Community Medicine MED Squad Team

Epidemiology
Epidemiology: Concepts and Uses

 Definition of Epidemiology: It is the study of:

• Distribution (frequency & pattern of health events in populations),
• Determinants (causes & factors influencing health events), and
• Dynamics of health-related states or events in specified populations,
and the application of this study to control health problems.
 Uses of Epidemiology:
• Determine the extent of disease in the community
• Measure trends of diseases over time
• Identify etiology and risk factors
• Study natural history and prognosis
• Identify community health needs
• Develop a rational basis for public policy & prevention programs
• Evaluate preventive and therapeutic measures
 Important Definitions:
• Health (WHO): Complete physical, mental & social well-being, not merely
absence of disease
• Infection: Entry & multiplication of an agent in the body (may not cause illness)
• Endemic: Constant presence of a disease in a specific area/population
• Epidemic: Excess number of cases above expected in a location/time period
• Outbreak: Localized epidemic in a confined area (e.g., school, hospital)
• Pandemic: Epidemic across multiple countries/regions
• Zoonoses: Diseases transmitted from vertebrate animals to humans (e.g.,
rabies, TB, brucellosis)

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 Etiology of Diseases:
1. Communicable Diseases → Epidemiologic Triad
• Disease occurs through interaction of:
o Host: age, sex, socioeconomic status, etc.
o Agent: bacteria, viruses, protozoa
o Environment: temperature, humidity,
water, air, poverty, etc.
• Chain of Infection:
Agent → leaves reservoir → portal of exit → mode of transmission → portal
of entry → susceptible host → symptoms after incubation
2. Non-Communicable Diseases
• Caused by multiple causal mechanisms
• Each cause must be sufficient to produce disease
• Each mechanism consists of risk factors = behaviors, attributes, or exposures
increasing disease probability
 Natural History of Disease:
• Phases
o Etiological Period: Exposure to causal factors
o Pre-pathogenic Period: Disease begins, no symptoms yet
o Pathogenic Period: Cellular/tissue changes, still asymptomatic
o Clinical Period: Signs & symptoms appear → ends as: Recovery, Disability or
Death. Clinical Period Stages:
1. Prodromal: Early, non-
specific symptoms
2. Clinical: Specific signs →
diagnosis & treatment
3. Convalescent: Recovery,
chronicity, or death

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Prevention and Control of Diseases:

 Types of Prevention:
1. Primary Prevention: Actions to prevent disease before it occurs in healthy
individuals.
A. General Prevention
o Health education & promotion
o Safe environment
o Good nutrition
o Effective healthcare delivery system
B. Specific Prevention
o Immunization
o Chemoprophylaxis
o Sero-prophylaxis
o Protection from occupational hazards (e.g., PPE like goggles)
2. Secondary Prevention: Actions to detect disease early (before symptoms or
with minimal symptoms) to make treatment easier & more effective.
Interventions:
I. Early diagnosis
o Screening tests
o Breast self-examination
o Pap smear
o Radiographic exams
o Mass Miniature Radiography
II. Treatment
3. Tertiary Prevention: Measures to reduce impairments and disabilities and
promote rehabilitation.
o Includes treatment of complications & rehabilitation
o Sequence: Disease → Impairment → Disability → Handicap
o Types of Rehabilitation: Medical, Social, Psychological
o Example: Prompt treatment + physical therapy to prevent complications

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 Types of Control:
• Measures Applied to Cases
o Case finding (early diagnosis)
o Reporting (notification to health authorities/WHO for notifiable diseases like
plague)
o Isolation (home or fever hospital depending on severity & home conditions)
o Disinfection (concurrent & terminal)
o Medical treatment
o Release after general condition improves
• Measures Applied to Carriers
o Detection
o Isolation & medical treatment
• Measures Applied to Contacts
o Listing all contacts
o Surveillance for maximum incubation period
o Manage anyone who develops disease as a case
o Screening to detect carriers (e.g., meningitis)
o Active measures: vaccination, chemoprophylaxis, sero-prophylaxis
o Health education on early signs & symptoms
• Measures Applied to the Environment
o Detect source of infection
o Water chlorination
o Supervision of food handlers

Epidemiological Tools for Community Health Assessment

 Disease screening
 Outbreak investigation
 Epidemic curve
 Surveillance systems

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L2 Epidemiology: Screening, Outbreak investigation

Screening for Diseases:
 Definition:
• Method for early detection of disease in an apparently healthy (asymptomatic)
population using a screening test to separate probable cases from non-cases.
• Screening tests are not diagnostic → positives must undergo confirmatory tests.
• Screening is part of Secondary Prevention.
 Uses of Screening Tests:
• Case detection
• Disease control
• Research
• Identify high-risk groups for
preventive intervention
 Types of Screening:
• Mass screening: Whole
population or large subgroups
• Selective screening: High-risk groups only (with well-known risk factors).
 WHO Principles of Screening:
A. Disease Characteristics:
• Public health importance
• High prevalence
• Long latent (asymptomatic) period
• Effective treatment exists and is more beneficial early
B. Test Characteristics:
• High validity Aspect Screening Test Diagnostic Test
(sensitive & specific) Aim Identify probable cases Confirm diagnosis
• Repeatable Population Apparently healthy With indication
• Low cost Application Groups Individuals
• Socially acceptable & Accuracy Less accurate More accurate
easy to perform Cost Less expensive More expensive

• No side effects or risks

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 Validity of a Screening Test:

• Validity = Sensitivity + Specificity
• Measured by comparing screening test with gold standard diagnostic test
• It is measured mainly during the stage of early introduction of a new test or
procedure.
• Example (Diabetes Screening): If we have 100 cases of diabetes mellitus & 100
persons free from disease, as proved by the glucose tolerance curve (golden
standard). We applied the proposed screening test, e.g. Glucose in a morning
urine sample, the results can be summarized in the following table:
 Sensitivity: Ability to Screening test Golden standard/Diagnostic Total
detect disease correctly Diseased (+) Disease-Free (−)
Test + a = 70 (True +ve) b = 10 (False +ve) 80
= a / (a + c) = 70 / 100
Test − c = 30 (False -ve) d = 90 (True -ve) 120
 Specificity: Ability to Total 100 100 200
detect non-diseased
correctly
= d / (b + d) = 90 / 100
 Note: Values >70% are
considered good.
 Predictive Values:
• It measures how this
screening test will function
well in the clinical encounter and population.
• what is the chance that a person with a +ve test truly has the disease? Or
• what is the chance that a person with a -ve test truly doesn’t have disease?
• Positive Predictive Value: (PPV) = True +ve / total positive by screening test
= A / (A + B) × 100
• Negative Predictive Value (NPV) = True -ve / total negative by screening test
= D / (C + D) × 100
• Influenced by disease prevalence
• Higher prevalence → higher PPV

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 Important Screening Tests:

• Antenatal care: Hb, BP, Rh, DM
• Infant period: Deafness, Blindness, PKU, TSH
• School children: Malnutrition, Parasitic diseases
• Middle age: HTN, DM, Colorectal cancer
• Women > 40 y: Breast cancer, Cervical cancer
• Elderly: Colorectal cancer

Outbreak Investigation

 Definition: An outbreak (epidemic) = an increase in disease above what is

expected in a specific population at a specific time.
 Objectives:
• Confirm that an outbreak has occurred
• Define the population at risk
• Identify the reservoir and method of spread
• Recommend prevention and control measures
 Steps in Investigating an Outbreak:
1. Prepare for fieldwork
2. Confirm the outbreak exists
3. Verify the diagnosis
4. Define, identify & count cases
5. Describe data by person, place &
time (Descriptive epidemiology)
6. Develop hypotheses
7. Evaluate & Prove hypotheses
(Analyze & interpret data)
8. Refine hypotheses & conduct additional studies
9. Implement control & prevention measures
[Link] findings, write a report, enter into NORS (National Outbreak
Reporting System)

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Epidemic Curve (Epi Curve):

 Definition: A frequency polygon showing number of cases by time of onset during
an outbreak.
 Importance:
• Pattern of spread
• Magnitude of the problem
• Outliers (early/late unrelated cases)
• Time trend (first case, peak, last case)
• Exposure/incubation period
• Mode of transmission
 Types of Epidemic Curves:
1. Common Source Outbreak: People exposed to the same source.
A. Point Source (Explosive)
o Exposure within one incubation period
o Rapid rise & fall (sharp peak)
o Example: Food poisoning at a single
event
B. Continuous Source (Progressive)
o Prolonged exposure
o Gradual rise, plateau, gradual fall
o May last >1 incubation period
o Example: Contaminated water
(Hepatitis A, Typhoid, Cholera)
2. Propagated Outbreak:
• Person-to-person transmission
• Successively taller peaks until the
pool of susceptible is exhausted or
control measures are implemented
• Time between peaks ≈ incubation
period
• Example: Measles, Mumps, COVID

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L3 Demography and Health Measures

Demography
 Definition:
• The statistical study of human populations
• Studies size, structure, distribution, and changes due to: Birth, Migration, Aging,
Death
 Importance of Studying Demography:
• Public health focuses on population health
• Requires studying population dynamics (factors changing size & characteristics),
such as: Aging, Teenage pregnancy, Urbanization, Refugees
 Data Collection Sources in Demography:
1. Census: National survey collecting and recording population data
2. Vital Registries: Births, deaths, and sometimes immigration & emigration
3. Household Surveys: Used when registries are absent or inaccurate (Common in
developing countries)
Census:
 Definition: National survey systematically collecting info of population members
 Data Collected
• Demographic: age, sex
• Social: marital status, occupation
• Economic: income
• Conducted usually every 10 years
 Census Methods:
1) De Facto 2) De Jure
o Counts individuals where found o Counts individuals where they usually
on census day reside
o Used in Egypt o Used in most Western countries
o Advantages: Easy to conduct, o Advantage: Reflects actual population
Avoids residence definition distribution
problems o Disadvantages:
o Disadvantage: Does not reflect  Difficult to conduct
actual population distribution  Requires extensive administrative work
during population movements  Problems defining “usual residence”

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Population Pyramid (Age-Sex Diagram):

 Definition:
• Diagram showing age and sex distribution of a population
• Two side-by-side bar graphs: Males (left), Females (right)
• Age shown in 5-year intervals
• Bar length represents number in each age-sex group
 Types of Population Pyramids:
1) Developing Countries (Young Population)
o Broad base, narrow apex
o High percentage of young
o Young population defined as:
 Ages 1–14 > 30%
 Ages ≥75 < 6%
o Example (Egypt, 2016): → Considered a young population
 1–14 years: 32.1%
 ≥75 years: 1.4%
2) Developed Countries
o Shape becomes more rectangular/column-like
o Nearly equal numbers in adjacent age groups
o Higher death rates begin after 65 years
o Pyramid shortens when mortality ↑ in younger age groups, not older ones
 Dependency:
• Dependent Age Groups
o <15 years (children in full-time education)
o >65 years (retirement age)
• Dependency Ratio
o Ratio of dependents (<15 & >65)
to
o Independent (15–65 years) population

