Compliance reached ≥80% for the consumption of bottled water, the use of repellents, routine vaccine update, and yellow fever immunization. Factors independently associated with low compliance with antimalarials

were traveling to the Indian Ocean or Asia, age <5 years, and monoparental family. The authors want to thank Mrs Penny Hands for her kind help in the drafting of the manuscript. The selleckchem authors state they have no conflicts of interest to declare relevant to this article. “
“Background. Traveling the world may result in infection with tropical or other travel-associated diseases. This applies increasingly also to people with immune-compromising and other medical conditions, as well as to elderly individuals. To reduce exposure and susceptibility to health risks, there is a need for appropriate pre-travel advice for these particular groups of travelers. Methods. In this observational study, we analyzed the overall risk of health problems among travelers with underlying medical conditions who attended the University of Amsterdam’s Academic Medical Center’s (AMC) travel clinic from January to October 2010. Telephone questionnaires were administered to 345 travelers with underlying conditions and 100 healthy travelers. Results. The most common underlying medical conditions studied included: (1) diabetes mellitus; (2) impaired immunity due to use of immune-suppressing

medication; (3) reduced gastric barrier; and (4) HIV infection. The overall incidence of travel-related diseases (TRDs) was higher among those patients with underlying medical conditions compared to healthy travelers [incidence Selinexor purchase FER rate ratio (IRR) 2.26, 95% CI (1.29–3.98)]. Of all diseases reported, gastrointestinal disease, fever, and respiratory problems were reported most frequently. Travel to Central

America, South Central Asia, Northeast Asia, and North Africa was associated with increased risk of contracting TRD. Hepatitis B protection was absent or unknown in 75% of these travelers. Conclusions. Travelers with medical conditions had a higher risk of obtaining TRD, predominantly gastrointestinal in nature. People travel the world extensively, and increasingly so. Between 20 and 70% of the 50 million people from the industrialized world visiting the developing world report illness associated with their travel. Although most illnesses are mild, 1 to 5% of returned travelers become ill enough to seek medical attention, and 1 in 100, 000 succumbs to travel-related disease (TRD).1 Among patients with underlying medical conditions, diseases acquired during travel may lead to more severe consequences compared to healthy travelers.2–5 Also, depending on the underlying condition there may be diminished immunogenicity and clinical efficacy of vaccinations. Live attenuated vaccines, such as that for yellow fever, may elicit disease.

B.-B. “
“The clone Escherichia coli O25 ST131, typically producing extended-spectrum beta-lactamases (ESBLs), has spread globally and became the dominant type among extraintestinal isolates at many parts of the world. However, the reasons behind the emergence and success of this clone are only partially understood. We compared the core

type genes by PCR of ESBL-producing and ESBL-nonproducing strains isolated from urinary tract infections in the United Arab Emirates and found a surprisingly high frequency of the K-12 core type (44.6%) among members of the former group, while in the latter one, it was as low (3.7%), as reported earlier. The high figure was almost entirely attributable to the presence of members of the clone O25 ST131 among ESBL producers. Strains from NU7441 the same clone isolated in Europe also carried the K-12 core type genes. Sequencing Erlotinib ic50 the entire core operon of an O25 ST131 isolate revealed a high level of similarity to known K-12 core gene sequences and an almost complete identity with a recently sequenced

non-O25 ST131 fecal isolate. The exact chemical structure and whether and how this unusual core type contributed to the sudden emergence of ST131 require further investigations. In Escherichia coli, the core oligosaccharide (OS) part of the lipopolysaccharide (LPS) molecule occurs in five different types: R1–4 and K-12, respectively

(Muller-Loennies et al., 2007). The core has a crucial role in maintaining the structure of the cell wall, although to what extent and how its specific type affects the colonizing capacity or the virulence of a pathogen remains to be elucidated. Nevertheless, earlier studies consistently found a highly disproportional distribution of these core types among commensal and clinical E. coli isolates (Gibb et al., 1992; Appelmelk et al., 1994; Amor et al., Thiamet G 2000; Gibbs et al., 2004). Among strains recovered from extraintestinal infections, the frequency of R1 core type reached 61.0–81.0%, while that of the K-12 type was found the least or the second least common (2.2–5.6%) (Gibb et al., 1992; Appelmelk et al., 1994; Amor et al., 2000). These frequencies were well reflected by the distribution of core-type-specific antibodies in the population (Gibbs et al., 2004). In the past decade, the spread of extended-spectrum beta-lactamase (ESBL)-producing E. coli strains considerably altered the epidemiology and treatment options of extraintestinal infections (Woodford et al., 2011; Van der Bij et al., 2012). A significant percentage of these isolates belong to a limited number of clones, some considerably differing in their panel of virulence factors from those described earlier (Totsika et al., 2011; Van der Bij et al., 2012).

