1

HEALTH PROGRAM
COMMON COMMUNICABLE DISEASES

By: HI STUDENTS G1
 Contents:
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 ☞Malaria program and its strategies

 ☞TB and Leprosy, strategies and prevention measure

s

 ☞HIV/AIDS and STI, prevention, Care and treatment

 ☞Other communicable diseases

 Learning Objectives
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 At the end of this lesson we should have to kno

w:
 Causes of Communicable Diseases
 How Communicable Diseases are Transmitted
 Types of Communicable Diseases and
 How to Control, Prevent and also Strategies of Com
municable Diseases
 Brainstorming
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 Q?What Do you know about Communicable Disease

s?
 What are they?
 Communicable Diseases
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 Are illnesses due to specific infectious agents or its t

oxic products, which arise through transmission of th
at agent,
 or its toxic products from an infected person, animal
or inanimate reservoir to a susceptible host, either d
irectly or
 indirectly, through an intermediate plant or animal h
ost, vector or inanimate environment.
 Most important recent communicable
Diseases
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 MALARIA


 HIV/AIDS
 TB (TB-MDR)

 LEPROSY

 HEPATITIS B


 CHOLERA
 1). MALARIA
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 Is a life-threatening disease caused by

 parasites that are transmitted to people throug
h the bites of infected mosquitoes or when bloo
d from an infected person is transfused to som
eone else, or needle sharing with an infected p
erson.

 Etiology
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 There are four causative plasmodium species:

 1) Plasmodium falciparum

 2) Plasmodium vivax

 3) Plasmodium ovale, and

 4) Plasmodium malarie
 Infectious agent
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 ƒPlasmodium falciparum/malignant tertian: Invade

s all ages of red blood cells. Red blood cell cycle is
48 hours
 ƒPlasmodium vivax/benign tertian: Invades reticul
ocytes only. Red blood cell cycle is 48 hours.
 ƒPlamodium ovale/tertian: Invades reticulocytes on
ly. Red blood cell cycle is 48 hours.
 ƒPlasmodium Malariae/Quartan malaria: Invades


 reticulocytes only. Red blood cell cycle is 72 hours.

 Global malaria prevalence
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 Every year, 500 million people become severely ill

with malaria
 causes 30% of Low birth weight in newborns Global
ly.
 >1 million people die of malaria every year. One c
hild dies from it every 30 seconds
 40% of the world’s population is at risk of malari
a. Most cases and deaths occur in SSA.
 Global malaria prevalence......
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 Malaria is the 9th leading cause of death in LICs an

d MICs
 11% of childhood deaths worldwide attributable to
malaria
 SSA children account for 82% of malaria deaths wo
rld.
 Plasmodium falciparum 60% and vivax 40% are co
mmon in Ethiopia.
 Mode of transmission
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 By the bite of an infective female anopheles mosqui

to, which sucks blood for egg maturation.
 Blood transfusion, hypodermic needles, organ trans
plantation and mother to fetus transmission is possibl
e. Since there is no
 pre-erythrocytic (tissue) cycle, the incubation period
is short.
 Anopheles gambae and funestus are common vector
s in Ethiopia.
 Treatment of Malaria
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 1. Plasmodium vivax, ovale and sensitive plasmodi

um falciparum
 ƒChloroquine or

 ƒFansidar

 2. Chloroquine resistant falciparum and when sensi

tivity pattern is not known.

 ƒQuinine or

 ƒFansidar
 Malaria Control
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 Early diagnosis and prompt treatment to cure patie

nts and reduce parasite reservoir
 Vector control:
 Indoor residual spraying
 Long lasting Insecticide treated bed nets
 Intermittent preventive treatment of pregnant wome
n
 Prevention of Malaria
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 Primary prevention
 Secondary prevention

 Tertiary prevention
 Primary prevention
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 ☞ Some primary prevention methods include:

 Vector control targeted at the environment
 Use of insecticide treated nets
 Indoor residual spraying using DDT
 Larval control
 Protective clothing
 Secondary prevention
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 The main secondary form of prevention is chemopro

phylaxis use to suppress malaria
 Drugs :
 -> Oral quinine
 -> Doxycycline
 -> Mefloquine
 -> Atovaquone
 -> Proguanil
 -> Artemether-lumefantrine
 Tertiary prevention
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 ☞Prompt diagnosis
 ☞Early treatment of the disease

