Download Approved

"Approved"
on a methodical conference
department of infectious diseases and epidemiology
"
" __________ 2008
Protocol №
Сhief of dept, professor
V.D. Moskaliuk
METHODOLOGICAL INSTRUCTIONS
To a fifth year student of the Faculty of Medicine
On independent preparation for practical training
TOPIC: PREVENTION AND ANTI-EPIDEMIC MEASURES AGAINST
ESPECIALLY DANGEROUS INFECTIONS (PLAGUE, CHOLERA).
Subject:
Major:
Educational degree and qualification
degree:
Year of study:
Hours:
Epidemiology
Medicine
Specialist
5
2
Prepared by assistant professor
Sydorchuk A.S., MD.
1. Topic: Prevention and Anti-epidemic Measures against Especially Dangerous Infections
(plague, cholera).
2. Lesson duration: 2 hours
3. Aims of study:
3.1. Students must know:
- aetiology of plague, cholera;
- social conditions that promote occurence and spreading of especially dangerous
infections;
- mechanisms and transmission ways of infection stimulus in case of plague and
cholera;
- sequence of epidemiologic inspection of the nidus;
- actions to eliminate epidemic nidus of plague and cholera according to the scheme:
isolation forms (hospitalization) of a patient, subsequent care of people who already
had the illnesses, disinfection methods and disinfectants, preventive measures for
healthy people (observation).
- rules of discharge of reconvalescents.
3.2. Students must be able to:
- draw up an epidemiological analysis;
- develop indications to conduct epidemiological inspection of the nidus;
- make a plan of anti-epidemic measures to destroy nidi of especially dangerous
infections;
- fill in medical documents of an epidemic inspection of nidus (emergency information
report, epidemiologic inspection card, control card of patient under clinic
observation);
3.3. Students must master the following practical skills:
- how to draw up an epidemiological anamnesis and analysis of the information
received;
- how to fill in document forms;
- how to do an inspection of the epidemiological nidus of especially dangerous
infections;
- how to make a plan of counteractions on the base of epidemiological inspections of
the nidus.
4. Students are advised to:
- pay special attention to specific features of epidemiological inspection of nidi of
infectious illnesses of especially dangerous infections.
- pay attention to functional duties of epidemiologist who received informationon
occurrence of especially dangerous infection nidus;
- when drawing up an epidemiological anamnesis, take into consideration duration of
incubation period (minimum and maximum).
- pay attention to factors of transmission of plague and cholera.
Advances in the prevention and treatment of PLAGUE.
Patients, which suffer from plague necessarily, hospitalize in appropriate hospitals where
they are transported by ambulance.
Treatment should be started already on place of revealing of the patient. Early
prescription of antibiotics (during the beginning of disease), as a rule, salvages it life. Efficiency
of antibioticoterapy in later terms is considerably lowest.
From etiotropic agents the most effective - Streptomycinum. At the bubonic form
immediately infuse 1 gr. of preparation into muscle, and then in hospital indicate 0,5-1,0 gr. 3
times per day during one week. At a pulmonary and septic plague a dose of Streptomycinum
enlarge to 5-6 gr. Antibiotics of tetracyclines (Oxytetracycline, Chlortetracycline), 0,25-1,0
gr. 4-6 times antibiotics are recommended. From other antibiotics it is possible to indicate
Monomicin, Morphocyclin, Ampicilini. After clinical indications it will be carried out
pathogenic and symptomatic treatments.
After normalization of a body temperature and reception of negative datas of bacteriological
researching from nasopharynx, sputum, punctate of bubones- patients leave hospital after 4-6
week.
Dispensary observation during 3 months it’s necessary for reconvalescense with obligatory
bacteriological researching from mucosa of pharynx and sputum.
It is necessary to protect people from expansion of plague diseases. This work is carried out
by workers of sanitation center, ambulatory - polyclinic network and antiplague establishments.
Plague is the quarantine diseases, so on it the international medicosanitary rules (WOPH, 1969)
there are distributed.
Workers of the general medical network observe health of the population with the purpose
of early revealing the patients on plague. Each medical worker should know the basic attributes
of disease, the rules of personal prophylaxis, be able to carry out initial antiepidemic actions.
At presence of epizootia among rats and diseases of camels vaccination of the population by
local services under the control of antiplague establishment will be carried out. As active
immunization use living plague vaccine (dose for epicutaneous indication for children till 7 years
1 billion, 7-10 years - 2 billion, adults 3 billion microbes bodies, at a hypodermic immunization
1/10 of epicutaneous doses). Immunity is kept during 6 months, then if it necessary will spend
revaccination in one year.
