Lectures Flashcards
1
Q
Define outbreak
A
2 or more cases of a disease that are linked OR occurrence of a disease not expected in the area
2
Q
define common source outbreak
A
when a group of persons have been exposed to a common source of an infectious agent or toxin
3
Q
define point source outbreak
A
when the exposure to an infectious agent or toxin has occurred over a brief period of time
4
Q
define propagated outbreak
A
when an outbreak is gradually spreading from person to person
5
Q
define endemic
A
persistent level of disease occurrence
6
Q
define sporadic
A
irregular pattern of occurrence
7
Q
define epidemic
A
occurrence within an area in excess of what is expected for a given time period
8
Q
define pandemic
A
epidemic widespread over several countries
9
Q
what are the stages in a chain of infection?
A
agent - mode of transmission - portal of entry - host - person to person spread - reservoir - portal of exit - agent
10
Q
define prevalence
A
number of existing cases at a given point in time in a defined population at risk
11
Q
define incidence
A
number of new cases occurring over a given time period in a defined population at risk
12
Q
define infectious dose
A
the quantity of micro-organisms needed to produce infection in the host
13
Q
define infectivity
A
the proportion of exposed persons who become infected
14
Q
define pathogenicity
A
the proportion of infected persons who develop the disease
15
Q
define virulence
A
the proportion of persons who develop disease who become severely ill or die
16
Q
odds ratio - if event is rare, odds ratio and risk ratio are…
A
similar
17
Q
which studies do we use to calculate odds ratios?
A
case control
18
Q
process of surveillance
A
collect data - analyse - interpret - respond
19
Q
examples of data sources
A
reports from clinicians, lab reports, screening, primary care reporting, death certification, surveillance units, enhanced surveillance and international surveillance
20
Q
what is surveillance?
A
systemic ongoing data collection using already available data (so cost efficient)
Uses time, person and place to detect change and gather timely feedback for action
21
Q
what are the possible reasons for a change in surveillance data?
A
reflects a true change in disease incidence - it is an outbreak or seasonal variation
spurious/artefactual -e.g. failure to notify or incorrect recording
change in diagnostic method
change in attention of observer
change in observer
random variation
22
Q
why do you use surveillance?
A
detect new diseases
monitor and evaluate preventative and control measures
aid prioritisation decisions
costing studies
aetiological clues
detect changes in a disease - outbreak detection, forecasting
track changes in a disease - extent and severity, risk factors, allows development of intervention
23
Q
different types of surveillance
A
enhanced surveillance
active surveillance
passive surveillance
sentinel surveillance
24
Q
what is enhanced surveillance?
A
form of active surveillance, limited to a specific area, time period or disease type
surveillance of disease, determinants of disease and of animal and bird reservoirs
25
what is active surveillance?
used in situations when completeness of reporting required - requires negative reporting from sources.
for rare conditions, contagious diseases (ebola, SARS), monitoring of vaccine failure, where goal is eradication of disease, where there needs to be a public health intervention
quality of data better
26
what is passive surveillance?
most surveillance systems are like this
routine lab or clinician notifications.
degree of incompleteness, inaccuracy and timeliness
27
what is sentinel surveillance?
type of sample surveillance e.g. gp practices
| works best for common diseases but more likely to miss rare diseases
28
does surveillance measure incidence?
rarely - measures a proxy measure
29
if there is an outbreak of a disease e.g. measles how do you manage it?
monitor - confirmed cases of measles, vaccine ordering and supply information, vaccination status of children on GP registers, continue routine MMR coverage collection
identify unvaccinated children
provide accessible services
long term sustainability
30
how do you identify unvaccinated children?
child health information systems
GP registers
letters and flyers through school system
31
How do you provide accessible services for vaccination?
routine/additional clinics in GP
school based clinics
community based clinics
32
How do you maintain long term sustainability if there is an outbreak?
have a system in place to check MMR status at all opportunities
plans to tackle under served communities with low coverage
33
```
what is cryptosporidium
what does it cause
peak age incidence?
clinical manifestation?
who gets chronic cryptosporidiosis?
transmission?
management?
```
intracellular parasite
commonest cause of non viral diarrhoea
1-5 years
self limiting in most, water diseases lasting 2-4 days, abdominal cramps, fever, vomiting, anorexia
immunodeficient individuals and those with AIDS
waterborne - oocysts resistant to standard chlorination, unboiled tap water, swimming pools - faeco-oral as in lamb and calf diarrhoea run off water contained and reservoir for infection in GI tract of humans and in manure fertilisers
enteric precautions - exclusion until 48 hours after first normal stool, avoid using swimming pools for two weeks after first normal stool, immunocompromised should boil drinking water
34
If water standard is breached, what do you need to do?
water supply regulations - water companies carry out risk assessments, treat water, monitor it and continuous sampling and daily analysis
35
what information is required if water standard breached?
when and where was sample taken?
no. of oocysts detected per 10L and results of any viability testing
source of affected water
how was water treated?
distribution area of water supply
any problems with supply
any recent changes in treatment or source of water
how fast water travels though the distribution area
history of sampling or previous outbreaks
36
what is the role of the health protection directorate?
to protect the community against infectious diseases and other dangers to health
37
how to action cryptosporidium outbreak
give advice to special groups
enhance surveillance for human cases
request alternaive source of water
boil water notice
38
what is the global outbreak alert and response network
technical collaboration for rapid identification, confirmation and response to outbreaks of international importance
39
define infection
the process by which a pathogen overcomes the body's defences and damages tissue either by their invasion, growth or production of toxins
40
define specific immunity
only effective against the same type of infection
41
define acquired immunity
immunity gained after infection
42
role of serology
to test for antibodies to a particular microbe. so if there is ongoing infection and the body has produced antibodies, test will show this up. Can also detect antibodies produced to previous immunisation or infection.
43
role of PCR
process by which you try to multiply microbial DNA.
