Communicable Diseases and National Health Programs – Unit 9 | B.Sc Nursing 5th Semester
- 1. Unit - 9 Communicable Diseases and National Health Programs Community Health Nursing 5th Semester B.Sc. Nursing By: Rakesh S Sajjan
- 2. Malari a Definition Malaria is a protozoal disease caused by the Plasmodium species and is transmitted to humans through the bite of an infected female Anopheles mosquito. It is a major public health problem in India, especially in rural and tribal areas.
- 3. Causative Agents There are five types of Plasmodium parasites that cause malaria in humans: • Plasmodium vivax (most common in India) • Plasmodium falciparum (causes severe malaria) • Plasmodium malariae • Plasmodium ovale • Plasmodium knowlesi (rare)
- 4. Epidemiology 1. Agent Factors a. Agent: Plasmodium species b. Reservoir: Humans c. Vector: Female Anopheles mosquito 2. Host Factors a. Affects all age groups b. Poor immunity increases risk c. Children, pregnant women, and immunocompromised people are most vulnerable 3. Environmental Factors a. Stagnant water (breeding site for mosquitoes) b. Humid and warm climate c. Poor housing, slum areas, and lack of mosquito protection
- 5. Mode of Transmission • Vector-borne: Bite of an infected female Anopheles mosquito • Rare: Blood transfusion, organ transplantation, shared needles
- 6. Incubation Period •Usually 9 to 14 days •P. vivax: 12–17 days •P. falciparum: 9–14 days
- 7. Signs and Symptoms • Fever with chills and rigors • Sweating after fever • Headache, vomiting • Muscle pain • Enlarged spleen and liver • In P. falciparum cases: confusion, convulsions, and even coma (cerebral malaria)
- 8. Diagnosi s • Peripheral blood smear (Gold standard) • Rapid Diagnostic Test (RDT) kits • CBC may show anemia • In some cases: Antigen/Antibody tests
- 9. Treatment ❗ Primaquine is contraindicated in pregnancy and G6PD deficiency. Drug Used for Chloroquine P. vivax (if sensitive) ACT (Artemisinin-based combo) P. falciparum Primaquine To kill liver-stage parasites
- 10. Preventio n and Control • Vector Control • Use of insecticide-treated bed nets • Indoor Residual Spraying (IRS) with insecticides • Elimination of mosquito breeding sites (stagnant water) • Personal Protection • Wearing full-sleeved clothes • Using mosquito repellents and coils • Environmental Measures • Proper drainage and waste disposal • Community education on eliminating stagnant water • National Program Support • National Vector Borne Disease Control Program (NVBDCP) runs targeted interventions like: • Early detection • Active surveillance • Mass awareness
- 11. Role of the Nurse Activity Explanation Surveillance House-to-house fever surveys, blood smear collection Health education Teach about mosquito control, personal protection Screening & referral Identify symptoms, use RDTs, refer severe cases Follow-up Monitor treatment compliance and recovery Participation in National Programs Support NVBDCP and ensure coverage of IRS, ITNs, awareness
- 12. Filaria (Lymphat ic Filariasis) Definition Filaria, or lymphatic filariasis, is a chronic parasitic disease caused by filarial worms. It is transmitted through the bite of infected Culex mosquitoes and affects the lymphatic system, leading to swelling of limbs and genitals (elephantiasis).
- 13. Causative Agent The disease is caused by the following filarial nematodes: • Wuchereria bancrofti (most common in India) • Brugia malayi • Brugia timori
- 14. Epidemiolo gy Agent Factors Parasite: Filarial worms Reservoir: Humans Vector: Culex mosquito, mainly Culex quinquefasciatus Host Factors People living in overcrowded, unsanitary areas Low immunity, poor hygiene Long-term exposure to mosquito bites Environmental Factors Stagnant dirty water Poor drainage systems Tropical and subtropical climate
- 15. Mode of Transmission • Bite of infected Culex mosquito, which carries microfilariae • The mosquito becomes infective after 10–14 days and spreads larvae when it bites again
- 16. Incubation Period • Varies from 6 months to several years • Symptoms may take years to appear
- 17. Signs and Sympto ms Acute phase: Fever with chills Swelling and pain in lymph nodes (groin, armpits) Localized inflammation Chronic phase: Elephantiasis: Thickening and swelling of limbs or genitals Hydrocele (fluid collection in scrotum) Lymphatic obstruction
- 18. Diagnosis • Night blood smear to detect microfilariae (sample collected between 10 pm – 2 am) • Antigen detection test (ICT Card test) for rapid diagnosis • Ultrasound may detect adult worms (Filarial dance sign)
- 19. Treatment Medication Purpose Diethylcarbamazine (DEC) Kills both adult and larval forms Albendazole Given with DEC in mass drug administration (MDA) Antibiotics For secondary bacterial infections Surgery Sometimes needed for hydrocele or lymphatic damage
- 20. Prevention and Control Vector Control Eliminate mosquito breeding sources (drain stagnant water) Insecticide sprays in drains and breeding sites Personal Protection Mosquito nets, repellents Covering body during peak mosquito hours Mass Drug Administration (MDA) Annually, DEC + Albendazole to entire eligible population Goal: Interruption of transmission Morbidity Management Limb washing, elevation, proper footwear Prevent secondary infections
- 21. Role of the Nurse Activity Description Health education On mosquito control, limb care, and importance of MDA Drug distribution during MDA Ensure correct dose of DEC + Albendazole is given Early detection & referral Spot symptoms and refer for night blood smear testing Supportive care Teaching limb washing, elevation, and prevention of infection Record keeping Maintain MDA records and follow- up charts
- 22. Kala-Azar (Visceral Leishmaniasis) Definition • Kala-azar, also known as Visceral Leishmaniasis, is a chronic parasitic disease caused by Leishmania donovani and is transmitted by the bite of infected female sandflies. • It primarily affects the liver, spleen, and bone marrow, causing prolonged fever, anemia, and weight loss.
- 23. Causati ve Agent • Parasite: Leishmania donovani • Vector: Female Phlebotomus argentipes (sandfly) • Reservoir: Humans (India), dogs and rodents in other countries
- 24. Epidemiolog y Agent Factors • Intracellular protozoa (Leishmania) • Survive and multiply in macrophages of the host Host Factors • Poor immunity • Malnourished individuals • Common in rural, low-income, and endemic areas (e.g., Bihar, Jharkhand, UP, West Bengal) Environmental Factors • Mud houses, dark and damp areas ideal for sandfly breeding • Poor waste disposal • Tropical climate
- 25. Mode of Transmissio n •Bite of an infected female sandfly •Sandflies bite mostly at night, in dark corners of poorly ventilated homes
- 26. Incubati on Period • Usually 2 to 8 months • May vary based on immunity and parasite load
- 27. Signs and Symptoms Early Symptoms Late Symptoms Irregular fever (often twice daily) Paleness and anemia Weakness and fatigue Massive enlargement of spleen and liver Weight loss Darkening of skin (hence the name Kala-azar) Loss of appetite Swollen lymph nodes in some cases
- 28. Diagnosis • rK39 Rapid Diagnostic Test (RDT): Simple test using finger-prick blood • Splenic/Bone marrow aspiration: For confirmation in hospitals • CBC: Shows anemia, leukopenia, and thrombocytopenia
- 29. Treatment Drug Comments Miltefosine Oral drug – 28 days (first-line in India) Amphotericin B IV – used in resistant cases Paromomycin Injectable alternative Sodium stibogluconate (SSG) Used in some settings
- 30. Preventio n and Control VECTOR CONTROL Indoor residual spraying (IRS) with insecticides Use of insecticide-treated bed nets (ITNs) ENVIRONMENTAL CONTROL Fill cracks in walls Improve ventilation and sanitation EARLY DETECTION AND COMPLETE TREATMENT Community awareness and screening of fever cases lasting >2 weeks Free diagnosis and treatment under National Kala- azar Elimination Programme
- 31. Role of the Nurse Activity Details Health education Promote IRS, mosquito nets, and awareness of fever symptoms Active case finding Identify suspected cases (long fever, splenomegaly) and refer Assist in diagnosis Support in RDT screening and documentation Administer medication Ensure completion of treatment and manage side effects Promote environmental cleanliness Educate families on preventing sandfly breeding
- 32. Japanese Encephalitis (JE) Definition • Japanese Encephalitis (JE) is a viral brain infection caused by the Japanese Encephalitis virus (JEV). • It is a mosquito-borne disease, primarily affecting children and young adults, and can lead to inflammation of the brain, coma, or even death.
