Communitive Diseases and Immunizations

Role

RT TO VACCINES

proper hand hygiene

education benifits:

Improving the client’s health status
promoting autonomy and decision making
adoption of healthy lifestyle practices
Promoting client safety, especially regarding medications and the management of illnesses
Promoting client adherence to the prescribed treatment plan
Reducing client anxiety
Improving client outcomes

screen, assessment, population, vaccines,

education: vaccine-preventable diseases and their potential risks, emphasizing the benefits of timely immunization in safeguarding children's health.

Notifieable diseases Surveillance system:

Covid 19
Diphtheria
Giardiases
Heamophilus influenzea
Hep A/B/C
Meningitis
pertussis
poliomyelitis
rubella
tetanus
varicella

children have lost of hand-to mouth = higher risk of GI and resp infection

hand washing

correct isolation: standard and transmission-based percaution

standard = universal based that any thing may have contagious agent
preventive = PPE, hand hygene, safe inject
transition

droplet: agent <3ft or mucous membrane

do not remain infectous over long distances = no special ventilation
single room
face mask, and pt wear surgical mask if outside
pertussis, FLU, meningitis, adenovirous, Rhinovirus, group A strept

Contact: indirect and contact

single room
gown/gloves → removed receptacle immediately priors to child room
C. diff, VRE, MRSA

Airborne: micro that suspended in air → travel long distance

(-) pressure + N 95
TB, covid, rubeola

PPE

hand hygene
gown
mask
face shield
gloves

→

gloves
face shield
gown
face mask
hand hyegene

Chickenpox

VZV → remains in latent

by aerosolized virus or contact an open vesicle

upper resp tract (2-6 day) → blood stream → viremia in 10-12 → vesicle

IgG Y immunity

in sensory nerve → shingles

s/s: small, itchy blisters → scabs

fever, fatigue, sore throat, h/a, 5- 7 days

dx: s/s → sample from vesicles + blood sample for immune responds

tx: relief

acetaminophen = fever

pruritis = calamine lotion, lukewarm baking soda or oatmeal bath, antihistamine

cotton clothing, and avoid overheating w/ heavy blanket

trimming child fingernails

NO ASA due to Reye syndrome

hydration

antiviral if severe or low immune → abx if 2nd bacterial

keep child away from pregnant, newborn, compromised immune

AIRBORNE + cared for someone varicella

immunization, frequent hand wash (infected contact, avoid close contact)

Diphtheria

Corynebacterium diphtheriae = exotoxins → inflammation of throat + gray pseudomembrane in the throat and pharynx → thickens = occludes airway + toxins in lymph/ hematologic → myocarditis and neuritis

impacts => integumentary and resp

risk:

non-adherence = DTaP
more in tropical, crowded

s/s:

FLU s/s ( throat, fever, malaise, h/a, cervical lymphadenopathy) + gray pseudomembrane in the throat and pharynx

hx of endemic regions w/ 2-5d incubation

gray pseudomembrane in the throat and pharynx

lab/dx:

throat swab, PCR for type of bacteria,

tx:

abx (penicillin G)/ erythromycin, diphetheria antitoxin (DAT) → CHECK ALLERGY

hospitalization

soft diet, fluid, calm enviroment , emotional support/ distraction

DTaP

Mumps

paramyxoviridae → upper airway + regional lymph nodes → viremia = slalvary, gonad, (rare CNS) inflammation

highly contageous by droplet or infected saliva or fomites = mostly salivary glands + orchitis

s/s:

parotid salivary glands → fever, h/a, anorexia, myalgia, fatigue

→ orchitis, meningitis, encephalitis,

lab/dx: s/s → RT-PCR, buccal swab, IgM

tx:

MMR, bosters

restm adequate hydration, thermo pain relief, elevation (orchitis) OTC analgestic

soft diet, isolation, emotional support

Measles (ruobela)

