Prepared by Dr.

Ebey Abraham PRVENTIVE AND SOCIAL MEDICINE Chapter 1 Men & medicine Time of atreya- 800 BC; takshila Time of charaka- 200 AD; court physician of king kanishka Charaka mentioned 500 drugs Sarpagandhi- indian snakeroot Time of susruta samhita- 800BC to 400AD golden age of indian medicine- bet 800BC to 600AD Humers in chinese medicine- yin- female & yang- male Period of greek medicine- 460- 136 BC Time of hippocratus- 460-370BC; fathrt of medicine Humers in greek medicine- phlegum, yellow bilr, blood, black bile Bhuta in greek medicine- earth air fire water Roman medicine- like greek medicine; galen (130-205 BC) Modern medicine- preventive medicine, curative medicine, social medicine Chapter 2 Concept of health & disease WHO -definition of health- "is a state of complete physical, mental and social well being and not merely the absance of diseases or infirmity" Diseases- condition in which body's health is impaired chapter 3 Epidemiology Epidemic treatment prevailance- all current cases existing to given population in given time Insidence- number of new cases occurring to given population in given time Source-thing from which infectious ajent passes to host Reservoir- thing in which infectious ajent lives- cases & carriers Cases- clinical, sub clinical & latent infection; primary cases, index cases, secondary cases Carriers- types- incubatory, convalescent, healthy. Duration- temporary, chronic. Portal of exit- urinary, intestinal, respiratory, others Mode of transmissiondirect: contact, droplet infection, soil contact, inoculation to skin or mucusa, transplacental (vertical); Indirect- vehicle borne, vector; mechanical or biological borne, air borne; droplet nuclei dust, fomite borne, unclean hand and fingers Direct contact-STD, AIDS, leprocy, leptospirosis, skin & eye infection Droplet infection- respiratory infection, eruptive feavers, cold, diphtheria, wooping cough, tb, meningococal meningitis Soil contact- hook worm, tetenus, mycosiis, leptospirosis Inocilation- rabies, hepatitis B, Transplacental- TORCH agents ( toxoplasmosis, rubella, cytomegalo virus, herpes), siphilis, AIDS, hepatitis B

Prepared by Dr. Ebey Abraham Vehicle borne- food, water, blood, tissue, organs; AIDS, typhoid, cholera, Vectir mode- vector living carrier, transmitting disease.- including mechanical transmition, biologocal (propogarive, cyclopropagative, cyclodevelopmental) Airbrone transmitiondroplet nuclei- tuberculosis, influenza, chicken pox, measles, respiratory infections dust.- fungal spores, viruses, tuberculosis Fomite born transmition Inanimate objects, -dyphtheria, typhoid, eye & skin infections. Unclean handa & fingers typhoid, eye & skin infections, dysentry, hepatitis A, paracitosis Incubation period- time taken for 50 % case to occur following exposure. Latent period- non infectious disease like incubation period Serial intervals- time in between primary & secondary cases in a group Immunity Active immunity- humoral, cellular, combination of two Passive immunity- normal human Ig, specific human Ig, animal antisera Vaccines- live attenuated, killed, toxiods Immunoglobulin- human antisera, nin human antisera Immunoglobulins-IgG, IgM, IgA, IgD, IgE Cold chai apparatus- for preservation of vaccines Disinfectant- destroyes harmful microbes applay only to inanimate objects Antiseptic- suitable for applay on living tissues Deodarant- neutralise odour Strtilition- destroy microbes including spores Dettol- cloroxenol- is a phenol compound Cresol- coal tar disinfectant Clorhexidine- hibitane Cetrimide- cetavlon Savlon- cetavlon & hibitane Chapter 5 Epidemology of communicable diseases Small pox caused by variola virus Clinical features- fever, vomiting, headache, convulsions, centrifugal rashes Incubation period-12 days- 7-17 days Evolution-slow Stages of rashes-macule pappule vesicle pastule scab Indias last case of small pox- 26 october 1977, WHO declared 8 may 1980 Factors for eradication- no animal reservoirs, no long term carrier, life ling immunity, easy detection, sunclinical patents don't transmit disease, effective vaccine, international cooperation Other varieties of pox- munkeypox, tanapox Ckicken pox Varicella zoaster virus- human herpesvirus 3

