Communicable Disease

By: Maynard P. Agustin

Introduction

Vaccination and control of communicable diseases are two of the great public health achievements of the last century Infectious diseases are now the world's biggest killer of children and young adults; both are vital age groups. They account for more than 13 million deaths a year - one in two deaths in developing countries

Introduction

About 32 percent of all deaths worldwide are caused by communicable diseases, maternal and perinatal conditions and nutritional deficiencies. Almost 90 percent of these deaths are caused by pneumonia, tuberculosis (TB), diarrheal diseases, malaria, measles, and the HIV. It is a fundamental part of the whole of Epidemiology.

What is a Communicable Disease?

A disease that is spread from one living thing to another or through the environment.

Pathogens

An organism that causes disease is called a pathogen. Pathogens include: Viruses Bacteria Fungi Protozoans

Viruses

They need living cells to reproduce. They are parasites. Antibiotics do not work against a virus. Examples include cold, flu, measles, herpes, mononucleosis, hepatitis HPV and HIV.

Bacteria

Bacteria are everywhere. Most are harmless. Antibiotics can be used to kill bacteria. Examples are strep throat , E. coli, gonorrhea & tuberculosis.

Fungi

Plantlike organisms, such as molds & yeasts. Examples are ringworm, Jock itch & athletes feet.

Protozoans

One celled animals Most are harmless, but some can cause disease Examples are malaria & amoebic dysentery

Rickettsias

Resemble bacteria. Like viruses, they multiply by invading the cells of another life form. Often enter humans through the bites of insects such as fleas or lice. Examples include typhus & Rocky Mt. Spotted fever.

Infectious disease
A clinically manifest disease of man or animals resulting from an infection.

Contagious disease
A disease that is transmitted through direct contact

Reservoir Any person, animal, arthropod, plant, soil, or substance ; in which an infectious agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such manner that it can be transmitted to a susceptible host.
Host

A person or animal ( including birds and arthropods) that afford subsistence or lodgment to an infectious agent under natural conditions.

Susceptible
A person or animal not possessing sufficient resistance against a particular pathogenic agent to prevent contracting infection or disease when exposed to the agent.

Carrier
A person or animal that harbors a specific infectious agent without apparent clinical disease and serves as potential source of infection.

Infectivity: Capacity of agent to enter and multiply in a susceptible host (hence produce infection/disease) (polio and measles have high infectivity)

Pathogenicity: Capacity of agent to cause clinical disease in the infected host (measles has high pathogenicity)

Virulence The degree of pathogenicity of an infectious agent. i.e. the ability of the agent to invade and damage tissues of the host causing severe manifestations or death. Toxigenicity: The ability of a microbe to produce bio chemicals, known as toxins that disrupt the normal functions of cells or are generally destructive to human cells and tissues

Resistance: Ability of agent to survive adverse environmental conditions (hepatitis agents generally very resistant whereas influenza viruses are typically fragile). Note: resistance is also applied to the host.

Antigenicity: Ability of agent to induce antibody production in the host (e.g. re-infection with measles virus is very rare).

Nosocomial infections

Nosocomial (hospital acquired) infection is an infection originating in a patient while in a hospital or another health care facility. It has to be a new disorder unrelated to the patients primary condition. Examples include infection of surgical wounds, hepatitis B and urinary tract infections.

Opportunistic infection

This is infection by organisms that take the opportunity provided by a defect in host defense (e.g. immunity) to infect the host and thus cause disease.
Opportunistic infections are very common in AIDS. (Herpes simplex, cytomegalovirus, M. tuberculosis.etc)

Dynamic of Diseases Transmission

Chain of Infection
A process that begins when an agent leaves
its reservoir or host through a portal of exit,

and is transported by some mode of

transmission, then enters through an

appropriate portal of entry to infect a
susceptible host.

Chain (Cycle) of infection

Agent
Susceptible Host

Reservoir

Portal of Inlet

Portal of Exit

Mode of transmission

Incubation Period

The period from exposure to infection to the onset of symptoms or signs of infectious disease. o The portal of entry.
o The rate of growth of the organism in the host. o The dosage of the infectious agent.

The length of incubation period depends on:

o The host resistance.