At occurrence of a plague among the population the antiepidemic actions carry out wich is
directed on localization and liquidation of epidemic pesthole. They include: revealing of patients
and their hospitalization in special hospitals in isolation wards with severe antiepidemic regime;
and establishment of territorial quarantine: revealing and isolation of all persons which was in
contact with patients they must be isolated for 6 days and will carry out emergency prophylaxis
by antibiotics - Streptomycinum 0,5 gr. 2 times per day in muscle or Tetracyclinum on 0,5 gr 3
times per day inside during 6 days); revealing the patients with fever and their hospitalization in
special departaments; final disinfection, and also disinfestation and deratization at territory of
settlement and around it. Invaluable things are liable to destruction. The personnel should be
work in antiplague costumes. For persons who need to leave zone of quarantine, will carry out an
observation.
MEASURES AGAINST CHOLERA
The measures of prophylaxis depend on epidemic situation in the country. The
information of world health organisation about cases of cholera in different countries
has an important meaning.
The incidence of disease can be diminished by sanitary-hygienic measures, sanitary
disposal of human feces, purification and protection of water supplies, pasteurization of
milk and milk products, strict sanitary supervision of preparation and serring of flood
exclusion of persons with diarrhea from handling food, organization of the work about
diseases of gastrointestinal tract and their examination on cholera.
Specific prophylaxis of cholera is performed by corpuscular vaccine and cholerogenanatoxin.
Parenterally inoculated killed complete cell vaccine has been available for years, this
vaccine stimulates high titers of serum vibriocidal antibodies, but it does not induce
antibodies to toxin. Protection by vaccine has been induced for approximately 1 years,
with vaccine efficacy approximately 70%. Local gastrointestinal tract immunity against
the organism and against the toxin should provide a better, less reactogenic
immunogen using recombinant DNA technology an ”attenuated” V. Cholerae organism
that lacks the genes for production of the A and B subunits of toxin was created. A
plasmid containing the subunit gene was then constructed and inserted. Thus a candidate
live V.cholera vaccine containing all the cell-was antigens necessary for adherence and
the capacity to produce only the subunit of toxin has been engineered.
MEASURES AGAINST ANTHRAX
It is estimated that approximately 20 percent of untreated cases of cutaneous anthrax will
result in death, whereas inhalation anthrax is almost always fatal. Deaths are. however, rare after
antimicrobial treatment in the cutaneous form.
Dressings with drainage from the lesions should be incinerated, autoclaved, or otherwise
disposed of as biohazardous waste. Patients with draining lesions should be placed in "contact
isolation." although this is superfluous is hospitals using "universal precautions." Person-toperson transmission has not been documented, including from patients with inhalation anthrax.
Immunization.
Both an attenuated live vaccine and a killed vaccine have been developed. However, the
only human vaccine in current use in the United States is the killed vaccine derived from a
component of the exotoxin. This vaccine was field tested in employees of four different textile
mills in the United States, and an effectiveness of 92,5 percent was demonstrated. This vaccine
should be used for all employees who may be exposed to contaminated materials or
environment. Additionally, anyone who comes into a mill processing B.antracis-contaminated
materials should also be vaccinated. Currently, the vaccine is given parenterally with three doses
given at 2-week intervals followed by three booster inoculations at 6-month intervals and the
annual booster inoculations. Veterinarians and other persons who, because of their occupation,
have potential contact with anthrax should also be immunized with the human anthrax vaccine.
The ability to prepare purified components of anthrax toxin by recombinant technology has
opened the possibility of new anthrax vaccines. For example, immunization with protective
antigen (PA) toxoid vaccines or PA-producing live vaccines elicits partial or complete protection
against anthrax infection and these new vaccines deserve careful field-testing.
5. Test questions
1. What is an epidemic nidus?
2. What does extent of the nidus depend on?
3. What are the sites a specialist must visit when carrying out epidemiological inspections?
4. How long does it take?
5. List of documents required registering results of epidemiological inspection, and their
significance.
6. List measures necessary to be taken to eliminate epidemic nidi, and their sequence.
7. When a nidus of an especially dangerous infection can be regarded eliminated?
8. Name the mechanism and ways of transmission of plague and cholera.
9. What is the epidemiological theory of correspondence? Its significance for applied
epidemiology.
6. References.
A. Basic:
Epidemiology and Fundamentals of Infectious Diseases. M.L. Volovskaya. Mir Publisher.
Moscow.
B. Adding:
A Lange Medical book. Medical Epidemiology. Second Edition. Raymond S.Greenberg, Stephen
R.Daniels. – Aplleton, Stamford, Connecticut. – 1996. – P.195.