5-105
Patient Education
General: Use tepid baths/fanning to bring down temperature.
Activity: Vigorous oral rehydration, 3-4 liters first day then follow and replace losses.
Diet: Maintain nutrition/electrolytes.
Medications: Avoid laxatives and salicylates or other antipyretics.
Prevention and Hygiene: Immunize with live attenuated oral ty21a vaccine (boost q 3 years) or the typhoid
polysaccharide Vi vaccine (boost q 2 years) pre-deployment. Practice handwashing, fly control, water
treatment. Salmonella typhi is killed by heating food or water to 135°F, iodination or chlorination. Do not have
patients infected with salmonella participate in general food preparation. Avoid fresh, uncooked vegetables and
fruits unless you can peel or carefully wash them yourself.
Follow-up Actions
Return Evaluation: Consider non-GI source of infection such as endocarditis, visceral or renal abscesses,
osteomyelitis.
Evacuation: Send to higher level of care where more diagnostic tools available when stable.
NOTES: Paratyphoid fever presents in a similar way but is generally milder, and is caused by Salmonella
enteritidis bioserotypes.
Chapter 14: Preventive Medicine
COL (Ret) Joel Gaydos, MC, USA & SFC Jeffrey Crainich, USAIntroduction: Preventive medicine (PM) procedures minimize disease/non-battle injuries (DNBI) during war
and contingency operations. PM measures should be integrated into all missions and training exercises.
Responsibilities of the medic include the following: monitoring the acquisition and treatment of potable water;
monitoring the acquisition, handling and preparation of food; monitoring and implementing vector (insect and
rodent) control programs; and monitoring the construction and maintenance of personal hygiene (washing)
facilities and solid and liquid waste disposal systems.
Table 5-5
REQUIRED IMMUNIZATIONS
Vaccine Initial dosage/route Booster dose Comments
Anthrax 0.5 ml SC at 0, 2, 4 weeks, then 0.5 ml SC annually Annual booster
6,12, and 18 months
Hepatitis A 1.0 ml IM at 0, and 6-12 months None currently required None
(HAVRAX or VAQTA)
Hepatitis B 1.0 ml IM at 0, 1, and 6 months None currently required None
Influenza 0.5 ml IM annually in October 0.5 ml IM at 6 months if Annual. Consider
still in risk area booster if in Southern
Hemisphere April-
September
Japanese B 1.0 ml SC at 0, 7, and 30 days 1.0 ml SC every three By geographic area
Encephalitis years only