COMMUNICABLE DISEASE

D. HANS WILSON
 `

• Communicable diseases are illness caused by a

“specific infectious agent, or its toxic products,
that arise through transmission of that agent,
or its product from an infected person, animal,
or inanimate sources to a susceptible host;
either directly or indirectly through an
intermediate plant or animal host, vector or
inanimate environment (Heymann, 2015, p.
694)
 TRANSMISSION OF COMMUNICABLE DISEASES
Communicable diseases kill more than 14 million people
each year, largely in resource poor countries. Preventing
transmission is key to controlling the number of people
infected with an organism.
There are many ways of classifying communicable diseases
and the categorization varies depending on the purpose and
use of the classification.
One way to classify is by the epidemiologic triangle. It is used
to describe the dynamics of the agent, host and the
environment.
In order for an infectious disease to be acquired , three
elements are needed: an infective agent, a susceptible host and a
supportive environment.
To prevent the disease, it is necessary to modify one or more of
the elements on the corners of the triangle
For example, you could immunize the host, disinfect a room
to eliminate the agent.
Understanding the infectious agent’s characteristics is
paramount to assisting health care providers to prevent,
diagnose and manage a communicable disease.
 CLASSIFICATION OF COMMUNICABLE DISEASES
A. sexually transmitted and blood-borne infections: gornohoea, syphilis,
hiv/aids, hepatitis
• B. enteric, food and water-borne infections: cholera, typhoid fever,
diarrhea diseases, poliomyelitis, food poisoning, hepatitis A.
• C. zoonotic and vector-borne infections : yellow fever, malaria,
trypanosomiasis, onchocerciasis, filariasis, rabies, anthrax.
• D. respiratory infections and Air-borne infections : measles, mumps,
chicken pox, whooping cough, diphtheria, meningitis, COVID-19
• E. health care-associated infections
 GENERAL PRINCIPLES OF COMMUNICABLE DISEASE
CONTROL
• Any control programme must consider the following:
• 1. Recognition of the disease and confirmation of diagnosis. This is
important when prompt action is acquired to prevent spread of the
disease.
• 2. Notification of the disease to the appropriate health authority.
Locally notifiable diseases, including meningitis, measles, HIV /
AIDS, yaws and other communicable disease which have epidemic
tendencies. The CD1 form is used for notification. By international
sanitary regulation, certain diseases are to be notified to the WHO.
These are cholera, plague and yellow fever
• 3. Identification of the source of infection. This is by:
• A. Investigating the infected person‘s movement during the
incubation period of the disease.
• b. Whether he has been in contact with any known or
suspected causative organism.
• c. Whether similar symptoms have developed among his
associates.
• d. Investigate any possible vehicles of infections in the
environment such as food and water supply.
• 4. Assess the extent of outbreak by finding other
cause and other exposed persons and give treatment.
• 5. Investigate the presence of carriers, since effective
control depends on their cooperation.
ACTUAL CONTROL METHODS OF
COMMUNICABLE DISEASES

Health
Education

Elimination of Interruption of Protection of

resevior of pathway of the susceptible
infection transmission host

Agent Host
 1. ELIMINATION OF RESERVOIR OF
INFECTION
• i. Treatment of all infected cases.
• ii. Identification of carriers and contacts and treating them.
• iii. Destruction or killing of the reservoir if it is an animal.
For example the destruction of dogs which are infected with
rabies, and rats in outbreaks of plague.
 2. INTERRUPTING THE PATHWAY OF TRANSMISSION

• This is to make sure the agent does not get through the host to
infect such as:
• i. Washing of hands before eating before handling food or
water, and after defaecating.
• ii. Proper disposal of faeces (wet refuse).
• iii. Proper disposal of dry refuse.
• iv. Proper covering of foods to prevent exposure to flies and
dust
• v. Proper storage of foods.
• vi. Proper washing of foods eaten raw with potassium
permanganate or concentrated salt solution. Foods like
carrots, lettuce, cabbage etc
• vii. Protection of drinking water.
• viii. Proper treatment of drinking water.
• ix. Proper cooking and supervision of public eating places.
• x. Inspection of animals before they are slaughtered.
• xi. Inspection of slaughtered meat before selling for
consumption.
• xii. Ensuring good personal hygiene measures.
• xiii. Regular medical inspection of food handlers.
• xiv. Proper handling of food.
 3. PROTECTION OF THE SUSCEPTIBLE HOST

• i. Active immunization against vaccine preventable diseases.