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Demographic Measures

 Importance:
• Portray health-related problems in a population
• Identify high-risk groups
• Measure success of prevention and control measures
• Evaluate effects of intervention programs
 Types of Demographic Measures:
• Mortality rates
• Fertility rates
• Rate of natural increase
• Population growth
• Life expectancy (Expected remaining years of life at a given age under current
mortality rates)
 Estimation of Population Size Between Census Years:
• Balancing Equation: Used to estimate population at any time between
censuses, based on the number of births, deaths and migration.
• Population at year 2008 = population (at year 2006) + natural increase (from
2006 to 2008) + Net migration (from year 2006 to 2008)
• Natural increase = Births (during 2007+2008) – Deaths (during year 2007+2008)
• Net migration = Immigration (during 2007+2008) – emigration (2007+2008)
 Demographic Transition:
• Model describing population
changes over time
• Transition from high birth &
death rates (pre-industrial)
to low birth & death rates
(industrialized)
• Helps understand current
population growth and guide
economic & social policies

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• Stages of Demographic Transition

Feature Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

Birth Rate High (no High (low Rapidly falling Low Slowly falling
contraception; contraception; (women (urbanization)
high child child labor empowerment,
deaths) valued) education,
contraception)

Death Rate High (poor Falls (improved Falls (medical Low, Low,
healthcare) healthcare) advances) fluctuating fluctuating

Growth Rate ~ Zero Very high High Zero Negative

Life Expectancy Low Increased Increasing High High

Population Mostly young Predominantly More survive Aging More older

Structure young to older ages population than younger
increasing people

Overall Pattern Slow growth Rapid population Growth Stable Population

maintained by expansion slowing population decline
high birth rate

Population Problems in Egypt

 Main Problems:
• Rapid population growth (overpopulation)
• Unbalanced geographic distribution (Population lives on only 5.5% of Egypt’s
surface area)
 National Hazards of Overpopulation:
• Housing: Slums, unsanitary conditions, high crowding index
• Food supply: Increased imports, rising prices (especially animal protein)
• Education: Crowded schools, poor educational quality
• Public services: Overburdened, inadequate
• Employment: ↓ job opportunities (large young population, mechanization &
automation)
• ↑ violence, accidents, child labor
• ↑ endemicity of some diseases

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Measurements in Health & Disease (Health Indicators)

 Types of Health Indicators:

• Mortality indicators
• Morbidity indicators
• Fertility indicators
• Socio-economic indicators
• Other indicators: Nutritional status, Health care delivery, Utilization rates,
Behavioral & mental health, Environmental, Disability, Health policy, Quality of
life
Mortality Measures (Mortality is incidence of death):
Measure Numerator Denominator Multiplier
Crude Death Rate Total deaths (all causes) in a Mid-year population ×1000
year
Cause-Specific Death Rate Deaths from specific cause Mid-year population ×1000
Proportionate Mortality Rate Deaths from specific cause Total deaths (all causes) ×100
Case Fatality Rate Deaths from specific disease Diagnosed cases of same ×100
disease
Neonatal Mortality Rate Deaths <28 days Live births ×1000
Post-Neonatal Mortality Rate Deaths 28 days–<1 year Live births ×1000
Infant Mortality Rate Deaths <1 year Live births ×1000
Under-Five Mortality Rate Deaths <5 years Live births ×1000
Maternal Mortality Ratio Pregnancy-related deaths Live births ×100,000

Morbidity Rates:

1. Incidence Rate (IR)

• Measures risk of developing disease
• Used in follow-up studies

𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒏𝒏𝒏𝒏𝒏𝒏 𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄 𝒐𝒐𝒐𝒐 𝒂𝒂 𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅 𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅 𝒂𝒂 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔 𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑 𝒐𝒐𝒐𝒐 𝒕𝒕𝒕𝒕𝒕𝒕𝒕𝒕
IR = 𝒙𝒙 𝟏𝟏𝟏𝟏𝟏𝟏𝟏𝟏
𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑 𝒂𝒂𝒂𝒂 𝒓𝒓𝒓𝒓𝒓𝒓𝒓𝒓 𝒕𝒕𝒕𝒕 𝒕𝒕𝒕𝒕𝒕𝒕𝒕𝒕 𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅𝒅 𝒊𝒊𝒊𝒊 𝒕𝒕𝒕𝒕𝒕𝒕 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔 𝒕𝒕𝒕𝒕𝒕𝒕𝒕𝒕

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2. Attack Rate
• Specific type of incidence rate
• Used in epidemics/outbreaks
• Expressed as percentage
• Common in foodborne outbreaks (food-specific attack rates)
3. Prevalence Rate:
• Measures disease burden
• Used in cross-sectional studies
• Helps set intervention priorities
𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄 (𝒐𝒐𝒐𝒐𝒐𝒐+𝒏𝒏𝒏𝒏𝒏𝒏)𝒊𝒊𝒊𝒊 𝒕𝒕𝒕𝒕𝒕𝒕 𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑 𝒂𝒂𝒂𝒂 𝒂𝒂 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔 𝒕𝒕𝒕𝒕𝒕𝒕𝒕𝒕
Prevalence = 𝒙𝒙 𝟏𝟏𝟏𝟏𝟏𝟏𝟏𝟏
𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑 𝒂𝒂𝒂𝒂 𝒕𝒕𝒕𝒕𝒕𝒕𝒕𝒕 𝒕𝒕𝒕𝒕𝒕𝒕𝒕𝒕

• Types
o Point prevalence: At specific moment (e.g., Monday)
o Period prevalence: During time interval (e.g., January)
• Relationship: Prevalence rates are influenced by incidence
& disease duration.
o If incidence is steady & population stable: Prevalence = Incidence × Duration

Fertility Rates: Fertility: Reproductive performance of a woman.

1. Crude Birth Rate (CBR)

𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃 𝒊𝒊𝒊𝒊 𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚 𝒂𝒂𝒂𝒂𝒂𝒂 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍
CBR= 𝒙𝒙 𝟏𝟏𝟏𝟏𝟏𝟏𝟏𝟏
𝑴𝑴𝑴𝑴𝑴𝑴𝑴𝑴𝑴𝑴𝑴𝑴𝑴𝑴 𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑𝒑 𝒊𝒊𝒊𝒊 𝒕𝒕𝒕𝒕𝒕𝒕 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚 𝒂𝒂𝒂𝒂𝒂𝒂 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍

• Simple general indicator

• Used in population estimation between censuses
• Disadvantage: relates births to total population (not women only)
2. General Fertility Rate (GFR)
• Number of live births born to 1000 females in child bearing period (aged 15-49
years) in a certain year and locality.
• Disadvantage: ignores marital status & age fertility differences
𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃 𝒊𝒊𝒊𝒊 𝒂𝒂 𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚 𝒂𝒂𝒂𝒂𝒂𝒂 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍
GFR= 𝒙𝒙𝒙𝒙𝒙𝒙𝒙𝒙𝒙𝒙
𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇 (𝟏𝟏𝟏𝟏−𝟒𝟒𝟒𝟒 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚)𝒊𝒊𝒊𝒊 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚 𝒂𝒂𝒂𝒂𝒂𝒂 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍

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3. Fecundity Rate:
• It is the number of live births given by married women during the child bearing
period in a certain year and locality.

𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃 𝒊𝒊𝒊𝒊 𝒂𝒂 𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚 𝒂𝒂𝒂𝒂𝒂𝒂 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍

Fecundity rate = 𝒙𝒙 𝟏𝟏𝟏𝟏𝟏𝟏𝟏𝟏
𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒎𝒎𝒎𝒎𝒎𝒎𝒎𝒎𝒎𝒎𝒎𝒎𝒎𝒎 𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇 (𝟏𝟏𝟏𝟏−𝟒𝟒𝟒𝟒 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚)𝒊𝒊𝒊𝒊 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚 𝒂𝒂𝒂𝒂𝒂𝒂 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍

4. Age-Specific Fertility Rate (ASFR):

• Shows fertility differences by age group
• Example: 25–<30 years

𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃𝒃 𝒐𝒐𝒐𝒐 𝒘𝒘𝒘𝒘𝒘𝒘𝒘𝒘𝒘𝒘 𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂 𝟐𝟐𝟐𝟐−<𝟑𝟑𝟑𝟑 𝒊𝒊𝒊𝒊 𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄𝒄 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚 𝒂𝒂𝒂𝒂𝒂𝒂 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍
ASFR = 𝒙𝒙 𝟏𝟏𝟏𝟏𝟏𝟏𝟏𝟏
𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵𝑵 𝒐𝒐𝒐𝒐 𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇𝒇 𝒂𝒂𝒂𝒂𝒂𝒂𝒂𝒂 𝟐𝟐𝟐𝟐−<𝟑𝟑𝟑𝟑 𝒊𝒊𝒊𝒊 𝒔𝒔𝒔𝒔𝒔𝒔𝒔𝒔 𝒚𝒚𝒚𝒚𝒚𝒚𝒚𝒚 𝒂𝒂𝒂𝒂𝒂𝒂 𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍

5. Total Fertility Rate (TFR):

• Total number of children a woman would have if she experienced current
ASFRs throughout ages 15–49
• Calculated by summing ASFRs (7 five-year age groups)
6. Gross Reproduction Rate (GRR):
• The reproduction rates measure the replacement of the female population only
whereas, the previous fertility rates involve births of both sexes
• It is the average number of daughters per woman if she survived at least to the
end of her childbearing period and affected by current ASFR
• Calculated by multiplying the total fertility rate by the percent of females among
the live birth which is 49%
7. Net Reproduction Rate (NRR):
• Similar to GRR but accounts for female mortality before end of reproductive
period
• Calculated by:
o ASFR × age-specific survival rate
o Sum results to get the number of births from the surviving mothers
o Then multiply sum by 49%
• Ultimate Family Planning Goal is to reduce NRR = 1
→ Each generation exactly replaces itself with daughters.

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Causes of High Fertility in Egypt

 Rural socio-economic pattern (early marriage)

 High infant mortality (linked to high birth rate)
 Psychological apathy of poverty
 Ignorance & religious beliefs (children seen as God’s will)

Socio-Economic Indicators

 These indicators do not directly measure health however; they are important in
the interpretation of the indicators of health and health care These include
• Rate of natural increase
• Unemployment rate
• Total dependency ratio
• Illiteracy rate
• Mean family size
• Crowding index (persons per room)

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Epidemiology of Communicable Diseases

Introduction to Communicable Diseases:

Definition: the most important findings in the disease.

