Prepared by Mrs.

Haifete

SIX (6) TARGET DISEASES

1. MEASLES/MORBILLI

Definition:
Acute, infectious, very contagious notifiable disease characterized by the light pink,
macular rash, commencing behind the ears, catarrhal inflammation of the eyes and
respiratory tract.

Causative organisms
Virus – morbilli

Incubation period: 10-14 days

Immunity: Second attacks are rare

Method of spread
Direct contact, droplet infection

Signs and symptoms

First stage
 Signs and symptoms of coryza, conjunctivitis, photophobia, bronchitis
 Koplik’s on the mucous membrane of the mouth. Small bluish-white spots
surrounded by a red areola
 Temperature is raised

Second stage (4th day)

 Koplik’s spots begin to disappear
 The rash, a light pink macular eruption is seen first on the forehead, behind the
ears, and soon spread all over the face and body, becoming dusky red in colour
later.

Third stage
 Temperature falls slowly
 Rash fades and is gone within a week
 Bleeding may occur in sever cases
Diagnosis according to koplik’s spots and rash

Complications
 Bronchopneumonia
 Acute gastro-enteritis
 Conjunctivitis/blindness
 Otitis media and mastoiditis
 Encephalitis inflammation of the brain
 Haemorrhagic measles

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  TB may develop due to lower immune system

Prognosis: Mortality for children under 3 years in high

General Nursing Care
 Strict isolation with concurrent disinfections
 Well ventilated room
- Routine nursing care of fever case

Primary Prevention
Health education regarding dangers of the disease and the need for immunization.
Knowing the target groups e.g. lower social-economic groups, poor nutrition
overcrowded conditions,
Affected children must be kept out of school
Vaccination of children at the age of 9 months

Secondary prevention

General nursing care

 Hospitalization is not essential, but strict isolation with concurrent disinfection
 Well ventilated room
 Routine nursing care of fever case

Specific nursing care

 Symptomatic nursing care
 Attention of darken the room, avoid direct sunlight, if ant discharge from the eyes,
bath the eyes with warm water
 Prevent stomatitis-oral hygiene
 Inhalation may be given to prevent laryngitis an for stridor
 Prevent complications

Tertiary Prevention
Rehabilitation, re-education, provision of facilities to limit disabilities.
Special schooling

2. POLIO MYELITIS

Definition:
An acute, communicable, notifiable disease characherised by inflammatory changes of
the motor nerve cells/central nervous system especially anterior horn cells of the spinal
cord.

Causative Organisms
Poliovirus 1 bruhilda-associated with paralytic illness
Poliovirus 2 Lansing-seldom associated with paralytic illness

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Poliovirus 3 Leon – not often associated with paralytic illness

Incubation period: 7-14 days

Methods of spread
Via the respiratory tract, and via contaminated food and milk. The virus will then be
ingested and can be found in the faeces.

3 Types of polioviruses
Wild poliovirus (WPV) – 3 serotypes
• Type 1 – 416 cases in 2013 (this is the only type of WPV in
circulation today)
• Type 2 – eliminated in 1999
• Type 3 – last case reported in 2012 (more time is needed to certify
eradication)

Signs and symptoms

The pre-paralytic stage
 Onset sudden, symptoms of slight cold
 Patient develops fever, sever headache and depression
 Signs of meningeal irritation, neck rigidity, photophobia
 Muscles are tender and painful and patient is very restless

The paralytic phase

 After 24-48 hours, the temperature falls and paralysis sets in
 There is no loss of sensation
 Pain and muscle tenderness may persist
 On drinking fluids, regurgitation through the nose takes place
 Respiratory distress may develop

Post-paralytic phase
The asymmetrically paralysed muscles lead to orthopaedic problems such as scoliosis,
dropped or shortening of a limb

Complications
 Permanent paralysis
 Malformation of limbs
 Bronchopneumonia
 Respiratory failure
 Urinary tract infection may lead to formation of calcium, phosphate stones

