COMMUNICABLE DISEASES PRESENTED BY Mr. SURESH KUMAR LECTURER

1. COMMUNICABLE DISEASES PRESENTED BY Mr. SURESH KUMAR LECTURER IN PHYSICAL EDUCATION P.G.G.C.G. SECTOR -11, CHANDIGARH

2. COMMUNICABLE DISEASES • INTRODUCTION A disease is a sickness that occurs when there is an upset or breakdown in the way the body usually functions. Most diseases make one feel sick or like something is not quite right with the body, but some diseases upset places in the body that one can not really feel, like blood, or one's internal organs. Symptoms are the changes that one can see or feel when one has a disease. Coughing can be a symptom of having a cold. People recover from some diseases in a short time. Others last a long time. Some leave permanent damage, other diseases can cause death. • Diseases that can be passed or transmitted from one person to another are called infectious or contagious, like the common cold. Illnesses like a heart attack or cancer are not contagious. If a person is around some one else who has an infectious disease, we say that person has been exposed. Very often, symptoms appear much later so the person never knows when he or she was exposed to the illness, that person has become infected.

3. MEANING OF COMMUNICABLE DISEASES A disease resulting from infection capable of being directly man and to animal or indirectly transmitted from man to man, animal to animal, and man and to animal form the environment like through air, dust, soil water, food etc. • There are many communicable diseases like Aids, small pox, measles, whooping cough, tuberculosis, viral hepatitis, hepatitis B, typhoid, malaria, rabies, tetanus etc. • HIV / AIDS Ever since the initial identification of the Human Immuno­deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) among the homosexual community of the developed nations in America and Europe in the late 1970's there has been an alarming rate of spread of the virus. This virus continues to spread around (he world.

5. AIDS did not originate from India. But this fact cannot overshadow the profound status of this HIV Infection in the present Indian Scenario, By the next decade, India will house nearly 50 million AIDS patients, In India the first case of HIV infection was officially reported from ft! clinic in Chennai in the summer of 1986. There has been a rapid spread of the disease across the nation ever since. The initial cases of HIV / AIDS were reported among commercial sex workers in Mumbai and Chennai and intravenous Drug users (IDU) in the north-eastern slates] In recent years it has spread from urban to rural areas and from individuals having "high-risk" behaviour to the general population, The estimated number of HIV / AIDS infected in the world as on 2001 are 36 million and one out of 10 people is Indian who is affected by this virus. • ORIGINS OF HIV / AIDS It may be said that the exact origin of AIDS will never In­completely elicited. There are, however, certain facts that have led in a more or less general agreement as to the source of this epidemic. II is plausible to conclude that HIV is a pathogen new to the human race, probably resulting from an non-pathogenic, subhuman primate retrovirus, which made a species jump from African Primates (monkeys) to human. There is widespread evidence that many old world primates e.g. chimpanzees, mandrills, and African Green Monkeys, in sub-saharan Africa have been infected with restrovirusc , similar to HIV for thousands of years, although they are non-pathogen ic and do not cause debilitating illness.

6. What is AIDS ? • AIDS stands for the Acquired Immune Deficiency Syndrome. • A - Acquired means that it is something people acquire from outside. It is not inherited from parents like eye color or blood type. II is transmitted through person's own behaviour or situation. • I - Immune refers to the immune system, the body's defense mechanism.against germs and infections (a weakened body defence system). • D - Deficiency indicates a lack or weakening of (the immune system). • S- Syndrome refers to the presence of a group of signs and symptoms. When the body's defenses are weakened, it is possible for many infections or diseases to simultaneously infect the body. The condition is referred to as a syndrome. It is a collection of signs and symptoms that are generally found together in a particular disease or diseases. • Currently the world health organization and UNAIDS estimated that 8,500 persons will become infected with HIV each day while an estimated 4,000 persons will die from HIV /AIDS related deaths each day.

