Introduction to

Communicable disease control

Wallaga University
School of Nursing & Midwifery
Department of Compressive Nursing

By: Lami A(BSc, MSc )

E-mail:
[email protected]
om
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 Introduction to
communicable disease
control

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 Objectives
At the end of the course the learner will be able to
 Manage a patient with communicable disease with out
contaminating other patients, by using the
environment, and transmitting disease to others
according to health procedure
 Describe the factors involved in the transmission of
communicable disease
 Apply methods of prevention in nursing measures for
the common communicable diseases
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Disease
 Genetic
 Biological
 Physical
 Chemical

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Brain storming

What does communicable disease means?

How communicable diseases are transmitted?
How we control these diseases?

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 Communicable diseases: -These are illnesses due to
specific infectious agent or its toxic products which arise
through transmission of that agent or its toxic products
from an infected person, animal, or inanimate reservoir
to a susceptible host, either directly or indirectly,
through an intermediate plant or animal host, vector or
inanimate environment.

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 Classification of Infectious Disease
 By duration
 Acute – develops and runs its course quickly.
 Chronic – develops more slowly and is usually less severe, but may
persist for a long, indefinite period of time.
 Latent – characterized by periods of no symptoms between
outbreaks of illness.
 By location
 Local – confined to a specific area of the body.
 Systemic – a generalized illness that infects most of the body with
pathogens distributed widely in tissues.
 By timing
 Primary – initial infection in a previously healthy person.
 Secondary – infection that occurs in a person weakened by a
primary infection.
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Communicable diseases
Communicable diseases can be conveniently divided based
on the mode of transmission or the causative agent
A. Based on mode of transmission
1. Airborne diseases
-Need droplet nuclei or dust for transmission
E.g. Tuberculosis
2. Vehicle borne disease
- Need non-living substance or object for transmission
E.g. Cholera
3. Vector Borne disease
-Need vectors for transmission
E.g. Malaria
4. Other sexually transmitted Diseases, contact diseases,
etc
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Communicable diseases…….

B. Based an the Biologic agent/Etiology, causative

organism or infectious agent:

Agent capable of causing infection or infectious disease.

1. Bacterial diseases e.g. syphilis, gonorrhea, etc

2. Protozoal diseases e.g. Malaria

3. Viral diseases e.g. HIV/AIDS

4. Helminthes diseases e.g. Ascariasis

5. Fungal diseases e.g. candidiasis

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Communicable diseases…….
C. Classification of infectious agent by size and sort

1. Metazoa (multicellular organisms e.g. helminthes)

 The largest, like tape worms or the filariae, are visible to the naked
eye.
 They are made up of many cells and are called metazoan.

2. Protozoa (unicellular organisms e.g. amoeba)

 Complicated but single-cell organisms, like malaria parasite and
amoeba are called protozoa.
 They are smaller and can only be seen when magnified by a

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microscope. Lami A ( Bsc, MSc)
 Communicable diseases……

3. Bacteria (e.g. T.pallidum, M.tuberculosis)

 They are smaller than protozoa simple, single cells best
seen under a microscope after they have been stained
with dyes.

4. Rickettsiae and Chlamydiae are smaller and can

only multiply with in cells

5. Viruses: -Smallest of all which can’t even be seen with

an ordinary microscope

6. Fungus e.g. C.albicans

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 Definition of important terms

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 Reservoir
 Any person, animal, arthropod, plant, soil or
substance (or a combination of these)
 In which an infectious agent normally lives and
multiplies, on which it depends primarily for
survival and where it reproduces it self in such a
manner that it can be transmitted to a susceptible
host.

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 Types of reservoirs

1. Man
 There are a number of important pathogens that
are especially adapted to man
E.g measles, small pox, typhoid, M. meningitis,
gonorrhea and syphilis.
 The cycle transmission is from man to man

2. Animals
 Some infective agents that affect man have their
reservoir in animal.
Zoonosis: -disease transmission from animals to
man under normal conditions.

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 Types of reservoirs……

Examples
 Bovine TBc - cow to man
 Brucellosis – cow, pigs and goats to man
 Anthrax – cattle, sheep, goats, horses to man
 Rabies – dogs, foxes etc to man

N.B. Man is not an essential part (usual reservoir)

of the life cycle of the agent.

