I. Review of Related Terms A.

Communicable Disease caused by an infectious agent which is acquired from an infected individual andtransmitted to a susceptible host either by direct and indirect contact or through direct inoculation into a broken skin or mucous membrane. The two persons important for a communicable disease to occur are the infected individual and thesusceptible host. Types of Communicable Disease 1.Infectious disease is NOT easily transmitted from person to person. It requires inoculation, e.g.tetanus, malaria, dengue, filariasis, rabies Inoculation entrance of microorganism through mechanical means, e.g. biting, puncturing,laceration, open wound 2.Contagious easily transmitted from one person to another through droplet, direct, or indirectcontact, e.g. tuberculosis, diphtheria, measles, chickenpox, meningococcemia B.Epidemiology the science of the patterns of disease, its occurrence, distribution, or spread and t h e prevention and control among group of individuals as public health; backbone of disease preventiona. Patterns of Disease Occurrence 1.Sporadic on-and-off attack of the disease; intermittent or occasional; 20% susceptible host, 80%immune (because occurrence is predictable and therefore, can be prevented) 2.Endemic constantly present in a certain locality; 50% immune, 50% susceptibleThree endemic in the Philippines: (1) Malaria, (2) Filariasis, & (3) Schistosomiasis (with high prevalence in Regions 5, 8, and 11) 3.Epidemic number of cases exceeds beyond the normal number of cases for a short period of time;80% susceptible host, 20% immune 4.Pandemic worldwide epidemic, e.g. AIDS, SARS, Bird Flu C.Triad of Disease Causation or the Epidemiologic Triad (by Leavell & Clark) factors that interact to cause a diseaseThree Factors: 1.Agent these are bacteria, viruses, protozoa, and parasites (biological agents)Characteristics of Agent: Infectivity ability to enter the human body and to move into tissues Virulence strength, potency, or power of the agent to cause a disease*the shorter the incubation period, the virulent the agent is Nonspecific response: Antigenicity ability to stimulate antibody response (specific response) Calor Rubor Pathogenicity ability to cause infection or disease Dolor 2.Environment Tumor the medium for survival and multiplication of causative agent Functio laesa 3.Host the area where the agent gets its nourishment a.Humans i.Carrier asymptomatic; a person who harbors microorganisms but does not manifest signs and symptoms; most dangerous ii.Sub-clinically ill manifests mild signs and symptoms; less dangerous iii.Clinically ill manifests ALL the signs and symptoms; least dangerous b.Animal serves as an intermediate host; secondary or transitional; important in the completionof the life cycle or the microorganisms, e.g. oncomelania quadrasi (snail) in schistosomiasis

c.Plants breeding places of animalsd. Soil, water, air, milk e.Fomites inanimate objectsAlert: All these factors are necessary to cause a disease; an absence of one factor will not cause a disease*** If one factor is absent, it will lead to health or wellness

D.Chain of Infection (ARPEMPS) 1.Agent causative agent that releases toxic products that can be found inside or outside the cell Type of toxin: a.Exotoxin toxic product that can be found outside the cell when the microorganism is still alive b.Endotoxin toxic product inside the cell that is released when the cell is already dead;more dangerous 2.Reservoir source of infection; normal area in the body where the organisms can be found 3.Portal of Exit from the reservoir to the outside environmenta.Respiratory system sneezing and coughing of respiratory secretions (SMILING is not included) b . G I T / A l i m e n t a r y t r a c t v o m i t u s a n d fecesc.GUT urine, semen, vaginal discharges d . S k i n o p e n w o u n d e.Mechanical bite of an insect or animal f . B l o o d b r o k e n s k i n o r m u c o s a g . T r a n s p l a c e n t a l m o t h e r t o f e t u s h.Exudates or discharges conjunctival secretions, saliva, pus 4.Mode of Transmission channel or the medium in which the microorganism is transmittedTypes: a.Direct Contact person to person; needs intimate contact; sexual intercourse, droplet (coughing and sneezing), airborne Droplet less than three feet; less than 30 minutes Airborne more than three feet; more than 30 minutes b.Indirect needs vehicle-borne or vector-borne i.Vehicle matters through which organism can be transmittede.g. milk, soil, water ii. Vector through animals e.g. arthropods or mollusks 5.Portal of Entry corresponds to the portal of exit 6.Susceptible Host prone individuals E.Stages of Diseases 1.Incubation period period from the first exposure to the causative agent to the appearance of the firstsigns and symptoms 2.Prodromal period (catarrhal period) period from the appearance of the first signs and symptoms to theappearance of pathognomonic sign (classical sign) 3.Stage of Illness manifestation of all signs and symptoms of the disease 4.Convalescence stage of recovery; the signs and symptoms gradually disappearing F.Immunity power to resist specific infection or disease a.Immunization

