5 Communicable Disease Nursing

I. EPI DISEASES
DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Tuberculosis
Other names:
Koch s Disease
Consumption
Phthisis
Weak lungs
Mycobacterium
tuberculosis
TB bacillus
Koch s bacillus
Mycobacterium bovis
(rod-shaped)
Airborne-droplet
Direct invasion
through mucous
membranes and
breaks in the skin
(very rare)
Incubation period :
4 6 weeks
1.
Usually asymptomatic
2. Low-grade afternoon
fever
3. Night sweating
4. Loss of appetite
5. Weight loss
6. Easy fatigability due
to increased oxygen
demand
7. Temporary amenorrhea
8. Productive dry cough
9. Hemoptysis
Diagnostic test:
· Sputum examination or the Acid-fast bacilli
(AFB) / sputum microscopy
1. Confirmatory test
2. Early morning sputum about 3-5 cc
3. Maintain NPO before collecting sputum
4. Give oral care after the procedure
5. Label and immediately send to laboratory
6.
If the time of the collection of the sputum is
unknown, discard
· Chest X-ray is used to:
1. Determine the clinical activity of TB, whether
it is inactive (in control) or active (ongoing)
2. To determine the size of the lesion:
a. Minimal very small
b. Moderately advance lesion is < 4 cm
c. Far advance lesion is > 4 cm
· Tuberculin Test purpose is to determine the
history of exposure to tuberculosis
Other names:
Mantoux Test used for single screening, result
interpreted after 72 hours
Tine test used for mass screening read after 48
hours
Interpretation:
0 -4 mm induration not significant
5 mm or more significant in individuals who
are considered at risk; positive for patients who
are HIV-positive or have HIV risk factors and are
of unknown HIV status, those who are close
contacts with an active case, and those who have
chest x-ray results consistent with tuberculosis.
10 mm or greater significant in individuals
who have normal or mildly impaired immunity
· Respiratory precautions
· Cover the mouth and
nose when sneezing to
avoid mode of
transmission
· Give BCG
BCG is ideally given at
birth, then at school
entrance. If given at 12
months, perform
tuberculin testing
(PPD), give BCG if
negative.
· Improve social
conditions
Most hazardous periodisease is the first 6-1Highest risk of develo3years old
d for development of clinical
2 months after infection
ping disease is children under
TREATMENT: SCRifampicin (R), IsoC/Short Course Chemotherapniazid (H), Pyrazinami
de (Z),
y, Direct observed treaEthambutol (E), Strepttment short course/DOTS;
omycin (S)
CATEGORY 1: 6
months SCC
Indications:
> new (+) smear
> (-) smear PTB witextensive
parenchymal lesions
on CXR
> Extrapulmonary T> severe concominaHIV disease
Intensive Phase: 2
months
R&I : 1 tab each; P2 tabs each
Continuation Phas4 months
R&I : 1 tab each
h
B
nt
&E
e:
CATEGORY 2: 8
months SCC
Indications:
> treatment failure
> relapse
> return after default
Intensive Phase:3 mos
R&I 1 tab each; P&E 2
tabs each
Streptomycin 1
vial/day IM for first 2
months = 56 vials (if
given for > 2mos can
cause nephrotoxicity
Continuation Phase: 5
months
R&I : 1 tab each
E : 2 tabs
CATEGORY 3: 6
months SCC
Indications:
> new (-) smear PTB
with minimal lesions
on CXR
Same meds with
Category 1
Intensive Phase: 2
months
R&I 1 tab each; P&E
2 tabs each
Continuation Phase:
4 months
R&I 1 tab each
CATEGORY 4:
Chronic (*Referral
needed)
SIDE EFFECTS:
Rifampicin
· body fluid
discoloration
· hepatotoxic
· permanent
discoloration of
contact lenses
Isoniazid
· Peripheral
neuropathy
(Give Vit
B6/Pyridoxine)
Pyrazinamide
· hyperuricemia
/gouty arthritis
(increase fluid
intake)
SIDE EFFECTS:
Ethambutol
· Optic neuritis
· Blurring of vision
(Not to be givento
children below 6 y.o. due
to inability to complain
blurring of vision)
· Inability to recognize
green from blue
Streptomycin
· Damage to 8th CN
· Ototoxic
· Tinnitus
· nephrotoxic
6 Communicable Disease Nursing

