respiratory infectionstill atleast 2 consecutive nose and throat swabs, atleast 24 hours apart are...

Respiratory Infections

Chickenpox

Agent Human Herpes Virus 3 or Varicella Zoster virus

Primary infection produces Chickenpox.

Reactivation- herpes zoster (shingles)

Source of infection Case of chickenpox

Communicable

period

2 days before rash to 5 days after

Secondary attack

rate

90%

Host Maximum- in children 4-10 years old.

Immunity One attack usually gives Life-long immunity

Mode of

transmission

Droplet infection, droplet nuclei

Contact- lesions of skin and mucosa

Congenital transmission

Incubation period 14-16 days (up to 3 weeks)

Case fatality Mortality in adults is 15 times higher as

compared to children

Pregnant women and immunosuppressed

Asymptomatic

infection

<5%

Rash Pleomorphism

Reservoir Human case; no animal reservoir

Maternal

Varicella

Infection during the first 28 weeks of gestation-

Congenital Varicella syndrome (CVS)

Infection late in gestation or immediately

following birth is referred to as 'neonatal

varicella'

Isolation Till scabbing or 6 days after rash

Immunization Varicella virus vaccine-

1-12 years – single dose

>12 years – 2 doses, atleast 4 weeks apart

Diagnosis IgM antibody

Treatment Acyclovir may be used in persons with

immunodeficiency, especially adults

Measles Agent Measles virus

Source of infection Case of measles (sub clinical- very rare)

No carriers

Mode of

transmission

Droplet infection and direct contact

Incubation period 8-15 days

Communicable

period

4 days before to 4 days after rash

Age 6 months 3 years

Clinical features Prodromal symptoms

Rash- maculo-papular

Koplik’s spots Bluish-white spots, on the buccal

mucosa opposite the first and second

lower molars

Complications Complications occur in 30% of cases

Most common complication- Otitis media

(10-15%)

Most serious complications - blindness,

encephalitis, severe diarrhea or severe

respiratory infections

Diagnosis anti-measles virus IgM antibodies

Treatment no specific treatment for measles.

Supportive care should be provided

Immunity Lifelong immunity

Control When measles incidence is less than 1

per 1 million.

Elimination Defined as absence of endemic measles

for a period of 12 or more months in the

presence of adequate surveillance

Measles Rubella campaign

Catch-up:

All the children between 9 months to 10 years will receive a supplementary dose of Measles-Rubella regardless of previous Measles vaccination or Measles illness

Keep-up:

To increase Measles-Rubella vaccination in routine immunization to more than 90% of successive birth cohorts

Follow-up:

every 3-5 years after catch-up phase, wherein all the children born after catch up phase and more than 9 months of age will be given an additional dose of Measles-Rubella vaccine regardless of previous Measles vaccination or Measles illness

Rubella Agent RNA Toga virus

Source of infection Mostly subclinical cases

Communicable

period

1 week before to 1 week after rash

Mode of

transmission

Droplet infection, droplet nuclei,

congenital transmission

Age 3-10 years

Immunity life-long immunity

Incubation period 18 days

Congenital rubella

syndrome

cataracts, sensorineural deafness);

cardiac and craniofacial anomalies

infection 4 weeks before conception to

20 weeks later

Diagnosis rubella IgM

Immunization Rubella containing vaccines

Priority

Women in reproductive ages –

Adolescent girls – School going girls -

infants

Mumps Agent Myxovirus parotiditis

Source of infection Clinical and subclinical cases (1/3rd)

Communicable

period

5 days before to 1 week after symptoms

onset

Secondary attack

rate

86%

Isolation Till swelling of parotids present

Age 5-9 years

Mode Droplet infection, direct contact

Incubation 18 days (up to 3 weeks)

Clinical features swelling of Parotids, Sublingual and

Submandibular gland

Complications Aseptic meningitis (50%)

Orchitis (50% post-pubertal males)

Oophoritis (5% of post-pubertal

females)

Diagnosis IgM antibodies

Reservoir Human cases, No carriers

Diphtheria

Agent Corynebacterium diphtheriae

Source of infection Carriers (95%) Cases (5%)

Communicable

period

Up to 4 weeks after disease onset

Modes of

transmission

Person to person through respiratory

droplet infection.

Age 1-5 years

Reservoir Human carriers and cases, no animal

reservoir

Incubation period 2-6 days

Clinical features Sore throat, cough, dysphonia or dysphagia

Characteristic membrane in the throat.

