Health care professionals, therefore, may be confronted with the ILI patient who has Q fever or another livestock-associated zoonosis at a time period that overlaps with or soon follows a high caseload of seasonal influenza. The health care professional could then make a misdiagnosis of influenza. The critical messaging opportunity for the Extension professional is to advocate the following precautions for managing livestock during gestation and birthing.
For health care professionals, occupational history is a critical component of the diagnostic process. Therefore, a request for primary occupation or place of employment in a patient's history may not reveal the individual's true risk for zoonoses. The U. Further, this workforce is comprised of individuals who may not be uniformly aware of their risk for zoonoses.
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The potential risk of zoonotic infection in these individuals is considerable, particularly if these workers are not educated in recognition and prevention of zoonoses. In a survey of western U. Additionally, there is the potential for cultural, language, and socioeconomic issues to influence an ill worker's decision to seek health care.
With regard to occupational information, therefore, the critical messages for Extension professionals to their audiences involved in raising livestock are simple. Rewards such as certificates of completion of short courses, public forums, or projects on zoonotic disease prevention can serve as effective motivators for 4-H participants and youth leaders. These educational programs emphasize such fundamental steps as hand washing, pen hygiene, animal health monitoring, visitor traffic control, and proper food hygiene practices.
Importantly, these fundamental practices mitigate transmission of disease among animals as well as among animals and humans. English and Spanish language resources are available at this site. In addition, an on-line course on selected zoonoses for animal or human animal or human healthcare professionals or students is available through this Center. In summary, relatively brief critical messages about zoonotic disease prevention and recognition have been provided in this article.
We believe that the diagnostic dilemmas surrounding zoonotic diseases must be clarified to critical audiences if those audiences are to be empowered to facilitate the diagnostic process. Extension professionals can deliver these messages to critical audiences at strategic times. For example, newsletters, website postings, or emails that focus on preparation for calving, lambing, or kidding season represent timely opportunities for message delivery about zoonotic risks related to livestock birthing.
Education of the animal-owning public about zoonotic disease has been long recognized as a core mission of veterinarians and Extension professionals. A fundamental first step in effective public education on zoonotic disease is to have an awareness of the multitude of challenges that health care professionals face when confronted with a patient with zoonosis. Livestock and pet owners must adapt an active role in communication of their potential risks and exposures to their health care professionals.
Information about zoonotic disease awareness can be integrated into many forms of communication between Extension professionals and the public. Extension professionals have developed relevant training programs for 4-H volunteers and livestock producers. Those proceedings were not copyrighted. Amass, S. Investigation of the ability to determine final destinations of pigs exhibited at the Indiana state fair. Journal of Swine Health and Production 12 6 , Angelakis, E. Q fever. Veterinary Microbiology.imypydygaquc.tk
Centers for Disease Control and Prevention a. Q fever: Statistics and epidemiology. Centers for Disease Control and Prevention b. Seasonal influenza flu. Cleaveland, S. Diseases of humans and their domestic mammals: Pathogen characteristics, host range, and the risk of emergence. Philosophical Transactions of the Royal Society of London , , Cleri, D. Fever of unknown origin due to zoonoses. Infectious Disease Clinics of North America 21 4 , Grant, S. Preventing zoonotic diseases in immunocompromised persons: The role of physicians and veterinarians. Emerging Infectious Diseases , 5 1 , Heponstall, J.
Occupation and infectious diseases. London: Arnold. Kahn, L. Confronting zoonoses: Linking human and veterinary medicine. Emerging Infectious Diseases , 12 4 , Kersting, A. Zoonoses and the physician's role in educating farming patients. Journal of Agromedicine , 14 3 , Kirkhorn, S. Current health effects of agricultural work: Respiratory disease, cancer, reproductive effects, musculoskeletal injuries, and pesticide-related illnesses. Journal of Agricultural Safety and Health , 8 22 , LeJeune, J. Zoonoses: An occupational hazard for livestock workers and a public health concern for rural communities.
Journal of Agricultural Safety and Health , 16 3 , Lipton, B. A survey of veterinarian involvement in zoonotic disease prevention practices. Journal of the American Veterinary Medical Association 8 , Marshall, R. Herd-health programs for limited-resource farmers: Prevention versus treatment. Menzies, P. Control of important causes of infectious abortion in sheep and goats. Miller, L. Moore, G. Disease reporting and surveillance: Where do companion animals fit in?
