DISEASE PREVENTION AND CONTROL

DR.K.ARULANANDEM

LECTURER/COORDINATOR

Disease Prevention And Control

A . Control of reservoir
B . Blocking the transmission C . Protecting the susceptible host

Chain of Infection

Control
Concept of control: The term disease control describes ongoing operations aimed at reducing: The incidence of disease The duration of disease and consequently the risk of transmission The effects of infection, including both the physical and psychosocial complications The financial burden to the community.

Control of infectious diseases (the 4 Cs

Control

Cases
Diagnosis notification isolation disinfection treatment follow up release
standard strict protective

Contacts

Carriers

Community

observation

detection

Epidemiological
Investigation & containment

Control the reservoir

a. b. c. d. e. f. Early diagnosis Notification Epidemiological investigation Isolation Treatment Quarantine

Early diagnosis is needed

1. To provide adequate treatment 2. To trace the primary source of Infection 3. To study descriptive epidemiology of disease 4. To initiate prevention and control measure

Aim of treatment
a. To reduce the communicability period of
the disease

b. To reduce the duration of illness

c. To interrupt the duration of exposure to others

Notification
Notification is an important epidemiological information source of

One an infection disease has been detected /suspected it should be notified to various health authorities to enable them to take adequate control measures.

Epidemiological investigation
It is conducted during the disease outbreak Investigation for 1.Nature of agent (Indigenous/Exogenous) 2.Primary source for infection 3.Mode of transmission 4.Person distribution 5.place distribution 6.Available social measures 7.What should be done to combat the disease

Isolation
Separation of the infected person/animal during the period of communicability in order to prevent transmission of the infectious agent to the susceptible host. The type of isolation varies with a . Mode of spread b . Severity of disease

It is not much use in subclinical or carriers

Treatment
1.Reduce the communicability of disease 2.Cuts short the duration of illness 3.Prevent development of secondary cases 4. Interrupting the transmission Treatment a. Individual b. mass

Quarantine
The limitation of freedom of movement of such well person or domestic animals exposed to communicable disease for a period of time not longer than the longest usual incubation period of the disease. (prevent effective contact with those not so exposed) Quarantine a. Absolute quarantine b. Modified quarantine c. Segregation Quarantine is replaced by active surveillance

Interruption of transmission
It is vary according to the modes of transmission 1.Direct a. Direct contact- use protective device b. Droplet- use protective device c. Inoculation through skin-protect body d. Transplacentalunmarried- marriage counselling Married-avoid pregnancy if necessary Pregnant-possible medicine e. Contact with soil-protect feet/body

2.Indirect a. Vehicle borne

Water-chlorinte/ozonation/Uvradiation Milk/food-food hygiene Blood-/serum/plasma-proper screening

b. Vector borne Vector controlAdult mosquito-residual spray/space spray Larva spraying of larvicidal oil over breeding source Other vector suitable chemical agents Entomological assessment

c. Air borne Incineration/burning

d. Fomite borne Autoclaving/disinfectant e. Unclean hands Personal hygiene/antiseptic

Susceptible host
1.Contact with patients - immunization(active/passive) 2.People in risk area -chemoprophylaxis

3.People in vulnerable group -avoidance of all allergens -health promotion

Prevention and control of communicable disease

1. Screening 2. Surveys 3. Diagnosis and treatment 4. Disinfectant 5. Chlorination of water 6. Use of insecticide

7.Immunization
8.Rehablitation 9.Other a. Epidemiological investigation b. Surveillance c. Entomological assessment d. Health education

Strategy for Prevention

Identify Populations at High Disease Risk
(based on demography / family history, host factors..)

Modify Existing Intervention Programs

Evaluate Intervention Programs

Assess Exposure

Apply Population-Based Intervention Programs

Conduct Research on Mechanisms

(including the study of genetic susceptibility)

 Control activities focus on primary prevention or secondary prevention, but most programs combine both.
control

elimination

eradication

Evaluation of control
Evaluation is the process by which results are compared with the intended objectives, or more simply the assessment of how well a program is performing. Evaluation should always be considered during the planning and implementation stages of a program or activity.

Evaluation may be crucial in identifying the health benefits derived (impact on morbidity, mortality, sequelae, patient satisfaction).
Evaluation can be useful inidentifying performance difficulties. Evaluation studies may also be carried out to generate information for other purposes, e.g., to attract attention to a problem, extension of control activities, training and patient management, etc.

Disease Elimination
Between control and eradication, an intermediate goal has been described, called "regional elimination" The term "elimination" is used to describe interruption of transmission of disease, as for example, elimination of measles, polio and diphtheria from large geographic regions or areas Regional elimination is now seen as an important
precursor of eradication

Disease Eradication
Eradication literally means to "tear out by roots". It is the process of Termination of all transmission of infection by extermination of the infectious agent through surveillance and containment. Eradication is an absolute process, an "all or none" phenomenon, restricted to termination of an infection from the whole world. It implies that disease will no longer occur in a population. To-date, only one disease has been eradicated, that is smallpox.

Monitoring
Monitoring is "the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population" (Thus we have monitoring of air pollution, water quality, growth and nutritional status, etc). It also refers to on -going measurement of performance of a health service or a health professional, or of the extent to which patients comply with or adhere to advice from health professionals.

To summarize
The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress. These goals are embodied in the word "prevention" Successful prevention depends upon a knowledge of causation, dynamics of transmission, identification of risk factors and risk groups, availability of prophylactic or early detection and treatment measures, an organization for applying these measures to appropriate persons or groups, and continuous evaluation of and development of procedures applied The objective of preventive medicine is to intercept or oppose the "cause" and thereby the disease process. This epidemiological concept permits the inclusion of treatment as one of the modes of intervention

Surveillance
surveillance means to watch over with great attention, authority and often with suspicion
According to another, surveillance is defined as "the continuous scrutiny (inspection) of the factors that determine the occurrence and distribution of disease and other conditions of ill-health"

Objectives of Surveillance
(a) to provide information about new and changing trends in the health status of a population, e.g., morbidity, mortality, nutritional status or other indicators and environmental hazards, health practices and other factors that may affect health

(b) to provide feed-back which may be expected to modify the policy and the system itself and lead to redefinition of objectives, and

(c) provide timely warning of public health disasters so that interventions can be mobilized.