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TOPIC 5 Communicable Diseases Date: 13th February 2017 Presenter : D. NAIDU Department of Primary Health Care D.NAIDU -Community Population Centered Nursing COMMUNICABLE DISEASES D.NAIDU -Community Population Centered Nursing Objectives: 1. Understand the prevalence and Incidence of Common Communicable diseases in Fiji and the region. 2. Discuss the etiology of the common communicable diseases occurring in Fiji and the Pacific. 3. Discuss nursing strategies for prevention of common communicable diseases. D.NAIDU -Community Population Centered Nursing Communicable Disease An illness due to an infectious agent or its toxic products which is transmitted directly or indirectly to a person from an infected person or animal through the agency of an intermediate animal, host or vector, or through the inanimate environment. D.NAIDU -Community Population Centered Nursing Legal Aspects • Reporting of cases • Isolation and disinfection • Contact tracing • Disease investigation • Sanitation Policy • Building Policy Dorms , Kitchen • Animals – Chickens , cows , horses out of the village • Discrimination , counselling , testing, reporting and confidentiality • Litter Decree • Demolition order • Health and safety at workplace D.NAIDU -Community Population Centered Nursing WHAT ARE COMMUNICABLE DISEASE Diseases that are spread from one person to the next Diseases that are “catching” Diseases that are caused by germs or pathogens Examples of pathogens include: viruses, bacteria, protozoa, parasitic worms and fungi. Examples of common communicable diseases… Cold Flu Hepatitis Leptospirosis Dengue fever STD’s HIV/AIDS TB typhoid athogens include: viruses, bacteria, protozoa, parasitic worms and fungi D.NAIDU -Community Population Centered Nursing WHAT ARE COMMUNICABLE DISEASE Diseases are grouped according to; • Mode of transmission • Means of prevention • Rather than by individual organism. – An illness that is transmitted by contact with body fluids • directly transmitted • acquired from a person or vector (ticks, mosquitoes, or other animal) – indirectly transmitted • by contact with contaminated objects. D.NAIDU -Community Population Centered Nursing WHAT ARE COMMUNICABLE DISEASE The topic of infectious diseases includes a wide variety of organisms pathology they may cause, diagnosis, treatment, prevention and control. Diseases are grouped according to; • Mode of transmission • Means of prevention • Rather than by individual organism. D.NAIDU -Community Population Centered Nursing History Of Communicable Disease And Public Health Nursing • Share a long history- with the growth of urban areas in the early part of the 19th century, epidemics swept through communities • Hospitals were unsanitary hot beds of infection –and often considered places where people went to die • In 1900, epidemics of communicable diseases were the leading cause of death throughout the world D.NAIDU -Community Population Centered Nursing History of Communicable Disease and Public Health Nursing • Share a long history- with the growth of urban areas in the early part of the 19th century, epidemics swept through communities • Hospitals were unsanitary hot beds of infection –and often considered places where people went to die • In 1900, epidemics of communicable diseases were the leading cause of death throughout the world • Fleas and rats spread the bubonic plague in 1348. 1/3 Europe died! D.NAIDU -Community Population Centered Nursing Some Infectious Diseases In The Pacific • Respiratory Infections • Influenza ,Tuberculosis, Acute Rheumatic Fever • STI • HIV/ AIDS, Syphilis, Gonorrhoea, Hepatitis • FECO-ORAL DISEASES • Cholera, Typhoid, Hepatitis A &E, Gastroenteritis, Shigellosis, amoebiasis D.NAIDU -Community Population Centered Nursing Epidemics , Endemics and Pandemics Epidemics Is defined as rates of disease significantly higher than the usual frequency. Epidemic is confined to a localized area. Can be referred to as an outbreak Endemic The usual frequency , endemic refers to the on-going , usual ,or constant presence of a disease in a community or among a group of people. For example influenza follows a seasonal trend with the highest number of cases in the winter months , it is considered endemic if the pattern is consistent from year to year. Pandemics Include large areas of the world A pandemic is an epidemic affecting or attacking the population of an extensive region , country or continent. Example : HIV / AIDs spread from one region to many other regions of the world. D.NAIDU -Community Population Centered Nursing Epidemics , Endemics and Pandemics Endemic: a disease that exists permanently in a particular region or population. Malaria is a constant worry in parts of Africa. Epidemic: An outbreak of disease that attacks many peoples at about the same time and may spread through one or several communities. Pandemic: When an epidemic spreads throughout the world. D.NAIDU -Community Population Centered Nursing Factors contributing to emergence of CD Human behaviors- high risk e g. drug use, unhealthy diet creates susceptible host International travel, migration Urbanization Widespread use of