COMMUNICABLE-DISEASE-NURSING Reviewer.pdf

5 Communicable Disease Nursing
I. EPI DISEASES
DISEASE CAUSATIVE AGENT
MODE OF
TRANSMISSION
PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
1. Tuberculosis
Other names:
Koch’s Disease
Consumption
Phthisis
Weak lungs
Mycobacterium tuberculosis
TB bacillus
Koch’s bacillus
Mycobacterium bovis
(rod-shaped)
Airborne-droplet
Direct invasion through
mucous membranes and
breaks in the skin (very
rare)
Incubation period :
4 – 6 weeks
1. Usually asymptomatic
2. Low-grade afternoon fever
3. Night sweating
4. Loss of appetite
5. Weight loss
6. Easy fatigability – due to
increased oxygen demand
7. Temporary amenorrhea
8. Productive dry cough
9. Hemoptysis
Diagnostic test:
Sputum examination or the Acid-fast bacilli (AFB) /
sputum microscopy
1. Confirmatory test
2. Early morning sputum about 3-5 cc
3. Maintain NPO before collecting sputum
4. Give oral care after the procedure
5. Label and immediately send to laboratory
6. If unknown when was the sputum collected,
discard
Chest X-ray is used to:
1. Determine the clinical activity of TB, whether it is
inactive (in control) or active (ongoing)
2. To determine the size of the lesion:
a. Minimal – very small
b. Moderately advance – lesion is < 4 cm
c. Far advance – lesion is > 4 cm
Tuberculin Test – purpose is to determine the history
of exposure to tuberculosis
Other names:
Mantoux Test – used for single screening, result
interpreted after 72 hours
Tine test – used for mass screening read after 48 hours
Interpretation:
0 - 4 mm induration – not significant
5 mm or more – significant in individuals who are
considered at risk; positive for patients who are HIV-
positive or have HIV risk factors and are of unknown
HIV status, those who are close contacts with an active
case, and those who have chest x-ray results consistent
with tuberculosis.
10 mm or greater – significant in individuals who
have normal or mildly impaired immunity
Respiratory precautions
Cover the mouth and nose
when sneezing to avoid
mode of transmission
Give BCG
Improve social conditions
TREATMENT: SCC/Short Course Chemotherapy, Direct –observed treatment short course/DOTS;
Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), Streptomycin (S)
CATEGORY 1: 6
months SCC
Indications:
> new (+) smear
> (-) smear PTB with
extensive
parenchymal lesions
on CXR
> Extrapulmonary TB
> severe concominant
HIV disease
Intensive Phase: 2
months
R&I : 1 tab each; P&E
2 tabs each
Continuation Phase:
4 months
R&I : 1 tab each
CATEGORY 2: 8
months SCC
Indications:
> treatment failure
> relapse
> return after default
Intensive Phase:3 mos
R&I 1 tab each; P&E 2
tabs each
Streptomycin – 1
vial/day IM for first 2
months = 56 vials (if
given for > 2mos can
cause nephrotoxicity
Continuation Phase: 5
months
R&I : 1 tab each
E : 2 tabs
CATEGORY 3: 6
months SCC
Indications:
> new (-) smear PTB
with minimal lesions
on CXR
Same meds with
Category 1
Intensive Phase: 2
months
R&I 1 tab each; P&E
2 tabs each
Continuation Phase:
4 months
R&I 1 tab each
CATEGORY 4:
Chronic (*Referral
needed)
SIDE EFFECTS:
Rifampicin
body fluid
discoloration
hepatotoxic
permanent
discoloration of
contact lenses
Isoniazid
Peripheral
neuropathy
(Give Vit
B6/Pyridoxine)
Pyrazinamide
hyperuricemia /gouty
arthritis (increase fluid
intake)
SIDE EFFECTS:
Ethambutol
Optic neuritis
Blurring of vision
(Not to be givento
children below 5 y.o. due
to inability to complain
blurring of vision)
Inability to recognize
green from blue
Streptomycin
Damage to 8th
CN
Ototoxic
Tinnitus
nephrotoxic
Most hazardous period for development of clinical
disease is the first 6-12 months after infection
Highest risk of developing disease is children under
3years old

