BACHELOR OF SCIENCE IN NURSING
NCMB 312 - COMMUNICABLE DISEASE NURSING
COURSE MODULE
COURSE UNIT
WEEK
3
11
13
Leprosy, Tetanus, Poliomyeltis, Meningitis,
Red Tide poisoning
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Read course and unit objectives
Read study guide prior to class attendance
Read required learning resources and refer to unit terminologies for jargons
Proactively participates in chat room discussions
Participate in weekly discussion
Answer and submit course unit tasks
✓ Module, Reference Books, Laptop, Internet, Headset
At the end of the course unit, learners will be able to:
Cognitive:
1. Enumerate the definition, signs and symptoms, mode of transmission, period of
communicability, nursing and medical management of leprosy, tetanus, poliomyelitis,
meningitis and red tide poisoning.
2. Identify their differences in terms of pathophysiology.
3. Integrate the application of concepts of leprosy, tetanus, poliomyelitis, meningitis and
red tide poisoning in the practice of nursing profession holistically and competently.
Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and ideas
3. Accept comments and reactions of classmates on one’s opinions openly and
graciously.
4. Develop heightened interest in studying Communicable Disease Nursing.
Psychomotor:
1. Participate actively during class discussions and group activities
2. Express opinion and thoughts during class
Leprosy – also known as Hansen's disease, is a chronic infectious disease caused by
Mycobacterium leprae. The disease mainly affects the skin, the peripheral nerves, mucosal
surfaces of the upper respiratory tract and the eyes. Leprosy is known to occur at all ages
ranging from early infancy to very old age.
Tetanus – is also called lockjaw, is a serious infection caused by Clostridium tetani. This
bacterium produces a toxin that affects the brain and nervous system, leading to stiffness in
the muscles. If Clostridium tetani spores are deposited in a wound, the neurotoxin interferes
with nerves that control muscle movement.
Meningitis – is an inflammation (swelling) of the protective membranes covering the brain and
spinal cord. A bacterial or viral infection of the fluid surrounding the brain and spinal cord
usually causes the swelling. However, injuries, cancer, certain drugs, and other types of
infections also can cause meningitis.
Poliomyelitis – is a highly infectious viral disease that largely affects children under 5 years of
age. The virus is transmitted by person-to-person spread mainly through the fecal-oral route
or, less frequently, by a common vehicle (e.g. contaminated water or food) and multiplies in the
intestine, from where it can invade the nervous system and cause paralysis.
Red Tide Poisoning – also known as Paralytic Shellfish Poisoning, or PSP, is a lifethreatening syndrome, and the onset of symptoms is rapid, usually within two hours of
consumption. Symptoms include tingling, burning, numbness, drowsiness, incoherent speech,
and respiratory paralysis.
LEPROSY
Hansen’s disease (also known as leprosy) is an infection caused by bacteria called
Mycobacterium leprae. These bacteria grow very slowly and it may take up to 20 years to
develop signs of the infection. It can also be called Hansenosis and Lepra. It is chronic disease
of the skin, peripheral nerves and nasal mucosa, when contracted they called “Living dead”,
and was perceived to be caused by sin. In 1873, Dr. Gerhard Henrik Armauer Hansen of
Norway was the first person to identify the germ that causes leprosy under a microscope.
Hansen's discovery of Mycobacterium leprae proved that leprosy was caused by a germ, and
was thus not hereditary, from a curse, or from a sin. The mode of transmission are: (1) droplet,
and (2) intimate skin to skin contact (inoculation through the skin break). It is not known exactly
how Hansen’s disease spreads between people. Scientists currently think it may happen when
a person with Hansen’s disease coughs or sneezes, and a healthy person breathes in the
droplets containing the bacteria. Prolonged, close contact with someone with untreated leprosy
over many months is needed to catch the disease. In the southern United States, some
armadillos are naturally infected with the bacteria that cause Hansen’s disease in people and it
may be possible that they can spread it to people. However, the risk is very low and most
people who come into contact with armadillos are unlikely to get Hansen’s disease.
There are two (2) types: (1) multibacillary (MB) – infectious, malignant, numerous macules,
papules and nodules, and (2) paucibacillary (PB) – hypopigmented macule. Hansen’s disease
can be recognized by appearance of patches of skin that may look lighter or darker than the
normal skin. Sometimes the affected skin areas may be reddish. Loss of feeling in these skin
patches is common. The disease can affect the nerves, skin, eyes, and lining of the nose
(nasal mucosa). The bacteria attack the nerves, which can become swollen under the skin.
This can cause the affected areas to lose the ability to sense touch and pain, which can lead to
injuries, like cuts and burns. Usually, the affected skin changes color and either becomes:
lighter or darker, often dry or flaky, with loss of feeling, or reddish due to inflammation of the
skin. If left untreated, the nerve damage can result in paralysis of hands and feet. In very
advanced cases, the person may have multiple injuries due to lack of sensation, and
eventually the body may reabsorb the affected digits over time, resulting in the apparent loss of
toes and fingers. Corneal ulcers and blindness can also occur if facial nerves are affected.
