Exam 3

Economic Issues and Acquirement

$120 Billion per year for treatment and lost productivity related to illness from infectious agent. NOTE: Factor in current Covid and this is even more! Food borne illness in the U.S. alone estimated at $77.7 Billion. Infectious diseases are acquired specifically and directly as a result of our behaviors and lifestyles: Contracted through: - Social gatherings - Travel and transport - Sexual activity (syphilis) - Occupational exposure - Sports and rec activities - Eat and drink (foodborne) - Pets (ticks) - Environment - Being in the hospital (increase risk for HA infections)

BIOTERRORISM AGENTSCATEGORY A-HIGHEST PRIORITY

Anthrax Smallpox Botulism Tularemia Viral hemorrhagic fever (Ebola) Plague More information In Canvas

Purposes of surveillance and investigation

Identify trends and unusual disease - establish baseline of endemic Set priorities - disease we need to respond to vs expected spike Develop and evaluate programs Surveillance gives that baseline (endemic) rates of disease occurrence and patterns of spread Surveillance makes it possible to have ongoing monitoring Also possible to study whether clinical protocols and public health policies that are in place based on current science to a disease/event rate actually declines. Helpful in determining whether a program was effective. Surveillance activities can: - Assess the public health status - Respond to unusual disease spread and terrorism - Define public health priorities - Plan public health programs - Evaluate interventions and programs - Stimulate research - Improve health

Immunization

Immunization biologicals are toxoids or vaccines that target a particular infectious micororganism, either a virus or a bacteria. Types of Vaccines - Inactivated - Live-attenuated - Messenger RNA (mRNA) - Subunit, recombinant, polysaccharide and conjugate - Toxoid

Communicable disease control

Increasing host resistance through: - Promoting general health - Preventing complications - Producing immunity through immunization Other control measures: - Compulsory immunization for school/day care - Compulsory examination of contacts and treatment of infected persons - Required screening for specific diseases in high-risk groups-TB - Mandatory reporting of communicable diseases (i.e. -surveillance) - screen high risk population - contact tracing

The investigation

Investigation objectives - To control and prevent disease/death - Identify factors that contribute to the outbreak of the disease and occurrence of the event - Implement measures to prevent occurrences/ re occurrences

Epidemiological clues bio attack

pg. 314 to determine whether a potential chemical or bio attack vs naturally occurring disease what might me clues? - when controlled illness starts popping up (2 sources in world) - cases of influenza, its around not concerned - location of outbreak (ebola is endemic in Africa, concerned if popped up in Midwest) - large number of cases (need to know endemic levels, if we see sudden spike- ex. large number of influenza in July, suspicious)

Chlorine

pulmonary/choking agent most common difficulty breathing, sore throat, laryngeal spams

Small pox

How to distinguish Smallpox vs. Chickenpox pg. 203 Be able to differentiate Smallpox is considered eradicated There is a vaccine but it is no longer routinely given except for those at risk prodromal stage before rash starts deep seated will hold shape if punctures, uniform throughout body Who is at risk?

Corona Virus -COVID 19 Sars COV2

1-30-20 WHO declared a public health emergency of international concern 1-31-20 USHHS Secretary declared a public health emergency for the U.S. In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. Spread - mainly person-to-person respiratory surface contact Vaccine

4 Stages of Disaster Management

1. Prevention (Mitigation and Protection) - Awareness and education - Organization and participation - Advocacy - Assess of environmental health hazards 2. Preparedness Personal -Personal checklist -Emergency supplies kit -ARC and FEMA Professional -Disaster medical assistance teams Community -National Health Security Strategy (NHSS) -Disaster and Mass Casualty Exercises

Historical Perspective

1900: communicable diseases were the leading causes of death in the United States. By 2000, improved nutrition and sanitation, vaccines, and antibiotics had put an end to the epidemics that once ravaged entire populations. As people live longer, chronic diseases replaced infectious diseases as the leading causes of death. Infectious diseases are still the number-one cause of death worldwide. New killers are emerging, and old familiar diseases are taking on different, more virulent characteristics.

Sarin (nerve agent)

nerve agent impacts acetylcholine an important neurotransmitter what receptors use acetylcholine in a synapse pinpoint pupils, impacted vision, uncontrolled secretions, muscle twitching, loss of consciousness, resp arrest, seizures, complete flaccidity or paralysis

4 stages of Disaster Management

3. Response-Disaster Management Cycle - First level of response occurs at the local level and near by communities (fire dept, law enforcement, public health and emergency services) - National Response Framework (NRF) when emergency declared, national guard when requested - National incident management system (NIMS), platform for disaster response, nation wide approach to assemble multiple agencies Response to biological incidents - BioWatch, BioSense, Project BioShield, Cities Readiness, Initiative, Strategic National Stockpile (SNS) International relief efforts - protect those that are responding Psychological stress of disaster workers - Delayed stress reactions

4 Stages of Disaster Management

4. Recovery - Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level prior to the disaster as is possible. - Often the hardest part of the disaster. - Recovery occurs as all involved agencies pull together to restore the economic and civic life of the community. When does disaster management begin?? In the first stage before disaster happens, the plan

Collaboration among partners

A quality surveillance system requires collaboration among a number of agencies and individuals. Such collaboration promotes the development of emergency responses and contacts for effective communication and information sharing. Nurses are often on the forefront of responses to be made in the surveillance process.

