The disease, anthrax, is caused by the bacterium, Bacillus anthracis. The spores of this bacterium live in the soil and are eaten by grazing livestock (such as cattle, sheep, goats, camels, antelopes and other herbivores). People get anthrax when they come in contact with infected animals or contaminated animal products. The people most likely to get anthrax are those who work in slaughterhouses. Anthrax is not spread from person to person.
Most cases of anthrax occur when bacteria enter the skin through a cut or abrasion in people who are handling contaminated meat, wool, hides, leather or hair products from infected animals. About seven days after exposure, symptoms of anthrax begin. The disease begins as a small red area on the skin and progresses to a blackened, painless ulcer. Soon lymph glands begin to swell and the patient may have fever, fatigue and headache. About 20 percent of those infected will develop difficulty breathing and a bloodstream infection that causes death. If treated with antibiotics, less than 2 percent of infected persons will die.
If people eat infected meat, they may experience fever, chills, swollen glands, sore throat, difficulty breathing, nausea, vomiting, diarrhea, stomach pain, and flushed face or red eyes. Typically, patients will have some, but not all of these symptoms, depending on what part of the digestive tract is most affected.
People can also be infected by inhaling, or breathing in, anthrax spores. When this happens, they can experience difficulty breathing, coughing, chest discomfort, confusion, nausea or vomiting, stomach pain, sweating or dizziness. Even with treatment about 4 or 5 of 10 people will die.
On occasion, people can be infected with anthrax through injection of heroin. When this happens, they may experience swelling at the injection site, nausea, vomiting, and sweating.
Anthrax is very rare in the United States. At the beginning of the 20th century it was estimated that about 130 cases of anthrax occurred every year. But now, with improved conditions for the testing and handling of animals, anthrax has virtually disappeared. The last case of natural anthrax in the United States was reported in 1992. In 2001, members of the media and postal workers were infected by anthrax following distribution of letters containing anthrax spores.
A long-lasting disease that included muscle pain, fatigue and headaches was significantly associated with deployment of military personnel to the Gulf War. Some suggested that Gulf War Syndrome (GWS) was caused by the anthrax vaccine. To determine whether anthrax vaccine caused GWS, a study was performed. Blood was taken from anthrax-vaccinated people who complained of symptoms of GWS and from those who did not. The percentage of people who had antibodies to anthrax was not different between the two groups. Therefore, the anthrax vaccine did not cause GWS.
Antibiotics such as penicillin, doxycycline and ciprofloxacin have all been found to kill anthrax bacteria and can be used effectively in the treatment of patients with anthrax.
The problem with antibiotics is that they can kill anthrax bacteria, but they don’t kill anthrax spores. In the event of a bioterrorist attack, spores would be released into the air and inhaled. Antibiotics would prevent the development of anthrax disease, but they would not necessarily kill all of the spores. If someone took antibiotics for several weeks, or even several months, and then stopped the antibiotics, the spores could reawaken (i.e., germinate) and cause disease. It is unclear exactly how long one should treat with antibiotics before it is certain that all inhaled spores will not germinate.
Also, not all people with anthrax who are treated with antibiotics survive. As with all diseases in medicine, prevention is always better than treatment.
For these reasons, the vaccine is of value.
Anthrax bacteria have been manufactured as an agent of biological warfare. Members of the military would be at greatest risk during a bioterrorist attack.
Anthrax is considered one of the most dangerous and lethal agents for a bioterrorist attack for several reasons:
- Anthrax spores can be easily sprayed into the air, and, with widespread distribution, inhaled by a large percentage of the population.
- Anthrax spores, more so than spores from other bacteria, are stable for long periods of time in the environment.
- Anthrax spores, when inhaled, are phenomenally deadly — about 95 of 100 people who inhale enough spores, and are not quickly treated with antibiotics, will die. Although not typical, the time from exposure to anthrax spores to symptoms of anthrax disease can be as short as one day.
Do the benefits of the anthrax vaccine outweigh the risks?
Anthrax bacteria could be used in an attack against military personnel in the United States during a conflict. Anthrax is a frightening agent in biological warfare because it is easily sprayed over a large area. Once inhaled, and if untreated with antibiotics, the anthrax spores can cause a uniformly fatal infection.
Because not all people with anthrax who are treated with antibiotics survive and because the length of treatment for someone who has inhaled spores is unclear, the anthrax vaccine is of value. On the other hand, the anthrax vaccine has a side effect profile similar to vaccines routinely recommended for children (i.e., occasional pain, redness, and tenderness at the site of injection; rarely, fever, chills, body aches and nausea).
No evidence supports an association between receipt of anthrax vaccine and long-term side effects. Therefore, for military personnel and others at high risk of exposure to anthrax spores, the benefits of the anthrax vaccine outweigh the risks.
Disease risks
- Easily spread via biological warfare
- Antibiotics don’t always work
- Disease can be fatal
Vaccine risks
- Pain, redness and swelling at the injection site (1 in 10 people)
- Severe pain and swelling (1 in 100 people)
- Fever, chills, body aches, and nausea (4 in 7,000 people)
How is the anthrax vaccine made?
