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Diseases

Anthrax

What is anthrax?
Anthrax is a rare infectious disease caused by the bacterium Bacillus anthracis. It can occur in wild and domestic hoofed animals, such as cattle, sheep, goats, etc. It can also occur in humans when they are exposed to the bacterium. There are 3 forms: cutaneous (skin), inhalation (lungs), and gastrointestinal (stomach and intestines). With intentional exposure, as in a bioterrorist release, breathing in the spores or contact with openings in the skin (cuts, scratches, abrasions, etc.) are the most likely routes of entry into the body. Gastrointestinal anthrax occurs when people eat meat from anthrax-infected animals.

What are the symptoms of anthrax?
- Cutaneous (skin): exposed skin itches; large boil-like sore appears; sore becomes a black scab. If not treated, the infection can spread to the lymph nodes and bloodstream.
- Inhalation (lungs): cold or flu-like symptoms; symptoms become severe with serious breathing problems.
- Gastrointestinal (stomach and intestines): fever; abdominal pain; loose, watery bowel movements; vomiting with blood in vomitus.

How soon after exposure would symptoms begin?
Symptoms generally develop between 1 and 7 days after exposure, but prolonged periods up to 60 days after exposure are possible.

Can anthrax be spread person to person?
Inhalation (lung) anthrax: not spread from person to person.
Cutaneous (skin) anthrax: drainage from an open sore presents a low risk of infection to others, and this must be direct contact.
Gastrointestinal (stomach and intestine) anthrax: not spread person to person.

Can anthrax be treated?
If given early in the illness, certain antibiotics are effective against anthrax.

How likely is it that I will be exposed to anthrax, other biological agents?
In West Virginia, the last reported case of human anthrax occurred in 1947. Historically, in the United States, the individual risk of disease from bioterrorism has been very, very small.

What will be done to evaluate an incident?
State and local public health, emergency, and law enforcement agencies will work together to evaluate all incidents. Examining the circumstances of the incident, the suspect material, and the type of exposure is required to determine if the incident represents a public health risk.

 

Anthrax Information for Public Health Officials

Spore-forming bacteria
Unique Epidemiological Characteristics

  • No natural reservoir in West Virginia
  • A newly reported case should be urgently investigated considering:
    • travel
    • highly unusual exposure
    • BT
  • Incubation: 1-60 days; with most cases occurring within the first week
  • No person-to-person transmission
  • Mortality: 60-100% for inhalation anthrax and 20% for cutaneous anthrax without therapy — dire emergency
  • Environmental: hardy for decades in the spore form
  • Treatment (Ciprofloxacin, doxycycline) effective in reducing mortality if begun early
  • Prophylaxis (Ciprofloxacin, doxycycline) effective in preventing disease
  • Laboratory confirmation
  • Screening tests should be completed by hospital laboratory; confirmation by OLS

Employee Health Considerations

  • Personal protective equipment / training required for persons doing environmental investigations
  • Prophylaxis required for employees who have been exposed.
  • Standard precautions for work with infected individuals

Life-saving Interventions – In Order

  1. Recognition / reporting / casefinding + early and appropriate therapy
  2. Risk factor and environmental investigation to establish source of exposure / population at risk AND rapid initiation of prophylaxis
  3. Antibiotic sensitivity testing of the isolate

Training Considerations

  • Physicians: recognition / treatment / reporting
  • ICPs: reporting, active surveillance procedures
  • Labs: screening tests and procedure for referral to OLS
  • Local health departments, regional epidemiologists: NPS issues > investigation
  • IDEP / DSDC / BPH: employee health / investigation / priorities for control.
  • Environmental Health: personal protective equipment, environmental sampling

Botulism

What is Botulism?

Botulism is a rare muscle-paralyzing illness caused by a nerve toxin produced by a bacterium called Clostride botulinum. There are three naturally occurring kinds of botulism:

  • foodborne botulism caused by eating toxin-contaminated food. No instances of waterborn botulism have ever been reported.
    wound botulism caused by toxin production in a wound infected with Clostridium botulinum. The botulinum toxin does not penetrate intact skin.
  • intestinal botulism caused by ingesting foods contaminated with spores of the Clostridium botulinum. The spores grow and develop into the bacteria, which release botulinum toxin in the intestines.
  • Inhalational botulism is a man-made kind of botulism that results when the botulinum toxin is distributed in an aerosol form, and is thought to be the most likely form that would be used by bioterrorists. When aerosolized, botulinum toxin is the most poisonous substance known.

