To improve the quality of medical care in developing countries, a new partnership between the American Society of Hematology (ASH) and Health Volunteers Overseas (HVO) aims to recruit and support physician volunteers to educate and train health-care providers in those countries on the treatment of patients with blood disorders.

This unique program will cover the management of a full range of blood disorders, from the many forms of anemia (including those associated with malaria, pregnancy, iron deficiency, thalassemia, and sickle cell disease), to disorders that lead to abnormal bleeding and clotting, to malignant disorders such as leukemia and lymphoma. Methods designed to enhance the purity of the blood supply in these counties will also be taught.

“ASH believes that by focusing on these disorders that have a profound and even deadly effect in the developing countries, the general health in these countries will be improved as will the overall level of care,” said Stanley L. Schrier, MD, the Chair of ASH’s Subcommittee on HVO, which oversees the program.

Currently, HVO has more than 60 programs in 25 developing nations in partnership with other medical, dental, and nursing societies. ASH is the first partner dedicated solely to hematology. This new venture is the continuation of more than 10 years of work by ASH to advance the care of patients with blood diseases around the world, including work with the World Health Organization and the Multilateral Initiative on Malaria to improve the diagnosis and treatment of patients, primarily children and pregnant women, with very severe anemia caused by malaria. ASH has also dedicated its efforts to international outreach through the International Outreach Initiative, which disseminates educational materials to hematology-related institutions in developing countries, as well as through the Visiting Trainee Program, an award program that allows hematology-related professionals to gain educational and practical experience on a specific topic for up to 12 weeks at a host institution.

The minimum stay for hematologists who volunteer for the program is two weeks. HVO training programs focus on local diseases and health conditions, and the procedures and skills taught are relevant, realistic, and sustainable, with the goal that the indigenous population will continue to benefit from the experience long after the volunteer has departed. In addition to teaching, volunteers may also shape curriculum design, influence national health policy, and promote realistic health interventions.

The American Society of Hematology (http://www.hematology.org) is the world’s largest professional society concerned with the causes and treatment of blood disorders. Its mission is to further the understanding, diagnosis, treatment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems, by promoting research, clinical care, education, training, and advocacy in hematology.

A private, nonprofit membership organization, Health Volunteers Overseas (HVO) was founded in 1986 to improve global health through education. HVO designs and implements clinical education programs in child health, primary care, trauma and rehabilitation, essential surgical care, oral health, infectious disease, nursing education, burn management, and wound care. In more than 25 resource-poor nations, volunteers train, mentor, and provide critical professional support to health-care providers who care for the neediest populations in the most difficult of circumstances. To learn more about HVO, visit the Web site, http://www.hvousa.org.

American Society of Hematology
http://www.hematology.org

The American Red Cross will provide $190,000 to support the emergency relief and recovery efforts in Pakistan. The money will be used to support the efforts of the Pakistan Red Crescent Society in responding to the devastating floods that have affected the country over the past few weeks. The International Federation of Red Cross and Red Crescent Societies reports that 300 people have lost their lives, and estimates that 1.65 million people have been affected by the storms and cyclone that hit Pakistan’s southern coast.

“Because of the generosity of people in America, the American Red Cross was able to provide an international relief delegate and funds to assist in the early stages of the Pakistan flood response — when survivors need it most,” said Alex Mahoney, Regional Manager of Asia and the Middle East for International Disaster Response at the American Red Cross. “The American Red Cross will continue to work with the International Federation, our sister societies throughout the world, and the international community to help Pakistan recover from this disaster.”

The $190,000 contribution by the American Red Cross is for the preliminary International Federation emergency appeal supporting the Pakistan Red Crescent Society’s response to the devastating floods. The preliminary appeal is focusing on providing flood survivors with distribution of food and relief items, shelter and basic health for 98,000 people for six months.

American Red Cross
http://www.redcross.org

Multilateral development banks are not fulfilling their commitments to support initiatives involving reproductive and sexual health in developing countries, according to a new study released by Gender Action, a Washington, D.C.-based organization that monitors the banks’ policies on women and gender equality, Inter Press Service reports. The 90-page report examines the quantity and quality of all spending for reproductive health and HIV/AIDS projects from 2003 to 2006 by the World Bank, African Development Bank, Asian Development Bank and Inter-American Development Bank. The report also looks at the effect of the International Monetary Fund’s fiscal and monetary policies.

