Epidemiology of Communicable

Diseases & Bloodborne Pathogens

Priyal Shah, MPH
Epidemiologist
Cleveland Department of
Public Health
Office of Communicable Disease
Surveillance and Epidemiology
pshah@city.cleveland.oh.us

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Definitions
• Epidemiology:
– The study of the determinants and
distribution of diseases and states of health
and the factors which influence these
distributions among human populations

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Definitions
• Surveillance:
– The ongoing systematic process that
collects and reviews information
regarding cases of a given disease

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Communicable Diseases that Public Health
Handles
• Common Food Borne Illnesses
– Salmonella, campylobacter, giardia, norovirus
• Hepatitis A, B, C
• Meningitis
• Vaccine Preventables

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Food Borne Illnesses

Spectrum of illness: Symptoms

Mild: Loose stools, nausea, fatigue,
malaise
Moderate: Vomiting, diarrhea, fever,
abdominal cramping
Severe: Bloody diarrhea, dehydration,
seizures, shock, death

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Modes of Transmission
• Foodborne
– Source contamination
• Mishandling
• Eating raw
• Waterborne
• Person-to-person
• Direct- Diaper changes, sexual activity, other intimate contact
(needle, drug-sharing)
• Indirect- Through an object or substance capable of carrying an
infectious organism

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Mean Incubation Period (Hours)

72hours Campylobacteriosis

48 hours
Salmonella, Shigella, E. Coli

24 hours

2-12 hours

0 20 40 60

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 Characteristics of Bacterial Food Poisoning:
Common Vehicles
• Campylobacteriosis • Salmonellosis
– milk, chicken, pet animals, – eggs, meat, poultry, fruit
livestock (rare), reptile pets

• E. coli (0157:H7) • Shigellosis

– salads, hamburger, salami, – milk, salads (potato, tuna,
water (recreational), other turkey)

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Reservoir

• Domestic and wild animals

• Poultry, swine, cattle, dogs, and cats
• Iguanas, tortoises, turtles, terrapins
• Rodents
• Chicks (baby chickens)

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Transmission

• Foodborne (Can be waterborne)

• Fecal-oral Route
– Eating foods contaminated with animal feces
– Contaminated foods usually look and smell normal
– Foods include: raw and undercooked eggs & egg
products, raw milk & raw milk products, poultry &
poultry products

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Transmission

• Contaminated foods often of animal origin

• Foods can be contaminated by unwashed
hands of infected food handler
• Person-to-person fecal/oral transmission is
important
• Reptiles, even if healthy, can harbor and transmit
salmonella

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Prevention

• Hand washing – at least 20 seconds, with warm, soapy water

• Refrigerate prepared foods
• Thoroughly cooking all foodstuffs derived from animal sources,
particularly poultry, pork, egg products, and meat dishes
• Avoiding recontamination within the kitchen after cooking is completed
• Maintaining a sanitary kitchen, protecting prepared foods against rodent
and insect contamination
• Exclude individuals with diarrhea from food handling and from care of
hospitalized patients, the elderly and children

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Treatment

• There is no vaccine to prevent GI illnesses

• HIV patients may require life-long therapy to prevent Salmonella
Septicemia
• Most people recover on their own
• Antibiotics and anti-diarrhea drugs are not generally recommended for
cases with intestinal infections

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Hepatitis A

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Hepatitis A

Transmission:
• Person to person - fecal / oral contact
– putting something in the mouth that has been contaminated with
infected feces
• Fecal contamination of food / water
– fruits, vegetables, or other uncooked food that has been
contaminated during handling
– drinking water or using ice that has been contaminated

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Hepatitis A

Symptoms:
• Children usually have no symptoms
• Adults / Children may experience
– jaundice
– fatigue
– nausea & vomiting
– abdominal pain
– dark urine / light stools
– fever

