Communicable Medical Diseases: A Holistic and Social Medicine Perspective for Healthcare Providers

Copyright © 2014 R H van den Berg.

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Cover art by BS [Bennie] Botha

Author Credits: Doctorate in Nursing and Masters in Higher Education

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ISBN: 978-1-4525-8772-1 (sc)

ISBN: 978-1-4525-8771-4 (e)

Library of Congress Control Number: 2013922150

Balboa Press rev. date: 12/16/2014

CONTENTS

Introduction

Description of concepts relating to communicable diseases

THEME I

THE ROLE PLAYERS

THE SYMBIOTIC AND DYNAMIC RELATIONSHIP BETWEEN THE HOST, THE PA THOGEN AND THE ENVIRONMENT IN THE CAUSATION, SPREAD AND CONTROL OF COMMUNICABLE DISEASES

Chapter 1   The Epidemiological Triad of Communicable Diseases Model – an exposition of the model as the point of departure

1.1   Exposition of Epidemiological Triad of Communicable Diseases model

1.1.1   Attributes of Man the human host

1.1.2   The Properties of the Pathogen (infectious Agent/pathogenic microbe)

1.1.3   The Characteristics of the Environment

1.2.   Key Notes

THEME II

BREAKING THE LINKS OF INTERRELATEDNESS

THE GENERAL PRINCIPLES UNDERLYI NG THE PREVENTION AND CONTROL OF COMMUNICABLE DISEASES

Chapter 2   Legislative Measures

2.1   National Health Act – Act 61 of 2003

2.1.1    The functions of the National Department of Health, the Provincial Department of Health and the District Health Authorities

2.2   Regulations regarding notifiable medical conditions

2.2.1   Notification of medical conditions

2.2.2   Information to be supplied with notification

2.2.3   Notifiable medical diseases

2.3   Regulations regarding the prevention and control of communicable diseases

2.3.1   General regulations regarding the prevention and control of communicable diseases

2.3.2   Specific measures in respect of the prevention and control of communicable diseases according to Regulation R703 of 30 July 1993

2.3.2.1   Prevention and restriction of communicable diseases

2.3.2.2   Quarantine and isolation

2.3.2.3   The handling, conveyance and burial of the bodies/bodily or mortal remains of persons that have died of communicable diseases

2.3.2.4   Prevention of the transmission of a communicable disease to persons by animals, insects and parasites

2.3.2.5   Compulsory medical examination, hospitalisation and treatment of persons suffering from a communicable disease

2.3.2.6   Compulsory removal, cleansing and disinfesting of persons and animals infested with fleas, lice or similar parasites

2.3.2.7   Carriers of communicable diseases

2.3.2.8   Compulsory immunization/vaccination

2.3.2.9   Specific measures relating to learners and educational institutions

2.3.2.10   Compulsory disinfesting and evacuating of premises

2.4   Other measures relating to communicable diseases

2.4.1   Measures concerning harbours, airports and inland borders (regulation promulgated under the Wet op Volksgezondheidt of 1918)

2.4.2   Regulations relating to the prevention of Plague (regulation promulgated under the Wet op Volksgezondheidt of 1918)

2.4.3   Measures to combating mosquitoes and the transmission of mosquito-borne diseases (regulation promulgated under Wet op Volksgezondheidt of 1918)

2.4.4   Regulations relating to vaccines, serum, cultures and rabies vaccine

2.4.5   Responsibilities as member of the South African Development Community (SADC) and signatory to the Protocol of Health

2.4.6   Signatory to the United Nations Convention of the Rights of the Child

2.5   Key Notes

Chapter 3   The prevention of communicable diseases

3.1   Healthcare interventions at the primary level of prevention

3.1.1   Promoting the well-being of the host system

3.1.1.1   Promoting the well-being of the individual as human host

3.1.1.2   Promoting and protecting the well-being of the family

3.1.1.3   Promoting the well-being of the community

3.1.2   Promoting and maintaining a healthy environment

3.1.3   Establishing a comprehensive healthcare system for service delivery

3.2   Healthcare interventions at the secondary level of prevention

3.2.1   Caring for the ill, carrier and contact hosts within familial and community context

3.2.2   Interrupting the transmission of infection from source to susceptible hosts

3.2.3   Modifying/reducing of risk factors in the environment

3.2.4   Reforming or correcting factors in the health care system

3.3   Healthcare interventions at the tertiary level of prevention

3.3.1   Rehabilitation of the disabled or carrier individual within familial and community contexts

3.3.2   Maintaining healthy environments in the community

3.3.3   Strengthening of the healthcare system for service delivery

3.4   Key Notes

Chapter 4   The control of communicable diseases

4.1   Using the scientific epidemiological process in the control of communicable medical diseases

4.2.   Key Notes

THEME III

THE HOST - THE ADVERSARY IN THE conflict

DEFENDING THE BODY AGAINST THE PENETRATION OF PA THOGENS AND CARING FOR THE INDIVIDUAL AFTER INVASION HAD TAKEN PLACE

Chapter 5   The battle - The body’s innate and adaptive immunological responses to the invasion of pathogens

