COMMUNICABLE DISEASE NURSING

Communicable Disease - Terms

Infectious Agent or its toxic products - AGENT 

Directly or Indirectly - MODE OF TRANSMISSION
Person, Animal or Intermediate Vector – HOST
Environment - ENVIRONMENT

ECOLOGIC TRIAD OF DISEASE

Agent – element, substance, animate or inanimate that may serve as stimulus to initiate a
disease process
Host – organism that provides nourishment for another organism
Environment – physical (climate), biological (plants & animals)

CONTAGIOUS VS. INFECTIOUS

Contagious - Diseases that are easily spread directly transmitted from person to person (direct
contact) through an intermediary host
Infectious - Diseases that caused by a pathogen not transmitted by ordinary contact but require
a direct inoculation through a break in the skin or mucous membrane.
NOTE: ALL CONTAGIOUS DISEASES ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS
CONTAGIOUS

What is Infection?
INFECTION - "the state or condition in which the body or part of the body is invaded by a
pathogenic agent (bacteria, virus, parasites etc.) which under favorable conditions multiplies
and produces effects which are injurious…"

Infectious Agent
A. RESIDENT ORGANISMS
deeply seated in the epidermis, not easily removed by simple handwashing,
Ex: Staphylococci

B. TRANSIENT ORGANISM
represent recent contamination,
survive for a limited period of time, acquired during contact with the infected colonized patient
or environment,
easily removed by good handwashing
Ex: ( Klebsiella & Pseudomonas)

Infectious Agent
Bacteria – heama organism, systemic
Virus – nuero organism, systemic
Fungi – skin organism, local
Protozoa – GI organism, local

FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE

Pathogenicity – ability to cause a disease
Infective dose – no of organism to initiate infection
Virulence – ability to enter or move through tissues
Specificity – ability of the organism to develop antigens

STAGES OF INFECTIOUS PROCESS

Means of Transmission
1. CONTACT - most common means of transmitting microorganisms from one person to
another.
A. Direct Contact (person to person) 
occurs when one person touches another
best vehicle is the Hands especially those of the Health Care workers

B. Indirect Contact (inanimate object)

- occurs when a person touches an inanimate object contaminated by an infected patient

2. AIRBORNE - droplet, dust, organisms in env.

3. VECTOR - insects or animals
4. VEHICLE - food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated
infusion)

PREVENTION OF COMMUNICABLE DISEASE

“Prevention is worth a pound than cure”

Health Education – primary role of the nurse

Specific Protection - handwashing, use of protective devices
Environmental Sanitation – clean and conducive for health

Definition of Prevention
“Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability.
The concept of prevention is best defined in the context of levels, traditionally called primary,
secondary, and tertiary prevention” ---A Dictionary of Epidemiology, Fourth Edition
by John M. Last
Prevention of Needlestick Injuries
Dispose Used Needles in Puncture Proof Needle Containers
Don’t Recap Needles (Unless using the One-handed Technique)
Use Gloves When Handling Needles (Won’t Prevent Injuries but May Lessen Chance of
Transmitting Diseases)

CONTROL OF C0MMUNICABLE DISEASE

1. Notification
2. Epidemiological Investigation
3. Case finding; early dx and prompt treatment
4. Isolation and Quarantine
5. Disinfection; disinfestation
6. Medical Asepsis
a. Handwashing
b. Concurrent disinfection
c. Personal protective equipments (PPEs)
d. Barrier Cards/Placarding
Objectives of CCD
Restoration of health, reduce deaths and disability
Interpretation of control measures to IFC for practice to prevent spread of CD.
Promotion of health and prevention of spread of CD

Diseases that require weekly monitoring:

1. Acute flaccid paralysis (AFP) polio
2. Measles
3. Severe acute diarrhea (SAD)
4. Neonatal tetanus
5. AIDS

Diseases that require reporting w/in 24 hrs

1. Acute flaccid paralysis (AFP) polio
2. Measles

Diseases targeted for eradication

1. Acute flaccid paralysis polio
2. Neonatal tetanus
3. Measles
4. Rabies

Epidemiology - Study of the occurrence and distribution of diseases in the population

Patterns of occurrence of disease –frequency of disease occurrence

Sporadic - On and off occurrence of the disease. Most of the time it is not found in the
community. One or two cases that occur are not related
Endemic - Persistently present in the community all year round
Ex: malaria in Palawan
Epidemic - An unexpected increase in the number of cases of disease
Pandemic - Epidemic of a worldwide proportions

TERMS
Disinfection – pathogens but not spores are destroyed

Disinfectant – substance use on inanimate objects

Concurrent disinfection – ongoing practices in the care of the patient to limit or control the
spread of microorganisms.

