Community Health Nursing 1: Communicable Diseases

FILARIASIS Vision: Healthy and productive individuals and families

for Filariasis-Free Philippines
Filariasis is a chronic parasitic infection caused by Mission: Elimination of Filariasis as a public health
nematode parasites known as Wuchereria bancroftim, problem thru comprehensive approach and universal
Brugia malayi, and/or Brugia timori access to quality health services
●Transmitted by mosquitoes
●Incubation period of 8-16 months Objectives
● Considered globally as a neglected tropical disease
-To sustain transmission interruption in provinces
(NTD)*
through strengthening of surveillance
Signs and Symptoms - To intensify interventions and interrupt transmission
-Swelling of the breast, Vagina / scrotum, arms, legs in persistent infection provinces
-Fever - To strengthen Morbidity Management & Disability
-Cough Prevention (MMDP) activities and services to alleviate
-Chills suffering among chronic patients
-Wheezing - To strengthen the health system capacity to secure LF
elimination
Assessments - Secure adequate investment from governmental and
-Physical examinations done in the main health centers nongovernmental sources to sustain all program
or during scheduled survey bites in the community objective
-Observation of the major and minor signs and
symptoms Program components
-History taking
1. INTERRUPTION OF TRANSMISSION: Elimination level
Laboratory examinations prevalence of microfilaremia of less than 1% and
Antigen rate of < 1% through Mass Drug Administration
1.Nocturnal blood examination (nbe) Blood is taken (MDA)
from the patient at the patient’s residence or in the
hospital after 8:00 PM 2. CONTROL AND REDUCE THE MORBIDITY: by
alleviating the sufferings and disability caused by its
2.Immunochromatographic test (ict) The rapid clinical manifestations through Morbidity Management
assessment method. It is an antigen test that can be Disability Prevention (MMDP)
done at daytime
Strategies, action points, and timeline
DOH: FILARIASIS ELIMINATION PROGRAM 1. Mass Drug Administration
2. Disability Management
Description
3. Monitoring through Midterm Sentinel surveys and
-Started in 2001 after a pilot study using the Evaluation through Transmission Assessment Survey
combination drugs in 2000 in five selected 4. Post Validation Surveillance
municipalities 5. Private-Public Partnership
-Total no. of province: 81
Program accomplishments and status - Provinces that
- Total Population in the country: 103, 741, 330 as of
have reached elimination level and declared as
2018
Filariasis-free as of 2017: 38 Provinces
- Total Endemic Provinces: 46 in 12 Regions
-Total Endemic Population: 8 Million Treatment
-Parasite: Majority is Wuchereria bancrofti - DEC (Diethylcarbamazine Citrate) is given to people
- Vectors incriminated: Aedes poecilius, Anopheles with clinical manifestations of the disease.
flavirostris

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Community Health Nursing 1: Communicable Diseases

-Mass Treatment Early diagnosis & prompt treatment

➢Distribution to all population • Clinical Method - signs & symptoms and PX history
➢ Endemic and infected or not infected with filariasis • Microscopic Method - blood smear of PX under the
in established endemic areas microscope
➢ Dosage of 6 mg/kg is taken as a single dose per year
SUSTAINABLE PREVENTIVE & VECTOR CONTROL
Surgical Treatment MEASURES
-INSECTICIDE - TREATMENT OF MOSQUITO NET
➢Elephantiasis and hydrocele can be handled through
-ON STREAM CLEARING
surgery and is usually referred to hospitals for
-HOUSE SPRAYING
management.
-ON STREAM SEEDING
➢ Mild cases of lymphedema can be treated by
lympho-venous anastomosis distal to the site of OTHER CONTROL MEASURES
lymphatic destruction -CLOTHING COVERING ARMS & LEGS
➢ Chyluria is operated on by ligation and stripping of -ZOOPROPHYLA -XIS
the lymphatics of the pedicle of the affected kidney - PLANTING NEEM TREE OR HERBAL PLANTS
while hydroceles can be managed by inversion or -USING MOSQUITO REPELLENTS
resection of the tunica vaginalis
CHEMOPROPHYLAXIS & ANTI- MALARIALS
Prevention -Chloroquine drug
-Use of mosquito repellants -Sulfadoxine
-Wear long sleeves, pants, and socks -Quinine sulfate
-Use of mosquito nets when sleeping -Quinine hydrochloride
-Tetracylcine hydrochloride
-Quinidine sulfate
-Quinidine glucolate
MALARIA
-Blood schizonticides
IS A MOSQUITO- BORNE DISEASE CAUSED BY
PLASMODIUM PARASITES. AS OF TODAY, IT MALARIA EPIDEMIC
CONTINUES TO BE A MAJOR HEALTH PROBLEM IN THE
COUNTRY New malaria cases are in excess of the expected -
Epidemic potential is a situation wherein an area is
-Incidence in the country is 5.1/1000 pop. vulnerable to malaria case upsurge due to causal
-There are 220 million cases worldwide factors (e.g. climate change, ecological change, socio-
-405,000 deaths are reported, 67% are children economic change)

