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

Abejo RN,, MAN

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

EPI TARGET DISEASES

Disease

Causative Agent

Mode of Transmission

Clinical Manifestation

Reservoir

Diagnostic Exam

Treatment

Nursing Implication

Tuberculosis Primary Complex is less than 3 years old - any child who does not return to normal health after measles or whooping cough. Most hazardous period: first 6-12 months after infection Highest in risk of developing: under 3 years old

Mycobacterium Tuberculosis

Droplet Infection ( inhalation of bacilli from patient who coughs and sneeze)

Degree of Communicability Depends upon: - num.of bacilli - virulence of bacilli - environmental

General weakness Loss of weight, cough and wheeze which does not respond to antibiotic therapy. Fever and night sweat Abdominal swelling with a hard painless mass and free fluid Hemoptysis and chest pain Painful firm or soft swelling in a group of superficial lymph nodes. Note: In young children the only sign of pulmonary TB may be stunted growth or failure to

Man And Diseased Cattle (Bovine TB)

Sputum Exam 3 sample are taken with 24 hrs: - spot sample (1st visit) - early morning specimen - spot sample (2nd visit) Note: at least 2 sample are positive

DOTS - patient is required to take the Ant-Tb drugs in the presence of a health care provider to ensure compliance to treatment regimen

Pointers for teaching on Anti-TB drugs:

Rifampicin: taken befor meals, causes red urine urine Isoniazide: causes peripheral neuritis, given with Vit.B6 Pyrazinamide: cause hyperurucemia

Anti-TB drugs: Ethambutol: causes

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

conditions

thrive Chest Xray Mantoux Test - .1 cc injection of PDD and 48-72 hours reading * 10 mm + 5 mm + (HIV pt.)

(RIPES) Rifampicin Isoniazid Pyrazinamide Ethambutol Streptomycin

optic neuritis/ blurring of vision Streptomycin: cause tinnitus, loss of hearing balance, damage to 8th cranial nerve

Note: After 2-4 weeks of treatment, patient is no longer contagious

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

The National Tuberculosis Control Program Vision: A country where Tb is no longer a public health problem Mission: Ensure that TB DOTS services are available, accessible and affordable to the communities in collaboration with the LGUs and other partners Goal: To reduce prevalence and mortality from TB by half the year 2015 ( Millennium Development Goal ) Targets: 1. Cure at least 85% of the sputum smear- positive TB patient discovered. 2. Detect at least 70% of the estimated new sputum smear-positive TB cases.

Increase and sustain support and financing for TB control activities Strategies: Facilitate implementation of TB-DOTS Center certification and accreditation Build TB coalitions among different sectors Advocate for counterpart input from local government units Mobilize/extend other resources to address program limitations

Objective D: Strengthen management (technical and operational) of TB control services at all levels

NTP Objectives and Strategies Objective A: Improve access to and quality of services provided to TB patients, TB symptomatics and communities by health care institutions and providers Strategies: Enhance quality of TB diagnosis. Ensure TN patients treatment compliance. Ensure public and private health care providers adherence to the implementation of national standards of care for TB patients. Improve access to services through innovative service delivery mechanisms for patients living in challenging areas.

Strategies: Enhance managerial capability of all NTP program managers at all levels Establish an efficient data management system for both public and private sectors. Implement a standardized recording and reporting system. Conduct regular monitoring and evaluation at all levels. Advocate for political support through effective local governance

KEY POLICIES Case Finding 1. DSSM ( Direct Sputum Smear Microscopy ) shall be the primary diagnostic tool in NTP case finding. Note: No TB diagnosis shall be made based on Xray result alone likewise result of PDD skin test (Mantoux Test) All TB symptomatic identified shall undergo DSSM for diagnosis before start of treatment Note: Only contraindication for sputum collection is hemoptysis After three sputum specimen yielding negative result X-ray and culture are necessary Note: Diagnosis based on Xray shall be made by the TB DiagnosticCommittee. Only trained medical technologist or microscopist shall perform DSSM.

Objective B: 2. Enhance the health-seeking behavior on TB by communities, especially the TB symptomatics Strategies: Develop effective, appropriate and culturally-responsive IEC/communication materials. Organize barangay advocacy groups 3.

4.

Objective C:

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

Patients with the following conditions shall be recommended for hospitalization: massive hemoptysis pleural effusion military TB ( TB of the Spine Pots Disease) TB meningitis TB pneumonia and those requiring surgical intervention RECOMMENDED CATEGORY OF TREATMENT REGIMEN

Category

Type of TB Patient

Treatment Intensive Phase

Regimen Continuation Phase Total Period

Anti-TB drugs: (RIPES) Rifampicin Isoniazid Pyrazinamide Ethambutol Streptomycin New smear positive PTB New smear positive PTB with extensive parenchymal lesion EPTB and Severe concomitant HIV disease Treatment Failure Relapse Return after default

2 RIPE

4 RI

6 mos.

Two Formulation of Anti-TB Drugs 1. 2. Fixed-Dose Combination ( FDCs) two or more first line anti-TB drugs are combined in one tablet. There are 2,3, or 4 drug fixed dose combinations. Single Drug Formulation (SDF) each drug is prepared individually. Isoniazid, Pyrazinamide and Ethambuto are in tablet form while Rifampicin is in capsule form and streptomycin is injectable.

II

2 RIPES /1 RIPE

5 RIE

8 mos.

III

New smearnegative PTB With minimal parenchymal lession Chronic ( still smear-positive after supervised retreatment )

2 RIP

4 RI

6 mos.