- 33. Causative Agent • Virus: Japanese Encephalitis Virus (JEV) • Family: Flaviviridae • Vector: Culex mosquito (Culex tritaeniorhynchus)
- 34. Epidemiolog y Agent Factors • JE virus is zoonotic – cycles between mosquitoes, pigs, and water birds • Humans are accidental dead-end hosts Host Factors • Children <15 years are at highest risk • More common in agricultural and rural areas • Immunocompromised individuals are more vulnerable Environmental Factors • Rice fields and pig farms promote mosquito breeding • Outbreaks occur during monsoon and post-monsoon
- 35. Mode of Transmission • Bite of infected Culex mosquitoes • Mosquitoes get infected by feeding on infected pigs or birds • Not transmitted person-to-person • Incubation Period • 5 to 15 days
- 36. Signs and Symptoms Mild (asymptomatic in many cases): • Fever • Headache • Weakness Severe (neuroinvasive stage): • High fever with vomiting • Neck stiffness • Disorientation, convulsions • Paralysis • Coma • Permanent brain damage or death in 20–30% cases
- 37. Diagnosis •Clinical history + endemic area exposure •IgM ELISA test in blood or cerebrospinal fluid (CSF) •Neuroimaging (CT/MRI) to rule out other causes
- 38. Treatment •No specific antiviral treatment available •Supportive care is the mainstay: •Fluids, oxygen, seizure control •Nursing care for unconscious patients •ICU care in severe cases
- 39. Prevention and Control Vaccination o JE Vaccine (Live SA 14-14-2) under Universal Immunization Programme (UIP) o 1st dose: 9–12 months o 2nd dose: 16–24 months o Catch-up campaigns in endemic areas (up to 15 years) Vector Control o Eliminate mosquito breeding in rice fields and water bodies o Use of mosquito nets, repellents, fogging Animal Control o Separate pig farms from human living areas Public Awareness o Educate parents to seek care for children with prolonged fever or seizures
- 40. Role of the Nurse Activity Details Health education Promote JE vaccination, mosquito protection Surveillance Identify children with signs of encephalitis Immunization support Assist in JE vaccine campaigns under UIP Supportive care Monitor vital signs, provide seizure management, nutrition Referral Refer severe or suspected cases to higher centers
- 41. Dengue Fever Definition • Dengue is an acute viral infection caused by the Dengue virus and transmitted by the bite of Aedes mosquitoes, especially Aedes aegypti. • It causes high fever, severe body pain, rash, and in some cases, bleeding and shock (Dengue Hemorrhagic Fever or Dengue Shock Syndrome).
- 42. Causative Agent • Virus: Dengue virus (DENV) • Types: Four serotypes — DENV-1, DENV-2, DENV-3, DENV-4 • Family: Flaviviridae • Vector: Aedes aegypti mosquito (active during daytime)
- 43. Epidemiolo gy Agent Factors • Virus can cause reinfection with a different serotype severe → dengue • Incubates in mosquitoes for 8–10 days Host Factors • Affects all age groups • Severe cases more common in children and previously infected individuals Environmental Factors • Urban slums, stagnant water in containers, coolers, flower pots • Peak during monsoon and post- monsoon seasons
- 44. Mode of Transmission • Bite of an infected Aedes mosquito • Mosquito becomes infective after feeding on an infected person • No human-to-human direct transmission • Incubation Period • 4 to 10 days after mosquito bite
- 45. Signs and Symptoms Classical Dengue Fever • Sudden high-grade fever • Severe muscle and joint pain (“breakbone fever”) • Headache and retro- orbital pain (pain behind eyes) • Skin rash • Nausea and vomiting Dengue Hemorrhagic Fever (DHF) • Bleeding gums/nose, blood in stool/urine • Low platelet count (thrombocytopenia) • Leaking blood vessels fluid → accumulation Dengue Shock Syndrome(DSS) • Sudden drop in BP • Cold clammy skin • Weak pulse • Can be fatal without urgentcare
- 46. Diagnosis • NS1 Antigen test (early detection – Day 1–5) • IgM ELISA (after 5 days) • CBC: Low WBCs, low platelets, increased hematocrit
- 47. Treatment • No specific antiviral treatment • Management is supportive: • Paracetamol for fever (❌ No aspirin/NSAIDs) • IV fluids for dehydration • Monitoring of platelet count and hematocrit • Blood transfusion if bleeding is severe
- 48. Prevention and Control Mosquito Control • Remove standing water from surroundings (weekly dry day) • Use of insecticides and larvicides in water containers • Biological control – larva-eating fish (Gambusia) Personal Protection • Mosquito repellents, full-sleeve clothes, bed nets • Aedes bites during the day, especially early morning and late afternoon Community Education • School and community campaigns during outbreaks • Display posters on “Do’s and Don’ts” for Dengue
- 49. Role of the Nurse Activity Details Health education On vector control, fever symptoms, and warning signs Fever surveillance Identify and report fever cases promptly Monitoring Check temperature, BP, fluid intake/output, platelet count Emergency care Prepare for IV therapy, manage bleeding/shock Referral Transfer to higher center if bleeding or shock develops
- 50. Chikungun ya Definition Chikungunya is a viral disease caused by the Chikungunya virus (CHIKV) and is transmitted by Aedes mosquitoes. It is characterized by sudden high fever, severe joint pain, headache, fatigue, and rash. Though rarely fatal, it can cause long-lasting joint pain and disability.
- 51. Causative Agent •Virus: Chikungunya virus (CHIKV) •Family: Togaviridae •Vector: Aedes aegypti and Aedes albopictus (same mosquitoes that spread dengue)
- 52. Epidemiology Agent Factors • Virus can be transmitted through mosquito bites after a 2–10 day incubation in the mosquito Host Factors • All age groups affected • Elderly and people with arthritis may experience prolonged symptoms Environmental Factors • Stagnant water in urban areas, construction sites, water containers • Peak incidence: Monsoon and post-monsoon season
- 53. Mode of Transmission • Bite of an infected Aedes mosquito • No person-to-person transmission • Rare vertical (mother to child) and blood transfusion-related cases reported • Incubation Period • Usually 3 to 7 days
- 54. Signs and Symptoms Joint pain is symmetric and affects multiple joints. Early Phase Later Phase High-grade fever Persistent joint pain/swelling (arthritis- like) Severe joint and muscle pain Rash on trunk and limbs Headache, nausea Fatigue and weakness Redness in eyes May last weeks to months in severe cases
- 55. Diagnosi s •IgM ELISA: Detects Chikungunya antibodies •RT-PCR: Confirms viral RNA in early stage •CBC may show low WBCs, normal platelet count
- 56. Treatment • No specific antiviral treatment • Symptomatic management: • Paracetamol for fever • Rest, fluids • Anti-inflammatory drugs (after ruling out dengue) • Physiotherapy for long-term joint pain
- 57. Prevention and Control Mosquito Control • Eliminate breeding sites (dry day once a week) • Cover water containers, clean coolers, avoid stagnant water • Fogging in affected areas Personal Protection • Use of mosquito nets, repellents, full-body clothing • Aedes mosquitoes bite during day time, especially early morning and late afternoon Community Awareness • Encourage people to seek care early • Avoid self-medication with NSAIDs during outbreaks (confusion with dengue)
- 58. Role of the Nurse Activity Details Health education Teach vector control, symptom recognition, and prevention Surveillance Identify and report suspected cases Supportive care Administer fever medications, maintain hydration, joint care Rehabilitation Assist in physiotherapy and mobility support for chronic cases Referral Refer severe or prolonged cases to higher centers
- 59. Leprosy (Hansen’s Disease) Definition Leprosy is a chronic infectious disease caused by Mycobacterium leprae, primarily affecting the skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes. It may result in nerve damage, deformities, and disability if left untreated.