• ii. Passive immunization with Antitoxins like Anti Tetanus
serum (ATS) anti snake serum etc.
• iii. Chemoprophylaxis e.g. anti malaria, especially to pregnant
women and children.
• iv. Protective clothing- treated nets, clothes, gloves, masks
and so on.
 4. HEALTH EDUCATION

Health education is given on:

• iv. How the reservoir of infection can be eliminated.
• v. Various ways by which the pathway of transmission of a
disease can be interrupted.
• vi. How the susceptible host can be protected against the
disease.
• iv. The dangers of the disease and its public health
importance, if any.
AIR-BORNE DISEASES
 MEASLES
• Description- measles is a highly infectious disease which
commonly affects children and has high fatality rates.
Causative organism- is morbilli rubeola (measles virus).
Reservoir - man
Incubation period - 7-14 days but commonly 10 days
Distribution- worldwide but has declined in Europe and North
America.
Susceptibility- children aged between 1½ years and 3 years.
Mode of transmission.
• Direct- by droplet spread through coughing, talking or spitting from
infected persons.
• d. Indirect- through freshly soiled articles from secretions from the
throat and nose of infected persons.
• The virus quickly spreads to the immediate lymph nodes
• Cases of measles have been seen in partially immunized children.
• Occasionally, infection have also been seen in the course of live
vaccine failure. However, the symptomatology is very much reduced.
 SIGNS AND SYMPTOMS
PRODROMAL SKIN G.I.T EYES

Fever  Rashes (maculo- Redness Conjunctivitis

popular) begin from
Headache the ears (4 days),
Soreness Redness of eye
Malaise face then spread Loss of soreness
over the body appetite
convulsion  Rashes redden all
over the body
Koplik's spot
 Desquamation Diarrhea
occurs Bloody stool
 COMPLICATIONS
• Complications
• - Laryngitis (inflammation of the larynx
• - Otitis media
• - Broncho pneumonia
• - Severe malnutrition
• - Post-measles encephalitis
 MANAGEMENT OF MEASLES.

• There is no specific treatment for measles but can be managed

by the signs and symptoms, so infected children should be sent
to the nearest hospital for effective management.
• Management
• Send child to hospital for symptomatic treatment.
• No drug is known to treat measles, but antibiotics can be given
to treat any secondary
• bacterial infection like pneumonia. Examples of drugs that
could be given are
• Streptomycin and Penicillin or Amoxicillin
• Tepid sponge to reduce fever.
• Clean oral sore with tomato juice or salt solution
• Paint the mouth with Gentian Violet solution if there is sore
mouth.
• Bath at least once a day and apply soothing pomade.
• Room should be well ventilated.
• Cloth child well to prevent pneumonia.
• Give nourishing diet to prevent malnutrition.
• The diet of the child should not contain pepper or hot spices
due to the mouth sore
• Plenty of fluids that the child can tolerate should be given to
prevent dehydration
 PREVENTION AND CONTROL OF MEASLES.

• Health education on the causes, signs and symptoms and

complications of the disease to the general public.
• Active Routine Immunization(ARI). All children under five
years of age should be immunized against all childhood
diseases including measles at nine (9) months old and repeat
immunization at eighteen (18) months old.
 PREVENTION OF MEASLES CONT;

• All newly born babies should be exclusively breastfeed

for six months and timely and proper complimentary
feeding should be introduce at six months alongside the
breastfeeding until two (2) years of the child's life.
• Infected persons should be sent to the hospital for
effective management.
 PREVENTION OF MEASLES CONT;

• Children above two years of age should be given anti-

helminthes (dewormer) at the Child Welfare Clinic
against worms which can cause malnutrition thereby
exposing them to childhood diseases including
measles.
 PREVENTION OF MEASLES CONT;
• Infected children should be segregated in order to prevent
further spread of the disease.
• People should be encouraged to avoid open spitting, coughing
and sneezing in order to curtail the spread of the disease since
it spreads through these process.
• Isolate the infected person from other children for 14 days.
• All contacts should also be isolated and observed for signs.
• Concurrent disinfection of articles of infected persons
• Proper disinfection of secretions from the nose and throat of
infected persons before disposal
• Measles immunization at nine months. During outbreak, it
should be given at six months and repeat at 1 year.
• Successful immunization campaigns and immunization
programmes.
• Health education on the cause, mode of spread, signs and
symptoms, prevention and control measures.
 DIPHTHERIA