Primary prevention

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  Health education about immunization
 During an epidemic,, trauma of any kind should be avoided, e.g. tooth extractions,
tonsillectomy etc.
 Satisfactory refuse and sewage waste disposal
 Good housing facilities, improvement of socio-economic conditions
 Pure water and food supplies
 Pasteurisation of milk
 Improved nutrition to raise the resistance of the population

General nursing care

 Notification
 Isolation with concurrent disinfection in a darkened room, quiet room for about
three weeks.
 Routine nursing care of a fever case

Specific nursing care

 Affected limbs must be put in a comfortable position
 Paralysed muscles must not be stretched
 Passive movements should be started from the onset.
 As soon as the acute tenderness of the muscles subsides, active exercises are
started
 Respirator, suction machine, bladder drainage
 Moral support is very important

Tertiary prevention
 Rehabilitation
 Re-education and provision of facilities to limit disabilities
 Physiotherapy
 Occupational therapy
 Special orthopaedic appliances
 Psychological support
 The assistance of a social worker
 Re-education and re-training

3. DIPHTHERIA

Definition
An acute, infectious, communicable, notifiable disease characterized by the formation of
a false membrane in the respiratory tract and symptoms caused by absorption of toxins.

Causative Organisms
Coryne-bacterium Diphtheria

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Incubation period: 1-5 days

Method of spread
Droplet infection – direct contact, fomites, contaminated milk and carriers

Signs and symptoms of facial diphtheria

(Commonest and severest type of diphtheria)
1. Onset gradual, child being off colour
2. Fever is mild, pulse rapid
3. Tonsilar glands are enlarged
4. Sore throat
5. Musty breath
6. Tonsils are covered with whitish grey membrane

Signs and symptoms of Nasal diphtheria

(Mildest type of diphtheria with few signs of toxemia)
1. Serious nasal discharge that is blood stained
2. Visible membrane.

Signs and symptoms of laryngeal diphtheria

1. Signs and symptoms similar to faucial diphtheria
2. Hoarseness with croupy cough
3. Obstruction by the membrane
4. Laboured breathing, stridor and dyspnoea
5. Cyanosis, restlessness, recession of ribs

Other types of diphtheria are:

 Heamorrhagic diphtheria: Petechial haemorrhages into the skin and mucpuse

membranes. This is the severest form of nasopharyngeal Diptheria. Seldom seen
in RSA.
 Cutaneouse diphtheria / wound diphtheria Commonest type in S.A
 Involvement of the conjunctivae, ears, umbilicus and genitals

Diagnosis:
 According to the presence of “false membrane”
 Throat and nasal swab will reveal the organisms

Complications:
 Acute myocarditis and heart-failure(pulse become rapid, soft, &irregular and
vomiting occurs)
 Paralysis of the soft palate, eye muscles, pharynx or diaphragm
 Peripheral neuritis, seen after 7th week
 Albuminuria as a result of toxaemia which has affected the nephrons of the
kidney

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  Otitis media

Prognosis: Fair with treatment

Primary prevention:
 Health education regarding the importance of immunization
 Booster dose give at 3yrs and when school
 Control of dairies, pasteurization or sterilization of milk
 Control of food-handlers

Secondary prevention
Objective:To prevent the spread and complications by early diagnosis and treatment.

General nursing care

 Notification
 Isolation with concurrent disinfection
 Hospitalization is imperative
 Routine nursing care of a fever case

Specific nursing care:

 Complete bedrest for at least 4 to six weeks

 Observe for signs and symptoms of heart failure vomiting, change of pulse-rate,
irregularity etc.
 Observation of respiration, cyanosis, dyspnoea
 Oxygen must be at hand
 Observe urine output: test for albumin .
 Give plenty of fluids and glucose fluids. Nasal feeds may be necessary.
 Aspiration / suction may be reguired
 Tracheostomy if obstruction is present

