procedures outlined in International Health Regulations. They must be rodent free or routinely deratted. Routine vaccination for plague is not required for international travel to almost all countries.
Poliomyelitis, Acute
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 communicability 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 include (1) effective vaccines (inactivated and live virus) that are available and beneficial; and (2) education of the local public concerning the advantages 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 unreported cases.
Trivalent vaccines should be put into use at the earliest indication of an outbreak in a local population.
International travelers should be adequately immunized prior to visiting endemic areas, usually third world countries.
Rabies
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 susceptible 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 incubation 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 intensive supportive medical care.
Preventive community measures rely heavily upon the licensing of dogs and cats with the documentation of antirabies vaccine receipt a requirement. Collect and destroy ownerless animals. Pet owners should be educated concerning necessary restrictions for dogs and cats, e.g., leashing or confining to owner’s 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 examined for evidence of rabies. Veterinary personnel should submit intact heads packed on ice (not frozen) of sacrificed animals or animals that die of suspected rabies to the cognizant laboratory for testing.
Individuals at occupational or operational high risk of wild/domestic animal bites should receive preexposure immunization with the antirabies 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 Syndrome)
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, conjunctivitis, headache, low grade fever, and minimal respiratory symptoms may occur. The rash consists of a pink eruption, which begins on the face and spreads downward over the trunk and
