COMMUNICABLE DISEASE

An Introduction Prepared by: Amelia F. Nacario RN,MAN

INFLAMMATORY RESPONSE

When the body is first invaded When a bacterial infection is established in the body, the purpose of the immune system is to control or eradicate it. The initial reaction of the immune system to an infection varies, depending on the site which has been invaded and on the nature of the invader.

There can be many "triggers", that can spur the immune system into action. Here are some of the ways in which the immune system can be activated: If the invasion is in an area of the body that is primarily defended by macrophages, such as the lungs or intestines, then these macrophages will be the first immune cells on the scene. They begin to digest the invading organism, and by presenting antigens (proteins from the destroyed bacteria), they stimulate other cells of the immune system into action.

for example Staphylococcus Aureus and Salmonella Typhi. . by acting as "breadcrumbs" which reveal the location of the invader.  Some bacteria. the immune cells whose function it is to consume and destroy the invading bacteria. which betray their presence to the immune system. Chemotaxins are chemicals that activate phagocytes. produce chemotaxins when they enter the body.

and are recognised by. which in turn produces chemical messengers (cytokines) that warn other cells of the immune system that the body has been invaded. . the complement system. Some bacteria first encounter.

the lymphocytes.e. These cells either directly fight the infection themselves. or control other cells to do so. .  The invader may be recognised by the acquired immune system. i.

Once activated. they also produce more cytokines. the phagocytes are activated and begin their task of digesting and destroying the invading bacteria. .    Immune Cascade All of the above methods have the effect of inducing phagocytes to migrate to the site of invasion. Once they reach that site. which further activate other cells of the immune system.

induces growth in B cells Activates B cells and inhibits Macrophage function Activates T cells and NK cells Induces proliferation of B cells and differentiation of T cells Activates Macrophages Causes activation of some Microphages. Macrophages T cells Macrophages T cells T cells. acts to initiate inflammation. e. Macrophages T cells Mast cells Inhibits T cell growth and Macrophage activation Similar to TNF. NK cells Induces differentiation of B cells. Induces inflammation and fever. T cells. and activates some Microphages Costimulator of T cells. induces hypothalamus to increase body temperature Causes proliferation of activated T and B cells. Induces catabolism of muscle and fat. but an important chemical mediator that induces blood vessel dilation and increases cell wall permeability . induces antibody synthesis Induces growth and differentiation of immune cells in bone marrow Promotes B cell growth and differentiation Cytokine Interleukin-1 Interleukin-2 Interleukin-3 Interleukin-4 T cells T cells T cells Interleukin-5 Interleukin-6 Interleukin-10 Interleukin-12 Interleukin-13 Gamma-Interferon T cells T cells.g. activates Microphages Not actually a cytokine. the initial immune reaction leads to a cascade of further immune reactions. thus leading to cachexia (bodily wasting) Tumor Necrosis Factor Macrophages Transforming Growth Factor Lymphotoxin Histamine T cells. Cytokines involved in the Inflammatory Response Producing cell Macrophages Action Stimulation of various cells. In a sense.

can cause a profound change on the bodies immune response to that organism. or the cells that produce them. if they interfere with any of the chemicals above.   The cells of the immune system communicate and co-operate in a complex fashion. . The full operation of the immune system is far from understood. An important point to note is that invading organisms.

permitting increased blood flow to the area. the blood vessels around the site of inflammation dilate. The primary physical effect of the inflammatory response is for blood circulation to increase around the infected area.    Effects of the inflammatory response. As a result of the increased blood flow.e. to pass. the immune cells. In particular. Gaps appear in the cell walls surrounding the infected area. allowing the larger cells of the blood. i. . the immune presence is strengthened.

which fuel the immune response.  All of the different types of cells that constitute the immune system congregate at the site of inflammation. which can itself have an anti-biotic effect. . swinging the balance of chemical reactions in favour of the host. There is an increase in body heat. along with a large supply of proteins.

The tissues in the area are swollen. causing mechanical pressure on nerve cells. and also due to the presence of pain mediators. as a result of the large amount of blood reaching the site. again due to the increased amount of blood and proteins that are present. due the expansion of tissues. .    The main symptoms of the inflammatory response are as follows. The area is painful. The tissues in the area are red and warm.

The colour of the pus depends on the organism causing the infection. . Pus is produced. Phagocytes continue to consume and destroy bacteria.   Once the inflammatory process has begun. the acquired immune system binds and disposes of harmful toxins. pus being the debris that is left over from the battle between the invader and the immune system. it continues until the infection that caused it has been eradicated.

The actual process by which the inflammatory response ends is now only beginning to be understood. the inflammatory response should only last for as long as the infection exists. Once the threat of infection has passed. The key element is a phenomenon known as "Apoptosis". . the area should return to normal existence.   Ideally.