The anthrax vaccine is made by taking a strain of the bacterium, Bacillus anthracis, and growing it in the laboratory. The bacteria release several harmful proteins, called toxins, into the surrounding broth. These toxins are responsible for disease in those infected with the anthrax bacteria. The toxins are then inactivated with formaldehyde so that they can no longer cause disease. The anthrax bacteria are filtered out of the vaccine. Therefore, the anthrax vaccine is made in a manner similar to the “acellular” pertussis vaccine.
Does the anthrax vaccine work?
At least 95 of 100 people given at least two doses of the anthrax vaccine will develop high levels of antibodies against anthrax in their blood. Unfortunately, there are not a lot of studies on the effectiveness of the anthrax vaccine, but one study, published in 1962, was interesting. In this study, mill workers at high risk of getting anthrax were given either vaccine or no vaccine. The effectiveness of the vaccine was about 92 percent. What was of interest in this study was that, during the study, an outbreak of “inhalational” anthrax occurred. “Inhalational” anthrax occurs when large numbers of anthrax spores are released in the air and is exactly analogous to what would happen if anthrax were used as a biological weapon. Five people in the study got anthrax disease after breathing in the anthrax spores — none of the five had received the vaccine.
Therefore, the anthrax vaccine appears to be effective in preventing “inhalational” anthrax (the type of anthrax expected in a bioterrorist attack).
Does the anthrax vaccine have side effects?
About one of every ten people who receive the anthrax vaccine will develop mild pain, redness and swelling at the site where the vaccine was given. And about one out of every 100 given the vaccine will develop severe pain and swelling.
In addition, four of every 7,000 people who get the anthrax vaccine will experience a short period of fever, chills, body aches or nausea after receiving the vaccine. A severe allergic reaction (called anaphylaxis) that includes difficulty breathing, hives or lowered blood pressure is extremely rare.
Q fever is an infection caused by a type of bacteria that you usually catch from animals.
Most people with Q fever suffer a mild infection similar to the flu, which can be treated easily. Rarely, people with Q fever experience serious health issues such as pneumonia and hepatitis.
Only about 1 in every 2 people with Q fever has symptoms. Your symptoms usually start about 2 to 3 weeks after you were infected and may last from 4 days to 6 weeks.
Symptoms of Q fever are similar to symptoms of the flu, including:
- high fevers (up to 41°C ) with chills or sweats, which may last up to 4 weeks
- bad headaches
- general feeling of being unwell, fatigue or muscle aches
- dry cough, sore throat
- nausea, vomiting, diarrhoea or abdominal pain
- chest pain when you breathe
- confusion
Q fever is caused by the bacterium coxiella burnetii, which is mostly found in farm animals such as cattle, sheep and goats. It is also found in other animals including dogs, cats and kangaroos.
Animals with Q fever don’t usually look sick, but they can spread the bacteria to people.
If you work with animals, you have a higher risk of being infected, for example, if you are a meat worker, shearer, farmer or vet. You usually get Q fever from breathing in infected air particles carrying dried up animal matter from an infected environment, such as these animal substances:
- milk
- urine
- faeces (poo)
- placenta
Clothing, wool, animal hides and straw can also carry the bacteria.
Infection rarely spreads from person to person. Drinking unpasteurised (unsterilised) milk may also put you at risk, as pasteurisation is a process that kills bacteria.
If your doctor suspects you have Q fever, they may refer you for blood tests to confirm the diagnosis.
Q fever is commonly treated with antibiotics. If you have a mild infection you’re likely to recover quickly. If you have chronic Q fever, you may need to take antibiotics for up to 18 months.
If you are at high risk of getting infected, and you are over 15 years old, you should have a Q fever vaccine to prevent infection.
Vaccination is recommended for people who work with animals. You should have skin tests and blood tests before vaccination to check if you’ve been exposed to Q fever in the past. If you’ve recovered from Q fever, you may have lifelong immunity to re-infection.
Do not drink unpasteurised milk, as this may cause infection.
You may develop long lasting fatigue after infection with Q fever. A few people develop long lasting (chronic) Q fever, which can recur months or years later and can cause serious problems, such as damage to your heart and other organs. It can also cause serious problems if you are pregnant. You’re at greater risk of chronic Q fever if you have other underlying illnesses that weaken your immune system.
Tularemia is a potentially serious illness that occurs naturally in the United States. It is caused by the bacterium Francisella tularensis found in animals (especially rodents, rabbits, and hares).
Symptoms of tularemia may include:
- Sudden fever
- Chills
- Headaches
- Diarrhea
- Muscle aches
- Joint pain
- Dry cough
- Progressive weakness
People can also develop pneumonia with chest pain, cough, and difficulty breathing.
Other symptoms of tularemia depend on how a person was exposed to the tularemia bacteria. These symptoms can include ulcers on the skin or mouth, swollen and painful lymph glands, swollen and painful eyes, and a sore throat.
