PHC modules • proper way to collect sample: Inhale or deep breath then
Primary Health Care and CHN
• MDG5 target- reduction of maternal mortality by
80/100,000 live births (mdg5)
• 2/3- reduction of child mortality rate (mdg4)
• Mdg 5- TARGET of three quarters reduction by 2015
• 11 mothers die everyday due to childbirth and delivery
• SDG 3– HEALTH and WELL being Centered ( disease
focus : HIV/AIDS , Malaria)
• SDG 6 – SANITATION centered
• Sustainable Development Goals 2030 Agenda :
“Transforming our world”
17 goals target is 2030
• SDG- 17 GOALS by 2030
• Goal 1: No Poverty
• Goal 2: Zero Hunger
• Goal 3: Good Health and Well-being (health centered
related)
• Goal 4: Quality Education
• Goal 5: Gender Equality
• Goal 6: Clean Water and Sanitation(sanitation centered)
• Goal 7: Affordable and Clean Energy
• Goal 8: Decent Work and Economic Growth
• Goal 9: Industry, Innovation and Infrastructure
• Goal 10: Reduced Inequalities
• Goal 11: Sustainable Cities and Communities
• Goal 12: Responsible Consumption and Production
• Goal 13: Climate Action
• Goal 14: Life Below Water
• Goal 15: Life on Land
• Goal 16: Peace, Justice and Strong Institutions
• Goal 17: Partnerships for the Goals
Tuberculosis / PTB- a highly infectious chronic disease that usually
affects the lungs.
Causative Agent: Mycobacterium Tubercles (acid fast BACTERIA)
• Robert Koch- discovered of Mycobacterium
tuberculosis, the bacterium that causes tuberculosis
(TB), on the evening of March 24, 1882
• Sign/Symptoms:
 cough for more than 2 weeks
 afternoon fever
o Swelling lyphnodes
 weight loss
 night sweat
 blood stain sputum - hemoptysis - ***late sign
• Primary Prevention for Tuberculosis - BCG
vaccination
• Case finding – Direct Sputum Smear Microscopy
(DSSM) and X-ray examination of TB symptomatics who
are negative after 2 or more sputum exams
• Sputum smear and culture or DSSM – CONFIRMATORY
test
• Tuberculin test (Mantoux test- detects the presence of
antibodies to CONFIRM EXPOSURE
(Results read after 48-72 hours from skin testing.
• Needs gauge 26 needle syringe (ID route bevel up)
• positive if within duration of 10mm or more.
Below 5 y/o and HIV + pt. - > or = 5mm is positive
Older than 5 y/o > or = to 10 mm is positive)
• Mantoux test- A positive reaction means that the client
has been
exposed to TB
• DOTS- was declared in 1996
cough up 3-5ml sputum
• Hemoptysis is CONTRAINDICATION of sputum collection
• 3x in a month – collection of sputum for case finding
• BCG – DO NOT GIVE to immunosuppressed baby- with
LEUKEMIA AND HIV
• Chest x-ray - determines the presence and extent of
disease
• the primary diagnostic tool in TB case finding is DSSM
• Direct Observed Treatment Short Course –
comprehensive strategy to detect and cure TB patients.
• DOTS (Direct Observed Treatment Short Course)
• Category I - 6 months treatment
o -new smear (+) PTB
-new smear (-) PTB with extensive lesions on
CXR
-EPTB
-Severe concominant HIV disease 2
o -DOTS: intensive for 2months of RIPE
o maintenance: 4months of RI
• Category II-treatment failure
-relapse
-return after default
-intensive: 2 months RIPES/1 month RIPE
• Maintenance: 5 months RIE
• Category III -new smear (-) PTB with minimal lesion on
CXR
o -DOTS: 2months RIPE
o maintenance: 4months RI
• Category IV –chronic MDR pt.
• Refer to specialized facility or DOTS Plus Center
Refer to Provincial/City NTP Coordinator
• Rifampicin causes urine discoloration.
Isoniazid give Vit. B6 or pyridoxine to prevent peripheral
neuropathy
Pyrazinamide - causes G.I upset.
Ethambutol causes optic neuritis-
-not given to children under 6 years or younger because
they cannot reliably monitor vision –
• Streptomycin causes- tinnitus and auditory impairment/
OTOTOXICITY.
• FDC – Fixed Dose Combination
• 4 FDC or 4 drugs combined in a blister pack – R.I.P.E
• 3 FDC or 3 drugs combined in a blister packs – R.I.P
• 2 FDC or 2 drugs combined i a blister packs – I.E or the
new drug R.I.
• Streptomycin – only TB drug in Vial
- causes hearing loss and damage to cranial nerve 8
- contraindicated in pregnancy
• DOTS therapy is recommended for the treatment of
ACTIVE TB
• The minimum duration of treatment for culture-positive TB
is 6 months
• For the treatment of TB in pregnant women, the initial
regimen should be INH(Isoniazid), RIF(Rifampicn), and
EMB(ethambutol) (RIPE) for at least 9 months
• X-rays must be done at diagnosis and then every after 2
months of treatment.
Leprosy
• RA 4073- Liberization and Treatment of Leprosy (February
as Leprosy Month)
• Hansen's disease - BACTERIA
• •Multi-Drug-Therapy (MDT)
• LEPROMATOUS TYPE is the most disfiguring type of
LEPROSY
CHOLERA or EL TOR (BLUE DEATH)
• Epidemic outbreak on August of 1854 Soho, a suburb of
London
• John Snow - FATHER OF MODERN EPIDEMIOLOGY in
part because of his work in tracing the source of a cholera
outbreak in Soho, London, in 1854
• Cholera is an acute diarrhoeal infection
• Humans are the only relevant reservoir,
• What is Cholera?
• VERY common in RAINY SEASON
• How is Cholera transmitted?
• Answer: Transmission to humans occurs through eating
food (seafood) or drinking water contaminated with
Vibrio cholerae from other cholera patients
• Mode of transmission: WATERBORNE and foodborne
disease.
• Where is the major reservoir for cholera?
• Answer: HUMANS
• In its most severe form what effect does Cholera have?
• Answer: Severe drop in blood pressure
• What is the major symptom of Cholera?
• Answer: Massive, rice-water diarrhea (Contains mucus)
(up to 10 liters per day!)
• What is the treatment for Cholera?
Answer: oral rehydration therapy
• How is Cholera prevented?
Answer: Prevention - Modern plumbing/sanitation and
clean drinking water
• Who was John Snow?
Answer: One of the fathers of epidemiology,
Founded that Cholera came from contaminated drinking
water.
• What is the causative agent of Cholera?
Answer: Vibrio Cholerae
BUBONIC PLAQUE – BLACK DEATH
• In what century did the Black Death Occur? - 14th
• Describe the definition of the Black Death- A widespread
epidemic of the Bubonic Plague the occurred in the 14th
century, killing millions of people.
• What type of flea carried the Disease?- The oriental rat
flea
• What was the most common strain of the Black Death?-
The Bubonic Plague
• What bought the Black Death from Asia to Europe?-
Rats and their FLEAS traveling on trade routes
• Where did the Black Death Originate?- Asia,
predominantly China
• Where did the Black Death first arrive in Europe?-
Messina, Italy
• What is another name for the Black Death?- the
Bubonic Plague
Helminths or PARASITES -
• Helminths - most common is ascariasis , hookworm
,trichuris (whipworm)
• **** EXCEPT = Taeniasis
• Beef tapeworm - Taenia saginata- ingestion of
undercooked beef
• Ancylostomiasis/Hookworm – causes anemia - penetration
of skin - walking barefooted
• Pinworms/ enterobiasis .- causes perianal itchiness at
night best way to diagnose this infection is through a tape
test.
HEPATITIS
• Hepatitis A , E or Infectious Hepatitis: oral-fecal route
• Hepatitis B ,C,D or Serum Hepatitis: blood-borne, Sex
BULLETS
• Red tide poisoning- first aid Drinking pure coconut milk
Rabies/ Lysa
• Cause by RHABDO VIRUS BY DOGS ,CATS AND
BATS CONTAMINATED SALIVA
 observe the dog for 14 days. If it dies or shows
signs suggestive of rabies, consult a physician.
• Rabies - hydrophobia, a morbid fear of water
• DOG BITE FIRST AID ACTION WASH WITH SOAP AND
RUNNING WATER
• Category 1
 Licking of intact skin
 Observe the dog for 14 days
 • CATEGORY II
 Abrasion, laceration, punctured wound on the lower • 10 weeks DPT+HIB-2 Hep B2 OPV2 RTV2 PCV2
extremities • 14 weeks DPT+HIB-3 Hep B3 OPV3 RTV3 PCV3
 Give active vaccine
- Observe dog for 14 day • Pneumococcal conjugate vaccine (PCV) – start to be
given at 6 weeks, protect the baby against pneumonia; safe
to mother and baby
• CATEGORY III
 Abrasion, laceration on upper extremities, head and • 9 months give Measles ***
neck. • 12 months MMR
 Dog is killed, lost died, stray • ****Rotavirus Vaccine – 2-3 doses antidiarrheal
 Give active vaccine plus Passive vaccine
Bullets drug Treatments:
• Varicella (Chicken Pox) • Cholera- first line antibiotic: tetracycline
- Varicella Virus Cholera second line- Cotrimoxazole
Communicable 1 DAY BEFORE ERUPTION OF
VESICLES to 6 days after first crop of vesicles have • Tetracycline: causes permanent green TEETH
formed STAINING of baby if used by pregnancy
• Antiviral agents – TREATED WITH • Pneumonia, Acute ear infection, Mastoiditis
ACYCLOVIR(ZOVIRAX) • Drug: Amoxicillin – 1st line
• Cotrimoxazole – 2nd line
• Fifth’s Disease
• Symptoms • in IMCI standard for fever is > 38.5oC or hot to touch -
 Classic rash of erythema on face (cheeks), “slapped give Paracetamol every 4-5 hours- analgesic and
face appearance” antipyretic

• Rubeola (measles) • Census is for gathering data in mass population or groups

• Viral infection • COPAR stands for - Community Organizing Participatory
• Communicable 4 DAYS just before the rash appears Action Research
• Pre-Eruptive Stage: • BAWANG – Cholesterol and hypertension
• fever, coughing, sneezing, and running of nose and • LAGUNDI – cough , colds fever, and dysentery
redness of eyes. • NIYOG NIYOGAN – traditional medicine act as
• Koplik spots—bluish-gray specks or “grains of sand” ANTIHELMINTHIC, to expel worms and parasites
on a red base—develop on the buccal mucosa • LEVEL 2 WATER FACILITY – STAND POST and
communal faucet
• HBMR – home based mothers record
• Mumps - PAROTITIS
• HBMR – is a tool used to render prenatal care
• Viral infection
consisting the risk factors and danger signs of pregnancy
• Transmitted by direct contact of saliva and respiratory
• PANEL 2 of HBMR – contains the risk factor and danger
droplet
signs of pregnancy
• Communicable immediately before swelling begins
• OPV-- SABIN VACCINE
• ORESOL is administered EVERY 4 HOURS
• PLAN C in dehydration treatment -- insertion of IVF
• Rubella(German measles)
• Viral Infection • IVF – for severe dehydration
• Communicable 7 days before to 5 days after rash • COURTESY CALL is done in -- PRE ENTRY PHASE of
**Pregnant people must avoid infected child=fetal COPAR
death • HYDROCEPHALUS and mental retardation is a form of
HEALTH DEFICIT –
• Pertussis (whooping cough) • POSTPARTUM BLUES- common normal 2-3 days
• Bacterial infection postpartum,
• Oxytocin- uterine contraction, given after 3rd stage of
labor
• Diptheria- bacterial cause- corynebacterium diphtheria- • CATEGORY1 - NO RESTRICTION....NO CONDITION
pseudomembrane WHICH CONTRADICTS THE USE OF THE METHOD...
• CATEGORY 4--- Method not to be used- A condition
• Zika virus which represents an unacceptable health risk if the
• a virus transmitted by Aedes mosquitoes. contraceptive method is used ( may sakit)
• Causes microcephaly baby in pregnancy • DEPO PROVERA – 3 months injectables, assess weight
gain
• IPV – IM • Feso4- 1 gram per singleton pregnancy- start at 5 months
• PCV VACCINE – IM to 2 months postpartum
• IPV- killed bacteria • SITE OF BBT – AXILLARY
• Measles route – SQ • Hand washing/ hand hygiene – 30 seconds
• Measles insertion 40-50 degree • Scurvy – Vit C deficiency
• Give every child a dose of Vitamin A every 6 months from • DPT interval. – 4 weeks
the age of 6 months. • Post Partum homevisit – home delivery is within 24
• Give every child mebendazole every 6 months from the hours….. hospital delivery- within 1st week or between 3-5
age of one year. days after delivery
• vitamin A,deficiency –Xeropthalmia and bitots spot
IMMUNIZATION: • BP cuff NOT INCLUDED inside PHN/ OB bag
• 6 weeks give DPT+HIB-1** Hep B1 OPV1 RTV1**** • RA 7160 LGU – DEVOLUTION CODE
PCV1***** • Vibrio cholera or El tor – common in rainy season
• VIT. A IU POSTPARTUM mother – 200,000 IU..
• Sabin – OPV – live attenuated virus
• Defrost freezer if ice build up of refrigerator is 2-3 cm or
1inch or more
• BCG – 0.05 (.05ml) – ID
• TB - SCC means SHORT COURSE CHEMOTHERAPY
• Einc protocol - 1st 30 second action : Drying thoroughly
• Cretinism – iodine deficiency
• Measles – infectious before rashes appear – 4th day
• TT1 protection – “NO “protection
• 6000 TOTAL POPULATION TARGET FOR EPI – 180
• Blindness – Vit. A
• Ampalaya – DM type 2
• Endometrial cancer s/s – unusual discharges or vaginal
bleeding
• KOPLIK SPOTS – measles or rubeola
• Unang yakap- dry the baby
• BMI- Obese- ≥30.00
--------Normal range - 18.50 - 24.99--------Overweight -
≥25.00
• Cheesy discharges and pruritus itchy vulva –
candidiasis, moniliasis
• Cauliflower cells – condylomata – HPV
• Clue cells – BACTERIAL VAGINOSIS
• STRAWBERRY CERVIX – TRICHOMINASIS
• Foul fishy discharges – bacterial vaginosis
• FROTHY DISCHARGES – TRICHOMONIASIS
• PID – CAUSED BY CHLAMYDIA
• Hiv – attacks CD4 cells
• HIV/AIDS .– attacks IMMUNE SYTEM
• VIT.D deficiency- RICKETS
• Family Planning – PD 965 – signed JULY 20 1976
• RH bill – 10354
• IUD – REVERSESSIBLE LONG TERM
• T cu 380 – 10 YEARS PROTECTION
• COLD CHAIN – a system that maintains potency of
vaccine
• RABIES – saliva of rabid animal
• Rabies – is known as lysa
• PTB – Koch disease
• BREASTFEEDING – the 3 E (Early, Exclusive, Extended)
• Aqua privies is level 1
• Breast self exam is a secondary level of prevention
• Iron must be given with vit. C
• Calcium absorption is with vit D
• IRON is in chicken liver and MONGO , camote tops and
kangkong
• brown vials of vaccines protects against sunlight to
MAINTAIN POTENCY
• *Breastmilk stool-mashy,golden yellow – sweet sour
smell- 3 – 4x a day
• *lactalbumin- breastmilk easily digestible protein
• *Content of colostrum - antibody IgA (immunoglubolin
antibody A)
• *Tetanus neonaturum- cord care management -
ALCOHOL AND HAND HYGIENE OR HANDWASHING
• -HAND HYGIENE - to break chain of infection
• *Dosages of immunization- Dpt Opv ,Hep.b- 3 doses
• Vaccines must be exposed only in room temperature up to
3x
• 3rd exposure – discard vaccine
• FEFO- First expiry first out
• Cold chain by dictrict level – 3 months
• Half life packs shelve of measles- 6 hours
• Half life packs shelve of Dpt, opv, bcg- 4 hours
• Half life packs shelve of Tt, heap b- 8 hours – discard if not
used up within the end of your shift
• Dosages- 0.5 ml IM( DPT,HEP. Penta, PCV)
• 0.5 ml SQ(Measles)
• 0.05 ml ID(BCG)
• 2 DROPS ORAL ( ROTA & OPV)
• 4 months or a 16 months baby completed the doses of 1
bcg dpt1-3 opv1-3 hepb1-3
• *Crude birthrate- TOTAL LIVEBIRTHS ÷TOTAL
POPULATION x 1000
• *Crude death rate - Total deaths ÷total population x1000
• Weakest link- mode of transmission
• Benedict's and acid test – performed in community to
pregnant mothers in home visit to test glycosuria and
proteinuria
• Roll over test- SIMS OR SIDELYING
• Severe abdominal pain - 90 degree angle or
Fowler's also
• Feeding in bed - 90 degree or fowlers
• 2nd degree burn - painful and blister
• Syphilis bacteria is in the painless ulcers or sores
• *Vit A- squash, papaya, yellow camote, yellow corn,
banana
• *Cretinism or mental retardation / Iodine
• *TB - intensive phase category 1&2
• *COPAR - courtesy call at pre entry, (immersion or
integration at ENTRY,)
• IFR* individual funding request.
• *IMCI/ danger signs –
Convusion
Unable to drink or breastfed
Vomits everything
Abnormally sleepy or difficult to awaken
• Stridor/chest indrawing - severe pneumonia
Fast breathing classify pneumonia
0-2 mos= more than 60cpm
2-12 mos = more than 50
12-5 years old = 40
Pneumonia first line antibiotics - AMOXICILLIN
• Cholera- vibrio eltor and cholerae in RAINY SEASON-
DIRTY WATER
• Salmonellosis – caused by food poisoning in canned
goods Or spoiled proteins
• Measles* cough, runny nose, conjunctivitis and
maculopapular rashes
• Koplik spots also in buccal mucusa
• Airborne transmission - measles
• *Colustrum – rich in maternal antibodies – thick yellow or
dirty white
• *Storage of breastmilk- 8 hours if room temperature
• *Prolactin - hormone that influences milk production
• *PRENATAL VISIT- AT LEAST 4 VISITS
• 36 weeks to term is everyweek
• *BSE- 7 DAYS AFTER MENSTRUATION
• (COPAR) - Community Organizing Participatory Action
Research
Pre-entry /Preparatory Phase
 Profiling of community
 Ocular survey/ Site selection
 PAy courtesy call to community leaders.
• Entry Phase
Integration with the community
 Self Awareness Leadership T raining
 Organization phase
 core group formation
social preparation
spotting & developing potential leaders
 A-R-A-S (Action- Reflection- Action-Session)
 community diagnosis
• Action Phase
 Organization and training of (BHWs):
 PIME of health services (Project Implementation
Monitoring and Evaluation)
 Setting up of linkages/ network/ referral systems
• Sustenance and Strengthening Phase  Oral trush in the newborn (CBQ)
 Formulation of by-laws Medications:
 Identification and development of “ secondary” leaders  Nystatin
 Setting up of a financing scheme