On receipt of a certain chemical signal. research has shown that cells can also be killed in another way.g. i. . by "committing suicide". This is known as Apoptotic death.  When cells of the body die in a normal fashion.e. this is known as Necrotic death. most cells of the body can destroy themselves. Recently. by being irreparably damaged or by being deprived of nutrients. e.

. are primed to kill themselves automatically within a certain period of time. By not receiving a "stay-alive" signal.   There are two main ways in which cells can commit Apoptosis. unless instructed otherwise. i. When an chemical signal is received that indicates that the cell should kill itself. it does so. Certain cells. to commit Apoptosis. By receiving an Apoptosis signal.e. once they reach an activated state.

there may be other cells that supply them with a "stay-alive" signal.  However. which delays the Apoptosis of the cell. . It is only when the primed cell stops receiving this "stay-alive" signal that it kills itself.

Helper T cells emit a stay-alive signal. It is only when the infection has been eradicated. thus allowing the cells involved in the inflammatory response to die off. . and there is no more foreign antigen that the helper T cells stop emitting the stayalive signal.   The immune cells involved in the inflammatory response. and keep emitting that signal for as long as they recognise foreign antigens in the body. are primed to commit Apoptosis. prolonging the inflammatory response. once they become activated.

or the helper T cells do not recognise that fact. . then chronic inflammation may develop. If foreign antigen is not eradicated from the body. or if the immune cells receive the stay-alive signal from another source.

the most important of which are detailed below. and Acquired immunity. but instead uses many strategies. The main division between the strategies is that between Innate immunity. The immune system does not rely on one single mechanism to deter invaders. which does not require previous exposure to the invading microbe.   The human immune is extremely complex. . whereby the immune system "remembers" how to deal with a microbe that it has dealt with before.

They are responsible for swallowing.   The Phagocytes Phagocytes are the soldiers of the immune system. killing and digesting invading microbes. and provide innate immunity. . The process of swallowing microbes is known as phagocytosis.

The bone marrow contains large reserves of microphages. . They are constantly circulating in the blood. PMNs and Polymorphs.   There are two main types of phagocytes Microphages. They cannot replicate. and live for only a few days. These cells start life in the bone marrow. These cells are also known as Polymorphonuclear Leucocytes.

which originate in the stem cells in the bone marrow. but when they are first called into action. Macrophages are not as numerous as microphages. usually in places that are not otherwise well defended.   Macrophages. . but they are longer lived than microphages. Macrophages are stationed at strategic locations throughout the body. they turn into macrophages. These cells start out life as monocytes. and there are no large reserves of them.

  These areas include the alveoli of the lungs. Macrophages are the front line of defense against microbial invasion in these areas. the abdominal (peritoneal) and chest (pleural) cavities. . under the top layer of the skin and the intestines.

The phagocytes produce oxygen based chemicals that are highly disruptive to the swallowed microbe. using oxygen. After the invading microbe has been ingested. i. the next task for the phagocyte is to kill the microbe. This is achieved in two main ways. or the respiratory burst. Aerobically. and these oxygen based chemicals "tear" the microbe apart. This process is known as the oxidative burst. .   The process of swallowing of microbes by the phagocytes is known as phagocytosis. Oxygen is highly chemically reactive.e.

thus preventing it from metabolising. i. . Another way is to increase the acidity of the internal environment of the phagocyte. One way to kill the microbe without oxygen is by using a chemical that deprives the microbe of iron.  Anaerobically. without using oxygen.e.

displaying the remnants of the destroyed invader on their surface. . the Macrophages have one further task to complete. This has the effect of stimulating the cells of the Acquired immunity system into action. They return to the lymph nodes.  When these tasks are complete.

these cells which provide acquired immunity are known as Lymphocytes.   Acquired Immunity The acquired immunity system comprises B Cells and T Cells. Together. humoral immunity and Cell Mediated Immunity (CMI). . The acquired immunity system further divides into two parts.

An antigen is a chemical feature (a protein) which is unique to any given type of invading organism. When B cells meet an invading organism for which they have the antibody. they do one of two things. Each B cell secretes a unique antibody.   B Cells provide "Humoral Immunity". . which acts against a particular antigen.

.  They may turn into antibody factories and start manufacturing as many copies of their antibody as they can. thus increasing the numbers of antibody factories. They may clone themselves. which results in an increased immune response to the target organism.

Cytotoxic T cells. which destroy host cells that have become infected with the invading organism. T cells have several functions. which control other cells. often referred to as "CMI". which dampen down the immune response when it is no longer needed. such as B cells or Macrophages.    T Cells provide "Cell Mediated Immunity". directing them to carry out their task. . Suppressor T cells. They can be:Helper T cells.

