PREVENTION AND CONTROL OF RABIES/HYDROPHOBIA

Rabies is an acute,almost fatal infectious disease of animals mainly in canidae  tribe from which man is secondarily infected.After 15 days of incubation period the infected dog shows symptoms in one of the two forms i.e dump or paralytic form and furious form.Furious canine rabies causes maximum cases of the diseases in man.Stray dogs and pet dogs are the intermediate host of the disease to human beings and animals like cow,be-fellow,cat,sheep,etc.When the disease occur in man it is known as Hydrophobia, means fear of water.In man the disease is characterized by sudden onset with headache malaise and nervous symptoms of depression progressing to paralysis with spasms of muscles on attempt to drink,followed by delirium and convulsion and resulting to death from respiratory failure with in two days to a week.The difficulty to drink water is in patients only in human beings,and does not occur in dogs or other animals.

The organism causing this disease is a neurotropic filterable virus.The strain recovered from the stray rabid dog has been named as"the street virus".It is found normally in the hippocampus of the rabid dogs/animals brain and that of man dying of hydrophobia.Virus is present in the saliva one week before symptoms appear.The street virus loses its virulence and retains the antigenic properties when passaged a hundred times through the rabbit.This is used for preparation of antirabic vaccine and is named as"Virus fixe"

The temporary reservoir of infection is found in the canidae. Some of the members of these families harbour the virus with out suffering from the disease or death,and also excrete it in saliva at intervals

for long time.The Indian mongoose and the American Vampire bats are also found to harbor the virus.Some wild rodents also have been suspected of playing an intermediary role in the transmission of infection from animal to animal with in these tribes of canidae families and non-canidae families to the wild canidae tribe,with out themselves suffering from the disease.Therefore,these animals serve as permanent reservoir of infection in nature,migrating from this reservoir occur in wild canidae like,jackals,foxes,wolves and wild dogs in whom reservoir is found.Transmission of virus then occur

from wild canidae to domestic stray dogs,when meeting them on the out sides of town,near butcheries

and refuse disposal yards.In rural areas the wild canidae can meet the  domestic stray dogs with in the areas of the villages.Domestic stray dogs thereafter transmit to pet dogs.

The canines suffer and die of the disease with in 10 days after the symptoms appear.For man the source of infection is from the rabid ,domestic,street,or pet dogs or cats.In rural areas wild dogs,foxes,jackals or wolves may attack human beings,during epizootics among st domestic dogs and cats.Infection is transmitted through bites coming out blood or licks on broken skin surface by the rabid dog.Infection doesnot occur with out some injury of epidermis or mucosa. Virus deposited at the site lastly reaches the central nervous system and the route and its travel up to brain is doubtful but the blood stream do not play a part;perineural lymphatics of the secondary nerves may be the route of travel.The average incubation period developing hydrophobia in man is 3 to 8 weeks,may vary from 10 to 90 or longer up to 6 months as per location of the bite and wound from head.The nearer the dog-bite to brain the shorter is the incubation period.In animals incubation period

is about 2 weeks.

The saliva of a rabid dog or fox is ineffective for a week to ten days,before symptoms appear,till death of the dog.but some times occurs only a time before the starting first symptoms of rabies appear. All warm blooded animals and mammals are susceptible.Man possess no natural immunity against the disease.Rabies has a distribution all over the wold.It was absent long time in some countries like New Zeal and, Australia,Hawaii and some pacific islands,and some other countries  like U.K, Scandinavia were strict anti-rabies vigilance is observed.In Asia and Africa the disease is very common.In India more than 7000 cases of hydrophobia occur in every year.

Preventive measures against hydrophobia;Immediate first aid treatment of dog bite  should  be given on the spot.All bites from dogs and other animals should be regarded as dangerous and first aid treatment should be carried out immediately.

The wound should be suddenly cleaned and washed thoroughly with soap and water to reach the depths of pockets of the wounds with the help of a forcible jet of water and application of tincture

of iodine or 70 % of ethyl alcohol should be carried out with swab so as to reach the depths of wound.

In emergency 20 percent soap solution can be used for this purpose.Local application of 5 ml hyper immune antirabic serum around and underneath wound is an added helpful first aid if possible.Tetanus toxoid 0.5 ml given to all pre immunized persons.Antibiotic treatment may be needed to treat badly lacerated cases and subsequent infection.Normally sutures do not apply for 3 days.

