The document discusses strategies for disease control including disease elimination, eradication, and surveillance. It defines disease control as allowing a disease agent to persist at a level that does not cause a public health problem. Disease elimination terminates transmission from a geographic region, while eradication terminates transmission globally. Surveillance involves monitoring health indicators to detect disease trends and evaluate strategies. The goals of surveillance are early detection of outbreaks to initiate effective response and monitor disease trends over time.

1. Jagjit Khosla

2. “In disease control, disease agent is permitted to persist in the
community at a level where it ceases to be a public health problem
according to the tolerance of the local population”
Aims :
• Reducing the incidence of disease
• Reducing duration of disease and risk of transmission
• Reducing the effects of infection
• Reducing the financial burden to community

3. • Interruption of transmission of disease from a large geographic
regions or areas
Disease Elimination
• Termination of all transmission of infection from whole world
Disease Eradication
• Performing and analysing routine measurements aimed at
detecting changes in the environment or health status of population
Monitoring
• Continuous scrutiny of the factors that determine the occurrence
and distribution of disease and other conditions of ill-health
Surveillance

4. Objectives
To detect early warning signals of impending outbreaks
To help initiate an effective response in time
To detect disease trends over time and evaluate control
strategies

5. Components
Integration and decentralisation of surveillance activities
Strengthening of public health laboratories
Human resource development
Use of IT for collection, compiling, analysis and
dissemination of data

6. • Data collected on weekly (Monday-Sunday) basis
• It includes :
• No. of cases of 20 diseases/syndromes & state specific disease
• Total OPD attendance
• Action taken in case of unusual increase in cases
• List and details of cases
• 3-yearly surveys of risk factors of Non-communicable diseases
S
P
L
Suspected Cases
Presumptive Cases
Laboratory confirmed Cases

7. PHC / CHC
Sub- Centres
District
Surveillance
Unit
State
Surveillance
Unit
Central
Surveillance
Unit
Distt. Hospital,
Medical colleges,
Public health laboratories,
Private labs and hospitals,
Pvt. Practictioners, and
other hospitals

8. Integrated
Disease
Surveillance
Project
Integrated Disease Surveillance Project
Entomology Unit
Training Centres
Video Conferencing 24 X 7 Call Centre
IDSP Portal
Outbreak Surveillance
and Response
Media Scanning and
Verification Cell Broadband
Connectivity

9. • Agent enters the host
• Incubation period starts
• Patient asymptomatic

10. Primary Prevention

11. Primary Prevention
Health Promotion
• Health Education
• Environmental
modifications
• Nutritional
interventions
• Lifestyle and
behavioural
changes
Specific Protection
• Immunization

12. Secondary Prevention
Early Diagnosis
and Treatment

14. • Measles surveillance
• Measles vaccine
• Measles immunoglobulin
• Isolation of cases till 7 days after onset of rash

15. • Live attenuated
• freeze dried vaccine
• Lyophilised
• Human Diploid Cell vaccine
• Edmonston Zagreb strain
• Heat sensitive – stored frozen at 2-8 0C

16. Lyophilised
vaccine
Diluent
Reconstituted
Vaccine
Reconstituted vaccine kept on ice – discarded after 4hrs

17. • Indian National Immunisation Schedule (Also WHO EPI)
 Single dose of Measles vaccine at 9 months
• Indian academy of Paediatrics
 One dose of Measles vaccine at 9 months
 One dose of MMR at 15 months
• Can be given between 6 to 9 months age if
 Measles outbreak occurs in community
 Malnourished children at high risk of complications
Second dose need to be given at 9 month age (4 weeks apart)

18. • 0.5 ml subcutaneous injection

19. • Right upper arm

20. Immunity develops 11-12 days after vaccination
Mild “measles” illness after 5-10 days
Attenuated virus multiplies in blood
Injection given

21. Adverse Effects
• Toxic Shock Syndrome –
• If vaccine is contaminated
• If reconstituted vaccine is used after 4 hours
• Others – Local reaction, mild measles
• Rare – Febrile seizures, anaphylaxis, Encephalopathy
Contraindications
• Pregnancy
• Acute illnesses
• Immunodeficiency
• Immunocompromised state
• Use of steroids
High grade Fever Vomiting Severe diarrhoea
Hypotension Diffuse Erythema Desquamation
Toxic Shock Syndrome

22. • Post Exposure prophylaxis to contacts within 2 days
of exposure
• Single dose 0.25 ml per Kg body weight or
0.5 ml per Kg if immunocompromised
• Followed by Live attenuated measles vaccine 8-12
weeks later

24. Early case reporting
and management
Integrated vector
management
Supporting
interventions
Long Term
Strategies

25. Fever alert surveillance
Strengthening of referral services
Sentinel surveillance sites with laboratory support
Involvement of private sector in sentinel surveillance
Case management
Epidemic preparedness and rapid response
Early Case
Management
Early Case
Reporting

26. Aedes aegypti

28. Mosquito breeding areasTemephos, Fention
Gambusia Poecilia reticulata

30. Aerosol space spraying (Pyrethrum extract 2%)FoggingInsecticide treated bed netsMosquito repellents

31. • Human resource development
• Behaviour change communication
• Inter-sectoral convergence
• Supervision and Monitoring
• Legislative Support

33. Control measures
• Notification
• Isolation of cases till 6 days after onset of rash
• Disinfection of articles soiled by nose, throat discharges
Prevention
• Varicella vaccine
• Varicella Zoster Immunoglobulin

34. • Life attenuated vaccine
• OKA strain
• 0.5 ml subcutaneous
• Dosage :
if <13 years – single dose
if > 13 years – two doses 4-8 weeks apart
• Aspirin should not be given for 6 weeks after
vaccination to prevent Reye syndrome
• Post-exposure prophylaxis
• MMRV

35. Side effects
• Local pain and redness
• Localised maculopapular or
vesicular rash
Contraindications
• Pregnancy
• Immunocompromised
• Immunodeficient
• Steroid therapy
• Age less than 1 year

36. • Postexposure prophylaxis within 3 days of exposure
• 12.5 units/Kg body weight i.m. upto max. 625 units
• Repeat dose after 3 weeks
Indications
• Immunosuppressive therapy
• Immunodeficiency
• Pregnant women
• Newborns
• Infants of Low birth weight