Refers to infection or disease that occurs regularly at low or

COMMUNICABLE DISEASE

moderate frequency.
 Eg. Malaria
Infectious Disease
Epidemic Disease
 It is a disease caused by a pathogen
 That requires direct inoculation of the organism through a break  Defined as greater than usual number of cases of a disease in a
n the skin or mucous membrane. particular region, usually occurring within a relatively short
period.
Communicable Disease  Occurs when there is sudden increase in frequency above
endemic levels.
 If the infectious disease is transmissible from one human to
 Eg. Dengue; SARS
another.
Pandemic Disease
Contagious Disease
 Disease occurring in epidemic proportions in many countries
 Communicable disease that is easily transmitted from one
simultaneously – sometimes worldwide.
person to another.
 The size of outbreaks is dependent upon factors such as the ratio
 Eg. Meningococcemia
of susceptible to immune subjects, period of infectivity,
Zoonotic Disease population density etc.

 Infectious diseases that human acquire from animal resources. Incidence – Occurrence
 Eg. Foot and mouth disease; Bird’s flu
 It is the number of new cases of that disease in a defined
Sporadic Disease population over a specific period.

 Occurs only occasionally (sporadically) and irregularly within the
population of a particular geographic area without specific
pattern.
Endemic Disease
 Disease that is always present within the population of a
particular geographic area. The number of cases of the disease
may fluctuate over time, but the disease never dies out
completely.
Prevalence – Popularity
 Describes the number of cases in a population at a point in time.
 2 types of prevalence:
1. Period Prevalence – number of cases of the disease
existing in a given population during a specific period.
2. Point Prevalence – number of cases of the disease
existing in a given population at a particular moment in
time.
Secular Trend Mortality Rate

 Refers to a change in the prevalence of infection over years.  Ratio of the number of people who died of a particular disease
 This relates to better living conditions, better hygiene, and during a specified period per a specified population.
vaccination.
COMMUNICABLE DISEASE
 Eg. The decrease in tuberculosis in the United Kingdom.
 Pathological conditions that are caused by biological agents that
Seasonal Trend
are infectious and are easily transferrable from host to host due
 Refers to the changes in the prevalence of infection occurring to an effective mode of transmission.
over the year.
Communicable Disease vs Infectious Disease
 Eg. RSV outbreaks; measles
 The reason the seasonality is unclear but changes of Communicable Disease Infectious Disease
temperature, crowding and humidity may play a role.  Biological causative  Biological opportunistic:
agent: specific variable
Seroprevalence  (+) Period of  No communicability
communicability  Confined
 Refers to the number of individuals who have antibodies to a
 High ability to spread  Diffused manifestations
particular pathogen. It shows how common the pathogen is in  (+) Clinical hallmark  Variable clinical course
the population.  Well defined clinical  Agent cannot usually be
course isolated externally
Prevalence vs Incidence  Mandated by Koch’s
postulates
 The prevalence of infection describes the number of cases in a
population at a point in time.
 The incidence refers to the number of cases arising over a Therefore, communicable disease principles…
defined period of time.
 Communicable diseases are infectious, but infectious diseases
Morbidity Rate are not communicable.
 CD’s have specific causative agent – drug of choice
 Expressed as the number of new cases of a particular disease
 CD’s have a potent mode of transmission
that occurred during a specified period per a specifically defines
 Causative agents of CD’s can produce the same manifestations
population.
of inoculated into another host.
  CD’s have identifying manifestations – clinical hallmark –
pathognomonic sign

ASPECTS OF CAUSATION

 CD causation is MULTIFACTORIAL
 Disease causation is due to the summation of all
contributory entities – no single entity can attribute a CD.
 Man is an open system.
 Interplay of both extrinsic and intrinsic factors.

