Disease Prevention

&
Control

Ms.Jayachelvi
 Introduction
WHO - Definitions
· Health is defined as a state of optimal physical, mental, and
social well-being and not merely the absence of disease and
infirmity

• There are ways of measuring health in a negative sense. They

measure the "5 ds" - death, disease, discomfort, disability,
and dissatisfaction.
 Concept of Health and Wellness
• Wellness defined as;
“the conscious and deliberate process by which
people are actively involved in enhancing their well-
being: intellectual, physical, social, emotional,
occupational and spiritual”

• Wellness is considered to be the positive component

of good health which reflects how one feels as well as
one’s ability to function effectively.
 Epidemiologic triad of disease occurrence

Human body (HOST): is the particular person or group of people

susceptible to illness.
Host factors include: age, sex, marital status, specific
immunity, genetic predisposition, occupation, education,
religion, lifestyle, health status, behaviors ……

AGENT: is the direct cause of disease without which a specific

disease cannot occur.
It may be exogenous (from pollution of the environment—
physical, chemical or biological) or endogenous (e.g.
psychological and mental disorders).
 Epidemiologic triad of disease occurrence

ENVIRONMENT:
It is the medium (surroundings) where man lives: It includes all
what is external to the agent and host. It is divided into:
The physical environment (weather, light, air quality, water,
radiation, pressure [altitude], noise, chemicals ….)
The biologic (infectious agents of disease, reservoir of infection,
vehicles of transmission as mosquitoes & flies, and modes of
propagation as air and water).
Socio-economic (overall economic and political organizations of a
society where individuals live).
 Stages of Diseases
• Incubation: It is the interval between the entry of disease
cause into the body and beginning of first non-specific
symptoms and signs of disease
• Prodromal: Arising first non-specific symptoms and signs of
disease
• Manifestation :There are specific symptoms and signs of
specific disease
• Disease conclusion: Healing and convalescence / chronic
disease / death
 Diseases can be divided into:
Communicable (or infectious) diseases [acute & chronic]: is
a disease caused by a specific infectious agent (organism) or
its products, and is transmissible from one individual to
another. Agents of infectious diseases are usually known.
Examples: Acute: influenza & measles Chronic: HIV, tuberculosis,
poliomyelitis

Acute disease: with rapid onset, short duration (occurs and subsides within
days, weeks or few months). Predictable.
Chronic disease: Its course takes longer periods (longer than three months
& sometimes for the remainder of one's life)
Non-communicable diseases [acute & chronic]:
They can not be transmitted from infected person to
another one.
Delineating the agents of these diseases is often
difficult because several or even many factors may
contribute to the development of a given non-
communicable health condition (multicausation
disease).
Examples: Chronic: cancer, diabetes, hypertension
Acute: heart attack, stroke, hypoglycemia.
 Occurrence of disease frequency in the
community may take one of the following
patterns
Epidemic (or outbreak)
A sudden occurrence of group of illnesses of similar nature;
affecting large number of the population in a community or a
specific geographic area; clearly in excess of normal expectancy;
and derived from a common or propagated source. (large
number of cases in a short time)
Examples: Occurrence of Cholera in a community getting water from
the same contaminated source, and Salmonella food poisoning in a
group of individuals who get food from the same contaminated
source in a camp.
Endemic: the habitual presence of a disease within a
given geographic area, continuously, without
importation from outside (why? Factors controlling
disease existence and persistence are present all the
time). Examples: Malaria

Pandemic: a disease spreads from one country to

another (occurs at the same time in different
countries). Example: Avian Flu pandemic, and HIV
pandemic.
Disease Prevention and
Control
 Disease Prevention
• Actions aimed at eradicating, eliminating, or
minimizing the impact of disease and
disability, or if none of these is feasible,
retarding the progress of disease and
disability.
Control, Elimination & Eradication
• Control: Disease incidence is reduced to a minimal
level, acceptable at the level of country/region, at
which the disease is no longer considered a public
health problem, while infection may still occur.
• Elimination: Reduction to zero of the incidence of a
specified disease in a defined community or country
or region as a result public health actions.
• Eradication: Worldwide disappearance of a disease
i.e. Permanent reduction to zero level
– e.g. smallpox since 1979.
 Disease Transmission
Route Example Disease
Direct contact Sexual contact, skin-to-skin contact STDs, skin infections, scabies

Organism on large respiratory Mumps, pertussis (whooping

Droplet droplets that people sneeze, cough, cough), common cold, ‘strep throat’,
drip, or exhale. Disease spread when meningitis
people are close to each other
(usually <3 feet) and inhale droplet.