Other measures:
 Detection of sources
 Detection of carriers and treatment
 Quarantine of contacts and prophylactic treatment

Medical treatment: Anti-toxin

IMI penicillin 1mu
Tertiary prevention:
 Rehabilitation, re-education and provision of facilities to prevent or limit
disabilities.
 Speech therapy may be necessary if a tracheostomy had to be doneor the palate
has been affected

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4.PERTUSSIS / WHOOPING COUGH

Definiton
An acute infectiouse, communicable, very debilitating desease, characterized by severe
coughing bouts which end in a “whoop”

Causative Organisms
Pertussis bacillus (borterlla/Haemophilus)

Incubation Period: 1-3 weeks

Method of spread
Droplet infection, in isolated cases formites.

Signs and symptoms

First stage (Catarrhal) lasting 1-2 weeks
 Child seems to have a bad cold
 Mild pyrexia
 Cough: may be associated with vomiting and increase in severity
 Anorexia
 Sleeplessness

Second stage (paroxysmal) lasting about 3 weeks

 Paroxysmal attacks of severe coughing
 The patient’s face becomes deep red in colour changing to purple-red and blue
 Child appears to suffocate then takes a deep breath with a loud “whoop”
 Vomiting frequently occurs at end of paroxysm
 The sticky mucous is expectorated
 Child may injure the tongue on teeth during paroxysm

The third stage (convalescent)

 Coughing bouts become gradually less severe
 Child is weak and exhausted by this time and has usually lost much weight
 A slight irritation may irritate a bout of coughing
 Vomiting and coughing may have become a habit

Complications
 Bronchopneumonia
 Brochiectasis
 Emphysema
 Gastro-enteritis
 Convulsions: may become fatal
 Heamorrhage into the brain, conjunctivae, the skin an the mucous membrane
 Hernia prolapse of the rectum

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Primary prevention
 Health education regarding the dangers of the disease and the need for
immunization
 Active immunization of infants and children

General nursing care

 Notification
 Isolation with concurrent disinfection for 6 weeks until cough subsided
 Routine nursing care of a fever case

Specific nursing care

 A well ventilated room
 Bed rest of cases with frequent paroxysms
 Light meals of high nutrient value
 Oxygen must be available
 Observation to prevent complications

Tertiary
Usually not applicable

5. TETANUS
Definition:
An acute, non-contagious disease characterized by painful mascular contractions,
especially of the muscles of mastication.

Legislation:
International measures: Acute immunization is advised for travelers

Causative Organisms
Tetanus bacillus-Clostridium tetani

Incubation period
Usually 10 days, but may be up to 3 weeks

Method of spread
The tetanus spores gain entrance through into the body during injury, e.g. stab or
puncture wounds. The spores can be present in soil, which is contaminated with faeces,
or manure from horses and cattle particularly, and once in the human body they require
anaerobic conditions to survive.

Signs and symptoms

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 a) The patient may give a history of injury while working in the garden, or a
complicated nature, or recovery after surgery or a minor surgery
b) Muscle stiffness, especially of the face, and difficulty in opening the
mouth.
c) After few hours, the muscles stiffness increases, muscles spasm set in, and
the patient experiences difficulty with speech and swallowing.
d) Muscle spasm becomes more severe, with the head in opisthotonos. The
facial muscle spasms give the appearance of a sardonic smile.
e) The patient is fully conscious, and nay scream with pain and anxiety
f) Breathing is impaired and skin is moist
g) Temperature and pulse are usually normal at the onset of the disease
h) The spasm can cause fractures, lead to exhaustion and death, if untreated

Complications
If no treatment, cardiac and respiratory failure

Primary prevention
 Health education regarding the need for active immunization of infants
 Formal tetanus toxoid given as booster for people at risk, workers in contact with
soil, military forces, policemen, youth attending camps
 Control of midwives and supervision of aseptic techniques at childbirth
 Any body who has been exposed to contamination with infected soil through
wounds
 Pregnant women should receive tetanus toxoid
 Thorough disinfection of wounds with peroxide
 Health education to pregnant women and birth attendants to avoid the use of soil
and cow dung on the cord.