NATIONAL TB CONTROL PROGRAM:
Vision: A country where TB is no longer a public health problem
Mission: Ensure that TB DOTS Services are available, accessible, and
affordable to the communities in collaboration with LGUs and others
Goal: To reduce prevalence and mortality from TB by half by the year 2015
(Millennium Development Goal)
Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered
2. Detect at least 70% new sputum smear (+) TB cases
Objectives: 1. Improve access to and quality of services
2. Enhance stakeholder’s health-seeking behavior
3. Increase and sustain support for TB control activities
4. Strengthen management of TB control activities at all levels
KEY POLICIES:
*Case finding:
- DSSM shall be the primary diagnostic tool in NTP case finding
- No TB Dx shall be made based on CXR results alone
- All TB symptomatic shall be asked to undergo DSSM before treatment
- Only contraindication for sputum collection is hemoptysis
- PTB symptomatic shall be asked to undergo other tests (CXR and culture),
only after three sputum specimens yield negative results in DSSM
- Only trained med techs / microscopists shall perform DSSM
- Passive case finding shall be implemented in all health stations
*Treatment: Domiciliary treatment – preferred mode of care
DSSM – basis for treatment of all TB cases
*Hospitalization is recommended: massive hemoptysis, pleural effusion,
military TB, TB meningitis, TB pneumonia, & surgery is needed or with
complications
*All patients undergoing treatment shall be supervised
*National & LGUs shall ensure provision of drugs to all smear (+) TB cases
*Quality of fixed-dose combination (FDC) must be ensured
*Treatment shall be based on recommended category of treatment regimen
DOTS Strategy – internationally-recommended TB control strategy
Five Elements of DOTS: (RUSAS)
Recording & reporting system enabling outcome assessment of all patients
Uninterrupted supply of quality-assured drugs
Standardized SCC for all TB cases
Access to quality-assured sputum microscopy
Sustained political commitment
s
MANAGEMENT OF CHILDREN WITH TUBERCULOSIS
Prevention: BCG immunization to all infants (EPI)
Casefinding:
- cases of TB in children are reported and identified in 2
instances: (a) patient was screened and was found symptomatic
of TB after consultaion (b) patient was reported to have been
exposed to an adult TB patient
- ALL TB symptomatic children 0-9 y.o, EXCEPT sputum
positive child shall be subjected to Tuberculin testing (Note:
Only a trained PHN or main health center midwife shall do
tuberculin testing and reading which shall be conducted once a
week either on a Monday or Tuesday. Ten children shall be
gathered for testing to avoid wastage.
- Criteria to be TB symptomatic (any three of the following:)
* cough/wheezing of 2 weeks or more
* unexplained fever of 2 weeks or more
* loss of appetite/loss of weight/failure to gain weight/weight
faltering
* failure to respond to 2 weeks of appropriate antibiotic therapy
for lower respiratory tract infection
* failure to regain previous state of health 2 weeks after a viral
infection or exanthem (e.g. measles)
-Conditions confirming TB diagnosis (any 3 of the following:)
* (+) history of exposure to an adult/adolescent TB case
* (+) signs and symptoms suggestive of TB
* (+) tuberculin test
* abnormal CXR suggestive of TB
* Lab findings suggestive or indicative of TB
- for children with exposure to TB
* a child w/ exposure to a TB registered adult patient shall
undergo physical exam and tuberculin testing
* a child with productive cough shall be referred for sputum
exam, for (+) sputum smear child, start treatment immediately
* TB asymptomatic but (+) tuberculin test and TB symptomatic
but (-) tuberculin test shall be referred for CXR examination
- for TB symptomatic children
*a TB symptomatic child with either known or
unknown exposure to a TB case shall be referred
for tuberculin testing
* (+) contact but (-) tuberculin test and unknown
contact but (+) tuberculin test shall be referred for
CXR examination
*(-) CXR, repeat tuberculin test after 3 months
* INH chemoprophylaxis for three months shall be
given to children less than 5y.o. with (-) CXR; after
which tuberculin test shall be repeated
Treatment (Child with TB):
Short course regimen
PULMONARY TB
Intensive: 3 anti-TB drugs (R.I.P.) for 2 months
Continuation: 2 anti-TB drugs (R&I) for 4 months
EXTRA-PULMONARY TB
Intensive: 4 anti-TB drugs (RIP&E/S) for 2 months
Continuation: 2 anti-TB drugs (R&I) for 10 months

2. Diphtheria
Types:
> nasal
> pharyngeal – most
common
> laryngeal – most
fatal due to proximity
to epiglottis
Corynebacterium diphtheria
Klebbs-loffler
Droplet especially
secretions from mucous
membranes of the nose
and nasopharynx and
from skin and other
lesions
Milk has served as a
vehicle
Incubation Period:
2 – 5 days
Pseudomembrane – mycelia of
the oral mucosa causing
formation of white membrane on
the oropharynx
Bull neck
Dysphagia
Dyspnea
Diagnostic test:
Nose/throat swab
Moloney’s test – a test for hypersensitivity to diphtheria
toxin
Schick’s test – determines susceptibility to bacteria
Drug-of-Choice:
Erythromycin 20,000 - 100,000 units IM once only
Complication: MYOCARDITIS (Encourage bed rest)
DPT immunization
Pasteurization of milk
Education of parents
3. Pertussis
Whooping cough
Tusperina
No day cough
Bordetella pertussis
Hemophilus pertussis
Bordet-gengou bacillus
Pertussis bacillus
Droplet especially from
laryngeal and bronchial
secretions
Incubation Period: 7 –
10 days but not
exceeding 21 days
(because if more than 21
days, the cough can be
related to TB or lung
cancer)
Catarrhal period: 7 days
paroxysmal cough followed by
continuous nonstop
accompanied by vomiting
Complication: abdominal hernia
Diagnostic:
Bordet-gengou agar test
Management:
1. DOC: Erythromycin or Penicillin 20,000 - 100,000 units
2. Complete bed rest
3. Avoid pollutants
4. Abdominal binder to prevent abdominal hernia
DPT immunization
Booster: 2 years and 4-5 years
Patient should be segregated until
after 3 weeks from the
appearance of paroxysmal cough
4. Tetanus
Other names:
Lock jaw
Clostridium tetani – anaerobic
spore-forming heat-resistant and
lives in soil or intestine
Neonate: umbilical cord
Children: dental caries
Adult: punctured wound; after
septic abortion
Indirect contact –
inanimate objects, soil,
street dust, animal and
human feces, punctured
wound
Incubation Period:
Varies from 3 days to 1
month, falling between 7
– 14 days
Risus sardonicus (Latin: “devil
smile”) – facial spasm; sardonic
grin
Opisthotonus – arching of back
For newborn:
1. Difficulty of sucking
2. Excessive crying
3. Stiffness of jaw
4. Body malaise
No specific test, only a history of punctured wound
Treatment:
Antitoxin
antitetanus serum (ATS)
tetanus immunoglobulin (TIG)
Pen G
Diazepam – for muscle spasms
Note: The nurse can give fluid provided that the patient is able
to swallow. There is risk of aspiration. Check first for the gag
reflex
DPT immunization
Tetanus toxoid immunization
among pregnant women
Licensing of midwives
Health education of mothers
5. Poliomyelitis
Other name:
Infantile paralysis
Legio debilitans
Polio virus
Enterovirus
Attacks the anterior horn of the
neuron, motor is affected
Man is the only reservoir
Fecal – oral route
Incubation period: 7 –
21 days
Paralysis
Muscular weakness
Uncoordinated body movement
Hoyne’s sign – head lag after 4
months
(!Safety)
Diagnostic test:
CSF analysis / lumbar tap
Pandy’s test
Management:
Rehabilitation involves ROM exercises
OPV vaccination
Frequent hand washing
Incidence: highest under 7 years of age
Mortality: highest among infants (<6 months)
One attack confers definite and prolonged
immunity. Second attack occasionally occurs

