INTRODUCTION TO COMMUNICABLE

DISEASES AND ITS CONTROL

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 Learning objectives

By the end of todays session students will be able to:

• Define communicable diseases.

Explain Specific Feature of Communicable Disease

• Explain Classification of communicable disease

• Discuss successive events in the chain of disease transmission

• Explain Host Parasite Interactions

• Describe Course of an Infectious Disease over Time

• Discuss general methods of prevention and control of

 Communicable diseases

Definition

 These are illnesses due to specific infectious agent 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 or indirectly, through an intermediate

plant or animal host, vector or inanimate environment

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.
 Specific Feature of Communicable Disease

• A case may be risk factor.

• Each infectious disease has its own incubation period.

• People may be immune.

• An individual may be a source without being recognized as a case.

• There is some times a need for urgency.

• Preventive measures (usually) have a good scientific ground.

• Intervention in infectious disease can have several effects.

 Classification of communicable disease

A. Based on mode of transmission

1. Airborne diseases- Need droplet nuclei or dust for

transmission, E.g. Tuberculosis
2. Vehicle borne disease- Need non-living substance or
object for transmission , E.g. Cholera
3. Vector Born disease- Need vectors for transmission ,E.g.
Malaria
4. Other sexually transmitted Diseases, contact diseases, etc
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 B. Based on Clinical manifestations or system
involved.

• Diarrheal disease – Watery/ secretary, dysentery/

invasive
• Febrile illness - Malaria, relapsing fever, typhoid fever
• Respiratory tract infection
• Central Nervous system infection – Meningitis
• Cardio vascular infection – endocarditis.
• UTI
 C. Based on time course

• Acute
– Disease with short duration (less than two weeks)
– It needs urgent care,
– Rapidly progressive
– Have abrupt onset.
• Chronic
 indicate duration usually > 2wks
D. Based on the Biologic agent

1. Bacterial diseases e.g. Syphilis, Gonorrhea, etc.

2. Protozoal diseases e.g. Malaria
3. Viral diseases e.g. HIV/AIDS
4. Helminthes diseases e.g. Ascariasis
5. Fungal diseases e.g. Candidiasis

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 Definition of other epidemiological terms

1. Expected level
A.Endemic: a present level of low to moderate
occurrence

B. Hyper-endemic: a persistently high level of

occurrence

C. Sporadic: occasional cases occurring at irregular

interval

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2. Excess of what is expected

Epidemic: occurrence of disease in excess of what is

expected in a limited period
Outbreak: same as epidemic often used by public
health officials because it is less provocative.
Pandemic: an epidemic spread over several countries
or continents, affecting a large number of people
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 Cont’d

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Illness:-Individual or subjective feeling of discomfort.
Disease:-A state of physiological and psychological
dysfunction.
Infection:-The entry and development or multiplication
of an infectious agent in the body of man or animal.

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Contamination – presence of living infectious agent
upon articles
Infestation – presence of living infectious agent on the
exterior surface of the body
Infectious - caused by microbes and can be transmitted
to other persons.
Infectious agent- an agent capable of causing infection
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 Chain of disease transmission

Refers to a logical sequence of factors or links of a chain that are

essential to the development of the infectious agent and progression of
disease.

It has six components:

1.The agent

2.Its reservoirs

3.Its portal of exits

4.Its mode of transmission

5.Its portal of entry, and

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6.The human host
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 1.The agent

 They range from viral particles to complex multicellular

organisms
Pathogenic mechanisms:
 Infectious agents may bring about pathologic effect through
different mechanisms

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There mechanisms include:
1.Direct tissue invasion
2.Production of a toxin
3.Allergic reaction
4.Immune suppression

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 2. Reservoirs

 They include organisms or habitat in which an

infectious agent normally lives, transforms, develops
&/ or multiplies.
 Thus, they include human beings, vertebrate animals,
invertebrates (arthropod),& environmental sources
like plants, soil, water, etc

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 Types of reservoirs

1.Man
 There are a number of important pathogens that are especially
adapted to man such as measles, small pox, typhoid,
gonorrhea and syphilis.
man cycle transmission man

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2. Animals
Animals cycle transmission man
Zoonosis:-disease transmission from animals to man under
normal conditions.
E.g. Bovine TB -cow to man
Brucellosis –cow, pigs and goats to man
Anthrax –cattle, sheep, goats, horses to man
Rabies –dogs, foxes etc. to man
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3. Non-living things as a 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 with stand

marked environmental changes in temperature and

humidity.