- 60. Causative Agent • Bacteria: Mycobacterium leprae • It is an acid-fast bacillus (slow- growing) • Has a strong affinity for nerves and skin
- 61. Epidemiology Agent Factors • Heat-sensitive and slow-multiplying organism • Multiplies within Schwann cells and skin tissues Host Factors • Affects all ages, more common in men • Risk higher in: • Overcrowded living • Poor nutrition • Close contact with untreated cases Environmental Factors • Poor hygiene and sanitation • Rural and tribal areas, especially in Bihar, UP, Odisha, Chhattisgarh
- 62. Mode of Transmission •Mainly through prolonged close contact •Spread by nasal droplets and respiratory secretions •Not highly contagious; requires long-term exposure
- 63. Incubation Period Very long: 2 to 5 years, may range up to 20 years
- 64. Signs and Symptom s Other signs: • Nosebleeds or nasal stuffiness • Eye damage leading to blindness (in untreated cases) Skin Symptom s Nerve Symptoms Light-colored or red patches with loss of sensation Numbness in hands/feet Nodules, plaques, thickened skin Tingling, burning, muscle weakness Loss of eyebrows/eyel ashes Claw hand, foot drop, facial palsy
- 65. Diagnosis • Clinical examination: Skin patches with sensory loss • Skin smear test: Detection of acid-fast bacilli • Lepromin test: For immune response classification (not diagnostic)
- 66. Treatment Multidrug Therapy (MDT) – Free under NLEP (National Leprosy Eradication Program) ❗ Treatment is completely curative if completed properly. Type Drugs Duratio n Paucibacillar y (PB) Rifampicin + Dapsone 6 months Multibacillar y (MB) Rifampicin + Dapsone + Clofazimine 12 months
- 67. Preventio n and Control Early Detection and MDT • Breaks the chain of transmission • Prevents deformity and disability Contact Tracing • Examine family/close contacts annually for 5 years Community Awareness • Fight stigma and promote early reporting • Promote self-care for those with disability Prevention of Deformity • Regular wound care • Physiotherapy • Protective footwear for numb
- 68. Role of the Nurse Activity Details Health education Reduce stigma, promote treatment, and self- care Surveillance Active case finding in community and contact tracing Treatment supervision Ensure adherence to MDT and manage side effects Referral Refer for reconstructive surgery or specialist care if needed Rehabilitation support Guide in use of assistive devices and exercises
- 69. Tuberculosis (TB) Definition • Tuberculosis (TB) is a chronic bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs (pulmonary TB), but it can also affect other organs (extrapulmonary TB). • It spreads through the air via droplets when an infected person coughs, sneezes, or talks.
- 70. Causative Agent • Bacteria: Mycobacterium tuberculosis • Acid-fast bacillus (AFB) • Other species: M. bovis, M. africanum, etc.
- 71. Epidemiolo gy Agent Factors • Highly infectious and airborne • Can survive in air for hours (droplet nuclei) Host Factors • Risk increases in: • Malnourished individuals • People with HIV/AIDS • Smokers, alcoholics • People living in overcrowded conditions Environmental Factors • Poor ventilation, overcrowding • Urban slums, prisons, refugee camps
- 72. Mode of Transmission • Airborne route: Inhalation of infected droplets • No transmission via objects, water, or food • Prolonged, close contact increases risk
- 73. Incubati on Period • 2 to 12 weeks for initial infection • Symptoms may develop months or years later (latent TB)
- 74. Signs and Sympto ms Pulmonary TB (most common) o Persistent cough >2 weeks o Blood in sputum o Chest pain o Weight loss, night sweats o Low-grade fever Extrapulmonary TB o Lymph node TB o TB meningitis o Spinal TB (Pott’s disease) o TB of bones, joints, abdomen, or genitals
- 75. Diagnosi s Test Purpose Sputum AFB smear microscopy Detects TB bacteria (2 samples – spot & morning) CB-NAAT / GeneXpert test Confirms TB and checks rifampicin resistance Chest X-ray Shows lung lesions Tuberculin skin test (Mantoux) For latent TB screening
- 76. Treatment • Under the National TB Elimination Programme (NTEP) • 4 months: HRE (Isoniazid, Rifampicin, Ethambutol) • Drug-resistant TB Regimen based on DST results (longer and more complex) • ❗ DOTS (Directly Observed Treatment, Short-course) is followed to ensure adherence. Category Drug regimen (daily for 6 months) New cases 2 months: HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol)
- 77. Prevention and Control Early Detection and Treatment o Mandatory sputum testing of symptomatic individuals o Free treatment under NTEP Vaccination o BCG vaccine at birth protects against severe forms of TB in children Infection Control o Cough hygiene, use of masks o Well-ventilated housing Nutritional Support o Nikshay Poshan Yojana – ₹500/month for TB patients for nutrition
- 78. Role of the Nurse Activity Details Health education Cough etiquette, stigma reduction, importance of adherence Screening and referral Identify symptoms (cough >2 weeks) and refer for sputum testing DOTS supervision Observe patient taking medicine and report side effects Contact tracing Screen family members and close contacts Nutrition counseling Guide on diet and follow-up under Nikshay Poshan Yojana Documentation and follow-up Maintain treatment cards, report defaulters, encourage completion
- 79. Vaccine-Preventable Diseases This group includes diseases that can be prevented through routine childhood immunization under the Universal Immunization Programme (UIP). Each disease below will be explained individually using the standard format.
- 80. Diphther ia Definition Diphtheria is an acute bacterial infection caused by Corynebacterium diphtheriae that affects the throat, nose, and sometimes skin, producing a thick grayish membrane that can obstruct breathing.
- 81. Causative Agent Corynebacterium diphtheriae (toxigenic strain) Incubation Period 2 to 5 days Mode of Transmission Droplet infection(coughing, sneezing) Direct contact with infected discharges or contaminated objects
- 82. Signs and Symptoms • Sore throat with difficulty in swallowing • Thick gray membrane in the throat or tonsils • Swollen neck (“bull neck”) • Fever, malaise • Possible airway obstruction or heart complications
- 83. Diagnosis o Clinical signs + throat swab culture Treatment o Antitoxin (to neutralize the toxin) o Antibiotics: Penicillin or Erythromycin o Hospital isolation
- 84. Preventio n • DPT Vaccine (Diphtheria, Pertussis, Tetanus) • Given at 6, 10, 14 weeks + booster at 16–24 months and 5 years • Isolation of cases • Contact tracing and prophylactic antibiotics
- 85. Role of the Nurse • Educate on immunization schedules • Ensure DPT vaccine administration • Identify cases early and isolate • Assist in sample collection and follow- up care
- 86. Pertussis (Whooping Cough) Definition Pertussis, or whooping cough, is a highly contagious bacterial disease characterized by severe coughing spells followed by a high-pitched "whoop" sound, especially in children. It can lead to complications such as pneumonia, seizures, and even death in infants.
- 87. Causative Agent • Bordetella pertussis • Gram-negative bacillus Mode of Transmission • Droplet infection: Coughing, sneezing • Close, prolonged contact with infected individuals Incubation Period • 7 to 10 days (range: 4–21days)
- 88. Signs and Symptoms Catarrhal Stage (1–2 weeks) • Mild fever • Runny nose • Sneezing • Mild cough Paroxysmal Stage (1–6 weeks) • Severe, repeated coughing fits • Characteristic "whoop" sound • Vomiting after coughing • Fatigue after episodes Convalescent Stage (weeks to months) • Gradual reduction in cough severity • Recurrences with respiratory infections
- 89. Diagnosis • Clinical history • Nasal/throat swab culture • PCR or serology if available Treatment • Macrolide antibiotics: Erythromycin, Azithromycin • Supportive care: hydration, rest • Hospitalization for infants or severe cases
- 90. Prevention and Control • DPT Vaccine under UIP • 6, 10, 14 weeks • Boosters at 16–24 months and 5 years • Isolate infected children • Prophylactic antibiotics for close contacts
- 91. Role of the Nurse Task Details Immunization Ensure timely DPT vaccination Health education Educate parents on symptoms, isolation, and care Surveillance Identify and report suspected cases Home care guidance Prevent dehydration, monitor for respiratory distress Referral Refer severe cases to health center or hospital
- 92. Tetanus Definition • Tetanus is a serious and often fatal bacterial disease caused by a toxin released by Clostridium tetani. It affects the nervous system, leading to muscle stiffness and spasms, particularly in the jaw and neck. • It can occur in newborns (neonatal tetanus), adults, and after injuries.