NATIONAL TB 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 LGUs and others
Goal: To reduce prevalence and mortality from TB by half by the year 2015
(Millennium Development Goal)
Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered
2. Detect at least 70% new sputum smear (+) TB cases
Objectives: 1. Improve access to and quality of services
2. Enhance stakeholder s health-seeking behavior
3. Increase and sustain support for TB control activities
4. Strengthen management of TB control activities at all levels
KEY POLICIES:
*Case finding:
-DSSM shall be the primary diagnostic tool in NTP case finding
- No TB Dx shall be made based on CXR results alone
- All TB symptomatic shall be asked to undergo DSSM before treatment
- Only contraindication for sputum collection is hemoptysis
- PTB symptomatic shall be asked to undergo other tests (CXR and culture),
only after three sputum specimens yield negative results in DSSM
- Only trained med techs / microscopists shall perform DSSM
- Passive case finding shall be implemented in all health stations
*Treatment: Domiciliary treatment preferred mode of care
DSSM basis for treatment of all TB cases
*Hospitalization is recommended: massive hemoptysis, pleural effusion,
military TB, TB meningitis, TB pneumonia, & surgery is needed or with
complications
*All patients undergoing treatment shall be supervised
*National & LGUs shall ensure provision of drugs to all smear (+) TB cases
*Quality of fixed-dose combination (FDC) must be ensured
*Treatment shall be based on recommended category of treatment regimen
DOTS Strategy internationally-recommended TB control strategy
Five Elements of DOTS: (RUSAS)
Recording & reporting system enabling outcome assessment of all patients
Uninterrupted supply of quality-assured drugs
Standardized SCC for all TB cases
Access to quality-assured sputum microscopy
Sustained political commitment
MANAGEMENT OF CHILDREN WITH TUBERCULOSIS
Prevention: BCG immunization to all infants (EPI)
Casefinding:
- cases of TB in children are reported and identified in 2
instances: (a) patient was screened and was found symptomatic
of TB after consultaion (b) patient was reported to have been
exposed to an adult TB patient
-ALL TB symptomatic children 0-9 y.o, EXCEPT sputum
positive child shall be subjected to Tuberculin testing (Note:
Only a trained PHN or main health center midwife shall do
tuberculin testing and reading which shall be conducted once a
week either on a Monday or Tuesday. Ten children shall be
gathered for testing to avoid wastage.
-Criteria to be TB symptomatic (any three of the following:)
* cough/wheezing of 2 weeks or more
* unexplained fever of 2 weeks or more
* loss of appetite/loss of weight/failure to gain weight/weight
faltering
* failure to respond to 2 weeks of appropriate antibiotic therapy
for lower respiratory tract infection
* failure to regain previous state of health 2 weeks after a viral
infection or exanthem (e.g. measles)
-Conditions confirming TB diagnosis (any 3 of the following:)
* (+) history of exposure to an adult/adolescent TB case
* (+) signs and symptoms suggestive of TB
* (+) tuberculin test
* abnormal CXR suggestive of TB
* Lab findings suggestive or indicative of TB
- for children with exposure to TB
* a child w/ exposure to a TB registered adult patient shall
undergo physical exam and tuberculin testing
* a child with productive cough shall be referred for sputum
exam, for (+) sputum smear child, start treatment immediately
* TB asymptomatic but (+) tuberculin test and TB symptomatic
but (-) tuberculin test shall be referred for CXR examination
-for TB symptomatic children
*a TB symptomatic child with either known or
unknown exposure to a TB case shall be referred
for tuberculin testing
* (+) contact but (-) tuberculin test and unknown
contact but (+) tuberculin test shall be referred for
CXR examination
*(-) CXR, repeat tuberculin test after 3 months
* INH chemoprophylaxis for three months shall be
given to children less than 5y.o. with (-) CXR; after
which tuberculin test shall be repeated
Treatment (Child with TB):
Short course regimen
PULMONARY TB
Intensive: 3 anti-TB drugs (R.I.P.) for 2 months
Continuation: 2 anti-TB drugs (R&I) for 4 months
EXTRA-PULMONARY TB
Intensive: 4 anti-TB drugs (RIP&E/S) for 2 months
Continuation: 2 anti-TB drugs (R&I) for 10 months
PERIOD OF COMMUNICABILITY OF
TUBERCULOSIS:
.as long as bacillus is contained in the
sputum
.Primary complex in children is NOT
contagious
.Good compliance to regimen renders
person not contagious 2-4 weeks after
initiation of treatment
7 Communicable Disease Nursing

