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20 APPENDIX A CDC Disease Quarantines

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APPENDIX A. CDC DISEASE QUARANTINES Symptoms in Symptoms Incubation Mechanism of Method for Method for Disease / Early Stage (prodrome stage) for Full Blown Illness (fulminant Period (average and range for Contagiousness Diagnosis in Early Stage Diagnosis during Incubation References stage) 95% of cases) Diphtheria Malaise, sore throat, loss of appetite, Adherent, gray membrane forms 2-5 days (range 1-10 days). Direct person-to-person transmission by intimate Detection of the lethal and potent toxin None established by CDC. 1-4 moderate fever, and barking cough. over the mucous membrane of the respiratory and physical contact. Cutaneous lesions are produced by the bacteria that causes the tonsils and/or pharynx. important in transmission. disease (C. diphtheriae) is the definitive test for making a diagnosis of diphtheria. Also, testing the levels of two enzymes (pyrazinamidase and cystinase) may aid diagnosis. Infectious TB Prolonged recurrent fever, chronic Coughing blood from the lungs, Average incubation period 21 Airborne route. Extended period of close contact. Abnormal chest radiograph. Respiratory Quantiferon-TB Test. 5-10 cough, anorexia, fatigue, and weight Chronic Obstructive Pulmonary weeks, 95% of cases will develop specimens smear or culture positive. loss. Disease, abnormal stretching and within 15-28 weeks. Tuberculin Skin Test (TST) or enlarging of the respiratory Quantiferon-TB Test positive. passages caused by mucus Symptoms based: combination of chronic blockage, fluid in the lungs. cough (>2 weeks), weight loss, and fatigue. <20% of Cholera patients will show Copious, painless, watery diarrhea. Cholera Short incubation period, from less Ingesting contaminated water or food; person-to-person Diagnosis is confirmed by identification None established by CDC. any symptoms before full onset Vomiting also occurs in most 11-14 than one day to five days. transmission is rare. of the organism in a stool specimen. of disease. patients. Smallpox High fever, back pain, headaches, Maculopapular rash that Incubation period averages about Spread by inhalation of air droplets or aerosols. Direct Characteristic rash and symptoms (fever, Close contact of case, virus found in throat 15-21 vomiting, malaise, and prostration. progresses to papules, then 12 to 14 days but can range from (within 6-7 feet) and fairly prolonged (approximately 3 abdominal pain, etc). Electron during incubation. vesicles, and then pustules and 7 to 17 days. hours) face-to-face contact is required to spread smallpox microscopic (EM) visualization. RT- scab lesions. from one person to another. PCR. Confirmation. Hemorrhagic Fever Fever, aching muscles, dizziness, neck Fast heart rate, enlarged lymph Ebola: 2-21 days. Length of Direct contact with blood or other infected tissues from After 6 days of illness, antibodies can be Virus can be isolated from blood or tissue Viruses pain, stiffness, backache, headache, nodes, and a rash caused by incubation may depend on the livestock or tick bite. Human to human close contact. detected (IgG or IgM). Prior to that, specimens in the first five days of illness, and 22-24 sore eyes and sensitivity to light. bleeding into the skin. Bleeding in mode of acquisition (Crimean- virus must be isolated from blood or grown in cell culture. Likely to find virus in Nausea, vomiting, sore throat, the mouth and throat, the upper Congo HV): tick bite, 1 to 3 days, tissue specimens and grown in host cells. throat swabs, nasal swabs, blood, lymph, and diarrhea, and generalized abdominal bowel, and the gums. Hepatitis. with a maximum of 9 days; Viral DNA may also be detected in the sputum/lungs. pain. Liver enlargement. Liver and kidney and pulmonary infected blood or tissues is blood. failure. usually 5 to 6 days, with a documented maximum of 13 days. Plague Fever, chills, headache, malaise, Bubonic: draining the site of the Bubonic: 2-6 days. Pneumonic: Flea bites. Direct contact with infectious animals or The swollen gland called a "bubo." F1 Ag None established by CDC. Bacteria likely found 25-31 aching muscles, nausea, and flea bite. Pneumonic plague: 2-4 days with range of 1-6 days. other materials or inhalation of infective respiratory immunocapture ELISA. Culture lysed by by throat swab or in lymph. prostration. Bubonic plague: painful, bloody sputum. droplets. Ingestion. specific bacteriophage. swollen lymph nodes. Pneumonic plague: cough, breathing difficulties. (continued on next page) 21

