Review Book of PSM- Vivek Jainpdf.pdf
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mebooksfree.com Contents SECTION 1 : ANNEXURES Annexure 1: Incubation Period of Diseases 3...
mebooksfree.com Contents SECTION 1 : ANNEXURES Annexure 1: Incubation Period of Diseases 3 Annexure 2: Important Days of Public Health Importance 5 Annexure 3: Instruments of Importance in Public Health 6 Annexure 4: Mode(s) of Transmission of Diseases 7 Annexure 5: Some Important Health Legislations Passed in India 8 Annexure 6: Some Important Health Programmes of India 9 Annexure 7: Vectors and Diseases Transmitted 10 Annexure 8: New Tuberculosis Diagnosis (RNTCP) Guidelines in India (w.e.f. 01 April 2009 onwards) 11 Annexure 9: National Population Policy (NPP) 2000 12 Annexure 10: National Health Policy (NHP) 2015 13 Annexure 11: Sustainable Development Goals (SDGs) 14 Annexure 12: New Malaria Treatment Guidelines in India (2013 onwards) 15 Annexure 13: Draft Guidelines: Biomedical Waste Management Guidelines 2011/2015 17 Annexure 14: Golden Points 18 Annexure 15: Current Public Health Related Statistics of India 31 Annexure 16: Honors in Health and Medicine 34 Annexure 17: High Level Expert Group (HLEG) Report on Universal Health Coverage (UHC) 35 SECTION 2 : TOPIC-WISE THEORY MCQs AND EXPLANATIONS Chapter 1: History of Medicine 39 Theory 39 Multiple Choice Questions 44 Explanations 47 Chapter 2: Concepts of Health and Disease 51 Theory 51 Multiple Choice Questions 60 Explanations 70 Chapter 3: Epidemiology and Vaccines 84 Theory 84 Multiple Choice Questions 118 Explanations 146 Chapter 4: Screening of Disease 201 Theory 201 Multiple Choice Questions 207 Explanations 213 Chapter 5: Communicable and Non-communicable Diseases 227 Theory 227 Multiple Choice Questions 290 Explanations 327 mebooksfree.com Contents Chapter 6: National Health Programmes, Policies and Legislations in India 391 Theory 391 Multiple Choice Questions 429 Explanations 446 Chapter 7: Demography, Family Planning and Contraception 481 Theory 481 Multiple Choice Questions 506 Explanations 518 Chapter 8: Preventive Obstetrics, Paediatrics and Geriatrics 542 Theory 542 Multiple Choice Questions 559 Explanations 569 Chapter 9: Nutrition and Health 590 Theory 590 Multiple Choice Questions 608 Explanations 624 Chapter 10: Social Sciences and Health 649 Theory 649 Multiple Choice Questions 657 Explanations 662 Chapter 11: Environment and Health 674 Theory 674 Multiple Choice Questions 693 Explanations 709 Chapter 12: Biomedical Waste Management, Disaster Management, Occupational Health, Genetics and Health, Mental Health 734 Theory 734 Multiple Choice Questions 748 Explanations 758 Chapter 13: Health Education and Communication 776 Theory 776 Multiple Choice Questions 782 Explanations 785 Chapter 14: Health Care in India, Health Planning and Management 791 Theory 791 Multiple Choice Questions 800 Explanations 809 Chapter 15: International Health 821 Theory 821 Multiple Choice Questions 825 Explanations 828 Chapter 16: Biostatistics 835 Theory 835 Multiple Choice Questions 854 Explanations 871 SECTION 3 : IMAGE-BASED QUESTIONS Image-based Questions 921 ix mebooksfree.com SECTION 1 Annexures 1. Incubation Period of Diseases 2. Important Days of Public Health Importance 3. Instruments of Importance in Public Health 4. Mode(s) of Transmission of Diseases 5. Some Important Health Legislations Passed in India 6. Some Important Health Programmes of India 7. Vectors and Diseases Transmitted 8. New Tuberculosis Diagnosis (RNTCP) Guidelines in India (w.e.f. 01 April 2009 onwards) 9. National Population Policy (NPP) 2000 10. National Health Policy (NHP) 2015 11. Sustainable Development Goals (SDGs) 12. New Malaria Treatment Guidelines in India (2013 onwards) 13. Draft Guidelines: Biomedical Waste Management Guidelines 2011/2015 14. Golden Points (Sets 1–5) 15. Current Public Health Related Statistics of India 16. Honors in Health and Medicine 17. High Level Expert Group (HLEG) Report on Universal Health Coverage (UHC) mebooksfree.com ANNEXURE 1 Incubation Period of Diseases Disease Causative organism Incubation Period (IP) Chicken pox Human (alpha) herpes virus 3 14 – 16 days Measles (Rubeonella) RNA paramyxovirus 10 – 14 days Rubella (German Measles) RNA Togavirus 14 – 21 days Mumps RNA Myxovirus 14 – 21 days Influenza Orthomyxovirus 18 – 72 hours Diphtheria Corynebacterium diphtheriae 2 – 6 days Pertussis (Whooping cough) Bordetella pertussis 7 – 14 days Meningococcal meningitis Neisseria meningitis 3 – 4 days SARS Corona virus 3 – 5 days Tuberculosis Mycobacterium tuberculosis Weeks – years Poliomyelitis Poliovirus 7 – 14 days Hepatitis A Enterovirus 72 (Picornavirus) 15 – 45 days Hepatitis B Hepadna virus 45 – 180 days Hepatitis C Hepacivirus 30 – 120 days Cholera Vibrio cholerae 1 – 2 days Typhoid fever Salmonella typhi 10 – 14 days Staphylococcal food poisoning Staphylococcus aureus 1 – 6 hours Ascariasis Ascaris lumbricoides 2 months Ancylostomiasis (Hookworm) A. duodenale 5 weeks – 9 months Malaria Plasmodium vivax 8 – 17 days Plasmodium falciparum 9 – 14 days Plasmodium malariae 18 – 40 days Plasmodium ovale 16 – 18 days Lymphatic filariasis Wuchereria bancrofti 8 – 16 months Rabies Lyssavirus type 1 (Rhabdovirus) 3 – 8 weeks Yellow fever Flavivirus fibricus 2 – 6 days Japanese encephalitis Group B arbovirus (Flavivirus) 5 – 15 days KFD Arbovirus (Flavivirus) 3 – 8 days Chikungunya fever Chikungunyavirus (Arbovirus A) 4 – 7 days Leptospirosis Leptospira interrogans 4 – 20 days Bubonic plague Yersinia pestis 2 – 7 days Pneumonic plague Yersinia pestis 1 – 3 days Septicemic plague Yersinia pestis 2 – 7 days mebooksfree.com Review of Preventive and Social Medicine Scrub typhus Rickettsia tsutsugamushi 10 – 12 days Q fever Coxiella burnetti 2 – 3 weeks Taeniasis (Tapeworms) T. solium, T. saginata 8 – 14 weeks Leishmaniasis (Kala azar) L. donovani 1 – 4 months Trachoma Chlamydia trachomatis 5 – 12 days Tetanus Clostridium tetani 6 – 10 days Yaws Treponema pertenue 3 – 5 weeks HIV/ AIDS HIV/ HTLV – III/ LAV Months – 10 years Swine Flu H1N1 Type A Influenza 1–4 days Crimean Congo Fever Nairovirus (Bunyavirus) 1–9 days H7N9 Influenza H7N9 Type A Influenza 1–10 days (3.3 days) MERS Betacoronavirus 12 days Ebola disease Ebolavirus 2-21 days Anthrax Bacillus anthracis 1-7 days Brucellosis Brucella melitensis 5-60 days Incubation Period of Diseases 4 mebooksfree.com ANNEXURE Important Days of 2 Public Health Importance 30th January Anti-Leprosy Day 4th February World Cancer Day 2nd Wednesday of March No Smoking Day 8th March International Women’s Day 15th March World Disabled Day 24th March Anti-TB Day 7th April