Other signs of advanced Hansen’s disease may include loss of eyebrows (madarosis), inability
to close eyelids (lagopthalmos) and saddle-nose deformity resulting from damage to the nasal
septum as leonine face as pathognomonic sign and gynecomastia. Since Hansen’s disease
affects the nerves, loss of feeling or sensation can occur. When loss of sensation occurs,
injuries such as burns may go unnoticed. Because patient may not feel the pain that can warn
patient of harm to the body, take extra caution to ensure the affected parts of the body are not
injured.
To confirm the diagnosis, the doctor will take a sample of the skin or nerve (through a skin or
nerve biopsy) to look for the bacteria under the microscope and may also do tests to rule out
other skin diseases. Slit Skin smear – to demonstrate M. leprae. If the number of lesions = 2-5
PB and > 5 MB with (-) in all site = Paucibacillary and (+) in all sites = Multibacillary. Also,
doctor perform lepromin test to detedt hypersensitivity to leprosy. Early diagnosis and
treatment usually prevent disability that can result from the disease, and people with Hansen’s
disease can continue to work and lead an active life. Once treatment is started, the person is
no longer contagious. However, it is very important to finish the entire course of treatment as
directed by the doctor. Any individual cannot get leprosy from a casual contact with a person
who has Hansen’s disease like: (1) shaking hands or hugging, (2) sitting next to each other on
the bus, (3) sitting together at a meal, and (4) Hansen’s disease is also not passed on from a
mother to her unborn baby during pregnancy and it is also not spread through sexual contact.
Hansen’s disease is treated with a combination of antibiotics. Typically, 2 or 3 antibiotics are
used at the same time. These are dapsone with rifampicin, and clofazimine is added for some
types of the disease. This is called multidrug therapy (MDT) – RA4073. This strategy helps
prevent the development of antibiotic resistance by the bacteria, which may otherwise occur
due to length of the treatment. Paucibacillary form – 2 antibiotics are used at the same time,
daily dapsone (100mg) OD (6-9 mos) and rifampicin (600mg) once per month. Multibacillary
form – daily clofazimine is added to rifampicin and dapsone. Day 1: R-600 D-100 C-300 once
month and Day 2-28: Dapsone 100 OD, Clofazimine (Lamprine) 50 mg OD. Treatment usually
lasts between one to two years. The illness can be cured if treatment is completed as
prescribed. Antibiotics used during the treatment will kill the bacteria that cause leprosy. But
while the treatment can cure the disease and prevent it from getting worse, it does not reverse
nerve damage or physical disfiguration that may have occurred before the diagnosis. Thus, it is
very important that the disease be diagnosed as early as possible, before any permanent
nerve damage occurs.
Health education by the nurse on Sulfone therapy like Dapsone that cause cutaneous
eruptions, and iritis, orchitis. Lamprine can cause brownish black skin discoloration, dryness
and flakiness that need to explain to the patient. Skin care to prevent injury. Separate
newborns from leprous mothers and report cases and suspects of leprosy. BCG vaccine and
education on mode of transmission. Nursing Diagnosis of altered body image and social
stigma.
TETANUS
Tetanus is a serious disease caused by a bacterial toxin that affects your nervous system,
leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can
interfere with your ability to breathe and can threaten your life. Tetanus is commonly known as
"lockjaw." The disease tetanus extends all the way back to the fifth century BC. However, it
was not until the late 1800s that Arthur Nicolaier discovered the toxins that caused tetanus
which have the ability to infect several species and that protection could be provided by
passive transfer of an antitoxin. Tetanus is an infection caused by a bacterium called
Clostridium tetani which is commonly found in soil, saliva, dust, and manure. Clostridium tetani
is an anaerobic, gram (+), toxigeni, spore forming bacteria and has two (2) types of toxin:
tetanospasmin referring to toxin impairs the nerves that control your muscles (motor neurons).
The toxin can cause muscle stiffness and spasms — the major signs and symptoms of tetanus
(muscle contraction) The toxin tetanolysin referring to breakdown of RBC. The bacteria
generally enter through a break in the skin such as a cut or puncture wound by a contaminated
object. They produce toxins that interfere with normal muscle contractions. The spores develop
into bacteria when they enter the body.
The common ways tetanus gets into the body is direct inoculation or break into the skin such
as stepping on nails or other sharp objects is one way people are exposed to the bacteria that
cause tetanus. These bacteria are in the environment and get into the body through breaks in
the skin. Wounds contaminated with dirt, and feces, burns, crush injuries, surgical procedures,
and dental infections. The incubation period — time from exposure to illness — is usually
between 3 days to 3 weeks in adult and 3 days to 30 days in newborn or a period of 3-4
weeks. However, it may range from one day to several months, depending on the kind of
wound. Most cases occur within 14 days. In general, doctors see shorter incubation periods
with more heavily contaminated wounds, more serious disease and a worse outcome
(prognosis).
Signs and symptoms of tetanus appear anytime from a few days to several weeks after
tetanus bacteria enter your body through a wound. Common signs and symptoms of tetanus
include: spasms and stiffness in the jaw muscles (trismus), stiffness of neck muscles, difficulty
swallowing, stiffness of abdominal muscles, painful body spasms lasting for several minutes,
typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light,
risus sardonicus (sardonic smile) – pathognomonic sign, opisthotonus, low grade fever,
diaphoresis and for tetanus neonatorum as difficulty sucking as the first sign and excessive
crying later leading to a strangled soundless and voiceless noise.
