Health protection Flashcards by Nader Raafat

Information needed to notify communicable disease

Severity: Morbidity, fatality, etc..

Transmissibility: Potential, route, sources, infectiousness

Contacts: Susceptibility/resistance among contacts, number, nature

Control measures: That would prevent transmission, availability/evidence

Special circumstances: e.g. age, pregnancy, occupation that increase risk of case

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Definition of incubation period

Time between inoculation and becoming symptomatic

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Latent period

Time between inoculation and becoming infectious

Caution if latent < incubation –> infective while asymptomatic

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Infectious period

Time during which patient is capable of infecting others

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Pathogenicity definition

Ability of organism to cause disease

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Virulence definition

Severity of illness caused by organism

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Interventions to reduce person-person transmission

Reduce infectiousness: Treatment, hygiene

Limit contact: Quarantine, isolation, advice

Reduce susceptibility of contacts: PPE, PEP, immunisation, Tracing/screening

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Interventions to reduce indirect transmission

Source decontamination

Vector source control

Zoonotic animal cull/movement ban

Source shutdown (restaurant, factory)

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Presentation of CO poisoning

Nausea, vomiting, confusion

Lethargy, flu-like symptoms

Headache, dizziness, syncope

Tachypnoea, metabolic acidosis, respiratory failure

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Normal carboxyhaemoglobin concentration

1-3% in non-smokers

5-10% in smokers

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Information to collect for suspected CO poisoning

New appliances?

CO alarm?

Who else at home? esp. pregnant, extremes of age, heart conditions

Any communal areas they have been in recently?

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Actions to take for CO poisoning

100% O2 until asymptomatic and normal COHb levels

Contact local Health Protection Team

Advise not to use new appliances + contact HSE/Gase Emergency Helpline

F/U at 1-2months

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Rationale for post-exposure chemoprophylaxis in meningococcal disease

Eradication of carriage of invasive meningococcal strain

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At-risk period for secondary cases of meningococcal disease

7 days is highest risk period

Chemoprophylaxis should be given within 24h

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Definition of close contact for antibiotic prophylaxis in meningococcal disease

Prolonged contact during preceiding 7d

Boy/girlfriend

Household contacts, shared dormitory, shared kitchen

Contact with large-droplet respiratory secretions within 24h (incl healthcare workers)

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Vaccination guidance after meningococcal case

Close contacts: Vaccination unless serogroup-immunised within preceding 12mo OR MenB case

Give full recommended vaccination to case if not already immunised (don’t re-immunise)

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Meningococcal cases requiring public health action

Clinical: Septicaemia, mengingitis, other invasive disease

AND

Lab: G-ve diplococci OR N. meningiditis organisms or DNA from sterile site

evidence of bacterial infection and N. meningiditis likely source (PH/microbiologist advice)

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Timings for measles symptoms

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7-21d (typically 10-12d) incubation period

2-4d prodromal phase: fever, cough, conjunctivitis

7d maculopapular, nonitchy rash

Infectious period for measles

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4d before and after rash onset

Extremely infectious (respiratory droplets)

Ideal samples for measles testing

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Oral fluid is ideal sample

Mouth viral swab if not possible

Serum IgM/IgG to assess contact immunisations status

Factors increasing risk/likelihood of measles

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Recent international mass gathering

Epi link to confirmed measles case or visit to area with known circulation

Not fully immunised

Local community with low vaccination rate

Adolescents/young adults (fewer similar disease presentations)

Individual info to be collected for notifying measles

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Travel Hx - incl. GP/A&E visits

Vaccination Hx

Epi link to outbreaks

Ethnic/cultural background (Esp if low vacc community)

Signs, symptoms, lab results

Which contacts should be traced following measles case?

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Household contacts

>15min in closed, confined space (e.g. classroom)

Face-to-face contact of any length

Priority groups for measles contact tracing?

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Immunocompromised
Pregnant or infant <12mo
Healthcare workers
Healthy contacts

Post-exposure treatment for measles contacts

MMR vaccination and serum IgG testing Consider IgG for immunocompromised individuals

Presentation of O157 E. Coli

Mild non-bloody diarrhoea Bloody diarrhoea HUS (ESP \<5YO)

Incubation period for O157 E. Coli

3-4 days

Sources of O157 E. Coli

Faeco-oral transmission from infected animal excreta: * **Water:** drinking/vegetables * **Meat:** during slaughter, if not properly cooked; contact with other raw meat * **Direct:** E.g. farms, petting zoos * **Human-human:** esp in nurseries, primary schools due to prolonged contact, immature immune systems, poor personal hygiene

Indications for faecal culture in acute diarrhoea (bloody or non-bloody)

1. Vulnerable: \<16y, \>60y, pregnant, frail, immunocomp 2. Recent travel abroad 3. Bio plausible contact to O157/ part of outbreak 4. Severe/protracted illness

What to avoid in O157 management

Antibiotics - higher risk of HUS Anti-motility, opioids, NSAIDs

Active vs passive surveillance

**Passive:** Relies on routine data collection, cheap but incomplete coverage **Active:** Surveillance team reaches out to labs/clinicians/patients to collect data e.g. during outbreaks

Sentinel surveillance

Centres with high probability of seeing cases identify and notify the disease as routine to pick up trends

Enhanced surveillance

Collection of additional info if disease suspected (e.g. TB routine info not enough)

Definition of epidemic

Occurence of illness/health-behaviour in a population in excess of normal expectancy Interchangeable with outbreak Pandemic = global epidemic

Case fatality definition

Proportion of cases that are fatal within a given time period

Definition of cluster

Cases in a similar time/place where an epidemiological link is possible but unconfirmed

Basic reproduction number

Average number of secondary cases from a single index case in a totally susceptible population **Affected by:** Rate of contact, probability of transmission, duration of infectious period

Effective reproduction number (R)

Average number of 2ry cases in a population with a mixture of susceptible/unsusceptible individuals R= R0x where x is the fraction of the population that is susceptible

Herd immunity threshold

Proportion of population that needs to beimmunised to make disease stable in population (i.e. R=1) 1- 1/R0

Attack rate

Number of new cases/population at risk within specified time

Secondary attack rate

Number of cases among contacts/Number of contacts Within one incubation period

Point source epidemic curve

All cases appear within one incubation period e.g. food poisoning at wedding

Continuous source epidemic curve

Abrupt start within one incubation period Continuous source = prolonged, high level of cases

Propagated epidemic curve

Waves occuring within average incubation period - increasing until susceptible population falls or intervention measures succeed

Health protection Flashcards

(44 cards)