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FPH exam > 2G communicable diseases > Flashcards

2G communicable diseases Flashcards

1
Q

Define incubation period

A
  • also known as subclinical period
  • time between acquiring infection and onset of symptoms
  • may be affected by the infecting dose
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2
Q

Define: latent period

A
  • time between acquiring infection and becoming infectious
  • typically slightly shorter than the incubation period
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3
Q

Define: period of communicability

A
  • Also known as the infectious period
  • time during which person is capable of transmitting the infective agent
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4
Q

What is passive immunity

A

Short term immunity acquired either via transfer of IgG across the placenta or due to administration of immunoglobulins either as treatment or as prophylaxis

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5
Q

What is active immunity

A
  • longer term immunity acquired by prior encounter with an antigen either due to previous infection or vaccination
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6
Q

Epidemic threshold

A

The number of susceptible people in a population needed for an epidemic to occur

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7
Q

What is herd immunity

A
  • a phenomenon of reduced spread in a population due to a relatively high proportion of immune individuals
  • The herd immunity threshold is the proportion of immune people in a population, above which the incidence of infection with decrease
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8
Q

what is surveillance

A

The systematic collection, collation, analysis, interpretation of data and dissemination of results

Provides information for action

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9
Q

List the types of surveillance

A
  1. passive surveillance
  2. active surveillance
  3. enhanced surveillance
  4. sentinel surveillance
  5. syndromic surveillance
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10
Q

Types of surveillance: Passive surveillance

A
  • most common form of surveillance
  • involves automatic collection of data from routine sources
  • simple but often incomplete

ie hospital episode statistics or lab reports

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11
Q

Types of surveillance: active surveillance

A
  • a special effort to confirm diagnosis and ensure more accurate complete reports eg through follow up surveys
  • used in outbreak investigation
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12
Q

Types of surveillance: Enhanced surveillance

A
  • collection of data above that collected for passive surveillance, usually at the patient level and often to design or evaluate an intervention or aid control of more important health hazards
  • ie gaining epidemiological evidence in cases of MRSA bacteraemia in order to evaluate the effect of healthcare interventions on the incidence
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13
Q

Types of surveillance: Sentinel surveillance

A
  • when surveillance is carried out on a subset (sample) of the population
  • this may be a geographical sample (ie only some GP practices) or based on high risk groups (ie hep B surveillance in men who have sex with men)
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14
Q

Types of surveillance: Syndromic surveillance

A
  • monitors cases of symptoms rather than waiting for doctor reports of confirmed cases
  • allows for earlier detection of outbreaks
  • may be useful in emergencies or to investigate an outbreak
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15
Q

Who is responsible for coordinating national surveillance of communicable diseases in the UK

A

UKHSA

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16
Q

Give some principle sources of information for a national surveillance system using examples from England

A
  1. NOTIFIABLE DISEASE
    - diseases which clinicians have a statutory duty to report
    - report should be based on clinical suspicion rather than waiting for lab confirmation
  2. LAB REPORTS
  3. DEATH REGISTERS
  4. HOSPITAL EPISODE STATISTICS

5.SYNDROMIC SURVEILLANCE
- ie Royal college of GPs weekly returns systems for respiratory and GI conditions

6.SEXUAL HEALTH CLINIC STATISTICS
- GUMCAD

  1. VACCINATION COVERAGE
    - Cover Of Vaccination Evaluated Rapidly (COVER)
  2. ENHANCED SURVEILLANCE
    - london TB register
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17
Q

Give examples of 2 global surveillance systems

A
  1. European centre for disease prevention and control infectious disease surveillance
  2. Global public health intelligence network
    - developed in Canada, this system trawls the internet for communicable disease reports in various forums and news wires
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18
Q

What factors should an evaluation of a surveillance system consider?

A

RC CRAFTS

Qualitative:
- simplicity
- flexibility
- acceptability
- completeness
- representativeness

Quantitative:
- reliability
- timeliness
- cost

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19
Q

What is the acronym for methods of infection control

A

QUID SIC

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20
Q

List and give examples of the 7 methods of infection control

A

QUID SIC

  1. QUARANTINE
    - eg national lockdown or quarantine of diagnosed o contacts in COVID 19 pandemic
  2. UNIVERSAL PRECAUTIONS
    -ie washing hands
    - ie PPE (masks, gloves to avoid contact with bodily fluids)
  3. ISOLATION
    - ie single room isolation for MRSA
    - ie negative pressure room for source isolation (ie TB)
    - ie Positive pressure room for protective isolation (ie severely immunocompromised patient)
  4. DECONTAMINATION
    - ie disinfection of equipment
  5. SOURCE CONTROL
    - ie product recall
    - ie closure of a restaurant
  6. IMMUNISATION
    - ie vaccination of an exposed person (ie hep B vaccination for those exposed)
  7. CHEMOPROPHYLAXIS
    - ie abx for close contacts of meningococcal disease
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21
Q

