10 Communicable Disease Control Program

I. Tuberculosis  reportable communicable dse. w/c 4. exposure if bacilli to sun or

is characterized by pulmonary manifestations UV light
A. Causes 5. aerolization
1. mycobacterium H. Susceptibility & Resistance
tuberculosis (gram + , acid-fast bacillus) 1. most hazardous period 6 –
2. mycobacterium 12 mos. After infection
africanum 2. high risk
3. mycobacterium bovis  a. 3 yrs. & below
from cattle  Lower in later childhood
B. Pathophysiology b. adolescents,
C. Signs & Symptoms young adults & the elderly
1. Cough for 2 weeks or more, usually with c. Immunosupress
expectoration ion
2. Night sweating d. Under nutrition
3. Loss of appetite e. Under weight
4. Weight loss  due to hypoxia f. DM
5. Fever, on & off especially in the g. Substance
afternoon abusers
6. Chest and/or back pain
7. Hemoptysis or blood streak sputum I. Methods of Control
♣ Preventive Measures
D. Diagnostics 1. BCG vaccination of newborn,
1. tuberculin test / Mantoux test  purified infants and grade I/school entrants.
2. Educate the public about the
protein derivative test
mode of spread, methods of control and
2. chest x-ray  presence of calcified lesions importance of early diagnosis.
or tubercle 3. Improve social conditions, such
 done if sputum is negative as overcrowding.
 When a person has TB, his/her X-ray 4. Make available medical,
results will show spots on his/her lungs. laboratory and x-ray facilities for
These spots will remain in the lungs as examination of patients, contacts and
scars even when the person is already suspects
cured of TB. 5. Provide public health nursing
 The X-ray result will also show if the and outreach services for home
bacteria is active or inactive. supervision of patients
3. sputum exam  acid-fast bacilli in sputum
 if (+), 100% contagious J. National Tuberculosis Control Program
♣ VISION:A country where TB is no
longer a health problem
E. Mode of transmission ♣ MISSION: Ensure that TB DOTS
1. Airborne droplets services are available, accessible, and
2. Direct invasion through mucous affordable to the communities in
membranes, which is extremely rare collaboration with LGUs and other partners
3. Bovine tuberculosis  ingestion of ♣ GOAL: To reduce the prevalence
unpasteurized milk or dairy products
and mortality from TB by half by the year
4. EP tuberculosis  NOT communicable 2015
except laryngeal TB ♣ TARGETS:
1. Cure at least 85% of the sputum
F. Incubation period  2 – 10 weeks smear positive TB patient discovered
2. Detect at least 70% of the
G. Period of TB Communicability As long as estimated new sputum smear positive
tubercle bacilli are being discharged in the cases
sputum
♣ Degree of Communicability depends on: ♣ National TB Program (NTP)
1. number of bacilli Objectives
2. virulence of bacteria 1. OBJECTIVE A  improve access to
3. adequacy of ventilation and quality of services provided to TB
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patients, TB symptomatics, and Anti-TB DRUGS