Diagnosis

Growth on Loeffler’s/Tellurite media

PCR test

Isolation

Till atleast 2 consecutive nose and throat

swabs, atleast 24 hours apart are negative.

Treatment Diphtheria antitoxin, 20,000-1 lac IU

Penicillin/ Erythromycin

Carriers management 10 days Erythromycin

Complications Systemic-

Diphtheric carditis, Diphtheric neuritis

Meningococcal Meningitis Agent Neisseria meningitidis

Source of

infection

Carriers (majority), Cases (minority)

Communicable

period

Till meningococci are absent from nasal/throat

swabs

Incubation

period

4 days (2-10 days)

Reservoir Human carriers. No Animal reservoir

Mode of

transmission

Droplet infection, close contact

Case fatality rate 9-12 %

Secondary attack

rate

2-3%

Temporal pattern late winter and early spring (dry season)

Age Children, mostly infants

Clinical

Presentation

stiff neck, high fever, sensitivity to light,

confusion, headaches and vomiting.

Management

Ceftriaxone is the drug of choice.

Carriers- Rifampicin

Pertussis Agent Bordetella pertussis, B. parapertussis

Source of infection Case- no subclinical case/ no carrier

Incubation period 7-10 days

Communicable

period

Up to 3 weeks

Age Infants and young children

Mode of transmission Droplet infection, direct contact

Incubation 1-2 weeks

Secondary attack

rate

90%

Reservoir Human cases

Clinical features Local disease

Catarrhal stage- 10 days

Paroxysmal stage – 2-4 weeks

Convalescent stage- 1-2 weeks

Complications Secondary bacterial pneumonia,

seizures, encephalopathy, otitis media,

anorexia and dehydration

Diagnosis Culture and PCR

Isolation 4 weeks

Management Cases- isolation

Cases- and contact- erythromycin – 10

days

All of the following statements are true about congenital rubella except- (AIPGME 2005, AIIMS 2011)

a)It is diagnosed when the infant has IgM antibodies at birth

b)It is diagnosed when IgG antibodies persist for more than 6 months

c)Most common congenital defects are deafness, cardiac malformations and cataract

d)Infection after 16 weeks of gestation results in major congenital defects

Recommended vaccination strategy for Rubella is to vaccinate first and foremost- (AIPGME 2007)

a)Women 15-49 years

b)Infants

c)Adolescent girls

d)Children 1-14 years

Which of the following is not true about measles? (AIPGME 2008)

a)High secondary attack rate

b)Only one strain causes infection

c)Not infectious in prodromal phase

d)Infection confers life-long immunity

Xavier and Yogender stay in the same hostel. Xavier develops infection with Group B meningococci. After a few days, Yogender develops infection due to Group C meningococci. All the following are true statements except- (AIPGME 2002)

a)Educate students about meningococcal transmission and take preventive measures

b)Chemoprophylaxis against both Group B and Group C

c)Vaccine prophylaxis of contact of Xavier

d)Vaccine prophylaxis of contact of Yogender

In Measles, when do the Koplik’s spots appear? (UPSC CMS 2011)

a)On the day that fever occurs

b)On the day that rashes appear

c)1-2 days before the rashes appear

d)1-2 days before the fever occurs

All of the following are true about varicella virus except (AIIMS 2010)

a)Prognosis is better when infection happens in early childhood

b)All stages of rash are seen at the same time

c)Secondary attack rate is 90%

d)Rash commonly seen in flexor area

Which of the following is least common complication of measles? (AIIMS 2007)

a)Diarrhea

b)Pneumonia

c)Otitis media

d)SSPE

True about Diphtheria are all except-

a)Carriers are more common sources of infection than cases

b)Incubation period is 2-6 days

c)Cows are the reservoir of infection

d)Diphtheria is an endemic disease in India

Recommended drug for chemoprophylaxis against H5N1 influenza is

a)Zanamivir

b)Oseltamivir

c)Amantadine

d)Rimantadine

All the following are complications of chickenpox, Except-

a)Varicella pneumonia in neonates

b)Cutaneous scars as birth defects

c)Reye’s syndrome

d)Macrocephaly in newborn following maternal varicella during pregnancy

MMR vaccine is recommended at the age of

a)9-12 months

b)16-24 months

c)2-3 years

d)10-19 years

Alimentary infections

Hepatitis A Causative agent Hepatitis A virus

Mode of

transmission

Feco-oral transmission

Commonest

Parenteral transmission

Sexual transmission amongst men

Incubation period 28 days

Reservoir of

infection

Cases of hepatitis A

Period of infectivity 1-2 weeks before onset to 3 weeks

after onset.