Refer to or DOTS to City

Specialized Plus Center Provincial Coordinator

facility refer NTP

IV

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

Categories II : 2 RIPES / RIPE / 4RIE (FDC) DOSAGE PER CATEGORY OF TRATMENT REGIMEN A. Fixed-Dose Combination Formulation The number of tablets of FDCs per patient will depend on the body weight. First Two (2) Months 3rd Month FDC-B ( RI ) Categories I and III : 2 RIPE / 4 RI ( FDC) FDC-A (RIPE) Body Weight (kg) No.of tablets per day Intensive Phase ( 2 months ) FDC-A ( RIPE) 30 - 37 38 54 55 70 More than 70 2 3 4 5 No. of tablets per day 30 37 Continuation Phase ( 4 months ) FDC-B (RI) 2 3 4 5 B. Single Dose Formulation ( SDF ) Simply add 1 tablet of Isoniazid ( 100mg) , Pyrazinamide (500mg) and Ethambutol ( 400mg) each for the patient weighing more than 50kg before treatment initiation. Modify drug dosage within acceptable limits according to patients body weight, particularly those weighing less than 30 kg at the time of diagnosis. 38 54 55 70 More than 70 3 4 5 0.75 g 0.75 g 0.75 g 3 4 5 3 4 5 2 3 3 2 0.75 g 2 2 1 Streptomycin FDC-A (RIPE) E 400 mg Body Weight Intensive Phase Continuation Phase

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

Categories I and III: 2 RIPE / 4 RI (SDF) Anti-TB Drugs No. of tablets per day Intensive Phase ( 2 months ) Rifampicin Isoniazid Pyrazinamide Ethambutol 1 1 2 2 No. of tablets per day Continuation Phase ( 4 months ) 1 1 Rifampicin Isoniazid Pyrazinamide Ethambutol Categories II: 2 RIPES / 1 RIPE / 5 RIE Streptomycin 5 ( 4 6 ) mg/kg and not to exceed 400 mg daily 10 ( 8 12 ) mg/kg and not to exceed 600 mg daily 25 ( 20 30 ) mg/kg and not to exceed 2 mg daily 15 ( 15 20 ) mg/kg and not to exceed 1.2 g daily 15 ( 12 18 ) mg/kg and not to exceed 1 g daily Anti-TB Drugs Dose per Kg Body Weight and Maximum Dose Drug Dosage per Kg. Body Weight

Anti-TB Drugs

No. of Tablets / Intensive (3months ) First 2 months

Vial per day Phase

No.of Tablets per day Continuation Phase ( 5 months )

D.O.T.S ( Directly-Observed Treatment Shortcourse ) TuTok Gamutan

5 Elements of D.O.T.S Sustained political commitment Access to quality-assured sputum microscopy Standardized short-course chemotherapy for all cases of TB Uninterrupted supply of essential drugs Recording and reporting system enabling outcome assessment of all patients and assessment of overall program performance.

3rd months 1 1 2 2 2 1 1

Rifampicin Isoniazid Pyrazinamide Ethambutol Streptomycin

1 1 2 2 1 vial per day

Note: 56 vials of Streptomycin for two months

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

MANAGEMENT OF CHILDREN WITH TB Prevention BCG vaccination shall be given to all infants. BCG vaccine is moderately effective. It has a protective efficacy of: 50 % against any TB disease 64 % against TB meningitis 74 % against death from TB

Management For children with exposure to TB Should undergo physical examination and PDD testing (Mantoux Test) A child with productive cough shall be referred for DSSM, if found positive, treatment shall be started immediately. PDD testing shall no longer needed. Children without sign/symptoms of TB but with positive Mantoux Test and those with symptoms of TB but negative Mantoux Test shall referred for chest x-ray examination.

For children with signs and symptoms of TB Case Finding Cases of TB in children are reported and identified in two instances: - The patient sought consultation. - The patient was reported to have been exposed to an adult with TB All TB symptomatic children 0-9 years old, except sputum positive child shall subject to PDD testing - Only trained nurse and midwife shall do the PDD test and recording - Testing and reading shall be conducted once a week either on Monday or Tuesday. Note: 10 children shall be gathered for testing to avoid wastage. A child shall be suspected as having TB and considered symptomatic if with any three (3) of the following sign and symptoms: cough and wheezing for 2 weeks or more unexplained fever for 2 weeks or more loss of appetite, loss of weight, failure to gain weight failure to respond to a 2 weeks of appropriate antibiotic therapy failure to regain state of health 2 weeks after a viral infection or after having measles. A child to have signs and symptoms of TB with either known or unknown exposure shall be referred for Mantoux test. For children with known contact but with negative Mantoux and those unknown contact but with positive Mantoux shall be referred for chest x-ray examination. For a negative x-ray report, Mantoux test shall be repeated after 3 months. Chemoprophylaxis of Isoniazid for 3 months shall be given to children less than 5 years old with negative chest x-ray after which Mantoux test shall be repeated

Treatment D.O.T.S will still be followed just like in adult Short course regimen: - at least 3 anti-TB drugs for 2 months ( intensive phase ) - 2 anti-TB drugs for 4 months ( continuation phase ) * For Extra Pulmonary TB Cases: - 4 anti-TB drugs for 2 months ( intensive phase ) - 2 anti-TB drugs for 10 months ( continuation phase ) Domiciliary treatment shall be the preferred mode of care No treatment shall be initiated unless the patient and health worker has agreed upon a caseholding mechanism for treatment compliance.

A child shall be clinically diagnosed or confirmed of having TB if he has any three (3) of the following condition: positive history of exposure to an adult/ adolescent TB case presence of sign and symptoms suggestive of TB positive Mantoux Test abnormal chest radiograph suggestive of TB

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

Treatment Regimen A. Pulmonary TB Drugs Intensive Phase Rifampicin Isoniazid Pyrazinamide 10-15 mg/kg body weight 10-15 mg/kg body weight 20-30 mg/kg body weight Continuation Phase Rifampicin Isoniazid 10-15 mg/kg body weight 10-15 mg/kg body weight 4 months 2 months Daily Dose (mg/kg per body weight ) Duration

Continuation Phase Rifampicin Isoniazid 10-15 mg/kg body weight 10-15 mg/kg body weight 10 months

Public Health Nurse Responsibilities ( Childhood TB )

1. 2. 3. 4. 5. 6.

Interview and open treatment cards for identified TB children. Perform Mantoux testing and reading to eligible children Maintain NTP records Manage requisition and distribution of drugs Assist the physician in supervising the other health workers of the RHU in the proper implementation of the policies and guidelines on TB in children. Assist in the training of other health workers on Mantoux testing and reading.

B. Extra Pulmonary TB Drugs Intensive Phase Rifampicin Isoniazid Pyrazinamide 10-15 mg/kg body weight 10-15 mg/kg body weight 20-30 mg/kg body weight Plus Ethambutol OR Streptomycin 2 months Daily Dose (mg/kg per body weight ) Duration

15-25 mg/kg body weight 20-30 mg/kg body weight

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

EPI TARGET DISEASES

Disease Causative Agent Mode of Transmission Clinical Manifestation Reservoir Diagnostic Exam Treatment Nursing Implication

Diphteria it is an acute pharyngitis, acute nasopharyngitis or acute laryngitis with Pseudo membrane grayish white in color with leathery consistency in the throat and on the tonsil

Corynebacterium diphtheriae

Respiratory Droplets

Nasal dryness of the upper lip serosanguinous secretion in the nose

Man

Schicks Test - test for the susceptibility to Diptheria

Antibiotics

Pen G Potassium Erythromycin

Pharyngeal Bullneck appearance because of the enlarge cervical lymph nodes.