An example of artificial passive immunity would be

A. Chicken Pox (if vaccinated, active artificial, if had disease active natural) B. Breastfeeding (natural passive) C. Immunoglobulin (artifical passive, someone else made it) active- my body passive- given immune response somewhere else

Roles of the Nurse is Disaster Response

Advocate - proper allocation of resources Assessment of individuals and community (hazards) Understand what community resources are available Often first responder - Case finding and referring - Prevention - Health education - Surveillance - Triage

Transmission Epidemiological Triad: Agent, Host and Environment

Agent Factors: 4 main categories of infectious agents: - Bacteria - Fungi - Parasites - Viruses Six Characteristics of an Infectious Agent: - Infectivity-ability to enter and multiply in the host - Pathogenicity-ability to produce a specific clinical reaction after infection occurs - Virulence-ability to produce a severe pathological reaction - Toxicity-ability to produce a poisonous reaction - Invasiveness-ability to penetrate and spread throughout a tissue - Antigenicity-ability to stimulate an immunological response Epidemiologic Traingle - host -agent - environment Pg. 197 Box 11-1

Vaccine administration and adverse effects

Always confirm the dose following manufacturer's dosing directions. Adverse Effects: Minor: Fever, adenopathy Minor rash, soreness at injection site, urticarial (hives), arthritis Severe: Fever higher than 103⁰F, rash/urticaria, dyspnea, cyanosis, anaphylaxis

When to investigate

An unusual increase in disease incidence should be investigated Amount of effort depends on severity - what it is, who's affected, cost Numbers of people involved Potential for spread - readily spread vs rapid spread (high virulency) Availability/effectiveness or intervention measures 1. Confirm 2. Describe 3. Determine cause 4. Control...

A 50-year old male Hispanic patient is in for a wellness visit. His vaccination records indicated that he has not received any vaccinations in the past 12 months. Given this information the following vaccinations would be recommended for this patient at this time. (Select all that apply). No partial points awarded.

Annual Vaccination Zoster vaccination (RZV) recombinant zoster vaccine The CDC recommends a 50 year old individual should receive annual seasonal influenza vaccination, a Td if it has been 10 years since last administered, zoster recombinant zoster vaccine (RZV) should be initiated at age 50 and included 2 doses 2-6 months apart. Others may be indicated under special consideration. HPV vaccination provides the most benefit when given before a person is exposed to any HPV. This is why CDC recommends HPV vaccination at age 11-12 years. HPV vaccination is also recommended through age 26 years for everyone who did not get vaccinated when they were younger. Vaccination is not recommended for everyone older than age 26 years. In general, HPV vaccination of people in this age range provides minimal benefit because most people have been exposed to HPV already. However, some adults aged 27-45 years who are not adequately vaccinated might be at risk for new HPV infection and might benefit from vaccination. For adults who are 27-46 years old, clinicians can consider discussing HPV vaccination with people who are most likely to benefit. HPV vaccination does not need to be discussed with most adults over age 26 years. The Pneumococcal vaccination (PCV13) is administered at age 65 years unless patient is considered a special population and clinically indicated. The recommended vaccinations would be the annual seasonal influenza vaccination and the Zoster vaccine (RZV). The patient's age do not meet recommendation for the HPV vaccine or the PCV13 vaccine.

Role of the Nurse is Disaster Recovery

Assessment of consequences of disaster and of clean-up efforts Attention to sanitation and safe water and food supplies Identification of environmental hazards Identification and referral of individuals with delayed stress reactions.

Example

Barbara thinks that she has flu. She feels weak, nauseated, is vomiting, and has diarrhea. She decides to go to the emergency room, and the nurse there, James, begins to ask Barbara questions. He asks Barbara what she's has done in the last three days and how she has been feeling. Barbara tells him that she has felt fine at her office, but started feeling bad last night after eating at a sandwich shop. Barbara thinks that she has could have been exposed to the flu at either place. James has seen other patients throughout the last few days with similar stories and has been keeping track of symptoms. James is performing syndromic surveillance, the ongoing systematic collection of data. The data is then analyzed and interpreted in order to identify clusters of illnesses, which will help to reduce mortality and morbidity. James collects some blood work from Barbara, gives her medication to help with her nausea, and administers some intravenous fluids. He will enter information into the symptoms reporting system and the patient's medical record. This will help determine if Barbara's symptoms relate to other patient's emergency room visits.

