CHAPTER 1 PUBLIC HEALTH

INFECTIOUS DISEASE
1. An infectious disease is a clinically evident disease of humans or animals that damages or injures the host so as to impair host function, and results from the presence and activity of one or more pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multi-cellular parasites, and aberrant proteins It is a disease caused by a microorganism that is potentially transferable to new individuals. Example: HIV, Malaria 2. A communicable disease is an infectious disease that readily spreads from person to person, and is easily caught from an infected person. Example: a cold or chicken pox 3. A non communicable disease an infectious disease (i.e., with a microorganism etiology) that is not typically spread from person to person. The distinction, not spread from person to person, is important since it implies not only that: i. individuals carrying the disease are not likely to spread the disease to others ii. whatever led to the infection in such an individual likely did not include person to person contact Example : Cancer, Asthma, Heart Disease

DISEASE CAUSED BY CONTAMINATION

1. Waterborne Disease Waterborne diseases are caused by pathogenic microorganisms which are directly transmitted when contaminated fresh water is consumed. Waterborne disease can be caused by protozoa, viruses, or bacteria, many of which are intestinal parasites

Water borne diseases spread by contamination of drinking water systems with the urine and feces of infected animal or people. This is likely to occur where public and private drinking water systems get their water from

surface waters (rain, creeks, rivers, lakes

etc.), which can be contaminated by infected animals or people. Runoff from landfills, septic fields, sewer pipes, residential or industrial developments can also sometimes contaminate surface water. Example of Waterborne Disease 1. Diarrhea
is caused by a bacterial, viral, or parasitic infection. Diarrhea may be accompanied by cramping, abdominal pain, nausea, an urgent need to use the bathroom, or loss of bowel control. Some infections that cause diarrhea can also cause a fever and chills or bloody stools.

2. Cholera Cholera occurs because of the bacteria present in water contaminated by incorrect sanitation, or in improperly cooked fish, especially shellfish Cholera is transmitted through feces contaminated with the bacterium. The contamination normally appears when sewage water is released into the waterways, affecting the drinking water, fish and food washed in the water. In normal conditions it doesn't spread from person to person, but this is possible in poor sanitary conditions. Common symptoms include severe diarrhea abdominal cramps, fever and vomiting. If not treated immediately, the dehydration can cause death through circulatory volume shock in just a few hours. Cholera can be prevented by respecting a number of sanitary rules

3. Typhoid Fever is caused by the infection with a bacterium called Salmonella typhi. It is very common, as it is transmitted by water or food contaminated with feces from infected people. symptoms including a high fever, slowly rising from 39 to 40 degrees Celsius (103 to 104 degrees Fahrenheit), chills, bradycardia (low pulse rate) and weakness Typhoid fever can be dangerous, and if untreated, it has a mortality rate between 10 and 30%. A vaccine is available and it is highly recommended for anyone traveling to regions where typhoid fever is common. 4. Dysentery Dysentery is characterized by a severe inflammation of the intestines, affecting the body in a significant measure. Dysentery used to be a common disease in the past centuries, but it is becoming less common today. Pathogen agent : Shigellosis, caused by Shigella bacteria, an amoeba called Entamoeba histolytica that transmitted by contaminated water The usual sign of epidemic dysentery is blood appearing in the feces, associated with diarrhea, abdominal cramps, fever and rectal pain. Sepsis and kidney failure may occur in more severe cases.

Prevention Clean water is a pre-requisite for reducing the spread of water-borne diseases It is well recognized that the prevalence of water-borne diseases can be greatly reduced by provision of clean drinking water and safe disposal of feces

Water is disinfected to kill any pathogens that may be present in the water supply and to prevent them from growing again in the distribution systems

Disinfection is then used to prevent the growth of pathogenic organisms and to protect public health and the choice of the disinfect depends upon the individual water quality and water supply system. Without disinfection, the risk from waterborne disease is increased.

