Prevention and Control of Infectious Disease

PREVENTION AND CONTROL
OF INFECTIOUS DISEASES
Infectious Agent
Every disease has

Susceptible Host
Reservoir
certain weak points
susceptible to attack.
CHAIN OF INFECTION
The basic approach in
controlling disease is
to identify these weak
Portal of Entry
points and break the
Portal of Exit
weakest links in the
Mode of Transmission
chain of transmission.
IDENTIFYING WEAK POINTS
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Measures,
pending results
od epidemiologic
investigation:
The reservoir or
source of infection
The route(s) of
transmission
The susceptible host
(people at risk)
If the first link in the chain of

causation is deemed to be the
weakest link, logically, the most
desirable control measure would be
to eliminate the reservoir or source, if
that could be possible.
CONTROLLING THE
RESERVOIR
Elimination of the reservoir may be

pretty easy with the animal reservoir
but is not possible in humans in
whom the general measures of
reservoir control comprise early
diagnosis,
notification,
isolation,
treatment, quarantine , surveillance
and disinfection all directed to
reduce the quantity of the agent
available for dissemination.
(1) EARLY DIAGNOSIS

The first step in the control
communicable
disease
is
its
identification.
of a
rapid
(2) NOTIFICATION
Once
an infectious disease has been

detected (or even suspected), it should be
notified to the local health authority whose
responsibility is to put into operation control
measures, including the provision of medical
care to patients, perhaps in a hospital.
Certain
diseases are statutorily notifiable.

The diseases to be notified vary from
country to country: and even within the
same country. Usually, diseases which are
considered to be serious menaces to public
health are included in the list of notifiable
diseases. Notifiable diseases may also
include non-communicable diseases and
(2) NOTIFICATION
Notification
is an important source of
epidemiological information. It enables early
detection of disease outbreaks, which permits
immediate action to be taken by the health
authority to control their spread. The other uses
of m=notification are discussed elsewhere,
Notification
of infectious diseases is often made

by the attending physician or the head of the
family, but any one including the lay people can
report, even on suspicion. In all cases, the
diagnosis is verified by the local health
authority.
(2) NOTIFICATION
Under
the International Health Regulation

(IHR) certain prescribed diseases are notified
by the national health authority to WHO,
These can be divided into:
Those diseases subject to IHR (1969). 3rd
Annotated Edition. 1983 cholera, plague
and yellow fever.
Diseases under surveillance by WHO
louse-borne typhus fever, relapsing fever,
paralytic polio, malaria, viral influenza, etc.
Health administrations are required to
notify to WHO Geneva for any notification
(3) EPIDEMIOLOGICAL
INVESTIGATIONS
An
epidemiological investigation is called for

whenever there is a disease outbreak the
methodology for which is given elsewhere.
Broadly,
the investigation covers the

identification of the source of infection and
of factors influencing its spread in the
community.
These
may include geographical situations,

climatic condition, social, cultural and
behavioral patterns, and more importantly
the character of the agent, reservoir the
vectors and vehicles and the susceptible
host populations.
(4) ISOLATION
Isolation
is the oldest communicable disease

control measure. It is defined as separation,
for the period of communicability, of infected
persons or animals from others in such
places and under such conditions, as to
prevent or limit the direct or indirect
transmission of the infectious agent from
those infected to those who are susceptible,
or who may spread the agent to others.
In
general, infections from human/animal

sources can be controlled by physical
isolation of the case or carrier and it
necessary, treatment until free from
infection, provided cases and carriers can be
(4) ISOLATION
The purpose of isolation is to protect the
community by preventing transfer of infection from
the reservoir to the possible susceptible hosts.
The type of isolation varies with the mode of
spread and severity of the disease.
There are several types of isolation standard
isolation, strict isolation, protective isolation,
high security isolation.
For each patient, the relative risks to the patient
and to others should be assessed and the
appropriate type of isolation determined.
Hospital isolation, wherever possible, is better than
home isolation.
Isolation is particularly difficult in rural areas, in
some situations that entire village or rural
(4) ISOLATION
Isolation
may also be achieved in some

diseases by ring immunization, that is
encircling the infected persons with a barrier
of immune persons through whom the
infection is unable to spread.
This method when applied worldwide in the
1960s and 1970s eradicated smallpox.
In North America, ring immunization is being
applied in measles control and eradication.
The duration of isolation is determined by the
duration of communicability of the disease
and the effect of chemotherapy on infectivity.
PERIOD OF ISOLATION
RECOMMENDED
DISEASE
DURATION OF ISOLATION
Chickenpox
Until all lesion created about 6

days after onset of rush
Measles
From the onset of catarrhal

stage thought 3rd day of rush
Diphtheria
Cholera
3 days after tetracycline

started, until 48 hours of
antibiotics/or negative culture
after treatment
Shigellosis
Until 3 consecutive negative

