Download epidemiology

"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: Epidemiology inspection of infectious focus and
measures on his liquidation. Prophylactic and antiepidemic
role of polyclinic.
Subject:
epidemiology
Major:
Medicine
Educational degree and qualification degree: Specialist
Year of study:
5
Hours:
6
Prepared by
Sydorchuk A.S., MD. PhD.
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1. Theme: Epidemiology inspection of infectious focus and measures on his
liquidation. Prophylactic and antiepidemic role of polyclinic.
2. Lesson duration: 4 hours.
3. Educational purpose:
3.1. A Student must know:
- Concept "focus" of the infectious disease;
- Sequence of leadthrough of inspection of infectious disease focus;
- Features of collection of epidemiology anamnesis at the different groups of
infections (anthroponotic, antropozoonotic, zoonotic);
- Possible ways of transmission, terms, and factors, that distributed of infection;
- Measures, in relation to liquidation of infectious disease focus, depending on the
category of exciter;
- Basic functions of an infectionist in polyclinic.
3.2.
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3.3.
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A student must be able:
to collect epidemiology anamnesis;
to define the territorial scopes of nidus;
to conduct antiepidemic measures in nidus of infectious diseases;
to work out a plan of disease measures on localization of nidus infection;
to carry out the review of nidus;
to collect material (water, pieces of suspicious food products, tests of soil,
material from a patient, and others like that) for diagnostic and sanitary-hygenic
researches;
to make a conclusion and design a medical document in relation to the results of
epidemiology inspection of focus.
To posses practical skills:
collection of epidemiology anamnesis;
registration of medical document (urgent report, map of epidemiology inspection
of focus);
collection of material for bacteriological, virologic, parasitologic, immunological
and sanitary-hygienic researches.
4. Advices to the student:
At the study of method of epidemiology inspection of infectious focus, to pay a
regard to that inspections begin with questioning a patient in permanent establishment
(on houses), setting the date of disease, entering time permanent establishment, possible
reasons, place, circumstances, which an infection, type of epidemic process (domestic,
food, parenterally), possible source of infection, happened at, here.
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To pay a regard to sequence and care of filling of map of epidemiology
inspection.
Inspecting a cell, to estimate the sanitary state of apartment, point out the exposed
defects, presence of terms for inhibition of rules of the personal hygiene.
A role of sanitary education, sanitary-educational work, is in the focus of
infection.
Features of prophylactic and anti epidemic work of policlinic infectionist.
Preventive measures aimed to control infectious diseases taken by medical
personnel are divided into preventive and anti-epidemic.
 Preventive measures are carried out regardless of the presence or absence of
infectious diseases at a given time and locality. These measures are aimed at
prevention of infectious diseases.
 Anti-epidemic measures are necessary when an infectious disease develops. It has
already been said that the following three basic factors are necessary for
development of an epidemic: the source of infection, transmission mechanism,
and susceptibility of population.
Exclusion of any of these factors terminates the spread of an epidemic process.
Prophylactic and antiepidemic measures are therefore aimed at control of the source of
infection, disruption of the route by which infection spreads, and strengthening of nonsusceptibility of population.
Control of infection source. Patients with some infectious diseases, e. g. measles,
pertussis, dysentery or cholera, liberate the pathogenic microorganisms into the
environment during the last days of the incubation period or during the first day of the
disease. Timely revealing of the sick is thus very important. Active detection of the sick
is performed by medical personnel at hospitals, polyclinics, medical posts and the like.
Health education of population by medical personnel promotes early attendance of the
sick for medical aid and thus helps timely detection of infectious patients. Examination
of population in outpatient conditions (in residential districts) is helpful in this respect.
An infectious disease is diagnosed on the basis of findings, epidemiologic
anamnesis and laboratory tests. All patients with the diagnosis of an infectious disease
should be entered into a special record. The record should be made by a physician or a
medical nurse. All cases of infectious diseases or suspected cases should be entered into
the record, and higher epidemiologic authorities should be informed not later than within
24 hours. In cases of plague, cholera or other disease that requires quarantine measures,
local medical personnel must inform higher authorities of the health system.
