Egxeiridio - Taxidiotikhs - Iatrikhs

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XI
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XII
1:

1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
1.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
1.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
2:
2.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
2.1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
2.1.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
2.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
3:
3.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
3.1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
3.1.2 (Jet lag) . . . . . . . . . . . . . . . . . . . . . . . . . . .32
3.1.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
3.2 . . . . . . . . . . . . . . . . . . . . .36
3.2.1 - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
3.2.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
3.2.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
3.2.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
3.2.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
4:
4.1 . . . . . . . . . . . . . . . . . . . . . . . .43
4.1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
4.1.2 . . . . . . . .45
4.1.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
4.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
4.2.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
4.2.2 . . . . . . . . . . . . . . . . .50
4.3
4.4
4.5
4.6
4.7
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
4.3.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
4.3.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
4.3.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
4.3.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
4.6.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
4.6.2 . . . . . . . . . . . . . . . . . . . . . . . . . . .59
4.6.3 . . . . . . . . . . . . . . . . .60
, . . . . . . . . .62
4.7.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
4.7.2 ,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
5:
5.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
5.1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
5.1.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
5.1.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
5.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
5.2.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
5.2.2 . . . . . . . . . . . . . . . . . . . . .89
1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
5.2.3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120
1) - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
2) - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125
4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
5.2.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
6:
6.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
6.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133
6.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
6.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
6.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
6.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
7:
7.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
7.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
7.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
7.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164
7.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
7.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
7.7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167
8:
8.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
8.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174
8.2.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .174
8.2.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
8.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
8.4 HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178
8.5 ( HIV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180
8.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180
8.7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182
8.8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182
9:
9.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
9.1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
9.1.2 - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
9.1.3 () . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190
9.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
9.3
9.4
9.5
9.6
9.7
9.8
9.2.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
9.2.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
9.2.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209
9.4.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209
9.4.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212
9.4.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215
9.4.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .218
9.4.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225
9.5.1 - . . . . . . . . . . . . . . . . . . . . . .225
9.5.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237
10:
10.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241
10.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242
K 11:
11.1 - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243
11.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .245
11.3 , ,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .246
: . . . . . . . . . . . . . . . . .249
: . . . . . . . . . . . . . . . . . .251
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257
XI
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XII

,
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,
,
.
, 1950
50 ., 1970 150 ., 2001
693 ., . 20 30
300% 480%! 1999, 75 .
,
.
,
, ,
. ,
, , HIV
.
SARS , ,
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,
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, ,
1980,
.

,
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XIII

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.

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,
, , .

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,

. 45% 70%
,
.
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, , ,
.
.

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,
,
. Lassa,
1969
.
.
,
, ,
,
.
K 1.1

, ,
, (.1).
40%
. (ETEC)
.
16
(Campylobacter, ), (Salmonela),
(Shigella), Giardia lamblia, Entamoeba histolytica,
(Cryptosporidum), , .
.
2 , ...,
, .
, 8%. , ,
, 20%.
20 - 66% 2
. ,
.
, .
1%
.

,
.
.
1261 100,000
.
.

(attack rate) 13% . '

2,6 . ,
.

, .

(antigen variants) .
(H3N2) 1997
, ... .

. 1999,
289 ,
. (1:100,000)
.
17

.

8 .
.
.
,

.
, ( ), (
), (..
),
.
,
2 - 3% ( 1.).
30,000
, 2%.
(P. falciparum).

, ( 1,700 ) .
. 1989
1995, 373 9 25 ...
P. falciparum.

.
( 1.). ... ,
30 - 50% . ,
.
, , .
20 , 235 1835 .
, 300
100,000 , 2,000
100,000 ( 1 50)
.
,
.
,
, ,
.
. 80 - 420
100,000 ( ( 1.).
18
. 16
. O
. Steffen
30
100,000 ( 1.).
(salmonella typhi) ,
.
.
,
,
.
A, C, W135 Y .
.
C.
.
,
Aedes.
,
.
.
.
0,2 100,000 ( 1.).
1980 2 100,000.

. 2002

70% .
.
.
50 1970 1987, 21
. .
,
. 24%
1995 1999 .
.
. 1 1,000,000.

.

.
.
, . ,
. ' .
19
()
. 4 20%
, .

HIV .

,
.
.

.
,
. (Neisseria gonorrhoeae)
( ) ... (Steffen et
al.) 300 100,000
, .

.

.
.
: , , , ,
.
.
Haemophilus ducreyi Calymmatobacterium inguinale.
, .

. HIV
.
10% HIV ,
HIV 300 .

.
1981.
, ,
. 20
.

.
, . Aedes
.
,
Aedes.
20
1999 Nipah

.
.
. , , .
K 1.2
.

,
,
.
K 1.3

() . (60 69 ) (69%)
(21%).
. , (49% 25%, ) .
25 44 , 2 - 3

( ). .
,
, , ,
,
,
. ,

,
. ,
. 70%
.
20 - 118 10,000, ,
9 - 67 10,000
1.4 10,000 .
3
' .
.
. ,
,
.
. ,

21
, ' ,
. 1.2 , 65% .
(, )
. (Ferry boats)
.
.

(16% ).
.
,
.

.
, ,
3.
1. ( / 100.000 /
)
(/ 100.000 /
)
30-80.000
E.coli (ETEC)
10.000
( )
2-3.000
1.000
3.000
60
300
200
(,
, )
30
HIV
10
( )
80-420
0,2
0,04
0,1
: Steffen R. Epidemiology: Morbidity and Mortality in Travelers. In: Keystone JS, Kozarsky PE,
Freedman DO, Nothdurft HP, Connor BA. Travel Medicine. Spain: Elsevier;2004.p.5-13.
22
Steffen R, De Bernardis C, Banos A (2003) Travel epidemiology-a global perspective,

International Journal of Antimicrobial Agents 21 (2003) 89-95.
Behrens RH, Collins M, Botto B et al. (1995) Risk for British travelers of acquiring hepatitis A.
BMJ,311,193.
Centers for Disease Control and Prevention (1997) Update: influenza activity: United States,
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www.who.int/inth/chapter03_01.html
www.travax.com/travinfo/travinfo_articles/showcontent.asp
www.cdc.gov/travel/diseases
Rocky Mountain Center and Environmental Health, University of Utah, U.S.A. Cabin location
and the like hood of motion sickness in cruise passengers. J Travel Med, May-June 2002,
7(3):120-4
www.iatronet.com/HTMLpages/MainPages/YgoiaNosoi/EpigontaPerist/asth
www.travmed.com
www.in.health.gr
Jane Zuckerman. Principles and practice of travel medicine, ed. Wiley, 2001; pg: 234-242
Keystone JS, Kozarsky PE, et al. Environmental Aspects of Travel Medicine, in: Travel
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62
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65
Ostrosky-Zeichner L, Ericsson CD. Travelers' diarrhea. In: (ed) Zeckerman JN. Principles and
Practice of Travel Medicine. John Wiley & Sons Ltd, Chichester 2001, p.153-163.
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, , . .
, , 2000, . 355-358, 361-363.
Centers for Disease Control and Prevention. Risks From Food and Drink. In: Centers for
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https:// www.travax.com/medtopics/medtopics_articles/showcontent.asp?DocID=travdiar
World Health Organization. https:// www.who.int/inth/chapter03_01.html
Travax. Traveler's diarrheaQ www.travax.com/travinfo/travinfo_articles/showcontent.asp
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edition Mosby, Edinburgh-London-New York-Oxford-Philadelphia-St Louis-Sydney-Toronto
2004, 5-7
The responsible traveler:www.istm.org/publications/resptrav.aspx
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www.cdc.gov/travel/other/animal-hazards.htm
www.travax.com/traveler information/marine envenomation - swimming
www.ucmp.berkeley.edu/echinodermata/holothuroidea.htm
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www.cdc.gov/healthypets/diseases/rabies.htm
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Blood transfusion. In: W.H.O. : International Travel and health (2004)
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3
.
72
,
.
American Academy of Paediatrics. Hypersensitivity reactions to vaccine constituents. In: Peter

G, ed 1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove
Village, IL: American Academy of Pediatrics;1997:32.
American Academy of Paediatrics. HIV infection. In Peter G, ed 1997 Red book: Report of the
Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL: American Academy of
Paediatrics; 1997:293.
American Academy of Paediatrics. Treatment of Anaphylactic Reactions. In Peter G, ed 1997

Red Book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL:
American Academy of Pediatrics;1997:45.
Mandell. Principles and Practices of Infectious Diseases. 5th ed. Immunization, : 32073229.
Guide d'information et de conseils pratiques - Medecine des voyages - Edisions Format Utile Societe de Medecine des Voyages. 1998.
Measles, Mumps, and Rubella- Vaccine Use and Strategies for Elimination of Measles, Rubella,
and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory
Committee on Immunization Practices (ACID). MR 1998; 47: RR-8.
Prise en charge des personnes infectees par le VIH. Recommandations d'un groupe d'experts.
Rapport 2002 sous la direction du Professeur JF DELFRAISSY. Medecine Sciences
Flammarion.
Recommandations sanitaires pour les voyageurs 2003. Bull Epidemiol Hebd 2003;26-27:11724.
73
K 5.2
5.3.
0 .
15 .
(1)
d
IPV
Hep A

A, C, Y, W135

Hep
30
45 .
d (2)
IPV
Hep
Hep
5.2.1

.
1. (Yellow Fever Vaccine)

(Aedes
Haemagogus) .
. H
,
. '
'
(, , , , ...).

(1/1.000 1/5.000 , ),
(1). .
(2) 2 >20 .
74
,
. . 10
. .
-
,
- 1
- . (
...).
(..

). , CDC

.
, ,
( transit),
.

.

CDC , 9
( ) CDC.
.

,
( ...)
, . 10
. 10 .

, ,

.
.
. ,
, ,

.
( Rockefeller 17 D).

.

0,5 ml.
75
10
30-35 . ' ' ,
10 .
+0 C +5 C. .
,
.
9
.
: 4 ,
4-9 , .
:
(, , ,
, , , )
, '
.
(< 2 ) (10 mg
) ,
.
HIV AIDS,
, ( 77%
17% HIV ,
). ' ,
.

.
:
.
.
.

( ).

,
. : test
, prick, scratch, puncture test, 1:10 .
test () test
(). 15-20 .
> 3 mm test ,
76
, test , , .
,
0,02 ml 1:100 .
> 5mm, , .
,
,
.
, 15-20 : (1) 0,05 ml
1:10 , (2) 0,05 ml , (3) 0,1 ml , (4) 0,15 ml
, (5) 0,20 ml .
:
.

: ,
( 6 ),
.
(
).
, '
,
. ,
.
: ,

.
: (YEL-AVD)
70 (. ).
,
.
:
(, , gravis,
Di George)
(YEL-AVD). CDC,

.

,
4 .
3 ,
.
77
, ,

.
Mantoux, 4-6
.
in vitro,

.
, ,
.
, 8
.