6. Measles
Other names:
Morbilli
Rubeola
RNA containing paramyxovirus Droplet secretions from
nose and throat
Incubation period: 10
days – fever
14 days – rashes appear
Period of
Communicability:
4 days before and 5 days
after the appearance of
rash
1. Koplik’s spots –
whitish/bluish pinpoint patches
on the buccal cavity
2. cephalocaudal appearance of
maculopapular rashes
3. Stimson’s line – bilateral red
line on the lower conjunctiva
No specific diagnostic test
Management:
Supportive and symptomatic
Measles vaccine
Disinfection of soiled articles
Isolation of cased from diagnosis
until about 5-7 days after onset of
rash
7. Hepatitis B
Other names:
Serum Hepatitis
Hepatitis B virus Blood and body fluids
Placenta
Incubation period:
45 – 100 days
1. Right-sided Abdominal pain
2. Jaundice
3. Yellow-colored sclera
4. Anorexia
5. Nausea and vomiting
6. Joint and Muscle pain
7. Steatorrhea
8. Dark-colored urine
9. Low grade fever
Diagnostic test:
Hepatitis B surface agglutination (HBSAg) test
Management:
> Hepatitis B Immunoglobulin
Diet: high in carbohydrates
-Hepatitis B immunization
-Wear protected clothing
-Hand washing
-Observe safe-sex
-Sterilize instruments used in
minor surgical-dental procedures
-Screening of blood products for
transfusion
Hepatitis A – infectious hepatitis; oral-fecal
Hepatitis B – serum hepatitis; blood and body fluids
Hepatitis C – non-A non-B, post-transfusion hepatitis; blood and body fluids
Hepatitis D – Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis B
Hepatitis E – oral-fecal
II. DISEASES TRANSMITTED THROUGH FOOD AND WATER
MODE OF
TRANSMISSION
1. Cholera
Other names:
El tor
Vibrio cholera
Vibrio coma
Ogawa and Inaba bacteria
Fecal-oral route
5 Fs
Incubation Period:
Few hours to 5 days;
usually 3 days
Rice watery stool
Period of Communicability:
7-14 days after onset,
occasionally 2-3 months
Diagnostic Test:
Stool culture
Treatment:
Oral rehydration solution (ORESOL)
IVF
Drug-of-Choice: tetracycline (use straw; can cause staining of
teeth)
Proper handwashing
Proper food and water sanitation
Immunization of Chole-vac
2. Amoebic Dysentery Entamoeba histolytica
Protozoan (slipper-shaped body)
Fecal-oral route Abdominal cramping
Bloody mucoid stool
Tenesmus - feeling of
incomplete defecation
Treatment:
Metronidazole (Flagyl)
* Avoid alcohol because of its Antabuse effect can cause
Proper handwashing

(Wikipedia) vomiting
3. Shigellosis
Other names:
Bacillary dysentery
Shigella bacillus
Sh-dysenterae – most infectious
Sh-flesneri – common in the
Philippines
Sh-connei
Sh-boydii
Fecal-oral route
5 Fs: Finger, Foods,
Feces, Flies, Fomites
Incubation Period:
1 day, usually less than 4
days
Abdominal cramping
Bloody mucoid stool
Tenesmus - feeling of
incomplete defecation
(Wikipedia)
Drug-of-Choice: Co-trimoxazole
Diet: Low fiber, plenty of fluids, easily digestible foods
Proper handwashing
Fly control
4. Typhoid fever Salmonella typhosa (plural,
typhi)
Fecal-oral route
5 Fs
Incubation Period:
Usual range 1 to 3
weeks, average 2 weeks
Rose Spots in the abdomen –
due to bleeding caused by
perforation of the Peyer’s
patches
Ladderlike fever
Diagnostic Test:
Typhi dot – confirmatory test; specimen is feces
Widal’s test – agglutination of the patient’s serum
Drug-of-Choice: Chloramphenicol
Proper handwashing
5. Hepatitis A
Other names:
Infectious Hepatitis /
Epidemic Hepatitis /
Catarrhal Jaundice
Hepatitis A Virus Fecal-oral route
5 Fs
Incubation Period:
15-50 days, depending
on dose, average 20-30
days
Fever
Headache
Jaundice
Clay-colored stool
Lymphadenopathy
Anorexia
Prophylaxis: “IM” injection of gamma globulin
Hepatitis A vaccine
Hepatitis immunoglobulin
Complete bed rest – to decrease metabolic needs of liver
Low-fat diet; increase carbohydrates (high in sugar)
Proper handwashing
Proper disposal of urine and feces
Separate and proper cleaning of
articles used by patient
6. Paralytic Shellfish
Poisoning (PSP I Red
tide poisoning)
Dinoflagellates
Phytoplankton
Ingestion of raw of
inadequately cooked
seafood usually bivalve
mollusks during red tide
season
Incubation Period:
30 minutes to several
hours after ingestion
Numbness of face especially
around the mouth
Vomiting and dizziness
Headache
Tingling sensation/paresthesia
and eventful paralysis of
hands
Floating sensation and
weakness
Rapid pulse
Dysphonia
Dysphagia
Total muscle paralysis leading
to respiratory arrest and death
Treatment:
1. No definite treatment
2. Induce vomiting
3. Drink pure coconut milk – weakens the toxic effect
4. Sodium bicarbonate solution (25 grams in ½ glass of
water)
Advised only in the early stage of illness because
paralysis can lead to aspiration
NOTE: Persons who survived the first 12 hours after ingestion
have a greater chance of survival.
1. Avoid eating shellfish such as
tahong, talaba, halaan,
kabiya, abaniko during red
tide season
2. Don’t mix vinegar to
shellfish it will increase toxic
effect 15 times greater
ROBERT C. REÑA, BSN

