Disease Causing Agents: Classification of Etiologic agents

DISEASE CAUSING AGENTS (PATHOGENS)
NATIONAL INSTITUTE OF HEALTH

Disease-Causing Agents
http://www4.od.nih.gov/oba/rac/guidelines_02/APPENDIX_B.htm

APPENDIX B.     CLASSIFICATION OF HUMAN ETIOLOGIC AGENTS ON THE BASIS OF HAZARD
Appendix B-II.   Risk Group 2 (RG2) Agents
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Administrators note:
With all the people that die from these disease-causing agents in food and water contamination incidents,
the government still says they are rarely serious and treatment is often available.

In 1996, Dr. Ralph J. Touch, Chief Sanitarian at U.S. Department of Health and Human Services
discussed some of the problems in a paper for the Fourth World Congress on Environmental
Health. However, even he doesn't like to talk about death in the United States associated with food and water
contamination. He doesn't mention the over 400 deaths in the CRYPTOSPORIDIOSIS
outbreak, which was shown to be a human strain. He doesn't talk about the deaths associated with the 80 million food
contaminated incidents. Nor does he discuss the millions of tons of infectious sludge/biosolids disposed of as a fertilizer
on food crops, on home lawns and gardens,on wetlands, on parks, golf courses, school yards, and within 30 meters of
streams and rivers. The government position is that if you wash your hands enough, you are not going to inhale any
infectious disease-causing agents, your are not going to drink any infectious agent contaminated water, and you are not
going to eat any infectious contaminated food, unless you happen to be in a hospital.

Infectious and parasitic diseases are still the leading cause of death worldwide in 1990s. According to the
World Health Organization nineteen and a half million adults and children died of infectious diseases in
1992.

According to the Centers for Disease Control and prevention, food poisoning affects as many as 80 million
people in the U.S. each year at a cost of 7.6 billion dollars. Restaurant, hospitals, nursing home and
child/day care workers fail to wash there hands over 60 percent of the required time. Each year there are
over 2 million health care acquired infections in the U.S. resulting in over 30,000 deaths.

- E. COLI O157:H7: Commonly consumed food items contaminated with infectious agents place large
numbers of persons at risk. Although escherichia coli is a common bacterium that all human beings have in
their intestines, one strain of E. coli called E. coli O157:H7 is especially virulent. In 1993, hamburgers
contaminated with this bacterial strain caused a multi-state outbreak of severe bloody diarrhea and several
deaths in the USA.

- CRYPTOSPORIDIOSIS: We are so accustomed to, safe, clean and plentiful water supplies that we think
about water only when a problem arises. The largest recorded waterborne disease outbreak in our nation's
history occurred in Milwaukee, Wisconsin in April 1993. A parasitic infection of the small intestine which can
produce severe watery diarrhea. Outbreaks of gastro-intestinal illness due to contaminated municipal water
still occur. This out-break of cryptosporidiosis affected over 400,000 people, and more than 4,400 people
were hospitalized.

- BACTERIAL MENINGITIS: In May 1996 infected more than 100,000 people in West Africa, killing more than
10,000.
http://www.atsdr.cdc.gov/SO/emergdis.html
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RG2 agents are associated with human disease which is rarely serious and for which preventive or therapeutic
interventions are often available.

Appendix B-II-A.   Risk Group 2 (RG2) - Bacterial Agents Including Chlamydia

--Acinetobacter baumannii (formerly Acinetobacter calcoaceticus)

--Actinobacillus

--Actinomyces pyogenes (formerly Corynebacterium pyogenes)

--Aeromonas hydrophila

--Amycolata autotrophica

--Archanobacterium haemolyticum (formerly Corynebacterium haemolyticum)

--Arizona hinshawii - all serotypes

--Bacillus anthracis

--Bartonella henselae, B. quintana, B. vinsonii

--Bordetella including B. pertussis

--Borrelia recurrentis, B. burgdorferi

--Burkholderia (formerly Pseudomonas species) except those listed in Appendix B-III-A (RG3))

