Communicable Diseases: Monday, October 31, 2016 DR Fqd-Lnu PHCM 2 1

COMMUNICABLE
DISEASES
an
overview
Monday, October 31, 2016
Dr FQD-LNU PHCM 2
At the end of this discussion,

all must be able to answer these
1. What is communicable disease?
questions:
2. Are all communicable diseases, infectious? Are
all infectious diseases, communicable?
3. How do infection and infestation differ?
4. How is infectious process initiated and
completed?
5. Is there a general pattern of the natural history
of infectious diseases?
6. How do we classify the infection process in the
context of an individual patient and the general
population?
7. Can we totally prevent or control communicable
diseases in the community? How?
Dr FQD-LNU PHCM 2
The ROADMAP
Definition of terms:
Communicable vs Contagious
Infection vs Infestation
The Infection Cycle

NHD of an infectious disease
Categories of infectious / communicable diseases
Onset and duration

Systems involvement
Manner of spread / control
10/31/16
Dr FQD-LNU PHCM 2
WHAT IS..
COMMUNICABLE DISEASE
Dr FQD-LNU PHCM 2
?
4
THE INFECTIOUS DISEASES THAT

ARE TRANSMITTED FROM THE
PATIENT TO A SUSCEPTIBLE PERSON
DIRECTLY OR INDIRECTLY ARE
COMMUNICABLE
DISEASES
Dr FQD-LNU PHCM 2
Other CD WORDS worthremembering
Infection is the entry into

body tissues of organisms
followed by their
multiplication and/or toxin
production with or without
signs and symptoms.
Infestation is the invasion of
the skin or mucous
membrane by helminths,
insects, mites, or ticks.
Communicable disease (CD)

is an infectious disease that
is transmitted directly or
indirectly from the patient
to a susceptible person.
Contagious disease is a
communicable disease that
is directly transmitted from
the patient to a susceptible
individual.
Zoonotic disease is an
infectious disease process
of animals that is capable
of transmission to man
Dr FQD-LNU PHCM 2
the TRIANGLE of EPIDEMIOLOGY

Every disease is caused by the congruence of a number of factors, some
inherent in the:
HOST,
AGENT, and
ENVIRONMENT
environment
host
Dr FQD-LNU PHCM 2
agent
Advanced model of the triangle of

epidemiology
Time
Dr FQD-LNU PHCM 2
The chain of infection
Dr FQD-LNU PHCM 2
Case Scenario
In Bgy Gomez, Malasiqui.. there is a
recent report of unusually more than
the usual number of diarrhea cases.
Epidemiological investigation
disclosed CHOLERA
10/31/16
Dr FQD-LNU PHCM 2
10
PRE-REQUISITES FOR INFECTION

1.
2.
3.
4.
AN AGENT (PATHOGENS OR MICROBES)

A RESERVOIR AND A SOURCE OF INFECTION
ESCAPE OF THE AGENT FROM THE RESERVOIR
PROPAGATION OF THE AGENT THROUGH A
CHANNEL OF TRANSMISSION
5. SUCCESSFUL SURVIVAL OF THE AGENT DURING
THE COURSE OF ITS TRANSMISSION
6. A SUSCEPTIBLE HOST (HUMAN BEING)
7. ENTRY OF THE AGENT INTO THE HOSTS BODY
Dr FQD-LNU PHCM 2
11
AGENT PATHOGENIC
NO
NO INFECTION
YES
NO INFECTION
NO
NO INFECTION
YES
EXIT FROM RESERVOIR
BLOCKED?
NO
SURVIVES DURING
TRANSMISSION
YES
ENTRY TO HOST
BLOCKED?
NO
YES
HOST RESISTANT
YES
NO INFECTION
NO INFECTION
NO
SUCCESSF
UL
CONDITIONS FOR
SUCCESSFUL INFECTION
CATEGORIES of
Subcategory as to nature of initiating
CLASSES PATHOGENS/AGENTS
BACTERIA,
PROTOZOA, FUNGI,
VIRUSES, HELMINTHS,
RICKETTSIAE, etc
NATURE INFECTIVITY,
PATHOGENICITY,
TOXIGENICITY AND
VIRULENCE
CAPACITY and
ADAPTATION for
SURVIVAL
the infectious process
1. Infectivity ability of
the pathogen to invade
the tissues of the host.
2. Pathogenicity ability
to induce or initiate
disease process
3. Toxigenicity ability to
produce toxins capable
of damaging the
tissues
4. Virulence capacity to
produce severe grades
of disease.
Dr FQD-LNU PHCM 2
13
Subcategories as to
NATURE of the INFECTIOUS PROCESS
INFECTIVITY ability to invade the
tissue of the host.
PATHOGENICITY ability to induce or
initiate an infectious disease process.
TOXIGENICITY ability to produce
toxins or poisonous substances capable
of damaging the hosts tissues.
VIRULENCE ability to produce severe
grades of disease.
Dr FQD-LNU PHCM 2
14
2.the RESERVOIR and the

SOURCE OF INFECTION
Are they the same or
different?
Dr FQD-LNU PHCM 2
15
RESERVOIR
..is a person, animal, arthropod or
soil in which the infectious
organism live and multiply and
on which they depend primarily
for survival
Dr FQD-LNU PHCM 2
16
SOURCE OF INFECTION
is a person, animal, arthropod,
soil or substance from which the
infectious organism directly
enter the host tissue
Dr FQD-LNU PHCM 2
17
RESERVOIR AND SOURCE OF

INFECTION
1. SAME RESERVOIR AND SOURCE: human host
RESPIRATORY = measles, diphtheria, tuberculosis,

chickenpox and mumps.
GASTROINTESTINAL = cholera, typhoid, hepatitis B,
poliomyelitis, dysentery, etc.
REPRODUCTIVE = STIs, including HIV/AIDS
2. DIFFERENT RESERVOIR AND SOURCE:
Dr FQD-LNU PHCM 2
18
RESERVOIR AND SOURCE OF

INFECTION
SAME RESERVOIR AND SOURCE: animal
DIFFERENT RESERVOIR AND SOURCE:
Dr FQD-LNU PHCM 2
19
CASES and
CARRIERS
HUMAN SOURCE:
CASES - are sick individuals who act as a

source of infection only in the period of
communicability
Example: - mumps, measles, typhoid and cholera
CARRIERS are persons who harbor the

pathogenic organism and excrete them, but
are free of signs and symptoms
Examples: - typhoid, hepatitis B, meningitis,
diphtheria, salmonellosis, gonorrhea and
amoebiasis
Dr FQD-LNU PHCM 2
20
ANIMALS and ARTHROPODS

AS SOURCE OF INFECTION
Animals are source of infection as long as they
have clinical disease.
Exceptionally, they become infectious even
before the development of symptoms as in
the case of rabies.
Arthropods that transmit diseases biologically
become the source of infection only after lapse
of certain period. During this time the pathogen
inside their body multiplies or matures and
thereby acquires the capacity to infect other
hosts. This time lag is called extrinsic
incubation period
Dr FQD-LNU PHCM 2
21
3. EXIT FROM RESERVOIR, the

routes:
RESPIRATORY PASSAGE MEASLES, DIPTHERIA, MUMPS,

TUBERCULOSIS AND PNEUMONIA (droplets and
secretions)
GASTROINTESTINAL CHOLERA, TYPHOID, DYSENTERY,
HEPATITIS A, POLIOMYELITIS (vomitus and feces)
REPRODUCTIVE SYSTEM SEXUALLY TRANSMITTED
INFECTION (penile or vaginal secretions)
RENAL SYSTEM SCHISTOSOMIASIS (urine)
UDDER or Mammary gland - BRUCELLOSIS (milk)
Dr FQD-LNU PHCM 2
22
4. Propagation in..
and
5. Survival through the..
CHANNELS OF
TRANSMISSION
Dr FQD-LNU PHCM 2
23
4-5.CHANNELS OF TRANSMISSION
AIR
(respiratory secretions, droplet nucleus or

droplet dust)
HOUSEFLY (feces to food)
FOMITES (clothes, crockery, combs, toys, watch,
pipe, syringes, lancets or tatooing
needles)
FINGERS (infectious bodily secretions or feces
to
food and drinks)
OTHERS
_water, milk, food (meat or fish)
Dr FQD-LNU PHCM 2
24
No channels of
transmission-
without passing through an intervening medium
STIs genital-genital or oral-genital

Scabies skin-to-skin
Rubella or AIDS - virus transferred transplacentally
Congenital syphilis fetus picks up the spirochete
through mothers genital passage
5. Rabies dog directly implants virus to the
persons skin
6. Tetanus spores reach directly the skin
7. Leptospirosis and Ancylostomiasis direct
transcutaneous entry
1.
2.
3.
4.
10/31/16
Dr FQD-LNU PHCM 2
25
The Pathogens
CAPACITY for SURVIVAL
FOR SUCCESSFUL TRANSMISSION OF
INFECTION, the pathogen can beat the
odds of the outside world of its reservoir or
host as it progresses through the channel of
communication to a new host.
THESE ARE THE POSSIBLE DETERRENTS:
Natural forces sunlight, absence of
nutrients
Artificial factors chlorine or other
disinfectants
10/31/16
Dr FQD-LNU PHCM 2
26
ROUTES OF EXIT from the s-r-channel

and
6-7. ENTRY to the

Generally,
infectious
agent enters the
SUSCEPTIBLE
HOST
hosts body through the same route

through which it has left the reservoir.
Examples:
SKIN GAMETOCYTES EXIT FROM THE SKIN AND
SPOROZOITES GAIN ENTRY
ALIMENTARY CANAL
EXIT FROM THE LOWER
END TO THE UPPER END
RESPIRATORY
INFECTIONS EXIT AND ENTER

THROUGH NASAL PASSAGE
Dr FQD-LNU PHCM 2
27
Exceptions to the rule:

divergent routes entry and exit
10/31/16
Dr FQD-LNU PHCM 2
28
HOST SUSCEPTIBILITY
THREE LEVELS OF DEFENSE AGAINST INFECTION
1. MECHANICAL PROTECTION OF THE SKIN OR

CHEMICAL PROTECTION INSIDE THE
STOMACH
2. INFLAMMATORY RESPONSE OF THE PART OF
THE BODY INVADED BY THE PATHOGEN
3. IMMUNITY
Dr FQD-LNU PHCM 2
29
IMMUNITY
Immunity is the protection against
infectious diseases based on immune
system of the body. The structures of this
system comprise the bone marrow,
thymus, lymph glands, spleen, Peyers
patches, tonsils and adenoids
Immunity depends on SPECIAL CELLS &
PROTEINS
Dr FQD-LNU PHCM 2
30
SPECIAL CELLS AND SPECIAL

PROTEINS
The special cells that take part in
immunity are B and T cells.
Other cells that take part in the
defense against infection are
macrophages of the RES, these cells
devour particulate matter.
Dr FQD-LNU PHCM 2
31
SPECIAL CELLS AND SPECIAL

PROTEINS
THE MOST IMPORTANT PROTEINS INVOLVED IN IMMUNITY ARE THE
IMMUNOGLOBULINS OR ANTIBODIES.
Antibodies are modified serum globulins

which are IgG. IgA, IgM IgD and IgE.
Other group of proteins are the
lymphokines which are secreted by
sensitized lymphocytes. These are:
lymphotoxin, B cell growth factor, and
interleukin
Dr FQD-LNU PHCM 2
32
POST INFECTION
PHENOMENA
1. SUBCLINICAL no
BEHAVIOR OF THE
AGENT ON THE
PERSON
SUBCLINICAL
INFECTION
LATENT INFECTION
CLINICAL
INFECTION
detectable signs or
symptoms upon
assessment
2. LATENT pathogen
in its dormant state
resides in the
hosts body
3. CLINICAL the full
blown
manifestations of
infection
Dr FQD-LNU PHCM 2
33
POST INFECTION
PHENOMENA
1. Exotic not indigenous and it
BEHAVIOR OF THE
DISEASE IN THE
COMMUNITY
EXOTIC
SPORADIC
ENDEMIC
EPIDEMIC
PANDEMIC
2.
3.
4.
5.
occurs when a native visits a

foreign country, contracts the
disease there and returns
home.
Sporadic cases are few and
scattered
Endemic it presents in the
community all round the year
Epidemic cases are in
excess of the expected
incidence
Pandemic it arises in one
country and rapidly spreads
to many other countries.
Dr FQD-LNU PHCM 2
34
ENDEMICITY TYPES
HYPO-ENDEMIC
<10%
MESO-ENDEMIC
10-50%
HYPER-ENDEMIC51-75%
HOLO-ENDEMIC
>75%
Dr FQD-LNU PHCM 2
35
GENERAL CONTROL
MEASURES
THREE BROAD APPROACHES
1. MEASURES AIMED AT DESTRUCTION OR
BARRICADING OF THE PATHOGEN
2. MEASURES AIMED AT IMPROVING HOST
RESISTANCE
3. MEASURES AIMED AT IMPROVING
EFFICIENCY OF THE CONTROL
PROGRAMS
Dr FQD-LNU PHCM 2
36
Control Measures aimed

at:
DESTROYING or
BARRICADING the PATHOGEN
Destruction of pathogens in the human host
Destruction of agent within the discharges of affected
persons
Blocking the escape, transmission or entry of the
pathogen
10/31/16
Dr FQD-LNU PHCM 2
37
GENERAL CONTROL MEASURES
Destroying Pathogen
THE PATHOGEN CAN BE DESTROYED INSIDE
THE BODY OF THE HUMAN HOST
THROUGH CHEMOTHERAPY:
FOLLOWING CONDITIONS MUST BE SATISFIED
ALL PERSONS INFECTED WITH THE ORGANISM

ARE DETECTED AND BROUGHT UNDER
TREATMENT
A DRUG OR COMBINATION OF DRUGS IS/ARE

AVAILABLE FOR TREATMENT OF THE DISEASE
CAUSED BY THE ORGANISM
Dr FQD-LNU PHCM 2
38
GENERAL CONTROL
MEASURES
METHODS OF DETECTION of
INFECTIONS IN THE POPULATION:
Quarantine
Contact tracing (family, neighborhood,
school, occupational or causal
Cluster testing
Active and Passive Surveillance
Sputum Microscopy
Blood Smear Examination
Dr FQD-LNU PHCM 2
39
Destroying Pathogen
If the pathogenic agent is within
the discharges of affected
persons, the kind of
destruction is carried out with
disinfection and sterilization
Dr FQD-LNU PHCM 2
40
THE DESTRUCTION OF PATHOGENIC

ORGANISM WITH THE USE OF
DISINFECTANT OR GERMICIDE is
DISINFECTION
Dr FQD-LNU PHCM 2
41
KINDS OF DISINFECTION
1. Prophylactic
PROPHYLACTIC
Applied in water and milk
disinfection
CURRENT
2. Current
TERMINAL
Carried out during the

course of infection (sputum,
stools, discharges)
3. Terminal
Carried out after the

patients recovery or death.
Dr FQD-LNU PHCM 2
42
KINDS OF DISINFECTANTS
LIQUID
ALCOHOL, TINCTURE OF IODINE, FORMALIN, PHENOL OR
CRESOL
SOLID
BLEACHING POWDER AND POTASSIUM PERMANGANATE
GASSEOUS
FORMALDEHYDE AND ETHYLENE OXIDE
PHYSICAL
MOIST HEAT(BOILING), DRY HEAT(BURNING), UV
RAYS(SUNNING), AND IONIZING RADIATION
Dr FQD-LNU PHCM 2
43
THE DESTRUCTION OF BOTH THE NONPATHOGENIC AND PATHOGENIC ORGANISMS

INCLUDING THE SPORES is known as:
STERILIZATION
Dr FQD-LNU PHCM 2
44
Destroying Pathogen
IF THE PATHOGEN IS LOCATED WITHIN THE BODY OF
ANIMAL RESERVOIR AND VECTOR, THE METHOD OF
BLOCKADE DEPEND ON THE NATURE OF ILLNESS
In case of water-borne GI diseases, it

is done by raising sanitation barrier
Examples: sanitary latrines and control
of houseflies, proper hand-washing,
covering and proper storage of food.
Dr FQD-LNU PHCM 2
45
Destroying Pathogen
ANIMAL RESERVOIR AND VECTOR, THE METHOD
OF BLOCKADE DEPEND ON THE NATURE OF
ILLNESS
In droplet infections, patients are

exhorted to avoid spitting and
covering their nose and mouth
while coughing and sneezing,
isolation and reverse isolation
Dr FQD-LNU PHCM 2
46
Destroying Pathogen
ANIMAL RESERVOIR AND VECTOR, THE METHOD OF
BLOCKADE DEPEND ON THE NATURE OF ILLNESS
In arthropod borne diseases, agents

are blocked thru screening of
houses, sleeping under bed nets and
the use of repellants
In STIs avoid sexual promiscuity,
safe sex practices/use of protective
condoms
Dr FQD-LNU PHCM 2
47
IMPROVING OR BOOSTING THE

HOSTS RESISTANCE
IMMUNOPROPHYLAXIS
CHEMOPROPHYLAXIS
PROMOTION OF NUTRITIONAL STATUS
IMPROVEMENT OF LIVING
CONDITIONS
SUPPLY OF PROTECTED WATER
PROVISION OF SANITATION FACILITY
Dr FQD-LNU PHCM 2
48
IMMUNOPROPHYLAXIS
ACTIVE
IMMUNIZATION
TOXOIDS
KILLED BACTERIA
VACCINE
KILLED VIRAL VACCINE
LIVE-ATTENUATED
VACCINE
CELL FRACTION
VACCINE
Active immunization
is the kind of
immunoprophylaxi
s by which the
bodys immune
system is
stimulated to
produce its own
antibodies.
Dr FQD-LNU PHCM 2
49
IMMUNOPROPHYLAXIS
PASSIVE
IMMUNIZATION
SENSITIZED
LYMPHOCYTES
ANTI-SERA
POOLED SERUM
IMMUNOGLOBULINS
Passive
immunization is
the other kind of
immunoprophylaxi
s induced through
the administration
of sensitized
lymphocytes,
antisera, pooled
serum or
immunoglobulins.
Dr FQD-LNU PHCM 2
50
EFFICIENCY OF CONTROL
PROGRAMME
NOTIFICATION
HEALTH INFORMATION SYSTEM
EMERGENCY PREPAREDNESS
TRAINING AND SUPERVISION
ACCESSIBILITY TO DRUGS AND
SERVICES
PEOPLES PARTICIPATION
Dr FQD-LNU PHCM 2
51
SUMMARY
Communicable disease is an illness due to specific infectious
agent or its toxic products, arising thru transmission of that agent
or its product from reservoir to susceptible host, either directly as
from an infected person or animal, or indirectly through the
agency of an intermediate plant or animal host, a vector or the
inanimate environment.
Infection is the entry and development or multiplication of an
infectious agent in the body of a man or an animal.
Contagious disease implies transmission to a direct contact.
The term use to describe the periodicity of communicable
disease occurrence, namely; epidemic, endemic, pandemic, sporadic,
epizootic, enzootic, and zoonoses.
There are seven pre-requisites of a successful infection.
The epidemiologic concept and knowledge of these
conditions for the occurrence of communicable disease is needed
for preventive and control purposes.
The 3 basic levels of prevention is capable in all specific types
of communicable diseases.
Dr FQD-LNU PHCM 2
52

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COMMUNICABLE

Monday, October 31, 2016

At the end of this discussion,

The Infection Cycle

Onset and duration

Monday, October 31, 2016

THE INFECTIOUS DISEASES THAT

Other CD WORDS worthremembering

Infection is the entry into

Monday, October 31, 2016

Communicable disease (CD)

the TRIANGLE of EPIDEMIOLOGY

Monday, October 31, 2016

Advanced model of the triangle of

Monday, October 31, 2016

The chain of infection

Monday, October 31, 2016

PRE-REQUISITES FOR INFECTION

AN AGENT (PATHOGENS OR MICROBES)

Monday, October 31, 2016

the infectious process

2.the RESERVOIR and the

Monday, October 31, 2016

Monday, October 31, 2016

Monday, October 31, 2016

RESERVOIR AND SOURCE OF

RESPIRATORY = measles, diphtheria, tuberculosis,

2. DIFFERENT RESERVOIR AND SOURCE:

Monday, October 31, 2016

RESERVOIR AND SOURCE OF

DIFFERENT RESERVOIR AND SOURCE:

Monday, October 31, 2016

CASES - are sick individuals who act as a

CARRIERS are persons who harbor the

ANIMALS and ARTHROPODS

3. EXIT FROM RESERVOIR, the

RESPIRATORY PASSAGE MEASLES, DIPTHERIA, MUMPS,

Monday, October 31, 2016

5. Survival through the..

(respiratory secretions, droplet nucleus or

Monday, October 31, 2016

without passing through an intervening medium

STIs genital-genital or oral-genital

ROUTES OF EXIT from the s-r-channel

6-7. ENTRY to the

hosts body through the same route

EXIT FROM THE LOWER

END TO THE UPPER END

INFECTIONS EXIT AND ENTER

Monday, October 31, 2016

Exceptions to the rule:

1. MECHANICAL PROTECTION OF THE SKIN OR

Monday, October 31, 2016

SPECIAL CELLS AND SPECIAL

Monday, October 31, 2016

SPECIAL CELLS AND SPECIAL

Antibodies are modified serum globulins

Monday, October 31, 2016

Monday, October 31, 2016

Monday, October 31, 2016

occurs when a native visits a

Monday, October 31, 2016

Monday, October 31, 2016