A full course of antirabic vaccination is the only specific procedure which  prevents hydrophobia.The

principle is to make an active immunity by giving daily injection by the modified inactivated rabies virus during the incubation period.Vaccination must be started and completed very early after the rabid dog bite.

Generally there is no danger of infection through unbroken skin,but the virus may have been present in the saliva of the dog up to 10 days before the onset of the symptoms,the patient has to decide for himself whether there is any possibility of the dog having licked on the broken skin during that period.The medical attendant should not be expected to decide this for him.If the patient is with considerable doubt in such cases antirabic treatment is generally given to be on the safe side.

In some cases, antirabic treatment is not necessary.1.Drinking of milk from rabid animals.2.If the biting animal remains healthy and alive for a minimum period of 10 days after the bite.3.A bite through clothes with out tearing, when the skin not broken,even though the bruise co lour may be present.4.Handling of clothes or materials contaminated by the rabid animal or a patient of hydrophobia.5.Handling of animals bitten by rabid animals provided the skin of the individual is free from cuts,abrasions open injuries.6.Attendance on a case of hydrophobia,unless bitten by him.

Complication of antirabic treatment;Anaphylactic reaction may happen in sensitive persons.Non specific reaction may also occur, like,moderate local pain,redness and swelling,etc.mainly in obese patients.For these complaints local fomentation may apply.High fever,malaise,headache,pain and stiffness in neck and back or limbs may appear after 4th day due to allergic manifestations which is rare complication to antirabic vaccine treatment.In India the reported cases were one in fifteen thousand persons under vaccine treatment.This occurs between 9th and 15th day of treatment

more in males than in females.and among adults than in children.

Prevention and control of rabies in animals; It consists of mainly controlling the stray dog population,protection of pet dogs and cats and prevention of importation of disease from out side,if the country is already disease free, and personal protection against dog bite.Destroy or plan the growth of number of stray dogs in the country specially owner less dogs.All pet dogs to be registered

and use of metal badges on the collar,to identify from them stray dogs and owner less dogs.For promoting registration the local authorities should give free pre-exposure antirabic immunization and free treatment for other canine diseases.Ingress of wild canidae in habitations and their mixing with domestic dogs can be controlled making the slaughter houses,rubbish disposal yards,poultry farms and such other places attracting dogs,animal food and disposal of all such waste by burning.To  promote caniculture, publicity campaign should be carried out,registration of pet dogs,their protection and destruction stray dogs.Education regarding the dangers of rabies,rabid dog bites and important of early vaccine treatment must be carried out.During an epizootic,restrain the movements of all dogs and  observe them at least for 3 months.Dogs that have been bitten by rabid dog should be destroyed preferably.Dogs in contact with ,but not known to have been bitten by a rabid dog to be kept and given antirabic vaccine treatment and be observed for 6 months.Self protection from dog bites,as the bites are through clothes and likely to transmit disease,trousers and full sleeve shirts are more protective than other type of Indian clothing.Disinfect all places where a rabid animal has been confined and the carcase of a rabid animal must be buried with quick lime or cresol solution.Health laws of some countries do not permit any dog to import from any country.Some countries permit them to import after quarantining period of six months.Some countries with and others with out taking compulsory immunization as per their law permits.

Particulars of all dog bites and cases of hydrophobia to be warned all concerned regarding the presence of epizootic or endozootic in the area,and also report should be given to higher medical

authorities.All valuable animals should be given regular vaccination in endozootic areas.The mortality is 100 percent and no curative treatment is not available,patients should be admitted hospital and observed in a quiet room shaded light and all the forms disturbance must be avoided.Attendants must wear gloves,gown goggles.In case he comes to expose the risk of infection

by the bite of patient or contact with his saliva on broken skin,he must take correct course of treatment.Bedding and clothing used by patients or contacted by rabid dogs should be soaked in 5%

cresol solution or exposed to formalin mixed with potassium permanganate fumes for one day,then washed and dried in the sun for 24 hours.There being no other points presently with me,this has come

to an end.

