Immunization for International Travelers / 한양의대학술지

In 2006, the annual number of Koreans traveling internationally increased to 11 million. With this increased number of Koreans traveling to developing countries, various infectious diseases have been reported to be imported into Korea. Immunization is an important tool for the prevention of such diseases. Vaccination offered to international travelers is divided into 3 categories, i.e., obligatory vaccination, vaccines against diseases with an increased risk in developing countries, and routine vaccination. Vaccination that is obligatory for travelers includes yellow fever vaccine for travelers entering yellow fever-endemic areas and meningococcal vaccination for pilgrims traveling to Saudi Arabia. Recent reports of the adverse event following yellow fever vaccination, i.e., vaccine-associated viscerotropic disease, pose a caution in the administration of yellow fever vaccine to the elderly or individuals with thymic diseases. Protein-conjugated meningococcal vaccines are generally preferred; however, polysaccharide vaccines are also effective in short-term travelers. The vaccinations recommended for the health of travelers include administration of hepatitis A (HAV), meningococcal, typhoid, rabies, tick-borne encephalitis, and plague vaccines. As many young Korean adults lack immunity against hepatitis A, the administration of the HAV vaccine is recommended for all Korean individuals in their 20s and all Korean seronegative individuals in their 30s. The risk of acquiring typhoid fever is high among travelers traveling to the rural areas of developing countries for 2 weeks or more. The rabies vaccine may be recommended for travelers traveling for longer than 3 months and animal handlers. Both tick-borne encephalitis and plague are rarely encountered among Korean travelers; furthermore, vaccines for these diseases are not available in Korea. As Japanese encephalitis is endemic in Korea, vaccination against encephalitis is not essential for Korean adults. Pre-travel counseling is an important opportunity for catch-up vaccination of healthy travelers who missed routine vaccinations.

Traveling and Imported Parasitic Diseases

Recently, many peoples travel abroad for sightseeing, business, missionary and other works. At the same time, imported parasitic diseases including malaria has been increased in Korea. The vector borne and food borne diseases were imported from many other countries, Africa, Middle East and South east Asia. Recently many foreigners entered to Korea for studying, working and other purposes. Imported foods, fishes, meats, vegetables are important for parasitic infection, too. The author reviewed imported parasitic diseases in Korea from 1970 to 2006 with literatures. Malaria is most prevalent. And babesiosis of 6 cases, cutaneous leishmaniasis of over 20 cases, visceral leishmaniasis of 5 cases, loiasis of 3 cases, gnathostomiasis of 40 cases, angiostrongylosis of 10 cases, heterophydiasis of 2 cases, schistosomiasis haematobium of 6 cases, schistosomiasis mansoni of 3 cases, hydatidosis of 24 cases, cutaneous larva migrans of 4 cases, and one case of ancylostomiasis, syngamosis, cutaneous myiasis and pentastomiasis are reported, respectively. The protozoa of 5 species and helminthes of 11 species are imported from many other countries. In Korea, re-emerging malaria was appeared at Demilitarized zone (DMZ) on 1993. Last year, 2,051 cases of indigenous malaria were reported by Korean Center for Diseases Control (KCDC). However, the most prevalent imported malaria was Plasmodium falciparum and indigenous malaria was only P. vivax. For the prevention of imported parasitic diseases, the education, training for tropical medicine, supply of medication and vaccine are needed. The surveillance system for imported diseases was started by KCDC on 2001.

Pre-travel medical consultation for international travelers / 대한내과학회지

No abstract available.

A Case of Concomitant Disseminated Gonococcal Infection with Acute Viral Hepatitis C / 감염과화학요법

Gonorrhea is endemic in developing countries. Frequent sexual contacts are common among travellers to endemic countries and the risk of sexually transmitted disease as gonorrhea is believed to be high. Disseminated gonococcal infection (DGI) results from blood dissemination of Neisseria gonorrhoeae from the primary mucosal infection and is a common cause of infective arthritis in sexually active adults in the USA. The usual manifestations of DGI are dermatitis, tenosynovitis, and septic arthritis. We experienced a case of DGI concomitant with acute viral hepatitis C, probably acquired by sexual contacts in Philippines. A 40-year-old man took a trip to Philippines and stayed for a week. During his stay in Philippines, a hemorrhagic bulla and several pustules developed on his extrimities. Subsequently he suffered from high fever and arthralgia of several joints, including both knee joints. Neisseria gonorrhoeae was identified by culture of an aspirate from the right knee joint and he was managed with ceftriaxone for 3 weeks under the diagnosis of DGI and gonococcal arthritis. During the follow-up at the outpatient clinic, alanine aminotransferase and aspartate aminotransferase levels began to rise and an anti-HCV antibody became positive. Because HCV viral loads were surging up from 56,703 copies/mL to 538,292 copies/mL during the next 4 weeks, interferon-alpha 2b was administered for 6 months with resultant normal liver function tests and undetectable HCV viral loads.

A Case of Concomitant Disseminated Gonococcal Infection with Acute Viral Hepatitis C / 감염과화학요법

Gonorrhea is endemic in developing countries. Frequent sexual contacts are common among travellers to endemic countries and the risk of sexually transmitted disease as gonorrhea is believed to be high. Disseminated gonococcal infection (DGI) results from blood dissemination of Neisseria gonorrhoeae from the primary mucosal infection and is a common cause of infective arthritis in sexually active adults in the USA. The usual manifestations of DGI are dermatitis, tenosynovitis, and septic arthritis. We experienced a case of DGI concomitant with acute viral hepatitis C, probably acquired by sexual contacts in Philippines. A 40-year-old man took a trip to Philippines and stayed for a week. During his stay in Philippines, a hemorrhagic bulla and several pustules developed on his extrimities. Subsequently he suffered from high fever and arthralgia of several joints, including both knee joints. Neisseria gonorrhoeae was identified by culture of an aspirate from the right knee joint and he was managed with ceftriaxone for 3 weeks under the diagnosis of DGI and gonococcal arthritis. During the follow-up at the outpatient clinic, alanine aminotransferase and aspartate aminotransferase levels began to rise and an anti-HCV antibody became positive. Because HCV viral loads were surging up from 56,703 copies/mL to 538,292 copies/mL during the next 4 weeks, interferon-alpha 2b was administered for 6 months with resultant normal liver function tests and undetectable HCV viral loads.

Infections Associated with International Travel and Commerce / 감염

In 1992, the Institute of Medicine's report, Emerging Infections : Microbial Threats to health in the United States, expanding international travel and commerce was identified as one of six principal factors contributing to the global development and spread of emerging and reemerging pathogens. International travel has increased dramatically during the 20th century, and populations are now in motion to a degree never before seen in history. It has been estimated that during 1995 over 1.4 tourists corssed international borders every day, an annual total of over 500 million persons. Mobile populations include leisure and business travelers, military personnel, immigrants, refugees and missionaries. Travelers not only put themselves at risk by visiting areas where diseases are emerging, but they also run the risk of exposure to disease they do not usually encounter at home. After exposure they may then incubate these illnesses and not manifest symptoms until they return home, risking the potential for spread of microbes to new areas. International travelers visiting developing countries are at particular risk for a variety of bacterial, viral, and parasitic infectious diseases. Increased trade and expanded markets for imported foods, which occasionally contain bacterial or viral contaminants. International interchange of mankinds and goods afford ample opportunity for the unrecognized movement of pathogens from place to place and for rapid global spread of microbial agents. From the microbe's point of view, the global village of the late 20th century provides global opportunities for disease emergence and transmission.