1

SYLLABUS
CBCS 415: ENVIRONMENT AND HEALTH
(2 Credits – 30 Hours)
Objectives
To understand the role of Environment in human Health
To understand the need for Environmental sanitation
To acquire the knowledge of Non-communicable and Communicable diseases
To acquire the knowledge of Nutrition and Dietetics
To acquire the knowledge of Occupational health hazards

1.1 Dimensions of health- Physical, mental and social health; Spiritual health. Disease triangle. Health
Justice.
5 Hours
2.1 Aero-allergens: Dust mites- Pollens
2.2 Water borne endemic disease: Fluorosis , Arsenic poisoning and Methemoglobinemia
2.3 Soil borne endemic disease: Tetanus, Melioidosis
2.4 Vector borne diseases: Plauge and Malaria; emerging diseases: Dengue, Chikungunya, Zika, Ebola,
Swine Flu, Bird Flu, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome
(MERS); Zoonosis- Leptospirosis; Kyasanur forest disease (KFD) and Toxoplasmosis.
2.5 Drug safeties: Thalidomide Tragedy; Antibiotic stewardship; New Delhi Antibiotic-Resistant
superbug.
2.6 Malnutrition: Vitamin deficiency diseases and Mineral deficiency diseases; Folic acid requirement
during pregnancy; Food Safety- Adulterants and preservatives; Pesticide Toxicity: Endosulfan and
DDT; Genetically Modified Food.
15 Hours
3.0 Environmental Sanitation and Hygiene: Safe disposal of human excreta; Solid waste disposal;
Sanitation value chain.
5 Hours
4.0 Occupational health: Sick Building Syndrome (SBS); Light and Temperature; Noise and Radiation;
Stress and Fatigue; Carpal tunnel syndrome (CTS) Methyl mercury and cerebral palsy; Synergistic effect;
Life style related diseases: Cigarette smoking and pregnancy complications - Cigarettes and Other Tobacco
Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and
Distribution) Act, 2003.
5Hours
References

1. Bedi and Yashpal. 1971. Handbook of Hygiene and Public Health. Atma Ram &Sons, Delhi.
2. Park.k 2009.Park's Textbook of Preventive and Social Medicine, 20th Edition.Misc Publ.
 2

ESOE 415: ENVIRONMENT AND HUMAN HEALTH

Introduction

Ecology is constituted by the total environment of man. The environment of man is partly natural
and partly man-made. It consists of physical, biological and social factors which are dynamic and
interacting both within themselves and with the life processes in the internal environment of
man. The important physical factors are: air, water, soil, food, building and their contents and
multiple devices produced by man to adjust the physical environment around him. The important
biological factors are: pathogens, beneficial microbes, vectors and plants, which have
implications in health and disease. The important social factors are: customs, beliefs, laws,
peculiarities and modes of living of human beings with their implications in health and disease.

Definition: Health is defined as a state of complete physical, mental and social wellbeing
and not merely absence of any disease or infirmity (WHO, 1948).

The WHO definition of health projects three different dimensions of health- physical, mental and
social- all closely related. The fourth dimension has also been suggested namely “spiritual”.

The WHO played a leading role when it fostered the development of the health promotion
movement in the 1980s. This brought in a new conception of health, not as a state, but in
dynamic terms of resiliency, in other words, as "a resource for living". The 1984 WHO revised
definition of health defined it as "the extent to which an individual or group is able to realize
aspirations and satisfy needs, and to change or cope with the environment. Health is a resource
for everyday life, not the objective of living; it is a positive concept, emphasizing social and
personal resources, as well as physical capacities”.

Factors for cultivation of health: The important factors for cultivation of health are (i)
Environment conducive for healthful living (ii) balanced diet (iii) adequate physical activity and
rest as per the individual needs (iv) promotive, preventive, and therapeutic and welfare services
(v) suitable occupation with job satisfaction and (vi) proper use of leisure and wholesome mental
attitude to life.

The Alma-Ata Declaration of 1978 emerged as a major milestone of the twentieth century in the field of
public health, and it identified primary health care as the key to the attainment of the goal of Health for
All. The Sustainable Development Goal No.3: GOOD HEALTH AND WELLBEING.

Health Justice aims to provide a concrete ethical grounding for the human right to health, while
advancing the field of health policy and placing health at the centre of social justice theory.

A disease is a sustained or progressive impairment of an organism’s cells or tissues that

causes structural or functional abnormalities.
The disease triangle is a conceptual model that shows the interactions between the environment,
the host and an infectious (or abiotic) agent. This model can be used to predict epidemiological
outcomes in human health and public health, both in local and global communities.
 3

Fig.1 Disease Triangle

Time Scale a Disease Progression

-----------------------------------------------------------------------------------------------------→

Pre -pathogenic period Pathogenic period Outcome

Death --------------------→Mortality

Incapacity --------------------→Morbidity

Chronic Disease ------------------→Chronic Stage

Advanced Disease -----→ Convalescence -----→Recover

Symptoms

Exposure ------------------------------------------------------------------------------------→
Pre clinical stage*Latent period→Incubation period

*The time between infection and infectiousness

 4

2.1 AERO- ALLERGINS

1. POLLEN ALLERGY

Pollen: Microscopic body that contains male reproductive cell of a plant. They are present in
anther of the flower.

They cause allergy to humans during flowering seasons.

Few examples of allergic pollens (Allergins) are: Parthenium pollens, Castor pollens and
Grass pollens.

Atopy(Clinical symptoms):

1. Asthma: Bronchial asthma

Drug: Ephedrine
2. Rhinitis (Hay Fever) : persistent runny nose ;stuffy nose
Drug: Avil (Pheniramine maleate)
3. Eczema:Pin –head eruption all over the body ; redness; oozing serum;
Drug Antihistamine cream
4. Urticaria : Large red itchy blotches
Drug: Antihistamine tablet
Treatment recommended for a long period:
Based on the ‘Pollen Calendar’ of an area, IMMUNOTHERAPY (Allergy Shot) is
given to the patients during pre-seasonal, co-seasonal and post seasonal period of
flowering of plants (Angiosperms).

Fig.2 Erdtman’s Pollen Grains

 5

2. DUST MITES

Dust mites cause indoor allergy. The causative arthropod is Dermatopagoides pteronyssinus.
About 10,000- 15,000 mites are present per gram of dust. They feed on dust, dust bunnies and
dander. About 2-5% asthma of Indians is caused by dust mites.

Fig.3 Dust mite (Dermatopagoides pteronyssinus)

Control Measures

Dust mites are insects that thrive on mattresses, furniture, carpets and other fabric. They feed on
skin flakes shed by people and pets every day, thriving in warm, humid environments. Their
presence is associated with reduced respiratory health, triggering asthma and other allergy
related attacks. Unfortunately, dust mites can never be totally eliminated from the home.
However, the dust mite population in your home can be reduced by proper cleaning, protecting
household items and other methods.

1. Change your bedding regularly. Most dead skin build-up occurs in and around your bed
because you spend so much time there. This attracts dust mites and accumulates allergens. Have
multiple blankets, sheets and pillowcase covers to switch out with.

2. Wash bedding. Wash all blankets, sheets, pillow cases, bed covers and other bedding with
detergent in hot water at a minimum of 131°F weekly to kill dust mites and remove allergens.
High water temperature can kill dust mites better than just using detergent. Also wash curtains.
 6

Set your washing machine to its hottest setting. If the water isn’t hot enough, check your hot
water heater. Most hot water heaters have an adjustable knob to change the maximum
temperature .If you can't wash bedding in hot enough temperatures, throw them in the dryer for
at least 15 minutes at a temperature above 130 °F to kill mite. Afterward, wash and dry the
bedding so allergens are removed. You could also dry items in direct sunlight.

3. Vacuum regularly. Vacuum everything that you can, including couches, mattresses,
armchairs, floors, mattresses and other places where people frequently sit or lay down on. To
trap allergens effectively, your vacuum should have a double-layered micro filter bag or a high-
efficiency particulate air (HEPA) filter. This is important because it helps ensure that dust is not
re-circulated into the air. Vacuuming removes surface dust but can’t remove most dust mites and
dust mite allergens. Mites are tiny enough to pass through the vacuum cleaner bag. Get
underneath and behind furniture to keep "dust bunnies" from forming. If you have severe
allergies, leave the area being vacuumed and let someone else do the work. Stay away from the
vacuumed room for about two hours to let everything settle.

4.Damp dust. Feather dusters and dry cloths will stir up allergens into the air. Use a damp or
oiled mop, rag or electrostatic cloths to clean hard surfaces once a week. This will help keep dust
and dust mites down.

5. Change your flooring. Carpet is a haven for dust mites, especially if it sits on concrete, which
holds moisture and provides a humid environment for dust mites.

6. Use tannic acid. Tannic acid neutralizes the allergens from dust mites naturally. Tannic acid
powder can be purchased from health food stores and other specialist providers. Sprinkle it
liberally over mattresses, couches, pet beds and other dust mite havens to help reduce the impact
of allergens. You can also make your own solution of tannic acid by adding one cup of weak tea
to a gallon of water, spraying carpets and vacuuming 3 hours later.

7. Reduce stuffed toys. Minimize your child's stuffed toys to one or two favorites. Get plastic
toys or washable stuffed toys instead. If you choose washable stuffed toys, wash them often in
hot water and dry thoroughly. Keep stuffed toys off beds. Put any non-washable stuff toys that
you keep in the freezer every couple of weeks to kill living dust mites.

8 Try not to sleep on your couch. This can attract more dust mites to the area by providing
ample food in the form of your dead skin cells. Couches tend to be more difficult to protect from
dust mites than beds. It is better to sleep in a bed with a dust mite cover for protection from
allergens and mites.

9. Leave your bed unmade. That’s right, now you have a legitimate reason not to make your
bed every day! Leaving the bed unmade each morning with the sheets exposed to air will air-dry
and release moisture from bedding. This significantly reduces the number of dust mites

10. Ventilate your home. Open windows and screen doors to allow fresh air to circulate. This
reduces humidity and can help move dust and other allergens out. Do this often to reduce dust
mite populations.
 7

11.Use direct sunlight. Sunlight kills dust mites. Hang bedding, clothing and other furnishings
outside or in direct sunlight. Air blankets, rugs and other heavy bedding items outside as often as
possible. Open curtains and blinds to let the sun shine in.

12. Reduce clutter. Excess items in the bedroom such as books, magazines, clothing baskets,
knickknacks, ornaments, toys and piles of clothing that make it hard to clean or dust create an
excellent home for dust mites. Try making a minimalist bedroom.

13.Reduce humidity. Dust mites thrive in humid environments because they absorb water from
the atmosphere. Avoid humidifying, and use a dehumidifier or air conditioner to keep relative
humidity below 50%. A hygrometer, available at hardware stores, measures humidity levels in
the home so you can have more control.

14.Control temperatures. Dust mites do very well in temperatures between 65°F and 84°F and
a relative humidity of more than 50%. To cut down on dust mite populations, make your home
less comfortable for them. Along with a reduction in humidity, consider lowering your in-home
temperatures to below 70°F or more.

15. Use an air purifier. There are many types of air purifiers that can be attached to the central
air return. These purifiers decrease irritants and food sources for dust mites with most filters
removing 50 to 70% of material. HEPA filters, however, will remove up to 99% of dust mite
feces, dust, animal dander, pollen, cockroach feces, and other material.

2.2 WATER BORNE DISEASES

1. FLUOROSIS (Mottled enamel) (Colorado Brown stain, 1901)

Hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel

formation.This hypomineralized enamel has altered optical properties and appears opaque and lusterless

relative to normal enamel. Most crucial course is during the first 2 years of child’s life. 14 states in India

are recognized as “Fluoride Belt”. Fluorosis is the endemic imperfection of teeth.

Normal Teeth: The enamel represents the translucent, semi-vitriform (glass like), pale creamy white
colour. Enamel of the teeth is due to Enamelin and Amelogenin.

Symptoms: Tooth discolouration and physical damage to the teeth (brittle and fragile teeth)

Stages:

1.Very mild: Small opaque ‘ paper’ white areas scattered irregularly over the teeth, covering less than
25% of the tooth surface.

2. Mild form: Mottled patches up to half of the surface area of the teeth.
 8

3. Moderate: Mottling spread all over the teeth; Teeth may be ground down- disfigure the teeth.

4. Severe: Brown discolouration and pitting.

Mechanism: Hydroxyapatite → Fluoroapatite

Ca10 (PO4 )6 (OH)2 + F-+ H+ → Ca10(PO4)6OH F + H2O

Source: 40% of fluorosis is caused by consuming water containing more than 1.5 ppm of fluoride.

The WHO Standard in drinking water is 1 ppm.

Management: Tooth bleaching, Composite filling, crowns

Fluorosis also causes “Psycho- social effect” which means the affected individual have poor socialization

due to their poor dentition; they are tight lipped and even never smiles.

2. ARSENICOSIS: Elevated level of Arsenic in body.

Chronic arsenic poisoning results from drinking contaminated well water over a long period of
time. Many aquifers contain high concentration of arsenic salts. The World Health Organization
(WHO) recommends a limit of 0.01 mg/L (10 parts per billion) of arsenic in drinking water. One
of the worst incidents of arsenic poisoning via well water occurred in Bangladesh, which the
World Health Organization called the "largest mass poisoning of a population in history.

Short term effect: Vomiting, abdominal pain, encephalopathy; watery diarrhea that contains
blood.

Long term effect:can result in thickening of the skin, darkened skin, abdominal pain , diarrhea,
cardio vascular disease (CVD), numbness and cancer.

Arsenic affects 200 enzymes in the body.

Diagnosis: Concentration of As in urine, blood and hair; Garlic odour of the breath; Finger nail
white pigmentation: “Mee’s line.”

Case: Napolean Bonaparte (1769-1821)- imprisoned at Island of St. Helena; Forensic Report of
his hair did show high level, 13 times the normal level of the element.

Endemic area: West Bengal and Bangladesh

Treatment: Dimercaprol
 9

3. METHEMOGLOBINEMIA: Cyanosis (Blue Baby Syndrome)

Cause: presence of Nitrate (NO3) drinking water. Nitrate gets reduced to nitrite in the stomach
and intestine due to low level of oxygen. [NO 3-→NO2- ].

Nitrite being a powerful oxidizing agent oxidizes Hemoglobin into ‘Methemoglobin’. The
oxygen carrying capacity is thereby affected. Due to low level of oxy-hemoglobin, blue patches
appear on the body.

Diagnosis: When exposed to air, the blood of methemoglobinemic patient remains chocolate
brown in colour. Normal blood turns red after absorbing oxygen from air.

Permissible Limit in potable water: 1 For children = 20 mg/L; For adult= 45mg/L

2.3 SOIL BORNE DISEASES

1. TETANUS (Lock Jaw Disease)

2.
Pathogen: Clostridium tetani
Host: Human
Environment: Found in Animal manure and contaminated soil
Symptoms
Muscular spasm (cramp) and muscular rigidity; spread to the neck and throat; strong
enough to cause spinal fracture; Difficulty in swallowing; sore throat; fever headache;
sensitivity to light and touch ( patients are admitted in dark room and treated); Rapid
heartbeat( Tachycardia).
Other causes are:
Animal bite, skin burn, drug injection using dirty (unsterilized needle); Tatoos and body
piercing with unsterilized equipment
Treatment: Penicillin, Tetracycline
Vaccination: Tetanus Toxoid (TT)

2. MELIOIDOSIS

“Time Bomb of Vietnam” Prevalent during Vietnam War (1954-1975)

Pathogen: Burkholderia pseudomallei

Habitat: Paddy Fields, Flooded Areas; Tsunami affected areas

Season: Soon after the rainy seasons (South West and North East Monsoon)
 10

Endemic region in India: Goa, Karwar, Udupi , Dakshina Karana and Coastal region of Kerala

Symptoms: Fever, Joint pain, Pneumonia and Deep Abscesses

The disease spreads due to aerosolized Burkholderia pseudomallei.

Vulnerable Group: Diabetic patients, Alcoholics; person suffering with Chronic / kidney
diseases.

Death is due to wrong diagnosis as Tuberculosis (TB) and wrong treatment.

Treatment: Meropenum, Ceftazimide

2.4 VECTOR BORNE DISEASES

Infections transmitted by Arthropods. e.g., Mosquitoes

Arthropods are ectothermic i.e., they change their body temperature according to the
ambient temperature.

1. MALARIA

( ‘mal aria’ – bad air in Medieval Italian). It is a life threatening disease.

Parasite : Plasmodium falciparum

Vector: Female Anapheles mosquito

The mosquitoes are active during dusk and dawn and sucking ‘blood meal’.

Incubation period: 9-14 days.

Symptoms: Fever shivering, headache, vomiting; sweating after return to the normal
temperature; tiredness.

High Grade Fever(107⁰F); chills;prosration ( Prayer Position) ; Photophobia;respiratory

distress; bleeding ; anaemia; jaundice, neck rigidity.

Cerebral Malaria: 80% deaths are due to Central Nervous System (CNS) involvement.
Swelling of brain; parasite filled blood cells block small blood vessels to brain; renal failure;
black water fever (cola urine)

Treatment: Antimararial Drugs 1. Chloroquine 2.Praguanil (Malarone)

 11

Control: Mosquito Net coated with repellent

2. DENGUE (Breakbone Fever)

(Pronounced in Swahili language as DEN gee)

Vector: Aedes aegypti

Environment(Habitat): Fresh Water

Pathogen : Virus ( Arbovirus)

Symptoms: Begins 3-14 days after infection;High fever, headache, vomiting, muscle and joint
pain; Characteristic skin rash (Measles like rash) “Islands of white in a sea of red.”

Aedes aegypti biting a person

 12

“Islands of white in a sea of red”

Recovery period: 7 days

Dengue Haemorrhagic Fever (DHF): Nose and mouth bleeding; Low levels of blood platelets;
Dengue Shock; Diarrhoea.

Preventive Measures: Habitat elimination- spraying of Organophosphate or Pyrethroid

insecticide.

Management: Antiviral Drugs plus Paracetamol; Oral rehydration therapy

Never use Ibuprofen and Asprin which will aggravate the risk of bleeding.

Papaya leaf juice, Kiwi fruit will increase blood platelet count
 13

3. CHIKUNGUNYA

Makonde root: verb- Kungunyala means “that which bendsup” “to become contorted”

“Contorted posture’.

Vector: Asian tiger mosquito – Aedes aegypti

Pathogen: Virus

Incubation period: 1-12 days

Symptoms:Fever (102⁰C) Arthritic symptoms; joint pain; skin rash; headache ;fatigue;
conjunctivitis; Musculo – skeletal pain.

Joint pain lasts for weeks, months or for years; both arms and legs are affected; Pain in the joints
of wrists, ankles, hands and feet. Pain in larger joints: shoulders, elbows and knees.

Note:In contrast to dengue fever, Chikungunya fever rarely cause ‘ Hemorrhage

complications’.

If at all there is a bleeding, it might be due to “Co- infection”

Treatment: Non Asprin Analgesics such as Paracetamol; Oral rehydration

4. ZIKA VIRUS (ZIKV)

Vector : Day time active i.e., Morning and evening (M/E) active Aedes aegypti.

Its name came from the Zika Forest in Uganda.

Symptoms: Mild fever, Skin rashes, conjuctivities, muscle and joint pain, headache- lasts
for 2-7 days.

According to WHO, Zika infection during pregnancy causes Congenital brain

abnormality “ Microcephaly” ie., small head circumference.

Treatment: No specific treatment. Analgesics such as Paracetamol; Adequate rest and

children and elders must drink enough fluids.
 14

Prevention: Wearing light coloured clothing that covers as much as that of the body

possible; use of Mosquito net ; insect repellent; No fresh water stagnation inside the

empty containers, tiers, flower pots etc.

PLAGUE

Pathogen: Bacteria (Yersinia pestis)

Vector: Rat Flea ( Xenopsylla cheopsis)

Environment: Air (Droplets); Soil; Fecal – Oral transmission by contaminated food.

Three Stages of Plague:

1. Bubonic plague : The expansion of Lymph nodes (“ Bubo”)

(GK., Bubo- Groin) Swollen lymph glands → Buboes
2. Septicemic plague: Bacteria enter the blood stream and travel to any part of the body.
3. Pneumonic plague: Infection of the lungs ( Gk., Pneumono – Lungs)

1994- Epidemic in Surat, India.

Treatment: Quarintine the patients.

Antibiotics: Streptomycin, Tetracycline

LETOSPIROSIS

Weil’s disease (Rat Fever) Harvest Fever

Pathogen: Spirochete- Leptospira

Host: Rodents (Rats) → Human

Mice and Rat’s urine

First Stage Symptoms: Fever, chill, intense headache, severe myalgia, conjunctivitis (Red
Eyes), abdominal pain, skin rash.

Second severe stage:Meningitis (Inflammation of membrane covering the brain)

Damage to liver causing Jaundice (person turns yellow)

Kidney failure

Severe pulmonary Haemorrhage (Bleeding of lungs)

 15

Risk Occupations: Veterinarians, Farmers, Sewer workers, Solid waste disposal workers.

Treatment: Effective Antibiotics: Penicillin, Ampicillin, Amoxicillin

Prevention : Rodenticide →Rat control

Avoidance of rat urine contamination

Vaccine is available in Cuba and China

EBOLA VIRUS DISEASE (EVD)

Ebola Haemorrhagic Fever (EHF)

Vector: Fruit eating Bats; Consuming “Bush Meat” of Bat)

Pathogen: Ebola Virus

Incubation period: 4-10 Days

Symptoms: Influenza like stage; Fever (101⁰F); tiredness; loss of appetite; muscular and joint
pain; sore throat; headache.

Second stage: Vomiting , diarrhea, chest pain, abdomen pain and shortness of breath
 16

Third stage: Decreased blood clot; internal and external bleeding; vomiting of blood; cough
up of blood or blood in stool; Low BP

Recovery: Begins between 7 and 14 Days.

Management: Quarantine patients in Isolation wards.

Rehydration: Salt and sweet water should consumed periodically.

Use bleach powder or detergent to clean the ward/bed room; Wear protective gear, mask,
goggles.

Safe burial : Cremation of the body.

ZOONOSIS (Diseases transmitted by Animals)

KYASANUR FOREST DISEASE (KFD)

History : Heavy mortality (death rate) of Langur and Red faced Bonnet Monkeys in 1955
in forests of Shimoga, Karnataka. The outbreak (1983-1984): 2167 cases and 69 deaths. In
1997 , 75cases and 4 deaths.

Pathogen : Flavi virus

Habitat : Forest

Vector: Tick- Haemophysalis spinigera

Amplifying Host: Monkeys→Man

Seasons: 1.Adult Ticks are active during SW Monsoon ie., June – September

2. Larvae are active from October to December

3.Nymphs are very active during January to May which is the “Epidemic period”.

Clinical features: Sudden onset of fever, headache, severe myalgia (muscle pain) with prostration
for about 2 weeks.

Severe stage: Haemorrhage and Encephalitis

Fatality 4-16%

Treatment: Antipyretics and Analgesics

 17

Control of the Tick: 2.24 Kg Lindane per Hactre of the forest floor; Restrict cattle and people
movement.

TOXOPLASMOSIS

Pathogen: Parasite – Toxoplasma gondii

Host: Cat→ Pregnant Women

Symptoms: Influenza like; Swollen Lymph Nodes, headache, fatigue, myalgia for more than a
month.

Severe condition: Seizures, pneumonia, blurred vision due to retinal infection.

Apart from pregnant women, AIDS patients, children, those who are taking Chemotherapy and
those who have received organ are also affected.

Congenital Toxoplasmosis: Foetus is affected via the placenta; causes abortion; Foetus brain is
affected.

Toxoplasmosis Antibody is found to be more in blood of the mother, therefore, likely to have
boy baby than girl baby.

Treatment: Spiramycin- Before the foetus get infected

Sulfadiazin- Pregnant women

Pyrimethamine- After the foetus get infected

Control: Safe disposal of cat feces; Pet Hygiene; Sand beds and garden soil should be handled
with hand gloves.

SWINE FLU

(Swine-Origen Influenza Virus)

Pathogen : Viral strains-H1N1,H1N2,H2N1,H3N1,H3N2,H2N3

Host: Swine→Human (Zoonotic)

The first case of man was reported in Mexico in 2009.

Symptoms: Fever, cough, sore throat, watery eyes, body ache, shortness of breath, head ache,
chill, weight loss, sneezing, runny nose, dizziness; abdominal pain, lack of appetite and fatigue .
In 2009 outbreak reported diarrhea and vomiting.
 18

Person to person spread by ‘droplets’ by sneezing. Hand-to-nose/mouth/eyes

Fatalities: More in children and elders.

Environmental Factor: Wind speed and direction influence the rapid spread. ‘Pandemic.’

Treatment: Tamiflu or Relenza (Shouls be prescribed by the physician)

Caution: Self medication of the above drugs should be avoided.

BIRD FLU

(Avian Influenza)

Pathogen: Influenza A Virus (HPAI Strain H5NI)

Host: Wild Aquatic Birds →Other Birds→ Domestic Poultry→Animals

H5N1 Strain was isolated in Goose in 1996.

The virus found in nostrils, beak eyes and droppings.

Poultry workers →Common people

Subtype: H7N9 is a dangerous strain for human.

Symptoms: Cough, diarrhea, respiratory distress, Fever(>100.4⁰F); headache, runny nose, sore
throat, pneumonia.

It first occurred in Hong Kong in 1997, after consuming under cooked eggs.

Cats are infected by consuming an infected bird.

Treatment: Antiviral drug- Tamiflu should be started within 48 hours.

Management: ‘Pandemic Threat’; Quarintine the patients.

Mass culling of the infected birds and incinerate or bury them deep and cover with lime
(Calcium carbonate).
 19

SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

Pathogen: SARS Coronavirus

Host: Macaques in Canada; Masked Palm Civet in China; Other amplifying hosts are : Ferret,
Domestic cat, Raccoon and Bats

First outbreak was reported in Asia, 16th April 2003.

Symptoms: Fever, headache, myalgia (muscle pain), cough, sore throat, dyspnea (difficult or
laboured breathing), malice (unwell) and pneumonia; vomiting; Decrease in Lymphocytes in
blood; Kidney failure and death.

Treatment: Antiviral drugs; Steroides to reduce swelling of the lungs.

Ventilation is required for oxygen support.

Prevention: 1. Avoid direct contact with SARS patients for 10 days.

2. Cover nose and mouth when cough and sneeze.

3. Wash hands often.

4. Do not share food, drink. Linen, towel and utensils.

MIDDLE EAST RESPIRATORY SYNDROME (MERS)

MERS emerged first in Arabian Peninsular in 2012. Symptoms and treatment are as mentioned
above.

Nipah Virus(NiV)

In 1999 NiV was reported first time in a place Nipah in Malaysia.

Pathogen : NiV

Vector : Bats

Symptoms: Fever, Headache, Myalgia; Acute Respiratory Illlness; Inflammation of Brain leads
to fatal Encephalitis; drowsiness, disorientation and mental confusion

.Kozhikode District and Malapuram in Kerala was affected in 2018. It caused 17 deaths.
 20

2.5 DRUG SAFETIES

Thalidomide Tragedy

Thalidomide was released onto the market in 1958 in West Germany under the label of
Contergan. Primarily prescribed as a sedative or hypnotic, thalidomide also claimed to cure
"anxiety, insomnia, gastritis, and tension. Afterwards it was used against nausea and to alleviate
morning sickness in pregnant women.

Thalidomide became an over-the-counter drug in Germany around 1960 and could be bought
without a prescription. Shortly after the drug was sold, in Germany, between 5,000 and 7,000
infants were born with phocomelia. Merely 40% of these children survived. Research also
proves that although phocomelia did exist through the 1940s and 1950s, cases of severe
phocomelia multiplied in the 1960s, when thalidomide was released in Germany; the direct cause
was traced to thalidomide. The statistic was given that 50 percent of the mothers with deformed
children had taken thalidomide during the first trimester of pregnancy.

Throughout Europe, Australia, and the United States, 10,000 cases were reported of infants with
phocomelia; only 50% of the 10,000 survived. Thalidomide became effectively linked to death
or severe disabilities among babies. Those subjected to thalidomide while in the womb
experienced limb deficiencies in a way that the long limbs either were not developed or
presented themselves as stumps.

Other effects included: deformed eyes, hearts, alimentary, and urinary tracts, and blindness and
deafness.
 21

ANTIBIOTIC STEWARDSHIP

Antimicrobial stewardship is a coordinated program that promotes the appropriate use of

antimicrobials (including antibiotics), improves patient outcomes, reduces microbial
resistance, and decreases the spread of infections caused by multidrug-resistant organisms.

The “antibiotic stewardship” is most effective in disease control and management. However,
the best evidence to date suggests the following components will help ensure the implementation
of an effective antibiotic stewardship program.

1. Preauthorization or prospective audit and feedback – Targeted antibiotics, such as those

that treat emerging drug-resistant bacterial infections, should require preauthorization. This
means providers need to get approval to use antibiotics before they are prescribed. Prospective
audit and feedback can be an alternate strategy or combined with preauthorization. Prospective
audit allows antibiotic stewards to engage the prescribing clinician after the antibiotic has been
used, typically after two or three days, to optimize antibiotic treatments. Both methods can
reduce antibiotic misuse and decrease the development of resistance. Hospitals should choose
one or both of these methods as part of their program based on their local resources and
expertise.

2. Syndrome-specific interventions – The guidelines recommend focused multifaceted

interventions for the treatment of specific syndromes, rather than trying to improve
treatment of all infections at once. For example, a hospital’s antibiotic stewardship program
might take a close look at management of pneumonia during winter, including making
recommendations to shorten the amount of time people are treated and switching to an oral agent
more quickly, and then measuring the results of those interventions. In the fall, the program
 22

might focus on urinary tract infections and then several months later, switch to skin and soft
tissue infections. “This method makes stewardship more manageable and provides a targeted and
clear treatment message rather than trying to disseminate 100 different lessons at the same time,”

3. Rapid diagnostic testing: The guidelines note that rapid diagnostic testing of respiratory
specimens can help determine if the cause is viral and therefore reduce the inappropriate use of
antibiotics. The rapid testing of blood cultures in addition to conventional culture is helpful, but
should be guided by the antibiotic stewardship team for maximum benefit to the patient.

New Delhi Metallo-beta-lactamase-1 (NDM-1)

1. New Delhi Metallo-beta-lactamase-1 (NDM-1) is an enzyme that makes bacteria resistant to

a broad range of beta-lactam antibiotics. These include the antibiotics of the carbapenem family,
which are a mainstay for the treatment of antibiotic-resistant bacterial infections. The gene for
NDM-1 is one member of a large gene family that encodes beta-lactamase enzymes called
carbapenemases. Bacteria that produce carbapenemases are often referred to in the news media
as "superbugs" because infections caused by them are difficult to treat. Such bacteria are
usually susceptible only to polymyxins and tigecycline.

NDM-1 was first detected in a Klebsiella pneumoniae isolate from a Swedish patient of Indian
origin in 2008.

The Indian health ministry has disputed the conclusion of the August 2010 Lancet study that the
gene originated in India, describing this conclusion as "unfair" and stating that Indian hospitals
are perfectly safe for treatment. Indian politicians have described linking this new drug
resistance gene to India as "malicious propaganda" and blamed multinational corporations for
what they describe as selective malignancy. The Indian Ministry of Health released a statement
"strongly refuting" naming the enzyme "New Delhi".

In contrast, an editorial in the March 2010 issue of the Journal of Association of Physicians of
India blamed the emergence of this gene on the widespread misuse of antibiotics in the Indian
healthcare system, stating that Indian doctors have "not yet taken the issue of antibiotic
resistance seriously" and noting little control over the prescription of antibiotics by doctors and
even pharmacists. The Times of India states that there is general agreement among experts that
India needs both an improved policy to control the use of antibiotics and a central registry of
antibiotic-resistant infections.

Ajai R. Singh, editor of Mens Sana Monographs, demanded that such 'geographic names giving'
be abandoned and replaced by 'scientific name giving'. He proposed changing NDM-1 to PCM
(plasmid-encoding carbapenem-resistant metallo-beta-lactamase).

2. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in

different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or
staph -- because it's resistant to some commonly used antibiotics.
 23

3 Multiple Drug resistant Tuberculosis (TB)

2.6 MALNUTRITION

VITAMIN DEFICIENCY DISEASES

Vitamin A

The Ancient Egyptians and Greeks wrote about night blindness, or ‘nyctalopia’. This affliction makes it
impossible to see in dim light, and sufferers become completely blind when night falls. The Egyptians
found that they could cure sufferers by feeding them liver, which contains high levels of vitamin A, the
deficiency of which causes night blindness. Vitamin A deficiency still affects one third of all children on
Earth under the age of five, resulting in over half a million deaths each year. Most high dose vitamins
obtain their vitamin A from liver, which is dangerous at high levels and can cause various health
complications. In the past, starving Antarctic explorers would eat their dogs for food but became sick
when they ate too much liver. Vitamin A found in carrots is a slightly different molecule to that found in
liver and is not toxic in high doses, although it can cause skin to turn yellow. During the Second World
War, the Allies announced that they ate carrots to see well, although carrots only help maintain normal
vision and do not improve it beyond this.
 24

Night Blindness

Vitamin B

Beriberi is a disease whose symptoms include weight loss, body weakness and pain, brain damage,
irregular heart rate, heart failure, and death if left untreated. It was endemic in Asia for a long time.
Strangely, Beriberi occurred almost exclusively amongst the richer members of society, and was
unknown in the poor. Although recognized to be a nutritional deficiency, doctors were baffled as to why
wealthy people with plentiful and clean food would fall victim to beriberi whereas the poor with limited
food did not. As it turned out, beriberi is a deficiency of vitamin B1 (thiamine) which is found in cereal
grain husks. The rich had been washing their rice so well that they removed the husk with its vitamin B1,
whereas the poor did not wash their food as well and consumed enough vitamin B1. White bread can also
potentially cause beriberi, so today developed countries add extra vitamin B1 to it. Beriberi is now found
mostly in alcoholics whose bodies become poor at absorbing vitamin B1

Beri Beri

Pellagra : (Pe-lag-rah) (It. Pelle- skin; agro- rough):After the discovery and exploration of the
Americas, corn was grown by settlers and all around the world. The natives who had originally grown it
 25

would treat it with lime, but the taste was unpleasant to the Europeans and they omitted this part of the
preparation. As corn was increasingly farmed, the disease pellagra began to spread. Symptoms included
diarrhea, dermatitis, dementia, and finally death. Many people believed that corn was in some way toxic,
but could not explain the lack of pellagra among native New Worlders. After thousands of deaths, it was
discovered that corn, although high in carbohydrates, lacked vitamin B3 (niacin). Farmers would
sometimes eat little other than corn and succumb to the deficiency. The Native Americans had actually
been using lime as a way of adding vitamin B3. Today it is well known that by eating a variety of foods
vitamin B3 is freely obtained and pellagra is easily treated.

Pelagrah

Vitamin C

Scurvy: was first noted among people who spent a long time at sea. Boats would only carry non-
perishable foods such as salted meats and dried grain, so sailors ate few if any fruits or vegetables. Scurvy
causes lethargy, skin spots, bleeding gums, loss of teeth, offensive breath ,delay in healing wounds fever,
and death. Ancient sea-faring civilizations would cure it with various herbs. In more recent times, these
ancient cures were not used consistently and their value was not realized. In the 18th century horse meat
and citrus fruits were found to cure scurvy, and British sailors consumed limes to the extent that they
were nicknamed ‘limeys’. It is now known that these foods contain vitamin C, and in modern times
 26

scurvy is rarely fatal as it once consistently was. Today, there are groups who advocate vitamin C mega
doses of hundreds of times the recommended daily requirement; although any positive effects have not
been firmly demonstrated and harmful overdoses can occur.

Bleeding Gums

Vitamin D

Rickets causes muscles and bones to become soft, which can cause permanent deformities in children. It
is most common in children and infants who have a poor diet or who are housebound, but is nowadays
relatively rare in developed countries. Breast-fed babies are at higher risk if they or their mothers do not
take in enough sunlight, and baby formula is now designed to prevent this. Rickets is caused by a lack of
vitamin D or of calcium. Vitamin D is required for calcium to be properly absorbed into bones to
strengthen them. Adults rarely develop rickets because their bones are not growing and do not need much
calcium. Vitamin D itself is obtained from many foods but the body can only use it if it has been
converted into its active form via sunlight. In recent years there has been a slight increase in children with
rickets possibly due to too many of them staying indoors. .In children vitamin D deficiency
causes“Rachitic Rosary” (beading of the ribs).
 27

Bandy Legs
 28

Multiple Vitamin deficiency “Sprue”: It is prevalent in tropical countries and USA.

Symptoms are: Weight loss, weakness,

Muscular wasting, sores in the mouth and tongue, indigestion, diarrhea, ‘large, fatty,
frothy, foul-smelling stool’.

Folic acid, another form of which is known as folate, is one of the B vitamins. The recommended daily
intake level of folate is 400 micrograms from foods or dietary supplements. Folic acid is used to treat
anemia caused by folic acid deficiency. It is also used as a supplement by women during pregnancy to
prevent neural tube defects (NTDs) in the baby. ‘Spina bifida’ is a birth defect where there is
incomplete closing of the backbone and membranes around the spinal cord. Low levels in early
pregnancy are believed to be the cause of more than half of babies born with neural tube defects. More
than 50 countries use fortification of certain foods with folic acid as a measure to decrease the rate of
NTDs in the population. It is found naturally in meat and meat products, fish and fish products,
sea food, beans, Avocado and green leafy vegetables.

Note: Spina bifida can be surgically closed before or after birth.

 29

MINERAL DEFICIENCY DISEASES

Mineral/Element Diseases
Iodine Hypothyroidism, Goitre
Fluoride Dental caries
Calcium Osteomalacia(Softening of Bones)
Osteoporosis (Brittle Bone)
Iron Pernicious Anaemia

1. FOOD ADULTERATION

An adulterant is a substance found within other substances such as food, fuels or chemicals
even though it is not allowed for legal or other reasons.

The addition of adulterants is called adulteration. The most common reason for adulteration is
the use by manufacturers of undeclared materials that are cheaper than the correct and declared
ones. The adulterants may be harmful, or reduce the potency of the product, or they may be
harmless.

The term "contamination" is usually used for the inclusion of unwanted substances due to
accident or negligence rather than intent. Adulteration therefore implies that the adulterant was
introduced deliberately in the manufacturing process, or sometimes that it was present in the raw
materials and should have been removed, but was not.

An adulterant is distinct from, for example, permitted food additives. There can be a fine line
between adulterant and additive; chicory may be added to coffee to reduce the cost or achieve a
desired flavor, this is adulteration if not declared, but may be stated on the label. Chalk was often
added to bread flour; this reduces the cost and increases whiteness, but the calcium actually
confers health benefits, and in modern bread a little chalk may be included as an additive for this
reason.

Examples

Food Products Adulterants

Turmeric Powder Metanil Yellow*
Green Peas Malachite Green*
 30

Meat Kabab Congo red*

Milk Starch,Urea,Formalin,
Ice Cream Detergents

*Carcinogens (Cancer causing agent)

The Food Safety and Standards Authority of India, controls food adulteration.
Penalty: Adulterant is not injurious- 2 Lakhs
Adulterant is injurious- 10 Lakhs

3. FOOD PRESERVATIVES
Substance added to food products to prevent microbial decomposition or
undesirable chemical change is known as a preservative.

Food Products Preservatives

Jams, Fruit Juices, Carbonated Sodium benzoate( Allergic to
beverages, Pickles, Soy Sauce asthma patients)
Meat ‘curing’ Nitrite and Nitrate
Bread Sodium propionate
Smoked Meat Phenol
Fish Formaldehyde
Milk Hydrogen peroxide
Natural preservatives Salt, Sugar, Hops, Vinegar,
Alcohol

FOOD SAFETY

All India Prevention of Food Adulteration Act 1954

In India certain food products are deliberately adulterated, which causes irreversible damage to
human health.

1. Ajinomoto (name of the Japanese Company) produces Mono sodium glutamate

(MSG), which is crucial ingredient in Chinese food. It is a flavor enhancer but also a
 31

‘Silent Killer’. It may cause high BP, high cholesterol, insomnia (sleeplessness); High
sodium is not good for the heart. The foetus is sensitive to Ajinomoto.
2. Calcium carbide: (CaC2) is sprayed on unripe mangoes for early ripening. This is a bad
method of ripening.
(CaC2) + H20 → ACETYLENE, which is responsible for ripening.
Calcium carbide causes intestinal disorder.
3. ‘Mithai’ and ‘Pan’ are coated with Aluminium leaves instead of Silver leaves.
4. Argemone Mexicana seed are mixed with Mustard seeds.
This causes Dropsy (Edema);, Glaucoma ( Loss of vision because optic nerve is
affected)
5. Potassium dichromate is mixed with Chilly powder. Chromium present in it causes
“Chrome Jaundice”.
6. Yellow oxide of Lead is mixed with Turmeric powder. Lead affects the RBC
formation.
7. Of late, a fake rice “Plastic Rice” was mixed with normal rice in Vietnam.

PESTICIDE TOXICITY

1.DDT (Discovered in 1874)

Dichloro diphenyl trichloro ethane

It is a broad spectrum pesticide (Kills many pests).It is persistent in the environment.

It is fat soluble and therefore deposit in fatty areas (adipose tissues) of the body.

Due to ‘biomagnification’, its concentration gets quadrupled when it moves from one

trophic level to another.

0.001ppm→0.01 ppm→0.1ppm→1.0ppm

Water Algae Fish Man

Even it is degraded slowly, its metabolites are more toxic than that of the mother
product.

Pesticide Treadmill (Robert van Den Bosch): New generation pesticides come again
and again as the pest develop resistivity to them.

It reduces the thickness of the egg shells of birds such as Bald Eagles. In 1962, Rachel
Carson published “Silent Spring” describing the peril of the over use of DDT and
“silencing of birds”.
 32

DDT has been widely used as an aerial spray to eradicate malaria mosquitoes. In 1994,
during “Surat Plague”, DDT was widely used to eradicate rat flees.

Adverse Effects:

Girls exposed to DDT before puberty are five times more likely to develop breast
cancer in middle ages; it also causes male infertility; miscarriages and low birth
weights; developmental delay. It affects nervous system.

2. ENDOSULFAN

It was discovered in 1950s.It is labeled yellow in toxic category.

Toxicity: Endocrine distruptor; 35 mg /kg of body weight cause the damage.

Effects: 1. Reproductive damage

2. Growth retardation

3. Birth defects

It is widely used in Cashew plantation.

Many children in Kasargod, Kerala were severely affected.

It is a suspected carcinogen and cause breast cancer.

According to Insecticide Act, 1968, Karnataka banned this pesticide.

Also, it was banned according to Stockholm Convention on Persistent Organic

Pollutants (2011).
33
 34

8.
 35

9.

GENETICALLY MODIFIED FOOD

This is referred to as traditional cross breeding and involves selecting plants and animals with the
most desirable characteristics (e.g. disease resistance, high yield, good meat quality) for breeding
the next generation.

Today’s techniques use new ways of identifying particular characteristics and transferring them
between living organisms. For example, it is now possible to make a copy of a particular gene
from the cells of a plant, animal or microbe, and insert the copy into the cells of another
organism to give a desired characteristic.

Foods derived from genetically modified organisms are called ‘GM foods’. All of the GM
foods approved so far are from GM plants, for example corn plants with a gene that makes them
resistant to insect attack, or soybeans with a modified fatty acid content that makes the oil better
suited for frying. Plants that use less water to grow have also been developed so they are more
suitable for changing climatic conditions.
Golden rice is a variety of rice (Oryza sativa) produced through genetic engineering to biosynthesize
beta-carotene, a precursor of vitamin A, in the edible parts of rice. It is intended to produce a fortified
food to be grown and consumed in areas with a shortage of dietary vitamin A, a deficiency (Vitamin A
Deficiency-VAD) which is estimated to kill 670,000 children under the age of 5 each year. Rice is a
staple food crop for over half of the world's population, making up 30–72% of the energy intake for
people in Asian countries, making it the perfect crop for targeting vitamin deficiencies.

3.0 ENVIRONMENTAL SANITATION

SAFE DISPOSAL OF HUMAN EXCRETA

Is Faecal Sludge and Septage Management (FSSM) an effective and long-term solution in the
sanitation value chain? That was the question that Indian sanitation experts reflected on in Jaipur,
the state capital of Rajasthan, at a multi-stakeholder dialogue on ‘FSSM Matters: Looking
Forward’ on 10 January 2017.
 36

The opportunity to prevent disease and death to enhance the quality of people’s lives through
improved sanitation in the developing world is greater than ever. More than 40% of the world’s
population ice., 2.5 billion people primarily in rural areas, still practice open defecation or use pit
latrines that do not safely contain their waste. Another 2.1 billion people who live in urban areas
are containing their wastes but not disposing it safely.

The Bill and Melinda Gates Foundation works with a wide range of partners through its Water,
Sanitation and Hygiene initiative to reduce the burden of water borne diseases and improve the
lives of the poor. There are number of existing grants to support sanitary approaches to clean
water and hygiene in Africa and Asia where the burden of poor sanitation is the highest.

In Sanitary Value Chain (SVC) , waste must be captured and stored so that it does not
come in contact with people or contaminate the local environment especially water bodies.
In densely populated urban areas, waste must also be extracted, transported, treated and
 37

disposed of safely. Both rural and urban areas can potentially reuse night soil for
agriculture purpose and energy production.

Ashif Shaikh, founder and convener of the Rashtriya Garima Abhiyan, a grassroots campaign
against manual scavenging, explained the systematic discrimination that emerges from this
practice:

The manual carrying of human feces is not a form of employment, but an injustice akin to
slavery. It is one of the most prominent forms of discrimination against Dalits, and it is central to
the violation of their human rights.

On September 6, 2013, the Indian Parliament passed The Prohibition of Employment as Manual
Scavengers and Their Rehabilitation Act, 2013 (the 2013 Act), committing itself yet again to
ending manual scavenging. Seven months later, on March 27, 2014, the Indian Supreme Court
held that India’s constitution requires state intervention to end manual scavenging and
“rehabilitate” all people engaged in the practice. This meant not only ending the practice but also
ending the abuses faced by communities engaged in manual scavenging.
 38

BIOTOILETS
 39

MANAGEMENT OF SOLID WASTES (Bangalore Model)

Biodegradable or wet waste should be handed over to collectors in a green-coloured bin,

hazardous waste should be given in a red-coloured bin.

The Karnataka High Court on Thursday directed using ‘two bins and one bag’ system while
prohibiting citizens from using plastic bags or covers to dispose wet and hazardous wastes.

A Division Bench comprising Justice N. Kumar and Justice B.V. Nagarathna said that it would
be mandatory for all categories of waste generators — residential, non-residential and
government offices — to segregate waste into wet, hazardous and dry at source.

While biodegradable or wet waste should be handed over to collectors in a green-coloured bin or
container, hazardous waste should be given in a red-coloured bin, the Bench said, while asking
citizens to use reusable bags for handing over dry waste to collectors.

The court also said that plastic liners or plastic bags should not be used inside the bins while
storing wet waste. Instead, recyclable papers or old newspapers could be used. The Bench
prohibited citizens from throwing or dumping any waste in public or open spaces, including
roadsides, drains or water bodies.

Pointing out that the Bruhat Bengaluru Mahanagara Palike (BBMP) alone cannot handle the
enormous amount of garbage generated in the city; the court said cooperation is needed from
citizens, who are entrusted with the fundamental duty of protecting and improving the natural
environment under Article 51A of the Constitution.

The Bench directed the BBMP to identify violators and impose penalty as per provisions of the
Karnataka Municipal Corporations Act after publicizing the changed system of waste collection
and disposal.

The High Court on Thursday came up with a 'two bins, one bag' formula for the segregation of
garbage at source. All garbage generators, including individual homes, will henceforth, segregate
waste they generate into three parts - hazardous, biodegradable wet waste and dry waste. There is
a strict ban on the use of plastic in garbage segregation. Each household will have two bins - one
red and one green, in addition to a bag, made of some recyclable material, for the dry waste. This
will make it easier for garbage collectors to keep the waste separate and transport it to the final
destination.
 40

RESPONSIBILITY OF HOMES
Hazardous waste includes diapers, razors, syringes, napkins, medicine wrappers, condoms and
other such. Kitchen waste, greens and others, go into the green bin. Cardboards, plastics, bottles
and other recyclables will go into the bag. The BBMP is giving the campaign wide publicity and
collectors are forbidden from collecting unsegregated waste from anybody. The amended Section
341A of the Karnataka Municipal Corporations Act (KMC Act) will be invoked on those who do
not segregate waste. Before the amendment last year, a fine of Rs 10 was imposed on those not
segregating waste. This has been enhanced to between Rs 200 and Rs 5,000. The HC has made it
clear that no garbage generator can refuse to segregate it.

4.0 OCCUPATIONAL HEALTH HAZARDS

Definition: The sum of the external conditions and influences which prevail at the place of work
and which have a bearing on the health of the working population.

There are five interactions in the work place environment:

1. Physical: LIGHT, heat, cold, ionizing radiation and noise

2. Chemical: Dust, fumes and toxic gases
3. Biological: Viral, bacterial and fungal
4. Man – Machine: Machines are used for the mass production of goods. They affect the
workers directly or indirectly by accidents, un physiological postures, fatigue, backache,
joint pain and muscle pain
5. Man- Man: Human relationship among workers and with authorities.
Leadership style, payment, incentives and welfare schemes

“Ergonomics” is the study of man and his work environment. (Gk., Ergon-work; nomikos-
management/law).The objective of ergonomics is to achieve the best mutual adjustment of man
and his work for the improvement of human efficiency and well-being. It simply means” fitting
the job to the worker”.

1. Light: Both, poor illumination or excessive brightness affect the eyes.

2. Poor illumination causes “nystagmus”.

Nystagmus is a condition of involuntary eye movement, acquired in infancy or later in life, that
may result in vision. Due to the involuntary movement of the eye, it is often called "dancing
eyes".

Excessive light causes visual fatigue and lachrymation (tears).

 41

3. Temperature: “Hot spots” of the work site or summer season cause exhaustion and
dehydration.
Cold condition causes chilblains; immersion foot.
Heat causes boils/ blisters Sun burn and Sun stroke.

The gradation is: Comfort Level→ Discomfort level→ Distress level

At distress level, the workers develop clinical manifestations.

The Comfort zone should have 20.5⁰C – 26.6⁰C.

The favourable temperature at the work site should be 25⁰C (77⁰C).

Man- Machine Interaction: Vibration or pressure on the wrist causes “Carpal Tunnel
Syndrome” (CTS); pinched nerve in the wrist.

CTS is caused by pressure on the ‘median nerve’, run from forearm to hand through small
space in the wrist called ‘carpal tunnel’.

People with CTS experience numbness, tingling, or burning sensations in the thumb and fingers,
in particular the index and middle fingers and radial half of the ring finger, because these receive
their sensory and motor function (muscle control) from the median nerve. Ache and discomfort
can possibly be felt more proximally in the forearm or even the upper arm. Less-specific
symptoms may include pain in the wrists or hands, loss of grip strength, and loss of manual
dexterity.

Affected group: Typist, Data Feeders, Computer Programmers, and House maids Pneumatic
drill handlers.

Management: Adequate intermittent rest should be given to hands. Swing the hands and walk
for a while, during leisure time.
 42

Area of muscle wastage without treatment

 43

SICK BUILDING SYNDROME

Sick building syndrome (SBS) is a phenomenon affecting building occupants who claim to
experience acute health and comfort effects that appear to be linked to time spent in a building,
but where no specific illness or cause can be identified. SBS is also used interchangeably with
"building-related symptoms", which orients the name of the condition around patients rather than
a "sick" building.

Sick building causes are frequently pinned down to flaws in the heating, ventilation, and air
conditioning (HVAC) systems. Other causes have been attributed to contaminants produced by
outgassing of some types of building materials, volatile organic compounds (VOC), molds
improper exhaust ventilation of ozone (byproduct of some office machinery), light industrial
chemicals used within, or lack of adequate fresh-air intake/air filtration.

Symptoms

Building occupants complain of symptoms such as sensory irritation of the eyes, nose, throat;
neurotoxic or general health problems; skin irritation; nonspecific hypersensitivity reactions;
infectious diseases; odor and taste sensations.

Extrinsic allergic alveolitis has been associated with the presence of fungi and bacteria in the
moist air of residential houses and commercial offices.

The WHO has classified the reported symptoms into broad categories, including: mucous
membrane irritation (eye, nose, and throat irritation), neurotoxic effects (headaches, fatigue, and
irritability), asthma and asthma-like symptoms (chest tightness and wheezing), skin dryness and
irritation, gastrointestinal complaints.

Several sick occupants may report individual symptoms which do not appear to be connected.
In most cases, SBS symptoms will be relieved soon after the occupants leave the particular room
or zone. In some cases, particularly in sensitive individuals—there can be long-term health
effects.

Engineers are often affected by Sick building syndrome. Specific careers are also associated with
specific SBS symptoms. Transport, communication, healthcare, and social workers have highest
prevalence of general symptoms. Skin symptoms such as eczema, itching, and rashes on hands
and face are associated with technical work.

Prevention

Toxin-absorbing plants, such as Sansevieria or peace lily can be grown interior.

Replacement of water-stained ceiling tiles and carpeting.

Use of paints, adhesives, solvents, and pesticides in well-ventilated areas and use of these pollutant
sources during periods of non-occupancy.
 44

Increasing the number of air exchanges; the American Society of Heating, Refrigeration and Air-
Conditioning Engineers recommend a minimum of 8.4 air exchanges per 24-hour period.

Proper and frequent maintenance of HVAC systems.Regular vacuuming with a HEPA filter vacuum
cleaner to collect and retain 99.97% of particles down to and including 0.3 micrometers.

There might be a gender difference in reporting rates of sick building syndrome because women
tend to report more symptoms than men do. Some studies have found that women have a more
responsive immune system and are more prone to mucosal dryness and facial erythema. Also,
women are alleged by some to be more exposed to indoor environmental factors because they
have a greater tendency to have clerical jobs, wherein they are exposed to unique office
equipment and materials (example: blueprint machines), whereas men often have jobs based
outside of offices.

Sansevieria zeylanica (Mother-in –law’s tongue) Peace Lily (Spathiphyllum)

According to NASA’S Report, Peace Lily can absorb all VOCs such as Formaldehyde,

Benzene, Trichloroethylene, Toluene and Xylene.

 45

METHYL MERCURY AND CEREBRAL PALSY

Causes

Methylmercury is a type of mercury, a metal that is liquid at room temperature. A nickname for
mercury is quicksilver. Methylmercury is a very poisonous form of mercury. It forms when
bacteria react with mercury in water, soil, or plants. It has been used to preserve grain that is fed
to animals.

Methylmercury poisoning has occurred in people who have eaten meat from animals that ate
grain that was treated with this from of mercury. Poisoning from eating fish from water that is
contaminated with methylmercury has also occurred. One such body of water is Minamata Bay
in Japan.

Methylmercury is used in fluorescent lights, batteries, polyvinyl chloride, and latex paint.

Unborn babies and infants are very sensitive to methylmercury's effects. Methylmercury causes
central nervous system (brain and spinal cord) damage.

The FDA recommends that women who are pregnant, or may become pregnant and nursing
mothers avoid Deep Sea Tuna fish that may contain unsafe levels of methylmercury. Others
include swordfish, king mackerel, shark, and tilefish. Infants should not eat these fish, either.

Some health care providers have raised concerns about ethyl mercury (thiomersal), a chemical
used in some vaccines. However, research shows that childhood vaccines do not lead to
dangerous mercury levels in the body. Vaccines used in children today only contain trace
amounts of thiomersal.

Symptoms of methylmercury poisoning include:

Blindness

Cerebral palsy (movement and coordination problems, and other complications) paralysis,
especially that which is accompanied by involuntary tremors.

Impaired mental functioning

Lung function impairment

Microcephaly (Small head)

 46

Treatment

Methylmercury damage cannot be reversed. Treatment will depend on how severe a person's
condition is. It is similar to treatment for cerebral palsy. The person should be moved away from
the source of exposure to methylmercury. Treatment may involve: Activated charcoal by mouth
or tube through the nose into the stomach, if mercury is swallowed.

SYNERGISM

Synergism comes from the Greek word "synergos" meaning working together. It refers to the
interaction between two or more "things" when the combined effect is greater than if you added
the "things" on their own (a type of "when one plus one is is greater than two" effect).

In toxicology, synergism refers to the effect caused when exposure to two or more chemicals at
as time results in health effects that are greater than the sum of the effects of the individual
chemicals.

When chemicals are synergistic, the potential hazards of the chemicals should be re-evaluated,
taking their synergistic properties into consideration.

In comparison, a synergistic effect is the situation where the combined effect of two chemicals
is much greater than the sum of the effects of each agent given alone, for example:

2 + 2 >> 4 (maybe 10 times or more)

Our bodies have enzymes that are designed to do specific "jobs". For example, there is an
enzyme that helps break down alcohol - this is why we do not stay intoxicated "forever" after
consuming alcohol. These enzymes normally transform (metabolize) the foreign substances
(alcohol in this example) into less toxic or non-toxic substances which are eliminated out of the
body.

With synergism, an enzyme function could either be inhibited (restricted) or accelerated in some
way. Either way, the result is that the chemicals are either "free" or "enhanced" to cause a greater
biologic effect in the body.

Examples

(a) Carbon tetrachloride and ethanol (ethyl alcohol) are individually toxic to the liver, but
together they produce much more liver injury than the sum of their individual effects on the
liver.
 47

(b) The much higher incidence of lung cancer resulting from occupational exposure to asbestos
in smokers (compared to exposed non-smokers).

NOISE

Noise may be defined as the sound that is unpleasant and unwanted by the listener because
of its bothersome nature, interferes with the perception of wanted sound or its harmful
physiological or psychological effects. “ The wrong sound in the wrong place at the wrong
time”.

Tinnitus (Pron. Tin- nye-tus)

Although it is often referred to as "ringing in the ears," tinnitus can be perceived as many
different sounds including buzzing, hissing, clicking or whistling.

Tinnitus affects up to 1 in 10 adults and is more likely in those over 60.

Common causes are excessive or cumulative noise exposure, head and neck injuries, and ear
infections. In a small number of individuals, tinnitus is a sign of a serious underlying medical
condition.

There is no cure for tinnitus, although there are many options for managing it. The majority of
individuals with chronic tinnitus adjust to the ringing over time.

For others, tinnitus can be debilitating, and may lead to insomnia, difficulty with concentration,
poor work or school performance, irritability, anxiety, and depression.

Permissible Limit of Noise in the occupational Environment: 90dB

Noise Level dB Exposure time

90 8 hours
93 4 hours
100 48 minutes
110 4.8 minutes
120 28.8 seconds
130 2.8 seconds
140 1.0 second
 48

LIFE STYLE RELATED DISEASES

10 Health Effects Caused by Smoking

By 1964, it was official: The U.S. Surgeon General confirmed that cigarette smoking causes lung
cancer. But in the 50 plus years that followed, we learned that smoking is responsible for a heap
of other awful diseases, contributing to the tobacco epidemic we face today.
 49

Here are some health consequences of smoking you might not have heard before…

1. Going Blind
 50

Smoking doesn't do your peepers any good. Smoking increases your risk of age-related
macular degeneration, the leading cause of blindness in adults over the age of 65.

2. Type 2 Diabetes

Smoking contributes to type 2diabetes and increases the risk of complications from the
disease— including poor blood flow to legs and feet. This can lead to infection and result
in the need to amputate a limb. Yep–you could lose your foot or leg!

3. Erectile Dysfunction

Male sexual function is affected when you smoke. Tobacco causes narrowing of blood
vessels all over your body, including those that supply blood to the penis. Good news is that
quitting will make a big difference.
 51

4. Ectopic Pregnancy

Ectopic pregnancy is a life-threatening reproductive complication in women that is more

likely in smokers. It occurs when a fertilized egg implants somewhere other than the
uterus. The egg can’t survive and it puts mom's life at serious risk.

5. Hip Fractures
 52

Smokers lose bone density at a faster rate than non-smokers which puts you at risk for
breaking body parts like your hip. Putting down the cigarettes can help slow down this
process and keep you breaking a sweat, not your bones, on the dance floor.

6. Colorectal Cancer

Colorectal cancer, which forms in your intestines (colon or rectum), is the second leading
cause of cancer deaths in the United States. .

7. Rheumatoid Arthritis
 53

Rheumatoid arthritis is a chronic inflammatory disease more common in women that

affects the joints in your hands and feet. It causes painful swelling that can eventually result in
bone loss and joint deformity. Smoking is one of the causes, and is also associated with
developing the disease at an earlier age.

8. Cleft Lip and Cleft Palate

These birth defects, commonly called orofacial clefts, occur when a baby’s lip or mouth
doesn't develop properly during pregnancy. Women who smoke during pregnancy are
more likely to have babies with orofacial clefts.

9. Fertility Issues
 54

Moms-to-be take note: Smoking can affect your ability to conceive. It causes reduced
fertility in women and can contribute to other problems during pregnancy.

10. Gum Disease

Smoking contributes to periodontis—a gum infection that destroys the bone that supports
the teeth. It is a major cause of tooth loss in adults.

COTPA

The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation
of Trade and Commerce, Production, Supply and Distribution) Act, 2003 or COTPA, 2003
is an Act of Parliament of India enacted in 2003 to prohibit advertisement of, and to provide for
the regulation of trade and commerce in, and production, supply and distribution of cigarettes
and other tobacco products in India. This Act was enacted by the Parliament to give effect to the
Resolution passed by the 39th World Health Assembly, urging the member states to implement
measures to provide non-smokers protection from involuntary exposure to tobacco smoke.

Provisions

The Act prohibits smoking of tobacco in public places, except in special smoking zones in hotels,
restaurants and airports and open spaces. Places where smoking is restricted include auditoriums, movie
theatres, hospitals, public transport (aircraft, buses, trains, metros, monorails, taxis,) and their related
facilities (airports, bus stands/stations, railway stations), restaurants, hotels, bars, pubs, amusement
centres, offices (government and private), libraries, courts, post offices, markets, shopping malls,
canteens, refreshment rooms, banquet halls, discothèques, coffee houses, educational institutions and
parks. Smoking is allowed on roads, inside one's home or vehicle. The meaning of open space has been
extended to mean such spaces which is visited by public, and includes open auditorium, stadium, bus
stand.
 55

Advertisement of tobacco products including cigarettes is prohibited. No person shall participate in

advertisement of tobacco product, or allow a medium of publication to be used for advertisement of
tobacco products. No person shall sell video-film of such advertisement, distribute leaflets, documents, or
give space for erection of advertisement of tobacco products. However, restricted advertisement is
allowed on packages of tobacco products, entrances of places where tobacco products are sold. Surrogate
advertisement is prohibited as well under the Act.

Tobacco products cannot be sold to person below the age of 18 years, and in places within 100 metres
radius from the outer boundary of an institution of education, which includes school colleges and
institutions of higher learning established or recognized by an appropriate authority.

Tobacco products must be sold, supplied or distributed in a package which shall contain an appropriate
pictorial warning, its nicotine (0.1mg), tar (1mg) and Carbon Monoxide (1 mg) contents. Cigarette
packets are required to carry pictorial warnings of a skull or scorpion or certain prescribed pictorial
warnings along with the text SMOKING KILLS and TOBACCO CAUSES MOUTH CANCER in both
Hindi and English.

The Act also gives power to any police officer, not below the rank of a sub-inspector or any officer of
State Food or Drug Administration or any other officer, holding the equivalent rank being not below the
rank of Sub-Inspector of Police for search and seizure of premises where tobacco products are produced,
stored or sold, if he suspects that the provision of the Act has been violated.

A person who manufactures tobacco products fails to adhere to the norm related to warnings on packages
on first conviction shall be punished with up to 2 years in imprisonment or with fine which can extend to
Rs. 5000, in case of subsequent conviction shall be punished with up to 5 years in imprisonment or with
fine which can extend to Rs. 10000.

A fine up to Rs. 200 can be imposed for smoking in public place, selling tobacco products to minors, or
selling tobacco products within a radius of 100 metres from any educational institution.

A person who advertises tobacco products on first conviction shall be punished with up to 2 years in
imprisonment or with fine which can extend to Rs. 1000, in case of subsequent conviction shall be
punished with up to 5 years in imprisonment or with fine which can extend to Rs. 5000.

The Act repealed The Cigarettes (Regulation of Production, Supply and Distribution) Act, 1975 .

The owner/manager/in-charge of a public place must display a board containing the warning "No
Smoking Area - Smoking here is an offence” in appropriate manner at the entrance and inside the
premises. In place where tobacco products are sold must display appropriate messages like "Tobacco
Causes Cancer" and "Sales of tobacco products to a person under the age of eighteen years is a
punishable offence".

ALL THE BEST!

-Dr. Wilson