BAHENA, CINCO, HERRERA, ROSAS, PACHECO, LUPIAN, BATAYOLA, BANDOLON

GROUP 4

COMMUNICABLE DISEASES
= any condition which is transmitted directly or indirectly to a person from an infected person or animal through the agency of an intermediate animal, host, or vector, or through the inanimate environment. Transmission Direct Indirect Vector-borne- malaria, onchocerciasis, trypanosomiasis Fomites Zoonotic diseases animal handling and feeding practices (Mad cow disease, Avian Influenza) Blood-borne or sexual HIV, Hepatitis B,C Inhalation Tuberculosis, influenza, anthrax Food-borne E.coli, Salmonella, Contaminated water- Cholera, rotavirus, Hepatitis A

TUBERCULOSIS CONTROL PROGRAM

Considered as the worlds deadliest disease and remains as a major public health problem in the Philippines. In 1993, TB was declared as global emergency by the World Health Organization because of the resurgence of TB in many parts of the world. In the Philippines, tubercolosis ranks sixth in the leading cause of morbidity (2002) and mortality (2002).

Signs& Symptoms Cough of two weeks or more Fever Chest or back pains not referable to any musculo-skeletal disorders Hemoptysis or recurrent blood-streaked sputum Significant weight loss Etc. such as sweating, fatigue, body malaise and shortness of breath Transmission Airborne droplet coughing, sneezing, shouting, Direct invasion Bovine tuberculosis results from exposure to tuberculosis cattle, usually by ingestion of unpasteurized milk. The National Tuberculosis Program Vision: A country where TB is no longer a public health problem. Mission: Ensure that TB DOTS services are available, accessible, and affordable to the communities in collaboration with the LGUs and other partners.

Goal: To reduce prevalence and mortality from TB by half by the year 2015 (MDG) Targets: 1. Cure at least 85 per cent of the sputum smear-positive TB patient discovered o 2. Detect at least 70 per cent of the estimated new sputum smear-positive TB cases

National TB Control Program The rising incidence of tuberculosis has economic repercussions not only for the patients family but also for the country. Eighty percent of people afflicted with tuberculosis are in the most economically productive years of their lives, and the disease sends many self-sustaining families into poverty. The rise in the incidence of tuberculosis has been due to the low priority accorded to anti-tuberculosis activities by many countries. The unavailability of anti-TB drugs, insufficient laboratory networking, poor health infrastructures, including a lack of trained health personnel, have also contributed to the rise in the incidence of the diseases. Objectives of NTP Objective A: Improve access to and quality of services provided to TB patients, TB symptomatics, and communities by health care institutions and providers. Objective B: Enhance the health-seeking behavior on TB by communities, especially the TB symptomatics. Objective C: Strengthen management (technical and operational) of TB control services at all levels, Directly Observed Treatment (DOTS) In 1996, WHO introduced the Directly Observed Treatment Short Course (DOTS) to ensure completion of treatment. The DOTS strategy depends on five elements for its success: Microscope, Medicines, Monitoring , Directly Observed Treatment, and Political Commitment). If any of these elements are missing, our ability to consistently cure TB patients slips through our fingers. Recommended Category of Treatment Regimen Category of ttt Category I Type of Patient New sputum smearpositive Seriously ill smear negative Seriously ill extrapulmonary Regimen 2(HRZE)3 4(HR)2

Category II

Sputum smear positive positive relapse 2(HRZES)3/1(HRZE)3/5(HRE)3 Sputum smear positive failure Sputum smear positive treatment after default Sputumsmear negative not seriously ill 2(HRZ)3/4(HR)3

Category III

PHN Responsibilities (Adult TB) 1. Together with other NTP staff/workers, manage the procedures for case-finding activities. 2. Assign and supervise treatment partners

3. 4. 5. 6. 7. 8.

