TABLE OF CONTENTS
EDITORIAL BOARD ...... iii COLLABORATORS AND OTHER PRIMARY REVIEWERS ...... v FOREWORD: GEORGES C. BENJAMIN, MD, FACP ...... xviii FOREWORD: LEE JONG-WOOK ...... xx PREFACE ...... xxi USER’S GUIDE TO CCDM18 ...... xxiii REPORTING OF COMMUNICABLE DISEASES ...... xxvi RESPONSE TO AN OUTBREAK REPORT ...... xxviii DELIBERATE USE OF BIOLOGICAL AGENTS TO CAUSE HARM AGENTS ...... xxxii ACQUIRED IMMUNODEFICIENCY SYNDROME ...... 1 ACTINOMYCOSIS ...... 10 AMOEBIASIS ...... 12 ANGIOSTRONGYLIASIS ...... 16 ABDOMINAL ...... 18 INTESTINAL ...... 18 ANISAKIASIS ...... 19 ANTHRAX ...... 21 ARENAVIRAL HEMORRHAGIC FEVERS IN THE WESTERN HEMISPHERE ...... 27 ARTHROPOD-BORNE VIRAL DISEASES ...... 30 INTRODUCTION ...... 30 TABLE: DISEASES IN HUMANS CAUSED BY ARTHROPOD- BORNE VIRUSES ...... 31 ARTHROPOD-BORNE VIRAL ARTHRITIS AND RASH ...... 36 ARTHROPOD-BORNE VIRAL ENCEPHALITIDES ...... 39 I. MOSQUITO-BORNE VIRAL ENCEPHALITIDES ...... 39 II. TICK-BORNE VIRAL ENCEPHALITIDES ...... 43 ARTHROPOD-BORNE VIRAL FEVERS ...... 46 I. MOSQUITO-BORNE AND CULICOIDES-BORNE VIRAL FEVERS ...... 46 I.A. VENEZUELAN EQUINE ENCEPHALOMYELITIS VIRUS DISEASE ...... 46 I.B. OTHER MOSQUITO-BORNE AND CULICOIDES-BORNE FEVERS ...... 48 II. TICK-BORNE VIRAL FEVERS ...... 51 III. PHLEBOTOMINE-BORNE VIRAL FEVERS ...... 52 ARTHROPOD-BORNE VIRAL HEMORRHAGIC FEVERS ...... 55 I. MOSQUITO-BORNE DISEASES ...... 55 II. TICK-BORNE DISEASES ...... 55
x II.A. CRIMEAN-CONGO HEMORRHAGIC FEVER ...... 55 II.B. OMSK HEMORRHAGIC FEVER KYASANUR FOREST DISEASE ...... 57 ASCARIASIS ...... 59 ASPERGILLOSIS ...... 62 BABESIOSIS ...... 65 BALANTIDIASIS ...... 68 BARTONELLOSIS ...... 70 BLASTOMYCOSIS ...... 73 BOTULISM AND INTESTINAL BOTULISM ...... 75 BRUCELLOSIS ...... 82 BURULI ULCER ...... 85 CAMPYLOBACTER ENTERITIS ...... 88 CANDIDIASIS ...... 91 CAPILLARIASIS ...... 94 I. CAPILLARIASIS DUE TO CAPILLARIA PHILIPPINENSIS ...... 94 II. CAPILLARIASIS DUE TO CAPILLARIA HEPATICA ...... 95 III. PULMONARY CAPILLARIASIS ...... 96 CAT-SCRATCH DISEASE ...... 98 CHANCROID ...... 100 CHICKENPOX/HERPES ZOSTER ...... 102 CHLAMYDIAL INFECTIONS ...... 108 GENITAL INFECTIONS, CHLAMYDIAL ...... 109 URETHRITIS, NONGONOCOCCAL AND NONSPECIFIC ...... 112 CHOLERA AND OTHER VIBRIOSES ...... 113 I. VIBRIO CHOLERAE SEROGROUPS O1 AND O139 ...... 113 II. VIBRIO CHOLERAE SEROGROUPS OTHER THAN O1 AND O139 ...... 122 III. VIBRIO PARAHAEMOLYTICUS ENTERITIS ...... 124 IV. INFECTION WITH VIBRIO VULNIFICUS ...... 125 V. INFECTION WITH OTHER VIBRIOS ...... 127 CHROMOMYCOSIS ...... 128 CLONORCHIASIS ...... 130 OPISTHORCHIASIS ...... 131 COCCIDIOIDOMYCOSIS ...... 133 CONJUNCTIVITIS/KERATITIS ...... 136 I. ACUTE BACTERIAL CONJUNCTIVITIS ...... 136 II. KERATOCONJUNCTIVITIS, ADENOVIRAL ...... 138 III. ADENOVIRAL HEMORRHAGIC CONJUNCTIVITIS ...... 140 ENTEROVIRAL HEMORRHAGIC CONJUNCTIVITIS ...... 140 IV. CHLAMYDIAL CONJUNCTIVITIS ...... 142 COXSACKIEVIRUS DISEASES ...... 146 I.A. ENTEROVIRAL VESICULAR PHARYNGITIS ...... 146 I.B. ENTEROVIRAL VESICULAR STOMATITIS WITH EXANTHEM .. 146