- 93. Causative Agent •Clostridium tetani •Anaerobic, spore-forming, gram- positive bacillus •Spores live in soil, dust, and animal feces
- 94. Mode of Transmission •Through entry of spores into wounds (puncture wounds, burns, unclean deliveries) •Not spread person-to- person
- 95. Incubation Period 3 to 21 days (average 8 days) Shorter incubation = more severe disease
- 96. Signs and Symptoms Symptom Description Trismus Lockjaw – stiffness of the jaw Neck and back stiffness Rigid neck, difficulty swallowing Generalized muscle spasms Painful, can lead to breathing issues Opisthotonus Arched back posture Irritability, fever Due to continuous muscle contraction In neonatal tetanus: • Occurs in newborns (3–14 days after birth) • Infection from cutting umbilical cord with unclean
- 97. Diagnosis • Based on clinical signs • No specific lab test required • History of wound or unvaccinated status
- 98. Treatment • Tetanus immunoglobulin (TIG) to neutralize toxin • Antibiotics: Metronidazole or Penicillin • Muscle relaxants: Diazepam for spasms • Supportive care: Maintain airway, hydration, nutrition • Wound care: Remove dead tissue
- 99. Prevention and Control Immunization (under UIP) oDPT: For infants (6, 10, 14 weeks) oTd: For pregnant women (2 doses – Td1, Td2) oTT boosters: For adults every 10 years Clean delivery practices oUse of sterile instruments to cut the cord Wound management oClean, dress wounds early oProvide Tetanus toxoid (TT) and TIG when needed
- 100. Role of the Nurse Activity Details Immunization Ensure DPT, Td, and booster dose coverage Antenatal care Administer Td vaccine to pregnant women Health education Teach wound care, clean delivery, cord care Wound care Immediate cleaning, assessment, and referral if needed Early referral Identify symptoms and arrange transport to hospital Surveillance Notify neonatal or adult tetanus cases to PHC
- 101. Poliomyelitis (Polio) Definition • Poliomyelitis, commonly called polio, is a highly infectious viral disease that mainly affects children under 5 years and can cause paralysis, muscle weakness, and even death in severe cases. It primarily targets the nervous system.
- 102. Causative Agent • Poliovirus (3 serotypes: Type 1, Type 2, Type 3) • Family: Picornaviridae Mode of Transmission • Feco-oral route: Through ingestion of contaminated water or food • Occasionally by oral secretions • Virus multiplies in the intestines and spreads to the nervous system Incubation Period • 7 to 14 days • Range: 3 to 35 days
- 103. Signs and Symptoms Post-polio syndrome may occur years later with fatigue, muscle pain, and weakness. Type Symptoms Subclinical (90– 95%) No symptoms, but virus is shed in stool Abortive Polio Fever, sore throat, headache, nausea Non-paralytic Polio Stiff neck, back pain, mild CNS signs Paralytic Polio Sudden weakness in limbs (usually legs), floppy paralysis, no sensory
- 104. Diagnosis Stool sample for virus isolation PCR for poliovirus Clinical signs + history of vaccination or outbreak
- 105. Treatment No specific antiviral treatment Supportive care: Bed rest Physical therapy to prevent deformity Pain relief, mobility aids
- 106. Prevention and Control Vaccine Details Oral Polio Vaccine (OPV) Live attenuated; 5 doses (birth, 6, 10, 14 weeks, booster) Inactivated Polio Vaccine Injectable; given at 6 & 14 weeks
- 107. Vaccination under UIP • Pulse Polio Campaign: National program for mass OPV administratio n to all under- 5children Sanitation and Hygiene • Safe drinking water and clean food • Handwashing practices Surveillance • Monitor for Acute Flaccid Paralysis (AFP) • Report and investigate every AFP case in children <15 years
- 108. Role of the Nurse Task Details Immunization Ensure OPV and IPV doses are given on time Pulse Polio Campaigns Mobilize community, administer OPV to under-5 children AFP Surveillance Report and assist in stool sample collection for all AFP cases Health education Promote hygiene, sanitation, and vaccine trust Referral Refer children with paralysis or delayed milestones
- 109. Measle s Definition • Measles is a highly contagious viral disease characterized by fever, cough, conjunctivitis, and a characteristic red rash that spreads across the body. It primarily affects children and can lead to serious complications such as pneumonia, diarrhea, blindness, and encephalitis.
- 110. Causative Agent Virus: Measles virus Family: Paramyxoviridae Genus: Morbillivirus
- 111. Mode of Transmission • Droplet infection through coughing and sneezing • Highly contagious – virus can survive in air for up to 2 hours Incubation Period • 10 to 14 days
- 112. Signs and Symptoms Stage Features Prodromal stage Fever, cough, coryza (runny nose), conjunctivitis, irritability Koplik’s spots Small white spots inside the cheeks (early diagnostic sign) Rash stage Red maculopapular rash, starts behind ears and spreads downward Recovery phase Rash fades, skin peels; weakness persists
- 113. Diagnosis • Clinical signs (rash + fever + Koplik's spots) • IgM antibody test or RT-PCR in blood or throat swab • Recent contact with measles case supports diagnosis
- 114. Treatment • No specific antiviral drug • Supportive therapy: • Paracetamol for fever • Fluids and nutrition • Vitamin A supplementation to prevent complications • Treat secondary infections (e.g., pneumonia)
- 115. Prevention and Control Vaccination under UIP Measles-Rubella (MR) Vaccine: 1st dose: 9–12 months 2nd dose: 16–24 months Mass MR campaigns are also conducted in schools Isolation of Cases Keep infected child at home for at least 4 days after rash appears Health Education Encourage vaccination Promote hygiene and early health-seeking behavior
- 116. Role of the Nurse Task Details Vaccination Ensure timely MR vaccination, support campaigns in schools Case identification Recognize signs (fever + rash + Koplik's spots) Vitamin A administration Give two doses 24 hours apart (1 lakh IU <1yr, 2 lakh IU >1yr) Isolation guidance Educate family on home isolation and care Community awareness Dispel myths about vaccines, promote early treatment Report Notify suspected or confirmed cases to PHC
- 117. Enteric Fever (Typhoid Fever) Definition • Enteric fever, commonly known as typhoid fever, is a systemic bacterial infection caused by Salmonella typhi, affecting the intestinal tract and bloodstream. • It spreads through contaminated food and water, and is common in
- 118. • Salmonella typhi (main cause of typhoid) • Salmonella paratyphi A, B, C (cause milder paratyphoid fever) Causative Agent • Feco-oral route: • Ingestion of food/water contaminated with feces or urine of an infected person • Spread by carriers, especially food handlers Mode of Transmission • 7 to 14 days Incubation Period
- 119. Signs and Symptoms Systemic Symptoms Gastrointestinal Symptoms Gradual onset of high fever (step-ladder pattern) Abdominal pain Weakness and headache Diarrhea or constipation Loss of appetite Enlarged spleen and liver Rose spots on abdomen (in some cases) Coated tongue Delirium in severe cases Intestinal bleeding or perforation (rare)
- 120. Diagnosis • Widal test: Detects antibodies (usually after 7–10 days) • Blood culture: Most reliable in the first week of illness • Stool and urine culture: Helpful later in disease • CBC: Shows leukopenia
- 121. Treatme nt • Antibiotics: • Cefixime, Ciprofloxacin, or Azithromycin (based on resistance pattern) • Supportive care: • Bed rest, soft diet, fluids • Monitor for complications (bleeding, perforation)
- 122. Prevention and Control •Safe Water and Food • Boiled or chlorinated water • Properly cooked food • Avoid street food and raw vegetables •Sanitation and Hygiene • Handwashing with soap before eating and after defecation • Use of toilets; discourage open defecation •Vaccination • Typhoid Vi polysaccharide vaccine (for travelers or endemic areas) • Typhoid conjugate vaccine (used in children 6 months) ≥
- 123. Role of the Nurse Task Details Health education Promote hygiene, safe food/water habits Case identification Recognize prolonged fever and refer for testing Supportive care Monitor vitals, ensure rest, and hydration Medication adherence Educate on completing full antibiotic course Carrier surveillance Help trace and counsel carriers (e.g., food handlers) Reporting Notify suspected and confirmed cases to health authority
- 124. Viral Hepatitis (Hepatitis A & B) Introduction • Hepatitis refers to inflammation of the liver, most commonly caused by viruses. Among the various types, Hepatitis A and Hepatitis B are public health priorities in India due to their modes of transmission and potential complications.
- 125. Hepatitis A Definition • Hepatitis A is an acute viral liver infection caused by the Hepatitis A virus (HAV), transmitted via the fecal-oral route, often due to poor hygiene and contaminated food or water.
- 126. Causative Agent Virus: Hepatitis A virus (HAV) RNA virus, Picornaviridae family Mode of Transmission Feco-oral route: ingestion of contaminated water/food Person-to-person (poor hand hygiene) Often causes outbreaks in schools or slums Incubation Period 14 to 28 days
- 127. Signs and Symptoms Sudden fever Loss of appetite Nausea, vomiting Abdominal discomfort (especially right upper abdomen) Jaundice (yellowing of eyes and skin) Dark urine and pale stools Most people recover completely; no chronic infection occurs.