Supervise rural health midwives (RHMs) Maintain and update the TB Register Facilitate requisition and distribution of drugs Provide continuous health education to all TB patients. Coordinate with the physician, conduct training to HWs Prepare, analyze and submit quarterly reports to the PHO or CHO

PHN Responibilities (Childhood TB) 1. Interview and open treatment cards for identified tuberculous children 2. Perform tuberculin testing and reading to eligible children 3. Maintain NTP records 4. Manage requisition and distribution of drugs 5. Assist the physician in supervision of other HWs 6. Assist in training of other HWs on Tuberculin Testing.

LEPROSY CONTROL PROGRAM

Introduction Leprosy is an ancient disease and is a leading cause of permanent physical disability among the communicable diseases. It is a chronic mildly communicable disease that mainly affects the skin, the peripheral nerves, the eyes and mucosa of the upper respiratory tract. Leprosy has been a public health problem in the Philippines for several decades. In 1989 Multiple Drug Therapy (MDT) was implemented nationwide after a successful implementation of the MDT pilot study in Cebu and Ilocos Norte in 1985. In 1991, Philippines joined the movement to eliminate leprosy as a public health problem. Since then great progress has been made in decreasing the number of persons afflicted with leprosy. By the end of 2005, the prevalence rate is 0.36 which is 39% higher than 2004. The disease is unequally distributed throughout the country. Leprosy is still a public health problem in 8 cities (Laoag, Candon, Vigan, San Jose, Cagayan de Oro, Oroquieta, Iligan and Isabela) and 5 provinces (Ilocos Norte, Ilocos Sur, Basilan, Sulu and Tawi-tawi).

SIGNS & SYMPTOMS Early Signs & Symptoms Change in skin color either reddish or white. Loss of sensation on the skin lesion . Decrease/ loss of sweating and hair growth over the lesion. Thickened and/ or painful nerves. Muscle weakness or paralysis of extremities. Pain and redness of the eyes. Nasal obstruction or bleeding. Ulcers that do not heal. B. Late Signs & Symptoms Loss of eyebrow madarosis. Inability to close eyelids lagophthalmos. Clawing of fingers and toes. Contractures Sinking of the nosebridge. Enlargement of the breast in males or gynecomastia

Chronic Ulcers

Slit Skin Smear (SSS) It is only done only when clinical diagnosis is doubtful. Main Objective: to prevent misclassification and wrong treatment. Management/ Treatment Ambulatory chemotherapy through use of Multi-drug therapy. Domiciliary treatment as embodied in R.A. 4071 which advocates home treatment. Adjust dose appropriately for children less than 10 years. For example, Rifampicin 300 mg and Dapsone. Treatment for patients with single skin lesion & a negative slit skin smear. Single Dose ROM Rifampicin Ofloxacin Minocycline For MB Leprosy Case Drugs/Duration Rifampicin Clofazimine Dapsone Duration of Treatment Adult 600 mg once a month Child (10-14 years) 450 mg once a month 150 mg once a month, 300 mg once a month and and 50 mg every other 50 mg daily. day. 100 mg daily 50 mg daily 12 blister packs to be 12 blister packs to be taken monthly within a taken monthly within a maximum period of 18 maximum period of 18 months. *4 months. *3 Adult 600 mg 400 mg 100 mg Child (10-14 years) 300 mg 200 mg 50 mg

Adjust dose approximately for children less than 10 years. For example, Rifampicin 300 mg Dapsone 25 mg and Clofazimine 100 mg once a month and 50 mg twice a week. Should the patient fail to complete treatment within the prescribed duration, then said patient should continue treatment until he/she has consumed 24 MB blister packs.

Completion of Treatment All patients who have complied with the above mentioned treatment protocols are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain.

Public Health Nursing Responsibilities Prevention

Health education of patients, families and the community on the nature of the disease, symptomatology and its transmission. Children who are more susceptible to the disease should not be exposed to untreated lepromatous cases. Advocate healthful living through proper nutrition, adequate rest, sleep and good personal hygiene. BCG vaccination especially of infants and children.

