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CONTROL AND

PREVENTION OF
COMMUNICABLE
DISEASES
PRECIOUS DIANNE E. BARDON, RMT

- COMMUNICABLE VS
NONCOMMUNICABLE
- GERM THEORY
- PATHOGEN
- SUSCEPTIBILITY
- PATHOGENICITY

IMMUNE SYSTEM
INNATE IMMUNITY
- PHYSICAL (ANATOMICAL BARRIERS)
- CELLULAR
- CHEMICAL
ACQUIRED IMMUNITY
-HUMORAL (B-CELLS & AB)
- CELLULAR (T-CELLS & LYMPHOKINES)

FUNCTIONS OF INNATE IMMUNE


SYSTEM
1. RECRUIT IMMUNE CELLS TO SITES OF INFECTION (CYTOKINES)
2. ACTIVATION OF COMPLEMENT CASCADE FOR IDENTIFICATION
AND CLEARANCE
3. IDENTIFICATION AND REMOVAL OF FOREIGN SUBSTANCES
(WBC)
4. ACTIVATES ADAPTIVE IMMUNE SYSTEM (AG-AB)
5. PHYSICAL AND CHEMICAL BARRIERS

REACTION OF BODY TO PATHOGEN


1. INFLAMMATION
4 CLASSIC SIGNS:
- RUBOR (REDNESS)
- CALOR ( TEMPERATURE)
- DOLOR (PAIN)
- TUMOR (SWELLING)

LEUKOCYTES (WBC)
NEUTROPHIL MOST ABUNDANT, 1ST TO ARRIVE
DENDRITIC CELL PRESENT IN TISSUES, LINK BETWEEN INNATE AND
ADAPTIVE
BASOPHIL RELEASE HISTAMINE
EOSINOPHIL RELEASE TOXIC MOLECULES, MAY DAMAGE TISSUES
MAST CELL RELEASE HEPARIN, HISTAMINES, CHEMOKINES, CHEMOTAXIC
CYTOKINES. INVOLVED IN ALLERGIC/ANAPHYLAXIS AND WOUND HEALING.
MACROPHAGE - PHAGOCYTIC CELL
NATURAL KILLER CELL - AUTOLYTIC ACTION

ADAPTIVE IMMUNE SYSTEM


- HIGHLY SPECIFIC
- LONG TERM
E.G IMMUNIZATION

ADAPTIVE IMMUNE SYSTEM


RECOGNITION AND ANTIBODY PRODUCTION TO
ANTIGENS
GENERATION OF RESPONSES FOR MAXIMAL
ELIMINATION OF PATHOGENS
DEVELOPMENT OF IMMUNOLOGICAL MEMORY
(B-CELLS)

T-LYMPHOCYTES
T HELPER CELL (CD4+ T CELLS)
SECRETES CYTOKINES
ASSIST B CELLS MATURATION
ACTIVATES CYTOTOXIC T-CELLS & MACROPHAGE

CYTOTOXIC T CELL (CD8+ T CELLS)


DESTROYS VIRUS INFECTED CELLS

MEMORY T CELL (EITHER CD8+ OR CD8+)


GETS REACTIVATED UPON EXPOSURE

SUPPRESOR T CELL
SHUTS DOWN T CELL-MEDIATED IMMUNITY

NATURAL KILLER T CELL


PRODUCE SYTOKINES AND CYTOLYTIC MOLECULES

IMMUNOGLOBULINS
IgG - majority, trans placental
IgA mucosal areas, prevents colonization of
pathogens
IgM eliminates pathogen in the early stage
IgE binds allergens and triggers histamine
release from mast cells and basophils, protects
from parasite
IgD antigen receptor

HOW THEY SEES AND ANTIGEN


T cells
MHC - Processed form of antigen (peptide)
B cells
Needs helper T cells
Differentiates into an effector cell (plasma cell)

IMMUNOLOGICAL MEMORY
Passive (short term)
Active (long term)
Immunization process where person is made immune
or resistant to an infectious disease, typically by
administration of a vaccine.
- Live attenuated (modification)
- Inactivated (wholes or fractions)