, 2005) and in M. grisea GUY II (Leung et al., 1988). Activity was also detected in commercial enzyme preparations, such as Celluclast®. A three-step protocol was elaborated to purify the enzyme secreted by T. reesei RUT-C30. Using RNAse B as a test

substrate, the yield and specific activity enhancement could be estimated (Table 1 and Fig. 1). Taking advantage of the absence Epacadostat molecular weight of a carbohydrate-binding module in the Endo T, the Avicel adsorption step was efficient in removing the bulk of the cellulases (14-fold enrichment), although a substantial decline (61%) in yield was observed. Anion exchange chromatography yielded a large fraction at 180–300 mM salt, active against yeast invertase as detected by PAGE buy GPCR Compound Library band shifting. This purification step resulted in a substantial enrichment (172-fold) and almost no loss of activity. A

final 1300-fold purification with a 25% yield of activity and 870 μg of extracellular protein were obtained. Under reducing conditions of the purified protein, SDS-PAGE revealed two closely migrating protein bands in the 30–33 kDa range (Fig. 1). N-terminal sequencing of the minor fraction with the highest apparent molecular weight (Fig. 1, lane 6) indicated a contaminating RNAse from T. reesei. Its presence in the final Endo T preparation was not detrimental to the results of our study. CNBr treatment before trypsin digestion of the major fraction with the lowest molecular weight on gel (Fig. 1, lane 6) yielded a large peptide of 3212 Da; this peptide was fragmented and 26 residues (VGGAAPGSFNTQTI/LDSPDSATFEHYY) could be determined. Using the tblastn function against filtered model transcripts Glycogen branching enzyme in the T. reesei genome (Martinez et al., 2008), the gene was found on scaffold_15: 471437–472471. An ORF encoding a protein of 344 amino acids (protein ID name 65162) with a family fh18 domain was identified (Fig. 2). The experimentally determined internal peptide sequences covered almost 33% of the Endo T sequence (underlined in Fig. 2). Some unexpected tryptic peptides

(cleavage after Q97, T280 and E290) were observed. The latter residue could represent the C-terminus of the protein, and the other unspecific cleavage sites. Analysis using the signalp web application for predicting signal sequence cleavage sites indicates a 17-amino acid signal peptide. However, because the N-terminal sequence of the Endo T protein was determined as AEPTD, nine additional residues have been cleaved off. This processed form was used for numbering in Fig. 2. Upon C-terminal sequencing, only a strong signal for a glutamate (E) residue was detected. Four potential N-glycosylation sites were present: Asn70, Asn170, Asn240 and Asn316 (Fig. 2). The electrospray ionization (ESI) mass spectrum of the purified sample showed one abundant species of 32 102 Da with no evidence for glycoforms (data not shown).

Despite the slight drop in 2008, our conclusion, based on multivariate results, is that the overall incidence of bacteraemia rose slightly during this period, especially after 2004. This is consistent with data suggesting an increase in MRSA during this time interval [12,14]. The organism-specific bacteraemia rates reported in this study are consistent with previous findings in the literature that support the predominance of S. aureus, coagulase-negative staphylococci and S. pneumoniae as pathogens in bacteraemia among HIV-infected patients Alectinib in developed countries [2,8,15–19]. This contrasts with studies conducted in the developing world, particularly in

