5 Communicable Disease Nursing I.

EPI DISEASES

DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION

TRANSMISSION

1. Tuberculosis Mycobacterium tuberculosis Airborne-droplet 1. Usually asymptomatic Diagnostic test: Respiratory precautions
2. Low-grade afternoon Sputum examination or the Acid-fast bacilli (AFB) / Cover the mouth and
Other names: TB bacillus Direct invasion fever 3. Night sweating sputum microscopy nose when sneezing to
Koch’s Disease Koch’s bacillus through mucous 4. Loss of appetite 1. Confirmatory test avoid
Consumption Mycobacterium bovis membranes and 5. Weight loss mode of transmission
2. Early morning sputum about 3-5 cc
Phthisis breaks in the skin 6. Easy fatigability – due
(very rare) 3. Maintain NPO before collecting sputum Give BCG
Weak lungs (rod-shaped) to increased oxygen
demand 4. Give oral care after the procedure Improve social conditions
Incubation period : 7. Temporary amenorrhea 5. Label and immediately send to laboratory 6. If
Most hazardous period for development of 4 – 6 weeks 8. Productive dry cough unknown when was the sputum collected,
discard
disease is theclinical 6-12 months after infection 9. Hemoptysis
Highest risk of developing disease is children Chest X-ray is used to:
under 1. Determine the clinical activity of TB, whether it is
first 3years old inactive (in control) or active (ongoing)
2. To determine the size of the lesion:
TREATMENT: a. Minimal – very small
Rifampicin (R), I SCC/Short Course Chemotherapy, Direct – b. Moderately advance – lesion is < 4 cm
Ethambutol
observed treatment short course/DOTS; soniazid (H), (E), S c. Far advance – lesion is > 4 cm
CATEGORY 1: Pyrazinamide (Z), treptomycin (S) Tuberculin Test – purpose is to determine the history
6 months SCC CATEGORY
CATEGORY 2: 8 of exposure to tuberculosis
Indications: 3: 6 months SIDE EFFECTS:
Other names: SIDE EFFECTS:
months SCC SCC Rifampicin
> new (+) smear > Mantoux Test – used for single screening, result Ethambutol
Indications: Indications: body fluid
interpreted after 72 hours
(-) smear PTB with > treatment failure discoloration Optic neuritis
extensive > new (-) smear Tine test – used for mass screening read after 48 hours Blurring of vision
> relapse hepatotoxic Interpretation:
parenchymal PTB with minimal (Not to be givento
> return after default lesions on CXR 0 - 4 mm induration – not significant
lesions on CXR 5 mm or more – significant in individuals who are children below 5 y.o.
> Extrapulmonary Intensive Phase:3 mos Same meds with permanent due to inability to
considered at risk; positive for patients who are HIV
TB> severe Category 1 positive or have HIV risk factors and are of unknown complain blurring of
concominant HIV Intensive HIV status, those who are close contacts with an active vision)
R&I 1 tab each; P&E Phase: 2 months discoloration of case, and those who have chest x-ray results consistent
disease 2 tabs each Inability to recognize
Intensive Phase: R&I 1 tab each; contact lenses with tuberculosis.
10 mm or greater – significant in individuals who green from blue
2 months P&E 2 tabs each
Streptomycin – 1 Isoniazid have normal or mildly impaired immunity Streptomycin
R&I : 1 tab each; Continuation
Phase:4 months Peripheral Damage to 8th CN
P&E 2 tabs each neuropathy Ototoxic
Continuation vial/day IM for first 2 R&I 1 tab each
Tinnitus
Phase4 months months = 56 vials (if CATEGORY 4: (Give Vit nephrotoxic
R&I : 1 tab each Chronic (*Referral B6/Pyridoxine)
given for > 2mos can
cause nephrotoxicity
Pyrazinamide

Continuation Phase:
5 :
months
R&I : 1 tab each
E : 2 tabsneeded)
6 Communicable Disease Nursing
NATIONAL TB CONTROL PROGRAM:
Vision: A country where TB is no longer a public health problem Mission:
Ensure that TB DOTS Services are available, accessible, and affordable to
the communities in collaboration with LGUs and others Goal: To reduce
prevalence and mortality from TB by half by the year 2015 (Millennium
Development Goal)
Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered
2. Detect at least 70% new sputum smear (+) TB cases Objectives: 1.
Improve access to and quality of services
2. Enhance stakeholder’s health-seeking behavior 3. Increase and sustain
support for TB control activities 4. Strengthen management of TB control
activities at all levels KEY POLICIES:
*Case finding:
- DSSM shall be the primary diagnostic tool in NTP case finding
- No TB Dx shall be made based on CXR results alone
- All TB symptomatic shall be asked to undergo DSSM before treatment
- Only contraindication for sputum collection is hemoptysis
- PTB symptomatic shall be asked to undergo other tests (CXR and culture),
only after three sputum specimens yield negative results in DSSM - Only
trained med techs / microscopists shall perform DSSM
- Passive case finding shall be implemented in all health stations
*Treatment: Domiciliary treatment – preferred mode of care
DSSM – basis for treatment of all TB cases
*Hospitalization is recommended: massive hemoptysis, pleural effusion,
military TB, TB meningitis, TB pneumonia, & surgery is needed or with
complications
*All patients undergoing treatment shall be supervised
*National & LGUs shall ensure provision of drugs to all smear (+) TB cases
*Quality of fixed-dose combination (FDC) must be ensured
*Treatment shall be based on recommended category of treatment regimen
DOTS Strategy – internationally-recommended TB control strategy
Five Elements of DOTS: (RUSAS)
Recording & reporting system enabling outcome assessment of all patients
hyperuricemia /gouty
arthritis (increase fluid
intake)
s
MANAGEMENT OF CHILDREN WITH TUBERCULOSIS
- for TB symptomatic children
*a TB symptomatic child with either known or
Prevention: BCG immunization to all infants (EPI)
unknown exposure to a TB case shall be referred
for tuberculin testing
* (+) contact but (-) tuberculin test and unknown
Casefinding:
- cases of TB in children are reported and identified in 2
contact but (+) tuberculin test shall be referred for
instances: (a) patient was screened and was found symptomatic
CXR examination
of TB after consultaion (b) patient was reported to have been
*(-) CXR, repeat tuberculin test after 3 months
exposed to an adult TB patient
* INH chemoprophylaxis for three months shall be
- ALL TB symptomatic children 0-9 y.o, EXCEPT sputum
given to children less than 5y.o. with (-) CXR; after
positive child shall be subjected to Tuberculin testing (Note:
which tuberculin test shall be repeated
Only a trained PHN or main health center midwife shall do
tuberculin testing and reading which shall be conducted once a
Treatment (Child with TB):
week either on a Monday or Tuesday. Ten children shall be
Short course regimen
gathered for testing to avoid wastage.
PULMONARY TB
Intensive: 3 anti-TB drugs (R.I.P.) for 2 months
- Criteria to be TB symptomatic (any three of the following:)
Continuation: 2 anti-TB drugs (R&I) for 4 months
 Uninterrupted supply of quality-assured drugs
Standardized SCC for all TB cases
Access to quality-assured sputum microscopy
Sustained political commitment
* cough/wheezing of 2 weeks or more
* unexplained fever of 2 weeks or more
EXTRA-PULMONARY TB
* loss of appetite/loss of weight/failure to gain weight/weight
Intensive: 4 anti-TB drugs (RIP&E/S) for 2 months
faltering
Continuation: 2 anti-TB drugs (R&I) for 10 months
* failure to respond to 2 weeks of appropriate antibiotic therapy
for lower respiratory tract infection
* failure to regain previous state of health 2 weeks after a viral
infection or exanthem (e.g. measles)

