Category Archives: __6. Medical


 (Survival Manual/ 6. Medical/b) Disease/Tuberculosis)

 The global epidemic of tuberculosis (TB)
It is estimated that approximately 1.7 million people died of tuberculosis in 2009. There were an estimated 9.4 million new cases of tuberculosis in 2009 of which the majority were in Asia and Africa. It is thought that the rates of new tuberculosis infections and deaths per capita have probably been falling globally for several years now. However, the total number of new tuberculosis cases is still slowly rising due to population growth.

One-third of the world’s population is currently infected with TB or tuberculosis.
24 Mar 2012
The World Health Organization says TB remains a leading cause of death from infectious diseases worldwide, second only to HIV/AIDS. Last year alone, 8.4 million people contracted TB and 1.4 million died from the disease.

Control of Tuberculosis (TB)
In the 1950s the US and many European countries introduced immunization programs. As a result the incidence of TB fell dramatically. In the late 1980s there was a resurgence of TB cases in the large cities of the US and in Europe. There have been for a number of reasons for the increase, among them: Homelessness; overcrowding in shelters, prisons and in homes for the poor; increased immigration from countries with a high incidence of TB; drug abuse; HIV/AIDS.

Tuberculosis (TB) is a potentially serious infectious disease that primarily affects your lungs. The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes.

Tuberculosis was once rare in developed countries, but the number of TB cases began increasing in 1985. Part of the increase was caused by the emergence of HIV, the virus that causes AIDS. HIV weakens a person’s immune system so it can’t fight the TB germs.
Many strains of tuberculosis can resist the effects of the drugs most commonly used to treat the disease. People who have active tuberculosis must take several different types of medications together for many months to eradicate the infection and prevent development of antibiotic resistance.

A.  Symptoms
Although your body may harbor the bacteria that cause tuberculosis, your immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between:
•  Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn’t contagious.
•  Active TB. This condition makes you sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later. Most people infected with TB germs never develop active TB.

Signs and symptoms of active TB include:
•  Cough
•  Unexplained weight loss
•  Fatigue
•  Fever
•  Night sweats
•  Chills
•  Loss of appetite

What organs are affected?
Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:
•  Coughing that lasts three or more weeks
•  Coughing up blood
•  Chest pain, or pain with breathing or coughing

But tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.

 When to see a doctor
See your doctor if you have a fever, unexplained weight loss, drenching night sweats or a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause.

Tuberculosis is caused by bacteria that spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.
Although tuberculosis is contagious, it’s not especially easy to catch. You’re much more likely to get tuberculosis from someone you live with or work with than from a stranger. Most people with active TB who’ve had appropriate drug treatment for at least two weeks are no longer contagious.

HIV and TB
Since the 1980s, the number of cases of tuberculosis has increased dramatically because of the spread of HIV, the virus that causes AIDS. Tuberculosis and HIV have a deadly relationship — each drives the progress of the other.
Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are many times more likely to get TB and to progress from latent to active disease than are people who aren’t HIV-positive.

Drug-resistant TB
Another reason tuberculosis remains a major killer is the increase in drug-resistant strains of the bacterium. Ever since the first antibiotics were used to fight tuberculosis 60 years ago, the germ has developed the ability to survive attack, and that ability gets passed on to its descendants. Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well.

Risk factors
Anyone can get tuberculosis, but certain factors can increase your risk of the disease. These factors include:
Weakened immune system
A healthy immune system can often successfully fight TB bacteria, but your body can’t mount an effective defense if your resistance is low. A number of diseases and medications can weaken your immune system, including:
•  Diabetes
•  End-stage kidney disease
•  Cancer treatment, such as chemotherapy
•  Drugs to prevent rejection of transplanted organs
•  Some drugs used to treat rheumatoid arthritis, Crohn’s disease and psoriasis
•  Malnutrition
•  Advanced age
International connections
TB risk is higher for people who live in or travel to countries that have high rates of tuberculosis, such as:
•  Sub-Saharan Africa
•  India
•  China
•  Mexico
•  The islands of Southeast Asia and Micronesia
•  Parts of the former Soviet Union

Poverty and substance abuse
Lack of medical care:
If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States or are homeless, you may lack access to the medical care needed to diagnose and treat TB.
_ Substance abuse: Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to tuberculosis.

Where you work or live
Health care work:
Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand-washing greatly reduce your risk.
_ Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of tuberculosis. That’s because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.
_ Living in a refugee camp or shelter: Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of tuberculosis infection.

Without treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can spread to other parts of the body through your bloodstream. Examples include:
•  Bones. Spinal pain and joint destruction may result from TB that infects your bones. In many cases, the ribs are affected.
•  Brain. Tuberculosis in your brain can cause meningitis, a sometimes fatal swelling of the membranes that cover your brain and spinal cord.
•  Liver or kidneys. Your liver and kidneys help filter waste and impurities from your bloodstream. These functions become impaired if the liver or kidneys are affected by tuberculosis.
•  Heart. Tuberculosis can infect the tissues that surround your heart, causing inflammation and fluid collections that may interfere with your heart’s ability to pump effectively. This condition, called cardiac tamponade, can be fatal.

Tests and diagnosis
During the physical exam, your doctor will check your lymph nodes for swelling and use a stethoscope to listen carefully to the sounds your lungs make when you breathe.
The most commonly used diagnostic tool for tuberculosis is a simple skin test. A small amount of a substance called PPD tuberculin is injected just below the skin of your inside forearm. You should feel only a slight needle prick. Within 48 to 72 hours, a health care professional will check your arm for swelling at the injection site. A hard, raised red bump means you’re likely to have TB infection. The size of the bump determines whether the test results are significant.

 Results can be wrong
The TB skin test isn’t perfect. Sometimes, it suggests that people have TB when they really don’t. It can also indicate that people don’t have TB when they really do. A false-positive test may happen if you’ve been vaccinated with the bacillus Calmette-Guerin (BCG) vaccine. This tuberculosis vaccine is seldom used in the United States but is widely used in countries with high TB infection rates. False-negative results may occur in certain populations — including children, older people and people with AIDS — who sometimes don’t respond to the TB skin test. A false-negative result can also occur in people who’ve recently been infected with TB but their immune system hasn’t had time to react to the bacteria yet.

Blood tests
Blood tests may be used to confirm or rule out latent or active tuberculosis. These tests use sophisticated technology to measure your immune system’s reaction to TB bacteria. These tests may be useful if you’re at high risk of TB infection but have a negative response to the skin test, or if you received the BCG vaccine.

Chest X-ray
If you’ve had a positive skin test, your doctor is likely to order a chest X-ray. This may show white spots in your lungs where your immune system has walled off TB bacteria, or it may reveal changes in your lungs caused by active tuberculosis.

Sputum tests
If your chest X-ray shows signs of tuberculosis, your doctor may take a sample of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria. These bacteria can also be tested to see if they are resistant to the effects of medications commonly used to treat tuberculosis. This helps your doctor choose the medications that are most likely to work.

Treatments and drugs
Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections. With tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and its location in the body.

Most common TB drugs
If you have latent tuberculosis, you may need to take just one type of TB drug. Active tuberculosis, particularly if it’s a drug-resistant strain, will require several drugs at once. The most common medications used to treat tuberculosis include:
•  Isoniazid
•  Rifampin (Rifadin, Rimactane)
•  Ethambutol (Myambutol)
•  Pyrazinamide

Medication side effects
Side effects of TB drugs aren’t common but can be serious when they do occur. All tuberculosis medications can be highly toxic to your liver. When taking these medications, call your doctor immediately if you experience any of the following:
•  Nausea or vomiting
•  Loss of appetite
•  A yellow color to your skin (jaundice)
•  Dark urine
•  A fever that lasts three or more days and has no obvious cause

Completing treatment is essential
After a few weeks, you won’t be contagious and you may start to feel better. It might be tempting to stop taking your TB drugs. But it is crucial that you finish the full course of therapy and take the medications exactly as prescribed by your doctor. Stopping treatment too soon or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat.
To help people stick with their treatment, a program called directly observed therapy (DOT) is sometimes recommended. In this approach, a health care worker administers your medication so that you don’t have to remember to take it on your own.

B.  TB Medical Advisory Board Statement on the Treatment of Active Tuberculosis in Adults
1. Recommended Treatment Regimens
Unless there are contraindications, patients with active tuberculosis should be treated initially with four drugs: isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). Four drugs are recommended because (1) EMB helps to prevent the emergence of RIF-resistant organisms when primary resistance to INH may be present; (2) INH resistance continues to occur in our state, (3) foreign-borne persons from countries with high rates of drug resistance make up a growing number of TB cases in Indiana, and (4) six-month treatment regimens are not possible without the use of PZA.

 2. Drug Administration
The preferred regimen in our state is the ‘Denver Regimen.’ In this regimen, the patient is treated with daily medication for the first two weeks, followed by twice-weekly dosing until a total of 26 weeks of therapy are completed. This regimen must be given using directly observed therapy (DOT), meaning that a public health worker delivers medication to the patient and observes the patient ingest the medication. Completion of treatment is defined by the total number of doses ingested as well as the duration of treatment. Note: twice-weekly therapy is contraindicated for HIV-infected patients with CD4+ lymphocyte counts < 100 cells/µl. An overview of the ‘Denver Regimen’ is provided in Table 2 as “Option 1.” Doses for anti-tuberculosis medications are as follows:

Table 1

Table 2

Daily dosing for 5 rather than 7 days per week is an option for the daily portion of treatment options 1 and 2, but should only be used if dosing 7 days per week is not feasible. DOT must be used with this option.

INH, rifampin and pyrazinamide should be continued for the entire first two months. Ethambutol may be discontinued after the drug susceptibility test shows that the patient’s organism is susceptible to both INH and RIF.

3. Major Adverse Effects
All patients should be counseled to watch for symptoms of hepatotoxicity.  If hepatotoxicity develops (ALT or AST greater than five times the upper limit of normal, elevated bilirubin, or symptoms of hepatotoxicity), all drugs should be discontinued, and ISDH should be consulted immediately. The ISDH TB Medical Advisory Board has published guidelines on the management of hepatotoxicity. Other significant adverse reactions are listed in the table below:

Table 3

Drug Major Adverse Effects
Isoniazid Hepatitis, peripheral neuropathy
Rifampin Drug nteractions, hepatitis
Pyrazinamide Hepatitis, GI upset, hyperuricemia
Ethambutol Optic neuritis

4. Drug Dosages and Toxicity

The ISDH TB Medical Advisory Board does not recommend prescribing anything other than standard therapeutic doses (Table 1). Prior to treatment, measure CBC with platelets, liver enzymes, uric acid, visual acuity, and perform color vision screening. Then, assess monthly for side effects and order laboratory tests as indicated.

[What is hepatotoxicity? Hepatotoxicity is a general term for liver damage.
The signs and symptoms of hepatotoxicity vary depending on how badly the liver is damaged. Symptoms of liver damage include: nausea, vomiting, abdominal, pain, loss of appetite, diarrhea, feeling tired or weak, jaundice (yellowing of the skin and eyes), hepatomegaly (liver enlargement)
Pasted from<>]

5. Use of Drugs Other Than INH, RIF, PZA, or EMB
There are no substitutes for any of the first-line agents. Before rifampin was available, TB patients had to take medication for 18-24 months. The combination of INH and rifampin allowed completion of therapy within 9 months. Routine addition of PZA during the first two months has shortened duration of therapy to 6 months for most cases. Ethambutol is known as a ‘companion drug,’ and has bacteriostatic activity. Its primary purpose is to suppress the further development of resistance in situations where INH resistance is already present at diagnosis. Ethambutol can be discontinued as soon as the organism is known to be susceptible to both INH and RIF.

The drugs are not interchangeable. Second-line agents must be used when patients cannot take first-line drugs because of resistance or intolerance. These second-line agents are substantially less active, and not without risks of toxicity. Patients taking second-line drugs in lieu of both INH and RIF require treatment durations of up to 2 years with frequent monitoring for side effects.

If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won’t transmit tuberculosis to anyone else.

Protect your family and friends
If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick:
Stay home. Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.
Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.
Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.
Wear a mask. Wearing a surgical mask when you’re around other people during the first three weeks of treatment may help lessen the risk of transmission.
Finish your entire course of medication. This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.
Vaccinations. In countries where tuberculosis is more common, infants are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn’t recommended for general use in the United States because it isn’t very effective in adults and it causes a false-positive result on a TB skin test. Researchers are working on developing a more effective TB vaccine.

Coping and support
Undergoing treatment for tuberculosis is a complicated and lengthy process. But the only way to cure the disease is to stick with your treatment. You may find it helpful to have your medication given by a nurse or other health care professional so that you don’t have to remember to take it on your own. In addition, try to maintain your normal activities and hobbies, and stay connected with family and friends.
Keep in mind that your physical health can affect your mental health. Denial, anger and frustration are normal when you must deal with something difficult and unexpected. At times, you may need more tools to deal with these or other emotions. Professionals, such as therapists or behavioral psychologists, can help you develop positive coping strategies.

