Communicable diseases

1. Communicable Diseases
By Surg. Capt / Col
ABDUL SHAKOOR PN (R)
MBBS, UCC, DPH, MSC (Ada Medical ADM)
MS (PH)

2. Definition
• Communicable diseases are those illnesses
which can transmit from man to man or
insect/ Animal to man.
• These Diseases are caused by living organisms
called germs. These germs are divided into
number of different groups i.e. Viruses,
Rickettisia, Bacteria and protoza etc.

3. Classification of Communicable
Diseases
• Communicable diseases differ from one
another in a manner of there spread and type
of prevention and control on this basis they
are classified into five groups.
1. Respiratory Diseases
• These diseases are transmitted from the
nose, the mouth, the throat or lungs of
infected individual in the form of droplets
are spread due to cough, sneeze or breath.

4. Examples of Respiratory
diseases
a) Common Cold
b) Sore Throat
c) Meningitis
d) Pneumonia
e) Tuberculosis of lungs
f) Mumps
g) Measles
h) Whooping Cough
i) Diphtheria
j) Covid-19

5. 2. Intestinal Diseases
• Theses diseases are usually transmitted by food or water
that has been contaminated with germ or bacteria
bearing feces or urine of an infected individual or
animals, bacteria go into the body with infected food,
milk or water.
Examples
a) Typhoid
b) Cholera
c) Dysentery
d) Intestinal T.B
e) Infectious Hepatitis

6. 3. Venereal Diseases
• These diseases are transmitted from person to
person by sexual activities
Examples
- AIDS
- Gonorrhoea
- Syphilis

7. 4. Insect Borne Diseases
• These diseases transmitted from One person to
another person by insect
Example
- Malaria
- Typhus
- Yellow Fever

8. 5. Miscellaneous Diseases
• These diseases are included which do not fall
in previous four diseases
Examples
a. Tetanus
b. Scabies
c. Rabies
d. Foot Rot

9. Mode of Transmission of
Communicable Diseases
Chain of Infection
1- Source of infection
• Source of infection may be a case or a carrier
or an animal / insect.
• A person who is actually ill with disease is
called a Case.
• A person who carries germs of disease but does
not himself suffer from it is called a Carrier.

10. 2- Means of Transmission (Vehicle)
• Disease are transmitted by direct or indirect
method
i. Direct Transmission
• In this method transmission of organisms or
germs pass directly from person to person by
a. Physical Contacts
• These Diseases spread by actual physical contact
alone
Example
- Syphilis, gonorrhea, AIDS

11. b. Droplet Infection
• This type of infection occurs when droplets
spreads in coughing, sneezing or even talking
by infected individuals are picked up by
others.
Example
- Common Cold, Sore throat, T.B, Pneumonia

12. 2. In Direct Transmission
• In this method infection take place without
close contact by means of various agents.
a) Insects
b) Flies
c) Mousquetoes
d) Ticks
e) Lies
f) Disease spread from man to insect then to man

13. b) Water and Food
• Diseases which are transmitted by water and
food has become contaminated by faeces,
urine or other infectious material from a
patient or carrier, intestinal diseases are
usually transmitted by contaminated food,
milk or water.

14. c) AIR
• Some of the organisms that are spelled from
the respiratory track of an infected individual
are extremly small and light in weight,
Inhalation of these organisms by other
individual can cause illness.
Example: T.B, Common Cold, Pneumonia

15. d) Fomites
• These are objects or articles which become
contaminated with disease organisms from
infected individual e.g.: Clothing, Bed linen,
eating utensils, handkerchief, toys etc.

16. 3. Susceptible Individuals
• Is that person who has little or no resistance
against a particular organism and who, if
exposed to this organism is liable to contact
the disease.

