COMMUNICABLE DISEASES

Communicable Diseases are Primary Cause of Mortality Gap between

Rich and Poor Countries

Non-communicable diseases account for 59% of all deaths worldwide

– estimated to rise from 28m in 1990 to 50m in 2020
About 60% of deaths caused by communicable diseases can be
attributed to:

HIV/AIDS
Malaria
Tuberculosis
Measles
Diarrheal disease
Acute respiratory infection

Philippines top 10 leading causes of morbidity & mortality in the

year 2007:

1. Diarrhea
2. Bronchitis
3. Pneumonia
4. Influenza
5. Hypertension
6. Tuberculosis
7. Malaria
8. Heart diseases
9. Cancer
10. Accidents
11. Chronic obstructive pulmonary disease and other respiratory diseases
12. Diabetes and Kidney diseases.

Goal of WHO
1. Prevention of disease
2. Prevention of disability and death from infection
3.Prevention through immunization

Chain of Infection
- Pathogen or causative agent
biologic agent (organism) capable of causing disease

Eliminate organism by:

• Sterilizing surgical instruments and anything that touches

sterile spaces of the body
• Using good food safety methods
• Providing safe drinking water
• Vaccinating people so they do not become reservoirs of
illness
• Treating people who are ill
Reservoir

Any person, animal, arthropod, plant, soil, or substance (or combination of these) in which an causative agent
normally lives and multiplies, on which it depends primarily for survival, and where it reproduces in such numbers
that it can be transmitted to a susceptible host

Eliminate reservoirs by:

• Treating people who are ill
• Vaccinating people
• Handling and disposing of body fluids responsibly
• Handling food safely
• Monitoring soil and contaminated water in sensitive areas of
the hospital and washing hands carefully after contact with
either

Portal of exit
- the way the causative agent gets out of the reservoir (body fluid or skin)

Reduce risk from portals of exit by:

• Covering coughs and sneezes with a tissue
• Handling body fluids with gloves, then doing hand hygiene
• Keeping draining wounds covered with a dressing
• Not working when you have exudative (wet) lesions or
weeping dermatitis

Mode of transmission
- any mechanism by which a pathogen is spread from a source or reservoir to a person unwashed hands,
things which are not cleaned between patients, droplets, or, for a few diseases, the air

Eliminate the mode of transmission by:

• Hand hygiene
• Wearing gloves to minimize contamination of hands and
discarding them after each patient
• Cleaning, disinfection, or sterilization of equipment used by
more than one patient
• Cleaning of the environment, especially high-touch surfaces

Portal of entry
- hole in the skin that allows the infectious agent to get into the body (mouth, nose, eyes, rashes, cuts,
needlestick injuries, surgical wounds and IV sites)

Protect portals of entry (our own and our patients) by:

• Dressings on surgical wounds
• IV site dressings and care
• Elimination of tubes as soon as possible
• Masks, goggles and face shields
• Keeping unwashed hands and objects away from the mouth
• Actions and devices to prevent needlesticks
• Food and water safety
Susceptible host
- a person or animal lacking effective resistance to a particular infectious agent

Minimize risk to susceptible hosts by:

• Vaccinating people against illnesses to which they may be exposed
• Preventing new exposure to infection in people who are already ill, are receiving immunocompromising treatment,
orare infected with HIV
• Maintaining good nutrition
• Maintaining good skin condition
• Covering skin breaks
• Encouraging rest and balance in our lives

MICROBES against HUMAN

Definition:
Symptoms
- evidence of disease that is experienced or perceived (subjective)
subjective changes in body function noted by
patient but not apparent to an observer
Signs
- objective evidence of a disease the physician can observe and measure

Syndrome
- a specific group of signs and symptoms that accompany a particular disease

Incidence
- the number of people in a population who develop a disease during a particular time period

Prevalence
- the number of people in a population who develop a disease, regardless of when it appeared refers to both
old and new cases

