Diseases Transmitted by Air or Blood
The following diseases are specified as reasonably likely to be transmitted by Air or Blood during the normal course of an Emergency Workers duties.
1. Crimean—Congo Hemorrhagic Fever
Crimean Congo hemorrhagic fever (CCHF), one of the most severe human viral diseases, has a death rate of up to 50%. CCHF is a public health problem in many regions of the world, including Africa, Middle East, southern and eastern Europe, and Western Asia. The causative agent, Crimean Congo hemorrhagic fever virus (CCHFV), is transmitted to humans by the bite of Ixodid ticks or by contact with blood or tissues from human patients or infected livestock.
Diphtheria is an acute bacterial disease that usually affects the tonsils, throat, nose and/or skin. It is passed from person to person by droplet transmission, usually by breathing in diphtheria bacteria after an infected person has coughed, sneezed or even laughed. It can also be spread by handling used tissues or by drinking from a glass used by an infected person. Diphtheria can lead to breathing problems, heart failure, paralysis and sometimes death.
3. Ebola-Marburg Virus Infection
The virus that causes Marburg hemorrhagic fever is a disease which affects both humans and non-human primates. Marburg was first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany and in Belgrade, Yugoslavia (now Serbia). A total of 37 people became ill; they included laboratory workers as well as several medical personnel and family members who had cared for them. The first people infected had been exposed to African green monkeys or their tissues. In Marburg, the monkeys had been imported for research and to prepare polio vaccine.
4. Fifth Disease (Human Parvovirus Infection)
Doctors today refer to it as parvovirus infection or erythema infectiosum. Some people may call it slapped-cheek disease because of the face rash that develops resembling slap marks. It’s also commonly called Fifth Disease because it was fifth of a group of once-common childhood diseases that all have similar rashes. The other four diseases are measles, rubella, scarlet fever and Duke’s disease. Whatever the name, it’s still a common but mild infection in children that generally requires little treatment. However, parvovirus infection in some pregnant women can lead to serious health problems for the fetus. Parvovirus infection is also more serious for adults with some kinds of anemia or who have a compromised immune system.
5. Leprosy (Hansen’s Disease)
Leprosy is a chronic infectious disease which attacks the skin, peripheral nerves and mucous membranes (eyes, respiratory tract). Leprosy is also known as Hansen’s disease because the bacillus which causes it was discovered by G.A. Hansen in 1873. It is most common in warm, wet areas in the tropics and subtropics. Leprosy is characterized by multiple lesions accompanied by sensory loss in the affected areas. Usually, sensory loss begins in the extremities (toes, fingertips). In many cases, gangrene sets in, causing parts of the body to “die” (necrosis) and become deformed. Leprosy in all ages has been considered one of the more despicable diseases, and victims have been despised throughout history and kept in separate places. In the medieval period, leper colonies sprung up where victims of this then-untreatable disease would go to slowly die from the illness.
6. Hepatitis B Virus (Acute or Chronic Infection)
The term “hepatitis” refers to syndromes or diseases causing liver inflammation, including inflammation due to viruses and chronic alcohol abuse. Most people that become infected with Hepatitis B, get rid of the virus within 6 months. Approximately 10% of people infected with the Hepatitis B virus develop a chronic, life-long infection. People with chronic infection may have symptoms, but many of these patients never develop symptoms. These people are sometimes referred to as “carriers” and can spread the disease to others. Having chronic Hepatitis B increases your chance of permanent liver damage, including cirrhosis (scarring of the liver) and liver cancer. Hepatitis B is transmitted via blood and other body fluids.
7. Hepatitis C Virus (Acute or Chronic Infection)
Hepatitis C is the most common chronic blood borne infection in the United States. It is caused by a virus. It’s an infection of the liver that is caused by an RNA virus, is transmitted primarily by blood and blood products, as in blood transfusions or intravenous drug use, and sometimes through sexual contact. In most cases, carriers with chronic acute hepatitis have no symptoms. However, over time, this blood borne virus can cause long term damage to the liver, including cirrhosis and hepatocellular carcinoma. Severe liver damage may not develop for 10-40 years after infection.
