Download Communicable Disease Control

COMMUNICABLE DISEASE CONTROL
Lecture (13)
Communicable Disease Control
2

Communicable disease poses a major
threat to public health and is of
significant concern to community health
nurses. A communicable disease is one
that can be transmitted from one person
to another. It is caused by an agent that is
infections (capable of producing infection)
and is transmitted from a source, or
reservoir, to a susceptible host.
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
Knowledge of communicable diseases is
fundamental to the practice of community
health nursing because these diseases typically
spread through communities of people.
Understanding of the basic concepts of
communicable disease control, as well as the
numerous issues arising in this area, helps a
community health nurse work effectively to
prevent and control communicable disease in
population and groups.
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
It also helps nurses teach important and
effective
preventive
measures
to
community members, advocate for those
affected, and protect the well-being of
uninfected persons (including the nurses
themselves).
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Basic concepts regarding communicable diseases:
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Evolution of Communicable Disease Control:
 Communicable
diseases have challenged
health care providers for centuries. They have
led to the development of countless nursing
and medical preventive measures, form simple
procedures such as hand-washing, sanitation,
and proper ventilation to the research and
development of vaccines and antibiotics.
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
Because these preventive measures have
greatly reduced the spread of
communicable disease, many people
consider communicable diseases to be a
threat of the past.
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
Yet the is not so. Communicable diseases,
particularly those of epidemic and
pandemic proportions, such as TB and
acquired immunodeficiency syndrome
(AIDS), continue to cost millions of lives
and billions of dollars to the global
human society every year.
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Global Trends:
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
During ht last several decades, substantial
progress has been made in controlling
some major infectious diseases around the
world, although other diseases have not
been managed as well. The following are
some of the major accomplishments:
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
The WHO's Expanded Program on
Immunization (EPI) was launched in 1974.
as a result, by 1995, more than 80% of
the world's children had been immunized
against diphtheria, tetanus, whooping
cough, poliomyelitis, measles, and TB,
compared with fewer than 5% in 1974
(WHO, 1998)
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Global eradication of smallpox was
achieved in 1980.
 In
1988, a campaign for global
eradication of poliomyelitis by the year
2000 was launched. Reported cases
worldwide have declined by 99% since
the campaign began.

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Polio
No cases of polio were reported since
1988.
The
combined
vaccination
programme of Oral Polio Vaccine (O.P.V.)
and Inactivated Polio Vaccine (I.P.V.) has
been implemented since 1978. The
national vaccination coverage is almost
100%.
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
Measles Palestine is considered by WHO to
be in the phase of eliminating this disease.
Measles elimination means that no measles
cases should occur inside the country but cases
could be imported from other countries and the
virus could circulate inside the country without
infection. The serosurvey of 2005 showed that
more than 98% of children had high immunity
against measles.
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
Only sporadic cases were reported in the
last ten years. Measles diagnosis,
hospitalization and treatment are offered
free of charge, as for other vaccinepreventable diseases.
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Neonatal tetanus
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The global goal set by WHO to eliminate
Neonatal Tetanus (NT) was achieved in
Palestine since 1990, as was recognized
by two expert missions from WHO/EMRO
that visited Palestine. Elimination means
that NT cases should be one case or less
reported for every 1,000 newborns per
year per district.
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
Two booster doses are given to all
children, one at school entry level and the
other at age 15. Tetanus toxoid is given
to every pregnant woman more than 28
years of age, with no documentation of
previous immunization for six doses. The
situation was aided by hospital deliveries
that reached 95% of all births.
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Hepatitis B
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
The prevalence of Hepatitis B in Palestine was
dramatically reduced after the introducing of
the Hepatitis B vaccine in the national
immunization schedule in early 1992. The
incidence of Hepatitis B in 1989 was around
7% and in 2000 it was around 3.4%.
Expectation for 2006 should not exceed 2%,
meaning that Palestine passed from an
intermediate to a low endemic country.
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
As for other diseases, no diphtheria cases
were reported in the past 20 years.
Tuberculosis is reported in adults only and
sporadic cases of pertussis are reported
yearly. A huge mumps outbreak was
averted following the Measles, Mumps
and Rubella (MMR) campaign that
targeted the group of 6-25 years old in
2005.
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
Building a computerized networking
system for all districts for better data
monitoring and surveillance of diseases at
the Ministry of Health, with the help of a
Management Information System has
improved and harmonized data collection
and reporting between Gaza, the West
Bank and UNRWA.
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Some major problem communicable diseases
and areas remain, including the following:
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Malaria remains a major threat, even though
the mortality rate has improved in the last 25
years.
 Cholera was mainly confined to Asia in the
early 20th century through improvements in
sanitation elsewhere. However, a series of
pandemics have affected much of the world
since 1960 and have become more
widespread and more frequent in Africa since
1970s.
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
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TB has made a powerful resurgence in the
last 3 decades as many countries let their
control programs become complacent.
WHO declared TB a global emergency in
1993.
 Emerging diseases are rarely or never
before seen.

