Port health problems.

As quarantine control of international travellers dies away, health screening of immigrants becomes more important. Port health controls attempt to identify the sick immigrant, thereby limiting disease spread among susceptibles and sparking early treatment. Port health controls also ease the impact of immigrants arriving at destinations by alerting relevant authorities so that they can begin health education procedures early, if they wish. Two problems arise: some destination authorities make little attempt to trace their immigrants and even those that do cannot find more than 70 per cent so notified. For receiving communities the most important disease the immigrant may carry or later develop is tuberculosis. In the indigenous population the incidence of this disease is decaying exponentially but, in communities of recent immigrants, may be stable or even rising. This means that in about ten years the great majority of new tuberculosis cases will be in recent immigrants, unless better preventive techniques are used. The overall trend is likely to be a fall in the number of cases, but the disproportion may provoke problems. What can be done? Assuming incoming immigrants are typical of their country of origin, many must enter Britain mantoux-negative, a fact supported by various destination authorities here which have performed testing. So, the logical solution is to ensure that all receive BCG vaccination, preferably before they migrate or otherwise as they enter Britain, and to ensure their babies born later in Britain also receive the protection of BCG vaccination. Consumption of medical services by the travelling public increases with the number of travellers and, as more people penetrate romantic but unhealthy areas formerly inaccessible, importation of communicable disease also increases. Many of these diseases could be prevented by good advice but, unfortunately, unfamiliarity blunts the edge of prophylaxis and diagnosis. Airport experience indicates that the general practitioner could help his patient more, particularly the overlander, by discussing sanitary precautions and suggesting anti-malarial drugs and immunization against typhoid and infectious hepatitis, when appropriate. Vaccination against smallpox, cholera or yellow fever may be obligatory and a valid certificate required; inoculation against diphtheria, poliomyelitis or tetanus may be sensible, and against rabies if the traveller may come into contact with animals abroad. Although complex queries about health hazards abroad should be addressed to such research centres as the Ross Institute, I suggest much practical advice can be obtained by phoning Heathrow health control 01-759 4361.