PREVENTIVE MEDICINE,

PUBLIC HEALTH, AND

CONTROL OF
COMMUNICABLE DISEASES
Preventive Medicine

➢ Science and art of preventing diseases,

prolonging life, and promoting physical
and mental health and efficiency.

Public health encompasses those undertaken

for the prevention of diseases and the
promotion of health which are primarily a
community responsibility.
Objectives of Preventive Medicine:

1.) promote optimum health

- have a physically and mentally
sounded body
2.) prevent departure from health
- free from any forms of illness
3.) prevent disabling illness after the onset of
disease in man.
- to fix any forms of disability by
means of rehabilitation.
 To maintain health, the person must be
protected from assaults by different agents.
This can be achieved through 3 levels of
prevention.
3 LEVELS of PREVENTION
1.) Primary level prevention
➢ Individual’s capacity is good and experiences
no illness.
➢ Its goal is to maintain his present health
status, or to further promote it.
➢ This level is designed to promote general
optimum health or by the specific
protection of man against disease agents or
the establishment of barriers against
agents in the environment.
2.) Secondary level prevention
➢ The individual is recovering from a disease

➢ This level is accomplished by early

diagnosis, prompt and adequate treatment
to prevent spread of the disease as well as
further complication is eliminated.

➢ Remedied by having periodic health

examinations

➢ Period of disability is shortened due to

adequate facilities were provided as a result
death is prevented.
3.) Tertiary Level Prevention

➢ The level wherein the defect and disability

have been fixed which is accomplished by
rehabilitation.

➢ To enhance the remaining capacities of an

affected individual :
1.) therapy hospital should be provided
2.) full employment to be given in
disabled person
 Classification of Infection Based on the
Distribution of the Microorganisms in the Host

1.) Local Infection

➢ Invading microorganisms are confined in

one area. i.e. wound

2.) Focal Infection

➢ Microorganisms are confined to one area,

w/c may serve as a source for further
dissemination of toxic materials to other
parts of the body. i.e. diarrhea
3.) Systemic or General Infection

➢ When there is a general invasion and the

entire body seems to be affected.
i.e. typhoid fever and cancer
5 Classification of Systemic Infection
1.] Bacteremia – presence of bacteria in the
bloodstream but no active multiplication on
it. i.e. Influenza and boils
2.] Septicemia – invasion of bacteria in the
bloodstream w/ an active multiplication of
microorganisms.
i.e. typhoid fever caused by contaminated
foods and drinks
Classification of Systemic
c.] Pyemia – presence of pus-forming bacteria in
the bloodstream, characterized by the
development of abscesses in various
organs. i.e. carcinoma
d.] Sapremia – a form of blood poisoning caused
by toxin produced by certain
microorganisms.
i.e. canned food poisoning
e.] Toxemia – condition of illness due to
presence in the bloodstream of toxins,
caused by the ingestion of foods
contaminated w/ toxins as in toxemia of
pregnancy.
i.e. ingestion of poisonous substance
 Classification of Disease According to their
Distribution
1.] Endemic disease – a small number of
people are affected among the population
of a community. i.e. meningococcal
meningitis, common colds
2.] Epidemic disease – when an endemic
disease flares up affecting a large number
of people and spread from person to
person w/in a certain community.
i.e. diarrhea, measles, chicken pox
3.] Pandemic – when an epidemic becomes
widespread and the disease is prevalent
throughout the entire country.
i.e. blood borne infections, HIV infection
Elements of an Infectious Disease Process

1.] Etiologic agents

2.] Reservoir

3.] Portals of entry and exit

4.] Mode of transmission

5.] Susceptible host

 Elements of an Infectious Disease Process
1.] Etiologic agents
➢ Protozoa - single celled parasites
i.e. malaria, amoeba
➢ Metazoa – multi-cellular parasites
i.e. tapeworms and blood flukes
➢ Fungi – unicellular structure w/ long
branching filaments
i.e. ringworm, histoplasmosis
➢ Bacteria – single cell structure
1.) normal bacteria found lining the
GIT, GUT and skin
2.) bacteria causing disease: invade &
multiply in a portion of the body; produce
toxin; initiate hypersensitivity response
Elements of an Infectious Disease Process
➢ Rickettsia – microorganisms that are in
between bacteria ( respond to
antimicrobial agents) and viruses.
➢ Viruses – obligate intracellular parasite

2.] Reservoir – the animal or place where the

infectious agent can propagate.

3 Types of Reservoir

A.] Human carrier

B.] Animals
C.] Environment
3 Types of Human Carriers
1.] Incubatory carrier – transmits the
infection before it becomes
symptomatic.
2.] Convalescent carriers – patients who had
recovered from an acute illness may
continue to shed the organism,
particularly enteric infections caused
by Salmonella or Shigella.
3.] Chronic carriers – patients who
develop chronic infections and
transmit the infection for long periods
of time, usually over 1 year.
 Types of Reservoir
B.] Animals – diseases that can be
transmitted under natural
conditions from vertebrate animals
to humans termed as zoonoses.
i.e. rabies, tularemia, leptospirosis
C.] Environment – certain biologic agents,
such as cryptococcus neoformans,
live free in the environment.
Causes:
1.] stagnant water esp. in canal where
mosquitoes can breed and multiply
2.] dirty sorrounding
3.] unsafe water supply due to pipeline
leakage
Elements of an Infectious Disease Process

