IT CONTAINS QUESTION AND ANSWERS ON COMMONLY ASKED QUESTIONS IN MUHS UNIVERSITY

1. ENVIRONMENT AND HEALTH

2. Question 1
EMPORIATRICS ?

3. Emporiatrics :
• It is a science which deals with promoting and protecting the
health of international travelers, providing them the advice related
to the travel they are about to undertake.
• It is a fast developing speciality as the international travel is fast
increasing.
Source : WHO

4. Importance of traveler’s health in India :
• Came into focus in February 2023.
• When respiratory illness SARS spread beyond China, several international
travelers became infected and within 4 months, 8000 cases of SARS and
nearly 800 deaths occurred in 29 countries.

5. Emporiatrics :
Aim :
• Is to eliminate or minimize the risk of transporting endemic diseases and
travel–related conditions to non endemic geographical areas without
affecting trade, tourism and other sectors of life.
• India being growing economy has major concern in traveler’s health.
Aim :

6. Purpose of visit and mode of transport :

7. Key determinants of health risk during travel :
Pre
existing/underlying
health issues of
travelers
Destinations
Purpose of travel
Mode of transport
Duration and season
of travel
Standards of
accommodation,
food hygiene and
sanitation

8. Determinants of health risk during travel:
1.Pre existing health issues of traveler : Past medical history, allergic history,
vaccine history, previous history of travel, past surgical history. In case of female
traveler, whether she is pregnant or breast feeding.
2.Destination, standards of accommodation food hygiene and sanitation:
Poor quality and unhygienic accommodation at destinations, inadequate medical
services and non access to clean water can cause serious risk to health of travelers.
Travelers traveling into remote area must be take precautions to prevent illness.

9. Determinants of health risk during travel:
3.Purpose of travel and behavior of traveler : Going for field works and
staying in temporary shelters are at higher risk due to exposure to natural
physical and biological environments.
4.Season and duration of travel : Season of travel will determine exposure to
infectious diseases and necessity of vaccines or drugs such as antimalarial
drugs.
5.Duration of travel : Determines traveler is exposed to noticeable
fluctuations due to altitude, humidity and temperature or to sustained
exposure to pollution.

10. 6.Mode of transport :
• Cruise / ship where large number of people from
different regions of world travel together was a
determinant in several influenza outbreaks.

11. Travelers at risk :
Pregnancy
Immunocom
promised
Children
Cardiac or Lung
disease Elderly
Diabetes
Long term
travelers
HIV
INFECTION
S

12. Travelers health risks :
Health risk factors related
to environment :
• Heat and humidity, UV radiation, foodborne and waterborne health hazards, intestinal
parasites, animals and insects bites, high altitude variations.
Exposed to prevalent infection in area visited.
Infectious diseases of
potential risk :
• Vector- borne diseases, Enteric fever.
• MODES OF TRANSMISSION : Foodborne and waterborne, vector-borne, zoonosis, STD, blood
borne , airborne or via soil.
Injuries and Violence – Road traffic Accidents ,
injuries during recreational activity such as
swimming, diving , sailing.
Psychological health : Feel separated from family and social
support system, to face foreign cultures, languages.

13. Various conditions experienced during travel:
Jet lag Travelers’ diarrhea
Motion sickness Altitude sickness
Road traffic Injuries
Communicable
diseases

14. Preventive Measures and precautions :
1.General Precautions :
Items to treat cuts, scratches , burns,
strains, splinters
Paracetamol, Antacids, laxative ,
sedative ,Travel insurance, pre
existing medical problems, nets,
syringes, medical kits.
Repellent, Sterile needles
and syringes, alcohol
swabs.
Rehydration solution,
Loperamide, Tinidazole ,
Norfloxacin ,
Azithromycin
Antihistamines, antibiotic
and Antifungal cream,
Antimalaria medicine

15. Preventive measures :
Food hygiene : Eat only thoroughly cooked food and drink only bottled or
packaged
• Cold drinks, ensuring that the seal has not been broken.
• Boil drinking-water
• If safety is doubtful. If boiling is not possible, a certified well-maintained
filter
• and/or disinfectant agent can be used.
Jet lag : it can be minimized by adapting to the local schedule as early as
possible. Prior adjusting sleep schedules before travelling.
Traveler’s diarrhea : caused by contaminated food,water along with
contributing factors such as anxiety, jet lag.

