U.S Health final exam- infectious disease

Question 1

wearing long sleeves can break the chain of infection at

Answer 1

C
Port of entry

a mosquito cannot get in

Question 2

Ten Greatest Pubic Health Achievements

Answer 2

Ten Great Public Health Achievements — Worldwide, 2001-2010
Reductions in Child Mortality
Vaccine-Preventable Diseases
Access to Safe Water and Sanitation
Malaria Prevention and Control
Prevention and Control of HIV/AIDS
Tuberculosis Control
Control of Neglected Tropical Diseases
Tobacco Control
Increased Awareness and Response for Improving Global Road Safety
Improved Preparedness and Response to Global Health Threats

Ten Great Public Health Achievements – United States, 2001-2010
Vaccine-Preventable Diseases
Prevention and Control of Infectious Diseases
Tobacco Control
Maternal and Infant Health
Motor Vehicle Safety
Cardiovascular Disease Prevention
Occupational Safety
Cancer Prevention
Childhood Lead Poisoning Prevention
Public Health Preparedness and Response

Question 3

Deadly infectious diseases

how has infectious disease impacted people

what are some examples of outbreaks

Answer 3

Throughout time many infectious diseases have killed millions of people

Bubonic plague (“Black Death”)-1/3 of European population
Small Pox- has been eradicated
Cholera
Tuberculosis (TB)
Typhoid
Yellow fever

Question 4

Public Health measures

Answer 4

Purification of water
Proper disposal of sewage
Pasteurization of milk
Immunizations
Improved nutrition
Personal Hygiene
Discovery of antibiotics

Question 5

Infectious Agents

Answer 5

Bacteria:
Tuberculosis, cholera, typhoid, tetanus, diphtheria, dysentery, syphilis, streptococci, staphylococci

Viruses:
Smallpox, poliomyelitis, hepatitis, measles, rabies, AIDS, yellow fever

Parasites:
Malaria, cryptosporidiosis, giardiasis, roundworms,
, hookworms, pinworms

Question 6

Diseases caused by viruses

Answer 6

Smallpox
Yellow fever
Polio
Hepatitis

Influenza
AIDS
Common cold
Measles

Question 7

Diseases caused by protozoa

Answer 7

Malaria
Cryptosporidiosis
Giardiasis
Pinworm

Tapeworm
Hookworm
Roundworm

Question 8

How can infectious diseases be transmitted?

Answer 8

Person-to-person
Via respiratory secretions
Sexually transmitted

Water
Fecal-oral route

Food

Vectors
Mosquitoes, rats, bats

Fomites- touching contaminated objects and putting hands to face, nose or eyes

Question 9

Chain of Infection Links
link 1

Answer 9

Link 1- Pathogen: Bacteria, virus, parasite that cause illness in humans

Question 10

Chain of Infection Links
link 2

Answer 10

Link 2: Reservoir: this is the place where the pathogen can live and multiply.

Question 11

Chain of Infection Links
link 3

Answer 11

Link 3: Method of transmission: this is the way a pathogen can travel from one host to another

Question 12

Chain of Infection Links
link 4

Answer 12

Link 4: Susceptible host: One that can be readily infected.
- Not all hosts are susceptible-they have immunity to the pathogen
- The support of the pathogen’s life and its reproduction depends on the degree of the host’s resistance

Question 13

Port of exit:
how can an infectious microorganism leave the body

Answer 13

How an infectious microorganism may leave the body
- Secretions of mucus
- Blood
- saliva
- Other fluids

Question 14

Port of entry

what is ths

what are the 4 methods of entry

Answer 14

: The route through which the pathogen enters a new host

4 methods of entry:
Respiratory system (inhalation)

Gastrointestinal (ingestion of pathogen)

Urinary and reproductive tracts (sexual contact)

Breaks in protective skin barrier

Question 15

How to interrupt the chain of infection:

what is link 1 and how can it be interrupted

Answer 15

The most vulnerable part of the chain is the point where public health measures can interrupt to prevent the spread of disease!

