Mode of transmission -- Droplet infections

Diseases Clinical features Treatment and Prevention

Measles/ 1. Prodromal stage Primary Prevention
Rubeola • 3 C's (conjunctivitis, 1. Health Promotion by health education, community
cough, coryza) counseling, environmental Modifications specially
High infectivity • Koplik's spots on buccal personal sanitatory and hygenic measure
mucosa opposite to ist 2. Specific protection by
For eradication, and 2nd upper molar , 1- i. Immunization (MMR vaccine single dose of 0.5 ml
immunization 2 days before rash injected on left deltoid subcutaneously at age of 9
coverage should appearance month and 12-15 month, Administration of
be at least 96% 2. Eruptive stage immunoglobulin)
• Rash begins behind ears Efficacy of single dose is 85-95% . Second dose is given
3. Post measles stage to produce immunity in persons who failed to respond
• Weight loss, Weakness to the first dose
Complications ii. Vit A
• Vit A deficiency Secondary Prevention
• Subacute pan- 1. Early diagnosis
encephalitis 2. Prompt treatments using specific drugs
• Toxic shock syndrome - Tertiary Prevention
severe diarrhea Isolation for 7 days after the onset of rash
• Otitis media
• Pneumonia
Mumps • Pain and swelling of Primary Prevention
parotid glands 1. Health Promotion by health education, community
• Orchitis---infertility counseling, environmental Modifications specially
• Pancreatitis personal sanitatory and hygenic measure
• CNS involvement 2. Specific protection by
• Oophoritis i. Immunization (MMR vaccine single dose of 0.5 ml
• Hearing loss injected on left deltoid subcutaneously at age of 15
months)
Secondary Prevention
1. Early diagnosis
2. Prompt treatments using specific drug (analgesics +
bed rest + soft food)
Tertiary Prevention
Rehabilitation
Rubella /German • Enlargement of Primary Prevention
measles postauricular lymph
nodes
 • Rash appears first on
face and then spread
rapidly onto trunk and
extremities
Congenital rubella syndrome -
chronic infection - infant has IgM
• Ist trimester
(cataract/glucoma,
deafness,patient ductus
arteriosus)
• 2nd trimester
(microencephalopathy)
• 3rd trimester (no
defects)
Pertussis Choking cough on expiration
/Whooping Whoop and barking cough
cough
1. Health Promotion by health education, community
counseling, environmental Modifications specially
personal sanitatory and hygenic measure
2. Specific protection by Immunization
MMR vaccine 0.5ml S/C on left deltoid on 9th and 12-
15 months
RA 27/3 live attenuated Rudivax vaccine developed in
human diploid fibroblast
Vaccine contraindicated in pregnancy. Women are
advised not to be pregnant over next 3 months.
Vaccination strategy:
First protect women of child bearing age
Then vaccination of children uner 1-14 years
Secondary Prevention
1. Early diagnosis
2. Prompt treatments
Tertiary Prevention
Rehabilitation measures
Primary Prevention
1. Health Promotion by health education, community
counseling, environmental Modifications specially
personal sanitatory and hygenic measure
2. Specific protection by
i. Immunization (DPT, a mixed vaccine 0.5ml I/M on
right thigh. P component enhance potency of DPT
vaccine
Ist dose ----- 6 weeks
2nd dose ----- 10 weeks
3rd dose ----- 14 weeks
Booster dose ----- 20-23 months
This vaccine is 90% effective so we cannot eradicate
pertussis 100% .
Should not be given after age of 2 years b/c of
neurological complications)
ii. Chemoprophylaxis with erythromycin
iii. Avoidance of cough provoking factors like smoke
iv. Steam inhalation
Secondary Prevention
1. Early diagnosis by culturing
 2. Prompt treatments using specific drugs (Antibiotics
such as Erythromycin, Tetracycline, Antitussive,
Sedatives)
Tertiary Prevention
Isolation for 4 weeks
Diphtheria • Sore throat Primary Prevention
• Difficulty in swallowing 1. Health Promotion by health education, community
Hoarseness counseling, environmental Modifications specially
• Myocarditis personal sanitatory and hygenic measure
• Bull neck 2. Specific protection by
• Membrane formation i. Active Immunization by DPT, a mixed vaccine 0.5ml
• Exotoxin I/M on right thigh
• Shick test (0.2 ml toxin Ist dose ----- 6 weeks
intradermal on 2nd dose ----- 10 weeks
forearm) . It tests 3rd dose ----- 14 weeks
presence of antitoxins Booster dose ----- 20-23 months
and state of Should not be given to seriously ill child
hypersensitivity to ii. Passive immunization by antitoxin
diphtheria toxin iii. Chemoprophylaxis (Erythromycin)
iv. Contacts
If someone contact with patient of diphtheria and is
previously immunized then give only booster dose if
there is no history of booster dose in previous 2 years.
No need of booster dose if received in previous 2
years. And if not previously immunized then given
active + passive
Secondary Prevention