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 Types of reservoirs……

3. Non-living things as a reservoir

 Many of the agents are basically saprophytes living in soil
and fully adapted to live freely in nature.
 Biologically, they are usually equipped to with stand
marked environmental changes in temperature and
humidity.

Examples
 C. botulinum etiology of botulism,
 C. tetani etiology of tetanus,
 C. welchi etiology of gas gangrene.
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Mode of transmission (mechanism of transmission)

This refers to the mechanism by which an infectious

agent is transferred from a reservoir to a new host.

 Portal of exit (mode of escape from the

reservoir)- The site through which the agent escapes
from the reservoir

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 Portal of entry
 The site in which the infectious agent enters to
the susceptible host.

Examples
 Mucus membrane- syphilis, HIV
 Respiratory tract- PTBc, pertusis
 GIT- Giardiasis

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 Period of communicability ……

 Some diseases are more communicable during the

incubation period than during the actual illness

e.g. hepatitis A, measles

 In diseases such as TBc, leprosy, syphilis, gonorrhea and
some of the salmonelloses, the communicable state may
exist over a long and sometimes intermittent period
when active chronic lesions permit the discharge of
infectious agent from the source of the skin or through
any of the body orifices.

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Period of communicability or communicable
period

 The period during which an infectious agent is

transmitted from the infected person to the susceptible
host.
 It can be from
Man to man
Man to animals
Animals to man

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 Period of communicability ……

 In diseases transmitted by arthropods, such as

malaria and yellow fever, the period of
communicability (or more properly infectivity)
is that during which the infectious agent occurs
in the blood or other tissues of the infected
person in sufficient number to permit infection
of the vector.

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 Susceptible host

 A person or animal not possessing sufficient resistance

against a particular pathogenic agent to prevent contracting
infection if or disease when exposed.
 Occurrence of infection and its out come are in part
determined by host factors.

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 Susceptible host…..

Resistance to infection is determined by non specific

and specific factors.

A) Non specific factors

Skin and mucus membrane, mucus, tears, gastric
secretion, reflexes (coughing, sneezing)
B) Specific factors
 Genetic- hemoglobin resistant to plasmodium
falciparum.
 Naturally acquired or artificially induced immunity.
 Acquired immunity may be active or passive.

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 Susceptible host……
1) Active immunity is immunity acquired following
 actual infection or
 immunization.

2) Passive immunity is when preformed antibodies

given to the host.
Incubation period
 The time interval between infection of the host
and the first appearance of symptoms and signs
of the disease.

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 Prodromal period
 The time interval between the onset of symptoms
of an infectious disease and the appearance of
characteristic manifestations.

E.g. In measles from the onset of fever and

coryza to the development of characteristic
signs like koplick spots and characteristic
skin lesions.
 Prelatent period
 The period in people between the time of exposure to a
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parasite and the time when the parasite can be detected in
 Incubation period in a vector

 Is the time between entrance of an organism in to

the vector and the time when that vector can
transmit the infection (extrinsic incubation
period).

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 Other terminologies
 Endemic: -A disease that is usually present in a
population or in an area at a more or less stable
level.
 Epidemics: -The occurrence of any health related
condition in a given population in excess of the
usual frequency in that population.
 Pandemic: -An epidemic disease which occurs
world wide (world wide epidemics).

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 Other terminologies….
 Sporadic: -A disease that does not occur in that
population, except at occasional and irregular intervals.
 Infection: -The entry and development or multiplication
of an infectious agent in the body of man or animal.
 Illness: -Individual or subjective feeling of discomfort.
 Disease: -A state of physiological and psychological
dysfunction.

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 Other terminologies….
Contamination:
 Presence of living infectious agent on a body surface, in
cloths, bedding, toys, surgical instruments or dressings
or other articles or substances including water and food.
 Contamination of a body surface does not imply a
carrier state.

