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INFECTIOUS DISEASE
[Definition, Terminologies, Classification,
Modes of transmission]
DEF: Illness caused by a specific infections agent [bacteria, fungus,
parasite, virus] or its toxic product that results from transmission of
that agent or its product from an infected person, animal or reservoir to
a susceptible host, either directly or indirectly through an intermediate
plant or animal host or vector or inanimate environment.
COMMUNICABLE DISEASE:
HOST: - TYPES:
1. Definitive host: The host that harbours an agent in mature or in a
sexually active phase.
2. Intermediate host: Host that harbours the agent in a larvae stage
or asexual development stage.
VECTOR: When the transmission of an agent is intermediated by
arthropod, this arthropod is called a Vector.
The vector may be simply:-
Mechanically: that they merely carry the agent that accidentally
contaminated it.
Biological: When the infectious agent obligatorily requires the vector to
pass from one phase to another in its development.
RESERVIOR OF INFECTION:
Primary source of infection in which the infections agent finds
conditions that permit to survive and multiply and from where it can be
transmitted to another susceptible host.
Q] what happens when a person gets infected?
IMMUNITY
TERMS:
1. INCUBATION PEROID [LATENT PERIOD]: The time from when
someone gets infected to when symptoms start.
2. INFECTIOUS PERIOD: Time when infected person can spread the
disease and infect other.
[CARRIERS: Necessarily not showing the symptoms]
3. CASE FATALITY RATE:

[a] Measure severity of disease

[b] Proportion of people who die after infection
CFR = 6/10*100=60%
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4. BASIC REPRODUCTION RATE [BRR]:

[a] How infectious a disease is

[b] Average no. of secondary cases that occur as a result of the
infected individual
Measles: - BRR is 15
One case of measles can cause up to 15 other cases of measles
5. SECONDARY ATTACK RATE: Measure of infectiousness or spread
of disease.
Proportion of people who exposed to disease get the disease
Influence – 10%
1 out of every 10 susceptible people exposed to a influenza case will
develop the infection.
 AfraTafreeh.com

INFECTIOUS DISEASES CATEGORY:

1. Zoonotic Diseases: disease of animals which when transmitted to
humans can cause disease
Animals ----> Humans
60% of human’s infectious disease is zoonotic
Eg: From Dog to Humans--> Rabies occurs
From Rat to Humans--> Leptospirosis
2. EMERGING INFECTIUOS DISEASE: Appears for the first time in a
population {new} or May have existed previously but increasing in
incidence or geographical range.
Eg: EBOLA, new Influenza strain, Middle East Respiratory
syndrome Corona Virus [MERS cov]
3. NEGLECTED TROPICAL DISEASES: Group of tropical disease that
affect the poorest countries of the world.
Not received attention but continue to cause illness in the most
vulnerable groups of people in the world [ Poor condition of living, poor
socio economic status, poor sanitation and hygiene.
Eg: trachoma, leishmaniasis, schistosomiasis, sleeping sickness
4. VECTOR BORNE DISEASES: Disease transmitted from an infected
human animal to another person through the bite of a vector
[Arthropod]
Vector can be: Mosquitoes, Flies, Flea, and Ticks
Eg: Malaria, Chikungunya, Dengue
17% diseases are vector borne disease
TRANSMISSION OF INFECTIOUS DISEASE:
EPIDEMIOLOGICAL TRIAD: Agent {organism}
Host [target of the disease]
Environment [surroundings that influence
the occurrence of disease]
MODES OF TRANSMISSION:
1. DIRECT TRANSMISSION : [a] Direct contact

[b] Direct spread

[c] Inoculation into skin or mucosa
[d] Contact with soil
[e] Trans placental
2. INDIRECT TRANSMISSION: [a] Vehicle borne
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[b] Vector borne[Mechanical or
biological]
[c] Fomite borne
[d] Unclean hands and fingers
 AfraTafreeh.com

EPIDEMIOLOGY
[Smallpox, Chickenpox, Measles, Mumps
& Rubella and its prevention & control]

RESPIRATORY INECTIONS: Small pox

Chicken pox
Measles [Rubella]
Mumps [Rubella]
Rubella [German measles]
SMALL CHICKEN MEASLES MUMPS RUBELL
POX POX A
CAUSITIVE Variola Varicella RNA RNA RNA
AGENT virus zoster paramyxo paramyxo toga
[major [human virus [only virus virus
& herpes one paratiditis [only
minor] virus-3 serotype] [only one one
Alpha] serotype] antigeni
c type]
SOURCE OF Cases Cases Cases Cases and Cases
INFECTION subclinica and
l cases subclinic
al cases
PERIOD OF 3 weeks 1-2 days 4 days 4-6 days A week
COMMUNI from before the before the before before
CABILITY onset of appearanc appearanc onset of te onset
rash e of rash e of the symptom of the
and 4-5 rash & 5 sto 7 days sympto
 days the days after after ms to 1
rash the week
patient apperance after
becomes of rash appeara
non nce of
infectious rash
once the
onset have
formed
SECONDAR 30-40% 90% 80% 86% -
Y ATTACK
RATE
HOST - Age <10 Age- 6 Age- 5-9 3-10
FACTORS years, months- 3 years, years in
pregnancy years in immunity developi
[affects developing life long ng
only when nation, >5
AfraTafreeh.com nations
the years of & >15
infection age in years in
occured developed develop
during first age, ed
20 weeks lifelong nations,
of immunity, lifelong
gestation, Malnouris immunit
immunity hed child y {40%
is durable of
women
of child
bearing
age are
suscepti
ble
 AfraTafreeh.com