5.1   The defence mechanisms of the body to prevent imbalance pathogenicity

5.1.1   The innate immunological system

5.1.1.1   The natural protective barriers of the body

5.1.1.2   The elements (phagocytic cells and soluble factors) of the innate immunological defence system

5.1.2   The adaptive physiologic immunological defence mechanism – the specific immunologic memory response

5.1.3   Eliciting of the adaptive immune response by a communicable disease or through vaccination

5.1.4   Infections in the immuno-defected or immuno-deficient or immuno-compromised host

5.1.5   Factors that alter the body’s defence mechanisms

5.1.5.1   Factors situated in the environment

5.1.5.2   Factors related to the host

5.1.5.2.1   Factors that enhance or impair the immune system (innate and adaptive) of an individual

5.1.5.2.2   Factors that enhance or compromise the natural defence barriers of the body

5.1.5.3   Factors related to the pathogenic microbe

5.2   Immunity

5.2.1   Natural and acquired immunity

5.2.2   Immune status (level of immunity)

5.3.   Key Notes

Chapter 6   Vaccination - Priming the adaptive immune system

6.1   Why priming the immune system

6.2   Ethical and cultural challenges or issues surrounding vaccination

6.2.1   Ethical Issues

6.2.2   Cultural and Social issues

6.3   Description of concepts

6.4   Administering of vaccines

6.4.1   Assessing the health status of the healthcare user

6.4.2   Selecting the correct vaccine

6.4.3   Administering of the vaccine

6.4.4   Information to be provided to healthcare users in respect to vaccination, vaccines and side-effects

6.5   Vaccines

6.5.1   BCG (Bacillus Calmette-Guérin) vaccine

6.5.2   Polio vaccine (oral and injectable)

6.5.3   Human Rotavirus vaccine

6.5.4   Diphtheria vaccine (pure and in combination)

6.5.5   Haemophilus influenza type B vaccine (Hib vaccine)

6.5.6   Hepatitis-B vaccine (HBV/Hep-B)

6.5.7   Pneumococcal Conjugated Vaccine (PCV)

6.5.8   Measles vaccine

6.5.9   Hepatitis A Vaccine (HAV/Hep-A)

6.5.10   Varicella-Zoster-virus vaccine

6.5.11   MMR vaccine (Measles, Mumps and Rubella)

6.5.12   Tetanus Toxoid vaccine

6.5.13   Typhoid Fever vaccine

6.5.14   Cholera vaccine

6.6   International certification of vaccination against specified diseases

6.7   Adverse events or reactions following immunization or vaccination (AEFI)

6.8   Hypersensitivity Reaction (Anaphylactic Shock) – The Most Serious Adverse Reaction

6.8.1   Pathophysiology of a hypersensitivity reaction

6.8.3   Clinical manifestation of a hypersensitivity reaction

6.8.4   Treatment of a hypersensitivity reaction

6.8.5   Measures to prevent a hypersensitivity reaction

6.8.6   Recording of and information to be provided regarding a hypersensitivity reaction

6.9   Key Notes

Chapter 7   The general pathogenesis and non-specific clinical manifestation of communicable infections

7.1   The general pathogenesis in the natural course of a surface and systemic infection

7.1.1   Entry and attachment – the stage of pre–pathogenesis after exposure had taken place

7.1.2   Defending of the body once penetration by invading pathogens has taken place – the commencement of the process of pathogenesis

7.1.3   Survival of the pathogen and inducing an infection/disease in the host – the incubation and prodromal period

7.1.4   The end result of the host-pathogen-battle

Disease as manifested in the characteristic-specific clinical manifestation of the particular communicable infection

7.1.5   The resolution of the infection – the recovery stage

7.2   The non-specific local and systemic clinical manifestation of an infection

7.2.1   Non-specific signs and symptoms produced by pathogens

7.2.1.1   Clinical signs and symptoms manifested at the local portal of entry

7.2.1.2   Clinical signs and symptoms manifested of the systemic inflammatory response

7.2.2   Non-specific signs and symptoms produced by the host’s immune responses

7.3.   Key Notes

Chapter 8   Invasion had occurred – The rendering of healthcare to the ill individual grounded in a comprehensive and holistic approach within a familial and community context

8.1   The healthcare brokering process

8.1.1   The data gathering phase - the assessment of the health status and health needs of all hosts - individuals, their families and the communities they live in

8.1.1.1   Identifying the properties of the specific infectious agent (pathogen)

8.1.1.2   Identifying all the healthy attributes of and risks/hazards in the environment

8.1.1.3   Confirming the health status of the host-system

8.1.1.3.1   Confirming the health status of the community as host-unit

8.1.1.3.2   Confirming the health status of the family as host-unit

8.1.1.3.3   Confirming the health status of the individual as a healthy, ill, contact, carrier host

8.1.2   The culturally-holistic healthcare brokering phase

8.1.2.1   Rendering of general fundamental (supportive and symptomatic) and specific individualized, comprehensive, holistic and culturally congruent healthcare to maintain, promote and restore health

8.1.2.2   The fundamental healthcare interventions (general supportive and symptomatic) to be rendered to the ill person at home or in the hospital

8.1.2.2.2   Standard precautions underlying the prevention and control of the spread of the disease

8.1.2.2.3   Principles underlying the general fundamental supportive and symptomatic healthcare to be rendered to all ill persons suffering from a communicable disease

8.1.2.2.4   The rendering of general routine fundamental healthcare – supportive and symptomatic

8.1.2.2.5   Meeting the unique age-related health needs of ill persons at home or in a hospital

8.1.2.3   The specific therapeutic healthcare interventions to be set

8.1.3   The outcome phase – the evaluation of the healthcare rendered

8.2   Immunotherapeutic products and chemotherapeutic products (antimicrobial agents) available for the treatment of communicable diseases

8.2.1   Immunotherapeutic Products

8.2.1.1   Immunotherapy

8.2.1.1.1   Passive transfer of antibody via an antiserum or an antitoxin

8.2.1.1.2   Antibody in pooled normal blood serum - human immunoglobulin

8.2.1.1.3   Non-specific cellular immunostimulation

8.2.2   Chemotherapeutic drugs – antimicrobial agents/drugs

8.3   Key Notes

THEME IV

VICTO RY FOR THE PATHOGEN - THE HOST HAS LOST THE BATTLE

THE CLINICAL MANIFESTATION OF COMMUNICABLE DISEASES AND THE SPECIFIC HEALTHCARE TO BE RENDERED

Chapter 9   Communicable infections affecting the central nervous system and the eyes

