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Y2 I&P > Health Protection > Flashcards

Health Protection Flashcards

1
Q

How does the Faculty of Public Health define public health?

A

the science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society

the public health approach is population based

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2
Q

What are the three domains of public health?

A
  1. health improvement
  2. health protection
  3. healthcare and public health
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3
Q

What are the factors involved in health improvement?

A
  • inequalities
  • education
  • housing
  • employment
  • family / community
  • lifestyles
  • surveillance and monitoring of specific diseases and risk factors
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4
Q

What are the factors involved in health protection?

A
  • infectious diseases
  • outbreaks
  • chemicals and poisons
  • radiation
  • emergency response
  • environmental health hazards
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5
Q

What are the factors involved in health care and public health?

A
  • clinical effectiveness
  • efficiency
  • service planning
  • audit and evaluation
  • clinical governance
  • equity
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6
Q

What 3 areas are covered under health protection?

A
  • communicable (infectious) diseases
  • emergency response
  • chemical hazards
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7
Q

What are the actions taken to acheive health protection?

Who carries this out?

A
  • interventions to reduce infection - exclusion, screening, immunisation
  • advice guidance and communication about risk
  • outbreak control and coordination
  • in England, the function is carried out by Public Health England
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8
Q

What is the aim of Public Health England?

A

to protect and improve the nation’s health and to address inequalities, working with national and local government, the NHS, industry, academia, the public and the voluntary and community sector

health protection is a specific directive of PHE with its own Medical Director

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9
Q

WHat is the structure of Public Health England like relating to health protection?

A

there are 8 PHE centres (outside London) who are the front doors of the organisation

each local centre director is a partner in the local public health system

the health protection agency is part of PHE

there are health protection teams located within the PHE centres

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10
Q

What is the primary concern of health protection teams?

What is their role?

A

health protection is a broad discipline for a collection of specialist skills

they provide specialist support to prevent and reduce the impact of infectious diseases, chemical and radiation hazards, and major emergencies

the primary concern is the risk of spread

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11
Q

What are the main activities carried out by health protection teams?

A
  • local disease surveillance
  • maintaining alert systems
  • investigating and managing health protection incidents and outbreaks
  • delivering and monitoring national action plans for infectious diseases at a local level
  • response to chemical and environmental hazards
  • food water and environmental lab will process food samples and environmental swabs
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12
Q

What do health protection teams do?

A

acute response:

  • response to individual cases
  • response to outbreaks and chemical incidents

programme work including surveillance:

  • tuberculosis and respiratory diseases
  • gastrointestinal diseases
  • vaccine preventable diseases
  • sexually transmitted infections
  • blood borne viruses
  • environmental hazards
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13
Q

What is meant by the statutory duty to report notifiable infections?

A
  • legal responsibility to notify rests with the doctor
  • notfications are made to the local Health Protection Team
  • laboratories are under legal obligation to inform Health Protection Teams of infections of public health importance
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14
Q

What are the stages involved in the pyramid of reporting disease?

A
  1. exposed to disease
  2. infected with disease
  3. seek medical attention
  4. clinical case
  5. clinical notifications / lab confirmations
  • any cases that we are aware of at any given time will only be a proportion of the true cases
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15
Q

What is the main purpose of receiving notifications for infectious diseases?

What are examples?

A

to enable prompt investigation, risk assessment and response to cases of infectious disease and contamination that present, or could present, a significant risk to human health

PHE aims to detect possible cases, outbreaks and epidemics of disease as rapidly as possible and faciliate necessary interventions

e.g. whooping cough, measles

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16
Q

What are the other reasons why notification of infectious diseases is important?

A
  • notifications of infectious diseases are monitored for trends
  • without the combinations of notification, syndromic surveillance and laboratory imports, we would have little idea as to epidemiology
  • in response to notification, action is taken
  • surveillance for sexually transmitted infections, GI infections, BBV and TB to monitor impact of public health activities
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17
Q

What diseases are included on the list of notifiable diseases?