Pathogen (Infectious Agent):
1. Bacteria – e.g., meningococci, Salmonella typhi
2. Viruses – e.g., poliovirus, hepatitis A virus (HAV)
3. Parasites – e.g., Wuchereria bancrofti
 Resistance Outside the Body
• Mild – e.g., meningococci (easily destroyed by disinfectants like chlorine)
• Severe – e.g., tubercle bacilli
 Pathogenicity: Ability of organism to produce pathological changes inside the body.

Host Factors:
 Age:
• Most diseases occur at any age
• Some are age-specific:
o Typhoid → adults
o STDs → sexually active youth/adults
 Sex: Males more affected (greater exposure to pollution, overcrowding, risk
factors)
 Socioeconomic Status (SES): Low SES (poverty, low education, unemployment) →
higher risk
 Habits (Risk Factors)
• Hugging/kissing → droplet infections
• Unprotected sex → STDs
• Eating unwashed raw vegetables/fruits
• Improperly cooked food → foodborne diseases

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 Immunity:
• Congenital (Passive Maternal): From mother to baby: Temporary (≈6 months)
• After Infection: Varies by disease:
o Measles → lifelong
o Influenza → months
• After Immunization: Depends on: Disease, Vaccine type, Vaccine efficacy, Host
response, Examples:
o Yellow fever, measles, rubella → lifelong
o Typhoid vaccine → 2–3 years
• Subclinical Infection
o Common in endemic areas
o May cause carrier state + immunity
o Examples: typhoid, polio, HAV
• Additional Risk Factors
o Malnutrition → lowers resistance; may activate latent TB
o Occupations → healthcare workers, farmers, night guards
Environmental Factors:
 Types: Physical, Biological, Social, Chemical
 Examples
• Respiratory diseases → overcrowding, poor housing
• Foodborne diseases → water pollution, poor sewage, contaminated food/milk
• Arthropod-borne diseases → vector breeding sites
 NB: Some diseases (e.g., STDs) are not directly related to environmental factors.
Reservoir of Infection: Habitat where the infectious agent lives, grows, and multiplies.
A) Human
• Case – typical or atypical (undiagnosed)
• Carrier – infected person without symptoms but capable of transmission
B) Animal (Zoonotic Diseases)
• Primarily infect animals; may accidentally infect humans.
• Examples: rabies, brucellosis, bovine TB
C) Environmental
• Plants, water, soil
• Example: soil → tetanus spores

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Source of Infection:
 Patient excreta: Blood, Semen, Stool
 NB: In indirect droplet infection, the reservoir is the source.
Period of Infectivity: Varies by disease.
 May occur during: Incubation, Illness, Convalescence
 Example: Typhoid → infectious during all three stages.
Portal of Exit: Route by which pathogen leaves the host.
 Respiratory discharge → respiratory diseases
 Stool → foodborne diseases
• Vomiting (cholera) • Urine (typhoid)
 Blood, semen, vaginal discharge → STDs
Modes of Transmission:
A) Droplet Infection:
1. Direct (Most Common)
• Coughing, sneezing, talking, Within 2 meters
• Example: meningococcal infection
2. Indirect: Contaminated utensils/fomites
3. Airborne
• Dust or droplet nuclei suspended in air
• Depends on organism viability
o Delicate organisms (mumps, meningitis) survive poorly outside body
B) Foodborne Transmission:
• Mechanical transmission (flies, cockroaches)
• Contaminated hands (food handlers)
• Contaminated food, milk, water
• Contaminated utensils
C) Sexually Transmitted Diseases (STDs):
• Sexual intercourse
• Blood transfusion
• Maternofetal transmission
D) Arthropod-Borne Diseases
• Bite of infected insect
• After extrinsic incubation period inside insect

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Portal of Entry: How pathogen enters host.

 Respiratory → nasopharynx
 Foodborne → oral cavity
 STDs → blood, skin/mucosal breaks, transplacental (AIDS, hepatitis B)
 Arthropod-borne → skin
Incubation Period (IP):
 Definition: Time between infection and first symptom.
 Varies by Disease
• HIV → up to 10 years
• Typhoid → 1–2 weeks
• Influenza → 1–3 days
 Importance
• Used in contact tracing
• Contacts monitored for maximum incubation period.
Clinical Picture & Complications:
 Signs and symptoms vary by disease.
 Onset of symptoms marks transition from subclinical → clinical disease.
 Most diagnoses occur during the clinical stage.
 Disease spectrum: may remain asymptomatic or range from mild to severe.
Diagnosis: Based on:
 Clinical manifestations
 Laboratory investigations:
• Serology (antigen/antibody detection)
• Bacteriological exam (urine, stool, blood)
• X-ray examination
Seasonal Variation
 Droplet infections → winter
 Foodborne diseases → summer
 STDs → all year
Prognosis
1. Cure 3. Complications
2. Carrier state 4. Death

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Prevention & Control of Communicable Diseases

 Prevention: measures to prevent occurrence.
 Control: measures to prevent transmission or complications after occurrence.
Primary Prevention:
A) Droplet Diseases
• Prevent overcrowding
• Ensure ventilation & good housing
• Improve SES (education, employment, income)
• Health education: Handwashing, Cough etiquette, Mask use, Proper distancing
B) Foodborne Diseases
• Eradicate fly breeding sites
• Periodic medical exam for food handlers
• Vehicle sanitation:
o Pasteurize milk, Chlorinate water (1 ppm; 4–6 ppm in epidemics)
• Food safety: Clean, Separate, Cook, Chill
• Proper sewage & waste disposal
• Improve SES
• Health & environmental sanitation education
C) STDs
• Social welfare & health education
• Promote prevention of illegal sexual relations
• Facilitate early marriage, recreation, employment
• Sanitary precautions during invasive procedures (dental, surgical, tattooing,
piercing)
• Prevent IV drug abuse, prostitution
D) Blood-Borne Infections
I. Standard Precautions
o Consider all patients potentially infected
o Use PPE (gloves, gowns, masks, eyewear, face shields)
o Change gloves between patients
o Wash hands after contact
o Properly discard and label contaminated articles

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II. Safe Injection Practices

o Use safety-engineered devices
o Use disposable finger punctures/materials once
o Avoid needle recapping
o Dispose sharps in puncture-proof containers (for incineration)
o Limit injections; prefer oral therapy when possible
III. Infection Control & Surveillance
o Strict infection control in healthcare settings
o Establish surveillance units for:
 Reporting needle-stick injuries
 Training & education
 Source tracing & testing, Follow-up
 Vaccination & post-exposure prophylaxis
o Blood bank safety:
 Screen donated blood
 Self-exclusion education
 Monitor post-transfusion hepatitis
o Sterilize instruments (surgery, dialysis, endoscopy, dental, OB/GYN)
IV. Safe Medical Waste Management
o Never dispose loose sharps in public/household trash or toilets
o Protect workers, household members, children
V. Community Health Education
o Avoid high-risk behaviors:
 Sharing razors, scissors, toothbrushes
 Tattooing, piercing, IV drug use
o Understand transmission risks
o Vaccination:
 Infant immunization (EPI)
 Catch-up vaccination
 Vaccinate high-risk groups (e.g., healthcare workers)
 Awareness of post-exposure prophylaxis
o Safe sharps use & disposal
VI. Screen pregnant women for blood-borne diseases

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E) Arthropod-Borne Diseases
• Eliminate vector breeding sites
• Use insecticides
• Health education in endemic areas:
o Protective clothing, Bed nets, Repellents on exposed skin
Specific Prevention:
1) Vaccination (Active Immunization): For each vaccine, consider:
• Nature: killed, live attenuated, toxoid, or special preparation (e.g., Hepatitis B)
• Dose: 0.5 mL for all injectable vaccines except BCG (0.1 mL)
• Route: Intradermal (ID), Intramuscular (IM), Subcutaneous (SC), Oral
• Site: Left/right shoulder, left/right thigh, oral cavity
• Schedule: of doses
• Indications: e.g., infants, travelers to endemic areas
• Side Effects: None or mild—pain at injection site, fatigue, headache, myalgia,
chills, joint pain, fever, nausea, malaise, lymphadenopathy
• Note: DPT commonly causes fever, pain, and swelling at injection site.
• Contraindication:
o Temporary: pregnancy, corticosteroids, cytotoxic drugs, severe diarrhea,
high fever
o Permanent: immunocompromised → no live attenuated vaccines
2) Sero-Prophylaxis (Passive Immunization)
• Definition: Ready-made antibodies → short-term protection (3–6 months).
Not a substitute for vaccination.
• Uses
o After exposure (usually)
o Before travel to endemic hepatitis A areas
o Example: Gamma globulin
• Role
o Given in 1st half of incubation period → prevents disease (sero-prevention)
o Given in 2nd half of IP → mild disease (sero-attenuation), e.g., measles
• Provides rapid, temporary, specific protection.
• Note: No sero-prophylaxis in bacterial diseases except tetanus (neutralizes
exotoxin).

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3) Chemoprophylaxis
• Definition: Use of drugs to prevent infection (pre- or post-exposure); temporary
protection.
• Examples
o Rifampicin → meningococcal meningitis
o INH → tuberculosis
o Tetracycline → cholera
o Chloroquine → malaria
• Note: No chemoprophylaxis in viral diseases.
Secondary Prevention
 Early case detection (screening of apparently healthy individuals)
 Proper treatment to prevent complications
Tertiary Prevention (Rehabilitation)
 For diseases like polio, TB
 Medical, social, and occupational rehabilitation
International Preventive Measures
 International Health Regulations (IHR)
• Prevent international spread of infectious diseases
• Define criteria for PHEIC (Public Health Emergency of International Concern)
 Quarantine (Historically): Cholera, yellow fever, plague
 Yellow Fever Measures
• Disinfection of aircraft
• Quarantine for imported monkeys
• Valid vaccination certificate required
• If absent → 6-day quarantine (international IP)
 Recent IHR Legal Instructions
• Wild poliomyelitis
• SARS
• COVID-19

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Control Measures:
 Measures Applied to Cases
• Early case finding (clinical/lab diagnosis)
• Notification: Local Health Office (LHO), WHO (for IHR diseases)
• Isolation (home or hospital)
• Disinfection
o Concurrent: during illness (e.g., alcohol, Dettol on infectious materials)
o Terminal: after recovery or death
• Treatment
o Specific (e.g., antibiotics for bacterial infections)
o Symptomatic (e.g., antipyretics)
o Supportive (e.g., fluids in gastroenteritis)
• Release Criteria
o Clinical recovery
o Good general condition
o Bacteriologically free
o Foodborne diseases → 3 consecutive negative stool cultures
 Measures Applied to Carriers: Same measures as cases
 Measures Applied to Animal Reservoirs:
• Eradication (rodents, stray dogs/cats, diseased cattle)
• Surveillance and management of farm/pet animals
 Measures Applied to Contacts:
• Contact: person exposed during incubation period.
o List contacts (age, sex, vaccination status)
o Detect carriers (e.g., enteric fever)
o Observe for maximum IP (surveillance)
o Exclude from work when necessary (e.g., food handler with typhoid)
o Treat if symptoms develop (manage as case)
 Environmental Measures:
• Identify infection source
• Improve SES
• Health education on transmission
• Environmental sanitation