xi I.C. ENTEROVIRAL LYMPHONODULAR PHARYNGITIS ...... 146 II. COXSACKIEVIRUS CARDITIS ...... 148 CRYPTOCOCCOSIS ...... 150 CRYPTOSPORIDIOSIS ...... 152 DIARRHEA CAUSED BY CYCLOSPORA ...... 154 CYTOMEGALOVIRUS INFECTIONS ...... 156 CYTOMEGALOVIRUS DISEASE ...... 156 CONGENITAL CYTOMEGALOVIRUS INFECTION ...... 156 DENGUE FEVER ...... 160 DENGUE HEMORRHAGIC FEVER/DENGUE SHOCK SYNDROME ...... 164 DERMATOPHYTOSIS ...... 167 I. TINEA BARBAE AND TINEA CAPITIS ...... 167 II. TINEA CRURIS AND TINEA CORPORIS ...... 169 III. TINEA PEDIS ...... 171 IV. TINEA UNGUIUM ...... 173 DIARRHEA, ACUTE ...... 175 DIARRHEA CAUSED BY ESCHERICHIA COLI ...... 176 I. ENTEROHEMORRHAGIC STRAINS ...... 176 II. ENTEROTOXIGENIC STRAINS ...... 180 III. ENTEROINVASIVE STRAINS ...... 182 IV. ENTEROPATHOGENIC STRAINS ...... 183 V. ENTEROAGGREGATIVE E. COLI ...... 186 VI. DIFFUSE-ADHERENCE E. COLI ...... 187 DIPHTHERIA ...... 188 DIPHYLLOBOTHRIASIS ...... 193 DRACUNCULIASIS ...... 195 EBOLA-MARBURG VIRAL DISEASES ...... 198 ECHINOCOCCOSIS ...... 201 I. DUE TO ECHINOCOCCUS GRANULOSUS ...... 201 II. DUE TO ECHINOCOCCUS MULTILOCULARIS ...... 204 III. DUE TO ECHINOCOCCUS VOGELI ...... 205 EHRLICHIOSIS ...... 206 ENCEPHALOPATHY, SUBACUTE SPONGIFORM ...... 209 I. CREUTZFELDT-JAKOB DISEASE ...... 209 II. KURU ...... 212 ENTEROBIASIS ...... 213 ERYTHEMA INFECTIOSUM/HUMAN PARVOVIRUS INFECTION ...... 216 EXANTHEMA SUBITUM ...... 219 FASCIOLIASIS ...... 222 FASCIOLOPSIASIS ...... 224 FILARIASIS ...... 226 DIROFILARIASIS ...... 230
xii OTHER NEMATODES PRODUCING MICROFILARIAE IN HUMANS ...... 231 FOODBORNE INTOXICATIONS ...... 232 I. STAPHYLOCOCCAL FOOD INTOXICATION ...... 233 II. CLOSTRIDIUM PERFRINGENS FOOD INTOXICATION ...... 235 III. BACILLUS CEREUS FOOD INTOXICATION ...... 237 IV. SCOMBROID FISH POISONING ...... 238 V. CIGUATERA FISH POISONING ...... 239 VI. PARALYTIC SHELLFISH POISONING ...... 240 VII. NEUROTOXIC SHELLFISH POISONING ...... 240 VIII. DIARRHETIC SHELLFISH POISONING ...... 241 IX. AMNESIC SHELLFISH POISONING ...... 241 X. PUFFER FISH POISONING (TETRODOTOXIN) ...... 242 XI. AZASPIRACID POISONING (AZP) ...... 242 GASTRITIS CAUSED BY HELICOBACTER PYLORI ...... 243 GASTROENTERITIS, ACUTE VIRAL ...... 246 I. ROTAVIRAL ENTERITIS ...... 246 II. EPIDEMIC VIRAL GASTROENTEROPATHY ...... 249 GIARDIASIS ...... 252 GONOCOCCAL INFECTIONS ...... 255 I. GONOCOCCAL INFECTION ...... 255 II. GONOCOCCAL CONJUNCTIVITIS (NEONATORUM) ...... 259 GRANULOMA INGUINALE ...... 261 HANTAVIRAL DISEASES ...... 263 I. HEMORRHAGIC FEVER WITH RENAL SYNDROME ...... 263 II. HANTAVIRUS PULMONARY SYNDROME ...... 266 HENDRA AND NIPAH VIRAL DISEASES ...... 269 HEPATITIS, VIRAL ...... 271 I. VIRAL HEPATITIS A ...... 271 II. VIRAL HEPATITIS B ...... 276 III. VIRAL HEPATITIS C ...... 285 IV. DELTA HEPATITIS ...... 287 V. VIRAL HEPATITIS E ...... 289 HERPES SIMPLEX AND ANOGENITAL HERPESVIRAL INFECTIONS ..... 292 MENINGOENCEPHALITIS DUE TO CERCOPITHECINE HERPES VIRUS 1 ...... 295 HISTOPLASMOSIS ...... 297 I. INFECTION BY HISTOPLASMA CAPSULATUM ...... 297 II. HISTOPLASMOSIS DUBOISII ...... 300 HOOKWORM DISEASE ...... 301 HYMENOLEPIASIS ...... 304 I. DUE TO HYMENOLEPIS NANA ...... 304 II. DUE TO HYMENOLEPIS DIMINUTA ...... 305 III. DIPYLIDIASIS ...... 306
