Amebiasis is a parasitic disease caused by organisms called protozoas.  Common symptoms include loose stools and stomach pain or cramping.  However, people can be infected but have no symptoms.  Rarely, it can cause dysentery which causes stomach pain, bloody diarrhea, and fever, or it can invade other parts of the body such as the liver (causing abscesses), lungs, or brain.

For those who become sick, it can take about 2-4 weeks from the time of exposure to the time of illness.  Without treatment a person can carry amebiasis for weeks or even years. 

Amebiasis is spread through the fecal-oral route.  A person needs to ingest the parasite which can occur from actions like diaper changing or sexual activity, or indirectly such as consuming contaminated food or water.

Anyone can become infected with amebiasis.  It is more common among:

• People living in areas with poor sanitary conditions (especially in tropical areas)
• Travelers and immigrants from these areas
• People in institutions with poor sanitary conditions
• Men who have sex with men

Contact your physician. The test for amebiasis is to look at stool under the microscope.  Your physician may request several stool cultures because it can be hard to distinguish from another similar parasite.

Amebiasis can be treated with antibiotics.

There is no vaccine for amebiasis. 

If you are traveling to an area where amebiasis is common, make sure to drink bottled water or boil the water and do not drink beverages with ice cubes.  Also do not eat any unpasteurized dairy products, and food from street vendors, or any fruit you did not peel yourself.  Good hand washing can help prevent amebiasis, especially after going to the bathroom and before preparing food.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book

Animals can inflict serious and even fatal injuries through their bite.  An animal bite can result in a break in the skin, bruise, or puncture wound.   It is important to seek prompt medical care when bitten. Even injuries that don't seem to be that serious can hide underlying damage to tissues or may get infected with germs or the rabies virus.  In addition to seeking medical treatment you should notify the Division of Disease Control (DDC) at 215-685-6748 to report the incident.  Once notified of the incident DDC will evaluate whether you are at risk for rabies infection and whether you need to receive postexposure prophylaxis (PEP).  Please refer to the rabies information page on this website for further information on the rabies virus and protocol. 

One of the best ways to prevent infection after a bite is to wash the area thoroughly with soap and water.  If the site of the animal bite is infected there is a chance that the infection can travel to other places in the body if not treated. A healthcare provider can help determine whether treatment or vaccines such as tetanus or rabies are needed to prevent infection. Symptoms of an infection that may result after a bite include the following:

• Fever
• Discomfort or tenderness at the site of the bite
• Redness or swelling at the site of the bite
• Puss or drainage at the site of the bite
• Improper healing time

A large majority of animal bite cases involve domesticated dogs.  However cat bites are more likely to cause infection.  Animals are capable of transmitting several kinds of bacteria and viruses through their bite.  These organisms are transferred from the animal's saliva, mouth, or teeth into the victims wound once the skin is broken.  For this reason it is important to thoroughly wash the area bitten or scratched and seek medical care even if you do not think the wound is serious. 

Two of the more serious infections that can be transmitted through an animal bite are rabies and tetanus. The likelihood of getting one of these disease is less if the animal is domesticated, it is up to date on its shots, and if you are up to date on your tetanus vaccination. An infection known as cat-scratch disease may also result after a cat scratch.

There are several steps you can take to prevent animal bites.  It is important to make sure that your pets are up to date on their vaccinations.  For animals that you may find in your household it is important to take the following precautions:

• Evaluate what type of pet is appropriate for your household
• Do not engage in aggressive play with domesticated animals 
• Make sure that children are supervised around animals in your household
• You may want to train animals to be around other people 
• Do not startle or disturb sleeping or eating animals
• If approached by an aggressive dog, don't scream and/or run, try to remain motionless and avoid eye contact.

The following precautions will help prevent animal bites from stray or wild animals.

• You should not try to approach, pet, or capture stray or wild animals
• If you see a stray/wild animal or if a stray/wild animal has bitten you, you should contact animal control professionals so they can come out to trap the animal and seek medical care
• Make sure that you seal cracks and gaps in your home so that bats cannot enter. If a bat enters your home contact your local animal control professionals to have it removed

All animal bites whether they are stray, wild, or domesticated animals need to reported to DDC in a prompt manner.

Please use the resources below, talk with your doctor, or contact the Division of Disease Control.

• Learn About Dog Bites (CDC)
• Learn about Animal Bites and Scratches (CDC)
• First Aid for Animal Bites (Mayo Clinic)
• PDPH Rabies Information
• Philadelphia Animal Care and Control Team

Anthrax is a serious infection that is caused by the spore-forming bacteria Bacillus anthracis. This type of bacteria can be found on wild and domestic animals, in humans if exposed to  the infected tissue/skin of an animal, or when used as a biological weapon. An anthrax infection can occur in the skin (cutaneous), respiratory ( pulmonary) tract, or gastrointestinal  tract of humans. Each form has its own unique signs and symptoms. Symptoms of anthrax typically occur within 7 days after exposure to Bacillus anthracis.

Symptoms of cutaneous anthrax include:

• A raised bump that has the appearance of an insect bite
• 1-3  cm painless sore with a black center
• Swollen lymph nodes surrounding the bump

Symptoms of pulmonary anthrax include:

• Cold like symptoms (sore throat, mild fever, muscle aches, fatigue)
• Chest discomfort

As the infection progresses individuals may experience the following:

• Trouble breathing
• Shock
• Severe Fever
• Meningitis

Symptoms of gastrointestinal anthrax include:

• Nausea
• Vomiting (blood in emessis as the infection progresses)
• Fever
• Loss of appetite
• Bloody diarrhea
• Difficulty swallowing
• Swollen Neck

Anthrax is transmitted through spores in the bacteria Bacillus anthracis, which can live in soil for several years. Humans can get anthrax by handling infected animal products or eating undercooked meats from infected animals. Anthrax is not known to be spread from person to person.

Individuals most at risk for getting Anthrax are:

• Individuals who work with Bacillus anthracis in a laboratory setting
• Veterinarians
• People who work with infected or infected animal products
• Military personnel

If you suspect that you have anthrax or have been exposed to the bacteria Bacillus anthracis contact your healthcare provider immediately, so that your doctor may further evaluate you and provide prompt treatment. Antibiotics such as cipro and doxycycline are often used to treat anthrax.

A vaccine has been developed, but it is only given to those who are at high risk for getting the disease. Antibiotics used for post prophylaxis exposure are the most effective in preventing anthrax after being exposed to it.

Please use the following resources, or contact your doctor or primary care physician.

• Pennsylvania Department of Health Anthrax FAQ
• CDC Disease Page
• Mayo Clinic Disease Page

Meningitis is a swelling of the membranes ("meninges") that cover the brain and spinal cord. Aseptic or viral meningitis is a relatively common and rarely fatal illness with multiple viral causes such as enteroviruses, arboviruses, echovirus and coxsackie viruses. This condition is called aseptic meningitis because tests for bacteria are negative. Viral meningitis occurs most commonly from June through October, when enteroviruses and arboviruses are widely circulating in the community.

Many people who are diagnosed with aseptic meningitis will experience symptoms of:

• Headache
• Fever
• Vomiting
• Nausea
• Photophobia (sensitivity to light)
• Rash 
• Neck stiffness
• Confusion
• Respiratory symptoms
• Muscle weakness

 
Aseptic meningitis is usually diagnosed by looking at the symptoms that you have, or by finding a virus in your cerebral spinal fluid (CSF) located in your spinal column, or by the lack of bacterial growth in the CSF.

Usually people get enteroviruses, which are the most common cause of viral meningitis, through direct contact with an infected person's stool.  Small children that have not been toilet trained and the adults who have contact with them can receive and spread the virus through poor handwashing and personal hygiene practices.

Enteroviruses can also be spread through direct or indirect contact with respiratory secretions (saliva, sputum, or nasal mucus) of an infected person.  Another leading cause of asceptic meningitis are arboviruses which are spread from the bite of infected mosquitoes and other insects.

Who is most likely to get Aseptic Meningitis?

Anyone can develop aseptic meningitis, however some situations may increase your risk of coming into contact with viruses that can lead to this condition.  Some of these situations include being in contact with diapered children, poor hygiene, missed vaccinations, and being outside where infected mosquitoes and other insects are more likely to bite you.  Individuals most at risk are small children who have not been toilet trained and the adults who have frequent contact with them.

Since the symptoms of viral meningitis are similar to those of bacterial meningitis, which is usually more severe and can be fatal, it is important for people suspected of having meningitis to seek medical care.  Your healthcare provider will determine if your spinal fluid should be tested. There is no specific treatment for viral meningitis. Most patients completely recover on their own within 2 weeks. Antibiotics do not help viral infections, so t

Following good hygiene practices such as washing your hands thoroughly and often, cleaning surfaces that have been contaminated with stool or respiratory secretions, covering your cough, and avoiding contact with others saliva through kissing or sharing utensils while they are sick can help avoid getting a virus. Receiving vaccinations included in the childhood vaccination schedule can also reduce the spread of viruses.  (Contact your healthcare provider or refer to CDC Vaccines & Immunizations for vaccine schedule) In order to prevent viruses transmitted by mosquitoes when you are outdoors use insect repellent that contains DEET or Picaridin.  Many mosquitoes are most active in the evening and during early morning hours. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours.

Please use the resources below, or contact your doctor or primary care physician.

• CDC Aseptic Meningitis Frequently Asked Questions
• MedlinePlus Aseptic Meningitis Page
• Mayo Clinic Aseptic Meningitis Page

Babesiosis is caused by parasites that infect your red blood cells.  The parasites are spread by the bite of an infected black legged tick (or deer tick).  There are several different kinds of babesiosis species found in small animals however Babesia microti is the primary species found in people. The blacklegged tick also carries the bacteria that cause Lyme disease and Anaplasmosis so it is possible to be infected with Babesia microti and another bacterium at the same time. 

Babesiosis is most common in parts of the Northeast and upper Midwestern United States; with most cases occurring during the warmer months. Babesiosis can be a severe, life-threatening disease in the elderly and those who have weakened immune systems. However, some people infected with the parasites may not have any symptoms.  

People who are diagnosed with babesiosis and who experience symptoms may develop:

• Headache
• Fever
• Chills
• Sweats
• Body aches
• Loss of appetite
• Nausea
• Fatigue
• Anemia

 

Babesiosis can also cause more serious complications such as:

• Hemolytic anemia (destruction of red blood cells)
• Low or unstable blood pressure
• Blood clots or bleeding
• Organ malfunction

Babesiosis is diagnosed by examining a sample of your blood under a microscope and by what signs and symptoms you have.  Some people may experience symptoms within a week though it can take weeks, months, or even longer for initial symptoms to develop if at all. 

Babesiosis is transmitted to people by the bite of an infected blacklegged tick.  The parasites that cause babesiosis exist naturally in white-footed mice and other small mammals.  Once the deer tick bites an infected animal it carries the parasites in it for the rest of its life cycle and can then pass the parasite to a human through a bite. 

The blacklegged tick needs to be attached to a human for at least 72 hours for the parasites to enter the body.  Babesiosis can also be transferred to another person by a blood transfusion if the donor was infected with the parasites or from a mother to her baby through breast milk. 

Anyone can get babesiosis, however some situations may increase your risk of coming into contact with ticks that can transmit these parasites. People who live in areas where babesiosis infections occur often are more likely to get this disease.  People who visit wooded or brushy areas with tall grass are more likely to come into contact with ticks that carry these parasites.  

Those with underlying medical conditions, without a spleen, or who are immunocompromised may be at greater risk for complications of babesiosis.

If you think you may be infected with babesiosis you should seek medical care as soon as possible.  Tick bites are very small and may not be recognized but if you recall a tick bite or if you have been in tick infested areas prior to becoming sick you should tell your healthcare provider. Effective treatments are available, and most people respond well. 

Babesiosis can best be prevented by limiting your exposure to ticks. You can limit your exposure to ticks by wearing light-colored clothing that allows you to see ticks that are crawling on your clothing. If you are in an area where ticks may be present you should wear pants that you can tuck into your socks and a long sleeved shirt. Using an insect repellant that contains Permethrin or DEET can be applied to help prevent tick attachment. After being in a wooded or brushy area you should do a body inspection before going indoors.  If you notice a tick on your skin it should be removed right away by using fine tipped tweezers.  

Please use the following resource, or contact your doctor or primary care physician.

• CDC Babesiosis Home Page

Botulism is a serious illness (although rare) that is caused by a nerve toxin produced by the bacterium Clostridium botulinum.   There are seven types of botulism toxin but only types A, B, E, and F cause illness in people.  The three main forms of human botulism are foodborne, wound, and infant.  Iatrogenic botulism, which results from the excess injection of therapeutic botulinum, has also been reported. Infant botulism is the most commonly reported form of botulism in the United States.

Symptoms include:

• Double or blurred vision
• Drooping eyelids
• Slurred speech
• Difficulty swallowing
• Dry mouth
• Muscle weakness or paralysis

Symptoms in an infant include:

• Lethargy
• Feeding poorly 
• Constipation
• Weak cry 
• Poor muscle tone

Without treatment, the disease can lead to paralysis of the body and respiratory muscles, which can be life-threatening.

Botulism can be difficult to diagnose.  Healthcare providers will look at symptoms and possible sources of exposure if botulism is suspected. A blood or stool sample will be taken to diagnose botulism.

Foodborne botulism most often develops after eating improperly processed home-canned foods or home-preserved meats.

Infants under twelve months of age can get botulism when fed foods, usually honey, that contains botulism spores or by ingesting botulinum spores from the environment.

People get wound botulism when the botulism spore, typically found in soil or gravel, gets into an open wound. 

Anyone can get botulism.

Children that are younger than twelve months old who are fed foods that contain botulism spores, such as honey, are at risk for getting infant botulism.   

Anyone who eats contaminated foods, usually foods that are not properly processed such as home-canned foods or home-preserved meats, is at risk for getting foodborne botulism. 

Anyone who has an open wound and is in areas with contaminated soil is at risk for getting wound botulism.

Contact your healthcare provider immediately. Untreated botulism can result in death.  If infected food is thought to still be in the person's stomach, removal via induced vomiting or enemas may be done.  If respiratory paralysis occurs, a person will be placed on a ventilator. 

Hospital care is necessary for all types of botulism. In most cases, an antitoxin medication is given for treatment. Antibiotics are sometimes given for wound botulism. 

Food botulism can be prevented by correct food preparation.  If canning foods or preserving meats at home, proper instructions need to be followed (please refer to the USDA's guide as listed below).  If food smells bad, do not eat it.  If a can or container is bulging, do not open the container or eat the food.  To prevent infant botulism, do not feed your infant honey products. However, honey is safe for people one year of age and older.  Infected wounds should receive immediate medical attention.  Do not use injectable street drugs.

Please use the following resources, or contact your doctor or primary care physician.

• Pennsylvania Department of Health Botulism Fact Sheet
• CDC Botulism Fact Sheet
• USDA Home Canning Guide

Brucellosis is a disease spread by infected animals or animal products to humans and is caused by Brucella bacteria. The disease usually presents as a “flu-like” syndrome in humans. It is also referred to as undulant, malta, rock, or gastric fever. Bruellosis is uncommon in the U.S. but hundreds of thousands of cases occur worldwide. Because Brucella can be aerosolized, it has been classified as a potential bioterrorism agent.

Symptoms of acute brucellosis include:

• Fever
• Fatigue
• Sweats
• Weight loss
• Arthralgia
• Myalgia
• Abdominal and back pain

Additionally, enlarged spleen, lymph nodes or arthritis may be present among physical examination by a healthcare provider. These symptoms typically develop 3-4 weeks after exposure to Brucella bacteria but may develop as late as 8 weeks after exposure.

In cases with the undulant form of brucellosis, symptoms may include rising and falling fevers, arthritis, and testicle inflammation in males. Cases with the chronic form of brucellosis may experience chronic fatigue syndrome, depression, and arthritis. Symptoms of undulant or chronic brucellosis develop after 8 weeks to more than a year after exposure to the bacteria.

Brucellosis may result in more serious complications such as meningitis, endocarditis, eye inflammation, and osteomyelitis. The number of people who are infected with Brucella and die is less than 2% and is typically the result of endocarditis.

Humans can become infected with Brucella through skin abrasions, cuts, or mucosal surfaces via direct contact with infected animals or their carcasses or secretions, drinking or eating unpasteurized milk or dairy products, or by inhaling Brucella bacteria.

Person to person transmission of brucellosis is rare but has been reported to occur through breastfeeding, sexual transmission, or tissue transplantation.

Anyone can be at risk for brucellosis however; those in high risk occupational groups such as veterinarians, slaughterhouse workers, farmers and laboratorians may be at greater risk due to their potential for greater exposure to Brucella bacteria.  Hunters may also be at risk in states where Brucella is more common as well as persons who consume unpasteurized milk or dairy products.

If you suspect you have brucellosis it is important for you to contact your healthcare provider as soon as possible. The diagnosis of brucellosis can be difficult because its symptoms can apply to a lot of other conditions and it is also very hard to culture the bacteria.  There are several blood tests that may be used to identify the infection along with your symptoms. Your healthcare provider may prescribe antibiotics to help treat the disease.

Brucellosis can be prevented by reducing your risk for exposure to the bacteria. For example, do not drink or consume unpasteurized milk or dairy products especially while traveling. Workers in high-risk occupational groups should use appropriate personal protective equipment.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• US Department of Agriculture Brucellosis Information

Campylobacteriosis is a bacterial illness that causes diarrhea. It is often called campylobacter.
Symptoms include:

• Diarrhea
• Abdominal pain/cramping
• Fever
• Nausea/vomiting

People with campylobacteriosis usually recover in 2-5 days, but they can be sick for up to 10 days. 
Long-term problems are rare, but they can range from arthritis to Guillain-Barré syndrome.

Most campylobacter infections occur from people eating undercooked /raw poultry or meat, or other food that has been contaminated by these meats.  Other sources of campylobacteriosis are unpasteurized milk or contaminated water.  It is not often spread from person to person. 

Anyone can get campylobacteriosis.  Those most at risk are:

• Infants
• Young adults
• Males

 

If you think you have campylobacteriosis, contact your physician. The test for campylobacter requires a stool sample. Campylobacteriosis can be treated with antibiotics.  Diarrhea can cause fluid loss and dehydration, so it is important to drink fluids.

There is no vaccine for campylobacteriosis. 

Good hand washing, especially before preparing food can help prevent campylobacteriosis.  Always cook meat and poultry to the correct temperature and use a meat thermometer to make sure it is the right temperature.  The color of the meat does not ensure it is done cooking.  Do not eat any unpasteurized dairy products or juices.  Do not swallow water when swimming.  Good hand washing can help prevent campylobacteriosis, especially after going to the bathroom and before preparing food.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book
• Campylobacteriosis Frequently Asked Questions PDF

Chlamydia (cla-mid-ee-ah) is a sexually transmitted disease (STD) caused by a bacteria called Chlamydia trachomatis. It can spread from person to person during sexual intercourse (vaginal and anal) when a person's mucous membranes come into contact with the vaginal secretions or semen of an infected person. It can be transmitted without complete insertion of a penis into the vagina or anus. It is less likely, although possible, to be transmitted to the throat during oral sex. It can also be passed from mother to newborn during childbirth. Chlamydia infections are treatable and curable with antibiotics.

Untreated chlamydia can lead to severe reproductive health problems for women, including sterility. Pelvic inflammatory disease (PID) is a common result of untreated chlamydia infection. In PID, the bacteria move from the vagina up through the cervix and into the uterus, fallopian tubes and ovaries. Blockage and scarring can damage the tubes, causing women who conceive to be more likely to have "tubal pregnancies."

In men, untreated chlamydial infections can lead to prostatitis (inflammation of the prostate gland), urethral scarring, infertility, or epididymitis (inflammation of the cord-like structure at the back of the testes).

If you are HIV positive and have chlamydia, inflamed genital tissues contain highly concentrated amounts of the virus, causing 8-10 times more HIV to be shed in your semen or vaginal secretions. If you are HIV negative and have chlamydia, your immune cells are especially susceptible to HIV if your partner is carrying the virus. Rectal chlamydia may increase chances of getting HIV ten to twenty-fold.

Symptoms usually appear from one to three weeks after infection, but then go away, even if left untreated. Many people infected with chlamydia never have any symptoms at all.

Women may experience pain and itching of the vulva or vagina; vaginal discharge; unusual vaginal or anal bleeding; pain with urination; and/or pain when having sex. 80% of infected women have no symptoms.

