NECTM3 Hamburg 2010

www.nectm.com 3rd NECTM 2010 Northern Conference on Travel Medicine Programme and Abstracts Conference Center Hamburg (CCH) May 26 ‐ 29, 2010 Only available online at www.nectm.com NECTM 2010 in Hamburg Index _______________________________________________________________________________________ Programme
Page
Thursday........................................................................................................ 3
Friday ............................................................................................................ 6
Saturday......................................................................................................... 11
Poster Presentations....................................................................................... 13
Industry Sponsored Symposia....................................................................... 24
Abstracts
Plenary Presentations.................................................................................... 26
Symposium Presentations..............................................................................31
Workshop Presentations................................................................................ 39
Free Communications....................................................................................47
Poster Presentations....................................................................................... 57
Abstracts of Industry Sponsored Symposia.................................................111
Social Events................................................................................................... 113
Organisation.................................................................................................... 114
Index of Faculty & Authors............................................................................. 115
_______________________________________________________________________________________ Page 2 NECTM 2010 in Hamburg Programme Thursday, May 27, 2010 _______________________________________________________________________________________ OPENING
09.00 – 09.30
PLENARY HALL G
PL01
09.30 – 10.30
PLENARY
PLENARY HALL G
Pandemic Influenza in 1918
Chairs:
G. Burchard (Hamburg, Germany)
H. Sudeck (Hamburg, Germany)
What Happened and Why Does it Matter in 2010?
D. Shanks (Enoggera, Australia)
PL01.01
10.30 – 11.00
COFFEE BREAK / EXHIBITION EXHIBITION AREA
PL02
11.00 – 12.30
PLENARY
PLENARY HALL G
Maritime Medicine
Chairs:
C. Schlaich (Hamburg, Germany)
P. Voltersvik (Bergen, Norway)
Part 1: Cruise Ship Medicine: Outbreak on Board of a Cruise
Ship – What the Doctor in Travel Medicine Needs to Know
PL02.01
From the View of the Shipping Company and the Ships Doctor
T. Lammerding (Rostock, Germany)
PL02.02
From the View of the Port Health Authority
J. Rjabinina (Talinn, Estonia)
Part 2: Short Lectures
PL02.03
Disease Patterns in Tele-Medicine Advice - Experiences from
Swedish RadioMedical
K. Westlund (Goeteburg, Sweden)
PL02.04
Piracy in Shipping
N. Nikolic (Rijeka, Croatia)
12.30 – 14.30
LUNCH BREAK /
SATELLITE SYMPOSIUM CRUCELL /
(12.45 – 14.15)
EXHIBITION AREA/
PLENARY HALL G
SY01
14.30 – 16.00
SYMPOSIUM
Vaccines
Chairs:
L. Rombo (Stockholm, Sweden)
T. Löscher (Munich, Germany)
PLENARY HALL G
SY01.01
Vaccine Administration Routes: Immunological Aspects
A. Kantele (Helsinki, Finland)
SY01.02
Development of New Influenza Vaccines
R. Cox Brokstad (Bergen, Norway)
SY01.03
Intradermal and Transdermal Vaccination
L. Visser (Leiden, The Netherlands)
_______________________________________________________________________________________ Page 3 NECTM 2010 in Hamburg Programme Thursday, May 27, 2010 _______________________________________________________________________________________ WS01
14.30 – 16.00
WORKSHOP
Tick-borne Diseases in Europe
Chairs:
J. Suess (Jena, Germany)
B. Jaremin (Gdynia, Poland)
ROOM E
WS01.01
Ticks in Europe: Go and Win?
J. Suess (Jena, Germany)
WS01.02
Borreliosis in Poland: Risk for Tourists and Local Population
J. Stanczak (Gdynia, Poland), A. Kotlowski (Gdynia, Poland)
WS01.03
Discussion: TBE Vaccine – For and Against
L. Lindquist (Stockholm, Sweden), F. von Sonnenburg (Munich,
Germany)
FC01
14.30 – 16.00
FREE COMMUNICATION
Chairs:
J. Cramer (Hamburg, Germany)
F. Genasi (Glasgow, United Kingdom)
FC01.01
A Novel Galacto-oligosaccharide Mixture Prevents the Incidence
of Travellers’ Diarrhoea in Vivo
G. Tzortzis (Milton Keynes, United Kingdom)
FC01.02
Self-reported Illness in Cruise Ship Travellers – Focus on
“Stomach Upset”
N.J. Bryant (London, United Kingdom)
FC01.03
Clinical Update: Booster Recommendation for the Vero-cell
Derived JE Vaccine
K. Dubischar-Kastner (Vienna, Austria)
FC01.04
Health Problems Incidence and their Management During
Deployments Abroad: The ESOPE Study
C. Rapp (Marseille, France)
FC01.05
A Prospective Study on the Incidence and Risk Factors of
Probable Dengue Virus Infection Among Dutch Travellers
G.G. Baaten (Amsterdam, The Netherlands)
FC01.06
Rabies Post Exposure Treatment at the Liverpool School of
Tropical Medicine, UK
L. Wijaya (Liverpool, United Kingdom)
16.00 – 16.30
COFFEE BREAK / EXHIBITION
ROOM F
EXHIBITION AREA
_______________________________________________________________________________________ Page 4 NECTM 2010 in Hamburg Programme Thursday, May 27, 2010 _______________________________________________________________________________________ SY02
16.30 – 18.00
SYMPOSIUM
PLENARY HALL G
Extreme Travel
Chairs:
J. Davies (Cornwall, United Kingdom)
S. Koeman (Amsterdam, The Netherlands)
SY02.01
Cold Injury and Altitude
H. Karinen (Tampere, Finland)
SY02.02
Methods of Expedition Medicine
M. Shaw (Auckland, New Zealand)
SY02.03
Expeditions to Meghalaya India
J. Davies (Cornwall, United Kingdom)
WS02
16.30 – 18.00
WORKSHOP
Post Travel: Case-based Differential Diagnosis
Chairs:
L. Lindquist (Stockholm, Sweden)
B. Myrvang (Oslo, Norway)
WS02.01
Fever: What‘s the Likely Diagnosis in the Returned Traveller?
C. Hatz (Basel, Switzerland)
WS02.02
Differential Diagnosis of Eosinophilia
K. Smith (Glasgow, United Kingdom)
WS02.03
Pneumonia in Travellers
E. Reisinger (Rostock, Germany)
STA01
16.30 – 18.00
STATE OF THE ART
Travellers’ Diarrhoea
Chairs:
A. Kantele (Helsinki, Finland)
R. Hammer-Boge (Oslo, Norway)
STA01.01
Epidemiology and Etiology of TD: Obsolete, Recent and Missing
Data
R. Steffen (Zurich, Switzerland)
STA01.02
Antimicrobial Resistance in Bacterial Pathogens Causing TD
A. Hakanen (Turku, Finland)
STA01.03
Vaccines for TD
H. Grewal (Bergen, Norway)
18.15 – 19.45
SATELLITE SYMPOSIUM GLAXOSMITHKLINE
ROOM E
ROOM F
ROOM C
_______________________________________________________________________________________ Page 5 NECTM 2010 in Hamburg Programme Friday, May 28, 2010 _______________________________________________________________________________________ COD01
08.00 – 08.45
08.00 – 08.45
CASE OF THE DAY
Case Report
H. Siikamäki (Helsinki, Finland)
ROOM E
HAMBURG HISTORY
ROOM F
Health and Immigrants in Hamburg – The Ballinstadt
R. Geitner (Hamburg, Germany)
EUROTRAV NET SYMPOSIUM ROOM
A2.2
08.00 – 08.45
Networking with EuroTravNet and the European Centre
for Disease Prevention and Control: An Open Discussion
Chair:
P. Parola (Marseille, France)
ECDC and Travel Related Threats
F. Santos O’Connor (Stockholm, Sweden)
EuroTravNet: How it Works and how it Grows
P. Parola (Marseille, France)
Travel Medicine in Europe: the EuroTravNet Survey
P. Schlagenhauf (Zurich, Switzerland)
PL03
9.00 – 10.30
PLENARY
PLENARY HALL G
Malaria and Other Vector-borne Diseases
Chairs:
K. Smith (Glasgow, United Kingdom)
R. Horstmann (Hamburg, Germany)
PL03.01
Malaria
P. Chiodini (London, United Kingdom)
PL03.02
CCHF: Threat in Travel Medicine?
A. Stich (Würzburg, Germany)
PL03.03
Japanese Encephalitis
M.R. Buhl (Aarhus, Denmark)
10.30 – 11.00
COFFEE BREAK / EXHIBITION
EXHIBITION AREA
_______________________________________________________________________________________ Page 6 NECTM 2010 in Hamburg Programme Friday, May 28, 2010 _______________________________________________________________________________________ SY03
11.00 – 12.30
SYMPOSIUM
PLENARY HALL G
Venomous Animals
Chairs:
M.R. Buhl (Aarhus, Denmark)
C. Wong (Liverpool, United Kingdom)
SY03.01
Shellfish Poisoning
H. Sudeck (Hamburg, Germany)
SY03.02
Dangerous Insects and Other Arthropods
D. Mebs (Frankfurt, Germany)
SY03.03
Horrors and Myths in Travel Medicine
G. Hasle (Oslo, Norway)
WS03
11.00 – 12.30
WORKSHOP
ROOM E
Risk Assessment and Evidence in Travel Medicine
Chairs:
R.H. Behrens (London, United Kingdom)
H. Nohynek (Helsinki, Finland)
WS03.01
The Absolute and the Relative – What Can the Mathematical
Approach Tell Us About Estimating Travel Related Risk?
K. Auranen (Helsinki, Finland)
WS03.02
The Psychology of Risk
L. Noble (London, United Kingdom)
WS03.03
Methodology for Estimating Risks to Travellers at Policy Level
and how this Translates to the Individual
R.H. Behrens (London, United Kingdom)
ABC01
11.00 – 12.30
ABC LECTURE
Malaria
Chairs:
K. Smith (Glasgow, United Kingdom)
H.D. Nothdurft (Munich, Germany)
ABC01.01
Malaria Education for Travel Health Advisors and the Travellers
J. Chiodini (London, United Kingdom)
ABC01.02
Blood, Sweat and Beer - The Secret Passions of the Anopheles
P. Schlagenhauf (Zurich, Switzerland)
ABC01.03
Antimalarials for Chemoprophylaxis and Stand-by Treatment
H.D. Nothdurft (Munich, Germany)
12.30 – 14.30
LUNCH BREAK /
SATELLITE SYMPOSIUM NOVARTIS
(12.45 – 14.15)
ROOM F
EXHIBITION AREA /
PLENARY HALL G
_______________________________________________________________________________________ Page 7 NECTM 2010 in Hamburg Programme Friday, May 28, 2010 _______________________________________________________________________________________ SY04
14.30 – 16.00
SYMPOSIUM
PLENARY HALL G
Occupational Health, Assistance, Repatriation
Chairs:
G. Sonder (Amsterdam, The Netherlands)
F. Genasi (Glasgow, United Kingdom)
SY04.01
Post Exposure Prophylaxis for Expatriates: HIV etc.
A. Grieve (London, United Kingdom)
SY04.02
Repatriation
G. Tothill (Croydon, United Kingdom)
SY04.03
Screening of Expatriates for Psychiatric Disorders
M.E. Jones (Edinburgh, United Kingdom)
WS04
14.30 – 16.00
WORKSHOP
Immunosuppression and Travel
Chairs:
P. Voltersvik (Bergen, Norway)
P. Noone (Dublin, Ireland)
WS04.01
Immunosuppression in the Traveller: Consequences for
Vaccination and Medication
C. Schade Larsen (Aarhus, Denmark)
WS04.02
The Elderly Traveller: Immunosenescence and Consequences
for Vaccination and Medication
P. Thornam (Bergen, Norway)
WS04.03
The Pregnant Traveller and Malaria: Risk and Prevention
P. Schlagenhauf (Zurich, Switzerland)
FC02
14.30 – 16.00
FREE COMMUNICATION
Chairs:
D. Colbert (Galeway, Ireland)
H. Siikamäki (Helsinki, Finland)
FC02.01
Non-adherence to Malaria Chemoprophylaxis: Can it be
Predicted from Communication in the Pre-travel Consultation?
L. Noble (London, United Kingdom)
FC02.02
Imported Malaria in Finland 1995-2008: An Overview of
Surveillance,Travel Trends and Antimalarial Drug Sales
S. Guedes (Helsinki, Finland)
FC02.03
Evaluation of Travel Medicine Practice by Yellow Fever
Vaccination Centres in England, Wales and Northern Ireland
N. Boddington (London, United Kingdom)
ROOM E
ROOM F
_______________________________________________________________________________________ Page 8 NECTM 2010 in Hamburg Programme Friday, May 28, 2010 _______________________________________________________________________________________ FC02.04
The RAGIDA Project – European Risk Assessment Guidance
for Diseases Transmitted on Aircrafts
K. Leitmeyer (Stockholm, Sweden)
FC02.05
Infants, Altitude and Air Travel
K. Neumann (Forest Hills, USA)
FC02.06
Acute Mountain Sickness of Travellers Who Consulted a Pretravel Clinic
M. Croughs (Antwerp, Belgium)
16.00 – 16.30
COFFEE BREAK / EXHIBITION
SY05
16.30 – 18.00
SYMPOSIUM
PLENARY HALL G
Late Breaker
Chairs:
H. Sudeck (Hamburg, Germany)
H.D. Nothdurft (Munich, Germany)
SY05.01
The New WHO International Travel and Health Publication
G. Poumerol (Geneva, Switzerland)
SY05.02
Risks for Travellers to South Africa and Recommendations
for Visitors to the FIFA World Cup
M. Mendelson (Cape Town, South Africa)
SY05.03
Consequences of Volcanic Eruptions for Travel Medicine
E. Gulliksen (Oslo, Norway)
WS05
16.30 – 18.00
WORKSHOP
Travel Medicine Qualification and Competencies
in NECTM Countries – the Way forward?
Chairs:
E. Walker (Glasgow, United Kingdom)
S. Grieve (London, United Kingdom)
WS05.01
Success of a Dutch Registration System for Travel Medicine
Physicians and Nurses
G. Sonder, S.C. Koeman (Amsterdam, The Netherlands)
WS05.02
Proposals for an Education Programme for the Nordic Countries
P. Voltersvik (Bergen, Norway)
WS05.03
Education in Travel Medicine – the Faculty of Travel Medicine
(RCPSG)
P. Chiodini (London, United Kingdom)
WS05.04
The Diploma in Travel Medicine (HPS) – an E-learning Course
L. Boyne (Glasgow, United Kingdom)
EXHIBITION AREA
ROOM E
_______________________________________________________________________________________ Page 9 NECTM 2010 in Hamburg Programme Friday, May 28, 2010 _______________________________________________________________________________________ STA02
16.30 – 18.00
STATE OF THE ART
Vaccinations for Travellers
Chairs:
L. Rombo (Stockholm, Sweden)
E. Reisinger (Rostock, Germany)
STA02.01
Yellow Fever Risk Mapping
D. Hill (London, United Kingdom)
STA02.02
New Dengue Vaccines
A. Wilder-Smith (Singapore, Singapore)
STA02.03
New Vaccines in the Pipeline
T. Löscher (Munich, Germany)
18.15 – 19.00
SATELLITE SYMPOSIUM SIGMA-TAU
ROOM F
ROOM F
_______________________________________________________________________________________ Page 10 NECTM 2010 in Hamburg Programme Saturday, May 29, 2010 _______________________________________________________________________________________ COD02
08.00 – 08.45
CASE OF THE DAY
Case Report
G.D. Burchard (Hamburg, Germany)
ROOM E
ABC02
08.00 – 08.45
ABC LECTURE
Vaccinations
Chairs:
C. Wong (Liverpool, United Kingdom)
L. Rombo (Stockholm, Sweden)
ROOM F
ABC02.01
Case Studies
L. Rombo (Stockholm, Sweden)
ABC02.02
Case Studies
C. Wong (Liverpool, United Kingdom)
SY06
09.00 – 10.30
SYMPOSIUM
PLENARY HALL G
Rapid Surveillance Systems
Chairs:
F. von Sonnenburg (Munich, Germany)
E. Petersen (Aarhus, Denmark)
SY06.01
News from the GeoSentinel Network
F. von Sonnenburg (Munich, Germany)
SY06.02
EuroTravNet – The European Travel Medicine Network
P. Parola (Marseille, France)
SY06.03
Health Map
A. Sonricker (Boston, USA)
WS06
09.00 – 10.30
WORKSHOP
ROOM E
Post travel: Case-based Differential Diagnosis in Tropical
Dermatology
Chairs:
M. Fischer (Hamburg, Germany)
G. Harms-Zwingenberger (Berlin, Germany)
WS06.01
Cutaneous Infections by Mycobacterium tuberculosis
U. Greinert (Borstel, Germany)
WS06.02
Cutaneous and Mucocutaneous Leishmaniasis in Travellers
M. Fischer (Hamburg, Germany)
WS06.03
Skin Diseases and STDs in Amazonia
S. Talhari (Manaus, Brazil)
_______________________________________________________________________________________ Page 11 NECTM 2010 in Hamburg Programme Saturday, May 29, 2010 _______________________________________________________________________________________ FC03
09.00 – 10.30
FREE COMMUNICATION
Chairs:
S. Schmiedel (Hamburg, Germany)
S. Hagmann (Bronx, USA)
FC03.01
An Analysis of the Pattern of Travel-related Morbidity Reported
by Hajj Pilgrims: An Irish Perspective
R.A. Raja Ali (Galway, Ireland)
FC03.02
Prospective Analysis of Infections in Immigrants and Refugee
Patients from an Athens General Hospital
A.K. Zacharof (Halandri, Greece)
FC03.03
Chagas Disease in Latin American Migrants. A European
Challenge
R. López-Vélez (Madrid, Spain)
FC03.04
Referral Sources for Travel Health Consultations Among
Travellers Visiting Friends and Relatives (VFRs) at an Inner-City
Hospital in the Bronx, New York
S. Hagmann (Bronx, USA)
FC03.05
Rare Worms are Rare - Still They Exist
H. Sudeck (Hamburg, Germany)
FC03.06
Long-term Stays Abroad and Terror: Aspects of Prevention and
Care
G. von Laer (Berlin, Germany)
10.30 – 11.00
COFFEE BREAK / EXHIBITION
PL04
11.00 – 12.30
PLENARY SESSION
PLENARY HALL G
Fair Tourism – Is it Possible?
Chairs:
H. Siikamäki (Helsinki, Finland)
R. Hammer-Boge (Oslo, Norway)
PL04.01
How Travel Affects our Environment – a Historical Perspective
E. Walker (Glasgow, United Kingdom)
PL04.02
Tourism Responding to the Challenge of Climate Change
M. Mero (Helsinki, Finland)
PL04.03
Cultural Aspects of Tourism – Our Common Responsibility
N. Middleton (Oxford, United Kingdom)
CLOSING
12.30 – 12.45
ROOM F
EXHIBITION AREA
PLENARY HALL G
_______________________________________________________________________________________ Page 12 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P1
Malaria and Malaria Prophylaxis
P1-01
Malaria: Cross-Cultural Variation in Attitudes. A Prospective Bilingual
Survey in Amazonian Peru.
Leckie, K., Smith, C.
P1-02
The Burden of Imported Malaria in Gauteng Province, South Africa
Baker, L., Weber, I.B., Blumberg, L.
P1-03
Validity of Malaria Diagnosis in Non-immune Travellers in Endemic
Areas
Barreto M.I., Weber, C., Fleischmann, E.1, Bretzel, Löscher, Th.
P1-04
Trends in Antimalarial Prescriptions in Australia 1992-2007
Leggat, P.A.
P1-05
Implications from Cardiac Ultrasound and ECG for Cardiac Function in
Children with Severe Malaria in Ghana
Mehrfar, P., Nguah, S., Hoffmann, S., Pelletier, D., Feldt, T., Ehrhardt, S.,
Herr, J., Burchard, G.D., Cramer, J.P.
P1-06
Current Understanding of the Need to Take Malaria
Chemoprophylaxis among Leisure Travellers and Travel
Destinations
Vassalou, E., Vassalos, C.M., Grigoraki, A., Sofos, N., Vakalis, N.
P1-06b
Severe Falciparum Malaria in a Polish Seaman Leading to Extensive
Feet and Hand Necrosis
Wichmann, D., Kluge, S., Burchard, G.D.
P1-06c
Decline in the Efficacy of a 3-day Artesunate-Mefloquine
Combination in the Treatment of Uncomplicated Falciparum
Malaria along the Thai-Myanmar Border of Thailand in 2009
Congpuong, K., Poolthin, S., Satimai, W., Pinyorattanachote, A.,
Tunchan, K., Cholaphol, S., Chompoonuch, C.
P2
Immunizations
P2-07
Yellow Fever Vaccine Uptake in Private Travel Medicine
Clinics in South Africa
Brink, G.K.
_______________________________________________________________________________________ Page 13 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P2-08
Typhoid Vaccination Patterns of Travellers from Greece Visiting
Developing Countries
Smeti, P., Pavli, A., Patrinos, S., Hadjianastasiou, S., Vakali, A., Sotiriou, G.,
Saroglou, G., Maltezou, H.C.
P2-09
One Dose of the Meningococcal Tetravalent Conjugate Vaccine
(MenACWY-TT) is Immunogenic with an Acceptable Safety Profile in
Unvaccinated Subjects and those Previously Vaccinated with a
MenACWY Polysaccharide Vaccine
Dbaibo, G., Van der Wielen, M., Reda, M., Medlej, F., Tabet, C., Sumbul, A.,
Anis, S., Miller, J.
P2
Immunizations
P2-10
Immunogenicity and Safety of Japanese Encephalitis Vaccines:
a Meta-Analysis
Masuet Aumatell, C., Ramon Torrell, J.M.
P2-11
Enzyme Immunoassay Detection of Immunoglobulin M and G
Antibodies to Cryptosporidium in Immunocompetent &
Immunocompromised Persons
Dorostkar Moghaddam, D., Eyni, H.
P2-12
Pertussis Vaccination of Adult Travellers: Awareness and Practicality
Van Damme, P., Theeten, H., Booy, R., Van Der Meeren, O., Chatterjee, N.,
Jacquet, J.-M., Mertsola, J.
P2-13
Consensus on Pertussis Booster Vaccination in Europe (C.O.P.E.)
Zepp, F., Bernatowska, E., Guiso, N., Heininger, U., Mertsola, J., Roord, J.,
Tozzi, A.
P2-14
Survey on the Tetanus Vaccination in Case of Wounded Patients
in an Emergency Unit. Usefulness of the Tetanos Quick Stick.
Bourée, P., Bisaro, F., Rouh-Neau, S.
P2-15
Evaluation of Hepatitis B Immune-Response in Elderly, Obese or
Medically Compromised Subjects after Vaccination with HAB
Combination or Monovalent Hepatitis B Vaccines
Chlibek, R., von Sonnenburg, F.,Van Damme, P., Smetana, J., Tichy,, P.,
Gunapalaiah, B., Knoblach, B., Jacquet, J.-M.
_______________________________________________________________________________________ Page 14 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P2-16
The Candidate Meningococcal Serogroups A, C, W-135, Y Conjugate
Vaccine (MenACWY-TT) Co-administered with a Combined Hepatitis A
and B Vaccine (HepA/B) is Immunogenic and welltolerated in Subjects
Aged 11–17 Years
Østergaard, L., Silfverdal, S.A., Schade Larsen, C., Bianco, V., Baine, Y.,
Miller, J.
P2-17
The Candidate Meningococcal Serogroups A, C, W-135, Y Tetanus
Toxoid Conjugate Vaccine (MenACWY-TT) and the Seasonal Influenza
Virus Vaccine are Immunogenic and Well-tolerated when Coadministered in Adults
Macalalad, N., Aplasca-De Los Reyes, M.R., Dimaano, E., Dbaibo, G.,
Bianco, V., Baine, Y., Miller, J.
P2-18
The Immunogenicity of the Candidate Meningococcal
Serogroups A, C, W-135, Y Tetanus Toxoid Conjugate Vaccine
(MenACWY-TT) is Non-inferior to the Licensed Meningococcal
Tetravalent Polysaccharide Vaccine and has an Acceptable
Safety Profile in Adults
Dbaibo, G., Macalalad, N., Aplasca-De Los Reyes, M.R., Dimaano, E.,
Bianco, V., Baine, Y., Miller, J.
P2-19
The Importance of a HBsAg Titer Control after HBV Vaccination
in Healthy Firefighters; Implications for the Traveller?
Kalule, J.W., Haverkort, M.E., de Jonge, M.E., Wetsteijn, J.C., Vlug, J.,
Lede, I.O., de Jong, E., van Vugt, M.
P2-20
The Total Number of TBE-vaccine Doses is Important for Serological
Response after Delayed Booster ?
Askling, H.H., Lindquist, L., Rombo, L., Rydgård, C., Vene, S.
P2-21
Cross-protection Induced by the Ty21a Vaccine (Vivotif®) Against
Paratyphoid A & B Fever
Erlanger, T.E., Herzog, C.
P2-22
IgA Subclass Distribution and Homing Properties of Specific Circulating
Plasmablasts Elicited by Oral or Parenteral Salmonella typhi Ty21a
Vaccines
Pakkanen, S.H., Kantele, J.M., Häkkinen, M., Kantele, A.
P2-22a
Long-term Antibody Persistence Observed 15 Years after Vaccination
with an Aluminium Adsorbed Hepatitis A Vaccine
Van Herck, K., Panis, T., Gunapalaiah, B., Macura-Biegun, A., Jacquet, J.-M.,
Van Damme, P.
_______________________________________________________________________________________ Page 15 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P3
Enteric Infections and Travellers’ Diarrhoea
P3-23
Frequency of Escherichia coli Pathotypes Obtained from Children with
Acute Diarrhoea
Kalantar, E., Soheili, F., Salimi, H.
P3-24
Isolation of Bacteria and Fungi from Housefly (Musca domestica L.) at
Slaughter House and Hospital in Sanandaj, Iran
Davari, B., Kalantar, E., Verdi, F., Zamini, G., Zahirnia, A.
P3-25
Antibacterial Effect and Physico-chemical Properties of Essential Oil of
Zataria multiflora Boiss
Alasvand Rarasvand, M., Kalantar, E.; Amin, M.
P3-26
Effect of Ultrasound Wave on Multi-drug Resistance E. coli and
Methicillin Resistance Staphylococcus aureus Isolated from Diarrheal
Patients
Maleki, A.; Kalantar, E.; Ebrahimi, R.
P3-27
Enteric Fever Imported to the Czech Republic
Stejskal, F., Trojanek, M., Reisingerova, M., Gabrielova, A., Maresova, V.
P3-27a
Real-time Multiplex PCR for Rapid Diagnosis of Entero- pathogenic
Bacteria in Stool Samples of Patients with Travellers’ Diarrhoea (TD)
Hagen R.M., Wiemer D., Priesnitz S., Helm F., Tannich E., Fischer M.
P5
Migrants and Refugees
P5-28
Diagnostic Approach in Two Cases of Microcytic Anemia in Refugees
from Congo
Zaccarin, M.
P5-29
Recurrent Crural Ulcers in a 21 Year old Male Migrant from Ghana
Mueller, A.1, Ziegler, U., Schulze, M.1, Tappe, D., Stich, A.
P5-29a
Cerebral Alveolar Echinococcosis in a Migrant
Stauga, S, Schmiedel, S., Lund, C.H.
P6
Returning Travellers
P6-30
Obtaining a Travel History from Returned Travellers Presenting with
Tropical Infectious Disease Symptoms – How Well Are We Doing?
Flaherty, G., Gately, R., Fleming, C.
P6-31
Murine Typhus Acquired During a Three Week Business Travel to the
Philippines
Kibsgaard, L., Lindberg, J., Villumsen, S.3, Larsen, C.S.
_______________________________________________________________________________________ Page 16 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P6-32
Travel-related Adults Fever: Aetiologies, Health Care Itinerary and
Outcome of 618 Hospitalized Cases.
Rapp, C., Delarbre, D., Ficko, C.1, Meynard, J.B., Méchaï, F., Imbert, P.
P6-33
Successful Treatment of Refractory Cutaneous Leishmaniasis with
Miltefosine
Elsner, E., Foroutan, B., Müller, R.
P6-34
Medical Repatriation of Business Travellers: The Etiological Spectrum
of Travel-related Infections
Rapp, C., Ficko, C., Delarbre, D., Aoun, O.1, Cambon, A., Méchaï, F.,
Imbert, P.
P6-35
Melioidosis in Travellers – Pitfalls in Diagnosis of Burkholderia
pseudomallei by Laboratories from Non-endemic Regions
Schultze, D., Dollenmaier, G., Bruderer, T., Riehm, J., Boggian, K.,
Müller, B., Rafeiner, P
P6-37
Imported Rabies after Travel to Highly Endemic Areas: Differing
Therapeutic Strategies in Two Cases of Travel Related Rabies in a
Hospital in Hamburg
Schmiedel, S.
P6-38
Severe Conjunctivitis due to Adenovirus and Neisseria gonorrhoeae
Co-infection in a Traveller Returning from Thailand
Müller, A., Ziegler, U., Schulze, M., Tappe, D., Schubert, J., Schargus, M.,
Stich, A.
P6-39
A Case of Severe and Prolonged Katayama Syndrome
Herr, J., Cramer, J.
P6-40
Returning Globetrotter with Cerebral Malaria Having Taken Antimalarial
Chemoprophylaxis
Vassalou, E., Vassalos, C.M., Vakalis, N.
P6-41
Diabetes Provoked by Fishing in Thailand
Kreuzberg, C., Sudeck, H.
P6-42
Other Causes of Eosinophilia than Helminth Infections in Returning
Travellers from South East Asia
Jordan, S., Schmiedel, S., Burchard, G.D.
P6-42b
Imported Versus Autochthonous Leptospirosis in Austria and Germany:
Differences in Clinical Manifestations
Cramer, J.P., Hoffmeister, B., Peyerl-Hoffmann, G., Pischke, S., Krause, R.,
Müller, C, Graf, A., Kluge, S., Burchard, G.D., Suttorp, N.
_______________________________________________________________________________________ Page 17 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P6-42c
Clinical and Laboratory Pattern in African Tick Bite Fever: a case series
of 14 German travellers to sub-Saharan Africa
Jochum J., Cramer, J.
P6-42d
First Imported Case of Fatal Dengue-hemorrhagic Fever in Germany
Schmidt-Chanasit, J., Racz, C., Racz, P
P6-42e
Toscanavirus Meningitis Acquired on the Island of Elba and Imported
into Switzerland
Gabriel, M., Resch, C., Günther, S., Schmidt-Chanasit, J.
P7
Long-Stay Travellers, Occupational Medicine
P7-43
Repatriation Training: How to Encourage Better Readjustment on
Repatriation
Phelan, D., Lawson
P7-44
Prevalence of Intestinal Helminths among Polish Peacekeepers in
Eastern Chad, Central Africa
Korzeniewski K.
P7-45
Seasonal Pattern of Rainfall and Malaria Incidence among Long Term
Expatriates Seeking Medical Attention in Central Nigeria over a 10
Years Period.
Grasteit, A.
P7-46
Automated External Defibrillators (AED) in German Embassies
Sasse, J., Boelke, N., Winkler, E.
P7-47
Risk Factors for Work-related Back Pain among Khon Kaen University
Office Workers in Thailand
Chaiklieng, S., Suggaravetsiri, P.
P8
Epidemiology of Infectious Diseases, Surveillance
P8-48
Travel-related Schistosomiasis, Strongyloidiasis, Filariasis, and
Toxocariasis: The Risk of Infection and the Diagnostic Relevance of
Blood Eosinophilia.
Baaten, G., Sonder, G., Van Gool, T., Kint, J., van den Hoek, A.
P8-49
Epidemiology of Travel Associated Infectious Diseases Morbidity in
Europe, 2008
Field, V., Gautret, P., Schlagenhauf, P., Burchard, G.D., Caumes, E.,
Jensenius, M., Castelli, F., Gkrania-Klotsas, E., Weid, L., von Sonnenburg, F.,
López-Vélez, R., Loutan, L., de Vries, P., Parola, P.
_______________________________________________________________________________________ Page 18 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P8-50
The Prevalence and Correlation of Giardiasis with the Nutritional Status
of Primary School Students in Isfahan City, Iran
Dorostkar Moghaddam, D., Eyni, H.
P8-52
Hazards of Scorpions Stings in South and Southwest of Iran
Bourée, P., Ensaf, A.
P8-53
Study on Snake Bites in Iran: 134 Patients
Ensaf, A., Bourée, P.
P8-54
Tick-borne Diseases in Romania - an Update
Popescu, C.P., Florescu, S.A., Ceausu, E., Calistru, P.I.
P8-55
Prevalence of Bartonella spp in Ectoparasites Collected from Domestic
(Canis familiaris) in Piraí, State of Rio de Janeiro, Brazil: Preliminary
Results
Moreira, N.S., Favacho, A.R.M., Souza, A.M., Barreira, J.D., Lemos, E.R.S.;
Almosny, N.R.P.
P8-56
Molecular Detection of Rickettsia sp in Ectoparasites Collected from
Domestic Dogs (Canis familiaris) in Piraí, in the State of Rio de Janeiro,
Brazil: Preliminary Results.
Moreira, N.S., Favacho, A.R.M., Rozental, T., Barreira, J.D., Lemos, E.R.S.,
Almosny, N.R.P.
P8-57
Seroprevalence for Anti-Ehrlichia canis and Anti-rickettsia rickettsii in a
Dog Population of Rio de Janeiro, Brazil.
Rozental, T., Moreira, N.S., Oliveira, R.C., Lemos, E.R.S.
P8-58
Border Health Measures at the Hamburg Airport during the 2009
Influenza Pandemic
Gau, B., Schlaich, C.C.
P8-59
Molecular Identification of Borrelia sp. in Arthropods Collected in Piraí
County, State of Rio de Janeiro, Brazil.
Favacho, A.R.M., Moreira, N.S., de Almeida, D.M.P., Pesoa Jr, A.A.,
Barreira, J.D. Lemos, E.R.S.
P8-60
Acute Primary Dengue Infections in Finland
Erra, E., Huhtamo, E., Vapalahti, O., Kantele, A.
P10
Travel Medicine Practice
P10-61
Evaluation of Foreign Travellers‘ Registrations in Balcali Hospital of
Cukurova University
Tanir, F., Aytac, N., Akbaba, M.
_______________________________________________________________________________________ Page 19 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P10-62
The Holiday Diver and a Clueless Doctor: a Risky Match
Faesecke, K.P.
P10-63
A Research Network in Travel Medicine
Goodyer, L.I., Johal, M., Flaherty, G.
P10-64
Results from an Online Survey evaluating Knowledge about
Risks, Prevention and Consequences of Infections with Hepatitis B
Virus among Travellers from Four European Countries
Herbinger, K.-H, Prymula, R., Nothdurft, H.D.
P10-65
Counseling the International Traveller – 3-Year Analysis from a
Reference Centre in Lisbon
Luis, N.M., Silva, C., Tavares, R., Bento, D., Leite, R., Alfaiate, D.,
Baptista, T., Aldir, I., Antunes, I. Araújo, C. Miranda, A.C., Borges, F.,
Mansinho, K.
P10-66
The Royal College of Nursing of the United Kingdom (RCN UK) Public
Health Forum (PHF) Travel Health Network
Grieve, A.W., Atwell, C., Bailey, L., Ashmore, J., Cocksedge, M., Dias, E.,
Everett, S., Umeed,M.
P10-66a
Travel and Tropical Medicine in Family Physician Practice in Slovenia
Rajtmajer, M.
P11
Travel Advice-Techniques & Outcomes
P11-67
Knowledge and Practices of Travel Medicine Providers about Rabies in
Greece
Pavli, A., Hadjianastasiou, S., Patrinos, S., Vakali, A., Smeti, P.,
Delasouda, A., Ouzounidou, Z., Maltezou, H.C.
P12
Global and Environmental Issues
P12-68
Prioritising Global Health and Development Education in an
Undergraduate Medical Curriculum
Flaherty, G., Vaughan, D., Connolly, M., Cormican, M., O‘Donovan, D
P12-68a
Medical Entomology in Military Camps of North Afghanistan /
South Uzbekistan
Krüger, A., Rossmann, K., Schmidt, S.
Tropical Medicine
P13
P13-69
Blastocystis hominis and the Evaluation of Efficacy of Metronidazale
and Trimethoprim/ Sulfamethoxazole
Dorostkar Moghaddam, D., Ghadirian, E.
_______________________________________________________________________________________ Page 20 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P13-70
Imported Tropical Diseases in Romania – Last 10 years
Florescu, S.A., Popescu, C.P., Ceausu, E., Calistru, P.I.
P13-71
2 Cases of Disseminated Histoplasmosis Imported from Thailand
Jordan, S., Schmiedel, S., Burchard, G.D.
P13-73
Long - term Application of Miltefosine: A Possibility for a Finally
Successful Treatment of Disseminated Cutaneous Leishmaniasis
Caused by L. major
Fischer, M., Racz, P., Burchard, G.D., Boecken, G.
P13-74
Unusual Case of Cutaneous Leishmaniasis and Experience with
Diagnostics and Treatment of South American Leishmaniasis
Stejskal, F., Tomickova, D., Vojackova, N., Koutnikova, H, Votypka, J.6
P13-75
Diagnosis of Dengue in Returning Travellers with Previous Flavivirus
Vaccinations
Walentiny, C.E.F.
P13-75a
Venomous Snake Bites in Lao PDR
Blessmann, J.
P14
Aviation and High Altitude Medicine
P14-76
Lofty Thoughts – Introducing Medical Students to High Altitude
Medicine
Flaherty, G., O‘Brien, T.
P14-77
The Significant Factor for Saving Patients with Altitude Sickness
- From the View Point of Consul
Yamamoto, K., Ishihara, Y., Saiki, K.
P14-78
The Long-term Influence of High Altitude on Blood Cell Counts in
Japanese Embassy Staffs and their Families Staying from Japan
to La Paz in Bolivia
Saiki, K.
P14-79
A Cetazolamide Provision at a Travel Clinic for Travellers to Altitudes of
Above 3000 metres.
Bradley, P.1, Ford, L., Lalloo, D.
P15
Trauma, Accidents, Security
P15-81
An Overview of Major Occupational Diseases and Injuries that
Affect Wildlife Veterinarians in Brazil
Nicolino, R.R., Pissinatti, A., Moreira, N.S., Monteiro, A.O.
_______________________________________________________________________________________ Page 21 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P16
Other Travel Related Topics
P16-82
Alcohol Level and Severity of Injury among Road Traffic Accidental
Patients at Nonsung Hospital, Nakhonratchasima Province, Thailand
Suggaravetsiri, P.1, Chaiklieng, S., Thongduang, P.
P16-83
Knowledge, Attitude and Practice Regarding Pandemic Influenza
A (H1N1) among Iranian Pilgrims: Previous the Hajj Period in 2009
Ghalyanchi Langeroudi, A., Majidzadeh, K., Soleimani, M., Jamshidiyan, E.,
Mohseni, A., Morovvati, A.
P16-84
Difficulties and Basic Considerations in the Treatment of Travelers
Abroad
Felkai, P.
P16-85
On the Significance of Differences between Standard Time and True
Solar Time for the Exposition against UVB -Radiation
Stick, C.
P16-86
Examination of the Admission Reasons of Tourists ın MersinKizkalesi who Applied to Primary Health Care Setting
Aytac, N., Duzel, V., Oztunc, G.2, Tanir, F.3
P16-87
Psychological Challenges During Journey
Ježewska, M., Grubman, M., Leszczyńska
P16-89
Risks for Travellers who Received Pretravel Consultations before
Visiting the Tropics
Grigoraki, A., Sotirchos, A., Sofos, N.1, Vassalos, C.M., Vassalou, E.,
Vakalis, N.
_______________________________________________________________________________________ Page 22 NECTM 2010 in Hamburg Poster Presentations _______________________________________________________________________________________ P17
Professional Education and Training in Travel Medicine
P17-90
Undergraduate Education of Travel Medicine for Medical Students and
Pharmacists
Felkai, P.
P17-91
Reducing the Risk of Travel-related Dengue Infection – An Irish
Perspective
Flaherty, G., Hamza, M., Colbert, D.
P17-92
Australian Travel Health Advisory Group: Activities of a Joint Travel
Industry and Travel Medicine Group Promoting Healthy Travel
Leggat, P.A., Hudson, B., Zwar, N.
P17-93
A Sub-Faculty of Expedition Medicine for Australasia
Shaw, M., Leggat, PA
_______________________________________________________________________________________ Page 23 NECTM 2010 in Hamburg Sponsored Symposia _______________________________________________________________________________________ ST01
MAY 27, 2010
12.45 – 14.15
SYMPOSIUM CRUCELL
Vaccines make the world go round
PLENARY HALL G
Introduction
T. Jelinek (Berlin, Germany)
Global prevention of hepatitis
J. Zuckerman (London, UK)
Cholera – risk for travelers?
T. Jelinek (Berlin, Germany)
The role of vaccines role in Global Health
H. Rosling (Stockholm, Sweden)
Discussion
ST02
MAY 27, 2010
18.15 – 19.45
SYMPOSIUM GSK
The BIG CONVERSATION
ROOM C
Topics:
 The changing profile and newly emerging categories of
travellers
 Travel medicine 20 years from now – the views from the
audience and the expert panel on the future challenges in
travel medicine.
 Highlights of the development of vaccines and meningococcal
meningitis prevention in the future
Speakers:
• Prof. Robert Steffen, Switzerland
• Prof. Thomas Löscher, Germany
• Prof. Eskild Petersen, Denmark
• Dr François Meurice, GlaxoSmithKline Biologicals, Belgium
_______________________________________________________________________________________ Page 24 NECTM 2010 in Hamburg Sponsored Symposia _______________________________________________________________________________________ ST03
MAY 28, 2010
12.45 – 14.15
SYMPOSIUM NOVARTIS VACCINES
Strategies in low incidence/high impact
diseases
PLENARY HALL G
Introduction
J. Zuckerman (London, UK)
Yes? No? I don't know? Should travelers be vaccinated
against Japanese Encephalitis?
T. Jelinek (Berlin, Germany)
Do travelers know the risk of rabies?
N. Tordo (Paris, France)
Preventing meningococcal disease in travelers
R. Steffen (Zurich, Switzerland)
ST04
MAY 28, 2010
18.15 – 19.00
SYMPOSIUM Sigma-Tau
Advancing and Optimizing Treatment for
Uncomplicated and Severe Malaria
ROOM F
Chair: F. v. Sonnenburg (Munich, Germany)
From Abele Sola to Ho Chi Minh: Historical references
on malaria and its treatments.
M. Corsi (Pomezia, Italy)
Development of Dihydroartemisinin/ Piperaquine
(Eurartesim®)
Q. Bassat (Barcelona, Spain)
Intravenous Artesunate: The new generation of lifesaving
treatment for severe malaria.
P.J. Weina, (Silver Spring, MD, USA)
_______________________________________________________________________________________ Page 25 NECTM 2010 in Hamburg Plenary Abstracts _______________________________________________________________________________________ PL01.01
Pandemic Influenza in 1918: What Happened and Why Does it Matter in 2010?
Shanks, G.D.1,2
1
Australian Army Malaria Institute, Enoggera, QLD, Australia, 2University of Queensland, School of Population
Health, Brisbane, QLD, Australia
Background: Pandemic influenza has great mortality potential as seen during 1918-19 but lacks predictability as
seen in 2009-10. How large populations fared during 1918-19 could give insights into what may or may not
occur during future influenza pandemics.
Methods: The influenza pandemic of 1918-19 occurred at the end of the First World War during a period of
unprecedented human movement. Various military groups' morbidity and mortality were examined in order to
better understand the public health consequences of this travel.
Results: Although influenza illness was commonly seen in 1:5 to 1:3 soldiers, mortality rates varied by a factor
>30 in groups that were otherwise undistinguishable. Medical and nursing personnel were often infected, but
died at comparatively low rates. The single most important risk factor for death in military groups was the length
of military service at the time of the pandemic. Mortality was predominately seen in recently recruited soldiers.
Previous exposure to multiple respiratory pathogens was protective against death especially the poorlycharacterized influenza-like illness that swept the world in mid-1918 prior to the main pandemic wave in late
1918. Most large naval ships had no deaths despite high infection rates; the exception being four particular
outliers which had been on patrol duty in the Southern Hemisphere. Mortality was especially severe on isolated
islands in the Pacific.
Conclusion: The influenza pandemic of 1918-19 caused highly variable mortality in military units with
consistent disease reporting. This suggests that host factors were important in determining mortality and the
observed death rates were not caused by an inherently pathogenic virus.
PL02.01
Cruise Ship Medicine: Outbreak on Board a Cruise Ship - What the Doctor in Travel Medicine Needs to
Know - From the View of the Shipping Company and The Ships Doctor
Lammerding, T.1
1
AIDA Cruises, Medical, Rostock, Germany
Content of lecture:
- Introduction of medical facilities on board a cruise ship (infirmary, Medical Staff, additional equipment) and
the range of duties of a ships surgeon.
- Definition criteria for an OUTBREAK.
- Presentation of different sources (Food-borne, Waterborne, Contagious) and germs (i.E. Salmonella, legionella,
norovirus, novel influenza) for an outbreak and the typical chain of infection.
- Measures of surveillance and detection of an outbreak at an early state, including specific tests and ways of
data collection.
- Countermeasures, particularly Disinfection measures for different situations and levels of outbreak, especially
for Norovirus, ARI/ILI, Novel Influenza, Legionella.
- Continuous prevention measures, to avoid that an outbreak is triggered from a small number of infected
persons.
- Logistic and other practical related problems which need to be solved during an outbreak (i.E. Dealing with a
large number of patients who need to be treated, Problems related to the isolation of patients, problems on
specific itineraries).
-Introducing the medical declaration of health.
-Cooperation with Port health authorities.
_______________________________________________________________________________________ Page 26 NECTM 2010 in Hamburg Plenary Abstracts _______________________________________________________________________________________ PL02.02
Cruise Ship Medicine: Outbreak on Board a Cruise Ship: What the Doctor in Travel Medicine Needs To
Know from the View of the Port Health Authority
Rjabinina, J.1
1
Health Board, Department of CD Surveillance and Control, Tallinn, Estonia
The objectives of this presentation are to:
1. Describe the preparedness of international harbours (as a part of the national preparedness plan), responsibility
of Public Health Authorities (PHA) in accordance with international and national legislation, possible public
health measures which could be implemented to arriving ships according to the epidemiological situation to
prevent the possible spread of infection (possible restrictions: isolation of ill persons, quarantine of suspected
persons, traveller screening procedure);
2. Review the common infections that affect cruise ships and problems related with outbreak detection and
investigation;
3.Introduce an international/national guidelines for the prevention and control of infectious diseases; promote the
integrated ship sanitation strategy;
4. Discuss the ways for better collaboration and communication between cruise ship, PHA and physicians to
prevent the possible spread of infectious diseases; SHIPSAN TRAINET partnership
PL02.03
Disease patterns in tele-medicine advice – experiences from Swedish Radio Medical. Swedish Radio
Medical (RM) 1997 – 2009.
Westlund, K1, Nilsson R. 1, Attvall S. 1, Blohm, 2.
1
Radio Medical Centre, Sahlgrenska University Hospital, Gothenburg, Sweden, 2MRCC Sweden
A descriptive study concerning symptoms, actions taken, number of evacuations, means of communication and
use of digital photos.
BACKGROUND: Sahlgrenska University Hospital in Gothenburg, Sweden is one of the largest hospitals in
Europe. It has provided medical support and advice to shipping worldwide since establishing the Radio Medical
(RM) Department in 1922. Sahlgrenska is also the international reference hospital for the Swedish Maritime
Administration. RM is asked for advisory service when working for new regulations. RM service is free of
charge to ships and seafarers in accordance with international agreements. The RM provides medical support and
advice to civil ships all over the world, the Swedish Navy and the Coast Guard.
The focus on the study has been to show if there are any differences over time (1997-2007) regarding
respiratory, musculoskeletal, digestive and urinary symptoms and circulatory diseases. We also wanted to study
if the use of digital photos was optimal and if access to Internet has had any effect on type of cases, more or less
minor illnesses/injuries and more or less evacuations.
METHOD: Data on RM cases is available since 1991 and the study describes 1997, 2002, 2007 and first six
months of 2009 concerning symptoms, treatment, number of evacuations, means of communication, use of
digital photos and consultations with other specialists.
All contact with the RM passes through the Swedish Maritime Rescue Co-ordination Centre - MRCC. The
MRCC’s role is to maintain an online link with duty Radio Medical physician and to ensure communication
between the physician and the ship. The MRCC-logs together with the RM physician´s documentation are
studied. The international classification for primary care, ICPC-2 ver 1.2 by Wonca:s international classification
committee (WICC) is used. This choice is made because it provides classifications for symptoms and complaints
as well as for diagnoses and diseases.
The average number of cases are 4 - 500 per year. In this study passengers are excluded.
RESULTS: A summary of the results has been presented at 10th International Symposium on Maritime Health,
Sept 2009: Total treatment onboard is given to 73%, evacuation 14 % and recommended physician next port of
destination 13 %. Musculosceletal symptoms 16, %, respiratory 12%, digestive 16%, urinary 6% and eye
symptoms 10%. 30-35% of the cases are dealing with infections. More detailed results will be presented.
A special thank to Dr Bas Rikken, Netherlands, board member of IMHA, for his valuable advices and comments.
_______________________________________________________________________________________ Page 27 NECTM 2010 in Hamburg Plenary Abstracts _______________________________________________________________________________________ PL02.04
Piracy - The Reality of the Problem
Nikolić, N.1
1
International Maritime Health Association, Rijeka, Croatia
Introduction: Piracy is not only a part of maritime history it is still present on the seas all over the world. The
problem is largely confined to Somalia coast, West Africa, South America and South East Asia. Study conducted
by the ICC International Maritime Bureau (IMB), noted that number of reported piracy attacks world-wide
continued to rise and in 2009 a total of 406 incidents of piracy and armed robbery against ships have been
reported. Last time piracy figures crossed 400 incidents was in 2003. Attacks included cruise ships with several
thousand people on board. These are serious and violent attacks, done by organized crime groups and targets are
merchant ships, passenger ships and cruising yachts. Sixty eight crew were injured in the various incidents and
eight crew killed.