Malaria is produced by: EARLY RECOGNITION & CONTROL OF MALARIA

• Plasmodium falcifarum EPIDEMIC
• Plasmodium vivax -Confirmation of follow up-cases
• Plasmodium ovale -Focal Spraying
• Plasmodium malariae -Mass Blood smear
-Stream Clearing
Signs and Symptoms
-Drug treatment & follow-up
-Recurrent Chills
-Insecticide treatment mosquito nets
-Fever
- Intensive IEC campaigns
-Profuse Sweating
-Collaboration of non- government and governmental
-Anemia
organizations
-Malaise
-Surveillance for 3 years
-Hepatomegaly
-Spleenomegaly

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MALARIA CONTROL PROGRAM
Vision: A Malaria–Free Philippines by 2030
Mission: Further accelerate malaria control and
transition towards elimination
Objectives:
• Objective 1 (Universal Access)
• Objective 2 (Governance and Human Resources)
• Objective 3 (Health Financing)
• Objective 4 (Health Information and Regulation)
NATIONAL DENGUE PREVENTION AND CONTROL
PROGRAM
Vision: A dengue free Philippines
Mission: Ensure healthy lives and promote well-being
for all at all ages
Goal: To reduce the burden of dengue disease
Objectives
1.) To reduce dengue morbidity by at least 25% by
2022
2.) To reduce dengue mortality by at least 50% by 2022
3.) To maintain Case Fatality Rate (CFR) to < 1% every
year.
DENGUE HEMMORHAGIC FEVER (DHF)
Dengue is a mosquito-borne viral infection causing a
severe flu-like illness and sometimes causing a
potentially lethal complication called severe dengue.
(WHO,2020)
CLASSIFICATIONS:
• Severe/Frank Type
• Moderate
• Mild
*Our country has 50,169 cases as of May 2020. 4.2
million cases worldwide have been reported in 2019.
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3 stages you need to know that can manifest for
about 10 days:
-Febrile or invasive stage - first 4 days
-Toxic or hemorrhagic stage - 4th - 7th days
-Convalascent or recovery stage - 7th - 10th days
All persons are susceptible to dengue especially those
who belong in the preschool and school age.
Source and Mode of Infection: Aedes Aegypti's bite
Incubation period: 6 days to one week
Period of communicability: 1st week of illness
Occurence: Rainy season from Sept.- Oct.
Diagnostic test:
Tourniquet Test (Rumpel Leads Test)- a physical
examination technique that can identify and stratify
dengue disease. Presence of petechiae 20 or more
when blood pressure cuff was inflated indicates
positive result for DHF
Management for DHF:
• Paracetamol (Fever)
• Analgesic ( Headache )
• Rapid replacement of Body fluids
• Intensive monitoring & follow-up
• ORESOL for rehydration
PREVENTIVE & CONTROL MEASURES FOR DENGUE
-RECOGNITION OF THE DISEASE
- EPIDEMIOLOGICAL INVESTIGATION
-CASE FINDING & REPORTING
-ISOLATION OF PX
-HEALTH EDUCATION
OTHER CONTROL MEASURES
-ELIMINATE VECTOR
-RESIDUAL SPRAYING WITH INSECTICIDES
-AVOID HANGING TOO MANY CLOTHES INSIDE THE
HOUSE
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SEXUALLY TRANSMITTED DISEASE CHLAMYDIA: is a sexually transmitted infection

caused by chlamydia trachomatis
Leading mode of transmission of HIV is Sexual
Intercourse Causative agent: Caused by the bacteria Treponema
Pallidum and passed by direct contact with infectious
1. Multiple sexual partners sore.
2. Unprotected sexual intercourse
3. Penetrative anal intercourse and clientele of sex Signs and Symptoms
workers
Primary stage: painless chancre at site entry of germs,
4. Sharing needles for injecting drug use
swollen glands
DEFINITION: a major global cause of acute illness,
Secondary stage: symptoms usually appear 1 week to 6
infertility, long term disability and death.
months after appearance of chancre and may include
The most common treatable STIs are: rash, patchy hair loss, sore throat, and swollen glands.
-Gonorrhea Both the primary and secondary sores will go away
-Syphilis even without treatment, but the germs will continue to
-Chlamydia spread throughout the body.
-Trichomoniasis
Late syphilis: varies from no symptoms to indication of
-Gardianella Vaginitis
damage to body organs such as the brain heart and
liver.

GONORRHEA: A Sexually Transmitted Disease (STD). Diagnosis: Dark field illumination test and Kalm test
People get it from having sexual intercourse with
Treatment: Antibiotics as prescribed
someone who is infected by it. It is usually called “the
clap”. Both men and women can get it, though men get
it more often than women.
SYPHILISA: highly contagious disease that mostly
Causative agent spread through sexual activities, including oral and
anal.
1.This STD comes from the bacteria called Neisseria
Gonorrhoeae. Causative agent: Chlamydia trachomatis and passed
2.Typically passed by direct contact between infectious during sexual contact
mucous membranes.
3.As with other germs, you can get the bacteria just Signs and Symptoms
from touching an infected area on another person.
4.Contaminated fingers can pass the organism from FEMALES: sometimes a slight vaginal discharge, itching
infected mucous membranes to the eyes and burning of vagina, painful intercourse, abdominal
pain, fever in late stages.
Signs and Symptoms
1.Genitals, anus, throat, and eyes can be infected MALES: discharge from penis, burning and itching of
2. Burning urination, painful or swollen testicles, and urethral opening, burning sensation during urination.
pus discharges from infection of urethra for the male
Diagnosis:
3. Vaginal discharges
1. Culture test can determine
4. Infection of eyes is rare in adults
2.Microscopic examination of discharge from urethra
Diagnosis: Gram staining and Culture of cervical & or cervix (has been recently developed).
urethral smear
Treatment: Antibiotics as prescribed
Treatment: Antibiotics as prescribed

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TRYCHOMONIASIS: Also called “trich” is a common

Sexually transmitted infection (STI).

