Control of communicable diseases

Control of

Communicable

Diseases

National Tuberculosis

Program –Directly

Observed Treatment,

Short-Course

(NTP-DOTS)

Tuberculosis is a disease caused by

a bacterium called Mycobacterium

tuberculosis.

Mainly acquired by

• inhalation of infectious droplets

containing viable tubercle bacilli.

• Infectious droplets:

–Coughing

–Sneezing

–talking

–singing

In 2007, there are 9.27 million

incident cases of TB worldwide and

Asia accounts for 55% of the cases.

Through the National TB Program

(NTP), the Philippines achieved the

global targets of 70% case detection

for new smear positive TB cases and

89% of these became successfully

treated.

The various initiatives undertaken

by the Program, in partnership with

critical stakeholders, enabled the

NTP to sustain these targets.

Nonetheless, emerging

concerns like drug

resistance and co-

morbidities need to be

addressed to prevent rapid

transmission and future

generation of such threats.

Coverage should also be

broadened to capture the

marginalized populations

and the vulnerable groups

namely, urban and rural

poor, captive populations

(inmates/prisoners), elderly

and indigenous groups.

Vision:

TB-free Philippines

Goal:

To reduce by half TB

prevalence and mortality

compared to 1990 figures by

2015

Objectives:

The NTP aims to:

• Reduce local variations in TB control

program performance

• Scale-up and sustain coverage of

DOTS implementation

• Ensure provision of quality TB

services

• Reduce out-of-pocket expenses

related to TB care

Elements of DOTS

• Political commitment with

increased and sustained financing

–Political commitment is needed to

foster national and international

partnerships, which should be linked to

a long-term strategic action plan.

Adequate funding is necessary to

improve the motivation of healthcare

workers.

• Case detection through quality-

assured-bacteriology

–Bacteriology remains to be

confirmatory diagnostic test for

tuberculosis. Properly equipped

laboratories and trained personnel

are necessary for quality-assured

sputum smear microscopy.

• Standardized treatment with

supervision and patient support

–The primary means of controlling

TB is organizing and administering

a standardized treatment for all

ages and for all types of

tuberculosis. This includes the use

of standardized treatment, such as

short-course chemotherapy (SCC)

and the fixed dose combination (FDC), to

facilitate adherence to treatment and to

reduce the risk for developing drug

resistance.

–Supervised treatment (directly observed

treatment by a health care provider)

ensures that patients take their drugs

regularly and completely. Particular

attention should be given to the poorest

and most vulnerable groups.

• An effective drug supply and

management system

–An uninterrupted and sustained supply

of quality-assured anti-TB drugs is

fundamental to TB control. Anti-TB

drugs should be available free of charge

to all TB patients, especially the poor,

because treatment has benefits that

extend to society. The use of anti-TB

drugs by all providers should be strictly

monitored.

The use of FDCs of proven

bioavailability and of

innovative packaging, such as

patient kits, can help improve

drug supply logistics and drug

administration, promote

adherence to treatment, and

prevent development of drug

resistance.

• Monitoring and evaluation

system, ad impact measurement

–This requires the standardized

recording of individual patient data,

including information on treatment

outcomes, which are then used to

compile quarterly treatment

outcomes in cohorts of patient.

These data, when compiled and

analyzed, can be used:

a)At the facility level to monitor

treatment outcomes;

b)At the district level to identify

local problems as they arise;

c)The provincial or national level to

ensure consistently high-quality

TB control

d) Nationally and internationally to

evaluate the performance of each

country

Regular programmed

supervision should be carried out to

verify the quality of information

and to address performance

problems.