1. Early diagnosis by culturing
2. Prompt treatments using specific drugs (Benzyl
penicillin 2.5 lac units every 6 hours / Erythromycin
250mg every 6h)
Tertiary Prevention
Isolation for atleast 2 weeks or until proved free of
infection
Atleast 2 consecutive cultures taken 24 hours apart
should be negative
TB/Phthisis/ The • Night sweats Primary Prevention
great white • Weight loss, 1. Health Promotion by health education, community
plague, Captain • Cough counseling, environmental Modifications specially
of the men of • Lung lobe caviation personal sanitatory and hygenic measure
death 2. Specific protection by
 • Predisposing factors are i. Immunization (BCG live attenuated vaccine 0.05 ml
High poverty, over crowding, intradermally over right deltoid region at birth or 0.1 m
pathogenicity large families, lack of after 1 month age ---> leave scar mark
Barometer of education, malnutrition , BCG vaccine can be given to asymptomatic HIV patient
social welfare low socioeconomic but not to symptomatic HIV). Commenest side effect of
status vaccine is supportive lymphadenitis, osteomyelitis ,
ulceration at site of vaccination . Should not be given
• Types : Pulmonary and in case of skin diseases and deficient immunity
extra pulmonary TB ii. Chemoprophylaxis (with isoniazid . It is very cheap
(joints, bones, genito and non toxic drug . However there is risk of serious
urinary tract, meninges, hepatitis) for infants whose mothers are open case of
lymph nodes) tuberculosis
Secondary Prevention (best strategy by WHO)
1. Early diagnosis by sputum culture, Montoux test and
x ray
Gold standard is sputum culture
2. Prompt treatments using Ist line drugs (isoniazid,
rifampicin, Ethambutol, Pyrazinamide, Streptomycin)
2nd line drugs for MDR TB (Azithromycin,
Clarithyromycin, Amikacin, Kanamycin, ofloxacin ,
Ciprofloxacin, Capreomycin, Cycloserine)
Directly observed treatment short course (DOTS)
Tertiary Prevention
Rehabilitation measures such as change of occupation ,
reducing working hours , Selective employment
Chickenpox • Rash centripetal, start on Primary Prevention
trunk and spread , 1. Health Promotion by health education, community
frequently involved counseling, environmental modifications specially
axilla. Palms and sole personal sanitatory and hygenic measure
seldom involved 2. Specific protection by
• Rash superficial, i. Immunization by Live attenuated vaccine or
unilocular and in MMRV 12-15 months and Immunoglobulins
different stages ii. chemoprophylaxis (tetracycline to prevent
• Area of inflammation secondary infection)
around vesicle iii. Disinfect articles used by infected
• Temperature rises with Secondary Prevention
each fresh crop of rash 1. Early diagnosis
• Complications are Reye's 2. Prompt treatments with analgesic and antiviral
syndrome drugs
(encephalopathy and Tertiary Prevention
Isolation for 6 days
 fatty degeneration) and
congenital anomalies
Smallpox • Rash centrifugal, axilla
usually not involved,
palms and soles
frequently involved
• Rash deep, multilocular
and in one stage
• No area of inflammation
around vesicle
• Fever subsides with
appearance of rash but
may rise again in
pustular stage
Meningococcal • Headache
meningitis • Fever
• Stiff neck
Influenza • Fever
• Cough
All known • Sore throat
pandemics • Muscle pain
caused by • Malaise
influenza strain • Pneumonia
A • Rapid spread due to
short incubation period
Shift - sudden change and leads
to pandemics (cyclic trend). It
causes
• Bird flue - H5N1
• Swine flue and seasonal
flue -H1N1
Drift - gradual change and don't
lead to pandemics
Primary Prevention
1. Health Promotion by health education, community
counseling, environmental Modifications specially
personal sanitatory and hygenic measure
2. Specific protection by
i. Immunization (vaccine)
ii. Chemoprophylaxis
Secondary Prevention
1. Early diagnosis
2. Prompt treatments
Tertiary Prevention
Rehabilitation measures
Short term measure
i. Antibiotics (penicillin/Ceftriaxone)
Long term measure
i. Isolation of patient
ii. Rifampicin for carrier
iii. Mass chemoprophylaxis with Ceftrioxone or
Ciprofloxacin
iv. Meningococcal vaccine (polysaccharide vaccine +
conjugate vaccine) for ≥ 2 years
Safe for pregnant women
Primary preventions
1. Health promotion by
Good ventilation of public buildings
Avoidance of crowded places during epidemic
Encouraging sufferers to cover their face when
sneezing and coughing
To stay at home at first sign of influenza
Hand washing
2. Specific protection by
Immunization (killed and live vaccine)
Secondary prevention
1. Early diagnosis by serology (HI test)
2. Prompt treatment with oseltamivir and zanamivir
Tertiary prevention
Rehabilitation
Vaccine in measles outbreak?
Two doses
First dose at 6-9month
2nd dose at 9 month
Must be a gap of 4 weeks between two doses