Morbillivirus: nasopharyngeal + conjuctival mucosa → regional lymph → spleen, liver, bone marrow → inflammation occurs in every cell attacked

direct contact or droplet (remian for 2 hrs)

fever, cough, rhinorrhea, conjutivitis → small, red spots w/ white center ( koplik) in mouth, hairline and downward rash

lab = s/s → serum or PCR (in outbreaks/ or atypical s/s)

most accurate = plaque reduction neutralization assay

tx: no viral tx

AIRBORN → nutrition, hydration, 2 day vit A sup

comfort = fever, resp

cool mist/ steamy for cough/ congestion

MMR + herd immunity

Poliomyelitis

mouth → GI = nasopharyngeal secretions and in stool

nervous system = paralysis (fecal-oral route but also contact/ sneeze)

from travelers and non vaccinated or weak immune

s/s = mild flue (2-5 days) → CNS = paralysis/ muscle weakness in legs (mild to complete loss) → resp failure

targets motor neurons in spine = loss of muscle control

lab/dx = assess s/s,

labs → throat swabs, stool, CSF = for virus and strain
MRI/ EMG for muscle function

early dx !!!!

tx:

mild = combact w/ immune
if paralusis or resp = PT, OT, orthopedic for skeletal deformities, resp support
nutrition/ hydration/ immunization
special devices (brace, wheelchair, orthopedic aid)
resp support, pain management, emotional support
immunization: inactive polio vaccine (IPV) or oral polio vaccine (OPV)

Covid

milder than adults

tissue damage + vs T cell, monocyte, neutrophil, cytokine

→ widespread response

direct contact/ resp (possible fecal-oral)

s/s: fever, cough, resp issue,

multisystem inflammatory syndrome in children (MIS-C) = inflammation of multiple organs

long term consequences after acute = fatigue, resp issue, neuro

dx: molecular, PCR/ rapid antigen/ nasopharyngeal sample collected, Y test

tx:

antiviral: remdesivir for hospitalized and required O2 or 3kgs or >28days

dor those >12y w/ 40kg mininum, mild-to moderate w/ risk of severe = ritonavir- nirtmatrelvir

O2, resp s/s, hydration/ nutrition

remote learning

good hand hygiene, air purify if possible, and wear a well-fitting mask for 5 days after testing positive, 6 feet

>6m old = immunization

Meningitis

Viral (aseptic)

entero, herpes, adenovirus → significant in <5yr _ immunocompromized

mouth/nose

found in fluids and stool → direct or indirect

being in close contant, crowded setting, weak immune

bacterial

meningococcus, pneumococcus, GBS, Hib

from saliva, nasal discharge, feces, sharing drink, utensil, person items w/ infected

communal setting, unvaccinated, low immune

nasopharynx/ URI (sinusitis. otitis media) → bacteremia → BBB

s/s: ~ to viral but can → sepsis, hearing loss, hydrocephalus, death

Brudzinski: involuntary flexion of knees when passive neck flexion

kernig: pain while exteding knee and pt is supine while hips are flexed

→ diff to elicit in young/ even if (-), cna still be meningitis

meningoccoccal → petechial rash → if not tx = necrosis of underlying rash tissue

lab:

viral<bacterial (>1k) WBC

mild protein < elevated

glucose normal > less than 40

tx: → hospitalization + early dx!!!

emperic abx → dx → abx adjusted

reduce fever, discomfort (corticosteroids reduce inflammation,) check hearing loss

exposed use prophylaxis ~ 3feet

check worsen ICP

dark enviroment, HOB 30, body alignement neutral

meningococcla, pneumococcal, Hib vaccine

Hepatits

A/B liver failure , C = chronic infection

A= food/water , B/C= bloodborn/ body fluids

risk factors = unsafe sex, IV drug, inadequate sanitation, exposure to infected fluids

s/s: fatigue, fever, jaundice, anorexia, abd pain, nausea, dark urine

A= more GI (n/v, diahrrea)

B = phases

prodromal = non specific → malaise, decreased appetite, RUQ pain
icteric: RT hepatic → jaudice, hepatomegalu, pale stool, dark urine
→ recover or chronic

C = no s/s if not then malaise/ low appetite

lab:

chronic = liver bipsy

Hep A= blood test and Y status

B= based on acute/ chronic = surface antigen (HBAg), or Y

Hep C = anti HCV and liver biopsy

tx: low s/s + complications ( chronic = low viral load)

antiviral

immunomodulator

liver transplant

regular monitoring, lifetyle and Rx adherance

A= supportive → hospitalization to manage dehydration or liver failure

B= acute is supportive + lamivudine ( !!!) / chronic = antoetroviral

ADR: h/a, nausea, fatigue, infection

C = since no s/s = usually fine

if chronic - interferon alfa-2b (immunomodulator) IM/ subq
- ADR = alopecia

hydration, nutrition, rest

immunization: Hep A/B,

hygiene (handwash/ sanitation) → Hep A

C= use sterile needle/ avoid contact w/ infected blood

Mononucleosis

Epstein-Barr virus (EBV) from saliva → B lymph of oropharyngeal → spreads to lymphatic synstek → nodes, liver, spleen inflammation (long incubation of 3-6week)

