PREVENTIVE AND SOCIAL

MEDICINE

Subject Outline
Concept of Health and Disease............................. 285 Maternal and Child Health.................................... 316

Vaccination................................................................... 286 Nutrition........................................................................ 318

Epidemiology................................................................ 288 Environment................................................................ 320

Health Information & Biostatistics..................... 296 Health Care and Planning...................................... 325

Communicable Diseases............................................ 304 Occupational Health.................................................. 327

Health Programmes of India................................. 308 Contraception.............................................................. 329

Demography................................................................. 314
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History of Medicine
PSM

Aristotle Hippocrates James Lind (British Naval John snow

surgeon)
Proposed Theory of Father of Medicine Prevention of scurvy Father of modern
spontaneous generation First true epidemiologist by citrus fruits epidemiology
"Man is a social animal" Introduced concept Conducted scurvy Shoe leather
were his words of relationship of trials epidemiology
environment with human First ever clinical trial
health

Pettenkofer Ronald Ross Sushruta Louis pasteur

Theory of Multifactorial Elucidated Life cycle of Father of Indian Germ Theory of
causation Plasmodium surgery disease
Coined the term
Vaccine developed
the 1st vaccine for :
Anthrax & Rabies
zz Father of Public health – Cholera
zz Barometer of social welfare - Tuberculosis
zz Quarantine was first applied for: Plague
zz Contagion theory was given by Girolamo Fracastoro.
zz Web of causation: McMahon and Pugh
zz Sufficient-component cause model/ Theory of necessary and sufficient cause- Ken Rothmann
zz Epidemiological triad theory was given by: Leavel & Clark
282

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zz BEINGS model:
 B-Biological and behavioural factors
 E-Environmental factors

PSM
 I-Immunological
 N-Nutritional
 G-Genetic factors
 S-Social, Spiritual and service factors
zz Malarial parasite discovered by – Alphonse Laveran
zz Transmission of Yellow fever by a specific mosquito - Walter Reed
zz Pioneer of evidence based medicine- david sackett
zz Edward JeNNer developed the first vaccine and coined the term ‘vacciNatioN’
zz First country to socialise medicine: Russia
zz First country to introduce compulsory sickness insurance: GERMANY
zz First country to start Family planning programme: INDIA
zz First country to start Blindness control programme: INDIA
zz First country to start bath, sewer and aqueduct for sanitation- ROME
zz First country to start concept of health care and public health – ENGLAND
zz First country to start pasteurisation- FRANCE
zz WHO declared global eradication of small pox on 8th May 1980
zz Concept of social medicine was introduced by JULES GUERIN.

Important Days, Weeks

and Months of Public Health World Breast feeding week 1st week of

Importance august
Eye donation fortnight 25th August to
Anti leprosy day 30th January 8th september

World disabled day 15th March World Literacy day 8th September

Anti Tuberculosis day 24 march World heart day 29th september¬

Anti malaria month June National voluntary blood 1st october

donation day
World Health day 7th april
World disaster reduction day 2nd Wednesday
World Malaria day 25th april
of October
Malaria week in India 1st week of May
World mental health day 10th October
World Red Cross day 8th May
World Anesthesia day 16th October
Thalassemia week 2nd week of May
Global Iodine deficiency 21st October
National Dengue day 16th May disorder prevention day
No smoking day 31st may National Cancer awareness day 7th November
World Environment day 5th june Universal Immunisation day 10th November
International day against drug 26th june World diabetes day 14th November
abuse and illicit trafficking
World AIDS day 1st December
Doctor’s day 1st july
International day for disabled 3rd December
World population day 11th july persons
World ORS day 29th july Human Rights day 10th december 283

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Some Important National 2006 Fssai

Programmes 2006-2011 NACP III

PSM

2012 Mental Health care Act

1951 National Family Planning
2013 Mental health care Bill
Programme
1953 National Malaria Control
Programme Some Acts of Public Health
1955 National Filaria Control Importance
Programme
1955 National Leprosy Control 1923 Workmen compensation act
Programme 1948 ESI Act, Factories Act
1958 National Malaria Eradication 1952 Coal mines act
Programme 1954 Central Government Health Scheme
1962 National Tuberculosis Programmes 1956 MCI Act
1975 Integrated Child Development 1961 Dowry Prohibition Act, Maternity
Services Benefit Act
1975 20 points programme 1969 Registration of Births and Deaths Act

