CHN - Communicable Disease

EPIDEMIOLOGY:
Epidemiology is the term derived from the Greek words epi means upon, demos means the people, and
logos means knowledge. It literally means the study of what happens to people.
DEFINITIONS:
There are many definitions on epidemiology. Few definitions are:
➢ It is a specialized form of scientific research that can provide health care workers, including
community health nurses, with a body of knowledge on which to base their practice and
methods for studying new and existing problems.
➢ A method of casual reasoning, based on developing and testing biologically plausible hypothesis
pertaining to occurence and prevention of morbidity & mortality.
➢ Epidemiology as defined by last(1988) “the study of the distribution & determinants of health
related states or events in specified populations, & the application of this study to the
prevention & control of health problems”.
➢ A quantitative basic science, built on a working knowledge of probability, statistics & sound
research methods.
➢ A tool for public health action to promote & protect the public’s health based on science, casual
reasoning, & a dose of practical common sense.
COMMUNICABLE DISEASE:
Communicable disease is an illness due to a specific infectious agent or its toxic product which arises
through transmission of that agent or its products from a reservoir to a susceptible host, either directly
as from an infected person or animal or indirectly, through an intermediate plant or animal host, vector
or the inanimate environment.
1. Respiratory tract infections (RTIs): are infections of parts of the body involved in
breathing, such as the sinuses, throat, airways or lungs.
• SMALL POX
INTRODUCTION:
Smallpox is one of the most shattering diseases known to humanity. Ancient
Indians & Egyptians experienced this before thousands of years itself. The
repeated epidemics swept across continents for many centuries. Smallpox killed
30% of the affected.
DEFINITION:
Definition of smallpox
It is an acute contagious febrile disease of humans that is caused by a poxvirus
(species Variola virus of the genus Orthopoxvirus), is characterized by a skin
eruption with pustules, sloughing, and scar formation.
EPIDEMIOLOGICAL TRIAD
CAUSATIVE AGENT:
Smallpox is an acute, communicable disease caused by the variola virus, a
member of the genus Orthopoxvirus, from the Poxviridae family.
HOST
All age groups and both sexes are affected.
ENVIRONMENT
Overcrowding is the factor enhances disease transmission.
MODE OF TRANSMISSION
1. DIRECT DROPLET INFECTION- Virus particles are expelled in droplets
from the infected person`s respiratory tract through coughing, sneezing
and talking which may be inhaled by a healthy person.
2. FOMITES- Transmission through FOMITES- such as clothes, bedding, etc
do not have important role in small pox transmission.
INCUBATION PERIOD
The incubation period of smallpox averaged 12 days, but ranges from 7 to 17
days. During this period the patient does not manifest any symptoms of infection.
CLINICAL FEATURES
Small pox has two stages, i.e. pre- eruptive and eruptive:
1. PRE- ERUPTIVE STAGE:
During pre-eruptive phase symptoms like fever, headache, chills, backache,
Pharyngitis, vomiting, delirium, diarrhea, abdominal pain and convulsions occur.
This stage lasts for 2-4 days
2. ERUPTIVE STAGE:
This stage is characterized by rash, which has distinctive features. Rash appears
on 3rd or 4th day of illness. It is first noticed on the face and upper part of the body
& spread to the extremities & trunk within 24 hours. It is centrifugal in
distribution. Palms and soles are usually involved but axilla is usually free.
Rash evolve through the stages of macules, papules, vesicles, pustules and scabs.
It takes about 17 days for rash to pass through all these stages and scabes fall off
in the next 1-2 weeks leaving behind permanent pock marks.
PROGRESSION OF SMALL POX

The disease progress by showing various stages of blisters like macules, papules,
vesicles, pustules and scab.
MACULES
• Minute red spots appears first in the tongue and palate
• Lesions appear on the face and forehead
Day 2:
• Pharyngeal lesions evolve quickly to and break down (virus present)
• Raised above the skin
• Fluid accumulating.
VESICLES
Day 3 and 4 of rash:
• Accumulation of fluid occurs
• Over next 24-48 hours, clear fluid becomes cloudy & begins to thicken.
PUSTULES
o Vesicles become full of pus
o Most lesions are pustular by 7th day
o Reach their maximum size by day 11
o As fluid is absorbed, lesions become flatter. Feels like hand Peas in skin.
SCABS
o As fluid is absorbed scabs form
o Patient is infectious until all scabs fall off
o In areas of thick skin (palms and soles) lesions are Embedded and may take
2-3 weeks to come off
COMPLICATIONS
1. SKIN: Pyoderma, Boil, Abscesses
2. RESPIRATORY SYSTEM: Bronchitis, bronchopneumonia,
pulmonary oedema
3. EYE: Blindness may occur
4. C.N.S. Encephalitis can occur
5. OTHERS: Arthritis, osteomyelitis, otitis media, etc
CLINICAL CLASSIFICATION OF SMALL POX
1.ORDINARY:
➢ Follows classical description of small pox
➢ Lesions pass through all four stages
➢ 26% mortality in unvaccinated persons
2. MODIFIED:
➢ Mild form
➢ Lesions are few in number
➢ Crusting complete in 10 days
3. FLAT TYPE
➢ Severe febrile illness
➢ Leisons progress slowly
➢ Vesicles tend to be flat, soft and velvety to touch
➢ Mortality varies from 80-100%
4. HEMORRHAGIC
➢ Severest form with prolonged pre eruptive stage
➢ Bleeding may appear on 2nd or 3rd day from eyes, mouth, nose, skin in
urine, in stool or from vagina in women.
➢ Death occurs suddenly between 4th & 7th day of illness
➢ 96% mortality
SMALL POX ERADICATED FROM WORLD

The last case of smallpox occurred in Somalia in 1977, and the last recorded case
in humans occurred in England in 1978; this final case resulted from an accidental
laboratory infection. In 1980, the World Health Organization (WHO) officially
declared that smallpox had been eradicated.
Routine smallpox vaccinations were stopped in 1972 and smallpox was declared
eradicated in 1980 after a worldwide vaccination program
SMALL POX ERADICATED FROM INDIA

The last indigenous case occurred in India on 17th May 1975 in Bihar, and on 24th
May 1977 an imported case was reported in Assam. India was declared “smallpox
free country” in April 1977 by international commission.
Factors that favored smallpox eradication
o Absence of animal reservoir
o Absence of subclinical cases
o Absence of carrier state
o Absence of second attacks
o Easy to recognize the disease
o Cooperation from public
o Cooperation from international health organization.
PREVENTION & CONTROL
1. VACCINATION: Through vaccination small pox can be prevented. The first
small pox vaccine was developed by Edward jenner in 1796.
2. NOTIFICATION: Small pox is a notifiable disease locally, nationally &
internationally.
3. CONTAINMENT VACCINATION: All person living in the affected locality
should be vaccinated.
4. ISOLATION OF PATIENTS: Patients should be isolated in their own homes
and not admitted to hospitals
5. CONCURRENT DISINFECTION: Articles soiled by Secretions should be
disinfected by boiling, cresol 5% for disinfecting sputum or nasal secretions.
6. TERMINAL DISINFECTION: Room and articles should be exposed to sunlight
for several hours. Dead body should be wrapped in bed sheet soaked in
10% formalin or 5% phenol.
CHICKENPOX
Chickenpox is an acute highly contagious viral disease caused by

varicella- zoster(V-Z) virus, characterized by different stages of rashes
that may be accompanied by fever, malaise, and vesicular skin lesions.
CAUSATIVE AGENT
Human herpesvirus 3 (alpha) or varicella zoster virus (VZV) the causative agent.
The virus is found in the oropharyngeal secretions and loins of the skin and
mucosa.
Infective period of the disease ranges from 1-2 days before the appearance of
rash and 4-5 days thereafter.
HOST FACTORS
It predominantly affects children under 12 years of age. People with reduced
immunity is prone for infection irrespective of their age.
Although almost all persons develop lifelong immunity her chickenpox infection,
the virus may remain dormant in the body and recur many years later as herpes
zoster (shingles).
Infection during pregnancy presents risk for fetus & neonate.
ENVIRONMENT
Overcrowding favors its transmission: This shows seasonal trend in India, the
disease occurring mostly during the first 6 months of the year.
Mode of Transmission
o Chickenpox transmission is mainly airborne respiratory droplets
o By direct contact with vesicle fluid of chickenpox cases, or contact with the
vesicle fluid of patients with herpes zoster
o Indirect contact occurs through articles freshly soiled by discharges from
vesicles of infected persons. Scabs are not infective
o This virus can cross the placental barrier and infect the fetus, condition
known as congenital varicella.
INCUBATION PERIOD:
The incubation period is from two to three weeks and is usually 14-16 days. This
may be prolonged in immunosuppressed persons or following immunoglobulin
administration as passive immunization against varicella.
CLINICAL FEATURES:
This takes two stages.
Pre-eruptive stage (Before the eruption of the rashes)
• Sudden onset
• Mild or moderate fever
• Back ache and malaise are common
This stage lasts for about the 24 hours in the children and 2-3 days in
adults.
Eruptive stage (eruption of the rashes): In children the rash is often first sign
coming on the day the fever starts.
This stage is characterized by the
• Centripetal Distribution: Rashes are symmetrical Rashes start to appear on
the trunk., where it is plentiful and then appear on the face. Arms and legs
where it is less abundant. Axilla may be affected palms and soles are not
usually affected. Density of the eruption diminishes centrifugally.
• Rapid advancement: Rash advances quickly through the stage of the
macules, papules, vesicles and scabs. Scabbing begin 4-7 days after the rash
appearance
• Pleomorphisms: All stages of the rash (Papule, vesicles and crusts) may be
seen simultaneously at one time in same area. This is due to the rash
appearing in the successive crops for the 4-5 days In same area.
• Fever: The fever does not run high. It shows exacerbation with the each
fresh crop of the eruption.
COMPLICATIONS:
Chickenpox is generally a mild disease and is usually self limiting.
• Secondary bacterial infection of the wound may take place
• Those with suppressed immunity and pregnant mothers are most prone to
suffer from severe complications like Pneumonia and encephalitis
• Acute cerebellar-ataxia may occur
• Reye’s syndrome (Acute encephalopathy associated with the fatty
degeneration of the liver)
• Newborn babies with severe illness may lead to death.
• Infection in early pregnancy may cause abortion, Congenital abnormalities
of the fetus and low birthweight
PREVENTION
Prevention is by active and passive immunization.
1. VARICELLA ZOSTER IMMUNOGLOBULIN
It affords passive immunity. It is given within 72 Hours of exposure in the
dosage of 12.5 units/kg body upto a maximum of 625 units.
2. VACCINE: Active immunization with live attenuated varicella virus vaccine is
safe.
a) Chicken pox vaccine affords 90% of protection in an outbreak if given
within 3-5 days of exposure
b) A live attenuated vaccine (OKA strain) is used. It causes mild local
reaction at the site of inoculation in about 1% of person.
c) The vaccine is safe and effective in preventing the disease.
d) For children between 12-18 months of age one dose of the chicken
pox vaccine is recommended if they have not had chicken pox.
e) For persons 12 years old and adults 2 doses given 4-8 weeks apart
are recommended if they are exposed to the disease.
Control Measures of Chickenpox