According to the report, there was a “profound decline” in World Bank spending on reproductive health and HIV/AIDS projects from $2.7 billion in 2003 to $1.5 billion in 2006. The World Bank approved a total of $7.5 billion for such projects during the four-year period. World Bank officials could not be reached for comment, according to Inter Press Service.

The report also said that the regional development banks’ programs focus almost solely on demographic issues and maternal health rather than on reproductive and sexual health and rights; do not include gender rights components; and fail to describe actionable solutions, according to Inter Press Service. “Compounding [the] lack of gender sensitivity in MDB projects is their unsustainability caused by endemic MDB project shortcomings, including short-term project duration and lack of funding for recurrent expenditures such as salaries for doctors and nurses,” the report said.

According to the report, the Tunisia-based African Development Bank from 2003 to 2006 gave $108 million for reproductive health projects and $44 million for HIV/AIDS projects and related components. The Manila, Philippines-based Asian Development Bank during the same period gave $47.4 million for reproductive health and HIV/AIDS projects, with most of the funds spent on HIV/AIDS grants. The Washington, D.C.-based Inter-American Development Bank, which lends to Latin nations, gave $3 million in loans and grants for reproductive health and HIV/AIDS during the time period, according to the report.

The report also said IMF loan packages and economic policies force most borrowing governments to restrict public sector wages and cut the number of doctors and nurses as part of its effort to reduce inflation and public spending, the Inter Press Service reports. “For these reasons, MDB project descriptions that promise to sustainably increase access to reproductive health, HIV/AIDS and other services are misleading,” the report concluded (Mekay, Inter Press Service, 7/9).

The report is available online. Note: You need Adobe Acrobat to view this report.

“Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

On Monday, July 9, two rockets fired by militants struck a primary school in Kunar province, killing one child instantly and injuring three other children. That same night, a school was burnt in Ghore province. And last tuesday a suicide bomber hit a Uruzgan province marketplace filled with schoolchildren.

“We are saddened by these tragic events. UNICEF is concerned by these incidents and the intimidation in some communities aimed at stopping families from sending children to school. Schools of course are a visible sign of reconstruction and progress, and there are those who perhaps fear such progress. What I do know is that communities want to see their children get an education, they recognize the value of learning - and that is underlined by the millions of children who are now enrolled in schools.”

“UNICEF believes that the solution to these challenges has to come from the communities themselves; and UNICEF has been and continues to be in discussion with local leaders, village elders and religious leaders, to identify ways in which education can be continued. We stand ready to support any initiative that will keep children learning in safety.”

About UNICEF

UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.

http://www.unicef.org

The Syrian Arab Red Crescent (SARC) and UNICEF Syria signed a cooperation agreement providing humanitarian support to children and women refugees from Iraq. The agreement covers an initial amount of 11 million SYP covering projects until end of 2007.

The focus of this cooperation with SARC will be on meeting the needs of Iraqi children refugees by creating an environment that protects and stimulates their development and helps them and their families overcome the stress related to their situation.

Dr. Abdel Rahman Attar, President of the Syrian Arab Red Crescent indicated “Our organisation is managing projects for our Iraqis brothers in cooperation with UNHCR, other Red Crescent and Red Cross branches and ECHO. The organisation launched a call for assistance to 20,000 Iraqi families in terms of health, education and social services and it will also cooperate with other humanitarian non-governmental organisations, once they are approved by the relevant Syrian authorities. This agreement is important to support Iraqi refugee women and children and we highly appreciate the support and close cooperation of UNICEF for the interest of Iraqi children refugees in Syria,” added Dr. Attar.

SARC will establish a minimum of four child friendly spaces which will be animated by 80 SARC volunteers through cultural, recreational and psychosocial support activities in affected communities. A minimum of 4,000 children per month are expected to be reached by the end of 2007. In addition to activities for the children, these spaces will represent an information and guidance hub to the families; particularly for mothers on child and maternal care, as well as a means to detect serious cases of distress among children and families that will need referral for more extensive psycho-social support.