Causative agent

1.Caused by a one-celled protozoan organism called

Trichomonas Vaginalis.
2. Passed by direct sexual contact
3.Can be transmitted through contact with wet objects,
such as towels, wash clothes, and douching equipment.

Signs and symptoms

Trichomoniasis often has NO symptoms. But when

symptoms do occur, the common symptoms of men
and women are:
1.Slight itching of penis
2.Painful urination
3.Clear discharge from penis
4.Vaginal itching and soreness
5.White or greenish-yellow odorous discharge

Diagnosis: Microscopic slide of discharge and culture

tests examination

Treatment: Curable with an oral medication

GUARDIANELLA VAGINITIS

Causative agent: varies

Signs and symptoms:

1.Rare in males
2.WOMEN: Sight grayish or yellow odorous vaginal
discharge and mild itching or burning sensation.

Diagnosis:

1.Microscopic slide
2. Chemical analysis of vaginal material
3.culture test from infection site

Treatment: Curable with antibiotics and vaginal creams

or suppositories

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Community Health Nursing 1: Communicable Diseases
CHICKEN POX
Etiology Agent: Human (alpa) herpesvirus 3 (varicella-
zoster virus), a member of the Herpesvirus group.
Source of Infection: Secretion of respiratory tract of
infected persons. Lesions of skin are of little
consequence. Scabs themselves are not infective.
Description: Acute infectious disease of sudden onset
with slight fever, mild constitutional symptoms and
eruptions which are maculo-papular for the few hours,
vesicular for 3-4 days and leaves granular scabs.
Lesions are more on covered than on exposed parts of
the body and may appear on scalp and mucous
membrane of upper respiratory tract.
Mode of transmission: 2-3 weeks, commonly 13 to 17
days.
Period of communicability: not more than one day
before and more than 6 days after appearance of the
first crop of vesicles.
Susceptibility, Resistance and Occurrence
-Universal among those not previously attacked.
Severe in adults. An attack confers long immunity.
-Second attacks are rare. Probably 70% have the
disease by the time they are 15 years of age.
-Not common in early infancy.
Methods of Prevention and Control
Case over 15 years of age should be investigated to
eliminate possibility of smallpox. Report to local
authority. Isolation. Concurrent disinfection of throat
and nose discharges. Exclusion from school for 1 week
after eruption first appears and avoid contact with
susceptibility.
INFLUENZA
Etiological Agents: Influenza Virus A, B, C
Sources of Infection: Discharges from the mouth and
nose of infected persons.
Description: Acute highly communicable disease
characterized by abrupt onset with fever which last 1
day to 6 days, chilly sensation or chills, aches or pains
in the back and limbs with prostrations. Respiratory
symptoms include coryza, sore throat and cough.
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Mode of Transmission: By direct contact, through
droplet infection, or articles freshly soiled with
discharges of nose and throat of infected person,
Airborne.
Incubation Period: Short, usually 24 to 72 hours
Period of Communicability: Probably limited to 3 days
from clinical onset.
Susceptibility, Resistance and Occurrence
-Universal but of varying degrees as shown by frequent
unapparent and typical infection during epidemics.
-Occurrence is variable, in pandemics, local epidemics
and as sporadic cases, often unrecognized by reason of
indefinite clinical symptoms
-Infection produces immunity of unknown duration to
the type and subtype of infecting virus.
Methods of Prevention and Control
-Education of the public as to sanitary hazard from
spitting, sneezing, and coughing.
-Avoid use of common towels, glasses, and eating
utensils.
-Active immunization with influenza vaccine provided
prevailing strain of virus matches antigenic component
of vaccine.
Public Health Nursing Responsibilities
-Isolate patient during acute stage.
-Report the case to local Health Officer immediately.
-During epidemics to minimize severity, to protect
patient from secondary infections, thus reducing
mortality. Patients should be instructed to go to bed at
the beginning of the attack and not to return to work
without the approval of the physician.
Nursing Care
-Keep patient warm and free from drafts in bed.
-Keep patient away from persons suffering from
respiratory tract infections to prevent pneumonia.
-Tepid Sponge for fever and use the proper technique
as a teaching tool to a responsible member of the
family
-Teach and demonstrate proper sneezing and cough
technique using paper tissue to cover the mouth and
nose during cough or sneeze.
-Teach the burning method or disposal of
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contaminated tissues and newspaper. Complications:

-Clothing soiled with throat and nose discharge should -Emphysema or pleural effusion
be boiled for 30 minutes before laundering. -Endocarditis or pericarditis with effusion
-Pneumococcal meningitis
-Otitis media in children
-Hypostatic edema and hyperemia of unaffected lung
PNEUMONIAS
in the elderly
Introduction: An acute infectious disease of the lungs -Jaundice
usually caused by the pneumococcus resulting in the -Abortion
consolidation of one or more lobes of either one or
both lungs.
Management:
Etiology:
-Majority of cases due to Diploccocus penumoniae. -Bedrest
-Occasionally pneumococcus of Friedlander. -Adequate salt, fluid calorie and vitamin intake. Water
-Viruses requirement increases because of fever, sweating and
increased respiratory rate; Plasma chlorides tend to fall
Predisposing Causes
in pneumonia; hence sodium chloride should be given
-Fatigue
by mouth or by vein if necessary. Adequate urine
-Overexposure to inclement weather (extreme heat or
output is essential for excretions of toxins and for
cold)
avoidance of serious urinary complications due to
-Exposure to polluted air
medications. Adequate caloric and vitamin (especially
-Malnutrition
Vit. C) intake is essential since the body reserves are
-Chemical irritants
rapidly depleted by the increased rate of metabolism
Incubation Period: 2 to 3 days -Tepid sponge for fever
-Frequent turning from side to side
Signs and Symptoms -Antibiotics based on Care of Acute Respiratory
-Rhinitis/common cold Infection (CARI) of the DOH
-Chest indrawing
-Rusty sputum
-Productive cough
-Fast respiration TYPHOID FEVER
-High fever
Etiologic Agent: Salmonella typhosa, typhoid bacillus
-Vomiting at times
-Convulsion may occur Source of Infection: Feces and urine of infected
-Flushed face persons. Family contacts may be transient carrier.
-Dilated pupils Carrier state is common among persons over 40 years
-Severe chill, in young children of age, especially females.
-Pain over affected lung
- Highly colored urine with reduced chlorides and Description: A systemic infection characterized by
increased urates continued fever, malaria, anorexia, slow pulse,
involvement of lymphoid tissues, especially ulceration
Diagnosis: of Peyer’s patches, enlargement of spleen, rose spots
-Based on history and clinical signs and symptoms on trunk and diarrhea. Many mild typical infections are
-Dull percussion note on affected side (lung) often unrecognized. A usual fatality of 10% is reduced
-X-ray to 2 or 3% by antibiotic therapy.