Clinical

features

Among children <6 years of age, most

(70%) infections are asymptomatic.

Among older children and adults,

infection is usually symptomatic with

jaundice occurring in >70% of patients.

Carrier No chronic or carrier state

Diagnosis anti-HAV IgM antibody

Vaccines Inactivated whole virus hepatitis A

vaccines

Combination vaccine with Hepatitis B is

also available.

Cholera

Agent Vibrio cholera O1, ElTor biotype, Ogawa

serotype; Vibrio parahemolyticus

Reservoir Human cases and carriers

Cases Most are mild and asymptomatic

Communicability 7 to 10 days

Host-age Highest incidence in children

Transmission Direct contact, through focally

contaminated water, food

Incubation period 1-2 days

Diagnosis Dark field microscopy or stool culture.

Treatment Oral rehydration solution / intravenous

fluids.

Adults – Doxycycline

Children- Cotrimoxazole

Pregnant- Furazolidone

Chemoprophylaxis- Tetracycline

Vaccines ShanChol, Dukoral

Oral, killed vaccine

Typhoid Agent Salmonella typhi, Salmonella paratyphi A&

B

Reservoir Man- cases and carriers

Carriers Incubatory carrier – 1 week

Convalescent carrier- 6-8 weeks

Chronic carriers- > 1 year

Infective material Urine and stool

Age 5-19 years, more in males

Incubation 10-14 days

Transmission Feco-oral, urine-oral

Diagnosis Blood culture, Widal

Treatment of

carriers

Ampicillin- 4-6 gm./day-6 weeks

Cholecystectomy

Treatment Cephalosporins – 3rd generation

Vaccine Vi polysaccharide vaccine- > 2 years,

single-dose, revaccination after 3

years, subcutaneously/IM

Regarding ETEC, true is (AIIMS 2010)

a)Invades sub-mucosa

b)Most common in children

c)Fomite borne

d)Not the most common cause of traveller's diarrhea

The false statement regarding oral cholera vaccine, Shanchol is-

a)It should not be used in infants

b)It needs to be administered in two doses 14 days apart

c)It is constitutionally same as mORCVAX vaccine

d)It provides some protection against ETEC infections.

Regarding Typhoid, the correct statement is-

a)Chronic carriers are those who excrete the bacilli for more than 6 months

b)Carrier rate is higher amongst males

c)Phage typing is epidemiologically useful in tracing the source of epidemic

d)Cell mediated immunity plays minimal role

Which one of the following gives strong evidence of typhoid fever carrier status?

a)Isolation of core antigen

b)Isolation of Vi antigen

c)Persistence of Vi antibodies

d)Demonstration of typhoid bacilli in stools

Cholecystectomy is done for the treatment of carriers in –

a)Amoebiasis

b)Cholera

c)Hepatitis B

d)Typhoid

A village affected with epidemic of cholera, what is the first step that should be taken to stop the epidemic?

a)Safe water supply and sanitation

b)Cholera vaccination to all individuals

c)Primary chemoprophylaxis

d)Treat everyone in the village with tetracycline

Vector-Borne Diseases

Dengue Agent Dengue viruses (DEN-1, DEN-2, DEN-3

and DEN-4)

Immunity Each serotype provides specific lifetime

immunity and short- term cross - immunity.

Vector Aedes aegypti

Mode of

transmission

Bite of infected female aedes mosquito

Reservoir Humans and monkeys

Incubation period 4-7 days

Clinical

presentation

The majority are asymptomatic.

The most common presentation is the

sudden onset of fever accompanied by

headache, retro-orbital pain, generalized

myalgia and arthralgia

Rash

Laboratory

presentation

Leukopenia and thrombocytopenia

Laboratory

confirmation

IgM –ELISA or RT-PCR

Dengue non-structural protein 1 (NS1)]

Dengue Hemorrhagic Fever Dengue with

Hemorrhagic tendencies

• Positive tourniquet test

• Petechiae, ecchymosis or purpura

• Bleeding from mucosa, gastrointestinal tract, injection sites or other sites

Plus

Thrombocytopenia (<100,000 cells per cu.mm.)

Plus

Evidence of plasma

• A rise in average hematocrit > 20%

• Signs of plasma leakage (pleural effusion, ascites, hypoproteinemia)

Dengue Shock Syndrome

All the criteria for DHF

Plus

Evidence of circulatory failure manifested by rapid and weak pulse and narrow pulse pressure (<20 mm Hg) or hypotension for age, cold and clammy skin and restlessness.

