Communicable Diseases

The objective of communicable disease control is ultimately to

stop transmission of the causative agent, so that no new
individuals will get infected and be at risk of developing
disease. Disease may be prevented by preventing transmission
or by preventing an infected person from developing the disease
(e.g., through vaccination). In some diseases, such as leprosy,
HIV, or typhoid, It may be very difficult to prevent transmission,
because people may be asymptomatic carriers who are
themselves unaware that they are infected and infectious to
others. No methods are available to prevent infection with M.
leprae. Isolation of infectious patients is no longer practiced, for
two main reasons: Most patients have been Infectious for a long
time by the time they are detected and therefore transmission
has likely already taken place; and treatment with MDT renders
even a lepromatous patient noninfectious within a few days.
’.MDT can therefore be seen as ‘chemical isolation
Public health legislation
Public health legislation has been an historical component of
communicable disease control in most industrialized countries
and is still used for control of TB in a number of locations. The
content of, and procedures for applying, public health law have
recently come under critical review. Using the example
primarily of its use in control of venereal disease and the
consequences of this for HIV/AIDS.
Host -Agent -Environment Triad.

The host–agent–environment traid, is fundamental to the success

of understanding the transmission of infectious diseases and
their control, including well-known diseases, those changing
their patterns, and those newly emerging or escaping current
methods of control. Infection occurs when the organism
successfully invades the host’s body, where it multiplies and
produces an illness.

Hosts are people, or other living animals, including birds and

arthropods, which provide a place for growth and sustenance to
an infectious agent under natural conditions. Some organisms,
such as protozoa or helminths, may pass through successive
stages of their life cycle in different hosts, but the definitive host
is the one in which the organism passes its sexual stage. The
intermediate host is where the parasite passes the larval or
asexual stage. A transport host is a carrier in which the organism
remains alive, but does not develop.

An agent of an infectious disease is necessary but not always

sufficient to cause a disease or disorder. The infective dose is
the quantity of the organism needed to cause clinical disease. A
disease may have a single agent as a cause, or it may occur as a
result of the agent in company with contributory factors, such as
in socially deprived and undernourished populations or among
immunocompromised people who are vulnerable to the spread
and development of the disease. A disease may be present in an
infected person in a dormant form, such as TB, or a preclinical
stage, such as poliomyelitis (polio) or HIV, without clinical
paralytic disease in the case of polio or before clinical AIDS
appears in the case of HIV. The virulence or pathogenicity of an
infective agent is the capacity of an infectious agent to enter the
host, replicate, damage tissue, and cause disease. Virulence
describes the severity of clinical disease and may vary among
serotypes or strains of the same agent.

Communicable diseases may be classified by a variety of

methods: by clinical syndrome, mode of transmission, methods
of prevention (e.g., vaccine preventable), or by major organism
classification, that is, viral, bacterial, fungal, and parasitic
disease.

A virus is a nucleic acid molecule (RNA or DNA) encapsulated

in a protein coat or capsid. The virus is not a complete cell and
can only replicate inside a living cell. The capsid may have a
protective lipid-containing envelope

Bacteria are unicellular organisms that reproduce sexually or

asexually and can exist in an environment with oxygen (aerobic)
or in a situation lacking oxygen (anaerobic). Some may enter a
dormant state and form spores where they are protected from the
environment and may remain viable for years.
Mycoses are infections caused by molds and yeasts. Clinical
manifestations of fungal disease range from relatively mild
superficial infection to systemic, life-threatening conditions.
Immunocompromised individuals are at elevated risk.
Cryptococcus, Candida, Aspergillus, and Mucor molds or fungi
are among the leading causes of morbidity in HIV-positive
patients and among immunosuppressed populations, such as
those receiving chemotherapy and radiation for cancer
treatment. Pneumocystis jiroveci (formerly P. carinii), once
thought to be a protozoan, is now classified a fungus, based on
genetic analysis.
Parasitology studies protozoa, helminths, and arthropods that
live within, on, or at the expense of a host. Protozoa include
oxygen-producing, unicellular organisms such as the flagellates
Giardia and Trichomonas, and amoebae such as Entamoeba, in
enteric and gynecological disorders.

Transmission of diseases occurs via the spread of an infectious

agent from a source or reservoir to a person. Direct transmission
from one host to another occurs during touching, biting, kissing,
sexual intercourse, projection via droplets, as in sneezing,
coughing, or spitting, or by entry through the skin. Indirect
transmission includes aerosols of long-lasting suspended
particles in air; this can be central among passengers on an
aircraft being exposed to a TB patient or a measles carrier.
Fecal–oral transmission such as foodborne and waterborne can
occur easily, as well as by poor hygienic conditions with
fomites, such as soiled clothes, handkerchiefs, toys, or other
objects. Waterborne and foodborne diseases are still among the
most common causes of death, particularly of children in low-
income countries with poor infrastructure for water and sewage
management.
Vectorborne diseases are transmitted via crawling or flying
insects, in some cases with multiplication and development of
the organism in the vector, as in malaria. The subsequent
transmission to humans is by injection of salivary gland fluid
during biting or by deposition of feces, urine, or other material
capable of penetrating the skin through a bite wound or other
trauma. Transmission may occur with insects as a transport
mechanism, as in Shigella on the legs of a housefly.
Surveillance of disease is the continuous scrutiny of all aspects
of the occurrence and spread of a disease pertinent to effective
control of that disease. Maintaining ongoing surveillance is one
of the basic duties of a public health system, and is vital to the
control of communicable disease, providing the essential data
for tracking of disease, planning interventions, and responding
to future disease challenges. Surveillance of infectious disease
incidence relies on reports of notifiable diseases by physicians,
supplemented by individual and summary reports of public
health laboratories. Such a system must concern itself with the
completeness and quality of reporting and potential errors and
artifacts. Quality is maintained by seeking clinical and
laboratory support to confirm first reports. Completeness,
rapidity, and quality of reporting by physicians and laboratories
should be emphasized in undergraduate and postgraduate
medical education. Enforcement of legal sanctions may be
needed where standards are not met.
Heymann DL, editor. Control of communicable diseases manual.
19th ed. Washington, DC: American Public Health Association; 2008

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Adapted from: World Health Organization. WHO guidelines on hand

hygiene in health care. Geneva: WHO; 2009.

at: http://whqlibdoc.who.int/publications/2009/9789241597906_eng
.pdf [Accessed 18 January 2013]. Centers for Disease Control and
Prevention. Hand hygiene in health care settings: guidelines.

at: http://www.cdc.gov/handhygiene/ [Accessed 18 January 2013].

Centers for Disease Control and Prevention. CDC definitions of
nosocomial infections.

at: http://health.utah.gov/epi/diseases/legionella/plan/cdcdefsnosoc
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in healthcare-associated infection prevention. J Hosp Infect
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