Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R.

Abejo RN,, MAN

COMMUNITY HEALTH NURSING Communicable Disease Lecturer: Mark Fredderick R. Abejo RN, MAN

CAUSATIVE/INFECTIOUS AGENT: A. Pathogenicity ability to cause disease B. Virulence ( disease severity ) and invasiveness (ability to enter and move through tissue) C. Infective dose number of organisms needed to initiate infection D. Organisms specificity ( host preference) antigenic variations E. Elaboration of toxin F. Viability- ability to survive outside the host G. Invasiveness ability to penetrate the cell RESERVOIR natural habitant of the organism that is where resides and multiplies. A. Human man is the reservoir of the diseases that is more dangerous to humans than to other species. B. Animal responsible for infestations with trophozoite, worms, etc. C. Non-animal street dust, garden soil, lint from bedding.

Communicable Disease Is defined as an illness caused by an infectious agent or its toxins, which can be transmitted directly or indirectly to a well person. Communicable diseases are caused either by bacteria or virus. Sources of infection consist of man, animal, contaminated food or water, insects and environmental factors, such as, dust and dirt.

Carrier harbors the organism but w/o signs of infection Categories of Carrier Incubatory - no signs and symptoms Convalescent disease subsided Intermittent occasionally disseminate the infectious organism Chronic carrying the infectious organism for years.

Contagious Easily transmitted through direct or indirect mode Transmitted via: a. Airbornemeasles, pneumonia b. Droplet-PTB, Hepatitis A, Diphtheria

Infectious Not easily transmitted

Transmitted via: a. Blood Transfusion-AIDS, Hepatitis B, b. Sexual Intercourse: multiple sex partners 1) Bacterial-gonorrhea, syphilis, STD 2) Viral-AIDS, Hepatitis B 3) Fungal-Candidiasis 4)Protozoal-Trichomonas vaginalis c. Contaminated Article/Equipment -needles and syringes d. Placental Transfer

PORTAL OF EXIT / Mode of Escape from Reservoir: A. Respiratory tract ( most common in man) B. Gastrointestinal tract C. Genito-urinary tract D. Open lesions E. Mechanical escape ( includes bite of insects) F. Blood MODE OF TRANSMISSION it indicates the potential of the disease; conveyance of the agent to the host; it can be by common source transmission, contact source, air-borne transmission. There are four main routes of transmission A. By Contact Transmission 1. Direct contact ( person to person ) 2. Indirect contact ( usually an inanimate object) 3. Droplet contact ( from coughing, sneezing, or talking, or talking by an infected person) By Vehicle Route ( through contaminated items) 1. Food salmonellosis 2. Water shigellosis, legionellosis 3. Drugs bacteremia resulting from infusion of a contaminated infusion product 4. Blood hepatitis B, Airborne Transmission 1. Droplet of nuclei 2. Dust particle in the air containing the infectious agent 3. Organisms shed into environment from skin, hair, wounds or perineal area.

CHAIN OF INFECTION

B.

C.

D. Vector borne Transmission, arthropods such as flies, mosquitoes, ticks and others.

PORTAL OF ENTRY / Mode of Entry of Organisms into Human. A. Respiratory tract B. Gastrointestinal tract C. Genitourinary tract D. Direct infections of mucous membrane/skin

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Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN

SUSCEPTIBLE HOST a person or animal or plant upon which parasite depends for its survival. Host Factors: 1. Age, sex, genetic 2. Nutritional status, fitness, environment factors 3. General physical, mental and emotional health 4. Absent or abnormal Ig. 5. Status of hematopoetic system, efficacy of the RES. 6. Presence of underlying disease DM, lymphoma, leukemia, neoplasia, granulocytopenia, or uremia. 7. Patient treated with certain antimicrobials, corticosteroids, radiations, or immunosuppressive agents.

