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Part IV Provision of Public Health Nursing to Vulnerable Populations Copyright © 2008 Delmar. All rights reserved. Chapter 20 Populations with Infectious and Communicable Disease Copyright © 2008 Delmar. All rights reserved. Contributing Factors • Institute of Medicine (IOM) 1992 report Emerging Infections: Microbial Threats to Health in the United States – Emerging infectious diseases – Increasingly present infectious diseases – Identified six important factors in disease emergence and reemergence 3 Copyright © 2008 Delmar. All rights reserved. Six Factors 1. Changes in human demographics and behavior 2. Advances in technology and industry 3. Economic development; changes in land use 4. Commerce 5. Microbial adaptation 6. Deterioration in the public health system 4 Copyright © 2008 Delmar. All rights reserved. Models of Transmission • Epidemiological triangle and the chain of transmission – Agent-host-environment • Agent and reservoir – Biological agents • Fungi, parasites • Bacteria, viruses 5 Copyright © 2008 Delmar. All rights reserved. Models of Transmission • Agent and reservoir – Reservoir • Human, animal, environment 6 Copyright © 2008 Delmar. All rights reserved. Models of Transmission • • • • Infectivity Pathogenicity Virulence Antigenicity 7 Copyright © 2008 Delmar. All rights reserved. Models of Transmission • Modes of exit – Respiratory – Gastrointestinal – Urinary and reproductive system • Mode of entry to a new host is often the same as the mode of exit from the reservoir 8 Copyright © 2008 Delmar. All rights reserved. Models of Transmission • Modes of transmission (Table 20-1) – Direct person to person – Common vehicle – Vectors 9 Copyright © 2008 Delmar. All rights reserved. Types of Host Immunity • • • • • Natural Acquired Passive Active Herd 10 Copyright © 2008 Delmar. All rights reserved. Levels of Prevention • Leavell and Clark (1958) Preventive Medicine for the Doctor in His Community –Three levels of prevention 1. Primary • • • Education, immunizations Chemoprophylaxis, universal precautions Protective clothing, barrier protection 11 Copyright © 2008 Delmar. All rights reserved. Levels of Prevention • Three levels of prevention 2. Secondary • • • • Screening Disease management Treatment Directly observed treatment (DOT) 3. Tertiary • • Management of complications Prevention 12 Copyright © 2008 Delmar. All rights reserved. Common Infectious and Communicable Diseases • Foodborne and waterborne disease – Food intoxication • Shellfish, mushrooms, bacterial growth, mercury – Food infections • Trichinosis, Salmonellosis • Escherichia coli, Toxoplasmosis • Hepatitis A, Parasites 13 Copyright © 2008 Delmar. All rights reserved. Prevention • Five keys to safer food: 1. 2. 3. 4. 5. Keep clean Separate raw and cooked Cook thoroughly Keep food at safe temperatures Use safe water and raw materials 14 Copyright © 2008 Delmar. All rights reserved. Vectors • Disease carriers – Animals, insects, birds • • • • • Malaria Anthrax Brucellosis Mad Cow Avian Flu 15 Copyright © 2008 Delmar. All rights reserved. Lyme Disease • Most common vector-borne disease – White-tailed deer – Bull’s-eye skin lesion • Red spot at the site of bite, followed by spreading rings of inflammation as infection progresses • Develops 3-30 days after tick bite 16 Copyright © 2008 Delmar. All rights reserved. Lyme Disease • Symptoms – Fatigue – Headache – Fever – Stiff neck, joint pain – Muscle aches – Enlarged tender lymph nodes 17 Copyright © 2008 Delmar. All rights reserved. Lyme Disease • Treatment: 10-14 days of penicillin or tetracycline – Left untreated can progress to Stage II • Neurological and cardiac symptoms – Stage III • Months to years of ongoing attacks – Arthritis and arthralgia 18 Copyright © 2008 Delmar. All rights reserved. Rocky Mountain Spotted Fever • Vector – Dog and wood ticks • Atlantic and western south central region 19 Copyright © 2008 Delmar. All rights reserved. Rocky Mountain Spotted Fever • Occurs 4-6 hours after bite • Incubation period 3-14 days – Maculopapular rash on extremities, palms of hands, soles of feet – Antibiotic therapy required 20 Copyright © 2008 Delmar. All rights reserved. Malaria • Vector – Infected mosquito • Tropical and subtropical area • Travelers should use mosquito repellent – Use mosquito nets while sleeping – Prophylaxis can begin 4-6 weeks prior to travel 21 Copyright © 2008 Delmar. All rights reserved. Parasitic Diseases • Tropical climates, underdeveloped countries – Lack of sanitation – Insufficient primary care – Inadequate access to medications 22 Copyright © 2008 Delmar. All rights reserved. Parasitic Diseases • Four groups of organisms: 1. 