Exam 1

5 SDOH

• Education Access and Quality 

• Health care and quality 

• Neighborhood and Built Environment 

• Social and Community Context 

• Economic Stability 

Education Access and Quality

• Early Childhood Education and Development 

• High School Graduation 

• Enrollment in Higher 

• Language and Literacy 

Health care and quality 

• Access to Health Care 

• Access to Primary Care 

• Health Literacy 

5 As 

• Acceptability 

  • Is the person needing care abe to receive acceptable treatment 

• Adequacy 

  • Are services available that are relevant to the needs of the community 

• Availability 

  • Is it available? 

  • Is the right thing available? 

• Accessibility 

  • Transportation  

• Affordability 

  • Can people with insurance, underinsured, or uninsured afford care 

Neighborhood and Built Environment

• Access to Foods that Support Healthy Eating Patterns 

  • Affordable, healthy, accessible food  

• Crime and Violence 

• Environmental Conditions 

• Quality of Housing 

Social and Community Context 

• Civic Participation 

• Discrimination 

• Incarceration 

• Social Cohesion

  • Affected by external factors and beliefs even in the presence of a common goal 

Economic Stability

• Employment 

• Food Insecurity 

• Housing Instability 

• Poverty

social ecological model

Societal 

• Most upstream (root of the issue) 

• Policy 

• How society enables diseases to occur 

Community 

• Neighborhood community and environment  

Interpersonal 

• Who you spend time with 

• Exposure to germs 

• Influences on health behavior 

Individual 

racism and health

• Racism also threatens health, both “upstream” and independent of class. At every income level, African Americans, Pacific Islanders, Native Americans and other people of color often fare worse than their white counterparts. 

• Social and economic policies have reduced health inequities in the past in the U.S. and in other countries 

• Make sure to ask about accessibility to transportation, money, and medications 

class and health

• Our economic, social, and built environments shape health 

• People who are middle to lower on the class pyramid are exposed to more health threats (material deprivation to chronic stressors) and have less access to the opportunities and resources needed to control their destinies. 

• People middle to higher on the class pyramid have access to more power and resources and in general live longer, healthier lives. This is true not only for the bottom and top but at every level. 

• Weathering: Chronic activation of the body’s stress response wears down our organs over time and increases disease risk 

• Black people and Native Americans experience lower health outcomes regardless of SES

health disparities vs health inequities

disparities

• a population where there is a significant difference in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to health status of the general population

inequities

• disparities in health that are systematic and unavoidable and unjust

health wealth gradient

consistent, positive relationship between socioeconomic status (including wealth and income) and health, where higher economic status is associated with better health outcomes, longer lifespans, and increased access to quality healthcare resources

choices and control

• 50% of what controls your health is outside your control

factors that have biggest effect on health

• social and economic factors (40%)

• health behaviors (30%)

• Clinical care (20%)

• Physical environment (10%)

public health focus

• A Public Health Nursing is a registered nurse who uses clinical knowledge and relationships with individuals, families and communities to prevent disease, promote health and prolong life 

types of communities

Collection of people who interact with one another and whose common interests or characteristics form the basis for a sense of unity or belonging 

Geographic 

• city, town, neighborhood 

Common interest 

• professional organizations, sports fans, charities 

Community of solution 

• group of people who come together to solve a problem that affects all of them 

Phenomenological 

• a group of people who share relationships, values, and perspective, identity, regardless of location 

• e.g., churches 

 

3 levels of prevention

• Prevention of health problems 

• Anticipating and averting problems or discovering them as early as possible to minimize potential disability and impairment 

• levels

  • primary

  • secondary

  • tertiary

primary prevention

• Keep illness or injury from occurring

  • safety education

  • vaccines

  • diet and exercise

secondary prevention

• Efforts to detect and treat existing disease 

• can reverse disease

  • referrals for diagnosis and treatment

  • screenings

  • disease education to prevent disease progression

tertiary prevention

• Reduce the extent and severity of a health problem to its lowest possible level to minimize disability and restore or preserve function 