Live attenuated
- VIRUS
Measles, mumps, rubella, varicella, rotavirus,
influenza (intranasal)
oral polio vaccine
- BACTERIA
Bacile Calmette- Guerin (BCG)
Oral typhoid vaccine

INACTIVATED VACCINES
Needs booster
INACTIVATED WHOLE VIRAL VACCINES
- polio, hepatitis, rabies, influenza
INACTIVATED WHOLE BACTERIAL VACCINES
- pertussis, typhoid, cholera, plague
FRACTIONAL VACCINES
- Subunits: hepatitis B, influenza, acellular pertussis, human
papillomavirus ,anthrax
- Toxoids: diphtheria, tetanus

POLYSACCHARIDE VACCINES
- Pneumococcal disease, meningococcal
disease and salmonella typhi
- Haemophilus influenza

RECOMBINANT VACCINES
- genetic engineering
- Hep B & HPV
- Look at pp. 66 table

BACTERIA
Prokaryotic
Biofilms (bacterial mats)
Do not usually have membrane bound
organelles within cytoplasm
Taxis influenced behaviors (chemo,
photo,energy,magneto)
Gram Staining + (blue) (pink)

ANTIBIOTICS

- Bacteriocidal (KILL)
- Bacteriostatic (prevent
growth

VIRUS
3 major components
- Genetic material
- Protein coat
- Envelope of lipids
Virion (complete virus particle)
Capsid (protein protective coat) (formed by capsomeres)
- Bacteriophage, mutation, Antigenic Shift

VIRUS REPRODUCTION
1.Attachment
2.Penetration
3.Replication
4.Release

PARASITES
PROTOZOA
HELMINTHS (Egg-Larvae-Adult): Flatworms,
Acanthocephalans, Roundworms
ECTOPARASITES
ARTHROPODS

IMPLICATION OF PUBLIC HEALTH


ACUTE vs CHRONIC
TRANSMISSION: direct, indirect, airborne, bloodborne, droplet, sexual contact
Infectivity: DISEASE
(Host, Pathogen, Environment)
Add: TIME

CHAIN OF INFECTION
Insert chart here

THE GOALS OF EPIDEMIOLOGY


Eradicate
Prevention
Intervention
Control

PREVENTIVE MEASURES
Primary forestall onset
Secondary (self-diagnosis & Self
Treatment); isolation & quarantine
Tertiary Control and Prevention

COMMUNICABLE
DISEASES

TUBERCULOSIS

TUBERCULOSIS OR TB
an infectious disease caused by the bacteria called
Mycobacterium tuberculosis.
Transmitted from a TB patient to another person through
coughing, sneezing and spitting. Thus, close contacts,
especially household members, could be infected with TB.
Lungs are commonly affected but it could also affect other
organs such as the kidney, bones, liver and others.
Curable and preventable. However, incomplete or irregular
treatment may lead to drug-resistant TB or even death.

CASE FINDING THROUGH (PASSIVE,


ACTIVE, INTENSIFIED)
Diagnosis
1. DSSM
2. TB Culture & Drug Susceptibility
3. Tuberculin Skin Testing (PPD)
4. Rapid Molecular Diagnostic Test (GenEXpert)

Lowenstein Jensen
media

PPD test/ Mantoux Test


-delayed hypersensitivity

TB CLASSIFICATION
1. Bacteriological Status
a. Bacteriologically-confirmed
b. Clinically diagnosed
2. Anatomical location
c. Pulmonary TB
d. Extra-pulmonary TB
3. History
e. New Case
f.

Retreatment Case

CASE HOLDING
Set of procedures which ensures that patients
complete their treatment

Directly Observed Treatment


Method developed to ensure treatment

compliance by providing constant and


motivational supervision to TB patients.