.
(2-5%), 4 15
, ,
, .
(1/1.000.000 )
.
(1/8.000.000 )
(Yellow fever vaccine Associated Neurotropic Disease - YEL-AND)
-.
< 4 , .
7-21 ,
. .
( 1996 2004, 28 100
. ),
17D (Yellow fever vaccine Associated Viscerotropic Disease - YEL
- AVD) .
70
. 2-5
. .
. 7-10
.
90% 94%.
(10 ).
92-97% 16-19
80% 30 .
78
Chiron/Evans Vaccines (08457 451500).

.
Aventis Pasteur MSD (01628 773737).
.
http://www.sante.gouv.fr/htm/dossiers/vaccins2003/11vaccin6.htm
www.cdc.gov/travel/diseases/yellowfever.htm
www.cdc.gov/travel/yb/outline.htm#2
www.nhs.uk. Travax. Travel Medicine Team of the Scottish Centre for Infection and
Environmental Health (SCIEH). Yellow fever vaccine
Monath T.P. Yellow fever vaccine. In: Plotkin SA, Orenstein WA. Vaccines. 4th ed. Saunders;
2004: p. 1095-1177.
Mandell. Principles and Practices of Infectious Diseases. 5th ed. Flaviviruses/Prevention and
Therapy, pg: 1730-33.
Virk A, Jong EC. Adult Immunizations. In: Kozarsky PE, et al. Travel Medicine. Mosby; 2004:
87-122.
Adverse Events Associated with 17D-Derived Yellow Fever Vaccination --- United States, 20012002. Morbidity and Mortality Weekly Report 9MMW. November 8, 2002 51(44); 989-993.
Fever, Jaundice, and Multiple Organ System Failure Associated With 17D-Derived Yellow Fever
Vaccination, 1996--2001Morbidity and Mortality Weekly Report (MMWR). August 3,
2001;50:643-645.
Cetron MS, Marfin AA, et al. Yellow fever vaccine. Recommendations of the Advisory Commitee
on Immunization Practices (ACIP). MMWR 2002; 51(RR-17):1-11.
Martin M, Tsai TF, et al. Fever and multisystem organ failure associated with 17D-derived yellow fever vaccination: a report of four cases. Lancet 2001; 358(9276): 98-104.
WHO Adverse events following yellow fever vaccination. Weekly Epidemiological Record 2001;
76(29): 217-218.
Yellow fever vaccine risk and updated yellow fever vaccine information statement (VIS). CDC
Travelers' Health. December 3, 2004.
79
2. (Meningococcal Vaccine, MV)

C
...
C,
-.
, " "
..
30 /100.000 , 10-12
.
, W135
. , 2000-2001,

.

, .
( ),
(> 1 )
.
:
1.
C, ,
, C, , W135.
.
2.
C (Meningococcal C Conjugated, MCC):
C CRM197
Corynebacterium diphtheriae .

.

.
80

5.4.

18 (1)
1 0.5 mL
, C, W135
2 (2)
1 0.5 mL
3-5 (3)
<12 :
3 0,5 ml
1
>12 :
1 0,5 ml
+2 C +8 C. .
Memomune 10 (
). 1 1
.

, ,
" ",
.

, 1 ' .

,
.
10 .

C ,
.
(1) < 18 ,
. < 18 ,
, .
(2) 4 2-3
, .
(3) .
3 .
81

( ) .
.
, .

.

:
, 2
.
:

.

, , .
24 ,
, , , ,
(, , ).
> 89%
> 83% C. C,
4 .
.
C
> 90%.
12 . ,
C .
( + C)
VACCIN MENINGOCOCCIQUE MERIEUX (Vianex, A.E.):
0,5ml. ( )
AC Vax (GSK)
C ( )
NEISVAC-C (Baxter Healthcare LTD, U.K.): : 10mcg/0,5ml ().
C ( CRM 197)
MENINGITEC (Wyelth): : 10mcg/0,5ml ().
82
MEN JUGATE ( .., ....): :

10mcg/0,5ml ().
MENINVACT (Vianex, A.E.): 100 mcg/0,5ml
().
A + C + Y + W 135
MEMOMUNE (Vianex, A.E.): 50 + 50
+ 50 + 50 mcg /0,5ml ( . /
)
ACWY Vax (GSK Biologicals).
www.cdc.gov/travel/diseases/menin.htm
Serogroup Y Meningococcal Disease - U.S. 1989-1996. MMWR Vol. 45 / No. 46, p. 1010-1013
Serogroup B Meningococcal Disease - Oregon, 1994. MMWR Vol. 44 / No. 7, p. 121-124
Environmental Health (SCIEH). Meningococcal vaccine.
Granoff DM, Feavers IM, Borrow R. Meningococcal vaccines. In: Plotkin SA, Orenstein WA.
Vaccines. 4th ed. Saunders; 2004: p. 959-987.
Avis du Conseil superieur d'hygiene publique de France concernant la vaccination contre les
meningocoques de serogroupe A,C,Y,W135 des voyageurs se rendant en zone d'endemie du 14
septembre 2001. Bull Epidemiol Hebd 2002; 24:118.
Avis du Conseil superieur d'hygiene publique de France relatif a la vaccination par le vaccin
conjugue contre le meningocoque C du 8 mars 2002. Bull Epidemiol Hebd 2002; 24:121.
Avis du Conseil superieur d'hygiene publique de France relatif a la vaccination par le vaccin
conjugue contre le meningocoque C du 15 novembre 2002. Bull Epidemiol Hebd 2002 ;6 :38.
87-122.
Denis F, Rey JL, Amadou A, et al.. Emergence of meningococcal meningitidis caused by W 135
serogroup in Africa. Lancet 1982 ;ii :1335-7.
Direction generale de la Sante, Prophylaxie des infections a meningocoque. Circulaire

DGS/SD5C/2002/400 du 15 juillet 2002. Bull Epidemiol Hebd 2002; 39:189-195.
Miller E, Salisbury D, Ramsay M. Planning, registration, and implementation of an immunisation campaign against meningococcal serogroup C disease in the UK: a success story. Vaccine
2002; 20: S58-S67.
Centers for Disease Control & Prevention. Control and Prevention of Meningococcal Disease
and Control and Prevention of Serogroup C Meningococcal Disease: Evaluation and
Management of Suspected Outbreaks: Recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR 46 (No. RR-5): 5, 1997.
83
3.
(Tick-Born Encephalitis, TBE Vaccine)

, ,
:
1. ( taiga ),
, , ,
.
2. ( )
, , , .
,
.
.
.
,
.
,
. ,
,
,
. ,
,
.

0,5 ml.

.

3 0,5 ml ( 3-15 ):
2 1-3 3 9-12 .
3 , 3-5
.
3 .
2 . 2 15
, 1 .
, Encepur: 3 0, 7
21 12-18 .
84
+ 2 C + 8 C. .

, .. ,
.

.

, ,
. ,
.

. 2
.

, , , .
, , , ,
Guillain-Bare ..

.
.
97% .
( )
Encepur (Chiron): .
FSME-IMMUN (Baxter AG):
.
FSME-BULIN : ( 2002).
85
www.cdc.gov/travel/diseases/tickenceph.htm
Environmental Health (SCIEH). Tick-borne encephalitis vaccine.
87-122.
Barratt PN, Dorner F, Plotkin SA. Tick-borne encephalitis vaccine. In Vaccines; Plotkin SA,
Orenstein WA. 3rd Ed. Saunders. Philadelphia 1999; 767-80.
Rodhain F. Arboviroses. Encycl Md Chir Paris, Maladies infectieuses 8062 A10, 1995; 16
pages.
4. (Japanese Encephalitis, JE Vaccine)

. ..
:
.
. < 15
,
. 1 20-1.000 ,
25%
30%.
(<1/1.000.000
). 20 20 .

(1/50.000 / ).
.
.

.
86

2 3 1 ml. 1-3
(0,5 ml).
5.5.
0, 7, 30
3 *
GREEN CROSS
0, 7-14
1 .: 1
: 3 *
10
. 2
1-2 ( 0, 7-14),
(80%) 3
12 GREEN CROSS. ,
, 3 0, 7, 14.
+ 2 C + 8 C. .
8 ( ).

2 ( WHO) 4
( CDC) , ,
(
).
,
.
, 100% ,

.

(, Quincke )
( ).
*
5-6 .
87
, ,
, . ,
.
, ,
.
1 .
.

, .

1/3 , ,
. 10%: , , , , , , , .

, 48 .
(1-64/10.000 ) : ,
, Quincke, , shock.
12 1 , 3 2
20 3 ,
. .

.
,
30
10 .
(1 /2,3 . )
, , , ..

.
2 ,
91% .
3 .
.
,
, .
88
B ( Aventis-Pasteur, MSD):
. ( Nakayama
).
..., . .
GREEN CROSS: .
,
( P-3)
( SA14-14-2)
, .
www.cdc.gov/travel/diseases/jenceph.htm
Environmental Health (SCIEH). Japanese encephalitis vaccine.
87-122.
TsaiI TF, Halstead SB. Japanese encephalitis vaccines. In Vaccines Plotkin SA, Orenstein WA.
Saunders Philadelphia 2004; 919-958..
Anderson MM, RonneT. Side effects with Japanese encephalitis vaccine. Lancet 1991; 337:
1044.
Inactivated Japanese encephalitis virus vaccine: Recommendations of the Immunization

Practices Advisory Committee (ACIP). MMWR 1993; n.RR-1: 1-15.
OMS. Encphalite japonaise, Vaccin inactive contre le virus de l'encephalite japonaise. Rel
Epidemiol Hebd 1994; 69: 113-8.
OMS. Vaccins contre l'encephalite japonaise. Rel Epidemiol Hebd 1998; 44: 337-44.
Ruff TA, Eisen D, Fuller A et al. Adverse reactions to Japanese encephalitis vaccine. Lancet
1991; 338 :881-2.
Hoke CH, Nisalak A, Sangawhipa N, et al. Protection against Japanese encephalitis by inactivated vaccines. N Engl J Med 1988; 319 :608-14.
89
5.2.2.

.
1. (Influenza Vaccine)

""
(
) ' ,
.
(split virus) 3 (
) .

. 9
( ),
9 .

5.6.
6 - 3
0,25 ml
1 2 *
3-9
0,5 ml
1 2 *
>9
0,5 ml

()
,
,
.
2 - 8 C. .
. 4-6
. . [ 2
13 ].
90
:
65 ,
" "

.

:
, ,

,
.
:
,
1
Guillain-Barre 6
Guillain-Barre.
:

( ).
6 .

.
.

450.
,
, , .
,
.