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Viral respiratory infections

Feature COVID-19 Chickenpox (Varicella) Influenza

Definition Infectious disease caused by SARS-CoV-2 Highly contagious disease with Contagious respiratory
(severe acute respiratory syndrome maculopapulovesicular rash illness caused by influenza
coronavirus 2); global pandemic viruses
Pathogen (Name & SARS-CoV-2; Varicella-zoster virus (VZV); Influenza A, B, C;
Resistance) Resistance outside: survives 3 hrs in droplets, Resistance outside: mild Resistance outside: mild;
up to 3 days on surfaces; killed by 70% alcohol; frequent mutations; no
variants (e.g., Delta: more infections, spreads cross-immunity
faster, more severe)
Host (Age, Sex, Any age; mild in children; severe in elderly; Mainly childhood; Immunity:
Immunity) mortality ↑ in males; lifelong immunity after infection/vaccine post-infection immunity
vaccine immunity 6–8 months; strain-specific & short (few
post-infection immunity 3 months–5 yrs months);
vaccine immunity developed
after 2 wks & lasts for season
[Link] As respiratory diseases
Reservoir Humans (cases + carriers: asymp. cases + Human cases only; no carrier Human cases: type A,B,C
children); possible animal reservoir (e.g., (no carrier);
minks) Animals: Influenza A also in
animals (birds, pigs, etc.)
subtypes based on
Hemagglutinin &
Neuraminidase proteins
Period of Peaks 2 days before to 1 day after symptoms; 2 days before rash until all lesions crust (~6 1 day before symptoms to
Communicability declines within 7 days days) 5–7 days after

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Feature COVID-19 Chickenpox (Varicella) Influenza

Portal of Exit / MOT / General Respiratory Respiratory secretions + vesicle fluid; General Respiratory
Entry droplets + contact
Incubation Period 2–14 days 2–3 weeks 1–4 days
Clinical Picture Fever, cough, dyspnea, loss of taste/smell, GI Pre-eruptive fever → Eruptive pleomorphic Sudden fever, myalgia,
symptoms; wide severity range irritating centripetal rash (macule→papule respiratory symptoms
(6-12hrs)→vesicle(1-2days)→crust (no scar))
Complications Pneumonia, ARDS, septic shock, fibrosis, heart Secondary bacterial infection, pneumonia, Sinusitis, otitis media,
failure; mortality up to 50% in critical cases. encephalitis (↑ in immunocompromised) pneumonia, myocarditis,
Older adults, underlying medical conditions at encephalitis, multi-organ
more risk failure
Diagnosis Clinical: new-onset of fever and/or respiratory Clinical: Rash; Clinical mainly;
tract symptoms Lab: IgM, virus isolation Lab: RIDTs, rapid molecular
Lab: NAAT (PCR), antigen test assays
Seasonal Variation As respiratory diseases As respiratory diseases Seasonal outbreaks
Prognosis Cure common; severe in elderly/comorbid; Usually cure; rare death Usually cure; complications
silent carriers possible (HF, pneumonia)
Prevention Primary: General, Specific: COVID vaccines Primary: General, Specific: Live attenuated Annual vaccine (inactivated
(safe, reduce severity); general prevention vaccine (0.5 ml SC, 2 doses); SC or live nasal); immunity
Secondary: General Seroprophylaxis: VZIG within 3–5 days post- after 2 weeks
exposure
Control Cases: release 10 days after symp. onset and General General
after fever resolution for 24 hours; Contacts:
tracing; quarantine 14 days; testing contacts

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Point of Comparison Mumps Measles (Rubeola) Rubella (German measles)

Definition Acute, self-limited systemic viral illness Acute, highly infectious systemic viral Acute, self-limited systemic viral illness;
with non-suppurative parotid swelling. Its illness. most benign childhood infection.
incidence in all age groups decreased after Incidence dropped in developed countries incidence in all age groups decreased
vaccination era after vaccination era

Pathogen Name: Mumps virus (single-strain RNA) Name: Measles virus (single-strain RNA) Name: Rubella virus (single-strain RNA)
Resistance: Mild to disinfectants Resistance: Moderate Resistance: Mild

Host Age: Early childhood, 10–14 yrs Immunity: Same as mumps but no Age: Childhood
Sex: Equal (CNS complications more in subclinical infection Sex: More in females
males) Immunity: Maternal passive
immunity <1 year; lifelong after infection
or vaccination

[Link] General

Reservoir Human cases (typical/atypical), subclinical Human: cases only (no carriers) Human: cases; asymptomatic in 20-30%
(asymptomatic in 20-30%), CRS infants act as carriers
Carriers: incubatory carriers

Period of 7 days (2 before parotitis, 5 after) 9 days (4 before rash, 5 after) 11 days (7 before rash, 4 after); CRS
Communicability infants infectious up to 1 year

Portal of Exit / MOT / Exit: respiratory secretions + saliva MOT: Respiratory droplets Respiratory droplets + transplacental
Entry droplets (no airborne)

Incubation Period 2–3 weeks (avg 18 days) 7–14 days (avg 10 days) 2–3 weeks

Clinical Picture Low fever, headache, myalgia → Pre-eruptive stage: 3 C’s (cough, coryza, Called 3 days of measles
parotitis ± other salivary glands conjunctivitis) + Koplik spots → Mild fever, headache, fine rash,

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Point of Comparison Mumps Measles (Rubeola) Rubella (German measles)

Eruptive stage: maculopapular rash suboccipital lymphadenopathy

starting behind ears then face at hairline 25-50% asymptomatic
then spread down to rest of body
Convalescent stage: fever subside, rash
fade

Complications Especially in adults Otitis media, diarrhea, pneumonia, Adults: Arthritis, thrombocytopenic
Orchitis (→ atrophy), oophoritis, mastitis, encephalitis purpura;
pancreatitis, aseptic meningitis, deafness, Pregnant: CRS, abortion, stillbirth
abortion

Diagnosis Clinical: Parotitis Clinical: Koplik spots + facial rash Clinical: Rash + suboccipital nodes Lab:
Lab: IgM; virus isolation (throat swab, Lab: ELISA antibodies Serology for antigen/antibody
urine, CSF)

Seasonal Variation General

Prognosis Usually self-limiting, Usually benign; fatality <5% Mild; severe in pregnancy
complications, deaths are rare

Prevention MMR vaccine (live attenuated) MMR vaccine Lifelong humoral immunity MMR vaccine Lifelong humoral
after 7 days (95%, 99% after 1st and 2nd immunity (77%, 88% after 1st and 2nd
doses) doses)
Post-exposure Ig: 0.25 mL/kg IM early in Sero-prophylaxis recommended in
IP early pregnancy

Control General General General + protection of pregnant

women

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COVID Vaccines:

Vaccine Nature Dose Indication Effectiveness Storage

(s) (Age) Temperature
Sputnik V Non-replicating viral vector 2 ≥ 18 years 92% 2–8°C

Oxford/AstraZeneca Non-replicating viral vector 2 ≥ 18 years 90% 2–8°C

Sinopharm Inactivated vaccine 2 ≥ 18 years 78% 2–8°C

Sinovac Inactivated vaccine 2 ≥ 18 years 65% 2–8°C
Johnson & Johnson Non-replicating viral vector 1 ≥ 18 years 66% 2–8°C
(Janssen)
Pfizer-BioNTech mRNA vaccine 2 ≥ 6 months 95% −70°C
Moderna mRNA vaccine 2 ≥ 18 years 95% −20°C

Chickenpox (Varicella) Vaccination:

1. Varivax®:
• For routine 2-dose schedule:
o 12–15 months
o 4–6 years
• Also for adolescents and adults
2. ProQuad® (MMRV):
• Combination: measles, mumps, rubella, varicella
• Licensed for children 12 months–12 years
• Immunity
o Solid lifelong immunity
o ~90% protection after 2nd dose
• Indications
o Children <13 years o Correctional institution inmates
o Healthcare professionals & staff
o Caregivers of o Military personnel
immunocompromised persons o Non-pregnant women of
o Teachers & childcare workers childbearing age
o Nursing home residents & staff o Adolescents/adults living with
o College students children
o International travelers

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Herpes Zoster (Shingles):

 Pathogen: Varicella-zoster virus (VZV)
 Mode of Transmission
• Reactivation of dormant VZV after prior chickenpox
• Not primary infection
 Clinical Picture
• Rash in 1–2 adjacent dermatomes (localized zoster)
• Common on trunk (thoracic dermatome)
• Does not cross midline
• Painful, itchy, or tingling
• Vesicular clusters form over 3–5 days
• Crust and heal in 2–4 weeks
• Possible permanent pigmentation and scarring
 Complication: Postherpetic Neuralgia (PHN):
• Pain >90 days after rash onset
• May last weeks, months, or years
 Infectivity
• Can transmit VZV to non-immune persons
• Spread by:
o Direct contact with vesicle fluid
o Inhalation of virus particles
• Exposed individuals develop chickenpox, not shingles
MMR Vaccine (Measles, Mumps, Rubella):
 Nature: Live attenuated
 Dose: 0.5 mL
 Route/Site: SC, right arm
 Schedule (Egypt): Compulsory, 2 doses: 12th and 18th months
 Indications
• Infants
• Older children
• Adolescent boys & girls (per school/state regulations)
• Premarital females
• Married females: 1 dose ≥3 months before expected pregnancy

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Sign / Symptom Common Cold Influenza (Flu)

Symptom Onset Gradual Abrupt
Fever Rare Usual; lasts 3–4 days
Aches Slight Usual; often severe
Chills Uncommon Fairly common
Fatigue / Weakness Sometimes Usual
Sneezing Common Sometimes
Chest Discomfort / Cough Mild to moderate; hacking cough Common; can be severe
Stuffy Nose Common Sometimes
Sore Throat Common Sometimes
Headache Rare Common

Influenza Vaccination (Active Immunization):

1) Injectable Vaccine
• Nature: Inactivated
• Dose: 0.5 mL annually, Children 6 months–8 years (not previously vaccinated): 2 doses
≥4 weeks apart
• Route: SC
• Immunity: develops after 2 weeks
• Schedule (Egypt): Not compulsory; annual, ideally by end of October
• Recommended for: All ≥6 months without contraindications
• Contraindications:
o Age <6 months
o Severe allergy to vaccine components
2) Nasal Spray Vaccine:
• Nature: Live attenuated
• Dose: Single annual dose
• Route/Site: Nasal spray (nasal cavity)
• Recommended for: 2–49 years
• Contraindicated in:
o Pregnant women
o Immunocompromised
o <2 years or >50 years