Period of Communicability
The time during which an infectious
agent my be transmitted directly or indirectly from an infected person to a susceptible person or animal. Its length varies from one disease to another

1. Agent

Microorganisms are responsible for disease production (viruses, bacteria, protozoa, parasites, fungi,.. Agent factors that affect disease transmission:
o

Infectivity

o
o o

Pathogenicity
Virulence Antigenicity

2. Source or Reservoir

The reservoir of an agent is the habitat in which an infectious agent normally lives, grows, and multiplies. any person, animal, arthropod, plant, soil, or substance, or a combination of these, in which an infectious agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such a manner that it can be transmitted to a susceptible host. It is the natural habitat of the infectious agent.

Types of reservoirs
Reservoir

Human Human reservoiir

Animal reservoir

Non-living reservoir

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Pathogen Reservoirs

Humans are the most important reservoir of human infectious disease.

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Human reservoir
Human reservoir

Cases

Carriers

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Cases
A case is defined as a person in the population or
study group identified as having the particular disease, health disorder, or condition under investigation

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Carriers

A person or animal without apparent disease who harbors a specific infectious agent and is capable of transmitting the agent to others.
It occurs either due to inadequate treatment or immune response, or the disease agent is not completely eliminated, leading to a carrier state.

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Carriers are dangerous because:

1.

They do not show any clinical manifestation so they carry normal life. The carrier and his contacts are not aware of their condition so, they take no precautions. It is difficult to discover them. It is not always possible to deal with them. They can remain infectious for a long time leading to repeated introduction of the disease to contacts.

2.

3. 4. 5.

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Types of Carriers:
1.

Asymptomatic (In-apparent) carrier: Examples: Polio virus, meningococcus, hepatitis A virus Incubatory, Convalescent, Post-Convalescent carriers:

The carrier state that may occur in an individual with an infection that is in-apparent throughout its course

2.

The carrier state may occur during the incubation period, convalescence, and post convalescence of an individual with a clinically recognizable disease.

Examples of Incubatory carrier: Measles, chickenpox

Examples of convalescent carriers: Salmonella typhi, Diphtheria, hepatitis B virus

3. Healthy (chronic) carriers:
They continue to harbour an agent for an extended time (months or years) following the initial infection.

Examples: Hepatitis B virus, S. typhi

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Animal reservoirs
Zoonosis

is an infection that is transmissible under natural conditions from vertebrate animals to man, e.g. rabies, plague, bovine tuberculosis.. There are over a 100 zoonotic diseases that can be conveyed from animal to man.

brucellosis (cows and pigs), anthrax (sheep),

plague (rodents),
rabies (bats, dogs, and other mammals).

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Zoonoses are Human Diseases with Animal Reservoirs.

Zoonoses

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Toxoplasmosis

Zoonoses

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Reservoir in non-living things

Water,

Soil and inanimate matter can also act as reservoir of infection.

For example
Soil

may harbor agents that causes tetanus, anthrax. of water are the primary reservoir of

Pools

Legionnaires bacillus.

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3. Portal of exit

Portal of exit is the path by which an agent leaves the source host.

Examples:

Respiratory tract
GIT

Skin and mucous membrane

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4. Modes of transmission

Many different ways As a rule only one route for each pathogen
o o

Typhoid fever ----- vehicle transmission Common cold---------direct contact

But there are others that may be transmitted by several route

o

AIDs, Salmonellosis, Hepatitis B, brucellosis, Q fever,..etc.

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Mode of transmission

Direct transmission

Indirect transmission
Vehicle-borne

Direct contact Droplet infection Contact with soil

Vector-borne:

Mechanical biological propagative

Cyclo-prop.

Air-borne

Cyclo-develop.

Inoculation into skin or mucosa

Trans-placental (vertical)

Fomite-born Unclean hands and fingers

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Modes of Transmission

Pathogen Transmission

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Direct transmission
Direct Contact
is essentially immediate transfer of the agent from a reservoir to a susceptible host by direct contact or droplet spread. Direct contact occurs through: Skin-to-skin contact, kissing, and sexual intercourse. Direct contact refers also to contact with soil or vegetation harbouring infectious organisms.
There
STDs,

AIDs, leprosy, Skin and Eye infections

Contact Transmission

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Rhinovirus?

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Direct transmission
Droplet Infection
Direct projection of a spray of droplets of saliva and naso-pharyngeal secretions Produced by sneezing, coughing, or even talking. Particles <5mmm can penetrate deeply and reach the alveoli. Usually limited to a distance of max 1 meter (30-

60cm).
o

Close proximity o Overcrowding o Lack of ventilation Common cold, TB, Meningococcal Meningitis, Whooping cough.

Droplet Transmission
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Measles?

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Direct transmission
Contact with soil
Direct exposure of the susceptible tissues to the disease agent in soil E.g. Tetanus, Hookworm.