communities by health care institutions (old) (new) Side effects
and providers. Rifampicin R R Hepatotoxic &
orange urine
2. OBJECTIVE BEnhance health- Isoniazid I H Peripheral neuritis
seeking behavior on TB by (↓ Vit. B6 /
communities, especially the TB pyridoxine)
symptomatics. Pyrazinamide P Z ↑ uric acid
Ethambutol E E Visual
3. OBJECTIVE C Increase and sustain disturbances
support and financing for TB control Streptomycin S S ototoxicity
activities.
4. OBJECTIVE DStrengthen the IP MP
management of TB control services at Regimen 1 RIPE RI
 (+) sputum
(2 mos) (4 mos)
all levels. exam  1st
time
♣ Key Policies  (-) sputum &
1. Case Finding  DSSM x-ray
FA/MA
a. Direct sputum smear  EP TB
microscopy (DSSM)  primary  TB w/ HIV
diagnostic tool Regimen 2  Relapse RIPES RIE
Failure (2 mos) (5 mos)
b. All TB symptomatics  must 
 Can’t be
undergo DSSM classified as another
c. 3 (-) DSSM PTB symptomatics regimen 1 or
2 RIPE (1 mo.)
 other diagnostics (x-ray & PPD)
Regimen 3  (-) sputum RIPE RI
d. NO Tb diagnosis must be made exam (8 wks) (16 wks)
from x-ray alone & same w/ PPD  PTB minimal
e. Only trained medical (x-ray)
technologists are allowed to do Regimen 4  Chronic (still  Refer to specialized facility
DSSM smear + after or DOTS Plus Center
supervised  Refer to Provincial/ City
2. Treatment must be based on DSSM re-treatment) NTP coordinator
a. Multi drug therapy
b. Domiciliary tx  combined  Streptomycin  56 vials for 2 mos (Regimen II)
drugs  Dosage
3. Patients requiring hospitalization Anti-TB drugs Intensive Phase Maintenance
a. Massive hemoptysis Phase
b. Pleural effusion (more than ½ of Rifampicin 1 tab/ day 1 tab/ day
lung field) Isoniazid
c. Miliary TB Pyrazinamide 2 tab/ day
d. TB meningitis Ethambutol 2 tab/ day
e. TB pneumonia Streptomycin 1 vial/ day (2
f. Those requiring surgical mos)
intervention/ with complications

4. All patients on treatment shall be

supervised (DOT)
2. Fixed Dose Formulation
5. National and Local Government Units (FDC)  Domiciliary
IP MP
shall ensure provision of drugs to all Regimen 1 FDC –A FDC –B
smear positive cases  (+) sputum
(2 mos.) (4 mos)
a. Fixed dose combination exam  1st
time
b. Single drug formulation
6. Quality of FDCs must be ensured.  (-) sputum &
x-ray
7. Treatment shall based on recommended
FA/MA
category of treatment regimen.  EP TB
♣ Treatment  TB w/ HIV
1. Multi Drug Therapy single Regimen 2  Relapse FDC –A + FDC –B +
 Failure streptomycin ethambutol
drug formulation (2 mos.) (5 mos)
 Can’t be
classified as another

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regimen 1 or 3. Supervise Rural Health

2 FDC –A (1 midwives (RHMs) to ensure DOTS
mo.)
Regimen 3  (-) sputum FDC –A FDC –B implementation
exam (2 mos.) (4 mos) 4. Maintain & update TB register
 PTB minimal 5. requisition & distribution of
(x-ray) drugs & NTP supplies
Regimen 4  Chronic (still  Refer to specialized facility 6. Continuous health education to
smear + after or DOTS Plus Center
supervised  Refer to Provincial/ City
all TB patients
re-treatment) NTP coordinator 7. Conduct training to all health
workers
8. Prepare, analyze & submit quarterly
 Dosage of FDC reports to PHO (provincial health office) or City
a. FDC A  RIPE (HRZE) health office
b. FDC B  RI (HR)
L. Management of Children w/ TB
 No. of tablets for all regimens
Body wt (kg) Intensive Phase Maintenance Phase 1. Prevention  BCG must be
given to all infants
FDC A S FDC B E
a. 50% efficacy  against
30 – 37 2 0.75 2 1 any TB dse.
38 – 54 3 g 3 1
b. 64% against TB
55 - 70 4 4 3
meningitis
> 70 5 5
c. 71%  deaths from TB
2. Case finding
For Category III:
∞ A TB patient who has been a. cases of TB in
taking medications for 2 weeks or more is not children are reported
communicable. 1) Patie
∞ How to know if the patient is
nt sought for consultation  (+) w/
cured? Sputum exam every 2 months. The patient is
cured if in a span of 6 months (intensive + maintenance screening or signs & symptoms
phase), he has 2 successive (–) sputum results. 2) Expo
∞ Pag (+), (+), (–), extend the sed to adult TB
treatment for 2 months para mag-(–). b. ALL TB symptomatic
∞ Pag (+), (+), (–), (+), Category II
na yun patient, considered a failure case (“defaulter”). children 0 -9 yrs. Old  except (+)
sputum must have tuberculin testing
* RA 1136 – creation of the division of TB in the DOH 1) PHN or trained
widwife  reads the result of
K. DIRECT OBSERVED TREATMENT SHORT tuberculin test
COURSE (DOTS) Comprehensive strategy 2) Tuberculin
which is being used by primary health services testing once a week (mon or tues)
around the world to detect and cure TB patients  10 children should be gathered
♣ 5 ELEMENTS: c. TB symptomatic if:
1. Political will in terms of funds 1) More than 2 weeks cough/
and manpower wheezing
2. Sputum microscopy service 2) More than 2 weeks unexplained
3. Regular drug supply fever
4. Recording books to monitor 3) Loss of weight, appetite
patient progress until cured 4) not responding to antibiotics for
5. Drug intake supervised by Acute URTI
health worker or family member d. Clinically diagnosed
child (if has any 3 of the ff: )
♣ PHN Responsibilities (Adult TB) 1) (+) adult TB
1. Manage procedures for case exposure
findings 2) (+) s/ sx of TB
2. assign & supervise a treatment 3) (+) Tuberculin
partner for patients undergoing DOTS test
4) Abnormal chest
x-ray