“This is a symbolic step that reflects our belief in the capacity of the SARC to make a difference for children. We saw this in the way they supported the Lebanese refugees last summer. Their support to Iraqi children in Syrian is already up and running,” said Mohamed Anis Salem, UNICEF Representative of Syria.

The second key component of this agreement is to strengthen the capacity and skills of the SARC volunteers on managing the child friendly spaces and on providing services to the children and women, including the provision of basic psycho-social support.

Finally, a resource centre on psychosocial support & child protection will be set up and managed by the SARC accessible to all partners involved in providing humanitarian support to Iraq refugee children and families. This centre will allow for establishing standards, ensuring quality control of services and developing communication and advocacy as well as represent a training hub for partners.

Since the invasion of Iraq in 2003, approximately 1.4 million Iraqi refugees have settled in Syria, residing mainly in Damascus and rural Damascus (Jaramanah, Qudsaya, Sayedah Zeinab, Masaken Barzeh). In addition to basic survival needs, which affected communities have difficulty in meeting, Iraq refugees (children and women in particular) face great psychosocial challenges. Refugees arrive from Iraq grappling with violence, exploitation, damaged/broken family life, stress, fear, anxiety and confusion. They also face a situation where they lack identification documentation, information and income and school drop-out is prevalent among the communities.

SARC, in cooperation with UNICEF, have already set up a child friendly space in the UNHCR registration centre. This space is managed by SARC volunteers who welcome an average of 100 children accompanied by their parents (on a daily basis) who are waiting for their registration appointments, for whom they organize recreational activities.

About UNICEF

UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.

http://www.unicef.org

An update on the government’s avian and pandemic influenza preparedness efforts was given today by leading infectious disease experts from around the country at a news conference at the National Press Club in Washington, D.C. The news conference, sponsored by the National Foundation for Infectious Diseases (NFID), addressed key issues and developments in the control and prevention of emerging infectious diseases, as well as highlighted global health risks of foodborne and water-related illnesses and the threat of multi-drug resistant tuberculosis.

“Emerging, and in some cases re-emerging, infectious diseases, notably avian and pandemic influenza, pose a very serious threat to the nation’s public health,” said Susan J. Rehm, MD, NFID Medical Director and Vice Chair, Department of Infectious Disease, at the Cleveland Clinic. “As health care professionals, we need to continue to identify these threats and take the necessary steps to respond quickly and effectively.”

Addressing the prospect of an influenza pandemic, Carole A. Heilman, PhD, director, division of microbiology and infectious diseases, at the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH) and the Department of Health and Human Services discussed how NIAID is leading efforts to help bolster the nation’s pandemic influenza preparedness, including activities exploring cell-based vaccines; expanding the domestic capacity for influenza vaccines; developing point-of-care diagnostics; supporting influenza antivirals; and advancing surge capacity for producing H5N1 vaccines. “NIAID is exploring all avenues to ensure that the infrastructure is in place to act on an influenza pandemic in this country,” stated Dr. Heilman. NIAID is the lead NIH institute for pandemic influenza preparedness efforts.

Additional topics discussed at the 12th Richard J. Duma/NFID Annual News Conference and Symposium on Infectious Diseases included:

— New Therapeutic Regimens in the Fight Against Multi-drug Resistant Tuberculosis: Michael D. Iseman, MD, professor of medicine, National Jewish Medical Center and Research Center in Denver, Colorado, discussed the threat of multi-drug resistant tuberculosis and new therapeutic strategies to help address the growing need to control tuberculosis and reduce barriers to accessing these regimens.

“Since the introduction of the fluorquinolones in the 1980’s there have been no significant advances in the treatment of tuberculosis,” stated Dr. Iseman. “With the emergence of multi-drug resistant tuberculosis, this is a critical juncture in our efforts to control this disease.”

— Vaccine Financing Issues: Jerome O. Klein, MD, professor of pediatrics at Boston University School of Medicine, discussed the rising costs of vaccines in this country and concerns regarding continued access to safe and effective vaccines.

