CPH Lesson 2 - Medical and Public Health Microbiology PDF

NATIONAL UNIVERSITY-MANILA COMMUNITY AND PUBLIC HEALTH AL GENESIS F. SALES, RMT NATIONAL UNIVERSITY-MANILA LESSON 2 MEDICAL AND PUBLIC HEALTH MICROBIOLOGY  COMMUNICABLE DISEAS...

NATIONAL UNIVERSITY-MANILA COMMUNITY AND PUBLIC HEALTH AL GENESIS F. SALES, RMT NATIONAL UNIVERSITY-MANILA LESSON 2 MEDICAL AND PUBLIC HEALTH MICROBIOLOGY  COMMUNICABLE DISEASE Communicable diseases are often the leading causes of illnesses in the country today. Most often they afflict the most vulnerable, the young and the elderly. They have numerous economic, psychological, disabling and disfiguring effects to the afflicted individuals, families and communities. What is doubly threatening is the emergence of newly discovered diseases and the re-emergence of old ones. Communicable diseases are readily transferred from one infected person to a susceptible and uninfected person and maybe caused by microorganisms TYPES OF MICROORGANISMS CAUSING INFECTIONS: BACTERIA FUNGI VIRUS PARASITE CHAIN OF INFECTION ETIOLOGIC AGENT The extent to which any microorganisms is capable of producing an infectious process depends on the number of microorganisms (pathogenicity), the ability of the microorganisms to enter the body, the susceptibility of the host, and the ability of the microorganisms to live in the host’s body. RESERVOIR There are many reservoirs, or sources of microorganisms. Common sources are other humans, the client’s own microorganisms, plants, animals, or the general environment. People are the most common source of infection for others and for themselves. PORTAL OF EXIT Before an infection can establish itself in a host, the microorganisms must leave the reservoir. METHOD OF TRANSMISSION After the microorganism leaves its source or reservoir, it requires a means of transmission to reach another person or host through a receptive portal of entry. These are the three mechanisms: 1. Direct transmission Involves immediate and direct transfer of microorganisms from person to person through touching, biting, kissing, or sexual intercourse. Droplet spread is also a form of direct transmission but can occur only if the source and the host are within 3 feet of each other. Sneezing, coughing , spitting, singing, or talking can project droplet spray into the conjunctiva or onto the mucous membranes of the eyes, nose, or mouth of another person 2. Indirect transmission a. Vehicle-borne transmission - A vehicle is any substance that serves as an intermediate means to transport and introduce an infectious agent into a susceptible host through a suitable portal of entry. Fomites (inanimate materials or objects), such as handkerchiefs, toys, soiled clothes, cooking or eating utensils, and surgical instruments or dressings, can act as vehicles. b. Vector-borne transmission - A vector is an animal or flying or crawling insect that serves as an intermediate means of transporting the infectious agent. Transmission may occur by injecting salivary fluid during biting or by depositing feces or other materials on the skin through the bite wound or a traumatized skin area. PORTAL OF ENTRY Before a person can become infected, microorganisms must enter the body. The skin is a barrier to infectious agents; however, any break in the skin can readily serve as portal of entry. Often, microorganisms enter the body of the host by the same route they used to leave the source. SUSCEPTIBLE HOST A susceptible host is any person who is at risk for infection. A compromised host is a person “at increased risk”, an individual who for one or more reasons is more likely than others to acquire an infection. Impairment of the body’s natural defenses and a number of other factors can affect susceptibility to infection WAYS TO BREAK THE CHAIN OF INFECTION 1. Increasing host resistance 2. Destruction of the source and reservoir of infection 3. Destruction of the agent in the environment 4. Avoidance of exposure Handwashing The MOST IMPORTANT procedure for preventing the transfer of microorganisms, and therefore nosocomial infection, is correct and frequent handwashing. Proper handwashing protects the patient, your co-worker, you, and your family. Handwashing should be done in all of the following instances: o At the beginning and end of every work shift o Before and after prolonged contact with a patient o Before invasive procedure o Before contact with especially susceptible patients o Before