People can get tularemia many different ways:
- Being bitten by an infected tick, deerfly or other insect
- Handling infected animal carcasses
- Eating or drinking contaminated food or water
- Breathing in the bacteria, F. tularensis
Tularemia is not known to be spread from person to person. People who have tularemia do not need to be isolated. People who have been exposed to the tularemia bacteria should be treated as soon as possible. The disease can be fatal if it is not treated with the right antibiotics.
Symptoms usually appear 3 to 5 days after exposure to the bacteria, but can take as long as 14 days.
Consult your doctor at the first sign of illness. Be sure to let the doctor know if you are pregnant or have a weakened immune system.
Your doctor will most likely prescribe antibiotics, which must be taken as directed by your doctor to ensure the best possible result. Let your doctor know if you have any allergy to antibiotics.
A vaccine for tularemia is under review by the Food and Drug Administration and is not currently available in the United States.
Tularemia occurs naturally in many parts of the United States. Use insect repellent containing DEET on your skin, or treat clothing with repellent containing permethrin, to prevent insect bites. Use care and wear gloves when handling sick or dead animals. Be sure to cook your food thoroughly and that your water is from a safe source. Note any change in the behavior of your pets (especially rodents, rabbits, and hares) or livestock, and consult a veterinarian if they develop unusual symptoms.
Francisella tularensis is very infectious. A small number (10-50 or so organisms) can cause disease. If F. tularensis were used as a weapon, the bacteria would likely be made airborne for exposure by inhalation. People who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if they are not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and grown in quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication.
CDC operates a national program for research into the epidemiology and natural ecology of tularemia as well as the development of improved diagnostic tests. CDC serves as a reference laboratory for the United States and a World Health Organization (WHO) collaborating center for tularemia. Additional things CDC is doing related to bioterrorism preparedness include stockpiling antibiotics to treat infected or exposed people and educational programs for health professionals, the public and the media.
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. Learn about MERS.
MERS-CoV is the acronym for Middle East Respiratory Syndrome Coronavirus, the virus that causes MERS. When referring to the virus and not the illness, CDC uses “MERS-CoV.” When referring to the illness, CDC uses “MERS.” The virus was first reported in 2012 in Saudi Arabia. It is different from any other coronavirus that researchers have found in people before.
MERS-CoV likely came from an animal source in the Arabian Peninsula. Researchers have found MERS-CoV in camels from several countries. Studies have shown that direct contact with camels is a risk factor for human infection with MERS-CoV. But we need more information to understand the interactions between humans and camels that are important for transmission.
Most people confirmed to have MERS-CoV infection have had severe respiratory illness with symptoms of:
- fever
- cough
- shortness of breath
Some people also had diarrhea and nausea/vomiting. For many people with MERS, more severe complications followed, such as pneumonia and kidney failure. About 3 or 4 out of every 10 people reported with MERS have died. Most of the people who died had a pre-existing medical condition that weakened their immune system, or an underlying medical condition that hadn’t yet been discovered. Medical conditions sometimes weaken people’s immune systems and make them more likely to get sick or have severe illness.
Pre-existing conditions among people who got MERS have included
- diabetes
- cancer
- chronic lung disease
- chronic heart disease
- chronic kidney disease
Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms at all.
The symptoms of MERS start to appear about 5 or 6 days after a person is exposed, but can range from 2 to 14 days.
MERS-CoV, like other coronaviruses, likely spreads from an infected person’s respiratory secretions, such as through coughing. However, we don’t fully understand the precise ways that it spreads.
MERS-CoV has spread from ill people to others through close contact, such as caring for or living with an infected person. Infected people have spread MERS-CoV to others in healthcare settings, such as hospitals. Researchers studying MERS have not seen any ongoing spreading of MERS-CoV in the community.
All reported cases have been linked to countries in and near the Arabian Peninsula. Most infected people either lived in the Arabian Peninsula or recently traveled from the Arabian Peninsula before they became ill. A few people have gotten MERS after having close contact with an infected person who had recently traveled from the Arabian Peninsula. The largest known outbreak of MERS outside the Arabian Peninsula occurred in the Republic of Korea in 2015 and was associated with a traveler returning from the Arabian Peninsula.
Public health agencies continue to investigate clusters of cases in several countries to better understand how MERS-CoV spreads from person to person.
Also see People at Increased Risk for MERS.
Yes, two patients in the U.S. tested positive for MERS-CoV infection, both in May 2014. Get the most up-to-date information about MERS in the U.S.
