Golden Notes for Preventive and Social Medicine

192
Doses of DPTI
Table 1: Rare serious adverse events. Doses of measles
administered vaccine administer
Vaccine Reaction
Doses of fDPTI
BCG Suppurative lymphadenitis, BCG
administered
osteitis, disseminated BCG infection

Hepatitis B Guillain-Barne syndrome (plasma ICold Chain

derived), anaphylaxis
Cold chain is a systemof storage and
Measles Febrile seizures, anaphylaxis, of the vaccines at tran
thrombocytopenia recommended tem
from the point of manufacture to
OPV Vaccine-associated paralytic polio (FMg. 2).
the pontratu
Tetanus Brachial neuritis, thrombocytopenla
The essential elements of the cold chain
DPT Persistent (>3 hours) inconsolable Cold chain handlers ar
screaming, seizures
Hypotonic hyporesponsive episode
Equipment for storage and transprtsi va
(HHE), Anaphylaxis/shock
Maintenance of the equipment
Encephalopathy
Timely sharing of information
rezardi
dispatch of vaccines and expected reach
reaction to previous dose. Monitoring8 time
Two types of cold chain equipment
Immunization Services electrical and nonelectrical.
is
available
Utilization Indicators
DPTI-DPT3 dropout rate: Electrical Cold Chain Equipment
Doses of DPT1
administered
Doses of DPT3 Walk-In-Freezers (WIF)
administered x 100 Use: Storage of
OPV vaccines
Doses of DPT1 administered and tor
tree
of icepacks.
DPTI-measles dropout rate: It maintains a
temperature
of -15 to -25C.
It is available in two sizes of
40 Cu. Mt.
16.5. 20. 3. ind

Vaccine Air transport

manufacturer (+2° to 8°C Primary store
and -15C (GMSD and/state Refrigerated/
insulated van
State store Insulaed 3

WIC (+2° to 8°C) and (+2' to 3C are

WIC (+2° to
to -25°C)
and WIF
8°C) (+2 to 8°C and WIF (-15" to -25 C) -15
(-15° to -15° to -25°C)
25°C)

Mother and
child Subcenter
session sites Vaccine
carrier (+2 Primary health Insulated van
District vaccine

to 8°C) center Store

ILR +2° to 8°C (+2° to 8°C) a
all vaccines
and ILR (+2° to C
in ILR DF(-15 to-25u

Fig. 2: Cold chain system

 Spots

ik oolers (WIC) 193

Bulk storage of vaccines at state and
Nonelectrical
Equipment
Cold Chain
CgiOnal stores.

maintain a temperature of +2°C to +8° Cold Boxes

F stores three months of require- .It maintains a
fvaCcines+25%bufferstock. It is temperature of 2 to 8°C.
available in two sizes: 5 1. and
capacity. 20 L
It isuseful for
D e c pF r e e z e r s
transportation of vaccines from
district store to
and small. the PHC and also
Kwa u1odels are available, large store vaccines as well as
useful to
is maintained frozen ice in packs
ihe cabinet temperature
eween -15°-25°C.
emergency.
Conditioned ice packs should be
time: At 43°C for 22 H, At 32°C for placed before
ld
Hold
over
loading the vaccines in cartons or
polythene
6 H. bags.
at district headquarters: Use for
Dep freezers
OPV vaccines and preparation of Cold box (large)
storage of
Hold over time: At 43°Cfor 96 hours (minimum)
icepacks.
at PHC headquarters: Use for Storage capacity: 20 to 25 liters
Deep freezers
packs only (20-25 ice packs
preparation of ice Cold box (small)
140 L DF in o n e day).
can be prepared by Hold over time: At 43°C for 48 hours (minimum)
Deep freeze (large) Storage capacity: 5 to 8 liters
275 to 300 liters
Storage capacity:
Deep freeze (small)
105 to 125 liters.
Vaccine Carriers
Storage capacity:
It maintains a temperature of2 to 8°C.
It can store vaccine for 12 hours
e Lined Refrigerator (ILR) It requires for 4 ice packs.
to 8°C. vials of vaccines
I t maintains a temperature of 2 It is useful for carrying 16-20
tubes filled or to villages.
I t contains lining of ice packs or and diluents to subcenters
ILR is
with water which freezes when the
operating. 8
Day Carrier
vaccines safe with as little as
LR can keep 6-8 vial (small quantities of
hours electricity supply in a 24-hour period. It is useful to carry
vaccine) for few hours
All vaccines along with diluents are placed in
ice packs.
the basket of the ILR. It requires two
to
Equence of storing vaccine from bottom
top as-OPV, measles, BCG and JE, rota, TT, Ice Packs
containers filled with
DPT and IPV, pentavalent, Hep B are plastic
Ice packs
in that
' Athermometer should also be placed in
water be stacked
eriss-crossed

same the basket. should

Ice packs
Two types available: DF horizontally and TT
1. ILR (large);: DT, hepatitis B
DPT,
The vials of placed in
direct
contact