Extrinsic Factors Disease Triad

 Climate  Responses of the human body is an interplay of all factors

 Topography pertaining to both intrinsic and extrinsic aspects.
 Geography
 Environmental conditions
 Presence of contacts, epidemics, endemics, etc. (exposure)

Intrinsic Factors

 Host conditions
 Immunity
 Nutrition
 Stress
 Activity
 Vices

INFECTIVE CYCLE

 The infective cycle is an intertwining chain of factors, which

shows the interplay of aspects that can lead to an infection.
CHAIN OF INFECTION b) Incubatory Carrier – person who is capable of
transmitting pathogen during the incubation period of a
 There are six components in the infectious process (aka chain of
particular infectious disease.
infection).
 A person who is incubating the illness

1. There must first be a PATHOGEN (AGENT).

c) Convalescent Carrier – harbor and can transmit a
 Causative Agent – is any microbe capable of producing a
particular pathogen while recovering from an infectious
disease.
disease.
a) Bacteria
 A person who is at the recovery stage of illness but
b) Viruses
continues to shed the pathogenic organism.
c) Chlamydiae
d) Fungi
d) Active Carrier/Chronic/Sustained Carrier – have
e) Protozoa
completely recovered from the disease but continue to
f) Parasites
harbor the pathogen indefinitely.
 A person who always has the infectious organism in
2. There must be a source of pathogen (RESERVOIR)
his/her system.
 Sources of microorganism that causes infectious diseases.
 Reservoir – it is a site where a pathogen can multiply or merely
e) Intermittent Carrier – a person who occasionally shed
survive until it is transferred to a host. Reservoirs may be a living
the pathogenic organism.
hosts or inanimate objects or materials.
Animals
1. Living Reservoir – include humans, pets, farms, animals, wild
 Infectious disease that humans acquire from animal resources
animals, certain insects. The human and animal reservoir may or
are called zoonotic disease or zoonoses.
may not be experiencing illness due to the pathogens they are
 Many pets and other animals are important reservoirs of
harboring.
zoonoses.
Human Carrier  Zoonoses are acquired by direct contact with the animal,
ingestion of the pathogen or injection of the pathogen by an
 Carrier – a person who is colonized with a particular pathogen,
arthropod.
but the pathogen is not currently causing disease in that person.
 Types of Carrier:
2. Non Living Reservoir
a) Passive Carrier – carry the pathogen without ever
 A.k.a. inanimate reservoirs of infection
having had the disease.
 Includes: air, soil, dust, food, milk, water, and formites.
3. There must be a PORTAL OF EXIT. c) Vehicle transmission
 Path or way in which the organism leaves the reservoir. - Transmission of infectious disease through particles or
 Common portal of exits are: substances that harbor the organism until it is ingested
a) Respiratory system or inoculated into the host.
b) Genitourinary tract
c) Gastrointestinal tract d) Vector transmission
d) Skin and mucous membrane - Occurs when intermediate carriers such as fleas, flies, and
e) Placenta (transplacental transmission) mosquitoes transfer the microbes to another living
organism.
4. There must be a PORTAL OF EXIT.
 Means by which the infectious agent passes through the portal 5. There must be a PORTAL OF ENTRY.
of exit of the reservoir to the susceptible host.  It is the venue where the organisms gains entrance into the
 Easiest link to break in the chain of infection. susceptible host.
 4 modes of transmission:  The infective microbes use the same venous when they exit from
a) Contact transmission the reservoir.
 Direct Contact – person to person transfer
- Direct skin-to-skin contact 6. There must be a SUSCEPTIBLE HOST.
- Direct mucous membrane-to-mucous membrane contact  The human body has many defenses against the entry and
multiplication of organism.
 Indirect Contact – susceptible person comes in contact with  When the defenses are good, no infection will take place.
a contaminated object.  However, in weakened host, microbes will launch in infectious
- Indirectly via airborne droplets disease.
- Indirectly via contamination of food and water by fecal
Symptomatology
material.
- Indirectly via arthropods vectors  Body will always respond to any stimuli given until point of
- Indirectly via formites exhaustion is reached.
 Communicable disease symptomatology is fixed due to
b) Air borne transmission specific action of causative agents.
- Occurs when fine microbial particles or dust particles  Clinical hallmark or pathognomonic sign
containing microbes remain suspended in the air for a - Is the most unique clinical manifestation of a
prolonged period. communicable disease.
- Infectious disease is spread by air current and is inhaled
by a susceptible host.
  A clinical hallmark highly suggests a CD and no other means of Isolation
diagnostics are usually needed.
 Separation of the patient during the longest period of
TERMINOLOGIES: (CD TERMS) communicability.

