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Nearly 40 million journeys abroad were recorded from the Federal Republic of Germany last year. 60-70% of travellers going to southern countries seek medical advice for preventive measures, particularly in Public Health centres. Inquiries for vaccinations are prevalent. Current aspects of immunization against yellow fever, cholera, tetanus, polio, typhoid fever, hepatitis A, hepatitis B, rabies meningococcal meningitis, European tick-borne encephalitis, measles and tuberculosis are discussed. Finally, some remarks on malaria prevention, hygiene, health insurance and information services are given in brief.
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PMID:[Preventive health care in travel, especially vaccinations]. 253 28

The itinerary of international travelers will largely determine the amount of pretravel counseling number of immunizations and type of malaria prophylaxis they will need. The countries visited are also the best predictor of traveler's diarrhea. Only yellow fever and cholera vaccines are required for entry into certain countries; the latter generally given only to satisfy entry requirements. Polio vaccine is important for some areas and is frequently neglected. For most malarious areas, chloroquine once per week is recommended. Fansidar should be prescribed weekly for very few travelers. Traveler's diarrhea is best prevented by avoiding high risk foods and beverages. Antibiotics, generally not recommended for prophylaxis, are very effective in treatment. Travelers should be reminded to advise physicians of their travel history during future medical encounters so that diseases, possibly contracted during travel, may be considered in diagnoses.
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PMID:Counseling the international traveler. 279 6

Most travellers to tropical countries are young adults aged between 25 and 44; they tend to be of average or high socioeconomic status, to have a university education and to live in urban areas. The number of countries visited is high (111). Half the travellers go to Senegal, Ivory Coast and French Guiana. Asian countries are underrepresented among the clients of the Bordeaux centre because they do not require yellow-fever vaccination. The main reasons for travel are pleasure (73%) and business (23%). The length of stay is closely correlated with the reason for travel. Considerably more people travel in the winter period. The most frequently performed vaccinations are yellow fever, tetanus and poliomyelitis, in roughly equal numbers. A major role of a vaccination centre in the eyes of the public is to provide travellers with information and advice. A specialist centre of this kind, kept regularly informed about epidemiological developments around the world, is best equipped to advise on effective malaria prophylaxis. The centre's health-education role extends to all risks associated with travelling, in particular the sexually transmitted diseases and specifically tropical diseases, and also the consequences of changes in climate or altitude and failure to take general hygiene precautions. Computerized data banks accessible to the general public are certainly an information medium for the future, but at present are still underused.
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PMID:[Vaccination protection and advice to travellers. Statistical data on the activity of the International Vaccination Center of Bordeaux (France) in 1988]. 280 May 59

In a Nigerian town with a stable population of 20,000, a door-to-door survey was conducted, using a questionnaire involving a complete census and a simple neurological evaluation which had previously showed a 95% sensitivity and an 80% specificity for detecting neurological disease. Positive responders were evaluated and categorised, using agreed criteria for diagnoses. Nearly 100% cooperation was obtained. Life prevalence ratio for at least one episode of headache was 51/1000. Crude point prevalence ratio for migrainous headache was 5.3/100, and peak age-specific ratio was in the first decade. Prevalence ratio for epilepsy was 533/100,000 and peak age-specific prevalence ratio occurred in the 5-14 years age groups. The prevalence ratio for peripheral nerve disorders was 268/100,000, and age-specific prevalence ratio for tropical neuropathy increased with age. Prevalence ratio for stroke was rather low at 58/100,000, but was probably due to the people's attitude to the disabled elderly and high mortality of stroke which showed annual mortality rate of 70/100,000 which increased with age to 1519/100,000 per year in the eighth decade. Crude prevalence ratios (cases per 100,000) for others are 112 for neurological complications (including sciatica) of spondylosis, 15 each for poliomyelitis, motor neurone disease, development speech disorders, 10 each for syncope, hereditary neuropathies. Parkinson's disease, benign essential tremor, primary cerebellar degeneration, cerebral palsy, mental retardation, organic psychosis (probable intracranial tumor) and 5 each for muscular dystrophy, pyomyositis, spina bifida occulta, alcohol dependence and cerebral malaria. The implications of the findings are important for development of community neurological services in the developing countries.
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PMID:Neurological disorders in Nigerian Africans: a community-based study. 303 73

Some 8% of Swiss citizens travel in the developing countries annually. Advising these travellers is an important task for the physician, though the most frequent infections are the less serious travellers' diarrhea and common colds. To some extent the more serious tropical diseases can be avoided by appropriate measures, e.g. vaccination (against yellow fever, tetanus, polio etc). and by chemoprophylaxis (malaria). Individual fitness for travel should be checked prior to any journey abroad, and special advice must be given to travellers with special risks (e.g. pregnant women, infants, persons with chronic diseases, diabetics etc.). Most important during a stay in the tropics is a sensible way of life with enough sleep, general hygiene, especially with regard to food, and avoidance of untreated water. Further safety measures are recommended for bathing, strong sun exposure, mountaineering above 10,000 ft and in general for exposure to special health risks. Recognition of risks and their avoidance is often the best prophylaxis.
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PMID:[Health advice before travel to tropical countries]. 308 75

