Epidemiology

– study of the occurrences, distribution and determinants of health-related states or

events in specified populations.
– backbone of the prevention of the disease
Epidemiologic Triad: HOST – AGENT – ENVIRONMENT
1. Host – intrinsic factor (man as primary host)
2. Agent – etiologic factor (virus, bacteria, fungi, parasites etc. )
3. Environment – extrinsic factor
John Snow – Anesthesiologist known as “FATHER OF EPIDEMIOLOGY”
● In 1800's - He studied the epidemic of CHOLERA erupted in the Golden Square
of Soho district London (1854)
In Epidemiology:
1. “DISTRIBUTION” - refers to descriptive epidemiology
- It answers the questions WHEN, WHERE, WHO
- time (when), place (where), and person (who)

2. “DETERMINANTS” - refers to analytic epidemiology.

- discovers causes, risk factors, modes of transmission
- It answers the WHY and HOW
- includes the causes (including agents), risk factors (including exposure to
sources)
Descriptive vs. Analytic epidemiology
1. Descriptive epidemiology can identify patterns among cases and in populations by
time, place and person. Survey are used to find out the nature of the population
affected by a particular disease noting the age, sex and occupation.

2. Analytic epidemiology is concerned with the search for causes and effects, or the why
and the how.
Patterns of Occurrence and Distribution
1. SPORADIC – intermittent occurrence of a few isolated (scattered) and unrelated cases
2. ENDEMIC – continuous occurrence throughout a period of time of the usual number of
cases in a given LOCALITY.
Endemic refers to the constant presence and/or usual prevalence of a disease or infectious
agent in a population within a geographic area
3. EPIDEMIC – unusual large number of cases in a relatively SHORT period of time usually
in weeks
Point source – food poisonings
Cyclical pattern – dengue fever
Secular trend – influenza
Propagated - HIV/AIDS

4.PANDEMIC – simultaneous occurrence of epidemic on the same disease in

SEVERALCOUNTRIES affecting large number of population
Pandemic diseases:
M ERS cov
Asian Flu
Spanish flu ( 1918-1919) - 40 to 50 million deaths
Antonine plague
Meningococcemia
A H1N1
B lack death / Bubonic plague by Yersinia pestis
H IV/AIDS
E bola and COVID – 19 by SARS-CoV-2

RA 3573 ( Law on reporting of Notifiable Diseases)

- Report to provincial and duty health office
- Midwife reports – under supervision of the nurse
- REPORT Measles Polio within 24 hours
- Tetanus Neonatorum, Severe and acute diarrhea, HIV within a WEEK
RA 11332 (MANDATORY reporting of Notifiable Diseases)
- Mandatory Reporting of Notifiable Diseases and Health Events of Public Health
Concern Act
- Surveillance and Response to Notifiable Diseases, Epidemics, and Health Events
of Public Health Concern
CHAIN OF INFECTION
1. Agent – Any micro-organism capable of producing an agent (Bacteria, virus, fungi,
parasites)
Killing the microorganism by :
DISINFECTION: Killing of micro organism but NOT their spores
STERILIZATION: Killing of ALL MICROORGANISM including spores
AUTOCLAVING –15 pounds pressure, moist heat and 250 degrees Fahrenheit.(121°C)
Black strips suggest successful autoclave
 2. Reservoir
- natural HABITAT in which the agent normally lives, grows, and multiplies.
- It includes, humans, animals, and environment
- Human reservoirs : Measles, mumps, HIV and STI
- Animal reservoir: anthrax (sheep) and rabies (dogs)
- Environment reservoirs: Histoplasmosis (soil)
TAKE NOTE:
Carrier—A person or animal that harbors a specific infectious agent WITHOUT
discernible clinical disease and serves as a potential source of infection
3. Portal of exit – path by which a pathogen leaves its host.
- Many portals of exit are identical to portals of entry
- Influenza and TB exit the respiratory tract and Cholera bacteria exit in in feces

4. Modes of transmission - Considered as the WEAKEST link

- Can be easily break by HAND WASHING
- Hand washing is the NUMBER ONE way to stop the transmission of infections
Hand Hygiene is the single MOST effective and important technique to use in preventing
and controlling transmission of infection
Handwashing / hand hygiene
3 elements of Handwashing:
A. Soap – (1 - 3 ml)
B. Water – running clean water
C. Friction – MOST important element
HANDWASHING TIME: (40–60 sec)
Minimum time each hands: 15 seconds
Average time: 20 seconds each hands
BEST time:30 seconds

● Alternative to soap and water: Hand based sanitizer with at least 60% ethanol
content

MODE OF TRANSMISSIONS
1. Contact transmission – MOST frequent means of transmitting infections in healthcare
facilities. Can be by direct or indirect.
A. Direct contact – occurs through. skin-to-skin contact, kissing, and sexual
intercourse
● contact with soil or vegetation harboring infectious organisms.
● infectious mononucleosis (“kissing disease”) and gonorrhea are spread from
person to person by direct contact.
● Hookworm is spread by direct contact with contaminated soil.
 B. Indirect transmission – transfer of an infectious agent from a reservoir to a host
by suspended air particles, inanimate objects (vehicles), or animate
intermediaries (vectors).
● 5 F’s — Fingers/hands, Fomites(inanimate object), Foods, Feces, Flies
Contact transmission
Multidrug resistant organism (methicillin)
Respiratory infections
Skin infections (leprosy, ringworm, scabies)

Wound infections (tetanus) and STI’s (HIV/AIDS)

Enteric infections (Gastrointestinal diseases)
Eye infections ( conjunctivitis)

Vehicle Transmission –Involves the transfer or microorganisms by way of vehicles, or

contaminated items that pathogens,
Ex. Milk and dairy foods carrying LISTERIOSIS (L. Monocytogenes)
● Food carrying salmonella, water carrying Legionella, blood borne hepatitis B
and C, drugs can carry bacteria from contaminated infusion supplies.
● Contaminated Blood, food, water, inanimate objects are vehicles of transmission.

2. Droplets transmission – Droplets are body fluids.

- It refers to spray with relatively large, short-range aerosols produced by
sneezing, coughing, or even talking.
- Droplets DO NOT remain suspended in the air for very long and seldom
travel more than 3 feet around the patient.
- Some studies in 2003 suggested that smallpox and SARS could reach persons
located 6 feet or more from the source. (Some examples- flu, rhinovirus, SARS,
group a strep, Neisseria meningitis.)
DROPLET PRECAUTION
Streptococcal infection and scarlet fever
Pertussis, pneumonia, parvovirus B-19
Influenza
Diptheria
Epiglottitis
Rubella
Mumps,measles,mycoplasma, meningitis
Adenovirus infection
Novel coronavirus ( COVID-19) Sars-Cov-2

3. Airborne transmission
- Droplet nuclei are dried residue of LESS than 5 microns in size.
 - Particles are suspended in the air for a LONG PERIOD OF TIME or when dust
particles contain pathogens
- MTV- Measles, TB, Varicella

4. Vectorborne Transmission
- Vectors are non human carriers that transmit organisms from 1 host to another
and can be biologic or mechanical. (mosquitoes, animals, fleas, and ticks)
- Deer ticks – lymes disease
- Mosquitos – dengue, malaria, filariasis
- Rat flea – black death/bubonic plague
- Dogs– rabies
- Snail – schistosomiasis
Mode of transmission continuation
5. Portal of entry – refers to the manner in which a pathogen enters a susceptible host.
For example:
● Respiratory tract (Influenza virus)
● Fecal -oral (gastroenteritis)
● Skin (hookworm)
● Mucous membranes (syphilis)
● Blood (hepatitis B, HIV).
Donning(putting on): from bottom up (shoe cover ni GowMa GoGlo)
Boot covers
Gown/Apron
Mask
Goggles
Gloves (when hands raised above head)

Doffing (taking off): alphabetical order

Boot covers
Gloves
Goggles
Gown
Mask

4. Host - The FINAL link in the chain of infection is a susceptible host.

- Compromised host - Host with lowered resistance to infection and disease
for any reason (for example, malnutrition, illness, trauma, or
immunosuppression).
STAGES OF INFECTIOUS DISEASE:
– Incubation period – time period between exposure to an infection and the
appearance of the FIRST symptoms (latency, no signs and symptoms)
 *Communicability period – time when disease are MOST contagious & easily
transmitted to others.

