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THE ROYAL PENTAGON REVIEW SPECIALISTS, INC.
2nd Floor, R.G. Casas Bldg. 886 España Blvd. Cor. G. Tolentino St., Sampaloc Manila Tel. Nos. (02) 309-9582 / (02) 734-6748 / (02) 7346783
Lecturer: Daniel Joseph Espina Berdida, R.M., R.N. I. Review of Related Terms A. Communicable Disease – caused by an infectious agent which is acquired from an infected individual and transmitted to a susceptible host either by direct and indirect contact or through direct inoculation into a broken skin or mucous membrane. • The two persons important for a communicable disease to occur are the infected individual and the susceptible host. Types of Communicable Disease 1. Infectious – disease is NOT easily transmitted from person to person. It requires inoculation, e.g. tetanus, malaria, dengue, filariasis, rabies Inoculation – entrance of microorganism through mechanical means, e.g. biting, puncturing, laceration, open wound 2. Contagious – easily transmitted from one person to another through droplet, direct, or indirect contact, e.g. tuberculosis, diphtheria, measles, chickenpox, meningococcemia B. Epidemiology – the science of the patterns of disease, its occurrence, distribution, or spread and the prevention and control among group of individuals as public health; backbone of disease prevention a. Patterns of Disease Occurrence 1. Sporadic – on-and-off attack of the disease; intermittent or occasional; 20% susceptible host, 80% immune (because occurrence is predictable and therefore, can be prevented) 2. Endemic – constantly present in a certain locality; 50% immune, 50% susceptible Three endemic in the Philippines: (1) Malaria, (2) Filariasis, & (3) Schistosomiasis (with high prevalence in Regions 5, 8, and 11) 3. Epidemic – number of cases exceeds beyond the normal number of cases for a short period of time; 80% susceptible host, 20% immune 4. Pandemic – worldwide epidemic, e.g. AIDS, SARS, Bird Flu C. Triad of Disease Causation or the Epidemiologic Triad (by Leavell & Clark) – factors that interact to cause a disease Three Factors: 1. Agent – these are bacteria, viruses, protozoa, and parasites (biological agents) Characteristics of Agent: Nonspecific Infectivity – ability to enter the human body and to move into tissues response: Virulence – strength, potency, or power of the agent to cause a disease • Calor *the shorter the incubation period, the virulent the agent is • Rubor Antigenicity – ability to stimulate antibody response (specific response) • Dolor Pathogenicity – ability to cause infection or disease • Tumor 2. Environment – the medium for survival and multiplication of causative agent • Functio laesa 3. Host – the area where the agent gets its nourishment a. Humans i. Carrier – asymptomatic; a person who harbors microorganisms but does not manifest signs and symptoms; most dangerous ii. Sub-clinically ill – manifests mild signs and symptoms; less dangerous iii.Clinically ill – manifests ALL the signs and symptoms; least dangerous b. Animal – serves as an intermediate host; secondary or transitional; important in the completion of the life cycle or the microorganisms, e.g. oncomelania quadrasi (snail) in schistosomiasis c. Plants – breeding places of animals d. Soil, water, air, milk e. Fomites – inanimate objects Alert: All these factors are necessary to cause a disease; an absence of one factor will not cause a disease *** If one factor is absent, it will lead to health or wellness
D. Chain of Infection (ARPEMPS) 1. Agent – causative agent that releases toxic products that can be found inside or outside the cell Type of toxin: a. Exotoxin – toxic product that can be found outside the cell when the microorganism is still alive b. Endotoxin – toxic product inside the cell that is released when the cell is already dead; more dangerous 2. Reservoir – source of infection; normal area in the body where the organisms can be found 3. Portal of Exit – from the reservoir to the outside environment a. Respiratory system – sneezing and coughing of respiratory secretions (SMILING is not included) b. GIT / Alimentary tract – vomitus and feces c. GUT – urine, semen, vaginal discharges d. Skin – open wound e. Mechanical – bite of an insect or animal f. Blood – broken skin or mucosa g. Transplacental – mother to fetus h. Exudates or discharges – conjunctival secretions, saliva, pus 4. Mode of Transmission – channel or the medium in which the microorganism is transmitted Types: a. Direct Contact – person to person; needs intimate contact; sexual intercourse, droplet (coughing and sneezing), airborne Droplet – less than three feet; less than 30 minutes Airborne – more than three feet; more than 30 minutes b. Indirect – needs vehicle-borne or vector-borne i. Vehicle – matters through which organism can be transmitted e.g. milk, soil, water ii. Vector – through animals e.g. arthropods or mollusks 5. Portal of Entry – corresponds to the portal of exit 6. Susceptible Host – prone individuals E. Stages of Diseases 1. Incubation period – period from the first exposure to the causative agent to the appearance of the first signs and symptoms 2. Prodromal period (catarrhal period) – period from the appearance of the first signs and symptoms to the appearance of pathognomonic sign (classical sign) 3. Stage of Illness – manifestation of all signs and symptoms of the disease 4. Convalescence – stage of recovery; the signs and symptoms gradually disappearing F. Immunity – power to resist specific infection or disease a. Immunization – the process of rendering the individuals immune b. Antigen – a substance that induces antibody formation c. Antibody – a protein substance in response to antigen stimulation Types of Immunity 