o There is no specific treatment for the chicken pox
Control measures of chickenpox in patient:
• Notify chickenpox to the health authorities
o Isolate the affected child; Do not send the child to school for 1 week
o Contact with the susceptible patient is avoided
o Concurrent disinfections of the articles soiled by the discharge must be
carried
o Quarantine is not necessary; child contact should be kept under the
observation for 21 days.
MANAGEMENT
➢ Periodic consultation with doctor or health care Professionals and
symptomatic treatment is necessary
➢ Plenty of water and adequate rest is needed during fever
➢ Advise to wear cotton gloves while at sleep to prevent Scratching of the
vesicles that may lead to infection
➢ Immunosuppressed and pregnant women should avoid contact with the
affected person
➢ Sick children should not be sent to school until all vesicles have dried up to
prevent the spread of the disease
➢ Close monitoring of the child is important. If the child has any symptoms
like fever, vomiting, drowsiness and refusal of food-proper medical
attention is necessary
➢ Parents should also closely monitor other children in the household for
signs and symptoms of chickenpox.
MEASLES (Rubeola)
The word ' Measles’ is an Anglo- Saxon word, derived from the word ' mascles’
which means spots. Rubeola means red spot (Rubor means redness, ola means
spots).
DEFINITION
Measles is an acute highly infectious disease caused by a specific virus of
paramyxo virus group,common among young children, clinically characterized by
fever, catarrhal symptoms (coryza, cough) followed by typical rash. It has a high
fatality & morbidity rate in developing countries.
CAUSATIVE AGENT
• The causative agent: RNA virus of paramyxo virus family, genus Morbilivirus
• Source of infection: cases of measles, no animal reservoir
• Infective material: Nasal secretion, respiratory tract Throat
• Communicability: Highly infectious during prodrom period and at the time
of eruption.
• Infection provides lifelong immunity; secondary represents error in
diagnosis
Host Factors
o Children aged 6 months to 3 years are affected in Developing countries
• Children above the age of 5 years are affected in developed Countries
• Incidence equal in both sexes
• One occurrence provides lifelong immunity
• Maternal antibodies protect infants for 6-9 months of age
• Malnourished children are susceptible to develop measles due to their
lowered resistance
• Children, poorly nourished are more prone, people whose body is
destabilized by HIV AIDS or other diseases.
Environmental Factors
• Winter season, overcrowding
• Poor living environment and socioeconomic status.
• Droplet nuclei and droplet infection that occur directly from person to
person
• Infective period is 4 days before and 4 days after the development of
rashes.
INCUBATION PERIOD
Incubation period is usually 10 days from exposure to onset However, rashes may
be manifested at about 14 days after exposure.
incubation period, 7 days.
Clinical Features
This occurs in 3 stages:
• Prodormal stage
• Eruptive stage
• Post measles stage
1. PRODORMAL STAGE
• 3Cs (cough, coryza, conjunctivitis)
• Photophobia
• Koplik spots (,Bluish red spots on white base in the mouth)
• Fever that runs for around 4 days fever(40°c)
2. ERUPTIVE STAGE
• Red maculopapular rash begins to appear behind the ear & gets
disseminated to all over the body within 2-3 days. The rashes become
confluent & blotchy.
3. POST- MEASLES
• Weakness & weight loss
• Diarrhea
• Cancrum oris
• Pyogenic infections
• Reactivation of pulmonary tuberculosis
Preventive Measures
VACCINE
Measles vaccine is given at the age of 9 months in India. If administered before
the age of nine months renders the vaccine ineffective due to natural antibodies
acquired from the mother.
• Live attenuated measles virus
• Dose-0.5 mL
• The diluent for reconstituting the vaccine Must Refrigerated at 4-8°C
• Vaccine is administered subcutaneously
Combined Vaccine-Measles, Mumps and Rubella (MMR)
Measles vaccine is combined with live attenuated vaccines of mumps and rubella
The reconstituted vaccine contains, in single dose of 0.5 mL not less than:
• 1000 CCID50 of Measles virus
• 5000 CCID of Mumps virus
• 1000 CCID of Rubella virus.
• Diluents: Sterile water for injection.
Immunoglobulin
Immunoglobulin 0.25 mL administered early period of incubation i.e. within 3-4
days of exposure to prevent the disease occurrence.
Live measles vaccine is administered to passively immunized persons after 8-12
weeks.
Control and Prevention of Measles
• Isolate for 7 days
• Immunize contacts within 2 days of exposure
• Standard precautions, airborne transmission precautions are indicated for 4
days after the onset of rash in children who are otherwise healthy;in case
of immune compromised patients the precautions should be taken through
out the period of illness
• There should be good follow-up measures.
Complications
• Diarrhoea
• Pneumonia
• Otitis media
• Convulsions
• Encephalitis
• SSPE( subcutaneous sclerosing panencephalitis)
WHO Strategies for Year 2020

World health organization aims to eliminate measles and rubella from at least five
regions of world health organization. (WHO).
To achieve the above WHO focuses on five important components they are:
• To provide and maintain high vaccination coverage using 2 doses of
“measles and rubella vaccines”
• To establish effective surveillance to assure encouraging Impact on
vaccination activities
• To establish readiness to respond to epidemics and Provide effective
treatment to cases of measles
• Engage in trust building activities to gain public confidence
• Conduct the research and development to support cost effective action.
INFLUENZA
Influenza an acute highly infectious, febrile, respiratory disease caused by
influenza virus that attacks mainly the upper respiratory tract that include the
nose, throat and bronchi and rarely the lungs.
CAUSATIVE AGENT
• Influenza virus belongs to the family of orthomixoviridae
There are three viral subtypes:
• Influenza type A, type B, and type C. Influenza A has 2 subtypes which
are important for humans: A (H3N2) and A (HINI), of which the former is
currently associated with most deaths.
• Influenza viruses are defined by 2 different protein components, known
as antigens, on the surface of the virus. They are spike-like features
called hemagglutin in (H) and neuraminidase (N) components. H antigen
initiates infection and the N antigen releases the virus from infected cell.
• Birds and animals are considered as the major reservoirs
• Usually the source of infection is the case or subclinical case
• Virus is present in the nasopharynx of infected person
• Period of infectivity is 1 to 2 days before and 1 to 2 days after the onset
of Symptoms.
HOST FACTORS
• Affects all ages and both sexes
• Highest mortality is found among old people over 65 years, children below
18 months and people with chronic diseases like diabetes
• Human mobility is major cause of spread of infection
ENVIRONMENTAL FACTORS
• Seasonal: Epidemics take place in winter in Norther hemisphere and in
winter or in rainy season in Southern hemisphere
• Overcrowding facilitates transmission.
o The virus spreads from person to person through droplet infection or
droplet nuclei by sneezing, coughing or talking.
• Portal of entry: The influenza virus enters the body through the nose or
throat.
Incubation Period
18-72 hours
Clinical Features:
The symptoms are like fever, headache, cough, sore throat and general malaise.
Complications
Bacterial pneumonia, ear infections, dehydration, myocarditis and even heart
attack occur as complications of influenza.
Prevention
• Vaccination is the prime measure for preventing influenza and bringing
down the impact of epidemics There are different types of influenza
vaccines available and in existence for more than 60 years
• It is recommended that elderly persons, and persons of any age who are
considered at “high risk” for influenza related complications due to
underlying health conditions, should be vaccinated
• WHO recommends annually a vaccine that targets the 3 most virulent
strains in circulation.
Killed Vaccine
o One dose of vaccine contains 15 micrograms of HA
• A single dose of 0.5 mL is given to adults and children over 3 years
• 0.25 mL is given for children between 6-36 months
• A single dose of inactivated vaccine annually is appropriate, except for
previously unvaccinated preschool children pre-existing with medical
conditions who should receive 2 doses at least one month apart.
Live Attenuated Vaccine

• Widely used in USSR 2
• Administered as nasal drops
Antiviral Drugs
• Antiviral drugs such as the M2 inhibitors (acting against type A virus) and
the more recently developed neuraminidase inhibitors (acting against both
type A and type B viruses) have been shown to be effective for treatment
(and for some agents, prophylaxis) and are now available in many
industrialized countries
• Presently Amantadine and rimantidine are not recom mended for antiviral
treatment or chemoprophylaxis of influenza A because of resistance in
circulating influenza A virus strains.
Antiviral Drugs for Adults
• Inhaled zanamivir is recommended for treatment of adults with
uncomplicated acute illness of influenza A or B virus, and for
chemoprophylaxis of influenza among adults
• Zanamivir is not advised to people with respiratory disease like asthma or
chronic obstructive pulmonary diseases (COPD)
• Zanamivir is given using inhaler device. This is administered as 5-mg blister
doses per inhalation. The Recommended dosage for influenza is 2
inhalations (10 mg) twice daily 12 hours apart
• For chemoprophylaxis zanamivir 10 mg is administered (2 inhalations) once
a day.
Antiviral Drugs for Children

• Zanamivir is recommended to treat influenza among children aged 7 years
and older. Duration of treatment is 5 days.
Zanamivir is approved for chemoprophylaxis of influenza among children aged
5 years and older
• Treatment and chemoprophylaxis dosing and frequency
are the same for children as for adults.
Control Measures
• Adequate ventilation required in living rooms
• Avoid overcrowded places during epidemics
• Stay at home at the first sign of influenza
• Infected persons should cover the mouth and nose with hand kerchief to
protect others from infection.
RUBELLA (GERMAN MEASLES)
German measles is an acute, infectious, viral disease usually affecting older
children and young adults caused by RNA virus of the toga virus family, clinically
characterized by mild Prodormal symptoms.
Causative Agent
• RNA virus of the toga virus family causes rubella
• This virus is found in the nasopharynx, throat, blood, CSF and urine of an
infected person
• All clinical and subclinical cases of rubella are the source of infection
• Person is infectious from a week before the appearance of symptoms to
about a week after the appearance of rashes
• Infants born with congenital rubella may shed the virus for many months.
• FIG: Epidemiological triad of rubella
HOST FACTORS
• Humans are the only known host
• Rubella affects mainly the children in the age group of
3-10 years
• Persons older than 15 years now account for over 70% of The cases in
developed countries.
ENVIRONMENT
This disease shows seasonal pattern of occurrence. Rubella occurs in temprate
zones during the later winter and spring with the epidemics of every 4-9 years.
TRANSMISSION
The rubella virus is transmitted by airborne droplets when infected people sneeze
or cough.
The virus can cross the placental barrier and infect the fetus.
INCUBATION PERIOD
Usually 2-3 weeks with an average of 18 days
SYMPTOMS
• Usually children manifest the symptoms of rash, low fever (<39°C), sore
throat, cough, nausea and mild conjunctivitis
• Rash starts on the face and neck before progressing down the body, and
lasts 1-3 days
• Lymph glands behind the ears and in the neck are swollen
• Infected adults, more commonly women, may tend to develop arthritis and
painful joints that normally lasts from 3-10 days.
COMPLICATIONS
• Affected pregnant women show 90% chance of transmitting the virus to
fetus. This can lead to miscarriage, stillbirth or severe birth defects known
as congenital rubella syndrome (CRS)
• In rare cases symptoms like arthralgia (in adults), thrombocytopenic
purpura and encephalitis are witnessed.
PREVENTION- VACCINATION
• There are monovalent and combined vaccines available against rubella.
Monovalent vaccine is directed at only one pathogen. Combined vaccines
are available with vaccines against measles (MR), measles and mumps
(MMR), or measles, mumps and varicella (MMRV).
• WisarRA live attenuated vaccine is administered in a single dose of 0.5 ml.
Subcutaneously. This is marketed as R-Vac.
• Vaccine is contra indicated in pregnancy and infants Under 1 year of age
• The women recipients of the vaccine are advised conceive over the next 3
months.
MUMPS
Mumps a viral infection of humans that primarily the salivary glands. The name
originates from the British word “to mump”, that is grimace or grin. The
appearance the patient as a result of swollen parotid gland seems to be in grin.
CAUSATIVE AGENT
• The causative agent is myxo virus parotiditis,a RNA virus of the myxovirus
family
• This virus is found in saliva, blood, human milk a urine. Occasionally found
in cerebrospinal fluid (CSF)
• Secondary attack rate accounts for 86%
• Period of Communicability: Usually 4-6 days belief onset of symptoms and a
week or more thereafter Once the parotid gland swelling subsided, the case
is no longer infectious.
HOST FACTORS
• Common among children between the age of 5-15 years
• No age is exempted
• Disease tends to be more severe in adults
• Single attack gives lifelong immunity
• Infants below 6 months are immune due to maternal bodies.
• Mumps is endemic. Peak incidence occurs during and spring
• Overcrowding facilitates epidemics
Humans are the only known natural host for mum which is spread through
direct contact or by airborne d from the upper respiratory tract of infected
individuals.
INCUBATION PERIOD
Varies from 2-3 weeks usually 18 days
CLINICAL FEATURES
• Fever and head ache
o Pain and swelling in either one or both parotid glands
o Ear ache in the affected side
o Pain and stiffness while opening the mouth
o Mumps may also affect the pancreas, testes, CNS, ovaries,Prostate, etc.
COMPLICATIONS
o Orchitis
o Epididymitis
o Oophritis
o Spontaneous abortion
o Sensori neural hearing loss, (uni or bilateral)
o Mild form of meningitis
o Encephalitis
o Mybilateral
o Polyarthritis.
Prevention-Vaccination
o A single dose of monovalent live attenuated mumps vaccine 0.5 mL is
administered intramuscularly or subcutaneously to children over the age of
1 year
o A single dose of mumps vaccine, either as single antigen or in combination,
has a protective efficacy of 90-95%
o In some countries the second dose is given at the age of 4-6 years
o Pregnant women, patients on immunosuppressive therapy should not be
given mumps vaccine.
o Combined vaccine measles, mumps and rubella (MMR) is also available.
Control of Mumps
o Early identification and diagnosis: It is difficult because of occurrence of
subclinical cases
o Isolation of the case: Isolate until the symptoms subsides. Concurrent
disinfection: All the articles used by the Patient is disinfected
o Surveillance: Continuously monitoring and follow-up.
o
ACUTE RESPIRATORY INFECTIONS & PNEUMONIA