- 128. Diagnosis • Clinical signs (jaundice + fever) • IgM anti-HAV antibodies in blood confirm infection • LFTs: Elevated bilirubin and liver enzymes(SGPT/SGOT) Treatment • Supportive care only: • Rest, hydration, nutritious food • Avoid alcohol and liver-damaging drugs
- 129. Prevention and Control • Safe drinking water • Good hand hygiene and sanitation • Proper food handling • Hepatitis A vaccine (2 doses – optional in India) • Role of the Nurse • Health education on personal hygiene and safe drinking water • Identify jaundice cases and refer • Monitor recovery and advise rest • Promote sanitation practices in the community
- 130. Hepatitis B Definition • Hepatitis B is a serious liver infection caused by the Hepatitis B virus (HBV), spread through blood and body fluids. It can lead to chronic infection, cirrhosis, and liver cancer.
- 131. • Virus: Hepatitis B virus (HBV) • DNA virus, Hepadnaviridae family. Causative Agent • Blood transfusion with infected blood • Unprotected sex with infected person • Mother-to-child during delivery • Sharing needles, razors, or dental tools • Occupational risk to health workers Mode of Transmission • 45 to 180 days (average~90 days) Incubation Period
- 132. Signs and Symptoms • Often asymptomatic in early stages • Loss of appetite • Fever, fatigue • Muscle/joint pain • Jaundice, dark urine • Enlarged liver • In some, it leads to chronic hepatitis, cirrhosis, or liver cancer.
- 133. Diagnosis • HBsAg test (Hepatitis B surface antigen) in blood • LFTs: Raised bilirubin, SGPT/SGOT • Additional markers: HBeAg, Anti-HBc, Anti-HBs Treatment • Acute cases: Supportive care • Chronic cases: • Antiviral drugs (e.g., Tenofovir, Entecavir) • Regular liver monitoring • Avoid alcohol and liver-toxic medications
- 134. Prevention and Control • Hepatitis B vaccine under UIP: • Birth dose (within 24 hours) + 6, 10, 14 weeks • Use of sterile syringes and needles • Blood screening before transfusion • Barrier methods during sex (condoms) • Post-exposure prophylaxis for health workers (HBIG + vaccine)
- 135. Role of the Nurse • Administer birth dose and complete vaccination • Educate on safe sex and injection practices • Screen pregnant mothers and refer if positive • Use gloves and universal precautions during procedures • Raise awareness during health talks and camps
- 136. HIV/AIDS (Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome) Definition • HIV is a virus that attacks and weakens the body's immune system, making it unable to fight infections and cancers. AIDS is the most advanced stage of HIV infection when the immune system is severely damaged.
- 137. Causative Agent • HIV-1 (common worldwide) and HIV-2 • Retrovirus family Mode of Transmission • Unprotected sexual contact with an infected person • Contaminated blood transfusions or needles • Mother-to- child transmission (during birth or breastfeeding) • Occupational exposure (needle-stick injuries in health workers) Incubation Period • Variable: HIV may remain in the body for years without symptoms • Progression to AIDS usually takes 5–10 years without treatment
- 138. Signs and Symptoms • Early (HIV infection): Fever, night sweats Weight loss, fatigue Recurrent infections (skin, mouth ulcers) • Late (AIDS stage): Tuberculosis Persistent diarrhea Oral thrush, Pneumonia Kaposi’s sarcoma (cancer)
- 139. Diagnosis • ELISA test: Screening • Western Blot or PCR: Confirmatory • CD4 Count: Monitors immune status • Viral Load: Measures virus level in blood
- 140. Treatment • ART (Antiretroviral Therapy): lifelong treatment to suppress the virus • Free under NACO (National AIDS Control Organization) • Regular monitoring of CD4 count and viral load • Treatment of opportunistic infections
- 141. Prevention and Control • Use of condoms during every sexual act • Blood screening before transfusion • Use of disposable needles and syringes • ART to prevent mother-to-child transmission • PEP (Post-exposure prophylaxis) for needle-stick injuries
- 142. Role of the Nurse • Provide counseling before and after testing • Educate on safe sex, ART adherence, and stigma reduction • Prevent occupational exposure (wear gloves, use safety box) • Support maternal HIV care and safe delivery planning • Community awareness on HIV
- 143. RTIs/STIs (Reproductive Tract Infections / Sexually Transmitted Infections) Definition • RTIs and STIs are infections spread through sexual contact, affecting reproductive organs, and if untreated, may lead to infertility, pregnancy complications, and HIV risk.
- 144. Commo n RTIs/STI s Disease Symptoms Syphilis Painless genital ulcer, rash on palms/soles Gonorrhea Pus-like discharge, painful urination Chlamydia Vaginal/penile discharge, pelvic pain Trichomoniasis Frothy green vaginal discharge, itching Candidiasis (Fungal) White thick discharge, itching Genital herpes Painful blisters or ulcers
- 145. • Diagnosis • Clinical examination • Swab tests (Gram stain, wet mount) • Blood tests (e.g., VDRL for syphilis) • Treatment • Syndromic approach: Treat based on symptoms • Antibiotics/antifungals as per guidelines • Treat both partners to prevent reinfection • Educate about complete course and no sex during treatment
- 146. Prevention and Control • Condom use • Early diagnosis and complete treatment • Avoid multiple sex partners • Educate adolescents on reproductive health • Confidential counseling and testing services
- 147. Role of the Nurse • Health education on safe sex and hygiene • Support in syndromic case management (SCM) • Promote condom use and family counseling • Refer complicated cases to PHC or specialist • Prevent mother-to-child transmission of infections
- 148. Diarrhe a (Acute Diarrheal Disease) Definition • Diarrhea is the passage of three or more loose or watery stools in a day. • It can lead to dehydration, malnutrition, and even death, especially in children under five years if not managed
- 149. Causative Agents Type Examples Viruses Rotavirus, Norovirus Bacteria E. coli, Shigella, Salmonella, Vibrio cholerae Parasites Giardia, Entamoeba histolytica
- 150. • Feco-oral route: Consumption of contaminated food or water • Poor hand hygiene • Use of unclean utensils, bottles, and feeding cups Mode of Transmission • Varies with organism • Usually 12 hours to 5 Incubation Period
- 151. Signs and Symptoms Mild to Moderate Severe / Complicated Frequent loose or watery stools Sunken eyes, dry mouth, no tears Abdominal cramps Extreme thirst, lethargy Vomiting, mild fever Skin pinch goes back slowly (sign of dehydration) Loss of appetite Reduced urine output or unconsciousness
- 152. Diagnosi s •Mainly clinical •Stool microscopy or culture in severe or prolonged cases •Assess dehydration level (some, severe, or none)
- 153. Treatment • ORS (Oral Rehydration Salts) solution — cornerstone of treatment • Replaces water and electrolytes • Give after each loose stool • Use zinc with ORS Oral Rehydration Therapy (ORT) • 10–20 mg/day for 14 days • Reduces duration and recurrence Zinc supplementation • Continue breastfeeding • Encourage small, frequent feeds Nutritional support • For children with severe dehydration who can’t drink IV Fluids • Only if blood in stool or diagnosed bacterial infection (e.g., Antibiotics
- 154. Prevention and Control Measure Action Safe drinking water Boil or chlorinate water Handwashing With soap before meals, after toilet use Food hygiene Wash vegetables, cover food, avoid raw/street food Sanitation Promote toilet use, discourage open defecation
- 155. Role of the Nurse Activity Details Early detection Recognize signs of dehydration ORS preparation & use Teach how to prepare and give ORS correctly Zinc administration Ensure correct dose for 14 days Health education Teach handwashing, food safety, toilet use Community-based care Monitor and manage diarrhea at home or community level Referral Refer severe dehydration or bloody diarrhea cases
- 156. Respiratory Infections (Including Acute Respiratory Infections – ARIs) Definition • Acute Respiratory Infections (ARIs) are infections that affect the nose, throat, airways, or lungs, occurring suddenly and lasting up to 2 weeks. • They are one of the leading causes of illness and death in children under 5 years in India.