Moloney Test - for hypersensitivity to Diptheria toxin

Isolate patient until 2-3 cultures taken at least 24hrs apart are negative Small frequent feeding Promote absolute rest Use ice collar to relieve pain of sore throat May put on soft diet

Laryngeal sore throat hoarseness brassy metallic cough At first, the infected child may have a common cold with runny nose, sneezing and mild cough Intermittent episode of paroxysmal cough followed by a whoop ending vomiting

Pertussis - 100 days cough - Whooping cough - tuspirina

Bordetella Pertussis

Airborne droplet Primarily by direct contact with he discharge from respiratory mucous membranes of infected person

Bordet-Gengou Agar Plate Man - used for culture medium

Erythromycin Ampicillin

- is given 5-7 days

Place the patient on NPO during paroxysmal stage to prevent aspiration Position prone for infants and upright for older

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

Neonatal Tetanus

Clostridium Tetani

Unhygienic cutting of umbilical cord

Assess the NEWBORN for a history of all 3 of the following:

Blood Culture

- which produces the exotoxins: Tetanolysin Tetanospasmin

Penicillin Erythromycin Tetracycline

Prevention

Improper handling of cord stump esp. when treated with contaminated substance

Normal suck and cry for the first 2 days of life Onset of illness between 3 and 28 days Inability to suck followed by stiffness of the body and convulsion Soil Intestinal canal of animal Man

CSF analysis - administered within 4 hours of injury

Aseptic handling of the neonatal umbilical cord Tetanus Toxiod immunization for mothers Active immunization of DPT

In OLDER CHILDREN, the following may be observed:

Trismus lockjaw Opisthotonus arching of the neck and back Ridus Sardonicus sardonic smile

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

Poliomyelitis Infantile Paralysis

3 Types of Polio Virus Type I Brunhilde Type II Lansing Type III Leon

Fecal-oral route

Abortive - did not progress to systemic infection

Throat swab Man Stool exam

Strict Isolation Hot moist compress to relieve spasm

Oral route through pharyngeal secretion

Non-paralytic slight involvement of the CNS Lumbar exam

Use protective devices: - handroll to prevent claw hand

Contact with infected person

Poker spine or stiffness of the spinal column

Pandys test - for CSF analysis

Spasms of the hamstring With paresis Paralytic severe involvement of CNS

- trochanter roll, to prevent outer rotation of femur - footboard

Hoynes Sign head falls back when he is in supine with shoulder elevated Paralysis Head log/drop Tripod position extend his arm behind for support when he sits up Kernigs sign Brudzinski sign

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

Hepatitis B - it is liver infection caused by the B type of hep.virus. It attacks livers the liver often resulting in inflammation Hepa B Virus 3 Ps

Prodromal/pre-icteric Symptoms of URTI Weight loss Anorexia RUQ pain Malaise Icteric Jaundice Acholic stool bile-colored urine 3 Cs Conjunctivitis Coryza Cough Kopliks spot bluish gray spot on the buccal mucosa. Generalized blotch rash Observe respiratory isolation Should kept out of school for at least 4 days after rash appear For Photophobic, darkened room, sunglasses Liver Function Test Man Increase CHO Moderate fat Low CHON

Person to person Parenteral Placental

Observed universal precaution

Measles

Paramyxo Virus

Droplet

Man

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

DISEASES TRANSMITTED THROUGH FOOD AND WATER

Disease Cholera Other names: El tor

Causative Agent Vibrio cholera Vibrio coma Ogawa and Inaba bacteria

Mode of Transmission Fecal-oral route 5 Fs Incubation Period: Few hours to 5 days; Usually 3 days

Pathognomonic Sign Rice watery stool Period of Communicability: 7-14 days after onset, occasionally 2-3 months

Management and Treatment Diagnostic Test: Stool culture Treatment: Oral rehydration solution (ORESOL) IVF Drug-of-Choice: tetracycline (use straw; can cause staining of teeth). Oral tetracycline should be administered with meals or after milk. Metronidazole (Flagyl) * Avoid alcohol because of its Antabuse effect can cause vomiting

Prevention Proper handwashing Proper food and water sanitation Immunization of Chole-vac

Amoebic Dysentery

Entamoeba histolytica Protozoan (slippershaped body)

Fecal-oral route

Abdominal cramping Bloody mucoid stool Tenesmus - feeling of incomplete defecation Abdominal cramping Bloody mucoid stool Tenesmus - feeling of incomplete defecation

Proper handwashing Proper food and water sanitation

Shigellosis Other names: Bacillary dysentery

Shigella bacillus Sh-dysenterae most infectious Sh-flesneri common in the Philippines Sh-connei Sh-boydii

Fecal-oral route 5 Fs: Finger, Foods, Feces, Flies, Fomites Incubation Period: 1 day, usually less than 4 days Fecal-oral route 5 Fs Incubation Period: Usual range 1 to 3 weeks, average 2 weeks

Drug-of-Choice: Co-trimoxazole Diet: Low fiber, plenty of fluids, easily digestible foods

Proper handwashing Proper food and water sanitation Fly control

Typhoid fever

Salmonella typhosa (plural, typhi)

Rose Spots in the abdomen due to bleeding caused by perforation of the Peyers patches Ladderlike fever

Diagnostic Test: Typhi dot confirmatory test; specimen is feces Widals test agglutination of the patients serum Drug-of-Choice: Chloramphenicol

Proper handwashing Proper food and water sanitation

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

Hepatitis A Other names: Hepatitis / Epidemic Hepatitis / Catarrhal Jaundice

Hepatitis A Virus

Fecal-oral route 5 Fs Incubation Period: 15-50 days, depending on dose, average 20-30 days

Fever Anorexia (early sign) Headache Jaundice (late sign) Clay-colored stool Lymphadenopathy

Prophylaxis: IM injection of gamma globulin Hepatitis A vaccine Hepatitis immunoglobulin Avoid alcohol Complete bed rest to reduce the breakdown of fats for metabolic needs of liver Low-fat diet; increase carbohydrates (high in sugar) In convalescent period, patient may have difficulty with maintaining a sense of well-being. Treatment: 1. No definite treatment 2. Induce vomiting 3. Drink pure coconut milk weakens the toxic effect 4. Sodium bicarbonate solution (25 grams in glass of water) Advised only in the early stage of illness because paralysis can lead to aspiration NOTE: Persons who survived the first 12 hours after ingestion have a greater chance of survival.

