Public Health -

Community Prevention of Infections

Tutorial Group D

Abigail Lindo
Surya Khanth Krishnan Melonie Morgan
Celestine Lawal Druvkumar Patel
Bianca Lewis
Joel Lightbourn
 Objective A

Influenza
List and describe infections
Aedes aegypti mosquito
(arboviral, influenza, covid)
in the region

SARS-CoV-2 SARS-CoV-2
Aedes aegypti mosquito

These are infections caused by

arthropods (e.g. mosquitoes and ticks)

Common arboviral infections:

- Dengue Virus
- Yellow Fever
Arboviral -
-
Chikungunya
Zika Virus
Infections Common Vector:
- Aedes aegypti mosquito
Dengue Virus or “Break Bone Fever”
4 Serotypes
DENV-1, DENV-2, DENV-3, DENV-4

Vectors
Aedes aegypti + aedes albopictus mosquitoes

Aedes albopictus mosquito

Aedes aegypti mosquito

Classic Dengue Fever
Symptoms

- High fever (40°C / 104°F)

- Headache, retro-orbital pain
- Nausea and vomiting
- Weakness and malaise
- Myalgia, arthralgia, ostealgia Rash seen in dengue virus infection - A macular or
maculopapular rash which becomes diffusely
(hence “break bone fever”)
erythematous, usually covering the whole body
- Lymphadenopathy
sparing islands of skin
- Rash
Dengue Hemorrhagic Fever (DHF)
Symptoms
- Severe abdominal pain, tenderness
- Persistent vomiting
- Bleeding from the nose or gums
- Blood in the stool, urine or vomit
- Irritability or restlessness
- Fatigue
- Early signs of shock (restlessness, cold
According to the WHO, the criteria needed to classify
a dengue infection as DHF include:
- Fever
- Hemorrhagic manifestations
- Thrombocytopenia
- Evidence of vascular permeability (e.g. elevated
haematocrit, hypoalbuminemia + pleural
effusion or ascites

clammy skin, rapid weak pulse + narrowing

of pulse pressure)
Dengue Shock Syndrome (DSS)

This occurs when a patient meets the four DHF criteria and exhibits evidence of
circulatory failure which manifests as:

- A rapid, weak pulse and narrow pulse pressure

Or

- Hypotension for age, restlessness and cold, clammy skin

Dengue in Children & Pregnancy

Symptoms in children are similar to other common childhood infections. Patients should
seek a healthcare provider if the following symptoms are noted:

- Fever or a low temperature (less than 36°C or 96.8°F) with any of the following:
- Sleepiness, lack of energy, or irritability
- Rash
- Unusual bleeding (gums, nose, bruising)
- Vomiting (at least 3 times in 24 hours)

In pregnancy, an infected mother can pass the virus to the fetus. This can cause
complications such as post-partum hemorrhage, low birth weight, premature birth and
even death of the fetus.
 Treatment

- Relieve pain and fever with acetaminophen

- Warn patients to avoid aspirin and other NSAIDS as they increase the risk of
hemorrhage
- Ensure the patient is kept hydrated
- Assess haemodynamic status frequently (check heart rate, blood pressure,
pulse pressure and urine output) and administer IV fluid replacement
therapy where necessary
- Perform haemodynamic assessments, platelet counts and baseline
hematocrit testing
Yellow Fever
Symptoms Severe Yellow Fever Symptoms

- Sudden onset of fever, chills - High fever

- Severe headache - Jaundice
- Generalised myalgia - Bradycardia and shock
- Back pain - Hemorrhagic manifestations
- Nausea and vomiting - Liver and kidney failure
- Fatigue and weakness
N.B. As much as 50% of patients who
develop severe symptoms die

Patient with yellow fever

Yellow Fever in Children & Pregnancy

- Not linked to birth defects.

- Vaccine can be given to infants traveling to an area where the virus is endemic
or where the vaccine is required for entry.

- Serious adverse reactions includes vaccine associated viscerotropic disease.

- Contraindications
Treatment

- Patient should be kept hydrated

- Acetaminophen given to reduce pain and fever
- Aspirin and other NSAIDS should be avoided as they increase the risk
of bleeding
- In the event of kidney failure, provide dialysis
- Treat hypotension with fluid resuscitation and vasoactive drugs
(dopamine)
Chikungunya (CHIKV)
Symptoms
- Arthralgia with or without arthritis, lasting
- Sudden onset of fever, chills
weeks, months or years
- Headache
- Conjunctival suffusion and mild photophobia
- Nausea and vomiting
- Rash
- Abdominal pain
- Myalgia

Chikungunya virus under electron microscope

An erythematous macular or
maculopapular rash mainly on the
torso and arms is seen in
chikungunya
CHIKV in Children & Pregnancy

- You may see febrile seizures in children with CHIKV due to

the high fevers. Children are also more likely to develop the
rash than adults.