Define vaccination

A

The administration of a vaccine

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22
Q

Define immunisiation

A

The administration of a vaccine AND the development of an immune response by the body

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23
Q

What must be considered when implementing a new vaccine

A

-The scientific evidence
- the programme strategy
- Finance
-Administration
- Vaccine purchase and distribution
- communication
- evaluation

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24
Q

Who is responsible for Vaccine policy in England

A

-Overall responsibility for vaccine policy lies with the department of health, it is supported by:

1 UKHSA
- undertakes vaccine research, epidemiological research and surveillance
2. NHS ENGLAND
- responsible for planning immunisation
3 JOINT COMMITEE ON VACCINATION AND IMMUNISATION
- independent group of experts who advises the government on matters relating to communicable diseases. They must make recommendations in the light of a cost benefit analysis

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25
Q

What decisions need to be made when planning an immunisation strategy

A
  • mass Vs selective immunisation
  • type of vaccine (ie live, inactivated)
  • age to be vaccinated
  • number of doses/need for boosters and interval between doses
  • surveillance
  • outbreak response (is vaccine stockpiling necessary)
  • investment in research
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26
Q

Types of vaccine: Live

A
  • contain live micro-organisms whose virulent properties have been disabled
    ie Oral polio vaccine
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27
Q

Types of vaccine: Inactivated

A
  • contains micro-organisms which have been killed
  • ie Inactivated polio injection
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28
Q

Types of vaccine: Conjugate

A
  • The surface of some bacteria are poorly immunogenic, linking them to polysaccharides can enable the body to make an immune response
    -ie pneumococcal conjugate vaccine
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29
Q

Types of vaccine: Subunit

A
  • contains a fragment of a micro-organism
  • ie HPV
30
Q

Types of vaccine: Toxoid

A
  • contains no micro-organism but inactivated toxic compounds
    -ie diphtheria, tetanus
31
Q

Types of vaccine: Polysccharide

A
  • contains polysaccharides from the surface capsule of the micro-organism
    ie pneumococcal polysaccharide vaccine
32
Q

Benefits/ risks of oral vs injected polio vaccine

A
  • Live/ inactive vaccines can have different benefit/risk profiles
  • oral (live attenuated) polio is more effective but it can cause vaccine associated paralysis
  • injectable (inactive) polio is therefore safer and used in many countries where polio has been eradicated
33
Q

Mass Vs Selective immunisation: mass immunisation

A
  • aims to vaccinate whole population to achieve herd immunity
  • ie rubella causes congenital abnormalities in foetus, however whole population is vaccinated to try and achieve herd immunity
34
Q

Mass Vs Selective immunisation: Selective immunisation

A
  • vaccination of the most at risk groups
  • lower cost and lower total number of adverse events
    eg HPV vaccine was initially just administered to girls as only girls were at risk of cervical cancer, the programme has now been extended to boys as well (herd immunity and genital warts protection)
35
Q

define Outbreak

A

An outbreak can be defined as:
- two or more linked cases of the same disease
- a greater number of cases of a disease than would be expected in a period of time (in a geographical area or amongst a specific group of people)
- A single case of a disease of high public health importance ie anthrax or diptheria

36
Q

What are the objectives of outbreak control

A
  1. minimise the number of primary cases ( identify outbreak and carry out source control)
  2. Minimise the number of secondary cases (identify cases and take action to prevent spread)
  3. Prevent further episodes of illness by identifying continuing hazards and eliminating them
  4. Introduce measures to prevent further outbreaks
37
Q

What key things should be included in outbreak control plans

A
  1. The roles and responsibilities of involved organisations and people
  2. Plan for informing and liaising with key personnel (ie director of public health, regional epidemiologist, reference lab)
  3. Plan for liaising with local government, hospitals
  4. The facilities required and where these can be accessed (ie room with computers and telephones)
38
Q

when should an outbreak control group be convened

A
  1. The disease poses an immediate health hazard to the population
  2. A large number of cases
  3. Unexpected cases appear in several districts
  4. Disease is unusual and severe
39
Q

Investigation of an outbreak: what are the 4 elements that need to happen concurrently

