson et al (2007) stated that population mobility and global public health is interconnected and therefore international traveling does not only give the exposure to infection but also modify the effect and response of infection, which creates another challenge for its treatment and care. In order to decrease the incidences, Komatsu and Sawada (2007) stated that “understanding migrant vulnerabilities and instituting policies to reduce them are essential to control of such infections” (p, 746). Stern and Markel (2004) also asserted that 1500 people die every 60 minutes, not only from old infectious disease but also from new emerging diseases like West Nile fever or Ebola virus, which demands new interventions and strategies to treat it.  Thus, international travel policies should be considered as an important part of public health as it contributed to decreasing the mortality and prevents outbreak around the world. Infectious Disease and Prevention PolicyHuman immunodeficiency virus (HIV) is one of the infectious diseases that “represents 4 percent of the global burden of disease and receives the largest share of funding at 33 percent” (Nugent, 2015, p, 6). According to World Health Organization (WHO), HIV has become a social disaster, affecting developing countries at most. WHO further estimated that in 2004, about 40 million people were affected by HIV globally (Peterson, 2006). Currently, Sub-Saharan Africa has the highest prevalence of HIV in the world due to which they face devastating health, social, economic, and demographic impact, as it reduces life expectancy and deepened poverty (Peterson, 2006). HIV/ AIDS is transmitted through blood and body fluid. According to UNAIDS (1998), mother to child transmission during pregnancy, delivery, and breastfeeding is responsible for more than 90 percent of infected cases in children worldwide, however, remaining 10 percent are infected with contaminated blood transfusion and the use of unsterile medical equipment. Peterson (2006) also asserted that mother to child transmission accounts for 10 percent of child mortality with a negative impact on child’s physical and mental development. WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID) have taken initiatives to reduce HIV transmission by increasing accessibility to health care and by reducing the inequities and disparities in developing nations (WHO, 2017). Based on its transmission and high prevalence, policymakers in developing and developed countries have shown commitment toward implementing national AIDs programme and have targeted the high-risk groups including sex workers, intravenous drug users, prisoners and transgender people (Peterson, 2006).  Prevention policies are derived from WHO guidelines which focus on community strengthen programmes, awareness program, strategies to enable environment, and prophylactic antiretroviral treatment. Center for Disease Control and Prevention (2017), emphasis on taking antiretroviral treatment for high- risk groups as taking antiretroviral treatment prophylactic reduces the risk of acquiring HIV by 70-92 percent. Although the prevention programmes had stabilized the incidences of new infection in last recent years, CDC estimated that the number of HIV infection still continue to grow by thousands each year. In order to intensify the effect of the prevention program, CDC initiated high impact prevention approach to capture right population in right geographical areas (CDC, 2017). Travel Advisory of the U.S and South AfricaThe Center for Disease Control and Prevention aims to save and protect lives of people by updating health status and outbreaks for each country. It also assists traveler’s to be updated prior to traveling to prevent transmission of communicable diseases across borders. In this paper, I will compare the prevention policies and disease warning of the United States with South Africa, one of the Sub-Saharan African countries.  CDC updates international travelers regarding disease warning, vaccinated and non-vaccinated preventable diseases prevalent in South Africa. Due to the unhygienic environment and high prevalence of communicable diseases in Sub-Saharan African countries, CDC highly recommends traveler to be vaccinated for hepatitis A and B, rabies, typhoid, malaria and Yellow fever before traveling. They further reinforced to avoid exposure and unsafe practices like tattoos, piercing and intravenous drug use during their visit (CDC, 2017). Furthermore, for non-vaccinated preventable diseases like HIV, tuberculosis, African tick-bite fever, Chikungunya, and H5N1 avian influenza, CDC provides guidelines for each disease to reinforce preventive actions. Level three of travel notice warns travelers to avoid unnecessary travel, however, if traveling to southern Africa is necessary, CDC recommends traveling in winters when African tick-bite vector is inactive (CDC, 2017). Moreover, healthcare providers visiting South Africa should strictly follow standard precautions and reach-out healthcare facility in case of exposure to HIV (CDC, 2017). According to the preventive guidelines’ by CDC, a traveler should undergo tuberculin skin test (TST) and interferon Y release assay (IGRA) test before leaving the US and 8-10 weeks after returning to the US, for early detection of tuberculosis (CDC, 2017). Recently, CDC has also updated all traveler to be cautious about malaria in South Africa. As malaria is one of the fatal diseases if remain undiagnosed, CDC emphasized after travel medical exam for timely diagnosis and treatment (CDC, 2017). Travelers including healthcare workers are also recommended to take antihistamines, diarrhea medicines, decongestants and other regular medicines for their safe travel. In addition, the proof of health insurance documents, vaccinations, routine prescriptions and emergency contact card should also be carried with them during the visit (CDC, 