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Babesiosis is considered to be an emerging tick-borne disease in humans worldwide. However, most studies on the epidemiology of human babesiosis to date have been carried out in North America, and there is little knowledge on the prevalence of infection and frequency of disease in other areas. The aim of this study was to investigate the prevalence of Babesia infections in a human population in Germany. A total of 467 sera collected between May and October 1999 from individuals living in the Rhein-Main area were tested for the presence of immunoglobulin G (IgG) and IgM antibodies to antigens of Babesia microti and Babesia divergens by indirect fluorescent-antibody (IFA) tests. These sera were derived from 84 Lyme borreliosis patients suffering from erythema migrans, 60 asymptomatic individuals with positive borreliosis serology, and 81 individuals with a history of tick bite. Cutoff values for discrimination between seronegative and seropositive results in the IFA tests were determined using sera from 120 healthy blood donors and 122 patients suffering from conditions other than tick-borne diseases (malaria, n = 40; toxoplasmosis, n = 22; syphilis, n = 20; Epstein-Barr virus infection, n = 20; and presence of antinuclear antibodies, n = 20). The overall specificities of the IFA tests for B. microti and B. divergens were estimated to be >or=97.5%. Positive IgG reactivity against B. microti antigen (titer, >or=1:64) or B. divergens antigen (titer, >or=1:128) was detected significantly more often (P < 0.05) in the group of patients exposed to ticks (26 of 225 individuals; 11.5%) than in the group of healthy blood donors (2 of 120 individuals; 1.7%). IgG antibody titers of >or=1:256 against at least one of the babesial antigens were found significantly more often (P < 0.05) in patients exposed to ticks (9 of 225) than in the control groups (1 of 242). In the human population investigated here, the overall seroprevalences for B. microti and B. divergens were 5.4% (25 of 467) and 3.6% (17 of 467), respectively. The results obtained here provide evidence for concurrent infections with Borrelia burgdorferi and Babesia species in humans exposed to ticks in midwestern Germany. They also suggest that infections with Babesia species in the German human population are more frequent than believed previously and should be considered in the differential diagnosis of febrile illness occurring after exposure to ticks or blood transfusions, in particular in immunocompromised patients.
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PMID:Seroprevalence of Babesia infections in humans exposed to ticks in midwestern Germany. 1208 58

Various measures are taken to ensure the safety of the blood supply. Donor selection begins with education of the public about transfusion-transmissible diseases. Potential donors must answer a questionnaire designed to identify specific risk factors for these infections. The questionnaire is the only line of protection against certain infections for which no testing is performed, such as malaria, babesiosis, leishmaniasis, and Chagas disease. All donations are tested for the presence of antibodies to HIV-1 and -2, HCV, HTLV and syphilis, the hepatitis B surface antigen (HbsAg), the p24 antigen (HIV), and also for HIV and HCV nucleic acids. The introduction of new and improved screening tests for transfusion-transmissible diseases has led to remarkable improvement in the safety of the blood supply, with substantial shortening of the window period for HIV, HCV, and HBV infections. The current challenge of the industry is to reduce even further the small but significant risk of bacterial contamination of platelet components. Finally, some safety measures are purely precautionary, such as the deferral of donors who have traveled to certain countries affected by the bovine spongiform encephalopathy (BSE).
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PMID:Blood donor selection and screening: strategies to reduce recipient risk. 1223 32

Initial results of research indicate that the Program for Appropriate Technology in Health (PATH) in Washington, D.C. has developed an HIV-1 screening test, the HIV ImmunoDot Test, appropriate to conditions in developing countries. This means it's affordable, quick, simple, and can be manufactured in developing countries. The need for such a test is based on the occurrence of HIV transmission through blood transfusions to anemic women and children, which is a leading cause of hospitalization. It is reported that in the hospital Mama Yemo of Kinshasa, Zaire that 12,800 transfusions were performed annually in 1985/6, of which 560 children contracted the AIDs virus that same year. The rate is 15% of patients compared to 2% for Europe. Although the number of transfusions in this hospital have declined, blood from donors is frequently contaminated by hepatitis, malaria, syphilis, or HIV-1. The HIV ImmunoDot Test produces results in 20 minutes. It is highly sensitive; easy to interpret, requires no refrigeration, special equipment or instruments; and costs 25 US cents. Manufacturing plans are being developed for its manufactured in developing countries. The test consists of 8 teeth or tabs on a comb activated by a synthetic peptide derived from the GP41 molecule and allows for testing 8 serum samples simultaneously. The comb may be cut to test fewer samples. The procedure involves setting the comb in the blood specimens for 10 minutes at ambient temperature. Then it is washed in a saline solution and set to incubate for 10 minutes in an indicator reagent. After this, it is washed again in a saline solution, and read after it has dried. A red dot indicates contact with HIV positive serum. The cost for a production run of 500,000 is 12 US cents per unit test compared to the ELISA test of 207 US dollars per unit test. The PATH ImmunoDot Test is stable for up to a year at ambient temperatures typical in Equatorial Africa. The test occasionally shows positive results when it is not (98.2% specificity). Such tests are rare enough that followup with ELISA or Western Blot can confirm accurate results. It is preferable to discard a unit of blood than to transmit the virus. The research was part of an international collaborative effort.
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PMID:New test for AIDS. 1228 91

