Influenza Measles
1)Definition Communicable viral disease Communicable viral
affectingthe resp tract
characterized by:
1-Epidemic in early winter
and pandemic occasionally.
2-Repeated attacks due to:
a)Different strains.
b) Multiple Mutations.
c) Mild specific immunity.
3-Self-limited disease cold
like symptoms.
2)Organism Influenza virus
a)name
b)nature Orthomyxoviridae
c)strains 3 types(A,B,C)
A has the most antigenic
change
d)cross immunity
e)resistance Moderate resistance outside
the body killed by heat or
chemicals
Rubella Varicella
Communicable viral Communicable viral
disease affecting the disease affecting the disease affecting the
resp tract characterized resp tract characterized resp tract characterized
by: by: by:
1)Skin rash. 1) Skin rash (70% only). 1- Skin rash.
2) Epidemic 2)Congenital rubella 2-Common in childhood
beforevaccination. Syndrome. 90%>15ys.
3) It affectsnearly all 3) Lymphadenopathy Rare in adults in
children. preceding rash. Endemic areas.
But now incidence
decreased.
Measles virus Rubella virus Herpes zoster virus
paramyxoviridae paramyxoviridae Herpes virus
Single strain
No cross immunity
Mild resistance outside Moderate resistance Moderate resistance
the body killed by heat outside the body killed outside the body killed
or chemicals by heat or chemicals by heat or chemicals
Page 1 of 33
4)Period of Clinical course Clinical course Clinical course Clinical course
communicability Late in IP
5)Exit Nasopharynx Nasopharynx Nasopharynx -Nasopharynx
-Fluid from ruptured
vesicles
6)Entry Nasopharynx Nasopharynx Nasopharynx -Nasopharynx
-Intact skin
7)MOT Droplet infection: Droplet infection: Droplet infection: Droplet infection:
-Closecontact -Closecontact -Closecontact -Closecontact
- Nuclei -nuclei -nuclei -nuclei
-Contaminated hands on -Contaminated hands on -Contaminated hands on -Contaminated hands on
entry sites entry sites entry sites entry sites
- in utero -in utero -In utero
- contact with ruptured
vesicles fluid
8)Host factors All age groups Was (Peak: 3-5 years Peak (5-17 years) All ages
a)age oldMax. at 10 years old)
Now (peak from 5-17
years)
b)sex Both

c)immunity -Natural or artificial -Natural or artificial -Natural or artificial -Natural or artificial

-Type specific -Lifelong immunity -Lifelong immunity -Lifelong immunity
-Recurrent attacks -Temporary maternal -Temporary maternal -Temporary maternal
immunity (6-9 months) immunity (6-9 months) immunity (6-9 months)

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d)environment Late autumn, early winter Late winter, early spring Late winter, early spring Late winter, early spring
Crowded and ill Crowded and ill Crowded and ill
ventilated areas ventilated areas ventilated areas
9)IP 1-3 DAYS AVERAGE 2 WEEKS

10)Clinical pic Fever/ headache / anorexia/malaise

Resp symptoms: cough/running nose/ sneezing
a)prodorme Lasts for 1-2 days Pre eruption stage: Pre eruption stage: Pre eruption stage:
-4days -1-2days 1-2days in children
-Enanthema (kopliks -lymphadenopathy. 2-3days in adults
spots)
b)disease Nonspecific cold like but Eruption stage:4thday Eruption stage: 2nddays eruption stage:
more severesymptoms Exanthema 30% have no rash 1)Rash
Maculopapular rash Macule-papule-vesicle
-chars (superficial/easily
rupture/filled è clear
fluid/not unbllcated)
2)fever
c)convalescence When symptoms disappear

d)complications -2ry bacterial infection -2ry bacterial inf -2ry bacterial inf -2ry bacterial infection
-sinusitis/otitis media -Otitismedia/ -CRS -pustule formation
bronchitis/pneumonia bronchitis/pneumonia -arthritis & arthralgia -Scar if vesicle ruptures
-Convulsions in young -Gastroenteritis & -Encephalitis (rare) -Reye's syndrome if
-Reye's syndrome if diarrhea treated & aspirin
treated with aspirin -sclerosing pan -Retinal necrosis
encephalitis (SSPE) -abortion

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11)diagnosis -Clinically
-Serological (igM)
-viral RNA by PCR
-isolation in tissue culture
-Clinically (kopliks spots)
-Serological (igM)/igG
-viral RNA by PCr
-isolation in tissue
culture
-saliva for IgA
-Clinically -Clinically
(lymphadenopathy) -Serological (igM)/igG
-Serological (igM)/igG -viral RNA by PCR
-viral RNA by PCR -isolation in tissue
-isolation in tissue culture
culture

12)General 1)Sanitary environment + rural & town planning: good ventilation- prevent overcrowding- air sanitation.
prevention 2)Health education about mode of transmission & prevention.
3)Health promotion: good nutrition - healthy life style.
13)Specific vaccine Vaccine and seroprophylaxis
prevention
a)Seroprophylaxis No After exposure: After exposure: After exposure:
-In immunosuppressive -in Early pregnancy -in High-risk contacts
-Susceptible young (serologically infected)
b)Vaccine nature Killed Live attenuated

c)Dose 0.5 ml (two doses) for the 0.5 ml (number of doses 0.5 ml (number of doses 0.5 ml (single) in
first time depends on the depends on the preschool
One in every year indication indication Two doses in elder pp
d)Booster dose Every year School entry School entry no

e)ROA IM Subcutaneous

Page 4 of 33
f)Protection 25-40 % Lifelong protection Lifelong protection 70-90%
95%-99% 95%-99%
g)Indications AT RISK PTS Compulsory Compulsory -At risk pts
Pregnant women (Medical staff/contacts)
Chronic disorders -Preschool and school -
Caregivers children
h)complications General: fever - malaise - headache
Infection (due to contamination): HIV - HBV-HCV - CMV
Local: pain - swelling - redness - tenderness - abscess at the site of infection
I)Contraindications Fever Immunocompromised (DM/HIV), STEROIDS,PREGNANCY
Children <6m
14)Control

Cases
Stump
Contacts

Environment

Carriers No carrier No carrier Incubatory carrier: No carrier

1)examination of
contacts
2)Routine examination
a)School children
b)Food handlers
c)Medical staff

Page 5 of 33
 Streptococcal tonsillitis Meningitis Pulmonary TB
1)Definition Communicabledisease affecting the resp Acute Communicabledisease Chronic Communicable disease
system affecting the resp system, affecting resp tract.
CNS,meninges characterized
by:
1)neck stiffness
2)MENINGOCOCCEMIA
2)Organism Group A b haemolytic streptococci Neisseria meningitides Mycobacterium tuberculosis
a)name
b)nature Bacteria Bacteria Bacteria
c)strains 130 serotypes Many serotypes Human (M.tyberculosis)
(A,B,C,W135,X,Y) Bovine (M.bovis)
d)cross immunity No cross immunity No cross immunity Present

e)resistance Moderate,killed by heat and chemicals Weak resistance killed by heat High resistance killed by UVR
and chemicals
3)Reservoir Cases Cases Cases (sputum +)
Incubatory and convalescent carriers 5-10% of population are Cattles
carriers
4)Period of -Late in IP Until disappearance of Open cases (as long as sputum +)
communicability -Clinical course meningococci from circulation
-Early in convalescence (24 hours after ttt)
5)Exit nasopharynx nasopharynx Nasopharynx
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 sputum
6)Entry nasopharynx nasopharynx nasopharynx
7)MOT Droplet infection: Droplet: contacts(mainly) Droplets:
Contacts, nuclei,dust,fomites,milk Nuclei plays a minor role contacts,nuclei,dust,fomites
b) sex Both Males >in some countries Males
c) immunity -Natural only -Natural and artificial -Natural and artificial
-Type specific -Type specific life long -Specific cell mediated immunity
-Recurrent attacks -Passive maternal immunity (re infection can occur)
(6-9 months) -No passive maternal immunity
d) environment Poverty,malnutrition,poor housings, winter -Bad life style
-Winter
-Overcrowding
9)IP 4 days average 4 days average (2-10) 1-3 months (primary lesion)
10)Clinical pic
a)prodorme Fever,headache,malaise,anorexia,resp symptoms (cough,sneezing)
b)disease -Tonsillar exudates -Neck stiffness Night fever,night sweat,loss of
-Cervical adenopathy -Projectile vomiting weight,loss of appetite
-Severe headache Cough,expectorations,hemoptysis
-Meningococcal septicaemia

c) convalescence Until symptoms disappear

d)complications Local: -Cranial nerves affection -Lung fibrosis
Quinsy,otitis media -Hydrocephalus -Spread to other sites
Systemic: -MR (kidneys,CNS)
PSGN -Peripheral thrombophlebitis -Fatality from severe hemoptysis
RF -Purulent arthritis and resp failure
-Pneumonia

Page 7 of 33
11)diagnosis -Clinical pic (not conclusive) -Clinical pic TST,QFT
-Throat swab and culture(gold) -Lumbar puncture Chest x ray
-RST -Detection of organism in CSF Sample of sputum
-Rising ASOT titre (recent infection) Or blood by PCR Detection of the organism on
culture or with PCR is the gold
standard
12)General 1)Sanitary environment + rural & town planning: good ventilation- prevent overcrowding.
prevention 2)Health education about mode of transmission & prevention.
3)Health promotion: good nutrition- healthy life-style
13)Specific -Chemoprophylaxis only -vaccine and -Vaccine and chemoprophylaxis
prevention (Appropriate in high-risk contacts) chemoprophylaxis =CHEMOPROPHYLAXIS:
-Penicillin long acting =CHEMOPROPHYLAXIS: -INH 5-10 mg/kg for 6-9 months
(1.200.0000 IU) IM injections - used for close contacts Given for:
-Erythromycin can be given in -- - rifampicin 600 mg twicedaily 1)TST +(contacts to active cases)
Hypersensitive cases to penicillin for 2 days (half the dosefor 2)immunosuppressed patients
Chemoprophylaxis is given for at least 5 children) 3)recent tuberculin convertor
yrs. -Three type specific vaccine
a)Seroprophylaxis no no
b) vaccine nature 1) Conjugate (ptn linked to BCG
Polysaccharide) Live attenuated
2) Polysaccharide
3) Ptn based vaccine
c)Dose Tetravalent 0.1 ml single dose
0.5 ml
d)Booster dose -Every 3 year according
to circumstances
e)ROA SC Intradermal
f)Protection 85% type specific immunity 80% for 10 yrs
Page 8 of 33
g)Indications -Preteens and teens -COMPULSORY
-High risk adults (medical -risk patients
personnel)
h)complications -General:fever - malaise - headache
-Infection (due to contamination): HIV - HBV-HCV - CMV
-Local: pain - swelling -Local: small papule then shallow
redness - tenderness ulcer with crust then healing by
abscess at the scar.
site of infection
I)Contraindications Fever -Immunosuppression
-Generalized eczema
-Debilitating conditions
-fever
14)Control
Cases
Contacts stump
Environment
Carriers Incubatory only: No carrier
1) Examination of contacts
2) Routine examination
a)school children
b)food handlers

Page 9 of 33
 POLIO HAV TYPHOID CHOLERA BRUCELLOSIS
1)Definition Communicable Communicable viral Communicable Communicable Communicable bacterial disease
viral disease disease affecting the bacterial disease bacterial affecting the GIT characterized by:
affecting the GIT GIT and liver affecting the GIT disease -Zoonotic disease
and CNS(in 1% of characterized by: affecting the -Undulant fever
cases) systemic and GIT strongly
intestinal linked to
manifestations insanitary
water.
2)Organism Polio virus HAV Salmonella typhi Vibrio cholera brucella
a)name S.paratyphi
(A,B,C)
b)nature virus virus bacteria Bacteria Bacteria
c)strains Three antigenic Single S.TYPHI -Classical B.abortus (cattle)
structures (Big numbers of (More virulent) B.melielitens (goats)
(1)Causes most serotypes) -El tor B.suis (pigs)
cases of paralysis S.paratyphi (More B.canis (dogs)
(2)Most common (3 serotypes) resistant) Destroyed by pasteurization and
in Egypt boiling of milk and chlorination of
water
d)cross immunity No cross immunity
e)resistance Moderate resistance killed by heat and chemicals outside the body
3)Reservoir All Cases Cases All cases -Cases -Animals only
All carriers Incubatory carriers All carries: -Carriers: -No man-to-man infection
(Favoured by the Incubatory
presence of Contact
cholecystitis and Convalescent
urinary lesions)

Page 10 of 33
4)Period of -Late period of IP About (4 weeks) -Late period of IP -Late period of -No man-to-man infection
communicability -Clinical course -Late in IP -Clinical course IP
-Early period of -Clinical course -Early period of -Clinical course
convalescence convalescence -Early period of
(6 to 8 weeks) (6 to 8 weeks) convalescence
-About two weeks -About two
in healthy and weeks in healthy
contact carrier and contact
carriers
5)Exit Stools Stool Stool Stool Animals:
Nasopharynx Blood (rare) urine vomitus Stool,urine,tissues,milk,discharges
6)Entry Mouth Mouth mouth Mouth -Mouth
Nasopharynx -Nasopharynx
-Skin(injured)
7)MOT -Feco-oral -Feco-oral -Contaminated Feco-oral -Food borne:
(Developing - parenteral (rare) food Contaminated Ingestion of raw milk and meat
countries) -Feco-oral water -Contact: through skin abrasions
-Droplet -Airborne infection:
(developed Dust of dried tissues and excreta
countries)
8)Host factors -6 to 5 yrs All ages All ages
a) age -shifting towards (in endemic areas, (in endemic areas
adolescents children are ,higher incidence
because of the susceptible) in 10-30 yrs)
vaccine.
b)sex Males Both -Male (more
cases)
-

Page 11 of 33
 Females(carriers)
c) immunity -Natural -Natural and artificial Natural and
andartificial -Lifelong immunity artificial
-lifelong -Passive maternal -Relative
-passive maternal immunity(6-9 immunity
immunity (6-9 months)
months)
d) environment More in summer
9) IP 2 weeks 2-6 weeks 2 weeks 5 days 6-60 days
10)Clinical pic 1-Inapparent (in -Mild non icteric -Gradual onset -Most cases: -acute or gradual onset with fever
90% of infected -Classical disease -Around 4 weeks asymptomatic of variable duration. (Continued,
persons) -fulminant in classical non -Rice water intermittent or irregular)
2-Manifest: treated cases stool - Headache, weakness, profuse
-Abortive -Atypical -Nausea and sweating, chills, arthralgia,
poliomyelitis (9%) presentation isn’t profuse depression, weight loss.
-Involvement of uncommon vomiting -generalized ache and localized
CNS (1%): infection of organs including liver
*Non paralytic and spleen may occur.
cases
*Paralytic cases

Page 12 of 33
11)Complications No chronicity -Intestinal hge -Dehydration part or the entire original
&perforation -Acidosis syndrome may reappear as
-Cholecystitis -Circulatory relapses.
- collapse
Thrombophlebitis -Hypoglycemia
-Myocarditis in children
-Renal failure
and death

12)Diagnosis Clinically -clinical: -clinical: -clinical:

-Impossible in Dark colored Vague early Not characteristic
abortive stage urine,jaundice -lab: Suspected when (chronic fever
-Only when -lab Blood culture: and vague pic)
paralytic or non- EM detection of virus conclusive not -Lab:
paralytic picture in stool exclusive Isolation from blood
appears Serology Widal test: culture,urine,excreta
-Lab: LFTs (Nonspecific) Abs begin to rise Serology
1)Isolation(stool or in the 2nd week -Brucellin test
throat)
2)serology
12)General -Sanitary housing -Sanitary housing -Sanitary housing -Sanitary Measures for Animals:
prevention -Good hygiene -Good hygiene -Good hygiene housing -Sanitary clean animal
-Sanitary water -Sanitary water -Sanitary water -Good hygiene environment.
supply, supply, supply, -Sanitary water -veterinary care.
sewage & refuse sewage & refuse sewage & refuse supply, -Management of aborted animals,
Page 13 of 33
 disposal disposal disposal sewage & and sanitary disposal of any
-food hygiene -food hygiene along -food hygiene refuse wastes.
along food chain along disposal -Vaccination (live attenuated) of
food chain -Fly control: food chain -food hygiene young animals in endemic areas.
-Fly control: -elimination of adult -Fly control: along -Agglutination screening.
-elimination of stage + breeding -elimination of food chain
adult areas adult -Fly control: 2. Measures for Man:
stage + breeding -health education stage + breeding -elimination of A. Prevention of Ingestion
areas areas adult infection:
stage + -Milk sanitation, ending by
breeding areas pasteurization or boiling.
-sanitary -Milk products must be made of
regulation of safe milk.
food handlers -Meat sanitation, ending by
General proper cooking or processing.
prevention is -Health education of the public
important here for safety of milk and meat.
13)Specific Vaccine and sero Vaccine and Vaccine and
prevention chemotherapy chemotherapy B. Prevention of occupational
contact infection:
a)Seroprophylaxis No practical Before expected
application exposure or within Chemotherapy: -Using protective clothing, gloves
few days of -Tetracycline and footwear, and personal
exposure to: oral 500mg/6 cleanliness
1)household,contacts hours for 3
2) travellers to days or single 1 C. Prevention of airborne
endemic areas gm dose infection:clean animal
-Contacts of environment, sanitary disposal of
cases sanitary disposal of

Page 14 of 33
 infected material, dust control
b) vaccine nature 1)Sabin (type 1,3) Inactivated 1)TAB vaccine 1) live and using masks.
Live attenuated Heat- attenuated
2)Salk (type 1,2,3) killed,phenol- 2)killed
Inactivated preserved (inactivated
2)Oral vaccine vibrios and B
Live attenuated subunit of the
3)polysaccharide toxin)
vaccine

c)Dose 1)sabin 3 drops at 1ml, two doses, two 1)TAB vaccine 1)single
(0,2,4,6,9,12,18 weeks apart Two doses(0.5 2)two doses 6
months) and 1 ml) 4 months apart
2)salk weeks apart
0.5 ml at(2,4,6 2)Oral vaccine
months) Four doses on
alternate days
3)polysaccharide
Single dose
d)Booster dose Sabin 1)TAB vaccine
at 18 months and Every 3 yrs
school entry
e)ROA 1) sabin oral IM in deltoid 1)TAB vaccine 1) oral
2) salk IM SC 2) IM
2)Oral vaccine
3)polysaccharide
parenteral
f)Protection 1)sabin 1)TAB vaccine
Page 15 of 33
 Humoral (95% Moderate (50-
lifelong) and 70%)
cellular local 2)Oral vaccine
immunity 65%
2)salk
Humoral ¸prevents
more than 90% of
paralytic cases

g)Indications Sabin (compulsory) -Chronic liver disease 1)TAB vaccine

Salk (endemic and -Travellers to In endemics to:
risk countries) endemic areas -Food handlers
-Lab workers -risk groups (lab
workers)
-Camps and
closed
communities
h)complications General: fever - malaise – headache /Infection (due to contamination): HIV- HBV-HCV- CMV
Local: pain - swelling - redness - tenderness - abscess at the site of infection
i)Contraindications Pregnancy,steroids, fever fever
immunodeficient
14)Control
Cases
Contacts
Environment
stump
Page 16 of 33
Page 17 of 33
 TETANUS RABEIS HBV HIV
1)Definition Acute Communicable Communicable viral disease affecting the Communicable viral disease Communicable
bacterial disease CNS characterized by: affecting liver viral disease
affecting the CNS 1)zoonotic (jaundice,dark urine) affecting the
characterized by: 2)long IP and short illness period immune system
1)general toxaemia
2)systemic
manifestations
2)Organism Clostridium tetani Rabies virus HBV HIV
a)name (Spore forming,
produce powerful
exotoxin
(tetanoplasmin)
b)nature bacteria virus virus virus
c)strains No strains Single antigenic type Single but has 3 antigens 1 and 2 types
(S,C,E)
d)cross immunity Nocross immunity present No cross immunity No cross
immunity
e)resistance High resistance killed High resistance killed by heat and Moderate resistance killed Weak resistance
by heat and chemicals chemicals by heat and chemicals killed by heat and
Better killed by steam chemicals
under pressure or
irradiation
3)Reservoir -Animals Animals -Cases Cases
-Man (harmless normal Urban type (dogs,cats) -carriers Incubatory
inhabitants) Sylvatic type (wild) incubatory & convalescent carriers
-soil Man (saliva)
4)Period of No Animal is infective 3-5 days before Late in IP Beginning of
disease and throughout the Clinical course infection and
Page 18 of 33
communicability clinicalcourse. Early in convalescence lasts forever
As long as (sAg) is present
5)Exit Excreta of animals Salvia Blood and body fluids Blood and body
fluids
6)Entry Injured skin Injured skin Blood Mucus
Mucous membranes membranes
Injured skin
7)MOT 1)injury contaminated 1)Bites or licks of rabid animals. 1)percutaneous,permucosal 1) sexual
places 2)Contact with saliva or brain tissue of 2)blood transfusion 2)contact of
With spores rabid animals. 3)organ transplantation injured skin
2)post operative 3)Inhalation of aerosolized rabies virus 4)renal dialysis 3)blood
Hospital infection and bat excreta. 5)sexual contact 4)vertical
3)after labour or 4)Potential risk of transmission in organ 6)perinatal (15-35%) at birth
abortion transplantation few cases have been (50%) breast
Puerperal tetanus reported feeding
4)neonatal inf with transplantation of the cornea.
Contaminated
Umbilical stamp
8) Host factors All ages Occupations: Susceptible in general 15-40 yrs
a) age Night guard,cave explorers, vets
b) sex Males Homosexuals
c) immunity -Natural (transient) No natural immunity -Occupation: Non circumcised
-Artificial (for 10 yrs) Artificial Medical and paramedical males
-Maternal passive -Patients during
immunity of vaccinated hospitalization blood
mothers transfusion
d) environment Rural

Page 19 of 33
9)IP 3 days-3 weeks From few days up to 4-8 weeks depends 2-3 months 1-15 yrs or longer
on:
-
site,character,amounts,virulence,number
of bites

10)Clinical pic -Lock jaw -Acute encephalomyelitis Indistinguishable from HAV early infection:
a)prodorme -Opisthotonus -Fever, malaise late infection
-Bitter laugh -Hydrophobia(spasm of swallowing latent phase
b)disease
(risus sardonicus) muscles)
c) convalescence In animals (2 stages)
1)EXCITATION
2)DUMB

d)complications Fatality ranges from Fatal due to resp failure Chronicity Refer to book
10-90% Carrier
Liver cirrhosis
HCC

11)diagnosis History of injury Clinically Clinical: Clinically

Clinical examination Lab: -Onset is insidious and Lab
-Fluorescent abs test afebrile Detection of p24
-Detection by PCR LAB: ag
-Detection of NEGRI BODIES markers Serology
sAg: infectivity
sAb:immunity
cAg: can’t be detected
cAb:before sAb
Page 20 of 33
 eAg:high infectivity
eAb:recovery

12)General 1)sanitary environment For animals a. Prevention of blood- Refer to book for
prevention including cleaning of 1) Destruction of stray dogs. transmitted infection general
the streets from dust, 2) Registration, licensing and vaccination b-Health education of the prevention and
prevention of animals of all pets by in activated or public and especially high- control
to walk in street, and Modified live virus vaccines. risk group Post exposure
exchanging animal 3)Avoid handling and feeding of c-Prevention of sexual prophylaxis:
carts with motor unfamiliar animals. infection 3 ARV drugs for
vehicles cars. d-Screening for HBV 28 days
infection should be done
2)Educate the public for:
about: 1)Blood and organ donors
* The necessity for 2)premarital examination
complete of partners
immunization. 3)Prenatal examination of
* The hazards of pregnant females
puncture wounds and
closed injuries

3)Sterilization of
operating theatre,
surgical instruments
and fomites used in
Page 21 of 33
 hospitals (toprevent
surgical tetanus),
maternity, neonatal
wards and place of
delivery to prevent
puerperal tetanus.

13)Specific Vaccine, sero,chemo Vaccine Vaccine

prevention Chemoprophylaxis: combined Sero
Single IM long acting combined
penicllin (1,200,0000
Iu)
a)Seroprophylaxis -Human or animal -With vaccine Seroprophylaxis:
-Combined vaccine and -After exposure: -Human specific IG(anti-HBSAB)
sero: Half the dose around and into the wound -Post exposure
When there is And half IM COMBINED:
exposure and not fully -Equine IG (40 IU/KG) 1)Infants born to infected mothers: A single
immunized within 10 -HUMAN IG (20 IU/KG) dose of HBIG, within 12 hours from birth.
yrs Vaccination is simultaneously started: the first
dose, 0.5 ml, IM, at the same time
at different site.
Then the TWO DOSES ARE GIVEN AT (1,6
months)

2)Post-exposure immunization: when an

individual is exposed to infection.
b) Vaccine nature 1)Monovalent 1)HDCV 1)plasma derived
Adsorbed tetanus 2)NTV Heat or formalin
toxoid Both inactivated inactivated HBsAG
Page 22 of 33
 2)divalent(DT) 2)yeast recombinant
Tetanus and diphtheria Recombinant DNA
toxoid
3)trivalent(DPT)
Killed pertussis,
Tetanus and diphtheria
toxoid
3)PENTA VACCINE.

c)Dose 1)Monovalent 1)HDCV 3 doses 0.5 ml at (0,1,6

3 doses: -Pre exposures months)
2 doses 0.5 ml 4 weeks 3 doses (0,,7,21)
apart and third one -Post exposure
after 6-12 months On dose daily for 5 days
Full (5 doses) 2)NTV
(0,1,6,12,12 months) Post exposure only
2)divalent(DT) -Daily for 14 days
As a booster dose after -SEVER EPOSURE:
4 yrs and school entry Sero +21 doses
3)trivalent(DPT)
3 doses 0.5 ml each
(2,4,6)
3)PENTA VACCINE.
3 doses 0.5 ml each
(2,4,6) instead of DPT

d) Booster dose 1)Monovalent HDCV 1ml every 5 yrs

Every 10 years -Every 2 yrs -continuous exposure

Page 23 of 33
 4)PENTA -In long exposure
At 18 months occupations

e)ROA 1)Monovalent 1)HDCV IM

Sc IM in deltoid
2)divalent(DT) 2)NTV
3)trivalent(DPT) SC IN THE ANTERIOR ABDOMINAL WALL
3)PENTA VACCINE.
IM

f)Protection Dpt 96%

99% for D and T while
87% for P for 3 yrs

g)Indications 1)Monovalent HDCV Compulsory

-military forces, -PRE exposure (occupational) (0,2,4,6 months) in PENTA
policemen and camps -Post EXPOSURE
residents. NTV For:
Post exposure only 1-medical and paramedical
-Farmers and due to its personnel, in general,
agricultural, animal, side effects especially those exposed to
sewage workers (encephalitis) the risk
of professional infection.
-Pregnant mothers 2
doses 0.5 ml S.C 2-Medical and paramedical
injection after the first students, on starting
Page 24 of 33
trimester (5th and 6th hospital training.
months) and one dose
in subsequent 3-cases in need of repeated
pregnancies to reach 5 blood transfusion or
doses (fully hemodialysis.
immunized). The
antibodies pass to the 4-Sexual partners and
fetus across the household contacts of
placenta to provide HBsAg positive persons.
protection against 5-International travellers to
neonatal tetanus. areas with intermediate to
Complete five doses in high rates of chronic HBV
which 4th after 1 yr infection.
from 3rd and 5th after 1
yr in:
1-young females
2-military groups
3-occuptional

2)divalent(DT)
Children developed
convulsions after dpt or
penta
3)trivalent(DPT)
Was compulsory

Page 25 of 33
h) Complications General: fever - malaise - headache
Infection (due to contamination): HIV - HBV-HCV - CMV
Local: pain - swelling - redness - tenderness - abscess at the site of
infection
i)Contraindications 1)trivalent(DPT)
-Children over 4 yrs
-History of epilepsy in
first degree relatives
immunocompromised

14)Control Stump
Cases
Contacts No man to man
Environment stump
Carriers No man to man

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1)Clean the wound with plenty of water + 20.0% soap solution, 70.0 % alcohol AND Never suture the wound

2) If:

1-The animal escaped ,the animal died/ killed and found Negri bodies ,Severe multiple wounds in the head and neck
Then, start active immunization immediately and complete the doses

You have to ask about the history of previous immunization

If no history: Give full doses

If previously immunized within 2 years: give fewer doses: HDCV: give only 2 doses, 3 days apart

NTV: give one dose daily for 5 days + 6' dose after 3 weeks:

2_low severity wound, and the animal is alive, confined, arrested or captured

Then, start active immunization, and observe the animal for 10 days

If the animal dies, complete the doses

If the animal kept alive, stop the doses

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 Yellow fever Filariasis Malaria
1)Definition Communicable viral disease characterized
by:
jaundice and fever
Zoonotic disease (monkeys)
2)Organism Yellow fever virus Wuchereria bancrofti Plasmodium malaria
a)name (flaviviridea) P.FALCIPARUM,
P.VIVAX
P.OVALE
b)nature Virus parasite
c)strains Single
d)cross immunity Share ag with west Nile virus and dengue
e)resistance Moderate resistance killed by heat and chemicals
3)Reservoir Jungle: Man (with microfilaria in blood) Reservoir:man
Reservoir:nonhuman Vector:culex pipiens mosquito Vector:female anopheles
vector:aedes mosquito
Urban
reservoir: man
vector: Aedes aegypti
4)Period of Man: Man: Man:
communicability Stage of viremia: As long as the microfilaria in As long as gametocytes in
late in IP and 3-5 days of disease blood Mosquito: blood(up to 3 yrs)
mosquitoes After biting by 2 weeks mosquitoes
infective(9-12 days) after biting then infective(9-12 days) after biting
infinitely then infinitely
5)Exit Blood of man and monkeys Blood of man

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7)MOT Urban:bite of female aedes aegypti The mosquito bites and ingests -Bite of the mosquito where
Jungle:bite of genu aedes the microfilaria then it develops sporozytes are present in
into larva then when it bites salivary glands
another person it enters the skin -Contaminated blood or blood
and becomes adult products
-In utero
8)Host factors All General All
a) age
b) sex All General Both
(Pregnant females are at great
risk of severe disease)
c) immunity Absolute immunity after infection After many years of exposure -Only after repeated infections
-Infants to immune mothers
are protected (3-5 months)
-Very specific
-black Africans have natural
immunity
-person with SC anemia have
milder parasitemia
-HIV infected persons are at
increased risk

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d) environment Who works in jungle Insanitary planning and -Occupation:
inadequate sewage disposal Malaria is predominately a
rural disease and is closely
related to agricultural practices.
- Socioeconomic conditions:
Low socioeconomic standard
Poor housing:
The Ill-ventilated and ill-lighted
houses
-Environmental factors:
Malaria is highly prevalent in
hot, humid season together
with rainfall
9) IP 6 days 9-40 days
10)Clinical pic -Mild form: Asymptomatic begins with slowly rising fever,
the typical attack is characterized by Acute form: chills, malaise, headache,
sudden onset, fever,chills, headache, Fever,lymphangitis,lymphadenitis nausea, lassitude,
muscle pain, prostration, nausea and Chronic form: muscle and joint pain.
vomiting. Obstruction due to fibrosis Then rigor sensation and
-severe form: Ten years later: rapidly rising temperature
Hemorrhagic symptoms including obstructed vessels lead to ending by profuse
epistaxis, gingival bleeding, hematemesis, elephantiasis of sweating.
melena, liver and renal failure. limbs,breast,genitalia The cycle of fever, chills,
Hydrocele,chyluria,nocturnal sweating is repeated either
asthma daily or every other day orevery
third day or irregularly
according to malaria species.

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11) Complications fatality rate of jaundiced cases may reach -Anemia
20-50% -Splenomegaly
-Abortion and fetal infection
-Falciparum malaria may be
associated with respiratory
distress, jaundice, liver failure,
encephalopathy, pulmonary
and cerebral edema, death

12) Diagnosis 1) viral Ag by ELISA Detection of microfilaria in blood -Demonstration of malaria

2)PCR (nocturnal) parasites in thick blood film.
3)Serology -Repeated microscopic
examination every 12-24 hours
may be necessary to cover all
parasite species.
SEVERAL TESTS:
Detection of Ag
PCR
serology
12)General -Environmental sanitation: -Environmental sanitation -Environmental sanitation
prevention Eradication or control of mosquito vector. -Health education -Health education
-control measures are directed to -Avoid blood from any
breeding places and use of insecticides. individual with a history of
-Health education malaria or travel to endemic
INTERNATIONAL MEASURES (REFER TO areas
BOOK)

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13)Specific Vaccine in endemics: Vaccine and chemoprophylaxis
prevention -MDA (single annual dose of DEC Chemoprophylaxis:
and albendazole for 4-6 yrs) Chloroquine phosphate
-DEC-MEDICATED COOKING SALT -(500mg orally once a week)
-1-2 week before travel, during
stay,4 weeks after leaving
In resistant cases, mefloquine
(250 mg orally once a week)
-Duration (Same as before)

a)Seroprophylaxis No No
b) Vaccine nature 17 D vaccine Several vaccines:
Live attenuated Sporozoite vaccines
c)Dose 0.5 ml single dose Merozoite vaccine
e)ROA SC Transmission blocking vaccine
f)Protection 99% for 10 yrs
g)Indications Travellers
h) Complications
i)Contraindications Pregnancy
Immunocompromised
14)Control
Stump

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 Staph FP Botulism FP Salmonella FP SHGELLOSIS
1)disease Commonest from of FP Highly fatal dysentry
2)Organism Enterotoxin (exotoxin) Exotoxin of Cl.botulinum S.typhi murium and Shigella
enteritidis
3)Reservoir Cases Soil -Animals -Cases
Carriers (5% of population) Animals (commensals) -Man: Carriers:(contact,Healthy,
cases and carriers Convalescent)
4)MOT Ingestion of toxin Ingestion of toxin -Ingestion of infected,
contaminated food
-Hand to mouth
5) IP 2-6 hours 12-36 hours 12-30 hours Usually less than 4
6)Clinical pic -Abrupt onset of: -Paralysis of cranial -Outbreak: -Fever,tenesmus,loose
Nausea,vomiting, nerves; gastroenteritis scanty stool made of
abdominal pain,diarrhea Visual disturbances -Sporadic: fresh blood and mucus
(For some hours followed by Dysphagia,dysphonia enterica like picture -Severe cases:
recovery -Resp paralysis -Bacteremia may lead to DEHYDRATION
-Fatality is almost nil -Fatality 70% arthritis,cholecystitis
7) Diagnosis clinically -Collecting food and -Clinically
isolation of organism -Isolation of organism
-Animal inoculation from stool, vomitus
8)General General measure for food -General measure for food
sanitation sanitation
prevention -Iv antitoxin (2 vials)
9) control Control of sporadic cases Control of sporadic cases
Inv for outbreak Inv for outbreak

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