9.1   Communicable diseases that affect the central nervous system

9.1.1    Infections of the meninges of the brain

9.1.1.1   Meningitis - bacterial and viral

9.1.2   Infections of the substance of the brain and spinal cord

9.1.2.1   Poliomyelitis (Polio)

9.1.3    Infections of the central nervous system caused by animal-transmitted pathogens

9.1.3.1   Vector-borne encephalitis

9.1.3.1.1   African Trypanosomiasis (sleeping sickness)

9.1.3.2   Zoonotic viral encephalitis

9.1.3.2.1   Rabies (also known as hydrophobia)

9.1.3.3    Zoonotic bacterial encephalitis

9.1.3.3.1   Tetanus (lock-jaw)

9.2   Communicable infections that affect the eyes

9.2.1   Infections of the conjunctiva

9.2.1.1   Chlamydial infection of the conjunctiva

9.2.1.1.1   Trachoma

9.2.1.2   Bacterial infections of the conjunctiva

9.2.1.2.1   Ophthalmia Neonatorum (gonococcal conjunctivitis)

9.2.1.3   Conjunctival infections transmitted by blood or the nervous system

9.3   Key Notes

Chapter 10 Communicable diseases affecting the respiratory system

10.1   Communicable diseases affecting the upper respiratory tract

10.1.1   Bacterial infections affecting the upper respiratory tract

10.1.1.1   Diphtheria

10.1.2   Viral infections affecting the glands and lymphoid tissue of the oropharynx

10.1.2.1   Infectious mononucleosis

10.1.2.2   Mumps (epidemic parotitis)

10.2   Communicable diseases affecting the lower respiratory tract

10.2.1   Acute lower respiratory tract infections

10.2.1.1   Bacterial infections affecting the lower respiratory tract

10.2.1.1.1   Whooping cough (Pertussis)

10.2.1.2   Viral infections of the lower respiratory tract

10.2.1.2.1   Severe Acute Respiratory Syndrome (SARS)

10.2.1.2.2   Influenza A-illnesses: Avian influenza, Swine Influenza and other animal-originated influenza A-illnesses

10.2.2   Chronic infections of the lower respiratory tract

10.2.2.1   Mycobacterium infection of the lower respiratory tract

10.2.2.1.1   Tuberculosis – drug-susceptible and drug-resistant

10.4   Key Notes

Chapter 11 Communicable diseases affecting the gastro-intestinal tract

11.1   Diarrhoeal diseases caused by bacterial and viral infection

11.1.1   Gastro-enteritis

11.1.2   Cholera

11.1.3   Shigellosis (Bacillary dysentery)

11.2   Systemic diseases initiated in the gastro-intestinal tract

11.2.1   Typhoid and paratyphoid fever

11.2.2   Viral Hepatitis

11.3   Intestinal parasitaemia with parasites

11.3.1   Protozoan Parasitaemia

11.3.1.1   Dysentery

11.3.1.1.1   Amoebic dysentery

11.3.2   Helminthic parasitaemia

11.4   Key Notes

Chapter 12 Communicable infections affecting the skin

12.1   Bacterial infections of the skin

12.1.1   Impetigo

12.2   Mycobacterium infections of the skin

12.2.1   Leprosy (Leprae, Hansen’s Disease)

12.3   Parasitic infections of the skin

12.3.1   Scabies

12.4   Mucocutaneous lesions caused by viruses

12.4.1   Systemic viral infections causing a maculo-papular skin rash

12.4.1.1    Measles (Morbilli)

12.4.1.2   German measles (Rubella)

12.4.2    Systemic viral infections causing a vesicular skin rash

12.4.2.1   Chickenpox (Varicella)

12.5    Other infections producing skin lesions

12.5.1   Scarlet fever (streptococcal sore throat with a skin rash)

12.6   Key Notes

Chapter 13 Communicable diseases affecting the genital-urinary tract

13.1   Diseases of the genital organs and reproductive system (venereal diseases or sexually transmitted diseases [STD’s] or sexually transmitted infections [STI’s])

13.1.1    Sexual transmitted infections characterized by a discharge

13.1.1.1    Gonorrhoea

13.1.2   Sexually transmitted infections characterized by ulceration

13.1.2.1   Syphilis

13.1.3   Sexually transmitted infections caused by viruses

13.1.3.1   Acquired immunity deficiency syndrome (AIDS)

13.2   Communicable diseases which affect the urinary tract

13.2.1   Bacterial infection of the lower urinary tract

13.2.1.1   Non-Gonococcal Urethritis

13.2.2   Helminthic (digenetic trematodes/flukes) infections of the urinary tract

13.2.2.1   Bilharzia (schistosomiasis)

13.3   Key Notes

Chapter 14 Zoonotic diseases – Vector-borne and multisystem infections transmitted from animals to humans

14.1   Vector-borne zoonotic diseases

14.1.1   Infections caused by Rickettsiae

14.1.1.1   Tick-bite fever

14.1.1.2   Typhus

14.1.2   Infections caused by Borrelia

14.1.2.1   Relapsing Fever (Borrelia Recurrentis)

14.1.3   Infections caused by the protozoan - Plasmodium

14.1.3.1   Malaria

14.2   Multisystem zoonotic diseases

14.2.1   Multisystem zoonotic diseases caused by bacteria

14.2.1.1   Brucellosis (Malta Fever, Mediterranean Fever, Undulant Fever or Abortus Fever)

14.2.1.2   Plague

14.2.2   Multisystem zoonotic infections caused by viruses

14.2.2.1   Viral Haemorrhagic fevers - Dengue fever, Congo fever, Marburg fever, Ebola fever, Lassa fever and Rift Valley fever

14.2.3   Multisystem zoonotic infections caused by other biotypes of protozoa

14.2.3.1   Toxoplasmosis

14.3   Key Notes

Bibliography

Introduction

As a health and medical phenomenon, communicable medical diseases/infections, just like all other medical conditions, have been known to humanity since the creation of man and the dawn of time. Although the first documentation of epidemics was only done at about 5000-4000 BC, several epidemics and/or pandemics occurred throughout the ages worldwide, often leading to the partial, sometimes the total erasure of populations. Regardless of the fact that communicable diseases have been declining as a cause of death in Europe and North America for nearly 150 years, communicable diseases are still the biggest killer in the developed, under-developed and developing world and are increasing at an alarming rate. Unknown and known communicable diseases continue to emerge or re-emerge due to drug resistant microbes, new patterns of travel and trade (especially food), new agricultural practices, altered sexual behaviour and overuse of antimicrobial drugs. Economic, social, and political changes have weakened healthcare systems while enhancing the effects of poverty and malnutrition. Thus, instead of claiming that communicable diseases are in irreversible decline, it has to be stated that every major change in society, population, use of land, climate, nutrition or migration is a public health event with its own pattern of diseases (especially communicable diseases). Although the impact of communicable diseases on the health of people has been reduced drastically over the past few decades (mainly because of the progress that has been made in the sciences of healthcare and environmental sciences), epidemics/pandemics can still occur on a large scale should the existing control regulations be relaxed. The resistance of certain pathogens against modern antimicrobial drugs heightens the possibility that communicable diseases can assume the magnitude of wide-spread epidemics and/or pandemics. Furthermore, modern means of transport today plays an important role in the spread of communicable diseases because communicable infections can now be spread within hours from one continent to another.

The prevention and control of communicable medical diseases is one of the eight basic components of a comprehensive healthcare service that needs to be delivered to the population in any country in the world by all the different healthcare systems that exist. Other services also to be implemented in the prevention and control of communicable medical diseases encompasses, among others

■ the maintaining of a healthy environment by providing non-personal (environmental) healthcare services

■ the provision of health information to individuals, families, groups and communities to take responsibility for their own health

■ the upholding of all legislative measures supporting all preventive, promotive, curative and rehabilitative programmes and services

■ the rendering of healthcare, at home or in hospital, to all healthy, ill, disabled and dying individuals within familial and community context

■ the keeping of accurate statistical information regarding population demographical, mortality and morbidity statistics, and making it available to assist in the planning for the delivery of the correct and comprehensive healthcare services as well as the prevention and control of communicable diseases.

The prevention and control of communicable medical diseases, as a component of a comprehensive healthcare services delivery system, is focused on the total well-being of the individual, the family, and the community, and encompasses preventive, promotive, curative, and rehabilitative healthcare services delivery and healthcare rendering that is supported by legislation, as sporadic/endemic/epidemic/pandemic episodes of communicable infections must be prevented at all times. However, should a sporadic/endemic/epidemic/pandemic outbreak occurs, it has to be effectively controlled. Based on the principles of primary healthcare services delivery and healthcare rendering, the prevention and control of communicable diseases forms an integral part of the primary healthcare services delivery system.

In South Africa, according to the National Health Act, Act 61 of 2003, the rendering of healthcare relating to communicable diseases must be affordable and of the highest possible quality, and all services must be available and accessible to all individuals (whether healthy or sick or disabled or dying), their families and their communities within the population. All care rendering must also comply (as underwritten in this text) with the Constitution of the RSA, the Bill of Human Rights, the Patients’ Rights Charter, and the Rights of Children, the Elderly, and the Disabled. Thus, in order to provide the expected and effective service delivery and healthcare rendering, it is imperative for all healthcare providers (professional, traditional and lay care) to be thoroughly conversant with communicable medical diseases as to protect and promote the health of all individuals, their families and their communities. Healthcare providers (professional, traditional and lay care) must also restore health by identifying all sick and suspect cases (individuals, or families, or communities); by applying control measures; by rendering compassionate, comprehensive, holistic and culturally congruent care to all hosts (individuals and/or families and/or communities whether healthy, or ill, or contact, or carrier) within familial and community context; by implementing the necessary legislative measures; and by giving health information to all individuals, families and communities as well as to all care-givers (professional, traditional, and lay care) about communicable diseases.