Men may experience discharge from the head of the penis or the anus; pain or itching at the head of the penis; and/or pain with urination. 50% of infected men have no symptoms.

A complete examination for chlamydia includes taking a sexual history, examining any symptoms you might be having and testing a sample of your genital secretions with a swab. In addition, there is a chlamydia test that can be done on a urine sample. The exact test(s) done will depend on where you go for your exam.

Some providers recommend that you get tested for gonorrhea at the same time as your chlamydia test. Talk to your provider about the options available to you when you go to get tested.

Antibiotics cure chlamydia. It is very important to take all the pills you are given even if you feel better, so the bacteria is completely wiped out.

Your sex partner(s) must be examined and treated too, because otherwise they can give the infection back to you and/or infect others. You need to abstain from sex for one week from when the antibiotics were started. If you still have symptoms after you've completed the treatment, it's important to go back to your provider for a check-up.

Once you are treated and cured of chlamydia, you can be re-infected if you're exposed to the bacteria again.

Abstinence is the only way to completely avoid getting chlamydia or other STDs. If you're sexually active, using condoms consistently and correctly for oral, anal and vaginal sex is your best bet for staying sexually healthy. Since chlamydia can be passed even if the penis or tongue does not completely enter into the vagina or rectum, it's important to use a condom from the very beginning to end of sexual contact.

The risk for chlamydia is directly related to the number of sex partners you have: The more sex partners, the greater the risk of contracting it. Having more sex with fewer partners reduces your risk of getting chlamydia.

If you have a new partner with whom you intend to be monogamous, consider having full STD checkups together before you start having sex. If you're sexually active with more than one monogamous partner, regular STD checkups at least every six months is recommended. Chlamydia and other bacterial STDs are curable with proper diagnosis and treatment.

Find out more about STDs at Take Control Philly.

Cholera is a diarrheal illness caused the bacteria Vibrio cholerae.  People with cholera infection often do not have symptoms or have a mild gastroenteritis (irritation or inflammation of the stomach and intestines).  However, in some cases it can be severe.  If severe cholera is not treated, the dehydration can quickly lead to shock and death.  Onset is often sudden, anywhere from hours to about 5 days.

Symptoms include:

• Watery stools often described as “rice-water stool”
• Vomiting
• Leg cramping
• Dehydration

Cholera can be spread a few different ways. The first is the fecal-oral route, meaning a person needs to ingest the parasite. This can occur from actions like diaper changing or sexual activity, or indirectly such as consuming contaminated food or water. Poor sewage systems and drinking water can cause cholera to spread quickly.
The cholera bacteria also live in brackish (a mix of fresh and salt water) rivers and coastal waters, and can contaminate shellfish.  Eating raw or undercooked shellfish from these areas can also cause infection. 

Anyone can become infected with cholera.  It is more common among these groups:

• Travelers to areas where cholera is common (especially countries with poor sewage systems)
• People who eat undercooked shellfish that are harvested from certain coastal areas or rivers

 

Contact your physician.  Diagnosis is confirmed through a stool specimen.  Rehydration is very important in treating people infected with cholera, and IV fluids may be needed for fluid replacement.  Antibiotics can shorten the length of the illness.

There are oral vaccines available outside of the United States. The CDC does not recommend these vaccines for most travelers because of the low risk for US travelers and also because this vaccine does not offer full protection.

If you are traveling to an area where cholera is common, make sure to drink bottled water or boil the water and do not drink beverages with ice cubes.  Also do not eat any unpasteurized dairy products, food from street vendors, or any raw fruit or vegetable (including salad). Avoid undercooked or raw fish, shellfish, and ceviche.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book

CJD is a rare and fatal disease that affects the nervous system. It results in a rapid progression of dementia, loss of motor control, paralysis, and death. CJD has been classified as having two forms: classic CJD and new variant CJD (nvCJD). Both forms of CJD belong to a group of diseases known as transmissible spongiform encephalopathies (TSEs), which means that the disease affects the brain and results in several microscopic holes giving it a sponge-like appearance. Other TSEs include bovine spongiform encephalopathy (mad cow disease) and chronic wasting disease.

Initial symptoms of classic CJD may include personality and behavioral changes such as memory loss, impaired thinking, anxiety, and depression. Later symptoms of CJD include rapid dementia, difficulty walking and talking, involuntary muscle jerking, loss of balance and coordination, and blurred vision or blindness. People with CJD eventually lose the ability to move and speak completely and usually die within one year of symptom onset.

nvCJD presents with similar symptoms as the classic form and has only been linked with persons living or visiting Great Britain and some other European countries. Clinical signs may be subtly different than the classic form. nvCJD tends to occur in younger persons, those under the age of 45. There is strong evidence suggesting that nvCJD is related to the occurrence of "mad cow disease".

Both forms of the disease can only be diagnosed through symptoms, detection of certain proteins in the cerebrospinal fluid, and by detection of spongiform changes in the brain. No cure is available for CJD.

CJD is caused by an abnormal form of a prion (self-replicating protein). In about 90% of cases the conversion of normal protein into a disease producing prion occurs spontaneously. In 10% of cases, the conversion may be familial and passed on through genes. A very small number of cases may get the disease by being exposed to the abnormal prion from contaminated human tissues, grafts, human pituitary hormone or a piece of medical equipment. Once exposed to the abnormal prion it may take a year to several decades for symptoms to appear.

 

CJD occurs worldwide and about one person per million population will get the disease. Persons older than 60 years of age are at higher risk for developing the classic form of the disease.

Speak to your doctor immediately if you believe you may have signs and symptoms of CJD.

 

Please use the following resources, or contact your doctor.

• Centers for Disease Control and Prevention
• National Institutes of Health

Cryptosporidiosis is a diarrheal illness caused by a parasite.  It is often called crypto.

Symptoms include:

• Diarrhea
• Weight Loss
• Stomach cramps/pain
• Fever
• Nausea
• Vomiting

Symptoms can occur 1 to 12 days after becoming infected with cryptosporidiosis.  Symptoms usually last up to several weeks, but the parasite can be shed in the stool for weeks after the symptoms have stopped.  This is important because millions of parasites can be released in one bowel movement, making it very contagious.

The parasite that causes cryptosporidiosis lives in the intestine of humans and animals.  The infection can be transmitted from drinking contaminated water or ice, which includes swallowing contaminated water while swimming.  It can also be passed through contaminated food and touching surfaces that have been contaminated with fecal matter from an infected person.

Anyone can become infected with cryptosporidiosis.  It is more common for these groups to get it:

• Travelers and immigrants from areas where cryptosporidiosis is common
• Diaper aged children, especially in child care settings
• Close contacts with someone who has cryptosporidiosis
• Swimmers who swallow contaminated water while swimming
• People exposed to fecal matter (stool) during sexual activities
• People who handle infected cattle

Contact your physician. The test for cryptosporidiosis is through a stool sample to look for the parasite.  Your physician may request several stool cultures because it can be hard to distinguish from another similar parasite.  Cryptosporidiosis can be treated with antibiotics.  Diarrhea can cause fluid loss and dehydration, so it is important to drink fluids. 

If you have a weakened immune system, it is very important to seek medical care. Cryptosporidiosis can be life threatening in people with weakened immune systems.

There is no vaccine for cryptosporidiosis. 

If you are traveling to an area where crypto is common, make sure to drink bottled water or boil the water and do not drink drinks with ice cubes. 

Good hand washing can help prevent crypto, especially after going to the bathroom or changing diapers, and before preparing food.

If you are swimming, follow proper swimming hygiene.  Do not swim until at least 7 days after your diarrhea has stopped and shower before swimming.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book
• Cryptosporidiosis Frequently Asked Questions PDF

Cyclosporiasis is an intestinal infection caused by a parasite.  It is commonly known as cyclospora.

Symptoms include:

• Watery diarrhea
• Frequent, sometimes explosive bowel movements
• Loss of appetite
• Weight loss
• Stomach cramps
• Bloating
• Increased gas
• Nausea
• Fatigue (tiredness)

Symptoms usually appear about one week after being infected.  Symptoms can last from a few days to over a month.  People can have relapses where they feel better and then have symptoms again.

Eating or drinking food or water that has been contaminated with stool that contains the parasite causes cyclosporiasis.  It is not usually transmitted person to person.  Fresh fruits and vegetables, especially berries, are often causes of cyclosporiasis infections.

Anyone can become infected with cyclosporiasis, but is more common for these groups to become infected:

• Travelers and immigrants from areas where cyclospora is common (often tropical areas)

 

Contact your physician. The test for cyclosporiasis is done through a stool sample to look for the parasite.  Your physician may request several stool cultures because it can be hard to distinguish from another similar parasite.  Cyclosporiasis can be treated with antibiotics.  Diarrhea can cause fluid loss and dehydration, so it is important to drink fluids. 

• There is no vaccine for cyclosporiasis. 
• Always wash fresh produce carefully before eating it.

If you are traveling to an area where cyclosporiasis is common, make sure to drink bottled water or boil the water and do not drink beverages with ice cubes.  Also, avoid raw produce and fruits not peeled yourself when traveling in these locations. 

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book

Dengue is caused by any one of four closely related viruses that are transmitted through the bite of an infected mosquito.  The same virus that causes dengue can also cause Dengue Hemorrhagic Fever which is a more severe form of dengue infection. The mosquito responsible for transmitting the virus is primarily found in tropical and sub tropic areas. Dengue rarely occurs in the continental United States, however it is common in Puerto Rico, and in many popular tourist destinations in Latin America and Southeast Asia. Signs and symptoms of dengue occur 4-7 days after being bitten by an infected mosquito.  

Many people who are diagnosed with dengue will experience symptoms of:

• Severe headache
• High fever
• Pain behind the eyes
• Muscle and joint pain
• Rash
• Mild bleeding (e.g. nose or gum bleed, easy bruising)
• Vomiting
• Nausea

Dengue is transmitted to people by the bite of the Aedes species of mosquito that is known to carry the dengue virus.  This type of mosquito species is a day biting mosquito.  The mosquito becomes infected with dengue virus when it bites a person who has dengue virus in their blood.  The mosquito can then transmit the virus to another person when it bites them. 

Anyone can be infected with dengue however, some situations may increase your risk of coming into contact with the virus.  People who live or travel in tropical areas, such as Asia, Central and South America, and the Caribbean where the mosquito species responsible for transmitting the dengue virus is present are at risk for getting this disease.  In addition people who live or travel in these areas and who do not take proper precautions to avoid mosquito bites are at the greatest risk for infection.

Call your health care provider if you have traveled to an area where dengue fever is known to occur and have developed symptoms of the disease.  Your healthcare provider may take a sample of your blood to test for dengue.  There is no specific treatment for dengue infections.  Treatment relies on managing whatever symptoms you may have.  Most people with this type of infection will recover completely on their own.

Avoiding mosquito bites is the most effective way to prevent this type of infection.  If you are going to an area where mosquitoes are likely to be you should wear an insect repellant that contains DEET or Permethrin.  If you live or visit an area where mosquitoes are present you should get mosquito netting to cover your bed and make sure your doors and windows have proper screens attached to them.  Lastly wearing appropriate clothing like long sleeves and long pants in areas where mosquitoes are present will help you avoid being bitten.  Destroying and removing mosquito breeding sites is also an effective way to avoid getting dengue and other illnesses transmitted by mosquitoes. These breeding sites include anywhere that can collect standing water e.g. flower pots, tires, discarded containers, etc.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Dengue and Dengue Hemorrhagic Fever: Questions and Answers
• MedlinePlus Dengue page

Diphtheria is a contagious bacterial illness caused by Corynebacterium diphtheriae. It primarily causes a respiratory illness affecting the throat or nose, but can also affect the skin and other areas of the body. Diphtheria is very uncommon in the United States. Only 5 cases have been reported in the United States since 2000.

Symptoms of respiratory diphtheria develop slowly and commonly include:

• Low-grade fever
• Sore throat
• Difficulty swallowing
• Tiredness
• Loss of appetite
• Gray, firm, fleshy matter that develops after 2-3 days of illness and sticks to the nose and throat

Symptoms usually begin 2-5 days after exposure to the bacteria.

People with untreated diphtheria may be able to transmit the disease for 2-6 weeks after infection. People who are treated with appropriate antibiotics are usually not contagious after 4 days of antibiotics.

The most frequent complications of diphtheria include myocarditis (heart muscle inflammation) and neuritis (nerve inflammation). Death occurs in 5%-10% of cases, with higher deaths rates (up to 20%) among persons younger than 5 and older than 40 years of age.

A diphtheria diagnosis is usually based on signs of illness. Laboratory tests are often used to confirm the diagnosis and may include a swab of the infected area.

Diphtheria is usually spread person-to-person through oral or respiratory secretions. It can also be transmitted from close contact with an infected person's skin lesions or soiled items. Rarely, it has also been transmitted through raw milk or milk products.

The bacteria are only present in humans and do not live in the environment.   

In the United States, unvaccinated travelers to endemic areas (e.g., newly independent states of the Soviet Union and countries in Africa, Asia, Latin America and the Middle East) are at risk of contracting diphtheria. Travelers staying for a prolonged period, those that will be staying in crowded living conditions, or those with exposure to children should be vaccinated prior to travel.     

Contact your doctor immediately to discuss your symptoms. 

The best way to prevent diphtheria is to get vaccinated. Diphtheria vaccine (usually DTaP) is given to children as part of the routine vaccination series at 2, 4, 6, and 15-18 months, and 4-6 years of age. Children 10 years of age and older also receive one dose of vaccine (Tdap). Adults are recommended to get a booster dose of vaccine (Td) every 10 years.

Individuals traveling to endemic areas should ensure they are up-to-date on their vaccinations.

Please use the following resources, or contact your doctor.

• Pennsylvania Department of Public Health
• Centers for Disease Control and Prevention

E. Coli is a large group of bacteria with many different strains or types. Some of the strains are harmless and others can be life-threatening.  Certain strains produce toxins, which are known as shiga toxin.

Symptoms include:

• Severe stomach cramping
• Diarrhea (often bloody)
• Vomiting
• Low grade fever

People usually become sick 3-4 days after exposure to E. Coli, but it can range from 1-10 days.  People will usually feel better within 5-7 days.  A small number of people with E. Coli (5-10%) will develop hemolytic uremic syndrome (HUS). HUS has three components: microangiopathic hemolytic anemia (a disorder of the small blood vessels causing anemia), thrombocytopenia (low platelets), and acute renal failure.

Symptoms of HUS include:

• Decreased frequency of urination (urinating less often)
• Feeling tired
• Losing color in the cheeks and inside of eyelids

HUS usually occurs around 7 days after the first symptoms, and usually when the diarrhea starts to improve.  People with HUS should seek medical care and will often be hospitalized to prevent kidney failure.

E. Coli is spread several ways. It is usually spread from people who are infected with this germ, who pass the bacteria in their bowel movements (stool). If an infected individual does not wash their hands properly, this germ can get into the foods or drinks they are handling. As a result, other people can then get sick by eating this food or drink. People can also get this germ on their hands when changing diapers or assisting a child with toileting.  Certain foods have greater risk of E. Coli infection, such as unpasteurized or raw milk or cheeses, unpasteurized apple cider, and contaminated water. Some people may also get sick from contact with cattle or petting zoos. 

Anyone can get E. Coli.  The people most at risk are:

• Very young children
• The elderly

If you think you have E. Coli, you should contact your doctor and discuss your symptoms. A stool sample will be collected to determine the diagnosis.  Supportive therapy, such as rehydration is important.  Antibiotics and anti-diarrheals are not helpful in treating E. Coli, because they increase the risk of HUS. 

There is no vaccine for E. Coli. 

Good hand washing with soap and water or alcohol based gels can help prevent E. Coli, especially after the following activities: going to the bathroom or changing a diaper, before preparing food, or after petting animals.  Always cook meat to the correct temperature and use a meat thermometer to make sure it is the right temperature.  The color of the meat does not ensure it is done cooking.  Do not eat any unpasteurized dairy products or juices. Do not swallow water when swimming.  Good hand washing can help prevent E. Coli, especially after going to the bathroom and before preparing food.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book
  • Escherichia coli - enterotoxigenic (ETEC)
  • Escherichia coli - enteropathogenic (EPEC)
  • Escherichia coli O157:H7 enterohemorrhagic (EHEC)
  • Escherichia coli - enteroinvasive (EIEC)
• E Coli Frequently Asked Questions PDF

Ehrlichiosis is the general name that describes several bacterial diseases that affect animals and humans. These diseases are caused by the organisms in the genus Ehrlichia. In the United States, there are two Ehrlichia species that are known to cause infection in humans, Ehrlichia chaffeensis and Ehrlichia ewingii.  

The initial signs and symptoms include:

• Fever
• Headache
• Fatigue
• Muscle aches

Other signs and symptoms could include:

• Nausea
• Vomiting
• Diarrhea
• Joint Pain
• Occasionally a rash may form

Symptoms typically appear 5 to 10 days after being bitten by a tick. However it is possible that some people who become infected with ehrlichiae will not become sick or will only have very mild symptoms.  

Ehrlichiosis is diagnosed through a combination of clinical signs and symptoms and lab tests, such as blood tests.

People can get ehrlichiosis if an infected tick bites them. The most commonly infected tick is known as the lone star tick.

Anyone can get this disease that lives in or travels to areas that have lone star ticks, such as the southern, eastern, and south-central United States. Certain people are at a higher risk of suffering from a more serious illness. These people include the elderly and people who have weak immune systems.  

Contact your doctor and explain the symptoms you have. If you are aware of a tick bite, notify your doctor.  A blood test can be done to determine if you have ehrlichiosis.  Ehrlichiosis is effectively treated with a course of antibiotics.   

Since avoiding exposure to tick habitats is not entirely possible, there are several things you can do in order to reduce the chances of getting the disease. When in outdoor areas where ticks are present, apply bug repellants that contain DEET. Also, wear light colored clothing so that you could easily spot a tick. If you are going into a high grass or bushy area where ticks may be present tuck your shirt into your pants and your pants into your socks so that ticks cannot crawl under your clothing and attach to your skin.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• MedlinePlus page
• Mayo Clinic page

Foodborne toxins are toxins that are found in different foods that can cause illness when they are consumed.  Some are naturally occurring toxins that are found in certain foods, and others are produced by bacteria that have contaminated a food item.  There are many different types of toxins, but the following highlights a few of the more common ones. 

Naturally Occurring Toxins

Ciguatera poisoning
Ciguatera poisoning occurs from consuming tropical and subtropical finfish which has an accumulation of natural toxins from its diet.  Symptoms usually appear about 6 hours after consumption of toxic fish and include numbness and tingling (paresthesia) around the mouth, which may spread to the extremities, nausea, vomiting, and diarrhea.  Neurological and cardiovascular symptoms may also occur. Symptoms usually resolve within several days, yet in severe cases, can last weeks to months.  Varieties of fish typically associated with ciguatera poisoning include groupers, barracudas, snappers, jacks, mackerel, and triggerfish.  Not all fish from these species will be toxic—occurrence is sporadic. 

Scombroid poisoning
Scombroid poisoning results from eating fish that has an accumulation of histamine as a result of the spoilage process.  Symptom onset can occur immediately or up to 30 minutes after consumption.  Tingling or a burning sensation in the mouth, an upper body rash, a drop in blood pressure, headache, and skin itching are common symptoms of scombroid poisoning.  Nausea, vomiting, and diarrhea may also occur.  Symptoms usually last about three hours, but may persist longer.  Species of fish that have been associated with scombroid are tunas (i.e. yellowfin and skipjack), mahi mahi, bluefish, sardines, mackerel, amberjack, and abalone.  However, other food products have been associated with scombroid as well—swiss cheese in particular is one food that can cause scombroid poisoning.   

Toxins Produced by Bacteria

Staphylococcal food poisoning
The enterotoxins produced by certain strains of Staphylococcus aureus can cause a rapid onset (usually in a few hours) of symptoms which can include nausea, vomiting, and abdominal cramping.  Symptoms generally last two to three days, but may last longer, depending on severity.  Foods typically associated with Staphylococcal food poisoning include meat, poultry, egg products, salads such as egg, potato, tuna, chicken, and macaroni, cream-filled pastries like eclairs, and milk and dairy products. It is also possible for humans to contaminate food with this toxin. For instance, foodhandlers can contaminate food products if they do not follow safe food handling procedures, such as proper handwashing when preparing food.