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Community Health Nursing 1: Communicable Diseases
Mode of Transmission: Direct or indirect contact with
patient or carrier. Principal vehicles are food and
water. Contamination is usually by hands of carrier.
Flies are vectors.
Incubation Period: Variable; average 2 weeks, usual
range 1 to 3 weeks.
Period of Communicability: if typhoid bacilli appear in
excreta; usually from appearance of prondromal
symptoms from first week throughout convalescence.
Susceptibility, Resistance, and Occurrence
-Susceptibility is general although many adults appear
to acquire immunity through unrecognized infections.
-Attack rated decline with age after second or third
decades. A high degree of resistance usually follows
recovery.
Methods of Prevention and Control:
-Same preventive and control measures as in Dysentery
and in addition, immunization with a vaccine of high
antigenicity.
-Education of the public and particularly the food
handlers.
Public Health Nursing Responsibility
-Teach members of the family how to report all
symptoms to the attending physician especially when
patient is being cared for at home. Teach, guide, and
supervise members of the family on nursing techniques
which will contribute to the patient’s recovery.
-Interpret to family nature of disease and need for
practicing preventive and control measures.
Nursing Care
-Demonstrate to family how to give bedside care, such
as tepid sponge, feeding, changing of bed linen, use of
bedpan and mouth care.
-Any bleeding from the rectum, blood in stools, sudden
acute abdominal pain, restlessness, falling of tempt
should be reported at once to the physician or the
patient should be brought at once to the hospital.
-Take vital signs and teach family members how to take
and record same.
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LEPTOSPIROSIS (Weils disease, Mud Fever, Trench
Fever, Flood Fever, Spiroketal Jaundice, Japanese
Seven Days Fever)
Introduction:
-Leptospirosis is a worldwide zoonotic disease caused
by bacteria called leptospires, Leptospira interrogans.
This species is divided o=into more than 200 serovars
with var, icterohemorrhagiae thought to be more
virulent and more likely to cause Weil’s disease, a
severe form of infection.
-Rat is the main host to leptospirosis although pigs,
cattles, rabbits, hare, skunk, and other wild animals can
also be as severe as reservoir host.
-it is an occupational disease affecting veterinarians,
miners, farmers, sewer workers, abattoir workers, etc.
Etiologic Agent: Leptospira interrogans- fine spiral
bacteria 0.1 urn in diameter and 6-20 urn in length.
Appears straight with 1 or both ends hooked.
Locomotion is achieved in a fluid medium by a whirling
motion around the longitudinal axis and by a
serpentine or corkscrew motion in semisolid medium.
Incubation Period: Ranges from 7-19 days, with
average of 10 days.
Mode of Transmission: Through contact of the skin,
especially open wounds with water, moist soil or
vegetation contaminated with urine of infected host.
Signs and Symptoms: Clinical manifestation are
variable with different degrees of severity. It has two
clinical Phases:
1.Leptospiremic phase- leptospires are present in the
bloods and Cerebro Spinal Fluid (CSF). Onset of signs
and symptoms are abrupt with fever, headache,
myalgia, nausea, vomiting, cough and chest pain.
2.Immune phase- correlates with the appearance of
circulating IgM.
Diagnosis: Leptospirosis can be diagnosed by its clinical
manifestations, culture of the organism, examination
of blood and CSF during the first week of illness and
urine after the 10th day.
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Community Health Nursing 1: Communicable Diseases
Treatment
-Penicillins and other related B-lactam antibiotics (PCN
at 2M units q 6H IM/IV)
-Tetracycline (Doxycycline at 100mg q 12H p.o)
-Erythromycin (500 mg q 12H p.o) in patients allergic to
penicillin
Prevention and Control
-Improved education of people at particular risk e.g
farmers, miners, etc, to increase their awareness and
enable early diagnosis and treatment.
-Use of protective clothing boots and gloves especially
by workers with occupational hazards.
-Stringent community – wide rat eradication program.
Remove rubbish from work and domestic environment
to reduce rodent population.
-Isolation of patient and concurrent disinfection of
soiled articles. -Report all cases of leptospirosis
-Investigation of contacts and source of infection
-Chemoprophylaxis in groups at high risk of infected
host.
RABIES
Introduction: Rabies is an acute viral encephalomyelitis
caused by the rabies virus, a rhabdovirus of the genus
lyssavirus. It is fatal once signs and symptoms appear.
There are two kinds: urban or canine rabies is
transmitted by dogs while sylvatic rabies is a disease of
wild animals and bats which sometimes spread to dogs,
cats, and livestock.
-Rabies remains a public health problem in the
Philippines. Approximately 300 to 600 Filipinos die of
rabies every year. Philippines has one of the highest
prevalence rates of rabies in the whole world.
Mode of Transmission: Usually by bites of a rabid
animal whose saliva has the virus. The virus may also
be introduced into a scratch or in fresh=h breaks in the
skin (very rare). Transmission from man to man is
possible. Airborne spread in a cave with millions of bats
have occurred, although rarely. Organ transplant
(cornea) taken from a person dying of diagnosed CNS
disease have resulted in rabies in the recipient.
Incubation Period: The usual incubation period in 2 to
8 weeks. It can be as long as a year or several years
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depending on the severity of the wounds, site of the
wound as distance from the brain, amount of virus
introduced, and protection provided by clothing.
Period of Communicability: In dogs and cats, for 3 to
10 days before onset of clinical signs (rarely over 3
days) and throughout the duration of the disease.
Susceptibility and Resistance: All warm-blooded
mammals are susceptible. Natural immunity in man is
unknown.
Signs and Symptoms
-Sense of apprehension; aerophobia ; inspiratory
spasm
-Headache
-Fever
– Sensory change near site of animal bite
– spasms of muscle or deglutition on attempts to
swallow (fear of water/hydrophobia)
-Paralysis
-Delirium and convulsion
-hypersalivation
* Without medical intervention, the rabies victim
would usually last only 2 to 6 days. Death is often due
to respiratory paralysis
Management and Prevention
-The wound must be immediately and washed with
soap and water. Antiseptics such as povidone iodine or
alcohol may be applied.
- patients may be given antibiotics and anti-tetanus
immunization.
-Post-exposure treatment is given to persons who are
exposed to rabies. it consists of local wound treatment,
active immunization (vaccination) and passive
immunization (administration of rabies
immunoglobulin)
-Active immunization or vaccination aims to
induce the body to develop antibodies against rabies
after 3 years
- passive immunization- the process of giving an
antibody to persons (with head and neck bites,
multiple single deep bites, contamination of mucous
membrane or thin covering of the eyes, lips, mouth) in
order to provide immediate protection against rabies
which should be administered within the first seven
days of active immunization. The effect of the
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immunoglobulin is only short term. Conduct of dog vaccination and Post immunization
- Then consult veterinarian or trained personnel to evaluation
observe your pet for 14 days for signs of rabies
-be a responsible pet owner
-have pet immunize at 3 months of age and every year
BIRD FLU or AVIAN INFLUENZA
thereafter
-never allow pets to roam the streets Introduction: Influenza is recognized both as an
-take care of your pet; bathe, feed them regularly with emerging and re-emerging viral infection and is
adequate food, provide them with clean sleeping described as an unvarying disease caused by a varying
quarters virus. The virus mutates but its burden on health, lives
-your pet's action is your responsibility and manpower is consistently overwhelming.
-consult for rabies diagnosis and surveillance of the
area Description: Bird Flu or Avian Influenza is an infectious
-mobilize for community participation disease of birds ranging from mild to severe form of
illness. All birds are thought to be susceptible to
National Rabies Prevention and Control Program infection with avian influenza, though some species are
more resistant to infection than others. Some forms of
Goal: Human rabies is eliminated in the Philippines
bird flu infections can cause illness to humans. It is due
and the country and declared Rabies-free
to a highly pathogenic influenza virus H5Ni. H5Ni
General objectives subtype has been shown to be transmitted from
infected poultry to human.
-to reduce the incidence of human rabies from 7 per
million to 1 per million population by to 2010 and Disease in Birds has two forms:
eliminate human rabies by 2015
-First form causes mild illness.
-to reduce the incidence of canine rabies from 70 per
100,000 to 70 per 100,000 dog by 2010 and eliminate -Second form is highly pathogenic avian influenza, first
canine rabies by 2015 recognized in Italy in 1878, extremely contagious in
birds and rapidly fatal and birds can die on the same
The program is jointly implemented by the Department
day that symptoms first appear.
of Agriculture (Bureau of Animal Industry), Department
of Health, Department of Education, Culture and Source of Infection: Viruses that normally infect only
Sports, Department of Interior and Local Government birds and less commonly pigs.
and Non-Government organization
Incubation Period: 3 days ranges of 2-4 days
Strategies
Signs and Symptoms:
a. Manpower development- training of health workers -Fever
veterinarian and laboratory technicians on -Body weakness or muscle pain
management of animal bite cases -Cough
-Sore throat
b. Social mobilization- organizational meetings,
-may have difficulty of breathing in severe case
networking with other sectors
-Sore eyes
c. Local Program Implementation-
Susceptibility, Resistance and Occurrence: All birds are
establishment/reactivation of local rabies control
susceptible to infection, but domestic poultry flocks are
committees and enactment/ enforcement of ordinance
especially vulnerable to infections that can rapidly
on dog control measures
reach epidemic proportion.
d. Dog immunization- Pre-vaccination activities
(identification of priority areas, Procurement
/Distribution of dog vaccines, Social preparation)