• Trichomoniasis
• Rates- relationship between a vital event and those sTrawberry cervix
persons exposed to event FROTHY, foul-smelling ("fishy" smell
• Ratio- relationship between two (2) numerical quantities ) vaginal discharge
• Infant Mortality Rate- good index of the general  Trichomona vaginalis, single cell protozoan
HEALTH CONDITION OF A COMMUNITY S/sx: Females: Yellow gray frothy
• Swaroops index- is the proportion of deaths of people discharge
aged 50 years and up. Dx:
• 3 CRITERIA FOR LAM use: - elevated vaginal pH 5.5+ ( alkaline
 Amenorrhea Mgmt: Metronidazole (Flagyl);
 Fully or nearly fully breast feeding her infant
 BF on demand basis (evey 2-4 hrs during the day, 4-6 • Bacterial vaginosis
foul, fishy smelling, thin gray vaginal discharge
hrs at night
 presence of CLUE CELLS (CBQ)
 Infant is less than 6 mos

• Gonorrhea PHC
Male:purulent yellow penile discharge
Females: - Greenish vaginal discharge LOI 949 - legal basis of PHC
• Goal of PHC:
• Genital Human Papillomavirus  Health in the Hands of the People by the Year 2020
HPV Mission of PHC: SELF RELIANCE
 condylomata, cauliflower-like warts • PHC- is universal and it extends even to people in the
 Acetic acid (vinegar) swabbing (will whiten lesion) hospital, both sick and well.
 Condylomata acuminata -Accessible – not more than 5 km to travel
-Available
• Hepatitis B -Affordable
 Spread through infected blood and bodily fluids such -Acceptable
as semen -Appropriateness

• Four Cornerstones/Pillars in Primary Health Care

• HIV – AIDS Active Community Participation
 Retrovirus (HIV1 & HIV2) Multisectoral - Intra and Inter-sectoral Linkages
 Attacks and kills CD4+ lymphocytes (T-helper) Use of Appropriate Technology
 Sexual intercourse (anal and vaginal) Support mechanism made available byDepartment of
Health (DOH)
• Exposure to contaminated blood, semen, breast milk
 Needlestick injuries
• Primary level- locally trained
 HIGH RISK GROUP – BLACK and HISPANIC (MEN)
• Villagers/Grassroots workers
 Homosexual or bisexual – most highest cases - BHW - frontline worker in community
 Sexual contact with HIV+ - Traditional birth attendants – traditional Hilots-
 Intravenous drug users traditionally acceptable to deliver pregnancy in
 HIV TEST community
 ELISA – Enzyme Link Immunosorbent Assay ( first test - Arbularyo or healers – uses herbs for treatment of
conducted) illnesses
 Western Blot - confirmatory test
•  HIV+ • Secondary- Intermediate workers
2 consecutive positive ELISA and Public Health Nurse – supervisor or immediate
1 positive Western Blot Test superior of the midwife of the midwife in RHU
•  Full blown AIDS- CD4 is less than 200/ml Midwives – frontline worker in RHU level

• Health deficits- TB, DM, hydrocephalus, polio,leprosy

• Health Threats – lack of immunization, no or lack
PELVIC INFLAMMATORY DISEASE prenatals
• Cause by CHLAMYDIA – primary agent • Foreseeable crisis – Abortion - Divorce or separation
• Gonorrhea is also secondary agent Marriage -Entrance at school –newborn - Death of a family
member
• MOST COMMON AFFECTED – OVIDUCTS or Fallopian
tube
• Malaria
 Chronic pelvic pain, fever, flu-like symptoms, pain during
Causative Agent: - PLASMODIUM (PROTOZOA)
or after intercourse(CBQ), vaginal bleeding, foul smelling
discharge, tenderness in lower abdomen, and chills • P. Falciparum (most fatal)
Vector
 Can cause ectopic pregnancies, infertility and abscesses
in the pelvis. Can be life threatening - very serious.  Anopheles female mosquito
• Signs & Symptoms:
• Candidacies  Chills to convulsion,
 Yeast infection  Elevated temperature
 With white cheesy patches (moniliasis)(CBQ) Treatment: chloroquine
• Schistosomiasis • Fe supplementation: 60 mg with 400 mcg of Folic
Causative Agent: Schistosoma japonicum Acid once a day
Snail : oncomelania quadrasi •  3 C of Home delivery
Signs & Symptoms: Bulging abdomen, Abdominal pain, CLEAN Hands
Loose bowel movement(black tarry), Low grade fever, CLEAN Surface
Seizure CLEAN Cord
 Preventive measures •  Vitamin A Supplement to Infants, Preschoolers (6mos – 7
Proper excreta disposal yeas and Mothers
Agricultural & vegetation improvement • Pregnant women - 10, 000 IU 2x a week starting on the 4th
Let water stand 2-3 days before usage month of pregnancy
Mollucides use  Do not give vit. A supplementation before the 4th month
Educate in Hand hygiene of pregnancy. It might congenital problems in the baby.
Rubber boots use • Postpartum women - 200, 000 IU - 1 cap; 1 dose only
 Treatment: Praziquantel (drug of choice) within 4 weeks after delivery
• Viamin A Deficiency (CBQ) - XEropthalmia – night
blindness
• Water Supply
• Level 1 (Point Source) - protected well or developed
spring
 Level II - With a source, reservoir, piped distribution
• Expanded Program for Immunization (EPI) network and communal faucets or stand post
Wednesday - immunization day
 Level III - Individual House Connections or Waterworks
 FULLY IMMUNIZED CHILD System - With a source, reservoir, piped distributor
 before the child's first birthday. network and household taps
 fully immunized child must have completed
 BCG 1
Toilet or sewerage
 DPT 3
 OPV 3
 HB 3 • Level I - pit latrines , pour flush toilet & aqua privies
 measles vaccines to complete FIC
• Level II - with septic vault/tank disposal - WATER-
• Bacillus Calmette-Guérin - Birth or anytime after birth SEALED AND FLUSH TYPE
• Level III - connected to septic tanks and/or to sewerage
system to treatment plant.
• Diphtheria-Pertussis-Tetanus Vaccine
6 weeks(DPT 1) • Epidemiology - the study of disease occurrence and
10 weeks (DPT 2) distribution
14 weeks (DPT 3) • Infection- entry and development or multiplication of an
infectious agent in the body of man or animals.
•  Oral Polio Vaccine – SABIN - • 4 types of disease distribution
 6 weeks(OPV 1) • 1. EPIDEMIC- “The unusual occurrence in a community of
 10 weeks (OPV2) disease- sudden outbreak of a disease in a short period
 14 weeks (OPV3) of time
2. Endemic- constant presence of a disease or infectious
agent within a given geographic area or population group.
3. Pandemic- worlwide distribution….geographic area
• OPV- Number of doses per vial/amp: 20
such as a section of a nation, the entire nation, a continent
• HEPA B , Measles & BCG
or the world
Number of doses per vial/amp: 10
4. Sporadic- “scattered about”. The cases occur
• Hepatitis B Vaccine - At birth – RNA RECUMBINANT, irregularly, The cases are few and separated widely in time
PLASMA and place
• Upper outer portion of the thigh, Vastus Lateralis (R-L-R) - On and off scattered cases –habitual occurence
• Warm compress for soreness - Brings more blood to the • Nosocomial (hospital acquired) - urinary tract
area where it is applied. infections are the most common.
• CARRIERS- “an infected person or animal that harbors
a specific infectious agent in the absence of discernible
• Warm - Reduces joint stiffness and muscle spasm, which
(visible) clinical disease and serves as a potential
makes it useful when muscles are tight.
source of infection to others

