Document Sample


Infectious Diseases

The purpose of this module is to provide exposure to HIV/AIDS some of the emerging
infectious diseases that will affect the health of the public. The module will examine the
challenges faced by pre-hospital providers and the overall public health system.

                          Goals and Objectives
      Describe the difference between HIV/AIDS
      Describe the stages of HIV
      Describe the opportunistic infections associated with HIV/AIDS
      Describe the causes and contributing factors, which lead to the emergence of
       infectious diseases.
      Describe the latest emerging infections, which have the potential to threaten
       people living in the Unites States.
      Describe in detail some of the measures that can be used to control and contain
       these infectious diseases.
      Describe how various components of the environment affect the public’s health
      Describe the roles and responsibilities of the healthcare provider in confronting
       healthcare threats related to the environment.
        What Are Emerging Infectious Diseases?
Emerging infectious diseases are human illnesses caused by microorganisms or their
poisonous byproducts and have the potential for occurring in epidemic numbers.

Why Should Pre-Hospital Providers Be Concerned?

      Infectious diseases pose a threat to all persons regardless of age, sex, lifestyle,
       ethnic background or socioeconomic status.
      Infectious disease cause mass suffering and potentially death.
      Infectious diseases place a huge financial burden on society.

                 Facts About Infectious Diseases
      Over the past century, infectious diseases have decreased as a cause of death in
       the United States.
      Improved sanitation, vaccination and antibiotics have played a large part in this
       decrease and are responsible to the increase in the lifespan of our residents.
      However, in the past twenty years the incidence of emerging infectious diseases
       has increased.
      In the U.S. about 25% of all physician visits are attributed to infectious diseases.

         How Are Infectious Diseases Acquired?
      Inhalation
      Ingestion (food, water, soil)
      Absorbed From Mucous Membranes
      Blood and Body Fluid Exposure

       HIV stands for human immunodeficiency virus. This is the virus that can lead to
       Acquired Immune Deficiency Syndrome, or AIDS. HIV is different from most
       other viruses because it attacks the immune system. The immune system gives our
       bodies the ability to fight infections. HIV finds and destroys a type of white blood
       cell (T cells or CD4 cells) that the immune system must have to fight disease.

       AIDS is the final stage of HIV infection. It can take years for a person infected
       with HIV, even without treatment, to reach this stage. Having AIDS means that
       the virus has weakened the immune system to the point at which the body has a
       difficult time fighting infections. When someone has one or more of these
       infections and a low number of T cells, he or she has AIDS.
                                   Stages of HIV
       Stage One-
           Short “Flu Like” illness, occurs one to six weeks after infection
           No symptoms at all
           Infected person can infect other people

       Stage Two- Asymptomatic
           Lasts for an average of ten years
           This stage is free from symptoms
           There may be swollen glands
           The level of HIV in the blood drops to very low levels
           HIV antibodies are detectable in the blood

       Stage Three- Symptomatic
           They symptoms are mild
           The immune system deteriorates
           Emergence of opportunistic infections and cancers

       Stage Four- AIDS
           The immune system weakens
           The illnesses become more severe leading to an AIDS diagnosis

Opportunistic Infections associated with AIDS
Bacterial- Tuberculosis (TB), Strep Pneumonia
Viral- Kaposi Sarcoma, Herpes, Influenza (flu)
Parasitic- Pneumocystis Carinii
Fungal- Candida, Cryptococcus

                       Herpes                           Kaposi Sarcoma
                         How is HIV Transmitted?
HIV is spread by sexual contact with an infected person, by sharing needles and/or
syringes (primarily for drug injection) with someone who is infected, or, less commonly
(and now very rarely in countries where blood is screened for HIV antibodies), through
transfusions of infected blood or blood clotting factors. Babies born to HIV-infected
women may become infected before or during birth or through breast-feeding after birth.