-Conditions confirming TB diagnosis (any 3 of the following:)

* (+) history of exposure to an adult/adolescent TB case
* (+) signs and symptoms suggestive of TB
* (+) tuberculin test
* abnormal CXR suggestive of TB
* Lab findings suggestive or indicative of TB

- for children with exposure to TB

* a child w/ exposure to a TB registered adult patient shall
undergo physical exam and tuberculin testing
* a child with productive cough shall be referred for sputum
exam, for (+) sputum smear child, start treatment immediately
* TB asymptomatic but (+) tuberculin test and TB symptomatic
but (-) tuberculin test shall be referred for CXR examination

7 Communicable Disease Nursing

2. Diphtheria Corynebacterium Droplet especially Pseudomembrane – mycelia Diagnostic test: DPT immunization
secretions from of the oral mucosa causing Pasteurization of milk
Types: diphtheria Klebbs-loffler mucous membranes formation of white membrane Nose/throat swab Education of parents
> nasal of the nose and on the oropharynx Moloney’s test – a test for hypersensitivity to
> pharyngeal – nasopharynx and diphtheria toxin
most common from skin and other Bull neck
Schick’s test – determines susceptibility to bacteria
> laryngeal – most lesions Dysphagia
fatal due to Dyspnea Drug-of-Choice:
proximity to Milk has served as a Erythromycin 20,000 - 100,000 units IM once only
epiglottis vehicle
Complication: MYOCARDITIS (Encourage bed
Incubation Period:
2 – 5 days
 rest)

3. Pertussis Bordetella pertussis Droplet especially Catarrhal period: 7 days Diagnostic: DPT immunization
Hemophilus pertussis from laryngeal and paroxysmal cough followed Booster: 2 years and 4-5 years
Whooping cough Bordet-gengou bacillus bronchial secretions by continuous nonstop Patient should be segregated
Bordet-gengou agar test
Tusperina Pertussis bacillus accompanied by vomiting until after 3 weeks from the
No day cough Incubation Period: Management: appearance of paroxysmal
7 – 10 days but not Complication: abdominal hernia 1. DOC: Erythromycin or Penicillin 20,000 - 100,000 cough
exceeding 21 days units 2. Complete bed rest
3. Avoid pollutants
(because if more than 4. Abdominal binder to prevent abdominal hernia
21 days, the cough
can be related to TB
Incidence: highest under 7 years of or lung cancer)

Mortality: highest among infants (<6 months)

4. Tetanus Clostridium tetani – anaerobic Indirect contact – Risus sardonicus (Latin: No specific test, only a history of punctured wound DPT immunization
inanimate objects, “devil smile”) – facial
Other names: soil, street dust, spasm; sardonic grin Treatment: Tetanus toxoid
One attack confers definite and prolonged animal and human immunization among
Lock jaw Antitoxin
spore-forming heat-resistant and immunity. feces, punctured Opisthotonus – arching of back antitetanus serum (ATS) pregnant women
Second attack occasionally occurslives in soil wound tetanus immunoglobulin (TIG)
For newborn: Pen G Licensing of midwives
or intestine
1. Difficulty of sucking Diazepam – for muscle spasms
2. Excessive crying Health education of mothers
Incubation Period: 3. Stiffness of jaw Note: The nurse can give fluid provided that the patient is
Neonate: umbilical cord Varies from 3 days to 4. Body malaise able to swallow. There is risk of aspiration. Check first for
Children: dental caries 1 month, falling the gag reflex
Adult: punctured wound; between 7 – 14 days
after septic abortion

5. Poliomyelitis Legio debilitans Fecal – oral route Paralysis Diagnostic test: OPV vaccination
Polio virus Muscular weakness Frequent hand washing
Other name: Enterovirus Incubation period: Uncoordinated body CSF analysis / lumbar tap
Infantile paralysis 7 – 21 days movement Hoyne’s sign –
Pandy’s test
Attacks the anterior horn of head lag after 4 months
the neuron, motor is Management:
affected (!Safety) Rehabilitation involves ROM exercises
Man is the only reservoir

8 Communicable Disease Nursing

 6. Measles RNA containing paramyxovirus Droplet secretions 1. Koplik’s spots – No specific diagnostic test Measles vaccine
from nose and throat whitish/bluish pinpoint Disinfection of soiled articles
Other names: patches on the buccal cavity Management: Isolation of cased from
Morbilli Incubation period: 2. cephalocaudal appearance Supportive and symptomatic diagnosis until about 5-7 days
Rubeola 10 days – fever of maculopapular rashes after onset of rash
14 days – rashes appear 3. Stimson’s line – bilateral
red line on the lower
Period of conjunctiva
Communicability:
4 days before and 5
days after the
appearance of rash