Pathogen identification
- Proper identification of infectious agent and appropriate treatment
- Correct antibiotic for treatment of infectious disease

Question 16

How to interrupt the chain of infection:
Eliminate the reservoir

how can we prevent the spread of food-borne pathogens

what can prevent water-borne pathogens

what two things are necessary

Answer 16

By maintaining proper hygiene you can prevent spread of food-borne pathogens

Having adequate water and sewage treatment can prevent spread of water-borne pathogens

Disinfection and sanitation

Question 17

How to interrupt the chain of infection:
Prevent means of transmission

Answer 17

Direct or indirect contact can be altered by:
- Proper hand washing
- Isolation of those infected (quarantine/isolation)
- Use of condoms
- Not working when contagious
- Wearing masks

Question 18

How to interrupt the chain of infection
Susceptible Host:

Answer 18

Resistance of host can be increased by immunization

Protect high-risk patients by wearing a mask with :
- Cancer patients
- AIDS
- Transplant patients
- Infant and elderly
- Proper disposal of needles/sharps

Question 19

How to interrupt the chain of infection
Ports of entry

what can you wear

what should you cover

what should you wahs before eating

what else should you wear

Answer 19

Wear long sleeve shirts to prevent malaria carrying mosquito from biting (break protective skin barrier)

Cover open wounds

Wash hands before eating (avoid pathogen entering via GI system)

Wearing PPE

Question 20

How to interrupt the chain of infection
Ports of exit

what should you always wash hands with

what else should you wear

what should you properly dispose of

what etiquette should you have

Answer 20

Hands: always wash hands with soap and water after handling potentially contaminated material

PPE such as gloves and masks if respiratory droplets are a concern

Proper trash and waste disposal

Respiratory etiquette

Question 21

What are some ways to break the chain of infection for COVID-19?

Answer 21

Wearing a mask

Social distancing

Hand hygiene

Cover coughs & sneezes

Clean & disinfect

Monitor daily health

are these all transmission?

Question 22

Public Health Measures
Epidemiological Surveillance:

what do PH officials always do and what will they do if necessary

what is contact tracing

what happens after contact tracing??

Answer 22

Epidemiological Surveillance:
- Public health officials watch for diseases. If necessary they will interrupt the chain of infections

• Contact tracing: Identification and diagnosis of persons who may have come into contact with an infected person.

When is contact tracing routinely used??
- Immunization and treatment of identified patients to prevent further spread
- Quarantine/isolation if necessary

Question 23

Eradication

when is eradiation possible

what disease was eradicated

what disease is eradiacted from in the western hemisphere but where are there still cases

what disease has had recent outbreaks in the U.S

Answer 23

Eradication is possible if there is no non-human reservoir and if a vaccine exists

Smallpox was eradicated from the world

Polio has been eradicated in the Western Hemisphere- still see some wild cases particularly in Afghanistan, Pakistan (not eradicated), Syria (has had outbreaks in refugee camps)

Measles- in the US have had recent outbreaks

Question 24

Rabies

what does it affect

what is the infectious agent

where is it found

how is it transmitted

what is the port of entry

Answer 24

Fatal disease of the nervous system

Infectious agent: Rabies virus

Is found in wild and domestic animals such as
- Dogs
- Raccoons
- Bats

Transmitted by the saliva of an infected animal

Port of entry: broken skin from bite or scratch

Question 25

Rabies
How can we break the chain?

what can we do to cats and dogs

what campaigns can we have

what can be administered to wildlife

who should get pre-exposure immunization

Why not vaccinate everyone??

Answer 25

Rabies immunization for all cats and dogs - link 4 susceptible host

Educational campaigns

Oral administration of vaccine to wildlife

Pre-exposure immunization
- veterinarians, park rangers

Why not vaccinate everyone??

Question 26

Smallpox

when was it eradicated

what was the mortality rate

what was the reservoir

how was it transmitted

how was it eradicated

Answer 26

Declared eradicated in 1979. The last known case was in 1978.

High mortality rate-30%

NO animal or environmental reservoir. Found only in humans

Transmitted by respiratory droplets or direct contact

Eradicated by “Ring Immunization”

Question 27

Measles

what is it the leading cause of

what is the R0 and what does that tell you about the infectious rate of the disease

what is the pathogen

how is it transmitted

how can it be controlled

Answer 27

The leading cause of vaccine-preventable deaths in children worldwide

Highly infectious communicable disease-R naught (R0) of 18

Pathogen: measles virus

Transmitted to humans by respiratory droplets

How can this be controlled?
- Immunizations
- Isolation of those infected

Question 28

rank the diseases on which is least to most contagious

mumps
hepatitis c
ebola
HIV
measles
SARS

Answer 28

Hepatitis C

ebola

HIV

SARS

Mumps

measles

ranked from most to least contagious

Question 29

Polio

what is it the main symptom that is it Characterized by

what pathogen is it caused by

what was the goal for eradication

what Countries have never interrupted the transmission of wild polio:

what is the main method of control

Answer 29

Characterized by flaccid paralysis

Pathogen: poliovirus

World Health Organization set a goal for worldwide eradication for 2000

Countries that have never interrupted the transmission of wild polio:
- Afghanistan
- Pakistan