2. Prodromal period – the time from the onset of nonspecific symptoms until specific
symptoms begin to manifest (mild signs and symptoms)

3. Stage of illness – Most severe stage of an infectious disease

- Signs and symptoms are MOST evident and MOST SEVERE at this time
4. Stage of decline - Body gradually returns to a normal state of health
- Signs and symptoms subside
- The immune response and antibody titers normally peak
5. Convalescence period – this is a period of recovery
TYPES OF INFECTIOUS DISEASE
– Zoonotic diseases transmitted from animals to humans.
– Nosocomial – hospital acquired infection, infection must occur: up to 48 – 72 hours after
hospital admission. (UTI)
– Iatrogenic infection – secondary to treatment and procedures
Three lines of defense against infection
FIRST LINE OF DEFENSE: INNATE IMMUNITY – Physical (Intact skin) and chemical barrier
SECOND LINE OF DEFENSE: Adaptive immunity (non specific)
THIRD LINE OF DEFENSE: Immune response (specific)

TYPES OF ANTIBODIES

IgG – ONLY antibody crossing placenta

IgA – BREASTMILK
IgM - FIRST immunoglobulin made following Ag exposure (infection)
IgE - Involved in mediating ALLERGIC reactions
Useful against parasitic infections
IgD – B lyphocyte maturation

Ab versus Ag
Globulins / Antibody: — A protective protein found in the blood associated to immune
system that is produced in response to foreign substances (e.g. bacteria or viruses) invading
the body.
Antigens: Foreign substances (e.g. bacteria or viruses) in the body that are capable of
causing disease..

TYPES OF IMMUNITY
1. Natural Active - Exposure to the disease organism , experiencing the actual disease
*Long lasting immunity/life long (Nagkasakit Ako)

2. Artificial Active - introduction of a killed or weakened form of the disease organism through
vaccination (Aray Aray like turok ng EPI vaccines)
3. Natural Passive - IgA found in human colostrum and milk and IgG tranplacental (Nanay
Pasuso(breastfeeding) and Nay Papasa ng IgG from placenta in pregnancy)
*Natural passive last only for 6 to 12 months

4. Artificial Passive
- Provides immediate protection, but short-term protection by injection of antibodies, (may last
2 – 3 weeks)
- Injection of gamma globulin, rabies antibodies, anti tetanus serum

COMMUNICABLE DISEASES
I. Acute Illness
- Less than 6 months
- Symptoms often are sever and appears suddenly or abruptly,
subside quickly
- Good prognosis
- Example: Dengue fever, measles

II. Chronic Illness

-Longer than 6 months
-Slow onset
-With periods of remissions and exacerbations
- Example: TB and leprosy
Communicable Disease (Vector Borne)
1. Leptospirosis
– Weil's disease
– Leptospirosis
– Canicola fever and trench fever
– Mud fever and flood fever
– Japanese 7 days fever and spiroketal jaundice
Causative Agent: Leptospira interrogans bacteria
Incubation period: usually 5 – 14 days ( ranging 2 – 30 days according to CDC)
Diagnostic test:
Microscopic agglutination test - gold standard serologic CONFIRMATORY test for leptospirosis
Blood and CSF can be tested during the first week of illness
Urine can be tested : After the 10th day of illness
Reservoirs: rodents and rats
Primary reservoir: RATS (especially brown rats) - worldwide source of leptosira interrogans.

Other sources: Cattle, Pigs, Horses, Dogs, Rodents, and Wild animals
Common during heavy rainfall season.
Mode of transmission: Ingestion or CONTACT to urine contaminated, water, soil, food and
entry of agent to mucous membranes of the eyes, nose , mouth and in a broken skin from a cut
or scratch.
TAKE NOTE: Person to person transmission is rare.
Outbreaks occurs due to exposure to contaminated floodwaters.

Sign and symptoms:

Red eyes (conjunctival suffusion) – pathognomonic sign
Abdominal pain, vomiting and diarrhea
Tender and painful muscles (myalgia)
Skin jaundice and sometimes rashes

PHASES OF DISEASE
1st phase of illness: fever, chills, headache, muscle aches, vomiting, or diarrhea
2nd phase of illness is more severe; kidney, liver failure or meningitis. (Weils disease)
Other Complications: Pulmonary hemorrhage, cardiac arrhythmia, and septic shock

Treatment:
Doxycycline – Drug of choice and prophylactic drug to prevent leptos
P – Pen -G
E – Erythromycin
T – Tetracycline

Prevention:
R – rubber boots use when wading flood waters
A – avoid wading, bathing, swimming in flood waters
T – take prophylactic drug 200 mg doxycycline taken weekly
S – seek consultation for fever 2 days after known exposure to flood waters.

2. Malaria (Ague or Marsh fever or BLACK WATER FEVER)

● Together with HIV/AIDS, tuberculosis and other neglected tropical
diseases, malaria control is included under Sustainable development Goal 3 by
2030
Vector: Female Anopheles mosquito (sporozoites from the salivary gland)
Biting time: bite between dusk and dawn (9 pm to 3am)
Causative Agent: PLASMODIUM parasites (protozoa)
P. Falciparum and P. vivax pose the greatest risk (MOST FATAL)
P. Malariae and P. Ovale

Diagnostic test:Laboratory confirmation of malaria is done on a blood film to detect

MALARIAL PARASITES.
Signs & Symptoms
C – chills to convulsion
H – headache
I – increased temperature(fever)
L – liver enlargement (hepatomegaly)
L – low hemoglobin level (anemia)
S – sweats profusely
* The hallmark of malaria is FEVER followed by chills to convulsion
TAKE NOTE: Malarial parasites invade and destroy red blood cells.

Watch out for: Icterus and Shock – refer to secondary or tertiary facility
Chemoprophylaxis –chloroquine taken at WEEKLY interval, starting from 1-2 weeks before
entering the endemic area.
Anti-malarial drugs: sulfadoxine, quinine sulfate, tetracycline, quinidine
Treatment for pregnant and infants: sulfadoxine-pyrimethamine
NOT malaria drug – Amoxicillin

PREVENTIVE MEASURES
M – mosquito nets/Insecticide treated nets (ITN's)
A – anti-mosquito soaps/ repellants and using long sleeved shirt when going out at night
L – larvivorous fish (guppy fish, gambusia fish, itar or kataba fish) - STREAM SEEDING
A – avoid going out between 9 pm to 3am
R – remember to take chloroquine tablets at WEEKLY INTERVALS
I – include planting neem trees in backyards and clearing hanging branches near rivers
A – apply insect repellant on house walls

3. Filariasis/ elephantiasis
● Lymphatic filariasis, commonly known as elephantiasis, is a neglected tropical disease.
Vector: Aedes poecillus mosquito
Breeding sites: water-filled leaf axils of abaca, banana, taro (gabi) and
screw pine (pandan/pandamus).
Peak Biting time: 10 pm to 2 am (Best time to collect blood sample
Causative agent: Wuchereria Bancrofti