over time: At 43°C for

22h, at 32°C should not
be
Hold vaccines
ice packs.
for 26h with
conditioned

capacity: 135 to 160 liters

2. ILR Orage
(small):
Thermometers
At 32°C
Hold over time: At 43°C for 68h,
Dial thermometers

for 72h A l c o h o l s t e m t h e r m o m e t e r s

torage capacity: 90 to 105 liters

 Medicine
Preventive and Social
Golden Notes for

194 Reconstituted BCG and measles

Aicoholic
thermometers are

record
more com
tempera
should not be used after
they
vaccines
hours
live
monly used as they
can
reconstitution
do not contain a
as are
preservative Ccines,
te
of
the
fures from +
50°C to 50°C.
freezers.
It is placed in
ILRs and deep contamination with Staphylococre even
accurate
more
thermometers are (Staphylococcus aureus is the cause
Alcohol

and sensitive than dial

thermometers.
shock syndrome). i toxie
records the
Designate a staff member Store the diluents, between +2 and
temperature twice a day

period the equipment

remains
diluents are supplied
be stored outside the cold
separately, these Can
Doun time It is the chain, but
out of service cooled least a day before use to
at be must
between reporting
ensure thae
The time taken vaccine and diluent are at +2 and +g O P Y J L O

Response time: . when

and correction of the being reconstituted. Otherwise, it can le
the defect in the equipment Fig
team.
defect by the mechanical to thermal shock, i.e., it can result in death
the proportion of cold some or all of the essential live organisms in
Cold chain sickness rate: It is
out of order at any point
of time.
chain equipment the vaccine.
to
Sickness reporting: Reporting system helps
reduce the "down time" of the equipment. It Conditioning Ice Packs Table 3 : AArrm

is desirable for efficient

that the
maintenance

"who wants the When ice packs are removed from a freezera
reporting should be direct from
Freezer

service" to "who will provide the service". -25°C they need to be kept at room temperaure
Chiller

Hold-over time is defined as the "time taken by the to allow the temperature of the ice at the core
of the ice pack to rise to 0°C. This processis Topmost se
equipment to raise the inside cabinet temperature
from its temperature at the time of power cut, to called "conditioning'. Middle self
maximum temperature limit of its recommended Conditioning of ice packs can be assessed by
looking at beads of water over surface of ice Lower most
range.
packs or by shaking the ice pack to listen the
Baskets
Vaccine Sensitivities and Storage sound of water (Fig. 4)
Door
Temperatures
Always store the "T-series' (Hepatitis B, JE,
Vaccine Vial Monitor
A vaccine vial monitor (VVM) is a label ihat
DPT, DT, and TT) vaccines (DTP, DT, TT)
vaccine between +2° and +8°C as they are changes colour when
the vaccine vial has been
damaged by freezing. exposed to heat over a period oftime and

Table 2: Thermosensitivity of vaccines.

Heat sensitive
Freeze sensitive
BCG after reconstitution (Most sensitive) Most Most
.OPV, Rota vaccine Hepatitis B (most sensitive)
IPV PCV
.Measles, MR (both before and after Pentavalent
JE (both reconstitution) IPV
DPT
before and
after reconstitution) DPT
BCG before reconstitution Td
Td Least

Penta, hepatitis B, PCV

Least
Lightsensitivity: BCG, MR
 Divents
invemts r e n t s

Mep
Hep Hep
Hope
- Rurneed viels

2 D
IPV
rste
eonteiner

Rot ReteRota Rota

cG e G
eCG

]OFVJIOPV
Il OPV PV
}OPV

PV
vaccine arrangements. Fig. 4: Placement of vaccines over the ice pack during
ILR
Fig. 3: outreach immunization session site.
Note: In well reconstituted BCG, MR/Measles while over
the ice pack OPV, JE and Rotavirus.

of vaccines and ice packs in the domestic refrigerator

3:Arrangements
oble
Keep ice packs for freezing. Leave space between ice packs for air circulation
No vaccine.
2ZET
chiller tray empty/remove from refrigerator
No vaccines. Keep
OPV, measles, BCG
p mostself ***

ddle self DPT,TT

Oermost self
Hepatitis B
the field
which have been returned from
No vaccines. Only melted ice packs
3askets
No vaccine. Only diluents
Door

VVM

VVM

Vial of freeze-dried
Ampoule of freeze-dried
vaccine
vaccine

VVM
vaccine
Vial of liquid

Fig. 5A
 Preventive and Social Medicine
Golden Notes for
196
Do not use
Use

O Square is
lighter than
outer circle

The color of the inner square of

the VVMs begins with a shade that
Is ighter than outer circle and
Discard point
Square
matches
circle
Square is
darker
than circle

Once a vaccine has reached or

the discard point, the color of theexceeded
will be the Same color or
inner
square darker
Continues to darken with than the outer circle
time and/or exposure to heat
Inform your supervisor

Cumulative heat exposure over time

Fig.5B
Figs.5A and B: Vaccine vial monitor.