Prevention and Control

• Submit all babies for BCG

immunization

• Avoid overcrowding

• Improve nutritional and health status

• Advise persons who have been

exposed to infected persons to

receive the tuberculin test and, if

necessary, chest x-ray and

prophylactic isoniazid

STRATEGIES IN CONTROLLING TB1. LOCALIZED IMPLEMENTATION OF TB CONTROL

2. MONITOR HEALTH CARE SYSTEM PERFORMANCE

3. ENGAGE ALL HEALTH CARE PROVIDER PUBLIC & PRIVATE

4. PROMOTE & STRENGTHEN POSITIVE BEHAVIOR OF COMMUNITIES

5. ADDRESS MDR, TB, HIV & NEEDS VULNERABLE

6. REGULATE & MAKE QUALITY TB DIAGNOSTIC TEST & DRUGS

7. CERTIFY & ACCREDIT TB CARE PROVIDERS

8. SECURE ADEQUATE FUNDING & IMPROVE ALL ALLOCATION & EFFICIENCY OF FUND UTILIZATION

National Leprosy

Control Program

• Vision: Empowered primary

stakeholders in leprosy and eliminated

leprosy as a public health problem by

2020

• Mission: To ensure the provision of a

comprehensive, integrated quality leprosy

services at all levels of health care

• Goal: To maintain and sustain the

elimination status

• Objectives:

The National Leprosy Control Program

aims to:

Ensure the availability of

adequate anti-leprosy drugs or multiple

drug therapy (MDT).

Prevent and reduce disabilities

from leprosy by 35% through

Rehabilitation and Prevention of

Impairments and Disabilities (RPIOD)

and SelfCare.

http://www.doh.gov.ph/node/1071.html

Improve case detection and post-

elimination surveillance system using the

WHO protocol in selected LGUs.

• Beneficiaries:

The NLCP targets individuals,

families, and communities living in hyper

endemic areas and those with history of

previous cases.

Schistosomiasis

SchistosomiasisBilharziasis/Snail Fever

• A slowly, progressive disease caused by blood flukes of class Trematoda. It is a chronic wasting disease common among farmers and their families in certain parts of Philippines.

Etiologic agent

• Schistosoma japonicum

–This agent infects the intestinal tract (Katayama disease)

–It is found to be the only type that is endemic in the Phil.

–This is also known as “oriental schistosomiasis”

• Schistosoma mansoni

–Also affects intestinal tracts

–Common in some parts of Africa

• Schistosoma haematobium

–Affects the urinary tract

–Can be found in some parts of the Middle East

Incubation period is at least 2 months.

SOURCES OF INFECTION:

• Feces of infected persons

• Dogs, pigs, carabaos, cows, monkeys, and wild rats have been found infected ad, therefore, also serve as host

Mode of transmission

• Ingestion of contaminated water

• Transmitted through skin pores

• Transmitted through intermediary host, a tiny snail called Oncomelaniaquadrasi

Clinical manifestations

• Pruritic rash, known as “swimmer’s itch”, develops at the site of penetration

• Low-grade fever, myalgia, and cough

• Abdominal discomfort due to hepatomegaly, splenomegaly and lymphadenopathy

• Bloody-mucoid stools, similar to those in dysentery, that comes on and off for weeks

• Becomes icteric and jaundice

• Later, belly becomes big because of an inflamed liver, resulting from accumulation of eggs in the organ.

• After some years suffering from this chronic disease the patient becomes weak and pale and there is marked muscle wasting.

• When the parasites reach the brain, the victim experience severe headaches, dizziness and convulsions.

Modalities of Treatment

• Praziquantel tablet for 6 months; 1 tab 2x a day for three months, then 1 tab a day for another three months.

• Fuadin injection given either IM or IV. The patient should consume 360mg for the entire treatment.

• If the patient continues to live in the endemic area, he frequentl gets reinfected and has to be treated.

Prevention and Control

To prevent schistosomiasis, one must have thorough knowledge of how the disease spreads. The basic principle of its prevention and control is interrupting the life cycle of the worm and protecting people from infection.

• Have a stool examination

• Reduce snail density by:

–Clearing vegetation, thus exposing the snails to sunshine

–Constructing a drainage system (canals) to dry the areas where the snails thrive; and

– Improve farming through proper irrigation and drainage, crop rotation and removal of weeds, thus disturbing the living conditions of the snail.