16. Measures for Adaptation to the Environment
• Excessive sun exposure can cause erythema, chemical hypersensitivity,
eye damage , bleaching of skin, skin cancers malignant melanoma.
• Clothing made of natural fibres , such as cotton having light colours is
preferable to dark fabrics,
• Should drink at least 2 liters of fluid/day.

17. Personnel Protection Measures :
• Avoid outdoor exposure, dawn to dusk.
• Wear long sleeved loose clothing after dusk, light colours.
• Avoid perfumes and colognes.
• Use repellent with 20-40 % DEET.
• Use knockdown sprays, coils, vapours .
• Sleep under nets impregnated with Permethrin.

18. Measures to prevent Road traffic collisions
and injuries :
• They should know formal and local traffic rules of destination countries.
• Beware of wandering animals.
• Do not drive on unfamiliar roads.

19. Specific precautions :
• Pre exposure Vaccination :
• Travelers should get
vaccinated with Hepatitis B
vaccine .
• Post exposure Vaccination:
• For protection against HIV and
hepatitis B, during accidental
exposure to infected blood or other
body fluids, immediate first-aid
care and post exposure
prophylaxis should be provided.

20. Specific Precautions :
• Vaccines for Travelers :
• Routine vaccination : DPT,
hepatitis B, H. Influenza type b,
MMR, Pneumococcal, OPV,
rotavirus, BCG, HPV.
• Selective use for travelers :
• Hepatitis A, Japanese
encephalitis, meningococcal,
rabies , typhoid, yellow fever.

21. Precautions :
Infants
A fit and healthy baby can travel by air 48 h after birth, but it is preferable to
wait until the age of 7 days. Until their organs have developed properly and
stabilized,
Premature babies should always undergo a medical clearance before
travelling by :
• Air.
• Changes in cabin air pressure may upset infants; this can be helped by
feeding or giving a pacifier to stimulate swallowing.

22. Precautions:
Pregnant women
• They can normally travel safely by air, but most airlines restrict travel in late
pregnancy.
• Guidelines for a woman with an uncomplicated pregnancy are:
— after the 28th week of pregnancy, a letter from a doctor or midwife should
be carried, confirming the expected date of delivery and that the
pregnancy is normal
— for single pregnancies, flying is permitted up to the end of the 36th week;
— for multiple pregnancies, flying is permitted up to the end of the 32nd
week.
• Each case of complicated pregnancy requires medical clearance.

23. Prophylaxis of malaria :
Short term Prophylaxis (less than 6 months )
• Daily antimalarial have to be
initiated the day before arrival to
destination area.
• Chloroquine (weekly) should be
started 1 week before travel and
mefloquine (weekly) should be
started 2-3 weeks before travel
and have to be taken regularly for
the whole duration of stay in the
malaria endemic area, and
continued for 4 weeks after
departure.
Long term prophylaxis
• 1 tablet (250mg) once a week on
the same day each week.

24. Knowledge of Travel – Related Risks :
• Knowledge of morbidity and mortality of travellers.
• Understanding of epidemiology and geography of communicable diseases.
• Awareness of non communicable risks.
• Vaccinations, indications, side effects.
• Knowledge and management of post- travel illness.
• Ability to communicate complex issues in simple ways.
• Understanding of when to refer.
• Geography, especially of major tourist destinations.
• Be aware of outbreaks and emergent issues
• Provide written material targeting specific risks.
• Be able to communicate using electronic media.

25. Risk Management :
• Identifying risks for individuals or groups.
• Advising about risk reduction strategies.
• Recommending and providing risk reduction interventions.
• Encouraging behavioral change to change risk level.

26. INTERNATIONAL HEALTH REGULATIONS:
• The International Health Regulations (IHR) is an agreement among 196
countries, including all WHO Member countries, to work together for health
security of the world.
• The IHR : Adopted in 1969,
•
• amended in 1973 and 1981
•
• completely revised in 2005.
• Aim : To prevent , protect against, control, and provide public health
responses to the international spread of disease in ways that are
commensurate with and restricted to public health risks, and that avoid
unnecessary interference with international traffic and trade.