ensure that heat damaged vaccines are not On

administered.
being frozen, the formed flakes will be
It is
gradually settled to the bottom after the vialis
a
temperature monitoring device. shaken (Figs. 6A and B).
There are currently four
types of VVM, chosen
to match the heat
sensitivity of the vaccine. Procedure
These four types are VVM2,
VVM7, VVM14 Test vial: Suspected vaccine vial that may
and VVM30. The VVM number have
is the time in
days that it takes for the inner square to reach been frozen.
the colour
indicating a discard point, if the vial Control vial: Vaccine vial of the same
anagen
is
exposed to a constant temperature of 37°C Same manufacturer, and same bateh mumbet
(Fig. 58). as the suspect vaccine vial
It does not Freeze control vial at -20°C
measure
exposure to
freezing overnight in the
temperature deep freeze.
VVM are kept at different
of vaccine which is
locations based on
type Vigorously shake the vials for 10-15 secondsD
shown here in this holding the control and the test vials togetne
5A) image (Fig.
between thumb and forefinger.
Place both vials on a flat surtace, and serve
The Shake Test
them for 30 minutes.
It is
designed to determine whether T series Sack test passed: If the sedimentation ravial
(DPT, DT, TT hepatitis B) vaccines have
or the "Test vial" is slower than in the
been froen in the cold
chain or not.
"FroZen
Shack test failed: If the sedimentationrate
Shake Test is not vial
applicable for lPV
Once the vaccine is
similar in both vials or faster in the
ine s
frozen, it needs to be than in the "Frozen" vial. It means vace
discarded.
damaged. Do NOT use.
 Test vial
Control vial
Control vial Test vial

Sedimentation
Figs. 6A and B: Shake test. (A) Shake test: Passed vaccine usable
(B) Shake test: Failed Do not use vaccine/Discard vaccine.

Messages
to the Care- Bibliography
Four Key Immunization Health
for
giverafter Vaccination 1. FAQs on
worker,2017,Ministry of Health and Family
and what disease
was given Welfare, Government of India.
What vaccine m e a s l e s vaccine
prevents 2. Handbook for Vaccine & Cold
Chain Handlers,
(e.g, Welfare India
it prevents 2016, Ministry of Health and Family
Handbook for Medical Officers,
measles)? 3. Immunization
come for the next
visit?
2017, Ministryof Health and Family Welfare,
When to how to
side effects and New Delhi, India.
the minor for Medical Officers,
What are 4. Immunization Handbook
Welfare,
deal with them? of Health and Family
bring 3rd edn, Ministry
card safe and to
To keep the
vaccination
New Delhi, India; 2016.
next visit.
it along for the
 Medicine
Preventive
and Social
Notes
for
Golden

198

iti.
Contd..
Mechanism of
Instruction Failure rate Remarks Images
Method action
Type There is a chance of Uterus
Prevent semen It should be 6-12/100 Contraceotive
Diaphragm/ Barrier
inserted before women toxic shock syndrome jeity Cervicai
Cervical cap methods, being deposited if diaphragm is left in cap
in vagina sexual inter years
(Physical vagina for a long period
methods) course. Spermi-
cidal jelly is to be
filled into it before Cerical
insertion. It must cap
remain in place
for more than 6
hours after course
Trade name "TODAY"
The sponge is 9-20/100
Vaginal sponge Barrier . I trelease women
used with spermicidal
spermicide moistened with
methods, years in nonoxynol-9
during coitus water, squeezed
(Physical and inserted high nulliparous
methods) It absorbs
and 20-40
ejaculate in vagina
in parous
it blocks the
women
entrance to
the cervical
canal

Sperm

Contu..
 Mechanism of
Type Method action Instruction Failure rate Remarks images
IUCD Intrauterine Impair viability Ideal timing: CUT 200: 1st generation: lippes
devices of gamete and Within 10 days 1-5/100 loop,
may have thus reduce of menstruation women 2nd generation: Cu T 380
all types of the chances of period or years, A (effective for 10 years),
mechanism, fertilization. immediately CuT 380-A: CuT 375 (effective for 5
such as Cu ion alter the after delivery of 0.6-0.8/100 years)
mechanical biochemical placenta (PPIUCD: women 3rd generation:
and hormonal composition of Postpartum IUCD) years Progestasert
cervical mucus,
affect sperm
Follow up
schedule: After
Mirena (LNG 20)
Contraindication:
T
motility, cap first menstrual Absolute: Pregnancy,
citation and period, and then PID, unexplained
survival. after the third Cu T 380 A:
bleeding, suspected Cu: copper, T for T shape. 380 is
increase the menstrual period cancer of genital
viscosity of and then after at a surface area in sq.mm over the
tract, previous history
mucus. six-month or one- of ectopic pregnancy device where copper wire is present,
IUCDs exhibit year intervals A denotes arm which is horizontal
Relative: Anemia,
foreign body like history of PID, and having copper sleeves. This extra
reaction copper increases effectiveness of
menorrhagia, copper T.
anatomical
deformity due to
fibroid, congenital
malformation,
purulent cervical
discharge
Common side effects:
Bleeding (MC), Pain (MC
reason for removal),
pelvic infection
Ideal candidate for
IUCD:
.
Having at least one
child,
 Mechanism of Remark
Image
ailure rate
Instruc tion
action No history of pelvir
Method
Type disease,
.Willingnesst o check
the IUCD thread,
.Monogamous
relationship
follow up
.Ready for
treatment if
visit and
any problems starts
~ihinyloestradiol Tablets
LR.
Levonorgastrei and
MALA-D Tablets iP.
0.1/100 withFerous Fuamarate
Start on 5th day, Estrogen (ethinyl Mala.bP
Prevent the women
Hormonal continue for 21 and
ovum
Estradiol) 30 ug
Combined pills release of years
Contraception Levonorgestrel
from ovary,
days
Followed by break 0.15 mg
inhibit sperm
of 7 days MALA-N
penetration and
MALA-N free in
tubal motility, government supply,
delayed taken daily for
transport of 21 consecutive days
sperm
Absolute Mala-N
C o n t r a i n d i c a t i o n :