2017). On the other hand, CDC also updates international travelers coming to the United States about current outbreaks and hurricanes. Recently, CDC gives disease warning of multidrug-resistant Campylobacter infection and Salmonella Typhimurium Infection in the United States. Although no deaths were reported, CDC initiated guidelines for clinicians and students to prevent infections (CDC, 2017). For the United States, CDC suggests traveler get all the recommended vaccines prior to travel and keep the proof of vaccination during travel (CDC, 2017). According to the safety laws and regulations, visitors are recommended to bring only necessary medicines along with prescription, however, unnecessary and unlabeled medicines are not advised. CDC mainly focus on after travel care for residents returning from developing the country to the United States due to the high risk of transmission of infectious disease (CDC, 2017).  In 2012, 85 percent of typhoid and 55 percent of malaria cases were reported in the United States among those who returned from developing countries, especially South Africa (CDC, 2017). Therefore, pre-travel counseling, routine medical check, travel history, vaccinations and timely detection of disease are an important element of post-travel care that a healthcare provider should consider (CDC, 2017). Teaching PlanWith the increase transmission of existing infectious diseases and outbreaks of emerging diseases, global health focuses on developing a framework to prevent and eradicate these infections as it poses a threat to global security. National Intelligence Estimate (NIE) (2000) projected that by 2020 majority of deaths will be the result of infectious diseases like HIV and TB in developing countries. The burden of infectious diseases remained modest in developed countries, but the incidences of re-emerging diseases and pandemic outbreak remains relatively high. NIE (2000) stated that Influenza has killed 30,000 Americans every year and numbers continue to rise. In order to halt the spread of infectious diseases in vulnerable regions like Sub-Saharan Africa and developed region like the United States, a framework is required to reinforce preventive policies and public health laws. Preventive strategies can be implemented at a national and individual level. A nurse practitioner can raise awareness by counseling regarding healthy lifestyles, avoiding unsafe practices, discouraging intravenous drug use and unprotected sex and regular medical exam for early detection and treatment of disease (CDC, 2017). Furthermore, reinforcing personal and environmental hygiene will also prevent malaria incidences. The preventive teaching plan at the national level should focus on improving access to care and vaccinations (NIE, 2000). Immunization is one of the cost-effective health intervention that can prevent up to 2 to 3 million of deaths and serious illness. Therefore, availability and affordability of immunization should be a priority in prevention plan (Controlling the spread of infectious disease, n.d., p. 154.) In addition, targeting high-risk communities for immunization and environmental sanitation projects will also help to overcome the risk factors for emerging and re-emerging diseases. For developed countries, preventive teaching plan at the national level should focus on expanding access to healthcare as it will facilitate screening, diagnosing and treating infectious disease in a timely manner (Controlling the spread of infectious disease, n.d.). Screening is one of the important public health strategies which manages comorbidities and treats disease within the timeframe. Based on the high prevalence of HIV in the United States, WHO emphasized on early management to reduce the transmission rates as “early treatment with antiretroviral drugs lowers the viral load of people with HIV and significantly reduces the risk of sexual transmission” (Controlling the spread of infectious disease, n.d., p, 155). Restructuring policies for mandatory testing at the prenatal and post-natal period and providing free treatment to HIV positive patient will also help to stabilize the mother-child transmission (Cecchine and Moore, 2006). However, a nurse practitioner can always promote preventive strategies by counseling and by reinforcing patients for early screening and treatment. Also, following up with patients in rural areas through telenursing will ensure proper implementation of prevention and control programs at an individual level.Global and Domestic Surveillance policyThe surveillance system for communicable diseases identifies the potential threat and evaluate the effectiveness of disease prevention and control program (WHO, 2006). The effective global surveillance system is crucial for containment of disease outbreak. As per the global surveillance policy, all countries are required to report, verify, maintain surveillance and develop response mechanism at the national level. The affected country is also required to verify and investigate for any outbreak that poses threat to public health to repress disease initially with the reporting to WHO within 24 hours (Hitchcock et al., 2007). The accurate and timely reporting of outbreaks holds a significance in global surveillance as it determines the global action and response to a specific outbreak.  