Slip test – 3

13-07-2023

KEY
1 You are a Public Health Officer of a small island of 40000 population, you have received
an information about a food & Water borne communicable disease of unknown Agent,
not responding to any Antibiotics and Anti-viral Medicines.
What steps you will take to prevent the spread of Disease to your Island.
The Infection is having high Case Fatality of 80%, attack rate – 20%, Incubation Period
is 10 days and Infectivity of the infection is 10 days. No sub-clinical cases are recorded.
All individuals affected by the infection will have a,b,c,d symptoms and signs. Till now
there is no diagnostic confirmative test. 10% of infected persons will get Encephalitis
symptoms. No carrier state. No extra-human reservoir for the disease. Deaths is
happening due to Encephalitis
2 Draw the figure of Integrated Drug Resistant TB Algorithm
3 “Vitamin A deficiency is a recognized risk factor for severe measles infections” do
agree to the statement. Write briefly on Clinical features Post Measles State
4 Name the steps of acute flaccid paralysis (AFP) surveillance and write briefly about the
each step
5 Write briefly about “three lines of defence against typhoid fever”
6 Chickenpox is Characterized by all except, (a) Scabs are infective (b) Pleomorphic Stages (c) Rashes Symmetrical
centripetal dew Drops like (d) Palms and soles not affected by rash
7 Positive Schick test indicates (a) immunity to diphtheria (b) Susceptibility to diphtheria (c) Hypersensitivity to
diphtheria (d) Infection with diphtheria
Freshly Prepared ORS (Oral Rehydration Solution) should not be used after (a) 6 Hours (b) 12 Hours (c) 18 Hours
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(d) 24 Hours
9 A village affected with epidemic of Cholera, what is the 1st step which should to be taken in the village to decrease
the mortality Rate from Cholera? (a) Safe water supply & Sanitation (b) Cholera Vaccination to all villagers (c)
Primary Chemoprophylaxis (d) Treat everyone with tetracycline
10 Chandlers Index is used in epidemiological studies of (a) Round Worms (b) Hook Worms (c) Guinea Worms (d)
Sand fly
• QNo- 1

You are a Public Health Officer of a small island of 40000 population, you have received
an information about a food & Water borne communicable disease of unknown Agent,
not responding to any Antibiotics and Anti-viral Medicines.
What steps you will take to prevent the spread of Disease to your Island.
The Infection is having high Case Fatality of 80% among encephalitis cases, attack rate –
20%, Incubation Period is 10 days and Infectivity of the infection is 10 days. No sub-
clinical cases are recorded. All individuals affected by the infection will have a,b,c,d
symptoms and signs. Till now there is no diagnostic confirmative test. 10% of infected
persons will get Encephalitis symptoms. No carrier state. No extra-human reservoir for
the disease. Deaths is happening due to Encephalitis.
Understanding the Situation
• You are a Public Health Officer of a small island of 40000 population, you have received an
information about a
• food & Water borne communicable disease.
• not responding to any Antibiotics and Anti-viral Medicines
• The Infection is having
o Incubation Period is 10 days
o Infectivity of the infection is 10 days.
o high Case Fatality of 80% among encephalitis cases
o attack rate – 20%,
o No sub-clinical cases are recorded
o All individuals affected by the infection will have a,b,c,d symptoms and signs.
o Till now there is no diagnostic confirmative test.
o 10% of infected persons will get Encephalitis symptoms. No carrier state. No extra-human
reservoir for the disease. Deaths is happening due to Encephalitis.
DISEASE PREVENTION AND CONTROL
• Quarantine
• Isolation
• Treatment (ICCU)
• Interruption of transmission
o Home Isolation
o Water Sanitation
o Food Sanitation
o Ban on imported food Items / Quality Check of
Imported food Items before entering to the market
 DISEASE PREVENTION AND CONTROL
(Continued)
• Protection of Susceptible host
o Surveillance of the cases
o Symptomatic Treatment
o Dangerous signs & Red flag Surveillance System
• Health Propaganda
• Health Awareness
• Health Education
• Capacity Building activity
• Research
Public Health Preventive Measures
• food & Water borne communicable disease : Safe Water Supply &
Strict Food Hygiene. Banning the any type of cooked food from the
outside the island.
• Incubation Period is 10 days – any body coming from out side the
island shall be quarantined for 10 days
• Infectivity of the infection is 10 days :
o all individuals arrived at the Island in recent past (< 20 days) shall be traced
and kept under observation for 10 days (Home Isolation)
o Tract high suspects of direct contacts with recently arrived travelers and
keep them under Home Isolation.
Public Health Preventive Measures
• No sub-clinical cases are recorded:
o Conduct active surveillance for “a,b,c,d symptoms and signs”
o All individuals with “a,b,c,d symptoms and signs” shall be kept
under Isolation along with all family members.
• 10% of infected persons will get Encephalitis symptoms
o All the persons of early signs of Signs & Symptoms of
Encephalitis shall be shifted to tertiary care units equipped with
Intensive Neuro care facilities.
QNo- 2