Breast cancer,

genital cancer,

t h r o m b o e m b o l i s m

history, abnormal

uterine bleeding, liver

disorder, congenital

hyperlipidemia

Conta...
 Medicine
Preventive
and Social
Notes for
Golden
202

MM

ieipaslke
 Conta.
injectable contraceptives
Hormonal Suppression ntran 0.1/100 w o m e n DMPA/Depo provera
DMPA (Depot
contraception o fovulation uscular years as "Antara" Trade name
medroxy included in the National
progesterone injection
acetate) 150 mg of 150 mng Family Planning Program
I t is effective for 3 months
every 3
Most common side effect
months.
unpredictable bleeding
0.4/100 women . I t is
effective for 2 months
Hormonal Suppression Intram-
NET-EN .Most common side effect
uscular years
(Norethisterone contraception of ovulation unpredictable bleeding
enanthate)
injection
of 200 mg
200 mg every 2
months

0.3/100 women Effective for 3 months

Hormonal Suppression Subcu
DMPA-SC 104 mg Most common side effect
taneous years
contraception ofovulation unpredictable bleeding
injection of
(Deposub
Q provera)
104 mg
and
Contains estrogens
Given at 0.2/100 women
Hormonal Suppression progesterone
Combined monthly years
of ovulation+ Given at monthly interval
contraception interval
injectable effects due to
contraceptives
progesterone

Norplant: 6 silastic
Sustained release system
Silastic cap 35 mg
Prevent the capsule having
Subdermal
Hormonal sule of rod levonorgestrel
contraception release of implanted two
implant ovum from Norplant (R) 2: only
beneath the
small rods
ovary, skin of fore
thicken Protect for 5 years
arm of up
cervical
per arm
mucous
 Preventive and Social Medicine
Golden Notes for
204
2. Lal S, Adarsh, Pankaj. Textbook of. Gener
Bibliography Medicine, 2nd edn. CBS Puhi.mmuni
Preventive and Distributors, New Delhi; 2010. t h eEs
1. K Park. Park's Textbook of and
Social Medicine, 23rd edn, Bhanot Publishers, 3. Mahabalaraju DK. Essentials of
Commn
M o s q

Medicine Practicals, 2nd edn, Jayneo

Jabalpur: 2016 Medical Publishers, New Delhi; 2017 Brother Anopk

6.6ENTOMOLOGY Aedes

A study of the arthropods of medical impor- General Features of the Thorax

tance is known as Medical Entomology. Part of the Mosquitoes
Phylum arthropoda has five classes, out of
which three are medically important (Table 1). Large in size as compare to other b0dy Cule
1. Class Insecta: Mosquitoes, flies, fleas, lice, and round in shape. part
bugs, etc. Dorsal surface is formed by a large plate
Class Arachnida: Mites, ticks, spiders, as the Mesonotum. calle
Mar
scorpions, etc. Its posterior end bears a
3. Class Crustacea: Cyclops, lobsters, crabs,
projection-like hair
structure called as "scutellum".
prawns, etc. Pair of wings is attached dorsally and
helps in flying.
that
General Features of the Head Part Buzzing noise is due to beating of the wvings Ge
of the Mosquitoes Halters: A pair of rudimentary wings
below the wings, which helps to
is
locaed the
Semiglobular in shape maintain M
There is a pair of large compound eyes.
balance while flying. That is why, they are aiso
A long needle like structure in the center called as "balancers".
(at Legs: 3 pairs of legs are attached venrally
anterior side) called as "proboscis" with which
it bites and sucks blood. which are multijointed and tip of last segmen
There is ends in a pair of claws.
pair of maxillary palpi, each on
a

either side of the proboscis.