The Nomadic Health Unit of the African Medical and Research Foundation (AMREF) has been running mobile clinics in 2-week excursions throughout Maasailand, Kenya for 30 years. The problems The problems encountered and their solutions and the nature of the operation are reported. In the early days of the program, the emphasis was on providing immunization and preventive services. A clinician carried a microscope until a laboratory technologist was hired in 1987. Standard laboratory equipment in the mobile clinic includes a lightweight Leitz microscope which runs on a 12-volt vehicle battery or a main electric source. There is also a small portable spectrophotometer. Blood is separated and sera preserved up to 2 weeks in liquid nitrogen, an then kept refrigerated at AMREF headquarters until needed. A portable battery- operated Toshiba computer is also available. Laboratory capability means blood analysis can be performed to detect malaria, particularly chloroquine-resistant malaria. Treatment for malaria no longer involves chloroquine; amodiaquine or Fansidar is now used. In 1990, 235 slides were examined for malaria of which 16% were positive. 36 sputum stains were analyzed for acid-fast bacteria, of which 5 were positive. Maternal health care involved 561 antenatal visits, which involved hemoglobin estimates and a syphilis reagent test. Most hemoglobin results ranged between 8-11 g/dl. Patients receive supplemental iron and folic acid. Of the 575 syphilis tests, 6% were positive and patients were treated with penicillin. In northwest Turkana there has been a high prevalence (5-10%) of Echinoccus granulosis which is detected with an ultrasound scanner by a parasitologist. Small cysts are not detectable by scanner or serology. Computer analysis is accomplished with a compiled Dbase program. Several methods of data entry were tried. At present, the clinician enters patient records directly into the computer; patients keep their own records. A paper copy is also available. WHO ICD9 codes are used for identifying diseases. Coding for lab tests and prescriptions is done with a self- generated system. Compilations are made of total prescriptions, lab tests conducted, and diseases encountered. Prescriptions average 3 Kenyan shillings (US $.10). A frequent problem is patients with vague complaints desiring drugs. Drugs are dispensed as necessary, or not at all. Traditional birth attendants (TBAs) are trained by a clinic nurse by visiting other TBAs and health clinics. Community volunteers manage tachoma. Other satellite activities include a school health program and a training program for village health workers.
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PMID:Taking health care to the Maasai. 1228 83