- CHIKV can be passed from mother to child during

pregnancy, but is not associated with congenital
abnormalities or increased risk of maternal complications.
Treatment

- Patient should be kept hydrated

- Acetaminophen given to reduce pain and fever

- Aspirin and other NSAIDS are not recommended unless dengue has

already been ruled out

Zika Virus (ZIKV)
Symptoms
- Conjunctivitis
- Fever
- Malaise
- Headache, eye pain
- Fatigue
- Arthralgia
- Rash
- Myalgia

Zika virus under electron microscope

A fine maculopapular rash found
on the face, trunk and extremities,
which can appear on the palms
and soles is seen in zika virus
Zika Virus in Children & Pregnancy
- Most children infected with zika virus are asymptomatic or have mild illness.
- Can be passed from mother to child. There are no associated maternal
complications, however, fetal loss increases in zika virus. ZIKV infection in
utero is associated with congenital microcephaly.
- Pregnant women are also encouraged to be careful during sexual intercourse as
zika virus can be spread through body fluids such
as semen, even if the infected person is asymptomatic.
Treatment

- Patient should be kept hydrated

- Acetaminophen given to reduce pain and fever

- Aspirin and other NSAIDS are not recommended unless dengue has

already been ruled out

Influenza What is Influenza (Flu)?
According to the CDC, Flu is a contagious respiratory illness
caused by influenza RNA viruses that infect the nose, throat, and
sometimes the lungs.
Influenza
Serotypes
There are four influenza serotypes: A, B, C, D
● Influenza A - infects humans and other animals
● Influenza B and C - infect humans
● Influenza C virus - very mild illness, does not cause epidemics
● Influenza D virus - primarily affects cattle

Hosts
The natural hosts of the influenza viruses are:
- Wild waterfowl
- Shorebirds
- Gulls,
However, they can infect a wide variety of birds and mammals,
e.g. chickens, turkeys, swine, horses and humans. These hosts are
called aberrant hosts.
Types of Human Flu Viruses
Two main types:
- Type A
- Type B
These viruses are responsible for the seasonal flu epidemics every year. However, Influenza A viruses are the only
ones known to cause flu pandemics.

Influenza A Influenza B
- Divided into subtypes based on proteins on the surface of - Not divided into subtypes, but instead
the virus: hemagglutinin (H) and neuraminidase (N). are further classified into two lineages:
- 18 different hemagglutinin subtypes and 11 different B/Yamagata and B/Victoria.
neuraminidase subtypes
- Current subtypes of influenza A viruses that routinely
circulate in people include: A(H1N1) and A(H3N2).
Symptoms
- Fever*
- Cough
- Sore throat
- Runny or stuffy nose
- Muscle or body aches
- Headaches
- Fatigue
- Vomiting/Diarrhoea**
 Complications

- Pneumonia
- Sinus infections
- Ear infections
- Worsening of chronic illness
Prevention and Treatment

- Yearly flu vaccine

- Remain hydrated
- Rest
- Supportive care to control the symptoms
- DPH
- Acetaminophen or Ibuprofen to reduce fever
Antigenic Drift
The H and N proteins of the Influenza virus can undergo minor changes or mutations,
leading to new strains. This is called “Antigenic Drift”.

N.B. Drift is an ongoing process and is one way the virus evades your body’s immune
system.
Influenza A Evolution
● 1918 (H1N1) → “Spanish” Flu pandemic (described as the “the greatest medical
holocaust in history”)
● 1957 (H2N2) → “Asian” Flu pandemic
● 1968 (H3N2) → “Hong Kong” Flu pandemic
● 2009 (H1N1) → “Swine” Flu pandemic
COVID
 SARS CoV 2 / COVID- 19 / NCoV 19
Coronavirus Family
Single stranded positive sense RNA viral
Capable of mutation
Coronaviruses family (SARS, MERS) mostly causes common cold. ( ⅓ of the common cold cases are are
causes by these viruses)
Covid 19 pandemic causing variant is believed to have zoonotic origin i.e bats
SARS CoV2 / COVID 19 is the successor to SARS CoV 1 outbreak during 2003, but is more virulent than the
2003 pandemic caused viral.
With the current ongoing covid19 pandemic, there are around 250 million people affected and with 4.9
million succumbing to the virus. Death in children due to covid is less than 0.3% of total deaths.
Transmission
- Spreads via close contact and interaction with virus containing aerosols or droplets, particularly
contact with eyes, nose or mouth
- Spread in poorly ventilated areas
- R value for Covid 19 is 2.4-3.4
- Asymptomatic + presymptomatic patients can still be infectious
- SARS Cov 2 gains entry into pneumocytes through ACE 2 protein
- Places of High Risk Transmission:
➢ crowded places,
➢ confined places with poor ventilation
➢ close setting environment
SYMPTOMS ACUTE COURSE and
COMPLICATION
Fever
Respiratory failure-ARDS
Cough that becomes productive
Cardiovascular complication-
New loss of taste or smell
Arrhythmia, Shock
Changes in the skin, such as discoloured areas on the feet and hands
Neurological complication-
Sore throat Encephalopathy, Stroke,
Gastrointestinal symptoms, such as nausea, vomiting, belly ache, diarrhea Seizures