 ☞Reduction of complications.
 Strategies of Malaria
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 • Health education
 • Early diagnosis and early treatment
 • Early recognition and referral of severe malaria
 • Community participation
 • Intersectoral collaboration
 • Chemo prophylaxis
 Effective planning of malaria control activities
requires:
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 • A core group of malaria experts within the Ministr

y of Health to develop evidence-based strategies,
assist health districts in technical matters, planning, i
mplementation and evaluation, and to consolidate p
artnership with other ministries and development ag
encies around interventions impacting on mortality
 • Functioning general health services, trained staff a
nd health workers at community level
 • Intersectoral cooperation at local, national and int
ernational levels_x0000_
 AIR-BORNE DISEASES
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 TB

Tuberculosis
 What is tuberculosis?
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 A chronic and infectious mycobacterial disease important as

a major cause of illness and death in many parts of the worl
d.
 TB is a bacillus, meaning rod shaped bacteria; it is from the
genus mycobacteria.
 TB most usually affects the lungs but it can affect other parts
of the body.
 Only TB of the lungs or throat is infectious.
 TB is an airborne disease which can be cured.
‹#›
 Mode of transmission
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 From persons with active ulcerative lesion of lung ex

pelled during talking, sneezing, singing, or coughing
directly.
 Untreated pulmonary tuberculosis positive (PTB+) ca
ses are the source of infection.
 Most important is the length of time of contact an in
dividual shares volume of air with an infectious case.
That is intimate, prolonged or frequent contact is re
quired.
 Mode of transmission...
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 Transmission through contaminated fomites (clot

hes, personal articles) is rare. Ingestion of unpa
steurizedmilk transmits bovine tuberculosis.
 Overcrowding and poor housing conditions fav
or the disease transmission.
 Global TB Prevalence
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 2 billion people infected with microbes that cause TB.

 Not everyone develops active disease
 A person is infected every second globally
 22 countries account for 80% of TB cases.
 >50% cases in Asia, 28% in Africa (which also has the highest
per capita prevalence)
 In 2005, there were 8.8 million new TB cases; 1.6 million death
s from TB (about 4400 a day)
 Highly stigmatizing disease
 Tb prevalence in Ethiopia
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 According to the Ministry of Health report in 1993 E.C, tubercu

losis was a leading cause of
 1. Outpatient morbidity (ranked 8th with 2.2%),
 2. Leading cause of hospitalization (ranked 3rd with 7.8%) an
d
 3. Leading cause of hospital death (ranked 1st with 10.1%).
 Pulmonary (80%) primarily occurs during childhood and secon
darily 15-45 years or later. The other is extra
 pulmonary.
 Control and prevention of TB
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 Aim: to recognise how TB presents and to enhance

early diagnosis and treatment through prompt refer
ral to TB Specialist Services.
 Objectives: To provide an overview of the identific
ation, prevention and treatment of Tuberculosis (TB)
in your area of clinical practice.
 Treatment
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 The following drugs are being used for treatment of

TB in Ethiopia.
 ƒStreptomycin (s) daily IM injection
 ƒEthambutol(E)

 ƒRifampin (R)

 ƒThiacetazone (T)

 ƒIsoniazid (H)

 ƒPyrazinamide (Z)
 Tb Control
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 The effort to control tuberculosis began in the early 60s

with the establishment of TB centers and sanatoria in thr
ee major urban areas in the country.
 The Central Office (CO) of the National Tuberculosis Co
ntrol Program (NTCP) was established in 1976.
 Prevention
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 • Cure of infectious patients is the best prevention as i

t stops transmission of the infectious agent.
 ☞BCG vaccination as early in life as possible provide
s a degree of effective protection for children (up to
80%), particularly against severe forms such as tuber
culous meningitis.
 ☞Chemoprophylaxis of infected individuals with isoni
azid for 6 months reduces the risk of disease by 80-9
0%, mainly in child.
 Prevention...
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 Contacts of smear-positive tuberculosis patients and in

HIV-infected individuals. An alternative to isoniazid is to
give rifampicin/pirazynamide for 2 months.
 ☞Environmental protection: air renewal (outside ventilat
ion); sunlight and UV light kill the infectious agent
 Educate patients with TB about the mode of disease tra
nsmission and how to dispose their sputum and cover the
ir mouth while coughing, sneezing, etc.
 Prevention...
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 Public health education about the modes of disease

transmission and methods of control
 ƒImproved standard of living
 ƒAdequate nutrition
 ƒHealth housing
 ƒEnvironmental sanitation
 ƒPersonal hygiene; etc.
 LEPROSY
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It is a chronic infectious disease caused by M.lep

rae, an acid fast, rod shaped bacillus.
 It mainly affects the skin, peripheral nerves, and

mucosa of the respiratory tract etc.