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5) (+) Smear/ RIPE RI

Or (10 mos)
culture  definitive for children RIPS
(2mos)

e. Children exposed to
 Dose:
TB  must undergo a) R & I  10 – 15mg/ kg
TB exposure Productive cough
b) P  20 – 30 mg/kg
c) E  15 – 25mg/kg
d) S  20 – 30mg /kg
Physical exam & Sputum exam
tuberculin test II. Leprosy Control ProgramChronic mildly
communicable disease affecting skin, peripheral
(-) sputum + sputum nerves, eyes, and mucosa of upper RT

(-) tuberculin NO tuberculin test • RA 4073 – Liberalization of the treatment of leprosy

(home treatment)
Chest x-ray
A. Etiologic Agent Mycobacterium leprae
f. Signs/ Symptoms of B. Susceptibility  12 and below more
TB (children) susceptible
C. Incubation Period 5 ½ months-8 years
(+) symptoms of TB
D. Mode of transmission
1.Airborne- droplet
Tuberculin test 2.Prolonged skin to skin contact

E. Diagnosis
(-) tuberculin w/ (+) Tuberculin, 1. Symptoms and signs
contact unknown contact 2. history of contact
3. Slit skin smear Ziehl Nielsen
Staining Method
x-ray
F. Types
# lesions Infectious Treatment Duration
Single lesion 1 No  Rifampicin
(-) x-ray (+) x-ray  Ofloxacin
 Minocycline
Paucibacillary 5 or less No • Rifampicin 6 – 9
(tuberculoid, • Dapsone mos.
Repeat tuberculin Chemoprophylaxis treatment
indeterminate)
after 3 mos. (3mos)  5 yrs and Multibacillary 6 & Yes  Rifampicin 24 – 30
below (lepromatous, above mos.
 Dapsone
borderline)  Clofazimine
3. caseholding & treatment (lamprene)
a. case holding DOTS
treatment observed
G. Signs and Symptoms
b. Treatment
1) Pulmonary TB Early Late
IP MP   Loss of eyebrows (madarosis)
RIP RI Change in skin color (reddish or
(2mos) (4 mos) white)
 Inability to close eyelids
 Dose:
 (lagopthalmos)
Absence of sensation on the skin
a) R & I  10 – 15mg/ kg lesion
b) P  20 – 30 mg/kg  Clawing
2) EP TB   Contractures
IP MP Loss of sweating and hair growth
on the lesion  Chronic ulcers

Muscle weakness or paralysis of  Enlargement of male breast
extremities (gynecomastia)

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  Sinking of the nosebridge a. recognize early s/ sx

Thickened and/or painful nerves b. takje patient & family hx
 c. conducts epidemiological
Ulcers that do not heal investigation
d. assist physicians in P.E.

