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COMMUNICABLE DISEASES EPIDEMIOLOGY, CONTROL & PREVENTION CHP300 COMMUNICABLE DISEASE Content Sources & transmission of infection Host-parasite relationship Cycle of infection Outcome of infection Disease mechanism Spectrum of disease Levels of disease occurrence Control and prevention of disease Levels of Prevention Natural History of disease COMMUNICABLE DISEASE DEFINITIONS COMMUNICABLE DISEASE An illness due to a specific infectious agent or its toxic products. COMMUNICABLE DISEASE DEFINITIONS EPIDEMIOLOGY Study of distribution and determinants of health-related states and events in specified populations and application of this study to control health problems. COMMUNICABLE DISEASE DEFINITIONS Control: Elimination : Eradication: Extinction: COMMUNICABLE DISEASE DEFINITIONS Control The reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. COMMUNICABLE DISEASE DEFINITIONS Elimination Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required. COMMUNICABLE DISEASE DEFINITIONS Eradication Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.. COMMUNICABLE DISEASE DEFINITIONS Extinction The specific infectious agent no longer exists in nature or in the laboratory. COMMUNICABLE DISEASE SOURCES OF INFECTIONS CASE OF DISEASE : a patient CARRIER : . Incubatory carrier . Convalescent carrier . Chronic carrier . In-apparent carrier ANIMAL RESERVOIR (ZOONOSIS) INANIMATE RESERVOIR (THE SOIL) COMMUNICABLE DISEASE SOURCES OF INFECTIONS CARRIER : A person or animal without apparent disease who harbors a specific infectious agent and is capable of transmitting the agent to others. COMMUNICABLE DISEASE SOURCES OF INFECTIONS Reservoir: Any person, animal, arthropod, plant, soil or substance (or combination of these) in which an infectious agent lives and multiplies, on which it depends primarily for survival, and where it reproduces itself, in such a manner that it can be transmitted to a susceptible host COMMUNICABLE DISEASE SOURCES OF INFECTION Reservoir Zoonosis animal animal human COMMUNICABLE DISEASE SOURCES OF INFECTION Examples: Neisseria gonorrhea -Source = humans -Reservoir = humans Salmonella typhi -Source = food/water -Reservoir = humans Hepatitis C -Source = transfusion, blood products -Reservoir = humans Rabies virus -Source = saliva of the dog -Reservoir = the dog COMMUNICABLE DISEASE MODE OF TRANSMISSION OF INFECTION: 1- AIR-BORNE 2- FOOD AND DRINK-BORNE 3- ARTHROPOD-BORNE 4- CONTACT TRANSMISSION COMMUNICABLE DISEASE TRANSMISSION OFINFECTION: 1. Water-washed dis. (Dis. of skin, eye) 2. Fecal-oral disease. (Viral, bact., parasitic) 3. Soil-mediated infections.(Tetanus, intestinal parasites) 4. Diseases of water contact. (Bilharzia, Guinea worm) 5. Food-borne dis. (F.P., intestinal flukes) 6. Infectious skin rashes. (Chickenpox, smallpox) 7. Respiratory infections. (Viral, bacterial) 8. Dis. Transmitted via body fluids. (STD) 9. Insect-borne. (Viral, parasitic) 10. Zoonosis. (Brucellosis, rabies) COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Droplet infection (direct spread): CSM, Whooping cough Droplet nuclei (direct air-borne): Measles, Chickenpox Infected dust (indirect air-borne): TB, Diphtheria COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: Pulmonary Tuberculosis • Caused by various strains of mycobacteria, usually Mycobacterium. • Spread through the air • Most infections are asymptomatic and latent COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: Influenza • caused by the influenza viruses RNA viruses • The most common symptoms are chills, fever, runny nose, sore throat, muscle pains, headache (often severe), coughing, fatigue and general discomfort. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: Pneumonia • Is an inflammatory condition of the lung • Caused by infection with viruses or bacteria and less commonly other microorganisms . • Typical symptoms include a cough, chest pain, fever, and difficulty breathing. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: Sore-throat • Inflammation of the pharynx caused by a viruses& bacteria (group A streptococcus). • Discomfort, pain, or scratchiness in the throat. It often makes it painful to swallow. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: Measles • an infection of the respiratory system and is highly contagious ,caused by a paramyxovirus • Symptoms include fever, cough, runny nose, red eyes and a generalized,confluent maculopapular, and erythematous rash. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: Whooping cough: • Caused by the bacterium Bordetella pertussis • The first symptoms are similar to those of a common cold . • It's characterized by severe coughing spells. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Diphtheria • Caused by Corynebacterium diphtheriae, • Spread by direct physical contact or breathing • Characterized by sore throat, low fever, and an adherent membrane on the tonsils, pharynx. • consequences myocarditis and peripheral neuropathy. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: Scarlet fever • caused by toxin , produced by the bacterium Streptococcus pyogenes (group A strep) • complications such as glomerulonephritis and endocarditis leading to heart valve disease, COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Chicken pox • caused by: varicella zoster virus (VZV). • Spread: coughing or sneezing or direct contact with secretions from the rash • Symptoms :vesicular skin rash also ulcers in the oral cavity and tonsil areas. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: Mumps • Caused by: the mumps virus. • Painful swelling of the salivary glands (the parotid gland) ,Painful testicular swelling (orchitis). Fever , headache , malaise and anorexia. • complications such as infertility or subfertility COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Rubella : • Caused by the rubella virus. • Transmitted via airborne droplet (Acquired)or if the mother is infected within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome (trans placental ) COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Cerebrospinal fever severe headaches, tenderness of the back of the neck, paralysis of the ocular muscles. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 1- AIR-BORNE Inhalation Infections: • • • • • • • • • Measles. Whooping cough Diphtheria Scarlet fever Chicken pox Mumps Rubella Cerebrospinal fever (Small Pox) COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 2- FOOD AND DRINK-BORNE Categories: The enterica (salmonellae) The dysentery (shigellae ,Amoebic) The rotaviruses (G.E.) Hep A Cholera Food poisoning (staph). Helminths. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 2- FOOD AND Water-BORNE Methods of transmission: The human hand Flies Musca domestica House fly COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 2- FOOD AND DRINK-BORNE Methods of transmission: Milk: Excellent medium • T.B. • F.P. • Diphtheria Dirty udder Dirty hands of milking man Dirty bottle Water: Very serious COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 2- FOOD AND DRINK-BORNE Methods of transmission: Meat: • Diseased animal • Contaminated meat. Fresh Vegetables and Fruits : • Poor medium. • Can be contaminated by: Flies Washing water Dirty hands Manure COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 3- ARTHROPOD-BORNE Methods of transmission: Can be: Biological transmission Harborage transmission Transovarial transmission Mechanical transmission COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 3- ARTHROPOD-BORNE Methods of transmission: Vector: Inoculation Contamination (broken skin or mucous membranes) • By infectious feces. • Body fluids (when crushed) COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 3- ARTHROPOD-BORNE Methods of transmission: Flies: • Enteric fevers. • Mucopurulent conjunctivitis. • Ascariasis. • Food poisoning. • Amoebic dysentery. • Poliomyelitis. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 3- ARTHROPOD-BORNE Methods of transmission: The louse (Pediculum humanus): • Epidemic typhus. • L.B. relapsing fever. human body louse Human Head louse COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 3- ARTHROPOD-BORNE Methods of transmission: The Flea (Xenopsylla cheopis; rat flea) : Bubonic plague Endemic typhus COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 3- ARTHROPOD-BORNE Methods of transmission: The Mosquito (female of): - Culex sp. (filariasis) - Anopheles sp. (malaria) - Aedes sp. (Dengue fever) COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 3- ARTHROPOD-BORNE Methods of transmission: The Sand Fly: - Cutaneous Leishmaniasis. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 4- CONTACT Methods of transmission: Can be: • Direct • Indirect • Disease which are easily transmitted by physical contact with the person suffering the disease, or by their secretions or objects they touched. COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 4- CONTACT Types: STD • • • • • Hep.B Syphilis Herpes simplex Lymphogranuloma HIV COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 4- CONTACT Types: Fungal Infection of the skin - Tinea capitis (ring worm). Tinea pedis (athlete’s foot). - Tinea cruris. (crotch itch) COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 4- CONTACT Types: Mycosis - Moniliasis (Oral Thrush) - Mycetoma Madura foot COMMUNICABLE DISEASE CHANNELS OF TRANSMISSION OF INFECTION: 4- CONTACT Types: -Scabies: mite (Sarcoptes scabiei) -Trachoma and other eye infections. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Epidemiologic Triangle Agent (Seed) Environment (Climate) Host (Soil) COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Infectious Disease Model Pathogen Host disease Environment COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Disease Agents • • • • • Biological Physical Chemical Mechanical Nutrient COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Biological Disease Agents • Bacteria • Viruses • Parasites • Protozoa • Metazoa • Rickettsiae • Fungi COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Microbes-humans Relationship Very few microbes are always pathogenic Many microbes are potentially pathogenic Most microbes are never pathogenic COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Microbes-humans Relationship (Symbiosis) Mutualism - Association in which both partners benefit (Bacteria and synthesis of vitamins K and B) Commensalism - Association in which one partner benefits and other is unharmed (Flora living on skin) Parasitism - Association in which the microbe befits at expense of host (pathogenic infection) COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Agent Factors Intrinsic Properties of “Agent” - Antigenic make-up. - Growth requirements. - Ability to survive outside the host (milk, water, soil). - Viability under varying conditions (temp, humidity). - Spectrum of hosts. - Resistance to treatment. - New genetic information. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Agent Factors Properties subject to interaction Infectivity Pathogenicity Virulence Immunogenicity COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Agent Factors Properties subject to interaction Infectivity Pathogenicity Virulence Immunogenicity Dose Source Route Duration before reaching the host Host characteristics • Age • Race • Nutritional Status COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Host Factors ( a HOST is a PERSON who can be infected under normal conditions.) • • • Exposure Susceptibility Response to the agent COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Host Factors Exposure • Age • Sex • Race • S.E.S ( occupation) • Behavior • Drug abuse • Sexual practice COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Host Factors Susceptibility and Response to the Agent • Age • Pregnancy • Malnutrition • Immunity • Other diseases • Medications COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Environmental Factors 1- Physical Environment • Climate • Geography • Water • Housing COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Environmental Factors 2- Biological Environment •Man •Microbes •Insects •Rodents •Animals • Agents • Reservoirs • Intermediate hosts • Vectors COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Environmental Factors 3- Psychosocial Environment • • • • • Education Occupation Beliefs Attitude Behavior COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Reservoir of Infection Types : 1. Human to Human Human Human • • • • Most viral and bact. RTIs Most staph and strept. Childhood exanthemata STD COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Reservoir of Infection Types : 2. Animal to Human Zoonosis animal animal human COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Reservoir of Infection Types : 3. Complex cycles - Malaria - Bilharzia - Tape worm COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Infection Phases of Infectious Disease : The Incubation Period : Initial infection ( exposure ) Onset of clinical disease ( symptoms or signs) Symptom = subjective complaint e.g.: pain, loss of appetite, lethargy Sign = observable or measurable change in body function eg : rash, fever COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Infection Phases of Infectious Disease : The Latent Period : Initial infection Start of infectiousness The Period of Communicability: 1. before onset early in disease course 2. After onset after recovery - convalescence - chronic COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Infection Phases of Disease Cycle : Incubation period: -Variable length -Prior to signs and symptoms Prodromal stage: - The period of early symptoms - Indicates the start of disease before specific symptoms and signs occur. - Often infectious/contagious - Innate immune response starts COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Infection Phases of Disease Cycle Illness stage : - Most severe phase - Clear evidence of signs and symptoms - Acquired immune responses begin Decline stage: - Alleviation of signs and symptoms - Recovery/convalescence COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Infection Phases of Infectious Disease : Cycle of Infection INFECTIOUS AGENT SUSCEPTIBLE HOST NEONATES DIABETICS IMMUNOSUPPRESSED CARDIOPULMONARY DISEASE BACTERIA VIRUSES FUNGI PROTOZOA HELMINTH PORTAL OF ENTRY BROKEN SKIN MUCOUS MEMBRANES GIT/RESPIRATORY URINARY TRACT RESERVOIR PEOPLE EQUIPMENT WATER PORTAL OF EXIT MODE OF TRANSMISSION AIRBOURNE INGESTION INNOCULATION CONTACT EXCRETIONS SECRETIONS DROPLETS SKIN COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Infection Phases of Infectious Disease : Outcome of Infection P H R COLONIZATION A O COVERT S disease I S OVERT T disease T E COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Infection Phases of Infectious Disease : Disease Mechanism – Tissue invasion – Toxin production – Hypersensitivity COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Infection Phases of Infectious Disease : Spectrum of Disease TB, Polio, Hep A f f f f f Measles, Chickenpox f f f f f Rabies, Amebic Encephalitis, Hemorrhagic Fever. f f f f f Inapparent f f Mild f Moderate f Sever f Fatal COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Communicable Disease : Communicable Diseases Occurrence: Sporadic Disease : Occurs irregularly and only occasionally in a population . e.g. Typhoid fever (Salmonella typhi) COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Communicable Disease : Communicable Diseases Occurrence Endemic Disease : Constant presence of an infectious disease within a given geographical area or population group. the usual or expected frequency of disease COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Communicable Disease : Communicable Diseases Occurrence Hyperendemic Disease : When occurrence frequency rises, but not to epidemic proportions. e.g. - Common cold in the winter months - high prevalence malaria COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Communicable Disease : Communicable Diseases Occurrence Epidemic : The occurrence of cases of disease, (( specific health related behavior, or other health related events )) clearly more than expected In a given area or among a specific group of people over a particular time. ? One example COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Communicable Disease : Communicable Diseases Occurrence Outbreak : epidemic-like increase in frequency, but in a very limited (focal) segment of the population; Usually