with the prevalence rate of less than 1% for the last five consecutive years. The eradication and elimination of the disease is crucial to sustainable improvement in public health. The focus of communicable disease, control is directed toward eradicating the disease, because it can reduce or eliminate the burden of disease and its associated mortality. Moreover, eradication is permanent, and its benefits address public health and socioeconomic issues in health care. FUNCTIONS OF THE PUBLIC HEALTH NURSE IN THE CONTROL OF COMMUNICABLE DISEASES 1. Report immediately to the Municipal Health Office any known case of notifiable disease. Refer immediately to the nearest hospital. 3. Conduct a strong health education program directed toward prevention of an outbreak. 4. Assist in the diagnosis of the suspect based on the signs and symptoms. 5. Conduct epidemiologic investigations as a means of contacting families’ case finding and individual as well as community health education. Tuberculosis (Phtisis, Consumption disease, Koch’s disease) Incidence ‘Tuberculosis (TB) is one of the oldest and deadly diseases worldwide (Enarson, 2000). The Global Tuberculosis Report of 2012 by WHO revealed that, there are 9 million new cases of TB in 2011 and 1.4 million TB deaths. ‘The WHO has predicted that by 2020, nearly one billion people would be infected with 7B, and of that number, 70 million would 286 die (Galvez, 2005). The Control accounted that 75% of the worldwide occur in Asia. In 2009, the wig reported that the Philippines ranked ning, among the 22 countries worldwide with » high TB burden. In the Western Pacific region, the country ranked second in terms of ney smear-positive TB notification rate and thind in case density. In the Philippines, TB ranked fifth in the leading causes of mortality among Filipinos with an average of 75 deaths every day (NSO, 2009). Despite the decrease in mortality rate in the past 20 years, TB remained to be a major public health problem in the Philippines. The burden of disease from TB in the Philippines is high among the poor sectors of the society. It is known to be a perennial disease of poor Filipinos due to unsanitary living conditions, overcrowding, _ poor ventilation, and malnutrition (Philippine Coalition Against Tuberculosis, 2004), Demographic profile of TB in the Philippines showed that majority are males, and 70% of the TB population is within the economically productive age group (DOH, 2010). Hence, it is estimated that 20-30% of household annual income is lost for morbidity, and 15 years of income is lost for mortality (Mangawang and Gonzales, 2002). Center for Disease Etiology Causative agent: Usually by Mycobacterium tuberculosis. and M. africanum from humans, but occasionally by M. bows from cattle, or M. canettii. Mode of transmission: Airborne droplet through inhalation of coughing, singi"® or sneezing, Incubation period: 4~6 weeks. Signs and symptoms: Fever: low sale late afternoon, loss of appetite ie fatigability, night sweats, dry cough 13 productive with hemoptysis, chest Pal”ry wostic test: Peart ‘smear microscopy is the 1 Diet $e senostic method adopted by pring nal Tuberculosis Program (NTP) oe ‘provides a definitive diagnosis of Sve TB, It is simple and economical, sc microscopy center could be put up and nremote areas ofthe country owing wg feasibility. A definitive diagnosis {PTB is made with the demonstration ot Mycobacterium tuberculosis using orescence acid-fast microscopy staining pecause ofits specificity and efficiency in detecing acid-fast bacilli (AFB) count in the sputum (Mendoza, 1987). WHO guideline for AFB quantification involves the following (Box 12.1): Guidelines for the interpretation of the results of the three specimens state that a smear positive (+) would mean at least two positive (+) sputum smear results, whereas smear negative (-~) would ‘mean all three sputum smear results as negative (-). The specimen out of the smear positive (+) results with the highest number is the final AFB quantification. Doubtful is the interpretation if there Negative (-) | No AFB seen in 100 fields Posine (4) | 1-9 AFB seen in 100 fields 1, 10-99 AFB seen in 100 fields ue 1-10 AFB seen in at least 50 fields 3+ More than 10 AFB seen in at least 20 fields is only one positive (+) out of the three specimens examined. In case of doubtful results, another set of three sputum specimens is requested to the Patient, If at least one specimen from the second set of specimen is positive (+), laboratory diagnosis is positive (+). If all three specimens from the second set of specimen are negative (-~), the diagnosis is negative (-). 2. Chest X-ray is another method used in the diagnosis of TB. However, it has assumed a secondary role in the diagnosis of TB based on the NTP. Alonzo. et al. (1990) cited that the infectivity of a person is difficult to determine by chest radiography alone. Second, there is no radiographic picture that is absolutely typical of TB; many other diseases can imitate the pattern of pulmonary TB (PTB). Moreover, the level of disagreement on the interpretation of chest radiography is high. Nevertheless, it is helpful in localizing the site of TB lesion, and may be useful in diagnosing ‘TB patients who are asymptomatic, and those who cannot submit sputum specimen but are suspected to have TB (Lim, 1991). ‘Management: TB is curable. In the Philippines, the National Tuberculosis Control Program was created with a vision of a country where TB is no longer a public health problem, Its mission is to ensure that TB services are available, accessible, and affordable to the communities in collaboration with the local government units (LGUs) and other partners, The goal is to reduce prevalence and mortality from TB by half by the year 2015 through its targets: (1) cure at least 85% of the new sputum smear-positive cases discovered, and (2) detection at