6 VECTOR BORNE DISEASE

1. LEPTOSPIROSIS 2. MALARIA
Weil's disease Ague/ Marsh (BLACK WATER FEVER)

Leptospirosis Together w/ HIV/AIDS, TB and other neglected tropical dses

Canicola fever and trench fever malaria control is included under SDG 3 by 2030

Mud & flood fever
Japanese 7 days fever and spiroketal jaundice
CA: Leptospira interrogans bacteria
IP: 5 – 14 days (ranging 2 – 30 days accor to CDC)
Dx:
Microscopic agglutination test (blood test)
- gold standard serologic CONFIRMATORY
Blood and CSF
- can be tested during the first week of illness
Urine After the 10th day of illness
Reservoirs: rodents and rats
Primary reservoir: Brown RATS (worldwide source of lep.
interrogans)
Other sources:
Vector: Female Anopheles mosq (sporozoites from salivary gland)
Biting time: between dusk and dawn (9 pm to 3am)
C.A: PLASMODIUM parasites (protozoa)
P. Falciparum and P. vivax pose- greatest risk (MOST FATAL)
P. Malariae & Ovale
Dx:
RDT (Blood Smear)
confirmation by blood film to detect MALARIAL PARASITES
s/sx:
C – chills to convulsion
H – headache
I – increased temperature(fever)
L – liver enlargement (hepatomegaly)
L – low hemoglobin level (anemia)
S – sweats profusely (diaphoresis)
hallmark of malaria is FEVER followed by chills to convulsion
TAKE NOTE:

Cattle, Pigs, Horses, Dogs, Rodents & Wild animals
common during heavy rainfall season
MOT:
INGESTION/ CONTACT TO URINE
TAKE NOTE:
Person to person transmission is rare.
Outbreaks due exposure to contaminated floodwaters
s/sx:
Red eyes (conjunctival suffusion-weil’s
(Pathognomonic sign)
Abdominal pain, vomiting and diarrhea
Tender and painful muscles (myalgia)
Skin jaundice and sometimes rashes
PHASES OF DISEASE
1st phase of illness:
Malarial parasites invade & destroy RBC (hemolysis)-anemia
WOF:
Icterus and Shock- refer 2nd/3rd facility
Tx:
1. Chemoprophylaxis (chloroquine)
- Taken at WEEKLY interval
- starting from 1-2 wks b4 entering the endemic area.
2. Anti-malarial drugs
- (sulfadoxine, quinine sulfate, tetracycline, quinidine)
- for preg/infants: sulfadoxine & pyrimethamine
- NOT malaria drug – Amoxicillin
Preventive Measures
M – mosq net/Insecticide treated nets (ITN's)
A – anti-mosq soaps/ repellants and using long sleeved shirt when
going out at night
L – larvivorous fish (guppy fish, gambusia fish, itar/ kataba fish)-
STREAM SEEDING
A – avoid going out between 9 pm-3am
R – remember to take chloroquine tablets at WEEKLY INTERVALS
I – include planting neem trees in backyards and clearing hanging
branches near rivers
A – apply insect repellant on house walls

fever, chills, headache, muscle aches, vomiting, diarrhea

2nd phase of illness

more severe

kidney, liver failure or meningitis. (Weils disease)

Other Complications:
Pulmonary hemorrhage, cardiac arrhythmia, and septic shock

Treatment:
Doxycycline – DOC & prophylactic drug to prevent leptos
P – Pen -G
E – Erythromycin
T – Tetracycline