Terminal disinfection – practices to remove pathogens from the patient’s environment after his
illness is no longer communicable

FACTORS AFFECTING ISOLATION

Mode of Transmission
Source
Status of the client’s defense mechanism
Ability of client to implement precautions

DISEASES

Tetanus
> Clostridium tetani
> Incubation Period: 5-10 days
> Wound contamination
-soil, dust, feces

S/SX
-Lock jaw
-Fever
-Seizure
-Asphyxia
-Risus sardonicus

Dx: Hx of the wound

Management:
1. CBR, Check Vital Signs, Assist with ADL
2. Tracheostomy – Mechanical ventilator and O2 Tank
3. Safety, Diazepam, Minimize light and sound
4. TATS, Metronidazole
5. Prophylaxis: Wound care – Wash soap and H2o, Betadine , Dressing
6. Vaccination: Toxoid – Adult (pregnant)
DPT – Pedia

Meningitis
> Neisseria meningitides
> Incubation Period: 2-10 days
>Droplet

Meningo – coccemia : prelude to meningitis

-Bacteremia
- Incubation Period: 3-4 days

S/SX
-Fever
-Purple Petechiae
-Increase ICP
-Headache
-Kernig’s Sign
-Brudzinski’s Sign
-Dec. LOC

Dx: Lumbar Tap

Mangement:
1. Hospitalization, Isolation, Droplet Precaution
2. Concurrent Disinfection, Check VS, CBR, Safety
3. Assist with ADL, Check GCS, 7/8 light coma
4. Semi – fowler’s = Dec. ICP, Diazepam
5. Mannitol + Lasix, Steroid
6. Ceftriaxone / Chloramphenicol
7. Prophylaxis: Ciprofloxacin / Rifampicin
-all close contact
8. Neuro Check: FLORA (Focus, Language, Orientation, Recall, Attention)
9. Meningo polysaccharides vaccine
RABIES
> Rhabdovirus
> Incubation Period: 10 days
>Bite of infected mammal
>Dog, cat, bat

S/SX
-Drooling
-Hydrophobia / Aerophobia
-Hypoxia

Dx: FRAT (Fluorescent Rabies Antibody Test); Dog – observe for 10 days; If dog dies, Head is cut,
Brain Biopsy (Negri Bodies)

Management:
1. Hospital, Isolation, Droplet Precaution
2. Concurrent Disinfection, Check Vital Signs, rest, Safety, Assist with ADL
3. Consent – Restraint, IVF – covered with opaque paper
4. Prophylaxis: Wound care
- Rabies Vaccine, Deltoid IM 5x
st
1 – 0 day
2nd – 3rd day
3rd – 7th day
4th – 14th day
5th – 21st or 28th

Prevention: Responsible Pet Ownership

-Hygiene
-Immunization

5. Rabies Ig – on the wound itself (once only)

POLIO
> 1, 2, 3
> Fecal – Oral Route
> Incubation Period: 14 days

S/SX
-Paralysis
-Fever
-Abdominal Pain

DX: Lumbar Tap

Management:
1. Hospital, Check Vital Signs, Rest, Assist with ADL
2. Check Respiratory Status – Intubation, Mechanical Ventilator
3. Enteric Precaution, Hand washing
4. Concurrent Disinfection – stool, provide comfort, ROM
5. Toilet Hygiene
6. Prevention: OPV Vaccine – Most effective
- IPV – 1st (Inactive Polio Vaccine)
- Provides immunity if GIT
- NPO – 30 minutes
- Diarrhea – Contraindicated

DENGUE
> 1, 2, 3, 4
> Incubation Period: 6 – 7 days; 14 days
> Aedes aegypti; day biting; clean water; female

S/SX
-Petechial rashes
-Fever
-Bleeding

Dx: Tourniquet’s Test / Rumpel Leads Test - >20 Petechial rashes

Platelet count – Confirmatory test

Management:
1. Hospital, CBR, Check Vital Signs, Safety
2. Watch out for bleeding, Tepid Sponge Bath, Paracetamol
3. Clear Diet, Oresol, No ASA
4. IVF = LR, Low Platelet = Platelet Concentrate
5. Hemorrhage = Fresh Whole Blood
6. Refuse BT = Consent – Plasma Expanders
Dextran = Gelofusine
7. Prevention
-Skin Repellant : Diethyltoluamide – DEET
-NET – Permethrin
-4 O’ Clock Habit
MALARIA
>Plasmodium Falcifarum – Incubation Period: 12 days – Most Dangerous (Cerebral Infection)
> Plasmodium Vivax / Ovale – Incubation Period: 14 days
> Plasmodium Malariae – Incubation Period: 30 days