Vaccine of measles in areas having high incidence of measles and HIV?

First dose at 6 months
Two additional doses according to national immunization schedule (9 week and 12-15 week)

Outbreak control measures?

1. isolation for 7 days after onset of rash
2. immunization of contacts within 2 days of exposure
3. If vaccine is contraindicated then give immunoglobulin
4. Prompt immunization at beginning of epidemic to limit spread

BCG vaccine
Infants can be given BCG vaccination directly without prior Tuberculin test. In older children (i.e
8 years) it is better to first carry Tuberculin test, and if it is negative then give BCG . However it
can be given without tuberculin test

Montoux test
Carried out by injecting intradermally on flexor surface of forearm PPD 0.1 ml . Result is ready after 48-
72 hours . Interpretation by measuring diameter of induration .
Induration exceeding 10 mm or 1cm ---- positive
Induration less than 6 mm ---- negative
Induration between 6-9 mm ---- doubtful
Why Montoux test is negative in HIV infection or Hodgkin's disease?
Because it depends upon measuring the response of a person's immune system . HIV infection damages
immune system of body
How to diagnose TB in a person with HIV?
Clinical examination and sputum culture in early stages of HIV
It is difficult to diagnose TB in advanced stages of HIV . However clinical examination and sputum culture
can be used to some extent because in advanced stages
Sputum culture negative
Montoux test negative
Chest radiography less usefull because there are less caviations
WHO criteria
 • Tuberculosis control is achieved when prevalence of natural infection in age group 0-14 years is
1%
o Prevalence is estimated by Tuberculin skin test
• A case of tuberculosis is defined as sputum positive for acid fast bacilli or pyrexia of unknown
origin for more than 3 weeks with persistent cough
• MDR strain is the one that is resistant to atleast INH and rifampicin
• XDR

WHO stragies
• Stop TB strategy
• DOTS
• End TB strategy

Can mother with tuberculosis feed her child?

Yes
She should take chemoprophylaxis

A woman was suffering from TB. She had a newborn child. Appropriate option to protect
newborn against disease ?
1. Start DOTs for mother (Chemoprophylaxis)
2. BCG vaccine for baby if Tuberculin test is negative
3. Isoniazid for baby if Tuberculin test is positive

Can mother with tuberculosis-HIV feed her child?

No
Treatment duration for New cases of TB
Intensive phase --- 2 months
Continuation phase --- 4 months

Treatment duration for Retreatment cases

Intensive phase --- 3 months
Continuation phase --- 5 months

Epidemiological triad for TB

Agent : bacteria
Host : Human
Environment : droplet, Poverty, Over crowding, warm and humid environment

Epidemiological triad for Diphtheria

Agent : Bacteria
Host : Human
Environment : droplet, over corwding (winter season)

Epidemiological triad for Measles

Agent : Orthomyxovirus
Host : Human (children)
Environment : over crowding, poor sanitation , poor housing

Epidemiological factors responsible for small pox/disease eradication

• No known animal reservoir
• Easy diagnosis from rash
• No long term carrier
• Highly effective vaccine
• Lifelong immunity after recovery
• International cooperation

Mycobacterium leprae
• Leprosy
• Affects skin, peripheral nerves and mucosa
• Loss of cutaneous sensation like light touch
• Operational indicator is Relapse rate
• Lepromin test is screening test
• Close contact may transfer disease
• BCG vaccine may give partial protection against leprosy

Positive Schick test and Negative thorat swab . Interpretation?