Bacillus cereus food poisoning
B. cereus produces two different endotoxins: one causes diarrheal illness and the other causes vomiting.  The diarrheal type of poisoning presents with watery diarrhea, abdominal pain and cramping 6-15 hours after eating contaminated food and lasts for about 24 hours.  The other type presents with nausea and vomiting occurring 30 minutes-6 hours after eating contaminated food and lasts usually less than 24 hours.  A wide range of foods such as meat, fish, vegetables, and dairy products can be associated with B. cereus poisoning, but rice products have been usually associated with the vomiting-type poisoning.

Clostridium perfringens food poisoning
C. perfringens is another bacterium that is capable of producing toxin.  Consuming food that has a large number of such bacteria can lead to severe abdominal cramping and diarrhea in 8-22 hours after eating.  Most cases resolve after 24 hours, but symptoms can last in some individuals for 1 to 2 weeks.  Meats, gravies, and other meat products are usually associated with C. perfringens food poisoning, and usually occurs when bacteria multiplies when these products are not cooled down properly.

People get sick from foodborne toxins by ingesting food that has had either an accumulation of naturally occurring toxins or food contaminated with bacteria that produce endotoxins.  Food that has been improperly handled or stored at improper temperatures has a higher likelihood of containing foodborne toxins.

Anyone who consumes food contaminated with toxin can get sick.  However, symptom severity and susceptibility will vary from person to person.

 

Consult your healthcare provider if you are experiencing symptoms of foodborne toxins.

 

• Adequately refrigerate meats, fish, vegetables and dairy products. 
• Rapidly cool cooked meals if they won't be eaten immediately
• Wash fruits and vegetables with chlorinated water to reduce potential toxins on fresh produce

Please use the following link, or contact your doctor.

• FDA's Foodborne Illness, Foodborne Pathogens & Natural Toxins
• Foodborne Toxins-Naturally Occurring Frequently Asked Questions PDF
• Foodborne Toxins- Toxins Produced by Bacteria Frequently Asked Questions PDF

Giardiasis is a diarrheal illness caused by a parasite.  It is often called giardia.

Symptoms include:

• Diarrhea
• Gas or flatulence
• Greasy stools
• Stomach or abdominal cramps
• Upset stomach
• Weight loss
• Dehydration

Symptoms will usually appear about 1 to 2 weeks after being infected with giardiasis. Symptoms can last 2 to 6 weeks on average. 

The parasite that causes giardiasis lives in the intestine of humans and animals.  The infection can be spread from drinking contaminated water or ice, which includes swallowing, contaminated water while swimming.  It can also be passed through contaminated food, touching surfaces that have been contaminated with stool from an infected person.

Anyone can become infected with giardiasis.  It is more common for these groups to get it:

• Travelers and immigrants from areas with a high rate  of giardiasis
• Diaper aged children, especially in child care settings
• Close contacts with someone who has giardiasis
• Swimmers who swallow contaminated water while swimming
• People exposed to stool during sexual activity

 Philadelphia has seen outbreak situations associated with swimming pools.

Contact your physician. The test for giardiasis is through a stool specimen to look for the parasite.  Your physician may request several stool cultures because it can be hard to distinguish from another similar parasite.  Giardiasis can be treated with antibiotics.  Diarrhea can cause fluid loss and dehydration, so it is important to drink fluids.

There is no vaccine for giardiasis. 

If you are traveling to an area where giardia is common, make sure to drink bottled water or boil the water and do not drink drinks with ice cubes. 

Good hand washing can help prevent giardia, especially after going to the bathroom and before preparing food.

If you are swimming, follow proper swimming hygiene.  Do not swim until 7 days after your diarrhea has stopped and shower before swimming.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book
• Giardiasis Frequently Asked Questions PDF

Group A Streptococcus (GAS) is a type of bacteria that is commonly found in the throat and skin. Most infections caused by GAS such as “strep” throat are mild and non-life threatening. However, sometimes this type of bacteria can cause severe illness when it is found in the blood, muscles, or lungs. When GAS is found in these places the infection is identified as invasive GAS disease.

Complications of invasive GAS infection include:

• Bacteremia
• Pneumonia
• Meningitis
• Endocarditis
• Septic Arthritis (Joint Infection)
• Cellulitis
• Pericarditis (infection of the sac covering the heart)
• Necrotizing fasciitis (an infection that destroys fat, muscle, and skin tissue)
• Streptococcal Toxic Shock Syndrome (an illness that causes a rapid drop in blood pressure and may lead to organ failure)

Group A Streptococci is spread by direct contact with secretions from an infected person's nose or throat.  In addition contact with infected wounds or skin may also increase an individual's risk of getting the infection.

Persons most at risk for getting this disease are:

• Individuals with chronic health conditions (diabetes, cancer, heart or lung disease)
• Individuals with cuts, open wounds, or chickenpox
• Adults with a history of alcohol abuse or injection drug use
• Individuals living in group settings

Persons with Invasive GAS disease are diagnosed by a healthcare provider typically within a hospital. The disease can be treated with antibiotics.

The best way to prevent this disease is by washing your hands thoroughly with soap and water or alcohol based gels after coughing and sneezing and before preparing and eating foods. Anyone who is diagnosed with this type of infection should not attend daycare, school, or work until they have completed 24 hours of antibiotic treatment. Individuals who have wounds should keep them clean and watch for signs of infection such as redness, swelling, and fever.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• E-medicine Group A Strep Information
• Group A Strep Frequently Asked Questions PDF

Gonorrhea (gon-or-e-uh) is a sexually transmitted disease (STD) caused by a type of bacteria called Neisseria gonorrhoea. Gonorrhea can be transmitted to both male and female partners during vaginal, anal and oral sex from a partner infected in his or her throat, vagina, urethra or anus. Gonorrheal infections are completely curable with antibiotics.

If you are HIV+ and have genital inflammation due to gonorrhea, the inflamed tissues contain highly concentrated amounts of the virus. If the gonorrheal infection is in your penis, you can shed 8-10 times more HIV in your semen.

If you are HIV- but have gonorrhea, the disease-fighting cells of your immune system are especially susceptible to HIV if you have unprotected sex with an HIV-infected partner. Rectal gonorrhea increases the risk of contracting HIV by ten to twenty times.

In about 1% of people with untreated gonorrhea, the infection can spread beyond the genital area to the bloodstream, skin, heart or joints. This is called Disseminated Gonococcal Infection (DGI). Symptoms include fever, multiple skin lesions, arthritis, infection of the inner lining of the heart, and meningitis. DGI can be treated with antibiotics.

PID (pelvic inflammatory disease), a serious pelvic infection in women, is a more common result of untreated gonorrhea. In PID, the bacteria move from the vagina up through the cervix and into the uterus, fallopian tubes and ovaries. Blockage and scarring can damage the tubes, making a woman who conceives more likely to have a tubal pregnancy. Left untreated, PID can cause infertility. Untreated gonorrhea can also cause chronic menstrual problems, postpartum endometritis, urinary tract infections, miscarriage, and cervical discharge.

Men with untreated gonorrhea can occasionally develop epididymitis, a painful infection of the testicles. Untreated gonorrheal infections can also cause inflammation of the prostate and urethral scarring, sometimes leading to infertility.

Most men develop symptoms of gonorrhea within two to five days after being exposed, with a possible range of one to thirty days. Although most women are asymptomatic (without symptoms), for those who do have symptoms, they usually appear within 10 days after being exposed.

Men who have gonorrhea in the penis or anal area may experience a discharge from the head of the penis or the anus; pain or itching of the head of the penis; swelling of the penis or testicles; pain and/or burning upon urination; frequent urination; anal or rectal itching; white anal discharge; and/or pain during bowel movements.

Women with gonorrhea may have a discharge from the vagina; lower abdominal pain, especially during or after sex; unusual bleeding with cramping; pain or burning with urination.

If you're infected with gonorrhea in the throat, there are usually no symptoms, except possibly a sore throat.

There are several different testing options for gonorrhea. Your medical provider will decide which one is best given your situation and the lab facilities available at the clinic or medical practice. Some tests are done on a urine sample, and some on a swab of the secretions from the infected area.

Your provider will give you antibiotics to kill the gonorrheal bacteria in your body. If you are prescribed antibiotics, take all of the pills, even if you feel better before you finish the dosage. Your sex partner(s) need to be examined and treated also, because if you have unprotected sex again, you can be re-infected. If you're non-monogamous, your partner is also capable of infecting others until he or she gets proper treatment.

It's important to talk to your partners to maintain your sexual health and that of our community. Also you must abstain from partner sex for one full week from when your antibiotic treatment is started.

The risk for gonorrhea is directly related to the number of sex partners you have: The more sex paartners, the greater the risk of contracting it. Having more sex with fewer partners reduces your risk of getting gonorrhea.

The only way to be 100% sure of eliminating your risk of contracting gonorrhea or other STDs is to abstain from sex. If you are sexually active, however, using condoms (male or female) for sexual activity is your best bet for protecting yourself. Since gonorrhea can be transmitted during oral sex, primarily mouth-to-penis or penis-to-mouth contact, it would be wise to use a condom when performing oral sex on a man or if you're a man, having oral sex performed on you. Also, we recommend regular STD checkups at least every six months if you're sexually active with more than one monogamous partner. Gonorrhea and other bacterial STDs are curable with proper diagnosis and treatment.

Find out more about STDs at Take Control Philly.

Guillain-Barrẻ syndrome is a rare disorder in which the body's immune system attacks the nerves. Illness is characterized by muscle weakness and numbness in the extremities that may progress to paralysis. The exact cause of Guillain-Barrẻ syndrome is unknown.

Symptoms of Guillain-Barrẻ syndrome may begin as an unnoticeable prickling sensation in the fingers and/or toes. The first noticeable symptoms may include a weakness or tingling sensation in the legs that spreads to the upper body. Symptoms can progress to total paralysis, including loss of breathing muscles, in some individuals. These instances are considered a medical emergency and individuals are placed on a medical respirator.

The exact cause of illness is unknown, but symptoms usually begin a few days or weeks after a person has had a respiratory or gastointestinal illness. Recent surgery or vaccinations may also trigger the syndrome.

Symptoms can progress over days or weeks. Most people experience their most severe symptoms 3 weeks after illness onset. Recovery may take a few weeks or a few years.  Most individuals with Guillain-Barrẻ syndrome will recover, however some may continue to have a degree of weakness. 

Guillain-Barrẻ syndrome can be difficult for doctors to diagnose because its symptoms may be similar to other neurological illnesses. A doctor may diagnose the syndrome based on signs of illness and perform a spinal tap or nerve test to confirm the diagnosis.

The exact cause of Guillain-Barrẻ syndrome is unknown, but most people have a preceding respiratory or gastrointestinal illness. Infection with Campylobacter jejuni, which causes diarrhea, is the most common illness linked to Guillain-Barrẻ syndrome. In some rare cases, the disorder has developed following surgery or a vaccination. Some cases appear to occur without any triggers.

In general, adults are more likely to develop the disorder than children. However, it is unclear why some people develop Guillain-Barrẻ syndrome and others do not. The disorder is very rare, affecting only 1 or 2 people in 100,000.

Contact your doctor if you are experiencing any of the mild signs or symptoms that might be Guillain-Barrẻ syndrome, such as prickling sensation in your toes or fingers. Seek immediate medical care if you experience difficulty breathing, choking on saliva, or tingling or weakness that affects your feet and hands and is spreading.

There is no cure for Guillain-Barrẻ syndrome, but there are treatments that can reduce the severity of symptoms and speed recovery. Two therapies currently used are plasmapheresis (blood cleaning) and intravenous immunoglobulin (antibodies from healthy donors are injected to reduce the severity of Guillain-Barrẻ attacks). Individuals recovering from the illness may also need physical and occupational therapy to regain function.

Please use the following resources, or contact your doctor.

• National Institute of Health

Hantavirus is an infectious disease that is often characterized by flu-like symptoms. These symptoms can rapidly progress into life threatening conditions that can affect an individual's respiratory system. Hantavirus can cause two types of syndromes in humans: Hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome (HFRS). Symptoms of hantavirus pulmonary syndrome occur 3-7 days after exposure to an infected rodent.  HFRS symptoms may take anywhere from several days to several months to appear.

Early symptoms of hantavirus pulmonary syndrome include:

• Fever
• Chills
• Headache
• Myalgia
• Nausea/Vomiting
• Diarrhea
• Dizziness

Latent symptoms of this syndrome include:

• Hypotension (low blood pressure)
• Hypoxia ( decrease in oxygen level in the blood)
• Pulmonary edema (lungs fill with fluid)
• Increased coughing and secretions
• Organ failure
• Respiratory distress
• Slower or faster than normal heart beat

Symptoms of HFRS include:

• Fever
• Headache
• Myalgias
• Respiratory distress
• Abdominal pain
• Nausea
• Vomiting
• Back pain
• Hypotension
• Decreased urinary output
• Severe bleeding

In North America the deer mouse is the primary carrier of hantavirus. People can become infected with hantaviruses by breathing in aerosolized droppings or urine from an infected animal. People can also get this disease through the bite of an infected animal or by eating food that has been contaminated with urine or feces.

Individuals who are most likely to get hantavirus are:

• Living in a rural area of the western United States
• Hunters
• Construction workers
• People who live, work, and play where rodents live

If you suspect that you have hantavirus, you should seek immediate care from your healthcare provider, so that your doctor may further evaluate you and provide prompt treatment. Your doctor will take a sample of your blood to see if you have been infected with hantavirus. If you are experiencing problems with breathing contact emergency help or have someone take you to the emergency room. 

Individuals can prevent hantavirus by avoiding or minimizing contact with rodents.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Hantavirus Disease Page
• Mayo Clinic Hantavirus Page

The swimming season is officially here.  Swimming is a great way to stay healthy, have fun, and cool off during the summer.  The Philadelphia Department of Public Health wants to ensure that everyone has a healthy summer and stays healthy while swimming. 

There are many bacterium, parasites, and viruses (germs) that can cause recreational water illnesses.  The two most common recreational water illnesses are caused by parasites: cryptosporidium (crypto) and giardiasis (giardia).  Diarrhea is a frequent symptom of recreational water illness caused by crypto, giardia as well as other germs such as norovirus, Shigella, and E. Coli. However recreational water illness can also cause other illnesses from swimmer's ear to hot tub rash to chemical burns causing a person to become ill from an improperly maintained pool.

There are many ways to prevent recreational water illnesses.

• Do not swim if you have diarrhea.  Wait until at least 2 weeks after the diarrhea has stopped before swimming again.
• Before entering a pool or hot tub, look at the water to see if it looks clean and clear, observe that there are no strong chemical smells, observe that tiles are not sticky.
• Do not swallow pool water.
• Take regular bathroom breaks while swimming.
• Check and change diapers often, in a diaper changing area.
• Wash your hands well after going to the bathroom or changing diapers.
• Take a shower before getting in the pool.  This will take off oils, sweat, lotion, hair products and feces on your bottom.
• Wash children and babies, especially their bottoms, before they get into the pool.
• If your child has a bowel movement in the pool, notify pool staff immediately.

Contact your healthcare provider and discuss your symptoms.  Seek healthcare if you have diarrhea that is bloody, you have a fever, or symptoms worsen.  Dehydration can easily occur if you have diarrhea, so be sure to drink plenty of fluids.  This is particularly important for children, pregnant women, and immunocompromised people.  DO NOT swim until two weeks after your diarrhea has resolved.

The Philadelphia Department of Public Health Division of Environmental Health, Environmental Engineering Unit inspects and helps monitor water quality in recreational water facilities. They can be contacted at: 215-685-7492.

• CDC Healthy Swimming
• PADOH Public Swimming and Bathing Places Regulations
• PDPH Environmental Engineering Page

Posters


• Healthy Swimming PDPH

Disease Fact Sheets


• Cryptosporidiosis
• Giardiasis
• Norovirus
• E. Coli
• Shigellosis

• Healthy Swimming & RWI Frequently Asked Questions PDF
  HealthySwimming_FAQ_2011.pdf
  Pdf image

  
  

Hepatitis A is a liver disease caused by the hepatitis A virus, which can be spread from person to person. Children are less likely to show symptoms than adults.

Symptoms of hepatitis A include:

• Fever
• Fatigue (tiredness)
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored or pale stools (feces)
• Joint pain
• Jaundice (yellowing of eyes and skin)

Usually, symptoms last for less than two months, but in some cases people can be sick for up to 6 months.

People with hepatitis A are contagious 1-2 weeks before they experience their first symptoms, and can remain contagious for up to a week after their first symptoms appear.

Most people who get hepatitis A feel sick for a few months, but they usually recover completely and do not have lasting liver damage. In some cases, hepatitis A can cause liver failure and death, but this is rare and happens more commonly in people older than 50 and people with other liver diseases.

The hepatitis A virus enters through the mouth, multiplies in the body, and is passed in the stool (feces). The virus is then carried on an infected person's hands. If the hands are not washed properly, the the virus can be spread to objects, food, or drink, which can come in contact with another person's mouth. Contaminated food and drink is one of the main ways that hepatitis A is spread. Sexual activities such as oral-anal contact with an infected person may result in person-to-person transmission.

The people most at risk for hepatitis A are those who:

• Travel to or live in countries where hepatitis A is common
• Have sexual contact with someone who has hepatitis A
• Are men who have sexual contact with other men (MSM)
• Use certain illegal drugs, whether injected or not
• Have clotting-factor disorders, such as hemophilia
• Are household members or caregivers of a person infected with hepatitis A

If you were recently exposed to hepatitis A and have not been vaccinated, you may benefit from a dose of vaccine or immune globulin (IG). Either must be given within two weeks of exposure to be effective. Your doctor can decide what is best for you based on your age and overall health.

If you think you have hepatitis A, you should contact your doctor, and discuss your symptoms. Your doctor may then request a blood test to diagnose you with hepatitis A.

There is no specific treatment for hepatitis A. Doctors usually recommends rest, adequate nutrition, and fluids. Only very few cases will need to be hospitalized. It can take a few months before people begin to feel better.

There is a vaccine that prevents hepatitis A. The vaccine is now routinely recommended for all children over 1 year of age. The vaccine is also recommended for people in the following groups:

• Travelers
• Men who have sexual contact with other men (MSM)
• Users of injection and non-injection illegal drugs
• People with chronic (lifelong) liver disease such as hepatitis B or hepatitis C
• People who are treated with clotting-factor concentrates for blood disorders
• People who work with hepatitis A in a research laboratory

Proper hand-washing with soap and warm water after using the bathroom and before preparing or eating food is also a major way to prevent hepatitis A from spreading.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Division of Viral Hepatitis (DVH): Hepatitis A FAQs for the Public
• CDC Division of Viral Hepatitis (DVH):Hepatitis A Patient Education Resources
• CDC Vaccines & Immunizations:Hepatitis A Vaccination
• CDC Hepatitis A Vaccine Information Statement
• PDPH Immunizations Page
• Hepatitis A Frequently Asked Questions PDF

Hepatitis B is a liver disease caused by the hepatitis B virus (HBV), which can be spread from person to person. Hepatitis B is spread through blood or body fluids of an infected person. Infection with HBV can be acute (short-term) or chronic (life-long).

The age at which a person is infected with HBV plays a major role in whether or not a person develops chronic hepatitis B. 5-10% of persons over 5 years of age that are infected with HBV develop chronic infection. 90% of infants infected with HBV develop chronic infection. 25-50% of children 1-5 years of age infected with HBV develop chronic infection.

Symptoms of hepatitis B include:

• Fever
• Fatigue (tiredness)
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored or pale stools
• Joint pain
• Jaundice (yellowing of eyes and skin)

Symptoms of acute hepatitis B usually last a few weeks, but can last as long as 6 months. Children under 5 are less likely to have symptoms when infected with HBV. Persons with chronic hepatitis B infection may not experience any symptoms at all, or may experience disease symptoms.

Persons with acute hepatitis B are contagious until the infection is resolved. Your doctor can tell you when an acute hepatitis B infection has been resolved. Persons with chronic hepatitis B can transmit the virus throughout their life, as chronic hepatitis B infection is life-long. Even if a person is not showing symptoms, they can still spread the virus as long as they are infected.

Chronic hepatitis B infection can lead to long-term health problems, and can eventually lead to liver damage, liver failure, liver cancer, and death.

HBV can survive outside the body for one week or more and still cause infection. Common disinfectants can kill the virus.