Contact with contaminated surfaces, Skin infections, diarrheal disease

Indirect contact clothing, etc

Bite from disease-carrying ticks, Lyme disease, La Crosse encephalitis

Vector fleas, mosquitoes
Eat/drink contaminated Some diarrheal disease, hepatitis
Vehicle food/beverage, transfuse infected b/c
blood, fomites (bedding, infected
tatoo needle)
Airborne Organism on dust particles or small Chickenpox, Tuberculosis,
respiratory droplets that may Smallpox, SARS,
become aerosolized when people Anthrax (inhalational)
sneeze, cough, laugh, or exhale
 Infection Control
Route Example Control Measures

Direct contact Sexual contact, skin-to-skin contact Use of barrier (condom, clothing,
dressing)
Droplet Organism on large respiratory Respiratory protocol
droplets that people sneeze, cough,
drip, or exhale.
Indirect Contact Contact with contaminated surfaces, Hand-hygiene, sanitizing infected
clothing, etc surfaces
Vector Bite from disease-carrying ticks, Vector control
fleas, mosquitoes
Vehicle Eat/drink contaminated food/drink, Proper hygiene and sanitation, cook
transfuse infected blood, fomites food/boil water, etc.
(bedding, infected tatoo needle)

Airborne Organism on dust particles or small Respiratory etiquette, isolation (if

respiratory droplets necessary)
Chain of Infection
 Reservoir & Sources Isolation
• The infected individual should be isolated from the
community in a fashion that prevents direct or indirect
spread of infectious agents.
• Isolation is usually done for a period which equals the
“period of communicability” at a hospital (fever hospital)
or at home. Ideally repeated negative sample are needed
before his release.
– represent important reservoir of infection
– must be exclusion from work
– treatment for the carrier state
– Careful husbandry and sterilization of animal products
 Susceptible Host
• Medical Surveillance:
– Close monitoring/Medical Supervision/ Incubation
Period
• Quarantine:
– Quarantine means separation (with restriction of
the movement) in a specific place (quarantine) of
apparently well persons or animals who have been
exposed (contact) to a case of infectious disease.
 Resistance of Susceptible
• Chemoprophylaxis: The administration of a
chemical, including antimicrobials, to prevent the
development of an infection (if given before
exposure) or to slow progression of the disease to
active clinically manifest disease (if given after
exposure).
• Sero-prophylaxis: prophylaxis using ready-made
antibodies also known as passive immunization
– (e.g. measles immunoglobulin and tetanus anti tetanic
serum (ATS)
Vaccination (Active immunization)
• Protection of susceptible host from
communicable diseases by the administration
of a modified living infectious agent, killed
organism, or inactive agent or part of the
agent.
 Infection Control

• Reduction of overcrowding (better housing

conditions, proper ventilation)
• Personal hygiene (cleanliness, hand washing, regular
bathing)
• Environmental sanitation: (e.g. sanitary sewage
disposal, sanitary refuse disposal, safe water supply,
…)
• Vector control (insecticides, indoor or aerial
spraying, mosquito-nets,…..
Control measures / Levels of Preventions

• The choice of the control measure is disease

dependent.
– Natural history, causation and dynamics of disease
transmission
– Identification of risk factors and high risk groups
– Availability of tools of intervention (vaccine
chemoprophylaxis or treatment,..)
• The concept of prevention is best defined in the
context of levels of prevention; primary, secondary,
and tertiary prevention.
 Primordial Prevention
• Prevention of emergence or development of
risk factors in countries or population groups
in which they have not yet appeared.
• Intervention: Individual and mass education.
• Examples: National programs and policies on
• Healthy & Balanced nutrition
• To Avoid smoking and drugs
• To promote regular physical exercise
 Prevention
• Primary Prevention (Pre-event): Action taken prior to
onset of disease, which removes the possibility that a
disease will ever occur.
– Intervention: Pre pathogenesis stage of disease.
– Modes of Intervention: Health promotion and Specific protection
• Secondary Prevention(Event) : Action which halts the
progress of the disease at its incipient stage and prevents
complication.
– Intervention: Early pathogenesis stage
– Modes of Intervention: Early diagnosis and Adequate/prompt
treatment.
 Prevention
• Tertiary Prevention (Post-Event): All measures
available to reduce or limit impairments and
disabilities and minimize suffering caused by
existing departures from good health and to
promote the patients adjustment to
irremediable conditions.
– Intervention: Late pathogenesis stage
– Modes of Intervention: Disability limitations and
Rehabilitation
 Primary
Prevention

Achieved by

Health Specific
Promotion Protection

• Health education • Immunization and seroprophylaxis

chemoprophylaxis
• Environmental • Use of specific nutrients or
modifications supplementations Protection against
• Nutritional occupational hazards
• Safety of drugs and foods
interventions
• Control of environmental hazards,
• Life style and e.g. air pollution
behavioral changes
Thank You