ARIs are the leading cause of morbidity and mortality in children. ARIs may cause
infection in any part of the respiratory system from nose to alveoli in the lungs.
ARIs are a complex and heterogeneous group of diseases caused by a number of
microbes.
ARI Problem in India
In India estimated that 2 million deaths among under 5 year children
2000 deaths per day
Main cause of death in young children in low income group
DEFINITION
ARIs indicate an infection of any part of the respiratory tract of less than 30 days
duration and otitis media of less than 14 days duration caused by bacteria,
viruses, fungi, parasites, allergens characterized by acute episodes of running
nose (cold), sore throat, cough, ear discharge, hoarseness of voice.
PNEUMONIA
Infection that inflames air sacs in one or both lungs, which may fill with fluid the air sacs may fill
with fluid or pus. The infection can be life-threatening to anyone, but particularly to infants, children
and people over 65.
Classification
WHO Classification
WHO has classified ARIS as below:
1. Acute Upper Respiratory Infections (AURIS): These include common cold,
pharyngitis and otitis media.
2. Acute Lower Respiratory Infections (ALRIS): These include epiglottitis,
laryngitis, laryngotracheitis, bronchiolitis and pneumonia.
EPIDEMIOLOGY
Agent Factors
ARIS are caused by a number of pathogens including viruses, bacteria, fungi,
parasites or allergens, simultaneously or one prepares the other to invade, Le.
primary infection such as coronavirus or rhinovirus causing common cold may
pave the way for invasion by pneumniae bacteriae
Host Factors
1. Age: Incidence of ARIs is very high among under-five children. Infants are the
hardest hit group. Incidence of AURIS decreases with increasing age. The
incidence increases again except in the third decade of life. Elderly persons are
also affected more than others.
2. Sex: ARIs is more common in male children than females in the ratio of 1.7:1.
3. Other factors: Low-birth weight-babies are more at risk of getting ARIS and is
also more severe among them:
a. Failure of breast feeding-this leads to deprivation of the child of maternal
antibodies from colostrum, predisposing him to infection.
b. Under nutrition also decreases the immune-mechanism and vitamin A
deficiency predisposes the child to ARIS infections by lowering the integrity of
respiratory epithelium.
1.Low-socio-economic level and poor living standard such as poor housing, over-
crowding, poverty, illiteracy, ignorance, poor personal hygiene and non-utilization
of health services
2. Air pollution due to industrialization and urbanization gives rise to smoke, dust
particles and fumes, which are emitted in large amount and pollute air.
3. Smoking both active and passive smoking predisposes people to infections of
respiratory tract.
4. Season-More common in winter than summer because people stay indoors and
there is overcrowding.
Mode of transmission
Air Bourne route
Direct droplet infection
INCUBATION PERIOD
It varies according to causative agent
Prevention and control
The measures for prevention and control of ARIs can be implemented at primary
and secondary levels of prevention.
Primary prevention
It consists of health promotion and specific health protection
Measures of health promotion
• Ensuring antenatal care of mothers to prevent LBW babies incidence
• Essential new born care and special care of the LBW babies
• Initiation of breastfeeding withi1/2 hours of delivery and exclusive
breastfeeding upto 6 months of age
• Improving sanitation and personal hygiene
• Encourage couples to family planning
• Prevention of smoke pollution
• Teaching parents to recognise danger signs such as fast breathing, chest
indrawing, vomiting and lethargy etc so that timely treatment of
pneumonia can be started.
SPECIFIC PROTECTION
• Getting the child completely immunized According to national
immunization schedule.
• Administration of vitamin A oral doses from 9 months till 5 years every 6
months
• Administration of HIB measles vaccine and pneumococcal pneumonia
vaccine
Secondary prevention (Early diagnosis and treatment)
WHO has recommended guidelines for the management of ARIs in children and
practical guide lines for outpatient care. This include clinical assessment,
classification of illness and treatment aspects of ARIs and follow up.
CLINICAL ASSESSMENT
1.History taking: Ask the mother about:
a)Age of the child.
b)How long the child has been coughing.
C)Whether the child is able to drink (if between 2 months upto 5 years of age).
d. Whether the baby < 2 months has stopped feeding well. E. If there has been
any prior illness such as measles.
f. If the child has fever, is excessively drowsy.
g. If the child has convulsions.
h. If the child has irregular breathing and bluish color skin.
I)If the child has any treatment during illness.
2.Physical assessment: It is done by looking and listening for the followings: a.
Count the respiration and see if fast breathing is present. Fast breathing will be
present if the
Respiratory rate is as follows:
I.60 breaths or more per minute in a child below 2 months of age.
II.50 breaths per minute or more in a child between 2 months to 12 months.
III.40 breaths per minute or more in a child between 12 months to 5 years.
b.Count the respiration for one minute. Recount in an infant < 2 months if the
respiratory rate is 60 breaths or more per minute.
C. Look for chest-indrawing: The child has chest-indrawing if the lower chest wall
moves in during Inspiration.
d.Look and listen for stridor: Stridor is present if there is harsh noise produced
during inspiration. It is due to narrowing of the larynx and trachea (This is also
called croup).
a.Look and listen for Wheeze: Wheezing is a whistling noise heard during
expiration, due to Narrowing of air passage. Child may show signs that breathing
out is difficult.
F. Check if there is severe malnutrition: Malnutrition is a risk factor for ARIS and
high case fatality rate.
g. Look for signs of cyanosis.
h. Check the temperature (fever or low baby temperature). 1. Look if the child is
abnormally sleepy or difficult to wake.
Classification of Illness
ARIS is classified as following which differ according to different age groups.
Classification is done to decide about the type and severity of the disease. Each
classification has a corresponding treatment plan which should be followed. The
child may be put into one of the four classifications:
1.Child aged 2 months to 5 years:
a. No pneumonia-cough or cold
b. Pneumonia (not severe)
c. Severe pneumonia
d.Very severe disease
Classification of severity of Pneumonia and management (Standard treatment) (2
months 5 years).
Classification of severity of pneumonia based on the signs and symptoms with
specific treat ment for each of them is given in the following table.
Follow-up
1.Mother should be told to keep the child warm and breastfeeding. Ask her to
bring the child back after two days or earlier if the child becomes sicker or is not
able to drink or breast feed.
2.If the breathing has improved, fever is less, child is eating or drinking better,
complete three days of antibiotic treatment. If no improvement in breathing,
fever and eating, change to 2nd line anti biotic.
3.Advise the mother to return after 2 days. If there are signs of severe or very
severe pneumonia, the child needs hospitalization.
Along with antibiotic the child also needs antipyretic and bronchodilator.
Note: For children below 2 months of age, cotrimoxazole is not routinely

recommended. They are treated as severe pneumonia with parenteral
antibiotics. Cotrimoxazole can be given if there is a delay in referral.
• Cotrimoxazole should also not be given to premature babies and neonatal

jaundice cases.Steroids are given as emergency drug.
Supportive Treatment at Primary Health Care Level
This is provided by the community health workers. They are trained in making
early diagnosis and giving treatment with cotrimoxazole. They should also do the
following:
1.Encourage the mother to continue breast feeding and intake of fluids.
2.They should refer the following types of ARIs cases to hospital early:
a.Neonatal pneumonia (pneumonia in <2 months of age).
b. Pneumonia among LBW babies.
c. Pneumonia following measles or with measles.
d. Patients who do not show improvement after 2 days treatment with
cotrimoxazole.
3. Teach the mother (family) about home care of the child suffering with cough
and cold and Pneumonia.
DIPHTHERIA
Diphtheria is a potentially deadly, contagious disease that usually involves the
nose, throat, and air passages, but may also infect the skin. Its most predominant
feature is the development of a grayish membrane over the tonsils and upper
part of the throat.
CAUSATIVE AGENT
• Diphtheria is a infection caused by Coryne bacterium diphtheriae bacteria.
It is a Gram-positive non motile organism
• Source of infection may be case or carrier
• Period of infectivity varies from 14 to 28 days
• Nasopharyngeal secretions, discharges from the skin Lesions,
contaminated fomites and dust are infectious
• There are nasal and throat carriers; nasal carriers are very dangerous
because of frequent shedding of organism into environment.
HOST FACTORS
• Children of 1-5 years of age are affected
• Both sexes are affected
• Infants born of immune mothers are relatively immune During the first few
weeks of life
• People who have not been immunized may get diphtheria at any age
Diphtheria occurs in all seasons although winter months favour it’s spread.
• Diphtheria is transmitted from person to person, usually through
respiratory droplets, coughing or sneezing
• Rarely, spreads from skin lesions or clothes that are contaminated with
discharges from lesions of an infected person
• A person also can get infected with diphtheria by coming in contact with an
object, like a toy, that has been contaminated with the bacteria that cause
diphtheria.
PORTAL OF ENTRY
• Respiratory route
• Non- respiratory route like skin cuts, open wounds,
Ulcers and umbilicus of newborn.
INCUBATION PERIOD
2-6 days, sometimes may be longer.
SIGNS & SYMPTOMS
The signs and symptoms of diphtheria differ depending upon the location of the
infection.
TYPES OF DIPHTHERIA
• Pharyngotonsillar diphtheria
• Laryngotracheal diphtheria
• Nasal diphtheria
• Cutaneous diphtheria
PHARYNGOTONSILLAR DIPHTHERIA
• Sore throat
• Difficulty in swallowing
• Low grade fever
• Whitish membrane can be wiped off easily over pharynx or tonsil in early
stages
• Later it becomes thick, blue-white to grey or black and Becomes adherent.
Any attempt to remove it will cause
Bleeding
• Mucosal erythema surrounds the membrane
• Marked edema of submandibular area and the anterior portion of the neck
along with lymphadenopathy gives “Bull neck appearance. This indicates a
high level of exotaxin in the bloodstream
• Obstruction of the airway may result in respiratory
Problems and death.
LARYNGOTRACHEAL DIPHTHERIA
• Hoarseness of voice
• Croupy cough
NASAL DIPHTHERIA
It is a real public health problem because it spreads the disease more rapidly than
other forms of diphtheria.
CUTANEOUS DIPHTHERIA
• Appears as secondary infection
• Lesion may be surrounded by edema and covered with a membrane.
SCHICK TEST
• Schick test is performed to know whether the individual is susceptible to
Corynebacterium diphtheriae toxin. 0.1 ml of Schick test toxin is injected
intradermally into the skin of forearm considered test arm. The same but
heat-inactivated dose is injected into the skin of the opposite forearm
considered control arm
The responses observed are:
Negative Reaction
There is no reaction in either arm. Blood serum contains >0.03 units of antitoxin
per ml- the test is recorded as “negative”
Positive Reaction
• In test arm a circumscribed red induration of 10-50 mm appears within 24-
36 hours and reaches its full development by 4th to 7th day: slowly fades in
to a brown patch and the skin desquamates.
• Control arm shows no change. The person who shows such reaction is
susceptible to diphtheria.
Pseudo Positive Reaction

A red induration appears equally in both arms and fades fast by 4 th day.
Combined Reaction
The test arm demonstrates a true positive reaction and the control arm shows
pseudo positive reaction. This person is susceptible to diphtheria.
Prevention and control of diphtheria Early Detection of Cases and Carriers
Early detection
• Active search for cases should begin in family and scho contacts
• Nasal and throat swab-culture tests should be done to detect the cases.
Isolation
• Isolate all cases, carriers in the hospital atleast for 14 days
• Isolation should be ended when two consecutive throat swabs taken 24
hours apart, are free of organism.
Treatment
Cases
• Administer a test dose of 0.2 mL intradermally for
Knowing the sensitivity
• Diphtheria antitoxin 10,000 to 80,000 units or ma administered IM or IV
depending upon the severity
• Apart from antitoxin each case is given penicillin 2 lakhs units every 6
hourly or Erythromycin 250 mg/6 Hourly/ for 5 to 6 days
Carriers
Carriers should be administered oral erythromycin for
10 days.
Contacts
Treatment to contacts depends upon their immune status to diphtheria:
• No action needed if primary dose was received within The previous 2 years
• Booster dose is recommended if primary dose or booster Was received
more than 2 years ago
• Non-immunized close contact Prophylactic penicillin or Erythromycin is
administered. Diphtheria antitoxin -1,000-2,000 units administered, and
surveillance Initiated.
At Community Level
• Active immunization of all infants as per schedule
• Booster doses every 10 years
COMPLICATIONS
• RESPIRATORY FAILURE: This occurs due to the ob of the airway by the
membrane developed by diphtheria
• Myocarditis: This develops by 2nd week and can lead to CHF, arrhythmia
and sudden death
• Neurological complications include develop Palatal palsy, ocular palsy,
loss of accommodation and Polyneuritis etc.
• Renal complications like oliguria and proteinuria
Immunization
Immunization against six killer diseases enabled greater on in the incidence rates
of the diseases like diphtheria, s tetanus, measles and poliomyelitis etc. There are
combined vaccines, single vaccines and antisera.
Combined Vaccine
• DPT: Diphtheria, pertussis and tetanus vaccine
• DT: Diphtheria, and tetanus toxoid
• dt: diphtheria, tetanus adult type
• For immunizing the infants the preparation of choice is DPT. DPT protects
the child against three diseases-Diphtheria, pertussis and tetanus. Pertussis
component of the DPT enhances the potency of Diphtheria toxoid.
GUIDELINES
• Refrigerate the DPT vaccine at 4-8°C
• Read the label carefully and use the vaccine before expiry
• Strict adherence to cold chain-After receiving at sub Centre the vaccines
should be used within a week under Strict cold chain process
• Check the health card thoroughly
• Exclude the infant/child who is seriously ill
• Inform the mother that there may be a fever anti pyretics should be given
as per the medical directions
• Record the date and order of dose carefully.
SINGLE VACCINE
• FT: Formal-toxoid
• APT: alum-precipitated toxoid
• PTAP: purified toxoid aluminium phosphate
• PTAH: purified toxoid aluminium hydroxide
• TAF: Toxoid antitoxin floccules
Antisera: Antisera are prepared from horse serum and used to treat diphtheria.
• Prophylactic dose-500-2,000 units/SC or IM
• For therapeutic dose-10,000-30,000 units /IM or 40,000-100000 units
/ IV administered in 2 divided doses with an interval of 30 minutes to
2 hours.
PERTUSSIS (Whooping cough)