 

Hepatitis B is spread through blood or body fluids (including semen and vaginal fluids) of an infected person. It is not spread through food or water.

Ways in which hepatitis B can be spread include:

• Unprotected sexual activity
• Sharing injection drug equipment
• Tattooing or piercing if equipment is not cleaned properly
• During birth from an infected mother to baby
• Contact with open sores of an infected person
• Occupational exposure such as needle sticks
• Sharing personal items such as: razors, toothbrushes, nail clippers, etc.

The people most at risk for hepatitis B are:

• Sexual contacts of people infected with HBV
• People with multiple sex partners
• People who have a sexually transmitted disease (STD), or have had an STD in the past
• Men who have sex with men (MSM)
• People who share injection drug equipment
• Babies born to mothers infected with HBV
• People who work in settings where they may be exposed to blood or bodily fluids
• Hemodialysis patients
• People who travel to countries with intermediate to high rates of hepatitis B

If you think you may have been exposed to the hepatitis B virus, call your doctor or health professional. If you have been exposed to the hepatitis B virus, vaccine and/or a shot called “HBIG” (hepatitis B immunoglobulin) can be given to prevent hepatitis B infection. Hepatitis B vaccine and HBIG are most effective in preventing hepatitis B infection if they are given within 24 hours of exposure.

If you think you have hepatitis B or have been exposed to hepatitis B, you should contact your doctor, and discuss your symptoms. Your doctor may then request a group of blood tests to determine whether or not you have hepatitis B.

There is no specific treatment for acute hepatitis B. Doctors usually recommend rest, adequate nutrition, and fluids.

For chronic hepatitis B, there is treatment available. Not everyone who has chronic hepatitis B is recommended for treatment. Your doctor will take a number of factors into consideration when deciding whether or not you should be on treatment.

There are several ways to prevent the transmission of HBV. Vaccination with hepatitis B vaccine is the most effective way to prevent HBV transmission. The hepatitis B vaccine is highly effective and safe. It is recommended for all infants, children, and adolescents through 18 years of age. Infants should be immunized as part of the routine childhood immunization schedule. Hepatitis B vaccine can be given together with other vaccines 

Other people who should be vaccinated for hepatitis B include:

• Persons whose sex partners have hepatitis B
• Persons with multiple sex partners
• Persons who currently have a sexually transmitted disease (STD), or have had an STD in the past
• Men who have sex with men (MSM)
• Persons who have close household contact with someone infected with the hepatitis B virus
• Persons who share injection drug equipment
• Healthcare and public safety workers at risk for exposure to blood or body fluids on the job
• Hemodialysis patients
• Persons that are incarcerated
• Persons working in correctional facilities
• Persons traveling to countries with moderate or high rates of HBV
• Residents and staff of facilities for developmentally disabled persons
• Persons with chronic liver disease, including hepatitis C
• Persons living with HIV infection

3-4 doses of hepatitis B vaccine are given, and the vaccine schedule may vary. Your doctor will be able to let you know when you will need to come in for vaccination.

 

Other ways to prevent transmission of hepatitis B include:

• Using condoms and having safe sex
• Not sharing injection drug equipment
• Not sharing personal items including razors, toothbrushes, blood glucose monitoring equipment, etc.
• Checking to see if tattoo/piercing equipment is clean
• Vaccinating exposed infants born to mothers who are positive for HBV

 

 

Please use the following resources, and contact your doctor or primary care physician.

• CDC Division of Viral Hepatitis (DVH): Hepatitis B FAQs for the Public
• CDC Division of Viral Hepatitis (DVH): Hepatitis B Patient Education Resources
• CDC Vaccines & Immunizations: Hepatitis B Vaccination
• CDC Hepatitis B Vaccine Information Statement
• PDPH Immunization Program
• Hepatitis B Frequently Asked Questions PDF

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which can be spread from person to person. Hepatitis C is spread through contact with blood of an infected person. Infection with HCV can be acute (short-term) or chronic (life-long).

Of people that are infected with HCV, 20% will have an acute infection, and clear the infection on their own. 80% of people infected with HCV will become chronically infected. If a person has an acute infection, and clears the infection, they can still become re-infected with HCV.

Symptoms of hepatitis C include:

• Fever
• Fatigue (tiredness)
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored or pale stools
• Joint pain
• Jaundice (yellowing of eyes and skin)

Of persons infected with HCV, 20-30% will experience symptoms. Those persons experiencing symptoms will usually develop symptoms anywhere from 2–24 weeks after being infected.
Persons with chronic hepatitis C may not experience any symptoms at all. Chronic infection with hepatitis C can lead to chronic liver disease, which can range from mild to severe, and can include cirrhosis (scarring of the liver) and liver cancer. Chronic liver disease as a result of chronic hepatitis C infection usually progresses slowly without any signs or symptoms for several decades.
Persons with chronic hepatitis C can transmit the virus throughout their life, as chronic hepatitis C infection is life-long. Even if a person is not showing symptoms, they can still spread the virus as long as they are infected.

Hepatitis C is transmitted through contact with blood of an infected person. Hepatitis C is not spread through food or water.

Ways in which hepatitis C can be spread include:

• Sharing needles, syringes, and other injection drug equipment
• Blood transfusions prior to 1992
• Small risk of being transmitted from mother to child at birth, but this risk increases if the mother has HIV too
• Tattooing or piercing if equipment is not clean
• Occupational exposure (needle sticks, etc.)
• Sex, specifically sexual behaviors that involve tearing and/or contact with blood
• Sex with multiple partners
• Sex when an individual has an active STD
• Sharing personal items including razors, toothbrushes, nail clippers, etc.

 

The people most at risk for hepatitis C are:

• Current and past injection drug users, including those who injected only one time or many years ago
• Recipients of donated blood, blood products, and organs prior to 1992
• People who received a blood product for clotting problems, made before 1987
• Hemodialysis patients
• People who received body piercing or tattoos done with non-sterile instruments
• People who work in settings where they may be exposed to blood
• HIV-infected persons
• Babies born to mothers infected with HCV

 

If you think you have hepatitis C or have been exposed to hepatitis C, you should contact your doctor, and discuss your symptoms and exposure. Your doctor may then request a blood test to determine whether or not you have hepatitis C.

If you have chronic hepatitis C, there are treatment options available. Not everyone who has chronic hepatitis C is recommended for treatment. Your doctor will take a number of factors into consideration when deciding whether or not you should be on treatment.

Currently, there is not a vaccine for hepatitis C. There are vaccines for hepatitis A and B. If you are at risk for hepatitis C, or have hepatitis C, getting vaccinated for hepatitis A and B is recommended in order to protect you from being infected with more than one type of hepatitis. Being infected with more than one type of hepatitis can be even more harmful to your liver.

Knowing your hepatitis C status is important. If you have hepatitis C, and you know your status, you can speak with your doctor about treatment options and lifestyle changes that can prevent further complications of hepatitis C infection. Knowing your status can also prevent you from transmitting hepatitis C to others.

Ways to prevent hepatitis C infection include:

• Not sharing injection drug equipment
• Using condoms and practicing safe sex
• Not sharing personal items, including razors, toothbrushes, blood glucose monitoring equipment, etc.
• Checking to see if tattoo/piercing equipment is clean

Please use the following resources, and contact your doctor or primary care physician.

• CDC Division of Viral Hepatitis (DVH): Hepatitis C FAQs for the Public
• CDC Division of Viral Hepatitis (DVH): Hepatitis C Patient Education Resources
• Hepatitis C Frequently Asked Questions PDF

Hepatitis D is a liver disease caused by the hepatitis D virus (HDV), which can be spread from person to person. Hepatitis D is also known as “delta hepatitis.”  The hepatitis D virus is spread in the same way as the hepatitis B virus, which is spread through blood or body fluids of an infected person. Infection with HDV can be acute (short-term) or chronic (life-long).

HDV is uncommon in the United States, and can only occur among people who are infected with the hepatitis B virus (HBV). The HDV virus cannot replicate on its own, and it requires the hepatitis B virus as a “helper virus” to replicate. A person with hepatitis B can be infected with hepatitis D only under certain circumstances: when their hepatitis B is in the acute phase (known as coinfection with hepatitis D) or when their hepatitis B is in the chronic phase (known as superinfection with hepatitis D).

Symptoms of hepatitis D include:

• Fever
• Fatigue (tiredness)
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored or pale stools
• Joint pain
• Jaundice (yellowing of eyes and skin)

Symptoms of HDV superinfection can appear anywhere from 2 to 8 weeks after infection. If HDV and HBV coinfection occurs, symptoms appear in the same time period as hepatitis B: 45-60 days, with an average of 90 days after infection.

Persons with HDV are contagious until the infection is resolved. Persons with chronic HDV can transmit the virus throughout their life, as chronic HDV infection is life-long. Even if a person is not showing symptoms, they can still spread the virus as long as they are infected.

Hepatitis D is spread through blood or body fluids (including semen and vaginal fluids) of an infected person. It is not spread through food or water.

Ways in which hepatitis D can be spread include:

• Sharing injection drug equipment
• Exposure to blood or blood products
• Unprotected sexual activity
• Tattooing or piercing if equipment is not cleaned properly
• Contact with open sores of an infected person
• Occupational exposure such as needle sticks
• Sharing personal items such as: razors, toothbrushes, nail clippers, etc.

Unlike hepatitis B, transmission from an infected mother to baby during birth is uncommon.

Although hepatitis D is uncommon in the United States, some groups are at higher risk for hepatitis D. The people most at risk for hepatitis D are:

• People who share injection drug equipment
• People with hemophelia
• People who have immigrated from countries with intermediate to high rates of hepatitis D

Other people at risk include:

• Sexual contacts of people infected with HDV
• People who work in settings where they may be exposed to blood or bodily fluids
• Hemodialysis patients
• People who travel to countries with intermediate to high rates of hepatitis D

If you think you have hepatitis D or have been exposed to hepatitis D, you should contact your doctor. Your doctor may then request a group of blood tests to determine whether or not you have hepatitis D.

There is no specific treatment for hepatitis D. Doctors usually recommend rest, adequate nutrition, and fluids.

There are several ways to prevent the transmission of HDV. Since HDV cannot be transmitted without the hepatitis B virus (HBV) present, vaccination with hepatitis B vaccine is the most effective way to prevent HDV transmission. The hepatitis B vaccine is highly effective and safe. Protection against HDV through vaccination with the hepatitis B vaccine is only effective in persons who are not infected with hepatitis B.

If a person is already infected with hepatitis B, the person should take extra care to not be exposed to HDV.

Other ways to prevent transmission of hepatitis D include:

• Not sharing injection drug equipment
• Using condoms correctly and having safer sex
• Checking to see if tattoo/piercing equipment is clean
• Not sharing personal items including razors, toothbrushes, blood glucose monitoring equipment, etc.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Division of Viral Hepatitis (DVH): Hepatitis D Information for the Public
• CDC Division of Viral Hepatitis (DVH): Hepatitis D Information for Health Professionals
• CDC Division of Viral Hepatitis (DVH): Hepatitis B FAQs for the Public
• CDC Division of Viral Hepatitis (DVH): Hepatitis B Patient Education Resources
• CDC Vaccines & Immunizations: Hepatitis B Vaccination
• CDC Hepatitis B Vaccine Information Statement
• PDPH Immunizations Page
• PDPH Hepatitis B Fact Sheet

Hepatitis E is a liver disease caused by the hepatitis E virus (HEV) that can be transmitted from person to person. HEV is commonly found in wild and domestic animals, including pigs and non-human primates, and can be a source of infections for humans as well. Transmission of HEV from person to person is less common than with hepatitis A.

HEV is uncommon in the United States. HEV is generally only seen in an acute (short-term) form, but in some rare cases it can become chronic (life-long). To date, chronic HEV infections have only been reported in organ transplantation patients.

Symptoms of hepatitis E include:

• Fever
• Fatigue (tiredness)
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored or pale stools (feces)
• Joint pain
• Jaundice (yellowing of eyes and skin)

In developing countries with poor environmental sanitation, HEV is more common among adolescents and adults (15-44 years old) than among children. Children that are infected with HEV usually have mild symptoms or no symptoms at all. Anywhere from 7-50% of HEV infections have been reported to have symptoms. When symptoms are present, they usually develop within 15-60 days, with an average of 40 days after exposure.

It is unknown how long a person infected with HEV can be contagious for, but the HEV virus has been found in stool up to 14 days after a person first shows symptoms of jaundice.

Most people infected with HEV recover completely, and less than 4% of cases are deadly. For pregnant women, HEV infection is more serious and the disease is deadly in 10–30% of infected pregnant women, particularly those in their third trimester. Pregnant women are more likely to have severe illness, including rapidly progressing severe hepatitis, and death.

The hepatitis E virus (HEV) is spread similarly to the hepatitis A virus. The hepatitis E virus (HEV) enters through the mouth, multiplies in the body, and is passed in the stool (feces). Since HEV can infect people and animals, HEV is most commonly spread through water that is contaminated with stool from an infected person or animal.

The people most at risk for hepatitis E are those who travel to or live in countries where hepatitis E is common.

If you think you have hepatitis E, you should contact your doctor, and discuss your symptoms. Your doctor may then request tests to diagnose you with hepatitis E.

There is no specific treatment for hepatitis E, and the infection usually resolves on its own without treatment. Doctors usually recommend rest, adequate nutrition, and fluids. Some severe cases will need to be hospitalized, and hospitalization should be considered for pregnant women with HEV.

Currently, there is not a vaccine for hepatitis E.

Hepatitis E can be prevented through good sanitation and drinking only clean water. Persons traveling to developing countries where hepatitis E is common can reduce their risk for hepatitis E by not drinking unpurified water. Boiling and chlorination of water will inactivate the hepatitis E virus.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Division of Viral Hepatitis (DVH): Hepatitis E Information for the Public
• CDC Division of Viral Hepatitis (DVH): Hepatitis E Information for Health Professionals

Invasive Haemophilus influenzae disease is caused by the gram negative bacteria Haemophilus influenzae. Invasive disease is described as bacteria isolated from a normally sterile site such as blood, cerebrospinal fluid, pleural fluid, or joint fluid.

Infection with Haemophilus influenzae most often causes bacteremia (infection of the blood), meningitis, pneumonia, epiglottitis (an infection and swelling of tissue in the throat), arthritis, cellulitis, bone infections, and other infections. Haemophilus influenzae type b (Hib) is a vaccine-preventable disease. Other types of Haemophilus influenzae can cause similar illness and are not vaccine-preventable.

Invasive Haemophilus influenzae disease can be spread person to person by breathing in respiratory droplets which contain the bacteria. The time from exposure to the germ to development of the illness is not well known.

Haemophilus influenzae can only be found in humans. Unimmunized or underimmunized children younger than 5 years of age are at the greatest risk for invasive Hib disease.

Additional risk factors for invasive Haemophilus influenzae disease include persons who:

• Live in crowded settings
• Attend child care settings
• Live with school-aged children
• Have chronic diseases such as sickle cell anemia, and antibody deficiency syndromes

Persons with Invasive Haemophilus influenzae disease are diagnosed by a healthcare provider typically within a hospital. The disease can be treated with antibiotics.

A vaccine for invasive Haemophilus influenzae type B (Hib) disease is available and is recommended for all children. Children should begin their primary series of Hib vaccine at 2 months of age and receive a booster dose at age 12-15 months.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Hib Vaccination Page
• Hib Vaccine Information Sheet
• Information in Spanish
• Immunization Action Coalition
• American Academy of Pediatrics
• Haemophilus Influenzae Frequently Asked Questions PDF

Histoplasmosis is a fungal disease caused by Histoplasma capsulatum. Only about 5% of persons infected with the fungus will experience symptoms. Symptoms of histoplasmosis vary depending on the primary site and duration of infection and typically appear between 3 to 17 days after exposure to the fungus. The acute form of the illness primarily affects the lungs and is characterized by respiratory symptoms, a dry cough, fever, and chest pains that last between 2 days to 2 weeks. Chronic histoplasmosis infection last months or years and can cause lung disease resembling tuberculosis along with prolonged fever, enlarged spleen, and more severe complications such as meningitis, pneumonia, or death if left untreated.

Histoplasmosis can be diagnosed by a healthcare provide using a combination of symptom and exposure history along with laboratory tests to identify H. capsulatum antibodies in blood or urine.

Persons can become infected with H. capsulatum after breathing in spores from soil or material contaminated with bat or bird droppings. Histoplasmosis is not spread person to person.

Anyone can develop histoplasmosis although it is most common in the eastern and central United States as well as Mexico, Central and South America, parts of eastern and southern Europe, parts of Africa, eastern Asia, and Australia. Infants, young children, older persons, immunocompromised persons, and those with chronic lung disease are at increased risk of severe disease.

If you suspect you have histoplasmosis, it is important to contact your healthcare provider. Your healthcare provider can evaluate your symptoms and may order laboratory tests to aid in the diagnosis. Most histoplasmosis infections will get better on their own. In more severe cases, your healthcare provider may prescribe antifungal medications.

If you are traveling to an area where histoplasmosis is common (see areas listed above), consider wearing personal protective equipment if you visit caves or areas with high concentrations of bird or bat droppings or are performing dust-generating activities such as construction.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• CDC NIOSH: Protecting Workers at Risk for Histoplasmosis

AIDS stands for Acquired Immune Deficiency Syndrome and is a group of health problems caused by a virus called HIV, the Human Immunodeficiency Virus. HIV is transmitted from person to person via exchange of bodily fluids – semen, blood, and vaginal fluids – during anal, vaginal, and possibly oral sex, or when sharing needles during intravenous drug use.

People who test positive for HIV do not necessarily have AIDS. Many people are HIV+ but don't show symptoms of illness for years, if at all. People who do get AIDS can get very ill and die from infectious diseases and cancers that usually don't cause problems for other people. There is currently no cure for AIDS.

People with HIV show signs of AIDS when their immune system is seriously damaged. People with AIDS can suffer from what are called opportunistic infections, such as Kaposi's sarcoma (a skin cancer), PCP (a lung infection), CMV (a virus that infects the eyes), and candida (a fungal infection). AIDS-related diseases also include severe weight loss, brain tumors, and a myriad of other health problems.

AIDS shows up differently in every infected person. Some people die soon after getting infected, while others live fairly normal lives for many years after they are diagnosed with AIDS.

There are now treatments available that can slow down the replication of HIV in your body, along with any immune system damage. The treatment is called anti-retroviral therapy. However, there is currently no cure for AIDS.

You might not know if you are infected with HIV. Some people get flu-like symptoms such as fever, headache, sore muscles and joints, stomach ache, swollen lymph glands, or a skin rash four to six weeks after exposure to the virus. Most people have no symptoms at all.

If you get infected with HIV, your body tries to fight the infection. It makes antibodies, special molecules that are supposed to fight HIV. The most common HIV test is a blood test which looks for these antibodies. If you have them in your blood, it means that you are HIV positive.

If you become infected with HIV, it usually takes between three weeks and two to three months for your immune system to produce antibodies to HIV. If you think you were exposed to HIV, you should get tested. During your visit, speak to your doctor about the possibility of taking post-exposure prophylaxis or PEP.

Newer tests can detect HIV antibodies in saliva, a scraping from inside the cheek, or urine. A rapid HIV test was approved by the FDA in November 2002. Rapid test results are available within a half an hour after a blood sample is taken. The home test kits on the market are designed to help you collect your own blood sample. The sample is then sent to a lab where it is tested for HIV.

Clinics and medical providers will offer either confidential or anonymous HIV testing services. Confidential antibody testing means that you and the health care provider know your results, which may be recorded in your medical file. The health care provider and any other staff in the clinic or office are bound by confidentiality not to disclose the results of your test to anyone without your permission.

Anonymous testing means that your name is never associated with your test results. Current federal law requires all positive HIV tests to be reported. Reports can be made without using your name, but instead via a unique code. Currently, a person who gets either type of HIV test is asked to participate in pre- and post-test counseling.

As mentioned earlier, there is no cure for AIDS. There are anti-retroviral drugs now available that can slow down the virus, and slow down the damage to your immune system. These drugs have also helped reduce the overall rates of opportunistic infections in people with AIDS. The drug regime is severe however – many expensive pills have to be taken regularly on a daily basis – and there can be side effects when the pills are taken for a long period of time. Many people who are able to, though, choose to go on anti-retroviral therapy once they are diagnosed HIV+ to stem any potential illness and keep their quality of life high as long as possible. For more detailed and current information about treatment, visit www.hivinsite.org.

