their infants should receive postexposure prophylaxis (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 patient unless an absolute emergency. Perform sterilization on all syringes, needles, acupuncture needles, and stylettes. The use of disposable equipment 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 disinfection 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.
Influenza
Influenza is an acute viral disease primarily involving the respiratory tract with symptoms of fever, chills, headache, muscular pain, exhaustion, 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 patients 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 any season of the year. The reservoir for the influenza 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 exposed.
Current policy requires that all active duty Navy and Marine Corps personnel receive the annual influenza vaccine.
Management of patients, contacts, and the nearby environment includes the following principles: 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 affected.
Malaria
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