8. Infection with the Delta Hepatitis Virus
Delta hepatitis is a liver disease caused by the Hepatitis D virus. Symptoms are similar to Hepatitis B and may include fever, lack of energy, nausea, vomiting, abdominal discomfort, and jaundice (yellow color to the whites of the eyes or skin and darkening of urine). Some persons who have delta hepatitis have no symptoms. Up to 20% of delta hepatitis infections are rapidly fatal. Infected persons may recover or may develop chronic, long-term hepatitis (carrier) and are at risk for cirrhosis (scarring of the liver) and liver failure. Delta hepatitis is an infection to humans. Acute delta hepatitis infection may be followed by recovery but usually becomes chronic and causes symptoms for years. An infected person with no symptoms can still spread delta hepatitis to others. Delta hepatitis infection can only occur along with hepatitis B infection. Infection with delta hepatitis can happen in a person with chronic hepatitis B infection, or new infections with hepatitis B and delta hepatitis may occur at the same time. The virus is spread by direct contact with the blood or less commonly with sexual fluids of an infected person. This can happen by sharing needles with injection drug users who are infected with delta hepatitis. Infected women can pass the virus to their babies but his is thought to occur at a low rate. The risk of sexual transmission has not been thoroughly studied, but it appears to be low.
9. HIV (Human Immunodeficiency Virus)
AIDS is a life-threatening illness caused by infection with the human immunodeficiency virus (HIV). This virus destroys part of the immune system. The immune system is the body’s natural defense against infection & disease. You are HIV positive if you have the virus but are still able to fight off infection. When you begin to lose the ability to fight off infection, you have AIDS. HIV is spread by direct contact with infected blood, semen or vaginal fluids. Direct contact includes: having sex with an infected person, sharing needles with an infected person and/or receiving HIV-infected blood or organ transplants. The virus is also found in smaller amounts of tears, saliva, brain/spinal fluid, breast milk, urine and feces. Contact with these fluids is not likely to spread the virus. The main cause of AIDS in adults over 55 is male-to-male homosexual contact (65%). The second leading cause is a past infected blood transfusion. These transfusions generally happened before 1985 when there was not a reliable way to test donated blood for the virus. Blood that is donated today is tested and is very safe. HIV is NOT spread by casual contact such as shaking hands, touching an infected person, touching something that the person has handled, using toilets, using telephones or swimming in pools.
10. Infection with HTLV-1 and HTLV-2 Virus
Human T-cell lymphotropic virus type (HTLV-1), the first discovered human retrovirus, is a blood-borne pathogen that has been determined to be the cause of adult T-cell leukemia and lymphoma (ATL) and tropical spastic paraparesis (TSP, also referred to as HTLV-associated myelopathy). Limited studies also suggest its association with a number of other hematological malignancies, including polymyositis, polyarthritis and uveitis. HTLV-1 is now recognized to occur worldwide, although it is characteristically endemic in certain foci in Japan, the Carribean, Southeastern USA, South America, Central Africa, Seychelles, and certain areas of Asia. The number of infected people worldwide has been estimated at 10-20 million, with 1.2 million in Japan alone. HTLV-1, or its associated diseases, has now been detected in several countries in the Middle East, including Iran, Egypt, Iraq, Kuwait and Israel. HTLV-2, is a close relative to HTLV-1, has a lower incidence worldwide and its association with diseases is less certain, although it has been detected at increasing frequencies among intravenous drug abusers and normal blood donors in Western countries.
11. Lassa Fever
Lassa Fever is an acute viral illness that occurs in West Africa. The illness was discovered in 1969 when two missionary nurses died in Nigeria, West Africa. The cause of the illness was found be Lassa Virus, named after the town in Nigeria where the first cases originated. The virus, a member of the virus family Arenaviridae, is a single-stranded RNA virus and is zoonotic, or animal-borne. In areas of Africa where the disease is endemic (that is, constantly present), Lassa Fever is a significant cause of morbidity and morality. While Lassa Fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multi-system disease. Lassa Fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50%.
12. Leishmaniasis Visceral (Kala-Azar)
Visceral leishmaniasis, which is the more severe form of the leishmniasis, hits an annual total of 500,000 people, mostly in the developing countries. It is caused by the parasite Leishmania infantum. A flagellate protozoan, it uses as vector an insect resembling a midge, the sand fly, colonizing the intestine and then the salivary glands. The female insect fees on mammals’ blood. It can thus pass the parasite on to humans by a single bite. Once in the blood stream, L. infantum passes into particular cells of the immune system, the macrophages. These eventually burst, releasing the parasites which move on to penetrate other cells. The infected subject suffers bouts of fever, anaemia, enlarged spleen and liver, and weight loss. In the absence of treatment, these clinical signs usually announce a fatal income.