The best thing you can do is to stay healthy — keep your stress levels low, eat well, exercise regularly, get lots of rest, and if you're sexually active, have protected sex with your partners. You also need to work closely with a medical provider to monitor your health and determine the best course of continued treatment over time. There are resources available to help HIV+ people in the U.S. get treatment and regular medical services, sometimes at low-cost or reduced fees.

In order to avoid transmission of the virus to your sex partners, as well as to protect yourself from getting other bacterial and viral STDs, we advise discussing your HIV status with a prospective partner before having sex. Communication is one of the keys to keeping our community sexually healthy.

The only way to be 100% sure you won't get HIV/AIDS is to abstain from sex and intravenous drug use. If you're sexually active, using condoms correctly each and every time you have anal or vaginal sex provides the best protection against HIV transmission. While there is not enough scientific evidence available yet to be certain, there are many individuals who also state that they have gotten HIV from participating in oral sex (as givers to infected men). It is advisable to consider using condoms for oral sex as well, especially because other STDs like syphilis and gonorrhea, which can increase your risk of getting HIV, can be transmitted via oral sex.

Find out more about STDs atTake Control Philly.

Find an HIV test site near you.

Influenza or the “flu” is a highly contagious viral infection of the respiratory system. Influenza can cause mild to severe illness, with death resulting in some cases.

Common symptoms of influenza include the following:

• Fever                                     
• Sore Throat
• Body Aches
• Tiredness
• Coughing
• Diarrhea
• Nausea/Vomiting

How long do symptoms last?
Symptoms of the “flu” typically last from 3-7 days.

How long can a person be contagious?
A person is able to spread the virus 1 day before symptoms appear or 5-7 days after becoming ill.

How long does the infection last?
The infection may last from several days to two weeks. Possible complications include: pneumonia, bronchitis, sinus infections, and ear infections.

An infected person can spread influenza to another individual through coughing or sneezing. Touching common surface areas, such as a doorknob, may also spread influenza.

Anyone is at risk for becoming infected with influenza. However, the following groups are at a greater risk for severe problems:

• Older adults
• Pregnant women
• Those with chronic health conditions (asthma, diabetes, or heart disease)

Contact your doctor if you have any of the previously mentioned symptoms because further examination may be needed to determine if you are experiencing complications related to the influenza virus. Influenza is diagnosed by collecting a nasal or throat sample, which is sent to a laboratory for further testing. Antiviral medications prescribed by your doctor can be used to treat influenza, if given at least two days after symptoms begin. The course of treatment is usually 5 days. Finally, it is important to drink fluids, take medications that relieve symptoms, and get plenty of rest.

The best way to prevent influenza is by getting the seasonal influenza shot each year. There are two types of vaccines that are given and they are:

• The “flu” shot– which is a vaccine that is given with a needle and given to those who are 6 months and older. People with chronic health conditions can also receive this vaccine.
• The nasal spray flu vaccine– This form of the vaccine can only be used in healthy individuals between the ages of 2-49 who are not pregnant.

 The spread of the influenza virus to others and household contacts can be prevented by thoroughly washing your hands with soap and water or using alcohol based gels.

Please use the following resources, or contact your doctor of primary care physician.

• PDPH Fighting the Flu
• CDC Flu Facts
• Influenza Frequently Asked Questions PDF

Legionnaire's disease is caused by bacteria known as Legionella. Persons infected with Legionella bacteria may become ill with Legionnaire's disease or Pontiac fever.  Both of these conditions present with similar signs and symptoms however Legionnaires' disease commonly results in pneumonia and hospitalization while Pontiac fever is a milder illness that is defined by fever and muscle or headaches.

Symptoms of Legionnaire's disease include:

• Pneumonia
• Fever
• Fatigue
• Muscle aches
• Headache
• Cough
• Chills
• Abdominal pain
• Diarrhea

More severe complications from Legionnaire's disease include respiratory failure and death.

Persons who develop Legionnaire's disease will usually have symptoms 2-10 days after being exposed to Legionella. The disease can be diagnosed through a combination of clinical symptoms and laboratory tests.

Legionella bacteria are waterborne germs that have been found in showers, air conditioning cooling towers, humidifiers, whirlpool spas, respiratory therapy devices, and decorative fountains among other sources. Persons can be exposed to Legionella by breathing in water droplets containing the bacteria. Legionnaire's disease is not spread person to person. For most cases, the source of infection is usually not identified.

Persons above the age of 50 are more likely to get the disease. Other risk factors include cigarette smoking, chronic lung disease,  diabetes, and any immunocompromising condition such as cancer,  those receiving corticosteroids, or those who have had a recent organ  transplant.

A healthcare provider can help diagnose Legionnaire's disease through physical examinations, chest x-rays or CT scans, and laboratory tests. Legionnaire's disease can be treated with intravenous and oral antibiotics.

It is important to educate yourself and your family about Legionnaire's disease. In addition, regular maintenance and improved designs of cooling towers and plumbing systems may help limit the growth and spread of Legionella.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Legionnaire's Disease Page
• Legionnaires Frequently Asked Questions PDF

Leprosy (Hansen's disease) is an infectious disease caused by bacteria, Mycobacterium leprae. It is characterized by disfiguring skin lesions, nerve damage, and progressive debilitation. The two main forms of leprosy are tuberculoid and lepromatous.

Tuberculoid is a milder form of the disease. Symptoms include one or a few well-defined lesions that may appear reddened or hypopigmented and have decreased or no sensation.

Lepromatous is the most severe form of the disease. Symptoms are ill-defined lesions that are reddened or hypopigmented and progress to large disfiguring lumps and bumps with decreased sensitivity. Other symptoms may include nasal congestion and nose bleeding.

Symptoms of the disease typically appear within 3-5 years after being exposed to leprosy.

Individuals with leprosy are contagious until they begin taking appropriate antibiotics. Complications of leprosy include nerve damage in the arms and legs, which causes sensory loss in the skin and muscle weakness.

Leprosy is diagnosed by a doctor from a test of skin scrapings or a lesion biopsy. 

It is unclear how leprosy is spread, however it is thought to be spread from one person to another through respiratory droplets.

Individuals who are in close contact with patients with active or untreated leprosy are most likely to get the illness. Also individuals living in countries where the disease is endemic are more likely to get the disease. Leprosy is not endemic in the United States. Most cases of leprosy occur in Brazil, Madagascar, Tanzania and Nepal.

If you suspect that you have leprosy, you should seek immediate care from your healthcare provider, especially if you have had contact with someone who has the disease. Your doctor may further evaluate you and provide prompt treatment.

Individuals can prevent the disease by avoiding close physical contact with people who have untreated leprosy.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Hansen's Disease Page
• National Hansen's Disease Program

Leptospirosis is a bacterial disease that causes illness in humans and animals. It is caused by Leptospira  bacteria. Infection with the bacterium may cause no illness, a mild illness, or in rare cases, severe disease.  Leptospirosis infections are found worldwide but most commonly occur in temperate or tropical climates.

Symptoms of leptospirosis include:

• Fever
• Chills
• Severe headache
• Muscle aches
• Nausea
• Vomiting

In some instances yellow eyes and skin (jaundice), red eyes, diarrhea, and a rash may also occur. Most persons will recover from leptospirosis without complications. In the small proportion of persons with severe illness, renal dysfunction, meningitis, and respiratory distress may also occur. 

Persons with leptospirosis may be sick for a few days or up to several weeks. Symptoms typically appear within 10 days with a range of 4 to 19 days after exposure to the bacteria. Those with self-limiting illness who may experience some of the initial symptoms will usually recover soon after.  Persons who recover for a few days and then become ill again may experience a more severe form of this disease known as Weil's disease.

Leptospirosis is spread through contact with an infected animal's urine. The bacteria are found in both wild and domesticated animals.  People can get leptospirosis by exposing their skin, eyes, or mouth to the Leptospira bacteria, through swimming or wading in freshwater or by contact with wet soil or food contaminated with infected animal urine. Direct contact with an infected animal's tissues or body fluids may also cause infection. The spread of leptospirosis from person to person is rare.  

While anyone is at risk for getting leptospirosis, those more likely to get leptospirosis include persons who work in jobs outdoors or people such as farmers, veterinarians, and sewer workers. Others at risk include those who engage in recreational activities that may put them into contact with contaminated water and people who own dogs or domesticated livestock.

The signs and symptoms of leptospirosis are common for many infectious diseases. It is important that you contact your healthcare provider to discuss your symptoms and exposures. Your healthcare provider may evaluate your symptoms and order lab tests to determine a diagnosis.
Leptospirosis can be diagnosed by your healthcare provider through a combination of symptoms and laboratory tests on blood, urine, or cerebrospinal fluid.  Leptospirosis can be effectively treated with antibiotics.

Leptospirosis can be prevented by avoiding swimming in lakes, ponds, and streams that may be contaminated by animal urine. You should also eliminate contact with potentially infected animals. Use of protective clothing and footwear may also reduce the risk for exposure to the bacteria.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing

Listeriosis is caused by the bacteria Listeria monocytogenes and can present as a mild febrile illness or more serious disease. Listeria bacteria is commonly found in contaminated foods.

Symptoms of this illness include:

• Fever
• Muscle Aches
• Nausea
• Diarrhea
• Headache
• Stiff neck
• Confusion

 

Symptoms of listeriosis can begin 3-70 days after exposure to the bacteria but typically occur after 3 weeks, but on average they continue for up to 3 weeks.

How is the disease diagnosed?
Listeriosis is diagnosed through clinical symptoms and laboratory testing. A blood or spinal fluid sample is collected and is sent to a laboratory for further identification of Listeria monocytogenes.

People get listeriosis by eating contaminated foods.  Listeriosis is not spread from person to person except during pregnancy. A pregnant woman may pass the infection to her unborn child.

Individuals most likely to get listeriosis are:

• Pregnant Women
• Newborns
• Individuals with weakened immune systems
• People with chronic medical conditions (cancer, diabetes, or kidney disease)
• The elderly

Contact your physician immediately if you have symptoms of listeriosis, so that further testing and examination can be done to confirm your diagnosis.  The medication that is used to treat listeriosis is a combination of antibiotics.

Listed below are several ways to prevent listeriosis:

• Eat ready to eat items as soon as possible
• Do not eat/drink unpasteurized foods or drink unpasteurized milk or juice
• Thoroughly cook all meat products, such as beef, pork, chicken, or hot dogs.
• Wash all raw vegetables before eating.
• Separate uncooked meats from vegetables and cooked meats
• Wash hands, knives, and cutting boards after handling uncooked foods

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Information Page
• FDA Consumer Page & Food Safety Site
• FDA Listeria Page
• United States Department of Agriculture Listeriosis Fact Sheet
• Listoseriosis Frequently Asked Questions PDF

Lyme disease is an infection caused by the bacteria known as Borrelia burgdorferi. The bacteria can be spread to humans from an infected blacklegged tick(also known as a deer tick).  Blacklegged ticks are brown and often no larger than the head of a pin which can make them difficult to spot. Borrelia burgdorferi can infect many different parts of the body, which can result in different symptoms. Not all people with Lyme disease will have the same symptoms.

Symptoms of Lyme disease include:

• Circular rash (erythema migrans)
• Fatigue (tiredness)
• Chills
• Fever
• Headache
• Muscle and joint pain
• Swollen lymph nodes

The red circular rash (erythema migrans) can appear anywhere from 1 to 30 days after the bite of an infected tick and will occur in approximately 70-80% of people. As the rash continues to grow the center may clear up, giving it a bulls-eye like appearance.
If Lyme disease is left untreated, the infection may cause other symptoms within a few days to weeks including neck stiffness, heart palpitations, Bell's Palsy (loss of muscle tone on one or both sides of the face), or arthritis.
Many of the symptoms caused by Lyme disease can be mistaken for other illnesses; therefore diagnosis of Lyme disease includes the patient having:

• A history of possible contact with ticks in areas where Lyme disease is known to occur
• Signs and symptoms of the illness
• Positive blood tests detecting that the patient has antibodies to the Lyme disease bacterium (Borrelia burgdorferi).

People get Lyme disease after being bitten by an infected blacklegged tick. Once a tick feeds on an infected animal (usually mice or squirrels), the tick will carry the bacterium for life and it will be able to pass it onto humans through a bite.

Ticks which carry the Lyme disease bacterium are present in the northeastern United States including Philadelphia. Anyone that goes outside in areas where deer ticks are known to live is at risk.  Areas that are bushy with tall grass and wooded are more likely to have high tick populations.

Contact your physician so that an evaluation can be made of your symptoms and tick exposure history.  Your physician may also do a blood test if Lyme disease is suspected. Lyme disease is treated with a course of oral antibiotics, which often clears the infection and will prevent complications.

Avoiding tick bites will prevent Lyme disease. Ticks prefer wooded and bushy areas with high grass. Ticks are more active during May, June, and July so if you are going to go into an area where ticks are more likely to be present you should take the following measures to protect yourself:

•  When you are outdoors use insect repellent with 20% - 30% DEET on exposed skin and clothing to prevent tick bites
• Wear long pants, long sleeves, and long socks to keep ticks off your skin
• Wear light-colored clothing to help you see ticks more easily
• Tuck your pant legs into socks or shoes and tuck your shirt into your pants to help keep ticks on the outside of your clothing.
• Check yourself for ticks after being in tick-infested areas and monitor your health closely after being bitten by a tick

In order to control ticks around your home you may create a tick-safe zone or apply certain pesticides. For more information on these prevention techniques please see the Centers for Disease Control page listed in the next section.

Please use the following resources, or contact your doctor.

• CDC Learn About Lyme Disease
• MedlinePlus page
• Lyme Disease Frequently Asked Questions PDF

Marlaria can be a serious disease caused by a parasite that is carried by certain species of mosquitoes.  The parasite is called Plasmodium and is transmitted from the mosquito to a human host when bitten. There are four different types of malaria caused by four different types of Plasmodium parasites. Infection with malaria parasites may result in a wide variety of symptoms, ranging from none at all or very mild symptoms to severe disease and even death.

Common Symptoms include:

• Fever
• Chills
• Headache
• Muscle Aches
• Tiredness
• Nausea
• Vomiting
• Diarrhea

Depending on the type of malaria a patient has, symptoms could begin 10 days to 4 weeks after being bitten by an infected mosquito.  However, a person may feel ill as early as 7 days after being bitten by an infected mosquito, or as late as 1 year later.

Malaria is diagnosed by a blood test.

People get malaria by being bitten by an infected mosquito. Only the Anopheles species of mosquitoes can spread malaria.  Although not a major source of transmission malaria can also be spread through blood transfusions, organ transplants, or through sharing needles with someone who has malaria. Malaria can also be spread from a mother to her unborn child before or during birth.

Since mosquitoes infect humans with their bite anyone is potentially at risk for infection.  However most cases of malaria occur in people who live in countries where malaria is common. There have been several isolated cases of malaria in the U.S., but it is seen more in countries with tropical areas.  People from the United States can become infected when they travel to these countries.

People who have developing or weakened immune systems, such as young children and pregnant women, have a greater chance of becoming very ill. Travelers coming from countries where malaria is not present are also more likely to become very sick.

You should contact your healthcare provider immediately and tell him/her if you have traveled to an area that has malaria, so that a blood test can be done.

Malaria can be treated with drugs prescribed by your healthcare provider. The type of drugs and length of treatment will depend upon the type of malaria, where you were infected, your age, whether or not you are pregnant, and how sick you are at the start of treatment.

If you are traveling to a high risk malaria area there are many drugs that you can take before the trip in order to prevent you from getting sick. You and your healthcare provider can decide on the best drug for you based on where you plan to travel and your medical history. To allow enough time for the drugs to become effective visit your doctor 4-6 weeks before travel. Taking precautions to avoid the bites of mosquitoes is also an effective means of prevention.  These precautions include wearing long sleeve pants and shirts, using an insect repellant that contains DEET or Picaridin, and using mosquito netting.

Please use the following resources, or contact your doctor.

• CDC Disease Listing
• World Health Organization Malaria page
• MedlinePlus Malaria page
• Malaria Frequently Asked Questions PDF

Measles is a respiratory disease that is caused by a virus. Measles is a very contagious disease that can be particularly serious in children and adults.

Symptoms include:

• High fever
• Cough
• Runny nose
• Watery eyes
• Rash which typically begins a few days after the other symptoms

Symptoms usually appear 8 to 12 days after being exposed to measles. The average time from exposure to appearance of the rash is 14 days.

A person who has measles can spread measles to other people for 3 to 5 days before the rash appears and at least 4 days after the rash appears.

Measles typically only lasts 1 to 2 weeks, however there are some complications that are associated with this disease. These complications can include: ear infections, pneumonia, seizures, encephalitis (inflammation of the brain), and sometimes death. 

Measles is diagnosed by a doctor based signs of illness (i.e., rash), the order that symptoms appear and/ or a laboratory test. Common laboratory test include a blood test and/or a nasal swab.

Measles is a highly contagious disease. It is found in the nose and throat of an infected person. Measles is spread from person to person when an infected person sneezes, coughs or talks.

The people most at risk for getting measles are:

• Children less than 15 months of age, who are too young to receive the vaccine
• People who are not vaccinated
• Children vaccinated before the age of one

Individuals who believe they have measles or who have been exposed to a person with measles should notify their doctor immediately. It is recommended that you call the doctor prior to going into a medical facility. The doctor may ask you to wear a mask to prevent spreading the illness to other patients in the office.

If you seek medical attention within 72 hours of exposure to a person with measles, your doctor may administer a dose of measles, mumps, and rubella (MMR) vaccine to you to prevent you from getting ill. Household contacts that are at risk, people where measles vaccine is contraindicated, or others with high-risk complications may be given a dose of Immune Globulin (IG) within 6 days of being exposed.

The measles, mumps, and rubella (MMR) vaccine is a live, weakened, combination vaccine that protects against the measles, mumps, and rubella viruses. After receiving the vaccine, the body develops protection against the measles that, in 95% of children, will last for a lifetime. Vaccine is usually given to infants 12-15 months old and again to children between 4-6 years of age.

Receiving the measles vaccine can prevent this disease. If someone is exposed to measles, they can contact their doctor to see if they have received the vaccine. If you have measles you should avoid public settings such as: school, work, or daycare settings for 4 days after the rash appears.

Please use the following resources or contact your doctor.

• Pennsylvania Department of Public Health Measles Fact Sheet
• CDC About Measles Fact Sheet
• CDC Measles Vaccine
• Measles Frequently Asked Questions PDF

Meningitis or bacterial meningitis is inflammation of the areas that cover the brain and spinal cord.  It is a severe infection and can cause many complications. Bacterial meningitis is caused by Haemophilus influenzae type b, Streptococcus pneumoniae, Listeria monocytogenes and Neisseria meningitidis.

Symptoms of this infection include:

• High Fever
• Severe Headache
• Stiff Neck
• Increased sensitivity to light
• Nausea/Vomiting
• Tiredness
• Confusion
• Seizures
• Rash

Infants and newborn may not have the classic signs and symptoms of meningitis. Instead they may have the following: constant crying, irritability, poor feeding, increased tiredness, a bulge in the soft spot at the top of their head, and stiffness in the baby's body and neck.

Diagnosis of bacterial meningitis is done by identification of symptoms and collecting a sample of spinal fluid or blood. The sample is then grown to identify the type of bacteria that is causing the infection.

Bacterial meningitis is spread by the exchange of throat and respiratory secretions and extended contact with an infected individual. In addition, eating foods such as hot dogs, soft cheeses, and lunchmeats that are contaminated with Listeria monocytogenes can spread this type of infection. It is also important to note that wild and domesticated animals are carriers of Listeria monocytogenes.

People who have been in close contact with the infected person for long periods of time are at a higher risk for getting meningitis. Possible complications of this infection are: brain damage, hearing loss, learning disabilities, organ failure, coma, decreased blood pressure, shock, and death

Individuals who are most likely to get meningitis are:

• Teenagers
• Individuals living in close living spaces
• People exposed to active and passive tobacco smoke
• Pregnant Women
• Immunocompromised Individuals
• Working with animals
• Microbiologist who work with isolates of Neisseria meningitidis

Contact your health care provider immediately if you have any symptoms of meningitis. Bacterial meningitis can be treated with antibiotics, but it is important to start the medication in the early stages of the illness.  This type of infection is commonly treated with vancomycin and ceftriaxone.

