Sexually transmitted diseases in Ukraine.

Letters epidemics occur (e.g., diphtheria in eastern Europe in the early and mid-1990s) (9). If needed, the World Health Organization can provide information on confirmed and uncon-firmed epidemics on a weekly basis. Travel and peacekeeping mission statistics share similarities. In Namibia, the South African Armed Forces had most often observed hepatitis (unspecified), with rare cases of tuberculosis, typhoid, and meningitis (unpub. SAMS report: Disease Profile of South West Africa, 1989), as did the UN mission to Namibia, where within 12 months and with 7,114 employees, seven cases of hepatitis (mostly hepatitis A, some unspecified) occurred (10). No other vaccine-preventable infections were diagnosed in this UN mission. Considering both risk (on the basis of incidence rates) and impact of infection, the priority for immunization (from highest to lowest) is measles. To administer all vaccines would be extremely costly and may also result in an increased rate of adverse side-effects. Immunizations against the more frequent, more severe infections should be given priority. If a mission is limited to one season, environmental factors of that respective season should be considered. This general rule is more important for vector-borne than for vaccine-preventable infections, except for influenza and meningococcal disease. Persons who are already immune (because of previous immunization or immunity after infection) need not be vaccinated. The latter cause is particularly often true of hepatitis A; troops recruited in developing countries have an anti-hepatitis A virus seroprevalence rate close to 100% (11). Hepatitis B immunization, except for non-and low-responders, probably grants lifelong protection (12); the same is likely for measles vaccine. Sometimes the host country may require proof of some specific vaccination based on the International Health Regulations (13), currently under fundamental revision to become a more effective tool in preventing the spread of infections that may be a global hazard (14). In addition to adequate epidemiologic information and coordination between the military, international health organizations, and the host country, successful intervention efforts require thorough knowledge of vaccine characteristics with varying rates of efficacy and duration of protection. Cost-benefit evaluations, which would be very desirable, are unlikely in areas of political instability. References 1. DuPont HL, Ericsson C. Prevention and treatment of travelers’ diarrhea. To the Editor: With the political changes in eastern Europe in the last 10 years have come social and economic changes (1). Ukraine not