Communicable Diseases

 Most important concern

 Epidemiology originates from study of
infectious diseases
 Cholera – father of public health
 Leading cause of mortality and morbidity
worldwide .
 Developing countries
 Children.
 Infectious disease : disease resulting from
infection
 Communicable disease: illness capable of
being transmitted from man to man, animal to
animal ,environment to animal.
 Contagious disease: disease transmitted
through contact.
 Types
Sporadic

Endemic

Epidemic

Pandemic

Exotic
Disease control phases

 Control

 Elimination

 Eradication
 Polio (1988-2008)
ELIMINATION

CONTROL
Chain of Transmission
Epidemiological Triad
 Epidemiological Triad
SOIL

SEED SHOWER
 Source of Infection
 Human
 Cases
 Carriers

 Animal

 Non living
 Modes of transmission
Direct:
Direct contact
Droplet infection
Contact with soil
Inoculation into skin / mucosa
Transplacental
 Modes of transmission
• Indirect :
 Vehicle borne

 Vector borne
 Mechanical
 Bilological
 Modes of transmission
 Air borne
 Droplet nuclei
 Dust

 Fomite borne

 Unclean hands & fingers

Chain of Transmission
Control of reservoir /source
 Early diagnosis
 Prompt treatment
 Notification
 Epidemiological investigation
 Isolation
 Quarantine
 Interruption of transmission

 Changing some components of man’s

environment eg. Safe water ,sanitation

 Behavioural changes

 Vector control
Strengthening the susceptible host

 Imunization
 Active

 Passive

 Chemoprophylaxis
 Non specific measures
 Communicable Diseases
• Respiratory
• Gastro –Intestinal
• Zoonoses –Rabies
• Surface Infection –Leprosy /STI
• HIV & AIDS
Respiratory Diseases
 Respiratory diseases
Bacterial- Viral –
 Pneumonia (acute  Measles
respiratory infections)  Mumps
 Diphtheria  Rubella
 Whooping cough  Influenza
 Meningococcal  SARS
meningitis
 Tuberculosis

Fungal
Aspergillosis
Coccidiomycosis
Mode of transmission
 Direct transmission
 Droplet

 Air borne transmission

 Hands
 Fomites
 Risk factors
 Close proximity
 Over crowding
 Poor ventillation
 Indoor air pollution
 Poor hygiene
 Measles
 Disease of childhood
 Leading killer among vaccine prevetable
diseases of childhood.
 Endemic all over the world
 Epidemics when proportion of unimmunized
children reach 40%
 Less common in developed countries
Magnitude

160,000-Deaths
 Agent & Source
 Agent : RNA- paramyxovirus

 Measles cases are only source of infections

 Highly infectious 5 days before and after

appearance of rash

 Secondary attack rate =90%

 Host
 6 months to 3 years ,higher age groups in
developed countries

 Equal in both sexes

 Maternal antibodies protective till 6 months

 Very severe in malnourished children.

 Clinical features
Prodrome :
10 -14 days after infection
 Fever ,coryza, cough, sneezing, nasal discharge,

conjunctivitis,
• Koplik’s spot.
Rash :
 Maculo papular, begins behind the ear, become

confluent ,spreads to lower extremities in 2-3 day

,disappears leaving a brownish discoloration.
 Complications
 Post measles stage:
• Malnutrition ,incresed susceptibility to other
infections.
 Complications:

 Diarrhea ,Pneumonia ,Otitis media, Vit A

deficiency
 Encephalitis ,SSPE ( subacute sclerosing

pan encephalitis)
 Treatment
• No specific treatment
• Symptomatic relief
• Adequate hydration
• Nutrition
• Vitamin A
• Isolation till rash subsides
 Prevention and control
 Vaccine – HDC –Edmonston Zagreb strain
 Live attenuated vaccine
 Sub cutaneous single dose at 9
th month.

