Community Health Nursing -I ( Epidemiology of Communicable disease)

1. POLIO MYELITIS
Prepared by:-
VANINDAR KUMAR B.C
Government College of Nursing
Victoria Hospital campus, Fort,
Bengaluru-02

3. DEFINITION
Polio myelitis is acute highly infectious
viral disease caused by RNA polio virus
basically affecting the human alimentary tract,
but may also infect the central nervous system,
i.e. the brain ,spinal cord and nerves .

4. Problem
Polio myelitis was widely spread in all countries
of the world in the pre-vaccination era. Since 1954,
due to extensive polio vaccination , the disease has
been eliminated from the developed countries.
India has achieved zero polio status in 2014. It is
a huge success story for India despite being highly
populated country and having low sanitation levels.
India was removed from the list of polio endemic
countries by the WHO on 25th February 2012.
Pulse polio programme implementation in India
since 9th December 1995 has shown their results of
zero polio cases in India in 2014.

5. EPIDEMIOLOGICAL TRIAD
Agent
(PolioVirus)
Host
(Infant & children under
3 years males>females)
Environment
(contaminated water and
food overcrowding,rainy
season)

6. AGENT
• The causative agent of poliomyelitis is
POLIOVIRUS. It has three types of sero-types 1,2
and 3. mostly the polio occurs due to type-1 polio
virus.
• The virus is found in the oropharyngeal secretions of
a patients infected with polio virus.
• The virus can live in feces for 6months & in water for
4 months.
• Reservoir of infection:- man is only the reservoir of
infection.
• Infectious material:- feces and oropharyngeal
secretions of the infected persons.

7. HOST FACTOR
• Age:- all the groups are effected, but Polio is
a disease of infancy and childhood. It means
most vulnerable age is between 6 months
and 3 years.
• Sex:- ratio of male to female is 3:1.
• Risk factors :- fatigue, trauma, intramuscular
injections, operative procedures.

8. ENVIRONMENTAL FACTORS
• It is more likely to occur in rainy season.
• Contaminated water,food, flies are the
environmental factors which can cause the
poliomyelitis.
• Polio virus is excreated in the faeces for 2-3
week, sometimes 3-4 months in polio case.
• Other causes of environment include
overcrowding, poor santitation etc.

9. MODE OF TRANSMISSION
• Faeco-oral route
Directly spread through fingers which are
contaminated with polio virus or indirectly
milk, water, food, flies and articles.
• Droplet Infection
Droplet infection is the mode of transmission of
infection. Personal contact with an infected
person with facilitate the spread of infection.

15. • Incubation period : 7 to 14 days( ranges from 3-35
days)
• CLINICAL MANIFESTATION:
 Asymmetrical flaccid paralysis
 Fever at the onset of paralysis which is suggestive of
polio.
 Anorexia
 Vomiting
 Nausea
 Malaise
 Headache
 Sore throat
 Abdominal pain
 Constipation

16. Stiffness of neck and back muscles.
Difficulty in swallowing
Weak or diminished deep tendon reflaxes
before the onset of paralysis.
– The paralysis in a case of polio reaches to its
maximum in less than 4 days. Paralysis occurs in
descending way i.e. starting at hip and then
moving down to distal parts of the extremity.
– In case of bulbar and bulbospinal form paralytic
poliomyelitis, cranial nerve involvement can cause
facial asymmetry, difficulty in swallowing. Death
can also occur due to respiratory insufficiency.

17. Diagnosis
Diagnosis is done by isolation of the wild polio
virus from the patient’s stool and by serological
tests.

18. PREVENTION AND CONTROL
(1) Immunisation :
it is one of the effective means to achieve
prevention of poliomyelitis.
The vaccine used for immunisation is of two
types.
 Inactivated polio vaccine(IPV)
 Oral polio vaccine(OPV)

19. Inactivated Polio Vaccine : (salk)
It is the salk vaccine. It contains all the three
types of virus of polio which are inactivated by
formalin. The main advantage of giving this
vaccine is that it does not contain live virus so it
can be administered safely to patients with
immune deficiency, on radiation therapy and on
corticosteroids.
Oral Polio Vaccine : ( Sabin)
The oral polio vaccine is sabin vaccine and contain
live virus according to National Immunisation
Schedule in india and WHO programme on EPI
recommend the administration of three polio
doses at an interval of 1 month.

