with  no  fever  and  the  cycle  of  chills,  fever,  and sweating is repeated each day, every other day, or every third day. If untreated, a primary attack continues  from  1  week  to  more  than  a  month. The diagnosis can be established by the iden- tification of malaria parasites in stained smears of  patient  blood  on  microscope  slides  (blood films). To find the parasites, it may be necessary to  repeat  the  blood  films. Malaria  occurs  in  many  tropical  and  sub- tropical  areas  worldwide  including  Central  and South  America,  Asia,  and  Africa. The infectious agents for the human malarias are,  Plasmodium   vivax,   P.   falciparum,   P. malariae,  and  P.  ovale.  Mixed  infections  fre- quently  occur.  Man  is  the  reservoir  for  human malaria. Malaria is transmitted by the bite of the female   Anopheles   mosquito   and   by   injection, blood transfusion, and contaminated needles and syringes. The  incubation  period  depends  on  the  par- ticular  Plasmodium   species,  and  it  may  range from  days  to  months.  Humans  are  infectious  to mosquitoes  as  long  as  gametocytes  are  in  their blood.  The  period  of  time  that  gametocytes  are in the blood varies with the species, strain, and medication. Preventive measures include (1) eliminating or reducing anopheline mosquito breeding places by draining  or  filling  impounded  water;  (2)  apply- ing effective approved residual insecticide to sur- faces  where  anopheline  mosquitoes  rest;  (3)  in endemic  areas,  spraying  sleeping  quarters  with pyrethrum  and/or  using  other  approved  insect repellents  on  exposed  skin;  (5)  obtaining  an  ac- curate  history  of  blood  donors  concerning  malaria and  possible  malaria  exposure  before  accepting blood;  (6)  locating  and  treating  all  acute  and chronic  cases  of  malaria  that  have  occurred  in  the same area as the index case; and (7) practicing the regular use of chemosuppressive drugs in malari- ous  areas.  Chloroquine  is  the  most  commonly used  drug  for  this, Patients should be isolated by blood precau- tions.   However, no   concurrent   disinfection measures are required. No quarantine measures are required and immunization of contacts is not applicable. An  increase  in  malaria  cases  may  be  expected with wars, other social upheavals, and any climac- tic changes that increase breeding areas for vec- tors  in  endemic  regions. International measures are extremely impor- tant.  Aircraft,  ships,  and  other  transportation vehicles going into and coming out of malarious and mosquito populated areas should be properly disinfected  by  health  authorities.  Finally,  consider the use of antimalarial drugs when there is a mass movement of migrants from areas where malaria is endemic to malaria free areas. Measles Measles is an acute viral disease with signs and symptoms of fever, conjunctivitis, rhinitis, cough, and  small  irregular  bright  red  spots  with  a  bluish white  center  (Koplik’s  spots)  located  inside  the mouth  on  the  cheeks.  A  red  blotchy  rash characteristically begins on the face between the third  and  seventh  day  and  then  spreads  to  the trunk. Measles is most serious in adults and in- fants; otitis media, pneumonia, and encephalitis may occur as complications. In the United States and  Canada,  since  the  onset  of  childhood  im- munization   programs,   measles   now   occurs primarily  in  preschool  children,  adolescents, young adults, and those refusing vaccination. In temperate climates, most cases occur in late winter or early spring. In the tropics, most children ac- quire measles at an early age as soon as the mater- nal  antibody  lowers. The infectious agent is the measles virus. Man is  the  reservoir.  Measles  is  spread  by  nasal  or throat  secretions  through  droplets,  direct  contact, and  less  frequently  by  airborne  methods  or fomites. The incubation period averages about 10 days from exposure until the onset of fever and may vary from 8 to 13 days. The rash usually ap- pears  14  days  after  exposure.  Measles  is  com- municable  from  just  prior  to  the  onset  of  fever to about 4 days after the appearance of the rash. Susceptibility is general except for those per- sons who have recovered from the disease or those who have been immunized. Recovery usually gives permanent immunity. Infants whose mothers are immune are usually immune for the first 6 to 9 months  of  their  lives. There  is  no  specific  treatment  for  measles. The primary preventive measure is vaccination with  the  live  attenuated  measles  vaccine.  It  is recommended  for  all  individuals  susceptible  to measles, For patient management, isolation is not prac- tical  for  an  entire  community;  however,  it  is recommended  that  children  be  kept  home  from school until at least 4 days after the appearance of  the  rash.  For  hospitalized  patients,  practice respiratory isolation from the onset of fever until after  the  fourth  day  of  rash  to  reduce  exposure of  other  high  risk  patients. 11-14