Proper handwashing Proper food and water sanitation Proper disposal of urine and feces Separate and proper cleaning of articles used by patient

Paralytic Shellfish Poisoning (PSP I Red tide poisoning)

Dinoflagellates Phytoplankton

Ingestion of raw of inadequately cooked seafood usually bivalve mollusks during red tide season Incubation Period: 30 minutes to several hours after ingestion

Numbness of face especially around the mouth Vomiting and dizziness Headache Tingling sensation/paresthesia and eventful paralysis of hands Floating sensation and weakness Rapid pulse Dysphonia Dysphagia Total muscle paralysis leading to respiratory arrest and death

Avoid eating shellfish such as tahong, talaba, halaan, kabiya, abaniko during red tide season Dont mix vinegar to shellfish it will increase toxic effect 15 times greater

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

DISEASES CAUSED BY VIRUS

Disease Chickenpox Other names: Varicella Causative Agent Human (alpha) herpes virus 3 (varicella-zoster virus), a member of the Herpesvirus group Period of Communicability: From as early as 1 to 2 days before the rashes appear until the lesions have crusted. Mode of Transmission Droplet spread Direct contact Indirect through articles freshly soiled by discharges of infected persons Incubation Period: 2-3 weeks, commonly 13 to 17 days Pathognomonic Sign Vesiculo-pustular rashes Centrifugal appearance of rashes rashes which begin on the trunk and spread peripherally and more abundant on covered body parts Pruritus Management and Treatment No specific diagnostic exam Treatment is supportive. Drug-of-choice: Acyclovir / Zovirax (orally to reduce the number of lesions; topically to lessen the pruritus) NEVER give ASPIRIN. Aspirin when given to children with viral infection may lead to development of REYES SYNDROME. Nursing Diagnoses: Disturbance in body image Impairment of skin integrity German Measles Other Names: Rubella Three-day Measles Rubella virus or RNAcontaining Togavirus (Pseudoparamyxovirus) German measles is teratogenic infection, can cause congenital heart disease and congenital cataract. Herpes zoster virus (dormant varicella zoster virus) Droplet Direct contact from secretion Droplet Incubation Period: Three (3) days Forscheimer spots red pinpoint patches on the oral cavity Maculopapular rashes Headache Low-grade fever Sore throat Enlargement of posterior cervical and postauricular Diagnostic Test: Rubella Titer (Normal value is 1:10); below 1:10 indicates susceptibility to Rubella. Instruct the mother to avoid pregnancy for three months after receiving MMR vaccine. MMR is given at 15 months of age and is given intramuscularly. Prevention Case over 15 years of age should be investigated to eliminate possibility of smallpox. Report to local authority Isolation Concurrent disinfection of throat and nose discharges Exclusion from school for 1 week after eruption first appears Avoid contact with susceptibles

MMR vaccine (live attenuated virus) - Derived from chick embryo Contraindication: - Allergy to eggs - If necessary, given in divided or fractionated doses and epinephrine should be at the bedside.

Herpes Zoster Other names: Shingles Cold sores

Painful vesiculopustular lesions on limited portion of the body (trunk and shoulder) Low-grade fever

Treatment is supportive and symptomatic Acyclovir to lessen the pain

Avoidance of mode of transmission

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

Mumps Other name: Epidemic Parotitis

Mumps virus, a member of family Paramyxoviridae

Direct contact Source of infection: Secretions of mouth and nose Incubation Period: 12 to 26 days, usually 18 days

Painful swelling in front of the ear, angle of the jaws and down the neck Fever Malaise Loss of appetite Swelling of one or both testicles (orchitis) in some boys

Supportive and symptomatic Sedatives to relieve pain from orchitis Cortisone for inflammation Diet: Soft or liquid as tolerated Support the scrotum to avoid orchitis, edema, and atrophy Dark glasses for photophobia

MMR vaccine Isolate mumps cases

Influenza Other name: La Grippe

Influenza virus A most common B less severe C rare Period of Communicability: Probably limited to 3 days from clinical onset

Direct contact wesDroplet infection or by articles freshly soiled with nasopharyngeal discharges Airborne Incubation Period: Short, usually 24 72 hours

Sudden onset Fever with chills Headache Myalgia / arthralgia

Supportive and symptomatic Keep patient warm and free from drafts TSB for fever Boil soiled clothing for 30 minutes before

Avoid use of common towels, glasses, and eating utensils Cover mouth and nose during cough and sneeze

Immunization: Flujob/Flushot effective for 6 months to 1 year

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

DISEASES CAUSED BY BACTERIA

Disease Pneumonia Types: a. Community Acquired Pneumonia (CAP) b. Hospital / Nosocomial c. Atypical Causative Agent Bacteria: Pneumococcus, streptococcus pneumoniae, staphylococcus aureus, Klebsiella pneumonia (Friedlanders bacilli) Virus: Haemophilus influenzae Fungi: Pneumonocystis carinii pneumonia Mode of Transmission Droplet Incubation Period: 2 3 days Pathognomonic Sign Rusty sputum Fever and chills Chest pain Chest indrawing Rhinitis/common cold Productive cough Fast respiration Vomiting at times Convulsions may occur Flushed face Dilated pupils Highly colored urine with reduced chlorides and increased urates Management and Treatment Diagnosis: Based on signs and symptoms Dull percussion on affected lung Sputum examination confirmatory Chest x-ray Management: Bedrest Adequate salt, fluid, calorie, and vitamin intake Tepid sponge bath for fever Frequent turning from side to side Antibiotics based on CARI of the DOH Oxygen inhalation Suctioning Expectorants / mucolytics Bronchodilators Oral/IV fluids CPT Prevention Avoid mode of transmission Build resistance Turn to sides Proper care of influenza cases