•Description- it is an acute infectious disease of the tonsils, pharynx, larynx, nose

and skin.
•Causative organism- a bacterium known as corynebacterium diphtheriae
•Reservoir- man (infected persons and carriers
•Incubation period - 2-5 days
•Distribution- worldwide but not common in Ghana
•Susceptibility- it affects children
•Mode of transmission
a. Direct- through droplets from sneezing, coughing by infected person on to
uninfected person.
b. Indirect- by contact with freshly soiled articles of discharges and lesions of
infected persons.
 SIGNS AND SYMPTOMS (TYPES)
CUTANEOUS OR SKIN PHARYNGEAL AND NASAL DIPHTHERIA
DIPHTHERIA TONSILAR
DIPHTHERIA
- Affects small wounds or - Begins as a sore - Nasal infection is
starts as a vesicle on throat usually mild but
leg - Oedema of the neck chronic
- The vesicle contains - Tenderness of the - One-sided nasal
straw-coloured fluid neck area discharge
- Pain at the side of - Enlargement of
vesicle cervical lymph nodes
- It bursts to leave a - Inability to breath
shallow round ulcer
- Results in lasting
•Complications include myocarditis and renal failure
•Management
 Send the child for treatment
 Give drugs as prescribed – injection procaine penicillin 20,000 –
100,000 units. For the skin type, the same dosage but it is given
close to the wound.
 Mouth - wash with saline or hydrogen peroxide.
 Give nourishing diet
 Provide good ventilation
 Give more oral fluids
 Bath at least once a day.
 PREVENTION AND CONTROL

 Isolation of infected people from others

 Investigate contacts and give treatment
 Effective treatment of infected persons
 Observe proper disposal of secretions from the throat, nose and skin
lesions
 Food handlers found to be exposed should be prevented from work till
investigated
 Immunization with DPT/HibHepB vaccine
 Attack of the skin types confers lasting immunity
 Health education on all aspects of the disease.
 PERTUSSIS (WHOOPING COUGH)
• Description- it is an acute bacterial disease which affects the respiratory tract-
from the trachea to the bronchioles.
• Causative organism- Bordetella pertussis
• Reservoir- man
• Incubation period- commonly 7-10 days but may take as long as 21 days
• Distribution- worldwide
• Susceptibility- children under 1 year old are more susceptible.
• Mode of transmissionc.
• Direct- droplets from the respiratory tract of infected persons
• d. Indirect- with articles freshly soiled with discharges of infected persons
 EPIDEMIOLOGY OF PERTUSSIS.

• Worldwide, whooping cough affects 48.5 million people yearly. As

of 2010 it caused about 81,000 death down from 167,000 in 1990.
This is despite generally high coverage with the Deptheria,
Tetanus, Pertussis (DTP) and Deptheria, Tetanus acellula,
Pertussis, (DTaP) vaccines.
• Pertussis is one of the leading causes of vaccine-preventable deaths
world-wide. 90% of all cases occur in developing countries.
 SIGNS AND SYMPTOMS
• It begins with fever, malaise and coryza (cold, headache and
nasal discharge)
• The person gradually develops a cough which increases in
frequency
• Eventually the cough gets into spasms or paroxysms (series of
coughs) followed by a long whoop.
• At the end of each episode, there is vomiting
• If prolonged, there is exhaustion and respiratory obstruction
• Convulsions may occur
 COMPLICATIONS
• Dehydration
• - Malnutrition (failure to thrive)
• - Bronchopneumonia
• - Otitis media
• - Rectal prolapse
• Ear-ache ( infection of the ear-drum)
• Seizures ( convulsion or epilepsy).
• Sub-conjunctival hemorrhages.
• urinary incontinence.
 MANAGEMENT
• Send affected person for treatment.
• Give prescribed drugs. Erythromycin 62.5mg- 250mg 6 hourly for 7 days
• Isolate child from other children
• Ensure adequate ventilation
• Bath child at least once a day
• Give well nourishing fluids
• Give nourishing diet
• Support child during coughing episodes
• Clean child up after coughing
•
 PREVENTION AND CONTROL
• Isolation of all infected children for 21 days (infective period)
• Secretions from the nose and throat should be well disposed
off
• Soiled articles should be washed well and iron if possible
• Child should have different toilet articles from other children
• Give effective treatment for infected cases
• Immunization of all children with DPT/HibHepB
• Effective immunization campaigns
 MUMPS (INFECTIOUS PAROTITIS) OR
EPIDEMIC PAROTITIS
•Description- it is a viral infection affecting the salivary glands,
especially the parotic gland. It may also affect the sub-mandibular
and sub-lingual glands.
•Causative organism- a virus called myxovirus (mumps virus)
•Reservoir- man
•Incubation period- 14 -28 days, commonly 18 days
•Distribution- worldwide
•Susceptibility- general, but younger children are more susceptible
 MODE OF TRANSMISSION-

a. Direct- through droplet spread from spitting, sneezing, coughing or

talking by infected persons
b.Indirect by:
• - The use of articles soiled with fresh secretions from the mouth,
nose and throat.
• - The use of infected person’s spoon, cup since the virus is in the
saliva
• - Eating with infected persons, or eating their left over foods.
• - Convalescent carriers can also infect people
 MUMPS.