CDC works 24/7 to protect people’s health. It is CDC’s job to be concerned and move quickly whenever there is a potential public health problem. CDC continues to closely monitor the MERS situation globally. CDC is working with the World Health Organization and other partners to better understand the virus, how it spreads, the source, and risks to the public’s health. We recognize the potential for MERS-CoV to spread further and cause more cases in the United States and globally. In preparation for this, we have:
- Continued to collaborate with international partners on epidemiologic and laboratory studies to better understand MERS
- Increased lab testing capacity in states to detect cases
- Developed guidance and tools for health departments to conduct public health investigations when MERS cases are suspected or confirmed
- Provided recommendations for healthcare infection control and other measures to prevent disease spread
- Provided guidance for flight crews, Emergency Medical Service (EMS) units at airports, and U.S. Customs and Border Protection (CPB) officers about reporting ill travelers to CDC
- Disseminated up-to-date information to the general public, international travelers, and public health partners
- Used Advanced Molecular Detection (AMD) methods to sequence the complete virus genome on specimens from cases to help evaluate and further describe the characteristics of MERS-CoV. (See U.S. MERS story: Decoding MERS Coronavirus: AMD Provides Quick Answers.)
The MERS situation in the U.S. represents a very low risk to the general public in this country. Only two patients in the U.S. have tested positive for MERS-CoV infection—both in May 2014 after recently traveling from Saudi Arabia—while more than 1,300 have tested negative. CDC continues to closely monitor the situation. Read to find out if you are at increased risk for MERS-CoV infection.
Visit the MERS prevention and treatment page to learn about how to protect yourself from respiratory illnesses, like MERS.
Also see Interim Guidance for Preventing MERS-CoV from Spreading in Homes and Communities. This guidance is intended for caregivers, household members, and other close contacts of people confirmed to have, or being evaluated for, MERS-CoV infection.
If you have had close contact(1) with a confirmed MERS case within the last 14 days without using the recommended infection control precautions, you should contact a healthcare provider for an evaluation. See People Who May Be at Increased Risk for MERS. Person-to-person spread of MERS-CoV, usually after close and prolonged contact such as caring for or living with an infected person, has been well documented.
It’s important to note, however, that most people who had close contact with someone who had MERS did not get infected or become ill.
Can I still travel to the Arabian Peninsula or neighboring countries where MERS cases have occurred?
Yes, there are currently no travel restrictions for the Arabian Peninsula.
If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula, you should call ahead to a healthcare provider and mention your recent travel. See People Who May Be at Increased Risk for MERS.
If you have had close contact with someone within 14 days after they traveled from a country in or near the Arabian Peninsula, and the traveler has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person. If you develop fever and symptoms of respiratory illness, such as cough or shortness of breath, you should call ahead to a healthcare provider and mention your recent contact with the traveler. See People Who May Be at Increased Risk for MERS.
CDC may detain individuals arriving in the U.S. or traveling between states who they believe are infected with a quarantinable disease, including MERS, as of July 31, 2014, per amended U.S. Executive Order 13295. “Isolation” is used to separate ill people who have a contagious disease from those who are healthy; “quarantine” is used to separate and restrict the movement of well people who may have been exposed to a contagious disease to see if they become ill. See About Quarantine and Isolation.
Currently, there is no vaccine available to protect against MERS.
There is no specific antiviral treatment recommended for MERS-CoV infection. Individuals with MERS often receive medical care to help relieve symptoms. For severe cases, current treatment includes care to support vital organ functions.
If you think you may have been exposed MERS-CoV, see People at Increased Risk for MERS.
If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after travel from a country in or near the Arabian Peninsula, you should call ahead to a healthcare provider and mention your recent travel or close contact. If you have had close contact with someone showing these symptoms who has recently traveled from this area, you should call ahead to a healthcare provider and mention your recent travel or close contact. Your healthcare provider will work with your state’s public health department to test you for MERS.
There are two main ways to determine if a person is, or has been, infected with MERS-CoV.
- One type of test, conducted by state and CDC labs, is called PCR, or polymerase chain reaction, assays.
- PCR assays are done with respiratory, serum, or stool samples and can quickly indicate if a person has an active infection with MERS-CoV.
- A second type of test, conducted by CDC lab, is called serology testing.
- Serology testing uses serum samples and is designed to look for antibodies to MERS-CoV that would indicate a person had been previously infected with the virus and developed an immune response or has an active MERS-CoV infection for approximately 14 or more days.
- Serology for MERS-CoV often includes two separate tests – (1) a screening test called ELISA or enzyme-linked immunosorbent assay and (2) a more definitive confirmatory test called the neutralizing antibody assay.
For more information see CDC Laboratory Testing for MERS-CoV.
For recommendations and guidance on the case definitions; infection control, including personal protective equipment guidance; home care and isolation; case investigation; and specimen collection and shipment, see Information for Healthcare Professionals.
No. MERS-CoV is not the same coronavirus that caused severe acute respiratory syndrome (SARS) in 2003. However, like the SARS virus, MERS-CoV is most similar to coronaviruses found in bats. CDC is still learning about MERS.
The Dengue virus is present in the blood of the Dengue patient. When an Aedes mosquito bites a patient and sucks his/her blood, the dengue virus enters into the body of the body. Then when the infected mosquito bites a normal human being, the virus is injected into the person’s body and he/she becomes infected. The first symptom of the disease appears in about 5-7 days after the infected mosquito bites a healthy person.