• +ve for diphtheria . Two cultures taken 24hours apart should be negative
• Should be isolated
Intestinal
Faeco-Oral Route

Disease Clinical features Control and Prevention

Poliomyelitis • Abortive ---- patient Oral polio vaccine (OPV)/Sabin type --- live attenuated,
recovers quickly given orally, helpful in epidemic, immunity produced
most is both humoral and intestinal, prevent intestinal
outbreaks
occur due to • Non paralytic ---- fever, reinfection, risk of VDPP, induce herd immunity,
type-1 virus malaise, sore throat, cannot be given to immunocompromised patient
headache, meningism Inactivated polio vaccine (IPV)/Salk type --- killed
• Paralytic ---- flaccid type, given I/M or S/C , not helpful in epidemic,
paralysis, Tripod sign induce only humoral immunity, doesn't prevent
• Stool test for intestinal reinfection, no risk of VDPP, don't induce
confirmation herd immunity, can be given to immunocompromised
patient
Line listing --- epidemiological database to take
appropriate follow up action in areas from where the
cases had been reported
Mopping up --- door to door immunization compagin
in high risk districts
Typhoid/ • Ist week Three lines of control
Enteric fever Step ladder fever 1. Control of reservoir
Bradycardia Case -- early diagnosis , notification, isolation,
5 F's • 2nd week treatment with ciprofloxacin , disinfection
Food Enlarged spleen Isolation until 3 consecutive stool culture are negative
Finger Red rose spots Carrier -- identification and treatment with Ampicillin
Fomites • 3rd week and Probenecid
Flies Intestinal hemorrhage 2. Control of Sanitation by health education , food
Faeces and perforation hygiene and improved sanitation
3. Immunization
Typhoid Marry was a chronic TAB killed vaccine, at any age after 1 year
carrier of typhoid Vivotif live attenuated vaccine, 3 capsules at any time
Chronic carriers are those who on 1,3 and 5 days 1h before meal
excrete bacilli continuously or
intermittently for > 1 year
Cholera • As many as 40 Primary prevention
stools/day 1. Health promotion by health education ,
• Rice water stools environment modefication especially sanitory and
Convalescent carrier, healthy personal hygiene
carrier, chronic (gall bladder) 2. Specific protection by
and incubatory carrier are i. Immunization --- 2 equal doses of vaccine
observed in cholera ii. Chemoprophylaxis (tetracycline)
Secondary prevention
Vibrio cholera , causative agent 1. Early diagnosis
can be killed by boiling 2. Prompt treatment with
i. rehydration therapy for mild diarrhea (ORS citrate
and ORS bicarbonate) Citrate stablize ORS + decrease
stool output
 Function of glucose in ORS is to increase absorption
of salt . 80 Kcal in packet
ii. 5 g table salt + 20 g sugar if ORS not available
iii. I/V fluids for severe diarrhea
iv. I/V tetracycline for severe diarrhea
Tertiary prevention
Rehabilitation
Food • Vomiting 1. Food sanitation
poisoning • Profuse diarrhea Health education
• Stap. aureus --- 1-8 h Personal hygiene
• S.typhi ---- 20-24 h Sanitary improvement
Food inspection
Food handling techniques
Thorough cooking
Milk pasteurization
2. Refrigeration
3. Surveillance
Tetanus • Trismus or lock jaw Primary prevention
• Risus sardonicus 1. Health promotion by health education, community
• Opisthotonus counseling, hygiene , sanitary improvement, 3 C's
• Cyanosis (Clean hands, Clean delivery surface, Clean blade for
• Spastic paralysis cutting clean cord)
• Neonatal tetanus 2. Selective prevention by
manifest at 7th day i. Active Immunization by DPT vaccine, tetanus toxoid
vaccine (TT)
TT vaccine to unimmunized pregnant women
2 doses
Ist dose after ist trimester or 7th month
2nd dose 1-2 month later or 8th month
Give TT in labour if she has not previously received TT
TT vaccine to immunized pregnant women
Only booster dose is sufficient and no need of booster
dose at every consecutive pregnancy
TT vaccine to unimmunized non pregnant women
5 doses
Ist dose any time
2nd dose 1 month after ist dose
3rd dose 6 months after 2nd dose
4th dose 1 year after 3rd dose
5th dose 1 year after 4th dose
TT vaccine to immunized non pregnant women
 Only 3rd , 4th and 5th doses
Booster course of immunization
Booster I dose one year after 2nd dose
Booster II dose 5 year after ist booster dose
3. Passive immunization by
Human tetanus hyperimmunoglobulin (TIG) - 1500
units
Anti tetanus serum (ATS) - 250 units
4. Combined active passive immunization in non
immune person
Secondary prevention
1. Early diagnosis
2. Prompt treatment with Benzathinen Penicillin
Tertiary prevention
Rehabilitation
Hepatitis A • Feco-oral route Proper disposal of human excreta
• Jaundice Vaccine
• Increased ALT, AST Immunoglobulins

