Download Communicable diseases - PGGCG

COMMUNICABLE DISEASES
PRESENTED BY
Mr. SURESH KUMAR
LECTURER
IN PHYSICAL EDUCATION P.G.G.C.G.
SECTOR -11, CHANDIGARH
COMMUNICABLE DISEASES
 INTRODUCTION
A disease is a sickness that occurs when there is an upset or
breakdown in the way the body usually functions. Most
diseases make one feel sick or like something is not quite right
with the body, but some diseases upset places in the body that
one can not really feel, like blood, or one's internal organs.
Symptoms are the changes that one can see or feel when one
has a disease. Coughing can be a symptom of having a cold.
People recover from some diseases in a short time. Others last
a long time. Some leave permanent damage, other diseases
can cause death.
 Diseases that can be passed or transmitted from one person to
another are called infectious or contagious, like the common
cold. Illnesses like a heart attack or cancer are not contagious.
If a person is around some one else who has an infectious
disease, we say that person has been exposed. Very often,
symptoms appear much later so the person never knows when
he or she was exposed to the illness, that person has become
infected.
 MEANING OF COMMUNICABLE DISEASES
A disease resulting from infection capable of being directly
man and to animal or indirectly transmitted from man to man,
animal to animal, and man and to animal form the
environment like through air, dust, soil water, food etc.
 There are many communicable diseases like Aids, small pox,
measles, whooping cough, tuberculosis, viral hepatitis,
hepatitis B, typhoid, malaria, rabies, tetanus etc.
 HIV / AIDS
Ever since the initial identification of the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency
Syndrome (AIDS) among the homosexual community of the
developed nations in America and Europe in the late 1970's
there has been an alarming rate of spread of the virus. This
virus continues to spread around (he world.
 AIDS did not originate from India. But this fact cannot overshadow the
profound status of this HIV Infection in the present Indian Scenario, By the
next decade, India will house nearly 50 million AIDS patients, In India the
first case of HIV infection was officially reported from ft! clinic in Chennai
in the summer of 1986. There has been a rapid spread of the disease across
the nation ever since. The initial cases of HIV / AIDS were reported among
commercial sex workers in Mumbai and Chennai and intravenous Drug
users (IDU) in the north-eastern slates] In recent years it has spread from
urban to rural areas and from individuals having "high-risk" behaviour to
the general population, The estimated number of HIV / AIDS infected in
the world as on 2001 are 36 million and one out of 10 people is Indian who is
affected by this virus.
 ORIGINS OF HIV / AIDS
It may be said that the exact origin of AIDS will never Incompletely elicited.
There are, however, certain facts that have led in a more or less general
agreement as to the source of this epidemic. II is plausible to conclude that
HIV is a pathogen new to the human race, probably resulting from an nonpathogenic, subhuman primate retrovirus, which made a species jump
from African Primates (monkeys) to human. There is widespread evidence
that many old world primates e.g. chimpanzees, mandrills, and African
Green Monkeys, in sub-saharan Africa have been infected with restrovirusc
, similar to HIV for thousands of years, although they are non-pathogen ic
and do not cause debilitating illness.
 What is AIDS ?
 AIDS stands for the Acquired Immune Deficiency Syndrome.
 A - Acquired means that it is something people acquire from




outside. It is not inherited from parents like eye color or blood type.
II is transmitted through person's own behaviour or situation.
I - Immune refers to the immune system, the body's defense
mechanism.against germs and infections (a weakened body defence
system).
D - Deficiency indicates a lack or weakening of (the immune
system).
S- Syndrome refers to the presence of a group of signs and
symptoms. When the body's defenses are weakened, it is possible
for many infections or diseases to simultaneously infect the body.
The condition is referred to as a syndrome. It is a collection of signs
and symptoms that are generally found together in a particular
disease or diseases.
Currently the world health organization and UNAIDS estimated
that 8,500 persons will become infected with HIV each day while an
estimated 4,000 persons will die from HIV /AIDS related deaths
each day.
 AIDS is a serious disorder of the Immune system. This system puts up a defence
against any infections and protects the body from illnesses. AIDS is the condition
where this system is under attack. The body's normal defences against infection
breaks down and the body becomes vulnerable to infections and other diseases.
Some of these infections would normally not affect healthy people. But when
immune system is weaknened or depressed, they find an opportunity to flourish
and so are called opportunistic infections.
 AIDS was first identified in 1981 in the U.S.A. when previously healthy,
homosexual men began to suffer and die on account of rare infections. After much
debate and research, scientists identified a new syndrome and later termed it as
AIDS.
 What is HIV ?
 AIDS is caused by an organism called HIV.
 H - Human indicates that the HIV only infects humans.
 I - Immunodeficiency indicates that HIV causes the immune system to become
weak and ineffective in defending the body against the germs. In this way, HIV
leads to AIDS.
 V - Virus is a disease causing parasite.
 AIDS is Acquired because it is caught from someone and is not inherited.
 Immune and Deficiency because the virus destroys the body's defense system and
as a result the person is more likely to get illness which the body would normally
be able to fight off easily
 (Hi) Syndrome describes the different signs and symptoms of the illness that
result from the HIV infections. These signs and symptoms appear as multiple
infection or illness.
 MODE OF TRANSMISSION
 Diseases can be caused by pathogens. There are organisms or germs which