Prevention:
R – rubber boots use when wading flood waters
A – avoid wading, bathing, swimming in flood waters
T – take prophylactic 200 mg doxycycline taken weekly
S – seek consultation for fever 2 days after known exposure to
flood waters.
 3. FILARIASIS (ELEPHANTIASIS) 4. BILHARZIASIS (CHISTOSOMIASIS)
- Lymphatic filariasis - Snail/Katayama Fever
- is a neglected tropical disease. - known as bilharzia
Vector: FEMALE Aedes poecillus mosq - vector-borne parasitic dse
Breeding sites: - caused by trematode flatworms of the genus Schistosoma
 water-filled leaf axils of abaca - considered one of the neglected tropical diseases (NTDs).
 banana
 taro (gabi) Vector:
 screw pine (pandan/pandamus).  Freshwater snails
Peak Biting time: 10 pm to 2 am/ at night (Best time to collect  Oncomelania hupensis quadrasi snail - vector of
Nocturnal blood sample Schistosoma japonicum in the Philippines and it is the
CA: Wuchereria Bancrofti-most common parasite intermediate host of S. Japonicum.
Breeding site: fresh waters in agricultural areas.
Others: Risk individuals: Farmers
A. Brugia Malayi – was first confirmed in Philippines in 1964 Caused by: BLOOD FLUKE (TREMATODES) – SCHISTOSOMA-
B. Brugia Timori cercariae
IP: 8 – 16 months (long incubation period) Dx:
Dx: A. Circumoval precipitin blood test- serological test used for
ALERE FILARIASIS TEST STRIP (FTS) – rapid diagnostic test diagnosis of schistosomiasis japonica
IMMUNOCHROMATOGRAPHIC BLOOD TEST (ICT) – done B. Kato-Katz test – stool exam under a microscope
daytime (confirmatory test for Snail fever/S. Mansoni)
NOCTURNAL BLOOD SMEAR – blood test taken after 8 pm
CA:
Stages Of Filariasis Schistosoma japonicum – most common in Philippines
Asymptomatic: NO clinical s/sx Schistosoma hematobium
A. Acute Stage: np1 Schistosoma intercalatum
 Fever Schistosoma mansoni – can deposit eggs in the brain tissue.
 Lhymphangitis (inflam of lymph vessels)
 Orchitis/epididymitis (painful and tender scrotum) MOT:
 Lymphadenitis (inflam of lymph nodes) Contact w/water infected w/cercariae/itlog (DIRECT and INDIRECT)
Swimmer’s itch or Cercarial dermatitis – early sign, itchy, raised
B. Chronic Stage: papules, commonly occur within 1–2 days of infection (due to
 Hydrocele (swelling and fluid accumulation in scrotum) cercariae penetration to skin)
 Elephantiasis (thickening and enlargement of
extremities, scrotum and breast) s/sx
 Lymphedema Lowgrade fever,
 Permanent disability- stigma Inflam of liver & spleen,
Pallor
Mgt:
1. Diethyl carbamazine citrate (DEC)/ Hetrazan/ biltricide - Bulging abdomen,
DOC & SE is Fever (6mg/kg)) Abdominal pain (RUQ)
2. Ivermectin (200mcg/kg) + albendazole Loose bowel movement-dark, tarry and black
3. Albendazole (400mg) 2x a year Muscle aches
4. No tx can reverse elephantiasis Seizure-s mansoni
Preventive measures:
F – Filariasis controlled preventive measures like vector control DOC for Bilhariasis: Biltricide (Praziquantel) CBQ
I – intensify health info campaigns in its prevention, control and Others: Diethyl carbamazepine citrate (DEC)
elimination
L – long sleeved shirt at night Preventive measures
A – annual mass drug adm using 2 drugs in all endemic areas (for F – feces and urine proper disposal/ use of sanitary toilets.
5 years) A – avoid bathing and washing in infested waters
R – repellants against mosq R – rubber boots to avoid skin penetration in agricultural places
I – intensify campaign to halt progression of dse tru disability M – molluscicides use (pamatay)-mollusk
prevention E – emphasize importance of hand washing
A – avoid going out at night usually 10 pm to 2 am R – remove cercariae in water by paper filtering/ use of iodine/
TAKE NOTE: There is NO known vaccination for Filariasis chlorine
S – Safe water use, let water stand 48 – 72 hours before using it.
Complication of Bilhariasis
 Cor pulmonale, pulmonary hpn
 Ascites and renal failure
 Liver cirrhosis (most common)
 portal hypertension

Take Note: Meningitis is NOT a complication of Bilhariasis

5. DENGUE (DANDY FEVER) 6.RABIES/ LYSSA/ HYDROPHOBIA/ LA RAGE

“Breakbone fever” neglected tropical dse

because of severe ms, joint, bone pains caused by a VIRUS that affects central nervous system, particularly
Vector: causing inflam in brain (encephalitis)