Others:
Brugia Malayi – was first confirmed in the Philippines in 1964
Brugia Timori
Incubation : 8 – 16 months (long incubation period)
Diagnostic test:
● Alere Filariasis Test Strip (FTS) – rapid diagnostic test
● Immunochromatographic test (ICT) – can be done in daytime
● Nocturnal blood smear – blood test taken after 8 pm
STAGES OF FILARIASIS
Asymptomatic: NO clinical signs and symptoms
Acute Stage:
Lhymphangitis(inflammation of lymph vessels)
Orchitis/epididymitis (painful and tender scrotum)
Lymphadenitis(inflammation of lymph nodes)

Chronic Stage:
Hydrocele (swelling and fluid accumulation in scrotum)
Elephantiasis (thickening and enlargement of extremities, scrotum and breast)
Lymphedema
Permanent disability

Management:
Diethyl carbamazine citrate or Hetrazan (6mg/kg)
Ivermectin (200mcg/kg) + albendazole
Albendazole (400mg) 2x a year
No treatment can reverse elephantiasis

TAKE NOTE: HETRAZAN is the DRUG OF CHOICE. (Side effect is fever)

Preventive measures:
F – Filariasis can be controlled by preventive measures like vector control
I – intensify health information campaigns in its prevention, control and elimination
L – long sleeved shirt at night
A – annual mass drug administration using 2 drugs in all endemic areas (for 5 years)
R – repellants against mosquito.
I – intensify campaign to halt progression of disease through disability prevention
A – avoid going out at night usually between 10 pm to 2 am
TAKE NOTE: There is NO known vaccination for Filariasis.
4. Schistosomiasis/ Snail Fever/Snail fever/Katayama fever/Bilharziasis
 ● Schistosomiasis (also known as bilharzia ) is a vector-borne parasitic disease caused
by trematode flatworms of the genus Schistosoma.
● Schistosomiasis is considered one of the neglected tropical diseases (NTDs).
Vector: Freshwater snails
● Oncomelania hupensis quadrasi snail - vector of Schistosoma japonicum in the
Philippines and it is the intermediate host of S. Japonicum.
Breeding site: fresh waters in agricultural areas.
Risk individuals: Farmers
Caused by: BLOOD FLUKE (TREMATODES) – SCHISTOSOMA
Diagnostic test:
Circumoval precipitin test is a serological test used for diagnosis of schistosomiasis japonica.
Kato-Katz test – stool exam under a microscope (confirmatory test for Snail fever/S.
Mansoni)

Causative Agent:
Schistosoma japonicum – most common in the Philippines
Schistosoma hematobium
Schistosoma intercalatum
Schistosoma mansoni – can deposit eggs in the brain tissue.

Mode of transmission: Contact with water infected with cercariae (DIRECT and
INDIRECT)
Swimmers itch or Cercarial dermatitis – early sign, itchy, raised papules , commonly occur
within 1–2 days of infection (due to cercariae penetration to skin)
Signs & Symptoms:
Lowgrade fever,
Inflammation of liver & spleen,
Pallor

Bulging abdomen,
Abdominal pain,
Loose bowel movement,
Muscle aches
Seizure

Drug of choice for Bilhariasis: Biltricide (Praziquantel)

Others: Diethyl carbamazepine citrate (DEC)

Preventive measures
F – feces and urine proper disposal or use of sanitary toilets.
A – avoid bathing and washing in infested waters
R – rubber boots to avoid skin penetration in agricultural places
M – molluscicides use
E – emphasize importance of hand washing
R – remove cercariae in water by paper filtering or use of iodine or chlorine
S – Safe water use, let water stand for 48 – 72 hours before using it.

Complication of Bilhariasis
● Cor pulmonale, pulmonary hypertension
● Ascites and renal failure
● Liver cirrhosis and portal hypertension
TAKE NOTE: Meningitis is NOT a complication of Bilhariasis

5. DENGUE
Also known as: “Breakbone fever” because of severe muscle, joint and bone pains.
Vector: FEMALE Aedes Aegypti mosquito.
Tiger mosquito
Characteristic of Aedes aegypti mosquito:
● Day biting
● Most active 2 hours after sunrise and 2 hours before sunset
● Small 4 – 7 millimeters
● black and white pattern (white/silver scale patches)
● Bites in nape, elbow and ankle
● Breeding sites
● Stagnant clean or clear water (bottle cap, dish dryer, plant axil, gutter, trash can, old
rubber tire, etc.)
Causative agent: Flaviviruses – common in the Philippines
Viral strains: DENV-1, DENV-2, DENV-3 and DENV-4
Recovery from infection is believed to provide lifelong immunity against that serotype.
Incubation period: 3 – 14 days (commonly 2 – 7 days)

Diagnostic test:
Dengue Dou – Dengue NS1 and IgG/IgM capture
1. Tourniquet test / Rumpel-Leede capillary-fragility test or simply a capillary fragility test–
screening test of dengue
● positive in the presence of more than 20 petechiae within an inch square, after 5
minutes of test
● Use BP cuff
2. Dengue NS1 RDT – Requested between 1-5 days of illness (detect virus antigen)
3. Dengue IgM/IgG – Requested beyond five days of illness (detect dengue antibodies
during) IgM in acute dengue infection.
IgG determines previous infection.
 4. Polymerase Chain Reaction (PCR) – gold standard laboratory tests to confirm dengue
virus
● Total While Blood Cell (WBC) count (result show decreasing level)
● Platelet (decreased)
● Hematocrit (increased)
Early signs:
H – headache and eye pain (retro orbital pain)
O – on and off fever
T – tourniquet test (+ petechiae)

Others signs:
L – low platelet
A – abdominal pain, loss of appetite, vomiting and diarrhea
M – muscle and joint pain
O – onset of fever
C – capillary refill longer than 2 seconds.(POOR TISSUE PERFUSION)
Normal capillary refill is 1 – 2 seconds.
Hermann's sign (petechial rash) – pathognomonic sign of dengue.
TAKE NOTE: Cold and clammy skin is a sign of dengue hemorrhagic fever

MANAGEMENT
D – DO NOT GIVE ASPIRIN
E – epistaxis – flex neck forward and apply cold packs in forehead.
N – note for any signs of shock (sudden transition of fever to afebrile state)
G – give oral fluids /oresol /intravenous fluid
U – use PARACETAMOL for fever
E – enhance the 5 – S campaign and mosquito vector control.

5 – S campaign
Search and destroy mosquito-breeding sites (Removal of water such as flower vases)
Self-protection measures like wearing long pants, long sleeved shirts and repellants
Seek early consultation
Support and say YES to fogging/spraying only in hotspot areas or impending outbreak.
Sustain Hydration

6.Rabies/ Lyssa/ Hydrophobia/ La Rage

● Rabies is a neglected tropical disease.
● Rabies is caused by a VIRUS that affects the central nervous system, particularly
causing inflammation in the brain (encephalitis)
● 99.9% mortality rate
BRAIN – is the MOST commonly affected by the rhabdovirus
BITES ON HEAD OR FACE has the SHORTEST INCUBATION PERIOD
● less than 50 days is the incubation if the patient is bitten on the head
● Bites or scratches in hands is longer incubation less than 1 year
Rabies is the deadliest zoonotic disease that threatens humans and animals on all continents
except Antarctica.
Vector: DOG – principal animal vector (99%)
Virus can be transmitted by Saliva
Causative Agent: VIRUS – Rabies lyssavirus, formerly Rabies virus of the rhabdovirus family.
Incubation period: 2 – 8 weeks (2-3 months)

