Epidemiology of selected communicable diseases

Question 1

what is the minimal time period required for a country to receive a certificate of elimination ?

Answer 1

3 consecutive years

Question 2

what two diseases have been eradicated globally ?

Answer 2

small pox

rinderpest

Question 3

what is the causative agent of tetanus ?

Answer 3

clostridium tetani

anaerobic gram positive bacilli

Question 4

what is the main reservoir of tetanus ?

Answer 4

soil

Question 5

what are the toxins produced by tetanus ?

Answer 5

tetanospasmin and tetanolysin

Question 6

which toxin of tetanus causes clinical manifestations of tetanus ?

Answer 6

tetanospasmin (neurotoxin)

Question 7

what is the mode of transmission of tetanus ?

Answer 7

must pass through the skin barrier “ no wound no tetanus”

Question 8

what are the presenting symptoms of tetanus ?

Answer 8

neurologic which start with headache, muscle stiffness in jaw and difficulty swallowing

Question 9

what type of individuals are more prone to getting tetanus ?

Answer 9

disease almost exclusively happens in unvaccinated individuals

Question 10

which countries have a higher rate of tetanus ?

Answer 10

developing and under developed countries

Question 11

what prevention protocol is followed for infants and children for tetanus?

Answer 11

1. infants at 2, 4, 6 months are given PENTA vaccine
2. at 18 months a booster dose of DPT vaccine is given
3. at school in the 4th year primary grade (Td)
4. after 10 years a third dose of TT vaccine is given

Question 12

what prevention protocol should be followed for prevention of tetanus during pregnancy if not previously immunized ?

Answer 12

1. first dose at 6 months
2. second dose at 7 months
   must be at least 2 weeks before delivery
3. 3rd dose after 6-12 months or in subsequent pregnancy
4. 4th and 5th dose each after one year

Question 13

what is the prevention protocol that should be followed for a previously immunized pregnant woman for rabies ?

Answer 13

1. 2 doses given after the first trimester

2. 3rd dose given after 6-12 months or in the next pregnancy

Question 14

what is the prevention protocol in adults who are not immunized for tetanus ?

Answer 14

monovalent vaccine tetanus toxoid is given to :

soliders , sewage workers, farmers and gardeners

Question 15

what does the monovalent vaccine tetanus toxoid include ?

Answer 15

primary course consists of two doses one month apart

the third dose is given after 6-12 months

Question 16

if the adult is previously immunised for tetanus what is the best protocol ?

Answer 16

one booster dose is given every 10 years

Question 17

what is the post exposure prophylaxis wound management for tetanus prevention if the patient is completely immunized ?

Answer 17

if it is an uninfected wound :

• less than 10 years from last dose then nothing should be done
• if more than 10 years from last dose then a booster dose should be given

Question 18

when can we consider an individual to be immunized from tetanus ?

Answer 18

if 2 out of the 5 doses has been taken

Question 19

if there is a tetanus prone contaminated wound in an immunized individual what is the best next step ?

Answer 19

less than 5 years from last dose , then nothing should be done
if it has been more than 5 years: Td vaccine should be taken

Question 20

if a patient with a wound comes in with incomplete tetanus vaccination what is the next best step in management ?

Answer 20

1. if it is a clean wound : give the age appropriate vaccine along with antibiotics
2. if it is a contaminated wound then : age appropriate vaccination should be started along with passive immunization (TIG) along with antibiotics ( give immunoglobulins)

Question 21

how do you immediately care for a case of tetanus ?

Answer 21

immediate treatment with human tetanus immune globulin (TIG)

Question 22

how is the rabies virus transmitted ?

Answer 22

through direct contact with saliva or brain and NS tissue from an infected animal

Question 23

what is the most common way to get rabies ?

Answer 23

bite of a rabid animal

Question 24

what are the symptoms associated with rabies infection ?

Answer 24

excitement
excessive salivation
hydrophobia

Question 25

which age group is highly associated with rabies ?

Answer 25

age group of under 15

Question 26

what is the most cost effective strategy for preventing rabies in people ?

Answer 26

vaccinating dogs

Question 27

what are the two vaccines for rabies ?

Answer 27

1. human diploid cell vaccine (HDCV) | 2. rabies vaccine adsorbed (RVA)

Question 28

how many doses are meant to be taken for each vaccine ?

Answer 28

each vaccine is associated with 5 doses

Question 29

what is the post exposure management of a human bitten by an animal ?

Answer 29

1. cleansing the wound 2. wound should not be sutured immediately 3. tetanus prophylaxis and antibiotics may be indicated 4. rabies immunoglobulin of human origin 5. vaccination

Question 30

how is the rabies immunoglobulin dose divided ?

Answer 30

half the dose is given through infiltration of the wound and the other half given IM

Question 31

what is the protocol for post exposure prophylaxis for rabies for non immunised individuals?

Answer 31

``` the first dose is given as soon as possible after the bite day 0 day 3 day 14 day 28 ```

Question 32

what is the post exposure prophylaxis for those who have been previously vaccinated for rabies?

Answer 32

given 2 doses on days 0 and 3

Question 33

what are the contraindications for post-exposure rabies vaccination ?

Answer 33

pregnancy and infancy are not contraindications

Question 34

what are the different categories of contact with suspect rabid animals ?

Answer 34

category 1 - touching or feeding animals, licks on intact skin category 2- nibbing of uncovered skin, minor scratches or abrasions without bleeding category 3 - single or multiple transdermal bites or scratches , contact with bats

Question 35

what is the best post exposure prophylaxis that should be applied for category 1 patients ?

Answer 35

none

Question 36

what is the best post exposure prophylaxis for category II patients ?

Answer 36

immediate vaccination and local treatment of the wound

Question 37

what is the best post exposure prophylaxis for category 3 patients ?

Answer 37

immediate vaccination n administration of rabies immunoglobulins local treatment of the wound

Question 38

what is the reservoir of the polio virus ?

Answer 38

man is the only reservoir

Question 39

how does the transmission of poliomyelitis occur ?

Answer 39

direct droplet infection n | faeco-oral infection

Question 40

what are the three different presentations of polio virus ?

Answer 40

1. inapparent infection 2. clinical poliomyelitis abortive polio (minor illness) 3. involvement of the CNS (major illness)

Question 41

what are the two forms of polio which involves the CNS ?

Answer 41

non-paralytic | paralytic polio

Question 42

which clinical presentation of polio is associated with acquired immunity ?

Answer 42

inapparent infection

Question 43

what are the presenting symptoms of non paralytic polio ?

Answer 43

stiffness and pain in the neck and the back , recovery is rapid

Question 44

what is the presentation of paralytic polio ?

Answer 44

involves destruction of the motor cells but not the sensory nerve cells

Question 45

what is the cure for polio ?

Answer 45

there is no cure but it can only be prevented

Question 46

when should polio vaccination be administered ?

Answer 46

``` IPV should be given at : 2 months 4 months 6 months 18 months 4 through 6 years ```

Question 47

what is the minimum interval between doses of the polio vaccine ?

Answer 47

4 weeks

Question 48

what is the minimum age for dose 1 of polio ?

Answer 48

6 weeks

Question 49

when should OPV be given ?

Answer 49

``` at 2 months 4 months 6 months 9 months 12 months 18 months ```

Question 50

why is it important to include OPV to IPV ?

Answer 50

OPV provides mucosal immunity and is required to stop person to person spread

Question 51

what is the difference between the terms eradication and endgame ?

Answer 51

eradication refers to the wild virus whilst endgame refers to management of VDPVs and VAPP