General nursing care

 Notification
 Isolation is not necessary
 Routine nursing care of a fever case

Specific nursing care

a) Nurse in Intensive Care Unit (ICU)
b) Disinfect the wound with peroxide. Remove of dead tissue or foreign bodies.
Wounds must not be sutured
c) The patient is nursed in a quite, dark room. Silence is important to avoid spasms
d) Tetanus injection should be given on admission
e) Sedatives and muscle relaxing drugs should be given
f) Nasal feeds
g) Intake and output chart
h) Regular observations of pulse, and BP
i) Most patients will require tracheostomy

Tertiary Prevention

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Rehabilitation, re-education and provision of facilities to limit disabilities
Recovery is gradual thus patient needs moral support
Active immunization of recovered patients

6. TUBERCULOSIS (TB)
Definitions
An infectious, chronic or acute or sub-acute notifiable disease characterized by lesion
formation in tissues and organs in the organs in the body, by far the most frequent being
the lungs

Pulmonary Tuberculosis (PTB): is the most common form of the disease, occurring in
Over 85% of all cases in Namibia. It is the only form of TB, which may be infectious
(open pulmonary TB with infectious sputum)

Extra Pulmonary Tuberculosis: is TB affecting other organs than the lungs.

Eg. - TB Pleuritis - TB lymphadenitis
- Military TB - TB Meningitis spine
- TB Pericarditis - Uro-genital TB
- TB Peritonitis - TB Arthritis

Legislation
Notification of cases
Supply of information to WHO centres
Patient may return to institution on submission of medical certificate.
Contacts may return immediately

Incubation Period: 6 weeks

Causative Organisms
Mycobacterium Tuberculosis/tubercle bacillus

Method of spread
 By direct contact with infected droplets from the lungs of a patient with a
pulmonary form of the disease, which are inhaled by a previous uninfected person
(Primary infection).
 Secondly the tubercle bacilli are resistant to atmospheric conditions (except strong
sunlight) and may remain active in the ground for long periods thus contact with
infected dust may produce infection.
 Milk from infected cattle may produce abdominal and extra pulmonary infections

Typical signs and symptoms

 Persistent cough for two weeks or more
 Haemoptysis (coughing up blood)

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  Chest pain
 Dyspnoea (shortness of breath)
 Loss of appetite
 Loss of weight

Complications
Haemoptysis (Coughing blood)
Acute respiratory distress-due to pneumo-thorax
Collapse of the lungs due to damage caused Pleural effusion (Fluid in the thorax) may
need quick relief through aspiration
Cardio-pulmonary insufficiency results in cor-pulmonary.

Primary prevention
BCG immunization immediately after birth
INH doses for babies of mothers’ with positive TB sputum
Health education to communities
- To understand the disease
- On principles of nutrition
On raised general standard of living or quality of life
Improved housing
Family spacing and limitation of overcrowding
Inspections of dairies, safe milk supplies, pasteurize milk.
Protection of exposed personnel

Specific nursing care

a) Hospitalisation
b) Chemotherapy; Standard Short Course Chemotherapy (SCC) consist of the
following drugs: Isoniazid (INH), Rifampicin (RIF), Pyrazinamide (PZA),
Ethambuto (E), Streptomycin (STREP) for six months. (see annex A for
dosage)
c) Avoid interruption of employment
d) Ambulatory treatment (DOTS)
e) Tracing of family contacts for investigation.
f) Improve diet and bedrest.

Tertiary Prevention
Rehabilitation, re-education on good nutrition, avoidance of physical and mental stresses
or strain.