Cytokines (meaning "cell movers") are the messengers of the immune system. but all work together in co-operative fashion . Phagocytes.   Cytokines Cytokines are the last element of the immune system. The above mentioned elements of the immune system (Complement. Lymphocytes) do not work separately.

This system is provided by the cytokines. Lymphotoxin. and Tumor Necrosis Factor. Gamma-Interferon. of which there are known to be at least twelve. Among the cytokines are the Interleukins. .  If they are to work effectively. they need a good system for communicating messages.

COMMUNICABLE DISEASE .

ENVIRONMENT . Infectious Agent or its toxic products . Environment .AGENT 2. Directly or Indirectly . 1.MODE OF TRANSMISSION 3. Animal or Intermediate Vector – HOST 4. Person.

animate or inanimate that may serve as stimulus to initiate a disease process 2. substance. ECOLOGIC TRIAD OF DISEASE 1. biological (plants & animals) . Environment – physical (climate). Agent – element. Host – organism that provides nourishment for another organism 3.

Diseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary host Infectious . CONTAGIOUS VS. NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS CONTAGIOUS  .Diseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane. INFECTIOUS Contagious .

"the state or condition in which the body or part of the body is invaded by a pathogenic agent ( bacteria.) which under favorable conditions multiplies and produces effects which are injurious…" . virus. What is Infection? INFECTION . parasites etc.

TRANSIENT ORGANISM represent recent contamination. acquired during contact with the infected colonized patient or environment. Ex: Staphylococci B. easily removed by good handwashing Ex: ( Klebsiella & Pseudomonas) . not easily removed by simple handwashing. Infectious Agent A. RESIDENT ORGANISMS deeply seated in the epidermis. survive for a limited period of time.

 FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE 1. Specificity – ability of the organism to develop antigens . Virulence – ability to enter or move through tissues 4. Pathogenicity – ability to cause a disease 2. Infective dose – no of organism to initiate infection 3.

 STAGES OF INFECTIOUS PROCESS Means of Transmission 1.most common means of transmitting microorganisms from one person to another. CONTACT . Direct Contact (person to person) occurs when one person touches another best vehicle is the Hands especially those of the Health Care workers Indirect Contact (inanimate object) .occurs when a person touches an inanimate object contaminated by an infected patient . A.

VECTOR . VEHICLE . water (shigellosis). dust.insects or animals 4. 2. medication ( contaminated infusion) .droplet. AIRBORNE . 3.food (salmonella). organisms in env. blood (Hepa B).

use of protective devices Environmental Sanitation – clean and conducive for health  . PREVENTION OF COMMUNICABLE DISEASE Prevention is worth a pound of cure PREVENTION OF COMMUNICABLE DISEASE Health Education – primary role of the nurse Specific Protection.handwashing.

  Definition of Prevention “Actions aimed at eradicating. traditionally called primary. secondary. eliminating. and tertiary prevention” . or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels.

Don’t Recap Needles (Unless using the One-handed Technique) 3. Use Gloves When Handling Needles (Won’t Prevent Injuries but May Lessen Chance of Transmitting Diseases) . Dispose Used Needles in Puncture Proof Needle Containers 2. Prevention of Needlestick Injuries 1.

Notification 2. CONTROL OF C0MMUNICABLE DISEASE 1. Epidemiological Investigation 3. Case finding. disinfestation . early dx and prompt treatment 4. Isolation and Quarantine 5. Disinfection.

Promotion of health and prevention of spread of CD . Personal protective equipments (PPEs) d. Concurrent disinfection c. Handwashing b. Barrier Cards/Placarding Objectives of CCD Restoration of health. Medical Asepsis a. 6. reduce deaths and disability Interpretation of control measures to IFC for practice to prevent spread of CD.

AIDS . Severe acute diarrhea (SAD) 4. Measles 3. Neonatal tetanus 5. Diseases that require weekly monitoring: 1. Acute flaccid paralysis (AFP) polio 2.

Acute flaccid paralysis (AFP) polio 2. Diseases that require reporting w/in 24 hrs 1. Acute flaccid paralysis polio 2. Measles 4. Measles Diseases targeted for eradication 1. Neonatal tetanus 3. Rabies .

