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North American mission boards were surveyed to identify and prioritize missionary medical problems and determine initiatives for improving health. Malaria was the most common nontrivial medical complaint, and viral hepatitis the most serious. Nevertheless, only 72 percent of boards recommend malaria prophylaxis, 57 percent ascribe to regular immune globulin use, and 31 percent advocate hepatitis B immunization. Sub-Saharan Africa was considered the region of the world where missionary health was most in peril. Besides strategies to minimize the risks of malaria and hepatitis, recommendations for improving missionary health include greater use of rabies and typhoid vaccines; increased attention to mental health concerns and accident prevention, particularly seat belt use; increased health education regarding both clinical issues and public health principles; improved scheduling for relaxation and family time; and greater availability of comprehensive health services before departing, while abroad, and upon returning from an overseas assignment.

A seroepidemiologic survey was conducted in 25 clinical and 31 nonclinical personnel engaged in substance abuse research and treatment. The antibody to hepatitis A virus (anti-HAV) was identified in 16 percent of the clinical employees and 39 percent of the nonclinical personnel, for a total prevalence of 29 percent. The prevalence of anti-HAV was age related, and the overall frequency was not greater than expected attack rates. Hepatitis B virus (HBV) markers were present in 16 percent of the clinical personnel tested but in only 3 percent of nonclinical personnel, for a total prevalence of 9 percent among the two groups. The nonclinical risk did not exceed the background prevalence of the disease, but the risk for clinical employees was three to five times greater. This risk appeared to be associated with exposure to blood and other potentially infectious body fluids; however, in no case could an employee with HBV markers recall a percutaneous injury, and covert means of transmission could not be excluded. Only one case (20 percent) of HBV infection manifested clinical symptomatology. Even though proper environmental safety measures may decrease the incidence of HBV infection in at-risk groups, some health care workers and researchers in the field of substance abuse may be at sufficiently increased risk of HBV infection to warrant immunization with hepatitis B vaccine.