Communicable

Diseases Control
course instructor : Bekele Simegn (BSc ; MPH)

November 2019

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 Course outline

 Course title:- Communicable Diseases control

 Total contact hour: 64hrs

 Credit hour: 4

 Batch:- Health Science students

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 Course Contents

UNIT 1: Over view of communicable Ds

UNIT 2: Transmission, prevention ,control of CDs

UNIT 3: Oro-focally transmitted Diseases

Unit 4: Air born and direct contact CDs

UNIT 5: Vector Born Diseases

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UNIT 6: Zoonotic Diseases

UNIT 7: Sexually transmitted Diseases

UNIT 8: Food born diseases

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 Class Schedule

• November 2019– March2019

• Every Monday morning

Can be adjusted as deemed necessary.

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 Evaluation
 Class attendance and participation……10%

 Exercises & Asign’ts………………20%

 Mid term examination…… 65%

 Final examination……………35%

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 Objectives of the course
At the completion of this course , students are expected to be able to:

 Describe the epidemiology and scope of Cds in Ethiopia and factors involved

in the transmission.

 Identify the preventive and control measures of each CD

 Play an active role in the prevention and control of CDs

 Organize and implement effective health education.

 Participate in teaching junior staff and significant others .

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 Methods of Instruction

 Lectures.

 Take-home assignments.

 In-class practical exercises and Group

discussions.

 Attendance at classes is strictly

compulsory.

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 Unit -1
Over view of communicable
Diseases

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 Main groups of disease, by cause
1) Genetic Eg: sickel cell anemia
2) Deficiency diseases Eg: Iron deficiency diseases
3) Environmental Eg: Communicable Ds
4) Degenerative ( Due to wear & tear of the body)
Eg: CHF, Senile arthritis
5) Malignant Eg: cancer of the liver .

•NB: most of the ds in africa are environmental ds &defficiency

related due to infection by living organisms.

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 1.1 Introduction
Definition:-
communicable diseases =infectious diseases
• Occur due to a specific infectious agent or its toxic products that
arise through transmission of that agent/its products from the
infected person, animal, or reservoir to a susceptible host, either
directly or indirectly through an intermediate plant or animal host,
vector or inanimate.

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 Communicable versus
non-communicable diseases
• Communicable disease: a disease that can be spread to a
person from another person, an animal or object.
Ex: common cold, influenza, tuberculosis, etc.

• Non-communicable disease/ a disease that can NOT be spread

from person to person.
Ex: cancer, heart disease, cirrhosis, etc.

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 Communicable versus
non-communicable diseases

Communicable diseases Non-communicable diseases

 Gradual onset
• Sudden onset
 Multiple causes
• Single cause
 Long natural history
• Short natural history
 Prolonged treatment
• Short treatment schedule
 Care predominates
• Cure is achieved
 Multidisciplinary
• Single discipline
 Prolonged follow up
• Short follow up

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• Make a huge contribution to the burden of morbidity and
mortality.
• The six leading groups of infectious diseases
1.Acute respiratory infections,
2.Diarrheal diseases
3.Measles
4.Malaria
5.HIV/AIDS,
6.Tuberculosis,
- Together cause over 11 million deaths worldwide every
year,

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• CDs constitute the leading cause of health
problems in Ethiopia.
• accounted for most of the top ten causes of
illness and death

• Most are easily preventable through simple

measures such as vaccination and changes
in human behaviour (for example,
handwashing with soap).
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 Few Important Terminologies related to
Communicable Diseases
1.Reservoir
• Any person, animal, arthropod, plant, soil, or substance, or a
combination of these, in which an infectious agent normally lives and
multiplies, on which it depends primarily for survival, and where it
reproduces itself in such a manner that it can be transmitted to a
susceptible host.

• Natural habitat of the infectious agent.

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2. Infection:

• Entry and development or multiplication of an infectious agent in

the body of man or animals.
• An infection does not always cause illness.
• There are several levels of infection (Gradients of infection):
– Colonization (S. aureus in skin and normal nasopharynx)
– Subclinical or inapparent infection (polio)
– Manifest or clinical infection
– Latent infection (virus of herpes simplex)

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 3. Infestation
• Lodgment, development and reproduction of arthropods on the
surface of the body or in the clothing,
e.g. lice, itch mite.