7. Hepatitis B Hepatitis B virus Blood and body 1. Right-sided Abdominal
fluids Placenta pain 2. Jaundice
Other names: 3. Yellow-colored sclera
Serum Hepatitis Incubation period: 4. Anorexia
45 – 100 days 5. Nausea and vomiting
6. Joint and Muscle pain
7. Steatorrhea
8. Dark-colored urine
9. Low grade fever
Diagnostic test: -Hepatitis B immunization
-Wear protected clothing
Hepatitis B surface agglutination (HBSAg) test -Hand washing
-Observe safe-sex
Management: -Sterilize instruments used in
> Hepatitis B Immunoglobulin minor surgical-dental
procedures -Screening of
Diet: high in carbohydrates blood products for
transfusion

Hepatitis A – infectious hepatitis; oral-fecal

Hepatitis B – serum hepatitis; blood and body fluids
Hepatitis C – non-A non-B, post-transfusion hepatitis; blood and body fluids
Hepatitis D – Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis B
Hepatitis E – oral-fecal

II. DISEASES TRANSMITTED THROUGH FOOD AND WATER

DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION

1. Cholera Vibrio cholera Fecal-oral route Rice watery stool Diagnostic Test: Proper handwashing
Vibrio coma Stool culture Proper food and water
Other names: Ogawa and Inaba bacteria 5 Fs Period of sanitation Immunization of
El tor Communicability: 7-14 Treatment: Chole-vac
Incubation Period: days after onset, Oral rehydration solution (ORESOL)
Few hours to 5 days; occasionally 2-3 months IVF
usually 3 days Drug-of-Choice: tetracycline (use straw; can cause staining
of teeth)
 2. Amoebic Dysentery Entamoeba histolytica Fecal-oral route Abdominal cramping Treatment: Proper handwashing
Bloody mucoid stool Proper food and water sanitation
Protozoan (slipper-shaped body) Tenesmus - feeling of Metronidazole (Flagyl)
incomplete defecation * Avoid alcohol because of its Antabuse effect can cause

9 Communicable Disease Nursing

(Wikipedia) vomiting

3. Shigellosis Shigella bacillus
Other names: Sh-dysenterae – most
Bacillary dysentery infectious Sh-flesneri –
common in the Philippines
Sh-connei
Sh-boydii
Fecal-oral route Abdominal cramping Drug-of-Choice: Co-trimoxazole Proper handwashing
Bloody mucoid stool Proper food and water
5 Fs: Finger, Foods, Tenesmus - feeling of Diet: Low fiber, plenty of fluids, easily digestible foods sanitation Fly control
Feces, Flies, Fomites incomplete defecation
(Wikipedia)
Incubation Period:
1 day, usually less
than 4 days

4. Typhoid fever Salmonella typhosa Fecal-oral route Rose Spots in the Diagnostic Test: Proper handwashing
(plural, typhi) abdomen – due to bleeding Typhi dot – confirmatory test; specimen is feces Proper food and water sanitation
5 Fs caused by Widal’s test – agglutination of the patient’s serum
perforation of the Peyer’s
Incubation Period: patches Drug-of-Choice: Chloramphenicol
Usual range 1 to 3
weeks, average 2 weeks Ladderlike fever

5. Hepatitis A Hepatitis A Virus Fecal-oral route Fever Prophylaxis: “IM” injection of gamma globulin Proper handwashing
Headache Hepatitis A vaccine Proper food and water
Other names: 5 Fs Jaundice Hepatitis immunoglobulin sanitation Proper disposal of
Infectious Clay-colored stool urine and feces Separate and
Hepatitis / Incubation Period: Complete bed rest – to decrease metabolic needs of proper cleaning of articles
Epidemic Lymphadenopathy used by patient
15-50 days, liver Low-fat diet; increase carbohydrates (high in
Hepatitis / depending on dose, Anorexia sugar)
Catarrhal average 20-30 days
Jaundice
6. Paralytic Dinoflagellates Ingestion of raw of Numbness of face Treatment: 1. Avoid eating shellfish such
Shellfish inadequately cooked especially around the 1. No definite treatment as tahong, talaba, halaan,
Poisoning (PSP I Phytoplankton seafood usually mouth 2. Induce vomiting kabiya, abaniko during red
Red tide bivalve mollusks Vomiting and dizziness 3. Drink pure coconut milk – weakens the toxic effect tide season
poisoning) during red tide Headache 4. Sodium bicarbonate solution (25 grams in ½ glass of 2. Don’t mix vinegar to
season Tingling water) shellfish it will increase
sensation/paresthesia and Advised only in the early stage of illness because toxic effect 15 times
Incubation Period: eventful paralysis of paralysis can lead to aspiration greater
30 minutes to hands NOTE: Persons who survived the first 12 hours after
several hours after Floating sensation and ingestion have a greater chance of survival.
ingestion weakness
Rapid pulse
Dysphonia
Dysphagia
Total muscle paralysis
leading to respiratory arrest
and death

ROBERT C. REÑA, BSN

10 Communicable Disease Nursing III. SEXUALLY TRANSMITTED DISEASES

DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION

TRANSMISSION

1. Syphilis Treponema pallidum Direct contact Primary stage: painless Diagnostic test: Abstinence
(a spirochete) Transplacental chancre at site of entry Dark field illumination test Be faithful
Other names: Buboes Fluorescent treponemal antibody absorption test – Condom
Sy Incubation Period: Condylomata most reliable and sensitive diagnostic test for Syphilis
Bad Blood 10 days to 3 months Gumma VDRL slide test, CSF analysis, Kalm test,
The pox (average of 21 days) Wasseman test
Lues venereal
Morbus gallicus Treatment:
Primary and secondary sores will go even Drug of Choice: Penicillin (Tetracycline if resistant
without treatment but the germs continue to Penicillin)
to spread throughout the body. Latent
syphilis may continue 5 to 20+ years with