2. Diphtheria
Types:
> nasal
> pharyngeal
most common
> laryngeal
most fatal due to
proximity to
epiglottis
Corynebacterium
diphtheria
Klebbs-loffler
***Diphtheria
transmission is increased
in hospitals, households,
schools, and other
crowded areas.
Droplet especially
secretions from
mucous membranes
of the nose and
nasopharynx and
from skin and other
lesions
Milk has served as a
vehicle
Incubation Period:
2 5 days
Pseudomembrane
mycelia of the oral mucosa
causing formation of white
membrane on the
oropharynx
Bull neck
Dysphagia
Dyspnea
Diagnostic test:
· Nose/throat swab
· Moloney s test a test for hypersensitivity to
diphtheria toxin
· Schick s test determines susceptibility to
bacteria
Drug-of-Choice:
Erythromycin 20,000 -100,000 units IM once only
Complication: MYOCARDITIS (Encourage bed
rest)
Plan nursing care to improve respiration.
DPT immunization
Pasteurization of milk
Education of parents
***Infants born to immune
mothers maybe protected
up to 6-9 months. Recovery
from clinical attack is
always followed by a
lasting immunity to the
disease.
3. Pertussis
Whooping cough
Tusperina
No day cough
Bordetella pertussis
Hemophilus pertussis
Bordet-gengou bacillus
Pertussis bacillus
Droplet especially
from laryngeal and
bronchial secretions
Incubation Period:
7 10 days but not
exceeding 21 days
Catarrhal period: 7 days
paroxysmal cough
followed by continuous
nonstop accompanied by
vomiting
Complication: abdominal
hernia
Diagnostic:
· Bordet-gengou agar test
Management:
1.
DOC: Erythromycin or Penicillin 20,000 100,000
units
2. Complete bed rest
3. Avoid pollutants
4. Abdominal binder to prevent abdominal hernia
DPT immunization
Booster: 2 years and 4-5
years
Patient should be
segregated until after 3
weeks from the appearance
of paroxysmal cough
Incidence: highest unMortality: highest amOne attack confers dimmunity. Second a
tder 7 years of age
ong infants (<6 months)
efinite and prolonged
tack occasionally occurs
4. Tetanus Clostridium tetani Indirect contact Risus sardonicus (Latin: No speci
fic test, only a history of punctured wound .DPT immunization
anaerobic spore-forming inanimate objects, devil smile ) facial .Tetanus toxoid (ar
tificial
Other names: heat-resistant and lives in soil, street dust, spasm; sardonic grin
Treatment: active) immunization
Lock jaw soil or intestine animal and human Antitoxin among pregnant women
feces, punctured Opisthotonus arching of antitetanus serum (ATS) .Training and L
icensing
wound back tetanus immunoglobulin (TIG) (if the patient has of midwives/ hilots
Neonate: umbilical cord
Children: dental caries
Adult: punctured wound;
after septic abortion Incubation Period:
Varies from 3 days
to 1 month, falling
between 7 14 days
For newborn:
1. Difficulty of sucking
2. Excessive crying
3. Stiffness of jaw
4. Body malaise
allergy, should be administered in fractional doses)
Pen G
Diazepam for muscle spasms
Note: The nurse can give fluid provided that the
patient is able to swallow. There is risk of aspiration.
Check first for the gag reflex
.Health education of
mothers
.Puncture wounds are best
cleaned by thorough
washing with soap and
water.
8 Communicable Disease Nursing

5. Poliomyelitis Legio debilitans

Polio virus
Fecal oral route Paralysis
Muscular weakness
Diagnostic test: OPV vaccination
Frequent hand washing
Other name: Enterovirus Incubation period: Uncoordinated body · CSF analysis / lum
bar tap
Infantile paralysis
Attacks the anterior horn
of the neuron, motor is
affected
Man is the only reservoir
7 21 days movement
Hoyne s sign head lag
after 4 months
(!Safety)
· Pandy s test
Management:
Rehabilitation involves ROM exercises
6. Measles RNA containing
paramyxovirus
Droplet secretions
from nose and throat
1. Koplik s spots
whitish/bluish pinpoint
No specific diagnostic test Measles vaccine
Disinfection of soiled
Other names: patches on the buccal Management: articles
Morbilli Incubation period: cavity Supportive and symptomatic Isolation of cased
from
Rubeola Period of
Communicability:
4 days before and 5 days
after the appearance of
rash
10 days fever
14 days rashes
appear
(8-13 days)
2. cephalocaudal
appearance of
maculopapular rashes
3. Stimson s line
bilateral red line on the
lower conjunctiva
diagnosis until about 5-7
days after onset of rash
7. Hepatitis B Hepatitis B virus Blood and body
fluids
1.
Right-sided Abdominal
pain
Diagnostic test: -Hepatitis B immunization
-Wear protected clothing
Other names: Placenta 2. Jaundice · Hepatitis B surface agglutination (HBSAg) test
 -Hand washing
Serum Hepatitis
Incubation period:
45 100 days
3. Yellow-colored sclera
4. Anorexia
5. Nausea and vomiting6.
Joint and Muscle pain
7. Steatorrhea
8. Dark-colored urine
9. Low grade fever
Management:
> Hepatitis B Immunoglobulin
Diet: high in carbohydrates
-Observe safe-sex
-Sterilize instruments used
in minor surgical-dental
procedures
-Screening of blood
products for transfusion
Hepatitis A infectious hepatitis; oral-fecal
Hepatitis B serum hepatitis; blood and body fluids
Hepatitis C non-A non-B, post-transfusion hepatitis; blood and body fluids
Hepatitis D Delta hepatitis or dormant hepatitis; blood and body fluids; needs p
ast history of infection to Hepatitis B
Hepatitis E oral-fecal
9 Communicable Disease Nursing
II. DISEASES TRANSMITTED THROUGH FOOD AND WATER
DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Cholera Vibrio cholera
Vibrio coma
Fecal-oral route Rice watery stool Diagnostic Test:
Stool culture
Proper handwashing
Proper food and water
Other names: Ogawa and Inaba bacteria 5 Fs Period of Treatment: sanitation
El tor
Incubation Period:
Few hours to 5 days;
usually 3 days
Communicability:
7-14 days after onset,
occasionally 2-3 months
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.
Immunization of Chole-vac
2. Amoebic Entamoeba histolytica Fecal-oral route · Abdominal cramping Treatment:
Proper handwashing
Dysentery
Protozoan (slipper-shaped
body)
· Bloody mucoid stool
· Tenesmus -feeling of
incomplete defecation
(Wikipedia)
Metronidazole (Flagyl)
* Avoid alcohol because of its Antabuse effect can
cause vomiting
Proper food and water
sanitation
3. 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
· Abdominal cramping
· Bloody mucoid stool
· Tenesmus -feeling of
incomplete defecation
(Wikipedia)
Drug-of-Choice: Co-trimoxazole
Diet: Low fiber, plenty of fluids, easily digestible
foods
Proper handwashing
Proper food and water
sanitation
Fly control
4. Typhoid fever Salmonella typhosa
(plural, typhi)
Fecal-oral route
5 Fs
Incubation Period:
Usual range 1 to 3
weeks, average 2
weeks
· Rose Spots in the
abdomen due to
bleeding caused by
perforation of the
Peyer s patches
· Ladderlike fever
Diagnostic Test:
Typhi dot confirmatory test; specimen is feces
Widal s test agglutination of the patient s serum
Drug-of-Choice: Chloramphenicol
Proper handwashing
Proper food and water
sanitation
5. Hepatitis A Hepatitis A Virus Fecal-oral route · Fever
· Anorexia (early sign)
Prophylaxis: IM injection of gamma globulin
Hepatitis A vaccine
Proper handwashing
Proper food and water
Other names: 5 Fs · Headache Hepatitis immunoglobulin sanitation
Infectious · Jaundice (late sign) Avoid alcohol Proper disposal of urine
10 Communicable Disease Nursing