In the health care setting, workers have been infected with HIV after being stuck with
needles containing HIV-infected blood or, less frequently, after infected blood gets into
a worker’s open cut or a mucous membrane (for example, the eyes or inside of the

Bodily Fluids
      Blood

      Semen

      Vaginal Fluids

      Breast Milk

IV Drug Use
      Sharing needles increases the chances of contracting HIV

Sexual Intercourse
      Vaginal

      Oral

      Anal

      Digital Sex

      Before Birth

      During Birth

      Postpartum (After Birth)
                         HIV in the United States*
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
                                   Fast Facts
      1.2 million people in the United States are living with HIV infection and 1 in 5
       are unaware of their infection.
      MSM, particularly young, black MSM, are most severely affected by HIV.
      By race, African Americans face the most severe HIV burden.

CDC estimates 1.2 million people in the United States (US) are living with HIV
infection. One in five (20%) of those people are unaware of their infection. Despite
increases in the total number of people in the US living with HIV infection in recent
years, the annual number of new HIV infections has remained relatively stable. However,
new infections continue at far too high of a level, with approximately 50,000 Americans
becoming infected with HIV each year.
In 2009, an estimated 42,011 people were diagnosed with HIV infection in the 40 states
with confidential name-based HIV infection reporting since at least January 2006. In that
same year, an estimated 34,247 people throughout the US (50 states and the District of
Columbia) were diagnosed with AIDS. Since the epidemic began, an estimated 1,108,611
people in the US have been diagnosed with AIDS.
More than 16,000 people with AIDS were estimated to have died in 2008, and nearly
594,500 people with AIDS in the US have died since the epidemic began.

                               By Risk Group
Gay, Bisexual, and Other Men Who Have Sex with Men (MSM) of all races and
ethnicities remain the population most severely affected by HIV.
      CDC estimates that MSM account for just 2% of the US population, but
       accounted for 61% of all new HIV infections in 2009.
       MSM accounted for 49% of people living with HIV infection in 2008 (the most
       recent year prevalence data are available).

Estimates of New HIV Infections in the United States, 2009, for the Most-Subpopulations
     In 2009, white MSM accounted for the largest number of new HIV infections of
       any group in the US, followed closely by black MSM.
     Young, black MSM were the only risk group in the US to experience statistically
       significant increases in new HIV infections from 2006–2009.

Heterosexuals and Injection Drug Users also continue to be affected by HIV.
      Heterosexuals accounted for 27% of estimated new HIV infections in 2009 and
       28% of people living with HIV infection in 2008.
      Injection drug users represented 9% of new HIV infections in 2009 and 17% of
       those living with HIV in 2008.
      HIV infections among women are primarily attributed to heterosexual contact or
       injection drug use. Women accounted for 23% of estimated new HIV infections in
       2009 and 25% of those living with HIV infection in 2008.
                       HIV in the Environment
Scientists and medical authorities agree that HIV does not survive well in the
environment, making the possibility of environmental transmission remote. HIV is found
in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva,
and tears. To obtain data on the survival of HIV, laboratory studies have required the use
of artificially high concentrations of laboratory-grown virus. Although these unnatural
concentrations of HIV can be kept alive for days or even weeks under precisely
controlled and limited laboratory conditions, CDC studies have shown that drying of
even these high concentrations of HIV reduces the amount of infectious virus by 90 to 99
percent within several hours. Additionally, HIV is unable to reproduce outside its living
host (unlike many bacteria or fungi, which may do so under suitable conditions), except
under laboratory conditions, therefore, it does not spread or maintain infectiousness
outside its host.
Casual contact through closed-mouth or "social" kissing is not a risk for transmission of
HIV. Because of the potential for contact with blood during "French" or open-mouth
kissing, CDC recommends against engaging in this activity with a person known to be
infected. However, the risk of acquiring HIV during open-mouth kissing is believed to be
very low. CDC has investigated only one case of HIV infection that may be attributed to
contact with blood during open-mouth kissing.

