CHAPTER-5-CONTROL-AND-PREVENTION-OF-COMMUNICABLE-DISEASES.pptx

O F C O M M U N I C A B L E D I S E A
S E S
CONTROL AND PREVENTION
GROUP 3 & 4

COMMUNICABLE
AND NON-
COMMUNICABLE
DISEASES

2 CATEGORIES OF DISEASES
• Communicable Diseases
- refers to type of diseases that can be transmitted to humans
humans either directly or through mediums
- caused by micro-organisms which can either be a bacteria,
parasite, fungi, prion or virus
• Non-communicable Diseases
- refers to a group of conditions that are not mainly caused by an
acute infection, result in long-term health consequences and often
create a need for long-term treatment and care. These conditions
include cancers, cardiovascular disease, diabetes and chronic
lung illnesses.

• The Germ Theory explains that the growth and
reproduction of a micro-organism (germ) inside a human
body can cause a specific disease.
• This disease-causing micro-organism is referred to as a
pathogen.
GERM THEORY

IMMUNE SYSTEM
2 Types of Immune System
• Innate Immune system
• Adaptive Immune System

IMMUNE SYSTEM
Innate Immune system
- is usually non-specific and does not confer a long term immunity
against a pathogen
- it is the first to respond and it responds in a more generic way.
-it has humoral and cell-mediate immunity components
functions:
• Recruiting immune cells to site of infection, through the production of
chemical factors, including specialize chemical mediators, called cytokines.
• Activation of the complement cascade to identify bacteria, activate cells and
promote clearance of antibody complexes or dead cells.

IMMUNE SYSTEM
3. The identification and removal of foreign substances present in organs,
tissues, the blood and lymph, by specialize white blood cells.
4. Activation of the adaptive immune system through a process known as
antigen ( antibody generator) presentation.
5. Acting as a physical and chemical barrier to infectious agents.
The cells involved in the Innate Immune System are also known
as White Blood Cells or Leukocytes ( neutrophil, dendritic cell,
basophil, eosinophil, mast cell, macrophage, and natural killer
cell)

IMMUNE SYSTEM
Innate Immune system
Being the first line of defense, the Innate Immune System
contains Anatomical Barriers that prevent the entry of micro-
organisms.
• Eyes
• Nasopharynx
• Respiratory Tract
• Gastrointestinal Tract
• Skin

IMMUNE SYSTEM
The first reaction of the body as a response to a pathogen or antigen is
inflammation. Inflammation is characterized by erythema or redness of
the skin (rubor), increased local heat temperature (calor), localized or
generalized pain (dolor) and swell ing of the tissue (tumor).
Inflammation is brought about by reactions of the macrophages,
dendritic cells, histiocytes and mastocytes. On the surface of these
cells are receptors called pattern recognition receptors which which
recognize certain common molecules present in all pathogens but not
present in the host's cells.

IMMUNE SYSTEM
The cells involved in the Innate Immune System are also known
as White Blood Cells or Leukocytes ( neutrophil, dendritic cell,
basophil, eosinophil, mast cell, macrophage, and natural killer
cell)
• Neutrophil - Most abundant form of phagocyte, the first to go to
the site of inflammation or infection (phagocytic).
• Dendritic Cell - Mostly present in tissues that are exposed to
external environment. It servers as the link between the innate
and adaptive immune system (phagocytic).
• Basophil - Releases histamine in response to a parasitic
infection

IMMUNE SYSTEM
• Eosinophil - Releases toxic molecules in response to a
bacterial or parasitic infection, may damage tissues.
• Mast Cell - Releases heparin, hetamines, chemokines,
chemotaxic cytokines. Involved in allergic reactions or
anaphylaxis and wound healing.
• Macrophages - Phagocytic cells which can move across the
walls of capillary vessels.
• Natural Killer Cell - Destroys compromised host cells such as
virus-infected cells or even tumor cells.

IMMUNE SYSTEM
Adaptive Immune system
- is highly specific and does it creates long term memory of
immunity against a pathogen.
- it provides protection to the host against pathogens
-it also has humoral and cell-mediate immunity components
3 Major functions:
• Recognition of specific “ non-self ” antigens in the presence of “self,
during the process of antigen presentation.
• Generation of responses that are tailored to maximally eliminate specific
pathogens or pathogen-infected cells.
• Development of immunological memory, in which pathogens are
“remembered” through memory B cells and memory T cell.

IMMUNE SYSTEM
Adaptive Immune System are called lymphocytes. There are B
and T lymphocytes.
T lymphocytes ( T helper cell, Cytotoxic T cell, Memory T cell,
Suppressor T cell, Natural killer T cell)

IMMUNE SYSTEM
B Lymphocytes are the predominant cells involved in the creation
of immunoglobulins (lg) or antibodies. The production of antibodies
is a process occurring in a humoral immunity responses.
There are five antibodies of Immunoglobulins.

Found in mucosal areas, such as the gut,
respiratory tract and urogenital tract. saliva,
tears, and breast milk; of colonization prevents
pathogens.
Functions mainly as an antigen receptor on B
cells that have not been exposed to antigens
Eliminates pathogens in the early stages of B
cell-mediated (humoral) immunity before there is
sufficient IgG
The majority of antibody- based immunity against
invading pathogens; the only antibody capable of
crossing the placenta to give Passive immunity to
the fetus.
Binds to allergens and triggers histamine release
from mast cells and basophils, and is involved in
allergy. Also protects against parasitic worms.
Description

IMMUNE SYSTEM
• When B cells and T cells are activated some will become memory B-
cells and some T-cells. lmmunological memory can be in the form of
either passive (short-term) memory or active (long-term) memory.
• On the other hand, Active memory is acquired after the activation of B
cells and T cells. The process of immunization artificially activates these
cells as well thus producing an active immunological memory against a
select group of pathogens. Immunization is the process whereby a
person is made immune or resistant to an infectious disease typically by
the administration of a vaccine. Vaccines stimulates the body’s own
immune system to protect the person against subsequent infection or
disease.