Hepatitis / Incubation Period: · Clay-colored stool Complete bed rest to reduce th

e breakdown of fats and feces
Epidemic 15-50 days, · Lymphadenopathy for metabolic needs of liver Separate and p
roper
Hepatitis / depending on dose, Low-fat diet; increase carbohydrates (high in sug
ar) cleaning of articles used by
Catarrhal Jaundice average 20-30 days
In convalescent period, patient may have difficulty
with maintaining a sense of well-being.
patient
6. Paralytic Dinoflagellates Ingestion of raw of · Numbness of face Treatment: 1.
Avoid eating shellfish
Shellfish inadequately cooked especially around the 1. No definite treatment suc
h as tahong, talaba,
Poisoning (PSP I Phytoplankton seafood usually mouth 2. Induce vomiting halaan,
kabiya, abaniko
Red tide bivalve mollusks · Vomiting and dizziness 3. Drink pure coconut milk weak
ens the during red tide season
poisoning) during red tide · Headache toxic effect 2.
Don t mix vinegar to
season
Incubation Period:
30 minutes to
several hours after
ingestion
· Tingling
sensation/paresthesia and
eventful paralysis of
hands
· Floating sensation and
weakness
4. Sodium bicarbonate solution (25 grams in ½
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.
shellfish it will increase
toxic effect 15 times
greater
· Rapid pulse
· Dysphonia
· Dysphagia
· Total muscle paralysis
leading to respiratory
arrest and death
ROBERT C. REÑA, BSN
Death from diarrhea is usually due to dehydration.
Food recall is the basis for the diagnosis of food poisoning.
11 Communicable Disease Nursing
III. SEXUALLY TRANSMITTED DISEASES
DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Syphilis
Other names:
Sy
Bad Blood
The pox
Lues venereal
Morbus gallicus
Treponema pallidum
(a spirochete)
Incubation Period:
10 to 90 days (3 months);
average of 21 days
Direct contact
Transplacental (after
16th week AOG)
Through blood
transfusion
Indirect contact with
contaminated
articles
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
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)
Abstinence
Be faithful
Condom
Secondary syphilis (6-8
weeks: generalized rashes,
generalized tender discrete
lymphadenopathy, mucus
patches, flu-like symptoms,
condylomata, patchy alopecia
Latent stage (one to two to
50 years): non-infectious
Primary and secondary sores
to spread throughout the bodysymptoms, but the person is Nmother can transmit th
e diseasO longer infectious to ote to her unborn child (cowill go even without t
reat. Latent syphilis may conher people. A pregnant
ngenital syphilis).
ment but the germs continue
tinue 5 to 20+ years with NO
2. Gonorrhea Neiserria gonorrheae Direct contact
genitals, anus,
Thick purulent yellowish
discharge
Diagnostic test:
Culture of urethral and cervical smear
Abstinence, Be faithful
Condom
Other names: mouth Burning sensation upon Gram staining
GC, Clap, Drip, urination / dysuria Prevention of gonococcal
Stain, Gleet, Incubation Period: Treatment: ophthalmia is done through
Flores Blancas 2 10 days Drug of Choice: Penicillin the prophylactic use of
ophthalmic preparations
with erythromycin or
tetracycline
3. Trichomoniasis Trichomonas vaginalis Direct contact Females:
white or greenish-yellow
Diagnostic Test:
Culture
Abstinence
Be faithful
Other names: Incubation Period: odorous discharge Condom
Vaginitis 4 20 days; average vaginal itching and Treatment:
Trich of 7 days soreness
painful urination
Males:
Slight itching of penis
Painful urination
Clear discharge from penis
Drug of Choice: Metronidazole (Flagyl) Personal Hygiene
4. Chlamydia Chlamydia trachomatis
(a rickettsia)
Direct contact Females:
Asymptomatic
Diagnostic Test:
Culture
Abstinence
Be faithful
12 Communicable Disease Nursing