pm kutty

FOOD POISONING AND ITS PREVENTION AND CONTROL

Consumption of unwholesome food or drinks leads to food poisoning.In its broad sense includes the ill effects produced by the ingestion of food contaminated by bacteria or in many other ways such as addition by a criminal intent or accidentally of poisons like lead,arsenic or by through eating mistakenly of poisonous items such as certain mushrooms or fishes or by adulteration of food with poisonous articles like Argemone mexicana in mustard or gingelly oil producing epidemic dropsy in man and also some virulent seeds mixed with food item seeds and adulterated for profit and regular

ingestion of such foods may cause diseases like Parkinson and crippling paralysis etc. Gastro-enteritis

caused by bacterial pollution of food or drinks also normally known as food poisoning.There are three types,namely,infection type,toxin type and botulism type due to toxin produced by bacterial contamination in food and it is deferential from other types.The prominent symptom of botulism type poison affects on the nervous system.The early symptom is loss of visual accommodation and gradually muscles of the body gets weaker.In infection type,due to living bacteria present in food, man gets fever,vomiting and diarrhea and watery motions.Dehydration is more in these cases. .Incubation period is with in hours to one day and decease is about 5 days.In the Toxin type is due to multiplication of bacteria in food,severe loose motions and vomiting with dehydration occurs.incubation period is 4 hours to 24 hours.
Causative organisms  for bacterial food poisoning by salmonella organisms which is commonly in ice creams and suffer diarrhea,dysentery,etc.Reservoir of infection is salmonella organisms, are natural commensals of rodents,pigs.poultry,cattle,ducks eggs and also some healthy human carriers.The source of infection commonly comes to a healthy person by man handling the food from its production to consumer.Rat droppings and fowl faeces may also come as source of infection.A Cow or sheep with mastitis may act as source of infection of milk. Auto-infection of meat during slaughtering and processing may occur.
Route of infection normally is the tinned and preserved food stuffs,generally of animal origin or milk or fruits. Infective bacteria/virus/fungi are derived from animals slaughtered or are transferred from the handler of milk,meat,or fruits from its source,through processing to the consumer.A milk man may infect milk from his infected finger or ear or nose or skin boils or contaminated hands.Pollution may occur while processing,and flies may also transfer infection.
All those who have been infected do not suffer from the syndrome,excretion of bacteria of salmonella type is common among chronic cases of loose motions{diarrhea}.Carrier ship may exist.Any person carrying salmonella and staphylococci may possess an indefinite period of infectivity. Man possess
no natural immunity against salmonellosis and toxins of other organisms.An infection does not confer long standing immunity.Children suffer more from complaints and cases of fatality is also more among children than adults.
Out breaks of food poisoning is mostly in close community catering organisations like students hostels,old peoples homes and messes,but some times in hotels and marriage auditoriums,rarely such out breaks occur in house old cooking,and mostly on festive occasions when large gatherings of the meal,and also out breaks are common when the temperature is high.
Prevention of out breaks and their control:Meat and meat products coming from slaughter houses should not contaminate by any type of pollution by organisms and a care full control from the slaughter of the animal to the final preparation for consumption is necessary and should include a thorough system of meat inspection.Animals also are to be inspected before slaughtering.Strict supervision of of made-up food and milk should be boiled and all care must be taken against further contamination.
Individuals suffering from septic fingers,throat,eye lids or skin lesions should not be employed as cooks or food handlers.Persons having history of  suffering from enteric fever or food poisoning also should not be employed as food handlers as they may be the carriers of typhoid,paratyphoid etc.Everything is to be done to prevent access of rats,mice or other animals to food stored for human consumption.For maintenance of high standard of sanitation and freedom from fly nuisance strict supervision is necessary,and personal hygiene and inspection for the presence of any intestinal,skin or nasal infection among food handlers are important. A large number of organisms are required to produce clinical symptoms of food poisoning.These can be only ha-pend when their multiplication occurs in the prepared dish stored for some time at normal temperature.It is,therefore,necessary that made up food in which raw eggs have been used must be kept in a proper
ice box or refrigerator.
For controlling of an out break of food poisoning the only and most important precaution is to prohibit consumption of any articles of food which are suspected of forming a part of the suspected food articles.Subsequently specific precautions are to be taken to ensure recurrence are made after exact circumstance is known on investigation and also improving hygiene and sanitation to a good standard.
 pm kutty