A
  • acute encephalitis
  • anthrax
  • botulism
  • brucellosis
  • cholera
  • diptheria
  • food poisoning
  • leprosy
  • leptospirosis
  • malaria
  • measles
  • meningitis & meningococcal septicaemia
  • mumps
  • plague
  • rabies
  • rubella
  • scarlet fever
  • tetanus
  • tuberculosis
  • typhoid & paratyphoid fever
  • typhus
  • viral haemorrhagic fever
  • viral hepatitis
  • whooping cough
  • yellow fever
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18
Q

What are the 3 stages involved in the surveillance process?

A
  • surveillance
  • outbreak detection
  • epidemiological analysis (time / person / place)
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19
Q

How is whooping cough pertussis transmitted?

Who is at highest risk and how does it tend to present?

A
  • B. pertussis is exclusively human pathogen
  • transmission via close direct contact
  • clinical presentation varies with age
    • atypical / mild infection in older vaccinated individuals
    • unimmunised infants are at highest risk of complications & deaths
20
Q

What are the actions taken when surveillance detects cases of whooping cough pertussis?

A
  • vaccination is the most effective strategy to prevent severe disease, but does not offer lifelong protection
  • benefit of chemoprophylaxis in preventing secondary transmission is limitied to close prolonged contact
21
Q

What is involved in the primary course of pertussis vaccination?

A

three doses of a pertussis-containing product with an interval of one month between each dose given to infants

22
Q

How often does pertussis tend to peak?

What age group is affected the most?

A

there tends to be regular peaks every 3-4 years

the highest disease incidence is in infants <3 months of age

23
Q
A
24
Q

What are the main recent changes in the routine infant vaccination process regarding pertussis?

A
  • introduction of pre-school booster in 2001
  • use of acellular vaccine in 2004
  • the availability of serology testing allows diagnosis at a later stage of illness than PCR or culture, and has led to more pertussis being confirmed in adults
25
Q

What is shown by this graph about the number of deaths from whooping cough in infants?

A
  • the increase in infant cases resulted in more deaths in babies with pertussis than was seen in a decade (2012)
  • all cases were in babies who were <10 weeks at disease onset and too young to be fully protected by immunisation
26
Q

After the peak in pertussis deaths in infants in 2012, what action was taken?

A

the Department of Health introduced a temporary programme offering pertussis vaccination to pregnant women between 28-32 weeks gestation

27
Q

What is the current vaccination programme regarding pertussis that came in in 2016?

Why was this course of action taken?

A
  • maternal pertussis immunisation can take place from week 16 of pregnancy
  • vaccination programme extended to pregnant women post 20 weeks of pregnancy to provide protection to newborn babies until their own vaccination schedule begins
  • pregnant women mount a good immune response to pertussis vaccines, and this is a good method of transferring temporary immunity to the neonate
28
Q

What are the different mechanisms by which individuals contract communicable diseases?

A

direct:

  • faeco-oral - e.g. E. coli & Hepatitis A
  • direct contact - STIs, scabies

vector-borne:

  • e.g. malaria
  • vehicle-borne - viral, Hepatitis B

airborne:

  • respiratory - TB, legionella
29
Q

What public health measures are in place to control spread of communicable diseases?

A
  • clean water, sanitation and housing
  • access to healthcare services
  • diagnostics
  • health promotion and awareness raising
  • vaccination
  • and more…
30
Q

What is the purpose of vaccination to protect populations?

How effective is it?

A

vaccination is the single most effective medical intervention, second only to access to clean water as a public health intervention

  • it protects individuals & communities from serious infections
  • it is a proactive measure for well people
  • reflects NHS & professional quality
31
Q

What us the aim of vaccination from a public health perspective?

A

to reduce mortality and morbidity from vaccine preventable infections using vaccination strategy adapted to the epidemiology

32
Q

What is meant by the strategic and programmatic aim of vaccination?

A

strategic aim:

  • selective protection of the vulnerable
  • elimination (herd immunity)
  • eradication

programmatic aim:

  • prevent deaths
  • prevent infection
  • prevent transmission (secondary cases)
  • prevent clinical cases
33
Q

Where does information from the surveillance of foodborne outbreaks come from?

Why is this necessary?