Incubation Period: Dyspareunia Condom

2 to 3 weeks for Fishy vaginal discharge Treatment:
males; usually no Drug of Choice: Tetracycline
symptoms for Males:
females Burning sensation during
urination
Burning and itching of
urethral opening
(urethritis)
5. Candidiasis Candida albicans Direct contact White, cheese-like vaginal
discharges
Diagnostic Test:
Culture
Abstinence
Be faithful
Other names: Curd like secretions Gram staining Condom
Moniliasis
Candidosis Treatment:
Nystatin for oral thrush
Cotrimazole, fluconazole for mucous membrane
and vaginal infection
Fluconazole or amphotericin for systemic infection
6. Acquired
immune
deficiency
syndrome (AIDS)
Retrovirus
(Human T-cell
lymphotrophic virus 3 or
HTLV 3)
Attacks the T4 cells: T-
helper cells; T-
lymphocytes, and CD4
lymphocytes
The major route of HIV
transmission to adolescent
is SEXUAL
TRANSMISSION.
French kissing brings low
risk of HIV transmission.
Direct contact
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
1. 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)
2. Acute Primary HIV
Infection
a. short, symptomatic
period
b. flu-like symptoms
c. ideal time to undergo
screening test (ELISA)
3. Asymptomatic HIV
Infection
a. with antibodies against
HIV but not protective
Diagnostic tests:
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.
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
13 Communicable Disease Nursing

15 years or longer.
(PHN Book)
b. lasts for 1-20 years
depending upon factors
4. 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
5. 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
Kaposi s sarcoma (skin
cancer; bilateral purplish
patches)
Herpes simplex
Pseudomonas infection
Blindness
Deafness
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.
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.
14 Communicable Disease Nursing
IV. ERUPTIVE DISEASES
DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Chickenpox Human (alpha) herpes
virus 3 (varicella-zoster
Droplet spread Vesiculo-pustular rashes No specific diagnostic exam
Treatment is supportive.
Case over 15 years of age
should be investigated to
Other names: virus), a member of the Direct contact Centrifugal appearance of el
iminate possibility of
Varicella Herpesvirus group
Period of
Communicability:
From as early as 1 to 2
days before the rashes
appear until the lesions
have crusted.
Indirect through articles
freshly soiled by
discharges of infected
persons
Incubation Period:
2-3 weeks, commonly
13 to 17 days
rashes rashes which
begin on the trunk and
spread peripherally and
more abundant on covered
body parts
Pruritus
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 REYE S SYNDROME.
Nursing Diagnoses:
Disturbance in body image
Impairment of skin integrity
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
2. German Rubella virus or RNA-Droplet Forscheimer spots red Diagnostic Test: MM
R vaccine (live
Measles containing Togavirus
(Pseudoparamyxovirus) Incubation Period:
pinpoint patches on the
oral cavity
Rubella Titer (Normal value is 1:10); below 1:10
indicates susceptibility to Rubella.
attenuated virus)
-Derived from chick
Other Names: Three (3) days embryo
Rubella German measles is Maculopapular rashes Instruct the mother to avoid preg
nancy for three Contraindication:
Three-day teratogenic infection, can Headache months after receiving MMR vaccine
. -Allergy to eggs
Measles cause congenital heart
disease and congenital
cataract.
Low-grade fever
Sore throat
Enlargement of posterior
cervical and postauricular
lymph nodes
MMR is given at 15 months of age and is given
intramuscularly.
-If necessary, given in
divided or fractionated
doses and epinephrine
should be at the bedside.
3. Herpes Zoster Herpes zoster virus
(dormant varicella zoster
Droplet
Direct contact from
Painful vesiculo-pustular
lesions on limited portion
Treatment is supportive and symptomatic Avoidance of mode of
transmission
Other names: virus) secretion of the body (trunk and Acyclovir to lessen the pai
n
Shingles shoulder)
Cold sores
Low-grade fever
4. Dengue Dengue virus 1, 2, 3, and Bite of infected Classification (WHO): Diagn
ostic Test: 4 o clock habit
Hemorrhagic 4 and Chikungunya virus mosquito (Aedes
Fever Aegypti) -characterized Grade I: Torniquet test (Rumpel Leads Test / capil
lary Chemically treated
Types 1 and 2 are by black and white a. flu-like symptoms fragility test) PRESUM
PTIVE; positive when 20 mosquito net
15 Communicable Disease Nursing

