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Part IV
Provision of Public Health
Nursing to Vulnerable Populations
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Chapter 20
Populations with
Infectious and Communicable Disease
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Contributing Factors
• Institute of Medicine (IOM) 1992 report
Emerging Infections: Microbial Threats to
Health in the United States
– Emerging infectious diseases
– Increasingly present infectious diseases
– Identified six important factors in disease
emergence and reemergence
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Six Factors
1. Changes in human demographics and
behavior
2. Advances in technology and industry
3. Economic development; changes in land
use
4. Commerce
5. Microbial adaptation
6. Deterioration in the public health system
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Models of Transmission
• Epidemiological triangle and the chain of
transmission
– Agent-host-environment
• Agent and reservoir
– Biological agents
• Fungi, parasites
• Bacteria, viruses
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Models of Transmission
• Agent and reservoir
– Reservoir
• Human, animal, environment
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Models of Transmission
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•
•
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Infectivity
Pathogenicity
Virulence
Antigenicity
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Models of Transmission
• Modes of exit
– Respiratory
– Gastrointestinal
– Urinary and reproductive system
• Mode of entry to a new host is often the same as
the mode of exit from the reservoir
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Models of Transmission
• Modes of transmission (Table 20-1)
– Direct person to person
– Common vehicle
– Vectors
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Types of Host Immunity
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•
•
•
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Natural
Acquired
Passive
Active
Herd
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Levels of Prevention
• Leavell and Clark (1958) Preventive
Medicine for the Doctor in His Community
–Three levels of prevention
1. Primary
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•
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Education, immunizations
Chemoprophylaxis, universal precautions
Protective clothing, barrier protection
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Levels of Prevention
• Three levels of prevention
2. Secondary
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Screening
Disease management
Treatment
Directly observed treatment (DOT)
3. Tertiary
•
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Management of complications
Prevention
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Common Infectious
and Communicable Diseases
• Foodborne and waterborne disease
– Food intoxication
• Shellfish, mushrooms, bacterial growth, mercury
– Food infections
• Trichinosis, Salmonellosis
• Escherichia coli, Toxoplasmosis
• Hepatitis A, Parasites
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Prevention
• Five keys to safer food:
1.
2.
3.
4.
5.
Keep clean
Separate raw and cooked
Cook thoroughly
Keep food at safe temperatures
Use safe water and raw materials
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Vectors
• Disease carriers
– Animals, insects, birds
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•
•
•
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Malaria
Anthrax
Brucellosis
Mad Cow
Avian Flu
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Lyme Disease
• Most common vector-borne disease
– White-tailed deer
– Bull’s-eye skin lesion
• Red spot at the site of bite, followed by spreading
rings of inflammation as infection progresses
• Develops 3-30 days after tick bite
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Lyme Disease
• Symptoms
– Fatigue
– Headache
– Fever
– Stiff neck, joint pain
– Muscle aches
– Enlarged tender lymph nodes
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Lyme Disease
• Treatment: 10-14 days of penicillin or
tetracycline
– Left untreated can progress to Stage II
• Neurological and cardiac symptoms
– Stage III
• Months to years of ongoing attacks
– Arthritis and arthralgia
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Rocky
Mountain Spotted Fever
• Vector
– Dog and wood ticks
• Atlantic and western south central region
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Rocky
Mountain Spotted Fever
• Occurs 4-6 hours after bite
• Incubation period 3-14 days
– Maculopapular rash on extremities, palms of
hands, soles of feet
– Antibiotic therapy required
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Malaria
• Vector
– Infected mosquito
• Tropical and subtropical area
• Travelers should use mosquito repellent
– Use mosquito nets while sleeping
– Prophylaxis can begin 4-6 weeks prior to
travel
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Parasitic Diseases
• Tropical climates, underdeveloped
countries
– Lack of sanitation
– Insufficient primary care
– Inadequate access to medications
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Parasitic Diseases
• Four groups of organisms:
1.
2.
3.
4.
Roundworms
Tapeworms
Flukes
Single celled organisms
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Nosocomial Infections
• Acquired in a hospital setting
• May affect anyone who has contact with a
hospital
– Other patients
– Staff
– Environment
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Respiratory Infections
• Tuberculosis
– Airborne pathogen
• Droplet nuclei
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Respiratory Infections
• Symptoms
– Fever, cough, chest pains, fatigue
– Hemoptysis, weight loss
– Incubation period 4-12 weeks
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Respiratory Infections
• Active cases begin 6-12 months after
infection
– Extrapulmonary
– Multi-drug resistant
• Isoniaid and Rifampin
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Respiratory Infections
• Influenza
– Influenzia A, B, or C virus
– Occur annually
– Last 5-6 weeks
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Respiratory Infections
• Small children and elderly most vulnerable
– Flu vaccine 70-90 percent effective
• Pneumonia
– Aspiration of virulent and nonvirulent
organisms
– Inhalation of toxic fumes
– Aspiration of stomach acids
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Respiratory Infections
• Symptoms
– Upper respiratory tract infection
– Chills, fever, cough
– Chest pain and dyspnea
• Treatment
– Antibiotics
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Hepatitis
• Hepatitis A
– Fecal-oral routes
– Vaccine available and provides protection
• Hepatitis B
– Blood borne pathogen
• Fatigue and right upper quadrant discomfort
• Treat with Interferon and Lamivudine
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Hepatitis
• Hepatitis C
– Blood-borne infection
– Causes up to 10,000 deaths a year
– Interferon, Ribavirin
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HIV
• Destruction of immune system
• Antibody test can confirm diagnosis
• Early detection better prognosis
– Elisa
– Western Blot
• Treatment
– Protease inhibitors, anti-retroviral drugs
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HIV
• Role of public health nurse
– Promote prevention of spread of HIV through
education
• Venereal Warts
– HPV
• Gardasil
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STDs
• Syphilis
• Gonorrhea
– Bacterial disease, purulent discharge with
painful urination
– Treatment
• Antibiotics
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Bioterrorism
• Three categories of biological agents:
1. Category A highest risk
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Easy spread
Can be transmitted person to person
High death rates
Public panic
Require special action
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Category A
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Anthrax
Plague
Smallpox
Botulinum toxin
Tularemia
Hemorrhagic fever
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Category B
2. Category B second highest:
–
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Moderately easy to spread
Moderate illness rates
Low death rates
Require specific enhancements of CDC’s
lab capacity
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Category B
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Q Fever
Brucellosis
Glanders
Melioidosis
Psittacosis
• Ricin toxin
• Typhus Fever
• Staphylococcal
Enterotoxin B
• Viral encephalitis
• Food and waterborne
diseases
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Category C
3. Category C third highest priority:
–
–
–
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Emerging pathogens
Easily available
Easily produced and spread
Potential for high morbidity and mortality
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Category C
•
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Napin virus
Hantaviruses
Tick-borne encephalitis viruses
Yellow fever virus
Multi-drug resistant Mycobacterium
tuberculosis
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Managing Bioterrorism
• Plans in place for local response
• State and Federal agencies can assist
• U.S. Department of Homeland Security
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Strategies for Nurses
• Often first to detect presence of illness
• Often manages the communicable disease
program for county
– Surveillance systems
– Nurse conducts case and contact follow up
– Communication skills
• Risk communication
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Planning for
Pandemic Disease Events
• WHO Global Influenza Preparedness Plan
– Inter-pandemic
• Phase I and II
– Pandemic alert
• Phase III, IV, V
– Pandemic period
• Phase VI
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