Airborne Pathogens

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Airborne Pathogens
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Annual Competency
Chesapeake Medical Staffing

Content
Tuberculosis
SARS
Avian Influenza

Introduction
Airborne pathogens differ from bloodborne
pathogens in that they are spread by
inhaling a pathologic microorganism. An
infectious person's coughing or sneezing
can send tiny droplets of moisture into the
air that contain the pathogen. Depending
on the environment, these contaminants
can remain airborne for several hours.

Types of Airborne Pathogens
There are three types of airborne
pathogens:
• viral
• bacterial
• fungal

Illnesses caused by Airborne
Pathogens
Examples of diseases transmitted
through the air include:
• meningitis
• influenza
• pneumonia
• Tuberculosis
• SARS

Exposure
If an airborne pathogen is inhaled, the pathogen
may be transmitted to a receptive host.
Exposure to airborne pathogens, however, does
not always result in infection. Those individuals
who are around an infectious person on a
regular basis, such as family members and
coworkers, are more susceptible to airborne
pathogens than someone who experiences a
single isolated exposure.

Risk for Health Care Providers
According to the CDC, heath care workers
face a greater risk of exposure to
airborne pathogens than the general
Public. Standard Precautions and Droplet
Precautions should be used when caring
for any patient with symptoms of
respiratory illness.

Respiratory Protection
OSHA requires healthcare settings that use
respiratory protection to prevent the inhalation
of infectious droplet nuclei to develop,
implement, and maintain a personal respiratory
protection program. All healthcare workers who
use respiratory protection must be included in
the program. The two most critical elements of a
personal respiratory protection program are:
• training of healthcare workers
• selection of appropriate, well-fitting respirators (CDC,
2004).

N-95 Respirators (Masks)
Anyone working in an area where there is a
possibility of exposure to tuberculosis, must be fitted
for a respirator hepa-filter mask.
• Fit-testing must be done by an Infection Control
Practitioner, Clinical Nurse Specialist or trained
designee.
• A NIOSH (National Institute for Occupational Safety
& Health) approved N95 respirator is the only
appropriate respiratory protection to be used when
caring for a patient with possible active tuberculosis.

Tuberculosis
Tuberculosis (TB) is an airborne disease
caused by Mycobacterium tuberculosis (M.
tuberculosis). It is spread primarily by
droplet nuclei—tiny airborne particles—
expelled by an individual who has infectious
TB disease (CDC, 2004). If another person
inhales air containing these droplet nuclei,
transmission may occur.

Likelihood of Transmission
When a susceptible individual inhales droplet
nuclei containing the tubercle bacilli, TB
transmission may occur. The probability that TB
will be transmitted depends on the:
• infectiousness of the individual with TB disease
• environment in which exposure occurred
• duration of exposure
• virulence of the organism

TB Infection Control Program
An effective TB infection control program
comprises the following three-level hierarchy of
controls:
• administrative controls, to reduce the risk of
exposure to individuals with potentially infectious TB
• environmental controls, to prevent the spread and
reduce the concentration of infectious droplet nuclei
• individual respiratory protection use in situations
that pose a relatively high risk for exposure to TB
(CDC, 2004)

Effective TB Infection Control
Effective TB infection control depends on:
• early detection
• airborne infection
• isolation
• treatment of individuals with infectious TB

Symptoms of TB
People with TB infection often have no
symptoms and do not feel sick. If the
infection advances to TB disease,
however, the person's symptoms may
include:
• weight loss
• fever/chills
• night sweats
• feeling weak
• cough (> 3weeks)
• chest pain
• hemoptysis
(coughing up blood)

Annual TB Testing
All healthcare workers who have patient contact
are required to receive a PPD annually (some
hospitals may require more frequent PPD
testing). The PPD or purified protein derivative is
a tuberculin skin test that has been the
traditional method of demonstrating infection
with the bacteria that causes TB. The purpose of
the TB skin test or PPD is to determine whether
an individual has been exposed to TB and has a
TB infection.

TB Exposure
Like an exposure to a bloodborne pathogen, any
exposure to a known TB source should be
reported to CMS. Following an exposure you
should be medically evaluated and tested for TB.
A baseline skin test (PPD) should be performed,
followed by a second test in eight to twelve
weeks after exposure.
Under the direction of the CMS medical director,
CMS offers annual PPD testing at no cost for all associates.