ENVIRONM - It shows It occurs It occurs Late

ENTAL seasonal mainly in mainly in winter
FACTORS variations winter and winter and
as it peaks early and spring, it
during spring spring shows
winter and cyclic
spring trend
every 4-
9 years
MODE OF Air Droplet Droplet Droplet Droplet
TRANSMIS droplet infection infection infection infection
SION vertical and direct and
transmissi contact vertical
on transmis
sion
INCUBATIO 12 days 14-16 days 10-14 days 14-18 18 days
N PERIOD [7- but it is days
17days] shortened
to 7 days
in
artificially
induced
measles
CLINICAL Centrifu Centrifugal Cough, Most Fever,
FEATURES gal, non- ,unilocular coryza commonl post
pleomor ,superficial conjunctivi y salivary auricular
phic, ,pleomorp tis & cold gland &
rash, hic rash Koplik’s enlargem posterio
deep spot[ at ent r cervical
multiloc upper 2nd [parotid lymphad
ular and molar gland] inopathy
affect tooth], ,CRS [
external maculopa congenit
 surfaces pular al
rash[behin rubella
d the ear] syndrom
retro e] in 1st
auricular trimeste
region r
A)
cataract
B) heart
defect
C)senso
neural
deafness
COMPLICA Scar, Generally Pneumoni Orchitis, Joint
TIONS blindnes no a is the oophiritis, problem
s, complicati most pancreati s &
osteomy ons common
AfraTafreeh.com tis thrombo
elitis while the cytopeni
most a
dangerous purpura
and rarest
SSPG [
subacute
scleroting
pan
encephalit
is] can
occur 7
persons in
million
cases of
measles
DIAGNOSIS Clinicall Clinically, Clinically Clinically Heme
 AfraTafreeh.com

y, PCR PCR or agglutin

cellulitis ation
test
PREVENTIO Live Isolation Isolation Isolation RA 27/3
N& vaccine case for 6 of case for of cases vaccine
CONTROL days 7 days till
Acyclovir,g after rash disappaer
ancyclovir Measles of
or vaccine: symptom
puscarnet MMR s
drugs Cátchup, Live
Varicella keep up & vaccine:
zoster follow up Jeryll
1a{in first 2012-2020 lynen
72 hrs} strain
Live
vaccine:
OKA stain
for 12-18
months
IMMUNITY - Protects 6 months 6 months 4-6
[from infants months
maternal from
antibodies] sometime
[few
months]

Q) Why small pox could be eradicated?

- No known animal reservoir
- No long term carrier state
- Infection provide lifelong immunity
 -Case detection simple due to characteristic rash
- Sub clinical cases did not transmit the disease
- A highly effective vaccine was available
- International cooperation

Q) Difference between chicken pox rash & small pox rash?

CHICKEN POX RASH
Dew drop or rose petal
appearance
Centripetal distribution
Pleomorphic rash
Superficial & unilocular
Inflammation around vesicle
present AfraTafreeh.com
Flexor surfaces involves axilla
Spares palms & soles
Rapid evolution
Scabies after 4-7days
SMALL POX RASH
-
Centripetal distribution
Non pleomorphic rash
Deep seated & multilocular
No inflammation around vesicle
Extensor surfaces [spares axilla]
Affects palms & soles
Slow evolution
Scabies after 10-14 days

Q) Most common late complication of chicken pox?

Answer: SHINGLES {reactivation of virus decades after initial
episodes of chicken pox}
Q) Most rapid and sensitive means of diagnosis?
Answer: Examination of vesicle fluid under electron microscope
[round particles]
 AfraTafreeh.com

Q) Measles elimination strategy?

Answer: Catch-up: nationwide vaccination campaign targeting all
children from 9 months to 14 years of age irrespective of history of
measles disease or vaccination status
KEEP UP: Routine services aimed at vaccination >95% of
each successive birth rate
Follow up: subsequent national wide vaccination campaign
condition every 2-4 years targeting usually all children born after catch-
up campaign
 EPIDEMIOLOGY
(Influenza, Diphtheria & Pertussis and Its
Prevention and control)

INFLUENZA DIPTHERIA PERTUSIS(WHO

OPING OR 100
DAYS COUGH)
AGENT Orthomyxocin Cory bacterium 95% Bordet Ella
3 types: A,B,C diphtheria pertussis
Type A: Most (gram +ve, 5% Bordet Ella
common cause non-motile parapatrics
of outbreaks / bacteria)
epidemics / Gravis, mites,
AfraTafreeh.com
only cause of Belfast &
pandemics intercedes
Type B & C not
circulating
currently
H1N1(Type A):
cause of swine
flu
H2N2(Type A)
H3N1(Type A):
can cause avian
Influenza or
bird flu
Cyclical trends
in influenza:-
Type A
 AfraTafreeh.com