- 157. Agents Type Examples Viruses RSV, Influenza, Parainfluenza, Adenovirus Bacteri a Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma
- 158. Mode of Transmission • Droplet infection: Through coughing, sneezing, talking • Direct contact with nasal secretions or contaminated surfaces • Spread easily in crowded and poorly ventilated areas Incubation Period • 1 to 7 days, depending on the pathogen
- 159. Signs and Symptoms • Upper Respiratory Tract Infection (URTI) – mild: o Runny nose, nasal congestion o Sore throat o Dry or wet cough o Low-grade fever o Sneezing, ear pain (otitis media) • Lower Respiratory Tract Infection (LRTI) – severe: o Fast breathing o Chest indrawing o High fever o Difficulty in breathing o Cyanosis (blue lips) in severe cases o Child not able to feed or drink
- 160. Diagnosis • Clinical assessment: Based on respiratory rate, chest movement, and general condition • WHO IMNCI chart used for children • Chest X-ray and sputum culture in severe cases
- 161. For mild cases (URTI): • Paracetamol for fever • Encourage fluids • Nasal saline drops • Rest For severe cases (LRTI / Pneumonia): • Antibiotics: Amoxicillin or Cotrimoxazole • Oxygen therapy for breathing difficulty • Hospital referral for danger signs ❗ No antibiotics for viral URTI.
- 162. Prevention and Control Measure Action Vaccination Pentavalent (includes Hib), Measles, PCV (in some states) Nutrition Breastfeeding, Vitamin A, balanced diet Hygiene Cover mouth while coughing, frequent handwashing Avoid smoke exposure No indoor cooking with firewood; no smoking near children Ventilation Keep rooms airy and well-lit
- 163. Role of the Nurse Activity Details Early identification Use IMNCI guidelines (e.g., fast breathing, chest indrawing) Health education On cough hygiene, handwashing, breastfeeding, and danger signs Vaccination Ensure complete immunization (measles, Hib, etc.) Basic treatment Teach home care for mild cases; provide antibiotics if trained Referral Refer severe cases for oxygen support or hospital management Follow up children after treatment and advise on
- 164. COVID-19 (Coronavirus Disease 2019) Definition • COVID-19 is an infectious disease caused by the novel coronavirus SARS-CoV- 2. It primarily affects the respiratory system, but can also involve other organs and lead to serious complications such as pneumonia, blood clots, and multi-
- 165. • Virus: SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) • Family: Coronaviridae • RNA virus Causative Agent • Droplet and aerosol transmission from coughing, sneezing, talking • Surface contact with contaminated objects (fomites), then touching face • Close contact within 1 meter of an infected person Mode of Transmission • 2 to 14 days (commonly around 5–7 days) Incubation Period
- 166. Signs and Symptoms Common Symptoms Severe / Emergency Symptoms Fever, dry cough Difficulty in breathing Fatigue, body ache Chest pain or pressure Loss of smell/taste Confusion or inability to stay awake Sore throat, headache Cyanosis (blue lips or face) Diarrhea Low oxygen saturation (SpO₂ < 90%)
- 167. Diagnosis • RT-PCR test: Gold standard (nasal or throat swab) • Rapid Antigen Test (RAT) for screening • Chest X-ray or HRCT chest in severe cases • Blood tests: D-dimer, CRP, CBC for severity assessment
- 168. Treatme nt Type of Case Treatment Measures Mild Home isolation, rest, paracetamol, fluids, steam inhalation Moderate Hospital care, oxygen therapy, steroids (as advised) Severe ICU admission, ventilatory support, anticoagulants, antivirals Self-medication is discouraged. Antibiotics are not useful unless bacterial infection is present.
- 169. Prevention and Control Preventive Action Description Vaccination Covishield, Covaxin, Corbevax — 2 doses + booster Mask-wearing Properly covering nose and mouth in public Hand hygiene Washing hands with soap or using sanitizer frequently Social distancing Maintain at least 1 meter distance from others Isolation and quarantine For infected and close contacts Ventilation Keep homes and workspaces well-ventilated
- 170. Role of the Nurse Task Details Community screening Identify symptoms, refer for testing Vaccination campaigns Administer vaccines and observe for side effects Education and awareness Explain hand hygiene, mask use, isolation rules Monitoring home isolation cases Regular follow-up and emergency referral Infection control Follow PPE protocols, disinfect equipment and surroundings Mental health support Counsel patients and families dealing with fear or anxiety
- 171. Soil-Transmitted Helminth Infections (Worm Infestations) Definition • Soil-Transmitted Helminth (STH) infections are caused by intestinal parasitic worms that are transmitted through contaminated soil. • They affect nutritional status and physical development, especially in children.
- 172. Causative Agents Type of Worm Scientific Name Roundworm Ascaris lumbricoides Whipworm Trichuris trichiura Hookworm Ancylostoma duodenale, Necator americanus
- 173. • Feco-oral route: Swallowing worm eggs via contaminated hands or food • Skin penetration: Hookworm larvae penetrate bare feet • Linked to open defecation and poor sanitation Mode of Transmission • Few weeks after exposure Incubation Period
- 174. Signs and Symptoms • Abdominal pain, bloating • Loss of appetite • Anemia (especially hookworm) • Malnutrition, weight loss • Itching or rash at site of larval entry (hookworm)
- 175. Diagnosis Stool microscopy: Detection of worm eggs Blood test: Anemia, eosinophilia Treatment Albendazole 400 mg – single dose Mebendazole 500 mg – alternative Repeat dose after 6 months if needed Iron supplements in case of anemia
- 176. Prevention and Control • Deworming under National Deworming Day (NDD) for all 1–19 years • Use of toilets, no open defecation • Washing hands before eating and after defecation • Wash fruits and vegetables before consumption • Wearing slippers/shoes
- 177. Role of the Nurse • Deworming administration during NDD • Educate school children and parents • Promote sanitation and hygiene • Monitor for reinfection and growth delays
- 178. Scabies Definition • Scabies is a highly contagious skin infection caused by a mite (Sarcoptes scabiei) that causes intense itching, especially at night.
- 179. Mode of Transmission • Prolonged skin- to-skin contact • Sharing clothes, bedding, towels Signs and Symptoms • Intense itching (especially at night) • Small blisters or burrow lines (between fingers, wrists, waist) • Rash spreads to arms, abdomen, genitals
- 180. Treatment •Permethrin 5% cream: Applied to whole body at night and washed off next morning •Benzyl benzoate lotion: Alternative •Treat close contacts simultaneously •Wash clothes and linen in hot water
- 181. Role of the Nurse • Identify and treat early • Educate on application of cream and washing bedding • Prevent reinfection and break transmission cycle • Reduce stigma and promote hygiene
- 182. Pediculosis (Head Lice Infestation) Definition • Pediculosis is an infestation of head lice (Pediculus humanus capitis) causing scalp itching and irritation, especially in school-age children.
- 183. Mode of Transmission • Close contact (head-to-head) • Sharing combs, hair accessories, caps, or pillows Signs and Symptoms • Itching of scalp • Visible lice or nits (eggs) on hair shafts • Scratching sores or infection →
- 184. Treatment •Permethrin 1% lotion or shampoo •Manual removal of nits using a fine-toothed comb •Wash bedding, combs, and clothes •Repeat treatment after 7–10 days
- 185. Role of the Nurse Identify cases in schools or camps Demonstrate use of medicated shampoo Health education on personal hygiene Counsel families to avoid sharing items
- 186. Rabies (Zoonotic Disease) •Definition •Rabies is a fatal viral disease that affects the central nervous system. It is transmitted to humans through the bite or scratch of infected animals, most commonly dogs. Once symptoms appear, death is almost certain.
- 187. • Virus: Rabies virus • Family: Rhabdoviridae • Genus: Lyssavirus Causative Agent • Bite, scratch, or lick on broken skin or mucous membrane by an infected animal • Most common source: stray dogs • Other animals: Cats, bats, monkeys, foxes • Not transmitted person to person Mode of Transmission • Typically 1 to 3 months, but can range from a few days to a year • Depends on the site, severity, and virus load (shorter in face/neck bites) Incubation Period
- 188. Signs and Symptoms • Fever, headache • Pain/tingling at bite site • Anxiety, restlessness Initial Stage: • Hydrophobia (fear of water) • Aerophobia (fear of air or drafts) • Excessive salivation, hallucinations • Paralysis, coma → death Neurological Stage:
- 189. Diagnosis • Clinical diagnosis after exposure • Lab confirmation (only post-mortem or in research settings) Treatment • ❗ Once symptoms begin, no effective treatment exists. Prevention is critical.