Redness and pain in the eye e. Assess health of family
members & other household contacts

Nasal obstruction or bleeding 3. Role of PHN: to
show sympathy, care, & concern to
H. Treatment encourage the patient to finish the treatment
Multi-drug Therapy
Adult Children (10 No. of III. Schistosomiasis  “Bilharziasis/ Snail Fever”
– 14yrs) Blister A. Cause
Packs
Single lesion w/  Rifampicin  Rifampicin 1. Schistosoma japonicum 
neg/ slit skin (600mg) (300mg) oriental Schistosomiasis (endemic in Phil)
(SINGLE dose)  Ofloxacin  Ofloxacin 2. schistosoma mansoni
(300mg) (200mg) 3. schistosoma haematobium
 Minocycline  Minocycline
(100mg) (50mg)  ↑ prevalence  Region 5 (Bicol), Region 8
Paucibacillary  Rifampicin
 Rifampicin 6 (Samar & Leyte) & Region 11 (Davao)
(600mg) blister
a.<6lesions
 Dapsone
(450mg)  packs
B. Host: Snail (Oncomelania quadrasi)
b.non- (100mg)
1st day of (9 C. Incubation Period  at least 2 mos.
infectious month mos) D. Mode of Transmission
 Dapsone 1. ingest
(50mg)
ion of contaminated water
D1 – 28
12 2. skin
Multibacillary  Rifampicin
 Rifampicin
(600mg) blister pores
a.> 6 450mg 1 st

lesions  Dapsone
day of
packs 3. Onco
(100mg) (18
b.infectious  Lamprene
month mos) melania quadrasi  tiny snail
(300mg)  Dapsone
(50mg)  E. Diagnostics
D1 - 28 1. fe
 Lamprene calysis
(150mg)  2. E
D1 - 28 LISA
♣ Treatment Completion 3. C
1. A patient on PB regimen should ercum Ova Precipetin Test (COPT) 
take6 blister packs within 9 months. definitive
2. A patient on MB regimen should F. Pathophysiology
take 12 blister packs within 18 Oncomelania quadrasi (tiny
snail)
months.
 If patient failed to complete Miracidum (lives inside snail)
treatment  consume 24 MB blister
packs
Cercaria (evolved
3. At the end of this duration, the miracidium)
patient should be considered as
Treatment Completed (TC). Skin penetration
I. Collaborative Mg’t
1. Prevention of G. Signs and Symptoms
Leprosy (HABAG) 1. s
a. Health education wimmer’s itch  pruritic rash on site of
b. Avoidance of prolonged entry
skin-to-skin contact 2. fe
c. BCG vaccination ver
d. Adequate nutrition
e. Good personal hygiene
2. Case finding
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3. a 1.
bd. Discomfort  hepatomegaly, Wuchereria bancrofti life span 10 yrs.
splenomegaly & lymphadenopathy 2.
4. bl Brugia malayi
oody mucoid stool 3.
5. ic Brugia timori
teric & jaundice B. Incubation Period
 8 – 16mos.
H. Collaborative Mg’t C. Mode of
1. p
Transmission  aedes poecilius (night biting)
revention
D. Diagnostics
a. Health educ.  MOT and methods
of protection
1. circulating filarial antigen (CFA) finger-
prick blood droplet
b. Dispose wastes (feces & urine
properly) 2. Nocturnal Blood examination (NBE) 
c. Reduce snail habitats blood taken at home or residence at 8:00pm
1) expose nail to sunshine 3. Immo-chromatographic Test (ICT) 
 clears vegetation rapid assessment method (can be done anytime
via blood)
2) construct drainage to dry
E. Signs and
land surface  where nail strives Symptoms
3) Molluscides Treat snail Asymptomatic Acute Stage Chronic Stage
sites Stage
4) If exposed with sites 1. No S/ Sx 1. 10 – 15 yrs form
infested  treat skin w/ 70% alcohol 2. Lymphadenitis  onset of attack
5) Inactivating cercaria  ↑microfilariae  lymph nodes 1.
iodine, chlorine or filter paper - wait men > women inflammation hydrocele 
for 48 - 72 hours before use 2. scrotal
swelling
d. prevent people from bathing the Lymphangitis
streams lymph vessels 2.
2. c inflammation Lymphedema
ontrol of patients, contacts & immediate 3.  temp.
Male genitalia  swelling of
environment upper
a. report to local health funiculitis,
epidydimitis, or extremities
authority in selected endemic areas
orchitis 3.
b. concurrent disinfection  Elephantiasis
sanitary disposal of feces and urine  scrotum,
c. quarantine none extremities or
d. immunization  none breast
3. In F. Collaborative Mg’t
vestigation of contacts & source of 1.prevention
infection a.sleep under mosquito net
a. meds b.use mosquito repellamt
c.take yearly dose of medicine w/c kills worms in
1) praziquantel (Biltricide)  drug the blood
of coice
2. meds  ivermectin, diethylcarbamazene
2) oxamniquine  S. mansoni (DEC) or hetrazan
3) metrifonate haematobium  Side Effects of DEC  Fever due to
b. examine for schisosomiasis & treat if destruction of parasites
infected 3.Supportive
c. annual stool exaM a. elephantiasis of legs  eased up by
elevating legs
IV. Filariases/ Elephantiasis b. washing 2x a day w/ soap & water
 Filariasis Control Units (FCU)  ↑ Sulu &↓
Cebu 4. prophylaxis  6mg/kg SD
A. Cause 5. surgery elephantiasis & hydrocele