• Cold compress for pain relief and swelling

Leptospirosis – Vector is Rat
Causative Agent: - bacteria--- Leptospira interrogans
• 85% of measles can be prevented by immunization at 9 • Sign/Symptoms: High fever, Chills, Vomiting, Red/ orange
MOS. eyes, Diarrhea, Severe headache, muscle aches, may
•  VVM or Vaccine vial monitor - a thermochromic label include jaundice (yellow skin and eyes), abdominal pain
put on vials which gives a visual indication of vaccine Treatment: PET - Penicillins G, Erythromycin,
potency Tetracycline,
• • Doxycycline as prophylactic drug
•  “Eligible population”
- group of people targeted for specific immunizations
susceptible to EPI diseases.”
• PENTA – 6 WEEKS – IM Dengue - mosquito-borne infection
• MMR- 12 MOS-SQ
 • Vector is female aedes aegypti mosquito, day biting,
low flying, STAGNANT CLEAR WATER,stripes black
white body.
• Agent is a Virus.. dengue virus 1,2,3,4
treatment is supportive therapy.
 Intravenous fluids
 A platelet transfusion
• DENGUE DIAGNOSIS:
- Tourniquet test (capillary fragility test or Rumpel Leads
Test), a presumptive test which is positive in the presence
of more than 20 petechiae within an inch square, after 5
minutes of test
• TOURNIQUET TEST - (BP Cuff):
o fluids (most important treatment) like oresol and IV
o paracetamol ( do not give aspirin)
o for nose bleeding or EPISTAXIS, flex the neck lean
forward to prevent aspiration
o avoid unnecessary movement
• assist in the management of shock. Dorsal recumbent
to TRENDELENBURG POSITION
Hepatitis
What is hepatitis?
• Hepatitis is an inflammation of the liver. The condition
can be self-limiting or can progress to fibrosis
(scarring), cirrhosis or liver cancer.
• Hepatitis viruses are the most common cause of
hepatitis
• There are 5 main hepatitis viruses, referred to as
types A, B, C, D and E.
• B and C - most common cause of liver cirrhosis and
cancer.
• Hepatitis A and E are typically caused by ingestion
of contaminated food or water.
• Hepatitis B, C and D usually occur as a result of
parenteral BLOOD contact with infected body
fluids.
• Common modes of transmission for these viruses
include receipt of contaminated blood or blood
products, invasive medical procedures using
contaminated equipment and for hepatitis B
transmission from mother to baby at birth, from
family member to child, and also by sexual contact.
• Hepatitis A virus (HAV) transmitted through
consumption of contaminated water or food.
• transmitted mainly through the fecal oral route.
(foodborne)
• Hepatitis B virus (HBV) is transmitted through
exposure to infective blood, semen, and other body
fluids.
• HBV can be transmitted from infected mothers to
infants at the time of birth or from family member to
infant in early childhood
• Hepatitis C virus (HCV) is mostly transmitted
through exposure to infective blood.
• It is considered to be the most serious of the
hepatitis viruses
• Hepatitis D virus (HDV) infections occur only in those
who are infected with HBV.
• Hepatitis E virus (HEV) is mostly transmitted
through consumption of contaminated water or
food.
• transmitted mainly through the fecal oral route.
(foodborne)
• FHSIS/Record & Report:
Components:
1. Family tx record = Daily
2. Target Client list = weekly
3. Reporting forms = monthly
4. Output reports = quarterly;annually
• *Family tx record - fundamental building block;
foundation of FHSIS
*Target client list - 2nd building block
CHN
The Primary focus of CHN is Health Promotion & Disease
Prevention
• Primary goal - self reliance in health or enhanced
capabilities
• Ultimate goal - raise level of health of citizenry
• Philosophy of CHN- Worth and dignity of man - by the
nature of her work has the opportunity & responsibility for
evaluating the health status of people & groups & relating
them to practice.
• The COMMUNITY. is the patient in CHN,
• the family is the unit of care and the
• ROLES OF THE PHN
• ❖ Clinician - taking care of the sick people at home or in
the RHU.
• ❖ Health educator- dissemination of correct info;
educating people
• ❖ Facilitator, who establishes multi-sectoral linkages by
referral system
• ❖ Supervisor- monitors & supervises the performance of
midwives
o Census (100%) : Most ideal, enumeratx of data
conducted 6 mos.
Level Of Disease Prevention
• PRIMARY – health promotion and disease prevention
o Health education
o Immunization: Method of health promotion
o Chemoprophylaxis: Intake of drugs Ex. Vit C to
avoid URTI
o Reproduction & Sexual Health
o Responsible Parenthood
• Through Environmental Control
o Safe Water Supply -
o Food Sanitation/ Good Food
o Hygiene
o Environmental sanitation
• Secondary Level Of Disease Prevention
- Early diagnosis & prompt intervention to halt
pathological process to shorten
a. Screening Methods
• Mass Screening: Should be simple & inexpensive
• Case Finding: Positive cases of leading causes of
morbidity
Gold Standard for TB test: Culture and Sensitivity
Sputum smear microscopy- TB test
• Contact Tracing and Surveillance
• Tertiary Level Of Disease Prevention -
• Rehabilitation is the goal
• Leading New Cancer Cases
• lung cancer was the most common cancer in MEN
 • In Females, breast cancer was the most common
****Smoking (including passive smoking) is the most • Symptoms- Mild-severe respiratory illness
important factor. Gastrointestinal symptoms
Ebola: Mapping the outbreak Complications-pneumonia, kidney failure
From the section of WEST Africa
Ebola crisis • Treatment: No specific treatment
The hunters breaking an Ebola ban on bushmeat- FRUIT • No vaccine or specific treatment is currently available.
BATS
• Primary source = fruit bats or flying foxes , old world bats
• Other sources: • Philhealth.
o Chimpanzees
o Gorillas Medical Cases:
o fruit bats Newborn care package (NCP) — 1,000 — increased to
o monkeys 1,750
o antelope
o porcupines
o symptomatic humans • Surgical Cases:
• Ebola largest outbreak in West Africa was first Normal spontaneous delivery (NSD) in Level 1 hospitals —
reported in March 2014, 8,000
• discovery in 1976. Normal spontaneous delivery (NSD) Levels 2 to 4 hospitals
Virus is named after the ebola river — 6,500
• There are 5 strains of EBOLA virus Delivery by caesarian section (CS) — 15,000 — increased
• EBOZ or ebola ZAIRRE strain is the most deadliest to 19,000
strain
to avail of your PhilHealth benefits
• RESTV or EBOR (ebola reston) species, found in
Philippines and the People's Republic of China, have • Payment of at least 3 months’ worth of premiums within
been found to infect humans but they do not cause illness the immediate 6 months of confinement.
or death
HOME VISIT is a family-nurse contact which allows the health
• Diphtheria- bacteria Corynebacterium diphtheriae.
• throat infection causes a gray to black, tough, fiber-like worker to assess the home and family situations in order to provide
covering the necessary nursing care and health related activities.
• Shick test for Susceptibility to diphtheria: A + shicks
means no immunity or suceptible; (antigen test)
• Moloney test – for sensitivity of diptheria
Purposes

Tetanus
1. To give care to the sick,
• caused by the bacterium Clostridium tetani,
• present with trismus (“lockjaw”), 2. To assess the living condition
• give TETANUS TOXOID TO PREVENT Clostridium 3. To give health teachings
INFECTION
4. To establish close relationship
5. To make use of the inter-referral system
• L. monocytogenes CAUSES Listeriosis
- BACTERIA Listeria monocytogenes.
- listeriosis after eating contaminated food.
- primarily affects pregnant women, newborns, older adults, and Principles
people with weakened immune systems.
Foods associated with listeria?
Non-pasteurized milk & milk products (soft cheeses, ice cream), hot 1. A home visit must have a purpose or objective.
dogs, deli meats, caramel apples 2. Planning and delivery of care should involve the
individual and family.
• Middle East respiratory syndrome coronavirus (MERS- 3. The plan should be FLEXIBLE.
CoV)
- CAMEL FLU or SARS of MIDDLE EAST
Steps
• a VIRAL respiratory disease caused by a novel coronavirus
(MERS‐CoV) that was first identified in Saudi Arabia in 1. Greet the patient and introduce yourself.
2012.
2. State the purpose of the visit (Question after
• 1st case - april 2012
Greeting the patient and introducing yourself what
2nd case - sept. 2012
is your next action? = State the purpose of the
• CAMELS - major reservoir host for MERS-CoV and an
animal source of MERS infection in humans visit)
3. Assess or Observe the patient and determine the
• Transmission- human-to-human contact
health needs.
• Highest Risk : IMMUNOSUPRESSION (CANCER)

4. Put the bag in a convenient place and then proceed
to perform the bag technique.
5. Perform the nursing care needed and give health
teachings.
6. Record all important date, observation and care
rendered.
7. Make appointment for a return visit.
BAG TECHNIQUE is a tool by which the nurse, during her visit
will enable her to perform a nursing procedure with ease and
deftness, to save time and effort with the end view of rendering
effective nursing care to clients.
PUBLIC HEALTH BAG is an essential and indispensable
equipment of a public health nurse which she has to carry along
during her home visits.
Principles
• will minimize, if not, prevent the spread of
any infection.- most important central feature
• It saves time and effort in the performance of nursing
procedures.
• The bag technique can be performed in a variety of
ways depending on the agency’s policy, the home
situation, or as long as principles of avoiding transfer
of infection is always observed.
*BP apparatus and stethoscope are carried separately and are
never placed in the bag.
4 C Points to consider
COMPLETE- contain all the necessary articles,
supplies and equipment that will be used to answer the
emergency needs
CLEAN - contents should be cleaned very often, the
supplies replaced and ready for use anytime.
CONTENT protection- contents should be well
protected from contact with any article in the patient’s
home.
*Consider the bag and its contents clean and sterile, while
articles that belong to the patients as dirty and
contaminated.
CONVENIENT- arrangement of the contents of the
bag should be the one most convenient to the user,
to facilitate efficiency and avoid confusion.
Initial step in bag technique : Upon arrival at the patient’s home,
place the bag on the table lined with a clean paper. The clean
side must be out and the folder part, touching the table Steps
BULLETS
• Spacing of pregnancy - 3-5 years
• Vit.D for calcium absorption prevents RICKETS in children
and osteomalasia in adult- sources dairy products ,cod
liver oil, fish, milk, cheese , anchovies, salmon, sardines
• VIT C prevents SCURVY
• Solutions like alcohol must be must be placed in the
center of the Public health Bag
• IRON- 60 mg per tablet once a day and 400 mcg of folic
acid for 6 months
• Vitamin A for postpartum – 200,00 IU one dose
• Vitamin A for pregnant– 10,00 IU 2x a week starts at 4
months
• Vitamin A for Children 12 months and above – 200,00 IU
dose every 6 months
• Vitamin capsule colors: RED
• Vitamin A treatment of Xeropthalmia and Measles
• Beta-carotene in vegetables such as carrots and sweet
potatoes is the most common provitamin A.
• Dairy products (such as cheese and fortified milk), eggs,
cod, liver oil and halibut are rich sources of preformed
vitamin A.
• Plant-based sources of provitamin vitamin A include
pumpkin, broccoli, and dark green, leafy vegetables.
NEWBORN CORD CARE
- keep skin clean and dry, no tub baths, wash around area with
water, ALWAYS AIR DRY THE CORD
- monitor for bleeding, redness, drainage, foul odor
- fold diapers below cord stump, clean area around cord
after each diaper change, allow cord to fall off on its own
- Hemorrhage(keep cord clamped securely for 24 hours after
birth)
- Infection(keep cord clean and dry, do not use creams or
lotions near the cord),
- umbilical clamp can be removed after 24 hrs if cord is dried
and occluded and is not bleeding
- keep cord clean and dry ~~> soap and water ONLY WHEN
SOILED
- NEVER APPLY COVER- REMOVE COVER IF PRESENT
- keep the diaper from covering the cord ~~> fold diaper
below cord
- assess cord for odor, swelling, or discharge
- the newborn is washed via a sponge bath until the cord
falls off (within 2 wks)
- The cord needs to be kept dry to promote its "falling off"
without risk of infection.
- Tub baths will have to wait until the cord falls off.
- Diapers will need to be rolled down so that the cord
stays dry (and, if necessary, the penis needs to be pointed
down for boys).
- The cord will fall off at about 2-weeks of age (7-10 DAYS).
- WATCH FOR Signs and symptoms of infection include a
red ring around the umbilical area, foul smell, moist oozing
cord, drainage at the site, and either a high or very low core
temperature in the newborn.
- Allow the client/family to watch the MIDWIFE perform
cord care correctly, and ask them to repeat for return
demonstration.
RETURN DEMONSTRATION – THE BEST EVALUATION
TECHNIQUE FOR TEACHING
SOLID WASTE MANAGEMENT
Color coded trash bins
Black - Non-infectious dry waste
Green - Non-infectious wet waste (kitchen, dietary etc.)
Yellow -- Infectious and Pathological waste
Yellow with black band ---Chemical waste including those w/ heavy
metals
 💥 💥Orange--- Radioactive waste
💥 💥Red---- Sharps and pressurized containers
Epidemiology
– study of the occurrences,
distribution and determinants of health-related states or
events in specified populations.
– backbone of the prevention of the disease
Epidemiologic Triad: HOST – AGENT – ENVIRONMENT
1. Host – intrinsic factor (man as primary host)
2. Agent – etiologic factor (virus, bacteria, fungi, parasites etc.
)
3. Environment – extrinsic factor
John Snow – Anesthesiologist known as “FATHER OF
EPIDEMIOLOGY”
• In 1800's - He studied the epidemic of
CHOLERA erupted in the Golden Square of
Soho district London (1854)
In Epidemiology:
1. “DISTRIBUTION” - refers to descriptive epidemiology
- It answers the questions WHEN, WHERE, WHO
- time (when), place (where), and person (who)
2. “DETERMINANTS” - refers to analytic epidemiology.
- discovers causes, risk factors, modes of
transmission
- It answers the WHY and HOW
- includes the causes (including agents), risk
factors (including exposure to sources)
Descriptive vs. Analytic epidemiology
1. Descriptive epidemiology can identify patterns among
cases and in populations by time, place and person.
Survey are used to find out the nature of the
population affected by a particular disease noting the
age, sex and occupation.
2. Analytic epidemiology is concerned with the search for
causes and effects, or the why and the how.
Patterns of Occurrence and Distribution
1. SPORADIC – intermittent occurrence of a few isolated
(scattered) and unrelated cases
2. ENDEMIC – continuous occurrence throughout a period of time
of the usual number of cases in a given LOCALITY.
Endemic refers to the constant presence and/or usual prevalence of
a disease or infectious agent in a population within a geographic area
3. EPIDEMIC – unusual large number of cases in a relatively
SHORT period of time usually in weeks
Point source – food poisonings
Cyclical pattern – dengue fever
Secular trend – influenza
Propagated - HIV/AIDS
4.PANDEMIC – simultaneous occurrence of epidemic on the same
disease in SEVERALCOUNTRIES affecting large number of
population
Pandemic diseases:
M ERS cov
Asian Flu
Spanish flu ( 1918-1919) - 40 to 50 million deaths
Antonine plague
Meningococcemia
A H1N1
B lack death / Bubonic plague by Yersinia pestis
H IV/AIDS
E bola and COVID – 19 by SARS-CoV-2
RA 3573 ( Law on reporting of Notifiable Diseases)
- Report to provincial and duty health office
- Midwife reports – under supervision of the nurse
- REPORT Measles Polio within 24 hours
- Tetanus Neonatorum, Severe and acute
diarrhea, HIV within a WEEK
RA 11332 (MANDATORY reporting of Notifiable Diseases)
- Mandatory Reporting of Notifiable Diseases and
Health Events of Public Health Concern Act
- Surveillance and Response to Notifiable
Diseases, Epidemics, and Health Events of
Public Health Concern
CHAIN OF INFECTION
1. Agent – Any micro-organism capable of producing an
agent (Bacteria, virus, fungi, parasites)
Killing the microorganism by :
DISINFECTION: Killing of micro organism but NOT their spores
STERILIZATION: Killing of ALL MICROORGANISM including spores
AUTOCLAVING –15 pounds pressure, moist heat and 250
degrees Fahrenheit.(121°C)
Black strips suggest successful autoclave
2. Reservoir
- natural HABITAT in which the agent normally
lives, grows, and multiplies.
- It includes, humans, animals, and environment
- Human reservoirs : Measles, mumps, HIV and
STI
- Animal reservoir: anthrax (sheep) and rabies
(dogs)
- Environment reservoirs: Histoplasmosis (soil)
TAKE NOTE:
Carrier—A person or animal that harbors a specific infectious
agent WITHOUT discernible clinical disease and serves as a
potential source of infection
3. Portal of exit – path by which a pathogen leaves its host.
- Many portals of exit are identical to portals of
entry
- Influenza and TB exit the respiratory tract and
Cholera bacteria exit in in feces
4. Modes of transmission - Considered as the WEAKEST
link
- Can be easily break by HAND WASHING
- Hand washing is the NUMBER ONE way to stop
the transmission of infections
Hand Hygiene is the single MOST effective and important - Some studies in 2003 suggested that smallpox
technique to use in preventing and controlling transmission of and SARS could reach persons located 6 feet or
infection more from the source. (Some examples- flu,
rhinovirus, SARS, group a strep, Neisseria
Handwashing / hand hygiene meningitis.)
3 elements of Handwashing: DROPLET PRECAUTION
A. Soap – (1 - 3 ml) Streptococcal infection and scarlet fever
B. Water – running clean water Pertussis, pneumonia, parvovirus B-19
C. Friction – MOST important element Influenza
HANDWASHING TIME: (40–60 sec) Diptheria
Minimum time each hands: 15 seconds Epiglottitis
Average time: 20 seconds each hands Rubella
BEST time:30 seconds Mumps,measles,mycoplasma, meningitis
Adenovirus infection
• Alternative to soap and water: Hand based Novel coronavirus ( COVID-19) Sars-Cov-2
sanitizer with at least 60% ethanol content
3. Airborne transmission
MODE OF TRANSMISSIONS - Droplet nuclei are dried residue of LESS than 5
1. Contact transmission – MOST frequent means of microns in size.
transmitting infections in healthcare facilities. Can be by - Particles are suspended in the air for a LONG
direct or indirect. PERIOD OF TIME or when dust particles contain
A. Direct contact – occurs through. skin-to-skin pathogens
contact, kissing, and sexual intercourse - MTV- Measles, TB, Varicella
• contact with soil or vegetation harboring
infectious organisms. 4. Vectorborne Transmission
- Vectors are non human carriers that transmit
• infectious mononucleosis (“kissing disease”) and
organisms from 1 host to another and can be
gonorrhea are spread from person to person by
biologic or mechanical. (mosquitoes, animals,
direct contact.
fleas, and ticks)
• Hookworm is spread by direct contact with
- Deer ticks – lymes disease
contaminated soil.
- Mosquitos – dengue, malaria, filariasis
B. Indirect transmission – transfer of an infectious
- Rat flea – black death/bubonic plague
agent from a reservoir to a host by suspended air
- Dogs– rabies
particles, inanimate objects (vehicles), or animate
- Snail – schistosomiasis
intermediaries (vectors).
• 5 F’s — Fingers/hands, Fomites(inanimate Mode of transmission continuation
object), Foods, Feces, Flies
5. Portal of entry – refers to the manner in which a pathogen
Contact transmission enters a susceptible host.
Multidrug resistant organism (methicillin) For example:
Respiratory infections
Skin infections (leprosy, ringworm, scabies) • Respiratory tract (Influenza virus)
• Fecal -oral (gastroenteritis)
Wound infections (tetanus) and STI’s (HIV/AIDS) • Skin (hookworm)
Enteric infections (Gastrointestinal diseases) • Mucous membranes (syphilis)
Eye infections ( conjunctivitis) • Blood (hepatitis B, HIV).