Streptococcal sore throat Other name: Pharyngitis Tonsillitis

Group A beta hemolytic streptococcus Other diseases: Scarlet fever St. Anthony fire Puerperal sepsis Imoetigo Acute glomerulonephritis Rheumatic Heart Disease

Droplet Complication: Rheumatic Heart Disease

Sudden onset High grade fever with chills Enlarged and tender cervical lymph nodes Inflamed tonsils with mucopurulent exudates Headache Dysphagia

Diagnosis: Throat swab and culture Treatment: erythromycin Care: Bed rest Oral hygiene with oral antiseptic or with saline gargle (1 glass of warm water + 1 tsp rock salt) Ice collar

Avoid mode of transmission

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

Meningitis Other name: Cerebrospinal fever

Meningococcus Neisseria meningitides

Direct (Droplet) Incubation Period: 2 - 10 days

A. Sudden Onset - high fever accompanied by chills - sore throat, headache, prostration (collapse) B. entrance into the bloodstream leading to septicemia (meningococcemia) a. rash, petchiae, purpura C. Symptoms of menigeal irritation - nuchal rigidity (stiff neck) earliest sign - Kernigs sign when knees are flexed, it cannot be extended - Brudzinski signs pain on neck flexion withautomatoc flexion of the knees - convulsion - poker soine (poker face / flat affect) - Increased ICP (Cushings triad: hypertension, bradycardia, bradypnea) and widening pulse pressure

Diagnostic Test: Lumbar puncture or Lumbar tap - reveals CSF WBC and protein, low glucose; contraindicated for increased ICP for danger of cranial herniation Hemoculture to rule out meningococcemia Treatment: Osmotic diuretic (Mannitol) to reduce ICP and relieve cerebral edema; Alert: fastdrip to prevent crystallization Anti-inflammatory (Dexamethasone) to relieve cerebral edema Antimicrobial (Penicillin) Anticonvulsany (Diazepam / Valium) Complications: Hydrocephalus Deafness (Refer the child for audiology testing) and mutism Blindness

Respiratory Isolation

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

VECTOR-BORNE DISEASES
Disease Malaria Causative Agent Plasmodium Parasites: Vivax Falciparum (most fatal; most common in the Philippines) Ovale Malariae Mode of Transmission Bite of infected anopheles mosquito Night time biting High-flying Rural areas Clear running water Pathognomonic Sign Cold Stage: severe, recurrent chills (30 minutes to 2 hours) Hot Stage: fever (4-6 hours) Wet Stage: Profuse sweating Episodes of chills, fevers, and profuse sweating are associated with rupture of the red blood cells. - intermittent chills and sweating - anemia / pallor - tea-colored urine - malaise - hepatomegaly - splenomegaly - abdominal pain and enlargement - easy fatigability Management and Treatment Early diagnosis identification of a patient with malaria as soon as he is seen through clinical and/or microscopic method Clinical method based on signs and symptoms of the patient and the history of his having visited a malaria-endemic area Microscopic method based on the examination of the blood smear of patient through microscope (done by the medical technologist) QBC/quantitative Buffy Coat fastest Malarial Smear best time to get the specimen is at height of fever because the microorganisms are very active and easily identified Chemoprophylaxis Only chloroquine should be given (taken at weekly intervals starting from 1-2 weeks before entering the endemic area). In pregnant women, it is given throughout the duration of pregnancy. Treatment: Blood Schizonticides - drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations 1. QUININE oldest drug used to treat malaria; from the bark of Cinchona tree; ALERT: Cinchonism quinine toxicity 2. CHLOROQUINE 3. PRIMAQUINE sometimes can also be given as chemoprophylaxis 4. FANSIDAR combination of pyrimethamine and sulfadoxine Prevention *CLEAN Technique *Insecticide treatment of mosquito net *House Spraying (night time fumigation) *On Stream Seeding construction of bio-ponds for fish propagation (2-4 fishes/m2 for immediate impact; 200-400/ha. for a delayed effect) *On Stream Clearing cutting of vegetation overhanging along stream banks *Avoid outdoor night activities (9pm 3am) *Wearing of clothing that covers arms and legs in the evening *Use mosquito repellents *Zooprophylaxis typing of domestic animals like the carabao, cow, etc near human dwellings to deviate mosquito bites from man to these animals Intensive IEC campaign NURSING CARE: 1. TSB (Hot Stage) 2. Keep patent warm (Cold Stage) 3. Change wet clothing (Wet Stage) 4. Encourage fluid intake 5. Avoid drafts

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

Filariasis Other names: Elephantiasis Endemic in 45 out of 78 provinces Highest prevalence rates: Regions 5, 8, 11 and CARAGA

Wuchereria bancrofti Brugia malayi Brugia timori nematode parasites

Bite of Aedes poecillus (primarily) Aedes flavivostris (secondary) Incubation period: 8 16 months

Asymptomatic Stage: Presence of microfilariae in the blood but no clinical signs and symptoms of disease Acute Stage: Lymphadenitis Lymphangitis Affectation of male Genitalia. Chronic Stage: (10-15 years from onset of first attack) Hydrocele Lymphedema Elephantiasis

Diagnosis Physical examination, history taking, observation of major and minor signs and symptoms Laboratory examinations Nocturnal Blood Examination (NBE) blood are taken from the patient at his residence or in hospital after 8:00 pm Immunochromatographic Test (ICT) rapid assessment method; an antigen test that can be done at daytime Treatment: Drug-of-Choice: Diethylcarbamazine Citrate (DEC) or Hetrazan

CLEAN Technique Use of mosquito repellents Anytime fumigation Wear a long sleeves, pants and socks

Shistosomiasis Other Names: Snail Fever Bilharziasis Endemic in 10 regions and 24 provinces High prevalence: Regions 5, 8, 11

Schistosoma mansoni S. haematobium S. japonicum (endemic in the Philippines)

Contact with the infected freshwater with cercaria and penetrates the skin Vector: Oncomelania Quadrasi

Diarrhea Bloody stools (on and off dysentery) Enlargement of abdomen Splenomegaly Hepatomegaly Anemia / pallor weakness

Diagnostic Test: COPT or cercum ova precipitin test (stool exam) Treatment: Drug-of-Choice: PRAZIQUANTEL (Biltracide) Oxamniquine for S. mansoni Metrifonate for S. haematobium *Death is often due to hepatic complication

