LOCALLY ENDEMIC DISEASES CONTROL

KEY TERMS:
EPIDEMIC
 “outbreak” is defined as a greater than usual number of cases of a disease in a particular region, usually
occurring within a relatively short period
SPORADIC
 one that occurs only occasionally (sporadically) within the population of a particular geographic area.
ENDEMIC
 disease that are always present within the population in a particular geographic area

LOCALLY ENDEMIC DISEASES CONTROL PROGRAM

 Focuses on the prevention of the occurrence of locally endemic diseases.
 Prevent transmission through vector control

I. MALARIA (Marsh fever, Periodic fever, King of tropical diseases)

 A systemic protozoan infection
 Common in forested, mountainous areas
 Endemic in Palawan and Mindoro
Causative Agent: Protozoa genus Plasmodium
1. P. falciparum – 70%
2. P. vivax – 30%
3. P. ovale
4. P. malariae
Symptoms
 Recurrent fever
 Chills
 Profuse sweating
 Malaise
 Anemia
MOT: bite of a mosquito; Vector (female Anopheles mosquito)
Incubation Period: 7 days or longer
Lab./Diagnostic test:
 Hx of having been in a malaria-endemic area
 Blood smear
Treatment:
A. Oral
1. Chloroquine phosphate 250mg – all species except P. malariae
2. Sulfadoxine 50mg - for resistant P. falciparum
3. Primaquine – use for relapse P. vivax/P. ovale
4. Pyrimethamine 25mg/tab; for all species
5. Quinine sulfate 300mg/tab
6. Tetracycline HCl 250mg/cap
7. Quinidine sulfate 200mg/durules
Prevention and Control
A. Mosquito control
1. Chemical methods
2. Biological methods
3. Zooprophylaxis
4. Environmental methods
5. Screening of houses
6. Educational methods
7. Mechanical methods
B. Universal precaution
C. Screening of blood donors

Chemoprophylaxis
 Only Chloroquine drugs should be given, to be taken at weekly intervals, starting from 1–2 weeks before
entering the endemic area and continued unto 4–6 weeks after leaving the area.
Chemoprophylaxis Treatment Schedule Guide
Age in years Chloroquine (150 mg base / tablet)
 0–4 ½ tablet
 5–8 1 tablet
 9 – 12 1 ½ tablet
 Over 12 2 tablets
II. FILARIASIS (Elephantiasis, Filarioidea infection)
 a chronic parasitic infection caused by parasites that lives in the lymphatics
Causative Agent: Wuchereria bancrofti, Brugia malayi
MOT: Bite of mosquito; Vector: Aedes poecilus, Culex quinquefasciatus
Incubation Period: 8 – 16 months
S/S:
 Chills
 Fever
 Myalgia
 Lymphangitis with gradual thickening of the skin
Lab. Diagnostic test: Circulating filarial antigen (CFA) – finger prick
Tx: Diethylcarbamazine citrate (DEC) or Hetrazan
Prevention and Control:
 Eradication of vectors
 Mass treatment - the dosage is 6mg/kg body weight taken as a single dose per year

III. SCHISTOSOMIASIS (Snail fever, Bilharziasis, Bilharza)

 Caused by several species of flatworms/flukes
 Affects farmers and their families in rural areas
Causative Agent: Schistosoma japonicum, Schistosoma mansoni, Schistosoma haematobium
Incubation period: 2 months
Vector: Oncomelania quadrasi (snail)
MOT: Vehicle (water), indirect
Lab./Diagnostic test: Direct stool examination
S/S:
 Rash at the site of inoculation
 Enlargement of the abdomen
 Diarrhea – bloody stool
 Body weakness
 Spleenomegaly
 Anemia
 Inflamed liver
Tx: Praziquantel (Biltricide); Oxamniquine for S. mansoni and S. haematobium
Prevention and Control:
 Proper disposal of feces and urine
 Proper irrigation of all stagnant bodies of water
 Prevent exposure to contaminated water
 Eradication of breeding places of snails
 Use of molluscicides
 Provide treatment of water for drinking, bathing and washing clothes

III. LEPROSY (Hansenosis, Hansen’s disease, Leontiasis)

Causative Agent: Mycobacterium leprae/Hansen’s bacillus
MOT : prolonged skin contact, droplet infection
Incubation period : 5 months to 5 years
Lab./Diagnostic test: Skin slit test
S/S :
A. Early signs
 Reddish or white change in skin color
 Loss of sensation on the skin lesion
 Decrease/loss of sweating on the lesion
 Loss of hair growth on lesions
 Thickened and/or painful nerves
 Muscle weakness
 Pain or redness of the eye
 Nasal obstruction/bleeding
 Ulcers that do not heal
B. Late signs
 Madarosis – loss of eyebrow
 Lagophthalmos – inability to close eyelids
 Clawing of fingers and toes
 Contractures
 Sinking of the nose bridge
 Gynecomastia in males – enlargement of the breast
 Chronic ulcers
Patient Classification
1. Paucibacillary (PB) – ( - ) skin slit test or five or less lesion
2. Multibacillary (MB) – ( + ) skin slit test and more than five lesions

MDT for Leprosy (RA 4073)

 Involves the use of two or more drugs (Rifampicin, Clofazimine and Dapsone)
A. Rifampicin
S/E: reddish discoloration of urine few hours after intake
B. Clofazimine S/E: brownish, black discoloration and dryness of the skin but disappears within few months after
treatment.
C. Dapsone
 S/E: causes allergic reactions; itchy skin rashes (exfoliative dermatitis)
 Patient allergic to sulfadoxine are not given this drug
Prevention and Control:
 BCG vaccination
 Avoidance of prolonged skin to skin contact with active untreated case
 Good personal hygiene
 Adequate nutrition
 Health education