Prepared by Dr. Ebey Abraham Clinical features- vesiclular rashes, fever, malaise Source of infections- case, oropharyngeal secretion, herpes zoaster ptient Infectivity- 1-2 days before ra h, 4-5 days thereafter. Virus die out before pustular stage Secondary attack rate- 90% Host- usually below 10 Innunity- life long Infection in pregnancy - risk to infants Transmition- droplet, droplet niclei Portal entry- respiratory tract Incubation period -14-16 days; 7-21 days Rash distribution- symmetrical, centripetal Evolution rapid- macule pappule vesicle pastule scab Dew drops like appearance Pleomorphysm of rashes- all etages at a time Complications- Rey's syndrome- encephopathy with fatty degeneration of liver, varicella hemorrhagica, Pneumonia, encephalitis, cerebellar ataxia (acute) Measles RNA Mixovirus Clinical features- fever, coryza, cough, rashes, Source - cases Infective material- sacretions of nose throat Infective periods- during prodromal periods & at time of eruption Age- 6 month-3 years Transmition- droplet infection, droplet nuclei Incubation period- 10 day for fever, 14 day for rash Koplik's spots- 2 days before rash, on buccal muco opposite to 1st & 2nd upper molars Complications- SSPE- 7 cases in one million, measles associated diarrhoea, pneumonia, otitis media encephalitis, Must be treated with vitamin-A Rubella- german measles Virus- RNA virus- togavirus Acute childhood infection Fever, limphadinopathy, rash Source- linical; sunclinical cases Period of communicablity- 1 week before & after rashes Host- children-3-10 years Immunity- lifelong Infants of immune mothers are protectde for-4-6 months Time- winter, spring Transmition- droplet, droplet nuclei Incubation period- 2-3 weeks, 18 days limphadinopathy- post aurivular, posterior cervical

Prepared by Dr. Ebey Abraham Complications- arthralgia, ITP, encephalitis, Conjenital rubella syndrome Glucoma, retinopathy, microcephalus, CP, IUGR, MR, hepato splenomegali In first trimester Mumps Mixovirus paritiditis- RNA virus Sources- clinical & subclinical cases Period of communicablity- 4-6 days before oncet & 1 week thereafter Age- 5-15 years severe attack in adults immune 6 months due to maternam antibodies Incidents- winter spring Transmition- droplet, directly contact Clinical features- parotid swelling, ear ache, Effect- testes, ovary, pancreas, CNS, prostate Complications- orchitis, overitis, pancreatitis, meningo- encephalitis, myocarditis Influenza Influenza virus A,B, & C- otrthomixivirus Features- chills, malaise, fever, muscle pain cough Reservoirs- animals, birds, Sources- clinical subclinical cases Infectivity period- 1-2 dats before & after symptoms Season- winter, rainy seasons, india- summer Mode of transmition- droplet, droplet nuclei Incubation period- 18-20 hours Complications- secondary infections, pneumonia- if fever don't subsided for 5 days Diphtheria Corynebacterium diphtheriae- gram+ non motile. types- gravis, mitis, intermedius clinical features- false membrane on pharunx, tonsills, Marked conjection, oedema, local tissue destruction limphadinopathy, sore throat, disphagia, toxaemia Fatality rate- 10-5% Source- cases, carriers- common sourses- temporary/ chroniv, nasal/ throat carriers Infective material- nasopharyngeal secretions, discharge from skin lesions, infected dust, contaminated fomites Age- 1-5 Kolkatta- august month, winter. Mode of transmition- droplet infection, infected cutaneous lesions, transmition by objects- cups, thermometers, pensils, toys-short period Portal of entry- respiratory, wounds, cut ambilicus, eye, jenitalia, middle ear Incubation period- 2-6 days Test for dyphtheria- schick test-inradermal test-10-50 mm of patch- +ve on test area only Wooping cough- pertusis Ajent- bordrtella pertusis- bacterial disease Oncet with mild fever - turns into whoop cough