In 2004, CDC published findings from a state health department investigation of an
incident that suggested blood-to-blood transmission of HIV by a human bite. There have
been other reports in the medical literature in which HIV appeared to have been
transmitted by a bite. Severe trauma with extensive tissue tearing and damage and
presence of blood were reported in each of these instances. Biting is not a common way
of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV

                       Saliva, Tears, and Sweat
HIV has been found in saliva and tears in very low quantities from some AIDS
patients. It is important to understand that finding a small amount of HIV in a body fluid
does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not
been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or
sweat has never been shown to result in transmission of HIV.
From the onset of the HIV epidemic, there has been concern about transmission of the
virus by biting and bloodsucking insects. However, studies conducted by researchers at
CDC and elsewhere have shown no evidence of HIV transmission through insects--even
in areas where there are many cases of AIDS and large populations of insects such as
mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the
conclusion that insects do not transmit HIV.

       Special Note
              a. People infected with HIV also have a high possibility of being
                  co-infected with Hepatitis and/or Tuberculosis due to
                  suppressed immune systems.


There is no cure for HIV/AIDS, but a variety of drugs can be used in combination to
control the virus. Each of the classes of anti-HIV drugs blocks the virus in different
ways. It's best to combine at least three drugs from two different classes to avoid
creating strains of HIV that are immune to single drugs. The classes of anti-HIV drugs

      Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable
       a protein needed by HIV to make copies of itself. Examples include efavirenz
       (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
      Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty
       versions of building blocks that HIV needs to make copies of itself. Examples
       include Abacavir (Ziagen), and the combination drugs emtricitabine and
       tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
      Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs
       to make copies of itself. Examples include atazanavir (Reyataz), darunavir
       (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).
      Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells.
       Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
      Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a
       protein that HIV uses to insert its genetic material into CD4 cells.
When to start treatment
Current guidelines indicate that treatment should begin if:

      You have severe symptoms
      Your CD4 count is under 500
      You're pregnant
      You have HIV-related kidney disease
      You're being treated for hepatitis B

Treatment can be difficult
HIV treatment regimens may involve taking multiple pills at specific times every day
for the rest of your life. Side effects can include:

      Nausea, vomiting or diarrhea
      Abnormal heartbeats
      Shortness of breath
      Skin rash
      Weakened bones
      Bone death, particularly in the hip joints

Treatment response
Your response to any treatment is measured by your viral load and CD4 counts. Viral
load should be tested at the start of treatment and then every three to four months while
you're undergoing therapy. CD4 counts should be checked every three to six months.

HIV treatment should reduce your viral load to the point that it's undetectable. That
doesn't mean your HIV is gone. It just means that the test is not sensitive enough to
detect it. You can still transmit HIV to others when your viral load is undetectable.

                                  What is Staph and MRSA?
Staph is a type of bacteria. It may cause skin infections that look like pimples or
boils. Skin infections caused by Staph may be red, swollen, painful, or have pus
or other drainage. Some Staph (known as Methicillin-Resistant Staphylococcus
aureus or MRSA) are resistant to certain antibiotics, making it harder to treat

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is
resistant to certain antibiotics. These antibiotics include methicillin and other more
common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections,
including MRSA, occur most frequently among persons in hospitals and healthcare
facilities (such as nursing homes and dialysis centers) who have weakened immune
MRSA infections that occur in otherwise healthy people who have not been recently
(within the past year) hospitalized or had a medical procedure (such as dialysis,
surgery, catheters) are known as community-associated (CA)-MRSA infections. These
infections are usually skin infections, such as abscesses, boils, and other pus-filled

                                         Who can get it?
       Anyone can get a Staph infection. People are more likely to get a Staph infection
       if they have:
                Skin-to-skin contact with someone who has a Staph infection
                Contact with items and surfaces that have Staph on them
                Openings in their skin such as cuts or scrapes
                Crowded living conditions (Nursing homes, day care, schools, recently
               found in Firehouses)
                Poor hygiene

                               How is MRSA transmitted?
Patients who already have an MRSA infection or who carry the bacteria on their bodies
but do not have symptoms (colonized) are the most common sources of transmission.

The main mode of transmission to other patients is through human hands, especially
healthcare workers' hands. Hands may become contaminated with MRSA bacteria by
contact with infected or colonized patients. If appropriate hand hygiene such as
washing with soap and water or using an alcohol-based hand sanitizer is not performed,
the bacteria can be spread when the healthcare worker touches other patients.