Dengue should always be treated as a medical emergency because-
- There is no specific treatment for dengue/ severe dengue, but early detection and access to proper medical care lowers fatality rates below 1%.
- Early recognition and prompt initiation of appropriate treatment are vital to reduce the severity of the symptoms and to prevent complications.
- Dengue patients frequently experience many complications like severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, and blood in vomit. which needs immediate medical attention.
Dengue viruses are responsible for dengue fever (DF) and dengue hemorrhagic fever. Since dengue fever is usually a mild self-limiting disease, most patients can be treated at home. But for the treatment of dengue hemorrhagic fever, the patient should be hospitalized.
But if complications arise, hospitalization is also needed for the patients suffering from Dengue fever. The doctor may suggest hospitalization if the patient experience the following conditions-
- Bleeding
- Fever is not reduced even after paracetamol intake
- The patient becomes semi-conscious or unconscious
- Patients who cannot eat or drink due to extreme weakness should also be hospitalized.
- If the Dengue patient is suffering from other diseases like cardiac problems and/or anemia and/or obesity, they should be hospitalized.
- Infants (age <1 year) are at high risk of developing severe DHF, they are also required immediate hospitalization.
Dengue is a self-limiting disease. There is no specific treatment for the Dengue viral infection. Antibiotic therapy is not useful for Dengue fever. Antibiotic therapy may even invite more complications of patients.
If the temperature remains high despite the administration of paracetamol, a sponge bath is recommended.
For moderately ill Dengue patients, administration of intravenous fluids is not necessary. But if the patient has complications like severe vomiting or dehydration, intravenous administration of fluids is needed.
The warning signs of Dengue fever include
- Severe abdominal pain,
- persistent vomiting,
- rapid breathing,
- bleeding gums,
- fatigue,
- restlessness and
- blood in vomit etc.
The patient experiencing any of the above symptoms should immediately rush into the hospital, requiring immediate medical attention.
Dengue is a self-limiting disease. It is a serious flu-type viral infection. The symptoms are mild to moderate in some patients whereas these are severe in other Dengue patients.
Intake of a proper diet with the drinking of plenty of liquids is necessary for Dengue because a proper diet-
- maintains better nutritional status
- increases appetite
- helps to maintain electrolyte balance
- rehydrates the body and prevents dehydration
- reduces the severity of symptoms
- reduces the risk of serious complications
- ensure early recovery
- increases the platelet count
Initially liquid to soft diet is recommended for the patients. As the patient recovers gradually the diet should be changed to a more normal diet. It is found that the liquid diet is better tolerated than a normal diet. Small and frequent feeding is encouraged
Drinking plenty of water and fluid rich foods like buttermilk, chaas, fruit juices, vegetable soups, coconut water, etc. should be given to the patients. These liquid foods are better tolerated by patients. They ensure an adequate intake of fluids, minerals, vitamins, and antioxidants.
Soft drinks, alcoholic beverages, too hot tea, and coffee should be avoided. All fried foods and fatty foods should be omitted.
No, there is no vaccine is available for preventing dengue infection.
Since there is no specific treatment and/ or vaccine is available against Dengue Fever, controlling the mosquito growth is the only way to prevent the spreading of Dengue. All of us should take preventive measures meticulously. Taking the following household measurements kills the mosquitoes and prevent the Dengue infection.
- Cover all the containers used for water storage.
- Emptying all the domestic water storage containers every week.
- Water from coolers and other small containers (plastic containers, buckets, used automobile tires, water coolers, pet watering containers, and flower vases) should be emptied at least once in 3-4 days.
- Wearing long-sleeved clothes reduces the risk of the mosquito bite.
- Fitting window screens prevent the entry of mosquito inside the house.
- Mosquito repellents, coils, vaporizers, etc. should be used to prevent mosquito bites.
- Sleeping, both at day and night time, use of mosquito net is mandatory.
- Appropriate insecticides should be applied to the water storage outdoor containers.
- Dengue patients should be kept carefully inside the mosquito net to prevent mosquito bites. This will prevent further spread of dengue to other persons in the house.
Female Aedes aegypti mosquitoes are the main culprit of spreading the disease, so Dengue can be prevented by controlling or killing the mosquitoes.
Ixodid (hard) ticks, especially those of the genus, Hyalomma, are both a reservoir and a vector for the CCHF virus. Numerous wild and domestic animals, such as cattle, goats, sheep and hares, serve as amplifying hosts for the virus. Transmission to humans occurs through contact with infected ticks or animal blood. CCHF can be transmitted from one infected human to another by contact with infectious blood or body fluids. Documented spread of CCHF has also occurred in hospitals due to improper sterilization of medical equipment, reuse of injection needles, and contamination of medical supplies.
The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception.
As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks. In documented outbreaks of CCHF, fatality rates in hospitalized patients have ranged from 9% to as high as 50%.
The long-term effects of CCHF infection have not been studied well enough in survivors to determine whether or not specific complications exist. However, recovery is slow.