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Hepatitis A

Treatment:
• No specific treatment
• Infection will clear up in a few weeks to months usually
with no serious after effects
• Once recovered individual is immune and will never get
HAV infection again
Prevention:
• Exclude patients from sensitive occupations or childcare
until 10 days after onset of symptoms
• Immune globulin (IG) can provide temporary immunity if
given prior to exposure or within 2 weeks after contact

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Viral/Bacterial Meningitis

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Meningitis

• Illnesses that refer to inflammation of the

meninges-the lining that covers the brain

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Causes:

Infectious Agents:
• Organisms transmitted from environment / people
– bacteria
– virus
– fungi
– other, non specified

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Viral Meningitis

Transmission:
• Person to Person
• specific transmission routes vary according to specific agent
– Respiratory secretions
– Airborne
– Fomites
– Fecal / Oral contamination

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Viral Meningitis

• Symptoms
– Fever
– Headache
– Stiff neck
– Rash, similar in appearance to hives
– Intestinal symptoms

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Viral Meningitis

Treatment
• There is no specific medicines or antibiotics used to
treat viral meningitis

• In most all cases, persons will completely recover

with no lasting ill effects

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Bacterial Meningitis

• Many different groups

– Hib (Haemophilus influenzae)
– Streptococcus pneumoniae
– Neisseria meningitidis

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Meningococcal Disease

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Meningococcal Disease

• Infections caused by the bacteria

N. meningitidis

The most important meningococcal diseases are:

– Meningococcal meningitis
– Meningococcemia

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Meningococcal Disease

• Rare form of bacterial meningitis

• Bacteria enters body through the nose and

throat and infects the blood stream before
reaching the brain

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Meningococcal Meningitis

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Meningococcal Meningitis
Symptoms
• Time between exposure to the bacterium and onset of
illness is usually 3 -4 days, but may be anywhere
from 2-10 days.
• Sudden onset of high fever
• Intense headache
• Nausea / vomiting
• Stiff neck
• Body rash

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 Meningococcal Meningitis

Transmission
• Spread by direct contact with mucus or saliva from
the nose and throat of an infected individual
– Close contact with infected person
– Exchange of saliva by kissing, mouth to mouth
resuscitation, or sharing of utensils

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 Meningococcal Meningitis

Treatment
• Early medical attention is important
• Certain antibiotics are very effective in eliminating the germ from the
nose and throat
• Effective prophylaxis treatment for contacts
– Within 7 days (prior to the illness) from last exposure to a case
(during infectious period)
• Rifampin
• Ciprofloxacin
– Casual contact as might occur in a regular classroom, office or factory
setting is not usually significant enough to cause concern

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Meningococcemia

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Meningococcemia
• N. meningitidis enters the body through the nose and
throat and infects the bloodstream and the whole
system.
• Meningococcemia spreads throughout the system,
but does not necessarily cause meningitis.
• An acute bacterial infection affecting the entire body.

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 Meningococcemia

Symptoms
-Time between exposure to the bacterium and onset of illness is
usually 3 -4 days, but may be anywhere from 2-10 days.
• Sudden onset of fever
• Vomiting
• Weakness
• Irritability
• Usually a body rash w/in 24 hrs
• Person feels very ill and rapidly deteriorates

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Meningococcemia

Transmission
• Spread by direct contact with mucus or saliva from
the nose and throat of an infected individual
– Close contact with infected person
– Exchange of saliva by kissing, mouth to mouth
resuscitation, or sharing of utensils

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 Meningococcemia
Treatment
• Early medical attention is important
• Certain antibiotics are very effective in eliminating the germ from the
nose and throat
• Effective prophylaxis treatment for contacts
– Within 7 days (prior to the illness) from last exposure to a case
(during infectious period)
• Rifampin
• Ciprofloxacin
(Casual contact as might occur in a regular classroom, office or factory setting is not
usually significant enough to cause concern)

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 Meningococcal Disease

PREVENTION
• Good hand washing habits are among the best
precautions against the spread of meningococcal
diseases.
• Education