--Campylobacter coli, C. fetus, C. jejuni

--Chlamydia psittaci, C. trachomatis, C. pneumoniae

--Clostridium botulinum, Cl. chauvoei, Cl. haemolyticum, Cl. histolyticum, Cl. novyi, Cl. septicum, Cl. tetani

--Corynebacterium diphtheriae, C. pseudotuberculosis, C. renale

--Dermatophilus congolensis

--Edwardsiella tarda

--Erysipelothrix rhusiopathiae

--Escherichia coli - all enteropathogenic, enterotoxigenic, enteroinvasive and strains bearing K1 antigen, including E.
coli O157:H7

--Haemophilus ducreyi, H. influenzae

--Helicobacter pylori

--Klebsiella - all species except K. oxytoca (RG1)

--Legionella including L. pneumophila

--Leptospira interrogans - all serotypes

--Listeria

--Moraxella

--Mycobacterium (except those listed in Appendix B-III-A (RG3)) including M. avium complex, M. asiaticum, M. bovis BCG
vaccine strain, M. chelonei, M. fortuitum, M. kansasii, M. leprae, M. malmoense, M. marinum, M. paratuberculosis, M.
scrofulaceum, M. simiae, M. szulgai, M. ulcerans, M. xenopi

--Mycoplasma, except M. mycoides and M. agalactiae which are restricted animal pathogens

--Neisseria gonorrhoeae, N. meningitidis

--Nocardia asteroides, N. brasiliensis, N. otitidiscaviarum, N. transvalensis

--Rhodococcus equi

--Salmonella including S. arizonae, S. cholerasuis, S. enteritidis, S. gallinarum-pullorum, S. meleagridis, S. paratyphi, A,
B, C, S. typhi, S. typhimurium

--Shigella including S. boydii, S. dysenteriae, type 1, S. flexneri, S. sonnei

--Sphaerophorus necrophorus

--Staphylococcus aureus

--Streptobacillus moniliformis

--Streptococcus including S. pneumoniae, S. pyogenes

--Treponema pallidum, T. carateum

--Vibrio cholerae, V. parahemolyticus, V. vulnificus

--Yersinia enterocolitica

Appendix B-II-B.   Risk Group 2 (RG2) - Fungal Agents

--Blastomyces dermatitidis

--Cladosporium bantianum, C. (Xylohypha) trichoides

--Cryptococcus neoformans

--Dactylaria galopava (Ochroconis gallopavum)

--Epidermophyton

--Exophiala (Wangiella) dermatitidis

--Fonsecaea pedrosoi

--Microsporum

--Paracoccidioides braziliensis

--Penicillium marneffei

--Sporothrix schenckii

--Trichophyton

Appendix B-II-C.   Risk Group 2 (RG2) - Parasitic Agents

--Ancylostoma human hookworms including A. duodenale, A. ceylanicum

--Ascaris including Ascaris lumbricoides suum

--Babesia including B. divergens, B. microti

--Brugia filaria worms including B. malayi, B. timori

--Coccidia

--Cryptosporidium including C. parvum

--Cysticercus cellulosae (hydatid cyst, larva of T. solium)

--Echinococcus including E. granulosis, E. multilocularis, E. vogeli

--Entamoeba histolytica

--Enterobius

--Fasciola including F. gigantica, F. hepatica

--Giardia including G. lamblia

--Heterophyes

--Hymenolepis including H. diminuta, H. nana

--Isospora

--Leishmania including L. braziliensis, L. donovani, L. ethiopia, L. major, L. mexicana, L. peruvania, L. tropica

--Loa loa filaria worms

--Microsporidium

--Naegleria fowleri

--Necator human hookworms including N. americanus

--Onchocerca filaria worms including, O. volvulus

--Plasmodium including simian species, P. cynomologi, P. falciparum, P. malariae, P. ovale, P. vivax

--Sarcocystis including S. sui hominis

--Schistosoma including S. haematobium, S. intercalatum, S. japonicum, S. mansoni, S. mekongi

