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10/10/2009 Dr. Salwa Tayel 1 Learning Objectives: • Identify the levels of prevention of infectious diseases and tools for intervention at each level. • Describe the specific control measures for infectious diseases 10/10/2009 Dr. Salwa Tayel 3 Levels of prevention: 1. Primary prevention. 2. Secondary prevention. 3. Tertiary prevention. 10/10/2009 Dr. Salwa Tayel 4 Levels of Prevention • Primary prevention => pre-event phase • Secondary prevention => event phase • Tertiary prevention => post-event phase Promotion (1ry prevention) Early detection & care (2ry prevention) Rehabilitation (3ry prevention) 10/10/2009 Dr. Salwa Tayel 5 Primary Prevention 10/10/2009 Secondary Prevention Tertiary Prevention Dr. Salwa Tayel 6 The pyramid and iceberg of disease Intervention 1 1 Nil, except observation 2 Review 3 Opportunistic or population 2 Screening or health education 5 Protection of current status Diagnosed, uncontrolled 3 Undiagnosed disease screening 4 Diseased, diagnosed & controlled 4 Risk factors for disease 5 Free of risk factors (Health Promotion) 10/10/2009 Dr. Salwa Tayel 7 I- Primary Prevention: Actions taken prior to the onset of the disease which aim to remove the possibility that a disease will ever occur” It limits the incidence of diseases by preventing healthy people from developing disease. Tools for intervention include: A. Health promotion B. Specific protection 10/10/2009 Dr. Salwa Tayel 8 A. Health promotion It is intended to improve the general health of the individual and community, through: 1. Adequate nutrition 2. Environmental sanitation 3. Personal hygiene 4. Health education 5. Socio-economic development 6. Genetic counseling … etc. 10/10/2009 Dr. Salwa Tayel 9 B. Specific Protection is achieved through: 1. Specific immunizations. 2.Chemoprophylaxis. 10/10/2009 Dr. Salwa Tayel 10 II- Secondary Prevention: Actions that detect and treat disease at an early stage thus hinder the progress of a disease and prevent complications. i.e. intervention in early pathogenesis phase. The methods (tools) employed for early diagnosis are: 1. Screening for sub-clinical disease, either in screening surveys or in periodic medical examinations. 2. Case finding (individual and community). 10/10/2009 Dr. Salwa Tayel 11 III- Tertiary prevention: Actions taken when the disease process has advanced beyond its early stages i.e. intervention in late pathogenesis phase. The aim of tertiary prevention is to limit disability and prevent further complications or death. Tools for tertiary prevention include rehabilitation 10/10/2009 Dr. Salwa Tayel 12 Rehabilitation: It is a measure to train disable individuals to reach the highest level of functional ability by using combined coordinated medical, social, vocational, psychological and educational measures. 10/10/2009 Dr. Salwa Tayel 13 Rehabilitation comprises: 1. Medical rehabilitation – restoration of function or physical loss. 2. Educational rehabilitation change of educational methods. 3. Vocational (occupational) rehabilitation – restoration of the capacity to earn a livelihood. 4. Social rehabilitation: restoration of family and social relationships. 5. Psychological rehabilitation: restoration of personal confidence. 10/10/2009 Dr. Salwa Tayel 14 Examples of rehabilitation: 1. Special schools for blind pupils. 2. Provision of aids for crippled. 3. Reconstructive surgery for leprotics. 4. Modification of life for tuberculous or cardiac patients. 10/10/2009 Dr. Salwa Tayel 15 Summary E 10/10/2009 Dr. Salwa Tayel 16 Specific Control Measures Factors affecting choice of appropriate prevention and control measures: It depends upon the knowledge of: • causation and dynamics of disease transmission, • identification of risk factors and high risk groups • availability of tools of intervention (vaccine chemoprophylaxis or treatment,..) In general, control measures should be directed towards the link in the infection chain is most susceptible to interference. 