Mode of Transmission: Droplet from respiratory tract of an infected person or a carrier directly or indirectly. Nursing Assessment: A child with diphtheria usually seeks medical help for one of the following complains (sometimes they are called types). 1. Sore throat: Fever. Difficulty to swallow. Swelling of the neck. Exudates or a yellow-gray membrane on tonsils and may be the pharynx. (Membrane varies from thin to thick one). 2. Croup: Hoarse or croupy cough and stridor. Noisy respiration, the child may have severe respiratory distress. The membrane may cover the vocal cord (When examined with laryngoscope). Nasal discharge: Purulent, bloody nasal discharge. The membrane can be seen on the nasal septum. Infected skin ulcer: This skin ulcer can be confused with impetigo (skin disease). The membrane is not always present in diphtheria. Other sings and symptoms: That could be present (especially in severe cases): Purulent conjunctivitis. Otitis media. Ulcerative vulvo-vaginitis. Toxins from organisms produces fever and malaise.

Control of Communicable Diseases: Control of Communicable Disease regulated under R.A 3573: Public Health Workers (PHW) to report any occurrence and incidence of communicable diseases 3. PHWs: namely 1. 2. 3. 4. 5. 6. 7. 8. are members of the health team who are professionals Medical Officer (MO)-Physician Public Health Nurse (PHN)-Registered Nurse Rural Health Midwife (RHM)-Registered MidwifeDentist Nutritionist Medical Technologist Pharmacist Rural Sanitary Inspector (RSI)-must be a sanitary engineer

4.

5.

5 Communicable Diseases to be reported weekly and monthly: 1. Rabies 2. Measles 3. Polio 4. Neonatal Tetanus-children delivered at home by midwives/hilots 5. Sexually Transmitted Disease (STD)-all forms Diarrhea-not a disease but a symptom which should be reported by PHN monthly

Common Communicable Diseases Caused by Bacteria

1. DIPHTHERIA

Etiology: Corynebacterium diphtheria (Diphtheria bacillus). Incubational Period: 2-5 days or longer. Communicability Period: Several hours before onset of the disease until organism disappear from the respiratory tract.

Nursing Consideration: 1. Isolate the child (place him in isolating room, use medical aseptic techniques). Keep the child in isolation until 2 consecutive nose and throat culture are negative (24 hours apart between the two cultures). 2. Bed rest for about 6 weeks for all types except in nasal diphtheria. 3. For respiratory distress (if present): suction to trachea and larynx to remove secretions and pieces of membrane, oxygen humidifier. 4. For fever: check vital signs, use 2-3-4 hours schedule; depending on the degree of fever, degree of respiratory embarrassment and change in pulse rate. Check blood pressure frequently. 5. For the membrane: Oral hygiene (warm mouth wash, never use tooth brush or swabs because of danger of distracting the membrane leading to bleeding and rapid spread of toxins into blood system. 6. Observe: vital signs, secretion and the need for suction, observe signs and symptoms of paralysis. 7. Tracheostomy and /or intubation trays must be ready at bedside table of the child. If tracheostomy or intubation is done, apply the proper care of tracheostomy or intubation. In intubation, the child can expel the tube when he coughs, so watch constantly as he cant call for help. Frequent suctioning of the tube use proper restraints so that he will not remove the tube. 8. If myocarditis appears as a complication, guard the child for exhaustion, beside the other nursing care. Treatment: Bed rest. Antibiotics. Anti-toxins.

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Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN

Prevention: 1. Active immunization: DPT vaccine. 2. Passive immunization: injection with anti-toxins. Complications; Bronchopneumonia. Kidney dysfunction. Paralysis. Myocarditis. Cardiac failure.

2. PERTUSSIS (Whooping Cough)

Nursing Consideration: 1. Isolation: Disinfection all utensils. 2. Bed rest: keep the child in bed in a well ventilated room. 3. For paroxysmal stage: Provide; Calm atmosphere to avoid emotional swings as laugh and cry causing coughing attacks. Avoid dust in the room. Oxygen with humidity to relief cyanosis (may use oxygen tent). 4. For vomiting: Raise head and shoulders of older children to avoid aspiration of vomitus. For young children, place them on abdomen if no one is attending in the room. Mouth care. Small frequent feeding. Refeed the child immediately after vomiting. Accurate intake and output must be kept. 5. For anorexia: High caloric soft diet. Encourage the child to eat. Weight the child daily. 6. If anoxia occurs during paroxysms a tracheopharyngeal suction may be needed. So keep the suction machine available. 7. Protect the child from secondary infection, keep him warm. 8. Observe: respiratory distress and convulsions. 9. Observe signs and symptoms of airway obstruction e.g. restlessness, cyanosis, retraction. Treatment: Symptomatic: sedatives and antispasmodics are important. Antibiotics are effective if given early (Ampicillin and Erythromycin). Prevention: 1. Active immunization: DPT vaccine. 2. Passive immunization: Gamma Globulin. 3. In exposed immunized children, give an immediate booster dose of pertussis vaccine. Complication: Otitis media. Bronchiectasis. Hemorrhage may occur. Marasmus. Encephalitis. Pneumonia.