Pertussis is one of the 6 killer diseases of young children. Pertussis is major cause
of infant deaths l worldwide and continues to be a public health concern even in
countries with high vaccination coverage. Pertussis is an acute infectious disease
of young children, caused by B. Pertussis. Pertussis is also known as "whooping
cough" because of the "whoop" noise created when gasping for air after a bout of
coughing. Chinese address it a "Hundred Day Cough". Globally, there are an
estimated 16 million cases of pertussis and 195,000 deaths per year.
Agent Factors
• Agent: Causative agent is a B. pertussis.
• B. pertussis infects only man. Source of infection is a case of
pertussis.
• The bacteria occur in nasopharyngeal and bronchial secretions and
freshly contaminated objects
• Infectious 1 week after exposure to about 3 weeks after the onset of
the paroxysmal stage.
• Secondary attacks averages to 90% in unimmunized contacts
Host Factors
• It is a disease of infants and preschoolers. Highest incidence is found
in children below 5 years of age
• Infants below 6 months are at risk of mortality. The disease is known
to affect female more than male children
• Recovery from infection and immunization provides adequate
immunity
• Infants are susceptible to infection right from birth since maternal
antibody does not provide protection.
• Pertussis occurs throughout the year, but seasonal variations are
found. Higher incidence in winter and spring months occurs due to
overcrowding.
• Poor socioeconomic conditions favour’s occurrence of pertussis.
• Pertussis spread mainly by droplet infection and direct contact
• The bacilli are sprayed in air when the infected person coughs,
sneezes, or talks
• The role of fomites is very small unless freshly Contaminated.
INCUBATION PERIOD
7 to 14 days, but not more than 3 weeks.
SIGNS AND SYMPTOMS

The clinical course of the disease occurs in three stages:
• Catarrhal stage: 10 days
• Paroxysmal stage: 2-4 weeks
• Convalescent stage: 1-2 weeks
• The illness generally lasts for 6-8 weeks
CONTROL
Early detection, isolation, treatment of the cases and disinfection of discharges
from nose and throat are the efficient measures to control the disease.
• Cases to be isolated until they are considered Noninfectious
• Infants and young children should be kept away from infected person
• The drug of choice is erythromycin: 30-50 mg/kg body weight in 4 divided
doses for 10 days. Other possible Alternatives are ampicillin, septran and
tetracycline
• Prophylactic treatment for known contacts Erythromycin or ampicillin for
10 days.
Active Immunization
Immunization against pertussis with DPT is an effective
Means of control and prevention of the disease.
Combined Vaccine
• Diphtheria, pertussis, tetanus (DPT) is a combined vaccine given to prevent
three diseases
• It is given at the age of 6, 10, and 14 weeks and the booster doses are
given at 16-24 months and at 5-6 years.
Single Vaccine
• It is a killed whole cell preparation available against pertussis alone. The
dose of the conventional vaccine is 0.5 mL or as specified on the label by IM
or SC
• This vaccine given in three doses at intervals of 6-8 Weeks starting when
the infant is 2-3 months old.
• Two boosters spaced at 3 years interval should follow Primary
immunization.
MENINGOCOCCAL MENINGITIS
It is an acute communicable disease caused by Neisseria meningitidis,
characterized by intense head ache, vomiting and stiff neck. It can progress to
coma within a few hours. It is a part of septicemic process. It has a case fatality
rate of about 80% if untreated. With early diagnosis and treatment, case fatality
rate has come down to less than 10%.
HOST FACTORS
• N. Meningitidis is found in the nasopharyngeal secretions Of cases and
carriers
• Normal population of 5-30% may harbor the organi in the nasopharynx
during inter epidemics During epidemics the carrier rate may go up to 70-
80%
• Cases become noninfectious within 24 hours of specific Treatment
• All age groups are susceptible; younger age groups more susceptible.
• Epidemics are common in dry and cold months
• Overcrowding
• Poor housing conditions
• Low socioeconomic groups
TRANSMISSION
This is transmitted from person-to-person through droplets and throat secretions
from carriers.
The transmission is facilitated through close and lengthened contact. They may
include kissing, sneezing or coughing at someone without covering the mouth,
sharing living rooms, living in dormitory, using common utensils for eating and
drinking with an infected person etc.
INCUBATION PERIOD
Normally the incubation period is 4 days, but it can range From 2 to 10 days
SIGNS AND SYMPTOMS
The most common symptoms include:
• Stiff neck
• High fever
• Sensitivity to light
• Confusion, headaches and vomiting.
COMPLICATIONS
The major complications are brain damage, hearing loss and Learning disability
Meningococcal septicemia may lead to hemorrhagic rash and circulatory collapse.
PREVENTION AND CONTROL

• Meningococcal disease is fatal and should be considered as medical
emergency.
• Hospitalization is essential: no need to isolate the patient.
• Appropriate antibiotic therapy should be started as soon as the diagnosis is
confirmed with necessary diagnostic tests.
• It is always best to start the treatment after lumbar puncture (LP). If
treatment is initiated before LP it may be difficult to grow the bacteria in
cerebrospinal fluid to confirm the diagnosis
• There are a good number of antibiotics available to the infection like
penicillin, ampicillin, chloramphenicol and ceftriaxone etc.
TREATMENT
• Cases: The drug of choice is penicillin. If patients are allergic to penicillin
Chloramphenicol is the alternative drug
• Carriers: The drug of choice is rifampicin
• Chemoprophylaxis: Suggested for contacts
• Sulfadiazine 1 g BDX 2 days
• Rifampicin 600 mg BDX 2 days if allergic to sulfadiazine
Mass Treatment
Though it causes immediate drop in the incidence rate, it requires close medical
supervision of the population.
Immunization
• Meningococcal polysaccharide vaccines are:
• Bivalent (groups A and C)
• Trivalent (groups A, C and W)
• Tetravalent (groups A, C, Y and W) help to control the disease.
• The first vaccine against NmB, made out of 4 protein components, was
released in 2014
• Meningococcal conjugate vaccines against group C is Widely in practice
since 1999
• Tetravalent A, C, Y and W conjugate vaccines are used in children and
adults since 2005 in Canada, the United States of America, and Europe.
ENVIRONMENTAL IMPROVEMENT
• Improved housing conditions
• Avoid overcrowding
• Health educate the population about preventive measures
WHO Initiative in High-Epidemic Countries (Africa)
World health organization (WHO) concentrates on epidemic preparedness,
prevention and response.
Preparedness
For adequate preparedness WHO uses surveillance, starting from case
identification to investigation.
Prevention
WHO aims to vaccinate 1-29 years of all in the “African meningitis belt” with the
MenA conjugate vaccine.
Response
• WHO aims at providing technical support regularly at the field level to
countries facing epidemics
• Prompt case management with ceftriaxone
• Mass vaccination specifically to cover those who were not protected
through vaccination
TUBERCULOSIS (TB)
Tuberculosis is a specific chronic infectious disease caused by Mycobacterium
tuberculosis which primarily affects the lungs and cause pulmonary Tuberculosis.
CAUSATIVE AGENT
• The causative organism of tuberculosis is M. Tuberculosis (Mycobacterium
tuberculosis) is a facultative intracellular parasite
• There are two strains: Human strain responsible for vast majority of cases
occurring among human beings and bovine strain is responsible for
infecting cattle and other animals
• The source of infection is human cases whose sputum is positive for
tubercle bacilli and milk from infected animal
• Patients are infective as long as they remain untreated
HOST FACTORS
• TB affects all ages and more prevalent in than in females
• Though it is not a hereditary disease, twin studies indicate that
inherited susceptibility is an important risk factor
• Malnutrition predisposes tuberculosis due to poor resistance
• Immunity is acquired as a result of natural infection BCG vaccination
• With the initiation of chemotherapy host fact are considered less
relevant in the epidemiology of Tuberculosis.
• Poor quality of life
• Poor housing conditions
• Overcrowding
• Population explosion
• Malnutrition
• Lack of education
• Lack of awareness
• Large families
• Early marriages.
• Tuberculosis is transmitted mainly by droplet infection and droplet nuclei
generated by sputum of poutist patients with pulmonary tuberculosis.
Droplets are generated by coughing
• Tuberculosis is transmitted by fomites, such as dishes and other articles
used by the patients.
INCUBATION PERIOD
The incubation period ranges between 3 and 6 weeks. The development of
disease depends on closeness of contact extent of disease, extent of infection and
host-parasite relation.
CLINICAL MANIFESTATIONS
• Persistent cough
• Weight loss
• Fever
• Night sweats
• Hemoptysis
• Chest pain
• Fatigue
LAB INVESTIGATIONS
Mantoux Test
• The tuberculosis screening test is conducted by injecting tuberculin purified
protein derivative (PPD) of 0.1 mL into the inner surface of the forearm.
• A tuberculin syringe is used to administer this Intradermal injection. The
injection will produce a pale elevation of the skin as a wheal 6 to 10 mm in
diameter
• The reaction of the skin test should be read within 48-72 hours of
administration.
• Incase if the patient does not visit the clinic within 72 Hours he has to be
called for another skin test
• The reaction is measured in millimeters of the induration (palpable, raised,
hardened area or swelling); the reader should not measure erythema
(redness). The diameter of the indurated area should be measured across
the forearm (perpendicular to the long axis). If the induration is more than
10 mm the test is said to be positive.
Skin Test Interpretation Depends on Two Factors

• Measurement of induration in millimetres
• Person’s level of risk of being infected with TB and of development to
disease if infected
•
Prevention and Control

• The control measures consists of Case finding and TB treatments as
curative measure
• BCG vaccination as preventive measure
Case Finding
• Early detection of all cases means finding people whose sputum is positive
for TB bacilli
• Finding the suspects means whose sputum is negative but X ray shows
suggestive shadows of TB
• The patients seeking medical advice voluntarily with Chest symptoms like
persistent cough and fever are the Most appropriate target group for case
finding.
Sputum Examination
Sputum examination is the cheapest and most suited tool for finding the cases.
Sputum smears collected from suspected persons should be collected early in the
morning on three successive days. The presence of atleast 10,000 organisms per
ml of sputum is considered “TB positive.”
As per “Revised national tuberculosis control program” (RNTCP) priority for
sputum smear examination should be given to patients who come on their own to
hospital or health centre with the following symptoms
• Persistent cough of 3-4 weeks duration
• Continuous fever
• Chest pain
• Hemoptysis,
Sputum Culture
• It is a long process needs trained people to perform
• It is delivered only as centralized service in district hospitals
• Advised for the patients whose sputum smear but has chest symptoms.
Mass Miniature Radiography
This is abandoned as a case finding measure because of its Poor yields with high
cost.
Chest X-ray
Chest X-ray is recommended as additional method to diagnose pulmonary
tuberculosis when only one smear is positive.
Chemotherapy
Effective treatment is available to treat tuberculosis. The main aim is to eliminate
fast and slowly multiplying bacilli from a case and provide cure. Chemotherapy is
readily available, free of cost to every detected case. Patient or the case is the
core component of the success of the treatment because it requires Strict
compliance from the patient. Most often tuberculosis patients default since they
start to feel good and active only by completing with 2 weeks of medicine at start.
Anti-TB drugs are grouped into two:

• First-line drugs and
• Second-line drugs.
First-line drugs are further grouped into
• Bactericidal drugs: INH, Rifampicin, pyrizinamide and streptomycin
• Bacteriostatic drugs: Ethambutol and thioacetazone
A combination of these are used to treat TB patients.
First Line of Drugs
Bactericidal Drugs
Rifampicin
This is able to pervade all tissue membranes including blood brain and placental
barriers.
This is the only drug which is active against dormant (inactive) bacilli found in
solid lesions.
• Can be used only as oral drug
• Total daily dose- 10-12 mg/kg body weight
• Administer 1 hour before or 2 hours after food Because absorption is
reduced by food
• Patient should be told that the drug will turn the Urine red
Toxic effects of rifampicin- hepatotoxicity, gastritis,Influenza, thrombocytopenia

and nephrotoxicity.
INH
Administered as single daily dose of 4-5 mg/ kg body weight (subject to a
maximum dose of 300 mg.)
For intermittent therapy the dose is 600 mg.
Side effects: peripheral neuritis, gastrointestinal irritation And hepatitis Addition
of 10-20 mg of pyridoxine prevents peripheral neuropathy.
Streptomycin
Given as daily dose of 0.75-1g in a single injection.
Side effects: Vestibular damage (ringing in the ears) Giddiness and ataxia.
Pyrazinamide
Dose: 30 mg/kg body weight divided into two or three doses per day or 45-50 mg
/kg body weight twice weekly.
Side effects: hepatitis, arthralgia and rarely gout
Bacteriostatic Drugs
Ethambutol-15 mg/kg body weight (800 mg a day) given in 2 to 3 doses and 1,200
mg for intermittent therapy
Side effects: Blurring of vision and retrobulbar neuritis.
Thioacetazone
• 2 mg/kg body weight (150 mg a day)
Side Effects
Gastrointestinal disturbances and blurring of vision.
Second Line of Drugs
The second line of drugs is used where first line drugs cannot be used for various
reasons.
The second-line drugs are ethionamide, prothionamide cycloserine, kanamycin,
viomyein, ofloxacin and capreomycin.
Domiciliary Treatment
It is the method of self-consumption of prescribed anti-TB drugs by the patients
without getting admitted to the hospital Domiciliary treatment includes only oral
drugs,
Short Course Chemotherapy (SCC)

Wallace Fox and his colleagues from British medical research council added (1972)
Rifampicin and Pyrazinamide to anti TB regimen and reduced the duration of
treatment from 18 months to 6-8 months.
In short course chemotherapy the drugs are given in two Phases.
Intensive Phase
This is the initial phase lasts for 2 months; a combination of 3 or 4 drugs are given.
During this phase a combination of three or more drugs are used to kill off as
many bacilli as possible.
Continuation Phase
This is the maintenance phase lasts for 4-6 months under short course
chemotherapy in which a combination of 2 or 3 drugs are given.
Treatment is given daily or biweekly (Intermittent).
Drug Administration in Directly Observed Treatment Short Course
Chemotherapy (DOTS)
➢ In intensive phase of treatment a health worker or trained person closely
watches the patient swallowing the drug In his presence
➢ During continuation phase the patient is issued I week medicine in a
multiblister combi-pack. The first dose is swallowed by the patient in front
of health worker
➢ The drug consumption in the continuation phworker Counter-checked by
return of empty multiblister combi Pack while collecting the drugs for next
week
➢ The drugs are provided in patient-wise boxes with Sufficient shelf life.
Tuberculosis cases are divided in to three categories for the sake of putting them
under different regimens based on specific criteria.
Interpretation of the numbers and letters placed in the regimens
➢ Prefix number indicates the number of months for that regimen
➢ Suffix number indicates the frequency of administration in a week
➢ No suffix means given daily
➢ R-Rifampicin
➢ H-Isoniazid
➢ S-Streptomycin
➢ Z-Pyrazinamide.
BCG Vaccination
▪ BCG vaccination was invented by Calmette and Guerin. French scientists.
BCG stands for Bacilli of Calmette and Guerin. It is a widely used live
bacterial vaccine. There are two types of BCG vaccine: Liquid and Freeze
dried. Freeze dried is more stable.
▪ The vaccine is stored below 10°C
▪ The vaccine must be protected from exposure to sunlight
▪ It comes in freeze-dried powder form in ampoule. It is reconstituted with 1
ml normal saline (Distilled water is not used since it causes irritation.).
▪ Strength is 0.1 mg in 0.1 ml.
▪ The dose for newborns aged below 4 weeks is 0.05 mL
▪ It is advised to clean the site using saline swab before administering the
vaccine
▪ Using tuberculin syringe BCG is administered intrader mally in left upper
arm just above the insertion of deltoid muscle.
▪ When properly administered, the injection should produce a wheal
measuring 5 mm in diameter.
Chemoprophylaxis
This preventive treatment is administered to contacts: INH for 1 year or INH and
Ethambutol are given for 9 months.
Category-1 (Drug regimen-(2H,R,Z,E,+ 4H₂R₂)
➢ New Sputum smear cases

➢ Seriously ill sputum smear negative
➢ Seriously ill extra pulmonary
➢ If sputum smear is positive at the end of the intensive phase additional
month of intensive treatment is given
Surveillance
This focuses on the continuous monitoring and measurement. It closely monitors
and measures the rates of incidence, prevalence and other rates like TB death
rates. It helps the epidemiologist to have current knowledge about what is
happening and what he has to do to control the diseases.
Revised National Tuberculosis Program

In the year 1992 Govt. Of India, WHO and world bank together reviewed the
national tuberculosis program.(NTP). After the revision it is referred to “Revised
national tuberculosis program (RNTCP)”
The main objectives of RNTCP:

➢ To achieve the cure rate of not less than 85% through short course
chemotherapy
➢ To detect 70% of the estimated cases through sputum smears
➢ To involve nongovernmental organizations (NGOs)
➢ Use DOTS as community based treatment.
The WHO’s Stop TB Strategy

▪ World health organization recommends all countries, public and private
sectors functioning at national, local levels to implement the following to
bring down the burden of TB:
▪ Practice high-quality of “DOTS” expansion and enhancement.
▪ Secure political commitment with enough and continued financing
▪ Ensure early detection of cases and diagnosis and maintain quality
▪ Provide standardized treatment with suitable Supervision and patient
support
▪ Assure effective drug supply and management
▪ Continuous monitoring and evaluation
▪ Pay attention on TB-HIV, MDR-TB, and the needs of Vulnerable populations
▪ Strengthen primary health care with valid contribution
▪ Include all care providers
▪ Empowerment of patients with tuberculosis and Communities through
partnership
▪ Take necessary steps to improve and enhance research.
SEVERE ACUTE RESPIRATORY SYNDROME(SARS)

SARS is a frightening viral respiratory illness caused by a coronavirus known as
SARS-associated coronavirus (SARS Cov, usually shortened to SARS or SARS virus).
SARS is associated with a flu-like syndrome, which may progress into pneumonia,
respiratory failure, and sometimes death. Initially in February 2003 SARS was
reported in Asia. Within a few months, this has been spread to more than 24
countries in North America, South America, Europe, and Asia.
Causative Agent
SARS is caused by a corona virus known as SARS-associated Corona virus (SARS-
CoV, or SARS virus).
SARS thought to be an animal virus from uncertain animal reservoir perhaps bats,
that spread to other animals (civet cats).
SARS virus is present in the nasal and throat secretions, urine and stool of the
cases.
Host Factors
▪ Most often the cases are health care workers due to their involvement in
procedures which generate aerosols
▪ Children are rarely affected Men are affected
▪ Men are affected more than women.
Environment
▪ It is an airborne disease
▪ Survives longer period in cold
▪ Can survive hours in external environment.
Transmission
➢ Mainly SARS seems to spread by close person to person contact and most
readily by respiratory droplets (droplet Spread) produced when an infected
person cough or sneezes.Droplet is propelled a short distance generally
upto 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 eyes.
Incubation Period
2 to 7 days generally 3 to 5 days
Clinical Symptoms of SARS
➢ SARS begins with a high fever (temperature greater than 100.4°F or 38.0°C
➢ Other symptoms may include are headache, discomfort and body aches
➢ There may be diarrhea in some patients
➢ After 2 to 7 days dry cough may appear. Most often patients develop
pneumonia
Prevention and control of SARS

Early Detection of Infected Persons
➢ Focus the attention on people with the history of contact With SARS or
travel in SARS area
➢ Isolation of people with suspected symptoms
➢ Notification
➢ Information, education and communication (IEC) activities to create
awareness.
Containment of Infection
➢ Segregate the suspected cases until diagnosis is established
➢ Keep the doors closed
➢ Visits must be Prohibited
➢ Provide maximize natural ventilation; and use of exhaust fans
➢ Concurrent disinfection of secretions, linens and utensils of the patients.
Personnel Protective Measures

➢ Respiratory protection by N-95 masks
➢ Protect eyes with goggles
➢ Contact protection by use of gown and gloves
➢ Hand hygiene is the fundamental preventive measure. Hands washed
properly after every contact with the cases
➢ No aerosol therapies.
Others
• Limit the movements of the patients
• Advice patients to use protective attire-gown, mask to house-hold contacts
• Be vigilant for fever and respiratory symptoms
• Strictly adopt protective attire with a special reference to hand hygiene
• Disposable gloves should be used to clean the surfaces
• Disinfect all the linens used by the patient
• Promote natural ventilation in the rooms.
INTESTINAL INFECTIONS
Infection of the intestine that may be due to virus, bacteria, parasites.
POLIOMYELITIS
Poliomyelitis (polio) is a highly infectious viral disease that largely affects children
under 5 years of age. The virus is transmitted by person-to-person spread mainly
through the faecal-oral route or, less frequently, by a common vehicle (e.g.
contaminated water or food) and multiplies in the intestine, from where it can
invade the nervous system and cause paralysis.
Causative Agent
❖ Poliomyelitis is an acute viral infection caused by poliovirus. Though it has
three serotypes, 1, 2 and 3 most outbreaks occur due to type 1 virus
❖ Man is the only known reservoir of infection
❖ The poliovirus can be inactivated by autoclaving and different physical and
chemical methods
❖ The virus is found in the feces and oropharyngeal Secretions of an infected
person
❖ The cases are most infectious 7 to 10 days before and after the onset of
symptoms.
Host Factors
• All age groups can be affected. However, children are More susceptible
than the adults are
❖ Polio incidence varies between male and females with
The ratio of 3 males to 1 female
❖ The risk factors found to provoke the disease in individuals already infected
with the virus
❖ Maternal immunity received from mother will be lost During first 6 months
of life.
❖ Most often occurs during rainy season
❖ Sources of infection are contaminated water, food, and flies
❖ Poliovirus survives for a long time in a cold environment
❖ Overcrowding and poor sanitation facilitate infection.
Transmission
➢ Fecal-oral route: The main route of spread of infection is fecal-oral route

directly through contaminated fingers or indirectly through contaminated
water, milk, other foods, flies, and articles of daily use
➢ Droplet infection: Close personal contact during the acute phase of the
disease facilitates transmission through droplet infection
➢ Incubation Period: 7 to 14 days (ranges from 3 to 35 days).
Symptoms
➢ Sore throat
➢ Fever
➢ Tiredness
➢ Anorexia
➢ Nausea and vomiting
➢ Headache
➢ Abdominal pain
➢ Constipation
➢ Stiffness of neck and back muscles
➢ Difficulty in swallowing
➢ Weak or diminished tendon reflexes before the onset of paralysis.
➢ The paralysis starts at the hip and descending to the Distal parts.
➢ Weakness or loss of voice
➢ Death can occur due to respiratory insufficiency
Preventive Measures
Immunization
There are two types of vaccines available
➢ Inactivated polio vaccine
➢ Oral polio vaccine
Inactivated Polio Vaccine (IPV)

Dr Jonas Salk introduced inactivated polio vaccine (IPV) In 1955 and it is also
called the “Salk vaccine IPV has all three strains of inactivated poliovirus types. It
is administered by intramuscular injection and requires a trained health personnel
to administer the vaccine.
Advantages
• IPV does not have a risk of vaccine-associated polin paralysis since it is not a
live vaccine
o IPV develops an exceptional protective immune response in most people.
Disadvantages
o IPV induces very low levels of immunity in the intestine As a result, when a
person immunized with IPV b infected with wild poliovirus, the virus can
still multiply inside the intestine and be shed in the faeces, risking
continued circulation
o IPV is costly. This costs five times more than oral polio Vaccine
o Administering the vaccine requires well-trained health workers, sterile

equipment and strict compliance to sterile technique throughout the
procedure.
Oral Polio Vaccine (OPV)
In 1961 Albert Sabin developed the oral polio vaccine (OPV) and also called
“trivalent oral polio vaccine” or “Sabin vaccine OPV has a mixture of live,
attenuated (weakened) poliovirus strains of all three poliovirus types. OPV tends
to produce antibodies in the blood to all three types of poliovirus a child contact
infection, these antibodies protect against by preventing the transmission of
poliovirus to the nervous system. Oral polio vaccine triggers local, mucosal
immune response in the mucous membrane of the intestine. The intestinal
immune response to OPV is considered to be major reason for mass campaigns
with OPV quickly person-to-person transmission of poliovirus.
Advantages
▪ OPV is administered orally. It does not need training or sterile equipment
▪ This vaccine is comparatively inexpensive
▪ Oral polio vaccine is safe, effective, and brings long lasting immunity to all
three types of poliovirus
▪ After few weeks of vaccination, the vaccine virus replicates in the intestine.
This gets excreted in the feces, and transmitted to others who are in close
contact So wherever the hygiene and sanitation are poor, the immunization
with oral polio vaccine can cause “passive” Immunization of people though
they are not directly immunized.
Disadvantages
▪ The live attenuated vaccine virus in oral polio vaccine may induce paralysis
in rare cases
▪ The virus in the vaccine may inherently change and start to flow in a
population
The newly introduced heat stabilized oral polio vaccines an be stored at 4°C for a
year period without losing its Potency
Nonstabilized oral polio vaccines -20°C in a deep freeze.
Human Normal Ig
This is passive immunization. Almost this has been eliminated use due to active
immunization with oral polio vaccine. This is given in a dose of 0.25-3 ml. Per kg
body weight
Surveillance
Early Diagnosis and Surveillance
Acute Flaccid Paralysis Surveillance
Nationwide acute flaccid paralysis (AFP) surveillance
Is considered the gold standard for detection of cases of
Poliomyelitis. This involves four steps of surveillance
• Identifying and reporting children with acute flaccid Paralysis (AFP)
• Sending stool samples for analysis
• Isolating and finding out the poliovirus in the laboratory
• Mapping the virus to find out the place of origin of the Virus strain
AFP Reporting Procedure