1975 National Cancer control 1971 MTP Act

programme 1986 Consumer Protection Act

1976 National Programme for Control 1987 Mental Health Act

of Blindness 1994 Transplantation of Human Organs Act
1982 National Mental Health 2004 Vandemataram scheme
Programme 2005 Right to Information Act
1983 National Leprosy Eradication INDIA–GENERAL INFORMATION(RECENT
Programme DATA)
1987 National AIDS Control Programme zz Population of India - 121 crores
(NACP)
zz Annual Growth rate - 1.4
1987 National Mental Health Act
zz Population density - 382 / sq km
1992 RNTCP zz Sex ratio - 943 females / 1000 males
1992 CSSM programme zz Child sex Ratio- 914 girls/ 1000 boys
1995 Pulse polio immunization zz Literacy Rate - 74.04 (Males- 82; F- 65)
programme zz Life Expectancy at birth - Males = 63;
1996-97 District Mental Health programme Females= 66
(4 components --PERT zz Total fertility rate - 2.2
Public awareness zz Infant mortality rate- 34/1000 live births
Early detection and treatment
zz Maternal mortality rate- 167/lac live births
Record keeping Training)
zz NMR - 25/1000live births
1997 RCH programme
zz Birth rate – 20.4/ 1000 mid year population
1999-2004 NACP II
zz Death rate – 6.4/ 1000 mid year population
2005-2012 NRHM zz Population doubling time- 50 years
2006 Stop TB strategy zz India’s population pyramid has a broad base
284 2006 MNREGA and tapering top.

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CONCEPT OF HEALTH AND DISEASE

PSM
Standard of Living

zz refers to usual scale of our expenditure, goods we consume and services we enjoy
zz includes level of education, food, dress, house, amusements and comforts of modern living.

Quality of Life

zz A composite measure of physical, mental and social well being as PERCEIVED by each Individual
zz PHYSICAL QUALITY OF LIFE INDEX [PQLI]
 Adult literacy rate
 Infant mortality rate
 Life expectancy at age 1
[Remember it as “ADIL AT AGE 1”]
zz HUMAN DEVELOPMENT INDEX [HDI]
 Knowledge (mean years of schooling for adults and expected years of schooling for 0-18 year
olds) [Maximum-100 & Minimum-0 ]
 Income (Real GDF in purchasing power parity) [Maximum-40,000 & minimum- 0]
 Life expectancy at BIRTH [Maximum-85 & minimum- 0]
[Remember HDI as “KILL AT BIRTH”]
zz HUMAN POVERTY INDEX
 Knowledge → adult literacy rate
 Long and healthy life (probability at birth of not surviving till age 40)
 Standard of living(% of population not using improved water source/% of underweight
children)
[Remember it as “knowledge LOST”]
 HPI-1 → for developing countries
 HPI-2 → for developed countries
zz GLOBAL HUNGER INDEX
 Child mortality rate
 Child Malnutrition rate
 Calorie deficient population proportion
[Remember it as “Chandu Chandrakar Memorial College-CCMC”]

Measures of Disability

zz Sullivan's index = life expectancy - years of life lived with disability [YLD] = Expectation of Life
free of disability
zz Disability Adjusted Life Years [DALY] = YLD + YLL (years of life lost due to premature death)
zz Health adjusted Life Year [HALY] = life expectancy - years of ill health (disability + disease)
zz Years of potential life lost → Years of potential life lost due to premature death
Y P L L
zz YPLL rate = Population under 65 X 100 285

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Levels of Prevention
PSM

HEALTH PROMOTION
• Environmental sanitation
• Proper Nutrition
• Health education
• Correction of Lifestyle
SPECIFIC PROTECTION: [Brand New Vodka Daru at Cnnaught Place]
• Bednets for malaria
• Nutritional supplementation
• Vaccination
• Defluoridation of water
• Minus Desk to prevent backache
• Condoms for HIV, Chemoprophylaxis for contacts
• Pasteurisation

IMPAIRMENT → DISABILITY → HANDICAP

Any loss or abnormality of
Psychological,physiological
or anatomical structure or
function.
Any restriction or lack
of ability to perform an
activity in the manner or
within the range considered
normal for a human being
a disadvantage for a given individual, resulting
from an impairment or a disability, that limits
or prevents the fulfilment of a role that is
normal (depending on age, sex, and social and
cultural factors) for that individual"