. 1064% , 1-2 . (1-10%)
, , , .
6-12 1-2 .
. , .
91
, 65 ,
70% 90%.
:
ADDIGRIP (): , : 15 + 15 +
15 mcg/0,5 ml ().
AGRIPPAL (): , : 15 + 15 +
15 mcg/0,5 ml ().
EVAGRIP (Glaxo SmithKline): , : 15 +
15 + 15 mcg/0,5 ml ().
FLUARIX (Solvay Pharma): , : 15 + 15
+ 15 mcg/0,5 ml ().
INFLUVAC SUB-UNIT (Solvay Pharma): ,
15 + 15 + 15 mcg/0,5 ml ().
VAXIGRIP (Vianex): , 15 + 15 + 15
mcg/0,5 ml ().
VAXIGRIP () (Vianex): , 7,5
+ 7,5 + 7,5 + 7,5 mcg/0,25 ml ().
1. .

FDA ,
. .
www.cdc.gov/travel/diseases/infuenza.htm
www.nhs.uk.Travax. Travel Medicine Team of the Scottish Centre for Infection and
Environmental Health (SCIEH). Infuenza vaccine.
Mandell. Principles and Practices of Infectious Diseases. 5th ed. Influenza virus/Prevention, pg:
1839-1842.
OMS. Vaccins antigrippaux. Releve epidemiologique hebdomadaire; n35; 1er septembre 2000.
CDC. Prevention and control of influenza : recommendations of the Advisory Commitee on

Immunization Practices (ACIP). MMWR April 25, 2003 / 52 (RR08) : 1-36.
92
2. (Hepatitis A Vaccine, Hep A)

, .
2 ,
.
-
-
.
,
( ).
,
.
4
) : ,
, ,
, , .
,
.
) :
. .
) :
, , .
.
) :
, .
, .
, " " . ,
, 5%
15-20 .

.
3-6 / 1.000 /
, 2000 /1.000 /
, 2%
40 .

, 1 .
, ,
, ,
93
,
.
, ,
,
(<1 ), ,

.
, ,
IgG .
(
),
:
1960

( )

.
.
>96%.
(69-98%) 15
. 6 , 100%
.
94%.
,
. :
HIV : CD4 > 200 /ml.
: ,
,
.

,
2 6-12 18 ,
10-20 .
.
:
20 10 .
2
4 . ,
,
94
,
.
5.7.
Havrix 1440*
Vaqta*
Avaxim#
Epaxal#
Allen
Vianex
Vianex
Instituto Sieroterapico Berna SRL,

Italy
HM 175

MRC-5
HM 175

MRC-5
GBM

MRC-5
1440 Elisa
50
160
1 ml
1 ml
0,5 ml
0,5 ml
(2)
0, 6-12 (1)
(2)
0,6-18 (1)
(2)
0,6-18 (1)
(2)
0, 6-12
* ,
# , .
(1) 3 ,
.
95
5.8.
Havrix 720*
Havrix 360**
Vaqta25*
Epaxal#
Allen
GSK
Vianex
Instituto Sieroterapico Berna SRL,

Italy
HM 175 HM 175 CR326F

MRC-5
MRC-5
MRC-5
720
Elisa(1)
360
Elisa(1)
25
, -

0,5 ml
1-18
0,5 ml
1-18
0,5 ml
2-18
0,5 ml
> 2
(2)(1)
0, 6-12 (2)
(3)(1)
0, 1, 6-12 (2)
(2)
0, 6-18 (2)
(2)
0, 6-12

. MRC-5 .

, 2 ,
2 .
2 - 8 C. .
* ,
** , # , .
(1) (.. 360 ),
(360 ).
3 .
(2) 3 ,

96
.

, ( ).

, , < 1
( < 2
HAVRIX).
'
.

.
. ,
2 ,
, , , , , , .
-
,
.
(IG),
, .
(Twinrix ),
,
,
( 2.3).
97
5.9. .
Twinrix*
Twinrix
*
Viatim
(vaxim +
Typhim Vi)#
Hepatyrix
(Havrix +
Typherix)#
GSK
GSK
Vianex
GSK
HM 175

MRC-5
HM 175

MRC-5
GBM
HAV MRC-5
HM 175
HAV MRC-5
720 Elisa
(HAV)
360 Elisa
(HAV) + 10g
HBV
160
HAV +
0,025 mg
1440 Elisa
HAV + 0,025 mg
1 ml
0,5 ml
< 15
1 ml
> 15
1 ml
> 15
(3)
0, 1, 6 (1)
(3)
0, 1, 6
1 (2)
1 (2)
( 5.7, 5.8, 5.9).
2.. (HAIG)
,
.
thimerosal .
* ,,
#
, .
(1) : 0, 7, 21 12
.
(2) : 1 6
3
98
,
,
.
(Lancet, 1999:353;1136-9)
.
, ,
( )

(.. ).

( ).
-
IG (0.02 mL/kg) 35 . 3
(0.06 mL/kg).
:
5.10.

(Kg)
mL*
<3
<23
0.5
23-45
1.0
>45
2.0
<10
0.5
10-22
1.0
23-45
2.5
>45
5.0
3-5
.
thimerosal.

. ,
IgA. .
99

(
) .

( , C HIV). < 2
.

.
.
,
, - - (MMR)
, . MMR
3 , 5
. ,
2 MMR 3
,
.
,
MMR
5 .
www.cdc.gov/travel/diseases/hav.htm
www.nhs.uk Travax. Travel Medicine Team of the Scottish Centre for Infection and
Environmental Health (SCIEH). Hepatitis A vaccine.
CENTERS FOR DISEASE CONTROL AND PREVENTION. Prevention of hepatitis A through

active or passive immunization. Recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR, 1996; 45 No. RR-15: 1-30.
Flehmig B, Staedele H, Xueref C, Vidor E, Zuckerman J, Zuckerman A. Early appearance of

neutralizing antibodies after vaccination with an inactivated hepatitis A vaccine. J Infect 1997;
35: 37-40.
Teyssou R, Nicand E, Koeck JL, Buisson Y. Prevention et prophylaxie vaccinale de l'hepatite A

In epatites virales enterotransmissibles. Guides Mdi/bio. Elsevier Eds. 200.
Wiedermann G, Kundi M, Ambrosch F, Safary A, D'Hondt E, Delem A. Inactivated hepatitis A

vaccine: long-term antibody persistence. Vaccine 1997; 15: 612-5.
100
3. B (Hepatitis B Vaccine, Hep B)

(HBsAg) , :
: , .. ,
: , , , ,
,
: , , .
.
,
:
i. (
6 ),
ii. (
),
iii. (
),
iv. ( , ,
piercing ),
v. ( ,
).

, 6 ,
, , ,
.
, ,
( ,
), (" ") ,
(, piercing, )
.
.
(HBsAb, HBcAb)
" ". , ,
.
.
( >10 mUI/ml), ,
90% 95%
. , 50-90%
. , 10 mUI/ml,
.
101
,
: ( > 25 ), (), ,
HLA.
, ,
.
80-95% ,
, ,
100%.
(HBsAb)
:
(,
, ),
,
,
.
1-2 .
10 mIU/ml, 3 (
1-2 ). ,
, 15-25%, 2
30-50%.

3 (0, 1 6 ).
: , 0, 1, 4 0, 2, 4. , ,
2 1 1, 3 2
2. 3 ,
3 0, 1, 2 12
. , -
(0, 7, 21 ) .
3 ,
.
10-15 2 ( Recombivax
), (1 ml) ( 2
,
). 1 (0,5 ml),
3 .
,
, 3 . 2
, . ' 2
, 3 3-5 . 3 ,
. 3 , .
:
,
2 4 ,
(4 ).
HIV
.
102
5.11.

HBsAg
Engerix 20
Allen
> 15
1 ml
20 g
Engerix 10
Allen
< 15
0,5 ml
10 g
HBvax-PRO 10ug
Aventis Pasteur
> 15
1 ml
10 g
HBvax-PRO 5ug
Aventis Pasteur
< 15
0,5 ml
5 g
HBvax-PRO 40ug
Aventis Pasteur
1 ml
40 g (2)
Recombivax 10*
Vianex
> 15
1 ml
10 g
Recombivax 5*
Vianex
< 15 (1)
0,5 ml
5 g
Recombivax 40*
Vianex
1 ml
40 g (2)
Recombinand
hepatitis B**
Help ABEE
> 15
1 ml
10 g

. antiHBs , 85% ,
3 ,
5 , 50% , 9 .

.
10 MIU/ml, ,
.
anti-HBs .

9 . "
", , ,
5 ,
. , , :
3 4 25 ,
,
25 ,
10 mIU/ml,
* ,
**
(1) 10-15 , ,
(1 ml). , (0,5 ml),
.
(2)
103
1-2 . >10 mIU/ml,

. , (
) 6.
,
10 mIU/ml .

.
(HBsAg) ,
DN
.
, .
,
.

, -
.
.
2-8 C. .

( ),
.
:

,
.
(thimerosal) (Engerix
) 6 .
.
, ,
,

.

(3-29%) , ,
, >37.7 C (1%-6%).
104
: , , , , / , , , , , , .
,
, ,
.
1 /100.000

. 7
.

,
(HBIG),
.
, , ,
.
5.12.
TWINRIX
()
GSK
TWINRIX
()
GSK
20 g HBsAg
1 ml
720
ELISA HAV
> 15
0, 1, 6
10 g HBsAg
360
0,5 ml
AgELISA HAV
< 15
0, 1, 6
Allen
(1)
10 g HBsAg
0,5 ml
2 5
2, 4,
16-18
(HEXAVAC)
Pasteur
Merieux
`(1)
5 g HBsAg
0,5 ml
2 5
2, 4,
16-18
INFANRIX
PENTA
GSK
(2)
10 g HBsAg
0,5 ml
2 7
2, 4, 6
INFANRIX
HEPB
GSK
(3)
10 g HBsAg
0,5 ml
2 7
2, 4, 6
INFANRIX
HEXA
(1) -- -- -
(2) -- --
(3) -- -
105
ENGERIX 20 (Allen): , 1 ml
20 g (HBsAg).
ENGERIX 10 (Allen): , 0,5 ml
10 g (HBsAg).
HBVAX-PRO 10ug (Aventis Pasteur): ,
1 ml 10 g (HBsAg).
0,5 ml 5 g (HBsAg).
1 ml 40 g (HBsAg).
RECOMBIVAX 10 (Vianex): , 1 ml
10 g (HBsAg) (
).
RECOMBIVAX 5 (Vianex): , 0,5
ml 5 g (HBsAg) (
).
RECOMBIVAX 40 (Vianex): , 1
ml 40 g (HBsAg) (
).
RECOMBINAND HEPATITIS B (Help ABEE): 10 g/1 ml (
).
3.. (HBIG)

( ,
).
( ) :
, ,

. ,
< 1
.
106
www.cdc.gov/travel/diseases/hbv.htm
Environmental Health (SCIEH). Hepatitis B vaccine.
87-122.
Mandell. Principles and Practices of Infectious Diseases. 5th ed. Prevention of Hepatitis b virus
infection, pg: 1674-1678.
. 1/ 4543, 10/09/1997
.
.. 7/91, 16/02/2000.
. .. 1/. 5844, 19/11/1997.