Nationally notifiable diseases

Box 17-3 PG. 311 Reporting of disease is essential if trends are to be accurately monitored. States compile disease incidence data and transmit electronically to the CDC weekly through NEDSS

MonkeyPox CDC Recommendations

CDC recommends that people with monkeypox remain isolated at home or at another location for the duration of illness Current data suggest people can spread monkeypox from the time symptoms start until all symptoms have resolved, including full healing of the rash with formation of a fresh layer of skin. Until all signs and symptoms of monkeypox illness have fully resolved Do not share items that have been worn or handled with other people or animals. Launder or disinfect items that have been worn or handled and surfaces that have been touched by a lesion. Avoid close physical contact, including sexual and/or close intimate contact, with other people. Avoid sharing utensils or cups. Items should be cleaned and disinfected before use by others. Avoid crowds and congregate settings. Wash hands often with soap and water or use an alcohol-based hand sanitizer, especially after direct contact with the rash. Vaccines may be used for the prevention of monkeypox disease: JYNNEOS vaccine is approved for the prevention of monkeypox and smallpox disease. ACAM2000 vaccine is approved for immunization against smallpox disease and made available for use against monkeypox under an Expanded Access Investigational New Drug (EA-IND) protocol. The standard regimen for JYNNEOS involves a subcutaneous route of administration with an injection volume of 0.5mL. In the context of the current national Public Health Emergency (PHE), an alternative regimen involving intradermal (ID) administration with an injection volume of 0.1mL may be used under an Emergency Use Authorization (EUA). People may be vaccinated after exposure to monkeypox virus to help prevent monkeypox disease not test

COMMUNITY HEALTH NURSES ROLE IN PREVENTION & CONTROL OF COMMUNICABLE DISEASE

CHNs play an important role in recognizing: - Populations at risk for communicable disease - Potential reservoirs of sources of infectious disease agents -- Environmental factors promoting transmission Case finding, referral, follow-up Collaboration with other health professional in: - Establishing immunization and education programs - Improving community infection control policies - Developing services to populations at risk Political activity and advocacy

Disasters May

Cause premature death, illness, and social well-being of the people Destroy the local health care infrastructure and prevent an effective response to the emergency Create environmental imbalances-thereby increasing the risk of communicable disease and environmental hazards Affect the psychological, emotional, and social well-being of the people Cause shortages of food and water Displace populations of people

Vector prevention and education

What education for the Vector-Borne? What prevention? use of bug spray, mosquito netting, long sleeves and pants, check for ticks after being outside,

Patterns of occurence

Help to define the boundaries of the problems to help investigate possible causes or sources of the problem Common source Refers to a group exposed to a common noxious influence (agent) in a common place - such as the release of noxious gases (ricin in Japanese subway system several years ago) Point source Specific type of common source where all persons exposed become ill at the same time during one incubation period in one particular geo location. vs Continuous: exposure to source is prolonged over extended time & perhaps more than one incubation Mixed A common source followed by secondary exposures related to person-to-person contact as in spreading influenza or example below (combination of point source and common source) Intermittent/continuous source Cases may be exposed over a period of days or weeks, food poisonings at a restaurant chain relating to a contaminated item Propagated Does not have a common source and spreads gradually from person to person over more than one incubation period such as tuberculosis from one person to another - person to person spread over more than on incubation period

Rabies

Highest case fatality rate of any known human infection - difficult to detect, once symptoms appear there is not successful treatment available Dogs, raccoons, skunk fox coyote bats Animal bite or scratch Transmitted to human by introducing virus-carrying saliva into the body Clean the wound with soap and water immediately consult medical care No successful treatment once symptoms appear -- Immunoglobulin and post-exposure vaccine administration Vaccine

Future of Disaster Management

Continue to plan and train in all-hazards environment, regardless of specialty practice. The nature of disasters will retain the element of unpredictability. -- That unpredictability and the medical and public health surge requirements in disaster make prevention and preparedness activities on the part of individuals and communities even more important.

