548130504-UNIT-3-Biomedical-Foundations-of-Public-Health.pdf

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1. UNIT III:
Biomedical Foundations of
Public Health
Part I: Communicable/Infectious
Diseases
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

2. Learning outcomes
Bytheendofthisunit,studentsareexpectedto:
1.Describethebiomedicalfoundationsofpublichealth
2.Definetermsthatarekeytoexplainingthebiologicalandmedical
foundationsofpublichealth
3.Describethedifferentepidemiologyofdiseasesandmodeof
transmission(focusingoncommunicablediseases)
4.Describehowinfectiousdiseasesarelargelyconqueredthroughpublic
healthincludingchlorination,wastedisposal,properhygiene,and
immunization.
5.Understandthethreatsofinfectiousdiseasesandtheroleofthe
Philippinehealthsysteminrespondingtoemergingnewthreats.
6.Identifydifferentlocalhealthprogramsoninfectiousdiseasesbeing
implementedinthePhilippines
7.BeawareofthebiosafetyandbiosecurityprogramsoftheDOHand
understandtheconceptofemergencyresponsetobioterrorism
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

3. Outline
•Definition of terms
•Historical Landmarks
-Semelweissexperiments
-Jenerand vaccination against smallpox
-Jon Snow
-Koch’s postulate
•The Epidemiologic triad
•Chain of Infection
•Prevention and Control
•Models of Chain of Infection
-Rabies
-Polio
-Measles
•Evolution of Vaccines and
Antibiotics
•Emerging and Re-emerging
Diseases
•HIV and other STIs
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

4. Definition of Terms
•Communicablediseases
-spreadfromonepersontoanotherthroughavarietyofways
thatinclude:contactwithbloodandbodilyfluids;breathingin
anairbornevirus;orbybeingbittenbyaninsect(vector)
•InfectiousDiseases
-aredefinedasdisorderscaused bypathogenic
microorganisms,suchasbacteria,viruses,parasitesorfungithat
canbespreaddirectlyorindirectly(vector-borne)fromone
individualtoanother.
From:EncyclopediaofBioinformaticsandComputational
Biology,2019
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

6. Definition of Terms
•Infectiousdiseases,alsoknownasinfectiology,isa
medicalspecialtydealingwiththediagnosisand
treatmentofcomplexinfections.
•Aninfectiousdiseasespecialist'spracticeconsistsof
managingnosocomial(healthcare-acquired)infectionsor
community-acquiredinfectionsandishistorically
associatedwithtravelmedicineandtropicalmedicine.
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

7. Definition of Terms
•Tropicalmedicineisaninterdisciplinarybranchofmedicinethat
dealswithhealthissuesthatoccuruniquely,aremorewidespread,
oraremoredifficulttocontrolintropicalandsubtropicalregions.
•Physiciansinthisfielddiagnoseandtreatavarietyofdiseasesand
ailments.
•Mostinfectionstheydealwithareendemictothetropics.Afewof
themostwell-knownincludemalaria,HIV/AIDS,andtuberculosis.
•Theymustbeknowledgeableinthe18lesserknownneglected
tropicaldiseases,whichincludeChagasdisease,rabies,and
dengue.
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

8. Historical landmarks in Communicable diseases
Epidemiology and Public Health
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

9. Historical landmarks in Communicable diseases Epidemiology and Public
Health
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

10. Historical landmarks in Communicable diseases Epidemiology and Public
Health

11. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

12. The Epidemiologic Triad (sourced from CDC)
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

13. Definition of Terms
•Agent
-originallyreferredtoaninfectiousmicroorganismor
pathogen:avirus,bacterium,parasite,orothermicrobe.
-Generally,theagentmustbepresentfordiseasetooccur;
however,presenceofthatagentaloneisnotalways
sufficienttocausedisease.
-Conceptofnecessaryandsufficientcauses*
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

14. Definition of Terms
•Host
-referstothehumanwhocangetthedisease
-Avarietyoffactorsintrinsictothehost,sometimescalled
riskfactors,caninfluenceanindividual’sexposure,
susceptibility,orresponsetoacausativeagent.
-Opportunitiesforexposureareofteninfluencedby
behaviorsandphysiologicsusceptibility
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

15. Definition of Terms
•Environment
-referstoextrinsicfactorsthataffecttheagentandthe
opportunityforexposure.
-Environmentalfactorsincludephysicalfactors,biologic
factors,andsocioeconomicfactors
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

16. Chain of Infection
-referstothespreadofinfection(oragent)fromasource
toasusceptiblehost
-usefulframeworkinthedesignofpreventionandcontrol
measuresasspecificstrategiescanbeaimedatvarious
pointsalongthechainofinfection
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

18. Lifted from Ottawa Public Health website
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

19. Prevention and Control
Prevention Control
-Strategiesoractionsaimedat
eradicating,eliminatingor
minimizingtheimpactofdisease
anddisability,orifnoneoftheseare
feasible,retardingtheprogressof
diseaseanddisability.
-Ongoingoperationsatreducing
the:
-IncidenceofDisease
-Durationofdisease
-Effectsofthedisease
-Burdentocommunity
-Reductionintheriskandseverity
ofadiseaseattheindividuallevel
-Reductioninthefrequencyand
severityofadiseaseatthe
communitylevel
Lifted from: Lectures on Prevand Control –Bermudez, UPM-CPH, 2019
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