E.g. C.botulinum etiology of botulism, C.tetani etiology of

tetanus,
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C.welchi etiology of gas gangrene. 22
 Carrier
It is an infected person or animal who does not have
apparent clinical disease but is a potential source of a
disease

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 Types of carriers

1.Healthy or asymptomatic carriers: Transmitting an infection with

out ever showing symptom. E.g. Polio, Hepatitis,

2. Incubatory carrier: Transmitting infection by shading the agent

before the onset of clinical manifestations

E.g. chicken pox, measles, hepatitis

3. Convalescent Carrier: Transmitting infection after the time of

recovery from the diseases E.g., HBV, Salmonella.

4. Chronic Carrier: Shade the agent before a long period of time

E.g., HBV, Typhoid, HIV

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 3. Portal of exit

 It is the way through which the infectious agent

leaves its reservoir
 Possible portal of exit include all body secretions &
discharges: mucus, saliva, tears, breast milk, vaginal
discharges, excretions (feces & urine), blood, etc.

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 4. Mode of Transmission

 It includes the various mechanisms by which agents are

conveyed to a susceptible host

 Transmission may be direct or indirect

1. Direct transmission

1.1 Direct contact- refer to the contact of skin, mucosa, or

conjunctiva from another person or vertebrate animal,
through
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Touching:
Examples
-Eye- hand -eye e.g. Trachoma
-Nose-hand-mouth e.g. Common cold
-Mouth hand mouth e.g. Mononucleosis
-Feces-hand- mouth e.g. shigellosis
-Skin- skin e.g. Ring worm

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-Kissing e.g. mononucleosis
-Sexual intercourse e.g. syphilis
-Biting e.g. rabies
-Passage through birth canal (e.g. gonococcal ophthalmia
neonatarum)

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 1.2 Direct projection of saliva droplet created by expiration
activities such as coughing, sneeze, spitting, talking, singing, etc.
- Saliva droplets are emitted, these, if large can reach another
host directly at distances of up to one meter.
E.g. Common cold

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1.3 Trans placental transmission

- It is transmission of diseases from mother to her fetus

through the placenta.
E.g. TORCHS (Toxoplasmosis, Rubella,
Cytomegalovirus infection, Herpes simplex infection,
syphilis, others including HIV/AIDS)

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2. Indirect transmission

2.1. Airborne
 Dissemination of the infectious agent by air to a
suitable portal of entry usually the respiratory tract.

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Two types of particles can result in airborne transmission:
a) Dust:- are small infectious particles of widely varying size &
that may arise from, soil, clothes, bedding or contaminated floors
and be suspended by air currents
b) Droplet nuclei:-are small residues resulting from evaporation
of fluid (droplets) emitted by an infected host.
 They usually remain suspended in the air for long periods of
time.

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2.2. Vehicle borne

 A vehicle is defined as any non- living substance or

object by which an infectious agent can be
transported and introduced in to a host.
E.g. food, water, milk, fomites, towels, clothes, etc

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2.3. Vector borne-

 A vector is an organism which transports an infectious agent

to a susceptible host.
There are two types of vectors
a. Biological vectors:- In such type of vectors, there is a period
of multiplication and/ or development of the agent in the
vector is required before transmission to the host can occur.
 This period is called the extrinsic incubation period.
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Biological vectors based on the mechanism of inoculation of the
agent in to the host are classified as;
i. Sal Varian transmission:- In which case infective saliva is
injected in to the host.
E.g. Female anopheles mosquito→ Malaria

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ii. Stercorarian transmission:- In which case infective fecal or
regurgitated material will be deposited near the bite wound, then
the agent enters the host through autoinoculation.
E.g. Body louse →Relapsing fever

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b. Mechanical vectors:-In this case, there are no periods of
development and multiplication of the agent but are not
responsible for transporting the agent to human host.
 A disease often has several modes of transmission
 It is very important to distinguish between the predominant
mode (s) of transmission and those which are of little
importance