and after touching wounds o After contact with body substances, even when gloves are worn o Anytime you are in doubt about the necessity for doing so Gloves Gloves are worn for three reasons: 1. First, they protect the hands when the health worker is likely to handle any body substances, e.g. blood, urine, feces, sputum, mucous membranes, and non-intact skin. 2. Second, gloves reduce the likelihood of health workers transmitting their own endogenous microorganisms to individuals receiving care. 3. Third, gloves reduce the chance that the health worker’s hands will transmit microorganisms from one client or a fomite to another client. In all situations, gloves are changed between client contacts.  SPECIFIC PROTECTION AGAINST DISEASE IMMUNIZATION Is the process of introducing vaccine into the body to produce antibodies that will protect our body against a specific infectious agent Most vaccines are given more than once since the first dose gives only half of the protection the body needs. A second shot or “booster” is needed to give the body full protection against the disease Immunization against communicable diseases a. For infants b. Following exposure c. For all persons in endemic areas d. For person subject to unusual risk e. For known cases Vaccines Available for Routine Immunization 1. DPT (Diptheria, Pertussis, Tetanus) 2. OPV (Oral Polio Vaccine) 3. MMR (Measles, Mumps, Rubella) 4. HiB (H. Infleunzae type-B) 5. Hepatitis B 6. BCG (Bacillus of Calmette and Guerin) 7. CDT (Cholera, Dysentery, Typhoid) CHEMOPROHYLAXIS Administration of drugs to prevent occurrence of infection E.g., Penicillin for gonorrhea, Chloroquine for malaria, INH for tuberculosis MECHANICAL PROPHYLAXIS Placing mechanical barriers between the sources of agent and host such as use of mosquito nets, masks or glove NATIONAL UNIVERSITY-MANILA COMMUNICABLE DISEASES  TUBERCULOSIS Highly contagious bacterial infection usually affecting the lungs but can also affect other organs of the body like brain, kidney, intestines and bones Considered as the world’s deadliest disease and remains as a major public health problem in the Philippines It often occurs in children of under developed and developing countries in the form of primary complex especially after a bout of a debilitating childhood disease such as measles In the Philippines, TB ranks sixth in the leading cause of morbidity (2004) and mortality (2004). The estimated incidence of all TB cases in the Philippines is 243/100,00 population (2006) CAUSATIVE AGENT Mycobacterium tuberculosis MODE OF TRANSMISSION Inhalation of the infective droplets present in the air SIGNS AND SYMPTOMS Cough of two weeks or more Fever Chest or back pains not referable to any musculo-skeletal disorders Hemoptysis or recurrent blood-streaked in the sputum Significant weight loss Other signs and symptoms such as sweating, fatigue, body malaise and shortness of breath PERIOD OF COMMUNICABILITY As long as viable tubercle bacilli are being discharged in the sputum. Some untreated or inadequately treated patients maybe sputum-positive intermittently for years The degree of communicability depends on the number of bacilli discharged, the virulence of the bacilli, adequacy of ventilation, exposure of the bacilli to sun or UV light and opportunities for aerosolization by coughing, sneezing, talking or singing. Children with primary complex are generally not infectious TREATMENT DRUGS No. of tablets per day No. of tablets per day SIDE EFFECTS INTENSIVE PHASE CONTINUATION PHASE (2 months) (4 months) Rifamficin (R) 1 1 Red-orange body fluids Peripheral neurophathy / 1 1 Numbness Isoniazid (H) TX: Vitamin B6 Hyperuricemia / Gout 2 Pyrazinamide (Z) TX: Allopurinol Color blindness to red and 2 Ethambutol (E) green PREVENTIVE MEASURES Prompt diagnosis and treatment of infectious cases BCG vaccination of newborn, infants, grade 1/school entrants Educate the public in mode of spread and methods of control and the importance of early diagnosis Improve social conditions, which increase the risk of becoming infected, such as overcrowding Make available medical, laboratory and x-ray facilities for examination of patients, contacts and suspects.  