xiii INFLUENZA ...... 307 KAWASAKI SYNDROME ...... 313 LASSA FEVER ...... 316 LEGIONELLOSIS AND NONPNEUMONIC LEGIONELLOSIS ...... 319 LEISHMANIASIS ...... 322 I. CUTANEOUS AND MUCOSAL ...... 322 II. VISCERAL ...... 325 LEPROSY ...... 329 LEPTOSPIROSIS ...... 334 LISTERIOSIS ...... 338 LOIASIS ...... 342 LYME DISEASE ...... 345 LYMPHOCYTIC CHORIOMENINGITIS ...... 350 LYMPHOGRANULOMA VENEREUM ...... 352 MALARIA ...... 354 MALIGNANT NEOPLASMS ASSOCIATED WITH INFECTIOUS AGENTS . 371 I. HEPATOCELLULAR CARCINOMA ...... 371 II. BURKITT LYMPHOMA ...... 372 III. NASOPHARYNGEAL CARCINOMA ...... 373 IV. MALIGNANCIES POSSIBLY RELATED TO EBV ...... 374 IV.A. HODGKIN DISEASE ...... 374 IV.B. NON-HODGKIN LYMPHOMAS ...... 375 V. KAPOSI SARCOMA ...... 375 VI. LYMPHATIC TISSUE MALIGNANCY ...... 377 VII. CERVICAL CANCER ...... 377 MEASLES ...... 379 MELIOIDOSIS ...... 386 GLANDERS ...... 388 MENINGITIS ...... 389 I. VIRAL MENINGITIS ...... 389 II. BACTERIAL MENINGITIS ...... 391 II.A. MENINGOCOCCAL INFECTION ...... 391 II.B. HEMOPHILUS MENINGITIS ...... 398 II.C. PNEUMOCOCCAL MENINGITIS ...... 400 II.D. NEONATAL MENINGITIS ...... 402 MOLLUSCUM CONTAGIOSUM ...... 404 MONONUCLEOSIS, INFECTIOUS ...... 406 MUMPS ...... 409 MYALGIA, EPIDEMIC ...... 413 MYCETOMA: ACTINOMYCETOMA AND EUMYCETOMA ...... 415 NAEGLERIASIS AND ACANTHAMEBIASIS ...... 417 NOCARDIOSIS ...... 420 ONCHOCERCIASIS ...... 422
xiv ORF VIRUS DISEASE ...... 426 PARACOCCIDIOIDOMYCOSIS ...... 428 PARAGONIMIASIS ...... 430 PEDICULOSIS AND PHTHIRIASIS ...... 433 PERTUSSIS AND PARAPERTUSSIS ...... 436 PINTA ...... 442 PLAGUE ...... 444 PNEUMONIA ...... 451 I. PNEUMOCOCCAL ...... 451 II. MYCOPLASMAL ...... 455 III. PNEUMOCYSTIS ...... 457 IV. CHLAMYDIAL ...... 459 IV.A. DUE TO CHLAMYDIA TRACHOMATIS ...... 459 IV.B. DUE TO CHLAMYDIA PNEUMONIAE ...... 460 OTHER PNEUMONIAS ...... 462 POLIOMYELITIS, ACUTE ...... 463 PSITTACOSIS ...... 470 Q FEVER ...... 473 RABIES ...... 477 RAT-BITE FEVER ...... 486 I. STREPTOBACILLOSIS ...... 486 II. SPIRILLOSIS ...... 487 RELAPSING FEVER ...... 488 RESPIRATORY DISEASE, ACUTE VIRAL ...... 492 I. ACUTE VIRAL RHINITIS—THE COMMON COLD ...... 493 II. ACUTE FEBRILE RESPIRATORY DISEASE ...... 494 RICKETTSIOSES, TICK-BORNE ...... 498 I. ROCKY MOUNTAIN SPOTTED FEVER ...... 498 II. BOUTONNEUSE FEVER ...... 500 III. AFRICAN TICK BITE FEVER ...... 501 IV. QUEENSLAND TICK TYPHUS ...... 501 V. NORTH ASIAN TICK FEVER ...... 502 VI. RICKETTSIALPOX ...... 502 RUBELLA AND CONGENITAL RUBELLA ...... 503 SALMONELLOSIS ...... 508 SCABIES ...... 513 SCHISTOSOMIASIS ...... 516 SEVERE ACUTE RESPIRATORY SYNDROME ...... 520 SHIGELLOSIS ...... 527 SMALLPOX ...... 532 VACCINIA ...... 534 MONKEYPOX ...... 535 SPOROTRICHOSIS ...... 537 STAPHYLOCOCCAL DISEASES ...... 539