  • treatments such as surgery

  • continuous monitoring

public/community health nursing practice vs.

community-based nursing practice

Community & Public Health Nursing- 

• Population focused, promoting health and preventing disease and disability 

Community Based Nursing – 

• “application in the nursing process in caring for individuals, families and groups where they live go to school or as they move through the healthcare System" 

acute care nursing vs. public health nursing

Acute care nursing 

• Care of solitary patients 

• Primarily illness end of health continuum 

Public health nursing 

• Care encompasses a much wider vista 

• Primary charge to prevent health problems 

• Promote higher levels of health 

public/community health nursing characteristics

• Field of nursing with a shift from individual to aggregate 

• Combines nursing science with public health science 

• Community based and population focused 

• Public health sciences and nursing theory 

• Focus on population-level outcomes 

• Emphasis on prevention 

 

population vs aggregate

Population: 

• All people occupying an area or all of those who share one or more characteristics 

• People not necessarily interacting with one another; not necessarily sharing a sense of belonging to that group 

Aggregate: 

• Mass or grouping of individuals considered as a whole 

• Loosely associated with one another 

• Community split into categories 

health and wellness

• Health: holistic state of well-being including soundness of mind, body, and spirit 

  • How people feel (subjective) 

  • How well people can function in their environment (objective)

• Wellness: health plus the capacity to develop a person’s potential leading to a fulfilling and productive life 

• Illness: state of being relatively unhealth 

B

Kelly is a registered nurse who is employed by a county public health agency. One of her responsibilities within the agency is coordinating the lead poisoning prevention program. She recently initiated a door-to-door screening program in a high-risk area of the county. She also has started providing countywide education about lead poisoning prevention. During the past several months she has seen an increase in the number of new cases of lead poisoning that have been reported. This may be related to the new initiatives she has implemented in the county. However, she decides that it would be beneficial to organize a task force to examine the increasing incidence of lead poisoning and develop interventions that could be used to decrease this problem. 

What intervention did Kelly perform that best exemplifies secondary prevention? 

A. Organizing a task force to look at the lead poisoning problem in the county 

B. Initiating a door-to-door lead screening program 

C. Providing countywide education about lead poisoning prevention 

D. Discovering an increase in the number of new lead poisoning cases 

D

Kelly is a registered nurse who is employed by a county public health agency. One of her responsibilities within the agency is coordinating the lead poisoning prevention program. She recently initiated a door-to-door screening program in a high-risk area of the county. She also has started providing countywide education about lead poisoning prevention. During the past several months she has seen an increase in the number of new cases of lead poisoning that have been reported. This may be related to the new initiatives she has implemented in the county. However, she decides that it would be beneficial to organize a task force to examine the increasing incidence of lead poisoning and develop interventions that could be used to decrease this problem. 

What is the focus area of Kelly's nursing practice? 

A. Public health nursing 

B. Community health nursing 

C. Community-based nursing 

D. Both A and B 

risk

Probability that a disease or unfavorable health condition will develop 

Chain and Web of Causation

• Recognizes the complex interrelationships of many factors interacting, sometimes in subtle ways, to increase (or decrease) the risk of disease 

• Associations are sometimes mutual, with lines of causality going in both directions 

chain

• reservoir → portal of exit → mode of transmission → agent → portal of entry → host

Specificity vs. Sensitivity

Sensitivity

• quantifies how accurately the test identifies those with the condition or trait

• true positives 

• false negatives

Specificity

• indicates how accurately the test identifies those without the condition or trait

• true negatives 

• false positives

Increased sensitivity = decreased specificity 

Morbidity vs. Mortality

Morbidity frequency measures 

• Incidence & prevalence 

Mortality frequency measures 

• Mortality rate 

Incidence vs. Prevalence

Incidence

• the number of new cases or events in a population at risk during a specified period of time 

• Number of persons developing a disease/Total number at risk per unit of time 

• A measure of choice to study etiology because it is affected only by factors related to the risk for developing disease and not to survival or cure 

• Useful evaluating the effectiveness of prevention and control programs

Prevalence

• the number of existing (new and pre-existing) cases in a given population at a given point in time 

• Number of persons with a characteristic/Total number in population 

• Based on both incidence and duration of illness 

• High prevalence of a disease within a population might reflect high incidence or prolonged survival without cure or both. 