can invade the body from outside, it can cause illness. Viruses, bacteria,
fungi, and protozoa can be called the pathogens. All/ of these organisms
are very small living creatures and can not been1 seen with the naked eyes.
A virus is a tiny organism which carries instruction for reproducing itself
(called the genetic material). But it must invade a living cell (such as one in
a person's body) to reproduce.
Concentration of virai load - There must a sufficient quantity of HIV to
allow infection to occur. If the concentration is too low then it is not
possible for infection to take place.
Port of Entry - There must a way for HIV to enter into the body. If HIV
infected fluid does not have a path into another person's body then
infection can not take place.
Body fluids like blood, semen, menstrual blood, vaginal fluid contain a
high enough concentration of HIV / AIDS to and can be exchanged.
Body fluids like sweat, tear, skin oils do not contain the virus to infect.
Fluids like crebrospinal fluid, Amniotic fluid, focal matter are not
normally exchanged between persons.
HIV / AIDS has been isolated from the body fluids or infected persons,
including saliva and tears. However, only blood, semen, vaginal secretions,
and breast milk have been implicated in transmission.





There are only three modes of transmissionSexual Transmission.
Blood Transmission
Mother to Child Transmission.
Sexual Transmission: The virus can be transmitted from an infected person
to his or her sex partner (man to woman, woman to man and man to
man). Sexual intercourse can damage the linings of sexual organs and can
facilitate transmission of HIV / AIDS from the infected partner to the
uninfected one by exchange of body fluids. It is easier for the virus to be
transmitted if the uninfected partner is already suffering from some
sexually transmitted disease because in this case the lining is already
damaged. Due to the high rate of sexual transmission of the virus, sexual
behaviour is the prime focus interrupting transmission. In India, sexual
intercourse is the most frequent mode of transmission of HIV /AIDS.
 Blood Transmission: It occurs through the transfusion of infected blood or
blood products or the use of blood contaminated needles, syringes or other
skin piercing instruments. Recipients of a single unit of HIV infected
blood have a virtually 100% probability of becoming infected.
 Blood transfusion is a significant problem in areas where HIV infection is
common and where HIV antibody screening of blood donors has not yet
been introduced.
 When blood is needed it should be obtained from a licensed blood bank. Licensed
blood banks test blood for HIV and place a sticker on the blood unit indicating that
it has been tested. Even though the bag has been tested for HIV, there is still a
chance that it contains the virus if it was obtained from a patient in the window
period. Blood received in the window period does not contain antibodies produced
in response to HIV.
 HIV can live between 30 seconds to one minute when exposed to air. When a






needle pierces the skin and its contents ejected, blood pressure and capillary action
can push injected blood back into the bone and hub of the needle. How long HIV
can live inside the needle depends on the conditions the needle is stored in.
Mother to Child Transmission: Transmission of HIV / AIDS from an infected
women to her foetus / infant may occur before, during and shortly after birth. The
overall risk of HIV transmission from HIV infected women to her foetus in utero or
during delivery is about 30%.
The breast milk of mothers infected with HIV contains small amounts of the virus.
Researchers have found that one third of babies
born to HIV infected women become infected through milk, recent data confirms
that some transmission may occur through breast feedingIt is Bserved that extra-marital sex is the primary mode of infection, 8"@% of
AIDS patients identified, owned their extramarital sex to be the cause.
Such rapid spread of the epidemic across the country today is also due to the labour
migration and mobility in search of employment from economically backward to
more developed regions
Low literacy levels leading to low awareness among the potential high risk group
 NON-TRANSMISSION OF HIV / AIDS
 The present attitudes towards AIDS are similar to the attitudes once seen towards
syphils in the early 19th century. Myths and emotional hysteria can be generated due
to misinformation about AIDS. Many myths about HIV today center around the way
in which it can be transmitted. There are only three routes of HIV transmission.
 HIV / AIDS DOES NOT SPREAD BY  (i)
Drinking water from the same glass as an infected person.
 (ii) Swimming in pools used by people with HIV / AIDS.
 (in) Getting bitten by a mosquito that has already bitten an infected person.
 (iv) Getting bitten by an infected person.
 (v)
Socialising or casually living with people with HIV / AIDS.
 (vi) Caring and looking after people with HIV / AIDS.
 (vii) Use of the same toilets as AIDS patients or people infected
with HIV.
 (viii) Shaking hands with people with HIV / AIDS.
 (ix) Hugging or kissing a person with HIV / AIDS.
 (x)
Casual contacts such as sitting next to an infected person, or
by coughing and sneezing, or from water, food, clothing, cups,
glasses, plates, forks, spoons and other shared objects.
 (xi) Receiving and reviewing literature from areas of the world
where there is AIDS.
 (xii) Donating blood.
 (xiii) Bedbugs, flies, lice, and other insects and pests do not spread
HIV / AIDS.
 Identifying AIDS - World Health Organisation (WHO) has