Current Facts
Although current activities to control TB are yielding
significant results nationwide, TB elimination will require
sustained effort, long-term commitment, new tools, and
strong partnerships with other federal health agencies and
state and local health departments (CDC, 2004). Even
though the 2005 TB rate was the lowest recorded in the
United States since national reporting began in 1953, the
average annual decline has slowed during the past three
Years. MDR (multi-drug resistant) TB remains a threat,
and disparate rates of TB persist among certain
racial,ethnic, and foreign-born populations (CDC, 2006a).

SARS
Severe acute respiratory syndrome (SARS) is a
viral respiratory illness caused by a coronavirus,
called SARS-associated coronavirus (SARS-CoV).
SARS was first reported in Asia in February
2003. Over the next few months, the illness
spread to more than two dozen countries in
North America, South America, Europe, and Asia
before the SARS global outbreak of 2003 was
contained.

SARS Outbreak in 2003
In 2003, an outbreak of severe acute respiratory
syndrome (SARS) in some parts of the world caused a new
concern. SARS is primarily an infectious disease,
transmitted when an infected person coughs or sneezes
within close proximity of others. During the 2003
epidemic, almost 10% of the approximately 8000 known
SARS victims in the world died. Only 7 people in the
U.S. were known to have contracted SARS after
international travel to epidemic areas. The U.S.
Centers for Disease Control and Prevention continues
to monitor the risks of SARS and will issue updates
and warnings if new outbreaks occur.

Symptoms of SARS
In general, SARS begins with a high fever
(temperature greater than 100.4°F [>38.0°C]).
Other symptoms may include headache, an
overall feeling of discomfort, and body aches.
Some people also have mild respiratory
symptoms at the outset. About 10 percent to 20
percent of patients have diarrhea. After 2 to 7
days, SARS patients may develop a dry cough.
Most patients develop pneumonia.

How SARS Spreads
The main way that SARS seems to spread is by close person-to-
person contact. The virus that causes SARS is thought to be
transmitted most readily by respiratory droplets (droplet spread)
produced when an infected person coughs or sneezes. Droplet
spread can happen when droplets from the cough or sneeze of an
infected person are propelled a short distance (generally up to 3
feet) through the air and deposited on the mucous membranes of
the mouth, nose, or eyes of persons who are nearby. The virus
also can spread when a person touches a surface or object
contaminated with infectious droplets and then touches his or her
mouth, nose or eye(s). In addition, it is possible that the SARS
virus might spread more broadly through the air (airborne
spread) or by other ways that are not now known.

“Close Contact”
In the context of SARS, close contact means
having cared for or lived with someone with
SARS or having direct contact with respiratory
secretions or body fluids of a patient with SARS.
Examples of close contact include:
• kissing or hugging
• sharing eating or drinking utensils
• talking to someone within 3 feet
• touching someone directly

CDC Update on SARS
CDC continues to work with other federal agencies, state
and local health departments, and healthcare
organizations to plan for rapid recognition and response if
person-to-person transmission of SARS-CoV recurs. CDC
has developed recommendations and guidelines to help
public health and healthcare officials plan for and respond
quickly to the reappearance of SARS in a healthcare
facility or community. These are available in the document
Public Health Guidance for Community-Level Preparedness and
Response to Severe Acute Respiratory Syndrome (SARS).
CDC provides the latest information on SARS on the
SARS website.

Avian Influenza
Avian influenza is an infection caused by avian
(bird) influenza (flu) viruses. These influenza
viruses occur naturally among birds. Wild birds
worldwide carry the viruses in their intestines,
but usually do not get sick from them. However,
avian influenza is very contagious, and some
domesticated birds—including chickens, ducks,
and turkeys—can become infected and even die.

Risk from Avian Influenza
The risk from avian influenza is generally low for
most people because the viruses occur mainly among
birds and do not usually infect humans. However,
more than 200 human cases of avian influenza
infection have been reported since 1997. Most cases
of avian influenza infection in humans have resulted
from direct or close contact with infected poultry (eg,
domesticated chicken, ducks, and turkeys) or
surfaces contaminated with secretion/excretions from
infected birds.

