1. Control of Communicable Diseases Ahmed Mandil Prof of Epidemiology KSU College of Medicine

2. Headlines Aims of Communicable Disease Control Aims of Communicable Disease Control Measures towards: reservoir, contacts, carriers, environment Measures towards: reservoir, contacts, carriers, environment Outbreak control Outbreak control Examples Examples 16 October 201516 October 201516 October 2015CD Control2

3. Aims of CD control Eradication of the disease, if possible. This may indicate complete extinction of its agents, reservoir or vectors. It also means complete prevention of transmission. Eradication of the disease, if possible. This may indicate complete extinction of its agents, reservoir or vectors. It also means complete prevention of transmission. If eradication is not possible, then transmission could be reduced, in order to control morbidity (elimination) If eradication is not possible, then transmission could be reduced, in order to control morbidity (elimination) If the latter cannot be achieved, we try to reduce severity and gravity of the disease (control) If the latter cannot be achieved, we try to reduce severity and gravity of the disease (control) 16 October 201516 October 201516 October 2015CD Control3

4. Measures towards reservoir (1) 1. Eradication: Extinction of animal reservoirs has been successful with diseases as bovine T.B. and rabies in several countries. Such procedure is only possible for domestic animals, while it is difficult or almost impossible for wild animals (e.g. in jungle yellow fever, some sylvatic/wild reservoirs of leishmaniasis) 16 October 201516 October 201516 October 2015CD Control4

5. Measures towards reservoir (2) 2. Reduction of communicability: (A) Segregation of cases: This means that the patient is isolated from the community in a fashion that prevents direct and indirect spread of the infectious agent. This is usually done for a period which equals the "period of communicability", at hospital or at home. Ideally, repeated negative samples from the patient are needed before his (her) release. 16 October 201516 October 201516 October 2015CD Control5

6. Measures towards reservoir (3) (B) Treatment of cases: Early diagnosis and prompt treatment of infections with the appropriate regimens (e.g. antibiotics or chemotherapeutic agents) helps reducing communicability very much 3. Disinfection: Disinfection of the soiled articles by the patient discharges concurrently (during his presence) and/or terminally (e.g.after discharge from the hospital) helps in reduction of communicability. 16 October 201516 October 201516 October 2015CD Control6

7. Measures towards carriers Detection and control of carriers would be worthwhile in the following conditions: (A) If they represent important reservoirs of infection. (A) If they represent important reservoirs of infection. (B) If their proportion in the community is small. (B) If their proportion in the community is small. (C) If they were suspected in a closed community, such as a boarding school or army barracks (C) If they were suspected in a closed community, such as a boarding school or army barracks 16 October 201516 October 201516 October 2015CD Control7

8. Measures towards contacts (1) After enlistment the following procedures could be applied: a. Surveillance: a. Surveillance: This means close medical supervision of the contacts, without restricting their movement, for the purpose of early detection of the disease in question. This should be for the longest incubation period. 16 October 201516 October 201516 October 2015CD Control8

9. Measures towards contacts (2) b. Quarantine: This is only done for a limited number of diseases nowadays such as pneumonic plague and pneumonic anthrax. It implies restriction of the movement of all those exposed to a case of such a disease, in order to prevent their contact with those not exposed. It also allows early detection of the disease among these individuals. It is done also for a period equaling the longest incubation period. 16 October 201516 October 201516 October 2015CD Control9

10. Measures towards contacts (3) c. Increasing the resistance of susceptibles: c. Increasing the resistance of susceptibles: This is done either through active &/or passive immunization, or chemoprophylaxis. The choice of the measure is disease dependent. The value of immunization of contacts in preventing disease depends on the relation between the incubation period and the time needed to develop immunity. This is done either through active &/or passive immunization, or chemoprophylaxis. The choice of the measure is disease dependent. The value of immunization of contacts in preventing disease depends on the relation between the incubation period and the time needed to develop immunity. 16 October 201516 October 201516 October 2015CD Control10

11. Measures towards contacts (4) d. Disinfestation: which is useful in diseases transmitted by insects to contacts, as in louse-borne typhus. d. Disinfestation: which is useful in diseases transmitted by insects to contacts, as in louse-borne typhus. 16 October 201516 October 201516 October 2015CD Control11

12. Measures towards environment (1) Reduction of overcrowding (better housing conditions) Reduction of overcrowding (better housing conditions) Environmental sanitation (e.g. sanitary sewage disposal, sanitary refuse disposal, sanitary water supply, Environmental sanitation (e.g. sanitary sewage disposal, sanitary refuse disposal, sanitary water supply, Vector control (insecticiding: directly or through aerial spraying techniques, mosquito-nets, insect repellents, etc.) Vector control (insecticiding: directly or through aerial spraying techniques, mosquito-nets, insect repellents, etc.) 16 October 201516 October 201516 October 2015CD Control12