TB DISEASE REGISTRATION GROUPS


New
Relapse
Treatment after Failure
Treatment After Lost to Follow-up
Previous Treatment Outcome Unknown
Others

DRUG TREATMENT
Fixed Dose combination
Single drug formulation
Type of treatment regimen given depends on
category
Treatment discontinued either by disappearance
of symptoms or by adverse reactions (Minor &
Major)

STAGES OF TB PATHOGENESIS
Exposure to infection
Progression to disease
Late or inappropriate diagnosis and
treatment
Poor treatment adherence and
success.

PLASMODIUM
P. falcifarum
P. vivax (hypnozoites)
P. ovale
P.malariae
P. knowlesi

ENDEMICITY
a.Stable Malaria Areas
b.Unstable Malaria Areas
.Uncomplicated Malaria
.Complicated Malaria
* Signs and symptoms are nonspecific

PARASITOLOGICAL DIAGNOSIS
Improved
Identification
Prevention
Confirmation
Improved

TYPE OF STAINS
Romanowsky (Nucleus(RED);
Cytoplasm (BLUE)
Giemsa Stain Gold Standard
Leishmans stain (thin smear)
Wrights stain (rapid)

MALARIA RAPID DIAGNOSTIC TEST

TREATMENT FOR P. FALCIFARUM


MALARIA
Uncomplicated Malaria
Antipyretics
Anti-emetics
Convulsions

TREATMENT FOR NON- P. FALCIFARUM


MALARIA
Oral chloroquinoline
Primaquine (contraindicated
with G6PD)

PROPHYLAXIS
NO prophylaxis regimen offers complete
protection
Chloroquine
Chloroquine plus proguanil
Mefloquine
doxycyline

INSECTICIDE TREATED BED NETS


Pyrethoid insecticides
Piperonyl butoxide
Long lasting insecticide-treated nets

DENGUE

DENGUE FEVER/ DENGUE


HEMORRHAGIC FEVER

ADMINISTRATIVE ORDER NO. 20120006


Revised Dengue Clinical Case Management
Guidelines 2011
Classification of levels of severity &
Appropriate Clinical Management (Dengue w/o
warning signs, Dengue w/ warning signs,
Severe Dengue)

TREATMENT AND PREVENTION

RABIES

INCUBATION PERIOD (TIME OF EXPOSURE


TO SIGNS AND SYMPTOMS APPEARANCE)
FACTORS
- amount of virus
inoculated
- severity of exposure
- Location of Exposure

PRODROMAL
STAGE

Acute Neurologic
Stage

Initial viral
multiplication in
muscle cells
Paresthesia pain
at the site of bite

Virus reach brain (Gray


matter)
2 types
- encephalitic/ furious
- paralytic/ dumb
- hypersalivation

DIAGNOSIS
Clinical Manifestations (hydrophobia/
aerophobia)
History of Exposure
If paralytic: lab diagnosis on fresh tissue
specimen with glycerine preservative
Post-Exposure Prophylaxis (PEP)

RABIES
Vaccine- preventable disease (active and
passive immunization)
Intradermal (ID) 0.1 ml (PVRV & PCECV);
One dose per deltoid (0,3,7,28 days)
Passive: Rabies Immunoglobulin (RIG)
Human RIG (HRIG): 21 days hf
Equine RIG (ERIG) : 14 days hf

SKIN TEST
Performed prior to ERIG
Positive (>6 mm)

TREATMENT AND PREVENTION


Chemical and Physical Means
Pets Vaccination
Pre-exposure immunization

SCHISTOSOMIASI
S

MOT:
CONTAMINATED
WATER

PATHOPHYSIOLOGY
Its not the egg, but the cellular infiltration from the immune
response
Katayama Fever.

Treatment: Praziquantel (annual)

FILARIASIS
Elephantiasis

PARASITES
Wuchereria bancrofti
Brugia malayi & timori

Microfilaraemic Direct
observation on Peripheral
Blood
Amicrofilaraemic Clinical
Observations or Antigen
Detection

DIAGNOSIS
Microfilariae in blood smear
Giemsa Stained
Finger prick test gold
standard

MASS ANNUAL TREATMENT


Diethylcarbamazine Citrate &
Albendazole
November as Filiriasis Mass
Treatment Month