Epidemiology ,control and management of plague

Seminar presentation on epidemiology ,control and management of plague

1. EPIDEMIOLOGY, CONTROL & MANAGEMENT OF PLAGUE.

2. INTRODUCTION

3. Cont Plague is a zoonotic diseases caused by yersinia pestis, found in a small mammals. It is transmitted between animal by their fleas. The bacteria, the animal reservoir and the vector in a given area collectively called a “plague natural focus”.

4. HISTORY OF PLAGUE Plague has been responsible for wide spread pandemic throughout history including the so called a black death that caused over 50 M death in Europe during 15 th century . In 1994 plague in India was an outbreak of bubonic and pneumonic plague in South central and western india from 26 th August to 18 th October 1994. 693 suspected cases and 56 deaths were reported from the five affcted indian states as well as the Union territory of delhi.

5. DEFINITION Plague is a diseases that affects humans and other mammals. It is caused by the bacterium , yersinia pestis .

6. EPIDEMIOLOGICAL DETERMINANTS AGENT FACTORS AGENT : causative agent – yersinia pestis. Bacilli occur in great abundance in buboes, blood, splen, liver and other viscera of infected person and in sputum of pneumonia plague. Plague bacilli can survive and multiply in soil of rodent burrows, where micro – climate and other conditions are favourable.

7. Cont RESERVOIRS OF INFECTION: Wild rodents are the natural reservoir Or plague. E.g ; field mice, skunks, gerbills, and other small animals. These are found in mountain, desert, cultivated area and forest in temperature and tropical region. In india, the wild rodent, TATERA indica has been incriminated as the main reservoir.

8. Cont - Sources of infection : Infected rodents Fleas Cases of pneumonic plagues.

9. HOST FACTOR- Age and sex : Human activities : Movement of people : Immunity Race Ethnicity

10. ENVIRONMENTAL FACTORS- Season Temperature and humidity Rainfal Urban and rural areas. Human dwelling

11. PATHOPHYSIOLOGY It consists of two components:- The transmission of bacteria from fleas The host response to the bacteria

12. The transmission of bacteria from fleas.

13. Cont The host resonse to the bacteria

14. HUMAN PLAGUE Mode of transmission- Bite of infected flea Direct contact with tissues of infected animal. Droplet injection from cases of pneumonic plague.

15. Cont

16. INCUBATION PERIOD Bubonic plaque :2 to 7 days. Septicaemic plague : 2 to 7 days. Pneumonic plague : 1 to 3 days.

17. Types of plague diseases in man Bubonic plague :- most common The infected rat fleas usually bite on the lower extremities and inoculate the bacilli. The bacilli are intercrepted by the regional lymphatics glands where they proliferate.

18. Typical feature of bubonic plague Sudden fever, chills, headache, prostration. Painfull lymphadenities It can’t be spread from person to person. Enlarged lymph nodes develop in the groin, and less often in the axilla or neck, depending upon the site of bite by flea.

19. Pneumonic plague Primary pneumonic plague is rare. It follows complication of bubonic septicaemic plague. The incidence of bubonic plague is usually 190. Its highly infectious nad spread from man to man by droplet infection. The plague bacilli are present in the sputum. It is also known as black death

20. Septicemic plague Primary septicaemic plague is rare except for accidental laboratory infections. Untreated septicemic plague is almost always fatal. Early treatment with antibiotics reduces the mortality rate to b/w 4 and 15 percent. It may cause death before anything symptoms occur. If the bacteria enter the blood stream rather then the lymph or lungs, they multilply and causing bqcterium and severe sepsis.

21. Clinical manifestation

22. Laboratory investigation STAINING CULTURE SEROLOGY OTHER METHODS .

23. Complication Complications of plague may include Death Gangrene Meningitis

24. Prevention and control Control of cases Early diagnosis during epdemic situations diagnosis can be made on clinical grounds. E.g acute fever. In other situation “rat flea /dead rat provide a useful warning a possible outbreak. Plagur suspected of a human and rodents must be examined bacteriologically to confirm the presence of plague. NotDis

25. Cont Notification- If a human or rodent case is diagnosed health authorities must be notify. Case notification is required by international health regulation. ISOLATION- Although most bubonic plague patients are
non-infectious , isolation is recommonded whenever possible.

26. Cont • Treatment - must be started without waiting for
confirmation of the diagnosis. • The drug choice is – streptomycin (30mg per kg
of body weight daily) 1m in 2 divided doses for 7 to 10 days Tetracycline,orally (30-40mg per kg of body
weight daily and sometime given in combination with streptomycin, Gentamycin, 2mg 1kg of body weight loading

27. Cont Dose , then 1-7 kg body weight every 8 hours intravenously. Sulphonamides may be used , if other drugs not available DISINFECTION - Disinfection of sputum ,disincharges and articles soiled by the patients should be carried out. Dead bodied shoudh be handled with aseptic precautions.

28. Cont CONTROL OF FLEAS Most effective method to break the chain of transmission is distruction of rat fleas by insecticides.
DDT 10% and BHC 3% should be used as dust.• In areas of resistance to one or both of these, oust of carbaryl 2%or malathion 5% is used. The organochlorine insecticides remain effective for 2 to 4 months. Before sprying remove all foodstuffs and eating cooking vessels from the house. Insecticidal spraying upto,the radius of 5 miles around each infected locality is consideraded adequate.

