COMMUNICABLE DISEASE PREVENTION & CONTROL

• National TB Program-Directly Observed Treatment, Short-

course (NTP-DOTS)
• National Leprosy Control
• Schistosomiasis Control Program
• Filariasis Control program
• Malaria Control Program
• Rabies Control program
• Dengue Control Program
• STI & AIDS Control Program
National TB Program-Directly Observed
Treatment, Short-course (NTP-DOTS)
 TUBERCULOSIS

• Is considered as the world’s deadliest disease & remain as the

major public health problem in the Philippines.
• Rank 6th in the leading cause of morbidity & mortality (2002)
• 243/100,000 population/ year (WHO report 2006)
• Philippines rank 9th among 22 burdened countries under the
WHO watch list.
• Philippines ranks 4th in the world for the number of cases of
TB and has the highest number of cases per head in Southeast
Asia(WHO)
• Almost 2/3 of Filipinos have tuberculosis, and up to five
million people are infected yearly in our country.
• Sx & Sx: cough for 2 weeks or more, fever, chest & back
pain, hemoptysis, significant weight loss; other symptoms
such as sweat with chills, fatigue, body malaise, shortness of
breath
• Infectious agents: Mycobacterium Tuberculosis & M
africanum primarily from humans & M Bovis from cattle
• Mode of Transmission:
– airborne droplet through coughing, sneezing; direct
invasion through mucous membranes or break in the skin
(rare);
– Bovine TB results from exposure to TB cattle, usually by
ingestion of unpasteurized milk or dairy products
• Period of Communicability: as long as viable tubercle
bacilli are being discharged in the sputum
• Susceptibility & Resistance: the most hazardous period
for development of clinical disease is the first 6-12 months
after infection
– The risk of developing the disease is highest in children
under 3 years old; lower in later childhood, high among
adolescents, young adults & very old
Method of Control:

• Preventive measures:
– Prompt diagnosis
– BCG vaccination
– Educate the public in the mode of spread & method of control & the
importance of early diagnosis
– Improve social conditions
– Make available medical, laboratory & x-ray facilities for examination of
patients
– Provide public health nursing & outreach services for home
supervisions of patients
 THE NATIONAL TUBERCULOSIS CONTROL PROGRAM

• NTP is the Government’s commitment to

address the TB problem in the country. The
NTP is being implemented nationwide in all
government health centers and government
hospitals.
 Directly-Observed Treatment Short-course
(D.O.T.S.)

 It is a comprehensive strategy endorsed by the (WHO) and

International Union Against Tuberculosis and Lung Diseases
(IUATLD) to detect and cure TB patients.
 Five elements of DOTS that need to be fulfilled. These are:
1. political commitment
2. quality sputum microscopy for diagnosis
3. regular supply of anti-TB drugs
4. standardized recording and reporting of TB data
5. supervised treatment by a treatment partner
VISION:

• A country where TB is no longer a public health

problem
MISSION:
Ensure that TB DOTS services are available , accessible,
& affordable to the communities in collaboration
with the LGU’s & other partners
Goal:

• To reduce prevalence & mortality from TB by half by the year

2015 (Millennium development Goal)
Targets:
1. Cure at least 85% of the sputum smear- positive TB patient
discovered
2. Detect al least 70% of the estimated new sputum smear-
positive TB cases
NTP STRATEGIES

To achieve certain objectives and targets, the NTP shall focus

on the following:
A. Advocate for political commitment
B. Ensure the availability of drugs and other supplies
1. Systematic drug procurement and distribution from central
(regional) to various levels
2. Regular monitoring and inventory of anti-TB drugs and
other NTP supplies
3. Supplementation of logistics from the LGUs
 Medications for TB

• H – ISONIAZID (300mg) (800MG),

• R – RIFAMPICIN (450MG),
• Z – PYRAZINAMIDE (1g),
• E – ETHAMBUTOL
• S – STREPTOMYCIN (1g).
 Treatment Regimen

 Regimen I :2HRZE / 4HR

 New pulmonary smear (+) cases
 New seriously ill pulmonary smear (-) cases with extensive
parenchymal involvement
 New severely ill extrapulmonary TB cases
Drug & Duration of Treatment
 HRZE for 2 mos during the intensive phase.
 HR for 4 mos during the maintenance phase.
Adjustment by
Adjustment by Body Weight:

• Add 1 tablet of INH(100mg), PZA(500mg), and

EB(400mg) each for the patient with more
than 50kg body weight before the initiation of
the treatment.
TYPE 1BLISTER PACK:
Rifampicin (R): one capsule of 450mg
Isoniazid (H): one tablet of 300mg
Pyrazinamide (Z): two tablets of 500mg
TYPE II BLISTER PACK:
Rifampicin (R): one capsule of 450mg
Isoniazid (H): one tablet of 300mg
Ethambutol tablet and streptomycin vial:

Ethambutol (E) : two tablets of 400mg

Streptomycin (S): one vial of 1.0g

 Procedures
A. Registration and initiation of Treatment

1. Inform the patient that he/she has TB and motivate

the patient to undergo treatment.
2. Refer the patient to a medical officer for pre-
treatment evaluation and initiation of treatment.
3. Open the NTP Treatment Card and two NTP ID Cards (one is
for the treatment partner and the other is for the patient) and
start the treatment using any of the three treatment regimens
best to the suited to the patient’s disease classification, type
and previous history of treatment.
4. Register the patient in the NTP TB Register. Refer the patient
to the most accessible BHS
B. Ensuring Treatment Compliance through “DOT”

1. Explain the importance of treatment compliance to the

patient.
2. Administer the patient’s drugs daily. The patient and his/her
treatment partner shall meet at their agreed treatment unit
everyday. The treatment partner shall make sure that the
patient swallows his/her drugs daily. After intake of the drugs,
the treatment partner shall check and sign the treatment
partner’s NTP ID Card as well as the patient’s NTP ID Card.
3. On Saturdays, Sundays and holidays, when the health center
or clinic is closed, treatment could be done at home but
should be supervised by a family member
4. The treatment partner shall regularly motivate the TB patient to
continue treatment. The treatment partner shall emphasize key
messages, such as:
 TB should be cured but requires regular drug intake for the
prescribed duration.
 The patient should report any adverse reaction to the drugs.
 The patient should undergo follow-up sputum examination on
specified dates
5. The responsible health worker (MHO or PHN or RHM) shall conduct
regular (preferably weekly) consultation with the treatment partner
together with the patient for treatment evaluation at BHS or RHU.
6. The treatment partner and all the health workers shall
immediately exert effort to retrieve a patient upon failure to
report on the day the patient is expected.
7. To monitor the response to treatment, follow-up sputum
examination should be done on the specified date Sputum-
smear examination for follow-up requires only one specimen
collection, preferably in the early morning.
 SCHEDULE OF SPUTUM SMEAR FOLLOW-UP
EXAMINATION

Schedule of Sputum Category I Regular Treatment With One Month of

(2HRZE/4HR)
Smear Follow-up Extension (HRZE)
Examination

Towards the end of YES (If positive)

the 2nd month ↓ ↘
Towards the end of ↓ (If negative) YES
the 3rd month
Towards the end of YES
the 4th month
Towards the end of YES
the 5th month
Towards the end of YES
the 6th month
Towards the end of YES
the 7th month
National Leprosy Control program
 Leprosy

• Is an ancient disease & is a leading cause of

permanent physical disability among CDs.
• It is a chronic mildly communicable disease that
mainly affect the skin, the peripheral nerves, the
eyes & mucous of the URT
• In 1991, Philippines joined the movement to eliminate leprosy
as a public health problem.
• By the end of 2005, the prevalence rate (PR) is 0.36 which is
5.8% lower than 2004. However the New case detection Rate
for 2005 is 2.55 which is 39% higher than 2004.
• Leprosy is still public problem in 8 cities (Laoag, Candon,
Vigan, San Jose, CDO, Oroquieta, Iligan & Isabela) & 5
provinces( Ilocos Norte, Ilocos Sur, Basilan, Sulu, & Tawi-tawi)
 Signs and Symptoms

EARLY Sx & Sx:

 Changes in skin color – either reddish or white
 loss of sensation/numbness on the skin
 loss of sweating and hair growth over the skin lesions
 thickened and/or painful nerves in the neck, forearm, near elbow joint
and the back of knees
 Pain & redness of the eyes
 Nasal obstruction or bleeding
 Ulcer that do not heal
Late Signs & Symptoms:

 loss of eyebrow (Madarosis)

 Inability to close eyelids (lagophthalmos)
 Clawing of fingers & toes
 Contractures
 Sinking of nosebridge
 Enlargement of the breast in males or gynecomastia
 Chronic Ulcers
Infectious Agent:

• Mycobacterium leprae an acid fast, rod-shaped bacillus which

can be detected by Slit Skin Smear (SSS)
• Method of Transmission:
– Airborne- inhalation of droplet/spray from
coughing and sneezing of untreated leprosy
patient
– Prolonged skin-to-skin contact
Diagnosis:

• Based on clinical signs & symptoms specially if

there is history of contact with Leprosy
• SSS examination an optional procedure; done
only when clinical dx is doubtful
Susceptibility: children especially 12 years &
below are more suseptible
Prevention & Control:

• Avoidance of prolonged skin-to-skin contact with a

lepromatous case
• treat all leprosy cases to prevent spread of infection
• young children should avoid direct contact with untreated
patients
• practice personal hygiene
• maintain body resistance by healthful living
- good nutrition; enough rest and exercises & clean
environment
• BCG vaccination
Management/treatment:

• Ambulatory chemotherapy through use of

multi-drug therapy
• Domiciliary treatment as embodied in R.A.
4073 which advocates home treatment
 Highly effective cure available

– Multidrug therapy (MDT)

• Is a combination of 2 / 3 drugs (clofazimine,
rifampicin, dapsone)
• Cures patients in 6 months / 12 months
depending on form of leprosy
• Kills the leprosy bacilli and stops its
transmission
• Can be delivered under field conditions without
special staff and institutions
• Is available free of charge from WHO
 Leprosy Control Program

• Leprosy Control Program envisions to eliminate Leprosy as a

human disease by 2020 and is committed to eliminate leprosy
as a public health problem by attaining a national prevalence
rate (PR) of less than 1 per 10,000 population by year 2000.
• Its elimination goals are: reduce the national PR of <1 case per
10,000 population by year 1998 and reduce the sub-national
PR to <1 case per 10,000 population by year 2000
 Kilatis Kutis Campaign

• Program thrust is towards finding hidden cases of leprosy and

put them on Multi-Drug Therapy (MDT), emphasizing the
completion of treatment within the WHO prescribed duration.
• Strategies are case-finding, treatment, advocacy,
rehabilitation, manpower development and evaluation.