The document discusses several communicable diseases including smallpox, chickenpox, measles, mumps, influenza, dengue, plague, malaria, and diphtheria. For each disease, it covers the causative agent, symptoms, transmission, treatment, and prevention methods such as vaccination. International cooperation and the availability of an effective vaccine were key factors in the eradication of smallpox. Chickenpox, caused by the varicella zoster virus, presents with a characteristic rash and can later cause shingles. Measles is highly infectious and prevents second attacks through lifelong immunity. Mumps is transmitted through air droplets and causes salivary gland swelling. Influenza has several types

1. Communicable Disease
Presented by
Dr. Mohammad Abas Reshi
Medical Officer
J&K Government

2. Small Pox
Small Pox
• Epidemiological reasons/basis for Smallpox eradicationQ:
– No known animal reservoir
– No long term carrier state
– Infection provides lifelong immunity
– Case detection simple due to characteristic rash
– Subclinical cases did not transmit the disease
– A highly effective vaccine was available
– International cooperation

3. Chicken Pox
Synonym: ‘Varicella’
• Causative agent: Varicella zoster virus [Human (alpha) Herpes Virus – 3]Q
• Incubation period: 14 – 16 daysQ
• Source of infection: Case (person-to-person contact)
• Mode of transmission: Air droplets (respiratory)
• Period of communicability: 1-2 days before to 4-5 days after appearance of rash
• Secondary Attack rateQ: 90%
• Rash: Had to be differentiated from rash of Small pox

4. Chicken Pox Continue
MC late complication of chicken pox: Shingles (caused by reactivation of the virus
decades after the initial episode of chickenpox)
• Most rapid and sensitive means of diagnosisQ: Examination of vesicle fluid under
elec-
tron microscope (shows round particles)
• Congenital Varicella: Most threatening if transmitted in Ist trimester of pregnancy
• Live attenuated Chicken pox Vaccine:
– Strain: OKA strainQ
– SeroconversionQ : >90%

5. Chicken Pox contd….
Varicella Zoster immunoglobulin (VZIG):
– Given within 72 hours of exposure
– Dose: 1.25 – 5.0 ml intramuscularly
– Reserved for:
– Immunosuppressed contacts of acute cases
– Newborn contacts

7. Measles
Measles (Rubeola)
● Causative agent: RNA paramyxovirus (so for only one serotype known)
● Incubation Period: 10-14 days
● Source of Infection: cases (carriers are not known to occur)
● Mode of transmission: Air droplets (respiratory)
● Period of CommunicabilityQ: 4 days before and 5 days after the appearance of rash (Rash:
Retro-auricular origin)
● Measles is highly infectious during pro-dromal period and during eruption
● Measles has no second attacks (life long immunity seen)
● Secondary attack rate of Measles: 80%
● Measles shows a cyclical trend: Increase every 2-3 years

8. Measles contd….
● Pathogonomic clinical feature of Measles : Koplik spots (buccal mucosa opposite
upper 2nd molar)
● MC complication of measles in young children: Otitis media
○ SSPE (Subacute Sclerosing Pan Encephalitis) is a rare complication of
measles: 7 per million cases of Measles (7-10 years after initial infection)
● Measles is prevented by:
○ Active immunization by measles vaccine:
■ Live, attenuated
■ Strains: Edmonston Zagreb (MC), Schwarez, Moraten
● Passive immunization by measles immunoglobulin (WHO recommended dose: 0.25
ml/kg body weightQ)

9. Mumps
• Causative agent: Myxovirus parotiditis (RNA paramyxovirus)
• Incubation Period: 14-21 daysQ
• Source of Infection: Clinical & subclinical cases
• Mode of transmission: Air droplets (respiratory)
• Period of Communicability: 4-6 days before to 7 days after onset of
symptoms
• Mumps show life long immunity
• Secondary attack rate of MumpsQ: 86%

10. Mumps Contd….
● Clinical features:
○ Salivary (esp. Parotid) glands involvement
○ MC complication: Aseptic meningitis
○ MC complication in adolescents: Orchitis, Oopheritis
● Mumps is prevented by: Active immunization by Mumps
vaccine:
○ Type: Live attenuated vaccine
○ Strain: Jeryll Lynn strain