• This term could be also used to describe the invasion of the gut by
parasitic worms,
e.g. ascariasis.

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 4. Contamination
• Presence of an infectious agent on a surface,

• on body or in clothes,
• beddings,
• toys,
• surgical instruments or dressings, or other articles or
substances including water and food

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 5. Nosocomial infections
• Nosocomial (hospital acquired)
• infection originating in a patient while in a hospital or health center.

• It has to be a new disorder unrelated to the patient’s primary condition.

• Examples : infection of surgical wounds, hepatitis B and urinary tract

infections.

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 6. Opportunistic infection
• This is infection by organisms that take the opportunity
provided by a defect in host defense (e.g. immunity) to infect
the host and thus cause disease.

• For example, opportunistic infections are very common in

AIDS. Organisms include Herpes simplex, cytomegalovirus,
,M. tuberculosis….

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 7.Cases
• A case is defined as

• “a person in the population or study group identified as having

the particular disease.

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 8. Communicable diseases are:
a. Infectious : Not easily transmitted from one person to another.
Eg : Malaria, dengue, tetanus
b. Contagious : Easily transmitted;
: Transmitted through contact.
- may be grouped as either highly or not highly contag.
Eg :
1. By droplets / direct contact : Tb
2. Through sex : HIV, gonorrhea
3. body contact: scabies, trachoma…

NB: All communicable diseases are infectious but not all are contagious.

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 9. Vector of infection
• An insect or any living carrier that transports an infectious
agent from an infected individual or its wastes to a susceptible
individual or its food or immediate surroundings.

• Both biological and mechanical transmissions are encountered.

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 10. Incidence and Prevalence of infectious diseases

• Incidence of an infectious disease:

Number of new cases in a given time period

• Prevalence of an infectious disease:

Number of cases (old and new) at a given time

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 Relationship between organisms:
• Normal flora: normal inhabitants of the host
ex. S.epidermidis on skin, E.coli in intestine
• Commensalism – One organism benefits; the other
unaffected; can be opportunistic infector

• Mutualism: both benefit; E. coli makes us Vit. K; We provide

nice environment and food
• Parasitism: One benefits at the other’s expense; tapeworm
or leach

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• Toxins – Poisonous microbial bypoducts that are
produced by the microbe and diffuse into tissues
causing damage.

1. Exotoxin
2. Endotoxin

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• Exotoxins – excreted outside of cell, both Gram+ and Gram
– bacteria produce some of these highly destructive
proteins.

• Endotoxin – Released by many Gram (-) bacteria when

cells lyse

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 Enzymes that help invasion

– Collagenase – breaks down collagen, the protein

holding cells together, thus allows spreading.
Clostridia that invade tissue can produce these
proteases to digest connective tissue elements (C.
perfringens

– Hyaluronidase – breaks down hyaluronic acid, the

polysachharide that may hold some cells together, S. pyogenes
produces such an enzyme
• Causes necrosis and blackening of tissue

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- Coagulase – Affects the fibrin in blood causing it to clot,

- Hemolysin – This exotoxin is an enzyme and lyses RBC

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 Importance of Communicable Diseases

• Significant burden of disease especially in low and middle

income countries
• Social impact
• Economic impact
• Potential for rapid spread
• Human security concerns
• Intentional use
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 CDs have a significant economic impact in affected countries

• At the macro level

– Reduction in revenue for the country (e.g. tourism)
• Estimated cost of SARS epidemic to Asian countries: $20 billion (2003) or $2 million
per case.
• Drop in international travel to affected countries by 50-70%
• Malaria causes an average loss of 1.3% annual GDP in countries with intense
transmission
• The plague outbreak in India cost the economy over $1 billion from travel
restrictions and embargoes

• At the household level

– Poorer households are disproportionately ( excessively) affected
– Substantial loss in productivity and income for the infirmed and caregiver
– Catastrophic costs of treating illness
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 1.2 Classification of CDs

 Communicable Diseases can be classified in several ways:

1. Clinically/ system involved

2. Time course

3. Taxonomy of infectious agent

4. Mode of transmission

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1. Based on C/M or system involved
a. Diarrheal diseases: secretary/watery, invasive/ dysentery

b. Febrile diseases

c. Respiratory diseases : upper or lower

d. CNS infection

e. CVD

f. Urinary tract infection: upper or lower UTI

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 2. Based on time course

1. Acute: diseases of shorter duration (less than 2 weeks),

- rapidly progressive,

- abrupt onset,

- in need of urgent care.