Roest, H. The Q fever epidemic in the Netherlands: History, onset, response, and reflection. Epidemiology and Infection , 1 , The prophylactic use of antiviral agents in asymptomatic persons who have had potential exposure to B virus e. Viral hemorrhagic fever VHF is caused by a diverse group of viruses belonging to the families Arenaviridae, Bunyaviridae, Filoviridae , and Flaviviridae. Person-to-person transmission and nosocomial transmission have been demonstrated for VHFs due to Ebola [ 48 ], Marburg [ 49 ], Lassa [ 50 ], Crimean-Congo hemorrhagic fever [ 51 ], Argentine hemorrhagic fever [ 52 ], and Bolivian hemorrhagic fever [ 53 ] viruses.
Transmission of VHF has been associated with reuse of unsterile needles and syringes and with provision of patient care without appropriate barrier precautions to prevent exposure to blood and other body fluids that contain the virus including vomitus, urine, and stool [ 54 ]. Airborne transmission of VHF has been described in primates [ 54 ] but has never been described in humans; it is considered a possibility only in rare instances that involve persons with advanced stages of disease. One patient with Lassa fever who had extensive pulmonary involvement may have transmitted infection by the airborne route [ 55 ].
In general, a combination of contact and airborne isolation precautions should be used for patients who are suspected of having VHF. The use of an adjoining anteroom is suggested, if available, but its need has not been scientifically demonstrated. Careful evaluation of outbreaks should be undertaken to assess the need for some of the CDC recommendations that exceed those contained in contact and airborne isolation precautions, including the suggestion for an anteroom and decontamination of body fluids before disposal via a sanitary sewer i. Monkeypox, which is caused by a member of the genus Orthopoxvirus , is enzootic in squirrels and monkeys in the rain forests of western and central Africa.
Clinical signs of monkeypox include a centrifugally distributed vesiculopustular rash, respiratory distress, and, frequently, lymphadenopathy this aids in its differentiation from smallpox and varicella. Monkeypox has occurred sporadically in humans in Africa. Multiple generations up to 5 of person-to-person transmitted disease have been reported.
However, computer simulations have predicted that, even though individual outbreaks might last as long as 14 generations before dying out, self-sustaining transmission is highly unlikely [ 59 ]. Like variola virus, monkeypox virus appears to enter through skin abrasions or the mucosa of the upper respiratory tract. Person-to-person spread is well documented, but the risk of nosocomial transmission has not been assessed.
Given the likely modes of viral transmission, contact and droplet precautions should be used when treating infected patients until lesions are dried and crusted. If possible, contact with patients who have monkeypox should be limited to medical workers who have received smallpox vaccination.
No specific guidelines have been reported regarding possible postexposure prophylaxis.
Vaccinia immune globulin is available, but its use as postexposure prophylaxis has not been evaluated. Humans become infected through contact with infected animals most commonly, rock squirrels, prairie dogs, or cats or their fleas. Plague may manifest in 1 of 3 clinical forms: bubonic, septicemic, or pneumonic. Patients with plague may transmit infection via the droplet route if they have pneumonia and are coughing. The last case of plague acquired from person-to-person spread in the United States was reported in Droplet precautions plus eye protection e.
Contact and droplet precautions should be used during aspiration or irrigation of buboes. Close contacts i. Individuals who have died of plague should be handled with routine strict precautions [ 14 ]. Contact with remains should be limited to trained personnel, and the safety precautions for transporting corpses for burial should be the same as those for transporting ill patients.
Aerosol-generating procedures, such as bone sawing associated with surgery or postmortem examinations, are associated with special risks of transmission and are not recommended [ 14 ]. If such aerosol-generating procedures are necessary, high-efficiency particulate air-filtered masks and negative pressure rooms should be used [ 14 ]. Q fever, a zoonotic disease with worldwide distribution, is caused by Coxiella burnetii , an intracellular, gram-negative bacillus [ 62 ].