Based on the epidemiological fact that all communicable medical diseases are characterised by the existence of a dynamic and symbiotic relationship between three elements, namely, the human host, the environment and specific pathogenic microbes and that these three elements are inextricably interwoven in the causation, prevention and control of all communicable medical diseases, the point of departure of this book is based on Social Medicine and the Holism of human life and well-being. Because Social medicine describes all social, economic and other determines of health and disease, it is applicable to all healthcare practices to ensure a healthier society, and because the questions asked are bio-social in nature, the impact of all bio-physical, social, economic and other factors of importance on the health and disease patterns of individuals/families/communities must be determined when communicable medical diseases occur. The concept Holism/Holistic/Holistically is used because it refers to the wholeness of human life and well-being as it takes in account that all human beings live in relation to or having dialogues with himself/herself, in relation to/with all other human beings, in relation to/with a Creator, and in relation to/with the universe and because it relates to the epistemological fact that the wholeness of human life and wellbeing are as such intertwined/interwoven with the environment and the infinite different systems which forms the environment. As the individual, the family and the community forms an integrated unit that can never be separated from one another and because the wholeness of the well-being of all individuals/families/communities and the environment is determined by the interplay and interdependence of all these infinite factors, the combined effect of all these factors that influence the state of health/well-being of all individuals/families/communities and the environment they live in must be assessed and described when grounding the healthcare to be rendered at primary, secondary and tertiary level as to provide in the life needs of all healthcare users in familial and community context. This relational approach ensures that compassionate, holistic and culturally congruent healthcare is rendered to promote, to protect and to restore the wholeness of human life and well-being. The best practices for upholding the wholeness of human life and well-being, based on a combination of modern scientific diagnosis and monitoring techniques as well as healthcare practices practiced for millenniums, must thus be prescribed as to provide in the life needs of healthcare users within their familial and community context.

In the light of above, the specific educational exit level outcome of this book is as follows:

All professional and traditional healthcare providers/practitioners must render to all inhabitants (individuals/families/communities whether healthy or ill or contact or carrier), in a responsible and accountable manner, comprehensive (scientific fundamental and specific healthcare at primary, secondary, and tertiary level), holistic, compassionate, and culturally congruent healthcare that leads to self-caring and self-reliance within familial and community context, by

☐ having a full working knowledge of the symbiotic and dynamic interrelatedness and interdependence of the human host, pathogen (infectious agent) and the environment/milieus in the causation, control and prevention of communicable diseases

☐ preventing and controlling communicable diseases at primary, secondary and tertiary level by means of breaking the links between the symbiotic and dynamic interrelatedness and interdependence of the host, pathogen and the environment through compiling and implementing the necessary programmes

☐ understanding the defence mechanisms of the innate and adaptive physiological immunological systems of the body against the penetration of pathogens and the factors that improve or impair the immune system

☐ diagnosing communicable diseases and rendering healthcare which is compassionate, comprehensive, holistic and culturally congruent in nature and that is based on a combination of traditional and scientific fundamental and specific healthcare interventions, to all persons suffering from a communicable disease within their familial and community context

☐ complying conscientiously with all standards and transmission-based precautions as well as with all legislative measures in the prevention and control of communicable diseases.

To achieve the specific educational exit level outcome, the book has been divided into four themes:

• In Theme I the point of departure, namely, The Epidemiological Triad of Communicable Diseases model is discussed. The symbiotic and dynamic interrelatedness of the human host system, the environment and the pathogenic microbe (infectious agent) in the causation, prevention and control of communicable diseases is depicted as well as a description given of all the characteristics/properties/attributes intrinsic to each element to be taken account of

• Theme II focuses on breaking the links of interrelatedness between the human host system, the environment and the pathogenic agent to prevent and control communicable medical diseases. A full description is given of the general principles underlying the prevention and control management of communicable diseases as prescribed in relevant legislation, programmes for the prevention of communicable diseases, and the control of communicable diseases as based on the Epidemiological process wherein the Epidemiological Triad of Communicable Diseases model is integrated

• Theme III focuses on the host as the adversary in the conflict. The discussion concern the body’s defence mechanisms against the entry of pathogenic agents into the body and the reaction of the body to the pathogen after invasion of the body had occurred. The body is protected by the innate and adaptive immune systems consisting of the natural protective barriers based on anatomical, biochemical and mechanical factors, the inflammatory response and phagocytosis, and the antibody-mediated and cell-mediated physiological immunological responses. After gaining entry into the body, the local as well as the systemic inflammation reactions develop in the body which are manifested in a general clinical way. Vaccination programmes to prime the adaptive immune system as well as the comprehensive, compassionate, holistic and culturally congruent fundamental healthcare to be rendered in hospital or at home are also discussed

• In Theme IV- Victory for the pathogen - the host has lost the battle - the epidemiology, pathogenesis and clinical manifestations of selected communicable diseases are discussed as well as the specific healthcare (excluding pharmacological prescriptions) to be rendered and the specific preventive and control measures to be taken.

Please take note that this book is a complete re-writing of the original book Oordraagbare Siektes - ‘n Verpleegkundige Perspektief published in 1989 with

RH van den Berg and MJ Viljoen as editors

Description of concepts relating to communicable diseases

Address

An address refers to the physical residential address of a person, not a postal box address

Antibody (immunoglobulin)

Antibody or immunoglobulin is specialized soluble factor proteins that are mediated or synthesized by the B-lymphocytes of the human host. Antibody possesses the ability to recognize the antigen(s) of the infectious agent and then coats the infective pathogen with several adaptor antibody molecules to induce complement fixation and phagocytosis by the adapter antibody. Specific antibody (sub-classes) is mediated by the B-lymphocytes in reaction to the presence of the foreign protein of the infectious agent. Antibody, as such, circulates in the blood and help to destroy the specific infectious agent or inactivate it by

• complexing/bonding with the antigen whereby the resulting complex activates the first component of the complement C1 for neutralizing the toxic properties of the pathogen

• causing it to precipitate through lysis and opsonisation when antibody and complement act together whereby the rate of phagocytosis is thousand-fold enhances

• making it more vulnerable to phagocytosis

• causing the pathogen to agglutinate and to render the pathogen more susceptible to phagocytosis

• neutralizing toxic properties through blocking the microbial reactions of the toxin(s) on the body cells