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Community Health Nursing 1: Communicable Diseases
Control Measures in Birds
1. Rapid destruction (culling or “stamping out” pf all
infected pr exposed birds), proper disposal of carcasses
and quarantining and rigorous disinfection of farms.
2.Restriction on the movement of live poultry
Preventive Measures in Human
1.All workers directly or indirectly involved with
handling live poultry should be given the current
season’s influenza vaccine to reduce the possibility of
dual infection with human and influenza viruses.
2.DOH shall coordinate with vaccine suppliers on the
yearly availability and reasonable cost of the influenza
vaccine for human, especially for those workers
directly or indirectly involved in live poultry.
3.The yearly vaccination of poultry workers and/or
employees with regular or periodic direct contact with
poultry shall be the expense of the employer.
4. Persons not directly involved in taking care of
poultry should avoid contact with chicken, ducks, or
other poultry as much as possible. Children, in any
instance, should be discouraged from handling poultry.
5.Release an advisory on proper cooking of poultry
should be observed.
Nursing Care
1.Patient will be isolated in designated hospital using
hospital referral network.
2.Same principles of Infection Control applied for SARS
will be observed.
3.Early recognition of cases of highly pathogenic Avian
Influenza (HPAI) during outbreak among poultry.
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SARS – SEVERE ACUTE RESPIRATORY SYNDROME
Introduction: It is newly recognized form of a typical
pneumonia that had been described in patients in Asia,
North America and Europe. The earliest known cases
were identified from Guagdong Province, China in
November 2002. The WHO issued the global alert on
the outbreak on March 12,2003 and instituted
worldwide surveillance. The first case in the Philippines
was recognized on April 11,2003 in a Caucasian
business commuter between Hong Kong and Manila.
Etiology: It is a novel human coronavirus based on
serological and molecular tests done on specimens
from SARS patients.
Mode of Transmission: Close contact with respiratory
droplet secretion from SARS patient. Transmission
occurs when another person’s mucous membranes
(mouth, nose and eyes) are exposed to droplet
secretions when a SARS patient coughs, sneezes or
talks. Droplet do not remain suspended in the air but
may travel for a short distance of three feet then
settles on surfaces.
Incubation Period: 2-10 days but may be long as 13
days based on cohort analysis of cases from Hong Kong
and Canada.
Signs and Symptoms:
Prodromal Phase: Fever> 38 C sometimes with chill
malaise, myalgia, and headache. Rash and neurologic
or gastrointestinal findings are typically absent,
although some patients have reported diarrhea during
febrile prodrome. During this stage, the infectivity is
none too low.
Respiratory Phase: within 2-7 days the illness may
proceed to this stage characterized by dry, non-
productive cough with or without respiratory distress.
Common findings include hypoxia and crackles or rales,
dullness on percussion and decreased breath sounds
on physical examination. In 10%-20% of cases, the
respiratory illness is severe enough to progress to
acute respiratory distress syndrome requiring
mechanical ventilation. Infectivity is highest during the
respiratory phase.
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Community Health Nursing 1: Communicable Diseases
Preventive measures and control
1.Establishment of Triage
1.1 Assign a specific area for triage of patient who may
have SARS
1.2 Patient wears mask
1.3 Screen patients for travel history, symptoms and/or
close contact with cases.
1.4 Admit if they meet the case definition
2. Identification of patient
3. Isolation of suspected probable case
4. Tracing and monitoring close contact
5. Barrier nursing technique for suspected and
probable cases
Nursing Care
1.The infection control goals should be following:
1.1 Provide the best possible clinical care like:
a. Detect early suspect case
b. Implement appropriate isolation measures
c. Protect health personnel
d. Protect other patients
e. Protect family and community members
2.Be sure there is an isolation Facility such as:
2.1 Establishing a separate isolation facility including
the following:
a. Hand washing facility
b. Dedicated bathroom facilities
c. Capacity for waste and laundry
d. Control and monitor elevator traffic
e. Sufficient number of staff
f. Good ventilation
g. Air movement: Corridor to isolation room to outdoor
h. Turn-off air-conditioning if isolation room cannot be
isolated
2.2 Contingency plan for converting other areas.
2.3 Utilize personal protective equipment (PPE) which
include the wearing of N95 respiratory mask, googles
(protective eyewear), disposable gown and gloves, cap
and shoe cover.
2.4 Apply the principles of handwashing and when:
Before and after patient contact; after removing
gloves; after contact with blood and other body fluids;
after using the toilet; after blowing or wiping of nose;
before eating and before preparing the food.
Heist N. Ladao
MENINGOCOCCEMIA
Etiological Agent: Gram negative bacteria caused by
Neissseria Meningitidis, a Gram negative Diplococcus
Source of infection: Direct contact with respiratory
droplets from nose and throat of infected persons.
Description: The disease is usually sporadic (cases
occur alone or may affect household members with
intimate contact). Although primarily a disease of
children, it may occur among adults especially in
conditions of forced overcrowding such as institutions,
jails, and barracks. It occurs more in males than in
females, around 1% in young children (under 5 years),
5% in young teenagers and 20%-40% in young adult.
There is an increased rate in smokers, overcrowded
households, and military recruits.
Mode of Transmission: direct contact with respiratory
droplets from nose and throat of infected persons.
Carrier may exist without cases of meningitis.
Transmission through inanimate objects like personal
belongings of patient is insignificant.
Signs and Symptoms
1.High grade fever for first 24 hour,
2. Weakness
3.Joint and muscle pain
4.Hemorrhagic rash
5. Progressing from few petechiae to widespread
purpura and ecchymoses
6. Meningeal irritation like headache
7. Nausea and vomiting
8.Stiff neck
9.Bulging fontanel (among infants)
10.Seizure or convulsion and sensorial changes.
Incubation Period: variable; 2-10 days with an average
of 3-4 days
Methods of Prevention and Control
1.Respiratory isolation of patients for the first 24 hours
upon admission to prevent exposure of hospital staff
2.Hospital personnel upon entry to meningococcaemia
room are required to wear mask, gloves, googles and
gown especially when doing endo-tracheal incubation.
3.Chemoprophylaxis should be given among school
children/household contact especially in young
children with direct exposure to index patient’s
secretion through kissing, sharing of eating utensils or
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Community Health Nursing 1: Communicable Diseases
sleeps in the same house as index patient in previous 7
days.
4.The public should be educated to avoid overcrowded
places to reduce the risk of exposure particularly
among the young and the elderly.
5. Hospital personnel are rarely at risk even when
caring for patients, thus only those with intimate
exposure to nasopharyngeal secretion (mouth to
mouth resuscitation) or unprotected exposure during
endo-trachea incubation warrants chemoprophylaxis
Nursing care
1.The patient must be given chemoprophylaxis before
discharge to assure the elimination of meningococcus
in the nasopharynx.
2.Observe Infection Control measures like proper
washing of hands with soap and water and other
respiratory isolation and especially for the first 24
hours upon admission.
3. Practice the gown technique including mask,
goggles, and gloves especially when doing
endotracheal intubation
4. Bear in mind other isolation techniques like non-
sharing of utensils, cups, lipstick, cigarettes, and other
water bottles, dishes, glasses. Don't use also musical
instruments with mouth pieces, mouth guards, or
anything else that has been in the mouth of the
infected person.
5. Health teachings regarding the importance of
healthy diet, regular exercise, adequate sleep and rest
and no alcohol and cigarette smoking. 6. Advice
the importance of check- up after one week discharge,
then monthly for those with complications
(neurological deficit) till improve and contract tracing.
Heist N. Ladao
HEPATITIS A – (Infectious hepatitis, epidemic
hepatitis, catarrhal jaundice)
Introduction: A form of acute hepatitis occurring either
sporadically or in epidemics and caused by viruses
introduced by fecal contaminated water or food. Young
people especially school children are most frequently
infected.
Etiology: Hepatitis A virus
Predisposing Factos
1. Poor sanitation
2. Contaminated water supplies
3. Unsanitary method of preparing and serving of food
5. Malnutrition
6. Disaster and wartime conditions.
Incubation Period: 15- 50 days, depending on dose,
average 28 to 30 days
Signs and Symptoms
1.influenza-like such as headache
2. Malaise and easy fatigability
3. Anorexia and abdominal discomfort/pain
4. Nausea and vomiting
5. Fever
6. Lymphadenopathy
7. Jaundice accompanied by pruritus and urticaria
8. Bilirubinaemia with clay-colored stools
Management/ Treatment
1.prophylaxis- IM injection pf gamma globulin
2.Complete bed rest
3.Low fat diet but high in sugar
Prevention and Control
1. ensure safe water for drinking
2. Sanitary method and preparing handling and serving
food
3. Proper disposal of feces and urine
4.Washing hands very well before eating and after
using the toilet
5.Separate and proper cleaning of particles used by
patient
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HEPATITIS B High risk groups to Hepatitis B infection