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5.Portal of entry
 The site in which the infectious agent enters to the susceptible
host.
E.g. -Mucus membrane-syphilis, HIV
-Respiratory tract-PTB, pertussis
-GIT-Giardiasis

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6.Susceptible host
 A person or animal not possessing sufficient resistance
against a particular pathogenic agent to prevent
contracting infection or disease when exposed.
 Occurrence of infection and its out come are in part
determined by host factors.
 Resistance to infection is determined by non specific and
specific factors.
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A) Non specific factors
 Skin and mucus membrane, mucus, tears, gastric
secretion, reflexes (coughing, sneezing)

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 Cont’d

B) Specific factors

 Genetic- hemoglobin resistant to plasmodium falciparum.

 Naturally acquired or artificially induced immunity.

 Acquired immunity may be active or passive.

 Active immunity is immunity acquired following actual

infection or immunization.

 Passive immunity is when preformed antibodies given to the

host
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Host Parasite Interactions
1. Infectivity
• Infectivity is ability of the infectious agent to
invade and multiply/produce an infection) in
exposed host
2. Pathogenicity
• Ability of an agent to produce clinically manifest
disease in susceptible host.
• Measured by the proportion of infections that
result in clinically apparent disease
 3. Virulence

• Ability of an agent to produce sever disease.

• Measured by proportion of clinical cases
resulting in sever clinical manifestation
• Proportion of cases that require different kinds
of treatment
 CONT’D….

Note that;
• High infectivity different from High
Pathogenicity
• High pathogenicity different from High
virulence e.g.Rhinovirus infection: High
Pathogenicity but low virulence
Measles infection :high Pathogenicity,low
virulence
HIV;high Pathogenicity & high virulence
NATURAL HISTORY OF DISEASES

 progress of a disease process in an individual over

time, in the absence of any intervention.
 Begins with exposure to causative agent capable of
causing disease
 Without intervention:- recovery, disability or death.
 Halted at any time in the progression by intervention,
host factor, other influences.

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Natural history time lines for infection and disease

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 Course of an Infectious Disease over Time

Prepatent period:-The time interval between infection

and the point at which the infection can first be detected

I.e. between biological onset and the time of first

shading of the agent

Incubation period:- is the time interval between

infection and first clinical manifestation of the disease

: - I.e. between biological onset and clinical onset

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Prodromal period:-The time interval between the onset of
symptoms of an infectious disease and the appearance of
characteristic manifestations.
E.g. In measles from the onset of fever and coryza to the
development of characteristic signs like kop lick spots and
characteristic skin lesions.
Communicable period:- It is the period during which an infected
host can transmit the infection to others
Latent period:- The time period between recovery and the
occurrence of relapse or reactivation in clinical disease
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Figure , Time Course of a Disease in Relation to Its Clinical
Expression and Communicability

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 Determinants of disease

 Agent;-The agents need a suitable environment in which to grow

and multiply and thus be able to spread and infect another host.

 If not they die out.

 There is there fore a balance between the agent, the host and the
environment which can be shown as:
The Host, Agent, Environment Triad
HOST

AGENT ENVIRONMENT
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Host:-A person or other living animal that affords
substance to an infectious agent under natural conditions.
 primary or definitive hosts; in which the parasite
attains maturity or passes its sexual
 secondary or intermediate hosts. stage those in which
the parasite is in a larval or asexual state.

 A transport host; is a carrier in which the

organism remains alive but does not undergo
development.
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 Environment ;-Hosts are affected by their environment.
E.g. they may live in a hot and wet climate in which there
are many mosquitoes.
 But people can also change this environment by draining
swamps.
 Similarly the environment can affect the agent. E.g. the
altitude and temperature for malaria.

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 Cont’d

 When the balance between these three is constant,

there will be a fairly steady number of people getting sick
all the time. When this happens, a disease is said to be
endemic.
 When the balance is shifted in favor of the organism, for
example when many non-immune children have been
born in an area since the last measles epidemic, a large
number of cases of measles occur in a short time. This is
called an epidemic.
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 Spectrum of Infectious Disease/ Gradient of Infection/

• Spectrum of infection implies the range in the

expression of disease be it in terms of the
degree of severity or clinical manifestation.
II. GENERAL METHODS OF PREVENTION AND
CONTROL OF COMMUNICABLE DISEASES

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 Levels of disease prevention

The different points in the progression of a disease at which

one can intervene to prevent further out come.
There are three levels of prevention.
1. Primary prevention: The objectives here are to promote
health, prevent exposure, and prevent disease.