20. At birth, OPV-Odose is given, then 1st
dose of OPV is given at age of 6 weeks.
Booster dose of OPV is given at an age of 16-
24 months.
Vaccine Dose Route Age
Oral polio
vaccine
3 drops doses
+
Oral At birth- 0 Dose
2 booster doses 6 weeks – 1st dose
10 weeks – 2nd dose
14 weeks – 3rd dose
16-24 months – Booster dose

21. • Oral polio vaccine induces humoral and
intestinal immunity. It should not be
administrated in cases such as:
Fever
Diarrhoea
Dysentry
Acute infectious disease
Leukemias
Malignancy
Taking corticosteroids

22. • Note :
Oral polio vaccine should be kept at 4 degree celcius if
the vaccine is stabilised vaccine.
Non-stabilised vaccine should be kept at -20 degree
celcius in a deep freeze.
Vaccine should not be frozen and thawed repeatedly,
as this can have deleterious effects on the potency of
live vaccine.
 Passive Immnunisation :
Human normal Ig is used as a passive immunisation.
But the use of passive immunisation is eliminated due
to active immunisation with oral polio vaccine.the
dose of normal human Ig is 0.25- 0.3 ml per kg of body
weight.after a few weeks, the active immunisation
should be started.

23. (2)Early Diagnosis And Treatment of Cases :
The polio cases should be detected as early as
possible and appropriately treated in order to
prevent the spread of infection as well as to
control the disease.
(3) Surveillance :
Surveillance is one of the way to achieve, control
and prevention by identifying the rise, stability
or decreasing in number of cases.

24. (4) Isolation :
The polio cases should be isolated during the
period of communicability i.e. 7-10 days
before and after the onset of symptoms.
(5) Environmental sanitation :
As polio occur due to certain environmetal
condition such as contaminated water, food
etc. it also occurs due to poor sanitation and
overcrowding. Appropriate sanitary measures
should be adpoted to decrease the incidence
of polio. The over crowding should be
avoided.

25. (6) Handwashing :
Handwashing is one of the effective way to achieve
prevention. As a polio virus is excreated in faeces
and it can go into GI tract through fingers, if
hands are not washed after defaecation. So, it is
important to wash the hands.
(7) Pulse Polio Compaign/Immunisation :
In pulse polio immunisation, oral polio vaccine is
given to all children 0-5 years of age regardless of
previous immunisations. It includes 2 rounds for
4 days. On 1st day, polio drops are administrated
at booth. On 2nd 3rd & 4th day, homes are visited
to administer.

26. • Polio drops to children under 5 years of age.
Tothose who did not come to booth on first
day. Remaining three day the children left
without polio drops,are administered polio
drops by visiting the homes.

27. Thank You

29. DRACUNCULIASIS
(GUINEA WORM DISEASE)
Dracunculiasis cases reported during 2003
were 32193 world-wide.
A total of 3190 cases were reported in 2009
whereas 892,005 cases were reported in 1989.
The last case reported in India was in July
1996, on completion of three years of zero
incidence, India was declared free of guinea
worm disease.

30. Definition
Dracunculiasis or guineaworm disease is a vector
borne disease, mainly of the subcutaneous
tissues,( usually leg and foot). Caused by
nematode parasite.
Characterized by
1. Blisters on the affected leg.
2. Itching
3. Burning sensation
4. May cause secondary infection like arthritis.

36. EPIDEMIOLOGICAL TRIAD
Agent
(dracunculus medinensis)
Host
(all ages, both sexes)
Environment
(water contaminated with
cyclops)

37. Agent
• Dracunculiasis is caused by dracunculus
medinesis which is a vector borne parasitic
disease .
• The female dracunculus makes her way to the
limbs near skin surface in an infected person.
• Blisters are formed due to inflammatory response
& these break on contact with water and release
a number of parasites into water , which are
taken by cyclops and develpoment of parasites
inside the cyclop takes 15 days.

38. • Cyclops are present in water and when the
human beings drink water contaminated with
cyclops , it goes into G.I. tract.
• In the G.I. tract with digested by gastric juice,
parasites are released and penetrate the
duodenal wall.
• Form here the agent moves to the subcutaneous
tissue of various parts of the body and takes 9-12
month to become an adult.
• The reservoir of infection :- is a person
who harbours the gravid female
dracunculus medinesis.

39. • HOST
• It can occur among all ages, both sexes .
• Multiple & repeated infections can occur in
the same person.

40. ENVIRONMENTAL FACTOR
• Contaminated water with cyclops.
• Dry season(March- May)

41. MODE OF TRANSMISSION
• Water –borne route.
Under Eradication
• Guinea-worm disease has been eradicated.
The eradicated strategies used were :-
• Diagnosis and treatment of cases. The drug
used were mebendazole, metronidazole etc.
• Surveillance for reserch of new cases .
• Control of cyclops.

42. Clinical course.
Due to toxic secretion of the parasite liberated
during parturition , the following symptoms
appears.
1. Severe pruritis
2. Giddiness
3. Sometimes vomiting and diarrhoea
4. Severe dyspnoea
5. Asthma symptoms.

43. prevention
Provision of safe drinking water
Control of Cyclops
Health education.
Treatment of cases with mebendazole and
metronidazole.