                         How serious are these Staph infections?

Most Staph skin infections are minor and may be easily treated. Staph also may
cause more serious infections, such as infections of the bloodstream, surgical sites, or
pneumonia. Sometimes, a Staph infection that starts as a skin infection may worsen. It is
important to contact your doctor if your infection does not get better. An important thing
to remember is do not scratch or pick at a possible staph infection.

                       How are Staph related infections treated?

Treatment for a Staph skin infection may include taking an antibiotic or having
a doctor drain the infection. If you are given an antibiotic, be sure to take all of
the doses, even if the infection is getting better, unless your doctor tells you to
stop taking it. Do not share antibiotics with other people or save them to use later.
                  How can I prevent the spread of Staph infections?

         Wash your hands often AND use an alcohol-based hand sanitizer
         Keep your cuts and scrapes clean and cover them with bandages
         Do not touch other people's cuts or bandages
         Do not share personal items like towels or razors
         Shower immediately after exercise and contact sports
         Use barrier clothing, such as a towel, while utilizing gym equipment
         Ensure that highly contacted surfaces remain clean

                                  HEPATITIS A

Description         Hepatitis A is a liver disease caused by the hepatitis A virus. Hepatitis A can affect
                    anyone. In the United States, hepatitis A can occur in situations ranging from
                    isolated cases of disease to widespread epidemics.

                    Good personal hygiene and proper sanitation can help prevent hepatitis A. Vaccines
                    are also available for long-term prevention of hepatitis A virus infection in persons
                    12 months of age and older. Immune globulin is available for short-term prevention
                    of hepatitis A virus infection in individuals of all ages.
TRANSMISSION                HAV is found in the stool (feces) of persons with hepatitis A.
                            HAV is usually spread from person to person by putting something in the
                             mouth (even though it might look clean) that has been contaminated with
                             the stool of a person with hepatitis A.

                                   HEPATITIS B

DESCRIPTION         Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus,
                    which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis
                    (scarring) of the liver, liver cancer, liver failure, and death.

                    Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus
TRANSMISSION                Occurs when blood from an infected person enters the body of a person
                             who is not infected.
                            HBV is spread through having sex with an infected person without using a
                             condom (the efficacy of latex condoms in preventing infection with HBV
                             is unknown, but their proper use might reduce transmission), by sharing
                             drugs, needles, or "works" when injecting drugs, through needle sticks or
                             sharps exposures on the job, or from an infected mother to her baby during

                    Persons at risk for HBV infection might also be at risk for infection with hepatitis C
                    virus (HCV) or HIV.
                                      HEPATITIS C
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons
who have this disease.

TRANSMISSION                    Occurs when blood from an infected person enters the body of a person
                                 who is not infected.
                                HCV is spread through sharing needles or "works" when "shooting" drugs,
                                 through needle sticks or sharps exposures on the job, or from an infected
                                 mother to her baby during birth.

                                      HEPATITIS D
Hepatitis D is a liver disease caused by the hepatitis D virus (HDV), a defective virus that needs the
hepatitis B virus to exist. Hepatitis D virus (HDV) is found in the blood of persons infected with the virus

TRANSMISSION                                Occurs when blood from an infected person enters the body of
                                             a person who is not immune.
                                            HBV is spread through having sex with an infected person
                                             without using a condom (the efficacy of latex condoms in
                                             preventing infection with HBV is unknown, but their proper
                                             use may reduce transmission);
                                            By sharing drugs, needles, or "works" when "shooting" drugs;
                                            Through needle sticks or sharps exposures on the job; or
                                            From an infected mother to her baby during birth.

                                      HEPATITIS E
Hepatitis E is a liver disease caused by the hepatitis E virus (HEV) transmitted in much the same way as
hepatitis A virus. Hepatitis E, however, does not occur often in the United States.

TRANSMISSION                                HEV is found in the stool (feces) of persons and animals with
                                             hepatitis E.
                                            HEV is spread by eating or drinking contaminated food or
                                            Transmission from person to person occurs less commonly
                                             than with hepatitis A virus
                                            Most outbreaks in developing countries have been associated
                                             with contaminated drinking water.