Africa and Southeast Asia, which document higher rates of Salmonella species bacteraemia [3,20]. The incidence of S. aureus decreased in recent years; however, the incidence of bacteraemia NOS increased. The high proportion of bacteraemia NOS makes it difficult to interpret see more trends in organism-specific rates. When we examined

all bacteraemia-NOS episodes at one of the largest sites, we found that the most common organism cultured was S. aureus (38%) followed by other Staphylococcus (18%). Of the total cases of S. aureus bacteraemia, 61% were MRSA. The high proportion of MRSA bacteraemia is consistent with other studies demonstrating an increasing prevalence of MRSA bacteraemia in HIV-infected

patients in recent years [12]. Unfortunately, the specific ICD-9 code for MRSA was implemented only in 2008 and did not appear in the data for previous years, so we were not able to subdivide our general category for S. aureus bacteraemia by antibiotic sensitivity. To the extent that the rise in bacteraemia-NOS admissions is attributable to MRSA, the results Inositol monophosphatase 1 point to a growing problem, with potentially adverse effects on morbidity, mortality and treatment expenditures. Consistent with prior studies, IDU was a strong, independent risk factor for bacteraemia [5,7,11]. This association was significant, even though our measure reflects a history of IDU, and not necessarily current IDU. Skin-popping, use of dirty needles and inadequate skin cleaning among IDUs may promote bacterial infection [21]. Previous investigations have also demonstrated an association between IDU and S. aureus bacteraemia in HIV-infected individuals [22]. Evidence suggests that the reason for this association may be, in part, the higher rates of nasal colonization by MRSA and S. aureus in IDUs [23–25]. Because this study relied on administrative data, we were unable to examine a link between bacterial nasal colonization and subsequent development of bacteraemia in this population. Black, but not Hispanic, patients were more likely to have a bacteraemia diagnosis than White patients.

18 Hentrich M, Berger M, Hoffmann C et al. HIV-associated Hodgkin’s lymphoma (HIV-HL): results of a prospective multicenter trial. J Clin Oncol 2010; 28(Suppl 15): Abstract 8035. 19 Jacobson CA, Abramson JS. HIV-associated Hodgkin’s lymphoma: prognosis and therapy in the era of cART. Adv Hematol 2012; 2012: 507257. 20 Lister TA, Crowther D, Sutcliffe SB et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 1989; 7: 1630–1636. 21 Hasenclever Saracatinib nmr D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998; 339: 1506–1514. 22 Spina M, Re A, Vaccher E

et al. High international prognostic score predicts a worse outcome for patients with Hodgkin’s disease and HIV infection: results of a Dactolisib concentration prospective study with Stanford V regimen. Ann Oncol 2003; 14: 655–656. 23 Hentrich M, Maretta L, Chow KU et al. Highly active antiretroviral therapy (HAART) improves survival in HIV-associated Hodgkin’s disease: results of a multicenter study. Ann Oncol 2006; 17: 914–919. 24 Ribera JM, Navarro JT, Oriol A et al. Prognostic impact

of highly active antiretroviral therapy in HIV-related Hodgkin’s disease. AIDS 2002; 16: 1973–1976. 25 Errante D, Gabarre J, Ridolfo AL et al. Hodgkin’s disease in 35 patients with HIV infection: an experience with epirubicin, bleomycin, vinblastine and prednisone chemotherapy in combination with antiretroviral therapy and primary use of G-CSF. Ann Oncol

1999; 10: 189–195. 26 Bohlius J, Schmidlin K, Costagliola D et al. Incidence and risk factors of HIV-related non-Hodgkin’s lymphoma in the era of combination antiretroviral therapy: a European multicohort study. Antivir Ther 2009; 14: 1065–1074. 27 Clifford GM, Rickenbach M, Lise M et al. Hodgkin lymphoma in the Swiss HIV Cohort Study. Blood 2009; 113: 5737–5742. 28 Dauby N, De Wit S, Delforge M et al. Characteristics of non-AIDS-defining malignancies in the HAART era: a clinico-epidemiological study. J Int AIDS Soc 2011; 14: 16. 29 Franzetti M, Adorni F, Vergani B et al. Incidence trends and outcome of non-aids-defining malignancies (NADM) in a cohort of HIV-infected patients during the period 1985–2008. Infection 2011; 39: S30. 30 Lanoy E, Rosenberg Amisulpride PS, Fily F et al. HIV-associated Hodgkin lymphoma during the first months on combination antiretroviral therapy. Blood 2011; 118: 44–49. 31 Lanoy E, Rosenberg PS, Fily F et al. Risk of HIV-associated Hodgkin lymphoma during the first months after initiation of combination antiretroviral therapy. Infect Agents Cancer 2010; 5(Suppl 1): A71. 32 Mwakigonja AR, Kaaya EE, Mgaya EM. Malignant lymphomas (ML) and HIV infection in Tanzania. J Exp Clin Cancer Res 2008; 27: 9. 33 Eichenauer DA, Engert A, Dreyling M. Hodgkin’s lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; 22(Suppl 6): vi55–58.

