E Textbook 23

TE
23
Personal health and
infectious diseases
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bioccfc23.e
In 2003, a new coronavirus caused the severe acute respiratory

syndrome (SARS) epidemic which killed 774 people worldwide.
Links to prior knowledge Chapter preview

In Junior Science, you learned that most
infectious diseases are caused by 23.1 The meaning of health
infection of microorganisms (Topic 12.3). 23.2 Concept of disease
This chapter explores the meaning of
health and the concept of disease. You
23.3 Causes of infectious diseases
will learn about the causes of infectious 23.4 How infectious diseases are
diseases, and how they are transmitted transmitted
and treated. What you know about the
structure of bacteria (Chapter 3) will
 23.5 Treatments for infectious
diseases
help you understand the actions of
antibiotics on disease-causing bacteria.
TE
23 Personal health and infectious diseases
Major disease outbreaks in Hong Kong
Compared with a few decades ago, Hong Kong people now suffer less from infectious
diseases. However, disease outbreaks can happen at anytime, as new disease-causing
agents emerge from time to time and easily spread within our dense population.
The timeline below shows some major outbreaks of infectious diseases in Hong Kong.
Picture depicting a Pupils washing

scene at Tai Ping Shan their hands
Street during the plague during the SARS
outbreak
1894 1937 1967 2003

Plague: Cholera: Measles: SARS:
2547 deaths 1082 deaths 878 deaths 299 deaths
1938
Smallpox:
1986 deaths
Memorial stone of the

Tung Wah Smallpox
Hospital, a major facility of
treating and preventing
smallpox at the time
Think about …
1. What are infectious diseases?
2. How do infectious diseases spread?
3. What is the general trend of the number of deaths in the outbreaks of infectious diseases in
Hong Kong over the past century? Can you suggest explanations for the trend?
Answer
(Refer to p.A1 for answers.)
plague 鼠疫 measles 麻疹
23- 2 cholera 霍亂 SARS (severe acute respiratory syndrome)
smallpox 天花嚴重急性呼吸系統綜合症
Learning objective 23.1 The meaning of health

Recognize the meaning of health
To many people, health means not being sick. But according to

the World Health Organization (WHO), health is ‘a state of complete
physical, mental and social well-being, and not merely the
absence of disease’.
There are three different aspects of health: physical health, mental

health and social health (Figure 23.1). A person is considered as
healthy if he or she attains well-being in all three aspects.
Test yourself
Suggest some ways to improve
Physical well-being
your own well-being in these
- The person’s body
three aspects of health.
Physical functions properly.
(Refer to p.A1 for answers.) Answer
health - The person is free from
disease and injury.
Social well-being Mental well-being

- The person has good Health - The person can cope
inter-personal with stress in life.
relationships. Social Mental - The person can work or
- The person respects health health study productively and
and gets along well realizes his or her own
with others. potential.
Figure 23.1 The three aspects of health
Key point
Health is a state of complete physical, mental and social well-being, and
not merely the absence of disease.
Learning objective 23.2 Concept of disease

• Understand the concept of
disease
Even though health is not merely the absence of diseases, our
• Distinguish between infectious
and non-infectious diseases physical health will be affected if we suffer from a disease.
A disease is an abnormal condition that affects the body of an

organism. It is indicated by signs and symptoms (Figure 23.2 on
the next page).
health 健康 sign 病徵
disease 疾病 symptom 症狀 23- 3
All answers
A sign is an objective evidence of the presence of a disease which

can be observed or measured by the patient and other people.
Fever and cough are examples of signs. In contrast, a symptom is
a sensation (e.g. headache) or change in body function experienced
by the patient only. To put it simply, symptoms are subjective.
Test yourself
a b
Give examples of signs and
symptoms of food poisoning.
Figure 23.2 a Fever and b headache are a sign and a symptom of

influenza respectively.
Diseases can be classified into two broad types: infectious diseases

and non-infectious diseases.
Infectious diseases are diseases that can be spread from one

person to another. They are caused by pathogens (disease-
causing agents). Cholera and influenza are examples of
infectious diseases.
Non-infectious diseases are diseases that cannot be spread

from person to person. They can be caused by biological factors
(e.g. ageing and heredity), environmental factors and
behavioural factors. Diabetes, cancers and cardiovascular
diseases are examples of non-infectious diseases.
Key point
Diseases are abnormal conditions that affect the body of an organism. They
can be classified into two broad types: infectious diseases and non-infectious
diseases.
Checkpoint
Which of the following is an infectious disease?
A. anaemia due to iron deficiency
B. hepatitis B caused by the sharing of needles
C. lung cancer caused by smoking
D. diabetes mellitus due to heredity
infectious disease 傳染病

23- 4 non-infectious disease 非傳染病
pathogen 病原體
TE
Learning objective 23.3 Causes of infectious diseases

Learn some common infectious
diseases and their causative
agents Infectious diseases are caused by pathogens. Most pathogens are
microorganisms, which include viruses, bacteria, protists and
Remember this fungi. After getting into our body, they cause diseases in various
ways.
Not all pathogens are
microorganisms. Some pathogens
are large parasites. For example,
liver fluke disease is caused by a
A. Viruses
parasitic worm.
Viruses are non-cellular entities that consist of a protein coat
surrounding genetic material (DNA or RNA). Some viruses have
an envelope outside the protein coat (Figure 23.4).
protein coat
nucleic acid
envelope
surface protein
x250,000
Figure 23.3 An influenza virus Figure 23.4 The basic structure of a virus
Viruses do not carry out metabolism and can only reproduce or

multiply inside living cells. After a virus gets into a living cell (the
host cell), the virus takes over the cell’s metabolism to produce
new virus particles. The newly produced viruses will then be
released to infect more cells (Figure 23.5).
Most viruses cause disease by interfering with the cell functions

(e.g. synthesis of nucleic acids or proteins) or damaging the cell
membrane of the host cell.
virus 病毒 fungus 真菌 liver fluke disease 肝吸蟲病

bacterium 細菌 23- 5
protist 原生生物
Many diseases in humans are caused by viruses. Some examples of

viral diseases are influenza (commonly known as flu), hepatitis B,
dengue fever, acquired immunodeficiency syndrome (AIDS),
Remember this
measles and severe acute respiratory syndrome (SARS).
AIDS is the late stage of human
immunodeficiency virus (HIV)
infection. HIV damages certain
white blood cells and weakens
the body’s immune system.
HIV
x500,000 x200,000
Figure 23.5 Newly synthesized HIV Figure 23.6 Coronavirus that causes
budding out of an infected human SARS
white blood cell
B. Bacteria
Link it
Bacteria reproduce quickly under favourable conditions (e.g. with
The basic structure of bacteria was
warmth and moisture), and the human body can provide these
discussed in Chapter 3.
conditions. Some bacteria are pathogenic. They produce enzymes
or toxins that can damage cells or interfere with their normal
functioning. For example, the bacterium causing cholera produces
toxins that irritate the intestines, causing severe diarrhoea.
Cholera, tetanus and tuberculosis are examples of diseases caused

by bacteria.
Remember this
Most types of bacteria are
harmless to humans and some are
even beneficial. Only a very small
percentage of bacteria are
pathogenic to humans.
x5000 x20,000
Figure 23.7 Vibrio cholerae which Figure 23.8 Mycobacterium
causes cholera tuberculosis which causes
tuberculosis
dengue fever 登革熱 human immunodeficiency virus (HIV) tuberculosis 結核病