xv I. IN THE COMMUNITY ...... 539 II. IN HOSPITAL NURSERIES ...... 542 III. ON HOSPITAL MEDICAL AND SURGICAL WARDS ...... 545 IV. TOXIC SHOCK SYNDROME ...... 547 STREPTOCOCCAL DISEASES CAUSED BY GROUP A (BETA HEMOLYTIC) STREPTOCOCCI ...... 549 GROUP B STREPTOCOCCAL SEPSIS OF THE NEWBORN ...... 555 DENTAL CARIES OF EARLY CHILDHOOD ...... 557 STRONGYLOIDIASIS ...... 558 SYPHILIS ...... 561 I. SYPHILIS ...... 561 II. NONVENEREAL ENDEMIC SYPHILIS ...... 566 TENIASIS ...... 568 ASIAN TENIASIS ...... 571 TETANUS ...... 572 TETANUS NEONATORUM ...... 577 TOXOCARIASIS ...... 579 GNATHOSTOMIASIS ...... 581 CUTANEOUS LARVA MIGRANS ...... 582 TOXOPLASMOSIS ...... 583 CONGENITAL TOXOPLASMOSIS ...... 583 TRACHOMA ...... 587 TRENCH FEVER ...... 590 TRICHINELLOSIS ...... 592 TRICHOMONIASIS ...... 595 TRICHURIASIS ...... 597 TRYPANOSOMIASIS ...... 599 I. AFRICAN ...... 599 II. AMERICAN ...... 603 TUBERCULOSIS ...... 607 DISEASES DUE TO OTHER MYCOBACTERIA ...... 618 TULAREMIA ...... 620 TYPHOID FEVER AND PARATYPHOID FEVER ...... 624 TYPHUS FEVER ...... 630 I. EPIDEMIC LOUSE-BORNE ...... 630 II. ENDEMIC FLEA-BORNE ...... 633 III. SCRUB TYPHUS ...... 634 WARTS, VIRAL ...... 637 YAWS ...... 640 YELLOW FEVER ...... 643 YERSINIOSIS ...... 648 ZYGOMYCOSIS ...... 652 MUCORMYCOSIS ...... 652 ENTOMOPHTHORAMYCOSIS ...... 654
xvi ABBREVIATIONS ...... 655 EXPLANATION OF TERMS ...... 660 TABLE: IMMUNIZATION SCHEDULES ...... 672
xvii FOREWORD
The world of communicable diseases continues to present a challenge to the professionals who track and contain them. These diseases are a leading cause of morbidity and mortality around the world and remain an enigma to many. The new threat of bioterrorism has become a significant security concern of all nations. Emerging and reemerging infectious diseases are also a growing threat. New diseases such as Hantavirus, HIV/AIDS, Ebola, E. coli O157:H7 and SARS are but a few of the new threats over the last 30 years. No doubt more are to come. This new version of Control of Communicable Diseases Manual (CCDM), the 18th revision of this 87-year-old favorite of the health community, is available to address these important concerns. The text was initially written in the early 20th century, as a pamphlet for New England health officials, by Dr. Francis Curtis, then the health officer of Newton, Massachusetts. Later, Dr. Robert Hoyt, a health officer from Manchester, New Hampshire, recognized its importance and convinced the American Public Health Association (APHA) at its annual convention in Cincinnati to review, edit, and adopt the text as its own. In 1917, it was published in Public Health Reports (32:41:1706–1733), by the United States Public Health Service. Its 30 pages contained disease control measures for the 38 communicable diseases that were then reportable in the United States. It was available from the Government Printing Office for a modest five