A pair of antennae, one on either
side palpi, General Features of the Abdomen
which helps to feel. of
The hairs over antennae are Part of the Mosquitoes
long and bushy in
male mosquitoes and short and less
female mosquitoes.
bushy in Abdomen is long and narrow.
I t i s composed of 10 segments.
Only 8 segments are visible while last
Table 1:Classes of phylum arthropoda. segments have been modified intw genit
Insecta Arachnida Crustacea These genitalia are represented in
le

Body Head, Cephalo- while in eme

division thorax and thorax and
Cephalo mosquito by a pair of clasper,
thorax and mosquito as pair of cerci.
abdomen abdomen re
abdomen Claspers are long and curved and ce
Legs 3 pairs 4 pairs 5 pairs Small and rounded: This feature
hepa

Antennae 1 pair
2 pairs deciding male or female mosquito.
Wings 1 or two
pair Life stage duration:
of wings or
Fgg= 1-2 days
wingless Larva 5-7 days
=

Habitat Land Land Pupa = 1-2 days

Water
Adult 2 weeks
 ldentifhcation Features of Head
Generalh
the
Different Types of
Differer
Bears 2 pair of
of eyes
Eggs One pair is small,
tMosquitoes
he
soon after this temporary:
disappear
Other pair is stage, called larval eyes
lays her eggS singly
large and permanent, called
imaginal eyes
Hnythees

anopheles
emale
are oa1
shaped. Mouth is located anteriorly which
ggs
lateral
p o s s e s s e s
aters (Fig. 1). feeding brushes on either side of has
Rg mouth which the
lack in colorand of cigar shape.
helps in catching
and active movements. the fnnd
are
ggS
also lays eggs singly
(Fig. It has
odes
mosquito a
pair of palpi and a pair of
Thorax: antennae
2)
here are
no lateral floaters. Single large segment, wings and legs
absent are

Call clusters or
raft-like structure and Abdomen:
lateral floats (Fig. 3). 10
her do not possess segments, 8 and 9 fused to form
SONa: respiratory apparatus, 10 segment
lay's her eggs in star-shaped clusters anal gills or anal possess
: hairs opening, tip bears caudal
which are attached under surface to the
r0otofcertain aquatic plants (pistia plants). Some larva
possess special hairs
palmate hairs, helps in identificationcalled
and
General ldentification Features of tloating
It feeds on
algae, bacteria, and
the Larva of the Different Types of matters vegetable
Mosquitoes Passes through 4
stages of growth called
is a free
Instars with moulting between
he larva swimming creature with an each stage.
ongated body divisible into head, thorax and
abdomen. Larva of Anopheles (Fig. 4A)
Floats horizontally just below the surface of
water
Very active with swift movement
No siphon tube, but
breathing apparatus
consist of parallel air tube at the tail end.
Known as surface
feeder
Larva of Culex and Aedes (Fig. 48)
Fig.1: Egg of Anopheles.
Suspended in water with head downwards

Fig, 2: Fa
 Preventive and Social Medicine
Golden Notes for

206 Wings are spotted at outer edue

Siphon tube
Surface
Exceptionally
(Figs. 5A and B).
Palpi long in
hoth se
It rests at 45° angle with the surf.
It is known as sophisticated
moses
2. Breeding place: Anophe
moving and clean water breedsuito
in
sl
3 Flight range: 3-5 km depends on th.
uaNandascas
species and feeding status. the ypee
4. Feeding and biting hahit. (only ten
and mainly at night.
5. Species:
Larva of Anopheles;
A. culicifacies: Main vector for
Figs. 4A and B: (A) periurban rural
an
(B)Larva of culex and Aedes.
A. stephensi: Main vector f,r
urbaan
Much slower with snake like nmovement industrial area.
tube thhen it is Culex
Has long narrow siphon A. fluviatilis: Main vector for
hill ar
and if it is small and thick then it is Aedes larva. forest, forest fringes
Known as bottom feeder. A. minimus: Main vector for fopt
north-eastern states nil
Mansonia A. dirus: Main vector for forest
the north-eastern states
vecto
Larvas of Mansonia are attached to rootlet of
An. epiroticus: Main vector
aquatic plant by their siphon tube. tor
no
restricted toAndaman and Nicocar sande
General ldentification Features of General ldentification Features of
the Pupa of the Different Types of the Aedes Adult Mosquitoes
Mosquitoes 1. Appearance
Comma shaped in appearance with Wings are unspotted.
large
rounded cephalothorax and a narrow There are white strips over the b.a.s a
abdomen. that is why, it is known as rige
Two small respiratory tubes or trumpets Palpi are shorter than proboscis emd
project from the upper surface of the thorax.
If breathing mosquito.
trumpet is short with very wide It rests parallel to the
opening just like broad funnel then it is pupa surtace
2. Breeding place:
of Anopheles while if breathing
narrow with narrow
trumpet is Anopheles breeds in artificial eleenono
either Culex or Aedes.
opening then it is pupa of
water, such as water in coolets ukeS
Represents the resting phase in the life tlowerpots, overhead tanks. dised ns
of mosquito. history or tyres, etc.
Does not feed and 3. Flight range:
prefer to stay quite at water
surface Fight range of Aedes mosquito
100M. (But
WHO says it is 40UNI it 1d
General ldentification Features of coincides with Aedes aegypti nues
at

the Anopheles Adult the

1. Appearance:
Mosquitoes airports should be zero in 400
airports)
4.
4.
Body is divided in three Feeding and biting habit:
thorax and abdomen with parts-head, Only female bites and mainly at d
and three pairs of legs. pair of wings, and highly anthropophilic.
Preferred site ofbiting is below the
 Spots