Other names:
H-fever
common in the
Philippines
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
stripes
Daytime biting
Low flying
Stagnant clear water
Urban
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
b. Herman s sign
c. (+) tourniquet sign
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)
or more oetechiae per 2.5 cm square or 1 inch
square are observed
Platelet count CONFIRMATORY; (Normal is
150 -400 x 103 / mL)
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
Larva eating fish
Environmental sanitation
Antimosquito soap
Neem tree (eucalyptus)
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 H-
fever.
7th 10th days:
Recovery/Convalescent
Stage
-appetite regained
-BP stable
16 Communicable Disease Nursing
V. VECTOR-BORNE DISEASES
DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Malaria Plasmodium Parasites:
Vivax
Falciparum (most fatal;
most common in the
Philippines)
Ovale
Malariae
-attacks the red blood
cells
Bite of infected
anopheles mosquito
Night time biting
High-flying
Rural areas
Clear running water
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
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
Early Diagnosis and Prompt 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
*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
17 Communicable Disease Nursing

2. 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
3. Shistosomiasis Schistosoma mansoni
S. haematobium
Contact with the
infected freshwater with
Diarrhea
Bloody stools (on and off
Diagnostic Test:
COPT or cercum ova precipitin test (stool exam)
Dispose the feces properly
not reaching body of water
Other Names: S. japonicum (endemic in cercaria and penetrates dysentery) Use mol
luscides
Snail Fever the Philippines) the skin Enlargement of abdomen Treatment: Prevent
exposure to
Bilharziasis
Vector: Oncomelania
Splenomegaly
Hepatomegaly
Drug-of-Choice: PRAZIQUANTEL (Biltracide) contaminated water (e.g.
use rubber boots)
Endemic in 10 Quadrasi Anemia / pallor Oxamniquine for S. mansoni Apply 70% alco
hol
regions and 24 weakness Metrifonate for S. haematobium immediately to skin to ki
ll
provinces
*Death is often due to hepatic complication
surface cercariae
Allow water to stand 48-72
High prevalence: hours before use
Regions 5, 8, 11
ROBERT C. REÑA, BSN
REFERENCES:
.
THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DI
SEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN
.
CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING
IN THE PHILIPPINES, 10th EDITION
.
DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph
.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov
18 Communicable Disease Nursing
VI. DISEASES TRANSMITTED BY ANIMALS
DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Leptospirosis Leptospira interrogans
bacterial spirochete
Through contact of the
skin, especially open
Leptospiremic Phase
-leptospires are present in
Diagnosis
Clinical manifestations
.Protective clothing,
boots and gloves
Other Names: wounds with water, blood and CSF Culture of organism .Eradication o
f rats
-Weil s Disease
-Mud Fever
RAT is the main host.
Although pig, cattle,
moist soil or vegetation
infected with urine of
-onset of symptoms is
abrupt
Examination of blood and CSF during the first
week of illness and urine after the 10th day
.Segregation of domestic
animals
-Trench Fever
-Flood Fever
-Spirochetal
Jaundice
-Japanese
Seven Days
fever
rabbits, hare, skunk, and
other wild animals can
also serve as reservoir
Occupational disease
affecting veterinarians,
miners, farmers, sewer
workers, abattoir workers,
etc
the infected host
Incubation Period:
7-19 days, average of
10 days
-fever
-headache
-myalgia
-nausea
-vomiting
-cough
-chest pain
Immune Phase
-correlates with the
appearance of circulating
IgM
Leptospira agglutination test
Treatment:
Penicillins and other related B-lactam antibiotics
Tetracycline (Doxycycline)
Erythromycin
Most common complication: kidney failure
.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.
2. Rabies Rhabdovirus of the genus Bite or scratch (very Sense of apprehension D
iagnosis: Have pet immunized at 3
lyssavirus rare) of rabid animal Headache history of bite of animal months of ag
e and every
Other Names: Fever culture of brain of rabid animal year thereafter
Lyssa Degeneration and necrosis Non-bite means: Sensory change near site demonst
ration of negri bodies
Hydrophobia of brain formation of leaking, scratch, organ of animal bite Never a
llow pets to roam
Le Rage negri bodies transplant (cornea), Spasms of muscles of Management: the s
treets
inhalation/airborne deglutition on attempts to *Wash wound with soap immediately
. Antiseptics
Two kinds of Rabies: (bats) swallow e.g. povidone iodine or alcohol may be appli
ed Take care of your pet
a. Urban or canine Source of infection: Fear of *Antibiotics and anti-tetanus im
munization
transmitted by dogs saliva of infected water/hydrophobia *Post exposure treatmen
t: local wound National Rabies
animal or human Paralysis treatment, active immunization (vaccination) and Preve
ntion and Control
b. Sylvatic disease of Delirium passive immunization (administration of rabies P
rogram
wild animals and bats Incubation period: Convulsions immunoglobulin) Goal: Human
rabies is
which sometimes spread 2 8 weeks, can be *Consult a veterinarian or trained pers
onnel to eliminated in the
to dogs, cats, and livestock years depending on FATAL once signs and observe the
pet for 14 days Philippines and the
severity of wounds, site symptoms appear country is declared rabies-
of wound as distance *Without medical intervention, the rabies victim free
from brain, amount of would usually last only for 2 to 6 days. Death is
19 Communicable Disease Nursing