7. AIDS is a serious disorder of the Immune system. This system puts up a defence against any infections and protects the body from illnesses. AIDS is the condition where this system is under attack. The body's normal defences against infection breaks down and the body becomes vulnerable to infections and other diseases. Some of these infections would normally not affect healthy people. But when immune system is weaknened or depressed, they find an opportunity to flourish and so are called opportunistic infections. • AIDS was first identified in 1981 in the U.S.A. when previously healthy, homosexual men began to suffer and die on account of rare infections. After much debate and research, scientists identified a new syndrome and later termed it as AIDS. • What is HIV ? • AIDS is caused by an organism called HIV. • H - Human indicates that the HIV only infects humans. • I - Immunodeficiency indicates that HIV causes the immune system to become weak and ineffective in defending the body against the germs. In this way, HIV leads to AIDS. • V - Virus is a disease causing parasite. • AIDS is Acquired because it is caught from someone and is not inherited. • Immune and Deficiency because the virus destroys the body's defense system and as a result the person is more likely to get illness which the body would normally be able to fight off easily • (Hi) Syndrome describes the different signs and symptoms of the illness that result from the HIV infections. These signs and symptoms appear as multiple infection or illness.

8. MODE OF TRANSMISSION • Diseases can be caused by pathogens. There are organisms or germs which can invade the body from outside, it can cause illness. Viruses, bacteria, fungi, and protozoa can be called the pathogens. All/ of these organisms are very small living creatures and can not been1 seen with the naked eyes. • A virus is a tiny organism which carries instruction for reproducing itself (called the genetic material). But it must invade a living cell (such as one in a person's body) to reproduce. • Concentration of virai load - There must a sufficient quantity of HIV to allow infection to occur. If the concentration is too low then it is not possible for infection to take place. • Port of Entry - There must a way for HIV to enter into the body. If HIV infected fluid does not have a path into another person's body then infection can not take place. • Body fluids like blood, semen, menstrual blood, vaginal fluid contain a high enough concentration of HIV / AIDS to and can be exchanged. • Body fluids like sweat, tear, skin oils do not contain the virus to infect. • Fluids like crebrospinal fluid, Amniotic fluid, focal matter are not normally exchanged between persons. • HIV / AIDS has been isolated from the body fluids or infected persons, including saliva and tears. However, only blood, semen, vaginal secretions, and breast milk have been implicated in transmission.

9. There are only three modes of transmission- • Sexual Transmission. • Blood Transmission • Mother to Child Transmission. • Sexual Transmission: The virus can be transmitted from an infected person to his or her sex partner (man to woman, woman to man and man to man). Sexual intercourse can damage the linings of sexual organs and can facilitate transmission of HIV / AIDS from the infected partner to the uninfected one by exchange of body fluids. It is easier for the virus to be transmitted if the uninfected partner is already suffering from some sexually transmitted disease because in this case the lining is already damaged. Due to the high rate of sexual transmission of the virus, sexual behaviour is the prime focus interrupting transmission. In India, sexual intercourse is the most frequent mode of transmission of HIV /AIDS. • Blood Transmission: It occurs through the transfusion of infected blood or blood products or the use of blood contaminated needles, syringes or other skin piercing instruments. Recipients of a single unit of HIV infected blood have a virtually 100% probability of becoming infected. • Blood transfusion is a significant problem in areas where HIV infection is common and where HIV antibody screening of blood donors has not yet been introduced.

10. When blood is needed it should be obtained from a licensed blood bank. Licensed blood banks test blood for HIV and place a sticker on the blood unit indicating that it has been tested. Even though the bag has been tested for HIV, there is still a chance that it contains the virus if it was obtained from a patient in the window period. Blood received in the window period does not contain antibodies produced in response to HIV. • HIV can live between 30 seconds to one minute when exposed to air. When a needle pierces the skin and its contents ejected, blood pressure and capillary action can push injected blood back into the bone and hub of the needle. How long HIV can live inside the needle depends on the conditions the needle is stored in. • Mother to Child Transmission: Transmission of HIV / AIDS from an infected women to her foetus / infant may occur before, during and shortly after birth. The overall risk of HIV transmission from HIV infected women to her foetus in utero or during delivery is about 30%. • The breast milk of mothers infected with HIV contains small amounts of the virus. Researchers have found that one third of babies • born to HIV infected women become infected through milk, recent data confirms that some transmission may occur through breast feeding- • It is Bserved that extra-marital sex is the primary mode of infection, 8"@% of AIDS patients identified, owned their extramarital sex to be the cause. • Such rapid spread of the epidemic across the country today is also due to the labour migration and mobility in search of employment from economically backward to more developed regions • Low literacy levels leading to low awareness among the potential high risk group