[End of article]

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(Survival Manual/6. Medical/b) Disease /Syphilis)
 Source information pasted from <>

History of Syphilis
The first well-recorded European outbreak of what is now known as syphilis occurred in 1495 among French troops besieging Naples, Italy. It may have been transmitted to the French via Spanish mercenaries serving King Charles of France in that siege. From this centre, the disease swept across Europe. As Jared Diamond describes it, ” When syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people’s faces, and led to death within a few months.” The disease then was much more lethal then, than it is today. Diamond concludes,” By 1546, the disease had evolved into the disease with the symptoms so well known to us today.” The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease.
Researchers concluded that syphilis was carried from the New World to Europe after Columbus’ voyages.
Many of the crew members who served on this voyage later joined the army of King Charles VIII in his invasion of Italy in 1495, resulting in the spreading of the disease across Europe and as many as five million deaths.

Syphilis is caused by a bacteria called Treponema pallidum. The bacteria like the warm moist linings of the genital passages, the rectum and mouth, but dies quickly outside the body. Syphilis has an incubation period of between 9 days and 3 months. Syphilis is almost always a result of unprotected sex with an infected person.

Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on your genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.
After the initial infection, the syphilis bacteria can lie dormant in your body for decades before becoming active again. Early syphilis can be cured, sometimes with a single injection of penicillin. Without treatment, syphilis can severely damage your heart, brain or other organs, and can be life-threatening.
Syphilis rates in the United States have been rising since 2000, particularly among men who have sex with men. The genital sores associated with syphilis can make it easier to become infected with HIV, the virus that causes AIDS.

Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don’t always occur in the same order. You may be infected with syphilis and not notice any symptoms for years.
Primary syphilis
[Photo at left, Primary Syphilis]
The first sign of syphilis is a small sore, called a chancre (SHANG-kur). The sore appears at the spot where the bacteria entered your body. While most people infected with syphilis develop only one chancre, some people develop several of them. The chancre usually develops about three weeks after exposure. Many people who have syphilis don’t notice the chancre because it’s usually painless and it may be hidden within the vagina or rectum. The chancre will heal on its own within six weeks.

Secondary syphilis
[Photo at right, Secondary Syphilis]
Within a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body — even the palms of your hands and the soles of your feet. This rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area. Some people also experience muscle aches, fever, sore throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

Latent syphilis
If you aren’t treated for syphilis, the disease moves from the secondary to the latent (hidden) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage.
Tertiary or late syphilis
About 15 to 30 percent of people infected with syphilis who don’t get treatment will develop complications known as tertiary, or late, syphilis. In the late stages, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection.
Congenital syphilis
Babies born to women who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. Later symptoms may include deafness, teeth deformities and saddle nose — where the bridge of the nose collapses. 

When to see a doctor
Call your doctor if you or your child experiences any unusual discharge, sore or rash — particularly if it occurs in the groin area.

The cause of syphilis is a bacterium called Treponema pallidum. The most common route of transmission is through contact with an infected person’s sore during sexual activity. The bacteria enter your body through minor cuts or abrasions in your skin or mucous membranes. Syphilis is contagious during its primary and secondary stages, and sometimes in the early latent period.
Less commonly, syphilis may spread through direct unprotected close contact with an active lesion (such as during kissing) or through an infected mother to her baby during pregnancy or childbirth (congenital syphilis).
Syphilis can’t be spread by using the same toilet, bathtub, clothing or eating utensils, or from doorknobs, swimming pools or hot tubs.
Even if you’ve been cured of syphilis, you can become re-infected if you have contact with someone’s syphilis sore.

Risk factors
You face an increased risk of acquiring syphilis if you:
•  Engage in unprotected sex
•  Have sex with multiple partners
•  Are a man who has sex with men
•  Are infected with HIV, the virus that causes AIDS

Without treatment, syphilis can lead to damage throughout your body. Syphilis also increases the risk of HIV infection and, for women, can cause problems during pregnancy. Treatment can help prevent future damage but can’t repair or reverse damage that’s already occurred.
•  Small bumps or tumors
Called gummas, these bumps can develop on your skin, bones, liver or any other organ in the late stage of syphilis. Gummas usually disappear after treatment with antibiotics.
•  Neurological problems
Syphilis can cause a number of problems with your nervous system, including: Stroke, Meningitis, Deafness, Visual problems,,Dementia
•  Cardiovascular problems
These may include bulging (aneurysm) and inflammation of the aorta — your body’s major artery — and of other blood vessels. Syphilis may also damage heart valves.
•  HIV infection
Adults with sexually transmitted syphilis or other genital ulcers have an estimated two- to fivefold increased risk of contracting HIV. A syphilis sore can bleed easily, providing an easy way for HIV to enter your bloodstream during sexual activity.
•  Pregnancy and childbirth complications
If you’re pregnant, you may pass syphilis to your unborn baby. Congenital syphilis greatly increases the risk of miscarriage, stillbirth or your newborn’s death within a few days after birth.

Tests and diagnosis
Syphilis can be diagnosed by testing samples of:
•  Blood. Blood tests can confirm the presence of antibodies that the body produces to fight infection. The antibodies to the bacteria that cause syphilis remain in your body for years, so the test can be used to determine a current or past infection.
•  Fluid from sores. Your doctor may scrape a small sample of cells from a sore to be analyzed by microscope in a lab. This test can be done only during primary or secondary syphilis, when sores are present. The scraping can reveal the presence of bacteria that cause syphilis.
•  Cerebral spinal fluid. If it’s suspected that you have nervous system complications of syphilis, your doctor may also suggest collecting a sample of cerebrospinal fluid through a procedure called a lumbar puncture (spinal tap).

Treatments and drugs
When diagnosed and treated in its early stages, syphilis is easy to cure. The preferred treatment at all stages is penicillin, an antibiotic medication that can kill the organism that causes syphilis. If you’re allergic to penicillin, your doctor will suggest another antibiotic.
A single injection of penicillin can stop the disease from progressing if you’ve been infected for less than a year. If you’ve had syphilis for longer than a year, you may need additional doses.
Penicillin is the only recommended treatment for pregnant women with syphilis. Women who are allergic to penicillin can undergo a desensitization process that may allow them to take penicillin. Even if you’re treated for syphilis during your pregnancy, your newborn child should also receive antibiotic treatment.
* The first day you receive treatment you may experience what’s known as the Jarisch-Herxheimer reaction. Signs and symptoms include fever, chills, nausea, achy pain and headache. This reaction usually doesn’t last more than one day.

Treatment follow-up
•  After you’re treated for syphilis, your doctor will ask you to:
•  Have periodic blood tests and exams to make sure you’re responding to the usual dosage of penicillin.
•  Avoid sexual contact until the treatment is completed and blood tests indicate the infection has been cured.
•  Notify your sex partners so that they can be tested and get treatment if necessary.
•  Be tested for HIV infection.

 * The main of therapy for syphilis is antibiotic treatment, usually penicillin. Doxycycline may be used if you have a penicillin allergy.

Penicillin is given either intramuscularly or intravenously depending on the stage of syphilis. Follow up blood tests (RPR) are usually taken to track the efficacy of the treatment.

If the appropriate antibiotic treatment is given for syphilis in its primary and secondary stages it completely cures this disease. In the latent and tertiary or final stage of syphilis treatment can still eradicate and stop further damage occurring. The damage that has already happen has to be treated but is often difficult or impossible to repair.

Tetracycline dosages for syphilis:
Usual Adult Dose for Syphilis – Early (less than 2 years duration)
Tetracycline should be used only if penicillins are contraindicated.
Doxycycline 200 mg orally daily for 20 days or tetracycline HCl 500 mg orally 6 hourly for 20 days

Usual Adult Dose for Syphilis – Latent
500 mg orally every 6 hours for 28 days; alternatively, 30 to 40 g in divided doses over a period of 10 to 15 days has been recommended.
Tetracycline should be used only if penicillins are contraindicated.

Usual Adult Dose for Tertiary Syphilis
doxycycline 200 mg orally daily for 30 days or tetracycline HCl 500 mg orally 6 hourly for 30 days

To help prevent the spread of syphilis, follow these suggestions:
•  Abstain or be monogamous. The only certain way to avoid syphilis is to forgo having sex. The next-best option is to have mutually monogamous sex with one partner who is uninfected.
•  Use a latex condom. Condoms can reduce your risk of contracting syphilis, but only if the condom covers the syphilis sores.
•  Avoid recreational drugs. Excessive use of alcohol or other drugs can cloud your judgment and lead to unsafe sexual practices.

[End of post]

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Eye injuries

(Survival Manual/6. Medical/c) General Clinic/Eye injuries)

 A.  First Aid
Take prompt action and follow the steps below if you or someone else has an eye-related injury.
Pasted from <>

Small object on the eye or eyelid
The eye will often clear itself of tiny objects, like eyelashes and sand, through blinking and tearing. If not, take these steps:
1.  Tell the person not to rub the eye. Wash your hands before examining it.
2.  Examine the eye in a well-lighted area. To find the object, have the person look up and down, then side to side.
3.  If you can’t find the object, grasp the lower eyelid and gently pull down on it to look under the lower eyelid. To look under the upper lid, you can place a cotton-tipped swab on the outside of the upper lid and gently flip the lid over the cotton swab.
4.  If the object is on an eyelid, try to gently flush it out with water. If that does not work, try touching a second cotton-tipped swab to the object to remove it.
5.  If the object is on the eye, try gently rinsing the eye with water. It may help to use an eye dropper positioned above the outer corner of the eye. DO NOT touch the eye itself with the cotton swab.
A scratchy feeling or other minor discomfort may continue after removing eyelashes and other tiny objects. This will go away within a day or two. If the person continues to have discomfort or blurred vision, get medical help.

Object stuck or embedded in the eye
1.  Leave the object in place. DO NOT try to remove the object. DO NOT touch it or apply any pressure to it.
2.  Calm and reassure the person.
3.  Wash your hands.
4.  Bandage both eyes. If the object is large, place a paper cup or cone over the injured eye and tape it in place. Cover the uninjured eye with gauze or a clean cloth. If the object is small, cover both eyes with a clean cloth or sterile dressing. Even if only one eye is affected, covering both eyes will help prevent eye movement.
5.  Get medical help immediately.

Chemicals in the eye
1.  Flush with cool tap water immediately. Turn the person’s head so the injured eye is down and to the side. Holding the eyelid open, allow running water from the faucet to flush the eye for 15 minutes.
2.  If both eyes are affected, or if the chemicals are also on other parts of the body, have the victim take a shower.
3.  If the person is wearing contact lenses and the lenses did not flush out from the running water, have the person try to remove the contacts AFTER the flushing procedure.
4.  Continue to flush the eye with clean water or saline while seeking urgent medical attention.
5.  After following the above instructions, seek medical help immediately.

Eye cuts, scratches, or blows
1.  If the eyeball has been injured, get medical help immediately.
2.  Gently apply cold compresses to reduce swelling and help stop any bleeding. DO NOT apply pressure to control bleeding.
3.  If blood is pooling in the eye, cover both of the person’s eyes with a clean cloth or sterile dressing, and get medical help.

Eye lid cuts
1.  Carefully wash the eye. Apply a thick layer of bacitracin, mupirocin, or other antibacterial ointment on the eyelid. Place a patch over the eye. Seek medical help immediately.
2.  If the cut is bleeding, apply gentle pressure with a clean, dry cloth until the bleeding subsides.
3.  Rinse with water, cover with a clean dressing, and place a cold compress on the dressing to reduce pain and swelling.

