- You are in a small hospital in Venezuela. You have seen a lot of people with "flu" in your consulting rounds. Six local people have been admitted with confusion, convulsions and fever. Two have already died. Lumbar puncture showed an increased number of lymphocytes in each of them. The local veterinary surgeon tells you that in the past 14 days a great many horses have died in the area. What do you think?
- A farming family in Nigeria is increasing the size of their field. The land has been prepared. Five days later the father suddenly develops a high fever. Two days later he becomes yellow. Hepatitis is suspected. The following day he bleeds from his nose and mouth. He still passes 100 ml of urine in 24 hours. The following day he vomits a great deal of black liquid and dies the following evening. Then, his wife becomes seriously ill. What do you think and what do you do? Differential diagnosis?
- You are working in a clinic in eastern India. A feverish 6-year-old boy in a coma is brought to you. There is no previous history of trauma or epilepsy. Administering glucose does not produce any improvement. The laboratory finds trophozoites of P. vivax in the blood. What do you do?
- Nigeria. The local authorities learn that you have been treating a patient with suspected yellow fever. They want to keep you in isolation for 21 days. What are your arguments when talking to the public health people?
- You are in Thailand. Your girlfriend develops fever with muscular and back pain. There is no diarrhoea, coughing or neck stiffness. The prophylactic treatment for malaria consisted of chloroquine and proguanil, which was taken diligently. A year ago she was vaccinated against Japanese Encephalitis. What do you think and what do you do?
- Why is importance attached to proof of vaccination against yellow fever? Why is the vaccine only given in approved centres in Europe?
- Why would the booster injection against yellow fever be valid at once, while the validity of a first vaccination only starts from the tenth day?
- A man comes back from rural Nigeria. He has never been vaccinated against yellow fever. Fourteen days after arriving in Amsterdam he becomes seriously ill. He starts to vomit blood. Should yellow fever be considered?
- Brazil. A dengue epidemic. Someone comes to a village to say that containers with water, discarded tins, cola and other bottles, used coconut shells, flower pots, old car tyres, water tanks, bamboo stubble, rainwater containers, water collections in small boats and bromelias have to be cleared up. Rain gutters have to be unblocked and cleaned. Hollows in tree-trunks have to be filled up. The local people agree to clear up the rubbish but want flower vases and rainwater containers to remain. Is it possible to achieve? What is your input? How often do the small fishing boats have to be upturned or emptied? Can the application of temephos (Abate®) or methoprene (Altosid®) provide a solution for large, important water reservoirs?
- Intercontinental shipment, China. Why should car tyres require fumigation with methylbromide before their export to another continent?
- Nepal. From August to October ’98 in the lowlands a thousand people developed encephalitis. Could this be Japanese Encephalitis?