11. NON-TRANSMISSION OF HIV / AIDS • The present attitudes towards AIDS are similar to the attitudes once seen towards syphils in the early 19th century. Myths and emotional hysteria can be generated due to misinformation about AIDS. Many myths about HIV today center around the way in which it can be transmitted. There are only three routes of HIV transmission. • HIV / AIDS DOES NOT SPREAD BY - • (i)Drinking water from the same glass as an infected person. • (ii)Swimming in pools used by people with HIV / AIDS. • (in) Getting bitten by a mosquito that has already bitten an infected person. • (iv)Getting bitten by an infected person. • (v)Socialising or casually living with people with HIV / AIDS. • (vi) Caring and looking after people with HIV / AIDS. • (vii)Use of the same toilets as AIDS patients or people infectedwith HIV. • (viii)Shaking hands with people with HIV / AIDS. • (ix)Hugging or kissing a person with HIV / AIDS. • (x)Casual contacts such as sitting next to an infected person, orby coughing and sneezing, or from water, food, clothing, cups,glasses, plates, forks, spoons and other shared objects. • (xi)Receiving and reviewing literature from areas of the worldwhere there is AIDS. • (xii)Donating blood. • (xiii)Bedbugs, flies, lice, and other insects and pests do not spreadHIV / AIDS.

12. Identifying AIDS - World Health Organisation (WHO) has listed a few signs that help in provisional diagnosis of AIDS. • MAJOR SIGNS: • Weight loss greater than 10% of the body weight. • Continue fever for a period greater than one month.(Hi) Chronic diarrhoea (for more than one month). • MINOR SIGNS: • Persistent cough for a period longer than one month. • General itching dermatitis (skin irritation).(in) Recurrent Herps zoster (shingres) • Oropharyngealcandidiasis (fungus infection in the mouth /throat) • Swelling of the lymp glands. • Cure for AIDS - So far there is No-Cure For AIDS and a vaccine of prevention of infection may be far aWay. Even if there is a cure, the cost of the medicine would prevent it from being used in many developing countries.

13. Prevention of HIV / AIDS Infection: At present prevention is the only cure for AIDS. Since AIDS is a sexually transmitted disease, sexual behaviour is the prime focus of action for interrupting transmission. Itjstherefore important to have an information and education programme aimed at all men and women, to have facilities for detection and treatment of other sexually transmitted diseases and to have an environment which would promote condom use and frank information dissemination without somatization and discrimination against people known or suspected to have HIV/ AIDS. In India, prevention of sexual transmission is an immediate priority. To save from aid the following steps must be taken :— • Safer sex activities for prevention • Sexual activities e.g. Hugging, kissing etc. • Anything that does not involve the sharing of semen, vaginalsecretion or blood.

14. (Hi) Long term mutually faithful relationship, be faithful to one partner. • (iv) Proper and consistent use of condoms. • For prevention of HIV / AIDS transmission through infectedblood and blood products, include recruiting voluntary non-paiddonors, screening all donated blood for HIV and educatinghealth care workers to reduce unnecessary transfusions. • Preventing transmission at health care setting rests on careful attention to infection control procedure including proper sterilization of equipment, proper adherence to procedures based on "Universal Health Precautions", and provision of necessary supplies and equipment. • Preventing blood borne transmission among drug injectors should go hand in hand with efforts to prevent sexual transmission among them. These include reducing the demand for drugs, the use of drugs by injection and the sharing of injection equipment. • To screen blood and blood products, thorough testing of all blood samples for HIV should be done. This does not take into account blood screening done during the window period, where the person is already infected but his immune system has not produced antibodies against HIV. There blood samples may or may not be free of HIV. In Bhutan, Indonesia and Thailand, all donated blood is now screened for HIV. • For preventing transmission from mother to child is, to prevent sexual transmission of HIV to women at reproductive age. Secondary prevention would depend on the avoidance of child bearing by mothers who know or suspect that they are infected.

15. Counselling and contraceptive services should be made available for all men and women. • World Health Organisation (WHO) estimates that 16-17 million adults and children are infected with the HIV / AIDS virus in the world. Most of these will develop HIV related illnesses and ultimately AIDS. Therefore we need to plan for care of these patients at hospitals and at the home. They must receive treatment for common opportunistic infections such as tuberculosis, etc. As AIDS affects people in their most productive years, the economic impact on families with HIV infected members is enormous especially on children who may be orphaned. The impact of AIDS on society would include erormous health care costs, decimation of the work force and loss of skilled labour and educated professionals. • VIRAL HEPATITIS: 'Viral Hepatitis' is caused by two viruses, namely Hepatitis A virus (HAV) and Hepatitis B virus (HBV). A third form of hepatitis, referred to as non-A, non-B (NANB), has been found in all countries and is known as Hepatitis 'C. There are three types of Hepatitis, A, B, and C. • Hepatitis A- It is an acute communicable disease caused by Hepatitis A virus (HAV). It is one of the most widespread infectious disease worldwide. It is common in places with poor standards of hygiene and sanitation. The virus attacks the liver and causes varying degrees of illness in patients.