least 70% of the estimated new sputum smear positive cases. The NIP became one of the DOH flagship programs. More recently, the Philippines adopted the 287Comprehensive Unified Policy on TB control. ‘The Comprehensive Unified Policy put all TB control protocols under one umbrella and enjoined other key government agencies and private organizations involved in TB control to carry out their respective TB control efforts in the context of the NTP (Aban, NIP adopted DOTS, which is believed to be the most effective strategy for controlling ‘TB. However, political commitment, quality microscopy services, regular supply of anti-TB drugs, supervised medication by a treatment partner, and standardized reporting are essential elements to ensure success in its implementation (Peabody etal., 2004). The directly observed treatment (DOT) or locally known as Tutok Gamutan is a method developed to ensure treatment adherence by providing constant supervision to TB member, watch the TB patient take med every day during the whole cour treatment (DOH, 2005). TB can be cured but requires adhere to drug intake for the prescribed du (Pratt, 2005). This comprises a combination ‘of antibiotics, which need to be taken together to prevent the development of, resistance. Antibiotics taken involved major drugs, namely, isoniazid (H), rifampicin (R), pyrazinamide (2), ethambutol (8), and streptomycin (5). The first four are given rally, and the latter is given parenteral. Local Studies have shown that these antibiotics are the most potent antibiotics against all forms of TB (Maramba et al., 1977). These drugs are used for short-course chemotherapy because of their sterilizing effect on TB bacilli (Iseman, 1982; East African/British Medical a Council, 1981; Jindani et al., 1980). See Table patients. DOT works by having a responsible 122. person, referred to as treatment partner such as a nurse, midwife, or trained community Category of tuberculosis treatment regimen for adults Table 12.2 ‘Treatment regimen ‘Maintenance: phase ‘Types of TB patients iste phase Category New smear-positive PTB New smear-negative PTB with extensive parenchymal lesions on chest X-ray Extrapulmonary TB “Treatment failure (patient while on treatment, is sputum smear-positive at 5 months or later during the couse of treatment) Relapse (patient previously treated for TB, who has been declared cured or treatment completed, and is diagnosed with bacteriologically positive TB) ‘+ Return after default (RAD) (patient who return: el A Ss to treatment with positive bacteriology, following interruption of treatment for 2 months or more) New smear-negative PTB with mini Ney se ee with minimal parenchymal Chronic (still smear-positi ae positive after HRZE (2 months) HRZES (2 months) + Ea supervised | Second-line generation antibiotics based on rest of culture and sensitiviygal phase of treatment should consist PP HIRZE, and continuation phase gp n0ttts for 4 months. The fixed-dose «asi OF (FDC), in which two or more cotingis are combined in one tablet, 3 iE commended, especially when 5 itl pgestion is not observed. Single- seliatioN tion (SDF), in which each drug 407 ndividually, i also available, FDC. syiepral advantages over SDF: (1) FDC bs Seinistered more easily than SDF; (2) is Wperapy is avoided, therefore there is sane of drug resistance; (3) there is a we in medication errors; (4) itis useful see OT is not possible; and (5) it improves wash workers and patients adherence. These tg are usually available in blister packs fod for one week. The number of tablets of scsper patient depends on the body weight. fence all patients must be weighed (using llogram) before treatment is started. For TB treatment for children, see Box. 12.2. Prenton: 1, Bacillus Calmette-Guérin (BCG) vaccination of newborn infants provides 50% protection against any TB disease Health education Environmental sanitation Early diagnosis and treatment Respiratory isolation pei p non {oles and responsibilities of the nurse in the NIP and DOTS strategy * Nurse as administrator. As a public health nurse, the Comprehensive and Unified Policy for TB Control of the Philippines (00H) enumerated specific functions such as 1 Manage the procedures for case-finding, activities with other NTP staff workers; Assign and supervise a treatment partner s Ee Patients who will undergo DOTS; * Supervise rural health midwives to ensure proper implementation of TS. Maintain and update the NTP ster, 2 Treatment regimen Types of TB [intensive | Maintenance phase phase Pulmonary T8 | HRZ HR (2 months) | (4 months) Extrapulmonary | HRZS HR 1B (2 months) | (10 months) © Nurse as 5. Facilitate requisition and distribution of rugs and other NTP supplies; 6. Provide continuous health education to all TB patients placed under treatment and encourage family and community participation in TB control; 2. Conduct training of the health workers in coordination with MHO/CHO; and 8, Prepare and submit the Quarterly Reports to PHO/CHO. Analyze the data together with the MHO/CHO for future planning activity. health educator. Patient education is very important in the intensive phase of treatment. However, itis vital to a successful treatment outcome that patient education will be an on-going process throughout the duration of treatment period (WHO, 2003). © Nurse as case manager and coordinator. ‘The roles of the TB nurse manager can be summed up into two major functions (Ghebrehiwet, 2009): 1, Managing services for the individually diagnosed or suspected of having ‘TB from initiation to completion of treatment and a change in the diagnosis or death, 2. Immediately schedule another date if patient is unable to keep appointments to avoid the patient being labeled 289as delinquent. TB case management is directed toward accomplishing the following goals: a. All hospitalized patients diagnosed or suspected of TB disease received continuity of care during transition from hospital to the outpatient setting without interruption in treatment or essential service. b, Disease progressions without drug resistance are preventive. . Each patient received TB care and treatment according to prescribed standards of care. 4. An integrated, coordinated system of health care allows patients to experience TB care along continuum rather than in fragments. e. Patients complete TB treatment with appropriate time frames and with minimal interruption in their lifestyle or work. {, Transmission of TB within the community is prevented through effective contact investigation and delinquency control activities. g The —_ patient/family/community is educated about TB infections, disease, and treatment. hh. Individuals diagnosed with clinically active or suspected TB are reported according to regulations, and TB control activities are complemented according to standards of the country, regional, or municipal TB control program. i. Case managers participate in policy development within the health care system that positively affects clinical and TB control outcomes ‘Case managers participate in studies to improve case management services and documentation, enhancement of adherence, and TB nursing © Nurse as community organizer (CO). TB is a public health priority and of concem to the community as a whole, 290 not just to the TB patient and but also immediate contacts. The workplace ig » part of the community. Activities can be carried out in collaboration with loca authorities, community associations ongovernment organizations (NGOs), and donor agencies. With this, the nurse can assume the role as CO, and ensures that all activities related to the TB control program are done in such a way that the patients and the people in general will benefit. There should be a collective effort among all concerned individuals or groups to achieve its goals. One activity that has been initiated and functional is the establishment of the TB Network. Community organization activities: 1. Generate data on the incidence of TB in the locality. 2. Conduct home visitation to patients and treatment partners 3. Meet health workers and other key leaders. 4, Determine resources for the treatment regimen. 5. Build the team. 6. Conduct networking and linkaging with the LGUs, and NGOs. Nurse as treatment partner. The nurse may continue to use the nursing process as a systematic approach in providing individualized care to the patient. Nurse as TB advocate. Following are some of the roles of the TB-DOTS advocate: 1. Shares experiences and accomplish: ments in terms of cure and referral °° ‘TB network, 2. Disseminates correct information om TB through available information education, and communication campaign materials. . 3. Serves as moral support to TB patients and fellow advocates. 4. Refers individuals with cough weeks or more to the nearest center for proper management for 2 pots< Conducts health education activities on pow TB is acquired and developed « Promotes the DOTS services of TS * partners including the private sector. 7, Advocates DOTS as a strategy for curing ‘TB. g, Participates during NTP activities including National Health Events, if possible. 9, Encourages other people from different sectors to be TB-DOTS advocates. 10. Assists the treatment partner or may serve as the treatment partner, if necessary. Mosquito-borne diseases Dengue (hemorrhagic fever, break bone or dandy fever, dengue shock syndrome) Incidence Dengue is a public health problem in the Philippines. The disease once associated with the rainy season has begun to change its pattem in the country. Although the case fatality rate decreased in 2005, recent statistics shows that dengue cases in the Philippines incteased in 2009 to its peak with 57,819 cases (WHO, 2010). The sudden change of pattern may be attributed to climate change and urbanization, since the vector of the disease Proliferates in congested urban areas. Causative agent: Dengue virus (DEN), a single stranded RNA virus of four types (DEN-1, 2, 3, 4) that belong to the Senus Flavivirus, family Flaviviridae. All of the four types have been isolated in the country, Therefore, a person can get the infection four times since there is no ‘“oss-immunity between types. However, |ifeime immunity is possible for a veer ecific type of virus. wor Infected female Aedes mosquitoes. Aedes aegypti, also known as yellow “ver mosquito or tiger mosquito, is the Principal vector predominant in urban “as seen in tropical and subtropical “ountties, ‘These mosquitoes proliferate > in clean, clear and unpolluted stagnant bodies of water used for domestic water storage or rain-filled habitats like flower vases, earthen jars, concrete water tanks, discarded vehicle tires, ant traps, metal drums, water barrels, tin cans, and any other containers that can accumulate water up to 7 days. Typically, these mosquitos fly within a 100-meter radius from the breeding place with a flight range of 50 meters. They feed almost entirely on humans at dusk, just before sunset, at dawn, and just after sunrise when indoors. As domestic mosquitoes, Aedes aegypti prefer to rest in cool, dark comers of the house. Commonly, they are found in closets and under beds, tables, and chairs. Aedes albopictus, also known as the Asian tiger mosquito, is the secondary vector predominant in rural areas that proliferates in leaf axils, tree holes, bamboo stumps, coconut shells or husks, and ground or deep holes. These mosquitoes feed on other mammals aside from humans during daylight in the outdoors (Estrada-Franco and Craig, 1995). Unlike A. aegypti, A. albopictus usually rest in clearings and vegetation, and they can survive even in cold temperatures (Romi, 2006). They can fly within a 200-meter radius from the point of origin with a flight range of 180 meters. Moreover, they are the only mosquitoes that can transmit the chikungunya virus (Hoschedez, 2006). Dengue outbreaks in other countries have also been attributed to Aedes polynesiensis and several species of Aedes scutellaris (Edman, 2005). Each of these species has a particular ecology, behavior, and geographical distribution. Therefore, it is important to note their characteristics as vectors to control dengue. However, one common characteristic of these three species is that their eggs are found in water-filled habitats closely associated with human dwellings (Hill et. al, 2008) 291‘Mode of transmissio Susceptible: Incubation perit The dengue virus is transmitted to humans through the bite of an infected Aedes mosquito. The dengue virus circulating in the blood of infected individuals is ingested by female mosquitos during feeding. The vinus then infects the mosquito’s mid-gut and subsequently spreads systemically over a period of 8-12 days. After this, the virus can be transmitted to other humans during subsequent probing or feeding, All individuals regardless of age, gender, or geographic location are at risk. However, children between 0-9 years are commonly affected based on age distribution. Moreover, the epidemic is frequent in populated areas with poor environmental conditions conducive for vector breeding i: 3-14 days, commonly 5-7 days Laboratory/diagnostic test: 1 292 Tourniquet test or Rumpel-Leads test. ‘This test_ measures the coaguability of the blood. This is done by applying a tourniquet on a client's extremity and observing the amount of petechiae produced, It is the presumptive test for dengue, which is used to assess bleeding tendencies of a patient suspected to have the disease (Halstead, 2008). Before doing the test, the public health nurse must explain the procedure and purpose, and he or she must assess the individual's arm for any petechiae, ecchymoses, or infections that may affect the result. The tourniquet test is also contraindicated for individuals with fistula, those with arteriovenous shunt, and those who have undergone a mastectomy (Daniels, 2009). The public health nurse must inform the individual that the patient may be uncomfortable for a while but not in pain. In performing this test, the nurse places the sphygmomanometer on the upper arm of the individual and inflates the blood pressure cuff to a . Hemagglutination-inhibition (HI) point midway between the systolic diastolic pressure for 5 minutes, the cuff is released and the nurse ya an imaginary 1-inch (2.5 cm) square below the cuff, at the antecubital ft Finally, the nurse inspects and coin, the number of petechiae in a Linch (2 cm) square. A positive result would meay the presence of 20 or more petechiae per 1-inch square. Capillary refill test or nail blanch tet, Capillary refill is the rate at which blood refills empty capillaries. It measures dehydration and decreased peripheral perfusion for patients with dengue. it can be measured by holding a hand higher than heart-level, then the soft pad of the thumb nail or toe nail is pressed until it tums white or until blanching oceurs.Pressure is then released and the time needed for the color to return once pressure is released is measured. Normal refill time is less than 3 seconds. Hence, a refill time of more than 3 seconds isa ‘warning sign. . Platelet count and hematocrit (HCT)count To confirm the diagnosis of dengue a laboratory test such as platelet and hematocrit count should be performed. rapid decrease in platelet count (150,000 to 400,000 cumm) in parallel with 2 rising hematocrit (F=36-46%, Moll 53%) is suggestive of progress 10 the critical phase of dengue. If no propet laboratory services are available, the minimum standard is the pointofa® testing of hematocrit by capillary (Fig prick) blood sample with the use ofa microcentrifuge (WHO, 2009). This test is frequently used for patient admitted in the hospital, 3% would require paired sera. ie based on the ability of den! * antibodies to inhibit ageluti™® (WHO, 2009). —case classification eto the differing clinical presentations and unpredictable clinical evolution and Scomes, a new model for dlassifying Sengue has been developed by a WHO. fapert consensus group. This model is for the practical use in the clinician's decision {sto where and how intensively the patient. Should be observed and treated. Table 12.3 shows the new dengue case classifications and levels of severity. Dengue Du‘ Phases of Illness 1. Febrile phase lasts from 2 to 7 days ~ high-grade fever, facial flushing, skin erythema, generalized body ache, myalgia, arthralgia, and headache. Some may have sore throat, infected pharynx, and conjunctival infection. Anorexia, nausea, and vomiting are common. A positive tourniquet test result increases the probability of dengue. Therefore, monitoring for warning signs and other parameters is needed to recognize progress to critical phase. Mild hemorshagic manifestations like petechiae and mucosal membrane (nose and gums) bleeding may be seen. A Progressive decrease in total white cell count in the blood would alert the nurse to ahigh probability of dengue. . Critical phase lasts from 24 to 48 hours - when the temperature drops and remains below 37.5-38°C or less usually on days 3 to 7 of illness, an increase in capillary permeability in parallel with increasing hematocrit levels may occur. Rapid decrease in platelet count usually precedes plasma leakage. Pleural effusion and ascites may be detectable. Shock may occur when a large amount of plasma is lost through leakage that is preceded by waming signs. Prolonged shock results in organ impairment(severe hepatitis, encephalitis, myocarditis), metabolic acidosis, and disseminated intravascular coagulation. Recovery phase usually takes place in the following 48-72 hours - The general well-being improves, appetite returns, gastrointestinal symptoms subsides, and hemodynamic status become stable. Table 12.3 Dengue case classification and levels of severity Probable dengue Warning signs (require strict observation and medical intervention) Severe dengue Live intravel to dengue endemic area. Fever and two of the following criteria: |. Nausea, vomiting Rashes Aches and pains Torniquet test (+) Leukopenia ‘Any warning sign 1. Abdominal pain or tenderness Persistent vomiting Clinical fiuid accumulation ‘Mucosal bleeding Lethargy, restlessness Liver enlargement >2cm Laboratory: increase in HCT concurrent with rapid decrease in platelet count Mounwn Severe plasma leakage leading to: 1, Shock (dengue shock syndrome or DSS) 2. Fluid accumulation with respiratory distress Severe bleeding as evaluated by clinician Severe organ involvement 4. Liver: AST or ALT 21,000 2. CNS: Impaired consciousness 3. Heart and other organs Source: wii0, 2009 Dengue Guidelines for diagnosis, "aeatment, prevention and control: New edition 2009 293Management: ‘Treatment for dengue is symptomatic and supportive. Follow-up is also important for proper observation and monitoring of patients. All suspected cases of dengue should be referred immediately for proper management and to prevent complications. 1. Give paracetamol every 6 hours. If the patient still has high fever, do tepid sponge bath. Do not give acetylsalicylic acid (aspirin), ibuprofen, or other nonsteroidal anti-inflammatory agents (NSAIDs), as these drugs may aggravate Dleeding. Acetylsalicylic acid (aspirin) may be associated with Reye's syndrome. 2. Encourage oral intake of oral rehydration solution (ORS), fruit juice, and other fluids containing electrolytes and sugar to replace losses from fever and vomiting ORS like ORESOL can be given at 75 ml/KBW in 4 hours to children or at 2-3 liters in adults. If not tolerated, start intravenous fluid therapy of 0.9% saline or Ringer’ lactate with or without dextrose at maintenance rate. 3, Advise the patient to avoid dark-colored foods that can mask bleeding, Diet should be low fat, low fiber, nonitritating, and noncarbonated 4. Ensure strict bed rest and protect patient from trauma to reduce the risk of bleeding. 5. Do not give intramuscular injections to avoid hematoma. 6. Instruct the caregivers that the patient should be brought to the hospital immediately if any of the following occur: no clinical improvement, deterioration around the time of defervescence, severe abdominal pain, persistent vomiting, cold and dammy extremities, lethargy or irritability/restlessness, bleeding (e.g., black stools or coffee-ground vomiting), and not passing urine for more than 4-6 hours. 7. Fornose bleeding (epistaxis), maintain an elevated position and apply ice compress 294 to promote vasoconstriction. If the bleeding of gums, give ice chips. an) advise the patient to use a soft-bris toothbrush. For gastrointestinal bleedin, place the patient on NPO. % 8. Blood transfusion should be given as soon as severe bleeding is suspected oy recognized. However, blood transfusion must be given with care because of the tisk of fluid overload. 9. In cases of shock, place patient in a dorsal recumbent Position to promote circulation. 10. Monitor laboratory results such as platelet and hematocrit count accordingly. ‘Those with stable laboratory results, without fever, or with no danger signs for 72 hours can be sent home afier being advised to return to the hospital immediately if they develop any of the ‘warning signs such as abdominal pain ot tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy, and restlessness. ‘The four “S" in dengue prevention: 1. Search and destroy breeding places of mosquito 2. Seek immediate treatment 3. Say no to indiscriminate fogging 4, Self-protection Malaria (marsh fever, periodic fever, king of tropical diseases) Causative agent: Plasmodium: P. falciparum P. vivax P ovale P. malariae P. knowlesi by. Symptoms: Recurrent fever preceded chills and profuse sweating (triad sie"! malaise, anemia le Mode of transmission: Vector (femal Anopheles) Protozoa genustoryldiagnostic testi ron of having been in a malaria endemic area: Palawan and Mindoro. 4, Blood smear 5 Rapid diagnostic test (RDT) ‘reatment Oral: 1, Chloroquine phosphate 250 mg - all species except P. malariae 2, Sulfadoxine 50 mg - For resistant P. falciparum 3, Primaquine ~ For relapse P. vivax and P. ovale Pyrimethamine 25 mg/tab Quinine sulfate 300 mg/tab Tetracycline HCl 250 mg/cap Quinidine sulfate 200 mg/durules Parenteral: Quinine hydrochloride 300 mg/ml, 2ml, quinidine glucolate 80 mg (50 mg) 1 vial Malaria prevention and control: 1, Mosquito control 2. Chemical methods ~ use of insecticides 3. Biological methods ~ stream seeding 4. Zooprophylaxis - larvae-eating fish, farm animals should be kept near the house Environmental methods ~ cleaning and irrigating canals 6. Screening of houses Educational methods Mechanical methods - use of fly swats or traps Universal precaution Screening of blood donors rividea Fllaiasi asi incon (lephantasis, Causative agent: Wuchereria bancroft, Burgia malayi Mode of transmission: Bite of mosquito Si Aedes poecilus, Culex quinquefasciatus ‘Sn and symptoms: Chills, fever, myalgia, lymphangitis with gradual thickening of the — skin (commonly affecting limbs, scrotum) resulting in elephantiasis and hydrocele Laboratory/diagnostic test: Circulating filarial antigen (CFA) ~ finger prick Treatment: Diethylcarbamazine (Hetrazan) Prevention: Eradication of vectors citrate Sexually transmitted infections Gonorrhea (clap, drip, tulo) Causative agent: Neisseria gonorrhoeae ‘Mode of transmission: Sexual contact Incubation period: 2~7 days Signs and symptoms: Thick purulent urethral discharge, frequency of urination among females, burning urination among males/ females Diagnostic examination: 1. Culture of specimen in cervix - female 2. Gram stain ~ male ‘Treatment: Penicillin, ceftriaxone, doxycycl ‘Nursing care: Symptomatic Prevention: Crede’s prophylaxis tetracycline Avoid contact with secretions Practice monogamous sexual contact silver nitrate/ Syphillis Causative agent: Treponema pallidum Mode of transmission: Sexual contact, Incubation period: 10-90 days Signs and symptoms: 1. Primary ~ chancre 2. Secondary - condylomata, alopecia, sore throat, mucous patches of the mouth 3. Tertiary - gumma formation, cardiovascular and nervous system involvement Laboratory/diagnostic test: 1. Darkfield illumination test 2. Venereal disease research laboratory (VDRL) test 3, Fluorescent treponemal antibody test 295Treatment: Penicillin, _ tetracycline, erythromycin Nursing care: Symptomatic Prevention: Practice monogamy Sex education Candidiasis Causative agent: Candida albicans (most common cause), Candida tropicalis (rare cause) Mode of transmission: Contact with secretions or excretions of mouth, skin, vagina, and feces, from patients or carriers. Incubation period: Variable Period of communicability: Presumably while lesions are present Signs and symptoms: Severe vulvar pruritus (prominent feature); vaginal discharge (scanty, whitish, yellow, thick to form curds, nonoffensive); sore vulva due to itching, speculum examination - thick whitish plugs attached to vaginal wall, vaginal epithelium bleeds when the plug is removed, but the cervix is normal. Diagnosis: Microscopic demonstration of pseudohyphae or yeast cells in infected tissue or body fluids (vaginal discharge) ‘Treatment: 1, Nystatin vaginal pessary, 2. Miconazole or clotrimazole creams, 3. Ketoconazole 4, Fluconazole in recurrent cases Prevention and control: 1. Case treatment 2. Treatment of underlying medical conditions or predisposing factors Human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS) Causative agent: HIV 1 and 2 Mode of transmission: Sexual contact, blood transfusion, contaminated syringes, 298 needles, nipper, blades, direct contac of open wounds/mucous membranes with contaminated blood, body fluids, semen, and vaginal discharges : Incubation period: varies (3-6 months) io ‘many years (8-10) Signs and symptoms: Major signs include ‘weight loss, chronic diarrhea, prolonged fever for 1 month. Minor Signs involves cough for 1 month, pruritic dermatitis, recurrent herpes zoster, candidiasis, and lymphadenopathy Prevention of HIV/AIDS: 1. Blood and blood products a. Screen blood donors. 'b. Observe universal precaution, Refrain from using contaminated needles and syringes. 2. Sexual transmission fa, Abstain from promiscuous sexual contact. b. Be faithful to your partner and practice monogamous sexual contact. Follow correct and consistent use of condoms, 3. Mother-to-child transmission. For HIV+ mothers, consult with health workess to have access to care, treatment, and support to services during pregnancy labor and delivery, and postpartum. List of treatment facilities for HIV in the Philippines In the Philippines, public health facilities in different regions are identified as treatment hubs or hospital facilites with an established HIV/AIDS Core Tea”? (HACT), providing prevention, treatmet care, and support services to peorle living with HIV including but not limite! to HIV counseling and testing, “lini management, patient monitoring, ° other care and support services. Anti —_ 4sgn (ARV) treatment can only be accessed gh these facilities treen Lazaro Hospital (SLH) located at Quiticada St, Sta. Cruz, Manila philippine General Hospital at Taft ‘Avenue, Ermit, Manila 4, Research Institute for Tropical Medicine (RITM) at Filinvest Corporate City, ‘slabang, Muntinlupa City 4, Jose B. Lingad Memorial Medical Center at San Fernando City, Pampanga 5, Ilocos Training and Regional Medical Center (ITRMC) at San Fernando, La Union 6. Baguio General Hospital and Medical Center (BGHMC) at BGHMC Compound, Baguio City 7. Cagayan Valley Medical Center at ‘Tuguegarao City, Cagayan Valley 8, Bicol Regional Training and Teaching Hospital (BRTTH) at Legazpi City, Albay 9, Westen Visayas Medical Center (WVMC) atQ. Abeto St, Mandurtiao, Iloilo City 10. Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH) at Lacson St, Bacolod City, Negros Occidental Vicente Sotto, Sr. Memorial Medical Center (VSSMC) at B. Rodriguez St., Cebu City Davao Medical Center (DMC) at J.P. Laurel St., Bajada, Davao City 2 |3. Zamboanga City Medical Center (ZCMC) at Evangelista St, Zamboanga City Community su oe port organizations for kivjaips, ‘ ontt®® are several NGOs, people's peinlzations, and medical __service iret in the Philippines that provide ling ee on SUPPOM services for people HIV/AIDS (PLWHA), their affected ‘py and significant others: ‘Noy Plus Association (PPA) is a sole (anization composed of PLWHA. It wwetrgctPPOM group dedicated to the relfare of PLWHA in the Philippines. — 9. 10. u Positive Action Foundation Philippines Inc. (PAFPI) is an organization founded in 1998 composed of HIV-positive and non-positive staff members and volunteers whose mission is to contribute to the national response to HIV and AIDS prevention, treatment, and care services for PLWHA and their families. Remedios AIDS Foundation (RAF) is a nonstock, nonprofit organization that works with communities, individuals, and families working in the prevention and control of STIs, HIV, and AIDS. Babae Plus is a support group of ‘women living with HIV and AIDS in the Philippines. It was founded to create an enabling environment that addresses the psychological, economic, health, and gender-related concerns of women living with HIV/AIDS and their affected families. AIDS Society of the Philippines (ASP) Health Action Information Network (HAIN) Lunduyan para sa_Pagpapalaganap, Pagtataguyod at Pagtatanggol ng Karapatang Pambata Foundation, Inc. (LUNDUYAN) The Library Foundation Sexuality Health and Rights Educators Collective, Inc, (TLF SHARE) Action for Health Initiatives, Incorporated (ACHIEVE) Alliance Against AIDS in Mindanao, Inc. (ALAGAD) Foundation for Adolescent Development, Inc. (FAD) 4Cs in syndromic case management for STI: 1. Compliance of clients in the treatment, prevention and successful recommendation for preventing recurrence of disease . Counseling and education on the nature of the disease, signs and symptoms, ‘management, and prevention. 