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PubMed2001

Multiyear prospective study of intestinal parasitism in a cohort of Peace Corps volunteers in Guatemala.

We conducted a prospective, longitudinal study in a cohort of 36 Peace Corps volunteers (PCVs) in Guatemala to study the incidence and natural history of intestinal parasitic infections during the PCVs' >2-year overseas stay. PCVs collected stool specimens at least monthly and when ill with gastrointestinal symptoms. Of the 1,168 specimens tested, 453 (38.8%) were positive for at least one parasite and 48 (4.1%) were positive for a pathogenic parasite. A median interval of 187 days (range, 14 to 752 days) elapsed before the first documented parasitic infection, and the median intervals from arrival until subsequent infections (e.g., second or third) were >300 days. The PCVs had 116 episodes of infection with 11 parasites, including up to 4 episodes per PCV with specific nonpathogens and Blastocystis hominis. The incidence, in episodes per 100 person-years, was highest for B. hominis (65), followed by Entamoeba coli (31), Cryptosporidium parvum (17), and Entamoeba hartmanni (17). The PCVs' B. hominis episodes lasted 6,809 person-days (28.7% of the 23,689 person-days in the study), the E. coli episodes lasted 2,055 person-days (8.7%), and each of the other types of episodes lasted <2% of the person-days in the study. Gastrointestinal symptoms were somewhat more common and more persistent, but not significantly so, in association with pathogen episodes than with B. hominis and nonpathogen episodes. Although infections with pathogenic parasites could account for only a minority of the PCVs' diarrheal episodes, the continued acquisition of parasitic infections throughout the PCVs' >2-year stay in Guatemala suggests that PCVs repeatedly had fecal exposures and thus were at risk for infections with both parasitic and nonparasitic pathogens throughout their overseas service.

Adult↗
PubMed1991

Human immunodeficiency virus infection among Peace Corps volunteers in Zaire. No evidence for unusual modes of transmission.

A prospective study of US Peace Corps volunteers (PCVs) serving in Zaire, central Africa, was undertaken to determine the risk of human immunodeficiency virus (HIV) and hepatitis B virus infection in an acquired immunodeficiency syndrome-aware expatriate population living in an area of high endemicity for both diseases. Of the 338 PCVs who served in Zaire between October 1985 and May 1988, 282 (83%) were enrolled, representing 7776 volunteer-months of service. Analyses of serum samples for HIV and hepatitis B virus were performed on enrollment and at completion of service. All PCVs received extensive education and counseling regarding HIV and acquired immunodeficiency syndrome throughout their stay in Zaire. There were no documented seroconversions to HIV among 282 PCVs who lived in Zaire for periods ranging from 1 to 81 months, with a mean length of stay of 27.4 months. Of the 14 (6.2%) of 226 PCVs tested who had at least one positive serologic marker for infection with hepatitis B virus, none was documented to have seroconverted during service. During the study period, the rate of all sexually transmitted diseases among PCVs in Africa decreased from 131 to 68 per 1000 study population per year, and there were 52 cases of confirmed malaria among volunteers in Zaire. These data suggest that the risk of acquiring infection with HIV or hepatitis B virus in PCVs in Zaire is very low, and there is no evidence for unusual modes of transmission.

Adult↗
PubMed1990

Subclinical infection with hepatitis A in Peace Corps volunteers following immune globulin prophylaxis.

A study was undertaken to determine the incidence of subclinical infection in Peace Corps volunteers (PCVs) maintained on a routine prophylactic immune globulin (IG) regimen. Serum markers to hepatitis A virus (HAV) were detected in 172 of 1,508 (11.4%) single serum samples from a cross-sectional sample of PCVs. Of those tested prior to service, 15/298 (5%) were seropositive for HAV. Those tested at 1-12 months showed 48/417 (11.3%) seropositivity, while 72/529 (13.6%) of those with greater than 12 months of service had antibody to HAV. Only 3/80 (3.8%) of those seropositive PCVs who received their IG injections at least every 6 months were documented to have shown clinical signs of HAV infection during service. This compares to 6/30 (20%) of those who had received irregular prophylaxis (P = 0.01, Fisher's exact test, 2-tailed). Significant numbers of PCVs are subclinically infected with HAV overseas and increasingly develop active immunity with greater length of service.

Cross-Sectional Studies↗
PubMed1997

Psychological and Readjustment Problems Associated with Emergency Evacuation of Peace Corps Volunteers.

Background: To assess the psychological impact of emergency evacuation on individuals temporarily residing in foreign countries, we surveyed two groups of recently returned Peace Corps Volunteers. Methods: Cases were individuals (n = 265) who had been evacuated under emergency circumstances from their countries of service: Liberia, the Philippines, and Yemen. The control group (n = 90) consisted of the immediate predecessors of cases from the same countries who had completed their service under regular circumstances. Results: There were no significant age or gender differences between cases and controls. The median length of service in the foreign country was 14 months for evacuees and 24 months for regular returnees. Feelings of depression were self-reported by 60% of evacuees while 29% of controls reported this. For feelings of disorientation, 55% of cases versus 33% of regular returnees reported such symptoms. Other symptoms identified by more than 40% of evacuees included: difficulty making decisions (49% versus 26% of controls); anxiety (46% versus 27% of controls); numbness of feelings (43% versus 14% of controls); and periods of crying (43% versus 12% of controls). Conclusion: Temporary residence in a foreign culture may be associated with significant psychological symptoms upon return to one's home country. When forced to depart from one's host country under emergency conditions, the likelihood of individuals reporting these symptoms markedly increases.