Factors hindering polio eradication in Pakistan, Afghanistan, Nigeria?

• Misconceptions about polio vaccine
• Poor routine EPI schedule
• Non availability of female worker
• Storage of vaccine
• Cold chain boxes not available
• Cultural issues
• Convalescent carrier
• Child is immunecompromised or having enterovirus infection

How we can achieve eradication of polio in near future ?

• Introduction of bivalent polio vaccine
• Improvement in monitoring system
• Development of comprehensive district specific plan
• Intersectoral collaboration
• Well function polio laboratory

Vaccine-derived poliovirus (VDPP) is a strain of the weakened poliovirus that was initially included in
oral polio vaccine (OPV) and that has changed over time and behaves more like the wild or naturally
occurring virus.
The persons in whom VDPV is found, have potential to spread this virus to others in their community. If
persons in the community are not vaccinated for polio, they may develop paralysis.
Confirmatory test for Polio
Stool sample at 24h and 48 hour

Diagnostic Tests for Typhoid

1. Gold standard (blood culture) 1-4 weeks
2. Stool culture
3. Urine culture
4. Typhidot test --- IgM,IgG --- very fast
5. Widal test --- detect antibodies to antigen of organism
• High titer of antibodies to O antigen ---- active infection
• High titer of antibodies to H antigen ---- past infection/past immunization
• High titer of antibodies to Vi antigen ---- carrier

How will you manage very high rate of Tetanus Neonatorum in an area?
• Train dai's about 3 C's
• Give two doses of tetanus toxoid to pregnant woman at 7th and 8th month interval
• Infant born to mother who have not received tetanus toxoid must be immunized by
injection of antitoxin within 6hours of births to prevent death

Cholera Free Area

An area is declared free of cholera when twice the incubation period (10 days) has elapsed
since death, recovery or isolation of the last case

Defination of Diarrhea according to WHO/UNICEF

Passage of 3 or more loose stools per day
Severe dehydration = 100-110 ml/kg fluid loss
Mild dehydration = 40-50 ml/kg fluid loss
Low osmolality ORS should be preferred to avoid adverse effect of hypertonicity
on net fluid absorption in gut
Host factors
• Age
• Malnutrition
• Poverty
• Reduced gastric acidity
 • Prematurity
• Deficient functioning of immune system
• Lack of hygiene
• Incorrect feeding practices
Short term management
• ORS
• IV rehydration : Ringer lactate or normal saline
• Maintenance therapy : fluids and electrolytes
• Appropriate Breast feeding
• Chemotherapy : neomycin, purgatives
• Zinc supplementation

Long term management

1. MCH care practices
• Maternal nutrition during prenatal period
• Child nutrition
✓ breastfeeding
✓ weaning
✓ vit A supplements
2. Preventive strategies
• Sanitation
• Health education
• Immunization
✓ measles
✓ Rota virus vaccine
3. PHC