LEPROSY Is an ancient disease and is a leading cause of permanent physical disability among the communicable diseases. It is a chronic mildly communicable disease that mainly affects the skin, the peripheral nerves, the eyes and mucosa of the URT CAUSATIVE AGENT Mycobacterium leprae MODE OF TRANSMISSION Airborne – inhalation of droplet/spray from coughing and sneezing of untreated patient Prolonged skin-to-skin contact SIGNS AND SYMPTOMS EARLY signs and symptoms LATE signs and symptoms Change in skin color – either reddish or white Loss of eyebrow – madarosis Loss of sensation on the skin lesion Inability to close eyelids – lagophthalmos Decrease/loss of sweating and hair growth over Clawing of fingers and toes the lesion Sinking of the nose bridge Thickened and/or painful nerves Enlargement of the breasts in males – gynecomastia Muscle weakness or paralysis of extremities Chronic ulcers Pain and redness of the eyes Nasal obstruction or bleeding Ulcers that do not heal SUSCEPTIBILITY Children especially 12 years and below are more susceptible PREVENTION Avoidance of prolonged skin-to-skin contact especially with a lepromatous case Children should avoid close contact with active, untreated leprosy case BCG vaccination Good personal hygiene Adequate nutrition Health education TREATMENT Ambulatory chemotherapy through use of Multi Drug Therapy (MDT)  DIPHTHERIA Acute febrile infection of the tonsil, throat, nose, larynx or a wound marked by a patch or patches of grayish membrane from which the diphtheria bacillus is readily cultured CAUSATIVE AGENT Corynebacterium diphtheriae (Klebs-Loeffler Bacillus) SOURCE OF INFECTION Discharges and secretions from mucus surface of nose and nasopharynx and from skin and other lesions MODE OF TRANSMISSION Contact with patient or carrier or with articles soiled with discharges of infected persons. Milk has served as a vehicle PERIOD OF COMMUNICABILITY Variable until virulent bacilli has disappeared from secretions and lesion SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE Infants born of mothers who had diphtheria infection are relatively immune but the immunity disappears before 6th month Recovery from attack of diphtheria is usually but not necessarily followed by persistent immunity Two-thirds or more of the urban cases are in children under 10 years of age METHODS OF PREVENTION AND CONTROL Active immunization of all infants and children with 3 doses of DPT toxoid administered at 4 to 6 weeks intervals and then booster doses following year after the last dose of primary series and another dose on the 4th or 5th year of age Pasteurization of milk Education of parents  WHOOPING COUGH (Pertussis) Acute infection of respiratory tract. It begins as an ordinary cold, which in a typical case increasingly severe, and after the second week is attended by paroxysms of cough ending in a characteristic whoop as the breath is drawn in CAUSATIVE AGENT Bordetella pertussis (Haemophilus pertussis, Bordet-Gengou Bacillus) SOURCE OF INFECTION Discharges from laryngeal and bronchial mucous membrane of infected persons MODE OF TRANSMISSION Direct spread through respiratory and salivary contacts. Crowding and close association with patients facilitate spread SUSCEPTIBILITY, RESISTANCE, AND OCCURENCE Susceptibility is general, predominantly in childhood disease, the incidence being highest under 7 years of age and mortality highest in infants particularly under 6 months of age. One attack confers definite and prolonged immunity. METHODS OF PREVENTION AND CONTROL: Routine DPT immunization of all infants which can be started at 1 ½ months of life and given at monthly intervals in 3 consecutive months. Booster dose is usually given at the age of 2 years and again at 4 to 5 years of age  TETANUS Acute disease induced by toxin of Tetanus bacilli growing anaerobically in wounds and at the site of umbilicus among infants. Characterized by muscle contractions CAUSATIVE AGENT: Clostridium tetani (Tetanus bacillus) SOURCE OF INFECTION: Immediate source of infection is soil, street dust, animal and human feces MODE OF TRANSMISSION Usually occurs through contamination of the unhealed stump of the umbilical cord SUSCEPTIBILITY, RESISTANCE, AND OCCURRENCE Susceptibility is general. An important cause of death in many countries in Asia, Africa and South America especially in rural tropical areas. Resistance – immunity is induced by tetanus toxoid anti-toxin METHODS OF PREVENTION AND CONTROL: Pregnant women should be actively immunized in regions where tetanus neonatorum is prevalent Health education of mothers, relative and attendants in the practice of strict aseptic methods of umbilical care in the newborn  LEPTOSPIROSIS Weil’s disease, Mud