23- 6 acquired immune deficiency syndromes (AIDS) 人類免疫力缺乏病毒 Vibrio cholerae 霍亂弧菌
後天免疫力缺乏症 (愛滋病 ) tetanus 破傷風 Mycobacterium tuberculosis 結核桿菌
C. Protists
Test yourself
A number of protists are parasites of humans. They live inside a
Bacteria are prokaryotic cells while
host and cause diseases. For example, several species of the
protists are eukaryotic cells. What
are the differences in cellular protozoan Plasmodium can infect humans and cause malaria
structures between bacteria and (Figure 23.9).
protists?
Answer
(Refer to p.A1 for answers.)
Upon entering the bloodstream, Plasmodium first invades and
reproduces in the liver cells, and then in the red blood cells (Figure
23.10). The infected red blood cells eventually burst, releasing a
large number of mature parasites to infect other cells. Plasmodium
also secretes toxins that cause fever, sweating and shivering in the
infected person.
Plasmodium
red blood cell
Plasmodium
red
blood
cell
x400 x3200
Figure 23.9 Photomicrograph of a Figure 23.10 Red blood cells
blood smear containing Plasmodium invaded by Plasmodium
D. Fungi
Link it
Some pathogenic fungi grow on the surfaces of the human body.
The structure of fungi will be They secrete digestive enzymes onto the human tissues and then
discussed in Chapter 29.
absorb the products of digestion for growth. The fungus Trichophyton
rubrum can grow on the skin and nails, causing athlete’s foot and
Remember this onychomycosis.
Some fungal infections affect
mucous membranes. For example,
the fungus Candida albicans
frequently infects the lining of the
mouth, oesophagus and vagina.
In people with a weakened
immune system, the fungus may
even invade internal organs, e.g.
the lungs and the brain.
Figure 23.11 Athlete's foot causes a Figure 23.12 A culture of athlete’s

rash on the foot. foot fungus
Plasmodium 瘧原蟲屬 athlete’s foot 腳癬

malaria 瘧疾 onychomycosis 甲癬 (俗稱灰甲) 23- 7
Trichophyton rubrum 紅色毛癬菌 Candida albicans 白色念珠菌
TE
Taking it further
Prions
An additional type of pathogens called prions have been discovered. They are
smaller than viruses. They do not contain genetic materials and are composed
of proteins only. Mad cow disease in cattle and Creutzfeldt–Jakob disease
(CJD) in humans are caused by prions.
Prions are misfolded versions of a harmless protein normally found in the
central nervous system of mammals. They can induce normal protein molecules
to change their shapes and become prions like themselves. As prions continue
to accumulate in the brain, the neurones are destroyed, leaving holes in the
brain tissue. As a result, the brain tissue becomes spongy.
holes
x100
 Brain tissue infected with prions has a
sponge-like appearance.
Prions appear to be transmitted by eating contaminated food or by organ

transplant from an infected donor. Currently, there is no treatment for
diseases caused by prions.
Practical 23.1 Examination of some pathogens
Procedure Video
Practical 23.1
1. Examine prepared slides, photomicrographs or live cell images of some
e-aristo.hk/r/
pathogens provided by the teacher. bioccpv2301.e
2. Identify the structures of each pathogen. Draw a labelled diagram of each

of the pathogens to show the features observed.
3. Try to classify the pathogens into different groups of microorganisms: viruses, bacteria, fungi or
protists.
prion 病原性蛋白顆粒
23- 8 mad cow disease 瘋牛症
Creutzfeldt–Jakob disease (CJD) 克雅二氏症
All answers TE
Discovering science
Koch’s postulates—identifying the causative agent of a disease
It was not until the late 19th century that the role of microorganisms in infectious diseases
was understood. In 1882, German doctor Robert Koch (1843‒1910) proposed four criteria
for determining whether a particular microorganism is the cause of a specific infectious
disease. These criteria are now known as Koch’s postulates, and have helped scientists in
identifying the pathogen of many diseases (e.g. gastric ulcer and SARS).
The four postulates are shown below:
diseased animal healthy animal

Robert Koch

Postulate 1: The suspected
pathogen must be found in
all animals suffering from the red blood
disease, but not in healthy cell observe blood / red blood cell
animals.
tissue under
suspected microscope
pathogen
streak agar plate
Postulate 2: The pathogen
with sample from
must be isolated from the
either diseased or
diseased animal and grown
healthy animal
in pure culture.
colonies of
suspected introduce the
pathogen suspected
pathogen into a
Postulate 3: The cultured healthy animal
pathogen must cause the
same disease when introduced
diseased animal
into a healthy animal.
take blood or
tissue sample and
observe under
microscope
Postulate 4: The same suspected
pathogen must be isolated pathogen
from the infected animal. Animation
laboratory culture How scientists
transformed the
way we think
pure culture about diseases
of the same e-aristo.hk/r/
pathogen bioccani2301.e
Demonstration of the Koch’s postulates


Questions for discussion
1. How did the technological development of microscopes (including electron microscopes) help in identifying
pathogens of different diseases?
2. Which of Koch’s postulate must not be applied in the study of infectious diseases that occur in humans only?
Explain your answer.
3. Discuss how Koch’s postulates contribute to the control and treatment of infectious diseases.
gastric ulcer 胃潰瘍

23- 9
TE All answers
Key point
There are four main groups of pathogens: viruses, bacteria, fungi and
protists. Each group has its specific features and causes diseases in different
ways.
Checkpoint
Which of the following combinations correctly matches the disease and
the type of pathogen?
Disease Type of pathogen
A. cholera virus
B. malaria fungus
C. tetanus bacterium
D. athlete’s foot protist
23.4 How infectious diseases are

Learning objective transmitted
• Understand how infectious
diseases are transmitted
Infectious diseases are diseases that can spread from one person
• Discuss how to reduce the
to another, but how do they spread?
spread of some common
infectious diseases
A. By contact
Pathogens can be transmitted from one person to another by direct
physical contact (e.g. touching, kissing or sexual intercourse), or
by sharing personal items (e.g. towels, combs and clothes). The
pathogens may enter our bodies through wounds on the skin, or
when we rub our eyes or nose with our hands, which have contacted
the pathogen.
Surf the net Athlete’s foot, chickenpox, hand, foot and mouth disease, and some
Visit the website below to learn sexually transmitted diseases (e.g. genital herpes) are examples of
about various kinds of infectious diseases transmitted by direct contact.
diseases.
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bioccstn2301.e
chickenpox 水痘
23- 10 hand, foot and mouth disease 手足口病
genital herpes 生殖器疱疹
To reduce the risk of contact transmission, we should take the

following preventive measures:
Avoid direct physical contact with infected persons. Wear

protective gloves and clothing when taking care of infected
people.
Do not share personal items (e.g. towels, combs or clothes).
Maintain good personal hygiene (e.g. washing hands after

contact with an infected person).
B. By droplets and air

Most respiratory infections such as the common cold, influenza and
SARS are transmitted by droplets. When an infected person talks,
coughs or sneezes, tiny droplets of mucus and saliva containing
pathogens are sent out into the air (Figure 23.13). The droplets may
also land on and contaminate nearby surfaces. The pathogens are
transmitted when these droplets reach the mucous membranes of
Figure 23.13 Thousands of
the nose, eyes and mouth of another person.
droplets are released in a
sneeze. Some pathogens (e.g. viruses and fungal spores) are so tiny that
they can travel long distances and stay suspended in the air for a
long time. For example, measles virus remains active in the air for
Remember this
hours. Chickenpox and tuberculosis are also transmitted by air.
Some infectious diseases have
more than one mode of To reduce the risk of droplet and air-borne transmission, we should
transmission. For example,
chickenpox can be transmitted
take the following preventive measures:
by contact and by air.
Wear a face mask if infected or when in close contact with
infected people.
Cover our mouth and nose with tissue paper or a handkerchief

when we sneeze or cough. Wash hands with liquid soap or rub
hands with disinfectants (e.g. alcohol-based handrub) afterwards.
Avoid going to crowded and poorly ventilated public places