Introduction: Hepatitis is a disease of the liver which 1. Newborns, infants and children of infected mothers
can be caused by viruses, bacteria, protozoa, toxic 2. Children in localities where the occurrence of
chemicals, drugs, and alcohol Hepatitis B cases is high
3. Sexual and household contacts of acute cases and
There are several types of viral hepatitis namely: carriers
Hepatitis A, B non A and non B, (C) and D (delta), C, E. 4. health workers exposed to handing blood or blood
products as doctors, dentists, nurses, medical
Among these, Hepatitis B, a sexually transmitted
technologists, technicians, attendants and others
disease is considered to be the most serious due to the 5. Person requiring/undergoing frequent blood or
possibility of severe complications such as massive liver plasma transfusion such as haemophiliacs
damage and hepatocarcinoma of the liver.
Possible outcomes of Hepatitis B infection
Signs and Symptoms 1. Most people get well completely and develop
1.Loss of appetite lifelong immunity
2.easy fatigability
3.Malaise 2.Some people do not get well and Hepatitis B virus
4.Joint and Muscle pain(similar to influenza) remains in their blood
5.Low grade fever 3.They become can your carriers of the virus and
contrast and can transmit the disease to others
6. Nausea and vomiting
4. Almost 90% of infected newborns become carriers.
7. Right-sided abdominal pain About 25% of these carriers develop fatal liver
8. Jaundice (yellowish discoloration of skin and sclera) complications in adult life
9. Dark-colored urine.
Preventive Measures
Mode of Transmission
a. From person to person through: 1.Immunization with Hepatitis B vaccine especially
- Contact with infected blood through broken skin and among infants and high groups with negative HB sag
mucous membrane of the mouth, the rectum, and the test
genitals. 2.Wear protective clothing such as gowns, mask,
gloves, eye cover when dealing with blood semen
-Sexual contact via the vaginal and seminal secretions
vaginal fluids and secretions
-Sharing of personal items with an infected person
3.Wash hands and other skin areas immediately and
which may cause skin break (razor, nail clipper, thoroughly after contact with these fluids and after
toothbrush,etc) removing gloves and gowns
4. Avoid injury with sharp instruments as needles,
b. Parental transmission through: scalpel, blades
-blood and blood products- by transfusion of blood 5. Use disposable needles and syringes only once and
from carriers and non-carriers discard properly or sterilized non-disposable needles
-Use of contaminated instruments for injection ear and syringes before and after use
piercing, acupuncture, and tattooing 6.Sterilized instrument used for circumcision, ear
holding, tattooing, acupuncture and those used for
-Use of contaminated hospital and laboratory minor-surgical procedures
equipment such as dialysis apparatus and others. 7. Avoid sharing of toothbrush, razors and other
instruments that can become contaminated with blood
c. Perinatal transmission- this can occur during
labor and delivery through leaks across the placenta
8. Observe safe sex practices such as
and can be precipitated by injury during delivery. It
may also occur through exposure of the infant to
maternal secretions in the birth canal. • have sex with only one faithful partner or
spouse
• Avoid sexual practices which may break the
skin like anal intercourse
• use condom properly