PREVENTION AND CONTROL OF MALARIA

It is an insect borne communicable disease,caused by Sporozo parasites belonged to genus plasmodium,characterized by intermittent fever.chills.cold,shivering,enlargement of spleen and a tendency to relapse.Temperature may shoot up to 39-40 centigrade,make patient shivering and finally wet stage with sweating brings down temperature.It may occur daily,alternative days or 36-48 hours.Each lasts 10-15 hours and rarely up to 24 hours or longer. Diagnosis is confirmed by microscopic examination of blood smear,There are 2 types of malaria commonly depend upon severity of paroxysms of the species of plasmodium i.e. benign Tirtian fever and malignant Tirtian fever.Relapses are more common in benign malaria and is not common in malignant tertian..The parasite has to under go 2 cycles that is,namely sexual cycle in mosquito and asexual cycle in man by the bite of infected female Anopheles mosquito.
2.Incubation period is period in human being is 14 days and in mosquito is 10-14 days.Man has no immunity against malaria.There are 3 recognized malaria zones,those are the tropical zone between
the cancer and Capricorn,has almost universal endemic malarial area.The malaria season is long in areas near equator it may last throughout the year.In India malaria transmission season is from July to November with its peak in September.A secondary infection occurs in April-May relapsed and delayed primary attacks by malaria.In southern India the season varies according rainy season.In hill areas the disease occurs from February to June,meanwhile in plain areas malaria occurs in autumn or in early of spring corresponding the starting of monsoon.In Assam malaria
 is high just arrival of monsoon from March to June with a peak in May and June.
3.Anti malaria measures;There are three broad Groups of antimalarial measures aimed at breaking the "man-mosquito-man" cycle of transmission.namely,personal protection against mosquito bite,chemo prophylaxis and chemotherapy.
Individual protection against mosquito bite obtained by the use of net,application of repellents to exposed skin parts when not under net,and protection by proper use of clothing from dusk to dawn.Of all these measures,the use of mosquito net is the most useful single measure.Screening of homes and public buildings had been tried in so many places in south east Asia,but it is not practicable or economical.
Chemo prophylaxis is a supplementary measure under high risk situations,but it is not a substitute for other control measures.It reduces clinical attacks by suppressing the malarial parasite,sporozites induced per infected mosquito bite.Theoretically it is possible to control malaria in a country by giving radical treatment with ideal and specific drugs,but this can be achieved rarely in practice. Chemotherapy reduces the parasite count in community and it is an ideal and valuable aid in control programmes.
Health education among public regarding transmission of disease from mosquito to man and important of personal protective measures.to prevent mosquito breeding,residual insecticide spray and etc.
Space spray is carried out once in week in a highly malarious area to be occupied for purposes of industrial .defense and engineering projects at short notice.to control quickly an epidemic or as a remedial measure in the locality where local transmission is detected.
Malaria control in India in its first phase till 1934 larval control was the main method used.Few achievements were gained due engineering methods and larvicidal oils were used.They were slow,expensive and laborious.
An ideal anti-malaria drug for use in mass control program-me should be a prophylactic drug against all species of sporozites of malaria i.e.it should not allow to develop further,it should be a radical curative i.e it should destroy all types malaria parasite and should possess very low toxicity and should be available readily at a low cost.The drugs at present available have various limitations.
Mass chemotherapy may also be used after withdrawal from or passing through a hyper endemic. area.
pm kutty

PREVENTION OF CORONARY HEART DISEASES

 Coronary heat diseases

Coronary  heart diseases occur due to lack of blood supply to heart muscles by an increased cardiac demand or decreased coronary supply to heart muscles.Both these elements are the causes for heart attack.Complete blockage of coronary artery is causing in myocardial infarction.Sometimes it happens due to syphilitic aortitis resulting in sealing the mouth of coronary artery and the process may affect the arteries themselves.Death may occur any time before the complete recovery of diseased cardiac muscles  with in 6-8 weeks or more.It may again occur due to myocardial infarct increase for a second attack due to blockage or an extension of first one,or due to myocardial failure,congestive heart failure,or blockage or rupture of the necrosed heart muscle.Due to pericarditis and endocarditis over the patches of infarction may occur and may cause pulmonary or coronary failure and cause death.

Coronary thrombosis,Myocardial infarction,Angina pectoris and,myocardial insufficiency are under the groups of ischemic or coronary heart diseases.Death rates over the last 60 to 80 years ,increased all over the world almost every where especially highly modernized and industrially and commercially developed countries.The incidence is related with national income and industrial production and activity,international commercial transactions and tempo of life.The increased incidence noticed by the mortality numbers confirmed by autopsy studies,medical practitioners"and hospital statistics and social security organisations.statistics of national insurance and commercial insurance organisations and by surveys in general population.

Diet.It is commonly associated with dietary habits in that the individuals with high fat,sugar contents in their foods are liable to suffer more.The incidence is more in countries with large consumption of fat especially the animal fats or fats containing a high proportion of saturated fatty acids and low contents of unsaturated fats in their diets.

Heredity.The incidence is more among siblings of those who have attacks.