“kissing disease”

s/s:

fever, fatigue, lymphadenopathy, h/a, malaise
enlarged tonsils w/ exudate patches
splenomegaly or hepatosplenomegaly
~→ airway obstruction, splenic rutpture, Guillain- Barre syndrome

lab/dx: heerophile Y test (monospot) + WBC of high lymphocytes

tx:no antiviral so alleviate s/s

rest,hydration, pain relief for pharyngitis, fever

no active/ contact sports for 4-6 w due to possible slepic rupture + infor on s/s → HCP
gargling warm water w/ sal or throat lozenges, regurlar moniotring

educate hygiene, no sharing cups or utensils

Roseola Infantum (exanthem Subitum)

“sixth disease” herpe virus (HHV-6)

leukocyte cell in salivary gland → febrile seizure due to enter of BBB

saliva contact and rRESP DROPLET

Fifth Disease (Erythema Infectiosum)

human parvovirus B19 “ fifth disease” , DROPLET or contact blood

hand, foot, mouth disease (HFMD)

enterovirus, cozxackievirus → resp tract, oral secretion, or vesicle fluid

enter mouth → lymoh tissue in lower intestine + pharyn - regional lymph

→ skin, CNS, heart, liver

6 weeks post-infection in stool and oropharynx sheed in 4 week

transmission:

oral-fecal
direct/ indirect
close contact or w/ oral, nassal secretion, fluid vesicles

more in summer, and both adult and 5yr old

s/s:

low-grade fever, sore throat, malaise, exanthem of shallow ulcer sores (widespread rash) w/ red borders and white/ gray-yellow bases
maculopapular or vesicular rash (hands, feet, small, red spots, blister) in buttocks, perineum, arms, legs

lab: distinguish from VZV, and herpes from microscopy bipsy or vesicular scrap, stool sample

tx:smooth for mouth pain (cold foods/ liquid)

can become meningitis/ encephalitis

CONTACT, fever, hydration, nutrition (of soothing foods from mouth ulcer and irritation),

avoid hot beverages/ acidic fruit and juice

popsicles are best

rest, comfortable clothing

hygiene, cleanliness and communlal areas, no Rx or vaccines

impetigo

high contagious + honey colored crusted facial leasion

primary: area infection in area not impacted/ second = bacterium w/ estblish wound

bullous/ non bullous

(group A- beta-hemolytic strep/ Staph. aureus)bacteria → fibronectin recptors → bacterial colonization

s/s: in integumentary

nonbulluos (common) = honey-crusted in vesicular/ pustular form in face + lymphadenopathy

bullous by large bullae (blister) → small vesicel → large blister = clear/ yellow into purulent or dark in color but hiney crust does not form + ~ lymphadenopathy/ fever

lab: s/s + bacterial culture and bipsy

tx:

abx (tpical)= mupirocin

oral abx = cephalexin (for nobullous) due to # of satellite lesions and system s/s + bullous

decrease rheumatic fever, education on acute post-strep glomerulonepphritis

correct application of abx = clean crust tw/ soap/water then topical abx

wash clothing and bed linen to prevent re-infection

cover lesion and contact w/ other avoided

conjutivitis

bacterial

moraxella catarhalis, Strept. pneumoniae, Haemophilus influenzae w/ close contact or touch object w/ bacteria then touching eye

vertical transmission of Chlamydia from vaginal birth

close contact w/ contagious person, inadequate hand hygiene, pre0existing ocular condition (SJS), wear contact lenses adn if do not properly celan or sleep w/ them

s/s: engorgement of blood vessel in conjuctival lining from pink/red appearance of conjusctiva and formation of purulent drainage

scelreal red, purelent disharge (stick to eyelash), eye irritation

lab: eye exam, sample of disharge for bacterial culture

tx:

topical abx eye drop or ointment = ciprofloxacin ophthalmic

hygiene, cool/warm compress over closed eyelid (use celan each time)

