their infants should receive postexposure pro-
phylaxis (hepatitis B immune globulin and
hepatitis B vaccine).
Strict testing discipline should be enforced in
all blood banks. Donated blood should be tested
for HBsAg. All donors should be rejected who
have a history of viral hepatitis, present evidence
of drug abuse, or received a blood transfusion or
tattoo within the past 6 months. Unscreened blood
or blood products are not administered to any pa-
tient unless an absolute emergency. Perform
sterilization on all syringes, needles, acupuncture
needles, and stylettes. The use of disposable equip-
ment is recommended.
Management of patients, contacts, and nearby
environment includes (1) isolation (inpatient and
outpatient) with precautions for blood and body
fluids until the disappearance of HBsAg and the
appearance of anti-HBs; (2) concurrent disinfec-
tion for all equipment contaminated with blood,
saliva, or semen; and (3) immunizing contacts
with hepatitis B immune globulin, human immune
globulin, or hepatitis B vaccine, as directed by a
medical officer. It is very important to administer
prophylaxis as soon as possible after exposure.
There is no requirement for quarantine.
If the occurrence of two or more cases can be
related to a common exposure, search for more
cases. Enforce strict aseptic techniques. If blood
derivatives are implicated, recall the lot and trace
all persons who received the product, in search
of additional cases. No international measures are
required for hepatitis B patients or their contacts.
any season of the year. The reservoir for the in-
fluenza is man.
Influenza is transmitted most commonly by
the airborne route through infective droplets from
coughing, sneezing, and close talking, especially
in crowded populations. The incubation period
is very short, approximately 1 to 3 days. The
period of communicability is approximately 3
days, beginning with the first clinical symptoms.
An attack gives immunity only to the specific
type or subtype of the virus involved. Vaccines
provide immunity to a particular virus and related
strains to which an individual has been previously
Current policy requires that all active duty
Navy and Marine Corps personnel receive the an-
nual influenza vaccine.
Management of patients, contacts, and the
nearby environment includes the following princi-
ples: Because there is a usual delay in establishing
the diagnosis, many others can become infected.
Therefore, it is usually not practical to isolate
cases. It may be desirable to isolate infants and
younger children by keeping them in the same
room. No concurrent disinfecting is required. No
quarantine is required. Investigation of contacts
is of no value and is not recommended.
At the beginning of epidemics, it is important
that preventive medicine personnel establish
surveillance of epidemics to determine the extent
and progress that community functions are
Influenza is an acute viral disease primarily
involving the respiratory tract with symptoms of
fever, chills, headache, muscular pain, exhaus-
tion, acute rhinitis, sore throat, and cough.
Recovery is usually complete within 2 to 7 days.
During large epidemics acute illnesses and deaths
may be expected among the elderly and other pa-
tients with chronic medical disorders.
Influenza occurs worldwide as epidemics or
localized outbreaks. Attack rates are about 15 to
25 percent in large communities and in isolated
populations may be as high as 40 percent. The
infectious agents are types A, B, and C influenza
virus. Epidemics of type A occur in the United
States approximately every 1 to 3 years; type B
occurs every 3 to 4 years, with occasional mixed
epidemics. Epidemics usually occur during the
winter in temperate regions and in the tropics at
Early symptoms of the four different types of
human malarias are similar. Laboratory studies
are necessary for differential diagnosis.
Falciparum malaria is the most serious type and
usually has various symptoms of fever, chills,
sweating, headache, jaundice, blood coagulation
defects, shock, renal failure, liver failure, and
disorientation and delirium. Prompt diagnosis and
treatment of all malarias is essential; however,
falciparum malaria, because of its severity, should
be considered a medical emergency.
The other three types of malarias are not life
threatening for healthy adults; however, the very
young, the aged, and individuals with other
diseases may beat serious risk. General symptoms
for these malarias include an indefinite period of
malaise, which is followed by chills, shaking, fast
rising temperature, usually headache, nausea, and
sweating. Symptoms are followed by a time period