ADAL MEDICAL UNIVERSITY

Communicable Disease Control (CDC)

By; Mekonin M.(Bsc, MSc)

02/25/2024 1
 Contents
• Introduction
• Feco-oral disease
• Air-borne diseases
• Arthropod-borne (intermediate host-borne)
diseases
• Sexually transmitted diseases / STIs/
• Zoonotic diseases
 Introduction to CDC
• Diseases can be divided by:
1. Time course:
– Acute (characterized by a rapid onset and a short duration), and
– Chronic disease (characterized by prolonged duration).
2. Cause:
– Infectious (i.e. caused by living parasitic organisms such as
viruses, bacteria, parasitic worms, insects, etc.)
– Non-infectious (which are caused by something other than a
living parasitic organism).
• Most diseases in Africa are infectious diseases which are
caused due to infection by living organism
 Communicable diseases
• These diseases are called communicable
diseases, because they spread from person to
person, or sometimes from animals to people.
• They occur at all ages but are most serious in
childhood & they are preventable.
 Communicable diseases cont…
• Communicable diseases are important in
developing countries because:
Many of them are very common
Some of them are serious and cause death &
disability
Some cause outbreaks (epidemics)
Lack of access to modern health care
Most of them are PREVENTABLE
 Communicable diseases cont…

• Communicable diseases can be conveniently

divided:

A. Based on mode of transmission

B. Based on the Biologic agent

 A. Based on mode of transmission
1. Airborne diseases-
-Need droplet nuclei or dust for transmission
E.g. Tuberculosis
2. Vehicle borne disease
- Need non-living substance or object for
transmission
E.g. Cholera
3. Vector Borne disease
-Need vectors for transmission
E.g. Malaria
4. Sexually transmitted diseases.
 B. Based on the Biologic agent

1. Bacterial diseases; e.g. syphilis, gonorrhea, etc

2. Protozoal diseases; e.g. Malaria

3. Viral diseases; e.g. HIV/AIDS

4. Helminthes diseases; e.g. Ascariasis

5. Fungal diseases; e.g. candidiasis

 Definition of important terms
• Disease – a state of physiologic or psychologic
dysfunction
• Infection - is the entry and development or
multiplication of an infectious agent in the
body of man or animals.
– An infection does not always cause illness.
• Infestation - It is the lodgment, development
and reproduction of arthropods on the surface
of the body or in the clothing, e.g. lice
 Definition of important terms cont…
• Epidemics - the occurrence of any health related
condition in a given population in excess of the
usual frequency in that population
• Endemic - a disease that is usually present in a
population or in an area at a more or less stable
level.
• Sporadic - a disease that does not occur in that
population, except at occasional and irregular
intervals.
• Pandemic - an epidemic disease which occurs
worldwide
 Chain of disease transmission
• A logical sequence of factors or links of a chain
that are essential to the development of the
infectious agent and progression of disease.
• Six factors involved in the chain of disease
transmission:
1. The agent
2. Its reservoirs
3. Its portal of exits
4. Its mode of transmission
5. Its portal of entry, and
6. The human host
 1.The agent (Infectious agent)
• An organism that is capable of producing
infection or infectious disease. E.g. Viruses,
bacteria.
• It includes:
– Metazoa (e.g., helminthes)
– Protozoa (e.g., Ameobae)
– Bacteria (e.g., treponema pallidum,
mycobacterium TB)
– Fungus (e.g., candida albicans)
– Virus (e.g., chicken pox, polio, etc.)
 2. Reservoir
• Any person, animal, arthropod, plant, soil or water in
which an infectious agent normally lives and
multiplies
Types of reservoirs
a. Man: E.g. Measles, smallpox, typhoid, meningitis,
gonorrhea, syphilis, etc. The cycle of transmission is
from human to human.
b. Animals: E.g. Bovine TB, anthrax, rabies. The cycle
of transmission is from animal to person
c. Non-living things as reservoir: it may be soil, water,
etc. E.g. C. tetani
 3. Portal of exit (mode of escape from the reservoir)