III. SEXUALLY TRANSMITTED DISEASES
MODE OF
TRANSMISSION
1. Syphilis
Other names:
Sy
Bad Blood
The pox
Lues venereal
Morbus gallicus
Treponema pallidum
(a spirochete)
Direct contact
Transplacental
Incubation Period:
10 days to 3 months
(average of 21 days)
Primary stage: painless chancre
at site of entry
Buboes
Condylomata
Gumma
Diagnostic test:
Dark field illumination test
Fluorescent treponemal antibody absorption test – most
reliable and sensitive diagnostic test for Syphilis
VDRL slide test, CSF analysis, Kalm test,
Wasseman test
Treatment:
Drug of Choice: Penicillin (Tetracycline if resistant to
Penicillin)
Abstinence
Be faithful
Condom
2. Gonorrhea
Other names:
GC, Clap, Drip,
Stain, Gleet,
Flores Blancas
Neiserria gonorrheae Direct contact – genitals,
anus, mouth
Incubation Period:
2 – 10 days
Thick purulent yellowish
discharge
Burning sensation upon
urination / dysuria
Diagnostic test:
Culture of urethral and cervical smear
Gram staining
Treatment:
Drug of Choice: Penicillin
Abstinence
Be faithful
Condom
3. Trichomoniasis
Other names:
Vaginitis
Trich
Trichomonas vaginalis Direct contact
Incubation Period:
4 – 20 days; average of 7
days
Females:
white or greenish-yellow
odorous discharge
vaginal itching and soreness
painful urination
Males:
Slight itching of penis
Painful urination
Clear discharge from penis
Diagnostic Test:
Culture
Treatment:
Drug of Choice: Metronidazole (Flagyl)
Abstinence
Be faithful
Condom
Personal Hygiene
4. Chlamydia Chlamydia trachomatis
(a rickettsia)
Direct contact
Incubation Period:
2 to 3 weeks for males;
usually no symptoms for
females
Females:
Asymptomatic
Dyspareunia
Fishy vaginal discharge
Males:
Burning sensation during
urination
Burning and itching of urethral
opening (urethritis)
Diagnostic Test:
Culture
Treatment:
Drug of Choice: Tetracycline
Abstinence
Be faithful
Condom
5. Candidiasis
Other names:
Moniliasis
Candidosis
Candida albicans Direct contact White, cheese-like vaginal
discharges
Curd like secretions
Diagnostic Test:
Culture
Gram staining
Treatment:
Nystatin for oral thrush
Cotrimazole, fluconazole for mucous membrane and vaginal
infection
Abstinence
Be faithful
Condom
Primary and secondary sores will go even without treatment but the germs continue
to spread throughout the body. Latent syphilis may continue 5 to 20+ years with NO
symptoms, but the person is NO longer infectious to other people. A pregnant
mother can transmit the disease to her unborn child (congenital syphilis).

Fluconazole or amphotericin for systemic infection
6. Acquired immune
deficiency syndrome
(AIDS)
Retrovirus (Human
T-cell lymphotrophic virus 3 or
HTLV 3)
Attacks the T4 cells: T-helper
cells; T-lymphocytes, and CD4
lymphocytes
Direct contact
Blood and body fluids
Transplacental
Incubation period:
3-6 months to 8-10 years
Variable. Although the
time from infection to the
development of
detectable antibodies is
generally 1-3 months, the
time from HIV infection
to diagnosis of AIDS has
an observed range of less
than 1 year to 15 years or
longer.
(PHN Book)
1. Window Phase
a. initial infection
b. lasts 4 weeks to 6 months
c. not observed by present
laboratory test (test should be
repeated after 6 months)
2. Acute Primary HIV
Infection
a. short, symptomatic period
b. flu-like symptoms
c. ideal time to undergo
screening test (ELISA)
3. Asymptomatic HIV
Infection
a. with antibodies against HIV
but not protective
b. lasts for 1-20 years depending
upon factors
4. ARC (AIDS Related
Complex)
a. a group of symptoms
indicating the disease is likely to
progress to AIDS
b. fever of unknown origin
c. night sweats
d. chronic intermittent diarrhea
e. lymphadenopathy
f. 10% body weight loss
5. AIDS
a. manifestation of severe
immunosuppression
b. CD4 Count: <200/dL
c. presence of variety of
infections at one time:
oral candidiasis
leukoplakia
AIDS dementia complex
Acute encephalopathy
Diarrhea, hepatitis
Anorectal disease
Diagnostic tests:
Enzyme-Linked Immuno-Sorbent Assay (ELISA)
- presumptive test
Western Blot – confirmatory
Treatment:
1. Treatment of opportunistic infection
2. Nutritional rehabilitation
3. AZT (Zidovudine) – retards the replication of
retrovirus
4. PK 1614 - mutagen
Abstinence
Be faithful
Condom
Sterilize needles, syringes, and
instruments used for cutting
operations
Proper screening of blood donors
Rigid examination of blood and
other blood products
Avoid oral, anal contact and
swallowing of semen
Avoid promiscuous sexual
contact
HIV/AIDS Prevention and
Control Program:
Goal: Contain the transmission of
HIV /AIDS and other
reproductive tract infections and
mitigate their impact

Cytomegalovirus
Pneumonocystis carinii
pneumonia (fungal)
TB
Kaposi’s sarcoma (skin cancer;
bilateral purplish patches)
Herpes simplex
Pseudomonas infection
Blindness
Deafness
ROBERT C. REÑA, BS
IV. ERUPTIVE DISEASES
MODE OF
TRANSMISSION
1. Chickenpox
Other names:
Varicella
Human (alpha) herpes virus 3
(varicella-zoster virus), a
member of the Herpesvirus
group
Not more than one day before
and more than 6 days after
appearance of the first crop of
vesicles
Droplet spread
Direct contact
Indirect through articles
freshly soiled by discharges
of infected persons
Incubation Period:
2-3 weeks, commonly 13 to
17 days
Vesiculo-pustular rashes
Centrifugal appearance of rashes
Pruritus
No specific diagnostic exam
Treatment is supportive and symptomatic; infection viral in
origin, and therefore is self-limiting
Drug-of-choice:
Acyclovir (orally to reduce the number of lesions; topically to
lessen the pruritus)
Case over 15 years of age should
be investigated to eliminate
possibility of smallpox.
Report to local authority
Isolation
Concurrent disinfection of throat
and nose discharges
Exclusion from school for 1
week after eruption first appears
Avoid contact with susceptibles
2. German Measles
Other Names:
Rubella
Three-day Measles
Rubella virus or RNA-
containing Togavirus
German measles is teratogenic
infection.
Droplet
Incubation Period:
Three (3) days
Forscheimer spots – red
pinpoint patches on the oral
cavity
Maculopapular rashes
Headache
Low-grade fever
Sore throat
Diagnostic Test:
Rubella Titer (Normal value is 1:10)
Instruct the mother to avoid pregnancy for three months after
receiving MMR vaccine.
MMR vaccine (live attenuated
virus)
- Derived from chick embryo
Contraindication:
- Allergy to eggs
- If necessary, given in divided
or fractionated doses and
epinephrine should be at the
bedside.
3. Herpes Zoster
Other names:
Shingles
Cold sores
Herpes zoster virus
(dormant varicella zoster virus)
Droplet
Direct contact from secretion
Painful vesiculo-pustular lesions
on limited portion of the body
(trunk and shoulder)
Low-grade fever
Treatment is supportive and symptomatic
Acyclovir to lessen the pain
Avoidance of mode of
transmission
4. Dengue
Hemorrhagic Fever
Other names:
H-fever
Dengue virus 1, 2, 3, and 4 and
Chikungunya virus
Period of communicability:
Unknown. Presumed to be on
Bite of infected mosquito
(Aedes Aegypti)
Daytime biting
Low flying
Classification (WHO):
Grade I:
a. flu-like symptoms
b. Herman’s sign
Diagnostic Test:
Torniquet test (Rumpel Leads Test / capillary fragility test) –
PRESUMPTIVE; positive when 20 or more oetechiae per 2.5
cm square or 1 inch square are observed
4 o’clock habit
Chemically treated mosquito net
Larva eating fish
Environmental sanitation

