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Copyright © 2008 Delmar. All rights reserved.

  1. 1. Part IV Provision of Public Health Nursing to Vulnerable Populations
  2. 2. Chapter 20 Populations with Infectious and Communicable Disease
  3. 3. Contributing Factors <ul><li>Institute of Medicine (IOM) 1992 report Emerging Infections: Microbial Threats to Health in the United States </li></ul><ul><ul><li>Emerging infectious diseases </li></ul></ul><ul><ul><li>Increasingly present infectious diseases </li></ul></ul><ul><ul><li>Identified six important factors in disease emergence and reemergence </li></ul></ul>
  4. 4. Six Factors <ul><li>Changes in human demographics and behavior </li></ul><ul><li>Advances in technology and industry </li></ul><ul><li>Economic development; changes in land use </li></ul><ul><li>Commerce </li></ul><ul><li>Microbial adaptation </li></ul><ul><li>Deterioration in the public health system </li></ul>
  5. 5. Models of Transmission <ul><li>Epidemiological triangle and the chain of transmission </li></ul><ul><ul><li>Agent-host-environment </li></ul></ul><ul><li>Agent and reservoir </li></ul><ul><ul><li>Biological agents </li></ul></ul><ul><ul><ul><li>Fungi, parasites </li></ul></ul></ul><ul><ul><ul><li>Bacteria, viruses </li></ul></ul></ul>
  6. 6. Models of Transmission <ul><li>Agent and reservoir </li></ul><ul><ul><li>Reservoir </li></ul></ul><ul><ul><ul><li>Human, animal, environment </li></ul></ul></ul>
  7. 7. Models of Transmission <ul><li>Infectivity </li></ul><ul><li>Pathogenicity </li></ul><ul><li>Virulence </li></ul><ul><li>Antigenicity </li></ul>
  8. 8. Models of Transmission <ul><li>Modes of exit </li></ul><ul><ul><li>Respiratory </li></ul></ul><ul><ul><li>Gastrointestinal </li></ul></ul><ul><ul><li>Urinary and reproductive system </li></ul></ul><ul><ul><ul><li>Mode of entry to a new host is often the same as the mode of exit from the reservoir </li></ul></ul></ul>
  9. 9. Models of Transmission <ul><li>Modes of transmission (Table 20-1) </li></ul><ul><ul><li>Direct person to person </li></ul></ul><ul><ul><li>Common vehicle </li></ul></ul><ul><ul><li>Vectors </li></ul></ul>
  10. 10. Types of Host Immunity <ul><li>Natural </li></ul><ul><li>Acquired </li></ul><ul><li>Passive </li></ul><ul><li>Active </li></ul><ul><li>Herd </li></ul>
  11. 11. Levels of Prevention <ul><li>Leavell and Clark (1958) Preventive Medicine for the Doctor in His Community </li></ul><ul><ul><li>Three levels of prevention </li></ul></ul><ul><ul><ul><li>1. Primary </li></ul></ul></ul><ul><ul><ul><ul><li>Education, immunizations </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Chemoprophylaxis, universal precautions </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Protective clothing, barrier protection </li></ul></ul></ul></ul>
  12. 12. Levels of Prevention <ul><li>Three levels of prevention </li></ul><ul><ul><li>2. Secondary </li></ul></ul><ul><ul><ul><li>Screening </li></ul></ul></ul><ul><ul><ul><li>Disease management </li></ul></ul></ul><ul><ul><ul><li>Treatment </li></ul></ul></ul><ul><ul><ul><li>Directly observed treatment (DOT) </li></ul></ul></ul><ul><ul><li>3. Tertiary </li></ul></ul><ul><ul><ul><li>Management of complications </li></ul></ul></ul><ul><ul><ul><li>Prevention </li></ul></ul></ul>
  13. 13. Common Infectious and Communicable Diseases <ul><li>Foodborne and waterborne disease </li></ul><ul><ul><li>Food intoxication </li></ul></ul><ul><ul><ul><li>Shellfish, mushrooms, bacterial growth, mercury </li></ul></ul></ul><ul><ul><li>Food infections </li></ul></ul><ul><ul><ul><li>Trichinosis, Salmonellosis </li></ul></ul></ul><ul><ul><ul><li>Escherichia coli, Toxoplasmosis </li></ul></ul></ul><ul><ul><ul><li>Hepatitis A, Parasites </li></ul></ul></ul>
  14. 14. Prevention <ul><li>Five keys to safer food: </li></ul><ul><ul><li>Keep clean </li></ul></ul><ul><ul><li>Separate raw and cooked </li></ul></ul><ul><ul><li>Cook thoroughly </li></ul></ul><ul><ul><li>Keep food at safe temperatures </li></ul></ul><ul><ul><li>Use safe water and raw materials </li></ul></ul>
  15. 15. Vectors <ul><li>Disease carriers </li></ul><ul><ul><li>Animals, insects, birds </li></ul></ul><ul><li>Malaria </li></ul><ul><li>Anthrax </li></ul><ul><li>Brucellosis </li></ul><ul><li>Mad Cow </li></ul><ul><li>Avian Flu </li></ul>