•  DO NOT press or rub an injured eye.
•  DO NOT remove contact lenses unless rapid swelling is occurring, there is a chemical injury and the contacts did not come out with the water flush, or you cannot get prompt medical help.
•  DO NOT attempt to remove a foreign body that appears to be embedded in any part of the eye. Get medical help immediately.
•  DO NOT use cotton swabs, tweezers, or anything else on the eye itself. Cotton swabs should only be used on the eyelid.
•  DO NOT attempt to remove an embedded object

B.  Foreign Body, Eye Treatment

Self-Care at Home
You should be able to care for minor debris in your eye at home. If you have trouble removing something in your eye or if a larger or sharper object is involved, you should seek medical attention. If you are wearing a contact lens, it should be removed prior to trying to remove the foreign body. Do not put the contact lens back into your eye until your eye is completely healed.
For minor foreign bodies, such as an eyelash, home care should be adequate.
1.  Begin by rinsing your eye with a saline solution (the same solution used to rinse contact lenses). Tap water or distilled water may be used if no saline solution is available. Water will effectively flush out your eye, but the chlorine in most tap water can cause varying levels of irritation. How you wash out your eye is less important than getting it washed out with great amounts of water.
…..•  A water fountain makes a great eye wash. Just lean over the fountain, turn on the water, and keep your eye open.
…..•  At a sink, stand over the sink, cup your hands, and put your face into the running water.
…..•  Hold a glass of water to your eye and tip your head back. Do this many times.
…..•  If you are near a shower, get in and put your eye under the running water.
…..•  If you are working outside, a garden hose running at a very modest flow will work.
…..•  If washing out your eye is not successful, the object can usually be removed with the tip of a tissue or a cotton swab.
2.  Pull back the eyelid by pulling down on the bottom edge of the lower lid or by pulling up on the upper edge of the upper lid.
3.  Look up when evaluating for a foreign body under the lower lid.
4..  Look down when evaluating for a foreign body under the upper lid. You will often need someone to help you in this case.
5.  Be very careful not to scrape the tissue or the cotton swab across your cornea, the clear dome over the iris.
6.  For larger foreign bodies or metal pieces, you should seek medical care, even if you are able to safely remove them at home.
…..•  If the foreign body is easily accessible and has not penetrated your eyeball, you may be able to remove it carefully with a cotton swab or a tissue.
…..•  If you have any question about penetration of the eye, do not remove the object without medical assistance.
…..•  If you cannot remove the object or if you continue to have the sensation that something is in your eye even after the debris is removed, you should seek medical care.
7.  After the foreign body is removed, your eye may be red and tearing.
8.  You may protect your eye by cutting the top part off of a Styrofoam or paper cup and placing the cup over your eye. If you place a cup over your eye, do not put any pressure on the injured eye, because it could cause additional injury to your eye.
…..•  This cup can be taped in place and will form a cover over your eye.
…..•  It is very important not to rub your eye or to apply any pressure to your eye. If you have punched a hole in your eye (called a ruptured globe or eyeball), you can do significant damage by pressing or rubbing your eye. This is especially true with small children who will rub their eyes to try to remove the debris.

Medical Treatment
•  For scratches on your cornea (called corneal abrasions), the usual treatment is an antibiotic ointment and/or antibiotic eye drops and pain medicine. If the abrasion is large (greater than 50% of the corneal surface), then it may also be treated with a patch.
•  Any noted damage to the iris, the lens, or the retina requires immediate evaluation by an ophthalmologist and may or may not require surgery.
•  A ruptured eyeball requires surgery by an ophthalmologist.
•  If no other injury is noted, hyphema (blood in between the cornea and the iris) requires close follow-up care with an ophthalmologist.

C.  Corneal Abrasion
Scenario: A branch brushes your face and there’s sharp pain in your eye. It hurts to blink.
[Image at right: Description: A corneal abrasion is a scratch over the clear part of the eye. It causes an irritable   or sharp “foreign body” sensation in the eye. Often it feels like   something scratchy is stuck under the upper eyelid, because the eyelid rubs over the scratch as it blinks. With a very minor corneal abrasion, the eye may simply feel “dry.” The abrasion usually heals quickly, often overnight.
Except for a   little redness, the eye with a corneal abrasion often looks normal. Painful eyes should be checked, regardless of how “normal” they look.]

A large abrasion may take a long time to heal, and can cause an inflammatory reaction within the eyeball. Sometimes a sharp object cuts into the deep tissue of the cornea. This can permanently change your vision. Debris in the scratch, such as shreds of tree bark, can lead to infection and ulceration of the cornea. There may still be a scratchy particle stuck under your upper eyelid, and it will continue to damage your cornea. So don’t take chances with your eyeballs. If the scratchy sensation hasn’t gone away after you get back to your car (around an hour), head for the ER.

See the doctor if:
– the scratchy sensation doesn’t go away promptly
– vision is blurry
– the eye is sensitive to light
– there is deep pain
– you develop mucous in the eye

Immediate care:
Don’t rub the eye. It’s best to rest a minute, letting the eye water, with the eyelids as relaxed as possible. If the symptoms don’t go away, turn around and head back.

Foreign Body
You get a chunk of something in your eye. The eye begins to sting and water.
[Image at left: Description: Foreign material in the eye can scratch the cornea. There may be an irritable, stinging, or sharp “foreign body” sensation in the eye.  Sharp bits of sand or wood can rapidly dig themselves into the tissue of the   cornea or underside of the upper lid.
Foreign body under the lower eyelid margin. Particles are   easier to remove here, but are actually more common under the upper eyelid.]

The foreign matter can damage the cornea — the part of the eye you see through. Debris in the eye can lead to infection and ulceration of the cornea. A scratchy particle under your upper eyelid will continue to scratch up your cornea. So don’t take chances with your eyeballs. If the scratchy sensation hasn’t gone away after you get back to your car (around an hour), head for the ER.

See the doctor if:
– the scratchy sensation doesn’t go away quickly
– vision is blurry
– the eye is sensitive to light
– there is deep pain
– you develop mucous in the eye

Immediate care:
Don’t rub the eye. (Rubbing the eye can grind loose sharp particles into the cornea!) It’s best to rest a minute, letting the eye water, with the eyelids as relaxed as possible. If the symptoms don’t go away, turn around and head back.

If you’re far out in the woods and the eye is extremely watery and painful, you can try to dislodge the particle. Usually it will be under the upper eyelid. Assuming your squirt bottle has clean water in it, flush the eye. Turn your head sideways, so the squirt bottle can aim slightly downward as it faces the eye. With the eyelids gently closed, put your index finger and thumb together and press against the eye, as though you were going to take hold of your eyelids.

[ Image at left: While holding gentle pressure, spread the thumb and finger to pull the lids aside. Now squirt for several seconds. If the scratching continues, grasp the upper eyelashes and pull the eyelid straight forward away from the eye. Squirt up into the slit between the eyelid and eyeball. Then rest a minute to see if   the symptoms subside.     Position of  the squirt bottle to flush debris from the eye. The victim is lying down, and   the bottle is aiming towards the gap between the retracted upper eyelid and   eyeball. The rescuer is pulling up on the brow and upper eyelid, while the   victim looks towards the feet.]

If you can feel exactly where the particle is, you could try to rub it off. Wash your hands thoroughly. Now pull the eyelid forward, with your thumb on the underside. As the eyelid comes forward, put a free finger (middle finger) against the cleft between the eyelid and eyebrow, then rotate the pad of the thumb so slips under the edge of the eyelid. Run it sideways along the underside of the eyelid where you feel the particle. Be careful about this — not every doctor would think it’s a good idea — because you’re getting germs from your finger into the eye. And (unless you succeed in removing a particle) the more you mess with your eye, the worse it will feel.

If the foreign body sensation persists, leave the eye alone. There may be an abrasion of the cornea, which feels exactly like something scratchy is still in the eye. Go have the eye

D.  UV Eye damage
Ultraviolet radiation harms more than just your skin. Too much unfiltered sunlight can harm your eyes by damaging the lens and even the retina.
1.  Cataracts
•  Overexposure to the sun’s UV rays can damage the lens of the eye and increase your risk of developing cataracts.
•  Cataracts occur when the lens of the eye becomes cloudy, rendering all images blurry and out of focus.
•  Cataracts are the leading cause of blindness.
** See also the 4dtraveler post: (Survival Manual/6. Medical/c) General Clinic/Eyeglass repair & emergency glasses) which discusses how to make emergency glasses for several survival scenerios.

2.  Retinal damage – Macular Degeneration
•  Prolonged exposure to UV radiation can damage the retina (the sensitive lining of the eye used for sight).
•  Macular degeneration occurs when the macula (an area in the retina) is damaged, thus causing loss of central vision.
•  While studies have yet to prove what causes macular degeneration, it is possible that overexposure to the sun’s UV light may be a contributing factor.
•  Most forms of retinal damage are irreversible.

3. Snow Blindness
Exposure  to  reflected sunlight from  snow, ice, or water, even on grey overcast days, can result in  sunburn of the tissues comprising the  surface  of  the   eye, as well as  the retina, producing snow blindness. Symptoms. Symptoms  may not be apparent until  up  to 12 hours after exposure. The   eyes initially  feel  irritated and  dry; then, as  time passes, eyes feel as though they are full of  sand. Blinking and moving the eyes may be extremely painful.  The eyelids are usuallyred, swollen, and difficult  to open.

Remedial Action: A  mild case will heal spontaneously in a few days, but you can  obtain some relief by applying cold compresses and a lightproof  bandage.  An ophthalmic  ointment can be  applied hourly to relieve pain and lessen the inflammatory reaction.

Prevention: Snow blindness can be prevented by constant  use  of   sunglasses or a  tinted helmet  visor.  If  the  glasses or helmet are lost, an emergency  set of goggles can be made from a  thin piece of leather, cardboard, or other lightproof material. Cut the material the width of the face with  horizontal  slits over the eyes. These  improvised  goggles can be held in place with string or cord from the parachute shroud lines  attached to the  sides and tied  at  the back of the head.

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Personal Protective Equipment

(Survival Manual / 6. Medical / c) General Clinic / Personal Protective Equipment)

Personal Protection Equipment (PPE) by hazard
Biological hazard protection
Protective equipment for biological hazards includes masks worn by medical personnel (especially in surgery to avoid infecting the patient but also to avoid exposing the personnel to infection from the patient.) Gloves, frequently changed, are used to prevent infection but also transfer between patients.

*** PPE should always be regarded as a ‘last resort’ to protect against risks to safety and health.

Ballistic personal protective equipment (or armor) is used in combat by soldiers and in lesser conflicts by law enforcement.

Blunt Trauma
Law enforcement and Corrections officers wear Blunt Trauma PPE for crowd management, civil disturbances, cell extractions, riot control, violent disturbances, and other emergency response operations.

Fire proximity suit

Protective clothing is also worn for contact sports, such as ice hockey and American football. Baseball players wear sliding shorts and a cup under their pants. See baseball clothing and equipment, cuirass, goalie mask, jockstrap. Law in many countries requires protective headgear and eyewear for riding a motorcycle.

Air-Purifying Respirator
Respirators such as “gas masks” and particle respirators filter chemicals and gases or airborne particles. A second type of respirator protects users by providing clean, respirable air from another source. This type includes airline respirators and self-contained breathing apparatus (SCBA). In work environments, respirators are used when adequate ventilation is not available or other engineering control systems are not feasible.

Biological & Chemical Hazard

1.  Principles for using biological (and chemical ) Personal Protective Equipment (PPE)
In all cases, the following principles apply:
PPE reduces but does not completely eliminate the possibility of  infection (contamination).
•  PPE is only effective if used correctly and at all times where contact may occur.
•  Any contact between contaminated (used) PPE and surfaces / clothing / people outside the isolation area must be avoided.
•  Used PPE must be sealed in appropriate disposal bags and sterilized or decontaminated. If staff temporarily leave the isolation area, a complete change of PPE and hand washing required.
•  The use of PPE does not replace basic hygiene measures such as hand-washing, washing is still essential to prevent transmission.
•  Exposure to the infected patientt should be kept to an absolute minimum necessary for the level of care required.

Who should use Personal Protective Equipment?
•  All those who are handling infected or suspected to be infected poultry and poultry products. These include cullers and animal husbandry/veterinary staff.
•  All doctors, nurses and health care workers who provide direct patient care to avian influenza cases (keep to minimum necessary for patients’ condition);
•  All support staff including medical aides, X-ray technicians, cleaners, transport staff, laundry staff (keep staff to the minimum necessary, designate avian influenza laundry staff, etc.);
•  All laboratory staff who handle patient specimens from suspect cases (keep to the minimum the staff necessary for laboratory procedures);
•  Family members who care for avian influenza patients (visits should be avoided where possible); The patient(s) should wear a mask (N95 preferable) when other people are in the isolation area. Contacts and international travelers during home isolation/quarantine must wear a mask (N95 preferable).

Personal Protective Equipment (lowest level threats)
The items included are:
•  Masks (N-95; N/P/R-100, If not available N80 or surgical masks as last resort)
•  Gloves
•  Gloves and aprons
•  Hair Covers
•  Eye protective ware (goggle)
•  Boots or shoe covers

2.  Basic Sanitation techniques (If you need to wear PPE then you should be following the steps listed below):
Hand washing
•  It is the single most important and effective component for preventing the transmission of infection and removal of contamination.
•  Running water and soap with friction should be ideally used for 15 to 20 seconds.
•  It is important to dry hands after washing.
•  A 70% alcohol-based hand rub solution after hand washing can be used.

Hand washing  should be done:
•  After removing gloves
•  Before and after patient contact or contact with potentially infected material
•  After contact with blood and body fluids
•  After taking samples
•  After taking blood-pressure or vital signs from patient
•  After using bath room
•  After blowing/wiping nose
•  Before eating and preparing food.
•  When leaving the isolation unit.