10/10/2009 Dr. Salwa Tayel 17 The cycle of infection has three major links: Agent HOST Environment M.O.T 10/10/2009 Dr. Salwa Tayel 18 Source - Disinfection -Sterilization -Immunization -Chemoprophylaxis HOST Agent Environment Reservoir -Isolation -Treatment - Detection of carriers - Control of animals M.O.T -Vector control. -Snail control. -Environmental sanitation 10/10/2009 Dr. Salwa Tayel 19 Measures Directed to the Reservoir Measures applied to cases • Case finding (early diagnosis) • Reporting • Isolation • Treatment (Chemotherapy) • Disinfection of contaminated objects with appropriate “enteric precautions,” “respiratory precautions,” “universal precautions” 10/10/2009 Dr. Salwa Tayel 21 Isolation is separation of infected persons from those not infected for the period of communicability. Isolation is of decreasing value because: • in-apparent infection may be large proportion, • maximal infectivity may occur during the early stages, • carriers of infective agents may go undetected, or • many mild cases of infection spread disease without being detected 10/10/2009 Dr. Salwa Tayel 22 • Quarantine means separation in a specific place (quarantine) of apparently well persons or animals who have been exposed (contact) to a case of infectious disease. • Quarantine is for the duration of the maximal incubation period of the disease counted from date of last exposure. • This measure is applied for contacts of pneumonic plague and pneumonic anthrax. 10/10/2009 Dr. Salwa Tayel 23 Measures applied to carriers 1. Detection of carriers: It is important in certain diseases e.g. Enteric fever. 2. Exclusion from work: in certain occupations for example; – food handler (e.g. Typhoid carrier) or a – teacher (e.g. Diphtheria carrier). 3. Treatment for the carrier state. 10/10/2009 Dr. Salwa Tayel 24 Measures applied to animal reservoir • Destruction of infected animals (in rabies, plague), • Inspection or slaughtering (in bovine tuberculosis), • Testing and Immunization (in brucellosis), • Careful husbandry and sterilization of animal products (in anthrax). 10/10/2009 Dr. Salwa Tayel 25 Measures that Interrupt the Transmission of Organisms Environmental Measures to prevent transmission of diseases by Ingestion of contaminated vehicles include: • Purification of water • Pasteurization of milk • Inspection of food handlers & public food places • Improvements in housing conditions, and • Educating people in proper personal hygiene and hand washing. 10/10/2009 Dr. Salwa Tayel 26 Measures Reduce transmission of respiratory infection: • Proper ventilation of public places & classrooms, • Minimize close person to person contact (reduce overcrowding) • Control of dust. 10/10/2009 Dr. Salwa Tayel 27 Measures to reduce transmission of arthropod borne infections Measures to control (reduce or eradicate) the vector include: • biological • mechanical and • chemical methods 10/10/2009 Dr. Salwa Tayel 28 Measures that reduce host susceptibility Non-specific measures: • Measures to increase general resistance (Health education, Personal hygiene, Good standard of nutrition,..) Specific measures: • Use of specific passive and active immunization and chemoprophylaxis. 10/10/2009 Dr. Salwa Tayel 29 a) Active immunization as in case of measles. b) Passive immunization as in case of diphtheria. c) Chemoprophylaxis: Is the administration of chemicals including antibiotics, to prevent the development of an infection or the progression of an infection to active manifest disease. 10/10/2009 Dr. Salwa Tayel 30 Examples of chemoprophylaxis: 1. Isoniazid (INH) for contacts of tuberculous patients. 2. Sulphadiazine or Rifampicin for contacts of meningeococcal meningitis. 3. Erythromycin or penicillin for unimmunized contacts of a diphtheria case. 4. Tetracycline for contacts of cholera and pneumonic plague. 5. Chloroquine for travelers to malaria areas. 10/10/2009 Dr. Salwa Tayel 31 The End Thank You Website http://faculty.ksu.edu.sa/73234/default.aspx [email protected] 10/10/2009 Dr. Salwa Tayel 32