Antigen

Antigens refer to the distinctive properties of the different groups of pathogens causing communicable diseases, namely, prions, viruses, bacteria, fungi, protozoa, helminths and arthropods. Each group of pathogens has distinctive properties such as structural and molecular make-up, biochemical and metabolic strategies, reproductive processes and living either intracellular or extracellular. These distinctive properties determine how the different infectious microbes interact with the human host and how the specific infectious pathogens cause disease/infection. After recognition by or priming of the specialized receptor sites for antigen(s) on antigen-dependant T-helper-cells, the B-lymphocytes are activated by the primed T-helper-cells to mediate/synthesize antibody immunity with memory while simultaneously stimulating T-cells to differentiate and mediate T-cell-immunity with memory. Antigens not only select and clonally expand B-lymphocytes and T-lymphocytes bearing complementary receptors but also control the immune response of the adaptive immune system as the concentration of the antigen activates the immunity response and then switch off the response when the antigen is no longer present (when the antigen is eliminated by metabolic catabolism and clearance through the immune response, the stimulus to the immune system disappears). Pathogens evade/elude recognition by lymphocytes through concealment of antigens (remaining inside cells without their antigens being displayed on the cell surface) and antigenic variations (through mimicry, antigenic drift and antigenic shift)

Antiseptic preparations

Antiseptic preparations are chemical compounds that inhibit (retard) the growth of microbes without destroying/killing them

Arthropods

Arthropods are fleas, lice, bedbugs in any stage of development of the relevant species

Asepsis

Asepsis is the absence of living pathogenic agents and/or any infectious matter that cause an infectious condition

Bacteraemia

Bacteraemia refers to the condition occurring in the body when pathogenic microbes (excluded viruses) exist and multiply in the bloodstream

Barrier healthcare or barrier nursing care (Isolation/restriction)

Barrier healthcare or barrier nursing and medical care or isolation is the practice of seclusion of an infected person from other persons for the period of communicability (period the disease is transmissible). Barrier healthcare or barrier nursing and medical care or isolation measures refer to all those care measure put in place to prevent the spread of the causative microbe/pathogen to other human beings. Barrier healthcare/barrier nursing and medical measures/isolation measures can be classified as either routine barrier healthcare/barrier nursing and medical care/isolation measures or high grade barrier healthcare/barrier nursing and medical care/isolation measures

• In routine barrier healthcare or routine barrier nursing and medical care or isolation all Standard Precautionary Control Measures (including cough etiquette); transmission-based precautions; engineering control of ventilation; environmental hygiene; and waste control) are applicable and are put in place in general hospital units/wards to control the airborne transmission of infected droplets. For the control of gastro-intestinal communicable diseases enteric precautions and disinfecting of the environment must be instated

• High-grade barrier healthcare or high-grade barrier nursing and medical care or high-grade isolation is instituted for a specific group of communicable diseases that constitute a serious risk to all healthcare practitioners because they are transmitted via blood; fomites and airborne infected droplets (when seeding of the lungs had taken place and profuse growth of the pathogen in the lungs had occurred). High grade barrier/isolation care is only instituted in a specialized isolation unit for communicable diseases (these measures can never be put in placed in general hospital wards/units)and the care has to be rendered by specialized trained healthcare personnel only. No visitors (family and friends) are allowed in this specialized isolation unit. All ccontacts (even entire communities) will be placed under quarantine. The service of the National Defense Force can be called in to enforce all quarantine measures

Note   Routine barrier healthcare or routine barrier nursing and medical care or routine barrier isolation as well as high-grade barrier healthcare/high-grade nursing and medical care/high-grade isolation can never be implemented when family members render care to the sick individual at home as the family members are not professionally educated to institute the above specialized isolation healthcare regimes

Carriage/carrier state

Donates a state of being a carrier of a particular communicable disease as identified by means of laboratory tests and/or other examinations

Carrier

A carrier is a person who does not show any clinical signs and symptoms of a specific communicable disease at a specific time although it has been proven by means of laboratory or other tests that the person is infected and therefore able to spread the disease. The carrier harbours the specific pathogen in his/her body, causing the person to become a source of infection. A person can become a carrier after having been ill and recovered (the pathogen is still harboured within his/her body) or the person may have become infected without ever having been ill at all (healthy carrier)

Case

A case is any person who actually suffers from the particular disease and has been diagnosed as such. The term does not refer to the infected person as such

☐ Index case

An index case is the first person brought to the attention of the authorities as having contracted a communicable disease. It may not necessarily be the primary case

☐ Primary case

The primary case is the first person who has been infected and thus spreads the communicable disease within the community

☐ Secondary case

A secondary case is a person or persons in whom the disease develops after contact with a primary case

☐ Suspected case

A suspected case is a person who has been exposed to other persons in whom the disease has already been clinically manifested. The person’s medical history and symptoms indicate that he/she may have contracted the communicable disease

Chain of infection

The chain of infection is sequence of events or links underlying the development/outbreak of all communicable diseases, namely, a specific infectious agent/pathogen (mode of transmission; portals of entry and exits); a reservoir (the host [infected person or source of infectious agent]) and a new susceptible (uninfected) host

The route of transmission can be simple or complicated

☐ Heterogeneous chain of infection: Transmission occurring from a host of one species to a host of another species, for example, avian flu, measles in pigs (animals to human)

☐ Homogeneous chain of infection: Transmission occurring from a host to a host of the same species, namely, from human to human, for example, influenza (type B and C), pneumonic plague

Child

A child is any person under the age of 18 years (The Child Welfare Act, Act 38 of 2005)

Communicable diseases / communicable medical diseases / communicable infections

This group of medical diseases are caused by specific infectious agents that are transmitted horizontally (from one person to another person or from an animal to a person [directly] or indirectly by an intermediary such as either a vector or a vehicle) or vertically (from mother to child). A particular communicable disease is caused by a specific pathogenic agent and the signs and symptoms are characteristic of that particular disease. A person who has had contracted a particular disease is usually immune to that specific disease as the physiologic adaptive immune response (antibody-mediated and cell-mediated immunity with memory) had been elicited. Diseases transmitted from animals to humans as well as all sexual transmitted diseases are the exception to this rule as no immunity with memory is induced

Contact

A contact is a person who was exposed to the risk of infection as he/she has been in direct physical contact with a sick or infected person or animal, or has been directly or indirectly exposed to an infectious agent or a contaminated environment or fomites, and for these reasons the infectious agent could have gained entry into the body of the person. Depending on the mode of transmission of the infectious agent, specific persons will be considered to be contacts to that particular disease. Based on factors such as natural physiological resistance (innate and adaptive) as well as acquired physiologic immunity, the contact may or may not become ill. A contact that becomes ill is a source of infection

Contagiousness/Communicability/Transmissibility

Contagiousness/communicability/transmissibility refers to the ability of pathogenic microbes to retain their pathogenicity when transmitted from person to person or from an animal to a person thus causing the particular disease in a susceptible human host. A number of pathogenic microbes, however, lose this ability soon after the characteristic signs and symptoms of the particular disease have manifested. The disease can now no longer be transmitted by the sick person and susceptible hosts will now not contract the communicable disease