A
  1. Follow the epidemiological sequence
  2. Instigate control measures
  3. Convene outbreak control group
  4. Communicate with media
40
Q

Investigation of an outbreak: Follow the epidemiological sequence

A
  1. Establish case definitions
  2. Ensure cases are real
  3. establish background rate of disease
  4. establish whether it is true outbreak
  5. Identify cases
  6. Describe epidemiological characteristics of cases in terms of time, person and place as well as clinical features and lab reports
  7. Plot the epidemic curve
  8. Generate hypothesis
  9. Test hypothesis via an analytical study
  10. consider further studies
  11. Generate conclusions
41
Q

Investigation of an outbreak: Instigate control measures

A
  • control the source
  • control the mode of spread
  • protect persons at risk
  • continue surveillance of control measures
  • declare outbreak over when cases return to background level
    -introduce measures to prevent further outbreak
42
Q

Investigation of an outbreak: Convene outbreak control group

A

May include many people:
1. Director of public health
2. Consultant in communicable diseases
3. Consultant microbiologist
4. Consultant toxicologist
5. Administrative staff
6. Food standards agency
7. environmental health officer
8 UKHSA representative
9. Member of state vetinary services
10. Water company
11. Regional epidemiologist
12. Manager of the institution
13. Press officer

43
Q

Investigation of an outbreak: Communication with media

A
  • consider best form of media to communicate
  • use media constructively
  • ensure communication is accurate and timely
44
Q

Response to disasters: what are the stages in the WHO disaster response cycle

A
  1. Prevention
  2. Preparedness
  3. Detection and alert
  4. Response
  5. Recovery
45
Q

WHO disaster response cycle: what is in the prevention phase?

A
  • minimise the likelihood of an every occurring (eg flood defences, security services)
46
Q

WHO disaster response cycle: What is in the preparedness phase?

A
  • gather information on potential hazards
  • have incident response plan
  • train response teams
47
Q

WHO disaster response cycle: what is in the detection and alert phase

A
  • detect incidents as early as possible
  • eg earthquake detection systems, health surveillance systems
48
Q

WHO disaster response cycle: what is in the response phase?

A
  • Respond as determined by the incident
49
Q

WHO disaster response cycle: What is in the recovery phase?

A
  • following the incident actions need to be taken to return to normal (ie victim support, risk assessments) and learn from mistakes (incident investigation)
50
Q

Infection control at the national level: the department of health responsibilities

A
  • overall responsibility for all matters relating to health
  • In England the chief medical officer and chief nursing officer develop guidelines, policies and tools for the NHS
  • they seek advise from experts within and outside of the department of health to advise them on infection control matters
51
Q

Infection control at the national level: UKHSA responsibilities

A

RESPONSIBLE FOR:
- infectious disease surveillance
- providing specialist and reference microbiology and microbial epidemiology
- coordinating investigation of national and uncommon outbreaks
- responding to international health alerts

52
Q

Infection control- what organisations are involved

A

NATIONALLY
- Department of health
-UKHSA

LOCALLY
- Health protection teams
- local authorities
- Hospitals

53
Q

Infection control at the local level: Health protection teams responsibilities

A
  • delivery of UKHSA services across England
  • Control of communicable disease at the local level with support from UKHSA if it affects a larger area or is of national significance
  • Provides specialist health protection advice as well as operational support on all health protection matters to NHS trusts, local authorities, community health services (incl. schools and social services) and the general public
54
Q

Infection control at the local level: Local government responsibilities

A
  • Local authorities have a range of powers that can be enacted to prevent, protect against, control or provide a health protection response to an incident that could cause significant harm to human health, including:
    1. imposing restrictions on people
    2. requiring premises are closed
    3. require a person to share relevant information

-They also have powers to control
1. waste operations
2. radioactive substances activity
3. water discharge and ground water activities (incl. sewage discharge)
4. supply of food
5. Private water supplies
6. pest control

55
Q

Infection control at the local level: Hospitals- structure of infection control

A
  • hospitals in england have to have an infection control team, this must include:
    1. Infection control physician/ microbiologist
    2. infection control nurse

One of these people is the Direction of Infection Prevention and control (DIPC)

56
Q

Infection control at the local level: What is the hospital infection control team responsible for

A
  • policies and procedures
  • clinical waster management
  • purchasing necessary equipment
  • audit
  • staff training and education
  • surveillance ie antibiotic usage
  • advice on outbreak management
  • advice on isolation
57
Q