virus introduced, and

protection provided by
clothing
often due to respiratory paralysis.
3. Bubonic
Plague
Bacteria (Yersinia pestis)
Vector: rat flea
Direct contact with the
infected tissues of
rodents
Fever and lyphadenitis Streptomycin, tetracycline, chloramphenicol Environmental
Sanitation
VII. DISEASES OF THE SKIN
DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
1. Leprosy Mycobacterium leprae Airborne-droplet Early signs:
Change in skin color either
Diagnostic Test:
Slit Skin Smear -determines the presence of M.
Avoid prolonged skin-toskin
contact
Other names: Prolonged skin-toreddish
or white leprae; optional and done only if clinical diagnosis
Hansenosis skin contact Loss of sensation on the skin is doubtful to prevent mis
classification and wrong BCG vaccination
Hansen s disease lesion
Loss of sweating and hair growth
treatment
Lepromin Test determines susceptibility to
practical and effective
preventive measure
-an ancient Thickened and painful nerves leprosy against leprosy
disease and is a Muscle weakness or paralysis or
leading cause of extremities Treatment: Good personal hygiene
permanent Pin and redness of the eyes Ambulatory chemotherapy through use of MDT
physical disability Nasal obstruction or bleeding Domiciliary treatment as embod
ied in RA 4073 Adequate nutrition
among the Ulcers that do not heal which advocates home treatment
communicable Health education
diseases
MDT Facts:
It reduces communicabilit4-6 weeks time.
It prevents development of
It shortens the duration of
y period of leprosy in
resistance to drugs.
treatment.
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)
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 client s house
MULTIBACILLARY (lepromatous and
borderline); infectious type
Duration of treatment: 24-30 months
Major activity of leprosy
control program:
casefinding and treatment
with effective drugs
Prevent deformities by
self-care, exercise, and
physical therapy.
Procedure:
Supervised: Rifampicin, Dapsone, and Lamprene
20 Communicable Disease Nursing

(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 client s house
2. 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
1. Cutaneous form most
common
-itchiness on exposed part
-papule on inoculation site
-papule to vesicle to eschar
-painless lesion
2. 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
3. Gastrointestinal anthrax
contracted from ingestion of
meat from infected animal
-violent gastroenteritis
-vomiting
-bloody stools
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
Itching
When secondarily infected:
Skin feels hot and burning
When large and severe: fever,
headache, and malaise
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
4. Pediculosis
Other name:
Phthipiasis
Pediculosis
Capitis (head lice)
Corporis (body lice)
Pubis (crab lice)
Direct contact
Common in school
age
Itchiness of the scalp Kwell shampoo
One tbsp water + one tbsp vinegar
Proper hygiene
21 Communicable Disease Nursing
ROBERT C. REÑA, BSN

VIII. INTESTINAL PARASITISM

DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Ascariasis
Other names:
Roundworm
Giant worms
Ascaris lumbricoides
(nematode)
Fecal-oral route
5 Fs: Finger, Foods,
Feces, Flies, Fomites
Pot-bellied
Voracious eater
Thin extremities
Diagnostic Test: Fecalysis
Treatment:
Antihelminthic: Mebendazole / Pyrantel Pamoate
Proper handwahing
2. Taeniasis
Other name:
Tape worm
Taenia solium pork
Taenia saginata beef
Dyphyllobotruim latum
fish
Eating inadequately
cooked pork or beef
5 Fs: Finger, Foods,
Feces, Flies, Fomites
Muscle soreness
Scleral hemorrhage
Diagnostic Test: Fecalysis
Treatment:
Antihelminthic: Mebendazole / Pyrantel Pamoate
Proper handwahing
Cook pork and beef
adequately
3. Capillariasis
Other name:
Whip worm
Trichuris trichuria
Capillararia
Philippinensis
Eating inadequately
cooked seafood
5 Fs: Finger, Foods,
Feces, Flies, Fomites
Abdominal pain
Diarrhea
borborygmi
Diagnostic Test: Fecalysis
Treatment:
Antihelminthic: Mebendazole / Pyrantel pamoate
Proper handwahing
Cook seafoods adequately
4. Enterobiasis
Other name:
Pinworm
Enterobium vermicularis Inhalation of ova
Toilet seat
Infected bedsheets
5 Fs: Finger, Foods,
Feces, Flies, Fomites
Nocturnal anal itchiness Diagnostic Test: Fecalysis / tape test
Treatment:
Antihelminthic: Mebendazole / Pyrantel pamoate
Proper handwahing
Proper disinfection of
beddings
5. Ancyloclostomiasis
Other name:
Hookworm
Ancyclostoma duodenal
Necatur americanus
Walking barefooted
5 Fs: Finger, Foods,
Feces, Flies, Fomites
Dermatitis
Anemia
Black fishy stool
Diagnostic Test: Fecalysis
Treatment:
Antihelminthic: Mebendazole / Pyrantel pamoate
Proper handwahing
Avoid walking barefooted
22 Communicable Disease Nursing
IX. OTHER COMMUNICABLE DISEASES
DISEASE CAUSATIVE AGENT MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Pneumonia
Types:
a. Community
Acquired
Pneumonia (CAP)
b. Hospital /
Nosocomial
c. Atypical
Bacteria:
Pneumococcus,
streptococcus
pneumoniae,
staphylococcus aureus,
Klebsiella pneumonia
(Friedlander s bacilli)
Virus:
Haemophilus influenzae
Fungi: Pneumonocystis
carinii pneumonia
Droplet
Incubation Period:
2 3 days
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
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
Avoid mode of
transmission
Build resistance
Turn to sides
Proper care of influenza
cases
2. Mumps Mumps virus, a member
of family
Direct contact Painful swelling in front
of the ear, angle of the
Supportive and symptomatic MMR vaccine
Other name: Paramyxoviridae Source of infection: jaws and down the neck Sedative
s to relieve pain from orchitis Isolate mumps cases
Epidemic Parotitis Secretions of mouth and
nose
Incubation Period:
12 to 26 days, usually
18 days
Fever
Malaise
Loss of appetite
Swelling of one or both
testicles (orchitis) in some
boys
Cortisone for inflammation
Diet: Soft or liquid as tolerated
Support the scrotum to avoid orchitis, edema, and
atrophy
Dark glasses for photophobia
3. Influenza Influenza virus
A most common
Direct contact
Droplet infection or by
Sudden onset
Fever with chills
Supportive and symptomatic Avoid use of common
towels, glasses, and eating
Other name: B less severe articles freshly soiled Headache Keep patient warm and
free from drafts utensils
La Grippe C rare with nasopharyngeal
discharges
Myalgia / arthralgia TSB for fever
Boil soiled clothing for 30 minutes before
Cover mouth and nose
during cough and sneeze
23 Communicable Disease Nursing

