Basics on Transmission and Prevention

Dr.T.V.Rao MD
Dr.T.V.Rao MD 1
HOW TO CLASSIFY
DISASS

Acute Diseases

Acute diseases are those conditions in

which the peak severity of symptoms
occurs within three months (usually
sooner), and recovery in those who survive
is usually complete

Chronic Diseases

Chronic diseases or conditions are those in

which symptoms continue longer than
three months and in some cases for the
remainder of the persons life. Recovery is
slow and sometimes incomplete.
Dr.T.V.Rao MD 2
CLASSIFYI!" DISASS
#cont$d.%

Comm&nica'(e #In)ectio&s% Diseases

Diseases )or *+ic+ 'io(o,ica( a,ents or t+eir -rod&cts
are t+e ca&se and *+ic+ are transmissi'(e )rom one
individ&a( to anot+er
T+e disease -rocess 'e,ins *+en t+e ca&sative a,ent
is a'(e to (od,e and ,ro* or re-rod&ce *it+in t+e
'od.
T+e -rocess o) (od,ment and ,ro*t+ o) a
microor,anism or vir&s in t+e +ost is termed infection

Non-communicable (Noninfectious)
Diseases/Illnessses
T+ose diseases or i((nesses t+at cannot 'e transmitted
)rom an in)ected -erson to a s&sce-ti'(e/ +ea(t+. one
Severa(/ or even man./ )actors ma. contri'&te to t+e
deve(o-ment o) a ,iven non0comm&nica'(e +ea(t+
condition
T+e contri'&tin, )actors ma. 'e ,enetic/
environmenta(/ or 'e+aviora( in nat&re
Dr.T.V.Rao MD 3
C(assi1cation o) Diseases
T.-es o) Diseases22222
3am-(es22222222222222

Acute Diseases
Communicable Common cold, pneumonia,
mumps, measles, pertussis, typhoid fever,
u
!on"communicable Appendicitis, poisoning, trauma
(e.g., (incl. trauma) due to automobile accidence,
#res, etc.)

Chronic Diseases
Communicable $yme disease, tuberculosis, A%&',
syphilis, rheumatic fever following
streptococcal infections, herpes
!on"communicable &iabetes, coronary heart disease,
osteoarthritis, cirrhosis of the liver dur
to alcoholism, hyptertension
Dr.T.V.Rao MD 4
in4)ec4tion
dictionar. means

a. %nvasion by and multiplication of

pathogenic microorganisms in a bodily part or
tissue, which may produce subse(uent tissue
in)ury and progress to overt disease through a
variety of cellular or to*ic mechanisms.

b. An instance of being infected.

c. An agent or a contaminated substance

responsible for one+s becoming infected.

d. ,he pathological state resulting from having

been infected.
Dr.T.V.Rao MD 5
De1nitions

Disease and In)ectio&s Disease

Disease

Any deviation from a condition of

good health and well"being

In)ectio&s Disease

A disease condition caused by the

presence or growth of infectious
microorganisms or parasites
Dr.T.V.Rao MD 6
De1nitions

Pat+o,enicit. and Vir&(ence

Pat+o,enicit.

,he ability of a microbe to cause

disease

,his term is often used to describe

or compare species

Vir&(ence

,he degree of pathogenicity in a

microorganism

,his term is often used to describe

or compare strains within a species
Dr.T.V.Rao MD 7

Infection is the invasion

of a host organism's
bodil tiss!es b disease"
ca!sing organisms# their
m!lti$lication# and the
reaction of host tiss!es to
these organisms and the
to%ins the $rod!ce.
Infections are ca!sed b
microorganisms s!ch as
vir!ses# $rions# bacteria#
and Viroids# and larger
organisms li&e $arasites
and f!ngi.
In)ection
means
Dr.T.V.Rao MD 8
S-anis+ F(& #5657% c+an,es t+e
&nderstandin, o) Comm&nica'(e
Diseases *it+ mi((ions e8ected and
9i((in, man.
Dr.T.V.Rao MD '
CO:RS OF I!FCTIO:S
DISASs

-*posure.%nvasion of
/ost

%ncubation "" period of

time between
e*posure and onset of
symptoms "" e.g.,
interval between /%0
infection and
development of A%&'
can be as long as 12"
13 years

/ost reaction

&isease runs course ""

treatment,
recovery.death (most
people dont die from
infectious diseases)
Dr.T.V.Rao MD 1(
Ca&sative A,ents e8ectin,
+&mans

Bacter
ia

Vir&se
s

F&n,i

Proto;
oa

He(min
t+s

Prions
Dr.T.V.Rao MD 11
I!C:BATIO! PRIOD

0aries by disease

'almonella "" 14"54 hours after infection6 symptoms

usually resolve in 3"5 days, unless infected person is
in a very weakened health status

7easles (rubeola) "" appro*. 12"14 days (prodomal ""

i.e., interval between the earliest symptoms and the
appearance of the rash or fever "" rash onset, on
average, 18 days

/%0 "" 9 weeks upward to months6 interval between

/%0 infection and development of A%&' can be as long
as 12"13 years

4"9 weeks after infection in many, but not all,

diseases, most people develop antibodies against
reinfection
Dr.T.V.Rao MD 12
MODS OF COMM:!ICABL
DISAS TRA!SMISSIO!

Direct
Transmissi
on

Indirect
Transmissi
on
Dr.T.V.Rao MD 13
De1nitions

Ac&te in)ection vs. c+ronic in)ection

Ac&te In)ection

An infection characteri:ed by sudden

onset, rapid progression, and often with
severe symptoms

C+ronic In)ection

An infection characteri:ed by delayed

onset and slow progression
Dr.T.V.Rao MD 14
De1nitions

Primar. in)ection vs. secondar.

in)ection

Primar. In)ection

An infection that develops in

an otherwise healthy individual

'econdary %nfection

An infection that develops in

an individual who is already
infected with a di;erent
pathogen
Dr.T.V.Rao MD 15
De1nitions

Loca(i;ed in)ection vs. s.stemic in)ection

Loca(i;ed In)ection

An infection that is restricted to a

speci#c location or region within
the body of the host

S.stemic In)ection

An infection that has spread to

several regions or areas in the
body of the host
Dr.T.V.Rao MD 16

Opportunistic
infection

An infection
caused by
microorganisms
that are
commonly found
in the hosts
environment ,his
term is often
used to refer to
infections caused
by organisms in
the normal ora
De1nitions
Dr.T.V.Rao MD 17
DIRCT TRA!SMISSIO!

%mmediate transfer of the disease

agent by direct contact between the
infected and the susceptible
individuals

<ccurs through such acts as

touching, biting, kissing, se*ual
intercourse, or by direct pro)ection
(droplet spread) by coughing or
snee:ing within a distance of one
meter

-*amples of diseases for which

transmission is usually direct are
A%&', syphilis, gonorrhea, and the
common cold
Dr.T.V.Rao MD 1)
I!DIRCT TRA!SMISSIO!

7ay be one of three types= air"borne, vehicle"

borne, or vector"borne

Air-borne transmission "" transmission of

microbial aerosols to a suitable port of entry,
usually the respiratory tract

7icrobial aerosols are suspensions of dust

or droplet nuclei made up wholly or in part
by microorganisms "" may be suspended
and infective for long periods of time

-*amples of air"borne diseases include

tuberculosis, inuen:a, histoplasmosis, and
legionellosis
Dr.T.V.Rao MD 1'
I!DIRCT TRA!SMISSIO!
#cont$d.%
Vehicle-borne transmission -- contaminated materials or
ob)ects (fomites) serve as vehicles, nonliving ob)ects by which
communicable agents are transferred to a susceptible host
,he agent may or may not have multiplied or developed on
the vehicle
-*amples of vehicles include toys, handkerchiefs, soiled
clothes, bedding, food service utensils, and surgical
instruments
Also considered vehicles are water, milk, food (e.g.,
common vehicles), or biological products such as blood,
serum, plasma, organs and tissues
Almost any disease can be transmitted by vehicles,
including those for which the primary mode of transmission
is direct, such as dysentery and hepatitis
Dr.T.V.Rao MD 2(
I!DIRCT TRA!SMISSIO!
#cont$d.%
Vector-borne transmission "" disease transfer by a
living organism, such as a mos(uito, y, or tick

,ransmission may be mechanical, via the contaminated

mouth parts or feet of the vector, or biological,
involving multiplication or developmental changes of
the agent in the vector before transmission occurs

In mechanical transmission, multiplication and

development of the disease do not usually occur "" e.g.,
organisms that cause dysentery, polio, cholera, and
typhoid fever have been isolated from such insects as
cockroaches and house ies and could presumably be
deposited on food prepared for human consumption
Dr.T.V.Rao MD 21
I!DIRCT TRA!SMISSIO!
#cont$d.%

%n biological transmission , multiplication

and.or developmental changes of the
disease agent occur in the vector before
transmission occurs

>iological transmission is much more

important than mechanical transmission in
terms of its impact on public.community
health

-*amples of biological vectors include

mos(uitoes, eas, ticks, lice, ies and
other insects
Dr.T.V.Rao MD 22
I!DIRCT TRA!SMISSIO!
#cont$d.%

Mosquitoes are e*tremely important

vectors of human diseases "" e.g., they
transmit the viruses that cause yellow
fever and dengu? fever as well as 422
other viruses "" they also transmit
malaria, which infects 122 million people
in the world each year (most in tropical
areas), killing at least 1 million of them
each year

Ticks are another important biological

vector, transmitting Rocky 7ountain
spotted fever, relapsing fever, and $yme
disease
Dr.T.V.Rao MD 23

Redness

Swelling

Tenderness

Warmth

Drainage

Red streaks
leading away
from wound
Signs & Symptoms of Infection
Dr.T.V.Rao MD 24
DISAS A!D I!<:RY
PRV!TIO!
A!D CO!TROL

Preention

%ncludes individual, clinical, or personal health

services such as immuni:ations, screening for
high blood pressure and follow"up services, or
the use of @ap smears to detect the precursors
to cancer of the cervi*

Protection

%ncludes the activities of organi:ations, both

public and private, to reduce e*posure to
ha:ards such as polluted water, contaminated
food, traAc accidents, mos(uitoes, or use of
electric saws without safety devices
Dr.T.V.Rao MD 25
Be,innin, o) in)ection
contro( Pro,rammes

7odern hospital
infection control
programs #rst
began in the 1B32s
in -ngland, where
the primary focus
of these programs
was to prevent and
control hospital"
ac(uired
staphylococcal
outbreaks.
Dr.T.V.Rao MD 2*
PRV!TIO! OF COMM:!ICABL
DISASS

Primar! Preention
%n the chain of infection model, primary prevention
strategies are evident at each link of the chain
'uccessful application of each strategy can be seen as
weakening the link "" with the ultimate goal of
interrupting the disease transmission cycle

Communit! measures "" e.g., chlorination

of the water supply, inspection of restaurants,
immuni:ation programs that reach all citi:ens,
maintenance of a well"functioning sewer system,
proper disposal of solid waste, and control of vectors
and rodents
Dr.T.V.Rao MD 2+
PRV!TIO! OF
COMM:!ICABL DISASS
#cont$d.%

Personal/In"ii"
ual actions ""
hand washing,
proper cooking of
foods, ade(uate
clothing and
housing, use of
condoms,
obtaining all of
the available
immuni:ations
against speci#c
diseases
Dr.T.V.Rao MD 2)
PRV!TIO! OF
COMM:!ICABL DISASS
#cont$d.%

#econ"ar! Preention

Communit! e$ort includes measures taken

to control or limit the e*tend of a disease
outbreak.epidemic "" e.g., maintaining records
of cases and compliance with regulations
re(uiring the reporting of noti#able diseases,
investigating cases and contacts, those who
may have become infected through contact
with cases

In"ii"ual e$ort includes either (1) self"

diagnosis and self"treatment with
nonprescription medications or home
remedies, or (4) diagnosis and treatment with
an antibiotic or other physician"prescribed
medicine
Dr.T.V.Rao MD 2'
PRV!TIO! OF
COMM:!ICABL DISASS
#cont$d.%

<ccasionally, secondary disease control

measures may include isolation or quarantine

Isolation = separation, for the period of

communicability, of infected persons or
animals from others so as to prevent the direct
or indirect transmission of the communicable
agent to a susceptible person.host

%uarantine = limitation of the freedom of

movement of well persons or animals that
have been e*posed to a communicable disease
until the incubation period has passed
Dr.T.V.Rao MD 3(
PRV!TIO! OF
COMM:!ICABL DISASS
#cont$d.%
Curther measures may
include disinfection ""
the killing of
communicable agents
outside the the host,
and mass treatment
with antibiotics
@ublic health education
and health promotion
should also be used as
both primary and
secondary preventive
measures

Time(. (a'orator.
Dia,nosis sto- o)
man. In)ections
Dr.T.V.Rao MD 31
PRV!TIO! OF COMM:!ICABL
DISASS #cont$d.%

Tertiar! Preention

Convalescence from infection, recovery to full or

partial health, and return to normal activity

%n some cases, such as paralytic polio, return to

normal activity may not be possible, even with
e*tensive physical therapy

At the community level, proper removal of infected

items such as clothing, disinfection, and burial of the
dead, for e*ample

,ertiary prevention may also involve the

reapplication of primary and secondary measures to
prevent further cases "" e.g., in Dapan and 'outh
Eorea, people with colds or u wear gau:e masks in
public to reduce the spread of the disease
Dr.T.V.Rao MD 32
33
An a--roac+ to in)ection
contro( in deve(o-in, co&ntries
In)ection Contro( Team> In)ection Contro( Pro,ramme
A&dit (process) F outcome S&rvei((ance

v
i
d
e
n
c
e
B
a
s
e
d


P
r
a
c
t
i
c
e
C
o
s
t

e
8
e
c
t
i
v
e
,o reduce infection rate to
Girreducible minimum.
Divert reso&rces Waste)&(
-ractices
:nsa)e
-ractices
d&catin, o&r
Hea(t+ Care
Wor9ers

-ducation programs for employees and

volunteers are one method to ensure
competent infection control practices. %t is a
uni(ue challenge since employees represent a
wide range of e*pertise and educational
background. ,he %C@ must become
knowledgeable in adult education principles
and use educational tools and techni(ues that
will motivate and sustain behavioral change.
7uch has been written about the education of
healthcare workers (/CHs). 'ome of the tools
used to educate /CHs successfully include
newsletter, posters and videos
Dr.T.V.Rao MD 34
TOOLS AVAILABL TO TH
?STAT@ FOR TH CO!TROL OF
COMM:!ICABL DISAS

RPORTI!" "" @hysicians and other health

professionals must report speci#ed diseases to a
designated authority, usually to local or state
health authority

LABORATORY RPORTI!" "" %n many states,

licensed laboratories must report positive results
for certain diseases to the health department,
even though a diagnosis may not have been
established

S:RVILLA!C "" ,he systematic

measurement of health status and risk factors

MO!ITORI!" 00 %nvolves the ongoing

assessment of a condition after intervention has
been initiated
Dr.T.V.Rao MD 35
TOOLS AVAILABL TO TH ?STAT@
FOR TH CO!TROL OF
COMM:!ICABL DISAS

LABORATORY A!ALYSIS "" %nvolves

public health laboratories with authority
for the study and detection of infectious
diseases

CO!TACT I!VSTI"ATIO! "" <nce a

case of a particular disease has been
diagnosed, personnel from the health
department are authori:ed to interview
the victim to establish a list of possible
contact. (A practice of considerable
debate recently because of A%&'.)
Dr.T.V.Rao MD 3*
TOOLS AVAILABL TO TH ?STAT@
FOR TH CO!TROL OF
COMM:!ICABL DISAS

TRATM!T "" @ublic health agencies are

re(uired to provide treatment services for
speci#ed infectious diseases. (%n many cities,
special hospitals were built for this purpose.)
$ocal health departments are also re(uired to
provide services for people infected with se*ually
transmitted diseases or tuberculosis. ,hese
services are not regarded as welfare services but
rather as tools to prevent the spread of
dangerous communicable diseases. %t is
important to note, however, that the state cannot
require treatment. ,he state can only force
treatment if it can prove that the victim is (1)
gravely disabled, and (4) a danger to self or
others because of the disability
Dr.T.V.Rao MD 3+
TOOLS AVAILABL TO TH ?STAT@
FOR TH CO!TROL OF
COMM:!ICABL DISAS

ISOLATIO! "" 7eans separation of infected

people from non"infected people during the
period of communicability. Collows the Ileast
restrictiveJ principle

IMM:!IAATIO! "" All states have

re(uirements for the immuni:ation of children
against certain infectious diseases "" most
common are diphtheria, pertussis (whooping
cough), tetanus, rubella (Kerman measles), and
polio. ,he controlling agency is usually the
school system, which is re(uired to prevent
entry of any child who has not been properly
immuni:ed
Dr.T.V.Rao MD 3)
TOOLS AVAILABL TO TH ?STAT@
FOR TH CO!TROL OF
COMM:!ICABL DISAS

I!VSTI"ATIO!S "" %n addition to

the speci#c authorities noted above, most
health departments are re(uired to
investigate unusual occurrences of disease
or in)ury. ,his includes the authority to
review medical records, to perform
laboratory investigations, to e*amine
patients, and to interview both patients
and others who may have been e*posed
to the disease or in)ury. (,he public health
authorities may re(uire court authori:ation
to undertake these investigations.)
Dr.T.V.Rao MD 3'
O&r Vision to F&t&re

In)ection
contro( programs
must maintain
training records of
employees. ,he
minimum training
re(uired is annual
<'/A blood borne
pathogen,
tuberculosis
prevention and
control and new
employee
orientation.
Dr.T.V.Rao MD 4(
Im-act o) In)ectio&s
Diseases
conomic
Loss o) reven&e )or t+e )ami(.
Loss o) -rod&ctivit. )or t+e
em-(o.er
Conta,ion
Ot+er c+i(dren in c+i(d care
Fami(ies
Care,ivers>teac+ers and t+eir
)ami(ies
Disr&-tion
A(ternative care,ivers
Ot+er co((ea,&es 1((in, in )or
missin, -arent at *or9
Hea(t+ care
Man. oBce visits to ,et ?sic9
notes@
Ina--ro-riate &se o) anti'iotics
Added res-onsi'i(it. o)
administerin, medication
in c+i(d care
Impact of Infectious Diseases

All members of society are affected

Hand *as+in, sti(( contin&es to 'e
'est o-tion to -revent in)ections
1(,2+,14 Dr.T.V.Rao MD 43
HA!D WASHI!" STIIL
SAVS MA!Y LIVS
FROM I!FCTIO!S
Dr.T.V.Rao MD 44
Visit me )or more artic(es o)
interest on in)ectio&s diseases
CC
1(,2+,14 Dr.T.V.Rao MD 45

Pro,ramme Created '.

Dr.T.V.Rao MD )or Medica(
and Hea(t+ care *or9ers in
t+e Deve(o-in, Wor(d

-mail

doctortvraoLgmail.com
Dr.T.V.Rao MD 4*