Vehicle Transmission –Involves the transfer or microorganisms by Donning(putting on): from bottom up (shoe cover ni GowMa
way of vehicles, or contaminated items that pathogens, GoGlo)

Ex. Milk and dairy foods carrying LISTERIOSIS (L. Boot covers
Monocytogenes) Gown/Apron
Mask
• Food carrying salmonella, water carrying Goggles
Legionella, blood borne hepatitis B and C, Gloves (when hands raised above head)
drugs can carry bacteria from contaminated
infusion supplies. Doffing (taking off): alphabetical order
• Contaminated Blood, food, water, inanimate Boot covers
objects are vehicles of transmission. Gloves
Goggles
Gown
2. Droplets transmission – Droplets are body fluids. Mask
- It refers to spray with relatively large, short-range
aerosols produced by sneezing, coughing, or 4. Host - The FINAL link in the chain of infection is a
even talking. susceptible host.
- Droplets DO NOT remain suspended in the air - Compromised host - Host with lowered
for very long and seldom travel more than 3 resistance to infection and disease for any
feet around the patient.
 reason (for example, malnutrition, illness,
trauma, or immunosuppression).
STAGES OF INFECTIOUS DISEASE:
– Incubation period – time period between exposure to
an infection and the appearance of the FIRST
symptoms (latency, no signs and symptoms)
*Communicability period – time when disease are MOST
contagious & easily transmitted to others.
2. Prodromal period – the time from the onset of nonspecific
symptoms until specific symptoms begin to manifest (mild signs
and symptoms)
3. Stage of illness – Most severe stage of an infectious disease
- Signs and symptoms are MOST evident and MOST SEVERE at this
time
4. Stage of decline - Body gradually returns to a normal state of
health
- Signs and symptoms subside
- The immune response and antibody titers normally peak
5. Convalescence period – this is a period of recovery
TYPES OF INFECTIOUS DISEASE
– Zoonotic diseases transmitted from animals to humans.
– Nosocomial – hospital acquired infection, infection must
occur: up to 48 – 72 hours after hospital admission. (UTI)
– Iatrogenic infection – secondary to treatment and
procedures
Three lines of defense against infection
FIRST LINE OF DEFENSE: INNATE IMMUNITY – Physical (Intact
skin) and chemical barrier
SECOND LINE OF DEFENSE: Adaptive immunity (non specific)
THIRD LINE OF DEFENSE: Immune response (specific)
TYPES OF ANTIBODIES
IgG – ONLY antibody crossing placenta
IgA – BREASTMILK
IgM - FIRST immunoglobulin made following Ag exposure (infection)
IgE - Involved in mediating ALLERGIC reactions
Useful against parasitic infections
IgD – B lyphocyte maturation
Ab versus Ag
Globulins / Antibody: — A protective protein found in the blood
associated to immune system that is produced in response to
foreign substances (e.g. bacteria or viruses) invading the body.
Antigens: Foreign substances (e.g. bacteria or viruses) in the
body that are capable of causing disease..
TYPES OF IMMUNITY
1. Natural Active - Exposure to the disease organism , experiencing
the actual disease
*Long lasting immunity/life long (Nagkasakit Ako)
2. Artificial Active - introduction of a killed or weakened form of the
disease organism through vaccination (Aray Aray like turok ng EPI
vaccines)
3. Natural Passive - IgA found in human colostrum and milk and IgG
tranplacental (Nanay Pasuso(breastfeeding) and Nay Papasa ng IgG
from placenta in pregnancy)
*Natural passive last only for 6 to 12 months
4. Artificial Passive
- Provides immediate protection, but short-term protection by
injection of antibodies, (may last 2 – 3 weeks)
- Injection of gamma globulin, rabies antibodies, anti
tetanus serum
COMMUNICABLE DISEASES
Acute Illness
- Less than 6 months
- Symptoms often are sever and appears suddenly or abruptly,
subside quickly
- Good prognosis
- Example: Dengue fever, measles
Chronic Illness
-Longer than 6 months
-Slow onset
-With periods of remissions and exacerbations
- Example: TB and leprosy
Communicable Disease (Vector Borne)
1. Leptospirosis
– Weil's disease
– Leptospirosis
– Canicola fever and trench fever
– Mud fever and flood fever
– Japanese 7 days fever and spiroketal jaundice
Causative Agent: Leptospira interrogans bacteria
Incubation period: usually 5 – 14 days ( ranging 2 – 30 days
according to CDC)
Diagnostic test:
Microscopic agglutination test - gold standard serologic
CONFIRMATORY test for leptospirosis
Blood and CSF can be tested during the first week of illness
Urine can be tested : After the 10th day of illness
Reservoirs: rodents and rats
Primary reservoir: RATS (especially brown rats) - worldwide source
of leptosira interrogans.
Other sources: Cattle, Pigs, Horses, Dogs, Rodents, and Wild
animals
Common during heavy rainfall season.
Mode of transmission: Ingestion or CONTACT to urine
contaminated, water, soil, food and entry of agent to mucous
membranes of the eyes, nose , mouth and in a broken skin from a cut
or scratch.
TAKE NOTE: Person to person transmission is rare.
Outbreaks occurs due to exposure to contaminated floodwaters.
Sign and symptoms:
Red eyes (conjunctival suffusion) – pathognomonic sign
Abdominal pain, vomiting and diarrhea A – anti-mosquito soaps/ repellants and using long sleeved
Tender and painful muscles (myalgia) shirt when going out at night
Skin jaundice and sometimes rashes L – larvivorous fish (guppy fish, gambusia fish, itar or
kataba fish) - STREAM SEEDING
PHASES OF DISEASE A – avoid going out between 9 pm to 3am
1st phase of illness: fever, chills, headache, muscle aches, vomiting, R – remember to take chloroquine tablets at WEEKLY
or diarrhea INTERVALS
2nd phase of illness is more severe; kidney, liver failure or meningitis. I – include planting neem trees in backyards and clearing
(Weils disease) hanging branches near rivers
Other Complications: Pulmonary hemorrhage, cardiac arrhythmia, A – apply insect repellant on house walls
and septic shock

3. Filariasis/ elephantiasis
Treatment: • Lymphatic filariasis, commonly known as elephantiasis, is a
neglected tropical disease.
Doxycycline – Drug of choice and prophylactic drug to prevent
leptos Vector: Aedes poecillus mosquito
Breeding sites: water-filled leaf axils of abaca, banana, taro (gabi)
P – Pen -G
and
E – Erythromycin
screw pine (pandan/pandamus).
T – Tetracycline
Peak Biting time: 10 pm to 2 am (Best time to collect blood sample
Causative agent: Wuchereria Bancrofti
Prevention:

R – rubber boots use when wading flood waters Others:

A – avoid wading, bathing, swimming in flood waters
Brugia Malayi – was first confirmed in the Philippines in 1964
T – take prophylactic drug 200 mg doxycycline taken weekly
Brugia Timori
S – seek consultation for fever 2 days after known exposure to flood
Incubation : 8 – 16 months (long incubation period)
waters.
Diagnostic test:
2. Malaria (Ague or Marsh fever or BLACK WATER
FEVER) • Alere Filariasis Test Strip (FTS) – rapid diagnostic test
• Together with HIV/AIDS, tuberculosis and other • Immunochromatographic test (ICT) – can be done in
neglected tropical diseases, malaria control is daytime
included under Sustainable development Goal 3 • Nocturnal blood smear – blood test taken after 8 pm
by 2030
STAGES OF FILARIASIS
Vector: Female Anopheles mosquito (sporozoites from the salivary
Asymptomatic: NO clinical signs and symptoms
gland)
Biting time: bite between dusk and dawn (9 pm to 3am) Acute Stage:
Causative Agent: PLASMODIUM parasites (protozoa)
P. Falciparum and P. vivax pose the greatest risk (MOST FATAL) Lhymphangitis(inflammation of lymph vessels)
P. Malariae and P. Ovale Orchitis/epididymitis (painful and tender scrotum)
Diagnostic test:Laboratory confirmation of malaria is done on a Lymphadenitis(inflammation of lymph nodes)
blood film to detect MALARIAL PARASITES.

Signs & Symptoms

Chronic Stage:
C – chills to convulsion
H – headache Hydrocele (swelling and fluid accumulation in scrotum)
I – increased temperature(fever) Elephantiasis (thickening and enlargement of extremities, scrotum
L – liver enlargement (hepatomegaly) and breast)
L – low hemoglobin level (anemia)
S – sweats profusely Lymphedema
* The hallmark of malaria is FEVER followed by chills to convulsion
TAKE NOTE: Malarial parasites invade and destroy red blood Permanent disability
cells.

Watch out for: Icterus and Shock – refer to secondary or tertiary Management:
facility
Diethyl carbamazine citrate or Hetrazan (6mg/kg)
Chemoprophylaxis –chloroquine taken at WEEKLY interval, Ivermectin (200mcg/kg) + albendazole
starting from 1-2 weeks before entering the endemic area. Albendazole (400mg) 2x a year
Anti-malarial drugs: sulfadoxine, quinine sulfate, tetracycline, No treatment can reverse elephantiasis
quinidine
Treatment for pregnant and infants: sulfadoxine-pyrimethamine
TAKE NOTE: HETRAZAN is the DRUG OF CHOICE. (Side effect is
NOT malaria drug – Amoxicillin
fever)

Preventive measures:
PREVENTIVE MEASURES

M – mosquito nets/Insecticide treated nets (ITN's)

F – Filariasis can be controlled by preventive measures like vector R – remove cercariae in water by paper filtering or use of iodine or
control chlorine
I – intensify health information campaigns in its prevention, control S – Safe water use, let water stand for 48 – 72 hours before using it.
and elimination
L – long sleeved shirt at night
A – annual mass drug administration using 2 drugs in all endemic Complication of Bilhariasis
areas (for 5 years) • Cor pulmonale, pulmonary hypertension
R – repellants against mosquito.
• Ascites and renal failure
I – intensify campaign to halt progression of disease through
• Liver cirrhosis and portal hypertension
disability prevention
A – avoid going out at night usually between 10 pm to 2 am TAKE NOTE: Meningitis is NOT a complication of Bilhariasis
TAKE NOTE: There is NO known vaccination for Filariasis.

4. Schistosomiasis/ Snail Fever/Snail fever/Katayama

fever/Bilharziasis 5. DENGUE
• Schistosomiasis (also known as bilharzia ) is a vector- Also known as: “Breakbone fever” because of severe muscle, joint
borne parasitic disease caused by trematode flatworms of and bone pains.
the genus Schistosoma. Vector: FEMALE Aedes Aegypti mosquito.
• Schistosomiasis is considered one of the neglected tropical Tiger mosquito
diseases (NTDs). Characteristic of Aedes aegypti mosquito:
Vector: Freshwater snails • Day biting
• Oncomelania hupensis quadrasi snail - vector of • Most active 2 hours after sunrise and 2 hours before sunset
Schistosoma japonicum in the Philippines and it is the • Small 4 – 7 millimeters
intermediate host of S. Japonicum. • black and white pattern (white/silver scale patches)
• Bites in nape, elbow and ankle
Breeding site: fresh waters in agricultural areas. • Breeding sites
Risk individuals: Farmers • Stagnant clean or clear water (bottle cap, dish dryer, plant
Caused by: BLOOD FLUKE (TREMATODES) – SCHISTOSOMA axil, gutter, trash can, old rubber tire, etc.)
Diagnostic test:
Circumoval precipitin test is a serological test used for diagnosis of Causative agent: Flaviviruses – common in the Philippines
schistosomiasis japonica. Viral strains: DENV-1, DENV-2, DENV-3 and DENV-4
Kato-Katz test – stool exam under a microscope (confirmatory Recovery from infection is believed to provide lifelong immunity
test for Snail fever/S. Mansoni) against that serotype.
Incubation period: 3 – 14 days (commonly 2 – 7 days)
Causative Agent:

Schistosoma japonicum – most common in the Philippines Diagnostic test:

Schistosoma hematobium
Schistosoma intercalatum Dengue Dou – Dengue NS1 and IgG/IgM capture
Schistosoma mansoni – can deposit eggs in the brain tissue. 1. Tourniquet test / Rumpel-Leede capillary-fragility test or
simply a capillary fragility test– screening test of dengue
Mode of transmission: Contact with water infected with • positive in the presence of more than 20 petechiae within
cercariae (DIRECT and INDIRECT) an inch square, after 5 minutes of test
• Use BP cuff
Swimmers itch or Cercarial dermatitis – early sign, itchy, raised 2. Dengue NS1 RDT – Requested between 1-5 days of illness
papules , commonly occur within 1–2 days of infection (due to (detect virus antigen)
cercariae penetration to skin) 3. Dengue IgM/IgG – Requested beyond five days of illness
(detect dengue antibodies during) IgM in acute dengue
Signs & Symptoms:
infection.
Lowgrade fever, IgG determines previous infection.
Inflammation of liver & spleen, 4. Polymerase Chain Reaction (PCR) – gold standard
Pallor laboratory tests to confirm dengue virus
• Total While Blood Cell (WBC) count (result show
Bulging abdomen, decreasing level)
Abdominal pain, • Platelet (decreased)
Loose bowel movement, • Hematocrit (increased)
Muscle aches
Seizure Early signs:

H – headache and eye pain (retro orbital pain)

Drug of choice for Bilhariasis: Biltricide (Praziquantel) O – on and off fever
Others: Diethyl carbamazepine citrate (DEC) T – tourniquet test (+ petechiae)

Others signs:
Preventive measures
F – feces and urine proper disposal or use of sanitary toilets. L – low platelet
A – avoid bathing and washing in infested waters A – abdominal pain, loss of appetite, vomiting and diarrhea
R – rubber boots to avoid skin penetration in agricultural places M – muscle and joint pain
M – molluscicides use O – onset of fever
E – emphasize importance of hand washing
C – capillary refill longer than 2 seconds.(POOR TISSUE
PERFUSION)
Normal capillary refill is 1 – 2 seconds.
Hermann's sign (petechial rash) – pathognomonic sign of dengue.
TAKE NOTE: Cold and clammy skin is a sign of dengue
hemorrhagic fever
MANAGEMENT
D – DO NOT GIVE ASPIRIN
E – epistaxis – flex neck forward and apply cold packs in forehead.
N – note for any signs of shock (sudden transition of fever to afebrile
state)
G – give oral fluids /oresol /intravenous fluid
U – use PARACETAMOL for fever
E – enhance the 5 – S campaign and mosquito vector control.
5 – S campaign
Search and destroy mosquito-breeding sites (Removal of water such
as flower vases)
Self-protection measures like wearing long pants, long sleeved shirts
and repellants
Seek early consultation
Support and say YES to fogging/spraying only in hotspot areas or
impending outbreak.
Sustain Hydration
6.Rabies/ Lyssa/ Hydrophobia/ La Rage
• Rabies is a neglected tropical disease.
• Rabies is caused by a VIRUS that affects the central
nervous system, particularly causing inflammation in the
brain (encephalitis)
• 99.9% mortality rate
BRAIN – is the MOST commonly affected by the rhabdovirus
BITES ON HEAD OR FACE has the SHORTEST INCUBATION
PERIOD
• less than 50 days is the incubation if the patient is bitten
on the head
• Bites or scratches in hands is longer incubation less
than 1 year
Rabies is the deadliest zoonotic disease that threatens humans and
animals on all continents except Antarctica.
Vector: DOG – principal animal vector (99%)
Virus can be transmitted by Saliva
Causative Agent: VIRUS – Rabies lyssavirus, formerly Rabies virus
of the rhabdovirus family.
Incubation period: 2 – 8 weeks (2-3 months)
FACTS on RABIES
• Asia and Africa are worst affected as more than 95% of
rabies associated human deaths.
• Bat rabies is responsible for most human rabies deaths in
the United States of America and Canada
• 40% of people bitten by suspect rabid animals are
children under 15 years of age.
Mode of transmission: Dog bite
Diagnostic test:
• direct fluorescent antibody (DFA) test, which looks for the
presence of rabies virus antigens in brain tissue .
• Human rabies can be confirmed intra-vitam and post
mortem by various diagnostic techniques that detect whole
viruses, viral antigens, or nucleic acids (negri bodies) in
infected tissues (brain, skin or saliva)
Signs and symptoms:
• Initial symptoms : fever with pain and unusual or
unexplained tingling, pricking, or burning sensation
(paresthesia) at the wound site.
1. Furious rabies — hyperactivity, excitable behavior
• hydrophobia (fear of water) and sometimes aerophobia
(fear of drafts or of fresh air).
• Hydrophobia and aerophobia are pathognomonic for
rabies and occur in 50% of patients
2. Paralytic rabies
• 20% of the total number of human cases.
• Muscles gradually become paralyzed, starting at the site of
the bite or scratch.
• Bladder dysfunction, Generalized weakness, quadriparesis
to COMA AND DEATH
Paralysis and death occurs in both dumb and furious forms 4– 8 days
after the onset of clinical signs
Dog bite
FIRST AID: Immediate and thorough flushing and washing of the
wound for a minimum of 15 minutes with soap and running
water, detergent, povidone iodine or other substances that remove
and kill the rabies virus.
AVOID: Garlic, batobalani (tandok) and suctioning. NO to tandok
The infected animals usually dies within 7 to 10 days of becoming
sick.
(FEED DOG PROPERLY and Observe the dog for 14 days)
CATEGORIES OF DOG BITE
Category I - touching or feeding animals, animal licks on intact skin
(no exposure)
Category II - nibbling of uncovered skin, minor scratches or
abrasions without bleeding (exposure) – GIVE ACTIVE VACCINES
Category III - single or multiple transdermal bites or scratches,
contamination of mucous membrane or broken skin with saliva from
animal licks, exposures due to direct contact with bats (severe
exposure) – GIVE ACTIVE AND PASSIVE (RIG vaccine)
RABIES IMMUNIZATION
1. ACTIVE IMMUNIZATION – develops antibody that gives 2
– 3 years protection
Example:
PCEC (Purified Chick Embryo Vaccine)
PDEV (Purified Duckling Embryo Vaccine)
RABIPUR and VERORAB OR VEROWELL(cheap)
Purified Vero cell rabies vaccine (PVRV)
Dose:
ID - 0.1 ml
IM - 0.5 ml
Purified chick embryo cell vaccine (PCECV)
DOSE:
ID-0.1 ml
IM-1.0ml
2. PASSIVE IMMUNIZATION
PASSIVE IMMUNIZATION – administered to patients with head
bites, and multiple bites to the different parts of the body especially
the upper part of the body to be administered WITHIN 7 days after
exposure.
E – Evident signs of dehydration (THIRST is the earliest and first
sign)
R – “RICE watery” stool is the pathognomonic sign
A – Antibiotic drug of choice – Tetracycline .
PREVENTION: SANITATION, FOOD SAFETY, CHOLERA
VACCINE

Example: 2. SALMONELLOSIS
Sign and symptoms
ERIG (Equine rabies Immunoglobulin) – derived from HORSE • Acute onset of fever
serum. • Abdominal pain/cramps
• Acute Diarrhoea
HRIG (human Rabies Immunoglobulin)
• Anorexia, nausea and vomiting.
Standard ROUTE: Intramuscular

Remaining doses are infiltrated around wound. MANAGEMENT

Days of immunization: Day 0, 3, 7, 14, 28 PRIORITY: Fluid and Electrolytes therapy

PVRV dose: 0.5 ml
PCECV dose: 1.0 ml
Site of injection: One deltoid or anterolateral thigh in Infants
Prevention:
R – responsible pet ownership (Republic Act 9482)
A – anti-rabies immunization of pets beginning at age 3 months
YEARLY
B – bathe, feed them with safe and clean food and water
I – if you are bite , scratched or licked by dog – wash the site
immediately for 15 minutes.
E – ensure that pets are NOT roaming in the streets (your pet action
is your responsibility.)
S – support and mobilize community participation
FIVE TIPS TO AVOID DOG BITES:
P – pet the dog gently by stroking back first and allowing dog to sniff
hands first.
E – eye to eye contact must be avoided
T – try to stand still like a tree trunk (DO NOT RUN)
📍Ensure food is properly cooked and still hot when served.
📍Avoid raw milk and products made from raw milk. Drink only
pasteurized or boiled milk.
📍Avoid ice unless it is made from safe water.
📍When the safety of drinking water is questionable, boil it
📍Wash hands thoroughly and frequently using soap
📍Wash fruits and vegetables carefully
3. Hepatitis A
• Hepatitis A is an inflammation of the liver that can cause
mild to severe illness.
• The hepatitis A virus (HAV) is transmitted through ingestion
of contaminated food and water or through direct contact
with an infectious person.
• Almost everyone recovers fully from hepatitis A with a
lifelong immunity. However, a very small proportion of
people infected with hepatitis A could die from fulminant
hepatitis.
• The risk of hepatitis A infection is associated with a lack of
safe water and poor sanitation and hygiene (such as
contaminated and dirty hands).
• A safe and effective vaccine is available to prevent
hepatitis A.

M – make sure all dogs are vaccinated against rabies yearly. Agent: hepatitis A virus (HAV)
E – eating, playing, sleeping or scared dog should NEVER BE
DISTURBED. MOT: faecal-oral route — foodborne or waterborne that is
contaminated with the faeces of an infected person.

FOOD BORNE DISEASES Predisposing Factor: unsafe water or food, inadequate

sanitation, Low and middle income countries, poor personal
1. CHOLERA/EL TOR hygiene and oral-anal sex.
• acute diarrhoeal infection
Incubation period: 14–28 days.
Agent: Vibrio cholerae BACTERIA
Diagnostic: Specific diagnosis is made by the detection of HAV-
MOST COMMON IN RAINY SEASON
specific immunoglobulin G (IgM) antibodies in the blood
Incubation Period: 12 hours to 5 days
📍MOT: Ingestion of contaminated water or food RT -PCR
(waterborne/foodborne)
📍bacteria are present in their faeces for 1-10 days after infection and RISK FACTORS:
are shed back into the environment • poor sanitation;
CONFIRMATORY TEST: STOOL CULTURE • lack of safe water;
• living in a household with an infected person;
C – called as “Blue Death”
• being a sexual partner of someone with acute hepatitis A
H – Hands and feet are wrinkled known as “washer woman hands”
infection;
O – Oral rehydrating solution “Tubig Kubeta Oresol”
• use of recreational drugs;
L – Loose and fishy odor stool
• sex between men; and
 • travelling to areas of high endemicity without being
immunized.
SIGNS AND SYMTOMS
Hot (fever)
Eye and skin discoloration (jaundice)
Pain in RUQ of abdomen
A norexia, nausea/vomiting and diarrhea
Asymptomatic – some cases has no signs and symptoms
*dark-coloured urine is also present
Treatment
• There is NO specific treatment for hepatitis A.
• Recovery from symptoms following infection may be slow
and can take several weeks or months.
• It is important to avoid unnecessary medications like
Acetaminophen, paracetamol and medication against
vomiting should be avoided.
Prevention
• Improved sanitation, food safety and immunization are the
most effective ways to combat hepatitis A.
• adequate supplies of safe drinking water;
• proper disposal of sewage within communities; and
• personal hygiene practices such as regular handwashing
4. Botulism:
• Clostridium botulinum is a bacterium that produces
dangerous toxins (botulinum toxins) under low-oxygen
conditions.
• Botulinum toxins are one of the most lethal substances
known.
• Botulinum toxins block nerve functions and can lead to
respiratory and muscular paralysis.
• Human botulism may refer to foodborne botulism, and
infant botulism, wound botulism
• Homemade canned, preserved or fermented foodstuffs are
a common source of foodborne
Agent: Clostridium botulinum (bacteria)
MOT: FOODBORNE
📍foods, including low-acid preserved vegetables, such as green
beans, spinach, mushrooms, and beets; fish, including canned tuna,
fermented, salted and smoked fish; and meat products, such as ham
and sausage.
Incubation Period: Symptoms usually appear within 12 to 36 hours
(within a minimum and maximum range of 4 hours to 8 days) after
exposure
Diagnosis: Culture Test of C. botulinum from stool, wound or food.
Misdiagnosed as: stroke, Guillain-Barré syndrome, or myasthenia
gravis.
SIGNS AND SYMPTOMS:
Botulinum toxins are neurotoxic
📍Descending, flaccid paralysis that can cause respiratory failure.
📍Early symptoms include marked fatigue, weakness and vertigo,
usually followed by blurred vision, dry mouth and difficulty in
swallowing and speaking.
📍Vomiting, diarrhoea, constipation and abdominal swelling may also
occur.
📍There is NO fever and no loss of consciousness.
TREATMENT & PREVENTION:
📍early administration of ANTITOXIN and intensive respiratory care
The WHO Five Keys of Food poisoning prevention are:
• keep clean, mop floors wash chopping boards (RIGHT
PREPARATION)
• separate raw and cooked (RIGHT PREPARATION)
• cook thoroughly (RIGHT COOKING >70 to 85°C)
• keep food at safe temperatures (RIGHT STORAGE)
• use safe water and raw materials. (RIGHT SOURCE)
*when water is from questionable source boil it at least 3
mins or more
5. Foodborne trematode infections:
Foodborne trematode infections result in severe liver and lung
disease.
• Clonorchis and Opisthorchis from ingestion of freshwater
fish
• Fascioliasis from Aquatic vegetables
• Paragonimus from ingestion of crustacean
AGENT: PARASITES
MOT: FOODBORNE
DIAGNOSIS: direct sputum smear microscopy for
PARAGONIMIASIS
Katokatz smear for Clonorchis and Opisthorchis
SIGNS & SYMPTOMS:
Opisthorchis spp and Clonorchis sinensis may be asymptomatic,
fever, right upper-quadrant pain (obstruction of the gallbladder by the
worm)
📍Fascioliasis intermittent pain, jaundice, anaemia, pancreatitis and
gallstones
📍Paragonimiasis may be asymptomatic.
📍chronic cough with blood stained sputum, chest pain, dyspnoea,
and fever, and can result in complications of pleural effusion and
pneumothorax.
📍Symptoms and signs of PARAGONIMIASIS can be confounded
and mistakenly diagnosed with TUBERCULOSIS.
Treatment:
• Clonorchiasis and opisthorchiasis — praziquantel
• Fascioliasis — triclabendazole
• Paragonimiasis — triclabendazole or PRAZIQUANTEL
6.Taeniasis/cysticercosis – intestinal infection with
tapeworms.
AGENTS: PARASITES
Taenia solium (pork), Taenia saginata (beef) and Taenia asiatica.
Only T. solium causes major health problems
MOT: FOODBORNE — ingestion of the undercooked and infected
pork.
Human to human via Feco-oral route.
FACT SHEET:
 • Human tapeworm carriers excrete tapeworm eggs in their
faeces and contaminate the environment when they
defecate in open areas.
• Humans can also become infected with T. solium eggs due
to poor hygiene (via the fecal-oral route) or ingesting
contaminated food or water.
• Ingested T. solium eggs develop to larvae (called
cysticerci) in various organs of the human body. When they
enter the central nervous system, they can cause
neurological symptoms (neurocysticercosis), including
epileptic seizures.
• T. solium is the cause of 30% of epilepsy cases in many
endemic areas where people and roaming pigs live in close
proximity. In high-risk communities it can be associated
with as many as 70% of epilepsy cases.
• More than 80% of the world's 50 million people who are
affected by epilepsy live in low and lower-middle income
countries
TREATMENT:
Praziquantel (10 mg/kg) or niclosamide (adults and children over 6
years: 2 g, children aged 2–6 years: 1 g).
Albendazole at 400 mg for 3 consecutive days.
Prevention and control
• treatment of human taeniasis;
• intervention in pigs (vaccination plus anthelmintic
treatment);
• Supporting measures:
• community health education, including hygiene and food
safety;
• improved sanitation - ending open defecation (Proper
disposal of human feces)
7.LISTERIOSIS:
Agent: bacteria — Listeria (L. monocytogenes.)
MOT: Foodborne
Sources: deli meat and ready-to-eat meat products (such as cooked,
cured and/or fermented meats and sausages), soft cheeses and cold
smoked fishery products.
Incubation: 2 days to 90 days
Risk individuals:
• 📍Pregnant women — 20x risk
• 📍Elderly
• 📍Individuals with a weakened immune system
• 📍HIV/AIDS — 300x risk
• 📍Leukaemia, cancer, kidney transplant and steroid
therapy
DIAGNOSIS: BLOOD SMEAR and CSF SMEAR
TREATMENT: AMPICILLIN and Penicillin ANTIBIOTIC to prevent
meningitis
Prevention: WHO Five Keys to Safer Food (1. Keep clean. 2.
Separate raw and cooked. 3. Cook thoroughly. 4 Keep food at safe
temperatures. 5. Use safe water and raw materials.)
8. Typhoid fever:
Agent: Salmonella Typhi bacteria
MOT: Foodborne (food or water)
Incubation: 7 to 14 days in average ( Ranging from 3days to 2
months)
Diagnostic test: Widals Test —First serological test used
Typhidot (or Widal Test) is a rapid serological test for the diagnosis
of typhoid fever. Typhidot test is a dot ELISA kit that detects IgM and
IgG
Fact sheet:
• 📍11–20 million people get sick from typhoid and between
128 000 and 161 000 people die from it every year.
• 📍Urbanization and climate change have the potential to
increase the global burden of typhoid.
• 📍Salmonella Typhi lives ONLY in humans.
• 📍Persons with typhoid fever carry the bacteria in their
bloodstream and intestinal tract.
• 📍Typhoid fever can be confirmed through blood testing.
SIGNS AND SYMPTOMS: Prolonged high fever (STEPLADDER
FEVER)
Headache and fatigue
Abdominal pain
Nausea
Diarrhea (child) or Constipation (Adult)
Spots (rash) — ROSE SPOTS (pathognomonic)
Treatment: Antibiotics — Chlorampenicol as first line antibiotic
(fluoroquinolones, newer antibiotics such as cephalosporins and
azithromycin)
Prevention:
• 📍HANDWASHING
• 📍WHO FOOD SAFETY
• 📍TYPHOID VACCINE
• 📍Access to safe water and Adequate sanitation
EMERGENT DISEASE
– Ebola virus disease:
- EVD first appeared in 1976 in 2 simultaneous
outbreaks, one in what is now Nzara, South
Sudan, and the other in Yambuku, DRC.
- The latter occurred in a village near the Ebola
River, from which the disease takes its name.
Agent: Ebola virus (EBV)
Six species: Zaire, Bundibugyo, Sudan, Taï Forest, Reston and
Bombali.
Natural virus hosts/reservoir: FRUIT BATS
MOT: Direct contact
📍close contact with the blood, secretions, organs or other bodily
fluids of infected animals such as fruit bats, chimpanzees, gorillas,
monkeys, forest antelope or porcupines found ill or dead or in the
rainforest.
Incubation period: 2 to 21 days
The 2014–2016 outbreak in West Africa was the largest Ebola
outbreak since the virus was first discovered in 1976.
Signs and Symptoms: Signs and symptoms:

– Fever Asymptomatic
– Fatigue Breathing difficulty (DOB/SOB)
– Muscle pain Cough
– Headache Diarrhea
– Sore throat Episodes of Nausea and vomiting
Fever
– 35% mortality among patients
– This is followed by: – 80% of cases are from Saudi Arabia
– Vomiting – South Korea —largest MERS outbreak outside the
– Diarrhoea Middle East.
– Rash Treatment:
Symptoms of impaired kidney and liver function – NO CURE
In some cases, both internal and external bleeding (for example, – Oxygen therapy and mechanical ventilator
oozing from the gums, or blood in the stools). – Treatment for MERS-CoV focuses on relieving symptoms
and includes rest, fluids, pain relievers and, in severe
Laboratory findings include low white blood cell and platelet counts cases, oxygen therapy.
and elevated liver enzymes.

PREVENTION
Diagnosis:
Minimize close contact to camels and symptomatic person
– antibody-capture enzyme-linked immunosorbent assay Emphasize importance of handwashing at least 20secs.
(ELISA) Report any suspected cases to local health authority
– antigen-capture detection tests Sneezing into a sleeve, flexed elbow, or a tissue
– serum neutralization test
– reverse transcriptase polymerase chain reaction (RT- Cook meats and any food properly
PCR) assay Observe and follow a contact precaution
– electron microscopy Visit a health facility for immediate medical attention for acute
– ·virus isolation by cell culture. respiratory illness

Treatment:
Supportive care - rehydration with oral or intravenous fluids - and
treatment of specific symptoms improves survival.
Two monoclonal antibodies (Inmazeb and Ebanga) were approved
for the treatment of Zaire ebolavirus (Ebolavirus)
Vaccine: Ervebo vaccine, Zabdeno-and-Mvabea
CHRONIC DISEASE
– Tuberculosis / PTB /Koch's disease: 6th leading cause
of morbidity and mortality
Tuberculosis (TB) is caused by bacteria (Mycobacterium
tuberculosis) that most often affect the lungs. Tuberculosis is curable
and preventable.

Robert Koch - founder of modern bacteriology, the scientist who

PREVENTION: discovered agent of TB

Emphasize importance of handwashing discovered the agent causing Cholera, Anthrax and
B urial ceremony is NOT allowed Tuberculosis(1882)
O Utbreak containment measures Causative Agent: Mycobacterium Tuberculosis (BACTERIA)
L aboratory and health workers PPE
Apply STANDARD PRECAUTION to all patients BACTERIA

- Mycobacterium bovis - Deer, cattle, Humans

2.MERS COV: viral respiratory disease caused by a novel
coronavirus - Mycobacterium tuberculosis – Humans ONLY

– ZOONOTIC infection - Mycobacterium avium - Birds

– First identified in Saudi Arabia in April 2012. Incubation period: 2 weeks to 12 weeks
– Major natural reservoir host/source: Dromedary Camels
Mode of transmission: TB bacteria are spread through the air from
Middle East respiratory syndrome coronavirus (MERS-CoV): one person to another. (AIRBORNE)
Agent: MERS Cov of Beta-coronavirus Sign/Symptoms:
MOT: Direct and Indirect contact Cough more than 2 weeks, chest pain, weakness and weight loss
Hemoptysis (blood stained sputum)
Non-human to human transmission
Elevated temperature (low grade afternoon fever)
Incubation: 2 – 14 days (The symptoms usually appear 5–6 days Sweats at night and weight loss
after exposure) Tender and swollen lymph nodes

Diagnosis: polymerase chain reaction tests

TAKE NOTE: The four cardinal signs and symptoms of TB are at
least two weeks duration
of cough, unexplained fever, unexplained weight loss and night Direct Sputum Conventional test that serve as a basis
sweats Smear for the diagnosis of TB cases. (CBQ)
microscopy
(DSSM) Case finding tool for TB(CBQ)
Primary complex – TB of children Definitive test (CONFIRMATORY TEST)
(CBQ)
– Symptoms are weight loss, low appetite, and swollen lymph
nodes in the neck area. (CBQ) SPUTUM COLLECTION:
– Mycobacterium tuberculosis is acquired by the child
through respiratory DROPLETS(CBQ) ▪ Should preferably have 3 specimen, three specimens
• A child may also inhale the bacteria, commonly through are enough to confirm the diagnosis.
close contact. ▪ 2 specimens should be collected spot-spot 1-hour apart
• Remains healthy and usually has NO symptoms. (TB of or spot-early morning collection.
children are hard to detect.) ▪ Collect 3 – 5 ml of sputum (NOT Less than 3 ml) (CBQ)
▪ If TWO (2) of the first three sputum smears are
• Tuberculin skin-testing or Mantoux test is the best way to
positive. (CBQ)
diagnose TB among children
▪ The ONLY contraindication for sputum collection is:
HEMOPTYSIS (CBQ)

SPUTUM COLLECTION:
Days Samples Explanation
o Should preferably have 3 specimen, three specimens are Day 1 Sample 1 (Spot) Patient provides an ‘on the spot’
enough to confirm the diagnosis. sample under supervision.
o 2 specimens should be collected spot-spot 1-hour apart or (Patient is then given the sputum
spot-early morning collection. container to take home for an
o Collect 3 – 5 ml of sputum (NOT Less than 3 ml) (CBQ) early morning sample (sample 2)
o If TWO (2) of the first three sputum smears are positive. for the following day.
(CBQ) Day 2 Sample 2 Patients produces and brings
o The ONLY contraindication for sputum collection is: ‘early morning sample’ to the
HEMOPTYSIS clinic
Sample 3 (Spot) Patient produces another ‘on the
spot’ sample under
supervision
Collection of Sputum Specimens:
SPUTUM
▪ Tell patient NOT to touch inside of the container at any ▪ Sputum is thick and mucoid and comes from the lungs
time. ▪ The color is white to green or bloody.
▪ As soon as you wake up in the morning (before you eat or ▪ Sputum is NOT saliva or nasal secretions which are
drink anything), brush your teeth and rinse your mouth with runny and clear
WATER. Do not use toothpaste or mouthwash.
▪ Take a very deep breath and hold the air for 5 seconds. Patient Instructions for Collection of Sputum Specimens: (CBQ)
Slowly breathe out. Take another deep breath and cough
hard until some sputum comes up into your mouth. 1. Tell patient NOT to touch inside of the container at
▪ Spit the sputum into the plastic tube. any time.
▪ Take another deep breath and cough hard and spit the 2. As soon as you wake up in the morning (before you
sputum into the plastic tube. Keep doing this until the eat or drink anything), brush your teeth and rinse your
mouth with WATER. Do not use toothpaste or
sputum reaches the 5 mL line on the tube. (3mL is the
mouthwash.
minimum volume necessary for this test
3. Take a very deep breath and hold the air for 5
Treatment: TB is a treatable and curable disease. Active, drug- seconds. Slowly breathe out. Take another deep breath
susceptible TB disease is treated with a standard 6-month course and cough hard until some sputum comes up into your
mouth.
of 4 antimicrobial drugs. (CBQ)
4. Spit the sputum into the plastic tube.
Direct Observed Treatment Short Course (DOTS) – 5. Take another deep breath and cough hard and spit the
comprehensive strategy to detect and cure TB patients that was sputum into the plastic tube. Keep doing this until the
sputum reaches the 5 mL line on the tube. (3mL is the
started in the country in year 1996 (FREE drugs)
minimum volume necessary for this test.

Adjuvant diagnostic tools

PULMONARY TUBERCULOSIS DIAGNOSIS: (CBQ)
PRIMARY DIAGNOSTIC TOOL
Xpert MTB/RIF automated molecular assay and rapid
test that detects Mycobacterium
tuberculosis (MTB) and rifampicin
resistance.
Xpert Ultra is a newer generation of Xpert MTB/RIF
assay. Due to its higher sensitivity than
that of Xpert MTB/RIF, specificity is slightly
lower.
TB-LAMP manual molecular assay that can be read
with the naked eye under ultraviolet light to
detect MTB.
Chest X-rays CXR should be performed for all smear-
negative presumptive PTB
CXR can be done in parallel or
sequential to DSSM
useful tools to aid diagnosis of TB when
the TB disease cannot be confirmed with
bacteriological diagnostic tools.
Tuberculin skin Basic screening tool for TB infection
test (TST) among CHILDREN
Mantoux Test Test presence of antibodies (Confirms
exposure)
Read result after 48-72 hours(CBQ)
 Injection of purified protein derivative
(PPD) MDR-TB is treatable and curable by using
second-line drugs.
TAKE NOTE:
▪ Recent BCG vaccination causes
false-positive result
▪ Immunocompromised child,
HIV/AIDS and severely
malnourished child causes false- TB DRUGS SIDE EFFECTS MANAGEMENT
negative result. Rifampicin (R) Severe nausea & Give the
vomiting Rifampicin after
TST positive if Red/orange colored food
urine(CBQ) Reassure patient
▪ In children with it is normal
immunosuppressed conditions, Isoniazid /INH (H) Numbness or tingling Supplement with
such as HIV or severe sensation on the tab. Vit. B6
malnutrition TST result is positive extremities (pyridoxine) at a
if the induration is more than 5 (Peripheral dose of 5 mg
mm neuropathy) daily(CBQ)

▪ In other children regardless of Pyrazinamide/PZA Joint pains Check the dosage

BCG vaccination status, TST (Z) Nausea/vomiting (G.I by weight as it is
result is positive if the induration upset) usually caused by
is more than 10 mm Loss of appetite over-dosage.
Increase uric acid Easily alleviated
with Aspirin
Treatment: WOF!
▪ TB is a treatable and curable disease. Active, drug- Hepatotoxicity
susceptible TB disease is treated with a standard 6-month Yellowish palms –
course of 4 antimicrobial drugs. (CBQ) refer! (CBQ)

Direct Observed Treatment Short Course (DOTS) Ethambutol (E) Optic toxicity Children below 6
▪ comprehensive strategy to detect and cure TB patients that Optic neuropathy years must NOT
was started in the country in year 1996 (FREE drugs) Vision loss be given
(CBQ) Ethambutol due
to the risk of
▪ It has five basic elements damage to the
(a) availability of quality assured Eyes(CBQ)
sputum microscopy
(b) uninterrupted supply of anti-TB Streptomycin (S) Giddiness Reduce dosage
drugs (staggering / loss by one quarter,
(c) supervised treatment of balance) but if it persists for
(d) patient and program monitoring Ototoxicity more than one
(e) political will. ▪ Ringing of week STOP and
ears Refer!
DOTS (Direct Observed Treatment Short Course) (CBQ) (tinnitus)
Category Classification ▪ Hearing DO NOT give
Category I N – NEW smear (+) TB patient(CBQ) loss streptomycin
E – Extensive lesion shown in CXR (-) smear drug to pregnant
patient client it may
W – with Extra pulmonary TB, PLHIV, and damage the ear
severe concomitant disease of baby.