FEMALE Aedes Aegypti mosquito (Tiger mosq) 99.9% mortality rate

 Day biting BRAIN – is the MOST commonly affected by the rhabdovirus
 Most active BITES ON HEAD OR FACE has the SHORTEST INCUBATION
- 2 hours after sunrise (pagsikat ng araw) PERIOD
 - 2 hours before sunset (paglubog ng araw)
 Small 4 – 7 millimeters <50 days is the incubation if the patient is bitten on the head
 black and white pattern (white/silver scale patches)
 Bites in nape, elbow and ankle Bites/ scratches in hands is longer incubation <1 year
 Breeding sites- Stagnant clean  Rabies is the deadliest zoonotic disease that threatens humans
CA: Flaviviruses – common in the Philippines and animals on all continents except Antarctica.
Viral strains: DENV 1 to 4 Vector:
IP: 3 – 14 days (commonly 2 – 7 days)  DOG – principal animal vector (99%)
 Virus can be transmitted by Saliva
Dx: CA: VIRUS – Rabies lyssavirus, formerly Rabies virus of
DENGUE DOU – Dengue NS1 and IgG/IgM capture the rhabdovirus family.
1. Tourniquet test / Rumpel-Leede capillary IP: 2 – 8 weeks (2-3 months)
- Fragility/ simply a capillary fragility test– screening test of
dengue FACTS on RABIES
- Hermann sign- positive in the presence of >20 petechiae(>30
petechiae) within an inch square (2.5 cm), after 5 min of test Asia and Africa are worst affected as more than 95% of rabies
- Use BP cuff/sphygmomanometer associated human deaths.
2. Dengue NS1 RDT (protein)
- Requested between 1-5 days of illness (detect virus antigen) Bat/ Paniki rabies is responsible for most human rabies deaths in the
- not confirmatory US of America and Canada
3. Dengue IgM/IgG/Elisa
- Requested beyond 5 days of illness (detect dengue antibodies 40% of people bitten by suspect rabid animals are children under
during) 15 years of age.
 IgM in acute dengue infx MOT: Dog bite
 IgG determines previous infx Dx:
4. Polymerase Chain Reaction (PCR) – gold standard DIRECT FLUORESCENT ANTIBODY (DFA) TEST
laboratory tests to confirm dengue virus
 Total While Blood Cell (WBC) count (result show looks for presence of rabies virus antigens in brain tissue
decreasing level)
 Platelet (decreased) Human rabies confirmed intra-vitam and post mortem by various
 Hematocrit (increased) diagnostic techniques that detect whole viruses, viral antigens, or
nucleic acids (negri bodies) in infected tissues (brain, skin or saliva)
Early signs:
H – headache and eye pain (retro orbital pain) likod ng mata s/sx:
O – on and off fever INITIAL SX:
T – tourniquet test (+ petechiae) - fever w/ pain
Maculopapular rash - unusual or unexplained tingling
- pricking/ burning sensation (paresthesia) at the wound site.
Others signs: FURIOUS RABIES
L – low platelet - Hyperactivity & excitable behavior
A – abdominal pain, loss of appetite, vomiting and diarrhea - hydrophobia (fear of water)
M – muscle and joint pain - sometimes aerophobia (fear of drafts or of fresh air).
O – onset of fever - Hydrophobia and aerophobia are pathognomonic for rabies
C – capillary refill longer than 2 seconds (POOR TISSUE and occur in 50% of patients
PERFUSION) Paralytic rabies
Normal capillary refill is 1 – 2 seconds. - 20% of the total number of human cases.
Hermann's sign (petechial rash) – pathognomonic sign of - Muscles gradually become paralyzed, starting at the site of the bite
dengue. or scratch.
TAKE NOTE: Cold and clammy skin is a sign of dengue - Bladder dysfunction, Generalized weakness, quadriparesis to
hemorrhagic fever & sign of hemorrhagic shock COMA AND DEATH
- Paralysis and death occur in both dumb and furious forms 4– 8
Grade 1: Dengue Fever days after the onset of clinical signs
- s/sx: HOT
- tx; Fluid and paracetamol Priority ND: Risk for aspiration and respiratory arrest (cause of death)
Grade 2: DHF
- s/sx: HOT plus bleeding tendencies Dog bite:
- tx: Lrs, injury prevention, avoid dark color foods FIRST AID:
(salycylates) -Immediate & tru flushing & washing the wound for minimum 15 mins
Grade 3- Dengue w/Circulatory Failure w/ soap & running water
Dengue 4: DSS -detergent, povidone iodine or other substances that remove and kill the
- Hypovolemic shock rabies virus
- Plasma leakages
- Organ failure
- BT w/lrs blue water, no dextrose AVOID:
-Garlic, batobalani (tandok) and suctioning. NO to tandok
Prevention: except no to fogging
-infected animals usually die within 7 to 10 days of becoming sick.
Mgt: -(FEED DOG PROPERLY and Observe the dog for 14 days)
D – DO NOT GIVE ASPIRIN
CATEGORIES OF DOG BITE
E – epistaxis (nose bleeding) – sit lean forward with flex neck
CATEGORY I - touching or feeding animals, animal licks on intact
INDEPENDENT: apply cold packs in forehead. skin (no exposure)
N – note for any signs of shock (sudden transition of fever to CATEGORY II - nibbling of uncovered skin, minor scratches/
afebrile state) abrasions w/o bleeding (exposure) – GIVE ACTIVE VACCINES
G – give oral fluids /oresol /IVF CATEGORY III – single/ multiple transdermal bites/ scratches,
U – use PARACETAMOL for fever contamination of mucous membrane or broken skin w/ saliva from
E – enhance the 5 – S campaign and mosquito vector control. animal licks, exposures due to direct contact with bats (severe
exposure) – GIVE ACTIVE AND PASSIVE (RIG vaccine)
5 – S campaign CBQ
Search and destroy mosquito-breeding sites (Removal of water
such as flower vases) RABIES IMMUNIZATION
Self-protection measures like wearing long pants, long sleeved ACTIVE IMMUNIZATION
shirts and repellants
Seek early consultation develops antibody that gives 2 – 3 years protection
Support and say YES to fogging/spraying only in hotspot areas or
impending outbreak. Example:
Sustain Hydration  PCEC (Purified Chick Embryo Vaccine)
 PDEV (Purified Duckling Embryo Vaccine)
 RABIPUR and VERORAB OR VEROWELL (cheap)
 Purified Vero cell rabies vaccine (PVRV)
Dose:
 ID - 0.1 ml
 IM - 0.5 ml
 Purified chick embryo cell vaccine (PCECV)
Dose:
 ID-0.1 ml
 IM-1.0ml