VACCINATION
zz Pioneer in concept of specific protection by vaccine were Chinese.
zz Currently vaccine derived polio outbreaks is due to Type-2.
zz Live attenuated vaccines- [BOMYVJHT]
 BCG
 OPV
 MMR
 Yellow fever
 Varicella
 Japanese encephalitis
 Hepatitis-A
 Typhoral
zz Post exposure immunisation given in: MoTipuR Medical College Hospital
 M — Mealses
 T — Tetanus
286  R — Rabies
 M — Meningococcal meningitis

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 C — Chicken pox
 H — Hepatitis
zz Avian influenza vaccine- Intramuscular route
zz Early Chinese Physicians were Pioneer in concept of specific protection by vaccine

PSM
zz Prophylaxis for travellers-
 Diarrhoeal diseases- precaution is most important
 Hep-A Immunoglobins(0.02-0.05 mg/kg every 4 months)
 Hep-B- Vaccine
 Hep-E-avoidance of contaminated food.
 Malaria- Chemoprophylaxis
 YF- vaccine
 Tetanus- vaccine
zz Minimum interval between two live vaccines is 4 weeks[2018]

MISSION INDRADHANUSH-[HOT Maal DPT] [2018]

H — Hep-B
O — OPV
T — TB(childhood)
Maal — Measles
D — Diphtheria
P — Pertussis
T — Tetanus
BCG Vaccine MEASLES Vaccine
• Bacilli Calmette Guerin • Zagreb strain
• Danish 1331 strain • Lyophilised freeze dried vaccine
• Lyophilised freeze dried vaccine • 0.5 ml, subcutaneous over Right Fold of triceps at
• 0.1 ml (>1 month) or 0.05 ml(<1 month) 9 months
Intradermal over Left deltoid at birth(maximum • Incubation period for vaccine induced measles→7
till 1 year) days
• Normal Saline is used as a diluents • To be used within 4 hours of reconstitution
• To be used within 4 hours of reconstitution • If used after 4hrs→TSS
• If used after 4hrs→TSS • Efficacy of vaccine→85%
• Efficacy after 2 doses→95%
Rotavirus vaccine Pentavalent vaccine
• Available as RotaTEC and RotaTRIC • DPT + Hep B + Hib vaccine
• 5 drops Given at 6, 10, 14 weeks • 0.5 ml Intramuscular in thigh at 6, 10, 14 weeks
OPV Vaccine
• Bivalent is used in Pulse Polio immunisation
• Trivalent is used in Routine immunisation
• July-september is high transmission season for Polio
Vaccine vial monitor (VVM)
DPT vaccine Rubella vaccine
• D and T are Toxoids whereas P component is killed acellular bacilli • Priority given to
• Side effects are mainly due to P component reproductive age group
• 0.5 ml Intramuscular in Anterolateral Thigh, middle 1/3 females
• Al2(PO4)3 and Al(OH)3 is used as adjunct →↑ immunogenicity 287
• Thiomersal is used as a preservative

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BCG Danish 1331

Chicken Pox Oka strain
PSM

Cholera Dukoral(WCrBS), Sanchol MORC VAX

Diphtheria Park Williams 8 strain
Hepatitis A HM 175, GBM strain
Japanese Encephalitis SA 14, 14, 2, Nakayama strain
Malaria SPf66(used in rapid detection ELISA kit), Pf25
Measles Edmonston Zagreb, Schwartz
Mumps Jeryl Lynn strain
Polio Lansing, Leon strains
Rabies Pitts Moore strain
Rubella RA 27 / 3
Typhoid Ty21a (TYPHORAL), Vi polysaccharide Vaccine (TYPHIM Vi)
Yellow fever 17D , Dakar

EPIDEMIOLOGY
Tools of Measurement

zz RATE
 It measures the occurance of some particular event in a population during a specified time
period.
 Expressed per 1000/10,000/1,00,000 (to avoid fractions)
 Numerator is a part of denominator
zz RATIO
 It expresses relation in size of two random quantities
 Result of division of two quantities expressed as X/Y or X:Y
 Numerator is not a part of denominator
zz PROPORTION
 It is a ratio that tells the relation of a part to the whole.
 Usually expressed as percentage
 Numerator is always a part of denominator.

