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This conclusion holds especially in poor countries, where the burden of communicable diseases is high. Although the magnitude and nature of their economic effects vary, the returns to combating many of these diseases, even calculated on a narrow economic basis, are also high. For example, the control of onchocerciasis in West Africa led to the opening up of fertile agricultural areas to farmers who had previously been forced to subsist on marginal lands. In principle, the world is far better equipped to deal with infectious diseases than it was in the past, but the practical problems are still formidable. The main source of trouble in any common property system is ensuring collective action among the individual agents. A so-called "rogue country" with a weak commitment to , or capacity for, rigorous public health management can allow the spread of a virulent pathogen that threatens not only its own population, but also those outside its borders who come into contact with it. Since such countries are not uncommonly at odds in political and security matters with their neighbors or other groups of countries, the task of agreeing on the right course of action and how to share the costs, and then of actually implementing it, will demand skilful diplomacy or even sanctions. A more serious threat is likely to come from the more numerous "failed states", which can exert little control over their borders or internal affairs, much less reach their populations with public health measures. The decay of public health systems in what can be called "faltering" states is also very troubling. The chaos and poverty following the breakup of the Soviet Union led to intermittent and uneven immunization coverage, as well as deteriorating water and sanitation services, and so permitted the resurgence of infectious diseases. Periodic outbreaks of measles and other diseases over the 1990s were clear evidence that the public health system had deteriorated (Jones and Revenga, 2000). As a result, immigrants from the former Soviet Union often arrive in Western Europe without current, standard vaccinations. Nigeria, whose reputation in most matters of governance and administration is unenviable, has also come under scrutiny once more, this time in connection with polio. These countries offer fertile ground for instability of all kinds, including the spread of communicable diseases. In many of these cases, the immunization technology exists, and often successful immunization coverage has been achieved in the past; but failed or faltering states cannot or will not perform basic public health functions, so placing the rest of the world at risk. The international system displayed its strengths and effectiveness in dealing with epidemics, particularly in its instant response and ability to mobilize and coordinate essential expertise. The flaw lay in the assumption that China, like other countries, not only monitors its epidemiological situation closely, but also would report any untoward developments quickly. Without the sequence of immediate international response, sharing of information and cooperation, the epidemic would have spiraled out of control and become a worldwide pandemic. It should be added that had the pathogen been more aggressive or complex, the delay in initial reporting might have made such a disastrous outcome unavoidable. While the international community compensated for these failures, it was alerted too late to avert the resulting morbidity and mortality outside China. The delays in identifying the emerging epidemic caused the direct and indirect economic losses sustained by China and other affected countries. They can provide guidance and information based on the experiences and challenges facing its member countries, and they can promote best practice in member countries and collaboration among them. While these bodies have no direct authority over 33 country-level surveillance and disease management, they are expected to compensate for lapses in country commitment and action that threaten international health. An operations and evaluation department should monitor the performance of member states and formally report their failures to adhere to established standards. Egregious and persistent cases should be referred to a central gremium, and thence, in the absence of the required corrective action, to the U. To the extent that performance so measured depends heavily on good administration and governance, there would be a correspondingly strong incentive to improve them. And because countries are increasingly interdependent, and infectious diseases affect not only the health of individuals but also of economic activity, disease control has become a truly global issue. Summary Characteristics of Selected Infectious Diseases Linked to Epidemics 5/27 Diseases Period of Epidemic 2002/03 epidemic Source of Infection Coronavirus Form of Transmission Through respiratory contact with infected animals or humans Disease Nature and Speed of Transmission Symptoms: occur within 4-5 days Death: depends on individual, but can occur within 48 hours, especially of elderly. Case fatality rate: 10-15% Symptoms: 8-10 years delay; transmit infection when asymptomatic Death: avg. Center for Health and Wellbeing, Research Program in Development Studies, Princeton University.