4 Arthropods Borne infection

Disease and Clinical features Control and Prevention

Vector
Dengue fever • Abrupt onset of fever, Primary prevention
malaise , headace Integrated Vector Control (IVC) :
Agent is • Retrobulbar pain i. Travellers should be advised to sleep under nets
Flavivirus and • Rash appear on limbs and ii. Adult mosquito should be destroyed by sprays
Vector is Aedes spread to trunk iii. Keep flower pots dry
mosquito - day • Hemorrhagic manifestation iv. Avoid exposure to sunrise and sunset
time feeder (postive tourniquet test) v. Apply mosquito repellant lotion on body
Habbits • Liver enlargement vi. Wash water containers daily
Flower pots • Thrombocytopenia vii. Ovitraps
Coconut shells (petechiae and purpura) Secondary prevention
Free holes • Increase in haematocrit 1. Early diagnosis by low platelets and NS1
Erthern pots 2. Prompt treatment by
Fire buckets i. Antipyretics (avoid aspirin)
ii. Electrolytes and acid base balance in
hemorrhagic shock
iii. 5% dextrose saline solution
iv. Blood transfusion in persistent shock
Tertiary prevention
Rehabilitation
Malaria • Cold stage 1. Prevention of man vector contact by using
• Hot stage repellant, protective clothing and screening of
Agent is • Sweating stage house
plasmodium • Jaundice Destruction of mosquito larva by drying of water
and vector is • Incidence is highest in containers
Anopheles tropical africa Destruction of adult mosquito by spray such as
mosquito • Blood film positive for ring Pyrethrum and DDT . These are contact poison, act
of protozoan on nervous system and paralysis legs and wings of
Most common • Thick film to identify mosquito
cause of malarial parasite 2. Malaria roll back program (to prevent mosquito
economic • Thin film to identify specie bite, the mosquito net should be treated with
distress of parasite insecticides)
• incubation period 10 days 3. Measures against malarial parasites
i. Chemoprophylaxis (chloroquine)
ii. Chemotherapy
Drugs to treat chloroquine resistant P.falciparum
are pyrimethamine and sulphadoxine
Drug to treat malaria in pregnant women, infant
and G-6PD deficiency is Pyrimethamine
Drugs to treat severe and complicated malaria are
Quinine and Artemether IV
 Zika virus • Serious for pregnant women
disease • Causes microcephaly and
• neurological disorders
Vector is Aedes
Filariasis Elephantiasis Use mosquito nets
Use mosquito repellents
Culex mosquito Destruction of mosquito
Treatment of infected person

How malaria is measured ?

1. Spleen rate or index (% of children between 2-10 years of age showing spleen enlargement)
2. Parasite rate or index and (% of children between 2-10 years of age showing malarial parasite in their
blood)
3. Annual parasite index ---- best index to determine incidence in community
Areas having API ≥ 2 are high risk
4. Infant parasite rate ---- most sensitive index of recent malaria transmission in a locality. If IPR is 0 for 3
consecutive years, it means absence of malaria transmission
5. Selected rate = number of blood slides of 2-10 years children found for malarian parasites/total
number of slides of 2-10 years of children examined
It is an easy test . It tells us about rise and fall of disease as it is very sensitive

Epidemiological triad for Dengue

Host : Human
Agent : Flavivirus
Environment : Standing water

Epidemiological triad for Malaria

Host : Human
Agent : Plasmodium
Environment : Standing water

Why Yellow Fever is of Public health concern for Pakistan ?

All factors except the infectious agent are present in Pakistan . All efforts are therefore directed toward
entry of the virus either through an infected person or through entry of infected vector

Vaccination of Yellow fever

0.5 ml
S/C route
Single dose
 Zoonosis (diseases transferred from animal to human)
Disease Clinical features Control and Prevention
Rabies • Hydrophobia Pre exposure prophylaxis ----- 1ml I/M cell culture
• Aerophobia vaccine on 0, 7 , 28 day and booster after one
• Pain or tingling at bite site month . Further booster dose given after every 2
• Increased salivation - may years
contain virus Best strategy by WHO
• Muscle spasm Anti rabies vaccine to dogs on mass level
• Negri bodies in nerve cells of Post exposure prophylaxis -----
brain Immediate flushing and washing the wound with
• Street virus vs Fixed virus plenty of water to prevent entry of viral agent into
• Fixed virus used for nerve endings
preparation of antirabies Not immediate suturing i.e should be done after 24-
vaccine 48 hours
Antibiotics and Anti-tetanus measure
Combined active-passive immunity in category II and
III

