First, the patient populations are different Our cohort is predo

First, the patient populations are different. Our cohort is predominantly MSM who have high-risk sexual exposures. In the Swiss cohort, the majority of requests for NPEP were by heterosexual individuals and only 15% of NPEP requests were for exposures in MSM [6]. MSM sources

were also less likely than all other groups to be available for testing; 19% compared with nearly 50% or more in other groups [6]. Our results compare click here better with a San Francisco post-exposure prophylaxis (PEP) study where only 16% of individuals were able to identify a source, and the majority of these were HIV Ab-positive regular partners [7]. When the source’s HIV Ab status was unknown, only 1.8% recruited their source within 4 days. In addition, women were more likely to recruit their source than men (23% compared with 8.5%) [7]. Secondly, the Swiss have a ‘PEP policy’. An Infectious Diseases resident is available ‘around the clock’ to assess the exposed person and to enquire about the source. If a phone number is available, the resident contacts the source directly. In the case of sexual exposure,

Dasatinib datasheet the resident informs the source that there is also a benefit for them to be tested as they may have been exposed to HIV (from the patient who requested NPEP). To increase the rate of success, the resident also makes it clear that the test is free of charge for the source and anonymous (Gilbert Greub, University of Lausanne, Lausanne, Switzerland; personal communication). Our ethics committee did not give approval for the treating clinician to contact the source directly, except if during the consultation the exposed person were present. In addition, the HIV test result of very the exposed person would often be available before the source was tested. This raises the question of whether it is ethical to tell the source that they are at risk too if the exposed person is already known to be HIV negative. Finally, in Switzerland NPEP is paid for by the patient, with some reimbursement via medical insurance [6]. In Australia, NPEP is provided free of charge to exposed individuals. Thus, there is no monetary incentive involved in contacting

the source and preventing or stopping NPEP. The benefits of source tracing for the exposed person perceived by our service, namely elimination of side effects, anxiety and the need for follow-up HIV testing, were not perceived as sufficiently beneficial to outweigh the discomfort of calling a casual partner to discuss HIV. It would seem that the combination of a predominantly MSM population, service model differences and the availability of NPEP free of charge in Australia makes the implementation of successful source tracing in Australia unfeasible. The Victorian NPEP Service is funded by the Victorian Department of Health. No funding was received for this project. Conflicts of interest: There are no conflicts of interest.

Although previous studies have demonstrated that various ID rabie

Although previous studies have demonstrated that various ID rabies vaccine schedules provide long lasting immunity,10,11 the persistence of antibodies after a TRID2 schedule warrants further investigation. The antibody response to subsequent vaccine boosters after the TRID2 schedule also needs to be assessed, but it is reassuring that other studies have shown good response to boosters a year or more after standard and abbreviated rabies ID vaccination www.selleckchem.com/products/dabrafenib-gsk2118436.html schedules.9,10,14,15 The immunogenicity of TRID2 should also be compared to other abbreviated schedules using ID rabies vaccines.10,14,16 The use of the ELISA technique rather than the WHO recommended gold standard RFFIT method should also be taken

into account when interpreting the results of this study.1,12 The TRID2 schedule should be considered an option for pre-exposure rabies vaccination in clinics with staff who are experienced at administering ID vaccines. Further research is required to confirm the findings in this case series, assess the

variation in response between different age groups and gender, and determine the optimal timing of vaccine doses and serology. If such additional work supports our findings, it may become appropriate to consider revisions to the current vaccination guidelines to include a modified ID pre-exposure Obeticholic Acid price rabies vaccination schedule. We would like to thank the staff at Dr Deb—The Travel Doctor, Brisbane, Australia for collecting the data, and Justine Jackson (RN) for managing and collating the data. This study was not subsidized, funded or associated with Janus kinase (JAK) the vaccine manufacturers in any way. D. J. M. and C. L. L. are doctors at privately owned, independent travel medicine clinics, and provide rabies vaccines to travelers. The other authors state they have no conflicts of interest to declare. “
“A 54-year-old woman presented with 2 weeks of fever after a trip to the Northeastern United States. Except for an erythematous

skin lesion on her right shoulder, no physical abnormality was detected. We diagnosed concomitant borreliosis and babesiosis. Both infections were possibly acquired by one bite from Ixodes scapularis. A 54-year-old woman presented in July 2009 with a 2-week history of chills and fever up to 40°C. Because of her job as event manager, she had visited Egypt, Costa Rica, and South Africa over the past years. In February and March 2009, she had traveled to Indonesia (Bali, Sulawesi, and Papua) taking atovaquone–proguanil as malaria chemoprophylaxis. On a recent trip to the United States in June, she had visited Boston, the Niagara Falls area, and Cape Cod where she went hiking with a friend. We saw a moderately ill, febrile woman, neither anemic nor jaundiced. Except for an erythematous skin lesion of 5 cm diameter on her right shoulder, no physical abnormalities were detected.