2. Gonorrhea Direct
symptoms, but contact –isgenitals,
the person Thick purulent yellowish Diagnostic test: Abstinence
Neiserria gonorrheae discharge Culture of urethral and cervical smear Be faithful
Other names: NO longer infectious to other
anus,people
mouth Burning sensation upon Gram staining Condom
GC, Clap, Drip, urination / dysuria
Stain, Gleet, pregnant Incubation Period: Treatment:
Flores Blancas mother can transmit the disease
2 – 10 days to Drug of Choice: Penicillin
her unborn child (congenital syphilis).
 3. Trichomoniasis Trichomonas vaginalis Direct contact Females: Diagnostic Test: Abstinence
white or greenish-yellow Culture Be faithful
Other names: Incubation Period: odorous discharge Condom
Vaginitis 4 – 20 days; average vaginal itching and Treatment:
Trich of 7 days soreness painful Drug of Choice: Metronidazole (Flagyl) Personal Hygiene
urination
Males:
Slight itching of penis
Painful urination
Clear discharge from penis

4. Chlamydia Chlamydia trachomatis Direct contact Females: Diagnostic Test: Abstinence

(a rickettsia) Asymptomatic Culture Be faithful
Incubation Period: Dyspareunia Condom
2 to 3 weeks for Fishy vaginal discharge Treatment:
males; usually no Drug of Choice: Tetracycline
symptoms for Males:
females Burning sensation during
urination
Burning and itching of
urethral opening (urethritis)

5. Candidiasis Candida albicans Direct contact White, cheese-like vaginal Diagnostic Test: Abstinence
discharges Culture Be faithful
Other names: Curd like secretions Gram staining Condom
Moniliasis
Candidosis Treatment:
Nystatin for oral thrush
Cotrimazole, fluconazole for mucous membrane and
vaginal infection

11 Communicable Disease Nursing

Fluconazole or amphotericin for systemic infection
6. Acquired Retrovirus (Human T-cell Direct contact 1. Window Phase
immune lymphotrophic virus 3 or Blood and body a. initial infection
deficiency HTLV 3) fluids b. lasts 4 weeks to 6
syndrome (AIDS) Transplacental months c. not observed
Attacks the T4 cells: T- by present
helper cells; T- Incubation period: laboratory test (test should
lymphocytes, and CD4 3-6 months to 8-10 years be repeated after 6
lymphocytes months)
Variable. Although the
time from infection to 2. Acute Primary HIV
the development of Infection
detectable antibodies is a. short, symptomatic
generally 1-3 months, period b. flu-like
the time from HIV symptoms
infection to diagnosis c. ideal time to undergo
of AIDS has an screening test (ELISA)
observed range of less
than 1 year to 15 years 3. Asymptomatic HIV
or longer. Infection
(PHN Book) a. with antibodies against
HIV but not protective
b. lasts for 1-20 years
depending upon factors
4. ARC (AIDS Related
Complex)
a. a group of symptoms
indicating the disease is likely
to progress to AIDS
b. fever of unknown origin
c. night sweats
d. chronic intermittent
diarrhea e.
lymphadenopathy
f. 10% body weight loss
Diagnostic tests: Abstinence
Enzyme-Linked Immuno-Sorbent Assay (ELISA) Be faithful
- presumptive test Condom
Western Blot – confirmatory
Sterilize needles, syringes,
Treatment: and instruments used for
1. Treatment of opportunistic infection cutting operations
2. Nutritional rehabilitation
3. AZT (Zidovudine) – retards the replication of Proper screening of blood donors
retrovirus
4. PK 1614 - mutagen Rigid examination of blood
and other blood products
Avoid oral, anal contact
and swallowing of
semen
Avoid promiscuous sexual
contact
HIV/AIDS Prevention
and Control Program:
Goal: Contain the transmission
of HIV /AIDS and other
reproductive tract infections
and mitigate their impact

5. AIDS
a. manifestation of severe
immunosuppression
b. CD4 Count: <200/dL
c. presence of variety of
infections at one time:

oral candidiasis
leukoplakia
AIDS dementia complex
Acute encephalopathy
Diarrhea, hepatitis
Anorectal disease
12 Communicable Disease Nursing
Cytomegalovirus
Pneumonocystis carinii
pneumonia (fungal)
TB
Kaposi’s sarcoma (skin
cancer; bilateral purplish
patches)
Herpes simplex
Pseudomonas infection
Blindness
Deafness

ROBERT C. REÑA, BS
IV. ERUPTIVE DISEASES
DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION

1. Chickenpox Human (alpha) herpes Droplet spread Vesiculo-pustular rashes No specific diagnostic exam Case over 15 years of age
virus 3 (varicella-zoster should be investigated to
Other names: virus), a Direct contact Centrifugal appearance of Treatment is supportive and symptomatic; infection viral eliminate possibility of
Varicella member of the in origin, and therefore is self-limiting smallpox.
Herpesvirus group Indirect through articles rashes Pruritus Report to local authority
freshly soiled by Drug-of-choice: Isolation
discharges of infected Acyclovir (orally to reduce the number of lesions; topically Concurrent disinfection of
persons to lessen the pruritus) throat and nose discharges
Period of Exclusion from school for 1
Communicability: Not Incubation Period: week after eruption first
more than one day before 2-3 weeks, commonly 13 appears Avoid contact with
and more than 6 days after to 17 days susceptibles
appearance of the first crop
of vesicles

2. German Measles Rubella virus or RNA Droplet Forscheimer spots – red Diagnostic Test: MMR vaccine (live
containing Togavirus pinpoint patches on the Rubella Titer (Normal value is 1:10) attenuated virus)
Other Names: Incubation Period: oral cavity - Derived from chick
Rubella German measles is Three (3) days embryo Contraindication:
Three-day Measles teratogenic infection. Maculopapular rashes - Allergy to eggs
Headache - If necessary, given in
Low-grade fever Instruct the mother to avoid pregnancy for three months divided or fractionated doses
Sore throat after receiving MMR vaccine. and
epinephrine should be at
the bedside.
 3. Herpes Zoster Herpes zoster virus Droplet Painful vesiculo-pustular Treatment is supportive and symptomatic Avoidance of mode of
(dormant varicella zoster virus) Direct contact from secretion lesions on limited portion of transmission
Other names: the body (trunk and shoulder) Acyclovir to lessen the pain
Shingles
Cold sores Low-grade fever

