2 diseases Flashcards
types of epidemiological paradigms for disease causation (x3)
- Programming:
- critical periods of growth: exposure here leads to outcome
eg barker hypothesis: IU malnutrition leads to CVD as adult
- Adult Risk factor:
- risk factors of LIFESTYLE AND BEHAVIOUR as adult leads to outcome
eg: exercise –> outcome
- Life Course:
- programming and adult risk factor together
top causes of death High income and low income
From WHO: Global health estimates 2021
top cause of death globally is IHD
High income:
- Driver: Aging population
- conditions: IHD, covid, stroke, Alzheimer’s, lung cancer, COPD, colon ca, LRTI, Kidney, HTN
Low income:
Driver: high rates of communicable disease (8/10 communicable)
conditions: LRTI, stroke, IHD, malaria, Preterm birth, covid, diarrhoeal, TB, birth, HIV
HIV deaths decreasing
Global burden of disease
Lancet study published in 2024 for 2021 data
- Looks at DALYs
2010 -2021
KEY TAKE AWAYS
- non communicable largest burden: make up 16/25
- decrease communicable ( caveat COVID new entry at TOP )
- CMNN remain high (communicable, maternal, neonatal, nutrition)
Depression
Clinical: low mood >2 weeks, with functional disability. Physical and mental
Aetiology: genetic, biological, environmental
Public Health relevance:
World: Commonest mental health disorder no. 12 on GBD
UK: (fingertips)
13% prevalence
Time: increasing
Person:
- ethnic minority
- W>M
- increases with age
- unemployed
Place:
- South Yorkshire and North east
Prevention:
- secondary
Suicide
Clinical: intentionally causing own death. coroner’s verdict.
Aetiology: genetic, biological, environmental
Public Health: leading cause of death for young adults. Early intervention prevents suicide
UK: (ONS)
10 per 100,000 deaths per year
Time:
-decrease since 1982
- increase 08-10 (financial crash)
Person:
- Men >women
-highest >45
- Low SEC
- other MH
Place:
- North East HIGHEST
- London lowest
Prevention:
- 1: strengthen protective factors
- 2: detect those at risk, intervention
England suicide prevention strategy 2023-28
Dementia
Clinical: neurodegenerative, memory loss, confusion, speech, understanding
Aetiology: Alzheimer’s 60% (beta-amyloid, tau) + Vascular (infarcts)
PH relevance:
- aging population, cost, undiagnosed, no cure
UK:
- 12% deaths due to dementia
4.3% prevalence in England
Time:
- increasing (1.6mil by 2040)
Person:
- increase with age
- W > M
place:
- IMD high
- North West, south east, north east, East England,
Schizophrenia
Clinical: psychosis. Positive, negative, cognitive
Aetiology: unknown
PH relevance:
- high disease burden
- high physical health burden
- stigmatised and hard to reach group
UK:
- 1% prevalence
Time:
- ?falling (poor data)
Person:
- male, 25-40, black
- low SEC
- ?cannabis use
Place:
- Urban >rural
Prevention:
- Early intervention for first presentation psychosis
Parkinsons
Clinical: progressive neurological disorder that primarily affects movement. Motor + non-motor symptoms
Aetiology: loss of dopamine producing neurons in SN + lewy body
PH relevance:
- increasing with aging population
- falls, fractures and hospital admission
- social care
UK
200 per 100,000
Time:
Time: prevalence stable (Okunoye et al 2022 cohort study), but will increase as population gets older
Person: increase with age (doubles between 50-69), Male, sporadic
place: n/a
Prevention:
no routine screening
Coronary heart disease