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22 APPENDIX A. CDC DISEASE QUARANTINES Symptoms in Symptoms Incubation Mechanism of Method for Method for Disease / Early Stage (prodrome stage) for Full Blown Illness (fulminant Period (average and range for Contagiousness Diagnosis in Early Stage Diagnosis during Incubation References stage) 95% of cases) SARS High fever, headache, body aches. Dry cough. Most patients develop Average is 4 days. 95% of cases Close person-to-person contact. Most readily transmitted RT-PCR and ELISA antibody assays are None established by CDC. 32-35 Mild respiratory symptoms at the pneumonia. will develop within 12 days. by respiratory droplets. People occasionally may become the most commonly used. Isolation in cell outset. About 10 percent to 20 percent infected by touching a surface with influenza virus on it culture, electron microscopy for CoV-like of patients have diarrhea. and then touching their mouth, nose or eyes. particles, and immunohistologic or in situ probe hybridization studies on tissue specimens (not recommended). Yellow Fever Fever, muscle pain (with prominent Fever, relative slow heart beat, 3-6 Days. Mosquito bite. No recorded human to human Blood tests (serology assays) can detect None established by CDC. 36-37 backache), headache, shivers, loss of jaundice, renal failure, and transmission. yellow fever antibodies. appetite, nausea and/or vomiting. hemorrhagic complications. Pandemic Influenza Fever, headache, tiredness, cough, Pneumonia, acute respiratory Typically 1-4 days, with an Person to person in respiratory droplets when people who Immunofluorescence tests. Rapid antigen None established by CDC. 38-41 sore throat, runny or stuffy nose, body distress, respiratory failure, and average of 2 days. are infected cough or sneeze. People occasionally may detection (ELISA), virus isolation and aches. Diarrhea and vomiting (among life-threatening complications. become infected by touching a surface with influenza reverse transcription-polymerase chain children). virus on it and then touching their mouth, nose or eyes. reaction (RT-PCR). Embryonic egg culture (not recommended). References: 1. 2. 3. Efstratiou et al. 2000. Current Approaches to the Laboratory Diagnosis of Diphtheria. J. Infect. Dis. Vol 181. Suppl: p 138. 4. Efstratious and George. 1996. Screening Tests for the Presumptive Identification of Corynebacterium diphtheriae in a Diagnostic Laboratory. J. Clin. Microbiol. Vol. 34. No. 12: p 3251 5.§ion=dis 6. ten Asbroek et al. 1999. Estimation of serial interval and incubation period of tuberculosis using DNA fingerprinting. Int. J. Tuberc. Lung Dis. Vol. 3. No. 5: p 414 7. Ismail. 2004. Pulmonary tuberculosis-- a review of clinical features and diagnosis in 232 cases. Med J. Malaysia. Vol 59. No. 1: p 56 8. 9. Marais et al. 2006. A refined symptom-based approach to diagnose pulmonary tuberculosis in children. Pediatrics. Vol. 118. No. 5:e1350 10. Harada. Characteristics of a diagnostic method for tuberculosis infection based on whole blood interferon-gamma assay. Kekkaku. Vol. 81. No. 11: p 681. 11. 12. 13. 14. Keen and Bujalski. 1992. The diagnosis and treatment of cholera. Nurse Pract. Vol. 17. No. 12: p 53. 15. 16. Lofquist et al. 2003. "Smallpox: a review of clinical disease and vaccination." Am. J. Health Syst. Pharm. Vol. 60. No. 8: p749. 17. 18. Sarkar et al. 1973. "Virus excretion in smallpox: excretion in the throats of household contacts." Bull. WHO. Vol 48: p 523. 19. Henderson et al. 1999. "Smallpox as a Biological Weapon: Medical and Public Health Management." JAMA. Vol. 281: p 2127 20. 21. 22. 23. 24. Borio et al. 2002. Hemorrhagic Fever Viruses as Biological Weapons: Medical and Public Health Management. JAMA. Vol. 287: p 2391 25. 26. 27. 28. 29. 30. Rahalis et al. 2000. Diagnosis of Bubonic Plague by PCR in Madagascar under Field Conditions. J Microbiol. Vol. 38. No. 1: p 260. 31. "Distribution of Biological Agents in Medical Samples." Dec. 20, 2005. Report by Gryphon Scientific. Prepared for Jeff Grotte, Institute for Defense Analyses. 32. Meltzer. 2004. "Multiple Contact Dates and SARS Incubation Periods." Emerging Infectious Diseases. Vol. 10. No. 2: p 207. 33. 34. 35. 36. Borio et al. 2002. Hemorrhagic Fever Viruses as Biological Weapons: Medical and Public Health Management. JAMA. Vol. 287: p 2391 37. 38. 39. 40. 41.