Category II R – remission
E – Extra-pulmonary TB, new (CNS/bones or
joints)
S – sputum smear positive patients who have;
T – treatment failure
A – after treatment interruption.
R – relapse of disease(CBQ)
T – treatment after default/return after default
Category III New smear (-) PTB with minimal lesion shown
on X-ray result.
Category IV Multi drug-resistant TB (MDR)
Chronic TB who are still sputum (+) after
supervised re-treatment.
Needs REFERAL for 2nd line treatment drugs
“Category IV regimens”.
Multidrug-resistant tuberculosis (MDR-TB) is a
form of TB caused by bacteria that do not
respond to isoniazid and rifampicin, the 2
most effective first-line anti-TB drugs.
Drug formulations
1. Fixed–dose combination (FDCs)
▪ Two or more first-line anti-TB drugs are combined in one
tablet.
BLISTER PACKS:
2 drug fixed-dose combination – Rifampicin(R) and Isoniazid (H).
3 drug fixed-dose combination – Rifampicin, Isoniazid and
Ethambutol (CBQ)
4 drug fixed-dose combination – Rifampicin, Isoniazid,
Pyrazinamide and Ethambutol.
2. Single drug formulation (SDF)
▪ Each drug is prepared individually, either as tablet,
capsule, syrup or injectable (Streptomycin) form.
Category Intensive phase
I 2 months (Rifampicin and Isoniazid) (CBQ)
II 2 months RIPES/1 month RIPE
III 2 months RIPE
 Monitoring treatment:
2. Multibacillary Leprosy (MB)
▪ Sputum microscopy: Examine sputum for AFB at ▪ Lepromatous leprosy
specified intervals ▪ Infectious type
▪ Clinical: Conduct clinical assessment including weight ▪ Shows 6 or more lesions, nodules, plaques,
assessment ▪ thickened dermis and involvement of the nasal mucosa.
▪ Drug intake: Assess patient’s records for regularity. ▪ Treated for 12 months to 18months
(Blister packs)
▪ Two sputum smear examinations (taken as two early
morning samples within 2 days)
Signs and Symptom:
• For smear-positive patients:
EARLY signs:
- End of the 2nd month for new cases or 3rd
month for re-treatment cases E – enlarged nerve especially elbow, knee, neck (painful thickened
- End of 5th month nerves) (CBQ)
- End of 7th month
For smear-negative patients only at the end of the 2nd month A – anesthetic (numbness or loss of sensation) (CBQ)

Tuberculosis prevention: (CBQ) R – redness to copper colored skin (skin color changes)
B – BCG vaccination
C – clean and fresh air, Adequate rest and exercise L – loss of muscle strength (muscle weakness)
G – good personal Hygiene, and well balanced diet. Y – you may also find nodules, patches and ulcers that do not heal.
MOST IMPORTANT HEALTH TEACHING: STRICT compliance
to treatment regimen
LATE signs:

G – gynecomastia (enlargement of breast)

M – madarosis (loss of eyebrows)

2.LEPROSY:
I – inability to close eyelids (lagopthalmos)
▪ Leprosy / Hansen's Disease - 1873: Dr. Gerhard Henrik
Armauer Hansen - founded the agent of leprosy. C – crippling/clawing of hands and feet, paralysis, and blindness.
(CBQ)
MUST KNOWS!
S – sinking of nose bridge (saddle nose deformity)
▪ Leprosy is a Neglected Tropical Diseases (NTDs)
▪ The disease mainly affects the skin, the peripheral nerves,
the eyes and mucosa of the upper respiratory tract TAKE NOTE: leonine facies – pathognomonic of leprosy (looks
Causative agent: Mycobacterium leprae (acid-fast, rod-shaped like a lion)
bacillus.) Cardinal signs of leprosy include hypoesthesia, skin lesions, and
Incubation period: Average of 5 years. (3 – 5 years) (CBQ) peripheral neuropathy.
Mode of Transmission: Droplets (from nose and mouth) and
prolonged contact
Prolonged, close contact with someone with untreated leprosy over Treatment: Multi-drug therapy – use of 2 or more drugs renders
many months is needed to catch the disease. (CBQ) patients non-infectious a week after starting treatment.
Reservoir: Humans
Check: LIVER function first.
Diagnosis of leprosy: Skin smears/skin biopsy (CBQ)
MDT:
Skin Slit Smear (SSS) to CONFIRM a diagnosis.
MDT DRUGS: Leprosy is curable with multidrug therapy (MDT).
Specimens and Tests: specimens may be collected:
1. Rifampicin - given once a month.
Skin smears from the earlobes, elbows, and knees
Normal side effect: slightly reddish urine discoloration. (CBQ)
Skin biopsy from edges of active patches

Nerve biopsy from thickened nerves

Acid fast staining: Ziehl-Neelson method using 5% sulphuric acid as
decolorizing agent is used. The presence of acid-fast bacilli confirms
the diagnosis of Hansen’s disease.
2. Clofazimine - most active when administered daily.
Normal side effect: brownish black discoloration and dryness of skin.
Discoloration disappears within few months after stopping treatment.

Types of Leprosy:
1. Paucibacillary leprosy(PB)
▪ Tuberculoid leprosy and intermediate
▪ Non infectious type of leprosy
▪ Less than 5 hypopigmented, anesthetic skin lesions
▪ Treated up to 6 to 9 months
3. Dapsone
This drug is very safe in the dosage used in MDT
Main side effect is allergic reaction, causing itchy skin rashes and
exfoliative dermatitis. DO NOT GIVE to patients known to be allergic
to any sulpha drugs
MUST KNOWS: Agent: RETROVIRUS (HIV)

DOH campaign: “Kilatis Kutis Campaign” Reservoir/host: Humans

Aims to find leprosy cases in high prevalence areas through skin *HIV weakens the immune system,destroying a type of WBC (CD4
consultation. or T-helper cells)

MOT: SEXUAL CONTACT

TAKE NOTE: INCUBATION: seroconverison is 1 to 4 weeks

▪ All patients who have complied w/ MDT are considered
cured and no longer regarded as a case of leprosy, even if
some sequelae of leprosy remain.
▪ Untreated, leprosy can cause progressive and permanent
damage to the skin, nerves, limbs, and eyes. (CBQ)
▪ RA 4073 – An Act further liberalizing the treatment of
leprosy
▪ World Leprosy Day (Every last Sunday of January)
▪ Leprosy Control Week (Every 4th week of February)
▪ National Skin Disease Detection and Prevention Week
(Every 2nd week of November)
AIDS is manifested 2 to 10 years after HIV onset.
Diagnosis
▪ EIA/ELISA — Screening test for HIV antibodies
▪ Western Blot - confirmatory testing for HIV antibodies.
▪ Western blot is the confirming test for people who initially
tested antibody-positive in the screening ELISA test for
HIV.
▪ The Western blot test is unlikely to generate a false-
positive result.
▪ This will be used to confirm or refute the ELISA test results

3. HIV/AIDS:
▪ HIV (human immunodeficiency virus) is a virus that attacks
the body’s immune system. If HIV is not treated, it can lead
to AIDS (acquired immunodeficiency syndrome).
▪ There is currently no effective cure. Once people get
HIV, they have it for life.
▪ But with proper medical care, HIV can be controlled.
People with HIV who get effective HIV treatment can live
long, healthy lives and protect their partners
Note: it is the HIV ANTIBODIES being tested not the actual virus
itself
CD4 CELL COUNT:
▪ A normal CD4 count is from 500 to 1,400 or 500 to 1500
cells per cubic millimeter of blood. CD4 counts decrease
over time in persons who are not receiving ART.
▪ Less than 200 cells/mm³ is AIDS
MODE of Transmission:

A — Anal sex ( male to male sex contact) ‐ 84%

HIV HISTORY:

▪ HIV infection in humans came from a type of chimpanzee V — Vaginal sex (male to female)
in Central Africa. O— Oral sex
▪ The chimpanzee version of the virus (called simian
immunodeficiency virus, or SIV) was probably passed to N — Needles (sharing and pricks) — 4%
humans when humans hunted these chimpanzees for meat
and came in contact with their infected blood.
▪ Studies show that HIV may have jumped from 20% – OFW
chimpanzees to humans as far back as the late 1800s.
MAJORITY is male.

▪ Formerly known as "4H disease", as the syndrome seemed

to affect heroin users, homosexuals, hemophiliacs,
and Haitians.
▪ The term GRID, which stood for gay-related immune
deficiency, had also been coined
▪ the term AIDS was introduced at a meeting in July 1982.
▪ By September 1982 the CDC started referring to the
disease as AIDS.
MODE of Transmission:
PREGNANCY (vertical transmission)
— results to spontaneous abortion (repeated abortion), stillbirth and
prematurity, perinatal and infant mortality, intrauterine growth
retardation, low birth weight, chorioamnionitis, and mild weight loss.
HIV do not cause INFERTILITY