Clinical: inadequate blood supply to heart. Angina, MI, cardiac arrest
Aetiology: atherosclerosis
PH relevance:
- one of the top causes of death in the UK
UK:
Time: fallen since 80s
Person:
- M, increasing age,
age, lifestyle, disease, family, other
Place:
North, Scotland, wales
Prevention:
1: exercise, diet
2: treatment
Stroke
Clinical: form of CVD: ischaemic or haemorrhagic
TIA
Aetiology: CVD, HTN
PH relevance:
- leading cause of death and disability
- preventable
UK
100K strokes a year
Time:
- increasing due to age (age adjusted decreasing)
Person:
male, old, low SEC
Place: n/a
Prevention:
1: lifestyle, HTN, cholestrol
2: FAST
Breast Cancer
Relevance: major cancer in women
Incidence: 173 per 100,000 (females)
5 year survival :85%
Time: survival increasing
Person: female, older, deprivation, white higher ethnic lower (start family early), genetic
breast cancer screening in place (50-71 every 3 years)
Lung Cancer
Relevance: high case fatality rate + preventable
Incidence: 66 per 100 000
5 year survival: 20%
Time: improving ( reducing smoking, stage shift)
Person: men, over 50
targeted lung cancer screening started (55-74)
Colorectal cancer
PH Relevance:
- 4th most common cancer in the UK
- known RF
- Screening
Incidence: 56.6 pr 100 000
5 year survival: 60%
Time: survival improving,
Person: older Age, diet, smoking, gastro conditions
(increasing in younger age but 90% still >50)
Screening: 50-74: Home FIT kit (then colonoscopy)
Prostate cancer
2nd most common cause of cancer in the UK
Incidence: 88 per 100,000
5 year survival: 87% 5 year survival
Time: improving
Person: Men, old, African,
Screening: ?(prostate then MRI screening: NEJM
Cervical cancer
Common cancer in women
Incidence:
5 per 100,000
highest in females aged 30 to 34
decreasing
5 year survival: 70%
Improving
Person: gender, younger age, lower deprivation
Prevention:
Primary:
HPV vaccine (1 HPV vaccine 12/13: coverage 83% F, 65% M)
Secondary: screening
screen (25-64) uptake 72-76&
HPV first
Asthma
Clincal: chronic, inflam condition, shortness of breath
PH relevance:
Commonest chronic condition in childhood
UK:
Prevalence: 12%
Time
Person:
Boys, childhood, viral,
Place:
air pollution,
Prevention:
I: air quality
2: annual review, personalised asthma plan, medication
COPD
Clinical: Chronic bronchitis and emphysema
Public health:
- preventable (smoking)
- high mortality and morbidity
UK
- 3 million in the UK
- Common reason for ED admission and hospital readmission
Time:
- increasing
Person:
Men = women,
older age,
lower SEC,
smoking
place:
prevention:
1: stop smoking, occupational exposure
2: vaccination
sickle cell
Clinical: red blood cell disease, sickling, obstruct blood
aetiology:
Autosomal recessive (Ch 11)
Public health prevalence:
- Health inequality
- screening
UK:
Prevalence: Afro-Caribbean: 1 in 10-40 have trait 1 in 60-200 have disease
UK Prevalence: 20 per 100,000
- Screening:
1. blood test for mothers and fathers who mother is a carrier - in high prevalence areas to all women
- family origin questionnaire
- in low prevalence areas then blood test - Heel prick test
- all new-borns
1 +2 then diagnostic test (CVS and amnio)
diabetes
Clinical: multisystem characterised by hyperglycaemia
aetiology:
T1DM: autoimmune
T2DM: insulin resistance and relative insulin deficiency
Public health relevance:
- Increasing mortality and morbidity
- increasing prev.