13. Measures towards environment (2) Personal hygiene (cleanliness, hand- washing, regular bathing) Personal hygiene (cleanliness, hand- washing, regular bathing) National/international measures: which include different public health measures undertaken within and between countries, in order to protect the individual and the community at large, from different communicable diseases. National/international measures: which include different public health measures undertaken within and between countries, in order to protect the individual and the community at large, from different communicable diseases. 16 October 201516 October 201516 October 2015CD Control13

14. Outbreak Control An outbreak is occurrence of a number of cases of a disease that is unusually large or unexpected for a given place and time. An outbreak is occurrence of a number of cases of a disease that is unusually large or unexpected for a given place and time.  Outbreaks in emergency situations can spread rapidly giving rise to high morbidity and mortality rates.  Aim should be to detect and control the outbreak as early as possible. 16 October 201516 October 201516 October 201514CD Control

15. Steps in the management of a communicable disease outbreak 1. Preparation 2. Detection 3. Response 4. Evaluation 16 October 201516 October 201516 October 201515CD Control

16. Preparation Health coordination meetings Health coordination meetings Strong surveillance system Strong surveillance system Outbreak response plan for each disease Outbreak response plan for each disease Stocks of IV fluids, antibiotics and vaccines Stocks of IV fluids, antibiotics and vaccines Plans for isolation wards Plans for isolation wards Laboratory support Laboratory support 16 October 201516 October 201516 October 201516CD Control

17. Detection of outbreak Surveillance system with early warning system for epidemic prone diseases. Surveillance system with early warning system for epidemic prone diseases. Inform ministry of health and WHO in case of outbreaks of specific diseases. Inform ministry of health and WHO in case of outbreaks of specific diseases. Take appropriate specimens (stool, CSF or serum) for laboratory confirmation. Take appropriate specimens (stool, CSF or serum) for laboratory confirmation. Include case in the weekly report. Include case in the weekly report. 16 October 201516 October 201516 October 201517CD Control

18. Response to the outbreak Confirm the outbreak Confirm the outbreak Activate the outbreak control team Activate the outbreak control team Investigate the outbreak Investigate the outbreak Control the outbreak Control the outbreak 16 October 201516 October 201516 October 201518CD Control

19. Evaluation Assess appropriateness and effectiveness of containment measures Assess appropriateness and effectiveness of containment measures Assess timeliness of outbreak detection and response Assess timeliness of outbreak detection and response Change public health policy if indicated Change public health policy if indicated Write and disseminate outbreak report. Write and disseminate outbreak report. 16 October 201516 October 201516 October 201519CD Control

20. Prevention and Control of specific communicable diseases Acute Respiratory Infections Acute Respiratory Infections Cholera Cholera Conjunctivitis Conjunctivitis Dengue Dengue Diphtheria Diphtheria Hepatitis Hepatitis HIV/AIDS HIV/AIDS Japanese Encephalitis Japanese Encephalitis Leishmaniasis Leishmaniasis Malaria Malaria Measles Measles Meningococcal Meningitis Meningococcal Meningitis Relapsing Fever(louse borne) Relapsing Fever(louse borne) Scabies Scabies Sexually Transmitted Infections Sexually Transmitted Infections Trypanosomiasis Trypanosomiasis Tuberculosis Tuberculosis Typhoid Typhoid Typhus (Epidemic louse borne) Typhus (Epidemic louse borne) Viral Hemorrhagic fever Viral Hemorrhagic fever 16 October 201516 October 201516 October 201520CD Control

21. Prevention and Control of Acute Respiratory Infections Early recognition and treatment Early recognition and treatment All children with cough carefully assessed All children with cough carefully assessed Assess signs of malnutrition Assess signs of malnutrition Refer severely malnourished to hospital Refer severely malnourished to hospital Manage pneumonia with antibiotics Manage pneumonia with antibiotics Follow national treatment protocols Follow national treatment protocols Supportive measures Supportive measures Vaccination against measles,diphtheria and whooping cough reduces the impact of ARI. Vaccination against measles,diphtheria and whooping cough reduces the impact of ARI. 16 October 201516 October 201516 October 201521CD Control

22. Prevention and Control of Cholera Prompt diagnosis and management Prompt diagnosis and management Establish treatment centers with barrier nursing. Establish treatment centers with barrier nursing. Fecal material and vomit properly disinfected and disposed. Fecal material and vomit properly disinfected and disposed. Health Education on hygiene,safe water, safe food and hand washing. Health Education on hygiene,safe water, safe food and hand washing. Funerals to be held quickly and near the place of death. Meticulous hand washing for those who handle the body. Funerals to be held quickly and near the place of death. Meticulous hand washing for those who handle the body. Promote washing hands with soap and water when food is being handled. Promote washing hands with soap and water when food is being handled. 16 October 201516 October 201516 October 201522CD Control

