Communicable and

Non-Communicable
Diseases…
A Public Health Perspective
Dr Gulzar Usman
MBBS, MPH, DFHC
dr.gulzar79@gmail.com
Definition of Communicable
diseases
 A communicable disease is an illness due to
a specific infectious (biological) agent or its
toxic products capable of being directly or
indirectly transmitted from man to man, from
animal to man, from animal to animal, or from
the environment (through air, water, food,
etc..) to man.
Another Definition…

 Communicable disease: a disease that can

be spread to a person from another person,
an animal or object. Ex: common cold,
influenza, tuberculosis, etc.

 Non-communicable disease: a disease that

can NOT be spread from person to person.
Ex: cancer, heart disease, cirrhosis, etc.
Common Pathogens:
Viruses, Bacteria, Fungi &
Protozoa
 Virus: smallest simplest life form. Not alive, and cause upper
respiratory infections and many other type of diseases.

 Bacteria: simple one-celled organisms. They are everywhere.

Not all bacteria is bad.

 Fungi: more complex than bacteria, but cannot make their own
food. Thrive in warm, moist environments.

 Protozoa: one celled, animal like organisms.

Communicable versus
non-communicable diseases
Communicable diseases Non-communicable diseases
 Sudden onset Gradual onset

 Single cause Multiple causes

 Short natural history Long natural history

 Short treatment schedule Prolonged treatment

 Cure is achieved Care predominates

 Single discipline Multidisciplinary

 Short follow up Prolonged follow up

 Back to normalcy Quality of life after treatment

Usually…
 The poor hygiene behaviors promote the transmission of
infectious diseases

 The fecal-oral and respiratory routes are the most

common sources of transmission

 Young children and adults may not wash their hands

after using toilets and before eating/preparing food.
 CD- Modes of transmission

 Direct
 Blood-borne or sexual – HIV, Hepatitis B,C
 Inhalation – Tuberculosis, influenza, anthrax
 Food-borne – E.coli, Salmonella,
 Contaminated water- Cholera, rotavirus, Hepatitis A
 Indirect
 Vector-borne- malaria, trypanosomiasis
 Fomites
 Zoonotic diseases – animal handling and feeding
practices (Mad cow disease, Avian Influenza)
How are pathogens spread?
 Direct Contact: hands and skin
ex: Scabies
 Indirect Contact: coughs, sneezes, expelling pathogens
in the air ex: flu
 Contact with animals or insects – animal and insect
bites ex: Lyme’s disease (ticks) – chills, fever,
headaches, discomfort, a skin eruption, and
inflammation with swelling of the joints.
 Other contacts such as contaminated food or water. Ex:
Salmonellosis – infection of the digestive tract. Sharp
pain, fever, and bloody, watery diarrhea that occur 6 to
48 hours after eating. Nausea and vomiting are common.
Epidemiologic triad
• Demographic characteristics
• Biological characteristics
• Socioeconomic characteristics

Host

Agent Environment
•Biological agents • Physical environment
•Physical agents • Biological environment
•Chemical agents • Social environment
•Nutrient agents
•Mechanical agents
•Social agents
Few Important Terminologies
related to Communicable
Diseases…

-Infection
 Infection is the entry and development or
multiplication of an infectious agent in the body of
man or animals. An infection does not always cause
illness.
 There are several levels of infection (Gradients of
infection):
 Colonization (S. aureus in skin and normal nasopharynx)
 Subclinical or inapparent infection (polio)
 Latent infection (virus of herpes simplex)
 Manifest or clinical infection
contamination

 The presence of an infectious agent on a

body surface, on or in clothes, beddings,
toys, surgical instruments or dressings, or
other articles or substances including water
and food
Infestation

 It is the lodgment, development and

reproduction of arthropods on the surface of
the body or in the clothing, e.g. lice, itch mite.
This term could be also used to describe the
invasion of the gut by parasitic worms, e.g.
ascariasis.
Contagious disease

 A contagious disease is the one that is

transmitted through contact. Examples
include scabies, trachoma, STD and leprosy.
Vector of infection

 An insect or any living carrier that transports

an infectious agent from an infected
individual or its wastes to a susceptible
individual or its food or immediate
surroundings. Both biological and mechanical
transmissions are encountered.
Reservoir

 Any person, animal, arthropod, plant, soil, or

substance, or a combination of these, in
which an infectious agent normally lives and
multiplies, on which it depends primarily for
survival, and where it reproduces itself in
such a manner that it can be transmitted to a
susceptible host. It is the natural habitat of
the infectious agent.
Incidence and Prevalence of
infectious diseases
 Incidence of an infectious disease:
Number of new cases in a given time period

