Committee to Advise on Tropical Medicine and Travel - The Immunocompromised Traveller: Canada
An increasing number of Canadians are living with conditions that reduce immune competence, including organ transplantation, HIV infection and treatment with corticosteroids or immunosuppressive agents for a variety of indications. A growing number of these individuals are travelling to tropical and low-income countries. Some of these travellers are immigrant Canadians who may be less likely to seek pre-travel advice and more likely to be exposed to infectious risks of travel. A broad range of common medical conditions including diabetes, alcoholism, renal failure and even advancing age can have significant but non-specific effects on susceptibility to infectious diseases, including some of those related to travel. However, this guideline focuses on more specific and more substantial abnormalities of immune function including solid organ or stem cell transplantation, HIV infection, malignant diseases (and their therapies), high-dose corticosteroid or cytotoxic drug therapy and splenectomy. Specific types of immune suppression tend to be associated with specific disease risks. This statement focuses on health risks and interventions that are in addition to those experienced by and recommended for, immunocompetent travellers. It is intended to supplement the standard care, e.g., vaccinations recommended to transplant recipients and other immunocompromised hosts, irrespective of travel. The statement is available online at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/acs-04/index_e.html.
Source: Canada Communicable Disease Report, Volume 33, ACS-4, 1 April 2007

First Tuberculosis Cases Resistant to all Tested Drugs: Italy
A study from Italy and Germany has recently demonstrated that the occurrence of XDR-TB, as currently defined, has both a clinical value (predicting poor outcome) and an operational implication (underlying the loss of first-line drugs coupled with key second-line ones). The study reports on the first two cases that were resistant to all drugs tested. The cases have some similarities: both of them were young females, born in Italy and belonging to middle class families. Both of them were diagnosed and initially treated in non-specialised TB facilities where they received three different treatment courses for over 30 days before being admitted as MDR-TB to the reference hospital in Sondalo with a very severe clinical picture (extended bilateral cavities). Both died in 2003, before 50 years of age, after a long, unsuccessful treatment with all the available drugs without achieving bacteriological conversion.
Source: Eurosurveillance Weekly, Volume 12, No. 5, 17 May 2007

Measles Outbreak: Japan
On 21 May 2007, Waseda University suspended almost all classes after 30 students were confirmed infected with measles amid an outbreak spreading throughout the Tokyo area. About 55,000 undergraduate and graduate students were told not to come to school until 29 May 2007. The university is the largest in terms of number of students whose activities have been affected by the outbreak. Other universities in the Tokyo area have already closed their doors because of the measles scare; at least 150,000 students attending major universities based in Tokyo have been affected. According to the Tokyo metropolitan education board, 279 students and pupils attending 104 metropolitan-run schools had been diagnosed with the disease by 18 May 2007. A total of 9 of those schools have or had suspended all of their classes because of the outbreak, while 2 schools cancelled some classes. The measles outbreak has spread to Chiba, Saitama and Kanagawa prefectures. In Chiba Prefecture, at least 350 students at more than 10 colleges and universities were confirmed to have developed measles symptoms by 17 May 2007. There are 4 students at Saitama University who had also shown symptoms.
Source: ProMED, International Society for Infectious Diseases, 22 May 2007

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.