antibiotics-leading to drug resistance Food production Environmental changes D.NAIDU -Community Population Centered Nursing Infectious Disease Mode of Transmission As discussed earlier infections CD are based on mode of transmission : INSECT BORNE DISEASES E.g.: Dengue, Malaria WATER- WASHED DISEASES E.g.: Scabies, lice, fungal infections, Trachoma, Conjunctivitis, Tropical ulcers D.NAIDU -Community Population Centered Nursing Infectious Disease Mode of Transmission INFECTIOUS SKIN RASH E.g.: Chickenpox FOOD BORNE DISEASES Food poisoning, staph, clostridium(Gram positive anaerobic spore forming rod like bacteria commonly found in soil and in the intestinal tract) D.NAIDU -Community Population Centered Nursing Infectious Disease Mode of Transmission DOMESTIC ZOONOSES E.g.: Leptospirosis, Brucellosis, Filariasis • Leptospirosis is a zoonosis that lurks in water, soil and foods contaminated by urine of infected animals, especially cattle, rats and pigs. • The disease can become especially problematic after heavy floods. In • The past, this was what happened in parts of, Cuba and Nicaragua where many cases of leptospirosis occurred after floods. D.NAIDU -Community Population Centered Nursing D.NAIDU -Community Population Centered Nursing Mode of Transmission • Horizontal transmission- is the transport of infectious agents from person to person. • Vertical transmission – is the passing of the infection from parent to offspring via sperm , placenta , milk , or contact in the vaginal canal transmission of HIV and syphilis. • The transport of infectious agents between hosts can be accomplished in a number of ways like Direct contact , indirect contact , common vehicle , airborne, or vector born. Most sexually transmitted infections are spread by direct sexual contact. D.NAIDU -Community Population Centered Nursing Modes of transmission cont. • Direct transmission- is the immediate transfer of disease from the infected host to the susceptible host ,transmission of STI ,needle stick injury. • Indirect transmission- occurs when the human host comes in contact with vehicles or vectors that support and transport the infectious agent e.g.. fleas transporting bubonic plague from infected rats to human hosts. D.NAIDU -Community Population Centered Nursing Modes of transmission cont. • Airborne transmission- happens when microorganisms are suspended in the air and spread to a suitable port of entry • Occurs primarily through droplet nuclei or aerosols • Droplets containing measles virus are contained in the spray from sneezing-find conjunctiva or mucus membrane for portal of entry D.NAIDU -Community Population Centered Nursing Modes of transmission cont. • Fecal oral transmission- occurs directly when the hands or other objects are contaminated with organisms from human or animal feces and then placed in the mouth. Example : Typhoid • Can also occur indirectly- ingestion of water or food that has been contaminated with fecal particles-E. coli and Hepatitis A D.NAIDU -Community Population Centered Nursing Transmission of Communicable Disease The transmission of communicable disease depends on the successful interaction of the infectious agent , the host and the environment. These three factors make the: Epidemiologic Triangle D.NAIDU -Community Population Centered Nursing How are Communicable disease Spread Direct Contact: Exposure to infected body fluids such as blood or saliva. Vectors/Reservoirs: Germs are spread by an animal or insect, usually through a bite Airborne: Germs are spread through the air, for example when someone coughs or sneezes. Food and Water: Food and water can become contaminated with germs and people can get sick when they eat or drink them. Indirect contact: Pathogens remain on surfaces that were in contact with an infected person. D.NAIDU -Community Population Centered Nursing Epidemiological Triangle The epidemiological triangle recognises three major factors in pathogenesis • Agent • Host • Environment This model is well suited to an explanation of the aetiology of infections disease. D.NAIDU -Community Population Centered Nursing Epidemiological Triangle • The agent is the cause of the disease ; whose absence or presence causes a disease. • the host is an organism , usually a human or an animal that harbors the disease; • the environment includes those surroundings and conditions external to the human or animal that cause or allow disease transmission and time accounts for incubation periods , life expectancy of the host or the pathogen , and duration of the course of the illness or condition. D.NAIDU -Community Population Centered Nursing Agent Factors Four (4) major categories of agents cause most infections and infectious disease: • Bacteria ( Salmonella and E.coli) • Fungi (Aspergillus and Candida) • Parasites (Helminthes and Protozoa) • Viruses ( Hepatitis A and B and HIV) D.NAIDU -Community Population Centered Nursing Seven Characteristics of an Infectious Agent 1.Infectivity: The ability of the agent to enter a host and multiply to an infectious dose, thereby producing the infection or disease. 