the 1st
week of illness up to
when the virus is still present in
the blood
Occurrence is sporadic
throughout the year
Epidemic usually occur during
the rainy seasons (June to
November)
Peak months: September and
October
Stagnant clear water
Urban
Incubation Period:
Uncertain. Probably 6 days to
1 week
Manifestations:
First 4 days:
Febrile/Invasive Stage
- starts abruptly as fever
- abdominal pain
- headache
- vomiting
- conjunctival infection
-epistaxis
4th
– 7th
days:
Toxic/Hemorrhagic Stage
- decrease in temperature
- severe abdominal pain
- GIT bleeding
- unstable BP (narrowed pulse
pressure)
- shock
- death may occur
7th
– 10th
days:
Recovery/Convalescent
Stage
- appetite regained
- BP stable
c. (+) tourniquet sign
Grade II:
a. manifestations of Grade I plus
spontaneous bleeding
b. e.g. petechiae, ecchymosis
purpura, gum bleeding
Grade III:
a. manifestations of Grade II
plus beginning of circulatory
failure
b. hypotension, tachycardia,
tachypnea
Grade IV:
a. manifestations of Grade III
plus shock (Dengue Shock
Syndome)
Platelet count – CONFIRMATORY; (Normal is 150 - 400 x
103
/ mL)
Treatment:
Paracetamol for fever
Analgesic for pain
Rapid replacement of body fluids – most important treatment
ORESOL
Blood tansfusion
Diet: low-fat, low-fiber, non-irritating, non-carbonated.
Noodle soup may be given. ADCF (Avoid Dark-Colored
Foods)
ALERT! No Aspirin
Antimosquito soap
Neem tree (eucalyptus)
Eliminate vector
Avoid too many hanging clothes
inside the house
Residual spraying with
insecticide
V. VECTOR-BORNE DISEASES
MODE OF
TRANSMISSION
1. Malaria Plasmodium Parasites:
Vivax
Falciparum (most fatal; most
common in the Philippines)
Ovale
Malariae
Bite of infected anopheles
mosquito
Night time biting
High-flying
Rural areas
Clear running water
Cold Stage: severe, recurrent
chills (30 minutes to 2 hours)
Hot Stage: fever (4-6 hours)
Wet Stage: Profuse sweating
- intermittent chills and
Early Diagnosis and Prompt Treatment
Early diagnosis – identification of a patient with malaria as
soon as he is seen through clinical and/or microscopic method
Clinical method – based on signs and symptoms of the patient
and the history of his having visited a malaria-endemic area
Microscopic method – based on the examination of the blood
smear of patient through microscope (done by the medical
technologist)
*CLEAN Technique
*Insecticide – treatment of
mosquito net
*House Spraying (night time
fumigation)
*On Stream Seeding –
construction of bio-ponds for
fish propagation (2-4 fishes/m2

sweating
- anemia / pallor
- tea-colored urine
- malaise
- hepatomegaly
- splenomegaly
- abdominal pain and
enlargement
- easy fatigability
NURSING CARE:
1. TSB (Hot Stage)
2. Keep patent warm (Cold
Stage)
3. Change wet clothing (Wet
Stage)
4. Encourage fluid intake
5. Avoid drafts
QBC/quantitative Buffy Coat – fastest
Malarial Smear – best time to get the specimen is at height of
fever because the microorganisms are very active and easily
identified
Chemoprophylaxis
Only chloroquine should be given (taken at weekly intervals
starting from 1-2 weeks before entering the endemic area). In
pregnant women, it is given throughout the duration of
pregnancy.
Treatment:
Blood Schizonticides - drugs acting on sexual blood stages of
the parasites which are responsible for clinical manifestations
1. QUININE – oldest drug used to treat malaria; from
the bark of Cinchona tree; ALERT: Cinchonism –
quinine toxicity
2. CHLOROQUINE
3. PRIMAQUINE
4. FANSIDAR – combination of pyrimethamine and
sulfadoxine
for immediate impact; 200-
400/ha. for a delayed effect)
*On Stream Clearing – cutting
of vegetation overhanging along
stream banks
*Avoid outdoor night activities
(9pm – 3am)
*Wearing of clothing that covers
arms and legs in the evening
*Use mosquito repellents
*Zooprophylaxis – typing of
domestic animals like the
carabao, cow, etc near human
dwellings to deviate mosquito
bites from man to these animals
Intensive IEC campaign
2. Filariasis
Other names:
Elephantiasis
Endemic in 45 out of
78 provinces
Highest prevalence
rates: Regions 5, 8, 11
and CARAGA
Wuchereria bancrofti
Brugia malayi
Brugia timori
– nematode parasites
Bite of Aedes poecillus
(primarily)
Aedes flavivostris
(secondary)
Incubation period:
8 – 16 months
Asymptomatic Stage:
Presence of microfilariae in the
blood but no clinical signs and
symptoms of disease
Acute Stage:
Lymphadenitis
Lymphangitis
Affectation of male genitalia
Chronic Stage: (10-15 years
from onset of first attack)
Hydrocele
Lymphedema
Elephantiasis
Diagnosis
Physical examination, history taking, observation of major and
minor signs and symptoms
Laboratory examinations
Nocturnal Blood Examination (NBE) – blood are taken from
the patient at his residence or in hospital after 8:00 pm
Immunochromatographic Test (ICT) – rapid assessment
method; an antigen test that can be done at daytime
Treatment:
Drug-of-Choice: Diethylcarbamazine Citrate (DEC) or
Hetrazan
CLEAN Technique
Use of mosquito repellents
Anytime fumigation
Wear a long sleeves, pants and
socks
3. Shistosomiasis
Other Names:
Snail Fever
Bikharziasis
Endemic in 10 regions
and 24 provinces
Schistosoma mansoni
S. haematobium
S. japonicum (endemic in the
Philippines)
Contact with the infected
freshwater with cercaria and
penetrates the skin
Vector: Oncomelania
Quadrasi
Diarrhea
Bloody stools
Enlargement of abdomen
Splenomegaly
Hepatomegalu
Anemia
weakness
Diagnostic Test:
COPT or cercum ova precipitin test
Treatment:
Drug-of-Choice: PRAZIQUANTEL (Biltracide)
Oxamniquine for S. mansoni
Metrifonate for S. haematobium
Dispose the feces properly not
reaching body of water
Use molluscides
Prevent exposure to
contaminated water (e.g. use
rubber boots)
Apply 70% alcohol immediately
to skin to kill surface cercariae
Allow water to stand 48-72