44
different types of vaccine
attenuated live vaccine - strains of microbe that are less virulent - BCG, oral polio, measles, yellow fever
killed vaccines - vaccines containing killed bacteria - tyhpod fever, whooping cough
certain diseases due to the effects of toxins (tetanus and diphtheria). toxins made non poisonous (toxoids)
45
how do macrolides work and examples
work by inhibiting protein synthesis
| erythromycin
46
how do tetracyclines work and examples
inhibit protein synthesis
| tetracycline, doxycycline
47
how do quinolones work and examples
block DNA synthesis by inhibiting one of the enzymes needed
| ciprofloxacin
48
how do trimethoprim work and examples
inhibits the biosynthesis of folic acid and therefore affects cells metabolism
implications for pregnancy (folic acid and neural tube defects)
49
examples of beta lactam antibiotics
penicillin
| cephalosporins
50
how does penicillin work and examples
inhibits the formation of the bacterial cell wall
| amoxicillin, penicillin V, ben pen
51
how do cephalosporins work and examples
inhibit formation of bacterial cell wall
treat a broad range of bacterial infections
cefotaxime and cefixime
52
initial steps in outbreak management
find out that you have a problem
characterise and describe problem
carry out risk assessment of problem
put measures in place to control the outbreak and to prevent more cases
53
examples of formal local surveillance
routine: notifications, lab reports - limited range of disease, delayed and frequently absent
enhanced: targeted, prospective - accurate, good data leads to good epidemiology, labour intensive
54
examples of informal local surveillance
anecdotes
| useful for point source outbreaks
55
what information do we need when describing a problem?
do we have an organism
is this a clinical or microbiological diagnosis
do we have an outbreak
how many cases
are they associated
is there evidence of a point source
is there evidence of person to person spread
56
Descriptive epidemiology requires?
person - age, sex, residence, occupation, habits, state of health immunocompetence
place - family, workplace, institution, community, city
time - hours, days, weeks, months, years
purpose - causative agent of disease, likely source, who is likely to be at risk, what exposure and risk factors predispose to disease, how to prevent more cases
57
who is part of incident management team
```
health protection specialists
infectious disease physicians
microbiologist
environmental health officers
lab staff
health authority/commissioners
regional and national experts
```
58
why do we need an incident management team
```
assess what we know so far
assess what we still don't know
decide how to find out what we don't know
decide who will do the finding
determine control strategies
management communication issue
manage media issues
determine resources needed
evaluate control measures taken
to declare the outbreak over
to undertake a structured debrief
to report to the board
```
59
steps if outbreak of communicable disease
undertake active surveillance
alert local clinicians and other relevant stakeholders
encourage sampling to identify cases
alert regional contacts
alert national and international contacts as required
investigate source - send in local authority etc, sample widely, observe and document.
identify 'at risk' groups
identify common factors in the cases - questionnaire
generate or review hypothesis
CASE CONTROL to test hypothesis
60
steps to prevent further cases of communicable disease
kill or inactivate agent at source - antibiotics, decontamination, disinfection, sterilisation, heat treatment
protect the host - isolation, immunisation, chemoprophylaxis
interrupt pathway of transmission - isolation, environmental hygiene, personal hygiene, personal protective equipment
61
for infections generating permanent immunity, individuals are in one of three states:
susceptible to infection
infected and infectious
recovered and immune
62
what is the reproduction ratio?
the average number of secondary infections caused by a single typical infectious individual over their lifetime into a completely susceptible population
63
what is herd immunity?
the fact that a population is protected when not everyone is immune
64
difference between deterministic and stochastic generally?
Stochastic models possess some inherent randomness. The same set of parameter values and initial conditions will lead to an ensemble of different outputs. In deterministic models, the output of the model is fully determined by the parameter values and the initial conditions.
65
difference between deterministic and stochastic in terms of answers, how many runs, chance and numbers needed?
Deterministic: same answer each time, 1 run needed, no accounting for probability, not applicable to small numbers
Stochastic: different answer each time, many runs needed to build up picture of outcomes, includes variability from chance, can be applied to small populations
66
what is the generation time?
the mean time interval between an individual's infection and the onward infections that they cause
67
what is meningitis?
inflammation of the meninges covering the brain and spinal cord
68
causes of meningitis
mumps, enteroviruses, coxsackie
meningococcus, pneumococcus (strep pneumonia, h. influenza)
medication, drugs, toxins
autoimmune - SLE
radiation, cancers, fungal and parasitic infections
69
meningococcal disease is caused by...
neisseria meningitides
70
two main manifestations of meningococcal disease
meningitis
| septicaemia
71
neisseria meningitides:
reservoir
transmission
incubation period
humans
respiratory droplets/naso-pharyngeal secretions
2-10 days, usually 3-4 days
72
symptoms of meningococcal meningitis
```
headache
fever
vomiting
photophobia
neck stiffness
confusion
drowsiness/loss of consciousness
```
73
gram negative diplococci with polysaccharide capsule - what is it?
neisseria meningitides
74
symptoms of meningococcal septicaemia
```
cold hands and feet
circulatory collapse
pale, blotchy, mottled skin
muscle or joint pains
petechial, non blanching rash, becomes purpuric
```
75
complications of meningococcal disease
```
mortality - higher in septicaemia
blindness
deafness
brain damage
amputations (arterial occlusions leading to gangrene of extremities)
```
76
investigations for meningococcal disease
```
blood culture
LP
throat swab
rash aspirate
PCR
serology
FBC
CRP
GOLD: culture germ from a normally sterile site (CSF, blood, joint fluid)
Antigen detection
```
77
define confirmed case and do you report with meningococcal disease
clinical diagnosis with lab confirmation - REPORT
78
define probable case and do you report with meningococcal disease
clinical case with no lab confirmation but most likely - REPORT
79
define possible case and do you report with meningococcal disease
no lab confirmation and other diagnosis equally likely - no immediate action
80
what time of the year do you suspect meningococcal disease in northern hemisphere?
october to may
81
define cluster outbreak
two cases of same type within 4 weeks
82
how to action a cluster outbreak
```
depends on:
attack rate
isolation of the same organism
establishing link between cases
public anxiety
if in community look for links, define at risk population and calculate age specific attack rates
```
83
further public health action is there is an outbreak
```
contact school/nursery/university
standard letter warning and informing
customised letter if unusual circumstances e.g. death
offer leaflets
offer information/support/helpline
media handling
```
84
who are close contacts?
close contacts living in same household, anyone who has slept in same household in previous 7 days, if case stayed overnight elsewhere in last 7 days, intimate kissing contacts in last 7 days
85
what do you give close contacts in meningococcal disease?
antibiotics to eradicate throat carriage - ciprofloxacin, rifampicin, ceftriaxone
offer prophylaxis to household contacts up to 4 weeks after case became ill
prophylaxis for meningococcal conjunctivitis
offer vaccine to unvaccinated close contacts within one week
86
different vaccines for meningitis
men A+C polysaccharide - africa
men c conjugate in childhood schedule
men ACWY
polysaccharide only give 3-5 years protection.