The two most common methods to kill microorganisms in the water supply are: oxidation with chemicals such as chlorine, chlorine dioxide or ozone, and irradiation with Ultra-Violet (UV) radiation

2. Food borne Disease is any illness resulting from the consumption of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food, rather than chemical or natural toxins. Cause by improper handling, preparation, or food storage. More than 250 different food borne diseases have been described. Most of these diseases are infections, caused by a variety of bacteria, viruses, and parasites that can be food borne Common food borne disease 1. Campylobacter is a bacterial pathogen that causes fever, diarrhea, and abdominal cramps. It is the most commonly identified bacterial cause of diarrheal illness in the world. These bacteria live in the intestines of healthy birds, and most raw poultry meat has Campylobacter on it. Eating undercooked chicken or other food that has been contaminated with juices dripping from raw chicken is the most frequent source of this infection.

2. Salmonella is also a bacterium that is widespread in the intestines of birds, reptiles and mammals. It can spread to humans via a variety of different foods of animal origin. The illness it causes, salmonellosis, typically includes fever, diarrhea and abdominal cramps. In persons with poor underlying health or weakened immune systems, it can invade the bloodstream and cause life-threatening infections. 3. E. coli is a bacterial pathogen that has a reservoir in cattle and other similar animals. Human illness typically follows consumption of food or water that has been contaminated with microscopic amounts of cow feces. The illness it causes is often a severe and bloody diarrhea and painful abdominal cramps, without much fever. In 3% to 5% of cases, a complication called hemolytic uremic syndrome (HUS) can occur several weeks after the initial symptoms. This severe complication includes temporary anemia, profuse bleeding, and kidney failure. Prevention 1. Keep clean Wash your hands before handling food and often during food preparation Wash your hands after going to the toilet Wash and sanitize all surfaces and equipment used for food preparation Protect kitchen areas and food from insects, pests and other animals 2. Separate raw and cooked Separate raw meat, poultry and seafood from other foods

 Use separate equipment and utensils such as knives and cutting boards for handling raw foods Store food in containers to avoid contact between raw and prepared foods 3. Cook thoroughly Cook food thoroughly, especially meat, poultry, eggs and seafood Bring foods like soups and stews to boiling to make sure that they have reached 70C. For meat and poultry, make sure thatjuices are clear, not pink. Ideally, use a thermometer Reheat cooked food thoroughly 4. Keep food at safe temperatures Do not leave cooked food at room temperature for more than 2 hours Refrigerate promptly all cooked and perishable food (preferably below 5C) Keep cooked food piping hot (more than 60C) prior to serving Do not store food too long even in the refrigerator Do not thaw frozen food at room temperature 5. Use safe water and raw materials Use safe water or treat it to make it safe Select fresh and wholesome foods Choose foods processed for safety, such as pasteurized milk Wash fruits and vegetables, especially if eaten raw Do not use food beyond its expiry date 3. Vector Disease

Occur in infectious microbes such as viruses, bacteria, parasite, etc that present in a vector.
Mosquito, birds, rat, insects and all others pests that transfer diseases are referred to as a vector.

The vector picks up the disease organism from an infected host, an animal or a human, and transmits it either to an intermediary host or directly to the human host.

The transfer happens directly by bites, or infestation of tissues, or indirectly through disease transmission.

Example of Vector Disease No 1. Vector Aedes Mosquito Disease Chikungunya Dengue Virus West Nile Virus Yellow Fever 2. 3. 4. Anopheles Mosquito Bird Rats Malaria Avian influenza (Bird flu) Leptospirosis Plague (via Fleas) Leishmaniasis (via Sand Fly)

Symptom of disease 1.Dengue Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 314 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults. Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue. It is important to maintain hydration. Use of acetylsalicylic acid (e.g. aspirin) and non steroidal antiinflammatory drugs (e.g. Ibuprofen) is not recommended. Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical

diagnosis and careful clinical management by experienced physicians and nurses increase survival of patients In January 2009, reported there are 5000 cases of dengue.