21. Chain of infection –Disease in focus:
Rabies
https://prezi.com/shsraauperh6/public-health-chain-of-
infection/
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

22. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

24. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

25. Chain of Infection: Smallpox, Measles,
and Polio
•pathogenic viruses, including small pox, measles and
polio, have no nonhuman reservoir
•The concept of vaccination originated with smallpox: the
observation that survivors of the disease were immune to
future infection
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

26. On smallpox eradication
•As of 2014, the debate over smallpox virus destruction was still
ongoing. Some scientists believe that valuable lessons remain to be
learned by studying the virus.
•Others agree with D. A. Henderson, leader of the WHO’s eradication
effort, who says,
“Let’sdestroythevirusandbedonewithit...We
wouldbebetteroffspendingourmoneyinbetter
ways.”
Oneconcernisthatthemolecularsequenceofthe
virusispubliclyknown,meaningthat,evenifall
smallpoxvirusesareeliminated,someonecould
synthesizeitinalaboratoryandlooseitontheworld.
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

27. On Polio
•Poliovirus,likesmallpoxvirus,infectshumanbeingsonly,andpoliosimilarlyhasthe
potentialtobeeradicated.
•In1988,atatimewhen350,000childrenwerebeingparalyzedeachyear,WHO
setagoaloferadicatingpoliobytheyear2000.
•Thisgoalwasnotmet,butsubstantialprogresshasbeenmadeagainstthis
cripplingdisease
•poliohasbeenessentiallyeliminatedfromtheWesternHemisphere,Europe,
SoutheastAsia,andtheWesternPacific,andby1999,annualpoliocaseswere
reducedby99%worldwide.
•Onlythreecountriescontinuetohaveendemicpolio—Nigeria,Pakistan,and
Afghanistan—buteradicationfromthesecountrieshasprovenextremelydifficult.
•SeveralNigerianstateshaltedvaccinationsandnumberofcasesinNigeria
jumpedto800in2004,andthevirusspreadtoseveralotherAfricancountriesthat
hadpreviouslybeenpoliofree
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

28. Polio Chain Of Infection
https://prezi.com/m-9sp_q6xbua/polio-chain-of-infection/
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

29. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

30. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

31. https://www.endpolio.org.

32. What ideas do you have for the
effective control of new polio
outbreaks in the Philippines?

33. On Measles
•anotherviraldiseasethatcouldintheorybeeradicated
•offersanexampleofwhathappenswhenpublichealthrelaxesits
vigilance
•Beforeavaccinewasavailable,almostallchildrencontracted
measles,causing400to500deathsayearintheUnitedStatesand
4000casesofchronicdisabilityfrommeaslesencephalitis.
•Avaccinebecameavailablein1963,andthenumberofcasesin
theUnitedStatesdroppedprecipitously.
•In1978,theU.S.DepartmentofHealthandHumanServicesseta
goaltoeradicatemeaslesfromthiscountryby1982.Thatambition
provedoverlyoptimistic.
•Oneproblemwasthatoutbreaksofmeaslesbegantooccur
among highschoolandcollegestudentswhohadbeen
vaccinatedasbabies.
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

34. Measles Chain of Infection
https://prezi.com/ddoeg8wcaczw/measles-chain-of-infection/

35. https://www.who.int/philippines/news/feature-stories/detail/questions-
and-answers-on-the-measles-outbreak-in-the-philippines
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

36. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

37. Vaccines, Issues
Antibiotics,

39. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

42. Source: The Pipettepen, Amanda Smythers
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

43. Public Health Issues on Vaccines and AMR
•Dipping Vaccine confidence
•MDR and XDR TB
•Nosocomial infections and “superbugs”
•Improper use and disposal of antibiotics
•Antibiotics in industrialized agriculture
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

44. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

47. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

48. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

49. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

50. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

51. https://epomedicine.com/wp-content/uploads/2016/12/mdr-
xdr-tb.jpg
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

54. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

55. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

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62. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

64. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

65. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

66. Emerging and Re-Emerging Diseases
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

67. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

68. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

69. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

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73. PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

76. HIV and Other Blood Borne Sexually TransmittedInfections
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH

77. What is a Sexually Transmitted Infection (STI)?
•ASexuallyTransmittedInfection(STI)isaninfectionthat
canbepassedthroughvaginal,oraloranalsex.
•MostSTIsaretransmittedthroughtheexchangeofsexual
fluids,butsomecanbepassedthroughskintoskingenital
contactorthroughcontactwithbloodandotherbodily
fluids.
•Practicingsafersex,canreducetheriskofSTBBIs.
-OttawaPublicHealth

78. STTBIs
•SexuallytransmitteddiseasesorSTDshaveanewname.
Theyarenowcalled“sexuallytransmittedandblood-
borneinfections(STBBIs)”.Theword“infection”ismore
accurategiventhatsomeconditionsmayormaynot
havevisiblesymptoms.