87
why do you give conjugate vaccine instead of polysaccharide in less than 2 years?
evokes immune response
88
how to manage an individual case of meningococcal disease
confirm diagnosis of infection - samples for culture
characterise the pathogen - PCR, antigen detection or serology
identify source of infection
identify who else may be at risk
raise awareness and warn others at risk
89
epidemic of meningitis in subsaharan africa - group A+C
causes
who is affected
current WHO strategy
dry season laden winds, URTI due to cold nights, decrease in local immunity in pharynx, overcrowded housing, large population displacements due to pilgrimages, her immunity leads to cyclical epidemics
children, teenagers and young adults
presumptive treatment approach
90
examples of viral GI infections
rotavirus, norovirus, hep A , hep E
91
examples of bacterial GI infections
campylobacteriosis, salmonellosis, VTEC (e.coli), typhoid, cholera, listeriosis, botulism
92
examples of parasitic GI infections
cryptosporidiasis, giardiasis, amoebiasis, worms
93
list different categories of at risk groups
Group A: any person of doubtful personal hygiene or with unsatisfactory toilet hand washing or hand drying facilities at home, work or school
Group B: all children aged 5 years or under
Group C: people whose work involved preparing or serving unwrapped foods to be served raw or not subjected to further heating
Group D: clinical, social care or nursing staff who work with young children, the elderly or any other particularly vulnerable persons
94
```
Vertocytotoxin producing escherichia coli (0157)
how can it be eliminated
where can it be acquired from
environment/transmission
risk groups
symptoms
investigations
```
cooking meat to a high temperature
drinking raw milk, contaminated swimming pools etc
faeco-orally transmitted - contaminated water/food, direct contact with animals, secondary from infectious case, occupational exposure, high risk settings (nursery, farm, petting farm)
people under 5, older people
incubation 2-4 days (min 6 hours and max 10 days), bloody diarrhoea, cramps, self limiting
small % of children get haemolytic uraemic syndrome
stool sample: culture (0157 does not ferment sorbitol), toxins, genotyping
95
If you think outbreak of E.coli what do you need to know?
```
potential exposures
incubation period
date of onset
clinical presentation
severity
duration of illness
```
96
if e.coli as a medical practitioner you need to notify..
individual cases of notifiable disease
| the proper officer of the local authority
97
treatment for e.coli
hydration
anti-pyretics
watch out for HUS
98
to prevent spread of e. coli what do you do?
provide information leaflet
advise on personal hygiene
provide advice on food hygiene and environmental cleaning
assess whether case is in at risk group
ensure faecal specimens from: all suspected cases, all contact in risk groups, symptomatic contacts not in risk groups
warn contacts to watch our for symptoms
exclude for 48 hours after becoming symptom free, until microbiological clearance (if in at risk group)
99
who is in an outbreak control team?
from your organisation, PHE: yourself CCDC, nurse, epidemiologist and communication officer, microbiologist from food water environment lab
from council: public health specialist, environmental health professionals
microbiologist from hospital
100
what would be your initial concerns if you suspect outbreak of e. coli and what would you do?
collect information on source, contacts, common exposure contacts
advice about toilet and cooking hygiene
exclude for 48 hours after symptom free, if at risk groups need microbiological clearance.
101
describe point source outbreak
source has infected cases at one particular geographical location, during a short period of time. (single point in time and place). bell shaped curve which increases sharply, peaks and then declines sharply which reflects the normal distribution of the incubation period of the causative agent in humans.
102
describe propagated outbreak
when an infectious disease is communicable then we can no longer consider a single common source.
the single source is propagated within the population through human contact patterns. the shape of the curve varies.
103
describe continuing source outbreak
when all cases in an outbreak have been infected by the same source over a prolonged period of time. for example leptospirosis in a recreational lake - causes an epidemic curve that doesn't increase sharply but reaches a plateau
104
what does an epidemiological curve look like in person to person spread?
multiple peaks as wave after wave spreads through population. cases in one peak may be sources for cases in subsequent peak.
105
legionellosis:
caused by?
particles generated by...
main cause
legionella pneumophila
aerosol containing bacteria - running taps, showers, fountains, humidifiers, spa pools, whirlpool baths, evaporative condensers
hotel/cruise breaks
106
symptoms of legionellosis
```
incubation period 2-10 days (normally 5-6)
flu like illness
muscle aches
tiredness
headache
dry cough
fever
pneumonia
multi organ failure
```
107
diagnosis of legionellosis
detect urinary antigen - culture gold standard!
108
treatment of legionellosis
antibiotics and intensive care
109
is legionellosis a notifiable disease?
no but health protection teams need to know as environmental issue. european network monitors travel associated cases.
110
prevention of legionellosis?
building code of practice for the control of legionella in water supplies
good plumbing techniques
maintain water temp above 55 degrees
regular flushing and disinfection
adequate cleaning and chlorination
outbreak in 2002 barrow in furness, 180 cases and 7 deaths
111
what causes severe acute respiratory syndrome?
when did it first occur?
incubation period
SARS coronavirus
november 2002
2-7 days
112
symptoms of SARS
```
high fever
cough
shortness of breath
CXR: pneumonia or respiratory distress syndrome
myalgia
diarrhoea
```
113
case fatality rate of SARS is higher in which age group?
65+ years
114
control measures for SARS
surveillance
isolation
quarantine
115
what lessons have been learnt about SARS
```
vulnerability of health care workers
dangers of rapid international travel
difficulty controlling a disease you don't know how it spreads
value and limitations of PPE
importance of international links
value of WHO global response network
need for openness in a global outbreak
```
116
```
pneumococcal infection:
what is it caused by
what serious disease does it cause?
what less serious disease does it cause?
most common in?
```
strep pneumonia
meningitis, septicaemia, severe pneumonia (invasive pneumococcal disease)
>50% of otitis media in children, milder pneumonia and bronchitis
babies and children <2 years old, over 65 years, younger age groups with concurrent medical conditions
117
risk factors for pneumococcal infection
physiological - young and elderly
non immune defects - decreased vascular perfusion (sickle cell, heart failure), skull fracture, damaged lung tissue, inhalation/aspiration
immunological defects - antibody deficiencies, hyposplenism
factors impairing lung clearance of pathogens - hyperaemia, acidosis, alcohol, toxic inhalations, pulmonary oedema, uraemia, malnutrition, steroids, immunosuppressive agents, viral infection, mechanical obstruction
118
treatment of pneumococcal infection
antibiotics (resistant to penicillin and other beta lactams (erythromycin and trimethoprim).
not resistant to cephalosporins
119
PCV vaccination: what we have learnt
large herd immunity effect in adults
less marked for meningitis
magnitude of replacement disease small in elderly
replacement substantial in HIV+ adults
giving PCV 7 to children is an effective way of preventing disease in adults
120
```
respiratory syncytial virus:
major cause of what in infants?
how does it spread?
how long does it survive for?
incubation period
```
bronchiolitis
large droplet and secretion
survives on hard surfaces for 4-7 hours
incubation period 3-5 days
121
respiratory syncytial virus: epidemiology
sharp winter peaks
starts nov-dec
lasts 4-5 months
122
respiratory syncytial virus: highest risk of severe disease in...
babies <6 months
premature babies
babies with underlying chronic lung disease
123
respiratory syncytial virus: symptoms
```
rhinitis
cough
fever
ear infection
croup
```
124
respiratory syncytial virus: management
no vaccine or specific treatment.
ribavirin in severe cases
palivizumab - prevent serious LRTI in high risk infants
125
what are the key antigens in influenza virus?
haemagglutinin (15 subtypes) - virus binding and entry to cells
neuraminidase (9 subtypes) - cuts newly formed virus from infected cells.