2. Malaria Malaria is a major disease in the tropics and subtropics. Each year, it is estimated that more than 225 million cases of malaria, killing around 781 000 people according to WHO. Historical records suggest that the disease has infected human since the beginning of mankind. When a person is infected, he or she will suffer symptoms including fever, chills, headache, muscle pain, sweating or vomiting. Severe cases will progress to coma and death. These symptoms normally appear between 10 to 15 days after being bitten by the Anopheles mosquito. The disease can also be transmitted from a mother to her unborn baby and by blood transfusions. 3. Bird Flu Bird flu or avian influenza is a highly contagious disease which can cause sickness and death especially in domesticated birds like chickens, geese, ducks and turkeys. Bird flu is caused by avian influenza (AI) virus which normally only infects birds, less commonly pigs and rarely horses, seals, whales, humans and other animals. There are many subtypes of AI virus. The subtype H5N1 currently circulating among birds worldwide was first detected in 1997. Since 2003 has spread among many countries in Asia and Europe causing heavy mortalities in poultry flocks and wild birds. Over 200 million poultry and birds have died or were killed since 1997 due to this virus. The H5N1 virus is also capable of causing disease in humans under certain circumstances. Malaysia has been free from bird flu until August 2004 when cases were detected for the first time, in Kelantan. The disease was promptly eradicated

and Malaysias disease-free status was reinstated on 5 January 2005. Isolated cases are again reported exactly one year later, in Kuala Lumpur which is being eradicated. This disease can spread by migration birds and movement of infected bird Birds get infected when they come into contact with these, with dead birds and with contaminated feed and water, equipments, vehicles and other objects. Virus is shed in feces, saliva and nasal secretions of infected birds. Avian influenza viruses do not usually infect humans but people can contract the disease through close contact with infected poultry and the feces. Only 140 human cases reported, mostly in South East Asia (Vietnam, Thailand, Indonesia, Cambodia and China) with over 70 deaths, despite widespread outbreaks in poultry and wild birds. 4. Leptospirosis Leptospirosis is a most common zoonotic disease caused by Leptospira Interrogans bacterium, which affects both humans and animals. It is transmitted through contaminated fresh water, food or soil which is swallowed or comes in contact with broken skin, eyes and mucous membranes. This Leptospira spreads through infected animals urine and contagious while it is moist. Rats, mice and voles known to be primary hosts while dogs, deer, rabbits, cows, sheeps, and certain marine mammals are possible carrier and known to be secondary hosts. This biphasic disease normally begins with flu-like symptoms such as fever, chills and intense headache. It will then cause meningitis, renal failure and liver damage that cause jaundice.

Disease Transmission

NON COMMUNICABLE DISEASE

1. Lead Lead accounts for most of the cases of pediatric heavy metal poisoning (Roberts 1999). It is a very soft metal and was used in pipes, drains, and soldering materials for many years. Millions of homes built before 1940 still contain lead (e.g., in painted surfaces), leading to chronic exposure from weathering, flaking, chalking, and dust. Every year, industry produces about 2.5 million tons of lead throughout the world. Most of this lead is used for batteries. The remainder is used for cable coverings, plumbing, ammunition, and fuel additives. Other uses are as paint pigments and in PVC plastics, x-ray shielding, crystal glass production, and pesticides.

Since lead is chemically very similar to calcium, it is handled by the body as if it were calcium. Thus the first place to which it is transported is to the plasma and the membrane sites in soft tissues. It is then distributed to the other sites where calcium plays an important role, most notably in the teeth of developing children and in bone at all ages.

Target organs are the bones, brain, blood, kidneys, and thyroid gland

2. Mercury Mercury is generated naturally in the environment from the degassing of the earth's crust, from volcanic emissions. It exists in three forms: elemental mercury and organic and inorganic mercury. Mining operations, chloralkali plants, and paper industries are significant producers of mercury (Goyer 1996). Atmospheric mercury is dispersed across the globe by winds and returns to the earth in rainfall, accumulating in aquatic food chains and fish in lakes (Clarkson 1990). Mercury compounds were added to paint as a fungicide until 1990. T These compounds are now banned; however, old paint supplies and surfaces painted with these old supplies still exist. Mercury continues to be used in thermometers, thermostats, and dental amalgam. (Many researchers suspect dental amalgam as being a possible source of mercury toxicity [Omura et al. 1996; O'Brien 2001].) Medicines, such as mercurochrome and merthiolate, are still available. Algaecides and childhood vaccines are also potential sources. Inhalation is the most frequent cause of exposure to mercury. The organic form is readily absorbed in the gastrointestinal tract (90-100%); lesser but still significant amounts of inorganic mercury are absorbed in the gastrointestinal tract (7-15%). Target organs are the brain and kidneys.