Yellow fever • Mokeys and Man are
reservoir
Vector is • Pakistan is yellow fever
aedes receptive area because virus
mosquito of yellow fever is the missing
link in chain of transmission
Brucellosis • Undulent fever
• Caused by nndercooked
meat or unpasteurized milk
Plague by • Bubonic plague --- can't
Yersina pestis spread from person to
person.
• Pneumonic plague --- can
spread
Chills, fever, painful lymphadenitis
Taeniasis • T. solium -- undercooked
pork
• T. saginata -- undercooked
beef
• Neurocysticercosis
• Segments of parasite during
defecation
1ml I/M cell culture vaccine at deltoid muscle on 0, 3,
7, 14, 28 and booster dose on day 90
Anti rabies serum prevent replication of virus at site
of bite I/M in gluteal region
Post exposure treatment of persons who have been
vaccinated previously
Cell culture vaccine (HDC vaccine) I/M on day 0, 3
and 7
Rabies vaccine is not contraindicated in pregnant
Travellers from endemic areas must possess valid
international certificate of vaccination against yellow
fever before they enter a receptive area (Pakistan).
Vaccine is valid after 10 days of receiving it and
remains valid for 10 years
Passengers without this certificate are liable to
quarantine for 6 days
Incoming aircrafts are required to disinfected
Control mosquito breeding by spray within range of
400m of airports
Isolation of patients with pneumonic plague
Destruction of fleas and rodents
Immunization
Chemoprophylaxis by tetracycline
Treatment with antibiotics (Streptomycin/
Tetracycline)
Primary prevention
1. Health promotion by
• health education
• adequate sewage treatment and disposal
• meat inspection
• avoiding raw meat
Secondary prevention
Early detection and prompt treatment with
praziquantal and albindazole to prevent
cysticercosis
Surgical removal of symptoms producing cysts
Tertiary prevention

Hydatid • Dog (definitive host) -sheep
disease by (intermediate host) cycle
cestode • Ingestion of eggs or water
Echinococcus contaminated with dog
feaces
• Casone test for diagnosis
Soil • Round worm -- ascariasis
transmitted • Hook worm (Ancylostoma
helminthic and Necator) -- anemia
infection • Whip worm (Trichuris) --
appendicitis
• Transmitted by feco-oral
route
• Ancylostoma enter body by
penetrating feet skin
Chandler's index used in
epidemiological study of Hookworm
disease
Scabies by • Itching
Sarcoptes • Itchy red papules
scabiei • Scratches by nails
• May be complicated by
secondary infection
Treatmen of Rabies
• Isolation of patient in a quiet room protected from external stimuli such as bright light, cold air
Rehabilitation
Primary prevention
1. Health promotion by
• washing fruits and raw vegetables before
eating
• washing hands before eating or after
handling dogs
• discouraging dogs from licking and don't kiss
dogs
• not allowing dogs to defecate near vegetable
garden or children's play area
• reducing amount of disease in dogs
Secondary prevention
Praziquantal
Primary prevention
1. Health promotion by
• health education
• good hygiene
• sanitary improvement
• proper disposal of feaces i.e Prevent faecal
contamination of soil
• Interupting transmission
• Provision of safe drinking water
Secondary prevention
Albendazole
Treat anemia by folic acid + ferrous sulphate
Preventive chemotherapy
Primary prevention
1. Health promotion by
• Health education about proper cleanliness
and body care coupled with frequent change
of underclothing and bedding
• Children who are infested should be
excluded from school until disinfected
Secondary prevention
Topical scabicides (Permethrin, Malathion, Sulphur
ointment)
 • Relive anxiety and pain by sedatives
• Relive muscle spasm if present
• Ensure hydration and diuresis
• Intensive therapy in form of respiratory and cardiac support
• Immunization

Categorize Intensity of Bite/Classification of Exposure

According to the severity of the wound, the WHO categorizes the animal bite as
Category I ----- touching/feeding of animals or licks on intact skin
Category II ----- nibbling of uncovered skin, minor scratches or abrasions without bleeding“
Category III ----- single or multiple transdermal bites or scratches, licks on broken skin, contamination of
mucous membrane with saliva from licks, multiple wounds 5 or more in number

Category II and III exposure assessed as carrying a risk of developing rabies and risk increases if
• bitting animal is known reservoir of specie
• bite was unprovoked
• bitting animal cannot be traced or identified
• animal has not been vaccinated

Rabies free area has been defined as one where no case of indigenously acquired rabies has occurred
for 2 years

Types of Vaccines used for rabies ?