M2 ion channel
ribonucleoprotein
126
why do we need to produce a new vaccine every year?
because genome segmented, gene re-assortment can occur in infections.
gene swappingg can occur during co-infection with human and avian flu virus
prone to mutation
antigenic drift
antigenic shift
127
what is antigenic drift
minor antigenic variation causes seasonal epidemics
128
what is antigenic shift
gene re-assortment and major antigenic variation may be associated with pandemics
129
main influenza strains in humans
A and B
130
how is influenza transmitted?
aerosols from coughs and sneezes
131
what is R0?
the number of secondary cases you would expect in a totally susceptible population
132
symptoms of influenza
```
upper/lower respiratory tract symptoms
fever
headache
myalgia
weakness
```
133
complications of influenza
bacterial pneumonia
134
which underlying medical conditions could increase mortality from influenza
```
chronic cardiac and pulmonary diseases
old age
chronic metabolic diseases
chronic renal disease
immunosuppressed
```
135
treatment options for influenza
oxygenation
hydration/nutrition
maintain homeostasis
prevent/treat secondary infections
136
when does influenza normally occur?
in winter months and peaks between dec and march in northern hemisphere
137
who tends to get annual flu vaccination
at risk groups and children
138
what happens to cause pandemic flu
| complications
virus mutates markedly (antigenic shift) and large proportion of population susceptive
high morbidity, excess mortality, social and economic disruption
139
in pandemic flu, what is the incubation period and how long are people infectious for? how long does it take before vaccine available?
incubation period 1-4 days
infectious from onset of symptoms to 4-5 days after
4-6 months before vaccine available
140
what increases pandemics?
more travel
more people
intensive farming
but... better nutrition, better supportive care, vaccination, antivirals
141
how to control avian fly (H1N1)
```
cull affected birds
biosecurity and quarantine
disinfecting farms
control poultry movement
vaccinate workers with seasonal influenza vaccine
antivirals for poultry workers
personal protective equipment
reduce chance of co-infection
```
142
prior to pandemic of swine flu what was done
```
international surveillance
vaccine research
stock piling of drugs
plans written - strategic
preparation of information for public and professionals
```
143
what to do in containment and treatment phase of pandemic
containment - identify cases, treat cases, contact tracing, large scale prophylaxis
treatment - treat cases only, national flu pandemic service
144
infection control measures in pandemic
```
hand hygiene
cough etiquette
universal precautions and PPE(mask, apron, gown, gloves)
surgical masks
segregation of patients
reduce social contact
flu surgeries
environmental cleaning
```
145
how to manage cases of flu pandemic
call centres
non medical staff manage cases according to algorithm
patient or relative collects antivirals
home delivery of antivirals
clinical staff free to treat high risk and severely ill
hospital admission criteria
146
issues of antivirals
what happens if virus develops resistance
what about side effects
who do we give them to
how do we distribute them
147
wider impact of pandemic influenza on health system
```
anxiety/unwilling to work
adequate protection
access to antivirals
risk to family
child care
segregation of staff
redeployment of staff
recycling of staff
organisations sharing staff
```
148
population wide interventions in pandemic of influenza
```
travel restrictions
restrictions on mass public gatherings
school closure
voluntary home isolation of known cases
screening of people entering UK ports
```
149
what are health care associated infections a result of
health care interventions such as medical or surgical or from being in contact with a healthcare setting
150
types of hospital acquired infection
```
pneumonia
primary bloodstream infection
UTI
surgical site infection
clostridium difficile
neonatal sepsis
```
151
do hospital acquired infections have higher or lower DALYS than influenza, TB and HIV?
HAIs have higher
152
how does antimicrobial resistance emerge in bacteria?
by naturally occurring pre-existing resistance mechanisms
by de novo mutations (spontaneous and random)
by horizontal transfer of mobile genetic elements
153
how may antibiotics promote AMR?
by exerting selective pressure
by facilitating transmission of resistant bacteria
by facilitating transmission of antibiotic resistance genes
154
what are carbapenemases?
enzymes that hydrolyse carbapenem antibiotics making the organism resistant
155
what are carbapenems
meropenem, imipenem, doripenem - last line of defence as they are the broadest spectrum available
156
risk factors for HAI
```
age
immune status
length of stay
invasive procedures
number of procedures
indwelling catheters
antibiotic treatment
poor standards of infection control
hospital throughput
```
157
how are HAIs spread
contaminated equipment, environment, food, healthcare workers, patients, visitors
158
what issues with the hospital setting could increase HAIs
```
status of other patients
availability of isolation rooms
staff to patient ratio
hand hygiene compliance
climate/high temperature/moisture
```
159
predictors of death for carbapenem resistance klebsiella pneumonia
```
advanced age
severity of illness
severe comorbidities
carbapenem resistance
inappropriate therapy
monotherapy
```
160
what is the clinical importance of Carbapenem-resistant Enterobacteriaceae
resistance is highly transmissible and fast evolving
potential of spread into the community
limited/sub optimal treatment options
high morbidity and mortality burden
161
the Antimicrobial resistance indicators include the following five domains:
```
Antimicrobial resistance
Antibiotic prescribing
Healthcare-associated infections
Infection prevention and control
Antimicrobial stewardship
```
162
the five year UK AMR strategy
1. Improvinginfectionpreventionandcontrolpractices
2. Optimisingprescribingpractices(stewardship)
3. Improvingprofessionaleducation,trainingandpublic engagement
4. Developingnewdrugs,treatmentsanddiagnostics
5. Better access to and use of surveillance data
6. Better identification of research needs
7. Strengthened international collaboration
163
PHE role in HAI
* Local Knowledge & Intelligence
* Local Health Protection Teams
* Local & National Surveillance data
* Access to Field Epidemiology Services
* Access to National Infection Services - Reference Laboratory, Typing Data WGS
* Gateway to National Expert Advice – AMR, AMS, IPC, Decontamination, ( Peer Support Visits) Behavioural change expertise
* Gateway to other Directorates in PHE – Chief Nurses Office, Knowledge & Intelligence, Behavioural Change, Evolving Pathogens, Research & Development, International & Global Health ,Heath Protection Research Units.