HIV transmission is the greatest single risk of blood transfusion today. The World Health Organization estimated in late 1900 that 8-10 million persons worldwide were HIV seropositive. In Africa, 10% of adult and 25% of early childhood HIV infections are believed to be caused by contaminated transfusions. 90% of patients transfused with contaminated blood will become infected. The other serious infectious risks of transfusion are hepatitis B, malaria, and syphilis. Accidents and complications of transfusion can be avoided if transfusions are limited to absolute indications, clinical examinations of donors are thorough, the blood group is reliably determined, and testing of blood for HIV is reliably conducted. Transfusions not formally indicated are now formally contraindicated. The vital risk if the patient is not transfused must be assessed before the transfusion is done, as should the risk of transmitting infection through the transfusion. When emergencies occur in isolated areas, the donor is often a family member or person accompanying the patient. The blood of the donor as well as of the patient must be typed. The medical history and clinical examination of the donor to exclude contraindications must be thorough. The physical contraindications to blood donation are infectious disorders and especially AIDS, a history of untreated syphilis or jaundice, and recent malaria. Blood should never be donated by persons with fever, jaundice, cutaneous lesions suggesting syphilis or AIDS, clinical anemia, or cardiac insufficiency. Pregnant women and children under 15 should not donate blood. Aseptic conditions must be maintained during all handling of the blood. ABO and rhesus grouping and testing for HIV infection must be done in all cases. ELISA tests are most often used for blood screening, but the rapid tests developed a few years ago are equally reliable and more suited to isolated medical facilities or those that perform few transfusions. Because the tests give false positive results in a significant proportion of cases, they should be repeated before a positive result is reported. The results of an HIV test, whether positive or negative, should only be reported to the donor if information on the consequences of a positive test has been provided and consent to the test has been obtained, the screening test results have been confirmed by a diagnostic test, and the seropositive individual can receive medical follow-up and counselling. Prevention of syphilis transmission can be achieved by limitation of indications for transfusion, selection of low risk donors, clinical examination of donors, use of blood stored for 72 hours at 4 degrees celsius or lower, use of screening tests, and prophylactic administration of antibiotics. Clinical examination and a careful medical history are the main tools for preventing hepatitis B transmission. Systematic prophylaxis against malaria following national protocols is recommended.
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PMID:[Transfusion practice in isolated areas: prevention of HIV transmission]. 1228 4

Blood transfusion programs can minimize the risk of transfusing infected blood through three strategies: 1) recruiting and counseling voluntary donors who are at low risk of human immunodeficiency virus (HIV), 2) screening all donated blood for HIV and other infections transmitted by blood and safely disposing of infected blood, and 3) reducing the number of blood and blood product transfusions. Schools, universities, church groups, community centers, and workplaces provide opportunities for educating and recruiting people at low risk of HIV. Avoided should be paid donors; men and women who sell their blood are often at high risk of serious communicable diseases. All donated blood should be screened for HIV, hepatitis B, syphilis, and, depending on local disease patterns and resources, hepatitis C, Chagas' disease, and malaria. Donors should be informed of their HIV infection only after two tests have produced positive results. Because of the HIV "window period," during which antibodies are not yet detectable, a few infected blood units may be released. Where possible, blood substitutes such as saline or blood pre-collected from the patient should be used. Key to reducing the number of blood transfusions, however, is the prevention of anemia and pregnancy complications -- the indications for most transfusions.
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PMID:Strategies for safe blood. Reducing HIV transmission. 1229 28

In order to have a rational approach to necessary preventive measures it is essential to know the health risks. The 80 million travellers each year with destinations in Africa, Asia, Latin America, Pacific Islands and remote areas in Eastern Europe are exposed to a broad range of pathogens that are rarely encountered at home. The risk depends on the degree of endemicity in the area visited, the duration of stay, the individual behaviour and the preventive measures taken. Travellers' diarrhoea (TD) is the most frequent ailment of visitors to countries with poor hygiene. The incidence rate is 25-90% in the first 2 weeks abroad. The risk of TD is far less in travellers originating in a high risk country, as some immunity develops. Malaria is an important risk for travellers going to endemic areas. Without chemoprophylaxis, the monthly incidence is high in some destinations, among them frequently visited tropical Africa where 80-95% of the infections are due to Plasmodium falciparum. The incidence rates are lower in most endemic areas of Asia and Latin America where Plasmodium vivax predominates. The risk is nil in all capital cities of South America and SE Asia, as well as in many frequently visited tourist destinations. The diseases preventable by immunization will be discussed in a separate paper (Vaccination priorities; page 175). Sexually transmitted diseases occur frequently, as some travellers (5% of Europeans) engage in casual sex, approximately half of them without being protected by a condom. The prevalence for HIV-infection, syphilis, gonorrhoea, etc. often exceeds 50% in prostitutes. In some European countries, a major proportion of heterosexuals with newly acquired HIV-infection have acquired it while abroad.
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PMID:Travel epidemiology--a global perspective. 1261 69