27. Principles of International Health Regulations
• With full respect for dignity, human rights and fundamental freedom of
persons.
• Guide by the charter of the United Nations and the constitution of the
WHO.
• Guided by the goal of their universal application for the protection of all
people of the world from the international spread of disease.
• States have right to legislate and to implement legislation in pursuance of
their health policies.

28. International health regulations :

29. Public health emergencies of international
concern :
• A public health risk to other countries through the international spread of
disease.
• Potentially requires a coordinated international response.
• Determined by WHO after consultation with Emergency Committee.

30. Notification
• Each State Party shall notify WHO, within 24 hours about assessment of
public health information of all events accurately and in detail which
constitutes a PHEIC.
Four decision criteria to assess public health events :
• 1. Is the public health impact of this event potentially serious?
• 2.Is this event unusual or unexpected ?
• 3. is there the potential for international spread ?
• 4. is there the potential for travel and trade restrictions?
• If 2 of the criteria are met, countries are required to notify WHO within 24
hours.

31. Question 2 :
Sources and biological effects of Radiation exposure ?

32. Sources of radiation exposure :
Among general public Among occupationally exposed individuals
Major isotopes : I- 131, Tc – 99m, Co
– 60, Ir-192, Cs-137
Radiography
Televisions X-ray technicians
Medical X-rays Nuclear power plant
Smoke detectors Nuclear medicine technicians
Nuclear medicine Major isotopes : Cobalt-60, cesium-
137, americium-241

33. Effect of ionizing radiation :
1.Somatic
Immediate Delayed
(1) Radiation sickness (1) Leukemia
• (2)Acute radiation syndrome (2)Carcinogenesis
(3)Foetal developmental abnormalities
• (4)Shortening of life

34. Effect of ionizing radiation :
2.GENETIC
1.Chromosome mutations – associated with sterility.
2. Point mutations – affects genes.

35. Biological effects of radiation :
Dose Biological response
<5 rad No immediate observable effects
5 rad – 50 rad Slight blood changes may be detected by medical
evaluations
50-150 rad Slight blood changes noted and symptoms of nausea,
fatigue, vomiting etc.
150- 1100 rad Severe blood changes noted and symptoms appear
immediately
1100- 2000 rad Probability of death 100% within one to two weeks
>2000 rad Death is a certainty.
>5000 rad Central nervous system (brain and muscles) can no
longer control the body functions, including breathing
and blood circulation.

36. Biological effects of radiation exposure:
1. Exposure to high doses of radiation over a short period of time
producing acute or short term effects.
2. Exposure to low doses of radiation over an extended period of time
producing chronic or long term effect.
3. High doses tend to kill cells, causing organ damage. This inturn may
cause whole body response often called “Acute Radiation Syndrome”

37. Question 3
• Role of Global Warming in Health ?

38. Global warming:
• Emission of green house gases into the atmosphere have been increasing
ever since the beginning of the industrial revolution.
• Major component of emission of carbon dioxide is from the combustion of
fossil fuels.
• Effects of this include an increase of about 3 degree C in the average
global surface temperature by the year 2030, rise in sea level of 0.1 – 0.3
metres by 2050.

39. World scenario :
Globally there are 150,000 deaths and 5million deaths
attributed to global warming.
Global loss of 5.5 million Disability Adjusted life Years.
(DALYs).
South East Asian countries contributing to loss of 2.5
million DALYs.
In India, about 27% DALYs lost and about 30% deaths.

41. Sources of Global warming :
Carbon dioxide from
burning fossil fuels,
power stations,
deforestation.
Methane released
from paddy field,
marshes, animal
husbandry and
landfills.
Nitrous oxide from
exhausts of cars,
disposal of waste and
fertilizer use.