Animal herders, livestock workers, and slaughterhouse workers in endemic areas are at risk of CCHF. Healthcare workers in endemic areas are at risk of infection through unprotected contact with infectious blood and body fluids. Individuals and international travelers with contact to livestock in endemic regions may also be exposed.
Laboratory tests that are used to diagnose CCHF include antigen-capture enzyme-linked immunosorbent assay (ELISA), real time polymerase chain reaction (RT-PCR), virus isolation attempts, and detection of antibody by ELISA (IgG and IgM). Laboratory diagnosis of a patient with a clinical history compatible with CCHF can be made during the acute phase of the disease by using the combination of detection of the viral antigen (ELISA antigen capture), viral RNA sequence (RT-PCR) in the blood or in tissues collected from a fatal case and virus isolation. Immunohistochemical staining can also show evidence of viral antigen in formalin-fixed tissues. Later in the course of the disease, in people surviving, antibodies can be found in the blood. But antigen, viral RNA and virus are no more present and detectable.
Treatment for CCHF is primarily supportive. Care should include careful attention to fluid balance and correction of electrolyte abnormalities, oxygenation and hemodynamic support, and appropriate treatment of secondary infections. The virus is sensitive in vitro to the antiviral drug ribavirin. It has been used in the treatment of CCHF patients reportedly with some benefit.
The long-term effects of CCHF infection have not been studied well enough in survivors to determine whether or not specific complications exist. However, recovery is slow.
Agricultural workers and others working with animals should use insect repellent on exposed skin and clothing. Insect repellants containing DEET (N, N-diethyl-m-toluamide) are the most effective in warding off ticks. Wearing gloves and other protective clothing is recommended. Individuals should also avoid contact with the blood and body fluids of livestock or humans who show symptoms of infection. It is important for healthcare workers to use proper infection control precautions to prevent occupational exposure.
An inactivated, mouse-brain derived vaccine against CCHF has been developed and is used on a small scale in Eastern Europe. However, there is no safe and effective vaccine currently available for human use. Further research is needed to develop these potential vaccines as well as determine the efficacy of different treatment options including ribavirin and other antiviral drugs.
Eating undercooked meat or consuming unpasteurized/raw dairy products
The most common way to be infected is by eating or drinking unpasteurized/raw dairy products. When sheep, goats, cows, or camels are infected, their milk becomes contaminated with the bacteria.
If the milk from infected animals is not pasteurized, the infection will be transmitted to people who consume the milk and/or cheese products.
Breathing in the bacteria that cause brucellosis (inhalation)
Breathing in the bacteria that causes brucellosis may also lead to infection. This risk is generally greater for people in laboratories that work with the bacteria. In addition, slaughterhouse and meat-packing employees have also been known to be exposed to the bacteria and ultimately become infected.
Bacteria entering the body through skin wounds or mucous membranes
Bacteria can also enter wounds in the skin/mucous membranes through contact with infected animals.
This poses a problem for workers who have close contact with animals or animal excretions (newborn animals, fetuses, and excretions that may result from birth). Such workers may include:
- slaughterhouse workers
- meat-packing plant employees
- veterinarians
People who hunt animals may also be at risk. When they are in contact with infected animals, exposure to the bacteria may occur through:
- skin wounds
- accidentally ingesting undercooked meat
- inhaling the bacteria while dressing their game. Commonly infected animals include: bison, elk, caribou, moose and wild hogs (feral swine).
Person-to-person spread of brucellosis is extremely rare. Infected mothers who are breast-feeding may transmit the infection to their infants. Sexual transmission has been rarely reported. While uncommon, transmission may also occur via tissue transplantation or blood transfusions.
The best way to prevent brucellosis infection is to be sure you do not consume:
- undercooked meat
- unpasteurized dairy products, including:
- milk
- cheese
- ice cream
Pasteurization is when raw milk is heated to a high temperature for a short period of time. This heating process destroys harmful bacteria that may make the milk unsafe to consume.
If you are not sure that the dairy product is pasteurized, do not eat it.
People who handle animal tissues (such as hunters and animal herdsman) should protect themselves by using:
- rubber gloves
- goggles
- gowns or aprons
This will help ensure that bacteria from potentially infected animals do not get into eyes or inside a cut or abrasion on the skin.
Before treatment begins, a diagnosis of brucellosis infection must be made by a doctor.
Tests will be performed to look for bacteria in samples of blood, bone marrow, or other body fluids. In addition, a blood test can be performed to detect antibodies against the bacteria.
Once a diagnosis is made, a doctor can prescribe antibiotics.
Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months. Death from brucellosis is rare, occurring in no more than 2% of all cases.
Areas at Risk
Although brucellosis can be found worldwide, it is more common in countries that do not have effective public health and domestic animal health programs. Areas currently listed as high risk are:
- the Mediterranean Basin (Portugal, Spain, Southern France, Italy, Greece, Turkey, North Africa)
- Mexico, South and Central America
- Eastern Europe
- Asia
- Africa
- The Caribbean
- The Middle East
Occupational Risks
People in certain occupations or settings may face increased exposure to the bacteria that cause brucellosis.
