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 containing the toxin) by a medical officer; and (3) investigation of the most recent food consumed by patients affected and recovering suspected food for testing and proper disposal. There is no requirement for quarantine.
If a single case is suspected, immediately consider 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 product is involved, an immediate recall is indicated. NAVSUPPINST 10110.8 series outlines procedures to be taken by Navy and Marine Corps food service facilities.
Chickenpox— Herpes Zoster (Varicella—Shingles)
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 sensation 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 examination. Occurrence is worldwide. The infectious agent is the varicellazoster virus. Man is the reservoir.
Chickenpox is readily transmitted from man to man by direct contact, droplet and airborne respiratory secretions, fluid from vesicles (including 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. Treatment is symptomatic.
Preventive measures include (1) protecting high-risk individuals from exposure; and (2) administering Varicella-Zoster Immune Globulin to immunosuppressed patients which will modify or prevent the disease when given within 4 days of the exposure.
Management of patients, contacts, and the nearby environment requires (1) exclusion of children from school for 7 days after the appearance of the rash; (2) strict isolation when patients are hospitalized to protect susceptible immunocompromised patients; (3) concurrent disinfection of fomites soiled by discharges from the nose, throat, and lesions of patients; and (4) quarantine from 7 to 21 days after exposure could be justified to protect immunologically compromised patients in hospitals. Epidemic measures are not necessary. However, when large numbers of children are crowded in conditions such as emergency housing, large outbreaks may occur.
Cholera
Cholera is an acute bacterial intestinal infection. 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 include 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 transmission is drinking water contaminated with excretions of patients. Other avenues are from contaminated food (including raw seafood from