cents. This manual is now the classic by which all other infectious disease manuals are measured. CCDM has undergone several rewrites over the years. Even the last word in the title was changed from “Man” to “Manual” to remove the perception of gender bias. There has been a CD-ROM version and this new 18th edition will for the first time be available online. Translations into several languages—currently Bahasa Indonesia, Italian, Korean, Portu- guese, Serbian, and Spanish—have made this text a global treasure. It covers over 140 diseases and groups of diseases of importance to communicable disease hunters and researchers. In its history only five people have served as editors for the CCDM: Haven Emerson: 1st–7th editions John Gordon: 8th–10th editions Abram S. Benenson: 11th–16th editions James Chin: 17th edition David L. Heymann: 18th edition Dr. Heymann and his team at the World Health Organization have assembled an impressive group of experts from around the world to serve as reviewers, authors, and editors. They have completed the transforma- tion of this text into a resource responsive to the needs of the global health
xviii community. I thank them for their work. I also want to thank the many men and women who work silently behind the scenes and on occasion have given their lives to contain the threat of infectious disease. Finally, I would be remiss in not acknowledging the death during work on this edition of long-time CCDM editor, Dr. Abram S. Benenson, who died December 15, 2003, at his home in Lenox MA. A renowned scientist, research doctor, and professor, Dr. Benenson was editor of CCDM for 28 years, for the 11th–16th editions. Dr. Benenson set a high standard of excellence for CCDM and APHA will always be grateful for his outstanding contributions to the health of the nation and the world, and to the scientific knowledge base of the profession.
Georges C. Benjamin, MD, FACP Executive Director American Public Health Association
xix FOREWORD
The Control of Communicable Diseases Manual has long been respected as a major tool in the quest for the control of commun- cable diseases. It is with great pleasure that WHO has shared in the preparation of this 18th edition with the American Public Health Association, and helped broaden its scope to accommodate the needs of developing countries. CCDM18, like previous editions, remains compact and easy to use. Our commitment to translate the manual into other languages will make it useful to many countries, and during the coming years we shall work with the WHO Regional Offices and the American Public Health Association to translate it into all official WHO languages. By making guidance on prevention and control measures avail- able to countries in easy to access format, and by highlighting where drugs and vaccines may be obtained for many of the diseases in this manual, CCDM18 is a public good that will help countries move closer to universal access to and equity in public health.
