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4 www.NationalNursesUnited.org VRE: Vancomycin-resistant Enterococci (VRE) can sometimes cause hard-to-treat infections. Most VRE infections occur in hospitals and other health care settings. VRE is spread via contact with contaminated surfaces or directly from person-to-person. Norovirus: This virus is the most common cause of acute gastroenteritis and is often responsible for out- breaks in community and health care settings. The CDC estimates that over 23 million gasterenteritis cases each year may be caused by norovirus, and that norovirus may lead to over 91,000 emergency room visits and 23,000 hospitalizations each year in the U.S. Contaminated food or water are a common source for norovirus outbreaks as well as exposure to aerosols from an infected person vomiting. Influenza: Illness may be caused by several different influenza virus strains with varying levels of infectivity and severity. Flu season generally occurs in the late fall through winter in the Northern hemisphere. Some flu seasons are more severe than others, depending on which strain is circulating. The CDC collects and reports annual surveillance data. Influenza can be transmitted via breathing in droplets and aerosols emitted by infected persons as well as contact with contaminated surfaces. Measles: This vaccine-preventable disease has made more appearances recently, such as the outbreaks in Disney theme parks in 2015, the outbreak in Minnesota in 2017, and several others reported on the CDC's web- site. Measles is highly contagious and can spread via an infected person's coughing and sneezing. The virus can survive for several hours in airspace and on surfaces and is so contagious that 90% of people close to an infected person will also become infected if not already immune. Meningitis: This disease can be caused by bacteria, viruses, and other pathogens. Bacterial meningitis is a severe and serious disease that can result in death in as little as a few hours. The CDC reports that bacterial men- ingitis causes about 4,100 cases and 500 deaths in the U.S. each year. Bacterial meningitis can be spread by an infected person's coughing and sneezing in close contact with others as well as other means such as contaminated food. Pertussis: Also known as whooping cough, pertussis is a very contagious, vaccine-preventable disease that is caused by a bacteria called Bordetella pertussis. Pertussis can be spread from person-to-person through coughing or sneezing from an infected person or by sharing breath- ing space for a long time. The annual number of pertussis cases has gone down since 1922, as reported by the CDC. However, outbreaks still occur. See Figure 1. SARS: Severe acute respiratory syndrome (SARS) was first reported in 2003 in Asia and shortly spread across the world before it was contained. SARS is caused by infection with a coronavirus that is easily spread between people in close contact via respiratory droplets and airborne aerosols. While the CDC reports that no cases of SARS have been identified since 2004, newly emerg- ing diseases like SARS can pose a significant hazard to nurses and other health care workers where employers have not implemented sufficient protection and preven- tion measures. MERS: Middle East Respiratory Syndrome (MERS) was first reported in Saudi Arabia in 2012. Since then it has caused several outbreaks in health care facilities. MERS is caused by a virus and most infected persons develop a severe acute respiratory illness with a fatality rate around 3 to 4 out of every 10 MERS patients. MERS can be spread through close contact and through the air when an infected person coughs or sneezes and releases droplets and aerosols. Tuberculosis: Infection by Mycobacterium tubercu- losis most often occurs in the lungs and can lead to TB or latent TB infection (LTBI). TB bacteria are spread through the air when a person with active TB disease coughs, speaks, sings, or breaths and releases TB bacte- ria into the air. The CDC reports that one-fourth of the world's population is infected with TB. Over 9,000 cases of TB were reported in the U.S. in 2016. Drug-resistant strains of TB are increasing worldwide. Ebola: Ebola virus disease is caused by infection with the Ebola virus. Clinical presentation of persons acutely ill with Ebola virus disease includes profuse vomiting, diarrhea, and severe mucotaneous bleeding. Each of these bodily fluids contains viral RNA in sufficient quantities to transmit infection during patient care, post-mortem care, and room decontamination. The dose of viral particles required to cause infection is very low. Transmission occurs via contact, respiratory droplets, and aerosols emitted from infected patients or generated during patient care. During the 2014 Ebola outbreak in Sierra Leone, the CDC estimated that the rate of Ebola infection in health care workers was 103 times higher than in the general population. Figure 1: Reported NNDSS pertussis cases 1922 to 2016, from CDC https://www.cdc.gov/pertussis/images/ incidence-graph.png

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