LIVE ATTENUATED VACCINE
• Derived from "wild", or disease causing, viruses or
bacteria.
• Is a weakened form of a virus or other invader.
• Must replicate to be effective.
• Immune response similar to natural infection.
• Usually effective with one dose.
EXAMPLE:
- Measles
- Smallpox
- Mumps

INACTIVATED VACCINE
• Is a killed version of a virus or other germ.
• Not alive and cannot replicate.
• Immune response mostly humoral.
• Always require multiple doses.
EXAMPLE:
- Vaccine against influenza.
- Hepatitis A
- Rabies

POLYSACHARIDE VACCINE
• Are a unique type of inactivated subunit vaccine.
• Composed of long chains of sugar molecules that
make up the surface capsule of certain bacteria .

PARASITE
S
• They have non-mutual symbiotic relationship with
their host.
• Parasites do not kill their host , they will often live in
or on their host for an extended period.
3 MAIN CLASSES OF PARASITES
• Protozoa
• Helminthes
• Ectoparasites

Protozo
a
• These are microscopic , one-celled organisms that can infect and
multiply in human beings .
• They are abundant in aqueous environment and soil, occupying a
range of trophic levels.
• The group includes FLAGELLATES , CILIATES, AMOEBAE.
4 GROUPS OF PROTOZOA (MODE OF MOVEMENT)
• Sarcodina (Amoeba)
• Mastigophora (Flagellates)
• Ciliophora (Ciliates)
• Sporozoa (Plasmodium and Cryptosporidium)

Helminth
s
• They are large, multicellular organisms that are generally visible to the
naked eye in their adult stage.
• In their adult form, helminths cannot multiply in humans.
3 MAIN GROUPS OF
HELMINTHS
• Flatworms or
platyhelminths
• Acanthocephalins
• Roundworms

LIFE CYCLE OF A
HELMINTH
• Egg stage
• Larvae stage
• Adult stage

Ectoparasite
s
• blood-sucking arthropods (mosquitoes)
• it refer to organisms such as ticks, fleas, lice, and mites that are attach
into the skin and remain there for relatively long periods of time.

Implications In Public
Health
• ACUTE DISEASE - if the disease / illness lasts for
less than 3 months
• CHRONIC DISEASE - if the disease / illness lasts
for more than 3 months

Modes of Transmission
• Direct Contact Transmission - spread of infectious organisms from the skin of one
person directly to another person.
• Indirect Contact Transmission - spread of infectious organisms by coming into
contact with a contaminated object and then bringing the germ into your body.
• Airborne Transmission - Spread of infectious organisms through the air. These
germs can survive in the air for long periods of time and travel far distances from the
infected person.
• Blood-borne Transmission - spread of infectious organisms through blood-to-blood
contact.
• Droplet Transmission - spread of infectious organisms from an infected person in
tiny droplets of fluid that can travel small distances (less than one meter).
• Sexual Contact Transmission - spread of infectious agents from an infected person
to another person through sexual contact (e.g., vaginal, oral, or anal sex).

• The infectivity or the
ability of the organism
to enter and replicate
in the host depends
on the 3 major factors:
the nature of the
organism, the nature
of the host and the
nature of
environment.

Public Health
Interventions
Hosts
:
Agent
s:
Environme
nt:
• Immunization or Increasing nutrition - to boost immune
system.
• Wearing of protective barriers - to prevent contact with
the agent.
• Production of antibiotics or anti-viral drugs - that would
target the organism and disrupt its replication.
• Creation of vaccines - that will address the agent or
pathogen.
• Environmental sanitation and destruction of breeding sites of
pathogens.

Vecto
r
- any agent that carries and transmits an
infectious pathogen into another living
organisms. Examples are:
Mosquito
es
Flies Lies Tic
ks
Mit
es
Anthropo
ds
Vector-borne

Common Vector-borne Diseases in the
Philippines
Disea
se
Vector Causative
Agent
Mala
ria
Chikungu
nya
Lymphatic
filariasis
Japanese
Encephalitis
Schistosom
iasis
Deng
ue
Aedes
mosquito
Anopheles
mosquito
Freshwater
snails
Aedes
mosquito
Variety of
mosquitoes
Mosquit
oes
Dengue
virus
Plasmod
ium
Chikungunya
virus
Wucheria
bancrofti
IE
viru
s
Schistosom
a sp.

Variation in the chain
of Infection
• Case or
carrier -
the one who is well but infected
and is capable
of serving as a source of
infection. Example is HIV.
• Zoonoses - disease for which the
reservoir is not humans
but animals. Example is Plague
and rabies.
• Anthroponose
s -
Disease for which humans aret he only
known reservoir. Example is measles

Goals of
Epidemiology
• Prevent - planning and taking of
action to prevent or forestall the
occurrence of an undesirable event.
• Control - the containment of disease
and the limiting of transmission of
a communicable disease in a
population
• Eradicate - the total elimination of
a disease from a human population.

3 approaches of prevention
and control
• Primary prevention - to forestall
the onset of illness or injury
during the pre-pathogenesis period.
2. Secondary prevention - self-diagnosis
and self- treatment (nonprescription
medications) or diagnosis and treatment
(with an antibiotic prescribed by a
physician).
3. Tertiary prevention - convalescence
from infection, recovery to full health,
and return to normal activity.

Tuberculosis (TB) is caused by a bacterium
called Mycobacterium tuberculosis. The
bacteria usually attack the lungs, but TB
bacteria can attack any part of the body
such as the kidney, spine, and brain. If
not treated properly, TB disease can be
fatal.