Mortality Indicators
zz CRUDE DEATH RATE
 number of deaths from all causes per 1000 estimated mid year population
Number of deaths during the year
 CDR = X 1000
Mid-Year population

zz SPECIFIC DEATH RATE

 Number of deaths due to a specific disease or in a specific group per mid year population
Number of deaths during the year due to that
288 Disease or in that group
 Specific DR of a disease/group = X 1000
Mid-Year population (of that group)
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zz CASE FATALITY RATE

 It is ratio of Deaths to case

PSM
 Good measure of severity of acute disease, i.e Represents Killing Power of Disease
Total no. of deaths due to a particular disease
 CFR = X 100
Total no. of cases of the same disease
zz PROPORTIONAL MORTALITY RATE
 Number of deaths due to a particular cause per 100 (or 1000) total deaths
zz SURVIVAL RATE
 It is number of patients alive after 5 years per 100 patients diagnosed/treated
 Yardstick for assessment of standards of therapy
zz ADJUSTED/STANDARDISED RATES
Standardization: for comparing health status of Population
DIRECT STANDARDIZATION INDIRECT STANDARDIZATION
(as does not needs age-specific death rate)
• Age specific death rate of a study population • Death rate of a standard population applied on a
applied on standard population and added study population and added and divided by total
and divided by standard population to number of expected death x 100 to calculate
calculate standardized age adjusted death standardized mortality ratio [SMR]
rate Observed deaths
• SMR = X 100
Expected deaths

Morbidity Indicators

Incidence

zz Number of NEW cases in a defined population during a specified time period

zz It is RATE and is expressed per 1000
Number of new cases of specific disease
zz Incidence = X 1000
Population at risk during that period

zz can be calculated from a Cohort study

zz Types
INCIDENCE Cumulative incidence / risk rate / risk for short follow up period
Incidence density /incidence rate/ hazard for long follow up period

Prevalence

zz All current cases (NEW + OLD) at a given point of time

zz It is a PROPORTION and is expressed in percentage

Number of total cases (new +old) of specific disease

zz Prevalence = X 1000
Total Population
289
zz Can be calculated from a Cross sectional study
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zz Types
PREVALENCE Point prevalence
PSM

Period prevalence → point prevalence at start + incidence

 Prevalence = Incidence X Mean Duration

Epidemiological Methods

[A]-Descriptive Study: Time Distribution of Disease

Short term Fluctuation: Best example is an Epidemic

Periodic Fluctuation

zz Seasonal trends- Seasonal variations in a disease, occurs specially in many communicable diseases.
Ex; measles in early spring and URTI in winter
zz Cyclic trends- Diseases occurring in cycles spread over short periods of time which may be days,
weeks, months or years. Ex: Influenza pandemics occurring once every 7-10 years.

Long Term Fluctuation/Secular Trend-

 implies changes in the occurrence of disease (i.e., a progressive increase or decrease) over a
long period of time, generally several years or decades.
Ex: decrease in communicable disease incidence and an increase in Non- communicable
disease incidence.

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[B]-Analytical studies

Ecological Studies

PSM
zz 1st level of hypothesis study
zz Unit of study is population [2018]
zz Less expensive and easy to perform
zz It involves investigation of a
disease or a condition in a whole
population.

Longitudinal Study

COHORT STUDY CASE CONTROL

• At the start of study people are free from disease
• Types:
ƒƒ Prospective Cohort/ Concurrent cohort- both
exposure and outcome ascertained during study
ƒƒ *Retrospective Cohort- Outcome ascertained
during study but exposure ascertained from past
records like School register free admission medical
test etc
• Incidence and Relative risk can be calculated thus
better than case control study but is expensive and
time taking.
Incidence of disease among exposed
• Relative risk =
Incidence of disease among non- exposed
[2018]
• Suitable for RARE EXPOPSURE
• NESTED CASE CONTROL STUDY
ƒƒ A case control study inside a cohort study
ƒƒ Done with the help of previously collected and
stored data or samples
ƒƒ Eliminates recall bias, selections bias and temporal
• Mini case: control ratio = 1:1
• Normally ratio is kept at 1:4/1:5
• Easy, rapid and inexpensive study
• Suitable for RARE DISEASES
• Suitable for diseases with long latent period and
with multiple etiological factors
• does not give incidence thus is a weak study
• Temporal relationship cannot be established with
this study and many biases are encountered
• ODDS ratio can be calculated here:
Product of those proving the hypothesis
ODDS Ratio =
Product of those opposing the hypothesis
ad
=
bc
Disease
+ -
TEST + a b

ambiguity _ c d

zz Attributable Risk/Risk difference

Incidence among exposed - Incidence among non- exposed
 AR= Incidence of disease among exposed

 Tells as what % of disease can be attributed to the exposure

zz Population Attributable Risk
 determines estimate of amount by which a disease can be reduced if the suspected factor is
reduced/eliminated/modified