UK:
- 4 million in the UK
- large undiagnosed
Time: increase
Person:
- deprived, LMIC, more common England
Alcohol use disorder
clinical: drink >14 units in a week, harmful drinking + dependence
Aetiology: addiction cycle
Public health:
- short and long term effects ( HTN, stroke, CHD, pancreatitis, liver disease)
- prevention
UK
21% of adults
time:
- overall decrease since 2000 with decrease in binge drinking in young adults
place: all 4 nations. worse scotland
person:
mortality: 39.5 per 100,00
prevention:
SAFER
Strengthen restriction
Advance drink driving counter measures
Facilitate screen and treatment
Enforce bans on advertising
promotion, sponsorship
Raise price
Air pollution
overview:
- household, particulate, ozone
causes:
- transport, industry, farming, energy consumption, heating
public health importance:
- increase CVD, resp infections and diseases, maternal, neonatal, cancers
UK:
28K deaths a year due to air pollution
time:
- increasing worldwide
- decrease UK
person:
- high risk groups
place:
- cities, location to road/ polluter
drug misuse
clinical: dependence leading to harm
Public health:
- preventable
- inequality
- cross-sector
UK:
- 2% drug use disorder
time:
- opioid USA, increasing UK
place:
- deprivation, Scotland
Person:
men, young
Smoking
leading cause of cancer, COPD
Why PH:
- cause of cancer
- preventable
- inequality
UK:
- 13% adults smoke
- declining
- 1 in 4 cancer deaths
cost:
- England £17 billion
- productivity
- direct (healthcare costs) and indirect
Vaping:
- increasing around 13% of youth
reasons: social, and mental health
control:
tobacco and vapes bill 2024
MPOWER
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco
UK Gov:
1998: smoking kills (seminal white paper)
2024: tobacco and vapes bill (smoke free generation)
Oral health
conditions: tooth decay, periodontal disease, oral cancers
Public health:
- cost £3.6billion per year
- tooth decay most common hospital admission for 5-9 year olds
UK:
- 1/4 of <5 experience tooth decay
- deprivation
time:
- better
person:
- young, elderly, LD
- homeless, prison
place:
- North West
- deprivation
prevention:
1: fluoride brush and varnish, breastfeeding, less sugar, fluoridation of drinking water
Obesity
definition: >30 BMI
public health:
1 in 8 obese WW
increase risk of multiple conditions (DN, cancer, HD)
UK:
26% adults
cost £4bill each year to the NHS
primary
secondary
treatment: ?ozempic
Road traffic injuries
TBC
screening
the process of identifying apparently healthy people who may have an increased chance of a disease or condition.
Individuals can then be offered more information, further tests or treatment as appropriate.
3 approached to screening
1 population:
- offered to a group of people identified form the whole population, and defined eg by sex or age
eg. bowel, breast, cervical
- targeted
- offer screening to a more specific group with a higher risk of a condition
eg targeted lung cancer screening to smokers
- stratified:
- happens in both above
- offer testing which varies in frequency and modality based on individual risk
eg. HPV +ve follow different CC screening pathway, FHx of breast cancer invited more frequently.
Wilson and Junger
Disease – importance, preclinical course, natural history, latent period
test – valid, safe, effective, acceptable, reliable, cheap
Diagnosis and treatment – evidence-based, acceptable, cost-effective, safe, facilities adequate
Overall programme – evidence-based, ethical (Beauchamp and Childress, informed decision and popularity paradox), legal (4 aspects), economic (opportunity cost), social (factors affecting participation)
Overview of national screening programmes
- Pregnancy
- infectious disease
- Foetal anomaly scan
- sickle and thalassemia - New born
- Heal prick
- new born and infant physical exam
- new born hearing - Adult
- Cervical cancer: 25- 64 (25-49: 3Y, 50-64: 5Y)
- Bowel cancer (50-74 M and F: FIT kit)
- Breast Cancer: (50-71 F. AgeX trial to x2 one off at 47-49, 71-73)
- AAA ( M year turn 65)
- Diabetic eye check (>12 diabetes, every year, if x2 -ve every 2 years)
others:
- NHS health checks
- Chlamydia (targeted F)
- prostate
- TB
Cervical screening
WHY:
- common cancer in women (14)
- highest in females aged 30 to 34
- pre-clinical stage: dysplasia: CIN (1-3)->cancer
- strategy to eliminate by 2040
High risk HPV testing, cytology, colposcopy.
Impact:
- estimate save 4500 lives every year
- cervical rates have halved
Uptake:
- 30% eligible never screened
- lowest in ethnic minority and young age groups, deprived
- letter language, accessible appointments, discomfort
HPV vaccine
- 1 dose for M and F in Y8
- 9 types of HPV
Bowel cancer screening
WHY:
- 42K cases a year
- 17K deaths
- 80% >60 years
- -early treatment Increases survival: duke (90%) Vs metastatic (10% 5ys)
Works?