• It is the way through which the infections

agent leaves its reservoir
• Possible portal of exit include all body
secretions & discharges: mucus, saliva, tears,
breast milk, vaginal discharges, excretions
(feces & urine), blood, etc.
– GIT: typhoid fever, bacillary dysentery, amoebic
dysentery, cholera, ascariasis, etc.
– Respiratory: tuberculosis, common cold, etc.
– Skin and mucus membranes: Syphilis
 4. Mode of Transmission
• The mechanisms by which infectious agent is transferred from
one person to another or from a reservoir to new host.
• Transmission may be direct or indirect
1. Direct transmission
1.1. Direct contact- refer to the contact of skin, mucosa, or
conjunctiva from another person or vertebrate animal, through
• Touching: Eye- hand -eye e.g. Trachoma
– Feces-hand- mouth e.g. shigellosis
• Sexual intercourse e.g. syphilis
• Biting e.g. rabies
• Passage through birth canal (e.g. gonococcal ophthalmia
neonatarum)
 4. Mode of Transmission cont…

1.2. Direct projection of saliva droplet created

by expiration activities such as coughing, sneeze,
spitting, talking, singing, etc.
• Saliva droplets are emitted, if these is large
can reach another host directly at distances of
up to one meter. E.g. Common cold
 4. Mode of Transmission cont…
1.3. Trans-placental transmission
• It is transmission of diseases from mother to
her fetus through the placenta.
• E.g. TORCHS (Toxoplasmosis, Rubella,
Cytomegalovirus infection, Herpes simplex
infection, syphilis, others including
HIV/AIDS)
 4. Mode of Transmission cont…
2. Indirect transmission
2.1. Airborne: Dissemination of the infectious
agent by air to a suitable portal of entry usually
the respiratory tract.
2.2. Vehicle borne: It is defined as any non-
living substance or object by which an infectious
agent can be transported and introduced in to a
host.
• E.g. food, water, milk, clothes, etc.
 4. Mode of Transmission cont…
2.3. Vector borne: A vector is an organism
(usually an arthropod such as an insect, tick, or
louse), which transports an infectious agent to a
susceptible host or to a susceptible vehicle.
• There are two types of vectors
– Biological vectors
– Mechanical vectors:-
 a. Biological vectors

• In such type of vectors, there is a period of

multiplication and/ development of the agent
in the vector is required before transmission to
the host can occur.
– This period is called the extrinsic incubation
period.
 a. Biological vectors cont…
• Biological vectors based on the mechanism of
inoculation of the agent in to the host are classified as:
i. Salvarian transmission: - In which case infective
saliva is injected in to the host.
E.g. Female anopheles mosquito  Malaria
ii. Stercorarian transmission: -In this case infective
fecal or regurgitated material will be deposited near the
bite wound, and then the agent enters the host through
autoinoculation.
E.g. Body louse Relapsing fever
 b. Mechanical vectors
• In this case, there are no periods of
development and multiplication of the agent
but are responsible for transporting the agent
to human host.
E.g. Flies  Cholera
• A disease often has several modes of
transmission
 5. Portal of entry
• The site in which the infectious agent enters to
the susceptible host. For example:
– Mucus membrane
– Skin
– Respiratory tract
– GIT
– Blood
 6. Susceptible host (host factors)
• A person or animal lacking sufficient
resistance to a particular pathogenic agent to
prevent disease if or when exposed.
 Types of Carriers
• A carrier is an infected person or animal who does not
have apparent clinical disease but is a potential source
of infection to others.
A. Healthy or asymptomatic carriers: -These are
persons whose infection remains unapparent
throughout its course.
• E.g. polio virus, meningococus and hepatitis virus
B. Incubatory or precocious carriers: -These are
individuals or persons who excrete the pathogens during
the incubation period (before the onset of symptoms).
• E.g. Measles, mumps, chicken pox and hepatitis
 Types of Carriers cont…
C. Convalescent carriers:-These are those who
continue to harbor the infective agent after
recovering from the illness.
• E.g. Diphtheria, Hepatitis B virus
D. Chronic carriers: -The carrier state persists
for a long period of time.
• E.g. Typhoid fever, HB virus infection
 Prevention and control of communicable diseases
• Disease prevention:-Inhibiting the dev`t of a
disease before it occurs or if it occurs
interrupting or slowing down the progression
of diseases.
• Disease control: -Involves all the measures
designed to reduce or prevent the incidence,
prevalence and consequence of a disease to a
level where it cannot be a major public health
problem.
 Levels of disease prevention

• The different points in the progression of a

disease at which one can intervene to prevent
further out come.
There are three levels of prevention.
1. Primary prevention: The objectives here are
to promote health, prevent exposure, and
prevent disease.
 Primary prevention cont..