17. COMMUNICABLE DISEASE

18. COMMUNICABLE DISEASE
“An infectious disease transmissible
(as from person to person) by direct
contact with an affected individual or
the individual's discharges or by
indirect means (as by a vector)”

19. AIR-BORNE DISEASES

20. Outline
• Epidemiology triad
• Chicken pox
• Measles
• Mumps
• Rubella
• MR/MMR vaccines
• Small pox
• Repiratory Diseases

21. Agent Host
Environment
Epidemiological
triad

22. INFECTIOUS CHAIN
 Air borne or droplet or respiratory tract infections:
 Agent : virus, bacteria, fungi.
 Reservoir: mainly man, animal.
 Exit: respiratory secretion.
 Mode of transmission: inhalation
 Inlet: nose, mouth.
 Host: susceptible individual.
AIR- BORNE DISEASES

24. MEASLES

25. MEASLES
Measles is a leading cause
deaths in developing countries
of childhood
Annually around 30 million cases of
Measles are seen and about 9 lakh
children die because of Measles
Measles still kills about million people, annually

26. MEASLES (contd)
Next disease amenable for eradication
Challenges in elimination: Weak
immunization system High infectious
nature Inaccessible population
Increasing refusal of immunization
Changing epidemiology
Gaps in human and financial resources

27. RNA
paramyxovirus
6 months
To 3
years
Seasonal trend
M
easles

28. Period of infectivity

29. CHARACTERISTICS OF RASH
Initial symptoms : high fever (103-105°F) & skin rash
Followed by cough, runny nose, and/or conjunctivitis
Rash usually appears about 14 days
after exposure and lasts 5 - 6 days
It beginsat the hairline, then involves
the face and upper neck
Over next 3 days, rash gradually proceeds
downward
& outward, reaching hands & feet – becomes confluent

30. KOPLIK’S SPOTS

31. RASH IN MEASLES

33. 1. R
espiratory
Otitis media, pneumonia, sec. bact. pneumonia
Laryngitis, croup, bronchitis
2. CNS
Encephalitis – head ache, convulsions, coma
SSPE – slow, months after, MR
3. Gastro-intestinal
Gastro-enteritis, Heapatitis, mescentric adenitis.
Complications of Measles

34. 23
by 50%)
Treatment of Measles
• Isolation for 7 days after the onset of rash
• No specific antiviral treatment.
• Supportive care: good nutrition, adequate fluid intake
and treatment of dehydration.
• Antibiotics: to treat eye and ear infections, and
pneumonia.
• All children diagnosed with measles should receive two
doses of vitamin A supplements, given 24 hours apart.
Vitamin A can help prevent eye damage and blindness.
(Vitamin A supplements reduces the deaths from measles

35. 35
Prevention of Measles
Immunization:
•Eradication can be achieved by immunization rate of
atleast 96% under one year of age
•Ongoing immunization against measles
•Measles vaccination: live attenuated, subcutaneous,0.5
ml, at 9-12 months, life long immunity in 90-99%;
Reactions: Mild fever
•MMR vaccine
•Immunoglobulin(human):with in 3-4 days of exposure

36. 36
Measles outbreak control
• Isolation for 7 days after the onset of rash
• Active Immunization of contacts within 2 days of
exposure (or passive immunization within 3-4
days)
• Prompt immunization at the beginning of outbreak

37. CONTROL OF AN OUTBREAK
• Isolation of cases for 7 days after rash
• Active Immunization of contacts within 2
days of exposure (or passive
immunization within 3-4 days)
• Immunization at the beginning of an
epidemic

38. MUMPS

39. Mumps
More than 85% of children become susceptible
to mumps by the age of 9-12 months
and continue to be so in the first 5 years of life
It is estimated that about 8.5 - 9 lakh cases
of mumps occur in our country every year.

40. Myxovirus
parotiditis
5 to 9
years
children
Seasonal trend
M
umps

41. Obvious sign of mumps is swelling of
parotid region, because of Acute parotitis.
Swelling usually lasts for 10 days with fever,
Ear-ache, difficulty to talk, eat, open the mouth
for 1-6 days.
ovaries (females), pancreas, breast and joints
The symptoms- signs of Mumps
Affects various organs like salivary glands -
Parotid glands, kidneys, testicles (Males),

43. Source : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
43

44. 44
Complications of Mumps
Frequent but not serious:
•Orchitis (25-40%): 7-10 days after parotitis,with high fever
(Unilateral in 75% orchitis cases, Most common extra-salivary gland
manifestation in adults)
•Epididymitis
•Pancreatitis(4%)
•Mild form of meningitis
•Thyroiditis, Neuritis, Hepatitis,Ovaritis,
•Oophoritis (5% adult women)
•Spontaneous abortion(25% in pregnancy)
Rare:
Hearing loss, Polyarthritis, Encephalitis, Cerebellar ataxia

45. 45
Management of Mumps
• Supportive
• Case should be isolated till symptoms subside
• Contacts should be kept under surveillance

46. 46
Prevention of Mumps
Immunization
• Mumps vaccine: Live attenuated,0.5 ml, IM
• MMR vaccine

47. MR/MMR VACCINE

48. Vaccine schedule
Measles Vaccine at the age of 9 months
MMR Vaccine at 12-15 months
If missed any time up to 13 years of age

49. Contact diseases

50. What are contact
diseases
• “These are diseases caused by microorganisms
that are spread by person-to-person contact or
indirect contact with contaminated objects.”

51. Direct contact
Infectious diseases are often spread through direct contact.
Types of direct contact include:
1. Person-to-person contact
Transmission occurs when an infected person touches or
exchanges body fluids
STDs can be passed from mother to baby during childbirth.
2. Droplet spread
Coughing and sneezing can spread an infectious disease.
Indirect contact
Infectious diseases can also be spread indirectly through the
air and other mechanisms. For example:
1. Airborne transmission
Some infectious agents can travel long distances and remain
suspended in the air for an extended period of time. You can
catch a disease like measles by entering a room after someone
with measles has departed.
2. Contaminated objects

52. 3. Food and drinking water
E. coli
Clostridium botulinum, which can lead to botulism.
4. Animal-to-person contact
The Toxoplasma gondii parasite can be found in cat feces.
Pregnant women and people with compromised immune
systems should take extra care (disposable gloves and good
hand washing) when changing cat litter, or avoid it altogether.
5. Animal reservoirs
a. Anthrax (from sheep)
b. Rabies (from rodents and other mammals)
c. West nile virus (from birds)
d. Plague (from rodents)
6. Insect bites (vector-borne disease)
These include mosquitos, fleas, and ticks.
Malaria, West Nile virus, and Lyme disease

53. 7. Environmental reservoirs:
Soil, water, and vegetation containing infectious organisms
can also be transferred to people. Hookworm, for example, is
transmitted through contaminated soil. Legionnaires’ disease
is an example of a disease that can be spread by water that
supplies cooling towers and evaporative condensers.

54. PREVALENCE
• HIV, tuberculosis, malaria, neglected tropical
diseases (e.g., visceral leishmaniasis) and viral
hepatitis affect billions of people around the
world, and cause more than 4 million deaths
each year

55. HOST
•Age
•Genetic susceptibility
•Nutritional status
•Previous exposure
•Immunization status
•General physical condition
ENVIRONMENT
•Shelter
•Altitude
•Humidity
•Sanitation
•Food supply
•Water supply
•Temperature
•Overcrowding
•Essential services
AGENT
•Virulence
•Infectious dose
•Susceptibility to drugs
•Mode of transmission
•Ability to adapt to change
VECTOR
Equilibrium Between the Population, Infectious Agent, and the
Environment

56. SCABIES:
• Scabies is a skin problem caused by a
bug called a mite.
• A female mite lays eggs under the skin
of a human and stays inside until she
dies.
• We cannot see scabies because they are
very small.

57. • Over 300 million cases each year
• Infectious disease caused by a mite that
burrows in skin
• Leads to sores
• Very common in nursing homes and assisted-
living facilities
• Contagious

58. • An itchy skin condition
• Caused by mite- Sarcoptes Scabei
• Mite buries itself in skin
• After several weeks, intense itching occurs

59. • Skin-to-skin contact
• Anyone can get scabies
• Spreads easier in crowded areas
• Spread from family member to family member
through contact

60. Pathophysiology
• The female mite burrows into the
epidermis of the host using her jaws and
front legs, where she lays up to 3 eggs per
day for the duration of her 30-60 day
lifetime.
• An affected host harbors approximately 11
adult female mites during a typical
infestation. The eggs hatch in 3-4 days.
• The larvae leave the burrow to mature on
the skin. Fewer than 10% of the eggs laid
result in mature mites.

61. Pathophysiology
• A delayed type IV hypersensitivity reaction
to the mites, their eggs, or scybala
(packets of feces) occurs approximately 30
days after infestation.
• This reaction is responsible for the intense
pruritis, which is the hallmark of the
disease.
• Individuals who already are sensitized from
a prior infestation can develop symptoms
within hours.

62. Symptoms
• Scabies only affects the skin, outside the body.
• Scabies causes extreme itching, which is usually worse
at night.
• Rashes, blisters, or bumps may appear.
• Rashes and itching may last for 2-3 weeks, even after
being treated.

64. Infection around the arm

65. Complications:
• Furunculosis
• Impetigo
• Paronychia
• Pyodermia

66. Diagnosis
• Definitive diagnosis of scabies is made
by direct visualization of the mite,
eggs, or feces.
• Diagnosis can be confirmed by
demonstrating, under a microscope the
parasite obtained from a lesion

68. • Sulphur ointment applied from neck down to
cover entire body
• Antihistamines help relieve itching

69. • Need prescription medicine in order to cure
scabies
• Dose of ivermectin has been shown to cure
scabies
Image from Harden MD

70. • A bath is preferable and benzyl benzoate 20%-
25% emulsion in water
• Tetmosol (tetraethylthiuram monosulphide)

71. • Clean sheets and clothing
• Treat people in close contact with infected
person because of the incubation period
• Wash and disinfect house
• Keep infected area covered with clothing and
avoid contact with others

72. Prevention cont.
• Wash bedding in hot water and dry at high
temperatures (130 degrees Fahrenheit) for
at least 20 minutes.
• If you are not able to wash something,
sealing it in a plastic bag will kill the bugs.
• After reporting of cases; frequent
inspections, proper treatment of causes
and prophylaxis of contacts.

73. Tetanus
Cause:
•Caused by Clostridium tetani, an anaerobic, gram-positive, endospore-
forming rod.
Transmission:
•Associated with skin wounds. Any break in the skin can allow C. tetani spores
to enter. (if environment is exposed to its spores)
Infection:
•If oxygen tension is low, spores germinate and release the neurotoxin
tetanospasmin.
•Tetanospasmin is an endopeptidase that selectively cleaves the synaptic
vesicle membrane protein synaptobrevin.
•This prevents its release from the cell and also of inhibitory neurotransmitters
(gamma-aminobutyric acid and glycine) at synapses within the spinal cord
motor nerves.
•The result is uncontrolled stimulation of skeletal muscles (spastic paralysis). A
second toxin, tetanolysin, is a hemolysin that aids in tissue destruction.

74. Course of disease:
• Causes tension or cramping and twisting in skeletal muscles surrounding
the wound
• Tightness of the jaw muscles. With more advanced disease, there is trismus
(“lockjaw”), an inability to open the mouth because of the spasm of the
masseter muscles.
• Facial muscles may go into spasms, producing the characteristic expression
known as risus sardonicus.
• Spasms or contractions of the trunk and extremity muscles may be so severe
that there is board like rigidity, painful tonic convulsions, and opisthotonos.
• Death usually results from spasms of the diaphragm and intercostal
respiratory muscles.
Prevention:
• Active immunization with toxoid.
• Proper care of wounds contaminated with soil.
• Prophylactic use of antitoxin.
• Administration of penicillin.

75. Disease Prevention And Control
of Communicable Diseases
• Wash your hands often.
• Get vaccinated.
• Use antibiotics sensibly.
• Stay at home if you have signs and
symptoms of an infection.
• Be smart about food preparation.
• Pay special attention to cleaning the 'hot
zones' in your home.

76. Disease Prevention And Control
• Don't share personal items.
Use your own
• Toothbrush
• Comb
• Razor blade
• Avoid sharing drinking glasses or dining utensils
• Travel wisely
• Keep your pets healthy.

77. ROLE OF DOCTORS IN PREVENTING
COMMUNICABLE DISEASES
a. Controlling the reservoir
a. Early Diagnosis
Precise treatment
Epidemiological Investigation- study time place &
person
Distribution of the disease and
For institution of prevention and control measures.
b. Notification
c. Isolation
d. Quarantine

78. ROLE OF DOCTORS IN PREVENTING
COMMUNICABLE DISEASES
b) Interruption of transmission
“Breaking the chain of Transmission”
c) Susceptible Host
a. Active immunization.
b. Passive Immunization
c. Combined Active and passive immunization.
d) Non-specific measures
Better housing, water-supply, sanitation.
nutrition and education.
Legislative measures- to formulate and
effective implementation of measures.

79. What is a Vaccine?
 It is an immuno-biological substance
designed to produce specific protection
against a given disease

80. •IMMUNIZATION:
“Procedure by which the body is
prepared to fight against a specific
disease vaccine ”
•VACCINATION:
“Injecting of vaccine into the body”

81. Aims & Objectives of
Immunization
• Prevention of serious diseases and their
complications
• Protection of individuals and communities
• Containment of outbreaks
• Elimination of certain diseases, e.g. tetanus
• Eradication of diseases,
e.g. smallpox (1980) & polio (target date 2006)

82. Antigen
 Molecules from a pathogen or foreign
organism that provoke a specific
immune response.
Antibodies
Proteins that recognize and bind to a
particular antigen with very high specificity
Made in response to exposure to the antigen
Belong to a group of serum proteins called
immunoglobulins (Igs)

83. Active Immunity
Immunity developed after contacting
pathogens inside the body
Natural Immunity Artificial Immunity
•Passive Immunity
• Immunity provided by antibodies or
antitoxins provided from outside the
body
e.g. Injection of attenuated live /
killed organism or toxoid
e.g. Infection
Natural Immunity Artificial Immunity
e.g. Injection of antibodies or
antitoxin
e.g. Antibodies from
mother

84. ACTIVE IMMUNIZATION
• When dead or alive attenuated antigen is given to
body to produce antibodies
• Vaccines include inactivated toxins, killed
microbes, attenuated microbes
PASSIVE IMMUNIZATION
• When already prepared antibody are given to body
• Antisera / Gamma globulin

85. LIMITATIONS OF ARTIFICIAL
IMMUNIZATION
• Faulty preparation
• Contamination
• Faulty techniques
• Hypersensitivity reaction
• Carrier state

86. EXAMPLES OF VACCINES:
Killed or Attenuated organisms
vaccines
Microbial Fragments Vaccines
Modified Toxins to Toxoid vaccines
Anti- idiotype antibodies & DNA
vaccines

87. Live –Attenuated Vaccines:
Advantages-
• One initial dose is
usually sufficient but
additional boosters
doses may be required
• Causes less allergic
reactions than KV
products
• More rapid protection
than KV products
• Tend to be less
expensive
Disadvantages
• Must be handled and
mixed with additional
care
• Potential for excessive
immune response
• Some risk of causing
abortion or transient
infertility
• Potential to mutate to a
virulent form

88. Live attenuated vaccine
BACTERIAL:
•BCG
•Oral Typhoid
VIRAL:
Oral polio
Yellow fever
Measles
Rubella
Mumps
Chicken pox
Influenza

89. • Inactivation of
toxins is the most
effective and
successful
bacterial toxins
• Tetanus and
diphtheria
vaccines are based
on this method

91. Killed vaccines (KV) and Toxoids
Disadvantages
Advantages
Slower onset of immunity
More stable in storage
Likely to cause allergic
reactions
Available for a wide variety
of diseases
More expensive than live-
attenuated vaccines
No risk of reverting to
virulent form
May not produce as strong or
as long lasting immunity as
the live-attenuated products
Excellent stimulant of passive
Abs in colostrum

93. Factors that affect vaccine effectiveness:
1- Induction of the right sort of immunity
2- Be stable on storage
3- Have sufficient immunogenicity
Q: What is an adjuvant?
4- Safety
5- Cost

94. SMALL POX
• The last
known
natural
case
was in
Somalia
in 1977

95. EPI
o Expanded Programme on immunization (EPI)
was initiated in Pakistan in 1978 with the aim
to prevent the mothers from tetanus and their
children against six deadly diseases that
include tuberculosis, poliomyelitis, diphtheria,
pertussis , measles and tetanus
o The Expanded Programme on Immunization
(EPI) unit aims to build a Region free from
vaccine-preventable diseases

96. In EPI program
ONLY
ACTIVE
IMMUNIZATION
is done

97. AGE VACCINE
At birth BCG
OPV 0
At 6 weeks Pentavalent I, PCV I, OPV 1,
Rotavirus I
At 10 weeks Pentavalent II, PCV II, OPV II,
Rotavirus II
At 14 weeks Pentavalent III, PCV III, OPV III,
IPV
At 9 months Measles
12-15 months
(booster)
Measles II

98. Intra-Muscular
(90°angle)
Sub-Cutaneous
(45°angle)
Intra-Dermal
(15 -20°angle)
Oral

99. VACCINE DOSAGE ROUTE OF
ADMINISTRATION
BCG 0.05 ml Intradermal (Upper
right arm)
OPV 0.5 ml Oral
Pentavalent 0.5 ml Intramuscular - vastus
lateralis (Anterolateral
aspect of mid-thigh
LEFT)
Pneumococcal 0.5 ml Intramuscular (Ant.
Lat. Site of Mid thigh
RIGHT)
Measles 0.5 ml Subcutaneously

100. VACCINE ADVERSE EFFECT
BCG Local reaction, Suppurative adenitis,
Lupus or osteitis, Generalized B.C.G. inf.
OPV (Live
attenuated Sabin)
Paralysis, Killed vaccine is harmless. Live
causes paralysis in vaccinated persons
Pentavalent Redness, swelling, pain, Fever > 38⁰C
and death
Pneumococcal Pain at site of shot, Redness or swelling
where the shot is given, Irritation where
the shot is given, Headache, Feeling tired
or weak, Muscle pain
Measles Moderate fever (101ºF -105ºF) with or
without rash, local reaction with redness,

101. • Infants born to mothers who are sputum positive (for
AFB) should be given primary prophylaxis with INH 5
mg/Kg body weight for a minimum period of 3
months and then vaccinated with BCG, if tuberculin
negative at 3 months (not at birth as in
normal infants). If tuberculin positive then treat for 6
months in all

102. SHAKE TEST
• DPT, hepatitis B and tetanus toxoid vaccines can all
be damaged by freezing. By shaking two vials, side-
by-side, one that might have been frozen and one
that has never been frozen, health workers can
determine if a vaccine has spoiled

103. Vaccine vial monitor
• Every vial is also shipped with a temperature-
sensitive label, that health workers monitor during
vaccination sessions

104. COLD CHAIN
• They must be stored in correct cold
temperature, o’c-8’c
• 0°C TO+8°C = OPV, MEASLES, MMR, BCG
• +2° TO +8°C = DPT, DT, DT, TT& HB,HIB
• Kept cold during transport by using vaccine
carrier
• Polio vaccine is the most sensitive vaccine to
heat
• Live attenuated vaccines are allowed to be
frozen (OPV, MEASLES, MMR AND BCG).
• Inactivated vaccines must not be frozen (
Pentavalent, PCV, DPT, DT, DT , TT AND HB)
form flakes in shaking test

105.  Resistance a population acquires as a whole to
infectious disease
 When 70% of individuals in a population are
immune, the propagation from individual to
individual is not sustained and epidemics do not
occur

106. SWOT Analysis of EPI Program
Strengths
Commitment of political leadership
Understanding and priority in civil/field
operations
A network of manpower and cold chain
Sanctioned reach in the farthest areas
Consensus on fighting preventable diseases
Reinforcement through NIDs
Opportunities
18th Amendment empowering provinces
Willingness of international community to
Help
Commitment of future funds/budget
Willingness of communities to help
operations
Private sector’s willingness and ability to help
Weaknesses
No regular monitoring, evaluation & feedback
Heterogeneous service capacity across
provinces
Lapses in budgetary releases
Poor synergies with other health sector NIDs
hindering routine immunization
Non-customized public awareness campaigns
Weak grievance redressal system
Threats
Lack of accountability framework
Natural disasters, conflicts and IDPs Norms
preventing access
Missing birth records, lack of population
census
Lack of motivation and incentives for ground
staff
Lacunas in vaccines stock management
17

107. Evidence suggests that underachievement of
the EPI is due to a combination of factors
including;
• Inadequate performance in the areas of service
delivery
• Program management
• Monitoring and evaluation
• Logistics control
• Human resources management and financing,
as well as community health-seeking behaviors
and other demand-side issues