29. Cont 3.) CONTROL OF FLEAS - continuous destruction or rodent is important plague preventive measure 4.) VACCINATION- immunization with plague vaccine is a valuable preventive measure. Vaccination should be carried out at least week before an antipated outbreak and the vaccine should be given in 2 doses.

30. Dosage of plague vaccine Age and sex Ist dose 2 nd dose Six monthly Adult male Adult females Children 1-4 yearrs 5-10 years 11-16 years Infants under 6 months are not immunized 0.1 ml 0.75 ml 0.2 ml 0.3ml 0.4 ml 1.5 ml 1.0 ml DoubLe the f First dose 1.0 ml 0.75 ml Same as the dose

31. NURSING MANAGEMENT DIAGNOSIS : chest pain related to resouartory system. Goal: To maintain respiratory problem . Assess vital sign Auscultate breath sound
Give comfort position to patient Encourage breathing exercise to patient

32. C Diagnosis :- Altered body Temperature related to infection as evidenced by hyperthermia. Goal:- To maintain normal body temperature Intervention :- provide assessment to patient and take vital sign for baseline data
Provide cool and calm environment to the patient
- Windows and doors are open and air ventilation by fan are provided
- Provide asepsis care to patient
. Provide anti- pyretics meditation as prescribed by physician
- Assess vital sign and give assurance to Patient

33. 3.) Diagnosis :- Deficient fluid volume r/t vomiting. Goal:- To maintain fluid volume Intervention :- Monitor for possible sources of fluid loss
Monitor the clients intake and output
monitor coagulation studies – administer anti-diarrheal medication as
prescribed, in addition to IV fluids. -. Prepare IV fluids and electrolyte balance

34. 4.) Diagnosis :- Anxiety related to change in health status Goal :- To improve health status Intervention :- Assess the client level of anxiety
Acknowledge and awareness of client anxiety
reduce unnecessary external stimuli by maintaining a quiet environment maintain a confident assured manner while interacting with the client

35. 5 .) Diagnosis :- Risk of infection
related to unhygienic activity of
patient G oal :- To provide healthy and hygiene routine to patient Intervention :- Monitor the patient daily care routine and activities
- find out the unhygienic activities of the patient
- provide healthy education about healthy hygiene and its importance to patient - provide support and assistance in day to day care to patient - provide a family health education to patient -. Remove excessive and tight clothing

36. 6.) Diagnosis :- decreased cardiac output due time alteration in hear rate. Goal: To maintain the hear rate Intervention: Assess client’s heart rate and bp Including peripheral pulses like direct intra arterial monitoring as order. Monitor oxygen as order. Assessed for any change in level of consciousness. Provide electrolytes replacement as prescribed. Administer fluid and blood replacement therapy as prescribed

37. HEALTH EDUCATION Health education is an essential part of any plague control programme. EmPhasis Must be placed On the need for the prompt reporting of dead rats and suspected human so that preventing measures can be taken. Medical practitioners should keep plague in mind for differential diagnosis of any cases of fever with lymphadenopathy, or when multiple cases of pneumonia occur. Fill holes and gaps in home to stop mice, rats and the squirrel from getting in.

38. Cont Wear gloves while touch wild animal alive or dead. Use flea control spray or other treatment on pet.

39. RESEARCH ARTICLE Published 10 th April 2020 Research done by – Catherine killer. Title : soil salinity and aridity specify plague foci in the United status of America.

40. Cont Abstract : plague is a deadly ZOONOSIS that periodically remerges as small outbreaks in geographically limited foci where the causative agent YERSINIA PESTIS may reside in soil. We analyzed a data set of 1.005 carefully documented plague cases that were geo referenced over 113 years in peer. – reviewed literature in the contiguos United status. Plotting outbreaks by countries defined as plague foci on geographical maps. We observed a significant co localization of plague outbreaks with high soil salinity measured by an electric conductivity of >4ds /m and aridity measured by an atidity index <0.5

41. Summary Today we learned about the definition of plague, their cause, host factor and environmental factor and how to diseases can transmit from animals to men and their incubation timr to know the sign and symptoms of plague. Then we learned about different types of plague, their laboratory investigation, and their prevention and control of plague, their management, vaccination treatment.

42. Conclusion Plague is infectious disease that can easily transmitted from men to men. In some cases not reated Earlier it is 100%fatal.rodents are the reservoir of plague. All age group and both sexes are susceptible to disease. Plague is responsible for widespread throughout the history. Now a days, vaccine are available globally 600 cases are report in year but now treatment has lowered mortality rate to approx 11%.

43. BIBLIOGRAPHY Park’s textbook of preventive and social medicine, 23 rd medicine. Robert D. And Jacqueline D. Fathets on. Yersinia pestis – etiology agent of plague, clinical mucrobiology reviews jan, 1997.pg -35 to 66 volume -10(1) Internet sources.. www. En.M.Wikipedia. Org/wiki/Plague diseases