Test yourself
when an air-borne disease is prevalent.
Suggest why crowded and poorly
ventilated places often favour the Maintain good indoor ventilation so that droplets are blown
spread of air-borne diseases.
away by fresh air.
Frequently clean and disinfect surfaces which may be touched

in public areas, such as door handles, lift buttons, handrails, etc.
droplet 飛沫
23- 11
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C. By food and water

If we ingest food or drink water contaminated with pathogens, we
may become infected. Food and water may be contaminated in
various ways, as shown in Figure 23.14.
a b c
Eggs, meat or other food products If an infected person handles food If sewage drains into water supply
from an infected animal may carry with unwashed hands after going to systems without proper treatment,
pathogens. the toilet, the food may be faeces containing pathogens may
contaminated by pathogens. contaminate drinking water.
Figure 23.14 Ways in which food and water may be contaminated
Diseases transmitted by food or water are called food-borne

diseases and water-borne diseases respectively. Examples include
cholera, gastroenteritis, amoebic dysentery and hepatitis A.
To reduce the risk of food-borne and water-borne diseases, we

should take the following preventive measures:
Wash hands with liquid soap after going to the toilet and
before handling food.
Adopt good hygiene practices in food handling (e.g. use

separate cooking utensils for handling raw and cooked food).
Buy food from clean and reliable shops or markets.
Cook food and boil drinking water thoroughly.
Refrigerate food at the right temperature. Maintain the

Figure 23.15 Water should be
boiled thoroughly before refrigerator at or below 4 °C and the freezer at or below -18 °C.
drinking.
Dispose of faeces and sewage properly.
gastroenteritis 胃腸炎
23- 12 amoebic dysentery 阿米巴痢疾
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D. By body fluids
Some pathogens are present in body fluids (e.g. blood, semen and
vaginal secretion) of infected persons. The body fluid of an infected
person may enter the body of another person through wounds, by
sharing of needles or syringes, or during sexual intercourse.
Remember this
AIDS, hepatitis B and syphilis are examples of diseases
Outside a human host, the virus transmitted by body fluids.
which causes AIDS (HIV) cannot
reproduce and soon disintegrates.
To reduce the spread of diseases by body fluid transmission, we
It cannot be spread by hugging,
shaking hands, sharing toilets or should take the following preventive measures:
sharing dishes.
Wear gloves when treating wounds or handling blood.
Avoid sharing toothbrushes, razors and other objects that may

be contaminated with blood.
Practise safe sex and wear a condom during sexual contact.
Screen blood before transfusion.
Never share injection syringe and needles.
STSE connections
Needle exchange programme
In the United States and some European countries,
free clean needles and syringes are available to
people who inject drugs. These needles and
syringes are given out by needle exchange
programme funded by the government. Drug
users are required to return their used needles
and syringes in exchange for new sterile ones.
Researches have found out that this type of
programme is a cost-effective way to reduce the
spread of AIDS and hepatitis B among drug
addicts and thus to the wider community. Drug addicts who share

needles with others are at
However, there have been concerns that the
high risks of getting AIDS
programme may encourage drug use, or increase and hepatitis B.
the number of needles that are disposed of
improperly.
syphilis 梅毒
23- 13
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E. By vectors
A vector is an organism that carries pathogens from one host to
another. Cockroaches, houseflies and mosquitoes are some
common vectors of infectious diseases.
Cockroaches and houseflies feed on faeces in sewers or food waste.

Their body parts may pick up the pathogens that cause cholera or
other diseases. If they land on and touch food items, the food will
become contaminated with pathogens.
a b c
Cockroaches may carry pathogens to Houseflies can transmit cholera and The mosquito Aedes albopictus can
our food. typhoid fever. transmit dengue fever.
Figure 23.16 Some common vectors of diseases
Remember this Mosquitoes are the vectors for malaria, dengue fever, Japanese
Only female mosquitoes bite and encephalitis and Zika fever. The mosquito first bites an infected
suck blood from animals to obtain person and takes up the pathogens. When it bites a healthy person,
the necessary proteins for their
eggs. Male mosquitoes survive by the pathogens are transmitted to that person.
feeding on nectar and fruit juices.
To reduce the spread of vector-borne diseases, we should take the
following preventive measures:
Do not leave food unattended. Place food in covered containers

so that cockroaches and houseflies cannot reach the food.
Kill vectors, e.g. by spraying pesticides or larvicidal oil around

mosquito's habitats.
Remove the potential breeding grounds of vectors, e.g. clear

standing water which is a common breeding site for mosquitoes.
Avoid mosquito bites, e.g. wear light-coloured long-sleeved

clothing, apply insect repellents and use mosquito nets or
screens.
vector 媒介 typhoid fever 傷寒 Zika fever 寨卡熱

23- 14 Aedes albopictus 白紋伊蚊
Japanese encephalitis 日本腦炎
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STEM activity 23.1 STSE connections

Making a mosquito trap The ovitrap index
You can make a mosquito To monitor the population of mosquitoes, especially
trap by using simple the Aedes mosquitoes which can transmit dengue
materials, such as plastic fever and Zika virus, the Food and Environmental
bottles, yeast and brown Hygiene Department (FEHD) set ovitraps in 52
sugar. selected areas in Hong Kong. The ovitraps attract
mosquitoes to lay eggs inside. The FEHD uses the
e-aristo.hk/r/ percentage of ovitraps with mosquito eggs to
bioccstem.e calculate the ovitrap index. It indicates the
extensiveness of breeding of mosquitoes in an area.
The ovitrap index is divided into four levels. When
An ovitrap

the index of an area reaches a high level (e.g. level 4),
the FEHD will boost mosquito control measures in
that area. People living there are also advised to take
anti-mosquito measures.
A mosquito trap
 STSE connections
'The mosquito factory'
Many countries are stepping up their efforts to kill mosquitoes in order to
control mosquito-borne diseases. In Guangzhou, a team of scientists in Sun
Yat-sen University are actually breeding 20 million male mosquitoes.
The scientists inject mosquito eggs with Wolbachia bacteria. When the
bacteria-infected mosquitoes are released and mate with females in the wild,
the females produce infertile eggs. The project’s aim is to control the mosquito
population, and prevent the spread of dengue and Zika fever.
 Large numbers of mosquitoes

are now being bred in laboratory
to control dengue fever.
In a trial, 500,000 Wolbachia-infected male mosquitoes were released onto a

small island in March 2015. Three months later, the mosquito population on
the island had dropped by half.
Early research shows that Wolbachia is not harmful to humans or the
environment—but since mosquitoes are prey for birds and fish, the long-term
effects on the ecosystem are unclear.
ovitrap index 誘蚊產卵器指數

Wolbachia 沃爾巴克氏菌 23- 15
TE All answers
Key point
Infectious diseases are transmitted from person to person through the
following routes:
• By contact
• By droplets and air
• By food and water
• By body fluids
• By vectors
Checkpoint
Which of the following combinations correctly matches the disease and
its way of transmission?
Disease Way of transmission
A. malaria by contact
B. dengue fever by water
C. athlete’s foot by air
D. cholera by vectors
 23.5 Treatments for infectious