Chills Thromboembolic
Complication- DVT, PE
Muscle ache, extreme fatigue and severe headache

Nasal congestion Inflammatory complication

Secondary Infections- Fungal

Mucormycosis
COVID 19 IN PREGNANT WOMEN
● Pregnant and recently pregnant people have higher
chances to get severely ill with covid 19.

● Serious illness mean requires to be hospitalised into ICU

and using ventilators to help to breath. Factors that Increases the Risk

1. Underlying Medical Conditions

● Effect on Pregnancy outcome - preterm birth and with 2. Older than 25 yrs
3. Working in crowded place
other worse outcome like pregnancy loss. 4. Living in the community that has
high number of cases
5. Unvaccinated
● Preterm infants have poorly developed lungs and have
increased chance of getting infected with covid 19.
COVID 19 IN INFANTS AND CHILDREN
● During the first wave in 2020, children made up 8% of all covid cases. Number of cases in
children has risen by 10% in 2021
● Children typically have milder symptoms
● Infants have higher risk of severe illness
● Newborns can be infected during birth + by exposure to infected caregivers
● Children with comorbidities can become seriously ill from covid infection
● Why children have milder symptoms is unknown, symptoms tend to be those of a mild cold or
may go unnoticed
 COMPLICATIONS
MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN MIS-C

- MIS-C is a serious condition linked with Covid 19

- Affects organs and tissues such as - heart, lungs, liver, Signs and Symptoms of MIS-C
kidney, GI tract, CNS, eye, skin etc,. ● Fever that lasts 24 hours or longer
- In the USA, MIS-C is more prevalent in Latino and African ● Vomiting
● Diarrhea
American children
● Pain in the stomach
- Emergency warning signs:
● Skin rash
● Feeling unusually tired
Confusion, turning pale or blue coloured lip or nail, difficulty
● Fast heartbeat
in breathing, unable to stay awake, stomach pain. ● Rapid breathing
● Red eyes
Tx: Usually supportive
● Redness or swelling of the lips and tongue
● Redness or swelling of the hands or feet
● Headache, dizziness or lightheadedness
● Enlarged lymph nodes
 DIAGNOSIS AND TREATMENT
DX:

● Nasal swab- for PCR test/ Ag Ab detection or Phlegm collection for determining the presence of covid antibodies.
● Symptoms are usually mild in children, radiological examinations are recommended only in severe cases.
● CXR- Consolidation and ground glass opacity
● CT Scan- ground glass opacity, thickened pleura, thickening of interlobular septum
● USG- only if CXR and CT not available.

TX:

● Usually treatment is not required for mild cases in children.

● Remdesivir is recommended in children >or= 12 age with risk of developing severe illness and emergent requirement of
supplemental O2 and in children >or= 16 age
● Other tx is usually supportive
● Children also have long term effects like feeling tired, joint pain, unable to concentrate etc. This could be present for a
month or two after the covid infection.
 Objective B

Describe strategies geared

toward prevention
Prevention
Disease prevention involves strategies that are individual and population based that aim to
minimize the impact of diseases and the associated risks.
● Primary Prevention: Actions that focus on avoiding the manifestation of a disease
● Secondary Prevention: Early detection to improve the chances for positive health
outcomes
● Tertiary Prevention: Management of disease after diagnosis with the objective of
minimizing impact on the patient or terminating the disease
Health Education and Health Promotion

Health Education - a combination of learning experiences that help us to achieve

voluntary actions which are supportive of health.

Health Promotion - the process of enabling people to increase control over the
determinants of health and thereby improve their health.
Arbovirus Prevention Strategies
● Use of nets
● Cover any container/material capable of
holding water
● Proper garbage disposal
● Empty tyres and vases that can function
as mosquito breeding grounds
● Bore holes in outside containers
● Use repellents
● Wear long lightly coloured clothing
● Vaccination
Influenza Prevention Strategies
● Practice good hygiene
○ Frequent handwashing
○ Avoid touching eyes
○ Cover mouth when coughing/sneezing
○ Avoid sick people
○ Stay home when sick
● Vaccination
COVID-19 Prevention Strategies
● Vaccinations
● Social Distancing
● Mask Mandates
● Prevention of Large Gatherings - schools, churches, night clubs, gyms, sports events
● Restriction of Freedom (Lockdown / Curfews)
● Penalties/Fines
● Travel Restrictions and Regulations
● Quarantine Requirements
● Proper Hygiene - Hand washing, Sanitization, cleaning of Surfaces
● Temperature Checks
● COVID Testing Requirements
● Contact Tracing
● Hospital Resource Management (Education of Staff, Infrastructure, Organization)
 Objective C