164
how can you determine if infection is community or hospital acquired?
within 48 hours of admission = community
| after 48 hours of admission = hospital
165
what are the target infections in HAI
```
SSIs – surgical site infections
Ventilator associated pneumonias
Gram negative sepsis in assisted care e.g. pseudomonas in SCBU MRSA bacteraemias
C difficile colitis
Other antibiotic resistant organisms
```
166
reasons why hospitals are good places for infections
```
Crowded open wards and bays Patients admitted with infections Staff make multiple patient contacts Invasive procedures
Personal care
Shared bathroom facilities
Open wounds
Body fluids
Visitors
Susceptible and vulnerable patients
```
167
risk of MRSA in which patients
newborns, elderly, IV drug users, patients undergoing surgery
168
what can MRSA cause
Skin infections, cellulitis Bacteraemia & septicaemia
| Septic arthritis, acute osteomyelitis Pneumonia
169
MRSA prevention
```
Handwashing, ‘Bare below the elbows’ Aseptic techniques Appropriate wound care
Use of PPE
Ward cleaning
Waste disposal Cleaning/sterilisation of equipment
Sound antibiotic use
Surveillance systems
Screening elective admissions
Decolonisation where necessary
Liaison between hospital and community
```
170
MRSA outbreak control measures
```
Investigate outbreaks
Confirm they are linked – lab tests for strain type Screen staff to detect carriers
Environmental investigation
Review clinical practice
Review infection control practice – HAND HYGIENE! Restrict/suspend admissions
Minimize staff and patient movement
Limit use of temporary agency staff
Limit visitors
Ward closure?
```
171
C diff management
Control antibiotic usage
Esp. Ampicillin, amoxicillin & cephalosporins
Standard infection control procedures Surveillance & case finding
Any patient with diarrhoea
Isolate
Enteric precautions
Test stool samples
Environmental cleaning
Treat cases with metronidazole or vancomycin
172
symptoms of norovirus
diarrhoea, nausea, cramps headache, fever, chills, myalgia
173
where does c diff occur?
Hospitals Care Homes Schools Cruise ships Families
174
what does the infection control team do in a hospital?
```
Carry out surveillance
Develop policies and procedures
Educate staff
Carry out audits
Provide advice e.g. on lay out of wards/buildings
```
175
what is the infection control strategy?
```
Hygiene e.g. handwashing
Antibiotic usage
Waste disposal
Manage outbreaks/incidents Decontamination, sterilization & disinfection Manage high risk patients or conditions Isolation facilities
Domestic cleaning, food preparation and laundry Staff immunisation
Sharps injuries & PEP
Transfer/discharge of patients
Pest control
```
176
key steps in tackling the CPE problem?
Sampling – risk assessment, who needs testing?
Laboratory testing methodology – 2 stage testing, setting standards
Isolation of high risk cases pending screening results
Frequency of re-testing
Information to patient
Once positive, always positive – marking records GP and hospital
Which antibiotics to treat – Fosfomycin, Colistin, Tigecycline, sometimes aminoglycosides
Contact tracing
No effective method of clearance
Very high standard of hygiene
177
how is TB spread?
aerosol drops - lung to lung
178
where does pulmonary TB tend to settle?
apex of lung - form a granuloma which then forms a cavity. expelled when patient coughs
179
symptoms of TB
```
cough
fever
weight loss
night sweats
dyspnoea
chest pain
```
180
clinical features of TB
```
positive tuberculin skin test
high temp
upper lobe disease on CXR
dyspnoea
crackles on chest exam
```
181
what can happen if tb not contained
becomes extra pulmonary - genitourinary, military, pleural, bone and joint
182
if HIV+ve what is lifetime risk of disease
50%
183
which neonates should receive BCG?
those born in an area with high incidence
have one or more parent or grandparent born in a high incidence country
have a family history of TB in last 5 years
184
why does BCG not work in some cases?
the role of environmental mycobacteria which are similar
blocking - pre existing immune responses to antigens common for the mycobacteria block the replication of BCG and therefore decrease vaccine take
masking - exposure to env. mycobacteria offers some level of MTB protection and BCG adds little additional protective benefit beyond this baseline level
185
what is DOTS
```
to control TB by combining prevention with care
direct sputum smear microscopy
observation of treatment
treatment monitoring
short course
```
186
investigation for TB
sputum exam - cough >3 weeks, if suspected, 3 sputum within 48 hours
culture - solid LJ slope, liquid culture MGIT
ziehl Nielsen stain - light microscopy
PCR
187
why do you monitor with TB treatment
for response and for adherence
188
what are the outcomes of TB treatment
```
cured
complete (smear -ve remains -ve)
died
failed (smear +ve stays +ve)
defaulted (misses treatment)
transferred out
```
189
problems with DOTS
```
passive case finding
diagnosis - 3 samples and journeys and lab requirements
observation - travel
failures and second line
implementation
```
190
causes of a false negative TST
```
inactive solution
not administered to raised blister
immunosuppression
malnutrition
recent viral illness
recent live virus
vaccination
```
191
causes of a false positive TST
read erythema not induration
previous BCG
exposure to environment mycoplasma
booster phenomenon
192
two tests for latent TB
tuberculin skin test
| interferon gamma release assays
193
how to treat latent tb
6 months of isoniazid or 3 months of rifampicin and isoniazid for people aged 16-35 not with HIV or older than 35 if treatment recommended
194
role of vaccinations
to protect selected high risk groups - influenza, pneumococcal
to contain an infection in population - tetanus, measles, diphtheria (herd immunity)
to eradicate an infectious disease - smallpox, polio
195
type of immunisation
active immunisation - stimulate immune system with an antigenic substance
passive immunisation - introduce antibodies from another immune person
196
types of vaccine
live unattenuated - original cowpox inoculations
live attenuated - MMR
killed whole organisms - injectable polio
disrupted toxin - tetanus toxoid
antigenic components from organisms - flu vaccine
manufactured virus like particles - human papilloma vaccine
197
what part does the host play in immunisation
| what factors affect it
must be susceptible to the disease
immunity - natural infection previously
age (babies - passive immunisation from breastfeeding IgA)
immunocompetence - immune deficiency syndromes, immunosuppressive treatments, steroids, intercurrent infection
198
what are the two steps in implementing new vaccination programmes?
decision making
| implementation
199
what is part of the decision making stage of implementing new vaccination programmes?
disease burden - no of cases, morbidity, mortality
is immunisation the best strategy for controlling disease?
what will be the net impact of introducing a new vaccine?
how well is our current immunisation programme working?
how much disease will be prevented?
what are the possible negative effects of the vaccine programme?
logistics of delivering vaccination
what additional resources will be needed?
impact on public perception
is the vaccine a good investment
200
what is part of the implementation stage of implementing new vaccination programmes?
who? (group with greatest mortality, window of opportunity for prevention, optimum effectiveness, vaccine efficacy)
how do you implement new programme?
when do you vaccinate?