Learning objective diseases
• Recognize various ways to treat
infectious diseases
Nowadays, there are various ways to treat infectious diseases. As
• Learn how antibiotics act
infectious diseases are caused by pathogens, most of these
• Discuss the consequences of
indiscriminate use of antibiotics
treatments kill the pathogens or prevent their growth with drugs.
Antibiotics and sulpha drugs are two types of drugs used to treat
bacterial infections and diseases.
A. Antibiotics
Antibiotics are chemicals produced by certain bacteria and fungi
which can kill or inhibit the growth of other competing
microorganisms. The first known antibiotic is penicillin produced
by the fungus Penicillium. It was discovered in 1928 by the British
scientist Alexander Fleming (1881–1955), and was then isolated
and used to treat infections during World War II.
antibiotic 抗生素 Penicillium 青黴屬

23- 16 penicillin 青黴素
All answers TE
Since the discovery of penicillin, many other antibiotics have been

found. As scientists learn more about the chemical nature of
antibiotics, they have begun to produce more and more synthetic
antibiotics. Antibiotics are now used to treat various bacterial
infections and diseases.
Discovering science
The discovery and development of penicillin
The discovery of penicillin happened accidentally. In 1928, Alexander Fleming cultured the bacterium Staphylococcus
on agar plates, and some of the plates were contaminated by a green mould. He noticed on one plate that there was
a bacteria-free zone around the mould. He proposed that the mould produced a substance which could kill or slow
down the growth of Staphylococcus.
Fleming then carried out a series of experiments. He isolated the mould, cultured it and extracted some liquid from
it. His further experiments showed that the mould liquid extract could kill bacteria. Fleming identified the mould as
a fungus of the genus Penicillium and thus named the antibacterial substance penicillin. However, he could not
isolate pure penicillin from the mould extract.
bacterial colonies
little bacterial growth

near the fungus
the fungus Penicillium
Alexander Fleming
 Fleming’s contaminated agar plate

Although Fleming published the results in a medical journal, his discovery went unnoticed for ten years. In 1939,
Howard Florey (1898–1968) and Ernst Chain (1906–1979) developed a method to purify penicillin and used it to treat
bacterial infections in mice and humans. Later, they developed methods to manufacture penicillin in large quantities.
Since then, penicillin has been widely used as an antibacterial drug and saved millions of lives during World War II.
In 1945, Fleming, Chain and Florey were jointly awarded the Nobel Prize in Physiology or Medicine for the discovery
of penicillin and its effect of treating various infectious diseases.
1. What was Fleming’s hypothesis before he experimented with the mould liquid extract?
2. Elaborate on how the following aspects of the nature of science are demonstrated in the discovery and
development of penicillin:
(a) Science is based on both observation and inference.
(b) Observations are theory-laden.
(c) Science is affected by the technology and the types of equipment available at the time.
Staphylococcus 葡萄球菌
23- 17
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1. Actions of antibiotics
Antibiotics kill bacteria or inhibit their growth by the following
ways (Figure 23.17):
Some antibiotics prevent bacterial cell walls from forming

properly during cell division. As the cell walls become
weakened, the bacterial cells eventually burst (lyse) due to the
influx of water by osmosis.
Some antibiotics destroy the cell membrane and the cell

contents leak out.
Some antibiotics inhibit protein synthesis by binding to

bacterial ribosomes.
Some antibiotics inhibit the synthesis of nucleic acids, so the

bacteria cannot reproduce.
inhibition of
cell wall formation
inhibition of
nucleic acid synthesis
inhibition of protein
synthesis by binding disruption of
ribosome cell membrane
to ribosome
Figure 23.17 The actions of antibiotics
Clear your concepts

Antibiotics can be used to treat all kinds of infectious diseases.
Antibiotics are ineffective against viral diseases (e.g. the common cold and
influenza) because viruses are non-cellular entities and have no cellular
activities. Antibiotics are usually only effective against bacterial diseases.
23- 18
Worked example 23.1
An investigation was carried out to study the effects of three antibiotics on a species of bacteria,
Staphylococcus aureus. In the investigation, the bacteria were first inoculated on the surface of an agar
plate. Four paper discs were soaked with three antibiotics (A, B and C) of the same concentration and
distilled water respectively. The discs were then placed on the surface of the agar plate (Figure 1) and
the plate was incubated at 37 °C for 24 hours. After incubation, it was observed that clear zones of
different sizes were formed around the discs soaked with antibiotics (Figure 2).
bacterial lawn (a layer

of bacteria growing
distilled A on the surface of an
water agar plate)
paper disc
incubation
for 1 day clear
zone
B C
Figure 1 Figure 2
(a) Bacteria are of very small size and can only be seen with a microscope. Explain why a bacterial
lawn can be observed after the agar plate was incubated for 24 hours in 37 ºC. (2 marks)
(b) What do the clear zones on the agar plate represent? (1 mark)
(c) The diameter of a clear zone shows the effectiveness of an antibiotic. Explain the relationship
between them. (4 marks)
(d) Arrange the three antibiotics in ascending order of effectiveness against S. aureus. (1 mark)
Solution
(a) During incubation, bacteria reproduce by binary fission / asexually. .......................................... (1)
A large number of bacteria are formed, producing a bacterial lawn which is visible to the naked eye /
without a microscope. ............................................................................................................... (1)
(b) Clear zones are areas with no bacterial growth. ......................................................................... (1)
(c) The larger the diameter of the clear zone, the more effective is the
antibiotic............................................................................................(1)
Antibiotics diffuse out from the paper discs. ......................................(1)
Reminder
The further away from the paper disc, the lower is the concentration of
antibiotic. ..........................................................................................(1) Remember to explain why a
more effective antibiotic will
A more effective antibiotic can inhibit bacteria growth even at a lower give a larger clear zone.
concentration. ...................................................................................(1)
(d) B, C, A....................................................................................................................................... (1)
Try Exam Practice Q11 (p.31), 18 (p.35)
23- 19
TE
Taking it further
Broad-spectrum and narrow-spectrum antibiotics
Antibiotics can be classified into two major types depending on the range of
bacteria that they act on. Broad-spectrum antibiotics act on a wide range of
bacteria, whereas a narrow-spectrum antibiotic act on a specific type of
bacteria.
Broad-spectrum antibiotics are usually used when the pathogenic bacterium
has not yet been identified and there is an urgent need to treat a life-
threatening disease. However, it is better to use narrow-spectrum antibiotics if
the bacterium is known. This reduces the number of harmless bacteria in the
human body being killed by antibiotics, and the presence of certain natural
bacteria could help limit the growth of pathogenic bacteria.
2. Indiscriminate use of antibiotics

Antibiotics were once considered ‘wonder drugs’ (Figure 23.18).
However, over the past few decades, antibiotics have become less
effective due to the indiscriminate use by people. Examples include:
Antibiotics are wrongly prescribed to treat viral infections (e.g.

influenza).
Figure 23.18 An advertisement
for penicillin as a cure for
Some patients do not finish the whole course of antibiotics.
gonorrhoea in the 1940s

Antibiotics are added to animal feeds to prevent illnesses
among livestock.
Figure 23.19 On industrial farms, livestock

live in crowded and often unsanitary
conditions. Antibiotics are added to animal
feeds to prevent illnesses and to promote
weight gain.
The consequences of using antibiotics indiscriminately include:
Many antibiotics have become ineffective because the

indiscriminate use speeded up the development of antibiotic
resistance in bacteria (Figure 23.20). Multidrug-resistant bacteria
(‘superbugs’) may develop. Infections caused by ‘superbugs’
are incurable by most antibiotics and are often life-threatening.
New antibiotics and antibacterial drugs are thus needed, but
developing these drugs is costly and time-consuming.
antibiotic resistance 抗生素抗性 broad-spectrum antibiotic 廣譜抗生素

23- 20 narrow-spectrum antibiotic 狹譜抗生素
Animation Some antibiotics kill beneficial bacteria in the human body.