fever, Trench fever, Flood fever, Spiroketal jaundice, Japanese seven days fever It is a worldwide zoonotic disease. Rat is the main host of the disease although pigs, cattle, rabbits and other wild animals can also serve as reservoir hosts It is an occupational disease affecting veterinarians, miners, farmers, sewer workers, abattoir workers, etc CAUSATIVE AGENT Leptospira interrogans. There are about 200 serovars, var icterohemmorhagiae thought to be more virulent and causes leptospirosis MODE OF TRANSMISSION: Through contact of the skin, especially open wounds with water, moist soil or vegetation contaminated with urine of infected host SIGNS AND SYMPTOMS: 1. Leptospiremic phase – leptospires present in blood and CSF. Onset of symptoms are abrupt with fever, headache, myalgia, nausea, vomiting, cough and chest pain 2. Immune phase – correlates with the appearance of circulating IgM TREATMENT: Penicillin and other B-lactam antibiotics Tetracycline Erythromycin PREVENTION AND CONTROL: Improved education of people at particular risk Use of protective clothing boots and gloves especially by workers with occupational hazards Rat and other potential hosts control Investigation of contacts and source of infection  ANTHRAX Malignant pustule, Malignant edema, Woolsorter’s disease An acute bacterial disease usually affecting the skin but which may vary rarely involves the oropharynx. Lower respiratory tract, mediastinum or intestinal tract. CAUSATIVE AGENT Bacillus anthracis MODE OF TRANSMISSION Cutaneous infection is by contact with tissues of animals (cattle, sheep, goats, horses, pigs) dying of the disease; possibly by biting flies that had partially fed on such animals; Contaminated hair, wool, hides or products made from them such as drums or brushes; Contact with soil associated with infected animals FORMS OF ANTHRAX 1. Cutaneous anthrax Most common and is contracted by contact with infected animals The exposed part of the skin begins to itch and a papule appears in the inoculation site. This papule becomes a vesicle and then evolves into depressed black eschars The lesion is not painful and often untreated which will result to septicemia and death when not treated early 2. Pulmonary anthrax Contracted by inhalation of spores of Bacillus anthracis At the onset of illness, the symptoms are mild and resemble that of common upper respiratory tract infection The symptoms become acute, with fever, shock and death results 3. Gastrointestinal anthrax Contracted by ingestion of meat from infected animals and is manifested as violent gastroenteritis with vomiting and bloody stools PREVENTION AND CONTROL Immunize high-risk persons Educate employees handling potentially contaminated articles about modes of anthrax transmission Personal cleanliness Control dusts and proper ventilation in hazardous industries especially those that handle raw animal materials  CHOLERA (El Tor) An acute serious illness characterized by sudden onset of acute and profuse colorless diarrhea, vomiting, severe dehydration, muscular cramps, cyanosis and in severe cases collapse CAUSATIVE AGENT Vibrio cholerae (El Tor) SOURCE OF INFECTION Vomitus and feces of infected persons and feces of convalescent or healthy carriers SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE Susceptibility and resistance general although variable. Frank clinical attacks confer a temporary immunity which may afford some protection, for several years Immunity artificially induced by vaccine is of variable and uncertain duration Appears occasionally in epidemic form in the Philippines METHODS OF PREVENTION AND CONTROL Bring patient to hospital for proper isolation and prompt and competent medical care Other preventive measures are the same as those of Typhoid and Dysentery All contacts should submit themselves for stool examination and be treated accordingly if found positive  BACILLARY DYSENTETY (Shigellosis) An acute bacterial infection of the intestine characterized by diarrhea, fever, tenesmus and in severe cases bloody mucoid stools Severe infections are frequent in infants and in elderly debilitated persons CAUSATIVE AGENT: Shigella boydii Shigella sonnei Shigella flexneri Shigella dysenterae SOURCE OF INFECTION: Feces of infected persons, many in apparent mild and unrecognized infection MODE OF TRANSMISSION Eating contaminated foods or drinking contaminated water and by hand to mouth transfer of contaminated materials; by flies, by