--Strongyloides including S. stercoralis

--Taenia solium

--Toxocara including T. canis

--Toxoplasma including T. gondii

--Trichinella spiralis

--Trypanosoma including T. brucei brucei, T. brucei gambiense, T. brucei rhodesiense, T. cruzi

--Wuchereria bancrofti filaria worms

Appendix B-II-D.   Risk Group 2 (RG2) - Viruses

Adenoviruses, human - all types

Alphaviruses (Togaviruses) - Group A Arboviruses

--Eastern equine encephalomyelitis virus

--Venezuelan equine encephalomyelitis vaccine strain TC-83

--Western equine encephalomyelitis virus

Arenaviruses

--Lymphocytic choriomeningitis virus (non-neurotropic strains)

--Tacaribe virus complex

--Other viruses as listed in the reference source (see Section V-C, Footnotes and References of Sections I through IV)

Bunyaviruses

--Bunyamwera virus

--Rift Valley fever virus vaccine strain MP-12

--Other viruses as listed in the reference source (see Section V-C, Footnotes and References of Sections I through IV)

Caliciviruses

Coronaviruses

Flaviviruses (Togaviruses) - Group B Arboviruses

--Dengue virus serotypes 1, 2, 3, and 4

--Yellow fever virus vaccine strain 17D

--Other viruses as listed in the reference source (see Section V-C, Footnotes and References of Sections I through IV)

Hepatitis A, B, C, D, and E viruses

Herpesviruses - except Herpesvirus simiae (Monkey B virus) (see Appendix B-IV-D, Risk Group 4 (RG4) - Viral Agents)

--Cytomegalovirus

--Epstein Barr virus

--Herpes simplex types 1 and 2

--Herpes zoster

--Human herpesvirus types 6 and 7

Orthomyxoviruses

--Influenza viruses types A, B, and C

--Other tick-borne orthomyxoviruses as listed in the reference source (see Section V-C, Footnotes and References of
Sections I through IV)

Papovaviruses

--All human papilloma viruses

Paramyxoviruses

--Newcastle disease virus

--Measles virus

--Mumps virus

--Parainfluenza viruses types 1, 2, 3, and 4

--Respiratory syncytial virus

Parvoviruses

--Human parvovirus (B19)

Picornaviruses

--Coxsackie viruses types A and B

--Echoviruses - all types

--Polioviruses - all types, wild and attenuated

--Rhinoviruses - all types

Poxviruses - all types except Monkeypox virus (see Appendix B-III-D, Risk Group 3 (RG3) - Viruses and Prions) and
restricted poxviruses including Alastrim, Smallpox, and Whitepox (see Section V-L, Footnotes and References of
Sections I through IV)

Reoviruses - all types including Coltivirus, human Rotavirus, and Orbivirus (Colorado tick fever virus)

Rhabdoviruses

--Rabies virus - all strains

--Vesicular stomatitis virus - laboratory adapted strains including VSV-Indiana, San Juan, and Glasgow

Togaviruses (see Alphaviruses and Flaviviruses)

--Rubivirus (rubella)

Appendix B-III.    Risk Group 3 (RG3) Agents

RG3 agents are associated with serious or lethal human disease for which preventive or therapeutic interventions may
be available.

Appendix B-III-A.   Risk Group 3 (RG3) - Bacterial Agents Including Rickettsia

--Bartonella

--Brucella including B. abortus, B. canis, B. suis

--Burkholderia (Pseudomonas) mallei, B. pseudomallei

--Coxiella burnetii

--Francisella tularensis

--Mycobacterium bovis (except BCG strain, see Appendix B-II-A, Risk Group 2 (RG2) - Bacterial Agents Including
Chlamydia), M. tuberculosis

--Pasteurella multocida type B -"buffalo" and other virulent strains

--Rickettsia akari, R. australis, R. canada, R. conorii, R. prowazekii, R. rickettsii, R, siberica, R. tsutsugamushi, R. typhi
(R. mooseri)

--Yersinia pestis

Appendix B-III-B.   Risk Group 3 (RG3) - Fungal Agents

--Coccidioides immitis (sporulating cultures; contaminated soil)

--Histoplasma capsulatum, H. capsulatum var.. duboisii