  16. 16. Lyme Disease <ul><li>Most common vector-borne disease </li></ul><ul><ul><li>White-tailed deer </li></ul></ul><ul><ul><li>Bull’s-eye skin lesion </li></ul></ul><ul><ul><ul><li>Red spot at the site of bite, followed by spreading rings of inflammation as infection progresses </li></ul></ul></ul><ul><ul><ul><li>Develops 3-30 days after tick bite </li></ul></ul></ul>
  17. 17. Lyme Disease <ul><li>Symptoms </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Stiff neck, joint pain </li></ul></ul><ul><ul><li>Muscle aches </li></ul></ul><ul><ul><li>Enlarged tender lymph nodes </li></ul></ul>
  18. 18. Lyme Disease <ul><li>Treatment: 10-14 days of penicillin or tetracycline </li></ul><ul><ul><li>Left untreated can progress to Stage II </li></ul></ul><ul><ul><ul><li>Neurological and cardiac symptoms </li></ul></ul></ul><ul><ul><li>Stage III </li></ul></ul><ul><ul><ul><li>Months to years of ongoing attacks </li></ul></ul></ul><ul><ul><ul><ul><li>Arthritis and arthralgia </li></ul></ul></ul></ul>
  19. 19. Rocky Mountain Spotted Fever <ul><li>Vector </li></ul><ul><ul><li>Dog and wood ticks </li></ul></ul><ul><li>Atlantic and western south central region </li></ul>
  20. 20. Rocky Mountain Spotted Fever <ul><li>Occurs 4-6 hours after bite </li></ul><ul><li>Incubation period 3-14 days </li></ul><ul><ul><li>Maculopapular rash on extremities, palms of hands, soles of feet </li></ul></ul><ul><ul><li>Antibiotic therapy required </li></ul></ul>
  21. 21. Malaria <ul><li>Vector </li></ul><ul><ul><li>Infected mosquito </li></ul></ul><ul><li>Tropical and subtropical area </li></ul><ul><li>Travelers should use mosquito repellent </li></ul><ul><ul><li>Use mosquito nets while sleeping </li></ul></ul><ul><ul><li>Prophylaxis can begin 4-6 weeks prior to travel </li></ul></ul>
  22. 22. Parasitic Diseases <ul><li>Tropical climates, underdeveloped countries </li></ul><ul><ul><li>Lack of sanitation </li></ul></ul><ul><ul><li>Insufficient primary care </li></ul></ul><ul><ul><li>Inadequate access to medications </li></ul></ul>
  23. 23. Parasitic Diseases <ul><li>Four groups of organisms: </li></ul><ul><ul><li>Roundworms </li></ul></ul><ul><ul><li>Tapeworms </li></ul></ul><ul><ul><li>Flukes </li></ul></ul><ul><ul><li>Single celled organisms </li></ul></ul>
  24. 24. Nosocomial Infections <ul><li>Acquired in a hospital setting </li></ul><ul><li>May affect anyone who has contact with a hospital </li></ul><ul><ul><li>Other patients </li></ul></ul><ul><ul><li>Staff </li></ul></ul><ul><ul><li>Environment </li></ul></ul>
  25. 25. Respiratory Infections <ul><li>Tuberculosis </li></ul><ul><ul><li>Airborne pathogen </li></ul></ul><ul><ul><ul><li>Droplet nuclei </li></ul></ul></ul>
  26. 26. Respiratory Infections <ul><li>Symptoms </li></ul><ul><ul><li>Fever, cough, chest pains, fatigue </li></ul></ul><ul><ul><li>Hemoptysis, weight loss </li></ul></ul><ul><ul><li>Incubation period 4-12 weeks </li></ul></ul>
  27. 27. Respiratory Infections <ul><li>Active cases begin 6-12 months after infection </li></ul><ul><ul><li>Extrapulmonary </li></ul></ul><ul><ul><li>Multi-drug resistant </li></ul></ul><ul><ul><ul><li>Isoniaid and Rifampin </li></ul></ul></ul>
  28. 28. Respiratory Infections <ul><li>Influenza </li></ul><ul><ul><li>Influenzia A, B, or C virus </li></ul></ul><ul><ul><li>Occur annually </li></ul></ul><ul><ul><li>Last 5-6 weeks </li></ul></ul>
  29. 29. Respiratory Infections <ul><li>Small children and elderly most vulnerable </li></ul><ul><ul><li>Flu vaccine 70-90 percent effective </li></ul></ul><ul><li>Pneumonia </li></ul><ul><ul><li>Aspiration of virulent and nonvirulent organisms </li></ul></ul><ul><ul><li>Inhalation of toxic fumes </li></ul></ul><ul><ul><li>Aspiration of stomach acids </li></ul></ul>
  30. 30. Respiratory Infections <ul><li>Symptoms </li></ul><ul><ul><li>Upper respiratory tract infection </li></ul></ul><ul><ul><li>Chills, fever, cough </li></ul></ul><ul><ul><li>Chest pain and dyspnea </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><ul><li>Antibiotics </li></ul></ul></ul>