High prevalence:
Regions 5, 8, 11
hours before use
REFERENCES:
THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN
CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th
EDITION
DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov
VI. DISEASES TRANSMITTED BY ANIMALS
MODE OF
TRANSMISSION
1. Leptospirosis
Other Names:
- Weil’s Disease
- Mud Fever
- Trench Fever
- Flood Fever
- Spirochetal
Jaundice
- Japanese Seven
Days fever
Leptospira interrogans –
bacterial spirochete
RAT is the main host. Although
pig, cattle, rabbits, hare, skunk,
and other wild animals can also
serve as reservoir
Occupational disease affecting
veterinarians, miners, farmers,
sewer workers, abattoir workers,
etc
Through contact of the skin,
especially open wounds with
water, moist soil or
vegetation infected with urine
of the infected host
Incubation Period:
7-19 days, average of 10 days
Leptospiremic Phase
- leptospires are present in
blood and CSF
- onset of symptoms is abrupt
- fever
- headache
- myalgia
- nausea
- vomiting
- cough
- chest pain
Immune Phase
- correlates with the appearance
of circulating IgM
Diagnosis
Clinical manifestations
Culture of organism
Examination of blood and CSF during the first week of illness
and urine after the 10th
day
Leptospira agglutination test
Treatment:
Penicillins and other related B-lactam antibiotics
Tetracycline (Doxycycline)
Erythromycin
Protective clothing, boots and
gloves
Eradication of rats
Segregation of domestic animals
Awareness and early diagnosis
Improved education of people
2. Rabies
Other Names:
Lyssa
Hydrophobia
Le Rage
Rhabdovirus of the genus
lyssavirus
Degeneration and necrosis of
brain – formation of negri bodies
Two kinds of Rabies:
a. Urban or canine – transmitted
by dogs
b. Sylvatic – disease of wild
animals and bats which
sometimes spread to dogs, cats,
and livestock
Bite or scratch (very rare) of
rabid animal
Non-bite means: leaking,
scratch, organ transplant
(cornea), inhalation/airborne
(bats)
Source of infection: saliva of
infected animal or human
Incubation period:
2 – 8 weeks, can be years
depending on severity of
wounds, site of wound as
distance from brain, amount
of virus introduced, and
protection provided by
Sense of apprehension
Headache
Fever
Sensory change near site of
animal bite
Spasms of muscles of
deglutition on attempts to
swallow
Fear of water/hydrophobia
Paralysis
Delirium
Convulsions
“FATAL once signs and
symptoms appear”
Diagnosis:
history of bite of animal
culture of brain of rabid animal
demonstration of negri bodies
Management:
*Wash wound with soap immediately. Antiseptics e.g.
povidone iodine or alcohol may be applied
*Antibiotics and anti-tetanus immunization
*Post exposure treatment: local wound treatment, active
immunization (vaccination) and passive immunization
(administration of rabies immunoglobulin)
*Consult a veterinarian or trained personnel to observe the pet
for 14 days
*Without medical intervention, the rabies victim would
usually last only for 2 to 6 days. Death is often due to
Have pet immunized at 3
months of age and every year
thereafter
Never allow pets to roam the
streets
Take care of your pet
National Rabies Prevention
and Control Program
Goal: Human rabies is
eliminated in the Philippines
and the country is declared
rabies-free

clothing respiratory paralysis.
3. Bubonic Plague Bacteria (Yersinia pestis)
Vector: rat flea
Direct contact with the
infected tissues of rodents
Fever and lyphadenitis Streptomycin, tetracycline, chloramphenicol Environmental Sanitation
VII. DISEASES OF THE SKIN
MODE OF
TRANSMISSION
1. Leprosy
Other names:
Hansenosis
Hansen’s disease
-an ancient disease
and is a leading cause
of permanent physical
disability among the
communicable
diseases
Mycobacterium leprae Airborne-droplet
Prolonged skin-to-skin
contact
Early signs:
Change in skin color – either reddish or
white
Loss of sensation on the skin lesion
Loss of sweating and hair growth
Thickened and painful nerves
Muscle weakness or paralysis or
extremities
Pin and redness of the eyes
Nasal obstruction or bleeding
Ulcers that do not heal
Late Signs:
Madarosis
Loss of eyebrows
Inability to close eyelids
(lagophthalmos)
Clawing of fingers and toes
Contractures
Chronic ulcers
Sinking of the nosebridge
Enlargement of the breast
(gynecomastia)
Diagnostic Test:
Slit Skin Smear - determines the presence of M. leprae;
optional and done only if clinical diagnosis is doubtful to
prevent misclassification and wrong treatment
Lepromin Test – determines susceptibility to leprosy
Treatment:
Ambulatory chemotherapy through use of MDT
Domiciliary treatment as embodied in RA 4073 which
advocates home treatment
PAUCIBACILLARY (tuberculoid and indeterminate);
noninfectious type
Duration of treatment: 6 to 9 months
Procedure:
Supervised: Rifampicin and Dapsone once a month on the
health center supervised by the rural health midwife
Self-administered: Dapsone everyday at the client’s house
MULTIBACILLARY (lepromatous and borderline); infectious
type
Duration of treatment: 24-30 months
Procedure:
Supervised: Rifampicin, Dapsone, and Lamprene (Clofazimine)
once a month on the health center supervised by the rural health
midwife
Self-administered: Dapsone and Lamprene everyday at the
client’s house
Avoid prolonged skin-to-skin
contact
BCG vaccination – practical
and effective preventive
measure against leprosy
Good personal hygiene
Adequate nutrition
Health education

2. Anthrax
Other names:
Malignant pustule
Malignant edema
Woolsorter disease
Ragpicker disease
Charbon
Bacillus anthracis
Incubation period:
few hours to 7 days most
cases occur within 48 hours
of exposure
Contact with
a. tissues of animals
(cattle, sheep, goats,
horses, pigs, etc.) dying
of the disease
b. biting flies that had
partially fed on such
animals
c. contaminated hair,
wool, hides or products
made from them e.g.
drums and brushes
d. soil associated with
infected animals or
contaminated bone meal
used in gardening
1. Cutaneous form – most common
- itchiness on exposed part
- papule on inoculation site
- papule to vesicle to eschar
- painless lesion
2. Pulmonary form – contracted from
inhalation of B. anthracis spores
- at onset, resembles common URTI
- after 3-5 days, symptoms become
acute, with fever, shock, and death
3. Gastrointestinal anthrax –
contracted from ingestion of meat from
infected animal
- violent gastroenteritis
- vomiting
- bloody stools
Treatment: Penicillin Proper handwahing
Immunize with cell-free
vaccine prepared from culture
filtrate containing the
protection antigen
Control dust and proper
ventilation
3. Scabies Sarcoptes scabiei
- An itch mite
parasite
Direct contact with
infected individuals
Incubation Period:
24 hours
Itching
When secondarily infected:
Skin feels hot and burning
When large and severe: fever, headache,
and malaise
Diagnosis:
Appearance of the lesion
Intense itching
Finding of causative mite
Treatment: (limited entirely to the skin)
Examine the whole family before undertaking treatment
Benzyl benzoate emulsion (Burroughs, Welcome) – cleaner to
use and has more rapid effect
Kwell ointment
Personal hygiene
Avoid playing with dogs
Laundry all clothes and iron
Maintain the house clean
Environmental sanitation
Eat the right kind of food
Regular changing of clean
clothing, beddings and towels
4. Pediculosis
Other name:
Phthipiasis
Pediculosis
Capitis (head lice)
Corporis (body lice)
Pubis (crab lice)
Direct contact
Common in school age
Itchiness of the scalp Kwell shampoo (twice a week)
One tbsp water + one tbsp vinegar
Proper hygiene
VIII. INTESTINAL PARASITISM

MODE OF
TRANSMISSION
1. Ascariasis
Other names:
Roundworm
Giant worms
Ascaris lumbricoides
(nematode)
Fecal-oral route
5 Fs: Finger, Foods, Feces,
Flies, Fomites
Pot-bellied
Voracious eater
Thin extremities
Diagnostic Test: Fecalysis
Treatment:
Antihelminthic: Mebendazole / Pyrantel Pamoate
Proper handwahing
2. Taeniasis
Other name:
Tape worm
Taenia solium – pork
Taenia saginata – beef
Dyphyllobotruim latum – fish
Eating inadequately cooked
pork or beef
Flies, Fomites
Muscle soreness
Scleral hemorrhage
Treatment:
Antihelminthic: Mebendazole / Pyrantel Pamoate
Proper handwahing
Cook pork and beef adequately
3. Capillariasis
Other name:
Whip worm
Trichuris trichuria
Capillararia Philippinensis
Eating inadequately cooked
seafood
Flies, Fomites
Abdominal pain
Diarrhea
borborygmi
Treatment:
Antihelminthic: Mebendazole / Pyrantel pamoate
Proper handwahing
Cook seafoods adequately
4. Enterobiasis
Other name:
Pinworm
Enterobium vermicularis Inhalation of ova
Toilet seat
Infected bedsheets
Flies, Fomites
Nocturnal anal itchiness Diagnostic Test: Fecalysis / tape test
Treatment:
Proper handwahing
Proper disinfection of beddings
5. Ancyloclos-
tomiasis
Other name:
Hookworm
Ancyclostoma duodenal
Necatur americanus
Walking barefooted
Flies, Fomites
Dermatitis
Anemia
Black fishy stool
Treatment:
Proper handwahing
Avoid walking barefooted
IX. OTHER COMMUNICABLE DISEASES
MODE OF
TRANSMISSION
1. Pneumonia
Types:
a. Community
Acquired Pneumonia
(CAP)
b. Hospital /
Nosocomial
c. Atypical
Bacteria:
Pneumococcus, streptococcus
pneumoniae, staphylococcus
aureus, Klebsiella pneumonia
(Friedlander’s bacilli)
Virus:
Haemophilus influenzae
Fungi: Pneumonocystis carinii
pneumonia
Droplet
Incubation Period:
2 – 3 days
Rusty sputum
Fever and chills
Chest pain
Chest indrawing
Rhinitis/common cold
Productive cough
Fast respiration
Vomiting at times
Convulsions may occur
Flushed face
Dilated pupils
Diagnosis:
Based on signs and symptoms
Dull percussion on affected lung
Sputum examination – confirmatory
Chest x-ray
Management:
Bedrest
Adequate salt, fluid, calorie, and vitamin intake
Tepid sponge bath for fever
Frequent turning from side to side
Avoid mode of transmission
Build resistance
Turn to sides
Proper care of influenza cases

Highly colored urine with
reduced chlorides and increased
urates
Antibiotics based on CARI of the DOH
Oxygen inhalation
Suctioning
Expectorants / mucolytics
Bronchodilators
Oral/IV fluids
CPT
2. Mumps
Other name:
Epidemic Parotitis
Mumps virus, a member of
family Paramyxoviridae
Direct contact
Source of infection:
Secretions of mouth and nose
Incubation Period:
12 to 26 days, usually 18 days
Painful swelling in front of the
ear, angle of the jaws and down
the neck
Fever
Malaise
Loss of appetite
Swelling of one or both testicles
(orchitis) in some boys
Sedatives – to relieve pain from orchitis
Cortisone – for inflammation
Diet: Soft or liquid as tolerated
Support the scrotum to avoid orchitis, edema, and atrophy
Dark glasses for photophobia
MMR vaccine
Isolate mumps cases
3. Influenza
Other name:
La Grippe
Influenza virus
A – most common
B – less severe
C – rare
Probably limited to 3 days from
clinical onset
Direct contact
Droplet infection or by
articles freshly soiled with
nasopharyngeal discharges
Airborne
Incubation Period:
Short, usually 24 – 72 hours
Sudden onset
Fever with chills
Headache
Myalgia / arthralgia
Keep patient warm and free from drafts
TSB for fever
Boil soiled clothing for 30 minutes before laundering
Avoid use of common towels,
glasses, and eating utensils
Cover mouth and nose during
cough and sneeze
4. Streptococcal sore
throat
Other name:
Pharyngitis
Tonsillitis
Group A beta hemolytic
streptococcus
Other diseases:
Scarlet fever
St. Anthony fire
Puerperal sepsis
Imoetigo
Acute glumerulonephritis
Rheumatic Heart Disease
Droplet
Complication:
Rheumatic Heart Disease
Sudden onset
High grade fever with chills
Enlarged and tender cervical
lymph nodes
Inflamed tonsils with
mucopurulent exudates
Headache
dysphagia
Diagnosis:
Throat swab and culture
Treatment: erythromycin
Care:
Bed rest
Oral hygiene with oral antiseptic or with saline gargle (1 glass
of warm water + 1 tsp rock salt)
Ice collar
Avoid mode of transmission
5. Meningitis
Other name:
Cerebrospinal fever
Meningococcus
Neisseria meningitides
Direct (Droplet)
Incubation Period:
2 - 10 days
A. Sudden Onset
- high fever accompanied by
chills
- sore throat, headache,
prostration (collapse)
B. entrance into the bloodstream
leading to septicemia
(meningococcemia)
a. rash, petchiae, purpura
Diagnostic Test:
Lumbar puncture or Lumbar tap - reveals CSF WBC and
protein, low glucose; contraindicated for increased ICP for
danger of cranial herniation
Hemoculture – to rule out meningococcemia
Treatment:
Osmotic diuretic (Mannitol) – to reduce ICP and relieve
cerebral edema; Alert: fastdrip to prevent crystallization
Respiratory Isolation

C. Symptoms of menigeal
irritation
- nuchal rigidity (stiff neck) –
earliest sign
- Kernig’s sign – when knees
are flexed, it cannot be extended
- Brudzinski signs – pain on
neck flexion with automatoc
flexion of the knees
- convulsion
- poker soine (poker face / flat
affect)
- Increased ICP
(Cushing’s triad: hypertension,
bradycardia, bradypnea) and
widening pulse pressure
Anti-inflammatory (Dexamethasone) – to relieve cerebral
edema
Antimicrobial (Penicillin)
Anticonvulsany (Diazepam / Valium)
Complications:
Hydrocephalus
Deafness (Refer the child for audiology testing) and mutism
Blindness
IX. KILLER DISEASES OF THE NEW MILLENNIUM
MODE OF
TRANSMISSION
1. Meningococcemia Neisseria meningitides Direct contact with
respiratory droplet from
nose and throat of infected
individuals
Incubation Period:
2 – 10 days
High grade fever in the first
24 hours
Hemorrhagic rash –
petechiae
nuchal rigidity
Kernig’s sign
Brudzinski sign
Shock
Death
Respiratory isolation within 24 hours
Drug-of-Choice: Penicillin
Universal precaution
Chemoprophylaxis
Proper hand washing
2. Severe Acute
Respiratory Syndrome
/ SARS
Earliest case:
Guangdong Province,
China in November
2002
Global outbreak: March
12, 2003
First case in the
Philippines:
April 11, 2003
Coronavirus Close contact with
respiratory droplet
secretion from patient
Incubation Period:
2 – 10 days
Prodromal Phase:
Fever (>38 0
C)
Chills
Malaise
Myalgia
Headache
Infectivity is none to low
Respiratory Phase:
Within 2-7 days, dry
nonproductive cough
progressing to respiratory
distress
No specific treatment
PREVENTIVE MEASURES and CONTROL
1. Establishment of triage
2. Identification of patient
3. Isolation of suspected probable case
4. Tracing and monitoring of close contact
5. Barrier nursing technique for suspected and
probable case
Utilize personal protective
equipment (N95 mask)
Handwashing
Universal Precaution
The patient wears mask
Isolation

3. Bird Flu
Other Name:
Avian Flu
Influenza Virus H5N1 Contact with infected birds
Incubation Period:
3 days, ranges from 2 – 4
days
Fever
Body weakness and body
malaise
Cough
Sore throat
Dyspnea
Sore eyes
Control in birds:
1. Rapid destruction (culling or stamping out of all
infected or exposed birds) proper disposal of carcasses
and quarantining and rigorous disinfection of farms
2. Restriction of movement of live poultry
In humans:
1. Influenza vaccination
2. Avoid contact with poultry animals or migratory
birds
Isolation technique
Vaccination
Proper cooking of poultry
4. Influenza A (H1N1)
Other Name:
Swine Flu
May 21, 2009 – first
confirmed case in the
Philippines
June 11, 2009 - The
WHO raises its
Pandemic Alert Level to
Phase 6, citing
significant transmission
of the virus.
Influenza Virus A H1N1
This new virus was first
detected in people in
April 2009 in the United
States.
Influenza A (H1N1) is
fatal to humans
Exposure to droplets from
the cough and sneeze of
the infected person
Influenza A (H1N1) is not
transmitted by eating
thoroughly cooked pork.
The virus is killed by
cooking temperatures of
160 F/70 C.
Incubation Period:
7 to 10 days
- similar to the symptoms of
regular flu such as
Fever
Headache
Fatigue
Lack of appetite
Runny nose
Sore throat
Cough
- Vomiting or nausea
- Diarrhea
Diagnostic:
Nasopharyngeal (throat) swab
Immunofluorescent antibody testing – to distinguish
influenza A and B
Treatment:
Antiviral medications may reduce the severity and
duration of symptoms in some cases:
Oseltamivir (Tamiflu)
or zanamivir
- Cover your nose and mouth
when coughing and sneezing
- Always wash hands with
soap and water
- Use alcohol- based hand
sanitizers
- Avoid close contact with
sick people
- Increase your body's
resistance
- Have at least 8 hours of
sleep
- Be physically active
- Manage your stress
- Drink plenty of fluids
- Eat nutritious food

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