4. Dengue Dengue virus 1, 2, 3, and 4 Bite of infected Classification (WHO): Diagnostic Test: 4 o’clock habit
Hemorrhagic Fever and Chikungunya virus mosquito (Aedes
Aegypti) Grade I: Torniquet test (Rumpel Leads Test / capillary fragility test) Chemically treated mosquito
Other names: Period of a. flu-like symptoms – PRESUMPTIVE; positive when 20 or more oetechiae net Larva eating fish
H-fever communicability: Daytime biting b. Herman’s sign per 2.5 cm square or 1 inch square are observed Environmental sanitation
Unknown. Presumed to be Low flying
on

13 Communicable Disease Nursing

the 1st week of illness up to
when the virus is still present
in the blood
Occurrence is sporadic
throughout the year
Epidemic usually occur
during the rainy seasons
(June to
November)
Peak months: September
and October
Stagnant clear water c. (+) tourniquet sign Platelet count – CONFIRMATORY; (Normal is 150 - Antimosquito soap
Urban 400 x 103/ mL) Neem tree (eucalyptus)
Grade II:
Incubation Period: a. manifestations of Grade I Treatment: Eliminate vector
Uncertain. Probably 6 days plus spontaneous bleeding Supportive and symptomatic Avoid too many hanging
to 1 week b. e.g. petechiae, Paracetamol for fever clothes inside the house
ecchymosis purpura, gum Analgesic for pain Residual spraying with
Manifestations: bleeding insecticide
Rapid replacement of body fluids – most important
First 4 days: Grade III:
Febrile/Invasive Stage a. manifestations of Grade treatment ORESOL
- starts abruptly as fever II plus beginning of
- abdominal pain circulatory failure Blood tansfusion
- headache b. hypotension,
- vomiting tachycardia, tachypnea Diet: low-fat, low-fiber, non-irritating, non-
- conjunctival infection carbonated. Noodle soup may be given. ADCF
-epistaxis Grade IV: (Avoid Dark-Colored Foods)
a. manifestations of Grade
4th– 7th days: III plus shock (Dengue ALERT! No Aspirin
Toxic/Hemorrhagic Shock Syndome)
Stage - decrease in
temperature - severe
abdominal pain
- GIT bleeding
- unstable BP (narrowed
pulse pressure)
- shock
- death may occur

7th– 10th days:

Recovery/
 Convalescent Stage
- appetite regained
- BP stable

ROBERT C. REÑA, BSN

V. VECTOR-BORNE DISEASES
DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION

1. Malaria Plasmodium Parasites: Bite of infected Cold Stage: severe, Early Diagnosis and Prompt Treatment *CLEAN Technique
Vivax anopheles mosquito recurrent chills (30 Early diagnosis – identification of a patient with malaria as *Insecticide – treatment of
Falciparum (most fatal; minutes to 2 hours) soon as he is seen through clinical and/or microscopic mosquito net
most common in the Night time biting method Clinical method – based on signs and symptoms of *House Spraying (night
Philippines) Ovale High-flying Hot Stage: fever (4-6 the patient and the history of his having visited a malaria- time fumigation)
Malariae Rural areas endemic area Microscopic method – based on the *On Stream Seeding –
Clear running water hours) Wet Stage: examination of the blood smear of patient through construction of bio-ponds
microscope (done by the medical technologist) for fish propagation (2-4
Profuse sweating - fishes/m2

intermittent chills and

14 Communicable Disease Nursing

sweating QBC/quantitative Buffy Coat – fastest for immediate impact; 200-
- anemia / pallor Malarial Smear – best time to get the specimen is at height 400/ha. for a delayed effect)
- tea-colored urine of fever because the microorganisms are very active and *On Stream Clearing –
- malaise easily identified cutting of vegetation
- hepatomegaly overhanging along stream
- splenomegaly Chemoprophylaxis banks
- abdominal pain and Only chloroquine should be given (taken at weekly
enlargement intervals starting from 1-2 weeks before entering the *Avoid outdoor night
- easy fatigability endemic area). In pregnant women, it is given throughout activities (9pm – 3am)
the duration of pregnancy. *Wearing of clothing that
covers arms and legs in the
Treatment: evening *Use mosquito
NURSING CARE:
Blood Schizonticides - drugs acting on sexual blood stages repellents
1. TSB (Hot Stage) *Zooprophylaxis – typing
2. Keep patent warm of the parasites which are responsible for clinical
manifestations 1. QUININE – oldest drug used to treat of domestic animals like
(Cold Stage) the
3. Change wet clothing malaria; from the bark of Cinchona tree; ALERT:
Cinchonism – quinine toxicity carabao, cow, etc near
(Wet Stage) human dwellings to deviate
4. Encourage fluid intake 2. CHLOROQUINE
3. PRIMAQUINE mosquito bites from man to
5. Avoid drafts these animals
 4. FANSIDAR – combination of pyrimethamine and
sulfadoxine Intensive IEC campaign

2. Filariasis Wuchereria bancrofti Bite of Aedes poecillus Asymptomatic Stage: Diagnosis CLEAN Technique
Brugia malayi (primarily) Presence of microfilariae in Physical examination, history taking, observation of major
Other names: Brugia timori Aedes flavivostris the blood but no clinical and minor signs and symptoms Use of mosquito repellents
Elephantiasis (secondary) signs and symptoms of Anytime fumigation
– nematode parasites disease Laboratory examinations Wear a long sleeves, pants
Endemic in 45 out Incubation period: Nocturnal Blood Examination (NBE) – blood are taken and socks
of 78 provinces 8 – 16 months Acute Stage: from the patient at his residence or in hospital after 8:00
Lymphadenitis pm Immunochromatographic Test (ICT) – rapid
Highest prevalence Lymphangitis assessment method; an antigen test that can be done at
rates: Regions 5, 8, Affectation of male genitalia daytime
11 and CARAGA
Chronic Stage: (10-15 Treatment:
years from onset of first Drug-of-Choice: Diethylcarbamazine Citrate (DEC)
attack) or Hetrazan
Hydrocele
Lymphedema
Elephantiasis