epidemic: 2-3
years
Type B
epidemic: 4-7
years
Type A
pandemic: 10-
15 years
SOURCE OF Case and Case, Only cases
INFECTION subclinical case
subclinical,
carrier(95%
carrier to 5
cases)
PERIOD OF 1-2 days before 14-28 days after A week after
COMMUNICABI onset of onset of exposure to 3
LITY symptoms to 1- symptoms weeks after
2 days there onset of
after paroxysmal
stage
SECONDARY 5-15%(H1N1- - 90%
ATTACK RATE 22-33%)
HOST FACTORSAll age & both 1-5 years of age <5 years age
sex are affected & both sexes group incidence
but highest equally affected & motility is
mortality is <18 high in females
months & >65
years
ENVIRONMENT Overcrowding & All seasons but All seasons but
AL FACTORS poor ventilation more in winter more seen in
winter & during
spring, over
crowding
MODE OF Person to Mainly person Person to
TRANSMISSION person by to person by person by
droplet droplet droplet
infection & infection & also infection
droplet nuclei through for (contact)direct
mites
INCUBATION 18-72 hours 2-6 days 7-14 days( max
PERIOD 3 weeks)
CLINICAL Fever, sore Bull neck Paroxysms of
FEATURES throat, appearance due cough which is
coughing, body to Edema & followed by
ache lymphadenopat high pitch
hy in neck inspiratory
veins, pseudo
membrane
COMPLICATION Acute sinusitis, Myocarditis, Bronchitis,
AfraTafreeh.com
bronchitis, kidney damage, bronchopneu
pneumonia & nerve damage monia ,epitasis,
otitis media convulsions,
RYEES coma,
syndrome Conjunctival
influenza is haemorrhage
infection
DIAGNOSIS ELISA for Culture for Culture and
seasonal flu diagnosis & serological
RTPCR for H1N1 susceptibility to method
& viral culture infection is
SCHIK TEST
PREVENTION & Antiviral drug ( Penicillin or Erythromycin
CONTROL Oseltamivir erythromycin for treatment
Tamiflu 75mg for treatment DPT
for 5 days) Pentavalent
 AfraTafreeh.com

Vaccine( killed DPT

IM & live nasal
route)
IMMUNITY FOR - Few weeks to No protection
MATERNAL few months of from maternal
ANTIBODY infancy antibodies
therefore
children <6
months have
highest
mortality

Q) Antigenic variation in influenza?

Answer: Most common type A
ANTIGENIC SHIFT ANTIGENIC DEFECT
OCCURS DUE TO Genetic Point mutation
recombination/reasso
rtment/reabsorption
NATURE Sudden Gradual/insidual
change
MAY LEAD TO Pandemic Epidemics

Q) SCHICK: An intradermal test of immunity status and hypersensitivity

to diphtheria toxin
SCHICK TEST has been replaced by HEMAGGLUTINATION TEST
MENINGOCOCCAL MENINGITIS/ CEREBRO SPINAL FEVER:
Causative agent:
 1. Neisseria meningitis it is a gram –ve diplococcic
2. Serotype A,B,C,D,W135, X&Y
Source of infection: Carrier is most important source of infection
than cases
Mode of transmission: Droplet nuclei
Incubation period: 2-10 days
Case fertility rate: 80%
Drug of choice: 1. Rx cases: PENICILLIN
2. Rx carrier: RIFAMPICIN
3. Chemoprophylaxis of contacts: RIFAMPICIN (600MG
BD for 2 days)
Meningococcal vaccine: killed vaccine, cellular fraction 0.5ml
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subcutaneously. Antero lateral part of thigh
*VACCINE is not available for GROUP B MENINGOCOCCI*
 AfraTafreeh.com

EPIDEMIOLOGY
(Acute Respiratory Infections,
Tuberculosis & Its Prevention & Control)

ACUTE RESPIRATORY INFECTIONS:

IMNCI (Integrated Management of New Born Childhood Illness): Aims
to provide Holistic health
1. Acute Respiratory Infection (ARI) (2 months child)
2. Diarrheal
3. Measles (2 months-5years)
4. Malaria
5. Malnutrition
ARI (acute respiratory infection):
Bacteria: 1. Bordetella pertussis
2. Corynebacterium
3. Hemophilus
4. Klebsiella
5. Legionella
6. Staphylococcus pyrogens can lead to acute pharyngitis &
tonsillitis
7. Streptococcus pneumonia
*Hemophilus & klebsiella forms pneumonia i.e., lobular/bronco
pneumonia*
Virus: 1. Adenovirus
2. Enterovirus
3. Influenza ABC
4. Measles
5. Para influenza
6. Respiratory sensital virus
Others Agents that lead to ARI: 1. chlamydia Tupe B
2. Coxiella burnelti
3. Mycoplasma pneumonia (atypical)
If Child 2 months-5 years:

TYPE OF ARI COLOURAfraTafreeh.com

SIGNS/ MANAGEMENT
CODING SYMPTOMS
No pneumonia Green No signs of At home:
severe or very Inhaled
sever bronchodilator
pneumonia, for 5 days
Cough/cold If cough is >14
days refer TB
assessment
If recurrent
wheeze, refer
for ASTHMA
management
Follow in 5 days
if no
improvement
 AfraTafreeh.com

Advise the
mother when to
return
immediately
PNEUMONIA Yellow RR(Respiratory At PHC:
(not severe) Rate) >50 (in a -Oral
child of 2-12 Amoxicillin for 5
months) days
RR>40 (in a -Inhaled
child of 12 Bronchodilators
months-5 years) for 5 days
(FAST
-Sooth throat
BREATHING)
Cough > 14 days
Chest in
asses for TB
drawing +ve
-If recurrence of
wheeze refer
for asthma
-Follow up in 3
days
-Advise mother
when to return
immediately

SEVERE/ VERY Pink -stridor in a Refer to CHC?