Journal Article↗
PubMed1978

Prophylactic doxycycline for travelers' diarrhea. Results of a prospective double-blind study of Peace Corps volunteers in Kenya.

We performed a randomized double-blind study to determine the efficacy of doxycycline (100 mg daily) in preventing travelers' diarrhea among 39 Peace Corps volunteers during their first five weeks in Kenya. The volunteers took either doxycycline or placebo for three weeks and were observed for an additional two weeks. Nine of 21 taking placebo and one of 18 taking doxycycline had travelers' diarrhea during the treatment period (P = 0.012). The protection seemed to persist for at least one week after the drug was stopped. Enterotoxigenic Escherichia coli was the only pathogen isolated from the placebo group, but was not detected in persons taking doxycycline. None of these organisms were resistant to doxycycline or tetracycline, whereas resistance to tetracyclines and other antibiotics was common among the nonenterotoxigenic Esch. coli. We conclude that doxycycline effectively prevented most episodes of travelers' dirrhea.

Adult↗
PubMed1979

Prophylactic doxycycline for travelers' diarrhea: results of a prospective double-blind study of Peace Corps volunteers in Morocco.

A second randomized double-blind study to determine the efficacy of doxycycline, 100 mg daily, for the prevention of travelers' diarrhea was carried out among 50 Peace Corps Volunteers during their first 10 wk in Morocco. The volunteers took either doxycycline or placebo for 3 wk, and were observed for an additional 7 wk. Eleven of 24 taking the placebo and 2 of 26 taking doxycycline had travelers' diarrhea during the treatment period (P less than 0.01). One week after cessation of the doxycycline, however, persons in that group developed an increase in frequency of travelers' diarrhea (P less than 0.05) so that by 3 wk after the drug was stopped, there were no differences between groups. Enterotoxigenic E. coli, most of which were sensitive to doxycycline, were the most frequently isolated pathogens during the entire study. This study corroborates the effectiveness of doxycycline prophylaxis for travelers' diarrhea.

Adult↗
PubMed2005

On the medical edge: preparation of expatriates, refugee and disaster relief workers, and Peace Corps volunteers.

Travelers to extreme environments and those who spend long periods of time in settings with limited health care resources need to have more detailed pretravel screening and education than the routine short-term traveler. Expatriates, relief workers, and Peace Corps volunteers need to receive careful pretravel medical, dental, and psychologic screening before deployment. Knowledge of special risks associated with the environment in which they will be stationed is necessary to provide effective education about ways to reduce or eliminate the risk of illness and death. The travel medicine practitioner should also provide detailed, region-specific recommendations regarding emergency care while traveling in remote regions. Information on foreign medical facilities and practitioners should be gathered in advance and regularly updated. Many fee-for-service directories of overseas medical centers are often out of date and do not include emergency contact information. Once deployed, systems should be in place to ensure the traveler's continued personal safety and maintenance of good health. Although these systems are generally beyond the scope of work of travel medicine providers, it is important for the long-term traveler to be aware of the need to be prepared to deal with unexpected medical events. In the event of an overseas emergency, the travel medicine specialist may be called on to facilitate ground or air medical evacuation to the most appropriate medical center, to communicate treatment priorities and pertinent medical details to foreign medical providers, and to facilitate international air evacuation or repatriation if necessary. In each of these cases, the experience for the patient and the travel health professional is dramatically improved by adhering to risk-reduction measures, such as pretravel screening, pretravel health and safety education, and preparing for emergencies in advance.

Altitude Sickness↗
PubMed1993

Schistosomiasis in U.S. Peace Corps volunteers--Malawi, 1992.

Schistosomiasis (i.e., "snail fever" or "bilharzia") is a parasitic infection caused by trematodes (flukes) and is endemic in 74 countries in Africa, South America, the Caribbean, and Asia. U.S. residents who work or travel in these countries may be at risk for schistosomiasis. During 1992, two U.S. Peace Corps volunteers (PCVs) were evacuated from Africa because of Schistosoma hematobium infection of the central nervous system (CNS). Both were exposed to fresh water while vacationing at Cape Maclear, a popular resort area on Lake Malawi (Figure 1), in December 1991. This report summarizes the investigation of these two cases and a follow-up investigation of expatriates residing in Malawi.

Adult↗
PubMed1989

Serologic evidence of Cryptosporidium infection in US volunteers before and during Peace Corps service in Africa.

To obtain prevalence data on Cryptosporidium infection in healthy US adults and to determine how often Cryptosporidium infection occurs after relocation to a situation of potentially great exposure, an enzyme-linked immunosorbent assay for anti-Cryptosporidium IgM or IgG was used to examine serum from 75 US Peace Corps volunteers before overseas service and after up to two years in West Africa. Of the volunteers, 32% had detectable anti-Cryptosporidium IgG initially, suggesting that infection sometime in life is common. After six weeks, one year, or two years overseas, 5% (1/19), 14% (8/56), and 13.6% (3/22), respectively, became newly IgG positive. This implies that the risk of acquiring Cryptosporidium infection and its associated diarrhea is real for travelers and temporary workers in endemic areas. Persistence of IgG and/or IgM response for 12 months or more occurred in some volunteers, although the significance is unclear.

Adult↗