• Immediate reporting of AFP cases below 15 years of age
and paralytic illness on suspected age for polio attack. This Should be investigated
within 48 hours
• Collect two stool specimens 24-48 hours apart and within 14 days of the
onset of paralysis
Environmental Surveillance
Testing sewage and other environmental samples for the
Presence of poliovirus are the vital measures of environmental surveillance.
Generally environmental surveillance most often helps in identifying poliovirus
infections in the absence of cases of paralysis.
Systematic environmental sampling (eg in Egypt And Mumbai, India) provides
important supplementary Surveillance data.
Ad-hoc environmental surveillance (especially in polio free regions) provides
insights into the international spread of poliovirus.
Pulse Polio Immunization Program

India began its Pulse Polio Immunization program in 1995 All the children in the
age group of 0-5 years are administered polio drops under national immunization
rounds every year. About 172 million of children are immunized during each
National Immunization Day (NID), WHO on 24th February 2012 removed India
from the list of countries with active endemic wild poliovirus transmission.
VIRAL HEPATITIS
It is the infection of the liver caused by many types of viruses. Earlier there were
only hepatitis A and B virus causing the disease. Nevertheless, today hepatitis
viruses C, D, E and G have also been discovered. Hepatitis A, B, C are diseases
Caused by three different viruses Although each can cause similar symptoms, they
have different modes of transmission and can affect the liver differently.
Viral Hepatitis A
Hepatitis is the name given to a family of viral infections that disturb the liver.
Hepatitis A is a viral infection of the liver that can cause mild to severe illness.
Poor sanitation and lack of safe drinking water predisposes hepatitis A infection
Causative Agent
• Hepatitis A disease is caused by enterovirus-hepatitis A
• Human cases are the only reservoirs of Infection
• Feces, blood, serum and other fluids of infected person are infectious.
Urine may also contain virus
• Cases are infective 2 weeks before and I week after the onset of jaundice
Host Factors
• More frequent among the children than adults. However
• All age groups are affected
• Both sexes are equally susceptible
• Secondary attacks are rate (5%).
People at Risk to Get Hepatitis A Virus infection
Though any one can get hepatitis A. Certain groups of people are at higher risk
• Travel to or live in countries where hepatitis A is endemic
• Men who have sexual contact with other men
• Use illegal drugs, whether injected or not
• Have clotting-factor disorders, such as hemophilia
• Live with someone who has Hepatitis A
• Have oral anal sexual contact with someone who has Hepatitis A
• Overcrowding
• Low standards of hygiene
• Rainy season
• Lack of awareness
Clinical Symptoms
• Fever, chills and headache

• Fatigue
• Loss of appetite
• Anorexia
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored stool
• Joint pain
• Jaundice (a yellowing of the skin or eyes),
Transmission
• Fecal oral routes: By direct person-to-person cont indirectly by

contaminated food, Water or milk
• Parenteral route-very rare
• Sexual transmissions: May occur in homosexual men Because of oral-anal
contact
Incubation Period: Usually from 25 to 30 days

Lab Investigations
• Stool specimen tested for hepatitis A virus
• Blood serum investigation Of person to detect Antibodies to HAV(hepatitis

A virus).
Prevention and Control of Reservoir

• Notify the cases as they are identified
• Complete bed rest advised.
• Disinfection of all the articles used by the cases
• Disinfect the feces
• Sodium hypochlorite 0.5% is used for disinfection.
Control of Transmission
• Improved sanitation, food safety and immunization an the most effective
ways to combat hepatitis A
• The spread of hepatitis A can be controlled by provision Of safe drinking
water, proper disposal of sewage and personal hygiene practices such as
hand-washing with soup and water
• Handwashing with soap and water after visiting the ret room, changing a
diaper, or before handling food at help prevent the hepatitis A.
Control of Susceptible Population

• Human Immunoglobulin
• One dose of human immunoglobulin provides short-term protection, i.e.
approximately for the period of 3 months against Hepatitis A
• Immunoglobulin is administered either before or after exposure to the
Hepatitis A virus. If any person travel to a place where Hepatitis A is
prevalent he or she must get vaccinated before travel
• This is also used after exposure to the Hepatitis A Virus to prevent infection
• Immunoglobulin must be administered within 2 weeks after exposure for
getting best protection.
Hepatitis A Vaccine
• Inactivated or live attenuated vaccines are available against hepatitis A
• Two shots of “hepatitis A vaccine” is administered 6 months to 18 months
Combined Vaccine
• The Hepatitis A vaccine also comes in a combination form, containing
inactivated Hepatitis A and recombinant hepatitis B vaccine, that can be
given to persons 18 years of age and older
• This form is given as 3 shots, over a period of 6 months.
Hepatitis B
Hepatitis B is an infectious liver disease of viral origin that ranges in severity from
a mild illness lasting a few weeks to a serious, lifelong illness.
Causative Agent
➢ Hepatitis B virus originally known to be “Dane particle” is the causative
agent
➢ Man is the only reservoir of infection
➢ Virus is found in the blood, saliva, vaginal secretions and semen. But
contaminated blood is the main source of infection
➢ Readily destroyed by sodium hypochlorite.
Host Factors
Normally affects 20-40 years of age. Both sexes are affected
➢ People who are at greater risk of getting hepatitis B People who have sex
with an infected person
➢ Those who have multiple sex partners
➢ Have a sexually transmitted disease
➢ Homosexuals
➢ Drug addict or those who share needles, syringes or other drug equipment
➢ Live with a person who has chronic Hepatitis B
➢ Infants born to infected mothers
➢ Health care professionals who are exposed to blood On the job
➢ Patients on hemodialysis
➢ People who travel to countries with moderate high rates of Hepatitis B.
o Hepatitis B virus is able to live outside the body for 7 days. During that time,
the virus can still cause infection.
o Contaminated blood and other secretions on the surfaces are source of
infection.
Symptoms
The symptoms are same like other type of hepatitis, Chronic liver disease and
carrier state still more complicate the condition. Occasionally chronic liver disease
may lead to liver cancer.
Parental route: By infected blood and blood products
o Transfusion
o Dialysis
o Contaminated syringes and needles
o Needle-stick injuries
o Handling infected blood
o Surgical procedures
o Immunization
o Ear and nose piercing
o Ritual circumcision
o Acupuncture
o Traditional tatooing.
Perinatal transmission
o Spread from an infected mother to her baby during birth
Sexual transmission
o By intimate contact or sexual route
o Sexually promiscuous especially male homosexuals are at great risk
Other Routes
o Physical contact between children impetigo, scabies and cuts or grazes.
Incubation Period
• This is between 45 and 180 days.
• Lower doses of virus often result in longer incubation period

Prevention
Testing
People who are happen to have one or more risk factors for hepatitis B infection,
should get a HBV blood test done. This blood test helps in determining about the
probability of getting infected with hepatitis B virus:
• Is he immune to hepatitis B
• Is he susceptible to hepatitis B and need vaccination?
• Is he infected with hepatitis B and need further evaluation by a physician?
Perinatal Hepatitis
• It is ideal to test all pregnant women for hepatitis B infection:

• It is a known fact that HBV-infected mother can pass the
Infection to the baby during the birthing process, unless the baby gets
immunized within hours of birth,
• Hepatitis B vaccine should be administered to baby Within 24 hours of birth
• Giving the infant HBIG (hepatitis B immune globulin) and HBV vaccine
straightaway is very much reliable in Preventing infection of the infant.
Developing Healthy Habits Measures to reduce the risk of getting hepatitis B, C,
and HIV
• Do not abuse drugs; do not inject drugs. Never ever Share needles and
syringes
• Sharing personal care items like razors, toothbrushes etc. Should be
avoided since they might have infected blood
• Health care professionals must have strict compliance to universal
precautions while handling blood or body fluids; safe handling of needles
and other sharps is sought all time
• Avoid risk procedures like tattooing, body piercing and acupuncture etc.
• Have healthy sex with one partner only. People have sex with more than
one steady partner should use latex condoms to prevent the spread of
sexually transmitted diseases (STDs) and viral hepatitis and HIV
• Persons who have recently been exposed to HBV should be administered
Hepatitis B immune globulin (HBIG) and vaccine preferably within 24 hours,
but not later than 2 weeks of exposure.
VACCINATION
The hepatitis B offers brilliant protection against H vaccine is safe and greatly
effective. Vaccination c doses of vaccine over the course of 6 months it peut
person for 20 years from hepatitis B
Hepatitis B vaccine (rDNA) is a no recombinant DNA Hepatitis B vaccine.
Paediatric dose vaccine: 10 mcg dose (in 05 ml Suspension
Is recommended for neonates, infants and children upto
10 years of age. Adult dose vaccine 20-mcg dose (1.0 ml
Suspension) is recommended for adults and chidden above
10 years of age.
Time schedule for injections:
1st dose At selected date
2nd dose 4-10 wks after 1st dose
3rd dose 1-5 months after 2nd dose
Route of administration-IM
Hepatitis B Immunoglobulin
This is used for protecting those acutely exposed to health care professionals,
newborn infants of carrier mother’s, sexual contacts of acute hepatitis B patients.
Ideal to give within 6 hours but not later than 48 hours Simultaneously the
victim’s blood is tested for HBSAG
If it is negative, routine course of hepatitis B vaccine is given.
Combined Vaccine
Simultaneous administration of hepatitis B immunoh (HBIG) and hepatitis B is
more efficacious than HBIG alone
HBIG-0.05-0.07 ml/kg body weight within 24 hours
Hepatitis B vaccine-1mL (20mcg/1 ml)-within 7 days of exposure, the next dose
after 1 month and the
Third dose after 6 months of the 1st dose.
OTHER MEASURES
• Screening the blood donors
• Hygienic measures like strict hand washing
• Strict check on sterilization procedure
• Screening of health care professional
• Carriers must be educated about the dangers that he may Cause to others
by sharing his personal items like razors.
HEPATITIS C
Approximately 50,0000 people die every year due to hepatitis C-related liver
infections. Hepatitis C is a liver disease caused By the hepatitis C virus. The
hepatitis C is a blood borne virus and most commonly transmitted through blood.
The unsafe practices such as inadequate sterilization and the transfusion of
unscreened blood and blood products cause hepatitis C virus infection. Hepatitis C
is found globally. The most affected regions are Africa and Central and East Asia.
Causative Agent
• Hepatitis C is caused by the hepatitis C virus.
• Hepatitis C is widely found globally. Africa and Central and East Asia are
most affected regions.
Incubation Period
The incubation period ranges between 2 weeks and 6 months.
Primary Prevention Measures
World health organization provides various preventive
measures at primary, secondary and tertiary levels.
• Thorough hand hygiene: This includes surgical
Scrubbing, hand washing and use of gloves, safe and
Cautious handling and disposal of sharps and waste
• Provision of comprehensive services to people especially those who inject
therapeutic drugs
• Screening and testing of donated blood for hepatitis B and C and for HIV
and syphilis
• Thorough training to health personnel
• Promoting the correct and consistent use of condoms
Secondary and Tertiary Prevention
For people infected with the hepatitis C virus:
Provision of education and counselling for care and treatment
Immunize with the hepatitis A and B vaccines to prevent coinfection and to
protect the liver.
Early and suitable medical measures that may include
antiviral therapy where suitable.
Periodic Monitoring for early detection of chronic Liver disease.
Screening Hepatitis C Infection
WHO launched “Guidelines for the screening, care and treatment of persons with
C in April 2014. The screening guidelines include:
• Screening to identify persons with HCV infection.
• When to confirm Screening for alcohol use and counselling to reduce
diagnosis of chronic HCV infection moderate and high levels of alcohol
intake
• Assessing degree of liver fibrosis and cirrhosis
• Recommendations on treatment of HCV infection
HEPATITIS D
Hepatitis D otherwise called delta hepatitis is caused by the hepatitis delta virus
(HDV), a defective RNA virus. HDV requires the help of a hepadnavirus like
hepatitis B virus (HBV) for its own replication.
The hepatitis delta virus is prevalent worldwide and affects all age groups.
HDV can be transmitted percutaneously or sexually through contact with infected
blood or blood products. Blood infectious through all phases of active hepatitis D
infection. Infectivity is at highest levels before the onset of acute disease. Chronic
HBV carriers are at risk for infection with HDV.
There is no effective antiviral therapy available currently for hepatitis D. The only
alternate measure is to perform liver transplantation for cases of fulminant acute
and end-stage chronic hepatitis D.
HEPATITIS E
Every year there are an estimated 20 million hepatitis E infections, and 56 600
hepatitis E-related deaths. Hepatitis E is found to be prevalent in East and South
Asia. Hepatitis E is caused by the hepatitis E virus
1. Food borne transmission through ingestion of products of infected animals
2.Waterborne
3.Transfusing of infected blood products
4. Mother to child transmission from a pregnant woman to her child.
Incubation period:
3 to 8 weeks or an average of 40 days
PREVENTION
The transmission risk can be reduced by following quality standards for public
water supplies
Proper disposal systems to dispose sanitary waste. Strict adherent on hygienic
practices like hand washing before handling food
Avoiding drinking water and ice from unknown sources
Be compliant to WHO safe food practices.
ACUTE DIARRHEAL DISEASES