The best way to prevent meningitis is to receive the recommended vaccinations. Currently, there are vaccines for three types of bacteria that can cause meningitis: Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b (Hib).  Refer to the current recommendations for preventing Neisseria meningitidis.

Please use the following resources, or contact your doctor or primary care physician.

• Pennsylvania Department of Health- Meningitis Disease Page
• CDC-Questions & Answers about Meningitis
• Mayo Clinic Meningitis Disease Information Page
• Medline- Meningitis Overview
• Meningitis Frequently Asked Questions PDF

This bacteria, often called 'Staph', is one of the most common causes of skin infections in the U.S. Staph is usually found on the skin or in the noses of healthy people and does not always cause infection. When staph does cause infection, it usually is minor and results in pimples or boils. More serious infections of Staph such as surgical wound infections or pneumonia can occur and may  require special antibiotics for treatment.

Some staph bacteria are resistant to certain antibiotics. Methicillin-resistant  S. aureus (MRSA) are resistant to the antibiotic  methicillin and related antibiotics. Other antibiotics can be used to treat MRSA, but treatment may take longer and/or be more expensive. As with all regular staph infections, recognizing the signs and receiving treatment for skin infections in the early stages reduces the chances of the infection becoming severe.

Symptoms include:

• Redness, warmth, swelling, tenderness of the skin, and boils or blisters
• Staph infections are sometimes mistaken for spider bites
• Some people may also have fever and chills

A sample of the infected area is taken and tested. Only laboratory tests can confirm whether the infection is due to staph or MRSA.

It is spread by close contact with infected people. Staph can rub off the skin of an infected person onto the skin of another infected person. Staph can also come off the infected skin of a person onto a shared object or surface, and get into the skin of the next person who uses or touches that object.

Examples include:

• Towels
• Soap
• Sheets
• Clothes
• Benches in saunas or hot tubs
• Athletic equipment

MRSA infections are more common in people with the following risk factors:

• Recurrent skin diseases or open wounds
• Been a patient in a hospital/health care setting within the last year
• Recent antibiotic use
• Spend time in crowded settings (gyms, jails, etc.)

MRSA can only be diagnosed by a physician using laboratory tests. Many MRSA infections can be treated by draining the abscess or boil and may not require antibiotics, however, only healthcare providers should drain sores. Always keep draining sores covered to prevent others from getting sick. Most MRSA infections are treatable with antibiotics. If your case is severe, you may need very strong antibiotics that can only be given in a hospital.

• Know the signs of MRSA skin infections and get treated early
• Keep open cuts clean and covered
• Good hygiene such as cleaning hands regularly
• Avoid sharing personal items such as towels and razors

Please use the following resources, or contact your doctor or primary care physician.

• CDC MRSA Fact Sheet
• PDPH MRSA
• MRSA Frequently Asked Questions PDF

The mumps is a contagious illness that is caused by the mumps virus.

Symptoms of mumps include:

• Swollen salivary glands (either unilateral or bilateral)
• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite

Symptoms usually appear 14-18 days after being exposed to mumps.

Individuals with mumps can spread the virus from 2 days before until 5 days after they develop parotitis. 

Symptoms tend to decrease after 1 week and usually resolve after 10 days. Many people who are diagnosed with mumps usually recover without any complications. However, in cases where the infection is severe, complications include: 

• Inflammation of the testicles in males who have reached puberty
• Inflammation of the ovaries and breast in pubescent females
• Temporary or permanent deafness
• Viral Meningitis

Mumps is diagnosed by a doctor based on physical signs of disease (i.e., parotitis) and/or laboratory tests. Laboratory tests may include a blood test and/or a swab of the mouth.

Mumps virus is present in the saliva and respiratory secretions of an infected person. Mumps is spread from person to person when an infected person coughs, sneezes or talks.

Individuals who have not received two doses of the measles, mumps, and rubella (MMR) vaccine or have not had mumps disease are at higher risk for contracting the illness.

Individuals who believe they have mumps or who have been exposed to a person with mumps should notify their doctor. A doctor may diagnosis mumps based on physical signs of illness (i.e., parotitis) and/or laboratory tests.

Currently, there is no medical treatment for mumps. Individuals that are ill with the mumps should get plenty of rest, drink fluids, and take medication to relieve the symptoms of mumps (i.e., fever reducers). People with mumps should also stay at home and away from others for 5 days after their glands swell. Anyone who experiences complications should seek medical attention immediately.

Receiving the measles, mumps and rubella (MMR) vaccine is the best way to prevent and decrease the spread of the mumps virus.  Vaccine is usually given to infants 12-15 months old and again to children between 4-6 years of age. Anyone who has not been vaccinated should receive at least one dose of MMR vaccine. Anyone born before 1957 is considered immune and does not need to be vaccinated.

• Individuals with mumps should stay home from school and work for 5 days after their glands swell and try not to have close contact with household contacts.
• Always cover your mouth and nose with a tissue or your sleeve when you sneeze and cough.
• Wash your hands with soap or use alcohol-based hand sanitizers, especially before eating or touching your face.
• Don't share drinking glasses or eating utensils with others.

Please use the following resources, or contact your doctor.

• Philadelphia Department of Public Health Mumps Page
• Pennsylvania Department of Health Disease Index
• CDC Mumps Page
• Mumps Frequently Asked Questions PDF

Norovirus is a virus that causes the “stomach flu” or gastroenteritis (irritation or inflammation of the stomach and intestines).

Symptoms include:

• Nausea
• Vomiting
• Stomach cramps
• Diarrhea
• Low grade fever
• Headache
• Feeling of tiredness

There is usually 1-2 days between the time of exposure to the time that symptoms appear, but this time can be as short as 12 hours. Illness typically lasts 12-60 hours and is self-limiting (persons will get better on their own).

Norovirus can be easily spread from person-to-person through direct contact, contact with contaminated surfaces or by consuming contaminated food or drinks. Only a few virus particles can cause illness and the virus can survive on surfaces for weeks. Contamination of food and drink may occur when infected individuals handle food or beverages, leading to many infections among individuals who consume those products.

Anyone can get norovirus.  Because it is so easily spread, people in institutions such as long term care facilities and schools have a greater chance for exposure.

If you think you have norovirus, you should contact your doctor, and discuss your symptoms. While there is no specific treatment for norovirus, supportive therapy can include drinking plenty of fluids, rest, and antiemetics (a drug used to treat nausea and vomiting).  In more severe cases, hospitalization is sometimes required to receive intravenous fluids to prevent dehydration. 

• Good hand washing is the best way to prevent norovirus.  Be sure to wash hands frequently with soap and water especially before and after food preparation, and after changing diapers or going to the bathroom. 
• Frequently clean commonly touched surfaces, such as doorknobs and railings, with a fresh mixture of bleach and water (1 ½ cups bleach per gallon of water).
• If you are sick with symptoms of norovirus, stay home for 3 days after you recover, especially if you work in healthcare, as a food handler, or at a daycare. 
• Dirty clothing can be washed in hot, soapy water.
• Towels used to clean vomit or stool should be thrown away in plastic bags or washed in hot, soapy water.

 

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book
• PDPH Fact Sheet
• Norovirus Frequently Asked Questions PDF

Pertussis (whooping cough) is a very contagious respiratory disease. It is caused by bacteria (Bordetella pertussis) and lasts for many weeks. Pertussis is characterized by a severe cough, whooping and vomiting after cough in children, but the disease may be milder in vaccinated children and adults.

Pertussis symptoms develop in 3 stages:

• Catarrhal Stage (lasts 1 to 2 weeks)
• Runny nose
• Sneezing
• Low-grade fever
• Mild, occasional cough
• Infants may have gagging, gasping, or apnea (pauses in breathing)
• Paroxysmal Stage (last 1 to 6 weeks)
• Bursts of numerous, rapid coughs
• High-pitched whooping sound after coughing fits
• Turning blue
• Vomiting and exhaustion after cough fits
• Distress
• Between attacks the person appears fine
• Convalescent Stage (lasts weeks to months)
• Cough gradually disappears
• Coughing fits may recur for many months

Symptoms may begin 7-10 days after being exposed to pertussis. Adults and vaccinated children with pertussis may have milder symptoms or may not have any symptoms of illness (asymptomatic).  

People with untreated pertussis are most contagious during the catarrhal stage of the illness until 2 weeks after the cough develops (i.e., approximately 21 days). People are no longer contagious after 5 days of appropriate antibiotic medications. 

Pertussis symptoms can last 6-10 weeks or longer. Symptoms decrease gradually over weeks to months. Complications from pertussis among older children and adults may include fainting, sleep disturbance, incontinence (unintentional loss of urine), rib fractures, and pneumonia. Pertussis is most severe when it occurs to infants less than 6 months of age, particularly in preterm and unimmunized infants. Complications among infants can include pneumonia, seizures, encephalopathy (disease in the brain) and rarely, death. 

Pertussis is diagnosed by a doctor based on the signs of illness (i.e., whooping, coughing fits, etc.) and/or laboratory tests. Laboratory tests may include blood tests or a nasal swab.

Pertussis is spread person to person by contact with airborne droplets from the nose and mouth of an infected person.

Anyone can get pertussis. People who are not vaccinated and people who have not had pertussis before are more likely to get pertussis. Also people who live in the same household with a person with pertussis are very likely to get the disease. 

If you believe that you have pertussis, call your doctor immediately. Your doctor can diagnose you with pertussis based on your signs and symptoms of illness and often times a positive laboratory test.

Antibiotic medication prescribed by a doctor is used to treat pertussis and prevent the spread of disease. It is important that you take all the antibiotic medications prescribed to prevent spreading the illness to others.

Pertussis is very contagious in households, so your doctor may also prescribe antibiotic medication for your household members. It is important that your household members take all the antibiotic medication prescribed in order to prevent spreading the illness to others. 

Your doctor may also administer vaccinations to children who have not completed their pertussis vaccinations. 

Vaccination with a pertussis-containing vaccine (like DTaP for children or Tdap for adolescents and adults) is the best way to prevent illness. Pertussis vaccine is given to children in 4 doses at 2 months, 4 months, 6 months and 15-18 months of age. A booster dose of vaccine is given to children before school entry (4-6 years old). Adolescents 11-12 years of age are also recommended to receive a booster dose of vaccine.

Pertussis vaccine is also available for older adolescents and adults (younger than 65 years of age). Any person who wants to be protected against pertussis should speak to their doctor about vaccination. People who live or work with small children (<12 months) or who have direct patient care are especially encouraged to get a booster dose of pertussis vaccine.

Others ways to prevent pertussis are:

• People with pertussis should stay at home and away from others until they have completed 5 days of their antibiotics. People with pertussis who do not want to take antibiotics should stay home and away from other for 21 days after cough onset.
• Always cover your mouth and nose with a tissue or your sleeve when you sneeze and cough.
• Wash your hands with soap or use alcohol-based hand sanitizers, especially before eating or touching your face.

For more information, use the resources listed below or contact your doctor.

• Pennsylvania Department of Public Health Pertussis Fact Sheet
• CDC Pertussis Disease Listing
• PDPH Immunizations Page
•  Pertussis Frequently Asked Questions PDF

Plague is a zoonotic infection that is spread by infected rodents , carnivores, and fleas. The infection is caused by the organism Yersinia pestis. There are three types of plague that humans can contract; they are bubonic, pneumonic, and septicemic. The severity of signs and symptoms are dependent upon the type of plague.  Symptoms will typically develop within 1 to 7 days.

Common symptoms associated with bubonic plague are:

• Swollen lymph nodes in the groin, arm pit, or neck
• Tender or warm touch lymph nodes
• Headache
• Malaise
• Sudden onset of fever or chills
• Muscle aches

Common symptoms associated with pneumonic plague are:

• Cough with bloody mucous
• Difficulty breathing
• High fever and chills
• Nausea
• Vomiting
• Generalized weakness

Common symptoms associated with septicemic plague are:

• Fever and chills
• Abdominal pain
• Diarrhea
• Vomiting
• Shock
• Blackening and death of the tissue in the extremities (fingers, toes, and nose)

People become infected with plague when fleas from infected animals bite a human. Bacteria can also enter the body through breaks in the skin that come into direct contact with an infected animal's blood or tissues. Individuals can also be infected by the plague by breathing in contaminated respiratory droplets that are coughed into the air.

Persons most likely to get the plague are the following:

• People who live in rural areas of the western states and who are exposed to infected rodent fleas or wild rodents
• Veterinarians
• People who camp, hunt, or hike in areas with infected animals

If you suspect that you have plague contact your healthcare provider immediately, so that your doctor may further evaluate you. Your doctor may take samples from your blood, lymph nodes, and lungs to test for the plague.

There is no vaccine available to prevent plague, but there are antibiotics that can help fight off the infection. Listed below are several recommendations to prevent infection with plague:

• Rodent-proof your home
• Keep your pets free of fleas
• Use insect repellant

Please use the following resources, or contact your doctor or primary care physician.

• CDC Plague Home page
• Mayo Clinic Plague Disease Page

Polio is a contagious, viral illness caused by polioviruses. Polio is often characterized as a paralysis, however polio paralysis is rare. Polio was declared eradicated from the Western Hemisphere in 1991.

Polio can cause varying types of infections. Most infections are asymptomatic, meaning the person has no symptoms of the disease. In some people, polio can cause a sore throat, fever, vomiting, stiff neck, and leg and arm pain. Less than 1% of polio infections cause paralysis.

Symptoms of polio usually begin 3-6 days after exposure to the virus.

People with poliovirus are most infectious 7-10 days before and after the onset of symptoms.

Polio is diagnosed by a doctor, usually based on signs of illness and laboratory tests.

Polio is usually spread person to person when an individual ingests the virus. 

Unvaccinated individuals living in areas where polio is endemic or epidemic are at risk for contracting the disease. These areas include South Asia, the eastern Mediterranean and Africa.

In addition, healthcare workers caring for infected patients and laboratorians working with the virus are at greater risk of developing disease. 

There has not been a case of polio paralysis in the United States since 1999. 

Contact your doctor immediately and tell them your symptoms.

The best way to prevent polio is to get vaccinated. Polio vaccine is usually given to children during the routine vaccination series at 2, 4, and 6-18 months, and 4-6 years of age.

Routine vaccination of adults who reside in the United States is not necessary or recommended because most adults are already immune and have a very small risk of exposure to the virus in the United States. 

Please use the following resources, or contact your doctor.

• Pennsylvania Department of Public Health
• Centers for Disease Control and Prevention

Psittacosis is an acute respiratory illness that is caused by the organism Chlamydophila psittaci. This disease is rare and can be hard to detect in people. Symptoms of psittacosis typically appear within 5 to 19 days after being exposed to the bacteria.

Symptoms include:

• Fever
• Non-productive cough
• Headache
• Joint aches
• Muscle aches
• Fatigue
• Chills
• Generalized discomfort

In addition pneumonia may also be evident via chest x-ray.  The illness is often mild or moderate but can be severe for elderly people, especially if untreated. Some complications can include: endocarditis, encephalitis, myocarditis, thrombophlebitis or hepatitis. 

People get psittacosis by inhaling dried droppings, secretions and dust from the feathers of infected birds.  Psittacine birds such as parakeets, parrots, cockatiels, and budgerigars are the main reservoirs for the bacteria, but it can also be transmitted from poultry (turkeys and ducks), pigeons, canaries, and sea birds. Psittacosis is rarely spread person-to-person, but if this does occur it only occurs during the coughing phase of the illness.

Those most at risk are people who come in contact with birds.  This group includes:

• Pet bird owners
• Veterinarians
• Lab workers who work with birds
• Pet store employees
• Employees of poultry processing plants

If you suspect that you have psittacosis, you should seek immediate care from your healthcare provider, so that your doctor may further evaluate you and provide prompt treatment.  Your doctor may take several images of your chest, listen to your lungs for irregular breath sounds and will usually take a sample of your blood or sputum in order to test it for psittacosis. Several antibiotics may be used to treat this infection and your health care provider will determine which is best for you.

There is no vaccine available to prevent psittacosis; however there are control measures that can be instituted to prevent the spread of the illness. All birds that are suspected to be the source of human infection should be evaluated by a veterinarian and then either treated or destroyed.  All potentially contaminated caging and housing areas should be disinfected with a phenolic compound and aired out before re-using, because they may contain infectious organisms.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Psittacosis Disease Page
• National Association of State Public Health Veterinarians

Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii. These bacteria are able to become airborne and last in the environment longer than most bacteria. Infections with Coxiella burnetii have been reported worldwide. The bacterium typically infects animals such as sheep, goats and cattle, but can also affect pets, such as cats, dogs, birds and rabbits.

Many people who are infected with Q fever will recover on their own or not experience any symptoms.  Roughly 50% of people who are infected with the bacteria will experience symptoms of:

• High Fever
• Severe headache
• Fatigue
• Muscle aches
• Confusion
• Sore throat
• Chills
• Sweats
• Cough
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Chest pain

Symptoms typically appear 2-3 weeks after exposure to the bacteria. Thirty to fifty percent of patients with a symptomatic infection will develop pneumonia. A majority of patients will also have abnormal results on liver function tests and some will develop hepatitis. If left untreated Q fever can lead to chronic Q fever, which is a serious and sometimes fatal disease that can last for years.

The bacteria are present in the milk, urine, and feces of infected animals.  Human infections usually occur by breathing in organisms from air that contains airborne barnyard dust contaminated by dried placental material, birth fluids, and excreta of infected herd animals. Direct contact with contaminated materials such as wool, straw, fertilizer, or laundry can also pass on the bacteria.  Less common ways of getting Q fever include drinking raw contaminated milk, tick bites, and mother to infant transmission.

People who are most likely to get Q fever include people who come into contact with animals who carry the bacteria or those who work with the by products of these animals.  Many of the people in this group include farmers, laboratory workers who work with the bacteria, veterinarians, and dairy workers.

Anyone can get Q fever although people with heart valve problems and those with weakened immune systems are at greatest risk of infection.

If you think you may have become exposed to this bacterium or you have symptoms of Q fever you should contact your healthcare provider as soon as possible.  Your healthcare provider will diagnosis this condition based on your symptoms and by analyzing a sample of your blood.

Educating people in high risk occupations on how the bacteria are transmitted and how to protect themselves from getting this disease is an important way of preventing infection.  Restricting access to sheds, barns and laboratories is another important way to decrease the number of people who may be potentially exposed to the bacteria. Other measures such as drinking only pasteurized milk can also help prevent the disease.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• MedlinePlus Q Fever page
• Mayo Clinic Q Fever page

Rabies is a deadly but preventable virus that is spread primarily after the bite of an infected animal.  In the U.S. the virus is mainly found in wild animals such as bats, coyotes, foxes, raccoons, groundhogs, and skunks but has also been found in some domestic animals such as dogs, cats, and ferrets.  Small mammals such as squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, and rabbits are almost never found to be infected with rabies and are not known to cause rabies among humans in the U.S.

Initial symptoms of rabies infection in humans are usually vague and tend to increase in severity as the infection spreads to the brain.  Once symptoms begin, survival is rare.  Deaths that occur in the U.S are usually the result of people not knowing that they are infected with the virus and as a result treatment was never started.  Rabies postexposure prophylaxis (PEP) which is a series of preventative shots, is nearly 100% effective in stopping the rabies virus from infecting you.

Early symptoms include irritability, headache, fever and sometimes itching or tingling pain at the site of exposure.  The disease eventually progresses to paralysis, swallowing difficulties, excess salivation, convulsions, delirium and death.

Rabies virus is found in infected mammals' saliva. When the sick animal bites another animal or human the virus can be passed through broken skin.  It is possible but rare for people to get rabies if an infected animal's saliva gets directly into their eyes, nose, mouth, or an open wound. The rabies virus is also present in an infected animal's brain tissue and exposure to these contents can result in infection as well. Rabies is not spread person to person though there have been documented cases where transplanted tissues from infected people have caused rabies infection in the transplant recipients. Touching a person with rabies or other casual contact with non-infectious urine, blood, or feces does not result in rabies.

The period between exposure to rabies virus and the development of symptoms in humans is variable but is normally 3 to 8 weeks. Incubation periods up to several years have also been recorded. 

Anyone can be at risk for rabies infection.  However if you work with animals, work in a laboratory that tests for rabies, or are traveling to a country where rabies is more common the likelihood of exposure is greater. Activities that may put you in areas where contact with rabid animals is higher, such as exploring caves where bats may be present can also increase your risk. 