Etiology: Gram-negative bacillus. Incubation Period: 5-14 days. Communicability Period: 4-6 weeks from the onset of the disease. Mode of Transmission: Droplet (direct and indirect). Nursing Assessment: Three stages: aCatarrhal stage: (coryza or prodormal stage) It lasts 7-14 days. Mild fever, headache, anorexia. Sneezing. Persistent cough with tearing. bParoxysmal stage (Spasmodic or whooping stage): Lasts 14-28 days (2-4 weeks). Paroxysmal cough develops. It is characterized by several sharp coughs in one expiration, followed by one deep inspiration, which may be accompanied by a whoop. Cough is worse at night, interferes with sleep and frequently causes vomiting. With cough, face becomes flushed and in some instances cyanosis and dyspnea might occur. Anorexia. Lymphocytosis occurs. cConvalescent stage: It lasts 21 days. Cough and vomiting become less.

3. TETANUS (Lock Jaw)

Etiology: Clostridium tetanti (tetanus bacillus). Incubational Period: 3-21 days. Communicability Period: Not communicable from man to man, as the organism usually live in animals intestinal tract. Mode of Transmission: Through a wound as organism is present in soil.

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Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN

Nursing Assessment: Onset of the disease is either gradual or acute. 1. Convulsions are the first warning symptoms in children. 2. Excessive irritability and restlessness. 3. Difficulty in swallowing. 4. Stiff neck. 5. Within 24-48 hours, the muscular stiffness progress: Trismus i.e. tight jaw, inability to open the mouth. Stiff arm and legs, then entire stiffness of the body. Swallowing usually becomes impossible. Resus sardonicus due to spasm of facial muscles. Opisthotonos, i.e., backward arching of the back as a result of the dominance of the extensor muscles of the spine, head draws back. These ongoing tetanic spasms lasts about 10 seconds and occurs following a slightest stimuli, such as, claming the door or bumping the bed. 6. Dyspnea and cyanosis can develop. 7. Fever 38.5 -40C. 8. Constipation may develop. 9. Lumbar puncture reveals increase reveals increase spinal fluid pressure. Nursing Consideration: 1. Isolation. 2. Protect the child from any stimuli (auditory or tactile stimuli), so place the child in dark, quite room and minimum handling. 3. If dyspnea and cyanosis are present, give oxygen. 4. For tetanic spasm: Protect the child from falling. The nurse must be alert for number, duration and frequency of convulsion (in relation to sedation administered). Record any change in trismus or inability to swallow. 5. For inability to swallow: I.V. therapy for nutrition and fluid balance. Gavage feeding may be ordered. So, the nurse must report if insertion of the tube causes convulsions. Accurate intake and output chart is necessary. Mouth care if he can open his mouth. For constipation, give enema. Check vital signs carefully. If tracheostomy is performed; care of tracheostomy. Naso-pharyngeal suction is done frequently.

