Community Health Lecture

4
Unit 4: Communicable diseases
Lecturer: Mrs. C. Teixeira

Welwitchia Health Training Centre

October 2020
 Unit objectives
At the end of this unit, student should be able to:
 Define important concepts related to communicable diseases
 Explain the triad of communicable diseases
 Describe five stages through which communicable disease
develop
 List routes (portal of entry) by which micro-organisms enter
the body
 Identify the products of micro-organisms
 Differentiate forms of rashes and other skin lesions found in
infectious diseases
Unit objectives

 Discuss various communicable diseases that are important in

Namibia
 Describe various strategies in the prevention and control of
communicable diseases
 Define the concepts of epidemiology as related to
communicable diseases
 Identify risk populations to communicable diseases
 Differentiate between communicable and non-communicable
diseases
 Introduction

 We are living in the world full of potential infection

 Humans in particular are a constant source of micro-
organisms
 Although we live in this world of potential infection, the
environments are not always ideal for infection to take root
 Our body have certain natural defenses, such as our immune
system and
 The environment may not be ideal for the specific pathogen
to multiply
 Introduction cont’d

 In order to be able to identify and treat the

communicable diseases, it is necessary to understand the
following:
 Related concepts,
 Transmission,
 Various strategies in the prevention and control of CDs
 Defining the concepts of epidemiology
 Pre-knowledge

 Communicable diseases
 Chain of infection
 Modes of transmission
 Incubation period
 Isolation
 Quarantine
 Non-Communicable diseases
 Concepts related to communicable
diseases
Communicable diseases (CDs):
 Are those diseases spread by direct contact with an
infectious agent
Or
 Are diseases or illness that arises from transmission of an
infectious agent or its toxic waste products from an
infectious person, animal or reservoir to a susceptible
host either directly or indirectly through intermediate
plant or animal host, vector or environment
 Concepts related to communicable diseases

 Chain of infection: is a series of events or conditions that lead

to the development of a particular communicable diseases
 Modes of transmission: is the means by which the infectious
agent that causes the disease is transferred from an infected
person to uninfected one
 Disease: A clinical manifestation of an infection or syndrome
relating to an infectious agent or
 It is disorder of structure or function in a human, animal, or
plant especially one that produces specific symptoms or that
affects a specific location and is not simply a direct result of
physical injury.
Concepts related to communicable diseases
Incubation period: This is the time taken from when the infecting agent enters the
human body and clinical disease occurs. This may vary according to the immune
competency of the person exposed.
Isolation: Patient placement to reduce transmission-usually requires room or may be a
cohort or several similarly infected patients in one ward or area; transmission based
precautions are essential
Quarantine: Is a period of detention, used to separate and restrict the movement of
people or animals across the boarders or arriving from abroad; it is a restraint upon
the activities or communication of persons or the transport of goods designed to
prevent the spread of disease or pests', for a certain period of time usually
consisting of the maximum known incubation period of the suspected disease.
 Activity

 State reasons why disease outbreaks are

erupting/spread around the world?
 Reasons disease outbreaks are erupting
around the world

 More travel, trade, and connectivity

 Urbanization
 Pervasive poverty means outbreaks will be worse
 A warming climate or moist environments is helping fuel
more disease outbreaks
TRIAD OF COMMUNICABLE
DISEASES

 Organism
 Host
 Environmental factors
 TRIAD OF COMMUNICABLE
DISEASES
 Organism may be bacteria, virus, fungus, protozoon
 Host factors:
-General condition
-Immunity
-Carrier states
-Incubation periods
 TRIAD OF COMMUNICABLE
DISEASES
 Environmental Factors:
 -Humidity
 -Temperature
 -Sanitation
 -Overpopulation
 -Poverty
 -Vectors
Sickness will depend on :-

-Number of organisms
-Period of exposure
-General condition
-Nutritional status
 FIVE STAGES THROUGH WHICH COMMUNICABLE DISEASE DEVELOP

 The incubation period which extends from the time of

contamination of tissue until the first signs of infection
appear.
 Prodromal period extends from the appearance of the
first signs of indisposition until the first characteristic
signs and symptoms of the disease.
 FIVE STAGES THROUGH WHICH
COMMUNICABLE DISEASE
DEVELOP…..