. .. 1/. 396, 22/01/1998.
Protection against viral hepatitis: recommendations of the Immunization Practices Advisory

Committee (ACIP). Morbidity and Mortality Weekly Report, 1990;39(RR-2):1-26.
General Recommendations on Immunization: Recommendations of the Advisory Committee on

Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP).
MMWR, 02/08/02 vol. 51(RR02);1-36.
Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States
through universal childhood vaccination: recommendations of the Immunization Practices
Advisory Committee (ACIP). Morbidity and Mortality Weekly Report, 1991;40(RR- 13):1-19.
Alternate two-dose Hepatitis B vaccination schedule for adolescents aged 11-15 years).
Morbidity and Mortality Weekly Report, 2000; 49(12);261
Avis du Comite technique des vaccinations et de la section des maladies transmissibles du

Conseil superieur d'hygiene publique de France concernant la vaccination contre l'hepatite B.
Bull Epidemiol Hebd 1998; 31 : 133-4.
Avis du Conseil superieur d'hygiene publique de France relatif a la vaccination contre l'hepatite
virale B du 8 mars 2002 Bull Epidemiol Hebd 2002; 24 : 119.
Conference de consensus " la sclerose en plaque ". 7 et 8 juin 2001. ANAES. Septembre 2001
n.9 Cahier 2 Tome 157.
Sadovnick AD, Scheifele DW. School-based hepatitis B vaccination programme and adolescent
multiple sclerosis. Lancet. 2000 ; 3555 : 549 - 50.
Zipp F, Weil JG, Einhaupl M. No increase in demyelinating diseases after hepatitis B vaccination. Nature Medicine. 1999 ; 5 : 964-65.
107
4. (Typhoid Fever Vaccine)

. ,
, , ,
.
(0,3/1.000 ).
3 :
1. :
, .
, ,
, ,
2. (Ty21a):
Ty21a. :
( :
buffer. 100ml
).
3. (Vi): Vi
.
-
5.13. .
1
(1)
1

( 3
4(2) )

per os
1
( 3 )
0,5 ml
(5)
(1)
(3)
(3)
(4)
5 (3)
6 (4)

4 ... , 3
(. 3 4 )
1-5 ,
5 > 6 .
(5) .
108
1
.
5 . 3 4
, 3 .
(. 3 4 , 1
).
, 2-3
3 .
2 . < 2
, 2-5 .
,
.

+ 2C + 8C.
. 6 37C 2 22C.
48 .
.
(> 1 )

.
100% ,
.
' ,
.
: ,
.
.

( ) , ,
6 .
.
,
.
(
), ,
1 .

,
, ,
109
4
--.

4 .

.

. ,
8 .
,
Ty21a
. , .. Ty21a in vitro,

, .
24-72
(24 72 ).
10 .

, ,
, ' 48
. .
1 .
.
(
) , ,
, , DTaP, , MR.
( .2,
2.3).

. , ,
, , , , .

1-2 (7%),
.
(1%) .
96% 3 78% 5
.
,
5 .
60% 2 , 3 62% 7 , 4
. 3
3 .
110
< 6
,
. 2-6
:
,
.
60% (7455%) 2 . ,
, 2-4
,
85-95% ( 2 ),
, 68-87,5%, .
3 .

5 .

.

Vi: 2-5
91,5% (2 6 ).
.

DNA: .

DNA: .

TYPHOID VACCINE (Wyeth- Ayerst): 5 x 108
/ 0,5 ml. .
VIVOTIF Berna (Berna Institut):
. ...
.
TYPHIM Vi ( Pasteur): 0,025 mg
/0,5 ml.
/ .
TYPHERIX (Allen): 0,025 mg
/0,5 ml. .
(
)
VIATIM [vaxim + Typhim Vi] (Vianex)
HEPATYRIX [Havrix + Typherix] (GlaxoSmithKline)
111
www.cdc.gov/travel/diseases/typhoid.htm
www.nhs.uk.
Ivanoff B, Levine MM, Lambert PH. Vaccination against Typhod Fever : Present Status,Bull
OMS 1994; 72 (6): 957-71.
87-122.
Typhoid immunization. Recommendations of the Advisory Committee on Immunization

Practices (ACIP) MMWR 1994;43(RR-14);1-7.
Vaccins antityphoidiques : Note d'information de l'OMS. Relev Epidemiol Hebd 2000 ; 75/25764.
5. (Cholera Vaccine)

, -
.
, ... Vibrio
cholerae 1, . 7
, 1961, -
, . 1992,
139 ( ),
( " "), 11
. 1995,
.
0,01 0,001%. , (.
, ). ,
, .
1. Pasteur:

.

:
2. (KWC, Dukoral): V.
cholerae O1 ( El Tor, Inaba Ogawa)
.
.
112
3. (CVD 103-HgR): V. cholerae

O1 ( , Inaba)
.
.
:
, ,
.

.

5.14. o .

2-6
75ml
1-6
(KWC + CTB,
Dukoral)
150ml
2 1-6
(CVD 103-HgR)

10 .
6 ,
. ( 1 , 3 ml),
( buffer). 150
ml ( 2-5 75 ml ) .
(1 2 ).

8 .
. 1 (
buffer).
100 ml .
, .
+ 2 C + 8 C.
. 3-4 4 C, 1
37 C, 1 .
18-24 4 C 19 37 C.
113
2000 .
,
,
.

(> 1 )

.
...
. ,
, ,

.
.
, .
.
,
.

8
,
.
, 1 .
3
,
.

.
.
: (>10%), , , ,
, , , (<1%), (<38 C)
(1-10%).
114
( - )
IgA .

,
.

1985, 89.596 .
3 6-12
2-5 . > 5 ,
78%, 63%.
2-5 100% 6
21% 6 .
86%. ()
El Tor (). 67% 3
ETEC.

anti-LPS , IgA
. (
) 2 x 108 CFU
2 x 109 CFU
.
91% 80%
. 8
6 . 67.000

. El Tor
Inaba Ogawa.
DUKORAL (SBL vaccines, Stockholm): V. cholerae O1 (

El Tor, Inaba Ogawa)
.
( , ).
OROCHOL/OROCHOL E (Swiss Serum and Vaccine Institute, SSVI, Berne):
V. cholerae O1 ( , Inaba).
2 x 108 CFU (Orochol) 2 x 109 CFU (Orochol ).

( , , ,
).
( ):
V. cholerae ( ).
115
www.cdc.gov/travel/diseases/cholera.htm.
Sack DA, Lang DR. Cholera vaccines. In: Plotkin SA, Orenstein WA. Vaccines. Saunders 4th ed;
2004: 905-917.
Fournier JM. Etat actuel des recherches sur le vaccin anticholerique. Bull Soc Path Ex 1998;
91: 412-5.
87-122.
Clemens JD, Sack DA, Harris JR, et al. Field trial of oral clolera vaccines in Bangladesh.
Lanvet 1986; 2: 124-127.
Sanchez JL, Vasquez B, Begue RO, et al. Protective effect of oral whole-cell/recombinant- Bsubunit cholera vaccine in Peruvian military recruits. Lancet 1994; 344: 1273-6.
Trach D.D, Clemens JD, Ke NT et al. Field trial of a locally produced oral cholera vaccine in
Vietnam. Lancet 1997; 349: 231.
Steffen R. New Cholera Vaccines - for Whom? Lancet 1994; 344: 1249-52.
Taylor DN, Tacket CO, Losonsky G, et al. Evaluation of a bivalent (CDV 103-HgR/CDV 111)
live oral cholera vaccine in adult volunteers from the United States and Peru. Infect Immun
1997; 65: 3852-6.
Teyssou R, Chevalier B, Buisson Y. Le vibrion cholereque. Infectiologie & Immunologie 1996;

3: 236-46.
Tsai TF, Kollaritsch H, Que JU, et al. Compatible concurrent administration of yellow fever 17D
vaccine with oral, live, attenuated cholera CVD103-HgR and typhoid Ty21a vaccines. J Infect
Dis 1999; 179: 522-4.
6. (Rabies Vaccine Absorbed)

. ,
, , , .
.
. : : , ,
, , , , ,
..: , , , ,
. , " ",
, , ,
,
: , ,
, ...
. ,
( 7 ) 100% .
116
.
,
,
, ,
.

( ).
.
1. HDCV (human diploid cell vaccine): -

( Pitman-Moore) MRC-5 .
2. PCECV (purified chick embryo cell vaccine):
- ( Flury LEP) .
3. RVA (rabies vaccine adsorbed): ( Kissling Challenge Virus Standard, CVS).
, , rhesus,
.
(1ml) 2,5 IU . , '
.

, , . . HDCV
( ).
, .
( 1/10 )
' .

5.15.
HDCV
1 ml
0,7, 21-28
0,1 ml
0,7, 21-28
1 ml
0, 3
0,1 ml
0, 3
1 ml
0, 3, 7, 14, 28
117
3 , 0, 7, 21-28.
1ml ( 0,1 ml HDCV)
. 7-14
3 , 2 .
.
2 , 0 28.
( 1-2%), '
2
( ).
:
4 0,1 ml (HDCV),

1 .
,
. ,
( 5 ),
.
.
2-3
, (<0.5 IU/ml)
6 2 .
.
.
, 1 .
:
(>30IU/ml) 7 ,

. , 75% ,
10 ,
.
+2 C +8 C. .
HDCV 3,5 ,
(37 C) 1 .

:
: ,
, ..
,
,

(
, , , , ..).
118
, '
.

(
5 3)
.
.
.
, 17
1,3% ' , 8,9% 0,5%
.
.
(
,
),
( ), PCECV
.
.
, ,
. HIV
CD4<300 /mm3 ( <15%)
.

HDCV 1 . ,
.

(25%)
, , , (20%)
, , , , , .
3 Guillain-Barr 12
,
.
(6%) ,
"",
, 2-21 .
100%
. 2 93%-98%
3 83%-95% 3
119
.
( 0,5 IU/ml
) .
,
( )
.
.
HDCV
VACCIN RABIQUE MERIEUX (Vianex): Wistar Virus PM/W1
38 1503-3M.
( 1.0 mL).
. / .
www.cdc.gov/travel/diseases/rabies.htm
www.nhs.uk: Travax/Rabies Vaccine.
CENTERS FOR DISEASE CONTROL AND PREVENTION. Human Rabies prevention, United
States 1999. Recommendation of the Advisory Committee on Immunization Practices (ACIP).
MMWR 1999; 48: n.RR-1.
87-122.
Plotkin, S.A. Rabies. Clin Infect Dis. 2000; 30(1): 4-12.
Plotkin S, Rupprecht C, Koprowski H. Rabies vaccine. In: Plotkin S, Orenstein W. Vaccines.

Philadelphia PA: W, B Saunders; 4th ed. 2004: 1011-1038.
120
5.2.3

.
, " ",
, .
, , . ,
,
.