2. 3. 4. Roundworms Tapeworms Flukes Single celled organisms 23 Copyright © 2008 Delmar. All rights reserved. Nosocomial Infections • Acquired in a hospital setting • May affect anyone who has contact with a hospital – Other patients – Staff – Environment 24 Copyright © 2008 Delmar. All rights reserved. Respiratory Infections • Tuberculosis – Airborne pathogen • Droplet nuclei 25 Copyright © 2008 Delmar. All rights reserved. Respiratory Infections • Symptoms – Fever, cough, chest pains, fatigue – Hemoptysis, weight loss – Incubation period 4-12 weeks 26 Copyright © 2008 Delmar. All rights reserved. Respiratory Infections • Active cases begin 6-12 months after infection – Extrapulmonary – Multi-drug resistant • Isoniaid and Rifampin 27 Copyright © 2008 Delmar. All rights reserved. Respiratory Infections • Influenza – Influenzia A, B, or C virus – Occur annually – Last 5-6 weeks 28 Copyright © 2008 Delmar. All rights reserved. Respiratory Infections • Small children and elderly most vulnerable – Flu vaccine 70-90 percent effective • Pneumonia – Aspiration of virulent and nonvirulent organisms – Inhalation of toxic fumes – Aspiration of stomach acids 29 Copyright © 2008 Delmar. All rights reserved. Respiratory Infections • Symptoms – Upper respiratory tract infection – Chills, fever, cough – Chest pain and dyspnea • Treatment – Antibiotics 30 Copyright © 2008 Delmar. All rights reserved. Hepatitis • Hepatitis A – Fecal-oral routes – Vaccine available and provides protection • Hepatitis B – Blood borne pathogen • Fatigue and right upper quadrant discomfort • Treat with Interferon and Lamivudine 31 Copyright © 2008 Delmar. All rights reserved. Hepatitis • Hepatitis C – Blood-borne infection – Causes up to 10,000 deaths a year – Interferon, Ribavirin 32 Copyright © 2008 Delmar. All rights reserved. HIV • Destruction of immune system • Antibody test can confirm diagnosis • Early detection better prognosis – Elisa – Western Blot • Treatment – Protease inhibitors, anti-retroviral drugs 33 Copyright © 2008 Delmar. All rights reserved. HIV • Role of public health nurse – Promote prevention of spread of HIV through education • Venereal Warts – HPV • Gardasil 34 Copyright © 2008 Delmar. All rights reserved. STDs • Syphilis • Gonorrhea – Bacterial disease, purulent discharge with painful urination – Treatment • Antibiotics 35 Copyright © 2008 Delmar. All rights reserved. Bioterrorism • Three categories of biological agents: 1. Category A highest risk • • • • • Easy spread Can be transmitted person to person High death rates Public panic Require special action 36 Copyright © 2008 Delmar. All rights reserved. Category A • • • • • • Anthrax Plague Smallpox Botulinum toxin Tularemia Hemorrhagic fever 37 Copyright © 2008 Delmar. All rights reserved. Category B 2. Category B second highest: – – – – Moderately easy to spread Moderate illness rates Low death rates Require specific enhancements of CDC’s lab capacity 38 Copyright © 2008 Delmar. All rights reserved. Category B • • • • • Q Fever Brucellosis Glanders Melioidosis Psittacosis • Ricin toxin • Typhus Fever • Staphylococcal Enterotoxin B • Viral encephalitis • Food and waterborne diseases 39 Copyright © 2008 Delmar. All rights reserved. Category C 3. Category C third highest priority: – – – – Emerging pathogens Easily available Easily produced and spread Potential for high morbidity and mortality 40 Copyright © 2008 Delmar. All rights reserved. Category C • • • • • Napin virus Hantaviruses Tick-borne encephalitis viruses Yellow fever virus Multi-drug resistant Mycobacterium tuberculosis 41 Copyright © 2008 Delmar. All rights reserved. Managing Bioterrorism • Plans in place for local response • State and Federal agencies can assist • U.S. Department of Homeland Security 42 Copyright © 2008 Delmar. All rights reserved. Strategies for Nurses • Often first to detect presence of illness • Often manages the communicable disease program for county – Surveillance systems – Nurse conducts case and contact follow up – Communication skills • Risk communication 43 Copyright © 2008 Delmar. All rights reserved. Planning for Pandemic Disease Events • WHO Global Influenza Preparedness Plan – Inter-pandemic • Phase I and II – Pandemic alert • Phase III, IV, V – Pandemic period • Phase VI 44 Copyright © 2008 Delmar. All rights reserved.