CONTROL OF COMMUNICABLE DISEASE

BY: Jacquelyn D. Inaldo

A. National TB Program

TUBERCULOSIS
 TB is a highly infectious chronic disease caused by the tubercle bacilli.
 It is primarily a respiratory disease but can also affect other organs of the body.
 It is most common in malnourished individuals living in crowded areas.
 It often occurs in children of underdeveloped and developing countries in form of
primary complex especially after deliberating childhood disease such as measles.

Signs and Symptoms

 Bad cough (lasting longer than two weeks).

 Chest or Back pain not referable to any musculo-skeletal disorder
 Coughing up blood or sputum (mucus).
 Fatigue or weakness.
 Loss of appetite.
 Weight loss.
 Chills.
 Fever.
 Night sweats

Infectious Agents

 Mycobacterium tuberculosis
 M. Africanum primarily from human
 M. Bovis primarily from cattle

Mode of Transmission

 Airborne droplet method through coughing, singing or sneezing

 Direct invasion through mucous membrane or breaks in the skin may occur, but is
extremely rare.
 Bovine tuberculosis results from exposure to tuberculosis cattle usually by ingestion
of unpasteurized milk or dairy product.

Period of Communicability

 As long as viable tubercle bacilli are being discharged in the sputum.

 Some untreated or inadequately treated patients may be sputum-positive
intermittently for years
 Children with primary tuberculosis are generally not infectious

Susceptibility and 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 under 3 years old, lower in later
childhood and high gain among adolescents,young adults and very old
 Increased susceptibility in HIV infection
 Immunosuppression
 Underweight
 Undernourished with silicosis, diabetes, gastrectomies
 Substance abusers

Methods of Control
Preventive Measures
 Prompt diagnosis and treatment of infectious cases
 BCG Vaccination of newborn, infants and grade I/school entrants
 Educate the public in mode of spread and methods of control and the importance of
early diagnosis
 Improve social conditions, which increase the risk of becoming infected, such as
overcrowding
 Make available medical, laboratory and x-ray facilities for examination of
patients,contacts and suspects, and facilities for early treatment of cases and persons
at high risk of infection and beds for needing hospitalization
 Provide public health nursing and outreach services for home supervision of patients to
supervise therapy directly and to arrange for examination and preventive treatment of
contacts.

THE NATIONAL TUBERCULOSIS PROGRAM

Vision: A country where TB is no longer a public problem

Mission

 To reduce TB burden (TB incidence and TB mortality)

 To achieve catastrophic cost of TB-affected households
 To responsively deliver TB service

Program Components

 Health Promotion
 Financing and Policy
 Human Resource
 Information System
 Regulation
 Service Delivery
 Governance

Target Population / Client

Presumptive TB and TB affected households

Strategies, Action Points and Timeline

2017-2022 Philippine Strategic TB Elimination Plan

 Activate communities and patient groups to promptly access quality TB services

 Collaborate with other government agencies to reduce out-of-pocket expenses and
expand social protection programs
 Harmonize local and national efforts mobilize adequate and competent human
resources
 Innovate TB information generation and utilization for decision making
 Enforce standards on TB care and prevention and use of quality products
 Value clients and patients through integrated patient-centered TB services
  Engage national, regional and local government units/ agencies on multi-sectoral
implementation of TB elimination plan.

KEY POLICIES

A. Casefinding

1. Direct Sputum Smear Microscopy (DSSM) shall be the primary diagnostic tool in NTP
case finding
2.All TB symptomatics identified shall be asked to undergo DSSM for diagnosis before start
of treatment, regardless of whether or not they have available X-ray results or whether or
not they are suspected of having extra-pulmonary TB. The only contraindication for sputum
collection is hemoptysis; in which case, DSSM will requested after control of hemoptysis.
3. Pulmonary TB symptomatics shall be asked to undergo other diagnostic tests(X-ray and
Culture), if necessary, only after they have undergone DSSM for diagnosis with three
sputum specimens yielding negative results.Diagnosis based on x-ray shall be made by the
TB Diagnostic Committee (TBDC).
4.Sine DSSM is the primary diagnostic tool, no TB diagnosis shall be made based on the
results of X-ray examinations alone. Likewise, results of the skin test for TB infection (PPD
skin test) should not be used as bases for TB diagnosis in adults.
5. Passive case finding shall be implemented in all health stations. Concomitant active case
finding shall encouraged only in areas where a cure rate of 85 per cent or higher has been
achieved , or in areas where no sputum-smear positive case has been reported in the last
three months.
6. Only trained medical technologists or microscopists shall perform DSSM (smearing,
fixing and staining of sputum specimens, as well ass reading, recording, and reporting of
results). However, in fur flung areas, BHWs may be allowed to do smearing and fixing
specimens, as long as they have been trained and are supervised by their respective NTP
medical technologists/microscopists.

B. Treatment

1. Aside from clinical findings, treatment of all TB cases shall be based on a reliable
diagnostic technique, namely, DSSM.
2. Domiciliary treatment shall be the preferred mode of care.

C. Patients with the following conditions shall be recommended for hozpitalization:

1. Massive hemoptysis;
2. Pleural effusionobliterating more than one-half of a lung field;
3. Miliary TB
4. TB meningitis
5. TB Pneumonia
6. Those requiring surgical intervention or with complication

D. All patients undergoing treatment shall be supervised (Directly Observed Therapy). No

patient shall initiate treatment unless the patients the patients and DOTS facility staff have
agreed upon a case holding mechanism for treatment compliance.

E. The national and local government units shall ensure provision of drugs to all
smear-positive TB cases.
2 Formulations of Anti-TB drugs:

1. Fixed-dose combination (FDCs)- two or more first-line anti TB drugs are combined in one
tablet. There are 2-,3-, or 4-drug fixed-dose combination.
2. Single drug formulation (SDF)- Each drug is prepared individually.INH, Ethambutol and
pyrazinamide are in tablet form while Rifampicin is in capsule form.

Recommended Category of Treatment Regimen

Category Type of TB patient Treatment Regimen

Intensive Phase Continuation Phase
I  New smear-positive PTB,
 New smear-negative PTB
with extensive parenchymal
lesions on CXR as assessed 2HRZE 4HR
by the TBDC
 EPTB, and
 Severe concomitant HIV
disease
II  Treatment Failure 5HRE
 Relapse 2HRZES/1HRZE
 Return After Default
 Other
III  New smear-negative PTB 2HRZE 4HR
with minimal parenchymal
lesions on CXR as assessed
by the TBDC
IV Chronic (still smear-positive after Refer to specialized facility of DOTS Plus
supervised re-treatment) Center Refer to Provincial/City NTP
Coordinator

Dosage per category of Treatment Regimen

A. Fixed-Dose Formulation (FDC)

The number of tablets of FDCs per patient will dependon the body weight. Hence, all
patients must be weighed (using kilogram as a unit) before treatment is started.

