Letters to the Editor
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Additional Letters to the Editor Available Online: Genital Herpes Mimicked by Smallpox Vaccination Exposure Jennifer K. Benson, M.D., and David B. Benson, LT, MC, USNR Physicians Should Be Trained in Handling End-of-Life Issues Marcus C. Reeves, M.D. |
Advise Sexually Active Patients to Consider HIV Testing
to the editor: "In the absence of a cure for human immunodeficiency virus (HIV) infection, prevention is the most effective strategy for reducing the number of new cases."1 This sentence from the 2004 American Family Physician article "HIV Counseling, Testing, and Referral" by Dr. Gallant was just as true in 1987.2 I'm delighted that the Centers for Disease Control and Prevention (CDC) revised its recommendations to reduce barriers to testing.3 As a disease with a long asymptomatic stage during which an infected person may unknowingly spread the infection to others, and with a test that is highly sensitive and specific, HIV is a classic condition for early detection. Routine screening should be the norm.
The price of occasional anxiety over a false-positive test result is small compared with the millions who have died because we have been so slow to institute widespread testing. Physicians should advise their patients to raise the topic of HIV infection in conversation with a prospective sexual partner and suggest that both be tested before they have intercourse.
REFERENCES
1. Gallant JE. HIV counseling, testing, and referral. Am Fam Physician 2004;70:295-302,307-8.
2. Dykers JR Jr. AIDS: discrimination and justice. N C Med J 1987;48:661-3.
3. Centers for Disease Control and Prevention. Revised guidelines for HIV counseling, testing, and referral. MMWR Recomm Rep 2001;50(RR-19):1-57.
Travel Immunizations: Benefits and Precautions
to the editor: The article "Travel Immunizations" provided an excellent overview of the vaccine-preventable illnesses.1 I would like to make two points with respect to travel immunizations.
In addition to the obvious benefits of influenza vaccine for international travelers, physicians should consider an indication for the use of this vaccine in travelers to isolated Amerindian populations of the lowlands of South America. Such populations, with recent and minimal outside contact, suffer significant mortality as a consequence of contracting influenza and need to be protected from influenza introduced by travelers.
The authors correctly point out that analysis of recipients of the yellow fever vaccine in the United States from 1990 to 1998 indicated that persons 65 years or older were at increased risk for neurologic and systemic reactions. These adverse reactions appear to have occurred almost exclusively in first-time users of yellow fever vaccine who were older than 65 years, but not in those older than 65 years who underwent revaccination. A recent report in the Lancet2 indicated that persons with a history of thymus disease or thymectomy are at greatest risk for developing multiple organ failure and should not be given yellow fever vaccine.
REFERENCES
1. Lo Re V 3d, Gluckman SJ. Travel immunizations. Am Fam Physician 2004;70:89-99,103-4.
2. Barwick R; Eidex for the Yellow Fever Vaccine Safety Working Group. History of thymoma and yellow fever vaccination. Lancet 2004;364:936.
editor's note: This letter was sent to the authors of "Travel Immunizations," who declined to reply.
Send letters to Jay Siwek, M.D., Editor, American Family Physician, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672; fax: 913-906-6080; e-mail: afplet@aafp.org.
Please include your complete address, telephone number, fax number, and e-mail address. Letters should be submitted on disk, double-spaced, fewer than 500 words, and limited to one table or figure and six references. Please submit a word count.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
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