Case finding Recognize early signs and symptoms of leprosy and refers suspects to the RHU physicians or skin clinic for diagnosis and treatment. Takes patient and family history and fills up patient records. Conducts epidemiological investigation and report findings to MHO. Assists physician in physical examination of patients in the clinic/home. Assess health of family members and other household contacts. Performs/assists in examination of contacts. Integrates casefinding of leprosy cases in other activities such as MCH, EPI, inspection, examination of school children and other programs.

SCHISTOSOMIASIS CONTROL PROGRAM

Bilharzia; Katayama fever; Swimmer's itch; Blood fluke; Snail Fever is a parasitic disease caused by trematode flatworm of the genus Schistosoma: japonicum, heamatobium & mansoni. Larval forms of the parasites, which are released by freshwater snails, Oncomelena quadrasi, penetrate the skin of people in the water like farmers and their families in rural areas. endemic in 10 regions, 24 provinces, 183 municipalities & 1, 212 barangays estimating 6.7M population. 3,391 snail colonies, area approximation 11, 250 hectares high prevalence rate in region 5 (Bicol), region 8 (Samar & Leyte) & region 11 (Davao) In the body, the larvae develop into adult schistosomes, which live in the blood vessels. The females release eggs, some of which are passed out of the body in the urine or feces. Others are trapped in body tissues, causing an immune reaction. In urinary schistosomiasis, there is progressive damage to the bladder, ureters and kidneys. In intestinal schistosomiasis, there is progressive enlargement of the liver and spleen, intestinal damage, and hypertension of the abdominal blood vessels. Control of schistosomiasis is based on drug treatment, snail control, improved sanitation and health education. Signs & symptoms Diarrhea Bloody stools Enlargement of abdomen Spleenomegaly Weakness Anemia Inflamed liver Signs & Tests o Antibody tests o Biopsy of tissue suspected of being infected o CBC to check for signs of anemia o Eosinophil count o Stool examination o Urinalysis

Treatment This infection is usually treated with the drug praziquantel (anti-helmintic). If the infection is severe or involves the brain, corticosteroids may be given. Complications Bladder cancer Chronic kidney failure Chronic liver damage and an enlarged spleen Colon (large intestine) inflammation with bloody diarrhea Kidney and bladder obstruction Pulmonary hypertension Repeated blood infections can occur, because bacteria can enter the bloodstream through an irritated colon Right-sided heart failure Seizures Transmission infected people who urinate or defecate in fresh waters contaminate it Miracidium larva form that penetrates the snail Cercaria infective stage after 2mos; it swims freely in open bodies of water then enters the skin. Upon contact: 1. the parasite burrows into the skin, matures into another stage (schistosomula) 2. migrates to the lungs, liver, & heart through systemic circulation, where it matures, copulates & lay eggs about 1mo. 3. the adult worm then migrates to either: the bladder, rectum, intestines, liver, portal venous system (the veins that carry blood from the intestines to liver), spleen, and lungs. Methods of Control A. Preventive measures a. Public education in MOT & protection b. Proper human waste disposal c. Improve irrigation, reduces snail habitation d. Molluscicides e. Rubber boots: accidental exposure i. Towel dry vigorous & complete ii. 70% alcohol f. Water to be used must be uncontaminated i. Iodine or chlorine treatment ii. Paper filtration iii. 2-3 days storage g. Treat patients to prevent spreading

h. Travelers visiting should know the risks B. Control of Patient, Contacts, & immediate environment a. Report b. Sanitary disposal of feces & urine c. No immunization, nor quarantine C. Investigation of contacts & source of infection a. Praziquantel DOC b. Examine for disease & treat all affected ones especially in children c. Motivate people to have annual stool exam d. PHN must head all control & preventive measures