In healthy people, infection with My-
cobacterium tuberculosis often causes no
symptoms, since the person's immune sys-
tem acts to "wall off" the bacteria. The
symptoms of active TB of the lung are
coughing, sometimes with sputum or
blood, chest pains, weakness, weight
loss, fever and night sweats.

In preventing and controlling the
spread of Tuberculosis, it is
important to detect cases and treat
them accordingly. Case finding is the
identification and diagnosis of TB
cases among individuals with signs
and symptoms presumptive of
tuberculosis. The current approach to

The available tests utilized
by the program for diagnosing
TB are;
direct sputum smear
microscopy, TB culture and
drug susceptibility test,
tuberculin skin test and

Tuberculin skin test(TST) is a basic screening tool for TB infection
among chil dren using purified protein derivative (PPD) tuberculin
solution to trigger a delayed hypersensitivity reaction among those
previously infected.
Also known as the PPD test or Mantoux test, it is one of the criteria
used in deter- mining disease activity among children. Rapid molecular
diagnostic tests endorsed by the WHO will be utilized by the NTP

Passive case finding is when symptomatic patients
are screened for disease activity upon consultation
at the health facility. Active case finding is a health
worker's purposive effort to find TB cases in the
community or among those who do not consult with
personnel in a DOTS facility. Intensified case finding
is active case finding among individuals belonging to
special or defined populations: (e.g., high-risk groups
including those who consult or find themselves at
the facility for other purposes)

1. Close contact - A person who shared an enclosed
space, such as the household, a social gathering
place, workplace or facility, for extended periods
within the day with the index case during the 3
months before commencement of the current treatment
episode. 14
2. High-risk clinical groups - Individuals with
clinical conditions that put them at risk of
contracting TB disease, particularly those with
immune-compromised states

3. High-risk populations - Persons
with known high incidence of
TB,particularly those in closed
environments or living in
congregate settings that promote
easy disease transmission.

TB Disease Classification can be based
on bacteriological status"

a. Bacteriologically- confirmed -
A TB patient from whom a
biological speci- men is positive
by smear microscopy, culture or
rapid diagnostic tests

b. Clinically-diagnosed - A PTB
patient who does not fulfill the
criteria for bacteriological
confirmation but has been
diagnosed with active TB by a
clinician or other medical
practitioner who has de- cided
to give the patient a full

It can also be classified based on its
anatomical location. Remember that Tuber-
culosis can infect any part of the human body:
a. Pulmonary TB (PTB) - Refers to a case of
tuberculosis involving the lung parenchyma. A
patient with both pulmonary and extra-pulmonary
TB should be classified as a case of pulmonary
TB.
b. Extra-pulmonary TB (EPTB) - Refers to a case
of tuberculosis involving organs other than the
lungs (e.g., larynx, pleura, lymph nodes,
abdomen, genitourinary tract, skin, joints and

MALARIA
Malaria, a global health issue caused by Plasmodium
species, has been linked to marshes since 1700 BC.
In 2010, it caused 216 million clinical cases and 655
000 deaths, with 90% in Africa. It affects four species
and is increasing in South-East Asia. Malaria is
transmitted by sporozoites from infected female
mosquitoes.

MALARIA
Plasmodium falciparum, found worldwide, causes severe
malaria. Plasmodium vivax, found in Asia, Latin America, and
Africa, can cause severe illness due to dormant liver stages
called hypnozoites. P. ovale, found in west Africa and the
western Pacific, is similar to P. vivax but can infect individuals
negative for the Duffy blood group. P. malariae causes
persistent, lifelong infections, with some patients developing
serious complications like nephrotic syndrome.

MALARIA
Endemicity of malaria describes the intensity of malaria
transmission in a given community or region and can be
classified according to parasite rates. Based on intensity of
transmission, populations or regions may be classified as
follows:

MALARIA
Stable malaria areas - In these regions:
• transmission occurs all year round, though there may be
seasonal variations;
• young children are susceptible to severe malaria.
Unstable malaria areas - In areas with low transmission:
• intermittent transmission may be annual, biannual (twice a year)
or variable;
• immunity to malaria is usually low or absent.

MALARIA
Uncomplicated malaria is symptomatic, without signs of severity or
organ dysfunction, primarily seen in tropical children, presenting
with fever, chills, headaches, body pains, malaise, nausea, vomiting,
and joint weakness.
Parasitological diagnosis is crucial for malaria diagnosis, ensuring
better care for parasite-positive patients, identifying parasite-
negative patients for further diagnosis, preventing unnecessary anti-
malaria use, confirming treatment failures, and improving case
detection and reporting in all transmission settings.

MALARIA
Malaria rapid diagnostic tests (RDTs) detect malaria-specific
antibodies from blood stages of parasites, providing clinical
diagnosis support and a valid alternative to microscopy for
uncomplicated malaria, with sensitivity and specificity comparable to
field microscopy.

MALARIA
Treatment of Uncomplicated Falciparum Malaria
• Artemether plus lumefantrine
⚬ This is currently available as a fixed-dose formulation with
dispersible or standard tablets containing 20mg of
artemether and 120mg of lumefantrine.
• Artesunate plus amodiaquine
⚬ The combination is available in fixed-dose tablets with
25/67.5, 50/135, or 100/270mg of artesunate and
amodiaquine, as well as blister packs with separate scored
tablets.

MALARIA
• Artesunate plus mefloquine
⚬ Blister packs with separate scored tablets containing 50mg
of artesunate and 250mg of mefloquine base are available.
• Artesunate plus sulfadoxine-pyrimethamine
⚬ This is currently available as separate scored tablets
containing 50mg of artesunate and 500mg of sulfadoxine
and 25mg of pyrimethamine.

MALARIA
• Dihydroartemisinin plus piperaquine
⚬ This is currently available as a fixed-dose combination with
tablets containing 40mg of Dihydroartemisinin and 320mg
of piperaquine.