What are the symptoms of botulism?

Once botulinum toxin is absorber, either in the lungs or intestines, the bloodstream circulates the toxin, delivering it throughout the body. The toxin acts on the nerves that supply muscles, interrupting communication between the brains and muscles. All forms of human botulism have virtually the same symptoms:

  • Double or blurred vision; drooping eyelids.
  • Slurred speech; difficulty swallowing; dry mouth.
  • Muscle weakness that begins at the shoulders and travels down the body.
  • Paralysis of muscles involved in breathing will cause a person to stop breathing and die unless breathing assistance is provided.

How soon after exposure would symptoms begin?
The speed at which symptoms would occur and the severity of botulism is dependent upon the amount of toxin absorbed.

  • Symptoms of foodborne botulism typically begin within 12-72 hours but could be seen as early as 2 hours or as late as 8 days after ingesting the toxin.
  • An accidental exposure to an unknown amount of aerosolized botulinum toxin produced symptoms approximately 72 hours after inhalation exposure.

Can botulism be spread person to person?
Botulism is not spread person to person.

Can botulism be treated?
Early recognition and active management is key to patient recovery. Affected persons require rapid administration of antitoxin. Patients with respiratory compromise need respiratory support.

How likely is it that I will be exposed to botulism or another biological agent?
Naturally occurring botulism is extremely rare and only 3 cases of inhalational botulism have ever been described. Historically, in the United States, the individual risk of disease due to a bioterrorism attack has been very, very low.

How could an intentional release of botulinum toxin be managed?
State and local public health, emergency, and law enforcement agencies will work together to evaluate all incidents. Examining the circumstances of the incident, the suspect material, and the type of exposure is required to determine if the incident represents a public health risk.


Botulism Information for Public Health Officials


Pre-formed bacterial toxin
Unique Epidemiological Characteristics

  • Natural reservoir for the bacteria is soil
  • A newly reported case should be urgently investigated considering:
    • Foodborne (intentional or unintentional)
    • Wound
    • Aerosol (intentional)
  • Incubation: 12-72 hours; sometimes longer
  • No person-to-person transmission
  • Mortality: very high (without therapy) due to respiratory muscle paralysis – dire emergency
  • Environmental:
    • Aerosolized toxin decays at about 1-4% per minute – not environmentally stable
    • Foods can continue to be a source as long as they are in circulation
  • Prophylaxis – not available
  • Treatment – antitoxin + artificial respiration – effective if initiated early

Lab confirmation
Virginia State Health Department
Implications: Use a clinical case definition early in the investigation: diplopia, dysarthria, dysphonia, dysphagia

Employee Health Considerations

  • Exposed employees should be placed under surveillance for development of symptoms
  • Standard precautions for work with affected individuals

Lifesaving interventions – in order:

  • Recognition / reporting / casefinding + early and appropriate therapy
  • Collect and analyze risk information to identify source AND
    • remove source (e.g., food) from the environment AND
    • identify the exposed population to be placed under surveillance.

Training considerations

  • Physicians: recognition / treatment / reporting
  • ICPs: reporting, active surveillance procedures
  • Labs: procedure for referral of specimens
  • Local health departments, regional epidemiologists: investigation
  • IDEP / DSDC / BPH: employee health / investigation / priorities for control
  • Environmental Health: sampling of foods and other environmental specimens

Tularemia

What is tularemia?
Tularemia is an infectious disease caused by the bacterium Francisella tularensis, and is considered to be one of the most infectious disease-causing bacteria known. These bacteria are most commonly found in rabbits, hares, voles, muskrats and other wild rodents, but can also be found in sheep, cattle, and cats. About 200 cases of tularemia in humans are reported each year in the United States, mostly in people who live in the south-central and western states. However, tularemia occurs sporadically through the United States, including West Virginia. Tularemia is also know as “rabbit fever” and “deerfly fever”. In addition to causing natural disease, F. tularensis has been implicated as a possible agent for use in bioterrorism. Use of tularemia as a biological weapon would most likely occur as an aerosol release of the bacterium, although the potential for alternate delivery also exists.