Methods: Survey of data by International Maritime Bureau. Typical pattern of attacks and types of piracy are
described and time frame of the piracy attack simulated.
Results: Recent data from International Maritime Bureau presented and analyzed indicate a dramatic increase in
attacks of piracy. Worldwide 153 vessels were boarded, 49 were hijacked, 84 attempted attacks and 120 vessels
fired upon. A total of 1052 crew were taken hostage.
Conclusion: 2009 is the third successive year that the number of reported incidents has increased with 239, 263
and 293 incidents reported in 2006, 2007 and 2008 respectively. Gulf of Aden, Somalia and Nigeria remain the
places to be for pirates of the 21st century, ranking first, second and third in acts of piracy up to the end of 2009.
In the wake of the late events in Somalia and the reality of terrorist attacks, piracy is threatening the security of
passengers and crews all over the world.
PL03.01
Malaria - recent advances
Chiodini, P.
London, United Kingdom
The presentation will discuss recent advances in our knowledge of the malaria parasite, focussing on
Plasmodium knowlesi and Plasmodium ovale,examine the quality and impact of rapid diagnostic tests and the
future for inexpensive molecular diagnostics.
PL03.02
Crimean-Congo Haemorrhagic Fever: Threats in Travel Medicine?
Stich, A.1
1
Medical Mission Hospital, Dept. of Tropical Medicine, Würzburg, Germany.
Viral haemorrhagic fevers (VHF) are important differential diagnoses in patients with symptom combination of
fever and spontaneous bleeding. The most prevalent in travel medicine is Dengue fever although haemorrhagic
complications are rare in European travellers. Like other viral infections such as Rift Valley fever or Hanta
haemorrhagic fever, Dengue does not have a risk of direct man to man transmission.
However, a limited group of viral diseases with the potential for haemorrhagic complications pose a high risk of
man to man transmission, especially in the set-up of a health system with limited resources. They can be
considered as severe public heath threats: Lassa, Marburg, Ebola and Crimean-Congo haemorrhagic fever
(CCHF). In travellers, these diseases are rare but dramatic events. In the last 10 years, all of them have been
reported as imported infections in Europe.
In recent years, CCHF has been considered as an emerging problem. Case series have been reported from
Turkey, Greece and states from former Yugoslavia. In addition active foci are known in many other countries,
especially Pakistan and Afghanistan. In 2009, two patients with CCHF have been diagnosed in Germany.
CCHF is a potentially life threatening disease. Fever, myalgia and bleeding from various sites should raise the
clinical suspicion. Sometimes, the patients report outdoor activities, a history of tick exposure or contact with
_______________________________________________________________________________________ Page 28 NECTM 2010 in Hamburg Plenary Abstracts _______________________________________________________________________________________ potentially infected domestic animals. On laboratory examination, platelets are low and lactate dehydrogenase
levels raised. Intravenous administration of ribavirin is the only causative therapeutic option.
Already on suspicion, patients have to be isolated and nursed with special protective equipment. Contact persons
need to be traced with urgency. Outbreak counter measures need close coordination between clinicians and
public health specialists. A close cooperation between centres specialized in the treatment of patients with highly
contagious diseases is urgently required.
PL03.03
Japanese Encephalitis
Buhl, M.R.
Aarhus, Denmark
Japanese encephalitis is a viral disease that infects animals and humans. It is transmitted by mosquitoes
belonging to the Culex tritaeniorhynchus and Culex vishnui groups. Most JE virus infections in humans are mild
(fever and headache) or without apparent symptoms, but approximately 1 in 200 infections results in severe
meningoencephalitis with a case fatality rate as high as 60% among those with disease symptoms; 30% of those
who survive suffer from lasting damage to the central nervous system. In areas where the JE virus is common,
encephalitis occurs mainly in young children because older children and adults have already been infected and
are immune. Japanese encephalitis is a leading cause of viral encephalitis in Asia with 30,000-50,000 clinical
cases reported annually. It occurs from the islands of the Western Pacific in the east to the Pakistani border in the
west, and from Korea in the north to Papua New Guinea in the south. Japanese encephalitis is a patchy disease
and important outbreaks have occurred in a number of places in the past 15 years, including South India and in
Sri Lanka.
“It seems that JE infected Culex tritaeniorhyncus are present at places and at times of the year it should not be
and the mosquitos do not acknowledge the rule not to bite travellers within there first 28 days of stay”. Judged
from the cases reported current vaccination recommendations are incapable of protecting travellers, including
short term travellers, against this rather unfortunate, sometimes fatal, Japanese encephalitis. Our understanding
of the traveller risks for JE is so far incomplete. The risk for JE among Nordic travellers to Thailand, mainly
during the dry season, is in the order of one in 400 000 travellers.
PL04.01
A Historical Perspective on Travel and our Environment
Walker, E.
Glasgow, United Kingdom
This talk will be a light-hearted but serious look the relationship between travel and our environment (and visaversa). It will go back as far as the last major ice age and forward to the present time. It will use many
illustrations showing various modes of travel used over the centuries and allow us to consider their varying
environmental impact.
Since the early human settlements and up until the recent rapid process of urbanisation there has been an
increasing ability of humans to manipulate the environment. Working towards transitory human desires and
pleasures regardless of the impact on our environment has become increasingly the norm. We must remember
we are part of the ecological environment and ignore this fact at our peril.
Urbanisation has highlighted the divide between self-responsibility and dependency resulting in much loss of
local community support mechanisms, understanding of how we obtain essential food and water supplies,
manage our waste and sewage, recognise illness and death as integral to life. Various phrases are used to
describe the need to need to keep ‘down to earth’ or keep our ‘feet on the ground’.
Modes of travel since the 19th century have changed most rapidly and have become increasing dependant upon
fossil fuels - this impact on the environment has been enormous. Until recently little importance has been given
to identifying and controlling modes of travel that have a negative impact on the environment.
Science and Technology give us the means to make adjustments.
Have we the will?
_______________________________________________________________________________________ Page 29 NECTM 2010 in Hamburg Plenary Abstracts _______________________________________________________________________________________ PL04.02
Tourism responding to the challenge of Climate Change
Mero, M1
1
Association for Fair Travel (Finland) and Travel Agency Avara Maailma
Despite efforts by tourism industry to downplay its role, global tourism is now estimated to cause approximately
5 % of the global greenhouse gas emissions. This is caused largely by aviation, although surface transport,
accommodation establishments and leisure activities also contribute to the burden. Furthermore, CO2 emissions
vary greatly between different types of trips, with long distance, short duration travel being the most carbon
intensive.
Tourism is also a major contributor to world economy, and its environmental effects must be considered against
this background. According to estimates, over 200 million people worldwide are employed in tourism-related
activities, and its significant economic impacts are often used as justifying factors for the high carbon footprint.
The global tourism industry has so far taken a two-fold approach to the issue of climate change. There is
growing concern for the harmful impacts of the changing climate on tourism, as droughts, heat waves and
tropical storms are expected to increase in popular destination areas such as the Mediterranean, the Caribbean
and North America. Furthermore, as rising temperatures are forecasted to particularly affect winters in
continental Europe, the economically vital snow tourism is under threat. Most winter tourism countries are now
well aware of these risks, and investments in snow-making technology as well as income diversification
initiatives have been started. Adaptation to the impacts of climate change is now understood as a vital part of
survival strategies of countries that rely on tourism as an economic driving force.
In the meanwhile, mitigation initiatives have not been as widespread. In 2007, the United Nations World
Tourism Organisation (UN-WTO) organised an international conference that for the first time acknowledged
tourism industry’s responsibility in tackling the challenge of lowering global greenhouse gas emissions.
According to conference delegates that represented the global tourism industry, destination countries and nongovernmental organisations, this should mostly be done through increased eco-efficiency, awareness raising
campaigns and, to a lesser extent, voluntary carbon offsetting schemes. Of these, carbon offsetting is the
preferred method as it effectively shifts the responsibility of mitigating greenhouse gas emissions to consumers.
However, the scientific community has questioned the reliability of this method, while the travelling public has
been slow to adapt it. Despite recent proliferation of carbon offsetting schemes, only a small minority of
travellers are currently paying for voluntary offsetting.
Other, so far little explored strategies to reduce CO2 emissions from tourism include offering holiday packages
based on alternative transport modes, extending durations of stays and encouraging travellers to explore areas
closer to their country of origin, thus reducing their dependency on air travel. On longer term, affecting people’s
lifestyles by encouraging a slower pace of life in general can be seen as a crucial step on the road towards a
greater sustainability of tourism.
PL04.03
Cultural Aspects of Tourism - Our Common Responsibility
Middleton, N.1
1
Oxford University, School of Geography, Oxford, United Kingdom
Experiences of another culture come high on the wish-list of most tourists. Diverse monuments and customs,
festivals and food attract short-stay visitors who inevitably carry with them their own cultural norms and
behavioural patterns. The resulting collision of cultures can degrade the host through commodifying and 'cocacolaising' a destination, but cultural tourism when conducted responsibly can help sustain traditional cultures.
Drawing on examples from all over the world, this presentation argues that, for the visitor, travelling with
respect earns respect and enhances the tourist experience.
_______________________________________________________________________________________ Page 30 NECTM 2010 in Hamburg Symposium Abstracts _______________________________________________________________________________________ SY01.01
Vaccine Administration Routes: Immunological Aspects
Kantele, A.1
1
Helsinki University Central Hospital and University of Helsinki, Department of Medicine, Division of
Infectious Diseases, Helsinki, Finland
The purpose of vaccination is to teach the immune system to recognize pathogens and evoke immunity. This is
achieved by presenting whole pathogens or parts of them to the immune system in vaccines. These can be
administered to the body by various mucosal or parenteral routes. The choice of the route of immunization has a
significant effect on the ensuing immune response - a fact not commonly recognized.
Immune responses are not distributed equally throughout the body but, instead, lymphocytes are guided mostly
to tissues where they are expected to be needed. This need is evaluated by the immune system on basis of the site
where the pathogen was first encountered: each pathogen has a typical environmental locus which the route of
transmission is usually associated with. Therefore, the pathogen is likely to use the same route of invasion each
time and, accordingly, it appears advantageous to concentrate immune defense at that site.
The targeting of the activated lymphocytes is determined by the site of antigen encounter. Dendritic cells at local
lymph nodes conduct the orchestra: they present the antigen to the lymphocytes and, at the same time, provide
the lymphocytes with instructions on where to traffic. Circulation carries the lymphocytes everywhere in the
body, but they can step out and home only into certain tissues. The homing event is a multistep process where
tissue-specificity is mediated by certain homing-associated surface molecules (CCR, HR) on the homing
lymphocyte. Ligands for these different lymphocyte surface molecules are only found in certain tissues.
Lymphocytes can home to their particular tissues only if they carry the right set of surface molecules to
recognize the set of ligands in that tissue, i.e. the lymphocytes have the right homing profile. Lymphocytes are in
general guided to areas where the antigen was first encountered, as well as to certain other sites. Mucosal sites
can communicate with each other with help of these trafficking lymphocytes, and, as a result, immunization at
one site may elicit an immune response at an anatomically remote site.
Paradoxically, even though the majority of pathogens enter the body through mucosal sites, most of our current
vaccines are given parenterally. This indicates that we provide the body with partly misleading information: the
immune system interprets the parenteral route as the most probable site for pathogen invasion, and the immune
response is focused accordingly!
SY01.02
Development of New Influenza Vaccines
Cox Brokstad, R.J.1
1
University of Bergen, Influenza Centre, The Gade Institute, Bergen, Norway
Influenza is a major respiratory pathogen, which causes almost annual epidemics/outbreaks and occasional
pandemics. While antiviral therapy plays an important role in control of influenza, vaccination remains the most
effective prophylactic measure to prevent infection and limit viral spread in the general population. Current
inactivated vaccines are produced by propagation in embryonated hens' eggs and the availability of eggs is a
limiting factor in vaccine production and the global manufacturing capability cannot meet the pandemic vaccine
requirements. Development of candidate avian pandemic vaccines has shown that two doses of influenza vaccine
are required in immunologically naïve (unprimed) population. However, clinical trials of pandemic influenza
H1N1 2009 vaccines found that one dose of vaccine is sufficient to elicit protective antibody responses in the
general population, but two doses of vaccine were required for children under the age of 10 and
immunocompromised individuals. Earlier pandemic vaccine studies have shown that vaccines containing
candidate avian influenza viruses are poorly immunogenic in man as compared to seasonal influenza subtypes
and require effective adjuvants to elicit protective immune responses at antigen doses equal to or lower than
those used in current seasonal influenza vaccines. The proprietary oil-in-water emulsion systems such as MF59,
AS03 and AF03, allow significant dose sparing and enhance homologous and heterologous antibody responses
after H5 vaccination. This talk will discuss progress in influenza vaccine development for annual and pandemic
vaccination.
_______________________________________________________________________________________ Page 31 NECTM 2010 in Hamburg Symposium Abstracts _______________________________________________________________________________________ SY01.03
Intradermal and Transdermal Vaccination
Visser, L.G.1
1
Leiden University Medical Centre, Infectious Diseases, Leiden, Netherlands
The high density of antigen presenting cells and the extensive dermal lymphatic network provide unique
immunological characteristics that explain the efficacy of the cutaneous route of vaccination. Depending on the
technique and depth of antigen delivery intradermal, epidermal and transdermal vaccination routes can be
distinguished. With intradermal (id) vaccination, antigen is delivered in a limited volume (0.1 mL) into the
dermis, usually via needle and syringe. The antigen-dose sparing potential with an immunogenicity comparable
to that of the standard intramuscular dose has renewed the interest in this vaccination technique, especially for
vaccines that are expensive (such as rabies vaccine) or scarce (e.g. influenza or yellow fever vaccine). In
comparison to the subcutaneous or intramuscular route, intradermal vaccination causes more visible reactions at
the injection site, such as erythema and swelling.
Epidermal vaccination refers to antigen delivery into the epidermis via microneedle arrays. Microneedles are
shorter than 1mm with a cross-sectional diameter of 300 µm or less. Vaccination through vaccin-coated of via
hollow microneedle arrays is one approach towards painless, needle-free and dose-sparing vaccination.
Transdermal vaccination refers to topical application of antigen onto the skin. For large macromolecules the
stratum corneum needs to be disrupted, for example by tape stripping. Immunization with an antigen-coated,
transcutaneous patch with heat-labile enterotoxin of enterotoxicogenic Escherichia coli is one example of this
vaccination technique. Several key clinical trials investigating intradermal, epidermal and transdermal vaccine
delivery will be discussed.
SY02.01
Cold Injury and Altitude
Karinen, H.M.1
1
University of Tampere, Institute of Health Science, Tampere, Finland
Local cold injuries and hypothermia are aggravated by high altitudes. Cold injury is an objective danger in
mountain climbing as well as in many outdoor and recreational sports such as skiing, fishing, etc. Frostbite
occurs in mountaineers more often than in the general population. Severe frostbite is more common in
mountaineering because of the lack of oxygen at altitude than in the polar areas. High winds may increase the
prevalence of frostnip and mild frostbite.
Cold injuries can be divided into localized injury to a body part, systemic hypothermia, or a combination of both.
Life-threatening deep hypothermia with coma and insufficient circulation or cardiac arrest may be reversible
after rewarming. Usually local frostbite is not life-threatening, but has often deleterious effects. Rapid rewarming
is mandatory. After rewarming, the difference between superficial and deep frostbite can be established. Daily
sterile treatment of the injury, whirlpool bath and prevention of infections belong to standard treatment.
Frostnip/frostbite is most common in toes, fingers, nose and cheeks. Stage one (Frostnip) shows as white or pale
yellow patches, with a strong burning sensation when tissue is re-warmed. Frostnip will result in temporary loss
of sensation in the affected area for up to one year. Stage two is red swelling of the area followed by blue spots.
If untreated, the spots will grow into black areas (Frostbite) and stage three. The final stage of Frostbite is bloodpoisoning (septicaemia) which can be fatal. Frostnip (white/red/light blue patches) can be reversed if treated in
time. Frostbite (black) can be kept stable but will not heal until after patient have left the ice. Prevention is the
key. Good blood circulation is essential.
Cold-induced vasodilation (CIVD) may prevent the occurrence of local cold injuries. A significant reduction in
CIVD is observed at high altitudes. Altitude acclimatisation combined with an exercise training protocol appears
to decrease the risk of cold injury in the exercising limb by enhancing the CIVD response. During long
expeditions, also Non-freezing cold injury, a syndrome involving local cold neuropathy, hyperaemic following
rewarming, and chronic sequelae may occur.
_______________________________________________________________________________________ Page 32 NECTM 2010 in Hamburg Symposium Abstracts _______________________________________________________________________________________ SY02.02
Methods of Expedition Medicine
Shaw, M.1
1
James Cook University, Auckland, New Zealand
Introduction: There is considerable overlap between expedition and adventure travel, and leisure travel and
there are many reasons why travellers choose to travel remotely on expeditions:
· Exploration and discovery
· Achieving a geographical goal
· Testing personal endurance
· The element of danger
· Scientific research
· Education
· Personal development
· Cultural exchange
· Enjoyment!
Exploration and adventure travel are increasingly attractive to people of widely differing ages, experience,
physical health and interests. This creates new challenges to practitioners of expedition medicine but the aims
remain to anticipate preventable medical problems, to maintain health throughout the expedition, to optimise
achievement and enjoyment, but on no account to stifle enthusiasm or ambition.
The modern practice of expedition medicine is to encourage adventure but to attempt to minimise the risk of
trauma and diseases by proper planning involving risk assessment, preventive measures such as vaccinations,
prophylactic drugs and medical equipment, knowledge of first aid, emergency and primary healthcare skills,
communication skills, and an attitude of caring for both the anticipated team and the anticipated cultures of the
expedition. Important also in the pre-trip planning is local knowledge of the area to be travelled, and this must
essentially include an assessment of local hospitals and health care facilities, and the potential of needing to
repatriate an expedition casualty.
The MO has two primary roles: a) to maintain the physical and psychological health of the team members. For
all that, however, the expedition doctor will need to work closely with the expedition leader to formulate a
formal risk assessment and to brief all team members on likely health hazards.
Conveniently the role of the expedition doctor can be divided into three main phases
· Pre-expedition
· During the expedition
· Post-expedition
All these phases are dependant on the type, style and nature of an intended expedition.
This presentation will look at 'methods of expeditions' and classify them with respect to their intended outcomes.
SY02.03
Expeditions to Meghalaya India
Davies, J.E.1
1
British Travel Medicine Association, Sale, United Kingdom
Two villages in the remote rainforests of Meghalaya, North East India, were visited on two separate occasions.
The people are Lingam, although once thought to be part of the Garo and Khasi tribes, their language marks
them out as being a separate tribe. It is thought that less than 5,000 individuals live separately as Lingam and up
to 100,000 may be living within the Garo or Khasi tribes. There is very little documented about these people.
Cultural data was collected and an epidemiological study of malaria was carried out on the second visit
demonstrating the presence of Pl. Vivax and Pl. Falciparum malaria. A nutritional study was also carried out at
the same time. The people have no medical services and their traditional healer died with no successor. This
study will look at beliefs around illness and death and, using other ethnographic data from Africa and India will
show how an approach to delivering health care to small tribal areas may not be appropriate, using only the
construct of western medicine which may result in misinterpretations due to superstition, rumour and postcolonial thinking especially when it fails to offer the recipients all the answers and challenges a pluralistic
medical tradition.
_______________________________________________________________________________________ Page 33 NECTM 2010 in Hamburg Symposium Abstracts _______________________________________________________________________________________ SY03.01
Shellfish Poisoning
Sudeck, H.1
1
Bundeswehrkrankenhaus Hamburg, Tropical & Internal Medicine, Hamburg, Germany
Objectives: To create awareness about the widespread and serious problem of shellfish derived algae-toxins and
the health threat they are locally and seasonally to travellers and people living in affected coastal areas.
Travellers can be affected by visiting restaurants or by collecting and preparing toxic shellfish by themselves.
Case report: After having visited a medical conference a previously healthy surgeon was invited by a sponsor to
a prestigious sea-food restaurant . After 24 hours he experienced a severe episode of chest pain, vomiting,
diarrhoea and circulatory problems. As an emergency he was admitted to his own hospital and had a thorough
diagnostic work up which excluded myocardial infarction, viral infection, septicaemia, meningitis, aortic
dissection and embolism. Lab tests showed initially eosinophilia and acute renal failure which went along with
an episode of marked diabetes insipidus. Morphine requiring extreme chest pain and gait - ataxia together with a
loss of sensorium at TH 9 and others symptoms were lasting for more than 18 months. A number of therapeutic
options were tried despite the fact that there are no evidence-based recommendation for this problem.
Summary: Various toxins are linked to different clinical entities ranging from simple acute gastrointestinal
symptoms like diarrhea and vomiting to severe and life threatening systemic- cardiac, neurological, complications probably with life-long sequelae. Up to now chronic conditions are not usually attributed to them
which seems to be wrong.Toxins are not denaturated by cooking or freezing and a single piece on one sea-food
platter is sufficient to create severe intoxication. Interference with sodium channels and other neuromuscular
structures is the underlying pathophysiology in many toxins. Checking the literature and discussing this case
with colleagues from other continents one gets the impression that this entity is in single cases a serious and
unsolved problem bringing along probably lifelong disability. Ciguatera-intoxication must be differentiated and
seems also to be able to cause chronic conditions - a fact which has not yet been sufficiently been discussed or
published.
Conclusion: Patients with acute or chronic symptoms which cannot easily be attributed to known illnesses must
be asked also for a history of seafood intake and should not be referred easily to the psychiatrist due to the
complex and stunning characteristics of their symptoms.
SY03.02
Dangerous Insects and Other Arthropodes
Mebs, D.1
1
Institute of Legal Medicine, University of Frankfurt, Germany
Scorpions, spiders and insects like bees, wasps, hornets, ants and caterpillars are causing envenoming symptoms
by stinging and biting. Pain around the sting area may need no particular treatment. But a wide variety of general
symptoms may occur such as cardiovascular problems and often fatal pulmonary oedema in cases of scorpion
stings, coagulopathy after the contact with caterpillar hairs, allergic reactions and fatal anaphylactic shock after
the sting of Hymenoptera species, general pain, local necrosis and occasionally intravascular haemolysis
following the bite of certain spiders. Children are particularly at risk. In most cases treatment has to be
symptomatic, antivenom, if available, is administered i.v. in cases of scorpion envenoming and of certain spider
bites. Immediate medical intervention is essential in cases anaphylactic reactions such as following single bee nd
wasp stings including self-injection of adrenaline to prevent sudden death.
SY03.03
Horrors and Myths in Travel Medicine
Hasle, G.1
1
Reiseklinikken - Oslo Travel Clinic, Oslo, Norway
There are lots of travel related horror scenarios, as we know them from novels and movies: Is it possible to
disappear in quick sand like in "Lawrence of Arabia"? What is the risk of being eaten by sharks, large cats or
crocodiles? Would Tarzan have had a chance, fighting with these animals? How often do snakes attack tourists?
Is it really true that a fish called candiru may enter the urinary tract of swimmers in the Amazons? Do
pirayas kill humans? Is elephantiasis a threat for travellers? To what extent is leprosy contagious? Was Ben Hur
_______________________________________________________________________________________ Page 34 NECTM 2010 in Hamburg Symposium Abstracts _______________________________________________________________________________________ ever at risk? Does the contagious agent of the Black Death still exist? Are pirates a substantial risk for Yacht
sailors? May we encounter cannibals?
In pre-travel advice we get questions like this, and people engaged in travel medicine should know something
about the myths an facts of these issues, which of course are much more exiting than advices about food hygiene,
mosquito repellents, condoms, alcohol and traffic.
Wet quick sand is a tixotropic gel, that is more common in temperate than tropical conditions. Because of
buoyancy nobody will be sucked down, but imminent high tide may make the situation dangerous. Dry quick
sand has been made in a laboratory, the researchers managed to make light objects sink, but it does probably not
occur in nature. Sharks attack about 60 persons per year, less than ten attacks per year are fatal. Lions, tigers and
leopards kill about 1000-1500 people altogether and crocodiles about 1000 persons per year. In an unprovoked
attack by a lion attendees should try to attack it. Fighting back is the only option for bettering survival chances
when being attacked by a large cat, although chances are modest. In an unprovoked attack some carnivores (e.g.
bears, but not polar bears!) will stop the attack if someone plays dead. Snakes kill 30-50000 people every year,
but it is predominantly the rural people that are killed. The candiru exists, but it normally feeds from gills of
larger fish. Pirayas flee when people are swimming. Elephantiasis is seen in the local population in endemic
areas; tourists seem for some reason not to be at risk. Leprosy is contagious, but the attack rate is low, and
almost like zero in expatriates. If the Black Death really was Yersinis pestis, it definitely still exists, but it is not
as dangerous as it was in Europe 1347-50. Yacht piracy is an increasing, and may be underreported problem.
Indigenous cultures that practise cannibalism do hardly longer exist.
SY04.01
Post Exposure Prophylaxis for Expatriates: HIV etc.
Grieve, A.M.1
1
Independent Occupational Health Practitioner, Broom, United Kingdom
Occupational Health and Travel Medicine are complementary disciplines. The role of occupational medicine in
international companies and enterprises essentially involves travel medicine considerations and duties.
This presentation will characterize the nature of occupational medicine, the expatriate population and the health
care provisions that must be made for them.
Whilst numerous provisions can be made, not all health risks can be prevented by vaccination or preventive
medicines. "Post exposure prophylaxis" is a strategy which can be used as a "safety net" in such cases. The post
exposure prophylaxis of HIV is used to illustrate how such provisions can be made and how they should be used.
SY04.02
Repatriation
Tothill, G.1
1
FirstAssist Services Ltd., Surrey, United Kingdom
Companies, Government Bodies, NGO's and the Military who have a significant expatriate workforce,
sometimes in hostile and hazardous environments, seek to safeguard the health of their staff in a variety of ways.
Prudent selection criteria, pre travel medical assessment, hazardous environment training, vaccination and
chemoprophylaxis attempt to ensure that suitably fit and prepared individuals are deployed. In country, a
combination of the local healthcare infrastructure and purpose built (or sponsored) medical facilities deliver care
to staff.
Whilst many organizations strive to achieve a level of care comparable to that provided to their staff in their
home countries this can be hugely challenging. Even with considerable investment it can prove impossible to
provide anywhere close to the range of services found in a most local hospitals in the EU. Additionally,
employees tend to become less vigilant of their surroundings as they become familiar with them and often,
emulating their more experienced colleagues, become less complaint with prophylaxis and other health and
safety advice.
When illness or injury overtakes them, employees (and often their employers) are often at a loss as to what to do.
Whilst the options for the severely ill are often limited by a requirement for rapid evacuation to a regional centre
of excellence, those with less severe disease may feel under considerable pressure to remain in-country.
Providing robust and practical guidance in these circumstances often falls to Assistance and Aeromedical
Retrieval Companies. Managing the conflicting expectations of patient, employer, relatives, Physicians and
Insurers whilst maintaining sight of clinical goals can be a challenging, but ultimately rewarding, task.
_______________________________________________________________________________________ Page 35 NECTM 2010 in Hamburg Symposium Abstracts _______________________________________________________________________________________ This presentation aims to explore the provision of acute medical care for expatriates in remote locations from the
time at which the Assistance Service is activated to the eventual repatriation of the patient or their return to
work. Along the way we will examine the decision making process, legal and political issues, local versus
regional healthcare, accreditation of facilities, funding models and the appropriate use of Aeromedical resources.
SY04.03
Screening of Expatriates for Psychiatric Disorders
Jones, M.E.1,2
1
HealthLink360, Medical Department, Edinburgh, United Kingdom, 2Western General Hospital, Regional
Infectious Diseases Unit, Edinburgh, United Kingdom
Introduction: Cross cultural adaptation is a major stressor for expatriates and enculturation may take 2 years or
more to substantially complete. Stress experienced in the host country will have basic, cumulative and
sometimes traumatic components. Those with background psychiatric morbidity are unlikely to cope well with
these stress factors and consequences include emergency repatriation, poor performance in post and adverse
effects on the well being of colleagues and family. Unexpected costs may be significant for employing
commercial or voluntary agencies if an exptriates returns prematurely. Available data suggests that one third
return early.
Is it legal to screen for Psychiatric disorders?
Under UK legislation, Yes. Screening procedures may be undertaken if workers have to enter a hazardous
envirnoment and the work demands enhanced physical or mental fitness. Relevant disability must be assessed by
an occupational health physician and rejection is justifed if the risk is too great and adjustments cannot be made.
Components of a screening process: Screening should include a history of primary family experience obtained
during interview, personal mental health history, family mental health history, assessment of working and family
relationships and close examination of references. Cluster B personality disorders (antisocial, borderline,
histrionic and narcissistic) pose a particular challenge for assessors and although hard evidence on the benefit of
psychometric measures is limited, these may fine tune the screening process, particularly in concert with
references. Personality inventories include the MMPI for which there is some evidence of useful discriminatory
benefit, the Cattell scale, which has a poor theoretical base and the NEO Five Factor Inventory which aligns
closely with current personality theory but for which evidence is limited in this context. Police checks to exclude
previous behaviour which might endanger children should be undertaken.
Other non-psychiatric issues: Sexual practice and orientation are very sensitive areas but may have life
threatening consequences in Fundamentalist Islamic countries. Unstable partnerships, recent breavement or other
significant loss may indicate the need for deferral. Children with special needs or entering adolescence may be
coherent facors deterring some parents from expatriate service.
SY05.01
The New WHO International Travel and Health Publication
Poumerol, G.1
1
World Health Organization, International Health Regulations, Geneva, Switzerland
The WHO´s "International travel and Health" book, also called the "Green Book" is addressed primarily to
medical and public health professionals who provide health advice to travellers. The book is intended to give
guidance on the full range of significant health issues associated with travel. The roles of the medical profession,
the travel industry and travellers themselves in avoiding health problems are recognized. The recommendations
address the health risks associated with different types of travel and travellers. The printed edition of this book is
revised and published every year.
In the 2010 edition, advices for the HIV/AIDS traveller have been added. The worldwide distribution of the
major infectious diseases is shown in updated maps. Vaccine recommendations and schedules have been updated
and other chapters have been reviewed to reflect current prevention and treatment options. The main infectious
diseases that pose potential health threats for travellers have been revised. Amoebiasis, Angiostrongyliasis,
Cooccidioidomycosis and Histoplasmosis have been added. Corresponding preventive measures and information
on environmental factors that may have adverse effects on the health of travellers and well-being have also been
added. The chapter on malaria provides updated information on malaria prophylaxis as well as treatment options
for malaria in travellers. The lists of countries at risk of yellow fever and requirements for yellow fever
vaccination at entry in countries have been updated.
_______________________________________________________________________________________ Page 36 NECTM 2010 in Hamburg Symposium Abstracts _______________________________________________________________________________________ The Internet version (http://www.who.int/ith) allows continuous updating and provides links to other useful
information, such as: news of current disease outbreaks of international importance; useful country web links for
travel and health; an interactive map for yellow fever and malaria status, requirements and recommendations;
and high resolution and more precise disease distribution maps. The website also features a section on “latest
updates for travellers” with recent substantial developments in travel and health.
Plans for the development of an interactive Website will be shared.
SY05.02
Risks for Travellers to South Africa and Recommendations for Visitors to the FIFA World Cup
Mendelson, M.1
1
Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South
Africa
On 11th June 2010, South Africa hosts the FIFA World Cup, the first to be held on the African Continent. It is
the largest mass gathering for a single sport with over 350,000 international visitors expected to attend.
Using the GeoSentinel Network Surveillance Project database, the largest existing database of destinationspecific travel-related illness, we have defined illnesses in travellers returning from South Africa, to facilitate an
evidence-based approach to the pre-travel consultation. Febrile systemic illness, skin conditions and acute
diarrhoeal disease are the commonest syndromic diagnoses in ill travellers returning from South Africa to a
GeoSentinel Site. Interestingly, although the three same syndromic groups are also commonest in returning
travellers from South Africa’s neighbouring countries and the rest of sub-Saharan Africa, important differences
were identified with respect to the type of individual diagnoses that South Africa travellers manifest. This paper
will discuss the findings of our study and present a comprehensive checklist of advice for visitors attending the
FIFA World Cup. SY05.03
Consequences of Volcanic Eruptions for Travel Medicine
Gulliksen, E. 1
1
Institute of Aviation Medicine, Oslo, Norway
The field of travel medicine is often regarded as a subspecialty of tropical medicine that deals with the
prevention, diagnosis and treatment of tropical diseases, which travellers might encounter. Immunizations and
preventive medications are considered prior to trips to different parts of the world.
Travel medicine has over the years evolved and the approach to the travellers covers now a wider range of topics
and includes aviation medicine, expedition medicine and general precaution.
Volcanic eruptions on Iceland have affected international air-traffic since April 2010 and the future situation is
uncertain. This creates new challenges and need for information among travellers.
The presentation will cover risk assessment regarding human health and general aviation. It will also cover what
the travellers are financially entitled to under EU Regulation 261.
SY06.01
News from the GeoSentinel Network
v. Sonnenburg, F 1
1
University of Munich, Infectious Diseases & Tropical Medicine, Munich, Germany
The purpose of the presentation is to present the GeoSentinel network. It is a network of travel/tropical medicine
clinics initiated by the International Society of Travel Medicine (ISTM) and the Centers for Disease Control
(CDC). Surveillance of morbidity and mortality in travellers serves a number of purposes. Firstly, it provides
information to assist in the prevention of morbidity in travellers. Secondly travellers can serve as sentinels for
changes that affect the morbidity and mortality of local populations. Thirdly, travellers can be a factor in the
spread of diseases in their countries of origin. GeoSentinel is based on the concept that these clinics are ideally
situated to effectively detect geographic and temporal trends in morbidity among travellers, immigrants and
refugees. Strengths and weaknesses of the network will be highlighted. Results of recent analyses will be
presented on Illness in Long-Term Travellers, Travel-related Infectious Diseases in Europe and Rickettsial
Diseases in International Travellers
_______________________________________________________________________________________ Page 37 NECTM 2010 in Hamburg Symposium Abstracts _______________________________________________________________________________________ SY06.02
EuroTravNet - The European Travel Medicine Network
Parola, P.1
1
EuroTravNet, Infectious Diseases and Tropical Medicine Unit, Marseille, France
Specialized travel/tropical medicine clinics in Europe are ideally situated to effectively detect emerging
infections and to track ongoing trends in travel-related illness and emerging agents in collaboration with
laboratories of microbiology. Over the past decade, both global and regional provider-based surveillance
networks have emerged that have provided, for the first time, systematic and robust data that define the spectrum
of illness and the places of exposure to the most significant health risks that face travellers. EuroTravNet - the
European Travel Medicine Network (www.eurotravnet.eu) - has been initiated in 2008 to create a network of
clinical experts in tropical and travel medicine to support the European Centre for Disease Prevention and
Control (ECDC) for the detection, verification, assessment and communication of communicable diseases that
can be associated with travelling and specifically with tropical diseases. The goal of EuroTravNet is to build,
maintain and strengthen a multi-disciplinary network of highly qualified experts with demonstrated competence
in diseases of interest, ideally in the field of travel advice, tropical medicine, clinical diagnosis of the returned
traveller, and detection, identification and management of imported infections. EuroTravNet Members are
ISTM member clinicians located in a European country and working in a clinical site with significant numbers of
post-travel patients. They are willing to provide leads and contacts when they encounter patients having unusual
imported diseases. They are willing to respond to email queries regarding potential outbreaks or trends in travelrelated infections, and participate in discussion within the network. All members are welcome to participate in
the annual meeting organized in collaboration with ECDC. Benefit of membership includes recognition as a
member of an ECDC collaborative network. It will allow accelerated acquisition of alerts and advisories on
breaking events. We present here the work that has been accomplished in the first 18 months of EuroTravNet, in
terms of collaboration with ECDC, detection and surveillance of imported diseases as well as original research
projected conducted between members.
SY06.03
Health Map
Sonricker, A.L.1
1
Children’s Hospital Boston; Division of Emergency Medicine
HealthMap (www.healthmap.org) was developed with the aim of creating an integrated global view of emerging
infectious diseases, based not solely on traditional public health datasets, but rather on a broad range of available
information sources including these informal Internet channels. HealthMap is a publicly available online
resource that collects, filters and visualizes disease outbreak reports in real-time, by means of a series of
automated text processing algorithms. Sources include online news through aggregators such as Google News,
expert-curated discussion such as ProMED-mail, and validated official reports from organizations such as the
World Health Organization. Disease outbreak reports are collected in seven languages (English, French, Russian,
Spanish, Arabic, Chinese and Portuguese), classified by disease and location, and then mapped to a user-friendly
interactive display.
Currently, HealthMap serves as a direct information source for over a million visitors a year, and serves as a
resource for libraries, physicians, international travelers, local health departments, governments (e.g., the US
Centers for Disease Control and Prevention), and multinational agencies (e.g., the World Health Organization),
which use the HealthMap data stream for day-to-day surveillance activities. HealthMap both extracts data and
provides a user interface that is particularly focused on providing users with news of immediate interest while
reducing information overload.
_______________________________________________________________________________________ Page 38 NECTM 2010 in Hamburg Workshop Abstracts _______________________________________________________________________________________ WS01.01
Tick in Europe: Go and Win?
Suess, J.1
1
Friedrich-Loeffler-Institute, National Reference Laboratory for Tick-borne Diseases, Jena, Germany
Interactions between ticks, competent hosts and various pathogens are complicated and only partially
understood. As ticks are ectoparasites which spend most of their life cycle in the environment, their development
is influenced by many individual elements of the complex climate system. Humidity of the air and ground
temperature are of particular importance, but other factors must not be neglected either. We have seen that the
current climate change improves the conditions of ticks, but hard facts for these very complicated interactions
are not available enough. Increased mean temperatures induce changes in the developmental cycle, e.g. the
spring and fall season may be prolonged which increases the time span for host search and moulting. The
microclimate in the tick habitat in terms of an 'ecological niche' is of importance in this respect. Factors which
protect the tick from extreme climatic influences are of crucial significance. Questing and diapausing ticks are
especially susceptible to outside influences and are better protected in milder winters.Individual scientifically
firm observations have been made in ticks in Europe which can be associated with the climate change, e.g. the
northward spread of Ixodes ricinus (I.r.) in Sweden and the first occurrence of TBE cases at the southern tip of
Norway. Milder winters and a prolonged spring and fall season have produced similar effects in Denmark. In
Latvia, the numbers of both, I.r. and I. persulcatus (I.p.) have increased. The northernmost TBEV focus in the
world is located in Finland (100 km south of the arctic circle !).The results presented over the past years show
that I.r. has expanded its range from approx. 800 m above sea level to 1200 m (Czech Republic) and 1560 m
above N.N. (Austria) and are also able to transmit TBEV at these higher altitudes. A significant increase in the
host-questing activity of I.r. in the winter and a northward spread of other tick species, e.g. D. reticulatus, must
also be mentioned. These facts lead to a (climate-induced ?) increased incidence of tick-borne diseases. First
results of a long-term project in various areas of Germany shows the very complicated interactions between
climate, microclimate, tick activity and tick development stages.In addition, there are other social, political,
economic, demographic and ecological factors which produce similar effects, but which are associated with the
term „exposure to tick-bites“.
WS01.02
Lyme Borreliosis in Poland: Risk for Tourists and Local Population
Kotlowski, A.1, Stanczak, J.B.1
1
Medical University of Gdansk, Interfaculty Institute of Maritime and Tropical Medicine, Gdansk, Poland
Lyme borreliosis (LB) is the most commonly occurred tick-borne disease in northern hemisphere. Its etiological
agent, Borrelia burgdorferi sensu lato (s.l), is divided into 15 genospecies, of which B. afzelii, B. burgdorferi
sensu stricto and B. garinii are of pathogenic significance in Europe.
Ixodes ricinus is the primary vector of LB in Poland. Infection of ticks with B. burgdorferi s.l. is frequent and
their infection rates vary from 0.77% to 58.3%. Currently, expansion of I. ricinus towards cities increases the
risk of infection in different recreation areas like parks, green squares etc. For instance, in urban forests of the
Gdańsk agglomeration (northern Poland), up to 38% of ticks harbour spirochetes. Infected I. ricinus were also
found in wooded areas of Warsaw (19.2-31%), Katowice (4-12.3%) and Poznań (9.5-34.6%) (east-central,
southern and western Poland, respectively).
In recent years a significant growth of LB cases has been observed in Central Europe, including Poland. In 2004
there were 3822 reported cases, in 2006 - 6679 and in 2008 - 8255 cases. Current mean morbidity is 21.7/100
000, being the highest - 82.1/100 000 - in north-eastern Poland (Podlasie Voivodship), 55.8/100 000 in West
Pomeranian region and the lowest - 7.0/100 000 - in Pomeranian region.
The groups of particular exposure to infection are forestry workers, hunters, farmers, tourists and forest
undergrowth pickers. LB is one of the most frequently certified occupational disease in the employees of forestry
in Poland and this high risk of acquiring borreliosis calls for systematic and obligatory monitoring of this group.
Anti-B. burgdorferi antibodies are regularly examined in the sera of forestry workers in almost all forest
managements. For instance, in south-eastern Poland, the percentage of seropositive workers was 40%, in Lower
Silesia - 35% and in West Pomerania - 35-61.9%.
In farmers from areas considered as endemic for Lyme borreliosis, the proportion of positive results was 33%.
On the other hand, among healthy blood donors from randomly selected voivodeships, anti-B. burgdorferi
antibodies were detected in 12-13% of serum samples.
_______________________________________________________________________________________ Page 39 NECTM 2010 in Hamburg Workshop Abstracts _______________________________________________________________________________________ Propagation of the principles of prophylactics against the risk of a tick bite, as well as undertaking appropriate
measures concerning diagnosis and treatment of borreliosis are needed.
WS01.03
Discussion: TBE Vaccine – For and Against
Lindquist, L., von Sonnenburg, F.
Debate: No Abstract available
WS02.01
Fever: what's the likely diagnosis in the returned traveller?
Hatz, C.F.R.1
1
Swiss Tropical and Public Health Institute, Basel, and Institute of Social and Preventive Medicine, University of
Zürich, Switzerland
Fever after a stay in tropical and subtropical countries challenges the physician with a wide differential diagnosis
of a variety of infectious and non-infectious diseases. Apart from tourists and long-term residents, visiting
friends and relatives are travelling from industrialised countries to these destinations. The most common
imported diseases include respiratory, gastrointestinal and urinary tract, systemic viral (seasonal and pandemic
flu, Dengue) and rickettsial infections. Non-infectious causes of fever must also be kept in mind. Life threatening
diseases such as malaria, septicaemia due to meningitis, pyelonephritis, pneumonia, typhoid fever, severe
gastrointestinal infections as well as amoebic liver abscess and viral haemorrhagic fevers have to be recognised
without delay in order to start appropriate management.
A detailed travel (exposures, duration of and preventive measures during the trip) and personal history
complement the findings of the clinical assessment. Epidemiologic knowledge is important to consider the
possible infections. Contacting an expert in tropical and travel medicine and a few excellent internet sources (e.g.
www.fevertravel.ch) can be of great help to assess the cause of the fever.
WS02.02
Differential Diagnosis of Eosinophilia
Smith, K.1
1
Health Protection Scotland, United Kingdom
Eosinophilia has a wide range of causes, including parasitic infection, allergic states, autoimmune diseases and
malignancies. It is a common finding in travellers returning from the tropics and may be the only marker of
infection in asymptomatic returning travellers.
Clinicians involved in the diagnosis and management of returning travellers should be familiar with the causes of
eosinophilia and the geographical distribution of the organisms involved. A scheme for investigating returning
travellers and migrants, such as that devised by the British Infection Society1 may help to bring about earlier
diagnosis and facilitate appropriate treatment in a timely manner.
Clinical cases of returning travellers with eosinophilia will be discussed to examine the range of clinical
presentations and management options for those involved in the care of returning travellers.
Checkley AM, Chiodini PL, Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and
initial management. J Infect. 2010 Jan;60(1):1-20.
WS02.03
Pneumonia after Travel
Reisinger, E.C.1
1
Division for Tropical Medicine and Infectious Diseases Department of Medicine II, Rostock University Medical
School, Rostock, Germany
Approximately 1% of the travellers visiting tropical and subtropical regions develop respiratory tract infections
or pneumonia during or after their trip. Of the febrile episodes in returning travellers, up to 11% are caused by
respiratory tract infections.
The spectrum of causative agents includes those seen in temperate regions, with legionellosis being diagnosed
increasingly, and a number of other agents which are rare or absent in temperate regions.
_______________________________________________________________________________________ Page 40 NECTM 2010 in Hamburg Workshop Abstracts _______________________________________________________________________________________ On a worldwide scale, the most common causative agents of pneumonia are Streptococcus pneumoniae,
Haemophilus influenzae, Mycoplasma pneumoniae and Chlamydia pneumoniae. Besides, tuberculosis,
legionellosis, and influenza constitute special risks for travellers. Rare causes of imported pneumonia which are
limited to certain regions include tularemia, anthrax, melioidosis, glanders, plague, and infections with
dimorphic fungi such as histoplasmosis, coccidioidomycosis, and North or South American blastomycosis.
Ubiquitous but rare causes of travel-associated pneumonia are Coxiella burnetii, Chlamydia psittaci, Chlamydia
trachomatis, Actinomyces spp., RSV and Hanta viruses, Toxoplasma gondii and Cryptococcus neoformans
(European blastomycosis). In addition, lung involvement in generalized diseases after long-distance traveling has
to be considered like falciparum malaria, scrub typhus, ehrlichiosis, amebiasis, brucellosis, viral hemorrhagic
fevers and others.
In case of pneumonia and eosinophilia, an allergic etiology, aspergillosis, or helminthiasis should be considered.
Fever and eosinophilia after traveling in tropical regions should also evoke suspicion of Katayama syndrome. In
the early stages of some nematode infections (Ascaris lumbricoides, Strongyloides stercoralis, Necator
americanus and Ancylostoma duodenalis), larval migration may provoke lung infiltrates associated with
peripheral eosinophilia. Rare causes of eosinophilia-associated lung infiltrates or lung involvement in travellers
include infections with lung flukes, echinococcosis, Larva migrans, Dirofilaria immitis, and Toxocara spp.
WS03.01
Predicting hazards - what can the modelling approach tell us about estimating travel related risk?
Auranen, K.1
1
National Institute for Health and Welfare, Department of Vaccines and Immune Protection, Helsinki, Finland
Models are increasingly used to predict outcomes of different intervention programmes or consequences of
different types of risk behaviour. Although statistical modelling seems appropriate when addressing questions
about such future outcomes, many predictive models in epidemiology defy formal requirements on coherent
statistical reasoning. This is at least partly due to the need of causal inferences and more generally to
uncertainties in choosing appropriate model structures or types. Sometimes, when nature has spoken, predictive
models become useless. Models may then serve as basis to address more scientific questions.
In this talk, I ponder about what contributions modelling could have to epidemiology and travel-related risk
assessment in particular. I try to approach the problem in terms of different overlapping taxonomies of models
(statistical vs. mathematical; predictive vs. explanatory; subjective vs. objective; decision-driven vs. evidencedriven; scenario-based vs. risk-based etc.). For example, there is a deep division according to whether statistics
or mathematics is emphasized in building and interpreting models for risk. While mathematical models are often
scenario-driven (“What would happen if travel restrictions would be enforced now?”), statistical models at least
on the surface aim at more coherent apprehension of uncertainties (“What is my risk of acquiring A/H1N1v if I
travel now?”).
WS03.02
The psychology of risk
Noble, L.1
1
University College London, London, United Kingdom
Travellers face a bewildering array of potential health threats and associated preventative measures to help them
avoid disease, injury and death. How can health professionals help them navigate through this in order to make
informed decisions? Travellers require accurate information about risks and a balanced view of the risks and
benefits of engaging in prevention. This session will consider approaches to risk management (precaution vs.
resilience), risk perception, communication of statistics about risk, the problem of uncertainty, and the
expectations and obligations of the provider-traveller relationship.
_______________________________________________________________________________________ Page 41 NECTM 2010 in Hamburg Workshop Abstracts _______________________________________________________________________________________ WS03.03
Methodology for estimating risks in travellers at policy level and how this translates to the individual
Behrens, R.H.1
1
Hospital for Tropical Diseases and London School of Hygiene and Tropical Medicine, London, United
Kingdom
Current risk estimates, particularly for infectious threats to travellers, are based on the presence of the infectious
agent in the destination country or region. Many policy groups base their malaria prophylaxis recommendation
on the presence and species of parasite in the endemic regions but not on the epidemiological ascertained risk
they pose to the average traveller. Their recommendation change little and the changing malaria epidemiology
has little impact, other than occasional inclusion or exclusion of geographical sites where there has been a
sustained change in malaria transmission. I will explore the advantages and disadvantages of different methods
of risk assessment giving examples of malaria in S-E Asia and global enteric fever. I will look at the advantages
and disadvantages of the strategies commonly used, including; geographical presence of disease, local
epidemiological transmission, cases in returning travellers, incidence in returning travellers, proportionate
morbidity and finally expert opinion as ways of deciding infectious disease threat. I will examine the thresholds
used for deciding the use or not, of interventions and the threat relevance to the traveller, and how this may
influence policy. This risk analysis and intervention need to be balance with the risk and costs of the
interventions used and how this balance is incorporated into policy on risk. I will finally explore how risk policy
fits in to the assessment made by health professionals and the needs of travellers.
WS04.01
Immuno-suppression in the Traveller: Consequences for Vaccination and Medication
Schade Larsen, C.1
1
Aarhus University Hospital, Skejby, Infectious Diseases, Aarhus N, Denmark
An increasing number of people are living with a primary or acquired immunodeficiency, including those with
HIV-infection and patients treated with immuno-suppressive or biological therapy. Many can live a nearly
normal life which includes travelling abroad for the purpose of tourism, business, visiting friends and relatives or
education. However they may have a higher susceptibility to infections, impaired response to immunizations, the
need to bring along medication, and potential difficulties of obtaining travel insurance. The experience with
travel vaccines in this group of patients is limited and at there is a general paucity of data. At the moment there is
no simple or good immunological parameter(s) that can be used to reliable predict the vaccine response.
Therefore serological evaluation may be warranted to secure that the traveller with an immunodeficiency
seroconvert and is protected. Immunological and serological analysis may be costly and the question is who is
going to pay? Further not all serological analysis is routinely available.
In addition the immunocompromised traveller may need antibiotics for prophylaxis or for standby-treatment of
infections.