In humans, C. The primary mode of acquisition of C. Contaminated clothes have served as a source for human infection. Sporadic human infections have been reported to occur via intradermal injection, blood transfusion, and transplacental transmission resulting in congenital infection, and during autopsies. In addition, Q fever has been reported in an obstetrician who performed an abortion on an infected pregnant woman.
Standard precautions are adequate for the management of patients with C. It would be reasonable to use contact plus droplet precautions during obstetric procedures for infected pregnant women. Additional practice should include safe disposal of the products of conception and avoidance of aerosolization of amniotic fluid [ 63 ]. Given the rarity of person-to-person transmission, prophylaxis after exposure to an infected person is probably not necessary.
Rabies is primarily a disease of animals [ 64 , 65 ]. The epidemiology of human rabies is a reflection of both the distribution of the disease in animals and the degree of contact with these animals [ 64 ]. Rabies is most commonly acquired via a bite or scratch from a rabid animal or from contact between nonintact skin and infective saliva. Saliva and nervous tissue are highly infectious. Generally, contact with other body fluids does not constitute exposure. Uncommon routes of infection include contamination of mucous membranes, corneal transplantation 8 cases , exposure to aerosols from spelunking or laboratory activities, and iatrogenic infection through improperly inactivated vaccines [ 66 ].
Clinical signs attributed to rabies include paresthesia, anxiety, agitation, confusion, disorientation, hydrophobia, aerophobia, hypersalivation, dysphagia, paresis, paralysis, and fluctuating levels of consciousness [ 67 ]. There are anecdotal reports of person-to-person transmission of rabies [ 68 ]. Fluids from the upper and lower respiratory tracts of humans frequently test positive for rabies virus [ 69 ]. Given the mechanism of disease transmission and concern among health care workers, contact isolation precautions should be used for patients with known or suspected rabies, and health care workers who care for such patients should wear either masks and eye protection or face shields.
Health care workers with nonintact skin or mucous membrane exposure to infective saliva should receive postexposure prophylaxis. Zoonotic diseases pose a nosocomial hazard [ 70 ]. However, prompt recognition and use of established isolation precautions can successfully protect health care workers. Preexposure and postexposure prophylaxis regimens exist for many potentially serious zoonotic diseases.
Decontamination of persons possibly contaminated with Bacillus anthracis, Yersinia pestis, or Coxiella burnetii. The need for decontamination depends on the exposure that is suspected; in most cases, decontamination will not be necessary. The goal of decontamination after potential exposure to a bioterroristic agent or a laboratory accident is to reduce the extent of external contamination of the patient and to contain the contamination to prevent further spread.
Decontamination should only be considered in instances of gross contamination. Patients should be instructed to remove their contaminated clothing and store it in labeled plastic bags. After removal of contaminated clothing, patients should be instructed or assisted, if necessary to shower immediately with soap and water. Potentially harmful practices, such as the bathing of patients with bleach solutions, are unnecessary and should be avoided. Clean water, saline solution, or commercial ophthalmic solutions are recommended for rinsing eyes. If indicated, after removal of patient clothing at the decontamination site, the clothing should be handled only by personnel wearing appropriate protective equipment gloves, gown, and surgical mask and placed in a plastic bag to prevent further environmental contamination.
Data are from [ 7 , 30 ]. Management of patients with suspected viral hemorrhagic fevers VHFs due to Marburg, Ebola, and Crimean-Congo hemorrhagic fever viruses. The following recommendations apply to patients who, within 3 weeks before the onset of fever, have either traveled in the specific area of a country where VHF has recently occurred; had direct contact with blood, other body fluids, secretions, or excretions from a person or animal with VHF; or worked in a laboratory or animal facility that handles viruses that cause hemorrhagic fever.
The likelihood of acquisition of VHF is considered extremely low for persons who do not meet any of these criteria. The cause of fever in persons who have traveled in areas where VHF is endemic is more likely to be a different infectious disease e. Because most ill persons who undergo prehospital evaluation and transport are in the early stages of disease and would not be expected to have symptoms that increase the likelihood of contact with infectious body fluids e.
If a patient has respiratory symptoms e. Blood, urine, feces, or vomitus, if present, should be handled as described in the following recommendations for hospitalized patients. Patients in a hospital outpatient or inpatient setting should be placed in a private room.