Infestation:
 For persons or animals, the lodgment, development and
reproduction of arthropods on the surface of the body or
in the clothing.
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 Chain of disease transmission
 Refers to a logical sequence of factors or links of a chain that
are essential to the development of the infectious agent and
progression of disease.
 It has six components
 The agent
 Its reservoirs
 Its portal of exits
 Its mode of transmission
 Its portal of entry, and
 The human host
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 The agent

 They range from viral particles to complex multicellular

organisms
 Pathogenic mechanisms
 Infections agents may bring about pathologic effect
through different mechanisms
 There mechanisms include
Direct tissue invasion
Production of a toxin
Allergic reaction
Immune suppression
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 Reservoirs
 They include organisms or habitat in which an infectious
agent normally lives, transforms, develops &/ or multiplies.
 Thus, they include
 Human beings,
 Vertebrate animals,
 Invertebrates (arthropods, mollusks), &
 Environmental sources like plants, soil, water, etc
 For some diseases humans are the only reservoirs

Examples STDs, Measle, Pertussis

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 Reservoirs……

 Diseases with environmental reservoirs include

Cholera (water)
 Tetanus
 Ascariasis (soil).
 Diseases with invertebrate reservoirs
include
Malaria,
Plague,
Schistosomiasis, etc
 Diseases with both vertebrate animals & human beings as
reservoirs
include
Taeniasis,
Yellow fever etc.

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 Portal of exit

 It is the way through which the infections agent

leaves its reservoir
 Possible portal of exit include all body
secretions & discharges:
 Mucus, saliva, tears, breast milk, vaginal
discharges, excretions (faces & urine),
blood, etc

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 Mode of Transmission

It includes the various mechanisms by which

agents are conveyed to a susceptible host

Transmission maybe direct or indirect

1. Direct transmission

Direct contact
 Refer to the contact of skin, mucosa, or
conjunctiva from another person or vertebrate
animal, through:
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 Mode of ………
Touching:

Examples
 Eye- hand -eye e.g. Trachoma

 Nose-hand-nose e.g. Common cold

 Mouth hand mouth e.g. Mononucleosis

 Faces-hand- mouth e.g. shigellosis
 Skin- skin e.g. Ring worm
 Kissing e.g. mononucleosis
 Sexual intercourse e.g. syphilis
 Biting e.g. rabies
 Passage through birth canal (e.g. gonococcal ophthalmia neonatarum)

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 Mode of………..

Direct projection of saliva droplet

 Created by expiration activities such as coughing,
sneeze, spitting, talking, singing, etc.
 Saliva droplets are emitted, these, if large can
reach another host directly at distances of up to
one meter.

E.g. Common cold

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 Mode of ……………………….

Trans placental transmission

- It is transmission of diseases from mother to

her fetus through the placenta.

E.g. TORCHS (Toxoplasmosis, Rubella,

Cytomegalovirus infection, Herpes simplex
infection, syphilis, others including HIV/AIDS)

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Mode of………..

2. Indirect transmission

Airborne
 Dissemination of the infections agent by air to a suitable
portal of entry usually the respiratory tract.
 Two types of particles can result in airborne transmission

a) Dust: - are small infectious particles of widely varying size

& and that may arise from, soil, clothes, bedding pr
contaminated floors and be suspended by air currents.

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Mode of………..

b) Droplet nuclei:
 Are small residues resulting from evaporation of
fluid (droplets) emitted by an infected host.
 They usually remain suspended in the air for long
periods of time.

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 Mode of………..

Vehicle borne
 A vehicle is defined as any non- living substance or object
by which an infectious agent can be transported and
introduced in to a host.

Examples: food, water, milk, fomites, towels, clothes, etc

Vector borne
 A vector is an organism (usually an arthropod such as an
insect, tick, or louse), which transports an infectious agent
to a susceptible host or to a susceptible vehicle.

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 Mode of………..

There are two types of vectors

Biological vectors:
 In such type of vectors, there is a period of
multiplication and/ or development of the agent
in the vector is required before transmission to
the host can occur.
 This period is called the extrinsic incubation
period.

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Mode of………..
 Biological vectors based on the mechanism of
inoculation of the agent in to the host are
classified as;

 Salvarian transmission: - In which case

infective saliva is injected in to the host.
E.g. Female anopheles mosquito-
Malaria
 Stercorarian transmission: -In which case
infective fecal or regurgitated material will be
deposited near the bite wound, then the agent
enters the host through autoinoculation.
E.g. Body louse - Relapsing fever
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 Mode of………..