3.) Portals of Entry and Exit

A.] Portal of exit
1.] respiratory tract
2.] genitourinary tract
3.] alimentary tract
4.] skin
5.] in user transmission – belongings
of an infected person like
handkerchief of a hepatitis
infected
B.] Portal of entry – similar to the portal
of exit
Elements of an Infectious Disease Process
4.) Mode of Transmission
A.] Direct transmission
B.] Indirect transmission
Direct transmission – occurs when the
reservoir and the susceptible host are in
close proximity.
➢ Person-to person spread occurs from skin
contact (i.e. syphilis) or w/ an organism in
the environment (i.e. sporotrichosis)
➢ Droplet spread occurs when infectious aerosols
produced by coughing, talking, and
sneezing transmit infection to susceptible
hosts. (i.e. mumps)
Mode of Transmission
B.] Indirect transmission – occurs when the
reservoir and the susceptible host
are separated. The separation
can be fast, near or in a far distance.
Examples:
1.] Vector spread involves mosquitoes,
fleas and ticks
2.] Vehicle spread involves transportation
of an infectious agent on
inanimate objects ( fomites ) like
toys, beddings or contaminated
food, water, milk or biologic
materials.
Indirect transmission

3.] Airborne spread – produced by

talking, singing, coughing, or
sneezing and float on air
currents for varying periods of
time.
General Principles of Communicable Disease
Control
Education is fundamental to the
application of all other control measures. This
involves dissemination of appropriate and
feasible information, communication, intrinsic
motivation. It is necessary to prevent most
diseases.
 General Principles of Communicable Disease
Control
1.] Fixing of responsibility
2.] Authority
3.] Reporting
4.] Early diagnosis
5.] Isolation
6.] Immunization of contacts
7.] Quarantine
8.] Maritime quarantine or Ship quarantine
9.] Disinfection and fumigation
10.] Carrier control
11.] Community immunization
12.] Official’s responsibility for communicable disease
control
13.] Control of intermediate host
General Principles of Communicable Disease Control

1.] The fixing of responsibility

➢ The government is the one responsible for
the control of contagious diseases. The
practicing physician does not have direct
responsibility for enforcement of measures for
the control of communicable diseases.
2.] Authority
➢ Authority is required to control communicable
diseases. A police power is instituted to
protect the community from a recalcitrant
(disobedient) patient w/ a contagious
disease who refuses to observe the
regulations of the health department.
 General Principles of Communicable Disease
Control

3.] Reporting

➢ A workable system for reporting all

contagious diseases in the community
must be devised. It is the duty of the
practicing physician to report all cases of
communicable diseases.

➢ Reports should be made as soon as possible

after the tentative diagnosis has been made.
General Principles of Communicable Disease Control

4.] Early diagnosis

➢ The physician who first sees the patient

makes a tentative diagnosis and
institutes tentative unofficial isolation
measures.

➢ He reports the case to the health

department

➢ He may ask for any necessary laboratory

aids in diagnosis i.e. FTA-ABS test for
syphilis
General Principle of CDC

5.] Isolation

➢ When the diagnosis of communicable

disease has been made the patient is
isolated
Purposes:
1.) isolation of the patient protects the
community from dissemination of
the specific agent to others.
2.) the patient is protected from factors
that may influence the course of the
disease unfavorably.
General Principles of CDC

6.] Immunization of contacts

➢ After the patient has been isolated next to consider
is the possibility of preventing the disease
among his contacts. This is immunizing the
family contacts to get rid from such disease.
7.] Quarantine

➢ Family contacts and other immediate

contacts undergo quarantine. The
duration is from the date of last
exposure to the incubation period of
the disease.
➢ The purpose is to prevent the spread of
the disease.
 General Principles of CDC
8.] Maritime quarantine or Ship quarantine
➢ Its purpose is to prevent the spread of a few highly
important communicable diseases from infected
ports to disease free nations.
➢ This quarantine is organized on an international basis.
➢ Diseases subject to quarantine such as cholera,
hepatitis A and B, yellow fever, typhus, plague,
small pox, leprosy, anthrax, AIDs, typhoid fever
and CMV.
9.] Disinfection and fumigation
➢ This is done by thorough cleaning, airing and sunning
of the sickroom, using only soap and water w/c are
adequate protective measures.
➢ In the hospital all these matters are the responsibility
of the nurse who attends to the sick person.
General Principles of CDC

10.] Carrier control

➢ The chronic carrier of an infectious agent is of great
importance as a source of infection in communicable
diseases.
➢ The detection and control of carrier is the function of the
official health department.
11.] Community immunization
➢ There are cases that a mass community immunization
is needed to eradicate for the control of
communicable diseases.
➢ The DOH takes charge of this project
➢ To date the nation have a national immunization day to
give the population a chance to avail of free
vaccines and toxoids against some common
infectious diseases.
General Principles of CDC

12.] Official’s responsibility for

communicable disease control

➢ The local health department is responsible for

communicable disease control measures.
➢ This is usually aided by the national gov’t.
➢ Often, the health department is aided by the
national laboratory services where the
production of biological products like
vaccine, toxoids and hyper-immune sera
takes place.
➢ Then products are used for prophylactic and
therapeutic treatments.
General Principles of CDC

13.] Control of intermediate host

➢ Fumigation is now used chiefly to check

diseases that are transmitted by those
insects and rodents that are intermediate
factors in the spread of disease
➢ The most effective fumigant is hydrocyanic
acid gas.
➢ Steam is often used in the destruction of
infectious agents on clothing and is an
excellent germicide particularly if placed
under 15 lb pressure.
THANK YOU