Waste disposal
The practices as approved by the Hospital Infection Control Committee or hospital authorities must be followed. Some of these are:
•  Waste should be collected in designated color coded plastic bags for sterilization and disposal.
•  Double bag system for transport should be used.

Cleaning and disinfection of hospital environment and equipment
The practices as approved by the Hospital Infection Control Committee or hospital authorities must be followed. Some of these are:
•  Cleaning staff should wear full PPE
•  Cleaning should be done thoroughly to be followed by disinfection
•  Items and areas requiring cleaning and disinfection are:
•  Bedside table, bed stand, accessible areas of bed and floors (Use 0.1% sodium hypochlorite as disinfectant)
•  If any surface is grossly contaminated, pour 1% sodium hypochlorite first and leave it for 10-15 minutes to be followed by cleaning and usual disinfection (0.1% sod. hypochlorite).
•  Basins and bedpans should be cleaned and disinfected before being used for another patient.
•  Spray disinfectant is prohibited.

PPE reduces but does not completely eliminate the possibility of infection or contamination.
•  PPE is only effective if used correctly and at all times where contact may occur.
•  Any contact between contaminated (used) PPE and surfaces / clothing / people outside the isolation area must be avoided.
•  Used PPE must be sealed in appropriate disposal bags and sterilized or decontaminated. If staff temporarily leave the isolation area, a complete change of PPE and hand washing required.
•  The use of PPE does not replace basic hygiene measures such as hand-washing, washing is still essential to prevent transmission.
•  Exposure to the infected patient should be kept to an absolute minimum necessary for the level of care required.

3.  Discussion of general protective clothing
•  Surgical mask: Surgical masks are designed to protect the sterile field of the patient from contaminants generated by the wearer. Although surgical masks filter out large-size particulates, they offer no respiratory protection against chemical vapors. These masks are effective against respiratory droplets and are used when treating infected patients who require “droplet precautions” such as pneumonic plague.
•  Protective Clothing: Most protective clothing is aimed at protection against chemicals and CWAs because intact skin provides an effective barrier against all BWAs except the trichothecene mycotoxins.
• Chemical-protective clothing: Chemical-protective clothing (CPC) consists of multilayered garments made out of various materials that protect against various hazards. Because no single material can protect against all chemicals, multiple layers of various materials are usually used to increase the degree of protection. Aluminum-lined, vapor-impermeable garments increase the level of protection. Protection is maximized by total encapsulation. An assortment of types of chemical-protective hats, hoods, gloves, and boot covers complements the garments.
•  Barrier gown and latex gloves: Barrier gowns are waterproof and protect against exposure to biological materials, including body fluids, but do not provide adequate skin or mucous membrane protection against chemicals. Latex gloves also protect wearers from biological materials but are inadequate against most chemicals.
Barrier gowns, latex gloves, and leg and/or shoe covers together comprise “contact precautions” and are useful for agents such as viral hemorrhagic fevers.
•  Chemical-protective gloves: Chemical-protective glove sets consist of a protective outer glove made out of butyl rubber and an inner glove for absorption of perspiration. Glove sets are available in 4 sizes and 3 thicknesses (7, 14, and 25 mL) with varying tactile sensitivities. Gloves may be worn for 12 hours in the contaminated environment. After visual inspection, gloves may be reused for another 12 hours. After use, gloves may be decontaminated and reused.
•  Chemical-protective footwear covers: Chemical-protective footwear covers (CPFC) are single-sized butyl rubber footwear covers that protect combat boots against all agents. Vinyl over boots are also available.

4.  Biohazard Levels
The United States’ Centers for Disease Control and Prevention (CDC) categorizes various diseases in levels of biohazard, Level 1 being minimum risk and Level 4 being extreme risk. Laboratories and other facilities are categorized as BSL (BioSafety Level) 1-4 (Pathogen or Protection Level) as follow:

Biohazard Level 1:
Bacteria and viruses including Bacillus subtilis, canine hepatitis, Escherichia coli, varicella (chicken pox), as well as some cell cultures and non-infectious bacteria.
•  At this level precautions against the biohazardous materials in question are minimal, most likely involving gloves and some sort of facial protection.
•  Usually, contaminated materials are left in open (but separately indicated) waste receptacles. Decontamination procedures for this level are similar in most respects to modern precautions against everyday viruses (i.e.: washing one’s hands with anti-bacterial soap, washing all exposed surfaces of the lab with disinfectants, etc.). In a lab environment, all materials used for cell and/or bacteria cultures are decontaminated via autoclave.

Biohazard Level 2:
•  Bacteria and viruses that cause only mild disease to humans, or are difficult to contract via aerosol in a lab setting, such as hepatitis A, B, and C, influenza A, Lyme disease, salmonella, mumps, measles, scrapie, dengue fever, and HIV.
•   “Routine diagnostic work with clinical specimens can be done safely at Biosafety Level 2, using Biosafety Level 2 practices and procedures. Research work (including co-cultivation, virus replication studies, or manipulations involving concentrated virus) can be done in a BSL-2 (P2) facility, using BSL-3 practices and procedures.

Biohazard Level 3:
•  Bacteria and viruses that can cause severe to fatal disease in humans, but for which vaccines or other treatments exist, such as anthrax, West Nile virus, Venezuelan equine encephalitis, SARS virus, variola virus (smallpox), tuberculosis, typhus, Rift Valley fever, Rocky Mountain spotted fever, yellow fever, and malaria. Among parasites Plasmodium falciparum, which causes Malaria, and Trypanosoma cruzi, which causes trypanosomiasis, also come under this level.

Biohazard Level 4:
•  Viruses and bacteria that cause severe to fatal disease in humans, and for which vaccines or other treatments are not available, such as Bolivian and Argentine hemorrhagic fevers, Dengue hemorrhagic fever, Marburg virus, Ebola virus, hantaviruses, Lassa fever, Crimean-Congo hemorrhagic fever, and other hemorrhagic diseases.
•  When dealing with biological hazards at this level the use of a Hazmat suit and a self-contained oxygen supply is mandatory.
•  The entrance and exit of a Level Four biolab will contain multiple showers, a vacuum room, an ultraviolet light room, autonomous detection system, and other safety precautions designed to destroy all traces of the biohazard. Multiple airlocks are employed and are electronically secured to prevent both doors opening at the same time. All air and water service going to and coming from a Biosafety Level 4 lab will undergo similar decontamination procedures to eliminate the possibility of an accidental release.

5. Employer Guidelines for appropriate PPE (Personal Protective Equipment)
<>Personal protective equipment is divided into four categories based on the degree of protection afforded.
PPE Level A 
(To be selected when the greatest level of skin, respiratory, and eye protection is required.  )
Definition: The hazardous substance has been   identified or is an unknown, and requires the highest level of protection for   skin, eyes, and the respiratory system based on either the measured (or   potential for) high concentration of atmospheric vapors, gases, or   particulates; or the site operations and work functions involve a high   potential for splash, immersion, or exposure to unexpected vapors, gases, or   particulates of materials that are harmful to skin or capable of being   absorbed through the skin.
—Substances with a high degree of hazard to   the skin are known or suspected to be present, and skin contact is possible;   or
—Operations must be conducted in confined,   poorly ventilated areas, and the absence of conditions requiring Level A have   not yet been determined.
—When an event is uncontrolled or   information is unknown about: the type of airborne agent, the dissemination   method, if dissemination is still occurring or it has stopped.
Components: A fully encapsulated, liquid and vapor   protective ensemble selected when the highest level of skin, reparatory and   eye protection is required.
Positive pressure, full face-piece   self-contained breathing apparatus (SCBA), or positive pressure supplied air   respirator with escape SCBA, approved by the National Institute for Occupational Safety and Health (NIOSH).  Closed-circuit Rebreather/ open   circuit SCBA.
Totally-encapsulating chemical-protective suit.
—Gloves, outer, chemical-resistant.
—Gloves, inner, chemical-resistant.
—Boots, chemical-resistant, steel toe and   shank, outer booties.
—Disposable protective suit, gloves and   boots (depending on suit construction, may be worn over totally-encapsulating   suit).
*—Long underwear.
*—Hard hat (under suit), personal cooling   system, chemical resistant tape.
**Optional/as needed.
PPE Level B  (The highest level of respiratory protection is necessary but a lesser level of skin protection is needed.) 
The type and atmospheric concentration of   substances have been identified and require a high level of respiratory   protection, but less skin protection.
—The atmosphere contains less than 19.5   percent oxygen; or
—The presence of incompletely identified   vapors or gases is indicated by a direct-reading organic vapor detection   instrument, but vapors and gases are not suspected of containing high levels   of chemicals harmful to skin or capable of being absorbed through the skin.
—A liquid-splash-resistant ensemble used   with the highest level of reparatory protection.
—The suspected aerosol is not longer being   generated, but other conditions may present a splash hazard.
Components: A liquid-splash-resistant ensemble used   with the highest level of reparatory protection.
Positive pressure, full-face piece   self-contained breathing apparatus (SCBA), or positive pressure supplied air   respirator with escape SCBA (NIOSH approved).
Hooded chemical-resistant clothing   (overalls and long-sleeved jacket; coveralls; one or two-piece   chemical-splash suit; disposable chemical-resistant overalls).
—Gloves, outer, chemical-resistant.
—Gloves, inner, chemical-resistant.
—Boots, outer, chemical-resistant steel toe   and shank.
—Boot-covers, outer, chemical-resistant.
—Hard hat, personal cooling system,   chemical resistant tape.
*—Face shield.
**Optional/as needed.
PPE Level C  (The concentration and type of airborne substance is known and the criteria for using air purifying respirators are met)
Definition: The atmospheric contaminants, liquid   splashes, or other direct contact may adversely affect or be absorbed through   any exposed skin.
—The types of air contaminants have been   identified, concentrations measured, and an air-purifying respirator is   available that can remove the contaminants; and
—All criteria for the use of air-purifying   respirators are met.
Components: A liquid-splash-resistant ensemble, with   the same level of skin protection as Level B, used when the concentration(s)   and type(s) of airborne substances(s) are known and the criteria for using   air-purifying respirators are met.
Full-face or half-mask, air purifying respirators (NIOSH   approved).
Hooded chemical-resistant clothing   (overalls; two-piece chemical-splash suit; disposable chemical-resistant   overalls).
Gloves, outer, chemical-resistant.
Gloves, inner, chemical-resistant.
—Boots (outer), chemical-resistant steel   toe and shank.
—Boot-covers, outer, chemical-resistant.
*—Hard hat, face shield, personal cooling   system.
*—Escape mask.
*—Face shield.
**Optional/as needed.
PPE Level D
Definition: Selected when the atmosphere contains no   known hazards.   Work   functions preclude splashes, immersion, or the potential for unexpected   inhalation of or contact with hazardous levels of any chemicals.   This level has no respiratory protection   and minimal skin protection. Level D protection is the normal work clothes   and non- respiratory PPE. Work shirt, safety boots and safety glasses are all   examples of PPE used at this level. Dust masks used on a voluntary basis   would still fall under Level D protection. In   hospitals, Level D consists of surgical gown, mask, and latex gloves   (universal precautions). Level D PPE provides no respiratory protection and   only minimal skin protection.
Level   D Modified
– This Level is the same as Level D for respiratory protection,   but the skin protection is increased to that of Level C. Components: A work uniform affording minimal   protection: used for nuisance contamination only.
—Boots/shoes, chemical-resistant steel toe   and shank.
—Boots, outer, chemical-resistant   (disposable).
*—Safety glasses or chemical splash   goggles.
*—Hard hat.
*—Escape mask.
*—Face shield.
**Optional/as needed.
6.  Types of Respirators
Surgical masks
Surgical masks are not respirators and are not certified as such; they do not protect the user adequately from exposure. The primary purpose of a surgical facemask is to help prevent biological particles from being expelled by the wearer into the environment. Persons suspected of having avian influenza should be separated from others and asked to wear a surgical mask. If a surgical mask is not available, tissues should be provided and patients should be asked to cover their mouth and nose when coughing.
The benefit of wearing surgical masks by well persons in public settings has not been established and is not recommended as a public health control measure at this time. Surgical masks are not adequate PPE for airborne infections. Even though influenza is primarily spread via droplet, there may also be airborne spread. An N95 respirator or PAPR should be recommended, at least in the initial stages of a pandemic and while supplies last.
In contrast to healthcare workers who necessarily have close contact with ill patients, the general public should try to avoid close contact with ill individuals. Nevertheless, persons may choose to wear a mask as part of individual protection strategies that include cough etiquette, hand hygiene, and avoiding public gatherings. Mask use may be most important for persons who are at high risk for complications of influenza and those who are unable to avoid close contact with others or must travel for essential reasons such as seeking medical care.
Respirators are designed to help reduce the wearer’s exposure to airborne particles. Respirators protect the user in two basic ways.
•  a) The first is by the removal of contaminants from the air. Respirators of this type include particulate respirators, which filter out airborne particles [ie., volcanic ash, dust storms]; and, b )  “gas masks” which filter out chemicals and gases [‘tear gas’, smoke, many hazardous chemical and dangerous biological agents].
•  Other respirators protect by supplying clean respirable air from another source. Respirators that fall into this category include airline respirators, which use compressed air from a remote source; and self-contained breathing apparatus (SCBA), which include their own air supply.