MALARIA
Treatment for Uncomplicated Non-Falciparum Malaria
Chloroquine-sensitive vivax malaria is treated with oral
chloroquine at 25mg/kg, followed by anti-relapse medicine
primaquine at 0.25mg/kg bw. Amodiaquine, mefloquine, and
quinine are also effective. P. ovale and P. malariae infections are
generally sensitive to chloroquine, and treatment for P. ovale is the
same as for P. vivax, with only chloroquine being sufficient for P.
malariae.

MALARIA
• Prophylaxis against Malaria
⚬ Good chemoprophylaxis reduces fatal disease risk, with
recommended medicine regimens including chloroquine,
proguanil, mefloquine, or doxycycline, depending on local
malaria risk and resistance patterns.
• Chloroquine alone can only be recommended for areas where
malaria is due exclusively to P. vivax or fully chloroquine-
sensitive P. falciparum.

MALARIA
• Chloroquine+proguanil can be recommended for areas where
both P. vivax and P falciparum malaria transmission co-exist
and where chloroquine resistance is emerging For these areas,
atovaquone+proguanil can be used as an alternative that can
be started the day before travel.
I

MALARIA
• Insecticide-treated bed nets (ITNs) are a personal protection
method that reduces malaria illness and death in endemic
regions. In African settings, ITNs have reduced the death of
children under 5 years from malaria by about 20%. Only
pyrethroid insecticides are approved for use on ITNs, which
pose low health risks to humans and mammals but are toxic to
insects. The need for frequent retreatment and high insecticide
costs hinder widespread use in endemic countries.
I

MALARIA
Vaccine
• WHO recommends RTS,S/AS01 malaria vaccine for
moderate to high P. falciparum transmission in children,
and R21/Matrix-M in October 2023, allowing broad-scale
deployment across Africa.

DENGUE FEVER/DENGUE
HEMORRHAGIC FEVER

DENGUE FEVER/DENGUE HEMORRHAGIC FEVER
Dengue Fever is a disease caused by five closely related dengue
viruses, transmitted by infected mosquitoes. The Aedes aegypti
mosquito is the most important transmitter in the Western
Hemisphere, with over 100 million cases annually. The
mosquito bites a person with dengue virus in their blood,
causing symptoms or no symptoms. Dengue cannot be directly
spread.

Dengue hemorrhagic fever (DHF) is a 2-7 day fever with
symptoms similar to dengue fever. It can lead to persistent
vomiting, abdominal pain, and difficulty clining, causing
excessive permeability of blood vessels, potentially leading to
circulatory system failure, shock, and death if not corrected.

Dengue fever causes a high fever — 104 F (40 C) — and any
of the following signs and symptoms:
• Headache
• Muscle, bone or joint pain
• Nausea
• Vomiting
• Pain behind the eyes
• Swollen glands
• Rash

RABIE
S
• A zoonotic disease and human infection
caused by Lyssavirus, usually occurring after a
transdermal bite or scratch by an animal.
• Transmission may also occur through contact
with infectious material, such as saliva
• Rare cases involve inhalation of virus-
containing aerosol or organ transplants.
Global Impact
• Estimated 55,000 deaths annually worldwide
• Predominantly in Asia (56%) and Africa (43.6%),
especially in rural areas
• Present on all continents except Antarctica
• Highly fatal, with symptoms including consciousness
fluctuations, spasms, and autonomic instability

Challenges
• Neglected disease affecting poor and vulnerable
populations
• Limited reporting of deaths, particularly in remote
rural communities
• Lack of preventative measures in areas with dog-to-
human transmission
• Under-reporting hinders international resource
mobilization for rabies elimination
• Rabies remains a public health problem in the
Philippines
• Most acutely fatal infectious disease, causing 200-
250 deaths annually
• One-third of deaths in children under 15 years
• Two-thirds of cases are males
Philippine
Scenario

Modes of
Transmission
• Bites from infected animals, particularly dogs and cats,
are the most common mode
• Exposure can also come from other domestic and wild
animals, including bats
• Non-bite exposures are less common but may include
scratches, open wounds, and mucous membranes licked
by an infected animal
• Important note: Bites from rats, rabbits, rodents, reptiles,
and birds do not pose a risk for rabies infection
Points of Entry for Rabies Virus
• Contamination of intact mucosa (eyes, nose, mouth, genitalia) with saliva
• Licks on broken skin
• Inhalation of aerosolized virus in closed areas (e.g., caves with rabid bats,
laboratories)

Incubation Period
• Period from exposure to the appearance of first clinical signs and
symptoms
• Average incubation period: 1-3 months
• 90-95% cases have an incubation period of less than one year, but longer
periods in 5-10% cases
• Factors influencing incubation: amount of virus, severity, and location of
exposure
• Rabies virus multiplies in muscle cells or may directly invade nerves
• Potential persistence of the virus locally at the site of inoculation, explaining
some long incubation periods
• Virus then penetrates peripheral nerve cells and is transported to the central
nervous system (CNS)
PATHOGENESIS

• In vitro studies show axonal transport velocity ranges from 25 to 50 mm
per day
• Spread of the virus in the coulometer and optic nerves could be as fast as
12 mm/day
• Once in the CNS, rabies replication occurs primarily in neurons through
viral budding
• Virus spreads and infects nearby brain cells
• Dissemination through cerebrospinal fluid (CS) in late stages of infection

Prodromal Stage
• Initial viral replication at striated muscle cells at the site of inoculation
• Lasts for 0-10 days with non-specific manifestations: fever, sore throat,
anorexia, nausea, vomiting, malaise, headache, abdominal pain
• Paresthesia or pain at the bite site due to viral multiplication at spinal
ganglion
• Virus reaches the CNS and replicates predominantly in the gray matter
• Two types of presentation: encephalitic (furious, 80% cases) and paralytic
(dumb, 20% cases)
• Autonomic manifestations like hypersalivation
• Centrifugal spread to tissues: salivary gland, adrenal medulla, kidney, lung,
liver, skeletal muscle, skin, and heart
Acute Neurologic Stage