> Incubation Period: 12 – 30 days

>Anopheles; Night – biting; female; Dirty water

S/SX
-Anemia
-Hematuria
-Abdominal Pain
-High fever (Diaphoresis and Chilling)
-Cachexia

Dx: Blood Smear

Management:
1. Hospital, Check Vital Signs, Assist with ADL
2. High – Calorie, High – Iron, Hydration, TSB
3. Chloroquine + Primaquine (Drug of Choice + Kills Hepatic parasite)
4. Quinines, Quinidine, Pyremethamin, Doxycycline, Tetracycline
5. Prevention: DEET, NET – Permethrine
6. Pet Prophylaxis – Large Mammals
7. Neem Tree – Menthol Trees
8. Larvivorous Fishes – Tilapia

TUBERCULOSIS
>Mycobacterium tuberculae
> Incubation Period: 4 – 12 weeks
>Airborne / Droplet

S/SX
-Productive Cough
-Caseous necrosis
-Afternoon fever
-Hemoptysis

Dx: Exposure: PPD (Purified Protein Derivatives) Test after 72 hours

Fil: 10mm in diameter AIDS: 5mm in diameter (Induration)
Confirmatory: Sputum Exam
Extent: CXR
Management:
1. Hospital, Check Vital Signs, Isolation – (+)Sputum Exam, Airborne Precaution
2. Rest, TSB, High – calorie, High – protein, Hygiene
3. BCG Vaccine – to prevent TB Meningitis
4. Safety
DOTS:
Pyrazinamide: drug of choice to TB meningitis
Isoniazid: sole prophylaxis, Hepatotoxic, B6 loss – Peripheral neuritis, High – B6 diet = banana
Rifampicin: Nephrotoxic, orange urine, check intake / output, High fluid intake
Ethambutol: Optic Neuritis = Blindness, Red Green, Contraindicated - <6yo
Streptomycin: Ototoxic, CN8 – Acoustic Nerve = Hearing Loss, Balance Problem

PNEUMONIA
>Streptococcus pneumonia
> Incubation Period: 24 – 72hours
>Droplet

S/SX
-Fever
-Productive cough
-Rusty Sputum
-Difficulty to awake
-Inability to feed/drink
-Chest indrawing

Dx: Hospital: CXR, Sputum Exam

CHN: IMCI

Management
1. Hospital, High – fowler’s, Oxygen Therapy, Check Vital Signs
2. Isolation, Droplet Precaution, Rest, Assist with ADL
3. Oxygen Therapy, Nebulizer, CPT – Suctioning (before)
4. Hospital: Penicillin
<1 month = 200,000U; >1month = 400,000U; >12months = 800,000U
5. CHN: Cotrimoxazole – 5x/day
6. Prevention: Ventilation, Stop Smoking, Measles 10P : 1 measles

DIPTHERIA
>Corneybacterium diptheriae
> Incubation Period: 14days – Droplet
S/SX
-Fever
-Pseudomembrane
-Asphyxia

PERTUSSIS
>Bordetella pertusis
> Incubation Period: 21 days, Droplet

S/SX
-Violent cough without intervening inhalation followed by an inspiratory whoop
-Vomiting

DX: Throat Swab

Management:
1. Hospital, Isolation, Droplte Precaution
2. Concurrent Disinfection – soiled articles, Check Vital Signs, Rest
3. Assist with ADL, Erythromycin / Penicillin
4. Diptheria – DATS, Oral Gargle, Intubation
5. Pertussis – Nebulization, CPT, Suctioning
-Umbilical binder, Small frequent meals
-SAP, High – fowler’s
6. Prevention: DPT Vaccine

INFLUENZA
>1, 2, 3
>Droplet Precaution
> Incubation Period: 24 – 72 hours

S/SX
-Fever
-Malaise
-Cough
-Sneezing

Dx: Nasopharyngeal Swab

Management:
1. Home, Isolation
2. Droplet Precaution
3. Rest, Check Vital Signs
4. Assist with ADL
5. No Aspirin
6. Paracetamol + TSB
7. Oseltamivir
8. Annual Vaccine

DIARRHEAL DISEASE
>Fecal – oral route
>Stool Exam

S/SX
-Dehydration (Thirst)
-Hypokalemia
-Weakness
-Arrhythmias

Management:
1. Handwashing
2. Enteric Precaution, Toilet Hygeine
3. Proper Food Preparation
4. Boiling: 15 – 20 minutes
5. ORT: Oresol
HMO: 1tsp Salt + 8tsp Sugar + 1L Water
Gatorade, Pedialyte, Coconut Water
6. Severe dehydration = IVF = LR
7. BAG = High in potassium (Banana, Apple, Guava)