 Control
 Isolation for 7 days.
 Immunization of contacts
 Tuberculosis
 Very ancient disease
 ‘Kshaya’
 1882 – Robert Koch
 Chronic infectious disease
 Primarily affects lungs –pulmonary TB
 Also effects other organs –extra pulmonary
TB
 Pulmonary TB most important
 Tuberculosis in India
 TB is one of the leading causes of mortality in India-
 Kills -2 persons every three minute, nearly 1,000 every
day

 299: Estimated Prevalence (per 100,000 population, incl

HIV-positive) (2006)

 75: Estimated Incidence (new sputum smear positive

[ss+] per 100,000 population) (2006)
• Prevalence of TB infection
– 40%
– With a 10% lifetime risk of TB disease in the absence of HIV

• Estimated Multi-drug resistant TB

– < 3% in new cases
– 12% in re-treatment cases

• TB-HIV
– 10-15% annual risk (60% lifetime risk) of
developing active TB disease in PLWHA
– Estimated ~ 5% of TB patients are HIV
infected
Agent
 Mycobacterium tuberculosis
 Source of infection :
 Human case – sputum positive

 Bovine sources –occasionally

Social factors
 Poor quality of life
 Poor housing
 Overcrowding
 Large families etc…
 Host
 Age – max infection around 15 yrs
max cases in 25-34 yrs
 Males
 Nutrition
 Hereditary ??
 Immunity – cross infection & BCG.
 Air borne transmission
 Incubation period - variable
 Cardinal symptoms
 Persistent cough 2 weeks

 Continuous fever

 Chest pain

 Haemoptysis
Sputum Microscopy
 Treatment categories
Category I Category II
New sputum smear +ve /- ve Sputum smear +ve Relapse
Extra pulmonary cases Sputum Smear +ve Failure
Sputum smear +ve Treatment after
default

2H3R3Z3E3 + 2H3R3Z3E3S3 +
4H3R3 1H3R3Z3E3 +
5H3R3E3

Category IV –Chronic tuberculosis

 Vaccination
 Bacillus Calmette Guerin –live attenuated
 Freeze dried vaccine
 Dosage : 0.05ml at birth, 0.1ml at 1 month
 Intradermal ,left shoulder ,Tuberculin syringe
 0-20%, 15-20 years
 Protects against invasive childhood TB.
 Prevention
 Early diagnosis and treatment of cases
 Screening of contacts
 Environmental measures
 Socio economic measures
 BCG vaccine
 Cough hygiene
 Health education
 ARI
 Most common infections
 Substantial mortality and morbidity in young
children .

 Problem statement
 Under 5s -5 episodes ARI per year
 20% of under 5 deaths
 Pneumonia – 2 million deaths
 40% outpatient visits
 1/3rd of admissions
 Equal incidence of ARI world over,
 ALRI more common in developing countries
 Causative agents
 Bacteria :
 Streptococcus, Staphylococcus
,Haemophilus,Bordetella
 Viral :
 Influenza A,B,C .Measles, Adenovirus,
Rhinovirus, RSV ,
 Others :
 Chlamydia,Mycoplasma.
 Risk factors
 Young age
 Overcrowding
 Poor nutrition
 Low birth weight
 Indoor air pollution
 Urban communities
 Low socio-economic status
 Management of Young infant <2 months
Signs Classify as Treatment
Stopped feeding well Very severe Give first dose antibiotic
Convulsions disease Keep baby warm
Abnormally sleepy REFER urgently
Stridor in calm child
Wheezing
Fever or low body
temperature
Severe chest in drawing Severe Give first dose antibiotic
Respiratory rate >=60 pm pneumonia Keep baby warm
REFER urgently, if referal not
possible close monitoring
No severe chest in drawing No pneumonia Advice mother on home care:
Respiratory rate <60 pm Cough and cold Keep baby warm
Breast feed frequently
Clear nose
Danger signs
 Management of child >2 months
Signs Classify as Treatment
Not able to drink Very severe disease Give first dose antibiotic
Convulsions REFER urgently
Abnormally sleepy Treat fever
Stridor in calm child Treat wheeze
Wheezing
Severe malnutrition
Chest indrawing ( if also Severe pneumonia Give first dose antibiotic
recurrent wheezing ,go REFER urgently
directly to treat wheeze ) Treat fever
Treat wheeze
If referal not possible close
monitoring
 Management of child >2 months
Signs Classify as Treatment
No chest indrawing Pneumonia Advice mother on home
RR > 50 pm (2-12 month care
old ) Give an antibiotic
RR > 40 pm (12-60 month Treat fever /wheeze
old ) Return after 2 days or
earlier
No chest indrawing No pnuemonia Cough >30 days –REFER
RR < 50 pm (2-12 month Cough and cold Assess ear /throat problem
old ) Home care
RR < 40 pm (12-60 month Treat fever/wheeze
old ) Return after 2 days or
earlier
 Reassess after 2 days
Condition Action