FACTS on RABIES
● Asia and Africa are worst affected as more than 95% of rabies associated human
deaths.
● Bat rabies is responsible for most human rabies deaths in the United States of America
and Canada
● 40% of people bitten by suspect rabid animals are children under 15 years of age.
Mode of transmission: Dog bite
Diagnostic test:
● direct fluorescent antibody (DFA) test, which looks for the presence of rabies virus
antigens in brain tissue .
● Human rabies can be confirmed intra-vitam and post mortem by various diagnostic
techniques that detect whole viruses, viral antigens, or nucleic acids (negri bodies) in
infected tissues (brain, skin or saliva)
Signs and symptoms:
● Initial symptoms : fever with pain and unusual or unexplained tingling, pricking, or
burning sensation (paresthesia) at the wound site.
1. Furious rabies — hyperactivity, excitable behavior
● hydrophobia (fear of water) and sometimes aerophobia (fear of drafts or of fresh air).
● Hydrophobia and aerophobia are pathognomonic for rabies and occur in 50% of
patients

2. Paralytic rabies
● 20% of the total number of human cases.
● Muscles gradually become paralyzed, starting at the site of the bite or scratch.
● Bladder dysfunction, Generalized weakness, quadriparesis to COMA AND DEATH
Paralysis and death occurs in both dumb and furious forms 4– 8 days after the onset of clinical
signs
Dog bite
FIRST AID: Immediate and thorough flushing and washing of the wound for a minimum of
15 minutes with soap and running water, detergent, povidone iodine or other substances that
remove and kill the rabies virus.
AVOID: Garlic, batobalani (tandok) and suctioning. NO to tandok
The infected animals usually dies within 7 to 10 days of becoming sick.
(FEED DOG PROPERLY and Observe the dog for 14 days)

CATEGORIES OF DOG BITE

Category I - touching or feeding animals, animal licks on intact skin (no exposure)
Category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding
(exposure) – GIVE ACTIVE VACCINES
Category III - single or multiple transdermal bites or scratches, contamination of mucous
membrane or broken skin with saliva from animal licks, exposures due to direct contact with
bats (severe exposure) – GIVE ACTIVE AND PASSIVE (RIG vaccine)

RABIES IMMUNIZATION
1. ACTIVE IMMUNIZATION – develops antibody that gives 2 – 3 years protection

Example:
PCEC (Purified Chick Embryo Vaccine)
PDEV (Purified Duckling Embryo Vaccine)
RABIPUR and VERORAB OR VEROWELL(cheap)
Purified Vero cell rabies vaccine (PVRV)
Dose:
ID - 0.1 ml
IM - 0.5 ml

Purified chick embryo cell vaccine (PCECV)

DOSE:
ID-0.1 ml
IM-1.0ml

2. PASSIVE IMMUNIZATION
PASSIVE IMMUNIZATION – administered to patients with head bites, and multiple bites to the
different parts of the body especially the upper part of the body to be administered WITHIN 7
days after exposure.

Example:
ERIG (Equine rabies Immunoglobulin) – derived from HORSE serum.
HRIG (human Rabies Immunoglobulin)
Standard ROUTE: Intramuscular
Remaining doses are infiltrated around wound.
Days of immunization: Day 0, 3, 7, 14, 28
PVRV dose: 0.5 ml
PCECV dose: 1.0 ml
Site of injection: One deltoid or anterolateral thigh in Infants

Prevention:
R – responsible pet ownership (Republic Act 9482)
A – anti-rabies immunization of pets beginning at age 3 months YEARLY
B – bathe, feed them with safe and clean food and water
I – if you are bite , scratched or licked by dog – wash the site immediately for 15 minutes.
E – ensure that pets are NOT roaming in the streets (your pet action is your responsibility.)
S – support and mobilize community participation

FIVE TIPS TO AVOID DOG BITES:

P – pet the dog gently by stroking back first and allowing dog to sniff hands first.
E – eye to eye contact must be avoided
T – try to stand still like a tree trunk (DO NOT RUN)

M – make sure all dogs are vaccinated against rabies yearly.

E – eating, playing, sleeping or scared dog should NEVER BE DISTURBED.

FOOD BORNE DISEASES

1. CHOLERA/EL TOR
● acute diarrhoeal infection
Agent: Vibrio cholerae BACTERIA
MOST COMMON IN RAINY SEASON

📍
Incubation Period: 12 hours to 5 days

📍
MOT: Ingestion of contaminated water or food (waterborne/foodborne)
bacteria are present in their faeces for 1-10 days after infection and are shed back into the
environment
CONFIRMATORY TEST: STOOL CULTURE

C – called as “Blue Death”

H – Hands and feet are wrinkled known as “washer woman hands”
O – Oral rehydrating solution “Tubig Kubeta Oresol”
L – Loose and fishy odor stool
E – Evident signs of dehydration (THIRST is the earliest and first sign)
R – “RICE watery” stool is the pathognomonic sign
A – Antibiotic drug of choice – Tetracycline .

PREVENTION: SANITATION, FOOD SAFETY, CHOLERA VACCINE

2. SALMONELLOSIS
Sign and symptoms
● Acute onset of fever
● Abdominal pain/cramps
● Acute Diarrhoea
● Anorexia, nausea and vomiting.

MANAGEMENT
PRIORITY: Fluid and Electrolytes therapy
📍Ensure food is properly cooked and still hot when served.
📍Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.
📍Avoid ice unless it is made from safe water.
📍When the safety of drinking water is questionable, boil it
📍Wash hands thoroughly and frequently using soap
📍Wash fruits and vegetables carefully
3. Hepatitis A
● Hepatitis A is an inflammation of the liver that can cause mild to severe illness.
● The hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and
water or through direct contact with an infectious person.
● Almost everyone recovers fully from hepatitis A with a lifelong immunity. However, a very
small proportion of people infected with hepatitis A could die from fulminant hepatitis.
● The risk of hepatitis A infection is associated with a lack of safe water and poor
sanitation and hygiene (such as contaminated and dirty hands).
● A safe and effective vaccine is available to prevent hepatitis A.
Agent: hepatitis A virus (HAV)
MOT: faecal-oral route — foodborne or waterborne that is contaminated with the faeces of an
infected person.
Predisposing Factor: unsafe water or food, inadequate sanitation, Low and middle
income countries, poor personal hygiene and oral-anal sex.
Incubation period: 14–28 days.
Diagnostic: Specific diagnosis is made by the detection of HAV-specific immunoglobulin G (IgM)
antibodies in the blood
RT -PCR
RISK FACTORS:
● poor sanitation;
● lack of safe water;
● living in a household with an infected person;
● being a sexual partner of someone with acute hepatitis A infection;
● use of recreational drugs;
● sex between men; and
● travelling to areas of high endemicity without being immunized.
SIGNS AND SYMTOMS
Hot (fever)
Eye and skin discoloration (jaundice)
Pain in RUQ of abdomen
A norexia, nausea/vomiting and diarrhea

Asymptomatic – some cases has no signs and symptoms

*dark-coloured urine is also present

Treatment
● There is NO specific treatment for hepatitis A.
● Recovery from symptoms following infection may be slow and can take several weeks or
months.
● It is important to avoid unnecessary medications like Acetaminophen, paracetamol
and medication against vomiting should be avoided.
Prevention
● Improved sanitation, food safety and immunization are the most effective ways to
combat hepatitis A.
● adequate supplies of safe drinking water;
● proper disposal of sewage within communities; and
● personal hygiene practices such as regular handwashing

4. Botulism:
● Clostridium botulinum is a bacterium that produces dangerous toxins (botulinum toxins)
under low-oxygen conditions.
● Botulinum toxins are one of the most lethal substances known.
● Botulinum toxins block nerve functions and can lead to respiratory and muscular
paralysis.
● Human botulism may refer to foodborne botulism, and infant botulism, wound botulism
● Homemade canned, preserved or fermented foodstuffs are a common source of
foodborne
Agent: Clostridium botulinum (bacteria)
MOT: FOODBORNE
📍foods, including low-acid preserved vegetables, such as green beans, spinach, mushrooms,
and beets; fish, including canned tuna, fermented, salted and smoked fish; and meat products,
such as ham and sausage.
Incubation Period: Symptoms usually appear within 12 to 36 hours (within a minimum and
maximum range of 4 hours to 8 days) after exposure
Diagnosis: Culture Test of C. botulinum from stool, wound or food.
Misdiagnosed as: stroke, Guillain-Barré syndrome, or myasthenia gravis.
SIGNS AND SYMPTOMS:

📍
Botulinum toxins are neurotoxic
Descending, flaccid paralysis that can cause respiratory failure.