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
Resurging
diseases
are
those
communicable diseases that have been
endemic in some parts of the world but
are now endemic in more countries and
are increasing to epidemic proportions in
others.
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Modes of Transmission:
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
The reservoir of infection can be a
person, animal, insect, or inanimate
material in which the infectious agent lives
and multiplies and which serves as source
of infection to others. Transmission of a
communicable disease can occur by direct
or indirect methods
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Direct Transmission:
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
Direct transmission occurs by immediate
transfer of infectious agents from a reservoir to
a new host. It requires direct contact with the
source, through touching, biting, kissing, or
sexual intercourse, or by the direct projection
of droplet spray onto the conjunctiva or onto
the mucous membranes of the eye, nose or
mouth during sneezing, coughing, spitting,
laughing, singing, or talking. Direct transmission
is limited to a distance of 1 meter or less.
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Indirect Transmission:
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
Indirect transmission occurs when the
infectious agent is transported within
contaminated inanimate materials such as
air, water or food. It is also commonly
referred to as vehicle borne transmission.
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Airborne Transmission:
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
Airborne transmission occurs through droplet
nuclei – the small residues that result from
evaporation of fluid form droplets emitted by
an infected host. They may also be created
purposely by atomizing devices or accidentally
in microbiology laboratories. Because of their
small size and weight, they can remain
suspended in the air for long periods before
they are inhaled into the respiratory system of
a host
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Primary Prevention:
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in the context of communicable disease
control, two approaches are useful in
achieving primary prevention:
 Education using mass media and targeting
health messages to aggregates.
 Immunization.

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Education:
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Health education in primary prevention is directed
both at helping at – risk individuals understand
their risk status and at promoting behaviors that
decrease exposure or susceptibility.
Use of Mass Media for Health Education :
 All people need to be informed about the risks of
communicable disease. Often, use of the mass
media is the most effective way to reach the
largest number or people.