2. Chronic: indicate a duration usually greater than two weeks.

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3. Based on taxonomy of infectious agent
Metazoan

Protozoal

Bacterial

Fungal

Viral

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 1.3 Natural History of Diseases

What is Natural History of Diseases?

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• refers to the progression of disease process in an individual over time, in the
absence of intervention.

• Without medical intervention, the process ends with

•recovery,

•disability, or

•death.

• The usual course of a disease may be halted (stoped) at any point in the
progression by preventive and therapeutic measures, host factors, and

other influences.
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 The natural history of disease has four classical stages

1. Stage of susceptibility or period of exposure: disease has not yet

developed, but there are factors that favor occurrence.

2. Stage of sub clinical disease (pre-symptomatic stage): the disease

process has already begun, but the disease is not manifested

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3. Stage of clinical disease: signs and symptoms of the disease are
manifested.

4. State of disability or death: the disease has occurred and left over damage
to the body that limits the activity of the victim or has ended with the death
of the victim.
N.B. recovery can take place at any stage in the course of the disease.

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 Natural history time lines for infection and disease

Natural history time lines for infection and

disease

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 1.4 Courses of infectious disease over time

There are different periods that encountered in the course of

infectious period.
1. Prepatent period:
 It is the time interval between infection and the point at which the
infection can first detected, as first measured by the first shedding
(detaching) of the agent.

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2. Incubation period:
 The time interval between infection and the first clinical manifestation of
the disease
 i.e. b/n biological and clinical onset.

3. Communicable period:
 The period during which an infected host can transmit the infection to
others, which can be measured by the length of the time in which the

agent is shed by the host.

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4. Latent period:
-The time interval between recovery and the occurrence of a

relapse in clinical diseases.

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Epidemiologic Triangle And Triad (Balance Beam)

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 1.6 Carriers & their roles in CDC

• Definition:

- an infected person without manifestation of disease but capable of

transmitting the disease to others.

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Types of carriers:

1. Asymptomatic carrier
- also called healthy carrier, just carrier.
- infected person with no sn or sx, but capable of transmiting.
E.g. Poliomyelitis, Amoebiasis etc

2. Incubatory carrier- transmit infection during IP

E.g. measles,

- It should be noted that not all disease transmitted during the IP .

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 3. Convalescent carrier – Continue to transmit even after recovery .

E.g. Hepatitis B virus, Typhoid fever etc

4. Chronic carrier -continue to shed the agent for long period .

E.g. Hepatitis B virus

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 UNIT 2

Transmission, Prevention, & control of

CDs

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 OBJECTIVES OF THE LECTURE

• By the end of this lecture you will be able to:

• Identify chains of CD Transmission

o Identify the levels of prevention of diseases
o Identify measures for prevention and control of communicable diseases
• Measures towards reservoir
• Measures towards the MOT /environment
• Measures to contacts and susceptible host
o Immunization and types of vaccines

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 2.1 Chain of Disease Transmission
Definition: represents a series of events which must occur in order
for disease causing organism to cause infection.

There are six successive events

1. Causative Agent
2. Reservoir host
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host

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 Infectious agent (etiology of specific infection)

• are named scientifically, using a combination of two words,

• The ‘genus’ and

• The ‘species’ names.

•The genus name is written with its initial letter capitalised,
•Followed by the species name which is not capitalised.

Eg: Plasmodium falciparum

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Infectious agent (etiology of specific infection)-

 An organism capable of causing infection

Characteristics of an infectious agent:-

 Infectivity- ability of the agent to cause infection

- It can be measured by infection rate(IR):
IR= Total number of infected people x 100

Total number of susceptible people exposed

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 Pathogenicity- ability of microorganism to induce disease.

Pathogenicity= total number of clinical cases

total number of subclinical cases

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 Virulence: ability to cause severe outcome of the disease.
1. CFR
2. Hospitalization Rate

 Resistance- the ability of the agent to survive adverse

environmental conditions during transmission from one host to
another.