— Foodborne and Water-related Diseases: A National and Global Update: James M. Hughes, MD, professor of medicine and public health, Rollins School of Public Health at Emory University, the director of the Emory Program in Global Infectious Diseases and the Emory Center for Global Safe Water, provided an overview of the increasing prevalence and public health risks of foodborne illnesses caused by a variety of bacteria, viruses and parasites, and water-related diseases associated with drinking water, water not intended for drinking, and recreational water.

About the News Conference and Symposium

The 12th Richard J. Duma/NFID Annual News Conference and Symposium on Infectious Diseases was supported, in part, by unrestricted educational grants to NFID from the Biotechnology Industry Organization, GlaxoSmithKline, sanofi pasteur, and Wyeth Pharmaceuticals. This event is named for former NFID president and executive director Richard J. Duma, MD, PhD, currently director of infectious diseases at Halifax Medical Center in Daytona Beach, FL.

About the National Foundation for Infectious Diseases

The National Foundation for Infectious Diseases (NFID) is a non-profit, tax-exempt 501(c)(3) organization founded in 1973 and dedicated to educating the public and healthcare professionals about the causes, treatment and prevention of infectious diseases. For more information, please visit http://www.nfid.org.

National Foundation for Infectious Diseases
http://www.nfid.org

For the past two weeks, northern and central Texas have been hit with floods submerging hundreds of residences and businesses and leaving 11 people dead. Torrential storm systems continue flooding throughout Texas, Oklahoma and Kansas. In addition to the Midwest flooding, wildfires have devastated the Lake Tahoe community in California, destroying homes and forcing people to evacuate. The American Red Cross was among the first on the ground responding to these disasters by providing food, shelter, counseling and other assistance made possible by the financial support from members of the Red Cross Annual Disaster Giving Program and funds from the American Red Cross Disaster Relief Fund.

The Annual Disaster Giving Program and the Disaster Relief Fund are the financial resources through which the Red Cross can rush relief to disaster victims before the first donations have been given in response to these disasters. While additional donations are no longer needed to support the Red Cross’s response to the California wildfires, financial contributions are still needed to support the relief efforts for the massive flooding that continues to plague the Midwest. Emergency officials said Texas is experiencing its most extensive flooding since 1957. Early cost estimates for the Red Cross response in Kansas, Oklahoma and Texas is approximately $7 million, with an estimated $6 million of the costs designated for Texas.

Donations enable the Red Cross to provide essential resources needed to cope with the immediate aftermath of disasters and to deliver hope to disaster victims. Since the first sign of trouble in the Midwest, Red Cross volunteers and employees have opened shelters and fixed locations where people can find shelter and get a hot meal, and deployed Emergency Response Vehicles to meet the needs of those who cannot come to the Red Cross. Red Cross workers are also distributing comfort kits and clean-up kits and are initiating damage assessment.

In the coming weeks and months, the Red Cross will work with community partners to identify resources that can aid in the recovery of individuals and families affected by the Midwest floods and the California wildfires. As their needs evolve, the Red Cross will continue to help them through this process. The public’s continued support of the Disaster Relief Fund is essential to the Red Cross, which will help provide this lifesaving support in these affected communities.

“Our Annual Disaster Giving Program members and fellow Americans who support our disaster relief work ensure the Red Cross has the resources to respond to disasters before they even strike,” said Kathleen Loehr, Interim Senior Vice President of Development at the American Red Cross. “The help and generosity of these companies and individuals becomes even more critical during these times of multiple disasters.”

Americans can join the Annual Disaster Giving Program members in supporting the Disaster Relief Fund and help provide food, shelter, counseling and other assistance to the victims of thousands of disasters across the country each year. Log-on to http://www.redcross.org or call 1-800- RED CROSS to make a donation.

Annual Disaster Giving Program members pledge donations on an on-going basis, in advance of major disasters, to help the Red Cross ensure immediate response to meet the needs of those affected by disasters of all sizes, at no cost and regardless of income.