Leptospirosis is a potentially serious bacterial illness that is most common in the tropics. Leptospirosis can affect many parts of the body. Infected wild animals pass leptospirosis-causing bacteria in their urine. People get this disease by contact with fresh water, wet soil, or vegetation that has been contaminated by the urine of infected animals. Leptospirosis is treatable with antibiotics. To prevent leptospirosis, minimize contact with fresh water and mud that might be contaminated with the urine of infected animals.
14. Listeriosis Pneumonia
Listeriosis is a disease caused by the bacteria listeria monocytogenes. It is rare, but when it does occur, it most frequently affects pregnant women, newborns, and children and adults whose immunity is weakened by diseases such as cancer or AIDS. People who have had transplants are also more at risk for listeriosis. Listeria may be transmitted through food, soil, and water and has caused local outbreaks. There have been documented cases of its transmission through a variety of items: deli meats and cold cuts, soft-ripened cheese, milk, undercooked chicken, uncooked hot dogs, shellfish, and coleslaw made from contaminated cabbage. Many cases of infection, however, have no identifiable source.
15. Measles (Rubeola)
The disease is highly contagious, and can be transmitted from 4 days prior to the onset of the rash to 4 days after the onset. If one person has it, 90% of their susceptible close contacts will also become infected with the measles virus. The virus resides in the mucus in the nose and throat of the infected person. When that person sneezes or coughs, droplets spray into the air. The infected mucus can land in other people’s noses or throats when they breathe or put their fingers in their mouth or nose after handling an infected surface. The virus remains active and contagious on infected surfaces for up to 2 hours. Measles spreads so easily that anyone who is not immunized will probably get it, eventually.
16. Meningitis (Meningococcal Infection)
Meningitis is an infection of the fluid of a person’s spinal cord and the fluid that surrounds the brain. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of the illness and the treatment differ. Viral meningitis is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people.
17. Mumps (Infectious Parotitis)
Mumps is an acute viral illness. The virus is acquired by respiratory droplets. In 1934, Johnson and Goodpasture showed that mumps could be transmitted from infected patients to rhesus monkeys and demonstrated that mumps was caused by a filterable agent present in the saliva. This agent was later shown to be a virus. Mumps was a frequent cause of outbreaks among military personnel in the prevaccine era, and was one of the most common causes of aseptic meningitis and sensorineural deafness in childhood. During World War I, only influenza and gonorrhea were more common causes of hospitalization among soldiers. Outbreaks of mumps have been reported among military personnel as recently as 1986. This virus has been recovered from saliva, cerebrospinal fluid, urine, blood, milk and infected tissues of patients with mumps.
18. Whooping Cough (Pertussis)
Pertussis, or whooping cough, is an acute infectious disease caused by the bacterium bordetella pertussis. Outbreaks of pertussis were first described in the 16th century, and the organism was first isolated in 1906. In the 20th century, pertussis was one of the most common childhood diseases and a major cause of childhood mortality in the United States. Prior to the availability of pertussis vaccine in the 1940’s, more than 200,000 cases of pertussis were reported annually. Since widespread use of the vaccine began, incidence has decreased more than 98%, to an average of about 4,400 cases per year since 1980. Pertussis remains a major health problem among children in developing countries, with an estimated 285,000 deaths resulting from the disease in 2001.
19. Pneumonic Plague (Yersinia Pestis)
Pneumonic plague occurs when Y. Pestis infects the lungs. This type of plague can spread from person to person through the air. Transmission can take place if someone breathes in aerosolized bacteria, which could happen in a bioterrorist attack. Pneumonic plague is also spread by breathing in Y. Pestis suspended in respiratory droplets from a person (or animal) with pneumonic plague. Becoming infected in this way usually requires direct and close contact with the ill person or animal. Pneumonic plague may also occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to the lungs.