TREATMENT REGIMEN FOR CATEGORIES I & III: 2HRZE/4HR (FDC)

No. of tablets per day No. of tablets per day

Body Weight (Kg) Intensive Phase Continuation Phase
(2 months) (4 months)
FDC-A (HRZE) FDC-b (HR)
30-37 2 2
38-54 3 3
55-70 4 4
>70 5 5
TREATMENT REGIMEN FOR CATEGORY II:2HRZES/HRZE/4HRE (FDC)
BODY INTENSIVE PHASE CONTINUATION PHASE
WEIGHT First two months Third
(kg) month FDC-B E
FDC-A Streptomycin FDC-A (HR) 400mg
(HRZE) (HRZE)
30-37 2 0.75 g 2 2 1
38-54 3 0.75 g 3 3 2
55-70 4 0.75 g 4 4 3
>70 5 0.75 g 5 5 3

B. Single Drug Formulation (SDF)

Simply add one tablet of INH (100mg),PZA (500mg), and E (400mg) each for the patient
weighing more than 50kg before treatment initiation. Modify drug dosage within acceptable
limits according to patient’s body weight, particularly those weighing less than 30 kg at the
time of diagnosis.

Treatment Regimen for Categories I&II: 2HRZE/4HR (SDF)

Anti-TB Drugs No. Of tablets per day No. Of tablets per day
Intensive Phase Continuation Phase
(2 months) (4 months)
Isoniazid (H) 1 1
Rifampicin ( R ) 1 1
Pyrazinamide (Z ) 2
Ethambutol ( E ) 2

Treatment Regimen for Category II: 2 HRZES/1HRZES/5HRE

No. Of tablets/vial per day No. Of tablets per day
Anti-TB Drugs Intensive Phase Continuation Phase
(3 months) (5 months)
First 2 months rd
3 month
Isoniazid (H) 1 1 1
Rifampicin ( R ) 1 1 1
Pyrazinamide (Z ) 2 2
Ethambutol ( E ) 2 2 2
Streptomycin (S) 1 vial/day
*56 vials for 2 months

Drug Dosage per Kg Body weight

Drug Dose per kg body weight and maximum dose
Isoniazid (H) 5 (4-6) mg/kg, and not to exceed 400mg daily
Rifampicin ( R ) 10(8-12) mg/kg, and not to exceed 600mg daily
Pyrazinamide (Z ) 25(20-30)mg/kg, and not to exceed 2 g daily
Ethambutol ( E ) 15 (15-20)mg/kg, and not to exceed 1.2g daily
Streptomycin (S) 15(12-18) mg/kg, and not to exceed 1 g daily

Directly Observed Therapy Short -course(DOTS) STRATEGY

Five elements:
1. Sustained political commitment
2. Access quality-assured sputum microscopy
3. Standardized short course chemotherapy for all cases of TB under proper case
management conditions, including direct observation of treatment.
4. Uninterrupted supply of quality-assured drugs
5. Recording and reporting system enabling outcomes assessment of all patients and
assessment of overall program performance.
Public Health Nursing Responsibilities (Adult TB)
1. Together with other NTP staff/workers, manage the procedure for case finding activities.
2. Assign and supervise treatment partner for patient who will undergo DOTS.
3. Supervise rural Health midwives (RHMs) to ensure proper implementation of DOTS.
4. Maintain and update the TB Register.
5. Facilitate requisition and distribution of drugs and other NTP supplies.
6. Provide continuous health education to all TB patients placed under treatment and
encourage family and community participation TB control.
7. In coordination with the Physician, conduct training of health workers.
8. Prepare, analyze and submit the quarterly reports to the Provincial Health Office or City
Health Office.

MANAGEMENT OF CHILDREN WITH TB

1. Prevention
In accordance with the policies and procedure of Expanded Program on Immunization,
BCG vaccination shall be given in all infants. The BCG vaccine is moderately effective. It
has a protective efficacy of 50% against any TB disease. 64% against TB meningitis and
71% against death from TB.

2. Casefinding
A. Cases of TB in Children are reported and identified in two instances
 The patient sought consultation, was screened and was found to have signs and
symptoms of TB.
 The patient was reported to have been exposed to an adult TB patient

B. All TB symptomatic children 0-9 years old, except sputum positive child shall be
subjected to Tuberculin Testing
 Only trained Public Health Nurse or the main health center midwife trained as alternate
shall do tuberculin testing and reading
 Tuberculin testing and reading shall be conducted once a week either on Monday or
Tuesday. Ten children shall be gathered for testing to avoid wastage.
C. Patient shall be suspected as having TB and will be considered as a TB symptomatic if
with any three of the following signs and symptoms:
 Cough/wheezing of two weeks or more
 Unexplained fever of two weeks or more
 Loss of appetite/Loss of weight/failure to gain weight/weight faltering
 Failure to respond to 2 weeks of appropriate antibiotic therapy for lower respiratory tract
infection
 Failure to regain previous state of health 2 weeks after a viral infection or exanthem
(e.g. measles)

D. A child shall be clinically diagnosed or confirmed of having a TB if he has any three of

the following conditions:
 Positive history of exposure to an adult/ adolescent TB case
 Presence of signs and symptoms suggestive of TB
 Positive Tuberculin Test
 Abnormal chest radiograph suggestive of TB
 Laboratory findings suggestive of indicative of TB (histological, cytological, biochemical,
immunological, and/or molecular), However, bacteriological demonstration of TB bacilli
in the smear/ culture makes a diagnosis of TB in children.
E. For children with exposure to TB
 A child who had an exposure to an Adult TB patient (who is registered in the TB register)
shall undergo physical examination and tuberculin testing.
 A child with productive cough shall be referred for sputum examination. If the sputum
smear of the child is found positive, treatment shall be started immediately. Tuberculin
testing shall no longer performed.
 Children without signs and symptoms of TB but with positive tuberculin test.and those
with symptoms but with negative tuberculin test shall be referred for chest x-ray
examination.
F. For children with signs and symptoms of TB
 A child with symptoms or with either known or unknown exposure to a TB case shall be
referred for Tuberculin test.(Those with unknown exposure, the suspected adult source
shall be advised to undergo work-up following the NTP guidelines for adult.
 Children with known contact but with negative tuberculin test and those with unknown
contact but with positive tuberculin test shall be referred for chest x-ray examination.
 For children with negative chest x-ray, Tuberculin test shall be repeated after three
months.
 Chemoprophylaxis of INH for three month shall be given to children less than five years
old with negative chest x-ray;after which, Tuberculin Test shall be repeated. However
chemoprophylaxis shall only be followed if adequate resources are available.

3. Caseholding and Treatment

A. Caseholding mechanism
 Directly observed of treatment will still be followed just like in adults.
 Treatment partners could either be the health worker, any member of the community
such as barangay health worker, or local government official.
 Family members could also be treatment partners.

B. Treatment

 Treatment Regimen

1. Pulmonary TB
Drugs Daily Dose (mg/kg/body Duration
weight)
Intensive Phase
Isoniazid 10-15 mg/kg body weight 2 months
Rifampicin 10-15 mg/kg body weight
Pyrazinamide 20-30 mg/kg body weight
Continuation Phase
Isoniazid 10-15 mg/kg body weight 4 months
Pyrazinamide 10-15 mg/kg body weight

2. Extra Pulmonary TB
3. Extra Pulmonary TB Daily Dose (mg/kg/body Duration
Drugs weight)
Intensive Phase
Isoniazid 10-15 mg/kg body weight 2 months
Rifampicin 10-15 mg/kg body weight
Pyrazinamide 20-30 mg/kg body weight

Plus
Ethambutol or 15-25 mg/kg body weight
Streptomycin 20-30 mg/kg body weight
Continuation Phase
Isoniazid 10-15 mg/kg body weight 10 months
Rifampicin 10-15 mg/kg body weight

 Domicilliary Treatment shall be preferred mode of care

 No patient shall be initiated to treatment unless the patient and health worker has
agreed upon a caseholding mechanism for treatment compliance.
 All diagnosed TB case shall be treated based on the following regimen and the dose
shall be adjusted to the weight of the child. While on treatment, the dose shall be
adjusted based on the follow-up examination weight of the child.