Development of antibiotic Without beneficial bacteria, pathogenic bacteria may face less
resistance
e-aristo.hk/r/
competition for resources, such as nutrients and oxygen. This
bioccani2302.e can encourage the growth of pathogenic bacteria so the
disease may develop even faster.
Some people may develop an allergy to antibiotics after

prolonged use.
 Within a population of  With the indiscriminate  The antibiotic-resistant  Finally, the whole
bacteria, some bacteria use of the antibiotic, bacteria reproduce population of bacteria
have antibiotic the antibiotic-resistant rapidly and their becomes resistant to
resistance while others bacteria have a higher number increases. the antibiotic.
do not. chance to survive while
those without the
resistance are killed.
Key: normal bacterium dead bacterium resistant bacterium
Figure 23.20 Development of antibiotic resistance in a population of bacteria
Extras: Health issue

MRSA
Methicillin-resistant Staphylococcus aureus (MRSA) is an example of ‘superbug’. It is a form of S. aureus, a species of
bacterium that can be found in the nasal cavity and on the skin of some healthy persons. Infections caused by
MRSA are difficult to treat due to the resistance to methicillin and to some other antibiotics.
x4000 MRSA

MRSA infections are more common in hospitals and prisons because antibiotics are frequently used. Also, the
bacteria can spread quickly and widely due to the crowded conditions.
allergy 過敏
Methicillin-resistant Staphylococcus aureus (MRSA) 23- 21
耐甲氧西林金黃葡萄球菌
TE All answers
To slow down the development of antibiotic resistance and

prevent the emergence of ‘superbugs’, doctors, citizens, farmers
and the government should take up their responsibilities (Table
23.1).
Doctors should: Patients should:
Prescribe antibiotics only when necessary to Only take antibiotics prescribed by doctors; do not
reduce the exposure time of bacteria to share or use leftover antibiotics.
antibiotics.
Finish the whole course of antibiotics in order to
Use narrow-spectrum antibiotics if the kill all the pathogenic bacteria in the body.
pathogenic bacteria have been identified. Practise good hygiene.
This ensures the antibiotics only act on the
pathogenic bacteria but not on other bacteria
in the patients’ body.
Livestock farmers should: The government should:
Minimize the use of antibiotics; stop adding Educate the public and the livestock farmers not to
antibiotics into livestock feed. use antibiotics indiscriminately.
Table 23.1 Measures to slow down the development of antibiotic resistance
Applying concepts
Activity 23.1 Case study: Antibiotic-resistant superbugs found in 60% of

tested Hong Kong chicken
A Consumer Council study in 2016 found more than 60% of chicken in local market had antibiotic-
resistant bacteria due to the indiscriminate use of antibiotics. The diagram below shows how the misuse
of antibiotics in livestock farming threatens the public health.
 Antibiotics are added to  The bacteria survive if  Consumers may be  The bacteria spread
chicken feed. This speeds the meat has not been infected by the bacteria in the community
up the development of thoroughly cooked. after eating the meat. The (e.g. in the hospital).
antibiotic resistance in infection cannot be
the bacterial populations treated by most antibiotics
in chicken. and can be fatal.

1. What can customers do when handling chicken meat to avoid being infected with antibiotic-
resistant bacteria?
2. Suggest two measures that the government can implement to prevent the indiscriminate use of
antibiotics among livestock farmers.
23- 22
All answers TE
B. Sulpha drugs
Sulpha drugs are synthetic antibacterial drugs derived from
sulphur-containing compounds called sulphonamides.
Sulpha drugs are enzyme inhibitors. They inhibit the synthesis of

a metabolite (folic acid) which is necessary for cell division in
bacteria, thus slowing down bacterial growth. However, they do not
kill bacteria.
Sulpha drugs often cause allergy in patients. They have mostly

been replaced by antibiotics which are more effective and have
fewer side effects. Today, sulpha drugs are used to treat urinary
tract infections and prevent infection in patients with severe burns.
Key point
1. Antibiotics kill or inhibit the growth of bacteria. They are used to treat
bacterial infections or diseases.
2. The indiscriminate use of antibiotics speeds up the development of
antibiotic resistance in bacteria.
3. Sulpha drugs are enzyme inhibitors. They were once commonly used to
treat bacterial infections.
Checkpoint
Which of the following statements about antibiotics is incorrect?
A. Antibiotics are effective against bacteria.
B. The indiscriminate use of antibiotics leads to antibiotic resistance in
white blood cells.
C. Some antibiotics inhibit the growth of bacteria by interfering the
synthesis of bacterial cell walls.
D. Antibiotics do not destroy human cells.
sulpha drug 磺胺類藥物 sulphonamide 磺胺

folic acid 葉酸 23- 23
urinary tract infection 泌尿道感染
All answers
Article reading
Predicting the next disease outbreak

with Big Data
It is very common for people to search online for disease
symptoms once they start feeling sick. Google Flu Trend
(GFT) was an influenza surveillance tool that makes use of
these search records to predict the incidence of influenza.
GFT compared the number of real-time searches for
influenza symptoms (e.g. fever) in a certain region with
historical data. It then estimated the likelihood of the
region having an influenza outbreak. GFT accurately
predicted the outbreaks in the United States from 2008 to ▲ Have you ever ‘googled’ your symptoms
2012. when you start feeling sick?
Key: However, GFT was later closed because of

12
Google Flu Trend’s prediction privacy concerns and the overestimation in
Actual number of influenza
10 patients 2013. Despite the setback, some technology
Estimated percentage of
population with influenza
companies are now trying to use the same

8 idea, together with some other relevant data,
to predict the outbreaks of malaria and
6
dengue fever.
2
◄ Comparison of GFT's prediction with the actual
0 number of influenza patients in the United States
Jan 2011 Jan 2012 Jan 2013 from 2011 to 2013
Questions
1. Apart from ‘fever’, what keywords would you enter into a search engine when you have
influenza? (2 marks)
2. Suggest two reasons to explain why GFT overestimated the influenza incidence in the United
States in 2013. (2 marks)
3. If you were one of the GFT programmers, what additional data would you collect in order to
improve the accuracy of the predictions? (1 mark)
surveillance 監控
23- 24 incidence 發病率
e-dictionary
Key terms e-aristo.hk/r/
bioccedict.e
antibiotic 抗生素 p.16 pathogen 病原體 p.4
antibiotic resistance 抗生素抗性 p.20 penicillin 青黴素 p.16
bacterium 細菌 p.5 protist 原生生物 p.5
droplet 飛沫 p.11 sulpha drug 磺胺類藥物 p.23
fungus 真菌 p.5 vector 媒介 p.14
health 健康 p.3 virus 病毒 p.5
infectious disease 傳染病 p.4
Summary
23.1 The meaning of health

　
1. Health is a state of complete physical, mental and social well-being, and not merely the absence of
disease.
23.2 Concept of diseases