These can include:
- slaughterhouse workers
- meat-packing employees
- veterinarians
- laboratory workers
Risks from Unpasteurized Dairy Products
Raw milk and milk products are those that have not undergone a process called pasteurization that kills disease-causing germs. These types of products are common outside the United States and are increasingly being sold in mainstream supermarkets in the United States as well.
Consumption of raw milk containing Brucella can cause brucellosis. Most cases of brucellosis associated with raw milk are caused by a strain called Brucella melitensis or Brucella abortus in people who traveled to countries where these strains are common and drank contaminated cow, sheep or goat milk. In rare cases, brucellosis cases associated with other strains, including RB51 and Brucella suis, are reported.
RB51 is resistant to certain antibiotics that would normally be used to prevent or treat Brucella infections. CDC recommends that anyone exposed to RB51 receive antibiotics to prevent an infection.
Treatment recommendations: Exposure to RB51 through Raw Milk or Milk Products: How to Reduce Risk of Infection.
Risks for Expecting Mothers
Women who are pregnant and have been exposed to brucellosis should consult with their obstetricians/healthcare provider for evaluation. Laboratory tests and a short course of antibiotics also known as post-exposure prophylaxis (PEP) may be recommended.
Prompt diagnosis and treatment of brucellosis during pregnancy can be lifesaving for the fetus.
While rare, human-to-human transmission from lactating mothers to their breastfed infants has been reported.
If you have been diagnosed with brucellosis, please consult with your obstetrician/healthcare provider for healthy nursing options.
Hunters Risks
Many animals can have brucellosis. If you hunt certain kinds of wild animals, you may have an increased risk of brucellosis. This is because as a hunter you may come into contact with the blood and organs of the animals you are hunting.
Animals That Can Put Hunters at Risk
- wild hogs (feral swine)
- elk
- bison
- caribou
- moose
- deer
In addition, predators such as bears and wolves may get brucellosis after they feed on infected animals. If you hunt or trap these types of predatory animals, be aware of the risk for brucellosis and protect yourself. Dogs that are used for hunting can also be at risk for brucellosis.
How You Can Get Brucellosis from Animals
You can get sick if blood, fluid, or tissue from an infected animal comes in contact with your eyes, nose, mouth, or skin. This can happen when you are involved in hunting-related activities such as:
- Field dressing
- Butchering
- Handling or preparing raw meat for cooking
- Eating meat that is not thoroughly cooked
Protect Yourself from Brucellosis
Some animals may put hunters at risk for brucellosis, a disease that can cause severe illness.
When you are hunting, avoid all contact with visibly ill animals or those found dead. Be sure to practice safe field dressing techniques, since it is still possible for animals that appear healthy to have brucellosis.
Safe field dressing can help keep you from getting brucellosis. So, be sure to:
- Use clean, sharp knives for field dressing and butchering.
- Wear eye protection and rubber or latex gloves (disposable or reusable) when handling carcasses.
- Avoid direct (bare skin) contact with fluid or organs from the animal.
- Avoid direct (bare skin) contact with hunting dogs that may have come into contact with hunted animals.
- After butchering, burn or bury disposable gloves and parts of the carcass that will not be eaten.
- Don’t feed dogs with raw meat or other parts of the carcass.
- Wash hands as soon as possible with soap and warm water for 20 seconds or more. Dry hands with a clean cloth.
- Clean all tools and reusable gloves with a disinfectant, like dilute bleach. (Follow the safety instructions on the product label).
- Thoroughly cook meat from any animal that is known to be a possible carrier of brucellosis (see the list above).
- Be aware that freezing, smoking, drying and pickling do notkill the bacteria that cause brucellosis.
What To Do If You Think You May Have Brucellosis
It is possible for animals that appear healthy to have brucellosis.
Signs and symptoms of brucellosis can include fever, chills, sweating, headache, low appetite, fatigue, and joint or muscle pain.
It may take anywhere from a week up to a month after coming into contact with the infected animal for you to start feeling sick. See a doctor right away if you experience these signs and symptoms. Be sure to tell your doctor about your contact with wild animals, especially wild hogs, deer, moose, elk, and bison. Your doctor can test your blood for brucellosis.
If the test confirms brucellosis, your doctor will prescribe you medication (antibiotics) to treat the infection. You usually need to take them for 6 weeks or longer. If the illness is not treated or comes back, you could have serious problems in your bones, joints, or heart.
Brucellosis does not kill people often, but it can happen. So, be sure to take all of the antibiotics as prescribed by your doctor. This will help prevent the illness from coming back and keep you safe and healthy.
Brucellosis can cause of range of signs and symptoms, some of which may present for prolonged periods of time.
Initial symptoms can include:
- fever
- sweats
- malaise
- anorexia
- headache
- pain in muscles, joint, and/or back
- fatigue
Some signs and symptoms may persist for longer periods of time. Others may never go away or reoccur.