FILARIASIS CONTROL PROGRAM

Filariasis (Philariasis) is a parasitic disease and is considered an infectious tropical disease, that is caused by thread-like filarial nematodes (roundworms) in the superfamily Filarioidea, also known as "filariae". There are 9 known filarial nematodes which use humans as their definitive host: 1. lymphatic filariasis -these worms occupy the lymphatic system, including the lymph nodes, and in chronic cases these worms lead to the disease elephantiasis. a. Wuchereria bancrofti b. Brugia malayi c. Brugia timori 2. subcutaneous filariasis -these worms occupy the subcutaneous layer of the skin, in the fat layer a. loa loa (the African eye worm), b. Mansonella streptocerca c. Onchocerca volvulus d. Dracunculus medinensis (the guinea worm) 3. serous cavity -which occupy the serous cavity of the abdomen. a. Mansonella perstans b. Mansonella ozzardi, In all cases, the transmitting vectors are either blood sucking insects (flies or mosquitoes), or copepod crustaceans in the case of Dracunculus medinensis. Individuals infected by filarial worms may be depending on whether or not microfilaria can be found in their peripheral blood described as either: a. microfilaraemic -cases primarily through direct observation of microfilaria in the peripheral blood. b. amicrofilaraemic -Occult filariasis cases based on clinical observations and, in some cases, by finding a circulating antigen in the blood. Signs and symptoms

 Elephantiasis edema with thickening of the skin and underlying tissues of lower extremities, ears, mucus membranes, and amputation stumps o Wuchereria bancrofti -legs, arms, vulva, breasts, and scrotum (causing hydrocele formation) o Brugia timori -genitals The most spectacular symptom of lymphatic filariasis is elephantiasiswhich was the first disease discovered to be transmitted by mosquito bites. Interestingly, those who develop the chronic stages of elephantiasis are usually amicrofilaraemic, and often have adverse immunological reactions to the microfilaria, as well as the adult worm. The subcutaneous worms present with skin rashes, urticarial papules, and arthritis, as well as hyper- and hypopigmentation macules. o Onchocerca volvulus eyes: causing "river blindness" (onchocerciasis), the second leading cause of blindness in the world. o Serous cavity filariasis -similar to subcutaneous filariasis, plus abdominal pain, because these worms are also deep tissue dwellers. Diagnosis Identifying microfilariae on Giemsa stained thin and thick blood film smears, using the "gold standard" known as the finger prick test. -The finger prick test draws blood from the capillaries of the finger tip; larger veins can be used for blood extraction, but strict windows of the time of day must be observed. Blood must be drawn at appropriate times, which reflect the feeding activities of the vector insects. Examples are W. bancrofti, whose vector is a mosquito; night time is the preferred time for blood collection. Loa loa's vector is the deer fly; daytime collection is preferred. This method of diagnosis is only relevant to microfilariae that use the blood as transport from the lungs to the skin. Some filarial worms, such as M. streptocerca and O. volvulus produce microfilarae that do not use the blood; they reside in the skin only. For these worms, diagnosis relies upon skin snips, and can be carried out at any time. Worm lifecycle Human filarial nematode worms have a complicated life cycle, which primarily consists of five stages. After the male and female worms mate, the female gives birth to live microfilariae by the thousands. The microfilariae are taken up by the vector insect (intermediate host) during a blood meal. In the intermediate host, the microfilariae molt and develop into 3rd stage (infective) larvae. Upon taking another blood meal, the vector insect injects the infectious larvae into the dermis layer of the skin. After about one year, the larvae molt through 2 more stages, maturing into the adult worms. Prevention In 1993, the International Task Force for Disease Eradication declared lymphatic filariaisis to be one of six potentially eradicable diseases. Studies have demonstrated that transmission of the infection can be broken when a single dose of combined oral medicines is consistently maintained annually for approximately seven years. With consistent treatment, and since the disease needs a human host, the reduction of microfilariae means the disease will not be transmitted, the adult worms will die out, and the cycle will be broken.