Antigen 7 CATEGORIES RECOMMENDED IN ISOLATION

 Any protein that can stimulate the immune response.
Period of Communicability
 Duration in which the patient is discharging the infectious agent
Quarantine
 Restriction of movement in a place where a CD exist for a period
of time equivalent to the longest incubation period of that
disease.
Concurrent Disinfection
 The destruction of microorganisms as soon they leave the body.
1. Strict Isolation – to prevent highly contagious or virulent
infectious.
- Wash hands after every contact with the patient or
potentially contaminated articles and before taking care
of another patient.
- Articles contaminated with infectious materials should be
appropriately discarded or bagged and labeled before
they are sent for decontamination and processing.
- The health care worker may use a private room.
- Use of gowns, mask, gloves is a must.
- Negative pressure to surrounding area is desireable.
2. Contact Isolation – to prevent the spread of infection
primarily by close or direct contact.

Toxoid
3. Respiratory Isolation – to prevent transmission of infectious
 Exotoxin that has been detoxified but capable of producing disease over a short distances through the air.
antibodies.
4. TB Isolation (Negative Pressure Room) – for TB patient
Antitoxin
with (+) smear test or with CXR which strongly suggests
 Also called antiserums, neutralizes toxins produced by active TB.
pathogens.
N-95 mask desireable
Exanthem  skin eruption
- traps very small particulate matter
Enanthem  changes in mucous membrane
Negative Pressure Room

- Exclusive ventilation source with exhaust.

 - With on/off control  RED/GREEN  Disinfection
- After 2 weeks of anti-koch’s, may remove patient from  Supportive/Palliative care
room  Medication administration (drug of choice)
 Promotive/Preventive management
5. Enteric Precaution – for infections with direct contact with  Case finding and reporting
feces.

6. Drainage/Secretion Precaution – to prevent infectious that

are transmitted by direct/indirect contact with purulent
material or drainage from an infected body site.

7. Universal Precaution – which is applied when handling

blood and body fluids.
- This precaution is applied to patients with HIV/HBC
- It is intended to prevent parenteral, mucous membrane
and non intact skin exposure of health care workers to
blood borne pathogens.
- This isolation is necessary to prevent infections that are
transmitted by direct contact with infected blood or
body fluids.
- This is applied to blood, semen, vaginal secretions, and
other fluids (CSF, synovial fluid, pleural fluid, peritoneal
fluid, pericardial fluid, amniotic fluid) and tissues
containing visible blood.

DO’S OF CD NURSING MANAGEMENT

 Isolation
- Respiratory
- Enteric
- Reverse
 Quarantine
 Hand washing
TETANUS Sources

 Soil
 An acute disease induced by toxin of tetanus bacillus growing  Animal manure
anaerobically.  Human feces  found in the intestinal canal of herbivores
 Synonym – Lockjaw  Unsterile sutures, pins; rusty materials
 Characterized by generalized sporadic painful spasms of the
skeletal muscles  form of striated muscles used in voluntary Incubation – 3 to 21 days average of 10 days
movement.
Mode of Transmission - direct contact with open wound and unhealed
 Cardiac muscle, cannot be tetanized because of its intrinsic
umbilical stump.
electrical properties
 Agent: Clostridium Tetani  Infection generally occurs through wound contamination and
 Gram (-), spore forming, obligate anaerobic often involves a cut or deep punctured wound.
bacterium  Onset - insidious or acute
 2 Forms  Lockjaw – Trismus
1. Vegetative – easily destroyed by heat and chemicals  Risus Sardonicus – 1st sign
2. Spore Forming – resistant to heat  Severe spastic attacks

Toxins: Manifestations:

1. Tetanospasmin  Opisthotonus
 Difficulty in Swallowing
 Neurotoxin inactive inside the bacteria, but when the bacteria
 General muscle weakness
die, the toxin is released and activated by proteases and carried
 Restless
into the SC and brainstem
 Impermeability
 Damaged upper motor neurons can no longer inhibit lower
 Anemia-like manifestations
motor neurons.
 Produce the hallmark muscle rigidity and spasms Medical Management