objects soiled with feces of a patient or carrier SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE Disease is more common and more severe in children than in adults METHODS OF PREVENTION AND CONTROL Sanitary disposal of human feces Sanitary supervision of processing, preparation and serving of food particularly those eaten raw Adequate provision for safe washing facilities Fly control and screening to protect foods against fly contamination Protection of purified water supplies Control of infected individual contacts and environment Isolation of patient during acute illness  TYPHOID FEVER Systemic infection characterized by continued fever, malaise, anorexia, slow pulse, involvement of lymphoid tissue, Splenomegaly, rose spots on trunks and diarrhea. Many mild typical infections are often unrecognized CAUSATIVE AGENT Salmonella typhi SOURCE OF INFECTION Feces and urine of infected person. Family contacts may be transient carrier. Carrier state is common among person over 40 years of age especially females MODE OF TRANSMISSION: Direct or indirect contact with patient or carrier. Principal vehicles are food and water. Contamination is usually by hands of carrier. Flies are vectors PERIOD OF COMMUNICABILITY: As long as typhoid bacilli appear in excreta, usually from appearance of prodormal symptoms from first week throughout convalescent SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE: Susceptibility is general although many adults appear to acquire immunity through unrecognized infections METHODS OF PREVENTION AND CONTROL Same as preventive and control measures as in Dysentery in addition, immunization with vaccine of high antigenicity Education of the general public and particularly the food handlers  MENINGOCOCCEMIA The disease is usually sporadic (cases occur alone or may affect household members with intimate contact) Although primarily a disease of children, it may occur among adult especially in condition of forced overcrowding such as institution, jail and barracks There is an increased rate in smokers, overcrowded households and military recruits. CAUSATIVE AGENT Neisseria meningitides SOURCE OF INFECTION: Respiratory droplets from nose and throat of infected persons MODE OF TRANSMISSION Direct contact with respiratory droplets from nose and throat of infected persons. Carrier may exist without cases of meningitis. SIGNS AND SYMPTOMS High grade fever for first 24 hours Weakness, joint and muscle pain Hemorrhagic rash, progressing from few petechiae to widespread purpura Meningeal irritation like headache, nausea and vomiting, stiff neck, seizure or convulsion and sensorial changes  PNEUMONIA An acute infectious disease of the lungs usually caused by the pneumococcus resulting in the consolidation of one or more lobes of either one or both lungs CAUSATIVE AGENTS Majority of cases due to Streptococcus pneumoniae (Diplococcus pneumoniae) Occasionally Klebsiella pneumoniae Viruses PREDISPOSING CAUSES: Fatigue Overexposure to inclement weather (extreme hot or cold) Exposure to pollutes air Malnutrition SIGNS AND SYMPTOMS: Vomiting at times Rhinitis/common cold Pain over affected area Rusty sputum Highly colored urine Productive cough Severe chill, in young children High fever Fast respiration Dilated pupils MANAGEMENT: Bed rest Adequate salt, fluid, calorie and vitamin intake. Water requirement increases because of high fever, sweating and increased respiratory rate Tepid sponge for fever Frequent turning from side to side Antibiotics based on Care of Acute Respiratory Infection (CARI) of DOH  MEASLES An acute highly communicable infection characterized by fever, rashes and symptoms referable to upper respiratory tract; the eruption is preceded by about 2 days of coryza, during which stage grayish pecks (Koplik spots), maybe found on the inner surface of cheeks Death is due to complication (ex. Secondary to pneumonia, usually in children under 2 years old) Measles is severe among malnourished children with fatality of 95- 100% CAUSATIVE AGENT: Measles Virus SOURCE OF INFECTION Secretion of nose and throat of infected person MODE OF TRANSMISSION By droplet spread or direct contact with infected persons, or indirectly through articles freshly soiled with secretions of nose and throat INCUBATION PERIOD 10 days from exposure to appearance of fever, and about 14 days until rash appears METHODS OF PREVENTION AND CONTROL Avoid exposing children to any person with fever or