  31. 31. Hepatitis <ul><li>Hepatitis A </li></ul><ul><ul><li>Fecal-oral routes </li></ul></ul><ul><ul><li>Vaccine available and provides protection </li></ul></ul><ul><li>Hepatitis B </li></ul><ul><ul><li>Blood borne pathogen </li></ul></ul><ul><ul><ul><li>Fatigue and right upper quadrant discomfort </li></ul></ul></ul><ul><ul><ul><li>Treat with Interferon and Lamivudine </li></ul></ul></ul>
  32. 32. Hepatitis <ul><li>Hepatitis C </li></ul><ul><ul><li>Blood-borne infection </li></ul></ul><ul><ul><li>Causes up to 10,000 deaths a year </li></ul></ul><ul><ul><li>Interferon, Ribavirin </li></ul></ul>
  33. 33. HIV <ul><li>Destruction of immune system </li></ul><ul><li>Antibody test can confirm diagnosis </li></ul><ul><li>Early detection better prognosis </li></ul><ul><ul><li>Elisa </li></ul></ul><ul><ul><li>Western Blot </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>Protease inhibitors, anti-retroviral drugs </li></ul></ul>
  34. 34. HIV <ul><li>Role of public health nurse </li></ul><ul><ul><li>Promote prevention of spread of HIV through education </li></ul></ul><ul><li>Venereal Warts </li></ul><ul><ul><li>HPV </li></ul></ul><ul><ul><ul><li>Gardasil </li></ul></ul></ul>
  35. 35. STDs <ul><li>Syphilis </li></ul><ul><li>Gonorrhea </li></ul><ul><ul><li>Bacterial disease, purulent discharge with painful urination </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>Antibiotics </li></ul></ul></ul>
  36. 36. Bioterrorism <ul><li>Three categories of biological agents: </li></ul><ul><ul><li>Category A highest risk </li></ul></ul><ul><ul><ul><li>Easy spread </li></ul></ul></ul><ul><ul><ul><li>Can be transmitted person to person </li></ul></ul></ul><ul><ul><ul><li>High death rates </li></ul></ul></ul><ul><ul><ul><li>Public panic </li></ul></ul></ul><ul><ul><ul><li>Require special action </li></ul></ul></ul>
  37. 37. Category A <ul><li>Anthrax </li></ul><ul><li>Plague </li></ul><ul><li>Smallpox </li></ul><ul><li>Botulinum toxin </li></ul><ul><li>Tularemia </li></ul><ul><li>Hemorrhagic fever </li></ul>
  38. 38. Category B <ul><li>2. Category B second highest: </li></ul><ul><ul><li>Moderately easy to spread </li></ul></ul><ul><ul><li>Moderate illness rates </li></ul></ul><ul><ul><li>Low death rates </li></ul></ul><ul><ul><li>Require specific enhancements of CDC’s lab capacity </li></ul></ul>
  39. 39. Category B <ul><li>Q Fever </li></ul><ul><li>Brucellosis </li></ul><ul><li>Glanders </li></ul><ul><li>Melioidosis </li></ul><ul><li>Psittacosis </li></ul><ul><li>Ricin toxin </li></ul><ul><li>Typhus Fever </li></ul><ul><li>Staphylococcal Enterotoxin B </li></ul><ul><li>Viral encephalitis </li></ul><ul><li>Food and waterborne diseases </li></ul>
  40. 40. Category C <ul><li>3. Category C third highest priority: </li></ul><ul><ul><li>Emerging pathogens </li></ul></ul><ul><ul><li>Easily available </li></ul></ul><ul><ul><li>Easily produced and spread </li></ul></ul><ul><ul><li>Potential for high morbidity and mortality </li></ul></ul>
  41. 41. Category C <ul><li>Napin virus </li></ul><ul><li>Hantaviruses </li></ul><ul><li>Tick-borne encephalitis viruses </li></ul><ul><li>Yellow fever virus </li></ul><ul><li>Multi-drug resistant Mycobacterium tuberculosis </li></ul>
  42. 42. Managing Bioterrorism <ul><li>Plans in place for local response </li></ul><ul><li>State and Federal agencies can assist </li></ul><ul><li>U.S. Department of Homeland Security </li></ul>
  43. 43. Strategies for Nurses <ul><li>Often first to detect presence of illness </li></ul><ul><li>Often manages the communicable disease program for county </li></ul><ul><ul><li>Surveillance systems </li></ul></ul><ul><ul><li>Nurse conducts case and contact follow up </li></ul></ul><ul><ul><li>Communication skills </li></ul></ul><ul><ul><ul><li>Risk communication </li></ul></ul></ul>
  44. 44. Planning for Pandemic Disease Events <ul><li>WHO Global Influenza Preparedness Plan </li></ul><ul><ul><li>Inter-pandemic </li></ul></ul><ul><ul><ul><li>Phase I and II </li></ul></ul></ul><ul><ul><li>Pandemic alert </li></ul></ul><ul><ul><ul><li>Phase III, IV, V </li></ul></ul></ul><ul><ul><li>Pandemic period </li></ul></ul><ul><ul><ul><li>Phase VI </li></ul></ul></ul>

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