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Vaccine Preventables

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 Varicella (Chicken Pox)
• Occurrence-winter spring season
• Clinical manifestation
– Viral, fever, rash
• Transmission
– Person-to-person direct contact, fomite transmission
• Reservoir
– Humans

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Measles
• Source: Humans
• Mode of Transmission
– Droplet spread or direct contact with nasal or throat
secretions of infected person. Tiny droplets can be
suspended in the air for up to two hours or more.
– Virus is highly communicable
• Incubation period – 12-17 days, usually 14 days, before the
rash appears
• Symptoms – fever, nasal congestion, conjuctivitis, cough,
rash

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Mumps
• Source - Humans
• Mode of Transmission – direct contact with the saliva of an
infected person & by droplet spread
• Period of Communicability- How long the patient is
infectious
– The patient may be infectious from six days prior to
nine days after parotitis (swelling of salivary glands
located close to the jaw)
• Incubation Period -16-18 days, may range from 12-25 days
• Symptoms – fever, headache, parotitis

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Rubella
• Source - Humans
• Period of Communicability
• Mode of Transmission -Highly communicable; the
-Person-to-person via droplets period of maximum
shed from the respiratory
secretions of infected persons. communicability is from one
week before, to one week after
onset of the rash.
• Incubation Period
-12-23 days; usually 16-18 days.

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Symptoms of Rubella
• Rubella is a mild illness which may present few or no symptoms.
• Rash
• Slight fever
• Joint aches
• Headache
• Discomfort
• Runny nose and reddened eyes
• Lymph nodes just behind the ears and at the back of the neck may swell,
causing some soreness and/or pain.
• Arthritis or arthralgia (aching joints) may occur in up to 70% of adults

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Pertussis

• Reservoir – Humans
• Transmission – Respiratory droplets (coughing and
sneezing)
• Incubation period – 5-10 days, but can be up to 24 days
– Requires monitoring of contacts for symptoms for 24 days after last
exposure

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Clinical Features
 Adolescents and adults
– Are primary carriers of pertussis enabling transmission to infants and
children
– Have milder illness with less severe complications than infants and
young children
– Airway generally large enough (anatomically) to accommodate the
inflammation and secretions
– Pertussis accounts for up to 7% of cough illnesses in these groups
every year

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Clinical Features

 Infants and young children

– appear very ill and distressed
– may turn blue and vomit
– unable to swallow
– have unforgettable stridor or ‘whoop’
– airway too small to accommodate as adults do – easily obstruct and
need airway and respiratory assistance to survive
 Web sites where you can see and hear pertussis:
*www.pertussis.com
* www.vaccineinformation.org/pertussis

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Bloodborne Pathogens
Microorganisms that are carried in
the blood that can cause disease in
humans

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Common Bloodborne Pathogens Diseases

• Hepatitis B(HBV)
• Hepatitis C(HCV)
• Human Immunodeficiency Virus (HIV)

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Transmission Potential
• Contact with another
person’s blood or
bodily fluids that may
contain blood
• Mucous membranes:
eyes, mouth, nose
• Non-intact skin- cuts or
wounds
• Contaminated
sharps/needles

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Human Immunodeficiency Virus (HIV)

• HIV is the virus that causes AIDS

• HIV attacks the immune system – finds and destroys white
blood cells that are needed to fight disease
• The CDC estimates that there are ~40,000 new HIV infections
a year
• It is estimated that more than 1 million people are living with
HIV or AIDS

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 HIV

• HIV does not survive well outside

the body
• It is not transmitted through daily activities, such as shaking
hands, hugging, or a casual kiss
• Primarily found in the blood, semen, or vaginal fluid of
someone infected
• Transmitted 3 main ways:
-Having sex with someone infected (vaginal, oral, anal)
-Sharing needles and syringes with someone infected
-Being exposed before or during birth (fetus or infant) or through
breastfeeding