Contemporary Concerns in Communicable Disease Control

Drug-resistant - MRSA, VRE Vector borne illness (Lyme, West Nile, Zika virus etc.) Food borne illness again make headlines-- - E. coli infected spinach Salmonella - peanut butter etc. - Novel influenza H1N1 (new strain) Decline in immunization rates in some areas with subsequent increases in vaccine preventable disease. Random outbreaks of vaccine preventable diseases. Infectious disease as a means of terrorism. - ex. anthrax Worldwide infectious disease leading cause of death=respiratory infections, diarrheal illness, HIV/AIDS, TB, malaria, meningitis, pertussis, measles, Hepatitis B etc. Covid

Who should not receive live vaccines?

immunocompromised - could contract disease pregnant women - fetus risk, fetus could contract MMR, varicella and HPV after pregnancy- tdap because we want to make sure antibodies pass from mom to baby because pertussis is very dangerous for infants

Defining the magnitude of a problem/event

Endemic: persistent presence-provides the baseline Hyperendemic: persistently (usually) high number of cases in a particular location, maybe SD endemic flu rate (on average) but one or two counties 10 percent higher- hyperendemic in those counties Epidemic: occurrence of a disease within an area is excess of expected in a given time, increase above the baseline Possible for place to be hyperendemic and have an epidemic? yes Sporadic: irregular patterns (as opposed to seasonal- flu season) Pandemic: several countries areas, throughout geographical boundaries Holoendemic: prevalent problem found early in life decreases as age increases- malaria Africa - can affect entire population but often young are more susceptible Outbreak detection: identifying an increase in frequency of disease above the usual occurrence of the disease, function of the investigator.

Transmission of Communicable Disease

Environmental factors: - physical - biological - social - cultural factors that are external to the human host (different enviorments, ex. ecuador- extra vaccines, don't drink the water, antivirals These environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts. Reduction in communicable disease risk can be achieved by altering these environmental factors. - Mosquito nets, repellants, sewage , sanitation MASKS?? In the community

Public Health Surveillance can be used to:

Estimate the magnitude of a problem - covid outbreak in china, epidemic through Asia, pandemic worldwide Determine geographic distribution Portray the natural history of a disease Detect epidemics Generate hypotheses - how can we contain it Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Role of the Nurses in Disaster Preparedness

Help initiate or update the agency's disaster plan. Provide educational programs and materials regarding disasters specific to the area. Organize disaster drills. Provide an updated record of vulnerable populations within the community. Review individual strategies.

Transmission of Communicable Diseases

Host Factors (human or animal) The characteristics of the host that may influence the spread of disease are - host resistance - immunity - herd immunity - infectiousness of host Resistance: host ability to withstand infection Immunity can be acquired: natural- something we get after we have disease artificial- thorugh vaccines active- our body produces immunity passive- immunity from another source, immunoglobin injections, antigen from breastmilk to baby

Common Disease Immunizations Available

Diphtheria, tetanus, pertussis-bacterial Measles, mumps, rubella-live viral Smallpox (vaccinia)-live viral Hepatitis A, B-viral Influenza-"mist" is live viral "shot" is not live Haemophilus influenza-bacterial HPV-viral Varicella (chicken pox)-live viral

TDAP or DTAp

Diphtheria: Infects nose/throat - Thick grey matter back of throat, potential airway obstruction - Spread is easy: airborne cough/sneeze-kiss share drinks - S/S: sore throat, fever, swollen lymph nodes, weakness, grey matter in throat - Prevention: Vaccine - Tx: Penicillin, erythromycin, supportive care-trach if needed, antitoxin Pertussis: Highly contagious - Spread is easy: airborne cough/sneeze, saliva kiss/drinks - S/S: Mild to start then worse-cough-becomes chronic or severe and becomes paroxysmal, vomiting with cough, nasal congestion, sneeze, fever, fatigue - Prevention: Vaccine (dtap) school age and middle school age, tdap during pregnancy to cover until infant can get dtap at a few months old - Tx: erythromycin, supportive care-O2 etc. - aka whooping cough Tetanus

Disasters

Disaster events need not cause injury or death to be considered a disaster Although disasters cannot be prevented-much can be done to prevent further increases in accidents, death, and destruction after impact Accidents, acts of war or terrorism, or environmental mishaps cause disasters Pandemic & public health surge A concise, realistic, and well-rehearsed disaster plan is essential

Disaster

Disaster: any natural or human-made incident that causes disruption, destruction, and/or devastation requiring external assistance - Range in size - Are expensive (lives affected, property lost/damaged) - Developing countries experience disproportionate burden from natural disasters - Complex humanitarian emergencies Types of disasters - Natural disasters - Human-made disasters 5 days of hurricane Katrina documentary

Surveillance and outbreak investigation

Disease surveillance: the ongoing systematic collection, analysis, interpretation and dissemination of specific health data for use in public health Surveillance is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, susceptible populations)

Food and water borne disease

Food infections results from bacteria, viral, or parasitic infection of food. Much food-borne illness can be prevented-how? safe handling of foodi Salmonella-Bacterial Eat inadequate cooked food from infected animal, person to person, meat poultry eggs most associated, as well as reptiles - S/S: sudden onset of headache, abdominal pain, diarrhea, nausea, sometimes vomiting, almost always fever typically within 48 hours Tx. Antibiotic and support therapy Common outbreaks? E. Coli Bacterial Eat/drink items contaminated, person to person - petting zoos, hamburger primary concern - S/S: bloody diarrhea, abdominal cramps, infrequently fever appears usually 3-4 days after but could be as short as 1 day. - TX: Fluids - support therapy

Triage Category

Green 8-year old female walking around crying for her mother. Yellow 15 -old male - respirations 22 - capillary refill < 2 seconds - obeys commands- holding right leg, cannot stand Red 40-year old appearing male that is breathing but does not answer simple demands. Black Teen-age female with massive brain injury - no pulse- no respiration with head reposition

Monkeypox is the bacterial or viral?