, ,
.
5.16

HepB (Hepatitis B):
DTP (Diphtheria, Tetanus, Pertussis):
DTaP (Diphtheria, Tetanus, acellular Pertussis):

Hib (Haemophilus influenza b): b
IPV (Inactivated Polio Vaccine):
OPV (Oral Polio Vaccine):
BCG (Bacille Calmette Guerain):
Mantoux:
MMR (Measles, Mumps, Rubella):
MCC: C
PCV (Pneumococcal Conjugated Vaccine): 7-
23-PPV (23-Pneumococcal Polysaccharide Vaccine): 23-
HepA (Hepatits A):

Infuenza:
121
5.17. /
()
. ,
. .
, BCG,
. ,
.
1. :
2 . 2 4 . 1,
3 16 . 1. 3
6 . HBsAg (+), 1
12
, 4 .
2. DTP /DTP: 4 12 ,
2 3 6
. 4
. Td 11-12
, 5 DTP.
Td 10 .
3. b:
2 .
12 .
4. :
, 2 IPV 2
OPV. IPV
OPV 6 .
5. R: 2 4-6 ,

4 . 1
12 .
6. BCG: 6 ,
, 15 .

.
6. C:

,
,
.
. 3 0,5 ml
1 ,
12 1 0,5 ml.
7. : 7-

2 2 :
, , ,
, , ,
, , .. , ,
. 23 2 . 5 .
8. : 2 6
> 2
.
9. : > 6
: , , ,
, , , ..
122
1. -- (Measles-Mumps-Rubella, MMR
.

.

, (MMR)
28 . 6-11
. ,
MMR. ,
,
. 6
. 1
,
, 1 .
, 2
,
,
.

, 4
.
MMR
. : ( ),
( )
( ). ...
(, , ), / (
) .
,
( 3 )

( ).
.
.
Mantoux, 4-6 ,
( ).
1 MMR,
95% .
- - ( )
PRIORIX (Allen)
MMR-II (Vianex)
( / )
ROUVAX MERIEUX (Vianex)
EUXENIL (Vianex)
123
( / )
VACCIN RUBEOLE MERIEUX (Vianex)
RUDIVAX ( )
( )
Mumpsvax (Vianex)
www.cdc.gov/travel/diseases.htm#MMR
www.cdc.gov/travel/child-vax.htm
CDC. Measles, mumps, and rubella vaccine- Use and strategies for elimination of measles,
rubella, and congenital rubella syndrome and control of mumps: Recommendations of the
Advisory Committee on Immunization Practices (ACIP). MMWR 1998;47:RR-8.
CDC. otice to readers: revised ACIP recommendation for avoiding pregnancy after receiving
a rubella-containing vaccine. MMWR December 2001;50(49):1117.
2. -- (Diphtheria - Tetanus - Pertussis, DTP),

- () (Diphtheria - Tetanus, DT),
- (Td),

- . '90
,
. , ,
, , ,
, ,
.
(> 1 ),
, .
, .
, ,
, .
, ,
. ,
.
7
, 4 3 DT
, . ,
6 , 4
124
4 12 6 3
. 5 4 .
. , ,
,
. ,
.
7 ,
, - ,
, . 3 :
4-8 3 6-12 2.
, 3 4-8 2.
3 , 2 .
, 3
. 1 2 ,
.
,
-, 10
. 7 ,
5 .
--
, ,
, .
.
--, -
,
.
( > 40 C, ,
, 48
)
.
.
2
91% (>10 MIU/ml) 10
. 9598%. , 2
(>1 IU/ml) 5 .
90-95%
85%.
( )
ANATOXAL-TE-BERNA ()
VACCIN ANTITETANIQUE MERIEUX (Vianex)
- (Td) (
)
D.T.VAX (Vianex)
125
- (DT) ( )
ANATOXAL DI TE BERNA ()
- - DT ( )
D.T.COQ ABSORBE (Vianex)
- - (DTaP)( )
INFANRIX (Allen)
www.cdc.gov/travel/diseases/dtp.htm
Diphtheria, Tetanus, and Pertussis: Recommendations for Vaccine Use MMWR. Vol 40, No
RR10;001 08/08/1991
3. (Oral Polio Vaccine, OPV / Inactivated Polio Vaccine, IPV)

1964.
6 (,
, , , , )
. '

,
6 , ,
.
( 1
) .
3 Salk,
4-8 3 6-12 .
, :
- 8 , 3
4 ,
- 4 8 , 2
4 ,
- 4 , 1 .
,
.
3
,
10 . 3 ,
, .
,
Salk 6 .
126
, 4 ,
2 .
15
.
Salk
, .
Sabin (
30 ) ( 60 ).
1 / 7,8 .
, 1 / 5,5 .
.
Sabin ,
. , , Salk. Sabin
. Salk (, - )
.
,
.
Salk 80-90%.

5 . Sabin
.
1 .
(Sabin, PV)( .
/ )
VACCIN ANTIPOLIOMYELITIQUE/ MERIEUX (Vianex)
LIVE ORAL ANTIPOLIOMYELITIS VACCIN SABIN / S.K.F. (Smith Kline Beecham)
LIVE ORAL ANTIPOLIOMYELITIS VACCIN SABIN / S.K.F. (Vianex)
(Salk, IPV) ( .
/ )
IMOVAX POLIO
www.cdc.gov/travel/diseases/polio.htm
Poliomyelitis Prevention in the United States. Updated Recommendations of the Advisory

Committee on Immunization Practices (ACIP). MMWR, May 19, 2000/ 49(RR05);1-22.
Robertson SE. The immunological basis of immunization. Poliomyelitis. Geneva: World Health
Organization, 1993 (WHO/EPI/GEN/93.16).
127
4. b (Haemofilus Influenza b, Hib)

b
2 5 .
5 .
, , , . 5
, 1 2
.
.
.
b, .

.
,
,
100% .
.
ACT-HIB (Vianex)
HIBITER (Wyelth)
HIBERIX (Allen)
www.cdc.gov/travelchild-vax.htm
- , . 2000, 12, 3:
: :
, . 11-24
Peter G, ed. 1997 Red Boo. Report of the committee on infectious diseases. 24th edition.
American Academy of Pediatrics; 1997.
5. (Bacille Calmette - Guerin, BCG)

1960.
:
0,1 ml,
0,05 ml.
Mantoux,
.
.
15 ,
,
, .
.
128
.
, , .
, .
.
, .

. ,
(1 /1 . ).
.

75-80%.

0-80%.
15 .
VACCIN BCG Lyophilise (Pasteur Merieux)
www.cdc.gov/travel/diseases/tb.htm
Mandell. Principles and Practices of Infectious Diseases. 5th ed. Immunization, :3207-3229.
Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of

Vaccines and Immune Globulins in Persons with Altered Immunocompetence. - MMWR 1993;
42 (No. RR-4).
, . . ,
7, 1987:27-28.
Peter G, ed. 1997 Red Book. Report of the committee on infectious diseases. 24th edition.
Development of New Vaccines for Tuberculosis. - MMWR 1998; 47 (No.RR-13)
6. B
.
7. (Varicella)
,
.
,
. , ,
.
.
.
129
12 , .
13 1 , 13
2 4-8 .
.
, , MMR ,
28 .

.
,
.
, ,

( ).
.
97% 13 99% 13 ,
.
70-90% 95% .
VARIVAX (Vianex)
VARIRIX (Allen)
www.cdc.gov/travel/diseases/varicella.htm
TSOLIA M, GERSHON A, STEINBERG S, GELB L. Live attenuated varicella vaccine J Pediatr

1990; 116: 184-189.
Prevention of Varicella. Updated Recommendations of the ACIP. MMWR, May 28, 1999 /
48(RR06); 1-5.
Peter G, ed. 1997 Red Boo. Report of the committee on infectious diseases. 24th edition.
5.2.4 .
, ,
,
.
1. (Pneumococcal Polysaccharide Vaccine,

PPV / Pneumococcal Conjugated Vaccine, PCV)
23-
2 .
, .
7- 2 2
.
130
, ,
2 .
.
23-
PNEUMO-23 (Vianex)
PNEUMOVAX 23 (Vianex)
(
)
PREVENAR
www.cdc.gov/travel/diseases/tb.htm
Mandell. Principles and Practices of Infectious Diseases. 5th ed. Immunization, :3207-3229.
Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of

Vaccines and Immune Globulins in Persons with Altered Immunocompetence. - MMWR 1993;
42 (No. RR-4).

- - -
TETRACOQ MERIEUX (Vianex)
- - K -
TETRAVAC (Vianex)
- - - -
.
INFANRIX IPV HIB (Allen)
PENTAVAC (Vianex)
- - - - .
INFANRIX PENTA (Glaxo Smithkline Biologicals)
- - - - -
.
INFANRIX HEPB IPV HIB (HEXA) (Glaxo Smithkline Biologicals)
HEXAVAC (Pasteur Merieux)
- - -
INFANRIX HEPB (Glaxo Smithkline Biologicals)
- - .
PROCOMVAX (Pasteur Merieux)
- -
REVAXIS (Vianex)
131
5.18.

-1
- 2
-2
1-4
4 .
-3
6-18
DTaP-1
6 .
DTaP-2
10 .
DTaP-3
14 .
DTaP-4
15 -18
12
DTaP-5
4 - 6
Hib -1(1)
6 .
Hib-2
10 .
Hib3
14 .
Hib-4
12-15
12
IPV/OPV-1
6 .
IPV/OPV-2
10 .
IPV/OPV-3
6-18
14 .
IPV/OPV-4
4 - 6
18 .
MMR-1
12 - 15
12 (2)
MMR-2
4 - 6
13
BCG
-1
> 2
-2
> 30
30
(3)
(1) Hib PCV 6 ( ).

(2) 6 .
(3) 6 9 2 4 .
132
PPV-1
PPV-2
PCV-1(1)
6 .
PCV-2
10 .
PCV-3
14 .
PCV-4
12
(4)
12 - 15
(5)
12
(6)
MCC-1
MCC-2
MCC-3
+ C(7)
18
+ C + Y + W135(8)
per os

per os
(4)
(5)
(6)
(7)
(8)
12 13 1 , > 13 2 > 4 .
4 .
1 .
6 .
4 .
A 6
E
, ,
K 6.1

. , 300
- 500 , 1
, 5 . .
, .

1500 - 2000 , .
. 100
, 125 .
H "" .
, 30.000 ,
. 1-4% P. falciparum, . ,
, 40-70% ""
.
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.
. ,
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.
,
.
.

)
,
,
. '
134
, ,
.
().
,
, ,
. ,
. ,
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, 8
, .
:
9
.
.
,
.
6.1
: CDC, Malaria 2005-6
: CDC, Malaria 2005-6
135
136
)
6.1 .
. 5-49%
,
.

. .
2,4% , . 1,5% .
10-20 ,
30-40 .
,
. '
.
CDC WHO.

