Evaluation of travel medicine practice by yellow fever vaccination centers in England, Wales, and Northern Ireland.

BACKGROUND: The National Travel Health Network and Centre (NaTHNaC) introduced a program of registration, training, standards, and audit for yellow fever vaccination centers (YFVCs) in England, Wales, and Northern Ireland (EWNI) in 2005. Prior to rolling out the program, NaTHNaC surveyed YFVCs in England. OBJECTIVES: To reassess the practice of YFVCs in 2009, 4 years after the institution of the NaTHNaC program, to identify areas for ongoing support, and to assess the impact of the program. METHODS: In 2009, all YFVCs in EWNI were asked to complete a questionnaire on type of practice, administration of travel vaccines, staff training, vaccine storage and patient record keeping, use of travel health information, evaluation of NaTHNaC yellow fever (YF) training, and resource and training needs. Data were analyzed using Microsoft Excel® and STATA 9®. RESULTS: The questionnaire was completed by 1,438 YFVCs (41.5% of 3,465 YFVCs). Most YFVCs were based in General Practice (87.4%). In nearly all YFVCs (97.0%), nurses advised travelers and administered YF vaccine. An annual median of 50 doses of YF vaccine was given by each YFVC. A total of 96.7% of nurses had received training in travel medicine, often through study days run by vaccine manufacturers. The internet was frequently used for information during travel consultations (84.8%) and NaTHNaC's on-line and telephone advice resources were highly rated. Following YF training, 95.8% of attendees expressed improved confidence regarding YF vaccination issues. There was excellent adherence to vaccination standards: ≥ 94% correctly stored vaccines, recorded refrigerator temperatures, and maintained YF vaccination records. CONCLUSIONS: In the 4 years since institution of the NaTHNaC program for YFVCs, there has been improved adherence to basic standards of immunization practice and increased confidence of health professionals in YF vaccination. The NaTHNaC program could be a model for other national public health bodies, as they establish a program for YF centers.

Analysis of yellow fever vaccination practice in England.

BACKGROUND: Prior to initiation of a program of registration, training, standards, and audit for yellow fever vaccination centers (YFVCs) in England, the National Travel Health Network and Centre (NaTHNaC) assessed the current practice and resource needs of these centers. METHODS: A questionnaire was sent to all YFVCs on the English Department of Health (DH) database in November 2004. It surveyed type of practice, administration of travel vaccines, training and duties of staff, vaccine storage and record keeping, access to travel health information, and resource and training needs. RESULTS: The questionnaire was completed by 69% (2,933 of 4,242) of YFVCs on the DH database. Nearly all (94%) YFVCs were part of general practice; centers were widely distributed throughout England. A median number of 35 doses of yellow fever vaccine (YFV) were given every year, with 75% of centers giving less than one dose per week. Nurses administered YFV more frequently than physicians (96% of nurses vs 49% of physicians, p < 0.0001). More nurses in YFVCs had received travel health training compared with physicians (95% vs 57%, p < 0.0001). Study days run by pharmaceutical companies were the most frequent source of training. Most YFVCs properly refrigerated vaccine and maintained vaccination records. Of the centers that reported using Internet resources for every patient, the Travax (Health Protection Scotland) (64%) and DH (England) (48%) Web sites were most frequently accessed. YFVCs cited training opportunities, information for travelers, and specific travel medicine advice as resources that would be most helpful to them. CONCLUSIONS: The NaTHNaC program of registration, training, standards, and audit should help to meet important needs in practice settings and contribute to an improvement in travel health.

A double blind, randomized, placebo-controlled study of SP-303 (Provir) in the symptomatic treatment of acute diarrhea among travelers to Jamaica and Mexico.