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 Exercise
From 100 people who attended a wedding feast, 75 of them ate a
piece of wedding cake. Fifteen (15) of the participants who ate the
cake were later hospitalized with sever gastroenteritis and 6 of them
died of the infection. When the incident was later investigated it
was found that the wedding cake harbored the infectious agent
responsible for the outbreak. Immunoglobulin M antibody to the
agent indicative of recent infection was found in 55 of the 75
participants who had eaten the cake, including the 15 hospitalized
one. Another 20 of the 55 participants with antibodies had reported
having experienced diarrhea after having attended the wedding feast
but not serious enough for them to report to the health service.

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• Calculate
1. Infection rate

2. Pathogenecity

3. virulence

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 2. Reservoir of infection

 Reservoirs are a living ( animal, human being, arthropods, or plants) or

non living things( soil, water, food, etc) in which an infectious agent
normally lives, transforms and multiplies.

 depends primarily for survival & where it reproduce itself in such a way
that it can be passed (transmitted) to the susceptible host .

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 An agent can have more than one reservoir:

a. Man as the only reservoir- Eg: measles, gonorrhea, small pox, etc.

b. Animal as reservoir of infection- E.g. anthrax-cattle, Rabies-dog, etc

c. Non-living things as reservoir - these includes soil, water, food, etc. Eg:
Clostridium tetani ,Clostridium botulinum, Salmonella typhi of typhoid fever

etc.

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 3. Portal of Exit
 site on the reservoir of infection through which the infectious
agent escapes from the reservoir.
E.g. GIT- Typhoid fever

4. Mode of Transmission- Mechanism by which agent is transferred

from reservoir to new host.

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 There are two main mode of transmission
I. Direct transmission- immediate transfer of agent from an infected host to
an appropriate portal of entry

 Direct contact-: this refers to the contact of the skin, mucosa or

conjunctiva with infectious agent directly transferred from another
reservoir.

 It can occur through touching, breaking skin, kissing, passing

through the birth canal, etc.

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 Direct projection: droplets of saliva created by expiratory
activities of coughing, spitting, sneezing, talking, & singing.

 Trans-placental: from mother to her fetus in uterus through

the placenta.
E.g. syphilis, HIV, CMV, etc…

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 II. Indirect transmission-

 Airborne transmission: dissemination through respiratory tract as

particles, dust and droplet nuclei. (suspended)

e.g. Tuberculosis

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 Vehicle borne transmission: any non-living substance by which an
infectious agent can be transported or introduced

 Vehicles include food, water, milk, fomites, or towel, cooking & eating
utensils, syringes & needles, surgical instruments

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 Vector borne transmission: agent is carried susceptible host by

a vector.

It can be biological or mechanical.

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5. Route of entry- site on susceptible host through w/c agent gets in .
o GI tract e.g. for Typhoid fever

o Respiratory tract e.g. for Tuberculosis

o Skin and mucus membrane e.g. for STIs, Scabies etc

 Determines whether or not the agent will establish infection.

E.g. clostridium tetani is non-infectious when ingested.

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 6. Susceptible host

 transmission to be completed the existence of susceptible host is

necessary.

 Who is highly likely to acquire infection when exposed

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 2.2 Prevention and control of CDs

Prevention Definition:
- refers to the goal of medicine to preserve, protect, and restore
the individual and community well-being.

- To interrupt or slow disease progression.

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 Levels of prevention:
1. Primary prevention => pre-event phase
2. Secondary prevention => event phase
3. Tertiary prevention => post-event phase

- Health Promotion (1ry prevention)

- Early detection & care (2ry prevention)
- Rehabilitation (3ry prevention)

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 I- Primary Prevention:

• Actions taken prior to the onset of the disease

which aim to remove the possibility that a disease
will ever occur”

It limits the incidence of diseases by preventing

healthy people from developing disease.

Primary Prevention activities can be directed at

individuals or at the environment.

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 At individual level

• Measures to improve the general health of the individuals:

1. Health education efforts are directed at encouraging people to

develop good health habits (Adequate nutrition, exercise) and to
adopt hygienic practices (hand washing,….

2. Specific protective measures such as,

- Chemoprophylaxis,
- Sero-prophylaxis,
- Vaccination
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 At environmental level

• Environmental sanitation is used to provide an

adequate sewage system, safe drinking water,
clean air and proper ventilation.