Classification of Infectious Disease

Based on Behavior within host

Infectious Disease

- Any disease caused by invasion and multiplication of microorganisms

Contagious Disease
- disease that easily spreads from one person to another

Based on Occurrence of Disease

Sporadic Disease

-disease occurs only occasionally i.e. botulism, tetanus

Endemic Disease

- constantly present in a population, country or community i.e. Pulmonary Tuberculosis

Epidemic Disease
- acquire disease in a relatively short period greater than normal number of cases in an area within a short
period of time

Pandemic Disease

-epidemic disease that occurs worldwide i.e. HIV infection

Based on Severity or Duration of Disease

Acute Disease

-develops rapidly (rapid onset) but lasts only a short time i.e. measles, mumps, influenza

Chronic Disease
-Develops slowly, milder but longer lasting clinical manifestation

Based on State of Host Resistance

Primary Infection
- acute infection that causes the initial illness

Secondary Infection
- one caused by an opportunistic pathogen after primary infection has weakened the body’s defenses

Stages of Disease

Incubation Period
- time interval between the initial infection and the 1st appearance of any s/sx

Prodromal Period
- early, mild symptoms of disease

Period of Illness
- overt s/sx of disease WBC may increase or decrease can result to death if immune response or medical
intervention fails

Period of Decline
- s/sx subside vulnerable to secondary infection

Period of Convalescence
- regains strength and the body returns to its
pre diseased state recovery has occurred

Mode of Transmission
- The process of the infectious agent moving from the reservoir to the susceptible host

Contact Transmission - the most important and frequent mode of transmission

Type of Contact Transmission

Direct Contact Transmission

• Person to person transmission of an agent by

• physical contact between its source and
• susceptible host
• No intermediate object involved
• i.e. kissing, touching, sexual contact
• Source → Susceptible Host

Indirect Contact Transmission

• reservoir to a susceptible host by means of a

• non living object (fomites)
• Source → Non Living Object → Susceptible Host

Susceptible Host

Recognition of high risk patients

• Immunocompromised
• DM
• Surgery
• Burns
• Elderly

Percentage Nosocomial Infection

• 17%Surgic a l
• 34%UTI
• 13%LRI
• 14%Bac te re mia
• 22%Other (incldng skin Infxn)

Factors for Nosocomial Infection

Microorganism/Hospital Environment

Most common cause

• Staph aureus, Coag Neg Staph Enterococci
• E. coli, Pseudomonas, Enterobacter, Klebsiella
• Clostridium Difficile
• Fungi ( C. Albicans)
• Other ( Gram (-) bacteria)
• 70% are drug resistant bacteria

Compromised Host
- One whose resistance to infection is impaired by broken skin, mucous membranes and a suppressed
immune system

Skin and Mucous Membrane

- physical barrier i.e. burns, surgical wounds, trauma, IV site invasive procedures
 Suppressed Immune System
- i.e. drugs, radiation, steroids, DM, AIDS

IMMUNITY
-The human body has the ability to resist almost all types of organisms or toxins that tend to damage the tissues
and organs. This is called immunity

Functions of Immune System

1. Protects the body from internal threats

2. Maintains the internal environment by removing dead or damaged

cells.
3. Provides protection against invasion from outside the body.
The immune system

The major components of the immune system includes the bone

marrow which produces the white blood cells (WBC), the lymphoid
tissues which includes the thymus, spleen, lymphnodes, tonsils and
adenoids.

Natural Immunity (INNATE)

Non-specific immunity present at birth. This includes;
a. Phagocytosis of bacteria and other invaders by white
blood cells and cells of the tissue macrophage system
b. Destruction by the acid secretions of the stomach and by

the digestive enzymes on organisms swallowed into the stomach.

c. Resistance of the skin invasion by organisms

d. Presence in the blood of certain chemical compounds that

attach to foreign organism or toxins and destroy them like lysozyme,

natural killer cells and complement complex.
Acquired Immunity

The human body has the ability to develop extremely

powerful specific immunity against individual invading agents. It usually
develops as a result of prior exposure to an antigen through
immunization or by contracting a disease.

Active Acquired Immunity - immune defense are developed by the

person’s own body. This immunity last many years or a lifetime.
Passive Acquired Immunity - temporary immunity from another source
that has developed immunity through previous disease or
immunization. It is used in emergencies to provide immediate, short
acting immunity when the risk is high.

ANTIBODIES
Agglutination - clumping effect of antibodies between two antigen. It
helps to clear the body of invading organisms by facilitating
phagocytosis.
Opsonization – in this process, the antigen-antibody molecule is
coated with a sticky substance that facilitates phagocytosis.
1. IgG (75%)
•
Appears in serum and tissues
•
Assumes a major role in bloodborne and tissue infections
•
Activates the complement system
•
Enhances phagocytosis
•
Crosses placenta
2. IgA (15%)
•
Appears in body fluids (blood,saliva, tears, breat milk)
•
Protects against respiratory, GIT and GUT
•
Prevents absorption of antigens from food
•
Passes to neonate in breast milk for protection
3. IgM (10%)
•
Appears mostly in intravascular serum
•
First immunoglobulin produced in response to bacterial or
viral infection
•
Activates complement systems
4. IgD (.2%)
Appears in small amount in serum
5. IgE (.004%)
Allergic and hypersensitivity reactions
Combats parasitic infections
IMMUNIZATION

AND VACCINES

IMMUNIZATION

Process inducing immunity artificially by either vaccination (active) or

administration of antibody (passive)
Active : stimulates the immune system to produce antibodies, cellular
immune responses to protect against infectious agent
Passive : provides temporary protection through administration of

exogenous antibody

IMMUNIZING AGENTS

Vaccines : a preparation of proteins, polysaccharides or nucleic acids

of pathogens that are administered inducing specific responses that

inactivate or destroy or suppress the pathogen
Toxoid : a modified bacterial toxin that has been made nontoxic but
retains the capacity to stimulate the formation of antitoxin
IMMUNIZING AGENTS

Immune globulin : an antibody containing solution derived from human

blood obtained by cold ethanol fractionation of large pools of plasma
and used primarily for immunodeficient persons or for passive
immunization

Antitoxin : an antibody derived from serum of human or animals after

stimulation with specific antigens used for passive immunity
Expanded Program of Immunization
launched in July 1976 by DOH with cooperation with WHO and
UNICEF.
Objective was to reduce the mortality and morbidity among infants and
children caused by the six childhood immunizable diseases.
PKI, Diptheria, Polio, Measles and tetanus
•
PD no. 996 (September 16, 1976)- compulsory immunization
for children below the age of eight.
•
RA 7896 (December 30,1994) – compulsory hepatitis B for
children below eight years old
•
PP no.1066 (August 26,1997) – national tetanus elimination
starting 1997
APPROACH TO ACTIVE IMMUNIZATION
LIVE ATTENUATED VACCINES
–
induce response similar to an active infection
–

Organisms in live vaccines : multiply in recipient until desired

immune response occurs, considered to confer lifelong
protection

–
 Ex. Measles, mumps, rubella

APPROACH TO ACTIVE IMMUNIZATION

INACTIVATED OR DETOXIFIED VACCINE

–
include whole organisms, detoxified exotoxin, purified protein
antigens, polysaccharide
–
Lesser antigenic mass, requires booster vaccinations to
provide protection
–
Ex. Hepa B, pertussis, tetanus, diphtheria, influenza B,

pneumococcal

EXPANDED PROGRAM OF IMMUNIZATION

A fully immunized child under EPI (before 12 months of age)

•
1 BCG at birth or before 12 months
•
3 DPT and 3OPV > 6weeks old, 4 weeks apart
•
3 Hepa B >6 weeks old, 4 weeks apart
BACILLE-CALMETTE-GUERIN (BCG)
•
Only intradermal vaccine
•
Attenuated bovine strains of tubercle bacilli (M.bovis)
•
Freeze-dried, easily destroyed by heat and sunlight
•
Dose : 0.05 ml ID