The strategy for eliminating transmission of lymphatic filariasis is mass distribution of medicines that kill the microfilariae and stop transmission of the parasite by mosquitoes in endemic communities. Medicine albendazole is used with diethylcarbamazine to treat the disease. Using a combination of treatments better reduces the number of microfilariae in blood. Avoiding mosquito bites, such as by using insecticide-treated mosquito bed nets, also reduces the transmission of lymphatic filariasis. The efforts of the Global Programme to Eliminate LF are estimated to have prevented 6.6 million new filariasis cases from developing in children between 2000 and 2007, and to have stopped the progression of the disease in another 9.5 million people who had already contracted it. Dr. Mwele Malecela, who chairs the programme, said: "We are on track to accomplish our goal of elimination by 2020." In 2010 the WHO published a detailed progress report on the elimination campaign in which they assert that of the 81 countries with endemic LF, 53 have implemented mass drug administration, and 37 have completed five or more rounds in some areas, though urban areas remain problematic. Treatment The recommended treatment for patients outside the United States is albendazole (a broad spectrum anthelmintic) combined with ivermectin . A combination of diethylcarbamazine (DEC) and albendazole is also effective. All of these treatments are microfilaricides, they have no effect on the adult worms. In 2003 the common antibiotic doxycycline was suggested for treating elephantiasis. Filarial parasites have symbiotic bacteria in the genus Wolbachia, which live inside the worm and which seem to play a major role in both its reproduction and the development of the disease. Clinical trials in June 2005 by the Liverpool School of Tropical Medicine reported that an 8 week course almost completely eliminated microfilaraemia. Diethylcarbamazine citrate or hetrazan o kills almost all microfilaria and a good portion of adult worms o is given to pxs with clinical manifestations of microfilaria o Side effects: General and local both with or without fever Systemic reactions are manifestations due to host inflammatory responses to parasites antigen liberated by the rapid death of the microfilariae Localized reactions are induced by their death Mass treatment Distribution of all populations dosage is 6 mg/kg body wt taken as single dose per year Epidemiology In 1960, 43 of 63 provinces were endemic for filariasis; 45 of 77 provinces as of 1996 o development of National Filariasis Control Program (NFCP) in 1963 In 1984, it was estimated that approximately 20 million people were at risk of lymphatic filariasis (LF) in the Philippines. Provinces with highest prevalence rates are from the regions 5, 6, 11 and CARAGA (natl prevalence survey, 1960) Sulu had the highest prevalence rate of the disease and Cebu with the lowest prevalence rate

RABIES CONTROL PROGRAM

Hydrophobia, Lyssa Introduction

Rabies is an acute viral encephalomyelitis caused by the rabies virus, a rhabdovirus of the genus lyssavirus. It is fatal once signs and symptoms appear. Two kinds: 1. Urban or Canine Rabies transmitted by dogs 2. Sylvatic Rabies disease of wild animals and bats which sometimes spread to dogs, cats and livestock Rabies remains a public health problem in the Philippines. Approximately 300 to 600 Filipinos die of rabies every year. Philippines has one of the highest prevalence rates of rabies in the whole world. Mode of Transmission Usually by bites of a rabid animal whose saliva has the virus. The virus may also be introduced into a scratch or in fresh breaks in the skin (very rare). Transmission from man to man is possible. Airborne spread in cave with millions of bats have occurred, although rarely. Organ transplant (Corneal) taken from person dying of diagnosed central nervous system disease have resulted in rabies in the recipients. Incubation Period The usual incubation period is 2 to 8 weeks. It can be as long as a year or several years depending on the severity of the wound, site of wound as distance from the brain, amount of virus introduced and protection provided by clothing. Period of Communicability In dogs and cats, for 3 to 10 days before onset of clinical signs (rarely over 3 days) and throughout the duration of the disease. Susceptibility and Resistance: All warm-blooded mammals are susceptible. Natural immunity in man is unknown. Signs and Symptoms in Man Sense of apprehension Headache Fever Sensory change near site of animal bite Spasms of muscles or deglutition on attempts to swallow (fear of water / hydrophobia) Paralysis Delirium and convulsions Without medical intervention, the rabies victim would usually last for only 2 to 6 days. Death is often due to respiratory paralysis. Management / Prevention The wound must be immediately and thoroughly washed with soap and water. Antiseptics such as povidone iodine or alcohol may be applied. The patients may be given antibiotics and anti-tetanus immunization. Post-exposure treatment is given to persons who are exposed to rabies. It consists of local wound treatment, active immunization (vaccination) and passive immunization (administration of rabies imuunoglobulin) o Active immunization or vaccination aims to induce body to develop antibodies against rabies up to 3 years.

