Management of patients, contacts, and the
nearby environment includes (1) boiling or
disinfecting food and utensils containing toxin
with chlorine to destroy the toxin; (2) evaluation
of contacts (those who have eaten food contain-
ing the toxin) by a medical officer; and (3) in-
vestigation of the most recent food consumed by
patients affected and recovering suspected food
for testing and proper disposal. There is no re-
quirement for quarantine.
If a single case is suspected, immediately con-
sider a group outbreak which involves a family
or other group who shared the common food.
Home canned foods should be considered first.
If it is determined that a commercial food prod-
uct is involved, an immediate recall is indicated.
NAVSUPPINST 10110.8 series outlines pro-
cedures to be taken by Navy and Marine Corps
food service facilities.
Chickenpox Herpes Zoster
Chickenpox is an acute generalized viral
disease with sudden onset, low grade fever, and
mild constitutional symptoms. It begins with a
maculopapular rash and rapidly progresses to
characteristic vesicles that remain for 3 to 4 days
and form scabs.
Usually more lesion appear on skin covered
by clothing and in the hair than on uncovered
skin. New lesions appear through the course of
the disease; therefore, all stages of the lesions may
be present at the same time. Occasionally adults
develop severe constitutional symptoms and fever.
Deaths are rare for both adults and children.
Herpes zoster is a later attack from the same
infectious agent which may have remained latent
in the body for many years. It is characterized by
lesions similar to those of clinical chickenpox;
however, they appear on the body in a distribution
pattern supplied by sensory nerves or dorsal root
ganglia. The lesions are usually unilateral, deeper,
and more numerous than with chickenpox. Severe
pain and a prickling, tingling or creeping sensa-
tion of the skin is common. Zoster occurs much
more frequently in adults; however, some children
are affected, especially those who experienced
chickenpox prior to 2 years of age and those under
treatment for cancer.
Diagnosis is usually established by clinical ex-
amination. Occurrence is worldwide. The infec-
tious agent is the varicellazoster virus. Man is the
Chickenpox is readily transmitted from man
to man by direct contact, droplet and airborne
respiratory secretions, fluid from vesicles (in-
cluding cases of zoster) and freshly contaminated
fomites. Contacts infected by zoster develop
chickenpox. The incubation period is usually 2 to
3 weeks. The patient is communicable for 1 to 5
days prior to the onset of the rash and for about
6 days from the occurrence of vesicles. All persons
not previously having the disease are susceptible.
The first infection gives lifelong immunity. Treat-
ment is symptomatic.
Preventive measures include (1) protecting
high-risk individuals from exposure; and (2) ad-
ministering Varicella-Zoster Immune Globulin to
immunosuppressed patients which will modify or
prevent the disease when given within 4 days of
Management of patients, contacts, and the
nearby environment requires (1) exclusion of
children from school for 7 days after the appear-
ance of the rash; (2) strict isolation when patients
are hospitalized to protect susceptible immuno-
compromised patients; (3) concurrent disinfection
of fomites soiled by discharges from the nose,
throat, and lesions of patients; and (4) quaran-
tine from 7 to 21 days after exposure could be
justified to protect immunologically compromised
patients in hospitals. Epidemic measures are not
However, when large numbers of
children are crowded in conditions such as
emergency housing, large outbreaks may occur.
Cholera is an acute bacterial intestinal infec-
tion. Signs and symptoms are sudden and include
vomiting, large quantities of watery stools,
dehydration, and circulatory failure. In serious
cases with no treatment, the mortality rate may
be much greater than 50 percent and fatalities may
occur within a few hours of the onset of illness.
With proper medical care, the mortality rate can
be very low.
Historically it is endemic in parts of Asia. In
recent years, endemic areas have expanded to in-
clude Eastern Europe and Africa. Sporatic cases
occur among U.S. travelers coming from all parts
of the world.
The infectious agent is Vibrio cholerae. The
reservoir is man. The major method of trans-
mission is drinking water contaminated with
excretions of patients. Other avenues are from
contaminated food (including raw seafood from