Worse REFER
Not able to drink
Chest indrawing
Danger signs
Same Change antibiotic
REFER
Improving Finish 5 days antibiotic
Breathing slower course
Less fever
Eating better
 Vaccine preventable ARI
• Measles
• Diptheria
• Pertusis (whooping cough)
 Mumps

 Rubella

 HiB pneumonia

 Pneumococcal pneumonia

 Influenza

 Chicken pox
Control of respiratory infections
 Education of mother
 Improved nutrition
 Improving primary health care
 Immunization
 Early detection & treatment
 Control of indoor air pollution
 Improvement of overall socio-economic
conditions
Enteric diseases
 Symptoms
 Diarrhea

 Vomiting

 Pain abdomen

 Loss of appetite
 Causative agents
BACTERIAL VIRAL
 Typhoid -Polio
 Cholera -Rotavirus
-Norwalk
 E.coli
 Shiegella
PARASITIC
 Food Worms
poisoning Cryptosporidium

FUNGAL
MODES OF TRANSMISSION
WATER

FINGERS

HOST
FOOD
FAECES

FLIES

SOIL
 SANITATION BARRIER
WATER

FINGERS

HOST
FOOD
FAECES

FLIES

SOIL
 General control measures
Environmental sanitation

Safe water supply

Personal hygiene

Health education

Early diagnosis and transmission

POLIOMYELITIS
 Magnitude
 Pre vaccination era –all over the world
2011:
 Endemic countries –

India,Pakistan,Afghanistan,Niger
 12 countries- imported cases

 1 case in 2011

 Gujarat last case -2007 Mar.

 Polio virus
 P1 ,P2, P3
 Rapidly inactivated by pasteurization not by
common disinfectants .
 Man is only reservoir
 Mostly subclinical, mild
 No chronic carrier
 All age groups -6 months – 3 years
 Maternal antibodies protect for 6 months
 Risk factors
 Fatigue
 Trauma
 Intramuscular injection
 Tonsillectomy

Infectious – 7-10 days before /after disease

 Environmental factors
 Rainy season
 Contaminated water ,food, flies
 Over crowding
 Poor sanitation
 Stages
 In-apparent (subclinical ) infection-
91-96 %
 Abortive polio or minor illness 4-8%
 Non paralytic polio 1%
 Paralytic polio < 1%
 Fever & prodromal symptoms
 Descending assymetric paralysis
 No sensory loss
 Residual parlysis
 Prevention
 Inactivated (Salk) polio vaccine –IPV
 Oral (sabin ) polio vaccine –OPV
 Trivalent vaccine
 0 dose – at birth

 1
st dose -6 weeks

 2
nd dose -10weeks

 3
rd dose -14 weeks

 Booster at 18 & 60 months

Cold chain
 Pulse Polio
 1995
 Sudden simultaneous ,mass administration of
OPV on a single day to all children 0-5 years
of age regardless of previous immunization.
 NID /SNID
 November –February
 Extra doses
 No minimum interval
Typhoid
 Endemic in many developing countries
 2004 – 21 million cases
 2.5 -6 lakh deaths

India :
 1% of children upto 17 years of age every

year
 6.5 lakh cases & 417 deaths.
 Agent :
 Salmonella typhi
 Salmonella paratyphi A &B
 Gram negative bacilli
 Readily killed by drying ,pasteurization ,
common disinfectants

 Reservoir :
 Man (cases / carriers)
 All age groups , 5-19 years
 More cases reported among males
 Cell mediated immunity is protective
 Natural Typhoid infection does not conform
solid immunity.