The special challenges of giving pretravel advice to this group of travellers will be discussed based on casestories.
WS04.02
The Elderly Traveller: Immunosenescence and Consequences for Vaccination and Medication
Thornam, P.1
1
Haukeland University Hospital, Microbiology Department, Bergen, Norway
In today's ageing population travel among the elderly is on the increase. For the travel medicine specialist, this
trend has made the vaccination of the elderly a major concern.
Ageing leads to a natural decline of the immune system, this phenomenon is known as Immunosenescence.
Immunosenescence impairs the ability of an elderly person to fight infections, cancer and autoimmune diseases.
It also impairs the response to most vaccines. In particular, the capacity to produce long term memory through B
and T-memory cells declines with age. Booster doses that rely on memory cells produced before
Immunosenescence more often result in significant protection.
Immunosenescence influences the whole immune system from stem cells, phagocytes and NK cells to the
humoral (B-cells) and cell mediated cells (T-cells). The progressive involution of the thymus during aging,
which is the organ for T-cell production results in a lack of naive T-cells. This impairs the cell-mediated
_______________________________________________________________________________________ Page 42 NECTM 2010 in Hamburg Workshop Abstracts _______________________________________________________________________________________ response to infections and vaccines. For many vaccines the cell mediated response is as important as the B-cell
response. Most vaccines will also give a slower, slighter and less affinitive antibody response among the elderly.
Immunosenescence is probably caused by a combination of genetic programming and the exposure to various
antigens (viruses and bacteria) throughout ones life. Although all elderly will experience this form of aging, the
immunosenescence will progress differently depending on the fitness, general health and infection status of the
elderly person. It has been shown in several studies that a fit individual will give a better response to for instance
the influenza vaccine.
When conducting a travel consultation for an elderly traveler, it is important to be aware that the person is mildly
immunocompromised. An example of this is the yellow fever vaccine which has been shown to have more side
effects among the elderly than with younger travelers. In this instance these travelers are reliant on a safety
evaluation of the vaccine in relation to the traveler's health. The elderly traveler is more prone to several
infections and has less protection from some of the vaccines we offer. The challenge we are faced with is that
many travel related vaccines have never been studied in elderly populations. This means that a thorough and
adapted travel medicine consultation of elderly travelers is essential to providing a proper service to elderly
clients.
WS04.03
The pregnant traveller and malaria: risk and prevention
Schlagenhauf, P.1
1
University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, University
of Zürich, Switzerland
Travel medicine practitioners increasingly need to advise pregnant women who want and or/must travel to
malaria endemic areas. What degree of risk is involved? What are the clinical implications? When travel cannot
be deferred, how comprehensive is our evidence base to guide malaria prevention guidelines in pregnancy? Most
risk evaluations come from sub Saharan Africa where one in four pregnant women (approximately 25 million)
are at risk of Plasmodium falciparum infection at the time of delivery. Susceptibility to pregnancy malaria is
thought to be a combination of immunological and hormonal factors combined with the ability of infected
erythrocytes to accumulate in the placenta. Importantly, presumably because of increased emission of volatile
substances, including carbon dioxide, pregnant women are approximately twice as attractive to Anopheles
mosquitoes as are non-pregnant women. Non-immunes, such as pregnant female travellers have an increased risk
of malaria. Erythrocytes infected with Plasmodium falciparum sequester in the placenta through adhesion to
molecules such as chondroitin sulphate A. Placental parasitaemia is associated with maternal anaemia, excess
perinatal morbidity and mortality and premature or low birth weight infants. Although all four (recently 6)
Plasmodium species can infect pregnant women, most work has been done on susceptibility of pregnant women
to P. vivax and P. falciparum. Because P. vivax does not cytoadhere in the placenta, mono P. vivax infections
pose less risk for the pregnant traveller but are associated with a reduction in infant birthweight and maternal
haemoglobin. P. vivax infected pregnant women are also more likely to present with P. vivax relapses than their
non-pregnant counterparts and primaquine is contraindicated in pregnancy. With regard to prevention,
insecticide treated nets have been shown to be beneficial and safe in reducing the risk of placental malaria.
Pyrethroid insecticides are well tolerated by pregnant women with no evidence of toxicity. Mosquito repellents
such as DEET are considered safe in pregnancy with low risk of accumulation in the foetus. Guidelines for
malaria chemoprophylaxis in pregnancy vary internationally and there is limited evidence on safety,
pharmacokinetics and efficacy of anti-malarial drugs as pregnant women are usually excluded from clinical
trials. Chloroquine is considered safe in pregnancy but has limited applicability. Tetracyclines such as
doxycycline are considered contra-indicated during the entire pregnancy by the WHO and CDC but new
Swedish data suggest that doxycycline may be a possibility for malaria prophylaxis in early pregnancy.
Atovaquone/proguanil is currently not recommended in pregnancy due to limited data. New mefloquine post
marketing surveillance suggests a low (4.3%) birth prevalence of malformations and no specific pattern of
congenital malformations even in first trimester exposure. Mefloquine prophylaxis is allowed in all trimesters by
the CDC and in 2nd and 3rd trimesters by the WHO.
_______________________________________________________________________________________ Page 43 NECTM 2010 in Hamburg Workshop Abstracts _______________________________________________________________________________________ WS05.01
Success of a Dutch registration system for travel medicine physicians and nurses
Sonder, G.1, Koeman, S.1
1
National Coordination Center for Travelers Health Advice, Amsterdam, The Netherlands
The objectives of the Dutch National Coordination Center for Travelers Health Advice (LCR), are to improve
the uniformity of travelers’ health advice, and to enhance its quality. LCR does not receive any subsidy or
sponsorship. Expenses are covered by membership- and registration fees. Members are ‘travel clinics’ (public
health services, occupational health services, hospitals with departments for tropical diseases and general
practitioners). LCR offers national travel health guidelines and quality criteria for travel clinics, as well as for
basic and refresher courses in travel medicine. All institutions that offer travel medicine courses can apply for
LCR approval of their courses. Physicians and nurses who meet the curriculum criteria can enter the LCR
register of qualified travel health professionals. Opening an LCR register for travel health professionals has led
to a large increase in availability of courses, and of professionals who follow these courses and register as travel
health professional.
Although LCR is a non-governmental organization, the Ministry of Health considers LCR guidelines and quality
criteria as the national standards for travel medicine.
LCR membership and registration is not required by law to start, however professionals have a few reasons why
membership and registration is beneficial, e.g.,:
According to Dutch law, yellow fever centers have to meet all LCR criteria including membership of and
registration with LCR. Only LCR registered staff can sign international certificates of vaccination and
prophylaxis.
Nurses play an increasingly important role in travel medicine. According to Dutch law, nurses can not
prescribe medication or vaccinations. In agreement with the MoH, an exception is made for travel clinics that
meet all LCR criteria; nurses are allowed to give vaccinations and pre-signed malaria prescriptions to travelers
under strict conditions.
Developments
Due to a recent law change, it is now possible that specialized groups of nurses, under strict conditions, can
prescribe certain medications. The MoH has to acknowledge each group. In travel medicine, nurses already meet
most of these conditions. In order to prescribe medication, nurses’ basic courses will have to be extended with
pharmacotherapy education. LCR is now trying to have travel nurses acknowledged. Travel medicine is and will
be largely done by nurses, but always under responsibility, supervision and in cooperation with physicians.
WS05.02
Proposals for an education programme for the Nordic countries
Voltersvik, P.1
1
Norwegian Forum for Travel Medicine and the Prevention of Infectious Diseases, Oslo, Norway
The panel at the education symposium on the NECTM in Helsinki in 2008 decided to seek ways by which
Nordic based education in travel medicine can be introduced. Since then a working group, “Nordic Initiative on
Travel Medicine Education” (NITME), constituted by representatives from the Faculty of Travel Medicine,
Royal College of Physicians and Surgeons in Glasgow, and the Nordic travel medicine societies, has drafted a
programme for a interdisciplinary foundation course (FC) which will be part of an advanced course (AC) (master
or diploma) in travel medicine. In this process NITME has received advice from the Nordic Council of
Ministers. Programme modules are drawn from the courses in Glasgow and Health Protection Scotland. The
courses will be at university level, preferentially based at institutes of international health in the various
participating Nordic countries. The credits from these courses will apply to the courses given generally within
continuing medical education and continuous professional development within the Nordic region and Europe.
Training tools in travel medicine has traditionally come from specialist training in infectious/tropical diseases
and vaccinology. The FC and AC courses will validate these tools for travellers not just in relation to infectious
disease dynamics and epidemiology but also in relation to the pre-travel consultation process, non-infectious
disease (e.g. climate adaption, altitude, accidents, etc.) and the logistics of the travel itself (e.g. jet lag,
psychological adaptation, etc.). Topics on migrant and global health will also be covered.
_______________________________________________________________________________________ Page 44 NECTM 2010 in Hamburg Workshop Abstracts _______________________________________________________________________________________ WS05.03
Education in travel medicine - the Faculty of Travel Medicine (FTM, RCPSG)
Chiodini, P. 1
1
London School of Hygiene & Tropical Medicine, London, United Kingdom
The FTM was founded in 2006 to promote excellence in travel medicine practice with a strong emphasis on
education and professional development. This presentation will focus on the FTM's current and future strategy
for travel health education. Feedback from the audience regarding their future needs will be encouraged.
WS05.04
The Diploma in Travel Medicine - A Blended e-Learning Course
Boyne, L.1
1
Health Protection Scotland / RCPSG, Glasgow, United Kingdom
The Travel Team at Health Protection Scotland (HPS) have been delivering post-graduate Travel Medicine
courses since 1996. There are two courses: The Diploma in Travel Medicine (DTM) and the Foundation in
Travel Medicine (FTM). Both are affectionately known as ´The Glasgow Courses´.
The DTM is awarded by the Royal College of Physicians and Surgeons Glasgow (RCPSG) and candidates who
successfully complete the DTM may enter directly into the Faculty of Travel at RCPSG.
Students from around the world have undertaken The Glasgow Courses, with approximately 600 taking the FTM
and 400 taking the DTM.
During 2008, The Glasgow Courses were developed into blended e-Learning courses. This presentation will
briefly describe the processes of this development and will highlight advantages and disadvantages of blended eLearning from both an educational provider and student perspective.
WS06.01
Cutaneous Infections by Mycobacterium tuberculosis
Greinert, U.1
1
Medical Hospital Borstel and Research Center, Borstel, Germany
No Abstract available
WS06.02
Cutaneous and Mucocutaneous Leishmaniasis in Travellers
Fischer, M.1
1
Bundeswehr Hospital Hamburg, Tropical Medicine branch at Bernhard-Nocht-Institute for Tropical
Medicine, Hamburg, Germany
Cutaneous leishmaniasis (CL) is an important endemic disease in 88 countries with estimated 1.5 million cases
reported worldwide annually. Especially ecologic tourism and outdoor activities in desert areas of the old world
and adventure trips into tropical rainforests in Middle and South America led to an increase of reported cases
among travellers. The clinical appearance of cutaneous leishmaniasis varies and is often
- out of endemic areas - initially misdiagnosed, which consequently leads to delayed diagnosis and
inappropriate therapy.
While cutaneous leishmaniasis was formally either looked upon as a self healing disease with an often
disfiguring outcome or in severe cases painfully treated with the intralesional application of antimonials recently
several clinical trials were carried out and already established strain-specific alternative treatment options with
promising results.
This lecture aims to familiarize with different clinical aspects of cutaneous and mucocutaneous leishmaniasis
among travellers, appropriate diagnostic methods and will point out some Leishmania strain specific therapeutic
options.
_______________________________________________________________________________________ Page 45 NECTM 2010 in Hamburg Workshop Abstracts _______________________________________________________________________________________ WS06.03
Skin diseases and STDs in Amazonia
Talhari, S.1
1
Institute for Tropical Medicine, Manaus, Brazil
WHO (2001) stated that STI are a major global cause of acute ilness, infertility, long term disability and death,
with severe medical and psychological consequences for millions of men, women and children.
WHO estimated that 340 million new cases of curable STI, syphilis, gonorrhoea, clamydia, and trichomoniasis
have occurred throughout the world in 1999 in men and women aged 15-49 years.
In Brazil there is no good data regarding STD.
It is well known that HiV/AIDS is a growing world public health problem. From 1980 to 2007, Brazil has
registered 506,499 cases of HIV-AIDS with a detection rate of 17.8/100,000.
Patients with STD, and differential diagnosis and co-infected patients with HiV/AIDS/endemic tropical
dermatological diseases will be discussed in this presentation.
_______________________________________________________________________________________ Page 46 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ FC01.01
A Novel Galacto-oligosaccharide Mixture Prevents the Incidence of Travellers´ Diarrhoea in Vivo
Tzortzis, G.1
1
Clasado Ltd, Milton Keynes, United Kingdom
Background/objectives: Prebiotics have attracted interest for their ability to positively affect the colonic
microbiota composition, thus increasing resistance to infection and diarrhoeal disease. This study assessed the
effectiveness of a prebiotic galacto-oligosaccharide mixture (B-GOS) on the severity and/or incidence of
travellers' diarrhoea (TD) in healthy subjects.
Subjects/methods: The study was a placebo-controlled, randomized, double blind of parallel design in 159
healthy volunteers,who travelled for minimum of 2 weeks to a country of medium or high risk for TD. The
investigational product was the B-GOS and the placebo was maltodextrin. Volunteers were randomized into
groups with an equal probability of receiving either theprebiotic or placebo. The protocol comprised of a 1 week
pre-holiday period recording bowel habit, while receiving intervention and the holiday period. Bowel habit
included the number of bowel movements and average consistency of the stools as well asoccurrence of
abdominal discomfort, flatulence, bloating or vomiting. A clinical report was completed in the case of diarrhoeal
incidence. A post-study questionnaire was also completed by all subjects on their return.
Results: Results showed significant differences between the B-GOS and the placebo group in the incidence (P<
0.05) and duration (P< 0.05) of TD. Similar findings occurred on abdominal pain (P< 0.05) and the overall
quality of life assessment (P< 0.05).
Conclusions: Consumption of the tested galacto-oligosaccharide mixture showed significant potential in
preventing the incidence and symptoms of TD.
FC01.02
Self-reported Illness in Cruise Ship Travellers - Focus on “Stomach Upset”
Bryant, N.J.1, Nichols, G.1, Cartwright, R.2, Lawrence, J.3, Jones, J.3, Hadjichristodoulou, C.4
1
Health Protection Agency, Gastrointestinal, Emerging and Zoonotic Infections, London, United Kingdom,
2
MicroDiagnostics Ltd, Guildford, United Kingdom, 3Health Protection Agency, Travel and Migrant Health,
London, United Kingdom, 4University of Thessaly, Medical School, Department of Hygiene and Epidemiology,
Larissa, Greece
Objectives: The EU SHIPSAN TRAINET project, aims to develop an EU integrated strategy for safeguarding
the health of travellers and crew of passenger ships and preventing international spread of disease through ships.
Cruise ship travel accounts for 8% of the package holiday market in the UK. Using travel industry data, this
study aims to better define the incidence of “stomach upset” and other diseases in cruise passengers.
Methods: A major British tour operator regularly collects data from customers for market research using a
questionnaire administered on the return flight of their holiday. The questionnaires provide demographic data
and details about their holiday (e.g. length of stay, type of board) and questions on self-reported illness: stomach
upset for >24 hours, sea sickness, colds, sunburn or other illnesses. Data from questionnaires completed between
2001 and 2008 were imported into SPSS for analysis.
Results: Between 2001 and 2008, 5,890,102 questionnaires were completed, accounting for 1.7% of visits made
by UK holiday makers in that period, as estimated by the International Passenger Survey. Of the 287,895
customers (4.9%) who went on a cruise, 22% reported illness during their holiday. Sea sickness was most
frequently reported by cruise passengers (11%), followed by stomach upset (4.9%), other illnesses (3.7%), colds
(2.4%) and sunburn (1.3%). When seasickness was excluded from the analysis, only 10% of cruise passengers
reported illness on their holiday compared to 16% on land-based holidays. Reports of stomach upset on river
cruises in Egypt peaked in the summer months. Stomach upset reports on cruises in Spain, however, peaked
during the winter, but decreased over the study period from a high of 5.5% during winter 2002-3 to a low of 1.52.7% during winter 2008-9. For customers visiting Spain or Egypt, stomach upset was reported more frequently
by those on land-based holidays compared to those on cruises (p< 0.001).
Conclusions: Sea sickness is frequently reported on cruises, particularly in the winter months. The risk of other
illnesses, including stomach upset, is lower than for those going on land-based holidays. However, as large
outbreaks of gastroenteritis have been identified on cruise ships, travellers should be made aware of hygiene
measures prior to departure. The destination and season of a cruise greatly affect the risk of stomach upset and
pre-travel consultations for cruise passengers need to be tailored to the individual.
_______________________________________________________________________________________ Page 47 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ FC01.03
Clinical Update: Booster recommendation for the Vero-cell derived JE vaccine.
Dubischar-Kastner, K.1, Eder, S1, Schulle, E.1, Dewasthaly, S.1, Klade, C. S.1.
1
Intercell AG, Campus Vienna Biocenter, Austria -1030 Vienna, Europe
Introduction: IXIARO was licensed in the US, Europe, Canada and Australia (Jespect®) in 2009. IXIARO is
administered in a two-dose primary series. As with other inactivated vaccines the immune response to IXIARO
might require a booster to maintain protective antibody levels (a titer of ≥1:10 in a 50% plaque reduction
neutralization test is recognized as protective).
Methods: Three clinical trials investigated neutralizing antibody persistence and the effect of a booster dose: A.
In one trial, 181 subjects were followed-up for 3 years after primary immunization. B. In a second study, 198
subjects were boosted at 15 months after primary immunization and followed-up for one year, with serological
testing at 1, 6 and 12 months later. C. 349 subjects who had received different schedules of IXIARO in a
preceding trial were followed- up for 24 months and neutralizing antibodies were assessed at 6, 12 and 24
months after primary vaccination. Subjects with PRNT50<1:10 at month 6 or 12 received a booster dose on
month 11 (N=17) or month 23 (N=24) respectively.
Results: A. Across studies, after complete primary immunization, the rate of subjects with a PRNT50≥1:10 was
58% and 83% at 12 months, 69% at 15 months, 48% and 82% at 24 months and 85% at 36 months. B. A booster
dose given at 15 months after the first dose of the primary immunization led to 100% seroconversion and a GMT
of 900 one month later. At month 12, the rate of subjects with PRNT50≥1:10 remained high (98.5%) and GMT
(361) was still higher than after primary immunization. C. A booster dose at 11 or 23 months after the first
IXIARO dose in subjects with PRNT50<1:10 led to 100% seroconversion. A second dose at Month 11 after a
single 6 mcg dose (incomplete primary immunization) led to seroconversion in 99% of subjects (N=100). The
safety profile of a booster dose was similar to the primary immunization with 21.8% to 32.6% of subjects
reporting solicited local reactions, and 17.1% to 27.9% reporting solicited systemic AEs during 7 days after
boosting.
Conclusions: EMA has recently approved the booster recommendation for IXIARO: A booster dose (third dose)
should be given within the second year (i.e. 12 - 24 months) after the recommended primary immunization, prior
to potential re-exposure to JEV. Persons at continuous risk for acquiring Japanese encephalitis (laboratory
personnel or persons residing in endemic areas) should receive a booster dose at month 12 after primary
immunization.
FC01.04
Health Problems Incidence and their Management during Deployments Abroad: The ESOPE Study
Rapp, C.1, Aoun, O.1, Roqueplo, C.2, Ficko, C.1
1
HIA Bégin, Infectious and Tropical Diseases, Saint-Mandé, France, 2DRSSA, Marseille, France
Introduction: French armed forces have more than 10 000 men deployed abroad at anyone time. Along with
combat-related injuries, all these soldiers are exposed to non combat-related diseases with an underestimated
burden.
Objectives: To assess the incidence and impact on operating capacity of health problems occurring in French
soldiers during deployments abroad.
Methods: A prospective multicenter study was conducted during three months (July-September 2008) in 3
countries (Lebanon, Côte d'Ivoire and Afghanistan). All French soldiers consulting in one of the six sick bays
were included.
Results: Four thousand sixty five consultations were included with a 14 M:F ratio and a 28 year median age (1861). Four thousand two hundred ninety three health problems were reported.
The most frequent reasons for consultation were the following: traumas (20.5%), diarrheas (19%), dermatoses
(17.5%), upper and lower respiratory tract infections (10.3%), back pains (6.5%), psychiatric disorders (2.3%),
war injuries (1%), malaria (0.2%). Seven percent of cases presented with fever. Infectious diseases represented
44 % of all health problems. Out of ten consultations, nine were managed as ambulatory. Oral or parenteral
antibiotics were prescribed in 7% of consultations. Partial or complete unavailability was estimated 652
days/1000 men/month. Sixty eight (1.7%) medical evacuations to France were reported of which 28 psychiatric
and 26 trauma cases. Ten combat-related deaths were observed in Afghanistan. The health problems etiological
spectrum was similar in the three countries. However in Afghanistan, the inpatient management and medical
evacuation rates were significantly higher (p< 0.0001). The incidence of diarrhea was also higher (p< 0.05).
_______________________________________________________________________________________ Page 48 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ Conclusions: This work showed a wide spectrum of health problems occurring during military deployments
abroad. It highlights the importance of cosmopolitan infections and the burden of non combat-related pathologies
in the loss of operating capacity. This data is useful for improving the prophylaxis of health risks during
deployments abroad.
FC01.05
A Prospective Study on the Incidence and Risk Factors of Probable Dengue Virus Infection among Dutch
Travellers
Baaten, G.G.1,2,3, Sonder, G.1,2,3, Van Gool, T.3, Kint, J.1, van den Hoek, A.1,3
1
Public Health Service (GGD) Amsterdam, Department of Infectious Diseases, Amsterdam, Netherlands,
2
National Coordination Centre on Travellers' Advice, Amsterdam, Netherlands, 3Academic Medical Centre
Amsterdam, Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, Netherlands
Objective: In recent years, the number of reported symptomatic dengue virus infections among international
travellers has increased. This study prospectively assessed the occurrence of and risk factors for both clinical and
subclinical dengue virus infection in travellers to endemic areas in the (sub)tropics.
Methods: Adult short-term travellers (1 to 13 weeks) donated blood samples for serology before and after travel.
Data on travel itinerary, preventive measures taken against mosquito bites, and symptoms of infectious diseases
were recorded by using a structured diary. Blood samples were tested for antibodies against dengue virus.
Probable previous infection was defined as a seropositive pre-travel and post-travel sample. Probable recent
infection was defined as a seropositive post-travel sample with a seronegative pre-travel sample.
Preliminary results: Previous dengue virus infection was found in 87 of 1207 subjects (7.2%), and was
significantly related to being born in a non-western country, previous travel to the (sub)tropics, previous travel to
Latin America, and travel to visit friends and/ or relatives.
Probable recent dengue virus infection was found in 22 of 1207 travellers at risk (1.8%). The incidence rate per
1000 person-months was 22.9. The risk of recent infection was positively related to male gender, age, being born
in a western country, and travelling for work or education, although none of them significantly (p>0.05). The
risk was inversely related to the use of insect repellent and staying in accommodations with well-screened
windows or air-conditioning, or a mosquito net (p>0.05). Dengue-like illness was reported by 6 of 22 subjects
(27%).
Conclusion: The risk of dengue virus infection for travellers to endemic areas is considerable, and is related to
exposure from living in or previous travel to a non-western country. Compliance with preventive measures
against mosquito bites appears to be effective.
FC01.06
Rabies Post Exposure Treatment at the Liverpool School of Tropical Medicine, UK
Wijaya, L.1, Ford, L.1, Lalloo, D.1
1
Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Background: In 2008, 69 million UK residents travelled abroad. 54.4 million (78 %) visits were to Europe and
North America and 9.9 million (14.4%) were to Asia, predominantly to India, Pakistan and Thailand. Rabies is
widely distributed and continues to be a major public health issue in many developing countries, especially
Africa and Asia. The UK is free of rabies in terrestrial animals although cases of rabies in bats have been
reported. There have been four rabies deaths reported in the UK in the last 10 years. Three were due to exposure
overseas and one was in the UK in a licensed bat handler. This study examined the rabies post exposure
prophylaxis (PEP) service from 2000 to July 2009 at the Liverpool School of Tropical Medicine.
Methods: Medical records of patients who attended the clinic for rabies PEP were reviewed.
Results: 139 patients were treated for possible rabies exposure during the study period. The mean age was 35
years. Thailand and Turkey each accounted for 30 (21.5%) of the cases. 69 (49.6%) of those seen were due to
dog bites. Most injuries involved a lower limb (n=67, 48.2%) or hands (n=26, 18.7%). 86 (61.9%) had initiated
rabies PEP overseas but only three of the 78 (3.8 %) meeting UK criteria for rabies immunoglobulin received it
whilst overseas. Only an additional 11 patients received RIG on return to the UK; most were seen more than
seven days after initiation of PEP. The median time from exposure to receiving rabies PEP was one day (range 0
- 1720), regardless of whether it was initiated overseas or in the UK. Only 14 (10.1 %) of all individuals
requiring PEP had received pre exposure rabies vaccination.
_______________________________________________________________________________________ Page 49 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ Conclusion: The majority of travellers seeking post exposure rabies treatment at this clinic initiated treatment
overseas. Most had not received rabies immunoglobulin abroad, when it would have been appropriate. Initiation
of appropriate treatment is often delayed and is a concern in those without pre exposure rabies immunisation. In
view of the scarcity of rabies immunoglobulin, travellers need to be aware of the risks, consider pre-exposure
immunisation and present early for post exposure treatment.
FC02.01
Non-adherence to Malaria Chemoprophylaxis: Can It Be Predicted from Communication in the Pretravel Consultation?
Noble, L.1, Farquharson, L.2, Carroll, B.3, Jordan, A.4, Behrens, R.5
1
University College London, Division of Medical Education, London, United Kingdom, 2Royal Holloway
University of London, London, United Kingdom, 3University College London Hospital, London, United
Kingdom, 4NaTHNaC, London, United Kingdom, 5London School of Hygiene and Tropical Medicine, London,
United Kingdom
Objectives:
(1) To determine whether experienced clinicians could identify travellers who subsequently adhered poorly to
malaria chemoprophylaxis by assessing verbal transcripts of pre-travel consultations.
(2) To determine whether clinicians' perceptions of the quality of provider-traveller communication were related
to travellers' adherence.
Methods: The consultations of 130 consecutive travellers at a UK travel clinic were audiotaped and transcribed.
Travellers completed a telephone interview to assess adherence to malaria chemoprophylaxis 4-7 weeks posttrip. Three experienced travel clinicians were asked to identify whether the traveller adhered, from written
transcripts of the verbal communication in 18 pre-travel consultations (9 poor and 9 good adherers). Clinicians
gave each transcript a rating of quality and were interviewed to explore their criteria for a good quality
consultation.
Results: Two out of three clinicians were able to predict adherence better than chance. Clinicians gave higher
quality ratings to consultations where the traveller subsequently adhered well. The results indicated that
clinicians' perceptions of the quality of the communication were related to their prediction of adherence.
Clinicians valued consultations that were well-structured, highlighted key messages and provided a clear
rationale for the recommendations. Poor consultations were characterised by limited interaction or interest, lack
of detailed information and a reactive approach by the clinician.
Conclusions: The pre-travel consultation can provide an indication of the likelihood of subsequent adherence.
Specific communication strategies could be employed by clinicians to increase the effectiveness of discussions
about the prevention of malaria. The findings have implications for the training of professionals providing pretravel advice.
FC02.02
Imported Malaria in Finland 1995-2008: An Overview of Surveillance, Travel Trends and Antimalarial
Drug Sales
Guedes, S.1,2, Siikamäki, H.3, Kantele, A.3,4, Lyytikäinen, O.2
1
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease
Prevention and Control, Stockholm, Sweden, 2National Institute for Health and Welfare (THL), Helsinki,
Finland, 3Helsinki University Central Hospital, Department of Medicine, Division of Infectious Diseases,
Helsinki, Finland, 4Haartman Institute, Helsinki University, Helsinki, Finland
Objectives: In order to identify trends and risk groups, we analysed the surveillance data on malaria cases in
Finland during the period 1995-2008. We compared the data with information available on travelling and
antimalarial drug sales to find out if these sources could be useful to improve the existing surveillance system
and pre-travel advice.
Methods: Three different data sources were used: surveillance data, travelling and drug data. Surveillance data
comprised information on malaria cases reported to the National Infectious Disease Register during 1995-2008.
Travelling data was obtained from Statistics Finland (SF) and the Association of Finnish Travel Agents (AFTA).
SF data was based on monthly telephone survey and included information on overnight leisure trips to malaria
endemic countries during 2000-2008. AFTA data included annual number of organized trips during 1999-2007.
_______________________________________________________________________________________ Page 50 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ Quarterly number of antimalarial drug sales was obtained from the Finnish Medicines Agency. Descriptive and
time series analyses were performed.
Results: A total of 484 malaria cases (average annual incidence, 0.70/100,000 population) were reported; 283
Finnish-born and 201 foreign-born. Fifteen percent were children of which 72% foreign- and 28% Finnish-born.
Malaria infections were acquired mostly in Africa (76%) and South East Asia (12%). Among foreign-born, 89%
of the infections were acquired in the region of birth. Plasmodium falciparum (61%) and P. vivax (22%) were
the most common species isolated. There was no increase in organized trips but travelling to malaria endemic
areas increased. A decreasing trend in antimalarial drug sales was observed, which seems to be changing with
the introduction of proguanil-combinations in 2005. Travelling to malaria endemic countries and drug sales
followed the same seasonal pattern with peaks in the first and last quarter of the year. Malaria cases occurred all
year round with an increasing trend towards the end of the year.
Conclusions: This nationwide population-based study showed that there was no increase in reported malaria
cases during the 14-year period but travelling to malaria endemic countries increased and antimalarial drug sales
decreased. The introduction of proguanil-combinations in 2005 seems to be shifting the decreasing trend. The
study suggests that not all travel groups are reached by travel advice, especially foreign-born individuals visiting
their home country and travellers on self-organized trips.
FC02.03
Evaluation of Travel Medicine Practice by Yellow Fever Vaccination Centres in England, Wales and
Northern Ireland
Boddington, N.1, Simons, H.J.2, Bryant, N.1, Hill, D.R.1
1
The National Travel Health Network and Centre, London, United Kingdom, 2The National Travel Health
Network and Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Introduction: Yellow Fever Vaccination Centres (YFVCs) in England, Wales and Northern Ireland (EWNI) are
required to follow a programme of registration, biennial training, standards for yellow fever (YF) vaccine
administration and clinical audit. This programme was introduced by the National Travel Health Network and
Centre (NaTHNaC) in January 2005.
Objectives: To describe the practice of travel medicine (TM) by YFVCs in EWNI and to evaluate the impact of
the NaTHNaC programme on YFVCs. YFVCs had also been surveyed prior to initiation of the programme in
2005 (J Travel Med 15:287, 2008).
Methods: All civilian YFVCs (n=3,282) in EWNI were requested to participate by completing an on-line
questionnaire that queried: centre demographics, the practice of TM, staff training, vaccine storage, record
keeping and sources of information. YFVCs were also asked to evaluate YF training and if the training had
influenced their practice. The questionnaire was designed via Survey Monkey® and the data collated and
analysed using Excel® and STATA 11®.
Results: The questionnaire was completed by 1,462 YFVCs (44.5% response rate). Almost all YFVCs (86%)
were based in General Practice; 34% had specific sessions to provide TM consultations and 11-20 minutes was
the most frequently allocated appointment time (67%). A median of 50 (95% CI 70.3-89.2) YF vaccines were
administered per year. Other specialist travel vaccines offered were rabies (86%), Japanese encephalitis (63%)
and tick-borne encephalitis (52%). Fewer YFVCs had physicians with specific TM training (32%) compared to
nurses (97%) (p< 0.001); significantly more YFVCs had nurses who trained to a Diploma or Masters level
compared with physicians (p< 0.005). Following NaTHNaC YF training the level of confidence and knowledge
concerning YF risk assessment, safety and administration of YF vaccine, improved in 96%. However, only 25%
felt very confident or knowledgeable about vaccination of travellers aged ≥60 years. Training resulted in a
change to practice in 68% of YFVCs particularly in the areas of risk assessment, record keeping and use of
internet resources.
Conclusions: Administration of YF vaccine in EWNI occurs primarily in the general practice setting. Nurses in
YFVCs have more frequent and higher level training in TM than physicians. NaTHNaC YF training has
improved overall confidence and has resulted in changes in practice. The NaTHNaC programme can be used as a
model for other national programmes for YFVCs.
FC02.04
The RAGIDA Project - European Risk Assessment Guidance for Diseases Transmitted on Aircrafts
Leitmeyer, K.1, RAGIDA Expert Group
1
ECDC, Preparedness and Response Unit, Stockholm, Sweden
_______________________________________________________________________________________ Page 51 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ Background: The emergence of SARS illustrated the potential for a new disease to suddenly appear, spread and
to threaten the health, economic and social life of EU citizens. The fact that almost 800 million passengers are
carried on national/international flights within the EU alone highlights the potential risk of introduction and
spread of infectious diseases. Early recognition of disease and appropriate risk assessment are needed to initiate
the most appropriate response without unnecessarily alarming the public and disrupting air traffic.
Objectives: In order to assist national public health (PH) authorities in EU Member States to assess the risks
associated with the transmission of infectious agents onboard aircrafts, ECDC initiated in 2007 the RAGIDA
project (Risk assessment guidance for diseases transmitted on aircraft).
Methods: RAGIDA consists of two parts 1) a systematic review and 2) a series of disease specific guidance
documents. For the first part, a systematic review of over 3700 peer-reviewed articles and grey literature was
performed for the following diseases: Tuberculosis (TB), influenza, SARS, meningococcal disease, measles,
rubella, diphtheria, Ebola and Marburg hemorrhagic fever, Lassa fever, smallpox and anthrax. In addition,
general guidelines from international aviation boards and national/international PH agencies on risk assessment/
management were systematically searched. Standardized questionnaires were used to interview
national/international experts to assess case-based events. For the disease specific guidance documents, ECDC
convened in 2009 a first technical expert consultation on TB, SARS and meningococcal infections.
Results: The extensive literature review revealed that very limited information is available for the majority of
diseases and only single events are published in peer-reviewed journals. Except for TB, no international
guidance for contact tracing exists. During the first technical expert consultation, all evidence retrieved was
reviewed and assessed against expert knowledge/experience resulting in a disease specific operational guidance
for evidence based risk assessments.
Conclusions: Considering the lack of published information available evaluating the risk of transmission of
most infectious agents onboard aircrafts, the RAGIDA guidance provides a viable evidence-based tool for PH
authorities determining triggers and making decisions on whether to undertake contact-tracing in air
travellers/crew.
FC02.05
Infants, Altitude, Air Travel
Neumann, K.1
1
New York Presbyterian Hospital-Cornell Medical Center, Pediatrics, Forest Hills, NY, United States
There are no known reports in the medical literature of healthy newborn infants experiencing medical
consequences resulting from air travel. At the usual cabin atmospheric pressure of commercial jetliners the
arterial blood oxygen saturation of healthy infants is about 92 to 94%, slightly higher than that of healthy older
children and adults, a level that healthy infants appears to tolerate well. However, infants with histories of
premature birth or perinatal cardiopulmonary problems - even infants otherwise asymptomatic - may desaturate
significantly from these oxygen concentrations. Such infants should be medically cleared for air travel.
Air travel appears to be safe for infants experiencing upper respiratory infections, nasal allergies, and ear
infections and for infants with ear aerating tubes. Feeding infants more frequently during flight than at other
times does not prevent earaches or dehydration, and may be counterproductive. In flight dehydration is a myth.
At cruising altitudes, air in the stomach and intestines expands by 20%, the result of lower atmospheric pressure.
Encouraging infants to eat/suck unnecessarily adds more air, possibly causing discomfort.
As durations of non-stop flights increase, the physiology of air travel melds into that of acute mountain sickness.
Infants and children with unknown and asymptomatic conditions - certain cardiopulmonary pathology, seizure
disorders, and Down Syndrome for example - have had significant symptoms after 18 hours at mountain
elevations at which the atmospheric pressure corresponds to that in cruising aircraft.
FC02.06
Acute Mountain Sickness of Travelers Who Consulted a Pre-travel Clinic
Croughs, M.1,2, van Gompel, A.3, van den Ende, J.3,4
1
GGD Hart voor Brabant, Travel Clinic, 's-Hertogenbosch, Netherlands, 2Institute of Tropical Medicine, Travel
Clinic, Antwerp, Belgium, 3Institute of Tropical Medicine, Department of Clinical Sciences, Antwerpen,
Belgium, 4University Hospital Antwerpen, Tropical Medicine, Antwerpen, Belgium
Objective: The main objective of this study was to investigate the prevalence and predictors of Acute Mountain
Sickness (AMS) of travelers who consulted a pre- travel clinic and to what degree the advices on prevention and
_______________________________________________________________________________________ Page 52 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ treatment of AMS were followed. Secondary objective was to study the effects and side-effects of acetazolamide
in this population.
Method: A post travel questionnaire was sent to the clients of four local public health services in the
Netherlands and of the Institute of Tropical Medicine in Belgium.
All clients from March 1 until August 31 in 2008 who planned to climb above 2000m were asked to join. Data
were registered anonymously and analyzed using SPSS 15.0 for Windows.
Results: 793 persons returned the questionnaire (response 77%) and those who stayed above 2500m (744) were
included. The incidence of AMS was 25% and predictors were previous AMS (OR 2), female sex (OR 1.5),
maximum sleeping altitude (OR 1.2 per 500m) and the number of nights between 1500-2500m (OR 0.9 per
night). About 90% read and claimed to understand the written advices. Only 60% followed the advice to
acclimatize at least 2 nights between 1500-2500 m and 57% climbed not more than 500m/day. Acetazolamide
was taken along by 72% and 16% took it preventively. On appearance of AMS 34% started taking acetazolamide
and 12% adapted their travel schedule . 47% climbed higher while having AMS symptoms. The average curative
dose of acetazolamide was 4,2 mg/kg/day and 40% reported mild side effects. We found no relation between
acetazolamide prevention and AMS (p=0.540) nor between acetazolamide treatment and the duration of the
complaints (p=0.169).
Conclusion: One fourth of travelers who stayed above 2500 meter suffered from AMS. Predictors were previous
AMS, female sex, maximum altitude and number of days between 1500 and 2500 meter (acclimatization).
Although about 90% read the written advices, not more than about half of these travelers followed the preventive
and curative advices. We found no preventive or curative effect of a low dose of acetazolamide. We would
advise clients of a Travel Clinic, who will stay above 2500 meter, to acclimatize at least a few days between
1500 and 2500 meter and maybe we should advise to start acetazolamide treatment in a higher dose as soon as
AMS symptoms appear.
FC03.01
An Analysis of the Pattern of Travel-Related Morbidity Reported by Hajj Pilgrims: An Irish Perspective
Raja Ali, R.A.1, O'Halloran, J.1, Flaherty, G.1,2,3
1
National University of Ireland, School of Medicine, Galway, Ireland, 2Irish Society of Travel Medicine,
Galway, Ireland, 3Faculty of Travel Medicine, Glasgow, United Kingdom
Objectives: Annually, over 2.5 million Muslims embark on the Hajj pilgrimage to Mecca. The extreme
overcrowding during the Hajj pose a risk of considerable travel-related morbidity to pilgrims. The effects of
travel-related morbidity among Muslim pilgrims returning to Ireland have not previously been examined. We
conducted a prospective observational study to examine the demographic details, pre-departure health status and
vaccination profiles of Irish pilgrims attending the Hajj in 2008 and to investigate any travel-related morbidity at
weeks 1, 2, and 6 post-Hajj.
Methods: Demographic details were obtained from a computerised database provided by an authorised travel
agency along with the occupation, number of household members, countries of origin, duration of residency in
Ireland, health and vaccination profiles prior to departure. Written questionnaires over a 1 month period were
distributed to each pilgrim. Following the pilgrimage, pilgrims were invited to complete a second set of
questionnaires at weeks 1, 2 and 6.
Results: 167 pilgrims (102 males, 65 females, mean age 37.5 years) were interviewed. All the pilgrims had been
resident for at least 5 years in the Republic of Ireland. Fifty-four percent originated from North Africa, 32% from
South East Asia, 13% from the Middle East and 3% were born in Ireland. Most considered themselves healthy
and 9% reported at least one medical condition such as diabetes, hypertension, hyperlipidaemia, TB and
psoriasis. Vaccination profiles were incomplete for DPT in 52%, influenza in 65% but all had received the
mandatory meningococcal ACYW-135. At week 1 post-Hajj, 79% reported a sore throat, dry cough or flu-like
symptoms and 31% reported taking an antibiotic since returning from the pilgrimage with 2 patients required
hospitalisation for pneumonia and tonsillitis. At week 2, 15% reported similar symptoms and were still taking an
antibiotic. At week 6, 86% self reported as healthy but 14% were lost to follow up. 86% of pilgrims denied any
symptomatic household contacts at any stage following the pilgrimage.
Conclusion: A relatively high incidence of upper respiratory tract infection was evident among Irish pilgrims
following the Hajj pilgrimage with a significantly low pre-travel vaccination uptake for the influenza vaccine.
Educational efforts should focus on the importance of travel vaccination and hand hygiene for prospective Hajj
pilgrims in an effort to minimise morbidity in this population.
_______________________________________________________________________________________ Page 53 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ FC03.02
Prospective Analysis of Infections in Immigrants and Refugee Patients from an Athens General Hospital
Zacharof, A.K.1
1
Hellenic Red Cross Hospital, 2nd Department of Internal Medicine, Halandri, Greece
Objective: Frequently clinicians are faced with screening and providing preventive and hospital care to
immigrants and refugees who most focused on febrile diseases. We evaluated all causes of diseases of these
patients hospitalized in a tertiary care hospital in Greece.
Methods: Demographics, diagnoses, and destinations of immigrants and refugee patients admitted between
January 1999 and December 2008, were recorded. In addition to acute symptoms, we search for the symptoms of
diseases prevalent in the country of origin. Many unexpected pathologic conditions were detected by a thorough
physical examination.
Results: Of 155 patients admitted, 110 (71%) were males, and febrile diseases accounted for 94% of admissions.
Common diagnoses were pneumococcal pneumonia 54 (35%), klebsiella pmeumonia 15 (10%), haemophilus
influenza pneumonia 10 (6%), staphylococcal bacteremia 9 (6%), salmonellosis 18 (12%), brucellosis 6 (4%),
tuberculosis 39 (25%), malaria 3 (2%), HIV infection 2 (1%) and unidentified febrile disease in 11 (7%).
Diarrheal diseases accounted for only 11% of admissions. Regarding destination, 102 (66%) patients had been
from Asia, and 53 (34%) from Africa. Refugees and immigrants from Asia carried the highest risk of being
hospitalized (OR 1.85, 95% CI 1.16-2.97; p = .01). Most (59%) patients from Asia had bacterial and chlamydial
infectious diseases and those from Africa protozoal and helminthic. The principal health problem of patients
originating from Asia was tuberculosis (27%), and from Africa, pneumococcal pneumonia (22%). Males were
more likely to acquire pneumococcal pneumonia (OR 2.15, 95% CI 1.13-4.09; p = .02) and tuberculosis (OR
3.41, 95% CI 0.97-11.89; p = .05).
Conclusions: Febrile diseases were the most common cause for hospitalization, bacterial and chlamydial
infections and tuberculosis being the following most common disease. Diseases were destination related; refuges
and immigrants from Asia were associated with a higher rate of hospitalization. Tuberculosis and pneumococcal
pneumonia had a substantially male predominance, probably due to high risk conditions.
FC03.03
Chagas Disease in Latin American Migrants. A European Challenge
López-Vélez, R.1, Pérez-Ayala, A.1, Pérez-Molina, J.A.1, Norman, F.1, Navarro, M.1, Monge-Maillo, B.1, DíazMenéndez, M.1, Flores, M.2, Cañavate, C.2
1
Tropical Medicine & Clinical Parasitology. Infectious Diseases Department. Ramón y Cajal Hospital, Madrid,
Spain, 2Parasitology Department, CNM, Instituto de Salud Carlos III, Madrid, Spain
Introduction: As a consequence of immigration Chagas´ disease (ChD) has overcome the borders. The
objective of this study was to describe the prevalence and clinical-epidemiological characteristics, as well as
providing preliminary data on response and tolerance to treatment with benznidazole, of the largest cohort of
Latin American immigrants with chronic T. cruzi infection described in Europe to date.
Methods: Prospective, observational study during 2003-2009. ChD was diagnosed with at least two positive
serological tests. PCR was also performed. A baseline ECG and ECC were requested for all, and esophageal
manometry, upper gastrointestinal barium studies and barium enema were requested according to individual
patient symptoms. All were treated with benznidazole 5 mg/kg in 2-3 divided doses daily for 60 days.
Results: T. cruzi serology was performed for 1146 patients, and this was positive in 357 (31%). 212 patients had
one or both positive PCRs. The median age was 36 years, 346 (97%) were from Bolivia, and 346 (67.5%) were
female.
Visceral involvement was diagnosed in 56/252 (22.2%): 43 (17.1%) had cardiac involvement, 9 (3.5%)
gastrointestinal involvement and 4 (1.6%) both. There were no significant differences in visceral involvement by
sex (p=0.21). 29.7% patients stopped treatment because side-effects. There were no associations between
benznidazole dose and the occurrence or severity of adverse reactions. Median follow-up after treatment was one
year. For 8 patients, T. cruzi antibody levels decreased following treatment, but none of the serologies became
negative. In 70 cases, there was no documented fall in antibody levels following treatment. In the 65 patients
with a positive pre-treatment PCR this became negative following treatment in all of them.
Conclusions: ChD is no longer limited to the Latin American continent and has currently emerged in certain
non-endemic areas such as the USA and Western Europe. In Spain the majority of patients are female Bolivian
immigrants in the fourth decade of their lives, who can transmit the infection though blood transfusion, organ
_______________________________________________________________________________________ Page 54 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ transplantation or congenital transmission. Treatment tolerance is poor which can further limit current treatment
options. Sound epidemiological data are necessary in order to estimate the magnitude of a problem of great
relevance for public health and health resource planning.
FC03.04
Referral Sources for Travel Health Consultations among Travelers Visiting Friends and Relatives (VFRs)
at an Inner-City Hospital in the Bronx, New York
Hafeez, S.1, Purswani, M.1, Hagmann, S.1
1
Albert-Einstein College of Medicine, Bronx-Lebanon Hospital Center, Division of Pediatric Infectious
Diseases, Bronx, NY, United States
Background: In 2007 VFRs accounted for 38% of overseas travelers from the US. VFRs are known to have a
disproportionate risk of infectious diseases, yet are less likely to seek pretravel advice. A better understanding of
the VFRs´ sources of referral for travel consultations might inform how to better reach out to this vulnerable
traveling population.
Objectives: To assess the referral sources of VFRs who presented to a hospital based travel clinic in the Bronx,
New York.
Methods: Retrospective chart review of pretravel consultation visits from September 2003-July 2009. Only
records with available information on sources of referral were included in this study. Factors associated with the
source of referral were investigated using chi-square test and logistic regression.
Results: Of 828 travelers who received a travel consultation during the study period, data of 556 travelers (67%)
[394 (71%) VFRs and 162 (29%) non-VFRs] were eligible for analysis. VFRs were significantly more likely
than non-VFRs to be males (45% vs. 33%), to be children (67% vs. 15%), to travel to Africa (83% vs. 61%), and
to travel long term (70% vs. 22%) (p< 0.01). The sources of referral differed significantly between VFRs and
non-VFRs (p< 0.001) [hospital physician (76% vs. 35%), internet (6% vs. 42%), family/friends (10% vs. 14%).
In the adjusted analysis only purpose of travel and age were significantly associated with the source of referral
(p< 0.001). VFRs (OR=4) and children (OR=2) were more likely than non-VFRs and adults respectively to be
referred by a hospital physician than by any other source.
Conclusions: At this inner-city medical center VFRs seeking pretravel consultations were predominantly
referred within by hospital physicians. Innovative community based education efforts targeting e.g. sports clubs,
schools or religious institutions will allow to reach VFRs beyond the hospital clinics, and improve their overall
access to pretravel services.
FC03.05
Rare Worms Are Rare - Still They Exist!
Sudeck, H.1, Wiemer, D.1, Fischer, M.1
1
Bundeswehrkrankenhaus Hamburg, Tropical & Internal Medicine, Hamburg, Germany
By describing with images of different kind four "exotic" helminthic diseases in detail awareness for rarely with
immigrants or returning travellers imported infections shall be raised.
The entities are:
Gongylonema pulchrum - a nematode from eastern and southern Europe harboured in the mouth of patients.
Oesophagostomum - a helminth strictly only from the Togo - Ghana border-region and showing a singular and
pathognomonic ultrasound picture when the mesenterium of the colon is thoroughly examined.
Armillifer - sometimes only found post mortem - but also presenting with a specific and diagnostic aspect in
Xray-pictures.
Gnathostoma - a nematode taken up by man with fish, frogs,snails. This parasite is becoming more important in
the last years as he is now not only brought in from SEA and the Americas but also from Africa.
A detailed and thorough history about the travel and the risks of exposure to certain conditions and food and
especially exploring the eating habits of travellers can help to detect rare imports and to elucidate symptoms
which do not always point to parasitic disease clearly.
_______________________________________________________________________________________ Page 55 NECTM 2010 in Hamburg Free Communication Abstracts _______________________________________________________________________________________ FC03.06
Long-term Stays Abroad and Terror: Aspects of Prevention and Care
von Laer, G.1
1
German Foreign Office, Medical Service, Berlin, Germany
The looming threat of terrorist acts in the host country poses a challenge for everyone, including travellers and
expatriates. The objective of terror is to spread panic through the creation of an atmosphere of general fear,
which one cannot escape contrary to a more concrete threat. The only strategy which seems to work here is for
the individual person to just accept it.The „global players“ and their co-workers, but also individual expatriates
working abroad for small and medium-sized companies, organizations or NGO´s are subjected to massive
terrorist threats. The effects of fear on long-term travellers and people posted abroad can either
1) be of a very personal and individual nature. This is the case with expatriates working as diplomats,
missionaries or managers, who are targeted by terrorists through phone calls, letters or via the internet, or
2) be of a more general nature, if for example a terrorist threat is directed against the whole population, an entire
Embassy, foreigners or members of a religious group.
