Communicable Disease Review Discussion

Chapter 25 Communicable Disease Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Principles of Infection and Infectious Disease Occurrence  Biological and epidemiological principles ➢ Multicausation ➢ Spectrum of Infection ➢ Stages of Infection ➢ Spectrum of disease occurrence Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Multicausation Disease etiology is complex and multicausal. An infectious agent alone is not sufficient to cause disease; the agent must be transmitted within a conducive environment to a susceptible host. Host Environment Agent Epidemiological Triad Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Spectrum of Infection  Not all contact with an infectious agent leads to infection, and not all infection leads to an infectious disease. ➢ ➢ ➢ ➢ Subclinical infection: no overt symptomatic disease (unapparent or asymptomatic) Infections: entry and multiplication of infectious agent in host Infectious disease and communicable disease: pathophysiological responses of the host to the infectious agent, manifesting as an illness (considered a case) Carriers: people who continue to shed infectious agent without any symptoms of disease Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Stages of Infection  Latent period ➢ ➢  Communicable period ➢ ➢  Infectious agent has invaded a host and found conditions hospitable to replicate Replication before shedding Follows latency Begins with shedding of agent Incubation period ➢ ➢ Communicable Disease Review Discussion

Time from invasion to time when disease symptoms first appear May overlap with communicable period Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Stages of Infection (Cont.) Figure 25-1 From Grimes DE: Infectious diseases, St Louis, 1991, Mosby. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Spectrum of Disease Occurrence      Incidence—new cases in a population Endemic—diseases that occur at a consistent, expected level in a geographic area Outbreak—an unexpected occurrence of an infectious disease in a limited geographic area during a limited period of time Epidemic—an unexpected increase of an infectious disease in a geographic area over an extended period of time Pandemic—steady occurrence of a disease over a large geographic area or worldwide Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Chain of Transmission     Infectious agents Reservoirs Portals of exit and entry Modes of transmission ➢ Direct ➢ Indirect • Fomites or vectors ➢ Fecal-oral, airborne  Host susceptibility Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Chain of Transmission (Cont.) Figure 25-2 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Chain of Transmission: Part 1 Links of the Chain Definition Factors Infectious agent An organism (virus, rickettsia, bacteria, fungus, protozoan, helminth, or prion) capable of producing infection or infectious disease Properties of the agent: morphology, chemical composition, growth requirements, and viability. Interaction with the host: mode of action, infectivity, pathogenicity, virulence, toxigenicity, antigenicity, and ability to adapt to the host Reservoirs The environment in which a pathogen lives and multiplies Humans, animals, arthropods, plants, soil, or any other organic substance Portal of exit Means by which an infectious agent is transported from the host Respiratory secretions, vaginal secretions, semen, saliva, lesion exudates, blood, and feces Table 25-1 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Chain of Transmission: Part 2 Links of the Chain Definition Factors Mode of transmission Method whereby the infectious agent is transmitted from one host (or reservoir) to another host Direct: person to person Indirect: implies a vehicle of transmission (biological or mechanical vector, common vehicles or fomite) Airborne droplets Portal of entry Means by which an infectious agent enters a new host Respiratory passages, mucous membranes, skin, percutaneous injection, ingestion, and through the placenta Host susceptibility The presence or lack of sufficient resistance to an infectious agent to avoid or prevent contracting an infection or acquiring an infectious disease Biological and personal characteristics (e.g., gender, age, genetics), general health status, personal behaviors, anatomical and physiological lines of defense, immunity Table 25-1 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Breaking the Chain of Transmission    Controlling the agent Eradicating the nonhuman reservoir Controlling the human reservoir ➢  Controlling the portals of exit and entry ➢ ➢ Communicable Disease Review Discussion

 Quarantine—during incubation period Isolation of sick persons Universal precautions Improving host resistance and immunity Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Types of Immunity   Natural immunity: an innate resistance to a specific antigen or toxin Acquired immunity: derived from actual exposure to specific infectious agent, toxin, or appropriate vaccine ➢ ➢   Active acquired: body produces its own antibodies Passive acquired: temporary resistance that has been donated to the host Primary vaccine failure: failure of vaccine to stimulate any immune response Secondary vaccine failure: waning of immunity following an initial immune response Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Types of Acquired Immunity Type Natural How Acquired Length of Resistance Active Natural contact and infection with the antigen May be temporary or permanent Passive Natural contact with antibody transplacentally or through colostrum and breast milk Temporary Active Inoculation of antigen May be temporary or permanent Passive Inoculation of antibody or antitoxin Temporary Artificial Table 25-2 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Types of Immunity  Herd immunity: a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune Figure 25-3 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Public Health Control of Infectious Diseases  Control ➢  The reduction of incidence (new cases) or prevalence (existing cases) of a given disease to a locally acceptable level as a result of deliberate efforts Elimination ➢ Controlling a disease within a specified geographic area and reducing the prevalence and incidence to near zero ➢ The result of deliberate efforts, but continued intervention measures are required  Eradication ➢ Reducing the worldwide incidence of a disease to zero as a function of deliberate efforts (e.g., smallpox in 1977) ➢ No need for further control measures ➢ Only possible under certain conditions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Criteria for Disease Eradication           Human host only; no host in nature Easy diagnosis; obvious clinical manifestations Limited duration and intensity of infection Natural lifelong immunity after infection Highly seasonal transmission Availability of vaccine, curative treatment, or both Substantial global morbidity and mortality rates Cost effectiveness of campaign and eradication Integration of eradication with additional public health variables Eradication imperative over control measures – CDC (1993) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Notifiable Infectious Diseases in the United States    Communicable Disease Review Discussion