P.falciparum P. vivax.
5% P.ovale P.malariae.

. , 70-80%
P.falciparum, .
(. 6.1 6.2)
P.falciparum . , ,
, : ) : ,
,
. , , , ) :
, , , , ) :
(, , ), , ,
(, ), . ( , .
, , .. )
P.falciparum. P. vivax
, , ,
( /), , , .

, .
/,
.
137
6.2
: Alan J Magill, Malaria: Epidemiology and Risk to the Traveler In: Keystone JS, Kozarsky PE,
Freedman DO, Nothdurft HP, Connor BA. Travel Medicine. Spain: Elsevier;2004.p.133
K 6.3
""
"" . ,
, , , ,
, , , ,
, . ,
,
, .

. ,
, ,
.
, 3
. .
,
,
.
138
P.falciparum 1 - 2 , P.vivax P. vale

13-14 ( P.vivax 9-12
, ).
P.vivax P. vale 3-4 ( 2-3
) P.malariae 30-40 .
P.falciparum
, ,
. , ,
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, , , .
, ,
. , , ,
. .
, .
P.falciparum
2 ,
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), (, ) ()
,
, , .
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1.
2. (shock)
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250 mg +
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149
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20-30 kg 1/2 15-20 kg 1/4.
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,

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.
.
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LARIAM/Roche, 250mg

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.
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.
, .
152

Vibramycin 8 x 100mg, susp. 60ml x 50mg/5ml
Novimax, Caps 8 100mg
Microvibrate, 8 x 100mg, caps 40 x 100mg, caps 14 x 50mg
.
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.
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, 21 . 31-73 .
,
.
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.

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(84% P.vivax).

P.vivax P. vale .
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, < 5 kg.
40%.
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.

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, )
153
. ,
. .
(250mg 100 mg )
, . : 11-20 : 1/4
(62.5 mg/25 mg), 21-30 : 1/2 (125 mg/50 mg), 31-40 : 3/4
(187.5 mg/75 mg) .
, '
7 .
, '
.

Malarone, 250mg 100 mg .
Malarone paediatric, 62,5 mg 25 mg
. .
6) (Primaquine)
8-, 50 "
" P.vivax P. vale.
1990,
( P.ovale P.vivax).
4 ,
P.falciparum .
( 6 ).

( : 0,5 mg/kg, : 30 mg/)
P.falciparum P.vivax. ,
.
(.. , ...) P.vivax P.ovale,

. (" ").
: 15 mg (26.3 mg ), : 0.3 mg/kg (0.5 mg/kg ).
15 .

.
,
.
G6PD. ,
.
G6PD
. < 5
.
154

Primaquine, tab 15 mg
.

(Tafenoquine)
, ,
.
.

P.falciparum P.vivax.
3 3 ( "fire and forget")
1 . 1
.
89-100%.
(< 1 )
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P.vivax
.

, ,
, ,
, . :
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,
.
2. / (Pyrimethamine/Sulfadoxine - Fansidar):

(. Lyell).
3. (Pyrimethamine): .
4. (Quinine):

( ..)
5. (Azithromycin): P.falciparum
.
6. (Halofantrine): .
,
QT .
7. Artemisinin Qinghaosu: ,
.
6.3
: Travel Medecine; J.Keystone et al.2004; Malaria prophylaxis algorithm
155
156
6.5.
300 mg/
100 mg/
(Chloroquine)
ab 200 mg
Sir 25 mg/5 ml
( 1

,

4

)
250 mg/
(Mefloquine)
Lariam, ab
250mg
(Doxycycline)
Novimax,
Impalamycin,
Otosal,
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Smilitene,
caps 100mg
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sir 50mg/5 ml
( 2 - 3

,

4

).
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( 1
,

4

).

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,
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,

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,

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< 8 ,

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,

,
,
, .
157
(Atovaquone proguanil)
(Primaquine)
Malarone,
tb 250mg
+100mg
Malarone
Paediatric,
tab (62,5 mg
+ 25
mg )
Tab 15 mg
1 tab/.
( 1
,

7
)

: 15 mg/ (30
mg/ P.vivax

)

.
(
<30
ml/min).
,

<11 kg.
,
,
,

.

G6PD, ,
< 5
/,

G6PD,
, ,
200 mg/
(Proguanil)
Tab 100 mg
158
6.6.
1,5 mg/kg/.
5mg/kg/.
< 8,5 kg : 12,5 mg/.

9 - 16,5 kg : 25 mg/.
17 - 33 kg : 50 mg/.
33,5 - 46 kg : 75 mg/
5-6 kg : 25 mg/.
7-10 kg : 50 mg/.
11-14 kg : 75 mg/.
15-18 kg : 100 mg/.
19-24 kg : 125 mg/.
25-35 kg : 200 mg/.
36-50 kg : 250 mg/.
>50 kg > 14 : 300 mg/.
3 mg/ kg/
< 5 kg :
5 - 10 kg : 30 mg/ (1/8 tab)
11 - 20 kg : 50 mg/ (1/4 tab)
21 - 30 kg : 100 mg/ (1/2 tab)
31 - 45 kg : 200 mg/ (3/4 tab)
> 45 kg : 250 mg/ (1 tab)
< 8,5 kg : 25 mg/

9 - 16,5 kg : 50 mg/
17 - 24 kg : 75 mg/
25 - 33 kg : 100 mg/
33,5 - 46 kg : 150 mg/
> 50 kg > 14 : 200 mg/
1,5 mg/kg/ (max: 100 mg/)

< 25 kg < 8 :
25-35 kg : 50 mg/
36-50 kg : 75 mg/
> 50 kg > 14 : 100 mg/
/ 11 - 20 kg : 1/4 / 1 ;o /
21 - 30 kg : 1/2 / 2 /
31 - 40 kg : 3/4 / 3 /
> 40 kg : 1 /
0,3 mg/kg/ (max : 30 mg/)
: 0,3 mg/kg/ 14
159
Magill JA. Malaria: Epidemiology and risk to the traveler. In: J. Keystone, Ph. E. Kozarsky et
al., ed Travel Medicine, Mosby 2004: 131-136.
Phillips-Howard PA, Radalowcz A, et al. risk of malaria in British residents returning from
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. , 2003.
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160
Weiss WR, Oloo AJ, et al. daily primaquine is effective for prophylaxis against falciparum
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A 7
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(: Luis Ostrosky-Zeichner, Charles D.Ericsson. Travelers' Diarrhea. In: Principles and Practice of Travel
Medicine. Edited by Jane N.Zeckerman. 2001 John Wiley & Sons Ltd)
ETEC,
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(: The Sanford Guide to Antimicrobial Therapy 2004)
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60
10-30
>90
80
5-15
(: Loscher T and Connor BA. Clinical Presentation and Treatment of Traveler's Diarrhea. In: Travel
Madicine. eds: Keystone JS, Kozarsky PE, et al. Mosby 2004, Edinburgh:p.192)
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.
Ostrosky-Zeichner L, Ericsson CD. Travelers' diarrhea. In: Principles and Practice of Travel
Medicine (ed Zuckerman JN), pp 153-63. John Wiley and sons, Chichester.
Loscher T and Connor BA.. Clinical Presentation and Treatment of Travelers' Diarrhea. In:
Travel Medicine (ed Keystone JS, Kozarsky PE, Freedman DO, Nothdurft HD, Connor BA), pp
191-99. Mosby, Edinburgh.
www.travax.com/medtopics/medtopics_articles/showcontent.asp?DocID=travdiar
www.cdc.gov/travel/diarrhea.htm
www.who.int/ith/chapter03_02.html#4
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CDC : Health Information for International Travel 2003-2004

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DO, Nothdurft HD, Connor BA), pp 191-99. Mosby, Edinburgh.
Center of Diseases Control and Prevention. Health Information for International Travel 19992000, DHHS. Atlanta 1999; 212.
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187
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188
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Apure, Amazonas, Barinas, Bolivar, Sucre, Tachira.
P.falciparum Amazonas (Atabapo), Bolivar (Cedeno,
Gran Sabana, Raul Leoni, Sifontes Sucre) Delta Amacuro (Antonia Diaz, Casacoima,
Pedernales).
: P.vivax, ' <2500 .,
Beni, Pando, Santa Cruz Tarija, Lacareja, Rurenabaque,
Yungas La Paz. Cochabamba
Chuquisaca. P.falciparum Beni, Pando,
Guayaramerin, Puerto Rico Riberalta. La Paz.
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< 900, 9 "".
,
(Porto Velho, Boa Vista, Macapa, Manaus, Santarem,
Rio Branco, Maraba) .
.
Iguassu,
.
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' , 9
( Oiapoque) ( Maroni).
13 .
: P.falciparum (47%) P.vivax (53%),
, ' .
.
: P.vivax (79%) P.falciparum (21%) , '
< 1500 . El Oro, Esmeraldas,
Manabi. Cotopaxi, Loja, Los Rios. Guayaquil
Quito, Galapagos.
: P.vivax (58%) P.falciparum (42%), '
, , < 800,
Amazonas, Orinoquia, Pacifico, Uraba-Bajo Cauca..
Amazonas, Choco, Cordoba, Guainia, Guaviare, Putumayo Vichada.
193
P.falciparum , Pacifico, Uraba-Bajo Cauca.

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: , P.vivax,
Alto Parana, Caaguazu Canendiyu.
.
: P.vivax (78%) P.falciparum (22%), 21 33
(Ayacucho, Cajamarca, Cerro de Pasco, Chachapoyas, Chanca-Andahuaylas, Cutervo,
Cusco, Huancavelica, Jaen, Junin, La Libertad, Lambayeque, Loreto, Madre de Dios, Piura, San
Martin, Tumbes Ucayali. Jaen, Lambayeque, Loreto, Luciano Castillo, Piura, San Martin,
Tumbes Ucayali P.falciparum .
Puerto Maldonado.
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, 3 . Paramaribo 7
(Nickerie, Coronie, Saramacca, Wanica, Commewijne Marowijne
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, , .

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(Gabon), (The Gambia), (Ghana), (Guinea),
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izang ( Zangbo ) Yunnan.
P.vivax Anhui, Hubei, Hunan, Jiangsu, Jiangxi Shandong.
, , < 1500 .:
33 ,
33 25 ,
25 . . O
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18 ( 3 Da Lak, Gia Lai Kon Tum,
ca Mau, Bac Lieu, Tay Ninh).
201
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> 2000 ., Yangon Mandalay,
' .
. Kayin Shan,
. P.vivax
.
: P. falciparum , '
, ( Angkor Wat) Phnom Penh
Tonle Sap.
.
: P.falciparum P.vivax ,
Irian Jaya (
) Borobodur Java. .
Java Sumatra
Java Bali.
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. .
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: ' , ,
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. Myanmar.
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.
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Sequijor Manila.