11. Influenza
● Causative agent: Orthomyxovirus, 3 types: A, B, C
○ Type A: MC cause of outbreaks/ epidemicsQ; Only cause of pandemicsQ
○ Type B
○ Type C: Not circulating currently
● Currently circulating influenza viruses in world:
○ H1 N1 (Type A) – Cause of SwinefluQ
○ H2N2(Type A)
○ H5N1 (Type A) – Cause of Avian influenza (Birdflu)Q
○ H3N2
○ H7N9
○ Type B

12. Influenza Contd…
● Cyclical trends in Influenza:
○ Type A epidemics every 2 – 3 years
○ Type B epidemics every 4 – 7 years
○ Type A pandemics every 10 – 15 years
● Antigenic variations in Influenza: (MC in Type A)
● Incubation period: 18 – 72 hours
● Period of infectivity: 1 – 2 days before to 1 – 2 days after onset of symptoms

14. Killed vaccines:
– 2 doses, 3 – 4 weeks apart, 0.5 ml (for age > 3 years), subcutaneous
– 70 – 90% protective efficacy; duration 3 – 6 months
– Is rarely associated with Guillain Barre SyndromeQ (GBS)
• Live attenuated vaccines:
– Stimulate local + systemic immunity
– Antigenic variations presents difficulties in manufacture

15. Vaccine Contd…
Newer vaccinesQ:
– Split – virus vaccine:
- Also known as ‘Sub-virion vaccine’
- Highly purified
- Lesser side effects
- Less antigenic – multiple injections required
- Useful for children
– Neuraminidase – specific vaccine:
- Sub-unit vaccine containing N-antigen
- Permits subclinical infection – long lasting immunity

16. Recombinant vaccine:
- Antigenic properties of virulent strain transferred to a less virulent strain
– Contraindications to Inactivated Influenza vaccines:
- Severe allergy to chicken eggs
- History of hypersensitivity/anaphylactic reactions previously
- Development of Guillain Barre Syndrome (GBS) within 6 weeks of vac-
cine
- Infants less than 6 months age
- Moderate-to-severe illness with fever

17. Priority groups (in order) for Influenza vaccines:
– Pregnant womenQ
– Age > 6 months with chronic medical conditions
– 15-49 years healthy young adults
– Healthy young children
– Healthy adults 49-65 years
– Healthy adults >65 years

18. Influenza Contd….
Avian Influenza
• Also known as ‘Bird flu’ or ‘Highly pathogenic avian influenza’
• Causative agent: H5N1 (Type A Influenza virus)
• Avian Influenza is a Pandemic: Origin from Hong Kong (1997)
• Drug of choice: Oseltamivir (Tamiflu) 75 mg BD × 5 days (contraindicated in
infants)

19. Influenza subtype swine flu
Influenza: Pandemic (H1N1) Influenza 2009 [NEW NOMENCLATURE: Influenza A
(H1N1) pdm 09]
• WHO declaration of Influenza pandemic: 11 June 2009
– World is now post-pandemic EXCEPT: INDIA and NEW ZEALAND (locally
intense transmission)
– Problem statement India: 37000 cases, 1833 deaths [May 2009 – August 2010]
• Incubation period: 2–3 days

20. Swine flu contd….
• Clinical features:
– Uncomplicated influenza: Influenza like illness (Fever, cough, sorethroat, rhi-
norrhoea, headache, muscle pain), GIT illness (diarrhoea WITHOUT dehy-
dration)
– Complicated/severe influenza: Pneumonia, CNS involvement, Severe diarrhoea,
Secondary complications,
– Exacerbation of chronic diseases
– Progressive disease: Oxygen impairment/cardiopulmonary insufficiency, CNS
complications, Invasive secondary bacterial infection, Severe dehydration

21. Risk Factor
● Infants and children < 2 years
● Pregnant females,
● COPD,
● Chronic cardiac disease,
● Metabolic disorders,
● Chronic
renal/hepatic/neurological/hemoglobinopathies/immunosuppression
(INCLUDING HIV) disorders,
● Children on aspirin therapy,
● Persons aged > 65 years,
● Morbid obesity