- risk of dying of bowel cancer by 16%
What is it:
- 54- 74 every 2 years (increased to 50-74)
- FIT home test (blood) then colonoscopy
screening bias
Lead time: know ill earlier (longer lead in)
length time bias: slower developing illness
healthy screene effect
threshold
parallel and serial testing
threshold: need to set cut off
ROC: AUROC
parallel: both tests together (downs: USS + blood test),
serial: one after another (cervical)
Screening Vs Diagnostic test
Vs case finding
case finding:
strategy for targeting resources at individuals or groups who are suspected to be at risk for a particular disease. It involves actively searching systematically for at risk people, rather than waiting for them to present with symptoms or signs of active disease similar to screening
- communicable disease control
- health systems
legal aspects of screening
- confidentiality
- accreditation and qual
- right to NOT screen
- consent
informed choice for screening
GMC:
- purpose of screening
- likelihood of +ve and -ve result
- risks associated with screening
- implications for particular condition (medical, social, financial)
- follow up
Genetic screening
involve testing members of a population (or sub-population) for a defect or condition, no prior evidence of its presence
OR limited to a sub-population that is at particular risk of a genetic condition.
Issues:
1. ethical:
- 4 principles,
- autonomy
- reproductive choice
- legal
- consent
- confidentiality
- right to not be screened - social
- stigma
- counselling
- disclosure to family
- insurer/ employer
genotype vs phenotype
The set of alleles a person has is known as their genotype.
This genotype then codes a set of observable characteristics which are then expressed, known as the phenotype.
karotype
species-specific characteristic set of chromosomes.
how to make a protein
- transcription
- in nucelus. RNA polymerase
- mRNA from single strand DNA - splicing
- introns removed from mRNA - exporting
- leaves nucleus - translation
- ribosome
- mRNA adds tRNA which carries amino acis
5.protein modification
- translocation
patterns of inheritence
- monogenic
AD: huntingtins
AR: sickle cell
x- linked: Rett syndrome - polygenic
- many genes
- alzheimers - chromosomal
- numerical: trisomy (downs 21) loss monosomy (turners)
- structural: Charcot - MTD - mitochondrial: Leigh disease
- threshold effect
penetrance
proportion of people with a given genotype express phenotype
genetic testing
- individual if there is an indication
- medically
- fhx
can work out familial relative risk: risk in family/ riskin gen population
done:
1. molecular tests
- FISH
- karotyping
- non invasive prenatal: cfDNA
population screening
1. Heelprick for 9 rare conditions
- pregnant: downs, edwards, patua, SC and thalasemmia
nutrition
study of the the influence on food intake on health and wellbeing.
Macro and micronutrients
Surveillance:
- routine collection and collation of data
-food supply: FAO data
- ONS Living cost and food survey (2023)
- infant feeding survey
Nutritional status
- anthropmentry
- height, weigh, BMI
NHS child measurement programme - indices
- MUST - biochemical
- bioelectrical impedance
- imaging
- food surveys
Dietary nutritional values
EAR (estimated average requir): Average amount needed by a group of people (i.e. 50% of the
group’s requirements are met)
Reference Nutritional Intake: Amount that is enough to meet the dietary needs of about 97.5%
of a group of people (i.e. the majority need less)
Lower Reference NI: Amount that is enough for a small number (2.5%) of people in a
group with the smallest needs (most people will need more than this)
Safe intake: expert opinion
Intersalt study
Large cross-sectional individual and ecological
52 countries, 10k people
findings:
- urinary Na excretion related to higher blood pressure at ecological level
- BMI and alcohol independently associated with BP at ecological level
-> firs evidence that Salt linked to BP
types of diets
Bad
- western: high energy, sat fats, low fibre, high salt
- South asian: high fat
good:
- mediterranean
- japanese
physical activity
def: any force exerted that results in energy expenditure above resting.