1. Natural Immunity – inborn, innate, and inherent a. Active – exposure to certain disease and formation of memory cells b. Passive – maternal antibodies received bu the fetus through placenta and infant through breastmilk 2. Artificial - attained through the introduction of antigen – such as vaccine, toxoid, or antibody by artificial means a. Active – attained by introduction of antigen e.g. all EPI vaccine except Hepatitis B b. Passive – introduction of antibodies e.g. IgA, gammaglobulins, immunoglobulins from serum or human * Active – “slow to come, slow to go” * Passive – “quick to come, quick to go” ; immediate G. Prevention and Control of Communicable Diseases Based on RA 3573 – Law on Reporting Communicable Disease 1. Prevention a. Health Education b. Environmental Sanitation c. Specific Protection e.g. nutrition, immunization, personal hygiene
2. Control a. Notification and prompt intervention b. Isolation and quarantine c. Case finding – looking for the infected individuals Contact tracing – looking for the exposed individuals d. Epidemiological investigation 3. Outline Plan of Epidemiological Investigation (WHO) 1. Establish fact of presence of epidemic a. Verify the diagnosis – initial step b. Reporting c. Prevalence of disease (recording of old and new cases) * Incidence – recording new cases 2. Establish time and space relationship of the disease a. Area of concentration of the disease (space) b. Onset of the first known case (time) 3. Relations to characteristics of the group of community a. Age, sex, color, occupation 4. Correlation of all data obtained 4. Types of Isolation • Isolation – separation of infected individual from healthy one; used in case finding • Quarantine – limitation of the freedom of movement of exposed individual or animal; used in contract tracing a. Strict isolation – indicated for highly contagious diseases like SARS, meningococcemia, bird flu, anthrax b. Protective or Reverse Isolation – intended for those with low resistance or immunocompromised e.g. AIDS, burn, cancer, nephritic syndrome, organ transplant c. Respiratory Isolation – intended for respiratory diseases d. Enteric Precaution – intended for GIT diseases e.g. typhoid fever, cholera, shigellosis e. Wound and Skin Precaution – intended for persons with skin diseases e.g. leprosy, fungal infection, impetigo f. Blood and Body Fluids / Standard / Universal Precaution – first line of precaution; used when the disease is unknown; usage of gloves, masks, caps, mask, and goggles 5. Disinfection – destruction of pathogenic microorganisms excluding the spores • Sterilization – destruction of microorganisms including spores • Delousing – killing of lice or louse • Fumigation – destruction of microorganisms by the use of gases or fumes Two general means of killing microorganisms: a. Mechanical – boiling autoclaving, and burning b. Chemical – use of i. Disinfectant – used in inanimate objects (e.g. chlorox) ii. Antiseptic – used in live human tissues that inhibits the growth of microorganisms (e.g. hydrogen peroxide, betadine, Normal Saline Solution) * NSS – most effective antiseptic because as isotonic solution, keeps the wound moisten which facilitates cell regeneration * Povidone Iodine (Betadine) – inhibits growth of hair Two techniques of disinfection a. Concurrent – ongoing disinfection, the client is still the source of infection b. Terminal – final disinfection, the patient is no longer the source of infection performed upon discharge of the client (e.g. fumigation) 6. Asepsis – absence of pathogen or disease-causing microorganisms 1. Two types of Asepsis: a. Medical / Clean technique - in handwashing, hands are held lower than the elbow Purpose: 1. To prevent transfer of pathogens to others 2. To reduce the number of microorganisms b. Surgical / Sterile technique – to render area free from microorganisms. In handwashing, hands are held higher than the elbow
Techniques: 1. Handwashing – single most effective way of preventing transmission of microorganisms. * The most important factor in handwashing is friction. 2. Gowning 3. Masking 4. Disinfection 5. Placarding - barrier cards; “Unsterile / Unauthorized Persons Keep Out” II. Classification of Communicable Diseases According to Causative Agents A. Viral a. Measles / Rubeola b. German measles / Rubella c. Chickenpox d. Poliomyelitis e. H-fever (Dengue) f. Rabies g. Hepatitis h. AIDS i. Mumps j. Influenza B. Bacterial a. Tuberculosis b. Leprosy c. Diphtheria d. Pertussis e. Tetanus f. Cholera g. Typhoid fever h. Pneumonia i. Syphilis j. Gonorrhea k. Bubonic plague l. Botulism C. Protozoan Parasites a. Malaria b. Amoebiasis c. Trichomoniasis D. Fungal a. Ringworm b. Moniliasis E. Rickettsia a. Chlamydia F. Intestinal Parasites a. Ascariasis b. Enterobiasis c. Taeniasis d. Capillariasis e. Ancyclostosomiasis f. Schistosomiasis G. External Parasites a. Pediculosis b. Scabies
EXPANDED PROGRAM ON IMMUNIZATION Vaccine BCG Content Live attenuated bacteria DT- weakened toxin P-killed bacteria weakened virus Plasma derivative Weakened virus Form Freeze dried and reconstituted in special diluent Liquid Dosage infant- 0.05ml Preschool0.1ml 0.5 ml # of Doses 1 Route ID
OPV Hepatitis B Measles
Liquid Liquid Freeze dried and reconstituted in special diluent
2 drops 0.5 ml 0.5 ml
3 3 1
Oral IM Subcutaneous
Schedule of Vaccines Vaccine BCG (Bacille of Calmette and Guerin) DPT (Diphtheria, Pertussis, Tetanus) OPV (Oral Polio Vaccine) Hepa B Measles Age at 1st dose At birth or anytime after birth 6 weeks 6weeks At birth 9 months Interval between dose TB 4 weeks 4weeks Schedule: At birth, 6th week,14th week Diphtheria, Pertussis, and Tetanus Poliomyelitis Hepatitis B Measles Protection
5 Transcribed by: rbrtrñ07