Inoculation into skin or mucosa

The agent is directly inoculated into skin or mucosa. E.g. rabies, hepatitis B,

Trans-placental

TORCH, Varicella, Hepatitis B, AIDs

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Indirect Transmission
From a reservoir to a susceptible host by:

Vehicle borne: inanimate vehicle Vector borne: animate vector Airborne transmission: suspended air particles

The infectious agent must be capable of surviving outside the human host in the external environment.

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Vehicle borne:

An infectious agent is carried from a reservoir to a susceptible host by an inanimate intermediary.

1. 2. 3.

Vehicles include:
Contaminated food and water: typhoid, paratyphoid,
food poisoning, dysentery and cholera.

Biologic products (blood): Hepatitis B, AIDS, Syphilis. Fomites (inanimate objects such as: door knobs, toys, handkerchiefs, bedding, or surgical instruments). Influenza.

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Foodborne Transmission

Hepatitis A

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Waterborne Transmission

Cryptosporidium parvum?

Indirect-Contact Transmission Methicillinresistant Staphylococcus aurius (MRSA)?

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Beddings are an example of a Fomite, an inanimate object that can transmit pathogens between people.

Indirect-Contact Transmission
Influenza virus?

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Door knobs are another good example of a fomite.

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Vector-borne

Vector is an arthropod or any living carrier (e.g. snail) that transport an infectious agent to a susceptible individual. Arthropod include flies and mosquitoes, fleas, cockroaches, ticks and mites, sucking lice, eyc.

or undergo physiologic changes in the vector. For example, flies carry Shigella on appendages. Biologic transmission: When the agent undergoes changes and/or multiplication within the vector before it is transmitted.

Mechanical transmission: the agent does not multiply

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Modes of Transmission

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Airborne
Airborne transmission occurs by particles that are suspended in air. There are two types of these particles: - dust and - droplet nuclei.
1.

Dust particles:

-result from re-suspension of particles that have settled on floor or bedding, - infectious particles blown from the soil by the wind. Example: Fungal spores.

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2.

Droplet nuclei
They represent the dried residue of droplets that have been coughed or sneezed into the air. They are very tiny particles less than 5 (microns) in size and may remain suspended in the air for long periods. Tuberculosis is transmitted more often indirectly, through droplet nuclei, than directly, through direct droplet spread. Legionnaires disease and histoplasmosis also spread through airborne transmission.

Examples:

Airborne Transmission
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Mycobacterium tuberculosis?

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5. Portal of entry
An agent enters a susceptible host through a portal of entry. -The portal of entry must provide access to tissues

in which the agent can multiply or a toxin can act.

- Often, organisms use the same portal to enter a new host that they use to exit the source host.

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6. Susceptible host
A susceptible host is the final link in the chain of infection. The host is a person or other living organism that can be infected by an infectious agent under normal conditions. An infectious agent seeks a susceptible host aiming successful parasitism.

Four stages are required for successful parasitism:

1. Portal of entry

2.
3. 4.

Site of election inside the body

Portal of exit Survival in external environment

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Susceptibility of a host depends on:

1.

Genetic factors
General factors Host defense (Specific acquired immunity)

2.

3.

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General factors that may increase susceptibility

Malnutrition, Alcoholism, and Disease or therapy which impairs the immune response (Cortisone, cytotoxic drugs, ...

How Communicable Diseases are Transmitted

Direct Contact- shaking hands, kissing & sex. Indirect Contact- Contaminated objects, vectors, water & food. Airborne- sneezing & coughing, inhaling contaminated soil.

Infection
Is

a condition that occurs when pathogens enter the body, multiply and damage body cells

Strategies for Preventing Communicable Disease:

Washing hands Preparing, handling and storing food properly Avoid sharing eating utensils & personal items Avoid contact with people who are ill Make sure you are vaccinated Practice abstinence from sexual activity Learn to manage stress Take care of your health

Preventing Communicable Diseases

Physical

& Chemical Barriers

Skin Tears Sweat Mucous membranes Cilia Gastric juice

Preventing Communicable Diseases

Immune

System

Inflammatory response Lymphocytes (B & T cells) Memory Lymphocytes Active Immunity Passive Immunity

Preventing Communicable Diseases

Vaccines
Live-virus (measles, mumps & rubella) Killed-virus (flu shots, rabies, cholera & hepatitis A) Toxoids (tetanus, diphtheria) New & second-generation vaccines (Hepatitis B)