• Low prevalence might indicate low incidence, a rapidly fatal process, or rapid recovery. 

• Often measured for chronic diseases (e.g., diabetes, osteoarthritis) which have long duration and dates of onset that are difficult to pinpoint. 

• Useful in planning health care services because it is an indication of the level of disease existing in the population and of the size of the population in need of services 

case control study

Retrospective studies that compare individuals with a specific disease or outcome (cases) to those without the disease (controls). Researchers look back to investigate whether certain exposures or risk factors are more common in the cases than in the controls

• Do persons with the outcome of interest (cases) have the exposure characteristic (or a history of the exposure) more frequently than those without the outcome (controls)? 

• When an agent or factor is suspected of being causally related to the occurrence of a disease 

• Participants are selected on the basis of the presence or absence of the disease or outcome in question (one with health problem and one without), then prior exposure is assessed 

cohort study 

prospective studies that follow a group of individuals (cohort) over time to assess how different exposures or risk factors affect the likelihood of developing a disease or outcome. The participants are initially disease-free and are tracked to observe who develops the condition

• RR = 1 No difference in the risk of disease outcome in association with exposure status 

• RR < 1 The risk of disease is lower in an exposure group compared to no exposure group (Exposure is a protective factor) 

• RR > 1 The risk of disease is higher in an exposure group compared to no exposure group (Exposure is a risk factor)

experimental studies

researchers actively intervene by assigning participants to different groups (e.g., treatment and control groups) and then measure the outcomes to assess the effect of the intervention.

• Clinical Trials 

  • Randomization to groups 

  • Masking or “blinding” treatment 

• Community Trials 

• Often not feasible or ethical to conduct for many risk factor-disease associations 

cross-sectional study

observational study where data is collected at a single point in time to assess the prevalence of an outcome or condition and its associations with exposures. It provides a snapshot of the population at a specific moment

• Prevalence studies (= cross-sectional) – one time data collection 

epidemiology

The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems 

Descriptive Epidemiology 

• Distribution 

• Describes a disease according to its person, place, or time 

• What is the disease? Who is affected? Where are they? When do events occur? 

Analytic Epidemiology 

• Determinants of health - those factors, exposures, characteristics, and behaviors, and contexts that determine (or influence) the distribution or the patterns of health and disease 

• Investigate causes and associations 

• How does it occur? Why are some people affected more than other 

disease spectrum

Endemic 

• A disease outbreak that is consistently present but limited to a particular region 

• Types of endemics: holoendemic, hyperendemic, mesoendemic, and hypoendemic 

Epidemic 

• Unexpected increase in the number of disease cases in a specific geographical area 

Pandemic 

• When a disease’s growth is exponential 

• A virus covers a wide area, affecting several countries and population 

epidemiologic triangle

Made of 3 principles 

Environment 

• Blood 

• Temperature 

• Seasons  

Agent 

• Bacteria 

• Alcohol 

• Trauma 

• Radiation 

• Lack or excess of nutrition 

Host 

• Age 

• Sex 

• Race 

• Immune status 

hills criteria for causality

Strength of the association 

• Strong associations are more likely to be causal than weak associations 

Consistency 

• Repeated observation of an association in different populations under different circumstances 

Temporality 

• The necessity that the cause precedes the effect in time

Dose-response effect/biologic gradient 

• The presence of a monotone (unidirectional) dose- response curve 

Biologic plausibility 

criteria for screening

The goal of screening is to determine the likelihood that these individuals will develop the disease 

• Cost-effectiveness 

• Safety of administration 

• Availability of treatment 

• Ethics of administration/wide-spread implementation 

• Validity (Sensitivity & Specificity) – a high probability of correct classification of persons tested (= accuracy) 

• Reliability – results are consistent from place to place, time to time, and person to person (= precision; i.e., consistency or repeatability) 

sensitivity vs specificity trade offs

• High sensitivity is needed when early treatment is important and when identification of every case is important 

• High specificity is needed when rescreening is impractical and when it is important to reduce false-positive results 

• Want more sensitive test for serious diseases to identify all patients with it 

• Becomes less specific 

• High specificity for diseases with invasive treatments 

mortality rates

• A mortality rate is a measure of the frequency of occurrence of death in a defined population during a specified interval 

• When mortality rates are based on vital statistics (e.g., counts of death certificates), the denominator most commonly used is the size of the population at the middle of the time period. In the United States, values of 1,000 and 100,000 are both used for 10n for most types of mortality rates 

comparison groups

The ideal approach would be to compare one group of people who all have a certain characteristic, exposure, or behavior with a group of people exactly like them except that they all lack that certain characteristic, exposure, or behavior

odds ratio

compares the odds of exposure among cases to the odds of exposure among controls 

• OR = 1.0 The odds of exposure among cases are the same as the odds of exposure among controls 

• exposure does not affect odds of disease 

• OR > 1.0 The odds of exposure among cases are greater than the odds of exposure among controls 

• exposure is associated with higher odds of disease (Risk factor) 

• OR < 1.0 The odds of exposure among cases are lower than the odds of exposure among controls 

• exposure is associated with lower odds of disease (Protective factor) 

B, C

The Iowa Women’s Health Study, in which researchers enrolled 41,837 women in 1986 and collected exposure and lifestyle information to assess the relationship between these factors and subsequent occurrence of cancer, is an example of which type(s) of study? 

A. Experimental 

B. Observational 

C. Cohort 

D. Case-control 

E. Clinical trial 

A

An epidemic that becomes unusually widespread and even global in its reach is referred to as a _________________.  

a) Pandemic  

b) Hyperendemic  

c) Endemic 

C

A city has a population of 250,000. Of these, currently 10,000 have disease X, which is incurable. There are 1,000 new cases and 400 deaths each year from this disease. The prevalence of this disease is given by 

a. 400/250,000 

b. 600/250,000 

c. 10,000/250,000 

d. 1,000/250,000 

Sensitivity - B

• preferable in situations where it is critical not to miss any cases of the disease, such as in the early detection of highly contagious or severe illnesses where early treatment is crucial

Specificity - C

• preferable when the cost or risk of false positives is high. For example, when unnecessary treatment or anxiety caused by a false positive could lead to harm, a test that correctly identifies healthy individuals (low false positives) is more important

For which disease condition would you prefer to have a test high in sensitivity? Which disease condition would you prefer to be high in specificity?

a. Diabetes

b. Covid

c. Breast Cancer

d. High risk for falls

D

A public health department reports that 10% of the adult population in a city has been diagnosed with diabetes as of this year. This percentage includes all adults currently living with diabetes, whether they were diagnosed this year or in previous years. What epidemiological measure does this indicate?

a. Incidence

b. Case fatality rate

c. Morbidity rate

d. Prevalence

C

A researcher is investigating whether smoking is associated with an increased risk of developing lung cancer. They select a group of individuals who already have lung cancer and another group of individuals without lung cancer. They then compare the smoking histories of both groups to determine if there is a higher proportion of smokers in the lung cancer group. What type of study design is being used?

a) Cross-sectional study

b) Cohort study

c) Case-control study

d) Randomized controlled trial

C

Researchers want to examine the relationship between diet and the development of heart disease. They enroll a large group of healthy individuals and collect detailed information about their diets. Over the next 10 years, they track who develops heart disease and analyze how diet might have contributed to the risk. What type of study design is being used?

a) Cross-sectional study

b) Case-control study

c) Prospective cohort study

d) Randomized controlled trial

C

A public health researcher conducts a survey to assess the prevalence of obesity and its association with physical activity levels in a population at a single point in time. They measure both the body mass index (BMI) and physical activity levels of all participants during the survey period.