3. Shistosomiasis Schistosoma mansoni Contact with the infected Diarrhea Diagnostic Test: Dispose the feces properly
S. haematobium freshwater with cercaria Bloody stools COPT or cercum ova precipitin test not reaching body of water
Other Names: S. japonicum (endemic in and penetrates the skin Enlargement of abdomen Use molluscides
Snail Fever the Philippines) Splenomegaly Treatment: Prevent exposure to
Bikharziasis Vector: Oncomelania Hepatomegalu Drug-of-Choice: PRAZIQUANTEL (Biltracide) contaminated water (e.g.
Quadrasi Anemia use rubber boots)
Endemic in 10 weakness Oxamniquine for S. mansoni Apply 70% alcohol
regions and 24 Metrifonate for S. haematobium immediately to skin to kill
provinces surface cercariae Allow water
to stand 48-72

15 Communicable Disease Nursing

High prevalence: hours before use
Regions 5, 8, 11

ROBERT C. REÑA, BSN

REFERENCES:
THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM,
RN CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10 th EDITION
DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov

VI. DISEASES TRANSMITTED BY ANIMALS

 DISEASE CAUSATIVE AGENT
1. Leptospirosis Leptospira interrogans –
bacterial spirochete
Other Names:
- Weil’s Disease RAT is the main host.
- Mud Fever Although pig, cattle, rabbits,
- Trench Fever hare, skunk, and other wild
- Flood Fever animals can also serve as
- Spirochetal reservoir
Jaundice
- Japanese Seven Occupational disease
Days fever affecting veterinarians,
miners, farmers, sewer
workers, abattoir workers, etc
2. Rabies Rhabdovirus of the genus
lyssavirus
Other Names:
Lyssa Degeneration and necrosis of
Hydrophobia brain – formation of negri
Le Rage bodies
Two kinds of Rabies:
a. Urban or canine –
transmitted by dogs
b. Sylvatic – disease of
wild animals and bats
which
sometimes spread to dogs,
cats, and livestock
16 Communicable Disease Nursing
3. Bubonic Plague Bacteria (Yersinia pestis)
Vector: rat flea
MODE OF
TRANSMISSION
Through contact of the
skin, especially open
wounds with water, moist
soil or
vegetation infected with
urine of the infected host
Incubation Period:
7-19 days, average of 10 days
Bite or scratch (very rare)
of rabid animal
Non-bite means: leaking,
scratch, organ transplant
(cornea),
inhalation/airborne (bats)
Source of infection: saliva
of infected animal or
human
Incubation period:
2 – 8 weeks, can be years
depending on severity of
wounds, site of wound as
distance from brain,
amount of virus
introduced, and
protection provided by
clothing
Direct contact with the
infected tissues of rodents
PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
Leptospiremic Phase Diagnosis Protective clothing, boots
- leptospires are present Clinical manifestations and gloves
in blood and CSF Culture of organism
- onset of symptoms is Examination of blood and CSF during the first week of Eradication of rats
abrupt - fever illness and urine after the 10th day
- headache Leptospira agglutination test Segregation of domestic
- myalgia
- nausea Treatment: animals Awareness and early
- vomiting Penicillins and other related B-lactam antibiotics
- cough Tetracycline (Doxycycline) diagnosis Improved
- chest pain Erythromycin
education of people
Immune Phase
- correlates with the
appearance of circulating
IgM
Sense of apprehension Diagnosis: Have pet immunized at 3
Headache history of bite of animal months of age and every
Fever culture of brain of rabid animal year thereafter
Sensory change near site demonstration of negri bodies
of animal bite Never allow pets to roam
Spasms of muscles of Management: the streets
deglutition on attempts to *Wash wound with soap immediately. Antiseptics
swallow e.g. povidone iodine or alcohol may be applied Take care of your pet
Fear of water/hydrophobia *Antibiotics and anti-tetanus immunization
Paralysis *Post exposure treatment: local wound treatment, National Rabies
Delirium active immunization (vaccination) and passive Prevention and Control
Convulsions immunization (administration of rabies Program
immunoglobulin) Goal: Human rabies is
“FATAL once signs and *Consult a veterinarian or trained personnel to observe the eliminated in the
pet for 14 days Philippines and the
symptoms appear”
country is declared
*Without medical intervention, the rabies victim rabies-free
would usually last only for 2 to 6 days. Death is
often due to
respiratory paralysis.
Fever and lyphadenitis Streptomycin, tetracycline, chloramphenicol Environmental Sanitation
 VII. DISEASES OF THE SKIN
DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION

1. Leprosy Mycobacterium leprae Airborne-droplet Early signs: Diagnostic Test: Avoid prolonged skin-to-
Change in skin color – either reddish Slit Skin Smear - determines the presence of M. skin contact
Other names: Prolonged skin-to- or white leprae; optional and done only if clinical diagnosis is BCG vaccination –
Hansenosis skin contact Loss of sensation on the skin doubtful to prevent misclassification and wrong practical and effective
Hansen’s disease lesion Loss of sweating and hair treatment preventive
growth Thickened and painful Lepromin Test – determines susceptibility to leprosy measure against leprosy
-an ancient disease nerves Good personal hygiene
and is a leading Muscle weakness or paralysis Treatment: Adequate nutrition
cause of or extremities Ambulatory chemotherapy through use of MDT Health education
permanent physical Pin and redness of the eyes Domiciliary treatment as embodied in RA 4073
disability among Nasal obstruction or bleeding which advocates home treatment
the communicable Ulcers that do not heal
diseases PAUCIBACILLARY (tuberculoid and
Late Signs: indeterminate); noninfectious type
Madarosis Duration of treatment: 6 to 9 months
Loss of eyebrows Procedure:
Inability to close eyelids Supervised: Rifampicin and Dapsone once a month on
(lagophthalmos) the health center supervised by the rural health
Clawing of fingers and toes midwife Self-administered: Dapsone everyday at the
Contractures client’s house
Chronic ulcers
Sinking of the nosebridge MULTIBACILLARY (lepromatous and borderline);
Enlargement of the breast infectious type
(gynecomastia) Duration of treatment: 24-30 months
Procedure:
Supervised: Rifampicin, Dapsone, and Lamprene
(Clofazimine) once a month on the health center supervised
by the rural health midwife
Self-administered: Dapsone and Lamprene everyday at
the client’s house