Period of
Communicability:
Probably limited to 3 days
from clinical onset
Airborne
Incubation Period:
Short, usually 24 72
hours
laundering Immunization:
Flujob/Flushot effective
for 6 months to 1 year
4. Streptococcal Group A beta hemolytic Droplet Sudden onset Diagnosis: Avoid mo
de of
sore throat streptococcus
Complication:
High grade fever with
chills
Throat swab and culture transmission
Other name: Other diseases: Rheumatic Heart Enlarged and tender Treatment: eryth
romycin
Pharyngitis Scarlet fever Disease cervical lymph nodes
Tonsillitis St. Anthony fire
Puerperal sepsis
Imoetigo
Acute glomerulonephritis
Rheumatic Heart Disease
Inflamed tonsils with
mucopurulent exudates
Headache
dysphagia
Care:
Bed rest
Oral hygiene with oral antiseptic or with saline
gargle (1 glass of warm water + 1 tsp rock salt)
Ice collar
5. Meningitis Meningococcus
Neisseria meningitides
Direct (Droplet) A. Sudden Onset
-high fever accompanied
Diagnostic Test: Respiratory Isolation
Other name: Incubation Period: by chills Lumbar puncture or Lumbar tap -reveals
CSF
Cerebrospinal 2 -10 days -sore throat, headache, .WBC and protein, low glucose;
contraindicated
fever prostration (collapse) for increased ICP for danger of cranial herniation
B. entrance into the
bloodstream leading to
septicemia
(meningococcemia)
a. rash, petchiae, purpura
C. Symptoms of menigeal
irritation
-nuchal rigidity (stiff
neck) earliest sign
-Kernig s sign when
knees are flexed, it cannot
be extended
-Brudzinski signs pain
on neck flexion with
automatoc flexion of the
knees
-convulsion
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
24 Communicable Disease Nursing

-poker soine (poker face /

flat affect)
-Increased ICP
(Cushing s triad:
hypertension,
bradycardia, bradypnea)
and widening pulse
pressure
IX. KILLER DISEASES OF THE NEW MILLENNIUM
DISEASE CAUSATIVE
AGENT
MODE OF
TRANSMISSION
PATHOGNOMONIC
SIGN MANAGEMENT/TREATMENT PREVENTION
1. Meningococcemia Neisseria meningitides Direct contact with
respiratory droplet from
nose and throat of
infected individuals
Incubation Period:
2 10 days
High grade fever in the
first 24 hours
Hemorrhagic rash
petechiae
nuchal rigidity
Kernig s sign
Brudzinski sign
Shock
Death
Respiratory isolation within 24 hours
Drug-of-Choice: Penicillin
Universal precaution
Chemoprophylaxis with
Rifampicin to protect
exposed individual from
developing the infection
Proper hand washing
2. 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
Coronavirus Close contact with
respiratory droplet
secretion from patient
Incubation Period:
2 10 days
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
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
25 Communicable Disease Nursing

3. Bird Flu
Other Name:
Avian Flu
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
4. 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
ROBERT C. REÑA, BSN
REFERENCES:
.
THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DI
SEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN
.
CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING
IN THE PHILIPPINES, 10th EDITION
.
DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph
.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov