DISEASE

Etiologic agent

Gram stain Morphology and classification

Mode of transmission/ Vector

S/Sx /Target organ/s

Management

Prevention

Current Epidemiologic status

Yersinia pestis PLAGUE

G(-) enteric bacilli

Bordetella pertussis WHOOPING COUGH

G(-)bacilli B. pertussis is a small, fastidious Gram-negative coccobacillus with exclusive affinity for the mucosal layers of the human respiratory tract

can be transmitted in droplets,or physical contact with victims of the plague or fleabearing rodents, squirrels that carry the plague -bite of infected rodent fleas -vector: Xenopsylla cheopis flea spread the disease by coughing or sneezing while in close contact

swollen lymph glands, called buboes, commonly seen in armpits, groin or neck

several classes of antibiotics such as aminoglycosides e..g. streptomycin and gentamicin, tetr acyclines (especiall y doxycycline), and the fluoroquinolone ciprofloxacin

-environmental sanitation -public health education -preventive antibiotic therapy

WHO reports 1,000 to 3,000 cases per year

cough, with runny nose or congestion, sneezing affects the nose and throat and causes a bad sore throat, swollen glands, fever and chills

Antibiotic treatment of pertussis and judicious use of antimicrobial agents for postexposure prophylaxis will eradicate B. pertussis from the nasopharynx of infected persons (symptomatic or asymptomatic). A macrolide administered early in the course of illness can reduce the duration and severity of symptoms and lessen the period of communicability Approximately

best way to prevent pertussis is to get vaccinated.

2008 WHO estimates 16million cases worldwide,95% in developing countries and that about 195,000 children died from the disease

Maintaining high vaccination coverage rates among preschool children, adolescents, and adults and minimizing exposures of infants and persons at high risk for pertussis is the most effective way to prevent pertussis.

80% 90% of patients with untreated pertussis will spontaneously clear C. tetani is a slender, grampositive, anaerobic rod that may develop a terminal spore, giving it a drumstick appearance. The organism is sensitive to heat and cannot survive in the presence of oxygen. The spores, in contrast, are very resistant to heat and the usual antiseptics. They can survive autoclaving at 249.8F (121C) for 10 15 minutes. The spores are also relatively resistant to phenol and other chemical Enters the body through a break in the skin. Tetanus is not transmitted from person to person. Early symptoms: lockja w, stiffness in the neck and abdomen, and difficulty swallowing Later symptoms: sever e muscle spasms, generalized tonic seizure-like activity, severe autonomic nervous system disorders Treatment of tetanus is directed toward the treatment of muscle spasm, prevention of respiratory and metabolic complications, neutralization of circulating toxin to prevent the continued spread, and elimination of the source. immunization with tetanus-toxoid (TT) containing vaccines. Neonatal tetanus can be prevented by immunizing women of childbearing age with tetanus toxoid, either during pregnancy or outside of pregnancy. clean practices when a mother is delivering a child are also important to prevent neonatal and maternal tetanus. People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized. To be protected throughout life, an individual should receive 3 doses of DTP in infancy, followed by a TT-containing booster at school-entry age (4-7 years), in adolescence (12-15 years), and in early adulthood. People of all ages can get tetanus but the disease is particularly common and serious in newborn babies ("neonatal tetanus"). It requires treatment in a medical facility, often in a referral hospital. Neonatal tetanus, which is mostly fatal, is particularly common in rural areas where deliveries are at home without adequate sterile procedures. WHO estimated that neonatal tetanus killed about 180 000 babies in 2002.

Clostridium tetani TETANUS

agents. The spores are widely distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens.
Coryneba cterium diphtheria e Corynebacteri a are Grampositive, aerobic, nonmotile, rod-shaped bacteria classified as Actinobac teria. Corynebacteri a are related phylogenetica lly to mycobacteria and actinomycete s. They do not form spores or branch as do the actinomycete s, but they have the characteristic of forming irregular, club-shaped or V-shaped arrangements in normal growth. They undergo snapping movements

Diphtheria is an infectious disease spreading from person to person by respiratory droplets from the throat through coughing and sneezing.

The disease normally breaks out 2 to 5 days after infection.

an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane of the tonsil(s), pharynx, and/or nose. Diphtheria is a rapidly developing, acute, febrile infection which involves both local and systemic pathology. A local

DIPHTHERIA

Treatment consists of immediate administration of diphtheria antitoxin and antibiotics. Antibiotic treatment usually renders patients non-infectious within 24 hours.

The most effective method is mass immunization of the entire population. Those individuals who are in close contact with a sick person should be identified and treated immediately with antibiotics.The disease should be diagnosed early and proper case management procedures (i.e.immediate treatment and hospitalization) should be followed in order to prevent complications and death.

Diphtheria affects people of all ages, but most often it strikes unimmunized children. In temperate climates, diphtheria tends to occur during the colder months. In 2007, 4190 cases of diphtheria were reported worldwide.

just after cell division, which brings them into characteristic forms resembling Chinese letters or palisades.

lesion develops in the upper respiratory tract and involves necrotic injury to epithelial cells. As a result of this injury, blood plasma leaks into the area and a fibrin network forms which is interlaced with with rapidlygrowing C. diphtheriae cells. This membranous network, called a pseudomembran e, covers over the site of the local lesion leading to respiratory distress, even suffocation.

TUBERCULOSIS

Mycobacter ium tuberculosi s,

Mycobacteriu m tuberculosis is a fairly large nonmot ile rodshaped bacterium di

transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.

In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person's immune system

Tuberculosis is treatable with a sixmonth course of antibiotics.

TB is largely a preventable disease, and adequate ventilation is the most important measure to prevent its transmission in the In those parts of

According to World Health Organization estimates, each year, 8 million people worldwide develop active TB and nearly 2 million die.

stantly related to the Actinomycete s. Many non pathogenic mycobacteria are components of the normal flora of humans, found most often in dry and oily locales. The rods are 2-4 micrometers in length and 0.2-0.5 um in width. Mycobacteriu m tuberculosis is an obligate aerobe. For this reason, in the classic case of tuberculosis, MTB complexes are always found in the well-aerated upper lobes of the lungs. The bacterium is a facultative intracellular parasite, usually of macrophages,

acts to wall off the bacteria. The symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Symptoms of TB in the lungs may include y A bad cough that lasts 3 weeks or longer Weight loss Coughing up blood or mucus Weakness or fatigue Fever and chills Night sweats

the world where the disease is common, the World Health Organization recommends that infants receive a vaccine called BCG (Bacille CalmetteGuerin) made from a live weakened bacterium related to Mtb. BCG vaccine prevents Mtb from spreading within the body, thus preventing TB from developing. BCG has its drawbacks, however. It does not protect adults very well against TB. In addition, BCG may interfere with the TB skin test, showing a positive skin test reaction in people who have received the vaccine. In countries where BCG vaccine is used, the ability of the skin test to identify people infected with Mtb is limited. Because of these limitations, U.S. health experts do not recommend BCG for general use in this country. community.

y y

y y y

WHO estimates that the largest number of new TB cases in 2008 occurred in the South-East Asia Region, which accounted for 35% of incident cases globally. However, the estimated incidence rate in sub-Saharan Africa is nearly twice that of the South-East Asia Region with over 350 cases per 100 000 population. An estimated 1.7 million people died from TB in 2009. The highest number o f deaths was in the Africa Region.In 2008, the estimated per capita TB incidence was stable or falling in all six WHO regions. However, the slow decline in incidence rates per capita is offset by population growth. Consequently, the number of new cases arising each year is still increasing globally in the WHO regions of Africa, the Eastern Mediterranean and South-East Asia. It is estimated that the global TB incidence rate peaked in 2004. Therefore, the world as a whole is on track to achieve the MDG target of reversing the incidence of TB. Incidence rates are falling

and has a slow generation time, 15-20 hours, a physiological characteristic that may contribute to its virulence.

in five of WHOs six regions (the exception is the South-East Asia Region, where the incidence rate is stable). All WHO regions are on track to achieve the 50% mortality and prevalence reduction target, except for the Africa region (although rates of mortality are falling).
The disease gonorrhea i s a specific type of urethritis that practically always involves mucous membranes of the urethra, resulting in a copious discharge of pus, more apparent in the male than

GONORRHEA

Neisseria gonorrho eae is a Gramnegative coccus, 0.6 to 1.0 m in diameter, usually seen in pairs with adjacent flattened sides (Figure 1 Left and Fig 2 below). The organism is frequentl y found intracellul arly in polymorp honuclear leukocyte s (neutroph ils) of the gonorrhe a pustular exudate

You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. If you are pregnant and have gonorrhea, you may give the infection to your baby as it passes through your birth canal during delivery.

Gonorrhea does not always cause symptoms, especially in women. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause epididymitis, which affects the testicles and can lead to infertility. In women, gonorrhea can cause bleeding between periods, pain when urinating and increased discharge from the vagina. If untreated, it can lead to pelvic

antibiotics prescribed by your health care provider. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. cure gonorrhea with antibiotics prescribed by your health care provider

Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonor The surest way to avoid transmission of STIs is to abstain from sexual contact or be in a long-term, mutually monogamous relationship with a partner who has been tested and is not infected. By using latex condoms correctly and consistently during vaginal or rectal sexual activity, you can reduce your risk of getting gonorrhea and developing complications. rhea.

Gonorrhea is a curable sexually transmitted infection (STI), is the second most commonly reported bacterial STI in the United States, following chlamydia. In 2009, 301,174 cases of gonorrhea were reported to the Centers for Disease Control and Prevention. The highest rates of gonorrhea are among sexually active teenagers, young adults, and African Americans.

(Figure 1 Right). Fimbriae, which play a major role in adherenc e, extend several micromet ers from the cell surface (Figure 2 below). N. gonorrho eae is a relatively fragile organism, susceptibl e to temperat ure changes, drying, uv light, and other environm ental condition s. Strains of N. gonorrho eae are variable in their cultural requirem ents so that media containin g hemoglob in, NAD, yeast extract and other

inflammatory disease, which causes problems with pregnancy and infertility. Gonorrhea can pass from mother to baby during pregnancy.in
the female.

suppleme nts are needed for isolation and growth of the organism. Cultures are grown at 35-36 degrees in an atmosphe re of 310% added CO2.

breathing in mist

fever, chills, a cough and sometimes muscle aches and headaches

chest x-ray

LEGIONNAIRES DISEASE

serious and can be life-threatening. However, most people recover with antibiotic treatment. Avoid areas where you might encounter rat fleas or lice. Good sanitation and public health measures reduce the rat population

TYPHUS

Rickettsia typhi or Ric kettsia prowazekii

SYPHILIS "the great imitator."

Syphilis is caused by a bacteriu m called Tr eponema pallidum.

Usually from sexual contact with someone who has it. It can also pass from mother to baby durisexual contact with an infected person. If you are infected, you can pass the bacteria from infected skin or mucous

genital area, lips, mouth, or anus of both men and women . single, small, painless sore. Sometimes it causes swelling in nearby lymph nodes. If you do not treat it, syphilis usually causes a non-itchy skin rash, often on your hands and feet

antibiotics if you catch it early.

antibiotics if you catch it early. To prevent getting syphilis, you must avoid contact with infected tissue (a group of cells) and body fluids of an infected person. However, syphilis is usually transmitted by people who have

With prompt treatment and follow-up care, syphilis can be cured.

An ancient disease, syphilis is still of major importance today. In 2008, 13,500 cases

membranes (linings), usually your genital area, lips, mouth, or anus, to the mucous membranes or skin of your sexual partner. The bacteria are fragile, so you cannot get syphilis from sharing food or utensils, or from using tubs, pools, or toilets. Syphilis can be passed from mother to infant during pregnancy, causing a disease called congenital syphilis. ng pregnancy.

Syphilis (other than congenital syphilis) occurs in four stages that sometimes overlap.

no sores that can be seen or rashes and who do not know they are infected. If you aren't infected with syphilis and are sexually active, having mutually monogamous sex with an uninfected partner is the best way to prevent syphilis. Using condoms properly and consistently during sex reduces your risk of getting syphilis. Washing or douching after sex won't prevent syphilis. Even if you have been treated for syphilis and cured, you can be reinfected by having sex with an infected partner. The risk of a mother transmitting syphilis to her unborn baby during pregnancy declines with time but persists during latent syphilis. To prevent passing congenital syphilis to their unborn babies, all pregnant women

of syphilis were reported in the united States, mostly in people 20 to 29 years of age. Of these reported cases, 63 percent were among men who have sex with men. Syphilis rates have increased in males each year between 2000 and 2008 and in females each year between 2004 and 2008. HIV infection and syphilis are linked. Syphilis increases the risk of transmitting as as getting infected with HIV.

Primary Syphilis Secondary syphilis Latent syphilis

Tertiary Syphilis

should be tested for syphilis. back to top

Mycobacter iumleprae. HANSENS DISEASE a.) tubercul oid and b.)lepromat ous most severe, producing large, disfiguring lumps and bumps ( nodules).

not very contagious (difficult to transmit)

sensory loss in the skin and muscle weakness Skin lesions that are lighter than your normal skin color Lesions have decreased sensation to touch, heat, or pain Lesions do not heal after several weeks to months

Prevention consists of avoiding close physical contact with untreated people. People on long-term medication become noninfectious (they do not transmit the organism that causes the disease)

Aspirin, prednisone, or thalidomide are used to control inflammation.

Early recognition is important. Early treatment limits damage by the disease, renders the person noninfectious (you can't catch the disease from them), and allows for a normal lifestyle.

Bacillus anthracis

G(+)bacilli

WOOLSORTER S DISEASE

Cutaneous anthrax touches a cut or scrape on the skin.Inhalation anthrax develops anthrax spores ente r the lungs through the respiratory tract.Gastrointestina l anthrax occurs when someone eats anthrax-tainted meat.

1.Blister or ulcer 2.fever, malaise, headache, cough, shortness of breath, and chest pain 3. Nausea and vomiting (the vomitusE may include blood) Anemia

treated with antibiotics, including penicillin, doxycycline, and ciprofloxacin.

prescribe preventive antibiotics,

DISEASE

Etiologic agent/ Morphology and classification

Mode of transmission/ Vector virus incubation for eight to 10 days Dengue viruses are transmitted to humans through the bites of infective female Aedesmosquitoes. Mosquitoes generally acquire the virus while feeding on the blood of an infected person. After virus incubation for eight to 10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission, but the role of this in sustaining transmission of the virus to humans has not yet been defined. Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected humans for two to seven days, at approximately the same

S/Sx /Target organ/s

Management

Prevention

Current Epidemiologic status

DENGUE FEVER

Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. The clinical features of dengue fever vary according to the age of the patient. Infants and young children may have a fever with rash. Older children and adults may have either a mild fever or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash. Dengue haemorrhagic fever (DHF) is a potentially deadly complication that is characterized by high fever, often with enlargement of the liver, and in severe cases circulatory failure. The illness often begins with a sudden rise in temperature accompanied by facial flush and other flulike symptoms. The fever usually continues for two to seven days and can be as high as 41C, possibly with convulsions and other complications.

There is no specific treatment for dengue fever. For DHF, medical care by physicians and nurses experienced with the effects and progression of the complicating haemorrhagic fever can frequently save lives - decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient's circulating fluid volume is the central feature of DHF care.

At present, the only method of controlling or preventing dengue virus transmission is to combat the vector mosquitoes.

time that they have a fever; Aedes mosquitoes may acquire the virus when they feed on an individual during this period. Some studies have shown that monkeys in some parts of the world play a similar role in transmission. Characteristics to 10 days,

In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock and die within 12 to 24 hours, or quickly recover following appropriate medical treatment (see below). . The incubation period is commonly six to 20 days with a range of three to 35 days Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized. People most at risk There is presently no cure for polio. Treatment involves supportive care. Maintaining high levels of polio immunization in the community is the single most effective preventive measure. Key facts Polio (poliomyelitis) mainly affects children under five years of age. One in 200 infections leads to i rreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized. Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 1604 reported cases in 2009. The reduction is the result of the global effort to eradicate the disease. In 2010, only four countries in the world remain polio-endemic, down from more than 125 in 1988. The remaining countries are Afghanistan, India, Nigeria and Pakistan. Persistent pockets of polio transmission in northern India, northern Nigeria and the border between Afghanistan and Pakistan are the current focus of the polio eradication initiative. As long as a single child remains infected, children in all countries are at risk of contracting polio. In 2009-2010, 23 previously polio-free countries were

INFANTILE PARALYSIS

Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

Polio mainly affects children under five years of age. ays.

re-infected due to imports of the virus. In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems. Knowledge of the poliovirus has expanded with aggressive research carried out under the eradication effort. Success hinges on closing a substantial funding gap to finance the next steps of the global eradication initiative. Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 1604 reported cases in 2009. In 2010, only parts of four countries in the world remain endemic for the disease- the smallest geographic area in history. Through the success of the global eradication campaign, smallpox was finally pushed back to the horn of Africa and then to a single last natural case, which occurred in Somalia in 1977. A fatal aboratory-acquired case occurred in theUnited Kingdom in 1978. The global eradication of smallpox was certified, based on intense verification activities in countries, by a commission of eminent scientists in December 1979 and subsequently endorsed by the World Health Assembly in 1980.

SMALLPOX

The variola virus measures 260 by 150 nanometers and contains a molecule of double-stranded DNA putatively coding for some 200 different proteins, one of the largest viral genomes known. The size of the genome makes it especially difficult to create a synthetic copy of the virus Smallpox is an acute contagious disease caused by variola virus, a

In the absence of immunity induced by vaccination, human beings appear to be universally susceptible to infection with the smallpox virus. There is no animal reservoir. Insects play no role in transmission. Smallpox is transmitted from person to person by infected aerosols and air droplets spread in face-toface contact with an infected person after fever has begun, especially if symptoms include coughing. The disease can also be transmitted by contaminated clothes and bedding, though the risk of infection from this source is

The incubation period is followed by the sudden onset of influenza-like symptoms including fever, malaise, headache, prostration, severe back pain and, less often, abdominal pain and vomiting. Two to three days later, the temperature falls and the patient feels somewhat better, at which time the characteristic rash appears, first on the face, hands and forearms and then after a few days progressing to the trunk. Lesions also develop in the mucous membranes of the nose and mouth, and ulcerate very soon after their formation, releasing

Vaccine administered up to 4 days after exposure to the virus, and before the rash appears, provides protective immunity and can prevent infection or ameliorate the severity of the disease. No effective treatment, other than the management of symptoms, is currently available. A number of compounds are under investigation as

In the case of a widespread outbreak, people should be advised to avoid crowded places and follow public health advice on precautions for personal protection. Infection control in facilities Medical care givers, attendants, and mortuary workers, even if vaccinated, should wear gloves, caps, gowns, and surgical masks. All contaminated

member of the orthopoxvirus family. The causative agent, variola virus, is a member of the genus Orthopoxvirus, subfamily Chordopoxvirinae of the family Poxviridae. Other members of the genus include cowpox, camelpox, and monkeypox. Monkeypox virus has caused the most serious recent human poxvirus infections.

much lower.

large amounts of virus into the mouth and throat. The centrifugal distribution of lesions, more prominent on the face and extremities than on the trunk, is a distinctive diagnostic feature of smallpox and gives the trained eye cause to suspect the disease. Lesions progress from macules to papules to vesicles to pustules. All lesions in a given area progress together through these stages. From 8 to 14 days after the onset of symptoms, the pustules form scabs which leave depressed depigmented scars upon healing.

chemotherapeutic agents. One of these, Cidofovir, has produced promising results in laboratory studies.

instruments, excretions, fluids and other materials should be decontaminated chemically or by heat or incineration. Contaminated clothing and bedding, if not incinerated, should be autoclaved or washed in hot water containing hypochlorite bleach. Fumigation of premises may be done with formaldehyde. Cadavers should be cremated, in a properly designed facility, whenever possible and all persons coming in contact with them should be vaccinated or at least placed on daily fever watch. Body bags treated with hypochlorite bleach can also be used. Laboratory manipulations with infective materials

should be done in high containment facilities at Biosafety Level IV, authorized only at two WHO designated laboratories in the United States and the Russian Federation Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the cells that line the back of the throat and lungs. Measles is a human disease and is not known to occur in animals. The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts. Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection. The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days). Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHOrecommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia. All children in developing countries Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles. The measles vaccine is often incorporated with rubella and/or mumps vaccines in In 2008, there were 164 000 measles deaths globally nearly 450 deaths every day or 18 deaths every hour. More than 95% of measles deaths occur in low-income countries with weak health infrastructures. Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide. In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services up from 72% in 2000.

MEASLES

whose immune systems have been weakened by HIV/AIDS or other diseases. Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care. People who recover from measles are immune for the rest of their lives. Seasonal influenza is an acute viral infection caused by an influenza virus. There are three types of seasonal influenza A, B and C. Type A influenza viruses Seasonal influenza spreads easily and can sweep through schools, nursing homes or businesses and towns. When an infected person coughs, infected droplets get into the air and another person can breath them in and be exposed. The virus can also be spread by hands infected Seasonal influenza is characterized by a sudden onset of high fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and runny nose. Most people recover from fever and other symptoms within a week without requiring

diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

countries where these illnesses are problems. It is equally effective in the single or combined form. In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.

INFLUENZA

Antiviral drugs for influenza are available in some countries and effectively prevent and treat the illness. There are two classes of such medicines, 1) adamantanes (amantadine and

The most effective way to prevent the disease or severe outcomes from the illness is vaccination. Safe and effective vaccines have been available and used for more than

FluNet reports During this reporting period, National Influenza Centres (NICs) from 71 countries, areas or territories reported data to FluNet*. A total of 18,757 specimens were reported as positive for influenza viruses, 14,423 ( 76.9%) were typed as influenza A and 4,335 (23.1%) as influenza B. Of the sub-typed influenza A

are further typed into subtypes according to different kinds and combinations of virus surface proteins. Among many subtypes of influenza A viruses, currently influenza A(H1N1) and A(H3N2) subtypes are circulating among humans. Influenza viruses circulate in every part of the world. Type C influenza cases occur much less frequently than A and B. That is why only influenza A and B viruses are included in seasonal influenza vaccines. The family Paramyxoviridae consists of three genera: Paramyxo virus, which includes the parainfluenza viruses and mumps virus; Pneumovirus , which includes respiratory

with the virus. To prevent transmission, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.

medical attention. But influenza can cause severe illness or death in people at high risk (see below). The time from infection to illness, known as the incubation period, is about two days.

remantadine), and 2) inhibitors of influenza neuraminidase (oseltamivir and zanamivir). Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of treatment. WHO monitors antiviral susceptibility in the circulating influenza viruses.

60 years. Among healthy adults, influenza vaccine can prevent 70% to 90% of influenza-specific illness. Among the elderly, the vaccine reduces severe illnesses and complications by up to 60%, and deaths by 80%. Vaccination is especially important for people at higher risk of serious influenza complications, and for people who live with or care for high risk individuals.

viruses reported, 53.2% were i nfluenza H1N1(2009) and 46.7% were influenza A (H3N2).

The virus is spread in droplets. Primary infection consists of viremia and involvement of glandular and nervous tissue, resulting in inflammation and cell death. Mumps is spread by droplets of saliva or mucus from the mouth, nose, or

12 to 24 days are called the incubation period. Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting two or more days and without other apparent cause Mumps is a viral infection, primarily affecting the

INFECTIOUS PAROTITIS

There is no specific treatment for mumps. The virus usually causes mild disease in children, but in adults can lead to complications, such as meningitis and orchitis.

Vaccination with live attenuated mumps virus vaccine gives longlasting immunity, but reinfection may occur Mumps can be prevented by immunization. Active

Mumps is found worldwide. Without extensive vaccination it is endemic in cities with epidemic variations in 2 to 3 years intervals. In rural

syncytial virus; andMorbillivirus, which includes the measles virus. Structure: All paramyxoviruses are enveloped particles 150 to 300 nm in diameter. The tubelike, helically symmetrical nucleocapsid contains a monopartite, single-stranded, negative-sense RNA genome and an RNA-directed RNA polymerase. The nucleocapsid associates with the matrix protein (M) at the base of a double-layered lipid envelope. The spikes on the envelope contain two glycoproteins, a viral attachment protein, and a fusion protein. The paramyxoviruses can be distinguished by the gene order for the viral proteins and by the biochemical properties for their

throat of an infected person, usually when the person coughs, sneezes or talks. Items used by an infected person, such as cups or soft drink cans, can also be contaminated with the virus, which may spread to others if those items are shared. In addition, the virus may spread when someone with mumps touches items or surfaces without washing their hands and someone else then touches the same surface and rubs their mouth or nose. Most mumps transmission likely occurs before the salivary glands begin to swell and within the 5 days after the swelling begins. Therefore, CDC recommends isolating mumps patients for 5 days after their glands begin to swell.

salivary glands. The virus is transmitted by direct contact, or via airborne droplets from the upper respiratory tract of infected people. Initial symptoms usually appear 23 weeks after infection, and include headache, muscle pain, low-grade fever and malaise. Soon after, swelling of one or both parotid glands appears.

immunization against mumps is recommended for all children at 12 to 18 months of age in many countries. A combined live virus vaccine is available for mumps, measles, and rubella (MMR). The mump Minimize close contact with other people, especially babies and people with weakened immune systems who cannot be vaccinated. Stay home from work or school for 5 days after your glands begin to swell, and try not to have close contact with other people who live in your house. Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in the trash can. If you dont have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands. Wash hands well and often with soap, and teach

viral attachment proteins. In parainfluenza viruses, the viral protein spikes have hemagglutinating and neuraminidase activities (HN). Respiratory syncytial virus lacks both these activities and measles virus lacks neuraminidase but has hemagglutinating activity. All paramyxoviruses are labile to very labile and quickly inactivated, e.g. by heat, organic solvents, detergents, ultraviolet, or visible light, and low pH value. Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to have a sore. Generally, a person can only get HSV-2 Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive

children to wash their hands too. Dont share drinks or eating utensils. Regularly clean surfaces that are frequently touched (such as toys, doorknobs, tables, counters) with soap and water or with cleaning wipes.

.The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-

GENITAL HERPES

Genital herpes is one of the most common ulcerating diseases of the genital mucosa. It is estimated that in the USA, for example, from 40 to 60 million people are HSV-2-infected, with an incidence of 12 million infections and 600 000800 000 clinical cases per year. Prevalence in the 3040 year-old population is about 30%. Overall prevalence is higher in women compared with men, especially among the young. The same independent factors of HSV-2 infection were identified

infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected. HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips, so-called fever blisters. HSV-1 infection of the genitals can be caused by oral-genital or genitalgenital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV2 outbreaks.

outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.

therapy for symptomatic herpes can reduce transmission to partners.

term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes. Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know

in both genders: older age, higher lifetime number of sexual partners, positive HIV serology and positive syphilis serology. Prevalence in developing countries can vary from 274% according to the country, age, gender, or urban versus rural areas. Rates up to 40% have been reported among women 1519 years of age in rural Costa Rica, Kenya (Kisumu) and Mexico (Mexico-City). A study conducted on truck drivers in Bangladesh showed a high prevalence of HSV-2 (25.8%) , compared to syphilis (5.7%), gonorrhoea (2.1%), and chlamydia (0.8%).

that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection. ACQUIRED IMMUNE DEFICIENCY SYNDROME Rift Valley fever (RVF) is an acute, fever-causing viral disease that affects domestic animals (such as cattle, buffalo, sheep, goats, and camels) and How do humans get RVF? Humans usually get RVF through bites from infected mosquitoes and possibly other biting insects that have virus-contaminated mouthparts. Humans can RVF virus can cause several different disease syndromes. People with RVF typically have either no symptoms or a mild illness associated with fever and liver abnormalities. VF Usually the disease clears up without complications, There is no established course of treatment for patients infected with RVF virus. However, studies in monkeys and other animals have shown promise for VF C immitis infection rates are typically quoted in the 100,000 per year range within the United States. Peak incidence occurs during the summer to early fall months and is related to the variations in weather

VALLEY FEVER

humans. RVF is most commonly associated with mosquito-borne epidemics during years of unusually heavy rainfall. The disease is caused by the RVF virus, a member of the genus Phlebovirus in the family Bunyaviridae. The disease was first reported among livestock by veterinary officers in Kenya in the early 1900s. VF Coccidioidomycosi s is caused by C immitis, a soil fungus particularly adapted to arid conditions

also get the disease if they are exposed to the blood, body fluids, or tissues of infected animals. Direct exposure to infected animals can occur during slaughter or through veterinary and obstetric procedures. Infection through aerosol transmission of RVF virus has occurred in the laboratory environment. VF Symptoms may appear between 1-3 weeks VF People get infected with Coccidioides by inhaling fungal spores that become airborne after disturbance of contaminated soil by humans or natural disasters (e.g., dust storms and earthquakes). People get infected with Coccidioides by inhaling fungal spores that become airborne after disturbance of contaminated soil by humans or natural disasters (e.g., dust storms and earthquakes). after exposure.

However, in some patients the illness can progress to hemorrhagic fever (which can lead to shock or hemorrhage), encephalitis (inflammation of VF About 60% of infections do not cause any symptoms. People who develop symptoms may experience a flu-like illness, with fever, cough, headache, rash and muscle aches. Most people make a full recovery, within weeks to months of symptom onset, but a small number of people may develop chronic pulmonary infection or widespread disseminated infection. When the infection spreads outside of the lungs, it most commonly results in skin lesions, central nervous system infection, such as meningitis, and bone and joint infection. Some people are at increased risk for developing disseminated infection: people of AfricanAmerican, Asian or Filipino descent appear to be at increased risk, as do pregnant women during the third trimester and immunocompromised persons.

although in some cases, the lesions formed in the lungs may be difficult to cure. In rare cases, this disease may recur after weeks or months. Occasionally, the infection spreads throughout the body, causing lesions in the lungs, bones and other organs. Treatment consists primarily of rest. Antibiotics may be given to prevent secondary bacterial infection. Amphotericin B or ketoconazole may be used to reduce the risk of extra pulmonary dissemination or to obtain remission after dissemination occurs Usually the disease clears up without complications, although in some cases, the lesions formed in the lungs may be difficult to cure. In rare cases, this disease may recur after weeks or months. Occasionally, the infection spreads throughout the body, causing

ribavirin, an antiviral drug, for future use in humans. Additional studies suggest that interferon, immune modulators, and convalescentphase plasma may also help in the treatment of patients with RVF

and spore formation. In particular, outbreaks have been documented during earthquakes and wind storms, which agitate arthroconidia and cause them to become airborne. Historically, people at greatest risk for contact include farmers, construction workers, and archaeologists; the Northridge earthquake and outbreaks among archaeologists highlight these vents.2,3 Thus, otherwise healthy persons exposed to high spore burdens have a higher likelihood of more severe disease. C immitis cases are by no means confined to t he Southwestern United States; in fact, cases have been reported in travelers who visited endemic areas. This illustrates the need for careful history taking and possible exposure in endemic areas. International Affected areas include the lower Sonoran areas, which are characterized by semiarid climates with hot summers and alkaline soil. These areas include northern Mexico, Central America, and South America.

VF Avoidance of dusty environments in endemic regions may help to prevent infection. In addition, persons at risk for severe disease should avoid activities that may result in dust exposure, such as digging.

lesions in the lungs, bones and other organs. Treatment consists primarily of rest. Antibiotics may be given to prevent secondary bacterial infection. Amphotericin B or ketoconazole may be used to reduce the risk of extra pulmonary dissemination or to obtain remission after dissemination occurs

There is no established course of treatment for patients infected with RVF virus. However, studies in monkeys and other animals have shown promise for ribavirin, an antiviral drug, for future use in humans. Additional studies suggest that interferon, immune

ROSE GARDENERS DISEASE

Sporotrichosis is a fungal infection caused by a fungus called Sporothrix schenckii. It usually infects the skin.

The fungus can be found in sphagnum moss, in hay, in other plant materials, and in the soil. It enters the skin through small cuts or punctures from thorns, barbs, pine needles, or wires. It can also be inhaled and cause pulmonary infection or disseminated infection. It is not spread from person to person.

The first symptom is usually a small painless bump resembling an insect bite. It can be red, pink, or purple in color. The bump (nodule) usually appears on the finger, hand, or arm where the fungus first enters through a break on the skin. This is followed by one or more additional bumps or nodules which open and may resemble boils. Eventually lesions look like open sores (ulcerations) and are very slow to heal. Pneumonia rarely occurs as a result of inhalation of fungal spores, and can cause symptoms such as shortness of breath, cough and fever. The aconazole is the

modulators, and convalescentphase plasma may also help in the treatment of patients with RVF. Itraconazole is the preferred treatment for cutaneous and lymphocutaneous sporotrichosis. It may also be used to treat bone and joint infections. For patients with severe disease, and/or pulmonary, central nervous system or disseminated infection, a lipid formulation of amphotericin B should be used initially. Itraconazole can be used for stepdown therapy once the patient has stabilized. Potassium iodide (SSKI) is another option for cutaneous or lymphocutaneous disease that does not respond to itraconazole. SSKI and azole drugs like itraconazole should be avoided during pregnancy. Treatment recommendations may differ for children. Consult

Control measures include wearing gloves and long sleeves when handling wires, rose bushes, hay bales, conifer (pine) seedlings, or other materials that may cause minor skin breaks. It is also advisable to avoid skin contact with sphagnum moss. Moss has been implicated as a source of the fungus in a number of outbreaks.

Occurs worldwide and is an occupational disease for farmers, gardeners, and horticulturist.It is sporadic and relatively uncommon. Contact with infected cats was an exposure risk in a Brazilian outbreak.

GENITAL WARTS AND CERVICAL CARCINOMA

More than 100 different types of HPV exist, most of which are harmless. About 30 types are spread through sexual contact and are classified as either low risk or high risk. Some types of HPV cause genital warts--single or multiple bumps that appear in the genital areas of men and women including the vagina, cervix, vulva (area outside of the vagina), penis, and rectum. These are considered lowrisk types. High-risk types of HPV may cause abnormal Pap smear results. They could lead to cancers of the cervix, vulva, vagina, anus, or penis.

Genital warts are very contagious. You can get them during oral, vaginal, or anal sex with an infected partner. You can also get them by skin-to-skin contact during vaginal, anal, or (rarely) oral sex with someone who is infected. About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact. If you are infected but have no symptoms, you can still spread HPV to your sexual partner and/or develop complications from the virus.