17 Communicable Disease Nursing

2. Anthrax Bacillus anthracis Contact with 1. Cutaneous form – most Treatment: Penicillin Proper handwahing
a. tissues of animals common - itchiness on exposed
Other names: (cattle, sheep, goats, part Immunize with cell-free
Malignant pustule horses, pigs, etc.) - papule on inoculation site vaccine prepared from
Malignant edema Incubation period: dying of the disease - papule to vesicle to eschar culture filtrate containing
Woolsorter disease few hours to 7 days most b. biting flies that - painless lesion the
Ragpicker disease cases occur within 48 had partially fed protection antigen
Charbon hours of exposure on such animals 2. Pulmonary form – contracted
c. contaminated hair, from inhalation of B. anthracis Control dust and proper
wool, hides or spores ventilation
products made from - at onset, resembles common
them e.g. drums and URTI - after 3-5 days, symptoms
brushes become acute, with fever,
d. soil associated shock, and death
with infected
animals or 3. Gastrointestinal anthrax –
contaminated bone contracted from ingestion of meat
meal used in from infected animal
gardening - violent gastroenteritis
- vomiting
- bloody stools

3. Scabies Sarcoptes scabiei Direct contact with Itching Diagnosis: Personal hygiene
- An itch mite infected individuals Appearance of the lesion Avoid playing with dogs
parasite When secondarily infected: Intense itching Laundry all clothes and
Incubation Period: Skin feels hot and burning Finding of causative mite iron Maintain the house
24 hours clean
When large and severe: fever, Treatment: (limited entirely to the skin) Environmental sanitation
headache, and malaise Examine the whole family before undertaking treatment Eat the right kind of food
Benzyl benzoate emulsion (Burroughs, Welcome) – cleaner Regular changing of clean
to use and has more rapid effect clothing, beddings and
Kwell ointment towels

4. Pediculosis Pediculosis Direct contact Itchiness of the scalp Kwell shampoo (twice a week) Proper hygiene
Capitis (head lice)
Other name: Corporis (body lice) Common in school One tbsp water + one tbsp vinegar
Phthipiasis Pubis (crab lice) age
 VIII. INTESTINAL PARASITISM
18 Communicable Disease Nursing
DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION

1. Ascariasis Ascaris lumbricoides Fecal-oral route Pot-bellied Diagnostic Test: Fecalysis Proper handwahing
Voracious eater
Other names: (nematode) 5 Fs: Finger, Foods, Feces, Thin extremities Treatment:
Roundworm Flies, Fomites Antihelminthic: Mebendazole / Pyrantel Pamoate
Giant worms

2. Taeniasis Taenia solium – pork Eating inadequately Muscle soreness Diagnostic Test: Fecalysis Proper handwahing
Taenia saginata – beef cooked pork or beef Scleral hemorrhage
Other name: Dyphyllobotruim latum – fish Treatment: Cook pork and beef adequately
Tape worm 5 Fs: Finger, Foods, Feces, Antihelminthic: Mebendazole / Pyrantel Pamoate
Flies, Fomites

3. Capillariasis Trichuris trichuria Eating inadequately Abdominal pain Diagnostic Test: Fecalysis Proper handwahing
cooked seafood Diarrhea
Other name: Capillararia Philippinensis borborygmi Treatment: Cook seafoods adequately
Whip worm 5 Fs: Finger, Foods, Feces, Antihelminthic: Mebendazole / Pyrantel pamoate
Flies, Fomites

4. Enterobiasis Enterobium vermicularis Inhalation of ova Nocturnal anal itchiness Diagnostic Test: Fecalysis / tape test Proper handwahing
Toilet seat
Other name: Infected bedsheets Treatment: Proper disinfection of beddings
Pinworm Antihelminthic: Mebendazole / Pyrantel pamoate
5 Fs: Finger, Foods, Feces,
Flies, Fomites

5. Ancyloclos Ancyclostoma duodenal Walking barefooted Dermatitis Diagnostic Test: Fecalysis Proper handwahing
tomiasis
Necatur americanus 5 Fs: Finger, Foods, Feces, Anemia Treatment: Avoid walking barefooted
Other name: Flies, Fomites Antihelminthic: Mebendazole / Pyrantel pamoate
Hookworm Black fishy stool

ROBERT C. REÑA, BSN

IX. OTHER COMMUNICABLE DISEASES

DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION

1. Pneumonia Bacteria: Droplet Rusty sputum Diagnosis: Avoid mode of

Pneumococcus, Fever and chills Based on signs and symptoms
Types: streptococcus pneumoniae, Incubation Period: Chest pain Dull percussion on affected lung transmission Build
 a. Community staphylococcus aureus, 2 – 3 days Chest indrawing Sputum examination – confirmatory resistance
Acquired Klebsiella pneumonia Rhinitis/common cold Chest x-ray
Pneumonia (Friedlander’s bacilli) Productive cough Turn to sides
(CAP) Fast respiration Management:
b. Hospital / Virus: Vomiting at times Bedrest Proper care of influenza cases
Nosocomial Haemophilus influenzae Convulsions may occur Adequate salt, fluid, calorie, and vitamin intake
c. Atypical Flushed face Tepid sponge bath for fever
Fungi: Pneumonocystis Dilated pupils Frequent turning from side to side
carinii pneumonia

19 Communicable Disease Nursing

Highly colored urine with Antibiotics based on CARI of the DOH
reduced chlorides and
increased urates Oxygen inhalation
Suctioning
Expectorants / mucolytics
Bronchodilators
Oral/IV fluids
CPT

2. Mumps Mumps virus, a member Direct contact Painful swelling in front of Supportive and symptomatic MMR vaccine
of family the ear, angle of the jaws
Other name: Paramyxoviridae Source of infection: and down the neck Sedatives – to relieve pain from orchitis Isolate mumps cases
Epidemic Parotitis Secretions of mouth and nose Fever Cortisone – for inflammation
Malaise
Incubation Period: Loss of appetite Diet: Soft or liquid as tolerated
12 to 26 days, usually 18 days Swelling of one or both
testicles (orchitis) in some Support the scrotum to avoid orchitis, edema, and
boys
atrophy Dark glasses for photophobia