 Fastigium period is the advanced stage extending from

the appearance of the first characteristic signs of the
disease and lasts for as long as the temperature remains
elevated.
 FIVE STAGES THROUGH WHICH
COMMUNICABLE DISEASE
DEVELOP……

 The defervescent stage starts from the time when the

patient improves whereby the temperature subsides and
rash disappears.
 The convalescent stage occurs after the infection has been
completely overcome.
 ROUTES BY WHICH MICRO-ORGANISMS
ENTER THE BODY – PORTAL of ENTRY

 Inhalation
 Ingestion
 Innoculation
 Penetration -through the skin or mucous membrane e.g.
streptococci
 Migration- through natural openings e.g. urethral/bladder
 Across natural barriers e.g. placenta
 Transfusion
 PRODUCTS OF MICRO-
ORGANISMS

 Toxins (poisons)
 Enzymes are secreted by some microbes.
 Gases produced by Clostridium perfringens
NB. Also microbes act as antigens which stimulate the
body to produce antibodies against them.
 FORMS OF RASHES AND OTHER SKIN
LESIONS FOUND IN INFECTIOUS
DISEASES

 Exanthem: External rash, e.g. Scarlet

fever.
 Enanthem: Rash on mucous membranes, e.g.
Koplik’s spots in Measles.
 Blebs or Bullae: Larger blisters, 2-4cm in
size, e.g. Impetigo.
 Ecchymosis: Large bruise or bleeding into the skin and tissues
 FORMS OF RASHES AND OTHER SKIN
LESIONS FOUND IN INFECTIOUS
DISEASES….
 Erythema: A red flush – varies in colour from
bright red to brown red, due to vaso-dilation.
 Macules: A discoloured area of the skin, not
elevated above the surface or depressed, e.g. in
Measles.
 Miliary rash: Resembling a millet seed. May be
beads of clear fluid on skin, sometimes microscopic
in size.
 Nodules: Lumps deeply set in the skin.
 Papule: A solid elevation on the skin, which is
easily felt e.g. in Chicken pox
 FORMS OF RASHES AND OTHER
SKIN LESIONS FOUND IN
INFECTIOUS DISEASES…..
 Petechiae:Rash associated with bleeding.
 Purpura:Bleeding into the skin.
 Pustule:A superficial blister, filled with pus.
 Vesicle: A small superficial blister, filled with clear
serous fluid, e.g. during development of smallpox and
chickenpox rash.
Scarlet fever picture
Koplik’s Spots in measles (tiny spots
inside the mouth, all over the cheeks
The Measles Rash
Ecchymosis picture
Herpes labialis or Cold Sores (Fever Blisters)
Impetigo picture
Erythema
Miliary rashes
Nodules
Skin papule
Penile papules
Petechiae/purpura
Pustule
Vesicle
CHARACTERISTICS OF RASH,
PRODROMAL SYMPTOMS, WHICH
ASSIST IN FORMING A DIAGNOSIS

 Site of onset.
 Duration of rash.
 Original appearance and manner of spread.
 Nature of eruption – i.e. hyper-pigmented, de-
pigmented, erythematous, macular, vesicular, etc.
 Grouping, patterning and distribution of the rash
as a whole.
 CHARACTERISTICS OF RASH,
PRODROMAL SYMPTOMS, WHICH
ASSIST IN FORMING A DIAGNOSIS…….

 Color of rash, e.g. rose spots in Typhoid fever.

 Presence of secondary changes, if any.
 Loss of sensation, e.g. Leprosy.
 Abnormal sensation, e.g. Pruritis.
Identify the modes of transmission?
 Modes/Routes of transmissions

 Contact transmission: is the most frequent modes of

transmission of infectious disease
 Can be divided into two groups
 Direct contact transmissions:
 Involves direct person to person contact(body surface to body
surface)
 Transmission through direct contact involves skin-to-skin
contact or direct contact with mucous membrane discharges
between the infected person and another person
Modes/Routes of transmissions

 Indirect contact transmission: Transmission of pathogens

occurs after touching an infected or colonized body part
contaminated object
 Example sharing patient care equipment between patients
without disinfecting articles after each patient use
 Using medical devices that are inadequately cleaned before
sterilization
 Sharing toys between children in paediatric units
 Not changing personal protective equipment (PPE) after each
patient use
Modes/Routes of transmissions

 Droplets transmission: The source person generates droplets when

coughing, sneezing or talking
 The droplets generated by the infected person is propelled through the air
for a short distance(1metre)
 And deposited on the person surroundings (surfaces)
 Or contaminates the host’s conjunctivae, mouth
 Droplets do not remain suspended in the air for long as they will fall by
gravity
 And therefore does not require special ventilation
 Common cold, Diphtheria, Influenza, Meningitis, Mumps, Pertussis
(whooping cough), Plague, Rubella, Strep (strep throat, scarlet fever,
pneumonia are some of diseases that transmit through droplet infection.
 Modes/Routes of transmissions