with acute catarrhal symptoms Isolation of cases from diagnosis about 5-7 days after onset of rash Disinfection of all articles soiled with secretion of nose and throat Live attenuated and inactivated measles virus vaccines (MMR)  CHICKEN POX An acute infectious disease of sudden onset with slight fever, mild constitutional symptoms and eruption which are maculo-papular for a few hours, vesicular for 3-4 days and leaves granular scabs Lesions are more on covered than on exposed parts of the body and may appear on scalp and mucous membrane of URT CAUSATIVE AGENT Varicella-Zoster Virus SOURCE OF INFECTION Secretion of respiratory tract of infected persons. Lesions of skin are of little consequence. Scabs themselves are not infective. MODE OF TRANSMISSION Direct contact or droplet spread. Indirect through articles freshly soiled by discharges of infected persons. One of the most readily communicable diseases, especially in the early stages of eruption INCUBATION PERIOD 2-3 weeks SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE: Universal among those not previously attacked. Severe in adults. An attack confers long immunity Second attacks are rare Not common in early infancy METHODS OF PREVENTION AND CONTROL: Case over 15 years of age should be investigated to eliminate possibility of smallpox Isolation of infected person, Concurrent disinfection of throat and nose discharge Exclusion from school for 1 week after eruption first appears Avoid contact with susceptible  MUMPS (Epidemic Parotitis) An acute contagious disease characterized by the swelling of one or both parotid (salivary) glands, usually occurring in epidemic form CAUSATIVE AGENT Mumps Virus, a member of the family Paramyxoviridae SOURCE OF INFECTION Secretion of the mouth and nose MODE OF TRANSMISSION Direct contact with a person who has the disease or by contact with articles in his immediate environment which have become freshly soiled with secretion from the nasopharynx INCUBATION PERIOD 12 to 26 days, usually 18 days SIGNS AND SYMPTOMS: Painful swelling in front of ear, angle of jaws and down the neck Painful particularly when swallowing Fever and Malaise Loss of appetite Swelling of one or both testicles (orchitis) in some boys TREATMENT Prophylactic. A vaccine exists for the active immunization of patients against mumps (MMR) Active treatment. The average case before the age puberty requires little attention After the age of puberty. All patients, particularly adults, should remain quiet in bed until all fever and swelling have been absent for at least four days because of the danger of glandular complications In males, the scrotum should be supported by a properly fitted suspensory, pillow or a sling between the thighs, thus relieving the pull of gravity on the testes and blood vessels and minimizing the dangers of orchitis  INFLUENZA Highly communicable disease characterized by abrupt onset with fever which last 1 to 6 days, chilly sensation or chills, aches or pain in the back and limbs with prostrations. Respiratory symptoms include coryza, sore throat and cough CAUSATIVE AGENT Influenza Virus A, B, C SOURCE OF INFECTION Discharges from the mouth and nose of infected person SOURCE OF INFECTION Discharges from the mouth and nose of infected person MODE OF TRANSMISSION By direct contact, through droplet infection, or by articles freshly soiled with discharge of nose and throat of infected person, airborne PERIOD OF COMMUNICABILITY Probably limited to 3 days from clinical onset SUSCEPTIBILITY, RESISTANCE, AND OCCURENCE Universal but of varying degrees as shown by frequent unapparent and typical infection during epidemics Occurrence is variable, in pandemics, local epidemics, and as sporadic cases, often unrecognized by reason of indefinite clinical symptoms Infection produces immunity of unknown duration to the type and subtype of infecting virus PREVENTION AND CONTROL Education of the public as to sanitary hazard from spitting, sneezing and coughing Avoid use of common towels, glasses, and eating utensils Active immunization with influenza vaccine provided prevailing strain of virus matches antigenic component of vaccine  AVIAN INFLUENZA (Bird Flu) Influenza is recognized both as emerging and re-emerging viral infection and is described as an unvarying disease caused by a varying virus. The virus mutates but its burden on health, lives and manpower is consistently overwhelming It is an infectious disease of birds ranging from mild to severe form of illness. All birds are thought to be susceptible to infection with avian influenza, though some species are more resistant than others. Some forms of bird flu infections can cause illness to humans. It is due to highly pathogenic Influenza virus H5N1. It is the subtype that can be transmitted from infected poultry to human SOURCE OF INFECTION Viruses that normally infect only birds and less commonly pigs SIGNS AND SYMPTOMS Fever Body weakness and muscle pain Cough Sore throat May have difficulty in breathing in severe cases Sore eyes CONTROL MEASURE IN BIRDS Rapid destruction, proper disposal of carcasses and rigorous disinfection of farms Restriction on the movement of live poultry PREVENTIVE MEASURE IN HUMANS All workers directly or indirectly involved in handling live poultry should be given the current season’s influenza vaccine to reduce the possibility of dual infection with human and influenza viruses Yearly vaccination of poultry workers with regular of periodic direct contact with poultry  HEPATITIS A Infectious hepatitis, Epidemic hepatitis, Catarrhal jaundice A form of hepatitis occurring either sporadically or in epidemics and caused by virus introduced by fecally contaminated water or food Young people especially school children are most frequently affected CAUSATIVE AGENT Hepatitis Virus A PREDISPOSING FACTOR SIGN AND SYMPTOMS Poor sanitation Influenza-like symptom like headache Contaminated water supplies Malaise and easy fatigability Unsanitary method of preparing and Anorexia and abdominal discomfort serving of food Nausea and vomiting Malnutrition Fever Disaster and war time condition Lymphadenopathy Jaundice Bilirubinemia with clay colored stool MANAGEMENT Prophylaxis – IM injection of gamma globulin Complete bed rest Low fat diet but high in sugar PREVENTION AND CONTROL Ensure safe drinking water Sanitary method in preparing, handling, and serving food Proper disposal of urine and feces Washing hands very well before eating and after using the toilet Separate and proper cleaning of articles used by patient  SEVERE ACUTE RESPIRATORY SYNDROME (SARS) It is a newly recognized form of a typical pneumonia that had been described in patients in Asia, North America and Europe. The earliest known cases were identified from Guangdong Province, China in November 2002. The WHO issued the global alert on the outbreak on March 12, 2003 and instituted worldwide surveillance. CAUSATIVE AGENT It is a Novel Human Coronavirus based on serological and molecular tests done on specimens from SARS patients MODE OF TRANSMISSION Close contact with respiratory droplet secretion from SARS patient Transmission occurs when another person’s mucous membrane are exposed to droplet secretions when a SARS patient coughs, sneezes or talks PREVENTIVE MEASURES AND CONTROL Establishment of triage Identification of patients Isolation of susceptible probable case Tracing and monitoring of close contact SIGNS AND SYMPTOMS 1. Prodormal Phase Body temperature of more than 38 degrees Celsius sometimes with chill, malaise and headache During this stage the infectivity is none to low 2. Respiratory Phase Within 2 to 7 days the illness may proceed to this stage characterized by dry non- reproductive cough with or without respiratory distress Common findings include hypoxia, dullness on percussion and decreased breath sounds on physical examination Infectivity is highest during this phase  DENGUE (H Fever) CAUSATIVE AGENTS Dengue Virus Types 1, 2, 3 and 4 SOURCE OF INFECTION Immediate source is a vector mosquito, the Aedes aegypti or the common household mosquito MODE OF TRANSMISSION: Through bite of infected female mosquito SIGNS AND SYMPTOMS An acute febrile infection of sudden onset with clinical manifestation of 3 stages: 1. First 4 days – invasive stage starts abruptly as high fever, abdominal pain and headache 2. 4th to 7th days – toxic or hemorrhagic stage – lowering of temperature, severe abdominal pain, vomiting, frequent bleeding. Death may occur 3. 