27 April, 2010

Casablanca, Morocco

Time : November 16~18, 20~21, 1987.
Place: Casablanca, The Kingdom of Morocco
Major languages: Arabic (official), Berber, French, Spanish
Major religion : Islam
Monetary unit : Dirham = 100 centimes
Main exports : Minerals, seafood products, citrus fruit

The total numbers of Japanese, who live 3 months more = 50(+5 children).
We done health consultations of attaches, Embassy of Japan and other Japanese.

the center of Casablanca
from hotel window

Rabies vaccine

Rabies vaccine(Kaketsuken)

1) Transmission: Bitten by rabies-infected dogs.
-------------------The most common wild reservoirs of rabies are raccoons, skunks, 

------------------- bats, foxes,coyotes, cats and cattle.
2) Rabies vaccine: Inactivated Tissue Culture Rabies Vaccine.

------------------ Rabies virus(HEP Flury strain), culture in Chicken embryo cells.
3) Manufacture:    Kaketsuken, Kumamoto 860-8568, Japan
4) Dosage :
----------- 1) pre-exposure: 3 times( 0, 4 weeks later, 6~12 months later)

------------------------------- subcutaneously( not intramuscular).
---------- -2) post-exposure: 6 times.

Any questions: write to Keiji Hagiwara, MD
---------------------------------Kami-Ube Pediatric Clinic,
---------------------------------Ube 755-0097, Japan

22 April, 2010

Herpes zoster (Shingles)

1) What is Herpes zoster (Shingles)  ?
small blisters with itching and burning pain
----- a stripe or belt-like pattern along with rib.

2)  Commonly occurs on the torso(65%), but can appear on the face, eyes (20%)
-------or other parts of the body(15%).  

Herpes zoster(the orbit of the eye and frontal head;
 the ophthalmic division of the trigeminal nerve)
 --------------Ramsay Hunt syndrome: if affect the facial nerve to the 
vestibulocochlear nerve, resulting the hearing loss and vertigo.

Herpes zoster(back region)
Herpes zoster(Thigh region)

3)  The causative agent: Varicella zoster virus (=VZV )
Electron-microscopic image(white bar=100nm)

Herpes zoster occurs only in person who suffered from Chickenpox.  
After recovered, the virus live in the spinal nerve ganglia( There are 8 cervical nerves, 
12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves) adjacent to the spinal cord.
When a person have a stress or aging, the VZV is reactivated and go through the
nerve and rise to the skin regions.

4) Age: the majority of sufferers are older persons. Rare in infant.

5) Treatment )   i) Topical ointment: the mixture of 10% Zinc oxide and 2% phenol.
---------------- -ii) Antiviral drugs:  Acyclovir, Valaciclovir
----------------- The rash and pain usually subside within one month in child, but 
--------------------- some elderly patients develops a painful condition. In such case,
----------------------Please ask doctors.

Any questions:    write to      Keiji Hagiwara, MD
---------------------------------Kami-Ube Pediatric Clinic,
---------------------------------Ube 755-0097, Japan

Mumps vaccine

Mumps vaccine:  a live attenuated vaccine.  
Age ::   one year old or older.
Side effect of vaccine:  aseptic meningitis(1/5,000~1/10,000 ??)

➞ MMR vaccine contain Mumps, Measles and Rubella viruses.

21 April, 2010


Mumps: The swelling start from the site, under the Earlobe,
where parotid gland is there. Submandlbuiar glands are also
swelling.  At 2~3 year old, it is sometimes difficult to notice.
Mumps (Parotitis due to Mumps virus):
1) incubation period: 2~3 weeks
2) causative agent: Mumps virus
4) ages: 2~3 year and older.
5) complication:
------ i) After puberty, Orchitis occur, resulting the decrease of testicular Sperm's numbers.
------ ii) Aseptic meningitis: it's frequency may be 1/30~~1/300)
------ iii) Deafness: 1/10,000~20,000.

---- if your child suffered 2 or more times of Parotitis---- it is " recurrent parotitis".
----- Parotitis due to Mumps virus is suffered only one time.

6) prevention:  Mumps vaccine( MMR vaccine contain this vaccine)

Exanthema subitum(Roseola) ?

7 month old, boy
April 19. at noon, mother noticed fever 39.2℃. No cough, No running nose.

-----  20. at night, fever fell down and eruption appeared face and trunk.
-----  21. came to Clinic. Measles like eruption at trunk( front >back), face.
---------- not in hand and foot.

Comment:  This is not Exanthema subitum(Roseola), since duration of fever 
ーーーーーwas 1.5 days, two short ----- may be a type of Echovirus infection.

Any questions: write to Keiji Hagiwara,
--------------------------- Kami-Ube Pediatric clinic,
--------------------------- keijihagiwara@gmail.com

20 April, 2010

Cholera vaccine

1) Vibrio cholerae (Electron-microscopic image, x 2,000)

2) certificate of Cholera vaccine ( formerly used ):

3) killed whole-cell(Vibrio cholerae 01) vaccine for injection:
----- In 2001, WHO recommended the stop to use of this vaccine. 

------prophylactic usage is not currently recommended for routine use by the 
----- Centers for Disease Control and Prevention.

4) Oral cholera vaccine:
----- Brand name: Dukoral 
----- Munufacture: Crucell, Leiden,The Netherlands ( http://www.crucell.com/ )
------Dukoral® was first licensed in 1992 and is now licensed in over 60 countries.
------ Vaccine components: killed whole-cell Vibrio cholerae O1 and recombinant B subunit
-----------------------------------of cholera toxin. also protective against Vibrio cholerae 139.