Dispose the feces properly not reaching body of water Use molluscides Prevent exposure to contaminated water (e.g. use rubber boots) Apply 70% alcohol immediately to skin to kill surface cercariae Allow water to stand 48-72 hours before use 4 oclock habit Chemically treated mosquito net Larva eating fish Environmental sanitation Antimosquito soap Neem tree (eucalyptus)

Dengue Hemorrhagic Fever Other names: H-fever

Dengue virus 1, 2, 3, and 4 and Chikungunya virus Types 1 and 2 are common in the Philippines

Bite of infected mosquito (Aedes Aegypti) - characterized by black and white stripes Daytime biting Low flying Stagnant clear water Urban

Classification (WHO): Grade I: a. flu-like symptoms b. Hermans sign c. (+) tourniquet sign

Diagnostic Test: Torniquet test (Rumpel Leads Test / capillary fragility test) PRESUMPTIVE; positive when 20 or more oetechiae per 2.5 cm square or 1 inch square are observed Platelet count CONFIRMATORY; (Normal is 150 - 400 x 103 / mL)

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

Period of communicability: Unknown. Presumed to be on the 1st week of illness up to when the virus is still present in the blood Occurrence is sporadic throughout the year Epidemic usually occur during the rainy seasons (June to November) Peak months: September and October

Incubation Period: Uncertain. Probably 6 days to 1 week Manifestations: First 4 days: Febrile/Invasive Stage - starts abruptly as fever - abdominal pain - headache - vomiting - conjunctival infection -epistaxis 4th 7th days: Toxic/Hemorrhagic Stage - decrease in temperature - severe abdominal pain - GIT bleeding - unstable BP (narrowed pulse pressure) - shock - death may occur 7th 10th days: Recovery/Convalescent Stage - appetite regained - BP stable

Grade II: a. manifestations of Grade I plus spontaneous bleeding b. e.g. petechiae, ecchymosis purpura, gum bleeding, hematemesis, melena Grade III: a. manifestations of Grade II plus beginning of circulatory failure b. hypotension, tachycardia, tachypnea Grade IV: a. manifestations of Grade III plus shock (Dengue Shock Syndome)

Treatment: Supportive and symptomatic Paracetamol for fever Analgesic for pain Rapid replacement of body fluids most important treatment ORESOL Blood tansfusion Diet: low-fat, low-fiber, non-irritating, noncarbonated. Noodle soup may be given. ADCF (Avoid Dark-Colored Foods) ALERT! No Aspirin

Eliminate vector Avoid too many hanging clothes inside the house Residual spraying with insecticide Daytime fumigation Use of mosquito repellants Wear long sleeves, pants, and socks For the control of H-fever, knowledge of the natural history of the disease is important. Environmental control is the most appropriate primary prevention approach and control of Hfever.

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

DISEASES TRANSMITTED BY ANIMALS

Disease Leptospirosis Other Names: - Weils Disease - Mud Fever - Trench Fever - Flood Fever - Spirochetal Jaundice - Japanese Seven Days fever Causative Agent Leptospira interrogans bacterial spirochete RAT is the main host. Although pig, cattle, rabbits, hare, skunk, and other wild animals can also serve as reservoir Occupational disease affecting veterinarians, miners, farmers, sewer workers, abattoir workers, etc Mode of Transmission Through contact of the skin, especially open wounds with water, moist soil or vegetation infected with urine of the infected host Incubation Period: 7-19 days, average of 10 days Pathognomonic Sign Leptospiremic Phase - leptospires are present in blood and CSF - onset of symptoms is abrupt - fever - headache - myalgia - nausea - vomiting - cough - chest pain Immune Phase - correlates with the appearance of circulating IgM Bite or scratch (very rare) of rabid animal Non-bite means: leaking, scratch, organ transplant (cornea), inhalation/airborne (bats) Source of infection: saliva of infected animal or human Incubation period: 2 8 weeks, can be years depending on severity of wounds, site of wound as distance from brain, amount of virus introduced, and protection provided by clothing Sense of apprehension Headache Fever Sensory change near site of animal bite Spasms of muscles of deglutition on attempts to swallow Fear of water/hydrophobia Paralysis Delirium Convulsions FATAL once signs and symptoms appear Diagnosis: history of bite of animal culture of brain of rabid animal demonstration of negri bodies Management: *Wash wound with soap immediately. Antiseptics e.g. povidone iodine or alcohol may be applied *Antibiotics and anti-tetanus immunization *Post exposure treatment: local wound treatment, active immunization (vaccination) and passive immunization (administration of rabies immunoglobulin) *Consult a veterinarian or trained personnel to observe the pet for 14 days *Without medical intervention, the rabies victim would usually last only for 2 to 6 days. Death is often due to respiratory paralysis. Management and Treatment Diagnosis Clinical manifestations Culture of organism Examination of blood and CSF during the first week of illness and urine after the 10th day Leptospira agglutination test Treatment: Penicillins and other related B-lactam antibiotics Tetracycline (Doxycycline) Erythromycin Most common complication: kidney failure Prevention Protective clothing, boots and gloves Eradication of rats Segregation of domestic animals Awareness and early diagnosis Improved education of people Avoid wading or swimming in water contaminated with urine of infected animals. Concurrent disinfection of articles soiled with urine.

Rabies Other Names: Lyssa Hydrophobia Le Rage

Rhabdovirus of the genus lyssavirus Degeneration and necrosis of brain formation of negri bodies Two kinds of Rabies: a. Urban or canine transmitted by dogs b. Sylvatic disease of wild animals and bats which sometimes spread to dogs, cats, and livestock

Have pet immunized at 3 months of age and every year thereafter Never allow pets to roam the streets Take care of your pet

National Rabies Prevention and Control Program Goal: Human rabies is liminated in the Philippines and the country is declared rabiesfree

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

DISEASES OF THE SKIN

Disease Leprosy Other names: Hansenosis Hansens disease -an ancient disease and is a leading cause of permanent physical disability among the communicable diseases

Causative Agent Mycobacterium leprae

Mode of Transmission Airborne-droplet Prolonged skin-toskin contact

Pathognomonic Sign Early signs: Change in skin color either reddish or white Loss of sensation on the skin lesion Loss of sweating and hair growth Thickened and painful nerves Muscle weakness or paralysis or extremities Pin and redness of the eyes Nasal obstruction or bleeding Ulcers that do not heal Late Signs: Madarosis Loss of eyebrows Inability to close eyelids (lagophthalmos) Clawing of fingers and toes Contractures Chronic ulcers Sinking of the nosebridge Enlargement of the breast (gynecomastia)