World Health Day 25th April World Malaria Day 8th May World Red Cross Day 31st May No Tobacco Day 5th June World Environment Day 14th June World Blood Donor Day 26th June International Day Against Drug Abuse and Illicit Trafficking 1st July Doctors Day 11th July World Population Day 28th July World Hepatitis Day 8th September World Literacy Day 28th September World Rabies Day 1st October International Day for Older Persons 1st October National Voluntary Blood Donation Day 2nd Wednesday of October World Disaster Reduction Day 9th October World Sight Day 10th October World Mental Health Day 24th October UN Day 10th November Universal Immunization Day 25th November International Day for Elimination of Violence against Women 1st December World AIDS Day 3rd December International Day of Disabled Persons 10th December Human Rights Day Last Week of April World Immunization Week 1–7th May Anti–Malaria Week 1–30th June Anti–Malaria Month 1–8th August World Breast Feeding Week 25th August–8th September Eye Donation Fortnight 15–21st November Newborn Care Week mebooksfree.com ANNEXURE Instruments of 3 Importance in Public Health Instrument Use Ice Lined Refrigerator (ILR) Cold chain temperature maintenance Dial Thermometer Cold chain temperature monitoring Horrock’s Apparatus Chlorine demand estimation in water Chlorinator, Chloronome Mixing/regulating the dose of chlorine in water Chloroscope Measuring level of residual chlorine in drinking water Winchester Quart bottle Assess physical and chemical quality of drinking water Kata Thermometer Assess cooling power of air and air velocity (Latter Currently) Anemometer Assess air/wind velocity Hygrometer and Sling Psychrometer Assess air humidity (moisture content of air) Assman Psychrometer Assess air humidity (moisture content of air) Mercurial Barometer Atmospheric pressure Anaeroid Barometer Atmospheric pressure Wind Vane Assess air/wind direction Salter’s scale Field Instrument for Low Birth Weight (LBW) Infantometer Length of infants Stadiometer Height of adults Shakir’s Tape Mid-Arm Circumference (MAC) Sound Level Meter Measures intensity of sound Band Frequency Analyzer Characteristic of sound (pitch) Audiometer Hearing ability assessment mebooksfree.com ANNEXURE Mode(s) of 4 Transmission of Diseases Disease Mode(s) of transmission Remarks Chicken Pox Droplet infection, droplet nuclei. Face to face transmission Measles Droplet infection, droplet nuclei, through conjunctiva 4 days before rash to 5 days later Rubella Droplet infection, droplet nuclei, vertical 1 week before rash to 1 week later Mumps Droplet infection, direct contact Influenza Droplet infection, droplet nuclei Diphtheria Droplet infection, direct contact, fomite borne 95% transmission from carriers Whooping Cough Droplet infection, direct contact, fomite Meningococcal Droplet infection Carriers most important source of infection TB Droplet infection, droplet nuclei. Not Fomite borne Poliomyelitis Faeco-oral, droplet infection Hepatitis A Faeco-oral, parenteral, sexual Hepatitis B Perinatal, parenteral, sexual, horizontal Hepatitis C Perinatal, parenteral, sexual Hepatitis D Perinatal, parenteral, sexual Super-infection/co-infection to HBV Hepatitis E Feco-oral Cholera Feco-oral, contaminated foods/drinks, direct contact Typhoid Feco-oral, urine-oral Amoebiasis Feco-oral Ascariasis Feco-oral Ancylostomiasis Direct penetration(skin), oral Transmission may be perennial Dracunculiasis Consumption of water containing cyclops Water based disease Dengue Aedes bite Water breeding disease Leptospirosis Urine, feces, tissues of rats Direct skin contact Nipah virus Consumption of bats-eaten fruits Person-to-person in India Ebola virus Body fluids (blood, semen, urine, feces, vomit, tears, – sweat, saliva) Brucellosis Direct contact, food borne, air borne Aborted of foetus, placenta can transmit mebooksfree.com ANNEXURE Some Important Health 5 Legislations Passed in India The Quarantine Act, 1870 The Vaccination Act, 1880 The Epidemic Disease Act, 1897 The Child Marriage Restraint (SARDA) Act, 1929 The Employees State Insurance (ESI) Act, 1948 The Factories Act, 1948 The Prevention of Food Adulteration (PFA) Act, 1954 The Hindu Marriage Act, 1955 The Immoral Traffic (Prevention) Act, 1956 The Indian Medical Council (Prof. Conduct and Ethics) Act 1956 The Dowry Prohibition Act, 1961 The Maternity Benefit Act, 1961 The Insecticides Act, 1968 The Registration of Births and Deaths Act, 1969 The Medical Termination of Pregnancy (MTP) Act, 1971 The Narcotic Drugs and Psychotropic Substances Act, 1985 The Consumer Protection Act (COPRA), 1986 The Environmental Protection Act (EPA), 1986 The Mental Health Act, 1987 The Infant Milk Substitutes, Feeding Bottles and Infant Food (Regulation of production, supply and distribution) Act, 1992 The Protection of Human Rights Act, 1993 The Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) [PNDT] Act, 1994 The Transplantation of Human Organs Act, 1994 The Persons with Disabilities (Equal opportunities, Protection of Rights, Full Participation) Act, 1995 The Biomedical Waste (Management and Handling) Rules, 1998 The Tobacco Control Act, 2003 The Information Technology Act, 2000 The Disaster Management Act, 2005 The National Rural Employment Guarantee Act (NREGA), 2005 The Protection of Women from Domestic Violence Act, 2005 The Right to Information (RTI) Act, 2005 Prohibition of Child Marriage Act, 2006 The Food Standards and Safety Act, 2006 The Protection of Children from Sexual Offences (POCSO) Act, 2012 The Mental Health Care Bill, 2013 The Sexual Harassment of Women at Work Place (Prevention, Prohibition and Redressal) Act, 2013 The Juvenile Justice (Care and Protection of Children) Act, 2015 mebooksfree.com ANNEXURE Some Important Health 6 Programmes of India National Family Planning Programme: 1951 National Malaria Control Programme (NMCP): 1953 Lymphatic Filariasis Control Programme: 1955 National Leprosy Control Programme: 1955 National Malaria Eradication Programme (NMEP): 1958 National Tuberculosis Programme (NTP): 1962 National Goitre Control Programme (NGCP): 1962 National Trachoma Control Programme: 1963 Urban Malaria Scheme (UMS): 1971 Integrated Child Development Services (ICDS) Scheme: 1975 National Cancer Control Programme: 1975–76 National Programme for Control of Blindness (NPCB): 1976 Kala Azar Control Programme: 1977 Modified Plan of Operation (MPO): 1977 National Mental Health Programme: 1982 National Leprosy Eradication Programme (NLEP): 1983 National Guineaworm Eradication Programme: 1983–84 National AIDS Control Programme (NACP): 1987 Baby Friendly Hospital Initiative (BFHI) : 1991 Revised