why important:
- CVD, obesity, T2DM, cancer, mental health, skeletal health
epidemiology
Time: decrease in adults and children
person:
- lowest in asian, black and other (highest mixed)
-63% in england were physically active
place:
- lowest Tower hamlets, higher wandsowrth
environmental health
all external factors and conditions that contribute to health
- traditional: physical, chemical, biological
- Living and working
- global: Climate
Kuznet curve: n shaped curve of pollutants and wealth
environmental hazard and risk
hazard: factor that may harm health
risk: probability of event x impact
Sandman risk
= Hazard (size and probability) + outrage
depends on:
- control
fair
- process
- morality
- familiar
- dread
-memorable
- time and space
- voluntary
risk management
Assessment, management, communication
Assessment:
1. what are the issues: vulnerable groups, what is hazard, underlying concerns
- hazard: what is hazard, where and why important
- exposure assessment: how, what is it, why important
Management:
1. evaluation: identify and analyse
- control:
- source, pathway, receptor
- immediate, medium, long term - monitor
- lessons learned updated SOP
Communication
- throughout
- sandman’s risk
- culturally competent
Transport policies (wales 20mph)
Rational: Dr Sarah Jones, to increase active travel for children –> barrier unsafe streets
+ reduce crashes and serious injuries
+ less noise and fuel usage
2023 data: 100 fewer series injuries and 10 fewer dead (lowest since records began
issues:
- need 3 year of data
- balance of risks
- communication
campaign groups: 20splenty
- 75% of inner londoners live on a 20mph road
-
surveillance
ongoing systematic collection,
collation, analysis, and interpretation of
data and the dissemination of the information
generated to facilitate disease prevention
principles of surveillance
- case definition
- cases identifies through number of sources
- data collection tool
- systematic collection of case data = case definition
- analysis
- feedback to data providers
- dissemination and use
types of surveillance
- active: look for cases and report -ve
- passive: routine data
- enhanced: extra info (TB)
- notifiable
- sentinel: sample subset: eg GP for influenza
- syndromic: symptoms
GuMCAD STI surveillance system (report quarterly)
global: GOARN (global outbreak alert and response network)
legal health protection laws
Public Health (Control of Disease) Act 1984
Health Protection Regulations 2010
- notifiable disease
- closed consultation to update
- local authority powers
- responsible officer
- without a JP
- get notifiable disease reports
-child away from school, get a school list, - part 2a powers (Health Protection (Part 2A orders) Regulations 2010)
- JP required
- restrict movement
- restrict contact
- shut venues
not for treatment or vaccination
Environment:
- LA and EA have legal powers to control: waste, radioactive, water discharge
LA:
- Food (Food safety Act)
- private water (public by WSI)
- pests + nuisance
outbreak control
- Outbreak control group
- epi sequence:
- case definition
- confirm cases
- confirm outbreak
- collect cases
- descriptive epi
- epidemic curve
- generate hypothesis
- test hypothesis: analytical study - Control
- source, pathway, receptor
- immediate, medium, long term - communication
- immediate, medium, long term
Diptheria
(swab, PCR) NOTIFIABLE
c.diptheria or coynebacterium ulcerans
Acute URTI
- Membranous pharyngitis (pseudo membrane)
- Fever
- Enlarged anterior cerical lymph nodes and oedema: Bull necks