4. SCARLET FEVER

Etiology: Streptococcus pyogeneous. (Beta hemolytic streptococcus group A). Incubational Period: 2-5 days. Communicability Period: From onset to recover. Mode of Transmission: Droplet infection, direct and indirect. Nursing Assessment: In acute sudden onset: (toxin from the site of infection is absorbed into blood stream). Prodromal signs: Vomiting. High fever then it drops when rash appears. Headache. Rapid pulse. Tongue: white tongue coating desquamates and red strawberry tongue results. Tonsils are red, enlarged, swallow, and may have a patchy whitish exudates on their surface. Then, rash appears within the first 5 days of the disease. The rash will be all over the body but not on the face. The chest and back are affected first, and then the rash moves down-wards involving the legs last. The rash fades upon pressure. Distinct odor of the skin. Desquamation i.e., peeling of the skin, is the typical of scarlet fever. Desquamation could occur early at 4-5-6 day or later to 4th week of the disease. It starts at the top of the body and proceeds downwards. Nursing Considerations: 1. Isolation. 2. Bed rest for 12 days and good ventilated room. 3. Keep patient warm, dry and comfortable as possible. 4. For the distinct odor which associates with scarlet fever: daily bath and change linen frequently. 5. For skin: Lubricate skin well with oil (daily) as Dr. order. Protect skin under and around the nose and lips with ointment. (When nasal discharge is constant). 6. Nasal aspiration by gentle suction or soft rubber ear syringe is essential. 7. If the child is less than 2 years, elevate head and shoulders to prevent danger of otitis media. 8. Accurate intake and output chart is important. 9. Diet in the first week: High caloric liquids then soft diet. Avoid irritant liquid juice citrus. 10. For constipation, which accompanies scarlet fever enema or mild cathartics is needed. 11. If there is pain in cervical lymph nodes, treat with heat in the form of hot packs or cold in the form of ice collar according to doctors order. 12. Observe for complications.

6. 7. 8. 9.

Treatment: Antibiotics (Penicillin). Antitoxin. Tranquilizers. Prevention: 1. Active immunization: DPT vaccine. 2. Passive immunization: Injection of tetanus immuno-globulin or antitoxin (a few hours after a wound occur). Complication: Anoxia. Atelectasis. Pneumonia.

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Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN

Treatment: Penicillin. Diet. Sedatives for pain. Prevention: No immunization. Complication: Rheumatic fever. Glomerulo-Nephritis. Pneumonia.

2.

For rash (lesion): Cleaning the skin according to doctors order once or twice daily. Cool sponge bath without soap. Change childs clothes and bed linens daily to prevent skin infection. For itchy lesions, nails must be cut and cleaned. Mittens and gloves to prevent skin scratching. Restraints may be needed to control scratching. Observe the skin lesions, change in appearance and it must be recorded. If lesions in mouth, mouth wash. If lesions in genital organ, apply cold compresses. For fever: Check vital signs and record it, especially temperature. Keep records for the first 7 days of the disease. If secondary infection to skin occurs: intake and out put chart must be kept accurate. Observe for complications and report immediately to the doctor.

3.

Communicable Diseases Caused by Virus

4. 5. 1. CHICKEN POX (Varicella) This is a highly communicable disease in children.

Treatment: No specific treatment. To relieve itching, calamine lotion, antihistamine and local aneaethetaic ointment are prescribed. Antibiotics for secondary infection. Dont give aspirin due to high risk of Reye syndrome. Prevention: None Complication: Abscess. Encephalitis. Glomerulonephritis may occur.

Etiology: Virus [Varicella- Zoster- Virus (VZV)]. Incubational Period: 10-21 days (2-3 weeks). Communicability Period: One day before and six days after the appearance of the first vesicle. Mode of Transmission: Droplet (direct or indirect). Dry scabs are not infectious. Nursing Assessment: Onset is sudden with: Prodromal Stage: Mild or light fever. Anorexia. Headache. Acute Phase: Rash: Successive crops of macules, papules, vesicles, crusts (vesicles heals by forming the crusts by the end of the two weeks). (Acute Phase). Rash appears in successive crops and lesions in all stages of development at the same time. Rash is itchy. Nursing Consideration: 1. Isolation: Use medical aseptic technique. Nasal and oral discharge, cloths and linens are currently disinfected. Keep the child in isolation until all crusts disappear.

2. MEASLES (Rubeola) Most cases occur before adolescent and it occurs more in spring months.

Etiology: Paramyxoviridae Virus Incubational Period: 7-14 days (usually 10-20 days). Communicability Period: 4 days before the appearance of rash to 5days after rash appearance. Mode of Transmission: Droplet (direct or indirect).