National Tuberculosis Control Programme (RNTCP): 1992 Child Survival and Safe Motherhood (CSSM) Programme: 1992 National AIDS Control Programme I (NACP I): 1992–97 National Iodine Deficiency Disorders Control Programme (NIDDCP): 1992 Yaws Eradication Programme: 1996–97 Revised Lymphatic Filariasis Control Programme: 1996–97 Enhanced Malaria Control Project (EMCP): 1997 Reproductive and Child Health Programme I: 1997 National Anti Malaria Programme (NAMP): 1999 National Oral Health Project: 1999 National AIDS Control Programme II (NACP II): 1999–2004 National Vector Borne Disease Control Programme (NVBDCP): 2003–04 Integrated Disease Surveillance Project (IDSP): 2004–09 Reproductive and Child Health Programme II: 2004–09 National Rural Health Mission (NRHM): 2005–12 Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), 2006 National AIDS Control Programme III (NACP III): 2006–11 National Tobacco Control Programme (NTCP): 2007–08 National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS): 2008 National Program for Health Care of the Elderly (NPHCE): 2011 National Health Mission (NHM): 2013 National AIDS Control Program IV (NACP IV): 2012-17 Pradhan Mantri Jan Dhan Yojana (PMJDY), 2014 Pradhan Mantri Suraksha Bima Yojana: 2015 Pradhan Mantri Jeevan Jyoti Bima Yojana: 2015 mebooksfree.com ANNEXURE Vectors and 7 Diseases Transmitted Vector Disease(s) transmitted Housefly (Musca domestica) Diarrhoeal and dysentrical diseases, Poliomyelitis, Yaws, Anthrax, Trachoma Sandfly (Phlebotamus Kala azar (Visceral Leishmaniasis), Oriental sore (Cutaneous Leishmaniasis), Sandfly fever, Oroya argentipes) fever Tse-Tse fly (Glossina palpalis) Sleeping sickness of Africa (African Trypanosomiasis) Reduviid bug (Triatominae) Chagas Disease (Sleeping sickness of America- American Trypanosomiasis) Black fly (Simulum) Onchocerciasis (River Blindness) Soft tick Relapsing fever, Q fever, KFD (outside India) Hard tick Tularemia, Babesiosis, KFD (India), Tick paralysis, Tick encephalitis, Tick hemorrhagic fever, Indian Tick Typhus, RMSF Louse Epidemic typhus, Trench fever, Relapsing fever Mite Scrub typhus, Rickettsial pox Flea Plague, Murine typhus Anopheles mosquito Malaria, Filaria (outside India) Culex mosquito Bancroftian Filariasis, Japanese Encephalitis, West Nile fever, Viral arthritis Aedes mosquito Yellow fever, Dengue, DHF, Chikungunya, Rift Valley fever, Filariasis (Outside India) Mansonoides mosquito Malayan (Brugian) filariasis, Chikungunya mebooksfree.com ANNEXURE New Tuberculosis Diagnosis (RNTCP) Guidelines 8 in India (w.e.f. 01 April 2009 onwards) Tuberculosis Suspect: Any person with cough 2 weeks or more Number of specimen(s) required for diagnosis of smear positive pulmonary tuberculosis: Two – Spot sputum specimen (Day 1) – Morning sputum specimen (Day 2) Diagnosis of Tuberculosis: – None sputum positive: Doubtful – One sputum positive: Sputum positive pulmonary tuberculosis – Two sputum positive: Sputum positive pulmonary tuberculosis Management of clients: – None sputum positive: Give antibiotics for 10 – 14 days - Cough relieved: Non-tuberculosis person - Cough persists: Repeat two sputum smear examinations 1. None sputum positive: X-ray chest i. Findings suggestive of TB: Sputum negative tuberculosis; Start ATT ii. No findings suggestive of TB: Non-tuberculosis person 2. One sputum positive: Sputum positive pulmonary tuberculosis; Start ATT 3. Two sputum positive: Sputum positive pulmonary tuberculosis; Start ATT – One sputum positive: Start ATT – Two sputum positive: Start ATT New Revised Guidelines for Treatment of MDR-TB & XDR-TB (RNTCP 2015-16) I. MDR-TB Regimen (Category IVQ) Intensive Phase: 6-9 (K L C Z E Et) + Continuation Phase: 18 (L C E Et) (K Kanamycin; L Levofloxacin; C Cycloserine; Z Pyrazinamide; E Ethambutol; Et Ethionamide) II. XDR-TB Regimen (Category VQ) Intensive Phase: 6-12 (H Cm Cz L A M P) + Continuation Phase: 18 (H Cz L A M P) (H High dose Isoniazid; Cm Capreomycin; Cz Clofazimine; L Linezolid; A Amoxy-Clav; M Moxifloxacin; P PAS) mebooksfree.com ANNEXURE National Population 9 Policy (NPP) 2000 Objectives of National Population Policy 2000 – Immediate objectives: To meet unmet need of contraception; to strengthen health infrastructure; to strengthen health personnel and to promote integrated service delivery for basic RCH care – Mid-term objective: ‘To bring the total fertility rate (TFR) to Replacement Level; i.e. TFR to 2.1’ – Long-term objective: To stabilize population by 2045 National Socio-demographic Goals of NPP 2000 – Address the unmet needs for basic reproductive and child health services, (achieve by 2010) supplies and infrastructure – Make school education up to age 14 free and compulsory, and reduce drop outs at primary and secondary school levels to below 20 percent for both boys and girls – Reduce infant mortality rate to below 30 per 1000 live births – Reduce maternal mortality ratio to below 100 per 100,000 live births – Achieve universal (100%) immunization of children against all vaccine preventable diseases – Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age – Achieve 80 percent institutional deliveries and 100 percent deliveries by trained persons – Achieve universal access to information/counseling, and services for fertility regulation and contraception with a wide basket of choices – Achieve 100 percent registration of births, deaths, marriage and pregnancy – Contain the spread of Acquired Immunodeficiency Syndrome (AIDS), and promote greater integration between the management of reproductive tract infections (RTI) and sexually transmitted infections (STI) and the National AIDS Control Organisation – Prevent and control communicable diseases – Integrate Indian Systems of Medicine (ISM) in the provision of reproductive and child health services, and in reaching out to households – Promote vigorously the small family norm to achieve replacement levels of TFR – Bring about convergence in implementation of related social sector programs so that family welfare becomes a people centred programme mebooksfree.com ANNEXURE National Health Policy 10 (NHP)– 2015 National Health Policy 2015 (Draft) Goal: The attainment of the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence. Key Policy Principles Equity Universality Patient Centered & Quality of Care Inclusive Partnerships Pluralism Subsidiarity Accountability Professionalism, Integrity and Ethics Learning and Adaptive System Affordability Key Targets/Priority Areas “Health In All” approachQ as complement to Health For All. 7 Priority Action AreasQ: Swachh Bharat Abhiyan, Balanced and Healthy Diets, Nasha Mukti Abhiyan , Yatri Suraksha to