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Vaccinology nowadays is going through an explosive "evolution". This development, which is due to progress in molecular biology and immunology, is accompanied by a world-wide change of how we view vaccination strategies. Thus, the vaccination of travellers and migrants should be increasingly included in the global control of the infectious diseases. The risks linked to travelling, which thanks to extensive vaccination are now better controlled globally, should decrease as the success of these programs grows. However, risks connected to those diseases, which do not yet lend themselves to preventive mass vaccination carried out systematically, will no doubt prevail for a long time. This is the case, for example, for diarrhetic diseases, typhoid fever, malaria, severe respiratory diseases, AIDS, tuberculosis or more regional diseases such as dengue or leishmaniasis. As far as vaccination is concerned, the best approach must take into account industrial feasibility and immunological considerations, as to the nature of the "target" of these new vaccines and the desired time of protection. It is also necessary to simplify immunization protocols in order to improve conditions for those who are vaccinated. Priority is given to the search for new vaccinal formulas compatible with these objectives. Significant changes in the domain of vaccination should therefore be expected in a future near enough to have an impact on our upcoming preventive programs ... from the year 2000 onwards.
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PMID:[Vaccines in the year 2000]. 947 58

Fevers without distinguishing symptoms in persons who have visited tropical or subtropical areas is an increasing health problem in most western countries. The condition may be caused by several different microbes, but among cases diagnosed in Norway five infections dominate: falciparum malaria, vivax malaria, typhoid fever, paratyphoid fever, and dengue fever. In this article the authors give an overview of current microbes, and present diagnostic guidelines on how to handle cases of imported fevers in Norway. Primary measures should be taken against immediate life-threatening diseases, e.g. typhoid fever and falciparum malaria.
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PMID:[Imported fever]. 949 29

A first-hand account is given of the epidemic of typhoid in the Goroka area as it evolved from 1984 to 1990. The monthly admissions for typhoid to Goroka Base Hospital showed a peak in 1988. The sex and age distribution showed a predominance of young adults. The overall case fatality rate of hospitalized patients was of the order of 10-15%; in a carefully documented group of 374 patients 27% were assessed as having severe typhoid and this subgroup had a case fatality rate of 44%. The clinical features were studied in 516 patients. The high mortality appeared to result from septic shock; ileal perforation was found in only 1.3% of patients. A skin lesion equivalent to but significantly different from the classic rose spot was found in 30% of patients. The typhoid facies was commonly encountered in patients with well-established typhoid. Cerebellar tremor and hearing loss were frequent diagnostic findings. Blood and bone marrow cultures were used to confirm the diagnosis; bone marrow culture proved practicable but gave little increased yield over blood culture. A clinical algorithm to help distinguish typhoid and malaria was developed, principally for use in health centres in the highlands. The mainstay of treatment was chloramphenicol and very few problems were encountered with its use in inpatients. Bacteriological resistance to chloramphenicol did not develop over the study period. Other drugs, such as fluorinated quinolones, may be more effective when all aspects are considered, despite higher cost, but this remains to be investigated. Hydrocortisone in patients with severe disease was evaluated and shown to be ineffective but whether high-dose dexamethasone would reduce the mortality from typhoid in patients in Papua New Guinea still remains an unanswered question.
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PMID:Typhoid in the highlands of Papua New Guinea 1984-1990: a hospital-based perspective. 952 73

Viral haemorrhagic fevers, such as Lassa fever and yellow fever, cause tens of thousands of deaths annually outside the Netherlands. The viruses are mostly transmitted by mosquitoes, ticks or via excreta of rodents. Important to travellers are yellow fever, dengue and Lassa and Ebola fever. For yellow fever there is an efficacious vaccine. Dengue is frequently observed in travellers; prevention consists in avoiding mosquito bites, the treatment is symptomatic. Lassa and Ebola fever are extremely rare among travellers; a management protocol can be obtained from the Netherlands Ministry of Health, Welfare and Sports. Diagnostics of a patient from the tropics with fever and haemorrhagic diathesis should be aimed at treatable disorders such as malaria, typhoid fever, rickettsiosis or bacterial sepsis, because the probability of such a disease is much higher than that of Lassa or Ebola fever.
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PMID:[Viral hemorrhagic fever]. 956 57

Fevers without distinguishing symptoms in persons who have visited tropical or subtropical areas is an increasing health problem in most western countries. The condition may be caused by several different microbes, but among cases diagnosed in Norway five infections dominate: falciparum malaria, vivax malaria, typhoid fever, paratyphoid fever and dengue fever. Primary measures should be taken against immediate life-threatening diseases e.g. typhoid fever and falciparum malaria.
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PMID:[Imported fever. A diagnostic challenge]. 957 92