22. Swine flu Contd …
Laboratory diagnosis:
– Most timely and sensitive detection: RT-PCR testQ
– Samples: Nasopharyngeal + throat swabs [Tracheal/bronchial aspirates in
lower respiratory tract infection cases]Q
– Point-of-care/Rapid diagnostic tests: Not recommended

23. Swine flu vaccine
H1N1 Inactivated vaccine: Single i/m injection
– Strain: A/California/7/2009 (H1N1) V like strainQ
– Storage temperature: +2° to +8° C
– Contraindications: History of anaphylaxis/severe reaction/Guillian Barre Syndrome, Infants < 6 months,
Moderate-to severe illness with fever
– Protective immunity: Develops after 14 days (NOT 100%)
H1N1
Live attenuated vaccine: Nasal spray
– Side effects: Rhinorrhoea, nasal congestion, cough, sore throat, fever, wheez-
ing, vomiting

24. Swine flu Contd….
● Duration of isolation: for 7 days after onset of illness OR 24 hours after
resolution of fever/respiratory symptoms whichever is longer
● Antiviral therapy:
○ Severe/progressive clinical illness: OseltamivirQ (if not available or
resistance, use Zanamivir)
○ High risk of severe/complicated illness: Oseltamivir OR Zanamivir
○ Not high risk OR Uncomplicated confirmed/suspected illness: No need
of treat-ment
● Dosage:
○ Oseltamivir 75 mg BD × 5 days
○ Zanamivir 2 inhalations (2 × 5 mg) BD × 5 days

25. Dengue
Dengue viruses are arboviruses (Flavivirus) which may result in:
– Asymptomatic infection
– Dengue
– Dengue hemorrhagic fever (DHF)
– Dengue shock syndrome (DSS)
• Dengue viruses have 4 serotypesQ (Den 1, 2, 3, 4)

26. Dengue contd…
Vector for dengue: Aedes aegypti
• Reservoir: Man, Mosquito
• Incubation period: 5 – 6 days
• Classical dengue fever (DF):
– Also known as ‘breakbone fever’
– Clinical features: High grade fever (biphasic curve) with chills, intense head-
ache, muscle and joint pains, retro-orbital pain, photophobia, colicky pain,
abdominal tenderness, skin rash

27. Dengue Contd…
● Dengue hemorrhagic fever (DHF): Severe form of DF, caused by infection with
more than one dengue virus type
○ Incubation period: 4 – 6 days
● Clinical featuresQ: Features of DF plus
○ Rash less common
○ Rising hematocrit value (> 20% of baseline)
○ Moderate-to-marked thrombocytopenia (< 1 lac/ mm3)
○ Hepatomegaly
○ Positive tourniquet test: > 20 petechiae per sq. inch
● Diagnosis of DHF: Fever + hemorrhagic manifestations + thrombocytopenia +
hemoconcentration or rising hematocrit
● Dengue shock syndrome (DSS):
○ Diagnosis of DSS: DHF + shock [rapid and weak pulse, narrow pulse
pressure (< 20 mm Hg)/ hypotension, cold clammy skin, restlessness]

28. Dengue contd…
● Laboratory tests for Dengue:
○ Virus isolation within six days: Serum, plasma, autopsy tissue
○ Viral nucleic acid detection (RT-PCR assay)
○ Immunological response and Serological tests:
Hemeagglutination inhibition
○ Complement fixation/Neutralization test
○ IgM-capture MAC-ELISA /Indirect IgG-ELISA/IgM/IgG ratio
○ Viral antigen (EM and NS1) detection
○ Rapid diagnostic tests Hematological parameters

29. Dengue Classification and management
WHO classification and Grading of Dengue fevers:
● DHF Grade 1: Dengue fever PLUS Hemorrhagic manifestations PLUS Positive tourniquet
test
● DHF Grade II: Grade I PLUS Spontaneous bleeding DHF Grade III: Grade II PLUS
Circulatory failure DHF Grade IV: Grade III PLUS Profound shock
● DHF Grades III, IV are Dengue shock syndrome (DSS
●
Management of Dengue:
DHF Grade 1, II: Oral rehydration, Antipyretics
DHF Grade III, IV: Colloidal solution, Fresh whole blood transfusion