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Heist N. Ladao
Community Health Nursing 1: Communicable Diseases

9. Make sure that blood and blood products for Treatment: Medicines, such as interferon and ribavirin,
transmission have been properly screen for Hepatitis B do not cure hepatitis C, but they do make people feel
10.Observe Good personal hygiene better and they may prevent future liver problems.
11. Have adequate sleep, rest, exercise and eat
adequate nutritious food to build and maintain body
resistance.

Management and Treatment

1.There is no specific treatment. It depends on one's

natural body resistance to combat the disease.
Symptomatic and supportive measures such as
analgesic antipyretic (pain and fever) is given
2.care is carbohydrate is usually advice

HEPATITIS C

Description: a disease of the liver . Most people who

are infected with Hepatitis C do not have any
symptoms for years. The virus stays in the liver and
causes chronic liver inflammation, cirrhosis, or liver
cancer.

Etiology Agent: Hepatitis Virus : C strain

Mode of Transmission: Usually spreads through

contact with blood products, like accidentally being
stuck with a dirty (used) needle, using IV drugs and
sharing needles, or getting blood before 1992

Signs and symptoms

•Headache
• Nausea and vomiting
• Abdominal pain
• Jaundice (the skin turns yellow)
• Weakness and fatigue
• Dark yellow urine, light-colored stools, and yellowish
eyes
• Rashes and sores

Prevention and Control

1. Use a condom during sexual activity to protect
yourself and your partner from contracting Hepatitis C.
2. Do not share injecting device/ paraphernalia with
anyone.
3. Wear gloves if you have to touch anyone's blood.
4. Do not use an infected person's toothbrush, razor, or
anything else that could have blood on it.
5. Make sure any tattooing or body piercing is done
with clean tools.
6. There is no vaccine for Hepatitis C.

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Heist N. Ladao