📍Early symptoms include marked fatigue, weakness and vertigo, usually followed by blurred
📍Vomiting, diarrhoea, constipation and abdominal swelling may also occur.
vision, dry mouth and difficulty in swallowing and speaking.

📍There is NO fever and no loss of consciousness.

TREATMENT & PREVENTION:
📍early administration of ANTITOXIN and intensive respiratory care
The WHO Five Keys of Food poisoning prevention are:
● keep clean, mop floors wash chopping boards (RIGHT PREPARATION)
● separate raw and cooked (RIGHT PREPARATION)
● cook thoroughly (RIGHT COOKING >70 to 85°C)
● keep food at safe temperatures (RIGHT STORAGE)
● use safe water and raw materials. (RIGHT SOURCE)
*when water is from questionable source boil it at least 3 mins or more
5. Foodborne trematode infections:
Foodborne trematode infections result in severe liver and lung disease.
● Clonorchis and Opisthorchis from ingestion of freshwater fish
● Fascioliasis from Aquatic vegetables
● Paragonimus from ingestion of crustacean
AGENT: PARASITES
MOT: FOODBORNE
DIAGNOSIS: direct sputum smear microscopy for PARAGONIMIASIS
Katokatz smear for Clonorchis and Opisthorchis

SIGNS & SYMPTOMS:

Opisthorchis spp and Clonorchis sinensis may be asymptomatic, fever, right upper-quadrant
pain (obstruction of the gallbladder by the worm)
📍Fascioliasis intermittent pain, jaundice, anaemia, pancreatitis and gallstones
📍Paragonimiasis may be asymptomatic.
📍chronic cough with blood stained sputum, chest pain, dyspnoea, and fever, and can result in
complications of pleural effusion and pneumothorax.
📍Symptoms and signs of PARAGONIMIASIS can be confounded and mistakenly diagnosed
with TUBERCULOSIS.

Treatment:
● Clonorchiasis and opisthorchiasis — praziquantel
● Fascioliasis — triclabendazole
● Paragonimiasis — triclabendazole or PRAZIQUANTEL

6.Taeniasis/cysticercosis – intestinal infection with tapeworms.

AGENTS: PARASITES
Taenia solium (pork), Taenia saginata (beef) and Taenia asiatica. Only T. solium causes major
health problems
MOT: FOODBORNE — ingestion of the undercooked and infected pork.
Human to human via Feco-oral route.

FACT SHEET:
● Human tapeworm carriers excrete tapeworm eggs in their faeces and contaminate the
environment when they defecate in open areas.
● Humans can also become infected with T. solium eggs due to poor hygiene (via the
fecal-oral route) or ingesting contaminated food or water.
● Ingested T. solium eggs develop to larvae (called cysticerci) in various organs of the
human body. When they enter the central nervous system, they can cause neurological
symptoms (neurocysticercosis), including epileptic seizures.
● T. solium is the cause of 30% of epilepsy cases in many endemic areas where people
and roaming pigs live in close proximity. In high-risk communities it can be associated
with as many as 70% of epilepsy cases.
● More than 80% of the world's 50 million people who are affected by epilepsy live in low
and lower-middle income countries

TREATMENT:
Praziquantel (10 mg/kg) or niclosamide (adults and children over 6 years: 2 g, children aged
2–6 years: 1 g).
Albendazole at 400 mg for 3 consecutive days.

Prevention and control

 ● treatment of human taeniasis;
● intervention in pigs (vaccination plus anthelmintic treatment);
● Supporting measures:
● community health education, including hygiene and food safety;
● improved sanitation - ending open defecation (Proper disposal of human feces)

7.LISTERIOSIS:
Agent: bacteria — Listeria (L. monocytogenes.)
MOT: Foodborne
Sources: deli meat and ready-to-eat meat products (such as cooked, cured and/or fermented
meats and sausages), soft cheeses and cold smoked fishery products.
Incubation: 2 days to 90 days

Risk individuals:
📍Pregnant women — 20x risk
📍Elderly
●

📍Individuals with a weakened immune system

●

📍HIV/AIDS — 300x risk

●

📍Leukaemia, cancer, kidney transplant and steroid therapy

●
●

DIAGNOSIS: BLOOD SMEAR and CSF SMEAR

TREATMENT: AMPICILLIN and Penicillin ANTIBIOTIC to prevent meningitis
Prevention: WHO Five Keys to Safer Food (1. Keep clean. 2. Separate raw and cooked. 3.
Cook thoroughly. 4 Keep food at safe temperatures. 5. Use safe water and raw materials.)
8. Typhoid fever:
Agent: Salmonella Typhi bacteria
MOT: Foodborne (food or water)
Incubation: 7 to 14 days in average ( Ranging from 3days to 2 months)
Diagnostic test: Widals Test —First serological test used
Typhidot (or Widal Test) is a rapid serological test for the diagnosis of typhoid fever. Typhidot
test is a dot ELISA kit that detects IgM and IgG
Fact sheet:
● 📍11–20 million people get sick from typhoid and between 128 000 and 161 000 people
die from it every year.
 ● 📍Urbanization and climate change have the potential to increase the global burden of
📍Salmonella Typhi lives ONLY in humans.
typhoid.

📍Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract.
●

📍Typhoid fever can be confirmed through blood testing.

●
●

SIGNS AND SYMPTOMS: Prolonged high fever (STEPLADDER FEVER)

Headache and fatigue
Abdominal pain
Nausea
Diarrhea (child) or Constipation (Adult)
Spots (rash) — ROSE SPOTS (pathognomonic)

Treatment: Antibiotics — Chlorampenicol as first line antibiotic (fluoroquinolones, newer

antibiotics such as cephalosporins and azithromycin)
Prevention:
📍HANDWASHING
📍WHO FOOD SAFETY
●

📍TYPHOID VACCINE
●

📍Access to safe water and Adequate sanitation

●
●

EMERGENT DISEASE
– Ebola virus disease:
- EVD first appeared in 1976 in 2 simultaneous outbreaks, one in what is now
Nzara, South Sudan, and the other in Yambuku, DRC.
- The latter occurred in a village near the Ebola River, from which the disease
takes its name.
Agent: Ebola virus (EBV)
Six species: Zaire, Bundibugyo, Sudan, Taï Forest, Reston and Bombali.
Natural virus hosts/reservoir: FRUIT BATS

📍
MOT: Direct contact
close contact with the blood, secretions, organs or other bodily fluids of infected animals such
as fruit bats, chimpanzees, gorillas, monkeys, forest antelope or porcupines found ill or
dead or in the rainforest.
Incubation period: 2 to 21 days
The 2014–2016 outbreak in West Africa was the largest Ebola outbreak since the virus was
first discovered in 1976.