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 II- Secondary Prevention:

• Early detection and prompt treatment of a disease,

• Thus hinder the progress of a disease and prevent

complications.

i.e. intervention in early pathogenesis phase.

.

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 Measures of secondary prevention include:
1. Screening programs : used to detect diseases at
early preclinical stages, when effective therapy may
either cure the disease or limit its progression

2. Primary medical care: through early case finding at

PHCC.
- It is the predominant form of secondary prevention

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 III- Tertiary prevention:

• Actions taken when the disease process has advanced

beyond its early stages
- i.e. intervention in late pathogenesis phase.
• The aim of tertiary prevention is limitation of disability
and rehabilitation from disease.
• Tools for tertiary prevention include rehabilitation
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 Rehabilitation:

• It is a measure to train disable individuals to reach

the highest level of functional ability by using
combined coordinated medical, social, vocational,
psychological and educational measures.

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 Rehabilitation includes

1. Medical rehabilitation – restoration of function or physical

loss.
2. Educational rehabilitation change of educational methods.
3. Vocational (occupational) rehabilitation – restoration of the
capacity to earn a livelihood.
4. Social rehabilitation: restoration of family and social
relationships.
5. Psychological rehabilitation: restoration of personal
confidence.

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 Examples of uses of levels of prevention

• All three levels of prevention can be used to control a single

disease process.
1. BCG Vaccination of newborns (primary prevention).
2. Screening and early treating a person with active tuberculosis
(secondary prevention) may prevent transmission to another
person (primary prevention).
3. In advanced cases of tuberculosis, occupational and social
rehabilitation (tertiary prevention) by modification of working
conditions may help to regain the capacity to earn his
livelihood.
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 Control & Elimination of disease
CONTROL: Disease incidence is reduced to a minimal
level, acceptable at the level of country/region, at
which the disease is no longer considered a public
health problem, while infection may still occur.

ELIMINATION: Reduction to zero of the incidence of a

specified disease in a defined community or country
or region as a result public health actions.
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 Eradication

It means worldwide disappearance of a disease i.e.

(permanent reduction to zero level) :

 The organism may be present only in laboratories,

but there is no need for public health actions. e.g.
smallpox since 1979.

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 Methods of disease control

Host Reservoir&
Source

Mode of
transmission

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These Include:
I. Measures directed to Reservoirs

II. Measures directed to susceptible hosts

III. Measures directed to the environment

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 A. Measures towards reservoir
Objective of control measures towards reservoir
• Reduce quantity of agent (complete or partial reduction)
• Reduce communicability

1. Measures towards cases

2. Measures towards carriers
3. Measures towards animal reservoir

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 Measures towards cases

1. Segregation /isolation of cases

2. Case finding (early detection & Rx)
3. Disinfection
4. Reporting

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Segregation/Isolation of cases
This means that the patient is isolated from the community in a
fashion that prevents direct or indirect spread of infectious agents.
• Isolation is usually done for a period which equals the “period of
communicability” at a hospital (fever hospital) or at home.

• Ideally repeated negative sample are needed before his release.

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Treatment of cases
• Early diagnosis and prompt treatment of infections
with appropriate regimens (e.g. antibiotics, antiviral
or other chemotherapeutic agents) helps reducing
communicability.

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Disinfection
-Concurrent
-Terminal
Disinfection of the soiled articles by the patient discharges or
excreta concurrently (during his presence as source of
infection) and/or terminally (after his discharge from the
hospital or death) helps in reduction of communicability.

Disinfection of contaminated objects with appropriate “enteric

precautions,” “respiratory precautions,” “universal
precautions”

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 Measures applied to carriers
1. Detection of carriers:
– If they represent important reservoir of infection.
– If they were suspected in a closed community, such as
boarding schools, army barracks, food handling places,
…..
2. Exclusion from work: in certain occupations for example;
– food handler (e.g. Typhoid carrier) or a
– teacher (e.g. Diphtheria carrier).
3. Treatment for the carrier state (when applicable).