      Jaundice                                      Abdominal pain
      Fatigue                                       Loss of appetite
      Dark urine                                    Nausea
                                                     Fever

                          What is Influenza (Also Called Flu)?

The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild
to severe illness, and at times can lead to death. The best way to prevent the flu is by
getting a flu vaccination each year.

                                    Symptoms of Flu

Symptoms of flu include:
• Fever (usually high)                                • headache
• Extreme tiredness                                   • dry cough
• Sore throat                                         • runny or stuffy nose
• Muscle aches                                        • nausea, vomiting, and diarrhea

                                  Complications of Flu

Complications of flu can include bacterial pneumonia, ear infections, sinus infections,
dehydration, and worsening of chronic medical conditions, such as congestive heart
failure, asthma, or diabetes.
                                       How Flu Spreads

  Touching something with flu viruses on it and then touching your nose or mouth
  A person infected may spread the virus to others one day before becoming sick and up
  to five days after becoming sick

                             Preventing the Flu: Get Vaccinated

  People who should get vaccinated each year are:

  1. People at high risk for complications from the flu, including:
  • Children aged 6 months until their 5th birthday,
  • Pregnant women,
  • People 50 years of age and older,
  • People of any age with certain chronic medical conditions, and
  • People who live in nursing homes and other long term care facilities.

  2. People who live with or care for those at high risk for complications from flu,
  • Household contacts of persons at high risk for complications from the flu (see above)
  • Household contacts and out of home caregivers of children less than 6 months of age
  children are too young to be vaccinated)
  • Health care workers.

                                H1N1 (Swine Flu)
Novel H1N1 flu, popularly known as swine flu, is a respiratory infection caused by an
influenza virus first recognized in spring 2009. The new virus, which is officially called
swine influenza A (H1N1), contains genetic material from human, swine and avian flu

Technically, the term "swine flu" refers to influenza in pigs. Occasionally, pigs transmit
influenza viruses to people, mainly hog farm workers and veterinarians. Less often,
someone infected occupationally passes the infection to others. You can't catch swine flu
from eating pork.

Unlike typical swine flu, H1N1 flu spreads quickly and easily. In June 2009, when the
infection's spread had been verified worldwide, the World Health Organization declared
H1N1 flu a global pandemic.

An H1N1 vaccine has been developed for the 2009-10 flu season.

Swine flu symptoms in humans are similar to those of infection with other flu strains:

          Fever
          Cough
          Sore throat
          Body aches
          Headache
          Chills
          Fatigue
          Diarrhea
          Vomiting

Swine flu symptoms develop three to five days after you're exposed to the virus and
continue for about eight days, starting one day before you get sick and continuing until
you've recovered.


Influenza viruses infect the cells lining your nose, throat and lungs. The virus enters your
body when you inhale contaminated droplets or transfer live virus from a contaminated
surface to your eyes, nose or mouth on your hand.

                                         Risk factors

Because novel H1N1 virus is new, everyone is at some risk. Health care workers (EMS)
who provide direct patient care are at particular risk of catching H1N1 flu. College students
and children in school and child care are also at high risk. Children typically pick up the
virus in the classroom and pass it to other members of the household.

                                Treatments and medications

Most cases of flu, including human swine flu, need no treatment other than symptom relief.
If you have a chronic respiratory disease, your doctor may prescribe additional medication
to decrease inflammation, open your airways and help clear lung secretions.
The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can reduce the severity
of symptoms, but flu viruses can develop resistance to them. To make development of
resistance less likely and maintain supplies of these drugs for those who need them most,
antivirals are reserved for people at high risk of complications.
High-risk groups are those who:

          Are hospitalized
          Have shortness of breath along with other flu symptoms
          Are younger than 5 years of age
          Are 65 years and older
         Are pregnant
         Are younger than 19 years of age and are receiving long-term aspirin therapy,
          because of an increased risk for Reye's syndrome
         Have certain chronic medical conditions, including asthma, emphysema, heart
          disease, diabetes, neuromuscular disease, and kidney, liver or blood disease
         Are immunosuppressed due to medications or HIV


A vaccine has been developed to prevent swine flu. In the United States, vaccination is
recommended for:

   Pregnant women. The risk of swine flu complications is higher during pregnancy.
   Mothers can potentially provide protection to infants who cannot be vaccinated.