A group of diseases in which the predominant symptom is diarrhea is referred to
acute diarrheal diseases. The WHO/ UNICEF define “acute diarrhea” as an attack
of sudden onset which usually lasts 3-7 days but may last up to 10-14 days.
CAUSATIVE AGENT
Bacteria, viruses and parasites cause diarrheal diseases
In addition to above causes parenteral infection plays a role, especially in young
children. These include ENT. Respiratory, urinary-infections, malaria, and
meningitis even teeth eruption.
VIRUSES: Rotavirus, Astroviruses, Adenoviruses, Enteroviruses
BACTERIA: Campylobacter jejuni, E. Coli, shigella, salmonella, vibrio cholera
OTHERS: E. Histolytica, Intestinal worms, Cryptosporidium
HOST FACTORS
Diarrhea is most common in children under 5 years especially those between 6
months and 2 years.
People with low immunity are prone for diarrheal
Infections.
Diarrhea is more common in persons with malnutrition
Poverty prematurity, reduced gastric acidity, immunodeficiency, lack of personal
and domestic
Hygiene and incorrect feeding practices all contribute to
the occurrence of diarrheal diseases
Diarrhea occurrence shows seasonal patterns:
Bacterial diarrhea occurs more frequently in warm season in temperate climate;
whereas viral diarrhea, in particular that occurs due to rotavirus show peak
incidence during winter
Poverty, lack of education, people’s wrong beliefs and practices play a role in
predisposing the diarrheal diseases.
Faecal-oral route-This may he waterborne, foodborne or direct transmission
through fingers, fomites or dirt which may be ingested
Prevention and Control of Acute Diarrheal Diseases
Diagnosis and Treatment of Diarrhea
Assessment is vital considering the diagnosis of diarrhea. Diarrhea usually defined
as the passage of loose, liquid or watery stool more than three times a day.
However, the change in consistency & character of stools are more important
than the number of stools.
Dehydration: Dehydration is assessed and graded as mild or severe based on the
following criteria:
Mild dehydration may be treated at home or in the nearest treatment centers.
Severely dehydrated cases need to be referred for further management in the
hospitals ince they need intravenous fluid therapy to replace the fluid l
Chemotherapy
Antibiotics should be considered where the cause of diarrhoeas has been clearly
identified as shigella, typhoid or cholera
Zinc Supplementation
Zinc supplementation during acute diarrhea reduces duration and severity. WHO
and UNICEF recommend 10 mg of zinc for infants under 6 months of age and 20
mg for children older than 6 months for 10-14 days.
Better Maternal and Child Health (MCH) Care Practices
• A good attention to prenatal nutrition will reduce the low birthweight
babies .
• Education to mother on importance of breastfeeding during the antenatal
period will help to prepare the mother physically and mentally. The breast-
fed child is at low risk of developing severe diarrhea and death comparing
to the bottle-fed child
• Wean the infants at appropriate age Poor weaning practices are a major
risk for diarrhea. Exclusive breastfeeding for 6 month of life is
recommended
• The weaning foods should be prepared hygienically using nutritious and
locally available foods
Sanitation
Safe water supply
Sale disposal of excreta
Food hygiene
Domestic
Proper hand washing
Provision for sanitary latrines at homes
Avoid all sorts of contaminated food items.
Health Education
Community to be health educated on environmental sanitation
Immunization
Immunization against measles is a useful intervention to control diarrhea. The
measles vaccine can prevent 25% of diarrheal deaths in children under 5 years of
age.
Fly control
Adequate measures should be applied to control fly breeding
Diarrheal Control Program in India

This was started in 1978 to reduce the mortality and morbidity due to diarrheal
diseases. From 1992-93, the program has become a part of the Child Survival and
Safe Motherhood Program and all activities are now integrated with those of the
CSSM Program.
TYPHOID FEVER
Typhoid fever is commonly found disease in developing world and affects around
21.5 million people each year. The term enteric fever includes both typhoid and
paratyphoid fevers.
Causative Agent
-Salmonella typhi (S. Typhi) causes typhoid fever. It is readily killed by drying,
pasteurization
Persons with typhoid fever carry the bacteria in their Bloodstream and intestinal
tract.
Carriers, recover from typhoid fever but continue to spread the bacteria. Both
cases and carriers shed Salmonella Typhi in their feces
Host Factors
Typhoid affects all ages. However, the attack rate is the highest in children of 5-19
years
More cases are reported among males that females. But carrier rate is more in
females
All ages are susceptible. Antibody may be stimulated by Infection or by
immunization.
Environmental and Social Factors

Though the incidence is reported all through the year, peak incidence is reported
during July-September, ie the rainy season and increased fly population.
The bacilli are also found in water, ice, food and soil.
Vegetables grown in sewage water might be a source of contamination.
Social factors include:
Pollution of drinking water supplies
Open-field defecation and urination
Poor food hygiene
Poor personal hygiene
Health ignorance
Incubation Period: Usually 10-14 days, ranges between 3 days and 3 weeks.
Transmission
• Transmission occurs through fecal-oral or urine-oral Route.
• Direct transmission: Through soiled hands contaminated with feces, urine
of cases or carriers
• Indirect transmission: The transmission is possible through contaminated
food, water, soil
• Flies play a significant role in transmission.
Symptoms
• Persons with typhoid fever usually have a sustained fever as high as 103” to
104” F (39° to 40”)
• Weakness, headache, abdominal pains, loss of appetite.
• Rash of flat, rose-colored spots appears in some cases
• Fever ascends in a step ladder fashion, reaches normalcy after 7-10 days
• The patient looks toxic, may suffer with constipation or “pea soup”
diarrhea.
• To confirm the diagnosis of typhoid fever. Stool examination or blood test
for the presence of Salmonella typhi.
Control
Measures directed to reservoir
Case detection and treatment: Culture of blood and stools are done to diagnose
the cases. Cases should be notified to local authority. Seriously ill patients should
be given ini. Hydrocortisone 100 mg daily for 3 to 4 days.. Fluoroquinolones is the
drug of choice for typhoid fever. They are inexpensive better tolerated than the
first-line drugs
Treatment for Cases of Typhoid

First-line Antibiotics
• Chloramphenicol- Oral, IV 500 mg qid (50 mg/kg in 4 doses) for 14 days
• Trimethoprim-Sulfamethoxazole-Oral, IV 160- 800 mg bid (4-20 mg/kg in 2
doses) 14 days
• Ampicillin/Amoxycillin-Oral, IM, IV 1,000-2,000 mg
Qid(50-100 mg/kg: in 4 doses 14 days
• Second-line antibiotics: Fluoroquinolones
• Ciprofloxacin Oral/IV 500 mg bid/200 mg bid 10- 14 days
• Norfloxacin Oral 400 mg bid 10 days.
Isolation: Typhoid fever cases should be isolated to prevent the spread of

infection. Cases should be isolated till three bacteriologically negative stools and
urine reports are obtained on three separate days Surveillance: The carriers
should be prevented from Handling food, milk, or water for others
Disinfection
Stools and urine are received in closed conten and disinfected with 5% cresol for 2
hours
All soiled clothes and linen Should be soaked in health can chlorine and
autoclaved
Disinfection of hands is a must for professionals
Measures at Routes of Transmission

Water sanitation: Safe drinking water to be r Water treatment is done at large
and small scales Being and chlorination are used to treat the water at domestic
level.
Food sanitation: Food handlers must be screened be appointment and there
should be periodically medica checkup. Food hygiene must be strictly followed
Excreta disposal: There safe disposal of excreta need to be proper system
Fly control: Keep the environment clean and avoid fy breeding.
Immunoprophylaxis
Health Education
• Maintain cleanliness of utensils and surroundings
• Proper disposal of garbage
• Maintain clean hands with fingernails trimmed
• Before food, and after toilet or changing diapers hand must be washed
properly with soap and water
• Drink boiled cooled water
• Better to buy fresh food from trusted sources
Typhoid Vaccine
Two new-generation typhoid vaccines of demonstrated safety and efficacy are
available, the Vi polysaccharide vaccine which is administrated by injection and
the live attenuated Tyla vaccine which is given orally. The Vi polysaccharide
vaccine is composed of purified Vi capsular polysaccharide from the Ty2 S. Typhi
strain. It is administered subcutaneously or intramuscularly.
Typhoid Prophylaxis-Peadiatrics
Children above 2 Years
Ty2S vaccine, 0.5 mL is administered intramuscularly in the deltoid or the vastus
lateralis region. This must be administered 2 weeks before potential exposure to
S. Typhi. Booster dose of 0.5 mL is given intramuscularly every 2 if there is
sustained exposure to S. Typhi.
Usual Adult dose for Typhoid Prophylaxis

Typhoid vaccine 0.5 mL. IM once given in the deltoid. The vaccine should be given
at least 2 weeks before potential exposure to S. Typhi. Booster: 0.5 mL. IM every
years if there is continued exposure to S. Typhi.
CHOLERA
It is an acute diarrheal disease caused by vibrio cholerae characterized by sudden
onset of profuse, effortless, watery diarrhea, vomiting, muscular cramps, rapid
dehydration and supression of urine.
EPIDEMIOLOGICAL FACTORS
AGENT FACTORS
1: Agent causing cholera is V.cholera 0 group 1 or vibrio cholerae 01 & 0139.
Cholera now is caused mostly by EI Tor biotype and 0.139.
They are killed within 30 minutes by heating at 56°c
Cresol & bleaching powder are good disinfectants which kill vibrio cholerae
instantly
The vibrios multiply in the small intestine and produce an exotoxin(enterotoxin)
which causes diarrhea
2.Reservoir of infection: The human being is the only reservoir. He may be a case
or carrier
a.Case ranges from mild to severe infection
b.carriers are usually temporary but there are chronic carriers also which
are rare.
3.Infective material: stool and vomitus of cases & carriers are the source of
infection. These contaminate water, food and fomites.
4.Infective dose: when large number of vibrios enter the body through
ingestion, infection occurs.
5. Period of communicability: The case is infectious for 7-10 days.
HOST FACTORS
1. Age& sex: All ages & both sexes are affected, children are the most
affected.
2. Gastric activity: when acidity is of PH 5 or lower, the vibrio is
destroyed
3. Population mobility: Mobility of people during fair, festivals,
marriages and pilgrimages increase risk of exposure to infection.
4. Economic status: Highest in low socio economic groups.
5. Immunity: Natural infection confers good immunity but the duration
& degree of immunity are not known.
Poor environmental sanitation contaminated food and water spread vibrio
cholerae.
Indirect transmission: Ingestion of fecally contaminated food and water or drink
can spread infection.
Direct transmission: Person to person transmission through contaminated fingers
while handling excreta and vomit of the patient. A considerable number of cases
occur through direct contact.
INCUBATION PERIOD:
Few hours to 5 days, commonly 1-2 days
CLINICAL FEATURES
1. Stage of evacuation: It is marked with abrupt onset in which there is
profuse, painless, watery diarrhea, followed by vomiting . The patient may
have upto 40 stools in a day.It leads to dehydration, acidosis and
hypokalemia.
2. Stage of collapse: Due to dehydration the patient collapses. The signs of
dehydration include sunken eyes, hollow cheeks, scaphoid abdomen,
washerman`s hands...etc.These may lead to death due to dehydration and
acidosis.
3. Stage of recovery: If the patient survives, he show signs of improvement.
The blood pressure begins to rise, temperature returns to normal and urine
secretion starts.
DIAGNOSIS
Cholera is confirmed by stool examination in the laboratory. Stool should be
collected before starting antibiotic. Fresh stool specimen is required.
Serological tests and biochemical tests
Other methods include hanging drop, dark field illumination to see vibrio cholerae
in the stool specimen.
Vaccination
There are two types of oral cholera vaccines available
1. Dukoral(WC-rBS): It’s a monovalent & killed vaccine
2. Sanchol & mORCVAX: They are live attenuated bivalent oral cholera
vaccines
FOOD POISONING
Food poisoning is defined as an illness that occur as the result of consuming food
or water contaminated with bacteria or their toxins, parasites, viruses, or
chemicals. The most common causes are Norovirus, Escherichia coli, Salmonella,
Clostridium perfringens, Campylobacter, and Staphylococcus aureus.
Food poisoning is of two types:
Nonbacterial: It is caused by chemicals such as arsenic, Certain plants and sea
food.
Bacterial: It is caused by the ingestion of foods contaminated by living bacteria or
their toxins.
Bacterial Food Poisoning Include:
Salmonella food poisoning
Staphylococcal food poisoning
Botulism
Cl. Perfringes food poisoning
B. cereus food poisoning
Causative Agent
The cause can be bacterial or nonbacterial
Nonbacterial food poisoning is caused by chemicals such
As arsenic, certain plants and sea food
Bacterial food poisoning is caused by Salmonella, Staphylococcus, Clostridium
perfringens, B. Cereus, Campylobacter, etc
Signs and Symptoms