- 190. Prevention and Control Post-Exposure Prophylaxis (PEP) – After Animal Bite • Immediate wound washing: • With soap and running water for 10–15 minutes • Apply antiseptic (povidone-iodine) • Anti-Rabies Vaccine (ARV): • 5 doses (0, 3, 7, 14, and 28 days) • IM injection in deltoid or thigh • Rabies Immunoglobulin (RIG): • For category III exposures (severe bites or scratches) • Infiltrate around wound site Pre-Exposure Prophylaxis: • For high-risk groups: veterinarians, dog handlers, lab staff, travelers to high-risk areas Dog Population Control: • Vaccination of stray dogs • Animal birth control programs
- 191. Bite Exposure Categories (WHO): Categor y Type of Contact Action I Touching/lick on intact skin No PEP needed II Minor scratches or nibbling on intact skin Wash + ARV Bites or scratches Wash + ARV +
- 192. Role of the Nurse Task Details Wound care Immediate washing and antiseptic application Vaccination Administer full ARV schedule and RIG as per guidelines Health education Educate public on PEP, pet care, and importance of dog vaccination Dog bite surveillance Maintain records, refer to PHC or district hospital if needed Community awareness Conduct sessions in schools, slums, and during animal bite outbreaks
- 193. Role of Nurse in Control of Communicable Diseases Community Health Nurses play a key role in the prevention, early detection, treatment, education, and follow- up of communicable diseases at the individual, family, and community level.
- 194. Surveillance and Early Detection Activity Details House-to-house visits Identify fever, cough, rashes, diarrhea, skin lesions School health programs Screen for lice, scabies, conjunctivitis, etc. Reporting notifiable diseases TB, HIV, Measles, Dengue, Polio, etc., to PHC or district
- 195. Health Education and Behavior Change Communication (BCC) Topics Covered Purpose Personal hygiene Prevent diarrheal and skin infections Handwashing techniques Prevent feco-oral transmission Safe sex practices Prevent HIV, RTIs/STIs Vaccination importance Prevent vaccine-preventable diseases Use of mosquito nets and repellents Prevent vector-borne diseases
- 196. Vaccination Services Administer vaccines as per Universal Immunization Programme (UIP) Administe r Educate mothers on vaccine schedule and side effect management Educate Participate in Pulse Polio, MR, JE, COVID-19 and other campaigns Participat e in Maintain cold chain, immunization records, and follow-ups Maintain
- 197. Case Management and Referrals • Treat minor illnesses using standing orders • Give ORS, zinc, antipyretics, or antibiotics as per protocols • Refer cases of: • TB, leprosy, rabies, severe dehydration, respiratory distress • Assist in contact tracing and outbreak management
- 198. Environmental Sanitation and Vector Control • Educate on: • Clean water use • Proper disposal of waste and feces • Eliminating mosquito breeding sites • Supervise: • IRS (Indoor Residual Spraying) •Larvicide use and fogging campaigns
- 199. Deworming and Nutritional Support Participate in National Deworming Day (NDD) 1 Administer Albendazole and iron supplements 2 Monitor child growth and counsel on nutrition 3
- 200. Documentation and Reporting Maintain disease- specific registers: TB, malaria, HIV, diarrhea, etc. 01 Submit weekly/monthly reports to PHC 02 Use IDSP (Integrated Disease Surveillance Program) formats for outbreaks 03
- 201. Counseling and Community Mobilization Provide pre- and post-test counseling (HIV, TB, hepatitis) 1 Mobilize communities during immunization drives and outbreak responses 2 Form support groups for TB, HIV, leprosy patients to reduce stigma 3
- 202. National Health Programs Related to Communicable Diseases We will explain each program in detail, one by one, using this format: • Introduction • Objectives • Key components/services • Role of nurse
- 203. Universal Immunization Programme (UIP) Introduction • Launched in 1985, the Universal Immunization Programme (UIP) aims to provide free vaccination to all children and pregnant women in India to protect against vaccine- preventable diseases (VPDs).
- 204. Objectives Reduce infant and child mortality caused by VPDs 1 Ensure universal access to routine immunization services 2 Eradicate diseases like polio, eliminate measles, and control rubella 3
- 205. Vaccines Provided Under UIP Target Group Vaccines (given free of cost) Pregnant Women TT/Td (2 doses) Infants & Children BCG, OPV, IPV, Pentavalent (DPT+Hib+Hep B), Rotavirus, MR, JE Adolescents Td booster at 10 and 16 years ❗ Newer vaccines like PCV (Pneumococcal), HPV, and COVID-19 are also being added gradually.
- 206. Schedule Highlights (Child Immunization) Age Vaccine At birth BCG, OPV-0, Hep B-0 6, 10, 14 weeks Pentavalent, OPV, IPV, Rotavirus 9 months Measles-Rubella (MR), JE-1 16–24 months MR-2, DPT booster, JE-2, OPV-B 5–6 years DPT booster 10 & 16 years Td booster
- 207. Role of Nurse Function Details Vaccine administration Ensure correct dose, route, and schedule Cold chain maintenance Keep vaccines between 2–8°C in ILR or cold box Counseling Explain importance of vaccines and side effect management Record maintenance Update MCH cards, immunization registers Outreach support Participate in RI sessions, urban slums, and hard-to-reach areas
- 208. National Leprosy Eradication Programme (NLEP)? Introduction • The National Leprosy Eradication Programme (NLEP) is a centrally sponsored health initiative launched in 1983 with the goal to eliminate leprosy as a public health problem in India through early detection and complete treatment. • India declared elimination (prevalence <1 per 10,000 population) at the national level in 2005, but pockets of
- 209. Objectives • Interrupt transmission of Mycobacterium leprae • Detect all new cases early and provide complete Multi-Drug Therapy (MDT) • Prevent disability and deformity • Reduce stigma and promote community awareness • Strengthen surveillance and case reporting
- 210. Key Components and Activities Early Detection of Cases • Active case detection during: • Leprosy Case Detection Campaigns (LCDC) • School surveys • House-to-house visits • Focus on detecting cases with visible deformities Free MDT (Multi- Drug Therapy) • Provided through PHC and sub-centers • Blister packs of: • Paucibacillary (PB): 6-month course (Rifampicin + Dapsone) • Multibacillary (MB): 12-month course (Rifampicin + Dapsone +Clofazimine) Disability Prevention and Medical Rehabilitation (DPMR) • Footwear, splints, self-care kits • Referral for reconstructive surgery
- 211. IEC and BCC Activities • Mass campaigns to reduce stigma • Community-based rehabilitation support Surveillance and Monitoring • Case-based reporting using Nikusth portal • Maintain Leprosy registers at PHC level
- 212. Role of Function Details Early detection Identify skin patches with sensory loss and refer immediately MDT supervision Ensure correct and complete intake of medication Health education Spread awareness to eliminate fear and social stigma Rehabilitation support Teach self-care, wound management, and deformity prevention Contact tracing Examine and monitor close contacts of leprosy cases Documentation Update registers and support Nikusth reporting
- 213. Revised National Tuberculosis Control Programme (RNTCP) Introduction • RNTCP was launched in 1997 based on the DOTS strategy. It was renamed NTEP in 2020, with the goal of eliminating TB from India by 2025, five years ahead of the global target. • Elimination = <1 TB case per 1,00,000 population per year
- 214. Objectives • Detect all TB cases early, including drug-resistant ones • Ensure complete and free treatment to all TB patients • Reduce transmission, mortality, and drug resistance • Promote community engagement and nutritional support
- 215. Key Component s Early Diagnosis • Sputum examination: AFB smear • CBNAAT / GeneXpert: Rapid detection and rifampicin resistance • Active case finding in vulnerable populations (migrants, HIV+ patients, slums) Free and Complete Treatment • Daily regimen of anti-TB drugs (H, R, Z, E) • Fixed Dose Combination (FDC) provided by govt • DOTS (Directly Observed Treatment, Short-course) is still emphasized Digital Reporting through Ni-kshay • All TB patients are registered on Ni- kshay portal • Tracks diagnosis, treatment, follow-up, and incentives
- 216. TB Preventive Therapy (TPT) • Isoniazid (INH) for household contacts of TB patients • Focus on child contacts and people living with HIV Nutritional Support (Nikshay Poshan Yojana) • ₹500/month for every TB patient during treatment • Paid through Direct Benefit Transfer (DBT) Drug-Resistant TB Management • Special centers (DR-TB centers) • Use of second-line drugs (e.g., Bedaquiline, Delamanid)
- 217. Role of Nurse Task Details Early detection and referral Identify prolonged cough (>2 weeks), fever, weight loss Sputum collection Assist in sample collection and transportation to lab DOTS provider Ensure daily supervised medication with support and motivation Nutritional guidance Enroll patient in Nikshay Poshan Yojana and track payment Contact tracing Screen and provide preventive therapy to child contacts Education and stigma reduction Encourage treatment completion, promote awareness
- 218. Integrated Disease Surveillance Programme (IDSP) Introduction • The Integrated Disease Surveillance Programme (IDSP) was launched in 2004 by the Ministry of Health and Family Welfare (MoHFW) with support from the World Bank. • Its main aim is to detect, monitor, and respond to disease outbreaks in India in real time.
