NLE Community Health Nursing — Communicable Disease Control & ImmunizationCheat Sheet

Common values

Important facts

• Active immunity takes TIME to develop (lag phase) but is durable; passive immunity is IMMEDIATE but FADES.
• Vaccination harnesses active immunity; it does NOT provide instant protection.
• Herd immunity thresholds vary by disease (measles ~95%, polio ~80–85%, diphtheria ~85%).
• Maternal antibodies protect newborns initially but decline by 6–12 months (why EPI starts at birth/6 weeks).
• Live vaccines (BCG, OPV, measles, MMR) cannot be given to severely immunocompromised persons.
• Immunological memory: after initial exposure (natural or vaccine), subsequent encounters trigger faster, stronger response.

Key definitions

Diagrams to know

• The 'Immunity Spectrum' — active vs passive on one axis, natural vs artificial on the other (2×2 grid).
• Timeline of antibody levels in passively immunized vs actively immunized infant.
• Herd immunity threshold curve showing % immune vs disease transmission rate.

Common values

Important facts

• EPI targets: TB, diphtheria, pertussis, tetanus, poliomyelitis, measles (the classic 6).
• Program expanded to include Hepatitis B (birth dose), Hib, PCV, and MMR.
• Presidential Decree 996: compulsory basic immunisation for children <8 years.
• RA 10152 (Mandatory Infants and Children Health Immunization Act of 2011): mandates FREE routine immunisation for infants and children.
• Hepatitis B monovalent birth dose MUST be given within 24 hours of birth (RA 10152 requirement).
• FIC coverage is a KEY DOH performance indicator; low coverage signals outbreak risk.
• Vaccination must NOT be delayed for minor illnesses (low-grade fever, mild cough, mild diarrhea) — missed opportunities reduce herd immunity.
• Late vaccination is better than no vaccination; catch-up is allowed.

Key definitions

Diagrams to know

• EPI organizational structure (DOH → Regional → Provincial → RHU/health center).
• Timeline showing when children become FIC, CIC, and CPAB.
• Flow chart: Is the child eligible for catch-up vaccination?

Common values

Important facts

• SCHEDULE CORNERSTONE: 6–10–14 weeks = pentavalent, OPV, PCV (3 doses each, minimum 4-week interval).
• BCG & Hepatitis B at BIRTH (HepB within 24 hours per RA 10152).
• MCV1 (measles) at 9 MONTHS; MMR (MCV2) at 12 MONTHS (NOT before 9 months; maternal Abs interfere).
• OPV: 3 doses at 6–10–14 weeks + IPV at 14 weeks + IPV at 9 months (current combined schedule).
• Minimum interval between doses is 4 weeks for primary series (pentavalent, OPV, PCV).
• Route specificity: BCG = intradermal (0.05 mL); pentavalent/PCV/IPV = intramuscular (0.5 mL); OPV = oral (2–3 drops); measles/MMR = subcutaneous (0.5 mL).
• BCG successful take = wheal at injection site, later a small flat scar (~3–6 weeks); absence of scar may indicate vaccine failure.
• PPD/Koch's phenomenon = accelerated local reaction to BCG indicating prior TB exposure (do NOT revaccinate).
• Pentavalent = freeze-sensitive (do NOT freeze); DPT/Hep B/Td also freeze-sensitive.
• OPV = most heat-sensitive vaccine; store where coldest in cold chain.

Key definitions

Diagrams to know

• Vaccine schedule timeline from birth to 12 months showing all 8 vaccines and their ages.
• Route comparison chart: intradermal vs IM vs oral vs subcutaneous (site, needle angle, depth).
• Freeze-sensitive vs heat-sensitive vaccine classification.