A

information from the surveillance of foodborne disease outbreaks are provided on an annual basis to the European Food Safety Authority (EFSA)

for inclusion in the EU community summary reports on:

  • trends and sources of zoonoses
  • zoonotic agents
  • antimicrobial resistance
  • foodborne outbreaks
34
Q

Why is it important to protect populations from foodborne pathogens?

A

infectious intestinal disease (IID) is a common cause of illness in the community and results in a high burden of consultations to general practice

35
Q

What food pathogens are commonly associated with:

  • raw meat / poultry / eggs
  • burgers / mince
  • rice
  • gravy / stews
  • meat / meat products
  • soft cheese / pate
A
  • raw meat / poultry / eggs - Campylobacter / salmonella
  • burgers / mince - E. coli 0157
  • rice - Bacillus cereus
  • gravy / stews - Clostridium perfringens
  • meat & meat products - Staphylococcus aureus
  • soft cheese / pate - Listeria
36
Q

What is the difference between foodborne infection and foodborne intoxication?

A

foodborne infection:

  • the organism in ingested food invades and multiplies in the intestinal lining

OR

  • the organism in ingested food invades, multiplies and produces a toxin while in the intestinal tract

foodborne intoxication:

  • organism produces a toxin in food that is subsequently ingested
37
Q

How are most foodborne illnesses transmitted?

How does this happen?

A

most foodborne illness occurs through faecal-oral transmission

  • non-contaminated product may become contaminated when handled by an infected food handler
  • because many pathogens are excreted into the faeces, infected persons not only experience illness themselves but may be sources of infection to others
38
Q

What are the signs and symptoms of foodborne illness?

A

signs and symptoms of foodborne illness range from mild gastrointestinal discomfort to severe symptoms

most common are vomiting, abdominal cramps and diarrhoea

39
Q

What is tuberculosis?

How is it transmitted?

A

a bacterial infection caused by Mycobacterium tuberculosis

it is transmitted via droplet transmission over 8 hours

40
Q

What are the main symptoms of tuberculosis?

A

it typically affects the lungs, but is also extrapulmonary

  • cough
  • haemoptysis
  • fatigue
  • fever
  • night sweats
  • weight loss
41
Q

When someone is infected with TB, what is the chance they will have an active infection?

A
  • after exposure to TB, 20% of individuals are infected
  • 5-10% of these have active disease
  • 90-95% have a latent TB infection, which has a 5-10% chance of becoming active at some point if it is not treated
42
Q

What is the ideal scenario when it comes to treating TB?

What happens if it is not treated?

A
  • early identification
  • early treatment
  • good adherence
  • cure

if left untreated, a person with active pulmonary TB can infect up to 15 people per year

43
Q

What are the diagnostic tests for active TB disease and latent infection?

A

diagnostic tests for active TB:

  • chest X-ray / other imaging
  • sputum smear microscopy (smear +ve/-ve, AFB +ve/-ve)
  • culture and histology
  • rapid molecular tests

tests for latent infection:

  • tuberculin skin test (PPD / Mantoux)
  • interferon - gamma release assays (IGRA)
    • ​Quantiferon Gold / T-spot
44
Q

Who is offered TB screening once a case is identified?

What is the purpose of screening?

A

once a case of active TB is identified, screening is offered to close contacts

the purpose of screening is:

  • look for potential source
  • find other active cases and offer them treatment
  • find other latent cases and offer them treatment
45
Q

What are the social risk factors for TB?

How has this changed recently and what are the associated risks?

A

from 2014 to 2018 the proportion of people with TB who had a social risk factor has increased

  • being in prison
  • injecting drugs and alcohol
  • sleeping rough

people with social risk factors are:

  • 1.5 x more likely to die
  • 1.5 x more likely to have infectious TB
46
Q

What are the key public health measures in place to support TB control?

A
  • improve access and diagnosis
  • quality diagnostics
  • quality treatment and care
  • contact tracing
  • vaccination
  • reduce drug resistance
  • tackle TB in underserved populations
  • latent TB screening
  • surveillance and monitoring
  • workforce strategy

Y2 I&P (14 decks)

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