- Toxin: paralysis and cardiac failure
Incubation period: 2-5 days, infectious for 4 weeks
Epidemiology:
Low in UK: but high susceptibility (50% rising to 70% >70)
UK cases: non toxigenic strain of c.dip: mild sore throat or TRAVEL
c.ulcerans Resevoir: cattle
Vaccine:
- Toxin vaccine
- Three doses as a child part of combination: DTaP/IPV/Hib
- 2 3 4 months (+ 4 in 1 preschool booster + 3 in 1 teenage booster)
Control:
Cases:
- Antitoxin in hospital
- Antibiotics
- Complete vaccine to UK schedule
Contacts: antibiotic prophylaxis + vaccine
Vaccine: booster, unvaccianted: schedule
Pertussis
Bordtella pertussis Notifiable
(culture nasal, PCR, EIA)
- Catarrhal stage: cough, cold, fever - Whoop cough - Apnea episodes
Epidemiology:
- Every 3/4 years, highest in autumn
- 2012 outbreak: pregnant women vaccinated passive immunity: ROUTINE programme at 20 week scan (33% uptake in September 2024, ethnic disparities)
- Outbreak in 2024 after COVID
- Whole cell vaccine: prevent serious disease but not infection
- HCW vaccine
- acellular pertussis vaccine
Routine to infants in 6 in 1 vaccine: 2, 3, 4 months DTaP/IPV/Hib/Hep B + 4 in 1 preschool booster
Control:
- Antibiotics
- Vaccination
Vulnerable contact : abx prophylaxis and vaccinate <10 years
Tetanus
(toxin in serum) Notifiable
Toxin acute disease from clostridum tetani
Incubation: 4-21 days
Get:
- Rigidity, spasms
- Death
Epi
UK: routine immunisation 1961, low cases
- PWID (people who inject drugs) main outbreaks
Wounds, needles, abdo surgery
Vaccine: cell free purified toxin
- 2 3 4 months (+ 4 in 1 preschool booster + 3 in 1 teenage booster)
Tetanus prone wounds: given Immunoglobin + vaccine
Polio
notifiable
(viral culture, antibodies)
Poliomyeleits
- Gut then CNS
Transmission: feaco-oral, or pharyngeal secretions
UK
Last natural case 1984
Most vaccine associated, some abroad
Vaccine:
OPV: good local gut immunity to wild polio, contact immunisation (can spread to others immunising them ), easy to administer Vs vaccine associated polio disease, cold chain, lots of doses –> therefore OPV outbreak, IPV routine
2 3 4 month schedule (+ 4 in 1 preschool booster + 3 in 1 teenage booster)
H infleunza B (Hib)
NOTIFIABLE
a-f serotypes (these others less common)
- Meningtitis (60%) - Epiglottitis
Spread: airborne, close contacts
Epidemiology:
- Very low cases
- Increased in 1999, catch up vaccine programme in 2003. booster at 12 months (part of routine)
Conjugate vaccine
Vaccine 2 3 4 months booster at 12 months
Outbreaks:
- Rifampicin prophylaxis (households of cases)
Vaccine cluster cases
pneumococcal
notifiable
Gram positive cocci
- Penumonia
- Meningtis
- Sepsis
Aerosol. Droplet, direct contact
Epidemiology
- Infants and elderly, winter
- UK: 40,000 hospitalisation each year
- Reduction in serotypes via vaccination
Vaccine
- 3 months and 1 year (PCV 13)
- >65 years: 1 dose (PCV 23)
Outbreak:
- Vaccinate close contacts
- Chemoprophylaxis
meningococcal meningitis and septicaemia
notifiable
Gram negative diplococci
12 groups
6 groups cause serious disease: A, B, C, W135, X and Y
Transmission: aerosol, droplet, direct contact
Epidemiology
- <5 years of age: 1 year peak (men B), and 15-19 years
- Long term complications
- Decreased since 1999: vaccine and then 2022 lockdown
- Mass gatherings
Vaccine:
Men B (protein): 2 month, 4 months, 1 year
MenC/Hib: 1 year
ACWY vaccine (conjugate) : >14 years - 25 years
Outbreak:
- Chemoprophylaxis close contacts
Vaccinate if strain preventable
TB
TB
M.tuberculosis, bovis, africanum, microti
Any part of body: 55% Pulmonary UK
Respiratory route