Lesions are firm or rubbery, well-circumscribed, deep-seated, and often develop umbilication (resembles a dot on the top of the lesion). During the current global outbreak: - Lesions often occur in the genital and anorectal areas or in the mouth. - Rash is not always disseminated across many sites on the body. - Rash may be confined to only a few lesions or only a single lesion. - Rash does not always appear on palms and soles. Rectal symptoms (purulent or bloody stools, rectal pain, or rectal bleeding) have been frequently reported in the current outbreak. Lesions are often described as painful until the healing phase when they become itchy (crusts). Fever and other symptoms (chills, lymphadenopathy, malaise, myalgias, or headache) can occur before rash but may occur after rash or not be present at all​. Respiratory symptoms (sore throat, nasal congestion, or cough) can occur. Lesions typically develop at the same time and evolve together on any given part of the body. The evolution of lesions progresses through four stages—macular, papular, vesicular, to pustular—before scabbing over. The incubation period is 3-17 days. During this time, a person does not have symptoms and may feel fine. The illness typically lasts 2-4 weeks. not test

Shelter Management

Local Red Cross chapter Nurses working in shelters: - Provide assessments and referrals. - Meet health care needs, such as helping clients get prescription glasses, medications, first aid, and appropriate diet adjustments. - Keep client records. - Ensure emergency communications. - Provide a safe environment.

Disease of travelers

Malaria- most common protozoal (Parasite) infection- annual death rate of approximately 500,000 Prophylaxis WHO approved vaccine 10/21 What is a question that you should really ask patients when doing a history? any recent travel outside of the US

Anthrax (inhalation) -0 There are other forms cutaneous and gastrointestinal but inhalants is the concern

Manifestations - Headache - Fever / chills - Muscle ache - Chest discomfort - Severe dyspnea - Shock How is it spread? usually in the soil, inhalation is concern for bioterrism, spores are easily dispersible, not spread person to person that way - Viral or Bacterial? bacterial spores Cutaneous or GI- probably naturally occurring Inhalantion- bioterrorism Prevention - Vaccine for those at highest risk for exposure - Ciprofloxacin and doxycycline are recommended for prevention following exposure-mass casualty -priority to get antibiotic started Treatment/Care - IV Antibiotics if manifestations of anthrax present

Small Pox

Manifestations - High fever, fatigue, head and body aches - Rash begins on face and tongue, quick spread to trunk, arms, and legs, then hands and feet, then turns into pus-filled lesions - Onset is sudden fever with sever aches - Rash appears 2-4 days after fever (more on the face and limbs than the trunk) - Lesions are all in the same stage of development, deep vesicles, and do not collapse when punctured - can be spread person to person - How is it spread? person to person concern for bioterrorism - Viral or Bacterial? viral Prevention - Vaccine for those at high risk (10 years of immunity). -- farmers and ranchers/their cattle, government officials - Follow contact and airborne precautions - military vaccination? could be weaponized Treatment/Care - No cure - Support: hydration, pain management, antipyretics, antibiotics for secondary infection can look similar to chicken pox -- if smallpox lesions will all be in the same stage, deep seated lesions, doesn't collapse when punctured prodromal onset of headache fatigue chills before rash appears

Tularemia

Manifestations - Sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, progressive weakness - If airborne, life-threatening pneumonia & systematic infection - severely enlarged lymphnodes How is it spread? bites or scratches or animal wanders into drinking source Viral or Bacterial? bacteria- naturally occurring in animals, can be aerosolized- bioterrorism (but not spread person to person after aerosolized) Prevention - No current vaccine but under review Treatment/Care - Streptomycin or gentamicin is the antibiotic of choice - In mass casualty-ciprofloxacin or doxycycline

Viral Hemorrhagic fever ebola

Manifestations Fever, severe headache, joint and muscle aches, fatigue, weakness, hemorrhage, vomiting, diarrhea, shock How is it spread? Viral or Bacterial? Prevention - No approved vaccine - Protective equipment - Droplet and isolation precautions Treatment/Care - Supportive care, IV fluids, dialysis, airway.