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, ( Chhukha, Samchi, Samdrup Jonkhar, Geylegphug, Shemgang).
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erai .
.
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< 2000., ' .
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' , Colombo, Galle, Gampaha, Kalutara,
Matara Nuwara Eliya.

Terai ,
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(Equitorial Guinea), (Ethiopia), (Gabon),
(The Gambia), (Ghana), (Guinea), (Guinea-Bissau),
(Kenya), (Liberia), (Mali), (Niger), (Nigeria),
(Rwanda), Sao Tome Principe, (Senegal), (Sierra Leone),
(Somalia), (Sudan), (Tanzania), (Togo), (Uganda)
(Zambia), ) : (Bolivia), (Brazil), (Colombia),
(Ecuador), (French Guiana), (Guyana), (Panama),
(Peru), (Suriname) (Venezuela), ) : Trinidad
Tobago.
( < 6 )
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), (3)

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..., (4)

206
(1954) ...
.
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(Burkina Faso), ( Burundi), (Cameroon),
(Equitorial Guinea), (Ethiopia), (Gabon),
(The Gambia), (Ghana), (Guinea), (Guinea-Bissau),
(Kenya), (Liberia), (Malawi) (Mali), (Mauritania),
(Niger), (Nigeria), (Rwanda), Sao Tome Principe, (Senegal),
(Sierra Leone), (Somalia), (Sudan) 15 ,
(Tanzania), (Togo), (Uganda) (Zambia), ) : M
(Beliz), (Bolivia), (Brazil), (Columbia), (Costa Rica),
(Ecuador), (French Guiana), (Guyana),
(Guatemala), (Honduras), (Nicaragua), (Panama), (Peru),
(Suriname)
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207
K 9.3
: (New
South Wales), (Victoria), Queensland, Northern Territory, (Western
Australia), (South Australia) (Tasmania).
,
.
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1. .
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Strait, Sydney.
: rres Trait
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Australia Northern Territory).
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Australia, Queensland, New South Wales, Northern Territory Victoria.
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: .
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212
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.
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.
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.
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: , P.vivax, . Rodrigues .
(Burundi): , P.vivax,
. Rodrigues .
Comoros: P. falciparum , '
.
Reunion( ): .
217
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( Fort Portal, Jinja, Kampala, Mbale
Kigezi),' .
.
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.
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< 1800, ' .
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.

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d' Ivoire), , , , - (Guinea-Bissau), , , ,
, , Sao Tome Principe, , .

1. .
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.
.
.
219
2. .
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.
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222
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223
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224

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225
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229
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231

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232
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: , P.falciparum,
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: P. falciparum , ' -
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.
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.

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240
www.cdc.gov/travel/destinations
www.who.int/topics/travel
www.travax.com/destina
www.mdtravelhealth.com/destinations
Traveler's Diarrhea, Hepatitis A, Hepatitis E, Leptospirosis, Filariasis, Onchocerciasis, Chagas

Disease. In: Principles and Practice of Infectious Diseases. Mandell, Douglas, and Bennett's.
Rabies, Influenza. In: Travel Medicine. Keystone JS, Kozarsky PE, et al eds Mosby 2004,
Edinburgh
A 10

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6 .
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www.cdc.gov/travel/
www.travax.nhs.uk
www.who.int/ith/en/
A 11
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: Scientific analysis of risks relating to communicable diseases linked to tourism and travel. A summary
of a project report funded by thw Public Health Directorate of the European Commission (1999), hw Scottish
Center of Infection and Environmental Health (United Kindom) & Societe de Medecine des Voyages (France).
245
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ISTM. The Body of Knowledge for the practice of Travel Medicine
Jong EC Management of a Travel Clinic. In: Principles and Practice of Travel Medicine, 2001
(eds Zuckerman JN), pp 23-27, John Wiley and Sons Ltd.
Keystone JS, Kozarsky PE, Freedman DO. Internet and Computer-Based Resources for Travel
Medicine Practitioners. Clinical Infecious Diseases, 2001;32: 757-765.
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Steffen R and Lobel HO. Epidemiologic basis for the practice of travel medicine. Journal of
Wilderness Medicine 1995, 5, 56-66
TRAVAX. Cllinc Operations. Shoreland 2000.
(Depon,
Panadol)
Tablet 500mg
Syrup
120mg/5ml
:
: 0.51 g 3
,
<1
: 60 mg x
4/,
1-6 60120mg
,
6-12
150-300mg x
4/
(Phenergan)
Tablet 25mg
Syrup 5mg/5ml
:
:
25mg 2
: 2-5
:5-15mg
1-2
5-10 : 1025mg 1-2
Hyoscine
Butylbromide
(uscopan)
Tablet 10mg
:
: 20 mg
3
,
6-12 :
10 mg 3
(Primperan)
ablet 10mg
Syrup 5mg
/5ml
:
: 10
mg 3-4
,
6-14
2.5-5mg
3
(Amoxil)
(
)
Tablet
250mg,500mg,
1000mg
:
: 5001000mg 3
,
: 40-50
mg/kg/24
(..
Almora,
)

(Aspirin)
300mg tablet
:
,
>12
: 300900mg x 46/,

4g.
< 12
: 1015mg/kg x
6/
Cetirizine
(Zirtec)
Tablet 10mg
oral solution
10mg/ml
:
,
>12
,
>30kg : 10mg
,
<12
,
<30kg
: 5mg
(Ciproxin)
Tablet 250mg,
750mg (
)
:
: 500
mg 2

3
750 mg
(
(Maalox,
250
Ibuprofen
(Brufen)
Tablet 200mg,
400mg, 600mg
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:
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Loratadine
(Clarityne)
Tablet 10mg
Syrup 5mg/5ml
:
,
> 12
: 10mg
,
2-12
,
<30 kg:
5mg
Xylometazoline (Otrivin,
)
(Diprosone,
Betnovate)
251
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1.
Health information for international travel (the CDC Yellow Book)
International travel and health 2002 (WHO Green Book). (ISBN 92 4 158027 5).
Health information for overseas travel, 2nd edn Lea G, Leese J. UK:The stationery office; 2001.
(ISBN 0 11 322329 3).
Text book of travel medicine and health, 2nd edn DuPont HL, Steffen R. Hamilton, Ontario, Canada: B.C.
Decker;2000. (ISBN 1 55009 137 9).
Travel medicine and migrant health, Walker C, Calvert E et al. UK: Churchill Livingstone;2000.
(ISBN 0443062420).
Manual of travel medicine and health, 2nd edn DuPont HL, Steffen R. Hamilton, Ontario, Canada: B.C.
Decker;2003. (ISBN 55009 227 8).
The travel and tropical medicine manual, 3rd edn. Jong EC, McMullen R. UK: WB Saunders;2002.
(ISBN 0 7216 7678 2).
Travel medicine. Infectious disease clinics of North America, Freedman DO. Philadelphia, PA: WB
Saunders;1998, vol. 12:2. (ISSN 0891 5520).
Travel medicine. Medical clinics of North America, Jong EC. Philadelphia, PA: WB Saunders; 1999,
vol. 83:4.
Travel and routine immunizations. Thompson RF. Milwaukee, WI: Shoreland;2003.
Tropical medicine and emerging infectious diseases, 8th edn. Strickland T,Hunter's Philadelphia: WB
Saunders;2000. (ISBN 0 7216 6223 4).
Manson's tropical diseases, 21st edn. Cook G, Zumia A.UK: WB Saunders;2002.
(ISBN 0 7020 2640 9).
Travelers' malaria. Schlagenhauf, Hamilton P, Ontario, Canada: B.C. Decker;2001.
(ISBN 1 55009 157 3)
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International travel health guide, 12th edn .Rose, Northampton SR, MA: Travel medicine Inc; 2001.
http://www.travmed.com
Travelers health-how to stay healthy abroad, 4th edn. Dawood R. Oxford University Press 2002.
Lonely planet The "Healthy Travel" Series Young, I., 2000., http://www.lonelyplanet.com
The travelers' good health guide. Lankester, T. London: Sheldon Press; 1999. (ISBN 0 85969 827 0)
http://www.sheldonpress.com
Bugs, bites and bowels, healthy travel, 2nd edn. Wilson-Howarth, J. Cadogan Guides; 2002.
(ISBN 1 86011 866 2), http://www.cadoganguides.com
The pocket doctor: a passport to healthy travel, 3rd edn. Bezruchka, Stephen. Seatle, WA: Mountaineers
books; (ISBN 0 89886 6 146)
The rough guide to travel health, Jones, N. London: Rough Guides, Inc; 2001. (ISBN 1 85828 570 4)
http://www.roughguides.com
Travelling well, 9th edn. Mills, D.Brisbane: Travelling well; 2000. (ISBN 0 9577179 0 3)
http://www.travellingwell.com.au/page1.html
2.

Journal of Travel Medicine
http://www.istm.org/jtm.html
Emerging Infectious Diseases
http://www.cdc.gov/incidod/eid.htm
AJTMH
http://www. Astmh.org/journal.html
Transactions of the Royal Society of Tropical

Medicine and Hygiene
http://www.rstmh.org
Tropical Medicine and International Health
http://www.blacksci.co.uk/
Vaccine
http://www.elsevier.com/locate/vaccine
Journal of Wilderness Medicine
http://www.wms.org
Aviation, Space and Environmental Medicine
http://www.asma.org
Military Medicine
http://www.amsus.org/milmed
253
3.

CATIS (Toronto)
http://www.catis.org
PC, CD-ROM
MASTA (London)
On-line access via PC
TRAVAX and TRAVAX

Encompass (Milwaukee)
http://www.travax.com
http://www.shoreland.com
PC,diskette, or Internet (Travax

Encompass)
TRAVAX (Glasgow, Scotland)
http://travax.scot.nhs.uk
Password, Internet access by

Web browser
The Medical Letter,

http://www.medicalletter.com
Advice for Travelers (New York)
PC, CD-ROM
EXODUS TRAVELLER
(Dublin)
PC, CD-ROM, Internet access
office@exodus.ie
4.

ISTM
http://www.istm.org/
ISTM Directory of Travel Clinics
http://www.istm.org/disclinics.html
ASTMH
http://www.astmh.org
ASTMH Directory of Travel/Tropical Clinics
http://www.astmh.org/clinics/clinindex.html
RSTMH
http://www.rstmh.org
Divers Alert Network (DAN)
http://www.diversalertnetwork.org/
WMS
http://www.wms.org
ISMM
http://www.daedalus74.mc.duke.edu/ismm/index.html
254
5.

CDC Home Travel Information
http://www.cdc.gov/travel/
CDC Yellow Book 2004
http://www.cdc.gov/travel/yellowbk04.pdf
WHO Home Page
http://www.who.int
WHO Yellow Book 2004
http://www.who.int/ith/
WHO Infectious Diseases Health Topics
http://www.who.int/health-topics/idindex.htm
Health Canada Travel Medicine
http://www.hc-sc.gc.ca/hpb/lcdc/osh/tmp_e.html
UK Department of Health
http://www.doh.gov.uk/traveladvice/index.htm
Fit for Travel (Scotland)
http://www.fitfortravel.scot.nhs.uk/
Roll Back Malaria Program
http://www.mosquito.who.int
6.