LEE Jong-wook Director-General World Health Organization
xx PREFACE TO THE EIGHTEENTH EDITION
Communicable diseases kill, maim and surprise. Far from having been conquered, they have resurged dramatically in recent years. The microbial agents that cause them are dynamic, resilient, and well adapted to exploit opportunities for change and spread. Their public health significance in terms of human suffering, deaths, and disability is compounded by the considerable toll they take on economic growth and development. For many important diseases, control is problematic either because of the lack of effective vaccines and therapeutic drugs, or because existing drugs are being rendered ineffective as antimicrobial resistance spreads. Communicable diseases kill more than 14 million people each year, mainly in the developing world. In these countries, approximately 46% of all deaths are due to communicable diseases, and 90% of these deaths are attributed to acute diarrhoeal and respiratory infections of children, AIDS, tuberculosis, malaria, and measles. Other diseases, that rarely kill, maim millions. Large populations living in remote areas of the developing world are at risk of disabling diseases, such as poliomyelitis, leprosy, lymphatic filariasis, and onchocerciasis. For these diseases, the toll of suffering and permanent disability is com- pounded by a double economic burden. The huge number of permanently disabled persons reduces the work force and further undermines the financial security of already impoverished families and communities, who already take on the onus of care and economic support. Communicable diseases also deliver surprises, whether in the form of new diseases or well-known diseases behaving in new ways. As the emergence of severe acute respiratory syndrome (SARS) so clearly dem- onstrated, every country is vulnerable, and the economic consequences, exaggerated by public fear of the unknown, can be felt around the world. When severe and poorly understood diseases such as SARS and Ebola emerge, they often take their heaviest toll on health care workers and can jeopardize the capacity of health systems to cope. This situation is likely to be repeated when the next new disease emerges, when the next inevitable influenza pandemic occurs, or following the deliberate release of a pathogen with deliberate intent to harm. For all these reasons, concern about the impact of communicable diseases has increased, with some encouraging results. Lack of access to effective vaccines and drugs has been a long-standing problem in the developing world. Major new initiatives, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunization, and the Roll Back Malaria and Stop TB partnerships, have formed to attack the main communicable diseases that kill and are delivering badly needed drugs and vaccines. The concern of international
xxi community is also evident in time-limited drives to eradicate or eliminate polio, leprosy, lymphatic filariasis, onchocerciasis and other diseases that maim. While microbial agents will always deliver surprises, the shock of SARS has encouraged a number of countries to give infrastructures for protecting public health much higher priority. All health care will benefit. This 18th edition of the Control of Communicable Diseases Manual (CCDM18) provides guidance to countries as they give higher priority to the communicable disease threat, and is yet another tool in our collective efforts to protect world populations from communicable diseases— whether rare and exotic or all too common. It has been a privilege to work with the world’s experts in communicable disease control as CCDM18 has been updated, and to broaden this edition by adding considerations for developing countries. It was with great sadness, in mid-January of this year, just as the editorial review was completed, that we learned of the death of one of our long time colleagues and fellow editorial board member, Dr Robert E. Shope. Bob Shope was certainly the world’s authority on arboviruses, and shared his knowledge with all who asked, including CCDM18 where his final touches to the chapter on arboviruses are yet another memorial to his life and friendship.
David L. Heymann, M.D.
xxii USER’S GUIDE TO CCDM18
Each disease section in CCDM18 is presented in a standardized format that includes the following information: Disease name: Each disease is identified by the numeric code assigned by the WHO International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) and 10th Revision, ICD-10. Disease names recommended by the Council for International Organi- zations of Medical Sciences (CIOMS) and WHO in the International Nomenclature of Diseases, Volume II (Part 2, Mycoses, 1st edition, 1982, and Part 3, Viral Diseases, 1st edition, 1983) have been used unless the recommended name has become significantly different from that in current use. In that case, the recommended name is shown as first synonym.