What type of study design is being used?

a) Case-control study

b) Cohort study

c) Cross-sectional study

d) Randomized controlled trial

D

A clinical trial is conducted to evaluate the effectiveness of a new medication for lowering blood pressure. Participants are randomly assigned to receive either the new medication or a placebo. The researchers then compare the changes in blood pressure between the two groups over the course of the study.

What type of study design is being used?

a) Observational study

b) Case-control study

c) Cohort study

d) Experimental design study

germ theory vs holistic health

germ theory

• focused diagnosis and treatment on individual organism and individual disease.

• uni-causal

holistic

• Emphasizes prevention, self-care, and natural healing

• multi-causal

major leaders in epidemiology

• Louis Pasteur: the germ theory and pasteurization 

• Joseph Lister: antiseptic surgery 

• Robert Koch: developed pure culture and identified the organisms that cause TB, anthrax, and cholera disease 

• John Snow: “father of epidemiology” water pump cholera outbreak map in London 

• Florence Nightingale: environmental conditions during Crimean War 

causes of death in 1900s vs. 2010s

1900 

• Infectious disease 

2010 

• Heart disease and cancer 

• Mitigated infectious disease 

Establishment of Modern Health Care and Public Health Practice

• Emergence of germ theory focused diagnosis and treatment on individual organism and individual disease. 

• Community outcry for social reforms forced governments to take action. 

• Boards of health and health departments began in 1866. 

• TB surveillance began in 1889 

changes in public health focus

• Change from infectious diseases to chronic conditions 

• Modern medical advances (vaccination programs and antibiotics) 

• Holistic approach to health 

• Better sanitation and nutrition 

• Grecian Hygeia (i.e., healthful living) versus Panacea (i.e., cure) dichotomy 

• Multi-causal, not uni-causal, view of disease 

  • Uni-causal was the germ theory 

  • Multi-causal – holistic approach 

• Improved sanitation and nutrition are the reasons why we live much longer lives now 

lilian wald

• First to use the term “Public Health Nursing” 

• instituted school and industrial nursing as new areas of public health

• “House on Henry Street” Settlement in New York City 

• Started School Nursing 

• Metlife 

• National Organization for Public Health Nursing-1st president 

healthy community

• US department of Health and Human Services definition: 

• High-quality longer life 

• Health equity 

• Social and community environments that promote good health for all

nursing process caring for community

Deliberative 

• Intentional prevention 

Cyclical  

• Constant work  

Plan to meet health needs

• Set priorities 

• Establish goals and objectives –SMART goals 

• Implementation 

• Preparation 

• Nursing activities 

• Evaluate outcomes 

measured during community assessment

• Status/people: morbidity & mortality, demographics/aggregates 

• Structure: services and resources 

• Process: function effectively 

types of community needs assessments

Familiarization and ‘windshield survey’ 

• Sights, smells, etc. 

• observation 

Problem oriented assessment 

• Pick one problema nd look at the impact 

Community subsystem assessment 

• Students that live in Oakland community 

Comprehensive assessment 

• Look at everything 

Community assets assessment 

• What is good about the community 

Engage the community in planning the assessment 

where to get data on community

• What we observe (Windshield assessment) 

• What is documented (newspapers, radio/TV, historical sources, census reports, vital records, biostatistical reports, epidemiological studies, websites) 

• What people tell us about their community 

evaluation of community intervention

• summative evaluation - outcomes 

• formative evaluation - process 

community development theory

The process of COLLABORATING with community members to assess their COLLECTIVE NEEDS and desires for positive change and to address these needs through problem solving, collaboration with community stakeholders and resource development

B

Which of the following methods may help a community health nurse gain entry into a community?

A: making clear who is in charge

B: knocking on doors

C: joining certain clubs or societies

D: aligning mainly with leaders of the group

A

A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program and barriers to attendance. This survey allowed the community health nurse to _______ the program and design program improvements.

A) Evaluate the effectiveness of

B) Assess the expansion needs of

C) Identify problems with

D) Implement the expansion of

E

The nurse conducts a community assessment. The community is large and the members range from affluent executives to poor migrant workers. Which approach will provide the most accurate assessment of the most pressing public health problems for this nurse?

A. Surveys

B. Descriptive epidemiologic studies

C. Geographic information system analysis

D. Community forums and social media

E. Focus groups

F. Triangulation

A

The nurse conducts a community assessment in a town once supported by multiple paper factories. The factories closed 2 years ago and most of the population is now out of work. The school nurse notes that 68% of the students are behind schedule in their physicals and immunizations. Which recommendation should the nurse prioritize based on this community assessment?

A) the initiation of neighborhood clinics at low or no cost to the community.

B) the creation of a taskforce to assess the impact of low income on immunization compliance.

C) a formal petition to local government to mandate immunizations or monetary fines to parents.

D) a tax relief programs for new companies wishing to settle in the community

community diagnosis

• Increased risk of (disability, disease, etc.) among (community or population) related to (etiological statement) as demonstrated in (health indicators). 

• Increased risk of Lyme disease among rural Pennsylvanians related to tick borne illnesses as demonstrated in increased incidence of Lyme Disease 

health behavior change

• Many different reasons for change

• Attempts and failure several times before success

• Working at some changes possibly lifelong

• Most change on own without special programs

• People different; what works for one may not work for another

risk of poor health outcomes

• the probability that a specific event will occur in a given time frame” 

• A risk factor is exposure that is associated with a disease. Is usually negative. 

modifiable and nonmodifiable risk factors

Modifiable risk factors 

• Focus of public health 

• Individual has control. 

• Examples: smoking, lifestyle, eating habits, activities 

Nonmodifiable risk factors 

• Individuals have little or no control. 

• Examples: genetics, gender, age, environmental exposure 

change

• An imbalance or upset equilibrium requiring adjustments 

• Process of adopting innovation 

• Disruptive; generally new roles adopted 

types of change

• Evolutionary: gradual; adjustment on incremental basis 

• Revolutionary: rapid, drastic, threatening type; possible complete upset of balance of system 

stages of change

• Unfreezing (when desire for change develops) 

• Changing/moving (when new ideas are accepted and tried out) 

• Refreezing (when the change is integrated and stabilized in practice) 

rationalization

• Empiric–rational (similar to technostructural, data-based, and communication-related strategies) 

• People are rational; will adopt new practices that appear to be in their best interest 

normalization

• Normative–re-educative (similar to educational, facilitative, and persuasive strategies)

  • New information; direct influence on people’s attitudes and behaviors through persuasion 

  • Emotional component  

    • Anti-smoking commercials 

  • Social component 

    • Smoking only areas  

      • Make it isolating 

coercion

• Use of coercion based on fear 

  • Seatbelt laws and repercussions 

Pender’s Health Promotion model

• Nola Pender RN 

• Predicts behaviors that influence health promotion 

• Closely related to the health belief model 

Transtheoretical model

• Stages of Change 

• Change not always linear 

• Knowing what stage someone is in you can know how to communicate to facilitate change 

The Precede and Proceed models

• For educational health promotion in the community 

• Similar to the nursing process 

• Focus is on quality of life 

• Emphasis on perceived needs of the community 

C

Your patient was just admitted for a COPD exacerbation, their 2nd this year. She states to you “I know I should quit smoking, but I just can’t seem to make up my mind and just do it.” Using the Transtheoretical Model for Change, what stage is your patient in?