HIV in Philippines: POSTNATAL HIV transmission is through HIV-contaminated

breast milk.
▪ First HIV case in the Philipines was reported in January
1984
▪ Philippines has one of the lowest rate of infection but has
the FASTEST growing number of cases worldwide. HOT SPOTS:
▪ RA 11166 — Philippine HIV/AIDS Policy Act of 2018,
1. NCR (MSM)
making health services for HIV/AIDS more accessible yo
2. Region IV–A (needles)
Filipinos
3. Central Visayas
▪ RA 8504 — Philippine AIDS prevention and Control Act of
4. Region 3 (Female sex work)
1998
5. Region 11
HIV Signs and Symptoms:
INITIAL: flu-like symptoms within 2 to 4 weeks after infection
(called acute HIV infection).
▪ Fever,
▪ Chills,
▪ Rash,
▪ Night sweats,
▪ Muscle aches,
▪ Sore throat,
▪ Fatigue,
▪ Swollen lymph nodes, and
▪ Mouth ulcers.
Stage 1: Acute HIV Infection
▪ People have a large amount of HIV in their blood. They are
very contagious.
▪ Some people have flu-like symptoms. This is the body’s
natural response to infection.
▪ Fever, Chills, Headache, Rash, Night sweats, Muscle
aches, Sore throat, Fatigue, and Swollen lymph nodes.
▪ Peripheral nervous system manifestations are common
in HIV-infected patients. Sensory neuropathies with
manifestations of numbness, tingling, and pain in the
lower extremities affect about 30% of patients with AIDS.
Stage 2: Chronic HIV Infection
▪ This stage is also called asymptomatic HIV infection or
clinical latency.
▪ HIV is still active but reproduces at very low levels.
▪ People may not have any symptoms or get sick during this
phase.
▪ Without taking HIV medicine, this period may last a decade
or longer, but some may progress faster.
▪ People can transmit HIV in this phase.
▪ At the end of this phase, the amount of HIV in the blood
(called viral load) goes up and the CD4 cell count goes
down. The person may have symptoms as the virus levels
increase in the body, and the person moves into Stage 3.
▪ People who take HIV medicine as prescribed may never
move into Stage 3.
Stage 3: Acquired Immunodeficiency Syndrome (AIDS):
▪ The most severe phase of HIV infection.
▪ People with AIDS have such badly damaged immune
systems that they get an increasing number of severe
illnesses, called opportunistic infections.
▪ People receive an AIDS diagnosis when their CD4 cell
count drops below 200 cells/mm, or if they develop
certain opportunistic infections.
▪ People with AIDS can have a high viral load and be very
infectious.
▪ Without treatment, people with AIDS typically survive
about three years.
HIV/AIDS:
▪ Tuberculosis ”co-infection” is one of the leading causes
of sickness and death in those with HIV/AIDS being
present in a third of all HIV-infected people and causing
25% of HIV-related deaths.
▪ HIV is also one of the most important risk factors for
tuberculosis.
▪ Hepatitis C is another very common co-infection where
each disease increases the progression of the other.
▪ The two most common cancers associated with
HIV/AIDS are Kaposi's sarcoma and AIDS-
related non-Hodgkin's lymphoma
Treatment:
▪ Cachexia — HIV wasting syndrome, give Megestrol
acetate
▪ HIV ART — Zidovudine, lamivudine,nevirapine
▪ Antiretroviral drugs DOES NOT kill the virus that
causes the disease. It simply helps to fight infection
and prolongs life of patient even with the disease.
▪ Efavirenz should be avoided in pregnants
▪ Truvada and Descovy is used as PrEP (Pre Exposure
Prophylaxis)
WORLD HIV/AIDS DAY – December 1
International Candlelight Memorial happens every third Sunday
of May each year to commemorate people who have lost their lives
with HIV and celebrate the great strides the community has done
over the years for the HIV community.
PREVENTION
The key to prevent HIV is ABCDE which stands for
A – Abstinence
B - be mutually faithful with you partner
C - consistent and correct use of condoms (latex)
D - Don't use drugs and early detection
E – Education, educate self and others
COPAR
Community Organizing Participatory Action Research
(COPAR)
COPAR
▪ is a CONTINUOUS AND DYNAMIC PROCESS of
encouraging people to UNDERSTAND/DEVELOP
THEIR AWARENESSof their existing conditions by
providing the skills, capability training, and working
with the people collectively and efficiently on their
problems. – (CBQ)
▪ A social development approach that aims TO
TRANSFORM the Apathetic, individualistic,
voiceless poor INTODYNAMIC, PARTICIPATORY
and politically responsive community. (Turning a
passive to ACTIVE community)
TAKE NOTE: The COMMUNITY is NOT considered as
subjects of research they are considered as participants
orCO–RESEARCHERS – (CBQ)
IMPORTANCE OF COPAR
S – self reliance by preparing people to manage a
development program in the future.
A – active community participation and
involvement is maximized
M – mobilized community resources for community
services.
E – empowerment of the people and community
development
PRINCIPLES OF COPAR
P – people’s participation should always be present
(CBQ)
O – oppressed and exploited sectors are most
open to change.
W – with COPAR it should lead to self – reliant
community and society. (CBQ)
E – empowerment – Power must reside in the
people
 R – remember, COPAR should be for the interest
of the poorest sectors of the society.
Saul Alinsky – Father of Community Organizing
PHASES OF COPAR
I. Pre-entry Phase (1-2 months)
▪ Initial phase of the organizing process
▪ Looking for communities to serve or help. (Area
selection)(CBQ)
▪ Simplest phase
F – formulation of objectives and targets for the
program
I – institutional goals
R – revision of curriculum
S – seek and coordinate participation of other
departments within the institution.
T – training of faculty in CO-PAR
A – at the community level: encourage dialogues
with the people
C – criteria for site selection development
T – the ACTUAL SITE SECTION (CBQ)
I – initial or preliminary social investigation (PSI)
O – ocular survey noting accessibility, geography,
terrain, and available resources. (CBQ)
N – networking with LGUs and NGOs and other
department
5 activities of the pre entry phase.
A – area selection
C – courtesy call to the mayor
T – train students on baseline survey
I – interview
O – ocular survey
N – networking with other departments
Criteria for site selection(CBQ)
D – depressed and exploited rural community
E – ensure acceptance (No strong resistance from
the people)
P – poor
R – residents - 100-200 families
E – economically depressed
S – safe ( No serious peace and order problem)
S – shows high morbidity and infant mortality
cases.
E – ensure NO similar agency holding same
program
D – DO NOT have BHS or nearby hospital
II. Entry Phase
P – phase for “Social Preparation” (CBQ)
A – actual entry of the nurse or community
organizer into the community. (CBQ)
S – sensitization of the people on the critical events
in their life
O – organizer motivates the people to share their
dreams and ideas.
K – known also as the MOST CRUCIAL phase.
(CBQ)
GUIDELINES FOR ENTRY INTO THE COMMUNITY
P – pay courtesy call upon entry to the community to the
local authorities (Barangay Officials) (CBQ)
L – let them know your projects objectives
E – ensure to be a ROLE MODEL
A – avoid raising expectations/consciousness of the
community residents
S – speech, behavior and lifestyle should be in keeping with
those of the community residents
E – ensure to adopt a low key profile
1-Immersion/integration/sensitization with the community
▪ Establish rapport(CBQ)
▪ Converse with people in their usual
gatherings/area of congregation
▪ Living with the community
▪ Information Campaign on health programs
▪ Participate in livelihood activities.
▪ Support and lend hand in household chores
▪ Ensure to be a role model, AVOID gambling and
drinking alcohol
2. Deepening social investigation
3. Potential leader spotting
Leader spotting through sociogram.
A. Key Persons - approached by most
people
B. Opinion Leader - approached by key
persons
C. Isolates - Never or hardly consulted
Criteria for a potential leader
L – low profile
E – education: at least basic
primary education
A – approachable /respected by
both formal & informal sectors
D – develops a good
communication skill
S – serve willfully. (CBQ)
4. Core group (CG) formation
5. Self Awareness and Leadership Training (SALT)
III. Community Study/ Diagnosis Phase (Research
Phase)
Selection of the research team
Training of researchers on data collection(CBQ)
Planning for the actual gathering of data
Data gathering
Training on data validation
Community validation
Presentation of the community study/ diagnosis
and recommendations
Prioritization of community needs/ problems for
action
Methods of data selection
S urvey - most practical ( using
questionnaires)
I nterview - face to face ( using interview
guide) (CBQ)
R ecord review ( checklist)
C ensus – MOST IDEAL ( provides
BIGGEST BULK of data)
O bservation - occular surveys
CENSUS
▪ De facto - ACTUAL place (
individuals are recorded to the
geological area where they were
present at a specific time.)
▪ De jure - RESIDENCY (individuals
are recorded by their place of
residence-"usual residence"-the place
where a person lives and sleeps most
of the time)
IV. Community Organization and Capability Building
Phase
E lection of officers and delineation of roles and
task
L eaders or groups are being given trainings
(formal, informal, OJT)
E ntails the formation of more formal structures
C ommunity meetings to draw up guidelines for the
organization
T eam building Exercises
TAKE NOTE: A-R-A-S (Action- Reflection- Action-Session)
V. Community Action Phase
Organization and training of (BHWs)
PIME of health services(Project Implementation
Monitoring and Evaluation)
Resource mobilization
Setting up of linkages/ network/ referral systems
VI. Sustenance and Strengthening Phase(7-8 months)
▪ Occurs when the community organization has
already been established and the community
 members already actively participating in
community wide undertaking. (CBQ)
Formulation and ratification of constitution and by-laws
Identification and development of " secondary" leaders.
(CBQ)
Setting up of a financing scheme an implementation of
livelihood projects
Training and continuing education of BHW (CBQ)
TAKE NOTE: Formalize linkages, networks and referral
systems then register organization to S.E.C.(Security and
Exchange Commission)
7. Phase Out phase
▪ Gradual turn over of works
▪ Transfer of Community Organizing roles and
responsibilities and documents to the organization
▪ Follow up
FAMILY
▪ The UNIT OF SERVICE in the community (CBQ)
▪ is a small social system (2) or more people living
together who are related by blood, marriage,
adoption, or by arrangement over a period of time.
BEST definition of family: A group of people who live
together.(CBQ)
Genogram
▪ displays pertinent family information in a family tree
format, the family can see the family structure, its
members and their RELATIONSHIPS. (CBQ)
▪ diagram of family relationships
Ecomap
▪ Used to identify family relationships between
members of the community. (CBQ)
Pedigree chart
▪ Chart/diagram of the GENETIC HISTORY of a
family over several generations(CBQ)
CLASSIFICATION OF FAMILIES
1. Nuclear family – TRADITIONAL type, consists of
husband and wife (and perhaps one or more children).
2. Extended family – includes relatives (aunts, uncles,
grandparents, and cousins)
3. Single-parent family – consist of one parent and
children
4. Blended family- married couple, their children and their
children from previous marriages
5. Alternative family – Relationships include multiadult
households, "skip-generation" families (grandparents caring
for grandchildren), communal groups with children,
"nonfamilies" (adults living alone), cohabitating partners,
and homosexual couples.
6. Beanpole - Family comprised of 4 or more generations
7. Same Sex/Homosexual – Family comprised of
Gay/Lesbian partner w/ adopted/biological child
8. Communal – Unrelated individual/family in one roof
AUTHORITY:
▪ Patrifocal/Patriarchal – Father has main
authority
▪ Matrifocal/Matriarchal – Mother has
main authority
▪ Egalitarian – Equal authority of both
parents
▪ Matricentric - Prolonged absence of
father (OFW), Mother gets the dominant
power
LOCALITY:
▪ Patrilocal – Newly wed living nearby
father's side
▪ Matrilocal – Newly wed living near
mother's side
▪ Bilocal – Newly wed living near both side
FAMILY CARE PLAN
▪ blueprint of the care to the family
First Level Assessment
1. Health Deficits – FAILURE in health maintenance (
disease, disorders and disability)
Score: 3
Disease/ illness – hypertension, DM, heart
diseases, URTI, marasmus, scabies (CBQ)
Disabilities – deaf, mute, blind, polio, stroked
patient with paralysis.
Disorders – problems like mental retardation, down
syndrome (CBQ)
2. Health Threat – conditions conducive to disease,
accidents or failure to realize one’s health potential.
(Score:2)
B roken glasses and scattered sharp objects
A bsence or lack of prenatal visits or clinic
visits(CBQ)
S afety hazards: fires, falls and accident
U nhealthy lifestyle – faulty eating, sedentary
R odents and insects
A bsence or lack of immunization
S anitation issues and family history of diseases.
3. Stress Points/ Foreseeable Crisis(CBQ)
▪ anticipated periods of UNUSUAL DEMAND on
individual or family in terms of adjustment or family
resources (SCORE: 1)
Pregnancy
Abortion
Parenthood
Additional family member (Newborn) (CBQ)
Income loss (loss of job) (CBQ)
Separation or break ups and courtship
Divorce and annulment
Entrance in school(CBQ)
Adolescence (circumcision, menarche, puberty.)
Death of love ones.
PRIORITIZING HEALTH PROBLEMS
NATURE OF THE PROBLEM – health deficit, health threat
and foreseeable crisis
▪ Health deficit 3
▪ Health threat 2
▪ Foreseeable crisis 1
MODIFIABILITY OF THE PROBLEM –the PROBABILITY
OF SUCCESS of success in minimizing, alleviating or totally
eradicating the problem through intervention (CBQ)
▪ Easily modifiable 2
▪ Partially modifiable 1
▪ Not modifiable 0
PREVENTIVE POTENTIAL –refers to the nature and
MAGNITUDE of future problems that can be minimized or
totally prevented if intervention is done on the problem
under consideration
▪ High 3
▪ Moderate 2
▪ Low 1
SALIENCE – refers to the family’s PERCEPTION and
evaluation of the problem in terms of
seriousness and urgency of attention needed (CBQ)
▪ A serious problem, immediate attention
needed – 2
▪ A problem, not needing immediate attention –
1
▪ NOT seen as a problem – 0
CHN PROCEDURES
CLINIC VISIT steps - patient or family visits the health
center
I. Admission/Registration – initial and FIRST
ACTION in clinic visit.(CBQ)
▪ Greet and welcome clients (CBQ)
▪ Prepare the individual or family treatment
record
II. Waiting time – 1st come, 1st serve basis
III. Triaging
IV. Clinical evaluation
V. Laboratory test and other Diagnostic
examinations
VI. Referral-2-way referral system
VII. Prescription and Dispensing
VIII. Health education – LAST step of clinic visit
(CBQ)
HOME VISIT
▪ a nurse –family contact which allows
the health worker to assess the home
and family situations in order to
provide the necessary nursing care
and health related activities
ADVANTAGE OF HOME VISIT: provides opportunity to do
FIRST HAND APPRAISAL of the home situation(CBQ)
PURPOSES OF A HOME VISIT:
H – health care provider gives nursing care to the
sick, postpartum and her newborn.
O – observation and assessment of living condition
and family health practices.
M – may establish relationship between agencies
and the public for heath promotion.
E – educate the family regarding health promotion
and disease prevention.
PRINCIPLES OF A HOME VISIT
M – must “HAVE”a purpose or objective
U – use all available information about the patient
and his family
S – set and give priority TO the essential needs of
the FAMILY
T – the planning and deliveryMUST INVOLVEthe
individual and his family.
TAKE NOTE: Home visit must be FLEXIBLE
STEPS IN CONDUCTING HOME VISIT
1. Greet client and introduce self and ESTABLISH
RAPPORT (FIRST STEP) (CBQ)
2. State the purpose and objective of the visit
3. Assess health needs
4. Perform bag technique (Bag placement)
5. Physical examination and nursing care
6. Impart Health teaching
7. Record all data and observations
8. Appointment
PHN BAG- essential and indispensable equipment of a
PHN
IMPORTANT POINTS TO REMEMBER: 4 C’s + H
COMPLETE – contains all the necessary articles,
supplies and equipment.
CLEAN – Cleaned very often, supplies replaced
and ready for use anytime.
CONTAMINATION – bag contents are clean and
sterile, while articles belonging to
the patient as dirty and contaminated. (CBQ)
CONVENIENCE - collection of article should be
convenient to the user.
▪ Solutions like 70% alcohol, hydrogen
peroxide and betadine are placed at
the BACK of the bag (CBQ)
▪ Oral and rectal thermometers ,
syringes and needles should be
placed at the FRONT of the
bag(Thermometers should be
facing DOWN.)
Handwashing is done as frequently as situation
for, helps minimizing and
avoiding contamination of the bag and its contents.
(CBQ)
BAG TECHNIQUE
▪ A “TOOL” making use of a public health bag
through which the nurse, during his/her visit, can
perform nursing procedures with ease and
deftness, saving time and effort with the end in
view of rendering effective nursing care
PRINCIPLES OF BAG TECHNIQUE:
1. MINIMIZE, if NOT prevent the spread of any
infections. (Most important) (CBQ)
2. Saves time and effort in the performance of
nursing procedure.
3. Show the effectiveness of total care of the
individual and the family.
4. Variety of ways should be performed depending
on the agency’s policy.
COMMON BOARD QUESTIONS:
▪ Upon arriving at the clients home, place the bag on
the table or any flat surface lined with paper lining,
clean side out (folded part touching the table).
▪ Place the linen/plastic lining spread over work field
or area CLEAN SIDE OUT
▪ LAST item place back in bag is the
PLASTIC/PAPER LINING (CBQ)
▪ Sphygmomanometer (BP cuff) and stethoscope
is NOT included inside the bag(CBQ)
▪ DO NOT USE NEWSPAPERS only clean papers
as linings.
▪ FIRST thing you get from the CHN bag – soap in
a soap dish and hand towel
▪ AVOID frequent opening of the bag. (CBQ)
▪ Avoid shaking or swaying the bag when
carrying it.
▪ Bag technique shouldn't overshadow but rather
show the effectiveness of the total care given to the
individual and family.
ISOLATION TECHNIQUE IN THE HOME
CONSIDERATIONS:
1. Articles used by the patient should NOT be mixed with
the articles used by
other family members.
2. Frequent hand washing and disinfection of the room
are imperative and room exposure to sunlight.
3. Health provider should use PPE (gown and mask) and
should be used ONLY within the room.
4. Properly discard all used tissue paper with nasal and
throat discharges
5. Soiled articles with discharges should be boiled for 30
minutes before washing.
Demography is concerned with the study of population.
Demographic profile:
▪ Size, distribution, composition, and change in
population. (CBQ)
Philippine census is done every 5 years(CBQ)
Based on the 2017 demography report (JULY 2016
estimate), the Philippine population has reached: 102
Million (CBQ)
Demographic variables in population growth includes:
FERTILITY, MORTALITY and MIGRATION
TAKE NOTE: MORBIDITY is NOT included as
demographic variable. (CBQ)
Median age:2018 estimate: 23.7 years2020: 25. 7 years
Life expectancy: 2018 estimate: 69.6 years
Population structure is a diagram of
population typically presented in a
pyramid-like style format based on AGE
AND SEX (CBQ)
Aging population
 ▪ refers to a phenomenon in which the median age
of the population in a country rises significantly
compared to the total population in a country rises
significantly compared to the total population. This
is caused by any or combination of the following:
(CBQ)
A declining birth rate.
Rising life expectancy. .
Decreased fertility.

Situation – The public health nurse must have an

understanding of demography which should support health
care plan.

1. Demography is concerned with the study of population.

Which of the following are included in demographic profile?
A. Size, composition, health status, and environment.
B. Change in population, distribution, and health status.
C. Size, distribution, composition, and change in
population.
D. Size, distribution, and composition.

2. Based on the 2017 demography report (July 2016

estimate), the Philippine population has reached:
A. 140 million B. 120 million C. 102
million D. 85 million

3. There are three demographic variables in population

growth. Which one is NOT included?
A. Fertility B. Migration C. Morbidity
D. Mortality

4. Population structure is a diagram of population typically

presented in a pyramid-like style format based on
___________.
A. Sex and educational attainment C. Age
and civil status
B. Age and fertility D. Age
and sex

5. An aging population refers to a phenomenon in which the

median age of the population in a country rises significantly
compared to the total population in a country rises
significantly compared to the total population. This is caused
by any or combination of the following:
1. A declining birth rate. 4. Increased
child survival.
2. Rising life expectancy. 5. Better
health.
3. Decreased fertility.
A. 1, 2, 3 and 4. B. 1, 2, 4 and 5. C. 1, 2 and 3
D. 1, 2, 3, 4 and 5.