16. The severity of infection is age related with symptoms being more common in adolescents, adults, and young children. Acute symptoms last for four weeks to three months, requiring total rest and occasionally hospitalisation. This causes disruption of daily activities and often leads to absence from work to school. Complete recovery can take as long as 6-12 months, with serious and occasionally fatal complications occurring in minority of patients. Hepatitis A can relapse in 20% of the cases that acquire the disease, and the symptoms may persist for up to six months. • SYMPTOMS OF HEPATITIS A: ' • It includes nausea, vomitting, yellowness in eyes, skin and urine (jaundice). • Diarrhoea, pale stool, abdominal pain and fatigue. • Fever and chills, lack of appetite, sore throat. • The frequency and severity of these symptoms, depends on the age of the person. This affects the young children more than adults. Two to five year olds develop jaundice with associated dark urine and pale stools.

17. MODE OF TRANSMISSION ' • Hepatitis A vims is excreted in the faeces, and spread by faecal route. • Direct contact with an infected person's faeces or indirect contamination of food, water, hands and cooking utensils. • Raw or insufficiently cooked food (fruits, salads vegetables, seafood etc.). • Close contact with infected individuals within families, schools, day care centres and hostels. • Through contaminated needles and syringes or through contaminated blood products. • Poor standards of living, poor hygiene and sanitation. • The risk of early exposure is less among those living in an improved socio-economic environment. Any non-immune person exposed to the virus can develop hepatitis A. The children attending day care centres, schools etc, and individuals from upper socio­economic groups who are unlikely to have been exposed to the virus. The high risk of this virus is in travellers to highly endemic areas, food handlers, healthcare workers, school or day care employees and contacts with infected persons.

18. HEPATITIS B • It is an acute systematic infection with serious disorder in the liver, caused by hepatitis B Virus (HBV) and transmitted usually by the parental route. Hepatitis B is endemic throughout the world including the remote areas and islands. Its prevalence varies from country to country and depends upon a complex mix of behavioural, environmental arid host factors. It is lowest in countries or areas with high standard of living. • It is an acute infectious disease, and has world wide distribution. Infection is much higher in under developed areas of the world than in the developed countries. It is a DNA virus. Man is the only source of infection. Patients remaining HBS Ag positive for more than 6 months, following acute hepatitis B infection are called chronic carriers. The chronic carrier state may persist for years and may lead to chronic liver disease. This mainly contaminated blood and blood fractions and less frequently other secretions and excretions e.g., saliva, urine, semen. The period of communicability is usually several months, or as long as virus is present in blood. • It occurs at very early ages. High infections rates have been found in drug - abusers, prostitutes and homosexual population. Incubation period is 60 to 180 days. Lower doses of the virus results often in longer incubation periods.

19. Modes of Transmission • Parental Route: This is the most common route of spread of Hepatitis B. Traditionally Hepatitis B has been a hazard of (a) blood transfusion, (b) use of inadequately sterilized needles, syringes and other equipment during medical, surgical and dental procedures, and (c) exposure to infected blood. Transmission of Hepatitis B virus can take place in the family setting as a result of accidental percutaneous inoculation following the use of shared razors, toothbrushes, towels or by close contact. • Vertical Transmission : The Hepatitis B virus can get into the fetus from an infected mother. The mechanism of parental infections is uncertain. Hepatitis B virus can infect the fetus in uterus as a result of a leak of maternal blood into the body's circulation, or ingestion of accidental inoculation of blood. • Other Routes: Hepatitis B virus also exists in the variety ofbody secretions and excretions like Saliva, semen and vaginalfluid. This clearly states that kissing or sexual intercourse maytransmit infection.

