"... In PAGE 3: ... Summary of ACIP recommendations on immunization of health care workers with special conditions 298 Table 3. Summary of suggested work restrictions for health care personnel exposed to or infected with infectious diseases of importance in health care settings, in the absence of state and local regulations 299 Table4 . Recommendation for postexposure prophylaxis for percutaneous or permucosal exposure to hepatitis B virus, United States 303 Table 5.... In PAGE 15: ...56 Booster doses of vaccine are not routinely recommended, because per- sons who respond to the initial vaccine series remain protected against clinical hepatitis and chronic infection even when their anti-HBs lev- els become low or undetectable.57 The need for postexposure prophylaxis, vacci- nation, or both depends on the HBsAg status of the source of the exposure as well as the immu- nization status of the person exposed ( Table4 ).40 Table 4.... In PAGE 43: ...55 Category IA 6) Use both passive immunization with hepatitis B immune globulin and active immunization with hepatitis B vaccine for postexposure prophylaxis in susceptible personnel who have had a needlestick, percutaneous, or mucous membrane exposure to blood known or suspected to be at high risk for being HBsAg seroposi- tive (Table 6). Category IA 7) Follow current recommendations for post- exposure prophylaxis after percutaneous or mucous membrane exposure to blood and body fluids that is known or suspected to be at high risk for being HBsAg seropos- itive ( Table4 ).40 Category IA b.... ..."

"... In PAGE 3: ... Zoonotic disease affecting health care research and laboratory workers is addressed elsewhere in this chapter. Table44 -1 - Diseases spread by droplet/airborne transmission Disease Organism Clinical manifestations Health care/personal care workers at risk Adenovirus Adenovirus rhinitis, pharyngitis, malaise, rash, cough all, especially those in intensive care units, long- term pediatric care facilities and opthamology clinics Influenza Influenza virus fever, chills, malaise, cough, coryza, myalgias all, especially physicians and nurses Measles (Rubeola) Rubeola virus fever, rash, malaise, coryza, conjunctivitis, Koplik apos;s spots, adenopathy, CNS complications all Meningococcal disease Neisseria meningitidis fever, headache, vomiting, confusion, convulsions, petechial rash, neck stiffness emergency medical personnel, emergency department staff Mumps Mumps virus painful/swollen salivary glands, orchitis, meningoencephalitis all, especially pediatricians, dentists, day care workers Pertussis Bordetella pertussis malaise, cough, coryza, lymphocytosis, quot;whooping quot; cough all Parvovirus B19 Parvovirus B19 rash, aplastic anemia, arthritis, myalgias all, especially nurses Respiratory syncitial virus RSV often asymptomatic; respiratory symptoms all Rubella Rubella virus fever, malaise, coryza, rash all Tuberculosis Mycobacteria sp. fever, weight loss, fatigue, pulmonary disease, extrapulmonary involvement including lymphatic, genitourinary, bone, meningeal, peritoneal, miliary all, especially nurses, pathologists, laboratory workers, housekeeping staff Varicella Human herpesvirus 3 chickenpox or zoster presentation... In PAGE 4: ... Table44 -3 - Diseases spread via fecal-oral route Disease Organism Clinical manifestations Health care/personal care workers at risk Helicobacter pylori Helicobacter pylori gastric ulcers endoscopy personnel Hepatitis A Hepatitis A virus gastrointestinal symptoms, malaise, jaundice, hepatomegaly all health care and personal care workers, especially neonatal nurses Norwalk virus Norwalk virus gastrointestinal symptoms all health care and personal care workers, especially nurses and care attendants Polio Poliomyelitis virus muscle weakness, headache, stiff neck, fever, nausea and vomiting, sore throat all Salmonellosis Salmonella species gastrointestinal symptoms, fever, bacteremia, carrier state possible all health care and personal care workers, especially nurses and... In PAGE 5: ...Shigellosis Shigella species gastrointestinal symptoms all health care and personal care workers, especially nursery nurses Table44 -4 - Diseases spread by skin contact Disease Organism Clinical manifestations Health care/personal care workers at risk Herpetic whitlow Herpes simplex vesicles, pruritis all, especially dentists, anesthesiologists, dialysis technicians, physical therapists, physicians, nurses Tinea corporis ringworm Microsporum, trichophyton species ring shaped lesions or scaly lesions on body all Warts Papilloma virus dermatologic manifestations which vary widely in shape, size and appearance dermatologists The methods to control transmission of these diseases are well-established. Many of the diseases are vaccine preventable and are listed in table 44-5.... In PAGE 5: ... It is