A) Health promotion: - any intervention that promotes a

healthier and happier life.
• This consists of general non-specific interventions that
enhance health and the body's ability to resist diseases such as
 improvement of socio economic status through provision of
adequately paid jobs;
 education and vocational training;
 affordable and adequate housing,
 clothing and food;
 old age pension benefits, etc.
 Primary prevention cont…
B) Prevention of exposure: any intervention which
prevents the coming in contact between an infectious
agent and a susceptible host.
 This includes actions such as
 Provision of safe and adequate water;
 Proper excreta disposal;
 Vector control;
 Safe environment at home (proper storage of insecticides
and medicines),
 At school and at work (proper ventilation, monitoring of
harmful substances in factories).
 On the streets (driver licensing laws)
 Primary prevention cont…

C) Prevention of disease: - This occurs during

the latency period between exposure and the
biological onset of the disease.
• An example for this is immunization
 Primary prevention cont…
N.B. Breast feeding is an example of intervention that
acts at all three levels of primary prevention.
• Health promotion: by providing optimal nutrition for
a young child, either as the sole diet up to six months
of age, or as a supplement in later age.
• Prevention of exposure: by reducing exposure of the
child to contaminated milk.
• Prevention of disease after exposure: by the
provision of ant-infective factors, including
antibodies, WBCs and others.
 2. Secondary prevention
• Secondary prevention is after the biological onset
of the disease, but before permanent damage sets
in.
• The objective here is to stop or slow the
progression of disease so as to prevent or limit
permanent damage,
– through the early detection and treatment of diseases.
E.g.
– Breast cancer (prevention of invasive stage of the
disease)
– Trachoma (prevention of blindness)
– Syphilis (prevention of tertiary or congenital syphilis)
 3. Tertiary prevention
• Tertiary prevention is after permanent damage
sets in.
• The objective of tertiary prevention is to limit the
impact of that damage.
– The impact can be physical (physical disability),
psychological, social (social stigma), and financial.
• Rehabilitation refers to the retraining of
remaining functions for maximum effectiveness.
– Provision of special disability pension would be a
form of tertiary prevention
 Principles of communicable disease control

•The actions may be effected through:

1.Attacking the source (controlling reservoir)
2.Interrupting the mode of transmission and
3.Protecting the host (susceptibility)
 1. Attacking the source (Strategy related to agent)

Animals as reservoirs
Action determined by usefulness of the animals, how
intimately they are associated to man and feasibility of
protecting susceptible animals.
E.g. Plague → rat is pest and be destroyed
Rabies → pet dogs protected by vaccination & Stray
dogs can be destroyed.
 1. Attacking the source cont…
• Humans as reservoirs
i. Isolation of infected persons: separation of infected persons
from other for the period of communicability
Not suitable when,
 Large proportion are apparently infected, or
 In which maximal infectivity precedes over illness.
ii. Treatment
 Of cases (clinical) and carriers
 Mass treatment –treat everybody, without checking
whether individuals have disease or not.
 1. Attacking the source cont…

iii. Quarantine – the limitation of freedom of

movement of apparently healthy persons or
animals who have been exposed to a case or
infections disease.
Corona virus, Ebola virus, Cholera, plague, and
yellow fever are the 5 internationally
quarantinable diseases by international agreement.
 1. Attacking the source cont…

Non-living thing as reservoir

• Limit man’s activity to the affected area (e.g.
Soil, water)
2. Interrupting transmission (Strategy related to environment)
For Transmission by ingestation
i. Purification of water
ii. Pasteurization of milk
iii. Inspection procedures designed to ensure safe food supply
iv. Improve housing conditions
For Transmission by in halation
v. Chemical disinfections of air
vi. Use of UV-light
vii.Improving ventilation
Transmission by vector or intermediate hosts
viii.Vector – control measures
ix. Environmental manipulation
 3. Measures that reduce host susceptibility (Strategy related to the host)

i. Immunization
• Active immunization – when either the altered organism or its
products is given to a person to induce production of
antibodies. E.g. BCG
• Passive immunization – provision of ready – made antibodies
E.g. TAT
ii. Chemoprophylaxis – use of antibiotics for known contacts to
a case
E.g. Quinine/chloroquine for malaria
 3. Measures that reduce host susceptibility cont…
iii. Better nutrition
• Malnourished children get infections more
easily & suffer more severe complications
iv. Modification of personal behaviour
Enhancing good personal hygiene
Routine physical exercise
Use of mosquito bed net, etc.
• N.B Effective control of disease is most likely
when a combination of methods;
– Attacking the source,
– Interrupting transmission, and
– Protecting the host is used at the same time.