Types of surveillance

Sentinel: trends in commonly occurring diseases or key health events are monitored. A disease/event may be the sentinel or a population may be the sentinel. A sample of health providers/agencies are asked to report the problem. - BMI-Obesity Level - Covid-19 In Nursing Homes SD Special systems: developed for collecting particular types of data; may be combination of active, passive, and/or sentinel systems Example of Special system: Syndromic surveillance systems: as a result of bioterrorism, these new systems are being developed to monitor illness syndromes or events. This approach requires the use of automated data systems to report continued (real time) or daily (near real time) disease outbreaks. ID early outbreak or stay ahead.

Measles Mumps Rubella (MMR)

Measles - Acute illness - Highly contagious - Respiratory transmission - S/S: Fever, runny nose, sneezing, cough, rash all over body (left pic), Koplik spots (white patches in oral mucosa - Rubeola virus - Highly contagious and before knowing it** Mumps - A Contagious viral illness - Respiratory-airborne, saliva, contaminated surface - S/S: Fever, headache, muscle aches, fatigue, followed by swollen parotid salivary glands middle pic Rubella (German Measles) - Moderately contagious viral - Enlarged lymph nodes, fine, pink rash difficult to distinguish from measles or scarlet fever - Transmission inhalation or direct contact from respiratory tract secretions of infect persons. - Pregnant women at particular risk-rubella can cause intrauterine death, spontaneous abortion or congenital anomalies - pic on right Prevention for these? MMR vaccination

Modes of Transmission and Disease Development

Model of Transmission how they intereact Vertical (parent to offspring - Horizontal (person to person Vehicle- water blood saliva food Vector- mosquito, ticks exposure to agent does not always equal infection and disease Disease Development - Infection - Disease Incubation period: amount of time that elapses between exposure and signs and symptoms Communicable period- how long a person can spread the disease

Parasites

Nematodes (round/pin), cestodes (tapeworm), trematodes (flukes), protozoa PIN worm (round) most common parasite infection in US and seen in children. Looks like small piece of white thread S/S?? TX. Oral vermicide (deworming med-antiparasite med) albendazole

Disaster Management

The number of disasters, both human-made and natural, continues to increase, as does the number of people affected by them. The cost to recover from a disaster has risen sharply because of the amount of technology that must be restored. Nurses are increasingly getting involved in disaster planning, response, and recovery through their local health department or local government.

Types of surveillance systems

Passive: case reports are sent to local health departments by healthcare providers (physicians, nurses) or lab reports of disease occurrence are sent to the local health department - sits back and data comes in, case reports to health department Active: the nurse, as an employee of the health department, may begin a search for cases through contacts with local health care providers and health care agencies-gathers data about existing cases to determine the magnitude - health agency appointee goes out and seeks out cases, actively gathering information

Disease Spectrum

Persons with disease may exhibit broad spectrum of disease ranging from subclinical infection to severe and fatal disease. Subclinical or non-apparent infections are important from public health view because they are a source of infection but may not be receiving the care that the clinical disease individuals are. At the community level the disease may occur in: Endemic- there is always an expected level of disease ex. influenza, peak seasons but seen year round, this is our baseline in a certain area to monitor for outbreaks Epidemic- amount of cases higher than expected (endemic) Pandemic- worldwide cases, impacting geographical borders, major impact

How Disasters Affect Communities

Physical and emotional effects depend on - Type, cause, and location - Magnitude and extent of disaster - Duration of disaster - Amount of warning Stress reactions in individuals Box 16.4 - Adults (PTSD) - Children (Regression** response to trauma, Confusion) Stress reactions in the community (phases) - Heroic (community pull together, little sleep, first responders) - Honeymoon (thankful for survival, rejoicing for being spared, bad but its okay because we made it) - Disillusionment (realizing this happened, more help may be coming, rejoicing can turn into dispare, exhaustion from heroic activity) - Reconstruction (longest phase, rebuilding, relocating) Populations at greatest risk: Box 16.5 - Elders - Women (pregnant) - Children - Persons with disability - Hearing/vision - Chronic disease/mental health - Low income/homeless - Non-English speaking - Rural (lack of resources to begin with) - Tourist or new to area - Substance user - Undocumented

Vaccine- Preventable Disease

Population approach: - Diseases such as polio, diphtheria, pertussis and measles which occurred in epidemic proportions are now controlled by routine childhood immunizations. They are not eradicated so children need to be immunized. -- "No shots no school" -- Population most vulnerable however do not receive them on time despite free availability. At risk populations: - Inner-city children from minority and ethnic groups at risk for complete immunizations - Children from religious or philosophical objection - Adults from minority or ethnic groups - Adolescents have lower rates than children and adults-do not frequent preventive services

TDAP for pregnant women

Pregnant women should receive a dose of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, ideally between 27 and 36 weeks gestation. Cocooning Alone May Not Be Effective and Is Difficult to Implement anyone in contact with infant should have updated booster