201
What is WHO roles in vaccination strategy and policy?
makes recommendations for countries
| supports less able countries with vaccination strategy implementation
202
examples of international immunisation programmes
expanded programme on immunisation (EPI)
global polio eradication initiative
global alliance for vaccines and immunisation
203
expanded programme on immunisation:
aims
implementation strategies
eradicate polio, eliminate measles, eliminate neonatal tetanus, maintain zero diphtheria, prevent severe TB, reduce incidence of whooping cough, reduce incidence of bacterial meningitis due to h influenza
```
integrate vaccine with PHC services
expand vaccine coverage of eligible population
ensure regular supply of potent vaccines
strengthen cold chain
train health personnel
promote community participation
incorporate health education activities related to EPI
ensure logistic support
```
204
what are barriers to success in immunisation programmes
health systems and financial barriers - logistics, money, lack of cold chains, low motivation, inadequate staff
political barriers - management and leadership, priorities, corruption
geographical and socio-cultural barriers - hard to reach communities, knowledge and folk beliefs, workloads of mothers and lack of husband support
205
what is R
effective reproduction number - average number of secondary infections produced by a typical infective agent
206
R= R0 x s - what is s
the proportion susceptible in a homogeneously mixing population
207
what does R0 depend on
infectivity of organism
duration of infectiousness
mixing patterns of population
demographics
population density
208
what is R0
number of secondary infections produced by a typical infective agent in a totally susceptible population
does not fluctuate in short term
not affected by vaccination
property of infectious agent
209
what is herd immunity
offers indirect protection
| lowers the risk of infection of susceptible individuals because of the immunity of others
210
herd immunity provides ... protection to .... individual
indirect protection
| susceptible individuals
211
what is H
herd immunity threshold
H= 1-s
212
what is the vaccine efficacy equation
VE % = (attack rate unvaccinated) - (AR vaccinated) x 100
213
how does HIV spread?
sexual
blood
vertical
214
natural history of HIV
initial seroconversion illness within first 4 weeks
long asymptomatic phase of 2-15 years
symptomatic HIV - shingles, oral candida, skin disease
AIDS
215
important interactions of HIV with other infections
STIs - syphilis, HPV
tropical disease - leishmaniasis
hep B and C
TB
216
define low level epidemic
present in population for some years but no significant spread in any sub population
217
define concentrated epidemic
spread rapidly in defined sub population but remains at low level in general population
218
define generalised epidemic
firmly established in general population. disproportionate spread in high risk groups may occur
219
what surveillance would you do in a generalised epidemic
pregnant women attending sentinel ante natal clinics
| population based household surveys
220
what surveillance would you do in a low level epidemic
study key populations for estimates
221
risk factors for HIV
```
uncircumcised men
other STIs
female gender - education, domestic violence
IVDU
gay men
```
222
country with high HIV epidemic in Europe
Ukraine
223
how do STIs increase risk of HIV
urethritis cervicitis and genital ulcer disease
224
prevention and control of HIV
```
abstinence be faithful condom
education
voluntary counselling and testing
antiretroviral
male circumcision
STI control
vaccines
```
225
global strategies to deal with HIV epidemic
WHO 3 by 5
UNAIDS universal access campaign
UN millennium goal number 6
226
why is there no HIV vaccine
high genetic variability of HIV
absence of relevant and predictive animal models
difficulty implementing trials, eg in developing countries
227
impacts of HIV
```
illness
carers
workforce
orphans
discrimination
loss of income
costs
stigma
hospital services
TB
national budget
gender inequality
```
228
WHOs 5 key components that must be adhered to in HIV testing services
```
consent
confidentiality
counselling
correct test results
connection to prevention, care and treatment
```
229
how to address HIV testing gap
HIV testing service (HTS)
community testing (rapid diagnostic test)
linkage
appropriate targeting of key populations
230
how to prevent HIV
condoms (microbicidal gel, vaginal ring, male circumcision)
needle and syringe exchange
eliminate mother to child transmission
antiretroviral therapy
231
why are hospitals great places for infection?
```
crowded open wards and bays
patients admitted with infections
staff make multiple patient contacts
invasive procedures
personal care
shared bathroom facilities
open wounds
bodily fluids
visitors
susceptible and vulnerable patients
```
232
management of c diff
control antibiotic usage
stand infection control procedures
surveillance and case finding
any patient with diarrhoea: isolate, enteric precautions, test stool samples, environmental cleaning, treat with metronidazole/vancomycin
233
what hygiene measures can you use to prevent infections
```
handwashing
aseptic techniques
appropriate wound care
use of PPE
ward cleaning
waste disposal
cleaning/sterilisation to staff
training and feedback to staff
```
234
norovirus: infection control strategy
```
hygiene
antibiotic usage
waste disposal
manage outbreaks/incidents
decontamination, sterilisation
manage high risk patients or conditions
isolation facilities
domestic cleaning, food prep
staff immunisation
sharps injuries/PEP
transfer or discharge of patients
pest control
```
235
mode of transmission of norovirus
```
airborne
faeco-oral
bloodborne
sexual spread
vertical transmission
fomites/environment
person to person direct skin contact
naso-pharyngeal secretions
```
236
WHO clean care is safer care objectives
raise awareness of the impact of HCAI on patient safety
promote preventative strategies within countries
build commitment from countries to give priority to reducing HCAIs
test implementation of WHO guidelines on hand hygiene
integrated package of actions: clean products, practices, equipment, environment
237
how to tackle carbapenemese producing enterobacteriaceae
```
sampling
lab testing methodology (2 stages)
isolation of high risk cases
frequency of retesting
information to patient
which antibiotics to treat
contact tracing
```
238
how are hep A and E spread
faeco-oral
239
how are hep B and C spread
blood borne
240
hep b: where does it replicate?
how long does it survive on dried blood?
transmission?
human hepatocytes
7 days
percutaneous or mucosal contact with infectious blood or body fluids
241
hep B: people at higher risk
sex partners of infected person
individuals with high risk sexual practices
close family contacts
people who inject drugs
close family and sexual contacts who inject drugs
infants born to infected mothers
individuals at occupational risk
individuals receiving regular blood or blood products
body piercing, tattooing
needle sticky injury
children in residential care
travellers to high prevalence countries
people who come into contact with blood or open sores
242
hep B: diagnosis
incubation period normally 60-90 days
| insidious onset
243
hep b: symptoms
```
anorexia
vague abdo discomfort
nausea
vomiting
fatigue
fever
joint pain
jaundice
```
244
what does HBcAg indicate?
does not circulate in blood but detected in hepatocytes
245
what does HBsAg indicate?
current hep B infection
246
what does anti-HBc indicate?