Like global surveillance, domestic surveillance also required efforts to strengthen the communicable disease surveillance at a national level (WHO, 2000). Effective domestic surveillance creates a strong basis for global surveillance networks. WHO (2000) stated that “strong national systems will form the basis of an effective regional and global network for the surveillance and control of communicable diseases” (p. 8). Unlike global surveillance, domestic surveillance system mainly focuses on epidemic-prone diseases for that region in order to monitor trends and then eradicate at a national level. The effective domestic surveillance system helps to prioritize, plan and mobilize the resource at the time of the outbreak. Moreover, it also facilitates the decision making of policymakers of all countries (WHO, 2000). Surveillance activities focus on collecting information for different diseases, however, the core functions of surveillance activities involve case detection, reporting, investigation, analysis, and action/ response (WHO, 2000, p.9). Hitchcock et al (2007) stated that global disease prevention and control programs are purely based on active and rapid national surveillance systems which prompt the international health leaders to implement action plan within a time frame to prevent disease outbreak. Monitoring National Borders to Prevent Infectious DiseaseGlobal traveling has exposed people with a number of infectious diseases as international borders act as a carrier for transmission of the organism. International travel and health program by World Health Organization attempt to minimize the risk by reinforcing preventive guidelines (WHO, 2005). However, at the time of the active outbreak, CDC and WHO works collaboratively to prevent the spread of infection via borders (CDC, 2015). For example, in 2015 at the time of Ebola spread, CDC and WHO coordinated with health ministry of affected country, airlines and airports to initiate exit screening and travel restriction (CDC, 2015). This exit screening is not applicable for Ebola virus only, but also applicable for all other infectious diseases as it helps to restrict suspected or confirmed cases to travel until they are safe to do so. Furthermore, if any traveler was not identified at exit screening and landed to the United States, CDC works with the US airport to intensify entry screening (CDC, 2015). CDC (2015) stated that “screening and monitoring not only protects the health of these travelers but also reduces the chances of them spreading infections to others” (p. 1). Furthermore, International Health Regulation (IHR) by WHO was enacted in June 2005 with the intention to prevent the spread of disease across borders (Chan, 2007). These regulations aim to provide security against infectious disease and therefore focuses on proactive management to minimize the risk of spread. Chan (2007) also affirmed that “this strategy aims to detect an event early and stop it at its source – before it has a chance to become an international threat” (p. 7). ConclusionGlobalization has increased the spread of infectious diseases which has become a priority public health concern nowadays. World Health Organization and Center for Disease Control works together and provides guidelines to prevent transmission. International travelers are given pre-travel advisory and warning regarding the spread of diseases in the specific region. Being a nurse practitioner, it is our responsibility to counsel our patients regarding safe practices and preventive actions. Furthermore, considering travel history and detecting disease timely will also help to treat disease and avoid transmission to others. However, World Health Organization has also enacted International Health Regulations to overcome the impact of infectious diseases with increasing globalization. ReferencesBrower, J., Chalk, P., Kaplow, D., Lee, K., Buse, K., Fustukian, S., & Smith, A. P. (2005).Emerging and reemerging diseases and globalization. Journal of Health Politics, Policy and Law, 30(6). 1164-1178.Cecchine, G., & Moore, M. (2006). Infectious disease and national security: Strategicinformation needs. Santa Monica, CA: RAND Corporation. Center for Disease Control and Prevention (2017). Global disease detection program. Retrievedfrom Center for Disease Control and Prevention (2017). Traveler’s health. Retrieved from Center for Disease Control and Prevention (June 9th, 2015). The road to zero: CDC’s response tothe 2014 Ebola epidemic. Retrieved from, M. (2007). World health report 2007: Global public health security in 21st century.Switzerland: WHO Press.  Controlling the spread of infectious disease. (n.d.). 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(February, 2015).  WHO global coordination mechanism on the prevention andcontrol of non-communicable diseases. Switzerland: World Health Organization. Peterson, P. E. (2006). Policy for prevention of oral manifestations in HIV/AIDS: The approachof the WHO global oral health program. The Journal of Advance Dental Research, 19, 17-20.Saker, L., Lee, K., Cannito, B., Gilmore, A., & Lendrum, D. C. (2004). Globalization andinfectious disease: A review of the linkages (Report No. 3). Switzerland, Geneva: World Health Organization. Stern, A. M., & Markel, H. (2004). International efforts to control infectious diseases, 1851 tothe present. The Journal of the American Medical Association, 292(12). 1474-1479. UNAIDS, Joint United Nations Programme on HIV/AIDS. (1998). A review of HIV transmissionthrough breastfeeding. Retrieved from World Health Organization. (2017). HIV prevention, diagnosis, treatment and care for keypopulations: 2016 update. Retrieved from /10665/258967/1/WHO-HIV-2017.05-eng.pdf World Health Organization, human reproduction program. (2017). The importance of sexual andreproductive health and rights to prevent HIV in adolescent girls and young women in eastern and southern. Retrieved from WHO-RHR-17.05-eng.pdf World Health Organization. (2005). Strengthening health security by implementing theInternational Health Regulations. Retrieved from and mass gatherings/ en/ World Health Organization, Department of Communicable Disease Surveillance and Response.(2000). WHO Recommended Surveillance Standards. Retrieved from World Health Organization. (2006). Communicable disease surveillance and response systems:Guide to monitoring and evaluating. Retrieved from /publications/surveillance/WHO  


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