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Serum specimens (n = 6,045) obtained from 3,207 Protestant missionaries serving in 57 countries, including 28 African nations, between 1967 and 1984 were assayed for antibodies to the human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA) screening and Western blot confirmatory testing. Seventy sera (1.2%) from 51 missionaries (1.6%) were ELISA positive; however, on Western blot confirmatory testing none was diagnostic of HIV infection. Twenty-two (43%) of the Western blot tests were read as indeterminate, with band p17 occurring with the greatest frequency (57%), followed by p24 (23%), either alone or in combination. The significance of these equivocal results is unclear, but they do not appear to be a consequence of exposure to either HIV or the related retrovirus HTLV-I. Based on this seroprevalence survey, we conclude that missionary staff and their families were not at high risk of HIV infection between 1967 and 1984, even when serving in regions of high HIV endemicity.

Several risks can be posed by travel, even when the stay is not protracted nor the destination exotic. Air travelers should consider the potential problems associated with decreased cabin pressure, hypoxia, and circadian dysrhythmia, problems that can contraindicate flying for some. Motion sickness can affect those traveling by air, sea, or land; medications are available to combat the symptoms, and several other remedies such as changing visual stimuli are also worth trying. Persons staying in hotels, particularly high rises, should review several general guidelines for defensive action in case of fire and should become familiar with the physical layout and escape routes of the building in which they are staying.

The medical supplies appropriate for travel will quite naturally depend on the individual and on the nature, scope, and duration of the trip being planned. A basic kit containing nonmedicinal supplies, nonprescription drugs, and prescription medications can be a starting point in planning for both lay and physician travelers, however. Although medical responsibility for assisting in emergency situations during travels as well as liability differ from location to location, in general the physician should not hesitate to give aid in perceived situations of need.

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.

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.