Signs and Symptoms:

 – Fever
– Fatigue
– Muscle pain
– Headache
– Sore throat

– This is followed by:

– Vomiting
– Diarrhoea
– Rash
Symptoms of impaired kidney and liver function
In some cases, both internal and external bleeding (for example, oozing from the gums, or blood
in the stools).
Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

Diagnosis:
– antibody-capture enzyme-linked immunosorbent assay (ELISA)
– antigen-capture detection tests
– serum neutralization test
– reverse transcriptase polymerase chain reaction (RT-PCR) assay
– electron microscopy
– ·virus isolation by cell culture.
Treatment:
Supportive care - rehydration with oral or intravenous fluids - and treatment of specific
symptoms improves survival.
Two monoclonal antibodies (Inmazeb and Ebanga) were approved for the treatment of Zaire
ebolavirus (Ebolavirus)
Vaccine: Ervebo vaccine, Zabdeno-and-Mvabea

PREVENTION:
Emphasize importance of handwashing
B urial ceremony is NOT allowed
O Utbreak containment measures
L aboratory and health workers PPE
Apply STANDARD PRECAUTION to all patients

2.MERS COV: viral respiratory disease caused by a novel coronavirus

 – ZOONOTIC infection
– First identified in Saudi Arabia in April 2012.
– Major natural reservoir host/source: Dromedary Camels
Middle East respiratory syndrome coronavirus (MERS-CoV):
Agent: MERS Cov of Beta-coronavirus
MOT: Direct and Indirect contact
Non-human to human transmission
Incubation: 2 – 14 days (The symptoms usually appear 5–6 days after exposure)
Diagnosis: polymerase chain reaction tests

Signs and symptoms:

Asymptomatic
Breathing difficulty (DOB/SOB)
Cough
Diarrhea
Episodes of Nausea and vomiting
Fever
– 35% mortality among patients
– 80% of cases are from Saudi Arabia
– South Korea —largest MERS outbreak outside the Middle East.
Treatment:
– NO CURE
– Oxygen therapy and mechanical ventilator
– Treatment for MERS-CoV focuses on relieving symptoms and includes rest, fluids, pain
relievers and, in severe cases, oxygen therapy.

PREVENTION
Minimize close contact to camels and symptomatic person
Emphasize importance of handwashing at least 20secs.
Report any suspected cases to local health authority
Sneezing into a sleeve, flexed elbow, or a tissue

Cook meats and any food properly

Observe and follow a contact precaution
Visit a health facility for immediate medical attention for acute respiratory illness

CHRONIC DISEASE
– Tuberculosis / PTB /Koch's disease: 6th leading cause of morbidity and mortality
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the
lungs. Tuberculosis is curable and preventable.
Robert Koch - founder of modern bacteriology, the scientist who discovered agent of TB
discovered the agent causing Cholera, Anthrax and Tuberculosis(1882)
Causative Agent: Mycobacterium Tuberculosis (BACTERIA)
BACTERIA
- Mycobacterium bovis - Deer, cattle, Humans
- Mycobacterium tuberculosis – Humans ONLY
- Mycobacterium avium - Birds
Incubation period: 2 weeks to 12 weeks
Mode of transmission: TB bacteria are spread through the air from one person to
another. (AIRBORNE)
Sign/Symptoms:
Cough more than 2 weeks, chest pain, weakness and weight loss
Hemoptysis (blood stained sputum)
Elevated temperature (low grade afternoon fever)
Sweats at night and weight loss
Tender and swollen lymph nodes

TAKE NOTE: The four cardinal signs and symptoms of TB are at least two weeks duration
of cough, unexplained fever, unexplained weight loss and night sweats

Primary complex – TB of children

– Symptoms are weight loss, low appetite, and swollen lymph nodes in the neck area.
(CBQ)
– Mycobacterium tuberculosis is acquired by the child through respiratory
DROPLETS(CBQ)
● A child may also inhale the bacteria, commonly through close contact.
● Remains healthy and usually has NO symptoms. (TB of children are hard to detect.)
● Tuberculin skin-testing or Mantoux test is the best way to diagnose TB among children

SPUTUM COLLECTION:
o Should preferably have 3 specimen, three specimens are enough to confirm the
diagnosis.
o 2 specimens should be collected spot-spot 1-hour apart or spot-early morning
collection.
o Collect 3 – 5 ml of sputum (NOT Less than 3 ml) (CBQ)
 o If TWO (2) of the first three sputum smears are positive. (CBQ)
o The ONLY contraindication for sputum collection is: HEMOPTYSIS

Collection of Sputum Specimens:

▪ Tell patient NOT to touch inside of the container at any time.
▪ As soon as you wake up in the morning (before you eat or drink anything), brush your
teeth and rinse your mouth with WATER. Do not use toothpaste or mouthwash.
▪ Take a very deep breath and hold the air for 5 seconds. Slowly breathe out. Take
another deep breath and cough hard until some sputum comes up into your mouth.
▪ Spit the sputum into the plastic tube.
▪ Take another deep breath and cough hard and spit the sputum into the plastic tube.
Keep doing this until the sputum reaches the 5 mL line on the tube. (3mL is the minimum
volume necessary for this test
Treatment: TB is a treatable and curable disease. Active, drug-susceptible TB disease is
treated with a standard 6-month course of 4 antimicrobial drugs. (CBQ)
Direct Observed Treatment Short Course (DOTS) – comprehensive strategy to detect and
cure TB patients that was started in the country in year 1996 (FREE drugs)

PULMONARY TUBERCULOSIS DIAGNOSIS: (CBQ)

PRIMARY DIAGNOSTIC TOOL

Xpert MTB/RIF automated molecular assay and rapid test that detects Mycobacterium
tuberculosis (MTB) and rifampicin
resistance.
Xpert Ultra is a newer generation of Xpert MTB/RIF assay. Due to its higher sensitivity than
that of Xpert MTB/RIF, specificity is slightly lower.
TB-LAMP manual molecular assay that can be read with the naked eye under ultraviolet
light to detect MTB.
Direct Sputum Smear microscopy Conventional test that serve as a basis for the diagnosis of TB cases. (CBQ)
(DSSM)
Case finding tool for TB(CBQ)
Definitive test (CONFIRMATORY TEST) (CBQ)

SPUTUM COLLECTION:

▪ Should preferably have 3 specimen, three specimens are enough to confirm the diagnosis.
▪ 2 specimens should be collected spot-spot 1-hour apart or spot-early morning collection.
▪ Collect 3 – 5 ml of sputum (NOT Less than 3 ml) (CBQ)
▪ If TWO (2) of the first three sputum smears are positive. (CBQ)
▪ The ONLY contraindication for sputum collection is: HEMOPTYSIS (CBQ)

Days Samples Explanation

Day 1 Sample 1 (Spot) Patient provides an ‘on the spot’ sample under supervision.
(Patient is then given the sputum container to take home for an early
morning sample (sample 2) for the following day.
Day 2 Sample 2 Patients produces and brings ‘early morning sample’ to the clinic
 Sample 3 (Spot) Patient produces another ‘on the spot’ sample under
supervision

SPUTUM
▪ Sputum is thick and mucoid and comes from the lungs
▪ The color is white to green or bloody.
▪ Sputum is NOT saliva or nasal secretions which are runny and clear

Patient Instructions for Collection of Sputum Specimens: (CBQ)

1. Tell patient NOT to touch inside of the container at any time.

2. As soon as you wake up in the morning (before you eat or drink anything), brush your teeth and rinse your mouth
with WATER. Do not use toothpaste or mouthwash.
3. Take a very deep breath and hold the air for 5 seconds. Slowly breathe out. Take another deep breath and cough
hard until some sputum comes up into your mouth.
4. Spit the sputum into the plastic tube.
5. Take another deep breath and cough hard and spit the sputum into the plastic tube. Keep doing this until the
sputum reaches the 5 mL line on the tube. (3mL is the minimum volume necessary for this test.

Adjuvant diagnostic tools

Chest X-rays CXR should be performed for all smear-negative presumptive PTB

CXR can be done in parallel or sequential to DSSM

useful tools to aid diagnosis of TB when the TB disease cannot be confirmed with
bacteriological diagnostic tools.