42. Impact of global warming on health :
Changes due to global warming
• Warmer Temperatures and
stagnant air masses.
• Heavy precipitation events.
• Intense weather events
(Cyclones, Storms)
• Air pollution
• Ozone depletion
Impact on human Health
• Impact risk of heat strokes, heat
exhaustion.
• Changes in vector borne transmitted
diseases.
• Floods.
• Water pollution.
• Loss of life, injuries,life long handicaps.
• Diseases of outbreak
• Overcrowding, poor sanitation.
• Respiratory illnesses.
• Increased skin cancers and cataracts.

43. CLIMATE EFFECTS ON HEALTH :

44. Respiratory illness :
• Climate change will potentially lead to shifts in precipitation
patterns, more frost-free days, warmer seasonal air
temperatures, and more carbon dioxide (CO2) in the
atmosphere. These changes can affect:
• When the pollen season starts and ends and how long it
lasts each year,
• How much pollen plants create and how much is in the air,
• How pollen affects our health,
• How much pollen we’re exposed to, and
• Our risk of experiencing allergy symptoms.
• Extreme rainfall and rising temperatures also can
contribute to indoor air quality problems. For example, they
can cause the growth of mold indoors, which may lead to
worsened respiratory conditions for people with asthma
and/or mold allergies and heightened challenges in
maintaining adequate asthma control.

45. Vector borne and Zoonotic Diseases :
• Climate is one of the factors that influence the
distribution of diseases borne by vectors (such
as fleas, ticks, and mosquitoes, which spread
pathogens that cause illness).
• The geographic and seasonal distribution of
vector populations, and the diseases they can
carry, depends not only on climate but also on
land use, socioeconomic and cultural factors,
pest control, access to health care, and human
responses to disease risk, among other factors.

46. Diarrhoeal diseases :
• Major public health issue in developing countries.
• Exposure to a variety of pathogens in water and food causes diarrheal
disease. Air and water temperatures, precipitation patterns, extreme
rainfall events, and seasonal variations are all known to affect disease
transmission.
• In general, diarrheal diseases, including salmonellosis and
campylobacteriosis, are more common when temperatures are higher.

47. Natural disasters :
• Weather related morbidity and mortality :
• Increases in the incidence and intensity of extreme weather events such
as – hurricanes, floods , droughts, and wildfires may adversely affect
people’s health immediately during the event or later following the event.

48. • Neurological diseases and disorders : Climate change, as well as
attempts to mitigate and adapt to it, may further increase the number of
neurological diseases and disorders.
• Exposure to UV rays :
• The greatest burden is by UV induced:
• Cortical cataracts
• Cutaneous malignant melanoma
• Sunburn

49. Food security :
• Globally, climate change is expected to threaten food
production and certain aspects of food quality, as
well as food prices and distribution systems
• Many crop yields are predicted to decline because of
the combined effects of changes in rainfall, severe
weather events, and increasing competition from
weeds and pests on crop plants
• The nutritional value of some foods is projected to
decline. Elevated atmospheric CO2 is associated
with decreased plant nitrogen concentration, and
therefore decreased protein, in many crops,
such as barley, sorghum, and soy.

50. Mental health :
• Mental health problems increase, both among
people with no history of mental illness, and those
at risk – a phenomenon known as “common
reactions to abnormal events.”
• For example, research demonstrated high levels of
anxiety and post-traumatic stress disorder among
people affected by Hurricane Katrina, and similar
observations have followed floods and heat waves.

51. Occupational health :
• Global warming causing heat stress affects both indoor and outdoor
worker :
• Working in hot environments causes :
• Diminished ability to carry out physical tasks
• Diminishes mental task ability
• Increases accident risk
• Leads to heat exhaustion or heatstroke.

52. National action plan on climatic change :
(MOHW)
• National Solar Mission : Encouraging utilization of solar energy.
• National Mission for Enhanced Energy Efficiency : Enhance energy
efficiency in various industries.
• National Water Mission : Ensure integrated water resource management.
• National mission for Green India : Preservation of forests and afforestation.
• National Mission for Sustainable Agriculture : To protect agriculture and
crops from effect of climate change.
• National Mission for Strategic Knowledge for Climate Change: Establish
open platform to share knowledge and expertise on climate change.

