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Volume 15, Number 11—November 2009

Volume 15, Number 11—November 2009   PDF Version [PDF - 5.00 MB - 183 pages]

Perspective

  • Health Status of Visitors and Temporary Residents, United States PDF Version [PDF - 119 KB - 6 pages]
    E. A. Yanni et al.
        View Abstract

    Human mobility has always been associated with the spread of infection, and mobility of nonimmigrant visitors and temporary residents to the United States is increasing, from ≈12 million in 1987 to ≈37 million in 2007. Lack of information about the health status of these populations upon arrival and their need for and use of medical services in the United States hinders development of public health policy, education, and provision of adequate clinical care. After these issues and needs are clarified, intervention programs should be developed to increase access and decrease the disparities of care experienced by these populations.

  • Risk of Importing Zoonotic Diseases through Wildlife Trade, United States PDF Version [PDF - 141 KB - 6 pages]
    B. I. Pavlin et al.
        View Abstract

    The United States is the world’s largest wildlife importer, and imported wild animals represent a potential source of zoonotic pathogens. Using data on mammals imported during 2000–2005, we assessed their potential to host 27 selected risk zoonoses and created a risk assessment that could inform policy making for wildlife importation and zoonotic disease surveillance. A total of 246,772 mammals in 190 genera (68 families) were imported. The most widespread agents of risk zoonoses were rabies virus (in 78 genera of mammals), Bacillus anthracis (57), Mycobacterium tuberculosis complex (48), Echinococcus spp. (41), and Leptospira spp. (35). Genera capable of harboring the greatest number of risk zoonoses were Canis and Felis (14 each), Rattus (13), Equus (11), and Macaca and Lepus (10 each). These findings demonstrate the myriad opportunities for zoonotic pathogens to be imported and suggest that, to ensure public safety, immediate proactive changes are needed at multiple levels.

  • Population Mobility, Globalization, and Antimicrobial Drug Resistance PDF Version [PDF - 123 KB - 5 pages]
    D. W. MacPherson et al.
       

Synopses

  • Public Health Response to Imported Case of Poliomyelitis, Australia, 2007
    J. A. Carnie et al.
        View Abstract

    Australia, along with 36 other countries in the Western Pacific Region, was declared free of poliomyelitis by the World Health Organization in October 2000. Yet, the persistence of wild poliovirus in the 4 remaining polio-endemic countries—Afghanistan, India, Nigeria, and Pakistan—poses a risk for its importation into all countries declared polio free. We describe the public health response and outcomes resulting from the importation of a wild poliovirus infection in Melbourne, Australia, in July 2007. This response, based on an assessment of the risk for transmission, included offering vaccination with inactivated polio vaccine to the contacts and placing the index patient in isolation and the household contacts in quarantine until consecutive fecal specimens were negative for poliovirus by culture. The experience gained from the polio importation event in Australia may assist other polio-free countries to prepare for, and respond to, a similar event. No secondary clinical cases resulted from this importation.

Research

  • Hepatitis E Outbreak on Cruise Ship PDF Version [PDF - 180 KB - 7 pages]
    B. Said et al.
        View Abstract

    In 2008, acute hepatitis E infection was confirmed in 4 passengers returning to the United Kingdom after a world cruise. Epidemiologic investigation showed that of 789 persons who provided blood samples, 195 (25%) were seropositive, 33 (4%) had immunoglobulin [Ig] M levels consistent with recent acute infection (11 of these persons were symptomatic), and 162 (21%) had IgG only, consistent with past infection. Passenger mean age was 68 years. Most (426/789, 54%) passengers were female, yet most with acute infection (25/33, 76%) were male. Sequencing of RNA from 3 case-patients identified hepatitis E virus genotype 3, closely homologous to genotype 3 viruses from Europe. Significant association with acute infection was found for being male, drinking alcohol, and consuming shellfish while on board (odds ratio 4.27, 95% confidence interval 1.23–26.94, p = 0.019). This was probably a common-source foodborne outbreak.