207
Palpi
Proboscis
Proboscis

palp

Antenna

Proboscis

ProboscisS
Palpi

Palpi

Antenna

D
Culex male.
male; (C) Culex female: (D)
female; (B) Anopheles
igs. SA to D: (A) Anopheles
female
shorter than proboscis in
are
Palpi
5C and D).
General Identification Features of mosquito (Figs.
the surface.
parallel to
theCulex Adult Mosquitoes It rests
known as
nuisance mosquito.
It is also
Appearance parts-head,
2. Breedingplace:
2. Breeding place
breeds in dirty and
polluted
water

5Ody is divided in three Culex drains, cesspools,

norax and abdomen with pair of wings such as open
collection,
septic tanks, etc.
and three of legs.
pairs
Wings are unspotted.
 Golden Notes for Preventiveand Sotlal Medicine
208
3. Flight range: Flight range of Cule mosquito is Life Cycle (Fig. 6)
11 km.
4. Feeding and biting habit Lgg
Only female bites and mainly after dark
Preferred site of biting is below the knee.
Tlhe female lays egKs In iolat ler
er, such as human
and Aying ntga
manure heaps or gatbage anin
Housefly It lays about 120-150
epgs at e
Phyllum: Arthropoda around 600-900 eggs during her sittirng
Class: Insecta It is pearly white, (val in lifeiftie
shape and ahe
Genus: Musca I mm long and it can be easily seeny naked
Species: Usually the eggs hatch in
Domestica duringsummer, they may hatc h24in honrs
heu
Vicinia
Sorbens Larva
Nebulo
The larva of housefly also called as
It is 1-2 mm in length (at birth but maggot
Morphology up to 12 mm), white in color,
it
gro
footless.
segmented an
Head
Its anterior end is narrow while
There is posterior end
retractile labile proboscis for sucking
a is broad.
liquid foods. They are very active and eat voraciously and
It bears a pair of antennae and moult twice.
pair of large
compound eyes. In the male housefly, the eyes They are
photophobic so they preler to be
areclose together while
in female housefly, eyes under manure heaps or loose soil.
are set apart widely. The average duration of the larval stage is
2-7 days, but it may prolong in cold weather.
Thorax Adult

There are 2-4 dark

the thorax which is
longitudinal stripes over
characteristic identifica-
tion mark of genus, Musca. Pupa
Ithas three pair of and a
legs
Each leg has a pair of
pair of wings.
pad which helps to walk
on highly polished surface. Egg
The legs and the
body are covered with plenty
short and stiff hairs which are
called as tenet
hairs.
Tenet hairs secrete a
sticky substance.
Overall color of housefly is
gray.

Abdomen
The abdomen is
and dark
segmented and there are
light
markings over it. Larva

Fig. 6: Lifecycle of houselly

 Spots

The head has 209

dark-brown in color and barrel
d a r k - b r o w n

The wings arelong, slender and hairy antennae.

There are lots ofupright and lanceolate in shape.
P y p a
are

pupas
he
roximately6
i ns h a p e .

inlength. The second vein hairs over the wings.

over the
I is a p
as pupa
neitherfeed nor
grows and the first wing branches twice
eadystate the wing.
branch occurs in the middle of
during this stage.
for 3-6
for 3-6 dar
days in sunmer but The legs are out
lasts of the
this
stage
in winter
of the body. proportion of the size
prolonged

gets Egg of sandfly is torpedo in shape and breeding

mostly occurs at dark
places
sheds. near to cattle
Adult
from egg to adult
nulete life cycle The larva is hairy
1he

allytakes.
5-6 days in summer and 8-20 maggot.
Sandfly remains in crevices in wals and holes
in tree
during daytime.
days in winter.

span
is 15 days in summer and:25 days Only female sandfly bites.
tslife
The bite of sandfly is
very much
in winter.

irritating and
painful.
FeedingHabits
Sandly generally hops rather than flying and
and makes a solution and dispersion range is just 50 yards.
yomits on food
it
sucks liquid.
bite.
It does
not
defecates constantly during Lice
It mits and
feeding. Identification Features of the Head
to 4 miles (10-11 km).
,Housefly may disperse up Louse (Pediculosis Capitis) (Fig.8)
It is wingless ectoparasite.
Sandfly It is dorsoventrally flattened insect
There are three parts of the body-head,
ldentification Feature of Sandfly
thorax, and abdomen.
abdomenis
Fig.7)
into head,
Thorax is square in shape and
divided structure.
Sandfly is small hairy insect elongated nine segmented
body and thorax.
Pair of wings (hairy)

Head

Antennae
Abdomen

Thorax

Proboscis

than the body)

Legs (longer ofsandfly.
Morphology
Fig. 7:
 Fig. 8: Head louse.
Fig.9: Pubic louse.