SEVERE calm child Hospital
PNEUMONIA -Danger sign -First dose of
-Inability to referral
breast feed/ antibiotic
drink -Diazepam if
-Vomit out convulsing
everything -Rx to prevent
 -history of low sugar
convulsions -Keep child
-convulsing warmth
presently
-lethargic/
unconscious

If child 0-2months old/ young infant:

If Respiratory Rate >60 breaths/min (0-2months)
Chest in drawing +ve then it is pneumonia

VERY SEVERE COLOUR ANY OF THE REFER TO

PNEUMONIA CODING FOLLOWING CHC/HOSPITAL
DANGERS SIGN
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SEEN:
Pink -Not feeding -Give 1st dose of
well referral
-convulsions antibiotic
-severe chest in -Prevention of
drawing low sugar
-fever >37.5 C Keep the baby
-Body temp warmth
<35.5 C
-lethargic
-No movements
or movements
only on
stimulation
 AfraTafreeh.com

TUBERCULOSIS:
Agent: Mycobacterium Tuberculosis
Source of action: 1.Human source (smear +ve case)
2. Bovine source (infected milk)

Period of communicable: Smear +ve case as long as remains untreated

Host factors: All age & male
Environmental factors: Low socio economic status, overcrowding,
under dis nutrition, poor hygiene.
Mode of transmission: Droplet infection
Incubation period: From receipt of infection to +ve tuberculin test (3-6
weeks), there after the development of disease may
take years/months/weeks.
Clinical features: Fever, cough > 2weeks, weight loss
Complications: Hemoptysis, pleural effusion, fibrosis, death
Diagnosis:
Prevention & control: Anti TB drugs

EPIDEMIOLOGICAL INDICES OF TB:

1. Incidence of TB infection (also known as Annual infection
rate/Annual risk of infection(ARI)):
% of population under study who will be newly infected with TB
(a)
among non-infected in 1 year.
 (b) 1%ARI correspond to 50 sputum smear +ve cases/1,00,000
general population.
(c) Tuberculin conversion index
is the best indicator for evaluation
of TB problem & train in the community.
2. Prevalence of TB infection:

(a) Percentage of individual who show a +ve reaction to standard

tuberculin test.
(b) Represents cumulative experience of population in recent as
well as remote infection with TB.
(C) Tuberculintest is the only way estimating the prevalence of TB
infection in community.
3. Incidence of disease: Sputum smears examination reliable
method for estimation.
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4. Prevalence of disease: load of disease in community

-INDIA is a country with highest TB burden in the world

-Annual risk of infection in INDIA is 1.5%

MANTOUX TEST (IMMUNITY STATUS TEST):

(a) PPD (Purified Protein Derivative Measured in Tuberculin unit)
(b) Strength 50000 TU/mg
(c) Strain used for PPD – RT 23 with tween 80
(d) Dose 1 TU in 0.1 ml
(e) Given in flexor aspect of fore arm intradermally as a hyper
sensitivity skin test
 AfraTafreeh.com

(f) Ready after >72 hours

(g) Horizontal maximum diameter of induration

>9mm Positive Infected with TB

(current infection or
past infection not
indication)
6-9mm Equivocal Test is doubtful so
repeat the test)
<6mm Negative Never infected
FALSE +VE FALSE -VE
High coverage of BCG vaccination HIV
Measles
Immunosuppersor
False technique of infection
 EPIDEMIOLOGY
(Cholera, Typhoid, Hepatitis, Polio and its
Prevention & control)

GASTROINTSETINAL INFECTIONS:

CHOLERA TYPHOID
AGENT Two sero groups of Salmonella Typhi
vibrio cholera: O1 & O,H,Vi)
O139 Paratyphi A,B
Further O1 is
classified into 2
biotypes they are:
AfraTafreeh.com
1.Classical or Eltor
2.Ogawa, Inaba&
itikojine
SOURCE OF Cases & carrier Urine & feces of the
INFECTION (incubatory, carriers and cases,
Convalsent, healthy & also contaminated
chronic carriers) food and water
PERIOD OF Case remain Till bacilli disappear
COMMUNICABILITY infectious for 7-10 from stool or urine
days while covascent
carriers remain
infectious for 2-3
weeks &chronic
carriers lasts from
months to years
HOST FACTORS All age & both sexes, Can occur at any age
 AfraTafreeh.com