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a. mild (lymphedema) 
lymphovenous anastomosis
relapse
b. chyluria  ligation & stripping of Symptomatic RBC destruction
lymphatics of kidneys infection
c. hydrocele  inversion or resection of tunica anemia
vaginalis chills

V. Malaria ancient scourge/king of tropical diseases/ ↑ fever

March Fever
Profuse sweating
A. Etiologic Agent
1. Plasmodium falciparum most
common in the Philippines, around 70% of E. Diagnosis
cases 1. S/ sx  hx of malaria
malignant endemic area
brings about cerebral 2. (+) malarial smear
malaria
2. Plasmodium vivax F. Chemprophylaxis
3. Plasmodium malariae 1. Chloroquine
4. Plasmodium ovale not found taken 1-2 weeks before entering malarial
in the Phils area
2. Pregnant
B. Vector : Anopheles mosquito (primary vector; a. 3 tabs Sulfadoxine-
breeds in clear, slow flowing streams) pyrimethamine 500mg/25mg tab
b. When beginning of 2nd to 3rd
 Anopheles flavirostris (named after Flavier) trimesters
primary transmitter of the diseases c. Interval Not less than 1 mo
 night-biting mosquitoes: 9pm to 3am
G. Mg’t And Prevention
C. Signs & Symptoms 1. Blood Schizonticides  acts on
1. Recurrent chills sexual blood stages of parasites
2. Fever a. Chloroquine phosphate
3. Profuse sweating b. Quinine hydrochloride
4. Anemia c. Tetracycline Hcl
5. Malaise d. Quinidine sulfate
6. Hepatomegaly e. Sulfadoxine
7. Splenomegaly  Length of treatment: 7 days
 Once you have malaria, you have it for life. You
cannot donate blood.