Respirators are designed to reduce exposures of the wearer to airborne hazards. Biological agents, such as viruses, are particles and can be filtered by particulate filters with the same efficiency as non-biological particles having the same physical characteristics (size, shape, etc.). However, unlike most industrial particles there are no exposure limits established for biological agents. Therefore, while respirators will help reduce exposure to avian influenza viruses, there is no guarantee that the user will not contract avian flu. Respirators may help reduce exposures to airborne biological contaminants, but they don’t eliminate the risk of exposure, infection, illness, or death.

Beards, long mustaches, and stubble may interfere with a good seal and cause leaks into the respirator.

Recent CDC infection control guidance documents provide recommendations that health care workers protect themselves from diseases potentially spread through the air (such as SARS or Tuberculosis) by wearing a fit-tested respirator at least as protective as a NIOSH-approved N-95 respirator. The N95 only offers protection down to .3 microns, and viruses are smaller than this — human SARS coronaviruses measure between 0.1 and 0.2 microns. But viruses often travel on larger particles, such as globs of mucus, which can be filtered. Available data suggest that infectious droplet nuclei may range in size from 1 mm to 5 mm; therefore, respirators used in health care settings should be able to efficiently filter the smallest particles in this range.

[Photo at right: NIOSH approved N95 Particle/ Dust filter mask]

An N-95 respirator is one of nine types of disposable particulate respirators.
Particulate respirators are also known as “air-purifying respirators” because they protect by filtering particles out of the air you breathe. Workers can wear any one of the particulate respirators for protection against diseases spread through the air — if they are NIOSH approved and if they have been properly fit-tested and maintained. NIOSH-approved disposable respirators are marked with the manufacturer’s name, the part number (P/N), the protection provided by the filter (e.g. N-95), and “NIOSH.”
A N-95 filters at least 95% of airborne particles.
Higher level particulate respirators [i.e., N-100 filter at least 99.97% airborne] may also be used.

[Image below: The North® 7600 Full Face Mask Respirator: designed to provide eye, face and N100 respiratory protection, while ensuring optimal comfort and performance. Dual flange silicone seal with superior fitting characteristics, a hard-coated polycarbonate lens w/ over 200° field of vision & protects against irritating gases, vapors and flying particles. Includes 5-strap harness, oral nasal cup, chin cup and speaking diaphragm. NIOSH/MSHA approved.]

An N100 mask is well suited for those who want NIOSH’s highest rated filtration efficiency in a maintenance free respirator. It provides a minimum filter efficiency of 99.97% against non-oil based particles. It is nearly 200 times more effective than the N95 filter (typical style seen above), and is also about ten times more expensive.

Protective Respiratory Devices
Two basic types of respirators are available: atmosphere supplying (self-contained breathing apparatus [SCBA], supplied-air respirator [SAR]) and air purifying respirator (APR).

•  Self-contained breathing apparatus: SCBA consists of a full facepiece connected by a hose to a portable source of compressed air.
•  Supplied-air respirator: SAR consists of a full face piece connected to an air source away from the contaminated area via an airline.
•  Air-purifying respirator: An APR consists of a face piece worn over the mouth and nose with a filter element that filters ambient air before inhalation. Three basic types of APRs are available: powered, disposable, and chemical cartridge or canister.
_a)  Nonpowered APRs operate under negative pressure, depending on the inspiratory effort of the wearer to draw air through a filter. Because PAPRs function under positive pressure, they provide the greatest degree of respiratory protection. Various chemical cartridges or canisters, which eliminate various chemicals including organic vapors and acid gases, are available.
_b)  Disposable APRs are usually half masks, which do not provide adequate eye protection. This type of APR depends on a filter, which traps particulates. The use of a high-efficiency particulate air (HEPA) filter or use in combination with a chemical cartridge enhances disposable APRs.

One measure of respiratory filtration efficiency relevant to BWA exposures is the percent penetration of droplet nuclei into the face piece. For exposures to biological aerosols, a) PAPRs with HEPA filters are most efficient, b) followed by elastomeric half-mask HEPA filter respirators and, c) non-HEPA disposable APRs.
All APRs are limited by the adequacy of their face seals. Accordingly, APRs do not provide adequate respiratory protection in environments immediately dangerous to life or health.
•  High-efficiency particulate air filter (HEPA)
HEPA filters remove particles of 0.3-15 µm diameter with an efficiency of 98-100%, efficiently excluding aerosolized BWA particles in the highly infectious 1- to 5-µm range. HEPA filters are incorporated into various protective respiratory devices including PAPRs and elastomeric half-mask respirators. This type of filtration is required when caring for a patient infected with a disease requiring “airborne precautions” such as smallpox and viral hemorrhagic fevers. Use of an N-100 filter should provide the same protection as the HEPA filter.

7.   Masks
A.  North 760008A Full Face M/L Facepiece (by Honeywell Corporation)
AMAZON Price (2011): $148.94 +$6.58 = $155.52
Technical Details
•  Type: Full Face
•  Size: Medium/Large
•  Material: Silicone
•  Harness Type: 5 Point
•  For Use With: North Cartridges and Filters
Product Description
Half Full Facepieces – Respiratory Protection Type: Full Face Size: Medium/Large Material: Silicone Harness Type: 5 Point For Use With: North Cartridges and Filters Connection Type: Threaded
Technical Details
Designed to provide eye, face and respiratory protection while ensuring optimal comfort and performance. Dual flange silicone seal give this facepiece superior fitting characteristics. Hard-coated polycarbonate lens provides over 200° field-of-vision and protects the wearer’s eyes and face against irritating gases, vapors and flying particles. Lens meets ANSI standards for high impact and penetration resistance. Compatible with North cartridges, filters and accessories. NIOSH approved.

 B.  North 770030 Medium Silicone Half Mask Respirator 7700 Series, Mask Only
AMAZON Price: $19.99 +$5.90=$$25.89
The 7700’s soft non-allergenic silicone seal provides excellent protection, comfort and fit. The half masks cradle suspension system allows the facepiece to seal evenly on the face without creating pressure points. It’s low profile gives workers a wide field to vision and does not interfere with protective eyewear. The low inhalation and exhalation resistance of the 7700 Series makes breathing easier to reduce worker fatigue. NIOSH approved when used with North cartridges and/or filters. Dual Cartridge Silicone Half Mask: Silicone facepiece material conforms to facial features and doesn’t harden with age. Silicone is easy to clean, durable and resists distortion. Contoured sealing flange and cradle suspension system eliminates discomfort caused by pressure points on facial nerves. Nose area design is comfortable and well-fitting. Minimal dead air space limits re-breathing of exhaled air. Direct cartridge-to-facepiece seal minimizes replacement parts and simplifies maintenance. The most comfortable and durable half mask available. Does not interfere with protective eyewear.  Size: 770030S – Small 770030M – Medium 770030L – Large.

8.  Biohazard protection
•  North 7700 N100 filter; Recommended half mask for H1N1-type flu virus (Swine flu).
•  Hantavirus: Use of an N-100 filter should provide the same protection as the HEPA filter. Available evidence suggests that Hantavirus is transmitted by inspiring small (less than 5 micron) viral particles in aerosols which the N-100 is the most effective in removing.

A.  Mask particle filter protection efficiency
USA Filter Standards     Efficiency *
NIOSH N95                      94%
NIOSH N99                      99%
NIOSH N100                    99.97%

Assigned Protection Factors

Type of respirator Dust respirator Quarter mask Half mask Full
1. Air-Purifying Respirator max 4 5 10 50 …………..
2. Powered Air-Purifying Respirator (PAPR) ………….. 50 1,000 1,000
4. Self-Contained Breathing Apparatus (SCBA)  Pressure-demand or other positive-pressure mode circuit) ………….. ………….. 10,000 10,000

Two of North’s many filters
(these are my choices for an emergency kit): One for dust, blowing sand and ash, the other for many chemical and biological hazards.
See at <>

List of North filter cartriges/pictures/prices:
Most can be bought at Amazon at better prices than found elsewhere.


9.  DuPont TY127S Disposable White Tyvek Coverall Suit 1428
Amazon Price $5.49 + $4.57 S&H (same price as local Home Depot and Lowes paint department, less (my 8.25%) your state sales tax. Choose one size larger than your normal, to ensure al fit over your clothing and allow flexibility.
Technical Details
•  Serged seams, attached hood, front zipper closure, elastic wrists, and elastic ankles.
•  Inherent barrier protection against dry particulate hazards.
•  Applications range from agriculture to spray painting to lead remediation.
•  Even after abrasions, stops microporous particles better than other reusable garments.
•  The best balance of protection, durability and comfort.
What are the features of  Tyvek disposable coveralls?
•  It is made from a tough material that helps prevent skin contact with wet/dry, harmful objects, or chemicals in the environment.
•  Microscopic particles as small as 0.5 microns are retarded in access through a Tyvek coverall.
•  It can’t be easily scratched or torn
•  The coverall is made from one material in one layer
•  The Tyvek disposable coverall has the ability to let air and moisture pass through which can reduce possible heat stress.
•  Tyvek suits create a barrier to water from mild splash occurrences.
•  It is proved to be six times more breathable than microporous materials
•  It can be used in various low hazard applications. As Personal Protective Equipment it fulfills body/skin protection necessary for many Level D and C threats and partial protection for Level B threats.
•  Tyvek disposable coveralls are perfect for disaster clean-up work in order to protect the wearer with maximum comfort and protection. It comes in hooded coveralls for overall protection.


Sports Body Armor

Types of sports body armor
Padded pants are full-length protective armor for use when protection of hips, quads, shins, and calves is needed.
Upper body armor provides excellent soft-padded protection for the back, sides, shoulders, and arms.

Titan Sport Jacket, by Fox Racing, Amazon $139.95

Full body under jersey coverage has a new standard with the Titan Sport Jacket. Its complete plastic plating of key contact areas is unmatched. Its full mesh main body offers a precise, bunch-free fit. Add in the intelligently engineered ventilation zones and the Titan Sport Jacket truly becomes the ultimate battle suit.

Fox Racing’s new Titan Sport Jacket is probably the first hard-shell under-jersey body armor for down hill (DH) and free ride that doesn’t make you look like a linebacker. Despite protecting all critical upper-body contact areas, including shoulders and elbows, with lightweight, high-impact plastic the Titan is surprisingly svelte. The main body is made of a comfortable stretchy mesh fabric that prevents the jacket from bunching up under your jersey. Smartly designed vents in the chest and back plates also work with the mesh to help keep you cool. A major improvement is the addition of a hard-plastic chest-plate. The articulated spine protector is designed to move fluidly with a rider but can also be zipped off easily. Adjustment straps at the shoulders and ribs allow for a precise fit and better protection. The Velcro on the kidney belt has the mildly annoying habit of attaching itself to the jacket’s soft meshy parts, but that’s probably an unavoidable feature of good Velcro. While the Titan jacket is designed to be worn under your jersey, the anatomically shaped Batman aesthetic almost makes it cool enough to wear on its own.

Design & Function
Anatomic high impact two piece plastic chest plate
•  Removable articulated plastic back coverage
•  High impact plastic shoulder and elbow coverage
•  Soft vented mesh main body fabric for enhanced fit,
•  Comfort and ventilation
•  Center zipper for easy on and off

An Upper Body Bike padded top is often used with the following extreme sports and activities:
Skate: Derby, Mountain Board
Bike: Down Hill, Single Track, Street, Mountain
Motor bike: ATV, Dirt, Street, Street Bike, Motocross, Super Moto, Track
Field sports: Polo
Other sports: Clown Work, Equestrian, Martial Arts, Street Louge.

 Ballistic Body Armor

How to choose body armor: <>
Pictures/prices/sales: <>

Body Armor Threat Levels
Deciding which body armor to purchase is as important as any purchase you will make.
Before deciding on brands, you need a little knowledge about body armor to help with your decision.
All body armor products are categorized into one of six levels.

The levels begin with Level I which offers the least amount of protection and go up to Level IV which offers the most amount of protection. This level system is the most important factor in making a purchase. You don’t need a Level IV – which will stop rifle rounds – if the purpose of the vest is to give you protection from sharp edged weapons while walking a tier a Garden State Prison. However, if you are on a tactical entry team used for high risk assaults or handling prison riots, you will need armored protection that will stop more than just knives.