Risks to Human Health
Two main risks to human health from avian
influenza are:
• The risk of direct infection when the virus
passes from the infected bird to humans,
sometimes resulting in severe disease
• The risk that the virus—if given enough
opportunities—will change into a form that is
highly infectious for humans and spreads
easily from person to person.

Symptoms of Avian Influenza
in Humans
Symptoms of avian influenza in humans
have ranged from typical human influenza-like
symptoms (fever, cough, sore throat, and
muscle aches) to eye infections (conjunctivitis),
pneumonia, acute respiratory distress, viral
pneumonia, and other severe and life-
threatening complications. The symptoms of
avian influenza may depend on which specific
virus subtype and strain caused the infection.

Diagnosis of Avian Influenza
A laboratory test is needed to confirm avian
influenza in humans. Studies done in
laboratories suggest that the prescription
medicines approved in the United States for
human influenza viruses should work in treating
avian influenza infection in humans. However,
influenza viruses can become resistant to these
medications, so they may not always work.

Drug Resistant Organism
The H5N1 virus that has caused human illness
and death in Asia is resistant to amantadine and
rimantadine, two antiviral medications
commonly used for influenza. Two other antiviral
medications, oseltamivir (Tamiflu) and zanamivir
(Relenza), may work to treat influenza caused
by H5N1 virus, but additional studies are needed
to demonstrate their effectiveness.

Increased Resistance
Because of increased resistance to the adamantanes, the
CDC issued a Health Alert Network (HAN) notice in
January of 2006, recommending against the use of
adamantanes (amantadine and rimantadine) for the
treatment or prophylaxis of flu for the duration of the
2006 flu season. Healthcare practitioners should
ensure that the appropriate person(s) at their agencies are
subscribed to both the CDC Health Alert Network and their
state’s HAN, and that information from those networks is
distributed as deemed appropriate.

No H5N1 Vaccine Available
There currently is no commercially available
vaccine to protect humans against the H5N1
virus being seen in Asia and Europe. However,
vaccine development efforts are under way.
Research studies to test a vaccine to protect
humans against H5N1 virus began in April 2005,
and a series of clinical trials is ongoing. More
information is available from the National
Institutes of Health vaccine website and the
World Health Organization avian flu website.

Additional Precautions Needed
The rationale for the use of additional precautions for
avian influenza as compared with human influenza
include the following:
• The risk of serious disease and increased mortality from
highly pathogenic avian influenza may be significantly
higher than from infection by human influenza viruses.
• Each human infection represents an important
opportunity for avian influenza to further adapt to
humans and gain the ability to transmit more easily
among people.
• Although rare, human-to-human transmission of avian
influenza may be associated with the possible
emergence of a pandemic strain.

Vaccination of Healthcare
Workers
Healthcare workers involved in the care of patients with
documented or suspected avian influenza should be
vaccinated with the most recent seasonal human
influenza vaccine. In addition to providing protection
against the predominant circulating influenza strain, this
measure is intended to reduce the likelihood of a
healthcare worker’s being co-infected with human and
avian strains where genetic rearrangement could take
place, leading to the emergence of potential pandemic
strain.

Pandemic Risk
A pandemic is a global disease outbreak. A flu
pandemic occurs when a new influenza virus
emerges for which people have little or no
immunity, and for which there is no vaccine. The
disease spreads easily person-to-person, causes
serious illness, and can sweep across a country
and around the world in very short time.

Difficult to Predict
It is difficult to predict when the next influenza
pandemic will occur or how severe it will be.
Wherever and whenever a pandemic starts,
everyone around the world is at risk. Countries
might, through measures such as border
closures and travel restrictions, delay arrival of
the virus, but they cannot stop it.

Potential Human Pandemic
Health professionals are concerned that the continued
spread of a highly pathogenic avian H5N1 virus across
eastern Asia and other countries represents a significant
threat to human health. The H5N1 virus has raised
concerns about a potential human pandemic because:
• it is especially virulent
• it is being spread by migratory birds
• it can be transmitted from birds to mammals and in some
limited circumstances to humans
• like other influenza viruses, it continues to evolve

Preparation
Education and outreach are critical to preparing
for a pandemic. Understanding what a pandemic
is, what needs to be done at all levels to prepare
for pandemic influenza, and what could happen
during a pandemic helps people to make
informed decisions. Well-informed healthcare
professionals may help others in their
communities in this endeavor.

Airborne Pathogens

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