 Airborne transmission: Occurs when the infectious organism

is present in the air and is inhaled by a susceptible host during
respiration example H1N1, TB, Chickenpox, Influenza,
Measles and Smallpox
 It differ from droplet transmission in that it occurs by
dissemination of either airborne droplet nuclei
 or dust particles containing infectious agent(that remain
suspended in the air for longer period of time)
 Modes/Routes of transmissions

 Common vehicle transmission: this occurs when micro-

organisms are transmitted by contaminated items such as
food, water e.g. Cholera
 Vector borne transmission: Vectors such as mosquitoes,
fleas, ticks, cockroaches, flies, rats and other vermin
 Transmit micro organisms either by contact or during a
blood feed or bite
 Communicable diseases in
Namibia
Diseases transmitted by animals, vectors or zoonotic sources:
 Ancylostomiasis (Hookworm)
 Ascariasis (Roundworm)
 Ringworm of the skin (Tinea)
 Taeniasis (Tapeworm)
 Anthrax
 Ebola Fever
 Plague
 Schistosomiasis (Bilharzias)
 Communicable diseases in
Namibia
 Tetanus
 Tick-Bite Fever
 Tinea Pedis (Athlete’s foot)
 Trachoma
 Typhoid fever
 Communicable diseases in
Namibia
Sexual Transmitted Diseases:
 Chancroid
 Gonococcal Conjuctivitis (Opthalmia Neonatorium
 Gonorrhoea
 Hepatitis B and C
 Herpes zoster (shingles)
 Human immunodeficiency virus / Acquired immunodeficiency
syndrome
 Syphilis
 Trichomoniasis
 Communicable diseases in
Namibia
Diseases transmitted by humans:
 Amoebiasis
 Candidiasis
 Chickenpox
 Cholera
 Impetigo
 Influenza
 Communicable diseases in
Namibia
 Leprosy
 Tuberculosis
 Measles
 Meningococcal meningitis
 Parotitis (mumps)
 Pertussis (Whooping cough)
 Poliomyelitis
 Rabies
 EBOLA VIRUS DISEASE

Discuss Ebola diseases under the following heading

 Signs and symptoms
 Infecting agent
 Reservoir
 Modes of transmission and precautions
 Incubation
 Communicability
 Diagnosis
Ebola Fever:
Signs and symptoms:
 Acute suddenly onset with haemorrhage example
nose bleeds, haematuria, joint pains, high fever,
headache, muscle ache, abdominal pain, fatigue,
diarrhoea, chest pain, convulsions, shock, coma and
death.
Infecting agent:
 Filoviruses
 Arenaviruses
 Flaviviruses
 Bunyavirusis

Reservoir:
 Unknown African animal or bird species. Humans are
incidental hosts
Modes of transmission:
 An African zoonosis. Spread through direct or indirect contact. The
natural reservoir of the Ebola virus remains unknown

Precautions:
 Standard precautions
 Droplet precautions
 Isolate the patient
 Even if the patient has only suspected Ebola haemorrhagic fever, he
should be isolated in a private room with bath room and access restricted
 The patient becomes extremely contagious when the haemorrhagic phase
develops
Incubation: 2 – 21 days
Communicability: As long as viable virus is present in the blood
and secretions of the patient.
Diagnosis:
 Clinical signs and symptoms combined with a history of travel
to endemic area
 Laboratory confirmation: serological diagnosis(Elisa testing)
on the strength of antibody presence, or as polymerase chain
(PCR) (Viral present)
Tuberculosis

Most common signs and symptoms:

 Persistent cough for two weeks or more
 Haemoptysis (coughing up blood)
 Chest pain
 Dyspnoea (shortness of breath)
 Loss of appetite
 Loss of weight
Infecting agents:
 Mycobacterium tuberculosis
 Mycobacterium bovis
 Mycobacterium macroti
 Mycobacterium africanum

Incubation period: 2-4weeks could be shorter or longer

Standard precautions
 Cough hygiene
 Adequate ventilation
 Provision of Isoniazid preventative therapy
 Droplet precautions
 Immunization (BCG at birth)
Describe the various strategies of diseases prevention
Various strategies in the prevention and
control of communicable diseases