CHOLERA
>Vibrio cholera
> Incubation Period: 1 – 5 days
>Rice – watery stool
>Tetracycline
>Brining of shellfish

TYPHOID FEVER
>Salmonella typhi
>2 – 3 weeks
>Rose spots
>Chloramphenicol
>Protein – rich foods

AMOEBIASIS
>Entamoeba histolytica
> Incubation Period: 2 weeks
>Explosive, mucoid, foul smelling stool
>Metronidazole
>Water contaminant
>Resistant to chlorox
>Susceptible to Iodine

GONORRHEA
>Neisseria gonorrhea
> Incubation Period: 2 – 5 days
>DSI
>Burning sensation during urination

Dx: Male – Urethral Smear

Female – Pap smear

Management:
>Ceftriaxone , Augmentin

5 Golden Rules
1. Stop Promiscuity
2. Monogamy
3. Abstinence
4. Secrecy
5. Cross testing of partners

SYPHILIS
>Treponema pallidun
> Incubation Period: 3 – 6 weeks
>DSI

3 Stages
Primary – Painless Chancre (sore)
Secondary – Systemic psoriasis like rash
Tertiary – Stroke

Dx: Fluorescent Treponemal Antigen Test

Management:
>Penicillin
>Doxycycline
>5 Golden Rules
AIDS
>retrovirus
>DSI
>Blood bourne
> Incubation Period: 6 – 10 months

S/SX
-Chronic Diarrhea
-Dementia

Dx: ELISA, Western – Blot

Management:
1. Humor Therapy
2. Well – balance diet, Stress Management
3. Avoid Infection
4. Zidovudine, Efavirenz, Ritonavir
5. Prevention: 5 Golden Rule

HEPATITIS

A – Virus
> Incubation Period: 14 – 30 days
>Fecal – Oral route
>Infectiuos hepatitis

Control:
-Enteric Precaution
-Handwashing
-A vaccine / Ig

B –Virus
> Incubation Period: 30 – 50 days
>Blood bourne; DSI
>Serum hepatitis

Control:
-Standard Precaution
-B Vaccine / Ig

C – Virus
> Incubation Period: 50 – 90 days
>Blood Bourne; DSI
>Post – transfusion hepatitis

Control:
-Standard Precaution
-Lamivudine
-Interferon A

S/SX
-Fever
-RUQ Pain
-Nausea / Vomiting
-Jaundice
-Weakness
-Ascites

Dx: Hepatitis Surface Antigen Test

Mangement:
1. Rest, Assist with ADL, Check Vital Signs
2. Small frequent meals, Essentiale
3. Specific Management
4. High – Protein, High – Calorie
5. Cirrhosis – Low – protein, Lactulose
6. Ascites – Sleep (Side-lying)
Awake – Semi – fowler’s
Paracentesis
 Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs,
caused by one of several swine influenza A viruses.
 Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes
are also circulating in pigs (e.g., H1N2, H3N1, H3N2)
 The H3N2 swine virus was thought to have been originally introduced into pigs by
humans.
 Sometimes pigs can be infected with more than one virus type at a time, which can
allow the genes from these viruses to mix. This can result in an influenza virus containing
genes from a number of sources, called a “reassortant” virus.
 Although swine influenza viruses are normally species specific and only infect pigs, they
do sometimes cross the species barrier to cause disease in humans.
 The 2009 Swine flu outbreak in humans is due to a new strain of influenza A virus
subtype H1N1 that derives in part from human influenza, avian influenza, and two separate
strains of swine influenza.
Modes of Transmission:
 Most infections occur among people with direct pig contact.
 Sometimes a flu virus can mutate to be more transmissible to humans.
 People who work with swine, especially people with intense exposures, are at risk of
catching swine influenza if the swine carry a strain able to infect humans.
 Swine flu cannot be spread by pork products, since the virus is not transmitted through
food
Period of Communicability:
 The swine flu in humans is most contagious during the first five days of the illness
although some people, most commonly children, can remain contagious for up to ten days.
Signs and Symptoms:
The signs and symptoms of swine flu are similar to
those of influenza and of influenza-like illness in
general:
1. chills
2. fever
3. sore throat
4. muscle pains
5. severe headache
6. coughing
7. weakness
8. general discomfort
Diagnostic Procedures:
 To diagnose swine influenza A infection, a
respiratory specimen would generally need to be collected within the first 4 to 5 days of
illness (when an infected person is most likely to be shedding virus).
 However, some persons, especially children, may shed virus for 10 days or longer.
 Identification as a swine flu influenza A virus requires sending the specimen to CDC for
laboratory testing.
Vaccines and Treatment:
 Officials do not know if the seasonal flu vaccine will protect against the A(H1N1) swine
flu virus.
 In the laboratory, the antiviral drugs Tamiflu and Relenza are effective against this new
flu; amantadine and rimantadine are not.
Safety precautions:
1. Cover your nose and mouth with a tissue when coughing or sneezing.
2. Wash hands regularly with soap and water, especially after you cough or sneeze. 
Alcohol-based hand cleaners are also effective.
3. Avoid close contact with sick people.
4. If sick, self-monitor and stay home from work or school and limit contact with others.
5. Consult your doctor immediately should signs and symptoms of flu persist.

