Communicable diseases

Prevention, control and treatment

Infectious diseases are closely linked.
malnourished people are more
susceptible to most infections and their
consequences- severity of the infection,
and mortality- are worse. Infectious
diseases can also tip individuals whose
nutritional state is borderline into frank
malnutrition. This is specially true of
young children. Measures to prevent
infections are therefore of prime

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Prevention, control and management of

communicable diseases
Preventive measures can be considered
in the following major categories:
General health programme coordination
Immunization programmes
Prevention of micro-nutrient deficiencies
Prevention and treatment of other
specific important diseases
Environmental health measures

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General health measures include the overall

coordination and integration of health
services in emergency areas, in local and
national health services; the development and
use of clear standardized procedures for
prevention and treatment; and organization of
disease surveillance and reporting.
Immunization programmes are of particular
importance. Virtually all countries have
established

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Immunization programmes against

tuberculosis, diphtheria,
pertussis( whooping cough), tetanus,
poliomyelitis and measles. Measles and
meningitis vaccination may be of
particular importance in emergencies
Other specific important communicable
diseases include diarrheal and respiratory
diseases, malaria and other febrile and
parasitic diseases.

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Environmental health measures

include the provision of adequate
habitat( shelter and living space)
adequate and potable water supplies
and washing facilities, safe food
handling, and adequate latrines and
solid waste disposal. Good
environmental health measures are
the best insurance against most of
the communicable diseases.

Disease prevention and control

Acute respiratory diseases

Basic facts:
Acute respiratory infections can involve
- The upper respiratory tract- common
cold, otitis media, and pharyngitis
- The lower respiratory tract- bronchitis,
bronchiolitis and pneumonia.
The majority of acute respiratory
infections

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Involve the upper respiratory tract &

are only mild and resolve
spontaneously.
Acute lower respiratory tract
infections are a major cause of
mortality and morbidity in
emergencies situations
Some 25%-30% of deaths in children
under-five years of age are due to
LRTI, 90% of these deaths are due to

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It is therefore important that

pneumonia is recognized quickly and
treated appropriately.
Causative organisms may be
bacterial( mainly haemophilus
influenza and streptococcus
pneumoniae) or viral
Risk factors for pneumonia include low
birth weight, malnutrition, Vitamin A
deficiency, poor breastfeeding
practices, bad ventilation in shelters,
chilling in infants and overcrowding

Case management

Priority should be given to early recognition

and adequate treatment of pneumonia
All children presenting with cough and difficult
breathing should be carefully assessed
Signs of malnutrition should also be assessed
as this increases the risk of death from
pneumonia
Severely malnourished children should be
referred to hospital

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Management of pneumonia consists
of antimicrobial therapy
Choice of antimicrobial depends on
national protocols and available
drugs
Supportive measures, such as oral
fluids to prevent dehydration,
continued feeding to avoid
malnutrition, antipyretics to reduce
fever and protection from cold are
essential

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Vaccination against measles,

diphtheria, whooping cough is
effective in reducing the impact of
acute respiratory infections
Treatment guidelines using the most
available antimicrobial:
cotrimoxazole, amoxicillin and
procaine penicillin
Bacillary dysentery( shigellosis)
Basic facts
Bacillary dysentery is an acute
bacterial disease involving the large

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It is cause by bacteria of the genus
shigella of which S.dysenteriae type1
causes the most severe disease and the
largest outbreaks
It is the most important cause of bloody
diarrhoea
S.Dysenteriae type 1
The disease is most severe in young
children, the elderly and the
malnourished

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Displace populations are at high risk

in situations of overcrowding, poor
sanitation and limited access to safe
water
In an outbreak, up to 1/3 of the
populations at risk may be infected
Transmission occurs through
contaminated food and water and
from person to person
The disease is highly contagious-

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The infective dose is only 10-100

organisms
Treatment is only with antimicrobial,
which decrease the severity and
reduce the duration of the illness
The disease is not usually associated
with marked loss of fluid and
electrolytes
Without prompt effective treatment
the case- fatality rate can be as high

Case management

Refer seriously ill or severely

malnourished patients to hospital
immediately
Check the results of antimicrobial
sensitivity tests with the laboratory
Give an antimicrobial effective against
s.dysentriae type 1
Treat dehydration with oral rehydration
salt or intravenous fluids, if severe within
48 hours

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If the antimicrobial used are effective,
clinical improvement should be noted
with in 48hrs
Cholera
Basic facts
Cholera is an acute enteric disease cause
by the G-negative bacillus Vibrio cholerae

Vibrio cholerae produces a powerful

enterotoxin that causes profuse watery
diarrhoea by a secretory mechanism

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Infection results from ingestion of organisms
in food and water or directly from person to
person by the faecal-oral route
Acute carriers, including those with
asymptomatic or mild disease, are important
in the maintenance and transmission of
cholera
It is asymptomatic in more than 90% of cases
Attack rates in displaced populations can be
as

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10-15%, whereas in normal situations

it is estimated at 1-2%
Case fatality rates are usually around
5% but have reached 40% in large
outbreaks in refugee camps
With appropriate treatment( oral
rehydration in most cases) the case
fatality-rate can be reduced to 1% or
less

Prevention and Control measures

Prompt diagnosis and appropriate

treatment of patients must be carried
out
Cholera treatment centres should be
established with barrier nursing
procedures specific to enteric
pathogens
Faecal material and vomit must be
properly disinfected and disposed of

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Conducted on hygiene and disinfection

measures with simple messages on safe
food, safe water and hand washing
Funerals should be held quickly near the
place of death
Those who prepare the body for burial
must be meticulous about washing their
hands with soap and clean water

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Promote washing hands with soap
and clean water whenever food is
being handled
Inappropriate control measures
Mass chemoprophlaxis has never
succeeded in limiting the spread of
cholera
Trade and travel restrictions do not
prevent the spread of cholera

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Case management
The prevention and treatment of
dehydration are the mainstay of cholera
management
The use of antimicrobials (dioxcycline or
tetracycline) is essential for the
treatment of cholera but may be
recommended to reduce the volume of
dirrahoea and shorten the duration of
excretion

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Treatment is single dose of dioxcycline

300mg or tetracycline for 2days
A sensitivity profile of the outbreak strain
must be available as soon as possible to
decide on the possible choice of
antimicrobial for severe cases. Oral
antimicrobials only must be given, and
only after the patient has been
rehydrated usually in 4-6 hrs. and
vomiting has stopped