Describe barriers to
implementation
- Infectious diseases are caused by organisms such as bacteria, viruses, fungi,
etc., and can be passed from person to person, therefore, initiatives like
public health and social measures are helpful in limiting the quantity of
contaminations

- Research has been done to determine barriers to implementation of

community preventative measures against infectious diseases.
1. Lack of safety commitment from the public

● Safety commitment - self driven adoption of WHO public health measures against
infectious disease transmission
● Public safety commitment boosted by proper knowledge and public awareness
● Lack of public commitment leads to increased transmission rates
2. Poor safety culture

● A safety culture is a culture of

government that puts a strong
degree of emphasis on
protection principles, values and
attitudes - and these are shared
by most of the citizens in the
region
3. Lack of government support in communities

● Prevention strategies are largely dependent on the involvement of the

government

● For example, with the COVID-19 virus, implementation of lockdown days is

integral in reducing transmission of the virus which can only be put in place by
the government.
4. Lack of strict adherence to WHO regulations

The first step is the education of the public

For example, for mosquito borne diseases, it is often advised

that stagnant water is emptied around the house. However,
without knowledge of such considerations, people won’t act
accordingly.
5. Lack of medical facilities at the community level

Medical resources are scarce in the Island overall. So when

focusing on infectious diseases such as COVID where there is need
for vaccines, vaccination sites, testing facilities etc and in medical
facilities, shortage of personal protective equipment, ventilators and
oxygen will also exacerbate the issue.
6. Lack of government policies

It is a necessity for the government to put in place effective

legislation for the prevention, treatment and control of harmful
diseases. The government must also ensure that the information
shared with the public about these diseases is accurate, timely and
in keeping
with human rights principles.
7. Shortage of front line workers

Implementation of the public health measures to control and

prevents infection ( Covid-19) in community was challenged
by the limited number of community health workers.
8. Financial Barriers in community

During pandemic community members could face to

different different financial problems
like, buying food during
stay home time, buying
face mask ,etc.
9. Informational & Education related Barriers

Lack of proper source (Like TV, News Paper) in community

to get the information about infection and In some
community personals are not educated so they even can
not read the information regarding infection.
10. Negative Perception in community

The insufficient understanding of the diseases and the

value of seeking the public measures results from the
community to have an improper perception about the
disease and the public health measures for controlling
and preventing infection. “Like some people have a
thinking that because this area is hot and viru s could not
tolerate the heat”
 11. Resistance to change

In the continuous implementation of the measures was mainly

affected by the difficulty of community to get out of the long
standing habits and adopt the public health measures.
Ex.- During covid 19 pandemic
people had issues with wearing
continue face masks
12. Negligence in community

This negligence not because of the lack of information but

they tired of doing again and again. Like in early stage of
covid 19 pandemic most of community members were follow
all Precaution procedures but now
in late stage of pandemic
most of are careless.
13. Religious Norms

Religious related norms in the community were identified as

the major barriers to effectively implement public health
measures against the pandemic. In the community they
believe that pandemic is happened due to the evil act of the
human race and the solution is only
from God than the public
health measures.
References
● Centers for Disease Control and Prevention. (2021, September 21). Flu symptoms & complications. Centers for Disease Control and
Prevention. Retrieved October 21, 2021, from https://www.cdc.gov/flu/symptoms/symptoms.htm.
● Centers for Disease Control and Prevention. (2021, September 21). Understanding flu viruses. Centers for Disease Control and
Prevention. Retrieved October 21, 2021, from https://www.cdc.gov/flu/about/viruses/index.htm.
● Shao, W., Li, X., Goraya, M. U., Wang, S., & Chen, J.-L. (2017, August 7). Evolution of influenza A virus by mutation and Re-
Assortment. International journal of molecular sciences. Retrieved October 21, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578040/.
● Centers for Disease Control and Prevention. (2019, November 18). Types of influenza viruses. Centers for Disease Control and
Prevention. Retrieved October 21, 2021, from https://www.cdc.gov/flu/about/viruses/types.htm.
● Centers for Disease Control and Prevention
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html
● https://www.mayoclinic.org/diseases-conditions/mis-c-in-kids-covid-19/symptoms-causes/syc-2050255 0
● https://www.covid19treatmentguidelines.nih.gov/special-populations/children/
● Health promotion and disease prevention through population-based interventions, including action to address social determinants
and health inequity. World Health Organization. (2021). Retrieved from
http://www.emro.who.int/about-who/public-health-functions/health-promotion-disease-prevention.html.