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PubMed2003

Smallpox and smallpox vaccine: ocular and systemic risks and ethical uncertainties.

BACKGROUND: The threat of bioterrorism and use of biological weapons has drawn renewed attention to smallpox, and smallpox vaccinations have been resumed in the United States. Both smallpox and smallpox vaccine carry risk of potentially debilitating or fatal adverse effects. The optometrist must be familiar with the signs and symptoms of smallpox disease and complications of smallpox vaccine for proper management and preservation of vision. OVERVIEW: The literature on the ocular and systemic effects of smallpox and smallpox vaccination is reviewed to provide the practicing optometrist with an overview of the issues involved in case management. Recent guidelines have placed additional ocular-related contraindications to receiving the smallpox vaccine. Risk factors for complications arising from smallpox vaccination are discussed. A discussion of the ethical implications is also presented. CONCLUSIONS: Knowledge of the signs and symptoms of smallpox infection, and of adverse effects caused by smallpox vaccination, can provide the necessary background to help eye care providers make appropriate diagnoses and referrals. Understanding ethical and legal/Constitutional questions surrounding the risk of outbreak and various vaccination containment strategies will help optometrists make informed decisions as health care professionals, patient advocates, and concerned citizens, as well as weigh the risks and benefits of vaccination, if it is offered to them.

Contraindications↗
PubMed2003

[Influenza in global aspect].

Due to a high ability to change, the influenza virus is still a danger for humans. The outbreak of the next influenza pandemic is very probable. The disturbing events that occurred in Hong Kong in 1997 and in the beginning of 2003 confirmed such a possibility. Every year in Poland influenza causes from several hundred thousands to several millions of cases of infections. All over the world the annual number of influenza cases amounts to approximately 100 millions and from 0.5 million to 1 million patients die due to influenza. The most severe threat is connected with post-influenza complications that are the cause of death after influenza infection. The only one effective method of prophylaxis against influenza and its complications is vaccination. Moreover, since 1999 new anti-influenza drugs are available: oseltamivir (Tamiflu) and zanamivir (Relenza). They are effective for treatment or for treatment and prophylaxis of infections caused by influenza virus type A and also type B. The efficacy of these drugs depends on appropriate diagnosis. Due to this fact laboratory diagnostics of respiratory infections is so important and crucial. It should be emphasised that clinical symptoms of infection may indicate influenza even if the disease is caused by other viral or bacterial pathogen.

Antiviral Agents↗
PubMed2003

[Two cases of generalized tetanus presenting with dysphagia as an initial symptom].

We describe two patients with generalized tetanus, a 60-year-old man and a 76-year-old woman, presenting with dysphagia as an initial symptom of the disease. Eighty percent of patients with generalized tetanus manifest dysphagia on admission to a hospital. However, dysphagia is rare as an initial symptom. Both our patients had dysphagia as their initial symptom, followed by neck stiffness and trismus. We made a diagnosis of generalized tetanus based on these neurological findings in the absence of an apparent episode of trauma. After the administration of tetanus immunoglobulin on admission, they recovered without exhibiting generalized convulsion, autonomic storm, or any other serious complications. The vaccination of tetanus toxoid cannot maintain sufficient antibody titers more than ten years. Therefore, elderly people are considered susceptible to tetanus. We suggest that tetanus should be considered in the differential diagnosis of dysphagia particularly in elderly patients. We also suggest that treatment of tetanus should be initiated immediately, because tetanus still has a high mortality rate at present.

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