1. Identification presents the main clinical features of the disease and differentiates it from others that may have a similar clinical picture. Also noted are those laboratory tests most commonly used to identify or confirm the etiological agent.
2. Infectious agent identifies the specific agent or agents causing the disease; classifies the agent(s); and may indicate its (or their) important characteristics.
3. Occurrence provides information on where the disease is known to occur and in which population groups it is most likely to occur. Information on past and current outbreaks may also be included.
4. Reservoir indicates any person, animal, arthropod, plant, sub- stance—or combination of these—in which an infection agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such a manner that it can be transmitted to a susceptible host.
5. Mode of transmission describes the mechanisms by which the infectious agent is spread to humans.
6. Incubation period is the time interval between initial contact with the infectious organism and the first appearance of symp- toms associated with the infection.
7. Period of communicability is the time during which an infectious agent may be transferred directly or indirectly from an infected person to another person; from an infected animal to
xxiii humans; or from an infected person to animals, including arthro- pods. 8. Susceptibility (including immunity) provides information on human or animal populations at risk of infection, or that are resistant to either infection or disease. Information on subsequent immunity consecutive to infection is also given. 9. Methods of control are described under the following headings: A. Preventive measures: for individuals and groups. B. Control of patient, contacts and the immediate environ- ment: measures designed to prevent further spread of the disease from infected persons, and specific best current treatment to minimize the period of communicability and to reduce morbidity and mortality. ● Recommendations for isolation of patients depend first on “universal precautions’’ with specific measures cited mainly from CDC and WHO guidelines available on the worldwide web. ● CCDM18 is not intended to be a therapeutic guide. However, current clinical management is presented in section 9B7 of each disease. Specific dosages and clinical management are indicated primarily for those diseases where delay in instituting therapy might jeopardize the patient’s life. ● Some of the licensed drugs needed for treatment of rare or exotic diseases are available at no cost from WHO, and those which are not licensed may, at times, be available from CDC as Investigational New Drugs (IND). ● Details, including telephone numbers and e-mail addresses are entered in section 9B7 for those diseases where such drugs or biologics may be available. C. Epidemic measures: describes those procedures of an emer- gency character designed to limit the spread of a communicable disease that has developed widely in a group or community, or within an area, state or nation. D. Disaster implications: given a disaster, indicates the likelihood that the disease might constitute a major problem if preventive actions are not initiated. E. International measures: outlines those interventions designed
xxiv to protect populations against the known risk of infection from international sources. The WHO Collaborating Centres, the CDC, and other operational institutions can provide national authorities with the services following: laboratory diagnosis, consultation, analysis of information, production and distribution of standard and reference materials and reagents, training, organization of collaborative research, and provision of further information on specific diseases. WHO can be approached directly for further details about these Centres, listed at www.who.int/WHOCC_Net/ for WHO Collaborating Centres dealing specifically with commu- nicable diseases and http://whocc.who.int/ database for all other WHO Collaborating Centres. Outbreaks can be electronically reported 24 hours a day by e-mail at [email protected]. F. Measures in case of deliberate use of biological agents to cause harm (formerly bioterrorism measures): for selected diseases, this new section provides information and guidelines for public health workers who may be confronted with a threatened or actual act of deliberate use with a specific infectious disease agent. The relevant telephone numbers are:
● ϩ(0041) 22 791 2111 for WHO ● ϩ(001) 770 488 7100/ 404 639 3311/ 404 639 2888 for CDC. The relevant websites are:
● http://www.who.int/csr/delibepidemics for WHO ● http://www.cdc.gov/ Outbreaks can be electronically reported 24 hours a day:
● [email protected] ● [email protected] To update CCDM17, a literature review was done to identify publications during the preceding five-year period for each disease in that edition. These publications were provided to the primary reviewer for use in updating the chapter for CCDM18 (2004); additional chapters were added on Buruli ulcer and on Severe Acute Respiratory Syndrome (SARS). The name of each primary reviewer is provided in square brackets at the end of each disease entry. Some diseases did not undergo major updat- ing for the 18th edition and show no primary reviewer.
xxv REPORTING OF COMMUNICABLE DISEASES Reporting of some communicable diseases is required within countries and in some instances internationally to WHO. Reporting can take the form of either a case report or an outbreak report. 1. Case reports: Case reporting provides diagnosis, age, sex and date of onset for each person with the disease. Sometimes it includes identifying information such as the name and address of the person with the disease. Additional information such as treatment provided and its duration are required for certain case reports.