53. Question 3
• Indicators of Environmental Sanitation?

54. Importance of Environmental Health :
Promotes health
Prevents disease
transmission
Eliminates breeding
places of insects
Improves quality of life

55. Components of environmental sanitation :
Ventilation and air sanitation Water and Food sanitation Town (or village planning )
Vector and rodent control
measures
Waste disposal Sanitary housing

56. Water supply :
• In the villages :Well common meeting place of men and women for supply of
water, people bath and wash their clothes, animals are washed and given a
drink – these cultural practices lead to pollution of well water.
• People go on pilgrimage to some of rivers which are considered holy.
• They do no only have a dip but drink the raw water.
• Epidemics of cholera and gastroenteritis have been due to this cultural
practices.

57. Water sanitation:
• Provision of safe water , sanitation and hygiene are crucial for human
health and well being.
• Safe drinking water – Provision of RO Systems and cooler in schools.
• Boiling water in household.
• Awareness and sensitization- In school and community.
• Construction and maintenance of household toilets , school, community
toilet complex.
• Cleanliness Drives.
• Rainwater Harvesting.

58. Waste disposal :
• Villager is not aware that mosquitoes breed in collections of waste water.
• Solid waste is invariably thrown in front of the houses where it is permitted
to accumulate and decompose.
• Periodically it is removed to the fields and used as a manure.
• Animal dung is allowed to accumulate and sometimes used as manure
and often times pressed into cakes, sun- dried and used as fuel.

59. Disposal of human excreta :
• Large percentage of people in rural areas use open fields for defecation.
• He is ignorant that faeces is infectious and pollutes water and soil and
promotes fly breeding.

60. Methods of waste disposal are :
1.Dumping : Most insanitary method that creates public health
hazards, a nuisance, and severe pollution of environment.
2.Controlled tipping or sanitary land fill
3.Incineration
4.Composting
5.Manure pits
6. Burial

61. Housing :
• Houses are usually katcha and damp, ill – lighted and ill ventilated.
• For reasons of security , no windows are provided.
• Absence of separate kitchen, latrine, bathroom and drainage are characteristic
features of an average rural house.
• No separate place for animals.
• Houses are generally kept clean inside, regularly white washed or plastered
with mud and cowdung .

62. Food sanitation :
• Practice good personal hygiene.
• Use appropriate kitchen tools for Food Preparation.
• Washing of fruits and vegetables before use.
• Cook food to an appropriate temperature.
• Use clean water to prepare food.
• Keep dry foods separate from liquids.
• Clean utensils and cooking equipment.

63. Prevention of air pollution
OUTDOORS
• Minimize air pollution from cars.
• 2. Walk, bike or use public
transportation
• 3. save energy
• 4. maintain your wood stove or fireplace
• 5. recycle and buy recycled products.
• 6. plant trees.
• Raise awareness.
• 8. grow your own food
• 9. eat local, organic produce and less
meat.
INDOORS
• Keep air- purifying indoor plants.
• Open windows.
• Use natural products.
• Use essential oils.
• Do not smoke indoors.
• Test your home for radon.
• Clean dust.
• Use air purifiers.
• Keep indoor humidity low.

64. Maintenance of good ventilation and air :
• To remove the resumed air from the buildings.
• To remove the excessive moisture.
• To supply oxygen for humans in the building.
• To prevent the suffocations of theatres, assemble halls and other public
meeting places.

65. General Measures:
• Access to Improved Sanitation Facilities: This indicator measures the
percentage of the population with access to improved sanitation facilities,
such as flush toilets, ventilated improved pit latrines, or composting toilets.
• Open Defecation: The proportion of the population practicing open
defecation is another critical indicator. Open defecation contributes to
environmental pollution and the spread of diseases.
• Waste Management: This includes indicators related to solid waste
management, such as the percentage of waste collected, treated, or
disposed of in an environmentally sound manner.
• Water Quality: Indicators related to water quality assess the presence of
contaminants such as bacteria, heavy metals, and chemicals in water
sources. Parameters such as fecal coliform levels and turbidity are
commonly measured.

66. Sanitation at Household level :
• Proper personal hygiene, including frequent hand washing.
• Proper cleaning and sanitizing of all food contact surfaces and
utensils.
• Proper cleaning and sanitizing of food equipment.
• Good basic housekeeping and maintenance.

