Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

Control measures. Person-to-person transmission is not known to occur, although transmission
from contaminated clothing has been reported. Soap and water or a 0.5% chlorine solution can
be used for decontamination.
Reporting. If Q fever is suspected, contact your local and State health departments. If they are
unavailable, contact the CDC at 770-488-7100.
Staphylococcal Enterotoxin B
Staphylococcus enterotoxin B (SEB) is an exotoxin that acts on the intestine to produce a brisk
cascade of pro-inflammatory cytokines, resulting in an intense inflammatory response. Food
poisoning due to SEB results from ingestion of improperly handled food that contains
enterotoxin.
Signs and symptoms. Natural disease is generally localized to the GI tract. After a brief
incubation period (30 minutes to 8 hours, usually 2–4 hours), the exposed individual experiences
abrupt and sometimes violent onset of severe nausea, abdominal cramps, vomiting, and
prostration, often accompanied by diarrhea. There may be an associated low-grade fever or
subnormal temperature. Symptoms typically last 1–2 days. Inhalational exposure, as might be
expected in an incident of bioterrorism, results in predominantly respiratory symptoms, including
nonproductive cough, retrosternal chest pain, and dyspnea. GI symptoms may be seen as well if
toxin is inadvertently swallowed. Fever (103°–106°F) is likely and may last up to 5 days with
chills and prostration. There may be conjunctival injection, and fluid losses may lead to postural
hypotension. Chest radiographs are likely to be normal, but overt pulmonary edema can occur.
Diagnosis. Clinically, symptoms of staphylococcal enterotoxin ingestion can be distinguished
from other causes of food poisoning except those due to Bacillus cereus. Illness due to
Clostridium perfringens has a shorter incubation period and rarely is accompanied by vomiting.
Foodborne Salmonella or Shigella infection usually is accompanied by fever.
Symptoms of inhalation of SEB are similar to those caused by many other respiratory pathogens.
However, the clinical condition of respiratory disease due to inhaled SEB would be expected to
stabilize without specific therapy, unlike that caused by tularemia, anthrax, or pneumonic plague.
The absence of infiltrates on chest radiographs should also help distinguish respiratory tract
disease caused by SEB from that caused by other likely agents of bioterrorism.
SEB antigen can be detected in urine, serum, or respiratory secretions. In addition, acute and
convalescent serum samples should be submitted for antibody titer.
Treatment. Supportive care should include close attention to hydration and oxygenation.
Control measures. SEB is not absorbed through intact skin, and secondary aerosolization from
affected patients is not hazardous. Environmental surfaces may be decontaminated using soap
and water. Contaminated foodstuffs should be destroyed.
Reporting. If disease due to SEB is suspected, contact your local and State health departments.
If they are unavailable, contact the CDC at 770-488-7100.
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