Although the prevention of infection through immunization is a central goal of maternal-child health programs in all developing countries, it is important to recognize that the role of vaccines varies greatly from country to country, from infection to infection, and from vaccine to vaccine. Immunization strategies must be as responsive to local disease patterns, needs, and opportunities as to technological advances in the creation, production, storage, and delivery of vaccines. This paper outlines the present state of the art for vaccines against measles, pertussis, poliomyelitis, tetanus, and tuberculosis. Other childhood infections in the tropics in need of a vaccine are the enteric infections, serious bacterial infections, vertically transmitted viral infections, and parasitic infections such as malaria. Immunization technologies related to the cold chain, delivery techniques, and adjuvants are constantly improving. Gains have also been made in outcome evaluation and disease surveillance. Ultimately, the success of the immunization effort depends on community participation and awareness.
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PMID:Recent advances in immunization. 331 42

Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and 12% respectively. Infectious diseases dominate the medical scene in Ethiopia. In 1984, tuberculosis accounted for 11.2% of hospital admissions and 12.2% of deaths. The leading cause of childhood mortality in 1984 was diarrhea (45%). Malaria, trypanosomiasis, schistosomiasis, leishmaniasis, and meningococcal meningitis are endemic. Intestinal parasitism is rampant, and the nationwide prevalence of leprosy is 3/1000. Venereal diseases were the 9th most common cause of hospital outpatient visits in 1984, but AIDS is rare. The leading noninfectious diseases are rheumatic and syphilitic heart disease, hypertension, diabetes mellitus, hepatoma, and elephantiasis. Ethiopia has the highest number of cases of nonfilarial elephantiasis -- an estimated 350,000 cases -- in the world. Aside from a large influx of money, the most necessary changes to improve the health system are lowering the salaries of doctors and nurses, reorienting physician training toward primary health care, increasing the quality of existing health services, more efficient management, and better coordination between the Ministry of Health and the voluntary organizations.
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PMID:Health and medical care in Ethiopia. 271 Jan 85

The immune response of young Nigerian children to a full course of infant immunizations was studied in relation to their nutritional state at the time of vaccination. No significant correlations were found between anthropometric measurements made at the time of vaccination and the antibody response to triple, polio, measles, meningococcal and typhoid vaccines. Significant correlations were found between serum pre-albumin levels and the response to group A meningococcal polysaccharide vaccine and between serum albumin levels and the response to group C meningococcal polysaccharide vaccine. These correlations may reflect the depressive effect of malaria both on serum albumin and pre-albumin levels and on immune responsiveness to meningococcal polysaccharides. No significant correlations were found between nutritional state at the time of BCG vaccination and the development of a positive tuberculin reaction five weeks later. We conclude that under-nutrition has little or no effect on the immune response to vaccines used in routine infant immunization programmes.
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PMID:The immune response to vaccination in undernourished and well-nourished Nigerian children. 363 2

The immune response of 198 young Nigerian children protected against malaria by chemoprophylaxis with chloroquine to immunization with triple, poliomyelitis, measles, typhoid, meningococcal and BCG vaccines was compared with the immune response to vaccination of 185 control children. Good responses to triple, measles and BCG vaccines were shown by children in both groups; poorer responses were obtained to poliomyelitis, typhoid and meningococcal vaccines. The response to immunization of protected children was similar to that observed among control children for all the vaccines tested except for meningococcal polysaccharide vaccine. Protected children showed a significantly greater antibody response to both group A and group C meningococcal polysaccharides than control children. This finding supports the results of previous studies which have shown that the immune response to meningococcal polysaccharide vaccines is adversely affected both by acute malaria and by asymptomatic malaria parasitaemia.
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PMID:Malaria chemoprophylaxis with chloroquine in young Nigerian children. II. Effect on the immune response to vaccination. 383 41

Most communicable diseases in Singapore have been brought under control and some eliminated. In recent years, an increasing proportion of the reported cases turned out to be imported. Between the period 1977 and 1982, 96% of malaria, 44% of paratyphoid, 32% of typhoid, 20% of leprosy, 11% of acute viral hepatitis, 7% of dengue fever/dengue haemorrhagic fever and 7% of cholera were imported. About 10% of the notified tuberculosis cases were non-residents while all the sporadic cases of poliomyelitis (except in 1977) and diphtheria (except in 1982) were contracted outside Singapore. The majority of the infections originated from Southeast Asia and the Indian subcontinent. The main groups of population with imported infections were local residents who travelled to the endemic areas without taking adequate preventive measures, foreign contract workers, and foreign seeking medical treatment in Singapore. Whether or not these imported cases would spread the infection to others in the community and cause epidemics depend on the virulence of the pathogen introduced, the susceptibility of the population and the environmental conditions which favour transmission of infection. Measures taken to reduce the risk of transmission include provision of a high standard of environmental sanitation, epidemiological surveillance to detect and eliminate the focus of infection; maintenance of a high level of herd immunity through immunisation; health education of the medical practitioners and of the public on the need for personal prophylaxis when travelling overseas; and screening of foreign contract workers and returning residents in special situations.
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PMID:Imported communicable diseases in Singapore. 609 73


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