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Immunization:
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
Control of acute communicable diseases
through immunization has been a common
practice since the 19th century in the
United States. Immunization is the process
of introducing some form of diseasecausing organism into a person's system to
cause the development of antibodies that
will resist that disease.
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
In theory, this process makes the person
immune to that particular infectious
disease (i.e., able to resist a specific
infectious disease-causing agent).
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Vaccine-Preventable Diseases
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
Vaccine-preventable disease (VPD), such
as hepatitis B, H. influenza type b,
measles, polio, diphtheria, pertussis, and
chickenpox, are diseases that can be
prevented through immunization.
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
The vaccination programme in Palestine is
one of the best worldwide. The expanded
programme of immunization (EPI) includes
not only vaccination supplies and
coverage, but also vaccination cold chain
equipment, vaccine efficacy, side effects,
adverse events (complications), monitoring
and supervision and disease surveillance
and
safety
injections.
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
More than 100,000 newborns are
provided yearly with all the different
antigens
(vaccines)
according
the
Palestinian
EPI
schedule.
Around
1,200,000 injections and 300,000 doses
are administered on a daily basis with no
serious
adverse
events
following
immunization.
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
In 1995, when the Palestinian Authority
took over, a national EPI committee was
established from both the West Bank and
Gaza. This committee included experts
from the Medical Paediatric Association in
addition to one observer from the World
Health Organization (WHO) and another
observer from the United Nations
Children’s Fund (UNICEF).
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
The main role of the committee is
monitoring and evaluating the EPI’s
activities and planning for any other
activities that should be implemented,
including the introduction of new vaccines,
outbreak response, campaigns for global
goal achievement and recommendations
to improve the performance indicators of
vaccine-preventable disease surveillance.
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Schedule of Recommended
Immunizations:
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
Current recommendations call for a child
to receive ten different vaccines or
toxoids (many in combination form and all
requiring more than one dose) in six or
seven visits to a provider between birth
and school entry, with boosters in the
preteen to early teen years (CDC, 2003).
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Children vaccination Programme in Palestine
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Sight
Vaccine
Time
Oral drops
Lt. outer mid. Thigh IM
Rt. outer mid .thigh IM
Outer mid.thigh IM
OPV
DPT
Hep.B
Hib.
2nd month
Oral drops
Lt. outer mid. Thigh IM
Rt. outer mid .thigh IM
OPV
DPT
Hep.B
4th month
Oral drops
Lt. outer mid. Thigh IM
Rt. outer mid .thigh IM
OPV
DPT
Hep.B
6TH month
Rt upper arm subcut.
Outer mid.thigh IM
Measles
Hib.
9th month
Oral drops
Lt. outer mid. Thigh IM
OPV (Booster dose)
DPT (Booster dose)
12-24 month
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Children vaccination Programme in Palestine
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Herd Immunity:
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
Herd immunity is central to understanding
immunization as a means of protecting community
health. As described in chapter 8, it is the
immunity level present in a particular population
of people (Chin, 1999). If there are few immune
persons within a community, there is low herd
immunity and the spread of disease is more likely.
Vaccination of more individuals in the community,
so that a high proportion has acquired resistance
to the infectious agent, contributes to high herd
immunity.
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
High herd immunity reduces the probability that
the few unimmunized parsons will come in contact
with one another, making spread of the disease
less likely. Outbreaks may occur if the
immunization rate falls to less than 85%
(scutchfield & Keck, 2001) or if unimmunized
susceptible persons are grouped together rather
than dispersed throughout the immunized
community. An example of lack of herd immunity
is presented in the Global Community.
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Barriers to Immunizations Coverage:
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
Improving immunization coverage requires
examination of reasons that children are
not immunized. Many barriers exist. They
include religious, financial, social, and
cultural factors; philosophical objections;
and provider limitations that from barriers
adequate immunization.
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Adult Immunization:
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Many people erroneously assume that
vaccinations are for children only. Welladvertised influenza vaccination campaigns in
recent years have helped somewhat to correct
this notion.
 International
Travelers, immigrants, and
Refugees That amount of time is within the
incubation period of most infectious diseases,
and microbial agents are rapidly spread
around the globe.
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
SECONDARY PREVENTION:
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There are two approaches to secondary
prevention of communicable disease:
 Screening
 Contact investigation, partner notification,
and case-finding.

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Screening
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The term screening is used in community
health and disease prevention to describe
programs that deliver a testing
mechanism to detect disease in groups of
asymptomatic,
apparently
healthy
individuals.
 Venereal Disease Research Laboratory
(VDRL)
 A syphilis diagnosis.

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Screening is a secondary prevention
method because it discovers those who
may have already become infected in
order to initiate prompt early treatment.
 It is important to remember that the
screening itself is not diagnostic but rather
seeks to identify those persons with
positive or suspicious findings who require
further medical evaluation or treatment.

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Criteria for Screening Tests:
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
Validity and Reliability. The screening test
must be valid and reliable. Validity
refers to the test's ability to accurately
identify those with the disease. Reliability
refers to the test's ability to give
consistent results when administered on
different
occasions
by
different
technicians.
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
Predictive Value and Yield. The predictive
value of a screening test is important for
determining whether the screening
intervention is justified. Yield refers to the
number of positive results found per
number tested.
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Contact Investigation, Partner Notification, and
Case-Finding
 Another secondary prevention approach is
known as contact investigation, partner
notification, and case-finding. In this approach,
the community health nurse seeks to discover
and notify those who have had contact with a
person diagnosed with a communicable
disease such as with TB and to notify partners
in the case of STDs.
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
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
The objective of contact investigation and
partner notification is specifically to reach
contacts of the index case (diagnosed
person) before the contacts, in turn,
become infectious (CDC, 2002c).
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Tertiary Prevention:
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
The approaches to tertiary prevention of
communicable disease include isolation
and quarantine (‫ َك َر ْن ِتينا‬, ٌ‫ص ِحي‬
ِ ٌ‫ ) َم ْح َجر‬of the
infected person and safe handling and
control of infectious wastes.
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Thank you
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