3. Insecticide Pesticides are designed to kill "pests", but some pesticides can also cause health effects in people. The likelihood of developing health effects depends on the type of pesticide and other chemicals that are in the product you are using, as well as the amount you are exposed to and how long or often you are exposed. Most often, pesticides affect the nervous system (system in your body that controls your nerves and muscles). Some health effects from pesticide exposure may occur right away, as you are being exposed. Some symptoms may occur several hours after exposure. Other effects may not be noticed for years, for example cancer. Pesticides can enter your body during mixing, applying, or clean-up operations. There are generally three ways a chemical or material can enter the body: o o o through the skin (dermal), through the lungs (inhalation), or by mouth (ingestion).

In general, the risk of illness increases as the concentration (strength) of the pesticide, and duration (length) of exposure increases. "How much" and "how long" is necessary to cause illness will depend on the exact type of pesticide

4. Asbestos Asbestos is the name given to a group of naturally occurring minerals used in certain products, such as building materials and vehicle brakes, to resist heat and corrosion. Asbestos includes chrysotile, amosite, crocidolite, tremolite asbestos, anthophyllite asbestos, actinolite asbestos, and any of these materials that have been chemically treated and/or altered. The inhalation of asbestos fibers by workers can cause serious diseases of the lungs and other organs that may not appear until years after the exposure has occurred.

For instance, asbestosis can cause a buildup of scar-like tissue in the lungs and result in loss of lung function that often progresses to disability and death.

Asbestos fibers associated with these health risks are too small to be seen with the naked eye, and smokers are at higher risk of developing some asbestos-related diseases

Employee exposure to asbestos must not exceed 0.1 fiber per cubic centimeter (f/cc) of air, averaged over an 8-hour work shift. Short-term exposure must also be limited to not more than 1 f/cc, averaged over 30 minutes. Rotation of employees to achieve compliance with either permissible exposure limit (PEL) is prohibited.

5. Cadmium Cadmium is a byproduct of the mining and smelting of lead and zinc It is used in nickel-cadmium batteries, PVC plastics, and paint pigments. It can be found in soils because insecticides, fungicides, sludge, and commercial fertilizers that use cadmium are used in agriculture. Cadmium may be found in reservoirs containing shellfish. Cigarettes also contain cadmium. Lesser-known sources of exposure are dental alloys, electroplating, motor oil, and exhaust. Inhalation accounts for 15-50% of absorption through the respiratory system; 2-7% of ingested cadmium is absorbed in the gastrointestinal system. Target organs are the liver, placenta, kidneys, lungs, brain, and bones. 6. Nitrate Nitrates and nitrites are chemicals that can be found naturally in our environment. Two of earths most common elements, nitrogen and oxygen, combine to form these nitrogen-containing compounds. Nitrates are essential (needed) nutrients for plants to grow. Nitrates can be found in the air, soils, surface waters and ground water

The main exposure route to nitrates is by eating vegetables and preserved meats (70%). The remainder of the nitrate in a typical diet comes from drinking nitrate-contaminated water (about 21%)

Exposure to nitrates and nitrites are not usually an immediate (acute) health threat. When you eat or drink nitrates, they are absorbed from the small intestine (gut) into the blood. Nitrates then enter the large intestine from the blood.

If certain, normal conditions exist in the intestine, such as a low pH, the nitrate is simply processed and removed as waste without any harmful effects.

However, under other conditions, such as a high pH in the intestine, the nitrate will be changed into nitrite. This nitrite is then reabsorbed into the blood where it will react with the bloods hemoglobin iron to form methemoglobin.