☐ Period of contagiousness

The period of contagiousness refers to the time period during which the pathogenic microbes retains their pathogenicity and are able to cause the particular disease in a person

Contamination

Contamination is the presence of an infectious agent on the body surface (skin) of a person (for example, on hands/fingers or under nails) or an animal, as well as on any inanimate substances/utility items such as clothing, bed linen, toys, medical equipment and supplies, and in other inanimate substances such as water, milk and food. The infectious agent is alive and able to gain entry in the human body and cause an infection

Note   Contamination differs from pollution as the latter refers to the presence of offensive, non-infectious substances in the environment. Contamination also differs from infection as the latter refers to the presence of the pathogen within the cells (intracellular or extracellular) of the human body where it multiplies/replicates, spreads from and is shed from

Degree of impairment/Gradient of severity/Degree of seriousness

The degree of impairment/severity/seriousness refers to the severity of the disease which may vary from sub-clinical to moderate to serious to fatal. It is also known as the spectrum of the disease

Disease

Disease refers to a pathological disorder or condition or infection of the structure of the human body, such as an organ or a system of the body, or to a pathological disorder or condition in the functioning of the normal body organs such as the syntheses of glucose in the body, that is caused by various causes such as pathogenic microbes, genetic factors etc. This disorder/condition/infection of the structure and/or function of the body produces signs and symptoms that affect the life/lives of the human individual or/and his/her family and its members or a community as a whole, especially when the disease is a communicable medical disease or infection. All known diseases as medical conditions are classified by the science of medicine in specific groups and then broken down into a list of diseases, for example, a group of medical diseases classified as communicable medical diseases or infections which is then broken down into a specific list of conditions listed according to the body organs affected/inflicted and/or according to the pathogenic microbe causing the particular disease

Disinfectants

Disinfectants are chemical agents which inhibit (retard) the growth of pathogenic organisms or destroy them

Disinfection

Disinfection is the process of eliminating pathogenic microbes by means of chemical or physical methods from the surface of the skin of the body (but does not penetrate the skin) or from utility items or from the physical surroundings

☐ Concurrent disinfection

Concurrent disinfection entails administering disinfection immediately or as soon as possible after a person has been in contact with secretions/excretions of infectious material from the body of a person who suffers from a communicable disease, or the disinfection of contaminated articles which the sick person had any contact with

☐ Terminal disinfection

Terminal disinfection entails the cleansing of personal belongings, clothing and the immediate physical surroundings of a sick person who has recovered as the disease can no longer be transmitted

Disinfesting (de-lousing or de-flea-ing)

Disinfesting is the removal of lice or fleas from a person’s or an animal’s body

Educational institution

Educational institutions constitute all schools (pre-primary, primary, secondary – private and public [state-funded]), universities (academic and technological – private and public) and Colleges for Further Education and Training (FET) as well as hostels, homes or facilities maintained for the attendance, residence and care of the learners at an educational institution. Educational institutions also include any building or premises maintained or used for the attendance and care of more than six children of preschool age during any part of a day, or an entire day, on every day of the week or on certain days of the week only, and registered as an institution of care according to the Child Welfare Act, Act 38 of 2005. Playgroups and day care centres are also viewed as educational institutions

Endemic

Endemic refers to the phenomenon where there is a continuous presence of a communicable disease within a given geographic area

Endogenous infection

An endogenous infectious condition is caused by the normal flora (saprophytic microbes) living within or on the body of the human host

Epidemic

An epidemic refers to the phenomenon where a large number of persons contract a particular communicable disease within the same geographic area during the same period of time

Epidemiology

Epidemiology is the study of the nature and distribution of communicable medical diseases within the population. The study also includes all environmental conditions contributing to outbreaks of and contracting of communicable diseases; the lifestyles and health status of all human hosts as well as all other circumstances associated with the various states of health of the hosts, their families and their communities; and the characteristics of the different infectious agents, including the mutations of infectious agents. The principles of the epidemiological process are then applied in the control and prevention of communicable medical diseases

Erythema

Erythema is a diffuse or blotchy redness of the skin that becomes pale when pressure is applied. It is caused by congestion of the skin capillaries

Exogenous infection

An exogenous infectious condition is caused by the exposure to an external source of infectious agents such as pathogenic microbes (not by the natural flora living within or on the body of the individual)

Exposure

Exposure refers to the process by which an uninfected person is exposed to an infectious organism whereby the contraction of a communicable disease is promoted, for example, by being in direct contact with an infected or ill person, or by being directly or indirectly in contact with the pathogenic microbe

Fomites

Fomites are all infected discharges, excretions and secretions of an infected or a sick person, as well as all non-living intermediaries such as equipment, objects or/and any matter contaminated by the ill/infected person as he/she was in contact with it. Fomites act as a vehicle because it provides a means to transmit the infectious agent from the reservoir to the host

Fumigation

Fumigation is the process by which poisonous gas are used to exterminate arthropods and rodents

Healthcare users/patients

Healthcare users or patients refer to all individuals, families, groups, and communities (whether healthy, ill, carrier or contact) who access the healthcare service delivery system, public or private, for any form of healthcare rendering by professional and/or traditional healthcare practitioners

Healthcare providers

Healthcare providers refer to all professional healthcare practitioners registered with statuary councils or boards (for example, doctors, nurses, allied medical practitioners, environmental health officers, veterinarians, etc.); all traditional healthcare providers registered with a voluntary or statuary board or organization (for example, sangomas, herbalists, spiritual healers, traditional healers, traditional birth attendants etc.), and all lay care givers (for example, family members, voluntary care givers, care givers working for non-governmental organizations, etc)

Holism/Holistic/Holistically

The concept Holism/Holistic/Holistically refers to the wholeness of human life taking in account that all human beings live in relation to/having dialogues with himself/herself, to/with all other human beings, to/with a Creator, and to/with the universe human beings live in. Hence, the individual, the family and the community forms an integrated unit that can never be separated from one another and the wholeness of human life is as such intertwined or interwoven with the environment and the infinite different systems which form the environment or milieus. Therefore, the wholeness of the well-being of all individuals/families/communities and the environment is thus determined by the interplay and interdependence of all these infinite factors – the combined effect influencing the state of health of all individuals/families/communities and the environment they live in

Taking this relational approach of holism as point of departure, holistic healthcare (allopathic and traditional) promotes, protects and restores the wholeness of human life by taking in account all factors relating to the wholeness of and interdependence of these factors in the well-being of man. Therefore, holistic healthcare treats and care for the individual in totality within his/her family and community contexts by considering all aspects of the life and the needs of the individual or/and family or/and community through care rendering that provides in the needs (wellness, therapeutic, and/or high-risk) of all human beings (whether individuals, and/or families and/or communities). As such, holistic healthcare combines modern scientific diagnosis and monitoring techniques with healthcare practices practiced for millenniums to ensure the best practices for the upholding of the wholeness of human life and well-being and provision in the life needs of healthcare users within their familial and community context