Management and Treatment Diagnostic Test: Slit Skin Smear - determines the presence of M. leprae; optional and done only if clinical diagnosis is doubtful to prevent misclassification and wrong treatment Lepromin Test determines susceptibility to leprosy Treatment: Ambulatory chemotherapy through use of MDT Domiciliary treatment as embodied in RA 4073 which advocates home treatment PAUCIBACILLARY (tuberculoid and indeterminate); noninfectious type Duration of treatment: 6 to 9 months Procedure: Supervised: Rifampicin and Dapsone once a month on the health center supervised by the rural health midwife Self-administered: Dapsone (side effect: itchiness of the skin) everyday at the clients house MULTIBACILLARY (lepromatous and borderline); infectious type Duration of treatment: 24-30 months Procedure: Supervised: Rifampicin, Dapsone, and Lamprene Clofazimine; side effect: dryness or flaking of the skin) once a month on the health center supervised by the rural health midwife Self-administered: Dapsone and Lamprene everyday at the clients house

Prevention Avoid prolonged skin-to skin contact BCG vaccination practical and effective preventive measure against leprosy Good personal hygiene Adequate nutrition Health education Major activity of leprosy control program: casefinding and treatment with effective drugs Prevent deformities by self-care, exercise, and physical therapy.

MDT Facts: It reduces communicability period of leprosy in 4-6 weeks time. It prevents development of resistance to drugs. It shortens the duration of treatment.

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

Anthrax Other names: Malignant pustule Malignant edema Woolsorter disease Ragpicker disease Charbon

Bacillus anthracis Incubation period: few hours to 7 days most cases occur within 48 hours of exposure

Contact with a. tissues of animals (cattle, sheep, goats, horses, pigs, etc.) dying of the disease b. biting flies that had partially fed on such animals c. contaminated hair, wool, hides or products made from them e.g. drums and brushes d. soil associated with infected animals or contaminated bone meal used in gardening

Cutaneous form most common - itchiness on exposed part - papule on inoculation site - papule to vesicle to eschar - painless lesion Pulmonary form contracted from inhalation of B. anthracis spores - at onset, resembles common URTI - after 3-5 days, symptoms become acute, with fever, shock, and death Gastrointestinal anthrax contracted from ingestion of meat from infected animal - violent gastroenteritis - vomiting - bloody stools Itching When secondarily infected: Skin feels hot and burning When large and severe: fever, headache, and malaise

Treatment: Penicillin

Proper handwahing Immunize with cell-free vaccine prepared from culture filtrate containing the protection antigen Control dust and proper ventilation

3. Scabies

Sarcoptes scabiei - An itch mite parasite

Direct contact with infected individuals Incubation Period: 24 hours

Diagnosis: Appearance of the lesion Intense itching Finding of causative mite Treatment: (limited entirely to the skin) Examine the whole family before undertaking treatment Benzyl benzoate emulsion (Burroughs, Welcome) cleaner to use and has more rapid effect Kwell ointment

Personal hygiene Avoid playing with dogs Laundry all clothes and iron Maintain the house clean Environmental sanitation Eat the right kind of food Regular changing of clean clothing, beddings and towels

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

SEXUALLY TRANSMITTED DISEASES

Disease Syphilis Other names: Sy Bad Blood The pox Lues venereal Morbus gallicus

Causative Agent Treponema pallidum (a spirochete) Incubation Period: 10 to 90 days (3 months); average of 21 days

Mode of Transmission Direct contact Transplacental (after 16th week AOG) Through blood transfusion Indirect contact with Contaminated articles

Pathognomonic Sign Primary stage (4-6 weeks): painless chancre at site of entry of germ with serous exudates Tertiary stage (one to 35 years) : Gumma, syphilitic endocarditis and meningitis Primary and secondary sores will go even without treatment but the germs continue to spread throughout the body. Latent syphilis may continue 5 to 20+ years with NO symptoms, but the person is NO longer infectious to other people. A pregnant mother can transmit the disease to her unborn child (congenital syphilis). Thick purulent yellowish discharge Burning sensation upon urination / dysuria

Management and Treatment Diagnostic test: Dark field illumination test Fluorescent treponemal antibody absorption test, most reliable and sensitive diagnostic test for Syphilis; serologic test for syphilis which involves antibody detection by microscopic flocculation of the antigen suspension VDRL slide test, CSF analysis, Kalm test, Wasseman test Treatment: Drug of Choice: Penicillin (Tetracycline if resistant to Penicillin)

Prevention Abstinence Be faithful Condom

Gonorrhea Other names: GC, Clap, Drip, Stain, Gleet, Flores Blancas

Neiserria gonorrheae

Direct contact genitals, anus, mouth Incubation Period: 2 10 days

Diagnostic test: Culture of urethral and cervical smear Gram staining Treatment: Drug of Choice: Penicillin

Abstinence, Be faithful Condom Prevention of gonococcal ophthalmia is done through the prophylactic use of ophthalmic preparations with erythromycin or tetracycline

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

Trichomoniasis Other names: Vaginitis Trich

Trichomonas vaginalis

Direct contact Incubation Period: 4 20 days; average of 7 days

Females: white or greenishyellow odorous discharge vaginal itching and soreness painful urination Males: Slight itching of penis Painful urination Clear discharge from penis

Diagnostic Test: Culture Treatment: Drug of Choice: Metronidazole (Flagyl)

Abstinence Be faithful Condom Personal Hygiene

Chlamydia

Chlamydia trachomatis (a rickettsia)

Direct contact Incubation Period: 2 to 3 weeks for males; usually no symptoms for females

Females: Asymptomatic Dyspareunia Fishy vaginal discharge Males: Burning sensation during urination Burning and itching of urethral opening (urethritis) White, cheese-like vaginal discharges Curd like secretions

Diagnostic Test: Culture Treatment: Drug of Choice: Tetracycline

Abstinence Be faithful Condom

Candidiasis Other names: Moniliasis Candidosis

Candida albicans

Direct contact

Diagnostic Test: Culture Gram staining Treatment: Nystatin for oral thrush Cotrimazole, fluconazole for mucous membrane and vaginal infection Fluconazole or amphotericin for systemic infection

Abstinence Be faithful Condom

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

Acquired immune deficiency syndrome (AIDS)

Retrovirus (Human T-cell lymphotrophic virus 3 or HTLV 3) Attacks the T4 cells: Thelper cells; Tlymphocytes, and CD4 lymphocytes The major route of HIV transmission to adolescent is SEXUAL TRANSMISSION. French kissing brings low risk of HIV transmission.

