Center for Disease Control (CDC)

The center for disease control (CDC) is a federal agency that conducts and supports health
promotion, prevention and preparedness activities in the US with the goal of improving overall
public health.
Established in 1946 and its head quarter is located at Atlanta, Georgia. And it is managed by the
department of Health and Human services (HHS).
Aim of CDC: CDC works with partners at the local, state and national level to:
 Monitor and prevent disease outbreaks (Specially focus on the infectious disease, food
borne pathogens)
 Implement disease prevention strategies
 Maintain national health statistics.
Organization: CDC organized into “Centers, institutes and Offices”. And every unit has its own
area of expertise. E.g,
 Office of infectious disease
 Center for global health.
A 1952 polio epidemic killed 3,145 Americans and paralyzed another 21,000. But
by1955, American doctor Jonas Salk, who worked in collaboration with the CDC,
developed the first effective vaccine for polio. Polio was eradicated in the U.S. by 1979.

CDC and GLOBAL HEALTH

The CDC created partnership with many other international organizations such as World
health organization. The CDC is integral in working with WHO to establish the
International Health Regulations (IHR) which bind the 194 countries.

CDC in Pakistan
CDC has engaged with public health institutions in Pakistan to strengthen the public
health issues in Pakistan such as:
 Hepatitis surveillance
 Polio eradication
CDC placed staff in country in 2016 and also has strong partnerships with Aga Khan
University to do research in the areas of vaccinations and neonatal infections. CDC has
several projects related to bacterial diseases in Pakistan.
 Health policy
Definition: According to WHO “The decisions, plans and actions that are undertaken to
achieve specific health care goals within population/ community”
For example: To prevent an epidemic, a program for inoculating a population is
developed and implemented.
Types of policies:
 Personal health care policy
 Pharmaceutical policy
 Policies associated with public health such as vaccination policy & tobacco
control policy.

Health policy of Pakistan:

History of health policy in Pakistan:
In 1950, 1960 health system of Pakistan was US directed. Different campaigns / programs
were conducted.
Health policy 1990
First national policy focused on:
 health services
 family planning
 nutrition
 malaria control programs
 control of communicable diseases.
Health policy 1997
Second health policy focused on:
 Health promotion and education
 NCDS were highlighted for prevention and control.
Health policy 2001
focused on: to create mass communication awareness in public health matters and use
multimedia to provide information to public.
Health policy 2009 but it was not properly implemented because devolution of Ministry
of health occurs. Health was shifted from federal government to provisional government.
Ministry of national health services was established in 2012 April. It has many
departments such as Pharmacy council of Pakistan, National council of homeopathy and
Pakistan College of physician and surgeons.
Frame work of policy:

Agenda settings: Issue become as significant and draws the attention of policy makers.
Policy formulation: Different parties such as healthcare team, hospitals and government
are involved in the formulation of policy.
Policy selection: When policy is formed, then there should be proper reasoning why this
policy is chosen for population.
Policy implementation: when you implement the law or policy people are reluctant to
follow the rules.
Policy evaluation: Policy should be monitoring and evaluated for its successful or not.

Policy triangle

Context: Why need this policy.

Actors: Who participate in and influence
formulation and implementation of policy
Process: How was the policy brought
forward and implemented
Content: What is policy mainly about
Objectives of national health policy
 Achieve an acceptable standard for improved heath
 Increased access to public health system
 Create new health infrastructure
 Promote public private partnership
 Promote effective monitoring and evaluation of current policies
 Implementation of policies at district level
Challenges in developing countries
 Weak regulation and monitoring system
 Lack of purchasing power
 Influence of political system
 Reliance of external donor funds

Communicable diseases spread:

Direct contact
1- person to person contact
2- mother to unborn child through placenta
3- droplet spread.
Indirect contact:
1- Air borne transmission: some agents are suspended in air and transmit through long
distance. (measles, CHICKEN POX, TB, mumps)
2- Contaminated objects: used syringes, blades, door handles.
3- Contaminated food and water: E-coli
4- Animal to person contact:
5- Insects: mosquitoes (malaria)
Chapter # 3- Medical complication of drug taking
(General and socio-economic aspects)
Terminologies:
Drug taking: The activities of taking illegal drugs.
Stimulants: Stimulants are a class of drugs that increase the activity of the brain and the spinal
cord. E.g, cocaine, caffeine, amphetamine and its derivative.
Sedatives: Drugs that suppress anxiety and promote sleep; this includes benzodiazepines,
barbiturates
Hallucinogens: These drugs alter the user’s state of consciousness and creates a dream like
condition/state. E.g, LSD (Lysergic acid diethylamide), marijuana.
Drug addiction: It is the neuropsychological disorder that affects the brain, behavior of a
person and causes an inability to control the use of legal or illegal drugs or medicines.
Tolerance: A condition in which higher doses of a drug is required to produce the same effect
achieved during initial use.
Dependence: An adaptive physiological state that occurs with regular drug use.
Polysubstance abuse: The abuse of two or more drugs at the same time.
Withdrawal effects: Symptoms that occur after chronic use of a drug is reduced abruptly
or stopped.
Introduction:
Illegal use of drugs resulted in various health, social and economic adverse outcomes.
There are 4 main aspects of drug abuse.
1- Development of dependence and behavioral problems.
2- Medical complication (drug abuse can cause mortality and morbidity of various
diseases such as, HIV/AIDS, cancer, liver and heart diseases).
3- Financial problems such as drug abuser spends most of his money on drugs)
4- Drug abuse activities can influence a society in many ways such as ratio of broken
families, homelessness, crime, violence, drug trafficking (illegal trade of drugs) &
robbery was increased.
Medical complication associated with drug abuse
The major cause of medical complication regarding drug abuse is due to overdose of
that particular drug. E.g, Heroin + other CNS depressants (Alcohol &
benzodiazepine). The overdose is due to drug drug interactions. As mentioned above
CNS depressant may increase sedation, decrease respiration.
Medical complication of injected drug users
1-Abscess: Pus collected that build up within the tissue of the body at injection site.