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Community Medicine MED Squad Team

Bacterial Respiratory Infections

Meningococcal Meningitis Tuberculosis (TB) Streptococcal Sore Throat

Definition Inflammation of meninges Chronic, occupational, reemerging, social Acute bacterial disease, often
(brain/spinal cord membranes). disease (pulmonary/extrapulmonary). endemic or sporadic. In
developing countries
Pathogen Neisseria meningitidis (A, B, C, Mycobacterium (tuberculosis, bovis, avian). Group A Streptococcus (S.
(Name & Y, W-135, X). Severely resistant outside body; killed by pyogenes).
Resistance) Very delicate; low resistance heat/boiling, pasteurization. Moderate resistance outside
outside body. the body.
Host Factors Immunity: Immunity: Age: Children 5–15 years most
Congenital (6mo), Congenital: None (cell-mediated) common.
Post-infection: life-long (strain- Post-infection: not protective Immunity:
specific), Post-vaccine: incomplete/variable Post-infection: Partial
Post-vaccine (3yr). immunity protection
Occupations: scientists, Age: Extreme ages (young/old); more No vaccine.
technologists common in males. Malnutrition, debilitating
disease increase susceptibility.
Occupations: health care providers,
farmers, agricultural workers.
Environmental Crowded living (dorms, General General
Factors barracks, boarding schools).
"Meningitis belt" in sub-
Saharan Africa

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Community Medicine MED Squad Team

Meningococcal Meningitis Tuberculosis (TB) Streptococcal Sore Throat

Reservoir Humans only (Cases: Humans (Cases, No carriers) Humans (Cases/Carriers) and
typical/atypical; Carriers Animals (diseased cattle—M. bovis). Animals (diseased
(Meningococci frequently cattle/contaminated milk).
inhabit the pharynx): 10%
endemic, higher in epidemics).
Period of Until 24 hours after starting As long as bacilli are discharged in sputum; 2–3 weeks in untreated,
infectivity appropriate antimicrobial ttt. shortened/ended by proper treatment. uncomplicated cases.
Exit, MOT, Entry Exit: Resp. discharges. Exit: Resp. discharges. Exit: Resp. discharges.
MOT: Droplet (not airborne MOT: Droplet + ingestion (milk). Entry: MOT: Droplet + ingestion (milk).
due to fragility). Nasopharynx/Oral cavity. Entry: Nasopharynx/Oral cavity.
Entry: Nasopharynx.
IP 2–10 days. 4–6 weeks (to develop primary infection). 1–5 days.
Clinical Picture 3 stages: Not all infected get symptoms. Fever, sore throat, painful
1. Invasion: mild fever, sore swallowing, red tonsils/pus, red
TB Disease: Dry cough for 3wks, then
throat (recovery in 80%) spots on palate, swollen LNs,
hemoptysis, chest pain, night sweats/fever,
2. Septicemia sudden may have scarlet fever skin
weight loss.
rash/fever, headache, flushing rash.
(recovery in 80%) TB Latency: no symptoms, can’t spread
Complications: Tonsillar
3. Meningitis: fever, headache, disease.
abscess, swollen neck LNs,
stiff neck, vomiting,
Complications: affection of kidney, spine, sinusitis, ear infection,
photophobia, convulsions
brain. Can be fatal rheumatic fever, post-strept
Complications: in 10-20% of glomerulonephritis.
survivors: paralysis,
myocarditis, deafness, mental
retardation

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Community Medicine MED Squad Team

Meningococcal Meningitis Tuberculosis (TB) Streptococcal Sore Throat

Diagnosis Clinical: Neck rigidity, Clinical suspicion. Clinical suspicion.
Kernig’s/Brudzinski’s signs. Lab: TST/Blood (Quantiferon) test (+ve test Lab: Throat swab, rising ASO
Lab: CSF (turbid, low glucose, = person has been infected. It does not tell titer (indicates recent infection).
high protein), Blood/Throat if he has latent infection LTBI or TB disease),
culture. CXR (shadows),
Sputum culture (AFB).
Prognosis High mortality (70-85% Cure possible. Complications: Lung fibrosis, Cure or carrier state.
untreated; 10-15% treated). hemoptysis, death. Complications: Rheumatic fever
Sequelae: Deafness, paralysis. or kidney disease.
Prevention Vaccine (Conjugate or BCG Vaccine (ID, left arm). No vaccine. Chemoprophylaxis:
Polysaccharide). Chemoprophylaxis (INH) for high- Long-acting Penicillin 1200000
Chemoprophylaxis (Rifampin) risk/recent converters. IU IM every 2 weeks in winter to
for close contacts. prevent recurrence/rheumatic
activity.
Control Cases: Isolation (fever Cases: DOTS strategy (4 drugs INH, General
hospital). Treatment: Empiric Rifampicin, Pyrazinamide, Ethambutol) for
3rd gen cephalosporins 2mo, 2 for 4mo). Release after 3 negative
Contacts: active immunizations sputum cultures.
for contact school children in
Contacts: Surveillance by TST, X-ray,
threatening outbreaks,
sputum analysis
chemoprophylaxis for close
if TST -ve, give BCG
contacts
if TST +ve give INH

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Community Medicine MED Squad Team

Meningococcal Meningitis:

1. Vaccination (active immunization):

 Conjugate vaccine (new vaccine):

• Nature: Conjugate (monovalent A orC,
Tetravalent A, C, Y, W135)
• Dose: 0.5ml
• Mode of administration: SC.
• Schedule: every three years to
recommended groups
• Immunity: cellular and humoral.
• Indication: compulsory to all school
children and pilgrims.
• Side effects: general scheme.
• Note: B serotype is poorly
immunogenic so it is not present in the vaccine.
 Polysaccharide vaccine (old vaccine): available in some countries including Egypt.

2. Chemoprophylaxis:

 Drugs: Rifampin, ciprofloxacin, Rocephin, and ceftriaxone; as soon as possible,

ideally less than 24 hours after identification of index patient
 Target Group: To the close contacts of infected persons: Household members,
childcare center contacts, and anyone directly exposed to the patient’s oral
secretions during the 7 days before symptom onset
 Dose: * Rifampicin 600mg twice daily for 2 days.
• Rocephine 1 gm IV or IM for pregnant females.

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Community Medicine MED Squad Team

Tuberculosis:
Vaccination (active immunization): BCG vaccine (Bacillus, Calmette-Guerin)
 Nature: live attenutaed.
 Dose: 0.1 ml.
 Mode of administration: ID injection into left upper arm.
The vaccination usually leaves a small scar.
 Immunity: develop within 3 months after vaccination and lasts for 5-15 years.
 Indication: compulsory in Egypt in Figure9 BCG vaccination newborns during the
first 40 days of life, school children at 6 years, tuberculin-negative health care
workers, military recruits, and confined groups.
 Side effects: Some common side effects are fever and soreness or discharge from
the injection site. Serious side effects such as anaphylaxis and abscess with wrong
administration (SC instead of ID)
 Contraindications: refer to the general scheme.
Chemoprophylaxis:
 Drug of Choice: INH is the drug of choice.
 Dose: 5-10 mg/kg.
 Target: given to tuberculin-positive contacts, recent tuberculin converters, and
chronically debilitated patients for 6 months.
Secondary prevention: early diagnosis of cases by screening of at-risk (contacts to
cases, medical, paramedical personnel, people with chronic diseases) by mass
miniature radiography (MMR). People with suspected shadows should be followed by
chest x-ray and sputum culture. Followed by proper medical treatment.
Tertiary prevention: medical, social, and occupational rehabilitation.
Rheumatic fever (acute rheumatic fever)
 Definition: An autoimmune disease that can affect the heart, joints, brain, and skin.
 Development: Can develop if strep throat & scarlet fever infections are not treated
properly. Early diagnosis and treatment with antibiotics is key for prevention
 Transmission: People cannot catch a rheumatic fever from someone else because it
is an immune response and not an infection.
 Prophylaxis: People may need antibiotic prophylaxis for many years (often until 21
years old).

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Community Medicine MED Squad Team

Bacterial Foodborne Infections

Typhoid Fever (Enteric Fever) Brucellosis (Undulant Fever) Cholera

Definition Acute infectious disease; Zoonotic disease (no man-to-man Acute infectious disease linked
food/water-borne. Endemic in transmission). Also known as Malta to inadequate
Egypt. or Mediterranean fever. water/sanitation. Subject to
IHR.

Pathogen (Name, Salmonella typhi & Paratyphi. Brucella spp: Aerobic coccobacillus Vibrio cholerae (2 biotypes:
Resistance) Moderate resistance. It has 3 (melitensis > sheep > highest Classic & El Tor).
antigens: Somatic (O Ag), Flagellar pathogenicity Moderate resistance; survives
(H Ag), Surface (Vi Ag) , suis > pigs > high pathogenicity, in food/water for 1-14 days.
abortus > cattle > moderate, canis in icebox for 1-35 days
> dogs > moderate).. Moderate
resistance.

Host Factors Immunity: Previous attacks are not Occupations: Butchers, vets, hunters. Immunity:
protective. Immunity: Long-lasting. Congenital (temp 6 months).
Post-infection, vaccination:
relative, short immunity.
Classic type protects; El Tor
does not protect against
recurrence.

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Community Medicine MED Squad Team

Typhoid Fever (Enteric Fever) Brucellosis (Undulant Fever) Cholera

Reservoir Human: Cases (Typical/Atypical) & Animals: Infected cattle, goats, Human: Cases
Carriers (Fecal/Urinary). Food sheep, pigs, dogs. (Typical/Atypical) & Carriers.
handlers are most dangerous.

Period of From 1st week through No man-to-man transmission. As long as stool cultures are
Communicability convalescence. positive.

Exit, MOT, Entry Exit: Stool, urine. Exit: Animal urine, milk, meat. MOT: Exit: Stool, vomitus.
Contact, ingestion (raw milk),
inhalation.
Entry: Mouth, skin breaks,
conjunctiva, resp. tract.

Incubation Period 1–2 weeks. 2–4 weeks. Few hours to 5 days.