Japanese Encephalitis Agent Group B arbovirus

Vector C. tritaeniorhynchus, C. vishnui, C. gelidus

Host Pig- amplifier host

Man-accidental, dead end host

Iceberg

disease

For every 1 symptomatic patient, there will

be 300 to 1000 asymptomatic infected

persons.

Incubation

period

5 to 15 days

Mode of

transmission

Bite of female Culex mosquitoes

Reservoir of

infection

Birds (Herons and egrets), pigs

Symptoms Mild infections occur without apparent

symptoms

More severe infection is marked by

headache, high fever, neck stiffness,

stupor, disorientation, coma, and spastic

paralysis.

Kala Azar

Other names Visceral Leishmaniasis

Agent Leishmania donovani

Vector Sandfly (Phleboptomous argentipes)

Forms of

Leishmaniasis

Cutaneous, Mucocutaneous, Visceral

or Kala Azar

Reservoir Man

Asian VL has no animal reservoir

Age 5-9 years

Clinical features High fever, weight loss, enlarged liver

and spleen and anemia

Altitude Doesn’t occur beyond 2000 feet

Mode of

transmission

Bite of infected female sandflies

Blood transfusion, sharing needles and

syringes, organ donation

Diagnosis rK39 Rapid kit

Treatment Liposomal Amphotericin B

Lymphatic filariasis

Agent Wuchereria bancrofti

Mode of

transmission

Bite of female Culex mosquito

Vector Culex quinquifasciatus

Reservoir Humans are the only reservoir of

infection

Elimination /

Treatment

DEC

Chikungunya

Agent Chikungunya virus

Vector Aedes aegypti and Aedes albopictus

Reservoir Man

Mode of

transmission

Bite of mosquito, day time biting

Incubation period 4-8 days

Symptom Fever with Joint Pain

Diagnosis ELISA

Treatment There is no specific antiviral drug

treatment for chikungunya.

Symptomatic treatment

Yellow Fever

Agent Yellow fever virus (Flavivirus)

Geographical

location

15 N to 10 S

Vector Aedes aegypti (urban areas)

Aedes africanus and Aedes simpsoni

(Africa- Forest transmission)

Reservoir Sub-clinical human cases (urban)

Monkey (Rural and forest)

Mode of

transmission

Bite of female aedes mosquitoes

Incubation period 2-6 days

Period of

communicability

2 days after exposure to infection

till 3 days after onset of symptoms.

Clinical features Fever and Jaundice

Diagnosis PCR, IgM ELISA

Treatment Supportive care

Vaccination 17D strain

95% develop immune response in

2 weeks

0.5 ml SC

Yellow fever vaccination

• Travel to endemic countries

• The international Yellow fever vaccination certificate becomes valid 10 days after vaccination and remains valid lifelong

• Qurantine period- 6 days

Reservoir of Indian Kala Azar is- (AIIMS May 2003)

a) Man

b) Rodent

c) Canine

d) Equine

Which of these is not useful in the prevention of KFD? (AIIMS 2001)

a)Vaccination

b)Deforestation

c)Prevention of roaming cattle

d)Personal protection

Chikungunya is transmitted by (AIIMS 2010)

a)Aedes

b)Culex

c)Mansonoides

d)Anopheles

False about Japanese Encephalitis is- (AIIMS 2009)

a)Pigs are amplifier hosts

b)Water tanks serve as breeding sites

c)Transmitted by Culex mosquitoes

d)Two doses of vaccines are required

The incubation period of Yellow fever is (AIIMS 2004)

a)3-6 days

b)3-4 weeks

c)1-2 weeks

d)8-10 weeks

True statement regarding arbovirus-transmitted diseases is – (AIIMS 2010)

a)Yellow fever is endemic in India

b)Dengue has only one serotype

c)KFD was first identified in West Bengal

d)Chikungunya is transmitted by Aedes

In Japanese Encephalitis, which of the basic cycles of transmission mentioned below is not true? (UPSC CMS 2012)

a) Pig-Mosquito-pig

b) Cattle-mosquito-cattle

c) Man-mosquito-man

d) Bird-mosquito-bird

According to International health regulations, there is no risk of spread of Yellow fever, if the aedes aegypti index remains below (AIPGME 2004)

a) 1%

b) 5%

c) 8%

d) 10%

False about Leishmaniasis is- (AIPGME 2003)

a) Coinfection with AIDS is now emerging

b) Indian Leishmaniasis is a non-zoonotic infection with man as the sole reservoir

c) Aldehyde test of Napier is a good test for diagnosis

d) There are no drugs for personal prophylaxis

In Kyasanur Forest Disease, the amplifying host is

a) Pig

b) Monkey

c) Rat

d) Cattle

All of the following are true statements regarding filariasis except

a) Extrinsic incubation period is 10-14 days

b) No multiplication in the mosquito

c) Man is the intermediate host

d) Clinical incubation period is 8-16 months

Which of the following statements is false?

