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It may be difficult to distinguish yellow fever from hepatitis, malaria, leptospirosis, louse-borne relapsing fever, dengue, and other hemorrhagic fevers on clinical evidence alone Albuminuria is a constant feature in yellow fever patients and its presence helps differentiate yellow fever from other viral hepatitides Serologic confirmation is often needed

The second pillar of object-oriented programming, specialization, is implemented in C# through inheritance; specifically, by declaring that a new class derives from an existing class. The specialized class inherits the characteristics of the more general class. The specialized class is called a derived class, and the more general class is known as a base class. The specialization relationship is referred to as the is-a relationship. A dog is a mammal; a car is a vehicle. (Dog would be derived from the base class Mammal and Car from the base class Vehicle.) For example, a Manager is a special type of Employee. The Manager adds new capabilities (hiring, firing, rewarding, praising) and a new state (annual objectives, management level, and so on). The Manager, however, also inherits the characteristics and

Endemic area exposure (tropical South and Central America, Africa, but not Asia)

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Transmission is prevented through mosquito control Live virus vaccine is highly effective and should be provided for immunocompetent persons over 9 months of age living in or traveling to endemic areas Revaccination is recommended every 10 years for persons with continued exposure Vaccineinduced reactions, including viscerotropic and hepatotropic diseases that resemble yellow fever, are reported (particularly among patients of 60 years or older and patients with thymic dysfunction) Mass campaigns with the vaccine were carried out without significant complications in Cote d Ivoire The safety of the vaccine in pregnant patients is not verified, and pregnant women should, if possible, defer travel to endemic areas (see 30) Eradication is difficult because of the sylvatic cycle, with forest rodents serving as a reservoir Discrete enzootic foci of transmission appear to be more important than wandering epizootic foci as formerly thought (See 30)

Transmitted via ticks or ingestion of unpasteurized milk Long-term neurologic sequelae occur in 2 25% of cases Therapy is largely supportive Prevention is based on avoiding tick exposure, pasteurization of milk, and vaccination

capabilities common to all Employees. Thus, a Manager has an address, a name, and an employee ID, and Managers can be given raises, can be laid off, and so forth. Specialization allows you to create a family of objects. In Windows, a button is a control. A listbox is a control. Controls have certain characteristics (color, size, location) and certain abilities (can be drawn, can be selected). These characteristics and abilities are inherited by all of their derived types, which allows for a very powerful form of reuse. Rather than cutting and pasting code from one type to another, the derived type inherits the shared fields and methods. If you change how a shared ability is implemented in the base class, you do not have to update code in every derived type; they inherit the changes. You ll see specialization at work in 11.

Tick-borne encephalitis (TBE) is a flaviviral infection caused by TBE virus that is endemic in Russia and in eastern and central Europe In parts of Europe and the Baltic, attack rates exceed 100 cases per 100,0000 population and 10,000 to 12,000 cases are estimated to occur annually TBE occurs predominantly in the late spring through fall It is usually a consequence of exposure to infected ticks, although unpasteurized cow s, sheep s, and goat s milk are recognized forms of transmission The incubation period is 7 14 days for tickborne exposures but only 3 4 days for milk ingestion The principal reservoirs for TBE virus are small rodents; humans are an accidental host The vectors for most cases are Ixodes persulcatus and Ixodes ricinus

No specific antiviral therapy is available Treatment is directed toward symptomatic relief and management of complications If not in an endemic area, the patient should be isolated from mosquitoes to prevent transmission, since blood in the acute phase is potentially infectious

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