EPIDEMIOLOGY.
• Mumps is a disease that affects children, the highest
incidence occurs in children between 5 - 9 years of age.
• The disease is less contagious than other childhood
diseases such as measles and varicella.
 EPIDEMIOLOGY OF MUMPS CONT;

• According to a recent epidemiological survey in

America, 10% of the population had mumps
during the first 5 years of life, 74% had it by age
10, and 95% by 20 years of age. Mumps is
endemic in most urban areas.
 EPIDEMIOLOGY OF MUMPS CONT;

• Subclinical infections are common in very young infants

(2 - 3 years of age), and the proportion increases with age
in adulthood. Up to 90% of infections at the age of 10 – 14
years of age were associated with symptoms whilst almost
all infections are subclinical beyond 60 years of age.
 MUMPS.
CASE DEFINATION!!
• Mumps is an acute viral disease characterized by fever,
swelling of one or both of the parotid gland in the salivary
gland.
• The primary site of viral replication is the epithelium of the
upper respiratory or the GI tract or the eye. The virus
quickly spreads to the local lymphoid tissue around the
jaws and the neck.
• A person infected with mumps is contagious from
approximately 6 days before the onset of symptoms
until about 9 days after symptoms start.
• The incubation period (time until symptoms begin)
can be from 14–25 days, but is typically 16–18 days.
 SIGNS AND SYMPTOMS OF MUMPS.

• Fever and headache are prodromal symptoms of mumps,

together with malaise and anorexia. Other symptoms of
mumps can include dry mouth, sore ears, loss of voice.
• In addition, up to 20% of persons infected with the
mumps virus do not show symptoms, so it is possible to
be infected and spread the virus without knowing it.
 SIGNS AND SYMPTOMS CONT;
• Swelling at the jaws either both or one side
• Severe pain at the affected jaws.
• Difficulty in swallowing and chewing
• Headache
• Fever, thus rise in body temperature
• Loss of appetite
• General Malaise thus the feeling of weakness and tiredness
with any little work.
 COMPLICATIONS OF MUMPS.

• Mumps viral infections in adolescent and adult males

carry an up to 30% risk that the testes may become
infected (orchitis or epididymitis), which can be quite
painful; about half of these infections result in
testicular atrophy, and in rare cases sterility can follow.
 COMPLICATIONS OF MUMPS CONT;
• Oophoritis (inflammation of ovaries) in about 5% of adolescent
and adult females, but fertility is affected in almost half of these
5%.
• Pancreatitis in about 4% of cases, manifesting as abdominal pain
and vomiting
• Encephalitis (very rare, and fatal in about 1% of the cases when
it occurs)
•pancreatitis, infertility, mastitis and arthritis.
 MANAGEMENT
 No specific treatment but treat symptoms as they present
 Treat complications if they occur
 Clean mouth with saline or tomato juice
 Give nutritious diet
 Ensure proper ventilation
• Bath at least once a day
 PREVENTION AND CONTROL

 Isolation of infected persons during the infectious period

 Proper disinfection of discharges of infected persons before
disposal.
 Left over foods of infected persons should be discarded
 Strict hygienic measures should be observed in cleaning
feeding items
 Separate feeding items of infected person from the others
 Health education especially on the dangers of the disease.
 Avoid crowded places especially where a known mumps case
is to reduce the spread of the disease.
 RUBELLA (GERMAN MEASLES)

•Description- it is an acute viral infection of little consequence unless it is

contracted during pregnancy. It results in serious congenital defects in children
born of infected mothers.
•Causative organism- rubella virus
•Reservoir- man
•Incubation period- 14-21 days
•Distribution- worldwide
•Susceptibility- general
•Mode of transmission-
a. Direct- through the droplet spread from infected persons.
• Indirect- through contact with articles soiled with secretions of infected
persons
 SIGNS AND SYMPTOMS-
 Prodromal period of headache, malaise, conjunctivitis and fever
 On the 2nd day, a rash of rose pink or macular spots appear on the
face
 The rash then spreads to the trunk and extremities
 The rash unites into one body and fades rapidly after 1-3 days
 Tender swelling of occipital lymph nodes
 COMPLICATIONS INCLUDE-

•encephalitis. In the first trimester of pregnancy, congenital defects like

cardiac defects, deafness, cataract and mental retardation. If contracted
during the last trimester the child is born with neonatal infections like
pneumonitis. There may be low birth weight and enlargement of the
liver.
•Management
 Give symptomatic treatment
 Give nutritious diet
 Ensure proper ventilation
 Bath at least once a day
 PREVENTION AND CONTROL

