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Chapter: Medicine Study Notes : Public Health

Communicable Disease Control

Reasons for notification: o High morbidity and mortality (in epidemiology terms, ie deaths per 100,000 of well population). o Intervention available

Communicable Disease Control

·        Reasons for notification:

o   High morbidity and mortality (in epidemiology terms, ie deaths per 100,000 of well population).

o   Intervention available

o   Other:

§  High public interest.  Eg CJD – is both rare and untreatable

§  Historical.  Eg decompression sickness

·        Notifiable Diseases:

o  Under Health Act 1956

§  Section A: infectious diseases notifiable to a medical officer of Health and Local Authority 

§  [involve water or food transmission]: acute gastro-enteritis (where common source or person in high risk occupation), cholera, giardiasis, legionellosis, primary amoebic meningoencephalitis, shigellosis, yersiniosis, campylobacteriosis, cryptosporidiosis, Hepatitis A, Listeriosis, salmonellosis, typhoid and paratyphoid fever 

§  Section B: infectious diseases notifiable to Medical Officer of Health: AIDS, CJD, HIB, Hepatitis C, Hydatid disease, Leptospirosis, measles, Neisseria meningitidis, plague, rabies, rickettsial diseases, tetanus, yellow fever, anthrax, brucellosis, diphtheria, Hepatitis B, Leprosy, malaria, mumps, pertussis, poliomyelitis, rheumatic fever, rubella 

§  Notifiable non-infectious diseases: cysticercosis, taeniasis, trichinosis, decompression sickness, lead poisoning, poisoning from contamination of the environment

o  All forms of TB (under TB Act 1948)

o  Venereal Diseases Act (1986?): covers gonorrhoea and syphilis, and contract tracing

·        Classification of notifiable diseases:

§  Vaccine preventable diseases

§  Blood borne and sexually transmitted diseases

§  Food and water borne diseases

§  Vector borne eg Malaria

§  Zoonoses (ie animal stage) eg Brucellosis, Hydatids, Rabies

§  Other Infectious diseases: eg CJD, Hepatitis, Leprosy, TB 

§  Non-infectious diseases: Decompression illness, Lead poisoning, environmental contamination

·        Process of notification: 

o  Is a legal requirement, although compliance is poor with common things like campylobacter. Only a small proportion contact doctor, only a few of these tested, only a few of these reported, etc

o  When to notify:

§  If serious on suspicion (eg meningitis)

§  If not serious (eg gastroenteritis) then on confirmation

·        Possible interventions:

o  Food borne – isolate source and close it down 

o  If AIDS and spread by blood products ® screen blood

o  If AIDS and confined to a locality ® education campaign

·        Surveillance system:

o  Report to medical officer of health 

o  Clinical labs also report to medical officer of health (if a special case then refer sample to the CDC Reference Lab – ESR). 

o  These all report to the CDC Epidemiology Group (also at Porirua), produce the Public Health Report 

o  In turn report to the Ministry of Health and MAF, so they can form surveillance and disease control policy (eg vaccination and screening policy, promotion, etc)

o  Other surveillance systems: coroner, Births, Deaths and Marriage, OSH, Cancer Registry

·        Epidemics:

o  An outbreak or epidemic is relative, is „more than you would expect‟ 

o  An outbreak investigation involves analysis of the time over which illnesses have occurred, the places and the characteristics of the people affected

o  Patterns of epidemic:

§  Point source out-break (eg food poisoning) – short duration 

§  Multiple source out-break: eg measles, index case spreads to multiple cases – long duration with fluctuating incidence

o  Want to find:

§  Agent

§  Vector

§  Source 

§  Can affect rate without known the agent. Eg cholera was controlled through clean water in London before the bug was discovered

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