CHAPTER TWO

DEFINITION, DESCRIPTION OF THE TRANSMISSION,

PREVENTION AND CONTROL OF COMMUNICABLE
DISEASES
Learning Objectives

• At the end of this chapter the student will be able to:

• - Define communicable disease.
• - Describe the factors involved in the chain of
• communicable disease transmission.
• - Identify the different levels of disease prevention.
• - Apply the different control methods of communicable
diseases.
Communicable Diseases
• These are illnesses due to specific infectious agents or its
toxic products, which arise through transmission of that
agent, or its toxic products from an infected person, animal or
inanimate reservoir to a susceptible host, either directly
indirectly, through an intermediate plant or animal host,
vector or inanimate environment.
Chain of Disease Transmission

• This refers to a logical sequence of factors or links of a chain

that are essential to the development of the infectious agent
and propagation of disease. The six factors involved in the
chain of disease transmission are:
• a. Infectious agent (etiology or causative agent)
• b. Reservoir
Cont.
• c. Portal of exit
• d. Mode of transmission
• e. Portal of entry
• f. Susceptible host
Cont.
• a. Infectious agent: An organism that is capable of producing
infection or infectious disease. On the basis of their size, etiological
agents are generally classified into:
• Metazoa (multicellular organisms). (e.g. Helminths).
• Protozoa (Unicellular organisms) (e.g. Ameobae)
• Bacteria (e.g. Treponema pallidum, Mycobacterium tuberculosis, etc.)
• Fungus (e.g. Candida albicans)
• Virus (e.g. Chickenpox, polio, etc.)
Cont,
• b. Reservoir of infection: Any person, animal, arthropod,
plant, soil or substance (or 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.
Types of reservoirs

• 1. Man: There are a number of important pathogens that are

specifically adapted to man, such as: measles, smallpox,
typhoid, meningococcal meningitis, gonorrhea and syphilis.
The cycle of transmission is from human to human .
Cont.
• 2. Animals: Some infective agents that affect man have their
reservoir in animals. The term “zoonosis” is applied to
disease transmission from animals to man under natural
conditions. For example:
• Bovine tuberculosis - cow to man
• Brucellosis - Cows, pigs and goats to man
• Anthrax - Cattle, sheep, goats, horses to man
• Rabies - Dogs, foxes and other wild animals to man
Cont.
• 3. Non-living things as reservoir: Many of the agents are
basically saprophytes living in soil and fully adapted to live
freely in nature. Biologically, they are usually equipped to
withstand marked environmental changes in temperature and
humidity.
• E.g. Clostridium botulinum etiologic agent of Botulism
• Clostridium tetani etiologic agent of Tetanus
• Clostridium welchi etiologic agent of gas gangrene
Cont,
• c. Portal of exit (mode of escape from the reservoir): This is the site
through which the agent escapes from the reservoir. Examples include:
• GIT: typhoid fever, bacillary dysentery, amoebic dysentery, cholera,
ascariasis, etc.
• Respiratory: tuberculosis, common cold, etc.
• Skin and mucus membranes: Syphilis
Cont.
• d. Mode of transmission (mechanism of transmission of
infection): Refers to the mechanisms by which an infectious
agent is transferred from one person to another or from a
reservoir to a new host. Transmission may be direct or
indirect.
• 1. Direct transmission: Consists of essentially immediate
transfer of infectious agents from an infected host or
reservoir to an appropriate portal of entry.
Cont.
• a. Direct Vertical Such as: transplacental transmission of
syphilis, HIV, etc.
• b. Direct horizontal Direct touching, biting, kissing, sexual
intercourse, droplet spread onto the conjunctiva or onto
mucus membrane of eye, nose or mouth during sneezing
coughing, spitting or talking; Usually limited to a distance of
about one meter or less.
Cont,
• 2. Indirect transmission
• a. Vehicle-borne transmission: Indirect contact through
contaminated inanimate objects (fomites) like:
• Bedding, toys, handkerchiefs, soiled clothes, cooking or
eating utensils, surgical instruments.
• Contaminated food and water
Cont.
• Biological products like blood, serum, plasma or IV-fluids or
any substance serving as intermediate means by which an
infectious agent is transported and introduced into a
susceptible host through a suitable portal of entry. The agent
may or may not multiply or develop in the vehicle before it is
introduced into man.
Cont.
• b. Vector-borne transmission: Occurs when the infectious
agent is conveyed by an arthropod (insect) to a susceptible
host. Biological transmission: This is when the agent
multiplies in the arthropod before it is transmitted, such as
the transmission of malaria by mosquito.
Cont.
• C. Air-borne transmission: Dissemination of microbial
agent by air to a suitable portal of entry, usually the
respiratory tract. Two types of particles are implicated in this
kind of spread: dusts and droplet nuclei.
cont.
• Dust: small infectious particles of widely varying size that
may arise from soil, clothes, bedding or contaminated floors
and be resuspended by air currents.
Cont.
• e. Portal of entry: The site in which the infectious agent
enters to the susceptible host. For example:
• Mucus membrane
• Skin
• Respiratory tract
• GIT
• Blood
Cont.
• f. Susceptible host (host factors): A person or animal
lacking sufficient resistance to a particular pathogenic agent
to prevent disease if or when exposed. Occurrence of
infection and its outcome are in part determined by host
factors. The term “immunity” is used to describe the ability
of the host to resist infection.
Cont.
• Resistance to infection is determined by non-specific and
• specific factors:
• Non-specific factors
• Skin and mucus membrane
• Mucus, tears, gastric secretion
• Reflex responses such as coughing and sneezing.
Specific factors