OTC artificial tears dut not for those to reduce redness

clean water/ sterile, avoid eye rubbing, no sharing personal items

viral

adenovrius, but also herpes, enterovirus → dilation

~ w/ URI and hand-to eye contact or w/ contaminated surfaces

s/s:

red sclera, watery disharge, itching/ tearing

hx of resp and HSV if vesicles in face or eyelid

lab: s/s and ELISA

tx: no antiviral

artifical tears, cool compress

if herpes → eye drop = acyclovir/ ganciclovir

HSV can cause damage to cornea, uvea, retina → blindness

no eye touch/ rub, temporarily isolate child

allergic

from pollen, air pollution, pet dander = IgE → mast cell degranulation = inflammation

~ + rhinitis or asthmas

s/s: red, itchy, eyelid edma, burning/ eye discomfort + no disharge

lab = hx of allergy, s/s → allergy testing

tx: antihistamine or mast-cell stabilizing eye drop → if severe =oral

epinastine

cool compressm allergen avoidance (purifiers, windows closed during pollen peak, and avoid outdoos)

rinse eyes w/ cool, clean water, OTC tears

refrain from rubbing eye

can have allergy shots

forein body

like wood, snadm dust → red, tear, flush, gritty → when removed= no more s/s

lab: conduct eye assessment, potential irritant, anesthetic eye drops w/ pain, fluorescein dye stain to assess corneala abrasion

tx:

flush w/ water or sterile solution, artifical tears

flsuh for chemincal

remove object w/ soft dacial tissue → if not able to remove = ER

NSAID

wearing protective eyewear

Stomatitis

herpetic gingivostomatitis

mouth and gums by HSV → s/s herpetic lesion and ganglia infection = herpetic gingivostomatitis from HSV-1/2

direct contact w/ saliva/ lesions

s/s:

painful vesicular osres or ulcers on gums, tongue, inside cheeks → swollen/ bleeding gums, high fever, irritability, diff eating/ drinking

lab: s/s but use viral culture of ulcer tissue and confirm presence of HSV

tx: acyclovir or IV

hygiene, dehydration, pain releif,

aphthous stomatitis (Canker Sore)

canker sores = recurrent inflammattory condition for oral mucosa

T-cell lymph and cytokine tumor necrosis factor alpha

stress, nutritional deficiency, trauma, family hx, strep. snaguinis

s/s: painful, flat, round-shaped ulcers,\ white-gray/ yellow center/ red border

in inner lining lips, cheeks, tongue, floor mouth
small, ranging mll to 2-3 cm
not contagious but 10yr of age

lab: s/s, if ulcer → biopsy

tx: topical analgesic/

avoid spicy, acidic = discomfort/ quit cmolimg

corticosteroid ( triamcinolone acetonide)

antibacterial/ anesthetic mouthwashas, systemic costicosteriois

soft toothbrush, avoid abravive toothpaste

rising mouth/ warm saline solution, hydration, OTC pain med

stress reduction technique (avoid trigger), vit B/C/ zinc

Immunotherapy terms

Antibody: y protien w/ two heavy cahins and two light chains

neutralize, tag for destruction (opsonization), trigger complement system, enhance immune response, stimulate immune cells to target cells through antibody-dependent cellular cytotoxicity (ADCC)

IgG = most abbundant + long term

IgM= fist to be produce during infection

IgA = in body secretions (localized)

IgE= allergic/ parasites

IgD= precise → less understood on B cells

when B cells find presence of antigen (memory are for future attacks)

for vaccine, dx test (for past or present infeciton), Y-therapy for autoimmune, cancer, covid

Antigen: provoke immune response from parts od organism or non-infections (allergy)

lock and key w/ Y

stim T cell (recognize other intracellular pathogen)

foreing or autoantigen

dx: indenify infection or autoimmune,

vaccines w/ harmless antigen to stim Y

antitoxin: Y for toxin → neutralize and eliminate toxin from system

for toxin-related illness and posioning

→ botulism, tetanus, snake bites

passive immunity

attenuate: process of reducing virulence while maintianing its ability to induce immmune response → vaccine

methods:

passage from diff host/ culture → adapt = reduce ability to cause severe illness
expose to physcial or chem agents

good for long-lasting immune but not for weakned immune systems

for measles, mumps, rubella, chickenpox

cocooning: create protective barrier though immunization of close contacts and parents from immunecompromized, or newborns, or unable to receive vaccines

→ vs covid, FLU, pertussis

immunity:

natural: innate from body mecahnics (rapid/ nonspecific

→ barriers, immune cells (macrophages, neutrophil, NK), inflammation,

not long term

acquired:

active = from exposure naturally or artificially (temporary)

passive: when immune cells or Y are transferred

for long term

herd: large % of population is immune and harder for patho to spread and protect immunocompromised (95%) to prevent outbreaks

methods:

immunization campaign

can face vaccine hesitency, limited access, waning immunity

Immunobiologics

tx from biological source (cell, tissue, immune cell component)

vaccines
immunomodulators = modify immune
- for over reactive immune (autoimmune) or underreactive
- nonoclonal Y (mAbs) = lab Y to target for cancer, autoimmune, infectious
cell-based therapy: utilize immune cells to target cancer or pathogen
- adoptive T-cell

immunization

eradication or near-elimination of small pox, polio, measles, mumps, rubella, diptheria

rotuine ummunization

helps w. personal immunity while helping herd immunity

mRNA vaccine for rapid threats like Covid

barrriers: hesitancy, limited access, misinformation

Y therapy: healthy donors for Kawasaki disease to severe combined immunodeficiency disorders (SCID)

IV IG, injection (hepatitis B IG)

toxoids: vaccine vs toxins

chemical or heat to weaken/ deactivate

diphtheria/ tetanus

vaccine types

combination: multiple into one

→ reduce # of injections, streamline immunization schedules, clinic visits, improve adherence, ensure coverage

measles, mumps, rubella, diphetheria, tetanus, pertussis, polio, hep B, Hib

but requires extensive testing

conjugate: enhance immune response vs bateria that have polysaccharide capsules since they inc virulence

attach polysaccharide antigen to carrier proten → then immune system recognize

Strep, pneumonie, Hib, Neisseria meningitidis

usually required booster

monovalnet= for specific pathogen, usually for diff strains each year ( FLU, covid)

polyvalent: multiple strains of pathogent or RT pathogen (FLU)

FLU

Common vaccines

consideration = check C/I/ precaution

ADR/ guidelines/ type (IM)

precaution inc risk of ADR
mild illness should not delay immunization

Hib:

for <5y
2 and 4 m or 6m → booster of 12-15m = 3-4 doeses
IM in vastus lateralis
ADR: erythema, edema in site, fever
not foor under 6 e

Hep:

2 doses = 12-23m → 6 m between 6-11 months of travelling
early adm of single does does not exclude infants from receiving tarditional

3 dose= 24hr → 1-2m → 6-18 m → in combination
specialized scedules if LBW and parent w/ HbsAg +
mild fever

Polio:

inactivated poliovirus vaccine (IPV):
- 2m → 4m → 6-18m → 4-6yr = 6m period
- deloid if 1yr or older
oral polio vaccine (OPV)
- not recommended since can get polio if immunocompromised and is live

some formulations may have stroptomycin, polymyxin B, neomycin fo check allergy

C/I = acute febrile illness

pneumococcal: vs Strep penumoniae

penumococcal conjugate vaccine (PCV)
- 3 doses= 2→ 4 → 6 months → 12-15m
- may need boster
pneumococcal polysaccharide vaccine (PPSV) = after PCV for immunocompromised

ADR: soreness in injection, fever, sleep alteration

monitor for 1st 15 mins

rotavirus: live-attenuated vaccine =oral drop

2→ 4m = 2 doses → 6m = if 3 doses
started before 15 w and not after 8 m
usually due to GI

C/I = intussusception, SCID

mild: irritability/ temporary mild diarrhea vomit → can cause intussusception’

varicella:

12-15m → 4-6 yr
varicella or MMR/ varicella
IM or sub q for 12m<

C/I = pregnancy, immunosuppression, allergy for gelatin, neomycin,

injection site sorem milkd rash, low-grade fever
febrile seizure, pneumonia

DTaP

DTap <7y / Tdap >7y

DTaP = 2,4,6m → booster = 15-18m → 4-6yr

Tdap = 11-12yr → booster q10yr

C/I: severe allergic ; precaution = Guillain-Barre or severe pain or swell

MMR

12-15m → 4-6yr
stand alone or w/ varicella
is subq

C/I= preg, immunocompromise, seere allergy

ADR = fever, mild rash → febrile seizure

No relation to ASD

HPV: for 9-45yr

11-12yr → 6-12m apart (rec to 9-14yr)
or 3 dose = 15-45yr →1/2m apart → 6 m apart

ADR: injection site pain or swelling, temperature elevation, headache, nausea, or muscle or joint pain, syncope

Allergy to yeast

meningococcal:

ACWY → 11-12y → booster 16y
B= 16-8yr

ADR: erythema, swelling, and soreness at the injection site; fatigue; and headache

FLU: for 6m or older

→ 9yr < require annual

if <9y = 1month apart = 2 years apart

if under 9 = received 2 doses = anually

3-35m = 0.25mL/0.5mL → 3yr = 0.5mL

live-attenuated influenza vaccine (LAIV), nasal spray vaccine

C/I = egg, LAIV = gelatine, immunosupress, ASA, whezzing in past yr

low grade fever

COVID -19= 6m or older

6m-4yr for 2-3 doses
5-11yr → one-series
unvaccinated 12yr ager = receive updated
1 annual booster w/ 8weeks

ADR: site reaction, fever, myalgia, and irritability among young children, myocarditis, adolescent for syncope for 15min,

c/i: hx of allergic,

percautions: myocarditits, pericarditis,

parasites

from protozoa, to helminths, arthopods

from food, water, insect bites, infected individuals, exposure of contaminated soil

malaria , amoebasis, giardiasis, helminthic infection

prevention, accurate dx/ tx,

proper sanitation, access to clean water, vector control, reduce exposure,
tx: antiparasitic, supportive care, alleviate s/s

scabies

Sarcotes scabiei mite = survive 1-2m and latch eggs for 2-3w

direct contact of 10 mins

mites burrowing eggs = intense itching, inflammatory especially at night → wrist, genital, interdigital spaces

rash of tiny, linear burrow/ erythematous papule → impetigo or cellulitis

lab: examination, skin scraping,

tx: permethrin cream → relieve + eradicate

not for 2 month old, or any close mucosa,
~ SOB if allergy w/ ragweed
use gloves → remove cream 8-14hrs
shampoo → dry → apply → 10 mins

proper handwashing, avoiding skin-to-skin contact, laundering contaminated clothing and bedding in hot water, and implementing isolation measures in institutional settings help prevent the spread of scabies.

vaccuming furniture, trimming child fingernails, cool baths,

monitoring

lice

pruritis due to hypersensitivity → develop in 2-6 week

feed of human blood, spread through close contact, sharing personal combs, hats, bedding

small, red bums from scratch

→ visible nits

lab → s/s or wood lamp

tx: OTC, or RX shampoo, lotion, creams

→ permethrin, two step = apply → 1week then reapply

→ lindane, ivermectin can give neurotoxicity

fine-tooth comb, infested clothing, bedding, personal items in hot water to eliminate lice

trimming fingernails, all household members checked for lice

avoid close contact w/ infected individual, regular inspection

pinworm (enterobiasis)

egg → GI hatch 4-8w → anal opening

small, white, thread like parasitic worm from ingestion by hands, bedding, clothing, surface,

s/s: itching around anus, disturbed sleep, abd discomfort

lab → perianal area using transparent aghesive test or pinworm paddle = collect early morning

tx:

mebendazole → follow up 2 weeks later

not w. metronidazole, repeat dose in 2 week

wash hands after toilet, disinfect living spaces, trim fingernals, shower in morning to remove deposited eggs, laundering bedding, clothing and towel in hot water

giardiasis

GI: diarrhea, impaired absorption due to alterations of epithelial cells

poor sanitation or contaminated water sources → water/food due to fecal-oral

water sources, inadequate hgiene practices, contact w/ infected

as/s or

→ diaherrea, abd cramps, bloating, gas, fatigie, weight loss

may resolve on its own

lab: 3 seperate stool samples in Giardia cysts/ trophozoites over several days w/ DFA or EIAs

tx:

metroniadazole, proper hydration/nutrition, or IV fluid replacement

hand hyegene, proper sanitation, safe drinking water,

dairy sensitiity after infection

use water filters or boil water