   Household contacts and caregivers for children younger than 6 months of age. Younger
   infants are at higher risk of flu complications and cannot be vaccinated. Vaccination of
   those in close contact with infants less than 6 months old might reduce the infants' risk
   of exposure to the virus.

   Health care and emergency medical services personnel. Infections have been reported
   among health care workers, who can be a potential source of infection for vulnerable
   patients. Also, increased absenteeism in health care workers could reduce health care
   system capacity.

   Babies, children and teens, from 6 months through 18 years of age. Many cases of novel
   H1N1 influenza have occurred in children. Influenza viruses spread easily in school and
   child care, and children infected in these settings carry the infection to their families.

   Young adults, from 19 through 24 years of age. Immunization is important for young
   adults because they tend to live, work, and study in close proximity, and they move and
   travel often.

   People ages 25 through 64 years who have health conditions associated with higher risk
   of medical complications from influenza. These conditions include heart disease, lung
   disease and some types of cancer.


                                          What is TB?

  Tuberculosis (TB) is a disease caused by germs that are spread from person to person
  through the air. TB usually affects the lungs, but it can also affect other parts of the body,
  such as the brain, the kidneys, or the spine. A person with TB can die if they do not get
                                What are the symptoms of TB?

Feelings of sickness                  coughing                    night sweats
Weakness                              chest pain                  loss of appetite
Weight loss                           coughing up blood           chills
Fever                                 fatigue

                                     How is TB spread?

Coughing, sneezing, speaking, laughing, singing
TB germs can stay in the air for several hours depending on the environment
Persons who breathe in the air containing these TB germs can become infected, called
latent TB infection

         What is the difference between latent TB infection and TB disease?

Persons infected with latent TB infection have the TB germs in their bodies, do not have
any signs or symptoms of the disease and cannot spread the germs to others
They may develop the disease later, which then would be active TB and can spread to

                                    What is Meningitis?

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 illness and the treatment differ.

                                Bacterial vs. Viral Meningitis

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.

                         What are the symptoms of Meningitis?

Fever                                                drowsiness
Severe head ache                                     confusion
Stiff neck                                           nausea, vomiting
Sensitivity to bright lights

              *Symptoms can develop over several hours, or up to two days
                             How is Meningitis transmitted?

      Exchange of respiratory and throat secretions
      Coughing
      Kissing
      Fortunately, not as contagious as the common cold or flu virus
      Cannot contract the disease from breathing the air where an infected person is or
       through casual contact

Scabies is an infestation of the skin with the microscopic mite Sarcoptes scabei.
Infestation is common, found worldwide, and affects people of all races and social
classes. Scabies spreads rapidly under crowded conditions where there is frequent skin-
to-skin contact between people, such as in hospitals, institutions, child-care facilities, and
nursing homes.
                      What are the signs and symptoms of Scabies?

      Pimple-like irritations, burrows or rash of the skin, especially the webbing
       between the fingers; the skin folds on the wrist, elbow, or knee; the penis, the
       breast, or shoulder blades.
      Intense itching, especially at night and over most of the body.
      Sores on the body caused by scratching. These sores can sometimes become
       infected with bacteria.

                               How is Scabies transmitted?