National guidelines and legislation indicate which diseases must be reported, who is responsible for reporting, the format for reporting, and how case reports are to be entered into and forwarded within the national system. If there is a requirement for international case reporting, national governments report to WHO. 2. Outbreak reports: Outbreak reporting provides information about an increase above the expected number of persons with a communicable disease that may be of public concern. The specific disease may not be included in the list of diseases officially reportable, or it may be of unknown etiology if it is newly recognized or emerging.
National guidelines and legislation indicate which type of oubtreak must be reported, who is responsible for reporting, the format for reporting, and how case reports are to be entered into and forwarded within the national system. In general, outbreak reporting is required by the most rapid means of communication available. If there is a requirement for outbreak reporting international, national governments report to WHO. The diseases listed in CCDM18 are distributed among 5 classes of reporting, referred to by class number throughout the text under section 9B1 of each disease.
Class 1: Case report required internationally to WHO by the International Health Regulations or as a disease under surveillance by WHO.
Diseases subject to the International Health Regulations (1969): The International Health Regulations (IHR) are the only legally binding instrument requiring international reporting of communicable diseases (currently limited to cholera, plague and yellow fever). WHO is updating and revising the International Health Regulations to address the threat of other new and re-emerging infections, and to accommodate
xxvi new sources for reporting information on infectious diseases. WHO will formally consult its Member States and constituents on the proposed revisions during 2004 with a target for adoption of the Revised Regulations in 2005. The key proposals in the revision are to: ● Require the establishment of defined core capacities in surveil- lance and response to public health emergencies. ● Require the international reporting of public health emergen- cies of international concern as defined by decision-tree anal- ysis under the Regulations. ● Link reporting to specific response actions recommended by WHO and tailored to the epidemiology of the reported event. ● Enhance communication and collaboration during such emer- gencies through a network of national focal points for the International Health Regulations.
Diseases under surveillance by WHO: Diseases under surveillance by WHO include louse-borne typhus fever, relapsing fever, meningococcal meningitis, paralytic poliomyelitis, ma- laria, tuberculosis, HIV/AIDS, influenza and SARS. For both subcategories, case report is required to the WHO through the national health authority. Collective outbreak reports including the num- ber of cases and deaths may be requested on a daily or weekly basis for diseases with outbreak potential such as influenza.
Class 2: Case report regularly required wherever the disease occurs Diseases of relative urgency require reporting either because identifica- tion of contacts is required or because the source of infection must be known in order to begin control measures. National health authorities generally require reporting of the first recognized case in an area or the first case outside the limits of a known affected local area by the most rapid means available, followed by weekly case reports—examples include diseases under surveillance by WHO (above), typhoid fever and diphtheria. National health authorities may also require reports of infectious diseases caused by agents that may be used deliberately.
Class 3: Selectively reportable in recognized endemic areas Many national health authorities do not require case reporting of diseases of this class. Reporting may however be required by reason of
xxvii undue frequency or severity, in order to stimulate control measures or acquire essential epidemiological data. Examples of diseases in this class are scrub typhus, schistosomiasis and fasciolopsiasis.
Class 4: Obligatory report of outbreaks only—no case report required
Many countries require reporting of outbreaks to health authorities by the most rapid means. Information required includes number of cases, date of onset, population at risk and apparent mode of spread. Examples are staphylococcal foodborne intoxication and outbreaks of an unidenti- fied etiology.
Class 5: Official report not ordinarily justifiable
Diseases in this class occur sporadically or are uncommon, often not directly transmissible from person to person (chromoblastomycosis), or of an epidemiological nature that offers no practical measures for control (common cold). RESPONSE TO AN OUTBREAK REPORT The response to an outbreak report must be management of those infected, and containment of the outbreak by interrupting transmission of the infectious agent. Steps in an outbreak response are systematic and based on epidemiological evidence despite the fact that public and political reaction, urgency and the local situation may make this difficult. The following steps provide minimal guidance for responding to out- breaks and are sometimes done concurrently: