Module 4 Revised v2 For Students

Public Health and Education Data Analytics Online Course
Part 1: Introduction to Public Health In Schools
Module 4: Public Health in Schools
Module 4: Infectious Disease

Management and Surveillance
Objectives:
1. The learner should be able to describe some common infectious diseases that affect
Filipino children
2. The learner should analyze the role of the school clinic in individual management of
common infectious diseases and community disease surveillance
3. The learner should be able to discuss the different disease surveillance systems used
in the Philippines, and the role of school health providers in these systems.
4.1 What are some of the common infectious diseases that

affect Filipino children?
Although the top causes of mortality in the Philippines are due to non-communicable
diseases such as heart disease, cancers, and diabetes mellitusi, infectious diseases are
still a major cause of illness for all age groups in the country. Infectious or
communicable diseases can lead to absenteeism, hospitalization, and even death. Over
time, repeated infections are associated with poorer nutrition and health status,
especially among the young.
1. Acute diarrhea
Acute diarrhea is defined by the presence of loose, watery stools in 3 or more
episodes over a 24-hour period, but not lasting longer than 14 daysii. Diarrhea is a sign
that may point to several gastrointestinal problems, some of which may become life-
threatening if not urgently managed. Acute diarrhea may be generally classified into
two kinds: watery diarrhea (acute gastroenteritis) and bloody diarrhea (dysentery).
Common causes of watery diarrhea include food poisoning from improperly handled
or spoiled food, or infections with viruses such as rotavirus or bacteria such as Vibrio
cholerae. Watery diarrhea may also be caused by allergies or food intolerances such
as is seen in lactose intolerance. On the other hand, bloody diarrhea is often a sign of
a serious infection with bacteria such as Escherichia coli and Salmonella, or parasitic
infections such as amoebiasis.
Figure I: Discomfort from diarrhea
Source: https://www.flaticon.com/free-icons/diarrhea
Module 4: Infectious Disease Management and 1

This content is part of the Training Program “Public Health Data Analytics to Support Post-COVID Decision-Making Regarding School
developed by Philippine Association for Public Health Physicians, produced with support from the US Agency for International Development
through All Children Reading-Asia under Contract No. AID-OAA-TO-16-0001
In most cases, diarrhea is self-limited, and prevention of dehydration is the

paramount concern especially for infants and young children. Exclusive breastfeeding
or rehydration with healthy fluids for older children, as well as zinc supplementation
are advised in mild cases of diarrhea. Diarrhea can largely be prevented through hand
washing, proper use of WASH or WinS, and practicing food safety protocols iii.
2. Acute respiratory tract infections (upper and lower)

Respiratory tract infections such as pneumonia are a serious cause of illness and
mortality nationwide; in fact, pneumonia was noted as the 5th leading cause of death in
the Philippines in 2020. ivRespiratory tract infections can be confined to the nose,
mouth, and larynx in the upper respiratory tract, or can involve the trachea, bronchi,
and lungs in the lower respiratory tract. Of especial concern is pneumonia, which
refers to infection of the lungs. Respiratory infections in children are often caused by
viruses such as rhinoviruses (common cold), flu viruses. RSV (respiratory syncytial
virus), and SARS-COV2 (COVID-19), or by bacteria such as Haemophilus influenzae
and Streptococcus pneumoniae. Infections caused by both viruses and bacteria may cause
fever, difficulty of breathing, and cough. Infants may also be unable to eat and drink or
may even become unconscious or go into convulsions if the infection is severe,
especially in the case of pneumoniav. Upper respiratory infections may also cause
fever and cough, but are also associated with sore throat, nasal congestion/runny
nose, and painful swallowing. In severe cases, upper respiratory infections can also
cause breathing obstructions requiring emergency management.vi
Figure II: Child with pneumonia
Source: vecteezy.com
In many mild cases of viral respiratory infections, patients recover with home care.
Infants and young children, as well as patients with weakened immune systems, or
who are experiencing severe illness should be given medical attention or referred for
hospitalization. Antibiotics must only be used with a doctor’s supervision. Many
respiratory infections can be prevented with hand washing, practicing proper cough
etiquette, and proper wearing of personal protective equipment such as face masks.

3. Tuberculosis
Tuberculosis refers to any illness caused by a bacteria known as Mycobacterium
tuberculosis. This can cause illness in the lungs as well as other organs including the
bones and the brain. Patients with tuberculosis in the respiratory tract, also known as
pulmonary tuberculosis, can spread this illness through coughing, speaking, or singing
without practicing the appropriate protections such as wearing masks or coughing into
a napkin or handkerchief. Pulmonary tuberculosis usually manifests with a cough
lasting longer than two weeks, unexplained fever, night sweats, and involuntary
weight loss.
Some patients may even find blood in their phlegm or sputum. If left untreated,
tuberculosis can result in severe complications and eventually death.vii
Figure II1: TB infographic on signs and symptoms
Source: https://www.who.int/westernpacific/news-room/multimedia/infographics/tuberculosis/
Tuberculosis is treated with a combination of several medications taken over a period

of several months. This disease can be prevented through immunization with the BCG
vaccine for newborns, alongside reduction of risk factors for TB disease such as
smoking, poor nutrition, and poor management of comorbidities such as diabetes.viii
Check-In Question: What preventive measures can be used against

respiratory infections?
a. Vaccination
b. Practicing proper cough etiquette
c. Wearing of face masks
d. All of the above

4. Measles and Rubella

Measles and rubella are both caused by viruses that are transmitted through the
airborne route, making them very contagious. Both cause rashes, fever, and
conjunctivitis, but can be differentiated through other clinical features. Rubella, also
known as “3-day Measles”, is usually associated with mild illness in most patients.
However, this illness is more dangerous for pregnant women, since the rubella virus
can cause congenital problems in the unborn child. These include hearing
impairments, eye malformations, heart defects, and in some cases even fetal deathix.
Measles is a much more serious illness, with high fever lasting 4-7 days, accompanied
by nasal congestion, cough, a rash all over the body, and the appearance of small
white spots inside the mouth (Koplik’s spots). Measles can lead to complications such
as pneumonia, severe diarrhea, blindness, and even encephalitis/infection of the brain.
Complications are more common in children who are malnourished, have Vitamin A
deficiency, or have weakened immune systems.x
Figure IV: Measles Rash on a Child
Source: https://www.who.int/philippines/news/feature-stories/detail/questions-and-answers-on-the-
measles-outbreak-in-the-philippines
No cure exists for measles and rubella, and the only medical attention that can be
given is supportive therapy for symptoms and management of complications. Measles
and rubella are very preventable through vaccination, especially with the MMR
vaccine administered in the child’s first 12 months of age.
5. Mumps
Mumps is also caused by a virus which can be spread through direct contact with an
infected patient or with droplets from coughing and sneezing. Patients with mumps
may experience low-grade fever, and headache. Eventually patients have swelling of
the salivary glands, resulting in a bulging of the cheeks.
Although mumps is generally considered a mild illness, it can cause complications
such as infection of the testicles or orchitis in adolescent males.
Mumps is also preventable with the MMR vaccine that also prevents measles and
rubella.xi

Figure V: Child with Mumps
Source: https://www.practo.com/health-wiki/mumps-symptoms-complications-and-treatment/56/article
6. Chickenpox
Chickenpox is a viral infection caused by the varicella-zoster virus. This highly
contagious illness is characterized by a blister-like rash that is very itchy, but eventually
scabs over and peels away. Children with chickenpox may also have fever, headache
and loss of appetite. Although in most cases chickenpox is a mild illness for most
children, infants and immunocompromised children are at a higher risk for
complications. Adults who get chickenpox, especially pregnant women, may also have
complications. These include skin infections, bacterial pneumonia, and encephalitis.
Figure VI: Chickenpox vs Measles Rash
Source: https://www.medicalnewstoday.com/articles/322637
Chickenpox is also preventable with a vaccine that can be administered beginning 1

year of age.xii

Under the current National Immunization Program, the schedule for vaccines for
children and adolescents is as follows:
FIGURE V1I: Schedule of Childhood Immunization
Source: https://www.pidsphil.org/home/wp-content/uploads/2021/05/11-Vol-22-No-
1_Childhood_Immunization_Schedule_2021_v3.pdf
It is very important for children to complete their vaccinations especially within the
first year of life, in order to prevent succumbing to complications of preventable
communicable diseases.
Check-In Question: What is the primary means of preventing Measles,

Mumps, Rubella, and Chickenpox?
a. Social distancing
b. Providing isolation rooms
c. Vaccination
d. Anti viral medication
7. Dengue
Dengue is a viral infection transmitted to humans through the bites of several
mosquito species such as Aedes aegypti.
Figure VIII: Aedes aegypti mosquito
Source: https://www.niaid.nih.gov/diseases-conditions/dengue-fever

There are four serotypes of the dengue virus, which means that a single patient can
be reinfected with dengue multiple times. Patients with dengue fever can experience
fever, severe headache, pain behind the eyes, nausea, vomiting, joint pains, and a
reddish rash. Many patients who get dengue recover quickly with only supportive
treatment for their symptoms, but any patient diagnosed with dengue fever should be
watched for several “warning signs” that signal the onset of complications from
severe dengue.
These warning signs include severe abdominal pain, persistent vomiting, bleeding gums,
blood in vomit or other signs of hemorrhage. Patients with these signs and symptoms
should be given prompt medical attention to avoid deterioration and death.
In recent years, a vaccine has been developed against dengue fever to prevent
reinfection for patients who had experienced at least one dengue infection
previously. The primary means to prevent dengue fever is vector control through
destroying the breeding places of the Aedes aegypti mosquitoes, which are frequently
found in stagnant water sources in the communityxiii.
8. Malaria
Malaria refers to a disease that can be caused by several types of parasites known as
Plasmodium. In the Philippines, the Plasmodium falciparum type of parasite is most
associated with severe infections that can be fatal if left untreated. This parasite is
transmitted through the bite of the Anopheles mosquito, which is still found in some
areas of the country. Other types of malaria parasites cause “relapsing” malaria, which
is rarer in the Philippine context. Patients afflicted with malaria experience fever and
chills, accompanied by headaches, muscle aches, and vomiting. It is important to
confirm the diagnosis of malaria in areas where this disease is endemic, to avoid rapid
progression of symptoms and the onset of complications that can result in multi-organ
failure and death.xiv
Figure IX: Signs and Symptoms of Malaria
Source: https://commons.wikimedia.org/wiki/File:Symptoms_of_Malaria.png

Malaria is treated with drugs designed to eliminate all phases of the Plasmodium
parasite in the liver and bloodstream of patients. The primary means for controlling
malaria is the destruction of the breeding places of the Anopheles mosquito and the
use of barrier methods such as mosquito nets and insect repellents to protect against
insect bites. Recently, a vaccine against malaria has been developed for use in young
children residing in areas with a high prevalence of Plasmodium falciparum malaria.xv As
of 2019, only four provinces in the Philippines had local transmission of malaria:
Palawan, Sulu, Occidental Mindoro, and Sultan Kudarat. Fifty provinces have already
been declared as malaria-free, while twenty-seven more are in the process of
eliminating malaria in their communities, but no longer report high rates of infection
with this parasitic diseasexvi.
Check-In Question: What is an effective way to control both dengue and

malaria in the community?
a. Destroying breeding places of mosquitoes
b. Use of mosquito nets and insect repellents
c. Both a and b
d. Taking anti-malarial drugs
9. Leptospirosis
Leptospirosis is caused by a specific type of bacteria, Leptospira, that can affect both
humans and animals, including cattle, domestic pets such as dogs and cats, and vermin
such as rats. These bacteria are transmitted through the urine of infected animals,
which can contaminate water, soil, or food, or enter the human body through
wounds, cuts, or scratches. Leptospirosis outbreaks are usually associated with
exposure to contaminated floodwaters or other water sources in the community.
Patients with leptospirosis can experience high fever, muscle aches, headache, chills,
red eyes, diarrhea, and even jaundice (yellow skin and eyes). If left untreated,
leptospirosis can result in kidney or liver failure, or cause meningitis (infection of the
brain’s membranes).
Figure X: Leptospirosis Transmission
Source: https://www.pediatriconcall.com/articles/infectious-diseases/leptospirosis/leptospirosis-patient-
education
Leptospirosis is treated with antibiotics taken with a doctor’s supervision. Prevention

of leptospirosis infection is reliant on avoiding exposure to contaminated water and
soil. An example of such exposure is wading through floodwater. Another means of

prevention is wearing the appropriate protective clothing and footwear if such

exposure is necessary due to occupations or other circumstances. Control of rats and
elimination of other contaminated water sources are also considered means of
prevention against leptospirosisxvii.
10. Tetanus
Tetanus disease is a life-threatening condition caused by Clostridium tetani bacteria, the
spores of which can be found in the environment. The spores can infect improperly
cleaned wounds, and release toxins into the body. Patients with tetanus experience
painful muscle contractions, resulting in body contortions and the characteristic
“lockjaw” of the face. Patients can also experience painful swallowing, seizures, fever,
and headache. Complications of tetanus include breathing difficulties and airway
obstruction, which can be fatal.xviii
Figure XI: Child Suffering From Tetanus
Source: https://www.immunize.org/photos/tetanus-photos.asp
The most effective way to prevent tetanus infection is through vaccination, which can
be first administered at 6 weeks of age. Children and adults with deep and dirty
wounds are also eligible to receive booster shots against tetanus. Most notably,
tetanus toxoid vaccination of pregnant mothers has helped eliminate maternal and
neonatal tetanus, which until recent years was a common life-threatening
complication of unsafe delivery and newborn care practices.xix
Check-In Question: What is a complication of tetanus?

a. Kidney failure
b. Sepsis
c. Encephalitis
d. Airway obstruction
11. Skin Infections

Although skin infections in children are not seen as immediately serious or life-
threatening, they can cause grave illness and complications if left untreated or are
treated improperly. They can also easily spread among children in the same
household, or their classmates and close contacts. Bacteria such as Staphyloccoccus and
Streptococcus can cause easily recognizable infections such as impetigo on the face,
which manifests as sores with yellow crusting especially in childrenxx. Other causes of

skin infection include viruses, fungi and even parasites, which have different
manifestations such as itchiness and rashes on the affected areas.
Figure XII: Skin Infection
Source: https://www.healthline.com/health/skin-infection
Skin infections should be given the appropriate topical treatments, depending on

their causes. In severe cases, other medications such as antibiotics may be prescribed
by a doctor. Ways to prevent skin infection include proper hygiene, handwashing, and
appropriate wound treatment to prevent the introduction of harmful bacteria. Since
skin infections can easily spread, it is possible that more than one child in a
household may have to undergo treatment, depending on the nature of the skin
infection.
12. Conjunctivitis
Conjunctivitis, commonly known as “sore eyes”, can be very painful for a child with
this condition. A child may have red eyes, puffy eyelids, yellowish discharge or crusts,
eye itchiness or a gritty feeling. This can be caused by bacteria, allergies, or viruses.
Conjunctivitis caused by viruses or bacteria can easily spread if a child rubs his or her
eyes, then proceeds to touch other objects. This is why children with this condition
are advised to stay home from school or public places.
Figure XIII: Conjunctivitis “pink eye” in a child
Source: https://kidshealth.org/en/parents/conjunctivitis.html

A pediatrician or ophthalmologist can best prescribe a remedy for conjunctivitis, and

consultation must be sought if conjunctivitis begins to affect a child’s vision. The
spread of conjunctivitis may be prevented with proper hygiene, limits on crowding,
and removal of triggers such as allergensxxi.
Check-In Question: What is a means to prevent both bacterial

conjunctivitis and skin infections among children?
a. Use of disinfectants on every surface
b. Handwashing
c. Use of topical antibiotics
d. None of the above
13. Pediculosis capitis/ head lice infestation

Lice are wingless insects that can infect a person’s hair or body, with the intent of
sucking blood and laying eggs. Head lice can infest children in all socioeconomic
classes and conditions, but their presence is not associated with poor hygiene.
Patients with head lice usually have intense itching on the scalp and may develop
sores from repeated scratching. Live lice or their eggs, known as nits, may also be
seen on the hair. Although lice do not transmit diseases on their own, patients may
still get skin infections from wounds due to scratching. Lice are also easily transmitted
from hair to hair contact and may easily be passed among children in the same
household or in the same classroom.
Figure XIV: Lice eggs or “nits” in hair
Source: https://www.parents.com/kids/health/head-lice/3-ways-to-treat-lice-and-how-to-know-if-your-
child-really-has-them/
Head lice infestation may be treated with medicated shampoos and lotions, alongside
removal of nits from the person’s hair, clothes, and personal items. Children should be
discouraged from sharing hats, headscarves, combs, brushes, towels, and accessories
as part of controlling the spread of head licexxii.
14. Soil Transmitted Helminthiasis (ascariasis, trichuriasis, hookworms)

Infestation with parasitic worms (helminthiasis) is commonly caused by roundworms
known as Ascaris lumbricoides, whipworms known as Trichuriasis trichiura, and
hookworms such as Necator americanus and Ancylostoma duodenale. These worms are
known as soil-transmitted helminths since part of their life cycle requires their eggs
to

be passed out and deposited into soil. Here, the mature eggs of ascaris and trichura,
or the young larvae of hookworms may infect young children through hand-to-mouth
transmission of the eggs or through the hookworm larvae entering bare skin. Soil
transmitted helminthiasis are more common in areas with poor sanitation and are
associated with poor personal hygienexxiii. Patients with few worms may not develop
any symptoms of helminthiasis, but patients with a heavier worm burden may
experience abdominal pain, bloating, nausea, and diarrhea. Some patients may have
cough, wheezing, and fever if the worms pass through the respiratory tract. In severe
cases, ascaris infection is associated with complications such as intestinal obstruction.
Over time, infection with these worms may cause malabsorption and malnutrition that
can permanently the growth of childrenxxiv. Patients with heavy hookworm infestation
may also experience blood loss resulting to anemia.xxv
FIGURE XV: Ascaris lumbricoides, common cause of helminthiasis
Source: https://www.medicalnewstoday.com/articles/322340
Soil transmitted helminthiasis may be treated with deworming medication used under
the supervision of a healthcare practitioner. Regular mass deworming and
reinforcement of WASH practices are effective in controlling this condition on a
population level.xxvi The Department of Education implements a regular school-based
mass deworming program, with a target of at least 85% of all students dewormed
semi-annually. Deworming is done simultaneously by health personnel assigned to
schools, who will guide the students with how to take the deworming tablets. Health
personnel will also help manage any side effects that rarely arise from deworming. It
is important to also orient parents about what to expect from deworming activities,
and the benefits of regular deworming for their childrenxxvii.
Check-In Question: What are among the long-term effects of heavy worm
infestation in children?
a. Intestinal obstruction
b. There are no long-term effects of helminthiasis
c. Malabsorption and malnutrition
d. Cough and colds

4.2 What is the role of the school clinic in

managing childhood infectious diseases?
The school clinic is a point of care for the management of acute illnesses in the
school community but is also a venue for preventive care and health promotion.
Examples of roles of the school clinic include:
1. Providing urgent care and first aid for students, teachers, and staff who fall ill
or experience injury and distress within the school premises
2. Coordinating and advising parents/caregivers regarding the necessity for an ill
student to be absent from class, and ensuring proper health clearance
before return to school activities
3. Conducting routine screening for infectious diseases during annual
physical exams and other activities
4. Implementing preventive programs such as immunizations and school-based
deworming for the student body and school personnel. The school-based
immunization program, implemented yearly, provides the following
immunizations: measles-rubella (MR), tetanus-diptheria (Td)xxviii, and human
papillomavirus (HPV)xxix to the following eligible students:
Table 1: Eligible Groups For School-Based Immunization Programxxx,xxxi
Age/Demographic Group Vaccines to be Administered
All 6-7 years old Measles-Rubella (MR)

Tetanus-diphtheria (Td)
All 12-13 years old Measles-Rubella (MR)

Tetanus-diphtheria (Td)
Female learners enrolled in Grade 4 OR HPV vaccine

aged 9-14 years old
5. Coming up with plans for health communication and continuity if the school
community is facing an outbreak of any infectious diseasexxxii
6. Report disease incidence and prevalence to national surveillance systems.
Check-In Question: What is a role of the school clinic in managing

childhood infectious diseases?
a. Providing school-based deworming
b. Communicating with parents and the community about disease
outbreaks in the school
c. Providing urgent care for students and staff who fall ill within the
school premises
d. All of the above

4.3 What are the different diseases surveillance

systems present in the Philippines?
The Department of Health conducts ongoing disease surveillance for both
communicable and noncommunicable diseases nationwide. This is important for early
detection of outbreaks and epidemics, and to pinpoint possible areas for improvement
of health programs on a local level. Disease surveillance engages healthcare workers
and practitioners on all levels from national, regional, provincial, city/municipal, and
individual barangays. Health facilities such as hospitals and clinics, including school
clinics, also should participate in disease surveillance.
Disease surveillance can generally be either active or passive in nature. Active
surveillance involves regular collection of data and reporting at set intervals, regardless
of whether events happen or not. Case-finding activities in communities are also
considered under active surveillance. Passive surveillance relies on reporting “as it
comes” from health facilities and laboratories, with no extra effort exerted to seek
information. Both modalities are integrated under the Philippine Integrated Disease
Surveillance and Response (PIDSR) system, which focuses on several important
diseases and syndromes that may cause outbreaks or are cause for concern and
immediate intervention from the public health authorities.
Another reporting system that is familiar to many public health practitioners is the
Field Health Service Information System (FHSIS), which focuses on the delivery of key
population-based services as well as the prevalence of common communicable and
noncommunicable diseases.
PIDSR
The PIDSR operates on both national and local levels to gather information about
diseases from health facilities and other key points in communities such as airports,
ports, and the media. This system focuses on 3 categorizations of diseases and
events:
1. Epidemic-prone diseases (dengue, leptospirosis, bacterial meningitis, etc.)
2. Diseases targeted for elimination or eradication (polio, measles,
rabies, malaria)
3. Other conditions of public health importance (adverse effects
following immunization, hand, foot and mouth diseases, etc.)
The PIDSR also develops standard case definitions for all the diseases and syndromes
under surveillance, to ensure proper triaging and consistency in reporting. These
include specific signs and symptoms, as well as laboratory tests for confirmation of
the disease. Without these criteria, it is not safe to say that a person or community
has a case of a disease.
There are two types of reporting under the PIDSR: mandatory reporting of
immediately notifiable diseases, and weekly reporting of notifiable diseases. Mandatory
reporting must be accomplished within 24 hours for immediate action, while weekly
reporting is collected from public health facilities and ports of entry such as airports
and seaports.xxxiii

FHSIS
The FHSIS is accomplished monthly in health facilities and is published annually by
the Department of Health. This report covers the delivery of key health services such
as family planning, maternal health services (including intrapartum and postpartum
care), care for newborns, childcare including vaccinations for children under 5,
nutrition services for children, oral health, infectious disease control programs for
specific illnesses such as TB and soil transmitted helminthiasis, non-communicable
disease control, and environmental health and sanitation.
The FHSIS also is a means for collecting data on mortality from all causes, and
morbidity due to specific infectious diseases that are also covered in the PIDSR, as
well as other illnesses such as sexually transmitted infections, unspecified diseases such
as skin conditions and fever of unknown origin, and non-communicable diseases such
as hypertension and chronic obstructive pulmonary disease. When put all together,
the FHSIS provides a high-level overview of the state of health service delivery
nationwide, and response efforts to threats such as infectious diseasesxxxiv.
Assessment Questions:
Which childhood communicable illness is correctly paired with
1.
the means to control it?
a. Lice infestation : vector control
b. Rubella : vaccination
c. Leptospirosis: handwashing
d. Dengue: social distancing
2. Which services can be given at the school health program?

a. Deworming
b. Vaccination for measles and rubella
c. BCG vaccination
d. Both a and b
3. What quality best differentiates active surveillance from

passive surveillance?
a. Active surveillance involves regular case-finding activities in the
community, while passive surveillance relies on reports “as they
come” from providers
b. Active surveillance takes place two times a year,
passive surveillance takes place once a year
c. Active surveillance relies on reports from all health care
providers, passive surveillance relies on community case
finding activities
d. Active surveillance takes place daily, passive surveillance takes
place over several months

SUPPLEMENTAL CONTENT: IMMEDIATELY

NOTIFIABLE DISEASES
Some of the diseases monitored by the PIDSR are considered as immediately notifiable.
Mandatory reporting of these diseases must be done within 24 hours by health
facilities or any community leaders who encounter suspect or confirmed cases. These
diseases include the following:
- Acute flaccid paralysis

- Adverse events following immunization (AEFI)
- Anthrax
- Human Avian Influenza
- Measles
- Meningooccal Disease
- Neonatal Tetanus
- Paralytic Shellfish Poisoning
- Rabies
- Severe Acute Respiratory Syndrome (SARS)
These diseases are singled out for one or several of these reasons:
 These are diseases that are already for eradication or elimination, and even
a single case of these signifies a breach in immunization and infectious disease
control efforts. Examples of these include acute flaccid paralysis (polio),
measles, neonatal tetanus, and rabies. A single case of these illnesses already
breaches the recommended case threshold, and constitutes an outbreak
 These are diseases that can quickly cause mortality and morbidity if left
unchecked in a population. Contact tracing and defining the source of
the outbreak is essential for these illnesses. Examples include
meningococcal disease, measles, and paralytic shellfish poisoning.
 These are diseases that have been cause for global concern due to previous
epidemics. These include human avian influenza and SARS
 Anthrax, a bacterial infection, is considered a disease of concern due to
its bioterrorism implications in other countries.
 Adverse events following immunization (AEFI) must be investigated as part of
overcoming vaccine hesitancy and quality control/monitoring of routine and
stepped-up vaccination efforts.
Although not presently included under the PIDSR listing, mandatory reporting for
COVID-19 suspect and confirmed cases follows the same principles as reporting for
other immediately notifiable diseases.
Mandatory reporting of immediately notifiable diseases may be done verbally by
phone or written through email. This must be followed up with a properly
accomplished PIDSR form with more details of the case. Initial reporting is done
simultaneously to

the city/municipal health office and epidemiology unit as well as the provincial
counterpart of this unit. A report is also submitted simultaneously to the National
Epidemiology Center, which will then transmit this to the World Health
Organization.²³
Figure 1. Simultaneous Reporting and Actions Regarding

Immediately Notifiable Diseases
Disease reporting unit/healthcare personnel/community

City/Municipal, Provincial Health Office
NEC
Gather data regarding disease (who, what, where, when, etc)
Report to city/municipal health office, provincial health office and NEC
Receives initial report and PIDSR form
Conducts further investigation on case details to form reco
Formulates
recommendation
Declares outbreak if necessary
Transmits data to World Health Org
Graphic generated by PSPHP module writers

Depending on the disease reported, the NEC and local health authorities may
recommend one or several of the following actions:
1. Issuance of health advisories to the general public/community of the affected
area, to advise them on the next steps of action and seeking medical care
2. Stepping up immunization efforts (as seen with polio and measles outbreaks)
3. Source control through prohibiting the selling of affected shellfish in cases
of paralytic shellfish poisoning, or livestock in the case of human avian
influenza.
4. Quarantine or isolation of an affected area
5. Escalation and further inquiry, especially in the case of AEFIs

GLOSSARY OF TERMS
Acute flaccid paralysis Sudden loss of muscle tone resulting in a patient
feeling floppiness and an inability to move the affected
limbs. This is not a disease, but a syndrome or
collection of symptoms that should be investigatedxxxv
Anthrax A serious infectious disease caused by Bacillus
anthracis, which may be acquired from handling
contaminated animal products. This results in skin
blisters, fever, chills, cough, and nausea and occasional
bloody vomitingxxxvi.
Elimination Stopping local transmission (zero local cases) of a given
disease in a location, but the pathogen may still be
present elsewhere in the worldxxxvii
Epidemic An increase of cases of a certain disease in a given area
that is above what is expected for that setting. This
varies depending on the disease entityxxxviii.
Eradication Total reduction of new cases of a given disease to zero,
throughout the worldxxxix.
Human papillomavirus Virus with several strains that are associated with
several diseases such as warts and cervical cancer
Paralytic shellfish A condition associated with consuming shellfish
poisoning affected by “red tide” arising from specific marine
algae. The algae produces a toxin that causes nausea,
vomiting, tingling sensation, muscle weakness, and
even difficulty in breathingxl
Vector Living organisms such as insects that can transmit
diseases from persons or other animals.xli
ANSWER KEY
Check-In Question: What preventive measures can be used against
respiratory infections?
a.Vaccination
b.Practicing proper cough etiquette
c.Wearing of face masks
d.All of the above
Correct Answer: D. All of these measures have been effective against
different airborne respiratory illnesses
Check-In Question: What is the primary means of preventing Measles,

Mumps, Rubella, and Chickenpox?
a.Social distancing
b.Providing isolation rooms
c.Vaccination
d.Anti viral medication
Correct answer: C. Vaccination ensures that these diseases will not be
readily transmitted in a community

Check-In Question: What is an effective way to control both dengue and

malaria in the community?
a.Destroying breeding places of mosquitoes
b.Use of mosquito nets and insect repellents
c.Both a and b
d.Taking anti-malarial drugs
Correct Answer: C. Both options disrupt the mosquitoes’ breeding cycle
and the transmission of the malaria parasite. Taking anti-malarial drugs as
prophylaxis can protect against malarial infection but does not get rid of
the vector
Check-In Question: What is a complication of tetanus?

a.Kidney failure
b.Sepsis
c.Encephalitis
d.Airway obstruction
Correct Answer: D. The muscle spasms associated with tetanus may affect
the muscles in the airway, leading to closure and possible asphyxiation
Check-In Question: What is a means to prevent both bacterial

conjunctivitis and skin infections among children?
a.Use of disinfectants on every surface
b.Handwashing
c.Use of topical antibiotics
d.None of the above
Correct Answer: B. Handwashing and proper hygiene reduce the
transmission of bacteria from infected persons to other
persons.
Check-In Question: What are among the long-term effects of heavy worm
infestation in children?
a.Intestinal obstruction
b.There are no long-term effects of helminthiasis
c.Malabsorption and malnutrition
d.Cough and colds
Correct answer: C. Untreated helminthiasis leads to difficulty in absorbing
nutrients essential to growth and development. Intestinal obstruction and
cough are associated with high worm burden or migration to the
respiratory system
Check-In Question: What is a role of the school clinic in managing

childhood infectious diseases?
a.Providing school-based deworming
b.Communicating with parents and the community about disease outbreaks in the

school
c.Providing urgent care for students and staff who fall ill within the school premises
d.All of the above
Correct answer: D. All of these are roles for school health providers
1.Which childhood communicable illness is correctly paired with

the means to control it?
a.Lice infestation : vector control
b.Rubella : vaccination
c.Leptospirosis: handwashing
d.Dengue: social distancing
Correct answer: B. Rubella is very controllable by vaccination. Lice are
not transmitted by vectors. Leptospirosis is best controlled by reducing
exposure to contaminated flood water. Dengue is controlled by vector
control, not by social distancing
2. Which services can be given at the school health program?

a.Deworming
b.Vaccination for measles and rubella
c. BCG vaccination
d.Both a and b
Correct answer: D. BCG vaccination is not routinely offered in school-
based immunization
3. What quality best differentiates active surveillance from

passive surveillance?
a.Active surveillance involves regular case-finding activities in the community,
while passive surveillance relies on reports “as they come” from providers
b.Active surveillance takes place two times a year, passive surveillance takes
place once a year
c.Active surveillance relies on reports from all health care providers,
passive surveillance relies on community case finding activities
d.Active surveillance takes place daily, passive surveillance takes place over
several months
Correct answer: A. Active surveillance relies on case-finding activities
regardless of time interval, presence of disease, or number of persons
reporting. Passive surveillance relies on reports from health providers
who may see patients with certain diseases in the clinical setting, but do
not actively seek out cases in the community setting
REFERENCES
i
Philippine Statistics Authority. 16 March 2021. “Causes of Deaths in the Philippines
(Preliminary): January to December 2020.” Retrieved from: https://psa.gov.ph/content/causes-
deaths-philippines-preliminary-january-december-2020

ii
Philippine Society For Pediatric Gastroenterology, Hepatology And Nutrition. 2020.
“Guidelines For Health Care Professionals On The Treatment Of Acute Gastroenteritis With
No Signs Of Dehydration.” Retrieved from: https://pps.org.ph/wp-
content/uploads/2020/04/GUIDELINES-FOR-HEALTH-CARE-PROFESSIONALS-ON-THE-
TREATMENT-OF-ACUTE-GASTROENTERITIS-WITH-NO-SIGNS-OF-DEHYDRATION.pdf
iii
Philippine Society For Pediatric Gastroenterology, Hepatology And Nutrition. 2020.
“Guidelines For Health Care Professionals On The Treatment Of Acute Gastroenteritis With
No Signs Of Dehydration.” Retrieved from: https://pps.org.ph/wp-
content/uploads/2020/04/GUIDELINES-FOR-HEALTH-CARE-PROFESSIONALS-ON-THE-
TREATMENT-OF-ACUTE-GASTROENTERITIS-WITH-NO-SIGNS-OF-DEHYDRATION.pdf
iv
Philippine Statistics Authority. 16 March 2021. “Causes of Deaths in the Philippines
(Preliminary): January to December 2020.” Retrieved from: https://psa.gov.ph/content/causes-
deaths-philippines-preliminary-january-december-2020
v
World Health Organization. (2019). “Pneumonia”. Retrieved from:
https://www.who.int/news-room/fact-sheets/detail/pneumonia
vi
Meneghetti A. 2020 Sep 11. “Upper Respiratory Tract Infection.” Retrieved from:
https://emedicine.medscape.com/article/302460-overview
vii
Centers for Disease Control and Prevention. ”Tuberculosis.” Retrieved from:
https://www.cdc.gov/tb/default.htm
viii
Department of Health – National Tuberculosis Control Program. (2020). Manual of
Procedures 6th Edition.
ix
World Health Organization. “Rubella.” Retrieved from: https://www.who.int/news-
room/fact-sheets/detail/rubella
x
World Health Organization. “Measles.” Retrieved from: https://www.who.int/news-
room/fact-sheets/detail/measles
xi
World Health Organization. “Mumps.” Retrieved from: https://www.who.int/teams/health-
product-policy-and-standards/standards-and-specifications/vaccine-
standardization/mumps#:~:text=Mumps%20is%20an%20acute%20disease,respiratory%20tract
%20of%20infected%20individuals.
xii
Centers for Disease Control. “Chickenpox.” Retrieved from:
https://www.cdc.gov/chickenpox/index.html
xiii
World Health Organization. 19 May 2021. “Dengue and Severe Dengue.” Retrieved from:
https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
xiv
Centers for Disease Control and Prevention. “About Malaria -- Frequently Asked Questions
(FAQs).” Retrieved from: https://www.cdc.gov/malaria/about/faqs.html
xv
World Health Organization. 2021. “Malaria”. Retrieved from: https://www.who.int/news-
room/fact-sheets/detail/malaria
xvi
Department of Health. (2019). “PHL MALARIA-FREE BY 2030 – DOH.” Retrieved from:
https://doh.gov.ph/press-release/Phl-Malaria-Free-by-2030-DOH
xvii
Department of Health. “Leptospirosis.” Retrieved from: https://doh.gov.ph/Health-
Advisory/Leptospirosis
xviii
Centers for Disease Control and Prevention. “Tetanus”. Retrieved from:
https://www.cdc.gov/tetanus/about/symptoms-complications.html
xix
UNICEF. 29 Nov 2017. “Philippines eliminates Maternal and Neonatal Tetanus.” Retrieved
from: https://www.unicef.org/philippines/press-releases/philippines-eliminates-maternal-and-
neonatal-tetanus
xx
Centers for Disease Control and Prevention. “Impetigo.” Retrieved from:

https://www.cdc.gov/groupastrep/diseases-public/impetigo.html
xxi
The Royal Children’s Hospital, Melbourne. “Conjunctivitis.” Retrieved from:
https://www.rch.org.au/kidsinfo/fact_sheets/Conjunctivitis/
xxii
Centers for Disease Control and Prevention. “Head Lice.” Retrieved from:
https://www.cdc.gov/parasites/lice/head/index.html
xxiii
Department of Health. “Soil-Transmitted Helminthiasis And Parasitoses.” Retrieved from:
https://doh.gov.ph/Health-Advisory/Soil-Transmitted-Helminthiasis-and-Parasitoses
xxiv
Corvino DFD, Horrall S. “Ascariasis.” Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK430796/
xxv
Centers for Disease Control and Prevention.” Hookworm (Intestinal).” Retrieved from:
https://www.cdc.gov/dpdx/hookworm/index.html
xxvi
Department of Health. “Doh Conducts National Deworming Month To Reinforce Prevention
And Control Of Soil-Transmitted Helminths.” Retrieved from: https://doh.gov.ph/node/10545
xxvii
Department of Health. “WASH in Schools Three Star Approach”. Retrieved from:
https://www.susana.org/en/knowledge-hub/resources-and-publications/library/details/1839#
xxviii
Department of Education. “Advisory on the Implementation of School-Based Immunization
Program for SY 2021-2022. Retrieved from: https://depedcaloocan.com/dm-no-329-s-2021-
advisory-on-the-implementation-of-school-based-immunization-program-for-s-y-2021-2022/
xxix
Department of Education. “Implementation of the Medical-Nursing Services (Weekly Iron
Folic Acid (WIFA)), Deworming and School-Based Immunization (SBI) Program for SY 2020-
2021. Retrieved from: https://www.depedsagay.com/division_memo/2020/oct/memo272.pdf
xxx
Department of Education. “Advisory on the Implementation of School-Based Immunization
Program for SY 2021-2022. Retrieved from: https://depedcaloocan.com/dm-no-329-s-2021-
advisory-on-the-implementation-of-school-based-immunization-program-for-s-y-2021-2022/
xxxi
Department of Education. “Implementation of the Medical-Nursing Services (Weekly Iron
Folic Acid (WIFA)), Deworming and School-Based Immunization (SBI) Program for SY 2020-
2021. Retrieved from: https://www.depedsagay.com/division_memo/2020/oct/memo272.pdf
xxxii
Michigan Department of Education and Michigan Department of Health and Human
Services, Divisions of Communicable Disease & Immunization. 2020. “Managing
Communicable Diseases in Schools.” Retrieved from: https://www.deped.gov.ph/wp-
content/uploads/2019/07/TSA-WinS-Booklet-Deworming-PRINT-
20181031.pdfhttps://www.michigan.gov/documents/mde/Final_Managing_Communicable_Di
seases_in_Schools_7.2020_699432_7.pdf
xxxiii
National Epidemiology Center- Department of Health. April 2014. “Manual of Procedures
for the Philippine Integrated Disease Surveillance and Response.” Retrieved from:
https://doh.gov.ph/sites/default/files/publications/PIDSRMOP3ED_VOL1_2014.pdf
xxxiv
Department of Health. “FHSIS 2020.” Retrieved from:
https://doh.gov.ph/sites/default/files/publications/FHSIS%202020%20Annual%20Report.pdf
xxxv
National Institutes of Health. “Philippine Acute Flaccid Paralysis Program: Manual of
Operations.” Retrieved from: https://nih.upm.edu.ph/sites/default/files/Philippine%20Acute
%20Flaccid%20Paralysis%20Pro gram.pdf
xxxvi
Centers for Disease Control and Prevention. “Anthrax”. Retrieved from:
https://www.cdc.gov/anthrax/basics/index.html#:~:text=Anthrax%20is%20a%20serious%20inf ectious,animals
%20or%20contaminated%20animal%20products.
xxxvii
Department of Communications, Penn Medicine. “Global Health 101: Control, Eradication,
and Elimination, What’s the Difference?” Retrieved from:
https://www.pennmedicine.org/news/news-blog/2016/july/global-health-101-control-erad
xxxviii
Centers for Disease Control and Prevention. “Section 11: Epidemic Disease Occurrence.”
Retrieved from: https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html
xxxix
Department of Communications, Penn Medicine. “Global Health 101: Control, Eradication,

and Elimination, What’s the Difference?” Retrieved from:

https://www.pennmedicine.org/news/news-blog/2016/july/global-health-101-control-erad
xl
Feldman, M. “Paralytic Shellfish Poisoning” Retrieved from:
https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-
science/paralytic-shellfish-poisoning
xli
World Health Organization. “Vector Borne Diseases” Retrieved from:
https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases


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Public Health and Education Data Analytics Online Course

Part 1: Introduction to Public Health In Schools

Module 4: Public Health in Schools

Module 4: Infectious Disease

4.1 What are some of the common infectious diseases that

Module 4: Infectious Disease Management and 1

Module 4: Public Health in Schools

In most cases, diarrhea is self-limited, and prevention of dehydration is the

2. Acute respiratory tract infections (upper and lower)

Module 4: Infectious Disease Management and 2

Module 4: Public Health in Schools

Tuberculosis is treated with a combination of several medications taken over a period

Check-In Question: What preventive measures can be used against

Module 4: Infectious Disease Management and 3

Module 4: Public Health in Schools

4. Measles and Rubella

Module 4: Infectious Disease Management and 4

Module 4: Public Health in Schools

Figure V: Child with Mumps

Chickenpox is also preventable with a vaccine that can be administered beginning 1

Module 4: Infectious Disease Management and 5

Module 4: Public Health in Schools

Check-In Question: What is the primary means of preventing Measles,

Module 4: Infectious Disease Management and 6

Module 4: Public Health in Schools

Module 4: Infectious Disease Management and 7

Module 4: Public Health in Schools

Check-In Question: What is an effective way to control both dengue and

Leptospirosis is treated with antibiotics taken with a doctor’s supervision. Prevention

Module 4: Infectious Disease Management and 8

Module 4: Public Health in Schools

prevention is wearing the appropriate protective clothing and footwear if such

Check-In Question: What is a complication of tetanus?

11. Skin Infections

Module 4: Infectious Disease Management and 9

Module 4: Public Health in Schools

Skin infections should be given the appropriate topical treatments, depending on

Module 4: Infectious Disease Management and 1

Module 4: Public Health in Schools

A pediatrician or ophthalmologist can best prescribe a remedy for conjunctivitis, and

Check-In Question: What is a means to prevent both bacterial

13. Pediculosis capitis/ head lice infestation

14. Soil Transmitted Helminthiasis (ascariasis, trichuriasis, hookworms)

Module 4: Infectious Disease Management and 1

Module 4: Public Health in Schools

Module 4: Infectious Disease Management and 1

Module 4: Public Health in Schools

4.2 What is the role of the school clinic in

Age/Demographic Group Vaccines to be Administered

All 6-7 years old Measles-Rubella (MR)

All 12-13 years old Measles-Rubella (MR)

Female learners enrolled in Grade 4 OR HPV vaccine

Check-In Question: What is a role of the school clinic in managing

Module 4: Infectious Disease Management and 1

Module 4: Public Health in Schools

4.3 What are the different diseases surveillance

Module 4: Infectious Disease Management and 1

Module 4: Public Health in Schools

2. Which services can be given at the school health program?

3. What quality best differentiates active surveillance from

Module 4: Infectious Disease Management and 1

Module 4: Public Health in Schools

SUPPLEMENTAL CONTENT: IMMEDIATELY