highest in children,but highest incidence

immunity(not in 5-9 years age
known),post Case is males
vaccination(immunityCarriers is females
stays for 3-6months)No solid immunity
after natural infection
ENVIRONMENTAL Poor sanitation, poor Peaks in rainy season
FACTORS personal hygiene (July to September)
MODE OF Contaminated water Feco-oral & urine-oral
TRANSMISSION & food, direct contact route
INCUBATION PERIOD Hours to 5 days 10-14 days
(1-2days)
CLINICAL FEATURES Profuse and painless Fever (step ladder),
watery (rice watery), ped soup diarrhoea,
diarrhea followed by dicrotic pulse,
vomiting splenomegaly, ROSE
SPOTS(2nd weeks)
COMPLICATIONS Severe dehydration Rare intestinal
leading to death perforation (3rd week)
DIAGNOSIS Staining (darting B – Blood culture
motility) and culture A – Widal test
Transport media for S – Stool culture
stool sample CARRY U – Urine culture
BLAIR MEDIA Typhi(DOT)
Enrichment media:
Alkaline peptone
water
PREVENTION & Rehydration therapy Fluroquinolones,
CONTROL & Drug of choice is cephalosporins for
doxycycline for cases, cases
chemoprophylaxis Carriers: Ampicillin
(tetracycline) for and trobencid
 close contacts Vaccines: TYPHORAL
Vaccination (Dukoval, (ty 21a starin: 1
Sanchol) capsule to be taken
on day 1,3 & 5 every 3
years)
TYPHIMVI

FOOD POISONING (FP):

STAPH SALMO BACILLUS BACILLUS BOTULIS CLOSTRIDI

FP NELLA CEREUS CEREUS M FP UM
FP (EMETIC (DIARRHE PERFRING
FORM) FP AL ES FP
FORM) FP
A Staphyloc Salmone Bacillus Bacillus Clostridi Clostridiu
G occus lla AfraTafreeh.com
enterotox cerus um m per
E aureus typhimu in bituliniu fringes
N enteroto rium (performe m type (welchi)
T xin S. d toxin) A,B & E
(perform cholera (enterot
ed toxin) suis, oxin)
S. perform
enteritid ed
is
S Milk & its Milk, Raw food, Soup, Home Infection
O products meat, processed sauce, preserve of meat,
U eggs, food, meat, d foods poultry
RC urine & fried rice, gravy, such as (reheated)
E feces of smashed custard canned
O mice, potato, vegetabl
F rats, pasta es,
 AfraTafreeh.com

IN human smacked
FE carriers fish
CT
IO
N
In 1-6 hours 12-24 1-6 hours 12-24 18-36 6-24 hours
cu hours hours hours (peak is
ba 10-14
ti hours)
on
pe
ri
od
CL Vomiting, Nausea, Upper GI Lower GI Dysphag Diarrhoea,
IN nausea, headach symptoms tract ia, abdominal
IC cramps, e, symptom diplopia, cramps
AL diarrhoea vomitin s ptosis,
FE g, blurring
AT diarrhoe of vision,
U a, low weaknes
RE grade s,
S fever quadripl
agia
PR Fluid Death Dehydrati
EV therapy, due to on
E anti- respirato
N emetic, ry/
TI personal cardiac
O hygiene, failure
N health
& educatio
C n, food
O safety
N
TR
OL
TR Anti- Symptoma
EA toxin tic
T prophyla treatment,
M xis & to food
E reverse safety
N neuro measures
T muscula
r block
guanidin
e
hydrochl
oride is
useful
AfraTafreeh.com
HEPATITIS:
HEP HEP HEP C/POST HEP E/ NON
A/INFECTIO B/SERUM TRANSFUSI A-NON B
US HEPATITIS ON
HEPATITIS/E HEPATITIS
PIDEMIC
JAUNDICE
AGENT Hepatitis A Hepatitis B Hepatitis c Hepatitis E
virus virus virus (flavi virus (calcic
(entero (hepadns virus, virus/Alpha
virus type virus- DNA hepatic virus)
72- virus virus)
picomavirid Dane
ae family) particle/Blu
mber
 AfraTafreeh.com

antigen/Aus
trailian
antigen)
Source of case Case & Case Contaminat
infection carrier ed drinking
water
PERIOD OF 2 weeks Several Indetermina Not known
COMMUNIC before & 1 months or te
ABILITY weel after until
onset of disappearan
jaundice ce of HBsAg
HOST Children Surgeon, lab Adults 15-40 years
FACTORS more person,
affected homo sexual
than adults,
severity
increases
with age
MODE OF Feco-oral Parentral,pa Parentral Feco-oral
TRANSMISSI route (main) rinated (post routr
ON Parenteral (most transfusion)
route (rare) infection of blood,
Homo can occur at sexual,
sexuality the time of vertical
birth) (rare)
INCUBATIO 10-50 days 30-80 days 2 weeks-6 3-8 weeks
N PERIOD (15-45 days) (6 weeks to months
6 months)
CLINICAL Jaundice, GI Abdominal No Jaundice &
FEATURES symptoms pain, symptoms GI
anorexia, symptoms
jaundice
COMPLICAT 0.1% Liver Chronic Fulminant
ION mortality in cirrhosis, infection, hepatitis
children & hepato risk of (more
0.3-2.1% cellular cirrhosis & frequent in
adults carcinoma cancer pregnancy)
lead to
death in
80% cases
DIAGNOSIS LFT -HbsAg is HCV, Anti IgM/IgG
Viral antigenfirst antigen HCV RTPCR
Anti-HAV detected
Acute and seen in
infection- both acute
IgM anti and chronic
HAV cases
-HbcAg is
never seen
AfraTafreeh.com
in serum
-HbeAg is
marker of
infection &
virus
replication
-IgM anti
HBc: Acutely
infected
-Anti HBe
indicates
end of viral
replication
& infertility
-IgG Anti
HBc
 AfraTafreeh.com

indicates
recovery
this may
persists for
long time
-anti HBsAg
is
immunity/af
ter
vaccination