Annual Disaster Giving Program members include:

American Express Foundation
AT&T
AXA Foundation
Bristol Myers Squibb Foundation
Citi Foundation
ConAgra Foods Foundation
FedEx Corporation
Halliburton
JCPenney Company Fund
Kimberly-Clark Corporation
Lowe’s Companies, Inc
Marriott International, Inc
Merck & Co., Inc
Morgan Stanley
Nestl茅 Waters North America
Raytheon
State Farm
State Street Corporation
Target
TJX Companies, Inc
Woodman of the World/Omaha Woodman Life Insurance Society

The American Red Cross helps people prevent, prepare for and respond to emergencies. Last year, almost a million volunteers and 35,000 employees helped victims of almost 75,000 disasters; taught lifesaving skills to millions; and helped U.S. service members separated from their families stay connected. Almost 4 million people gave blood through the Red Cross, the largest supplier of blood and blood products in the United States. The American Red Cross is part of the International Red Cross and Red Crescent Movement. An average of 91 cents of every dollar the Red Cross spends is invested in humanitarian services and programs. The Red Cross is not a government agency; it relies on donations of time, money, and blood to do its work.

http://www.redcross.org

Five officers embarked aboard the Military Sealift Command (MSC) hospital ship USNS Comfort (T-AH 20) promoted to ranks ranging from lieutenant to captain in the U.S. Public Health Service鈥瞫 (USPHS) first at-sea promotion July 3.

Ceremony participants and guests gathered on the flight deck for the ceremony despite high winds and rolling seas.

“When the pictures from today make it back to Washington, there will be no doubt that this ceremony was held at sea,” said Capt. Bob Kapcio, Comfort’s humanitarian assistance mission commander.

Kapcio praised the USPHS members for their dedication to Comfort’s four-month humanitarian assistance deployment to Latin America and the Caribbean, saying he was proud to work alongside Public Health Service members.

“I have never been as impressed with an organization as I have with the Public Health Service,” said Kapcio. “They have absolutely astounded me with their can-do attitude, their spirit and their enthusiasm for this mission.”

Capt. Craig Shepherd, a USPHS environmental health officer and officer in charge aboard Comfort, said he hopes the partnership between the Public Health Service and the U.S. Navy can be the beginning of a more far-reaching relationship.

“We (USPHS) have an on-going and closely-linked relationship with other services,” he said. “We hope to be involved in more missions like this one in the future.”

USPHS personnel are embarked on Comfort during its 120-day humanitarian assistance deployment to Latin America and the Caribbean providing medical treatment to patients in a dozen countries.

During the deployment, Comfort is under the operational control of U.S. Naval Forces Southern Command, and the tactical control of Destroyer Squadron 24.

http://www.hhs.gov/

Fever, arthritis, and other symptoms occurring in people to who have recently traveled to islands in the Indian Ocean may signal infection with an imported virus called “chikungunya,” reports a study in the May/June issue of the journal Medicine®, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

A group of French researchers report on the symptoms and outcomes of chikungunya virus infection in 47 patients seen at the Leveran Hospital in Marseilles. The lead author was Dr Fabrice Simon, a specialist in infectious and tropical diseases at the hospital.

All of the patients became ill during or shortly after travel to an island in the Indian Ocean. Most were French tourists who had recently visited Reunion or other Indian Ocean islands, while others were residents of the islands who became ill while traveling in France. Several cases occurred in people originally from the island of Comoros there is a significant community of migrants from Comoros in Marseilles.

During the acute phase of the infection, which lasted seven to ten days, the main symptoms were fever and arthritis, most common in the fingers, wrists, toes, and ankles. About half of the patients also had a rash. Eight patients had to be hospitalized during the acute phase, including two with life-threatening disease.

In 38 of the 47 patients, symptoms continued beyond the first 10 days. This chronic phase of the infection was characterized by severe joint pain and inflammation, which severely limited the patients’ ability to walk and perform everyday tasks. Some patients were so disabled that hospitalization was required.

The chronic phase of the disease resolved very slowly over several months. Treatment was solely symptomatic: pain-relievers and anti-inflammatory drugs. Some patients improved with short-term steroid treatment. Even after six months, nearly half of patients continued to have symptoms. The infection was particularly painful and disabling for some elderly patients.