dangerous to assume a particular institution is safe unless specific inquiries are made regarding potential exposure and protective measures. Table44 -5 - Immunization/immunoprophylaxis recommendations for health care workers Diseases for which immunization is strongly recommended Diseases for which immunization or immunoprophylaxis may be indicated Diseases for which immunization may be indicated under special circumstances hepatitis B, measles, mumps, rubella, influenza, varicella (workers should be current for diptheria and tetanus) typhoid, hepatitis A, pertussis, meningococcal disease, TB rabies, Q fever, vaccinia, others as appropriate for circumstances Current information is easily available from the Centers for Disease Control and Prevention. The Morbidity and Mortality Weekly Report publishes many of the guidelines and recommendations pertaining to infectious disease in general and health care worker safety in particular.... In PAGE 6: ... Diseases of concern are listed in Table 44-6. Table44 -6 - Diseases affecting those who work with or around animals Disease Organisms Clinical manifestations Workers at risk Route of transmission/source Anthrax woolsorter apos;s disease, ragpicker apos;s disease Bacillus anthracis cutaneous papules and ulcers, upper respiratory symptoms, pneumonia, adenopathy, fever, myalgia veterinarians, animal handlers, agricultural workers, butchers, wool sorters, weavers inhalation, ingestion, cutaneous inoculation of spores or bacteria sheep, goats, cattle, horses, soil Brucellosis Bang apos;s disease, undulant fever Brucella species lymphadenopathy, myalgias, headache, hepatitis, quot;undulant fever quot; abattoir workers, veterinarians, agricultural workers ingestion, inhalation, cutaneous inoculation from blood, urine, other secretions and tissues swine, cattle, sheep Campylobacteriosis Campylobacter jejuni gastrointestinal symptoms, fever, sepsis agricultural workers, animal handlers ingestion, direct contact with infected material, usually feces laboratory, domestic... In PAGE 12: ... A listing can be found in Table 44-7. Table44 -7 - Fungal diseases affecting those who work outdoors Disease Organism Clinical manifestations Workers at risk Source/route of transmission Blastomycosis Blastocystis dermatitidis pneumonia, osteolysis, skin nodules and ulcers outdoor workers (Southeast USA and Mississippi Valley) contact with infected soil or dog feces or dog bite Candidiasis Candida albicans skin irritation and rash cannery workers, dishwashers, poultry workers ubiquitous organism, infection associated with wet work Chromomycosis various fungi skin papules, plaques, fistulas outdoor workers, agricultural workers direct skin contact with infected soil Coccidioidomycosis San Joaquin valley fever, desert fever Coccidioides immitis lung nodules, meningitis, disseminated disease outdoor workers in endemic region (Southwest USA) inhalation of spores from soil, fruit, cotton Cryptococcosis Cryptococcis neoformans pulmonary and central nervous system symptoms outdoor workers inhalation of spores from infected soil Maduromycosis Allescheria, aspergillus, nocardia, streptomyces species cellulitis, pain, purulent drainage, arthritis farmers, gardeners, floral workers direct contact with infected soil Mycetoma Actinomycetes species granulomas, abscesses barefoot agricultural workers direct contact with infected soil Paracoccidioidomycosis Paracoccidioides brasiliensis pneumonitis, mucosal ulcers agricultural workers (Central and South America) inhalation of spores from... In PAGE 13: ... A listing can be found in Table 44-8. Table44 -8 - Arthropod associated diseases affecting those who work outdoors Disease Organism Clinical manifestations Other hosts Vector VIRAL California encephalitis CAL virus fever, encephalitis birds, small mammals mosquito Colorado tick fever CTF virus fever, myalgia squirrels, porcupines, chipmunks, mice tick Dengue Breakbone fever DEN virus chills, headache, backache, retroorbital pain, arthralgias, bradycardia, hypotension, rash, splenomegaly, adenopathy, primates mosquito Eastern equine encephalitis EEE virus encephalitis horses, wild birds, small mammals mosquito LaCrosse encephalitis LAC virus fever, encephalitis chipmunks, foxes, squirrels, small mammals mosquito Powassan encephalitis POW virus encephalitis marmots, woodchucks, rabbits, squirrels, mice tick St. Louis encephalitis SLE virus fever, encephalitis wild birds mosquito Venezuelan equine encephalitis VEE virus fever, encephalitis horses, zebras, mosquito Western equine encephalitis WEE virus fever, encephalitis wild birds and mammals, horses mosquito Rift Valley fever, Russian spring-summer encephalitis, Sandfly fever, Crimean Congo hemorrhagic fever, Japanese encephalitis, over two hundred arboviral infections fever, encephalitis, variety of other symptoms