The diagnostic tests are clinical manifestations, history of wound, immunization status, blood
culture and tetanus antibody test. Tetanus is a medical emergency requiring: (1) care in the
hospital; (2) immediate treatment with medicine called human tetanus immune globulin (TIG),
ATS, TAT as passive immunization and TT and DPT as active immunization; (3) aggressive
wound care; (4) drugs to control muscle spasms and sedative (Diazepam); (5) Antibiotics (Pen
G, Metronidazole); (6) Emergency equipment at bedside tracheostomy set, ET tube and
mechanical ventilator.
The following nursing managements are: (1) preventing seizure by keeping the room dim and
quiet. Avoid stimuli of spasm. Avoid unnecessary handling. Close monitoring of v/s and muscle
tone. Raise side rails. Promote rest. (2) Provide adequate airway by inhalation of oxygen as
per doctor’s order. (3) Monitor for possible complications like aspiration pneumonia and
cardiac dysrhhythmias.
Serious health problems that can happen because of tetanus include: (1)
uncontrolled/involuntary tightening of the vocal cords (laryngospasm); (2) broken bones
(fractures); (3) infections gotten by a patient during a hospital visit (hospital-acquired
infections); (4) blockage of the main artery of the lung or one of its branches by a blood clot
that has travelled from elsewhere in the body through the bloodstream (pulmonary embolism);
(5) pneumonia, a lung infection, that develops by breathing in foreign materials (aspiration
pneumonia). Breathing difficulty, possibly leading to death (1 to 2 in 10 cases are fatal)
Being up to date with the tetanus vaccine is the best tool to prevent tetanus. Protection from
vaccines, as well as a prior infection, do not last a lifetime. This means that if you had tetanus
or got the vaccine before, still need to get the vaccine regularly to keep a high level of
protection against this serious disease. CDC recommends tetanus vaccines for people of all
ages, with booster shots throughout life. The tetanus vaccine usually is given to children as
part of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. This
vaccination provides protection against three diseases: a throat and respiratory infection
(diphtheria), whooping cough (pertussis) and tetanus. As prevention of tetanus neonatorum,
active immunization of pregnant mother with TT1 to TT5, strict asepsis during delivery and
licensing of health professional like the midwives and nurses.
MENINGITIS
Meningitis, also known as cerebrospinal fever is an inflammation of the membranes
(meninges) surrounding the brain and spinal cord. The swelling from meningitis typically
triggers symptoms such as headache, fever and a stiff neck. Most cases of meningitis in the
United States are caused by a viral infection, but bacterial, parasitic and fungal infections are
other causes. Some cases of meningitis improve without treatment in a few weeks. Others can
be life-threatening and require emergency antibiotic treatment. The etiologic agents of
meningitis are Neisseria meningitides, Streptococcus pneumonia, Haemophilus influenza,
Streptococcus agalactae and Listeria monocytogenes. The first definitive description of the
disease was by Gaspard Vieusseux in Switzerland in 1805. The bacterium was first identified
in the spinal fluid of patients by Weichselbaum in 1887. Neisseria meningitidis is a leading
cause of bacterial meningitis and sepsis in the United States and in the Philippines. The first
evidence that linked bacterial infection as a cause of meningitis was written by Austrian
bacteriology Anton Vaykselbaum who described meningococcal bacteria in 1887.
The mode of transmissions are respiratory droplets through nasopharyngeal mucosa, direct
invasion through otitis media and may result after a skull fracture, penetrating head wound.
The incubation period is 3 – 6 days and the period of communicability is as long as the
microorganism is present in the discharges. Early meningitis symptoms may mimic the flu
(influenza). Symptoms may develop over several hours or over a few days. Possible signs and
symptoms in anyone older than the age of 2 include: sudden high fever, petecchial/purpuric
rashes (sometimes, such as in meningococcal meningitis), signs of increased ICP - severe
frontal headache, altered level of consciousness (confusion or difficulty concentrating and
sleepiness or difficulty waking), restlessness, projectile vomiting, blurring of vision;
papilledema; diplopia, seizures, sensitivity to light, no appetite or thirst. Signs of meningeal
irritation as kernig’s sign, nuchal rigidity – pathognomonic sign, opisthotonus and brudzinski’s
sign with late signs of decerebration and decortications. Signs in newborns and infants may
show these signs: high fever, constant crying, excessive sleepiness or irritability, inactivity or
sluggishness, poor feeding, bulge in the soft spot on top of a baby's head (fontanel), stiffness
in a baby's body and neck. Infants with meningitis may be difficult to comfort, and may even
cry harder when held. Bacterial meningitis is serious, and can be fatal within days without
prompt antibiotic treatment. Delayed treatment increases the risk of permanent brain damage
or death.