Host

A host is any living person or warm-blooded animal required by microbes (saprophytic and pathogenic) to exist and to reproduce (multiply). As healthcare is the focus of all healthcare professions, the term host in this book, refers only to humankind/human beings as the client system that is affected by communicable diseases. Every human being is a potential host for any of the microbes that cause communicable diseases. Whether the person will become ill, depends on various factors such as a person’s nutritional status, immune status and many more. As all human beings are members of a family and a community, the term host refers to the individual person, his/her family and the community they live in

Illness/being ill/being sick

Being ill/sick or illness refers to the subjective feelings/emotions and the coping mechanisms an individual or family experience or portray when the individual or family members become sick/ill from a specific medical condition/disease classified as communicable medical disease. The term illness is not seen as the same as disease

Immune status

Immune status refers to the level of physiologic resistance (innate and adaptive) the body of a person has against the pathogen/pathogenic microbe that causes a particular communicable disease. When a person’s body has naturally mediated/formed its own antibody-mediated and cell-mediated immunity with memory against the pathogen/pathogenic microbe that causes a particular communicable disease, the individual will usually have a high immunity status against the particular disease which will last as long as the person lives. When a person has been vaccinated, his/her immune status may be high initially, but it diminishes with the passing of time (5 to 12 years) unless he/she receives booster dosages of the vaccine or is exposed to the pathogen causing the disease or contracts the particular communicable disease. A high immune status can be maintained if the person receives booster dosages regularly, thus enhancing his/her adaptive immune system (antibody-mediated and cell-mediated immunity with memory)

Note   When mutation of a pathogen/pathogenic microbe takes place, the pathogen changes its genetic composition, resulting in a new strain (modified form) of the specific infectious pathogen. The host’s body, however, has as yet not mediated any physiologic response [innate and adaptive]) against this mutant strain of the specific pathogen and therefore the person is susceptible to contract the mutant (new strain of) pathogen, thus becoming infected and sick. Only now can the individual’s body forms/mediates the specific physiological immunological resistance against the new strain of the specific pathogen

When a person again becomes sick of a particular communicable disease he/she previously suffered from (sub-clinically or in a very light form) and there is no physical evidence that mutation of the pathogen had taken place, the individual’s body has already mediated/formed a level of physiologic resistance (innate and adaptive) against the specific pathogen/pathogenic microbe during the first bout of the communicable disease but the level of resistance mediated is however not strong/high enough to combate the specific pathogen/pathogenic microbe at this stage in life when the individual is re-infected

Note   An individual’s body very seldom mediate any level of physiologic resistance (innate and adaptive) against the specific pathogens/pathogenic microbes that are transmitted by animals to humans (zoonotic communicable medical diseases) as well as against the pathogens that cause sexually transmitted infections (STI’s). Thus, individuals can be re-infected over and over time and again with either zoonotic communicable medical diseases or sexually transmitted infections or both and will become sick every time

Immunisation/Inoculation/Vaccination

Immunisation/vaccination is the procedure/process whereby a vaccine is administered to a person in order to stimulate the body to mediate (form/produce) its own physiologic resistance, namely, antibody-mediated and/or cell-mediated (sensitised T-lymphocytes) immunity with memory

Immunity and immune response

Immunity is the highly developed physiological resistance of the body against the influence and effects of any infectious agent (such as viruses, parasites, fungi, protozoa, bacteria and rickettsiae) after it had gained entry into the body. This highly developed physiologic resistance (immunological response) is the result of the innate (acute inflammatory response and phagocytosis) and adaptive (antibody-mediated and cell-mediated with memory) immunological reactions to the specific infectious agent that causes the particular communicable disease. The level of the physiologic resistance or immune status varies from one person to another

☐ Natural/general/humoral/innate immunity is the innate (born with) physiological resistance of the body consisting of external and internal defence mechanisms that do not require exposure to a specific pathogen for their development. The non-susceptibility of an individual to a particular communicable disease is mediated by the innate immune system

☐ Acquired/adaptive immunity - Acquired immunity, a homeostatic mechanism, is the physiologic resistance mediated by the adaptive immune system and is elicited by a specific antigen-antibody-response consisting of antibody-mediated and cell-mediated immune reactions with memory, both taking place simultaneously and complementing each other. Naturally acquired/adaptive immunity develops when a person has contracted the specific communicable disease (excluding the group of conditions where no immune response with memory is elicited) while artificially acquired immunity is elicited when the person has been successfully vaccinated against a particular communicable disease or when antibody are transferred from one individual to another individual. A particular communicable disease elicits its own specific adaptive immunological reaction

✳ The antibody-mediated immunological (immune) reaction is induced by the antigen-antibody-reaction whereby specific immunoglobulin is mediated by B-lymphocyte cells. The antibody (immunoglobulin) mediated against the specific infectious pathogen circulate in the blood plasma and lymph to protect the body against any further infection by that specific pathogen. The memory cells of the immunoglobulin cross (are transferred across) the placenta barrier, thus, providing passive naturally acquired immunity to the unborn foetus

✳ The cell-mediated immunological (immune) reaction is mediated when the production of specific sensitised T-lymphocytes with lymphoid characteristics are stimulated by a specific pathogen.

Note   Some infectious agents do not stimulate an antibody-mediated immunological [immune] reaction that mediate immunoglobulin but only mediate specific sensitised T-lymphocytes with lymphoid characteristics. The specific infectious agent is destroyed or rejected when the T-lymphocytes make direct contact with the specific infectious agent (antigen) as the T-lymphocytes destroy the antigen’s cell. The memory cells of the specific sensitised T-lymphocytes are continuously present in all of the body’s cells where they monitor all cells for the specific infectious agents. The memory cells of the sensitised T-lymphocytes do not cross (are not transferred across) the placenta barrier

Incubation period

This is the time period (length of time) that elapses from been exposed to specific infectious agent and its gaining entry into the body until the appearance of the characteristic signs and symptoms of the particular communicable disease. This period may last from several hours to days. Every particular communicable disease has its own specific incubation period. During the incubation period the infected person is not ill/sick as such but possesses the ability to transmit the pathogen to other individuals

Infection

Infection follows/is caused by the invasion of cells and/or tissues of the body by living pathogens/pathogenic microbes such as bacteria, viruses, fungi, helminths (worms) and protozoa. The pathogen multiplies and produces effects that are injurious to the host

Infected person

An infected person is a person who harbours a specific infectious agent in his body and manifests the clinical or subclinical medical picture of the disease. An infected person transmits the infectious agent to other persons. Always keep in mind that an infected person can suffers from more than one communicable disease at the same time (simultaneously).