Prepared by Dr. Ebey Abraham Sourse -cases Infective material- nasopharyngeal secretions Infective periods- before 1 week after 3 weeks of symptoms Secondary attack rate- 90% Age- below 5 years. Infants are suceptable from birth itself Mode of transmission- droplet, direct contact Incubation period- 7-14 days Stages-catarrhal stage-10 days paroxysmal- 2-4 weeks lasting, convalasent - 1-2 weeks lasting, Complications- bronchitis, subconjunctival hemorrhage, epistaxis, hemoptysis, coma, Contra indication of vaccine- epilepsy Meningococal meningitis caused by Niseria meningitidis; gram -ve diplococci fatal types- groups A,B,C Fatality in untreatrd case-80% Sourse of infection- nasopharynx of cases & carriers Causes- children and young adults Outbreak- dry cold seasons Mode of transmission- droplet infection portal entry- nasopharynx Tuberculosis Micobacterium tuberculosis Cattle tuberculosis- bovine tuberculosis sult of mantaux test read after 3 days; reaction exceeding 10 mm +ve, less than6 -ve, between 6-9 doubtful Poliomyelitis Viral infection by polio virus RNA virus Ajent- poliovirus 1,2,3 1- common form Virus can survive in water for 4 month, faeces for 6 months Reservoir of infection- man Infectious material- faces, oro pahryngeal secretions Period of infectivity- 7-10 days before and after symptoms Mode of transmission- faceal oral route, droplet infection Incubation period- 7-14 days Infection types- subclinical, abortive polio, non paralitic polio, paralytic polio, Vaccine- salk injection, sabin (OPV) Viral hepatitis Types hepatitis A,B,C,D,E,G Hepatitis A Entrovirus, picnoviride family Survives 10 weeks in water Reservour- human casas no carrier Infectivity period- 2 week before & 1 weeks after symptoms Infective material- excreta, blood, sreum, Virus excreted also thro' urine Immuniyu lifelong

Prepared by Dr. Ebey Abraham Seasons- rainy seasons Hepatitis B Serum hepatitis Route of transmission- parenteral route Incubation period- 6 weeks to 6 months Causes progressive liver failure leading to carcinoma Reservour of infection cases and carriers Dane particles- virus in liver cells Infective material - contaminated blood saliva semen vaginal secretions Period of infectivity - from incubation period to total disappearance of HBsAg STD homosexuals are more suceptable Incubation period -45 to 180 days Hepatitis C Parenteral transmission Incubation period -6-7 weeks Complications -chronic liver failure liver cancer Hepatitis D- infective only in the presence of hepatitis B Hepatitis E- waterbrone disease Cholera Vibrio cholerae Sudden oncet of watery diarrhoea followed by vomiting dehydration, loss of urinr, cramps Bacteria remain in ice for 4-6 weeks Produces exotoxin-diarrhoea Infective material -stools vomitus Period of infectivity- 2-10 days, convalasent cariers -2-3weeks, chronic cariers -upto 10 years or more Incubation period -few hours tob5 dats (1-2 days) Stools-40/day, ricewater appearance vomiting effort less, dehydration - sunken eyes, scaphoid abdomen, hollow cheeks, washerman's hand, absant pulse, low bp, ORH solutions - NaCl-3.5 gm, NaHCO3-2.5 gm, KCl-1.5 gm, glucose- 20 gm, water1 litre ORH solutions (citrate) - NaCl-3.5 gm, trisodium citrate-2.9 gm, KCl-1.5 gm, glucose- 20 gm, water-1 litre Typhoid By salmonella typhi only in man Enteric fever - typhoid and paratyphoid Reservour of infection - cases & cariers -temporary , convalasent , chronic cariers "typhoid mary" good example Host factors for immunity - gastric acidity & local intestinal immuniy Incubation period - 10-14 days Route of transmission - faceal oral route, urine oral route Food poisoning types - bacteria & non bacterial

Prepared by Dr. Ebey Abraham Bacterial - salmonella typhymurium, salmonella suis, salmonella enteritidis, Sourse - farm animal & poultry Incubation period -12-24 hours Streptococal food poisoning by streptococus aureus Incubation period - 1-6 hours Symptoms by toxins heat resistant toxin Botulism Clostridium botulinum Incubation period - 12-36 hours Toxin thermoliable- heating 100 destroyed it Clostridium food poison found in animal faces Incubation period- 6-24 hours Amobiasis Entamoeba histolitica- vegetative & cystic form Reservoir- man Period of communicability- several years Medicine- metronidazole Ascariasis Ascaris lumbricoids Hookworm Ancylostoma duodenale (necator americanus) Enter the body thro' feet by skin penetration Dracunculiasis= gunaeaworm disease nematode parasite- dracunculus medinensis Lives in subcutaneous tissue Cycle- man cyclops man ARTHROPODE BORN INFECTION Dengue syndrome Arbovirus Types- classical dengue fever(break bone fever), dengue haemorrhagic fever without shock, dengue haemorrhagic fever with shock mosquitoes- ades aegypti, ades albopictus MalariaParacite- plasmodium Stages- cold stage, hot stage, swetting stage Ajents- P. vivax, P. Falciparum, P. Malariae, P.ovale Asexual cycle- human cycle- hepatic phase, extra hepatic phase, gametogamy Sexual cycle- mosquito cycle Reservoir- chimpancies, man Mosquito- female anophiline- night feeding habit Incubation period- 10 days Filariasis

Prepared by Dr. Ebey Abraham W. B5anchofti, B. Malai, B.timori Exibit nocturnal peroidicity Definite host- man intermediate host- culex mosquito, mansonia, anophilous, ZOONOSES Rabies Hydrophobia, lyssavirus type 1 RNA virus Incubation period- 3-8 week following bites Transmission- by bites, licks, aerosols, person to person Rabies in dog- furious dog, dumb dog Yellow fever Arbo virus in america & africa Mosquito- ades aegypti Japanese encephalitis- flavivirus Mosquito- culex mosquito KSD- flavivirus By infective ticks Chicken gunya- fever By ades, culex, mansonia West nile fever- arbovirus Culex mosquito Sandfly fever By sandfly Brucellosis Gram -ve bacteria Leptospirosis Leptosoira Source of infection- rats, mice, cattle, sheep, goat, Transmission- direct contact, indirect contact, droplet infection Incubation period- 10 days(4-20) Plague Yersinia pestis Infected flea bites -xenopsilla cheopis Types- bubonic, pneumonic Typhus, Q fver, tick typhus, - rickettsial zoonoses Taeniasis Types- T-saginata, T- solium Transmission by ingession of cysticerci Hydatid disease Canine tapeworm- echinococcus leishmaniasis By leshmania donovani- intracellular parasite Kala azar Types- viseral leishmaniasis, cutaneous leishmaniasis Vector- sandfly (phlebotomus argentipus)

Prepared by Dr. Ebey Abraham Trachoma by chlamidia trachomatis Reservoir- infected cases, occular discharge, fomitus Transmission- fly, fingers, towel, kajal, suruma Incubation period- 5-12 days Tetanus Clostridium tetani Trismus (lock jow) Leprosy Hansen's disease by micobacterium leprae Types- tubercular leprosy, lepromatus leprosy Mode of transmission- droplet infection, contact, others- breast milk, tatoo, Incubation period- 3-5 years STDs Endemic treponematosis- pinta, endemic syphillis, yaws, AIDS Slim disease By retrovirus- hiv virus Lab tests- ELISA, western blot test, absolute CD4, Chapter7 Health programs in India National malaria control program- april 1953 (5 years) National malaria eradication program- 1958 Modified plan of NMEP- 1st april 1977 1999- National anti Malaria program National filaria control program- from 1955 National leprosy eradication program- 1955 Modified leprosy eradication compaign- april 1997 National tuberculosis program- 1962 Revised National tuberculosis program- 1992 National AIDS control program- 1987 National AIDS prevention & control policy - april 2002 national program for control of blindness- 1976 Trachoma control program- 1968 Iodine deficiency disorders program- 1962 (goiter control program) Universal immunization program- expanded program on immunization- by WHO1974; in india- 1978 Pulse polio immunization program- 1995 National guinea worm eradication program- 1984 National cancer control program- 1975- 76; 1990- 91 National water supply sanitation program- 1954 Accelerated rural water suppply program- 1972 Minimum need program- 1974- 1978- including; rural health, rural water suppply, rural electrification, elementary education, adult education, nutrition, environmental

Prepared by Dr. Ebey Abraham improvement of urban slums, house for landless labourers 20 Point program- in 1975 Chapter 8 Demography & family planning Demography- scientific study of human population Demographic cycle- 1- high stationary, 2- early expanding, 3- late expanding, 4- low stationary, 5- declining Population in 2000- 6054 million Family planning- avoiding unwanted birth, bring about wanted birth, regulate birth intervals, avoid aged mother's birth, determine number of children in a family Is the way of thinking & living adopted voluntarily upon the basis of knowledge, attitude and responsible decision of couples to promote health & welfare of family. First national population policy- april 1976 Contraceptive methods- spacing methods- barrier methods (physical, chemical, combined), IUCD, Hormonal methods, post- conceptional methods, miscellaneous. Terminal methods- male sterilisation, female sterilisation. Physical methods- condom, diaphrahm, vaginal sponge(today) IUCD- medicated, non medicated; first generation, second generation- copper IUD, third generation- hormone releasing. First- lipper's loop Second- copper T third- progestasert Apt time for IUCD insertion- during mensturation or within 10 days of beginning of mens. Hormones- oral pills- combined, progesteroe only pill, post coital pill, once a month pill, male pill.Depots- injection, subcutaneous implants, Vaginal rings. formulation of Mala d- norgesterol, ethinil oestradiol Injection- DMPA, NET-EN Implants- Norplant MTP act - 1971 MTP rules- 1975 Safe period described by - ogino (1930) Fertile period- 10- 18 day after start date of mensturation, or shortest cycle-18=first day of fertile period; longest day-10= last day of fertile period Chapter 10 Nutrition & health Food classification - animal origin, vegetetable origin Chemical composition- protein, fat, carbohydrate, vitamin, minerals. Classification by nutrition- cereals & millets, pulses, vegetable, nuts, fruits, animal foods, fat &oils, sugar & jaggery, spices, miscellaneous Nutrients Macronutrients- protein, fat, carbohydrate Micronutrients- vitamin, minerals. Amino acids- 24; essential-9 Essential amino acids are- leucine, isoleucine, lysine, methionine, phenylananine,

Prepared by Dr. Ebey Abraham threonine, valine, tryptophan, histidine. Protein source- milk products, pulces, cereals, beans Daily requirement- 1gm/kg of body weight Fats Fat- solid in 20C, oil are liquid in that temperature Fat- simple lipid- triglecerides, compount lipid- phospolipid, derived fat- cholesterol, Body fat is in the form of - trigericedes constitutes 10-15% of body weight Polyunsaturated oil- vegetable oil, saturated- animal fat. Fish oil contain bot coconut & palm oil contain more saturated fatty acids Essential fatty acid- not synthesise in body- lin oleic acid, highest in safflower oil Visible fat- can be seperated from source; invisible- can't be seperated During hydrogenation, unsaturated fat become saturated Phrenoderma- deficiency of essential fats Over fat cause- CAD, cancer, obesity 20% of daily diet should be fat Energy- 9 k cal\gm Carbohydrate Energy- 4kcal/gm Forms- starch, sugar, ccelluose vitamins Fat soluble - A:D:E:K: Water soluble- B:C: Vitamin A- retinoe, pro-vatamin- beta carotene Functions- vision, skeltel grouth, Source- milk products, leafi vegetables, Deficiency diseases- conjunctival xerosis, bitot's spot, corneal xerosis, keratomalacialiquifaction fo cornea, hyperkeratosis, grouth retardation, infections, Daily intake- 600 gm in adult; infant-350, lactation-950, alll others-600 Vitamin D Vitamin D2- calceferol, Vitamin D3- cholecalceferol UVray convert 7- dehydrocholesterol to vitamin D, Kidney hormone- vitamin-D Vitamin-D promote intestinal absorption of calcium & phosperous Source- milk products, egg, fish liver oil Deficiency- rickets- grouth failure, elevation of alkaline phosphatase Daily requirement- adult- 2.5mcg(100/iu), children- 5mcg(200/iu), pregnancy & lactation- 10mch(400/iu) Vitamin-E trochopherol Source- veg. oil, egg, butter Anti infertility vitamin Daily requirement- 0.8mg/g Vitamin-K types-K1, K2

Prepared by Dr. Ebey Abraham Source- milk, intestinal flora synthesise vitamin- k Daily requirement- 0.03mg/kg Thiamine Essential for the utilisation of carbohydrates Source- whole grain serials, pulces, oil seeds, nuts, Deficiency- beribery(dry, wet, infentile), wernick's encelopholopathy, Daily requirement- 0.5mg/1000 kcals Riboflavin (vitamin B2) Source- milk, egg, liver, green leafy vegetables. Deficiency- angular stomatitis, chelosis, glositis, Daily requirement- 0.6mg/1000 kcal energy Niacin (nicotinic acid) Precursor- amino acid tryptophan Not excreted through urine Source- liver, meet, fish, ground nut Milk is poor source of it Deficiency- pellagra; 3Ds- diarrhoea, dermattis, dementia Excess of leucine intake reduce niacin absorption (maise eating population) Vitamin B6 (pyridoxil) Source- milk, liver,fish, whole grain cereals, vegetables Daily requirement- 2mg/day Pantothenic acid synthesise of corticosteroid Daily requirement- 10mg Floate (folic acid) for normal development of blood cells Overcooking destroyes folic acid Deficiency- magaloblastic anemia, glositis, chelosis, infertility, demyelination Daily requirement- adult-100mcg,pregnancy- 400mcg, lactation- 150mcg, children100mcg, Vitamin B12 (cyanocobalamine) Source- liver, kidner, meet fish, egg, not found in vegetables Requirement- adult- 1mcg, pregnancy & lactation- - 1.5mcg, children- 0.2mcg Vitamin C (ascorbic acid)Man monkey guinea pig need it Heat sensitive vitamin needed for the formation of collagen Absorption of iron in vegetable food Source- fresh fruits, vegetable, deficiency- scurvy bleeding gum daily requirement- 40-60mg/ day Minerals Major elements- calcium, phosperous, sodium, pottasium, magnesium. Trace elements- iron, iodine, flourine, zinc, copper, cobalt, chromium, manganase, molibdinum, (selinium, nickel, tin, silicon, vanadium lead, mercury, barium, boron,

Prepared by Dr. Ebey Abraham aluminum) Calcium- 2%of the body weight bone formation, muscle contraction, cell division Source- milk products, green leafy vegetable, cereals, millets, ragi- rich in calcium Daily requirement- 400-500mg/day Daily requirement of iron in adult- 0.9mg/ day, females- 2.8mg/ day Iodine- synthesise of thyroid hormone Source- sea food, water Goitrogens- prevent absorption of iodine; cabbage, cauliflower, Daily requirement- 150gm/day Flourine- mineralisation of bone Source- drinking water, food Excess- flurosis Zinc requirement- 15.5mg/day Copper requirement- 2.2mg/day Cobalt deficiency- causes goiter Par boiling reduses amount of vitamin loss Lactose is found only in milk Vitamin c is absent in milk Egg contains all nutrition except carbohydrates & vitamin c One egg- 70kcal Boiled egg is superior; boiling destroyes "avidin" which prevent vitamin B absorption Flourosis- dental flurosis, skeltel flurosis, genu valgum Lathyrism- neurolathyrism, osteolathyrism by pulse lathyrus sativus (kesari dal); BOAA(beta oxalil amino alanine) Chapter 12 Environment & health Artesian well - water come out by pressure. Water pollution act- 1974 Biological layer above sandbe- schmutzdecke Nitrogen oxide- respiratory tract infection Hydrocarbons- lung cancer Ozone- cough, bronchoconctriction, respiratory tract irritation Sulphur dioxide- asthma, respiratory tract irritation Lead- MR in children Ventilation- exhaust ventilation, plenum ventilation, balanced ventilation, air conditions Light- 15 -20 candles basic light Recommended maximum sound intensity- 85db Auditory fatigue- 90db region above 4000hz sandfly- phlebotomus argentipus causes kala azar Tsetse fly- sleeping sickness (trypanosomiasis) Health committees in india Bhor committee- 1946

Prepared by Dr. Ebey Abraham Mudaliar committee- 1962 Chadah committee- 1963 Mukerji committee- 1965,1966 Junjalwalla committee-1967 Rural health scheme- 1977 9th five year plan- 1997-200