Mode of Transmission:
 Faeco-oral
 Urine –oral
 Environmental factors
 July –Sep (rainy season)
 Water pollution
 Open air defaecation / urination
 Low food / personal hygiene
 Health ignorance

Index of general sanitation in the country

 Symptoms
Days Symptoms /signs Complications
First 7-10 days Step ladder fever None
Malaise,Headache ,cough,
Sore throat
Pain abdomen with altered
bowel habits
Second 7-10 days Continous fever Intestinal haemorrhages
Rashes
Toxic looks
Coated tongue
Splenomegaly
3rd -4th week Continous fever Intestinal perforation
Toxic looks Pneumonia
Myocarditis
Osteomyelitis
Diagnosis :
 Bacterial culture : Blood ,Urine

,Stool,Bonemarrow
 Antibodies : Widal & Typhidot

Treatment :
 Depending upon condition of patient

 Antibiotics :Ciproflaxacin ,Chloromphenicol,

Cephalosporins
 Control
 Control of reservoir
 Cases
 Carriers

 Vaccination :
 Live oral (Ty21a) vaccine
 Subunit (Vi polysaccharide) vaccine

 General sanitation methods

 Safe water
 Heath education
Acute Diarrheal Diseases
 Passage of loose, liquid or watery stools

 Acute -<2 weeks

 Chronic -> 2 weeks

 Blood in stools –Dysentry.

 Magnitude
 Major health problem in Under 5 children
about 17% of mortality.
 3.2 episodes per child year
 Around 2.2 million deaths in 2005
 4% of all deaths and 5% of health loss to
disability
 Causative agents
VIRAL BACTERIAL
-Rotavirus  Typhoid
-Norwalk  Cholera
- Entero virus -  E.coli
Adenovirus
 Shiegella
OTHERS  Food
Worms poisoning
Giardia
Entamoeba
Cryptosporidium
 Appropriate case management
 More fluids than usual - oral rehydration salts
solution (ORS), Home available fliuids (HAF)
to prevent dehydration.

 Continue feeding.

 Consulting a health worker if there are signs

of dehydration or other problems.
Signs of dehydration
 Control of Diarrheal Diseases
Short term :
Appropriate case management

Long term:
Preventive strategies
Environmental sanitation
Safe water
Immunization
Health education
Worms
 Magnitude
 ‘Big three' (Ascaris, Hookworm &
Trichuris)
 Rarely fatal
 Considerable morbidity
 Global occurence
 WARM /Moist regions of the world
especially Developing countries
Factors contributing to Worm
infestations
 Common worms
Biological name Common name

1 Ascaris / Strongyloides Round worm

2 Ancylostoma Old world Hook worm

3 Necator American Hookworm

4 Entrobius Pin worm/ Thread worm

5 Trichuris Whip worm

6 Taenia Tape worm

 Problems due to worms
 Malnutrition
 Anaemia
 Allergic conditions
 Complications
 Poor development in children
 Decreased work capacity /performance
 Control of Worm infestation
• General methods:
 Proper sanitation practices.
 Appropriate & safe faeces disposal.
 Safe water.
 Good personal /food hygiene.
 Prompt and thorough treatment of infected
persons.
 Health eduncation.
 Mass drug admiistartion. (Albendazole,
Mebendazole)
 Specific methods:

 Personal protection of persons entering

an endemic areas, such as wearing
shoes.(Hook worm)

 Eating properly cooked meat.(Taenia )

 Eating properly cooked vegetables.