including hemorrhagic complications: variety of reservoirs and vectors RICKETTSIAL Ehrlichiosis Ehrlichia canis fever, myalgia, malaise, headache, no rash dogs... In PAGE 15: ...Malaria Plasmodium species fever, malaise, headache, chills, paroxysmal pattern of disease man, cattle, other animals mosquito Sleeping sickness African trypanosomiasis Trypanosoma brucei gambiense irregular fever, headaches, arthralgias, pruritus, rash, adenopathy, neurologic symptoms man, cattle, pigs fly Other diseases may be acquired via various routes and in various settings and are listed in Table 44-9. Table44 -9 - Other diseases affecting those who work outdoors Disease Organism Clinical manifestation Workers at risk Source/route of transmission Amebiasis Amebic dysentery Entamoeba histolytica gastrointestinal symptoms outdoor workers, animal handlers ingestion via water, food, fomites Cutaneous larval migrans Creeping eruption Ancylostoma species rash, pruritis outdoor workers contact with soil containing infected animal feces Hanta virus Hantavirus fever, myalgia, pulmonary involvement including pulmonary edema outdoor workers, pest control workers, agricultural workers aerosols from infected saliva and excrement of infected rodents Melioidosis Pseudomonas pseudomallei pulmonary symptoms, fever, septicemia, arthritis, meningitis, abscesses, osteomyelitis outdoor workers contact with contaminated soil, inhalation Nocardiosis Nocardia species pneumonia, empyema, brain abscesses, skin and visceral abscesses outdoor workers inhalation of or direct contact with infected soil Strongylodiasis Strongyloides stercoralis rash, diarrhea, nausea, coughing, pulmonary infiltrates outdoor workers direct contact with infected soil The arboviruses and many other diseases discussed in this section are an area of intense interest and many of them fall under the category of emerging infectious diseases. The Centers for Disease Control and Prevention as well as several non-government organizations track these diseases closely.... In PAGE 16: ... The Centers for Disease Control and Prevention provides a wealth of online and printed material pertinent to many of these diseases. Table44 -10 - Diseases affecting those who work in or around water Disease Organism Clinical manifestations Workers at risk Route/source of transmission Amebic meningoencephalitis Naegleria fowleri fever, headache, purulent meningoencephalitis divers through nasal mucosa Cholera Vibrio cholerae gastrointestinal symptoms divers, waste workers ingestion Erysipeloid Erythema migrans, fish handler apos;s disease Erisipelothrix rhusiopathiae rash, pruritis, arthritis fisherman direct contact with infected fish, shellfish, meat, poultry Leptospirosis Fort Bragg fever, Weil apos;s disease Leptospira species fever, hepatitis, uveitis, meningitis, renal failure waste workers, divers aerosol, cutaneous or ingestion contact with infected tissues or secretions (especially urine) from livestock, dogs, cats, mice, other animals Nanophyetiasis Nanophyetus salmincola gastrointestinal symptoms fish handlers, marine biologists hand to mouth Polio Poliomyelitis virus muscle weakness, headache, stiff neck, fever, nausea and vomiting, sore throat divers, waste workers ingestion Schistosomiasis Bilharziasis Schistosoma species rash, pneumonitis, granulomas, intestinal and hepatic fibrosis agricultural workers, divers skin contact, ingestion Schistosomal dermatitis Swimmer apos;s itch Schistosome cercariae itching, rash divers, agricultural workers skin contact Shigellosis Shigella species gastrointestinal symptoms waste workers... In PAGE 17: ... Most building-related illness and infection can be prevented by proper design and maintenance of heating, cooling and ventilation systems and assuring all water sources are free of biologic contaminants. Table44 -11 - Diseases affecting those who work indoors Organism Clinical manifestations Source Legionella pneumophila pneumonia cooling towers Histoplasma capsulatum systemic infection bird droppings Influenza respiratory and other symptoms humans Naegleria fowleri fever, headache, purulent meningoencephalitis contaminated reservoirs Mycobacterium tuberculosis respiratory and disseminated disease ventilation system TRAVEL MEDICINE Travel medicine is an area of great interest for multinational corporations and smaller companies which do business in foreign countries. Many of the diseases discussed elsewhere in this chapter become occupational when business related travel places a worker at increased risk of a... ..."

"... In PAGE 8: ...3. Results In this study breast cancer biopsy slides stained either for estrogen (ER) or progesterone (PgR) receptors were analyzed, as given in Table2 . One expert graded individually tumor nuclei in the available 28 biopsy images which amounted to 3015 nuclei.... ..."