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A) Health promotion:-
Any intervention that promotes a healthier and happier life.
 education and vocational training;
 affordable and adequate housing, clothing and food;
 old age pension benefits;
 emotional and social support, relief of stress etc

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B) Prevention of exposure:
 Any intervention which prevents the coming in contact
between an infectious agent and a susceptible host.
This includes actions such as
 provision of safe and adequate water;
 proper excreta disposal;
 vector control;

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C) Prevention of disease:-
 This occurs during the latency period between exposure
and the biological onset of the disease.
 An example for this is immunization.
 N.B. Immunization against an infectious organism does
not prevent it from invading the immunized host but
prevents it from establishing an infection.

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Breast feeding is an example of intervention that acts at
all three levels of primary Prevention.
1.Health promotion: by providing optimal nutrition for a
young child, either as the sole diet up to six months of age, or
as a supplement in later age.
2.Prevention of exposure: by reducing exposure of the
child to contaminated milk.
3. Prevention of disease after exposure: by the provision
of ant-infective factors, including antibodies, WBCs and
others.
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 2. Secondary prevention

 After the biological on set of the disease, but before

permanent damage sets in, we speak of secondary
prevention.
 Objective;- to stop or slow the progression of disease so
as to prevent or limit permanent damage, through the
early detection and treatment of diseases.

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E.g.
 Breast cancer (prevention of invasive stage of the
disease)
 Trachoma (prevention of blindness)
 Syphilis (prevention of tertiary or congenital syphilis)

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 3. Tertiary prevention

 After permanent damage sets in,

 Objective;-is to limit the impact of that damage.
 The impact can be physical (physical disability),
psychological, social(social stigma),and financial.

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Rehabilitation:
 Refers to the retraining of remaining functions for
maximum effectiveness, and should be seen in a very
broad sense, not simply limited to the physical aspect.
 Thus the provision of special disability pension would be
a form of tertiary prevention

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 Principles of communicable disease control

The actions may be effected through:

1.Attacking the source
2.Interrupting the mode of transmission and
3.Protecting the host (↓susceptibility)

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 Cont’d

1. Attacking the source

Domestic animals as reservoirs
 Immunization e.g. Brucellosis
 Destruction of infected animals e.g. Rabies

Wild animals as reservoirs

 Post exposure prophylaxis e.g. Rabies

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Humans as reservoirs
 Isolation of infected persons & separation of infected
persons form other for the period of communicability
Not suitable when,
 Large proportion are apparently infected, or
 In which maximal infectivity precedes over illness.

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Treatment
 Of cases (clinical) and carriers
 Mass treatment – where large proportion are known to
have a disease it is sometimes advisable to treat
everybody, without checking whether individuals have
disease or not MASS→TREATMENT

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 Quarantine – the limitation of freedom of movement of
apparently healthy persons or animals who have been
exposed to a case or infectious disease.
 Cholera, plaque, and yellow fever are the 3 internationally
quarantinable diseases by international agreement.
 These diseases are very infections, so cases shouldn’t be
referred but seniors must be requested to visit the health
center.

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 2. Interrupting transmission

For Transmission by ingestion

 Purification of water
 Pasteurization of milk
 Inspection procedures designed to ensure safe food
supply
 Improve housing conditions

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For Transmission by inhalation
 Chemical disinfections of air
 Improving ventilation

Transmission by vector or intermediate hosts

 Vector – control measures
 Environmental manipulation

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 3. Measures that reduce host susceptibility

Immunization
 Active immunization – when either the altered organism
or its products is given to a person to induce production
of antibodies e.g. BCG
 Passive immunization– provision of ready–made
antibodies e.g. TAT

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 Chemoprophylaxis– use of antibiotics for known
contacts to a case e.g. Ciprofloxacin for contacts to
a case of M. meningitis
 Better nutrition- Malnourished children get
infections more easily & suffer more severe
complications

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