POLIO Agent: RNA virus (1, 2,3)

Source of infection: Case (contaminated water, food &flies)
PERIOD OD COMMUNICABILITY: 7-10 days before onset of symptoms
to 3-4 weeks there after (max 3-4 weeks)
HOST FACTORS: Infancy & childhood (6months-3 years)
Male: Female is 3:1
ENVIRONMENTAL FACTORS: Rainy season (June to September),
overcrowding, poor sanitation
MODE OF TRANSMISSION: Feco-oral route & rarely droplet infection
INCUBATION PERIOD: 7-14 days
CLINICAL FEATURES: Sub clinical, abortive infection, no paralytic
illness, paralytic illness
COMPLICATION: Disability, deformity, post-polio syndrome
DIAGNOSIS: Stool culture (reverse cold chain)
PREVENTION & CONTROL: Vaccine OPV, IPV
Last case of polio is on 13th January 2011
Polio free is on 27th march 2014
Most common epidemic is P1
Most antigenic & most early eradicable is P2 (2015 20th September)
P3 is most common cause of vaccine associate paralytic polio

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EPIDEMIOLOGY
(Sexually Transmitted Infections & its Prevention &
Control)

SEXUALLY TRANSMITTED INFECTIONS (STD):

5 classical STD’s:
CAUSATIVE AGENT
1. Syphilis causative agent - TREPONEMA PALLIDIUM
2. Gonorrhoea - NESSERIA GONORRHEA
3. Cancroid - HEMOPHILUS DUCREYI
4. LGV (lymph granuloma - CHLAMYDIA TRACHOMATUS
-Vnerema)
5. Donovanosis - CALYMMATO BACTERIUM
GRANULOMATOUS

CAUSATIVE AGENT
Hepatitis A - Entero virus 72(PICORNA VIRUS)
Hepatitis B - Hepadno virus (Dane’s particle)
Hepatitis C - Hepaci virus
HIV/AIDS - Human immuno deficiency virus
Genital Warts - Human papillae virus
Scabieis - Sarcoptes scabiei
Trichomoniasis - Trichomonas vaginalis
Other sexually transmitted agents: 1. Streptococcus group B
2. Candida albicans

3. Urea plasma urealyticum

4. Shigella
5. Giardia lamblia
Incubation period of 5 STI:
1. Syphilis – 9-90 days
2. LGV – 3-12 days
3. Donovanosis – 3-21 days
4. Chancroid – 3-5 days
5. Gonorrhea – 1-5AfraTafreeh.com
days
6. HIV/AIDS -- months-10 years
SYNDROMIC APPROACH of STI:
Identification of consistent groups of symptoms and
easily recognized signs (syndromes) and provision of Rx that will deal
with majority or most serious organisms responsible for producing a
syndrome
Kit number Syndrome Kit colour Drugs
Kit 1 Urethral Grey Tab.
discharge(UD), Azithromycin 1g
cervical & Tab. Cefixime
discharge 9cd0, 400 mg
anorectic
discharge (ARD)
& painful scrotal
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swelling (PSS)
Kit 2 Vaginal Green Tab. Secnidazole
discharge (VD) 2g & Tab.
Fluconazol
150mg
Kit 3 Genital ulcer White Inj. Benzathine
disease-Non penicillin 2.4MU
herpetic (GUD- & Tab
NH) Azithromycin 1g
& Disposable
syringe 10ml
with 21 gauge
needle & Sterile
water 10ml
Kit 4 Genital ulcer Blue Tab. Doxycycline
disease-Non 100mg
herpetic (GUD-
NH)- for patients
allergic to
penicillin
Kit 5 Genital ulcer Red Tab. Acyclovir
disease-Herpetic 400mg
(GUD-H)
Kit 6 Lower abdominal Yellow Tab. Cefixime
pain (LAP/PID) 400mg & Tab.
Metronidazole
400mg & Cap.
Doxycycline
100mg
Kit 7 Inguinal bubo Black Tab. Doxycycline
(IB) 100mg & Tab.
Azithromycin
 EPIDEMIOLOGY
(Cardiovascular Disease & its Prevention
& Control)

NON COMMUNICABLE DISEASE: Epidemiological Transition

CARDIOVASCULAR DISEASE: Group of diseases that affect the
circulating system i.e., heart and blood vessels:
1. Coronary artery disease: Diseases of blood vessels supplying the
heart.
2. Cerebro vascular disease: Diseases of blood vessels supplying the
brain.
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3. Peripheral arterial disease: Diseases of blood vessels supplying
the limbs.
4. Rheumatic heart disease: Diseases caused due to damage to the
heart muscles and heart valves due to Rheumatic fever.
5. Congenital heart disease: Malformation of cardiac structure
existing since birth.
6. DVT & PE: Blood clots in the deep leg veins may get dislodged and
get transported to heart and lungs.
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Classification of Cardiovascular Disease:

Disease Burden: IHDs –27%

>60% of total disease burden
Risk factors for cardiovascular disease:

Major Risk Factors:

1. Tobacco dependence

2. Raised LDL cholesterol

3. Low HDL cholesterol

4. High blood pressure

5. Elevated blood pressure

6. Elevated C-reactive protein

7. Overweight or obesity

8. Physical inactivity

9. Dietary risk factors

Contributing Risk Factors:

1. Socio economic status

2. Elevated prothrombotic factors: Fibrinogen, plasminogen

activator inhibitor (PA)-1
 3. Markers of infection or inflammation

4. Raised homocysteine

5. Elevated lipoprotein (a)

6. Psychological factors

Cardiovascular Risk Factors:

A – Age and other non-modifiable risk factors
B – Blood pressure
C – Cholesterol levels, Current Smoking
D – Diabetes & diet
E – Excess weight & other modifiable lifestyle factors

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PREVENTION OF CARDIOVASCULAR DISEASES:

1. Primordial & Primary prevention
2. Secondary prevention:
Early Diagnosis:
(a) Screen for serum cholesterol abnormalities.
(b) Tracking of BP.
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(c) Early detection of onset of Hypertension.

(d) Abnormalities in blood sugar: (i) Age of 40 years with no risk factors
(ii) Age of 30 years with no risk factors
(e) Use low dose Aspirin (75mg daily dose) in individual with high risk of acute
CVD event to prevent MI & Stroke.
3. Tertiary prevention:
(a) Critical cardiac case for acute cardio vascular event
 EPIDEMIOLOGY
(Stroke, Hypertension, Rheumatic Fever & its
Prevention & Control)
STROKE: Condition seen because of reduced supply of brain that in turn
cuts off oxygen supply to brain leads to tissue damage.
Types of Stroke:
1. Ischemic Stroke:

(a) Most common type of stroke

(b) Block in blood supply to brain either by a clot or fatty deposit:
(i) Embolic Stroke: A blood clot or plague fragment that is formed
in the heart or larger arteries travels to the brain &
blocks blood vessels.
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(ii) Thrombotic Stroke: Blood clot that develop inside the artery
that supply.
2. Haemorrhagic Stroke: Blood vessels inside the brain bursts open
causing spillage of blood.
3. TIA (transient Ischemic Attack): Blood supply to the brain is
blocked in a very short span of time until it starts flowing normally
or collaterals are formed.

Why stroke is a public health problem?

Answer: 2nd leading cause of death & 3rd leading to disability.70%
stokes & 80% stroke related deaths – Low & middle income countries.
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Risk Factors:
- High Bp
- Smoking
- Alcohol consumption
- Diabetes
- Atrial Fibrillation
- History of TIA
- Reduced physical activity
- Family history
Symptoms:
- Face, arm, leg
- Confusion
- Difficulty in speech
- Difficulty in seeing with one or both eyes
Prevention:
Primordial - Health Education
Primary - Tobacco
- - Regular physical activity
- - Reduced salt consumption (5mg/day)
- - 400 b fruit & vegetable / day
- - Reduced Bp
Secondary prevention
– Blood test
- PT-INR
- Blood sugar
- lipid profile
- ECG
TREATMENT:
Ischemic stroke:
- TPA within 3hours of attack
- Anti-platelets
- Lipid lowering drugs
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Emergency procedure
Haemorrhagic stroke: Surgical repair
Tertiary prevention:
- Physical therapy
- Speech therapy
- Occupational therapy

HYPERTENSION:
Def: Condition in which blood vessels have persistently raised pressure
Stages:
BP stages Systolic(mm hg) Diastolic(mm hg)
Normal <120 <80
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Pre Hypertension 120-139 80-89

Stage 1 140-159 90-99
Stage 2 >160 >100

Classification of HTN:
1. Primary (essential): No identifiable cause
2. Secondary hypertension: Underlying medical complication
- Kidney disorders
- Endocrine System: Cushing Syndrome, sleep disorder,
pheochromocytoma
Hypertension/ Public Health Problem:
Prevalence of high BP in India: 25.4%
Disability: 7% of disease burden
Primary Prevention: Salt reduction
Secondary prevention:
- BP measurement
- BMI
- Waist circumference
- Peripheral pulse palpation
- Hearing for bruit
- Eye examination
ECG
Blood sugar testing
Blood urea, serum
Fasting lipid profile
Treatment: AfraTafreeh.com

RHEUMATIC HEART DISEASE:

- Group of heart diseases which include short term & long term
conditions occurring due to Rheumatic fever.
- Heart becomes inflamed & heart valves are permanently damage.
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- Occurs after a single or recurrent episode of Acute rheumatic

fever.
- RF is a febrile disease that usually affected connective tissues of
heart and joints preceded by throat infection caused by group A
beta haemolytic streptococcus.
- RHD are non-communicable disease, which results from a
communicable disease
Streptococcal Pharyngitis is 60%
India –25-45% burden of acquired heart disease
Epidemiological Factors:
Agent – Group A beta haemolytic streptococcus
Host – Age (5-14 years)
Prevalence of RHD – 25-40 years
Sex – Both gender equally
Socio economic status – Social disease 1. Poverty
2. Poor housing condition
3. Over crowding
Genetic susceptibility – HCA
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EPIDEMIOLOGY
(Diabetes Mellitus & its Prevention and Control)\