Effects

of acute nicotine (500 nm) on DA release probability and its sensitivity to activity were apparent. However, in NAc there was downregulation of the functional dominance of α6-nAChRs (α6α4β2β3), and an emergence in function of BGB324 non-α6* nAChRs. In CPu, there was no change in the control of DA release by its α6 nAChRs (α6β2β3) relative to non-α6. These data suggest that chronic nicotine subtly modifies the regulation of DA transmission, which, in NAc, is through downregulation of function of a susceptible population of α6α4β2β3 nAChRs. This imbalance in function of α6:non-α6 nAChRs might contribute to DA dysregulation in nicotine addiction. “
“The orbitofrontal cortex (oPFC) sends substantial projections to the ventrolateral striatum and aspects of the nucleus

accumbens that are, functionally, poorly understood. This is despite probable cortico-striatal involvement in multiple diseases such as addiction and obsessive-compulsive disorder. Here we surgically disconnected the oPFC from the ventrolateral striatum using unilateral asymmetric lesions in mice and classified instrumental decision-making strategies. Mice with symmetric lesions that spared one Idasanutlin purchase oPFC–striatal network served as controls. As a complementary approach, we selectively knocked down Brain-derived neurotrophic Nintedanib (BIBF 1120) factor (Bdnf) bilaterally in the oPFC and ascertained behavioral and neurobiological consequences within the downstream striatum. oPFC–striatal disconnection and oPFC Bdnf knockdown blocked sensitivity to outcome-predictive relationships in both food-reinforced and cocaine-associated settings. Bdnf knockdown simultaneously regulated striatal BDNF expression, and striatal c-Fos predicted sensitivity to action–outcome associative

contingencies. Previous evidence strongly implicates the dorsolateral striatum in stimulus–response habit formation. Our findings thus provide novel evidence for functional compartmentalisation within the lateral striatum, with the dorsal compartment subserving classical stimulus–response habit systems and a ventral compartment coordinating outcome-based decision-making via oPFC interactions. This compartmentalisation may apply to both ‘natural’, as in the case of food-reinforced behavior, and ‘pathological’, as in the case of cocaine-seeking, contexts. “
“Metformin is currently the first-line treatment drug for type 2 diabetes. Metformin is a well-known activator of AMP-activated protein kinase (AMPK). In experimental studies, metformin has been shown to exert direct vascular effects by increasing vascular endothelial growth factor expression and improving microvascular density.

Responders had to meet two pre-established criteria: (i) show statistically significant increases for detection performance of at least one additional selleck chemicals llc eccentricity at the end of the rTMS treatment (with regards to their performance at the end of the spontaneous recovery phase); and (ii) display significant performance improvements for the overall contralesional hemifield. If either one or both of these two criteria were not met then the subject was assigned to the Non-responder group. A repeated-measures anova was initially used to determine whether spontaneous

recovery or rTMS treatment yielded statistically significant ameliorations over the course of treatment for the active 10-Hz rTMS group. These analyses were done for performance levels (% correct detection) as a dependent variable, and follow-up phase (spontaneous recovery,

rTMS treatment, post-rTMS phase), visuospatial task (Static, Moving 2 tasks), and visual hemispace (ipsilesional, contralesional) as independent factors. The F-statistic from the repeated-measure anova is reported in the format Fdf factor, df error. We also conducted a-priori planned pair-wise comparisons using a Student’s t-test of the critical time points in the study (pre-lesion, post-lesion, pre-rTMS and post-rTMS). For lesion analysis, the percentage of spared cortex was determined with the above-mentioned calculation, and percentages of spared cortex were then averaged for each group. Repeated-measures anova was first conducted between groups using stereotaxic coordinates (A-P coordinates) selleck chemical as factors to determine whether significance in lesion size was present throughout the visual areas. Student’s t-tests ADP ribosylation factor were used to compare the total area of lesion between groups. Statistical significance was set to P < 0.05 for all parametric analyses used in this study. In accordance with prior studies, lesions targeting both banks of the feline right posterior parietal cortex (known as pMS) induced a complete contralesional visuospatial orienting deficit in all tasks. These deficits were present immediately after the lesion (only 24 h post-injury)

