Communicable Diseases

Question 1

6 functions of public health

Answer 1

health protection
health surveillance
disease and injury prevention
population health assessment
health promotion
emergency preparedness and response

Question 2

endemic

Answer 2

the steady presence of a disease in a defined geographic area or population

Question 3

outbreak/epidemic

Answer 3

when the new cases of a disease exceed the normal occurrence during a given period of time

Question 4

pandemic

Answer 4

when a disease spread affects a large number of populations worldwide

Question 5

purpose of immune systems

Answer 5

respond to foreign proteins (antigens) in the body with the intention to resist infection

Question 6

how we acquire immunity

Answer 6

active = host produces antibodies in response to an antigen
passive = host receives antibodies produced by another source
both have natural and artificial

Question 7

benefits of vaccination

Answer 7

considered the most significant achievement in preventative medicine in north america
incidence of new cases of select diseases drop by 100%
prevention of morbidity and mortality in those vaccinated and those around them (herd immunity)
benefit to health and savings in direct health care costs

Question 8

bacterial diseases that are vaccine preventable

Answer 8

streptococcus pneumoniae
diphtheria (corynebacterium diptheriae)
tetanus (clostridium tetani)
pertussis (bordetella pertussis)
neisseria meningities

Question 9

viral diseases that are vaccine preventable

Answer 9

influenza (influenza A and B)
hepatitis B
measles, mumps, rubella, varicella
HPV

Question 10

influenza

Answer 10

RNA virus
types A B and C
typing is based on types of surface proteins
A has subtypes B and C do not
A and B viruses cause seasonal epidemics while type C causes mild respiratory illness
A and B strains are included in each years influenza vaccine

Question 11

transmission and symptoms of influenza

Answer 11

transmission = via droplets or contact with respiratory secretions of infected individuals
symptoms = fever, respiratory illness (cough, sore throat, nasal congestion), headache, myalgia (muscle pain), malaise (body weakness)
rare symptoms = encephalopathy (brain disease), acute respiratory distress syndrome

Question 12

influenza incubation

Answer 12

incubation = 1 day before symptoms develop and 5 days after becoming ill
period person is contagious (communicability) = depends on age and health of person, influenza can spread from individuals with no symptoms

Question 13

complications of influenza

Answer 13

pneumonia (bacterial and viral)
ear and sinus infections
dehydration
worsening of chronic health conditions such as congestive heart failure, asthma, or diabetes

Question 14

groups at high risk of complications

Answer 14

adults older than 65 and those living in long term care facilities
children under 2 (all children under 5)
persons with chronic illness
immunosuppressed individuals
women who are pregnant or postpartum (within 2 weeks after delivery)
indigenous populations
obese individuals

Question 15

impact of influenza

Answer 15

causes about 12,000 hospitalizations and 4,000 deaths in canada each year
in 2015-2016 there were 61 deaths from influenza, 1655 hospitalizations, and 263 people admitted to ICUs

Question 16

influenza vaccine development

Answer 16

each february WHO provides a recommendation on the strains to be included in the vaccine for the northern hemisphere
two A viruses and one B virus are selected based on the characteristics of the current circulating influenza virus strains
a new vaccine is reformulated each year to protect against new influenza infections

Question 17

FluWatch program objectives

Answer 17

detect flu outbreaks as early as possible
provide timely up to date information on flu activity in canada and abroad to health professionals
monitor circulating strains of the flu virus and assess their sensitivity to antiviral medications
provide information that WHO can use to make its recommendations on the best vaccine for seasonal flu shots

Question 18

who is eligable for flu shots

Answer 18

all people 6 months of age or older who live, work, or go to school in alberta are eligible for a flu vaccine at no charge

Question 19

population health approach

Answer 19

measure and analyze health status and SEDoH
review evidence
multiple strategies
intersectoral collaboration
upstream
accountable for outcomes
public involvement

Question 20

socio-ecological determinants of health

Answer 20

income and social status
social support networks
social environments
education
work and working conditions
physical environments
biology and genetic endowment
personal health practices and coping skills
healthy childhood development
health services
culture 
gender

Question 21

pneumococcal disease

Answer 21

infectious agent = streptococcus pneumoniae
acute and serious illness caused by the bacterium streptococcus pneumoniae
92 serotypes recognized worldwide, 15 of which cause the majority of disease

Question 22

severity of streptococcus pneumoniae

Answer 22

pneumococcal pneumonia is the most common community-acquired bacterial pneumonia
estimated to affect approximately 100 of every 100,000 adults each year
complications = bacteremia, meningitis

Question 23

vaccination for pneumococcal

Answer 23

infants and children pneumococcal vaccination at 2, 4, and 12 months of age
high risk groups get an additional dose at 6 months
adults = 65 years and older, high risk related to living situations or chronic illness, some high risk groups receive a booster

Question 24

diphtheria

Answer 24

infectious agent = corynebacterium diptheriae

caused by release of diphtheria toxin by strains of corynebacterium diptheriae

Question 25

mode of transmission for diphtheria

Answer 25

respiratory droplets direct contact with exudate of respiratory secretions of infected people and exudate from skin lesions most respiratory infections occur in dry cold months and are associated with crowded conditions

