MLS 051- Community and Public Health-

Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

Lesson title: SMALLPOX ERADICATION PROGRAM & Materials:

EPIDEMIOLOGICAL PRINCIPLES OF DISEASE CONTROL
Pen, paper, lecture book
Lesson Objectives:

At the end of this module, you will be able to:

References:
1. Explain properly the natural history of the disease
process and smallpox eradication program. Bien Eli P. Nillos Introduction to
2. Explain accurately the nature of communicable Public Health., Educational
diseases. Publishing House, First Edition
3. Enumerate the communicable diseases’ disease 2015
control and preventive measures.
4. Discuss the incidence of communicable diseases.
5. Understand explain concisely the mitigation process
of disease control.

A. LESSON PREVIEW/REVIEW

The Chain of Infection

-a term used to describe the pattern by which an infectious disease is transmitted from person to person.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

THE SMALLPOX ERADICATION PROGRAMME - SEP (1966-1980)

2010 marks the 30th anniversary of the eradication of smallpox. Smallpox was officially declared
eradicated in 1980 and is the first disease to have been fought on a global scale. This extraordinary
achievement was accomplished through the collaboration of countries around the world.
At the end of the 1960s, smallpox was still endemic in Africa and Asia. Vaccination campaigns,
surveillance and prevention measures aimed to contain epidemic hotspots and to better inform
affected populations. All these strategies were used to combat the disease.The photographs presented
in the galleries below illustrate the various activities carried out to eradicate smallpox around the world.
They show how the same eradication methods and strategies were repeated in very different countries
around the globe.

Before 1967, the smallpox eradication strategy relied on mass vaccination. However, this strategy was
ineffective in densely populated regions where containment measures proved more effective.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

Prevention activities aimed to stop transmission by finding and treating anyone who had been in close
contact with infected people, thereby preventing transmission to others.

Surveillance programmes reported cases and also collected morbidity and mortality data to better
understand the disease and the effectiveness and duration of immunity from vaccines.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

Workers in the field often had to adapt to very difficult conditions. Finding an effective means of
transport to reach remote villages was challenging, and team members often had to travel on foot.

Since smallpox was only transferred from person to person, the last infected person was the last link in
the chain of transmission and represented the end of the disease in a country.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

WHO created posters to publicize the disease or to support programme activities aiming to eradicate
smallpox. A selection of these posters is displayed here.

Epidemiological Principles of Disease Control

Epidemiology is the study of the distribution and determinants of health-related states or

events in specified populations, and the application of this study to the control of health problems.

DISTRIBUTION

Frequency includes not only the number of events in a population, but also the rate or risk of disease in
the population. Determining the rate of disease occurrences (number of events divided by size of the
population) is critical for making valid comparisons across different populations.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

DETERMINANTS

Epidemiology is also used to search for causes and other factors that influence the occurrence of health-
related events. The occurrence of a health-related event is usually related to multiple determinants that
should be considered.

Examples of determinants include host susceptibility to a disease, and opportunity for exposure to a
microorganism, environmental toxin, insect vector or other infected individual that may pose a risk for
acquiring disease.

SPECIFIED POPULATIONS

Epidemiologists are concerned with the collective health of people in a community or other area and the
impact of health events on that population.

APPLICATION

Epidemiology provides data for directing public health action. An epidemiologist uses the scientific
methods of descriptive and analytic epidemiology in "diagnosing" the health of a community, but also
must call upon experience and creativity when planning how to control and prevent disease in the
community.
• Disease surveillance usually begins with descriptive epidemiology -- defining the what, who,
when and where of health-related events.

o WHAT - Define the disease events and/or its determinants

o WHO - Descriptions of demographic characteristics are helpful in determining which

groups are at risk for some outcome. The demographic characteristics usually include
age, sex and race/ethnicity. Other categories include socioeconomic status, history of
occupation (or smoking habits) which provide useful information about exposures that
may present a risk. A history of underlying diseases may be useful for determining
susceptibility to certain conditions.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

o WHEN - Following changes in disease rates over time, following long-term disease
trends and knowledge of the seasonality of certain diseases helps identify unusual
occurrences that may define epidemics. Temporal associations between particular
exposures on illness give information about incubation periods and exposures posing a
risk to others.

o WHERE - Insight into the geographical extent of health-related events gives an idea of
where the agent that causes a disease normally lives and multiplies, what may carry or
transmit it and how it spreads.

PURPOSES OF COMMUNICABLE DISEASE INVESTIGATION

Nothing is less self-fulfilling than going through the motions of a task without understanding its
purpose. When investigating a report of communicable disease, always keep in mind the purposes are
to:

PREVENT TRANSMISSION FROM CASES TO CONTACTS

Identify the Source of the Disease: The source may be in the environment, a food, or another person.
Its identification can lead to control.

Identify Other Cases: Each reported case should be regarded as a sentinel health event. Efforts to
identify other cases which are not diagnosed and/or reported may uncover outbreaks and common
sources. It is important to question the reported case about others who have been exposed or who
have similar symptoms.

Conduct Surveillance: Information collected when investigating a reported disease can be examined
on a state or regional basis to identify outbreaks or trends and to formulate policy. This information is
collected on standardized forms and often is sent to the Centers for Disease Control and Prevention for
surveillance on a national basis.