What are the symptoms of tularemia?
A skin ulcer and swollen, painful lymph glands are common symptoms of tularemia when the bacteria are introduced into the skin. If the tularemia bacteria are eaten or consumed in drinking water, they can cause sore throat, abdominal pain, vomiting, diarrhea, and mouth ulcers. If the tularemia bacteria are inhaled, symptoms would include fever, chills, headache, muscle aches, joint pain, dry cough, weakness, and pneumonia. Swollen and painful eyes can result from bacteria being introduced into the eyes.

How soon after exposure would symptoms begin?
Symptoms generally develop between 3 and 5 days after exposure, but possible as long as 14 days following exposure.

How is tularemia treated?
Tularemia can be treated with antibiotics from a physician. If you think you have tularemia, consult your doctor immediately.

How is tularemia spread?
People can get tularemia by being bitten by ticks, deerflies and some other insects that have fed on an animal that has the disease. The disease is also spread to humans by handling dead infected animals, by eating or drinking contaminated food or water, or by inhaling the bacteria. People have not been known to transmit the infection to other people.

Who is most at risk for tularemia?
People of all ages can get tularemia. People are more at risk if:

  • They hunt or trap rabbits or other rodents.
  • They are exposed to ticks and biting insects.
  • They eat undercooked rabbit meat or meat from other wild rodents.
  • They skin, process, or cook rabbit meat or meat from other wild rodents.

How can I protect myself?

  • Protect against tick and deerfly bites by wearing protective clothing and by using insect repellents.
  • Tell children not to handle dead or sick animals.
  • Wear rubber glovers when handling dead rabbits or other possibly infected animals.
  • Cook game meats thoroughly. Freezing does NOT kill the bacteria — frozen killed rabbit meats can remain infective for more than three years.

How could an intentional release of tularemia be managed?
Early recognition by physicians is key to managing this disease. Infected patients can be treated with antibiotics, and exposed individuals may take antibiotics to prevent disease.

Viral Hemorrhagic Fever

What is viral hemorrhagic fever?

Includes: Ebola, Marburg, Lassa, New World Arenavirus, Crimean-Congo, Rift Valley Fever, Dengue Fever, Yellow Fever, Omsk Hemorrhagic Fever, or Kyasanur Forest Disease

Viral hemorrhagic fevers are rare diseases in the United States but more prevalent in Africa. They are caused by four classes of viruses (Filoviruses, Arenaviruses, Bunyaviruses, and Flaviviruses). Humans are incidentally infected by a bite of an infected tick or mosquito, via aerosol generated from an infected rodent excretia, or by direct contact with infected animal carcasses. With the exception of Rift Valley fever and the diseases caused by Flaviviruses (Yellow fever, Omsk HF, and Kyasanur Forest Disease) which are not transmissible person-to-person, infected humans can spread the disease to close contacts by touching bodily fluids, which may result in community outbreaks and nosocomial infections. Person-to-person transmission by respiratory droplets through the air appears to be rare but cannot be ruled out. With intentional exposure, as in a bioterrorist release, breathing in airborne virus, or touching a substance with the virus and transferring it to the mucous membranes in the eyes or mouth are the most likely routes of entry into the body.

What are the symptoms of VHFs?
Clinical symptoms and signs of VHFs may include early onset of symptoms lasting for less than 1 week including fever, nausea and vomiting, joint and muscle pain, headache, extreme weakness, lack of strength, fatigue, sore throat, cough, chest and abdominal pain, and nonbloody diarrhea. Early signs also include slowing of pulse rate, rapid respiration, conjunctivitis, pharyngitis, weight loss, difficulty swallowing, shortness of breath, and for some VHFs, a rash. Later patients may show signs of bleeding of gums, vomiting blood, bloody stool, blood in urine, excessive bleeding at puncture sites, nose bleed, or blood in sputum.

How soon after exposure would symptoms begin?
Symptoms generally develop between 2 and 21 days after exposure.

Can VHFs be spread person-to-person?
Yes. Hemorrhagic fever viruses are highly contagious by touching bodily fluids of infected patients and then touching your mouth or eyes. Strict barrier precautions for infection control should be taken to prevent direct contact with infected patients.

How likely is it that I will be exposed to VHFs, or other biological or chemical agents?
There has never been a case of VHF in WV. Historically, in the United States, the individual risk of disease from a bioterrorist event has been very, very low.

What will be done to evaluate an incident?
State and local public health, emergency, and law enforcement agencies will work together to evaluate all incidents. Examining the circumstances of the incident, the suspect material, and the type of exposure is required to determine if the incident represents a public health risk.