IMMUNIZATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 56

in industrialized nations. Scratches are considered exposures because animals lick their
paws, covering them with infected saliva.)
Rubella
Rubella(Germanmeasles)isoneofthemostwidelydocumentedcausesofbirthdefects.
CDCrecommendsthateveryone,notjustwomen,bevaccinatedunlesstheyhavebeenpre-
viously infected or have laboratory evidence of immunity. A single injection of attenuated
live rubella virus vaccine provides lasting immunity.
Smallpox
Smallpox has been eliminated worldwide by a vigorous vaccination campaign carried
out by the WHO, an outstanding medical triumph. The last reported case of smallpox was
in Somalia in 1977. Entry requirements for recent smallpox vaccination have been elimin-
ated. The vaccine is considered more hazardous than the risk of contracting the infection,
although threats of terrorist attacks with microbiologic agents have prompted reconsidera-
tion of that policy.
Tetanus
The organisms producing tetanus are ubiquitous, and infections can result from trivial
wounds. Because treatment for tetanus is not effective, the mortality rate is high. Since im-
munization essentially completely prevents the devastating effects of such infections, in-
adequate protection against this disease is inexcusable. The initial series of tetanus toxoid
immunizations is two injections four to eight weeks apart. A third inoculation should be
obtained six to twelve months later. A booster should be obtained at least every ten years
thereafter. However, if a booster has not been received within five years, one should be ob-
tained before departing on a wilderness outing or following a contaminated wound.
Tetanus toxoid has been combined with diphtheria toxoid, a combination labeled Td.
Recently, pertussis (whooping cough) vaccine has been added, and the combination is
labeledTdap.Thattriplecombinationisnowrecommendedforimmunizationandboosters
for individuals eleven to sixty-four years old. Detailed information about the combination
and the new recommendations is available at www.cdc.gov/mmwr/preview/mmwrhtml/
rr5517a1.htm?s_cid=rr5517a1_e .
Typhoid
Typhoid immunization is estimated to be only about 70 percent effective in preventing
typhoid infection, but it does significantly reduce the severity of infections. Such immun-
ization is recommended, sometimes strongly, for travelers outside of major cities in de-
veloping countries. Two vaccine preparations are available: an attenuated live oral vaccine