7th to 10th day – convalescent or recovery stage DIAGNOSTIC TEST Torniquet test (Rumpel Leads Test) Platelet count SUPPORTIVE AND SYMPTOMATIC TREATMENT: Paracetamol, analgesic for fever, muscle pain or headache. DON’T GIVE ASPIRIN! Rapid replacement of body fluids CONTROL MEASURES: Vector elimination o Changing water and scrubbing sides of lower vases once a week o Destroy breeding places of mosquito o Keep water container clean and covered Avoid too many hanging clothes inside the house Spray with insecticides Health education of the public  RABIES Is an acute viral encephalomyelitis caused by the rabies virus, a rhabdovirus of the genus Lyssavirus It is fatal once signs and symptoms appear There are two kinds urban or canine rabies is transmitted by dogs while sylvatic rabies is a disease of wild animals and bats which sometimes spread to dogs, cats, and livestock Rabies remains a public health problem in the Philippines. Approximately 300 to 600 Filipinos die of rabies every year Philippines has the highest prevalence rate of rabies in the whole world MODE OF TRANSMISSION: Usually by bites of a rabid animal whose saliva has the virus. The virus may also be introduced into a scratch or in fresh breaks in the skin (very rare). Transmission from man to man is possible INCUBATION PERIOD: The usual incubation period is 2-8 weeks. It can be as long as a year or several years depending on the severity of wounds, site of the wound as distance from the brain, amount of virus introduced and protection provided by clothing SUSCEPTIBILITY AND RESISTANCE: All warm blooded mammals are susceptible. Natural Immunity in man is unknown SIGNS AND SYMPTOMS Sense of apprehension Headache Fever Sensory change near the site of animal bite Spasm of muscles or deglutition on attempt to swallow (fear of water) Paralysis Delirium and convulsion Without medical intervention, the rabies victim would usually last only for 2 to 6 days. Death is often due to respiratory paralysis MANAGEMENT AND PREVENTION The wound must be immediately and thoroughly washed with soap and water. Antiseptic such as povidone iodine or alcohol may be applied The patient must be given antibiotics and anti-tetanus immunization Post-exposure treatment is given to persons who are exposed to rabies. o Active immunization aims to induce the body to develop antibodies against rabies up to 3 years o Passive immunization is given in order to provide immediate protection against rabies which should be administered within the first seven days of active immunization. The effect of the immunoglobulin is only short term Consult a veterinarian or trained personnel to observe your pet for 14 days for sign of rabies Be a responsible pet owner Consult for rabies diagnosis and surveillance of the area Mobilize for community participation NATIONAL RABIES PREVENTION AND CONTROL PROGRAM Goal: Human rabies is eliminated in the Philippines and the country is declared rabies-free General Objectives: To reduce the incidence of human rabies from 7 per million to 1 per million population by 2010 and eliminate human rabies by 2015 To reduce the incidence of canine rabies from 70 per 100,000 to 7 per 100,000 dog by 2010, and eliminate canine rabies by 2015  SCABIES A communicable disease of the skin characterized by the eruptive lesions produced by the burrowing of the female parasite into the skin CAUSATIVE AGENT Sarcoptes scabiei, itch mite. The female parasite is easily is easily visible with a magnifying glass. She burrows beneath the epidermis to lay her eggs, and set up an intense irritation MODE OF TRANSMISSION: The disease is transmitted by direct contact with infected individuals or their clothing or bedding. PREDISPOSING FACTORS: Close crowding as in tenement districts Lack of personal cleanliness SIGNS AND SYMPTOMS: Itching Minor discomfort – skin may feel hot and burning When large areas are involved and secondary infection is severe, there will be fever, headache and malaise Secondary dermatitis is common DIAGNOSIS: Appearance of the lesion, and the intense itching and finding the causative mite Scraping from its burrow with a hypodermic needle or curette, and then examined under low power objective or hard lens TREATMENT: The whole family must be examined before undertaking treatment, as long as one member of the family remains infected, other members will get the disease Treatment is limited entirely to the skin Benzyl benzoate emulsion to clean the lesion and it has a more rapid effect PREVENTION AND CONTROL: Good personal hygiene – daily bath, washing of hands before and after eating and after using the toilet, cutting of fingernails Regular changing of clean clothing beddings and towel Eating the right kind of food and taking plenty of fluids Keeping the house clean Improving sanitation of the surroundings NATIONAL UNIVERSITY-MANILA END OF DISCUSSION THANK YOU!