Mechanical vectors:
 In this case, there are no periods of development
and multiplication of the agent but are responsible
for transporting the agent to human host.

NB: A disease often has several modes of

transmission. It is very importance to distinguish
between the predominant mode (s) of transmission
and those which are of little importance

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Portal of entry
 Needed to gain access to the host
 The type of disease often a direct consequence of
its route of entry into the host
 Common portal of entry
 Respiratory via inhalation
 Alimentary via ingestion
 Urogenital via sexual contact
 Skin via direct contact
 Through broken skin- naturally or artificially

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Susceptible host
 The susceptible human host is the final link in the
infectious process.
 Host susceptibility or resistance can be seen at
the individual and at the community level.
 Host resistance at the community (population)
level is called herd immunity

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 Herd immunity can be defined as the resistance
of a population to the introduction and spread of
an infectious agent, based on the immunity of a
high proportion of individual members of the
population, thereby lessening the likelihood of a
person with a disease coming into contact with
susceptible.

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 Carrier
It is an infected person or animal who does not
have apparent clinical disease but is a potential
source of a disease

Types of carriers

A. Healthy or asymptomatic carriers:

 These are persons whose infection remains
unapparent through out its course.
 In polio virus, meningococus and hepatitis virus
infections, there is a high carrier rate.
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 Carrier …….
B. Incubatory or precocious carriers:
 These are individuals or persons who excrete the
pathogens during the incubation period (before
the onset of symptoms or before the
characteristic features of the disease are
manifested)

E.g. Measles, mumps, chicken pox and hepatitis

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 Carrier ……

C. Convalescent carriers:
 These are those who continue to harbor the
infective agent after recovering from the illness.

E.g. Diphtheria, Hepatitis B virus

D. Chronic carriers:
 The carrier state persists for a long period of time.

E.g. Typhoid fever, HB virus infection

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 Time course of an infectious disease

Prelatent period:
 The time interval between infection and the point
at which the infection can first be detected in
laboratory.

i.e. Between biological onset and the time of first

shading of the agent

Incubation period:
 Is the time interval between infection and first
clinical manifestation of the disease
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i.e. Between biological onset and clinical onset
 Time course of………

Communicable period:
 It is the period during which an infected host can
transmit the infection to others

Latent period:
 The time period between recovery and the
occurrence of relapse or recrudescence in clinical
disease

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 Time course of………
Transmission cycle
 Is a cycle which describes how an organism
grows, multiplies and spreads.
 In some cases man may be the only host in which
case the infection spreads directly from man to
man.
Example:measles.
 In some cases like malaria the transmission cycle
involves man and mosquito.
Exposure:
 The contact between the agent and susceptible
host.

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 Time course of………
Infectivity:
 The ability of an agent to invade and multiply in a
host.
Pathogencity:
 The ability of an agent to produce clinically
apparent disease, or the property of an infectious
agent that determines the extent to which overt
diagnosis is produced.
Virulence:
 The ability of infectious agent to produce severe
disease among clinically infected persons.

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 Time course of………
Immunogenicity:
 The ability of an agent to produce specific
immunity.
Symptoms of a disease:
 Refers to malfunctions in which the patient
himself claims to feel. (E.g. fever, headache)
Signs of a disease:
 Manifestations of a disease that can be examined
by a physician.

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 Time course of………
Transmission:
 The travel or spread of an infectious agent from
its source to a susceptible host.

Source of infection:
 A person, animal or inanimate environment from
which the particular organism spreads to its new
host.

Viability:
 Ability of an organism hard enough potentially to
live.
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Survival or longevity:
 Time course of………
Infected individual:
 A person or animal that harbors an infectious
agent and who has either manifest disease or
unapparent infection.
An infectious person or animal
 Is one from which an infectious agent can be
naturally acquired.

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 Time course of………

An infectious disease:
 A clinically manifest disease of humans or animals
results from an infection.