 Isolation of infected persons

 Proper disinfection of discharges of infected persons before
disposal.
 Pregnant women should avoid exposure to rubella infection
especially during the 1st four months
 Those who have been in contact with the disease should be
protected with gamma globulin of German measles
 Infection results in lifelong immunity
 Health education on the disease.
 Testing for susceptibility in women who are exposed to the
infection
 PULMONARY TUBERCULOSIS (T.B)
• Description- it is usually a chronic disease characterized by pulmonary cavity and
caseation.
• Tuberculosis usually affects the lungs as in pulmonary tuberculosis. It can also
affect other
• parts of the body causing other types of tuberculosis (extra pulmonary T.B)
• Causative agent- is mycobacterium tuberculosis, a tubercle bacillus. There are
many types but the human and bovine ones are common.
• Reservoir- is man, and cattle for the bovine strain.
• Incubation period- 4-12 days
• Distribution- worldwide
 MODE OF TRANSMISSION
• Direct exposure to droplets from sputum, sneezing and
coughing.
• Sputum coughed on the ground mixes up with the soil and dries
up the organisms which mix up with air to infect people when
they breathe in.
• . Indirect contact through contaminated articles like
handkerchiefs.
• Ingestion of un-pasteurized milk or its products from infected
 SIGNS AND SYMPTOMS
• Loss of appetite.
• Prolonged cough for about three weeks or more, with or without expectorant.
• Recent weight loss.
• Fatigue with least exertion.
• Shortness of breath.
• Night sweats.
• Coughing of bloody sputum.
• Hoarseness of voice.
Note- cough for three weeks or more is the cardinal symptom that is used to
suspect pulmonary tuberculosis.
 MANAGEMENT
• All affected or suspected persons should have sputum smear tested 3 times
when
• coughing has persisted for 3 weeks or more (early morning spot is examined).
• Patients with 3 or more negative sputum results will need an x‘ray to confirm
diagnosis.
• Room should be well ventilated with client sleeping at the leeward side of the
room
• Give nourished diet to boost immune system of client.
• Strenuous work should be avoided.
• Explain full details of treatment to client for compliance
• The Fix Dose Combination Strategy requires that:
• Every client should have what is called Treatment Supporter
who supervises the taking of the prescribed drugs while the
client is in the community. The supporter is chosen by the
client but is encouraged to choose people who are always in the
community, and who they can rely on.
• This person should not necessarily be a health worker,
however, a health worker who lives close to the client can also
be chosen as a treatment supporter.
• The role of the treatment supporter include:
• Ensure the client takes the drug daily and on schedule for the full duration of the treatment. Agree with
client on time and place of taking the drug (either the home of client or treatment supporter).
• Have knowledge on possible side effects and appropriate action to take
• Re-assure the client and always be there for him or her
• Give the drug and watch the client swallow it with water or milk after meals
• Record on the TB treatment card with a stroke.
• When client fails to come for drug, visit the home to find out the reason and give the drug.
• Go to the health centre to collect a re-supply of drugs each month with client Make arrangement with client
if you or client is to be away for a few days. Give enough drugs to take him self for a maximum of one
week or refer the client to the health centre to decide what to do.
• Monitor patient‘s progress of recovery
 TREATMENT
• The treatment of tuberculosis in the country has gone through a lot of transition with
implementation strategies over the years. Currently, there is a shift from the previous
treatment with the combination of six different drugs to the Fix Dose Combination
Strategy. The transition to this new strategy emphasizes community involvement in the
treatment of tuberculosis. The strategy aims at increasing compliance to the treatment
regimen of tuberculosis. It also aims at reducing the number of visits to the clinic which
was a maim cause for non-compliance. It also emphasizes community- based Directly
Observed Therapy (DOT), and de-emphasizes facility-based DOT.
• The treatment strategy has an initial phase of 2 months and continuation phase of 4 months
for new cases, and 2 months of initial phase re-treatment cases and 6months of
continuation phase.
• Treatment in the initial phase is given according to categories
• Initial Phase
• New cases (category 1) – A combination of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol
• Re-Treatment (Category 11) - A Combination of Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and
Streptomycin
• Children (Category111) – Children are given a combination of Isoniazid, Rifampicin and Ethambutol.
• Note that injection streptomycin is given only for re-treatment cases. Children are not given pyrazinamide.
• Continuation phase
• New cases (category 1) – Isoniazid and Rifampicin
• Re-Treatment (Category11) – Isoniazid, Rifampicin and Ethambutol
• Children (Category 111) – Children are given Isoniazid and Rifampicin.
• Note also that the treatment regimen has reduced in the continuation.
• Note:
• a. Streptomycin is oxytoxic to the foetus.The substitute
drug during pregnancy is Ethambutol.
• b. Thiacetazone is contra-indicated in HIV positive
clients. Substitute drug is Ethambutol
• c. Rifampicin can lower effect of oral contraceptives.
 PREVENTION AND CONTROL
• The strategy adopted for the control of tuberculosis in Ghana is the WHO recommended strategy known as
DOTS (directly observed treatment strategy).
• Adequate testing of sputum smears and x‘ rays to confirm early diagnosis.
• Prompt treatment of infected persons.
• Treatment should be under DOTS with the Mixed Dose Combination Strategy to ensure effectiveness and
compliance.
• Contacts should be investigated and treated.
• Regular drug supply to ensure continuous treatment.
• Proper handling of soiled articles of infected persons.
• Proper disposal of sputum of infected persons (add ash to sputum and bury).
• Avoid drinking raw or un-pasteurized milk.
• Proper veterinary services to eliminate the bacillus in the cattle.
• Miners, quarry workers and all people who work in dusty environments
should wear masks.
• The mouth and nose should be covered when coughing or sneezing.
• Indiscriminate spitting should be avoided.
• BCG immunization at birth.
• Health education on the disease.
• Education on the disease and treatment compliance
 PUBLIC HEALTH IMPORTANCE OF TUBERCULOSIS
• 1. It has a multiple drug treatment for along period of time, the cost of the drugs
is high therefore increases expenditure on government.
• 2. The infected persons need to have long treatment period before recovery, it
therefore reduces productivity.
• 3. The treatment of the disease puts pressure on health facilities and health
providers.
• 4. There possibility of non- compliance to treatment is high, which renders the
organisms more infectious to others, thereby increasing the spread of the
disease.
• 5. The disease has a long-standing stigma attached to its infection, and this
prevents infected persons from reporting early for treatment to be started early.
 INFLUENZA
• EPIDEMIOLOGY.
• Is a worldwide infection, in Eurasia, Africa, Australia, North
and South America and the Antartica.
• Influenza reaches peak prevalence in winter, and because the
Northern and Southern Hemispheres have winter at different
times of the year, there are actually two different flu seasons
each year.
•Description – it is an acute respiratory infection caused by a virus.
• Causative Organism – Influenza viruses (types A, B and C). The types A
and B are more common types that cause influenza.
•Reservoir- man
•Incubation Period- 3 -4 days.
• Distribution – The type A causes Pandemic occurrences (worldwide)
while the type B infections occur in epidemic and endemic forms.
•Susceptibility – General but children are more susceptible.
 CAUSATIVE ORGANISMS.

