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SUB-PROBLEMS INCLUDING LEADING TO IMPAIRMENT AND BEST PRACTICES FOR EMERGING AND RE-EMERGING DISEASES

Special Highly Infectious Pathogenic Organisms

Travelers are especially at risk for infectious diseases. In 2011, United States citizens made over 85 million visits abroad. They are exposed to diseases endemic in the countries that they visit and then become potential hosts for the diseases and can easily bring them back to the United States. Hepatitis A and typhoid fever are considered high potential problems and therefore the traveler should be vaccinated prior to leaving the United States. Border entry screening for infectious diseases in people during a SARS outbreak was found to be very costly and a diversion of limited public health resources without a measurable effect. (See endnote 26.)

Emerging and re-emerging infectious and communicable diseases are of constant concern because they simply cannot be eradicated. Virtually every time people believe this has occurred the microorganisms seem to adapt to the current environment and new strains appear. Individual organisms may become resistant to drugs and new organisms may emerge from animals.

Pathogenic organisms of concern currently and the problems that they cause include:

  • Acinetobacter, a group of bacteria usually found in soil and water, causes infections especially in intensive care units and other areas housing very sick patients.
  • Borrelia hermsii causes a tick-borne relapsing fever usually occurring after sleeping in cabins infested with the ticks.
  • Burkholderia, a group of bacteria that can be found in soil and water, causes infections in people with weakened immune systems or chronic lung diseases.
  • • Chikungunya virus is spread by the mosquito Aedes aegyptii and causes insomnia, high fever, severe headaches, and joint and muscle pains that last for weeks.
  • Cryptosporidium is a microscopic parasite that causes a diarrheal disease resulting in dehydration, vomiting, elevated fever, and weight loss. It is found in water including recreational water that has been contaminated with sewage or feces from humans or animals.

It also can be contracted by eating contaminated food or touching surfaces that are contaminated by contaminated feces or sewage.

  • C. difficile is a bacterium that causes inflammation of the colon, diarrhea, and fever in individuals who have overused antibiotics.
  • Clostridium perfringens is the third leading cause of foodborne illness in the United States and may cause diarrhea and severe dehydration in the very young, the very old, and those debilitated by sickness. (See endnote 30.)
  • • Dengue fever creates symptoms of sudden high fever, severe headaches, pain behind the eyes, severe joint and muscle pain, vomiting and skin rash, and is a viral infection transmitted by the bite of an Aedes mosquito.
  • Escherichia coli 0157: H7 found in food and also acquired from person-to-person contact, produces Shiga toxins which create diarrhea (some people have no symptoms while others have severe diarrhea), abdominal cramps, and blood in the stools. Children under five can have a complication called hemolytic uremic syndrome which is extremely serious because red blood cells are destroyed leading to kidney failure. (See endnote 40.)
  • Helicobacter pylori is a bacterium that is transmitted through the oral-fecal route or through the oral-oral route and causes nausea, vomiting, loss of appetite, and bleeding, and is the major cause of peptic ulcers and gastritis.
  • • Hepatitis A is an oral-fecal route disease and may be transmitted by contaminated water or other sources of consumption of fecal material.
  • • Hepatitis B and hepatitis C viruses can be transmitted to patients and healthcare workers through injections, improper use of needles and syringes, and breaks in infection control techniques, especially in hemodialysis units, outpatient areas, long-term care facilities, and hospitals.
  • • Human metapneumovirus is a common but usually undetected cause of human respiratory diseases especially among children.
  • Klebsiella, a bacterium that has become increasingly resistant to antibiotics, is usually found in human feces in the healthcare setting and causes pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in already sick patients.
  • • Malaria is caused by the parasite Plasmodium and transmitted through the bite of a mosquito. In 2010, there were an estimated 219 million cases with 660,000 deaths.
  • • Meningitis can be caused by a group of different bacteria and viruses as well as various chemicals. The bacterial form is caused by the bacterium Neissera meningitides. Transmission is person-to-person through respiratory secretions.
  • Mycobacterium abscessus, a bacterium related to those that cause tuberculosis and leprosy, is found in water, soil, and dust and may contaminate medications and medical devices, leading to skin and soft tissue infections as well as lung infections.
  • Mycobacterium tuberculosis, an organism which causes infectious tuberculosis, is especially readily transmitted in healthcare facilities to patients and healthcare personnel.
  • • Non-polio enteroviruses, although similar to the common cold, for individuals with weakened immune systems can cause serious consequences.
  • • Norwalk-like calciviruses frequently cause food and waterborne outbreaks of disease.
  • Norovirus is a highly infective group of viruses spread from feces to food and water, from contact surfaces, and person-to-person in close contact, and can infect the individual repeatedly. This virus is especially problematic for the very young, debilitated, those with impaired immune systems, and the very old and produces symptoms of nausea, severe vomiting, abdominal pain, diarrhea, malaise, low-grade fever, and muscle pain.
  • • Polio entroviruses are once again becoming a source of concern in countries where vaccination may be not only opposed but opposed violently. The spread of the disease to the United States and other countries may happen quite rapidly through travel of individuals who become contaminated.
  • • Prions are small pieces of protein that cause disease. They are neither bacteria, viruses, nor fungi. They may cause degenerative brain diseases and an unusual form of dementia.
  • • Rotavirus. (See Respiratory and Enteric Viruses in Pediatric Care Settings below.)
  • Toxoplasma gondii is transmitted in unfiltered water containing the parasite’s oocysts. It also can be transmitted from food or water contaminated with cat feces or soil or by eating undercooked meat that contains the oocysts.
  • Vibrio cholerae, the causative agent of cholera, has had a resurgence in Dhaka and Bangladesh causing 30,000 cases of the disease.
  • • Yellow fever, a mosquito-borne viral infection, is still endemic in tropical countries in Africa and South America and can be transmitted to individuals from the bites of a mosquito, A. aegyptii, which can be found in the United States.
 
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