INFECTIOUS DISEASES

EPIDEMIOLOGY study of occurrences and distribution of diseases as well as the distribution and determinants of health states or events in the specific population and the application of this study to the control of health problems. backbone of the prevention of the disease. Epidemiologist a physician or medical scientist who studies the INCIDENCE, PREVALENCE, SPREAD, PREVENTION, AND CONTROL of diseases in a community or a specific group of individuals. Concerned with the WHO, WHAT, WHERE, WHY, AND HOW of infectious diseases. Concerned not only with deaths, illness and disability, but also with more positive health states and with the means to improve health. They develop ways to prevent, control or eradicate diseases in the population. EPIDEMIOLOGIC TERMINOLOGY Communicable Diseases diseases transmissible from human to human Contagious diseases - communicable disease that is easily transmitted from one person to another. Zoonoses/Zoonotic Diseases - infectious diseases that humans acquire from animal sources Incidence Rate - refers to the number of new cases of that disease in a defined population over a specific period. Morbidity Rate - refers to the number of new cases of a particular disease that occurred during a specified period of time per specifically defined population. Mortality Rate - the ratio of the number of people who died of a particular disease during a specified period per a specified population. PREVALENCE Period prevalence- the number of cases of the disease existing in a given population during a specific period Point prevalence the number of cases of the disease existing in a given population at a particular moment Period prevalence- the number of cases of the disease existing in a given population during a specific period Point prevalence the number of cases of the disease existing in a given population at a particular moment Patterns of Occurrence and Distribution of Diseases Sporadic Diseases one that occurs only occasionally within a population or a given area Endemic Diseases- diseases that are always present within the population of a particular area eg. Schistosomiasis in Leyte and Samar

Filariasis in Sorsogon Epidemic Diseases- outbreak , greater than the usual number of cases of a disease in a particular region, on a short period of time Pandemic diseases- disease that is occurring in epidemic proportions in many countries simultaneously sometimes worldwide eg. AIDS, TB

INFECTIOUS PROCESS Microorganisms include the following classifications: bacteria, viruses, fungi, algae, yeasts, and protozoa. These organisms are too small to be seen by the unaided human eye. They are found in the soil, in the water, and on plants and animals. In fact, billions are found in humans on the skin and in both the nasal and intestinal tracts. Although most microorganisms live in harmony with the human body, some called pathogens can infect the body and cause disease. Infectious diseases range from mild illnesses, such as a cold, to fatal illnesses, such as AIDS. We occasionally come into contact with people or animals that are infected and thus expose ourselves to the pathogens of their diseases. In fact, our environment is such that everyday we live with some risk of exposure to diseases. Some individuals, because of the work they do, are at risk for occupationally acquired infection. For this reason, special policies and procedures have been developed to minimize health risks. The infectious disease process is defined as the interaction between the pathogenic microorganism, the environment, and the host. The process may be thought of as a circular chain with six links. The following story illustrates the chain. The chain begins with the existence of a specific pathogenic microorganism.      Pathogenecity ( ability to cause disease) Virulence ( disease severity) and invasiveness Infective dose ( number of organisms needed to initiate infections) Organism s specificity (host preference) antigenic variations Elaboration of toxins The second link is the reservoir, an environment where the pathogen can survive.

Types of Reservoir Human Animal Non animal The third link is the means of escape from the reservoir. Respiratory tract Gastrointestinal tract Genito-urinary tract Open lesions Mechanical escape Blood The fourth link is the mode of transmission from the reservoir to the host.

Modes of Transmission Contact Transmission Vehicle Route Airborne Transmission Vectorborne Transmission Contact Transmission Direct Contact - person-person Indirect Contact - usually inanimate objects Droplet Contact - from coughing, sneezing, or talking by an infected person Vehicle Route (through contaminated items) Food salmonellosis Water shigellosis Drugs bacteremia resulting from infusion of a contaminated infusion product Blood Hepa B, or non A, non B hepatitis Body fluids Fomites Airborne Transmission Droplet Nuclei ( residue of evaporated droplets that remains suspended in air) Dust particles in the air containing the infectious agents Organisms shed into the environment from skin, hair, wounds or perineal area Vectorborne Transmission Via contaminated or infected arthropods such as flies, mosquitoes, ticks and others.

The fifth link is the means of entry into the host. o Respiratory o GIT o GUT o Direct infections of mucous membranes/skin o Blood entry o Placental entry And the last link is the host's susceptibility to the pathogenic microorganism.

Risk factors in Acquiring Infectious Diseases Age, sex, genetic composition of host Nutritional status, fitness, environmental factors General physical, mental and emotional health Absent or abnormal immunoglobulins Status of Hematopoietic system Presence of underlying disease Patient treated with certain antimicrobials, corticosteroids, irradiation, or immunosuppressive agents

For an infectious disease to occur, each link in the chain must be connected. a. b. c. d. If even one link of the chain is missing, it interrupts the process, and no infection will occur. Here the chain is broken at the point of host susceptibility. Here the mode of transmission breaks the chain of infection. Before looking at the infectious disease process for several different illnesses, see if you can correctly answer the question that follows. The chain of infection illustrates: Contact with a pathogen means you will become fatally ill. Every link in the chain must be broken to prevent infection. You can prevent infection by interrupting the process anywhere in the chain. All microorganisms are hazardous to your health.