Ensure that the Patient has Adequate Medical Supervision: Our responsibilities include making sure
the patient is well cared for and understands the consequences of his illness. Where medical care is
inadequate, appropriate referrals should be made.
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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

GENERAL PRINCIPLES OF PREVENTING TRANSMISSION

(Case Management & Contact Management)

CASE MANAGEMENT
A. Verify the Diagnosis
It is very important to promptly establish or verify the etiologic agent responsible for the disease.
For many diseases reported by physicians or others, there are often little or no laboratory data initially
available to verify the diagnosis. Since control efforts depend on the exact diagnosis, it is important to:

▪ (a) determine if this information exists;

▪ (b) arrange for laboratory tests if the information does not otherwise exist; or
▪ (c) Make the best guess about diagnosis if it cannot be obtained.

B. Determine if the Case is Infectious or Possibly Infectious:

If the case is still infectious, you must identify available measures for preventing transmission. There are
two ways to assess the case's infectivity:

◦ ESTIMATION--uses the date of onset of illness, dates of known treatment, and known periods
of infectiousness for an illness.
◦ VERIFICATION--requires laboratory testing of specimens for the case (for example, a stool
specimen for a food handler with salmonellosis). Which method you use depends upon the
disease (the period of communicability for some diseases is precise; for others it is not precise),
the quality of information about the case (e.g., is date of onset known?), and the need to know
definitely whether the case is infectious.

C. Minimize the Duration of the Case's Infectivity:

Drugs (antimicrobials) are the most important means to shorten the duration of infectivity for many
diseases. Usually, decisions about drug treatment will be made by the time you investigate. However,
sometimes it may be necessary to work with the patient and physician to ensure the patient is
appropriately treated.

D. Put into Effect Practices for Preventing Transmission:

These practices depend upon the disease and other circumstances.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

If the disease warrants, the case may have to employ these practices while ill and for a period after
recovery during which (s)he is still infectious:

◦ disinfect and dispose of contaminated material (e.g., blood, saliva, feces, urine, eating utensils,
bedding, clothes, toys, etc.)
◦ disinfect the case, clothing, bedding, etc. (e.g., lice)
◦ encourage behavioral practices of the case (e.g., handwashing, covering the nose and mouth
when coughing/sneezing, protecting lesions from contact with another person. Also, there may
be a need for changes if individual is a food handler.)
◦ isolate the case -- the duration and degree depends upon the illness

CONTACT MANAGEMENT

A. Determine the risk of infection to contacts:

What is the frequency, duration and dosage of the exposure?

Often, these characteristics can only be described vaguely.
It is usually reasonable to assume persons living in the same household had opportunity for exposure.
Is the contact susceptible? Has the person been vaccinated, or previously infected? Is there evidence of
a compromised immune system (surgery, steroids, etc.)? Does the disease result in immunity or are
people generally susceptible?

B. Determine if the contact is ill or infected:

Look for clinical signs or symptoms.

It is important to know if the contact is in the early stages of an illness or asymptomatic infected, you
must rely on the laboratory.
If you determine that a contact is ill or infected, manage him/her as a case.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

C. Prevent illness in susceptible:

It may be useful for you to think of contacts in two ways: Those who have been exposed, and those who
might yet be exposed, either to the original source or to a contact who subsequently acquires an
infection.

The choice of the preventive measure depends upon the disease. Rapid identification of susceptible is
important. Remember, vaccines usually require a time period greater than one incubation period to
develop antibody. Therefore, they rarely prevent illness in the first generation of contacts. They can,
however prevent illness in later generations. Immune globulins must be given within a few days of
contact to prevent or modify an infection, but they provide only short-term protection. Antimicrobials
are particularly important for contacts exposed to strep, tuberculosis and meningitis.

Limit the activities of exposed persons -- sometimes it may be prudent to recommend cessation of
contact between the contact and the source. Another example is quarantining exposed persons to
protect others not yet exposed.
Conduct personal surveillance of the exposed person -- it may be important to call an exposed person
by the end of the maximum incubation period to see if (s)he is ill (e.g., for hepatitis A), or simply ask the
contact to call you if (s)he develops symptoms. The intensity of the surveillance depends upon the
importance attached to preventing transmission from that person.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

CHECK FOR UNDERSTANDING

1. Identify 5 epidemiologic principles of disease control and explain on your own understanding.

EPIDEMIOLOGIC PRINCIPLES of DISEASE CONTROL

1.

2.

3.

4.

5.

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 MLS 051- Community and Public Health-
Lecture
Module #6

Name:__________________________________________ Class number: _________________

Section: _________ Schedule: ______________________ Date: _________________________

LESSON WRAP-UP
Activity: Thinking about Learning
Mark by circling the work tracker which is simply a visual to help students track how much work they have
accomplished and how much work there is left to do. This tracker will be part of the student activity sheet.

My Work Tracker: You are done with the session! Let’s track your progress:

P1 P2
1 2 3 4 5 6 7 8 9 10 11 12 13

Exit Ticket: Write down below a part of the discussion that is unclear to your understanding.

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