 It has left behind a terrifying image in history a
nd human memory of mutilation, rejection and ex
clusion from society.
 More Facts about Leprosy
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 Epidemiology
 Occurrence- Although common in rural tropics and sub
tropics, socio-economic conditions may be more import
ant than climate itself. Endemic in south and southeast
Asia, tropical Africa and Latin America.


 Reservoir- Humans
 Mode of transmission
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 Not clearly established.

 Household and prolonged close contact appear to be importa
nt.
 Millions of bacilli are liberated daily in the nasal discharges o
f untreated lepromatous patients.
 Cutaneous ulcers in lepromatous patients may shed large num
ber of bacilli.
 Organisms probably gain access (entrance) through the URT an
d possibly through broken skin.
 In children less than one year of age, transmission is presumed
to be transplacental.
 Treatment of Leprosy
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 1. Dapsone
 2. Refampicin
 3. Clfazamin three drugs for 12 months and t
hen dapsone alone for the next 12 months.
 4. Aspirin for mild reactions and inflammation
 5. Severe reaction can be treated with corticosteroi
ds
 GOAL AND OBJECTIVE OF LEPROSY ERADICA
TION PROGRAMME
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 Goal: elimination of leprosy i.e.to reduce

the prevalence rate to less than I per 100
00 population by the year 2000 AD.
 Objective: To arrest disease activity in all
the known cases of leprosy by the year 2
000AD
 CONTROL OF LEPROSY
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 It means no longer to be a public hea

lth problem
 • Prevention
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 − Early detection and treatment of cases.

 − BCG vaccination can induce protection against th
e tuberculoid form of the disease; this is part of the
control methods against tuberculosis in some countrie
s and must not be undertaken specifically against le
prosy.
 − Dapsone chemoprophylaxis is not recommended (l
imited effectiveness and danger of resistance).
 − Reducing contact with known leprosy patients is of
dubious value and can lead to stigmatization.
41

HIV/AIDS
 HIV-AIDS
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 Definition
 A severe, life - threatening clinical condition, first re
cognized as a distinct syndrome in 1981. This syndr
ome represents the late clinical stage of infection wi
th the human immuno deficiency virus (HIV), which m
ost often results in progressive damage to the immu
ne and other organ systems, including
 the CNS.
 HIV-AIDS
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 Human Immunodeficiency Virus

 • HIV-1 is more common worldwide (pandemic)
 • HIV-2 is found in West Africa, Mozambique, and
Angola
 HIV-2 is less easily transmitted and less pathogenic

 Transmission
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 • Direct contact with infected blood

 • Sexual contact: oral, anal, or vaginal
 • Direct contact with semen or vaginal and cervical s
ecretions
 • HIV-infected mothers to infants during pregnancy,
delivery, or breastfeeding
 Moreover, transplacental transmission from an infect
ed mother to the fetus.
 Global situation and trends
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 Since 1981, almost 78 million people have been infected with

the HIV virus and about 39 million people have died of HIV.
 Globally, 35.0 million people were living with HIV at the end o
f 2013.
 An estimated 0.8% of adults aged 15–49 years worldwide ar
e living with HIV, although the burden of the epidemic continue
s to vary considerably between countries and regions.
 Sub-Saharan Africa remains most severely affected, with nearl
y 1 in every 20 adults living with HIV and accounting for nearl
y 71% of the people living with HIV worldwide



 HIV Prevalence in Ethiopia
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 The MOH 2002 report depicts the following about t

he HIV/AIDS situation in Ethiopia:
 - The HIV prevalence rate for the country as a whol
e is estimated at 6.66 percent.
 The estimated HIV prevalence rate for urban areas
is 13.7 percent.
 HIV seems to be driving the TB epidemic in Ethiopia.
 The highest prevalence of HIV is seen in the age gro
up 15 to 24.
 Treatment
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 Treatment
 1. No specific treatment.
 2. Treatment of opportunistic infections.
 3. Use of anti-HIV drug to reduce transmission of th
e virus to the fetus of pregnant mothers reduces fet
al infection.
 Prevention of HIV/AIDS
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 1. Reducing sexual transmission through one or m

ore of the following:
 ♦ Postponing the start of sexual activity
 ♦ Practising non-penetrative sex
 ♦ Limiting the number of sexual partners
 ♦ Consistently and correctly using condoms (male an
d female)
 ♦ Preventing and treating common STIs, especially t
hose that cause ulcerative lesions.
 Prevention...
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 These activities are to be accompanied by HIV/AID