Clinical Picture Stepladder fever (39-40°C), coated Up-and-down (undulant) fever Most are asymptomatic
tongue, rash, splenomegaly, (FUO), sweating, fatigue, arthralgia
Painless rice-water diarrhea,
constipation/diarrhea. (joint pain).
vomiting, severe dehydration.
Total duration of illness 3-4 weeks,
Constitutional symptoms: anorexia, No fever.
10% of patients showed relapses.
asthenia, fatigue, weakness, and
With the new models of treatment, Complications: dehydration,
malaise, lymphadenopathy,
symptoms improved within 1-2 renal failure, hypovolemic
hepatomegaly, splenomegaly, weight
days and complete recovery within shock
loss and, arthralgias
10 days

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Community Medicine MED Squad Team

Typhoid Fever (Enteric Fever) Brucellosis (Undulant Fever) Cholera

Complications: intestinal Complications: arthritis, hepatitis

perforation, intestinal hemorrhage, osteomyelitis, endocarditis
hepatitis, cholecystitis, myocarditis,
shock, encephalopathy, pneumonia,
anemia.
Diagnosis (Clinical, Lab: Culture (Blood, urine, stool). Lab: Isolation of bacteria from blood. Lab: Dark field microscopy of
Lab) Widal test is obsolete. fresh stool.

Seasonal Variation General scheme. No seasonal differences. General scheme.

Prognosis Cure; Carriers (12%); Death (1-2%). Case fatality and chronicity are rare. Cure; Case fatality <5%.
No carrier state.

Prevention Vaccines (Vi PS & Ty21a). Primary: Vaccination of cattle/sheep. Vaccines (Vaxchora, Dukoral).
Note: about treatment old regimen Specific: No human vaccine.
was ampicillin, chloramphenicol, or
Bactrim.
New regimen as Cipro and Levaquin
or cephalosporins

Control General Cases: Doxycycline + Rifampin (45 General

days).
Contacts: enlistment, supervison
Community: Animal supervision.

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Item type Staphylococcal food poisoning Salmonella food poisoning Botulism

Definition The commonest form of food poisoning causes One of the common food Rare, highly fatal food
outbreaks in confined groups. poisonings. intoxication.
Pathogen (the Preformed exotoxin of Staphylococcus aureus Salmonella typhimurium and Exotoxin, neurotoxin, of
infectious bacteria. Salmonella enteritidis. Clostridium botulinum
agent) The exotoxin is thermostable. Moderate resistance. (anaerobic, spore-forming
bacilli).
Name:
Severe resistance.
Resistance
outside the
body:
Reservoir of Humans: Humans: Cases, Carriers Animal: excreta of animals in soil
infection: Cases with skin or respiratory infection. Animal: rodents, cattle, Soil: habitat of C. botulinum.
Carriers more than 5% of the population have swine, and poultry. cultivated crops may get
nasal or skin foci of infection. contaminated with these spores
from the soil.
Animal: infected cattle with staphylococcal
mastitis, contaminating the milk.
Period of No direct man-to-man transmission.
infectivity
Type of food Milk, cream, pastries, cakes. Which was Meat, meat products, eggs, Preserved vegetables, packed
contaminated by the staphylococcal organism and chicken are contaminated and canned meat or fish (Fessikh)
and the food was kept unrefrigerated at room by salmonella. contaminated by Clostridium.
temperature.
Incubation 2-4 hours. 12-30 hours. 12-36 hours.
Period (IP)

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Clinical Picture Sudden onset of acute gastroenteritis, with Sudden onset of acute Sudden onset of neurological
severe nausea, abdominal cramps, vomiting, gastroenteritis, with nausea, manifestations (visual
and diarrhea, with no or mild fever. severe abdominal cramps, disturbance, dysphagia,
vomiting, and diarrhea, with dysphonia)
no or mild fever.
Complications Dehydration Respiratory paralysis
Diagnosis Clinical: Clinical picture + history of eating the Clinical: Clinical picture +
same type of food. history of eating the same
Lab: Isolation of bacteria from stool or vomitus. type of food.
Lab: Isolation of bacteria from
food remnants.
Prognosis Self-limiting disease. The highly fatal disease,
fatality up to 70% due to
respiratory failure.
Specific No specific preventive measures. Seroprevention of anyone
prevention eats from this food by IV
polyvalent botulism antitoxin
serum as soon as possible.

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Community Medicine MED Squad Team

Bacillary Dysentery (Shigellosis):

 Definition: Acute infectious inflammatory bacterial disease of the colon.

 Pathogen: Shigella dysenteriae; moderate resistance outside the body.
 Epidemiology: Refer to general scheme for Host, Environment, Portal of Exit/Entry,
and Transmission.
 Reservoir: Humans (Cases and Carriers).
 Infectivity Period: Throughout the entire disease duration.
 Incubation Period (IP): 1–7 days.
 Clinical Picture: Sudden onset fever, tenesmus (squeezing pain, frequent loose
scanty stools with blood/mucus), and dehydration.
 Complications: Arthritis, nephritis, and dehydration.
 Diagnosis: Clinical picture and stool culture.
 Prognosis: Usually cure; complications and fatalities are rare.
 Prevention & Control: No specific measures; refer to general scheme.

Feature Amoebic Dysentery Bacillary Dysentery

Agent E. histolytica Shigella group

IP 3–4 weeks (min. 10 days) 1–7 days

Onset Insidious Sudden

Fever Usually absent Moderate to high

Stools Liquid, bulky, blood-streaked mucus Loose, scanty, bloody mucus

Motions/24h 3–4 Variable (can be >12)

Pain Less acute Grasping or squeezing

Complications Liver abscesses Uncommon (e.g., arthritis)

Course Usually chronic Acute attack (some chronic)

Treatment Flagyl (Metronidazole) Tetracycline

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Typhoid Prevention:

 Specific Prevention (Active Immunization):

• Vi Capsular Polysaccharide (ViCPS):
o Nature: Inactivated; Dose: 0.5ml IM.
o Schedule: 1 dose ≥2 weeks before travel; booster every 2 years.
o Indications: Travelers, close contacts, lab workers, children >2 years.
• Live Oral Vaccine (Ty21a):
o Nature: Live attenuated; Dose: 4 capsules (one every other day).
o Administration: Oral, 1 hour before meals with cold water; do not chew.
o Schedule: Finish ≥1 week before travel; booster every 5 years.
o Indications: Same as ViCPS, but for children >6 years.

Cholera Prevention:

 Active Immunization:
• Vaxchora®: Live attenuated, single oral dose for adults (18–64) traveling to
active transmission areas.
• WHO Approved (UN Supply): Dukoral®, ShanChol®, and Euvichol-Plus®
(inactivated/non-live).
• Note: Vaccination does not replace food/water safety (not 100% protective).
 Chemoprophylaxis: Single 1g dose of Tetracycline for contacts, travelers, and
returning pilgrims.

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Community Medicine MED Squad Team

Viral Food-borne Infections

Hepatitis A Poliomyelitis

Definition Acute, usually self-limiting disease; Acute viral disease; limited to 3 countries (Afghanistan, Pakistan,
40-50% of acute viral hepatitis; Nigeria) following improved vaccination.
endemic in Egypt.

Pathogen Name: Hepatitis A virus. Name: Poliovirus serotypes (types 1, 2, and 3) with no cross-immunity.
Resistance: Moderate to Resistance: Moderate to disinfectants; destroyed by heat and
disinfectants like chlorine. chlorine.

Host Age: Common in young children. Age: Less than 3 years.

Immunity: Congenital (fades within Immunity: Congenital (fades within 6 months); lifelong type-specific
6 months); lifelong after manifest after infection or immunization (2nd attack is rare).
disease, subclinical infection, or
immunization.

Reservoir Human: Clinical cases (typical, Human: Clinical cases (typical or atypical/undiagnosed). Carrier state is
atypical). No carriers (virus is present but details were unspecified in the text.
completely discharged in stool).

Period of Last half of the incubation period Throat: Last days of incubation and 1 week post-infection.
Communicability and one week after the onset of Stool: Last days of incubation and 4 weeks post-infection.
jaundice.

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Community Medicine MED Squad Team

Portal of Exit, Blood-borne transmission can Exit: Stools (developing countries); respiratory discharge (developed).
MOT, Entry occur during viremia, though less MOT: Foodborne (developing); droplet (developed). & transplacental
common). Entry: Oral cavity (developing); nasopharynx (developed).
Incubation 14–28 days (about one month). 1–3 weeks (average 13 days).
Period

Clinical Picture Ranges from asymptomatic to Invades small intestine lymph nodes, enters bloodstream, infects CNS
severe. Symptoms: fever, malaise, (anterior horn cells). Forms:
anorexia, diarrhea, nausea, Inapparent (70%): asymptomatic,
abdominal discomfort, dark urine, Minor/Abortive (24%): nonspecific illness, no clinical or lab evidence
jaundice. of CNS invasion, complete recovery in 1 wk + specific lifelong immunity
Non-paralytic: (<1%; spinal or bulbar): fever subside in 3-5 days and
Complications: Relapsing,
+ve kernig & Brudzinski signs
fulminant, or chronic hepatitis.
Paralytic: virus invades CNS, > fatigue, headache, neck stiffness, pain
in the limb causing total paralysis. < 1% of all polio infections in
children result in flaccid paralysis
Spinal paralysis: typically asymmetrical, more severe proximally,
associated with absent or reduced deep tendon reflexes and intact
sensation.
Bulbar paralysis: damage of the brain stem and medulla leads to
defects in the cranial nerves and medullary center.
Complications: Encephalitis (motor cortex affection)
Note: Paralytic disease may be caused by wild-type polioviruses,
attenuated polioviruses in the oral vaccine, or by vaccine-derived
polioviruses

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Community Medicine MED Squad Team

Diagnosis Clinical: Jaundice and discoloration. Clinical: Suspect in any case with acute flaccid paralysis.
Lab: Serological isolation of the Lab: Isolation of the virus in throat or stool swabs.
virus antigen or antibodies.
Prognosis Cure or complication; fatality is In abortive/nonparalytic forms: Complete recovery
rare. In paralytic polio: <25% severe permanent disability, ~25% mild
disability, >50% recover without residual paralysis.
Prevention Vaccination (active immunization): Specific (Vaccines):
- Nature: inactivated vaccine. 1. Inactivated poliovirus vaccine (IPV) (Salk):
- Dose: 0.5 ml 2 or 3 doses, 6 - Nature: formalin killed vaccine. Contains serotypes 1, 2, and 3.
months apart. IM in deltoid. - IM or SC in front of the thigh, 2, 4 months, compulsory in Egypt.
- Immunity: very effective up to - Immunity: Humoral immunity only circulates antibodies in the
100%. blood.
- Indication: recommended for - Efficacy: >90% immune after 2 doses At least 99% immune after 3
high-risk populations include doses.
international travelers 6 months - Contraindication: Severe allergic reaction to a vaccine component
of age or older going to or following a prior dose of vaccine.
countries where hepatitis A Oral poliovirus vaccine (OPV) (Sabin):
infection is common, also food - Nature: live attenuated.
handlers, and during epidemics. - Dose: 2 drops on the tongue at birth, 2nd, 4th , 6th , 9th month, 1
- Note: Not compulsory in Egypt. year, and 1.5 years.
Seroprophylaxis (pre/post- - Immunity: Cellular, humoral, and to the community.
exposure for contacts/travelers). - Efficacy: Up to 95% lifelong immunity.
- Contraindication: Pregnant woman, immune-compromised
Control No specific antiviral therapy Eradication in Egypt achieved via mass vaccination, IPV+OPV
currently available). scheduling, AFP surveillance, and environmental sewage surveillance).