Passive immunization the process of giving an antibody to persons (with head and neck bites, multiple single deep bites, contamination of mucous membranes or thin coverings of the eyes, lips, mouth) in order to provide immediate protection against rabies which should be administered within the first seven days of active immunization. The effect of the immunoglobulin is only short term. Then consult a veterinarian or trained personnel to observe your pet for 14 days for signs of rabies. Be a responsible pet owner o Have pet immunized at 3 months of age and every year thereafter o Never allow pets to roam the streets o Take care of your pet; bathe, feed the regularly with adequate foo, provide them with clean sleeping quarters o Your pets action is your responsibility Consult for rabies diagnosis and surveillance of the area. Mobilize for community participation o

National Rabies Prevention Program Goal: Human rabies is eliminated in the Philippines and the country is declared rabies-free General Objectives To reduce the incidence of Human Rabies from 7 per million to 1 per million population by 2010 and eliminate human rabies by 2015 To reduce the incidence of canine rabies from 70 per 100,000 to 7 per 100,000 dogs by 2010, and eliminate canine rabies by 2015

The program is jointly implemented by the Department of Agriculture (Bureau of Animal Industry), Department of Health, Department of Education, Culture and Sports, Department of Interior and Local Government and Non-Government Organizations. Strategies Manpower Development o Training of health workers, veterinarian and and laboratory technicians on management of animal bite cases Social Mobilization o Organizational meetings o Networking with other sectors Local Program Implementation o Establish/ Reactivation of Local Rabies Control Communities o Enactment/ Enforcement of Ordinance on Dog Control Measures Dog Immunization o Pre-vaccination activites Identification of priority areas Procurement/ Distribution of Dog Vaccines Social Preparation o Conduct of dog vaccination o Post-immunization Evaluation

MALARIA CONTROL PROGRAM

 is a disease caused by infection with single-celled parasites of the genus PLASMODIUM. The bite of the Anopheles mosquito transmits these parasites from one person to another. Four Plasmodia produce malaria in humans: 1. 2. 3. 4. Plasmodium falcifarum P. Ovale P. Malariae P. Vivax

The severity and characteristic manifestation of the disease are governed by: 1. Infecting species 2. The magnitude of the parasitemia 3. The metabolic effects of the parasite 4. The cytokines released as the result of the infection. Symptoms Recurrent chills Fever Profuse sweating Anemia Malaise Hepatomegaly Spleenomegaly Life cycle of a malaria parasite (VIDEO) EARLY DIAGNOSIS AND PROMPT TREATMENT: 1. Clinical Method- is based on the signs and symptoms of the patient and the hx of his/her having visited a malaria-endemic area. 2. Microscopic Method- is based on the examination of the bood smear of the patient through a microscope. CHEMOPROPHYLAXIS only Chloroquine drug should be given must be taken at weekly intervals, starting 1-2 weeks before entering the endemic area. in pregnant women, is given throughout the duration of pregnancy. Sustainable Preventive and Vector Control Measures: Insecticide- treatment of Mosquito net in an insecticide solution House Spraying- application of insecticide in the indoor surfaces On Stream Seeding- construction of bio-ponds for fish propagation On Stream Clearing- cutting of the vegetation overhanging along stream banks RECOMMENDED ANTI-MALARIA DRUGS: Blood schizonticides- drugs acting on sexual blood stages of the parasites which are responsible for clinical manifestations. Chloroquine phosphate Sulfadoxine Quinine sulfate Quinine hydrochloride Tetracycline hydrochloride