Bacterial meningitis - bacteria that enter the bloodstream and travel to the brain and spinal
cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the
meninges. This may be caused by an ear or sinus infection, a skull fracture, or, rarely, after
some surgeries. Several strains of bacteria can cause acute bacterial meningitis, most
commonly: Streptococcus pneumoniae (pneumococcus). This bacterium is the most common
cause of bacterial meningitis in infants, young children and adults in the United States. It more
commonly causes pneumonia or ear or sinus infections. A vaccine can help prevent this
infection. Neisseria meningitidis (meningococcus). This bacterium is another leading cause of
bacterial meningitis. These bacteria commonly cause an upper respiratory infection but can
cause meningococcal meningitis when they enter the bloodstream. This is a highly contagious
infection that affects mainly teenagers and young adults. It may cause local epidemics in
college dormitories, boarding schools and military bases. A vaccine can help prevent infection.
Haemophilus influenzae (haemophilus). Haemophilus influenzae type b (Hib) bacterium was
once the leading cause of bacterial meningitis in children. But new Hib vaccines have greatly
reduced the number of cases of this type of meningitis. Listeria monocytogenes (listeria).
These bacteria can be found in unpasteurized cheeses, hot dogs and lunchmeats. Pregnant
women, newborns, older adults and people with weakened immune systems are most
susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may be
fatal to the baby.
Viral meningitis is usually mild and often clears on its own. Most cases in the United States are
caused by a group of viruses known as enteroviruses, which are most common in late summer
and early fall. Viruses such as herpes simplex virus, HIV, mumps, West Nile virus and others
also can cause viral meningitis.
Chronic meningitis is a slow-growing organisms (such as fungi and Mycobacterium
tuberculosis) that invade the membranes and fluid surrounding your brain cause chronic
meningitis. Chronic meningitis develops over two weeks or more. The signs and symptoms of
chronic meningitis — headaches, fever, vomiting and mental cloudiness — are similar to those
of acute meningitis.
Fungal meningitis is relatively uncommon and causes chronic meningitis. It may mimic acute
bacterial meningitis. Fungal meningitis isn't contagious from person to person. Cryptococcal
meningitis is a common fungal form of the disease that affects people with immune
deficiencies, such as AIDS. It's life-threatening if not treated with an antifungal medication.
Meningitis can also result from noninfectious causes, such as chemical reactions, drug
allergies, some types of cancer and inflammatory diseases such as sarcoidosis.
Risk factors for meningitis include: (1) Skipping vaccinations. Risk rises for anyone who hasn't
completed the recommended childhood or adult vaccination schedule. (2) Age. Most cases of
viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those
under age 20. (3) Living in a community setting. College students living in dormitories,
personnel on military bases, and children in boarding schools and child care facilities are at
greater risk of meningococcal meningitis. This is probably because the bacterium is spread by
the respiratory route, and spreads quickly through large groups. (4) Pregnancy. Pregnancy
increases the risk of listeriosis — an infection caused by listeria bacteria, which may also
cause meningitis. Listeriosis increases the risk of miscarriage, stillbirth and premature delivery.
(5) Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant
drugs and other factors that affect your immune system also make you more susceptible to
meningitis. Having your spleen removed also increases your risk, and anyone without a spleen
should get vaccinated to minimize that risk.
The family doctor or pediatrician can diagnose meningitis based on a medical history, a
physical exam and certain diagnostic tests. During the exam, the doctor may check for signs of
infection around the head, ears, throat and the skin along the spine. The child may undergo
the following diagnostic tests: (1) Blood cultures. Blood samples are placed in a special dish to
see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide
and stained (Gram's stain), then studied under a microscope for bacteria. (2) Imaging.
Computerized tomography (CT) or magnetic resonance imaging (MRI) scans of the head may
show swelling or inflammation. X-rays or CT scans of the chest or sinuses also may show
infection in other areas that may be associated with meningitis. (3) Spinal tap (lumbar
puncture). For a definitive diagnosis of meningitis, a spinal tap to collect cerebrospinal fluid
(CSF). In people with meningitis, the CSF often shows a low sugar (glucose) level along with
an increased white blood cell count and increased protein. CSF analysis may also help the
doctor identify which bacterium caused the meningitis. If the doctor suspects viral meningitis,
he or she may order a DNA-based test known as a polymerase chain reaction (PCR)
amplification or a test to check for antibodies against certain viruses to determine the specific
cause and determine proper treatment. The treatment depends on the type of meningitis the
patient has.
Meningitis complications can be severe. The longer you or your child has the disease without
treatment, the greater the risk of seizures and permanent neurological damage, including: (1)
hearing loss, (2) memory difficulty, learning disabilities, brain damage, gait problems, seizures,
(3) respiratory problems (bronchitis and pneumonia), (4) otitis media and mastoiditis, (5)
blindness, (6) hydrocephalus, (7) kidney failure, (8) shock, and (9) death. With prompt
treatment, even patients with severe meningitis can have good recovery.
The medical treatments are antibiotic with Penicillin G as a drug of choice with alternative of
chlorampenicol, ampicillin, ceftraxiazone and aminoglycosides, Diuretics (Mannitol) to revent
cerebral edema, CNS stimulant (Pyrentinol/Encephabol), Anticonvulsant (Diazepam,
Phenytoin (Dilantin) to reduce restlessness and convulsion,
Corticosteroid
(Prednisone/Dexamethasone), Digitalis glycoside (Digoxin) to control arrhythmias, and
Acetamenophen to relieve fever and pain. Acute bacterial meningitis must be treated
immediately with intravenous antibiotics and sometimes corticosteroids. This helps to ensure
recovery and reduce the risk of complications, such as brain swelling and seizures. The
antibiotic or combination of antibiotics depends on the type of bacteria causing the infection.
The doctor may recommend a broad-spectrum antibiotic until he or she can determine the
exact cause of the meningitis. The doctor may drain any infected sinuses or mastoids — the
bones behind the outer ear that connect to the middle ear. Viral meningitis - antibiotics can't
cure viral meningitis, and most cases improve on their own in several weeks. Treatment of mild
cases of viral meningitis usually includes: bed rest, plenty of fluids, over-the-counter pain
medications to help reduce fever and relieve body aches. The doctor may prescribe
corticosteroids to reduce swelling in the brain, and an anticonvulsant medication to control
seizures. If a herpes virus caused the meningitis, an antiviral medication is available.
Treatment for chronic meningitis is based on the underlying cause. Antifungal medications
treat fungal meningitis, and a combination of specific antibiotics can treat TB meningitis.
However, these medications can have serious side effects, so treatment may be deferred until
a laboratory can confirm that the cause is fungal. Non-infectious meningitis due to allergic
reaction or autoimmune disease may be treated with corticosteroids. In some cases, no
treatment may be required because the condition can resolve on its own. Cancer-related
meningitis requires therapy for the specific cancer.
The nursing management are: (1) Respiratory Isolation: 24 hours after onset of antibiotic
therapy; (2) Provide non-stimulating environment; (3) Initiate seizure precaution; (4) Avoid
factors that increase ICP; (5) Assess for signs of increased ICP; (6) Watch out for deterioration
of condition; (7) Monitor fluid balance; (8) Watch out for reactions of antibiotics; (9) Position
carefully to prevent joint stiffness; (10) Maintain adequate nutrition and elimination; and (11)
Follow strict aseptic technique with head wounds and skull fractures.
Common bacteria or viruses that can cause meningitis can spread through coughing,
sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. These steps can help
prevent meningitis: (1) Avoid mode of transmission. (2) Prophylactic treatment of Rifampicin
with alternative of Ciprofloxacin. (3) Wash hands. Careful hand-washing helps prevent the
spread of germs. Teach children to wash their hands often, especially before eating and after
using the toilet, spending time in a crowded public place or petting animals. Show them how to
vigorously and thoroughly wash and rinse their hands. (4) Practice good hygiene. Don't share
drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else. Teach
children and teens to avoid sharing these items too. (5) Stay healthy. Maintain the immune
system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of
fresh fruits, vegetables and whole grains. (6) Cover the mouth. When need to cough or
sneeze, be sure to cover the mouth and nose. (7) If the patient is pregnant, take care with
food. Reduce the risk of listeriosis by cooking meat, including hot dogs and deli meat, to 165 F
(74 C). (8) Avoid cheeses made from unpasteurized milk. Choose cheeses that are clearly
labeled as being made with pasteurized milk. (9) Immunizations - some forms of bacterial
meningitis are preventable with the following vaccinations: Haemophilus influenzae type b
(Hib) vaccine. Children in the United States routinely receive this vaccine as part of the
recommended schedule of vaccines, starting at about 2 months of age. Here in the Philippines,
EPI is the sources. The vaccine is also recommended for some adults, including those who
have sickle cell disease or AIDS and those who don't have a spleen. Pneumococcal conjugate
vaccine (PCV13). This vaccine also is part of the regular immunization schedule for children
younger than 2 years in the United States. Additional doses are recommended for children
between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children
who have chronic heart or lung disease or cancer. Pneumococcal polysaccharide vaccine
(PPSV23). Older children and adults who need protection from pneumococcal bacteria may
receive this vaccine. The Centers for Disease Control and Prevention recommends the
PPSV23 vaccine for all adults older than 65; for younger adults and children age 2 and older
who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle
cell anemia; and for anyone who doesn't have a spleen. Meningococcal conjugate vaccine.
The Centers for Disease Control and Prevention recommends that a single dose be given to
children ages 11 to 12, with a booster shot given at age 16. If the vaccine is first given between
ages 13 and 15, the booster is recommended between ages 16 and 18. If the first shot is given
at age 16 or older, no booster is necessary. This vaccine can also be given to children
between the ages of 2 months and 10 years who are at high risk of bacterial meningitis or who
previously unvaccinated people who have been exposed in outbreaks.
POLIOMYELITIS
Polio is a contagious viral illness that in its most severe form causes nerve injury leading to
paralysis, difficulty breathing and sometimes death. Also known as Infantile paralysis and
Heine Medin Disease. In the U.S., the last case of naturally occurring polio was in 1979.
Today, despite a worldwide effort to wipe out polio, poliovirus continues to affect children and
adults in parts of Asia and Africa. Karl Landsteiner and Erwin Popper discovered poliovirus in
1908 by proving that it was not a bacterium that caused the paralysis, but a much smaller
entity—a virus. The disease was given its first clinical description in 1789 by the British
physician Michael Underwood, and recognized as a condition by Jakob Heine in 1840. The
first modern epidemics were fuelled by the growth of cities after the industrial revolution. On
March 26, 1953, American medical researcher Dr. Jonas Salk announces on a national radio
show that he has successfully tested a vaccine against poliomyelitis, the virus that causes the
crippling disease of polio. Albert Bruce Sabin was a Polish American medical researcher, best
known for developing the oral polio vaccine, which has played a key role in nearly eradicating
the disease.
The predisposing factors are (1) Age. About 60% of patient are under 10 years of age. (2) Sex.
Males are more prone to the disease than females. Death rate is proportionately higher in
males. (3) Heredity. Not heredity. (4) Environment and hygienic condition. The rich are more
often spared than the poor. Excessive work, strain and marked overexertion are also factors
causing the disease. The causative agent is polio virus/filterable virus Legio debilitans with
Type I – Brunhilde: permanent immunity; most paralytogenic; Type II – Lansing: temporary
immunity; and Type III – Leon: temporary immunity.
The mode of transmissions are fecal-oral through saliva, vomitus and feces, direct contact
from one person to another and ingestion through of contaminated food (fecal-oral route).
Inhalation of oropharyngeal secretions. People carrying the poliovirus can spread the virus for
weeks in their feces. People who have the virus but don't have symptoms can pass the virus to
others. The incubation period is 7 – 14 days and period of communicability is not accurately
known. Polio virus can be found in throat secretions as early as 36 hours and in the feces 72
hours after exposure to infection. Risk of spreading the microorganism is highest during the
prodromal period.
Some types of poliomyelitis are bulbar with respiratory paralysis, spinal with paralysis of the
upper and lower extremities and intercostal muscles and bulbospinal with involvement of
neurons both in brainstem and the spinal cord.
Signs and symptoms, inapparent/ subclinical stage where some patient are in asymptomatic
stage (90-95%). Abortive (Minor Illness Stage) – fever, sore throat, GI symptoms (vomiting),
low lumbar backache/ cervical stiffness on ante-flexion of spine, headache, pain or stiffness in
the arms or legs, muscle weakness or tenderness. Major Illness Stage - non-paralytic/ preparalytic or meningitic type with recurrence of fever, poker spine (stiffness of the back),
tightness and spasm of hamstring, hypersensitiveness of the skin, deep reflexes are
exaggerated and paresis. Paralytic polio is the most serious form of the disease is rare. Initial
signs and symptoms of paralytic polio, such as fever and headache, often mimic those of
nonparalytic polio. Within a week, however, other signs and symptoms appear, including: with
paralysis depending on the part affected, positive hoyne’s sign (head drop), (+) kernig’s and
brudzinki signs, loss of reflexes, severe muscle aches or weakness, loose and floppy limbs
(flaccid paralysis), muscle wasting (atrophy), breathing or swallowing problems, sleep-related
breathing disorders, such as sleep apnea, and decreased tolerance of cold temperatures.
Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people
years after having polio.
The diagnostic tests are blood and throat culture, lumbar tap (pandy’s test), EMG and stool
exam with culture and sensitivity. Doctors often recognize polio by symptoms, such as neck
and back stiffness, abnormal reflexes, and difficulty swallowing and breathing. To confirm the
diagnosis, a sample of throat secretions, stool or a colorless fluid that surrounds your brain and
spinal cord (cerebrospinal fluid) is checked for poliovirus.
Because no cure for polio exists, the focus is on increasing comfort, speeding recovery and
preventing complications. Supportive treatments include: pain relievers (aspirin and codeine),
sedatives (phenobarbital), ventilator supports to assist breathing (O2 therapy, tracheostomy
and mechanical ventilation), and moderate exercise (physical therapy) to prevent deformity
and loss of muscle function.
The nursing management are (1) strict isolation, enteric precaution, (2) CBR / Firm and nonsagging bed, (3) rest, (4) ROM exercises, (5) Relief of muscle spasm with analgesics / hot
moist compress, (6) protective devices like hand roll for claw hand, trochanter roll for outer
rotation of the femur and footboard, (7) monitor for possible complications like respiratory
paralysis and hypertension, and (8) promote rehabilitation by referring to physical and
occupational therapy for braces and orthopedic shoes.
Polio mainly affects children younger than 5. However, anyone who hasn't been vaccinated is
at risk of developing the disease. Paralytic polio can lead to temporary or permanent muscle
paralysis, disability, bone deformities and death. Of the 3 strains of wild poliovirus (type 1, type
2 and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type
3 has been found since the last reported case in Nigeria in November 2012. Both strains have
officially been certified as globally eradicated. As at 2020, wild poliovirus type 1 affects two
countries: Pakistan and Afghanistan. The strategies for polio eradication work when they are
fully implemented. This is clearly demonstrated by India’s success in stopping polio in January
2011, in arguably the most technically challenging place, and polio-free certification of the
entire WHO Southeast Asia Region in March 2014.
There are two vaccines for polio: Oral Polio Vaccine (OPV) and the Inactivated Polio Vaccine
(IPV). In the Philippines still using OPV, IPV does not replace the OPV vaccine, but is used
with OPV to strengthen a child's immune system and protect them from polio. IPV Salk are
killed formulized virus, given SC or MI, include circulating antibodies but not local (intestinal
immunity), prevents paralysis but does not prevent re-infection, difficult to manufacture and
costly and not useful with controlling epidemics. OPV Sabin are live attenuated virus, given
orally, immunity is both humoral and intestinal, induces antibody quickly, prevents paralysis
and prevent re-infection, easy to manufacture and cheaper and can be effectively use in
controlling epidemics
The most effective way to prevent polio is vaccination. Most children in the United States
receive four doses of inactivated poliovirus vaccine (IPV) at the following ages: two months
four months, between 6 and 18 months, Between ages 4 and 6 when children are just entering
school. IPV is safe for people with weakened immune systems, although it's not certain just
how protective the vaccine is in cases of severe immune deficiency. Common side effects are
pain and redness at the injection site. Allergic reaction to the vaccine - IPV can cause an
allergic reaction in some people. Because the vaccine contains trace amounts of the antibiotics
streptomycin, polymyxin B and neomycin, it shouldn't be given to anyone who's reacted to
these medications. Signs and symptoms of an allergic reaction usually occur within minutes to
a few hours after the shot. Watch for: difficulty breathing, weakness, hoarseness or wheezing,
rapid heart rate, hives, dizziness and get medical help immediately.
The Centers for Disease Control and Prevention (CDC) advises taking precautions to protect
the people from polio if traveling anywhere there's a risk of polio. Adults who have been
vaccinated who plan to travel to an area where polio is occurring should receive a booster
dose of inactivated poliovirus vaccine (IPV). Immunity after a booster lasts a lifetime.
RED TIDE POISONING
A "red tide" is a common term used for a harmful algal bloom. Harmful algal blooms, or HABs,
occur when colonies of algae—simple plants that live in the sea and freshwater—grow out of
control while producing toxic or harmful effects on people, fish, shellfish, marine mammals, and
birds. The human illnesses caused by HABs, though rare, can be debilitating or even fatal.
While many people call these blooms 'red tides,' scientists prefer the term harmful algal bloom.
One of the best known HABs in the nation occurs nearly every summer along Florida’s Gulf
Coast. This bloom, like many HABs, is caused by microscopic algae that produce toxins that
kill fish and make shellfish dangerous to eat. The toxins may also make the surrounding air
difficult to breathe. As the name suggests, the bloom of algae often turns the water red.
Red tide is a term used to describe coastal phenomenon in which the water is discolored by
high algal biomass or concentration of algae. The discoloration may not necessarily be red in
color but it may also appear yellow, brown, green, blue or milky, depending on the organisms
involved. It may either be harmful or harmless. Some red tides are considered harmless when
there is no harmful impact on the environment, living organism and humans as well. Almost
always red tides are harmful since they cause harm to the environment, living organisms and
to humans. Some cause mass mortality of fish or fish kills and some produce potent toxins that
are of public significance.
Red tide occurs when an algae rapidly increases in numbers to the extent that it dominates the
local planktonic or benthic community. Such high abundance can result from explosive growth,
caused, for example, by a metabolic response to a particular stimulus (e.g., nutrients or some
environmental condition like a change in water temperature), or from the physical
concentration of a species in a certain area due to local patterns in water circulation. Blooms
are caused by environmental conditions that promote explosive growth. Factors that are
favorable to the rapid increase include warm sea surface temperatures, and high nutrient
content. The similarity of these alga and heterotrophs often makes it difficult to identify the
precise cause of a harmful algal bloom, and to predict its impact on the affected ecosystem.
Red tide is a global phenomenon. However, since the 1980s harmful red tide events have
become more frequent and widespread. Detection of a spread is thought to be influenced by
higher awareness of red tide, better equipment for detecting and analyzing red tide, and
nutrient loading from farming and industrial runoff. Countries affected by red tide events
include: Argentina, Australia, Brazil, Canada, Chile, Denmark, England, France, Guatemala,
Hong Kong, India, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, New Guinea,
Peru, the Philippines, Romania, Russia, Scotland, Spain, Sweden, Thailand, the United States,
and Venezuela (WHO, 2007, CDC, 2012). In the Philippines, the known species of PSP toxinproducing dinoflagellates are: (1) Pyrodinium bahamense var. compressum; (2) Gymnodinium
catenatum; (3) Alexandrium tamiyavanichii; and (4) Alexandrium minutum but the most notable
one is due to Pyrodinium bahamense var. compressum.
Currently, red tides cannot be predicted, but researchers are investigating the possibility. At
present, methods to control red tides are still limited in scope and remain largely untested in
major blooms since it is premature to conclude whether control methods are feasible,
applicable and advisable due to lack of knowledge on the side effects of those methods and
research studies are needed to validate the methods.
The seafoods are unsafe to eat from waters affected by red tide are filter-feeding shellfish
which include clams, cockles, oyster, mussels and scallops from red tide affected coastal
areas are unsafe to eat. Shellfish are particularly prone to toxin contamination as they feed by
filtering microscopic food out of the water, and if toxic planktonic organisms are present, they
are filtered from the water along with other nontoxic foods. Whelks, moon snails and other
univalves can also accumulate dangerous levels of toxin during red tide as they feed on
contaminated shellfish. Acetes or alamang from red tide affected waters are also not safe for
consumption. Fish, squids, crabs and shrimps can be eaten during a red tide because the toxin
is not absorbed in the edible tissues of these animals, however, the gills, viscera and internal
organs of fish must be removed before cooking. Eating distressed or dead fish, and other
aquatic animals in areas affected by red tide is discouraged because the reason for the
animal’s strange behavior or death cannot be absolutely known. It could be something
unrelated to red tide.