2.Pathogenicity: The ability of the agent to cause disease in an infected host. 3.Virulence: This term refers to the severity of the infection. A highly virulent strain of a disease agent will most always produce severe cases or death. D.NAIDU -Community Population Centered Nursing Seven Characteristics of an Infectious Agent 4.Toxigenicity: This term refers to the ability of the agent to produce a toxin. The resulting illness or disease is from the toxin produced by the organism/agent and not the microorganism itself. 5.Resistance: This term refers to the ability of the agent to survive under adverse environmental conditions. It is also a measure of the agent's fragility. 6.Antigenicity: This term refers to the ability of the agent to induce antibody production in the host. 7. Invasiveness : The ability to penetrate and spread throughout a tissue D.NAIDU -Community Population Centered Nursing Six Types of Agent • Physical Agent: Mechanical forces or friction that may cause injury or temperature or excessive radiation. • Chemical Agent: Dusts , gases , vapours , fumes , liquids , toxins and poisons. • Nutrient Agents : basic dietary components that we need to survive. • Biological Agents: Insects , worms , protozoa , fungi , bacteria , viruses ( infection) • Genetic Agents : Parent to child through genes. • Psychological agent : stressful circumstances in the environment. D.NAIDU -Community Population Centered Nursing Host Factors A human or animal host can harbour an infectious agent. The characteristics of the host that may influence the spread of disease are Host resistance Immunity Herd immunity and Infectiousness of the host. An agent must be present for an infectious disease to develop Agent must be capable of infecting a host D.NAIDU -Community Population Centered Nursing Host Factors The host after exposure to an infection progresses through a chain of events. From subclinical infection to active disease The end result may be complete recovery permanent disability , disfigurement , or death. D.NAIDU -Community Population Centered Nursing Host Factors • Resistance – is the ability of the host to withstand infection , and it may involve Natural or Acquired immunity. • Natural Immunity – refers to species- determined innate resistance to an infectious agent. Example: People who had recovered from the plague would never get it again—they had acquired immunity. D.NAIDU -Community Population Centered Nursing Host Factors • Acquired Immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent. Acquired immunity may be induced by active or passive immunization. • Example: Having measles once protects against future infection. Acquired immunity may be induced by active or passive immunity. D.NAIDU -Community Population Centered Nursing Natural and Acquired Immunity D.NAIDU -Community Population Centered Nursing Active and Passive Immunization Two types of Acquired Immunity Active Immunization : Refers to the immunization of an individual by administration of an antigen (infectious agent or vaccine) and is usually characterised by the presence of an antibody produced by the individual host. E.g.: Immunization / Vaccination Passive Immunization : Refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual , such as the transfer of antibody –containing preparation E.g.: passing antibodies from mother to foetus. D.NAIDU -Community Population Centered Nursing Two type of Acquired Immunity D.NAIDU -Community Population Centered Nursing Host Factors Ability to cause infection is determined by a number of factors some are properties of host: An important determinant is the hosts ability to fight off the infectious agent Ability to fight has 2 main categories 1. Nonspecific defence mechanism 2. Disease specific defence mechanism D.NAIDU -Community Population Centered Nursing Non-Specific Defence Mechanism The human body is equipped with a number of means to reduce the likelihood that an agent will penetrate and cause disease Most environmental agents are unable to enter the body because of the protection by our • Skin • Mucosal Surface • Tears and Saliva • High pH of our gastric juice is lethal to marry agents. D.NAIDU -Community Population Centered Nursing Non-Specific Defence Mechanism • Several other factors influence host response to infectious agent. • E.g. As we age immunity decrease , through reduced immune function • Nutritional status of the host also critical , genetic factors. D.NAIDU -Community Population Centered Nursing Disease Specific Defence Mechanism • Includes immunity against a particular agent • Immunity refers to the resistance of the host to a disease agent. • Immunity to a disease may be either natural or artificial active or passive • Active immunity: body produces it own resistance through mild cases or vaccination. D.NAIDU -Community Population Centered Nursing Herd Immunity Refers to the immunity of a group or community. It is resistance of a group of people to invasion and spread of an infectious agent. Based on the resistance of a high proportion of individual members of a group to infection. It is the basis for increasing immunization coverage for vaccinepreventable disease. Example immunization greater than 90% of specified group of people. The higher the immunization coverage the