Either way, the long-term traveller will be affected in a negative way:
a) in his basic daily routine, such as living, eating and sleeping habits and in his personal relationships,
b) in his leisure time, e.g. free evenings, healthy sleep patterns and
c) in his work performance, e.g. creativity, motivation, quality of work or mistakes he makes at work.
Thus it is fair to say that the real, as well as the perceived threat of terror is an important factor in occupational
health medicine. It can lead initially to slightly abnormal behaviour. Medical workers of the Occupational Health
Services will then begin to see a deterioration of normal personal behaviour of individual persons and they will
interpret that as a warning sign for the whole group: The terrorist threat has finally arrived. Suffocating feelings
of fear, depression, social isolation and psychosomatic problems will emerge. The general work performance
will deteriorate, as everybody will focus more and more on „getting out safe“.
The author, a occupational health doctor with the German Foreign Office, can look back on nine years of firsthand experience in travel medicine. The staff of German Embassies and Consulates in countries of the Persian
Gulf, such as Iran, Pakistan, Afghanistan, but also India, Nepal and Sri Lanka are under his personal medical
care.
_______________________________________________________________________________________ Page 56 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P1-01
Malaria: Cross-Cultural Variation in Attitudes. A Prospective Bilingual Survey in Amazonian Peru
Leckie, K.1, Smith, C.2
1
Hairmyres Hospital, Department of Medicine for the Elderly, East Kilbride, United Kingdom, 2St Matthew's
Academy, Department of Modern Languages, Saltcoats, United Kingdom
Background: Malaria is estimated to cause around 1,000,000 deaths annually worldwide. Plasmodim
Falciparum malaria is known to be the most serious. The World Health Organisation invests substantial
resources targeting improved education of malarial prevention and treatment in the developing world.
Aims: To investigate variation in attitudes to malaria between Peruvian and UK citizens.
Methods: Prospective dual language survey in English and Spanish evaluating malarial prophylaxis and
precautions used on a charity project in a region of Amazonian Peru with known active Plasmodium Falciparum
malaria. The questionnaire was translated by a fluent Spanish speaker.
Results: 7 UK health-professionals and 8 Peruvian nationals (5 health-professionals, 3 non-medically trained)
completed the survey. All the participants sustained mosquito bites, day and nocturnal, during the 14-day period.
87.5% of the Peruvian nationals could name 3 malarial symptoms. UK participants named an average of 2.5
None of the Peruvians sought medical advice prior to leaving. One Peruvian developed malaria. All of the UK
participants sought medical advice prior to travel. This was from various sources and the suggested malarial
prophylaxis was varied. None of the Peruvians sought took chemoprophylaxis but 75% took precautions to avoid
bites.
Conclusion: There was substantial cross-cultural variation in knowledge of and attitudes to malaria. Despite
precautions, no-one successfully avoided mosquito bites. Peruvians, both medically trained and lay, had good
knowledge of malaria but none were taking chemoprophylaxis. UK citizens were less knowledgeable but were
taking suitable precautions and prophylaxis, although there was significant variation in pre-trip advice received.
P1-02
The Burden of Imported Malaria in Gauteng Province, South Africa
Baker, L.1,2, Weber, I.B.3, Blumberg, L.4
1
Amayeza Info Services, Johannesburg, South Africa, 2Malaria Advisory Group, National Department of Health
- Communicable Diseases, Pretoria, South Africa, 3University of Pretoria, School of Health Systems and Public
Health, Pretoria, South Africa, 4National Institute for Communicable Diseases, Johannesburg, South Africa
Objectives: Few scientific research reports address the burden of malaria imported into non malaria
transmission regions of African countries. Although a notifiable disease in South Africa, many cases in nonendemic areas are not notified. The malaria control programme works very well in the areas of malaria
transmission, reducing the burden of malaria and reporting cases. However , a significant number of unreported
cases are known to occur in South Africa's economic hub, the province of Gauteng (a province in South Africa
with no malaria transmission). We evaluated this burden.
Design: We conducted a survey of malaria cases diagnosed in public and private hospitals throughout Gauteng
from December 2005 through November 2006.
Outcome measures: Severe malaria was defined as symptomatic malaria with signs of severity or evidence of
vital organ dysfunction, while uncomplicated malaria was symptomatic malaria not meeting the criteria of
severity. All cases were laboratory diagnosed.
Results: We identified 1,701 malaria cases of which 1,548 (91%) cases were seen at public sector hospitals and
153 (9%) at private sector hospitals. Males accounted for 1,149 (68%) patients. Median age was 27 years (range
one month to 89 years).Disease severity did not differ by age or sex. Patients who were South African-born were
more likely to have severe disease, OR=1.43 (1.08-1.91), as were patients who experienced a delay of greater
than 48 hours between onset of symptoms and diagnosis or treatment, OR=1.98 (1.48-2.65). Nine percent of
severe malaria cases received a loading dose of quinine.
Conclusions: The incidence of malaria in Gauteng was higher than previously reported. The burden of severe
malaria in this population is increased by delays between onset and diagnosis or treatment exceeding 48 hours
and lack of partial immunity. Failure to administer the quinine loading dose occurred frequently. These findings
indicate the need to prevent malaria in travelers through reliable use of non-drug measures and, when indicated,
malaria chemoprophylaxis. Providers should consult the latest guidelines for treatment of malaria in South
Africa.
_______________________________________________________________________________________ Page 57 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P1-03
Validity of Malaria Diagnosis in Non-immune Travellers in Endemic Areas
Barreto Miranda, I.1, Weber, C.1, Fleischmann, E.1, Bretzel, G.1, Löscher, T.1
1
University Munich, Department of Infectious Diseses and Tropical Medicine, Munich, Germany
Background: Malaria has to be considered in all febrile persons during or after a stay in malaria endemic areas.
However, malaria diagnosis in endemic countries may be inaccurate due to limited capacity and lack of
resources of local health services. To assess the validity of malaria diagnosis in travellers in endemic areas we
investigated the retrospective confirmation of malaria by detection of specific antibodies.
Methods: Sera of 105 non-immune travellers who presented between 2003 and 2005 with a history of diagnosis
and treatment of malaria during a stay in malaria endemic countries within the previous six months were
analysed for antibodies against Plasmodium falciparum and P. vivax blood forms by an indirect
immunofluorescence test. 241 follow-up sera from 176 non-immune patients with microscopically confirmed
malaria served as a control group.
Results: Antibodies against plasmodia were detectable within 180 days after reported date of diagnosis and
treatment in 16 of 105 travellers (15.2%) only. In the control group 71.6% of analysed sera (151 of 211) showed
positive results within this interval. Within 8 to 60 days after diagnosis of malaria the seropositivity rates were
17.9% for travellers (n=56) and 92.4% for controls (n=92).
Conclusions: Although the sensitivity of malaria serology for retrospective confirmation of malaria is limited,
the results of this analysis strongly suggest that the majority of travellers with a recent history of malaria
diagnosed and treated in endemic countries did not have malaria and that diagnosis of malaria during travel in
endemic areas is frequently incorrect.
P1-04
Trends in Antimalarial Prescriptions in Australia 1992-2007
Leggat, P.A.1
1
James Cook University, Anton Breinl Centre for Public Health and Tropical Medicine, Townsville, QLD,
Australia
Objectives: The aim of this study was to investigate the trends in prescription of antimalarial drugs
recommended for chemoprophylaxis in Australia from 1992-2007.
Methods: In 2010, 16 years of data was extracted from the online Australian Statistics on Medicines reports
published by the Pharmaceutical Benefits Advisory Committee, Drug Utilization Committee, on antimalarials
used in Australia for the period 1992-2007.
Results: Doxycycline probably remains the malaria chemoprophylaxis of choice prescribed for Australians
visiting multiple drug resistant malarious areas. Over the past 16 years, there has been marked drop in the
prescription of less useful antifolate drugs, such as pyrimethamine-containing antimalarial drugs. There has also
been a reduction in the number of prescriptions for chloroquine and proguanil, although the downward trend in
prescriptions of mefloquine appears to have arrested and has remained steady in recent years. The number of
prescriptions for atovaquone and proguanil has been increasing dramatically, particularly since inclusion of this
combination antimalarial in the prevailing Australian guidelines. Artemether plus lumefantrine combination is
now available, but it is used in relatively small quantities.
Conclusions: The prescription of the antimalarials proguanil, chloroquine and the pyrimethamine containing
compounds has been steadily reducing in number. Prescription of mefloquine has remained relatively steady in
recent years. The atovaquone plus proguanil combination has increased dramatically in use. Trends in
antimalarial use may be influenced by a number of factors, including the availability of antimalarials, increasing
resistance, the issuing of updated guidelines for malaria chemoprophylaxis, and continuing education.
_______________________________________________________________________________________ Page 58 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P1-05
Implications from Cardiac Ultrasound and ECG for Cardiac Function in Children with Severe Malaria in
Ghana
Mehrfar, P.1,2, Nguah, S.3, Hoffmann, S.4, Pelletier, D.1, Feldt, T.4, Ehrhardt, S.1, Herr, J.1,2, Burchard, G.D.1,2,
Cramer, J.P.1,2
1
Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany, 2University Medical Center HamburgEppendorf, Hamburg, Germany, 3Komfo Anokye Teaching Hospital, Paediatric Health, Kumasi, Ghana,
4
Kumasi Centre for Collaborative Research, Kumasi, Ghana
Results of recent studies support the involvement of cardiovascular system in severe malaria. However, no
functional data are available yet on the question whether malaria parasites directly or indirectly affect the heart.
Objectives of the study were to investigate whether cardiac output and the electrical conduction system are
affected in children with severe malaria, whether anti-malarial drug-related cardiac toxicity is present, whether
cardiac impairment, if present, is associated with additional clinical symptoms and conditions or the clinical
course of malaria and whether cardiac impairment, if present, is associated with parasitological parameters. To
follow up with our previous pilot study looking at impaired cardiac function among adult patients with
uncomplicated malaria returning from pandemic malaria countries; a study looking at cardiac function among
children with severe malaria in Ghana was conducted. Informed written consents of parent or legal guardian of
eligible children with severe malaria in Ghana were obtained. Vital parameters, clinical parameters, cardiac
enzymes, and cardiac ultrasound parameters were assessed upon admission and at day 42 (±3 days) .
Furthermore, electrocardiography (ECG) to evaluate cardiac cycle (heartbeat) was used. One hundred and twenty
four male and 93 female with the mean age of 41 months ±1.5 (SE) (range: 12-108 months) were recruited.
While we were able to show impaired cardiac output in cases with impaired malaria we intend to analyse this
effect in children with severe malaria. Here we intend to present our first results and discuss potential impact on
severe malaria treatment strategies. The preliminary results looking specifically on ECG results have shown that
in our subjects, Mean (±SD) PR waves is not different within the group, while complex QRS is shorter (61 ± 8.1
vs. 63.3 ± 9.9, p=0.004) in children with severe malaria. Furthermore, QT waves were also significantly shorter
in children admitted at the hospital compared to day 42 (267.3 ± 35.5 vs. 304.0 ± 31.9, p=0.0001). These
preliminary results may suggest the presence of cardiac impairments in children with severe malaria. Further
analysis looking at malaria load and the use of anti-malaria drugs in this population to role out the direct or
indirect impact of malaria on cardiovascular function is required.
P1-06
Current Understanding of the Need to Take Malaria Chemoprophylaxis among Leisure Travellers and
Travel Destinations
Vassalou, E.1, Vassalos, C.M.1, Grigoraki, A.2, Sofos, N.2, Vakalis, N.1
1
National School of Public Health, Department of Parasitology, Entomology and Tropical Diseases, Athens,
Greece, 2Prefectural District of South Athens, Health Department, Athens, Greece
Objective of the study: We studied the understanding of the need to take malaria chemoprophylaxis among
leisure travellers who visited various geographic locations between mid-December 2008 and mid-December
2009.
Methods: Leisure travellers from Athens, Greece for whom antimalarial chemoprophylaxis had been
recommended, were investigated about their current comprehending of malaria chemoprophylaxis and their
travel destination by means of posttravel questionnaires. Statistical analysis was made using Fisher's exact test.
A p value less than 0.05 was considered statistically significant.
Summary of the results: A total of 97 travellers filled out both posttravel questionnaires. Among them, 51
(52.6%) were travellers visiting Sub-Saharan African countries, 30 (30.9%) were returnees from South American
countries where antimalarial chemoprophylaxis is recommended, and 12 (12.4%) were travellers returning from
the tropical regions of the Indian Subcontinent. Four (4.1 %) of 97 travellers visited locations in Southeast Asia
where antimalarial chemoprophylaxis is recommended. Of the 51 leisure travellers to Sub-Saharan Africa, 48
(94.1%) travellers reported that they had started malaria chemoprophylaxis regimens. Of the 30 leisure travellers
to countries in South America, 22 (73.3%) had taken antimalarial chemoprophylaxis. Of the 12 leisure travellers
to the Indian Subcontinent, 11 (91.7%) reported that they had begun malaria chemoprophylaxis. Three (75%) of
the four leisure travellers to Southeast Asia reported that they had completed chemoprophylaxis course. There
was a difference in understanding of the need to take malaria chemoprophylaxis between the leisure travellers
_______________________________________________________________________________________ Page 59 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ visiting South America and the travellers going to other tourist destinations where antimalarial prophylaxis had
been recommended (p=0.036).
Conclusions: In our study, all the travellers had been informed about the need for malaria chemoprophylaxis
before their trip. Leisure travellers visiting South American countries were less likely to be willing to take
malaria chemoprophylaxis regimens, as opposed to those travelling to African and Asian Countries. It currently
seems that understanding of the risk of contracting malaria in South American countries where malaria is present
only in certain popular tourist destinations -part of a multi-destination journey- remains poor. Those who are
travelling to such areas need to be aware of the risk of malaria transmission.
P1-06b
Severe Falciparum Malaria in a Polish Seaman leading to extensive feed and hand necrosis
Wichmann, D.1,2, Kluge, S.2, Burchard, G.D..1
1
Universitätskrankenhaus Hamburg-Eppendorf, Bernhard-Nocht-Klinik für Tropenmedizin;
2
Universitätskrankenhaus Hamburg-Eppendorf, Klinik für Intensivmedizin
The patient was serving as a 1st officer on a cargo vessel operating on the West African coastline from January
to April 2010 with multiple stopovers. With the beginning of the homeward bound he started to complain about
headache, fever and arthralgias, a symptomatic treatment with Paracetamol was initiated by the medical officer
of the ship. Passing the British Channel and entering the North Sea the clinical situation worsened. The patient
was in a progressive state of circulatory depression and altered vigilance. The decision was made to evacuate
him by helicopter. At the primary workup in the emergency department of another hospital it appeared that the
neurological state has progressed to somnolence, but he still was able to communicate in short sentences when
addressed sharply. An antigen test for falciparum malaria was positive and the patient was transferred to the
intensive care unit of our hospital.
On arrival on our intensive care unit the clinical state was characterised by deep coma and circulatory shock.
Laboratory examination showed a high parasitemia of 43%, altered liver function tests but normal kidney
function. Despite prompt treatment with quinine and intrarectal artemesinin the clinical state deteriorated. The
patient was intubated and extensive catecholamine support (noradrenalin 80µg/min plus dobutamine 4µg/min) as
well as fluid replacement (8 liter crystalloids) was necessary to restore septic shock. Renal failure developed and
continuous veno-venous renal replacement therapy was initiated. Disseminated intravascular coagulopathy was
treated with transfusion of packed red cells, thrombocytes, and fresh frozen plasma. IgM enriched
immunoglobulins were given as supportive therapy. Catecholamine free circulatory state could be archived with
in 36h, liver function tests normalised within one week, parasites where cleared within 9 days, but the patient
developed extensive necroses on both feet and the left hand.
P1-06c
Decline in the Efficacy of a 3-day Artesunate-mefloquine Combination in the Treatment of uncomplicated Falciparum Malaria along the Thai-Myanmar Border of Thailand in 2009
Congpuong, K.1, Poolthin, S.1, Satimai, W.1, Pinyorattanachote, A.2, Tunchan, K.3, Cholaphol, S.4,
Chompoonuch, C.5
1
Bureau of Vector Borne Diseases, Ministry of Public Health, Nonthaburi, Thailand, 2Office of Disease
Prevention and Control 11, Nakorn Si Thammarat, Nakron Si Thammarat province, Thailand, 3Vector Borne
Disease Center 9.3, Mae Sot district, Tak province, Thailand ,4Office of Disease Prevention and Control 10,
Chiangmai province, Thailand, 5Office of Disease Prevention and Control 4, Ratchaburi province, Thailand,
Background: The treatment of uncomplicated P. falciparum malaria in Thailand has been modified several
times during the past 30 years to counter the rapid emergence and spread of drug resistance. A two-day
combination of mefloquine and artesunate, MAS2, was first introduced in Thailand in 1995. This regimen was
extended to other provinces following evidence of inadequate clinical cure rates with mefloquine alone and
covered all provinces in 2005. In January, 2008, the country has replaced MAS2 by a 3-day artesunatemefloquine combination (MAS3) to ensure that artesunate covered two parasites asexual life-cycles, thereby
reducing the parasite biomass exposed to mefloquine alone. The cure rates of this regimen in Thai-Myanmar
bordered provinces in 2008 were 96.8-100%. This study reports the efficacy and safety of MAS3 in the treatment
of uncomplicated falciparum malaria in 2009.
Methods: The study was conducted during June to December 2009 in 4 provinces lacated along the ThaiMyanmar border, namely Mae Hong Son and Tak provinces in the northwestern border, Kanchanaburi province
_______________________________________________________________________________________ Page 60 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ in the central-western border and Ranong province in the southwestern border. Uncomplicated falciparum
malaria patients were enrolled. Inclusion, exclusion and study method followed the WHO protocol for
assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria.
Patients received a 3-day artesunate-mefloquine combination and were followed for 42 days.
Results: A total of 199 patients were enrolled in this study. According to the WHO assessment criteria, 9 (4.9%)
LCF and 10 (5.5%) LPF were found in this study. The Kaplan-Meier estimates of the PCR corrected 42-day cure
efficacy rate was 91.1% (95% CI 86.1-94.4) for all four sentinel sites. By individual sentinel sites cure rates were
92.9% [82.1; 97.3] in Kanchanaburi province, 93.1% [75.0; 98.2] in Mae Hong Son province, 88.2% [75.7; 94.5]
in Ranong province and 91.1% [79.9; 96.2] in Tak province. There were no differences (p= 0.768) in survival
distribution among the provinces by the log rank test (Mantel-Cox).
However, its efficacy declined rapidly when compared with the ACPR of 96.8-100% in 2008 in the same area
(BVBD, 2008). Current concerns for the decline in the efficacy of the MAS3 include the increase in parasitaemia
maintained during days 1-3. The proportion of patients with parasitaemia on days 1,2 and 3 were 68, 27 and 16%
compared to 33.8, 7.5 and 0.7% in 2008.
Conclusion: Rapid decline in the efficacy of a 3-day artesunate-mefloquine combination was found along the
Thai-Myanmar border of Thailand after only one year of implementation.
P2-07
Yellow Fever Vaccine Uptake in Private Travel Medicine Clinics in South Africa
Brink, G.K.1
1
The South African Society of Travel Medicine, Johannesburg, South Africa
Background: Yellow fever immunization in South Africa is regulated by the Department of Health according to
the Word Health Organization´s regulations. South Africa has the vector but no disease.
Clinics may administer yellow fever vaccinations once a licence has been obtained from the Department of
Health.
No data are available indicating the number of yellow fever vaccinations given in the private clinic setting in
South Africa.
Method: All members of the South African Society of Travel Medicine were approached to voluntarily submit
data on travellers travelling to destinations considered to be at risk for yellow fever and where yellow fever
vaccination was required by law.
Data was obtained from 44 clinics for the period from 1 January to 30 June 2009. Data recorded included
traveller demographics, yellow fever vaccination or a waiver certificate given, malaria chemoprophylaxis, destination, time to departure and other vaccinations administered.
Results: There were a total of 9876 consultations, of which 8584 consulted for their first vaccination. Waiver
certificates were issued to 344 travellers. 30% (3030) of the travellers were between the ages of 20 - 29, there
were 53 under the age of one year, with another peak between the 40 - 49 year age group of 2176 (22%).
Tanzania was the most popular destination requiring vaccination (18.9%) followed by Kenya (11%). Travel to
Argentina accounted for 1% of travellers requiring vaccination. Malaria chemoprophylaxis was prescribed to
3966(40%) travellers, of which 1142 (28%) received mefloquine, 1433 (26%) doxycycline and 1391 (35%)
atovaquone / proguanil. 3519 (35%) consulted within a five day period prior to departure, 2267 (23%) and 1311
(12%) consulted 7 and 14 days prior to departure, respectively. The reason for travel was obtained for 9675
travellers; business accounted for 5927 (61%) and leisure 3462 (36%) of travellers.Of the additional vaccines
administered, the four vaccinations most commonly given were hepatitis A, typhoid and the quadrivalent
meningitis vaccine.
Discussion: The implications of these findings will be discussed, in particular the time to departure, whether
there was an appropriate risk assessment given the fact that only 40% of travellers were prescribed malaria
chemoprophylaxis and the issuing of waiver certificates.
_______________________________________________________________________________________ Page 61 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P2-08
Typhoid Vaccination Patterns of Travelers from Greece Visiting Developing Countries
Smeti, P.1, Pavli, A.1, Patrinos, S.2, Hadjianastasiou, S.1, Vakali, A.1, Sotiriou, G.3, Saroglou, G.4, Maltezou,
H.C.5
1
Hellenic Centre for Disease Control and Prevention, Travel Medicine Office, Athens, Greece, 2Hellenic Centre
for Disease Control and Prevention, Department of Epidemiological Surveillance and Intervention, Athens,
Greece, 3Health and Welfare Department of Evros, Alexandroupoli, Greece, 4Hellenic Centre for Disease
Control and Prevention, Athens, Greece, 5Hellenic Centre for Disease Control and Prevention, Department for
Interventions in Health Care Facilities, Athens, Greece
Objectives: The aim of the study is to identify patterns of typhoid vaccination of travelers visiting countries in
Asia, Africa and Latin America where typhoid fever is endemic.
Methods: A prospective study was conducted from 01/01/2008 to 31/12/2009 in 57 health departments. Typhoid
vaccine is only available at these departments which are the official travel medicine providers in Greece. Data
were collected using a standardized individual form including demographic characteristics, travel related
information and travel counseling information from travelers seeking pre-travel medical advice.
Results: 3131 travelers traveling to typhoid endemic countries of Asia, Africa and Latin America attended the
health departments during the study period. Typhoid fever vaccine was recommended for 21.2% (664) of them.
27,6% (255) traveled for work, 21.5 % (314) for recreation, and 19.9 % (29) visiting friends and relatives
(VFRs). According to duration of travel 29.4% (919) stayed >1month of whom 30.6% (281) were vaccinated
including 29.8% who stayed 1-3months, 29% who stayed 3-6months, and 34% who stayed >6months. According
to area of travel, 79 stayed in rural areas, 1102 stayed in urban and rural areas, and 1496 stayed in urban areas;
however 27.8%, 25.9%, and 20.3%, were vaccinated respectively.According to place of residence, 78 stayed in
camps, 423 stayed at local people's home, 2106 stayed in hotels and 333 traveled on ships; the percentage of
travelers who received typhoid vaccine was 41%, 34.5%, 19%, and 12% respectively.
Conclusions: Our results show that there is lack of adequate typhoid vaccination for travelers to typhoid fever
endemic countries of Asia, Africa and Latin America. This indicates the need for increasing awareness and
education of travel health professionals with regards to correct recommendations of typhoid vaccine for travelers
seeking pre-travel advice.
P2-09
One Dose of the Meningococcal Tetravalent Conjugate Vaccine (MenACWY-TT) is Immunogenic with an
Acceptable Safety Profile in Unvaccinated Subjects and those Previously Vaccinated with a MenACWY
Polysaccharide Vaccine
Dbaibo, G.1, Van der Wielen, M.2, Reda, M.1, Medlej, F.1, Tabet, C.1, Sumbul, A.2, Anis, S.3, Miller, J.4
1
American University of Beirut, Department of Pediatrics, Beirut, Lebanon, 2GSK Biologicals, Wavre, Belgium,
3
GSK Pharmaceuticals, Dubai, United Arab Emirates, 4GSK Biologicals, King of Prussia, PA, United States
Objectives: Vaccination with successive doses of Neisseria meningitidis tetravalent (A,C,W-135,Y)
polysaccharide vaccine may lead to immunological hyporesponsiveness. In this study, the immunogenicity and
safety of a candidate MenACWY-TT conjugate vaccine (capsular polysaccharides MenACWY conjugated to
tetanus toxoid) were evaluated in subjects vaccinated with a MenACWY polysaccharide vaccine 30-42 months
before receiving MenACWY-TT, and in control subjects with no meningococcal vaccination history in the
preceding 10 years.
Methods: In this phase II study, subjects aged 4.5-34 years, either vaccinated with a polysaccharide vaccine 3042 months previously (MPS) or those who had received no meningococcal vaccination within the previous 10
years (noMPS), received 1 dose of MenACWY-TT. Serum bactericidal (rabbit complement [rSBA], cut-off 1:8
[associated with seroprotection in effectiveness studies]) antibodies were measured pre- and 1 month postvaccination. Adverse events (AEs) were assessed 4 (solicited local/general) and 31 days (unsolicited) postvaccination; serious AEs (SAEs) were reported up to 6 months post-vaccination.
Results: In the ATP cohort for immunogenicity, all subjects reached rSBA titres ≥1:8 for all serogroups 1 month
post-vaccination. Exploratory analyses showed that GMTs for all serogroups were statistically significantly
higher in the noMPS group. In addition, vaccine response rates for all serogroups were significantly higher in the
noMPS group (range 76.9-97.3%) compared with the MPS group (range 41.1-83.0%). The overall incidence of
local and general symptoms (solicited and unsolicited) during the 4-day follow-up was 57.8% (MPS) and 51.9%
(noMPS). Grade 3 (preventing everyday activity) local and general symptoms (solicited and unsolicited) were
_______________________________________________________________________________________ Page 62 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ reported in 11.5% (MPS) and 3.8% (noMPS) of subjects in the 4-day follow-up. One SAE of tendon rupture was
reported (MPS), but considered unrelated to vaccination.
Conclusions: In subjects aged 4.5-34 years not previously vaccinated, MenACWY-TT is preferable to the
polysaccharide vaccine for protection against invasive meningococcal disease, since use of the polysaccharide
vaccine may lead to lower responses upon subsequent vaccination. Furthermore, these data support revaccination
with 1 dose of MenACWY-TT conjugate vaccine following previous vaccination with a meningococcal
polysaccharide vaccine, although titres are lower with more recent polysaccharide vaccination than in naïve
subjects.
P2-10
Immunogenicity and Safety of Japanese Encephalitis Vaccines: A Meta-Analysis
Masuet Aumatell, C.1, Ramon Torrell, J.M.1
1
Hospital Universitari de Bellvitge, International Health Unit, Preventive Medicine Department, L'Hospitalet de
Llobregat, Spain
Objectives: To compare the immunogenicity and safety between two Japanese encephalitis virus (JEV) vaccines
in adults: inactivated Vero-cell derived (IC51) versus inactivated mouse brain derived one (JE-VAX®). IC51
contains aluminium hydroxide without stabilizer (porcine gelatine) nor preservative (thimerosal) unlike JEVAX®, so it is likely to result in fewer adverse events.
Methods: We searched Embase, Medline, the Cochrane Controlled Clinical Trial, and other online databases to
February 2010, in any language for randomised trials comparing different JEV vaccines in healthy adults.
Primary outcomes were the seroconversion rate (SCR), defined as Plaque Reduction Neutralization Tests
(PRNT) titer of ≥1:10, and the Geometric mean titer (GMT) at Day 56. Secondary outcomes were adverse
events.
The meta-analysis was performed using fixed model (Mantel-Haenszel or Variance inverse depending on the
outcome) and the statistical heterogeneity was quantified by use of the I2metric.
Results: We included 3 trials, which assessed IC51 (6 µg, im; 0-28 days) and JE-VAX (1.0 mL, sc; 0-7-28
days).The pooled IC51 SCR was 97.87% and 94.84% with JE-VAX (relative risk 1.03, 1.00-1.05; I2 41%). The
GMT weighted mean difference was 198.85 IC51 vs JE-VAX® (95%CI: 151.31-246.39; I2 77%). The overall
adverse events following immunisation was not statistically different between two vaccines (relative risk 1.05,
0.99-1.11), neither systemic events (relative risk 1.05, 0.99-1.11), but IC51 presents fewer local adverse events
than JE-VAX® (relative risk 0.22, 0.17-0.29).
Conclusion: IC51 shows “non-inferiority” to JE-VAX®, an excellent safety profile presenting local tolerability
favourable to JE-VAX® and a similar systemic tolerability profile. Nevertheless more large-scale
studies are needed to verify the high safety of IC51.
P2-11
Enzyme Immunoassay Detection of Immunoglobulin M and G Antibodies to Cryptosporidium in
Immunocompetent & Immunocompromised Perssons
Dorostkar Moghaddam, D.1, Eyni, H.2
1
School of Medicine, Isfahan University of Medical Sciences, Parasitology, Isfahan, Islamic Republic of Iran,
2
Sajad Medical Lab, Medical Lab, Najaf Abad, Islamic Republic of Iran.
Objectives: Cryptosporidium is an apicomlexan enteric parasite which causes cryptosporidiosis in human and
animals worldwide. Although cryptosporidiosis is a self-limited diarrheal disease in immunocompetent persons,it
is severe and life-threatening in immunocompromised persons.We developed a sensitive and reproducible
enzayme immunoassay foe detection of serum IgG or IgM to cryptosporidium.
Methods: Serum specimens were obtained from immunocometent, immunocompromised and risk factor persons
in Isfahan regions and then investigated by ELISA method.
Results: For IgG, 13 of patients with cryptosporidiosis and 26 of 26 patients with cryptosporidisis and AIDS
were positive, whereas 57 of 60 presumably uninfected individuals were negative.All three IgG- positive
presumably uninfected individuals had been potentially exposed. Sensitvity and specificity of this assay was
95%.
Patients without AIDS showed an early rise and fall of IgM and later elevation of IgG,
Some patients with AIDS showed produced IgM, and all produced IgG.
_______________________________________________________________________________________ Page 63 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Sera from 9(20.9%) of 44 isfahan children with diarrhea were positive for both IgM and IgG antibodies,106 sera
from persons with other parasitic illness showed a normal distribution for IgG antibody.
Conclusion: These ELISA data show that patients without and with AIDS have serum antibody response to
Cryptosporidium and suggest that exposure to or infection with Cryptosporidium is common.
P2-12
Pertussis Vaccination of Adult Travellers: Awareness and Practicality
Van Damme, P.1, Theeten, H.1, Booy, R.2, Van Der Meeren, O.3, Chatterjee, N.3, Jacquet, J.-M.3, Mertsola, J.4
1
University of Antwerp, Wilrijk, Belgium, 2National Centre for Immunisation Research and Surveillance
(NCIRS), The Children's Hospital, Westmead, NSW, Australia, 3GlaxoSmithKline Biologicals (GSK), Wavre,
Belgium, 4University of Turku, Department of Pediatrics, Turku, Finland
Despite effective infant immunisation against pertussis, the incidence of this vaccine-preventable disease is
increasing in adults and adolescents due to waning immunity. Although pertussis infections in adults are
frequently mild, complications such as sinusitis, otitis media and pneumonia are seen in about 25% of adult
cases. There also exists a serious risk of transmitting the disease to infants too young to be fully vaccinated.
Therefore, vaccination of adults against pertussis is increasingly recommended in industrialized countries,1 but is
limited by low awareness of the disease and limited opportunities to administer the vaccine to adults.
Awareness of the pertussis vaccine is currently variable amongst physicians2 and low amongst general
populations such as travellers.3 Nevertheless, replacement of diphtheria-tetanus (dT) vaccine with a reduced
antigen-content diphtheria-tetanus-acellular pertussis (dTpa) vaccine provides an opportunity to vaccinate adults
against pertussis and has been evaluated in a number of settings.
For adults who were not vaccinated in infancy, a primary course of dTpa or dTpa-IPV has been shown to be
immunogenic and well tolerated.4 In the emergency room setting, booster doses of dTpa have been found to be
effective and well tolerated in subjects who previously received primary vaccination against tetanus (>10 years
earlier).5 More recently, repeat administration of a dTpa booster after a 10 year interval has been shown to
induce vigorous immune responses and to be well tolerated in adults, supporting the use of dTpa as a decennial
booster to tackle pertussis.6,7
Conclusions: In addition to raising awareness about pertussis and its prevention, maximizing vaccination
opportunities will be essential for improving vaccination coverage against pertussis. Adult travellers are
important targets for pertussis vaccination offering an administration opportunity concomitantly with other travel
vaccines.
References:
1
Zepp F et al. ESPID, Brussels, Belgium, 9-13 June 2009
2
Hoffait M et al. ESPID, Brussels, Belgium, 9-13 June 2009
3
Wilder-Smith A et al. J Travel Med 2007;14:145-50
4
Van Damme P et al. Curr Med Res Opin 2007;23:2729-39
5
Hoel T et al. Eur J Emerg Med 2006;13:67-71
6
Mertsola J et al. WSPID, Buenos Aires, Argentina, 19-22 November 2009
7
Booy R et al. IDSA, Philadelphia, USA, 29 October-1 November 2009
P2-13
Consensus on Pertussis Booster Vaccination in Europe (C.O.P.E.)
Zepp, F.1, Bernatowska, E.2, Guiso, N.3, Heininger, U.4, Mertsola, J.5, Roord, J.6, Tozzi, A.7
1
Department of Pediatrics and Adolescent Medicine, University Medical Center, Mainz, Germany, 2Department
of Immunology, The Children's Memorial Health Institute, Warsaw, Poland, 3Institut Pasteur, Paris, France,
4
Division of Pediatric Infectious Diseases and Vaccines, University Children's Hospital, Basel, Switzerland,
5
Department of Pediatrics, University of Turku, Turku, Finland, 6Free University Medical Center, Amsterdam,
Netherlands, 7Bambino Gesu' Hospital, U.O Epidemiologia, Rome, Italy
Introduction: Introduction of universal infant immunisation against pertussis has dramatically reduced the
number of reported cases in infants and children. However, natural- as well as vaccine-acquired immunity wanes
over time resulting in older individuals becoming susceptible to infection again. Consequently, over recent years
pertussis has been increasingly seen amongst adolescents and adults. This results in direct morbidity in these age
groups in addition to posing a risk of transmitting B. pertussis to vulnerable non-immune infants.
_______________________________________________________________________________________ Page 64 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Methods: A panel of European experts recently reviewed the need for pertussis booster vaccinations in
adolescents and adults.
Results: The panel proposed the following recommendations for consideration.
 Adolescents (10-17 years) should receive a single dose of combined reduced-antigen-content
diphtheria-tetanus-acellular pertussis (dTpa) vaccine instead of dT, irrespective of a complete primary
vaccination schedule.
 Adolescents even with a clinical history of pertussis should receive dTpa according to routine
recommendations.
 Adults (≥18 years) should receive a single dTpa dose instead of dT for active booster vaccination if
their last dT dose was ≥10 years earlier, irrespective of disease history.
 The cocoon strategy (vaccinating close contacts of newborns with dTpa, e.g. parents, grandparents,
childcare and healthcare providers) should continue until immunisation coverage in adults is sufficient
for herd protection.
The need for improved surveillance with standardised biological diagnoses, health economic analyses and
education to raise disease awareness and capitalise on the opportunities to administer booster vaccinations was
emphasised.
Conclusions: Control of B. pertussis circulation is crucial, particularly for the prevention of severe
complications in very young non-immune infants and will require regular boosters for the whole population. As
an initial step, practical recommendations for booster vaccination of adolescents and adults in Europe have been
proposed. While implementation of these recommendations is likely to increase protection of the population as a
whole, accessing adolescents and adults to provide booster vaccinations is often challenging. Therefore any
opportunity to provide dTpa boosters in tandem with other vaccinations (e.g. individuals seeking travel
vaccination) should be considered.
P2-14
Survey on the Tetanus Vaccination in Case of Wounded Patients in an Emergency Unit. Usefulness of the
Tetanos Quick Stick
Bourée, P.1, Bisaro, F.2, Rouh-Neau, S.3
1
Bicetre Hospital, Paris XI University, Parasitology Unit, Kremlin-Bicetre, France, 2Paris VII University, UFR
Science of Life, Paris, France, 3Paris XI University, Parasitology Unit, Kremlin-Bicetre, France
Background: There is inadequate adult vaccination coverage against tetanus in France, and some 20 to 30 cases
of tetanus cases are reported each year. The treatment of wounds is the main prevention of the disease. The
recommendations of the French Health Department are based on the patient's vaccination status and the tetanusprone of the wounds. A treatment protocol for tetanus-prone wounds is proposed with objective criterias which
include the use of Tetanus Quick Stick to increase the tetanus immunization coverage in the population.
Methods: A prospective study was performed in the adult emergency unit of an hospital, near Paris, among
patients who came for wounds or cutaneous-mucous injuries, with regards to their vaccination status and they
received tetanus prophylaxis.
Results: 415 patients were included in the study (258 males and 93 females, from 18 to 70 years old). Among
these patients 64% reported being immunized against tetanus (booster< 10 years), but 17% ignored their vaccine
status. The tetanus prophylaxis respected the recommendations in 75% of cases. There was a lack of
prophylactic cover tetanus protection for 21% of cases, an excess for 4% of them. Treatment errors concerned
48% patients because of delayed vaccination and 38% because of tetanus-prone wounds. Only half of the
patients who needed immunoglobulins received them. The sensitivity of the Tetanus Quick Stick (TQS) was
85,3% and specificity was 87,2%. According to the query concerning the tetanus immunization, sensitivity was
60,3% and specificity was 73,3%. With the use of TQS, 56,9% of useless vaccination were avoided.
Conclusions: In France, tetanus immunization after a wound is inappropriate in 25% of cases. From a medical
and economical point of view, an algorithm including the Tetanus Quick Stick and objective criterias of
assessment of tetanus-prone wounds would be useful. The patient's tetanus vaccination coverage is insufficient
and its increase is necessary.
_______________________________________________________________________________________ Page 65 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P2-15
Evaluation of Hepatitis B Immune-Response in Elderly, Obese or Medically Compromised Subjects after
Vaccination with HAB Combination or Monovalent Hepatitis B Vaccines
Chlibek, R.1, von Sonnenburg, F.2, Van Damme, P.3, Smetana, J.1, Tichy, P.4, Gunapalaiah, B.B.5, Knoblach, B.6,
Jacquet, J.-M.7
1
University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic, 2University of
Munich, Department of Infectious Diseases and Tropical Medicine, Munich, Germany, 3Vaccine & Infectious
Disease Institute, Centre for the Evaluation of Vaccination (WHO Collaborating Centre), Antwerp, Belgium,
4
GlaxoSmithKline (GSK) Biologicals, Prague, Czech Republic, 5GSK Pharmaceuticals Ltd., Bangalore, India,
6
GlaxoSmithKline GmbH & Co. KG, Munich, Germany, 7GSK Biologicals, Wavre, Belgium
Objectives: Studies have shown reduced immune responses to hepatitis B vaccination among subjects who are
elderly, overweight or who have medical conditions. This study assessed the 4-year persistence of anti-HBs
antibodies and of immunological memory to hepatitis B in subjects aged ≥41 years with these conditions who
had received either a combined hepatitis A and B (HAB) vaccine or one of two monovalent hepatitis B (HBV)
vaccines.
Methods: In the open-label, multi-country, primary study, 596 subjects aged ≥41-years were randomised into
three groups and received either a combined HAB vaccine (Twinrix™, GlaxoSmithKline Biologicals) at 0, 1 and
6 months, or one of two different monovalent HBV vaccines (Engerix-B™, GlaxoSmithKline Biologicals, or
HBVAXPRO™, Merck & Co, NJ) given at 0, 1 and 6 months together with a HAV vaccine (at 0 and 6 months).
Randomisation was stratified by age, body mass index (BMI) and the presence of medical conditions. Subjects
were followed up until 4 years after vaccination, when they received an additional dose of the same vaccine(s).
Blood samples for determining antibody concentrations were collected yearly and then immediately before, 2
weeks and 1 month after the challenge dose, and anti-HBs geometric mean concentrations (GMCs) were
calculated (NCT00603252, NCT00684671).
Results: In subjects who were elderly (≥61 years at primary vaccination), had high BMI (≥30 kg/m2), or who
had an ongoing medical condition at the time of sampling, the percentage of subjects with seroprotective antiHBs concentrations (≥10 mIU/ml) 4 years after vaccination was highest in those given the combination HAB
vaccine (40.0, 33.3 and 52.2%, respectively), lower in those given Engerix-B™ (32.7, 31.7 and 39.8%,
respectively) and lowest in those given HBVAXPRO™ (20.0, 16.7 and 31.5%, respectively). One month after the
challenge HBV dose, the percentage of elderly subjects who mounted anti-HBs antibody concentrations ≥10
mIU/ml was highest in subjects given the combination HAB vaccine (91.1%), lower in subjects given EngerixB™ (89.1%) and lowest in the HBVAXPRO™ receiving group (76.4%).
Conclusions: In subjects who were elderly, obese or had ongoing medical conditions, the combined HAB
vaccine provided consistently greater anti-HBs response than either of the other monovalent vaccines examined,
4 years after primary vaccination.
Engerix-B and Twinrix are trademarks of the GlaxoSmithKline group of companies; HBVAXPRO is a
trademark of Merck & Co
P2-16
The Candidate Meningococcal Serogroups A, C, W-135, Y Conjugate Vaccine (MenACWY-TT) Coadministered with a Combined Hepatitis A and B Vaccine (HepA/B) Is Immunogenic and Well-tolerated
in Subjects Aged 11-17 Years
Østergaard, L.1, Silfverdal, S.A.2, Schade Larsen, C.1, Bianco, V.3, Baine, Y.4, Miller, J.4
1
Department of Infectious Diseases, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark, 2Pediatrics,
Department of Clinical Sciences, Umeå University, Umeå, Sweden, 3GSK Biologicals, Wavre, Belgium, 4GSK
Biologicals, King of Prussia, PA, United States
Objectives: To assess the immunogenicity and safety of a candidate MenACWY-TT conjugate vaccine coadministered with a combined HepA/B vaccine, compared with either vaccine alone in subjects aged 11-17
years.
Methods: Subjects were randomised 3:1:1 to receive: MenACWY-TT (Month 0)+HepA/B (Months 0,1,6)
[Coad]; MenACWY-TT alone (Month 0) [ACWY-TT]; or HepA/B alone (Months 0,1,6) [HepA/B].
Immunogenicity to meningococcal serogroups A, C, W-135 and Y serum bactericidal antibody (rSBA; cut-offs
1:8 and 1:128) was measured at Months 1 and 7; non-inferiority (Coad/ACWY-TT) was based on geometric
_______________________________________________________________________________________ Page 66 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ mean titre (GMT) ratios for each serogroup (LL of 95%CI ≥0.5). Immunogenicity to HepA/B was measured at
Month 7; non-inferiority (Coad minus HepA/B) was based on group difference in seroconversion (SC) (antihepA virus [anti-HAV] antibody ≥15 mIU/mL in initially seronegative subjects) or seroprotection rates (SP)
(anti-hepB surface antigen [anti-HBs] antibody ≥10 mIU/mL) subjects (LL of the standardised asymptomatic
95%CI ≥-10%). Adverse events (AEs) were assessed 4 (solicited local/general AEs) and 31 days (unsolicited
AEs) post-vaccination; serious AEs (SAEs) were reported up to 6 months post-vaccination; AEs that prevented
normal everyday activity/solicited local redness and swelling >50 mm/fever >39.5°C were recorded as Grade 3.
Results: 611 subjects were vaccinated (Coad, n=367; ACWY-TT, n=122; HepA/B, n=122). At Month 1, 98.3100% of subjects in Coad and ACWY-TT groups had rSBA titres ≥1:128 for all serogroups; titres remained high
at Month 7 (95.2-100%); LL of 95% CI of adjusted rSBA GMT ratio (Coad/ACWY-TT) were 0.7-0.9 for all
serogroups. At Month 7, ≥99.1% of subjects in the Coad and HepA/B groups were seroconverted or
seroprotected for Hep A and B, respectively; LL of 95% CI for group differences were >-10% (-1.2 and -2.6,
respectively). Grade 3 local and general symptoms (solicted and unsolicited) were reported by ≤9.5% in any
group during the 4 day follow-up of any dose. 5 subjects reported SAEs during the 7 month period (Coad n=4;
HepA/B n=1); 1 subject (Coad) reported concussion and syncope 8 days post-dose 1, which were considered
related to vaccination.
Conclusions: The immunogenicity of co-administration of MenACWY-TT and HepA/B was non-inferior to
either vaccine alone and both vaccines were well-tolerated. These data support the co-administration of
MenACWY-TT and HepA/B vaccine in areas endemic for meningococcal, and hepatitis A and B virus disease.
P2-17
The Candidate Meningococcal Serogroups A, C, W-135, Y Tetanus Toxoid Conjugate Vaccine
(MenACWY-TT) and the Seasonal Influenza Virus Vaccine Are Immunogenic and Well-tolerated when
Co-administered in Adults
Macalalad, N.1, Aplasca-De Los Reyes, M.R.2, Dimaano, E.3, Dbaibo, G.4, Bianco, V.5, Baine, Y.6, Miller, J.6
1
De La Salle University Medical Center (Department of Medicine), Cavite, Philippines, 2Research Institute for
Tropical Medicine (Medical Department), Alabang, Muntinlupa City, Philippines, 3San Lazaro Hospital, Manila,
Philippines, 4American University of Beirut (Department of Pediatrics and Adolescent Medicine), Beirut,
Lebanon, 5GSK Biologicals, Wavre, Belgium, 6GSK Biologicals, King of Prussia, PA, United States
Objectives: To demonstrate the non-inferiority of the candidate MenACWY-TT (ACWY-TT) vaccine when coadministered with a trivalent seasonal influenza virus vaccine, compared with ACWY-TT alone, in terms of
serum bactericidal antibodies (rSBA) to meningococcal serogroups A, C, W-135 and Y, and the immunogenicity
of ACWY-TT + influenza vaccine in terms of humoral immune response to influenza antigens.
Methods: In this Phase III multicentre study, subjects aged 18-55 years were randomised (3:1:1) to receive
ACWY-TT alone or with influenza vaccine (Coad [enrolled in the Philippines]), or licensed meningococcal
tetravalent polysaccharide vaccine (MenPS) alone. Antibodies were measured pre- and 1 month postvaccination; non-inferiority was pre-specified as rSBA GMT ratio (ACWY-TT/Coad) 95% CI upper limit (UL)
< 2.0. Humoral immune response (anti-haemagglutinin) to influenza antigens (A/H1N1, A/H3N2, B) was
assessed using criteria defined by the CHMP for adults 18-55 years old. Adverse events [AEs] were assessed
through 4 (solicited symptoms) and 31 days (unsolicited symptoms) post-vaccination; AEs preventing normal
everyday activity were recorded as Grade 3. Serious AEs [SAEs] were reported up to 6 months after vaccination.
Results: 520 subjects were vaccinated (ACWY-TT, N=311; Coad, N=105; MenPS, N=104). Coad was noninferior to ACWY-TT with regards to serogroups A, W-135 and Y, with ULs of the 95% CI on the GMT ratios <
2.0 (1.8, 1.7 and 1.7, respectively); for serogroup C the UL was marginally exceeded (2.03). Overall, >97% of
subjects in all vaccine groups achieved rSBA titres >1:128 for all serogroups. The Coad group met all criteria set
out by CHMP for all three influenza antibodies; lower limits of the 95% CIs were >70% for seroprotection rate,
>40% for seroconversion rate and >2.5 for seroconversion factor. Grade 3 solicited local/general symptoms were
reported by ≤1.9 of subjects in any group. SAEs were reported by 4 subjects (ACWY-TT); all resolved without
sequelae. One subject (ACWY-TT) reported an SAE of abdominal pain and gastritis, considered vaccine-related.
Conclusions: MenACWY-TT co-administered with seasonal influenza vaccine induced immunity to
meningococcal serogroups A, C, W-135 and Y with an acceptable immune response to influenza vaccine, and
was generally well tolerated. These data support the co-administration of these vaccines for combined
vaccination against meningococcal disease and seasonal influenza.
_______________________________________________________________________________________ Page 67 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P2-18
The Immunogenicity of the Candidate Meningococcal Serogroups A, C, W-135, Y Tetanus Toxoid
Conjugate Vaccine (MenACWY-TT) is Non-inferior to the Licensed Meningococcal Tetravalent
Polysaccharide Vaccine and has an Acceptable Safety Profile in Adults
Dbaibo, G.1, Macalalad, N.2, Aplasca-De Los Reyes, M.R.3, Dimaano, E.4, Bianco, V.5, Baine, Y.6, Miller, J.6
1
American University of Beirut (Department of Pediatrics and Adolescent Medicine), Beirut, Lebanon, 2De La
Salle University Medical Center (Department of Medicine), Cavite, Philippines, 3Research Institute for Tropical
Medicine, Alabang, Muntinlupa City, Philippines, 4San Lazaro Hospital, Manila, Philippines, 5GSK Biologicals,
Wavre, Belgium, 6GSK Biologicals, King of Prussia, PA, United States
Objectives: To compare the immunogenicity and safety of the candidate meningococcal tetravalent tetanus
toxoid-conjugate vaccine, MenACWY-TT (ACWY-TT), with the licensed meningococcal tetravalent
polysaccharide vaccine (MenPS) in healthy adults.
Methods: In this Phase III, multicentre study, subjects aged 18-55 years were randomised 3:1 to receive
ACWY-TT or MenPS. Serum bactericidal antibodies (rSBA) were measured pre- and 1 month post-vaccination;
non-inferiority was pre-specified as a 95% CI lower limit (LL) ≥10% for the group difference (ACWY-TT
minus MenPS) in the percentage of subjects with a vaccine response (rSBA titre ≥1:32 for initially Serosubjects, and ≥4-fold increase over pre-vaccination for initially Sero+ subjects). Adverse events (AEs) were
assessed through 4 (solicited symptoms) and 31 days (unsolicited symptoms) post-vaccination; AEs preventing
normal everyday activity, fever >39.5°C and redness/swelling >50mm were recorded as Grade 3. Serious AEs
(SAEs) were reported up to 6 months after vaccination.