Association with other diseases like hypertension,diabetes .etc.

Age.The disease is most common in people of 40-60 years of age,although more and more younger people are being affected these days.

The incidence is more in men than in women under 50 years of age which shows that the sex hormone may have to play some part in its genesis.

Profession.It is more common amongst highly efficient conscientious professional men in medical,legal,senior
executives of large corporate industrial and business establishments.In western countries out of 1000 men doctors below 41 years of age 200 develop ischaemic heart syndrome or disease before they are 65.It occurs less in farmers,miners and unskilled manual workers etc.More people getting attacks on
the top of their social or professional carriers and status and expectation of surprising achievements
 in life.

Obesity.It is about 3 times more among those who have 20% or more weight gain over their weight at
adult age.Although the thin one is not having immune to an attack.
Mode of life.It is more in people in sedentary works/professions and habits.More cases occurs in
urban than rural population.Smokers suffer more than nonsmokers.Sudden severe emotional strain/stress precedes and precipitates more attacks among such people.


Preventive measures.Prevention of death,disability,diseases and other factors are wider concept  of prevention.16 to 30 % of first attacks end in sudden deaths with in 60 minutes of onset.Briefly the main risk factors are hypertension,diabetes mellitus,over weight,cigarette smoking,'physical inactivity
and stress and strain 'producing mental activity,a 'positive family history of  vascular disease,onset before age forty and abnormal electrocardiogram.The other abnormalities are thyroid dysfunction,
renal disease and sedentary living habits. Obesity and over weight are taken to be a high coronary risk factor.

About 30-40% of the first myocardial infractions terminate fatally during the first 6 weeks of sickness.Survivors have life expectancy under the best of circumstances.The persons with previous
history of coronary heart disease have 5 times more chance to increase to mortality rate than those originally free from disease.It is, therefore,efforts must be taken to prevent the first attack in achieving primary prevention.It is now easy to prevent first attack by applying the recent knowledge of risk factors for the disease and to remedy

Early detection of susceptible cases and treatment of risk factors is very important to achieve primary
prevention of heart disease.The nutritional,hygienic,dietery and pharmacological means are available
to correct and control hypertension,over weight,cigarette smoking,diabetes and physical activity.This is to correct abnormalities and keep them for long time to establish new habits.As they are not known
the causing factors like diet,over weight avoidance,control of smoking and drinking restriction,increasing of exercise,relaxation from constant strain producing occupations and situations
and control of conditions known about heart diseases such as diabetes mellitus,hypertension,gall bladder and kidney diseases.Early detection and proper and prompt treatment to diverse causes of
these risk factors. Watching  natural events in heart diseases in the community and for prevention in an individual. Collection of data of causing diseases and research on the cases should be enhanced.

Serum cholesterol and triglyceride are controlled with in normal limits by diets.Diet control is necessary to 'prevent obesity and to balance anabolism and katabolism.Caloric requirement is to
be reduced/lowered as the age advances after 40 years.Hence animal fat consumption should be reduced mainly in diet.All vegetable oils have a high concentration of unsaturated essential fatty acids,except coconut oil. Regular exercise against obesity is an advantage like insurance.It keeps your
heart muscles in training to meet the additional demands in times of stress and also,men with sedentary works should adopt habits of regular exercise.

Weight regulation through avoiding obesity by diet regulation and exercise must be 'practiced.The person may inherit tendencies for obesity together with high cholesterol and such 'person has to be
more vigilant and careful.Although drinking and smoking is not essential for a healthy life,those should be avoided,if not,,moderation in drinking and smoking must be exercised.Drugs are available to quit smoking.Smoking affects the arterial system specially coronary system and stimulate
vasospasm rapidly and contracting blood vessels in cold injuries like frost bite,similarly the risk of cardiac coronary bloackage and infarct in myocardium is increased by heavy smoking,so that it must be 'prohibited among 'persons with risk factors of coronary heart diseases.Regular cardiovascular and urinary systems examinations are to be done to find out for normal functions of systems.Habitual dietery controls may reduce the 'progression of the conditions by keeping serum cholesterol at low level.Among socioeconomically well off communities,the doctors,lawyers, judges,bank officials executives and administers show a high tendency to get the disease more common than other individuals.The preventive measures,there fore,should be taken to detect the vulnerable groups and
individuals with in those groups and then control the contributory factors relevant to them.Early diagnosis and treatment of all the antecedent conditions are entirely necessary to enhance our knowledge for further studies and findings.

pm kutty