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 Measures applied to animal reservoir

• Inspection and slaughtering of infected animals (bovine Tb)

• Immunization of uninfected sheep, cattle ( brucellosis)
• Careful husbandry and sterilization of animal products (in
anthrax).
• Extinction/Destruction of animal reservoir has been
successful with diseases as rabies and bovine TB in
several countries.
• Such procedure is only possible for domestic animals
while it is difficult or almost impossible for wild animals
(e.g. in jungle yellow fever,….)

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 B. Measures to Contacts/ susceptible Host

1. Surveillance
2. Quarantine
3. Increasing resistance of susceptibles

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• Surveillance : Close medical supervision of contacts,

• without restricting their movement,

• for the purpose of early detection of the disease in question.

• should be done for duration of the longest “incubation

period” of the disease counted from date of last
exposure

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 Quarantine
• Means separation (with restriction of the movement) in a
specific place (quarantine) of apparently well persons or
animals who have been exposed (contact) to a case of
infectious disease.

• done for the duration of the longest “incubation period” of

the disease counted from date of last exposure.
• It allows early detection of the disease among these
individuals.
• This measure is applied for contacts of pneumonic plague
Ebola and pneumonic anthrax.
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 Increasing resistance of susceptibles

Measures to improve the defense mechanism of the host by using:

1. Chemoprophylaxis,
2. Sero-prophylaxis,
3. Immunization

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a) Chemoprophylaxis: The administration of a chemical, including
antimicrobials, to prevent the development of an infection (if
given before exposure)
• or to slow progression of the disease to active clinically

manifest disease (if given after exposure).

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Chemoprophylaxis is used for :-
- Travelers to endemic areas,
- Occupationally exposed persons (e.g. HCW)

- for contacts in closed communities (camps, schools and

institutions).

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• Examples:

1. Isoniazid (INH) for contacts of tuberculous cases.

2. Rifampicin for contacts of meningeococcal meningitis.

3. Chloroquine for travelers to malaria areas.

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b) Sero-prophylaxis: Prophylaxis using ready-made antibodies also
known as passive immunization
• (e.g. measles immunoglobulin and tetanus anti toxoid (TAT)

• In case of measles, if it is given within the first three days of the

incubation period, it prevents the attack and gives immunity for
4-5 weeks.

• If administered from the 4th to the 10th day of IP, the subject
gets a modified attack and permanent immunity.
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 c) Vaccination (Active immunization):
• Protection of susceptible host from communicable diseases by
the administration of a modified :
• Living infectious agent,

• Killed organism, or

• Inactive agent or
• Part of the agent.
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 C. Measures towards the environment

• Reduction of overcrowding

- e.g. better housing conditions, proper ventilation

• Personal hygiene

- e.g. cleanliness, hand washing, regular bathing

• Environmental sanitation:
- e.g. sanitary sewage disposal, sanitary refuse disposal, safe water
supply,…

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• Vector control :

eg. insecticides, indoor or aerial spraying, mosquito-nets,…..

• National and international measures: which include
different public health measures undertaken within and
between countries in order to protect the individuals
and communities from communicable diseases.
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 Immunization

• Vaccination and immunization,

• though used interchangeably in practice,
• are not exactly synonymous.

• Vaccination : process of inoculating the antigen (vaccine).

• Immunization : process of inducing immune response

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 Types Immunity

1. Congenital or innate non-specific immunity.

• It is the natural resistance of body e.g. skin, WBC etc.

2. Acquired or specific immunity

a. Natural acquired immunity
b. Artificial acquired immunity

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 Active immunity
• Resistance developed in response to stimulus by
an antigen (infecting agent or vaccine) and is
characterized by the production of antibodies by the
host

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 Passive immunity
• Immunity conferred by an antibody produced in
another host.
• It may be acquired naturally or artificially (through an
antibody-containing preparation).

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 Immunizing agents

1. vaccines
2. immunuglobulins
3. antisera

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 Immunoglobulins

• There are 5 major classes: IgM, IgA, IgG, IgE, IgD.

• Two types of immunoglobulin preparations are

available for passive immunization:
– Normal human immunoglobulin
– Specific (hyper-immune) human immunoglobulin

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 Antisera or antitoxins
• These are materials prepared in animals or non
human sources such as horses.

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 Vaccination

• a method of giving antigen to stimulate the immune

response through active immunization.

• A vaccine is an immuno-biological substance designed to

produce specific protection against a given disease.