79. Common STBBIs
•Chlamydia
-Chlamydia is an infection caused by the bacterium Chlamydia trachomatis. People with
chlamydia most often do not show symptoms.
•Genital Herpes
-Genital herpes is an infection caused by theHerpes simplex.People with genital herpes
remain infected for the rest of their lives.
•Gonorrhea
-Gonorrhea is an infection caused by the bacteriumNeisseria gonorrhoeae.A person can
have gonorrhea more than once in his or her life.
•Hepatitis A, B and C
-Hepatitis A, B and C are inflammations of the liver caused by different viruses. They can
be spread many ways, including through sex.

80. Common STBBIs
•HIV/AIDS
-The human immunodeficiency virus (HIV) attacks and weakens the immune system. The
infected person is then affected by various other diseases and infections. In time, if the HIV
infection is not treated, it can develop into AIDS (acquired immune deficiency syndrome).
People who get HIV are infected for life.**
•Human Papillomavirus (HPV)
-There are many types of human papillomavirus (HPV). Some of them can be transmitted
sexually.
•Lymphogranuloma Venereum (LGV)
-Lymphogranuloma venereum (LGV) is an infection caused by the bacterium Chlamydia
trachomatis. People infected with LGV do not always show symptoms.
•Syphilis
-Syphilis is an infection caused by the bacterium Treponema pallidum. A person may be
infected without knowing it.

84. On Counseling
•hh)Pre-testCounselingreferstotheprocessofprovidingan
individualwithinformationonthebiomedicalaspectsofHIV
AIDS,andemotionalsupporttoanypsychologicalimplications
ofundergoingHIVtestingandthetestresultitselfbeforethe
individualissubjectedtothetest;
•(ii)Post-exposureProphylaxisreferstoapreventivemedical
treatment startedimmediately afterexposure to
pathogen(HIV)inordertopreventinfectionbythepathogen
andthedevelopmentofthedisease;
•(jj)Post-testCounselingreferstotheprocessofprovidingrisk-
reductioninformationandemotionalsupporttoapersonwho
submittedtoHIVtestingatthetimetheresultisreleased;

85. •(ee)PartnerNotificationreferstotheprocessbywhichthe"index
client","source",or"patient"whohasasexuallytransmitted
infection(STI)includingHIV,isgivensupportinordertonotifyand
advisethepartnersthathavebeenexposedtoinfection.Support
includesgivingtheindexclientamechanismtoencouragetheclient's
partnertoattendcounseling,testingandotherpreventionand
treatmentservices.Confidentialityshallbeobservedintheentire
process;

95. ConclusionsThissystematicreviewandseriesofmeta-analysessupportthenotion
thatHIV-relatedstigmahasadetrimentalimpactonavarietyofhealth-related
outcomesinpeoplewithHIV.Thisreviewcaninformthedevelopmentof
multifaceted,intersectoralinterventionstoreducetheimpactofHIV-relatedstigma
onthehealthandwell-beingofpeoplelivingwithHIV.

96. https://www.thelancet.com/journals/lanpub/article/PIIS2468-
2667(18)30265-2/fulltext

98. •(y) Informed Consentrefers to the voluntary agreement of a person to undergo or be subjected to
a procedure based on full information, whether such permission is written or conveyed verbally;
•(z) Key Affected Populationsrefers to those groups or persons at higher risk of HIV exposure, or
affected populations whose behavior make them likely to be exposed to HIV or to transmit the
virus;
•(bb) Mature Minor Doctrine refers to the legal principle that recognizes the
capacity of some minors to consent independently to medical procedures, if they
have been assessed by qualified health professionals to understand the nature of
procedures and their consequences to make a decision on their own;
•(cc) Medical Confidentialityrefers to the core duty of medical practice where the information
provided by the patient to health practitioner and his/her health status is kept private and is not
divulged to third parties. The patient's health status can however, be shared with other medical
practitioner involved in the professional care of the patient, who will also be bound by medical
confidentiality. Medical confidentiality applies to the attending physician, consulting medical
specialist, nurse, medical technologist and all other health workers or personnel involved in any
counseling, testing or professional care of the patient. It also applies to any person who, in any
officially capacity, has acquired or may have acquired such confidential information;

109. Resources:
•Schneider, M.-J. (2000). Introduction to public health. Gaithersburg, Md:
Aspen Publishers.
•Gordis, L. (2014). Epidemiology(Fifth edition.). Philadelphia, PA: Elsevier
Saunders.
•Lecture notes by SYAM Villanueva. UPM-CPH (2019)
•https://healthcare-in-europe.com/en/news/global-opportunity-to-tackle-
antibiotic-production-waste.html
•https://www.cdc.gov/
•https://doh.gov.ph/
•https://www.who.int/
•All other images are sourced from open sources.
PREPARED BY: IAN PAULO C. GIGANTE, RMT LPT MPH