IgM indicates recent infection
| IgG indicates past infection
247
what does anti-HBs indicate?
indicates recovery
248
what does HBeAg indicate?
indicates active viral replication and infectiousness of patient
249
what does anti-HBe indicate?
decline in viral replication and non infectiousness of patient
250
advice to patients with Hep B
```
immediate family and household members should be tested
discuss infection with sexual partner and use condom
cover open sores and cuts with bandage
don't share razors or toothbrush
don't donate blood or organs
don't share injection drug equipment
clean blood spills
avoid alcohol and liver damaging drug
```
251
management of Hep B
hep B vaccine post or pre exposure
| hep B immunoglobulin
252
hep b vaccination: how many days to protect? how many years protection?
standard schedule
how long after exposure
10-14 days
20 years
0,1 and 6 months
can be given up to a week after exposure
253
am i at risk.... high school patient who aspires to do medicine?
not at risk - 3 doses at 0,1 and 6 months
254
am i at risk.... a medical student
at risk due to occupation - 0,1 and 2 months - if continues to be med student needs booster at 12 months and 5 years
255
am i at risk.... a house officer, not immunised, needle stick injury
immediate protection - hep B vaccination and HBIG
256
hep C: transmission
incubation period
symptoms
large or repeated percutaneous exposures to infectious blood
4-12 weeks (2-24)
anorexia, abdo discomfort, nausea, vomiting, fatigue, fever, joint pain, jaundice
257
diagnosis of hep C
depends on clinical symptoms and signs
hep C virus RNA or antibody to HCV (anti-HCV)
screening test for antiHCV 4-10 weeks post exposure
confirmatory test - HCV RNA PCR
258
treatment of hep C
pegylated interferon and ribavirin
259
PHE strategy for prevention and control of hepatitis
policy, planning, advocacy and resource mobilisation
surveillance
research for improvement of the viral hepatitis prevention and control programmes
prevention
education
medical care and treatment
260
what drives STIs
* Poverty/social deprivation
* Migration
* Rapid urbanisation
* Economic and political instability – war
* Absence of diagnostic and treatment services
* Early sexual debut
* Multiple partners
* Absence of visible symptoms
* Unprotected sex
* Substance misuse – increase risk taking
* Lack of public awareness
* Lack of training of health workers
* Long standing, widespread stigma
261
why do young adults have less access to STI care sometimes?
More likely to have multiple sexual partners rather than long term sexual relationships
May have difficulty using barrier methods that would offer protection from STIs
May be more likely to have higher risk partners
```
Lack of awareness
o Non disclosure of sexual activity
o Fear of being found out by parents/carers
o Restrictive policies of clinics
o Lack of money to pay for care
```
262
consequences of poor sexual health
poor reproductive and maternal health
poor newborn health
anogenital cancers
transmission of HIV
263
primary prevention techniques for STIs
reduce risk of acquiring disease
counselling and behavioural interventions
interventions targeted at key populations
education and counselling tailored to need to adolescents
immunisation
HIV - PrEP, PEP, PEPSE
male circumcision
tenofovir gel
264
secondary prevention techniques for STIs
identify and detect disease in early stages - case finding
STI screening
HIV testing
national chlamydia screening programme
265
tertiary prevention techniques for STIs
reduce morbidity and mortality
| treatment, prevent complications and transmission
266
how to treat STIs in resource poor settings
syndromic approach - treat on clinical signs and symptoms in case no lab facilities, no loss to follow up, all major pathogens treated
267
aims of STI surveillance
To determine info on the burden of STIs in population
To describe demographic and geographical distribution of STIs
To compare situation and trends in different demographic and geographical situations
268
examples of STI surveillance in UK
1. Gonococcal resistance to antimicrobial surveillance programme (GRASP) collects from sentinel GUM clinics and their associated laboratories on antimicrobial resistant Neisseria gonorrhoea
2. The enhanced lab surveillance for infectious syphilis programme collects data from all GUM clinics in London
3. HIV and AIDS reporting system (HARS)
a. Reduce reporting burden for reporting sites
b. Increase efficiency of HIV surveillance
c. Enhance standard HIV surveillance outputs
d. Produce quality of care indicators
e. Directly support commissioning services
Universal to GUM clinics:
• Confidentiality and non judgemental attitude
• Open access
• Accurate diagnosis and effective treatment
• Screen for concomitant infections
• Free treatment – single dose and oral
• Contact tracing
Sources of STI surveillance data in UK:
• GUM clinics
• Voluntary lab reporting – chlamydia, gonorrhoea, genital herpes
• HPA reference lab – syphilis
• Integrating STI services into existing health services
269
global strategy for prevention and control of STIs 2006-2015 WHO
* To reduce related morbidity and mortality
* To prevent HIV infection
* To prevent serious complications in women
* To prevent adverse pregnancy outcomes
270
benefits of partner notification
Break the chain of transmission
Prevent re-infection of index patient
Prevent complications of untreated infection
Epidemiological analysis – network studies
271
methods of partner notification
```
• Patient referral/passive referral
• Provider referral
o More effective
o Resource implications
o Ethical considerations if no choice
• Conditional/contract referral
• Offered assistance
```
272
new developments in partner notification
* Expedited partner services
* Patient delivered partner treatment
* Expedited partner therapy
* Accelerated partner therapy
* Patient delivered partner screening
273
how to prevent mosquito bites?
```
protect exposed areas
bed nets - insecticide treated
screening of dwellings - fitted doors and windows
air conditioning
clothing
DEET spray
coils
```
274
how to prevent malaria
chemoprophylaxis to prevent disease
275
problems with chemoprophylaxis for malaria
cost
drug resistance limits choice
poor compliance - underdosing
adverse effects
276
who are the high risk groups that get chemoprophylaxis for malaria
travellers from non malarious areas
non immune migrant workers from non endemic areas
indigenous to malarious areas e.g. pregnant women (IPTs) - 2 doses
277
schistosomiasis:
where from?
symptoms
treatment
ponds, lakes, rivers, reservoirs
high temp, itchy, red blotchy rash, cough, diarrhoea, muscle and joint pain, abdominal pain
anaemia, cystitis, cough, wheeze, SoB, seizures, dizziness
biltricide
278
how to control neglected tropical diseases
intensified disease management
preventative chemotherapy
control of vectors and their intermediate hosts
veterinary public health, water and sanitation
health awareness and education and capacity building
279
```
river blindness:
caused by?
core strategy?
how it works?
how are CDDs trained?
```
onchocerciasis (APOC)
community directed treatment with ivermectin
1 per year for 16-18 years. need adult worm to die.
health worker visits community chief and explains idea. community decides if they want to adopt strategy, inform of confirmed date for training
trained to: conduct a census, use measuring sticks to estimate how many ivermectin tablets to give, detect and treat minor side effects, refer cases to nearest health facility, keep records, report about treatment campaign
280
```
Guinea worm:
caused by
transmitted by
symptoms
how to eradicate
```
dracunculiasis
drinking stagnant water contaminated with tiny water fleas carrying infective guinea worm larvae. grow into worms - people only known reservoirs of disease. Infection and blister forms with burning. immerse in water and release larvae - bring round in full circle.
ensure wide access to safe drinking water, filter water, intense surveillance and control to detect every case, treat ponds with larvicide temepos, promote health education and behaviour change, map endemic villages
281
what is the role of the centre for radiation, chemical and environmental hazards?
identify and respond to health hazards
anticipate and prepare for emerging and future threats
provide specialist support to NHS and other agencies
provide specialist health protection services
advise public, professionals and government on the best way to protect health
282
monitoring during incidents with air quality
carry out environmental monitoring during acute chemical incident aids in refining public health risk assessment
monitoring provides a measure of concentrations over time
useful when carried out at receptor locations
can be compared to health based exposure standards
can provide reassurance
283
asbestos:
what is it
why it is dangerous
mineralogical term applied to certain minerals with following properties; capability of splitting into very thin fibrils, parallel fibres in bundles, fibres in form of thin needles, fibres show curvature
can split into long respirable fibres not cleared from lung
284
what factors from our environment can affect our health?