Quinidine sulphate Quinidine glucolate

Other Preventive Measures: 1. Wearing of clothing that covers arms and legs in the evening 2. Avoiding outdoor night activities, particularly during the vectors peak biting hours from 9PM to 3AM 3. Using mosquito repellents such as mosquito coils, soap lotion or other personal measures advocated by the DOH/MCS- Malaria Control Service 4. Planting of Neem tree or other herbal plants which are (potential) 5. mosquito repellents as advocated by the DOH/MCS- Malaria Control service 6. Zooprophylaxis-the typing of domestic animals like carabao, cow, etc., near human dwellings to deviate mosquito bites from man to these animals.

DENGUE FEVER CONTROL PROGRAM

-is an infectious tropical disease caused by the dengue virus. Signs and Symptoms An acute febrile infection of sudden onset with clinical manifestation of 3 stages: First 4 days- Febrile or invasive stage starts abruptly as high fever, abdominal pain and headache; later flushing which may be accompanied by vomiting, conjunctival infection and epistaxis. 4th- 7th days- Toxic or hemorrhagic stage- lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from gastrointestinal tract in the form of hematemesis or melena. 7th10th Convalescent or recovery stage generalized flushing with intervening areas of blanching appetite regained and blood pressure already stable. Classification Severe, frank type Moderate Mild SOURCE OF INFECTION: Aedes Aegypti, the infected person MODE OF TRANSMISSION: Mosquito Bite INCUBATION PERIOD: Uncertain. Probably 6 days to one week. Period of Communicability Unknown. Presumed to be on the 1st week of illness when virus is still present in the blood. Peak age of Dengue Acquisition Age groups predominantly affected are the preschool age and school age. Adults and infants are not exempted. Peak age affected 5-9 years. Peak month of Dengue occurrence Occurrence is sporadic throughout the year. Epidemic usually occur during the rainy seasons June-November. Peak months are September & October. DIAGNOSTIC TEST: tourniquet test (RUMPEL LEADS TEST ) -A positive tourniquet test on the left side of the image in a person with dengue fever. Pump up a blood pressure cuff on one of the arm to more than venous pressure (70 mm Hg) Keep it for 5 minutes and then ease the pressure. Examine the extremity of the pressure for petechiae.

If there are more than 2 petechiae, the test is positive.

Public Health Nursing in the Philippines Report immediately to the Municipal Health Office any known case outbreak. Refer immediately to the nearest hospital, cases that exhibit symptoms of hemorrhage from any part of the body no matter how slight. Assist in the diagnosis of suspect based on the signs and symptoms. Nursing Care For hemorrhage Keep the patient at rest during bleeding episodes. o For nose bleeding, maintain an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an ice bag over the forehead. o For melena, ice bag over the abdomen. Avoid unnecessary movement. o If transfusion is given, support the patient during the theraphy. Observe signs of deterioration(shock) such as low pulse, cold clammy perspiration, prostration. For shock o Prevention is the best treatment. Dorsal recumbent position facilitates circulation. o Adequate preparation of the patient, mentally and physically prevents occurrence of shock. o Provision of warmth- through lightweight covers (overheating causes vasodilation which aggravates bleeding). Diet Low fat, low fiber, non- irritating, non-carbonated. Noodle soup may be given. PREVENTION AND TREATMENT Bed rest during acute stage of fever Sponging to keep body temperature below 40 C Oral fluids in plenty to maintain circulating fluid volume Electrolyte therapy to counter dehydration Fluid replacement in case of loss of blood plasma, similar to that done in case of diarrhea The preventive measures would include: Destroying the mosquitoes, Aedes aegyptii and Aedes albopictus using chemical agents where they breed Improving environmental hygiene Disposal of solid waste hygienically Providing secure covering for water storage tank and containers.