Results: 1247 subjects were vaccinated (ACWY-TT, N=935; MenPS, N=312). The percentages of subjects with
rSBA vaccine response to ACWY-TT vs MenPS were 80.1% vs 69.8% (A), 91.5% vs 92.0% (C), 90.2% vs
85.5% (W-135) and 87.0% vs 78.8% (Y); the 95% CI LL for the group difference (ACWY-TT minus MenPS)
was 4.1, -3.9, 0.5 and 3.2 for serogroups A, C, W-135, Y, respectively. For serogroups A, W-135 and Y, vaccine
response rates and GMTs were significantly higher for ACWY-TT vs MenPS. Overall, ≥98.9% of ACWY-TT
subjects and ≥98.0% of MenPS subjects had rSBA titres ≥1:128 for all serogroups. For both groups, injection
site pain (19.4% vs 13.5%) and headache (16.3% vs 14.2%) were the most frequently reported solicited local and
general AEs, respectively; Grade 3 solicited local/general AEs were reported in ≤1.6% of subjects in any
vaccination group. SAEs were reported in 8 subjects (ACWY-TT, n=7 [0.7%]; MenPS, n=1 [0.3%]); all resolved
without sequelae. One subject (ACWY-TT) reported an SAE of abdominal pain and gastritis, considered
vaccine-related.
Conclusions: The immunogenicity of the candidate MenACWY-TT vaccine was non-inferior to MenPS vaccine
in healthy adults, inducing immunity against all serogroups, with significantly higher vaccine response rates to
serogroups A, W-135 and Y and an acceptable safety profile. These data suggest that MenACWY-TT conjugate
vaccine may be used for protection against invasive meningococcal disease.
P2-19
The Importance of HBsAg Titer Control after HBV Vaccination in Healthy Firefighters; Implications for
the Traveller?
Kalule, J.W.1, Haverkort, M.E.1, de Jonge, M.E.1, Wetsteijn, J.C.1, Vlug, J.1, Lede, I.O.1, de Jong, E.1, van Vugt,
M.1
1
Academish Medisch Centrum, Amsterdam, Netherlands
Objective: To evaluate the aHBsAg titer in healthy fire brigade personnel after a series of 3 Hepatitis B virus
(HBV) or combined Hepatitis A and B virus vaccinations.
Background: In the Netherlands the National Health Council has advised against vaccination of, amongst
others, police and fire department personnel because of a non-elevated prevalence of HBV infection in this
population. HBV vaccination therefore is voluntary, not free of charge and aHBsAg titer evaluation is not
routinely performed.
Methods: From February 2006 until present 436 firefighters were invited for vaccination at reduced prices with
Engerix-B® (20 µg im) or HBVAXPRO (10 µg im) (both HBV vaccines) or Twinrix® (20 µg im; combined
HAV and HBV vaccine) at 0, 1 and 6 months. The aHBsAg titer was measured voluntary and not free of charge
at week 4 after the third vaccination. An aHBsAg titer ≥ 10 IE/L was considered protective in this group.
Results: We excluded 259 persons from evaluation (n= 28 did not respond to the invitation, n= 75 are still under
evaluation, n= 27 were already adequately vaccinated, n= 49 did not complete the vaccination series and of n=
_______________________________________________________________________________________ Page 68 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ 80 we had no post-vaccination aHBsAg titer available). N= 177 completed the vaccination series and had an
aHBsAg titer measured; men 98.3 %, women 1.7 %. There were 163 responders (94.6 %), men 98.2%, mean age
38.8 years (range 21-59 years) and 14 non-responders (5.4 %), all male, mean age 39.2 years (median 39.5 years;
range 26-54 years).
Conclusion: In this large group of healthy persons there was only a low percentage of non-responders to HBV
vaccination present, with a wide range over the age groups, corresponding to results in literature. In high risk
travellers HBV post-vaccination serology should be performed, for all other travellers the costs of aHBsAg titer
measurement and subsequent revaccination will not outweigh the risk of acquiring an HBV infection.
P2-20
The Total Number of TBE-vaccine Doses is Important for Serological Response after Delayed Booster?
Askling, H.H.1, Lindqvist, L.1, Rombo, L.2, Rydgård, C.1, Vene, S.3
1
Karolinska Institutet and Karolinska University Hospital, Dept of Infectious Diseases, Stockholm, Sweden,
2
Centre for Clinical Research Sormland County Council, Eskilstuna, Sweden, 3Swedish Institute for Infectious
Diseases Control, Stockholm, Sweden
Objective of the study: Approximately 3000 cases of tick borne encephalitis (TBE) are reported in Europe
every year and the number of cases in all endemic regions has increased by almost 400% in the last 30 years.
The incidence is also increasing in Sweden despite even higher number of distributed doses of vaccine. TBEinfections have been seen in previously vaccinated patients. There is not sufficient knowledge of the antibody
response when doses are delayed. The aim of this study was to investigate the serological effect of delayed
booster compared to a normal booster interval.
Method and material: The study population consisted of 268 previously immunized adult individuals who
attended a vaccination clinic for a booster with TBE-vaccine (0.5 ml of im FSME-Immun, Baxter) in Stockholm,
Sweden, 2007-2009. The median age was 37 (range 21-80 years) and 163 (61%) were males. A normal interval
was defined as three doses within one year (0, 1, 5-12 months) followed by one dose after three years and
subsequent doses every fifth year. A delayed interval was defined as > 1 year after two doses, > 3 years after
three doses or > 6 years after ≥ 4 doses. A very delayed interval was defined as > 2 years after two doses and ≥
10 years after ≥ 3 doses. Antibodies were measured with a rapid fluorescent focus inhibition test for detection of
neutralizing antibodies to TBE virus.
Results: No participants with only 2 doses presented themselves within the normal (N) time interval. 3/3 with
delayed interval (D) had antibodies while only 39/91 with very delayed interval (VD) had titers. 49/52 without
titers in the VD group were young men who had been immunized during military service more than 10 years
ago.
The corresponding figures after 3 doses were 25/33 (N). 8 of them were males with a median age 64 years),
49/50 (D) and 15/15 (VD).
After at least 4 doses, antibodies were present in 56/57 (N), 15/15 (D) and 4/4 (VD)
Conclusion: The interval can be too long, even in young individuals, if the first three doses of TBE-doses have
not been given. Our results support the praxis to extend the booster interval to five years after the fourth dose.
We postulate that the total number of TBE-vaccine doses is important for serological response after delayed
booster. The final presentation at the NECTM 3 will include results from 60 additional individuals.
P2-21
Cross-protection Induced by the Ty21a Vaccine (Vivotif®) Against Paratyphoid A & B Fever
Erlanger, T.E.1, Herzog, C.1
1
Crucell, Medical Affairs, Bern, Switzerland
Enteric fever is caused by Salmonella enterica serovar Typhi (S. typhi) and Paratyphi A, B and rarely C (S.
paratyphi A, B or C). Globally, S. typhi causes 17 million illnesses and 200,000 - 600,000 deaths annually. S.
paratyphi is estimated to cause an additional 5.4 million illnesses annually. These estimates are based on
approximately 1 case of paratyphoid fever for every 3 cases of typhoid fever. However, these figures may no
longer be accurate as evidence shows that paratyphoid fever is becoming more widespread.
No vaccine is currently available for the primary indication of preventing S. paratyphi A & B. However, there is
evidence that the oral live attenuated Ty21a vaccine (Vivotif®) confers protection against paratyphoid fever A
and B. The basis for this protection is that Ty21a has the O12 surface antigen which is also produced by both S.
typhi and S. paratyphi A and B. Antibodies to O12 are likely to drive T-cell mediated cross-protection against
_______________________________________________________________________________________ Page 69 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ paratyphoid fever. Vaccines based on the Vi antigen, which is present only in S. typhi and S. paratyphi C, do not
confer cross-protection against S. paratyphi A or B.
There is evidence for cross-protection conferred by Ty21a from epidemiological, clinical and in vitro studies.
(i) The incidence of paratyphoid A fever in travelers to Nepal who were vaccinated either with Ty21a or a
parenteral vaccine was compared. Outcomes suggest that Ty21a might provide protection against S. paratyphi A.
(ii) A retrospective observational study in Israeli travelers who were vaccinated with either the Vi or Ty21a
vaccine showed that Ty21a offered 67% protection against paratyphoid A fever.
(iii) A re-analysis of pooled data of two large-scale clinical field trials with Ty21a in Chile showed a protective
efficacy of 49% against S. paratyphi B infections.
(iv) Peripheral blood mononuclear cells from volunteers vaccinated with Ty21a showed specific cell-mediated in
vitro antibacterial activity against S. paratyphi A & B.
P2-22
IgA Subclass Distribution and Homing Properties of Specific Circulating Plasmablasts Elicited by Oral or
Parenteral Salmonella Typhi Ty21a Vaccines
Pakkanen, S.H.1,2, Kantele, J.M.3, Häkkinen, M.1, Kantele, A.1,2
1
University of Helsinki, Haartman Institute, Department of Bacteriology and Immunology, Helsinki, Finland,
2
Helsinki University Central Hospital, Department of Medicine, Division of Infectious Diseases, Helsinki,
Finland, 3University of Turku, Department of Medical Microbiology and Immunology, Turku, Finland
Objectives: Typhoid fever remains a major global health problem in the world, with 17 million cases and
200 000-600 000 deaths annually. The disease is caused by Salmonella serovar Typhi (S. typhi). Intestinal IgA is
regarded to represent the first immunological defence line against the disease. IgA has two subclasses, IgA1 and
IgA2, and some pathogenic bacteria are known to produce IgA1-proteases able to degrade IgA1. We studied the
IgA subclass distribution of the immune response elicited by oral and parenteral vaccination by exploring
circulating S. typhi-specific IgA1- and IgA2-plasmablasts after oral and parenteral Ty21a vaccination. In
addition to the subclass distribution, the homing properties of typhoid specific IgA-plasmablasts were examined.
Methods: 12 volunteers were given typhoid vaccine orally and 7 parenterally. The oral vaccine was live
attenuated S. typhi Ty21a (Vivotif®) and the parenteral vaccine was a killed vaccine prepared from the same
strain. Peripheral blood mononuclear cells (PBMC) were collected before and 7 days after vaccination. PBMC
were sorted by their expression of homing receptors a4b7, L-selectin and CLA with immunomagnetic cell
sorting. S. typhi -specific IgA1, IgA2 and IgA-plasmablasts were enumerated with ELISPOT.
Results: 7 days after vaccination S. typhi -specific IgA-ASC were found in the circulation of all vaccinees. After
oral vaccination 84 ± 59 and after parenteral 24 ± 6 S. typhi specific IgA-ASC/million PBMC were found. After
oral 74 % and after parenteral 64% of them were IgA1-ASC. After oral Ty21a vaccination all antigen-specific
ASC expressed a4b7, the gut homing receptor (HR), and only a small part expressed L-selectin, the peripheral
lymph node HR and CLA, the skin HR. After parenteral vaccination, the majority of all S. typhi -specific ASC
expressed L-selectin and only half expressed a4b7 and a small part CLA. The homing profiles of IgA1- and
IgA2-ASC were similar.
Conclusions: The immunization route does not influence the IgA subclass distribution of S. typhi -specific
immune response, but it influences the targeting of the response: Oral vaccine brings about an intestinal homing
profile and parenteral vaccine a systemic homing profile. These results provide further evidence that oral
vaccination results in a better intestinal immune response than parenteral vaccination. The IgA subclass
distribution, by contrast, can't be influenced by the choice of immunization route.
P2-22a
Long-term Antibody Persistence Observed 15 Years after Vaccination with an Aluminium Adsorbed
Hepatitis A Vaccine
van Herck, K.1, Panis, T.1, Gunapalaiah, P.2, Macura-Biegun, A.3, Jacquet, J.-M.3, Van Damme, P.1
1
Centre for the Evaluation of Vaccination (WHO Collaborating Centre), Vaccine & Infectious Disease Institute,
University of Antwerp, Antwerp, Belgium, 2GlaxoSmithKline Pharmaceuticals Ltd., India, 3GlaxoSmithKline
Biologicals, Wavre, Belgium
Objectives: Two studies (NCT00291876 and NCT00289757) evaluated the long-term persistence of antibodies
and immune memory observed in adults over 15 years following primary immunisation with two doses of
inactivated hepatitis A vaccine given either 6 or 12 months apart
_______________________________________________________________________________________ Page 70 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Methods: In 1992, 119 subjects aged 18 to 40 years and 194 subjects aged 21–40 years, all of whom were naïve
for hepatitis A virus (HAV), were enrolled in two studies to receive 1440 EL.U of inactivated hepatitis A
vaccine (Havrix, GlaxoSmithKline Biologicals) according to a 0, 6 or 0, 12 month vaccination schedule.
Serum samples were taken 1 month after the second vaccine dose and every consecutive year up to 15 years after
primary vaccination to measure concentrations of persisting anti-HAV antibodies. At the 15 year time-point an
additional dose of HAV vaccine was administered to subjects who had become seronegative for anti-HAV
antibodies. The antibody response to this additional dose was then assessed after 14 and 30 days.
Results: At year 15, 100% (N=41) and 96.9% (N=98) of the subjects were still seropositive for anti-HAV
antibodies following vaccination at 0,6 or 0,12 months, with corresponding GMCs of 290.3 mIU/ml and 353.1
mIU/ml, respectively. All seronegative subjects who received an additional dose of the vaccine (n=6) mounted
anti-HAV antibody concentrations 15 mIU/ml and demonstrated an anamnestic response to the vaccine. The
additional dose was well tolerated.
Conclusions: These studies represent the longest annual follow-up of adults immunised with a hepatitis A
vaccine. The observed immune response to HAV induced by 2 doses of inactivated hepatitis A vaccine was
shown to persist for at least 15 years and the presence of immune memory was also confirmed in patients who
were seronegative for anti-HAV antibodies after this time. These results are consistent with earlier model-based
predictions, which estimated that seropositive anti-HAV levels would persist in at least 95% of vaccinees at year
25. Moreover, these results confirm that both schedules (0,6 and 0,12) are equally efficient.
Havrix is a trademark of the GlaxoSmithKline group of companies
P3-23
Frequency of Escherichia coli Pathotypes Obtained from Children with Acute Diarrhea
Kalantar, E.1, Soheili, F.2, Salimi, H.1
1
Kurdistan University of Medical Sciences, Microbiology, Sanandaj, Iran, Islamic Republic of, 2Kurdistan
University of Medical Sciences, Molecular Biology, Sanandaj, Islamic Republic of Iran
Aim and objective: To determine the frequency, antimicrobial susceptibility and plasmid profiles of
Escherichia coli pathotypes obtained from children with acute diarrhea.
Materials and methods: In a prospective study during 2008, 466 rectal swabs of children age 1 month to 5
years were collected and examined for the presence of Escherichia coli strains.
Results: Of the total number of specimens examined, 99 (21.24%) were positive for E. coli. The highest number
of isolates, 37 (37.4%), was recovered from the 13 - 24 month age group. Of the 466 children, 191 (41%) were
girls and 275 (59%) were boys with a total incidence of 21.24% (99 / 466).Based on the serological tests, 59
(59.59%) of the E. coli strains were identified as EPEC, 22 (22.22%) were identified as EIEC.The in vitro
antibiotic susceptibility pattern of E. coli strains showed that 89.89 % , 88.88%, 79.79 %, and 75% of isolates
were found to be resistance to Tetracycline, Chloramphenicol, Ampicillin and cefixime respectively.In plasmid
profiling, out of the 99 E. coli pathotypes, 35 (35.35%) were found to possess plasmids, which ranged in sizes
from 1.7 kb to 4.5 kb. These plasmids were detected and seen in 33 % of EPEC. Only two pathotypes possessed
single size plasmid in EIEC.
Conclusion: Our results revealed that EPEC, EIEC, EHEC, and ETEC have significant association with acute
diarrhea among children in Sanandaj and should be considered potential pathogens. Guidelines for appropriate
use of antibiotics in Sanandaj need updating.
P3-24
Isolation of Bacteria and Fungi From Housefly (Musca domestica L.) at Slaughter House and Hospital in
Sanandaj, Iran
Davari, B.1, Kalantar, E.2, Verdi, F.3, Zamini, G.4, Zahirnia, A.5
1
Kurdistan University of Medical Sciences, Department of Parasitology, Mycology and Entomology, Sanandaj,
Iran, Islamic Republic of, 2Kurdistan University of Medical Sciences, Microbiology, Sanandaj, Iran, Islamic
Republic of, 3Kurdistan University of Medical Sciences, Goths Hospital, Sanandaj, Iran, Islamic Republic of,
4
Kurdistan University of Medical Sciences, Parasitology, Entomology, Sanandaj, Iran, Islamic Republic of,
5
Hamedan University of Medical Science, Parasitology & Mycology, Hamedan, Islamic Republic of Iran
Objective: Houseflies have long been regarded as potential carriers of microorganisms especially bacteria and
fungi.Among bacteria, E.coli and Klebsiella spp are considered as dangerous pathogens in man and domestic
animal.There is abundant opportunity for flies to become contaminated and in turn to contaminate the patient
environment and residential regions. The aim of this study was to isolate and identify bacteria and fungi from the
_______________________________________________________________________________________ Page 71 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ slaughter house and the hospital environments. Also to determine.The antimicrobial susceptibility of the isolated
bacteria were investigated in this study.
Methods: The flies were captured with a sterile nylon net and transferred to the Entomology Laboratory for
identification by standard keys. Isolation of bacteria and fungi were done based on standard procedures.
Antimicrobial susceptibility was carried out by disc diffusion assay.
Results: In this study A total of 908 Musca domestica were collected: out of 908 flies 418 were collected from
the hospital environments and 490 flies were also collected from different part of the slaughter house in
Sannadaj.A total of 196 bacteria (158) and fungi (38) were isolated from the Slaughter house. Similarly, 320
bacteria (208) and fungi (112) were isolated from the hospital environments. Predominant bacteria isolated from
Slaughter house were Citrobacter spp and Klebsiella spp respectively. Similarly, the most predominant bacteria
isolated from hospital environment were Klebsiella spp and Ps aeruginosa respectively.The most prevalent fungi
isolated from the slaughterhouse were Aspergillus niger and Aspergillus flavus respectively. Bacteria isolated
from the slaughter-house were resistant to more ten antimicrobials. Among the bacteria isolated from the
hospital environment, Klebsiella spp were 60 % resistant to amoxycillin in and 46% to erythromycin.
Conclusion: The present study supports belief that the house fly is a potential vector of pathogenic bacteria as a
well as fungi. The results of this study revealed that Klebsiella spp were highly resistant to antibiotics like
amoxycillin and erythromycin.Houseflies therefore may act as vectors of potentially pathogenic bacteria in a
hospital and Slaughter house environment.
Keyword: House fly, Bacteria, Fungi
P3-25
Antibacterial Effect and Physico-chemical Properties of Essential Oil of Zataria multiflora Boiss
Alasvand Rarasvand, M.1, Kalantar, E.2, Amin, M.3
1
Kurdistan University of Medical Sciences, Pharmacology and Physiology, Sanandaj, Iran, Islamic Republic of,
2
Kurdistan University of Medical Sciences, Microbiology, Sanandaj, Iran, Islamic Republic of, 3Ahwaz
Jundishapur University of Medical Sciences, Microbiology, Ahwaz, Islamic Republic of Iran
Aim and objective: The use of medicinal plants to treat infections is an age-old practice all over the world.
Therefore, actions must be taken to develop new drugs, either synthetic or natural. Hence the present study is
aimed at evaluating the antibacterial effect and physico-chemical properties of essential oil of Zataria multiflora
Boiss.
Materials and methods: Antibacterial activities of essential oil of Zataria multiflora Boiss was assessed by agar
disc diffusion and minimal inhibitory concentration was done by E test.
Results: Essential oil of Zataria multiflora Boiss was effective on pathogenic bacteria particularly S. aureus.
The MIC values for the target cultures were ranged from 0.39 mg/ml to 1.56 mg/ml.
Physico-chemical Properties like effect of pH, temperature, detergents, and enzymes of essential oil from Zataria
multiflora Boiss was also determined. The essential oil was quits stable to temperature as tested against S. aureus
and E. coli. The essential oil was very stable over a wide range of pH. The antibacterial activity of essential oil
was insensitive to various protein denaturing detergents and enzymes like Proteinase K, Trypsin, lipase, and
lysosyme.
Conclusion: A potential use of Zataria multiflora Boiss need more studies including further purification, mass
spectra, nuclear magnetic resonance (NMR) and evaluation of toxicity are needed and in progress for
confirmation of this suggestion.
P3-26
Effect of Ultrasound Wave on Multi-drug Resistance E. coli and Methicillin Resistance Staphylococcus
aureus Isolated from Diarrheal Patients
Maleki, A.1, Kalantar, E.2, Ebrahimi, R.1
1
Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran, Islamic Republic of, 2Faculty of
Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran, Islamic Republic of
Aim and objective: E. coli and methicillin resistance Staphylococcus aureus are important pathogens that
produce widespread infections.The purpose of this study was to evaluate antimicrobial effect of ultrasonic
irradiation in combination with antibiotic on multi-drug resistance E. coli and methicillin resistance
Staphylococcus aureus.
_______________________________________________________________________________________ Page 72 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Material and methods: Rectal swabs were taken from the diarrheal patients. Bacteria were isolated and
identified based on standard procedures. Antimicrobial susceptibility testing was done based on CLIS.
Sonication experiment was carried out in a laboratory-scale batch sonoreactor with low frequency (42 kHz) plate
type transducer at 170 W of acoustic power
Results: Our results showed that E. coli and methicillin resistance Staphylococcus aureus were affected by the
ultrasound with the bactericidal effect increasing with time. It was also found that E. coli was more susceptible
to the ultrasonic treatment as compared to S. aureus.
Conclusion: The combination of US with an antibiotic (chloramphenicol) enhanced killing of both bacteria over
the use of US alone. It is worth to note that the standard strains were more susceptible as compare to the clinical
isolates.
Keywords: Ultrasonic waves, chloramphenicol, E. coli, methicillin resistance, Staphylococcus aureus
P3-27
Enteric Fever Imported to the Czech Republic
Stejskal, F.1,2, Trojanek, M.3, Reisingerova, M.4, Gabrielova, A.5, Maresova, V.3
1
Charles University, 1st Faculty of Medicine, Department of Tropical Medicine, Prague, Czech Republic,
2
Hospital Liberec, Department of Infectious Diseases, Liberec, Czech Republic, 3Charles University, 2nd Faculty
of Medicine, 1st Department of Infectious Diseases, Prague, Czech Republic, 4University Hospital Bulovka,
Department of Infectious Diseases, Prague, Czech Republic, 5University Hospital Bulovka, Department of
Microbiology, Prague, Czech Republic
Background: Enteric fever is an increasingly important infection in travelers and migrants returning from the
endemic countries. Since January 2004 there have been registered 25 imported cases of typhoid fever and 7 cases
of paratyphoid A in the Czech national surveillance system (EPIDAT). Majority of them, 14 typhoid and 4
paratyphoid A cases, were hospitalized at the University Hospital Bulovka in Prague.
Methods: In the study at our University Hospital there were evaluated patients with febrile illness returning
from tropics between January 2004 and December 2009. A case of typhoid or paratyphoid fever was defined as
isolation of Salmonella
enterica serotypes typhi or paratyphi A, B, C from blood, stool or urine. Epidemiological, clinical, microbiologic
and treatment data were analyzed retrospectively.
Results: Medical records of 13 patients (3 women and 10 men; aged from 16 to 59) with confirmed enteric fever
were investigated in the period from January 2004 till December 2009. 6 cases were diagnosed at Chinese
refugees, one in Indian boy VFR and 6 at Czech tourists visiting India or Nepal except for one case that was
acquired in Egypt. 2 of 6 turists were vaccinated with polysaccharide typhoid vaccine 2 years before traveling.
Fever was a predominant symptom in all patients, lasting from 9 to 26 days. Typical typhoid rash was observed
only in 2 Chinese refugees. Laboratory findings were leukocytopenia (range 2.0- 7.6; median 4.3×109/l),
thrombocytopenia (range 19-286; median 119×109/l) and moderate elevation of transaminases: AST (range 0.85.1; median 2.7 µkat/l), ALT (range 0.6-4.3; median 2.3 µkat/l). Diagnosis was confirmed by positive blood
culture in 10 patients, stool was positive in 4 cases. All Salmonella typhi isolates were laboratory sensitive to
wide range of antibiotics and treatment was started with ciprofloxacin. In 5 patients with failure of this treatment
therapy was switched to 3rd generation cephalosporin (3 cases) or chloramphenicol (2 cases).
Conclusion: Typhoid and paratyphoid fever are epidemiologically important diseases that may lead to
potentially life-threatening complications. It should be suspected in all travelers, even vaccinated, in which
clinical course is more severe and complications are more often. We present the large case series of typhoid and
paratyphoid fever in travelers from Central Europe country.
This research was partially supported by the Czech Ministry of Education grants MSM0021620806 and
FRVS1170/2010.
P3-27a
Real-time Multiplex PCR for Rapid Diagnosis of Enteropathogenic Bacteria in Stool Samples of Patients
with Travellers’ diarrhoe (TD)
Hagen R.M.1, Wiemer D.1, Priesnitz S.1, Helm F.1, Tannich E.2, Fischer M.1
1
Bundeswehr Hospital Hamburg, Tropical Medicine branch at Bernhard-Nocht-Institute for Tropical
Medicine, Hamburg, 2Bernhard-Nocht-Institute for Tropical Medicine, Hamburg
_______________________________________________________________________________________ Page 73 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Objectives: Travellers' diarrhoea (TD) a common problem worldwide with significant medical impact is caused
by a variety of pathogens including viruses, parasites and bacteria. Bacterial culture is still the ‘gold standard’ for
the identification of enteropathogenic bacteria but this techniques are time consuming and require 3-5 days.
Therefore, PCR-based methods have been developed. Unfortunately, the detection of multiple pathogens
simultaneously is limited by the differences in optimal PCR conditions for each pathogen-specific primer set.
To solve this problem we have developed a one tube real-time multiplex PCR for the detection of Salmonella
spp., Shigella spp./EIEC, Campylobacter jejuni and Yersinia spp.
Methods: Based on published sequence data, primer and probes were designed with primer3 software. The PCR
protocol for RotorGene 6000 (Corbett) was optimized, the sensitivity and specifity was tested in DNA-templates
from cultures and in spiked stool samples. 556 stool samples from travellers and in-patients were analysed. The
results were compared with established microbiological methods (stool culture).
Results: The PCR yielded results within 3 hours including the DNA-purification. No false positive signal or
cross reaction with DNA-templates from culture was observed. The analytical sensitivity for Salmonella was
4x104 cfu/ml, for Campylobacter 3x103 cfu/ml, for Shigella 3x105 cfu/ml and for Yersinia 4x105 cfu/ml. In
culture positive stool samples the PCR was able to detect Salmonella in 71 out of 72 (98,6%), Campylobacter in
84 out of 86 (97,7%), Shigella in 11 out of 11 and Yersinia in 10 out of 10 samples. In culture negative samples
(342), the PCR detected a further 24 Shigella, one Salmonella and 15 Campylobacter infections, respectively.
Conclusion: The PCR essay proved to be a sensitive and reliable tool for presumptive diagnosis of diarrhoea
caused by bacterial pathogens. Positive results in stool culture negative samples may be explained by the fact,
that Campylobacter and Shigella are difficult to cultivate and sensitive to transport conditions. Furthermore,
Shigella spp. contain a similar invasion plasmid as EIEC which is not analyzed in routine stool culture
examination. We consider this new method to be useful for the rapid diagnosis of Travellers’ diarrhoe.
P5-28
Diagnostic Approach in Two Cases of Microcytic Anemia in Refugees from Congo
Zaccarin, M.1
1
Aarhus University Hospital, Skejby, Dept. of Infectious Diseases, Aarhus N, Denmark
Introduction: The most common causes of anemia in Denmark are iron deficiency and chronic disease. In a
global perspective, the ethnicity related thalassemia and sickle cell disease are more frequent. The two cases
presented below describe differing causes of microcytic anemia in two Congolese refugees.
Case 1: A 27-year-old man from Congo had been living in a refugee camp in Zambia. Treated for recurrent
abscess in the right side of the jaw with poor result, he was moved to Denmark and diagnosed with osteomyelitis
but remained unresponsive to antibiotic treatment. After 10 months illness he was referred to our clinic and
presented an inflamed right cheek with excretion of pus and microcytic anemia was noted. After drainage and
culture he was prescribed with cefuroxime and metronidazole without improvement. Hemoglobin gel
electrophoresis confirmed sickle cell disease (Hb S 91.1%). Although no microbiologic agent was confirmed by
culture he was prescribed ciprofloxacin, as Salmonella is commonly known to cause osteomyelitis in people with
sickle cell disease, and steadily recovered.
Case 2: A 19-year-old woman from Congo had been living in a refugee camp in Rwanda and was moved to
Denmark for surgical treatment of ulcerating and infected breast cancer. Histologic diagnosis:
dermatofibrosarcoma protuberans. Microbiologic diagnosis: staphylococcus aureus and pseudomonas
aeruginosa. CT scan had revealed radiolucent left humerus and enlargened spleen. After two months without
improvement she was referred to our clinic and subcutaneous abscess under the skin transplant was found. After
drainage, cultures found pseudomonas aeruginosa and she was treated with piperacillin/tazobactam. Furthermore
microcytic anemia was noted; hemoglobin gel electrophoresis disproved sickle cell disease and subsequent
genetic testing for thalassemia was negative. Testing for malaria revealed plasmodium malariae and she was
treated with chloroquine phosphate with full recovery and normalized hemoglobin level.
Discussion: Even though sickle cell disease is only rarely encountered in Denmark, it should certainly be
considered in African refugees. However, if no ethnicity related cause can be established, anemia of chronic
disease still has to be explored - in the latter case by malaria infection. The presented cases demonstrate that
prolonged hospitalization can be avoided by thoroughly reviewing the patient's history and ethnic background in
order to establish the correct diagnosis.
_______________________________________________________________________________________ Page 74 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P5-29
Recurrent Crural Ulcers in a 21 Year Old Male Migrant from Ghana
Mueller, A.1, Ziegler, U.1, Schulze, M.1, Tappe, D.2, Stich, A.1
1
Medical Mission Hospital, Tropical Medicine, Wuerzburg, Germany, 2Institute of Hygiene and Medical
Microbiology, University Hospital, Wuerzburg, Germany
History: A 21 year old student from Ghana who lived for the past 8 years in Germany presented with 3 deep
skin ulcers of up to 4 cm in diameter in the left and right malleolar region. He complained of recurrent and long
lasting ulcerations for the past 4 years. No previous trauma, no history of recent travel. He mentioned to have
sickle cell disease.
Findings: 3 deep apparently superinfected ulcerations above / below the lateral malleolus on both legs.
Microbiological culture revealed a mixed infection with E. coli, sensitive to ciprofloxacin, as the relevant
pathogen. Multiple scars on both lower limbs. Sickle cell test was positive and Hb-electrophoresis confirmed
homozygous sickle cell disease. Hb was 7.8 g/dl, bilirubin 3,9 mg/dl, LDH 789 U/l. Ultrasound showed
hepatomegaly but a small spleen.
Course: Under oral antibiotic treatment according to resistance testing and daily wound dressing the ulcers
required several weeks to heal. 4 month later he presented again with new ulcerations, this time S. aureus was
grown. Conservative management with wound dressing alone was not successful and antibiotic treatment given
again.
Discussion: Recurrent crural ulcers are a common and sometimes disabling problem in homozygous sickle cell
disease but this is rarely seen in Germany. Long term antibiotic treatment according to resistance testing may be
required in case of superinfection. High serum LDH-levels seem to be an unfavourable prognostic factor.
P5-29a
Cerebral Alveolar Echinococcosis in a Migrant
Stauga S. 1, Schmiedel S.1, Lund C.H.1
1
University Medical Center Hamburg-Eppendorf, Germany
A 29-year old Siberian migrant presented in March 2007 with acute onset of grand mal seizures, weakness of the
left leg and cephalgia. He had a past history of hepatic alveolar echinococcosis (AE), treated with partial
hepatectomy in 2004, followed by 18 months of oral mebendazole.
MRI of the brain revealed two inoperable right-sided cystic lesions with surrounding oedema, suggesting
cerebral AE. Serology was positive for hydatid fluid and Echinococcus multilocularis-extract. CT of the thorax
revealed two small calcified lesions of the right lung, suggesting pulmonary AE. Albendazole (ABZ) was started
at a dose of 1200mg/d, corticosteroids were given for cerebral oedema, carbamazepine for seizure control.
Symptoms improved and the patient was discharged from the hospital.
Several hospital admissions followed since, with only transient improvement of neurological symptoms. In
February 2008, MRI showed progression of cerebral disease with compression of the right lateral ventricle and
midline shift due to cerebral oedema. Thus, a brain biopsy was performed and confirmed AE. Serum ABZsulfoxide levels were continuously below the recommended therapeutic range, despite increasing ABZ further,
and adding praziquantel and cimetidine to slow hepatic metabolisation of ABZ. Corticosteroid and
carbamazepine doses were optimised, levetiracetam added for better seizure control. Follow-ups in 2009 and
2010 showed great improvement of symptoms and MRI findings. Our case proves that medical treatment of
cerebral AE is a challenge to physicians. AE is a progressing disease and clinical outcome is poor despite years
of high-dose anthelmintic treatment.
_______________________________________________________________________________________ Page 75 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P6-30
Obtaining a Travel History from Returned Travellers Presenting with Tropical Infectious Disease
Symptoms - How Well Are We Doing?
Flaherty, G.1,2,3, Gately, R.1, Fleming, C.1,4
1
National University of Ireland, Medicine, Galway, Ireland, 2Irish Society of Travel Medicine, Galway, Ireland,
3
Faculty of Travel Medicine, Glasgow, United Kingdom, 4University Hospital Galway, Infectious Diseases,
Galway, Ireland
Introduction: The potential for importation of communicable infectious diseases from tropical and sub-tropical
regions poses a public health threat and a burden on the health services of the traveller's native country. Failure
to obtain a comprehensive travel history in the returned traveller may lead to diagnostic delay. Few studies have
examined the issue of quality control in respect to the travel history recorded by doctors practising in nontropical countries.
Objectives: This study investigated the quality of the travel history recorded from travellers returning to Ireland
from the tropics.
Methods: A retrospective study of the case notes of patients who presented to University Hospital Galway
(UHG) between 2005 and 2009 was performed. A case review form recorded demographic details and
information regarding their potential exposure to infectious diseases while travelling.
Results: Fifty-six returned travellers (32 male, 24 female) with a mean age of 23 years were identified. The
majority were Irish-born (n=23) with 26 of the remaining patients belonging to the VFR category. The most
common destinations were West Africa (n=26) and Asia (n=16). Fever (n=43) was the most common symptom
in these travellers. Only 1 patient was asked if pre-travel health advice had been received. Details of malaria
prophylaxis were recorded in 57% of patients. Seventy-five percent of returned travellers were asked about
travel vaccinations. In almost every case there was no record of the travellers' accommodation type, whether the
traveller went trekking, jungle travel, or contact with freshwater. In the majority of cases there was no inquiry
into the occurrence of illness abroad, whether food and water precautions were followed, and insect bite
avoidance. Most patients were not asked about their travel-related sexual history. Two-thirds of returned
travellers were not given preventive advice which would help to reduce their risk of developing travel-related
illness in the future.
Conclusions: This study reveals significant deficiencies in the quality of the travel history recorded by doctors
practising in an Irish hospital when presented with travellers returning from the tropics with symptoms of
tropical diseases. The findings of the study reinforce the need to improve education in travel and tropical
medicine. We recommend the introduction of a standardised checklist of items to be enquired about in returned
travellers in whom tropical disease is suspected.
P6-31
Murine Typhus Acquired during a Three Week Business Travel to the Philippines
Kibsgaard, L.1, Lindberg, J.2, Villumsen, S.3, Larsen, C.S.1
1
Aarhus University Hospital, Skejby Sygehus, Infectious Diseases, Aarhus N, Denmark, 2Regional Hospital,
Herning, Internal Medicine, Herning, Denmark, 3Statens Serum Institut, Copenhagen, Denmark
Case description: A 52 years old healthy man stayed three weeks in the northern part of Luzon, the Philippines.
He was vaccinated against hepatitis A, diphtheria and tetanus and took Malarone® as malaria prophylaxis. He
recalled no other exposures than mosquito bites.
Three days after returning home, he was admitted with fever, headache, retrobulbar pain and myalgia. Physical
examination was normal and routine blood samples only showed slightly elevated C-reactive protein (CRP).
Malaria smears and dengue virus rapid diagnostic test were negative. On day two, ceftriaxone was prescribed on
suspicion of typhoid fever, but despite this his condition deteriorated with persistent fever and development of
thrombocytopenia and lymphocytopenia. Four days later, he developed a maculopapular exanthema. The patient
became confused and developed septic shock and meropenem was substituted for ceftriaxone. Lumbar puncture
revealed mononuclear pleocytosis 31 cells/ml and elevated spinalprotein 0.61 g/l, but MR-scan of cerebrum was
normal. On day nine after admission, doxycycline was prescribed on clinical suspicion of rickettsiosis. During
the following week his condition slowly improved and he was discharged to an uneventful recovery.
A diagnosis of typhus-group rickettsiosis most likely murine typhus was confirmed by a very high R. typhi IgM
titer of 32.000 and a high IgG titer of 2.048.
_______________________________________________________________________________________ Page 76 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Discussion: Although murine typhus (MT) is distributed worldwide, it is rarely reported in returning travellers.
Partly because most cases of MT are mild and patients recover spontaneously without treatment. Rickettsia typhi
is transmitted by feces from rat fleas, but as in our case most patients do not recall exposure to rat fleas. The
clinical symptoms are notoriously unspecific and patients with murine typhus never have eschars. As
demonstrated here broad-spectrum beta-lactam antibiotics have no effects on rickettsiae. Diagnostics in the acute
phase is difficult since Rickettsia spp. will not grow in normal culture media, and as specialized culture and PCR
are not widely available. Specific antibodies can be detected after the first week.
Conclusion: Murine typhus and other rickettsioses should be considered in the returned traveller with fever,
especially when malaria, dengue fever, leptospirosis and typhoid fever have been excluded. Further empiric
antibiotic treatment with doxycycline in the acute phase should be initiated on clinical suspicion and not await
serological confirmation.
P6-32
Travel-related Adults Fever: Aetiologies, Health Care Itinerary and Outcome of 618 Hospitalized Cases
Rapp, C.1, Delarbre, D.1, Ficko, C.1, Meynard, J.B.2, Méchaï, F.1, Imbert, P.1
1
HIA Bégin, Infectious and Tropical Diseases, Saint-Mandé, France, 2Ecole du Val de Grâce, DESP, Paris,
France
Fever is a frequent cause of travel-related morbidity with a sometimes difficult diagnosis.
Objectives: To describe the aetiological field of hospitalized imported fevers and study the influence of health
care itinerary on management and outcome.
Methods: Retrospective study of all adults admitted in the tropical and infectious diseases or intensive care
wards of the Bégin hospital in Saint-Mandé, France, for a fever acquired during a stay outside metropolitan
France. Time frame was between January 1, 2002 and December 31, 2007.
Results: Six hundred and seventeen patients (197 females, 420 males) with a 34 year old average age (16-86)
were included. Two hundred and five were classified as tourists (33.2%), 209 as immigrants (35%), 152 as
military (24.6%) and 30 as expatriates (4.8%). Main destinations were: sub-Saharan Africa (SSA) (71.5 %),
South America-Caribbean (7.6%) and Asia-Pacific Ocean (47.4). Median duration of travel was 28 days. Ninety
eight (16%) patients presented symptoms during their stay, among them 72 required a medical evacuation. For
the others, median duration between return and onset of symptoms was 7 days. Median time to consultation was
4 days. Terms of initial management were as follows: emergency department (ED) (55%), general practitioner
(GP) (41%), hospital ward (3.7%). Comparing to ED, the initial recourse to GP was associated to a median late
diagnosis of 2 days and to a lower rate of diagnosis confirmation (39% vs 79%). Tropical aetiologies represented
67%. Malaria (56% of all cases, P. falciparum 86%) was the leading cause in all returnees from tropical
destinations. The distribution of other aetiologies was determined by the travel destination (ex dengue and AsiaPacific Ocean). Among the cosmopolitan pathologies which represented 29.4% of diagnoses, we noticed an
association between the following variables: meningeal infections and tourist, HIV infection and military,
respiratory tract infections and tourist older than 50 years, dengue and expatriate. The cause of fever was
unknown in 3% of cases. The median stay duration, which was independent from the initial management, was 5
days. Thirty three patients (5.6%) were admitted in intensive care. Four died (0.6%); among them, two malaria
cases.
Conclusion: Malaria remains the first cause of fever in hospitalized travelers. Early and suitable management of
imported fever is facilitated by the quick consultation of a specialist.
P6-33
Successful Treatment of Refractory Cutaneous Leishmaniasis with Miltefosine
Elsner, E.1, Foroutan, B.2, Müller, R.3
1
Federal Armed Forces Hospital Berlin, Department of Dermatology, Venerology and Allergology, Berlin,
Germany, 2Federal Armed Forces Hospital Berlin, Department of Internal Medicine, Section of Infectiology,
Berlin, Germany, 3Federal Armed Forces Hospital Berlin, Department of Laboratory Medicine / Clinical
Pathology, Berlin, Germany
Background: Infections with Leishmania ssp., a sandfly transmitted protozoal disease, endemic in many
countries of the Americas, Africa and Asia, with 2 million new cases each year, occur more and more frequently
in Central-Europe because of tourism and job-related travel. Depending on the Leishmania species and the host
immunity, different forms of cutaneous (CL), mucocutaneous (L. brasiliensis complex) or visceral leishmaniasis
_______________________________________________________________________________________ Page 77 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ (L. donovani as well as L. infantum) may develop. CL may heal spontaneously with scarring but can evolve in
diffuse CL or into recurrent CL. Diagnostic criteria include travel to an endemic area as well as ulcerated
nodules on exposed bodysites which show no tendency towards healing over several weeks. The diagnosis is
confirmed by finding Leishmania in a smear, tissue biopsy or culture. Therapy options range from topical
treatment of simple CL caused by L. major to systemic therapy which is needed for the most complex cases of
CL, mucocutaneous and visceral forms. Miltefosine is a relatively new and less toxic option to replace the
antimonial drugs and may be an effective alternative if treatment with amphotericin B fails.
Case report: A 74-year-old woman was admitted to our hospital for progredient ulcerated erythematous plaques
on the left cheek (Fig. 1), which was diagnosed as leishmaniasis caused by L. infantum eight months ago,
probably contracted in 2002 on Ibiza, a Balear island in the Mediterranean sea. She was already treated with two
2-week treatment courses of liposomal amphotericin B and intermittent oral itraconazole, initially with lowgrade improvement. Biopsy for skin smear, histology and PCR was performed. Bone marrow biopsy was also
done to rule out systemic disease. Skin smear showed multiple amastigote forms of Leishamania spp. (Fig. 2),
identified as Leishmania infantum (L. tropica complex) by PCR. We administered Miltefosine 150mg
bodyweight adapted twice a day for 6 weeks, which was well tolerated. Last follow up 9 months after therapy
showed flattened, healed lesions with scarring (Fig. 3).
Figure 2 Figure 1
Figure 3
Figure 4
P6-34
Medical Repatriation of Business Travelers: The Etiological Spectrum of Travel-Related Infections
Rapp, C.1, Ficko, C.1, Delarbre, D.1, Aoun, O.1, Cambon, A.1, Méchaï, F.1, Imbert, P.1
1
HIA Bégin, Infectious and Tropical Diseases, Saint-Mandé, France
Introduction: Business travelers represent less than 10 % of all travelers. Due to frequent travelling, they are
exposed to various health risks. Little is known concerning travel-related infections in air MedEvacs.
Objectives:
- To describe the etiological spectrum of travel-related infections in patients hospitalized after an air MedEvac
during a business trip.
- To compare the characteristics between the emergency MedEvacs (< 24 H) and the postponed ones.
Methods: A retrospective study was conducted from January 1, 2002 to December 31, 2008. We included all
adult travelers admitted in our infectious diseases unit following an air MedEvac during a stay abroad for
professional reasons.
Results: Ninety eight travelers (80 males, 18 females) with a 33 year old average age (18-73) were included. We
reported 46 (47 %) military, 26 (26 %) businessmen, 16 (16 %) expatriates (4.8%), 5 flying personnel and 5
humanitarian workers. Main destinations were: sub-Saharan Africa (n=60), Asia-Pacific Ocean (n=15), South
America (n=8) and North Africa (n=8). A pre-travel advice was given to 71 % of the travelers. Two third of
them received a malaria chemoprophylaxis prescription. Evacuees were escorted by a doctor or a nurse in 40
cases (doctors n=29, nurses n=11). Among them, 4 patients worsened during the flight. The main etiologies were
_______________________________________________________________________________________ Page 78 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Plasmodium falciparum malaria (n=19), hepatic amebiasis (n=10), meningitis (n=14), acute HIV infection (n=8),
viral hepatitis (n=6) and pneumonia (n=5). The main reasons for MedEvac were: unsuitable local medical
facilities (38.7 %), absence of etiological diagnosis (32.6 %) and severe outcome (13.3 %). We observed a
significant association between age, severity and emergency of the evacuation (p< 0.05).
Conclusions: Infections represent a small proportion of air medical evacuations. Most of them are preventable.
Malaria and meningitis are the major lethal causes but remain rare. Their severity and the difficulties to access to
good quality health care are the main determinants. This data is useful for reinforcing prevention in travelers for
professional reasons.
P6-35
Melioidosis in Travellers - Pitfalls in Diagnosis of Burkholderia pseudomallei by Laboratories from Nonendemic Regions
Schultze, D.1, Dollenmaier, G.1, Bruderer, T.1, Riehm, J.2, Boggian, K.3, Müller, B.3, Rafeiner, P.3
1
Institute for Clinical Microbiology and Immunology, St. Gallen, Switzerland, 2Federal Armed Forces Institute
of Microbiology, Munich, Germany, 3Cantonal Hospital, St. Gallen, Switzerland
Burkholderia pseudomallei, the etiologic agent of melioidosis, can cause pyogenic or granulomatous lesions and
is endemic to tropic regions, mainly in Southeast Asia and northern Australia. Melioidosis occurs sporadically in
travelers returning from disease-endemic areas, and physicians as well as laboratories in regions where this
disease is not endemic are not familiar with its broad-ranging manifestations and the identification of B.
pseudomallei.
Laboratories from non-endemic regions should be aware of misdiagnosis of isolates by automated methods for
bacterial identification and of the risks for laboratory personnel handling cultures of B. pseudomallei. Physicians
considering melioidosis in travellers must ensure appropriate sampling prior to commencement of empiric
antibiotic therapy in order to obtain viable bacteria and thus enable timely identification of the organism.
Without identification, infections might possibly be treated with inappropriate antibiotics or, if appropriate, over
a time period insufficient to ensure eradication of B. pseudomallei.
Two case reports of travellers with invasive melioidosis will illustrate these issues.
P6-37
Imported Rabies after Travel to Highly Endemic Areas Differing Therapeutic Strategies in Two Cases of
Travel Related Rabies in a Hospital in Hamburg
Schmiedel, S.1
1
University Medical Center Hamburg-Eppendorf, Germany
Rabies is a rare disease in Western Europe. Most cases nowadays are imported from high endemic areas. We
report on two cases that have been treated in our hospital in the past years. The first patient attracted his disease
after a dog bite in India. She was misdiagnosed as having hysteria and treated as a acute psychosis for many
days. Shortly after rabies was considered as a differential diagnosis the patient dayed from cardiac arrhythmia.
The second patient was suspected and rapidly diagnosed as having rabies from hos very early symptoms. He
attracted rabies after a dog bite in Morocco. The patient was treated according the “Milwaukee protocoll“ and
got postexposure vaccination according to WHO recommendations. We additionally administered an
experimental life-vaccine scheme with the oral attenuated virus strain O57 used in orla animal vaccines. Again
this patient died after 6 weeks of “neuroprotective“ deep sedation and mechanical ventilation throu dsyregulation
and arrhythmias.
Current diagnostic methods, treatment strategies and postexposure options will be discussed in addition to our
clinical report.
_______________________________________________________________________________________ Page 79 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P6-38
Severe Conjunctivitis due to Adenovirus and Neisseria gonorrhoeae Co-Infection in a Traveller Returning
from Thailand
Müller, A.1, Ziegler, U.1, Schulze, M.1, Tappe, D.2, Schubert, J.3, Schargus, M.4, Stich, A.1
1
Medical Mission Hospital, Tropical Medicine, Würzburg, Germany, 2Institute of Hygiene and Medical
Microbiology, University Hospital, Würzburg, Germany, 3Institute of Virology, University Hospital, Würzburg,
Germany, 4Department of Ophthalmology, University Hospital, Würzburg, Germany
History: A 27 year old German male stayed for a 28 day beach holiday in Ko Samui / Thailand. The day before
he returned home he noticed a burning and itching sensation of both eyes. 3 days later he was seen by an
ophthalmologist and treated for suspected viral conjunctivitis. Symptoms deteriorated and the day after he
noticed intense conjunctival swelling and increasing putrid secretion. He admitted a condom protected sexual
intercourse with a female prostitute 1 week prior to admission.
Findings: Intense bilateral conjunctival swelling and putrid discharge, allowing the patient hardly to open the
eyes. No fever or meningism but general malaise. No urethral discharge. CRP 4,2mg/dl (NR -0.5mg/dl), slightly
elevated transaminases, full blood count unremarkable. Gram stain of conjunctival secretions revealed gramnegative intracellular diplococci, confirmed as Neisseria gonorrhoeae by culture. Urinalysis showed leucocyturia
(>500 / µl) and erythrocyturia (150 / µl). PCR for Adenovirus DNA from conjunctival swabs was positive.
Course: The patient was admitted and received an initial intravenous antibiotic treatment with high dose
ampicillin plus ciprofloxacin and a topical treatment with ofloxacin eyedrops. After susceptibility testing was
available the antibiotic regimen was switched to azithromycin. Ophthalmological review 1 week later showed
slight nummular infiltrates of the right cornea compatible with keratoconjunctivitis epidemica, no deeper
ulcerations. 12 days after admission he presented without major complains, only a slight conjunctivitis was
visible.