Natural course:
- Eliminate
- Latent
- Active TB
Epidemiology
- Decline to 1980: reduction in general population
- 1980 peak: high risk populations
- Declining: peaks in 2010, one off increase in 2019
- Burden shifted to non-UK born, and at risk groups
- Mortality decreased: BCG, treatment
prevention:
primary:
BVG vaccine: at risk neonates (born high prev area, parents from high prev) or new immigrants 40 per 100,000
- Best for severe disease
- Not for respiratory disease
secondary:
Port health
Chest clinic
Latent TB testing and treatment programme for migrants
visa requirements
tertiary
- DOT
- MDR-TB
TB action plan 2021-26
- Recovery from covid
- Prevent
- Detect
- Control -
Workforce
mumps
Saliva, CSF, urine, serology
notifiable
Airborne and droplet
Paramyxovirus
- Bilateral parotid swelling
- Asymptomatic
- Meningism
- Pancreatitis, oophritis, orchitis sensorineural deafness
Epidemiology
- Reduction since MMR vaccine
- Peaks on 2003-2006, 2009, 2013, 2017-19
Outbreaks at university and colleges in the ‘wakefield cohorts’
- Missed out on MMR vaccine
Vaccine: (live attenuated)
MMR: 1 year, 3 y 4 months
measles
Morbillivirus of the paramyxovirus
notifiable
Airborne and droplet
- Rash - Fever - Cough, coryza or conjunctivits
Pregnant: miscarraige, LBW
Complications: ottits media, pneumonia, encephalitis (post infection, delayed, SSPE subacute sclerosing panecphalitis )
Epidemiology:
Decreased, since MMR but regular outbreaks
Recently 2023-2024: West Midlands and London, small clusters in other regions (herd immunity 95% coverage needed)
2,601 cases since Jan 2024
MMR: 1 y -3y4m
HNIG:
- Within 72 hours - 6 days
Contact to give:
- < 6 months: all
- 6-8 months if household (outside give MMR)
- >9 months: MMR
Pregnant woman if not vaccine
Rubella
Togavirus notifiable
- Rash - Congenital rubella syndrome: highest risk in early trimester
Epidemiology:
- First vaccine programme was for pre-pubesent and women: to stop CRS
- Then MMR
- Risk in those from outside: not infected or immunised
Vaccine:
MMR
HPV
dsDNA virus
> 100 types, around 13 cause cancer
- 16, 18 main cancer
- 6 and 11 warts
Epidemiology:
- Complex due to high asymptomatic
- Prior to vaccination rare <14 years then increased
Cervical cancer:
- Primary prevention: HPV vaccine
- around 70% uptake
- Decreasing since introduction (90% in cohort 1, to 70% recent cohort) similar trend in boys (81%–>67%)
- Lowest in london
Vaccine:
- Gardasil 9 (6,11,16,18,31,33,45,52)
- Given to boys and girls year 8 (12-13) + MSM
- One dose mainly (>25 MSM 2 doses, HIV/IC 3 doses)
- Cut cervical cancer by 87% for women in 20s who eligible for vaccine
Secondary:
- cervical cancer screening (as led to a 60% fall in C mortality 1974-2004) uptake falling 67-70% lower SEG and ethnic minority lowest uptake
- Peak 30-34 then 80s
- 3K cases a year
Genital warts:
- Was increasing prior to HPV vaccination now decreasing
- Highest in men (14k) women (10k)
NHS: eliminate cervical cancer by 2040
NHS App: ping and book for cervical screening
MRSA
Methicillin resistant staph
- Cellulitis - Conjunctivities - Sepsis
30% of population ae colonised
Epidemiology:
- Plateaued since 2014
Prevention: personal hygiene
Infection control
Control:
- Mandatory surveillance schemes (UKHSA)
Decolonisation
C.diff
hospital associated
Diahorrhea
Epidemiology:
Was plateauing but increase 2021
treatment: abx
control: isolation
GI infections
Campylobacter
Asymptoamtic to bloody diarrhoea
Faeco-oral, raw food
Epidemiology:
- Around 50K cases
Prevention: chlorination, pasterisation etc.
