their  infants  should  receive  postexposure  pro- phylaxis   (hepatitis   B   immune   globulin   and hepatitis B vaccine). Strict testing discipline should be enforced in all blood banks. Donated blood should be tested for  HBsAg.  All  donors  should  be  rejected  who have a history of viral hepatitis, present evidence of drug abuse, or received a blood transfusion or tattoo within the past 6 months. Unscreened blood or blood products are not administered to any pa- tient   unless   an   absolute   emergency.   Perform sterilization  on  all  syringes,  needles,  acupuncture needles, and stylettes. The use of disposable equip- ment  is  recommended. Management  of  patients,  contacts,  and  nearby environment includes (1) isolation (inpatient and outpatient) with precautions for blood and body fluids until the disappearance of HBsAg and the appearance of anti-HBs; (2) concurrent disinfec- tion for all equipment contaminated with blood, saliva,  or  semen;  and  (3)  immunizing  contacts with hepatitis B immune globulin, human immune globulin, or hepatitis B vaccine, as directed by a medical officer. It is very important to administer prophylaxis  as  soon  as  possible  after  exposure. There  is  no  requirement  for  quarantine. If the occurrence of two or more cases can be related  to  a  common  exposure,  search  for  more cases. Enforce strict aseptic techniques. If blood derivatives  are  implicated,  recall  the  lot  and  trace all  persons  who  received  the  product,  in  search of  additional  cases.  No  international  measures  are required  for  hepatitis  B  patients  or  their  contacts. any season of the year. The reservoir for the in- fluenza  is  man. Influenza  is  transmitted  most  commonly  by the  airborne  route  through  infective  droplets  from coughing, sneezing, and close talking, especially in  crowded  populations.  The  incubation  period is  very  short,  approximately  1  to  3  days.  The period   of   communicability   is   approximately   3 days, beginning with the first clinical symptoms. An attack gives immunity only to the specific type  or  subtype  of  the  virus  involved.  Vaccines provide immunity to a particular virus and related strains to which an individual has been previously exposed. Current  policy  requires  that  all  active  duty Navy  and  Marine  Corps  personnel  receive  the  an- nual  influenza  vaccine. Management  of  patients,  contacts,  and  the nearby  environment  includes  the  following  princi- ples: Because there is a usual delay in establishing the diagnosis, many others can become infected. Therefore,  it  is  usually  not  practical  to  isolate cases. It may be desirable to isolate infants and younger  children  by  keeping  them  in  the  same room. No concurrent disinfecting is required. No quarantine is required. Investigation of contacts is  of  no  value  and  is  not  recommended. At the beginning of epidemics, it is important that   preventive   medicine   personnel   establish surveillance of epidemics to determine the extent and   progress   that   community   functions   are affected. Malaria Influenza Influenza is an acute viral disease primarily involving the respiratory tract with symptoms of fever,  chills,  headache,  muscular  pain,  exhaus- tion,  acute  rhinitis,  sore  throat,  and  cough. Recovery is usually complete within 2 to 7 days. During  large  epidemics  acute  illnesses  and  deaths may be expected among the elderly and other pa- tients  with  chronic  medical  disorders. Influenza  occurs  worldwide  as  epidemics  or localized outbreaks. Attack rates are about 15 to 25 percent in large communities and in isolated populations  may  be  as  high  as  40  percent.  The infectious agents are types A, B, and C influenza virus.  Epidemics  of  type  A  occur  in  the  United States approximately every 1 to 3 years; type B occurs every 3 to 4 years, with occasional mixed epidemics.  Epidemics  usually  occur  during  the winter in temperate regions and in the tropics at Early symptoms of the four different types of human malarias are similar. Laboratory studies are   necessary   for   differential   diagnosis. Falciparum malaria is the most serious type and usually  has  various  symptoms  of  fever,  chills, sweating,  headache,  jaundice,  blood  coagulation defects,  shock,  renal  failure,  liver  failure,  and disorientation  and  delirium.  Prompt  diagnosis  and treatment  of  all  malarias  is  essential;  however, falciparum  malaria,  because  of  its  severity,  should be  considered  a  medical  emergency. The other three types of malarias are not life threatening for healthy adults; however, the very young,   the   aged,   and   individuals   with   other diseases  may  beat  serious  risk.  General  symptoms for these malarias include an indefinite period of malaise, which is followed by chills, shaking, fast rising temperature, usually headache, nausea, and sweating.  Symptoms  are  followed  by  a  time  period 11-13