In women, genital warts occur on the outside and inside of the vagina, on the opening to the uterus (cervix), or around the anus. In men, genital warts are less common. If present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus. Rarely, genital warts also can develop in your mouth or throat if you have oral sex with an infected person. Like many STIs, genital HPV infections often do not have signs and symptoms that you can see or feel. One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of women infected with HPV had no obvious symptoms. If you are infected but have no symptoms, you can still spread HPV to your sexual partner and/or develop

your doctor for more information.infectio n can spread to other parts of the body, including bones and joints and the central nervous system. here are treatments for genital warts, though the warts often disappear even without treatment. There is no way to predict whether the warts will grow or disappear. Therefore, if you suspect you have genital warts, you should be examined and treated, if necessary. Depending on factors such as the size and location of your genital warts, your health care provider will offer you one of several ways to treat them. y y Imiquimo d cream 20 percent podophyll in antimitoti c solution

The best way to prevent getting an HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact. If you or your sexual partner has warts that are visible in the genital area, you should avoid any skin-to skin and sexual contact until the warts are treated. Two HPV vaccines, Gardasil and Cervarix, are approved by the Food and Drug Administration. Both vaccines are highly effective in preventing persistent infection with HPV types 16 and 18, two "highrisk" HPVs that cause most (70 percent) of cervical cancers. Gardasil is also effective against types 6

Human papillomavirus (HPV) Human papillomavirus (HPV) causes cervical cancer which is the second most common cancer in women worldwide. In 2008, there were an estimated 529,000 new cases and 274,00 deaths due to cervical cancer. More than 85 % of cervical cancer deaths are in developing countries, where it accounts for 13% of all female cancers. Human papillomaviruses are common throughout the world. Although most infections with HPV cause no symptoms, persistent genital HPV infection can cause cervical cancer in women. Virtually all cervical cancer cases (99%) are linked to genital infection with HPV which is the most common viral infection of the reproductive tract. HPV can also cause other types of anogenital cancer, head and neck cancers, and genital warts in both men and women. HPV infections are transmitted through sexual contact.

complications from the virus.

0.5 percent podofilox solution 5 percent 5fluoroura cil cream Trichloro acetic acid (TCA)

and 11, which cause virtually all (90 percent) of genital warts. Both vaccines are licensed, safe, and effective for females ages 9 through 26 years. The Centers for Disease Control and Prevention (CDC) recommends that all girls who are 11 or 12 years old get the 3 doses of either brand of HPV vaccine to protect against cervical cancer and precancer. Gardasil is also licensed for boys and young men ages 9 through 26 years. Males may choose to get this vaccine to prevent genital warts.

If you are pregnant, you should not use podophyllin or podofilox because they are absorbed by your skin and may cause birth defects in your baby. In addition, you should not use 5-fluorouracil cream if you are pregnant. If you have small warts, your health care provider can remove them by one of three methods. y Freezing (cryosurg ery) Burning (electroca utery) Laser treatment

If you have large

warts that have not responded to other treatment, you may have to have surgery to remove them. Some health care providers inject the antiviral drug alpha interferon directly into warts that have returned after removal by traditional means. The drug is expensive, however, and does not reduce the rate that the genital warts return. Although treatments can get rid of the warts, none get rid of the virus. Because the virus is still present in your body, warts often come back after treatment. Tinea versicolor is caused by the dimorphic, lipophilic organisms in the genus Malassezi a, formerly known asPityrosporum. Eleven species are recognized within this classification of yeasts, of Tinea versicolor is spread through direct contact with infected skin or by contact with contaminated items, such as towels or bedclothes. Symptoms of tinea versicolor include a rash, made up of patches of skin that may be lighter or darker than the surrounding skin. The patches may also be flaky and itchy. Tinea versicolor responds well to both topical and oral antimycotic therapies. Many patients prefer oral therapy because of its convenience. Antifungals Topical antifungals temporarily Avoid close contact with those who have tinea versicolor. Keep your skin clean and dry: Bathe after physical exertion and sweating. Good personal Tinea versicolor occurs worldwide, with prevalences reported to be as high as 50% in the humid, hot environment of Western Samoa and as low as 1.1% in the colder temperatures of Sweden.

TINEASIS

which Malassezia globosa andMala ssezia furfur are the predominant species isolated in tinea versicolor.1,2,3,4,5 Malassezia is extremely difficult to propagate in laboratory culture and is culturable only in media enriched with C12- to C14sized fatty acids.Malassezia is naturally found on the skin surfaces of many animals, including humans. Indeed, it can be isolated in 18% of infants and 90-100% of adults.

eradicate the condition, although treatment may need to be intermittently repeated to prevent recurrence. Oral therapy for tinea versicolor is convenient and effective, but it does not prevent recurrences. A once-monthly (for 6 mo) oral dose of fluconazole is a popular alternative.

hygiene Wash personal items regularly: Do not share personal care items. Wash your hands frequently.