(Whip worm)
Zoonoses
 Zoonosis
 Diseases and infections which are naturally
transmitted between vertebrate animals and
man.
Reservoir Host Type of Zoonoses
Lower Vertebrate Man Anthropo-zoonoses

Man Lower Vertebrate Zoo-Anthroponoses

Both Both Amphizoonoses

Rabies
 Introduction

 Hydrophobia (in Man)

 Acute highly fatal disease of CNS

 Lyssa Virus Type 1

 Disease of cornivorous animals

• Always fatal.
 Magnitude
Worldwide
 150 countries
 Canine rabies 99%.
 55,000 deaths & 15 million -PEP.
India :
 30,000 deaths
 1.5 million PEP.

WHO/rabies/mediacentre
Agent :
 Lyssa virus type 1
Reservoir :
 Urban rabies – Dogs
 Wild life /Sylvatic rabies – Fox, Jackal etc..
 Bat rabies –Vampire bats
Source :
 Infected animal
Modes of transmission:
 Animal Bite
 Licks
 Aerosols
• Occupational Hazard
• Vaterinarians, Dog handlers, Hunters, those
working with Rabies virus
Clinical features

 1-3months incubation
 Prodromal symptoms:
Tingling sensation at the site of bite.
 Widespread excitation and stimulation of all
parts of nervous system.
 Mental changes
 End stage – spasms
,convulsions,Hydrophobia, Paralysis, coma.
 Treatment
 100% Fatal.
 No specific treatment
 Isolation
 Sedatives ,Muscle relaxants , Hydration,
Supportive therapy.
 Patients are potentially infectious
 Managing Dog bite
 Local treatment of wound
 Cleansing
 Chemical treatment.
 Avoid suturing
 Local antibiotics
 Anti tetanus measures
 Immunization – anti-serum /Vaccine
 Observe animal for 10 days
Vaccines:
 Nervous tissue vaccine

 Duck embryo vaccine

 Cell culture vaccine

• Human diploid cell vaccine

• Second generation tissue culture
vaccines.
 Post exposure prophylaxis
HDCV / Cell culture vaccine
 Intra muscular
 0,3,7,14,28 th day
 Intra dermal schedule also available
Pre exposure prophylaxis
 Intramuscular / Intradermal
 0,7,28 th day.

Adverse effects:
 Redness , pain ,headache ,fever.
 Control of Urban Rabies
 Registration & licensing of dogs
 Restraint on dogs in public
 Destruction of dog placess/cats bitten by rabid
animals
 Vaccination of dogs
 Controlling stray dog population
Leprosy
 Agent
• M.Leprae
• Occurs in the clumps or bundles
• Affinity for Schwann cells and cells of RE
system
• >20 antigens detected, important is PGL
• Not grow in artificial medium

• Source of infection: CASES

• Portal of exit: Nose /Skin

141
 Host
• All ages are susceptible
• A high prevalence, if seen among
children indicate that disease is
active
• More in males than females
• Immunity

142
 Environment
• Humidity and overcrowding favors

• Poverty

• Occupations –trauma

143
 Cardinal Features Of
Leprosy
• Hypo pigmented patches
• Partial or total loss of sensation in
the affected area
• Presence of thickened nerves

• Presence of Acid Fast bacilli in skin

or nasal smear

144
INDIAN CLASSIFICATION
1. Indeterminate Leprosy

2. Tuberculoid Leprosy

3. Borderline Leprosy

4. Lepromatous Leprosy

5. Pure Neural Leprosy 145

 WHO classification
Paucibacillary Multibacillary
147
 Management

• Prevention of deformity

• Rehabilitation

• Social issues

148
 STDs are a series of transmissible diseases
which spread primarily through sexual
activity.

 STDs can affect both genitourinary apparatus

and many other organs.