Diagnosis
• Often based on clinical manifestations and exposure history
• Hydrophobia and/or aerophobia pathognomonic; however, paralytic rabies
may pose diagnostic challenges
• Laboratory confirmation is necessary
• Diagnosis performed on fresh tissue specimens stored at appropriate
temperatures
• Transportation: glycerine preservative (+4°C or -20°C) or dried smears of
brain tissue on filter paper (+30°C)
Rabies Post-Exposure Prophylaxis (PEP)
• Crucial for individuals directly exposed to suspected rabid animals
• Initiation should not be delayed, regardless of exposure-to-consultation
interval
• Delay increases the risk of rabies and is associated with treatment failure

Category I - Type of Exposure
• Feeding/touching an animal
• Licking of intact skin
• Exposure to patients with signs and symptoms of rabies
• Casual contact
Category I - Management
• Wash exposed skin immediately with soap and water
• No vaccine or Rabies Immune Globulin (RIG) needed
• Pre-exposure prophylaxis may be considered for high-risk persons

Category II - Management
• Wash wound with soap and water
• Start vaccine immediately, complete regimen until Day 28
• May omit Day 28 dose under specific conditions
Category II - Type of Exposure
• Nibbling of uncovered skin
• Minor/superficial scratches/abrasions without bleeding including those
induced to blood
• All Category II exposures on the head and neck area are considered
Category III

Category III - Type of Exposure
• Wash exposed skin immediately with soap and water
• No vaccine or Rabies Immune Globulin (RIG) needed
• Pre-exposure prophylaxis may be considered for high-risk persons
Category III - Management
• Wash wound with soap and water
• Start vaccine and RIG immediately, complete regimen until Day 28
• May omit Day 28 dose under specific conditions

• Pregnancy and infancy not contraindications to PEP
• Babies born to rabid mothers should receive rabies vaccination and RIG
upon birth
• Exposed persons evaluated weeks or months after the bite should be
managed as if the exposure occurred recently
• Vaccine-preventable disease
• Animal Bite Treatment Centers (ABTC) established for PEP
• Intradermal (ID) regimen recommended for cost-effectiveness (60-80%
cost reduction)
• WHO-approved vaccines for ID use required
Special Considerations
Rabies Vaccination in the Philippines

• Days 0, 3, 7, 28
• 0.1 ml per dose on each deltoid or anterolateral thighs in infants
*PVRV (Purified Vero Rabies Vaccine) or PCECV (Purified Chick Embryo Cell
Vaccine)
• Days 0, 3, 7, 14, 28
• 0.5 ml per dose on one deltoid or anterolateral thigh in infants for PVRV
• 1.0 ml per dose for PCECV
Intradermal (ID) Vaccination Regimen
Intramuscular (IM) Vaccination Regimen

• Given with rabies vaccine for immediate availability of neutralizing
antibodies
• Human RIG (HRIG) or Equine RIG (ERIG) based on patient's condition
• Immune-compromised individuals should receive RIG for both Category II
and III exposures
Passive Immunization - Rabies Immunoglobulin (RIG)

Neglected Tropical
Disease
In the Philippine setting, there are at least two
major Neglected Tropical Disease (NTDs). These
are Filariasis and Schistosomiasis. These
parasitic diseases cause chronic disabilities and
deformities that hamper the growth and
development of children, as well as the working
ability or productivity of adults.

Neglected Tropical
Disease
Schistosomiasis
• Also known as Katayama Fever
• a disease caused by parasitic worms of the Schistosoma type
• The disease is spread by contact with water contaminated with the
parasites. These parasites have been released from their freshwater
snail hosts. The disease is especially common among children in
developing countries as they are more likely to play in contaminated
water.
• Schistosomes have a typical trematode vertebrate-invertebrate
lifecycle, with human being the definitive host. Infections by this
parasitic worm is in a family of diseases known as helminthiases.
• The life cycles of all five human schistosomes are broadly similar:
parasite eggs are released into the environment from infected
individuals, hatching on contact with fresh water to release the
free-swimming miracidium. Miracidia infect freshwater snails by

Neglected Tropical
Disease
Schistosomiasis
• Germ cells within the primary sporocyst will then begin dividing to
produce secondary (daughter) sporocysts, which migrate to the snail's
hepato-pancreas. Once at the hepatopancreas, germ cells within the
secondary sporocyst begin to divide again, this time producing
thousands of new parasites, known as cercariae, which are the larvae
capable of infecting mammals.
Schistosoma
mansoi
Cercariae emerge daily from the snail host in a
circadian rhythm, dependent on ambient temperature
and light. Young cercariae are highly mobile,
alternating between vigorous upward movement and
sinking to maintain their position in the water.
Cercarial activity is particularly stimulated by
water turbulence, by shadows and by chemicals
found on human skin.

Neglected Tropical
Disease
Schistosomiasis
• The most common way of getting schistosomiasis is by
wading or swimming in lakes, ponds and other bodies of
water that are infested with the snails (usually of the
genera Biomphalaria, Bulinus, or Oncomelania) that are
the natural reservoirs of the Schistosoma pathogen.
• Penetration of the human skin occurs after the cercaria
have attached to and explored the skin. The parasite
secretes enzymes that break down the skin's protein to
enable penetration of the cercarial head through the
skin. As the cercaria penetrates the skin it transforms
into a migrating schistosomulum stage.

Neglected Tropical
Disease
Schistosomiasis
The newly transformed schistosomulum may remain in the skin for two days
before locating a post-capillary venule; from here the schistosomulum
travels to the lungs where it undergoes further developmental changes
necessary for subsequent migration to the liver. Eight to ten days after
penetration of the skin, the parasite migrates to theliver sinusoids. S.
japonicum migrates more quickly than S. mansoni, and usually reaches the
liver within eight days of penetration. JuvenileS. mansoni and S.
japonicum worms develop an oral sucker after arriving at the liver, and
it is during this period that the parasite begins to feed on red blood
cells. The nearly-mature worms pair, with the longer female worm residing
in the gynaecophoric channel of the shorter male. Adult worms are about
10 mm long. Worm pairs of S. mansoni and S. japonicum relocate to the
mesenteric or rectal veins. S. haematobium schistosomula ultimately
migrate from the liver to the perivesical venous plexus of the bladder,

Neglected Tropical
Disease
Schistosomiasis is treatable using a single dose of the drug
praziquantel by mouth annually. Other possible treatments include a
combination of praziquantel with metrifonate, artesunate or
mefloquine. A Cochrane review found tentative evidence that when used
alone metrifonate was as effective as praziquantel.
Schistosomiasis

Neglected Tropical
Disease
Filariasis
A parasitic disease caused by an infection
with roundworms of the Filarioidea type.
These are spread by blood-feeding black
flies and mosquitoes. This disease belongs
to the group of diseases called
helminthiasis.
In the Philippines, Lymphatic filariasis
is more common and is caused by the worms
Wuchereria bancrofti, Brugia malayi, and
Brugia timori. These worms occupy the
lymphatic system, including the lymph
nodes; in chronic cases, these worms lead

Neglected Tropical
Disease
Filariasis
Individuals infected by filarial worms may be described
as either "microfilaraemic" or "amicrofilaraemic",
depending on whether microfilariae can be found in
their peripheral blood. Filariasis is
The adult worms, which usually stay in one tissue,
release early larval forms known as microfilariae into
the host's bloodstream. These circulating microfilariae
can be taken up with a blood meal by the arthropod
vector; in the vector, they develop into infective
larvae that can be transmitted to a new host.
diagnosed in microfilaraemic cases primarily through direct observation of
microfilariae in the peripheral blood. Occult filariasis is diagnosed in
amicrofilaraemic cases based on clinical observations and, in some cases,
by finding a circulating antigen in the blood.

Neglected Tropical
Disease
Filariasis is usually diagnosed by
identifying microfilariae on Giemsa
stained, thin and thick blood film
smears, using the "gold standard" known
as the finger prick test. The finger
prick test draws blood from the
capillaries of the finger tip; larger
veins can be used for blood extraction,
but strict windows of the time of day
must be observed. Blood must be drawn at
appropriate times, which reflect the
feeding activities of the vector insects.
Examples are W. bancrofti, whose vector
is a mosquito; night is the preferred
time for blood collection. This method of

Neglected Tropical
Disease
A major strategy of the Filariasis Elimination Plan of the
Philippines was the Mass Annual Treatment using the
combination drug, Diethylcarbamazine Citrate and Albendazole
for a minimum of 2 years & above living in established endemic
areas alter the issuance from WHO of the safety data on the
use of the drugs. The Philippine Plan was approved by WHO
which gave the government free supply of the Albendazole for
filariasis elimination. In support to the program, an
Administrative Order declaring "November as Filariasis Mass
Treatment Month was signed by the Secretary of Health in July
2004 and was disseminated to all endemic regions.

SEXUALLY
TRANSMITTER
INFECTIONS
(ST
I)

SEXUALLY TRANSMITTER INFECTIONS
• STI is also known as Sexually Transmitted Disease
• transmission: through sex, especially vaginal
intercourse, anal sex, and oral sex.
• signs and symptoms: vaginal discharge, penile
discharge, ulcers on or around genitals, and
pelvic pain.
• some may cause problems with the ability to get
pregnant.

SEXUALLY TRANSMITTER INFECTIONS
• according to WHO, STI control is a public health
outcome, measured as reduced incidence and
prevalence, achieved by implementing strategies
composed of multiple synergistic interventions.
• in the literature, “STI control” is frequently used
interchangeably with “STI treatment”.

SOME STIs ARE THE FOLLOWING:
• also known as “the clap”
• caused by the bacterium Neisseria gonorrheae
• symptoms in men: burning sensation with urination and
penile discharge
• symptoms in women: asymptomatic most of the time or
have vaginal discharge and pelvic pain.
• symptoms in both men and women: inflammation of the
epididymis or pelvic inflammatory or throughout the
body, affecting joints and heart valves.
GONORRHEA

“bacterium Neisseria gonorrheae”

GONORRHEA
burning sensation (men) pelvic pain (women)

• WHO estimation: 88 million cases of gonorrhea occur
each year, out of 448 million new cases of all curable
STI each year-- that also includes syphilis, chlamydia,
and trichomoniasis.
• treatment: common treatment is with ceftriaxone
(Rocephin) combined with either azithromycin or
doxycycline, as gonorrhea infections may occur along
with chlamydia, an infection that ceftriaxone does not
treat.
GONORRHEA

• the incubation period is 2 to 14 days, with most
symtoms appering between 4 and 6 days after
infection.
• - traditionally, gonorrhea was diagnosed with gram
stain and culture; however, new polymerase chain
reaction (PCR)-based testing method are becoming
more common.
GONORRHEA

• caused by bacterium Chlamydia trachomatis
• - a major infectious cause of human genital and eye
disease.
• - transmission: through vaginal, anal, and oral sex, and
can be passed from an infected mother to her baby
during childbirth.
• - in men: inflammation of the penile urethra causing a
white discharge from the penis with or without a burning
sensation during urination.
CHLAMYDIA

“bacterium Chlamydia trachomatis”

CHLAMYDIA
inflamed urethra
pelvic inflammatory
disease
inflamed epididymis

• spread to the upper genital tract in women (causing pelvic
inflammatory disease infection) or to men (causing
inflammation in epididymis)
• - the diagnosis of genital chlamydial infections evolved
rapidly from 1990 to 2006.
• - nucleic acid amplification tests (NAAT), such as
polymerase chain reaction (PCR), transcription mediated
amplification (TMA), and the DNA strand displacement
amplication (SDA) are now the mainstay.
CHLAMYDIA

• treatment: azithromycin, doxycycline, erythromycin, or
ofloxacin.
• - a person with chlamydia should abstain from sexual
activity for 7 days after receiving the antibiotics or until
completion of a 7-day course of antibiotics.
• - if the symptoms continue for more than a few days after
receiving treatment, he or she should return to a health
care provider to be reevaluated.
CHLAMYDIA

• multiple chlamydial infection in women will lead to serious
reproductive health complications, including pelvic
inflammatory disease and ectopic pregnancy.
• - women and men with chlamydia should be retested
about 3 months after treatment of an initial infection.
CHLAMYDIA

• caused by the spirochete bacterium Treponema pallidum.
• transmission: sexual contact; can transmit from mother to
fetus during pregnancy or at birth, resulting in congenital
syphilis.
• four stages of syphilis: primary, secondary, latent, tertiary
SYPHILIS

“spirochete bacterium Treponema
pallidum”

• signs and symptoms: single chancre (a firm, painless, no-
itchy skin ulceration); approximately 3 to 90 days after the
initial exposure (avrg. 21 days) a skin lesion, called
chancre, will appear; and, lesion may be painful or tender
(30%)
• transmission: direct sexual contact with the infectious
lesions of another person; primarily through direct contact
with a syphilis sore during vaginal, anal, or oral sex.
SYPHILIS (Primary
Syphilis)

SYPHILIS (Primary
Syphilis)
chancre

• most common location:
⚬ may occur outside the genitals (2-7%)
⚬ women’s cervix (44%)
⚬ penis in heterosexual men (99%)
⚬ anally and rectally relative commonly in men who
have sex with men (34%).
• healing duration:
⚬ healing of the primary chancre takes place in 1-8
weeks.
SYPHILIS (Primary
Syphilis)

• signs and symptoms:
⚬ with a diffuse rash, frequently in palms of the hands
and soles of the feet
⚬ occur approximately 4 to 10 weeks after the primary
infection
⚬ symptoms most commonly involve the skin, mucous
membranes, and lymph nodes
⚬ symmetrical, reddish-pink, non-itchy rash on the trunk
and extremities, including the palms and soles.
SYPHILIS (Secondary
Syphilis)

SYPHILIS (Secondary
Syphilis)

⚬ symptoms include fever, fatigue, wart-like sores, muscle
aches, weight loss, headaches, hair loss, swollen
lymph nodes.
• transmission:
⚬ through sexual contact
• common location:
⚬ any part of the body; usually in the palms and soles
SYPHILIS (Secondary
Syphilis)

⚬ has little to no symptoms
⚬ early latent syphilis: relapse of symptoms
⚬ late latent syphilis: asymptomatic (showing no
symptoms); not contagious (doesn’t spread to others by
direct or indirect contact) as early latent syphilis
SYPHILIS (Latent
Syphilis)

• transmission:
⚬ through sexual contact
• common location:
⚬ no specific location
• healing duration:
⚬ early latent syphilis (less than one year); late latent
syphilis (more than one year)
SYPHILIS (Latent
Syphilis)

⚬ gummas (soft, tumor-like balls of inflammation).
⚬ neurological symptoms (e.g. meningitis)
⚬ cardiac symptoms (e.g. aortic aneurysm)
⚬ may occur approximately 3 to 15 years after the initial
infection.
• transmission:
⚬ Tertiary syphilis is not directly transmitted to sexual
partners during this stage. It's a stage of complications
that can occur years after the initial infection.
SYPHILIS (Tertiary
Syphilis)

SYPHILIS (Tertiary
Syphilis)
gummas

• common Location:
⚬ gummatous syphilis, a form of tertiary syphilis, typically
affects the skin, bone, and liver, but it can occur
anywhere in the body.
• tertiary syphilis may be divided into three different forms:
gummatous syphilis (15%), late neurosyphilis (6.5%), and
cardiovascular syphilis (10%).
SYPHILIS (Tertiary
Syphilis)

• also known as late benign syphilis
• occurs 1 to 46 years after the infection (avrg: 15 years)
• characterized by the formation of chronic gummas (soft,
tumor-like balls of inflammation)
• typically affect the skin, bone, and live, but can occur
anywhere.
TERTIARY SYPHILIS (Gummatous
Syphilis)

• involve the central nervous system (CNS)
• may occur early (being either asymptomatic or in a form of
syphilic meningitis) or late (as meningovascular syphilis,
general paresis, or tabes dorsalis), which associated with
poor balance and lightning pain in the lower extremities
• late neurosyphilis typically occurs 4 to 25 years after the
initial infection.
• meningovascular syphilis (present apathy and seizure) and
general paresis ( with dementia and tabes dorsalis)
TERTIARY SYPHILIS (Neurosyphilis)

• transmitted during pregnancy or during birth
• 2/3 of syphilitic infants are born without symptoms
• common symptoms that develop over the first couple of
years of life include: enlargement of the liver and spleen,
rash, fever, neurosyphilis, and lung inflammation
• if untreated , late congenital syphilis occur in 40%
including: saddle nose deformation, higoumenakis sign,
sabershin, or clutton’s joints, among others
TERTIARY SYPHILIS (Congenital
Syphilis)

• syphilis has been known as “the great imitator”
• diagnoses is usually made by using blood tests
• bacteria can be detected using dark field microscopy
• preferred antibiotic for syphilis: intramuscular benzathine
penicillin G ( or penicillin G potassium given intravenously
for neurosyphilis), or ceftrixone, and in those who have
sever penicillin allergy, oral doxycycline or azithromycin.
SYPHILIS

• a collection of infections and symptoms associated with
acquired deficiency of the immune system.
• it is the late stage of HIV infection; immune system already
weakened and death is imminent.
• caused by the Human Immunodeficiency Virus (HIV)
• it is a retrovirus
• occurs by the transfer of blood, semen, vaginal fluid, pre-
ejaculate, or breast milk
ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

• in these body fluids, HIV is present as both free virus
particles and viruses within infected immune cells
• infects vital cells such as helper T cells (specifically CD4+
T cells), macrophages, and dendritic cells
• - HIV infection leads to low levels of CD4+ T cells through
a number of mechanisms, including: apoptosis of
uninfected bystander cells, direct viral killing of infected
cells, and killing of infeted CD4+ T cells by CD8 cytotoxic
lymphocytes.

• if the CD4+ T cell number decreases, cell-mediated
immunity will be lost and the body becomes progressively
susceptible to opportunistic infections.

HUMAN IMMUNODEFICIENNCY VIRUS (HIV)
• characteristics: roughly spherical; 120nm diameter;
around 60x smaller than RBC, yet large for a virus
• HIV is composed of 2 copies of positive single-stranded
RNA
• enclosed by a conical capsid composed of 2,000 copies of
viral protein p24
• single-stranded RNA is tightly bound to nucleocapsid
protein, p7, and enzymes (reverse transcriptase, integrase,
ribonuclease, and protease)

HUMAN IMMUNODEFICIENNCY VIRUS (HIV)
• a matrix composed of the viral protein p17 surrounds the
capsid ensuring the integrity of the virion particle.
• surrounded by the viral envelope (composed of 2 layers of
fatty molecules called phospholipids)

the HIV situation in the Philippines is concerning because
1. The number of HIV cases is consistently increasing.
2. Young adults are having sex at an early age, which increases
their risk of contracting HIV.
3. The country has a large population at higher risk of HIV, including
sex workers, men who have sex with men, clients of sex workers,
and people who inject drugs.
These factors contribute to the rising number of HIV cases in the
Philippines and highlight the need for increased awareness and
prevention efforts.
HIV/AID
S

The government's response to the HIV epidemic
started with policies for healthcare providers, but
in 1992, Executive Order No. 39 created the
Philippine National AIDS Council to serve as the
national policy and advisory body for preventing
and controlling HIV and AIDS.
HIV/AID
S

Republic Act No. 8504 or the Philippine AIDS
Prevention and Control Act— the policy backbone of
all HIV and AIDS programs in the country.
HIV/AID
S

Article 1( Education and Information) — focuses on who should
know about HIV and AIDS, what settings are the best venues for
disseminating information on the disease, and what kind of
information can be disseminated.
Article 2 ( Safe practices and Procedures) — designed to prevent
HIV transmission in the health care setting through standardized
practices such as the observation of general safety measures or
universal precaution.
HIV/AID
S
The Law consists of 8 Key
Sections

Article 3 ( Testing, Screening and Counseling) — seeks to provide the
stigmatization and the discrimination against PLHIVs in the workplace
and other settings through the strict prohibition of compulsory HIV
testing.
Article 4 ( Health and Support Services) — requires the provision of
services and benefits for persons living with HIV and AIDS, and what
government must do to respond to the epidemic.
Article 5 ( Monitoring) — provides for a mechanism by which the
epidemic can be tracked to determine it magnitude and progression
and enable the government to ascertain whether the country response
is adequate and effective.
HIV/AID
S

Article 6 ( Confidentiality) — mandates the strict observance of
medical confidentiality by all health practitioners and hospital staff
in handling the medical records of PLHIVs or those who undergo HIV
testing.
Article 7 (Discrimination Acts and Policies) — designed to protect
PLHIVs from stigma and discrimination by prohibiting denial to
PLHIVs of access to employment and livelihood, admission in schools,
travel and habitation, appointive office, credit and insurance, health
care and decent burial services.
Article 8 ( The PNAC) — defines the key role of the PNAC and entrusts
it with the responsibility of leading the country response to the HIV
and AIDS challenge.
HIV/AID
S

The HIV epidemic in the Philippines began in 1984 with only two
reported cases, and the country has successfully kept the prevalence
rate below 1% since then. The national goal is to maintain this low
rate. Early interventions have helped prevent the spread of HIV,
allowing the country to achieve this goal. However, recent trends
indicate a steep rise in new cases, with the doubling time now at
two-year intervals. From 2001 to 2005, an average of 16 new cases
was reported each month, and from January to December 2010, this
increased to five to six new cases every day. Some sentinel sites have
reported HIV prevalence among certain MARPs approaching or
surpassing the one-percent marker.
HIV/AID
S

A successful strategy to control sexually transmitted
infections (STIs) involves community-based interventions,
promoting and providing prevention methods, offering
clinical services, and creating a supportive environment.
This approach is backed by centuries of experience and
scientific evidence that has led to a decline in STI incidence
and prevalence in developed countries. Accurate data is also
crucial to guide the response and monitor progress.
HIV/AID
S
Controlling STIs

HIV/AID
S
Historical experience argues for co- ordinated effort in
five main areas:
(1) appropriate epidemiologic targeting, (2) primary
prevention and access to means of prevention; (3)
provision of effective clinical services to shorten the
duration of infectivity; (4) an "enabling environment"
for prevention; and (5) reliable data to guide decision-
making.

CHAPTER-5-CONTROL-AND-PREVENTION-OF-COMMUNICABLE-DISEASES.pptx

Recommended

Recommended

More Related Content

Similar to CHAPTER-5-CONTROL-AND-PREVENTION-OF-COMMUNICABLE-DISEASES.pptx

Similar to CHAPTER-5-CONTROL-AND-PREVENTION-OF-COMMUNICABLE-DISEASES.pptx (20)

Recently uploaded

Recently uploaded (20)

CHAPTER-5-CONTROL-AND-PREVENTION-OF-COMMUNICABLE-DISEASES.pptx