PASSIVE IMMUNIZATION

administered to pt with head bites, and multiple bites to the different

parts of the body especially the upper part of the body to be
administered WITHIN 7 days after exposure.
Example:
a) ERIG (Equine rabies Ig) – derived from HORSE serum
b) HRIG (human Rabies Ig)
- Standard ROUTE: IM
- Remaining doses are infiltrated around wound
- Days of immunization: Day 0, 3, 7, 14, 28
- PVRV dose: 0.5 ml
- PCECV dose: 1.0 ml
- Site of injection: One deltoid or anterolateral thigh in Infants

Prevention:
R – responsible pet ownership (Republic Act 9482)
A – anti-rabies immunization of pets beginning at age 3 months
YEARLY
B – bathe, feed them with safe and clean food and water
I – if you are bite, scratched or licked by dog – wash the site
immediately for 15 minutes.
E – ensure that pets are NOT roaming in the streets (your pet action is
your responsibility.)
S – support and mobilize community participation

FIVE TIPS TO AVOID DOG BITES:

P – pet dog gently by stroking back 1st & allowing dog niff hand first
E – eye to eye contact must be avoided
T – try to stand still like a tree trunk (DO NOT RUN)

M – make sure all dogs are vaccinated against rabies yearly.

E – eating, playing, sleeping or scared dog should NEVER BE
DISTURBED.