Communicable diseases

1. Dr. Dalia El-Shafei
Lecturer, Community Medicine Department,
Zagazig University

2. Viral
• Poliomyelitis
• Hepatitis A&E
• MCD
Bacterial
• Typhoid & paratyphoid
• Brucellosis
• Diarrheal diseases:
• Food poisoning
• Dysentery
• Diarrhea diseases in
children
• Cholera
Parasitic
• Ascariasis
• Entrobiasis
• Amoebic dysentery
• Heterophiasis
• Fascioliasis
• Hydatid cyst
• Giardiasis
• Toxoplasmosis

3. Mode of transmission:
Fecal oral infection:
a) Food-borne infection (ingestion infection).
Contaminated food: vehicles are milk and any
food that may be contaminated by handling,
flies, water, or dust, and sewage-polluted
water.
b) Hand-to-mouth infection

5.  FHMA
 Nausea
 Abdominal pain
 Vomiting
 Diarrhea
 Gastroenteritis
 Fatigue

6. Primary
Environment sanitation
Health promotion
International measures
Secondary
I. Measures for case:
 Case f & notification
 Isolation &
disinfection
 Treatment & release
2. Measures for cont:
 Surveillance
 Supervision
 Segregation
 Isolation
 immunizationTertiary
Prevent complications & care of handicapped

7. A) General Sanitation of Environment:
Safe water supply,
Sanitary wastes disposal (refuse & sewage),
 Insect control (flies & cockroaches).
Food sanitation includes control of food handlers
B)Health education :
proper clean habits (including clean hands)

8. I. Control of Cases:
Case-finding: needs efficient medical care (clinical &
laboratory services
Notification to the LHO.
Isolation: allowed at home when sanitary
requirements are fulfilled, otherwise must be at fever
hospital.
Disinfection: - concurrent: excreta (1% crude phenol),
articles and fomites.
- terminal for objects, and cleaning of the room.
Treatment: general and specific chemotherapy.
Rehabilitation

10. Polio Hepatitis
A
Hepatitis E
IP 7- 14 d 15- 50 d 21- 42 d
Mode of
transmissi
on
-Faeco-oral
-Food-borne
-Oral-oral (droplet)
faeco-oral
Parenteraly
(viraemia)
Contaminated
water or food
supplies
Reservoir -Cases
-Carriers (contact,
incubatory,
convalescent)
-cases
-Incubatory C
Infectivity From IP to
convalescence
Last week of IP till Jaundice
Agent -Polio virus Picorna virus

11. Polio Hepatitis A Hepatitis
E
C/P -Inapparent 90%
-Minor (Abortive)
9%
-Major (CNS) 1%
-Inapparent (influenza-like)
-Classical: pre-icteric, icteric,
post-icteric
- Fulminate: fatal
Diagnosi
s
-Lab: throat wash &
stools exam
-Serological: rising
Ab
- Lab: stools exam
- Serological: IGM, liver enz.
Specific
preventio
-Vaccine
-Seroprophylaxis
- Vaccine

17. Pre-icteric
• FHMA, myalgia, arthralgia
• GE, tender liver, dark urine
Icteric
• Jaundice (sclera)
• Enlarged tender liver
Post-icteric
• Convalescence

19. Active
immunization
Inactivated vaccine
1 ml IM(deltoid)
2 doses, 4 weeks
apart
1- At risk: CLD,
travelers, lab.
2- Children
Sero-
prophylaxis
Human Ig
Before or few days
after exp
1- Contacts (within 2
wks)
2- At risk: travelers
(before or within 2
wks)

30. UVR
& UVR

31. Most
frequent
Epidemic
I Wild
Endemic
II Oct 1999
Sporadic
III

33. • Reservoir
• Cases: all clinical forms
• Carriers: all types (incubatory. Convalescent, healthy
& contact who are temporary carrier .
In endemic area health carrier are most frequent due to
polluted environment.
• Period of Infectivity
• Contact & healthy carriers: about 2weeks.
• Case: From IP to convalescence(temporary)

