Risks to young volunteers in international social projects.

BACKGROUND: The number of young volunteers in international social projects has increased significantly with governmental and non-governmental project support. This paper investigates the hypothesis that the preventative medical advice currently given prior to departure is inadequate because the risk profile of young persons (<30 years) differs from that of the general population. METHODS: A retrospective cross-sectional study was performed with participants of international social projects. A specific questionnaire was developed; inclusion criteria were age between 18 and 30 years at departure and a duration with the project of at least 6 months. RESULTS: One hundred and fifty-three data sets could be evaluated. Fifty-three percent were females; the destinations were as follows: 65.4% to Asia, 14.4% to Africa, and 10.5% to Latin America. The mean age was 20 years. Ninety percent of the participants received some kind of advice in travel medicine prior to departure. The vaccination rate was quite good, but pertussis (13.7%), yellow fever (80%), typhoid fever (54%), and rabies (49.7%) should be improved when travelling to high-risk regions. Food is a very important potential source of problems as 66% receive catering by the project, 56.2% from street stalls, and 44% were regularly invited to dine with locals. In Africa, only two-thirds of the participants of projects had regular access to safe water and the sanitary facilities were also poor; 51.7% of respondents reported new sexual contacts (one to more than six new partners). In most cases, condoms were used, but there were two unintended pregnancies. CONCLUSIONS: We conclude that young people need to be targeted with specialized advice for health and safety while abroad. This should highlight age-specific risks compared to advice for a more general population. Vaccination status should be improved for some regions and diseases.

Drugs and drug administration in extreme environments.

Emergency medicine must often cope with harsh climates far below freezing point or high temperatures, and sometimes, an alternative to the normal route of drug administration is necessary. Most of this information is not yet published. Therefore, we summarized the information about these topics for most drugs used in medical emergencies by combining literature research with extensive personal communications with the heads of the drug safety departments of the companies producing these drugs. Most drugs can be used after temperature stress of limited duration. Nevertheless, we recommend replacing them at least once per year or after extreme heat. Knowledge about drugs used in extreme environments will be of increasing importance for medical personnel because in an increasingly mobile society, more and more people, and especially elderly -often with individual medical risks-travel to extreme regions such as tropical or arctic regions or to high altitude, and some of them need medical care during these activities. Because of this increasing need to use drugs in harsh climates (tourism, expeditions, peace corps, military, etc) the actual International Congress of Harmonization recommendations should be added with stability tests at +50 degrees C, freezing and oscillating temperatures, and UV exposure to simulate the storage of the drugs at "outdoor conditions."

The Golden Agers and Tick-borne encephalitis. Conference report and position paper of the International Scientific Working Group on Tick-borne encephalitis.

The 7th meeting of the ISW TBE had the main topic "Tick-borne encephalitis in the Golden Agers". Data from 14 European countries were presented about incidence and clinical course of Tick borne encephalitis (TBE) in general and especially in the population over 50 years of age. With age immunity is impaired quantitatively and qualitatively, the reactions to vaccinations are generally slower, antibody titres reach lower values and decrease earlier. The incidence of the disease is increasing with age, also the clinical course is more severe, they suffer significantly more sequelae, need a longer rehabilitation and have a higher case fatality. Vaccination as the only efficient protection is needed in endemic areas, considering that mobility has increased very much. For the age group over 50 years regular booster vaccinations according to the recommended vaccination intervals or even shorter intervals are most important.