How does the notifiable disease system work in England

A
  • there is a list of diseases which are statutorily notifiable
  • Clinicians have to report to the ‘proper officer’ at their local health protection team or local authority
  • must report with 3 days or within 24 hours if the case is urgent
  • Proper officer has to pass notification onto UKHSA within 3 days or within 24 hours if the case is urgent
58
Q

Give some examples of routine microbiological techniques

A
  • microscopy, culture and sensitivities
  • immunoassays
59
Q

What are molecular biological techniques

A

A range of modern molecular methods that involve the identification of specific RNA/ DNA in the specimen

60
Q

what are the strengths and weaknesses of routine microbiological techniques

A

STRENGTHS
- cheap
- Can provide definitive diagnosis

WEAKNESSES
- slow
- Poor sensitivity (ie if sample take after abx)
- may not be able to fully ID organism (ie toxin producing strains)

61
Q

What are ELISA immunoassays

A
  • method for detecting presence of an antigen
  • uses labelled immunoglobulin which will bind to target antigen
  • After mixing and washing the strength of the signal from any remaining bound immunoglobulin can be measured
62
Q

What are the strengths and weakness of immunoassays

A

STRENGTHS
- relatively simple
- rapid
- specific
- cost effective

WEAKNESSES
- lack sensitivity
- low positive predictive value
- low negative predictive value

63
Q

Give some examples of reference microbiological techniques

A

NUCLEIC ACID PROBES
- single strands of DNA or RNA which are used to search for complimentary genome sequences in the sample
-probe is labelled ie radioactive tag so it can be visualised afterwards
- nucelic acid probes available for N. gonorrhoea, CMV, HPV

NUCLEIC AMPLFICATION SYSTEMS
- used to first amplify any organism genetic material present which can then be detected
- available for Gonorrhoea and TB etc

64
Q

Strengths and weaknesses of reference microbiological techniques

A

STRENGTHS
- better sensitivity and specificity
- Fast
- can identify organisms that do not grown on culture
- can identify genes that lead to antimicrobial resistance
- can fingerprint isolates for epidemiological tracking

WEAKNESSES
- require specialised equipment
- require segregated rooms in labs
- currently only detect micro-organisms

65
Q

Strengths and weaknesses of automated and semi automated systems

A

ie blood culture systems

STRENGTHS
- reduces labour intensiveness
- provides quicker results
- performs tests more reproducibly

WEAKNESSES
- organisms may be incorrectly identified
- may miss resistance of an organism to an antibiotic

66
Q

The background to the WHO international health regulations

A
  • The international health regulations are an agreement between 196 countries to work together for global health security
  • Instrument of international law that is legally binding to WHO member states
  • The IHRS aims to prevent, protect against, control and respond to the international spread of disease without unnecessary interference with global travel and trade
67
Q

According to the WHO international health regulations what must countries have the capacity to do?

A

DARR

DETECT: ensure surveillance systems and labs can identify threats

ASSESS: work alongside other contries in making decisions for public health emergencies

REPORT: Report specific diseases and those meeting IHR criteria for Public Health Emergency of International Concern (PHEIC) to WHO

RESPOND: Respond to public health concerns

68
Q

What are the Public Health Emergency of International Concern (PHEIC) criteria for the WHO international health regulations?

A

Events meeting 2 of the 4 criteria:

  1. Is the public health impact of the event serious?
    2 Is the the event unusual or unexpected?
  2. Is there a significant risk of international spread?
  3. Is there significant risk of international trade/ travel restrictions?
69
Q

What act allowed establishment of port health authorities and what local authority department are they a part of, what powers do they have?

A
  • Public health act 1872 provided for the establishment of port health authorities
  • Port health authorities are local authority environmental health departments
  • have powers to control the public health aspects of port activity involving ships, international trains and aircraft
  • each port health authority appoints port health officers and port medical officers
70
Q

Give 5 functions of port health authorities

A
  1. Prevent importation of disease eg visit and inspect aircraft
  2. Rodent control eg inspect ships for rodents
  3. Imported food eg inspection and clearance of products of animal origin
  4. Food premises inspection eg inspect in flight catering
  5. Animal health eg assist with rabies control
71
Q

What is the Port Medical Officer and what is their role

A
  • may act as the port medical inspector providing advice to immigration
  • refers to the port medical inspector for medical clearance for people intending to stay in the UK for more than 6 months or who are unwell on arrival
  • Persons with infectious diseases likely to endanger health of others in the UK may be refused entry
  • Unless entry is refused, details of results (ie CXR report) and any examination are passed to the consultant for communicable disease control in the UK proposed area of residence

FPH exam (29 decks)

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