A negative-pressure room is not required during the early stages of illness but should be considered at the time of hospitalization to avoid the need for subsequent transfer of the patient. Nonessential staff and visitors should be restricted from entering the room. Health care workers should use barrier precautions to prevent skin and mucous membrane exposure to blood, other body fluids, secretions, and excretions.
All persons who enter the room should wear gloves and gowns to prevent contact with items or environmental surfaces that may be soiled. In addition, face shields or surgical masks and eye protection e. The need for additional barriers depends on the potential for fluid contact, as determined by the procedure performed and the presence of clinical symptoms that increase the likelihood of contact with body fluids from the patient. For example, if copious amounts of blood, other body fluids, vomit, or feces are present in the environment, leg and shoe coverings also may be needed.
Before entering the hallway, all protective barriers should be removed, and shoes that are soiled with body fluids should be cleaned and disinfected as described below see recommendation 6. An anteroom for putting on and removing protective barriers and for storing supplies would be useful, if available. For patients with suspected VHF who have a prominent cough, vomiting, diarrhea, or hemorrhage, additional precautions are indicated to prevent possible exposure to airborne particles that may contain virus. Patients with these symptoms should be placed in a negative-pressure room.
Persons who enter the room should wear personal protective respirators as recommended for care of patients with tuberculosis i. Measures to prevent percutaneous injuries associated with the use and disposal of needles and other sharp instruments should be undertaken as outlined in recommendations for isolation precautions [ 57 ]. Because of the potential risks associated with handling infectious materials, laboratory testing should be the minimum necessary for diagnostic evaluation and patient care.
Clinical laboratory specimens should be obtained according to the precautions outlined above see recommendations 1—4 , placed in plastic bags that are sealed, and then transported in clearly labeled, durable, leakproof containers directly to the specimen handling area of the laboratory.
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Care should be taken not to contaminate the external surfaces of the container. Laboratory staff should be alerted to the nature of the specimens, which should remain in the custody of a designated person until testing is done. Specimens in clinical laboratories should be handled in a class II biological safety cabinet according to biosafety level 3 practices. Blood smears e.
Routine procedures can be used for automated analyzers; analyzers should be disinfected as recommended by the manufacturer or with a ppm solution of sodium hypochlorite 1 : dilution bleach after use. Virus isolation or cultivation must be done at biosafety level 4. Environmental surfaces or inanimate objects contaminated with blood, body fluids, secretions, or excretions should be cleaned and disinfected according to standard procedures.
Disinfection can be accomplished by use of a US Environmental Protection Agency EPA -registered hospital disinfectant or a 1 : dilution of household bleach. Soiled linens should be placed in clearly labeled leakproof bags at the site of use and transported directly to the decontamination area. Linens can be decontaminated in a gravity displacement autoclave or incinerated. Alternatively, linens can be laundered in a normal hot water cycle with bleach if universal precautions to prevent exposures are precisely followed [ 57 ] and linens are placed directly into washing machines without sorting.
There is no evidence of transmission of viruses that cause VHF to humans or animals through exposure to contaminated sewage. As an added precaution, measures should be taken to eliminate or reduce the infectivity of bulk blood, suctioned fluids, secretions, and excretions before disposal. Care should be taken to avoid splashing when disposing of these materials. Potentially infectious medical waste e. If the patient dies, the amount of handling of the body should be minimal. The corpse should be wrapped in sealed leakproof material not embalmed and cremated or buried promptly in a sealed casket.
If an autopsy is necessary, the state health department and Centers for Disease Control and Prevention should be consulted regarding appropriate precautions. Persons with percutaneous or mucocutaneous exposures to blood, body fluids, secretions, or excretions from a person with suspected VHF should immediately wash the affected skin surfaces with soap and water. Application of an antiseptic solution or hand washing product may be considered also, although the efficacy of this supplemental measure is unknown.
Mucous membranes e. Exposed persons should receive medical evaluation and follow-up management. Data were adapted from [ 54 , 56 ]. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Zoonotic Diseases as a Nosocomial Threat. Andes Virus Infection. B Virus Infection. Q Fever. Appendix A. Appendix B. Oxford Academic. Google Scholar. David J. Reprints or correspondence: Dr.
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