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Community Medicine MED Squad Team

Blood-borne Infections
AIDS (HIV) Hepatitis B (HBV) Hepatitis C (HCV)
Definition Incurable but controllable with proper medical Vaccine-preventable bloodborne Highly endemic in Egypt (14.7%
care. pathogen. adult prevalence in 2008).
Pathogen Name: HIV (RNA virus) Name: HBV (DNA virus) Name: HCV (RNA virus)
Resistance: Mild; easily killed by disinfectants. Resistance: Mild; destroyed Resistance: Mild; destroyed
immediately by 70% alcohol. immediately by 70% alcohol.
Host Immunity: Weakens immune system by Occupation: Medical personnel at Occupation: Medical personnel
destroying immunity system cells. risk. at risk.
Immunity: Immunity:
lifelong after infection, variable after infection (second
95% protection after vaccine. attacks possible), no vaccine.
Reservoir Human (Case, Carrier). Human (Case, Carrier with high Human (Case, Carrier with high
risk of cirrhosis/HCC). risk of cirrhosis/HCC).
Communic From stage 2 and 3 illness through the patient’s As long as HBsAg is positive. 1 week before symptoms,
ability entire life. during acute attack, and all
chronic patients.
Exit, MOT, General General MOT: As HBV, but
Entry sexual/maternofetal
transmission is uncommon.
Incubation Up to 10 years. 2 to 3 months. 2 weeks to 6 months.

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Community Medicine MED Squad Team

Clinical Stage 1: Acute HIV: Acute: Flu-like/asymptomatic. Similar to HBV. Chronic

Picture Flu-like/asymptomatic, fever, chills, rash, aches, infection present in about 70%
Chronic: Carrier or cirrhosis.
swollen LNs. Within 2-4 weeks after infection, l of patients.
(jaundice, fatigue, abdominal
asts for few days to several weeks
pain, nausea, joint pain)
Stage 2: Chronic HIV Asymptomatic/latency for 2-
Complications: Cirrhosis, HCC.
7 days, billions of viruses shed every day
Stage 3: AIDS: Severe opportunistic
infections/malignancies. (Kaposi sarcoma)
Diagnosis Clinical: History, opportunistic infections. Clinical: History, liver cirrhosis. Clinical: History, liver cirrhosis.
Lab: Rapid tests, viral load, Lab:
Western blot (specific but less sensitive), CD4 < HBsAg: infectious, if persist > 6
200, months > chronic carrier state.
Lab: Positive HCV antibodies,
T4/T3 ratio < 1/2. HBeAg: highly infectious.
PCR to detect HCV RNA.
HBsAb +ve: immunity.
HBcAb IgM: recent infection.
HBeAb: evidence of recovery.
Prognosis ~3 years survival without treatment. Cure, carrier, complications Cure, carrier, complications
(cirrhosis, HCC), death. (cirrhosis, HCC), death.
Prevention Specific: No vaccine. PEP within 72 hours of Specific: HBV vaccine, Specific: No specific measures
exposure. Seroprophylaxis. available.
Control Cases: Lifelong ART, treat opportunistic infections General scheme. General scheme.
Contacts: Follow-up every 3 years.

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Community Medicine MED Squad Team

Active immunization: HBV vaccine:

 Nature: recombinant HBsAg, synthetically made from surface protein.

 Dose: 0.5ml
 Mode and site: IM in the arm in adults, and front of the right thigh in infants.
 Schedule:
• In adults: 3 doses, schedule 0, 1 month after the first dose, and 6 months after
the second dose.
• In infants (in Egypt):3 doses, at 0 day, 2, 4, and 6 months as a part of the
pentavalent vaccine.
 Immunity: very effective up to 95%.
 Indications: compulsory for Egyptian children It is also recommended to risk
groups; such as health care providers, Susceptible household contacts of hepatitis
B-positive persons, and patients on hemodialysis.
 Contraindications: allergy to a vaccine.

HBV Seroprophylaxis:

 Postexposure prophylaxis with human-specific antibodies.

 Recommended to infants borne to HBsAg positive mothers, after sexual intercourse
with HBsAg positive partners, and after needle prick injury from contaminated
syringe of HBsAg positive patient.
 Note: combined seroprophlaxis and vaccine are given to:
• infants born to infected mothers within 12 hours after birth to avoid chronic
carrier state.
• Post-exposure prophylaxis if the person was not vaccinated before.

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Community Medicine MED Squad Team

Sexually-Transmitted Infections
Gonorrhea Syphilis
Definition Sexually transmitted infection (STI); present worldwide. Chronic systemic disease; present worldwide.
Pathogen Name: Neisseria gonorrhoeae (Gram-negative intracellular Name: Treponema pallidum.
diplococci). Resistance: Mild resistance to disinfectants outside the
Resistance: Mild resistance to disinfectants outside the body. body.
Reservoir Human: Cases (acute, chronic). No carriers. Human: Cases (acute, chronic).
Period of As long as the organism is present in the discharge. May persist for several years.
Communicability
Portal of Exit, General Modes of Transmission: Refer to the general scheme +
MOT, Entry transplacental + direct contact with infectious mucosal
and cutaneous lesion secretions.
IP 2 to 8 days. 9 to 90 days.
Clinical Picture May be asymptomatic. 1ry acquired: Painless, round chancre with an indurated
Males: Urethritis (purulent discharge, painful urination). base and painless regional lymph node enlargement.
Females: Cervicitis, urethritis, vaginal discharge. Can lead to 2ry acquired: Fever, malaise, headache, maculopapular
PID, chronic pelvic pain, ectopic pregnancies, tubal factor rash (flexors > extensors), tender swollen regional
infertility. lymph nodes.
Infants: Neonatal ophthalmia (corneal perforation, blindness). Tertiary: Gummas affecting internal organs (CVS, bones,
Complications: Bacteremia, systemic involvement, septic etc.).
arthritis, endocarditis, meningitis, urethral stricture (males). Congenital: Hutchinson's teeth, rash, depressed nose,
perforated hard palate, deafness, abortion, stillbirth.
Diagnosis Clinical: Clinical picture. Clinical: Clinical picture.
Laboratory: Nucleic acid amplification testing (NAAT). Laboratory: Microscopical detection with dark ground
illumination. Serological detection of antibodies (e.g.,
VDRL test).
Prognosis Without treatment, may develop serious complications.
Prevention Specific: Chemoprophylaxis of sexual partners with antibiotics.

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Community Medicine MED Squad Team

Diseases Representing Contact Infections

Rabies Tetanus (Lockjaw) Ebola Monkeypox

Definition Vaccine-preventable viral Uncommon but serious Rare and highly fatal Viral zoonotic disease; primarily in
disease; >150 countries (95% disease caused by hemorrhagic viral disease tropical rainforests of central/west
in Asia/Africa). bacterial spores in soil. (up to 90% fatality). Africa.

Pathogen Name: Rabies virus Name: Clostridium tetani Name: Ebolavirus Name: Monkeypox virus (DNA
(neurotropic). (anaerobic spore-forming (filoviridae family). virus).
Resistance: Moderate. gram-positive). Resistance: Moderate. Resistance: Less resistant than
Resistance: Severe. smallpox.

Host General General General General + more common in

Occupation: Farmers, Occupation: Health homosexual men.
soldiers. workers lacking proper Occupation: Healthcare workers
infection control while dealing with infected persons or
caring for ebola patients specimens

Environmental General. General + more common Present in sub-Saharan More common in central and west
Factors in rural areas. African countries. Africa.

Reservoir Animal: Dogs, cats, rodents. Environment: Spores in Human: Cases. Human: Infected cases.
soil, dust, manure. They Animal: Infected fruit Animal: Rats, dogs, squirrels,
develop into bacteria bats, nonhuman monkeys.
when entering the body primates. (apes, monkeys)

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Period of No human-to-human No human-to-human While blood/secretions As long as skin lesions are present.
Communicability transmission. transmission. contain virus (semen up
to 7 weeks post-
recovery).
Portal of Exit, Exit: Saliva of infected Exit: Intestinal excreta of Exit: Mucous membranes, Exit: Body fluids, respiratory
MOT, Entry animals. animals/man. broken skin. discharge, lesions.
MOT: Bites/scratches via MOT: Wound MOT: Direct contact with MOT: Close contact with
saliva. contamination with soil infected blood/body lesions/fluids/droplets,
Entry: Wounds spores. fluids of a person sick or transplacental, sexual (homo).
(percutaneous). Entry: Wounds. died with ebola Entry: Broken skin, mucous
Entry: Broken skin, membranes.
mucous membranes.
Incubation 1 week to 1 year (depends on 1-3 weeks (shorter with 2 to 21 days. 5 to 21 days.
Period entry site and viral load). heavier contamination)
Clinical Picture Spreads to CNS. Jaw muscle spasms Sudden fever, severe Self-limited (2-4 wks). Fever,
Furious: Hyperactivity, ("lockjaw"), painful headache, muscle pain, headache, lymphadenopathy. Rash
hydrophobia, aerophobia. stiffness, seizures, weakness, vomiting, erupts 3 days after fever (macules
Death via cardiopulmonary headache, fever. diarrhea, stomach pain, → papules → vesicles → pustules →
arrest. Complications: rash, unexplained crusts) on face, extremities, palms,
Paralytic (20%): Gradual Laryngospasm, bone bleeding. soles, oral mucosa. Not on trunk
muscle paralysis from bite fractures, breathing Complications: Impaired Complications: Secondary
site, coma, death. (often difficulty. (Neonatal: kidney and liver function. infections, bronchopneumonia,
misdiagnosed, inability to suck, trismus, sepsis, encephalitis.
underreported) risus sardonicus,
Complications: Death 100% opisthotonos).
if no treatment

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Diagnosis Clinical: Hydrophobia, Clinical: Mainly clinical. Clinical: Symptoms + Clinical: Differentiate from other
aerophobia. exposure within 21 days skin eruptions.
Lab: Fluorescent antibody before onset of symptoms Lab: PCR from skin lesions.
test, Negri bodies in animal Lab: Low WBCs/platelets,
brain smear. elevated liver enzymes.
Viral isolation by cell
culture, ELISA for
antibodies.

Prognosis 100% fatal in unvaccinated 1 to 2 in 10 cases are fatal Fatal up to 90%. Case fatality is around 3-6%.
cases. (10-20%).