DIABETES MELLITUS:
Def: WHO & ADA (American Diabetes Association)- Group of metabolic
disorders characterized by HYPERGLYCEMIA resulting properly from
defects in insulin secretion, insulin action or both.
Classification:
1. Diabetes Mellitus:

- Type 1 or insulin dependent DM

- Type 2 or non-insulin dependent DM
- Malnutrition related DM(DRDM)
- Other types (Secondary or pancreatic, hormonal, drug induced,
genetic or other abnormalities)
2. Impaired glucose tolerance (IGT)

3. Gestational DM (GDM)

Public Disease Burden:

1. Prevalence of diabetes –73%

2. State with least prevalence of DM – Bihar (4.3%)

3. State with maximum prevalence of DM – Punjab (10%)

Prevention:
Primordial prevention:
1. Encoring health enhance behaviour:
 - Participation in lifestyle exercise
- Healthy eating
- Yoga
2. Avoidance of health harming behaviour:
- Smoking
- Excessive alcohol consumption
- Binge eating
3. Promoting health predictive behaviour:
- Health check up
- Clinic attendance
Primary Prevention:
- Health promotion: AfraTafreeh.com
Promoting healthy lifestyle
- Specific protection: Benefits of exercise & eating healthy
Exercise:
- Children & youth aged 5-17 years should practice at least 60
minutes of moderate to vigorous intensity physical activity daily.
- Adult aged 18-64 years should practice at least 150 minutes of
moderate – intensity physical activity
(e.g.: Jogging, bushwalking, and gardening)
(Or)
At least 75 minutes of vigorous intensity aerobic physical
activity throughout the week.
(Or)
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Equivalent combination of moderate & vigorous intensity activity

- For older adults the same amount of physical activity is
recommended but should also include balance and muscle
strengthening activities tailored to their ability and circumference.
Type 2 DM: Modifiable risk factors
Risky behaviour that need to be avoided to prevent type 2 DM:
- Excessive weight gain
- Unhealthy diet
- Physical in activity
- Obesity
- Over weight
- Management of stress
Population Based Strategy: High Risk Strategy
Secondary Prevention: Early diagnosis
Treatment:
2hours plasma glucose:
Diabetes – >200mg/dl
IGT – 140-200mg/dl
IFC – <140mg/dl
Fasting plasma glucose – 110-125mg/dl

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Management:
1. Non-pharmacological:

Nutrition: - IBW (Ideal Body Weight)

IBW = (height in cm’s - 100)*0.9
If IBW over weight – >120%
Under weight – < 90%
Following distribution of nutrients recommended:
- Carbohydrates – 50-60%
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- Protein – 15-20%
- Fat – < 30% (Saturated fat < 10%)
- Cholesterol – 300mg/dl
- Fibers – 20-40g/dl
- Sodium – 2000mg/dl
- Alcohol – not >5% of total calories
- Vitamins & Minerals – same as general population

PHARMACOLOGY:
- Sulfonylureas
- Meglitinides
- Thiazolidinedione
- Alpha – glycosidase inhibition
- biguanide
- Sodium glucose co transporter 2 (SGL-2) inhibitors
 EPIDEMIOLOGY
(Cancer & its Prevention and Control)

CANCER:

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Methods of cancer screening:

1. Mass screening: Cervical, breast, oral cavity, prostate

2. Selective screening

Tumor Marker:
1. Alpha feto protein – Hepato cellular carcinoma & germ cell tumor

2. Ca Antigen-125(Ca-125) - Ovarian carcinoma(Monitoring

disease progress)
3. Prostate specific Antigen – Prostate cancer(Monitoring disease
progress)
4. CEA(Carcino embryonic antigen) - Cervix, ovary, gastro intestinal,
pancreatic breast & lung cancer
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5. Ca 15-3(HER-2 neu) - Breast cancer

6. ER & PR – Breast cancer

7. HCG – Gestational trophoblastic disease, germ cell tumor,

choriocarcinoma
8. CA 19-9 Antigen – Pancreatic colo rectal cancer, gastro intestinal
tumors

WARNING SIGNS:
C – Change in bowel or bladder habits
A - A sore that does not heal
U – Unusual bleeding or discharge
T – Thickening or lump in breast, testicles or elsewhere
I – Indigestion or difficulty in swallowing
O – Obvious change in size, colour, shape or thickness of wart, mole
or mouth sore
N – Nagging of voice, hoarseness of voice
CANCER REGISTRATION PROGRAM:
- 1982 by IC MR
- Data base of cancer
- Picture of the magnitude and pattern of cancers in India
- Systemic collection of data patching to cancer cases
- Plan services for cancer control

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1. Population Based Cancer Registries: Take the sample population

in a geographically defined area.
2. Hospital Based Cancer Registries: Take data from patients causing
to a particular health institutions
- Monitor & plan patient care at institutional level
- Provide information on: (a) Methods of diagnosis
(b) Stage distribution
(c) Treatment methods
(d) Response to treatment
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- They do not provide information about INCIDENCE RATES of

cancer in general population.
- Epidemiological studies like
(a) Case control study
(b) To investigate ethology of a
particular cancer

3. Population Based Cancer Registries:

- Provide on incidence of cancer

- Distribution of cancer in well-defined population