Common values

Important facts

• Td1: given as early as possible (even first antenatal care visit); provides NO protection yet.
• Td2: given ≥4 weeks after Td1; protects newborn from neonatal tetanus (~3 years' protection to mother).
• Td3: given ≥6 months after Td2; extends maternal protection to ~5 years.
• Td4: given ≥1 year after Td3; extends maternal protection to ~10 years.
• Td5: given ≥1 year after Td4; provides LIFETIME tetanus/diphtheria protection.
• Two doses (Td1 + Td2) are the MINIMUM to protect the newborn; this is the definition of CPAB.
• Tetanus toxoid is freeze-sensitive; must be stored at +2°C to +8°C (cold chain requirement).
• Neonatal tetanus is an immediately notifiable disease (within 24 hours).
• Clean, safe delivery practices (clean hands, clean cord, clean environment) + maternal Td vaccination = elimination of neonatal tetanus.
• Traditional cord practices (use of unsterile substances) increase neonatal tetanus risk if mother is unvaccinated.

Key definitions

Diagrams to know

• Td dosing schedule and protection timeline (Td1 → Td2 → Td3 → Td4 → Td5).
• Duration of protection curve: shows how long each Td dose protects (3, 5, 10, lifetime years).

Common values

Important facts

• Health center/RHU refrigerator: +2°C to +8°C (standard cold room temp).
• Regional/provincial level freezers: −15°C to −25°C (for bulk OPV and measles stock).
• HEAT-SENSITIVE (most vulnerable): OPV > measles/BCG > pentavalent/DPT.
• FREEZE-SENSITIVE (must NOT be frozen): DPT, Hepatitis B, Td, pentavalent — freezing destroys potency.
• Refrigerator monitoring: thermometer checked twice daily (morning & evening); temperature log maintained.
• VVM storage rule: keep vaccines out of direct sunlight and UV light; VVM accelerates in UV.
• Shake test positive (opaque/clumpy) = vaccine frozen = potency destroyed = discard immediately.
• Vaccine coolers for outreach: use cool packs or ice; thermometer inside; ice should NOT touch vaccine vials directly (wrap in cloth).
• Expired vaccines: marked 'EXP' with thick marker, placed in 'discard box' for safe disposal.
• Cold chain breakdown (e.g., power outage, vaccine left in sun) = entire batch may be unusable — vaccine safety cannot be guaranteed.
• OPV most heat-sensitive because it's live attenuated; inactivated vaccines (IPV, Hep B) are more heat-stable but still sensitive.
• Storage order in RHU refrigerator: OPV/measles in coldest section; DPT/Hep B/Td in middle (not freezing).

Key definitions

Diagrams to know

• Cold chain flow diagram: vaccine manufacturer → freezer → RHU refrigerator → vaccine cooler → outreach → child (with temperatures).
• VVM color progression chart showing safe → unsafe transitions.
• Refrigerator layout showing temperature zones and vaccine placement.
• Shake test visual: clear liquid = safe; opaque/clumpy = frozen/unsafe.

Common values

Important facts

• LIVE vaccines (BCG, OPV, measles, MMR) are contraindicated in:
• - Severely immunocompromised children (symptomatic HIV/AIDS, on immunosuppressive therapy, malignancy on chemo).
• - Do NOT give BCG to clinical AIDS; wait until CD4 recovery on ART.
• - Contraindicated during pregnancy (though accidental exposure is not an indication for termination).
• INACTIVATED vaccines (IPV, Hep B, pentavalent, PCV, Td) are safe in immunocompromised — but response may be poor.
• Do NOT defer vaccination for:
• - Mild febrile illness (low-grade fever <38.5°C).
• - Mild cough or upper respiratory infection.
• - Mild diarrhea.
• - Asymptomatic malnutrition.
• - Use of antibiotics.
• - Recent exposure to infectious disease (vaccination can still prevent).
• - Breast-feeding (live vaccines safe during lactation).
• SEVERE REACTION to prior dose (convulsions, shock, encephalopathy within 3 days) → withhold subsequent doses of same vaccine; seek specialist advice.
• Relative contraindication (defer, don't withhold):
• - Moderate-to-severe febrile illness (>38.5°C) → vaccinate when fever resolves.
• - Severe diarrhea → defer until resolved (vaccine may not be absorbed).
• - Recent blood transfusion or IG → defer measles/MMR by ≥3 months (passive Abs interfere).
• Immunization errors are NOT contraindications to further vaccination — address the error and resume schedule (catch-up).
• If unsure, vaccinate! Missed vaccination opportunities > minimal risk of adverse event.