2973. Contact tracing facilitates the process of Partner treatment to prevent the spread of the disease. 4, Condom use and promoting them to risk individuals to reduce the risk of acquiring the disease. Schistosomiasis (Snail fever, Bilharziasis) Causative agent: Schistosoma japonicum, S. ‘mansoni, S. haematobium Vector: Oncomelania quadrasi (snail) Incubation period: 2 months Mode of transmission: Vehicle (water), indirect (skin pores) Laboratory/diagnostic test: examination 1. COPT (Cercum Ova Precipetin Test) 2. Kato Katz Technique Signs and symptoms: Rash at site of inoculation, enlargement ofthe abdomen, diarthea, body weakness Direct stool Treatment: Praziquantel —_(Biltricide), Oxamniquine for S. mansoni and S. haematobium Prevention: 1. Proper disposal of feces and urine 2. Proper irrigation of all stagnant bodies of water 3, Prevent exposure to contaminated water (wearing of rubber boots) 4. Eradication of breeding places of snails 5. Use of molluscicides. Rabies (Hydrophobia, Lyssa) Causative agent: Rhabdovirus ‘Mode of transmission: Bite of rabid animal Source: Saliva of infected animal or human High risk: Nonbite, handling of animals Incubation period: 20-90 days for humans, 1 week-7.5 months for dogs Laboratory/diagnostic test: Postmortem ct fluorescent antibody staining test 298 Signs and symptoms: A. Dog~at first withdrawn, changein moog shows nervousness and apprehension unusual salivation, paralysis stars on hind legs spreading towards entire boty, death t B. Human 1. Incubation period 2. Prodromal stage - headache, pain and numbness sensation at the site of bite, depression, penile erection or spontaneous ejaculation for males 3. Acute neurologic phase a. Spastic - anxiety, confusion, insomnia b. Dementia - intense excitement, difficulty in breathing, swallowing drooling, hytophobia c. Paralytic - flaccid ascending symmetric paralysis, coma, death Nursing management: 1, Isolate patient. 2. Encourage family to provide care and company. Darken room and observe silence. Give food if patient is hungry. Keep water out of sight. Observe universal precaution, which are essentially wearing gloves. Wash hands frequently. Remove oral and nasal secretions. Dispose contaminated materials 10. Perform terminal disinfection. Postexposure treatment for rabies: For dog bite: Wash wound with soap and water and see consultation Anti-tetanus serum/tetanus anti-toxin suture if severe wounds ; ‘Observe dog for 10 days, if possible for sis of rabies ‘A. Recommended vaccines that provide active immunity that is infiltrated ©and around afte vaccine. ‘ al the wound for the first dose ‘CN (purified vero cell vaccine) = 2, PDEV (purified duck embryo vaccine) = 0.2 ml a. Reduce multisite intramuscular (IM) (2-1-1) schedule reduce Mult-Site Intramuscular Regimen Prevention of rabies 1. Pre-exposure prophylactic treatment for high-risk individuals Treatment: High-risk every year (lab), 2x/year (vet) PDEV=1.0 mi PYCV = 0.5 ml Prevention of Rabies Gnedule | Siteandroute | Dose Schedule Dose Day Deltoid IM. 2 doses Day 0,7 1 dose IM [oay7.21_| Deltoid IM 1 dose Day 21 1 dose ID . 2 site intradermal regimen ~ cost effective Site intradermal Regimen = most cost ffective treatment Schedule | Siteandroute | Dose day0,3,7 | Deltoid 1D 2 doses Day 30 Deltoid 1D. 1 dose Day 90 Deltoid 1D 1 dose B. Recommended immunoglobulins that provides passive immunity administered IM route distant from the site of vaccine inoculation 1. Equine rabies = KBW x 0.2 ml 2. Human rabies = KBW x 0.133 ml ‘mmunoglobulins s chedule Site Dose De v0 Deltoid (adult) | 1 dose Anterolateral (infants) Deltoid (adult) 1 dose Anterolateral | infants) Leptospirosis (Canicola, Weils disease) Causative agent: Leptospira interrogans Mode of transmission: Inoculation into broken skin, ingestion Source of infection: Urine and excreta of rodents and infected Incubation period: 7-13 days Laboratory|diagnostic test: 1. Blood culture 2. Leptospira agglutination test (LAT) Signs ‘and symptoms: ~ Septicimic ~ High remittent fever 4-7 days, myalgia/myosites, particularly calf pain 2. Immune/toxic stage - jaundice 3. Convalescence ‘Treatment: 1. Medical management: Penicillin or tetracycline 2. Nursing management: Symptomatic Prevention: Eradication of source Leprosy (Hansenosis, Hansen's disease, Leontiasis) Causative agent: Mycobacterium leprae/ Hansen's bacillus Mode of transmission: Prolonged skin contact, droplet infection 299Incubation period: Smonths-5 years Laboratory/diagnostic test: Skin slit test Signs and symptoms: 1. Early signs - reddish or white change in skin color, loss of sensation on the skin lesion, decrease/loss of sweating and hair growth over the lesion, thickened and/or painful nerves, muscle weakness, pain or redness of the eye, nasal obstruction/bleeding, ulcers that do not heal. 2. Late signs - loss of eyebrow (madarosis), inability to close eyelids (lagophthalmos), clawing of fingers and toes, contractures, sinking of the nose bridge, enlargement of the breast in males (gynecomastia), chronic ulcers. Prevention: + BCG vaccination * avoidance of prolonged skin to skin contact with active untreated case + good personal hygiene «adequate nutrition * health education Patient classification of lepros 1. Paucibacillary (PB): (-) Skin five or less lesions 2. Multibacillary (MB): (+) Skin slit test and more than five lesions test or ‘Multidrug treatment therapy for leprosy Multidrug therapy (MDT) invole use of two of more drugs such as rif, lofazimine, and dapsone in the tan of leprosy. The main purpose of yp to kill all viable