stool cultures
Salmonellosis
Until 3 consecutive negative

stool cultures
Hepatitis A
3 weeks
PERIOD OF ISOLATION
RECOMMENDED
DISEASE
DURATION OF ISOLATION
Influenza
3 days after onset
Polio
2 weeks adult, 6 weeks

pediatrics
Mumps
Until swelling subsides
Pertussis
4 weeks or until paroxysm

cease
Meningococcal inf.
Until the first 6 hours of

effective antibiotic therapy
are completed
Streptococcal pharyng.
Until the first 6 hours of

effective antibiotic therapy
are completed
(4) ISOLATION
Isolation
has a distinctive value in the control

of some infectious diseases.
In some diseases where there is a large
component of subclinical infection and
carrier state, even the most rigid isolation
will not prevent the spread of the disease.
It is also futile to impose isolation if the
disease is highly infectious before it is
diagnosed as in the case of mumps.
Isolation has tailed in the control of diseases.
In the control of these diseases, the concept
of physical isolation has been replaced by
chemical isolation.
Lastly, cases are usually reported after the
(4) ISOLATION
Taking
all
these
limitations
into
consideration, it may be stated that isolation
which is a barrier approach to the
prevention and control of infectious disease
is not as successful as one would imagine
and may well give rise to a false sense of
security.
In
modern-day disease control, isolation is

more judiciously applied and in most cases
replaced
by
surveillance
because
of
improvements
in
epidemiological
and
disease control technologies.
Today
isolation is recommended only when
(5) TREATMENT
Many
communicable diseases have been

tamed by effective drugs.
The
object of treatment is to kill the

infectious agent when it is still in the
reservoir, i.e. before it is disseminated.
Treatment reduces the communicability o f

disease, cuts short the duration of illness
and prevents development of secondary
cases.
In
some diseases, early

treatment is of primary
diagnosis and
importance in
(5) TREATMENT
Treatment
can take the form of individual

treatment or mass treatment.
In the latter category, all the people in the
community are administered the drugs
whether they have the disease or not.
If the treatment is inadequate or inappropriate,
it may induce drug resistance in the infectious
agent and may frustrate attempts to control
the disease by chemotherapy.
It is well to remember that no disease has ever
conquered through attempting to treat every
affected individual.
(6) QUARANTINE
QUARANTINE:
DEFINITION
The limitation of freedom of movement of
such well persons or domestic animals
exposed to communicable disease for a
period of time not longer than the longest
usual incubation period of the disease, in
such manner as to prevent effective
contact with those not so exposed.
QUARANTINE
MEASURES
Applied by a health authority to a ship, an
aircraft, a train, road vehicle, other means
of transportation or container, to prevent
the spread of disease, reservoirs of disease
(6) QUARANTINE
QUARANTINE
may comprise:
Absolute quarantine
Modified quarantine, e.g. a selective partial
limitation of freedom or movement, such as
exclusion of children from school
Segregation which has been defined as the
separation for special consideration, control of
observation of some part of a group of persons
(or domestic animals) from the others to
facilitate control of a communicable disease,
e.g. removal of susceptible children to homes
of immune persons.
(6) QUARANTINE
In
contrast to isolation, quarantine applies to

restrictions on the healthy contacts of an
infectious disease. Quarantine which was
once popular method of disease control has
now declined in popularity. With better
techniques of early diagnosis and treatment,
quarantine, as method of disease control,
has become outdated. It has been replaced
by active surveillance.
A major aspect of communicable

disease control relates to breaking
INTERRUPTION
OFThis may
the chain of transmission.
mean changing some components of
TRANSMISSION
mans environment to prevent the
infective agent from patient or carrier
from entering the body of susceptible
host.
For example, water can be a medium

for transmission of many disease
such as dysentery, hepatitis A,
cholera.
Water
treatment
will
eliminated these diseases.
Depending
upon
the
level
of
population, this may vary from simple
chlorination to complex treatment.
INTERRUPTION
OF
Food-born
disease is particularly
TRANSMISSION
prevalent in areas having low
standards of sanitation.
Clean practices such as hand

washing, adequate cooking, prompt
refrigeration of prepared foods and
withdrawal of contaminated food will
prevent most food-born illness.
INTERRUPTION OF
TRANSMISSION
When the disease is vector-born,

control measures should be directed
primarily at the vector and its breeding
places.
INTERRUPTION OF
On the other hand, episodes of
TRANSMISSION
infection either by droplets or droplet
nuclei are not usually controlled
effectively by attempting to interrupt
their mode of spread; reliance is
placed on early diagnosis and
treatment
of
patients,
personal
hygiene and proper handling of
secretions and excretions.
The SUSCEPTIBLE
THE
third link in the chain
HOST
of
transmission is the susceptible host

or people at risk.
They may be protected by:
Active Immunization
Active immunization is one of the
most powerful and cost-effective
weapons the modern medicine.
ACTIVE
IMMUNIZATION
For example:
Against cholera
Given subcutaneously in
2 equal doses of 0.5 ml
at an interval of 4 to 6
weeks. Immunity
develops 6 days after
inoculation. Booster
dosees are
recommended every 6
months.
Against plague
Given subcutaneously or
l.m. 2 doses at an
interval of 7 to 14 days.
Immunity starts 5 to 7
THE SUSCEPTIBLE HOST
Passive Immunization
Passive immunization is a shortterm expedient useful only when

exposure to infection has just
occurred or is imminent within
the next few days. The duration
of immunity induced is short and
variable-1-6 weeks.
Combined active
immunization
and
passive