　
2. A sign is an objective evidence of the presence of a disease which can be observed or measured by the
patient and other people (e.g. fever). A symptom is a sensation (e.g. headache) or a change in bodily
function experienced by the patient only, i.e. it is subjective.
3. Differences between infectious and non-infectious diseases are:
Infectious diseases Non-infectious diseases
Body invaded by pathogens Biological factors, environmental factors

Causes
and behavioural factors
Transmission Can be transmitted from person to person Cannot be transmitted to others
Cholera, influenza and SARS Diabetes, cancer and cardiovascular

Examples
diseases
23.3 Causes of infectious diseases

　
4. Infectious diseases are caused by pathogens. Most pathogens are microorganisms, which include viruses,
bacteria, protists and fungi:
Type of pathogen Examples of diseases
Viruses Influenza, hepatitis, dengue fever, AIDS and measles
Bacteria Cholera and tuberculosis
Protists Malaria
Fungi Athlete’s foot
23- 25
23.4 How infectious diseases are transmitted

　
5. The ways of transmission of infectious diseases and the corresponding control measures are:
Ways of transmission Control measures Examples of diseases
By contact - Wear protective gloves and clothing when taking care of - Athlete’s foot
an infected person.
- Chickenpox
- Do not share personal objects (e.g. combs and towels).
- Hand, foot and
- Maintain good personal hygiene. mouth disease
By droplets and air - Cover our mouth and nose with tissue paper or a - Influenza
handkerchief when sneezing or coughing. Clean hands
- Tuberculosis
with liquid soap or disinfectants afterwards.
- Wear a face mask if infected or when in close contact
with infected people.
- Avoid going to crowded and poorly ventilated public
places.
- Maintain good ventilation indoors.
By food and water - Wash hands after going to the toilet and before handling - Cholera
foods.
- Gastroenteritis
- Adopt good hygiene practices in food handling.
- Food poisoning
- Buy food from clean and reliable shops or markets.
- Hepatitis A
- Cook food and boil drinking water thoroughly.
- Keep food in a refrigerator or a freezer.
By body fluids - Wear gloves when handling wounds or blood. - Hepatitis B

- Avoid sharing toothbrushes, razors and other objects - AIDS
that may be contaminated with blood.
- Syphilis
- Never share injection syringe and needles.
- Wear a condom during sexual contact.
By vectors - Store food properly. - Cholera

- Kill the vectors by using pesticides. - Malaria
- Eliminate the potential breeding grounds of the vectors. - Dengue fever
- Avoid being bitten by mosquitoes.
23.5 Treatments for infectious diseases

 　
6. Antibiotics are chemicals produced by certain bacteria and fungi to kill or prevent the growth of other
competing microorganisms.
7. The actions of antibiotics include:

-
inhibiting the formation of bacterial cell walls during cell division to cause lysis.
-
destroying bacterial cell membranes.
-
inhibiting the synthesis of proteins.
-
inhibiting the synthesis of nucleic acids.
23- 26
All answers
8. The indiscriminate use of antibiotics has the following consequences:

- It speeds up the development of antibiotic resistance, resulting in ‘superbugs’ which may lead to
incurable infections.
-
Resources are needed to develop new antibiotics and antibacterial drugs.
-
Beneficial bacteria in the human body are killed, which encourages the growth of pathogenic bacteria.
- It causes allergy in some people.
9. Sulpha drugs are used to treat bacterial infections. They are enzyme inhibitors. They inhibit the synthesis
of a metabolite which is necessary for cell division, slowing down bacterial growth.
Concept map
Complete the following concept map to review the key points of this chapter.
Diseases
can be divided into
Infectious Non-infectious
diseases diseases
are caused by can be

transmitted by
contact
include
air and droplets

viruses fungi
food and water
body fluids
can be killed or stopped can be stopped from

from growing by growing by vectors
antibiotics
indiscriminate use
speeds up the
following in bacteria
23- 27
All answers
Time allowed: 40 minutes

Self quiz Total score: 30 marks
Level 1: Understanding basic concepts (20 marks, 1 mark for each multiple-choice question)
1. Write ‘T’ for a true statement or ‘F’ for a false 5. Which of the following diseases can be transmitted
statement. (7 marks) by mosquitoes?
(a) When our bodies are free from disease, we are (1) malaria
healthy.
(2) HIV infection
(b) Infectious diseases are caused by
(3) Zika virus infection
pathogens.
A. (3) only
(c) Dengue fever is transmitted by mosquitoes.
B. (1) and (2) only
 (d) Antibiotics can be used to treat measles.
C. (1) and (3) only
 (e) Antibiotics are only effective inside the human
bodies. D. (2) and (3) only
 (f) The overuse of antibiotics would cause patients

to develop drug dependence. 6. The spread of dengue fever can be prevented by
using a mosquito lamp and a mosquito net. Which

(g) Sulpha drugs are used to treat bacterial
of the following correctly matches the principles of
infections because they kill bacteria.
these control methods?
2. Complete the following paragraph with suitable Using a mosquito Using a mosquito
lamp net
words. (5 marks)
A. Kill some mosquitoes. Prevent mosquito
Viruses can only (a) within bites.
living cells. After they have invaded a cell, they B. Kill all the male Prevent mosquito
take over cellular (b) to mosquitoes. bites.
produce (c) . This disrupts
C. Release radiations to Capture adult
the (d) of the host cell’s
prevent mosquitoes mosquitoes.
nucleic acids and proteins. Finally, the viruses
from laying eggs.
destroy the (e) ,
causing cell death. D. Prevent mosquitoes Reduce nutrient
from breeding. supply for male
mosquitoes.
3. Match the diseases in column 1 with the
appropriate descriptions from column 2. Put the
appropriate letter(s) in the space provided. 7. Which of the following diseases can be treated by
(4 marks) using sulpha drugs?
Column 1 Column 2 A. athlete’s foot

(a) tuberculosis A. non-infectious B. malaria
(b) malaria B. caused by a virus
C. urinary tract infection
(c) dengue fever C. caused by a protist
(d) diabetes D. caused by a bacterium D. hepatitis B
4. Which of the following correctly arranges the three

types of pathogens in order of increasing size?
A. bacterium, virus, protist

B. protist, bacterium, virus
C. virus, bacterium, protist
D. protist, virus, bacterium
23- 28
Level 2: Applying concepts (7 marks)
8. Read the article below and answer the questions that follow.
Outbreak of hepatitis A linked to frozen strawberries
55 cases of hepatitis A were linked to the consumption of packaged frozen strawberries in the United States in
2016. The strawberries were imported from Egypt. People who are infected with hepatitis A may show signs, which
include jaundice (yellowing of the skin or the eyes), vomiting and tea-coloured urine. To prevent hepatitis A, we
should maintain good personal, food and environmental hygiene.
Answer
(a) State the type of pathogen that causes hepatitis A. (1 mark)
(b) Based on the information given, suggest how hepatitis A was transmitted. (2 marks)Answer
(c) Suggest two measures that the general public should take in order to avoid getting hepatitis A from eating
strawberries. (2 marks)Answer
(d) Why are antibiotics not effective in treating hepatitis A?