Generally the symptoms of food poising differ inserity and blend. The mod
common ones are
Abdominal pain: It is severe in inflammatory process abdominal muscle cramps is
related to electrolyte los
Vomiting This is the major symptom of food poisoning that occurs due to S.
Aureus, B. Cereus or norovirus
Diarrhea normally lasts less than 2 weeks
Severe headache
Fever as a result of an infection outside the GI Tract
Stool changes bloody or mucous may be present in
Cholera profuse rice watery stools will be appearing
Reactive arthritis is found with salmonella, shigella
Management of Food Poisoning

Usually food borne illnesses are mild and cute without any specific treatment. But
some patients may have severe disease and need hospitalisation, hydration, and
antibiotic treatment
Diagnosis and Treatment
Based on the history and symptoms laboratory investigation To be advised and
treatment given accordingly. Always sak and the up for any common source that
had ca the food poisoning
Supportive Care
• The major idea of managing patients with food poisoning Is rehydration
and electrolyte supplementation Route of administration of fluids depend
on the condition of the patient
• Either oral rehydration solution or intravenous solution Are administered
according to the severity of the illness
• Lactose containing foods such as milk, dairy products etc should be avoided
during the cute phases of diarrhea
TREATMENT
Medications that may be needed to treat patients with food
Poisoning include the following
Antidiarrheals:Absorbents (eg, attapulgite, aluminum hydroxide)
Anti-secretory-agents (eg, bismuth subsalicylate)
Anti-peristaltics (eg, opiate derivatives such as phenoxylate with atropine
loperamide)
Antibiotics (eg, ciprofloxacin, norfloxacin.
Prevention and Control of Food Poisoning
Food Sanitation
Meat inspection: Ensure that the food animals are free from infection through
inspection by veterinary staff before and after slaughtering
Practice strict personal hygiene while cooking
Food handlers
Do not allow food handlers with infections like sore Throat, boils diarrhea, und
dysentery
Appropriate food handling techniques should be followed
Refrigeration
Keep all foods at appropriate temperatures to keep away bacterial food poisoning
AMEBIASIS
Amebiasis is an intestinal illness that is transmitted by consuming food items
contaminated with a parasite called Entamoeba histolytica.
Causative Agent
Caused by (E. Histolytica)
Host Factors
The disease occurs at any age and affect both sexes
Transmission
Occurs via the feco-oral route, either directly from person to person contact or
indirectly by consuming contaminated food or water
Closely related to poor sanitation and socioeconomic status
Fecal-oral route
Sexual transmission
Among male homosexuals
Vector vectors such as flies, cockroaches and rodents
TREATMENT
Symptomatic cases are treated with Metronidazole 30 mg per kg body weight per
day.
Assymptomatic cases
Di-iodohydroxyquin
• For adults:650 mg TDS X 20 days
• For children:30-40 mg per kg body weight in 3 divided doses per day X 20
days
• Diloxanidefuroate( for adults)-500 mg TDS X 10 days
HOOK WORM INFECTION

Hook worm infection is defined as, any infection caused by Ancylostoma
duodenale or Necator Americans”.
Causative Agent
Hookworm infection is caused by the nematode parasites Necator americanus (N.
Americanus) and Ancylostoma duodenale (A. Duodenale)
EPIDEMIOLOGICAL FACTORS
Agent: Ancylostoma duodenale & Necator Americanus
Reservoir of Infection Man is the only reservoir of infection
Source of Infection Man
Period of infectivity:As long as the person harbours the parsite.
Host Factors
All age groups and both sexes are affected
People involved in agricultural works and those walk with bare feet and those
with poor hand hygiene
Damp, sandy soil, with adequate moisture and oxygen facilitates the survival of
larvae
Temperature of 24°C to 32°C provides favorable platform for the survival of larvae
A rainfall of 100 cm and above
Human habits like indiscriminate open field defecation.
Use of untreated sewage for farming
Illiteracy
Low standards of living.
Transmission
Human hookworm infection is a soil-transmitted helminthiasis
Most adult worms are eliminated in 1 to 2 years, but they can live for several
years.
Incubation Period
In case of A. Deodenale – 5 weeks to 9 months
In case of N. Americans -7 weeks
SYMPTOMS
Dermatitis, increased eosinophils count, pneumonitis, and skin rashes.
Gastrointestinal symptoms include mild s nausea, vomiting, and anorexia. Iron-
deficiency to blood loss is often associated with hookworm infection.
Treatment, Prevention, and Control
Diagnosis
Diagnosis is done clinically. Hookworm infection is
established by identifying hookworm eggs in feces using light microscopy.
Treatment
Mebendazole and albendazole, Pyrantelpamote are the treatment of choice for
adult hookworms
Single dose of 500 mg of mebendazole (OR)
100 mg of mebendazole twice a day for 3 consecutive days. (OR)
Albendazole is given at a single dose of 400mg
Food Hygiene
Wash vegetables thoroughly before cooking
Maintain good hand hygiene throughout the process of Cooking
Proper Sewage Disposal
Proper sewage disposal system should be installed in urban areas.
Farming Practices
Farming practices such as using raw feces as raw fertilizers should be discouraged
Health Education
• Provide mass health education in the community
• Encourage community participation constructing low Cost sanitary latrines
in the rural areas
• Maintain personal hygiene
• Prevention of soil and water pollution
• Advice community to use footwear
• Use health facilities for treatment
ASCARIASIS
Ascariasis is an infection of the small intestine caused by Ascaris lumbricoides
transmitted through deco oral route.
CAUSATIVE AGENT
• Ascaris lumbricoides causes ascariasis
• Ascaris lumbricoides lives in small intestine of infected individual
HOST FACTORS
• Man is the only reservoir of infection
• Children are infected more often than Adults
• The most common age group affected is 3-8 years
• The eggs are excreted in feces
• Infected person is communicable until all fertile females Are destroyed and
stools are negative.
Indiscriminate open-air detecation is the main reason for the Spread of infection
• Mode of transmission: Fecal-oral route

• Incubation period: It is about 2 months
Clinical Symptoms
• Nausea
• Vomiting
• Constipation
• Intestinal obstruction
• Cough
• Abdominal pain
Prevention and Control

Primary Prevention
• Provision for sale drinking water
• Proper disposal of excreta
• Provision of latrines
Health education:
• Avoid contact with soil contaminated with human feces
• Wash hands with soap & water before handling food
• Wash all fruits and vegetables before cooking
• Trim nails
SECONDARY PPREVENTION
Cases are diagnosed by stool examination.
Infected persons are treated with
• Piperazine: 75 mg per kg body weight X 2 days with
Maximum dose of 3.5 g for 2 days
• Mebendazole: 100 mg BD X 3 days
• Levamisole 2.5 mg per kg body weight maximum dose Of 150 mg
• Pyrantel: 10 mg per kg body weight-a single maximum dose of Ig
Mass Treatment
Periodic deworming an intervals of 2-3 menths is Recommended to reduce the
worm-load in the community
DRACUNCULIASIS (GUINEA WORM DISEASE)

Dracunculiasis or guinea worm disease is a vector borne disease mainly of the
subcutaneous tissues( usually leg and foot) caused by nematodes parasite.
CAUSATIVE AGENT
Dracunculus medinensis causes the disease Dracunculiasis
LIFE CYCLE
• After a year of infection, a painful blister gets formed most often in the
lower leg following which one or more worms appear with a burning
sensation
• To reduce the burning pant, patients most often dip the infected area in
water. During that time the worm (s) Releases thousands of larvae into the
water
• These larvae is ingested by tiny crustaceans or copepods, Also called water
fleas
• When people drink contaminated water they also Swallow infected water
fleas
• Though the water fleas are killed in the stomach the Infective larvae gets
released
• They then penetrate the wall of the intestine and migrate Through the
body
• The fertilized female worms measures from 60-100 cm long migrate under
the skin tissues until it reaches its exit point. Generally reaches lower limbs,
form a blister or from which it finally emerges. The worm takes 10-14
months to emerge after infection.
HOST FACTORS
• It affects both sexes and all age groups
• Repeated infections can occur in a person
• Using surface water for washing and bathing
• Using step wells
• Peak transmission occurs during the dry season (March-May)
Transmission
Guinea worm disease is transmitted through consumption of water contaminated
with infected Cyclops.
Incubation period: 10-14 months
PPREVENTION
• Continuous surveillance to detect every Case within 24 hours of worm
emergence
• Adequate treatment to infected people to prevent transmission
• Regular cleaning and bandaging of the affected until the worm is
completely expelled out
• Advise the patient to avoid wading Into water

CHN - Communicable Disease

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CHN - Communicable Disease

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EPIDEMIOLOGY:

There are many definitions on epidemiology. Few definitions are:

PROGRESSION OF SMALL POX

SMALL POX ERADICATED FROM WORLD

SMALL POX ERADICATED FROM INDIA

Chickenpox is an acute highly contagious viral disease caused by

Control Measures of Chickenpox

WHO Strategies for Year 2020

Live Attenuated Vaccine

Antiviral Drugs for Children

• FIG: Epidemiological triad of rubella

ACUTE RESPIRATORY INFECTIONS & PNEUMONIA

Note: For children below 2 months of age, cotrimoxazole is not routinely

• Cotrimoxazole should also not be given to premature babies and neonatal

Pseudo Positive Reaction

PERTUSSIS (Whooping cough)

SIGNS AND SYMPTOMS

PREVENTION AND CONTROL

Skin Test Interpretation Depends on Two Factors

Prevention and Control

Anti-TB drugs are grouped into two:

Toxic effects of rifampicin- hepatotoxicity, gastritis,Influenza, thrombocytopenia

Short Course Chemotherapy (SCC)

➢ New Sputum smear cases

Revised National Tuberculosis Program

The main objectives of RNTCP:

The WHO’s Stop TB Strategy

SEVERE ACUTE RESPIRATORY SYNDROME(SARS)

Clinical Symptoms of SARS

Prevention and control of SARS

Personnel Protective Measures

➢ Fecal-oral route: The main route of spread of infection is fecal-oral route

Inactivated Polio Vaccine (IPV)

o Administering the vaccine requires well-trained health workers, sterile

AFP Reporting Procedure

Pulse Polio Immunization Program

• Fever, chills and headache

• Fecal oral routes: By direct person-to-person cont indirectly by

Incubation Period: Usually from 25 to 30 days

• Blood serum investigation Of person to detect Antibodies to HAV(hepatitis

Prevention and Control of Reservoir

Control of Susceptible Population

• This is between 45 and 180 days.

• Lower doses of virus often result in longer incubation period

• It is ideal to test all pregnant women for hepatitis B infection:

1st dose At selected date

2nd dose 4-10 wks after 1st dose

3rd dose 1-5 months after 2nd dose

ACUTE DIARRHEAL DISEASES

Diarrheal Control Program in India

Environmental and Social Factors

Treatment for Cases of Typhoid

Isolation: Typhoid fever cases should be isolated to prevent the spread of

Measures at Routes of Transmission

Usual Adult dose for Typhoid Prophylaxis

Signs and Symptoms

Management of Food Poisoning

HOOK WORM INFECTION

• Mode of transmission: Fecal-oral route

Prevention and Control

DRACUNCULIASIS (GUINEA WORM DISEASE)

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