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Questions and Answers
What is the UNAIDS 95-95-95 target?
What is the UNAIDS 95-95-95 target?
An ambitious treatment target to help end the AIDS epidemic by 2030.
In 2020, what percentage of people living with HIV knew their HIV status?
In 2020, what percentage of people living with HIV knew their HIV status?
84%
What percentage of all persons in treatment for HIV were virally suppressed in 2020?
What percentage of all persons in treatment for HIV were virally suppressed in 2020?
66%
What are the three main approaches to controlling communicable diseases?
What are the three main approaches to controlling communicable diseases?
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What does increasing host resistance in controlling communicable diseases involve?
What does increasing host resistance in controlling communicable diseases involve?
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One method of controlling communicable diseases is by ______ the agent.
One method of controlling communicable diseases is by ______ the agent.
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What was the leading cause of death in 1900?
What was the leading cause of death in 1900?
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Which of the following diseases were endemic in school children from 1950 to 1960?
Which of the following diseases were endemic in school children from 1950 to 1960?
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What does the term 'endemic' refer to?
What does the term 'endemic' refer to?
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What are the three key components needed in the transmission cycle of communicable diseases?
What are the three key components needed in the transmission cycle of communicable diseases?
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What is the most common mode of transmission for diarrheal disease?
What is the most common mode of transmission for diarrheal disease?
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Herd immunity protects only those who have been vaccinated.
Herd immunity protects only those who have been vaccinated.
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What is the threshold of immunity in relation to herd immunity?
What is the threshold of immunity in relation to herd immunity?
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Which of the following is NOT a characteristic of the infectious agent?
Which of the following is NOT a characteristic of the infectious agent?
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Match the following diseases with their characteristics:
Match the following diseases with their characteristics:
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What is the incidence rate of diarrheal disease globally each year?
What is the incidence rate of diarrheal disease globally each year?
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Which public health intervention is essential for managing outbreaks?
Which public health intervention is essential for managing outbreaks?
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Study Notes
Communicable Diseases Across Time
- Communicable diseases (CDs) were the leading cause of death in 1900.
- Measles and mumps were endemic among school children in the 1950s and 1960s.
- Emerging CDs became a concern at the end of the 20th century.
- CDs remain a major cause of morbidity and mortality in the 21st century, with newly emerging CDs appearing.
Global Causes of Death
- Communicable diseases are among the top 10 causes of death globally, including COVID-19, lower respiratory infections, diarrheal diseases, and tuberculosis.
Communicable Disease and Surveillance
- Public health agencies are responsible for local and global disease surveillance.
- An epidemic is a significant increase in disease cases.
- An endemic disease has a usual number of cases within a population.
- A pandemic is an epidemic that spreads globally.
Communicable Diseases and Nursing Practice
- Nurses provide care to patients with communicable diseases.
- Preventative measures, such as personal protective equipment (PPE), proper cleaning of equipment, and preventing transmission to coworkers, oneself, and other patients, are crucial.
- Nurses must understand communicable diseases on both individual and population levels.
Populations and Communicable Diseases
- Caring for patients with communicable diseases requires understanding the implications for the population.
- Key factors include the infectious agent, individuals at risk, mode of transmission, prevention strategies, and treatment options.
Communicable Diseases: Burden of Disease
- Improvements in technology and transportation have led to an increase in emerging and reemerging CDs, such as Zika, Ebola, tuberculosis, and SARS-CoV-2.
Infectious Respiratory Diseases
- Many bacterial and viral diseases can affect the respiratory system, including chickenpox, diphtheria, rubella, and influenza.
- Vaccinations have significantly reduced the incidence of these diseases.
Parasitic Diseases: Malaria
- Malaria is a global health problem spread by infected mosquitos, mainly in subtropical areas.
- It affects over half of the world's population, with approximately 172 million cases reported in 2020.
Diarrheal Disease
- Globally, there are 1.7 billion cases of diarrheal disease annually.
- It is the second leading cause of death for children under 5 years old.
Diarrheal Disease Causes and Transmission
- Diarrheal diseases are caused by bacteria, viruses, and protozoa.
- Modes of transmission include waterborne (e.g., cholera) and foodborne/person to person (e.g., Escherichia coli).
Emerging Communicable Diseases
- Emerging CDs place a burden on economic, social, and healthcare systems.
- Pandemics require a coordinated and timely response.
Eradicated and Reemerging Communicable Diseases
- Smallpox has been eradicated, and diseases like polio and dracunculiasis (Guinea worm) are close to eradication.
- Other CDs, like malaria, tuberculosis, and bacterial pneumonias, are reemerging in drug-resistant forms.
Tuberculosis
- Tuberculosis (TB) is caused by Mycobacterium tuberculosis.
- TB was recognized as preventable, not inherited, in 1889.
- The World Health Organization (WHO) End Strategy and the United Nations' Sustainable Development Goals aim to reduce TB deaths by 90% and incidence by 80% by 2030.
Communicable Disease Transmission
- Transmission requires three key components: agent, host, and environment.
The Cycle of Transmission
- The epidemiological triangle helps researchers understand the cycle of transmission.
Agent Characteristics
- The agent or pathogen is the infectious organism that causes the disease.
- Six general categories of pathogens: Bacteria, Rickettsia, Viruses, Mycoses, Protozoa, and Helminths.
Specific Agent Characteristics
- Infectivity: the agent's ability to enter and multiply in the host.