Unapparent infection:
 The presence of infection in a host with out
recognizable clinical signs and symptoms.
 It can be identified only by laboratory means
(blood).
 Asymptomatic, sub clinical and occult infection are
synonymous.
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 Time course of………
Host:
 A person or other living animal, including birds
and arthropods, that affords substance or
lodgment to an infectious agent under natural
conditions.
Some protozoa and helminthes pass successive
stages in alternate hosts of different species.
Hosts in which the parasite attains maturity or
passes its sexual stage are primary or definitive
hosts; those in which the parasite is in a larval
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secondary
A ( Bsc, MSc) or intermediate
 Time course of………
Contacts:
 A person or animal that has been in such
association with an infected person or animal or a
contaminated environment as to have had an
opportunity to acquire the infection.

Nosocomial infection:
 An infection occurring in a patient in a hospital or
other health care facility in whom it was not
present or including at the time of admission; or
the residual of an infection acquired during a
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previous admission.
 Time course of………

Pathogen
 Is an infectious agent that can cause clinically apparent
infection.
Infectious agent
 Is an agent that is capable of causing infection or infectious
disease.
Pattern of communicable disease:
 Different diseases are common in different places and at
different times. Why?
To understand this, we need to consider the agent, the
host and the environment.
The agents need a suitable environment in which to
grow and multiply and thus be able to spread and infect
another host.
 If they are not successful in doing this they die out.

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 Time course of………

HOST

AGENT ENVIRONMENT

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 The host, agent, environment triad
 Hosts are affected by their environment.
E.g. they may live in a hot and wet climate in
which there are many mosquitoes.
 But people can also change this environment by
draining swamps.
 Similarly the environment can affect the agent.
E.g. the altitude and temperature for malaria.
 When the balance between these three is
constant, there will be a fairly steady number of
people getting sick all the time.
 When this happens, a disease is said to be
endemic.

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 The host, agent, environment triad……………………..
 When the balance is shifted in favor of the
organism, for example when many non-immune
children have been born in an area since the last
measles epidemic, a large number of cases of
measles occur in a short time.
 This is called an epidemic.

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 Personal hygiene
Personal hygiene:
 Protective measures, primarily with in the responsibility of the
individual, that promote health and limit the spread of
infectious disease, chiefly those transmitted by direct contact.
 Such measures encompass:
 Washing hand in soap and water immediately after
evacuating bowel or bladder and always before handling
food or eating.
 Keeping hands and unclean articles, or articles that have
been used for toilet purposes by others, away from the
mouth, nose, eyes, genitalia and wounds.

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 Personal hygiene……

 Avoiding the use of common or unclean eating utensils,

drinking cups, towels, hand kerchiefs, combs, hair brushes

and pipes.
 Avoid exposure of other persons to spray from the nose

and mouth as in coughing, sneezing, laughing or talking.

 Washing hands thoroughly after handling a patient or the

patient’s belongings.
 Keeping the body clean by frequent soap and water baths.

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Healthy Environment … HEPP

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 GENERAL METHODS OF PREVENTION
AND CONTROL OF COMMUNICABLE
DISEASES

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GENERAL METHOD

Disease prevention:
 Inhibiting the development of a disease before it occurs or
if it occurs interrupting or slowing down the progression of
diseases.

Disease control:
 Involves all the measures designed to reduce or prevent the
incidence, prevalence and consequence of a disease to a
level where it can not be a major public health problem.

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GENERAL METHODS OF ……

Levels of disease prevention:

 The different points in the progression of a disease
at which one can intervene to prevent further out
come.

There are three levels of prevention.

1. Primary prevention: The objectives here are to

promote health, prevent exposure, and prevent
disease.

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GENERAL METHODS OF ……

Health promotion:
 Any intervention that promotes a healthier and happier life.
 This consists of general non-specific interventions that
enhance health and the body's ability to resist diseases such
as
 Improvement of socio economic status through provision
of adequately paid jobs;
 Education and vocational training;
 Affordable and adequate housing, clothing and food;
 Old age pension benefits;
 Emotional and social support, relief of stress etc.
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GENERAL METHODS OF ……

Prevention of exposure:
 Any intervention which prevents the coming in contact between
an infectious agent and a susceptible host.
 This includes actions such as
 Provision of safe and adequate water;
 Proper excreta disposal;
 Vector control;
 Safe environment at home(proper storage of insecticides and
medicines), at school and at work(proper ventilation,
monitoring of harmful substances in factories), on the streets
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GENERAL METHODS OF ……

Prevention of disease after exposure:

 This occurs during the latency period between
exposure and the biological onset of the disease.
Example: immunization.
N.B.
 Immunization against an infectious organism does
not prevent it from invading the immunized host
but prevents it from establishing an infection.