Tuberculin skin test (TST) Basic screening tool for TB infection among CHILDREN
Mantoux Test Test presence of antibodies (Confirms exposure)
Read result after 48-72 hours(CBQ)
Injection of purified protein derivative (PPD)

TAKE NOTE:
▪ Recent BCG vaccination causes false-positive result
▪ Immunocompromised child, HIV/AIDS and severely malnourished child
causes false-negative result.

TST positive if

▪ In children with immunosuppressed conditions, such as HIV or severe

malnutrition TST result is positive if the induration is more than 5 mm

▪ In other children regardless of BCG vaccination status, TST result is

positive if the induration is more than 10 mm

Treatment:
▪ TB is a treatable and curable disease. Active, drug-susceptible TB disease is treated with a standard
6-month course of 4 antimicrobial drugs. (CBQ)

Direct Observed Treatment Short Course (DOTS)

 ▪ comprehensive strategy to detect and cure TB patients that was started in the country in year 1996 (FREE
drugs) (CBQ)

▪ It has five basic elements

(a) availability of quality assured sputum microscopy
(b) uninterrupted supply of anti-TB drugs
(c) supervised treatment
(d) patient and program monitoring
(e) political will.

DOTS (Direct Observed Treatment Short Course) (CBQ)

Category Classification
Category I N – NEW smear (+) TB patient(CBQ)
E – Extensive lesion shown in CXR (-) smear patient
W – with Extra pulmonary TB, PLHIV, and severe concomitant disease

Category II R – remission
E – Extra-pulmonary TB, new (CNS/bones or joints)
S – sputum smear positive patients who have;
T – treatment failure
A – after treatment interruption.
R – relapse of disease(CBQ)
T – treatment after default/return after default

Category III New smear (-) PTB with minimal lesion shown on X-ray result.

Category IV Multi drug-resistant TB (MDR)

Chronic TB who are still sputum (+) after supervised re-treatment.
Needs REFERAL for 2nd line treatment drugs “Category IV regimens”.
Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not
respond to isoniazid and rifampicin, the 2 most effective first-line anti-TB drugs.

MDR-TB is treatable and curable by using second-line drugs.

TB DRUGS SIDE EFFECTS MANAGEMENT

Rifampicin (R) Severe nausea & vomiting Give the Rifampicin after food
Red/orange colored urine(CBQ) Reassure patient it is normal

Isoniazid /INH (H) Numbness or tingling Supplement with tab. Vit. B6

sensation on the extremities (pyridoxine) at a dose of 5 mg
(Peripheral neuropathy) daily(CBQ)

Pyrazinamide/PZA (Z) Joint pains Check the dosage by weight as it is

Nausea/vomiting (G.I upset) usually caused by over-dosage.
Loss of appetite Easily alleviated with Aspirin
Increase uric acid

WOF!
Hepatotoxicity
Yellowish palms – refer! (CBQ)
 Ethambutol (E) Optic toxicity Children below 6 years must NOT be
Optic neuropathy given Ethambutol due to the risk of
Vision loss damage to the Eyes(CBQ)

Streptomycin (S) Giddiness (staggering / loss Reduce dosage by one quarter, but if it
of balance) persists for more than one week STOP
Ototoxicity and Refer!
▪ Ringing of ears (tinnitus)
▪ Hearing loss DO NOT give streptomycin drug to
pregnant client it may damage the ear
of baby.

Drug formulations
1. Fixed–dose combination (FDCs)
▪ Two or more first-line anti-TB drugs are combined in one tablet.

BLISTER PACKS:
2 drug fixed-dose combination – Rifampicin(R) and Isoniazid (H).
3 drug fixed-dose combination – Rifampicin, Isoniazid and Ethambutol (CBQ)
4 drug fixed-dose combination – Rifampicin, Isoniazid, Pyrazinamide and Ethambutol.

2. Single drug formulation (SDF)

▪ Each drug is prepared individually, either as tablet, capsule, syrup or injectable (Streptomycin) form.

Category Intensive phase Continuation phase

I 2 months (Rifampicin and Isoniazid) (CBQ) 4 months RI
II 2 months RIPES/1 month RIPE 5 months RIE
III 2 months RIPE 4 months RI

Monitoring treatment:

▪ Sputum microscopy: Examine sputum for AFB at specified intervals

▪ Clinical: Conduct clinical assessment including weight assessment
▪ Drug intake: Assess patient’s records for regularity. (Blister packs)
▪ Two sputum smear examinations (taken as two early morning samples within 2 days)

• For smear-positive patients:

- End of the 2nd month for new cases or 3rd month for re-treatment cases
- End of 5th month
- End of 7th month

For smear-negative patients only at the end of the 2nd month

Tuberculosis prevention: (CBQ)

B – BCG vaccination
C – clean and fresh air, Adequate rest and exercise
G – good personal Hygiene, and well balanced diet.

MOST IMPORTANT HEALTH TEACHING: STRICT compliance to treatment regimen

2.LEPROSY:
▪ Leprosy / Hansen's Disease - 1873: Dr. Gerhard Henrik Armauer Hansen - founded the
agent of leprosy.
MUST KNOWS!
▪ Leprosy is a Neglected Tropical Diseases (NTDs)
▪ The disease mainly affects the skin, the peripheral nerves, the eyes and mucosa of the
upper respiratory tract
Causative agent: Mycobacterium leprae (acid-fast, rod-shaped bacillus.)
Incubation period: Average of 5 years. (3 – 5 years) (CBQ)
Mode of Transmission: Droplets (from nose and mouth) and prolonged contact
Prolonged, close contact with someone with untreated leprosy over many months is needed to
catch the disease. (CBQ)
Reservoir: Humans
Diagnosis of leprosy: Skin smears/skin biopsy (CBQ)
Skin Slit Smear (SSS) to CONFIRM a diagnosis.
Specimens and Tests: specimens may be collected:
Skin smears from the earlobes, elbows, and knees
Skin biopsy from edges of active patches
Nerve biopsy from thickened nerves
Acid fast staining: Ziehl-Neelson method using 5% sulphuric acid as decolorizing agent is used.
The presence of acid-fast bacilli confirms the diagnosis of Hansen’s disease.

Types of Leprosy:
1. Paucibacillary leprosy(PB)
▪ Tuberculoid leprosy and intermediate
▪ Non infectious type of leprosy
▪ Less than 5 hypopigmented, anesthetic skin lesions
▪ Treated up to 6 to 9 months

2. Multibacillary Leprosy (MB)

▪ Lepromatous leprosy
▪ Infectious type
▪ Shows 6 or more lesions, nodules, plaques,
▪ thickened dermis and involvement of the nasal mucosa.
▪ Treated for 12 months to 18months
Signs and Symptom:
EARLY signs:
E – enlarged nerve especially elbow, knee, neck (painful thickened nerves) (CBQ)
A – anesthetic (numbness or loss of sensation) (CBQ)
R – redness to copper colored skin (skin color changes)
L – loss of muscle strength (muscle weakness)
Y – you may also find nodules, patches and ulcers that do not heal.

LATE signs:
G – gynecomastia (enlargement of breast)
M – madarosis (loss of eyebrows)
I – inability to close eyelids (lagopthalmos)
C – crippling/clawing of hands and feet, paralysis, and blindness. (CBQ)
S – sinking of nose bridge (saddle nose deformity)

TAKE NOTE: leonine facies – pathognomonic of leprosy (looks like a lion)

Cardinal signs of leprosy include hypoesthesia, skin lesions, and peripheral neuropathy.