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Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN

Nursing Assessment: aCoryza: Primary symptoms which resembles common cold and occur before rash appearance: Sneezing. Fever (range from 38.5 to 40C, tending to be highest just before the appearance of rash). Brassy or barking cough. On the 4th day, conjunctivitis and photophobia. Acute catarrhal inflammation of the mucous membrane of the nose. Enlarged posterior cervical lymph nodes. bKopliks Spots: Are pathogenic appear on day before rash. Whitish spots resting on a reddish base appear on the inside of the mouth. They can appear and disappear suddenly. cRash: Rash appears on 2nd to 5th day and remain about a week. Appears first on face, behind the ears, on the neck, forehead or cheeks. Then, spread downwards over the rest of the body (trunk, arms, and legs). The rash is pinkish in color, begins with macular lesions which progress to the popular type. Then, rash becomes dark in color (brownish color on 5th day). Desquamation, which is find usually, follow the rash appearance and then fads (disappear). Rash is itchy. Nursing Consideration: 1. Isolation. 2. Bed rest: Occupy the child in bed after acute phase with activities. Explain the reason for being in bed if the child is old enough to understand. 3. For photophobia and conjunctivitis: Subduced light make the child more comfortable. Dark room. Eye care with warm saline solution to remove secretions or crust. Keep childs hands away from eyes, examine coma for signs and symptoms of ulceration. 4. For fever: Measure the temperature carefully. Antipyretic as doctors order. Encourage fluids. Tipped compresses. For itchy rash: Observe degree of itching and apply lotion or ointment as doctors order. For Kopliks spots: Mouth care. Use gargle solution. Carry out the plan of care of complicated cases, such as, encephalitis (convulsions), dyspnea. etc.

3. GERMAN MEASLES (Rubella) It is not as communicable as measles. Fetus may contact the disease in uterus if the mother develops the disease during the pregnancy (1st trimester).

Etiology: Rubella Virus ( Togaviridae, genus: Rubivirus) Incubation Period: 14 to 21 days. Communicable Period: During Prodromal period and for 5 days after the rash. Mode of Transmission: 1. Direct contact with nose and throat secretions of infected persons. 2. Indirect via articles freshly contaminated with nasopharyngeal secretion. 3. Trans-placenta congenital infection form infected mother to the fetus. Nursing Assessment: Prodromal Stage: Mild fever (Disappear when rash appear). Slight malaise, headache, and anorexia. Running nose, sore throat. Rash is faint macular rash. It is small pinpoint pink or pale red macules which are closely grouped to look like scarlet blush (botchy), which fades on pressure. It begins on face and hairline move to trunk then extremities. Rash disappears in 3 days. Swelling of posterior cervical and occipital lymph nodes. No Kopliks spots or photophobia. Nursing Consideration: 1. Isolation especially form pregnant women. 2. Bed rest until fever subsided. Treatment: Symptomatic. Prevention: aActive immunization; live attenuated rubella virus vaccine. bPassive immunization: Gamma- globulin. Complication: Fetus damage if mother contacts the disease during pregnancy. Newborn may have congenital anomalies, such as deafness, mirocephaly, mental retardation. Encephalitis.

5. 6. 7.

Treatment: Symptomatic. Antibacterial therapy. Prevention: aActive immunization: live attenuated vaccine. bPassive immunization: Newborn through the mothers while they were in uterus. Gamma-globulin. Complication: Otitis media. Tracheobronchitis. Imptiago,purpura. Lymphoadenitis. Pneumonia. Encephalitis.

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Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN

4. MUMPS (Infectious Parotitis) Mumps is common in children 5-10 years. It is acute virus infectious disease, which may involve, many organs but commonly affects the salivary glands (mainly parotids glands).