• Diminish infection rate through:

–Proper waste disposal

–Control of stray animals

–Prohibition of people, especially children, from bathing in infested streams

–The construction of footbridges over snail-infested streams

–Provision of an adequate water supply for bathing and laundering and safe water for drinking

Schistosomiasis Control Program

Goal: To reduce the disease prevalence by 50% with a vision of eliminating the disease eventually in all endemic areas

Objectives:

The Schistosomiasis control Program has the following objectives:

1. Reduce the Prevalence Rate by 50% in endemic provinces; and

2. Increase the coverage of mass treatment of population in endemic provinces.

Filariasis(Elephantiasis)

Filariasis

• A parasitic disease caused by microscopic, threadlike African eye worm. The adult worm can live only in the human lymphatic system. The disease is an extremely debilitating and stigmatizing and affects men, women, and children. It affects the poor in both rural and urban areas. The disease is rarely fatal; however, it causes extensive disability, gross disfigurement, ad untold suffering in millions of men, women, and children.

Causative organism

• Wuchereria bancrofti – a thread worm four to five centimeters long and affects the lymph nodes and lymph vessels of the legs. Arms, vulva, and breast.

• Brugia malayi – shows manifestations resembling that of the bancroftian, but swelling of the extremities is confined to the areas below the knees and below the elbow

• Brugia timori – rarely affects the genitals

• Loa loa – filarial parasite transmitted by the deer fly.

Mode of Transmission

• Transferred from person to person through mosquito bites.

• Persons having circulating microfilariae are outwardly healthy but transmit the infection to others through mosquito bites.

• Persons w/ chronic filarial swellings suffer severely from the disease but no longer transmit the infection.

Symptoms• On-and-off chills

• Headache

• Fever that lasts between months and one year after the insect bite

• Swelling

• Redness

• Pain in the arms, legs or scrotum

• Areas of abscesses may appear as a result of dying worms or a secondary bacterial infection

Diagnostic procedure

• Circulating filarial antigen (CFA) test –finger-prick blood droplet

Modalities of Treatment

• Ivermectin, albendzol, or diethylcarbamazine (DEC)

• Surgery may be performed

Nursing management

• Health education and information dissemination as to be the mode of transmission must be carried out.

• Environmental sanitation ad the destruction of breeding places of mosquitoes must be emphasized

• Psychological and emotional support to client and the family are necessary

• Personal hygiene must be encouraged

• The course of the disease must be explained

Prevention and Control

• Mosquitoes that carry the microscopic worms usually bite between the hours of dusk and dawn. It is therefore advised that people living in an area with filariasis should:

–Sleep under mosquito net

–Use mosquito repellant in the hours between dusk and dawn

–Take a yearly dose of medicine that kills the worms circulating in the blood

• Filariasis is a major parasitic infection, which continues to be a public health problem in the

Philippines.

• It was first discovered in the Philippines in 1907 by foreign workers.

• Consolidated field reports showed a prevalence rate of 9.7% per 1000 population in 1998.

• It is the second leading cause of permanent and long-term disability. The disease affects mostly the poorest municipalities in the country about 71% of the case live in the 4th-6th class type of municipalities.

• The World Health Assembly in 1997 declared “FilariasisElimination as a priority” and followed by WHO’s call for global elimination.

• A sign of the DOH’s commitment to eliminate the disease, the program’s official shift from control to elimination strategies was evident in an Administrative Order #25-A,s 1998 disseminated to endemic regions.

National FilariasisElimination Program

Goal: To eliminate Lymphatic Filariasis as a public health problem in the Philippines by year 2017

Vision: Healthy and productive individuals and families for Filariasis-free Philippines

Mission: Elimination of Filariasis as a public health problem thru a comprehensive approach and universal access to quality health services

General Objectives: To decrease Prevalence Rate of filariasis in endemic municipalities to <1/1000 population.

Specific Objectives:

The National Filariasis Elimination Program specifically aims to:

1. Reduce the Prevalence Rate to elimination level of <1%;

2. Perform Mass treatment in all established endemic areas;

3. Develop a Filariasis disability prevention program in established endemic areas; and

4. Continue surveillance of established endemic areas 5 years after mass treatment.

Program Strategies:

STRATEGY 1. Endemic Mapping

STRATEGY 2. Capability Building

STRATEGY 3. Mass Treatment (integrated with other existing parasitic programs)

STRATEGY 4. Support Control

STRATEGY 5. Monitoring and Supervision

STRATEGY 6. Evaluation

STRATEGY 7. National Certification

STRATEGY 8. International Certification

Malaria

Malaria is a parasite-caused disease that is usually acquired through the bite of a female Anopheles mosquito.