(2 marks)Answer
Level 3: Building a better answer (3 marks)
9. Read the following question and student A’s answer. Re-write and improve the answer based on the teacher's
comments.
Question
In Hong Kong, dengue fever is more common during the summer months. Suggest a reason for this.
(3 marks) Answer
Student A’s answer

In summertime, the mosquitoes are more active. 
Hence, the population size of mosquitoes increases, causing dengue fever. ✘
Teacher's comment
 The weather conditions that encourage the growth of the mosquito population should be mentioned.
 The term ‘active’ is too general. It may or may not mean that mosquitoes are ‘reproductively active’
in summer.
 The term ‘causing’ wrongly implies that mosquito is the causative agent (pathogen) of dengue fever.
Answers are available on p. A1. If you miss any of the questions, review the relevant section(s) again.
Question 1(a) 1(b) 1(c) 1(d) 1(e) 1(f) 1(g) 2 3 4 5 6 7 8(a) 8(b) 8(c) 8(d) 9
Section(s) 23.1 23.2 23.4 23.5 23.5 23.5 23.5 23.3 23.3 23.3 23.4 23.4 23.5 23.3 23.4 23.4 23.5 23.4
23- 29
TE All answers
Exam practice 4. During the World War II, a large number of people
died of cholera in prisoner-of-war camps. Which of
the following is the most probable reason?
Multiple-choice questions
A. There was a shortage of food and water.
Section 23.3 B. There were often a large number of mosquitoes
in the camps.
1. Which of the following statements about all
pathogens is/are correct? C. The drinking water was contaminated with
sewage.
(1) They are microorganisms.
D. People lived in close contact, increasing the
(2) They cause diseases by taking over the host risk of droplet transmission.
cell’s metabolism.
(3) They can be spread from one organism to
5. Which of the following diseases spread(s) in the
another.
same way as cholera? Hint 1
A. (3) only
(1) hepatitis A
B. (1) and (2) only
(2) chickenpox
C. (1) and (3) only
(3) gastroenteritis
D. (2) and (3) only
A. (3) only
B. (1) and (2) only
Section 23.4
C. (1) and (3) only
2. Which of the following correctly matches the
disease and its way of transmission? D. (2) and (3) only
Disease Way of transmission

6. One method of preventing dengue fever is to
A. cholera direct contact reduce the number of mosquitoes. Which of
B. gastroenteritis air or droplets the following measures will achieve this?
C. AIDS sexual contact A. Use chemicals that kill the dengue fever
pathogen in the human body.
D. tuberculosis vector
B. Use chemicals that inhibit the reproduction of
the dengue fever pathogen.
3. Hand, foot and mouth disease (HFMD) is a C. Apply insect repellent onto the skin before
common disease in children caused by a virus. carrying out outdoor activities.
Which of the following are effective ways to
protect oneself from HFMD? D. Remove stagnant water to prevent mosquitoes
from laying eggs.
(1) Cook food thoroughly.
(2) Avoid direct physical contact with infected 7. Drug addicts often share syringes and needles. This
people. may result in the transmission of Hint 2
(3) Wash our hands before touching our eyes.
(1) AIDS.
A. (1) and (2) only
(2) hepatitis B.
B. (1) and (3) only
(3) syphilis.
C. (2) and (3) only
A. (1) only
D. (1), (2) and (3)
B. (1) and (2) only
C. (2) and (3) only
D. (1), (2) and (3)
Hint 2: Most sexually transmitted diseases (e.g. syphilis) are transmitted by the exchange of body fluid. Note that blood is also a body fluid.
types of diseases and they are transmitted via different means.
Hint 1: Cholera is caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Be reminded that hepatitis A and hepatitis B are two
23- 30
All answers
 Section 23.5 11. The diagram below shows the results of an

investigation into the effect of six antibiotics (P to
8. Which of the following diseases can be cured by U) on a type of bacterium.
antibiotics?
paper disc soaked with
(1) chickenpox Petri dish
antibiotic
(2) dengue fever
P Q
(3) cholera
A. (3) only U R clear zone
B. (1) and (2) only
C. (1) and (3) only T S
D. (2) and (3) only region with bacteria

growing
9. Viral infections cannot be treated with antibiotics
because Which of the following conclusions can be drawn
from the result?
A. viruses live inside body cells.
B. viruses are too small. A. The bacterium is resistant to antibiotic P.
C. viruses do not have a cellular structure. B. The bacterium is resistant to antibiotic Q.
D. viruses are resistant to antibiotics. C. Antibiotic S is a more effective antibiotic than

antibiotic Q against this type of bacterium.
D. Antibiotic U is a more effective antibiotic than
10. Which of the following descriptions about
antibiotic R against this type of bacterium.
antibiotics is correct?
A. Antibiotics can engulf pathogens.

B. Antibiotics can be produced by fungi.
C. Antibiotics can bind to specific antigens.
D. Antibiotics can be produced by lymphocytes.
HKDSEE Biology 2013 Paper 1 Section A Q32
Short questions
Section 23.4
12. Complete the following paragraph with suitable words. (5 marks)
Chickenpox is caused by the varicella-zoster (a) . Patients usually have a fever, itchy skin
rashes and watery blisters or spots on the skin. It is transmitted through the (b) coughed out
from an infected person or through (c) with the discharge from blisters. The spread of
chickenpox can be prevented by wearing (d) when touching an infected person and
maintaining good personal (e) .
23- 31
All answers
13. The table below shows some information about five infectious diseases.
Infectious Type of causative

Name of causative organism(s) Main mode of transmission
disease organism
HIV / AIDS human immunodeficiency virus (HIV) sexual contact
cholera Vibrio cholerae ingestion of contaminated water

and food
tuberculosis Mycobacterium tuberculosis bacterium
measles measles virus virus aerosol (噴沫) / droplet infection
Plasmodium vivax or P. malariae or

P. falciparum or P. ovale
(a) Complete the above table. (3 marks)

(b) In 2011, the World Health Organization (WHO) published recommendations to help countries develop plans to
prevent the spread of HIV.
Discuss the factors that should be considered when making recommendations concerning the prevention of
sexual transmission of HIV. (4 marks)Answer
Cambridge International AS & A Level Biology 9700 Paper 22 Q4(a),(b) June 2014
14. Dengue fever is a vector borne disease transmitted by mosquitoes. The table below shows two methods adopted by
the Government to break the transmission link of this disease. Complete the table below to show how each method
works and comment on its advantage or disadvantage. (4 marks)
Comment (advantage or
Method How it works
disadvantage)
Spraying of
pesticides or
larvicidal oil around
mosquito’s habitat
Clearance of
accumulated water in
a neighbourhood
HKDSEE Biology 2012 Paper 1 Section B Q2
23- 32
 Section 23.5
15. In 1928, Alexander Fleming found a fungus called Penicillium in a Petri dish containing a culture of bacteria growing
on agar jelly.
The diagram shows what he observed.
petri dish
Penicillium
bacteria
Fleming made two conclusions.
1. A chemical released from Penicillium was harming the bacteria.

