procedures outlined in International Health
Regulations. They must be rodent free or rou-
tinely deratted. Routine vaccination for plague is
not required for international travel to almost all
Poliomyelitis (polio) is a serious viral disease
with symptoms that may include fever, malaise,
headache, vomiting, severe pain in muscles and
spasms, stiff neck and back, and the paralysis that
is characteristic of the disease. The virus multiplies
in the alimentary tract and may then invade the
central nervous system/spinal cord. Inapparent
infections and minor illness probably exceeds
paralytic cases by more than a hundred-to-one
when the infection occurs in the very young.
The infectious agent is the poliovirus types 1,
2, and 3. The reservoir is man. Poliomyelitis is
characteristically transmitted by fecal-oral or
pharyngeal modes. The incubation period for
paralytic cases is 7 to 14 days. The period of com-
municability is not known. Probably cases are
most infectious during the first few days before
and after the onset of symptoms.
There is no specific treatment. Expert care is
required during acute illness for patients who need
respiratory assistance secondary to paralyzed
muscles for breathing.
The two important preventive measures in-
clude (1) effective vaccines (inactivated and live
virus) that are available and beneficial; and (2)
education of the local public concerning the ad-
vantages of immunization and on the methods of
spread when a case is diagnosed.
For hospitalized cases, enteric precautions are
needed. The investigation of contacts is limited
to a search for sick persons, especially children,
to provide proper care to unrecognized and
Trivalent vaccines should be put into use at
the earliest indication of an outbreak in a local
International travelers should be adequately
immunized prior to visiting endemic areas, usually
third world countries.
Rabies is an acute viral disease of the central
nervous system that is essentially 100 percent fatal.
Symptoms include a sense of apprehension at the
onset, malaise, fever, headache, and sensory
changes referred to the site of the animal bite
wound. Symptoms progress to paralysis or
paresis, spasms to the muscles of swallowing
resulting in a fear of water (hydrophobia), and
convulsions follow. The usual duration is 2 to 6
days; death often is due to respiratory paralysis.
The infectious agent is the rabies virus.
Rabies occurs worldwide and the reservoir,
depending upon the country, is wild and domestic
animals, including dogs, cats, skunks, raccoons,
and some bats. Almost all mammals are suscep-
tible to rabies.
Rabies is contracted by the introduction of
virus-containing saliva of a rabid animal through
a break in the skin, usually a bite. The incuba-
tion period in humans may range from 10 days
to a year but is usually from 2 to 8 weeks.
The specific treatment for clinical rabies is in-
tensive supportive medical care.
Preventive community measures rely heavily
upon the licensing of dogs and cats with the
documentation of antirabies vaccine receipt a re-
quirement. Collect and destroy ownerless animals.
Pet owners should be educated concerning
necessary restrictions for dogs and cats, e.g.,
leashing or confining to owners premises, or that
strange-acting and sick animals of any species may
be dangerous and should never be picked up or
handled. Dogs and cats that have bitten a person
or show signs of rabies should be detained 10 days
for clinical observation. Wild animals and strays
should be sacrificed immediately and the brain ex-
amined for evidence of rabies. Veterinary person-
nel should submit intact heads packed on ice (not
frozen) of sacrificed animals or animals that die
of suspected rabies to the cognizant laboratory
Individuals at occupational or operational
high risk of wild/domestic animal bites should
receive preexposure immunization with the an-
tirabies vaccine. The prevention of rabies after an
animal bite is based on physical removal of the
virus by proper management of the bite wound
and by specific immunization protection.
Rubella (German measles) and
Congenital Rubella (Congenital Rubella
Rubella is a mild viral infectious disease. One
to 5 days prior to the appearance of a rash, mild
symptoms of malaise, loss of appetite, conjunc-
tivitis, headache, low grade fever, and minimal
respiratory symptoms may occur. The rash con-
sists of a pink eruption, which begins on the face
and spreads downward over the trunk and