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      Travel advice for the immunocompromised traveler: prophylaxis, vaccination, and other preventive measures

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          Immunocompromised patients are traveling at increasing rates. Physicians caring for these complex patients must be knowledgeable in pretravel consultation and recognize when referral to an infectious disease specialist is warranted. This article outlines disease prevention associated with international travel for adults with human immunodeficiency virus, asplenia, solid organ and hematopoietic transplantation, and other immunosuppressed states. While rates of infection may not differ significantly between healthy and immunocompromised travelers, the latter are at greater risk for severe disease. A thorough assessment of these risks can ensure safe and healthy travel. The travel practitioners’ goal should be to provide comprehensive risk information and recommend appropriate vaccinations or prevention measures tailored to each patient’s condition. In some instances, live vaccines and prophylactic medications may be contraindicated.

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          Spectrum of disease and relation to place of exposure among ill returned travelers.

          Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s. Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world. Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea. When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences. Copyright 2006 Massachusetts Medical Society.
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            "Choking game" awareness and participation among 8th graders--Oregon, 2008.

            The "choking game" is an activity in which persons strangulate themselves to achieve euphoria through brief hypoxia. It is differentiated from autoerotic asphyxiation. The activity can cause long-term disability and death among youths. In 2008, CDC reported 82 deaths attributed to the choking game and other strangulation activities during the period 1995-2007; most victims were adolescent males aged 11-16 years. To assess the awareness and prevalence of this behavior among 8th graders in Oregon, the Oregon Public Health Division added a question to the 2008 Oregon Healthy Teens survey concerning familiarity with and participation in this activity. This report describes the results of that survey, which indicated that 36.2% of 8th-grade respondents had heard of the choking game, 30.4% had heard of someone participating, and 5.7% had participated themselves. Youths in rural areas were significantly more likely (6.7%) to have participated than youths in urban areas (4.9%). Choking game participation was higher among 8th graders who reported mental health risk factors (4.0%), substance use (7.9%), or both (15.8%), compared with those who reported neither (1.7%). Public health surveillance of these strangulation activities among youths should be expanded to better quantify the risks and understand the motives and circumstances surrounding participation. Parents, educators, counselors, and others who work with youths should be aware of strangulation activities and their serious health effects; they should watch for signs of participation in strangulation activities, especially among youths with suspected substance use or mental health risk factors.
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              Nonfatal, unintentional medication exposures among young children--United States, 2001-2003.

              Young children are vulnerable to inadvertent exposure to prescription and over-the-counter (OTC) medications, especially when these items are not stored securely. In 2002, according to death certificate data, 35 children aged < or =4 years died from unintentional medication poisonings in the United States (CDC, unpublished data, 2005). In 2003, according to reports to U.S. poison control centers, pharmaceuticals accounted for 1,336,209 (55.8%) of unintentional chemical or substance exposures. Of those pharmaceutical exposures, 568,939 (42.6%) involved children aged <6 years. For this report, CDC analyzed 2001-2003 data from hospital emergency department (ED) visits reported by the National Electronic Injury Surveillance System--All Injury Program (NEISS-AIP). The results of this analysis indicated that, during 2001-2003, an estimated 53,517 children aged < or =4 years were treated annually in U.S. EDs for unintentional medication exposures. An estimated 72% of these exposures were in children aged 1-2 years. Children aged < or =4 years can reach items on a table, in a purse, or in a drawer, where medications are often stored; young children also tend to put objects they find in their mouths. Parents and others responsible for supervising children should store medications securely at all times, keep them out of the reach of children, and be vigilant in preventing access by children to daily-use containers such as pill boxes.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                12 February 2015
                : 11
                : 217-228
                [1 ]Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
                [2 ]Division of Medical Education, Washington University School of Medicine, St Louis, MO, USA
                Author notes
                Correspondence: Rupa Patel, Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8051, St Louis, MO 63110, USA, Email rrpatel@ 123456dom.wustl.edu
                © 2015 Patel et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.



                diarrhea, malaria, travel, vaccines, immunocompromised


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