2. The chemical was diffusing through the jelly.
Answer
(a) What is the evidence in the diagram for each conclusion? (2 marks)
(b) The chemical found in Penicillium was extracted and is known as penicillin.
(i) What name is given to types of drugs such as penicillin? (1 mark)Answer
(ii) Why has penicillin become less effective at killing bacteria in recent years? (2 marks)Answer
(c) Methicillin-resistant Staphylococcus aureus (MRSA) has become a serious problem in hospitals. Describe one
effective control measure used in hospital against MRSA. (1 mark)Answer
WJEC GCSE Biology 3 Higher Tier Jun 2013 Q5
Structured questions
Section 23.4
16. Vibrio cholerae is a prokaryotic organism. Figure 1 shows the structure of a cell of V. cholerae.
capsule A B C D
3 E
23
F
G
3.0 µm
Figure 1
(a) Calculate the magnification of Figure 1. Show your working and give your answer to the nearest whole
number. Hint 3 (2 marks)Answer
(b) Locate the structures in Figure 1 that apply to each of the features shown in Table 1.
Complete Table 1 by writing the appropriate letter and the name of the structure.
23- 33
Hint 3: 1 m = 100 cm = 1,000,000 µm
All answers
You must only give one letter in each case. You may use each letter once, more than once or not at all. The first
answer has been completed for you. (4 marks)
Table 1
Feature Identity Name

provides motility F flagellum
stores genetic information
partially permeable
composed of murein (peptidoglycan)
site of translation (protein synthesis)
(c) State three structural features that are present in a mesophyll cell in a leaf but are not present in a prokaryotic
cell such as that of V. cholerae. (3 marks)Answer
(d) Describe how V. cholerae is transmitted from an infected person to an uninfected person. (2 marks)Answer
(e) It is important to know how pathogens are transmitted in order to develop effective control methods. Explain
how this knowledge is used to control the spread of V. cholerae in the human population. (3 marks)Answer
Cambridge International AS & A Level Biology 9700 Paper 21 Q1 June 2014
17. Dengue fever is an acute viral disease. Prevention of this disease mainly depends on controlling the mosquito
population. Since 2000, the Food and Environmental Hygiene Department (FEHD) has been monitoring the
mosquito population in Hong Kong. The graph below shows the monthly mosquito population in a certain district
and the monthly mean temperature in 2007.
35 35
Key: Mean temperature
30 30
Mosquito population
25 25
Mosquito population 20 20
Mean temperature (°C)
(arbitrary unit)
15 15
10 10
5 5
0 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2007
(a) Suggest why the mosquito population is related to the incidence of dengue fever. (1 mark)
(b) Based on the information from the graph, suggest how temperature may affect the breeding of mosquitoes.
(2 marks)
(c) The risk of spreading of dengue fever is graded by the FEHD as high when the mosquito population is 20
arbitrary units or above. The FEHD will conduct special operations to eliminate potential breeding places for
mosquitoes.
(i) In which months were special operations conducted in 2007? (1 mark)
(ii) The Hong Kong Observatory has estimated that the annual average temperature in Hong Kong will
increase in the coming decades. Predict how this will affect the transmission of dengue fever. Justify your
answer. (3 marks)
(iii) If the mosquito population in the district you live is reported to be above 20 arbitrary units, suggest one
way to protect yourself from contracting dengue fever. (1 mark)
HKCEE Biology 2009 Paper 1 Q6
23- 34
 Section 23.5
18. A test was carried out to investigate the effects of four antibiotics against a species of bacteria isolated from a patient.
The bacteria were inoculated on the surface of an agar plate. Four filter-paper discs (each with a diameter of 5 mm)
soaked with different antibiotics A, B, C and D were placed on the surface of the agar. The agar plate was then
incubated to allow the growth of the bacteria. If bacterial growth is inhibited by an antibiotic, a clear zone surrounding
the filter-paper disc soaked with the antibiotic will be observed after 24 hours. The results of the test are shown
below:
paper disc soaked with antibiotic diameter of clear zone
A D
Incubate for
24 hours
B C
agar plate inoculated with bacteria area with bacterial growth
The following table shows the diameter of the clear zone measured in each of the filter-paper discs:
Antibiotic Diameter of the clear zone (mm)

A 13
B 5
C 10
D 21
(a) Explain why the agar plate should be incubated at 37 °C. (1 mark)
(b) (i) Based on the results, arrange the four antibiotics in descending order of effectiveness at inhibiting bacterial
growth. (1 mark)
(ii) Explain your reasoning in determining the order in (i). (3 marks)
(c) Antibiotic B has been commonly used. It was the most effective antibiotic against the same bacteria a few years
ago. Explain the result of antibiotic B in this test. (4 marks)
HKDSEE Biology Practice Paper Paper 1 Section B Q6
23- 35
Essays
Section 23.4
19. With reference to named examples, describe and explain how diseases caused by microorganisms are transmitted
and how transmission of these diseases can be reduced or prevented (your answer should not make reference to
viruses). (10 marks)Answer
WJEC GCE A/AS level Human Biology Module HB2 Jun 2016 Q7(a)
 Section 23.5
20. Write an account to include the causative organism, symptoms, mode of transmission, treatment and prevention of
the disease for
(a) cholera; Answer

(b) tuberculosis. Answer (10 marks)
WJEC GCE A/AS level Human Biology Module HB2 Jun 2011 Q7(b)
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In 2003, a new coronavirus caused the severe acute respiratory

Links to prior knowledge Chapter preview

Major disease outbreaks in Hong Kong

Picture depicting a Pupils washing

1894 1937 1967 2003

Memorial stone of the

Learning objective 23.1 The meaning of health

To many people, health means not being sick. But according to

There are three different aspects of health: physical health, mental

Social well-being Mental well-being

Figure 23.1 The three aspects of health

Learning objective 23.2 Concept of disease

A disease is an abnormal condition that affects the body of an

A sign is an objective evidence of the presence of a disease which

Figure 23.2 a Fever and b headache are a sign and a symptom of

Diseases can be classified into two broad types: infectious diseases

Infectious diseases are diseases that can be spread from one

Non-infectious diseases are diseases that cannot be spread

infectious disease 傳染病

Learning objective 23.3 Causes of infectious diseases

Viruses do not carry out metabolism and can only reproduce or

Most viruses cause disease by interfering with the cell functions

virus 病毒 fungus 真菌 liver fluke disease 肝吸蟲病

Many diseases in humans are caused by viruses. Some examples of

Cholera, tetanus and tuberculosis are examples of diseases caused

dengue fever 登革熱 human immunodeficiency virus (HIV) tuberculosis 結核病

red blood cell

Figure 23.11 Athlete's foot causes a Figure 23.12 A culture of athlete’s

Plasmodium 瘧原蟲屬 athlete’s foot 腳癬

Prions appear to be transmitted by eating contaminated food or by organ

Practical 23.1 Examination of some pathogens

2. Identify the structures of each pathogen. Draw a labelled diagram of each

diseased animal healthy animal

Demonstration of the Koch’s postulates

Questions for discussion

gastric ulcer 胃潰瘍

23.4 How infectious diseases are

To reduce the risk of contact transmission, we should take the

Avoid direct physical contact with infected persons. Wear

Do not share personal items (e.g. towels, combs or clothes).

Maintain good personal hygiene (e.g. washing hands after

B. By droplets and air

Cover our mouth and nose with tissue paper or a handkerchief

Avoid going to crowded and poorly ventilated public places

Frequently clean and disinfect surfaces which may be touched

C. By food and water

Diseases transmitted by food or water are called food-borne

To reduce the risk of food-borne and water-borne diseases, we

Adopt good hygiene practices in food handling (e.g. use

Buy food from clean and reliable shops or markets.

Cook food and boil drinking water thoroughly.

Refrigerate food at the right temperature. Maintain the

Avoid sharing toothbrushes, razors and other objects that may

Practise safe sex and wear a condom during sexual contact.

Screen blood before transfusion.

Never share injection syringe and needles.

Cockroaches and houseflies feed on faeces in sewers or food waste.

Do not leave food unattended. Place food in covered containers

Kill vectors, e.g. by spraying pesticides or larvicidal oil around

Remove the potential breeding grounds of vectors, e.g. clear

Avoid mosquito bites, e.g. wear light-coloured long-sleeved

Antibiotics are wrongly prescribed to treat viral infections (e.g.

Activity 23.1 Case study: Antibiotic-resistant superbugs found in 60% of