Biomedical subjects
SA Berger
Publications and source records attributed to SA Berger.
Re-emergence of Cholera Vaccine.
Although epidemic cholera was first described in 1817, the disease probably has been common in the Indian subcontinent since ancient times.1 Until recently, a single bacterial type (Vibrio cholerae 01) has been responsible for each of the seven recorded cholera pandemics. The current epidemic began in Celebes (Sulawesi), Indonesia, in 1961, and is currently raging through all continents.2 During the 1990s, over 1 million cholera cases have been reported from Latin America, 2000 from Ukraine and the Russian Republic during 1994 alone (GIDEON computer software, C.Y. Informatics, Ramat Hasharon, Israel). Of the 208,755 cases of cholera (5034 fatal) officially reported to the World Health Organization in 1995,3 41.1% were from Latin America, 34.0% from Africa, 24.4% from Asia, and 0.5% from Europe and Oceania. Interest in our own country of Israel stems from the popularity of tourism (over 1 million travelers exit Israel yearly) and the presence of disease in neighboring areas. Following an epidemic of 397 cases in Jerusalem during 1970, periodic outbreaks have occurred in Gaza, Judea and Samaria.4 Three tourists returned with the infection to Israel during the 1980s, all from Egypt (which officially claims to have no cholera).5 Despite universal interest in this ancient disease, medical science has long been frustrated in its search for an effective vaccine. The most important 'vaccine' against cholera is common sense, and consists of intelligent eating and drinking while in endemic areas. For example, local raw fish (ceviche) is a common source of the disease in Latin America, while shellfish (particularly oysters) are often implicated along the American Gulf Coast. Virtually all forms of water purification are effective against Vibrio cholerae. Although antibiotic prophylaxis might be considered in some circumstances (doxycycline; or a quinolone in areas of tetracycline resistance), it is not routinely advocated.
Relative Risk Concept in Travel Medicine - Diseases Left Behind.
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Emporiatrics Versus Geographic Medicine: Interface or Spectrum?
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Computer Program for Diagnosing and Teaching Geographic Medicine.
One of the unique aspects of infectious disease is its wide variety, both in time and place. The specialist practicing in India may have little or no expertise in Peruvian disease. A colleague in New York may be called upon to diagnose and treat conditions originating in Africa, Asia, South America, Fiji and Papua, New Guinea. At the same time, this colleague must be familiar with the pathogens that originate in Texas, Hawaii, and Canada. Indeed, even the full-time infectious diseases specialist may not be conversant in diseases such as lagochilascariasis, louping ill, and lobomycosis. War, famine, education, immigration, and business travel have contributed to the advent of specialists in Geographic Medicine and Emporiatrics, otherwise known as Travel medicine. The "art" of diagnosis is largely an ability (albeit subconscious) to rank probabilities based on the incidences of likely diseases and the chance of encountering given clinical features within each disease. In theory, Bayesian analysis could be employed to diagnose disease accurately when given proper input. A multicenter study was undertaken to test a comprehensive computer driven-software program that incorporates worldwide epidemiologic and clinical parameters.
Period tripling in periodic flows through curved pipes.
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