 Prevalence of an infectious disease:

Number of cases (old and new) at a given time
Epidemic

 “The unusual occurrence in a community of

disease, specific health related behavior, or
other health related events clearly in excess
of expected occurrence”
 (epi= upon; demos= people)
 Epidemics can occur upon endemic states
too.
Endemic

 It refers to the constant presence of a

disease or infectious agent within a given
geographic area or population group. It is the
usual or expected frequency of disease within
a population.
 (En = in; demos = people)
Pandemic and Exotic
 An epidemic usually affecting a large proportion of
the population, occuring over a wide geographic
area such as a section of a nation, the entire nation,
a continent or the world, e.g. Influenza pandemics.

 Exotic diseases are those which are imported into a

country in which they do not otherwise occur, as for
example, rabies in the UK.
Nosocomial infections

 Nosocomial (hospital acquired) infection is an

infection originating in a patient while in a
hospital or another health care facility. It has
to be a new disorder unrelated to the
patient’s primary condition. Examples include
infection of surgical wounds, hepatitis B and
urinary tract infetions.
Sporadic
 The word sporadic means “scattered about”. The
cases occur irregularly, haphazardly from time to
time, and generally infrequently. The cases are few
and separated widely in time and place that they
show no or little connection with each other, nor a
recognizable common source of infection.

 However, a sporadic disease could be the starting

point of an epidemic when the conditions are
favorable for its spread.
Opportunistic infection

 This is infection by organisms that take the

opportunity provided by a defect in host
defense (e.g. immunity) to infect the host and
thus cause disease. For example,
opportunistic infections are very common in
AIDS. Organisms include Herpes simplex,
cytomegalovirus,
 M. tuberculosis….
Incubation and Latent
periods
 Incubation period: time from exposure to
development of disease. In other words, the time
interval between invasion by an infectious agent and
the appearance of the first sign or symptom of the
disease in question.

 Latent period: the period between exposure and the

onset of infectiousness (this may be shorter or
longer than the incubation period).
Dynamics of disease
Transmission (Chain of
Infection)
I II III

Source or Reservoir Modes of transmission Susceptible host

Cases

 A case is defined as “a person in the

population or study group identified as having
the particular disease, health disorder, or
condition under investigation”
Carriers
 It occurs either due to inadequate treatment or immune
response, the disease agent is not completely
eliminated, leading to a carrier state.

 It is “an infected person or animal that harbors a

specific infectious agent in the absence of (visible)
clinical disease and serves as a potential source of
infection to others.
(II): Modes of transmission

Mode of transmission

Direct Indirect
transmission transmission

Direct Vehicle-borne
contact :Vector-borne•
Droplet infection •Mechanical propagative
•biological
.Cyclo-prop
Contact with soil
Air-borne .Cyclo-develop

Inoculation into skin or mucosa

Fomite-born
Trans-placental (vertical) Unclean hands
and fingers
(III): Susceptible host
 An infectious agent seeks a susceptible host
aiming “successful parasitism”.

 Four stages are required for successful parasitism:

1. Portal of entry
2. Site of election inside the body
3. Portal of exit
4. Survival in external environment
Common Communicable
Diseases
The common cold is a respiratory infection
caused by over 200 different viruses.
Symptoms include congestion, sore throat
and cough. It can be spread through direct
and indirect contact. Treatment includes rest,
liquids and over the counter medications.
Prevention techniques include handwashing
and avoiding contact with infected persons.
Influenza, more commonly called “flu”, is a respiratory
infection caused by several groups of viruses.
Symptoms include high fever, fatigue, muscle and
joint aches. It is spread through direct contact with
infected people and water droplets in the air from
coughs and sneezes.
Treatment includes rest, liquids, and over the
counter medications. Prevention includes avoiding
contact with infected persons and vaccines.
 Tuberculosis
 2 billion people infected with microbes that cause TB.
 Not everyone develops active disease
 A person is infected every second globally
 22 countries account for 80% of TB cases.
 >50% cases in Asia, 28% in Africa (which also has the

highest per capita prevalence)