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OTHER TOP RANKING COMMUNICABLE DISEASES IN NAMIBIA

MALARIA

Definition
A communicable notifiable debilitating disease characterized by intermitted attacks of
fever, rigors and prostration

As malaria is under surveillance by the WHO they must be informed of cases. Supply of
information to WHO centres

Causative Organisms
It is a protozoan infection caused by the parasite, plasmodium of malaria

There are 4 types:

Plasmodium Falciparum
Most common and most dangerous type that can cause cerebral malaria
Incubation period = 12 days

Plasmodium Malaria
Incubation period = 30 days

Plasmodium Vivax
Incubation period = 14 days

Plasmodium Ovale
Incubation period =14 days

Method of spread
Through the bite of an infected female anopheles mosquito
By blood transfusion

The factors influencing malaria transmission in Namibia

 Mosquitoes breeding, feeding and resting habits
 Climate
 Drug resistance
 Immunity to malaria

Signs and symptoms

 Recurrent attacks of high fever, accompanied by rigors, severe headaches and
vomiting
 Regular cycles of rigor occur about one week after onset
 The patient may develop jaundice
 Epigastric tenderness: Enlargement of the spleen

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  Abdominal discomfort. Diarrhoea
 Dehydration
 In serious cases, delirium and coma
 Muscular twitching, convulsions, oliguria, anuria and uraemia

Complications
 Cerebral malaria
 Epileptic attacks and hemiplegia
 Black water fever
 Abortion pregnancies
 Cirrhosis of the liver
 Shock

Primary prevention
How to prevent malaria in your own area
 Give information of the danger of malaria to health
 Advice people about prevention and elimination of mosquitoes in their habitat and
breeding places
 Spraying
 Spraying of surface water, dams and tanks
 Mosquito gauze on windows and doors
 Mosquito nets over beds
 Wearing of protective clothes
 Using of mosquito repellent
 Advising people to take prophylactic medication when visiting endemic areas
Secondary prevention
General nursing care
 A blood slide must be taken for microscopically examination before treatment is
commenced
 Notification
 Patient should sleep under a mosquito net
 Routine Nursing Care of a fever case

Specific nursing care

 Symptomatic nursing care
 Rehydration, intake/output charts
 Observations of blood pressure, pulse, temperature
 Treatment for shock

Tertiary Prevention: is not applicable

DIARRHOEAL DISEASES

1. CHOLERA

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Definition
A cute, infectious, formidable, notifiable disease characterized by severe diarrhoea,
massive fluid and electrolyte loss and dehydration

Causative Organisms
The vibrio cholera

Incubation Period = from a few hours to 5 days

Method of spread
Through contamination of water, in particular, food, vegetables and fruit may be
contaminated by water containing the micro-organisms.

Signs and symptoms

 Sudden onset: intense diarrhoea with watery stools
 Dehydration: the eyes become sunken, the skin cold and clammy
 Pulse rapid: temp subnormal, no abdominal pain
 Cramps in muscle tissue
 The patient may vomit and pass into shock or develop renal failure
 Collapse state may follow

Complications
Dehydration, muscle cramps, shock, vascular collapse, renal failure and hepatic failure.

Primary prevention

Health education about the following:

 Encourage the people to build and use latrines
 Wash hand after using a latrine
 Wash the vegetables before use with purified water
 Protection, purification and chlorination of public water supplies
 Human faces must never be used for fertilizing purposes
 Satisfactory removal of refuse. Prevention of fly-infestation
 Boiling of milk, pasteurization or sterilisation’s
 Vaccination of people at risk disinfections of water is very important

Secondary Prevention
General nursing care
 Early notification is essential
 Hospitalised the patient within three hours
 Isolate the patient
 Concurrent disinfections of urine. Faeces and vomitus will help to prevent the
spread of the disease

Specific nursing care

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Treat for shock
Urgent relief of dehydration
Electrolyte replacement
Maintenance of fluid intake
Accurate fluid balance chart

Tertiary Prevention

Rehabilitation
Re-education and provision of facilities to limit disabilities

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