Draw the figure of Integrated Drug Resistant

TB Algorithm
QNo- 3
“Vitamin A deficiency is a recognized risk
factor for severe measles infections” do
agree to the statement.
Write briefly on Clinical features Post
Measles State
Answer to QNo- 3
• “Vitamin A deficiency is a recognized risk factor for severe measles infections”
o I Agree to the statement.
• Clinical features Post Measles State
o The child will have lost weight and will remain weak for a number of days.
o There may be failure to recover and a gradual deterioration
 into chronic illness due
• to increased susceptibility to other bacterial and viral infections
• To nutritional and metabolic effects and the tissue destructive effects of the virus.
o There may be
 growth retardation
 Diarrhoea
 cancrum oris (a fast-acting gangrene infection that destroys the mucus membranes of
the oral and facial tissues)
 pyogenic infections
 Candidosis
 reactivation of pulmonary tuberculosis etc
QNo- 4
Name the steps of acute flaccid paralysis
(AFP) surveillance and write briefly about
each step
Acute flaccid paralysis surveillance

1. Finding and reporting children with acute flaccid paralysis (AFP):

o Passive & Active Surveillance
2. Transporting stool samples for analysis
o two specimens - taken 24-48 hours apart are to be collected and
transported at 4-8°C in a cold box so as to reach within 72 hours
3. Isolating polio Virus
o Isolation of Virus to differentiate between Vaccine Virus & Wild Virus
4. Mapping the virus
o Analyse the genetic making of Wild Virus and Identify precisely the
geographic origin of the Virus.
Finding and reporting children with acute
flaccid paralysis (AFP)
• every case of acute flaccid paralysis (AFP) in any child
under 15 years of age shall be reported by all Health
facilities including both public & private.
• public health staff shall make regular visits to all
hospitals and rehabilitation centres to search for AFP
cases.
• A country’s surveillance system needs to be sensitive
enough to detect at least one case of AFP for every
100,000 children under 15, even in the absence of
polio.
Transporting stool samples for analysis
• All children with acute flaccid paralysis (AFP) should be reported
and tested for wild poliovirus within 48 hours of onset
• To test for polio, faecal specimens are analyzed for the presence
of poliovirus
• two specimens - taken 24-48 hours apart are to be collected
• Stool specimens have to be sealed in containers and stored
immediately inside a refrigerator or packed between frozen ice
packs at 4-8°C in a cold box, ready for shipment to a laboratory.
• Specimens should arrive at the laboratory within 72 hours of
collection
Isolating polio Virus
• In a laboratory isolating poliovirus will be done from the
stool samples.
• If poliovirus is isolated
o It will be further studied to distinguish between wild
(naturally occurring) and vaccine-related poliovirus
• If wild poliovirus is isolated, it will be further studied
through 4th step
Mapping the virus
• Once wild poliovirus has been identified
o Testing for identifying the strain to understand the origination
o After determining the exact genetic make-up of the virus
o The wild viruses can be compared to others and classified into
genetic families which cluster in defined geographical areas.
o The newly-found poliovirus sequence is checked against a reference
bank of known polioviruses, allowing inferences about the
geographical origin of the newly found virus.
o When polio has been pinpointed to a precise geographical area, it is
possible to identify the source of importation of poliovirus
o Appropriate immunization strategies can then be determined to
prevent further spread of the poliovirus.
QNo – 5

Write briefly about “three lines of defence

against typhoid fever”
Three lines of defence against typhoid fever

1.Control of reservoir:
2.Control of sanitation
3.Immunization
control of reservoir
Cases CARRIERS
(i)Early diagnosis (i)Identification
(ii)Notification (ii)Treatment
(iii)Isolation (iii)Surgery
(iv)Treatment (iv)Surveillance
(v)Disinfection (v)Health Education
(vi)Follow-up
Control of sanitation
• Protection and purification of drinking water supplies
• Improvement of basic sanitation and promotion of food
hygiene
Immunization
• Vaccine can be given at any age upwards of two years
• It is recommended to :
(i) those living in endemic areas
(ii) household contacts
(iii) groups at risk of infection such as school children and
hospital staff
(iv) travelers proceeding to endemic areas
(v) Those attending melas and yatras.
QNo- 6