Prevention General: Wound General: Wound care. General: Avoid contact General: General + avoid contact
management (clean 15 Specific: Tetanus toxoid with infected with lesions/wild animals.
mins), observe animal 10 (active immunization), fluids/animals, use PPE, Specific: JYNNEOS vaccine (
days, dog vaccination, ATS or TIG cook meat properly. modified attenuated vaccinia virus
education. (seroprophylaxis), Specific: Ervebo (rVSV- (Ankara strain) due to cross-
Specific: HDCV vaccine Penicillin ZEBOV) vaccine single protection afforded for the immune
(active) & RIG (chemoprophylaxis). dose for adults ≥18. response to orthopoxviruses) (
(seroprophylaxis). (recommended for lab 0.5 ml, ID or SC 2 doses, 4 weeks
and healthcare personnel) apart).

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Community Medicine MED Squad Team

Rabies Prevention
 General Prevention
• Bite Management: Animal bites risk transmitting rabies, tetanus, and pyogenic
infections. Wash wounds promptly with soap and water for at least 15 minutes.
• Wound Care: Have healthcare professionals debride necrotic tissue or dirt.
Antibiotics are often needed to prevent local/systemic infections. Never suture
the wound unless it is lifesaving.
• Evaluation: Check the patient's rabies and tetanus immunization history.
Observe the animal for 10 days for rabies symptoms or death.
• Dog Vaccination: Vaccinating dogs is the most cost-effective method to
eliminate human rabies.
• Education: Promote awareness on dog bite prevention, immediate post-bite
care
 Specific Prevention: Active Immunization (HDCV)
• Nature: Inactivated virus (Human Diploid Cell Vaccine).
• Dose & Mode: 1 ml per dose; ID (pre-exposure) or IM (regular).
• Site: Deltoid area for adults; anterolateral thigh for children under 5 years.
• Recommended For: High-risk occupations, such as laboratory workers.
• Unimmunized Schedule: 5 doses given on days 0, 3, 7, 14, and 28.
• Previously Immunized Schedule: 2 doses given on days 0 and 3.
• Discontinuation: Vaccination can be stopped if the animal shows no rabies
symptoms or dies within the 10-day observation period.
 Specific Prevention: Seroprophylaxis (RIG)
• Indications: Required for bites on the neck/face, deep wounds, multiple bites,
or bites from an unknown animal.
• Administration: Infiltrate half the dose around the wound(s) and inject the
remainder Intramuscularly at a distant site (anterolateral thigh).
• Precaution: Never mix RIG in the same syringe as the vaccine, as it suppresses
active antibody production.
• Dose: 20 IU/kg of body weight (maximum 1500 IU).
• Timing: Administer from day 0 up to a maximum of 7 days after the first vaccine
dose.

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Tetanus Prevention
 Primary Prevention
• General: Standard wound care.
• Specific: CDC recommends lifelong tetanus booster shots for people of all ages.
 Active Immunization (Tetanus Toxoid)
• Nature: Toxoid.
• Dose & Mode: 0.5 ml; Subcutaneous (SC) or Intramuscular (IM) injection.
• Egypt Schedule: Compulsory in the infant pentavalent vaccine (2, 4, and 6
months) and DPT vaccine (18 months).
• Pregnancy Schedule: 2 doses (0.5 ml SC) given at least one month apart after
the first trimester to protect the fetus from neonatal tetanus.
• Recommended For: Children, military forces, agricultural workers, pregnant
women
 Seroprophylaxis & Chemoprophylaxis
• Seroprophylaxis: Antitetanic serum (1500–3000 IU) or Tetanus IG (250 units).
• Chemoprophylaxis: A single IM dose of long-acting penicillin (1,200,000 IU) to
halt the organism's local activity.
• Control: Refer to the general control scheme.
Tetanus Neonatorum (Neonatal Tetanus)
 Source: Infection typically follows the contamination of the
umbilical stump.
 Global Impact: A major cause of mortality in developing
countries, causing ~180,000 deaths annually.
 Symptoms (3–28 days post-birth): Inability to breastfeed,
excessive crying, trismus (lockjaw), risus sardonicus (forced
grin) & opisthotonos (backward arching of spine)
 Complications: Autonomic nervous system dysfunction
(hypertension, abnormal pulse) and respiratory failure due to
larynx/respiratory muscle spasms.
 Prognosis: The case-fatality rate approaches 100% without treatment.
 Prevention: Ensure clean, aseptic deliveries and maternal Tetanus Toxoid
vaccination.

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 Community Medicine MED Squad Team

Diseases Representing Vector-borne Infections

Filaria Malaria Yellow Fever Leishmania Plague
Definition Eliminated as a Re-emerging disease. Follows int. health Tropical, neglected Arthropod-borne
public health regulations. Egypt is disease present in bacterial zoonotic
problem in Egypt. receptive but free Egypt. disease. Epidemic,
from it. follows int.
regulations.
Pathogen Name: W. bancrofti Name: Plasmodium Name: Yellow fever Name: Intracellular Name: Y. pestis
nematode. protozoa (Vivax, arbovirus. protozoa (Gram-negative
Vector: Culex Falciparum, Ovale, Vector: Aedes aegypti, (Leishmania genus). bacteria).
pipens mosquito. Malaria). Haemagogus Vector: Vector: Fleas
Vector: Female Anopheles mosquitoes. Phlebotomine sand (Xenopsylla cheopis).
mosquito. flies.
Reservoir Human: Cases only Human: Cases only Human: Cases only Human: Cases. Animal: Rodents.
(microfilaria in (gametocytes in blood). (urban). Animal: Various
blood). Animal: Monkeys species.
(jungle).
Period of No human-to- No human-to-human. No human-to-human. No human-to- No direct human-to-
Communicability human. Mosquito Mosquito infective after Mosquito infective human except human except in
infective after 2 10-12 days. after 10 days (intrinsic through vector. pneumonic plague.
weeks. IP).

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 Community Medicine MED Squad Team

Filaria Malaria Yellow Fever Leishmania Plague

Exit, MOT, Entry Exit: Blood. Exit: Blood. Exit: Blood. Exit: Blood. Exit: Blood,
MOT: Mosquito MOT: Mosquito bite MOT: Mosquito bite. MOT: Sand fly bite. respiratory.
bite (filariform (sporozoites). Entry: Skin. Entry: Skin. MOT: Flea bite,
larvae). Entry: Skin, blood, handling tissues,
Entry: Skin. transplant, congenital. inhalation.
Entry: Skin,
nasopharynx.
Incubation 1 year. 9–40 days (varies by 3–6 days 2–6 months. 1–6 days
Period species). (Internationally 6 d) (Internationally 6 d).
Clinical Picture Phases: Phases: Phases: ranges in Types: Types:
& Complications 1. Asymptomatic, 1. Rising fever, chills, severity from a self- 1. Cutaneous (skin 1. Bubonic: swollen
2. Acute: early malaise, headache, limited febrile illness sores/ ulcers): LNs (inguinal, axillary,
inflammatory: muscle, joint pain, rapidly to severe liver disease sores may start as cervical), rapid fever
fever, lymphangitis, rising temps end by with bleeding papules/nodules , 2. Pneumonic: high
lymphadenitis profuse sweat. Symptoms: fever, may end up as fever cough, bloody
3. Chronic: Late 2. Cycle of fever, chills jaundice, and bleeding ulcers covered by sputum, chills
obstructive (rupture daily/every other day/3rd from different sites. scabs/crust. 3. Septicemic: fever,
of lymphatic day (species-dependent). Complications: 2. Visceral/Kala- prostration,
vessels): 3. Relapses possible after Hepatorenal failure Azar (spleen, liver, hemorrhagic or
obstruction, edema, period of cure. (50% in epidemic & 5% marrow), thrombotic
elephantiasis. in endemic) 3. Mucosal: nose phenomena,
Complications: (common), mouse, progressing to acral
Physical/social throat gangrene
disability.

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 Community Medicine MED Squad Team

Filaria Malaria Yellow Fever Leishmania Plague

Diagnosis Clinical: Clinical: Presentation. Clinical: Difficult early. Clinical: Clinical: Presentation.
Presentation. Lab: Parasites in thick Lab: PCR (virus in Presentation. Lab: Culture (bubo,
Lab: Microfilariae in blood film; Serology blood/urine); IgM Lab: Microscopy of blood, sputum);
thick blood film (antibodies). antibodies later. tissue (skin sores, Serology (antigen).
(nocturnal sample). bone marrow for
visceral).
Seasonal Follows mosquito Follows mosquito vector Follows mosquito Follows female Follows flea vector
Variation vector presence. presence. vector presence. sand fly vector presence.
Endemic in YF belt. presence.
(tropical areas of
Africa and Central &
South America)
Prognosis Fatal disease. Fatal disease. 50% of complicated Fatal with Fatal with
cases die within 7-10 d complications complications
Prevention Specific: MDA Specific: Specific: 17 D live Specific: None General: Rodent-
(Albendazole Chemoprophylaxis for attenuated vaccine available. proofing of buildings,
400mg twice/year). travelers (0.5ml SC, single dose) gloves when handling
(Chloroquine/Mefloquine) animals.
begin 1-2 weeks before Specific: No vaccine.
travel, during stay, Post-exposure
continued for 4 weeks Tetracycline.
after leaving endemic
areas

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Community Medicine MED Squad Team

Lymphatic Filariasis Elimination in Egypt:

 Egypt is one of 17 countries officially acknowledged for eliminating lymphatic
filariasis as a public health problem.
 The WHO launched the Global Program to Eliminate Lymphatic Filariasis (GPELF) in
2000, based on annual mass treatment.
 Strategy component 1: Stop infection spread via large-scale annual treatment for
all eligible people in endemic regions.
 Strategy component 2: Provide a recommended essential care package to alleviate
disease suffering.
 Mass Drug Administration (MDA) is the WHO-recommended preventive
chemotherapy, treating the entire at-risk population annually.
 MDA medicines have limited impact on adult parasites but effectively reduce
microfilariae density in the blood, preventing transmission to mosquitoes.
 The specific MDA regimen is Albendazole (400 mg) alone twice per year.
Yellow Fever:
 Egypt is protected from yellow fever by an
ecological barrier formed by cross- immunity with
other Flaviviruses (e.g., Dengue, West Nile).
 Active immunization is achieved using the 17 D
yellow fever vaccine, which is a live attenuated
vaccine.
 The vaccine is administered as a single dose of 0.5ml subcutaneously (SC).
 It provides life-long immunity, reaching effective levels within 10 days for 80-100%
of recipients, and within 30 days for >99%.
 Vaccination is indicated for all travelers visiting endemic areas (the yellow fever
belt).
 The vaccine is strictly contraindicated for pregnant
women and immunocompromised individuals.

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