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Epidemiological Biases

Bias is a Systematic error

PSM

RECALL BIAS Cases remember the exposure differently than controls

HAWTHORNE BIAS/ • Subjects improving/modifying their behaviour simply in response to the fact that
ATTENTION BIAS they are being studied or watched.
MEDICAL • Subclinical cases being detected more in patients regularly visiting clinics for other
SURVEILLANCE problems
BIAS • Usually seen in case control studies
BERKESONIAN • Occurs when the control for a study are not selected from general population.
BIAS/SELECTION Ex: Patients from other ward of same hospital
BIAS • Usually occurs as a selection bias in case control studies
NEYMAN’S BIAS/ Taking an Example of a case control study of protective effect of exercise on MI, the
SURVIVORSHIP survivors are more likely to give a history of daily routine exercises giving a false
BIAS/INCIDENCE conclusion that exercise does not protects from MI when in reality the ones who did
PREVALENCE BIAS not survive the attack were not included in the study and only the ones who survived
reached the hospitals and were included in the study.
HEALTHY WORKER • Selection bias seen in occupational studies
EFFECT • Due to selection of control from general population and survival of healthier men in
the occupation
SILVERBLAZE BIAS • Bias by pharmaceutical companies when they only show the studies in which they
got positive results and do not show the studies where they got negative results
• Prevented by registering every study being done by companies to the governing
body
zz Confounder- Factor that is associated with both exposure and disease and is distributed unequally
in study and control group
Blinding Matching Randomisation
• Can be: • Process of selecting • removes selection
ƒƒ Single blinded-participant not aware of the treatment controls so that bias and Known
ƒƒ Double blinded-participant + investigator not aware of they are similar to + Unknown
the treatment cases confounders thus is
ƒƒ Triple blinded- participant + investigator + analyser • removes known BEST of Three
are not aware of the treatment confounders
• removes Bias

Experimental Studies
Randomised control trials
zz Patient is the unit of study
zz Study designs:
 Parallel Study design:
ff Comparisons made between two randomly assigned groups with one group exposed to
specific treatment
ff Patient remains in the study group or control group for the entire duration of trial
 Cross over Studies:
ff each patient serves as his own control
292
ff Patients are assigned study/comtrol group randomly and after a period both groups cross
over
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ff This design assures that each patient receives the new treatment
ff ideally suitable if the changes DOES NOT change during the study
ff Not suitable if therapy of interest cures the disease

PSM
Non-Randomised/Non-Experimental Trials

zz Crude approach
zz Done in cases where:
 direct experimentation on humans is not possible due to ethical reasons
 preventive measures can be applied only to groups or community(water Defluoridation)
 disease frequency is low and natural history is long
zz Examples are:
 proving validity of Pap test for CaCx
 Before and after comparison study in John Snow's community diagnosis of Cholera
 Before and after comparison study in Australia regarding difference in Motor accident deaths
after introduction of compulsory seatbelts
*Metanalysis-Statistical analysis that combines and summarises the results of multiple scientific
studies

Association
zz Association may be defined as the concurrence of two variables more often than would be
expected by chance.
zz SPURIOUS ASSOCIATION
 There seems an association between two variables when actually there is not.
 Occurs when ‘like’ is not compared with ‘like’
zz INDIRECT ASSOCIATION
 It is a statistical association between a characteristic (or variable) of interest and a disease
due to the presence of another factor, known or unknown, that is common to both the
characteristic and the disease.
 This third factor (i.e., the common factor) is also known as the "confounding" variable. It is
related both to the disease and to the variable.
zz DIRECT (CAUSAL) ASSOCIATION- it may be one on one or a multifactorial relationship.
zz BRADFORD - HILL’S CRITERIA OF CAUSATION
 TEMPORAL ASSOCIATION
ff Cause should precede the effect
ff Most important criteria
ff Best deduced from a Cohort study
 STRENGTH OF ASSOCIATION: The stronger the association, the more likely it is that the
relation of A to B is causal
 DOSE: RESPONSE RELATIONSHIP → As the amount of exposure increases, so does the risk.
 SPECIFICITY OF ASSOCIATION
ff One on one relationship between cause and effect
ff Most difficult criteria to establish
ff Not necessary to prove
 CONSISTENCY OF ASSOCIATION → consistent if the results are replicated when studied in
different settings and by different methods.
 BIOLOGICAL PLAUSIBILITY → there should be biological credibility to the association 293
 COHERENCE OF ASSOCIATION → coherence with known facts that are thought to be relevant
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Infectious disease Epidemiology