• Influenzavirus A
• Influenzavirus B
• Influenzavirus C
 INFLUENZA-VIRUS A

• The influenza A virus can be subdivided into different

serotypes based on the antibody response to these
viruses. The serotypes that have been confirmed in
humans, ordered by the number of known human
pandemic deaths, are:
 INFLUENZAVIRUS A
HEMAGGLUTININ NEURAMINIDASE(HN)

• H1N1, which caused Spanish Flu in 1918, and Swine Flu in 2009
• H2N2, which caused Asian Flu in 1957
• H3N2, which caused Hong Kong Flu in 1968
• H5N1, which caused Bird Flu in 2004
• H7N7, which has unusual zoonotic potentials.
• H1N2, endemic in humans, pigs and birds.
• H9N2
• H7N2
• H7N3
• H10N7
• H7N9
 INFLUENZA-VIRUS B

• This genus has one species, influenza B virus.

Influenza B almost exclusively infects humans and is
less common than influenza A.
 INFLUENZA-VIRUS C

• This genus has one species, influenza C virus, which

infects humans, dogs and pigs, sometimes causing both
severe illness and local epidemics.
• However, influenza C is less common than the other
types and usually only causes mild disease in children.
 INCUBATION PERIOD.

• For H5N1- 7 days or less and often 2-5 days.

• For swine influenza, 2-5 days.

• Reservoir of Infection – Aquatic birds for influenza A subtypes,

and particularly H5N1
• Some mammals includes Pigs, whales, Seals, Horses, Ferrets,
Cats, Dogs, Tigers etc.
 MODE OF TRANSMISSION.
Influenza can be spread in three main ways:
• by direct transmission (when an infected person sneezes
mucus directly into the eyes, nose or mouth of another
person).
• the airborne route (when someone inhales the aerosols
produced by an infected person coughing, sneezing or
spitting)
 MODE OF TRANSMISSION CONT;

• through hand-to-eye, hand-to-nose, or hand-to-mouth

transmission, either from contaminated surfaces or
from direct personal contact such as a hand-shake.
 SIGNS AND SYMPTOMS OF INFLUENZA.
• Fever and extreme coldness (chills shivering, shaking (rigor))
• Cough
• Nasal congestion
• Runny nose
• Body aches, especially joints and throat
• Fatigue
• Headache
• Irritated, watering eyes
• Reddened eyes, skin, (especially face), mouth, throat and nose
• In children, gastrointestinal symptoms such as diarrhea and abdominal pain,(may be
severe in children with influenza B)
SIGNS AND SYMPTOMS CONT;
 MANAGEMENT
 Supportive treatment with analgesics and antipyretics.
 More serious cases may require intensive ventilator support
 Ensure adequate ventilation
 Give a nourishing diet
 Give barrier nursing
• Sponge to reduce temperature
 MANAGEMENT OF INFLUENZA.

• Since influenza is caused by a virus, antibiotics have no

effect on the infection; unless prescribed for
secondary infections such as bacterial pneumonia.
• People with the flu are advised to get plenty of rest, drink
plenty of liquids, avoid using alcohol and tobacco and, if
necessary, take medications such as acetaminophen (
paracetamol) to relieve the fever and muscle aches associated
with the flu.
 MANAGEMENT OF INFLUENZA CONT;

• The two classes of antiviral drugs used against influenza are

neuraminidase inhibitors (oseltamivir and zanamivir) and
M2 protein inhibitors (adamantane derivatives).
Neuraminidase inhibitors are currently preferred for flu virus
infections since they are less toxic and possibly more
effective.
• Neuraminidase inhibitors include the antiviral medications
oseltamivir (Tamiflu) and zanamivir (Relenza). These
medications may be effective against both influenza A and B.
 COMPLICATIONS OF INFLUENZA.

• Pneumonia
Secondary bacteria pneumonia e.g. staphylococcus
aureus or Haemophilus influenza
• Coronary heart disease or congestive heart failure
 PREVENTION AND CONTROL
 DPT/HibHepB immunization against the type B.
immunization for type A is not effective.
 Isolation of infected persons till they recover
 Proper disposal of discharges of infected persons
 Notification of the condition to the health authority
 Health education on the disease.
 All other air-borne control measures
 MENINGITIS

• Description- it is an acute inflammation of the meninges caused by a

bacterium or virus.
• Causative organism- Neisseria meningitides,which is a meningococcus. The
commonest cause of outbreaks is the type A strain. It may also be caused by a
virus.
• Reservoir- man
• Incubation Period- 2 – 10 days but commonly 2 – 4 days.
• Distribution- worldwide. The commonest type in Ghana is cerebrospinal
meningitis (CSM) which occurs in epidemic forms.
• Susceptibility- children under 5 years are more susceptible, but in epidemics
all age groups may be affected.
 MODE OF TRANSMISSION-

a. Direct droplets from the nose and throat of infected persons or

carriers.
b.Indirect by contact with infected person’s discharges or contaminated
articles, but this mode is not common since the organism does survive
for long.
•The transmission of cerebrospinal meningitis is facilitated by
overcrowding situations, excessive hot weather and poorly ventilated
 SIGNS AND SYMPTOMS

 It starts suddenly with fever and rigor, severe headache and sometimes
convulsions
 There is general body pains and particularly in the neck muscles
 The neck muscles then becomes rigid and Kernig’s sign is positive
 Nausea and vomiting may be present
 Rashes on the skin
 Photophobia
 Contusion and coma
 In severe cases, deafness and mental insufficiency

 MANAGEMENT
 Sponging to reduce temperature
 Treatment with chloramphenicol and penicillin
 Good nutrition to improve resistance
 Proper ventilation in sleeping rooms
 Give nourishing fluids
 PREVENTION AND CONTROL

 Effective treatment of all infected cases

 Identify immediate contacts and give treatment
 Avoid cooking or setting fire in sleeping rooms, especially during hot weather.
 Proper disinfection of discharges of contaminated articles
 Avoid direct contact with infected persons
 Isolate all infected persons
 Avoid large gatherings during epidemics
 Careful surveillance during outbreaks for early diagnosis
 Immunization of people at risk with CSM vaccine from two years and above
 Notification of the disease to the health authority
 Health education on the disease.
 CHICKEN POX (VARICELLA ZOSTER)

• EPIDEMIOLOGY.
• Primary varicella occurs in all countries worldwide.
• Varicella has a prevalence that is stable from
generation to generation. As of 2010 it caused about
6,800 deaths, down from 11,200 in 1990.
 EPIDEMIOLOGY CONT;