An old but still very valuable street cop rule-of-thumb is to have a level of ballistic performance that stops, at a minimum, the round you carry in your service weapon. This rule is as relevant and true today as it was when body armor was first available.
Be advised, though, there are many variables.
The ballistic threat of a round depends on more than just the round. Variables include its composition, shape, caliber, mass, angle of impact, and impact velocity. Because of the wide variety of rounds and cartridges available in a given caliber and because of the existence of hand loaded ammunition, body armor that will defeat a standard test round may not defeat other loadings in the same caliber.
The National Institute of Justice (NIJ) is the research, development, and evaluation agency of the United States Department of Justice. It is from the NIJ where we get the levels of body armor. It is called the National Institute of Justice (NIJ) Ballistic Resistance of Police Body Armor.

Below is a list describing the available levels of ballistic performance of body armor:

Level I  (22 LR; 38 Special)
Level I vests offer the most basic level of protection.  This level of protection is virtually obsolete due to the common use of higher velocity ammunition. During testing the ammunition used is a .38 caliber traveling at 850 feet per second and a .22 caliber fired from a long rifle with a traveling speed of 1,050 feet per second.  Level I vests only stop fragmentation and low-velocity pistol ammunition. They are not recommended for pistol ballistic protection but can be used for riot gear or for playing paintball.

Level II-A  (Lower Velocity 357 Magnum; 9 mm)
Level II-A vests are typically 4mm thick and tested using a 9mm full metal jacket at 1,090 feet per second and a .357 Magnum jacketed soft point ammunition at 1,250 feet per second.  These bulletproof jackets offer the minimum level of protection required to protect against most threats faced on the streets.  Since this vest is thinner than a level II or III-A it offers greater comfort and concealability at the cost of offering less protection against blunt trauma.

Level II  (Higher Velocity 357 Magnum; 9 mm)
Level II vests are typically 5mm thick and tested using 9mm full metal jacket ammunition at 1,175 feet per second and .357 jacketed soft point ammunition at 1,395 feet per second.  Since they are thicker they offer more protection against blunt trauma while remaining comfortable to wear and easy to conceal.  These bulletproof vests are ideal when vests need to be concealed, worn for a long time, or when the ability to move a lot is necessary.  Theses vests are often worn by police officers.  Since Level II vests are thicker they offer great levels of protection against blunt trauma caused by higher-velocity rounds.

Level III-A  (44 Magnum; Submachine Gun 9 mm)
Level III-A vests are between 8 to 10 millimeters thick and are tested for 9 mm full metal jacket ammunition at 1,400 feet per second (the velocity of a submachine gun) and .44 Magnum Lead Semi-Wadcutter ammunition at 1,400 feet per second.  These vests offer the highest level of blunt trauma protection while remaining concealable.  Level III-A vests are suited to protect against most handguns as well as all the weapons tested on the lower-level vests.  Among all the concealable bulletproof vests they are the most expensive, thick, stiff, and heavy.  They are ideal for high-risk situations including protection against explosions and grenade attacks.

Type IV  (Armor-Piercing Rifle)
This armor protects against 30 caliber armor-piercing bullets (U.S. military designation APM2), with nominal masses of 10.8 g (166 gr) impacting at a velocity of 868 m (2850 ft) per second or less. It also provides at least single hit protection against the threats mentioned in lower levels.

• Some professionals are more concerned they will be attacked with a knife or a blunt object, so when looking at armor select for penetration protection as well.

List  of ammunition shown in the photograph above:

1. .22 Magnum 40 gr. JHP (1209 FPS   / 369 MPS)
2. .32 ACP 60 gr. Silvertip JHP (936 FPS / 285 MPS)
3. .380 ACP 95 gr. FMC (902 FPS / 275 MPS)
4. .38 Special 125 gr. Nyclad SWHP (1009 FPS / 308 MPS)
5. .38 Special +P 110 gr. JHP (1049 FPS / 320 MPS)
6. .38 Special +P 140 gr. JHP (869 FPS / 265 MPS)
7. 9mm 124 gr. FMC (1173 FPS / 358 MPS)*
8. 9mm 125 gr. JSP (1121 FPS / 342 MPS)
9. 9mm 147 gr. Black Talon (1010 FPS / 308 MPS)
10. 9mm 147 gr. Golden Saber (1083 FPS / 330 MPS)
11. 9mm 147 gr. Hydra Shok (1011 FPS / 308 MPS)
12. .357 Magnum 158 gr. JSP (1308 FPS / 399 MPS)
13. .357 Magnum 110 gr. JHP (1292 FPS / 394 MPS)
14. .357 Magnum 125 gr. JHP (1335 FPS / 407 MPS)
15. .40 Caliber 180 gr. FMJTC (992 FPS / 302 MPS)
16. .40 Caliber 170 gr. FMJTC (1095 FPS / 334 MPS)
17. 10mm 155 gr. FMJTC (1024 FPS / 312 MPS)
18. 10mm 170 gr. JHP (1137 FPS / 347 MPS)
19. .41 Magnum 210 gr. LSWC (1141 FPS / 348 MPS)
20. .44 Magnum 240 gr. LFP (1017 FPS / 310 MPS)
21. .45 Long Colt 250 gr. LRN (778   FPS / 237 MPS)
22. .45 ACP 230 gr. FMJ (826 FPS / 252 MPS)
23. 12 Ga. 00 Buck (9 pellet) (1063 FPS / 324 MPS)
24. 9mm 124 gr. FMJ (1215 FPS / 370 MPS)*
25. 9mm 115 gr. Silvertip JHP (1252 FPS / 382 MPS)
26. 9mm 124 gr. Starfire JHP (1174 FPS / 358 MPS)*
27. .357 Magnum 158 gr. JSP (1453 FPS / 443 MPS)*
28. .357 Magnum 145 gr. Silvertip JHP (1371 FPS / 418 MPS)
29. .357 Magnum 125 gr. JHP (1428 FPS / 435 MPS)
30. 10mm 175 gr. Silvertip JHP (1246 FPS / 380 MPS)
31. .41 Magnum 210 gr. JSP (1322 FPS / 403 MPS)
32. .44 Magnum 240 gr. SJHP (1270 FPS / 387 MPS)
33. 9mm 124 gr. FMJ (1440 FPS / 439 MPS)*
34. 9mm 115 gr. FMJ Israeli (1499 FPS / 457 MPS)
35. 9mm 123 gr. FMJ Geco (1372 FPS / 418 MPS)
36. 9mm 124 gr. FMJ Cavin (1259 FPS / 384 MPS)
37. .44 Magnum 240 gr. LSWC (1448 FPS / 441 MPS)*
38. .44 Magnum 240 gr. HSP (1320 FPS / 402 MPS)
39. 12 ga. 1 oz. Rifled Slug (1290 FPS / 393 MPS)
40. 12 ga. 1 oz. Rifled Slug (1254 FPS / 382 MPS)

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Vaccination notes

(Survival Manual/6. Medical/c) General Clinic/Vaccination notes)

The romantic 1800s
14 December 2009, Health Sentinal, by Roman Bystrianyk
Many of us have a picture of the 1800s that has been colored by a myriad of filters that have led us to a nostalgic and romantic view of that era. We picture a time where gentleman callers came to call upon a well-dressed lady in a finely furnished parlor. We imagine a time where people leisurely drifted down a river on a paddle wheel riverboat while sipping mint juleps and a time of more elegant travel aboard a steam train traveling through the countryside. We picture an elegant woman dressed in a long flowing gown leaving a sleek horse drawn carriage with the aid of a well-dressed man in a top hat. We think of those times where life was simple, ordered, in a near utopian world free of the many woes that plague modern society.

But if we remove those filters and cast a more objective light upon that time a different view emerges. Now imagine a world where workplaces had no health, safety, or minimum wage laws. It was a time where people put in 12 to 16 hours a day at the most tedious menial labor. Imagine bands of children roaming the streets out of control because their parents are laboring long days. Picture the city of New York surrounded not by suburbs, but by rings of smoldering garbage dumps and shantytowns. Imagine cities where hogs, horses, and dogs and their refuse were commonplace in the streets. Many infectious diseases were rampant throughout the world and in particular in the larger cities. This is not a description of the Third World, but was a large portion of America and other western cities only a century or so ago.

Our perceptions of history encompass a lot of willful rejection of knowledge. It is easier and more convenient to wax nostalgically rather than acknowledge an uncomfortable reality. We insist on creating a more pleasant historical illusion, but by doing so we cloud a historical issue in a way that promotes a bad misunderstanding of the past, and has every potential to result in bad misunderstandings of the future.
•  1807-1812: Glasgow, England – Measles accounts for 11% of all deaths.
•  1830s: United States – Eastern seaboard cities have a mortality rate from tuberculosis of 400 per 100,000.
•  1845-1850: Ireland – Great Famine claims approximately 2 million lives, some from starvation, but far more from typhus and other epidemics consequent upon malnutrition and social collapse.
•  1854: New York City – Nearly 2,500 people are killed by cholera.
•  1847-1861: 2,589,843 Russians contract Cholera and over 1,000,000 die.
•  1861-1865: American Civil War – The Union Army loses 186,216 men to disease, twice the number killed in action; nearly half were claimed by typhoid and dysentery.
•  1855: Yellow fever rages in Norfolk and Portsmouth Virginia, Louisiana, and Mississippi. In the Virginia plague area one out of five die of the fever, its victims buried wholesale in trenches without coffins.
•  1865: New York City – Fifteen thousand tenement houses have been built, many of which are hardly more than “fever nests”.
•  1867-1872: Hospice des Enfants Assists reports 1,256 cases of measles and 612 deaths with a mortality of 49%. Malnutrition was known to be rife in orphanages at the time.
•  1871: A terrible smallpox epidemic which threw both New York and Philadelphia into morning. It killed over eight hundred people in the former city, more than ever before in its history, while the latter the deaths nearly reached two thousand.
•  1871-1872: England – Smallpox epidemic 42,200 deaths suggesting 200,000 or more cases.
•  1870-1875 Europe – One of the worst epidemics in European smallpox history is estimated to have killed at least 500,000 people.
•  Prussia – Great smallpox epidemic. Despite strict vaccination laws 69,839 die from smallpox more than in any other northern state.
•  Chicago – Despite a high vaccination rate, over 2000 people contract smallpox and more than a fourth of these die. The fatality among children under five is the highest ever recorded.
•  1873: Memphis – Suffers attacks of yellow fever, smallpox, and cholera simultaneously. People flee the city leaving half of the houses vacant.
•  1874: Bloomington, Illinois – All kinds of garbage and human and animal waste had been thrown into small streams running into Sugar Creek and became known as the “North and South Sloughs”. Over the years the Sloughs “became a … sodden pool of stench that was the breeding places for disease … because it drained sewage into the community’s primary water source, Sugar Creek.”

These historic points show that infectious diseases were a constant and deadly threat during these times. England was the country that early in 1838 began to keep statistics on causes of death and is the best source to find out the devastating impact of these infectious diseases.

What would happen if we stopped vaccinations?
In the U.S., vaccination programs have eliminated or significantly reduced many vaccine-preventable diseases. However, these diseases still exist and can once again become common—and deadly—if vaccination coverage does not continue at high levels.

Stopping vaccination against polio will leave people susceptible to infection with the polio virus. Polio virus causes acute paralysis that can lead to permanent physical disability and even death. Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. These annual epidemics of polio often left thousands of victims–mostly children–in braces, crutches, wheelchairs, and iron lungs. The effects were life-long.
In 1988 the World Health Assembly unanimously agreed to eradicate polio worldwide. As a result of global polio eradication efforts, the number of cases reported globally has decreased from more than 350,000 cases in 125 countries in 1988 to 2,000 cases of polio in 17 countries in 2006, and only four countries remain endemic (Afghanistan, India, Nigeria, Pakistan). To date polio has been eliminated from the Western hemisphere, and the European and Western Pacific regions. Stopping vaccination before eradication is achieved would result in a resurgence of the disease in the United States and worldwide.

Before measles immunization was available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963.

In the U.S., up to 20 percent of persons with measles are hospitalized. Seventeen percent of measles cases have had one or more complications, such as ear infections, pneumonia, or diarrhea. Pneumonia is present in about six percent of cases and accounts for most of the measles deaths. Although less common, some persons with measles develop encephalitis (swelling of the lining of the brain), resulting in brain damage.

As many as three of every 1,000 persons with measles will die in the U.S. In the developing world, the rate is much higher, with death occurring in about one of every 100 persons with measles.

Measles is one of the most infectious diseases in the world and is frequently imported into the U.S. In the period 1997-2000, most cases were associated with international visitors or U.S. residents who were exposed to the measles virus while traveling abroad. More than 90 percent of people who are not immune will get measles if they are exposed to the virus.

According to the World Health Organization (WHO), nearly 900,000 measles-related deaths occurred among persons in developing countries in 1999. In populations that are not immune to measles, measles spreads rapidly. If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected.
In the U.S., widespread use of measles vaccine has led to a greater than 99 percent reduction in measles compared with the pre-vaccine era. If we stopped immunization, measles would increase to pre-vaccine levels.