Chemoprophylaxis
Chemoprophylaxis
implies
the
protection from, or prevention of,
disease. For examples:
Cholera
Tetracycline or furazolidone
(furoxone) for house-hold
contacts/selective
chemoprophylaxis (one dose of
doxycycline)
Diphtheria
Erythromycin and first dose of

vaccine
Plague
Tetracycline for contacts of

pneumonic plague
Meningococcal
meningitis
Sulphadiazine for 4 days only if

strain is shown to be no-resistant,
for household and close community

Non-specific
Measures
Improvement in the quality of life
(e.g.
better
housing,
water
supply,
sanitation,
nutrition,
education) fall into this category.
BREAKING
THE CHAIN OF
INFECTION
PREVENTION AND CONTROL OF NOSOCOMIAL INFECTIONS
Susceptible
Host
Immunosuppressio
n
Diabetes-SurgeryBurns
Cardiopulmonary
Treatment
of
Infectious
Agent
Bacteria
Fungi
Viruses
Rickettsiae
Protozoal
Rapid,
accurate
Identificatio
n of
organisms
INVOLVES ALL
HEALTH
underlying disease
Recognition of highPROFESSIONALS
patients
Portal of Entry
YOU
Mucous membrane
Gl track
Respiratory track
Broken skin
Aseptic technique
Catheter care
Wound care
Means of
Transmission
Direct Contact
Fomites
Ingestioon
Hand washing
Airborne
Sterilization
Isolation
Food handling
Air flow control
Reservoirs
People
Equipment
Water
Employee health
Environmental
sanitation
Disinfection/steriliza
tion
Portal of Exit
Excretions
Secretions
Skin
Droplets
Proper attire
Hand washing
Control of excretions &
secretions
Trash & waste disposal
INCIDENCE
(EPIDEMIOLOGICAL)
The incidence of disease is defined as the number of new

cases of disease occurring in a population during a defined
time interval. The number is useful to epidemiologists
because it is a measure of the risk of disease.
The incidence per 1,000 is defined as follows:
Number of new cases of a disease occurring in a specified period of time

x 1000
Number of individuals at risk of developing the disease during that time
period
MORTALITY RATE
The proportion of individuals in a population that die ina

given period of time, usually a year and usually multiplied
by a 10n population size so it is expressed as the number
per 1,000, 10,000, 100,000, individuals per year.
These proportions are often broken

age-specific proportions and are
different groups can be compared
the middle of the time interval
denominator.
into cause-specific and

often standardized so
and the population at
is often used as the

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What are the steps involved in controlling the spread of an infectious disease?

What are the steps involved in controlling the spread of an infectious disease?

What are the different components of the chain of infection?

What are the different components of the chain of infection?

PREVENTION AND CONTROL

Every disease has

If the first link in the chain of

Elimination of the reservoir may be

(1) EARLY DIAGNOSIS

an infectious disease has been

diseases are statutorily notifiable.

of infectious diseases is often made

the International Health Regulation

epidemiological investigation is called for

the investigation covers the

may include geographical situations,

is the oldest communicable disease

general, infections from human/animal

may also be achieved in some

Until all lesion created about 6

From the onset of catarrhal

3 days after tetracycline

Until 3 consecutive negative

Until 3 consecutive negative

3 days after onset

2 weeks adult, 6 weeks

Until swelling subsides

4 weeks or until paroxysm

Until the first 6 hours of

Until the first 6 hours of

has a distinctive value in the control

modern-day disease control, isolation is

isolation is recommended only when

communicable diseases have been

object of treatment is to kill the

Treatment reduces the communicability o f

some diseases, early

can take the form of individual

contrast to isolation, quarantine applies to

A major aspect of communicable

For example, water can be a medium

Clean practices such as hand

When the disease is vector-born,

transmission is the susceptible host

They may be protected by:

THE SUSCEPTIBLE HOST

Passive immunization is a shortterm expedient useful only when

THE SUSCEPTIBLE HOST

Erythromycin and first dose of

Tetracycline for contacts of

Sulphadiazine for 4 days only if

THE SUSCEPTIBLE HOST

PREVENTION AND CONTROL OF NOSOCOMIAL INFECTIONS

The incidence of disease is defined as the number of new

The incidence per 1,000 is defined as follows:

Number of new cases of a disease occurring in a specified period of time

The proportion of individuals in a population that die ina

These proportions are often broken

into cause-specific and