of shorter duration. Example: Food poisoning, URTI COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Communicable Disease : Communicable Diseases Occurrence Pandemic : An epidemic occurring over a very wide area (several countries or continents) and usually affecting a large proportion of the population ? One example COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Communicable Disease : Communicable Diseases Occurrence Number of Cases of a Disease Endemic Epidemic : Endemic Time Epidemic COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Some Concepts of Communicable Disease : Communicable Diseases Occurrence Endemic Epidemic : Host Factors: - Change in behavior ? - Population movement - Immunity COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Communicable Diseases Occurrence Endemic Epidemic : Environmental Factors: - Adverse conditions: - War - Famine - Vector: - Mosquitos - Flies COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Communicable Diseases Occurrence Endemic Epidemic : Environmental Factors: - New or Exposure - Change in climate - Irrigation scheme - Control measures COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : Can be classified into: I Controlling the source of infection II Blocking the channels of transmission III Protecting the susceptible population COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Controlling the source of infection (CASES, CARRIERS AND ANIMAL RESERVOIR) - Early diagnosis Notification Isolation Treatment Quarantine Surveillance Disinfection COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Blocking the channels of transmission 1.Air- borne: - Bed-spacing - Dust-control - Effective ventilation - Good health habits - Air disinfection - Use of masks - Minimize over-crowding COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Blocking the channels of transmission cont. 2.Food and Drink - borne: – – – – – – – – – – Provision of safe/sufficient water. Pasteurization or boiling of milk. Proper personal hygiene. Sanitary sewage disposal. Control of flies. Washing fresh vegetables. Meat and slaughter house control. Refrigeration of unused food. Control of food handlers and vendors. Labs for food examination. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Blocking the channels of transmission cont. Food and Drink – borne: FOOD DRINK BOTH FOOD and DRINK COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP 3.Arthropod - borne: Lice: • Personal cleanliness. • Avoiding overcrowding. • Dusting by insecticides. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : II Blocking the channels of transmission : Arthropod - borne: Fleas: • Cleanliness of dwellings. • Avoid dust collection. • Spraying & dusting by insecticides. • Rodent control. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : II Blocking the channels of transmission : Arthropod - borne: Mosquitos : • Vector control. • Personal protection. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : II Blocking the channels of transmission : Contact Diseases : - Case finding and treatment. Tracing of contacts. Serological examination. Control of sexual behaviour. Personal cleanliness. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : II Blocking the channels of transmission : Contact Diseases : - Avoid use of common articles: - Comb. - Hair brush. - Towels. - Underwear. - Footwear ……. etc. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : III Protecting the susceptible population : - Primary Prevention: - Health promotion. - Specific protection. - Secondary Prevention: - Early diagnosis and - Prompt treatment. - Tertiary Prevention: - Limitation of disability. - Rehabilitation. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : III Protecting the susceptible population : - Primary Prevention: - Health promotion. - Adequate nutrition. - Health education. - Socio-economic development. - Environmental sanitation. - Personal hygiene. (- Genetic counseling.) COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : III Protecting the susceptible population : - Primary Prevention: - Specific protection. - Specific immunization. -- Protection Protectionagainst againstoccupational occupationalhazards. hazards. -- Protection Protectionagainst againstaccidents. accidents. -- Protection Protectionfrom fromcarcinogens. carcinogens. -- Avoidance Avoidanceof of allergens. allergens. allergens. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : III Protecting the susceptible population : - Secondary Prevention: - Early diagnosis and - Prompt treatment. - Health education - Screening for sub-clinical disease. - Case finding COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : III Protecting the susceptible population : - Tertiary Prevention: - Limitation of disability. - Adequate treatment. - Rehabilitation. - Psychological: - Restoration of personal confidence and independence. - Medical: - Physical restoration of function. COMMUNICABLE DISEASE HOST-PARASITE RELATIONSHIP Control of Communicable Disease : III Protecting the susceptible population : - Tertiary Prevention: - Rehabilitation. - Vocational: - Restoration of capacity to earn. (Occupational) - Social: - Restoration of family and community relationship. COMMUNICABLE DISEASE Natural History of Disease Recovery COMMUNICABLE DISEASE Natural History of Disease Recovery COMMUNICABLE DISEASE Natural History of Disease Recovery COMMUNICABLE DISEASE Natural History of Disease Recovery COMMUNICABLE DISEASE Natural History of Disease Recovery