Fig. 10:Xenopsylla cheopis.

The last segment of the abdomen is bilobed in

the female and
pointed in the male louse. Rat Flea (Fig. 10)
Louse shows
incomplete metamorphosis as
there is no pupa
stage (egg to nymph to Phylum: Arthropoda
adult). Class: Insecta
Family: Pulicidae
Identification Features of the Pubic Genus: Xenopsylla
Louse (Phthirus Pubis) Species:
(Fig. 9) X. cheopis
Almost similar to head louse, but
it has
X. braziliensis
and strong legs. large X. astia
The first pair of legs is thinner
than the other
pairs.
Claws are relatively larger than head louse.
Identification
ldentification Features
Features
It is wingless insect and it 1-2 mm in
ie
 Spots

tody i s b i l alaterally flattene

chitinous and
Mite (ltch 211
tividedi
into head,
covered i t h
thorax and abdomen.
bristles.
Mite-Sarcoptes Scabie)
Sarcoptes scabies is extremely small
Body
consists ofpair
antenn
offantennae, mouth parts arthropod just visible to the naked globular
The female eye.
Head
mis where parasite burrows into the
a n de y e s .

has 3
s e g m e n t s pro,
mes0 and meta itbreeds and leads epider
itch to scabies or
Thorax
of legs.
and 3 pairs
horax segments and last segment Body is
globular in
shape and
Abdomen
has bristles. covered with
spermatheca
n females and aedegus Size is just 04 mm.
cont
ains
inmales

bite to suck blood.

Body shows no demarcations (in head, thorax
Roth
male andfema flea or
abdomen) or segrment.
There are A pairs of legs.
Ticks (Table 2) 2 front pair of legs bears suckers, while two

Phylum: A r t h r o p o d a
rearpair of legs end in long bristles (Fig 1).
Male has sucker on all the
legs except 3rd pair
Class:A r a c h n i d a which distinguishes it from female.
Order: Acarina

Families:
Ixodidae-hard tick
Cyclops (Fig. 12)
Argasidae-soft tick Class: Arthropod

between hard tick and soft tick.

Table 2: Difference
Hard tick Soft tick
Ixodidae Argasidae
Family
Present Absent
SCutum
At anterior end Lies ventrally
Position of head nuomunsaogog,

Behind il and V coxa

Behind IV coxa
Spiracles 20-100 over long period of time
100-1000 in 1 sitting Lays eggs in batch of
EOgs
Number of nymphal stage 1

Pair of legs
Absent
Antennae Absent than 1 year
starvation for more
Cannot stand starvation Can stand
Feeding habits Capitulum not visible

Palpus
Capitulum visible Basis capituli

Eye
Dorsal shield

Leg
- Leg

Festoons
 and Social Medicine
Notes for Preventive
Golden

212

Fig.12: Cyclops (water flea,

Bibliography
1. Anderson, John F. The natural
Medical Clinics of North America.history tco oi
Fig. 11: Mite.
2002
18. doi:10.1016/s0025-7125(03)00022- 6i205
2. Barker SC, Murrell A. Systematics and
of ticks with erouton
a list of valid genus and spemes
Subclass: Crustacea
Most commony found in collection of fresh
names. Parasitology. 2004;129(S1 S.5-St
water
doi:10.1017/S0031182004005207
3. http://www.authorstream.com Presen:a.c
So also known as water flea
It is pear-shaped tiny arthropod. 4.
drnitin1312-1166556-entomology-1
http://www.sentinelassam.com s
It has
semitransparent body and forked tail
end melange_health_talk.php?sec=10ancsLeseela
it has single
ndppr=2anddtP=2014-05-18
pigmented eye. 5.
Klompen JS, Black WC, Keirans JE. Oer
It has 5
pairs of legs and 2 pairs of antennae Evolution of ticks. Annual Review of En:o
(used for swimming)
It swims in water
1996;41:141-61. doi:10.1146/annurev :
with 141.
characteristic jerky 6.
movements. K Park. Park's Textbook of Prevene
Average life span of cyclops is 3 months. Social Medicine, 23rd edn., Bhanot Pbses
Jabalpur; 2016. p. 767

6.7 GROWTH CHART

it is visual
It is also
display of child's growth.
known as road
Uses of growth chart:
w health chart. Examples of growth chart: (Figs. I and 2
Features of new
For growth growth chart:
of malnutritionmonitoring and early detection lt is based on WHO child growth reteren
Growth chart
standards (2006).
is an
mothers educational tool for Constructed by using Z-score rather tna
Growth chart is an action tool for
percentage of actual weight (Tables "

workers. and 2).

health
Growth chart There are
is a separate growth chart to
makers. planning tool for policy andgirls, blue for boys and pink for gi
Growth chart is useful ears

up to e
age.
 Spots

Birth to 5 years
(z-scores)
213

Months246
4 6 8 10 8 10 2 46&10
1 year years years 4 years 5 years
Birth
Age (completed months and years)

Fig. 1: Weight-for-age (boys).