Definition:
 Bird flu or Avian Influenza (A1) is a contagious disease of bird raging from mild to serve
form of illness.
 Some forms of bird flu infections can cause illness to humans.
 Bird flu is caused by an influenza A virus.
 The outbreaks affecting some Asian countries have been caused by influenza A/H5N1
virus. It can also cause severe infection in humans.
History:
 First identified in Italy in 1878, highly pathogenic avian influenza is characterized by
sudden onset of severe disease, rapid contagion, and a mortality rate that can approach
100% within 48 hours.
 Human deaths from avian influenza were unknown until 1997, when six people in Hong
Kongdied from the particularly virulent H5N1 strain.
 In January 2004, a new major outbreak of H5N1 avian influenza surfaced again in
Vietnam and Thailand’s poultry industry, and within weeks, spread to ten countries and
religions in Asia including Indonesia, South Korea, Japan, and China.
 In February 2004, avian influenza virus was detected in pigs in Vietnam, increasing fears
of the emergence of new variant strains.
 Fresh outbreaks in poultry were confirmed in Ayutthaya and Pathumthani provinces of
Thailand, and Chaohu city in Anhui, China, in July 2004.
 In North America, the presence of avian influenza was confirmed at several poultry
farms in British Columbia in February 2004.
 In August 2004 avian flu was confirmed in Kampung Paris, Kelantan, Malaysia. Two
chickens were confirmed to be carrying H5N1.
Etiologic Agent:
 The causative agent is the avian influenza (A1) virus. A1 viruses all belong to the
influenza virus, a genus of the Orthomyxoviridae family and are negative-stranded, and
segmented.
Modes of Transmission:
1. Avian influenza spreads in the air and in manure. Wild fowl often acts as resistant carrier
spreading it to more susceptible domestic stocks.
2. It can also be transmitted through contaminated feeds, water, equipment, and clothing;
however, there is no evidence that the virus can survive in well cooked meat.
3. Cats are also thought to be possible infection vectors for H5N1 strains of avian flu.
4. While avian influenza spreads rapidly among birds, it does not infect humans easily, and
there is no confirmed evidence of human-to-human transmission. Of the 15 subtypes
known, only subtypes H5 and H7 are known to be capable of crossing the species barrier.
Incubation Period:
 The incubation period is three to five days.
Signs and Symptoms:
1. Symptoms in animals vary, but virulent strains can cause death within a few days.
2. The symptoms of avian influenza in humans following exposure to bird flue infected
chicken patient develops:
 fever, body weakness or muscle pain, sore throat, cough, sore eyes, may have
difficulty of breathing in severe cases
Prevention and Treatment:
Avian influenza in humans can be detected reliably with standard influenza tests. Antiviral drugs
are clinically effective in both preventing and treating the disease. Vaccines, however, taken at
least four months to produce and must be prepared for each subtype.
1. Wash hands thoroughly with soap and water before and after handling live and dressed
chicken.
2. Cook chicken thoroughly.
3. Do not sell live chickens and other birds in the market while there is a threat of bird flu.
4. Do not let chickens roam freely. Keep them in cages or pens.
5. Do not place chicken, ducks and pigs together in one area, cage or pen.
6. Do not catch, get near or keep in captivity wild birds.
7. Report to the nearest agricultural/veterinary office any unusual death or illness of
chickens and other birds.
8. Report to the nearest local health centers any case of respiratory illness with history of
exposure to sick or dead chickens and other birds.
9. Individuals at risk are those directly exposed to sick chicken and other birds. The
government thereby advises prospective travelers to countries affected with bird flu not to
go to bird parks, poultry farms and markets where live chicken and other birds are sold.