20. PREVENTION • Hepatitis B Vaccine ("H-B-Vax"): The aim of this vaccination is to stimulate production of the surface antibody which is produced from the plasma of chronic carriers of hepatitis B virus. The immunization regimen consists of 3 doses of vaccine. • Hepatitis B Immunoglobulin (HBIG): It is used for those acutely exposed to HBs AG - positive blood, for example (a) surgeon, nurses or laboratory workers (b) newborn infants of carrier mother, and (c) sexual contacts of acute hepatitis B patients. The HBVIG should be given as soon as possible after an accidental inoculation (ideally within 6 hours and preferably not later than 48 hours). At the same time the victim's blood should be drawn for HBs Ab testing. If the test is negative, vaccination should be started immediately and a full course given. If test is positive for surface antibody, no further action is needed. • Positive-active Immunization: The simultaneous administration of HBIG and hepatitis B vaccine is more efficacious than HBIG alone. HBIG does not interfere with the antibody response to the hepatitis vaccine. This combined procedure is ideal both for prophylaxis of persons accidentally exposed to blood known to contain hepatitis B virus and for prevention of the carrier state in the newborn babies of carrier mothers.

21. Other Measures: No blood should be transfused until it is screened and blood donors tested positive should be rejected. Voluntary blood donors should be encouraged because purchased blood has shown a higher risk of post-transfusion hepatitis. The importance of adequate sterilization of all instruments and the practice of simple hygienic measures should be stressed among health workers. Finally people should be educated in terms of healthy living. • Hepatitis C : • Hepatitis 'C' is a slow killer. It is one of 40 new infectious diseases discovered since 1970, but has been around for decades, if not centuries. Before 1989, it was known as 'non-A, non-B hepatitis' Mode of Transmission • There is a minute risk of catching the disease from implements that can carry blood (razors, tatoo pens, tooth-brushes etc.) • It is also possible for mothers to pass it on to an unborn baby. • The infection is also through sexual contacts.

22. Prevention • Treatment is not always successful and depends on the virus 'geno type' or 'strain' but across the board 60% of patients will be cured when pegylated Inter Form is available. • One of the symptoms of Hepatitis-C is debilitating tiredness which can lead to it being mistakenly diagnosed as chronic fatigue synodrome. • 14.3. TETANUS • It is world-wide in occurrence. Tetanus is an important endemic infection in India. The natural habit of the organism is soil and dust. The risk of acquiring the disease is pretty high between 5 to 40 years of age. Tetanus occuring in the new born baby is known as "Neonatal Tetanus". Infants typically contact the disease at birth, when delivered in nonaspetic conditions - especially when the umbilical cord is cut with unclean instruments. Females are more exposed to the risk of tetanus especially during delivery or abortion. Its occurrence depends upon man's physical and ecological surroundings - the soil, agriculture, animal husbandry. The environmental factors such as unhygienic customs and habits e.g. application of dust or animal dung to wounds, ignorance of infection and lack of primary health care services. • The incubation period is usually 6 to 10 days. It may be as short as one day or as long as several months.

23. MODE OF TRANSMISSION • One gets infected through contamination of wounds with tetanus sores. The degree of accidents and injuries which may also lead to tetanus comprise a trivial pin prick, skin abrasion, puncture wounds, burns, human bites, animal bites, and stings, unsterile surgery,intra­uterine death, bowel surgery, dental extractions, injections, unsterile divison of umbilical cord, compound fracture,otitismelia, chronic skin ulcers, eye infections, gangrenous limbs. • PREVENTION • Prevention of tetanus can be done with the following: - • Active Immunization: Tetanus can be prevented by active immunization with tetanus toxoid. Tetanus toxoid stimulates the production of the protective nutitoxin. Every individual in the community should be vaccinated regardless of age. Active immunization is done through combined vaccine (DPT) and monovalent vaccines. • It is also recommended for all expectant mothers who were not satisfactory immunized earlier. Complete course of immunization lasts for atleast five years. Neonatal tetanus can be prevented by immunizing mothers during pregnancy. No pregnant mother should be denied even one dose of tetanus toxoid, if she is seen late. • All wounds must be thoroughly cleaned after injury - removal of foreign bodies, soil, dust, necrotic tissue. Tetanus may occasionally occur in spite of active or passive immunization or both. Passive Immunization: Protection against tetanus can be achieved temporarily by an injection of human tetanus hyperimmune globulin (TIG) or ATS. It gives a longer passive protection upto 30 days or more compared with 7-10 days of horse ATS. • Active and Passive Immunization: Active and passive immunization can be given simultaneously in non-immune persons.

24. Antibiotics: Active immunization with tetanus toxoid is the best method of tetanus prevention but it is of no immediate use to a person who is non-immune and has sustained injury. For these reasons, antibiotics are provided in the prophylaxis against tetanus. • Antibiotics alone is effective in the prevention of tetanus; it is not a substitute to immunization.

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