Vaccination of adults against travel-related infectious diseases, and new developments in vaccines

In vivo efficacy of olorofim against systemic scedosporiosis and lomentosporiosis

Clinically relevant members of the Scedosporium/Pseudallescheria species complex and Lomentospora prolificans are generally resistant against currently available systemic antifungal agents in vitro and the infection due to these species is difficult to treat. We studied the in vivo efficacy of a new fungicidal agent olorofim (formerly F901318) against scedosporiosis and lomentosporiosis in neutropenic animals. Cyclophosphamide immunosuppressed CD-1 mice infected by Scedosporium apiospermum, Pseudallescheria boydii (Scedosporium boydii) and Lomentospora prolificans were treated by intraperitoneal administration of olorofim (15 mg/kg every 8 h for 9 days). The efficacy of olorofim treatment was assessed by the survival rate at 10 days post infection, levels of serum (1-3)-β-d-glucan (BG), histopathology, and fungal burden of kidneys 3 days post infection. Olorofim therapy significantly improved survival compared to the untreated controls; 80%, 100% and 100% of treated mice survived infection by Scedosporium apiospermum, Pseudallescheria boydii, and Lomentospora prolificans, respectively while less than 20% of the control mice (PBS-treated) survived at 10 days post infection. In the olorofim-treated neutropenic CD-1 mice infected with all three species, serum BG levels were significantly suppressed and fungal DNA detected in the target organs was significantly lower than controls. Furthermore, histopathology of kidneys revealed no or only few lesions with hyphal elements in the olorofim-treated mice, while numerous fungal hyphae were present in control mice. These results indicate olorofim to be a promising therapeutic agent for systemic scedosporiosis/lomentosporiosis, a devastating emerging fungal infection difficult to treat with currently available antifungals.

Risk Behavior for Travelers' Diarrhea Among Finnish Travelers

Background: Contaminated food and drink are the primary sources of traveler's diarrhea (TD). Identification of the characteristics that make a traveler more prone to TD is needed to improve prevention and therapy of this illness. Methods: We evaluated, by questionnaire, the association of dietary errors with TD among 933 adult Finnish tourists vacationing in Morocco. A stool specimen was obtained from patients in the group that developed TD at the onset of the diarrheal episode, and from all participants in the study on their return to Finland. Results: Only 5% of the 933 subjects who responded to the questionnaire, and who gave a stool sample, had adhered strictly to generally accepted recommendations. About 45% made five or more dietary errors during the trip; of these, 75% consumed raw vegetables, 65% salads, 33% puddings, 32% mayonnaise or other cold dressings, 31% consumed food bought from street vendors, 29% consumed cold meat, 18% cold sandwiches, 4% drank tap water, and 2% consumed raw meat. The age of the subjects did not correlate with the number of dietary errors. Subjects who had been abroad during the preceding 12 months committed more dietary errors than those who had not (mean 3.9 versus 4.5; p <.001). Also, subjects who spent 2 weeks in Morocco committed more dietary errors than those who spent only 1 week (mean 4.0 versus 4.8; p <.001). However, no association between TD and the number of dietary errors was observed. Differences with respect to eating habits were not observed between subjects, with or without TD or with or without an identified pathogen in stool specimens. There was no correlation between eating habits and the presence, or absence, of a specific pathogen in the stool sample; this is with the exception of Campylobacter spp: subjects with this pathogen consumed steak tartar or salad more often than did other subjects. Conclusions: Etiologic agents are so ubiquitous in this high-risk area that instructions to avoid certain foodstuffs commonly thought to be contaminated may be to some extent without value. Moreover, dietary self restraint proved to be impossible in the real situation. (J Travel Med 2:77-84, 1995)

Hepatitis A in Western Austria--the epidemiological situation before the introduction of active immunisation

Several European countries report a decreasing prevalence of antibodies to hepatitis A virus (anti-HAV). This trend is most pronounced in the youngest age groups. In 1979, however, 58% of young Austrians aged 20 to 30 years were shown to possess anti-HAV. Here we describe the current epidemiological situation in western Austria. Prevalence of anti-HAV has decreased to 7% in those 18 to 30 years old. This percentage rises to 20% (31 to 40 years of age) and 57% (41 to 50 years of age) and is highest in those older than 50 years (87%). Of 180 cases of clinical hepatitis A occurring from 1985 to 1992 45% were imported by travel to HAV-endemic areas. Seventy-one percent of the cases in children (59/83) occurred in foreign workers' families and were also predominantly acquired abroad. A change in prevention policy should be considered in this respect, as vaccination is available now.