Direct, prolonged skin to skin contact with a person infected with Scabies
Sexual partners
Household members
Sharing clothing, towels, or bedding
A quick handshake or hug usually will not spread the disease

                                  Dengue Fever
Dengue (also called bone crusher disease) is an infectious disease caused by a virus. You
can get it if an infected mosquito bites you. It is common in warm, wet areas of the
world. Outbreaks occur in the rainy season. Dengue is rare in the United States, but in
2010 there have been 24 reported cases of Dengue Fever in South Florida

Symptoms include a high fever, headaches described as behind the eyes, exteme joint
and muscle pain, vomiting and a rash. Most people with dengue recover within 2 weeks.
Until then, drinking lots of fluids, resting and taking non-aspirin fever-reducing
medicines might help. Sometimes dengue turns into dengue hemorrhagic fever, which
causes bleeding from your nose, gums or under your skin. It can also become dengue
shock syndrome, which causes massive bleeding and shock. These forms of dengue are

To lower your risk when traveling in dengue-prone countries

        Wear insect repellent with DEET
        Wear clothes that cover your arms, legs and feet
        Close unscreened doors and windows

                                West Nile Virus
West Nile is a “flu-like” illness of sudden onset, caused by a subgroup of viruses called

Symptoms of WNV are fever, sore throat, headache, malaise, arthralgia or myalgia. Rash
is also very common.

Complications of WNV are meningitis or encephalitis (swelling or inflammation of the
brain tissue or the covering of the brain). If this occurs the disease is then named West
Nile Neuroinvasive Disease.


        Incubation period: usually 3 to 12 days
        Communicability- no direct person to person transmission, mode of transmission
         comes from the bite of an infected mosquito
        Prevention- Mosquito eradication and use of repellents
        Mortality rate: 3 – 15%

                            West Nile Virus:
                       a novelty becoming endemic
                                   Monkey Pox
Monkeypox is a rare viral disease that occurs mostly in central and western Africa. It is
called “monkeypox” because it was first found in 1958 in laboratory monkeys. Blood
tests of animals in Africa later found that other types of animals probably had
monkeypox. Scientists also recovered the virus that causes monkeypox from an African
squirrel. These types of squirrels might be the common host for the disease. Rats, mice,
and rabbits can get monkeypox, too. Monkeypox was reported in humans for the first
time in 1970.

In early June 2003, monkeypox was reported among several people in the United States.
Most of these people got sick after having contact with pet prairie dogs that were sick
with monkeypox. This is the first time that there has been an outbreak of monkeypox in
the United States.

The disease is caused by Monkeypox virus. It belongs to a group of viruses that includes
the smallpox virus (variola), the virus used in the smallpox vaccine (vaccinia), and the
cowpox virus.

In humans, the signs and symptoms of monkeypox are like those of smallpox, but usually
they are milder. Another difference is that monkeypox causes the lymph nodes to swell.

About 12 days after people are infected with the virus, they will get a fever, headache,
muscle aches, and backache; their lymph nodes will swell; and they will feel tired. One to
3 days (or longer) after the fever starts, they will get a rash. This rash develops into raised
bumps filled with fluid and often starts on the face and spreads, but it can start on other
parts of the body too. The bumps go through several stages before they get crusty, scab
over, and fall off. The illness usually lasts for 2 to 4 weeks.

In Africa, monkeypox has killed between 1 percent and 10 percent of people who get it.
However, this risk would probably be lower in the United States, where nutrition and
access to medical care are better.

People can get monkeypox from an animal with monkeypox if they are bitten or if they
touch the animal’s blood, body fluids, or its rash. The disease also can spread from
person to person through large respiratory droplets during long periods of face-to-face
contact or by touching body fluids of a sick person or objects such as bedding or clothing
contaminated with the virus.

Severe Acute Respiratory Syndrome (SARS)
Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a
coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported
in Asia in February 2003. The illness spread to more than two dozen countries in North
America, South America, Europe, and Asia before the SARS global outbreak of 2003
was contained.
Since 2004, there has been no known SARS transmission anywhere in the world. CDC
continues to maintain capacity test for SARS-CoV and to investigate suspected SARS
cases. Any new updates on SARS will be posted on this site.

       General Practices For Preventing Exposure To All Infectious Diseases

          Gloves should be worn during contact with blood or other body fluids that
           could possibly contain visible blood, such as urine, feces, or vomit.
          Cuts, sores, or breaks on both the caregiver’s and patients exposed skin should
           be covered with bandages.
          Hands and other parts of the body should be washed immediately after contact
           with blood or other body fluids, and surfaces soiled with blood should be
           disinfected appropriately. Also, an alcohol-based hand cleaner is
           recommended after hand washing.
          Needles and other sharp instruments should be used only when medically
           necessary and handled according to recommendations for health-care settings.
           (Do not put caps back on needles by hand or remove needles from syringes.
           Dispose of needles in puncture-proof containers out of the reach of children
           and visitors.)