greater the herd immunity. D.NAIDU -Community Population Centered Nursing Environmental Factor • The environment refers to everything that is external to the human host , including physical , biological , social , and cultural factors. • These environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts • Reduction in communicable disease risk can be achieved by altering these environmental factors. • Example: Using mosquito nets and repellents to avoid bug bites , installing sewage system to prevent faecal contamination of water supplies. D.NAIDU -Community Population Centered Nursing Environmental Factor Physical , Socio-Economic and Biological Environments. Physical Environment Geographical Structure , availability of resources , water and plants weather , climate. Seasons influence these factors. Socio-Economic Environment Environmental sanitation , pasteurization of milk , disposal of rubbish , availability of medical facilities immunization and medical care. Biological Environment Environmental factors that are necessary to maintain the agent or allow for its transmission. D.NAIDU -Community Population Centered Nursing Example of a Epi-Triad For TB: In this model the agent is the TB bacterium; host factors include non-immune, weakened resistance, poor nutrition; and environmental factors include crowded conditions, poor ventilation, and bad sanitation. D.NAIDU -Community Population Centered Nursing Community health nurses role relevant to communicable disease control • Community health nurses must arm themselves with information about new emerging infectious diseases • Recognizing infectious disease conditions is a challenge and responsibility of nurses working to protect the health of communities D.NAIDU -Community Population Centered Nursing Roles of CHN • Community health nurses should be well aware of the epidemiological principles so that they can use this knowledge to break the chain of infection • Strengthening the host through immunization and education, controlling the environment through protection of food and water supplies D.NAIDU -Community Population Centered Nursing Roles of CHN • Educating consumers about basic sanitation, principles related to food preparation as well as the importance of hand washing with proper soap • Water supplies protected from contamination, appropriate waste control, knowledgeable food growers and handlers, proper hand washing and safe sex practices D.NAIDU -Community Population Centered Nursing Nurses role in control of communicable diseases • Primary prevention- CHNs can be active participants in the education of individuals, families and communities • Informing individuals of disease risk and ways to prevent disease occurrence • Strengthening the host by immunization interrupts the spread of infection and supports primary prevention D.NAIDU -Community Population Centered Nursing Role of CHN cont. • Secondary prevention- minimizing effect of agent on host and environment • Nurses should be leaders in early recognition and treatment of infection to minimize the potential long term effects of these diseases D.NAIDU -Community Population Centered Nursing Role of CHN cont. • Tertiary prevention- nurses should be aware of agencies and other resources that can assist clients in the management of disease • Effective case management can help to eliminate the debilitating effects of disease D.NAIDU -Community Population Centered Nursing Prevalence and Incidence of Common Communicable diseases in Fiji. • Communicable diseases along with maternal, perinatal and nutritional conditions in Fiji accounted for an estimated 18 per cent of all mortality in 2008. • In 2012, Fiji’s HIV prevalence stood at 0.2 per cent; the figure had remained consistent at 0.1 per cent in the period 19902009. • The country is free from malaria. Estimated incidences of tuberculosis (TB) fell by nearly three-quarters in the period 1990-2012 and estimated mortality (when mortality data excludes cases co-morbid with HIV) also reduced significantly in that time. • There were two reported cases of leprosy in 2010, as well as one reported case of measles and one reported case of rubella in 2009. D.NAIDU -Community Population Centered Nursing Reporting of Communicable Disease The following are priority notifiable diseases: • • • • • • • Cholera Dengue Fever Influenza Leptospirosis Measles Rubella Typhoid Fever AKA Disease Surveillance D.NAIDU -Community Population Centered Nursing 1. Leptospirosis 2. Typhoid 3. Dengue fever 4. Filiarasis 5. Tuberculosis 6. Hepatitis B Divide into Six Groups and research on the above diseases try and collect information before coming for tutorial. Write the following things about the disease . Can use PPP. 15 minutes per presentation. D.NAIDU -Community Population Centered Nursing For the above Diseases. Discuss the Following. 1. Draw a Epidemiological Triangle (Agent , Host and Environment ) 2. Prevalence in Fiji ( age , gender , ethnicity ) Burden Cost 3. Mode of transmission 4. Incubation Period 5. Management of case 6. Complications 7. Control measures 8. Preventative actions 9. What’s important about this condition (summary) D.NAIDU -Community Population Centered Nursing