Digest/Update Irish immigrants have their immigrants had a standardized mortality these trends as large-scale Irish immigra- ratio a little lower than the female popula- tion is likely to continue. problems too tion in Ireland and a little higher than the (C.D.) D ECAUSE of longstanding free access total female population in England and Source: Adelstein AM, Marmot MG, Dean G, Lbetween both countries, there is an Wales. Mortality in both sexes was Bradshaw JS. Comparison of mortality of Irish established pattern of Irish emigration to highest, relative to Ireland, in conditions immigrants in England and Wales with that of Britain, especially in times of economic with a behavioural background, such as Irish and British nationals. Ir Med J 1986; 79: depression such as during the great famine smoking-related cancers, obstructive air- 185-189. of 1845-49, the 1930s, the 1950s and most ways disease, peptic ulcer, cirrhosis, ac- Contributors: D. Jewell, T. O'Dowd, C. Daly. recently in the mid-1980s. In 1971 1.8% cidents, poisoning and violence, and in of the population of England and Wales tuberculosis as well. had been born in both parts of Ireland. Ease of migration may mean that ill FILL THIS SPACE While Irish immigrants do not generally health and economic and social disadvan- Contributions to the Digest pages are share the linguistic, racial and broad tage, rather than acting as a barrier, may welcome from all readers. These cultural disadvantages of other im- act as a spur to migration. A change from should be from recent papers in migrants, -they tend to be from the lower the rural Irish environment to the in- research journals which general prac- social classes and have predictable mor- dustrial environment of England, and titioners might not normally read. tality patterns. The standard mortality heavy smoking habits, may explain the Send to: The Editor, Journal of the ratio of male Irish immigrants to England higher lung cancer rates among immigrant Royal College of General Practitioners, and Wales between 1970-72 was higher men. Doctors practising in areas such as 8 Queen Street, Edinburgh EH2 IJE. than that of the male population in London, the Midlands, Liverpool and Please quote the full reference to the Ireland and the general population in Glasgow - traditional destinations for article (authors, title, journal, year, England and Wales. In contrast, female Irish immigrants - should be aware of volume, page range). INFECTIOUS DISEASES UPDATE Advice for travellers 14, approximately £8), gives regions within ed on a named patient basis from Merieux countries where the greatest risk exists and UK Ltd in single dose or from Smith, The Department of Health and Social whether or not there is drug resistance. Kline and French Ltd in 10 dose vials. Security has in 1988 brought out a new This further information can help avoid and colourful edition of a travellers guide the unnecessary use of prophylactic for health entitled Before you go. This tablets with their occasional side effects Measles, mumps and rubella pamphlet SA40 replaces the previous and indicate when two drugs taken in vaccine SA30 and 35. It is free of charge and can combination may be preferred because of be obtained by telephoning 0800-555777 resistance problems. This combined vaccine will soon be in- or in bulk from DHSS Leaflets Unit, PO Further information for advising troduced throughout the UK and it should Box 21, Stanmore HA7 lAY. The infor- travellers is available in a variety of books: replace monovalent measles vaccine, nor- mation given includes a country by coun- Travellers health by Richard Daywood mally given to children at around 15 try listing of recommended vaccinations (Oxford University Press, 496 pages, price months of age. It is hoped that the and whether or not malaria is present. Ad- £6.95) gives a comprehensive look at publicity surrounding its introduction and ditional comments on immunoglobulin prevention. Well away: a health guidefor the advantages of a three-in-one injection against hepatitis A and on bacille travellers by E. Walker and G. Williams will encourage a high uptake which has Calmette-Guerin (BCG) are made and ad- (British Medical Journal, 56 pages, price never been achieved with the measles vac- vice given on rabies and the acquired im- £5.00) gives a briefer account for the lay cine alone. The combined vaccine has for mune deficiency syndrome. The advice is public or the general practitioner needing some years been used successfully in the concise and therefore is not able to take an occasional source of reference. USA and rubella vaccine alone should still into account to any great extent the be offered to girls at secondary school traveller's intended lifestyle - for exam- both to cover children who missed out on ple, administering cholera vaccine to the Meningococcal infection in the vaccine as infants and to ensure good businessman staying two nights in a four Africa antibody levels as girls reach the childbearing age. As with monovalent star hotel in Kuala Lumpa may be con- This year has seen a large outbreak of sidered excessive - but this can be allow- measles vaccine, when the combined vac- meningococcal septicaemia and men- cine is given to infants aged under one ed for during consultations. The booklet ingitis especially in the eastern parts of the gives advice on malaria prevention and year (for example prior to travel to highly 'meningococcal belt' of sub-Saharan measles general measures such as avoiding mos- Africa. Countries affected included endemic areas or to children with quito bites. It does not go into detail about Sudan, Ethiopia and Chad. Several fibrocystic disease) then a further dose regional differences in prevalence within thousands of cases were reported to the during the second year of life is advisable. a country or describe which prophylactic World Health Organization with a mor- tablets may be appropriate. tality of approximately 10%. In 1987 this Suggestions for topics to include in future The book updated annually by the annual epidemic spread across into the updates are welcomed and should be passed to World Health the contributor, Dr E. Walker, Communicable Organization, Vaccine cer- Arabian peninsular. A single dose of vac- Diseases (Scotland) Unit, Ruchill Hospital, tificate requirements and health advicefor cine which gives protection for about two Glasgow G20 9NB (041-946-7120), from whom international travel (available through Her years against the 'C strain' normally further information about the current topics Majesty's stationery offices, price Sw fr responsible for epidemics can be obtain- can be obtained. 330 Journal of the Royal College of General Practitioners, July 1988.