MMWR CDC Surveillance Summaries
http://www.cdc.gov/mmwr
WHO EMC Home
http://www.who.int/emc/index.html
EMC Outbreak
http://www.who.int/emc/outbreak?news/index.html
WER
http://www.who.int/wer/
Eurosurveillance Weekly
http://www.eurosurv.org/update/
Eurosurveillance Monthly
http://www.ceses.org/eurosurv/
CDR (London: England Weekly)
http://www.phls.co.uk/publications/cdrw.htm
Canada CDR
http://www.hc-sc.gc.ca/hbp/icdc/publicat/ccdr/
Australia Communicable Diseases
http://www.health.gov.au/publith/cdi/cdihtml.htm
ProMedmail
http://www.promedmail.org; e-mail version,

http://www.promedmail.org:8070/promed/promed.signup.form
255
7.

TravelMed (ISTM)
listserv@yorku.ca
TropMed (ASTMH)
listserv@yorku.ca
ProMedmail (ISID)
majordomo@promedmail.org
Malaria (Walter and Eliza Hall Institute, Australia)

listserv@wehi.edu.au
MMWR (CDC)
listserv@cdc.gov
EID (CDC)
listserv@cdc.gov
WER (WHO)
majordomo@who.ch
IDSA
Ein-idsa@uwashington.edu
8.

Travelhealth, On-Line
http://www.tripprep.com
Fit for Travel
http://www.fit-for-travel.de/en/index.html
Lonenly Planet Health
http://www.lonenlyplanet.com/health/
MASTA Australia
http://www.masta.edu.au/maps.html
Medicine Planet
http://www.medicineplanet.com/home/
9.

Diabetes (The Diabetes Monitor)
http://www.diabetesmonitor.com/other-14.htm
Dialysis (The Dialysis Finder)
http://www.dialysisfinder.com
National Kidney Foundation
http://www.kidney.org
Travelling with HIV
http://www.aegis.com
Global Access DTN
http://www.geocities.com/paris/1502/index.html
Access-Able Travel Source
http://www.access-able.com
Air Travel with Disabilities (New Orizon)
http://www.dot.gov/airconsumer/horizons.htm
Aeromonas spp
AIDS
(162)
(15, 56, 68)
Savarine
Scombroid
(139)
(50)
Artemisinin Qinghaosu
(154)
Shigella spp
(162)
Campylobacter jejuni
(162)
Vibramycin
(147)
Ciguatera
(43)
Wallis Fortuna
(227)
Ciguatoxin
(43)
(215)
(162)
(209)
Cyclospora cayetanensis
(162)
(225)
DEET
(174)
(Azithromycin)
(154)
(162)
(Zithromax)
(154)
Escherichia coli
(162)
(227)
Giardia lamblia
(15)
(209)
(56, 178)
(215)
Cryptosporidium
HIV
Jet lag
(32)
(56)
(50)
K-
(186)
Lariam
(133)
(Diamox)
(229)
(39)
Legionella
(45)
Malarone
(147)
(218)
Mariannes
(227)
(225)
Marshall
(227)
(209)
Microvibrate
(150)
(Halofantrine)
(154)
(209)
(Chagas Disease)
(186)
Nive
(207)
(183)
Novimax
(147)
(Amodiaquine)
P. falciparum
(147)
(Amebiasis)
(43, 45)
P. vale
(133)
(15, 245)
P.vivax
(133)
(209)
Plesiomonas shigelloides
(161)
(147)
Pseudomonas aeruginosa
(62)
Rotavirus
(162)
(154)
( HIV) (180)

(229)
Salmonella spp
(45)
(31)
SARS
(15)
(31)
258
(31, 35)
(45)
(45)
( )
(209)
(58)
(161)
(190)
(225)
(Lomotil)
(161)
(197)
(29)
(123)
/ (Atovaquone/ Proguanil) (152)
(229)
(53)
(Doxycycline)
(150)
(55)
Murray Valley
(207)
(207)
(203)
(173)
(212)
(HAIG)
(92)
(209)
(HBIG)
(99)
. ,
(197)
()
(190)
(229)
(199)
(186, 190)
(190)
(Brucella)
(43)
(15)
(190)
(24)
(186)
(17, 133)
(129)
(129)
(129)
(183)
(227)
HIV
(129)
(225)
(218)
b
(Haemofilus Influenza b, Hib)
(127)
(209)
(Varicella)
(129)
(218)
(227)
(229)
(186)
(190)
(218)
(Equatorial)
(212)
(218)
(229)
(174)

(Decadron)
(197, 209)
(39)
(67)
(Influenza Vaccine)
(89)
(89)
- ()
(Diphtheria - Tetanus, DT)
(123)
-
(Td)
(123)
--
(Diphtheria - Tetanus -Pertussis, DTP)
(123)

(Tick-Born Encephalitis, TBE Vaccine)
(83)
B
(Hepatitis B Vaccine, Hep B)
(100)

(Hepatitis A Vaccine, Hep A)
(92)

(Japanese Encephalitis, JE Vaccine)
--
(Measles-Mumps-Rubella, MMR)
(Yellow Fever Vaccine)
(Rabies Vaccine Absorbed)

(Meningococcal Vaccine, MV)

(Pneumococcal Polysaccharide Vaccine, PPV /
Pneumococcal Conjugated Vaccine, PCV)
259
(85)
(122)
(73)
(115)
(79)
(199)
(183)
I Norwalk
(161)
(197)
Ebola
(212)
(233)
(233)
(233)
(129)
(Oral Polio Vaccine, OPV /

Inactivated Polio Vaccine, IPV)
(125)

(123)
(48-50)
(225)
(209)
(199)
(183)
(209)

(Typhoid Fever Vaccine)
(107)

(Bacille Calmette - Guerin, BCG)
(233)
(127)
(209)
(Cholera Vaccine)
(111)
(197)
(183)
(58)
(215)
(56)
(225)
(225)
, ,

(209)
(Quinine)
(154)
(209)
(225)
(227)
(36)
(215))
(197)
(62)
(177)
(100)
(190)
(209)
(209)
(209)
(92)
(233)
(37)
(227)
(58)
Aedes
(197)
(83, 85)
(73)
(186, 229)
(50)
Aedes Haemagogus
(50)
(50)
(243)
(122)
(203)
(225)
(59)
(227)
260
(Giardia lamblia)
(15)
(233)
(199)
(186)
(Tavanic)
(167)
(218)
(183, 197)
(Botswana)
(222)
(183, 197)
(227)
(222)
(215)
(225)
(203)
(233)
(199)
(218)
( / )
(199)
(209)
(227)
(43)
(227)
(Listeria monocytogenes)
(212)
(197)
(Imodium)
(161)
(222)
(58, 60)
(227)
(215)
(31)
(Mayotte)
(215)
(203)
(197)
Malouines
(227)
(199)
(215)
(215)
(229)
(203)
(227)
(227)
Amanita phalloide
(43)
(209)
(227)
(229)
la Reunion
(215)
(215)
(222)
(218)
(141)
(32)
(218)
(186)
(218)
(233)
(186)
(Mefloquine)
(149)
(Procandia, Adalat)
(15, 19)
4 (Norocin)
(39)
(167)
(227)
Lyme
(197)
(209)
(215)
(186, 190, 203)
(203)
(229)
(50)
(233)
(229)
(186)
(229)
(215)
(209, 225, 233)
261
(225)
(218)
(225)
(233)
(190)
(218)
(Tabrin)
(167)
()
(251)
(251)
(199)
(173)
(218)
(203)
3(Ciproxin)
(161)
(209)
(59)
(186)
(215)
(15)
(222)
(19, 56)
(215)
(227)
(197)
(190)
(190)
(229)
(203)
(190)
(197)
(125)
(183)
(229)
(197)
(209)
(199)
(Primaquine)
(153)
(215)
(180)
(225)
(59)
(59)
, ,

(62)
(45)
Barmah Forest
(207)
Lassa
(209)
Rift Valley
(209)
Ross River
( )
(207, 237)
(Tafenoquine)
(154)
(229)
(215)
(199)
(227)
(218)
(183)
(227)
(183)
(Pyrimethamine)
(154)
(225)
(225)
(229)
/
(Pyrimethamine/Sulfadoxine - Fansidar)
154
(47)
(215)
(15)
(225)
(54)
(227)
(212)
(229)
(209)
262
(107)
(37)
(233)
(166)
(124)
(48)
(190)
(48)
(37)
(Chloroquine)
(39)
(58)
(Chloroquine/Proguanil)
(147)
(29)
(111)
(199)
(197)
HIV
-
(48)
(227)
(34)
(178)
(36)
(183)
(147)
(71)
(32)
, grouper, snapper, amberjack

barracuda
(43)
(38)
(237)

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, RN, MSc, PhD

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Public Health Laboratory Service (2000) Web site www.phls.org.uk.

Jane N. Zuckerman (2001) Principles and Practice of Travel Medicine

EnCompass Information. Travax, Shoreland Inc., Revision 2003.

EnCompass Information. Travax, Shoreland Inc., Revision 2003.

3.1.2 (Jet lag):

> 4 : 1 5mg 18.00-19.00

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1. (Yellow Fever Vaccine)

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2. (Meningococcal Vaccine, MV)

MEN JUGATE ( .., ....): :

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HM 175 HM 175 CR326F

( 5.7, 5.8, 5.9).

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Teyssou R, Nicand E, Koeck JL, Buisson Y. Prevention et prophylaxie vaccinale de l'hepatite A

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3. B (Hepatitis B Vaccine, Hep B)

1-2 . >10 mIU/ml,

. .. 1/. 5844, 19/11/1997.

Protection against viral hepatitis: recommendations of the Immunization Practices Advisory

General Recommendations on Immunization: Recommendations of the Advisory Committee on

Avis du Comite technique des vaccinations et de la section des maladies transmissibles du

4. (Typhoid Fever Vaccine)

Typhoid immunization. Recommendations of the Advisory Committee on Immunization

3. (CVD 103-HgR): V. cholerae

DUKORAL (SBL vaccines, Stockholm): V. cholerae O1 (

Teyssou R, Chevalier B, Buisson Y. Le vibrion cholereque. Infectiologie & Immunologie 1996;

6. (Rabies Vaccine Absorbed)

1. HDCV (human diploid cell vaccine): -

www.nhs.uk: Travax/Rabies Vaccine.

Plotkin, S.A. Rabies. Clin Infect Dis. 2000; 30(1): 4-12.

Plotkin S, Rupprecht C, Koprowski H. Rabies vaccine. In: Plotkin S, Orenstein W. Vaccines.

23-PPV (23-Pneumococcal Polysaccharide Vaccine): 23-

HepA (Hepatits A):