67. Sanitation at community level :
• In 1999, Indian government introduced the Total Sanitation Campaign
(TSC) to accelerate sanitation coverage throughout the country,
particularly in rural areas.
• It focused on information and education to generate public demands for
sanitation facilities, particularly in schools.
• It was renamed Nirmal Bharat Abhiyan in 2012 and relaunched as Swachh
Bharat Abhyan in 2014.

68. The Swachh Bharat Mission (SBM) :
Launched in 2014 to fulfil the vision of a cleaner India by 2 October
2019, as a tribute to Mahatma Gandhi on his 150th birth
anniversary.

69. Question 4
Epidemiological tools for control of outbreak of water borne
disease.

70. Water borne disease outbreak :
• Defined as two or more people that are linked epidemiologically by time,
location of exposure to water, and type of illness. Epidemiologic evidence
implicates water as the probable source of illness.
• Environmental evidence can be important for implicating water as the
source of infection (for example, water samples testing positive for
pathogens).

71. Water borne disease outbreak :
• Once a waterborne disease outbreak is detected, public health and
regulatory officials work to collect data to identify a source of
contamination and take action to prevent additional illnesses.
• Timely detection, response, and control of waterborne disease
outbreaks is crucial for protecting public health.
• Outbreak investigations can provide important data that may highlight
safety gaps in water systems or identify strategies to reduce
waterborne illness.
• Depending on the type of exposure and contaminant, waterborne
pathogens can cause a variety of health problems, including
gastrointestinal, respiratory, dermatological, and neurological illnesses.

72. Preparation for a Waterborne Disease
Outbreak Investigation
1.Organization
2.Partners
3.Training and Resources
4.Communication
5.Line List : They are utilized to summarize information
provided during case investigation. Line lists should include
demographic information and clinical information such as
signs and symptoms (type, duration), onset dates and times,
case status, and exposure information.

73. Control for outbreak of water borne disease :
6. Epidemic Curve :To help keep track of the number of illnesses over
time, create an epidemic curve. The pattern can help to determine if
the exposure is a point course or if exposure occurred over a longer
time period.
7.Maps and spatial analysis tools : Can be useful investigation tools
for visualizing the location of cases, facilitating recognition of any
spatial relationships, giving clues to outbreak source, and tracking
geographic spread over time.

74. Control Outbreak Through Remediation and
Outreach :
• Public health officials may decide on control measures on the basis of strong
epidemiological evidence about the disease’s origin, spread, and development.
They do not always need to wait for definitive proof of contamination from the
laboratory.
• This practice can result in earlier action to protect the public’s health. As
officials learn more during the investigation, they may change, focus, or expand
control measures and advice to the public.

75. Epidemiological tools for control of outbreak
of water borne disease :
• All control strategies require risk communication to inform the public about
the outbreak, how investigators are working to understand it, and what
they can do to reduce risk.
• Risk communication should be initiated early, even before the outbreak is
solved.
• While there are many ways to control waterborne disease outbreaks, there
are three practical strategies for public health recommendations— health
promotion, processes and policies, and water treatment to reduce risk.

76. Public health recommendations
MEASURE STRATEGY EXAMPLE
Health Promotion Protect the person . Healthy swimming messages
Boil water advisories.
Processes and Policies Change the way people interact
with water systems.
Bathroom breaks at pools.
Diarrhea exclusion policies.
Point-of-use water filters.
Water Treatment to Reduce
Risk
Isolate people from the hazard.
Remediation
Hyperchlorination
Temporary closure of building
wing
Temporary closure of a beach

77. Epidemiological tools for control of outbreak
of water borne disease :
• As many water systems are often connected to other community systems,
control measures such as elimination and substitution are often not practical or
effective unless there are extreme circumstances.Considerations for using
these approaches:
• Elimination : Physically remove the hazard.
Examples : Shutting off tap water supplies and closing springs.
• Challenges : People need tap water for multiple household uses, ill swimmers
will go to other facilities, people may continue to use unsafe water sources.
• Substitution : Replace the hazard.
• Examples: Providing an alternative source of water.
• Challenges: Providing supplemental water from a different source is
challenging for extended periods of time.

78. THANK YOU