Diseases that may affect humans include: (1) Paralytic Shellfish Poisoning (PSP) - this disease
is caused by the production of saxitoxin by the Alexandrium species. It is common along the
Atlantic and Pacific coasts in the US and Canada. Poisoning occurs when one ingests shellfish
contaminated with PSP toxins causing disruption of nerve function and paralysis. Extreme
cases may result in death by asphyxiation by respiratory paralysis. (2) Diarrhetic Shellfish
Poisoning (DSP) - This disease is caused by the Dinophysis species. It generally occurs in
Japan and Europe, but it has also been found in other countries such as Canada, the US,
Chile, New Zealand, and Thailand. Symptoms of DSP include diarrhea, nausea, vomiting,
abdominal pain, and cramps. DSP is generally not lethal. (3) Amnesic Shellfish Poisoning
(ASP) - this disease, which has been found along the eastern Canadian coast, is caused by
domoic acid producing planktonic and benthic algae. It can also be found in soft shell clams
and blue mussels infected by Pseudo-nitzschia delicatissima. Gastric and neurological
symptoms include dizziness, disorientation and memory loss.
In the Philippines, the most common shellfish poisoning syndrome is paralytic shellfish
poisoning (PSP). Eating toxin contaminated-shellfish can cause paralytic shellfish poisoning
(PSP) in humans. PSP is caused by saxitoxin, which is produced by toxic dinoflagellates, and
is one of the most potent toxins. After ingestion, this poison immediately affects the nervous
system, with symptoms usually occurring within 30 minutes. Severity depends on the amount
of toxin ingested. Initial reactions are tingling of the lips and tongue, which spreads to the face,
neck, fingertips and toes. Headache, dizziness and nausea follow. These symptoms maybe
mistaken for drunken conditions and are further aggravated by alcohol consumption. In severe
cases, muscular paralysis and respiratory difficulty may occur within five (5) to twelve (12)
hours. Fatalities from respiratory paralysis have been reported. The most
common human health problems associated with red tides and other harmful algae blooms are
various types of gastrointestinal, respiratory, and neurological disorders.
There is no antidote and direct treatment for PSP. Treatment is symptomatic and varies with
the severity of symptoms, which include pumping the stomach, inducing vomiting and charcoal
hemoperfusion (a process involving the pumping of arterial blood through an activated
charcoal filter to remove the poison). Alkaline fluids such as sodium bicarbonate are also
thought to be helpful in treating symptoms, as the toxin is unstable in alkaline conditions.
Artificial respiration may be required if patients exhibit respiratory stress.
Individuals should pay close attention to Red Tide Advisory and under no circumstances
should individuals harvest, market and consume shellfish from any areas under shellfish ban
due to red tides. Toxic shellfish taste and appear no different from nontoxic shellfish and
cooking does not destroy the red tide toxin. Testing is the only way to determine if shellfish
contain unsafe levels of toxin. Swimming is safe for most people. However, red tide can cause
some people to suffer from skin irritation and burning eyes. Use common sense. If you are
particularly susceptible to irritation from plant products, avoid red tide water. If you experience
irritation, get out of the water and wash thoroughly. Do not swim among dead fish because
they can be associated with harmful bacteria.
Red Tide Monitoring Program has been in placed to determine toxicity in shellfish and toxic
algae in seawater samples. The Bureau of Fisheries and some Local Government Units
conduct regular monitoring of the coastal waters of the country. Toxin levels in shellfish are
analyzed by mouse bioassay method. The Philippines’ regulatory level for PSP toxin is forty
(40) microgram per 100 grams of shellfish meat. When shellfish toxicity exceeds the regulatory
level, BFAR Director issues shellfish advisory, which declares shellfish, ban in red tide affected
areas. During shellfish ban harvesting, marketing and consumption of shellfish are prohibited.
Concerned LGUs and government agencies coordinate and collaborate in the implementation
of the ban thus preventing contaminated shellfish from reaching the market. When blooms
subside, shellfish purify themselves of the toxin, and when testing indicates a return to safe
levels, the areas are reopened. BFAR Director also issues bimonthly Shellfish Bulletin, which
provides information on the status of the coastal waters of the country with regards to toxic red
tide.
Navales, Dionesia M. (2010). Handbook of Common Communicable and Infectious Disease,
C and E Publishing, Inc. QC.
Hinkle, Janice L. (2014) Brunner & Suddarth's textbook of medical-surgical nursing,13th.
Philadelphia: Lippincott Williams & Wilkins.617.0231 H59 2014, c5
Borromeo, Annabelle R. et.al. (2014). Lewis's Medical-Surgical Nursing: Singapore: Elsevier
Mosby. 617.0231 L58 2014, c3
Links:
www.cdc.gov
www.ecdc.europa.eu
www.doh.gov.ph
http://caro.doh.gov.ph/infectious-diseases/
www.who.org
www.health.com
www.mayoclinic.org
Can access to YouTube, Google and other electronic communicable disease nursing books
available
Study Questions
• Download an article about poliomyelitis, meningitis and red tide poisoning and make a
reflection essay. (choose one). Submit in 200-300 words.