38. Polio
In apparent
(90%)
No clinical
manifestations
Acquired immunity
& carrier state
Manifest
(10%)
Abortive (minor
illness) 9%
CNS (major
illness) 1%
Non-paralytic
(FHMA +
Meningism)
Paralytic (spinal,
bulbar, bulbo-
spinal)
Case-fatality:
2-10%

39. • Throat washing or stools
• Serological (neutralizing Ab): rising titer

41. • Passive immunization (Sero-prophylaxis):
non-practical
Normal human Ig (0.3 ml/kg BW)
Exposed susceptible (pre exposure – rapidly
post exposure)
• Active immunization:
Sabin & Salk

42. • Oral, live attenuated trivalent vaccine
made of the three types, of
polioviruses.
• 2, 4 and 6 months of age
• 3 drops orally on the tongue.
• Recently a zero dose is giving after
birth as additional dose.
• Booster Immunization: a booster
dose is given at 9 months, 18-24
months, and school age.

43. • live attenuated viruses of the vaccine
invade and multiply in the intestinal cells,
stimulating: humoral and local cellular
immunity
• Humoral immunity: by neutralizing
antibodies in serum. It protects the CNS
Against invasion by the poliovirus.
• Cellular immunity: local tissue immunity
in the intestinal mucosa so prevents
establishment of infection in the intestine,
and so prevent a carrier.

44. 1. Gives humoral and tissue immunity
2. attenuated viruses are excreted in stools,
to disseminate infection in the community
3. easily administrated
4. used in mass immunization.
5. inexpensive.
6. Protective value up to 95%,
7. life long immunity.

45. • Cold chain:
regenerated below 4 C
• Contraindications:
1- Pregnancy 2- Corticosteroids 3- Immune-
deficiency
• Complications:
Paralysis: very rarely (1/5 million)

46. • Trivalent vaccine, inactivated (formalin).
• Used in non-endemic areas and together with
Sabin vaccine in endemic area.
• 4 doses, 1.0 ml each, IM, starting at 4 months
of age.
• 1st 3 doses 6-8 weeks apart, 4th dose 7 months
later.
• Booster dose : at school age, and whenever an

47. • Action: Salk vaccine gives humoral
immunity. no cellular immunity
• Protective Value: prevents < 90 % of
paralytic cases, and lowers severity of
paralytic effect in the affected.
• Salk is given in Egypt as quadruple Salk
DPT, IM, 2 doses at 4 &6 months

51. Control
Cases FNIDTR
Contacts
Enlistment
Case-
finding
(2wks)
Booster v.
or sero-
prophylaxis
Epidemics
Mass oral v.
Epid. study
Avoid
predisposin
g factors

53. • Sabin (1968):1ry &
booster
• Salk
Immunization
• Motivation
• Periodic campaigns
• Surveillance (1990)
Satisfactory
coverage rate

55. An adult male 30 years old is complaining from
fever, malaise, nausea, vomiting, abdominal pain
and dark urine.
a) What are the other signs you have to look for in
this case?
b) What is the most probable diagnosis?
c) How can you confirm this diagnosis?
d) What is the proper management of this case?
What is the expected prognosis?
e) What are the measures you should do for
contacts?

56. • Jaundice .
• Enlarged tender liver
• palpable spleen.
The most probable diagnosis
• Hepatitis A

57. • detecting virus in stools
• serological tests for IGM in acute
cases
• elevated liver enzymes (not
specific)

58. • Finding:
• Notification: to local health authorities.
• Isolation:
• Disinfection:
• Treatment
• Release

59. • Enlistment
• Immunization: Active and
passive immunization within 2
weeks of exposure.
• Examination: for early case
finding
• Surveillance: for 6 weeks

61. Bovine
Spongiform
Encephalopathy
(BSE)
Mad Cow
Disease
(MCD)
Cretuzefeld
Jacob
Disease
(CJD)