For example, the Huckleberry House Project in San Francisco reported that 90 percent of the girls involved in prostitution had been sexually molested (Harlan, Rodgers, & Slattery, 1981). Two other studies of juveniles estimated the percentage of girls engaged in prostitution who had a history of sexual abuse to be between 70 percent and 80 percent (Bagley & Young, 1987; Silbert & Pines, 1982). Research has demonstrated that the younger a girl is when she first becomes involved in prostitution, the greater the likelihood that she has a history of childhood sexual abuse and the greater the extent of the abuse (Council for Prostitution Alternatives, 1991). Further, the history of childhood trauma experienced by most girls involved in prostitution includes abuse that is chronic in nature and takes the form of physical abuse, emotional abuse, and/or sexual abuse by multiple perpetrators (Farley & Kelly, 2000). A 1994 National Institute of Justice report (as cited in Spangenberg, 2001) states that minors who were sexually abused were 28 times more likely to be arrested for prostitution at some point in their lives than minors who were not sexually abused. In addition to a history of childhood abuse, prostituted girls are likely to experience other forms of family disruption. Multiple studies suggest that girls involved in prostitution are more likely to come from homes where addiction was present (Raphael, 2004). For example, one study of 222 women in Chicago involved in prostitution found 83 percent had grown up in a home where one or both parents were involved in substance abuse (Center for Impact Research, 2001). Further, prostituted girls are more likely to have witnessed domestic violence in their home; specifically, girls are likely to have seen their mother beaten by an intimate partner (Raphael, 2004). Some literature has begun to recognize a correlation between school-related problems, most notably learning disabilities, and sexual exploitation. Current research does not allow us to distinguish whether the learning disability was present before or is a consequence of the exploitation. However, the later the disability is diagnosed and an appropriate educational plan put in place, the greater the likelihood of the 9 U. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation girl experiencing failure in school and/or low self-esteem, making her vulnerable to exploitation (Harway & Liss, 1999). Another risk factor that emerges for youth at risk for exploitation through prostitution is the loss of a parent through death, divorce, or abandonment. For example, in two separate studies of adolescent girls involved in prostitution, a third of the sample had a deceased mother (Norton-Hawk, 2002; Raphael & Shapiro, 2002). One study in Canada of 47 women in prostitution found that 64 percent had been involved in the child welfare system, and of these, 78 percent had entered foster care or group homes (Nixon, Tutty, Downe, Gorkoff, & Ursel, 2002). The themes of trauma, abandonment, and disruption, begun in childhood, are central to the narratives of adolescent girls trafficked into commercial sexual exploitation. Girls describe having had a profound sense of being alone without resources: "They [the women and girls] described their isolation, lack of connectedness, and feelings of separation as the single most important factor in making them vulnerable to prostitution to begin with. The prostitution of boys is not as visible as that of young girls (McKnight, 2006). According to Flowers (1998), boys primarily sell their bodies to "survive financially, explore their sexuality, and/or make contact with gay men," with money a major motivator to continue prostituting. Young prostituted males are also more likely to be involved in criminal or delinquent behaviors in addition to prostitution (Flowers, 1998); however, they are arrested much less frequently (McKnight, 2006). McKnight also states that boys are more likely than girls to leave home due to a feeling of being unwanted or misunderstood regarding their sexual orientation. Similar to girls, however, most boys exploited through prostitution come from dysfunctional homes and a large percentage have been the victim of some kind of abuse in the past (Flowers, 1998). Girls who run from their homes, group homes, foster homes, or treatment centers, are at great risk of being targeted by a pimp (or trafficker) and becoming exploited. Research consistently confirms the correlation between running away and becoming exploited through prostitution. Researchers have found that the majority of prostituted women had been runaways; for example, 96 percent in San Francisco (Silbert & Pines, 1982), 72 percent in Boston (Norton-Hawk, 2002) and 56 percent in Chicago (Raphael & Shapiro, 2002). Among prostituted youth (both boys and girls), up to 77 percent report having run away at least once (Seng, 1989). Experts have reported that within 48 hours of running away, an adolescent is likely to be approached to participate in prostitution or another form of commercial sexual exploitation (Spangenberg, 2001); however, no definitive published research substantiates this claim. Like girls, boys exploited through prostitution are most often runaways or throwaways (Flowers, 2001; Lankenau et al.