ensure road and rail safety, Nirbhaya Nari for action against gender violence, Reduced stress and improved safety in the work place, Reducing indoor and outdoor air pollution Swasth Nagrik Abhiyan a social movement for health Public health expenditure: ≥ 2.5% of the GDPQ Population to bed ratio: ≥ 1000 beds per million population (1 per 1000)Q NUHM to cover all State capitals, District headquarters and Cities/towns with more than 50,000 populationsQ Single digit Neonatal mortality and Stillbirth rates Increase the proportion of male sterilization from < 5% where it is currently, to > 30%Q Leprosy: Reduction to grade 2 disability to < 1 per million by 2020Q Life support ambulances linked to trauma management centers - 1 per 30 lakh population (Urban) - 1 per 10 lakh population (Rural) A nursing school in every large district/ cluster of districts of about 20-30 lakh population A Common Entrance Exam on the pattern of NEET for UG entrance at All India level needs to be enforced. A Licentiate Exam will be introduced for all medical graduates with a regular renewal at periodic intervals with CME credits accrued. All Indian students studying medicine abroad should undertake a screening test to obtain registration with the regulatory body and the same should be applicable for Indian colleges as well to ensure the quality of medical graduates A robust National Health Accounts System needs to be operationalized mebooksfree.com ANNEXURE 11 Sustainable Development Goals (SDGs) Sustainable Development Goals (SDGs) ‘Transforming our world: 2030 Agenda for Sustainable Development’Q - An intergovernmental set of 17 aspiration Goals with 169 targets Post 2015 Development Agenda (successor to MDGsQ) Directly Health related goalsQ: One (Goal 3) Directly Health disparities addressing goals: Six (Goals 1-6) 1. End Poverty in all its forms everywhere 2. End Hunger, achieve food security and improved nutrition and promote sustainable agriculture 3. Ensure Healthy lives and promote well-being for all at all ages 4. Ensure inclusive and equitable quality Education and promote lifelong learning opportunities for all 5. Achieve Gender equality and empower all women and girls 6. Ensure availability and sustainable management of Water and Sanitation for all 7. Ensure access to affordable, reliable, sustainable and modern Energy for all 8. Sustained, inclusive & and sustainable Economic growth, full and productive employment and decent work for all 9. Build resilient infrastructure, promote inclusive and sustainable Industrialization and foster innovation 10. Reduce Inequality within and among countries 11. Make cities and Human Settlements inclusive, safe, resilient and sustainable 12. Ensure sustainable Consumption and Production patterns 13. Take urgent action to combat Climate change and its impacts 14. Conserve and sustainably use the Oceans, Seas and Marine resources for sustainable development 15. Protect, restore and promote sustainable use of Terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss 16. Promote peaceful and inclusive Societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels 17. Strengthen the means of implementation and revitalize the Global partnership for sustainable development GOAL 3: Ensure Healthy lives and promote well-being for all at all ages TARGETSQ 3.1 By 2030, Global MMR < 70 per 100,000 live birthsQ 3.2 By 2030, End Preventable deaths of Newborns and Under-five children - NNMR 12 per 1,000 live birthsQ - U5MR 25 per 1,000 live birthsQ 3.3 By 2030, End Epidemics of AIDS, Tuberculosis, Malaria and Neglected tropical diseases and Combat Hepatitis, Water- borne diseases and other CDs 3.4 By 2030, Reduce by 33% Premature mortality from NCDsQ 3.5 Strengthen Prevention and Treatment of Substance abuse 3.6 By 2020, 50% reduction in Global deaths and injuries from Road traffic accidentsQ 3.7 By 2030, Universal access to Sexual and Reproductive health-care services 3.8 Achieve Universal Health Coverage 3.9 By 2030, Reduce Deaths and illnesses from hazardous chemicals, air/water/soil pollution 3.a Implementation of the WHO Framework Convention on Tobacco Control 3.b Research and Development of Vaccines and Medicines for CDs & NCDs 3.c Financing, recruitment, development, training and retention of Health workforce 3.d Strengthen capacity for early warning, risk reduction, management of Health risks mebooksfree.com ANNEXURE New Malaria Treatment Guidelines in 12 India (2013 onwards) I. VIVAX MALARIA Chloroquine X 3 days (10 mg per kg Day 1; 10 mg per kg Day 2; 5 mg per kg Day 3) + Primaquine X 14 days (0.25 mg per kg) II. FALCIPARUM MALARIA In Other States (Other than North-Eastern states): –– Artemisin based Combination therapy (ACT-SP) Artesunate X 3 days (4 mg per kg) + Sulfadoxine X Day 1 (25 mg per kg) + Pyrimethamine X Day 1 (1.25 mg per kg) –– Primaquine X Day 2 (0.75 mg per kg) In North-Eastern states: –– Artemether based Combination therapy (ACT-AL) Artemether X 3 days (80 mg BD) + Lumefantrine X 3 days (480 mg BD) –– Primaquine X Day 2 (0.75 mg per kg) PLEASE NOTE: Colour coding of age-wise blister packs for P. falciparum treatment: Age Colour code for blister pack 0-1 year Pink 1-4 years Yellow 5-8 years Green 9-14 years Red 15+ years White Treatment of Uncomplicated P. falciparum in Pregnancy: –– 1st trimester: Quinine X 7 days (10 mg per kg TDS) –– 2nd/3rd trimester: ACT-AL in NE states/ACT-SP in Other states III. MIXED INFECTIONS (P. VIVAX + P. FALCIPARUM) In Other States (Other than North-Eastern states): –– ACT-SP X 3 days –– Primaquine X 14 days (0.75 mg per kg) In North-Eastern states: –– ACT-AL X 3 days –– Primaquine X 14 days (0.75 mg per kg) IV. PLASMODIUM MALARIAE Treat as P. falciparum V. PLASMODIUM OVALE Treat as P. vivax VI. MIXED INFECTIONS Treat as P. falciparum Primaquine X 14 days mebooksfree.com Review of Preventive and Social Medicine VII. SEVERE & COMPLICATED MALARIA Initial parenteral treatment X 24-48 hours: –– Quinine, OR –– Artemether, OR –– Artesunate, OR –– Arteether Oral treatment after 48 hours: –– After Parenteral Quinine: Quinine + Doxycycline X 7 days, OR Quinine + Clindamycin X 7 days (Pregnancy & Children 6 weeks): Mefloquine weekly (Start 2 weeks before travel; Continue for 4 weeks after entering endemic New Malaria Treatment Guidelines in India (2013 onwards) area) 16 mebooksfree.com ANNEXURE Draft Guidelines: Biomedical Waste 13 Management Guidelines 2011/2015 Dear students, PLEASE NOTE: These guidelines are ‘draft proposed guidelines’ in Gazette of India. They have NOT YET been implemented in India. I shall update its’ implementation on my facebook page (www.facebook.com/Dr Vivek Jain) as