 RTI /STI /STD

 Classics venereal diseases

 Classics venereal diseases

– Syphilis
– Gonorrhea
– Chancroid
– Granuloma inguinale
– Venereal lymphogranuloma
 Sexually transmitted disease
 Urethritis  Tinea cruris
• Vaginitis  Scabies

• Genital herpes • Pediculosis inguinalis

• Genital warts
•AIDS /HIV
•Hepatitis B Virus
• Trichomoniasis
• Candidiasis of the
genitals
 Route of transmission

 Sexual behavior (directly dissemination) the

main mode of transmission, account for
above 95% of the whole cases

Spread though blood and blood products

 Other routes of transmission

 Iatrogenic infection: germ-carrying medical

appliance
• Spread though placenta
• Spread though obstetric canal
• Ascending infection: birth membranes
,amniotic fluid
 Host factors
 Age group – 20-24 years

 Cases more in Males

 Complications more in Females

 More common among single, divorced

 Lower socio-economic status.

 Social factors
 Prostitution
 Broken homes
 Sexual disharmony
 Easy money
 Emotional immaturity
 Urbanisation
 Social disruption
 Changing behaviour patterns……..
Specific diagnosis

Vs

Syndromic approach
 Syndromic approach
 Male :
 Urethral discharge
 Scrotal swelling
 Epidydemitis / Orchitis
 Females:
 Vaginitis / Cervicitis / urtheritis
 Salpingitis
 Infertility
Common syndromes:
 Genital ulcers
 Inguinal bubo
 Lower abdominal pain
 Proctitis
 Genital warts /carcinoma
 AIDS
 Control of STDs
 Case detection:
 Screening
 Contact tracing
 Cluster testing

 Case holding and treatment

 Contact /Epidemiological treatment.

 Personal prophylaxis
 Barrier contraception
 Vaccines

 Health education
 Other measures
 Primary health care

 Social welfare measures

 Information systems

 Legislations.
HIV & AIDS
 HIV – Human Immunodeficiency Virus 1 & 2
 AIDS – Aquired Immuno Deficiency
Syndrome

 HIV AIDS

 Life long infection

 Medications -prolong life but do not cure the
disease
Number of people infected
 HIV/AIDS Scenario in India

Categorization of Districts Estimated PLHIV - 2.47

based on HIV Sentinel
Surveillance Data (2004-06)
million (2—3.1 million)

Adult HIV prevalence - 0.36%

(0.29%-0.46%)
•156 A Category Districts
•39 B Category Districts
•Evidence of HIV positivity
among IDU in Punjab, WB,
Kerala and Orissa besides
North East

4/16/2019 168
 HIV Transmission
HIV enters the bloodstream through:
 Open Cuts
 Breaks in the skin
 Mucous membranes
 Direct injection
Mode or transmission Percentage (%)
Sexual 85.3
Perinatal 3.8
Blood products 2.05
IV drug use 2.34
Others 6.46
Modes of transmission
 HIV-Infected T-Cell

HIV HIV Infected New HIV

T-Cell T-Cell Virus
Virus
 Clinical features

 Oppurtunistic infections.

 Syndrome
 Window Period
 This is the period of time after becoming
infected when an HIV test is negative

 90 percent of cases test positive within three

months of exposure

 10 percent of cases test positive within three

to six months of exposure
 HIV Testing
 Requires a blood

 HIV test detects the body’s antibody response

to HIV infection

 The test does NOT detect the HIV virus

 HIV Risk Reduction
 Avoid unprotected sexual contact
 Use barriers such as condoms
 Limit multiple partners by maintaining a
long-term relationship with one person
 Talk to your partner about being tested
before you begin a sexual relationship
 HIV Risk Reduction
 Avoid drug and alcohol use to maintain good
judgment
 Don’t share needles used by others for:
Drugs
Tattoos
Body piercing
• Avoid exposure to blood products
• Prevention of mother to child transmission.
ABC of HIV reduction
Abstinence

Be faithful

Condom
 AIDS control

 Health education

 Specific protection

 Primary health care.