and started to improve spontaneously shortly thereafter. The basis of this improvement is likely to be a combination of network modulation vicariation (Rushmore et al., 2010) and reduction in acute effects such as inflammation, lesion-induced depolarization and cortical spreading depression events (see reviews by Cramer, 2008; Nudo, 2011). For the high-contrast moving task (Moving 1), subjects regained function in the contralesional visual hemispace within 5–10 days, and exhibited complete and stable recovery 30 days thereafter (Moving 1, 30 days post-injury 93 ± 4% vs. 98 ± 1% pre-lesion, P = 0.05; data not shown in figure form) which remained unaltered across the follow-up period. In contrast, recovery for static or laser-based moving targets (Day 70: Static pre-rTMS, 39 ± 7% vs. pre-lesion, 82 ± 3%; P = 0.

solani was evaluated at different concentrations (Fig. 3). The inhibition varied according to the type of antagonistic fungal isolate. This inhibition increased proportionally with the filtrate concentration of the antagonist isolate. The greatest inhibition was observed with T. atroviride culture filtrates. This Galunisertib experiment revealed that potato seed tubers planted in a substrate inoculated with both R. solani and antagonist germinated within 1 week.

The emergence of potato seed tubers was significantly low as compared with those planted in pots containing antagonist fungal isolates (data not shown) or compared with the control treatment (only treated with pathogen). In the case of pots uninfected with pathogen (untreated control), seed tubers planted in the presence of antagonistic fungal isolates started emerging at the same time as the untreated control. AZD9291 manufacturer Compared with the inoculated, untreated control, plants receiving antagonist isolates had a significantly reduced index of stem disease (Table 3). The highest

disease index of R. solani in stems was observed in the infected control treatment (4.46). The disease index differed significantly among the different treatments, ranging from T. atroviride (0.1), E. nigrum E8 (1.13), E. nigrum E18 (1.80), E. nigrum E1 (1.86), Phomopsis sp. (1.86) to A. longipes (2.86), with the untreated control at unity (1.00). The highest severity of disease was observed in the infected and noninoculated treatment (0.89) followed by A. longipes, Phomopsis sp., E. nigrum E18, E. nigrum E1, E. nigrum E8, and T. atroviride and the untreated control (0.57, 0.37, 0.36, 0.36, 0.22, 0.20, and 0.20, respectively). All treatments that were inoculated with R. solani and treated with antagonist had a significantly higher yield than the inoculated treatment (R. solani alone). The highest tuber weight (yield) was recorded in T. atroviride (211 g per plant), followed by the untreated treatment (199 g per plant), and then E. nigrum E8, E. nigrum E18, E. nigrum E18, A. longipes,

and Phomopsis sp. Results also showed significant differences in fresh weight, plant height, and root weight depending on the treatment. The best results were observed for treatments based using T. Demeclocycline atroviride or E. nigrum and the untreated control (results not shown). Our findings show that fungal endophytes have significant antagonistic activity against R. solani when tested by an in vitro dual culture. These fungi were identified as T. atroviride, Phomopsis sp., A. longipes, and E. nigrum (E1, E8, and E18) using ITS regions of rDNA. The inhibition rate varied significantly according to the type of antagonist. The highest inhibition rate against R. solani was recorded using T. atroviride, followed by Phomopsis sp., A. longipes, and three E. nigrum isolates.

solani was evaluated at different concentrations (Fig. 3). The inhibition varied according to the type of antagonistic fungal isolate. This inhibition increased proportionally with the filtrate concentration of the antagonist isolate. The greatest inhibition was observed with T. atroviride culture filtrates. This Trametinib chemical structure experiment revealed that potato seed tubers planted in a substrate inoculated with both R. solani and antagonist germinated within 1 week.

