ITEMS IN AFP WITH MESH TERM:
Travel Immunizations - Article
ABSTRACT: Advising travelers on vaccine-preventable illnesses is increasingly becoming the responsibility of primary care physicians. The approach to vaccine recommendations should be based on a thorough assessment of the risks for travel-related diseases, the time available before trip departure, and current knowledge of the epidemiology of vaccine-preventable diseases. Routine childhood vaccinations should be reviewed in all travelers and updated as necessary. Yellow fever vaccination may be required for entry by countries that lie within a yellow fever zone or for travelers coming from an endemic area to prevent introduction of the disease. Immunization against hepatitis B virus should be considered in travelers who expect to have close contact with local populations that have high rates of hepatitis B transmission. Japanese encephalitis vaccine should be offered to travelers who plan prolonged trips to rural areas in southeast Asia or the Indian subcontinent during the transmission season. Typhoid fever immunization is recommended for travelers who may be exposed to potentially contaminated food and drink. Preexposure rabies vaccination should be considered in travelers who plan a prolonged duration of stay in a remote area or who engage in activities that might involve working near animals or that could attract animals. Physicians should be aware of the adverse events and contraindications associated with each travel vaccine.
ABSTRACT: All pregnant women should be offered screening for asymptomatic bacteriuria, syphilis, rubella, and hepatitis B and human immunodeficiency virus infection early in pregnancy. Women at increased risk should be tested for hepatitis C infection, gonorrhea, and chlamydia. All women should be questioned about their history of chickenpox and genital or orolabial herpes. Routine screening for bacterial vaginosis is not recommended. Influenza vaccination is recommended in women who will be in their second or third trimester of pregnancy during flu season. Women should be offered vaginorectal culture screening for group B streptococcal infection at 35 to 37 weeks' gestation. Colonized women and women with a history of group B streptococcal bacteriuria should be offered intrapartum intravenous antibiotics. Screening for gestational diabetes remains controversial. Women should be offered labor induction after 41 weeks' gestation.
ABSTRACT: Menopause is the permanent cessation of menstruation resulting from the loss of ovarian and follicular activity. It usually occurs when women reach their early 50s. Vasomotor symptoms and vaginal dryness are frequently reported during menopause. Estrogen is the most effective treatment for management of hot flashes and night sweats. Local estrogen is preferred for vulvovaginal symptoms because of its excellent therapeutic response. Bone mineral density screening should be performed in all women older than 65 years, and should begin sooner in women with additional risk factors for osteoporotic fractures. Adequate intake of calcium and vitamin D should be encouraged for all postmenopausal women to reduce bone loss. Coronary artery disease is the leading cause of death in women. Postmenopausal women should be counseled regarding lifestyle modification, including smoking cessation and regular physical activity. All women should receive periodic measurement of blood pressure and lipids. Appropriate pharmacotherapy should be initiated when indicated. Women should receive breast cancer screening every one to two years beginning at age 40, as well as colorectal cancer screening beginning at age 50. Women younger than 65 years who are sexually active and have a cervix should receive routine cervical cancer screening with Papanicolaou smear. Recommended immunizations for menopausal women include an annual influenza vaccine, a tetanus and diphtheria toxoid booster every 10 years, and a one-time pneumococcal vaccine after age 65 years.
Clinical Briefs - Clinical Briefs
The Pretravel Consultation - Article
ABSTRACT: The increase in travel and travel medicine knowledge over the past 30 years makes pretravel counseling an essential part of comprehensive family medicine. Effective counseling begins with assessment of individual and itinerary-based risks, using a growing body of evidence-based decision-support tools and resources. Counseling recommendations should be tailored to the patient's risk tolerance and experience. An essential component of the pretravel consultation includes reviewing routine and destination-specific immunizations. In addition to implementing behavioral adaptations, travelers can guard against vectorborne disease by using N,N-diethyl-m-toluamide (DEET, 30%), a safe and effective insect repellent. Patients should also receive malarial chemoprophylaxis when traveling to areas of risk. Proper precautions can reduce the risk of food- and waterborne disease. Travelers should take appropriate precautions when traveling to high altitudes. Strategies for minimizing the risk of deep venous thrombosis during air travel include keeping mobile and wearing compression stockings. Accident avoidance and coping strategies for health problems that occur while abroad are also important components of the pretravel consultation.
ACIP Releases Recommendations for the Immunization of Health Care Workers - Special Medical Reports
ACIP Recommendations for the Prevention of Hepatitis A Through Immunization - Practice Guidelines
A Microcosm of the Health Care 'System' - From The Editor
Evidence to Guide Measles Immunization Recommendations - AFP Journal Club