RESPIRATORY INFECTIONS

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RESPIRATORY INFECTIONS
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Approach to Epidemiology of Communicable Diseases

• Agent
• Host
• Environment
• Mode of Transmission
• Incubation period
• Control
• Prevention

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How Health Systems address Communicable Disease

• Surveillance
• Routine
• Disease Specific AFP, Measles, HIV
• Routine Care
• Specialized Services
• Diagnosis eg AFB staining, ELISA, PCR
• Treatment eg DOTS, ART
• Control Prevention
• Isolation / Quarantine
• Immunization /Prophylaxis
• IEC

RESPONSIBILITY TO THE PATIENT RESPONSIBILITY TO
THE COMMUNITY
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Small Pox
Epidemiological Basis of Small Pox Eradication
-No animal reservoir -No long term
carrier -Life long immunity -Easy
detection -No transmission by subclinical
cases -Highly effective vaccine
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Coordinated Response to Small Pox

• Surveillance
• Vaccine
• Role of Other Systems
• School admissions
• Passport / Visa
• Community involvement

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Chicken Pox

• Agent - HHV3
• IP - 14 to 16 days
• C/F pre-eruptive eruptive pleomorphic
• Complications
• Pneumonia
• Encephalitis
• Haemorrhagic chicken pox

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Health System Response to Chicken Pox

• Patient care complications isolation
• Surveillance for large outbreaks
• Containment measures

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Measles

• RNA paramyxovirus
• I/P, C/F Kopliks spots, morbiliform rash
• Complications acute / chronic (SSPE)
• IgM ELISA for diagnosis (surveillance purposes
  only)

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Measles Surveillance

• Specific objectives
• Increased coverage of vaccine
• Fully investigate all detected/reported measles
  outbreaks
• Case based measles surveillance within integrated
  surveillance systems in countries that completed
  catch-up campaigns
• Provide a second opportunity for measles
  immunization

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Second Opportunity for Measles Immunization,
SEAR, 2007
Measles 2nd Opportunity through Routine
Immunization
Measles 2nd Opportunity through Catch-up/Follow
up Campaigns
4 Countries providing MR/MMR
Catch-up Campaigns completed
Catch-up/Follow-up Campaigns planned in 2007
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Rubella Mumps

• RNA viruses fever, rash, post auricular
  lymphadenitis
• Congenital Rubella Syndrome classical triad is
  cataract, deafness, PDA
• Vaccine MMR

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Rubella Mumps

• Mumps - myxovirus parotitis
• Complications possible
• MMR vaccine
• Live attenuated
• 15 to 18 months
• USA MMR vaccine
• NHS (UK) Rubella vaccine to adolescents

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Influenza

• RNA virus
• Antigenic shift Drift
• Types A,B and C
• Antigens H and N
• H1N1, H5N1
• Epidemiology short IP
• Control surveillance (case definitions),
  hygiene and sanitation
• Prevention judicious travel and interactions

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How to address Influenza?

• Specialized care facilities
• Flu may cause a worsening of underlying chronic
  medical conditions.
• Main complication in Pneumonia
• Death is often due to Respiratory Failure
• Health System Roles
• Reporting
• Diagnosis Treatment
• Isolation
• Care of Personnel
• Hygiene

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Diphtheria

• Corynebacterium diphtheriae
• ß phage - toxin
• Clinical features pseudo membrane, bull neck
• Control
• Chemotherapy
• Toxoid

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Pertussis

• Whoop
• Bordetella pertussis
• Vaccine
• DPT vaccine, DT vaccine, dT vaccine

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Meningococcal Meningitis

• Neisseria meningitidis
• Control - among contacts

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Rajayakshma - Robert Koch - Rifampicin
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Tuberculosis

• 1993 WHO GLOBAL EMERGENCY
• Types SP, SN, Default, Failure, Relapse, Extra
  Pulmonary
• Unholy alliances
• HIV and TB
• Diabetes and TB
• Smoking and TB
• New threats MDRTB, XDRTB

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Tuberculosis Manifestations
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Tuberculosis Diagnosis

• Thumb rules for screening
• gt 3 weeks cough, 2 sputum smears
• Staining
• ZN staining, Auramine rhodamine stain
• Culture Sensitivity
• Rapid (BACTEC) or Routine (L J medium)
• Tuberculin skin test, Radiology, Lesion specific
  tests

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TB - Management and Control

• Treatment DOTS
• Categories
• I (2H3R3Z3E3,4H3R3)
• II (2S3H3R3Z3E3, 1H3R3Z3E3, 5H3R3E3)
• III (2H3R3Z3, 4H3R3)
• DOTS Plus
• Other regimens - daily
• BCG vaccination ID (0.05 ml / 0.1 ml)
• Chemoprophylaxis

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TB control as a measure of Health System
Performance

• Diagnostic facilities
• Treatment appropriateness of regimens,
  availability of medicine
• Quality of care
• HMIS

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Acute Respiratory Infections

• Biggest killer of under fives
• Bacterial, Viral and Other agents (C. burnetti,
  Mycoplasma etc)
• Signs to watch out for
• Fast breathing
• Chest in drawing
• Stridor / Wheeze
• Consciousness
• Control microbiological diagnosis is not a
  must, prompt detection and management of severe
  disease is.

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Thank you!