Cholera
Viberio cholea produce toxin
Watery diarrhea, vomting, 50% case fatality f untreated
Epi: endemic in developing, UK travel
Control:
Cases: ORT, abx, exlcusion
Prevenion: travel advice
Cryptospodidosis
Self limiting if healthy
Fatal if immunocompromised
Epi: seasonal
Faeco-oral
Control:
Exlclusion for 48 hrs, avoid swimming,
Shigella
Loose stools, watery can be bloody
Faeco-oral route
Epi:
- increasing in MSM population
- Travel
- Children
Control:
- Abx
E.Coli
STEC: shiga toxin producing e.coli (0157 or non-0157)
- lead to HUS - death
- recent outbreak with 0145
HUS Notifiable
Prevention: hand hygiene, cleaning, cooking
Salmonella
Diarrhoea
Epi: endemic worldwide, outbreaks
Animal to person, faeco-oral route
Enteric fever (typhoid, and paratyphoid) notifiable
Salmonella t and parat
Oral or faeco-oral
Epi: travellers, or contacts from India
Vaccine:
Vi polysaccharide, Ty21a: not part of schedule for travel vaccine
Norovirus
Faceo-oral route
Exclude for 48 hrs
Survives in envrioment, short immunity
hepatitis
Hep A
- Asymptomatic -> fuliment hepatitis
- Jaundice in adults
Spread:
- Faeco-oral
- Person to person
- Food and drink
Epi:
- Shifted to affect older adults
- Downward trend in last 25 years
- 2010 outbreak in London and south west
- Outbreaks in MSM (faeco-oral route)
- Frozen berries
- Travel
Vaccine Hep A only hep A/B: 2 doses 6 months apart
Given to at risk groups (not part of routine in the UK)
HNIG:
- PEP for non-immune immunocompromised
Hepatitis B
Blood and bodily fluids (sex)
MTCT
-non specific prodrome illness
Jaundice and fever
HCC
cirrhosis
Hep D infection
CHRONIC CARRIER
Epidemiology:
- 200,000 people with chronic hep B in the UK
- Most migrants (95%), PWID, MSM, sex workers, detained
- Acute hepatitis clusters MSM
Vaccine:
- Childhood imunisation 2 3 4 months in th Dtap/IPV/Hib/Heb B
- Catch up vaccine for at risk groups
MTCT
- Univeral antenatal screening
- HBIG for at risk mothers at b
Chronic hep B
- Long term management
- Antiviral medications to supress
Hepatitis C
Blood
- Carriers
- Chronic hepatitis
- Cirrhosis
- Liver cancer
Epi:
- Main driver in the UK PWID
- Reduction in Chronic hep c: due to increased treatment (as PWID infections stayed same)
Control:
Direct acting antiviral (DAA) especially at risk groups
Prevention: needle
sexually transmitted infections
Chlamydia
Commonest bacterail STI (194K diagnosis a year)
Long term: PID, ectopic pregnancy,
Highest <25
Nationally Chlamydia screening programme: women <25 sexually active: after sex with new partner or annually
Why women:
- Highest long term harm
- No evidence that both gender reduced population prevalence
- Testing women regularly reduce period of harm
- Men: lower risk of harm and can clear infection without treatment
UK increasing: 85K diagnosis
Complications: PID, ectopic, septic arthiris
Abx:
Contact and partner tracing
Condom
HIV:
Statistics:
Prep need and on prep:
- Need met for GBMSM: 85%, hetrosexual men 60%, hetrosexual woman 62%
New diagnosis:
- 6008 in England (51% increase)
○ MSML rose by 7%
○ Hetro: 36% increase
○ Over half diagnosed abroad
Late diagnosis:
- 896, (3% increase, black ethnicity highest)
HIV care:
- Age increasing
- Tx coveraege covers 98%
Gonorrhoea
What is it: a bacterial infection
Lead to PID , infertility
Increased in 2023
Syphilis
Bacterial infection
Primary (chancre), secondary (rash), tertiary (disseminated)
Increasing
Highest in MSM
25-39 year olds
Increasing in heterosexuals
chickenpox
varicella virus
children:
- often self limiting
- secondary infections
- days off school
- pneumonitis, encephalitis, stroke
JCVI: reccomend vaccine MMRV 2 doses
- cost effective/ cost saving depending on vaccine price
- used data from USA to model
- less exogeneous boosting (middle aged adults get boost in immunity from circulating VZ, so less likely to get shingles)
Dahlgren and whitehead
Evans and stoddart
heath field model
- functional status and wellbeing
diderichsen and hallqvist
social determinants framework
- social stratification
- diff exposure
- diff vulnerability
- diff outcomes
SEED (early education development) study
longitudinal study
Attending high quality ECEC aged 2-4 –> better key stage 1 sores
40% most disadvantaged, >10 hrs free ECEC + <2 years –> better key stage 1 scores
Sure Start
IFS:
Reduction in hospital admissions,
Improved GCSE grades
Long term outcomes
initial early studies showed no effect
Family nurse partnership
Nurse for mothers <25 years of age
Local commissioning from public health grant
- Building blocks 1: RCT no short term outcome difference - Building blocks 2: follow up at 7 years. No difference on key stage 1, hospital usage
social marketing
- identify target
- research target
- competitive analysis
- set objective
- develop message
- sell message: product, price, place, promotion
- evaluate