Hepatitis B Virus The microorganism known as Hepatitis B Virus (or HBV) causes an inflammation of the liver. This can result in illnesses such as chronic hepatitis, cirrhosis of the liver, and liver cancer. Because the virus is present in the blood or body fluids of a person with the Hepatiis B Virus, it is termed a bloodborne pathogen. Hepatitis B Virus is a serious health concern for any employee whose work responsibilities bring them in contact with blood or body fluids. Human Immunodeficiency Virus (HIV) is another bloodborne pathogen. This life-threatening virus compromises the body's immune system. Early symptoms may be similar to those of the flu. During later stages of the disease, the body is incapable of warding off other infections which frequently prove fatal. Penetration into the Bloodstream Bloodborne pathogens are transmitted when an individual comes in contact with an infected person's blood or body fluids. However, contact alone does not mean infection will result. Pathogens must enter the bloodstream to cause infection. In the workplace, an employee may be exposed to Hepatitis B Virus or HIV when infected blood or body fluid is allowed to enter the body by means of penetration. This can occur through: a needlestick a cut or break in the skin contact with mucous membranes such as those of the eye, nose, and mouth Preventive Measures To interrupt the chain of infection for HepatitisVirus or HIV, use the following preventive measures: Wash your hands to remove infectious organisms before they can enter the body. Wear gloves as a barrier when handling blood and other body fluids. Wear face protection when work tasks include the potential for spraying or splattering of body substances.

Use caution when handling needles and other sharp objects. They can penetrate the skin and create entries for pathogens. The safest way to handle contaminated needles is to place them directly into a labeled sharps container without recapping. This practice minimizes your risk of a needle stick. If your work requires you to recap needles, you will want to learn a special one-handed technique. Finally, receive a Hepatitis B vaccination to decrease your susceptibility to the disease. Presently, no vaccine for HIV is available.

Preventing infection from bloodborne pathogens involves: a. Vaccination against HIV. b. Preventing blood or body fluids from contacting your skin or mucous membranes. c. Washing your hands before beginning work. d. Wearing gloves as a barrier against needlesticks. Mycobacteria (tuberculosis) Another group of pathogens known as Mycobacteria cause the chronic lung disease tuberculosis, also known as TB. Although human beings are the main reservoirs, other primates, cattle, and swine can also be reservoirs. Tuberculosis is transmitted primarily through the air. A person with an active case of the disease discharges the microorganisms by coughing or sneezing. Inhalation Exposure occurs when others breathe the contaminated air. Once inhaled, the pathogen may lodge in lung tissue and produce lesions. Preventive Measures How then can employees protect themselves from airborne diseases such as tuberculosis? Wear respiratory protection when working with people and animals in isolation for tuberculosis. Also, work within a laminar flow biological safety cabinet when manipulating cultures and specimens that may contain tuberculosis pathogens. Tuberculosis is an airborne disease: a. Transmitted by plants. b. That used to be a health concern, but is not relevant in the workplace any longer. c. Prevented by wearing a respiratory mask or working in a biological safety cabinet to prevent inhaling contaminated air. d. Prevented by holding your breath. Salmonella The next disease, salmonellosis, is caused by a group of bacteria called salmonella. The most common manifestation of this disease is acute gastroenteritis or intestinal inflammation. Both animals and humans are reservoirs for the salmonella organism. Diseased animals and humans discharge large numbers of salmonella in their feces.

Ingestion Infection results from ingesting (i.e., through the mouth) salmonella organisms. Employees may be exposed to these organisms when handling soiled diapers and linens, fecal specimen containers, or culture plates used to isolate salmonella. Preventive Measures You can guard against salmonella exposure by incorporating the following practices into your daily routine. As a first line defense against ingesting microorganisms, don't put anything in your mouth while at work. Wear gloves when your hands will likely come in contact with contaminated materials. Wipe counters with a disinfectant after performing tasks with materials that may be contaminated. And, thoroughly wash your hands after handling contaminated items. Even microscopic amounts of fecal matter may contain millions of salmonella organisms. Preventing ingestion of salmonella organisms involves: a. Not washing your hands if they look clean. b. Wearing gloves, washing hands, and disinfecting work surfaces. c. Not eating right after work. d. Putting only your own pencils and pens in your mouth. In summary, the infectious disease process typically consists of three routes of entry: PENETRATION into the bloodstream, exemplified by Hepatitis B Virus and HIV; INHALATION of airborne organisms, illustrated by Mycobacteria; and INGESTION of organisms, demonstrated by salmonella. As seen in the examples, occupational exposures and consequent infection can occur not only as the result of accidents but also during the performance of routine work activities. Therefore, it makes good sense to plan your work with regard to the basic principles of biosafety. The best strategy to decrease your risk of infection is to: a. Enhance your susceptibility through proper nutrition. b. Not worry about things you cannot see. c. Rely on vaccination. d. Break the chain of infection by using several preventive measures. PUBLIC HEALTH AGENCIES WHO( World Health Organization) - a specialized agency of the UN - Promotes technical cooperation for health among nations - Carry out programs to control and eradicate diseases CDC ( Centers for Disease Control and Prevention) - Assist state and local health departments in the application of all aspects of epidemiology