Discussion: Bilateral gonococcal conjunctivitis is a very rare medical problem in returning travellers. Coinfection with adenoviruses has not been reported yet. The pathognomonic presentation of the patient and the
evidence of gram-negative, intracellular diplococci already allowed the diagnosis of the bacterial infection. For
the initial treatment extensive and wide-spread antibiotic resistance of Neisseria gonorrhoeae isolates needs to be
considered. Culture and susceptibility testing is mandatory therefore. For gonococcal infections of the eyes
intravenous antibiotic treatment is recommended. The adenovirus co-infection may have been responsible for the
initial symptoms of the patient and was followed by the gonococcal infection.
P6-39
A Case of Severe and Prolonged Katayama Syndrome
Herr, J.1, Cramer, J.1
1
Bernhard-Nocht-Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Hospital, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
In nonimmune travellers the acute schistosomal infection can cause a systemic hypersensitivity reaction, the
Katayama syndrome. Most patients recover spontaneously after 2-10 weeks, whereas some develop persistent
and more serious disease. We report a case with a remarkable long course of disease.
A 50 year old woman had been working as a surgeon in the Democratic Republic of Congo. Four weeks after
return to Germany she presented with fever up to 39.3°C, chills and abdominal pain. Laboratory investigations
showed elevated liver enzymes (y-GT 296 U/l; GOT 372 U/l; GPT 603 U/l), an elevated bilirubin of 1.64mg/dl,
an elevated CRP
(59.3 mg/l) as well as an eosinophilia of 16%. Having a history of freshwater contact in Lake Kivu, a serological
testing for schistosomiasis was perfomed (IIF) which revealed a positive antibody titer of 1:20 against S.
mansoni. A few days later the patient's general condition became considerably worse with rising fever, acute
dyspnea and arthralgia. Eosinophilia was 28.9% (1830/µl). Serological testing now revealed an increase of
Schistosoma antibody titer to 1:1280. Schistosoma-DNA could be detected by PCR in the blood (Wichmann et
al.). Consequently the patient was diagnosed with Katayama fever and was treated with Praziquantel 40 mg/kg in
24 hours in another hospital.
In spite of therapy the patient still suffered from subfebrile temperatures, arthralgia and dyspnea, in addition
eosinophilia and elevation of y-GT persisted. Eight weeks and thirteen weeks after initial symptoms two further
courses of Praziquantel (40 mg/kg for three consecutive days) were given. Nevertheless, symptoms persisted for
_______________________________________________________________________________________ Page 80 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ another two years. In a liver biopsy 6 months after initial symptoms eosinophilic granuloma were seen, however
no eggs were found.
A long run with persistent symptoms for two years after Katayama syndrome is unusual. We do not think that
the patient developed chronic schistosomiasis because antibody titers were falling and no eggs were found in
repeated stool and urine examinations. Other diseases could be excluded, however, a heterozygous alpha-I
antitrypsin deficiency was found, which could be a co-factor in the development of chronic liver disease.
Literature: Wichmann et al. Diagnosing schistosomiasis by detection of cell-free parasite DNA in human
plasma. PLoS Negl Trop Dis. 2009;3(4):e422.
P6-40
Returning Globetrotter with Cerebral Malaria Having Taken Antimalarial Chemoprophylaxis
Vassalou, E.1, Vakalis, N.2, Vassalos, C.M.1
1
National School of Public Health, Department of Parasitology, Entomology and Tropical Diseases, Athens,
Greece, 2National School of Public Health, Athens, Greece
Objective of the study We describe the case of an international traveller returning with cerebral malaria who
had taken antimalarial prophylaxis.
Methods: The traveller with cerebral malaria who had received antimalarial prophylaxis with mefloquine was
investigated by means of a questionnaire on travel characteristics and malaria prophylactic course after discharge
from the hospital without sequelae.
Summary of the results: A European woman in her mid thirties travelled to Mali for two weeks during the
winter dry season. The patient reported she had onset of symptoms and was admitted to a hospital with fever,
severe headache and confusion five and six weeks, respectively, after return from the malaria-endemic region.
Although meningitis was first suggested, she was diagnosed with cerebral malaria and 2.2% parasitemia. She
reported she had been vaccinated against yellow fever and never missed a dose of mefloquine during her weekly
prophylactic schedule. She mentioned the use of topical insect repellent but not bed net. When questioned
further, the patient admitted that she travelled often in faraway destinations. She reported that in the period
between mid-week 3 and late week 4 after her returning from Mali she had been on a 10-day trip to the Middle
East. She also reported she had vomiting and diarrhoea for about four to five days during her second trip abroad.
Conclusions: Our report is important first and foremost because it indicates that cerebral malaria may occur
even in an international traveller who is fuly compliant with antimalarial chemoprophylaxis. Perhaps
gastointestinal disorders reported during the traveller's second trip abroad might account for mefloquine
prophylaxis failure. Blood levels of mefloquine were not determined. Globetrotters returning from malarious
areas with any symptoms should be checked for malaria presence irrespective of their compliance with
antimalarial chemoprophylaxis.
P6-41
Diabetes Provoked by Fishing in Thailand
Kreuzberg, C.1, Sudeck, H.1
1
Bundeswehrkrankenhaus Hamburg, Tropical & Internal Medicine, Hamburg, Germany
Case history: A forty-three year old patient presented himself in the clinic 6 days after he had returned from a
holiday trip to Pattaya and its beaches and environments .
He was suffering from severe headache, temperature was up to 41 Celsius when he had measured , chills and
malaise.
The patient himself feared Dengue-fever which he had had before when traveling in SEA and wanted to be sure
that there was no malaria. He was otherwise healthy and worked as an accountant in Hamburg.
On examination he was ill, pale, sweating ,not jaundiced and there was hepatomegaly, no splenomegaly and
some upper abdominal tenderness..
Laboratory examinations showed acute inflammation , raised liver enzymes, raised lipase and massive
glukosuria.
He declined the proposed admission and was followed up closely in the outpatient department.
Dengue, malaria and bacterial septicaemia were excluded. When returning the next day he was questioned about
his holidays activities and revealed that he had been fishing in a small sweet water stream to cach fish for is
aquarium at home.
Leptospirosis was now suspected and confirmed by serology and follow up titers.
_______________________________________________________________________________________ Page 81 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Treatment : Doxycyclin was prescribed as he was still in a window of 4 days.
He made after one week an uneventful recovery but remained diabetic and was put on Metformin.
Conclusion: Febrile illness and infection can provoke underlying metabolic disease which then will manifest
probably earlier in life.
A thorough history even for patients which seem to travel under standard conditions is important and will reveal
risks of exposure to specific infectious agents promptly which is important as Leptospirosis is a potentially lifethreatening diseases which can only be sufficiently treated by antibiotics if theses are initiated early enough.
Follows a short summary about the situation in Germany and the countries from which L. is mostly imported.
P6-42
Other Causes of Eosinophilia than Helminth Infections in Returning Travellers from South East Asia
Jordan, S.1, Schmiedel, S.1, Burchard, G.-D.1
1
University Hospital Hamburg-Eppendorf, Clinical Department I, Section Tropical Medicine, Hamburg,
Germany
Eosinophilia is a frequent finding in travellers returning from developing countries. Helminth infections are
known to be the major cause of eosinophilia in this group.
We present two cases of eosinophilia in returning travellers from South East Asia. Both patients were transferred
to our clinic for suspected helminth disease.
The first patient presented with fever, dry cough, muscular-skeletal pains and diarrhoea starting on the
homeward journey from a six week travel to SE Asia. Laboratory testing revealed elevated inflammation
parameters, elevated serum creatinine and a distinct eosinophilia (3200 c/µl). Abdominal ultrasound
demonstrated hepatospenomegaly. Repeated stool microscopy for helminth and protozoal infections were
negative. Also, serological tests for numerous helminth infections were negative, except for Strongyloides
antibodies which showed a weak positive result. Clinical symptoms and inflammation and renal markers
suspended spontaneously, eosinophilia declined. The patient was discharged and was followed up further in our
outpatient clinic. Due to anew rising eosinophil counts diagnostic tests were repeated but again, stool and blood
microscopy and serological tests remained negative. Nevertheless, an empiric antihelminthic treatment with
albendazole, ivermectin and praziquantel was started. Eosinophilia remained rising reaching total numbers of up
to 9200 c/µl. Finally, a neoplastic myeloproliferation was diagnosed in a bone marrow biopsy.
The second patient was admitted due to worsening dyspnoea and coughing during a visit to Vietnam. Due to
suspected chronic obstructive pulmonary disease oral steroid treatment was started by her pneumologist. A
thoracic CT scan showed diffuse interstitial infiltrations. Laboratory tests showed a marked eosinophilia and
mildly elevated inflammation parameters. Diagnostic tests for helminth disease (stool microscopy, serological
tests) remained negative. A bronchoalveolar lavage revealed a pronounced eosinophilia, infectious agents could
not be observed. Due to suspected Churg-Strauss Syndrome a high dose intravenous steroid therapy was started.
For further diagnosis a lung biopsy was performed. Biopsy did not show signs of vasculitis. Autoimmune
antibodies were negative. In summary chronic eosinophilic pneumonia was diagnosed.
Conclusion: The work up of Eosinophilia in returning travellers should also include non-travel associated
diagnoses such as hematological disorders and autoimmune diseases.
P6-42b
Imported Versus Autochthonous Leptospirosis in Austria and Germany: Differences in Clinical
Manifestations
Cramer, J.P.1,2, Hoffmeister, B.3, Peyerl-Hoffmann, G.4, Pischke, S.5, Krause, R.6, Müller, C.7, Graf, A.3, Kluge,
S.8, Burchard, G.D.1,2, Suttorp, N.3
1
Section Tropical Medicine, Medical Department, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany, 2Clinical Research Group, Bernhard-Nocht-Institute for Tropical Medicine,
Hamburg, Germany, 3Charité University-Medicine Berlin, Berlin, Germany, 4University of Freiburg,
Freiburg, Germany, 5University of Hannover, Hannover, Germany, 6University of Graz, Graz, Austria,
7
Ludwig-Maximilians-University, Munich, Germany, 8Department of Intensive Care Medecine,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Leptospirosis, a zoonosis occurring worldwide, has a broad spectrum of clinical manifestations. In Austria and
Germany as in other countries, growing numbers of imported cases are notified in addition to autochthonous
infections. Moreover, an increase of severe anicteric cases has recently been observed in various countries. We
_______________________________________________________________________________________ Page 82 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ compared clinical and laboratory-based characteristics as well as outcome in imported versus autochthonous
cases. 24 imported and 35 autochthonous cases treated between 1998 and 2008 in six hospital-based infectious
disease units were analyzed retrospectively. To compare disease severity, patients were classified according to
established independent risk factors for fatal outcome. Although severe leptospirosis occurred in similar
proportions of imported (67%) and autochthonous (86%) infections (p = 0.1), jaundice as one of the most
important clinical symptoms of severe leptospirosis was significantly less frequent in imported cases (3 versus
24; p <0.0001). In conclusion, an increasing incidence of severe anicteric leptospirosis cases should be
anticipated with rising global travel activities.
P6-42c
Clinical and Laboratory Pattern in African Tick Bite Fever: a case series of 14 German travellers to subSaharan Africa
Jochum J.1, Cramer, J.1
1
Section Tropical Medicine, Medical Department, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany
Introduction: African tick bite fever (ATBF) is an emerging tick-borne disease due to infection with Rickettsia
africae. The diagnosis often has to be made on a clinical basis since the median time to seroconversion is 25 days
after onset of symptoms. Typical eschars are present only in a minority of patients and typical laboratory patterns
like thrombocytopenia are often absent. With the present case series we intended to assess frequent findings in
patients with ATBF to improve clinical diagnosis before seroconversion occurs.
Methods: We retrospectively studied 14 German travellers to sub-Saharan Africa treated for ATBF at our
outpatient department for tropical medicine between 12/2007 and 03/2010. Besides results of clinical
examination and history taking, standard laboratory values and serology were obtained.
Results: Of twelve patients presenting with typical eschars, only two reported tick bites. Four patients had a
positive serology at the time of initial presentation. The most consistent laboratory feature was mild to moderate
monocytosis. Neither neutrophilia nor thrombocytopenia was present in any individual.
Conclusion: Thorough clinical examination is indicated in all patients with epidemiological possibility of ATBF
since patients may not recall tick bites despite typical eschar formation. Standard laboratory values were nonspecific in our case series and may function as a tool to exclude alternate diagnoses. The poor sensitivity of
Rickettsia serology during early stage of disease in this study is consistent with pre-existing findings.
P6-42d
First Imported Case of Fatal Dengue-hemorrhagic Fever in Germany
Schmidt-Chanasit J.1, Racz C. 1, Racz P. 1
1
Bernhard-Nocht-Institut, Hamburg, Germany
Dengue fever and dengue haemorrhagic fever (DHF) are acute febrile diseases which occur in the tropics, can be
life-threatening, and are caused by four closely related dengue virus (DENV) serotypes of the genus Flavivirus,
family Flaviviridae. DENV infections have been reportable in Germany since 2001, according to the Federal
Infection Protection Act. From 2001 through 2009, an average of ≈187 cases were reported per year (incidence
0.226/100,000) with a maximum of 298 cases in 2009. This case report demonstrates the first fatal DENV
infection in Germany that was imported from Ecuador and initially misdiagnosed as cholecystitis. Post mortem
immunohistochemical and serological analysis revealed a DHF caused by DENV type 1.
P6-42e
Toscanavirus meningitis acquired on the Island of Elba and imported into Switzerland
Gabriel, M.1, Resch, C. 1, Günther, S. 1, Schmidt-Chanasit J. 1
1
Bernhard-Nocht-Institut, Hamburg, Germany
Toscana virus (TOSV) is a serotype of Sandfly fever Naples virus (SFNV) within the family Bunyaviridae and
the genus Phlebovirus. TOSV is transmitted to humans by sandflies (Phlebotomus spp.) and is a prominent cause
of aseptic meningitis in Mediterranean countries. TOSV infections should be considered in travelers returning
from the Mediterranean area who have fever and signs of meningitis. This case report demonstrates the presence
of TOSV lineage A on the island of Elba by molecular detection and typing.
_______________________________________________________________________________________ Page 83 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P7-43
Repatriation Training; How to Encourage Better Readjustment on Repatriation
Phelan, D.1, Lawson, I.2
1
Atos Healthcare, Sheffield, United Kingdom, 2Rolls-Royce plc, Derby, United Kingdom
Organisational work practices are leading to more employees spending periods of time working on international
assignment. Culture shock is expected on expatriation however it is counter-intuitive to expect a similar
experience on repatriation.
Existing literature retrospectively describes repatriation distress in survivor populations. The aim of the study
was to identify the uptake of web-based repatriation training within an encouraged study population and describe
the subsequent effect of the uptake of repatriation training on the encouraged group's psychological distress
during the initial 3 months following repatriation compared with a non-encouraged control group. The study
consisted of a prospective, randomised encouragement trial of international assignees of a multi-national
engineering company and their spouses/partners repatriating to their home countries to continue employment
with the company between July and November 2008. The intervention group were encouraged to undertake the
company web-based repatriation training tool. Twenty-four assignees and six partners participated in the
study. The study participants were followed at 6 and 12 weeks post-repatriation using the GHQ-12 and ASSET
tools respectively. Encouragement (n=15) did not confer any benefit on repatriation for the intervention group;
only a quarter (n=3) of the intervention group responded positively to encouragement to undertake the
repatriation training tool aimed to improve their wellbeing. As was expected two assignees used the repatriation
training tool available on the company intranet.
Evaluation at six weeks post-repatriation showed statistically significant distress levels on the GHQ-12 in both
the encouraged and non-encouraged groups which had resolved 3 months post-repatriation. For those who used
the repatriation training tool, benefit on repatriation was demonstrated; however the study size was not large
enough to show a true association. Length of international assignment has been associated with increased
adjustment difficulties on repatriation however this was not demonstrated in this study. The pattern of symptoms
experienced by the assignee population mirrored that of an adjustment disorder, although repatriation distress is
not currently recognised as an adjustment disorder in its own entity under ICD-10. It is currently considered to
be the final phase of culture shock under ICD-10.
P7-44
Prevalence of Intestinal Helminthes among Polish Peacekeepers in Eastern Chad, Central Africa
Korzeniewski, K.1
1
Military Institute of Health Service, Department of Epidemiology and Tropical Medicine, Gdynia, Poland
Objective: The study presents results of the research into the prevalence of intestinal helminthes occurring
among Polish peacekeepers serving in the United Nations mission in eastern Chad, Central Africa.
Material and methods: The material subjected to analysis were fecal specimens collected from 274 patients of
Polish nationality aged 21 to 54, residing temporally (6-month period, May-October 2009) during rainy season in
Sahel region. Stool had been collected from each patient three times. The samples were then analyzed in terms of
incidence of parasitic diseases of gastrointestinal tract, mainly soil-transmitted helminth infections. The
following laboratory testing methods were applied: direct preparation in Lugol's solution, decantation procedures
in distilled water, Faust's flotation procedures.
Results: From September to October 2009, 113 cases of infestations with intestinal helminthes were diagnosed
in 95 patients of the examined group (n = 274) of Polish soldiers (percentage of the infected 34.7%). In most
cases they were simple infestations (77, 81% of patients). Complex infestations were diagnosed in 18 of all
infected patients (19%). Infestation with Strongyloides stercoralis prevailed (68 cases, 60.2% of all pathogens).
Other helminth pathogens also were diagnosed: Ascaris lumbricoides (41, 36.3%), Taenia sp. (4, 3.5%).
Conclusions: In eastern Chad, a region where soldiers of the UN mission execute mandatory tasks, there is a
high risk of helminth infections.
The source of parasite infestation is soil, water intakes, and infected food from the local market. Diagnosed
intestinal parasites (strongyloidiasis, ascariasis, taeniasis) pose a considerable health problem for infected
soldiers, they are also an epidemiological hazard for soldiers' relatives in country of origin, in cases of importing
pathogens.
_______________________________________________________________________________________ Page 84 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P7-45
Seasonal Pattern of Rainfall and Malaria Incidence among Long Term Expatriates Seeking Medical
Attention in Central Nigeria over a 10 Year Period
Grasteit, A.1
1
Life Camp Clinic, Abuja, Nigeria
A seasonal pattern for Malaria transmission related to rainfall is known in native population in endemic areas.
Transmission is associated with poor quality housing. Long Term staying Expatriates in Sub-Saharan Africa tend
to live in high quality accommodation. The influence of such difference is unknown. This Study is investigating
the Incidence of Malaria in Expatriates seeking medical attention in central Nigeria and whether this will
correlate with the seasonal pattern of precipitation.
Methods: In a retrospective investigation, medical records of 55032 Expatriate patients (pat) who were clinically
screened for Malaria from 2000 to 2009 were analyzed. The population, mainly of European origin, is living in
the periurban area of Abuja/Nigeria, in good quality houses with mosquito nets, air condition and closeable
windows. They had regular instructions about the risk of Malaria. None of them had a chemoprophylaxis.
Diagnosis was made if Malaria parasite of any species was confirmed by microscopy either in thin- or thickfilm,
Quantitative Buffy Coat test or Immunochromatographic test was positive. Rainfall was measured daily.
Spearman Rank Order Correlation Coefficient and Chi Square Test for linear trends were used for Statistical
Analysis.
Results: Out of the screened pat 8099 underwent laboratory investigation for Malaria. 428 were found positive.
The overall Malaria Incidence is 0,78/100pat. Incidence is lowest in Mar (0,21/100pat) and highest in Oct
(1,53/100pat), 2 months after peak rainfall. Incidence decreases afterwards. Rainfall is lowest in Dec to Feb (<
3mm) and increases to a peak in Aug ( 328mm) with strong variations over the years. There is a correlation for
rainfall and Malaria for the whole annual circle (p< 0,05). There is a strong correlation between Malaria and
increasing rainfall and from Mar to Aug and a decreasing rain from Oct to Feb. Despite high rainfall in Sep there
is a low Incidence. There is no correlation between single month rainfall and Malaria.
Conclusion: Overall Incidence of Malaria among Expatriates seeking medical attention in Central Nigeria is
low. Quality housing does not affect the correlation of rainfall and Malaria but may explain low overall
Incidence. Single month rain reports are not useful for Malaria prediction. Low Incidence in Sep can be caused
by washed out breeding habitats and traveling habits of the population. This study supports an increased Malaria
precaution at peak rain season and shortly after.
P7-46
Automated External Defibrillators (AED) in German Embassies
Sasse, J.1, Boelke, N.1, Winkler, E.1
1
German Foreign Office, Medical Service, Berlin, Germany
Objectives: Ventricular fibrillation (VF) remains one of the major cardiovascular causes of death worldwide.
Despite growing evidence of the beneficial impact of early defibrillation concepts designed for public
institutions in Germany are scarce. They are virtually non-existing for those abroad (e.g. German Embassies) on
account of both legal concerns and lack of appropriately trained staff.
Methods: The medical service of the German Foreign Office reviewed published data upon early defibrillation
by non-medical staff. Particular emphasis was put on both scientific evidence and legal aspects in medical
databases (e.g. pubmed) or guidelines of professional medical associations and legal statements of relevant
institutions (e.g. German Board of Physicians, Ministry of Justice). To match evidence and a solid legal
background with the specific setting of 230 German Embassies worldwide an AED-integrated concept was to be
designed.
Results: The published data supports strongly that early defibrillation by non-medical staff significantly reduces
mortality in VF. This is provided that they have received basic training in cardiopulmonary resuscitation (CPR)
before, i.e. a basic module (8 sessions of 90min each) incl. CPR and AED followed by a refresher module of
equal length. AED are likely to be of a reasonable benefit only in case of the following circumstances:
1) sufficient skills in CPR,
2) professional medical facilities to provide further cardiac care within reach (i.e. < 30min),
3) placement in a setting frequented by approximately 10,000 persons per year.
_______________________________________________________________________________________ Page 85 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ As a consequence eligible German Embassies and motivated staff to be trained were identified by a specific
questionnaire. Identified employees would participate in the basic training before they go abroad and the
refresher course during their home leave every 2 years.
Conclusions: Consistent with current medical guidelines and prevailing national law AED are considered to be
of substantial benefit only if preceded by adequate CPR and followed by state-of-the-art clinical management
regardless of any geomedical peculiarities. Hence, only those German Embassies matching these criteria will be
supplied with AED after standardized training modules for the employees.
P7-47
Risk Factors for Work-related Back Pain among Khon Kaen University Office Workers in Thailand
Chaiklieng, S.1, Suggaravetsiri, P.2
1
Khon Kaen University, Department of Environmental Health Science, Faculty of Public Health, Muang, Khon
Kaen, Thailand, 2Khon Kaen University, Department of Epidemiology, Faculty of Public Health, Muang, Khon
Kaen, Thailand
This descriptive study was designed to investigate risk factors and the prevalence of work-related back pain in
University office workers. Participants were 142 full time University office staff from Khon Kaen University.
Demographic data, stress, nutritional status, work environment factors, and behaviors of back pain prevention
were evaluated from structured questionnaires. The intensity of lighting at work stations was measured using a
light meter. Percentage of back pain, muscle pain and other parameters were calculated. Testing for association
between back pain and studied factors was performed using Pearson's Chi squared test. The results showed that
the mean age was 38.0 years among office workers (SD = 10.0). The average body mass index of men (23.2
kg/m2) and women (21.9 kg/m2) were significantly different (p-value = 0.04). Prevalence of back pain during
working hours among office workers during the past month was 69.0%. Most office workers experienced
discomfort of neck (61.3%), shoulder (64.8%), and low back (66.9%) during the last month. Light intensities at
most work stations (91.5%) were lower than the minimum standard requirement (600 lux). The high prevalence
of back pain and the results of work environment investigations suggest that University office workers are
exposed to hazards in their work environment.
P8-48
Travel-related Schistosomiasis, Strongyloidiasis, Filariasis, and Toxocariasis: The Risk of Infection and
the Diagnostic Relevance of Blood Eosinophilia
Baaten, G.1,2,3, Sonder, G.1,2,3, Van Gool, T.3, Kint, J.1, van den Hoek, A.1,3
1
Public Health Service Amsterdam, Infectious Diseases, Amsterdam, Netherlands, 2National Coordination
Centre on Travellers' Advice, Amsterdam, Netherlands, 3Academic Medical Centre Amsterdam, Infectious
Diseases, Tropical Medicine and AIDS, Amsterdam, Netherlands
Objective: The significance of helminth infection and the predictive properties of blood eosinophilia in
travellers is unknown. This study prospectively assessed the occurrence of and risk factors for clinical and
subclinical schistosomiasis, strongyloidiasis, filariasis, and toxocariasis, and the diagnostic relevance of
eosinophilia in travellers to tropical and subtropical destinations.
Methods: Adult short-term travellers donated blood samples for serology and blood cell count before and after
travel. Data on travel itinerary and symptoms of infectious diseases were recorded by using a structured diary.
Blood samples were tested for eosinophilia, and for antibodies against Schistosoma species, S. stercoralis,
filariasis, and T. canis. Probable previous infection was defined as a seropositive pre-travel and post-travel
sample. Probable recent infection was defined as a seropositive post-travel sample with a seronegative pre-travel
sample.
Results: Previous infection was found in 114 of 1207 subjects: 2.7% for schistosomiasis, 2.4% for
strongyloidiasis, 3.4% for filariasis, and 1.8% for toxocariasis. Eleven travellers had evidence for co-infection.
Recent schistosomiasis was found in 0.51% of susceptible subjects at risk, strongyloidiasis in 0.25%, filariasis in
0.09%, and toxocariasis in 0.08%. The incidence rate per 1000 person-months was 6.4, 3.2, 1.1, and 1.1,
respectively. Most recent infections were contracted in Asia.
None of the symptoms studied had any predictive value. The positive predictive value of eosinophilia for the
serological diagnosis of previous infection was 15% and of recent infection 0%.
Conclusion: The chance of recent infection with schistosomiasis, strongyloidiasis, filariasis, and toxocariasis
during one short-term journey to an endemic area is low. However, repeated exposure from previous travel leads
_______________________________________________________________________________________ Page 86 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ to a considerable cumulative risk of infection. Determining the blood eosinophil count appeared to be of no
value for routine screening for the four studied helminthic infections in asymptomatic travellers. Findings need
to be replicated in larger, prospective studies.
P8-49
Epidemiology of Travel Associated Infectious Diseases Morbidity in Europe, 2008
Field, V.1, Gautret, P.2, Schlagenhauf, P.3, Burchard, G.-D.4, Caumes, E.5, Jensenius, M.6, Castelli, F.7, GkraniaKlotsas, E.8, Weid, L.9, von Sonnenburg, F.10, López-Vélez, R.11, Loutan, L.12, de Vries, P.13, Parola, P.2,
EUROTRAVNET
1
Interhealth, London, United Kingdom, 2AP-HM, Infectious and Tropical Diseases, Marseille, France,
3
University of Zurich, Centre for Travel Medicine, Zurich, Switzerland, 4University Medical Center, BernhardNocht Clinic for Tropical Medicine, Hamburg, Germany, 5Hôpital Pitié Salpétrière, Infectious and Tropical
Diseases, Paris, France, 6University Hospital Ulleval, Infectious Diseases, Oslo, Norway, 7University of Brescia,
Institute for Infectious and Tropical Diseases, Brescia, Italy, 8Addenbrooke's Hospital, Cambridge, United
Kingdom, 9ISTM/GeoSentinel, Victoria, BC, Canada, 10LMU University, Infectious Diseases and Tropical
Medicine, Munich, Germany, 11Ramon y Cajal Hospital, Tropical Medicine and Clinical Parasitology, Madrid,
Spain, 12Geneva University Hospital, Division of International and Humanitarian Health, Geneva, Switzerland,
13
Academic Medical Centre, University of Amsterdam, Tropical Disease Unit, Amsterdam, Netherlands
Objective: To investigate the epidemiology of travel associated morbidity in European travelers in 2008.
Methods: Travelers presenting in 2008 to EuroTravNet Core sites with a presumed travel associated condition
were included in the analysis. Diagnoses with demographic, clinical and travel related predictors of disease were
documented.
Results: 6957 patients were included. Gastro-intestinal (GI) diseases accounted for 33% of illnesses, followed
by febrile systemic illnesses (20%), dermatological conditions (12%) and respiratory illnesses (8%). 3 deaths
were recorded; E.coli pyelonephritis and sepsis following a 2-month sojourn in Spain, Dengue Shock Syndrome
following a 3 week pre-arranged tourist trip in Thailand and a P. falciparum malaria related death in an aid
worker who had visited Liberia for 3 weeks. GI conditions included bacterial acute diarrhea (6.9%), as well as
giardiasis and amebiasis (2.3%). Among febrile systemic illnesses with identified pathogen, malaria (5.4%)
accounted for most cases followed by dengue (1.9%), chikungunya, rickettsiosis, leptospirosis, brucellosis,
Epstein Barr Virus infections. Among dermatological conditions, bacterial infections, arthropod bites, larva
migrans and animal bites requiring rabies post-exposure prophylaxis accounted for most cases. Leishmaniasis,
myasis, tungiasis and one case of leprosy and TBE respectively were also recorded. Respiratory illness included
112 cases of tuberculosis with 6 cases of multidrug-resistant and extensively drug-resistant tuberculosis, 104
cases of influenza like illness, 5 cases of Legionnaires disease (2 of which were acquired in Spain). Sexually
transmitted infection (STI) accounted for 0.6% of total diagnoses and included HIV/AIDS and syphilis. A total
of 165 cases of potentially vaccine preventable diseases were reported. Purpose of travel and destination specific
risk factors was identified for several diagnoses such as Chagas disease in immigrant travelers from South
America and P. falciparum malaria in immigrants from sub-Saharan Africa.
Conclusions: In 2008, a broad spectrum of travel associated morbidity was observed in EuroTravNet sites.
Diagnoses varied according to regions visited by travelers. Travel within Europe is also associated with
distinctive risk profiles for Eastern and Western Europe. These data define the epidemiology of travel associated
illness in European travelers and underline the necessity for evidence-based pre- and post-travel interventions.
P8-50
The Prevalence and Correlation of Giardiasis with the Nutritional Status of Primary School
Students in Isfahan City, Iran
Dorostkar Moghaddam, D.1, Eyni, H.2
1
School of Medicine, Isfahan University of Medical Sciences, Parasitology, Isfahan, Iran, Islamic Republic of,
2
Sajad Medical Lab, Medical Lab, Najaf Abad, Islamic Republic of Iran
Objectives: Giardiasis is distributed throughout the world.The prevalence of this parasitic disease ranges from 5
to 60% in Iran.It might be responsible for the development of malabsorption as well as malnutrition among some
chidren.
_______________________________________________________________________________________ Page 87 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Methods: This study was undertaken to determine the prevalence of this diseas as well as its role in the
nutritional sratus of primary school students in isfahan.
A total 1200 students was selected from among the first of fifth grade levels.
Specimens were collected in 10% formalin. Parasite specimens were concentrated by formalin-ether.Data were
analysed by SPSS to determine any significant difference between infection rates in students.
Results & conclusions: The prevalence rate was 41.4% and 41% among girls and boys, respectively.
According to class level from the first to fifth grades,it was 44.9%,49,3%,42,7% ,45.3,
and36.9%,respectively.
This project demonstrates that the prevalence of Giardiasis is relatively high Isfahan at primary school level.
In addition, malnutrition related to Giardiasis was higher among female rather than male students.
P8-52
Hazards of Scorpions Stings in South and Southwest of Iran
Bouree, P.1, Ensaf, A.2
1
Paris XI University, Parasitology Dept, APHP, Kremlin-Bicetre, France, 2Bicetre Hospital, Paris XI University,
Parasitology Unit, Kremlin-Bicetre, France
Background: Scorpion stings are a major public health problem in Iran. The northern part is covered by dense
rain forest, but the south, southern and eastern part consists mostly of semi-desert and desert areas and scorpions
stings are frequent (>50 000 cases/year).
Patients and methods: From 1977 to 2006, 44088 cases of animal bites had been reported to Khuzestan Health
Center and 61 deaths. Many soldiers, in the frontline Iran-Iraq, since 1981, were wounded by scorpion stings.
They were treated at emergency department with specific antivenom against Hemiscorpious lepturus, one of the
most dangerous scorpions in this country. Androctonus crassicauda is the second most frequent causes of
scorpion stings in south-west Iran.
Discussion: Most of the stings are harmless with a benign clinical course, but some patients have serious and
acute life-threatening complications in respiratory, neurologic and cardio-vascular systems. The leading causes
of death related to scorpion envenomations are cardiac dysfunction and pulmonary oedema. Scorpion venoms
contain neurotoxin, hemolysins, haemorragins, agglutinins, leucocytolysins, coagulins, ferments, lecithin and
cholesterin. Envenomation by scorpion stings in children is a major public health problem, mostly during the hot
season in the rural areas, with about 50 fatal cases/year. There are more than 32 species of scorpions in Iran, in 3
families : Buthidae, Scorpionidae and Hemiscorpiidae. In Khoozestan province, there is a large diversity of
species of scorpions, such as Hemiscorpius lepturus, Androctonus crassicauda and Mesobuthus eupeus which
play an important role in almost all cases of scorpion stings in this country. In Kashan, a city in central Iran,
most of the stings are due to Androctonus crassicauda and Mesobothus eupeus. Its venom can cause severe pain,
central nervous system and muscle disturbances and death. Its venom can stimulate a neurotoxic venom as
acetylcholine receptors through the body. So, sting of Odontobuthus doriae can provoke disoriented and severe
dyspnea, increased salivation, nausea, urinary incontinence, confusion, local muscle spasm and general muscle
paralysis. Polyvalent scorpion antivenom (Razi Vaccine & Serum Research Institute, Hesarak, Karaj, Iran) and
vaccination for tetanus are used. It is seriously recommended to be careful against scorpion stings in the south
and south-west province in Iran, especially during the hot period.
P8-53
Study on Snake Bites in Iran: 134 Patients
Ensaf, A.1, Bourée, P.2
1
Paris XI University, Parasitology Unit, Kremlin-Bicetre, France, 2Bicetre Hospital, Paris XI University,
Parasitology Unit, Kremlin-Bicetre, France
Background: With a great diversity of geographical and climatic conditions, Iran supports a rich flora and
fauna, particularity the snakes. In summer, snakes bites are frequent.
Patients and methods: Among 894 patients who complaint of animals bites, mostly are due to dogs (69%),
mice (12,6%) and snakes (4,4%). 103 adults patients with snake bites (72 males and 27 females) were evaluated.
Among these patients, were found hemoglobinuria (50%), hematuria (68%), proteinuria (29%), bacteriuria (1%),
anemia (33%), rhabdomyolysis (74,8%), myoglubinuria (45,6%), leukocytosis (12,7%), thrombocytopenia
(1,9%) and coagulopathy (65%), with a mortality rate of 8,6%. Moreover, 31 children complained of snake bites
_______________________________________________________________________________________ Page 88 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ (mean age : 5,1 years old), with a sex-ratio M/F 1,8. Most common clinical manifestations were pain (100%) and
swelling (95%), with a mean hospital stay time of 4,8 days.
Discussion: In Iran, more than 60 species of snakes have been identified which are belonging to different
families: Boidae, Colubridae, Crotalidae, Elapidae, Hydropidae, Leptotyphlopidae, Typhlopidae et Viperidae.
The dangerous semivenomous are Colubridae : Telescopus, Boiga, Maipolon, and Psammophis. The venomous
snakes are belonging to 4 families : Crotalinae, Elapidae, Hydrophilidae and Viperinae. The very dangerous
terrestrials venomous species are: Agkistrodon, Cerastes, Echis, Naja, Pseudocerstes, Vipera, Walternnesia. The
venomous sea snakes are Enhydrina and Hydrophis. One of the most dangerous is Echis carinatus because of its
high population density around the cities, agriculture areas and in the semi desert regions. These snakes have a
very complex heterogeneous venom, containing enzymes, lethal peptides, proteins, metals, carbohydrates, lipids,
biogenic amines, free amino acids and direct hemolytic factors. Children bitten by the venomous snakes produce
an emergency condition with high mortality. Patients are treated with polyvalent antivenom serum (Institute Razi
Iran). Dose-related anaphylactic reactions is mostly induced by too rapid injection of this serum. So, a skin test
for hypersensitivity to horse serum is necessary before administration of this antivenom.
Conclusion: As more snaked biting occurred in summer, it is advised to be careful in the open country, and even
around the cities. To avoid getting bitten by a snake we must not step on it, and it is better to reduce this risk by
wearing boots and using sticks to turn over rocks or logs.
P8-54
Tick Borne Diseases in Romania - an Update
Popescu, C.P.1, Florescu, S.A.1, Ceausu, E.1, Calistru, P.I.1
1
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
Background: The number and the behaviour of tick population is changing due to global warming; this is
followed by an increase of the tick bites in human population. The most frequent tick borne diseases in Romania
are Boutonneuse Fever (BF) and Lyme disease (LD) but in the climaterical context the risk of emergence of
other tick borne diseases is increasing, mainly for Crimean Congo Haemorragic Fever and Tick Borne
Encephalytis (recent outbreaks in Turkey, Greece respectively in Central Europe).
Methods: Retrospective study of epidemiological, clinical and diagnostic issues of the BF and LD admitted in
our clinical hospital between 2004- 2008.
Results: There were 32 LD and 69 BF cases. The LD cases were mainly women (22 versus 10); in BF sex ratio
was near 1:1. The age interval ranged between 1 - 75 years for BF (mean value 44,2); for BL the age interval
ranged between 5- 65 years (mean value 29,4). 45 BF cases were recorded during summer; on the contrary the
LD cases did not manifest any seasonality. 65 of the BF cases and in 19 LD cases had epidemiological risk
factors. The clinical manifestation for BF were fever, myalgia, rash (60 cases), tache noire (35) and conjunctival
hyperemia (4). Laboratory findings in BF cases were increased neutrophils count (45) and ALAT value (49),
thrombocytopenia (45). ELISA test for Rickettsia Conorii were positive in 59 cases. Patients were treated with
Cloramphenicol (29 cases), Doxycycline (14), Ciprofloxacin (9), Clarithromycin (4) or antibiotic associations
(13 cases). 5 BF cases presented encephalitis and 1 of them died. 18 patients with LD had erytema migrans (13),
parestesia, arthralgya (12), seizure (1), urinary bladder paresis (1), hallucination (1), taste and smell disturbance
(1), neuroretinitis (1). ELISA test for Borrelia Burgdorferii were positive in 25 cases, 8 of them were also
confirmed by Western- Blot test. Patients were treated with Ceftriaxon (29 cases), Doxycycline (2) and
Meropenem (1). All patients were cured.
Conclusions: BF mantained characteristic summer seasonality; no seasonality was recorded for LD.
Epidemiological risk factors were identified in 94,2% of BF cases and in 59,4% of LD cases. As a particular
aspect, LD cases were more frequent in women.
P8-55
Prevalence of Bartonella SPP in Ectoparasites Collected from Domestic Dogs (Canis familiaris) in Piraí,
State of Rio de Janeiro, Brazil: Preliminary Results
Moreira, N.S.1,2, Favacho, A.R.2, Souza, A.M.3, Barreira, J.D.2, Lemos, E.R.S.2, Almosny, N.R.P.3
1
Universidade Federal Fluminense, Vetrinaria, Niterói, Brazil, 2Instituto Oswaldo Cruz- FIOCRUZ, Laboratorio
de Hantavirose e Rickettsiose, Rio de Janeiro, Brazil, 3Universidade Federal Fluminense, Niterói, Brazil
Objectives: Bartonella spp., gram-negative bacteria, is the etiologic agent of human bartonelosis, is the agent of
Cat-Scratch Disease, but is also responsible for more severe conditions, transmitted by arthropod vectors, that
_______________________________________________________________________________________ Page 89 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ can cause clinical diseases in dogs. Mammals, among them cats and rodents, are the reservoirs and arthropods, as
lice, fleas, phlebotomines and ticks, the vectors. Recent publications emphasize its zoonotic potential. The aim of
the present study was to investigate the presence of Bartonella spp. in ectoparasites, using molecular methods
(polymerase chain reaction).
Methods: Ectoparasitic arthropods were captured from their healthy natural hosts (Canis familiaris) in Piraí,
State of Rio de Janeiro, southeast Brazil (latitude 22º28'12”, logitude43º49'32”), during rabies vaccination in
2006 and 2007. These ectoparasites were taken to the Laboratory of Hantavirosis and Rickettsiosis, Oswaldo
Cruz Institute, FIOCRUZ (Rio de Janeiro) and were kept at -20ºC for further processing. Tick tissues were
submitted to molecular analysis. QIAamp DNA Blood Mini Kit (QiagenTM, Hilden, Germany) was used for
DNA extraction, following the manufacturer's instructions. We searched for Bartonella genes using primers
CAT1 [5′GATTCAATTGGTTTGAA(G/A)GAGGCT3′] and CAT2 [5′
CACATCACCAGG(A/G)CGTATTC3′], targeting the gene htrA was done as previously described.
Results and conclusions: From the 186 ectoparasites obtained, 125 were Rhipicephalus sanguineus (adults), 3
R. sanguineus (nymph), 3 Amblyomma cajennense (adults), 16 A. cajennense (nymph), 30 Ctenocephalides
canis, 8 Ctenocephalides felis and 1 Anocentor nitens. From 97 samples analyzed, segments of Bartonella genes
were amplified in 41 (42,26%) samples. We concluded that members of genus Bartonella are circulated in this
region and this fact is relevant due to the zoonotic potential of this group of bacteria.
P8-56
Molecular Detection of Rickettsia SP. in Ectoparasites Collected from Domestic Dogs (Canis familiaris) in
Piraí, in the State of Rio de Janeiro, Brazil: Preliminary Results
Moreira, N.S.1,2, Favacho, A.R.M.2, Barreira, J.D.2, Lemos, E.R.S.2, Almosny, N.R.P.1
1
Universidade Federal Fluminense, Niterói, Brazil, 2Instituto Oswaldo Cruz- FIOCRUZ, Laboratorio de
Hantavirose e Rickettsiose, Rio de Janeiro, Brazil
Objectives: Diseases caused by spotted fever group rickettsiae (SFGR) pose an important problem to world
public health. Although several Rickettsia species have been recovered from different vertebrates and arthropods
as fleas, lice and ticks in the last decade, only 2 SFGR, Rickettsia rickettsii and R. felis, are known to cause
human infections in Brazil. The transmission of Brazilian spotted fever (BSF), an acute zoonose caused by R.
rickettsii, is primarily associated in endemic area with Amblyomma cajennense and A. aureolatum.
Rhipicephalus sanguineus, common ticks in urban area, has been also recognized as a vector of Rocky Mountain
spotted fever in United States but its role in transmission of SFGR to the human being has not been clarified in
Brazil. As Brazil is a large country with wide environmental diversity where ecotourism is an economic activity
and some of these areas are endemic to BSF, the aim of our study is to determine prevalence of SFGR infection
in R. sanguineus captured in an endemic for Brasilian Spotted Fever.
Methods: Ectoparasitic arthropods were captured from their healthy natural hosts (Canis familiaris) at Piraí Rio de Janeiro state, southeast Brazil (latitude 22º28'12”, logitude43º49'32”), between 2006 and 2007. These
ectoparasites were taken to the Laboratory of Hantavirosis and Rickettsiosis, Oswaldo Cruz Institute, FIOCRUZ
(Rio de Janeiro) and were kept at -20ºC for further processing. Tick tissues were submitted to molecular
analysis. QIAamp DNA Blood Mini Kit (QiagenTM, Hilden, Germany) was used for DNA extraction, following
the manufacturer's instructions. Specific primers for the selected genes (citrate synthase [gltA] and 17-kDa
protein [htrA]) were used for amplification (PCR).
Results and conclusions: From the 186 ectoparasites obtained, 125 were Rhipicephalus sanguineus (adults), 3
R. sanguineus (nymph), 3 Amblyomma cajennense (adults), 16 A. cajennense (nymph), 30 Ctenocephalides
canis, 8 Ctenocephalides felis and 1 Anocentor nitens. Segments of rickettsial genes, 17 kDa antigen gene and
gltA fragment, were amplified from 97 samples: 42 (43,29%) samples SFGR positive to 17-kDa protein and 13
(13,40%) positive to citrate.. Although the results are preliminary, this research not only confirms the importance
of dog as the amplifier host to SFGR in Brazil but also provides more evidence that R. sanguineus can be
important role in transmission to BSF.
_______________________________________________________________________________________ Page 90 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P8-57
Seroprevalence for Anti-Ehrlichia Canis and Anti-Rickettsia Rickettsii in a Dog Population of Rio De
Janeiro, Brazil
Rozental, T.1, Moreira, N.S.1, Oliveira, R.C.1, Lemos, E.R.S.1
1
Instituto Oswaldo Cruz- FIOCRUZ, Laboratorio de Hantavirose e Rickettsiose, Rio de Janeiro, Brazil
Objectives: The city of Rio de Janeiro is a region tropical climate and receives thousands of tourists annually.
Among some tropical diseases in the city, the tick born diseases are endemic among them and we can mention
the canine ehrlichiosis, the target of large studies in the field of public health. The presence of numerous cases of
canine ehrlichiosis is a factor to be studied clinically in healthy animals with history and presence of ticks in
order to assess their zoonotic potential, but also the participation of dogs as sentinel animals for other
rickettsiosis. The Ehrlichiosis is a zoonotic disease, the causative agent Ehrlichia spp, and is transmitted to the
host through arthropod´s bites.
Methods: Sera from 84 dogs (Canis familiaris), both sex aged between 1 month to 17 years, living in different
neighborhoods of Rio de Janeiro, were collected at the Institute of Veterinary Medicine Jorge Vaitsman and sent
to Hantavirosis and Rickettsiosis Laboratory. The tests were performed using a commercial Rickettsia rickettsii
and Ehrlichia canis indirect immunofluorescence assay for immunoglobulin G (PANBIO™ / SCIMEDX™)
considering a cut-off titer at 64.
Results and conclusions: All samples were negative to R.rickettsii and to E.canis: 4.76% were negative, 2.4%
reactive at 64 titration and 16.7% reactive at ≥ 512 titration. The results confirm the circulation of canine
ehrlichiosis in Rio de Janeiro and the presence of arthropod vectors can accidentally transmit the disease to
human. This is an important fact for the epidemiological study of ehrlichiosis due to the close relation between
dogs and men.
P8-58
Border Health Measures at the Hamburg Airport during the 2009 Influenza Pandemic
Gau, B.1, Schlaich, C.C.1
1
Institue of Occupational and Maritime Medicine, Hamburg Port Health Center, Hamburg, Germany
Objectives of the study: During the current 2009 Influenza pandemic most countries implemented border health
measures at points of entry for reasons of surveillance and containment of disease. The study reviews the
detection of cases through border health measures implemented at Hamburg Airport.
Methods: The study is a systematic review of the travelers who were medically assessed at the Airport from
April to September 2009. Data were collected prospectively by a standardized protocol. Included in the data
analysis are ill travelers and contacts to symptomatic persons. Airport employees and visitors of the airport are
excluded from the analysis. If the case definition was met, nasal and/or pharyngeal swabs were collected for
Influenza real time-PCR.
Results: A total of 108 passengers with symptoms or contacts to ill persons were assessed by the Hamburg Port
Health Center at the airport. Mean age of travelers seen by our service was 30 years (range 6 to 70 years). The
majority of passengers (102 out of 108 persons) were seen in July and August 2009. Most of these persons
returned from touristic sites in Spain. All persons consented to the medical assessment and documentation of
contact details. Only five times a case of communicable disease was detected onboard an airplane by the flight
attendants due to overt symptoms and resulted in a notification of disease by the pilot. Of 139 airplanes arriving
from affected areas which did not notify a disease were visited by our service right after arrival in Hamburg. In
none of those vessels the notification status changed as a result of the inspection. All passengers seen by our
service continued their voyage to their final destination. Referral to a hospital due to severity of disease was not
necessary in any person. In 34 symptomatic passengers nasal or pharyngeal swabs were taken. 8.3% of test
results (n=9) were positive for Influenza A H1N1.
Conclusion: The data presented do not allow to evaluate the effectiveness of specific border health measures
such as legal notification requirements or public notices to travelers. However it can be concluded that
symptomatic passengers and contacts to sick persons are willing to actively seek and utilize medical advice
before or after travel at the airport, if readily available and accessible. Border health measures as implemented in
Hamburg did not significantly interfere with the air traffic due to pre-event contingency planning.
_______________________________________________________________________________________ Page 91 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P8-59
Molecular Identification of Borrelia sp. in Arthropods collected in Piraí County, State of Rio de Janeiro,
Brazil
Favacho, A.R.M.1, Moreira, N.S.1, de Almeida, D.M.P.1, Pesoa Jr, A.A.1, Barreira, J.D.1, Lemos, E.R.S.1
1
Instituto Oswaldo Cruz- FIOCRUZ, Laboratorio de Hantavirose e Rickettsiose, Rio de Janeiro, Brazil
Objectives: Borreliosis are zoonoses caused by spirochetes of the genus Borrelia transmitted to humans and
other animals by ticks of the genus Ixodes and non-Ixodes, such as Amblyomma ticks. In the USA and Europe,
Borrelia burgdorferi sensu lato complex has been isolated and identified in many different animal species, yet
clinical manifestations of the disease have been reported in dogs, horse, and cattle. In Brazil, despite the clinical
and epidemiological evidence of the occurrence of a "Lyme-like" disease in the states of Amazonas, Mato
Grosso do Sul, Rio de Janeiro and São Paulo, to date, the agent was not characterized in our territory. The
disease in human typically begins with a skin rash, and often associated with flu-like symptoms that may be
followed weeks to months later by cardiac, neurological and joint disease. Travelling of pets from vector-borne
disease endemic areas into Brazil poses a risk for the introduction and dissemination of exotic pathogens if
competent vectors are present. The aim of this study was carried out in order to verify the possible presence the
DNA of Borrelia in arthropods found of dogs in Piraí County, located in a touristic region in the state of Rio de
Janeiro.
Methods: Arthropods were captured from their healthy natural hosts (Canis familiaris) at Piraí County - Rio de
Janeiro state, southeast Brazil. The arthropods were taken to the Laboratory of Reference Hantavirosis and
Rickettsiosis (LRHR) and were kept at -20ºC for further processing. All arthropods were taxonomically
identified at the LRHR (35 Rhipicephalus sanguineus, 14 Amblyomma cajennense, 10 C. canis and 04 C. felis).