3. Influenza Influenza virus Direct contact Sudden onset Supportive and symptomatic Avoid use of common
A – most common Droplet infection or by Fever with chills towels, glasses, and eating
Other name: B – less severe articles freshly soiled Headache Keep patient warm and free from drafts utensils
La Grippe C – rare with nasopharyngeal Myalgia / arthralgia TSB for fever Cover mouth and nose
discharges Airborne Boil soiled clothing for 30 minutes before laundering during cough and sneeze
Period of
Communicability: Probably Incubation Period:
limited to 3 days from Short, usually 24 – 72 hours
clinical onset
 4. Streptococcal Group A beta hemolytic Droplet Sudden onset
sore throat streptococcus High grade fever with
Complication: chills Enlarged and tender
Other name: Other diseases: Rheumatic Heart Disease cervical lymph nodes
Pharyngitis Scarlet fever Inflamed tonsils with
Tonsillitis St. Anthony fire mucopurulent exudates
Puerperal sepsis Headache
Imoetigo dysphagia
Acute glumerulonephritis
Rheumatic Heart Disease
5. Meningitis Meningococcus Direct (Droplet) A. Sudden Onset
Neisseria meningitides - high fever accompanied
Other name: Incubation Period: by chills
Cerebrospinal fever 2 - 10 days - sore throat, headache,
prostration (collapse)
B. entrance into the
bloodstream leading to
septicemia
(meningococcemia)
a. rash, petchiae, purpura
20 Communicable Disease Nursing
C. Symptoms of menigeal
irritation
- nuchal rigidity (stiff
neck) – earliest sign
- Kernig’s sign – when
knees are flexed, it cannot
be extended - Brudzinski
signs – pain on neck flexion
with automatoc flexion of
the knees
- convulsion
- poker soine (poker face /
flat affect)
- Increased ICP
(Cushing’s triad:
hypertension, bradycardia,
bradypnea) and widening
pulse pressure
IX. KILLER DISEASES OF THE NEW MILLENNIUM
Diagnosis: Avoid mode of transmission
Throat swab and culture
Treatment: erythromycin
Care:
Bed rest
Oral hygiene with oral antiseptic or with saline gargle (1
glass of warm water + 1 tsp rock salt)
Ice collar
Diagnostic Test: Respiratory Isolation
Lumbar puncture or Lumbar tap - reveals CSF WBC
and protein, low glucose; contraindicated for increased
ICP for danger of cranial herniation
Hemoculture – to rule out meningococcemia
Treatment:
Osmotic diuretic (Mannitol) – to reduce ICP and
relieve cerebral edema; Alert: fastdrip to prevent
crystallization
Anti-inflammatory (Dexamethasone) – to relieve
cerebral edema
Antimicrobial (Penicillin)
Anticonvulsany (Diazepam / Valium)
Complications:
Hydrocephalus
Deafness (Refer the child for audiology testing) and
mutism Blindness
 DISEASE CAUSATIVE AGENT MODE OF PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION

1. Meningococcemia Neisseria meningitides Direct contact with
respiratory droplet from
nose and throat of
infected individuals
Incubation Period:
2 – 10 days
High grade fever in the Respiratory isolation within 24 hours Universal precaution
first 24 hours Chemoprophylaxis
Hemorrhagic rash – Drug-of-Choice: Penicillin Proper hand washing
petechiae
nuchal rigidity
Kernig’s sign
Brudzinski sign
Shock
Death

2. Severe Acute Coronavirus Close contact with Prodromal Phase: No specific treatment Utilize personal
Respiratory respiratory droplet Fever (>38 0C) protective equipment
Syndrome / SARS secretion from patient Chills PREVENTIVE MEASURES and (N95 mask)
Malaise CONTROL 1. Establishment of triage
Earliest case: Incubation Period: Myalgia 2. Identification of patient Handwashing
Guangdong 2 – 10 days Headache 3. Isolation of suspected probable case
Province, China in Infectivity is none to low 4. Tracing and monitoring of close contact Universal Precaution
November 5. Barrier nursing technique for suspected and The patient wears mask
2002 Respiratory Phase: probable case Isolation
Within 2-7 days, dry
Global outbreak: nonproductive cough
March 12, 2003 progressing to
respiratory distress
First case in the
Philippines:
April 11, 2003

21 Communicable Disease Nursing

3. Bird Flu Influenza Virus H5N1 Contact with infected birds Fever Control in birds: Isolation technique
Body weakness and 1. Rapid destruction (culling or stamping out of all Vaccination
Other Name: Incubation Period: body malaise infected or exposed birds) proper disposal of carcasses Proper cooking of poultry
Avian Flu 3 days, ranges from 2 – Cough and quarantining and rigorous disinfection of farms 2.
4 days Sore throat Restriction of movement of live poultry
Dyspnea
Sore eyes In humans:
1. Influenza vaccination
2. Avoid contact with poultry animals or migratory
birds
4. Influenza A (H1N1) Influenza Virus A H1N1 Exposure to droplets - similar to the symptoms Diagnostic: - Cover your nose and
from the cough and of regular flu such as Nasopharyngeal (throat) swab mouth when coughing and
Other Name: This new virus was sneeze of the infected Fever Immunofluorescent antibody testing – to distinguish sneezing - Always wash
Swine Flu first detected in people person influenza A and B hands with soap and water
Headache
in April 2009 in the - Use alcohol- based
Fatigue hand sanitizers
May 21, 2009 – first United States. Influenza A (H1N1) is
confirmed case in not transmitted by eating Lack of appetite Treatment: - Avoid close contact
the Philippines Influenza A (H1N1) thoroughly cooked pork. Runny nose Antiviral medications may reduce the severity and with sick people
is fatal to humans Sore throat duration of symptoms in some cases: - Increase your body's
June 11, 2009 - The The virus is killed by Cough Oseltamivir (Tamiflu) resistance
WHO raises its cooking temperatures - Vomiting or nausea or zanamivir - Have at least 8 hours
Pandemic Alert Level of 160 F/70 C. - Diarrhea of sleep
to Phase 6, citing - Be physically active
significant Incubation Period: - Manage your stress
transmission of the 7 to 10 days - Drink plenty of fluids
virus. - Eat nutritious food

ROBERT C. REÑA, BSN