• Genetic-hemoglobin resistant to Plasmodium falciparum

• Naturally acquired or artificially induced immunity. Acquired
immunity may be active or passive.
• Active immunity- acquired following actual infection or
immunization.
• Passive immunity- pre-formed antibodies given to the host.
Carrier and Its Type
• A carrier is an infected person or animal who does not have
apparent clinical disease but is a potential source of infection
to others.
• a. Healthy or asymptomatic carriers: These are persons
whose infection remains unapparent. For example, in
poliovirus, meningococcus and hepatitis virus infections,
there is a high carrier rate.
Cont.
• b. Incubatory or precocious carriers: These are individuals
or persons who excrete the pathogen during the incubation
period (i.e. before the onset of symptoms or before the
characteristic features of the disease are manifested). E.g.
Measles, mumps, chickenpox and hepatitis.
• c. Convalescent Carriers: These are those who continue to
harbor the infective agent after recovering from the illness.
E.g. Diphtheria, Hepatitis B virus.
Time Course of Infectious Diseases
• Incubation period: It is the interval of time between
infection of the host and the first appearance of symptoms
and signs of the disease.
• Prodormal period: It is the interval between the onset of
symptoms of an infectious disease and the appearance of
characteristic manifestations. For example, in a measles
patient, fever
Levels of Prevention
• a. Primary prevention: The objectives here are to promote
health, prevent exposure, and prevent disease.
• Health promotion: This consists of general non-specific
interventions that enhance health and the body’s ability to
resist disease, such as measures aimed at the improvement of
socio-economic status through the provision of adequately
paid jobs, education and vocational training, affordable and
adequate housing, clothing, and food, old-age pension
benefits; emotional and social support, relief of stress, etc.
Cont.
• Prevention of exposure:- This includes actions such as the
provision of safe and adequate water, proper excreta disposal,
vector control, safe environment at home (e.g., proper storage
of insecticides and medicines, out of children’s reach), at
school and at work (e.g., proper ventilation, monitoring of
harmful substances in factories), and on the streets (e.g.,
driver licensing laws).
Cont.
• Detection and adequate treatment of cases: arrests the
communicability of the disease (e.g. Treatment of active
pulmonary tuberculosis).
• Isolation: separation of infected persons for a period of
communicability of the disease. Isolation is indicated for
infectious disease with the following features:
• - High morbidity and mortality
• - High infectivity
Cont.
• Quarantine: limitation of the movement of apparently well person or
animal who has been exposed to the infectious disease for a duration
of the maximum incubation period of the disease.
Cont.
• Interruption of transmission This involves the control of
the modes of transmission from the reservoir to the potential
new host through:
• Improvement of environmental sanitation and personal
hygiene
• Control of vectors
• Disinfections and sterilization
Cont.
• Protection of susceptible host: This can be achieved
through:
• Immunization: Active or Passive
• Chemo-prophylaxis- (e.g. Malaria, meningococcal
meningitis, etc.)
• Better nutrition
• Personal protection. (e.g. wearing of shoes, use of mosquito
bed net, insect repellents, etc.)