HCP MUST report to local or regional health departments → state health dept. →CDC Reported weekly in the MMWR Go to CDC website for latest listing of diseases: http://www.cdc.gov Note: State health departments have the responsibility for monitoring and controlling communicable diseases within their respective states; they determine which diseases will be reported within their jurisdiction. Those lists might be longer than the CDC’s list. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Vaccines and Infectious Disease Prevention  Immunization is a broad term used to describe a process by which active or passive immunity to an infectious disease is induced or amplified. ➢  Immunizing agents can include vaccines as well as immune globulins or antitoxins. Vaccination is a narrower term referring to the administration of a vaccine or toxoid to confer active immunity by stimulating the body to produce its own antibodies. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Recommended Immunization Schedules     Recommendations for international immunization practices determined by WHO In the United States, AAP and ACIP Current U.S. recommendations found on CDC website: http://www.cdc.gov/vaccines Schedules, footnotes, and educational fact sheets provide guidelines for practice Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Vaccines: Words of Caution   Information and recommendations on immunizations and vaccine usage change regularly Vaccine Information Statements (VISs) that explain the benefits and risks must be given out before vaccine is administered— a federal law!! (http://www.cdc.gov/vaccines/hcp/vis/index.html) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Available Vaccines by Type Live attenuated vaccines (See Textbook Table 25-3)  Viral: measles, mumps, rubella, oral polio, vaccinia, yellow fever, varicella  Bacterial: BCG (Bacille Calmette-Guérin)  Recombinant: oral typhoid Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Available Vaccines by Type (Cont.) Inactivated vaccines (See Textbook Table 25-3)  Viral: influenza, polio, rabies, and hepatitis A  Bacterial: typhoid, cholera, and plague  Subunit (fractional): influenza, acellular pertussis, typhoid Vi and Lyme disease  Toxoid: diphtheria and tetanus  Recombinant: hepatitis B  Conjugate polysaccharide: Haemophilus influenzae type B and pneumococcal 7-valent  Pure polysaccharide: Pneumococcal 23-valent, meningococcal, and Haemophilus influenzae type b Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Recommended Vaccine Schedules (Textbook Box 25-6)        Children/adolescents ➢ http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html Adults ➢ Communicable Disease Review Discussion

http://www.cdc.gov/vaccines/schedules/hcp/adult.html Travelers ➢ http://wwwnc.cdc.gov/travel/destinations/list Pregnant women ➢ www.cdc.gov/vaccines/pubs/preg-guide.htm Health care workers ➢ www.cdc.gov/vaccines/spec-grps/hcw.htm Specific health conditions ➢ www.cdc.gov/vaccines/spec-grps/conditions.htm Other special groups ➢ www.cdc.gov/vaccines/spec-grps/default.htm Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Vaccine Storage, Transport, and Handling        Cold chain Routes of administration, dosage, and sites Proper timing and spacing Hypersensitivity and contraindications Documentation Vaccine safety and reporting of adverse events and vaccine-related injuries (VAERS) Vaccine needs for special groups Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Prevention of Communicable Diseases  Primary prevention ➢  Secondary prevention ➢  To prevent transmission of an infectious agent and to prevent pathology in the person exposed to an infection Activities to detect early and effectively treat persons who are infected Tertiary prevention ➢ Caring for persons with an infectious disease to ensure that they are cured or that their quality of life is maintained Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Maria Lazarte Florida National University Nursing Department BSN Program Community Nursing Sep 30, 2019 Prof. Eddie Cruz, RN MSN Discuss the principles related to the occurrence and transmission of unicable and infectious diseases. Communicable diseases are the result of the interaction between the person, the agent of infection, and the environment. The person, also called the host, is the living organism that receives the agent of infection, this agent can transmit the infection by different mechanisms. Finally, the environment are the external factors that continue and keep the agent alive and Also, in the environment is space where the infectious agent and people are. An example is the bacteria that are contained in the contaminated water that arrives through the aqueduct service to animals and people, spreading diarrheal infections. Infectious diseases are the result of the interaction of microorganism capable of altering the genetic or physiological material of the host, since the infectious agent allows the migration of the microorganism towards a healthy organism, thus producing the genetic replication of the infection within the host. Also, there are different exit doors. The exit door is the mechanism that allows transmission, to find the link door, that is, the channel of infection in the healthy organism; The process from the epidemiological terminology is called Transmission Chain (Macdonald, 2015). Describe the three focus areas in Healthy People 2020 and the objectives that apply to communicable and infectious diseases Healthy People 2000, is a policy focused on promoting health and preventing disease in the American population. It describes different objectives aimed at improving the quality of citizens through a proposal of activities and development plans about individual, Communicable Disease Review Discussion