A study was undertaken to determine the role of typhoid in febrile illness. It was found that in 1992, Salmonella typhi, the causative agent of typhoid, played a 2.3% role in 25404 diagnostic specimens sent to Mulago Hospital, Kampala, the largest hospital in Uganda. The rates of isolation fell gradually from 2.3% in 1992 to 0.3% by 1995. Instead malaria was found to play a major role in febrile illnesses. Out of 355 patients attending a private clinic in Kampala, whose blood was examined for both malaria and typhoid, 97% were positive for malaria parasites compared to 0.84% with significant O and H Salmonella typhi antibody titres of > 1:80. Also malaria parasites were found in 60% (out of 105) of patients who had had persistent fevers and in whom doctors had also requested for HIV antibodies. Those who had HIV antibodies alone were six per cent and the ones with both were 28%, a finding which showed relatively low association of malaria and HIV. Where multiple tests were requested on one patient having general malaise or body joint pains and/or constant headaches, malaria was found to play a major role (73%) compared to syphilis (4.3%) and brucellosis (13.3%). Malaria parasites were seen in normal sizes and in somehow young or stunted forms. The latter were found more often in patients who had experienced one or a combination of the following: intermittent fevers, backache, headache, tiredness, joint and/or neck pains, and who had already received treatment for malaria.
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PMID:Selected laboratory tests in febrile patients in Kampala, Uganda. 964 Aug 25

The dissolution of the Former Soviet Union (FSU) has resulted in the disruption of the health infrastructure in many of the republics, as indicated in part by increases in infectious diseases that were previously controlled (e.g., diphtheria, typhoid, and hepatitis A). In 1994, the Ministry of Health (MOH) of Armenia (1995 population: 3.5 million) detected the first locally acquired case of malaria since the 1940s; the number of imported cases (15) was approximately twice the annual average during 1986-1989 (seven). In 1995, although no locally acquired cases were reported, the number of imported cases increased to 502. In 1996 and 1997, the total (locally acquired and imported) number of reported cases of malaria was 347 and 841, respectively. This report summarizes surveillance for malaria in Armenia during 1996-1997.
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PMID:Epidemic malaria transmission--Armenia, 1997. 966 25

One third of persons who travel abroad experience a travel-related illness, usually diarrhea or an upper respiratory infection. The risk of travelers' diarrhea can be reduced by eating only freshly prepared, hot foods. Combination therapy with a single dose of ofloxacin plus loperamide usually provides relief from travelers' diarrhea within 24 hours. Using a diethyltoluamide (deet)-containing insect repellent and wearing permethrin-coated clothing can reduce the risk of malaria, yellow fever and other diseases contracted from insects. Routine immunizations such as tetanus, measles, mumps and rubella, and influenza should be updated if necessary before the patient embarks on the trip. Hepatitis A immunization should be administered to persons traveling to places other than Canada, Australia, New Zealand, Japan and western European countries. Typhoid vaccination should be considered for travelers going to developing countries. Yellow fever immunization is indicated for travelers going to endemic areas of South America and Africa. Malaria prophylaxis with chloroquine is indicated for travelers going to Mexico and Central America. Mefloquine is recommended for those traveling to areas where malaria is resistant to prophylactic treatment with chloroquine. Medical advice for patients planning trips abroad must be individualized and based on the most current expert recommendations.
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PMID:Travel medicine: helping patients prepare for trips abroad. 1002 83

For over a decade we have maintained within a district of 5 million people, a system of prompt reporting of cases of childhood vaccine-preventable diseases, encephalitis, meningitis, hepatitis, and rabies; together with a sentinel laboratory surveillance of cholera, typhoid fever, malaria, HIV infection and antimicrobial-resistance patterns of selected pathogens. The system combined government and private sectors, with every hospital enrolled and participating. Reports were scanned daily on a computer for any clustering of cases. Interventions included investigations, immunisation, antimicrobial treatment, health education, and physical rehabilitation of children with paralysis. All vaccine-preventable diseases have declined markedly, whilst malaria and HIV infections have increased steadily. Annual expense was less than one US cent per head. The reasons for the success and sustainability of this model include simplicity or reporting procedure, low budget, private-sector participation, personal rapport with people in the network, regular feedback of information through a monthly bulletin, and the visible interventions consequent upon reporting. This district-level disease surveillance model is replicable in developing countries for evaluating polio eradication efforts, monitoring immunisation programmes, detecting outbreaks of old or new diseases, and for evaluating control measures.
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PMID:Disease surveillance at district level: a model for developing countries. 979 29

International air traffic has increased the risk of importation of infectious diseases to Norway. We have used notification data and a theoretical framework to assess the risk of importation and subsequent disemination of serious infectious diseases in Norway. Every year, a few cases of these diseases are imported to Norway, especially malaria, shigellosis and typhoid fever. A few secondary cases of enteric diseases may occur, but epidemics are unlikely. Counselling and immunisation of Norwegians going abroad is the first step in prevention. Secondly, health services all over the country should be able to diagnose imported diseases early and institute infection control measures. However, there is no need for concentrating resources for disease control at international airports in Norway.
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PMID:[Communicable disease control in connection with international air traffic to Norway]. 982 12


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