and when it takes place! Draft BMW Management Guidelines 2011 are NOT valid for: Radioactive waste Hazardous chemicals Municipal solid waste Leas acid batteries Hazardous waste Schedule I: Categories of BMW BMW category Type of waste Disposal steps Category 1 Human anatomical waste Incineration Category 2 Animal waste Incineration Category 3 Microbiological and Biotechnology waste 1. Chemical treatment/ Autoclaving/ Microwaving 2. Mutilation/ Shredding 3. Landfill/ Recyclers Category 4 Wasted sharps 1. Chemical treatment/ Destruction by needle or tip cutters/ Autoclaving/ Microwaving 2. Mutilation/ Shredding 3. Landfill/ Concrete sharps pit Category 5 Discarded medicines and cytotoxic drugs Landfill/ Incineration Category 6 Soiled waste Incineration Category 7 Infectious solid waste 1. Chemical treatment/ Autoclaving/Microwaving 2. Mutilation/ Shredding 3. Recyclers Category 8 Chemical waste 1. Chemical treatment 2. Disposal in drains Schedule II: Types of Containers and Disposal Color coding Waste categories Treatment options Yellow 1, 2, 5, 6 Incineration Red 3, 4, 7 1. Chemical treatment/ Destruction (needle/ tip cutters)/ Autoclaving/ Microwaving 2. Mutilation/ Shredding 3. Landfill/ Recyclers/ Concrete sharps pit Blue 8 1. Chemical treatment 2. Disposal in drains Black Municipal waste Municipal dump sites mebooksfree.com ANNEXURE 14 Golden Points PSM: GOLDEN POINTS 1 Father of Medicine/First True Epidemiologist Hippocrates Father of Public Health Cholera First Country to Socialise Medicine completely Russia Health as a “State of complete physical, social and mental WHO wellbeing” was defined by HDI(Human Development Index) comprises Knowledge (Literacy and Mean years of schooling), Income and Longevity (Life Expectancy at Birth) Life Expectancy is a Mortality Indicator (Positive Health Indicator) “Epidemiological Triad” comprises of Agent, Host and Environment Extermination of organism is Eradication Action taken prior to onset of disease is Primary Prevention Early Diagnosis and Treatment are Secondary Prevention Ivory Towers of Disease Large Hospitals ICD-10 Classification is for Diseases Prevalence is a Proportion (Total=New + Old Cases) Total no. of deaths/Total no. of cases is Case Fatality Rate Observed Deaths/Expected Deaths is Standardized Mortality Ratio (SMR) Prevalence/Duration is Incidence Both exposure and outcome have occurred before study starts in Case Control Study Cohort Study is Forward Looking/Prospective Study Matching Removes confounding, Ensures Comparability Relative Risk is Incidence among Exposed/ Incidence among non-exposed Framingham Heart Study is a Cohort Study Heart of a Control Trial is Randomization Occurrence of a Disease Clearly in excess of normal expectancy Epidemic Disease imported in a country where it doesn’t occur Exotic Iatrogenic Disease is Physician-induced First case to come to notice of investigator Index Case Pseudo-Carriers are Carriers of avirulent Organisms Malaria parasite in Mosquito is Cyclo-propagative Transmission Gap between Primary case and Secondary Case is Serial Interval Yellow Fever/BCG/Measles are Live Vaccines/ Lyophilised vaccines First Vaccine to be discovered Smallpox Vaccine (Edward Jenner) Risk of Cold Chain failure is greatest at Sub-centre and Village level Quarantine is for Healthy Contacts Most effective sterilizing agent Autoclaving (Steam under pressure) Beaching Powder contains 33% available chlorine mebooksfree.com Golden Points Advantage gained by screening Lead Time Sensitivity identifies True Positives Usefulness of a screening test is given by Sensitivity Small Pox was declared Eradicated on 8 May, 1980 Rash in Chickenpox is Pleomorphic and Dew-drop like Koplik Spots are diagnostic of Measles (upper 2nd molar) Incubation Period for Measles is 10-14 days Strain for Measles Vaccine is Edmonston Zagreb Strain for Rubella Vaccine RA 27/3 Highly Pathogenic Avian Influenza (Bird Flu) is by Type A (H5N1 strain) virus Hundred Day Cough is Pertussis (Whooping Cough) DOC for Chemoprophylaxis of Meningococcal Meningitis Rifampicin Positive Schick Test indicates Susceptible to Diphtheria Inability to drink is a sign of Very Severe Disease SARS is caused by Corona Virus Overall Prevalence of TB infection 30 - 40 % Sputum Smear +ve at or after 5 months ATT Failure Only Bacteriostatic drug in Primary ATT Drugs Ethambutol Category II treatment (RNTCP) duration is 8 Months (3m IP + 5m CP) WHO has recommended ‘DANISH 1331’ strain for BCG Vaccine Failure in RNTCP Sputum +ve at/after 5 months treatment Golden Points Case finding Tool of choice in RNTCP is Sputum Smear (ZN Staining) DOTS is Directly Observed Treatment, Short Course Chemotherapy Relapse/Defaulter/Failure in RNTCP is classified as Category II (8 Months treatment) For every 1 clinical case of Poliomyelitis, there are 1000 subclinical Cases Polio stool samples are transported in Reverse Cold Chain (+ 2° to + 8° C) HBeAg is Marker of Infectivity/Viral Replication ORS Solution should be used within 24 Hours Enteric Fever includes Typhoid and Para-typhoid Fevers Chandler’s Index for Hookworms is Av. No. of Eggs/gm of stool MC arboviral disease is Dengue Presumptive Treatment in Malaria Chloroquine Only communicable disease of man that is always fatal Rabies Main Vector for Yellow Fever is Aedes aegypti Pigs in Japanese Encephalitis are Amplifier Hosts KFD is transmitted in India by Haemaphysalis (Hard tick) Main reservoir of Plague in India Tatera indica (Wild Rodent) Scrub typhus is caused by Rickettsia tsustsugamushi Sandfly transmits Leishmaniasis (Kala Azar) Elimination Level for leprosy 0.85 WHO Blindness is 90% 230 mebooksfree.com Communicable and Non-communicable Diseases Varicella Zoster immunoglobulin (VZIG): – Given within 72 hours of exposure – Dose: 1.25 – 5.0 ml intramuscularly – Reserved for: – Immunosuppressed contacts of acute cases – Newborn contacts MEASLES Measles (Rubeola) Causative agent: RNA paramyxovirus (so for only one serotype known) Incubation Period: 10-14 daysQ I Source of Infection: cases (carriers are not known to occurQ) Incubation Period: 10-14 Mode of transmission: Air droplets (respiratory) days Period of CommunicabilityQ: 4 days before and 5 days after the appearance of rash (carriers are not known to occur) (Rash: Retro-auricular originQ) Secondary attack rate of – Measles is highly infectious during pro-dromal period and during eruption MeaslesQ: 80% Measles has no second attacks (life long immunity seen) Koplik spots (buccal Communicable and Non-communicable Diseases Secondary attack rate of MeaslesQ: 80% mucosa opposite upper 2nd Measles shows a cyclical trendQ: Increase every 2-3 