XXXX : recommendations for travelers to Nepal.

@entity1 @entity66 @entity10217 @entity693 @entity7135
In the Kathmandu Valley of Nepal, an epidemic of @entity10217 resulted in 875 cases and 95 deaths during the 1st 6 months of 1983. The overall annual attack rate was 103 cases/100,000 population; the case fatality ratio was 11%. The highest age-specific attack rate (223/100,000) occurred among @entity1 under age 1 year. 3 times as many cases occurred in Kathmandu during December 1983 and January 1984 as in the same period a year previously. A mass vaccination campaign was initiated on February 8, 1984, and 330,000 doses of bivalent A/C meningococcal vaccine were administered, achieving approximately 65% coverage of the target population. A marked decline in the number of @entity693 cases occurred coincident with the initiation of the mass campaign. In 1985 @entity10217 is occurring at a much lower rate than in 1984, but @entity7135 among hikers now is being recognized. Over the January 1984-January 1985 period, 2 culture-confirmed and 4 clinically suspected cases of @entity7135 were documented among tourists from western countries traveling in Nepal. @entity1 ranged in age from 16-40 years. 5 @entity1 had evidence of meningococcemia; the other had @entity693 alone. 2 @entity1 died, and all became ill during or shortly after hiking outside kathmandu. 3 @entity1 were from the US, 2 from Australia, and 1 from Switzerland. Tables present data on cases of specified @entity66 in the US.