Ticks were washed out using solution of sodium hypochlorite and 70% alcohol, and subsequently, their DNA
was extracted using QIAamp DNA Blood Mini Kit (Qiagen), following the manufacturer's instructions. The
polymerase chain reaction was performed in different stages (nymphs, larvae and adults), using pairs of primers
for Borrelia (OspA1/OspA2; p66-1/p66-2; Fla-1/Fla-2), which amplify different regions of the bacterial genome.
Results and conclusions: In a total of 56 samples tested for Borrelia ssp, 36 (64,3%) were PCR positive. These
preliminary results confirm the circulation of Borrelia spp in population of ticks of genus Amblyomma and
Rhipicephalus at Rio de Janeiro. Further studies, including molecular characterization of Borrelia, are necessary
in order to define the presence and the importance of the borreliosis in Brazil.
P8-60
Acute Primary Dengue Infections in Finland
Erra, E.1,2, Huhtamo, E.2, Vapalahti, O.2, Kantele, A.1,2
1
Helsinki University Central Hospital, Department of Medicine, Division of Infectious Diseases, Helsinki,
Finland, 2Haartman Institute, Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki,
Finland
Background: Dengue is a major international public health problem causing approximately 50 million
infections annually worldwide (WHO). Due to rapidly evolving epidemiology of the virus and increased travel to
dengue endemic regions, a traveller's acute dengue infection is no longer an uncommon finding in a non-endemic
country like Finland. The aim of this study was to characterize acute primary dengue infections diagnosed in
Finland during 1999-2008.
Methods: In Finland, the laboratory diagnostics of dengue fever is based on serological testing. The study
material consisted of patients who had experienced a serologically diagnosed acute primary dengue infection
(using criteria of having IgM antibodies and an IgG titer of 320 or less) in Finland during 1999-2008. Data were
gathered retrospectively from patient records on several factors, including among other things patient's
nationality, travel destination, clinical symptoms, laboratory findings and duration of hospitalization.
Results: From 1999 to 2008, altogether 90 acute primary dengue diagnoses were made in Finland. The number
of cases/year increased gradually during this follow-up. Further data was available in 81% of the cases. 12% of
the patients were foreign-born, having either visited friends and relatives in their home country or having
recently moved to Finland from an endemic area. Dengue was most often acquired from travels to Asia (71 %).
The single most common travel destination was Thailand (32%). Symptoms most often reported were fever
(89%), rash (68%) and headache (61%). The most common laboratory findings were a decreased platelet count
(60%), an increased level of alanine aminotransferase (59%) and a decreased white blood cell count (50%). Creactive protein was on average mildly increased (28.5 mg/l). In cases where CRP was higher than 100 mg/l, also
_______________________________________________________________________________________ Page 92 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ a co-existing bacterial infection or malaria was diagnosed. 74% of the patients were taken to hospital for a mean
duration of 4.5 days.
Conclusions: The number of patients with imported acute primary dengue infection has increased in Finland
over the past ten years. The infection is most often acquired in Thailand, which is at least partly explained by
recent changes in travel habits. Even though the disease is usually mild, the majority of the patients are taken to
hospital. Pre-travel advice on protection against mosquito bites should be emphasized when travelling to
destinations where risk of mosquito-borne diseases is high.
P10-61
Evaluation of Foreign Travelers Registrations in Balcali Hospital of Cukurova University
Tanir, F.1, Aytac, N.1, Akbaba, M.1
1
Cukurova University, Faculty of Medicine, Department of Public Health, Adana, Turkey
Aim: Balcali Hospital of Cukurova University, which is the 7th biggest university of Turkey, offers training,
research and health services as the biggest health institution of the region, with its capacity of 1208 beds. Foreign
travelers apply to the hospital either directly or indirectly through referral of a lower health institution. Our study
was planned to share the evaluation of the health profiles of the foreign tourists applying to the hospital in the
last one year.
Method: Health profiles of the foreign tourists applied to Balcali Hospital of the Faculty of Medicine of
Cukurova University, between October 1 and December 31, 2009 were evaluated on SPSS program. Our study is
cross-sectional, retrospective registration research, with a definitive- qualitative nature.
Results: 634 foreign tourists, including 311 males (49.1%) and 323 females (50.9%), from 41 different
countries, applied to Balcali Hospital in 2009. Their mean age was 33.2±5.7. Respectively, 133 (21.0%) were
from Afghanistan, 131 (20.7%) from Turkmenistan, 57 (9.0%) from Tajikistan, 36 (5.7%) from Jordan and 31
(4.9%) from Cyprus. 123 different diagnoses were made for the applicants. 885 (91.7%) of them were diagnosed
with at least 1 disease. The most frequently seen diseases were Epilepsy in 33 patients (5.2%), Anemia in 32
patients (5.2%), Hypertension in 24 patients (3.8%), Injury in 22 patients (3.5%), Tonsillitis in 20 patients
(3.2%) while 12 of them were found healthy (1.9%). 29 of the patients were diagnosed with 12 different cancer
types. Satisfaction of these patients with the services they received during their examination and treatment in the
hospital was found as 88.5%.
Conclusions: We believe that tourists in Adana, particularly the ones with chronic and complicated diseases,
prefer Balcali Hospital as it is furnished with all kinds of diagnosis facilities and treatment units. It is important
that such kinds of health institutions should be informed before the arrival of the foreign tourists with these
diseases. We believe in the necessity that travel agencies and tourism offices of both countries follow up such
information which is very important for the health of the tourists.
Keywords: Tourist health, travel medicine, foreign travelers, medical care
P10-62
The Holiday Diver and a Clueless Doctor: A Risky Match
Faesecke, K.P.1
1
Private Diving Medical Practice, Hamburg, Germany
All around the year, millions of North-Europeans are boarding airplanes to spend time in tropical areas with
underwater activities. The fascination of diving with colourful fish is still unbroken; the number of dive-resorts
in most remote areas is ever increasing and seemingly not affected by any economic crises. Agressive marketing
is continuously suggesting that every body can dive and should do so. Colourful dive magazines add to this
illusion. A look behind the high-gloss scene reveals horrible accounts of fatalities and near-misses which are
only communicated among insiders.
It remains a fact that the underwater world is a hostile environment for mankind, having lost the adaptations that
diving mammals still feature. Any alert diver should therefore contact a medical doctor to find out wether any
bodily shortcomings might pose a health risk when going underwater.
But what does the doctor know about these health challenges? At least in this country there exists no official
qualification to assure the diver that her/his special needs are served in full. What about problems like diving
with handicaps, with medications, while pregnant? What about age limits, dental problems, diabetes, asthma,
pace-makers? A history of myocardial infarction, of stents or artificial valves? Does hypertension really pose a
risk if controlled by medication?
_______________________________________________________________________________________ Page 93 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ We are aware that diving medical societies in most European countries offer a wide range of courses and
voluntary qualifications to overcome the general deficits in this special field. One or two hours of diving
medicine is also included in many travel medicine refresher courses. But the acceptance by the medical
community does not match the demand by the ever increasing number of recreational divers.
In Great Britain every sport diver can sign his own medical clearance; in the Netherlands exists a well
established system of doctors´ certifications that is supported by all relevant organizations and welcomed by the
diving population.
Also,any doctor easily signing off a diver´s health certificate must be aware that this has a legal aspect, too.
The message should be quite clear: Please take diving medicine serious! Keep your hands off a diver if you are
not fully acquainted with the physical and physiological aspects of this unusual activity. It puts the diver at risk
and it could ruin your medical career. Or take one or two courses at your country´s society and enjoy a
fascinating new experience.
P10-63
A Research Network in Travel Medicine
Goodyer, L.I.1,2, Johal, M.1, Flaherty, G.3
1
De Montfort University, Pharmacy, Leicester, United Kingdom, 2Nomad Medical, London, United Kingdom,
3
Clinical Science Institute National University of Ireland, School of Medicine, Galway, Ireland
Research in travel medicine is actively conducted at both a national and international level but is arguably in its
infancy, with many research questions currently being identified and an evidence base that is sometimes quite
actively debated. It has been proposed by the British Travel Health association (BTHA) and the Irish Society of
Travel Medicine (ISTM) that a useful exercise might be to explore setting up a research network amongst its
own members. The aim of the project was to gauge the interest and potential involvement of BTHA and ISTM
members in a research network as well as identify what they perceived as the type of project that could be
usefully conducted through such a network.
Members of the BTHA and ISTM for whom email addresses were held were sent a simple electronic survey to
gather and explore the opinions of various healthcare professionals involved in travel medicine. The survey tool
has been previously validated and piloted, consisting of mainly structured closed questions with free text boxes
where appropriate. The email and web link for the survey was sent out over summer 2009.
105 from the UK responded with 75% indicating they would join a research network. From Ireland 38 responded
and 45% would join a network. Nurses tend to have the greatest input in the UK whereas in Ireland doctors
comprise a larger proportion. In both regions time (60%) seems to be the biggest barrier to research being
conducted in travel medicine. 34% of health professionals in the UK felt that a lack of support from their
employer is an important barrier, however in Ireland there were no such issues. The form of data collection that
appears to be most favoured in both regions is asking travellers to fill in questionnaires. For priorities of research
both regions favoured quality of advice, incidence of illness and adherence issues. Accidents and trauma, level of
service delivery and cost issues on the other hand had a low priority.
The main barrier to travel medicine research is time and asking travellers to complete a questionnaire is the most
favoured method for data collection. There appears to be no differences in main priorities for research between
the two countries. Based on the numbers of practitioners volunteering to take part in a research network this
seems to be a viable proposition.
P10-64
Results from an Online Survey evaluating Knowledge about Risks, Prevention and Consequences of
Infections with Hepatitis B Virus among Travellers from Four European Countries
Herbinger, K.-H.1, Prymula, R.2,3, Nothdurft, H.D.1
1
University of Munich, Infectious Diseases and Tropical Medicine, Munich, Germany, 2University of Defense,
Epidemiology, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic, 3University of Defense,
University Hospital, Hradec Kralove, Czech Republic
Objectives: This online survey aimed to evaluate knowledge about risks, prevention and consequences of
infection with hepatitis B virus (HBV) among travellers from four European countries.
Methods: Individuals were recruited from existing Internet panels. Invitations were sent proportionally
according to population spread and age range to maximise the probability of a nationally representative sample.
All 4,203 respondents were: 18 years, or older; living in either The Czech Republic, The Netherlands, Spain or
_______________________________________________________________________________________ Page 94 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Sweden; and had travelled abroad into countries of moderate/high prevalence for hepatitis B within the previous
five years.
Results: Although 57.3% of respondents had travelled at least twice to countries where there is moderate/high
prevalence of HBV over the last 5 years, 62.3% of respondents did not know which main travel destinations had
a moderate/high prevalence of HBV. Most respondents were unaware of the consequences of catching HBV,
with only 11.8% selecting more than three out of six correct answers when asked to identify conditions caused
by the virus. A fifth (20.1%) were somewhat/very unaware of the ways in which HBV can be caught and 44% of
travellers aged 18-35 years participated in at least one risky activity abroad. 60.7% of those who knew their
vaccination status had not been vaccinated against HBV within the last 5 years, although some of the
respondents may have been vaccinated prior to this period. Only 48% visited a healthcare professional for travel
health advice prior to their last trip to moderate/high prevalence destination.
Conclusions: A high proportion of travellers, especially young travellers and those making multiple trips may be
at an elevated risk of HBV infection while visiting moderate/high prevalence countries. The proportion of
travellers who were appropriately prepared was low, and knowledge of the consequences of HBV infections was
limited. These results underline the importance of healthcare professionals determining if travellers will be
visiting a moderate/high prevalence area and providing guidance to these travellers on appropriate precautions.
Vaccination should be encouraged for all travellers visiting moderate/high prevalence areas, regardless of
planned activities or lifestyle.
P10-65
Counseling the International Traveller - 3-year Analysis from a Reference Centre in Lisbon
Luis, N.M.1, Silva, C.1, Tavares, R.1, Bento, D.1, Leite, R.1, Alfaiate, D.1, Baptista, T.1, Aldir, I.1, Antunes, I.1,
Araújo, C.1, Miranda, A.C.1, Borges, F.1, Mansinho, K.1
1
Centro Hospitalar Lisboa Ocidental / Hospital de Egas Moniz, Infecciologia e Medicina Tropical, Lisbon,
Portugal
Introduction: In a modern era characterized by global economy and new dynamics in human migration and
population movements, the number of persons travelling around the world is increasing exponentially. It is of the
utmost importance for the clinician to understand the epidemiologic features of each region, and to know its own
population of travellers, particularly their main travel destinations, economic constraints and health status.
Objectives: The objective of this study is to characterize demographically the population of travellers evaluated
and counselled at our medical centre, to identify their main concerns and special needs, and to recognize
particular at-risk populations.
Methods: A retrospective analysis of the clinical registries collected using a standardized form, between January
1st 2007 and December 31th 2009, was performed. The compiled data included demographic (age, sex), patientrelated (comorbidities, medications in use, previous immunizations) and travel-related (destination, duration of
stay, reason for travelling). The recommended prophylaxis and immunizations for the actual travel were
recorded.
Results: A total of 2411 consultations were performed. Of those, 101 (4.2%) were excluded due to insufficient
data recorded. For the remaining 2310 travellers, mean age was 42 years (4-100 years) and 51.3% were men.
The most common destination were sub-Saharan African countries (64.3%), and the main reasons for travelling
were leisure (57.4%) and business (19.9%). 39.3% of the travellers presented with one or more comobordities
such as cardiovascular disease (15.7%), depression (3.8%), immunosupression (3.1%) and diabetes (3.1%).
Concerning previous immunization status, only 52.1% referred updated tetanus / diphtheria (Td) vaccination,
and 34.3% were vaccinated against HBV. The most prescribed vaccines were against typhoid fever (75.4%),
yellow fever (55.1%), Td (34.2%), HAV (39.3%) and HBV (13.7%). Antimalarial prophylactic drugs most
prescribed were Mefloquine (56.1%) and Atovaquone/proguanil (21.5%).
Conclusions: The most common destination of our travellers was sub-Saharan Africa, particularly portuguesespeaking countries.
A significant proportion of patients presented with one or more comorbidities requiring specific management.
Traveller counselling is a good opportunity to reinforce preventive messages and to update adult immunization
schedule.
_______________________________________________________________________________________ Page 95 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P10-66
The Royal College of Nursing of the United Kingdom (RCN UK) Public Health Forum (PHF) Travel
Health Network
Grieve, A.W.1, Atwell, C.2, Bailey, L.2, Ashmore, J.2, Cocksedge, M.2, Dias, E.2, Everett, S.2, Umeed, M.2
1
Royal College of Nursing (UK), Public Health Forum, Broom, United Kingdom, 2Royal College of Nursing
(UK), PHF, London, United Kingdom
The Royal College of Nursing (RCN) of the United Kingdom (UK) is a professional body for nurses within
which are 41 Forums representing and supporting the spectrum of specialist areas of practice. In 2009 Forums
were streamlined. The Travel Health Forum (THF) together with occupational health, sexual health, public
health and TB nurses merged to form a Public Health Forum (PHF). The PHF Steering Committee was formed
from the elected Chairs of these five specialist areas of practice, now known as Networks, and other related areas
were identified and represented. Through the specialist networks the committee acts as a professional source of
expert opinion to the RCN. The overall aim of PHF is: "To lead on all aspects of public health and take a
strategic lead for the development of nursing practice." The shared objective is to support nurses in the field, to
disseminate knowledge, promote education and best standards of practice and influence and support the RCN
national and international agenda. The poster describes each network and how they collaborate on public health
issues supported by a PH Advisor and Membership Coordinator. An e-newsletter, dedicated website
communities and discussion zones and annual conferences are important communication and educational tools.
In the UK travel medicine is a nurse-led speciality, with services provided mainly in Primary Care, but also
through practitioners in PHF related Networks. Funding is available for research and education and travel health
practitioners collaborate with national and international organisations raising awareness of travel medicine as a
nurse specialty. Guidance for Practice was the first guideline developed for nurses in the field. Competencies
encompassing the skills and expertise required to manage and advise travellers, to promote best practice in
patient centred care and to contribute to the health outcomes in UK travellers were published and RCN
accredited in 2007. The Faculty of Travel Medicine (FTM) at the Royal College of Physicians and Surgeons of
Glasgow (RCPSG) continues to influence the development of this area of nursing, aiming to encourage nurses
involved in the speciality to expand their knowledge, gain recognised qualifications and admission to the FTM.
P11-67
Knowledge and Practices of Travel Medicine Providers about Rabies in Greece
Pavli, A.1, Hadjianastasiou, S.1, Patrinos, S.2, Vakali, A.1, Smeti, P.1, Delasouda, A.3, Ouzounidou, Z.3, Saroglou,
G.1, Maltezou, H.C.4
1
Hellenic Centre for Disease Control and Prevention, Travel Medicine Office, Athens, Greece, 2Hellenic Centre
for Disease Control and Prevention, Department of Epidemiological Surveillance and Intervention, Athens,
Greece, 3Health and Welfare Department of Cyclades, Ermoupolis-Syros, Greece, 4Hellenic Centre for Disease
Control and Prevention, Department for Interventions in Health Care Facilities, Athens, Greece
Objective: The number of travelers returning to Greece from rabies enzootic areas with animal bites has
increased the last years. The aim of this study is to assess the knowledge of travel-associated risk and adequate
preventive recommendations for rabies among travel medicine providers in Greece.
Method: A questionnaire was send to 100 health care providers from all (57) prefectures in Greece with
questions regarding assessment of rabies risk, and pre- and post-exposure preventive measures. Professional and
educational data were also included.
Results: Out of 100 health care providers 88% were female; 29% were from Attica. With regards to their
profession, 23% were doctors, 47% health visitors, 17% nurses, 8% health inspectors and 5% midwives. 50%
reported having been trained in travel medicine. Advice of preventive measures for rabies was given to longterm travelers, business travelers, travelers to rural areas and travelers engaged in animal activities by 44%, 22%,
58% and 75% of them, respectively. Regarding the type of preventive measures given to travelers, avoidance of
animals, post-exposure medical assistance, return back to their country and special caution about children was
recommended by 89%, 95%, 8% and 65% of health care providers, respectively. Regarding rabies pre-exposure
vaccination 61% of them recommended vaccination for travelers to rural areas, 35% for long-term travelers and
81% for travelers engaged in animal activities. 73% of travel medicine providers knew the right schedule for preexposure rabies vaccination. With respect to post-exposure vaccination, 78% and 37% answered correctly with
regards to travelers with no pre-exposure prophylaxis and travelers with pre-exposure prophylaxis, respectively.
Only 69% of them knew that rabies immunoglobulin should be given concomitantly with the first dose of rabies
_______________________________________________________________________________________ Page 96 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ vaccine, 32% that it is indicated for travelers with no pre-exposure vaccine prophylaxis, and 12% that it should
be given in the first 7 days after exposure to animal bite.
Conclusion: Management of specific situations in pre- and post-exposure rabies prophylaxis was deficient. Our
findings indicate the need to promote postgraduate and continuous training in travel medicine and also the
necessity for more practically orientated readily available information on specific prophylactic treatment against
rabies.
P12-68
Prioritising Global Health and Development Education in an Undergraduate Medical Curriculum
Flaherty, G.1,2,3, Vaughan, D.4, Connolly, M.4, Cormican, M.4, O'Donovan, D.4
1
National University of Ireland, Medicine, Galway, Ireland, 2Irish Society of Travel Medicine, Galway, Ireland,
3
Faculty of Travel Medicine, Glasgow, United Kingdom, 4National University of Ireland, Galway, Ireland
Introduction: Health and disease transcend national boundaries and are influenced by global factors. Medical
graduates ultimately work all over the world, including in developing countries and in humanitarian crises.
Doctors working in modern Ireland increasingly care for the health of migrants and returned travellers. Medical
educators must take account of these trends in designing their curricula.
Objectives: During the transition from a traditional to an integrated undergraduate curriculum in our medical
school, we aimed to introduce students to the global factors underlying health and illness in a designated global
health and development module.
Methods: Academic faculty members with expertise in public health, microbiology, travel medicine and
international health collaborated in designing a 3-credit global health and development module spanning an
entire semester in year 3 of the new 5-year curriculum. The module, with pre-defined learning outcomes, was
presented to the core curriculum review committee for approval. It was agreed that a minimum level of
performance would be a prerequisite for medical students wishing to gain academic credit for completing
elective rotations in developing countries at the end of year 4.
Results: A module was developed which would enable students to recognise the impact of globalisation and
socio-economic inequalities as determinants of health, understand the global burden of disease, become aware of
the challenges faced by indigenous health services in resource-poor nations, appreciate the roles of international
aid agencies, understand the health issues faced by migrants, and have a basic knowledge of the health risks
associated with international travel. Students attended 14 lectures covering globalisation, sanitation, international
health systems, HIV/AIDS, emerging infectious diseases, malaria, immunisation, maternal and child health,
climate change, humanitarian disasters, migrant health and travel medicine. Didactic teaching was supplemented
by student-led debates and practical sessions. Assessment involved a written paper and student presentations.
The module is currently undergoing formal evaluation.
Conclusion: This is the first core undergraduate module in global health and development in Ireland. We
recommend that other medical schools prioritise education in global health and development in order to better
serve the future professional needs of their students and the healthcare needs of society.
P12-68a
Medical Entomology in Military Camps of North Afghanistan/South Uzbekistan
Krüger, A.1, Rossmann, K.2, Schmidt, S.2
1
Bundeswehr Hospital Hamburg, Tropical Medicine branch at Bernhard-Nocht-Institute for
Tropical Medicine, Hamburg, Germany, 2Bundeswehr Medical Office, Dept. V, Munich, Germany
- Objectives: (i) To assess the risk of vector-borne diseases and venomous animal bites for German troops
deployed in ISAF forces as part of a Bundeswehr scheme on preventive and tropical medicine, and (ii) to collect
data for medical intelligence in less developed countries or regions without local medical and research structures.
- Methods: When, in 2005, International Security Assistance Forces (ISAF) troops began to set up a new camp
at Mazar-e Sharif (MeS) airport in northern Afghanistan, about 200 cases of zoonotic cutaneous leishmaniasis
(zCL) were recorded among them. This led to a quick establishment of vector and rodent reservoir surveillance.
Since then, the Bundeswehr preventive medicine has been given major attention to vector-borne disease
monitoring, in particular arthropod vectors of zoonotic cutaneous leishmaniasis and malaria. A cross-sectional
on-site survey was conducted by a multidisciplinary expert team in June 2009 using non-structured key
informant interviews, on site inspections of health, hygiene, kitchen, sanitation and accommodation facilities,
vector & reservoir habitats and collections of zoonotic relevant vectors. Furthermore there is an on-going vector
and rodent reservoir surveillance concerning vector-borne diseases implemented besides a standing monitoring
_______________________________________________________________________________________ Page 97 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ of all hygiene relevant aspects in the German Forces compounds. The routine vector monitoring was carried out
by means of Standard CDC light traps.
- Summary: The study area is mostly of Central Asian sub-tropical semi-desert types with virtually no rainfall
during the summer and only some ground vegetation, ranging between altitudes of 300 to 1800 meters. However,
the arthropod fauna is quite rich, including mosquitoes, which require at least temporal water bodies for
breeding. Among them, the proportion of malaria vectors, i.e. Anopheles species, is quite high. Moreover,
sandfly vectors of zCL, i.e. Phlebotomus species, are abundant all over the area, but are successfully controlled
to very low numbers within the military camps. Further relevant arthropods to be found were blackflies
(Simuliidae), biting midges (Ceratopogonidae), several tick species including Hyalomma vectors of CrimeanCongo Haemorrhagic Fever Virus, and several venomous animals such as blister beetles (Mylabris sp., family
Meloidae), scolopender (large myriapods), various scorpions and camel spiders (Solifugae).
- Conclusions: Although North Afghanistan appears to be rather hostile by means of its environment and climate
(not to speak of the political and military environment!) there exists a rich arthropod fauna resembling that of the
Mediterranean and the Middle East, including various potential vectors and causative agents of human disease.
Most of them are heat- and drought-tolerant species such as sandflies, certain ticks or scorpions. Personal
protection measures and exposure prophylaxis are mandatory. P13-69
Blastocystis hominis and the Evaluation of Efficacy of Metronidazole and Trimethoprim/Sulfamethoxazole
Dorostkar Moghaddam, D.1, Ghadirian, E.2
1
School of Medicine, Isfahan University of Medical Sciences, Parasitology, Isfahan, Iran, Islamic Republic of,
2
Private Hospital Ghaem, Internal, Isfahan, Islamic Republic of Iran
Objectives: Blastocystis hominis is commonly found in the intestinal tract of humans.
Although the pathogenicity of this unicellular parasite is controversial anti-protozoan agents are usually
administered to infected individuals.At present,the first choice of chemotheraputic agent is metronidazole as
described in the litrature.
Methods: In this study,we evaluated the effects of metronidazole and trimethoprim /sulfamethoxazole
(TMP/SMX) on persons infected with B.hominis.
A total of 104 subjects infected with B.hominis were admitted to laboratory during one year.All individuals were
non-immunocompromised and subjects were monitored for one year after treatment. All stools samples were
microscopically examined after staining with iodine and by culturing in an egg slant meduim.
Results & conclusions: Of the 104 infected individuals(52+_16 yearsof age, MF=60:44) with B.hominis
infection, 28 were discharging large numbers of parasites before treatment. Of 28 severely infected individuals,
12 were treated with metronidazole/250-750 mg at aregimen of 3x/day/10days and 4 of the 12 were eradicated.
Nine individuals were treated with TMP/SMX/1tab at a regimen of 3x/day/10days and 2 of the 9 were
eradicated.
For severe B.hominis infections,it appears that metronidazole and TMP/SMX are effective in some individuals,
but not all.
P13-70
Imported Tropical Diseases in Romania - Last 10 Years
Florescu, S.A.1, Popescu, C.P.1, Ceausu, E.1, Calistru, P.I.1
1
University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
Background: Romania is a geographical area free of tropical diseases. However, until '60 we had indigenous
cases of malaria and visceral leishmaniasis, eradicated rather easily due to summer/winter seasonality. Since
than, we had only imported cases.
Methods: Retrospective study of clinical, epidemiological and therapeutical data of patients diagnosed with
tropical diseases in our hospital between 2000-2009.
Results: During last 10 years there were 107 patients (94 men, 13 women) with tropical imported diseases, as
follow: 87 malaria, 13 visceral leishmaniasis, 3 amibiasis, 2 cutaneous larva migrans, one limfatic filariasis and
one cholera. The main sign was fever, which lead to clinical evaluation in 104 patients. 78 malaria patients
traveled to Africa (21 to Nigeria, 7 to Gabon, 7 to Congo, 6 to Ivory Coast, 5 to Camerun, 4 to Guineea, 3 to
Senegal, Benin, Sudan, Uganda and Zambia, etc), 4 o Papua New Guineea, 4 to Asia ( 3 to India, 1 to Indonesia),
and one to South America (Brasil). Only 31 malaria patients followed antimalarial chemoprophylaxis during
_______________________________________________________________________________________ Page 98 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ their journeys. Plasmodium species were diagnosed as follow: 59 Pl. falciparum, 15 Pl. vivax, 3 Pl. malariae, one
Pl. ovalae; 9 cases had double etiology (6 cases with Pl. falciparum and vivax). The etiological treatment was
Quinine in 53 patients, Artemisine derivatives in 26 patients, Hidroxicloroquine in 3 cases,
Proguanil+Atovaquone in 2 cases and Mefloquine in one case. 10 patients received Primaquine as secondary
prophylaxis. All 13 cases of visceral leishmaniasis were Romanian patients working in mediteranean countries (6
from Spain, 6 from Italy and 1 from Greece). The mean interval between the onset of symptoms and etiological
diagnosis was 3.2 months. The etiological diagnosis was established on direct parasitic determination in medular
aspirate (12 cases) and PCR for Leishmania (one case). The therapeutical options were Amphotericin in all
cases. 106 patients survived, 2 patients died from cerebral malaria.
Conclusions: During last decade, tropical imported diseases in Romania were mainly malaria and visceral
leishmaniasis. Fever was the main sign; thus, fever in any patients who recently traveled to endemic areas for
tropical diseases should determine clinical evaluation in specialized clinics. Due to global climate warming,
these two vectorial transmitted diseases should be carefully monitored in temperate climates.
P13-71
2 Cases of Disseminated Histoplasmosis Imported from Thailand
Jordan, S.1, Schmiedel, S.1, Burchard, G.-D.1
1
University Hospital Hamburg-Eppendorf, Clinical Department I, Section Tropical Medicine, Hamburg,
Germany
Histoplasmosis is gaining importance in nonendemic areas due to the increase in travel and immigration, being
the most common systemic mycosis acquired by European travellers. The majority of cases are acquired in
Northern and Latin America. An increased risk for travellers is associated with visits of bat caves. Only few
cases of imported Histoplasmosis from Asia have been reported.
We describe 2 cases of Histoplasmosis acquired in Thailand. Both patients were of Thai origin but were living in
Germany for a longer period, regular visits to Northern Thailand were stated.
In the first case the diagnosis was delayed due to an atypical presentation with disseminated subcutaneous
abscesses, lymphadenitis and osteomyelitis in a formerly healthy patient. After 2 months of recurrent abscesses,
progressive lymphadenitis and raising inflammation markers, the patient was transferred to our clinic. Further
investigations revealed osteolyses in the right femur and elbow. The patient developed clinical signs of a
meningoencephalitis. PCR assays from skin biopsies, abscess material and lymph node biopsy showed positive
results for Histoplasma capsulatum. Pending cultures from lymph node and skin biopsies were positive for
Histoplasma capsulatum. Treatment with liposomal amphothericin B lead to a rapid improvement of clinical and
labarotory findings.
The other patient presented with fever, cough and dyspnoea shortly after initiation of antiretroviral therapy for a
newly diagnosed HIV infection. Laboratory testing revealed a pancytopenia and a distinct elevation of
inflammation parameters and liver enzymes. The clinical state deteriorated rapidly. The patient had to be
intubated and artificially respirated. A bronchoalveolar lavage showed fungal spores which could be identified as
Histoplasma capsulatum via PCR assay. Cultures from liver biopsy and bone marrow also showed the growth of
Histoplasma capsulatum. The patient recovered under treatment with liposomal amphotericin B.
Conclusion: Histoplasmosis is a rare imported mycosis but should always be considered in travellers and
immigrants from endemic regions. Usually a self-limiting pulmonary disease in immunocompetent patients
Histoplasmosis can emerge in a life-threatening disseminated infection in immunocompromised patients - rarely
as we demonstrate disseminated infection can also occur in immunocompetent patients. PCR methods can help
to accelerate diagnosis as isolation from fungal cultures takes up to 3 weeks.
P13-73
Long-term Application of Miltefosine: A Possibility for a Finally Successful Treatment of Disseminated
Cutaneous Leishmaniasis Caused by L. major
Fischer, M.1, Racz, P.2, Burchard, G.D.3, Boecken, G.4
1
German Forces Military Hospital, Department of Tropical Medicine, Hamburg, Germany, 2Bernhard-NochtInstitut, Department of Pathology, Hamburg, Germany, 3University Medical Center Hamburg-Eppendorf,
Bernhard-Nocht-Klinik, Hamburg, Germany, 4German Foreign Office, Jaunde, Cameroon
Miltefosine is the first oral drug with proven efficacy rates of over 90% for Old World visceral leishmaniasis and
also shows promising results in the treatment of Old World cutaneous Leishmaniasis (OWCL) in patients from
_______________________________________________________________________________________ Page 99 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ L. major endemic areas in Iran. We report here on a 26 year old German soldier, who was suffering from
multiple mosquito bites during his deployment in Northern Afghanistan in autumn 2009 and developed a non
healing ulceration in his face a few weeks later. Diagnosis of OWCL was initially made by skin-smears in the
German field hospital and treatment with Fluconazole 200 mg/d was started and given for 7 weeks. After end of
mission the patient presented himself with a huge nodulous, partly ulcerated and crusteous cutaneous lesion up to
4 cm in diameter covering ostium and right wing of his nose extending to his cheek. Simultaneously he showed
two erythematous infiltrations on his left food. In all three lesions diagnosis of OWCL was reconfirmed by skin
smears (Giemsa staining), histopathology and PCR. Due to the extent of the facial lesion the patient was
systemically treated with oral miltefosine 3 x 50 mg/day, initially for 28 days. Screening laboratory tests (blood
count, liver enzymes and urea) were weekly monitored but remained at normal levels. After 25 days of treatment
complete healing was observed on his left food, whereas there was little improvement visible on the nose.
Following the idea that the lacking amelioration was not due to resistance of leishmania against miltefosine but
rather a consequence of the extent of the former lesion treatment with miltefosine was continued for further 17
days. 4 weeks later complete healing was observed. Again screening laboratory tests showed no abnormalities.
Miltefosine (hexadecylphoshocholine), initially developed as an anticancer agent, was found to eliminate
Leishmania promastigote forms in culture in the late 1980s. Oral administration was overwhelmingly efficacious
in various clinical studies for the treatment of visceral Leishmaniasis in India. However, the sensitivity to
miltefosine was variable among different species causing cutaneous leishmaniasis. Presently, the efficacy of
miltefosine is studied in various clinical trials in all endemic areas of CL. This clinical case shows that even in
complicated leishmaniasis with multiple lesions caused by Leishmania major miltefosine was finally highly
efficient and showed no side effects during a prolonged treatment of 45 days.
P13-74
Unusual Case of Cutaneous Leishmaniasis and Experience with Diagnostics and Treatment of South
American Leishmaniasis
Stejskal, F.1,2, Tomickova, D.3, Vojackova, N.4, Koutnikova, H.5, Votypka, J.6
1
Charles University, 1st Faculty of Medicine, Department of Tropical Medicine, Prague, Czech Republic,
2
Hospital Liberec, Department of Infectious Diseases, Liberec, Czech Republic, 3University Hospital Bulovka,
Department of Infectious Diseases, Prague, Czech Republic, 4University Hospital Bulovka, Department of
Dermatology, Prague, Czech Republic, 5University Hospital Bulovka, Department of Pathology, Prague, Czech
Republic, 6Charles University, Faculty of Sciences, Department of Parasitology, Prague, Czech Republic
Background: Cutaneous leishmaniasis (CL) is important cause of non-healing ulcers in travelers returning from
the endemic regions. Since 2003 there were diagnosed at Department of Tropical Medicine, University Hospital
Bulovka in Prague 14 cases of CL. Five of them were acquired in Old World (Morocco, Syria, Iran), but
majority, 9 cases were imported from South and Central America. There is a tendency of increase of New World
CL importation to Europe. As there is a risk of mucocutaneous dissemination of these CL antiparasitic treatment
is gathered by leishmania typing.
Methods: Epidemiological, clinical, parasitological and treatment data on imported New World CL were
analyzed retrospectively. Diagnosis was confirmed using histopathology or smear from cutaneous biopsy stained
by Giemsa, culture and PCR. Sequencing of internal transcribed spacer 1 (ITS1) of the ribosomal operon was
used for species determination. Clinical case of unusual nodular non-ulcerative lesion in patient with repeated
CL will be presented.
Results: Nine patients (2 women and 7 men; aged from 21 to 58) with histological, culture or PCR confirmed
South American CL were treated at our hospital since 2003. All five PCR confirmed of total nine cases were
caused by L. braziliensis subsp. guayanensis and imported from Brasilia, Bolivia, Peru and Costa Rica. In seven
of nine patients was administered meglumine antimonate (20 mg antimony/kg/day for 14 to 21 days) by
intramuscular, intravenous or perilaesional route with rapid healing of ulcers. One patient refused antimony
preparate. As miltefosine is not available in the Czech Republic and liposomal amphotericine is not reimbursed
by health insurance he was treated using oral itraconazole (200 - 400 mg daily) for 3 moths with only poor
response. One patient was treated unsuccessfully in Slovakia with fluconazole (200 mg daily) for 6 weeks.
Complete regression of lesion occurred under meglumine antimonate administration at our department.
Conclusion: Our case series shows that New World CL presents in a wide range manifestations including
multiple ulcers and atypical lesions. PCR typing or culture and isoenzyme analysis are needed for exact species
determination. Chemotherapy with antimony preparates is effective and severe side effects are not common.
Azole antifungal drugs are not very effective against L. braziliensis.
_______________________________________________________________________________________ Page 100 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ This research was partially supported by the Czech Ministry of Education grants MSM0021620806 and
FRVS1170/2010.
P13-75
Diagnosis of Dengue in Returning Travellers with Previous Flavivirus Vaccinations
Walentiny, C.E.F.1
1
Ludwig Maximilian Universität München, Abteilung für Infektions- und Tropenmedizin, München, Germany
Objective: Dengue fever is one of the most frequent febrile illnesses in travellers returning from the tropics. The
diagnosis often relies on a positive serology. Previous flavivirus-vaccinations can lead to the presence of crossreacting antibodies. We examined how previous vaccinations influence the serologic response in patients with
dengue fever.
Methods: Questionnaires about the vaccination status were sent to patients who had previously received the
diagnosis of an acute dengue virus infection at our department of infectious diseases and tropical medicine. The
influence of the flavivirus-vaccine-status and the time between onset of symptoms and presentation on the results
of enzyme linked immunosorbent essay (Dengue-ELISA) was then analyzed.
Summary of the main results: In patients presenting within less than 8 days after the beginning of symptoms,
the IgG-ELISA is significally (p 0.002) more frequently positive in patients with a previous flavivirusvaccination history than in naïve ones (91 vs. 45%). There is no such difference regarding IgM.
In patients presenting at least 8 days after the beginning of symptoms, the IgM-ELISA is significally (p 0.001)
more frequently negative in patients with a previous flavivirus vaccination (62 vs. 17%). There is no such
difference regarding IgG.
Conclusion reached: If serological analysis is used to confirm or diagnose a dengue fever infection, knowledge
of the flavivirus-vaccine-status of the patient is mandatory, as vaccinated patients show a serological response
mimicking a secondary dengue-infection, with an early rise in IgG antibodies and a lack of IgM response.
P13-75a
Venomous Snake Bites in Lao Pdr
Blessmann, J.1
1
Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
Twenty-one snakebite victims were admitted to a provincial hospital 80 km north of the capital city Vientiane
between January 2007 and June 2008. There were 13 Malayan Pit Viper (MPV) and 6 Green Pit Viper (GPV)
bites. Two patients could not identify the snake, but developed severe coagulopathy and were therefore most
likely bitten by a MPV or GPV. Seven of 13 patients bitten by the MPV and 3 of 6 patients with GPV bites
developed a coagulopathy; 2 patients bitten by a MPV had severe local signs of envenomation. The supply of
antivenom was limited, thus only 6 patients received this treatment, although it was indicated in 12. The
treatment was effective and the INR was normal or less than 3 within 24 hours. No early side effects occurred
after injection of monospecific antivenom obtained from the Thai Red Cross. Antivenom is not available in most
hospitals of the country.
P14-76
Lofty Thoughts - Introducing Medical Students to High Altitude Medicine
Flaherty, G.1,2,3, O'Brien, T.1
1
National University of Ireland, Medicine, Galway, Ireland, 2Irish Society of Travel Medicine, Galway, Ireland,
3
Faculty of Travel Medicine, Glasgow, United Kingdom
Introduction: High altitude medicine receives little coverage in undergraduate medical curricula. Increasingly,
medical graduates are participating in high altitude treks, either for recreation or as volunteer expedition doctors,
with little or no prior training in this specialised field of travel medicine.
Objectives: The concept of special study modules (SSMs) arose as a response to recommendations from the
General Medical Council in the UK. Optional modules which allow the student to spend more time studying
subjects of particular interest in more depth represent an exciting development in medical education. We set out
to develop and evaluate an SSM in high altitude medicine in our medical school.
Methods: An 8-week SSM requiring 48 hours of student effort was designed. Students were provided with a
handbook detailing the learning objectives, teaching methods, assessments, practical sessions, web resources and
_______________________________________________________________________________________ Page 101 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ a reading list. Students received a minimum of 2 hours' contact time with their supervisor per week. Scheduled
sessions included lectures, case study discussions, and a practical class demonstrating use of the portable
hyperbaric chamber. Students collaborated in the creation of a website to be used as an educational resource for
travel medicine practitioners. A field trip to a local mountain concluded the SSM.
Results: Seventy-eight percent of the students had never travelled to high-altitude destinations. Eighty-three
percent rated their knowledge of high altitude illness as “poor” or “very poor” prior to completing the SSM. All
of the students believed that the SSM provided them with the knowledge necessary to recognise high altitude
illness while 94% believed that the SSM equipped them with the practical skills necessary to manage high
altitude illness. Fifty percent of the students identified the case studies sessions as the most beneficial element of
the module. Forty-four percent of students stated that high altitude medicine should have a presence for all
students in the core undergraduate curriculum. Overall, 94% of students expressed an increased interest in high
altitude medicine as a result of the SSM. The student who achieved the highest mark in the SSM was awarded a
scholarship to attend an Expedition Medicine course in the UK.
Conclusion: The use of special study modules as an educationally desirable tool for introducing medical
students to high altitude medicine should be explored further and extended to other institutions.
P14-77
The Significant Factor for Saving Patients with Altitude Sickness--from the View Point of Consul
Yamamoto, K.1, Ishihara, Y.2, Saiki, K.3
1
Embassy of Japan in Bolivia, Consulate Section, La Paz, Bolivia, 2Embassy of Japan in Bolivia, Medical
Section, La Paz, Bolivia, 3Embassy of Japan in Kuwait, Medical Section, Kuwait, Kuwait
Objectives: To save patients with severe altitude sickness, effective management is equally essential to medical
treatments; timely detect, smooth transport, and coordination of various people. The objectives of the paper are
to show the real cases in which the non-medical management was very important besides the medical treatments,
and to stress the importance of good coordination in extra-medical matters from the viewpoint of a Consul of an
Embassy in Bolivia, which is located in the highest city in the world.
Methods: 286 cases of altitude sickness were seen by two medical attachés of Embassy of Japan in Bolivia
between 21st of April, 2006 and 21st of January, 2010.
31 out of 286 cases, including one dead case, were highly severe which were coordinated by a Consul and
needed emergency admission of a hospital or emergency transport to lower place.
Typical cases will be presented.
Case 1: A 43-year old man who was on a solo trip was found unconscious in his hotel room. The Medical
attaché and the Consul of Embassy of Japan visited him just after receiving a call from the hotel, and arranged a
private ambulance to transfer him to a private hospital, where he was admitted in ICU for five-day with
mechanical ventilation. After recovery, however, his mental status remained rather low due to previous hypoxia,
so that the Consul negotiated with an insurance company to send him back to Japan accompanied with a nurse.
Summery of the results: The main extra-medical problems summarized from our cases are;
1. Delayed detection of altitude sickness-Most of the severe cases was detected by lay people, who have limited
knowledge to find the danger signs.
2. Delayed actions to save the patient- Japanese tour conductors do not have necessary knowledge of the altitude
sickness. Delay of the care-seeking action causes death of altitude sickness.
3. Altitude itself- Most of the management in hospitals are satisfactory and private hospitals are well equipped,
however, most of the cities in Bolivia are at high altitude.
Conclusions: To save a patient's life, the most significant factors are early detection and timely transport of the
patient. Most of the discussions of altitude sickness are regarding medical treatments; however, our cases show
that extra-medical coordination is also greatly important factor to save patients. Therefore, it is strongly
recommended that medical personal should alert the risk of altitude sickness to the public in general more.
_______________________________________________________________________________________ Page 102 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P14-78
The Long-term Influence of High Altitude on Blood Cell Counts in Japanese Embassy Staffs and their
Families Staying from Japan to La Paz in Bolivia
Saiki, K.1
1
The Embassy of Japan in Kuwait, Medical Department, Kuwait, Kuwait
Objectives: To investigate the long-term influence of high altitude on blood cell counts in normal healthy
persons as control.
Methods: To compare hemoglobin concentration(Hb) and cell counts of erythrocytes(RBC), leukocytes(WBC),
and platelets(Plt) at medical health check in five classified period groups(pre-moved period;Pre, post-moved 16months;Post1-6, post-moved 7-12months;Post7-12, post-moved 13-24 months;Post13-24, and post-moved
more than 25months;Post25-). Data is statistically analysed in Wilcoxon method.
Subjects: Japanese diplomatic staffs of the Embassy of Japan in Bolivia and their families (males19, females16:
average age 35.9 with S.D.9.7 years-old, ranged 23-59 years-old) were in good health. They set off from Japan
to La Paz , Bolivia (3300-4000 m in Altitude), and lived there. Follow-up periods between set-off date and final
examination date were average 572 with S.D.355 days, ranged 43-1323 days. The study was done between April,
2004 and January, 2008.
Results (Period group/Average/S.D./Number):
Hb(g/dl)(Pre/14.5/1.45/14),(Post1-6/16.0/2.05/9),(Post7-12/16.2/1.78/14),(Post13-24/15.1/1.79/16),(Post25/15.6/1.69/8).
RBC(x10000/mm3)(Pre/464/47/14),(Post1-6/531/67/9),(Post7-12/538/56/14),(Post13-24/504/48/16),(Post25/501/55/8).
WBC(x1/mm3)(Pre/5205/1280/13),(Post1-6/6361/1529/9),(Post7-12/6518/997/12),(Post1324/6669/1661/16),(Post25-/6260/999/8).
The Hb ,RBC and WBC in post-moved 7-12 and 13-24 months significantly increased more than the ones in premoved period. The Hb RBC,and WBC in post-moved 13-24months significantly decreased more than the ones in
post-moved 7-12months.
Plt(x10000/mm3)(Pre/22.3/4.68/12),(Post1-6/26.6/5.14/9),(Post7-12/25.6/3.88/12),(Post1324/26.5/5.44/14),(Post25-/22.0/3.59/8).
The Plt was no change during periods.
Discussion & conclusion: The Increase of hemoglobin concentration and counts of erythrocytes and leukocytes
in post-moved 7-12months suggests some reaction to sustain oxygen supply to the body, and their some decrease
in post-moved 13-24months suggests some adaptation by compensatory reaction. No changes of counts of
platelets suggests no influence of high altitude on platelets.
P14-79
Acetazolamide Provision at a Travel Clinic for Travellers to Altitudes of above 3000 Metres
Bradley, P.1, Ford, L.2, Lalloo, D.2
1
Liverpool School of Tropical Medicine, Clinical Department, Liverpool, United Kingdom, 2Liverpool School of
Tropical Medicine, Liverpool, United Kingdom
Background: Travelling at altitude is challenging and when adequate acclimatisation is not possible
acetazolamide may be prescribed. This should reduce symptoms of acute mountain sickness and improve
acclimatisation. The Liverpool School of Tropical Medicine (LSTM) travel clinic has approximately 10,000 pre
travel consultations annually and provides acetazolamide to travellers whose itineraries do not allow adequate
acclimatization.
Objectives: To review the provision of acetazolamide at LSTM for those travelling to altitudes above 3000m
and determine the main destinations and activities of these travellers.
Method: Clinical records of those advised to take acetazolamide from September 2008 to December 2009 were
reviewed. Traveller characteristics, destinations and activities were determined and compared to other travellers
visiting the same regions who did not take acetazolamide.
Results: 159 travellers had trips to areas of altitude above 3000 metres: 38 (23.9%) were given acetazolamide.
Mean ages for men and women were 29.2 and 31 years respectively. All those receiving acetazolamide were
trekking. Of the 38, 10 were travelling to Machu Picchu/La Paz (11.5% of overall travellers to this destination),
3 to the Atlas Mountains, 1 to Kenya, 8 to Nepal (50%of travellers to altitude in Nepal) 1 to Mount Fiji and 15 to
Mount Kilimanjaro (30% of travellers)
_______________________________________________________________________________________ Page 103 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Mean ages were not different between those who received acetazolamide and those who did not for most
destinations with the exception of Nepal (43.5 v 37.5 yrs respectively). The duration of trip for those given
acetazolamide was much shorter in those going to South America (24.8 v 42.3 days) and Kilimanjaro (11.8 v
14.8 days) but was not different for those going to Nepal.
Conclusions: Many travellers plan trips to destinations above 3000 metres. These results show that a relatively
small proportion of travellers to altitude took acetazolamide and that age did not influence this significantly.
Those that did not take acetazolamide spent longer in the country during the trip, potentially allowing
acclimatisation, by reducing accent speed. The low proportion of eligible travellers taking acetazolamide means
that educating the traveller about early signs of acute mountain sickness is essential.
P15-81
An Overview of Major Occupational Diseases and Injuries that Affect Wildlife Veterinarians in Brazil
Nicolino, R.R.1, Pissinatti, A.2, Moreira, N.S.2,3, Monteiro, A.O.2
1
Universidade Federal de Minas Gerasi -UFMG, Veterinária, Belo Horizonte, Brazil, 2UNIPLI - Centro
Universitário Plinio Leite, Veterinária, Niterói, Brazil, 3Universidade Federal Fluminense, Niterói, Brazil
Objectives of the study: The study aims to survey the major diseases and occupational injuries that involve
wildlife veterinarians in Brazil.
Methods: The work was based on the research of Hill et al, 1998 - “Occupational Injuries and illnesses reported
by Zoo Veterinarians in The United States”. Forty-four questionnaires were distributed to veterinarians
specialized in wildlife and working in Brazil. From those, 90% (36/44) answered the questionnaire. The
questions were related to injuries and illnesses occurring during the act of occupation, security of work and five
demographic questions. Occupational diseases and injuries were grouped into five categories: physical injuries,
injuries caused by exposure to radiation; injuries caused by chemical exposure, allergic and irritating reactions
and zoonoses.
Results: Significant results reported by veterinarians include: Injuries caused by needles were, in percentage
terms, the second most reported physical injury by veterinarys, with a total of 88.9%, 100% use of IPE against
radiation, 94.2% of injuries caused by animals, 78% of the professionals reporting adverse reactions to
formaldehyde, 52% of cases of allergic reaction to insect bites, and 33% of practitioners reporting having
contracted zoonoses. Furthermore, we observed a higher percentage of women reporting musculoskeletal injuries
than men and, surprisingly, 64% of practitioners reported the inexistence of their own sorological history,
resulting on the ignorance about which pathogens they are exposed to.