COMMUNICABLE DISEASE CONTROL

Preventing the spread of disease through: Contact notification - Identifying exposed individuals - Informing them of exposure - Informing them about potential for disease and spreading it to others - Referring them for testing and treatment Chemoprophylaxis- using medications in exposed individuals to prevent the spread of disease to others

Levels of Prevention in Communicable Disease Control

Primary Prevention Goal is to reduce the incidence of disease by preventing it before it happens Education of members of community immunization Chemoprophylaxis- (malarial) Secondary Prevention Screening to detect disease in asymptomatic, apparently healthy individuals Contact investigation and case finding/referral Quarantine when necessary Tertiary Prevention Isolation Monitor compliance of treatment

State notifiable diseases

Requirements for reporting diseases are mandated by law or regulation. Each state differs on the list of reportable diseases Not all nationally notifiable diseases are legally mandated for reporting in a state

Interventions and protection

Response to bioterrorism or large-scale infectious outbreak may require use of emergency public health measures such as quarantine, isolation, closing public places, seizing property, mandatory vaccination, travel restrictions, disposal of deceased Protecting health care providers

Disasters

Sempt 2017- Harvey hurricane houstin october 2013- massive blizzard sioux falls April 2013- boston marathon bombing May 2011- Japlin tornado tsunmia, nuclear disaster, haiti earthquakes and hurricanes 9/11/2001- terorism

Tetanus

Spread: puncture with contaminated object potentially fatal bacterial infection (toxin of the bacteria) affects the nervous system Leads to S/S: painful muscle spasms through body last several minutes, "lock jaw and neck", difficulty swallowing, may cause breathing issues possible death, fever, elevated blood pressure Prevention: Tetanus vaccine and booster every 10 years. Tx: No true Cure. Supportive treatment: Wound care, antitoxin (immune globulin) antibiotics (penicillin, doxycycline) vaccine, sedatives, vent, trach

Surveillance of Communicable Disease

Surveillance: gather the who, when, where, and what; these elements are then used to answer why Cover this in Ch. 17 List of reportable diseases - Varies by state

Surveillance and outbreak investigation

The Constitution of the U.S. provides for "police powers" necessary to preserve health safety as well as other events. police powers- powers awarded to state or community to protect public health, mandates - infringe on individual rights? State and local "police powers" also provide surveillance - Health Departments determine where we're at for disease levels

Response

The five components of a comprehensive public health response to outbreaks of illness/biological/chemical: 1. Detect the outbreak 2. Determine the cause 3. Identify factors that place people at risk 4. Implement measures to control the outbreak (ex. contaminated water and lettuce, need to recall? exposure to covid- place in quarantine monitor for symptoms and isolate if symptoms) 5. Inform the medical and public communities about treatments, health consequences, and preventive measures use for sim prep

Vector Borne

Transmitted by vectors Lyme Disease bacterial - Stage I: erythema chronicum migrans (bulls eye shaped rash), fever, malaise, headache muscle pain, stiff neck, enlarged lymph nodes, migratory joint pain - Stage II: if not treated progresses to additional lesions, neurological and cardiac abnormalities - Stage III: recurrent attacks or arthritis and arthralgia - TX: tetracycline penicillin - Tick removal-pg. 210** Rocky Mountain Spotted Fever bacterial -- Sudden onset of moderate to high fever, severe headache, chills, deep muscle pain, and malaise-50% experience a rash -- TX: tetracycline West Nile:-viral headache, body aches, joint pains, vomiting, diarrhea, or rash. Most people with this type of West Nile virus disease recover completely, but fatigue and weakness can last for weeks or months. TX: ? tetracycline

Triage

Triage: process of separating casualties and allocating treatment on the basis of the victims' potentials for survival. Highest priority is always given to victims who have life-threatening injuries but who have the highest probability of survival once stabilized. allocate treatment based on need Respriation Perfusion Mental status thirty two can do - are they walking? yes, wait - separate deceased from urgent and waiting are they respirating? yes or no- open airway if not, move on, if yes- immediate thirty- breathing and over 30 red tag they need help now, under 30 move to perfusion perfusion- radial pulse or cap refill, if absent or cap >2 seconds get red tag control bleeding, immediate under 2 seconds and pulse go to mentation mentation (can do) - if no immediate, if they can they can wait RPM 32 can do have to be ambulatory to be green, pregnant- yellow even if all okay, need to assess fetus (green assessment could take hours) deceased- black

Vaccines (know child vaccine schedule!)