5. POLIOMYELITIS (infantile Paralysis) It attacks the brain stem and spinal cord.

Etiology: Paramyxovirus Virus. Incubational Period: 14-21 days. Communicability Period: One to six days before the first symptoms appears until the swelling disappears. Mode of Transmission: Direct or indirect contact with salivary secretion of infected person. Nursing Assessment: Prodromal stage Corayza: Low-grade fever. Vomiting. Headache. Malaise and anorexia. Acute Phase: 1. Pain in or behind ears and pain on swallowing or chewing. 2. Swelling and pain in glands (unilateral or bilateral), which return to normal in 10 days. 3. Orchitis in males and mastitis in female adolescent may occur. Nursing Consideration: 1. Isolation. 2. Bed rest until swelling disappears. 3. For fever: Encourage fluids and soft food, avoid food required chewing, and tipped compresses, antipyretics. 4. For glands: Mouth care and gargle frequently. Apply hot or cold compresses for the swelling. Use ice bag (watch weight of the bag in order not to increase the pain). 5. For Orchitis: Support scrotum, use cold compresses for 20 minutes, then, remove it for 30 minutes, then, reapply it for 20 minutesetc. For Mastitis: Breast support, use cold compresses. Incubational Period: 5-14 days. Communicability Period: Latter period of incubational period till the first week of acute illness. Mode of Transmission: Oral contamination by intestinal and pharyngeal secretions of infected person. Predisposing Factors: 1. Fatigue and muscle exertions. 2. Cortisone administration. 3. Tonsillectomy and adenoectomy. 4. Tooth extraction. 5. I.M injection of D.P.T. vaccine. Nursing Assessment: Severity of nerve involvement can vary from an absence of all clinical signs of paralysis to complete paralysis. There are different possible consequences of infection: Inapparent Poliomyelitis: (Silent) No signs or symptoms appears. Abortive Poliomyelitis: Initial symptoms of upper respiratory tract infection: fever, headache, vomitingetc. Non-Paralytic Poliomyelitis: Problems as those of Aseptic Meningitis Syndrome: Stiffness of neck, back and limbs. Nausea and vomiting become more severe than stage II. Fever. Increase protein in C.S.F. Paralytic Poliomyelitis: This may begin with manifestations of the abortive or non-paralytic type. Spinal: paralysis appear within a day or two after the above manifestations and 2-5 days from onset of the disease: Paralysis of limbs is the most common affected muscles. Etiology: Virus. The disease is caused by any one of 3 polioviruses: aType 1 (Brunhilde). bType 2 (Lansing). cType 3 (Leon).

6.

Treatment: Symptomatic. Sedatives. Prevention: Active immunization: Live attenuated vaccine. Passive immunization: Gamma- globulin. Complication: (rare) Sterility Ovaritis inflammation of testicles Deafness.

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Community Health Nursin Communicable Disease Lecture Notes Prepared by: Mark Fredderick R. Abejo RN,, MAN

Muscles of the chest, abdominal wall, diaphragm, urinary bladder and bowel can be affected constipation or stool incontinent and urinary incontinent may occur. Bulbar: More life threatening. It causes damage to cranial nerve nuclei, vital centers of respiration, circulation and temperature control. It may leads to swallowing problem and regurgitation of fluids from nose and inability to swallow saliva, which puddles in the pharynx. If not aspirated chocking may occur. Encephalitis: Manifesting as encephalitis, only diagnosed as polioencephalitis if spinal or bulbar affections or both are present:

Passive immunization: Gamma- globulin. Complication: Emotional disturbance. Gastric dilatation. Hypertension.

Convulsion. Personality disturbances.

Nursing Considerations: 1. Isolation and bed rest. 2. In acute stage: Put the child under close observation. Notify the doctor about the degree and progress of the paralysis (7or8 days of the disease). Rate and type of respiration and signs of respiratory distress must be observed and reported. Oxygen therapy or place the child on respirator when cyanosis occurs. If tracheostomy is done in case of diaphragmatic paralysis, care of tracheostomy. 3. For paralysis: Change position frequently. Careful positioning for affected limbs each time he is turned or moved. To minimize the degree of deformity, correct body alignment and optimum position must be maintained. Place the child on firm mattress. Use footboard to prevent foot drop when child is on back. If the child is on abdomen, pull the mattress away from foot of bed and letting feet protrude over the edge to prevent pressure on toes. Application of heat to affected muscles to relax them. Suction of the pharynx and postural drainage to prevent aspiration of secretions. For swallowing difficulties: Soft diet if they can swallow with difficulty. If swallowing is difficult, use gavage feeding. For incontinent: Skin care and perineal region is padded to provide absorption for excretions. Catheter may be done. For constipation: Use enemas. Treat fever and headache.

4. 5.

6.

7. 8.

Treatment: Symptomatic. Physiotherapy. Prevention: Active immunization: Trivalent poliovirus vaccine. (TOPV). Sabine: Attenuated virus, which is administered orally. Salk: Killed virus, which is administered by injection. Note: If a child is affected by poliomyelitis, he must receive the vaccine to prevent further infection from the other poliovirus types.

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