2. Tetanolysin  Prevention – immunization  DPT (for babies)

 Toxoid – Active  Booster every 10 years
 Responsible for destruction of RBC; hemolysis
 Antitoxin – Passive
 Fatal up to 60% of unimmunized person: fatal within 10 days of
 Anti-Tetanus Serum (ATS)
onset
 Neutralization of Toxins
 When symptoms develop within 3 days  poor prognosis
 ATS
  Tetanus Immunoglobulin (TIG)  High mortality rate if not treated.
 Destruction of C. Tetani spores  Agent: Neisseria Meningitides
 Antibiotics  Invades the bloodstream without involving the meninges
rd
 Penicillin, 3 generation cephalosporins  MOT: Direct contact with respiratory secretions
 Metronidazole –  bacterial count but has no effect  Onset: Acute
on toxin.  Incubation: 2-10 days with ave. of 3-4 days
 Supportive  Most common in Infants and Children
 Wound care – general
Meningococcemia vs Meningitis
 Diazepam – muscle relaxant
 Nutrition – NGT/TPN  Even with antibiotics, approximately 1 in 10 victims of
 O2 meningococcal meningitis will die.
 The sepsis type of infection is much more deadly, and results in a
Nursing Management
severe blood poisoning that affects the entire body  (septic
 Strict monitoring shock)
 Prevent complication
Manifestations
 Nutrition support
 Isolation  May be asymptomatic
 Avoid Stimulation  Restricted to nasopharynx or exhibit URTI
o No TSB  It may cause meningococcal septicemia or meningitis
o No circulating air  High grade fever (>38o) for 24 hours
o Do not startle  Purpuric rashes – 24 hours
o Avoid bright light and noise  Adrenal medulla hemorrhage extending
o Do not leave patient abruptly  WATERHOUSE FRIDERICHSEN SYNDROME
 Rapid development of petechiae and purpuric
MENINGOCOCCEMIA ecchymotic spots in associated with shock
 Runs a short course and is usually fatal.
 Called meningococcal meningitis, meningococcal septicemia,  Meningeal irritation – H/A, N/V, stiff neck
meningococcal bacterimial blood poisoning.  (+) Brudzinski, (+) Kernig’s
 Acute and potentially life threatening infection of the
bloodstream, leads to vasculitis. Medical Management
 Maybe asymptomatic, may be restricted to the nasopharynx, or
 Strict isolation
exhibit URTI.
 Pen G, 3rd generation cephalosporin, chloramphenicol
  IVF/BT Types:
 O2/Mechanical breathing support
1. Inapparent/Subclinical/Asymptomatic/Silent Type
 Wound care for areas of skin with blood clots
 Institute management for shock and DIC  Intact immune system – does not develop full blown polio
 Prophylaxis  Rifampicin, Ceftriaxone (Ciprofloxacin)  Person who are expose to poliomyelitis ward like the nurses and
 Patients suffering from meningococcal disease are other members of the health team.
treated with a large doses of antibiotics
2. Abortive
Nursing Care
 Does not invade CNS
 Avoid Stimulation – Dim light, quiet  A minor illness – flu-like symptoms
 Respiratory support  Recovery in 72 hours
 Complication precaution
 Proper monitoring 3. Non-Paralytic Aseptic
 Place on respiratory isolation within 24 hours.
 Flu-like symptoms with signs of meningeal irritation and
transient paresis.
POLIOMYELITIS  Usually lasts about a week with meningeal irritation persisting for
about 2 weeks.
 Infantile Paralysis, Heine-medin Disease
 (+) Pandy’s test  (+) Globulin in CSF
 Viral caused by ANS of the 3 polio viruses which affects the
 indicates inflammation in CNS
anterior horn cells of the spinal cord , medulla, cerebellum and
midbrain. 4. Paralytic Poliomyelitis
 Disease of the lower motor neuron  flaccidity
 90% of polio infections cause no symptoms at all - Progresses to paralytic disease in which the muscles become
 Agent: Polio virus, I – Brunhilde, II – Lansing, III – Leon weak, flappy and poorly controlled, and finally completely
 Was identifies in 1908 by Karl Lansteiner paralyzed; this condition is known as acute flaccid paralysis.
 MOT: Airborne, direct contact with droplet, close association - Classified depending on site of paralysis.
with infected people, fecal oral route. - (+) Kernig’s/Brudzinki’s sign
 Incubation: 7-21 days ave of 12 days - (+) Hoyne’s Symptom  way of confirming meningeal irritation
 POC: 1st 3 days – 3 months - Less DTR
 Most contagious during first day - Paralysis occurs
- Hypersensitivity to touch
  A. Spinal Paralysis  Poliovirus divide within gastrointestinal cells for about a week,
 Paralysis occurs in the muscles innervated by the SC from where it spreads to the tonsils, the intestinal lymphoid,
 Characterized by asymmetry, scattered paralysis on 1 or tissue including the M cells of Peyer’s patches, and the deep
both LE cervical and mesenteric lymph nodes, where it multiplies
 (+) respiratory difficulty abundantly.
 The virus is subsequently absorbed into the bloodstream.
 B. Bulbar Paralysis  The presence of virus in the bloodstream enables it to be
 Develops rapidly and is a more serious type widely distributed throughout the body.
 Motor neurons in the brainstem are attacked and affect
Clinical Manifestations
the medulla.
 Weakens the muscle supplied by the CN 9 and 10  Abortive – no evidence of CNS involvement.
 Paralyzed, facial, ocular and pharyngeal muscle  Preparalytic – with evidence of CNS involvement but without
 (+) respiratory difficulty and cardiac irregulation paralysis.
 Paralytic – with CNS involvement and paralysis.
 C. Bulbospinal Paralysis
 Involvement of neurons in the BS and SC.  A blockage of the lumbar anterior spinal cord artery due to polio.
 A photomicrograph of the lumbar spinal cord depicting
OUTCOME PROPORTION OF CASE
Asymptomatic 90-95% an infarct due to polio type III surrounding the anterior
Minor Illness 4-8% spinal artery.
Non-paralytic aseptic meningitis 1-2%  When spinal neurons die, Wallerian degeneration takes
Paralytic poliomyelitis 0-1-0.5% place resulting in muscle weakness of those muscles
- Spinal polio 79% of paralytic cases once innervated by the now dead neurons.
- Bulbospinal polio 19% of paralytic cases
- Bulbar polio 2% of paralytic cases Manifestations in children include:

Day 1-3: Fever but resolves immediately

Pathogenesis
Day 3-5: Headache, neck pain, muscle pain, fever
 Poliovirus enters the body through the mouth, infecting the first
Day 5-7: Mild paralysis
cells it comes in contact with – the pharynx (throat) and intestinal
mucosa. After Illness: Permanent paralysis
 The virus then hijacks the host cells own machinery, and begins
to replicate.
Diagnostics  Three doses of live-attenuated OPV produce protective antibody
to all three poliovirus types in more than 95% of recipients.
1. Throat swab
 It was licensed in 1962 and rapidly became the only polio
2. Stool C/S
vaccine used worldwide.
3. Lumbar Puncture with CSF Analysis   WBC  CHON
 Because OPV is inexpensive, easy to administer, and produces
Pandy Test excellent immunity in the intestine (which helps prevent infection
with wild virus in areas where it is endemic), it has been the
 screening test for globulin in the cerebrospinal fluid; a positive result vaccine of choice for controlling poliomyelitis in many countries.
is an indication of inflammation in the central nervous system.
IPV vs OPV
Medical Management:
 Until recently OPV was recommended for most children
 Symptomatic  OPV helped rid the world of polio, and it is still used in many
parts of the world.
Nursing Management:
 Both IPV and OPV gives immunity to polio
 CBR  But OPV is better at keeping the disease from spreading to other
 Warm compress on affected muscles people.
 Comfort measures  However, for a few people (about one in 2.4 million)
 ROM exercises  OPV actually causes polio
 On very rare occasions (about 1 case per 750,000 vaccine
Prevention: recipients) the attenuated virus in OPV reverts into a
form that can paralyze.
 Vaccination
 The polio shot (IPV) does not cause polio.
 Inactivated polio vaccine (IPV)
 Salk Vaccine (Jonas Salk, 1952)
 The Salk vaccine, or inactivated poliovirus vaccine (IPV), is based
on poliovirus grown in a type of monkey kidney.
 After two doses of IPV (given by IM injection), 90% or more of
individuals develop protective antibody in all three serotypes of
poliovirus, and at least 99% are immune to poliovirus following
three doses.
 Oral Polio Vaccine (OPV) (Albert Sabin, 1957)
 A single dose of Sabin’s oral polio vaccine produces immunity to
all three poliovirus serotypes in approximately 50% of recipients.