Public Health Nursing Responsibilities (Childhood TB)

1. Interview and Open treatment cards for identified tuberculous children
2. Perform tuberculin testing and reading to eligible children
3. Maintain NTP records (Treatment card, TB register for children and quarterly reports
4. Manage requisition and distribution of drugs
5. Assist the physician in supervising the other health workers of the RHU in the proper
implementation of the policies and guidelines on TB in children.
6. Assist in the training of other health workers on tuberculin testing and reading.

B.NATIONAL LEPROSY PROGRAM

LEPROSY
 It is an ancient disease and is a leading cause of permanent disability among the
communicable diseases.
 It is a chronic mildly communicable disease that mainly affects the skin, the peripheral
nerves, mucosa of the upper respiratory tract, and the eyes.
 Children especially twelve years and below are more susceptible.

Signs and Symptoms

A. Early Signs and symptoms

 Change in skin color-either reddish or white
 Loss of sensation on the skin lesion
 Decrease/Loss of sweating and hair growth over the lesion
 Thickened and or painful nerves
 Muscle weakness or paralysis of extremities
 Pain and redness of the eyes
 Nasal obstruction or bleeding
 Ulcers that do not heal

B. Late Signs and Symptoms

 Loss of eyebrow -madarosis
 Inability to close eyelids -lagophtalmos
 Clawing of fingers and toes
 Contractures
 Sinking of the nosebridge
 Enlargement of the breast in male or gynecomastia
 Chronic ulcers
Infectious Agents

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 of Leprosy is currently based on clinical signs and symptoms especially if

there is history of contact with person with Leprosy (PWL)
 Slit Skin Smear (SSS) examination is an optional procedure. It is done only when
clinical diagnosis is doubtful. The main objective is to prevent misclassification and
wrong treatment.

Prevention

 Avoidance of prolonged skin-to-skin contact especially with a lepromatous case

 Children should avoid close contact with active, untreated leprosy case
 BCG Vaccination
 Good Personal Hygiene
 Adequate nutrition
 Health Education

Management/Treatment

Ambulatory Chemotherapy through use of Multi-drug therapy

Domiciliary treatment as embodied in R.A. 4073 which advocates home treatment.

WHO classification of Leprosy which is the basis of modern management or Multi-Drug

therapy:

Paucibacillary (tuberculoid and indeterminate)

 Non-infectious types
 Duration of treatment 6-9 months

Multibacillary (lepromatous and borderline)

 Infectious types
 Duration Treatment

Multi-Drug Therapy (MDT) is the use of 2 or more drugs for the treatment of leprosy. It is
proven effective cure for leprosy and renders patients non-infectious a week after starting
treatment. Further MTD makes home treatment of leprosy patients possible.

For Paucibacillary (PB) Leprosy Cases

Drugs/Duration Adult Child (10-14 years)

Rifampicin 600 mg once a month 450 mg once a month
Dapsone 100 mg daily 50 mg daily
Duration of Treatment 6 blister packs to be taken 6 blister packs to be taken
monthly within a maximum monthly within a maximum
period of 9 months *1 period of 9 months *2
 Adjust dose appropriately for children less than 10 years. For example, Rifampicin
300mg and Dapsone 25mg.

 Patient with single skin lesion and a negative slit skin smear may be treated with the
single dose of the ROM regimen as follows:

Single Dose ROM Adult Child (10-14 years)

Rifampicin 600 mg 300 mg
Ofloxacin 400 mg 200 mg
Minocycline 100 mg 50 mg

For MB Leprosy Cases:

Drugs/Duration Adult Child (10-14 years old)

Rifampicin 600 mg once a month 450 mg once a month
Clofazimine 300 mg once a month and 50 mg 150 mg once a month and
daily 50 mg every other day
Dapsone 100 mg daily 50 mg daily
Duration of treatment 12 blister packs to be taken 12 blister packs to be taken
monthly within a maximum period monthly within a maximum
of 18 months *3 period of 18 months *3

 Adult dose appropriately for children less than 10 years. For example Rifampicin 300
mg Dapsone 25mg and Clofazimine 100 mg once a month and 50mg twice a week

 Should the patient fail to complete treatment within the prescribed duration, then said
patient should continue treatment until he/she has consumed 24 MB blister packs.

Completion of Treatment
All patients who have complied with the above mentioned treatment protocols are
considered cured and no longer regarded as a case of leprosy, even if some sequelae of
leprosy remain.

PUBLIC HEALTH NURSING RESPONSIBILITIES

 Prevention
 Health education of patients,families and the community on the nature of the disease,
symptomatology and its transmission.
 Advocate healthful living through proper nutrition, adequate rest, sleep and good
personal hygiene
 BCG Vaccination especially of infants and children.

 Casefinding
 Recognize early signs and symptoms of leprosy and refers suspects to the RHU
physicians or skin clinic for diagnosis and treatment.
 Takes patient and family history and fills up patients records
 Conducts epidemiological Investigation and report findings to MHO
 Assists physicians in physical examination of patients in clinic/home.
 Assesses health of family members and other household contacts. Performs/assists in
examination of contacts
 Integrates casefinding of leprosy cases in other activities such as MCH,EPI inspection,
examination of school children and other programs.
 Management and Treatment
 Rehabilitation
 Family Health
 Community Health
 Training,Supervision and Research

C. SCHISTOSOMIASIAS CONTROL PROGRAM

 Also known as Bilhariasis or snail fever.
 It is cause by a blood fluke, Schistosoma Japonicum that is transmitted by a tiny snail
oncomelania quadrasi.
 It affects mostly farmers and their families in the rural area.

Signs and Symptoms

 Diarrhea
 Bloody Stools
 Enlargement of the abdomen
 Spleenomegaly
 Weakness
 Anemia
 Inflamed liver

Infectious Agents:
 Schistosoma Mansoni,Schistosoma Haematobium,51:japonicum are the major species
causing human disease.
 Schistosoma japonicum is endemic in the Philippines
 The male and female parasites (s.japonicum) live in the blood vessels of the intestines
and liver. The eggs of the parasites are laid in the terminal capillary vessels in the
submucosa of the intestines and pass out with feces and upon contact with fresh water
hatches into larva(miracidium).The free swimming larva seeks and penetrates the soft
part of the intermediate host-a tiny snail called oncomelania quadrasi, multiplies and
within two months becomes the infective stage called cercaria.
 This fork-tailed larva emerges from the snail into the water and enters the skin of man
and other warm blooded animals as cows,dogs,carabaos,cats,rats,horse and goats
who comes contact with infected water.
 Through the lymphatic and then the veins, it eventually goes to the heart,systemic
circulation, and into the intrahepatic portal circulation where they mature, copulate and
start laying eggs in about one month’s time.