The infectious patients must be isolated in proper time. Patients with plague,
cholera, viral hepatitis, typhoid and paratyphoid fever, diphtheria, and similar
contagious diseases should be immediately hospitalized. The patients should be handled
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in special ambulance cars that should be disinfected after transportation of each patient.
The patient delivered to the hospital must be given appropriate sanitary treatment before
placing in the appropriate ward or an isolated room, if the diagnosis is not clear, or
infection is mixed by its character. Special measures should be taken in order to prevent
spread of infection within the hospital. In order to remove the danger of spreading
infection, the patient should be given appropriate therapy. Patients with scarlet fever,
escherichiasis, dysentery and the like diseases can remain at home where they must be
isolated from the other family. The family must be instructed how to prevent infection
and to disinfect the household utensils. Observation of the patient by the medical
personnel must be constant.
Persons cured from infectious diseases should be discharged from hospital after
alleviation of all clinical symptoms, and examination for the carrier state, specific for
each particular infection; for example, person who sustained diphtheria, can be
discharged from hospital after a complete clinical cure and two negative
bacteriological tests of the faucial and nasopharyngeal smears. Persons who
recovered from typhoid fever, paratyphoid, salmonellosis, dysentery should be observed
in outpatient conditions. The term of observation depends on each particular disease.
Carriers of infection should be revealed and isolated for medical examination and
treatment. Since it is impossible to screen the entire population, only those who can be a
danger for the surrounding people (personnel of children's institutions, food catering,
and the like establishments) should be inspected.
If the epidemiologic situation requires, the following groups of people should be
examined for the carrier state: (a) persons who can be in contact with typhoid fever
patients, patients with dysentery, paratyphoid, diphtheria, and meningococcal infection;
(b) persons with a history of sustained typhoid fever, paratyphoid, and dysentery; (c)
persons suspected for being a source of infection in the focus of infection.
The carriers must be immediately withdrawn from their occupation at food
catering or children's institutions till they are completely cured and given multiple tests
for the absence of the carrier state. Chronic carriers should be moved to other jobs that
are not connected with food or children. Infection carriers must be regularly treated and
observed according to special instructions.
If animals are the source of infection, measures differ. Veterinary measures
should be taken with respect to domestic animals. Animals with brucellosis should be
slaughtered. Horses with glanders should also be killed. Food and materials obtained
from diseased animals must be given special treatment. Farms where infection is
revealed, must be disinfected and quarantine established. Wild animals that are not the
object of quarry must be destroyed, and measures for their isolation from man should be
taken.
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Disruption of infection transmission pathways.
The pathways by which infection can be transmitted are disrupted by acting on the
transmission factors. Since intestinal infections are transmitted by the faecal-oral route,
all preventive measures are aimed to preclude contact of the infected material with
water, food, or hands. General sanitary measures should be taken constantly and
universally, regardless of the presence or absence of infection in a given locality.
Community hygiene is very important in prevention of infection spread. Layout of
settlements, housing conditions, the presence or absence of water supply and sewage
systems are important factors in this respect. Permanent control of water supply system,
a correct selection of water body and the site of water intake, protection of the water
intake zone, purification and decontamination of water are important preventive
measures. Soil protection from contamination with domestic wastes and sewage and
timely cleaning of settlements are decisive measures against flies.
5. Control questions:
1.
Name the epidemic factors and characterize them briefly.
2.
Name the phases of transmission of pathogenic microbes from one
macroorganism to another.
3.
What major factors are involved in the transmission of pathogenic
microorganism s?
4.
What measures are necessary to control the source of infection and to
disrupt the route of infection transmission?
5.
What measures are taken to strengthen insusceptibility of population
to infectious diseases?
6.
Name anti-epidemic measures that should be taken in a focus of
infection.
7.
Name the measures that should be taken to persons who were in
contact with the diseased?
6. LITERATURE
A. Basic:
1. Lecture.
2. Epidemiology and Fundamentals of Infectious Diseases. M.L. Volovskaya. Mir
Publisher. Moscow.
B. Additional:
1. A Lange Medical book. Medical Epidemiology. Second Edition. Raymond
S.Greenberg, Stephen R.Daniels. – Aplleton, Stamford, Connecticut. – 1996. – P.195.
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