If you have been bitten by a stray/wild animal or have been exposed to other infectious material (e.g. brain matter) you should seek medial evaluation as soon as possible.  In addition you should also notify the Division of Disease Control (DDC) of the incident by calling 215-685-6748. DDC and your healthcare provider will determine whether or not you need PEP based on the following factors: 

• What kind of animal was involved in the incident
• The health status of the animal
• Whether or not the animal can be observed for 10 days if the animal is a domesticated dog, cat, or ferret

If you are not sure whether or not you have been bitten you should also seek medical attention or contact DDC. This situation may occur if you have been exposed to a bat.  DDC will test any bat that has bitten you, or any bat that was present in a room where people were asleep or unconscious (because you often cannot feel a bat bite you or see the marks from a bite), or if that bat was in a room with a child or someone who is mentally/physically disabled or intoxicated.

There are several steps you can take to prevent infection from the rabies virus.  It is important to make sure that your pets are up to date and vaccinated against the rabies virus.  Pets should also be confined and supervised while outside so they will not come into contact with any wild animals.  You should not try to approach, pet, or capture stray or wild animals.  If you see a stray animal or if a stray animal has bitten you, contact animal control professionals so they can come out to trap the animal. To prevent exposures to bats, make sure that you seal cracks and gaps in your home so that bats cannot enter.  If a bat enters your home contact your local animal control professionals to have it removed. 

If you are traveling to a country with high rates of rabies transmission you can speak with your doctor about receiving the rabies pre-exposure vaccine.

If you have come into contact with an animal that is known to have rabies or if you were bitten by an animal that is unavailable for testing or observation for at least a 10 day period, you are a candidate for rabies post-exposure prophylaxis (PEP).  PEP consists of one dose of rabies immune globulin and four doses of rabies vaccine given over a 14 day period.  These shots are nearly 100% effective in preventing rabies infection so it is important to seek consultation from the health department or healthcare provider after an animal bite to see if you should receive the shots.

Please use the following resources, contact your doctor, or the Division of Disease Control.

• CDC Learn About Rabies
• PDPH Animal Bites Page
• Philadelphia Animal Care and Control Team Powered by the PSPCA
• Rabies Frequently Asked Questions PDF

Rocky Mountain Spotted Fever (RMSF) is caused by infection with the bacterial organism Rickettsia rickettsii. It is the most severe tick-borne rickettsial illness in the United States. The illness is named after the Rocky Mountain region, where the disease was first identified.  Rocky Mountain spotted fever occurs throughout the United States primarily during the months of April through September. The majority of the cases in the U.S. are reported from states that make up the south-Atlantic region of the country.

Symptoms will begin to appear 5 to 10 days after a tick bite. The early clinical presentation of RMSF is often nonspecific and may resemble many other diseases. Initial symptoms include:

• Fever
• Nausea
• Vomiting
• Muscle pain
• Lack of appetite
• Severe headache

Later symptoms include:

• Rash (90% of people will develop a rash)
• Abdominal pain
• Joint pain
• Diarrhea

The severity of illness varies from person to person but if treated early most people will recover at home with oral antibiotics.  RMSF can be fatal within the first eight days if not treated promptly.  Complications are rare but can include paralysis, hearing loss, and nerve damage.

  

People get Rocky Mountain Spotted Fever after being bitten by an infected tick. The American dog tick and the Rocky Mountain wood tick are the main carriers of the bacterial organism Rickettsia rickettsii.  An infected tick needs to be attached to your skin for about 4 to 6 hours in order for enough bacteria to enter your body and make you sick. There is no evidence of casual person-to-person transmission.

Anyone can get RMSF, however those people who live or travel in areas where high populations of the American dog tick and Rocky Mountain wood tick are present are at greater risk for infection.  In addition anyone who visits wooded,  brushy, or high grass areas where ticks are more likely to be are also at increased risk of infection.

If you become sick after a tick bite you should call your health care provider and explain your symptoms.  The only way to know for sure if you have this condition is by a lab test that analyzes a sample of your blood.  Be sure to tell your doctor about being in any habitat where ticks live prior to becoming sick or about any tick you may have found on your skin.

Rocky Mountain Spotted Fever is treated with antibiotics. Patients are treated for at least 3 days after the fever stops and until there is evidence of improvement. The standard duration of treatment is 5 to 10 days.

Avoiding ticks and tick bites is the best way to prevent RMSF. Ticks prefer wooded and bushy areas with high grass. These are areas to avoid especially during the warmer months. When you are outdoors adults should use insect repellent with 20% - 30% DEET on exposed skin and clothing to prevent tick bites.  While outdoors in wooded and bushy areas you should also wear long pants, long sleeves, and long socks to keep ticks off your skin. Wearing light-colored clothing will help you see ticks more easily. Tucking your pant legs into socks or shoes and tucking your shirt into your pants helps to keep ticks on the outside of your clothing. After you return from wooded and bushy areas check yourself for ticks.

Please use the following resources, or contact your doctor or primary care physician.

• Rocky Mountain Spotted Fever Disease Listing
• Mayo Clinic Rocky Mountain Spotted Fever Page
• MedlinePlus Rocky Mountain Spotted Fever Page

Rotavirus is a virus that infects the intestinal tract of children. Rotavirus is the most common cause of severe diarrhea in children worldwide. In the United States the rotavirus has winter seasonal patterns, with yearly outbreaks occurring from November to April.

Symptoms include:

• Vomiting
• Fever
• Diarrhea, usually watery
• Abdominal pain

Symptoms will begin approximately two days after being exposed to the virus. The symptoms can last anywhere from 3 to 8 days after onset.

With the combination of vomiting and diarrhea, the person with the virus is at risk for becoming severely dehydrated.

Rotavirus is diagnosed based on the symptoms and a physical exam. The virus is usually confirmed by testing a stool sample.

Most people get rotavirus by being in contact with the stool of an infected person, and then ingesting the virus in some way. People can get the virus through the ingestion of contaminated water or food or through contact with contaminated surfaces and then putting their hands in their mouths.

Children under 5 years of age, especially those that are between ages 6 months to two years, are the most susceptible to the disease.

Contact your doctor.

There is not a specific treatment for rotavirus. Children should be given plenty of fluids in order to prevent dehydration. Severe dehydration cases will be hospitalized and will receive intravenous (IV) fluids.

There are currently two types of the rotavirus vaccine. A baby should get either two or three doses depending upon which type of the vaccine is being used. The doses are recommended at these ages:

• First dose – 2 months of age
• Second dose – 4 months of age
• Third dose – 6 months of age (if needed)

The first dose could be given as early as 6 weeks of age, but it should be given by 14 weeks of age. The last dose should be given by 8 months of age. The vaccine can be given with other childhood vaccines.

One way to prevent the spread of the rotavirus is to get vaccinated. In addition, you can prevent the spread of rotavirus by washing your hands thoroughly and often, especially when coming into contact with stool.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Rotavirus Fact Sheet
• CDC Rotavirus Vaccination Fact Sheet

Rubella (German measles) is an acute viral disease that causes fever and rash.

Symptoms include:

• Slight fever
• Rash lasting 2-3 days
• Temporary swelling and pain in the joints
• Headache
• Weakness
• Runny nose
• Red eyes

Symptoms may begin 14-17 days after being exposed to rubella. .

People infected with rubella are contagious from 1 week before until 4 days after the rash first appears.

Rubella is usually a mild illness, however it can become very serious if a pregnant woman becomes infected. Rubella can cause Congenital Rubella Syndrome (CRS) in the fetus. CRS can cause deafness, blindness, heart damage, or mental disabilities to the baby.

Rubella is most commonly diagnosed by a blood test.

Rubella is primarily spread person-to-person by contact with the mucus or saliva from an infected person.

Although rubella is most common among children and young adults, people of all ages can develop the disease. Rubella is very dangerous when women become infected during the first few months of pregnancy.

Call your doctor immediately. If you are diagnosed with rubella, stay home for at least seven days after the start of your rash. Avoid all contact with unvaccinated people and pregnant women.

There is no specific treatment for rubella. Hospital care may be needed for severe infections, but most people can recover at home.

The measles, mumps, and rubella (MMR) vaccine is a live, weakened, combination vaccine that protects against the measles, mumps, and rubella viruses. The vaccine is usually given in two doses. The first dose is given to children between 12-15 months of age. A second dose is recommended to children between 4-6 years of age. However, children can get the second dose at any age, as long as it is at least 28 days after the first dose.

Ensuring that all children are appropriately vaccinated can help to prevent rubella. Also, infected people should avoid contact with people who have not received the vaccine. This can help prevent the further spread of rubella.  Good hand hygiene and cough etiquette can also decrease disease transmission.

Please use the following resources, or contact your doctor or prmary care physician.

• Pennsylvania Department of Public Health Rubella Fact Sheet
• CDC Rubella Disease Listing

Salmonellosis is an infection of the intestines caused by bacteria called Salmonella. 

Symptoms include:

• Diarrhea
• Stomach cramps
• Fever
• Nausea
• Vomiting

The symptoms most commonly appear 12-36 hours after exposure but it can be as long as 72 hours before symptoms show. A person with salmonellosis may begin spreading the infection as soon as they develop symptoms and in most cases, may continue to do so for several days to several weeks.

Salmonella can be found in foods including raw chicken, beef, turkey, pork, eggs, produce and unpasteurized milk products.  It may also be found on some pets, especially reptiles and baby chicks.  Infected humans can carry the bacteria in their feces (stool).  Eating raw or undercooked foods, food that came in contact with contaminated raw food, eating food contaminated by a cook infected with Salmonella, being in close contact with infected animals and humans or their feces can also spread the infection.

Anyone can get salmonellosis but the risk is highest in infants and children under 5 years of age.  People who are on antacid therapy and those who have suppressed immune systems are also at higher risk of getting salmonellosis.

If you think you have salmonellosis, you should contact your doctor, and discuss your symptoms and treatment options. Antibiotics are often not necessary.

In order to prevent getting salmonellosis, you should avoid eating raw or undercooked eggs, poultry, and meat. Raw eggs can be found in many foods, so you should take caution in eating foods like raw cookie dough, homemade ice cream, etc. Meats should be well cooked all the way through. Produce should be washed thoroughly.

People with salmonellosis should not prepare or serve food, or serve drinks to others until their diarrhea has gone away.

Hand-washing is also an important way to prevent salmonellosis from spreading.

You should always wash your hands after handling reptiles (including turtles) or birds (including chicks and ducklings). Since children are at high-risk for salmonellosis, they should not handle reptiles or birds.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• USDA Fact Sheet
• PDPH Turtle brochure
• Salmonella  Frequently Asked Questions PDF

SARS or severe acute respiratory syndrome is an acute respiratory illness that first appeared in China in November 2002. Within six weeks the illness spread quickly among unassuming travelers, causing a pandemic to occur. SARS is caused by a group of viruses called coronaviruses, which are also known to cause the common cold or upper respiratory infections. Symptoms typically occur within 1 to 7 days after being exposed to SARS.

Common symptoms include:

• Fever
• Chills
• Muscle soreness
• Headache
• General Discomfort

Most people get SARS through respiratory droplets or airborne particles in the air.  In addition, SARS can also be spread by touching contaminated objects such as telephones, elevator buttons or doorknobs. Individuals who test positive are known to carry coronavirus in their stool, virus, and blood, which can provide other sources of virus for transmission.

Individuals mostly likely to get SARS are those who have direct contact with sick patients. Close contacts such as roommates, family members, and healthcare professionals have an increased risk for contracting SARS.

If you suspect that you have SARS contact your healthcare provider immediately, so that your doctor may further evaluate you. SARS is a serious illness that can lead to death. It is also important that if you have the disease, that you not spread it to others–limit your contact with others and before going to healthcare facility make them aware of your symptoms.

People can prevent SARS by following the listed recommendations below:

• Frequently wash your hands with warm water and soap or an alcohol based sanitizer.
• Use disposable tissues to wipe your eyes and nose, instead of touching them with your hands.
• Wear disposable gloves when handling bodily fluids or stool.
• Wear a surgical mask when in the same room as a sick person.
• Use a disinfectant to clean areas that may have been contaminated with an infected person's bodily fluids.
• Any person who develops signs and symptoms of SARS should remain home for 10 days after being exposed to the illness.

Please use the following resources, or contact your doctor or primary care physician.

• CDC SARS Webpage
• OSHA SARS Fact Sheet

Shigellosis is a disease caused by the bacteria Shigella.  It causes diarrheal illness.

Symptoms include:

• Diarrhea
• Stomach cramps
• Fever
• Nausea
• Vomiting

Symptoms may start 1-7 days after being exposed to the germ. Most symptoms start within 2-4 days.

Shigellosis is spread several ways. It is usually spread from people who are infected with this germ, who pass the bacteria in their bowel movements (stool). If infected persons do not wash their hands well, this germ can get into the food or drink they are handling, and others can then get sick by eating this food or drink. People can also get this germ on their hands when changing diapers or assisting a child with toileting. It only takes a few germs to cause infection, and the germ is easily spread.

Anyone can get this infection.  In Philadelphia, shigellosis has been associated with outbreaks involving homeless shelters and childcare facilities, along with a larger community-wide outbreak.

If you think you have shigellosis, you should contact your doctor and discuss your symptoms.  Several antibiotics may be used to treat this infection.  Your doctor will prescribe the most appropriate antibiotic for this illness.  Treatment with antibiotics will shorten the length of the illness and help to clear the germ from the stool.

Frequent and careful hand washing is an important way to prevent shigellosis from spreading. People with shigellosis should not prepare or serve food, or serve drinks to others until they have shown that they are no longer carrying the bacteria, or until their diarrhea has been gone for at least 2 days.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• Shigella Frequently Asked Questions PDF

Herpes zoster, better known as shingles, is caused by the same virus that causes chickenpox (varicella).  After a person is infected with the varicella zoster virus (VZV), the virus remains dormant (inactive) in the body. The virus can then reactivate causing shingles, a localized painful rash.

Some people who are diagnosed with shingles may experience some of the following signs and symptoms:

• Painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7–10 days and clears up within 2–4 weeks.
• One to 5 days before the rash develops, there may be pain, itching, or tingling in the area where the rash will develop.
• The rash occurs in a single line around either the left or the right side of the body and in some cases, the rash occurs on one side of the face.
• Those with weakened immune systems may have rash that is more widespread and looks similar to the chickenpox rash.
• The most frequent debilitating complication of shingles is post-herpetic neuralgia (PHN), persistent pain at the site of the rash after it has resolved. 
• Shingles can also affect the eye and cause loss of vision.

Shingles cannot be passed from one person to another. However, someone with active shingles can spread VZV to a person who has never had chickenpox or the varicella vaccine. As a result, the person exposed to the virus might develop chickenpox, but they would not develop shingles. A person with shingles can spread the virus when the rash is in the blister-phase. Once the rash develops crusts or if the person has been on an antiviral for 24 hours, s/he is no longer contagious. Those with shingles are encouraged to keep the rash covered, not to scratch the rash, and to frequently wash hands to prevent disease transmission.

• Persons who are 50 years and older
• Persons with no zoster vaccine
• Persons with weakened immune systems due to a chronic condition (e.g., cancer, HIV, organ transplant, etc.) or use of medication that suppresses the immune system (e.g., oral steroids) 

If you think that you have shingles you should contact your doctor. The doctor will examine your rash and may prescribe you antiviral medication for 7 to 10 days. The antiviral medication will help shorten the length and severity of the illness, but it must be started as soon as the rash appears in order for it to be effective. Your doctor may also prescribe you medication to control the pain from the shingles rash.

A physician can diagnose shingles during a clinical exam or they may scrape lesions and test the samples for VZV.

A vaccine is available to reduce the risk of developing shingles and the long-term pain that can follow shingles. The shingles vaccine has been available since 2006 for people 60 years of age and older who do not have contraindications to receiving live vaccines.

Please note that the cost of the shingles vaccine will vary by the type of insurance a person has.  All Medicare Part D plans cover the shingles vaccine.  The patient's share of payment varies by Medicare plan. Medicare Part B does not cover the shingles vaccine.  If you have private insurance, your plan may or may not cover the vaccine; contact your insurer to find out.

For more information about shingles and the shingles vaccine, contact your regular doctor or visit the following websites:

• CDC Shingles Information
• Merck Shingles Information
• Shingles Frequently Asked Questions PDF

Smallpox is a highly contagious and often fatal disease caused by the variola virus. In 1979 the World Health Organization (WHO) declared smallpox successfully eradicated worldwide.

Initial symptoms of smallpox include high fever and severe head and body aches. Following this illness, lesions develop in the mouth. Next a rash begins on the face and spreads down the body. The rash begins as flat, red spots and develops to puss-filled blisters that have a depression in the center. These blisters harden, then crust over and fall off leaving deep scars.

Symptoms of smallpox typically appear 12 days after being exposed to the disease.

A person is contagious as soon as they become ill and remain infected until the last smallpox scab falls off, approximately 3 to 4 weeks. 

Smallpox is diagnosed by a doctor based on symptoms and laboratory tests.

Smallpox is transmitted primarily through respiratory droplets when an infected person cough, sneezes, or talks. Rarely, smallpox can also be transmitted from aerosol and direct contact with infected lesions, clothing or bedding.

Smallpox is eradicated worldwide in 1979 and there has not been a naturally occurring case since 1977. Individuals most likely to get smallpox are close contacts of infected individuals, such as household contacts and healthcare professionals. Additionally, beginning in 2002 there was concern that laboratory supplies of smallpox could be weaponized and used in a bioterrorism attack.

Smallpox is eradicated worldwide in 1979 and there has not been a naturally occurring case since 1977. However, if you suspect that you have smallpox, contact your healthcare provider.

Please use the following resource, or contact your doctor or primary care physician.

• CDC Smallpox Disease Webpage

Streptococcus pneumoniae is a bacterial infection that can cause mild infections such as an ear infection. However, this type of bacterial infection is more severe when it is found in the blood, muscles, lungs, and spinal fluid. When Streptococcus pneumoniae is found in these areas of the body the infection is classified as invasive. The most common invasive infections are meningitis (inflammation of the tissue around the brain and spinal cord), bacteremia (bacteria in the blood), and pneumonia.

Streptococcus pneumoniae is spread person to person through respiratory droplets from an infected person. This may occur when the individual coughs or sneezes. You cannot get the disease from insects, animals, or from the environment.

Anyone is at risk for getting this type of infection. However, the following groups are most at risk:

• Infants

• Young children
• Elderly individuals
• Individuals with chronic health conditions
• People with underlying medical conditions, such as HIV and sickle cell anemia

Contact your doctor immediately if you experience any symptoms of Streptococcus pneumoniae to make sure that you are not experiencing any complications related to the infection.

Invasive Streptococcus pneumoniae is diagnosed by getting a specimen from the blood, spinal fluid, lung fluid, or joint fluid. The specimen is then sent to a laboratory for further testing to confirm a diagnosis of Streptococcus pneumoniae. This type of infection is treated with antibiotics, such as penicillin.

Vaccination is best way to prevent invasive Streptococcal pneumonia. Vaccine is available and recommended for infants, adults 65 years of age and older, and children and adults with certain chronic medical problems or living in high-risk environments or social settings. Healthy individuals who are less than 65 years of age are not recommended to receive vaccine. Contact your health care provider to discuss your risk of invasive Streptococcal pneumoniae and your need for vaccination. 

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• National Network for Immunization Network-Vaccine Information
• Strep Pneumo Frequently Asked Questions PDF

Syphilis is a sexually transmitted disease (STD) caused by a type of bacteria called T. Pallidum. It can spread from person to person by physical contact during vaginal, anal, or oral sex. Syphilis infections are treatable and curable with antibiotics.

Untreated syphilis can lead to organ damage, including brain damage, and in some cases death. In addition, syphilis infection makes HIV easier to catch or to give to sex partners. New data show that for people who have HIV, syphilis can dramatically increase their viral load and cause a drop in CD4 counts. This increase resolves with syphilis treatment.

Syphilis infection occurs in four stages, named primary, secondary, latent, and tertiary (late).

Symptoms usually show up 2-12 weeks after being exposed. The first sign is often a skin sore called a chancre (shank-er). You may have more than one, or you may have chancres and not notice them because they are inside your anus or vagina. Chancres can also appear on your scrotum, penis, vaginal lips, anus or in your mouth. They are usually not painful. The sores will go away after several weeks without treatment, but you would still be infected.