Frequently clinicians are faced with screening and providing preventive care to immigrants, refugees, and international adoptees. Evidence-based medicine on which to base screening protocols for these populations is lacking. It is important to review all health and vaccination records of the patient. In addition to acute symptoms, one should inquire about the symptoms of diseases prevalent in the country of origin or transit (e.g., hematuria). Many unexpected pathologic conditions may be detected by a thorough physical examination. If a reliable immunization record is presented, one need not repeat the vaccines or check titers. Remaining vaccines should be administered according to ACIP guidelines, except for certain populations (e.g., adoptees). Routine laboratory screening tests should include CBC with differential, stool for ova and parasites, urinalysis, general chemistry profile, serology for hepatitis B, and tests for HIV and syphilis. A tuberculin skin test should be performed on all immigrants, and a chest radiograph should be obtained for any patient with symptoms or a positive PPD. Lead level, hepatitis C, and TSH should be obtained for all children and most adoptees. In addition, special screening tests (e.g., for malaria, hepatitis C, and STIs) may be indicated in high-risk populations. A more organized screening system that emphasizes evidence-based and population-specific screening protocols and better communication between international, federal, state, and local levels is needed in the United States.
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PMID:Screening of international immigrants, refugees, and adoptees. 1268 98

Because of the invasion of the Ottoman territory after the World War I, the Turkish War of Liberty was initiated by Mustafa Kemal Pasha and his friends. While they aimed at a successful outcome of the battle, they at the same time tried to achieve a nation-wide organization. In order to look after the nation's medical and social service, on May 2nd 1920, a new ministry called the Ministry for Medical and Social Service was founded. The new ministry's task was not only to concern itself with the medical and social service, but also with immigration and of the immigrants. At the beginning the hitherto existing social system and certain laws were not abolished until they were replaced by new ones in order to prevent an interruption in the social service. In these years the aim of the social system was to struggle against infectious diseases, to prevent infections, to decrease infant mortality and to increase the population, to take measures against diseases from abroad, to pass the laws needed and to form a central authority. Besides these laws which were directly related with the medical and social service during the War of Liberty, the governing of the districts and the regulations concerning the miners in Zonguldak were passed in order to protect peoples' health. Our political existence was confirmed through the signing of the agreement reached by the Lausanne Conference after the War of Liberty and consequently the Medical Care Supreme Council of Istanbul, which had continued its validity as a capitulation, was abolished. The social state policy of the period which had started with the foundation of the Turkish Republic aimed to extend the state's medical staff, continue the employment of the health personnel specialized in medicine, struggle against infectious diseases in an organised way, provide a wide-spread medical service, give priority to preventive health care and establish medical institutions, effect a cooperation of these institutes, pass the necessary laws and establish state supervision in all fields. In the first ten years of the Republic, new schools and courses were started in order to increase the number of the medical staff to be sent to areas deprived of social service. In accordance with the Obligatory Service Law of 1923, doctors who were sent to eastern Turkey were provided with encouraging advantages. The organizational work and the laws concerning infectious diseases like malaria, syphilis and trachoma, which were wide-spread, was effective and successful from the year 1925 onwards when Dr. Refik Saydam was the Minister for Health. The meetings of the Turkish National Congresses on Medicine helped solve the nation's health problems and influenced the state's policy and the Health Ministry's activities. The aim was not merely the protection of peoples' health through education. In this period, many laws were passed with the aim to protect the nation's health and to ensure state control in every field. Some of these are still in force today. Besides the medical treatment of the poor and the old, laws of validity for a long period, which were effective in the protection of the health of children, the adolescent and the pregnant women in the social life and employment, were passed. In the first ten years of the Republic a protective, comprehensive and human health policy was observed in accordance with the policy of the state.
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PMID:[Health policy of the Republic of Turkey in accordance with the Minutes of the Turkish Parliament (part I)]. 1457 15

Expatriates are at risk for a number of infectious diseases for which short-term travelers generally are not at risk. Returning expatriates should undergo a detailed physical examination and a basic set of laboratory tests; these tests should be tailored to their specific history and exposures. Febrile patients with an appropriate exposure history must be evaluated for malaria; other potential diagnoses may be determined by incubation period, geographic exposure, and associated symptoms. When evaluating an ill returned expatriate with fever, it is important to exclude malaria, typhoid, leishmaniasis, brucellosis, tuberculosis, HIV infection, and syphilis. Gastrointestinal irregularities in expatriates may be caused by a number of infectious and noninfectious causes, including intestinal helminthiasis, strongyloidiasis, schistosomiasis, liver flukes, and amebiasis. Eosinophilia in returned expatriates often is associated with an infectious process and should be evaluated. Many infections associated with long-term overseas deployment may include dermatologic manifestations, including filariasis and leishmaniasis.
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PMID:Medical problems in the returning expatriate. 1504 71


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