Three different levels of prevention of communicable

diseases are:
 Primary prevention of infection
 Secondary prevention of disease
 Tertiary prevention of disease
 Various strategies in the prevention and
control of communicable diseases

Primary prevention of infection:

 Aims to prevent a disease from occurring
 By targeting healthy individuals in the community
 Primary prevention can reduce both the incidence and
prevalence of a disease
 On personal level:
 Hand washing
 Applying good cough etiquette
 Good personal toilet habits
 General hygienic
 Various strategies in the prevention and
control of communicable diseases

 In the clinic:
 Triage clients
 Speed queuing
 Various strategies in the prevention and
control of communicable diseases

 Secondary prevention of disease

 Is usually applied after disease has occurred
 To prevent any further spread or complications in the client
him/herself
 Proper screening and prompt diagnosis
 Treatment to start immediately
 The goal of secondary prevention is to find and treat disease
early and encourage adherence to treatment and treatment
schedule.
 Various strategies in the prevention
and control of communicable diseases

 Tertiary prevention of disease

 The goal of tertiary prevention is to handle the symptoms of
a well – developed disease
 Aid the client’s recovery, returning him/her to adjust to
changes that can not be reserved example paralysis after
polio
 Risk populations to Communicable
Diseases (CDs)

 Children under the age of 5 years

 People with risk factors such as malnutrition, HIV
infection, Diabetic Mellitus, Cancer
 Old age people
Define epidemiology?
 The concept of epidemiology as
related to communicable diseases

 The concept “epidemiology” is derived from Greek

 “Epi” means on or among
 “demos” means people
 “logos” means science or theory
 Oxford Concise Medical Dictionary defined epidemiology
as:
 The study of the distribution of diseases and determinants
of diseases in populations
 The concept of epidemiology as
related to communicable diseases

 Epidemiology is the study of the distribution and

causes of ill-health in populations and the evaluation
of the effectiveness of health care
 Its goal is to: improve the health of human populations
 The concept of epidemiology as
related to communicable diseases

Epidemiology of communicable diseases:

 There are three factors involved in the transmission of
infection
 Sometimes called the triad of communicable diseases or
the epidemiological triad:
 An agent, reservoir or source of infection (eg an infected
person or contaminated water/food)
 The concept of epidemiology as
related to communicable diseases

 The mode of transmission (coughing droplets)

 A new host (the uninfected or susceptible client)
 Non – communicable diseases

Non-communicable diseases(NCDs):
 Are diseases that are no-infectious and therefore cannot be
transmitted from one person to the next by being in close
proximity to each other
 NCDs are also referred to as “man-made-diseases”
 Most of the important cause of developing an NCD is
leaving an unhealthy lifestyle
 Non-communicable disease
cont…
 It includes
 living a sedentary lifestyle;
 Using alcohol irresponsibly
 Smoking tobacco;
 Eating unhealthy food
 Becoming overweight and obese
 Living a stressful life
 Non-communicable disease
cont…
 However, it is also possible to develop NCD if you are
genetically predisposed to a particular condition
 NCD can also occur as part of the aging process
 Non-communicable diseases

Examples of non-communicable diseases:

 Hypertension
 Diabetic Mellitus
 Asthma
 Cardiac diseases
 Non-communicable diseases

Modifiable risk factors

 Addressing six modifiable risk factors will limit the
development of most NCD:
 Reduce / stop smoking tobacco
 Eat a healthy diet
 Maintain an acceptable body weight
 Lead a physically active life
 Stop using alcohol irresponsibly
 Manage stress levels
 Summary

 For one to differentiate between CD, forms of rashes

and other skin lesions found in infectious diseases
should be known.
 Addressing modifiable risk factors for NCD will limit
its development.
 Prevention is better than cure in both CD and NCD
 References

 Hantingh, S ., Dreyer, M., & Roos, S. (2013). Community Nursing: A South Africam
Manual. 4th ed. Oxford: University Press.
 Ketswe, KG., Naude, M., & Zungu, L. (2011). Basic Community Health Nursing.2nd
edition. Pearson: Cape Town
 Clark, M Jo. (1999). Nursing in the Community. 3rd ed. Aplleton & Lange: United State of
America
 MoHSS. (2015). Infection prevention and control guidelines. 2 nd edition: Namibia:
Windhoek
 Internet search
 Nzimande, P.N (2011). Communicable Diseases in the African Continent. Albert's
Publishers: 27th impression. September 2011.Natal