Question 26

severity of diphtheria toxin

Answer 26

``` complications = if left untreated leads to multi-organ toxicity heart damage (myocarditis) nerve damage (neurotoxin) renal failure (kidney damage) fatality rate 5-10% ```

Question 27

epidemiological history of diphtheria

Answer 27

in 1924 = 9000 cases reported in canada and was one of the most common causes of death in children aged 1-5 routine immunization initiated in 1930 by 1950 = substantial decrease in cases seen in alberta from 1981-2003 there were 5 cases reported

Question 28

tetanus mode of transmission

Answer 28

disease caused by release of the tetanus toxin (tetanospasmin) by the bacterium C. tetani organism is found commonly in soil and environment infection usually starts in a wound by organism in an anaerobic environment (leading to spore germination, growth and subsequent toxin production)

Question 29

clinical presentation of tetanus

Answer 29

prevents release of inhibitory neurotransmitters leading to sustained contractions and various muscle groups, lock jaw can affect both peripheral and autonomic nervous system

Question 30

severity of tetanus

Answer 30

cases often require extensive ICU care | death usually from respiratory arrest or cardiac arrest (dysrhythmias)

Question 31

epidemiological history of tetanus

Answer 31

1920-1930 = 40-50 deaths/year in canada toxoid vaccine introduced in 1940 between 2000 and 2013 in canada a total of 42 cases were reported (over 60 years of age accounted for 55% of the cases) between 1983-2003 in alberta a total of 10 cases (recent cases in males over 50 who lived in rural areas)

Question 32

epidemiology of tetanus

Answer 32

outside of the developed world it continues to be an epidemic especially after natural disasters over 10,000 cases/year worldwide by 2000, 135 countries had eliminated neonatal tetanus and annual deaths fell 75% from about 790,000 newborns a year to around 200,000 per year generally due to the practice of putting earth/dung on the umbilical area for healing

Question 33

vaccination for tetanus

Answer 33

boosters are required every 10 years

Question 34

pertussis transmission

Answer 34

infectious agent = bacterium called bordetella pertussis spread through droplets in the air from an infected persons cough or sneeze can also be spread through coming into contact with discharges from an infected persons nose or throat

Question 35

stages of pertussis

Answer 35

catarrhal stage = lasts 7-10 days, discharge from nose, tearing, low grade fever, sneezing, cough, clinically indistinguishable from a viral upper respiratory tract infection paroxsymal stage = 1-6-10 weeks, proxysms (bursts) of coughing fits followed by a long inspiratory "whoop" after 2-3 months the paroxysmal stage is followed by the convalescent phase = paroxysms decrease and cough gradually improves

Question 36

severity of pertussis

Answer 36

serious complications most often in infants pneumonia, lumbar strain, rib fractures, collapsed lung, subdural hematoma, seizures, ecephalopathy (hypoxia) babies younger than 1 = 1 out of 4 get pneumonia, 1 out of 100 will have convulsions, 3 out of 5 will have apnea, 1 out of 300 will develop encephalopathy (disease of the brain), 1 out of 100 die

Question 37

incubation and communicability

Answer 37

symptoms appear between 7 to 10 days after exposure but could be delayed up to 20 most contagious during the first two weeks when symptoms resemble those of a common cold contagiousness declines rapidly after that but may last up to three weeks people are no longer contagious after five days of treatment with appropriate antibiotics

Question 38

reasons for increasing incidence of pertussis

Answer 38

waning vaccine induced immunity of adults and adolescents increased circulation of B. pertussis decreased use of pertussis vaccine heightened awareness of pertussis amongst healthcare providers increased use of more accurate testing increased public health reporting

Question 39

neisseria meningitis

Answer 39

gram negative bacteria that colonizes in the oropharynx

Question 40

transmission of neisseria meningitis

Answer 40

usually via direct contact with nasal secretions can be transmitted via aerosols/respiratory droplets from colonized individuals period of communicability in those with invasive disease usually lasts until 24 hours after institution of appropriate antibiotic therapy

Question 41

severity of neiserria meningitis

Answer 41

``` complications = meningococcal meningitis sepsis pneumonia conjunctivitis pericarditis ```

Question 42

epidemiological trends for neisseria meningitidis

Answer 42

believed that 5-10% of the adult population carries neisseria meningitidis in their throat at any given time since 1950 the incidence has remained at less than 2.1 per 100,000 in canada less than 1 per 100,000 the epidemiology changes overtime with regards to serotypes causing disease

Question 43

measles in 2013-2014

Answer 43

from 2000-2013 in the calgary zone had 20 cases spread out over that period as of july 2013 nearly 30 cases in 6 provinces (BC, AB, ON, QB, NB, PEI) as of april 2014 there were 22 cases in alberta 2018 there were 27 cases in canada with 6 in alberta

Question 44

why is varicella dangerous

Answer 44

very unpleasant itchy rash which can cause permanent scarring pneumonia and swelling of the brain pregnant women exposed to chicken pox may giver birth to babies with severe deformities

Question 45

modes of transmission for hepatitis B

Answer 45

perinatal = breastfeeding ok as long as neonate receives HBV vaccine and HBlg at birth transfusion sexual transmission nosocomial infection (infected healthcare workers) organ transplant

Question 46

epidemiological trends of HBV

Answer 46

prevalence of HBV carriers in north america is 0.1-2% highest areas of infection are in asia (10-20%) including china, se asia, sub-saharan africa range in world prevalence due to age at infection in asia more people are infected in utero or at an early age

Question 47

ethical principles

Answer 47

respect for autonomy nonmaleficence beneficence distributive justice

Question 48

respect for autonomy

Answer 48

rights of individual to self-determination | this is rooted in societys respect for individuals ability to make informed decisions about personal matters

Question 49

nonmaleficence

Answer 49

first do no harm | it is more important to not harm than to do them good

Question 50

beneficence

Answer 50

actions that promote the well being or best interest of others

Question 51

distributive justice

Answer 51

society has the duty to the individual in need | everyone has the right to receive equitable access to the basic needs of life including healthcare

Question 52

role of public health in communicable disease management

Answer 52

collect, analyze, and communicate cases of a reportable disease support and advice for treating health care providers identification of potential contacts provision of preventative vaccinations outbreak control