23. Prevention and Control of Dengue Eliminate habitats of Aedes mosquitoes. Eliminate habitats of Aedes mosquitoes. Personal protection against mosquito bites during day time. Personal protection against mosquito bites during day time. Surveys to determine vector density and larval habitats. Surveys to determine vector density and larval habitats. In an outbreak use larvicide on all potential habitats of Aedes aegypti. In an outbreak use larvicide on all potential habitats of Aedes aegypti. Insecticides to reduce vector population. Insecticides to reduce vector population. Social mobilization to eliminate breeding sites. Social mobilization to eliminate breeding sites. 16 October 201516 October 201516 October 201523CD Control

24. Prevention and Control of Viral Hepatitis Enforcement of water and food sanitation. Enforcement of water and food sanitation. For Hepatitis B and C, all blood products should be screened for the two (and for HIV). For Hepatitis B and C, all blood products should be screened for the two (and for HIV). Vaccination of target population groups for Hepatitis A recommended. Vaccination of target population groups for Hepatitis A recommended. Health workers not immune to hepatitis A and B should be vaccinated. Health workers not immune to hepatitis A and B should be vaccinated. 16 October 201516 October 201516 October 201524CD Control

25. Prevention and Control of Leishmaniasis Reinforced surveillance, early detection and treatment. Reinforced surveillance, early detection and treatment. Reduction of animal reservoir. Reduction of animal reservoir. Vector control. Vector control. Personal protection with insecticide treated nets. Personal protection with insecticide treated nets. Health promotion and social mobilization. Health promotion and social mobilization. 16 October 201516 October 201516 October 201525CD Control

26. Prevention and Control of Malaria Rapid diagnosis and effective case management. Rapid diagnosis and effective case management. Use of insecticide treated nets. Use of insecticide treated nets. Permethrin sprayed blankets or treated clothing. Permethrin sprayed blankets or treated clothing. Indoor Residual Spraying. Indoor Residual Spraying. Chemo prophylaxis to non-immune expatriates and Intermittent Presumptive Therapy for pregnant women. Chemo prophylaxis to non-immune expatriates and Intermittent Presumptive Therapy for pregnant women. 16 October 201516 October 201516 October 201526CD Control

27. Prevention and Control of Meningococcal Meningitis Early detection and control of the outbreak. Early detection and control of the outbreak. Diagnosis and management of cases. Diagnosis and management of cases. Mass vaccination Mass vaccination Highest risk group for meningococcal meningitis is children aged 2-10 years and this should be the priority group during vaccination campaigns. Highest risk group for meningococcal meningitis is children aged 2-10 years and this should be the priority group during vaccination campaigns. 16 October 201516 October 201516 October 201527CD Control

28. Prevention and Control of Tuberculosis Need for integration with the national TB control Program and involve local TB coordinators. Need for integration with the national TB control Program and involve local TB coordinators. Use the national TB treatment protocols. Use the national TB treatment protocols. Cover the local population also. Cover the local population also. Refer seriously ill patients to local hospitals. Refer seriously ill patients to local hospitals. Laboratory services for sputum smears. Laboratory services for sputum smears. Procedures in place for follow up of cases. Procedures in place for follow up of cases. Program evaluation. Program evaluation. 16 October 201516 October 201516 October 201528CD Control

29. Prevention and Control of Typhoid fever Health education, clean water, food inspection, proper food handling and proper sewage disposal. Health education, clean water, food inspection, proper food handling and proper sewage disposal. Early detection and control are important in prevention of spread. Early detection and control are important in prevention of spread. WHO guidelines should be consulted. WHO guidelines should be consulted. Laboratory services are essential to know the outbreak strain and the anti microbial sensitivity pattern. Laboratory services are essential to know the outbreak strain and the anti microbial sensitivity pattern. Mass vaccination may be an adjunct for the control during a sustained high incidence epidemic. Mass vaccination may be an adjunct for the control during a sustained high incidence epidemic. 16 October 201516 October 201516 October 201529CD Control

30. Prevention and Control of Yellow Fever Personal protection against mosquito bites. Personal protection against mosquito bites. Sleeping and living quarters should be screened. Sleeping and living quarters should be screened. Mass vaccination is key to control of outbreak. Mass vaccination is key to control of outbreak. In urban areas mosquito breeding sites should be destroyed. In urban areas mosquito breeding sites should be destroyed. 16 October 201516 October 201516 October 201530CD Control

31. 16 October 201516 October 201516 October 2015CD Control Thanks for your kind attention 31