PSM

Some Important Definitions

INFECTION The entry and development or multiplication of an infectious agent in man’s/

animal’s body
CONTAMINATION The presence of infectious agent in inanimate articles or substances including food
INFESTATION Lodgement,development and reproduction of arthropods on surface of body or
invasion of gut by worms
HOST A person/animal/bird/arthropods that lodges an infectious agent under natural
conditions
INFECTIOUS DISEASE A clinically manifest disease of man/animal due to an Infection
CONTAGIOUS Disease transmitted through contact
DISEASE
COMMUNICABLE Illness due to specific infectious agent or its toxic products capable of direct or
DISEASE indirect transmission between man, animal and environment.
EPIDEMIC The unusual occurrence in a community or region of disease in excess of expected
occurance.
ENDEMIC Constant presence of disease/infectious agent in a specified geographical area or
group
SPORADIC Cases occurring haphazardly from time to time and infrequently
PANDEMIC Epidemic affecting a large proportion of population, Eg: country or a section of it,
continent or world
EXOTIC Disease imported into country in which they do not occur naturally
ZOONOSES Infection/infectious disease that can be transmitted to man from VERTEBRATE
animals under natural conditions
EPIZOOTIC An EPIDEMIC OF ANIMALS (ZOO) [that may affect humans also]
EPORNITHIC An EPIdemic of Birds (ORNITHOS)
ENZOOTIC An ENdemic occurring in animals (ZOO)
DISEASE CONTROL The agent continues to persist in the community below a critical level where it
ceases to be a public health problem thus disease is prevalent but Incidence and
transmission is reduced
ERADICATION Termination of all transmission of infection by extermination of the infectious agent
Only one disease has been eradicated till now: Smallpox
ELIMINATION It is complete cessation of disease transmission in a defined geographical area, the
causative agent may persist in environment
ISOLATION Separation of Infected persons/animals for a maximum period of communicability
QUARANTINE Separation of Well persons/animals who have been exposed to a communicable
disease for a period upto longest incubation period
PRODROMAL PHASE Entry of infectious agent to 1st SIGN of disease
INCUBATION PERIOD Entry of infectious agent to 1st SYMPTOM of disease
LATENT PERIOD Disease initiation to disease detection [for non infectious diseases]
294 Entry of organism to start of organism shedding[for communicable diseases

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GENERATION TIME Receipt of infection to maximal infectivity

PREPATENT TIME Time b/w invasion of an infectious agent and detection of presence of infectious
agent by laboratory means

PSM
INDEX CASE First case identified by Investigator, may or may not be the primary case
PRIMARY CASE First person becoming Sick in an epidemic
SECONDARY CASE Those which develop disease from contact with Primary case
SECONDARY ATTACK It is the number of exposed persons developing the disease out of total exposed
RATE [2018] susceptible.

Miscellaneous points to remember

zz Mortality rate in encephalitis associated zz Soil acts as a reservoir for
measles is 10-20%.  MY  - Mycetoma
zz Mortality rate of measles in developing  C  - Coccidiomycosis
countries is 10%.  Anthrax
T-Tetanus
Cholera vaccination is done in endemic areas.

zz
zz Carrier state
zz HBsAg is epidemiological Marker of HBV
low pathogenicity and High infectivity
Infection


 disease agent present in body

zz Notifiable disease under international
 recognisable sign and symptom absent in
surveillance are: body
 C Cholera  sheds disease agent even after treatment
 Y Yellow Fever  is seen in:
 P Plague ff P-Polio
zz Communicable diseases communicable EVEN ff D- Diphtheria
in Incubation Period are- ff C-Cholera
 Patna- Pertussis ff T-Typhoid
 Medical-Measles zz Pseudocarriers: carriers of avirulent
 College-Chickenpox organisms
Hospital-Hep- A
Dead end infections seen in: BuSTeR

zz
zz Iceberg phenomenon JHarKhand
 Floating tip- Clinical cases  Bubonic plague
 Submerged portion- Latent, Undiagnosed,  Scrub typhus
Inapparent, pre-symptomatic cases
 Tetanus
Line of demarcation- Separates apparent
Rabies


and Inapparent cases
 JE
 NOT shown by:[MTPR2]
 Hydatid cyst disease
ff M-Measles
 KFD
ff T-Tetanus
ff P-Pertussis
ff R-Rabies
ff R-Rubella

295

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