Modes of Transmission
 Infection occurs when skin comes in contact with contaminated fresh water in which
certain types of snails that carry schistosomes are living. It is the free-swimming larval
forms(cercariae) of the parasites penetrates the skin.
 Fresh water becomes contaminated by Schistosoma eggs when infected people
urinate or defecate in the water. The eggs hatch, and if certain types of snails are
present in the water, the parasites grow and develop inside the snails. The parasites
leaves the snail and enters the water where it can survive in 48 hrs.
Methods of Control

A. Preventive Measures
 Educate the public in endemic areas regarding the mode of transmission and methods
of protection
 Dispose of feces and urine so that viable eggs will not reach bodies of fresh water
containing intermediate snail host
 Improve irrigation and agriculture practices: reduce snail habitats by removing
vegetation or by draining and filling
 Treat snail-breeding sites with molluscicides.
 Prevent exposure to contaminated water (e.g use of rubber boots.)To minimize
cercarial penetration after brief or accidental water exposure, towel dry,vigorously and
completely, skin surfaces that are wet with suspected water. Apply 70% alcohol
immediately to the skin to kill surface cercariae.
 Provide water for drinking, bathing and washing clothes from sources free of cercariae
or treatment to kill them

B. Control of Patient, Contacts and the Immediate Environment

 Report to local health authority in selected endemic areas
 Concurrent Disinfection: Sanitary disposal of feces and urine

C. Investigation of contacts and sources of infection: Examine contacts for infection

from a common source. The search for a source is a community effort.

 Specific Treatment: Pranziquantel (Biltricide) is the drug of choice against all species.
Alternative drugs are Oxamniquine for S. mansoni and Metrifonate for haematobium.
 Epidemic Measures: Examine for Schistosomiasis and treat all who are infected, but
especially those with moderate to heavy intensities of egg passage; pay particular
attention to children.
 Motivate people in these areas to have annual stool examination.
 Public Health Nurse in endemic areas participates actively in the above preventive and
control measures.

D. FILARIASIS CONTROL PROGRAM

 It afflicts Filipinos living in endemic areas.
 The disease often progresses to become chronic, debilitating and disfiguring, since its
symptoms are often unnoticed and unfamiliar to health workers.

Infectious agents

 Human Lymphatic Filariasis is a chronic parasitic infection caused by nematode

parasites known as Wuchereria bancrofti, Brugia malayi and/or Brugia timori.
 The young and adult worms live in the lympathic vessel and lymph nodes while the
microfilariae are usually found in the blood.
 The lifespan of the adult parasites is about 10 years(but a 40-year life-span has been
reported) while the microfilariae live for about a year at the most.

Mode of Transmission
It is transmitted to a person through a bites from an infected female mosquito primarily
Aedes poecilius that bites at night.
Incubation Period

It starts from the entry of the infective larvae to the development of clinical manifestation is
variable. Nevertheless, it ranges from 8-16 months.

 Asymptomatic Stage
 Characterized by the presence of microfilariae in the peripheral blood
 No clinical signs ad symptoms of the disease
 Some remain asymptomatic for years and in some instances for life
 Others progress to acute and chronic stages
 Microfilariae rate increases with age and then levels off
 In the most endemic areas including the Philippines, men have higher micronlariae rate
than women.

 Acute Stage
Starts when there are already manifestation such as
 Lymphadenitis (inflammation of the lymph nodes)
 Lymphangitis (inflammation of the lymph vessel)
 In some cases, the male genetalia is affected leading to funiculitis( an inflammation of
the spermatic cord),epidydimitis(an inflammation of the small, coiled tube at the back
of the testicle) or orchitis (inflammation of one or both testicles) (redness, painful and
tender scrotum)
 Chronic Stage
Develop 10-15 years from the onset of the first attack
Immigrants from the areas with Filariasis is not endemic tend to develop this stage more
often and much sooner (1-2 years) than do the indigenous population of endemic areas.

 Chronic Signs and Symptoms

Hydrocoele (swelling of the scrotum)
Lymphedema (temporary swelling of the upper and lower extremities)
Elephantiasis (enlargement and thickening of the skin to lower and/or upper
extremities,scrotum, breast)

Diagnosis

 Physical Examination is done in the main health center or during scheduled survey
bites in the community.
 History taking
 Observation of the major and minor signs and symptoms

Laboratory Examination

 Nocturnal blood examination(NBE)- blood are taken from the patient at the patient’s
residence or in the hospital after 8:00 pm.
 Immunochromatographic Test (ICT)- It is a rapid assessment method. It is an antigen
test that can be done at daytime

Treatment

 Health workers must emphasize the importance of compliance to the prescribed

treatment regimen.
 Diethycarbamazine Citrate (DEC) or Hetrazan -kills all microfilaria and a good
proportion of adult worms. Drug is given with clinical manifestation and/or microfilariae.
 Side Effects and Contraindications of DEC (Hetrazan)
There are two types of side reactions, general and local, both with or without fever.
 The systematic reaction are manifestations due to host inflammatory responses to
parasites antigens liberated by the rapid death of the microfilariae while the localized
adverse reactions are induced by their death.

Mass Treatment
 Distribution of all population
 Endemic and infected or not infected with filariasis in established endemic areas
 The dosage is 6mg/kg body weight taken as a single dose per year

Surgical Treatment
 Chronic Manifestation such as elephantiasis and hydrocoele can be handled through
surgery. This is usually referred to hospitals for management.
 Mild cases of lymphedema can be treated by lymphovenous anastomosis distal to the
site of the lymphatic destruction.
 Chyluria is operated on by ligation and stripping of the lymphatics of the pedicle of the
affected kidney while hydrocoeles can be managed by inversion or resection of the
tunica vaginalis.

Supportive Care For Filariasis

Filariasis patients are advised to observe personal hygiene by washing the affected
areaswith soap and water at least twice a day or prescribed antibiotics or anti-fungals for
super infection

Prevention and Control

A. Measures aimed to control the vector
 Environmental sanitation such as proper drainage and cleanliness of surroundings
 Spraying with insecticides (may also produce harmful effects)

B. Measures aimed to protect the individual and families in endemic areas

 Use of mosquito nets
 Use of long sleeves, long pants and socks
 Application of insect repellants,Screening of houses
 Health Education

E. Malaria Control Program

Infectious Agents
It is produced by intraethrocytic parasites of the genus Plasmodium. Four plasmodia
produce malaria in humans: Plasmodium falciparum, P. Vivax, P. ovale, P. malariae. The
severity and characteristic manifestation of the disease are governed by the infecting
species, the magnitude of the parasitemia, the metabolic effects of the parasite, the
cytokines released as a result of the infection.