OBJECTIVE: The study was designed to evaluate the effectiveness of SP-303 (Provir), a plant-derived product with novel antisecretory properties, in the treatment of travelers' diarrhea. METHODS: A total of 184 persons from the United States who acquired diarrhea in Jamaica or Mexico were enrolled in a double-blind, placebo-controlled study examining the effectiveness of three doses of SP-303 in reducing illness. Subjects were treated with 125 mg, 250 mg, or 500 mg SP-303 or a matching placebo four times a day for 2 days. Subjects kept daily diaries of symptoms and were seen each day for 3 days. Of the subjects, 169 (92%) were included in the efficacy analysis. RESULTS: The most common etiological agent identified was enterotoxigenic Escherichia coli, found in 19% of subjects. The mean time interval from taking the first dose of medication until passage of the last unformed stool during 48 h therapy (TLUS48) was 38.7 h for the placebo group. TLUS48 was shortened by SP-303: 30.6 h for the 125-mg dose group (p = 0.005); 30.3 h for the 250-mg group; and 32.6 h for the 500-mg group (p = 0.01). Treatment failures were seen in 29.3% in the placebo group compared with 7.3% (p = 0.01), 4.3 (p = 0.002), and 9.8 (p = 0.026) in the three treatment groups. SP-303 was well tolerated at all doses. CONCLUSIONS: SP-303 was effective in shortening the duration of travelers' diarrhea by 21%. This antisecretory approach works directly against the pathophysiology of travelers' diarrhea and is not likely to potentiate invasive forms of diarrhea or to produce posttreatment constipation.

Enteric pathogens in Mexican sauces of popular restaurants in Guadalajara, Mexico, and Houston, Texas.

BACKGROUND: The transmission of traveler's diarrhea is primarily foodborne. OBJECTIVE: To examine the level of microbial contamination of tabletop sauces found in Mexican-style restaurants. DESIGN: Cross-sectional study of Mexican sauces. SETTING: Mexican restaurants in Guadalajara, Mexico, and Houston, Texas, during the summer of 1998. MEASUREMENTS: 71 sauces from Guadalajara and 25 sauces from Houston were examined. The number of sauces contaminated with Escherichia coli, the median number of E. coli colonies per gram of sauce, and enteropathogens were identified. RESULTS: 47 of 71 sauces from Guadalajara were contaminated with E. coli versus 10 of 25 sauces from Houston (P = 0.03); the median number of E. coli colonies per gram of sauce was 1000 in the Guadalajara sauces versus 0.0 in the Houston sauces (P = 0.007). Among sauces from Guadalajara tested for diarrheogenic E. coli, 4 of 43 sauces contained enterotoxigenic E. coli and 14 of 32 contained enteroaggregative E. coli. CONCLUSIONS: Contamination with E. coli was common in samples of Mexican tabletop sauces from Guadalajara restaurants. These sauces commonly contained enteric pathogens.

The impact of infant feeding patterns on infection and diarrheal disease due to enterotoxigenica Escherichia coli / El impacto de las modalidades de alimentación infantil en la infección y en las enfermedades diarreicas por Escherichia coli enterotoxigénica

Objetivo. Determinar el impacto de los factores dietéticos sobre patrones de infección por Escherichia coli enterotoxigénica productora de la toxina lábil (ECET-TL). Material y métodos. Se reclutaron 98 infantes al nacer, en agosto de 1986; se hizo seguimiento durante un año y una muestra de leche de las madres; éstas fueron entrevistadas sobre la morbilidad del niño. Se ajustaron modelos de hazard a la estancia de tiempo de los niños en los distintos estadios de la enfermedad causada por el ECET-TL. La ingestión de comida suplementaria y de líquidos por el niño, así como los niveles de anticuerpos específicos contra ECET, se incluyeron como variables en los modelos. Resultados. El riesgo de infección asintomática aumentó significativamente entre los niños que comían avena (tasa de Hazard= 4.01, IC 95 por ciento 2.77-5.24) y su duración se redujo si el niño tenía un episodio previo de diarrea causado por ECET (2.12; IC 95 por ciento 1.74-2.49) pero se prolongó si el niño ingería tés (0.53; IC 95 por ciento 0.27-0.7), Tanto los tés como la ingestión de altos niveles de anticuerpos específicos contra ECET en la leche materna redujeron el riesgo de infecciones sintomáticas. Los episodios sintomáticos pasaron a ser asintomáticos más rápidamente cuando el niño ingería agua de arroz. Conlusiones. Las comidas específicas de destete aumenta el riesgo de infección. Los anticuerpos de la leche materna y los líquidos reducen la duración del episodio de diarrea