2. Insecticide-treated nets
3. Indoor residual spraying
4. Environmental Friendly Program:
D. Pathophysiology CLEAN
Sporozoites (mosquitoes saliva)

Mosquito byte
 C – chemically treated mosquito nets
(Permethrine)
 Sa DOH lang pwede maka-bili ng Permethrine.
Blood strem (sporozoites) Kasi pag pwede siya mabili sa kahit saang
drugstore, hindi mamo-monitor yun cases ng
malaria. When you buy it from the DOH, you will
Liver (sporozoites mature) be under investigation.
 L – larvae-eating fish & biological
(carabaos)
Merozoites Hepato- hypozoites(left in  E – environmental cleaning of canals
(release in blood) splemoegaly liver)
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 A – anti-mosquito soap (laundry soap) a.fever

 *Free sa DOH para sa mga endemic b.+ tourniquet test
areas. Pag humingi ka, under investigation c.abd. pain
ka. It does not kill the mosquitoes, it just
drives the mosquitoes away because of its
2. Grade 2  grade 1 plus (mild-moderate)
lemon scent. a.spontaneous bleeding
 N – neem trees b.rashes
c.epistaxis
VI. Dengue Hemorrhagic Fever 3. Grade 3  grade 2 plus (moderate)
a. circulatory failure
A. Etiologic Agent  Dengue Virus Types 1, 2, b. weak thready pulse
3,4 and Chinkungunya virus c. narrow pulse pressure
B. Incubation Period 6 -7 days d. hypotension
C. Source of infection e. less hemorrhage & NO SHOCK
1. vector mosquito  aedes egypti 4. Grade 4  grade 3 plus (Severe, frank)
(female) a.profound shock
2. infected person b.No pulse or BP
D. Mode of transmission  Mosquito byte (aedes
egypti) J. Collaborative Mg’t
E. Diagnostics  1. Supportive
1. Dengue Blot Anaysis a. Diet  ↓ fat, ↓ fiber, non-irritating, non-
2. Rumpel Lead’s Test carbonated drinks ( NO DARK FOODS)
a. get the MAP & let stand for 5 b. Dehydration
1) IVF
minutes
b. Release cuff and make an 2) ORS moderate dehydration 75ml/kg
in 4- 6 hours or up to 3L (adults)
imaginary 2.5cm2 or 1 in2 just below the
cuff (antecubital fossa) c. Fever paracetamol and analgesics
d. Bleeding
c. Count petichiae
d. (+) 20 and above per 2.5cm2 or 1) nose bleed  ice bag on forehead
1 in 2 2) melena  abdominal ice bag
3) observe for signs of shock
F. Period of communicability  unknown,
preferably 1st week of illness (+) blood e. hemorrhage/ shock
G. Susceptibility, resistance and occurrence 1) position  dorsal recumbent
1. Susceptibility  ALL but peak bet. 5 -9 for facilitating circulation
yrs old 2) light weight covers 
providing warmth (over heating causes
2. Resistance  depending on type vasodilation)
3. Occurrence  all year round f. monitoring and follow up
H. Signs and Symptoms 2. Prevention
Stage 1 Stage2 Stage 3 a. recognition of s/sx of dse.
 Febrile  Toxic /  Convalescent/ b. isolation  screening or mosquito
(invasive hemorrhagic recovery stage nets
stage) stage c. epdidemiologic investigation
d. case finding & reporting
 1st 4 days  4th -7th day  7th – 10th day e. health education
1. (-) 1. temp 1. Generalized
tourniquet 2. Severe abd. flushing 3. Control
test  3rd Pain 2. BP stable
3. Vomiting 3. Appetite a. once a week change water &
day due to scrub sides of lower vases
low 4. GI bleeding regained
vasomotor 5. Death b. cleaning surroundings  destroy
tone breeding places
2. fever c. proper disposal  rubber tires , empty
3. flushing bottles & cans
4. Myalgia d. cover water containers
5. Epistaxis e. Avoid too many hanging clothes
f. residual spraying of insecticides

I. Classification 4. PHN Responsibilities

1. Grade 1 (mild) a. Out break  report to MHO
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b. refer  nearest hospital

c. Health education
d. assist in the diagnosis
e. epidemiologic investigations

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