Monday, November 8, 2010

cases: old man traveling to Amazon

fit, healthy 85 year old man traveling to Amazon jungle for 2 weeks- bird watching.
leaving in 4 weeks.
No medications on a regular basis.
vaccine history:
YF vaccine 30 years ago.(also valid, and avoid any possible side effection)
The YF vaccination certificate for international travel is valid for 10 years. This interval was based on published studies indicating that neutralizing antibodies were present in >90% of persons 16--19 years after vaccination (1). Later studies of U.S. military veterans from World War II tested 30--35 years after a single dose of YF vaccine demonstrated that >80% had neutralizing antibody; in certain subgroups, >95% still had neutralizing antibodies (2).
  1. Rosenzweig EC, Babione RW, Wisseman CL, Jr. Immunological studies with group B arthropod-borne viruses. IV. Persistence of yellow fever antibodies following vaccination with 17D strain yellow fever vaccine. Am J Trop Med Hyg 1963;12:230--5.
  2. Poland JD, Calisher CH, Monath TP, Downs WG, Murphy K. Persistence of neutralizing antibody 30--35 years after immunization with 17D yellow fever vaccine. Bull World Health Organ 1981;59:895--900.
routine vaccines up to date
No other vaccines for 15 years.
Past medical history unremarkable.
Vaccines?
1. flu
2.HepA
3. Td(Tdap, if the old man care for children.)
4 typhoid
5. pnemounia vaccine (MPSV)(for old people and hajj.)
antimalarials?
mefloquine

Diarrhea?
cipro.
other recommendations?
rabies
insect repellent
dengue

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