30. Plague
Synonyms: Black Death, Mahamari, The great death
• Causative agent: Yersinia pestis (Gram negative, non-motile cocco-bacillus)
– Bipolar staining with Wayson’s stain
Reservoir of Infection: Wild rodents (Tatera indica in IndiaQ)
• Source of Infection: Infected rodents ,fleas and cases of pneumonic plague
• Commonest and most efficient vector of Plague: Rat flea (Xenopsylla cheopsisQ)
– Both sexes of fleas bite and transmit the disease
• Mode of transmission: Bite of an infected flea, direct contact with tissues of infected
animal or droplet infection (pneumonic plague)

31. Types of plaque
Management of plaque:-
● Drug of choice for treatment: Streptomycin 30 mg/kg i.m. × 7-10 days
● Drug of choice for chemoprophylaxis: Tetracycline 500 mg QID × 5 days

32. Malaria

33. Malaria Contd…
● Season: Most common in July – November
● Definitive host: Anopheles mosquito (Intermediate host: Man)
○ Is seen in both rural as well as urban areas
● Vector: An. culicifacies (rural) and An. stephensi (urban)
Mode of Malaria Transmission
● Bite of female anopheline mosquitoes:
○ Infective forms: Sporozoites.
● Injection of blood of a malaria patient containing asexual forms: ‘Trophozoite
induced malaria
○ Transfusion malaria
○ Congenital malaria
○ Malaria in drug addicts

34. Malaria Transmission

37. Malaria Treatment
● VIVAX MALARIA
○ Chloroquine X3 days (10 mg per kg Day 1: 10 mg per kg Day 2:5 mg per kg Day 3)+
○ Primaquine X 14 days (0.25 mg per kg)
● FALCIPARUM MALARIA
○ In Other States (Other than North-Eastern states);
■ Artemisin based Combination therapy (ACT-SP)
1. Artesunate X3 days (4 mg per kg) +
2. Sulfadoxine X Day 1 (25 mg per kg)+
3. Pyrimethamine X Day 1 (1.25 mg per kg) Primaquine X Day 2 (0.75 mg per kg)
○ In North-Eastern states:
■ Artemether based Combination therapy (ACT-AL)
1. Artemether X3 days (80 mg BD)+
2. Lumefantrine X3 days (480 mg BD)
Primaquine X Day 2 (0.75 mg per kg)

38. Treatment of Malaria Contd….
● . MIXED INFECTIONS (P. VIVAX + P. FALCIPARUM)
○ In Other States (Other than North-Eastern states):
■ ACT-SP X 3 days
■ Primaquine X 14 days (0.75 mg per kg)
○ In North-Eastern states:
■ ACT-AL X3 days
■ Primaquine X 14 days (0.75 mg per kg)
● PLASMODIUM MALARIAE
○ Treat as P. falciparum
● V. PLASMODIUM OVALE
○ Treat as P. vivax

39. Diptheria
● Causative agent: Corynebacterium diphtheriae, a gram positive
non-motile organism
● Diphtheria is an endemic disease in India
● Source of infection: Case or carrier
○ Carriers are more important as source of infection: 95% of
total disease transmission.
○ Nasal carriers are more dangerous than throat carriers.
○ Incidence of carriers in a community: 0.5-1%
○ Immunization does not prevent carrier state

40. ● Incubation Period: 2-6 days
● Mode of transmission: droplet infection (main mode), directly from cutaneous
lesions and fomites
● Period of Infectivity: 14-28 days from onset of disease; longer for carriersQ
○ A case/carrier may be considered non-communicable when atleast 2 cultures from nose and
throat, 24 hrs apart, are negative

41. Type: Combined TRIPLE vaccine for Diphtheria, Pertussis & Tetanus; D & T are
Toxoids, P is killed acellular bacilli
• Dose: 0.5 ml
• Route: IntramuscularQ
• Site: Antero-lateral aspect of thigh, middle 1/3 (earlier it was administered at glu-
teal region ,but presence of fat in buttocks breaks the adjuvant & reduces absorp-
tion of DPT vaccine)
• Composition of DPT Vaccine:

42. Aluminium phosphate or aluminium hydroxide is used as adjuvant in DPT vaccine:
It increases immunogenicity of vaccineQ
– Thiomersal is used as preservative in DPT Vaccines