Haemophilus Influenzae Type b (Hib) Meningitis
Before Hib vaccine became available, Hib was the most common cause of bacterial meningitis in U.S. infants and children. Before the vaccine was developed, there were approximately 20,000 invasive Hib cases annually. Approximately two-thirds of the 20,000 cases were meningitis, and one-third were other life-threatening invasive Hib diseases such as bacteria in the blood, pneumonia, or inflammation of the epiglottis. About one of every 200 U.S. children under 5 years of age got an invasive Hib disease. Hib meningitis once killed 600 children each year and left many survivors with deafness, seizures, or mental retardation.

Since introduction of conjugate Hib vaccine in December 1987, the incidence of Hib has declined by 98 percent. From 1994-1998, fewer than 10 fatal cases of invasive Hib disease were reported each year.

This preventable disease was a common, devastating illness as recently as 1990; now, most pediatricians just finishing training have never seen a case. If we were to stop immunization, we would likely soon return to the pre-vaccine numbers of invasive Hib disease cases and deaths.

Pertussis (Whooping Cough)
Since the early 1980s, reported pertussis cases have been increasing, with peaks every 3-5 years; however, the number of reported cases remains much lower than levels seen in the pre-vaccine era. Compared with pertussis cases in other age groups, infants who are 6 months old or younger with pertussis experience the highest rate of hospitalization, pneumonia, seizures, encephalopathy (a degenerative disease of the brain) and death. From 2000 through 2008, 181 persons died from pertussis; 166 of these were less than six months old.

Before pertussis immunizations were available, nearly all children developed whooping cough. In the U.S., prior to pertussis immunization, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths.

Pertussis can be a severe illness, resulting in prolonged coughing spells that can last for many weeks. These spells can make it difficult for a person to eat, drink, and breathe. Because vomiting often occurs after a coughing spell, persons may lose weight and become dehydrated. In infants, it can also cause pneumonia and lead to brain damage, seizures, and mental retardation.

The newer pertussis vaccine (acellular or DTaP) has been available for use in the United States since 1991 and has been recommended for exclusive use since 1998. These vaccines are effective and associated with fewer mild and moderate adverse reactions when compared with the older (whole-cell DTP) vaccines.

During the 1970s, widespread concerns about the safety of the older pertussis vaccine led to a rapid fall in immunization levels in the United Kingdom. More than 100,000 cases and 36 deaths due to pertussis were reported during an epidemic in the mid 1970s. In Japan, pertussis vaccination coverage fell from 80 percent in 1974 to 20 percent in 1979. An epidemic occurred in 1979, resulted in more than 13,000 cases and 41 deaths.

Pertussis cases occur throughout the world. If we stopped pertussis immunizations in the U.S., we would experience a massive resurgence of pertussis disease. A study found that, in eight countries where immunization coverage was reduced, incidence rates of pertussis surged to 10 to 100 times the rates in countries where vaccination rates were sustained.

Before pneumococcal conjugate vaccine became available for children, pneumococcus caused 63,000 cases of invasive pneumococcal disease and 6,100 deaths in the U.S. each year. Many children who developed pneumococcal meningitis also developed long-term complications such as deafness or seizures. Since the vaccine was introduced, the incidence of invasive pneumococcal disease in children has been reduced by 75%. Pneumococcal conjugate vaccine also reduces spread of pneumococcus from children to adults. In 2003 alone, there were 30,000 fewer cases of invasive pneumococcal disease caused by strains included in the vaccine, including 20,000 fewer cases in children and adults too old to receive the vaccine. If we were to stop immunization, we would likely soon return to the pre-vaccine numbers of invasive pneumococcal disease cases and deaths.

Rubella (German Measles)
While rubella is usually mild in children and adults, up to 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop congenital rubella syndrome (CRS), resulting in heart defects, cataracts, mental retardation, and deafness.

In 1964-1965, before rubella immunization was used routinely in the U.S., there was an epidemic of rubella that resulted in an estimated 20,000 infants born with CRS, with 2,100 neonatal deaths and 11,250 miscarriages. Of the 20,000 infants born with CRS, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded.

Due to the widespread use of rubella vaccine, only six CRS cases were provisionally reported in the U.S. in 2000. Because many developing countries do not include rubella in the childhood immunization schedule, many of these cases occurred in foreign-born adults. Since 1996, greater than 50 percent of the reported rubella cases have been among adults. Since 1999, there have been 40 pregnant women infected with rubella.

If we stopped rubella immunization, immunity to rubella would decline and rubella would once again return, resulting in pregnant women becoming infected with rubella and then giving birth to infants with CRS.

Varicella (Chickenpox)
Prior to the licensing of the chickenpox vaccine in 1995, almost all persons in the United States had suffered from chickenpox by adulthood. Each year, the virus caused an estimated 4 million cases of chickenpox, 11,000 hospitalizations, and 100-150 deaths.

A highly contagious disease, chickenpox is usually mild but can be severe in some persons. Infants, adolescents and adults, pregnant women, and immunocompromised persons are at particular risk for serious complications including secondary bacterial infections, loss of fluids (dehydration), pneumonia, and central nervous system involvement. The availability of the chickenpox vaccine and its subsequent widespread use has had a major impact on reducing cases of chickenpox and related morbidity, hospitalizations, and deaths. In some areas, cases have decreased as much as 90% over prevaccination numbers.

In 2006, routine two-dose vaccination against chickenpox was recommended for all children, adolescents, and adults who do not have evidence of immunity to the disease. In addition to further reducing cases, this strategy will also decrease the risk for exposure to the virus for persons who are unable to be vaccinated because of illness or other conditions and who may develop severe disease. If vaccination against chickenpox were to stop, the disease would eventually return to prevaccination rates, with virtually all susceptible persons becoming infected with the virus at some point in their lives.

Hepatitis B
More than 2 billion persons worldwide have been infected with the hepatitis B virus at some time in their lives. Of these, 350 million are life-long carriers of the disease and can transmit the virus to others. One million of these people die each year from liver disease and liver cancer.

National studies have shown that about 12.5 million Americans have been infected with hepatitis B virus at some point in their lifetime. One and one quarter million Americans are estimated to have chronic (long-lasting) infection, of whom 20 percent to 30 percent acquired their infection in childhood. Chronic hepatitis B virus infection increases a person’s risk for chronic liver disease, cirrhosis, and liver cancer. About 5,000 persons will die each year from hepatitis B-related liver disease resulting in over $700 million in medical and work loss costs.

The number of new infections per year has declined from an average of 450,000 in the 1980s to about 80,000 in 1999. The greatest decline has occurred among children and adolescents due to routine hepatitis B vaccination. Infants and children who become infected with hepatitis B virus are at highest risk of developing lifelong infection, which often leads to death from liver disease (cirrhosis) and liver cancer. Approximately 25 percent of children who become infected with life-long hepatitis B virus would be expected to die of related liver disease as adults.

CDC estimates that one-third of the life-long hepatitis B virus infections in the United States resulted from infections occurring in infants and young children. About 16,000 – 20,000 hepatitis B antigen infected women give birth each year in the United States. It is estimated that 12,000 children born to hepatitis B virus infected mothers were infected each year before implementation of infant immunization programs. In addition, approximately 33,000 children (10 years of age and younger) of mothers who are not infected with hepatitis B virus were infected each year before routine recommendation of childhood hepatitis B vaccination.

Diphtheria is a serious disease caused by a bacterium. This germ produces a poisonous substance or toxin which frequently causes heart and nerve problems. The case fatality rate is 5 percent to 10 percent, with higher case-fatality rates (up to 20 percent) in the very young and the elderly.

In the 1920’s, diphtheria was a major cause of illness and death for children in the U.S. In 1921, a total of 206,000 cases and 15,520 deaths were reported. With vaccine development in 1923, new cases of diphtheria began to fall in the U.S., until in 2001 only two cases were reported.

Although diphtheria is rare in the U.S., it appears that the bacteria continue to get passed among people. In 1996, 10 isolates of the bacteria were obtained from persons in an American Indian community in South Dakota, none of whom had classic diphtheria disease. There was one death reported in 2003 from clinical diphtheria in a 63 year old male who had never been vaccinated.

There are high rates of susceptibility among adults. Screening tests conducted since 1977 have shown that 41 percent to 84 percent of adults 60 and over lack protective levels of circulating antitoxin against diphtheria.

Although diphtheria is rare in the U.S., it is still a threat. Diphtheria is common in other parts of the world and with the increase in international travel, diphtheria and other infectious diseases are only a plane ride away. If we stopped immunization, the U.S. might experience a situation similar to the Newly Independent States of the former Soviet Union. With the breakdown of the public health services in this area, diphtheria epidemics began in 1990, fueled primarily by persons who were not properly vaccinated. From 1990-1999, more than 150,000 cases and 5,000 deaths were reported.

Tetanus (Lockjaw)
Tetanus is a severe, often fatal disease. The bacteria that cause tetanus are widely distributed in soil and street dust, are found in the waste of many animals, and are very resistant to heat and germ-killing cleaners. From 1922-1926, there were an estimated 1,314 cases of tetanus per year in the U.S. In the late 1940’s, the tetanus vaccine was introduced, and tetanus became a disease that was officially counted and tracked by public health officials. In 2000, only 41 cases of tetanus were reported in the U.S.

People who get tetanus suffer from stiffness and spasms of the muscles. The larynx (throat) can close causing breathing and eating difficulties, muscles spasms can cause fractures (breaks) of the spine and long bones, and some people go into a coma, and die. Approximately 20 percent of reported cases end in death.

Tetanus in the U.S. is primarily a disease of adults, but unvaccinated children and infants of unvaccinated mothers are also at risk for tetanus and neonatal tetanus, respectively. From 1995-1997, 33 percent of reported cases of tetanus occurred among persons 60 years of age or older and 60 percent occurred in patients greater than 40 years of age. The National Health Interview Survey found that in 1995, only 36 percent of adults 65 or older had received a tetanus vaccination during the preceding 10 years.

Worldwide, tetanus in newborn infants continues to be a huge problem. Every year tetanus kills 300,000 newborns and 30,000 birth mothers who were not properly vaccinated. Even though the number of reported cases is low, an increased number of tetanus cases in younger persons has been observed recently in the U.S. among intravenous drug users, particularly heroin users.

Tetanus is infectious, but not contagious, so unlike other vaccine-preventable diseases, immunization by members of the community will not protect others from the disease. Because tetanus bacteria are widespread in the environment, tetanus can only be prevented by immunization. If vaccination against tetanus were stopped, persons of all ages in the U.S. would be susceptible to this serious disease.

Before the mumps vaccine was introduced, mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases. Mumps is usually a mild viral disease. However, serious complications, such as inflammation of the brain (encephalitis) can occur rarely. Prior to mumps vaccine, mumps encephalitis was the leading cause of viral encephalitis in the United States, but is now rarely seen.

Serious side effects of mumps are more common among adults than children. Swelling of the testes is the most common side effect in males past the age of puberty, occurring in up to 37 percent of post-pubertal males who contract mumps. An increase in miscarriages has been found among women who develop mumps during the first trimester of pregnancy.

Before there was a vaccine against mumps, mumps was a very common disease in U.S. children, with as many as 300,000 cases reported every year.  After vaccine licensure in 1967, reports of mumps decreased rapidly. In 1986 and 1987, there was a resurgence of mumps with 12,848 cases reported in 1987. Since 1989, the incidence of mumps has declined, with 266 reported cases in 2001. This recent decrease is probably due to the fact that children have received a second dose of mumps vaccine (part of the two-dose schedule for measles, mumps, rubella or MMR).  Studies have shown that the effectiveness of mumps vaccine ranges from 73% to 91% after 1 dose and from 79% to 95% after 2 doses and that 2 doses are more effective than 1 dose.

We can not let our guard down against mumps. A 2006 outbreak among college students led to over 6500 cases and a 2009-10 outbreak in the tradition-observant Jewish community in 2 states led to over 3400 cases. Mumps is a communicable disease and while prolonged close contact among persons my facilitate transmission, maintenance of high 2-dose MMR vaccine coverage remains the most effective way to prevent and limit the size of mumps outbreaks.

Other Notes:
•  Some counter culture types talk naively about living with nature in a society stripped of modern trappings and benefits. What they fail to recall is that, down through history, Mother Nature has been a real bitch.
•  Modern survival must entail using as many modern means and techniques as possible.
•  Nearly 100% of US deaths from disease now are chronic diseases of old age, such as heart disease, stroke and cancer.

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Viral Hemorrhagic Fevers

(Survival Manual/6. Medical/b) Disease/Viral hemorrhagic fevers)

Viral hemorrhagic (hem-uh-RAJ-ik) fevers are infectious diseases that interfere with the blood’s natural ability to clot. These diseases can also damage the walls of tiny blood vessels, making them leaky. The internal bleeding that results can range from relatively minor to life-threatening.