Note   As soon as a specific pathogen has gained entry into the body and has bonded with the tissue cells of the body, the cells of the body become infected (not contaminated) and the infected individual can now transmit the specific pathogen to other persons because the infected cells now shed the specific pathogen which then exits the body

Infection following gaining entry into the body

The process whereby an infectious agent penetrates into and attaches itself to body cells of a person or an animal is called gaining entry into the body. To elicit the particular communicable disease, the pathogen must gain entry into the body through the right portal of entry. After gaining entry and binding with the body cells, the local and systemic inflammation reaction takes place in the body. As soon as the pathogen has overwhelmed the normal defence mechanisms of the body and begins to multiply/reproduce in the body, an infection had been induced

Note   The presence of pathogenic agents on the body surfaces [unbroken skin] and/or on articles and/or on inanimate surfaces does not denote an infection, but represents contamination of such areas and articles. As soon as pathogens gained entry into the body, the cells of the body become infected by pathogenic microbes [not contaminated], as the pathogens live in body cells only, multiply there, spread to other body cells and are shed from the body cells as to be transmitted to other uninfected hosts

Infectious agent/pathogenic microbe or micro-organism/pathogen/infective microbe

The infectious agent is the primary cause of a particular communicable disease. All pathogenic microbes (protozoa, rickettsiae, helminths, fungi, parasites, viruses, bacteria, and spirochetes) possess the ability to cause an infection in humans or animals

Infectivity

Infectivity is the ability of an infectious agent to invade the host’s body and body systems and cause an infection. Infectivity is determined in part by the portal of entry and exit of the infectious agent and in part by the mode of transmission

Infested

Persons or animals are infested with arthropods when the arthropods are present on the surface of the person’s/animal’s body where they develop and reproduce. Infested articles (for example, clothing) or premises harbour arthropods or rodents

Inflammation

Inflammation is the complex reaction to injury or death of cells or tissues of the body. Inflammation is a non-specific internal defence mechanism initiated to control and/or eliminate the offensive pathogen and to prepare a bodily environment conducive for healing and repair. The inflammatory process takes place in the healthy tissues adjacent to the injured or dead cells. Inflammation is always present with infection, but infection is not always present with inflammation (for example, myocardial infarction) as they are two separate processes

Insecticides

Insecticides refer to any chemical substance (powder, liquid, aerosol, or paint spray) which is used to eradicate arthropods

Intermediaries

An intermediary provides the means of transmitting the infectious agent from reservoir to host. Intermediaries are not infected with the specific pathogen nor suffer from the infection (does not possess the ability to propagate the infectious agent as this can only be done by the source of infection) but act as a go-between in facilitating the transmission of the specific pathogen. Living intermediaries are called vectors, for example, flies, fleas, mosquito’s while non-living intermediaries are called vehicles, for example, water, milk, food, plasma, air, fomites, body fluids and secretions, clothing, toys, surfaces, toiletries, furniture etc.

International healthcare measures

International measures referred to in this book have only reference to situations where the World Health Organization must be informed by the National Department of Health of South Africa that an outbreak of a particular communicable disease(s) has/have occurred, and/or informing countries across the South-African national inland border that a particular communicable disease has broken out in South-Africa and may spread across the national border, and/or any information to be given to travellers to conform to the healthcare regulations of the country of entry

Learner/student

A learner/student is any person (immaterial of age) who attends or resides in an educational institution (pre-primary, primary, secondary and higher education) in order to receive some kind of education, counselling or training. (Children who attend play groups are also considered to be learners)

Legislative measures

Legislative measures are regulations which are contained in the National Health Act, Act 61 of 2003, describing measures to improve the health of the population of the RSA as well as to prevent the occurrence of outbreaks of epidemics. These measures are applicable to all persons and if it should prove necessary, a person can be taken to court for non-compliance. When necessarily (as soon as an epidemic or pandemic breaks out) these regulations/measures are given preference over the rights of an individual/group as imbedded in the Constitution of the RSA

Nosocomial infection

Nosocomial is an infection originating in or contracted in a healthcare establishment

Notification of cases

Notification of a case is a legislative measure whereby the health authorities is notified of an outbreak of a particular communicable disease in persons or animals and is done by means of an official report. According to law, it is the responsibility of all registered healthcare practitioners (professional and traditional) to report the legally notifiable diseases. Notification can be done by telephone or satellite phone (to be followed up in writing), by electronic mail/internet, fax or telegram

Pandemic

A pandemic is the phenomenon of an outbreak of a particular communicable disease world-wide over the same period of time, such as the Influenza-A pandemic of 1918, bird/avian flu in the early 21st century

Parasites

Parasites are microbes/animals/insects/arthropods/worms that live on or in the body of humans or animals and are dependent on the body tissues or blood of any human or animal for its continued existence. The parasite may be at any stage of development of that particular species

Parasitaemia

Parasitaemia refers to the condition of the presence of all types of worms developing, living and reproducing in the blood and/or body organs (most of the time in the intestinal tract) of humans and/or animals and are dependent on the body tissues and/or the blood of the host for their continued existence. Worms (or their eggs) living in the intestinal tract of the host are passed in faeces. The eggs of worms living in the bladder of the host are urinated. A biological vehicle (for example, a mosquito) transfers the eggs of worms living in the blood of the host to other hosts (human or animal)

Pathogenic microbe/pathogen/infectious agent/infective microbe

Pathogenic microbes/pathogens/infected microbes are infectious agents. A specific pathogenic microbe causes a particular communicable disease

Pathogenicity

Pathogenicity is the ability of an infectious agent to cause a disease in susceptible hosts. Pathogenicity is closely related to the attack rate which is the proportion of those hosts who eventually manifest the particular disease correlating to all hosts who were exposed to the infectious agent

Personal hygiene measures

These are the protective measures taken by an individual to promote his/her own health and to prevent the spread of communicable diseases which are mainly transmitted by being in direct contact with the infectious agent. These measures include

☐ keeping the body clean by thoroughly washing with soap and water on a daily basis

☐ washing of hands after using the toilet (urine and faeces)

☐ washing of hands after any physical activity inside or outside a home, hospital, work place, etc

☐ washing of hands after coming in contact with pets and garbage

☐ washing of hands after blowing the nose, coughing or sneezing

☐ washing of hands before preparing or eating food

☐ washing of the hands thoroughly after touching a healthcare user or his/her possessions or coming in contact with any discharge from any human or any animal

☐ washing of the hands before and after coming into contact with anybody who is sick or wounded

☐ keeping hands as well as contaminated articles and toilet articles away from the mouth, eyes, nose, ears and wounds

☐ avoiding the sharing of crockery, drinking utensils, towels, handkerchiefs, combs and brushes

☐ avoiding exposure to other persons who suffer from any infectious disease (speciality respiratory diseases) when coughing, sneezing, laughing, singing and talking

☐ using available material in public places to wash and clean hands or sanitize equipment before or after use

☐ covering of the nose and mouth when coughing or sneezing while disposing used tissues containing respiratory secretions in the nearest waste receptacle after use or incinerated it (if necessary) and washing hands after having contact with any respiratory secretions as well as any contaminated objects/material

Portal of entry and exit

The portal of entry and exit denotes the point/site of entry and the point/site of exit through which the infectious agent causing the particular communicable disease, gains entry into the body and leaves/sheds from the body of the infected host. Portals of entry include the respiratory tract and system, the gastro-intestinal tract, the skin and mucous membranes. Infectious agents leave the infected host through/are shed