Etiologic agent

• Plasmodium falciparum

• Plasmodium vivax – non-life threatening, except for the very young and very old

• Plasmodium malariae

• Plasmodium ovale

Incubation period

• 12 days for P. Falciparum

• 14 days for P. vivax and vale

• 30 days for P. malariae

It can be transmitted in the following ways:

(1) blood transfusion from an infected individual;

(2) sharing of IV needles;

(3) transplacenta (transfer of malaria parasites from an infected mother to its unborn child).

Clinical manifestations

• Paroxysms with shaking chills

• Rapidly rising fever with severe headache

• Profuse sweating

• Myalgia, with feelings of well-being in between

• Splenomegaly, hepatomegaly

• Orthostatic hypotension

• Paroxysms may last for 12 hours and may attack daily or every two days

• In children:

– Fever may be continuous

–Convulsions and gastrointestinal symptoms are prominent

– Splenomegaly is present

• In cerebral malaria:

– Severe headache, vomiting and changes in sensorium

– Jacksonian or grand mal seizure may occur

Diagnostic Procedure

• Malarial smear

• Rapid diagnostic test (RDT)

Malaria Control

Program

This parasite-caused disease is the 9th leading cause of morbidity in the country.

Goal: To significantly reduce malaria

burden so that it will no longer affect

the socio-economic development of

individuals and families in endemic

areas.

Vision: Malaria-free Philippines

Mission: To empower health

workers, the population at risk and

all others concerned to eliminate

malaria in the country.

Objectives:

Based on the 2011-2016 Malaria

Program Medium Term Plan, it

aims to:

1. Ensure universal access to

reliable diagnosis, highly effective,

and appropriate treatment and

preventive measures;

2. Capacitate local government

units (LGUs) to own, manage, and

sustain the Malaria Program in

their respective localities;

3. Sustain financing of anti-malaria

efforts at all levels of operation;

and

4. Ensure a functioning quality

assurance system for malaria

operations.

Program Strategies:

The DOH, in coordination with its

key partners and the LGUs,

implements the following

interventions:

1.Early diagnosis and prompt

treatment

• Diagnostic Centers were established and strengthened to achieve this strategy.

• The utilization of these diagnostic centers is promoted to sustain its functionality.

2. Vector control

The use of insecticide-

treated mosquito nets,

complemented with indoor

residual spraying, prevents

malaria transmission.

3. Enhancement of local

capacity

LGUs are capacitated to

manage and implement

community-based malaria

control through social

mobilization.

Rabies(Hydrophobia/Lyssa)

Rabies

• A specific, acute viral infection communicated to man by the saliva of an infected animal

Etiologic agent

• Rhabdovirus

–Bullet-shaped

–Sensitive to sunlight, ultraviolet light, ether, formalin, mercury and nitric acid

Incubation period

• One week to seven-and-a-half months in dogs

• Ten days to fifteen years in human

–Depends on the distance of bite to the brain, extensiveness of bite, species of the animal, richness of the nerve supply in the are of the bite, resistance of the host

Modes of Transmission

• An infected animal carries the rabies virus in its saliva and transmits it to humans by biting.

• Virus spread when the saliva comes in contact with the person’s mucus membranes

Clinical manifestations

• Prodromal/ invasion phase

– Fever, anorexia, malaise, sore throat, copious salivation, lacrimation, perspiration, irritability, hyperexcitability , apprehensiveness, restlessness, mental depression, melancholia and marked insomia

–Pain at the site of bite, headache and nausea

–Pt. becomes sensitive to light, sound and temperature

Nursing manangement

• Isolate the patient

• Give emotional and spiritual support

• Provide optimum comfort and prevent injury, especially during hyperactive episodes

• Darken the room and provide a quiet environment

• Pt. should not be bathed and there should not be any running water in the room or within the hearing distance of the pt.

• Concurrent and terminal disinfection should be carried out

National Rabies

Prevention

Control Program

Rabies is considered to be a

neglected disease, which is

100% fatal though 100%

preventable.

It is not among the leading

causes of mortality and

morbidity in the country but it is

regarded as a significant public

health problem because (1) it is

acutely fatal infection and (2) it is responsible for the death of 200-300 Filipinos annually.

Vision: To Declare Philippines

Rabies-Free by year 2020

Goal: To eliminate human rabies by the year 2020Program Strategies:To attain its goal, the program employs the following strategies:

1. Provision of Post Exposure Prophylaxis (PEP) to all Animal Bite Bite Treatment Centers (ABTCs)

2. Provision of Pre-Exposure Prophylaxis (PrEP) to high risk individuals and school children in high incidence zones

3. Health Education

Public awareness will be

strengthened through the Information,

Education, and Communication (IEC)

campaign.

• Program shall be integrated into the

elementary curriculum and the

Responsible Pet Ownership (RPO)

shall be promoted.

• In coordination with the

Department of Agriculture, the

DOH shall intensify the

promotion of dog vaccination,

dog population control, as well

as the control of stray animals.

RA 9482 or

“The Rabies Act of 2007”

rabies control ordinances shall

be strictly implemented. In the

same manner, the public shall be

informed on the proper

management of animal bites

and/or rabies exposures.

4. Advocacy

The rabies awareness

and advocacy campaign is a year-

round activity highlighted on two

occasions – March as the Rabies

Awareness Month and September

28 as the World Rabies Day.

5. Training/Capability Building

Medical doctors and

Registered Nurses are to be

trained on the guidelines on

managing a victim.

6. Establishment of ABTCs by

Inter-Local Health Zone

7. DOH-DA joint evaluation

and declaration of Rabies-free

islands

http://www.doh.gov.ph/content/national-rabies-prevention-and-control-program.html

Dengue• An acute febrile disease caused by infection

with one of the serotypes of dengue virus, which is transmitted by mosquito genus Aedes.

• Dengue hemorrhagic fever is a severe, sometimes fatal manifestation of the dengue virus infection characterized by a bleeding diathesis and hypovolemic shock.

Etiological agent

• Flaviviruses 1, 2, 3, 4, a family of Togaviridae, are small viruses that contain single-stranded RNA.

• Arboviruses group B

Mode of Transmission

• Bite of an infected mosquito, principally the Aedes aegypti

–Aedes aegypti is a day-biting mosquito

–Breeds in areas of stagnant water

–Has limited, low flying movement

–It has fine white dots at the base of the wings and white bands on the legs

• Aedes albopictus may contribute to the transmisson of the degree virus in rural areas

• Other contributory mosquitoes:

–Aedes polynensis

–Aedes scutellaris simplex

Incubation period

• The incubation period is three to fourteen days; commonly seven to ten days

Sources of Infection

• Infected persons – the virus is present in the blood of patients during the acute phase of the disease and will become a reservoir of the virus, sucked by mosquitoes, which may then transmit the disease.

• Standing water – any stagnant water in the household and its premises are usual breeding places of these mosquitoes.

Clinical Manifestations• Dengue fever

–Malaise

–Anorexia

– Fever and chills accompanied by severe frontal headache, ocular pain, myalgia with severe backache, and arthralgia

– Fever is non-remitting and persists for 3-7 days

–Nausea and vomiting

–Rash is prominent on the extremities and the trunk

–Petechiae

• Dengue Hemorrhagic Fever (DHF)

– This severe form of dengue virus infection is manifested by fever, hemorrhagic diathesis, hepatomegaly and hypovolemic shock.

Phases of the Illness

• Initial febrile phase lasting from two to three days

– Fever (39-40°C) accompanied by headache

– Febrile convulsions may appear

–Palms and sole are usually flushed

–Positive tourniquet test

–Anorexia, vomiting, myalgia

–Maculopapular or petechial rash may be present and usually starts in the distal portion of the extremities, the skin appears purple, with blanched areas of varying size.

–Generalized or abdominal pain

–Hemorrhagic manifestations like positive tourniquet test, purpura, epitaxis, and gum bleeding may be present

• Circulatory phase

– There is a fall of temperature accompanied by profound circulatory changes, usually on the 3rd to 5th days

–Patient becomes restless, with cool, clammy skin

–Cyanosis is present

–Profound thrombocytopenia accompanies the onset of shock

–Bleeding diathesis may become more severe and lead to GIT hemorrhage

– Shock may occur due to loss of plasma from intravascular spaces; hemoconcentrationwith markedly elevated hematocrit is present

–Pulse is rapid and weak; pulse pressure becomes narrow and blood pressure may drop ti an unobtainable level

–Utreted shock may result in com; metabolic acidosis and death may occur within two days

–With effective therapy, recovery may follow in two to three days

Classification according to severity

• Grade I

– There is fever accompanied with non-specific constitutional symptoms and the only hemorrhagic manifestation is positive (+) in the tourniquet test.

• Grade II

– All signs of Grade I, plus spontaneous bleeding from the nose, gums, and GIT, are present

• Grade III

– There is the presence of circulatory failure, as manifested by a weak pulse, narrow pulse pressure, hypotension, cold, clammy skin, and restlessness

• Grade IV

– There is profound shock, and undetectable blood pressure and pulse

Treatment Modalities

• Analgesic drugs

• Intravenous infusion

• Blood transfusion (severe bleeding)

• Oxygen therapy (for all patients in shock)

• Sedatives

Nursing Management• Patient should be kept in a mosquito-free

environment to avoid further transmission of infection

• Keep patient at rest during bleeding episodes

• Vital signs must be promptly monitored

• In cases of nose bleeding, keep the patient’s trunk elevated; apply ice bag to the bridge of nose and to the forehead

• Observe for signs of shock, such as slow pulse, cold, clammy skin, prostration, and fall of blood pressure

• Restore blood volume by putting the patient in Trendelenberg position to provide greater blood volume to the head part

• Patient with dengue is not infectious; therefore, isolation is not required.

Prevention and Control

• Health education

• Early detection and treatment of cases will not worsen the victim’s condition

• Treat mosquito nets with insecticides

• House spraying is advised– Changing water and scrubbing sides of flower vases once

a week,

– Destroying the breeding places of mosquitoes by cleaning the surroundings, and

– Keeping the water containers covered

• Avoid hanging too many clothes inside the house

• Case finding

National Dengue

Prevention and

Control Program

The National Dengue Prevention

and Control Program was first

initiated by the Department of

Health (DOH) in 1993.

Region VII and the National

Capital Region served as the

pilot sites.

It was not until 1998 when the program was implemented nationwide.

The target populations of the program are the general population, the local government units, and the local health workers.

Vision: Dengue Risk-Free

Philippines

Mission: To improve the quality of

health of Filipinos by adopting an

integrated dengue control approach in

the prevention and control of dengue

infection.

Goal: Reduce morbidity and mortality

from dengue infection by preventing

the transmission of the virus from the

mosquito vector human.

Objectives: The objectives of the

program are categorized into three:

health status objectives; risk reduction

objectives; and services & protection

objectives.

Health Status Objectives:

• To reduce incidence from 32

cases/100,000 population to 20

cases/100,000 population;

• To reduce case fatality rate by

<1%; and

• To detect and contain all

epidemics.

Risk Reduction Objectives:

• Reduce the risk of human exposure to

aedes bite by House index of <5 and

Breteau index of 20;

• Increase % of HH practicing removal

of mosquito breeding places to 80%;

and

• Increase awareness on DF/DHF to

100%.

National STI/HIV

Prevention

Program

It may be acquired through:

• Sexual contact (orogenital, anogenital) between opposite sexes, as well as of the same sex.

• Bacteria are transmitted through direct contact with contaminated vaginal secretions of the mother as the baby comes out of the birth canal.

Objective:

• Reduce the transmission of

HIV and STI among the Most

At Risk Population and

General Population and

mitigate its impact at the

individual, family, and

community level.

Program Activities:

With regard to the prevention and

fight against stigma and

discrimination, the following are the

strategies and interventions:

1. Availability of free voluntary HIV

Counseling and Testing Service;

2. 100% Condom Use Program (CUP) especially for entertainment establishments;

3. Peer education and outreach;

4. Multi-sectoral coordination through Philippine National AIDS Council (PNAC);

5. Empowerment of communities;

6. Community assemblies and for

a to reduce stigma;

7. Augmentation of resources of

social Hygiene Clinics; and

8. Procured male condoms

distributed as education materials

during outreach.

http://www.doh.gov.ph/content/national-hivsti-prevention-program.html