Some viral hemorrhagic fevers include:
•  Dengue – (see Survival Manual/6. Medical/b) Disease/ Dengue)
•  Ebola – (see Survival Manual/6. Medical/b) Disease/ Ebola)
•  Lassa – (see Survival Manual/6. Medical/b) Diseas/Lassa fever)
•  Marburg
•  Yellow fever – (see Survival Manual/6. Medical/b) Disease/Yellow Fever)

These diseases most commonly occur in tropical areas of the world. When viral hemorrhagic fevers occur in the United States, they’re usually found in people who’ve recently traveled internationally.
Viral hemorrhagic fevers are spread by contact with infected animals, people or insects. No current treatment can cure viral hemorrhagic fevers, and immunizations exist for only a few types. Until additional vaccines are developed, the best approach is prevention.

Signs and symptoms of viral hemorrhagic fevers vary by disease. In general, initial symptoms may include:
•  High fever
•  Fatigue
•  Dizziness
•  Muscle aches
•  Weakness
[Photograph at right: The face of this patient appeared flushed due to dilation of the capillaries. Severe     vomiting could also cause rupture of the blood vessels in the eyes.]

Symptoms can become life-threatening
Severe cases of some types of viral hemorrhagic fevers may cause bleeding:
Under the skin
•  In internal organs
•  From the mouth, eyes or ears
Other signs and symptoms of severe infections can include:
•  Shock
•  Nervous system malfunctions
•  Coma
•  Delirium
•  Seizures
•  Kidney failure

 When to see a doctor
The best time to see a doctor is before you travel to a developing country to ensure you’ve received any available vaccinations and pre-travel advice for staying healthy. If you develop signs and symptoms once you return home, consider consulting a doctor who focuses on international medicine or infectious diseases. A specialist may be able to recognize and treat your illness faster. Be sure to let your doctor know what areas you’ve visited.

The viruses that cause viral hemorrhagic fevers live naturally in a variety of animal and insect hosts — most commonly mosquitoes, ticks, rodents or bats.
Each of these hosts typically lives in a specific geographic area, so each particular disease usually occurs only where that virus’s host normally lives. Some viral hemorrhagic fevers also can be transmitted from person to person.

 How is it transmitted?
The route of transmission varies by specific virus. Some viral hemorrhagic fevers are spread by mosquito or tick bites. Others are transmitted by contact with infected blood or semen. A few varieties are breathed in if you’re around infected rat feces or urine.
If you travel to an area where a particular hemorrhagic fever is common, you may become infected there and then develop symptoms after you return home.

Risk factors
Simply living in or traveling to an area where a particular viral hemorrhagic fever is common will increase your risk of becoming infected with that particular virus. Several other factors can increase your risk even more, including:
Working with the sick
•  Slaughtering infected animals
• Sharing needles to use intravenous drugs
•  Having unprotected sex
•  Working outdoors or in rat-infested buildings

Viral hemorrhagic fevers can damage your: Brain, Eyes, Heart, Kidneys, Liver, Lungs and/ or Spleen; in some cases, the damage is severe enough to cause death.

Tests and diagnosis
Diagnosing specific viral hemorrhagic fevers in the first few days of illness can be difficult because the initial signs and symptoms — high fever, muscle aches, headaches and extreme fatigue — are common to many other diseases.
To reach an accurate diagnosis, your doctor is likely to ask about your medical and travel history and any exposure to rodents or mosquitoes. Be sure to describe international trips in detail, including the countries you visited and the dates, as well as any contact you may have had with possible sources of infection.
Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis. Because viral hemorrhagic fevers are particularly virulent and contagious, these tests are usually performed in specially designated laboratories using strict precautions.

Treatments and drugs
While no specific treatment exists for most viral hemorrhagic fevers, the antiviral drug ribavirin (Virazole, Rebetol) may help shorten the course of infection and prevent complications in some cases.

Supportive care is essential. To prevent dehydration, you may need fluids to help maintain your balance of electrolytes — minerals that are critical to nerve and muscle function.

Surgical and other procedures
Some people may benefit from kidney dialysis, an artificial way of cleaning wastes from your blood when your kidneys fail.
Patients receive supportive therapy, but generally speaking, there is no other treatment or established cure for VHFs. Ribavirin, an anti-viral drug, has been effective in treating some individuals with Lassa fever or HFRS.

 Preventing viral hemorrhagic fevers, especially in developing nations, presents enormous challenges. Many of the social, economic and ecological factors that contribute to the sudden appearance and spread of infectious diseases — war, displacement, destruction of habitat, lack of sanitation and proper medical care — are problems that have no easy or quick solutions.
If you live in or travel to areas where viral hemorrhagic fevers are common, you should take precautions to protect yourself from infection.

 Get vaccinated
The yellow fever vaccine is generally considered safe and effective, although in rare cases, serious side effects can occur. Check with the Centers for Disease Control and Prevention about the status of the countries you’re visiting — some require certificates of vaccination for entry. The yellow fever vaccine isn’t recommended for children under 9 months of age or for pregnant women, especially during the first trimester. Vaccines for several less common types of viral hemorrhagic fevers are currently in development.

 Avoid mosquitoes and ticks
Wear light-colored long pants and long-sleeved shirts or, better yet, permethrin-coated clothing. Don’t apply permethrin directly to the skin. Avoid unnecessary activities at dusk and dawn when mosquitoes are most active and apply mosquito repellent with a 20 to 25 percent concentration of DEET to your skin and clothing. If you’re staying in tented camps or local hotels, use bed nets and mosquito coils.

 Guard against rodents
To prevent rodent infestations in your home:
•  Keep pet food covered and stored in rodent-proof containers.
•  Store trash in rodent-proof containers, and clean the containers often.
•  Dispose of garbage on a regular basis.
•  Make sure doors and windows have tightfitting screens.
•  Place woodpiles and stacks of bricks and other materials at least 100 feet from your house.
•  Mow your grass closely and keep brush trimmed to within 100 feet from your house.

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Sunburn: Protection & Treatment

(Survival manual/6. Medical/e) Skin/Sunburn protection & treatment)

See also:

 Protective Clothing
Sunlight is strongest when it is directly above the sky.  This is why health professionals advise that a person must avoid the sun between ten o’clock in the morning to four o’clock in the afternoon.  A marathon conducted at exactly twelve noon not only plays havoc on the skin, but also causes heat stroke and dehydration.

If going out in the sun is unavoidable during such hours, a person should wear protective clothing.  Protective clothing can reduce the skin’s exposure to sunlight.  Long pants protect the legs.  Long-sleeved shirts protect the arms.  And broad-brimmed hats can protect the face, especially the eyes.  Umbrellas are also effective tools in reducing sun exposure.

Seven Tips for Treating a Sunburn at Home
A sunburn is an actual burn of your skin from the ultraviolet (UV) light from the sun or other UV light sources (ie tanning beds). A sunburn can occur from as little as 15 minutes of midday sun exposure in a very light-skinned person.
The first signs of a sunburn may not appear for a few hours after the UV exposure. Sunburns may often appear “worse” the day after being at the beach, as it can take 24 hours or longer for the full effect of the UV damage to your skin to appear.
Sunburned skin is red and tender skin that is warm to the touch. Severe sunburned skin may result in the formation of blisters. Almost all sunburned skin will result in skin peeling on the burned areas several days after the sunburn.

It is always best to PREVENT sunburns, but when the sunburn occurs use these seven tips for comfort and healing:

  1. Take anti-inflammatory medications such as ibuprophen (Advil, Motrin), naproxen (Aleve) or aspirin. Do NOT give aspirin to children. These help decrease the inflammation and reduce the amount of redness and pain. The pain from a sunburn is usually worst between 6 and 48 hours after sun exposure.
  2. If your skin is not blistering, moisturizing cream may be applied to relieve discomfort. Store the moisturizing cream in the refrigerator between applications as the coolness will aid in comfort to your skin.
  3. Apply cool compresses to the burned skin. Cold wash clothes work well.
  4. Avoid hot showers or bathes. Take a luke warm bath instead. If there is no blistering of the skin, consider adding Aveeno Collodial Oatmeal to the bath water. It will aid in anti-inflammatory relief and act as a moisturizer for your skin.
  5. Avoid any additional sun or UV light exposure while your sunburn is healing. Clothing is better than protection while healing – long sleeves, hats, etc.
  6. Avoid products that contain benzocaine and lidocaine. They may actually create more itching and inflammation by causing an allergic contact dermatitis.
  7. If your sunburned skin develops blisters, resist the urge to pop them. The blister cover is actually protecting your raw skin underneath.

Sunburn Protection
Most organizations recommend using sunscreen with an SPF between 15 and 50 (SPF ratings higher than 50 have not been proven to be more effective than SPF 50). A sunscreen with an SPF of 15 protects against about 93 percent of UVB rays, and one with an SPF of 30 protects against 97 percent of rays, according to the Mayo Clinic. No SPF can block 100% of UV rays.

Because some UV radiation still gets through the sunscreen and into your skin, the SPF number refers to roughly how long it will take for a person’s skin to turn red. Sunscreen with an SPF of 15 will prevent your skin from getting red for approximately 15 times longer than usual (so if you start to burn in 10 minutes, sunscreen with SPF 15 will prevent burning for about 150 minutes, or 2.5 hours), according to the American Academy of Dermatology.

The UV (Ultraviolet) Index
The UV Index scale used in the United States conforms with international guidelines for UVI reporting established by the World Health Organization. What follows is a description of each UV Index level and tips to help you avoid harmful exposure to UV radiation.
** You can sign up for the free, daily  EPA (Environmental Protection Agency’s UV Index alert e-mail for your zip code, at:

 2 or less: Low
A UV Index reading of 2 or less means low danger from the sun’s UV rays for the average person:
•  Wear sunglasses on bright days. In winter, reflection off snow can nearly double UV strength.
•  If you burn easily, cover up and use sunscreen.

Look Out Below:
Snow and water can reflect the sun’s rays. Skiers and swimmers should take special care. Wear sunglasses or goggles, and apply sunscreen with an SPF of at least 15. Remember to protect areas that could be exposed to UV rays by the sun’s reflection, including under the chin and nose.

3 – 5: Moderate
A UV Index reading of 3 to 5 means moderate risk of harm from unprotected sun exposure.
•  Take precautions, such as covering up, if you will be outside.
•  Stay in shade near midday when the sun is strongest.

Me and My Shadow: An easy way to tell how much UV exposure you are getting is to look for your shadow: If your shadow is taller than you are (in the early morning and late afternoon), your UV exposure is likely to be low. If your shadow is shorter than you are (around midday), you are being exposed to high levels of UV radiation. Seek shade and protect your skin and eyes.

6 – 7: High
A UV Index reading of 6 to 7 means high risk of harm from unprotected sun exposure. Apply a sunscreen with a SPF of at least 15. Wear a wide-brim hat and sunglasses to protect your eyes.
•  Protection against sunburn is needed.
•  Reduce time in the sun between 10 a.m. and 4 p.m.
•  Cover up, wear a hat and sunglasses, and use sunscreen.

Made in the Shades: Wearing sunglasses protects the lids of your eyes as well as the lens.

8 – 10: Very High
A UV Index reading of 8 to 10 means very high risk of harm from unprotected sun exposure. Minimize sun exposure during midday hours, from 10 a.m. to 4 p.m. Protect yourself by liberally applying a sunscreen with an SPF of at least 15. Wear protective clothing and sunglasses to protect the eyes.
•  Take extra precautions. Unprotected skin will be damaged and can burn quickly.
•  Minimize sun exposure between 10 a.m. and 4 p.m; seek shade, cover up, wear a hat and sunglasses, and use sunscreen.

Stay in the Game: Be careful during routine outdoor activities such as gardening or playing sports. Remember that UV exposure is especially strong if you are working or playing between the peak hours of 10 a.m. and 4 p.m. Don’t forget that spectators, as well as participants, need to wear sunscreen and eye protection to avoid too much sun.

11+: Extreme
A UV Index reading of 11 or higher means extreme risk of harm from unprotected sun exposure. Try to avoid sun exposure during midday hours, from 10 a.m. to 4 p.m. Apply sunscreen with an SPF of at least 15 liberally every 2 hours.
•  Take all precautions. Unprotected skin can burn in minutes. Beachgoers should know that white sand and other bright surfaces reflect UV and will increase UV exposure.
•  Try to avoid sun exposure between 10 a.m. and 4 p.m.
•  Seek shade, cover up, wear a hat and sunglasses, and use sunscreen.

Beat the Heat: It is possible to go outside when the UV Index is 11 or higher. Make sure you always seek shade, wear a hat, cover up, wear 99-100% UV-blocking sunglasses, and use sunscreen. Or you can opt to stay indoors and take the opportunity to relax with a good book rather than risk dangerous levels of sun exposure

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