family and community health; these objectives reflect the vision and mission of promoting in professionals of interest to develop these activities and citizens to participate actively. The current situation of the population has proved that people are increasingly living longer but not with a better quality of life, because, the older the people seem to suffer from more diseases compared to other times. Additionally, more and more children are victims of preventable diseases, such as diabetes and hypertension, which were once only a problem for the elderly. The goal of Healthy People 2020 is to reverse the damage caused by diseases in the current population and educate to new generations to take care of their health; It also aims to modify the mechanisms for financing health services, trying to objectively integrate the private and public sector into strategies to improve the quality of life from training and self-care (Embrey, 2108). These objectives respond to strategies designed to implement participatory activities in the community, improving people’s quality of life. Then, Healthy People 2000 seems to be the newest proposal for the problems that increase the health of political leaders, therefore, despite the multi-tactics of health professionals and healthpromoting organizations, the numbers of preventable diseases continue to grow (Embrey, 2018). Identify and discuss nursing activities for the control of infectious diseases at primary, secondary and tertiary levels of prevention The main objective of nursing activities around health is to prevent the spread of diseases and the occurrence of preventable diseases. Prevention is the key to health care at the first level, because it is the space where there is less control of microorganisms or infection agents and guests are usually more vulnerable to acquire any infection; For example, flu outbreaks or respiratory diseases are more frequent in first-level pediatric units, since all kinds of patients circulate and transit freely in this space (Huskins, 2017). An essential competence for nurses is the monitoring and control of deteriorating environmental factors. Surveillance is necessary at all levels of care since the inspection is based on the prevention of health, safety, and quality of care for patients (Huskins, 2017). In the second level of care, nurses have the same competences as in the first level but require a deeper degree of knowledge about the population risk of developing, contracting, or transmitting diseases. These nurses focus their activities on minimizing the chances of infection or illness of the patients. However, at this level of care, there is usually greater control of nurses since there are several units that interact with a single medical care center. For example, in a hospital, there may be pediatric, gerontological, oncological, and emergency units (Huskins, 2017). On the third level, nurses are responsible for maintaining the barriers of aseptic and control of infectious diseases. At this level of care, patients tend to have more critical health situations compared to other levels, as they are specialized health care centers since patients are referred for the complexity of their diseases, so patients have a higher risk of contracting diseases of the healthcare environment and having more severe consequences than other patients. These nurses should direct their activities to train health personnel and patients. For example, a center for the attention of patients contaminated with HIV, nurses teach patients and professionals how to handle syringes and protective implements (Huskins, 2017). Identify and discuss a communicable and/or infectious disease that it was believed to be eradicated and have reemerged now. For example; measles Although measles had been believed to be eradicated, in the present, the figures of insistence and recurrence of cases of measles have reappeared due to the migration of sick people to healthy environments. The difference is that healthy organisms do not have the necessary protection tools or barriers to reduce the impact of infection on the body, so it spreads rapidly. The route and transmission of this disease are viral, that is, through the environment and secretions such as saliva (Mankazana, 2018). Romania is one of the regions most affected by this disease due to the poor prevention strategies and poor health conditions of citizens. These factors increase the likelihood of infection since there are no environmental control or disease containment tools (Mankazana, 2018). On the other hand, Measles is one of the diseases with rapid action, since, after exposure to the disease, symptoms progress gradually until fever, cough, skin rashes and eye irritation approximately ten days after exposure. Rashes cause itching in the host, causing them to scratch, and the infection is on their nails. This type of disease usually causes death in the child population and older adults, besides, it can have consequences such as pneumonia and blindness. The most vulnerable populations tend to be the focus of attention for nursing activities and health policies since it is understood that they should protect people most likely to die (Mankazana, 2018). References Embrey, M. L. (2018). Navigating Through the Healthy People 2020 Process. NASNewsletter,23(6), 210-211. doi:10.1177/1942602×08324918 Macd …