listed a few signs that help in provisional diagnosis of AIDS.
MAJOR SIGNS:
Weight loss greater than 10% of the body weight.
Continue fever for a period greater than one month.
(Hi) Chronic diarrhoea (for more than one month).
MINOR SIGNS:
Persistent cough for a period longer than one month.
General itching dermatitis (skin irritation).
(in) Recurrent Herps zoster (shingres)
Oropharyngeal candidiasis (fungus infection in the mouth /
throat)
Swelling of the lymp glands.
Cure for AIDS - So far there is No-Cure For AIDS and a
vaccine of prevention of infection may be far aWay. Even if
there is a cure, the cost of the medicine would prevent it from
being used in many developing countries.
 Prevention of HIV / AIDS Infection: At present prevention
is the only cure for AIDS. Since AIDS is a sexually transmitted
disease, sexual behaviour is the prime focus of action for
interrupting transmission. Itjs therefore important to have
an information and education programme aimed at all men
and women, to have facilities for detection and treatment of
other sexually transmitted diseases and to have an
environment which would promote condom use and frank
information dissemination without somatization and
discrimination against people known or suspected to have
HIV/ AIDS. In India, prevention of sexual transmission is an
immediate priority. To save from aid the following steps must
be taken :—
 Safer sex activities for prevention
 Sexual activities e.g. Hugging, kissing etc.
 Anything that does not involve the sharing of semen, vaginal
secretion or blood.
 (Hi) Long term mutually faithful relationship, be faithful to one partner.
 (iv) Proper and consistent use of condoms.
 For prevention of HIV / AIDS transmission through infected
blood and blood products, include recruiting voluntary non-paid
donors, screening all donated blood for HIV and educating
health care workers to reduce unnecessary transfusions.
 Preventing transmission at health care setting rests on careful attention to
infection control procedure including proper sterilization of equipment, proper
adherence to procedures based on "Universal Health Precautions", and provision of
necessary supplies and equipment.
 Preventing blood borne transmission among drug injectors should go hand in
hand with efforts to prevent sexual transmission among them. These include
reducing the demand for drugs, the use of drugs by injection and the sharing of
injection equipment.
 To screen blood and blood products, thorough testing of all blood samples for HIV
should be done. This does not take into account blood screening done during the
window period, where the person is already infected but his immune system has
not produced antibodies against HIV. There blood samples may or may not be free
of HIV. In Bhutan, Indonesia and Thailand, all donated blood is now screened for
HIV.
 For preventing transmission from mother to child is, to prevent sexual
transmission of HIV to women at reproductive age. Secondary prevention would
depend on the avoidance of child bearing by mothers who know or suspect that
they are infected.
 Counselling and contraceptive services should be made available for all
men and women.
 World Health Organisation (WHO) estimates that 16-17 million adults and
children are infected with the HIV / AIDS virus in the world. Most of these
will develop HIV related illnesses and ultimately AIDS. Therefore we need
to plan for care of these patients at hospitals and at the home. They must
receive treatment for common opportunistic infections such as
tuberculosis, etc. As AIDS affects people in their most productive years,
the economic impact on families with HIV infected members is enormous
especially on children who may be orphaned. The impact of AIDS on
society would include erormous health care costs, decimation of the work
force and loss of skilled labour and educated professionals.
 VIRAL HEPATITIS:
'Viral Hepatitis' is caused by two viruses, namely Hepatitis A virus (HAV)
and Hepatitis B virus (HBV). A third form of hepatitis, referred to as nonA, non-B (NANB), has been found in all countries and is known as
Hepatitis 'C. There are three types of Hepatitis, A, B, and C.
 Hepatitis A- It is an acute communicable disease caused by Hepatitis A
virus (HAV). It is one of the most widespread infectious disease worldwide.
It is common in places with poor standards of hygiene and sanitation. The
virus attacks the liver and causes varying degrees of illness in patients.
 The severity of infection is age related with symptoms being