S education, voluntary counselling and testing.
 − Avoiding transmission through infected material fo
r injection/surgery/dentistry/other
 − Safety of injection equipment (sterilization techniq
ues, “autodisable” syringes, etc.) for therapy, includi
ng dentistry, for immunizations or for recreational us
e.
 ♦ Setting up needle/syringe exchange programmes
 ♦ Setting up drug treatment programmes if approp
riate.
 Prevention...
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 Avoiding transmission through transfusion:

 ♦ Ensuring screening of blood for transfusions and f
or other blood products
 ♦ Ensuring that blood tested positive is removed fro
m the blood supply and not transfused
 ♦ Minimizing recourse to transfusions
 ♦ Encouraging auto-transfusion where possible.
 Prevention...
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 − Reducing vertical mother-to-child transmission:

 ♦ Treatment of infected mothers and their baby acco
rding to national guidelines
 ♦ Long-term multitherapy during pregnancy and child
birth according to national guidelines:
 ♦ The most complex regimen includes antepartum and
intrapartum zidovudine for the mother and postnatal
doses forthe infant; the simplest regimen requires a si
ngle dose of nevirapine at the onset of labour and a
single dose for the
 newborn
 Hepatitis B Virus
52

 Hepatitis B accounts for an estimated 385 million ca

rriers and more than 1 million deaths each year. Ch
ronic infection and severe sequelae occur – an estim
ated 15% to 25% will die prematurely of either cir
rhosis or hepatocellular carcinoma.
 The virus of hepatitis B may be the cause of up to 8
0% of all cases of hepatocellular carcinoma worldw
ide, and is second only to tobacco among known hu
man carcinogens._x0000_
 Main modes of transmission
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 The virus is transmitted by percutaneous or permuco

sal exposure to blood or other infectious body fluids
. It is found in highest concentrations in blood and se
rous exudates; lower concentrations are found in oth
er body secretions, including saliva, semen and vagi
nal fluid.
 HBV is stable on environmental surfaces for at least
7 days, and indirect inoculation of HBV can also occ
ur via inanimate objects. _x0000_
 Main modes of transmission....
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 Major modes of HBV transmission include sexual con

tact with an infected person, perinatal transmission f
rom mother to infant (especially in hyperendemic ar
eas), shared needles or syringes among injecting dr
ug users, household contact (e.g. communally used r
azors and toothbrushes) and nosocomial exposure (t
ransfusions, non-sterile parenteral equipment).


 Transmission of HBV in households occurs from child t

o child. _x0000_
 Treatment of Hepatitis B
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 No specific treatment for acute viral hepatitisB.

 Alpha interferon and lamivudine are available for
treatment of chronic hepatitis B in some countries.
 Apply universal precautions to prevent exposure to
blood and body fluids.
 Equipment contaminated with blood or body fluids
must be disinfected as soon as possible_x0000_
 • Prevention
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 Routine universal infant vaccination is the essential ele

ment of strategies to prevent HBV infection. Monovale
nt andcombination vaccines are available.
 Hepatitis B vaccine schedules are flexible, and the v
accine must be incorporated into national immunizatio
n schedules.
 Where the level of HBV endemicity is high, routine in
fant vaccination will rapidly eliminate transmission be
cause virtually
 all chronic infections are acquired among children und
er 5_x0000_
 Other means to prevent HBV infection include:
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 Testing all donated blood for HBsAg by sensitive tests (enzy

me immunoassay)
 Avoiding and discouraging the use of paid donors
 Preventing injection-associated transmission by reducing inje
ction overuse and using safe injection practices, including ap
propriate use and disposal of needles and syringes
 Appropriate disinfection and sterilization practices for equip
ment and environmental surfaces
 Proper use of multi-dose medication vials._x0000_
 References
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 WHO Recommended Strategies for the Prevention and Control

of Communicable Diseases
 Eshuis Manschot, 1978, Communicable Diseases: A Manual for
Rural Health Workers, African Medical and Research Associati
on, Nairobi.
 Abraham S. Benenson, 1995, Control of Communicable Diseas
es Manual, 16th edition
 Ministry of Health, 1997, Manual of National Tuberculosis and
Leprosy Control Program, 1st edition,
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 Prepared by HI Students(Bsc.)