Lackof naturalboostereventsandwaningimmunitysincechildhoodimmunization wereresponsiblefortheincreaseincasesof pertussisinpeopleolderthan10yearsof age notedbeforeuseof theadolescentboosterimmunization. Culturecanbenegativeif takenfromapreviouslyimmunizedperson,if antimicrobialtherapyhasbeen started,if morethan3weekshaselapsedsincecoughonset,orif thespecimenisnot handledappropriately. If thecontactlivesinahousehold withapersonathighriskof severepertussis(eg,younginfant,pregnantwoman,personwhohascontactwithinfants)orisathighriskhimself orherself,chemoprophylaxis shouldbegiven,evenif thecontactisfullyimmunized. Children andchildcareproviderswhoaresymptomaticorwhohaveconfirmedpertussisshouldbe excludedfromchildcarependingphysicianevaluationandcompletionof 5daysof the recommendedcourseof antimicrobialtherapyif pertussisissuspected. Recommendations for Scheduling Pertussis Immunization for Children Younger Than 7 Years of Age in Special Circumstances. Aprecautionisaconditioninarecipientthatmightincreasetheriskof a erious s adversereactionorthatmightcompromisetheabilityof thevaccinetoproduce immunity. Recommendations for Routine Adolescent Booster Immunization With Tdap1,2 · Adolescents11yearsof ageandoldershouldreceiveasingledoseof Tdapinsteadof Tdforboosterimmunizationagainsttetanus,diphtheria,andpertussis. Aspartof standardwoundmanagementcare topreventtetanus,atetanustoxoid-containingvaccinemightberecommendedfor woundmanagementinapregnantwomanif 5yearsormorehaveelapsedsince 1 CentersforDiseaseControlandPrevention. Adultsof anyagewhopreviouslyhavenotreceivedTdap,includingadultswho haveoranticipatehavingclosecontactwithaninfantyoungerthan12monthsof age, shouldbegivenasingledoseof Tdap,withnominimumintervalsuggestedorrequired betweenTdapandpriorreceiptof atetanus-ordiphtheria-toxoidcontainingvaccine. Ahistoryof severeArthushypersensitivityreactionafterapreviousdoseof atetanus ordiphtheriatoxoid-containingvaccineadministeredlessthan10yearspreviouslyshould leadtodeferralof TdaporTdimmunizationfor10yearsafteradministrationof thetetanusordiphtheriatoxoid-containingvaccine. Apositivefluorescentantibodytestresultforthepresenceof Y pestisindirectsmearsorculturesof blood, buboaspirate,sputum,oranotherclinicalspecimenprovidespresumptiveevidenceof Y pestisinfection. Peopleliving inareaswithendemicplagueshouldbeinformedabouttheimportanceof eliminatingsourcesof rodentfoodandharboragenearresidences,theroleof dogsandcatsin bringingplague-infectedrodentfleasintoperidomesticenvironments,theneedforflea controlandconfinementof pets,andtheimportanceof avoidingcontactwithsickand deadanimals. Preventionof pneumococcaldiseaseamonginfantsand c hildren-useof 13-valentpneumococcalconjugatevaccineand23-valentpneumococcalpolysaccharide v accine. Combination therapywithvancomycinandcefotaximeorceftriaxoneshouldbeadministeredinitially toallchildren1monthof ageorolderwithdefiniteorprobablebacterialmeningitis becauseof theincreasedprevalenceof S pneumoniaeresistanttopenicillin,cefotaxime, andceftriaxone. Performance Standards for Antimicrobial Susceptibility Testing: 18th Informational Supplement. Additionof rifampintovancomycinafter24to48hoursof therapyshouldbeconsideredif theorganismissusceptibletorifampinand(1)after24to48hours,despitetherapy withvancomycinandcefotaximeorceftriaxone,theclinicalconditionhasworsened; Table 3. Dosages of Intravenous Antimicrobial Agents for Invasive Pneumococcal Infections in Infants and Childrena Antimicrobial Agent PenicillinG Cefotaxime Ceftriaxone Vancomycin Rifampinc Chloramphenicol Clindamycin Meropeneme a b Meningitis Dose/kg Dose per day Interval 4­6h 250000­400000Ub 225­300mg 100mg 60mg 20mg d Nonmeningeal Infections Dose/kg Dose per day Interval 4­6h 250000­400000Ub 75­100mg 50­75mg 40­45mg Notindicated 75­100mg 25­40mg 60mg 8h 12­24h 6­8h. Control of Transmission of Pneumococcal Infection and Invasive Disease Among Children Attending Out-of-Home Child Care. Dailyantimicrobialprophylaxisisrecommendedforchildrenwith functionaloranatomicasplenia,regardlessof theirimmunizationstatus,forpreventionof pneumococcaldiseaseonthebasisof resultsof alarge,multicenterstudy(see ChildrenWithAsplenia,p88). Onthebasisof limitedavailabledata,arecommendedregimenof oral prednisoneforchildrenyoungerthan13yearsof ageis1mg/kg/dose,twicedailyforthe first5daysof therapy;0. Immunizationisrecommended onlyforcertainadultswhoareatagreaterriskof exposuretowild-typepolioviruses thanthegeneralpopulation,includingthefollowing: · Travelerstoareasorcountrieswherepoliomyelitisisormaybeepidemicorendemic; · Membersof communitiesorspecificpopulationgroupswithdiseasecausedbywildtypepolioviruses; · Laboratoryworkershandlingspecimensthatmaycontainwild-typepolioviruses;and · Healthcarepersonnelinclosecontactwithpatientswhomaybeexcreting wild-typepolioviruses. Tissuesassociatedwithhighlevelsof infectivity(eg,brain,eyes,andspinalcordof affectedpeople)andinstrumentsincontact withthosetissuesareconsideredbiohazards;incineration,prolongedautoclavingathigh temperatureandpressureafterthoroughcleaning,andespeciallyexposuretoasolution of 1Norgreatersodiumhydroxideorasolutionof 5. Humanstypicallyacquireinfectionbyinhalationof C burnetii