These can include:
- recurrent fevers
- arthritis
- swelling of the testicle and scrotum area
- swelling of the heart (endocarditis)
- neurologic symptoms (in up to 5% of all cases)
- chronic fatigue
- depression
- swelling of the liver and/or spleen
Disease surveillance is a cornerstone of public health practice, enabling early detection, rapid characterization, and efficient response to public health threats like brucellosis. Healthcare providers and public health practitioners are key partners in effective brucellosis surveillance.
Brucellosis Case Definition
The brucellosis surveillance case definition, available at the National Notifiable Diseases Surveillance System (NNDSS) site, provides a set of uniform criteria used to define the disease for public health surveillance. This definition enables public health officials to classify and count cases consistently across jurisdictions.
Historic CDC Surveillance Data
CDC maintains brucellosis surveillance data that are published weekly and annually. These data are available in the NNDSS notifiable infectious disease data tables data tables.
Case Reporting
Brucellosis is a reportable condition in all states and territories. Brucellosis cases must be reported to jurisdictions when identified by a healthcare provider, hospital, or laboratory. Specific reporting requirements – including who must report, how to report, and timing of report – may vary by jurisdiction.
Case Notification
Brucellosis is a nationally notifiable condition (NNC). In 2009, the Council of State and Territorial Epidemiologists (CSTE)external icon developed criteria pdf icon[PDF – 44 KB] for timeliness of NNC case notifications. CSTE requests the following notifications pdf icon[PDF – 13 KB]external icon for confirmed or probable brucellosis cases, dependent on the situation:
Immediate, Urgent: Notification within 24 hours
- Notification criteria: In the event of multiple brucellosis cases, temporally or spatially clustered.
- What to do: The state/territorial epidemiologist (or delegate) should call the CDC Emergency Operations Center (EOC) within 24 hours of knowing the notification criteria are met.
- A CDC subject matter expert (SME) will call back within 4 hours and send written or email confirmation that the case notification was received by CDC.
- Electronic transmission to NNDSS should be completed by the next regularly scheduled transmission cycle (see Data Submission below).
- Changes in case classification should also be submitted by the next regularly scheduled transmission cycle.
Following immediate, urgent notification:
- For subsequent epidemiologically linked cases: The state/territorial epidemiologist (or delegate) should directly notify the CDC staff who responded to the initial notification, rather than contacting the CDC EOC.
- If a patient is determined to meet case classification criteria during a discussion with CDC, additional notification to the CDC EOC is not needed.
Standard: Notification by electronic transmission
- Notification criteria: In the event of brucellosis cases that are NOT temporally or spatially clustered.
- Electronic transmission to NNDSS should be completed by the next regularly scheduled transmission cycle (see Data Submission).
- Changes in case classification should also be submitted by the next regularly scheduled transmission cycle.
Data Submission
National-level monitoring of notifiable conditions helps protect the health of the nation. Information from surveillance notifications shared by health departments can be used to better understand disease occurrence, impacted populations, and appropriate prevention and response strategies.
If a patient meets probable or confirmed case criteria, CSTE requests that general information about the patient and disease be submitted to NNDSS using NETSS messages or the generic message mapping guide. For timeliness of electronic reporting, see Case Notification, above.
At this time, additional disease-specific (extended) data for brucellosis cases can be shared separately through the following channels:
- Brucellosis case report form (CRF)
The case report form is available in English as a fillable PDF form that can be completed electronically or can be printed and completed by hand. Completed forms can be emailed, faxed, or mailed to CDC.
Brucellosis Case Report Form pdf icon[PDF – 1086 KB, Print and Fillable PDF]
- Bacterial Special Pathogens Branch (BSPB) DCIPHER Portal
DCIPHER is a web-based data integration platform that is used by several CDC programs. CDC is now also using this platform for brucellosis surveillance, linking case data to CDC laboratory and NNDSS data.
DCIPHER features fillable forms, and point-and-click visualization and tabulation tools. These tools can be used by CDC and jurisdictions to rapidly aggregate and visualize case data, share visualizations and simple analyses, and link case data with other data sources to gain regional or national perspectives on outbreaks, other public health events, and surveillance.
Access to the BSPB DCIPHER portal is granted via SAMS credentialing. Options for data submission using DCIPHER include:
- Direct entry into a web-based form, similar to the existing CRFs
- Submission of a data extract from a jurisdictional surveillance system as a CSV file. Submitters can upload the CSV file directly into DCIPHER, via a SAMS folder, or send using another secure method
Jurisdictions may benefit from using the visualization and tabulation tools within DCIPHER, and can access the BSPB DCIPHER portal regardless of which method they choose to share disease-specific surveillance data.
References
Plotkin SA, Orenstein W, Offit PA, and Edwards K. Anthrax Vaccines in Vaccines, 7th Edition. 2018, 134-148.
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Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD)
Middle East Respiratory Syndrome (MERS) – CDC
Dengue – https://wellnessmunch.com/13-frequently-asked-questions-on-dengue/
Crimean-Congo Hemorrhagic Fever (CCHF) – CDC
Brucellosis – CDC