 Breast feeding is an example of intervention that

acts at all three levels of primary Prevention.

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GENERAL METHODS OF ……

Examples

Health promotion:
 By providing optimal nutrition for a young child, either as
the sole diet up to six months of age, or as a supplement in
later age.

Prevention of exposure:
 By reducing exposure of the child to contaminated milk.

Prevention of disease after exposure:

 By the provision of ant-infective factors, including
antibodies, WBCs and others
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GENERAL METHODS OF ……

2. Secondary prevention:
 After the biological on set of the disease, but before permanent damage
sets in, we speak of secondary prevention.
 The objective here is to stop or slow the progression of disease so as to
prevent or limit permanent damage,

through the early detection and treatment of diseases.

Examples
 Breast cancer (prevention of invasive stage of the disease)
 Trachoma (prevention of blindness)
 Syphilis (prevention of tertiary or congenital syphilis)
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GENERAL METHODS OF ……

3. Tertiary prevention:
 After permanent damage sets in, the objective of
tertiary prevention is to limit the impact of that
damage.
 The impact can be physical (physical disability),
psychological, social(social stigma),and financial.
Rehabilitation
 Refers to the retraining of remaining functions for
maximum effectiveness, and should be seen in a
very broad sense, not simply limited to the physical
aspect.
 Thus the provision of special disability pension
would be a form of tertiary prevention.
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Principles of communicable disease control

The actions may be through:

 Attacking the source
 Interrupting the mode of transmission and
 Protecting the host ( susceptibility)

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Principles of communicable…….

1. Attacking the source

 Domestic animals as reservoirs
 Immunization e.g. Brucellosis
Destruction of infected animals

Example: Rabies
 Wild animals as reservoirs
 Post exposure prophylaxis

Example: Rabies

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Principles of communicable…….

Humans as reservoirs
 Isolation of infected persons & separation of
infected persons from others for the period of
communicability

Not suitable when,

 Large proportion are apparently infected, or
 In which maximal infectivity precedes over
illness.
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Principles of communicable…….

 Treatment
 Of cases (clinical) and carriers
 Mass treatment – where large proportion are
known to have a disease it is sometimes
advisable to treat everybody, without checking
whether individuals have disease or not.

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Principles of communicable…….

Quarantine
 The limitation of freedom of movement of apparently healthy
persons or animals who have been exposed to a case or infections
disease.

Examples:
 Cholera,
 Plaque, and
 Yellow fever are the 3 internationally quarantinable
diseases by international agreement.
 These diseases are very infections, so cases shouldn’t be referred
but seniors must be requested to visit the health center.

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Principles of communicable…….

2. Interrupting transmission

Transmission by ingestion
 Purification of water
 Pasteurization of milk
 Inspection procedures designed to ensure safe
food supply
 Improve housing conditions

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Principles of communicable…….

Transmission by inhalation
 Chemical disinfections of air
 Use of UV-light
 Improving ventilation

Transmission by vector or intermediate hosts

 Vector – control measures
 Environmental manipulation

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Principles of communicable…….

3. Measures that reduce host susceptibility

Immunization
 Active immunization – when either the altered organism or
its products is given to a person to induce production of
antibodies
Example: BCG
 Passive immunization – provision of ready – made
antibodies
Example: TAT
Chemoprophylaxis: antibiotics for known contacts to a case

Example: Ciprofloxacin for contacts to a case of M. meningitis

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Principles of communicable…….

Better nutrition
 Malnourished children get infections more easily &
suffer more severe complications
N.B: Effective control of disease is most likely
when a combination of methods:
Attacking the source,
 Interrupting transmission, and
Protecting the host is used at the same

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