Signs and Symptoms

 Recurrent Chills
 Fever
 Profuse sweating
 Anemia
 Malaise
 Hepatomegaly
 Spleenomegaly
Life Cycle of Malaria Parasite
1. Sporozoites from the salivary gland of a female Anopheles mosquito are injected under
the skin.
2. Then they travel through the blood stream to the liver and mature within hepatocytes to
tissue schizonts.
3. Up to 30,000 parasites are then released into the blood stream as merozoites and
produce symptomatic infection as they invade and destroy the blood cells.
4. However, some parasites remain dormant in the liver as hypnozoites (these are the
parasites that cause relapsing malaria in P. Vivax or P. Ovale infection).
5. Once within the bloodstream, merozoites invade red cells and mature to the
ring( trophozoite and Schizont asexual stage)
6. Schizonts lyse invade their host red cells as they mature and release the next
generation of merozoites,which they invade previously uninfected red cells.
7. Within the red cells some parasites differentiate to sexual forms (male and female
gametocytes.)
8. When taken up by a female anopheles mosquito, the gametocytes mature to male and
female gametes, which produce zygotes.
9. The zygote invades the gut of the mosquito and develop into oocyst..
10. Mature oocyst produce sporozoites, which migrate to salivary gland of the mosquito
and repeat the cycle.
11. Infection by the injection of the contaminated blood bypasses this constraint and
permits transmission among intravenous drug addicts or to recipient blood transfusion.

Early Diagnosis and Prompt Treatment

 Clinical Method -is based on the signs and symptoms and history of his/her having
visited a malaria-endemic area.

 Microscopic Method- is based on the examination of the blood smear of the patient
through a microscope.

Chemoprophylaxis

Only Chloroquine drug should be given. It must taken at weekly intervals, starting from 1-2
weeks before entering the endemic area.
In pregnant women, it is given throughout the duration of pregnancy.

Sustainable Preventive and Vector control measures

Objective of this measure is to reduce the source of infection in the human population; man
-vector contact, and the density of the mosquito vector population.

A. Insecticide- Treatment of the mosquito net- this involves the soaking of insecticide
solution and allowed to dry.
B. House Spraying
C. On stream seeding- this involves the construction of bio-ponds for fish propagation
which shall be the responsibility of the LGUs and their corresponding communities.
D. On stream clearing- this is cutting of the vegetation overhanging along stream banks to
expose the breeding stream to sunlight, rendering it unsuitable for mosquito vector
habituation.
Recommended Anti-Malaria Drugs

 Bloos Schizonticides- drug acting on sexual blood stages of the parasites which are
responsible for clinical manifestation.

 Chloroquine Phosphate 250 mg (150mg base/tablet)

 Sulfadoxine (or Sulfalene) 50 mg-pyrimethamine 25mg/tablet
 Quinine sulfate 300mg tablet
 Quinine hydrochloride 300mg/ml, 2 ml ampule
 Tetracycline hydrochloride 250mg/capsule
 Quinidine sulfate 200mg/durules
 Quinidine glucolate 80mg (50mg base) ml, 1 ml vial

Other Preventive measures

 Wearing of clothing that covers arms and legs in the evening

 Avoiding outdoor night activities, particularly during the vector’s pick biting hours from
9Pm to 3 AM.
 Using mosquito repellents, such as mosquito coils, soap lotion or other personal
protection measures advocated by the DOH/MCS -Malaria Control Service
 Planting of Neem tree or other herbal plants which are (potential) mosquito repellents
 Zooprophylaxis- the typing of domestic animals like the carabao, cow etc. Near human
dwellings to deviate mosquito bites from man to these animals.

Prevention of the Epidemic

1. The following should be done in the event that an imminent epidemic occurs:
 Mass Blood Smear (MBS) collection
 Immediate confirmation and follow-up of cases
 Insecticide-treatment of mosquito nets
 Focal spraying
 Stream clearing
 Intensive IEC Campaign

2. All cases should be given drug treatment and followed-up until clinically and/or
microscopically found negative.
3. Continuous surveillance measures should be implemented for three years.
4. The LGU in collaboration with the NGO and the technical assistance from the Provincial
Malaria Coordinator should contribute in terms of IEC campaign and logistics support.

Public Health Nursing Responsibilities

1. Participates in the implementation of the following:

A. Treatment policies
B. Provision of drugs
C. Laboratory confirmatory diagnosis
D. Training of Barangay Health workers and volunteers on the diagnosis and treatment of
malaria
E. Supervision of malaria control activities of all health personnel in the area
F. Collection, analyis and submission of required reports

2. Recognition of early signs and symptoms for management and further referrals.

3. Educate the individual/families/community of the importance of the following:

A. Taking of chemoprophylaxis
B. Wearing of long sleeved clothing and trousers when going out at night.
C. Application of insect repellant to skin
D. Use of mosquito nets
E. Use of screen in doors and windows. If no screen, close the door and windows during
the night time.
F. Use of insecticide aerosols and pyrethroid mosquito coils
G. Clearing of hanging branches of trees along the stream.
4. Availability of anti-malarial drugs and chemoprophylaxis drugs

F.DENGUE HEMORRAGIC FEVER (H-FEVER)

 The severe form of Dengue Fever that can cause serious bleeding, a sudden drop in
blood pressure (shock) and death.

Signs and Symptoms

An acute febrile infection of sudden onset with clinical manifestation of 3 stages:

 First 4 days
 Febrile or invasive stage starts abruptly as high fever
 Abdominal pain
 Headache
 Later flushing accompanied by vomiting, conjunctival infection and epistaxis.

 4th-7th days (Toxic/hemorrhagic stage)

 Lowering temperature
 Severe abdominal pain
 Vomiting
 Frequent bleeding from gastrointestinal tract in the form of hematemesis or melena.
 Unstable BP,narrow pulse pressure and shock
 Death may occur
 Tourniquet test which may be positive on 3rd day may become negative due to low or
vasomotor collapse.

 7th-10th day (Convalescent or recovery stage)

 Generalized flushing with interventing areas of blanching appetite regained
 Blood pressure already stable

Classification

 Severe, frank type

 With flushing
 Sudden high fever
 Severe Hemorrhage
 Sudden drop of temperature
 Shock
 Terminating in recovery or death
 Death

 Moderate
 High Fever
 Less Hemorrhage
 No shock

 Mild
 Slight fever
 With or without petechial Hemorrhage

Etiologic Agent

 Dengue Virus Types 1,2,3, & 4

 Chikungunya virus

Source of Infection
 Immediate source is a vector mosquito, The Aedes Aegypti or the common household
mosquito
 The infected person

Mode of Transmission: Mosquito bite (Aedes Aegypti)

Incubation Period: Uncertain. Probably 6 days to one week

Period of Communicability: Unknown. Presumed to be on the first week of illness when

virus is still present in the blood.

Susceptibility,Resistance and Occurrence:

 All person are susceptible
 Age groups predominantly affected are the preschool and school age.
 Adults and infants are not exempted
 Peak age affected 5-9 years old

 Occurrence is sporadic throughout the year.

 Epidemic usually occur during rainy seasons June-November
 Peak months are September to October

 Acquired immunity may be temporary but usually permanent

Diagnostic test

Tourniquet Test (Rumpel Lead Test)

It is a physical examination technique that can identify and stratify dengue disease.
Infection with DENV may result in increased capillary permeability, a physiological state
that the TT exploits by applying sustained pressure to these small vessels.

1. Take patient’s BP and record it, for example 100/70

2. Inflate the cuff to a point midway between, SBP and DBP and maintain for 5 minutes
(100+70)/2=85 mmHg
3. Release the cuff and make an imaginary 2,5 cm square 0r 1 inch square just below the
cuff, at the antecubital fossa
4. Count the number of petechiae inside the box
5. A test is (+) when 20 or more petechiae per 2.5 cm or 1 inch square is observed.
Management

 For fever, give paracetamol for muscle pains. For headache give analgesic.DON’T
GIVE ASPIRIN
 Rapid replacement of body fluids is the most important treatment
 Includes intensive monitoring and follow-up.
 Give ORESOL to replace fluid as in moderate dehydration at 75ml/kg in 4-6 hrs or up to
2-3L in adults. Continue ORS intake until patient’s condition improves

Methods and Prevention and Control

The infected individual,contacts and environment:

 Recognition of the disease
 Isolation of the patient (screening or sleeping under the mosquito net)
 Epidemiological Investigation
 Case finding and reporting
 Health Education

Control Measures

1. Eliminate vectors by:

A. Changing water and scrubbing sides of lower vases once a week

B. Destroy breeding places of mosquito by cleaning surroundings
C. Proper disposal of rubber tires,empty bottle and cans
D. Keep water containers covered

2. Avoid too many hanging clothes inside the house

3. Residual spraying with insecticide

Public Health Nursing Responsibilities

1. Report immediately to the Municipal Health Office any known case outbreak
2. Refer immediately to the nearest hospital,cases the exhibit symptoms of hemorrhage
from any part of the body no matter how slight.
3. Conduct a strong health education program directed towards environmental sanitation
particularly destruction of all known breeding places of mosquitoes.
4. Assist in the diagnosis of suspect based on the sign and symptoms. For those without
signs of hemorrhage, the nurse may do the “tourniquet” test.
5. Conduct epidemiologic investigations as a means of contacting families,case finding
and individual as well as community health education.

Nursing Care

1. For Hemorrhage- keep the patient at rest during bleeding episodes.

 For nose bleeding, maintain an elevated position of trunk and promote vasoconstriction
in nasal mucosa membrane through an ice bag over the forehead
 For melena, icebag over the abdomen
 Avoid unnecessary movement
 Observe signs of deterioration (shock) such as low pulse,cold clammy
perspiration,prostration.

2. For shock-prevention is the best treatment. Dorsal recumbent position facilitates

circulation
Adequate preparation of the patient, mentally and physically prevents occurrence of
shocks.
Provision of warmth-through lightweight covers (overheating causes vasodilation which
aggravates bleeding).

3. Diet-low fat, low fiber, non-irritating, non-carbonated. Noodle soup should be given

G.RABIES CONTROL PROGRAM

 It is an acute viral encephalomyelitis(attack of inflammation in the brain and spinal cord

that damages myelin – the protective covering of nerve fibers) caused by the rabies
virus, a rhabdovirus of the genus lyssavirus.
 It is fatal once signs and symptoms appear.
 There are two kinds: Urban or Canine rabies is transmitted by dogs while Sylvatic
rabies is a disease of wild animals and bats which sometimes spread to dogs,cats and
livestock.

Mode of Transmission

 Usually by bites of a rabid animal whose saliva has the virus.

 The virus may also introduced into a scratch or in fresh breaks in the skin (very rare)
 Transmission from man to man is possible.
 Airborne spread in a cave with millions of bats have occurred(rare)

Incubation Period

 The usual incubation period is 2-8 weeks

 It can be as long as a year or several years depending on the severity of the wounds,
site of the wound as distance from the brain, amount of virus introduced and protection
provided by clothing

Period of Communicability
 In dogs and cats, for 3 to 10 days before onset of clinical signs (rarely over 3 days) and
throughout the duration of the disease.

Susceptibility and Resistance

 All warm blooded mammals are susceptible. Natural immunity in man is unknown.

Signs and Symptoms in Man

 Sense of apprehension
 Headache
 Fever
 Sensory change near site of animal bite
 Spasm of muscles or deglutition on attempts to swallow (fear of water/hydrophobia)
 Paralysis
 Delirium and convulsions
 Without medical intervention, the rabies victim would usually last only for 2-6 days.
Death is often due to respiratory paralysis.

Management and Prevention

 The wound must be immediately and thoroughly washed with soap and water.
Antiseptic;s such as povidone iodine or alcohol may be applied.
 The patients may be given antibiotics and anti-tetanus immunization.
 Post-exposure treatment is given to persons who are exposed to rabies. It consist of
local wound treatment, active immunization (vaccination) and passive immunization
(administration of rabies immunoglobulin)
 Active immunization or vaccination aims to induce the body to develop antibodies
against rabies up to 3 years.
 Passive immunization- the process of giving an antibody to persons (with head and
neck bites, multiple single deep bites, contamination of mucous membranes or thin
coverings of the eyes,lips and mouth.) in order to provide immediate protection against
rabies which should be administered within the first seven days of active immunization.
The effect of the immunoglobulin is only short term.
 Then consult a veterinarian or trained personnel to observed your pet for 14 days for
signs of rabies.
 Be a responsible pet owner
 Have pet immunized at 3 months of age and every year then after
 Never allow pet to roam the streets
 Take care of your pet,bathe, feed them regularly with adequate food, provide them with
clean sleeping quarters.
 Your pet’s action is your responsibility
 Consult for rabies diagnosis and surveillance of the area
 Mobilize for community prevention

National Rabies Prevention and Control Program

VISION

To declare Philippines Rabies-Free by year 2022

MISSION

To eliminate human rabies by the year 2020

OBJECTIVES

To eliminate rabies as a public health problem with absences of indigenous cases for
human and animal

The following organizations/agencies take part in attaining the goal of the National Rabies
Prevention and Control Program:

 Department of Agriculture (DA)

 Department of Education (DepEd)
 Department of Interior and Local Government (DILG)
 Department of Environment and Natural Resources (DENR)
 World Health Organization (WHO)
 Animal Welfare Coalition (AWC)
STREATEGIES

A. Manpower Development
B. Social Mobilization

 Organizational Meeting
 Networking with other sectors

C. Local Program Implementation

 Establishment/Reactivation of Local Rabies Control Committees

 Enactment/Enforcement of Ordinance on Dog Control Measures

D. Dog Immunization

 Pre-Vaccination Activities

 Identification of priority areas

 Procurement/Distribution of dog vaccines
 Social Preparation

 Conduct of dog vaccination

 Post-Immunization Evaluation

H. Sexually Transmitted Infections and AIDS Control Program

 Sexually Transmitted Infection(STI) and their complications belong to the Top five
disease categories for which adults seek health care in developing countries, according
to WHO.
 This are the major global cause of acute illness, infertility and long term disability and
death, with severe medical and psychological consequences for millions of men,
women and children.
 Unlike HIV, many STI’s can be treated and cured relatively easily and cheaply if
diagnosed early enough.

A. GONORRHEA (GC,Clap, Drip)

Causative Agent
Bacteria: Neisseria gonorrhea. Typically passed by direct contact between the infectious
mucous membranes, e.g genitals,anus and mouth of one person with the mucous
membrane of another. Contaminated fingers can pass the organism from infected mucous
membranes to the eye.

Incubation Period: Usually 2-10 days, possibly 3 days or more

Signs and Symptoms

 Genitals (penis or cervix),anus, throat and eyes can be infected.
 Males: Burning urination and pus discharges from infection of urethra (5-10% have no
symptoms)
 Females: may have vaginal discharge although up to 80% have no symptoms for
cervical infection of rectum
 Often no symptoms or mild sore throat for gonorrhea of the throat
 Infection of eyes is rare in adults.

Diagnosis
Gram Staining
Culture of cervical & urethral smear

Treatment:
Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant
Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that
uncomplicated gonorrhea be treated with the antibiotic ceftriaxone — given as an injection
— with oral azithromycin (Zithromax).- AS PRESCRIBED

Complications
 Pelvic inflammatory Disease (PID)
 Sterility in both sexes
 Arthritis
 Blindness
 Meningitis
 Heart damage
 Kidney damage
 Skin rash
 Ectopic pregnancy and eye damage in new born

B. SYPHILIS (Sy, Bad blood, the pox)

Causative Agent: Treponema pallidum, passed by direct contact with infectious sore.

Incubation: 10 days to 3 months, with average of 21 days

Signs and Symptoms

Primary stage: painless chancre (sore) at the site of entry of germs, swollen glands

Secondary Stage:
 Symptoms usually appear 1 week to 6 months after the appearance of chancre and
may include rash, patchy hair loss,sore throat and swollen glands.
 Primary and secondary sore will go away even without treatment but the germs
continue to spread throughout the body.
 Latent syphilis may continue 5-20 years with no symptoms, but the person is no longer
infectious to other people.
 A pregnant women can transit the disease to her unborn child (congenital syphilis)

Late syphilis: varies from no symptoms to indication of damage to body organs such as
the brain and heart and liver.

Diagnosis

 Dark field illumination test- This technique is mainly used to highlight surface defects,
scratches or engraving. Dark field illumination usually uses a low angle ring light
that is mounted very close to the object.
 Treponemal tests- also called confirmatory tests, detect antibodies specific to
syphilis. Treponemal antibodies will appear earlier after acute infection than
non-treponemal antibodies. The antibodies detected in these tests usually remain
detectable for life even after successful treatment.
Treatment
A single injection of long-acting Benzathine penicillin G can cure the early stages of syphilis.
This includes primary, secondary, or early latent syphilis.-AS PRESCRIBED

Complications

 Severe damage to nervous system and other body organs possible after many years
 Heart disease
 Insanity
 Brain damage
 Severe illness or death of newborns

C. CHYLAMYDIA (Chylamydia trachomatis)

Causative Agent
Chylamydia trachomatis. Passed during sexual contact. Infants can become infected during
vaginal delivery. Highly contagious.

Incubation: 2-3 weeks for males;usually no symptoms in females

Signs and Symptoms

Females:
 Slight vaginal discharge (sometimes)
 Itching and burning of vagina
 Painful intercourse
 Abdominal pain
 Fever in later stage

Males:
 Discharge from penis
 Burning and itching of urethral opening
 Burning sensation during urination

Diagnosis

 A urine test. A sample of your urine is analyzed in the laboratory for presence of this
infection.
 A swab. For women, your doctor takes a swab of the discharge from your cervix for
culture or antigen testing for chlamydia. This can be done during a routine Pap test.
For men, your doctor inserts a slim swab into the end of your penis to get a sample
from the urethra.

Treatment
You may be started on antibiotics once test results have confirmed you have chlamydia..

The two most commonly prescribed antibiotics for chlamydia are:

 doxycycline
 azithromycin
Complications

 Sterility
 Pre-maturity and stillbirths
 Infant Pneumonia
 Eye infection in infants which can lead to blindness

D. Gardianella Vaginitis (Nonspecific Vaginitis)

Causative agent

Gardnerella vaginalis is an anaerobic bacterium that is the causative agent in bacterial

vaginosis (BV). This bacteria normally is part of the vaginal flora and any overgrowth can
cause BV which is the most common cause of vaginal discharge.

Signs and Symptoms

 Rare in males
 Female symptoms may include a slight grayish or yellow odorous vaginal discharge
and mild itching or burning sensation.

Diagnosis

 Microscopic slide
 Chemical analysis of vaginal material
 Culture test from infection site

Treatment

 Consists of a five- to seven-day regimen of antibiotics, prescribed either vaginally or orally.

Metronidazole (Flagyl) and clindamycin (Cleocin) are two common options.

Complication

 Prematurity
 Other abnormal Pregnancy outcomes

E. TRICHOMONIASIS (Trich)

Causative agent

 Protozoan-Trichomonas Vaginalis
 Usually passed by direct sexual contact
 Can be transmitted through contact with wet objects, such as towels, wash clothes and
douching equipment

Incubation: 4-20 days, with average being 7 days

Signs and Symptoms

About 70% of people with the infection do not have any signs or symptoms.
Men with trich may notice:

Itching or irritation inside the penis;


 Burning after peeing or ejaculating; and
 Discharge from the penis.
Women with trich may notice:

 Itching, burning, redness or soreness of the genitals;

 Discomfort when peeing; and
 A clear, white, yellowish, or greenish vaginal discharge (i.e., thin discharge or
increased volume) with a fishy smell.

Diagnosis

 Microscopic Slide of discharge

 Culture Test
 Examination

Treatment
Trichomoniasis is usually treated quickly and easily with antibiotics.Most people are
prescribed an antibiotic called metronidazole, which is very effective if taken correctly

Complications:

 Long-term effects in adults not known

 There is some evidence that infected individuals are more likely to develop cervical cancer

F. HEPATITIS B

 Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B

virus (HBV). It is a major global health problem.
 It can cause chronic infection and puts people at high risk of death from cirrhosis and
liver cancer.

Signs and Symptoms

 Loss of Appetite
 Easy fatigability
 Malaise
 Joint and muscle pain (similar to influenza)
 Low grade fever
 Nausea and vomiting
 Right-sided abdominal pain
 Jaundice (yellowish discoloration of the skin and sclera)
 Dark-colored urine

Mode of Transmission

A. From person to person through:

 Contact with infected blood through broken skin and mucous membrane of the mouth,
the rectum and the genitals.
 Sexual contact via vaginal and seminal secretion
 Sharing of personal items with infected person which may cause skin break (razor,nail
clipper,toothbrush etc.)

B. Parental Transmission through:

 Blood and Blood Product-by transfusion of blood from carries to non carries
 Use contaminated instruments for injection, ear piecing,acupuncture and tattooing.
 Use of contaminated hospital and laboratory equipment such as dialysis apparatus and
others

C. Perinatal Transmission
 This can occur during labor and delivery through leaks across the placenta and
exposure of the infant to maternal secretion in the birth canal.

High Risk Groups to Hepatitis B infection

 Persons born in places where hepatitis B infection is common (especially China,

Southeast Asia, the Pacific Islands, sub-Saharan Africa, and the Amazon basin in
South America).
 Children of parents born in those places.
 Injecting drug users
 Hemodialysis patients
 Health care and public safety workers who may have contact with blood
 People having sex with an HBV-infected partner
 Men who have sex with men
 Those living in the same household with an HBV-infected person
 Travelers to places where hepatitis B infection is common who will have extended,
close contact with the local population.

Preventive Measures

The best way to prevent hepatitis B is with vaccination/ Immunization especially among
infants and high groups with negative HBsAg result.

 Do not inject drugs. If you do inject drugs, stop and get into a treatment program. If
you can’t stop, never share needles, syringes, water, or “works”
 Do not share personal care items that might have blood on them (razors,
toothbrushes)
 If you are a health care or public safety worker, follow universal blood/body fluid
precautions and safely handle needles and other sharps
 Consider the risks if you are thinking about tattooing, body piercing, or acupuncture
– are the instruments properly sterilized?
 If you’re having sex with more than one steady partner, use latex condoms correctly
and every time to prevent the spread of sexually transmitted diseases, including
viral hepatitis and HIV.

 HBsAg (Hepatitis B surface antigen) - A "positive" or "reactive" HBsAg test result

means that the person is infected with hepatitis B. This test can detect the actual
presence of the hepatitis B virus (called the “surface antigen”) in your blood.
Management and treatment

There are also approved drugs for both adults and children that control the hepatitis B virus,
which helps reduce the risk of developing more serious liver disease, but there is still no
complete cure.

Current treatments for hepatitis B fall into two general categories:

 Immune modulator Drugs – These are interferon-type drugs that boost the
immune system to help get rid of the hepatitis B virus. They are given as a shot (similar
to how insulin is given to people with diabetes) over 6 months to 1 year.
 Antiviral Drugs – These are drugs that stop or slow down the hepatitis B virus from
reproducing, which reduces the inflammation and damage of your liver. These are taken
as a pill once a day for at least 1 year and usually longer.

AIDS CONTROL PROGRAM

 Human Immunodeficiency Virus (HIV) Infection /Acquired Immune Deficiency

Syndrome (AIDS)
 Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening
condition caused by the human immunodeficiency virus (HIV). By damaging your
immune system, HIV interferes with your body's ability to fight infection and disease.
 HIV targets and infects the same immune system cells that protect us from germs and
illnesses. These cells are a type of white blood cell called CD4 cells (which are a type of
T cells).

Causative Agent
Retrovirus-Human T-cell lymphotropic virus 3 (HTLV-3)

Mode of Transmission
 Sexual contact
 Blood Transfusion
 Contaminated syringes, needles,nipper, razor blades
 Direct contact of open wounds/mucous membrane with contaminated blood, body
fluids, semen and vaginal discharge.

Incubation Period
Variable. Although the time from infection to the development of detectable antibodies is
generally 1-3 months, the time from HIV infection to diagnosis of AIDS has an observed
range of less than 1 year to 15 years longer.

Signs and Symptoms

A. Physical
 Maculo-popular rashes
 Loss of appetite
 Weight Loss
 Fever of unknown origin
 Malaise Persistent diarrhea
 Tuberculosis (localized and disseminated)
 Esophageal candidiasis
 Kaposi’s Sarcoma (Skin Cancer)
 Pnemocystis carinii pneumonia
 Gaunt-looking, apprehensive
B. Mental
 Early Stage
 Forgetfulness
 Loss of Concentration
 Loss of libido
 Apathy
 Psychomotor-retardation
 Withdrawal

 Later Stage
 Confusion
 Disorientation
 Seizure
 Mutism
 Loss of Memory
 Coma

Diagnosis
 Enzyme-linked immunosorbent assay (ELISA) is an immunological assay commonly
used to measure antibodies, antigens, proteins and glycoproteins in biological
samples.Presumptive test
 Nucleic Acid Test (NAT)
 looks for the actual virus in the blood.
 This test can tell if a person has HIV or how much virus is present in the blood (HIV
viral load test).

Prevention
 Maintain monogamous relationship
 Avoid promiscuous sexual contact
 Sterilize needles, syringes and instruments used for cutting operations
 Proper screening of blood donors
 Rigid examination of blood and other products for transfusion
 Avoid oral,anal contact and swallowing of semen
 Use condoms and proper protective device

HIV/AIDS Prevention and Control Program

Objective:

Reduce the transmission of HIV and STI among the Most At Risk Population and General
Population and mitigate its impact at the individual, family, and community level.

Program Activities:

With regard to the prevention and fight against stigma and discrimination, the following are
the strategies and interventions:

1. Availability of free voluntary HIV Counseling and Testing Service;

2. 100% Condom Use Program (CUP) especially for entertainment establishments;

3. Peer education and outreach;

4. Multi-sectoral coordination through Philippine National AIDS Council (PNAC);

5. Empowerment of communities;

6. Community assemblies and for a to reduce stigma;

7. Augmentation of resources of social Hygiene Clinics; and

8. Procured male condoms distributed as education materials during outreach.

Responsibilities and Function of the community health Nurse in HIV/AIDS

Prevention/Control

 Prevention
 Casefinding
 Supportive-care during management of AIDS cases

The following precautions are given for health workers dealing with AIDS patients:

 Extreme care must be taken to avoid accidental wounds from sharp instrument
contaminated with potentially infectious material from AIDS patients.
 Avoid contact of open skin lesions with material from AIDS patient.
 Gloves should be worn when handling blood specimens,blood soiled items, body
fluids,excretion and secretions as well as all surface materials and objects exposed to
them.
 Gowns should be worn when clothing may be soiled with body fluids, blood secretions
or excretions.
 Hands should be washed thoroughly and immediately if they become contaminated
with blood and after removing gowns and gloves and before leaving the rooms of
suspected or known AIDS patients.
 Blood and other specimens should be labeled prominently with a special warning, such
as “AIDS Precautions”
 Blood spills should be cleaned up promptly with a disinfectant solution such as sodium
hydrochloride(household bleach).
 Article soiled with blood should be placed in an improvised bags labeled in bold letters.
“AIDS Precautions” being reprocess.
 Instruments with lenses should be sterilized after use on AIDS patients.
 Needles should not be bent after use, but should be promptly placed in a
puncture-resistant container used solely for such disposal. Needles should not be
re-inserted into their original sheaths before being discarded into the container since
this is common cause of needle injury. Disposable needles and syringes are preferred.
 Patients with active AIDS should be isolated
 Masks are not routinely necessary but are recommended only for direct, sustained
contact with patients who are coughing profusely.
 Care of thermometer-wash with warm soapy water. Soak in 70% alcohol for 10
minutes,dry and store. The thermometer should be reserved for patient use only
 Personal articles-toothbrushes,razor and razor blades should not be shared with other
family members. Used razor blade may be discarded in the same manner as
disposable needles and syringes.
 OTHER COMMUNICABLE DISEASES

1. MEASLES
2. CHICKEN POX (VARICELLA)
3. MUMPS(EPIDEMIC PAROTITIS)
4. DIPHTHERIA
5. WOOPING COUGH (PERTUSSIS)
6. TETANUS NEONATORUM AND TETANUS AMONG OLDER AGE GROUPS
7. INFLUENZA
8. PNEUMONIAS
9. CHOLERA (El Tor)
10. THYPHOID FEVER
11. BACILLARY DYSENTARY (SHIGELLOSIS)
12. SOIL TRANSMITTED HELMINTHIASES
13. PARAGONIMIASIS
14. HEPATITIS A
15. PARALYTIC SHELFISH POISONING(PSP I RED TIDE POISONING)
16. LEPTOSPIROSIS (WELLS DISEASE, MUD FEVER,TRENCH FEVER, FLOOD
FEVER, SPIROKETAL JAUNDICE, JAPANESE SEVEN DAYS FEVER)
17. SCABIES
18. ANTHRAX
19. MENINGOCOCCEMIA
20. BIRD FLU OR AVIAN INFLUENZA
21. SARS-SEVERE ACUTE RESPIRATORY SYNDROME