2- Thromobo-phelibitis: A condition where an inflammation in a vein is caused by a

blood clot affecting normal blood flow.

3- Gangrene: Death body tissues due to lack of blood flow or serious bacterial
infection.
4- Septicemia: Serious bloodstream infection caused by bacteria.
5- Collapsed veins: It is because of repeated use of same vein, inappropriate
techniques.
 Medical complications associated with non-injected users
Intranasal: Nose bleeds, ulceration, rhinitis (inflammation of mucous membrane of
the nose), septal perforation, risk of transmission of hepatitis C if equipment is
shared.
Inhalation: Asphyxiation, aspiration, peri oral dermatitis (rash around the mouth).
Smoking: Respiratory infection, cough, cancer, burns, chronic lung disease
Oral: Gastric irritation
Other medical complications:
Effect on immunity: Some studies suggested that heroin may affect the immune
system of the body.
Vitamin & other nutritional deficiencies.
Shared syringes: Shared syringes can cause transmission of diseases from one
infected person to another. Such as, AIDS, Hepatitis B & C
Sexually transmissible infection and gynae problems: AIDS, gonorrhea, pelvic
inflammatory disease, menstrual irregularities are common among drug user’s community.
Tuberculosis: common in HIV infected injecting drug users.
Parasitic infections: malarial outbreaks are linked with sharing of needles.
Cardiovascular complications: tachycardia, vasoconstriction, rise in BP observed in users
of CNS stimulants.
Respiratory complications: all CNS drugs cause respiratory depression which in overdoses
life threatening.
Other infections: Tetanus, botulism (serious disease caused by toxin that attacks body
nerves) is common in drug user who inject SC with non sterile equipment, where microbes
find anaerobic environment.
Mental illness: Anti- social personality disorder and affective disorder (mood disorder) are
extremely common among drug users. visual disturbances, impairment of cognition
(confusion & memory lose) & psychomotor dysfunction (mental and physical function slow
down), interference with short term memory that is necessary for work performance.
Amphetamine and cocaine used is linked with acute paranoid psychosis (delusion develop
which may last for few days to month).

Health problems associated with opioids:

Opioid Examples:
  Natural or semi-synthetic: Morphine, codeine, hydrocodone, oxycodone,
hydromorphine
 Synthetic: fentanyl, methadone, propoxyphene
 Buprenorphine, tramadol
Clinical indications:
 Analgesic
 Anti-tussive (suppress cough reflex)
 Anti-diarrheal (Inhibit intestinal motility)
Dosage form available:
 Oral
 Transdermal
 Transmucosal
 Parenteral forms
 Quick onset
 Short acting
 Slower onset longer acting
 Sustained release medicine
Toxic (abuse) effects of opioids:
 Respiratory: Opiates suppress the respiratory center which is the main cause of death.
 Gastrointestinal: Nausea, vomiting and constipation are all side effects of opiate use.
 Tolerance and physical dependence: Tolerance develops rapidly in heroin users; they
shift snorting to injecting.
 Mentally: Sedation, Cognitive impairment.
 *Methadone suppresses saliva production. This coupled with lifestyle factors such as
poor oral hygiene can lead to dental problems.
Opioid withdrawal effects:
 Muscle aches, joint pains, sweating, stomach, cramping, diarrhea.
 Irritability, arousal, wakefulness
 Mild increase blood pressure and heart rate
 Mydriasis (Dilated pupils)

Health problems associated with stimulants (Cocaine and amphetamine)

Cocaine is the most commonly abused substance in the world. Methamphetamine is called as ice.

 Cardiac:
Hypertension (stimulants activate sympathetic autonomic activity resulting in increased
BP) & Arrhythmias
  Neurological: Due to raised blood pressure, headaches, strokes and cerebral bleeds may
occur. Amphetamine can also induce a psychotic state in some users.
 Respiratory: Smoking cannabis is linked to development of COPD (Chronic obstructive
pulmonary disease).
 Mentally: Anxiety, psychosis, seizures.
Medical Complication Associated with Alcohol:
Alcohol spares no body organs. Common complications include:
 Alcoholic liver diseases
 Cirrhosis
 Peptic ulcers
 Cardio myopathy
 Osteoporosis
Medical Complication associated with Nicotine:
Either smoked or chewed:
 Leading cause of LUNG Cancer
 Cancer of Oropharynx
 Peripheral vascular disease
 Peptic ulcer