- Pathogenicity: the agent's capacity to cause disease in the human host.
- Virulence: quantitatively measures the degree of pathogenicity.
- Toxigenicity: the ability to release toxins that contribute to disease.
- Antigenicity: the ability to produce antibodies in the human host.
Environmental Characteristics
- Environment: the external conditions associated with agent transmission.
- Reservoir: where the agent resides (human, animal, water, food, air, or soil).
Human Reservoir
- A person with acute illness or a carrier.
- Carriers can be incubating (infected but not showing symptoms), convalescent (infected but no longer showing acute signs), or chronic (infected for long periods with no signs).
Mode of Transmission
- How the agent leaves the reservoir and enters the host.
- Routes include water, food, air, vectors (insects), fomites (inanimate objects), unprotected sexual contact, or penetrating trauma.
Host Characteristics
- The human at risk for disease due to exposure to the agent.
- Susceptibility: likelihood of becoming infected.
- Immunity and resistance are key factors.
Host Characteristics: Immunity
- Two types of immunity: innate and adaptive.
- Innate: "first responders" with immune cells and chemicals.
- Adaptive: targeted to specific pathogens through antibody production.
- Humoral immunity: production of antibodies by B cells.
- Cellular immunity: destruction of pathogens by T cells.
Host Characteristics: Immunity (continued)
- Passive immunity: transferred from one individual to another (natural or artificial).
- Active immunity: acquired through exposure to the agent.
Host Characteristics: Defense Mechanisms
- Avoidance: preventing exposure through anatomic or chemical barriers (e.g., skin).
- Resistance: resisting disease without antibodies (inherited or acquired).
- Tolerance: enhancing tissues' capacity to resist pathogen-induced damage.
Host Characteristics: Colonization
- Colonization: infection with the agent but no signs of disease.
- Individuals can still spread the disease (e.g., MRSA).
Breaking the Chain of Infection
- The cycle of transmission for a specific pathogen provides information on interventions to break the chain.
- Interventions can target any point in the cycle.
Outbreak Investigation Steps
- Systematic investigation determines the sudden increase in CD incidence, defines cases, assesses severity, maps epidemic curve, generates hypotheses, conducts case finding, identifies common exposure sources, determines transmission sources, and takes action.
Life Cycle of the Agent
- Understanding the life cycle of an agent helps understand its transmission.
Case Fatality Rate and the Epidemic Curve
- Case fatality rate (CFR) determines outbreak severity (number of fatal cases divided by total cases).
- The epidemic curve plots the number of cases over time, showing the time from exposure to symptoms.
Epidemic Curve
- Epidemic curve helps identify point source (single exposure), intermittent source (exposure comes and goes), or continuous source (ongoing exposure).
Managing an Outbreak
- Manage an epidemic by identifying and isolating the source and determining how to break the cycle.
- Incubation period is the time between exposure and symptoms.
- Herd immunity protects those who cannot be vaccinated or choose not to by having a large enough portion of the population immune.
Managing an Outbreak (continued)
- Prompt action is required on multiple levels to break the transmission cycle and protect the population.
Infectious Agents and Attack Rates
- The incubation period is the time between exposure and the first signs of disease.
- The infectious period is the time during which an infected person can transmit the infection.
Herd Immunity
- The immunity of a population to an agent.
- A high enough percentage of the population immune (through vaccination or prior infection) prevents widespread transmission.
- The threshold of immunity is the percentage needed for herd immunity.
Attack Rate and Secondary Attack Rate
- Attack rate: the number of ill individuals divided by the total population.
- Secondary attack rate: the number of new cases among contacts divided by the total number of contacts.
Sexually Transmitted Infections (STIs)
- STIs are transmitted through sexual contact and exchange of bodily fluids.
- They are preventable and caused by over 25 infectious agents.
- STIs can cause serious illness and disability, including reproductive, fetal, and perinatal health problems, and cancer.
Notifiable STIs in the United States
- The three notifiable STIs with federal control programs are chlamydia, gonorrhea, and syphilis.
STI Risk Factors
- The main risk factor for STIs is unprotected sexual contact.
- Disparities exist based on gender, ethnicity, sexual orientation, socioeconomic factors, underreporting, and access to care.
HIV and AIDS
- HIV emerged in 1981 and initially had a high fatality rate.
- Effective treatments now mean an HIV diagnosis is no longer a death sentence in the United States.
- At the end of 2019, 1.12 million people aged 13 and older were living with HIV in the United States.
HIV and AIDS (continued)
- Individuals can remain infected with HIV for 15 years before developing AIDS.
- 13% of people with HIV in the United States are unaware of their infection.
- 25- to 29-year-olds have the highest rate of new cases.
- Men who have sex with men, Black, and Hispanic/Latinx communities have the highest incidence.
- Numbers are increasing among older adults.
UNAIDS 95-95-95
- UNAIDS 95-95-95 is an ambitious treatment target to end the AIDS epidemic by 2030, aiming for 95% of people with HIV to know their status, 95% of those diagnosed to be on sustained antiretroviral therapy, and 95% of those in treatment to be virally suppressed.
- In 2020, 84% knew their HIV status, 73% were on therapy, and 66% were virally suppressed.
Controlling Communicable Diseases
- Three main approaches:
- Changing the environment: altering or eliminating the reservoir, controlling vectors, applying hygiene measures, and using aseptic technique.
- Deactivating the agent: using physical and chemical agents.
- Increasing host resistance: active or passive immunity, including vaccines.
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