more common in adolescents, adults, and young children.
Acute symptoms last for four weeks to three months,
requiring total rest and occasionally hospitalisation. This
causes disruption of daily activities and often leads to absence
from work to school. Complete recovery can take as long as 612 months, with serious and occasionally fatal complications
occurring in minority of patients. Hepatitis A can relapse in
20% of the cases that acquire the disease, and the symptoms
may persist for up to six months.
SYMPTOMS OF HEPATITIS A: '
It includes nausea, vomitting, yellowness in eyes, skin and
urine (jaundice).
Diarrhoea, pale stool, abdominal pain and fatigue.
Fever and chills, lack of appetite, sore throat.
The frequency and severity of these symptoms, depends on
the age of the person. This affects the young children more
than adults. Two to five year olds develop jaundice with
associated dark urine and pale stools.
 MODE OF TRANSMISSION '
 Hepatitis A vims is excreted in the faeces, and spread by faecal route.
 Direct contact with an infected person's faeces or indirect





contamination of food, water, hands and cooking utensils.
Raw or insufficiently cooked food (fruits, salads vegetables, seafood
etc.).
Close contact with infected individuals within families, schools, day
care centres and hostels.
Through contaminated needles and syringes or through
contaminated blood products.
Poor standards of living, poor hygiene and sanitation.
The risk of early exposure is less among those living in an improved
socio-economic environment. Any non-immune person exposed to
the virus can develop hepatitis A. The children attending day care
centres, schools etc, and individuals from upper socioeconomic
groups who are unlikely to have been exposed to the virus. The high
risk of this virus is in travellers to highly endemic areas, food
handlers, healthcare workers, school or day care employees and
contacts with infected persons.
 HEPATITIS B
 It is an acute systematic infection with serious disorder in the liver,
caused by hepatitis B Virus (HBV) and transmitted usually by the
parental route. Hepatitis B is endemic throughout the world
including the remote areas and islands. Its prevalence varies from
country to country and depends upon a complex mix of
behavioural, environmental arid host factors. It is lowest in
countries or areas with high standard of living.
 It is an acute infectious disease, and has world wide distribution.
Infection is much higher in under developed areas of the world than
in the developed countries. It is a DNA virus. Man is the only source
of infection. Patients remaining HBS Ag positive for more than 6
months, following acute hepatitis B infection are called chronic
carriers. The chronic carrier state may persist for years and may lead
to chronic liver disease. This mainly contaminated blood and blood
fractions and less frequently other secretions and excretions e.g.,
saliva, urine, semen. The period of communicability is usually
several months, or as long as virus is present in blood.
 It occurs at very early ages. High infections rates have been found in
drug - abusers, prostitutes and homosexual population. Incubation
period is 60 to 180 days. Lower doses of the virus results often in
longer incubation periods.
 Modes of Transmission
 Parental Route: This is the most common route of spread of
Hepatitis B. Traditionally Hepatitis B has been a hazard of (a)
blood transfusion, (b) use of inadequately sterilized needles,
syringes and other equipment during medical, surgical and dental
procedures, and (c) exposure to infected blood. Transmission of
Hepatitis B virus can take place in the family setting as a result of
accidental percutaneous inoculation following the use of shared
razors, toothbrushes, towels or by close contact.
 Vertical Transmission : The Hepatitis B virus can get into the
fetus from an infected mother. The mechanism of parental
infections is uncertain. Hepatitis B virus can infect the fetus in
uterus as a result of a leak of maternal blood into the body's
circulation, or ingestion of accidental inoculation of blood.
 Other Routes: Hepatitis B virus also exists in the variety of
body secretions and excretions like Saliva, semen and vaginal
fluid. This clearly states that kissing or sexual intercourse may
transmit infection.
 PREVENTION
 Hepatitis B Vaccine ("H-B-Vax"): The aim of this vaccination is to
stimulate production of the surface antibody which is produced
from the plasma of chronic carriers of hepatitis B virus. The
immunization regimen consists of 3 doses of vaccine.
 Hepatitis B Immunoglobulin (HBIG): It is used for those acutely
exposed to HBs AG - positive blood, for example (a) surgeon, nurses
or laboratory workers (b) newborn infants of carrier mother, and (c)
sexual contacts of acute hepatitis B patients. The HBVIG should be
given as soon as possible after an accidental inoculation (ideally
within 6 hours and preferably not later than 48 hours). At the same
time the victim's blood should be drawn for HBs Ab testing. If the
test is negative, vaccination should be started immediately and a
full course given. If test is positive for surface antibody, no further
action is needed.
 Positive-active Immunization: The simultaneous administration
of HBIG and hepatitis B vaccine is more efficacious than HBIG
alone. HBIG does not interfere with the antibody response to the
hepatitis vaccine. This combined procedure is ideal both for
prophylaxis of persons accidentally exposed to blood known to
contain hepatitis B virus and for prevention of the carrier state in
the newborn babies of carrier mothers.
 Other Measures: No blood should be transfused until it is