Chikungunya virus is one of a group of viruses called arboviruses, which includes West Nile virus. It comes from eastern Africa, where it is spread by mosquitoes. (In the Makonde language of Tanzania and Mozambique, “chikungunya” means “that which bends up” describing the contorted posture caused by painful arthritis.)

Recently, Chikungunya virus has spread to Asia and India. In the past two years there has been an “explosive outbreak” of Chikungunya virus infection in the Indian Ocean islands particularly on Reunion Island, where 35 percent of a population of 770,000 became infected over a 6-month period. In 2006, the U.S. Centers for Disease Control issued a warning about Chikungunya virus for people traveling to the Indian Ocean islands, as well as to India and Sri Lanka.

The new report from France shows that this potentially serious infection can easily be imported to Western countries by people who travel to areas where outbreaks of Chikungunya virus sometimes called “CHIKV” have occurred. As with other tropical diseases, Western physicians may be unfamiliar with the symptoms and course of the infection, which can lead to delays in making the correct diagnosis. “Physicians should consider CHIKV when presented with a patient with an unusual rheumatic syndrome after traveling to the tropics,” Dr. Simon and colleagues conclude.

About Medicine®

Medicine® provides insight from leading scholars about the latest results in clinical investigation. Relevant to both hospital and office practice, the journal includes analytical reviews of Internal Medicine, Dermatology, Neurology, Pediatrics, and Psychiatry topics. Articles typically include original patient data from the author’s own experience along with a scholarly review of the literature. Medicine® also offers follow-up studies, practice-oriented reports of clinical observations, and “Reviews in Molecular Medicine,” monographs that focus on how the “new genetics” and genomics have altered understanding and management of a particular disorder. It is one of the most respected and frequently cited journals in the field.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (http://www.LWW.com) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information for professionals and students in medicine, nursing, allied health, pharmacy and the pharmaceutical industry. Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company with annual revenues (2006) of 鈧?.7 billion and approximately 19,900 employees worldwide. Visit http://www.wolterskluwer.com.

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With the surge of global tourism comes the possibility of exposure to rabies. A new review of the current rabies considerations for travelers is published in the latest issue of Wilderness Medicine.

In 2004, tourism growth was particularly strong in Asia and the Pacific, where it increased 28 percent. In 2005, growth was strongest in Sub-Saharan Africa, 13 percent, and Kenya had an increase of 26 percent. Well over 90 percent of human rabies deaths occur in these two areas.

Despite the growing risk of rabies with increased tourism, ignorance about rabies abounds. This is seen in a written survey completed at the 1998 Los Angeles Times Travel Meeting, which was attended by 23,500 people. Though the respondents described themselves as “seasoned travelers taking frequent international trips,” only 33 percent knew that rabies was 100 percent fatal in humans, and that the disease can be contracted without a person’s knowledge. In addition, a high majority of the rabies cases in the United States and the United Kingdom were acquired in other countries, which makes the case for travelers to study the risk of rabies.

Recommendations for a pre-exposure vaccine vary somewhat from group to group. The Advisory Committee for Immunization Practices (ACIP) of the Centers for Disease Control and Prevention recommends that travelers obtain the vaccine when going to areas where there is rabies for a stay of 30 days or more.

In 1991, a group of investigators at the Canadian International Water and Energy Consultants (CIWEC) clinic in Kathmandu challenged the recommendation for travelers because the cost of vaccination is high, and they determined the probability for exposure to be low. However, investigators from the Queen Saovabha Memorial Institute in Bangkok subsequently surveyed 1,882 departing English-speaking travelers from the Bangkok air terminal and determined that 1.2 percent had been bitten by a dog and 8.7 percent had been licked by a dog during their stay. These investigators recommended that all travelers be routinely vaccinated for rabies by the intramuscular route.

Another consideration for the preexposure vaccine is postexposure therapy. If travelers are unable to receive timely postexposure therapy, the vaccine is recommended, according to a New England Journal of Medicine study. This is echoed by the CIWEC clinic that recommends preexposure vaccination for travelers visiting locations more than 24 hours from a reliable source of postexposure rabies vaccine.

Wilderness Medicine is a peer-reviewed quarterly medical magazine published by the Wilderness Medical Society. For more information, visit http://www.wms.org.

Allen Press
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