• In temperate countries, chickenpox is primarily a disease of

children, with most cases occurring during the winter and
spring, most likely due to school contact. It is one of the classic
diseases of childhood, with the highest prevalence in the 4–10
year old age group. Like rubella, it is uncommon in preschool
children. Varicella is highly communicable, with an infection
rate of 90% in close contacts. In temperate countries, most
people become infected before adulthood, and 10% of young
adults remain susceptible.
• Description- it is an acute viral infection which has a sudden
onset with constitutional symptom and skin rashes.
•Causative organism - varicella zoster virus.
•Reservoir- man
•Incubation Period - 10-20 days
•Distribution- worldwide
•Susceptibility- general but tends to be severe in adults than in children.
•Mode of Transmission-
a. Direct through droplets spread from infected persons.
• Indirect through articles freshly soiled with discharges from the mucus
membrane and vesicles of infected persons
 MODE OF TRANSMISSION.
• Chickenpox is an airborne disease which spreads easily through
coughing or sneezing of ill individuals or through direct contact with
secretions from the rash. A person with chickenpox is infectious one
to two days before the rash appears. They remain contagious until all
lesions have crusted over (this takes approximately six days).
Immuno-compromised patients are contagious during the entire
period as new lesions keep appearing. Crusted lesions are not
contagious.
 CASE DEFINITION!
• Chicken Pox is a highly contagious disease caused by primary
infection with varicella zoster virus (VZV). It usually starts
with vesicular skin rash mainly on the body and head rather
than at the periphery and becomes itchy, raw pockmarks,
which mostly heal without scarring. On examination, the
observer typically finds skin lesions at various stages of
healing and also ulcers in the oral cavity and tonsil areas.
 SIGNS AND SYMPTOMS
 It begins with a prodromal period of 1-2 days – fever, headache, malaise.
 Eruption of the rash begins from the 2 nd day as macules, and progress to
papule, vesicles and finally leave a crust
 The lesions tend to be more on covered than exposed parts of the body
(centripedal distribution).
 Fever continues when new eruptions are to appear.
 The rashes appear in crops and are at different stages of maturity.
 The mouth lesions ulcerate and the virus is present in the saliva which
can spread to other people.
 The patient is no more infectious when mucosal lesions have healed.
 SIGNS AND SYMPTOMS OF CHICKENPOX
• The early (prodromal) symptoms in adolescents and adults
are nausea, loss of appetite, aching muscles, and headache.
This is followed by the characteristic rash and/or oral sores,
malaise, and a low-grade fever that signal the presence of the
disease. Oral manifestations of the disease (enanthem) not
uncommonly may precede the external rash (exanthem).
 SIGNS AND SYMPTOMS OF CHICKENPOX
• In children the illness is not usually preceded by prodromal
symptoms, and the first sign is the rash or the spots in the
oral cavity. The rash begins as small red dots on the face,
scalp, torso and upper arms and legs; progressing over 10–
12 hours to small bumps, blisters and pustules; followed by
umbilication and the formation of scabs.
 SIGNS AND SYMPTOMS CONT;
• At the blister stage, intense itching is usually present. Blisters may also
occur on the palms, soles, and genital area. Commonly, visible evidence
of the disease develops in the oral cavity and tonsil areas in the form of
small ulcers which can be painful or itchy or both.
• Because watery nasal discharge containing live virus usually precedes
both exanthem (external rash) and enanthem (oral ulcers) by 1 to 2 days,
the infected person actually becomes contagious one to two days prior to
recognition of the disease. Contagiousness persists until all vesicular
lesions have become dry crusts (scabs), which usually entails four or
five days, by which time nasal shedding of live virus also ceases.
 MANAGEMENT
 Give supportive treatment (no specific treatment)
 Barrier nursing and concurrent disinfection of articles
 Bath at least once a day with soft sponge with a little
disinfectant in water
 Apply calamine lotion after bath to sooth skin
 Control scratching of the skin lesions to prevent sores
 Apply gentian violet in the mouth lesions after cleaning
with saline solution.
 COMPLICATIONS OF CHICKENPOX.
• Damage to brain: encephalitis, microcephaly, hydrocephaly,
aplasia(incomplete development of brain).
• Damage to the eye: lens vesicles, cataracts, optic atrophy.
• Skin disorders: secondly skin infection, skin lesions heal
with scars (cicatrix).
 PREVENTION AND CONTROL

 Avoid contact with infected persons

 Infected children should be excused from school (isolation)
 Isolation of all infected cases
 Proper disposal and cleaning of soiled articles
 Cover mouth when coughing or sneezing
 Identify contacts, investigate and isolate them early
 Notification of the disease to the health authority.
 One attack confers life-ling immunity
 Health education on the disease.