- 219. Objectives Establish a decentralized system for early detection of disease outbreaks Strengthen data collection, analysis, and reporting from all levels Facilitate rapid response to disease outbreaks and public health emergencies Monitor trends of epidemic-prone diseases
- 220. Key Features and Components Disease Surveillance Network • Covers 33 communicable diseases like malaria, dengue, TB, cholera, measles, etc. • Works at district, state, and national levels Weekly Reporting System • Health workers submit “S” (suspect), “P” (presumptive), “L” (laboratory- confirmed) case data every week • Enables trend analysis and outbreak prediction Outbreak Investigation • Rapid Response Teams (RRTs) are trained to investigate and control outbreaks • Early warning triggers help activate emergency measures
- 221. Lab Strengthening • District labs upgraded for basic tests • Referral labs support advanced diagnosis (RT- PCR, ELISA) IT-Based Monitoring • Uses IDSP portal and SMS/email alerts • Daily epidemic updates at https://idsp.nic.in
- 222. Diseases Commonly Tracked by IDSP • Vector-borne: Malaria, Dengue, JE • Waterborne: Cholera, Typhoid, Hepatitis A/E • Respiratory: Measles, Influenza, COVID-19 • Zoonotic: Rabies, Leptospirosis • Vaccine-preventable: Diphtheria, Polio
- 223. Role of the Nurse Activity Details Case detection and notification Identify suspect cases and report to ANM or PHC in charge Weekly reporting Help prepare and submit S, P, L forms to the health supervisor Community awareness Educate public during outbreaks (e.g., ORS use during diarrhea) Outbreak response Participate in door-to-door surveillance, sample collection, IEC Coordination Support Rapid Response Teams in field investigations Maintain fever survey, contact list, referral
- 224. National AIDS Control Programme (NACP) 🩺 Introduction • Launched in 1992, the National AIDS Control Programme (NACP) is India’s flagship program to prevent and control HIV/AIDS. It is implemented by NACO, under the Ministry of Health and Family Welfare. • As of now, the program is in Phase V (2021–2026) with a vision to make India AIDS- free. • Managed by: National AIDS
- 225. Objectives Prevent new HIV infections Prevent Provide free HIV testing and treatment Provide Reduce HIV-related stigma and discrimination Reduce Improve quality of life for People Living with HIV (PLHIV) Improve
- 226. Key Strategies and Componen ts • IEC & BCC campaigns promoting safe sex, condom use, awareness • Targeted interventions among high-risk groups: • Female sex workers (FSW), MSM (men having sex with men), injecting drug users (IDU), transgender persons HIV Prevention • Integrated Counseling and Testing Centres (ICTCs) offer free: • Pre- and post-test counseling • HIV testing (ELISA/rapid tests) HIV Testing and Counseling • Free ART provided through ART centers in govt hospitals • Viral load and CD4 monitoring • Lifelong treatment improves survival and reduces transmission Antiretroviral Therapy (ART)
- 227. Prevention of Parent-to- Child Transmission (PPTCT) • HIV testing for all pregnant women • ART to mother and newborn • Safer delivery and feeding counseling • Blood Safety • 100% testing of blood and blood products • Strict screening before transfusion • Social Protection & Support • Nutritional aid, travel allowance, insurance schemes • Linkages with other welfare departments (education, employment) • Stigma Reduction and Community Support • Formation of self-help groups, Red Ribbon Clubs in schools/colleges • PLHIV networks and peer educators
- 228. Key Services under NACO Facility Type Services Provided ICTC HIV testing and counseling ART Center Free ART and medical care for PLHIV Link ART Center (LAC) Medicine distribution near patient's home Drop-in Centers (DICs) Peer support, counseling, group activities for PLHIV
- 229. Role of the Nurse Activity Details Counseling support Provide pre/post-test counseling with empathy Testing support Assist in ICTC and mobile screening camps ART adherence monitoring Encourage regular follow-up and manage side effects PPTCT services Guide HIV-positive pregnant mothers and ensure infant prophylaxis Community awareness Promote safe practices, condom use, and stigma reduction Documentation and
- 230. National Vector Borne Disease Control Programme (NVBDCP) Introduction • The National Vector Borne Disease Control Programme (NVBDCP) is a comprehensive health program under the Ministry of Health and Family Welfare aimed at the prevention and control of six major vector-borne diseases in India. • These diseases together account for a major public health burden, especially in tropical and sub-tropical regions.
- 231. Objectives Reduce morbidity and mortality due to vector-borne diseases Reduce Ensure early detection and prompt treatment Ensure Strengthen surveillance, vector control, and IEC activities Strengthen Achieve elimination goals for diseases like Kala-azar and Filariasis Achieve
- 232. Diseases Covered under NVBDCP Disease Vector Malaria Female Anopheles mosquito Filaria Culex mosquito Kala-azar Phlebotomus sandfly Dengue Aedes aegypti mosquito Chikungunya Aedes aegypti mosquito Japanese Encephalitis Culex mosquito
- 233. Key Program Componen ts • Early Diagnosis and Complete Treatment • Fever surveillance in high-risk areas • Rapid Diagnostic Tests (RDTs) and blood smear collection • Free treatment: ACT for malaria, DEC for filaria, Amphotericin for kala-azar • Integrated Vector Management • Indoor Residual Spraying (IRS) • Use of Long Lasting Insecticidal Nets (LLINs) • Larvicidal measures (e.g., temephos in water bodies) • Source reduction (e.g., eliminating stagnant water)
- 234. Mass Drug Administrati on (MDA) • Annual distribution of DEC + Albendazole to prevent filariasis • Vaccination • JE vaccine for children in endemic districts • Measles-Rubella vaccine also reduces JE-like symptoms • Behavior Change Communication (BCC) • Community meetings, IEC posters, school campaigns • Use of mass media to promote awareness on mosquito control
- 235. Elimination Targets Disease Target Year Malaria Elimination by 2030 Filaria Elimination by 2030 Kala- azar Elimination by 2023 (almost achieved)
- 236. Role of the Nurse Activity Details Fever surveillance House visits, identify fever cases and collect blood samples Drug administration Administer ACT, DEC, Albendazole as per guidelines Vector control participation Support IRS and distribution of bed nets Health education Inform community about breeding sites, LLIN use, and early care Mass campaigns Participate in anti-larval drives, MDA rounds, JE vaccination Reporting and Update disease registers and track
- 237. National Air Quality Monitoring Programme (NAQMP) Introduction • The National Air Quality Monitoring Programme (NAQMP) is a flagship environmental health initiative by the Central Pollution Control Board (CPCB) under the Ministry of Environment, Forest and Climate Change. • It aims to monitor, assess, and manage air quality across India to protect public health from air pollution-related illnesses.
- 238. Objectives • Monitor air quality trends across urban and rural areas • Provide data to inform policy decisions and health alerts • Support action plans for pollution control and reduction • Raise public awareness on the health impact of air pollution
- 239. Key Components of NAQMP Monitoring Stations • Over 800 stations across 300+ Indian cities • Measure key pollutants like: • PM10, PM2.5 (Particulate matter) • SO₂ (Sulfur Dioxide) • NO₂ (Nitrogen Dioxide) • CO, Ozone, Lead, Ammonia, Benzene Air Quality Index (AQI) System • Categorizes air quality from Good (0–50) to Severe (401–500) • Issued daily by CPCB and State Pollution Control Boards • Used to issue health warnings and advise public action
- 240. • Real-time alerts during smog or high AQI days • School closures, traffic restrictions, or advisories may be issued Health Risk Alerts • Supports National Health Mission (NHM) and Environment Health Projects • Helps plan action for non-communicable diseases (e.g., asthma, COPD) Integration with Health Initiatives
- 241. Health Hazards of Poor Air Quality Pollutant Health Impact PM2.5 & PM10 Respiratory irritation, asthma, lung cancer NO₂ and SO₂ Coughing, wheezing, bronchitis Ozone Reduced lung function, chest pain Lead Neurological damage, especially in children
- 242. Role of the Nurse Activity Details Community education Teach public about dangers of air pollution and AQI meanings Health counseling Guide asthmatics and elderly on precautions during poor AQI days School outreach Educate children on pollution control and personal protection Reporting symptoms Note respiratory symptoms