screened and blood donors tested positive should be rejected.
Voluntary blood donors should be encouraged because
purchased blood has shown a higher risk of post-transfusion
hepatitis. The importance of adequate sterilization of all
instruments and the practice of simple hygienic measures
should be stressed among health workers. Finally people
should be educated in terms of healthy living.
Hepatitis C :
Hepatitis 'C' is a slow killer. It is one of 40 new infectious
diseases discovered since 1970, but has been around for
decades, if not centuries. Before 1989, it was known as 'non-A,
non-B hepatitis' Mode of Transmission
There is a minute risk of catching the disease from implements
that can carry blood (razors, tatoo pens, tooth-brushes etc.)
It is also possible for mothers to pass it on to an unborn baby.
The infection is also through sexual contacts.
 Prevention
 Treatment is not always successful and depends on the virus 'geno type' or




'strain' but across the board 60% of patients will be cured when pegylated
Inter Form is available.
One of the symptoms of Hepatitis-C is debilitating tiredness which can
lead to it being mistakenly diagnosed as chronic fatigue synodrome.
14.3. TETANUS
It is world-wide in occurrence. Tetanus is an important endemic infection
in India. The natural habit of the organism is soil and dust. The risk of
acquiring the disease is pretty high between 5 to 40 years of age. Tetanus
occuring in the new born baby is known as "Neonatal Tetanus". Infants
typically contact the disease at birth, when delivered in nonaspetic
conditions - especially when the umbilical cord is cut with unclean
instruments. Females are more exposed to the risk of tetanus especially
during delivery or abortion. Its occurrence depends upon man's physical
and ecological surroundings - the soil, agriculture, animal husbandry. The
environmental factors such as unhygienic customs and habits e.g.
application of dust or animal dung to wounds, ignorance of infection and
lack of primary health care services.
The incubation period is usually 6 to 10 days. It may be as short as one day
or as long as several months.
 MODE OF TRANSMISSION
 One gets infected through contamination of wounds with tetanus sores. The degree
of accidents and injuries which may also lead to tetanus comprise a trivial pin prick,
skin abrasion, puncture wounds, burns, human bites, animal bites, and stings,
unsterile surgery,intrauterine death, bowel surgery, dental extractions, injections,
unsterile divison of umbilical cord, compound fracture,otitis melia, chronic skin
ulcers, eye infections, gangrenous limbs.
 PREVENTION
 Prevention of tetanus can be done with the following:  Active Immunization: Tetanus can be prevented by active immunization with
tetanus toxoid. Tetanus toxoid stimulates the production of the protective nutitoxin.
Every individual in the community should be vaccinated regardless of age. Active
immunization is done through combined vaccine (DPT) and monovalent vaccines.
 It is also recommended for all expectant mothers who were not satisfactory
immunized earlier. Complete course of immunization lasts for atleast five years.
Neonatal tetanus can be prevented by immunizing mothers during pregnancy. No
pregnant mother should be denied even one dose of tetanus toxoid, if she is seen
late.
 All wounds must be thoroughly cleaned after injury - removal of foreign bodies, soil,
dust, necrotic tissue. Tetanus may occasionally occur in spite of active or passive
immunization or both. Passive Immunization: Protection against tetanus can be
achieved temporarily by an injection of human tetanus hyperimmune globulin (TIG)
or ATS. It gives a longer passive protection upto 30 days or more compared with 7-10
days of horse ATS.
 Active and Passive Immunization: Active and passive immunization can be given
simultaneously in non-immune persons.
 Antibiotics: Active immunization with tetanus toxoid is
the best method of tetanus prevention but it is of no
immediate use to a person who is non-immune and has
sustained injury. For these reasons, antibiotics are
provided in the prophylaxis against tetanus.
 Antibiotics alone is effective in the prevention of tetanus;
it is not a substitute to immunization.
 THANK YOU