Chickenpox is Characterized by all except

(a) Scabs are infective
(b) Pleomorphic Stages
(c) Rashes Symmetrical centripetal dew Drops like
(d) Palms and soles not affected by rash
Mention the Chickenpox Vaccination
Schedule
6 Chickenpox is Characterized by all except,
(a) Scabs are infective
(b) Pleomorphic Stages
(c) Rashes Symmetrical centripetal dew Drops like
(d) Palms and soles not affected by rash
Ans (a) Scabs are infective
• Children between 12-18 months of age who havenot had chickenpox.
• When 2 doses are administered, the minimum interval between doses is either 6
weeks or 3 months for children (12 months to 12 years of age inclusive)
IAP – recommended shedule
• Children need 2 doses of varicella vaccine for adequate protection.
The dosage schedule is as follows:
• For 15 months babies
• Dose 1 at age 15 months.
• Dose 2: 3-6 months after dose 1.
• For those >12 years
• 2 doses are administered at an interval not less than 4 weeks.
Qno – 7
Positive Schick test indicates
(a) immunity to diphtheria
(b) Susceptibility to diphtheria
(c) Hypersensitivity to diphtheria
(d) Infection with diphtheria
Briefly mention the Symptoms of the Disease.
7 Positive Schick test indicates
(a) immunity to diphtheria
(b) Susceptibility to diphtheria
(c) Hypersensitivity to diphtheria
(d) Infection with diphtheria
Ans: (b) Susceptibility to diphtheria
Respiratory tract forms of diphtheria consist of pharyngotonsillar,
laryngotracheal, nasal, and combinations thereof. Patients with
pharyngotonsillar diphtheria usually have a sore throat, difficulty in
swallowing, and low-grade fever at presentation.
Qno – 8
Freshly Prepared ORS (Oral Rehydration Solution)
should not be used after
(a) 6 Hours
(b) 12 Hours
(c) 18 Hours
(d) 24 Hours
Why not, it shall not be used later to your Answer.
 Freshly Prepared ORS (Oral Rehydration Solution) should not be used after
(a)6 Hours
(b)12 Hours
(c)18 Hours
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(d)24 Hours
Ans: (d) 24 Hours
Why should ORS be discarded after 24 hours?
• Since there is no residual chlorine activity in the ORS,
• the ORS should still be discarded after 24 hr, even if made from chlorinated water.
QNo- 9
A village affected with epidemic of Cholera, what is the
1st step which should to be taken in the village to
decrease the mortality Rate from Cholera?
(a) Safe water supply & Sanitation
(b) Cholera Vaccination to all villagers
(c) Primary Chemoprophylaxis
(d) Treat everyone with tetracycline
How do you confirm the epidemic id due to
Cholera
9 A village affected with epidemic of Cholera, what is the 1st step which should to be
taken in the village to decrease the mortality Rate from Cholera?
(a) Safe water supply & Sanitation
(b) Cholera Vaccination to all villagers
(c) Primary Chemoprophylaxis
(d) Treat everyone with tetracycline
Ans: (a) Safe water supply & Sanitation
Stool Microscopic examination for Motile Bacilli (Vibrio Cholera)
Microscopic Examination of Stools
• If a microscope with dark field illumination is available, it
may be possible to diagnose about 80 per cent of the cases
within a few minutes, and more cases after 5-6 hours of
incubation in alkaline peptone water.
• In the dark field , the vibrios evoke the image of many
shooting stars in a dark sky. If motility ceases on mixing
with polyvalent anti-cholera diagnostic serum, the
organisms are presumed to be cholera vibrios.
• A presumptive diagnosis of cholera can thus be established.
Q No – 10
Chandlers Index is used in epidemiological studies of
(a) Round Worms
(b) Hook Worms
(c) Guinea Worms
(d) Sand fly

Define Chandlers Index

10 Chandlers Index is used in epidemiological studies of
(a) Round Worms
(b) Hook Worms
(c) Guinea Worms
(d) Sand fly
Ans : (b) Hook Worms
Chandler Index: It is the average number of hookworm eggs per gram of faeces for the
entire community.
Thank you