On and off occurrence of the disease Most of the time it is not found in the community One or two cases that occur are not related Endemic .Epidemic of a worldwide proportions .Persistently present in the community all year round Ex: malaria in Palawan Epidemic An unexpected increase in the number of cases of disease Pandemic . Epidemiology Study of the occurrence and distribution of diseases in the population Patterns of occurrence of disease –frequency of disease occurrence Sporadic .

an increase is expected or there is usual increase. Time Related Patterns of Occurrence 1.dengue fever during rainy seasons are increased but it is not considered an epidemic because it is expected to rise at this particular time 3.cyclical variation a periodic increase in the number of cases of a disease 2.hot spot-a rising increase that may lead to an epidemic .a seasonal disease.

) the change in the pattern of occurrence of polio after being eradicated in 2000. b. Short time fluctuation A change in the frequency of occurrence of a disease over a short period of time Maybe (+) or (-) Secular variation A change in the frequency of occurrence of a diseae taking place over a long period of time Ex: a.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of today . then sudden repport of cases in 2001 due to mutant restraints.

Ex.concerned with disease frequency & distribution Analytic Epidemiology Is a study of the factors affecting occurrence and distribution of the disease. Types of Epidemiology Descriptive Epidemiology . Epidemiologic investigation Therapeutic/Clinical Study of the efficacy of a treatment of a particular disease Ex. Clinical trial of a newly proposed therapeutic regimen .

Evaluation of the under five clinic Note: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatment . Evaluation Epidemiology Study of the over-all effectiveness of a total/ comprehensive public health program. Ex.

Ratio between nurse and the population being served Ex. Types of Epidemiologic Data Demographic data Demography is the study of population groups Ex. Population size and distribution Vital Statistics Environmental data Health services data Ex. Degree of utilization of health facility/ service .

 Epidemiologic Investigation 1st step. person. place.Appraisal of facts – describing the epidemic in terms of time.Statement of the problem 2nd step.Conclusion and recommendation . 3rd step.formulation of hypothesis 4th step-Testing the hypothesis 5th step.

Terminal disinfection – practices to remove pathogens from the patient’s environment after his illness is no longer communicable . TERMS Disinfection – pathogens but not spores are destroyed Disinfectant – substance use on inanimate objects Concurrent disinfection – ongoing practices in the care of the patient to limit or control the spread of microorganisms.

FACTORS AFFECTING ISOLATION Mode of Transmission Source Status of the client’s defense mechanism Ability of client to implement precautions ISOLATION

EPI Launched by DOH in cooperation with WHO and UNICEF last July 1976 Objective – reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseases PD No. 996 (Sept. 16, 1076) – “ Providing for compulsary basic immunization for infants and children below 8 y/o PP No. 6 (April 3, 1996) – “ Implementing a United Nations goal on Universal Child Immunization by 1990”

RA 7846 (Dec. 30, 1994) – immunization hepa B PD No. 4 (July 29, 1998) – “Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign” Legislation, Laws affecting EPI Proclamation No. 46 – “polio eradication project” Proclamation No. 1064 – AFP surveillance Proclamation No. 1066 – National Neonatal Tetanus Elimination Campaign

Poliomyletis Hepatitis B Measles . Pertussis.TB DPT – Diptheria. Tetanu OPV . EPI BCG .

 Immunization Contraindications -conditions that require hospitalization For DPT 2 and 3 – history of seizures/ convulsions within 3 days after the first immunization with DPT Nursing responsibility: ask how the child reacts to the first dose For infant BCG – clinical AIDS .

5 ºC Simple or mild acute respiratory infection Simple diarrhea without dehydration Malnutrition (it is indication for immunization) . The following conditions are NOT contraindications: Fever up to 38.

right arm School entrance BCG When the child enters Grade 1 with or without scar on the right arm then still go on with the vaccination except if he is repeating Grade 1 .05 ml (dose) – ID. Schedule of immunization Infant BCG 0 to 11 months or 0 to 1 year at birth 0.

vastus lateralis . 4 weeks or 1 month interval Target age: 1 ½ to 11 months but child is eligible up to 6 years If 7 years old and above DT only not P 0. DPT 3 doses.5 ml. IM.

4 weeks/1 month Target population: same as above. but advise the mother to avoid feeding the child for 30 minutes after the vaccine. oral route *Feb 8-March 8: Oplan Polio Revival Drive No side effect. if vomits within the 30 minute period. repeat the vaccination . eligibility until Grade 6 2-3 drops.  OPV 3 doses.

IM. vastus lateralis Patient may experience local tenderness . Hepa B 3 doses. 4 weeks Can be given at birth Target age 1 ½ to 11 months 0.5 ml.

5 ml. subcutaneous. Measles 9 to 11 months Most babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off. other virus if it still active it will kill the vaccine 0. any arm Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles) .

HB) Completely Immunized Child All vaccines given but went beyond 0ne year of age . MV. 3 doses DPT.  Fully Immunized Child when he received all the antigens that should be given in the first year of life (1 dose BCG. OPV.