Method of control: immunization in early childhood

Question 30

Immunizations

how does it effect diseases

what are the risks of it

Answer 30

Immunizations are the most effective intervention for preventing disease and promoting health

Immunizations do not come without risks
- Allergy to eggs
- Allergies to components of vaccine (neomycin, latex, thiomersal)
- Seizures
- Guillain-Barre syndrome

Question 31

Fear of vaccines

what are people scared that it might cause

what do some vaccines come with and what do some parents refuse to accept

what is lost if many people do not get vaccine, what is once example

why are pharmaceutical companies reluctant to develop vaccines

Answer 31

Fear of autism (MMR) and SIDS (pertussis) from vaccines

Side effects do exist for some vaccines, Some parents refuse to accept risks

Herd immunity is lost if many people do not get vaccinated
- Measles outbreak example of losing herd immunity

Pharmaceutical companies are reluctant to develop vaccines
- Low profits
- Risk of law suits

Question 32

Public health

what have measures been successful to do

Answer 32

Many public health measures have been successful in controlling disease but requires constant diligence

What do you think are some issues that may result due to budget cuts?

Question 33

Dengue Fever

what is it and what are the 2 forms

what are the symptoms

what are the viruses that cause it

Answer 33

Dengue is an acute infectious disease that comes in two forms: dengue and dengue hemorrhagic fever.

The principal symptoms of dengue are high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain, and rash. Generally, younger children have a milder illness than older children and adults.

Dengue and dengue hemorrhagic fever are caused by any one of four closely related flaviviruses, designated DEN-1, DEN–2, DEN-3, or DEN-4.

Question 34

Dengue Fever

was it an endemic, pandemic, epidemic etc and where

how is it transmitted

what animals can serve as a reservoir

what was approved for this disease

Answer 34

Dengue is endemic in many tropical countries in Asia and Latin America, most countries in Africa, and much of the Caribbean, including Puerto Rico.

Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus.

Monkeys may serve as a reservoir in some parts of Asia and Africa. Dengue cannot be spread directly from person to person. Susceptibility to dengue is universal. Residents of or visitors to tropical urban areas and other areas where dengue is endemic are at highest risk of becoming infected

A vaccine was recently approved in US, only for those with lab confirmed previous infection. The best preventive measure for residents living in areas infested with Aedes aegypti is to eliminate the places where the mosquito lays her eggs.

Question 35

Dengue Fever Cain of Infection

Reservoirs:
Portals of exit:
Modes of transmission:
Portals of entry:
Factors in host susceptibility:

Answer 35

Reservoirs:
Portals of exit:
Modes of transmission:
Portals of entry:
Factors in host susceptibility:

Question 36

What is One Health?

what is connected

what happens as the pop. grows

what makes people more vulnerable to disease

Answer 36

It means that animals, humans and environment health care connected

As the population grows, we interact with animals and the environment in new ways that increase the risk of becoming infected with new diseases

Poverty, war, limited access to healthcare make people vulnerable to disease

Question 37

What are some ways that infectious diseases are spread?

how can it be spread through the globe

how can it be spread through food

what environment can spread pathogens quickly

where do these viruses persist

Answer 37

Global travel:
- New pathogens can be introduced via global air travel
- One example is the SARS outbreak of 2003
—-Jumped from animals at an urban market in China and spread widely via global air travel
- COVID-19 had a similar means of transmission

Industrial food production
- Farms are much bigger and more disruptive to natural ecosystems causing pathogens to spread quickly between wildlife, domestic animals and people
- Avian Influenza (H1N1 & H7N9)- These viruses persist in Asia and Africa as wild birds infect poultry and are in close contact with people

Question 38

How can viruses spread to humans?

how often to viruses evolve and adapt to which host

who do humans have contact with the transmit diseases

what inssects most often carry disease

what makes people have high risk of infections

Answer 38

Viruses evolve much faster and adapt to humans quickly

Disturbing wildlife habitats, humans have much greater contact with animals that transmit viruses

Countries response to disease threats

Mosquitoes and ticks carrying virus into new habitats as seasons and climates change

Without clean water and food waste disposal and medical care people have higher risk of infections

Question 39

Viral threat: HIV/AIDS

when was it first recognized

is there a cure

what are 2 ways of transmission

Answer 39

First recognized in the USA in 1981

There is no cure to date but many treatments to manage it

Transmission:
Sexual contact:
—Homosexual transmission is the most common in the US
—Heterosexual transmission is the most common around the world

Sharing of needles
- IV drug abusers at high risk
- Medical use of unsterile needles

Question 40

Viral Threat: HIV/AIDS

how can it transmitted to child

what is screened and what is the result

Answer 40

Transmission
- Mother to infant
- Prenatal or during birth
- Breastfeeding

Blood transfusions
- We screen blood products in the US so not typically seen in the US but can occur globally if they do not screen blood products

Question 41

How can we control transmission?