organisms in a relative short period of time rendering the pat noninfectious. It is highly cost-effective the treatment of leprosy and in preven drug resistance. WHO information shoys that relapse rate is very low (e.,, 0.1% pe year for PB and 0.06% per year for MB on the average). Among these, rifampicin js the most important drug included in the treatment of both types of leprosy. Its potent bactericidal agent against M. lerae The high bactericidal activity of sfampicn makes it feasible and cost-effective for Teprosy control. However, rifampicin cause slightly reddish discoloration of the urine for a few hours after its intake. Clofazimine causes brownish black discoloration and dryness of skin, but it disappears within few months after treatment. Dapsone cause allergic reaction such as itchy skin rashes and exfoliative dermatitis. Patients known to be allergic to sulfa drugs are not given this drug. Therefore, it is important to explain the side effects of the drug to patiens starting MDT regimen (see Tables 12.4 t0 12.6 for more information). Table 12.4 Single lesion and negative skin slit smear cases Drug Adult dosage Gilder ae heal Rifampicin 600 mg 300 mg Ofloxacin 400 mg 200 mg Minocycline 100 mg 50 mg Frequency Single dose Single dose 300ins Drugs and dosage for paucibacilary (PB) cases pple Adult Children (10-14 year old) schedule Drugs and dosage Drug and dosage aft Rifampicin 600 mg Rifampicin 450 mg Dapsone 100 mg Dapsone SO mg ar) Dapsone 100 mg Dapsone 50 mg Faas 6 blister packs 6 blister packs duration for 6 months for 6 months ple 12.6 Drugs and dosage for multibacillary (MB) cases ee Adult Children (10-14 year old) Schedule Drugs and dosage Drug and dosage Day 1 Rifampicin 600 mg Rifampicin 600 mg Clofazimine 300 mg Clofazimine 150 mg Dapsone 100 mg Dapsone 50 mg Day 2-28 Clofazimine 50 mg Clofazimine 50 mg every other day Dapsone 100 mg Dapsone 50 mg Full course 12 blister packs 12 blister packs duration for 12 months for 12 months "S#Ferchen younger than 10 years ld the dose must be adjusted according to body weight Description Reporting of Communicable Diseases Requires all individuals and health facilities to report notifiable diseases to local and national public health authorities. Pursuant to Section 3 of Act 3573, the lists of notifiable disease are epidemic-prone diseases, which are targeted for eradication, oF elimination, and subject to international health regulation, Category | (immediately notifiable) includes acute flaccid paralysis, adverse event following immunization, anthrax, human avian ~~ _____| influenza, meesies_ meningococcal dseese, neonatal tetanus, 301Description paralytic shelfish poisoning, rabies, and Severe Acute Respiatoy ‘Syndrome (SARS). Category I! (Welly Notifiable) includes acuig nloody diarrhea, acute encephalitis syndrome, acute hemorrhag. fever syndrome, acute viral hepatitis, bacterial meningitis, choles, dengue, diphtheria, influenza-like illness, leptospirosis, malaria rnon-neonatal tetanus, pertussis, typhoid and paratyphoid fever Republic Act 4073 ‘An Act Liberalizing the Treatment of Leprosy No persons afflicted with leprosy shalll be confined in a leprosetium provided that such person shall be treated in any government skin clinic, rural health unit or by 3 duly licensed physician. Republic Act 8504 Philippines AIDS Prevention and Control Act of 1998 ‘An act promulgating policies and prescribing measures for the prevention and control of HIV/AIDS in the Philippines, instituting a nationwide HIV/AIDS information and educational program, establishing @ comprehensive HIV/AIDS monitoring system, strengthening the Philippine National AIDS Council and for other purposes. Republic Act 9482 ‘The Rabies Act of 2007 Rabies control ordinances shall be strict implemented and the public shall be informed on the proper management of animal bites and/or rabies exposures. Republic Act 1136 Memorandum Circular No. 98-155 Tuberculosis Law of 1954 Creation of the Division of Tuberculosis under an appointed Director of the National Tuberculosis Center of the Philippines (NTCP) established at the DOH compound. a Pronounced the National Tuberculosis Control Programs as the highest priority public health program of the LGUs. Presidential Proclamation No. 46 of 1992 Reaffirming the commitment to the Universal Child and Mothe" Immunization goal by launching the Polio Eradication Project which aims to make the Philippines polio-free by 1995. Presidential Proclamation No. 1204 of 1998 Declaring the month of June of every year as National Dengue ‘Awareness Month, and formulation of the National Dengue Prevention and Control Program to reduce morbidity and mortally due to dengue so that it will no longer be a public health provler Administrative Order No. 24 series of 1996. The National Tuberculosis Control Program adopted Drea Observed Treatment, Short-Course (DOTS) in the manageme™ of TB. 302municable diseases remain to be one Fe major public health problems in the c fsiippines. Being Knowledgeable of the dierent communicable diseases common in theeommunity as well as the different public feath programs and policies concerning ‘hem is essential to all public health nurses fp prevent and control communicable diseases, The public health nurse must work colaboratively with other health professionals in eliminating and eradicating communicable diseases in response to the Philippine’s commitment to the MDGs set be achieved in 2015. LEARNING ACTIVITIES 1. Make a table of the common communicable diseases in the Philippines. Columns should indicate the mode of transmission, incubation period, signs and symptoms, laboratory or diagnostic examination, and treatment. 2. Organize a health education program on the control of communicable disease in your assigned community. REFERENCES ADicionary of Nursing, 2008. Daniels R, 2009. 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