1. Human diploid cell vaccine (HDCV)
2. Duck embryo vaccine
3. Nervous tissue vaccine

A 10 year boy was bitten by dog on his leg. What is plan of action if
1. dog is pet and available with the owner ?
• Immediate active+passive Immunization to child as we don't know previous Immunization status
• Observe dog for 10 days. if it remains healthy then distincontinue post-exposure prophylaxis
2. dog escaped ?
• Active+Passive immunization as we don't know about his previous Immunization status against
rabies
• Restraint of dogs in public
• Immediate killing of animals bitten by rabid dog
• Health education of public
3. dog is dead ?
• Active+Passive immunization as we don't know about his previous Immunization status
 • Cut head of dog and send for refrigeration and examination. If examination shows rabies disease
in dead dog then continue post exposure prophylaxis . And if examination shows no rabies in
dead dog then distincontinue post-exposure prophylaxis
4. boy was immunized 4 months back as he was bitten by a rabid dog ?
• Single dose of cell culture vaccine intramuscularly or 2 doses intradermally on 0 and 3 day for
rabies-exposed patient with pre-exposure vaccination
• No need of passive immunization (Immunoglobulins)

Epidemiological triad of Scabies

Host : Human
Agent : Sarcoptes Scabiei (itch mite)
Environment : Close contact , unhygienic conditions

Surface Infection
Disease Clinical features Prevention and treatment
AIDs Initial stage --- fever, sore A. Four basic approach for prevention
Transmitted throat and rash 1. Health education -- avoiding indiscriminate
by sexual Asymptomatic carrier sex and using condoms
contact, blood stage 2. Blood and blood products safety
contact and Last stage --- AIDs 3. Injection safety
maternal fetal Less than 200 CD4 cells 4. Improve access of youth to effective
transmission Kaposi sarcoma finding HIV/AIDs control program
alone is sufficient for B. Cluster sampling for early diagnosis
diagnosis AIDS for C. Antiretroviral treatment
surveillance purpose D. Prophylaxis against penumonia, TB,
Kapsinsarcoma, cryptococcus meningitis,
candidiasis
Trachoma Follicles 1. Health education
Corneal panus 2. Assessment of problem to prevent blindness
Herbert's pits 3. Chemotherapy to reduce severity , lower the
Conjunctival scarring incidence and prevalence with Tetracycline,
Trichiasis Erythromycin and Rifampicin
Entropion i. Mass treatment/Blanket treatment in case of
prevalence of more than 5% severe and
moderate trachoma in children under 10 year
age
ii. Selective treatment in communities with low
to medium prevalence
 4. Surgical correction to treat lid deformities
like entropion and trichiasis
5. Surveillance
6. Evaluation

Window period
• The time period from exposure to HIV infection to when the body produces enough HIV
antibodies to be detected by standard HIV tests
• 30-60 days

Nosocomial infections/Hospital accquired infections

UTI ---- 40%
Surgical sites ---- 16%
Respiratory ---- 15%
Meningitis, Gastroenteritis ---- 12%
Skin ---- 8%
Septecemia ---- 6%
Preventive measures
• Source Isolation (barrier nursing) where the patient is the source of infection
• Protective Isolation (reverse barrier nursing) where the patient requires protection i.e. they are
immunocompromised.
• Hospital staff suffering from skin diseases or other infectious ailments must be kept away from
work until completely cured
• Hand washing
• Disinfection of articles used by patient
• Face masks
• Nursing techniques
• Administrative measures

Emerging (new) Diseases

• Ebola virus - transmitted through direct contact with blood and body secretions of infected animal or
human . It causes hemorrhagic fever. No specific treatment available
• Hanta virus pulmonary syndrome
• E.coli O157:H7
• Influenza

Re-emerging Diseases
TB
Malaria
VRSA, MRSA
Neisseria gonorrhea
Shigella dysentery
Salmonella typhi
E.coli

Factors responsible
• Unplanned and underplanned urbanization
• Over crowding and rapid population growth
• Poor sanitation
• Inadequate public health infrastructure
• Resistance to antibiotics
• Increased exposure of humans to disease vectors and reservoir of infection in nature
• Rapid and intense international travel
• Microbial genetic mutation