Answer 41

Education
Behavior modification
Treatment of drug users
Distribution of condoms
Clean syringes
Needle exchange programs
Abstinence

Question 42

Other emerging viruses

what are the 5 viruses and where are the outbreaks

Answer 42

Measles- 1282 cases in US during 2019 (372 cases in all of 2018)

Ebola- Have had several outbreaks in west African countries in 2014-2016. Current outbreak in Democratic Republic of Congo (DRC)

Monkey pox- have had outbreaks in Nigeria

Hantavirus- Have had outbreaks in 4 corners of the US

West Nile Virus- reported in more than 40 states last year

Eastern Equine Encephalitis-rare but can be deadly

Question 43

Influenza

what kind of virus is it

how often does it mutate

what is antigenic shift vs drift

how many people did the spanish flu kill

Answer 43

Influenza is an RNA virus like HIV

It is constantly mutating so the vaccine must be changed frequently

Periodically will have an antigenic shift-the influenza strain is drastically different from anything the population has been exposed to.

• Antigenic drift-slight mutation in the sequence of the prevalent strain

Spanish flu of 1918-1919 killed 20-40 million people worldwide

Avian influenza (H5N1) and H1N1 are concerning

Question 44

Bacterial Threats

Answer 44

Legionnaire’s disease
Lyme Disease
Group A streptococci
E. coli 0157:H7 in food
Antibiotic resistance
- Natural progression of bacteria
- Improper medical use
- Use in agriculture
- MRSA

Question 45

Tuberculosis (TB)

how does it rank in infectious disease worldwide

how many people are infected

when was there a resurgence

people with what disease are at a much higher risk

how is it transmitted

what is the fatility rate of those not treated

Answer 45

TB is the leading cause of infectious disease worldwide
- One third of the world population is infected

There was a resurgence in the US in the early 1990s

People with HIV are at a much higher risk

TB is transmitted by respiratory aerosol droplets

Fatality rate for untreated TB is 50%

Question 46

Tuberculosis

what are effective but must be taken daily

what can improper use of it lead to

what is DOTS

Answer 46

Antibiotics are effective but must be taken daily for several months

Improper use of antibiotics leads to resistance, including multi-drug resistance—this may increase fatality rate

Directly Observed Therapy (DOTS) works!
- Best approach for preventing antibiotic resistance

In 2007, the CDC revised its requirements for overseas medical screening of applicants for immigration to the US

Question 47

Tuberculosis

what are the Prime transmission sites for TB

Answer 47

Prime transmission sites for TB
- Homeless shelters
- Prisons
- Urban hospitals
- Riskiest behavior is breathing!

Question 48

Prions

Answer 48

Also called transmissible spongiform encephalopathies

Rapidly progressive and total brain diseases

Not considered a bacteria or a virus- it is an infectious protein

Question 49

Prions

what is another name for the disease

what stage of life does it appear

what country does it have a history and what are other names of the disease

who does the new variant affect and how do they get it

regulations have been tightened om what

Answer 49

Creutzfeldt-Jakob Disease (CJD)

Sporadic CJD is the most common

CJD usually appears later in life

Bovine spongiform encephalopathy (BSE) or “mad cow disease” has a history in Britain

New variant of CJD (vCJD) in the UK affects younger people- thought to be caused by eating infected beef

Regulations have been tightened on animal feed

Question 50

Prions

what are the symptoms

what is there a deficit in

how long does it take to progress

Answer 50

Clinical presentation of CJD:

Fatigue, sleep disturbances, weight loss, headaches, anxiety, vertigo, malaise, poorly defined pain

Deficits in higher cortical function

Progresses over weeks to months to profound dementia

Question 51

Prions

what is another name for it

which people was it found and during what years

what disease does it result and what are the physical effects

what does it eventually lead to

how did people get this disease and in what gender

Answer 51

Kuru

Found in Fore people of Papua New Guinea in the 1950-60’s

Neurological disease is characterized by progressive loss of coordination and control over muscle movements

Eventually leading to death

Resulted from funeral rituals of cannibalism mostly in women because they ate the brain

Question 52

Public Health Response to Emerging Infections

what is there a global surveillance for

what is improved

what is there a reduction in and what can be done as a response

Answer 52

Global surveillance of potential epidemics

Veterinary surveillance

Improved public health capacity

Reduction of inappropriate use of antibiotics
- Educate to not use antibiotics for viral infections