Rabies is a disease caused by a virus found in the saliva of infected animals and is transmitted to pets and humans by bites or possibly by contamination of an open cut. Treatment of an infected person is critical. Untreated, rabies causes a painful death. Most animals can be infected by the virus and can transmit the disease to man. Infected bats, raccoons, foxes, skunks, dogs or cats provide the greatest risk to humans. Rabies may also spread through exposure to infected domestic farm animals, groundhogs, weasels and other wild carnivores. Squirrels, rodents and rabbits are seldom infected.
21. German Measles (Rubella)
Rubella, a commonly known as German Measles or 3-day measles is an infection that primarily affects the skin and lymph nodes. It is caused by the rubella virus (not the same virus that causes measles), which is usually transmitted by secretions from the nose or throat. It can also pass through a pregnant woman’s bloodstream to infect her unborn child. As this is a generally mild disease in children, the primary medical danger of rubella is the infection of pregnant women, which may cause congenital rubella syndrome in developing babies.
Pulmonary tuberculosis (TB) is a contagious bacterial infection caused by Mycobacterium tuberculosis. The lungs are primarily involved, but the infection can spread to other organs. Tuberculosis can develop after inhaling droplets sprayed into the air from a cough or sneeze by someone infected with Mycobacterium tuberculosis. The disease is characterized by the development of granulomas (granular tumors) in the infected tissues. The usual site of the disease is the lungs, but other organs may be involved. The primary stage of the infection is usually asymptomatic (without symptoms). In the United States, the majority of people will recover from primary TB infection without further evidence of the disease. Primary pulmonary TB develops in the minority of people whose immune systems do not successfully contain the primary infection. In this case, the disease may occur within weeks after the primary infection. TB may also lie dormant for years and reappear after the initial infection is contained. Infants, the elderly, and individuals who are immunocompromised—for example, those with AIDS, those undergoing chemotherapy, or transplant recipients taking antirejection medications—are at higher risk for progression to disease or reactivation of dormant disease. In pulmonary TB, the extent of the disease can vary from minimal to massive involvement. Without effective therapy, the disease becomes progressively worse.
23. Herpes Zoster (Varicella)
Herpes Zoster, commonly known as shingles, is caused by the same virus responsible for chicken pox. After the initial exposure, herpes zoster, lies dormant in certain nerve fibers. It may become active as a result of many factors such as: aging, stress, suppression of the immune system, and certain medications. Because of the layout of the nerves that herpes zoster resides in, it only affects one side of the body or face during an outbreak. It begins as a rash that lead to blisters and sores on the skin. When the nerve branch that supplies the eye is involved, the forehead, nose and eyelids may also be affected. Sores on the nose are a key signal of possible eye involvement.
Chickenpox is caused by the varicella zoster virus, which is a member of the herpesvirus family and is associated with herpes zoster (shingles). Chickenpox is highly contagious but for the majority of children it is a mild disease characterized by small round lesions on the skin that cause intense itching. It lasts from two to three weeks and recovery from the disease usually gives permanent immunity to it. Half of all cases occur in children between the ages of 5 and 9. It has been estimated that only 10 percent of Americans over the age of 15 have never had chickenpox. 3.7 million cases of varicella were estimated to occur in the US annually in the early 1990’s. Data from 1992 showed that about 158,000 cases of chickenpox were reported and 100 deaths were reported. More than half of the deaths were in adults because chickenpox is more serious in adults than children. Up to 20 percent of adults who get chickenpox can develop severe complications such as pneumonia. Other rare complications from chickenpox include serious bacterial infection of the lesions and brain inflammation, which is reported in less than one percent of children who get chickenpox. Most children and adults who develop severe complications from chickenpox disease have compromised immune systems or other health problems.
Shingles, commonly known as herpes zoster, is a late manifestation of the chicken pox virus known as varicella zoster. Although shingles affects millions of adults by the time they reach 80, it is not uncommon for younger people to develop the virus. When the virus activates it travels along nerve fibers, usually breaking out on one side of the body into small blisters called vesicles. Within a few days the blisters rupture forming scabs. Shingles is associated with severe pain, itching, redness, numbness, and the development of a rash. Shingles can affect the eyes. This is due to the fact that the eyes are connected to nerves that may be infected with the virus. Early diagnosis and treatment is important to minimize the symptoms and reduce the risk of complications that may compromise vision.