Most people who have secondary syphilis notice a skin rash covering their body 4 to 12 weeks after infection. The identifying feature of this rash is that it shows up on the palms of the hands and soles of the feet. Often it is not itchy. Other common symptoms of secondary syphilis are swollen glands in various areas of the body, fever, fatigue, patchy hair loss, weight loss, and headache. Since these symptoms are so similar to those of many other health problems, syphilis has sometimes been called “the great imitator.”

Additional symptoms during secondary syphilis that are particularly important are syphilis warts and white patches (condylomata lata and mucous patches, respectively). These warts and patches are highly infectious and can occur in moist areas of the body like the mouth, side of the tongue, anus, etc.

Secondary syphilis symptoms usually last anywhere from 1 to 3 months, but sometimes they last longer, and once in awhile the symptoms come and go over a year or two. But even after the symptoms of secondary syphilis clear up, if left untreated, the infection continues in your body.

Latent syphilis causes no symptoms. The infection can be detected only by a blood test. If not treated, latent syphilis continues for life. Many people with latent syphilis never have serious problems, but some progress to the final stage, called tertiary syphilis.

About one-third of untreated people with syphilis experience serious damage to various organs and body systems. Tertiary syphilis can appear any time from a year to 50 years after becoming infected; most cases occur within 20 years. The brain, heart, liver, and bones are the most commonly involved organs. Tertiary syphilis can cause paralysis, mental problems, blindness, deafness, heart failure, and death.

A complete examination for syphilis in a doctor's office or clinic includes taking a sexual history, examining any symptoms you might have (chancres, rash, etc.) and a blood test. There are special tests available at Philadelphia Health Care Center to diagnose syphilis from sores if they are present.

Penicillin shots cure syphilis. If you are allergic to penicillin, there are alternative antibiotics. One common alternative is called doxycycline. It is safe and effective.

Even though symptoms will clear up after treatment, sometimes the first treatment doesn't completely cure the infection. It is very important to have several repeat syphilis blood tests to be sure the treatment worked and the infection is completely gone. In most cases this means repeat blood tests one week after treatment, then every few months for the next year.

Your sex partner(s) must be examined and treated too. Otherwise they can give the infection back to you and/or infect others. It's important to talk to your partners to maintain the sexual health of our community. Once your treatment is completed, you will no longer be contagious and cannot spread syphilis to others. Until then, you need to abstain from sex or use condoms for anal, oral and/or vaginal sex.

The risk for syphilis is directly related to the number of sex partners you have: The more sex partners, the greater the risk on contracting it. Having more sex with fewer partners reduces your risk of getting syphilis.

Abstinence is the only surefire way to avoid getting syphilis or other STDs. If you're sexually active, using condoms consistently and correctly for oral, anal and vaginal sex is your best bet for staying sexually healthy. Also, regular STD checkups at least every six months if you're sexually active with more than one monogamous partner is recommended. Syphilis and other bacterial STDs are curable with proper diagnosis and treatment.

Find out more about STDs at Take Control Philly.

Tetanus, sometimes referred to as lockjaw, is a bacterial disease that affects the nervous system. It is caused by the bacterium Clostridium tetani.

Symptoms develop gradually over 1 to 7 days. Early symptoms include:

• Jaw muscle cramping or lockjaw
• Stiffness in the neck and abdomen
• Difficulty swallowing

Severe symptoms may persist for 1 week, but gradually subside over several weeks in people who recover. Later symptoms include:

• Severe muscle spasms
• Seizure-like activity
• Autonomic nervous system disorders

Symptoms can begin 3 days to 3 weeks after being exposed to tetanus.

Complications from tetanus can include bone fractures, abnormal heart rhythms, pneumonia, and sometimes death.

Tetanus is diagnosed based on signs/symptoms of illness and a physical exam. Laboratory testing is not helpful in diagnosing tetanus.

People get tetanus when a wound, or break in the skin, has become contaminated with the bacteria. The bacteria are present everywhere in the environment and especially in soil and animal and human intestine, or anywhere where excreta contamination is common.

Tetanus is not spread from person-to-person.

Anyone who is not adequately vaccinated is at risk for getting tetanus. The elderly and those with weak immune systems are at a higher risk for developing complications.

Contact your doctor to discuss your symptoms.

The best way to prevent tetanus is to get vaccinated. Tetanus vaccine (usually DTaP) is given to children as part of the routine vaccination series at 2, 4, 6, and 15-18 months, and 4-6 years of age. Children 10 years of age and older also routinely receive one dose of vaccine (Tdap). Adults are recommended to get a booster dose of vaccine (Td) every 10 years.

Although any open wound could become contaminated with the bacteria, wounds contaminated with dirt, feces, soil, or saliva are at the greatest risk. All wounds should be properly cleaned. Individuals with deep puncture wounds or tissue injury should see a doctor. Your doctor will determine if you need a tetanus booster.

Please use the following resources, or contact your doctor or primary care physician

• Pennsylvania Department of Public Health Tetanus Fact Sheet
• CDC Tetanus Vaccine

Toxic shock syndrome (TSS) can be caused by toxin-producing Staphylococcus aureus or Group A Streptococcal bacteria. Toxic shock syndrome is a severe illness characterized by a sudden onset of fever, rash, muscle aches, hypotension, and signs of multiorgan involvement. Diarrhea, vomiting, and peeling of the skin on the palms and soles may also be present in staphylococcal TSS. The case fatality rate for TSS is ~5%.

TSS is usually diagnosed through clinical signs and symptoms although laboratory tests may confirm the presence of a bacterial infection.

Toxic shock syndrome is not spread person to person. The syndrome arises when the bacteria grow on a mucous membrane and produce a toxin which causes illness.

Women who are menstruating, using barrier contraceptive devices, or have recently given birth are among the high risk groups for developing TSS. Additional risk groups include persons with a recent history of surgery or postoperative wound infection.

Contact your healthcare provider immediately to be evaluated and treated in a healthcare facility. 

TSS can be prevented in menstruating women by using less-absorbent tampons, changing your tampon every 4 to 8 hours, and intermittently using sanitary napkins throughout a cycle. Women who use barrier contraceptive devices such as diaphragms and contraceptive sponges should follow manufacturer's instructions and not keep them in place for more than 30 hours. Proper infection control in hospitals also reduces the risk of TSS developing in patients who are undergoing surgery or wound care.

Please use the following resource, or contact your doctor or primary care physician.

• CDC Disease Listing

Trichinellosis (also called trichinosis) is a disease caused by ingesting the Trichinella larvae or worms.  This mainly occurs from eating undercooked or raw meat from domestic pigs (pork) or feral carnivorous animals.

Symptoms of trichinellosis will begin with nausea, diarrhea, vomiting, fatigue, fever, and abdominal discomfort.  These symptoms are often followed by headaches, fevers, chills, cough, eye swelling, aching joints and muscle pains, itchy skin, diarrhea, or constipation.

Disease severity is related to number of worms or larvae ingested.  In mild or moderate cases, symptoms will usually subside in a few months.  Some people may not experience any symptoms at all.

In very severe cases, heart failure, breathing problems, and death can occur. 

Diagnosis of trichinellosis is done through a muscle biopsy or through a blood sample.

Trichinosis is spread by eating undercooked meat from an animal infected with the Trichinella worms or worm eggs. Eating undercooked or raw pork is a common cause of trichinosis infections, but meat from other animals can also harbor Trichinella infection including bears, wild felines, foxes, dogs, wolves, horses, seals, and walruses.  The worms once ingested by a person will travel from the intestine, through the blood and settle into muscle.

People who eat undercooked or raw meat are at risk for trichinosis.

Contact your healthcare provider if you think you may have trichinosis, who can test and treat for trichinosis. 

Properly cooking meat can help prevent trichinellosis.  This includes cooking whole cuts of meat and wild game meat (excluding poultry) to an internal temperature of at least 145º F. Cook poultry (whole cuts and ground) to at least 165 º F. Also, freezing pork for 20 days at 5ºF (if less than 6” thick) will kill worms.  Freezing wild game will not kill worms, so it is important to properly cook it.  Meat grinders need to be cleaned carefully.  Curing, drying, smoking or microwaving meat does not kill worms.

There is no vaccine for trichinosis and it cannot be spread person to person.

Please visit:

• CDC Parasite Fact Sheets
• CDC Trichinosis Prevention and Control

Tularemia is a potentially serious bacterial illness that occurs throughout the United States. It is caused by the bacterium Francisella tularensis, and can infect humans and animals (especially rodents, rabbits, and hares).

Symptoms of tularemia vary depending on how the bacteria enter the body, and all include a fever. Main forms of tularemia are:

• Ulceroglandular. Tularemia enters the body from a tick or deerfly bite or after handling an infected animal. A skin ulcer appears at the site where the organism enters the body. Other symptoms include painful lymph node swelling, usually in the armpit and groin. This is the most common form of tularemia.
• Glandular. Symptoms are similar to the ulceroglandular form, but without the ulcer. Bacteria enter the body through a tick or deerfly bite or after handling an infected animal.
• Oculoglandular. In this form, tularemia enters the body through the eye when a person in handling or butchering an infected animal and then touches their eye. Symptoms include eye irritation and swelling of the lymph nodes in front of the ear. 
• Oropharyngeal. Tularemia enters the body through the mouth, usually from eating and drinking contaminated food or water. Symptoms are sore throat, mouth ulcers, tonsillitis, and swelling of the lymph nodes in the neck. 
• Pneumonic. This form of tularemia occurs when the bacteria enter the body by breathing dust or aerosols that contain the organism. It can also occur when other forms of tularemia are left untreated and the bacteria spreads through the blood to the lungs. Symptoms of pneumonic tularemia include cough, chest pain, and difficulty breathing. This is the most serious form of tularemia.

Symptoms usually begin 3 to 5 days after exposure to the bacteria.

The disease can be fatal if it is not treated with the right antibiotics.

Tularemia is a rare disease and is difficult to diagnose. Blood tests and cultures as well as history of exposure to certain animals, ticks, or flies can help confirm the diagnosis.

People can get tularemia from animals or the environment through different routes, however tularemia is not spread person-to-person

• Ticks and Flies – In the United States, dog ticks, wood ticks and lone star tick bites can all transmit disease to humans, as well as deerflies.
• Infected Animals – Tularemia can be transmitted to humans through skinning, handling or eating undercooked meat from infected animals. It can also be ingested through untreated water that is contaminated by infected animals. Tularemia can infect different types of animals. Rabbits, domestic cats, muskrats, prairie dogs and other rodents are known to transmit illness to humans.
• Other exposures – Tularemia can also be transmitted by inhaling dust or aerosols that contain the bacteria. This can occur during farming and landscaping when mowers and equipment run over infected animals or carcasses.

Individuals who spend time outdoors in areas with infected ticks or deerfly are at risk. Animal hunters and trappers are at a higher risk of getting tularemia. Disease is more common in the mid-western United States.

Contact your doctor at the first sign of illness. Since tularemia can be difficult to diagnose and its symptoms can be mistaken for other illnesses, it is important to share with your doctor any likely exposures, such as tick and deerfly bites, or contact with sick or dead animals.

Tularemia can be treated with a course of antibiotics. 

To prevent tularemia, when hiking, camping or working outside avoid tick and deerfly bites:

• Use insect repellants with DEET, picardin or IR3535
• Wear long pants, long sleeves, and long socks
• Remove attached ticks promptly and completely with fine tipped tweezers
• Don't drink untreated surface water

When mowing or landscaping:

• Don't mow over sick or dead animals
• Consider using dust masks to reduce your risk of inhaling the bacteria in endemic area

When hunting, trapping, and skinning animals

• Use gloves to handle animals, especially rabbits, muskrats, prairie dogs and other rodents.
• Cook game thoroughly before eating

Please use the following resources, or contact your doctor or primary care physician.

• CDC Tularemia Page
• MedlinePlus Tularemia Page
• Occupational Safety & Health Administration (OSHA) Tularemia Page
• University of Minnesota Center For Infectious Disease Research & Policy Tularemia Page

Typhoid fever is a bacterial illness caused by Salmonella Typhi.  While it can be a mild illness in endemic areas (countries where there typhoid is common), if untreated it can be life threatening.

Symptoms include:

• Fever
• Headache
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain/cramps
• Constipation
• Cough
• Diarrhea
• Fatigue
• Loss of appetite

Usually, symptoms appear 1 to 2 weeks after exposure, but can appear anywhere from 3 to 60 days after exposure, especially without treatment.
After the acute infection period, people can be carriers of typhoid, meaning they have no symptoms but continue to shed the bacteria in the stool and are infectious.  A small percentage of people (less than 5%) will become permanent carriers of typhoid.

Typhoid fever is spread from eating or drinking food or water that has been contaminated by an infected person's feces or urine.  Flies can also infect food.  Although unusual, typhoid has been transmitted through sexual contact.

The people most at risk for typhoid are those who:

• Travel to or live in countries where typhoid is common
• Are household members or caregivers of a person infected with typhoid
• Have sexual contact with someone who has typhoid

In Philadelphia, typhoid is uncommon and has been associated with travelers and immigrants.

If you think you have typhoid, you should contact your doctor, and discuss your symptoms. A stool, urine or blood sample will be collected to determine the diagnosis.

Antibiotics can be used to treat typhoid.  Your doctor will determine treatment based on drug sensitivity, or which drugs are resistant to typhoid.

Preventing transmission to others is very important. The best way to prevent typhoid transmission by an infected person is by proper hand washing, especially after using the bathroom and before preparing or eating food. There are typhoid vaccines available for people traveling to areas where typhoid is common.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• CDC Typhoid Fact Sheet
• CDC Traveler's Health Yellow Book Chapter 4

Chickenpox, also known as varicella, is an infectious disease caused by the varicella-zoster virus (VZV).

Some people who are diagnosed with chickenpox may experience some of the following signs and symptoms:

• Generalized, itchy rash consisting of >250 lesions that mostly look like fluid-filled blisters.
• Crops or waves of lesions (a few more new lesions appearing with each passing day)
• Fever
• Malaise
• Chickenpox rashes in previously vaccinated individuals are usually mild with <50 lesions and few or no fluid-filled blisters, making it difficult to distinguish from other rashes.

• Persons with no history of disease
• Persons with no varicella vaccine
• Persons with immuno-compromising conditions

Chickenpox is transmitted through airborne droplets (i.e. coughing and sneezing) or by direct contact with lesions. A person is contagious 2 days before the appearance of the chickenpox rash, and continues until rash has dried and crusted which may take 5-10 days from rash onset. After a person is infected with VZV, the virus remains dormant in the body and can reactivate causing shingles (herpes zoster). A person with a shingles rash may also spread VZV, which will cause chickenpox in an exposed, susceptible person.

A physician can diagnose chickenpox during a clinical exam or they may scrape lesions and test the samples for VZV.

If you think that you have chickenpox you should contact your doctor. The doctor will examine your rash and may scrape a few lesions to test for the VZV.  Adults, immuno-compromised persons, and patients with moderate to severe chickenpox illness may be given antiviral medication for 7 to 10 days. 

A vaccine to prevent chickenpox has been available since 1995.  One dose of the chickenpox vaccine is recommended for children 1 to 3 years of age and 2 doses are recommended for those 4 years of age and older. Immununo-compromised individuals and susceptible pregnant women who are ineligible for varicella vaccination should notify their healthcare provider as soon as possible following a chickenpox or shingles exposure, since treatment is available that may prevent chickenpox or modify disease severity.  Those with chickenpox should stay home from school, childcare, or work until the rash has scabbed over, in order to prevent transmission to others. 

Please use the following resources, and contact your doctor or primary care physician:

• CDC- Varicella Disease Questions and Answers
• CDC- Chickenpox Vaccine: What you need to know

West Nile virus (WNV) is a potentially serious illness that humans get after being bitten by an infected mosquito. West Nile virus is seen more in the summer and fall months. Many people who are infected with WNV will not experience any symptoms. About 20% of people will develop a milder illness and less than 1% will develop more severe symptoms.

Milder Symptoms of West Nile virus include:

• Fever
• Headache
• Body aches
• Nausea
• Skin rash on the chest, stomach, and back

Severe symptoms of West Nile virus include:

• High fever
• Neck stiffness
• Disorientation
• Coma
• Muscle weakness
• Vision loss
• Numbness and paralysis
• Convulsions and tremors (seizures and shaking)

The milder symptoms can last as short as a few days or can last up to several weeks. The severe symptoms can last several weeks and the neurological effects could be permanent.
People typically get sick 2-14 days after being bitten by an infected mosquito. However, some people may not feel sick for up to 21 days after being bitten. 

West Nile virus is usually diagnosed by looking at the symptoms that you have and by finding the virus in your blood or in your cerebral spinal fluid (CSF) located in your spinal column.

How do people get West Nile Virus?
Most cases of WNV occur after people have been bitten by an infected mosquito. However, in some cases people can be infected with WNV through blood transfusions, organ donation, and during pregnancy from mother to child. WNV is not spread through touching or kissing.

Who is most likely to get West Nile Virus?
People over the age of 50 and people with weak immune systems are more likely to develop some of the severe symptoms of WNV if they become sick.  It is important for these individuals and all others to avoid being bitten by mosquitoes.

 

What should I do if I have been bitten by a mosquito and I start to have symptoms of WNV?
Most persons with mild WNV illness do not need to seek medical attention as they usually get better on their own. Persons with severe headaches or confusion, symptoms of severe WNV illness, should seek medical attention immediately. Such cases can receive supportive treatment in a hospital. Women who are pregnant or nursing are encouraged to talk to their healthcare provider if they develop symptoms that could be WNV.

How can I prevent West Nile Virus and other diseases transmitted by mosquitoes?
West Nile Virus and other diseases caused by mosquitoes can be prevented by avoiding mosquito bites. The following tips help prevent mosquito bites and breeding around your home:

• When you are outdoors use insect repellent that contains DEET or Picaridin. Be sure to follow the directions on the insert package.
• Avoid being outdoors during dusk and dawn when mosquitoes are most active. If you are outdoors during this time, wear long sleeves and pants and use insect repellant.
• Use screens on windows and doors to keep mosquitoes out.
• Prevent mosquitoes from breeding by emptying anything that contains standing water such as flowerpots, buckets, and barrels. Change the water in pet dishes and replace the water in birdbaths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when they aren't being used.

Please use the following resources, or contact your doctor.

• CDC West Nile Virus Questions and Answers
• MedlinePlus West Nile Virus Page
• PDPH West Nile Virus Brochure
• West Nile Virus Frequently Asked Questions PDF

Yellow fever is a viral illness that is transmitted through the bite of an infected mosquito.  Only certain types of mosquitoes transmit this virus.  Most infections of yellow fever occur in the tropical areas of Africa and regions of South America.  Yellow fever varies in how serious an infection will be.  Many people may have a mild illness with symptoms resolving on their own.  However up to 50% of infections that progress and result in internal bleeding and fever are fatal.

Yellow fever infection occurs in three stages.  During the first stage people may experience:

• Headache
• Fever
• Vomiting
• Chills
• Back ache
• Loss of appetite
• Muscle and joint aches

The second disease stage is when most cases will recover from their initial symptoms but some may progress to more serious complications within days.  Many of these complications will begin in the third stage and include heart, liver, and kidney failure, bleeding disorders, brain dysfunction, seizures, coma, and death.

People get yellow fever after being bitten by an infected mosquito.

Anyone can get yellow fever, but people who live in areas where the species of mosquitoes that carry the virus are present are at risk for getting this disease.  Males between 20 and 40 years of age who are more likely to be exposed to the tropical forest are also at increased risk of infection.  The elderly have a higher risk of severe infection.

If you become sick after a mosquito bite you should call your health care provider.  The only way to know for sure if you have this condition is by a lab test that analyzes a sample of your blood.  Be sure to tell your doctor about any recent mosquito bites or travel to an area where yellow fever is common.  

There is an effective vaccine against yellow fever. Ask your doctor at least 10 - 14 days before traveling if you should be vaccinated against yellow fever.  If you live or travel in an area where yellow fever is common you should use mosquito repellant that contains either DEET or Permethrin, sleep in screened housing, and wear appropriate clothing that covers your body.

Please use the following resources, or contact your doctor.

• CDC Yellow Fever Fact Sheet
• Medline Plus Yellow Fever Home Page
• Mayo Clinic Yellow Fever Home Page