Vaccines are among the most cost-effective clinical preventive services and are a core component of any preventive services package. Childhood immunization programs provide a very high return on investment. For example, for each birth cohort vaccinated with the routine immunization schedule (this includes DTap, Td, Hib, Polio, MMR, Hep B, and varicella vaccines), society: - Saves 33,000 lives. - Prevents 14 million cases of disease. - Reduces direct health care costs by $9.9 billion. - Saves $33.4 billion in indirect costs. Despite progress, approximately 42,000 adults and 300 children in the United States die each year from vaccine-preventable diseases.*Communities with pockets of unvaccinated and under-vaccinated populations are at increased risk for outbreaks of vaccine-preventable diseases.. - Source: Healthy People 2030

Influenza H1N1

Viral respiratory infection. Transmission airborne. Outbreaks common in winter and early spring. How is vaccine prepared each year for "seasonal flu" How do we educate the community? yearly flu vaccine wash your hands cover your cough Target population for seasonal flu? elderly, children At risk groups? elderly, children, immunocompromised except for nasal mist because it's live

Water-borne

Water-borne-the more common: - Hepatitis A (Viral) - Cholera, typhoid fever, bacillary dysentery (bacterial) - Giardia (protozoan) Usually enter water supply through animal or human fecal contamination.

Infectious Disease Prevention and Control

Worldwide concern about infectious diseases. - Concern has increased with the growth of migration. As people move from one place to another they bring their diseases, levels of immunity and resistance to diseases, and the viruses or bacteria they may harbor. Also requires a global perspective - recent outbreaks of Ebola, Zika, Covid. infectious disease and communicable disease are used intergchangeable for our purposes

Zika Virus

Zika is spread mostly by the bite of an infected Aedes species mosquito. Zika passed from a pregnant woman to her fetus. Infection during pregnancy can cause certain birth defects (of brain and head, hydrocephalus of fetus) Once infected can be spread through unprotected sex with infected individual Guillain-Barre There is no vaccine or medicine for Zika. Local mosquito-borne Zika virus transmission has been reported in the continental United States Many people infected with Zika virus won't have symptoms or will only have mild symptoms. The most common symptoms of Zika are: •Fever •Rash •Joint pain •Red eyes (conjunctivitis) •Muscle pain •Headache

TIME INTERVAL BETWEEN INVASION OF INFECTIOUS AGENT AND FIRST APPEARANCE OF SYMPTOMS:

incubation period

Ricin

ingestion or inhalation can present differently look at chart

Mustard

blistering agent- vesicant skin eye mucous membrane redness, skin blistering inhalation- airway damage choking and pulmonary agent has smell

Cyanide (blood agent)

brain not getting enough oxygen in hemoglobin n/v, develop hypotension, dark pink skin progressing to cyanosis, increase rate and depth of breathing bitter almond or chlorine smell

Vaccine schedule

chart linked in canvas** 4-6 school aged, DTap 5th dose, last dose of Polio, recommend influenza every year, last dose MMR and varicella adolescents- 11-12 year old range, starting HPV vaccines, meningococcal and tdap graduate- tetanus or tdap every 10 years and for wound management, age 50 shingles vaccine, 65 maybe pneumonia do you need to get shingles vaccine if you haven't got chicken pox? we don't know age population hasn't reaches that age yet, thought it if you hadn't gotten virus you shouldn't need the virus

Live vaccines

know which are live live attenuated- weakened form but still alive

Study

links for vaccine schedule posted in canvas ch. 11

Botulism

different forms- inhalation does not occur naturally can be from aeosolized or used to sabotage food supplies Manifestations - Double/blurred vision - Slurred speech - Difficulty swallowing - Progressive muscle weakness - Difficulty breathing How is it spread? inhalation (aerosolization) Viral or Bacterial? bacteria Prevention - No approved vaccine Treatment/Care - Airway management-possible ventilation - Administration antitoxin** - Elimination of toxin-induce vomiting, enemas, excision of wound tissue - Supportive care: nutrition, fluids, prevent complications

Plague

different forms- pneumonic the concern Manifestations Pneumonic (person-person) - Fever, headache, weak, pneumonia with SOB, chest pain, cough, bloody or watery sputum Bubonic - Swollen tender lymph nodes, fever, headache, chills, weak Septicemic - Fever, chills, weak, prostration, abdominal pain, shock, DIC, gangrene of nose and digits How is it spread? pneumonic is person to person Viral or Bacterial? bacteria Prevention - No vaccine in the U.S. - Contact precautions - Droplet precautions until 72 hours after antibiotics Treatment/Care Gentamicin and fluoroquinolones

All immunization drugs are universal in dosage

false

Protecting the nation's food supply from contamination by all the virulent microbes is complex, costly, and time consuming. However, much food-borne illness, regardless of causal organisms, can be prevented through simple changes in:

food preparation, handling, and storage.

Recommended immunization schedule

slide 31 ch. 11 power point use link in canvas instead

Chemical Agents

think about what chemical agent is targeting

Purpose of disaster planning is

to manage response to disasters

infection does not always cause disease

true example HIV/AIDS

A mosquito in communicable disease would be considered a:

vector vehicle: water, food, saliva