Z score from birth to 5 years (Boys)

e 1:Weightfor age
Weight-for-age BOYS
World Health| |Weight4or-age BOYS World Heaith
Birth to 5 years (2-5cores)
organizationBirnth to 5 yoars (2-scores) Organization
2s03so Year: Month Months 3s02 SD1 SDMedian 1S0
2 SO 1 50 Medan 1sD 11.3 133150
2:6 30
33 39
5 120135 152
121 137
33 123 13
210 124 140
1. 78 152 126 142 16.0
11312.7143 162
14123
4
2 1 315110
116 131
150
11.0 191341212

102 114
117
64 21137155

8 11.9 34140
101113 25 t41160
1431828
0.3 11.5 128
16314
105117
14
141120
1991221
131 148
11.1125139
232
101113127142
11.5 29 146 1141821 1
132. 142 1282049
119
0 20 134
12.0
1861
108 122 121
188
110 124 122
12125141
1 410 152 21.0
411
11 21143 Standards
163 184 WHO Child
Growth
1 129145
102
117 13.1 14.8
 Preventive and Soclal Medicine
Golden Notes for
14
Birth to 6 years (z-9cores)

24

22 22
20
20

16
14

12

10

Months 2 6 8 10 6 8 10 4 8 10 2 10
Birth year 2years AYear years
Age (comploto yeare)
Fig. 2:Weight-for-age (girls).

Table 2:Weight for age Z score from birth to 5 years (Girls).

Weight-for-age GIRLS
Birth to 5 years (2scores) World Health Welght-for-ago GIRLS World Health
Organization Birth to 5 y0ars (z-4coros)
Organization
Median 1SD 280380 ear.MonthMontha1s0 2 30 180Median190 30 30

2 0 0. 11.2 12.2L 144

11.4 129 14.7
11. 1 12
0411.7133L 161 3
9,3 0.8112 154 17
2:11
51
10.0 192012017 1.
10.6 12213.91 14.1
11.4 401. 184
12814213
120 12.7 144 .

124 10.1 212 146

10.2 1301441
103 1
13.1
64
1041 188 04 133 5.2 174
106
1.4
19.82113 10 120 13.8
199134 141 17.
A7
14. 0.8
48
13
123 40
110
4
143 A
7
M2
14S
113
1:11 164
167 H8
4148 14 219

17.0
17 11.7 A 182

17 118

180
18
130

142 235
WHO Chid Growth Standards
 Spots
215

Fig. 3:ICDS growth chart as per new WHO child growth standards (Boys).

GIRL Weig Birth to 5 vears

wtn Standares

ww.owwv
w www

standards (Giris).
WHO child
growth
new
growth chart as per
g . 4:ICDS
 Medicine
Peventive
and Social
Goider
Notes fv

216
Table 3 Interpretation
ofgrowth chart
Lengthheight
Weight forength/height BMI-for-age
Weightforoge
Z-score ese
Obese
Note2
Above NotE Ovenweight Overweight
Above? Noma Possibe risk of overweight Possible risk of
Nomal Normal
overweight
Above Normma
Noma
ma Normal
Madian Normal
NOma
Nioma Wasted
Seioa- Wasted
Beiow-2 Stunted Underwei
Severely wasted Severely wasted
Severely underneight
Beiow-3 Severely stunted

chid s ven ai SOmE endocrine disorders, such as growth-hormo

liness is not a senious issue uniess it s may De due
O
ormone-producing
dchiid shouid be assessec for the naving ocrine disorder

-Note
A chid wnose weight-for-age fals in this range may have a growth problem, but should be confirmed by utinn
other
parameters such as weight-for-iength hegt or BM-for-age.

Table4: Growth chart interpretation based on Table 5: Growth chart

location over the cunve.
interpretation based on
Curve direction.
Plotted point Interpretation of Growth curve
nutritional status
Interpretation
direction
Exactly on or just above the
1st curve (or) Upward growth Good: Adequate weig
Curve gain and child is healtty and
Between the 1st and 2nd Child growth is
growing well
Curve normal
Flat growth curve
Exactly on the 2nd curve Dangerous: Notgainin
weight and child' g,*h
Between the 2nd and 3rd
Curve
stagnant
Child is moderately
underwe
Dowward growth Very dangerous: Lo
n

Exacty on the 3rd curve urve

Plotted point is below the
weight which reguir
immediate referral an d tatt
3rd curve Child is seerely
underweight

Bibliography
1. https://www.nipccd.nic.in/file/elearn/manual/ 3. https://www.who.int/childgro

egm.pdf, National institute of Public sttwia boys z/en/, Child growth 9ta
. World Health
and Child Development Cooperatiron Organization. Trainin
2. https://www.who.int/childgrowth/standards Child Growth Assesssnent. (ena
sft_wía_boys_z/en/, Chid growth standards