 the process of rendering the individuals immune b.Antigen a substance that induces antibody formation c.Antibody a protein substance in response to antigen stimulation Types of Immunity 1.Natural Immunity inborn, innate, and inherent a.Active exposure to certain disease and formation of memory cells b.Passive maternal antibodies received bu the fetus through placenta and infant t h r o u g h breastmilk 2.Artificial - attained through the introduction of antigen such as vaccine, toxoid, or antibody byartificial means a.Active attained by introduction of antigene.g. all EPI vaccine except Hepatitis B b. Passive introduction of antibodies e.g. IgA, gammaglobulins, immunoglobulins from serum or human* Active slow to come, slow to go* Passive quick to come, quick to go ; immediateG. Prevention and Control of Communicable Diseases Based on RA 3573 Law on Reporting Communicable Disease 1.Prevention a.Health Education b.Environmental Sanitation c.S pecific Protection e.g. nutrition, immunization, personal hygiene 2.Control a.Notification and prompt intervention b.Isolation and quarantine c.Case finding looking for the infected individualsContact tracing looking for the exposed individuals d.Epidemiological investigation 3.Outline Plan of Epidemiological Investigation (WHO) 1.Establish fact of presence of epidemic a.Verify the diagnosis initial step b.Reportingc.Prevalence of disease (recording of old and new cases)* Incidence recording new cases 2. Establish time and space relationship of the diseasea.Area of concentration of the disease (space) b.Onset of the first known case (time) 3.Relations to characteristics of the group of community a.Age, sex, color, occupation4.Correlation of all data obtained 4.Types of Isolation Isolation separation of infected individual from healthy one; used in case finding Quarantine limitation of the freedom of movement of exposed individual or animal; used in contract tracinga. Strict isolation indicated for highly contagious diseases like SARS, meningococcemia, bird flu, anthrax b.

Protective or Reverse Isolation intended for those with low resistance o r immunocompromised e.g. AIDS, burn, cancer, nephritic syndrome, organ transplantc. Respiratory Isolation intended for respiratory diseasesd. Enteric Precaution intended for GIT diseases e.g. typhoid fever, cholera, shigellosise. Wound and Skin Precaution intended for persons with skin diseases e.g. leprosy, fungal infection, impetigo f.Blood and Body Fluids / Standard / Universal Precaution first line of precaution;used when the disease is unknown ;usage of gloves, masks, caps, mask, and goggles 5.Disinfection destruction of pathogenic microorganisms excluding the spores Sterilization destruction of microorganisms including spores Delousing killing of lice or louse Fumigation destruction of microorganisms by the use of gases or fumes Two general means of killing microorganisms: a.Mechanical boiling autoclaving, and burning b.Chemical use of i.Disinfectant used in inanimate objects (e.g. chlorox) ii.Antiseptic used in live human tissues that inhibits the growth of microorganisms (e.g. hydrogen peroxide, betadine, Normal Saline Solution)* NSS most effective antiseptic because as isotonic solution, keeps the wound moisten which facilitates cell regeneration* Povidone Iodine (Betadine) inhibits growth of hair Two techniques of disinfection a.Concurrent ongoing disinfection, the client is still the source of infection b.Terminal final disinfection, the patient is no longer the source of infection performedupon discharge of the client (e.g. fumigation) 6.Asepsis absence of pathogen or disease-causing microorganisms1 . Two types of Asepsis: a.Medical / Clean technique in handwashing, hands are held lower than the elbow Purpose: 1.To prevent transfer of pathogens to others 2.To reduce the number of microorganisms b.Surgical / Sterile technique to render area free from microorganisms. In handwashing, hands are held higher than the elbow

Techniques :1.Handwashing single most effective way of preventing transmission of microorganisms. * The most important factor in handwashing isfriction.

2.Gowning

3.Masking 4.Disinfection 5.Placarding - barrier cards; Unsterile / Unauthorized Persons Keep Out II.Classification of Communicable Diseases According to Causative Agents

A.Viral a.Measles / Rubeola b.German measles / Rubella c.Chickenpox d.Poliomyelitis e.Hfever(Dengue) f.Rabies g.Hepatitis h.AIDS i.Mumps j.Influenza E.Rickettsia a.Chlamydia B.Bacterial a.Tuberculosis b.Leprosy c.Diphtheria d.Pertussis e.Tetanus f.Cholera g.Typhoid fever h.Pneumonia i.Syphilis j.Gonorrhea k.Bubonic plague l.Botulism G.External Parasites a.Pediculosis b.Scabies F.Intestinal Parasites a.Ascariasis b.Enterobiasis c.Taeniasis d.Capillariasis e.Ancyclostosomiasis f.Schistosomiasis D.Fungal a.Ringworm b.Moniliasis C.Protozoan Parasites a.Malaria b.Amoebiasis c.Trichomoniasis

EXPANDED PROGRAM ON IMMUNIZATION

Vaccine BCG

Content Live attenuatedbacteria

Form Freeze dried andreconstituted inspecial diluent Liquid

Dosage infant0.05mlPreschool0.1ml

# of Doses 1

Route ID

DPT

OPV Hepatitis B Measles

DTweakenedtoxinPkilled bacteria weakened virus Plasma derivative Weakened virus

0.5 ml

IM

Liquid Liquid Freeze dried andreconstituted inspecial diluent

2 drops 0.5 ml 0.5 ml

3 3 1

Oral IM Subcutaneous

Schedule of Vaccines Vaccine BCG (Bacille of Calmetteand Guerin) DPT (Diphtheria, Pertussis,Tetanus) OPV (Oral Polio Vaccine) Hepa B Measles Age at 1st dose At birth or anytimeafter birth Interval between dose Protection TB

6 weeks 6weeks

4weeks 4 weeks Schedule: At birth, 6th week, 14th week

Diphtheria, Pertussis, andTetanus Poliomyelitis

At birth 9 months

Hepatitis B Measles