a) Lymphatic filariasis has been targeted for elimination

b) Strategy for elimination is by Annual Mass Drug Administration of DEC for 5 years or more

c) Children less than 2 years are not included in Annual Mass Drug Administration

d) DEC is safe in Pregnancy

Regarding Japanese Encephalitis the incorrect statement is-

a) Pigs are amplifier hosts

b) Culex vishnui is the vector

c) Man is the reservoir of infection

d) Vaccination of pigs is effective in controlling the disease transmission.

Zoonotic Diseases

Rabies

Agent Rabies Virus

Reservoir In developing countries- Dog

In developed countries- Fox, Racoon and

Coyote

Geographic

distribution

throughout the world, except in the

continents of Antarctica and Australia.

Around 50 countries are Rabies-free.

Animals

responsible for

transmission of

infection

Mainly dogs and cats

Modes of

transmission of

Rabies

- Bites from infected animals

- Licks on broken skin and mucous

membrane

- Scratches

Incubation period Average – 1-3 months

Ranges between 2 weeks to 6 years

Factors

influencing

incubation period

Site of bite, the amount of virus in saliva

of the biting animal, the virus strain, and

the age and immune status of the

victim.

Category Type of contact Recommended

treatment

I Licks on intact skin None

II Nibbling of uncovered skin

Minor scratches or abrasions

without bleeding.

Licks on broken skin

Vaccine

III Single or multiple

transdermal bites or

scratches. Contamination of

mucous membrane with

saliva

Administer rabies

Immunoglobulin

and vaccine

immediately

Passive immunization

• Passive immunization is carried out using either Equine Rabies Immunoglobulin (ERIG) or Human rabies Immunoglobulin (HRIG).

• Human Rabies Immunoglobulin (HRIG) - Dose: 20 IU per kg body weight (maximum 1500 IU).

• RIG should preferably be administered before administering the anti-rabies vaccination. It should, however, never be administered later than 7 days after start of vaccination

Vaccine schedules

Essen schedule:

• Five intramuscular injection administrations - on days 0, 3, 7, 14 and 28.

Zagreb Regimen:

• One dose of vaccine is administered intramuscularly into the left and one into the right upper arm (deltoid region) on day 0 followed by one dose into the upper arm (deltoid region) on days 7 and 21.

Updated Thai Red Cross Schedule

Regimen: 2-2-2-0-2 i.e. one dose of vaccine, in a volume of 0.1ml is given intradermally at two different lymphatic drainage sites, usually the left and right upper arm, on days 0,3,7 and 28.

Leptospirosis

Agent Leptospira interrogans (spirochete)

Geographic

distribution

tropical and subtropical areas with high

rainfall.

Source of

infection

Environment contaminated by urine of

infected animal

Reservoir of

infection

Rats and mice

Mode of

transmission

Direct - contact of exposed skin

(abrasions/cuts) or intact mucosa with

infected material (water contaminated

with urine of infected animal)

Incubation 10 days (4-20 days)

Symptoms Starts with a mild-flu-like illness.

Jaundice may be seen

Case Fatality

rate

5-30%

Occupation Agriculture, livestock farmers, sewer

workers, abattoir workers, meat and

animal handlers, veterinarians.

Chemoprophylaxis Doxycycline

Treatment Penicillin is the drug of choice.

Weil’s disease Fever, jaundice, renal failure,

haemorrhage, myocarditis with

arrhythmias, seen in less than 10%

cases

Plague

Agent Yersinia pestis

Source of

infection

Infected rodents, fleas, case of

pneumonic plague

Vector Rat flea (Xenopsylla cheopis), both

sexes bite and transmit

Reservoir Wild rodents

Incubation

period

Bubonic and septicemic plague- 2 to 7

days

Pneumonic plague- 1 to 3 days

Types Bubonic, Septicemic and Pneumonic

Diagnosis Laboratory- staining with Giemsa stain

to identify Y. pestis

Culture and serology

Management Isolation of all patients with

pneumonic plague

Streptomycin/Tetracycline

Control of fleas- DDT/BHC, Carbaryl,

Malathion dust up to 1 feet height

CFR 30-60%, if untreated

Chemoprophylaxis Tetracycline

For the treatment of a class III dog-bite, all of the following are correct, except- (AIPGME 2005)