Blood and body fluids Transplacental Incubation period: 3-6 months to 8-10 years Variable. Although the time from infection to the development of detectable antibodies is generally 1-3 months, the time from HIV infection to diagnosis of AIDS has an observed range of less than 1 year to 15 years or longer. (PHN Book)

Window Phase a. initial infection b. lasts 4 weeks to 6 months c. not observed by present laboratory test (test should be repeated after 6 months) Acute Primary HIV Infection a. short, symptomatic period b. flu-like symptoms c. ideal time to undergo screening test (ELISA) Asymptomatic HIV Infection a. with antibodies against HIV but not protective b. lasts for 1-20 years depending upon factors ARC (AIDS Related Complex) a. a group of symptoms indicating the disease is likely to progress to AIDS b. fever of unknown origin c. night sweats d. chronic intermittent diarrhea e. lymphadenopathy f. 10% body weight loss

Enzyme-Linked Immuno-Sorbent Assay (ELISA) - presumptive test Western Blot confirmatory Treatment: 1. Treatment of opportunistic infection 2. Nutritional rehabilitation 3. AZT (Zidovudine) retards the replication of retrovirus; must be taken exactly as ordered 4. PK 1614 mutagen Major signs of Pediatric AIDS: Chronic diarrhea > 1 month Prolonged fever > 1 month Weight loss or abnormally slow growth Breastmilk is important in preventing intercurrent infection in HIV infected infants and children. The care of HIV patients is similar to the routine care given to cases of other diseases. Not everybody is in danger of becoming infected with HIV through sex. Never give live attenuated (weakened) vaccines e.g. oral polio vaccine. HIV positive pregnant women and their partner must be informed of the potential risk to the fetus.

Abstinence Be faithful Condom Sterilize needles, syringes, and instruments used for cutting operations Proper screening of blood donors Rigid examination of blood and other blood products Avoid oral, anal contact and swallowing of semen Avoid promiscuous sexual contact Avoid sharing of toothbrushes. HIV/AIDS Prevention and Control Program: Goal: Contain the transmission of HIV /AIDS and other reproductive tract infections and mitigate their impact LECTURE DISCUSSION best method to use in teaching about safe sex Priority intervention when caring for AIDS patient: Use disposable gloves when in contact with non intact skin.

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

AIDS a. manifestation of severe immunosuppression b. CD4 Count: <200/dL c. presence of variety of infections at one time: oral candidiasis leukoplakia AIDS dementia complex Acute encephalopathy Diarrhea, hepatitis Anorectal disease Cytomegalovirus Pneumonocystis carinii pneumonia (fungal) TB Kaposis sarcoma (skin cancer; bilateral purplish patches) Herpes simplex Pseudomonas infection Blindness Deafness

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

DISEASES OF THE NEW MILLENIUM

Disease Meningococcemia Causative Agent Neisseria meningitides Mode of Transmission Direct contact with respiratory droplet from nose and throat of infected individuals Incubation Period: 2 10 days Pathognomonic Sign High grade fever in the first 24 hours Hemorrhagic rash petechiae nuchal rigidity Kernigs sign Brudzinski sign Shock Death Prodromal Phase: Fever (>38 0C) Chills Malaise Myalgia Headache Infectivity is none to low Respiratory Phase: Within 2-7 days, dry nonproductive cough progressing to respiratory distress Management and Treatment Respiratory isolation within 24 hours Drug-of-Choice: Penicillin Prevention Universal precaution Chemoprophylaxis with Rifampicin to protect exposed individual from developing the infection Proper hand washing

Severe Acute Respiratory Syndrome / SARS Earliest case: Guangdong Province, China in November 2002 Global outbreak: March 12, 2003 First case in the Philippines: April 11, 2003 Bird Flu Other Name: Avian Flu

Coronavirus

Close contact with respiratory droplet secretion from patient Incubation Period: 2 10 days

No specific treatment PREVENTIVE MEASURES and CONTROL 1. Establishment of triage 2. Identification of patient 3. Isolation of suspected probable case 4. Tracing and monitoring of close contact 5. Barrier nursing technique for suspected and probable case

Utilize personal protective equipment (N95 mask) Handwashing Universal Precaution The patient wears mask Isolation

Influenza Virus H5N1

Contact with infected birds Incubation Period: 3 days, ranges from 2 4 days

Fever Body weakness and body malaise Cough Sore throat Dyspnea Sore eyes

Control in birds: 1. Rapid destruction (culling or stamping out of all infected or exposed birds) proper disposal of carcasses and quarantining and rigorous disinfection of farms 2. Restriction of movement of live poultry In humans: 1. Influenza vaccination 2. Avoid contact with poultry animals or migratory birds

Isolation technique Vaccination Proper cooking of poultry

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

Influenza A (H1N1) Other Name: Swine Flu May 21, 2009 first confirmed case in the Philippines June 11, 2009 The WHO raises its Pandemic Alert Level to Phase 6, citing significant transmission of the virus.

Influenza Virus A H1N1 This new virus was first detected in people in April 2009 in the United States. Influenza A (H1N1) is fatal to humans

Exposure to droplets from the cough and sneeze of the infected person Influenza A (H1N1) is not transmitted by eating thoroughly cooked pork. The virus is killed by cooking temperatures of 160 F/70 C. Incubation Period: 7 to 10 days

- similar to the symptoms of regular flu such as Fever Headache Fatigue Lack of appetite Runny nose Sore throat Cough - Vomiting or nausea - Diarrhea

Diagnostic: Nasopharyngeal (throat) swab Immunofluorescent antibody testing to distinguish influenza A and B Treatment: Antiviral medications may reduce the severity and duration of symptoms in some cases: Oseltamivir (Tamiflu) or zanamivir

Cover your nose and mouth when coughing and sneezing Always wash hands with soap and water Use alcohol- based hand sanitizers Avoid close contact with sick people Increase your body's resistance Have at least 8 hours of sleep Be physically active Manage your stress Drink plenty of fluids Eat nutritious food