disease transmission and control defining control objectives and strategies who/csr epidemiological...
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Disease transmission and control
Defining Control objectives and strategies
WHO/CSRWHO/CSR
Epidemiological Surveillance and Epidemic Response UnitEpidemiological Surveillance and Epidemic Response Unit
Division of Emerging and Other Communicable DiseasesDivision of Emerging and Other Communicable Diseases
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Before we can talk about control measures we must assess our knowledge on:
• Disease transmissionDisease transmission– reservoir, sources, routesreservoir, sources, routes
• Infectious process Infectious process – exposure, infection, disease exposure, infection, disease
• Pathogenesis of disease statePathogenesis of disease state– target organs, virulence, immuneresponsetarget organs, virulence, immuneresponse
• Natural historyNatural history• Effectiveness of control measuresEffectiveness of control measures
WHO/CSRWHO/CSR
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Major transmission routes
Direct
Vector borne
Environmental
Droplet
Sexual
Blood
Skin to skin
Other
Insects
Animals
Food
Water
WHO/CSRWHO/CSR
AirborneDrop. nuclei
Dust
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Does a potential control measure reduce
• TransmissionTransmission• ExposureExposure• InfectionInfection• DiseaseDisease• DeathDeath• DisabilityDisability
WHO/CSRWHO/CSR
?
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Principles of control
• Prevent exposure• Protect susceptibles from infection• Prevent progression from infection to disease• Treat cases
– Prevent death and disability– Prevent further transmission
• Interrupt transmission– Environmental – Social/behavioural– Legal
WHO/CSRWHO/CSR
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
WHO/CSRWHO/CSR
Pathways of Disease Transmission
IncubationPeriod
PATHOGEN
PATHOGENHOST
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
WHO/CSRWHO/CSR
Susceptibility- previous exposure- immunity- compromise- prophylaxis
HOST
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
WHO/CSRWHO/CSR
General healthNutritionImmunityVirulenceImmune responseProphylaxis
HOST
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
WHO/CSRWHO/CSRTreatment
HOST
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Control
– Where does it fit in?
WHO/CSRWHO/CSR
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
7
2
5
4
6
Points for controlmeasures
3WHO/CSRWHO/CSR
Disability
1
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
1
Points for controlmeasures
WHO/CSRWHO/CSRDisability
Vaccination
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
2
Points for controlmeasures
WHO/CSRWHO/CSRDisability
Prophylaxis
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
Points for controlmeasures
3WHO/CSRWHO/CSR
Disability
TreatmentRehabilitation
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
5
4
Points for controlmeasures
WHO/CSRWHO/CSRDisability
IsolationTreatment
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
6
Points for controlmeasures
WHO/CSRWHO/CSRDisability
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
7
Points for controlmeasures
WHO/CSRWHO/CSRDisability
Isolation
RepellentsBed nets
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
1
2
5
4
6
Points for controlmeasures
3 WHO/CSRWHO/CSRDisability
Vaccination
Prophylaxis
Isolationtreatment
Treatment
RepellentsBednets7
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Approach to control
• What is feasible?
• What is available?
• What is effective?
• What is affordable?
WHO/CSRWHO/CSR
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What is the overall control objective ?
• Endemic disease control by• reducing incidence• reducing mortality
• Epidemic prevention and control• Elimination• Eradication
WHO/CSRWHO/CSR
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Control objectives should be
• Realistic
• Quantitative (time, place, person)
• Periodically evaluated
• Flexible
WHO/CSRWHO/CSR
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Exposure
Infection
Disease
Death Recovery
Direct
Vector
Envir
WHO/CSRWHO/CSR
SPECIFIC EXAMPLESOF CONTROL
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Exposure
Infection
Disease
Droplet
M. tb
TUBERCULOSIS
Death RecoveryDisability
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Exposure
Infection
Disease
Droplet
Vaccination?? - BCG
Prophylaxis??
Treatment
M. tb
TUBERCULOSIS
Death RecoveryDisability
Isolation??
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Exposure
Infection
Disease
Direct
Diphtheria
Death RecoveryDisability
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Exposure
Infection
Disease
Direct
Vaccination - DPT
Prophylaxis
Diphtheria
Treatment
Death RecoveryDisability
Isolation
Treatment
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Exposure
Infection
Disease
Death Recovery
Vector
Dengue
Aedes Aedes aegyptiaegypti
WHO/CSRWHO/CSR
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Exposure
Infection
Disease
Death Recovery
Vector
Dengue
Aedes Aedes aegyptiaegypti
Protection
Breeding sitesInsecticide
WHO/CSRWHO/CSRCase management
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Exposure
HIV +
AIDS
Death
Direct
HIV/AIDS
Sexual
Blood IVDUIatrogenic
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Exposure
HIV +
AIDS
Death
Direct
Vaccine ???
ART
HIV/AIDS
Sexual
Blood IVDUIatrogenic
Behaviour
ART
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Exposure
Infection
Disease
Death Recovery
Direct
Measles
Highly infectiousR0 = 10-20
WHO/CSRWHO/CSR
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Exposure
Infection
Disease
Death Recovery
Direct
Vaccination
Measles
Highly infectiousR0 = 10-20
WHO/CSRWHO/CSRCase management
Vitamin A
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Exposure
Infection
Disease
Death Recovery
Direct
Poliomyelitis
WHO/CSRWHO/CSR
Envir
?
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Exposure
Infection
Disease
Death Recovery
Direct
Vaccination
Poliomyelitis
WHO/CSRWHO/CSR
Envir
Case managementRehabilitation
?
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Global Eradication of Poliomyelitis
Definition:
Complete interruption of wild poliovirus
transmission
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Uses of surveillance
• How would surveillance help in achieving How would surveillance help in achieving control objectives?control objectives?
• How would it help in dealing with epidemic How would it help in dealing with epidemic disease?disease?
WHO/CSRWHO/CSR
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Thank you