infine-particleaerosolsgeneratedfrombirthingfluidsof infectedanimalsduringanimal parturitionorthroughinhalationof dustcontaminatedbythesematerials. Specialsafetypracticesare recommendedfornonpropagativelaboratoryproceduresinvolvingC burnetiiandforall propagativeprocedures,necropsiesof infectedanimals,andmanipulationof infected humanandanimaltissues. Since 2004,2adolescentfemalesandan8-year-oldgirl,allof whomhadnotreceivedrabies postexposureprophylaxis,survivedrabiesafterreceiptof acombinationof sedationand intensivemedicalintervention. Becausetheinjuryinflictedbya batbiteorscratchmaybesmallandnotreadilyevidentorthecircumstancesof contact mayprecludeaccuraterecall(eg,abatinaroomof asleepingpersonorpreviously unattendedchild),prophylaxismaybeindicatedforsituationsinwhichabatphysically ispresentinthesameroomif abiteormucousmembraneexposurecannotreliablybe excluded,unlessprompttestingof thebathasexcludedrabiesvirusinfection. Afterwoundcareiscompleted,concurrentuse of passiveandactiveprophylaxisisoptimal,withtheexceptionsof peoplewhopreviously havereceivedcompleteimmunizationregimens(preexposureorpostexposure)withacell culturevaccineandpeoplewhohavebeenimmunizedwithothertypesof rabiesvaccines andpreviouslyhavehadadocumentedrabiesvirus-neutralizingantibodytiter;these peopleshouldreceiveonlyvaccine. WithS minusinfection("sodoku"),aperiodof initialapparenthealingatthesite of thebiteusuallyisfollowedbyfeverandulcerationatthesite,regionallymphangitis andlymphadenopathy,andadistinctiverashof redorpurpleplaques.

In the Treaty of Shimonoseki, 1895, China was forced to recognise that its suzerainty over Korea had lapsed, Taiwan and the Pescadores were ceded to Japan. Japanese citizens (and hence other foreigners) were now permitted to open factories and manufacture in China. This sparked off an avalanche of further foreign claims, and a Chinese declaration of war on the foreign powers in 1900. Within two months China was defeated by joint action of the foreign powers and Russia occupied Manchuria. China was obliged to turn the area around Peking and Tientsin into a demilitarised zone, which left North China defenceless. They presumably expected to take over the whole of North China after a short campaign, and thereafter to dominate a compliant government in the South as part of their new order in Asia. However, the Chinese government reacted strongly, and the war with Japan lasted for eight years. Its impact was compounded by the civil war between the Kuomintang and communist forces. The destructive impact was similar proportionately to that of the Taiping rebellion of 1850­64. He suggests a ratio between 9 and 13 per cent, but my 5 per cent ratio refers only to places with 10 000 inhabitants or more. What had been a great lake on whose shores rulers, laws, religion and language were the same or similar became the scene of naval warfare and piracy. Trade disappeared almost entirely in the Mediterranean in the course of the eighth century. Spices, precious silk fabrics and other Oriental articles were hardly to be found in Western Europe. He argued that the barbarian takeover in Gaul and Italy preserved a good deal of the advantages of Roman civilisation, and that its demolition was due to the Islamic invaders and Charlemagne. They conclude that Pirenne exaggerated the survival of Roman institutions: "By the end of the sixth century, conditions in the Western Mediterranean bore little resemblance to those in the second century. These fairs were held six times a year about 40 kilometres southeast of Paris and 110 kilometres from Bruges. Two fairs were held in Troyes, two in Provins, one in Lagny and the other at Bar­sur­Aube. They were the major centres of West European commercial activity from 1200 to 1350. They attracted merchants from all regions of France, northern and central Italy, Flanders, Hainault, Brabant, Spain, England, Germany and Savoy. In return their agents kept law and order, helped to enforce contracts and kept notarial records. The fairs petered out when the sea route from Italy to Flanders was opened (see Verlinden, 1963). Possibilities for trade in the western Mediterranean had already been opened up by the recovery of Sicily (1090), Corsica (1091), Sardinia and Majorca (1232) from Arab control. Its cosmopolitan faculty made major contributions to Renaissance scholarship and to scientific development. The strategic port of Ceuta was captured and became a Portuguese stronghold (until 1580 when it was ceded to Spain). It was a useful port for Genoese, Venetian and Catalan merchants moving from the Mediterranean to the Atlantic, and seemed to be a first step in the conquest of Morocco. Henrique saved the remnant of his troops by promising to surrender Ceuta and leaving his younger brother as an Arab hostage. From 1471 to 1700 they amounted to 145 tons of which most would have gone to Portugal. The Portuguese were convinced that there were large Christian communities in Africa and Asia, and one of the missions of the explorers was to investigate the myth of the kingdom of Prester John. He had carried out an exploratory trip two years earlier along the coast of Venezuela and Guiana for Spain.