NOSOCOMIAL INFECTION Those that are acquired within hospitals or other healthcare facilities Also known as hospital-acquired infection ASEPSIS Absence of pathogens Medical Asepsis- clean technique, involves procedures and practices that reduce the number and transmission of pathogens. Surgical Asepsis- sterile technique, includes practices used to render and keep objects and areas sterile Contamination A condition indicating the presence of pathogens( called contaminants) How does Nosocomial Infections Occur? Indiscriminate use of broad spectrum antibiotic. Neglect of aseptic technique and safety precautions. Lengthy complicated surgery Overcrowding hospitals Shortage of hospital staff. Use of anti-inflammatory and immunosuppresant agents Use of indwelling medical devices a. IV fluids b. Indwelling catheter c. NGT d. Thoracostomy e. Tracheostomy tube f. Condom catheter g. Gastrostomy/Jejustomy Organisms Causing Nosocomial Infections Staphylococcus aureus Escherichia coli Enterococcus Pseudomonas Prevention and Control of Nosocomial Infections Increase resistance by immunization Segregate Isolate (Place patient in separate room) Treat those with contagious infection to prevent the spread of pathogens Identify and control potential reservoir and vectors of infectious diseases Institute effective sanitation measures to control diseases transmitted to water, sewage, and food.

IMMUNIZATION Induction or introduction of specific protective antibodies in a susceptible person or animal or the production of cellular immunity in such person or individual IMMUNITY The condition of being secured against any particular disease particularly the power which a living organism possesses to resist and overcome infection Ability or power to resist specific disease ACTIVE IMMUNIZATION Immunization that has been produced by natural or acquired stimulation so that the body produces its own antibodies Produced by clinical or subclinical infection, by vaccination with lived or killed microorganisms or their antigens, or by inactive vaccines and toxoids. The organisms have been treated by heating or by chemical inactivation to destroy their harmful properties w/o destroying their ability to stimulate antibody protection Active immunizations that are available for adults include tetanus and diptheria toxoid; adulttype tetanus toxoid, and vaccines for influenza, mumps, polio virus, measles, rubella, hepa B, and pneumococcal pneumonia. Vaccines are also available for cholera, plague, rabies, typhoid, typhus,yellow fever and small pox PASSIVE IMMUNITY A state of relative temporary protection produced by the infection of serum containing antibodies which have formed in another host. Types of Preparation for Passive Immunity Immunoglobulin Specific immunoglobulin ( for specific illnesses) Human immune serum globulin with a known antibody content Animal anti serum/ antitoxin FULLY IMMUNIZED CHILD Newborn- BCG 1 mos- DPT, OPV 2 mos- DPT,OPV, Hep B 3 mos- DPT, OPV, Hep B 9 mos- Measles vaccine Two Kinds of Immunity Natural inborn a. Passive b. Active Artificial exposure to vaccine, exposure to agents a. Passive b. Active

Natural Active exposure to an infectious disease a. Subclinical Immunization b. Recovery from disease Passive receiving maternal antibodies a. IgG- placental antibodies b. IgA- breastmilk Artificial Active introduction of antigen (ex., toxoid, vaccine) Passive introduction of antibody (human serum, animal serum) Human Defenses Against Diseases First line of defense a. Skin b. Respiratory tract c. GI tract d. Genito-urinary tract a. b. c. d. Second line of defense Fever production Iron defense Cellular secretions Blood proteins

TRIAD OF DISEASE CAUSATION Causative agent a. Infectivity b. Infective dose c. Pathogenecity d. Virulence e. Antigenecity Environment medium or culture for the continuous survival of organisms Host Human Plants Animals ASSIGNMENT Find out who is the Father of Handwashing Who discovered Penicillin Give and explain the 3 methods/means to destroy microbes Risk factors for infection Signs and symptoms of infection 4 Stages of Communicable Diseases Incubation Period the period when the pathogens invade the body until the the first signs and symptoms.

appearance of

Prodromal Period the period from the appearance of the first sign and symptom to the appearance of pathognomonic signs and symptoms. Stage of Illness pathognomonic signs and symptoms of the disease are manifested by the patient and observe by the others Convalescence recovery, treatment, supportive care

Prevention of Communicable Diseases Health in the hands of the people by the year 2020. Health Teaching Mother s Class/Father s Class EO 51 Community Assembly Trimedia EPI-PD 996 Environmental Sanitation Law PD 856 Anti-Littering Law PD 825 Proper Garbage Disposal Clean Air Act Case finding Diagnose early Prompt treatment Prophylaxis Rehabilitation Limitation of Disability CONTROL OF COMMUNICABLE DISEASES Reporting Epidemiological Investigation Case Finding/ Diagnosis/ Prompt Treatment Isolation/Quarantine Disinfection/Disinfestation Thank You!