  • Imported Infectious Diseases in Mobile Populations, Spain PDF Version [PDF - 197 KB - 8 pages]
    B. Monge-Maillo et al.
        View Abstract

    Migration has contributed to the emergence of certain infectious diseases. To determine which infectious diseases were most common among 2 mobile immigrant groups (sub-Saharan Africans and Latin Americans) in Spain, we analyzed health and demographic characteristics of 2,198 immigrants referred to the Tropical Medicine Unit of Ramón y Cajal Hospital over a 20-year period. The most frequent diagnoses were for latent tuberculosis (716 patients [32.6%]), filariasis (421 [19.2%]), hepatropic virus chronic infection (262 [19.2%]), intestinal parasites (242 [11.0%]), and malaria (212 [9.6%]). Health screening of immigrant populations is needed to ensure early diagnosis and treatment of potentially transmissible infections.

  • Epidemic of Plasmodium falciparum Malaria Involving Substandard Antimalarial Drugs, Pakistan, 2003
    T. Leslie et al.
        View Abstract

    Because of instability in eastern Afghanistan, new refugees crossed into the federally administered tribal areas of northwestern Pakistan in 2002. In 2003, we investigated an epidemic of Plasmodium falciparum malaria in 1 of the camps. Incidence was 100.4 cases/1,000 person-years; in other nearby camps it was only 2.1/1,000 person-years. Anopheline mosquitoes were found despite an earlier spray campaign. Documented clinical failures at the basic health unit prompted a drug resistance survey of locally manufactured sulfadoxine-pyrimethamine used for routine treatment. The in vivo failure rate was 28.5%. PCR analysis of the P. falciparum dihydrofolate reductase and dihyropteroate synthase genes showed no mutations associated with clinical failure. However, chemical analysis of the drug showed that it was substandard. As global incidence decreases and epidemics become more of a threat, enhanced quality assurance of control interventions is essential.

  • Epidemiology of Hepatitis A Virus Infections, Germany, 2007–2008 PDF Version [PDF - 329 KB - 9 pages]
    M. S. Faber et al.
       
  • Screening Practices for Infectious Diseases among Burmese Refugees in Australia PDF Version [PDF - 250 KB - 4 pages]
    N. J. Chaves et al.
        View Abstract

    Increasing numbers of refugees from Burma (Myanmar) are resettling in Western countries. We performed a retrospective study of 156 Burmese refugees at an Australian teaching hospital. Of those tested, Helicobacter pylori infection affected 80%, latent tuberculosis 70%, vitamin D deficiency 37%, and strongyloidiasis 26%. Treating these diseases can prevent long-term illness.

  • Illness in Long-Term Travelers Visiting GeoSentinel Clinics PDF Version [PDF - 353 KB - 10 pages]
    L. H. Chen et al.
       
  • Multicenter EuroTravNet/GeoSentinel Study of Travel-related Infectious Diseases in Europe PDF Version [PDF - 201 KB - 8 pages]
    P. Gautret et al.
        View Abstract

    We analyzed prospective data on 17,228 European patients who sought treatment at GeoSentinel sites from 1997 to 2007. Gastrointestinal illness (particularly in tourists), fever (those visiting friends and relatives [VFRs]), and skin disorders (in tourists) were the most common reasons for seeking medical care. Diagnoses varied by country of origin, region visited, or categories of travelers. VFRs who returned from sub-Saharan Africa and Indian Ocean islands were more likely to experience falciparum malaria than any other group. Multiple correspondence analysis identified Italian, French, and Swiss VFRs and expatriate travelers to sub-Saharan Africa and Indian Ocean Islands as most likely to exhibit febrile illnesses. German tourists to Southeast and south-central Asia were most likely to seek treatment for acute diarrhea. Non-European travelers (12,663 patients from other industrialized countries) were less likely to acquire certain travel-associated infectious diseases. These results should be considered in the practice of travel medicine and development of health recommendations for European travelers.

  • Medscape CME Activity
    Multicenter GeoSentinel Analysis of Rickettsial Diseases in International Travelers, 1996–2008 PDF Version [PDF - 129 KB - 8 pages]
    M. Jensenius et al.
       

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