a) Give immunoglobulins for passive immunity

b) Give ARV

c) Immediately stitch wound under antibiotic coverage

d) Immediately wash wounds with soap and water

Class II exposure in animal bites includes the following- (AIPGME 2003)

a) Licks on intact skin

b) Licks on a fresh wound

c) Scratch with oozing of blood on palm

d) Bites from wild animals

The most effective method to break transmission chain in plague is (AIIMS 2002)

a) Early detection and treatment

b) Control of fleas

c) Control of rodents

d) Vaccination

All of the following statements about plague are wrong, except- (AIIMS 2004)

a) Domestic rat is the main reservoir

b) Bubonic plague is the most common variety

c) The causative bacillus can survive up to 10 years in the soil of rodent burrows

d) The incubation period for pneumonic plague is one to two weeks

Most diagnostic of Rabies- (AIIMS 2010)

a) Negri bodies

b) Gaurneiri bodies

c) Cowdry A

d) Cowdry B

Pre-exposure prophylaxis for rabies is given on days-

a) 0,3,7,14,28,90

b) 0,3,7,28,90

c) 0,3

d) 0,7,28

Surface Infections

Tetanus

Agent Clostridium tetani- tetanospasmin

Reservoir Intestine of cattle

Source Soil and dust

Mode of

transmission

through contaminated wounds or tissue injuries Not transmitted from person to person.

Incubation period 7 days

CFR 40-80%

Age Neonates, 5 to 40 years

Occupation Agricultural workers

Immunity Maternal antibodies protect neonates.

There is no naturally-acquired immunity to

tetanus. Immunity to tetanus can be acquired

only by active or passive immunization.

No role of herd immunity

Treatment human tetanus immune globulin

Antibiotics - metronidazole or penicillin G.

Maternal and Neonatal Tetanus (MNT) Elimination Initiative

• To reduce MNT cases to such low levels that the disease is no longer a major public health problem

• Tetanus cannot be eradicated

• Neonatal tetanus elimination is defined as “less than one case of neonatal tetanus per 1000 live births in every district”

• Once NT elimination has been achieved, maternal tetanus is assumed to be eliminated.

• India achieved MNT elimination on May 15, 2015

Trachoma Agent Chlamydia trachomatis

Source of infection Ocular discharges of infected

persons, fomites

Reservoir of

infection

Children with active diseases

Age 2 to 5 years

Mode of

transmission

Direct contact with eye and nose

discharges

Contact with fomites

Flies (Musca sorbens)

Incubation 5 to 12 days

SAFE strategy Surgery for Trichiasis

Antibiotic treatment

Facial cleanliness

Environmental improvement,

improved access to water and

sanitation

If the baseline district prevalence of TF in 1–9-year-old

children is 10% or greater, antibiotic treatment of all

residents should be undertaken annually for 3 years.

Azithromycin (20 mg/kg) single dose is preferred

For the field diagnosis of trachoma, the WHO recommends that follicular and intense trachoma inflammation should be assessed in- (AIIMS May 2003)

a) Women aged 15-45 years

b) Population of 10-28 year range

c) Children aged 0-9 years

d) Population above 25 years of age irrespective of sex

All of the following are done to prevent tetanus neonatorum, except- (AIPGME 2007)

a) Two doses of TT to all pregnant women

b) TT to all females in reproductive age group

c) TT to all infants

d) Injection Penicillin to all newborns

SAFE strategy includes all of the following, except- (AIIMS 2006)

a) Screening

b) Antibiotics

c) Face washing

d) Environmental improvement

Regarding Clostridium tetani, all are true, except? (AIPGME 2011)

a) Spores are resistant to heat

b) 3 doses give immunity in primary immunization

c) Incubation period is 6-10 days

d) Person to person transmission occurs

All the following statements are true about Clostridium tetani infection, except- (AIIMS 2010)

a) Main reservoir is soil, animal and human intestine

b) Main mode of transmission is through trauma and contaminated wound

c) Herd immunity doesn’t have much value

d) Seen commonly in winter and dry climates

Neonatal tetanus is said to be eliminated when the rate is

a) >10 per 1000 live-births

b) >1 per 1000 live-births

c) <1per 1000 live-births

d) <0.1 per 1000 live-births

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