University of Gondar

College of Medicine and Health sciences

School of Nursing

Communicable Disease Control (CDC)

Chilot Desta (BSC,MPH)

Lecturer of Epidemiology and Bio-Statistics
email: chilotdesta@gmail.com or Chilot.Desta@uog.edu.et
2012 E.c
Gondar, Ethiopia

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 Course syllabus

Module Name: Medical Surgical Nursing I

Course title: Communicable Disease Control
 Credit hour: 2 Cr(32 hrs.)
 Module Code: NursM2083
 Course delivered to -Comprehensive Nursing 2nd year
 Course instructor –Chilot Desta(BScN, MPH in EPI/BIO)

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 Course description
 This course is designed to prepare graduate BSc.nurses who are competen
t providers of community health services with regard to early case
detections, management of cases, control and prevention of communicable
diseases:
 Major topics includes are:
 introduction of communicable diseases
 Methods of communicable diseases control
 Oro-fecal transmitted diseases

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 Course description …….
 Air borne diseases
 Food poisoning
 Course objectives
 Comprehend the basic concepts and theory regarding CDC
 Identify the common communicable disease
 Describe mode of transmission of communicable disease
 Describe factors involved in the transmission of CDC
 Explain methods of CDC

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 Course objectives …….
 Play an active role in the control of communicable diseases
 Organize effective heath education on CDC
 Recognizing nursing care and treatment of a patient with communicable
disease

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 supportive objective……

For the completion of this course, students will be able

Adopt general overview of CD, its unique feature and scope

Differentiate the natural history, time course and chain of infectious

disease

Identify epidemics and disease of public health importance in Ethiopia

Contribute in the disease prevention and control program

Identify, diagnose & manage of common CD

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Teaching method
 Brain storming
 Interactive lecture
 Group discussion
 Case study
 Assessment method
 Class Activity ……………………………5%
 Quizzes …………………………………...10%
 Assignment with presentation…………15%
 Mid exam…………………………………… .20%
 Final exam…………………………………50%
 Total………………………………………..100%

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Attendance criteria
 Students are expected to attend all classes(100%).

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 4. Course content

 Part I: Introduction
 Part II: Natural history of Diseases
 Part III : Air borne disease
 Part IV: Intestinal parasitic disease and infection
 Part V: Food borne diseases
 Part VI: Lymphedema/podoconiosis
 Part VII: Onchocerciasis

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 Chapter one : Introduction to communicable Disease

Learning Objectives:-
• Define communicable disease (CD).

• Identify different way of classifying infectious

disease .

• Describe the over view of Ethiopian health situation .

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 Intro….

• What are infectious diseases?

• What are communicable diseases?

• What are contagious diseases?

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 Definition of Communicable /infectious disease

• Disease due to a specific infectious agent /its toxic

products that transmitted from an infected
person/animal/reservoir to a susceptible host.
• Infectious diseases (IDs): are those that result from
infection or infestation.
• Contagious diseases: are those CDs that are transmitted
directly from the patient to a susceptible individual.
• They are called so because they spread from person to
person, or sometimes from animals to people.

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 Brain storming
 Discuss in pair the following terms( 5 minute )
 Disease
 infection
 Host
 Epidemic
 Endemic
 Sporadic
 Communicable disease
 Non- Communicable disease
 Pandemic
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introduction basic term definition

Disease:- a state of physiological or psychological dysfunction.

Infection – the entry and development or multiplication of an infectious
agent in the body of human beings or animals
Infestation – presence of living infectious agent on the exterior surface
of the body .
Host – the person or animal that affords subsistence or lodgment to an
infectious agent under natural conditions

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 Cont.……
 Infectious disease – a clinically manifest disease of a man or animal
resulting from an infection
 Communicable disease – an illness due to a specific infectious agents or
its toxic products capable of being directly or indirectly transmitted
from man to man, animal to animal or from environment to man or animal
 Epidemic – the unusual occurrence of disease in a community or region,
specific health related behavior or events clearly in excess of expected
occurrence

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 Cont. …
Endemic – constant presence of a disease or infectious agent within
a given geographic area or population group; without importation
from outside.
Sporadic – cases occur irregularly, haphazardly from time to time
and generally infrequent eg. polio, tetanus, herpes zoster
Pandemic – an epidemic affecting a large proportion of the
population occurring over a wide geographic area
Zoonosis – an infection transmissible under natural conditions from
vertebrate animals to man

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Cont.…

 Nosocomial (hospital acquired)infection – infection originating

in a patient while in hospital or other health care facility
 Opportunistic infection – an infection by organisms that take the
opportunity of defect in the host defense to infect the host and
cause disease
 Iatrogenic disease – is the result of diagnostic and therapeutic
procedures undertaken on a patient resulting from activity of
physicians or health professionals.

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 cont..

 Prevention -To keep from occurring or limitation of certain events.

 Control – ongoing operation aimed at reducing incidence, duration and
effects of disease
 Elimination – eradication of disease from large geographic region or
political jurisdiction eg measles, polio, diphtheria
 Eradication – termination of infection by extermination of the infectious
agent through surveillance and containment but the infectious agent is
present in the lab..
 Extinction–eradication of infectious agent including in the lab

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 Classification of disease

Different ways of classifying disease

Based on cause
Clinical
Time course
 Infectious agent
 Mode of transmission

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 The Global Burden of Infectious Diseases
 IDs are major causes of morbidity and mortality worldwide
 IDs contribute to 25% of death every year
 They occur at all ages but are most serious in childhood and they are
to a great extent preventable
 In countries where they have been prevented/developed countries,
other health conditions such as accident and degenerative diseases
become the most common.

What are the Impacts of infectious disease ?

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 Cont..
Communicable diseases remain very important in developing
countries because.
 Many of them are very common
 Some of them are serious and cause death and disability
 Some of them cause widespread out breaks of diseases or epidemics
 Most of them are preventable by fairly simple means
 Poor socio economic status of the individuals makes them vulnerable to
a variety of diseases
 Low educational status
 Lack of access to modern health care service
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 Special features of CD
A case must be a risk factor
Each infectious disease has its own IP (incubation period)
 People may develop immunity.
Individuals can be a sources without being recognized as a
case.
Preventive measures usually have a good scientific ground

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Over view of health situation of Ethiopia
In general , communicable disease in Ethiopia situation:
Are commonest cause of morbidity& mortality
Are relatively easy to prevent and control
Are epidemic prone (cause wide spread out breaks of disease ).
Put most of the population at risk
60-80% of the nation’s health problems are due to nutritional
problems & communicable disease.

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 Epidemiology and scope
What is the importance of Studying Communicable Diseases Epidemiology
?
 Changes in the pattern of infectious diseases
 Discovery of new infections
 The possibility that some chronic diseases have an infective origin

 Even though , CD is the leading cause of mortality and morbidity in

developing countries in the past 70 years the incidence of CD was fall
down.
 What are the reasons to decline incidence of CD in the past 7o years
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 Global Factors of Emerging Communicable Disease
Dramatic, societal and environmental changes
Explosive population growth
 Expanding poverty and urban migration
 International travel and commerce are increasing
Technology is rapidly changing and increases the risk of exposure,
Climatic change
Emerging of new viruses
Immuno-compromization
Resistance of Micro organisms to antibiotics
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 Chaptertwo:Natural History of disease

Learning Objectives

 Describe the natural history of diseases

 Describe the time courses of infectious disease

 Describe carriers and explain their role in disease transmission

 Describe chain of disease transmission

 Describe level of prevention and control mechanism of CD

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 Discuss in Groups (5-10)minutes

 Definition of natural history of the disease

 Discus about the stages of natural history of the disease with its
example
 You should have your own group Secretary

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There are four stages in the natural history of a disease. These are
1. Stage of susceptibility-period of exposure:
Disease has not yet developed, but there are factors that favor occurrence.
Examples:
A person practicing casual and unprotected sex has a high risk of getting
HIV infection.
An unvaccinated child is susceptible to measles.
High cholesterol level increases the risk of coronary heart disease.

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2. Stage of sub clinical disease /pre-symptomatic stage:-

The disease process has already begun but , the disease is not manifested
The disease can only be detected through special tests.
Example
Oval or intestinal parasite in the stool of apparently healthy children.
 Antibodies for polio virus are present in many adults less than one
percent.

3. Stage of clinical disease :-

signs and symptoms of the disease are manifested.

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 4.Stage of disability or death
The disease has occurred and left over damage to the body that limits the
activity of the victim(disability) or has ended with the death of the victim
Disability means any limitation of physical activity.
Examples: -
 Trachoma may cause blindness.
 Meningitis may also result in death.

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Time Course of an infectious disease

The different periods that are encountered in the course of infectious

disease :
1. Prepatent period
2. Incubation period
3. Communicable period
4. Latent period
5. Period of illness
6. Period of decline
7. Period of convalescence.
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 A. Incubation period

The interval of time between infection of the host & the first

appearance of symptoms & signs of the disease.

B. Pre patent period

This is the time interval between infection (or biological onset), and the
point at which the infection can first be detected, as measured by the
time of first shedding of the agent by the host.
In some conditions, like the AIDS, it is the so called "window period".

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 C. Communicable period
The period during which an infected host can transmit the infection to
others which can be measured by the time interval during which the agent
is shed by the host.

D. Latent period

The time interval between recovery and the occurrence of a relapse or

recrudescence in clinical disease, as in cases of malaria and epidemic typhus.

E. Period of illness : acute phase, most severe signs and symptoms & the
immune system either overcomes pathogen or person dies.

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24
 cont.….
F. Period of decline : signs and symptoms begin to subside.

G. Period of convalescence : host returns to pre-disease state

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 Carrier and its type
 Carrier:- is an infected person or animal without manifestation of
disease but capable of transmitting infection to others.
Three elements have to occur to form a carrier state:
1. The presence of the disease agent with in the body.
2. The absence of recognizable signs and symptoms of disease.
3. The shedding of disease agent in the discharge or excretions.

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 1. Healthy or asymptomatic carriers

 Persons whose infection remains unapparent. E.g. Polio virus,

meningococcus, hepatitis virus, HIV infection
2. Incubatory or precocious carries
 Individuals or persons who excrete the pathogen during the incubation
period (before onset of symptoms) E.g. measles, mumps, chicken pox,
hepatitis

3. Convalescent carriers

 Those who continue to harbor the infective agent after recovering from the

illness. E.g. diphtheria, hepatitis B virus

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 4. Chronic carriers

 The carrier state persists for a long period of time. E.g. typhoid, hepatitis B
virus
 Generally, carriers are important in epidemiology because of their:
 number (may become significant reservoir);
 difficulty in recognition(detectability);
 mobility; and
 chronicity, i.e repeated reintroduction and contribute to endemicity

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 Chain of disease transmission
is a series of events , which must occur in order for disease causing
organisms to cause infection .
There are six successive events implicated in the chain of disease
transmission.
1. Infectious agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
5. Rout of entry
6. Host12/4/2019
24
 chain of the disease
Publication bias

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 1. Infectious agent

 Is pathogen (disease causing micro organism ) that cause infection.

 The infectious agent is virus, bacteria, parasite or other microbes
 The agent causes infection and disease depending on its basic biological
characteristics .

 The outcomes of exposure to infectious agent can be

depends on:
─Infectiousness
─Pathogenecity
─Virulence
─ I m m u12/4/2019
nogenicity
Infectiousness (infectivity)

The ability of an infectious agent to cause infection in an exposed

human host

 Infectivity is measured by Infection Rate (IR):

Number of inf ectedPersons

IR   100
Number of Susceptible & exp sedPersons

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 Pathogenicity

─ The ability of an infectious agent to cause clinical disease among

infected human hosts

─ It is measured by clinical to sub-clinical ratio or proportion of clinical

cases among infected human hosts

Examples:

o High pathogenecity: HIV, Rabies, Measles… etc.

o Moderate pathogenecity: Mumps virus and Rhino virus

o Highly infectious but less pathogenic: Poliovirus

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 Virulence

It is the ability of an infectious agent to cause severe clinical disease or

death among clinical cases

Virulence of the infectious agent can be measured by:

o Case fatality Rate (CFR)

o Hospitalization Rate (HR)

Number of Fatal Cases

CFR   100
Total Number of Cases
Number of Hospitaliz ed Cases
HR   100
Total Number of Cases
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 Immunogenicity

 infection’s ability to produce specific immunity

 It is defined as the ability of a pathogen or a vaccine to inducing an
immune response after an infection or a vaccination respectively
 It may lead to protection against re-infection or re-activation with the
same or similar pathogen in the future
immunity

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 Immunogenicity

Immunity after infection may or may not be protective against re-

infection or may last for variable periods of time
osome infectious diseases confer lifelong immunity
o others confer partial immunity against severe symptomatic infection,
but much less against sub-clinical infection
osome confer no or no egligible immunity

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 Immunity..

oImmunity can be acquired either after natural infection or indirectly

o Maternal antibodies protect the newborn child against many infections
in the first few months of life
oVaccine-induced immunity can be lifelong or temporary
oFor temporary immunity, repeated booster vaccinations are necessary to
ensure protection against the infection
Example: TT vaccine

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 Immunity..

Individuals gain protective antibodies in two ways:

1) They develop antibodies in response to infection, vaccine, or toxoid;
immunity developed in these ways is called active immunity
2) They acquire their mothers’ antibodies before birth through the
placenta or they receive injections of antitoxins or immune globulin;
immunity that is acquired in these ways is called passive immunity

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 Disease progression

Disease
Exposure Infection Disease outcome

Infectiousness Pathogenecity
Virulence
(Infection Rate) (clinical : subclinical) (CFR, HR)

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 cont…
 Factors that influence disease development other than infectivity, pathogenicity,
immunogenecity and virulence of the agent are:

o Strain of agent

o Dose of agent

o Route of infection

o Influence of human host age

o Influence of human host nutritional status

o Influence of human host immune response

o Influence of treatment

o Influence of seasonal variation, etc…

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 2. Reservoir of infection
It is an organism or habitat, in which an infectious agent normally lives,
transforms, develops and/or multiplies.

Types of reservoirs:

• man –The cycle of transmission is from man to man.

• measles, smallpox, typhoid,

• N.meningitis, gonorrhea, syphilis.

A person who does not have apparent clinical disease, but is a potential

source of infection to other people is called a Carrier.

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 cont..
• Animals- cause zoonotic diseases
• Non-living things:- soil , food , water .
3. Portal of exit
 It is the site through which the agent escapes from the reservoir.

 Examples include:

 Gastrointestinal tract

 Respiratory tract

 Skin & mucous membrane

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 Cont…

Portal of exit includes:

—Body secretions and discharges (mucus, saliva and tears, breast milk,
urethral secretion, semen, vaginal secretion, pus, cervical secretion,
exudates etc…)

—Excretions (feces and urine), blood and tissues including placenta ,

etc…

—Flu or cold - mucous secretions

—Hepatitis A - stool

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 4. Mode of transmission

Mode of transmission is the mechanism by which the infectious agent

escapes from a reservoir and enters into a susceptible human host

 There are two major mechanisms of transmission

I. Direct transmission

II. Indirect Transmission

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 1. Direct transmission
 The immediate transfer of infectious agents from an infected host or
reservoir to the appropriate portal of entry on the susceptible host.
 What are the direct transmission and discus with your Groups
a) Transmission by direct contact
b) Transmission by direct projection
c) Trans-placental transmission
d) Blood transfusion
e) Organ transplantation

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 2. Indirect Transmission

a) Airborne transmission

b) Vehicle borne transmission

c) Vector borne transmission

d) Non vector intermediate host

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 5. Result 8

1. Air borne transmission

 Microbial agents are disseminated by air in to suitable portal of entry

usually the respiratory tract

 Two particles; dust & droplet nuclei are implicated in this kind of spread

2. Vehicle-borne transmission such as:

 Bedding, soiled clothes

 Contaminated food & water

 Biological products such as blood & serum, iv fluids

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 3. Vector- borne transmission
 The infections agent is conveyed by an arthropod (insect) to a
susceptible host

 A vector is responsible for introducing the agent into the

susceptible human host through a suitable portal of entry

—Biological vector: salivarian transmission (malaria by

mosquito)

—Mechanical vector: trachoma by common fly

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 cont..
 Biologic transmission -when the agent undergoes physiologic changes
within the vector, the vector is serving as both an intermediate host
and a mode of transmission

o An agent undergoes part of its life cycle inside a vector before being
transmitted to a new host

 Mechanical transmission - the agent does not multiply or undergo

physiologic changes in the vector

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4. A non-vector intermediate host

—These are hosts which are important for development of the infectious
agent but don’t play an active role in transporting the agent to the
susceptible human host.

Example: Aquatic snail for schistosomiasis

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 5. portal of entry
─ Portal of entry is the route through which a microorganism enters into
the susceptible human host

─ Whether an agent will establish infection depends on the suitable portal

of entry

Example: No harm in ingesting the Clostridium tetani (it is in fact the

normal flora of GIT system)

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 6.Susceptible host
 A person lacking sufficient resistance to a particular pathogenic agent to
prevent disease if exposed.

Level of susceptibility depends up on

 Age : extreme of age

 Nutritional status

 Stress

 pre- existing medical conditions

 Immune status
 Personal behaviors like drinking, smoking etc
 Anti-microbic
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 Exercise
 Suppose 40 4th year nursing students have gone to West Africa for clinical attachment
. Unfortunately 22 and 18 of them found to have SARS and Ebola infection with
laboratory investigation respectively. Among SARS infected individuals 10 developed
disease and 6 of them died. Among Ebola infected individuals 8 developed disease
and 3 of them died. Based on the above case scenario

 1. Calculate case fatality rate?

 2. which disease is more pathogenic?

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Goal & principle of CDC & prevention
Goals
• Eradication :

reducing the incidence to zero level.

• Elimination :

reducing the incidence of disease to zero level in specified geographic areas.

• Control:

reducing the incidence to the level where the disease is no more public health
importance.

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 cont..
There are three main methods of controlling communicable diseases:
1. Elimination of the Reservoir
a. Man as reservoir:
– Detection and adequate treatment of cases
Isolation:
– separation of infected persons for a period of communicability of
the disease.
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.
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 b. Animals as reservoir

Action will be determined by the usefulness of the animals, how intimately they
are associated to man and the feasibility of protecting susceptible animals

– destroy

– vaccination.

For example:

Plague: the rat is regarded as a pest and the objective would be to destroy
the rat and exclude it from human habitation.

Rabies: pet dogs can be protected by vaccination but stray dogs are
destroyed
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 cont..
c. Reservoir in non-living things
Possible to limit man’s exposure to the affected area (e.g. Soil, water, forest,
etc.)
2. Interruption of transmission
 Improvement of environmental sanitation and personal hygiene
 Control of vectors
 Disinfections and sterilization

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 3. Protection of susceptible host:

. This can be achieved through:

– Immunization: Active or Passive

– Chemo-prophylaxis(e.g.Malaria,meningococcal meningitis,etc.s)

– Better nutrition

– Personal protection. (e.g. wearing of shoes, use of mosquito bed net,

insect repellents, etc.)

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Herd immunity
 Host resistance at the community (population) level.

I.e. the resistance of the community to the introduction and spread of infectious
agent based on the immunity of high proportion of individuals in the
population , thereby lessening the likelihood of a person with a disease
coming in to contact with susceptible individuals.

Prerequisite for herd immunity

1. Single reservoir (the human host ).

2. Direct transition (direct contact or direct projection ).

3. Total immunity :partial immune hosts may continue to shed the agent
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Cont..

4.No shedding of agents by immune hosts (no carrier state ) .

5. Uniform distribution of immunes.

6. No over crowding.
 However , these conditions for the operation of herd immunity are seldom
fulfilled .
N.B. mostly a combination of different methods are used to control a specific
communicable disease .

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 level of prevention
A. Primary prevention
This is protection of healthy people from becoming sick.
The objectives here are to promote health , prevent exposure, and prevent
disease.

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 Health promotion
• This consist of general non specific interventions that enhance health & the
body’s ability to resist disease .

improve socio –economic status

adequate housing , clothing &food

Education and vocational training,

Emotional and social support and

relief of stress, etc.

• In short it is any intervention that promotes a healthier and happier life.

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 prevention of exposure
provision of safe and adequate water;

 proper excreta disposal;

 vector control;

 safe home, school, and

 street environments.

Prevention of disease

• This occurs during latency period between exposure and biological onset.

• Involves activities such as active and passive immunization

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 B. secondaryprevention

• is a type of prevention after biological onset of diseases and before

permanent damage by the disease.

The objective here is:-

 stop or slow the progression of disease.

 prevent or limit permanent damage.

 early detection and treatment of disease.

e.g. trachoma -prevention of blindness

syphilis- prevention of tertiary or congenital syphilis

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 C. Teritariy prevention
is a type of prevention after the disease has already occurred and
left residual damage.
• Rehabilitation refers to the retaining of remaining functions for
maximal effectiveness.
• Limitation of disability helps to limit or stop the damage and
impact of damage.
• The impact can be physical, psychological, social (e.g., social
stigma) and financial

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Level of prevention Point of intervention
Natural history of disease

Primary Health promotion

Prevention of exposure

Prevention of disease

Secondary
Early detection &treatment =screening
(prevention of clinical onset )
incubation period

Early treatment
(prevention of permanent damage )

Tertiary Limitation of disability

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Chilot D. in quality o f
life ) 25
Excerscise
For each of the following intervention , indicate what level of prevention
involved
1. Specials education for the handicapped children.
2. Treatment of people with a diagnosis of active TB.
3. Screening donated blood to exclude contaminating with causation agent of HBV.
4. Counseling DM patient how to take medication
5. Promoting awareness in high school students of self-protective measure again
HIV/AIDS.
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