The hemoglobin in our blood carries (transports) oxygen throughout our body. The condition where the nitrite reacts with the iron and hemoglobin is known as methemoglobinemia (often called blue baby syndrome). Unlike hemoglobin that carries oxygen throughout our body, methemoglobin is unable to transport oxygen. A person who has methemoglobinemia can lack the proper oxygen levels needed for the body to function correctly. One of the signs of methemoglobinemia is cyanosis (turning a blue color).

7. Particular Matter Particular matter is the sum of all solid and liquid particles suspended in air, many of which are hazardous. This complex mixture contains for instance dust, pollen, soot, smoke, and liquid droplets Particles are either directly emitted into the air by sources such as combustion processes and windblown dust, or formed in the atmosphere by transformation of emitted gases such as SO2.

In long-term exposure to current ambient particulate matter concentrations may affect the lungs of both children and adults and may reduce life expectancy by a few months, mainly in subjects with pre-existing heart and lung diseases.

Fine particles are more dangerous than coarse particles. Apart from the size of the particles, other specific physical, chemical, and biological characteristics that can influence harmful health effects include the presence of metals, PAHs, other organic components, or certain toxins.

When particulate matter is combined with other air pollutants, the individual effects of each pollutant are cumulated. In certain cases, especially for combinations of particulate matter with ozone or allergens, effects were shown to be even greater than the sum of the individual effects.

Certain groups of people are more susceptible to suffer health effects due to ambient particulate matter. These include elderly people, children, people with a pre-existing heart and lung disease, asthmatics, and socially disadvantaged and poorly educated populations.

8. Dioxin Dioxins are a group of chemically-related compounds that are persistent environmental pollutants. Dioxins are found throughout the world in the environment and they accumulate in the food chain, mainly in the fatty tissue of animals. More than 90% of human exposure is through food, mainly meat and dairy products, fish and shellfish. Many national authorities have programmes in place to monitor the food supply. Dioxins are highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer. Short-term exposure of humans to high levels of dioxins may result in skin lesions, such as chloracne and patchy darkening of the skin, and altered liver function.

Long-term exposure is linked to impairment of the immune system, the developing nervous system, the endocrine system and reproductive functions. Chronic exposure of animals to dioxins has resulted in several types of cancer.

No

Type of Heavy Metal

Source/Exposure

Organ Target/ Disease

1.

Lead

Used in pipes, drains, and soldering materials for many years. Transport to soft tissues Target organs are the bones, brain, blood, kidneys, and thyroid gland

Exposure from weathering, flaking, chalking, and dust.

Used for batteries. The remainder is used for cable coverings, plumbing, ammunition, and fuel additives.

Other uses are as paint pigments and in PVC plastics, x-ray shielding, crystal glass production, and pesticides.

2.

Mercury

generated naturally in the environment from the degassing of the earth's crust, from volcanic emissions

Target organ: brain and kidney.

Mining operations, chloralkali plants, and

paper industries are significant producers of mercury Used in paint, thermometer medicine and medical equipment 3. Insecticide Expose by inhalation From pesticide enter body during mixing, applying, or clean-up agriculture operations 4. Asbestos used in certain products, such as building materials and vehicle brake cause serious diseases of the lungs and other organs 5. Cadmium byproduct of the mining and smelting of lead and zinc used in nickel-cadmium batteries, PVC plastics, and paint pigments. can be found in soils because insecticides, fungicides, sludge, and commercial fertilizers that use cadmium are used in agriculture. Cadmium may be found in reservoirs containing shellfish Cigarette Effect liver, placenta, kidneys, lungs, brain, and bones. Absorb in respiratory system and gastrointestinal system affect the nervous system

6.

Nitrate

is by eating vegetables and preserved meats from drinking nitratecontaminated water From dust, pollen, soot, smoke, and liquid droplets emitted into the air by sources such as combustion processes

baby blue syndrome lack of oxygen heart and lung disease High risk to elderly people, children, people with a preexisting heart and lung disease, asthmatics, and socially disadvantage

7.

Particular Matter

8.

Dioxin

a group of chemicallyrelated compounds that are persistent environmental pollutants.

cause reproductive and developmental problems,

exposure is through food, mainly meat and dairy products, fish and shellfish.

damage the immune system, interfere with hormones

also cause cancer.