```
poor water quality or quantity
inadequate excreta disposal
poor hygiene
poor housing and overcrowding
inadequate solid waste disposal
poor drainage
presence of disease transmitting vectors
indoor air pollution
outdoor air pollution
extreme weather conditions
```
285
examples of faecal oral diseases
diarrhoea and dysentries - amoebic dysentry, giardia, cholera, shigella, salmonella,
enteric fevers - typhoid
hep A +E
286
examples of water washed diseases
```
skin diseases (scabies)
eye diseases (trachoma, conjunctivitis)
```
287
water based diseases
schistosomiasis, guinea worm
288
water related insect vector
filariasis, malaria, river blindness, dengue, yellow fever
289
most common cause of diarrhoea in developing country
rotavirus
290
three main forms of acute childhood diarrhoea
acute watery diarrhoea - cholera, e coli, rota virus
blood diarrhoea - shigella
persistent diarrhoea - undernourished, HIV/AIDS
291
```
cholera:
what is it caused by
symptoms
how it spreads
prevention
```
vibrio cholera - acute toxic reaction in small intestine
watery diarrhoea, vomiting, dehydration, collapse
faecal oral. drinking contained water, poor food hygiene, cross contamination
majority asymptomatic
o Community wide knowledge on cholera transmission and prevention
o Community wide effective excreta disposal
o Improved water supplies/good quality drinking water
o Good hygiene awareness and practice: hand washing with soap, good food hygiene, good personal hygiene, safe storage of drinking water
o Care at funerals when someone has died of cholera
o Need to give immediate fluid replacement!
292
```
trachoma
caused by
symptoms
transmission
prevention
```
chlamydia trachoma's
infection -> blindness
o Direct spread through play or sharing a bed
o Touch of fingers between mother and child
o Indirect spread – towels, tissues
o Eye seeking flies
o Coughing or sneezing
• Prevention
o WASH contribution
Good hygiene practice – facial cleanliness, hand cleanliness, not sharing face cloths
Improve sanitation – reduce fly numbers
Increased access to water – for improved facial and other hygiene including laundry
o SAFE strategy (WHO) to prevent blindness
Surgery
Antibiotics
Facial cleanliness
Environmental sanitation
293
Schistosomiasis
spread
symptoms
prevention
```
water based - parasitic blood flukes (worms)
o Blood in urine
o Painful urination
o Bladder cancer
o Kidney problems
o Diarrhoea
o Tiredness
o Abdominal pains
o Blood in faeces
o Complications of liver and spleen
```
o Water quality
o Reduce need for contact with infected water
o Health education
o Drugs for infected people
o Sanitation
o Molluscides
o Alternative special pools built for kids
294
integrated vector management
* Distribute long lasting impregnated mosquito nets and mosquito screening
* Health education
* Indoor residual spraying
* Improved sanitation
* Reduction of standing water in urban areas
* Insecticide to reduce blackfly populations
295
filariasis
| caused by
Caused by a worm transmitted by mosquitoes
| Largely transmitted by culex mosquitoes that breed in septic tanks and flooded pit latrines
296
how to reduce spread of environmental diseases in developing countries
Improved excreta and urine disposal – latrines – sold waste management – collection and transfer and dispose
Improved water supply – sustainable
Household water treatment
Hygiene promotion – wash hands after defecating, after attending a child defecating, before eating, before feeding a child, before preparing food, after caring for a sick person
effective drainage
297
why do you need to care about water hygiene in developing countries
save lives of newborns and infants
can reduce sickness so more time for productive activities
can save the sight of people
It can contribute to educational performance, increased dignity and keeping girls and boys in school
298
how is ebola transmitted
Close contact with blood, secretions, organs or other bodily fluids of infected animals
Human to human infections occur through mucosal surfaces, skin abrasions or through contaminated needles, after direct contact with the virus from dead or infected people or wildlife (only infectious when symptoms present)
299
how to diagnose ebola
Antibody capture enzyme linked immunosorbent assay (ELISA)
Anti-capture detection tests
Serum neutralization test
Reverse transcriptase polymerase chain reaction assay
Electron microscopy
Virus isolation by cell culture
300
symptoms of ebola
```
Fever
Headache
Joint and muscle aches
Chills
Weakness
Nausea and vomiting
Diarrhoea (bloody)
Red eyes
Raised rash
Cough
Stomach pain
Severe weight loss
Bruising
Bleeding
```
301
How to prevent wildlife to human transmission of ebola
* Limit direct contact with infected fruit bats or monkeys/apes
* Avoid the consumption of raw meat for fruit bats or monkeys/apes
* Animals should be handled with gloves and other appropriate protective clothing.
* Animal products (blood and meat) should be thoroughly cooked before consumption.
302
How to prevent human to human transmission of ebola
* Isolate all patients with confirmed Ebola infection
* Limit direct or close contact with people with Ebola symptoms, particularly
* with their bodily fluids.
* Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home.
* Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
303
How to contain an outbreak of ebola
* Prompt and safe burial of the dead,
* Identifying people who may have been in contact with someone
* infected with Ebola and monitoring their health for 21 days,
* Separate healthy from the sick to prevent further spread,
* Maintain good hygiene and a clean environment.
304
How to reduce the risk of possible sexual transmission of ebola
* Male survivors of Ebola virus disease practice safe sex and hygiene for 12 months from onset of symptoms or until their semen tests negative twice for Ebola virus.
* Contact with body fluids should be avoided and washing with soap and water is recommended.
* WHO does not recommend isolation of male or female convalescent patients whose blood has been tested negative for Ebola virus.
305
how to prepare health system response for ebola
1. Raising awareness and knowledge of health care providers
a. Sensitise staff at points of entry
b. Emphasise systematic questioning and recording of travel history
2. Putting procedures in place to deal with suspected cases
3. Diagnose and manage confirmed cases
4. Enhanced screening at airports for people from high risk countries
5. Assessment and monitoring
306
what measures should people working with ebola patients take
* Ensure people travelling to the country to work know what to do
* Case identification
* Use of PPE, hand hygiene, case management
* Conduct prompt and safe burials of dead
surveillance and contact tracing - monitor contacts for 21 days
