Prevention and Control

Of Disease
Course Objectives:

 By the end of this Lecture, we will be able to know the:

- Natural Course of Disease
-Levels of prevention and strategies
-Different control measures in the community.
-Public health approach in the control of disease.
Natural Course Of Disease
Definition:
Progression of a disease process in an individual
over time, in the absence of treatment.
Stage of Susceptability
Stage of Subclinical Disease
Incubation Period/Latency Period
 The time of exposure to onset of disease symptoms.
 Disease may be asymptomatic.
 IncubationPeriod- Infectious Disease Latency
Period-Chronic Disease
Stage of Clinical Disease
 Onset of symptoms
 Most diagnoses are made in this stage
Stage of Recovery/Disablity/Death
 Epidemiology Terms
 Infectivity-the proportion of exposed persons who become
infected
 Pathogenicity-the proportion of infected individuals who develop
clinically apparent disease.
 Virulence-the proportion of clinically apparent cases that are
severe or fatal
 Carriers-persons who are infectious but have subclinical disease
 Source: https://www.cdc.gov/csels/dsepd/ss1978/SS1978.pdf
Levels Of Prevention
 Primary Prevention
 Purpose of primary prevention is to prevent a disease from ever
occurring.
 Target population:healthy individuals
 Activitesthat limit risk exposure or increase the immunity of
individuals at risk to prevent a disease from progressing in a
susceptible individual to subclinical disease
Example: Immunization
 Secondary Prevention
 Early disease detection
 Target is healthy-appearing individuals with subclinical forms of
the disease.
 Occurs in the form of screenings.

Example: Papanicolaou (Pap) smear

 Tertiary Prevention
 Targets both the clinical and outcome stages of a disease
 Target Population: Symptomatic Patients
 Aims to reduce the severity of the disease as well as of any
associated sequelae
 Tertiary prevention aims to reduce the effects of the disease once
established in an individual

Example: Treatment and rehabilitation

 Quarternary Prevention
 Action taken to identify patients at risk of overmedicalization, to
protect him from new medical invasion, and to suggest to him
interventions, which are ethically acceptable.
-World Organization of National Colleges, Academies and Academic Associations
of General Practitioners/Family Physicians
Latest Defintion:

An action taken to protect individuals (persons/patients) from medical

interventions that are likely to cause more harm than good.
Prevention Strategies
 Primordial:
• Government policy: Increasing taxes on cigarettes;
Decreasing advertisement of tobacco
• Built Environment: Access to safe walking paths;
access to stores with healthy food options
Prevention Strategies
 Primary:
• Immunizations
• Tobacco Cessation Programs
• Needle Exchange Programs
• Micro-Nutrient Supplementation Programs
Prevention Strategies
 Secondary:
• Papanicolaou (Pap) smear for early detection of cervical
cancer[8]
• Mammography, for early detection of breast cancer
• Colonoscopies, for early detection of colon cancer
• Blood Pressure Screening
Prevention Strategies
 Tertiary:
• Occupational and physical therapy in burn patients
• Cardiac rehab in post-myocardial infarction patients
• Diabetic foot care
Prevention Strategies
 Quaternary:

The following conditions are susceptible to over-treatment:

• Radiological incidentalomas[9]
• The use of antiarrhythmic drugs after myocardial infarction
that reduced arrhythmias but increased mortality
• Medically unexplained symptoms
• Functional disorders
 The use of hormone replacement therapy led to an
increased number of cases of breast cancers, stroke, and
thromboembolic events. It was also a failure in reducing
cardiovascular mortality. 
 Bodily distress syndrome
 Source: https://www.ncbi.nlm.nih.gov/books/NBK537222/#:~:text=These
%20preventive%20stages%20are%20primordial,complications%20of%20a
%20manifested%20disease.
Different control measures in the community
Disease

 Definition:

A pathogenic condition in which the normal functioning of

an organism or body is impaired or disrupted resulting in
extreme pain, dysfunction, distress, or death. Source of disease
Disease Control

 Definition:

Reducing the transmission of a disease to a level where it no

longer remains a “public health problem“.
Disease Elimination

 Reduction of incidence of a disease in a defined geographic

area to a predetermined very low level or to zero with
continued intervention
Disease Eradication

 Eradication is permanent reduction to zero of the worldwide

incidence of infection caused by a specific agent as a result of
deliberate efforts.
Different Control Measures in the
Community
Communicable Diseases
Immunization
Mass Drug Distribution
(Chemoprophylaxis)
 Dealwith the community rather than the individual and are
not necessarily dependent on the effective presence of signs
or symptoms.
 Purpose is to ensure the protection of a community against
infection or to treat members of the community where the
disease is highly prevalent, without submitting individuals to
a preliminary clinical or parasitological investigation.
Food Safety

 Keep Clean
 Separate Raw and Cooked Food
 Cook thoroughly
 Keep food at safe temperature
 Use safe water and raw materials
Safe Water and Sanitation

 Even today, approximately 1 person in 4

worldwide remains without proper access to safe
water and 1 in 3 has no access to appropriate
sanitation. This leads to high morbidity and
mortality from water-related diseases.
Handwashing
 Studies of diarrhoea show that washing one’s hands with soap and
water (where soap is not available one may use ash) reduces the
incidence of diarrhoea by up to 35%. Hands must be washed:
 After defecation
 After any direct or indirect contact with stools
 Before preparing food
 Before eating
 Before feeding children.
Sanitation
 Improvements in water supply and environmental sanitation will
reduce the incidence of diarrhoeal diseases in the long run. Even
where sanitation is poor, simple measures help ensure the safe
disposal of stools and must be followed – particularly in the
case of outbreaks of diarrhoeal diseases:
 No defecation on the ground – cover stools with earth (or use
trench latrines that are regularly covered).
 No defecation near a water supply.
 Disposal of children’s stools in toilets or latrines or buried in the
ground.
 Washing hands with soap (or ash) after any contact with stools.
 Buildand use latrines – a pit latrine 2 metres deep with an
opening of 1 metre by 1 metre can be used by a family of 5
persons for a period of 2 to 4 years. Latrines must be sited
downhill and away from sources of drinking-water (at least 30
metres), washed daily and regularly disinfected with cresol or
bleaching powder
Injection safety and sterilization

 Worldwide, unsafe injection practices and the overuse of injections combine to cause an estimated 8
to 16 million hepatitis B infections, 2.3 to 4.7 million hepatitis C infections and 80 000 to 160 000 HIV
infections each year.
Sterilization
The term sterilization describes the procedures aimed at the
complete elimination of any microbial life, including spores.
The methods used for sterilization include:
· Heat
· Ionizing radiation (X-rays and gamma rays)
· Chemical means (mainly formaldehyde).
Blood Safety

 Transfusion-transmitted infections can be eliminated or

substantially reduced through a strategy for blood safety. It is
the responsibility of governments to ensure a safe and adequate
supply of blood. This responsibility may be delegated to a non-
profit nongovernmental organization, but the blood transfusion
service should be developed within the framework of the
country’s health care infrastructure
Vector Control

 The main current options for vector control

include:
· Larval control
· Control of adult vectors
· Limitation of contact between vectors and
humans (personal protection measures).
 Source:
http://apps.who.int/iris/bitstream/handle/10665/67088/W
HO_CDS_CPE_SMT_2001.13.pdf?sequence=1
Non Communicable Diseases
Tobacco Demand Reduction measures

 Increased excise taxes and prices

 Smoke-free policies
 Large graphic health warnings/plain packaging
 Bans on advertising, promotion and sponsorship
 Mass media campaigns
Harmful use of alcohol reduction measures

 Restrictions on physical availability

 Advertising bans or comprehensive restrictions
 Increased excise taxes
Unhealthy diet reduction measures

 Salt/sodium policies
 Saturated fatty acids and trans-fats policies
 Marketing to children –restrictions
 Marketing of breast milk substitutes restrictions
 Source: https://apps.who.int/iris/rest/bitstreams/1473354/retrieve
Public Health Approach in the Control Of
Disease