A. Action

B. Preparation

C. Contemplation

D. Precontemplation

B

You graduate and get a job working in a hospital. Every year, you must verify that you have received a flu shot, if you choose not to get one you must wear a mask for the whole flu season. This is an example of encouraging employees to get vaccinated against the flu through:

A. Rationalization

B. Normalization

C. Coercion

types of immunity

• a condition of being able to resist a particular disease especially through preventing 

• development of a pathogenic microorganism or by counteracting the effects of its products

Active 

• Natural  

  • Contracting the disease 

• Artificial 

  • vaccine 

Passive 

• Natural 

  • Maternal antibodies 

• Artificial 

  • Monoclonal antibodies 

communicable disease

An infectious disease that is transmissible by contact with infected individuals or their bodily discharges or fluids (such as respiratory droplets, blood, or semen), by contact with contaminated surfaces or objects, by ingestion of contaminated food or water, or by direct or indirect contact with disease vectors (such as mosquitoes, fleas, or mice) 

case investigator

• interview the case (actual sick person) 

• elicit names and contact information of the contacts to be monitored 

• provide guidance and resources to support people who are in isolation 

• they may also be the person who initially notifies a patient of a positive test result 

• Give contact tracer list of people to contact 

contact tracer

Letting people know they may have been exposed to a communicable disease and should monitor their health for signs and symptoms of that disease 

isolation

separates sick people with a contagious disease from people who are not sick 

quarantine

separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick 

herd immunity

A reduction in the risk of infection with a specific communicable disease (such as measles or influenza) that occurs when a significant proportion of the population has become immune to infection (as because of previous exposure or vaccination) so that susceptible individuals are much less likely to come in contact with infected individuals 

reportable conditions

Anything vaccine preventable 

why we must report

• Control 

• Prevention 

• Statistics 

• Interventions 

• Case Tracking 

• Disease Characteristics 

vaccination

What is a vaccination? 

• A preparation of killed microorganisms, living attenuated organisms, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease 

What is variolation? 

• The deliberate infection with smallpox. Dried smallpox scabs were blown into the nose (Africa and Asia) or through a puncture in the skin (Europe and America) of an individual 

Exposure via vaccination or directly from the pathogen 

• Primary 

• Get exposed, body learns to fight and survive it 

• Secondary exposure 

• Faster immune response due to memory cells 

perfect vaccine

• Single administration 

• Long lasting immunity 

• Broad protection 

• Safe 

• Minimal side effects 

• Inexpensive 

• Easy to administer 

• Easy Storage 

routes of transmission

• Respiratory (airborne/droplet) 

• Fecal-Oral 

• Mucosal 

• Surface/contact 

• Vector 

• Blood 

methods of prevention

• Quarantine/Isolation 

• Hand hygiene 

• Respiratory hygiene 

• Vaccination 

• Environmental controls 

• Sanitation 

• Sterilization 

R0 for Infectious Disease

• The average # of people that a sick person has the potential to infect  

• Depends on mode of transmission 

• Airborne -> easier 

• Measles and pertussis are the easiest to spread 

TB

Bacteria 

• M. Tuberculosis 

• MTB 

• Second most common place to get TB is in a cervical lymph node  

Spread 

• Droplet 

  • Suspended for a long time 

  • Travel great distances 

  • Higher level of respiratory protection (N95) is needed 

• Cough 

• Laugh 

• Sing 

• Sneeze 

Who is most at risk? 

• Anyone can be exposed to TB 

• Immune suppressed 

  • HIV 

  • Transplant 

  • Diabetes 

  • End Stage Renal Disease (ESRD) 

  • Biologic immune suppression 

• Recent exposure 

• Congregate settings/crowded housing 

• Low-income countries 

Contact investigations – ring theory 

• Chance of infection increases with duration of time exposed