 In 2005, there were 8.8 million new TB cases; 1.6 million
deaths from TB (about 4400 a day)
 Highly stigmatizing disease
Tuberculosis and HIV
 A third of those living with HIV are co-infected with TB
 About 200,000 people with HIV die annually from TB.
 Most common opportunistic infection in Africa
 70% of TB patients are co-infected with HIV in some countries in
Africa
 Impact of HIV on TB
 TB is harder to diagnose in HIV-positive people.
 TB progresses faster in HIV-infected people.
 TB in HIV-positive people is almost certain to be fatal if
undiagnosed or left untreated.
 TB occurs earlier in the course of HIV infection than many other
opportunistic infections.
Malaria
 Every year, 500 million people become severely ill with
malaria
 causes 30% of Low birth weight in newborns Globally.
 >1 million people die of malaria every year. One child
dies from it every 30 seconds
 40% of the world’s population is at risk of malaria. Most
cases and deaths occur in SSA.
 Malaria is the 9th leading cause of death in LICs and
MICs
 11% of childhood deaths worldwide attributable to malaria
 SSA children account for 82% of malaria deaths worldwide
Neglected diseases

 Cause over 500,000 deaths and 57 million

DALYs annually.
 Include the following
 Helminthic infections
 Hookworm (Ascaris, trichuris), lymphatic filariasis,
onchocerciasis, schistosomiasis, dracunculiasis
 Protozoan infections
 Leishmaniasis, African trypanosomiasis, Chagas disease
 Bacterial infections
 Leprosy, trachoma, buruli ulcer
Sexually Transmitted
Diseases
 Chlamydia
 Gonorrhea
 Genital Herpes
 Syphilis
 HIV/AIDS
Importance of Communicable
Diseases
 Significant burden of disease especially in
low and middle income countries
 Social impact
 Economic impact
 Potential for rapid spread
 Human security concerns
 Intentional use
CDs have a significant economic
impact in affected countries
 At the macro level
 Reduction in revenue for the country (e.g. tourism)

 Estimated cost of SARS epidemic to Asian countries: $20 billion (2003) or $2

million per case.
 Drop in international travel to affected countries by 50-70%
 Malaria causes an average loss of 1.3% annual GDP in countries with
intense transmission
 The plague outbreak in India cost the economy over $1 billion from travel
restrictions and embargoes

 At the household level

 Poorer households are disproportionately affected

 Substantial loss in productivity and income for the infirmed and caregiver

 Catastrophic costs of treating illness

International boundaries are
disappearing
 Borders are not very effective at stopping
communicable diseases.
 With increasing globalization
 interdependence of countries – more trade and human/animal
interactions
 The rise in international traffic and commerce
makes challenges even more daunting
 Other global issues affect or are affected by
communicable diseases.
 climate change
 migration
 Change in biodiversity
Human Security concerns

 Potential magnitude and rapid spread of

outbreaks/pandemics. e.g. SARS outbreak
 No country or region can contain a full blown outbreak
of Avian influenza
 Bioterrorism and intentional outbreaks
 Anthrax, Small pox
 New and re-emerging diseases
 Ebola, TB (MDR-TB and XDR-TB), HPAI, Rift valley
fever.
Prevention

 Ways to prevent Infectious Disease

– Getting enough sleep, avoiding alcohol/cigarettes,
and eating a healthy diet.
– Getting vaccines when available.
– Staying away from disease carrying animals or
food/water that is dirty.
Personal Responsibility and
action
 Improved hygiene and sanitation
 Hand washing, proper waste disposal, food
preparation and handling.
 Information, education and behavior change
 Changing harmful household practices
 Livestock handling, knowledge about contagion
 Cultural and social norms
 Self reporting of illnesses and compliance with
interventions and treatment.
Partnerships and
Collaboration
 Importance of partnerships –
 MDG 8: “Develop global partnerships for
development”
 Comparative advantage of partners
 Inclusiveness
 Examples of partnerships
 Over 70 Global health partnerships available
 Examples include the Stop-TB program, GFATM, RBM,
UNAIDS, GAVI, Global Outbreak Alert and Response
Network, GAIN, bilateral and multilateral organizations.
Isn’t Donor Collaboration Wonderful?
WHO INT NGO
CIDA UNAIDS 3/5
GTZ

RNE UNICEF
Norad WB
Sida
USAID T-MAP MOF
UNTG PMO
CF DAC GFCCP
GFCCP PRSP
PRSP
PEPFAR
GFATM MOEC
HSSP
HSSP MOH SWAP
SWAP

CCM
CTU
NCTP
NCTP CCAIDS
NACP

LOCALGVT CIVIL SOCIETY PRIVATE SECTOR

Source: WHO: Mbewe
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