• A vaccine is “antigenic” but not “pathogenic

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 Types of vaccines
1. Live vaccines
2. Attenuated live vaccines
3. Inactivated (killed vaccines)
4. Toxoids
5. Polysaccharide and polypeptide (cellular fraction)
vaccines
6. Surface antigen (recombinant) vaccines.

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 Live vaccines
• are made from live infectious agents without any
amendment.

• The only live vaccine is “Variola” (small pox vaccine),

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 Live attenuated (avirulent) vaccines
• Virulent pathogenic organisms are treated to become
attenuated and avirulent but antigenic.
• They have lost their capacity to induce full-blown disease
but retain their immunogenicity.
• should not be administered to persons with suppressed
immune response due to:
– Leukemia and lymphoma
– Other malignancies
– Receiving corticosteroids and anti-metabolic agents
– Radiation
– pregnancy

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 Inactivated (killed) vaccines
• Organisms are killed or inactivated by heat or chemicals but
remain antigenic.
• They are usually safe but less effective than live attenuated
vaccines.

• The only absolute contraindication to their administration is

a severe local or general reaction to a previous dose.

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 Toxoids
• Prepared by detoxifying the exotoxins of some bacteria
rendering them antigenic but not pathogenic.
• The antibodies produces in the body as a consequence of toxoid
administration neutralize the toxic moiety produced during
infection rather than act upon the organism itself.
• In general toxoids are highly efficacious and safe immunizing
agents.
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 Polysaccharide and polypeptide (cellular fraction)
vaccines
• They are prepared from extracted cellular fractions
- e.g. meningococcal vaccine from the polysaccharide
antigen of the cell wall, the pneumococcal vaccine from the
polysaccharide contained in the capsule of the organism,
and hepatitis B polypeptide vaccine.

• Their efficacy and safety appear to be high.

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 Surface antigen (recombinant) vaccines.

• It is prepared by cloning HBsAg gene in yeast cells

where it is expressed.

• HBsAg produced is then used for vaccine

preparations.

• Their efficacy and safety also appear to be high.

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 Routes of administration

1. Deep subcutaneous or intramuscular route (most

vaccines)

2. Oral route ( polio)

3. Intradermal route (BCG vaccine)
4. Intranasal route (live attenuated influenza vaccine)

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 Scheme of immunization
1. Primary vaccination
1.1 One dose vaccines (BCG, measles & yellow fever)
1.2 Multiple dose vaccines (polio, Penta)

2. Booster vaccination
To maintain immunity level after it declines after some time
has elapsed (Penta, MMR).

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 The Cold Chain
• a system of storage and transport of vaccines at low
temperature from the manufacturer to the actual vaccination
site.

• The cold chain system is necessary because vaccine failure

may occur due to failure to store and transport under strict
temperature controls.

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 The Cold Chain Equipment

Cold chain equipment consists of the following:

- Deep freezers and Ice lined Refrigerators:

- supplied to all districts and the
- used for making ice packs and to store OPV and
measles vaccines.
- Small deep freezers : One set is provided to PHCs,
and Family Planning Centers

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- Cold boxes: are supplied to all peripheral centers.
-used mainly for transportation of vaccines.

- Vaccine carriers: used to carry small quantities of vaccines

- The carriers should be closed tightly.

- Ice packs: contain water and no salt be added to it.

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• Among the vaccines, polio is the most sensitive to
heat, requiring storage at minus 20 degree C.

• Vaccines which must be stored in the freezer

compartment are : polio and measles.

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• Vaccines which must be stored in the COLD PART
but never allowed to freeze are :
- Pentav,
- Tetanus toxoid (TT)
- DT,
- BCG and
- Diluents

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 Immunization Schedule

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 Tetanus immunization

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 Herd immunity
Definition:
- It is resistance of the community to the introduction & spread
of infectious agent based on the immunity of high proportion of
individuals in the population,
- There by, lessening the likelihood of a person with disease
coming in to contact with susceptible individuals.

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 Prerequisite for herd immunity:

 Single reservoir( the human host)

 Direct transmission( direct contact or projection)

 Total immunity; partially immunized host may continue to shed the agent

 No shedding of the agent by the immune host (no carrier state)

 Uniform distribution of immunes

 No overcrowding

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 Thank you !!!

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