                              Post Exposure Management

-Provide First Aid
        -Removing contaminated clothing, washing with soap and water, using antiseptic
        hand cleaner, flushing eyes, nose and mouth with copious amounts of water
-Notification and Relief of Duty
        -Immediate supervisor notified and determination of whether person involved
        needs to be relieved of duty
-Assess Level of Exposure
        -Non-significant: little to no risk of transmission of disease
        -Significant: increased risk of transmitting and acquiring an infectious disease
-Assess Exposures to Blood or Body Fluids
        -A significant blood or body fluid exposure is considered a combination of one or
        more of the types of body fluids and one or more of the injuries listed below:
                -Body fluids
                        -Pleural, amniotic, peritoneal, synovial, and cerebrospinal
                        -Uterine/vaginal secretions, semen, feces, and urine
                -Action or Injury
                        -Percutaneous (through the skin-needle sticks, lacerations, bites,
                        -Mucous membrane (eyes, nose, mouth)
                      -Non-intact skin (chapped or abraded skin; also an increased risk
                      exists if the exposure is within 2 hours of shaving skin, scabs are
                      <24 hours old or if skin is still open)

-Assess Exposure to Airborne Droplets
       -A significant airborne exposure is considered a combination of a source
       exhibiting signs/symptoms of suspected airborne illness and an incident that
       would place the worker at risk of droplet or airborne exposure
                       -Aerosolized exhalations containing droplets, sputum, lung
                       secretions, or saliva by coughing, spitting, breathing, or by an
                       action by the worker such as suctioning, intubating and the worker
                       was not wearing appropriate respiratory protection (HEPA mask,
                       eye protection)
                       -Actions by the worker that have increased risk of airborne disease
                       spread include suctioning, active gag reflex upon suctioning or
                       insertion of tracheal tube, King Airway, OPA, NPA, or NG tube.


       -A significantly exposed worker should be transported to a designated
       facility as soon as possible for evaluation, testing and treatment. The
       worker and source patient should be transported to the same facility.
       Upon arrival at the medical facility, the person involved should
       recommend that the Medical Director be notified immediately of the
       situation as this will help to ensure a rapid assessment and prompt
       care is given to the on-duty individual.

                                Nabil El Sanadi M.D., MBA, F.A.C.E.P
                                          Cell: 954-560-1900

-Reporting the Exposure

       -Infectious Disease Exposure Report Form
       -Workmans Compensation Doc- http://lauderlink/Risk/InjuryNotice.asp
       -FR00010 Supervisor’s Accident Investigation Form
       -FR00015 Personal Injury Report

-Consent and Counseling

       -Counseling should be provided to and consent obtained from both the source of
       the exposure and the exposed worker

      -Post exposure testing for blood and body fluid exposures
      -Post exposure testing for airborne or droplet exposures


      -The Infectious Disease Exposure Reporting Form should be complete with a
      discharge summary that includes a description of all diagnostic tests performed on
      the worker. A copy of the form is router to the designated Infectious Disease
      Control Officer and a copy is provided to the worker

-Post Exposure Medical Follow Up

      -The employer is responsible to provide or make available post exposure
      monitoring as directed by the medical provider. Follow up testing for blood and
      body fluid exposures will be performed after the initial, at week six, week twelve,
      and week twenty-six after the exposure. Testing after one year may be indicated
      for high-risk significant exposures

                      Reference Material/Additional Reading

    Fort Lauderdale Fire Rescue Standard Operating Procedures Article 2001
    Fort Lauderdale Fire Rescue Information Bulletin 06-65, Post Exposure Handbook
    Infectious Disease Training Drill 2007
    What you need to know, Pre-hospital post exposure Handbook
    South Carolina AHEC

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