Any questions:  write to Keiji Hagiwara,
--------------------------- Kami-Ube Pediatric clinic,
--------------------------- keijihagiwara@gmail.com

18 April, 2010

Yellow fever vaccine

1) Vaccine          : live attenuated vaccine 
2) Trade name   : YF-VAX®
3) Manufacture : Sanofi Pasteur
4) Dosage, administration : reconstitute immediately before use with the sterile diluent provided 
------------------------------------- (Sodium Chloride Injection USP – contains no preservative).
-------------------------------------- a single subcutaneous injection of 0.5 mL.
5) Booster Doses  : Recommend every 10 years. Some studies suggests that yellow fever vaccine 
----------------------------immunity persists for at least 30 to 35 years and probably for life.
6) Indication         :  1) 9 months of age and older, because of the risk of encephalitis. 
-------------      - ----2) older than 65 year, if vaccinated, elderly persons should be carefully 
--------------  --     ---------monitored for adverse events for 10 days post-vaccination.

7) Contraindications:  1) as in the same of other live vaccines.
--------------------------2) infants less than 9 months of age. 
8) The certificate of Yellow fever vaccination: countries of sub-sahara Africa and south 
----America may be required. Must be ask the the destination country’s embassy or consulate.
-------------------     --------Examples: a) Accra, Ghana
--------------------     ---------------------b) Monrovia, Liberia
-------------------     ----------------------c) Konakry, Guinea

Countries that require proof of yellow fever vaccination for all arriving travelers

Angola, Benin, Bolivia, Burkina Faso, Burundi, Cameroon, Central African Republic,
Congo, Repubic of the Côte d’Ivoire, Democratic Republic of Congo, French Guiana,
Gabon, Ghana, Liberia, Mali, Niger, Rwanda, São Tomé and Príncipe, Sierra Leone,

※ Country requirements for yellow fever vaccination are subject to change at any time;
---- therefore, CDC encourages travelers to check with the destination country’s embassy
---- or consulate before departure.

References → Traveler's Health( Centers for Disease Control and Prevention)

Any questions:    write to      Keiji Hagiwara, MD
---------------------------------Kami-Ube Pediatric Clinic,
---------------------------------Ube 755-0097, Japan

17 April, 2010

Donka National Hospital, Conakry, Guinea

Time:  November 16, 1987.
Place: Donka National Hospital, Conakry, Guinea.

1) The car for blood transfusion by the donation from Japan:

2) Donka National Hospital:  poor equipped, not-clean hospital.
3)  Sun light drying of clothes in the street, Conakry.
4) A Hotel in Conakry:

A market at Conakry, Guinea

Stay period : November 14~17, 1987.
Place           : Conakry(capital),The Republic of Guinea
Major languages: French, various tribal languages
Major religions: Islam, Christianity, indigenous beliefs
Monetary unit : 1 Guinean franc
Electricity        : 220V, 50c/s

Photos)  taken at a market in Conakry.  Do not take photo, because the
---------- peoples in Guinea dislike. I took the photos from the behind the
---------- colleagues.





St. Joseh's Catholic Hospital, Liberia

St Joseph's Catholic Hospital, Monrovia, Liberia.

1) Place: St. Joseph's Catholic Hospital. P.O. Box 512, Monrovia, Liberia.
2) Time:  November 14, 1987.

This hospital is managed and supported by Catholic mission, based in Matrid, 
Spain.  In November 1987, when I visited; full time docters=6, volunteer docters=6, Technicians and Nurses, most of them came from Argentine and Spain.  
As you can see the photos, good hospital.
The entrance of Hospital:
Dr. Manuel G. Son, director, guided the inside of Hospital.
Maternity unit:
Performing the Intra-trachial intubation.
A private room:
Operation room:
Circumcision in neonate; the removal of some or all of the foreskin
from the penis is commonly practised in several ethnic groups in sub-equatorial 
Africa, the Jewish and Islamic faiths.
Infant incubators:
Pediatric ward:
Pediatric ward:

Any questions:    write to      Keiji Hagiwara, MD
---------------------------------Kami-Ube Pediatric Clinic, 
---------------------------------Ube 755-0097, Japan

Monrovia, Liberia

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Stay period      : November 11~13, 1987.
Place                : Monrovia(capital), Republic of Liberia
Languages      : English, 29 African languages.
Major religions: Christianity, Islam, indigenous beliefs
Monetary unit : Liberian dollar (L$)
Electricity        : 110V, 60c/s

WHO recommendation:

Yellow Fever
  Country requirement: a yellow fever vaccination certificate is required from all travellers 
         over 1 year of age.
  Yellow fever vaccine recommendation: yes
  Malaria risk due predominantly to P. falciparum exists throughout the year in the whole 
        country. Resistance to chloroquine and sulfadoxine-pyrimethamine reported.
  Mosquito bite prevention plus mefloquine, doxycycline or atovaquone+proguanil chemo-
       prophylaxis (select according to reported resistance pattern)
  Rabies risk:High risk
  pre-exposure immunization recommended for travellers and other people for whom contact 
        with domestic animals particularly dogs and other rabiesvectors is likely.

Liberia is famous for long-running, ruinous civil war(1989~1999).
At present, 15,000 UN peacekeepers are still in place. When I went to
Monrovia in November 1987, just the beginning of the conflict.

The people of Ghana were peaceful, but the eyes of Liberian were uneasy,
fighting and dark. If you stop the car in the street of Monrovia, children come
to rush the car for begging.