years molar) Pathogonomic clinical feature of MeaslesQ: Koplik spots (buccal mucosa opposite MC complication of upper 2nd molar) measles in young children: MC complication of measles in young childrenQ: Otitis media Otitis media – SSPE (Subacute Sclerosing Pan Encephalitis) is a rare complication of measlesQ: 7 per million cases of Measles (7-10 years after initial infection) Measles is prevented by: – Active immunization by measles vaccine: – Live, attenuated – Strains: Edmonston Zagreb (MC), Schwarez, Moraten – Passive immunization by measles immunoglobulin (WHO recommended dose: 0.25 ml/kg body weightQ) WHO Measles Elimination StrategyQ: ‘Catch up, Keep up, Follow up’ Catch up: Nationwide, vaccination campaign targeting all children 9 months to 14 years of age, irrespective of history of Measles disease or vaccination status Keep up: Routine services aimed at vaccinating more than 95% of each successive birth cohort Follow up: Subsequent nationwide vaccination campaigns conducted every 2–4 years targeting usually all children born after the catch-up campaign. Challenges for Measles Elimination: – Weak immunization systems – Highly infectious nature – Inaccessible populations (e.g. those in conflict) – Refusal to immunization – Changing epidemiology (increased transmission among adolescents/adults) – Need to provide Catch-up campaign to >130 million children in India – Gaps in human and financial resources at country/regional/global levels Accelerated Measles Mortality Reduction Strategy (WHO-UNICEF): Two doses of Measles containing vaccine (MCV) to all children through routine and supplemen- tary immunization activities Global Measles Elimination Targets by 2015: – Routine vaccine coverage >90% nationally – Routine vaccine coverage >80% district level – Reduction and annual maintenance of incidence 65 years – Morbid obesity Laboratory diagnosis: – Most timely and sensitive detection: RT-PCR testQ – Samples: Nasopharyngeal + throat swabs [Tracheal/bronchial aspirates in lower respiratory tract infection cases]Q – Point-of-care/Rapid diagnostic tests: Not recommended Duration of isolation: for 7 days after onset of illness OR 24 hours after resolution of fever/respiratory symptoms whichever is longer Antiviral therapy: – Severe/progressive clinical illness: OseltamivirQ (if not available or resistance, use Zanamivir) – High risk of severe/complicated illness: Oseltamivir OR Zanamivir – Not high risk OR Uncomplicated confirmed/suspected illness: No need of treat- I ment DOC for H1N1 – Dosage: Oseltamivir 75 mg BD × 5 days - Oseltamivir 75 mg BD × 5 days - Zanamivir 2 inhalations (2 × 5 mg) BD × 5 days 234 mebooksfree.com Communicable and Non-communicable Diseases Oseltamivir dosagesQ Treatment Prophylaxis By weight By weight < 15 kg: 30 mg BD × 5 days 50 years age) Mode of transmission: Respiratory (Live bird markets) – Human to human transmission: Rare but possible Treatment: Neuraminidase inhibitors – Oseltamivir – Zanamivir Vaccines for Influenza Killed vaccines: – 2 doses, 3 – 4 weeks apart, 0.5 ml (for age > 3 years), subcutaneous – 70 – 90% protective efficacy; duration 3 – 6 months – Is rarely associated with Guillain-Barré SyndromeQ (GBS) Live attenuated vaccines: – Stimulate local + systemic immunity – Antigenic variations presents difficulties in manufacture Newer vaccinesQ: – Split – virus vaccine: - Also known as ‘Sub-virion vaccine’ - Highly purified - Lesser side effects - Less antigenic – multiple injections required - Useful for children – Neuraminidase – specific vaccine: - Sub-unit vaccine containing N-antigen - Permits subclinical infection – long lasting immunity – Recombinant vaccine: - Antigenic properties of virulent strain transferred to a less virulent strain – Contraindications to Inactivated Influenza vaccines: - Severe allergy to chicken eggs - History of hypersensitivity/anaphylactic reactions previously - Development of Guillain-Barré Syndrome (GBS) within 6 weeks of vac- cine - Infants less than 6 months age - Moderate-to-severe illness with fever 235 mebooksfree.com Review of Preventive and Social Medicine H1N1 (Swine flu) Vaccine H1N1 Inactivated vaccine: Single i/m injection I – Strain: A/California/7/2009 (H1N1) V like strainQ H1N1 Inactivated – Storage temperature: +2° to +8° C vaccine: Strain: A/ – Contraindications: History of anaphylaxis/severe reaction/Guillian Barre California/7/2009 Syndrome, Infants < 6 months, Moderate-to severe illness with fever – Protective immunity: Develops after 14 days (NOT 100%) H1N1 Live attenuated vaccine: Nasal spray – Side effects: Rhinorrhoea, nasal congestion, cough, sore throat, fever, wheez- ing, vomiting Priority groups (in order) for Influenza vaccines: – Pregnant womenQ – Age > 6 months with chronic medical conditions – 15-49 years healthy young adults – Healthy young children – Healthy adults 49-65 years – Healthy adults >65 years Categorization of H1N1 Cases in India 2014-15Q Communicable and Non-communicable Diseases Category A patients Mild fever plus cough/sore throat with or without body ache, headache, diarrhoea and vomiting Do not require Oseltamivir Treat symptomatically Patients be monitored for their progress and reassessed at 24-48 hours No testing of the patient for H1N1 is required Patients should confine themselves at home and avoid mixing up with public and high risk members in the family Category B patients: In addition to all the signs and symptoms mentioned under Category-A, if the patient has, 1. High grade fever and severe sore throat Home isolation and Oseltamivir 2. One or more of the high risk conditions Children with mild illness but with predispos ing risk factors/Pregnant women/Persons aged 65 years or older/Patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS/Patients on long term cortisone therapy Oseltamivir No tests for H1N1 is required Patients should confine themselves at home and avoid mixing with public and high risk members in the family Category C patients: In addition to the above signs and symptoms of Category-A and B, if the patient has, 1. Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discoloration of nails 2. Children with influenza like illness who had a severe disease as manifested by the red flag signs (Somnolence, high and persistent fever, inability to feed well, convul sions, shortness of breath, difficulty in breathing, etc) 3. Worsening of underlying chronic conditions Testing, immediate hospitalization and treatment DIPHTHERIA I Carriers are more important Diphtheria as source of infection: Diphtheria Causative agent: Corynebacterium diphtheriae, a gram positive non-motile organ- ism 236 mebooksfree.com Communicable and Non-communicable Diseases Diphtheria is an endemic disease in India Source of infection: Case or carrier – Carriers are more important as source of infection: 95% of total disease transmis- sionQ – Nasal carriers are more dangerous than throat carriersQ – Incidence of carriers in a community: 0.5-1% – Immunization does not prevent carrier stateQ Incubation Period: 2-6 daysQ Mode of transmission: droplet infection (main mode), directly from cutaneous lesions and fomites Period of Infectivity: 14-28 days from onset of disease; longer for carriersQ – A case/carrier may be considered non-communicable when atleast 2 cultures from nose and throat, 24 hrs apart, are negativeQ DPT Vaccine Refer to Chapter 3, Theory Schick Test Communicable and Non-communicable Diseases Schick Test: An intradermal test of immunity status and hypersensitivity to Diphtheria toxin Dose: 0.2 ml (1/50 MLD) of Schick test toxin in test arm and 0.2 ml of heat inactivated toxin in opposite ‘control’ arm Interpretations of Schick Test: Observation Reading InterpretationQ Test arm Control arm No reaction No reaction NEGATIVE Immune to diphtheria Red flush No reaction POSITIVE Susceptible to diphtheria Red flush Red flush fading by PSEUDOPOSITIVE Hypersensitivity fading by 4th day 4th day Red flush Pseudopositive COMBINED Susceptibility & Hypersensitivity (Red flush=Positive reaction) Schick test negative if, >0.03 units antitoxin per ml in blood serum Schick test has been replaced by: Hemagglutination TestQ Hemagglutination Test: Measurement of serum antitoxin level WHOOPING COUGH Pertussis/ Whooping Cough Causative agent: Bordetella pertussis (5% cases by B. parapertussis) Also known as ‘Whooping Cough’ or ‘100 Day Cough’Q – Paroxysms of cough are followed by an inspiratory whoop (high pitch) Incubation period: 7 – 14 days Source of Infection: Case – There is no subclinical or chronic carrier stateQ – Neither vaccination nor infection confers long-term immunity Secondary Attack rate: > 90%Q Incidence and fatality: Females > Males Leukocytosis does not correlates with the severity of cough Chief complications: Brochitis, bronchopneumonia, bronchiectasis, subconjunctival hemorrhages, epistaxis, hemoptysis, punctuate cerebral hemorrhages, convulsions and coma. 237 mebooksfree.com Review of Preventive and Social Medicine Laboratory diagnosis: Culturing of nasopharyngeal swabs on Bordet-Gengou medium, polymerase chain reaction (PCR), immunofluorescence (DFA), and sero I logical methods Drug of choiceQ of Pertussis Drug of choiceQ: Erythromycin (40 mg/kg QID × 10 days) Erythromycin Vaccines: DPT [Refer to Chapter 3, Theory] MENINGOCOCCAL MENINGITIS Meningococcal Meningitis/ Cerebrospinal Fever Causative agent: – N. meningitidis, a gram negative diplococci – Serotypes A, B, C, D, 29E, W135, X, Y Meningococcal disease is endemic in India Carriers are the more important source of infection than casesQ – Mean duration of Temporary carriers: ~ 10 months – During epidemics, carrier rate may go up to 70-80% Mode of Transmission: Droplet infection Incubation Period: 2-10 days (average 3-4 days) Communicable and Non-communicable Diseases Case Fatality Rate (CFR) of Meningococcal meningitisQ: 80% – With early diagnosis and treatment, CFR < 10% Drugs of Choice: I Management Drug of choice Chemoprophylaxis of contacts of Meningococcus: Treatment of cases Penicillin Rifampicin Treatment of carriers RifampicinQ Chemoprophylaxis of contacts RifampicinQ (For chemoprophylaxis : Rifampicin 600 mg BD X 2 daysQ) Treatment with Penicillin does not eradicate carrier stateQ Meningococcal Vaccine Type of Vaccine: Killed vaccine, cellular fraction Dose: 0.5 ml Route: Subcutaneous Site: Antero-lateral thigh. Middle one-third Booster every 3 years Available for group A, C, W135 and Y meningococci I – Vaccine is not available for Group B meningococcus: Group B polysaccharide is Vaccine is not available for non-immunogenicQ Group B meningococcus: ContraindicationsQ: – Pregnancy – Infants and children < 2 years of age (due to development of immunologic tolerance) ARI/ PNEUMONIA No Pneumonia: Cough or Cold No chest indrawing, No fast breathing Management: – No antibiotics necessary – Treat symptomatically If cough > 30 days, refer for assessment 238 mebooksfree.com Communicable and Non-communicable Diseases Pneumonia (Not severe) No chest indrawing Fast breathing present (based on respiratory rate - RR) Age group Respiratory rate cut-off for fast breathingQ 0 – 2 months RR > 60 per minute 2 – 12 months RR > 50 per minute 12 months – 5 years RR > 40 per minute Management: – At home I – Give antibiotics – Drug of choice CotrimoxazoleQ Drug of choice Pneumonia: – Reassessment after 2 days Cotrimoxazole Severe Pneumonia SignsQ: – Chest indrawing Communicable and Non-communicable Diseases – Nasal flaring – Grunting – Cyanosis Management: – Give first dose of referral antibiotic (Ampicillin + Gentamicin) – REFER URGENTLY to hospital; – Drugs of ChoiceQ – Benzyl Penicillin (or Ampicillin or Chloramphenicol) for I Drugs of ChoiceQ Severe first 48 hours and then Procaine Penicillin (or Ampicillin or Chloramphenicol) Pneumonia: Benzyl for next 3 days Penicillin – Antibiotics to be changed if there is no improvement after first 48 hours Very Severe Pneumonia SignsQ: – Convulsions, abnormally sleepy or difficult to awake – Stridor when calm – Stopped feeding – Wheezing – Fever or low body temperature – Severe malnutrition Management: – Give first dose of referral antibiotic (Ampicillin + Gentamicin)Q – REFER URGENTLY to hospital – Drug of ChoiceQ – Chloramphenicol i/m for first 48 hours and then oral I chloramphenicol till total 10 days Drug of ChoiceQ Very – Antibiotics to be changed (to i/m Cloxacillin + Gentamicin) if there is no Severe Pneumonia: improvement after first 48 hours Chloramphenicol TUBERCULOSIS Tuberculosis Situation in India Country with highest TB burden in world: India Infected with TB (Mantoux positive)Q: Two out of five Indians (40%) Annual risk of becoming infected with TB: 1.5% Q Lifetime risk of disease among infected: 10% Indians developing TB everyday: 5000Q Sputum positive every year: 0.8 million TB deaths per year: 0.37 million 239 mebooksfree.com Review of Preventive and Social Medicine Epidemiological Indices for TB Incidence of TB infection (Annual infection rate, Annual risk of infection- ARI): Percent- age of population under study who will be newly infected with TB among non- infected in 1 year I – Expresses attacking force of TB in community 1% ARI corresponds to: 50 – In developing countries 1% ARI corresponds to: 50 SS +ve cases per 100,000 gen- SS +ve cases per 100,000 eral populationQ general population – Tuberculin conversion index is the ‘best indicator for evaluation of TB prob- lem and its trend’ in the communityQ Prevalence of TB infection: Percentage of individuals who show a positive reaction to standard tuberculin test – Represent cumulative experience of population in ‘recent as well as remote infection’ with TBQ – Tuberculin test is the ‘only way of estimating the prevalence of infection in a population’Q Incidence of disease: Percentage of new TB cases per 1000 population – Reveals trend of problem, including impact of control measures – Is of utility only in countries where high proportion of new cases are detected and notification is reliable Communicable and Non-communicable Diseases – Sputum smear examination (AFB) is a reliable method for estimationQ Prevalence of disease or case rate: Percentage of individuals whose sputum is positive for TB bacilli on microscopic examinationQ – ‘Best available practical index to estimate case load’ in communityQ – Age specific prevalence is most relevant index Prevalence of suspect cases: Is based on X ray examination of chest – No epidemiological significance is attached to this index Prevalence of drug-resistant cases: – Is directly related to chemotherapy Mortality rate: – Was earlier used as an index of magnitude of TB problem Tuberculin/ PPD TuberculinQ: Purified protein derivative (PPD) has replaced the antigen old tuberculin (OT) – Tuberculins have also been prepared from atypical mycobacterium: PPD-Y (M. Kansasii), PPD-B (Battey mycobacterium), Scrofula (M. scrofulaceum) Discovered by Von Pirquet (1907) PPD is a purer preparation, gives fewer non-specific reactions and is easier to standardise – Standard PPD (PPD-S) contains Q: 50,000 tuberculin units (TU) per mg [1TU= 0.00002 mg PPD] – WHO advocates ’PPD-RT-23 with Tween-80’Q Dosage: First strength (1TU), Intermediate strength (5TU), Second strength (250TU) Tuberculin test conversion is defined as an increase of 10 mm or more within a 2-year period, regardless of ageQ Tuberculin test in use: – Mantoux intradermal test: More precise test of tuberculin sensitivity – Heaf test: Quick, easy, reliable and cheap, preferred for testing large groups – Tine multiple puncture test unreliable, not recommended Tuberculin test is the ‘only way of estimating the prevalence of infection in a population’Q Tuberculin test has lost its sensitivity as an indicator of the true prevalence of infection, in countries with high coverage of BCGQ – True prevalence rates are exaggerated by infection with atypical mycobacteria and boosting effect of a second dose of tuberculin 240 mebooksfree.com Communicable and Non-communicable Diseases Mantoux Test (Tool for detection of TB infection) (Pirquet Test) I Tuberculin test conversion: Increase of > 10 mm within 2 years period DoseQ: 1 TU of PPD in Dose Q: 1 TU of PPD in 0.1ml injected intradermally on forearm 0.1ml WHO advocated preparation Q: PPD–RT–23 with Tween–80 ReadingsQ: Result read after Is a test of prognostic significance 72 hrs (3d) Has limited validity due to lack of specificity ReadingsQ: Result read after 72 hrs (3d) Only induration is measured: – Induration >9 mm: Positive (Past OR current infection with TB)Q – Induration 6-9 mm: Doubtful (M. tuberculosis or Atypical mycobacteria) – Induration 6 mm: Continue INH for 3 months (INH: Isoniazid; NA: Not available) The Stop TB StrategyQ Vision: A TB-FREE WORLD Goal: To dramatically reduce the global burden of TB by 2015 in line with the Mil- lennium Development Goals and the Stop TB Partnership targets Targets: – MDG 6, Target 8: Halt and begin to reverse the incidence of TB by 2015 – Targets linked to the MDGs and endorsed by the Stop TB Partnership: 1. by 2015Q: Reduce prevalence and deaths due to TB by 50% compared with a baseline of 1990 2. by 2050Q: Eliminate TB as a public health problem The End TB Strategy 2016-2035Q Vision: A world free of TB - Zero deaths, disease and suffering due to TB Goal: End the Global TB Epidemic MilestonesQ TargetsQ Indicators 2020 2025 SDG 2030 End TB 2035 Reduction in number of TB 35% 75% 90% 95% deaths compared with 2015 (%) Reduction in TB incidence rate 20% 50% 80% 90% compared with 2015 (%) (< 85/100,000) (< 55/100,000) (< 20/100,000) (< 10/100,000) TB-affected families facing Zero Zero Zero Zero catastrophic costs due to TB (%) 242 mebooksfree.com Communicable and Non-communicable Diseases TB Mission 2020 Launched: 28 October 2014 by MOHFW, Government of India Main Objective: Eliminate TB form India by 2020Q Components: - Free diagnosis and treatment of all patients in any institution (Government or Private) - Banning commercial serology for TB diagnosis - Bringing Anti-TB drugs under separate schedule of National Drug law - Mandatory notification of New TB case Latent Tuberculosis (LATENT TB, LTBI) Description: Latent tuberculosis is where a patient is infected with Mycobacterium tuberculosis, but does not have active tuberculosis disease – Latent TB are NOT INFECTIOUS Main risk: 10% will go on to develop active TB at a later life Tests used to identify patients with latent TB: – Tuberculin skin tests (Montaux test, Heaf test, Tine test) – alpha-interferon tests Communicable and Non-communicable Diseases National Reference Laboratories for TB in India National Institute for Research in Tuberculosis (NIRT), ChennaiQ National Tuberculosis Institute (NTI), BangaloreQ National Institute of TB and Respiratory Diseases (NITRD) Delhi and National Japanese Leprosy Mission for Asia (JALMA)—Institute of Leprosy and other Mycobacterial Diseases, AgraQ Regional Medical Research Centre (RMRC), Bhubaneswar Bhopal Memorial Hospital and Research Centre (BMHRC), Bhopal Revised National TB Control Program Also Refer to Chapter 6, Theory POLIOMYELITIS Poliomyelitis Situation 2015 WORLD [as on 01 January 2016] Total cases: 70 2 endemic countries:Q – Afghanistan – Pakistan 8 Vulnerable countries: – Cameroon – Sudan – Somalia – Syria – Ethiopia – Nigeria – Guinea – Iraq Poliomyelitis Situation 2015 INDIA [as on 31st December 2015] Total cases: NIL wild virus case [No case has been reported in India from 13 January 2011 onwards] 2 VDPV cases (P2) reported from India 243 mebooksfree.com Review of Preventive and Social Medicine Poliomyelitis Disease I – P1 is MCC of epidemics Causative agent: Poliovirus (serotypes 1, 2 and 3) – 3 is MCC of VAPP – P1 is MCC of epidemicsQ – For every 1 clinical case – P2 is Most antigenic and Most easily eradicable (Eradicated on 20 Sep 2015)) of polio: there are 1000 – P3 is MCC of VAPPQ (Vaccine associated paralytic poliomyelitis) – 1 per 1 subclinical cases million chanceQ