The emergence of potato seed tubers was significantly low as compared with those planted in pots containing antagonist fungal isolates (data not shown) or compared with the control treatment (only treated with pathogen). In the case of pots uninfected with pathogen (untreated control), seed tubers planted in the presence of antagonistic fungal isolates started emerging at the same time as the untreated control. MK-2206 solubility dmso Compared with the inoculated, untreated control, plants receiving antagonist isolates had a significantly reduced index of stem disease (Table 3). The highest

disease index of R. solani in stems was observed in the infected control treatment (4.46). The disease index differed significantly among the different treatments, ranging from T. atroviride (0.1), E. nigrum E8 (1.13), E. nigrum E18 (1.80), E. nigrum E1 (1.86), Phomopsis sp. (1.86) to A. longipes (2.86), with the untreated control at unity (1.00). The highest severity of disease was observed in the infected and noninoculated treatment (0.89) followed by A. longipes, Phomopsis sp., E. nigrum E18, E. nigrum E1, E. nigrum E8, and T. atroviride and the untreated control (0.57, 0.37, 0.36, 0.36, 0.22, 0.20, and 0.20, respectively). All treatments that were inoculated with R. solani and treated with antagonist had a significantly higher yield than the inoculated treatment (R. solani alone). The highest tuber weight (yield) was recorded in T. atroviride (211 g per plant), followed by the untreated treatment (199 g per plant), and then E. nigrum E8, E. nigrum E18, E. nigrum E18, A. longipes,

and Phomopsis sp. Results also showed significant differences in fresh weight, plant height, and root weight depending on the treatment. The best results were observed for treatments based using T. ID-8 atroviride or E. nigrum and the untreated control (results not shown). Our findings show that fungal endophytes have significant antagonistic activity against R. solani when tested by an in vitro dual culture. These fungi were identified as T. atroviride, Phomopsis sp., A. longipes, and E. nigrum (E1, E8, and E18) using ITS regions of rDNA. The inhibition rate varied significantly according to the type of antagonist. The highest inhibition rate against R. solani was recorded using T. atroviride, followed by Phomopsis sp., A. longipes, and three E. nigrum isolates.

Only four patients over 60 years (60, 62, 65, and 71 y) were vaccinated against learn more yellow fever, and only one who was in good physiological condition and traveled to Benin for 2 weeks received a primary vaccination. In this case the benefit of vaccination was assessed to be superior to risk. All 413 travelers needing vaccination and presenting no contra-indication

were vaccinated (100%, 95% CI: 99–100%). Although South Africa and the Comoros Islands are not endemic for yellow fever and vaccination is not recommended, three patients, however, received yellow fever vaccination without indication as they were traveling to these two countries.9 All the travel destinations were considered as at risk for hepatitis A. As many as 276 patients were considered immune to hepatitis A. Among the non-immune patients (n = 454), 442 patients were vaccinated (97.4%, 95% CI: 95.4–98.5%) against hepatitis A. Five patients refused vaccination (1.1%) Selleckchem Temsirolimus and vaccination was not proposed to seven patients (1.5%). To improve the services for travelers at our travel medicine and vaccine center, we wanted to increase our knowledge about the adequacy of the advice given to travelers

to national guidelines. We selected three fields of interest: malaria prevention, yellow fever, and hepatitis A vaccinations, which are key to safe travels in the tropics, and performed a 3-month prospective study before summer holidays. These three fields of interest are relevant since 83% of our travelers visited malaria-endemic areas, 74% visited yellow fever-endemic areas, and all of them were exposed to the risk of hepatitis A. Previous studies

have also shown that 35 to 49% of travelers to Africa carried either no or inappropriate prophylaxis.10,11 Overall our results look quite satisfactory since adequacy to national guidelines was above 95% for all three diseases. These results were obtained in the setting of a study of 730 travelers, assessing real prescriptions from physicians. These results compare favorably to results obtained in previous studies assessing the quality of travel medicine, most of which used questionnaires.12–18 Interestingly, doxycycline was the most frequent chemoprophylaxis prescribed for malaria in this study (48% of all prescriptions). This drug is the cheapest anti-malaria prophylaxis not in France, and is as effective as the other drugs.19–21 It is also well tolerated, with a better tolerability profile than mefloquine.22–24 The limitation for its use is the need to continue treatment for 4 weeks after leaving the malaria-endemic area, with a risk for suboptimal adherence23–24 and travelers who want to sunbathe, because of the risk of phototoxicity. During the 3-month period of the study, 413 travelers received yellow fever vaccination. This represents a large number of vaccinations as compared to travel centers in most parts of Europe.25 There are a number of potential explanations for these good results.