Treatment: Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week
after starting treatment.
Check: LIVER function first.
MDT:
MDT DRUGS: Leprosy is curable with multidrug therapy (MDT).
1. Rifampicin - given once a month.
Normal side effect: slightly reddish urine discoloration. (CBQ)

2. Clofazimine - most active when administered daily.

Normal side effect: brownish black discoloration and dryness of skin.
Discoloration disappears within few months after stopping treatment.
3. Dapsone
This drug is very safe in the dosage used in MDT
Main side effect is allergic reaction, causing itchy skin rashes and exfoliative dermatitis. DO
NOT GIVE to patients known to be allergic to any sulpha drugs

MUST KNOWS:
DOH campaign: “Kilatis Kutis Campaign”
Aims to find leprosy cases in high prevalence areas through skin consultation.

TAKE NOTE:
▪ All patients who have complied w/ MDT are considered cured and no longer regarded as
a case of leprosy, even if some sequelae of leprosy remain.
▪ Untreated, leprosy can cause progressive and permanent damage to the skin, nerves,
limbs, and eyes. (CBQ)
▪ RA 4073 – An Act further liberalizing the treatment of leprosy
▪ World Leprosy Day (Every last Sunday of January)
▪ Leprosy Control Week (Every 4th week of February)
▪ National Skin Disease Detection and Prevention Week (Every 2nd week of November)

3. HIV/AIDS:
▪ HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If
HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome).
▪ There is currently no effective cure. Once people get HIV, they have it for life.
▪ But with proper medical care, HIV can be controlled. People with HIV who get effective
HIV treatment can live long, healthy lives and protect their partners

HIV HISTORY:
▪ HIV infection in humans came from a type of chimpanzee in Central Africa.
▪ The chimpanzee version of the virus (called simian immunodeficiency virus, or SIV) was
probably passed to humans when humans hunted these chimpanzees for meat and
came in contact with their infected blood.
▪ Studies show that HIV may have jumped from chimpanzees to humans as far back as
the late 1800s.

▪ Formerly known as "4H disease", as the syndrome seemed to affect heroin users,
homosexuals, hemophiliacs, and Haitians.
▪ The term GRID, which stood for gay-related immune deficiency, had also been coined
▪ the term AIDS was introduced at a meeting in July 1982.
 ▪ By September 1982 the CDC started referring to the disease as AIDS.

HIV in Philippines:
▪ First HIV case in the Philipines was reported in January 1984
▪ Philippines has one of the lowest rate of infection but has the FASTEST growing number
of cases worldwide.
▪ RA 11166 — Philippine HIV/AIDS Policy Act of 2018, making health services for
HIV/AIDS more accessible yo Filipinos
▪ RA 8504 — Philippine AIDS prevention and Control Act of 1998

Agent: RETROVIRUS (HIV)

Reservoir/host: Humans
*HIV weakens the immune system,destroying a type of WBC (CD4 or T-helper cells)
MOT: SEXUAL CONTACT
INCUBATION: seroconverison is 1 to 4 weeks
AIDS is manifested 2 to 10 years after HIV onset.
Diagnosis
▪ EIA/ELISA — Screening test for HIV antibodies
▪ Western Blot - confirmatory testing for HIV antibodies.
▪ Western blot is the confirming test for people who initially tested antibody-positive in the
screening ELISA test for HIV.
▪ The Western blot test is unlikely to generate a false-positive result.
▪ This will be used to confirm or refute the ELISA test results
Note: it is the HIV ANTIBODIES being tested not the actual virus itself
CD4 CELL COUNT:
▪ A normal CD4 count is from 500 to 1,400 or 500 to 1500 cells per cubic millimeter of
blood. CD4 counts decrease over time in persons who are not receiving ART.
▪ Less than 200 cells/mm³ is AIDS

MODE of Transmission:
A — Anal sex ( male to male sex contact) ‐ 84%
V — Vaginal sex (male to female)
O— Oral sex
N — Needles (sharing and pricks) — 4%
20% – OFW
MAJORITY is male.

MODE of Transmission:
PREGNANCY (vertical transmission)
— results to spontaneous abortion (repeated abortion), stillbirth and prematurity, perinatal and
infant mortality, intrauterine growth retardation, low birth weight, chorioamnionitis, and mild
weight loss. HIV do not cause INFERTILITY

POSTNATAL HIV transmission is through HIV-contaminated breast milk.

HOT SPOTS:
1. NCR (MSM)
2. Region IV–A (needles)
3. Central Visayas
4. Region 3 (Female sex work)
5. Region 11

HIV Signs and Symptoms:

INITIAL: flu-like symptoms within 2 to 4 weeks after infection (called acute HIV infection).
▪ Fever,
▪ Chills,
▪ Rash,
▪ Night sweats,
▪ Muscle aches,
▪ Sore throat,
▪ Fatigue,
▪ Swollen lymph nodes, and
▪ Mouth ulcers.

Stage 1: Acute HIV Infection

▪ People have a large amount of HIV in their blood. They are very contagious.
▪ Some people have flu-like symptoms. This is the body’s natural response to infection.
▪ Fever, Chills, Headache, Rash, Night sweats, Muscle aches, Sore throat, Fatigue,
and Swollen lymph nodes.
 ▪ Peripheral nervous system manifestations are common in​HIV-infected patients.
Sensory neuropathies with manifestations of​numbness, tingling, and pain in the
lower extremities affect about​30% of patients with AIDS.

Stage 2: Chronic HIV Infection

▪ This stage is also called asymptomatic HIV infection or clinical latency.
▪ HIV is still active but reproduces at very low levels.
▪ People may not have any symptoms or get sick during this phase.
▪ Without taking HIV medicine, this period may last a decade or longer, but some may
progress faster.
▪ People can transmit HIV in this phase.
▪ At the end of this phase, the amount of HIV in the blood (called viral load) goes up and
the CD4 cell count goes down. The person may have symptoms as the virus levels
increase in the body, and the person moves into Stage 3.
▪ People who take HIV medicine as prescribed may never move into Stage 3.

Stage 3: Acquired Immunodeficiency Syndrome (AIDS):

▪ The most severe phase of HIV infection.
▪ People with AIDS have such badly damaged immune systems that they get an
increasing number of severe illnesses, called opportunistic infections.
▪ People receive an AIDS diagnosis when their CD4 cell count drops below 200
cells/mm, or if they develop certain opportunistic infections.
▪ People with AIDS can have a high viral load and be very infectious.
▪ Without treatment, people with AIDS typically survive about three years.
HIV/AIDS:
▪ Tuberculosis ”co-infection” is one of the leading causes of sickness and death in
those with HIV/AIDS being present in a third of all HIV-infected people and causing 25%
of HIV-related deaths.
▪ HIV is also one of the most important risk factors for tuberculosis.
▪ Hepatitis C is another very common co-infection where each disease increases the
progression of the other.
▪ The two most common cancers associated with HIV/AIDS are Kaposi's
sarcoma and AIDS-related non-Hodgkin's lymphoma

Treatment:
▪ Cachexia — HIV wasting syndrome, give Megestrol acetate
▪ HIV ART — Zidovudine, lamivudine,nevirapine
▪ Antiretroviral drugs DOES NOT kill the virus that causes the disease. It simply
helps to fight infection and prolongs life of patient even with the disease.
▪ Efavirenz should be avoided in pregnants
▪ Truvada and Descovy is used as PrEP (Pre Exposure Prophylaxis)
WORLD HIV/AIDS DAY – December 1

International Candlelight Memorial happens every third Sunday of May each year to
commemorate people who have lost their lives with HIV and celebrate the great strides the
community has done over the years for the HIV community.

PREVENTION
The key to prevent HIV is ABCDE which stands for
A – Abstinence
B - be mutually faithful with you partner
C - consistent and correct use of condoms (latex)
D - Don't use drugs and early detection
E – Education, educate self and others