Conclusion: The results were compared with other similar surveys on veterinarians working in the United
States. The frequency of injuries reported shows a great need for training programs on the prevention of
accidents at work and biosecurity for veterinarians to ensure the physical integrity of the professionals in their
activities. Further studies aimed at the safety of veterinarians should be performed as these studies are very rare
among these professionals, and more common among physicians and nurses.
P16-82
Alcohol Level and Severity of Injury among Road Traffic Accidental Patients at Nonsung Hospital,
Nakhonratchasima Province, Thailand
Suggaravetsiri, P.1, Chaiklieng, S.2, Thongduang, P.3
1
Khon Kaen University, Department of Epidemiology, Faculty of Public Health, Muang, Khon Kaen, Thailand,
2
Khon Kaen University, Department of Environmental Health Science, Faculty of Public Health, Muang, Khon
Kaen, Thailand, 3Medical Laboratory, Nonsung Hospital, Nonsung District, Nakhonratchasima, Thailand
The objectives of this study were to describe alcohol level and severity of injury among road traffic accidental
patients in Nonsung hospital, Nakhonratchasima province, Thailand. Data were collected from patients who had
accidents and were treated at Nonsung hospital from 1 January, 2007 to 31 December, 2008. Alcohol levels in
blood detected from breath were measured by Lion alcoholmeter SD-400P and alcohol levels in blood detected
from blood were measured by Headspace Gas Chromatography method. Structured records were used for
gathering data. Data analysis was performed by using Epi-Info for window. Percentage distribution, mean,
standard deviation and range were used in data analysis.
Results of the study in the alcohol level and severity of injury showed that there were 80 road traffic accidental
patients at Nonsung hospital. Most of them were males (95.0%). The average age were 33.8 years old, 51.3%
were married, 40.0% were head of the family, 30.0% had degree of bachelor. Most drivers (78.8%) had driving
_______________________________________________________________________________________ Page 104 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ license, 98.8% never had road traffic accident during the last year. Sixty five patients were drunk the alcohol
before driving (81.3%), of them were drunk beer 43.8% and 35.0% were drunk liquor. Most of patients did not
use safety helmet or safety belt (72.5%), 58.8% were motorcycle accident, 43.8% of accident were occurred on
main road, 22.5% were accidents on Friday, 47.5% were accident on time during 6.01 p.m. to 12.00 p.m.. The
average blood alcohol levels were 118.5 mg% (SD= 93.7 mg%) and 66.3% of patients had blood alcohol level
over than 50 mg%. Among 80 patients, number of cases measured blood alcohol levels by blood (51.2%) was
more than cases measured blood alcohol levels by breath (48.8%). The reason was that the most of cases were
unconscious and severe injury or death. The patients with higher than 50 mg% of blood alcohol level more likely
had severe injury than patients with lower or equal 50 mg% of blood alcohol level. Percentage of severe cases
and death cases were 7.7% and 21.4%, respectively.
The findings in this study showed that the most of road traffic accidental patients had the blood alcohol level
over than 50 mg%. There were more severity levels of injury among patients in this group compared to another
group with blood alcohol level 50 mg% or less. These suggest the prevention of road traffic accident by
controlling alcohol consumption among drivers and increasing a campaign to stop driving after alcohol drinking.
P16-83
Knowledge, Attitude and Practice Regarding Pandemic Influenza A (H1N1) among Iranian Pilgrims
Previous the Hajj Period in 2009
Ghalyanchi Langeroudi, A.1, Majidzadeh, K.1, Soleimani, M.1, Jamshidiyan, E.1, Mohseni, A.1, Morovvati, A.1
1
Tasnim Biotechnology Research Center, Tehran, Islamic Republic of Iran
Aims: The Hajj represents the largest mass migration on earth , during which several Muslims including Iranian
Pilgrims travel across the planet to descend on specific holy sites at Makkah in the Hijaz area of Saudi Arabia. A
pandemic caused by a novel influenza A virus (H1N1) poses a serious public health threat In 2009 , The first
case of H1N1 is observed in Iran .Also, Iran reported its first H1N1 flu death on August 26, that of a 36-year-old
woman. In this study, we evaluated Knowledge, attitude and practice regarding Pandemic influenza A (H1N1)
among Iranian Pilgrims during the Hajj period in 2009.
Methods: Trained interviewers randomly invited Pilgrims at the departure gates of MEHRABAD international
airport in Tehran to respond to a self-completion questionnaire developed by the researchers based on review of
the literature in November 2009 and checked for completeness and validated by trained interviewers. A total of
320 responses were collected. Data analysis was done by SPSS 11.
Results: The most range age of the respondents (56.3% Male & 43.8% Female) was stand between 41 to 64
years (41.3%). When education level was controlled, More than 60% of Pilgrims had at least a college education.
The most pilgrims had high knowledge regarding H1N1 symptom s transmission methods.93.8% and 70% of
traveler declare Fever and Body aches are the most common symptom of H1N1. In prevention section, most
pilgrims were willing to wear a mask (65%), frequently wash their hands (90%) and use disposable
handkerchiefs (81.3%).Main information sources were TV (61.3% of respondents had been satisfied from
performance of Iranian Iran Broadcasting Organization in promotion and propagation about H1N1) and Internet
had minimum efficacy. Also, Iranian Hajj Organization training course was important source. 62.6 % of travelers
numbered high score to act of Iranian Hajj Organization in information and education related to mentioned
disease. Another interesting result is above 80% Pilgrims will recourse to medical centers in Saudi Arabia when
suspected to disease and don't will treat themselves intractably.
Conclusions: This survey demonstrated that KAP about H1N1 was rich and acceptable among Pilgrims But
Strategies are needed for raising awareness of preventable after repatriation of them.
P16-84
Difficulties and Basic Considerations in the Treatment of Travelers Abroad
Felkai, P.1
1
SOS-Hungary Medical Servcie, Management, Budapest, Hungary
The author and his medical team treated about 900 foreign visitors in Budapest. Their experiences showed that in
the urban areas of Middle Europe where the hygenic and weather conditions are balanced, the health care system
is developed and there is no any endemic threat, the scope of the travelers' medical problem is slightly different
from the usually known morbidity data.
Upon the aforementioned experiences, author analyses the key issues of a foreign traveler's treatment: difficulties
caused by the language barrier, the shortage of time, the reluctant attitude of the traveler in seeking for doctor,
_______________________________________________________________________________________ Page 105 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ the limits in the treatment, caused by the insurance limits and all the expectations towards the doctor in the case
of an on-spot treatment.
Analysing the travelers' most frequent medical problems, we have made the conclusion that this kind of
treatment requires a broad-spectrum knowledge in different medical fields, first of all in the fields of emergency
medicine and travel medicine. In the treatment of a foreign visitor the doctor has to be dissolve the common
medical problems from the travel-related illnesses, and has to be well-informed about the basic principles of
repatriation (emerging a fit to fly report, etc.) Thus, the travel medicine specialists also have to play an important
role in the pre-travel advice, but they have to be well-trained in the treatment of presumable travel induced
medical problems as well.
P16-85
On the Significance of Differences between Standard Time and True Solar Time for the Exposition
against UVB-Radiation
Stick, C.1
1
University of Kiel, Institut für Medizinische Klimatologie, Kiel, Germany
The intensity of solar radiation depends on the elevation of the sun. Not all parts of the solar spectrum, however,
behave equally in this respect. Just the intensity of the shortest wavelengths in the solar spectrum, the so-called
UVB-radiation, depends much stronger on solar elevation than the intensity of visible light and infrared radiation
does. Since precisely these UVB-wavelength cause sunburn and other skin damage dermatologists advise people
to avoid exposure to the blazing sun around noontime. To follow this recommendation one needs to know the
sun`s culmination time at a respective location. This article is to point to the fact that in wide areas of Europe
there are substantial and significant deviations between true solar time and standard time. This applies in
particular to some of the most frequented travel-destinations.
The first deviation is due to the daylight saving time, i.e. standard time is set one hour ahead. Consequently,
culmination of the sun is not at 12 noon, but rather at 1 p.m. This deviation uniformly applies to all places in
European countries, where standard time is Central European Time (CET) or during summer Central European
Summer Time (CEST), respectively.
The second deviation depends on the geographical longitude. Although Central European Time refers to the
longitude 15° E, it is valid for all longitudes up to nearly 10° W, i.e. up to the Spanish coast of the Atlantic
Ocean. Since solar time depends on the geographical longitude this leads to a deviation between standard time
and solar time of nearly 1 hour and 40 min. A map of Europe will be shown illustrating the time shift between
standard time and mean local time depending on the geographic longitude.
Thirdly, the so-called equation of time causes another but comparably small time shift. It amounts up to a
maximum of about + 6 min 30 s at the end of July.
Altogether, the difference between standard time (CEST) and true solar time adds up to a maximum of about 2 h
40 min at the Spanish coast of the Atlantic Ocean. This means solar culmination is not at 12:00 h, but at 20 min
to 3 p.m. (14:40 h).
Recommendations to the people regarding their "exposure to the sun habits" should allow for these geographical
and astronomical facts. Travellers should be pointed to these basic facts. Guides, for instance, should include this
important information in the sections where topics as time zone, climate conditions or general information on the
destination are reported.
P16-86
Examınatıon of the Admıssıon Reasons of Tourısts ın Mersın-Kizkalesi Who Applıed to Prımary Health
Care Settıng
Aytac, N.1, Duzel, V.2, Oztunc, G.2, Tanir, F.3
1
Cukurova University Medical Faculty, Public Health, Adana, Turkey, 2Nursing Division of Adana Health
Sciences School, Adana, Turkey, 3Cukurova University Medical Faculty, Adana, Turkey
Introduction and aim: Kizkalesi is an important tourism center which is in south region of Turkey. It´a town of
Erdemli Mersin, it´s 23 km to Erdemli and 60 km to Mersin. Especially in summer the town is too crowded and
most of them are tourists from Turkey and foreign countries. In summer many tourists visit Kizkalesi and there is
touristic hotel capacity of 15 thousand people. In summer period many cultural activities and fiesta make the
_______________________________________________________________________________________ Page 106 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ town an enjoying place. This study was designed to examine the admission reasons of the tourists who apply to
primary health care setting in Kizkalesi.
Methods: Tourists who come to Kizkalesi for holiday mostly apply to Kizkalesi primary health care setting near
to town center for any disease. This study is a descriptional cross-sectional record study, in the study medical
records of the foreign tourists have been examined who applied to Kizkalesi primary health care setting between
2008 Semptember 1 and 2009 August 31. From the records these data have been collected; age, gender, country,
apply date, admission reason, medical diagnosis and treatment. Data were analysed with SPSS 16.0 software.
Results: Between 2008 September 1 and 2009 August 31, 177 foreign tourists applied to Kizkalesi primary
health care setting; 93 were male (52.5%) and 84 were female (47.5%). Mean age was 24.1(range 1-76). Their
distribution according to countries were; 78.6% Germany, 10.7% United Kingdom, 10.7% from the other eight
countries. 81.3% of the visits were done in June, July and August.
The admission reasons of the tourists to primary care setting were; 33.9% throat and ear pain, 28.8% allergy and
urticaria, 18.6% diarrhea, emesis and stomach ache, 18.6% other complaints. The distribution of diagnosis was;
33.9% upper respiratory infection, 29.9% dermal diseases, 17.5% gastrointestinal diseases, 18.6% other diseases.
Of the patients 91.5% were prescribed medicine, 2.8% were given legal report, 4.0% were referred to specialist
and 1.7% ear lavage was performed
Conclusion: The infectious disease ratio in foreign tourists in Kizkalesi is high. Thus, these tourists should pay
attention to hygienic rules and their awareness should be raised about this subject.
P16-87
Psychological Challenges during Journey
Jeżewska, M.1, Grubman, M.1, Leszczyńska, I.1
1
Medical University of Gdańsk, Interfaculty Institute of Maritime and Tropical Medicine, Clinic of Occupational
and Internal Diseases, Gdynia, Poland
Aim: Psychological estimation and guidelines concerning prevention of risk during journey.
Methods: Psychological researches concerning tourism developed rapidly. The most penetrated fields were
reviewed:
 psychological determiners of tourist activity (motivations, needs, interests, aspirations, personality traits
of travellers)
 psychical processes ( cognitive and emotional ) connected with tourist activity
 psychical effects of tourism
Main motives for travelling have been very carefully identified: education and culture relax and pleasure,
ethnical heritage. Nowadays the motives for journey are also:
 looking for work, business
 taking part in military or stabilization missions
 health, sport, hobby, need to change climate

adventure, taking part in history
 desire to get knowledge about world
Results: Tourists during their journey, especially in tropical countries, may face many unpredictable situations,
places or people. Those may lead to feeling of being lost and disoriented with the loss of sense of security, fear,
helplessness, irritation, anger or even aggression. Situations mentioned above may cause health and behaviour
disorders of tourists.
The most common pathologies connected with travelling are psychological or somatic originated:
Loss of control, risky behaviour:
- Dissolution ( unwanted pregnancies, sexually transmitted diseases)
- Sensation Seeking (inability to control impulses as an effect of excessive control in every day life)
- Abuse of alcohol, narcotics
- Food poisoning
- Balancing on the edge of life and death
 Travel sicknesses ( airsickness, seasickness)
 Jet Lag Syndrome
 Anxiety disorder (Agoraphobia, Claustrophobia)
 Negative emotions connected to high temperature and humidity in tropical countries
 Altitude sickness (above 3000 metres) - dizziness and headache, breath disorders, nausea, vomiting
 Psychosis of journey
_______________________________________________________________________________________ Page 107 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ Multiple culture contacts during journey may cause diseases and disorders among tourists. One of them is
“culture shock”, occurring in situation of being surprised by foreign culture (Stendhal´s Syndrome, Paris Syndr.,
Jerusalem Syndr.).
Conclusions: All of these indicate that it is necessary to pay more attention to psycho prophylaxis of travelling.
It is recommended not only as prevention of mentioned disorders, but also control of stressful and harmful
factors.
Keywords: Psychology of tourism, psychopathology of journey, risky behaviour
P16-89
Risks for Travellers who Received Pretravel Consultations before Visiting the Tropics
Grigoraki, A.1, Sotirchos, A.1, Sofos, N.1, Vassalos, C.M.2, Vakalis, N.2, Vassalou, E.2
1
Prefectural District of South Athens, Health Department, Athens, Greece, 2National School of Public Health,
Department of Parasitology, Entomology and Tropical Diseases, Athens, Greece
Objective of the study: This study was undertaken to find out about the risks of travellers who received
pretravel consultations prior to their visit to the Tropics in the period between January 2009 and December 2009.
Methods: Travellers from Athens, Greece who visited the Tropics filled out a questionnaire on demographic
data, health problems, accidents or other problems experienced during and after their travel up to 15 days after
their return.
Summary of the results: A total of 260 travellers (average age, 44 years; average duration of travel 27 days)
completed posttravel questionnaires. Among them, 164 (63.1%) travellers had university education. The reason
of travel for 61.5% (160/260) was tourism and for 22.7% (59/260) was business. Sub-Saharan Africa was the
most popular travel destination (114/260; 43.8%), followed by South America (89/260; 34.2%) and Tropical
Asia (57/260; 22%). Eighty-five (32.7%) of these travellers reported that they had during their trip some
problems like illness, and accidents; one case (0.4%) of robbery was also reported. Diarrhea (54/85; 63.5%) was
the most common health problem, followed by skin disorders (11/85; 12.9%), respiratory infections (9/85;
10.6%). Accidents and injuries (5/85; 5.9%), mountain sickness (4/85; 4.7%) and sun stroke (3/85; 3.5%) were
also reported. Of the 85 travellers who reported health problems during their travel, 48 (56.5%) travelers stated
that they had taken medication, ten (11.8%) reported that they had visited a doctor, while five (5.9%) had been
hospitalized. No case of diagnosed or suspected malaria was reported.
Conclusions: From the results of our study, diarrhoea, skin disorders and respiratory infections were the main
travel risks. Our finding that travellers are at risk during their trip to the Tropics is similar to that of studies from
other developed countries. Travellers should be aware of travel risks. Pretravel counseling should focus on
prophylactic measures so that travellers could be more effectively protected during their trip.
P17-90
Undergraduade Education of Travel Medicine for Medical Students and Pharmacists
Felkai, P.1
1
SOS-Hungary Medical Servcie, Management, Budapest, Hungary
As the number of travelers is getting higher, the hazard of commuicable diseases and the travel-induced linesses
is growing. Nowadays the body of knowledge of travel medicine has became a vital part of the education of
physicians regardless of specialty.
Unfortunately a considerable amount of travelers disregard the pre-travel advice and the vaccination, even if
their destinations are within endemic areas. Similarily the elderly patient, with multiple pre-existing diseases,
often miss the opportunity to visit a travel medicine specialists for advice before their trip. Instead, they turn to
general practicioners and to pharmacists.
In order to prevent ― at least to a small degree ― the various hazards of traveling, we have to provide easily
accessable but competent information. This philosophy, as a basic consideration, has led to the development of
an education program both for the general practitioners and for the pharmacists.
Our task for the future is to make travel medicine familiarised all the doctors involved in treating of travelers.
Travel medicine as an inevitable part of present day medicine, should have to become a part of undergraduate
education in medical and pharmaceutical schools.
The organisation of the education in different levels, the methods of the training and the contain of the courses,
as well as the initial results of this pioneer education program is surveyed by the author.
_______________________________________________________________________________________ Page 108 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ P17-91
Reducing the Risk of Travel-related Dengue Infection - An Irish Perspective
Flaherty, G.1,2,3, Hamza, M.1, Colbert, D.2
1
National University of Ireland, Internal Medicine, Galway, Ireland, 2Irish Society of Travel Medicine, Galway,
Ireland, 3Faculty of Travel Medicine, Glasgow, United Kingdom
Introduction: Irish travellers are increasingly likely to visit dengue-endemic regions. Lack of awareness of this
infectious disease and its clinical presentation may compromise the quality of the pre-travel health advice given
to travellers visiting areas where the dengue virus is prevalent and may contribute to diagnostic delay in returned
travellers who have contracted dengue infection overseas.
Objectives: This survey explores the level of awareness of dengue infection among the Irish travel medicine
community. The information obtained may help the Irish Society of Travel Medicine (ISTM) to better respond to
the specific educational needs of its members.
Methods: A 24-item validated online survey was distributed to members of the ISTM and responses were
collected between June and November 2009.
Results: 70 ISTM members responded to the survey, 72% of whom had received formal training in travel
medicine. Respondents had been members of the ISTM for an average of 6.7 years. The majority of respondents
(72.5%) estimated that less than 10% of their weekly clinical commitment is devoted to the practice of travel
medicine. The majority of respondents correctly recognised the causative organism of dengue infection and
92.9% identified mosquito bites as its mode of transmission. 87.1% of respondents suggested Asia as the region
of greatest risk. Half of respondents recalled any recent outbreak of dengue infection and few (24.3%) correctly
estimated the case-fatality rate. Half of the respondents were aware that risk is highest in urban areas but a
greater proportion (69.1%) identified daytime as the period of greatest risk. 38.6% correctly recalled the typical
incubation period. Few respondents were able to identify the classic rash. 44.3% of respondents were aware of
dengue haemorrhagic fever and very few (10%) were aware of Dengue Shock Syndrome as potential
complications. A poor knowledge of the investigations and the clinical indications for hospitalisation was
demonstrated. 23.1% of respondents do not routinely educate travellers visiting dengue-endemic areas about the
disease and its prevention.
Conclusion: The results of this survey suggest a lack of knowledge of dengue infection, its epidemiology,
prevention, clinical findings, investigations and management among travel medicine practitioners in Ireland.
Specific educational initiatives should be designed to address this learning need.
P17-92
Australian Travel Health Advisory Group: Activities of a Joint Travel Industry and Travel Medicine
Group Promoting Healthy Travel
Leggat, P.A.1, Hudson, B.2, Zwar, N.3, Travel Health Advisory Group
1
James Cook University, Anton Breinl Center, Townsville, QLD, Australia, 2Royal North Shore Hospital,
Department of Microbiology and Infectious Diseases, Sydney, NSW, Australia, 3University of New South
Wales, Sydney, NSW, Australia
Background: The Australian Travel Health Advisory Group (THAG), established in 1997, is a joint initiative
between the travel industry and travel medicine professionals that aims to promote healthy travel. THAG seeks
to promote cooperation in improving the health of travellers between the travel industry and travel medicine
professionals and to raise awareness of the importance of travel health to the Australian public.
Methods: The poster describes the major activities of THAG which include: networking and exchange among
groups interested in travel health; commissioning travel health research; promotion of travel health awareness
working through travel service providers; public relations activities to increase awareness of travel health risks
and the importance of seeking pre-travel health advice and vaccination; and the development of an increasingly
popular website to provide travel health information to Australian travelers.
Results: A travel health bookmark developed by THAG has been distributed extensively through travel agents,
Qantas Holidays and Youth Hostels Association. Travel health surveys conducted under the auspices by THAG
have been presented at the International Society of Travel Medicine (ISTM) conferences and articles focused on
hepatitis A and hepatitis B published in the Journal of Travel Medicine. The welltogo.com.au website was
developed in 2004; expansion of the content took place in 2005, and in 2007 the interactive World Map was
launched (providing health warnings for all regions). The use of the welltogo website has increased rapidly with
more than 42,000 visits per year. The Australian Government travel advisory site has a link to welltogo. THAG
_______________________________________________________________________________________ Page 109 NECTM 2010 in Hamburg Poster Abstracts _______________________________________________________________________________________ participated in the 2007 GlaxoSmithKline (GSK) Australian Olympic Committee immunisation campaign,
where the Shadow Olympic Team was vaccinated in preparation for Beijing. THAG profiled the welltogo
website and provided a spokesperson and research statistics for the campaign. THAG's professional organisation
profile was published in the Travel Medicine and Infectious Disease publication in 2007.
Conclusions: A partnership approach between the travel industry and travel medicine professionals can
effectively support a range of activities to promote the health of travelers. The welltogo website is now making
an important contribution in providing information to the Australian public on travel health.
P17-93
A Sub-Faculty of Expedition Medicine for Australasia
Shaw, M.1,2, Leggat, P.A.2
1
Worldwise New Zealand, Auckland, New Zealand, 2James Cook University, Anton Breinl Center, Townsville,
QLD, Australia
Background: The Australasian College of Tropical Medicine (ACTM) established a Sub-Faculty of Expedition
Medicine as part of the Faculty of Travel Medicine in 2009. The Sub-Faculty aims to provide professional
representation for those working in expedition medicine in Australasia. In 2010, Australia celebrates the
centenary of tropical medicine and the Sub-Faculty will be officially launched during these celebrations.
Methods: The poster describes the major activities of the Sub-Faculty, which include: Faculty of Travel
Medicine membership accreditation to Fellowship level; networking and scientific meetings of the College;
publications; development of policies in travel medicine; advocacy and public awareness; representation on
external committees related to expedition and wilderness medicine; and a website.
Results: The ACTM and the FTM publishes feature newsletters, the ACTM Bulletin and the Travel Medicine
Briefcase, which is sent to all members. It also publishes a journal, the Annals of the ACTM. The College has a
secretariat based at the Australian Medical Association in Brisbane, Queensland, Australia (email.
[email protected]). The ACTM has developed a website: http://www.tropmed.org, where information on the
College and the Faculty is provided. Content and links to the website continue to be enhanced. Membership
applications for the Sub-Faculty are accepted from doctors, nurses and paramedics. There is some flexibility in
the academic qualifications required. The ACTM publishes both online and print textbooks, including the
Dictionary of Tropical Medicine, the Primer of Travel Medicine and also a developing Primer of Tropical
Medicine. The ACTM and the FTM are also represented on various external committees and also contributes to
scientific meetings conducted by the College and other organisations. In 2010, it will be contributing to two
centennial conferences Townsville, including a joint medical science meeting from 4-7 June 2010 and the 6th
World Melioidosis Congress from 30 November to 3 December 2010.
Conclusions: The ACTM and the FTM, including the Sub-Faculty of Expedition Medicine, provide a useful
platform and recognition for those health professionals working in tropical, travel and expedition medicine in
Australasia. The Sub-Faculty of Expedition Medicine is expected to make a useful contribution to the support of
expedition, adventure and wilderness medicine. Promotion of membership remains one of the ACTM's major
activities.
_______________________________________________________________________________________ Page 110 NECTM 2010 in Hamburg Abstracts of Sponsored Symposia _______________________________________________________________________________________ ST01
Vaccines make the world go round
Crucell sponsored Symposium
No abstracts available
ST02
A Journey to the Future of Travel Medicine
GSK sponsored Symposium
The BIG Conversation Live is a new and exciting meeting format providing a change from traditional lecturebased symposia, introducing facilitator-led discussions with guest speakers and opportunities for the audience to
actively engage in the debate and ask questions.
The interactive programme is very innovative and future focused, including topics such as:
• The changing profile and newly emerging categories of travellers
• Travel medicine 20 years from now – the views from the audience and
the expert panel on the future challenges in travel medicine.
• Highlights of the development of vaccines and meningococcal meningitis
prevention in the future
ST03
Strategies in low incidence/high impact diseases
Novartis Vaccines sponsored Symposium
No abstracts available
ST04.01
From Abele Sola to Ho Chi Minh: historical references on malaria and its treatments
Corsi, M1
1
Clinical Research R&D Department, sigma-tau, Pomezia, Italy
Intermittent fevers have accompanied the path of humanity for many centuries. In particular, those that, at the
end of the Middle Ages, were defined “mal'aria”, were believed to be caused by the miasma exhaled from
stagnant waters and marshes. Even when the first effective treatment, the powder of the Countess of Cinchòn,
became available, the cause of these fevers remained unknown. It was only at the end of the XIX
century that most of the information on the cause and transmission of malaria were discovered.
There are many paths of scientific knowledge that have crossed the brilliant insights of Hippocrates and Varrone,
the therapeutic approaches of Talbor, Sydenham and Torti, the devotion to the cause of Manuel Incra Mamani
and the discoveries of Laveran, Ross and Grassi. With the aim to be a little bit unconventional (this should
intrigue the audience), we have chosen to include in the title the fil rouge that binds the almost completely
unknown Abele Sola with the very well known Ho Chi Min.
ST04.02
Development of Dihydroartemisinin/ Piperaquine (Eurartesim®)
Bassat, Q.1
1
Barcelona Centre for International Health Research (CRESIB) University of Barcelona, Spain
Artemisinin-based combination therapies (ACTs) are highly efficacious and fast acting antimalarial medicines.
The World Health Organization (WHO) recommends their use for treating uncomplicated malaria. In Africa,
their introduction on a wide scale began in 2003 and currently most African countries have adopted or are using
ACTs as first or second line treatments.
The co-formulation of dihydroartemisinin (DHA), the active metabolite of artemisinin derivatives, with
piperaquine (PQP), a bisquinoline structurally close to chloroquine, seems to be a promising combination for the
treatment of uncomplicated malaria. Indeed, several trials have assessed DHA-PQP safety, efficacy and
_______________________________________________________________________________________ Page 111 NECTM 2010 in Hamburg Abstracts of Sponsored Symposia _______________________________________________________________________________________ effectiveness, mostly in Asia, reporting an efficacy of about 90% over 28–63 days. However, until recently, there
was little information on the efficacy and safety of DHA-PQP in African children.
This presentation summarizes current knowledge regarding the use of DHA-PQP for the treatment of
uncomplicated malaria, both in adults and children, and in particular reports on results obtained in two different
phase III randomized controlled trials set up to fill the gaps needed for the international registration of DHAPQP. In the first multicentre trial, carried out in 5 African countries and designed as a noninferiority trial
between DHA-PQP and Artemether Lumefantrine (AL), DHA-PQP was shown to be as efficacious as AL in
treating uncomplicated malaria in African children from different endemicity settings, with a comparable safety
profile. In the second phase III trial, carried out in 3 Asian countries, DHA-PQP was also shown to be noninferior to the combination Artesunate-Mefloquine, again with a comparable safety profile.
Both the African and Asian studies have added very consistent data to the existing evidence of the good efficacy
and safety of the combination DHA-PQP. This combination will surely constitute in the near future a new, safe
and effective option to treat acute uncomplicated Malaria.
ST04.03
Intravenous Artesunate: the new generation of lifesaving treatment for severe malaria
Weina, P.J..1
1
Walter Reed Army Institute of Research, Silver Spring, MD, USA
Artemisinins are antimalarials derived from the Chinese herb, Artemisia annua. These compounds clear the
parasites from the blood more rapidly than other antimalarial agents. Intravenous formulations of artemisinins
have been used, but there are currently no regulatory-approved intravenous artemisinin products available in the
U.S. or Europe.
The Walter Reed Army Institute of Research (WRAIR) has a long history with the artemisinins. In 1982,
scientists at the WRAIR received a report from the WHO malaria steering group in Geneva saying there was a
promising new Chinese plant called ‘quing hao’. Rumors of a Chinese cure for malaria had been circulating for
years and it was known that the Chinese had first published their findings in the Chinese Medical Journal in
1979. In 1984, Dr. Dan Klayman independently determined the extraction process and was featured on the May
cover of one of the most prestigious U.S. journals, Science, with his announcement that artemisinin was a
poorly-water-soluble crystalline compound. Work proceeded rapidly at WRAIR only to be stymied by the
specter of neurotoxicity. Finally, between 2000 and 2002, the decision to replace quinidine in the U.S. was made
and two derivatives were in consideration for development to licensure. After intense scrutiny, artesunate was
selected to put forward into advanced development. Since 2002, the WRAIR has completed all pre-clinical
development, obtained Orphan Drug and Fast Track Status in the U.S. as well as Orphan Drug Status in the
European Union, and completed 4 major clinical studies. Meanwhile, artesunate was in use in much of the
malarial world as a non-International Conference on Harmonisation current Good Manufacturing Practices
formulation produced in China. This was used in the landmark SEAQUAMAT trial which showed a 35%
mortality benefit over quinine. This data gave WRAIR a chance to accelerate the development through a
505(b)(2) New Drug Application (NDA) with the U.S. Food and Drug Administration.
WRAIR has also assisted in a major clinical trial in children through the European and Developing Countries
Clinical Trial Partnership. This trial showed the same remarkable mortality benefit over quinine as seen in the
SEAQUAMAT trial. WRAIR partnered with the Centers for Disease Control to make this available in the U.S.
under compassionate use and with the Canadian Malaria Network to make this available to Canadian citizens
with severe malaria. We have partnered with Sigma-Tau Industrie Farmaceutiche Riunite S.p.A. to do the
manufacturing and distribution of this important new drug and with whom we will be filing for licensure of this
desperately needed life saving product. Material has been reviewed by the Walter Reed Army Institute of
Research. There is no objection to its presentation and/or publication. The opinions or assertions herein are the
private views of the author and are not to be construed as official, or as reflecting true views of the Department
of the Army or the Department of Defense.
_______________________________________________________________________________________ Page 112 NECTM 2010 in Hamburg Social Events _______________________________________________________________________________________ Nurses' Reception
Date
Time
Place
Address
Price
Wednesday, May 26, 2010
17.00 – 18.00
Congress Center Hamburg (CCH)
Am Dammtor, Marseiller Strasse
Free of charge for registered delegates
Welcome Get Together Party
Date
Time
Place
Address
Price
Wednesday, May 26, 2010
19.00 – 22.00
Congress Center Hamburg (CCH)
Am Dammtor, Marseiller Strasse
Free of charge
Date
Time
Place
Address
Price
Conference
Dinner
Friday, May 28, 2010
19.45 – 23.00
Hamburgmuseum
Holstenwall 24
70,00 EUR per person, invitation card is required
_______________________________________________________________________________________ Page 113 NECTM 2010 in Hamburg Organisation _______________________________________________________________________________________ ORGANISING SOCIETIES AND ASSOCIATIONS
 British Travel Health Association
 Danish Society of Travel Medicine
 Finnish Society for International Health
 German Society for Tropical Medicine and International Health
 Health Protection Scotland
 National Travel Health Network and Centre, UK
 Norwegian Forum for Travel Medicine and the Prevention of Infectious Diseases
 Royal College of Nursing
 Swedish Society for Travel Medicine
 The Netherlands National Coordination Centre for Travellers Health Advice
 Travel Medicine Society of Ireland
 International Society of Travel Medicine
The Congress Organisation C. Schaefer (COCS) is organising the NECTM10 on behalf of the above mentioned
organisations
ORGANISING COMMITTEE (OC)
Chair: G. Burchard












British Travel Health Association: E. Walker
Danish Society of Travel Medicine: M. Buhl
Finnish Society for International Health: H. Siikamäki
German Society for Tropical Medicine and International Health: G. Burchard
Health Protection Scotland: F. Genasi
National Travel Health Network and Centre, UK: D. Hill
Norwegian Forum for Travel Medicine and the Prevention of Infectious Diseases: P. Voltersvik
Royal College of Nursing: S. Grieve
Swedish Society for Travel Medicine: L. Rombo
The Netherlands National Coordination Centre for Travellers Health Advice: G.J.B. Sonder
Travel Medicine Society of Ireland: D. Colbert
International Society of Travel Medicine: F. von Sonnenburg
SCIENTIFIC COMMITTEE (SC)
Chair: Hinrich Sudeck, Co-chair: Sandra Grieve
Associate chairs: Anu Kantele and Randi Hammer Boge












British Travel Health Association: J. Davies
Danish Society of Travel Medicine: M. Buhl
Finnish Society for International Health: H.Siikamäki
German Society for Tropical Medicine and International Health: H. Sudeck, G.D. Burchard
Health Protection Scotland: K. Smith
National Travel Health Network and Centre, UK: C. Wong
Norwegian Forum for Travel Medicine and the Prevention of Infectious Diseases: P. Voltersvik, R.
Hammer Boge
Royal College of Nursing: S. Grieve
Swedish Society for Travel Medicine: L. Rombo
The Netherlands National Coordination Centre for Travellers Health Advice: G.J.B. Sonder
Travel Medicine Society of Ireland: P. Noone
International Society of Travel Medicine: F. von Sonnenburg
LOCAL ORGANISING COMMITTEE (LOC)
G. Burchard, H. Sudeck, F. von Sonnenburg
_______________________________________________________________________________________ Page 114 NECTM 2010 in Hamburg Faculty & Authors _______________________________________________________________________________________ Akbaba, M. P10-61
Alasvand Rarasvand, M. P3-25
Aldir, I. P10-65
Alfaiate, D. P10-65
Almosny, N.R.P. P8-55, P8-56
Amin, M. P3-25
Anis, S. P2-09
Antunes, I. P10-65
Aplasca-De Los Reyes, M.R. P2-17, P2-18
Aoun, O. P6-34
Araújo, C. P10-65
Ashmore, J. P10-66
Askling, H.H. P2-20
Atwell, C. P10-66
Auranen, K. WS03.01
Aytac, N. P10-61, P16-86
Baaten, G. FC01.05, P8-48
Bailey, L. P10-66
Baine, Y. P2-16, P2-17, P2-18
Baker, L. P1-02
Baptista, T. P10-65
Barreira, J.D. P8-55, P8-56, P8-59
Barreto, M.I. P1-03
Bassat, Q. ST04
Behrens, R.H. WS03, WS03.03, FC02.01
Bento, D. P10-65
Bernatowska, E. P2-13
Bianco, V. P2-16, P2-17, P2-18
Bisaro, F. P2-14
Blessmann, J. P13-75a
Blumberg, L. P1-02
Boddington, N. FC02.03
Boecken, G. P13-73
Boelke, N. P7-46
Boggian, K. P6-35
Booy, R. P2-12
Borges, F. P10-65
Bourée, P. P2-14, P8-52, P8-53
Boyne, L. WS05.04
Bradley, P. P14-79
Bretzel, G. P1-03
Brink, G. K. P2-07
Bruderer, T. P6-35
Bryant, Naomi J. FC01.02, FC02.03
Buhl, M.R. PL03.03, SY03
Burchard, G.D. Opening, COD02, PL01,
P1-05, P1-06b, P6-42, P6-42b, P8-49,
P13-71, P13-73, Closing
Calistru, P.I. P8-54, P13-70
Cambon, A. P6-34
Cañavate, C. FC03.03
Carroll, B. FC02.01
Cartwright, R. FC01.02
Castelli, F. P8-49
Ceausu, E. P8-54, P13-70
Chaiklieng, S. P7-47, P15-82
Chatterjee, N. P2-12
Chiodini, J. ABC01.01
Chlibek, R. P2-15
Cholaphol, S. P1-06c
Chompoonuch, C. P1-06c
Cocksedge, M. P10-66
Colbert, D. FC-02, P17-91
Congpuong, K. P1-06c
Connolly, M. P12-68
Cormican, M. P12-68
Corsi, M. ST04
Cox Brokstad, R. SY01.02
Cramer, J.P. P6-39, P6-42b, FC01, P6-42c,
P1-05
Croughs, M. FC02.06
Davari, B. P3-24
Davies, J. SY02, SY02.03,
Dbaibo, G. P2-09, P2-18, P2-17, P2-18
de Almeida, D.M.P. P8-59
de Jong, E. P2-19
de Jonge, M.E. P2-19
de Vries, P. P8-49
Delarbre, D. P6-32, P6-34
Delasouda, A. P11-67
Dewasthaly, S. FC01.03
Dias, E. P10-66
Díaz-Menéndez, M. FC03.03
Dimaano, E. P2-17, P2-18
Dollenmaier, G. P6-35
Dorostkar Moghaddam, D. P2-11, P8-50,
P13-69
Dubischar-Kastner, K. FC01.03
Duzel, V. P16-86
Ebrahimi, R. P3-26
Eder, S. FC01.03
Ehrhardt, S. P1-05
Elsner, E. P6-33
Ensaf, A. P8-53, P8-52
Erlanger, T.E. P2-21
Erra, E. P8-60
Everett, S. P10-66
Eyni, H. P2-11, P8-50
Faesecke, K.P. P10-62
Faroutan, B. P6-33
Farquharson, L. FC02.01
Favacho, A.R.M. P8-55, P8-56, P8-59
_______________________________________________________________________________________ Page 115 NECTM 2010 in Hamburg Faculty & Authors _______________________________________________________________________________________ Feldt, T. P1-05
Felkai, P. P16-84, P17-90
Ficko, C. P6-32, P6-34, FC01.04
Field, V. P8-49, P8-60a
Fischer, M. WS06, WS06.02,
P13-73, P3-27a, FC03.05
Flaherty, G. P6-30, P10-63, P12-68,
P14-76, P17-91, FC03.01
Fleischmann, E. P1-03
Fleming, C. P6-30
Flores, M. FC03.03
Florescu, S.A. P8-54, P13-70
Ford, L. P14-79, FC01.06
Gabriel, M. P6-42e
Gabrielova, A. P3-27
Gately, R. P6-30
Gau, B. P8-58
Gautret, P. P8-49
Geitner, R. Hamburg Special
Genasi, F. SY04, FC01
Ghadirian, E. P13-69
Ghalyanchi Langeroudi, A. P16-83
Goodyer, L.I. P10-63
Gkrania-Klotsas, E. P8-49
Graf, A. P6-42b
Grasteit, A. P7-45
Greinert, U. WS06.01
Grewal, H. STA01.03
Grieve, A. SY04.01, P10-66
Grieve, S. WS05
Grigoraki, A. P1-06, P16-89
Grubman, M. P16-87
Guedes, S. FC02.02
Günther, S. P6-42e
Guiso, N. P2-13
Gulliksen, E. SY05.03
Gunapalaiah, B. P2-15, P2-22a
Hadjianastasiou, S. P2-08, P11-67
Hadjichristodoulou, C. FC01.02
Hafeez, S. FC03.04
Häkkinen, M. P2-22
Hagen, RM P3-27a
Hagmann, S. FC03, FC03.04
Hakanen, A.J. STA01.02
Hammer-Boge, R. STA01, PL04
Harms-Zwingenberger, G. WS06
Hamza, M. P17-91
Hasle, G. SY03.03
Hatz, C. WS02.01
Haverkort, M.E. P2-19
Helm, F. P3-27a
Heininger, U. P2-13
Herbinger, K.-H. P10-64
Herr, J. P6-39, P1-05
Herzog, C. P2-21
Hill, D. STA02.01, FC02.03
Hoffmann, S. P1-05
Hoffmeister, B. P6-42b
Horstmann, R. STA01, PL03
Hudson, B. P17-92
Huhtamo, E. P8-60
Imbert, P. P6-32, P6-34
Ishihara, Y. P14-77
Jacquet, J.-M. P2-12, P2-15, P2-22a
Jamshidiyan, E. P16-83
Jaremin, B. WS01
Jelinek, T. ST01, ST03
Jensenius, M. P8-49
Ježewska, M. P16-87
Jochum, J. P6-42c
Johal, M. P10-63
Jones, M.E. SY04.03
Jones, J. FC01.02
Jordan, A. FC02.01
Jordan, S. P6-42, P13-71
Kalantar, E. P3-23, P3-24,
P3-25, P3-26
Kalule, J.W. P2-19
Kantele, A. SY01.01, STA01, P2-22, P8-60,
FC02.02
Kantele, J.M. P2-22
Kanungnit, P. P1-6c
Karinen, H. SY02.01
Kibsgaard, L. P6-31
Kint, J. P8-48, FC01.05
Klade, C.S. FC01.03
Kluge, S. P1-06, P6-42b
Knoblach, B. P2-15
Koeman, S.C. WS05.01, SY02
Kotlowski, A. WS01.02
Koutnikova, H. P13-74
Krause, R. P6-42b
Kreuzberg, C. P6-41
Krüger, A. P12-68a
Lalloo, D. P14-79, FC01.06
Lammerding, T. PL02.01
Larsen, C.S. P6-31
Lawrence, J. FC01.02
Lawson, I. P7-43
Leckie, K. P1-01
Lede, I.O. P2-19
_______________________________________________________________________________________ Page 116 NECTM 2010 in Hamburg Faculty & Authors _______________________________________________________________________________________ Leggat, P.A. P1-04, P17-92, P17-93
Leite, R. P10-65
Lemos, E.R.S. P8-55, P8-56, P8-57, P8-59
Leitmeyer, K. FC02.04
Leszcyniska, I. P16-87
Lindberg, J. P6-31
Lindquist, L. WS01.03, WS02, P2-20
Lopez-Velez, R. FC03.03, P8-49
Löscher, T. Opening, STA02.03, ST02,
SY01, P1-03
Lund, C.H. P5-29a
Loutan, L. P8-49
Luis, N.M. P10-65
Lyytikäinen, O. FC02.02
Macalalad, N. P2-17, P2-18
Macura-Biegun, A. P2-22a
Majidzadeh, K. P16-83
Maleki, A. P3-26
Maltezou, H.C. P2-08, P11-67
Mansinho, K. P10-65
Maresova, V. P3-27
Masuet Aumatell, C. P2-10
Mebs, D. SY03.02
Méchaï, F. P6-32, P6-34
Medlej, F. P2-09
Mehrfar, P. P1-05
Mendelson, M. SY05.02
Mertsola, J. P2-12, P2-13
Mero, M. PL04.02
Meurice, F. ST02
Meynard, J.B. P6-32
Middleton, N. PL04.03
Miller, J. P2-09, P2-16,
P2-17, P2-18
Miranda, A.C. P10-65
Mohseni, A. P16-83
Monge-Maillo, B. FC03.03
Monteiro, A.O. P15-81
Montgomery, F.U. Opening
Moreira, N.S. P8-55, P8-56, P8-57,
P8-59, P15-81
Morovvati, A. P16-83
Müller, A. P5-29, P6-38
Müller, B. P6-35
Müller, M.C. P6-42b
Müller, R. P6-33
Myrvang, B. WS02
Navarro, M. FC03.03
Neumann, K. FC02.05
Nguah, S. P1-05
Nichols, G. FC01.02
Nicolino, R.R. P15-81
Nikolic, N. PL02.04
Noble, L. WS03.02, FC02.01
Nohynek, H. WS03
Noone, P. WS04
Norman, F. FC03.03
Nothdurft, H.D. ABC01. ABC01.03,
SY05 , P10-64
O’Brien, T. P14-76
O’Donovan, D. P12-68
O’Halloran, J. FC03.01
Oliveira, R.C. P8-57
Østergaard, L. P2-16
Ouzounidou, Z. P11-67
Oztunc, G. P16-86
Pakkanen, S.H. P2-22
Panis, T. P2-22a
Parola, P. SY06.02, EuroTravNet Symposium,
P8-49
Patrinos, S. P2-08, P11-67
Pavli, A. P2-08, P11-67
Pelletier, D. P1-05
Pérez-Ayala, A. FC03.03
Pérez-Molina, J.A. FC03.03
Pesoa Jr., A.A. P8-59
Petersen, E. ST02, SY06
Peyerl-Hoffmann, G. P6-42b
Phelan, D. P7-43
Pinyorattanachote, A. P1-06c
Pischke, S. P6-42b
Pissinatti, A. P15-81
Popescu, C.P. P8-54, P13-70
Poolthin, S. P1-06c
Poumerol, G. SY05.01
Priesnitz, S. P3-27a
Prymula, R. P10-64
Purswani, M. FC03.04
Racz, C. P6-42d
Racz, P. P6-42d, P13-73
Rafeiner, P. P6-35
Raja Ali, R.A. FC03.01
Rajtmajer, M. P10-66a
Rapp, C. FC01.04, P6-32, P6-34
Ramon Torrell, J.M. P2-10
Reda, M. P2-09
Reisinger, E. STA02, WS02.03
Reisingerova, M. P3-27
Resch, C. P6-42e
Riehm, J. P6-35
Rjabinina, J. PL02.02
Rozental, T. P8-57, P8-56
_______________________________________________________________________________________ Page 117 NECTM 2010 in Hamburg Faculty & Authors _______________________________________________________________________________________ Rombo, L. ABC02, ABC02.01, STA02, SY01,
P2-20
Roord, J. P2-13
Roqueplo, C. FC03.04
Rosling, H. ST01
Rossmann, K. P12-68a
Rouh-Neau, S. P2-14
Rydgård, C. P2-20
Saiki, K. P14-77, P14-78
Salimi, H. P3-23
Santos O’Connor, F. EuroTravNet Symposium
Saroglou, G. P2-08
Sasse, J. P7-46
Satimai, W. P1-06c
Schade Larsen, C. WS04.01, P2-16
Schargus, M. P6-38
Schlagenhauf, P. ABC01.02, EuroTravNet
Symposium, WS04.03, P8-49
Schlaich, C. PL02, P8-58
Schmiedel, S. FC03, P5-29a,
P6-37, P6-42, P13-71
Schmidt, S. P12-68a
Schmidt-Chanasit, J. P6-42d, P6-42e
Schubert, J. P6-38
Schuller, E. FC01.03
Schultze, D. P6-35
Schulze, M. P5-29, P6-38
Shanks, D. PL01.01
Shaw, M. SY02.02, P17-93
Siikamäki, H. Opening, COD01,
PL04, FC02, FC02.02
Silfverdal, S.A. P2-16
Silva, C. P10-65
Simons, H.J. FC02.03
Smetana, J. P2-15
Smeti, P. P2-08, P11-67
Smith, C. P1-01
Smith, K. WS02.02, PL03, ABC01
Sofos, N. P1-06, P16-89
Soheili, F. P3-23
Soleimani, M. P16-83
Sonder, G. WS05.01, SY04, P8-48, FC01.05
Sonricker, A. SY06.03
Sotirchos, A. P16-89
Sotiriou, G. P2-08
Souza, A.M. P8-55
Stanczak, J. WS01.02
Stauga, S. P5-29a
Steffen, R. STA01.01, ST02, ST03
Stejskal, F. P3-27, P13-74
Stich, A. PL03.02, P5-29, P6-38
Stick, C. P16-85
Sudeck, H. SY03.01, SY05, PL01,
P6-41, FC03.05
Suess, J. WS01, WS01.01
Suggaravetsiri, P. P7-47, P15-82
Sumbul, A. P2-09
Suttorp, N. P6-42b
Tabet, C. P2-09
Talhari, S. WS06.03
Tanir, F. P10-61, P16-86
Tannich, E. P3-27a
Tappe, D. P5-29, P6-38
Tavares, R. P10-65
Theeten, H. P2-12
Thongduang, P. P15-82
Thornam, P. WS04.02
Tichy, P. P2-15
Tomickova, D. P13-74
Tordo, N. ST03
Tothill, G. SY04.02
Tozzi, A. P2-13
Trojanek, M. P3-27
Tunchan, K. P1-06c
Tzortzis, G. FC01.01
Umeed, M. P10-66
Vakali, A. P2-08, P11-67
Vakalis, N. P1-06, P6-40, P16-89
van Damme, P. P2-12, P2-15, P2-22a
van den Ende, J. FC02.06
van den Hoek, A. P8-48, FC01.05
van der Meeren, O. P2-12
van der Wielen, M. P2-09
van Gompel, A. FC02.06
van Gool, T. P8-48, FC01.05
van Herck, K. P2-22a
van Vugt, M. P2-19
Vapalahti, O. P8-60
Vassalou, E. P6-40, P1-06, P16-89
Vassalos, C.M. P1-06, P6-40, P16-89
Vaughan, D. P12-68
Vene, S. P2-20
Verdi, F. P3-24
Villumsen, S. P6-31
Visser, Leo SY01.03
Vlug, J. P2-19
Vojackova, N. P13-74
Voltersvik, P. WS04, WS05.02, PL02
Votypka, J. P13-74
von Laer, G. FC03.06
von Sonnenburg, F. WS01.03, SY06.01, ST04,
SY06, P2-15, P8-49
_______________________________________________________________________________________ Page 118 NECTM 2010 in Hamburg Faculty & Authors _______________________________________________________________________________________ Walentiny, C.E.F. P13-75
Walker, E. PL04.01, WS05
Weber, I.B. P1-02
Weber, C. P1-03
Weid, L. P8-49
Weina, P.J. ST04
Wersich, D. Opening
Westlund, K. PL02.03
Wetstejn, J.C. P2-19
Wichmann, D. P1-6b
Wiemer, D. P3-27a, FC03.05
Wijaya, L. FC01.06
Wilder-Smith, A. STA02.02
Winkler, E. P7-46
Wong, C. ABC02, ABC02.02, SY03
Yamamoto, K. P14-77
Zaccarin, M. P5-28
Zacharof, A. FC03.02
Zahirnia, A. P3-24
Zamini, G. P3-24
Zepp, F. P2-13
Ziegler, U. P5-29, P6-38
Zwar, N. P17-92
Zuckerman, J. ST01, ST03
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