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Hepatitis B (HBV)
• An estimated 3.2 million Americans are chronically infected
• May lead to chronic liver disease, liver cancer, and death
• HBV can survive for at least one week in dried blood
• Symptoms can occur 1-9 months after exposure
• HBV is transmitted through contact with body fluids infected with
HBV
– blood, semen, vaginal secretions
• Can be passed through exposure to sharp instruments
contaminated with infected blood
-tattooing, body piercing, needles, razors

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Hepatitis B
• Virus can survive outside the body for at least 7 days on a
dry surface
• 100 times more contagious than HIV
• People at risk include
– injection drug users
– sexually active homosexual & bisexual men
– babies born to infected mothers
– anyone with multiple sex partners

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Hepatitis B

Symptoms
• Flu like symptoms
– nausea, vomiting, fatigue, diarrhea, mild fever
• Jaundice
• A few patients have a more severe course of illness and
may die of liver failure shortly after getting sick
• Many people with acute HBV have no symptoms

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Hepatitis B

Treatment
• Only approved treatment is Interferon (what your body
produces to fight against disease and infection)
– other treatments are under investigation
• Approximately 90-95% of adults will recover within 6
months and not contract HBV again.
• If exposed to HBV
– should receive hepatitis B immune globulin (HBIG) w/in
14 days of exposure
– vaccine series should be started

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Hepatitis B
Chronic Carriers
• If unable to clear virus within six months patient is
considered chronically infected and a carrier of HBV
• Usually shows no signs or symptoms of infection
• Can unknowingly pass HBV to others
• Patients with HBV should consider being vaccinated
for hepatitis A

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Hepatitis B Vaccination

• Vaccination available since

1982
• Available for all age groups
• Given as 3-4 shots over a 6
month period
• Strongly endorsed by medical
communities
• After receiving 3 doses,
vaccine provides greater than
a 90% protection

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 Hepatitis C (HCV)
• Hepatitis C is the most common chronic bloodborne
infection in the United States
• Symptoms include: jaundice, fatigue, abdominal pain,
loss of appetite, intermittent nausea, vomiting; some
may have no symptoms
• May lead to chronic liver
disease and death

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Hepatitis C

Transmission
• HCV is transmitted through contact with blood infected with
HCV.
• Those at risk include:
– IV drug users
– anyone who had a blood transfusion prior to 1992
– those with multiple sex partners
• Transmission through sexual contact and saliva appears to
be low

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Hepatitis C
Treatment
• Antiviral therapy is recommended for patients with chronic
HCV who are at greatest risk for progression to cirrhosis

• There is no effective post-exposure prophylaxis

• Unlike HAV and HBV, previous infection of HCV does not

mean immunity

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Hepatitis C

Chronic Carriers
• If unable to clear virus within six months patient is considered
chronically infected and a carrier of HCV
• Disease may progress over a period of 10 - 40 years
• 20% will develop cirrhosis of the liver (liver slowly deteriorates)
– 25% of these will develop liver failure
• Can unknowingly pass HCV to others
• Patients with HCV should consider being vaccinated for
Hepatitis A & B

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Universal Precautions
• Use of proper PPE
– Latex gloves
– CPR mouth barriers
– Aprons
• Treat all blood and bodily fluids as if they are contaminated
• Proper cleanup and decontamination
• Disposal of all contaminated material in the proper manner
• Proper handwashing
• Wash hands for at least 20 seconds
• Use warm, soapy water

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What you Can Do?

• Report all communicable diseases and outbreaks

to Public Health for follow-up.

• Educate staff, clients, family/friends on the

importance of proper hand washing,
immunizations, and covering your cough.

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References

• MMWR Surveillance for Foodborne-Disease Outbreaks --- United

States, 1998—2002

• Communicable Disease Manual, APHA

• Infectious Disease Control Manual

http://www.odh.ohio.gov/pdf/IDCM/intro1.pdf

• Vaccine information- http://www.vaccineinformation.org/

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Questions??
Cleveland Department of
Public Health
Office of Communicable Disease
Surveillance & Epidemiology

216-664-EPIS (3747)

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??Questions??

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THANK YOU!!!!!

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