Key definitions

Diagrams to know

• Decision tree: 'Should this child be vaccinated?' (YES for minor illness; NO for severe allergy/immunosuppression).
• Common misconceptions vs. true contraindications comparison chart.

Common values

Important facts

• RA 9173 (Philippine Nursing Practice Law) requires nurses to report notifiable diseases as a function of community health nursing.
• Immediately notifiable diseases (24-hour reporting requirement):
• - Acute flaccid paralysis (polio surveillance).
• - Measles.
• - Neonatal tetanus.
• - Cholera.
• - Meningococcal disease.
• - Rabies (human).
• - Plague.
• - Yellow fever.
• Weekly notifiable (aggregated reporting):
• - Dengue fever.
• - Typhoid fever.
• - Dysentery (bacillary & amoebic).
• - TB (clinical diagnosis).
• Reporting pathway: frontline health worker (nurse/midwife/BHW) → RHU → City Health Office → Provincial Health Office → DOH.
• Each case triggers investigation (contacts, source, transmission) and appropriate control measures (isolation, quarantine, mass vaccination).
• Confidentiality maintained in reporting; patient identity protected per DOH guidelines.
• Failure to report is a breach of duty under RA 9173 and public health law.
• Nursing documentation must include: date of diagnosis, clinical signs, investigations, contacts, vaccination status, and isolation measures.

Key definitions

Diagrams to know

• Notifiable disease reporting pathway flowchart (case identification → RHU → CHO → PHO → DOH).
• Timeline of investigation and response (24 hours for urgent; 7 days for weekly).
• List of immediately notifiable vs. weekly notifiable diseases (two-column chart).

Common values

Important facts

• Five Elements of DOTS:
• 1. Political commitment with sustained financing.
• 2. Case detection through quality-assured bacteriology (Xpert MTB/RIF or DSSM).
• 3. Standardized treatment regimen with direct observation (DOT).
• 4. Uninterrupted supply of quality-assured anti-TB drugs.
• 5. Standardized recording and reporting system.
• First-line anti-TB drugs (HRZE):
• - H = Isoniazid: hepatotoxic; monitor LFTs.
• - R = Rifampicin: turns urine/tears/sweat ORANGE-RED (normal, warn patient); hepatotoxic; monitor LFTs.
• - Z = Pyrazinamide: hyperuricemia (gout-like); hepatotoxic.
• - E = Ethambutol: optic neuritis (loss of color vision, especially red-green); monitor vision at baseline and monthly.
• - S = Streptomycin: ototoxicity (hearing loss, vertigo); nephrotoxicity; used in Category II.
• Category I regimen (most common):
• - Intensive: 2 months of HRZE daily (or 5 days/week with 2 days missed).
• - Continuation: 4 months of HR daily (or 5 days/week).
• - Total = 6 months treatment.
• - Sputum smear monitoring: end of month 2 (should convert to negative), month 5 (confirm cure).
• Direct Observation is NON-NEGOTIABLE:
• - Health worker or treatment partner WATCHES patient swallow EVERY dose (especially in intensive phase).
• - Directly observed = adherence → cure; non-observed = risk of default and drug resistance.
• Drug-Resistant TB (MDR-TB, XDR-TB):
• - Managed under Programmatic Management of Drug-Resistant TB (PMDT).
• - Requires longer regimen (18–24 months) with second-line drugs.
• - Resistance develops from incomplete/interrupted treatment.
• Contact tracing & household screening: all close contacts (especially children <5 yrs) must be screened for TB and TB infection.
• Infection control: TB patient should avoid crowded places, cover mouth when coughing, ensure ventilation at home; most infectious in first 2 weeks of treatment.
• TB notifications: presumptive TB cases (cough >3 weeks) and confirmed cases are notifiable; reported weekly.
• Treatment success definition: patient completes full regimen and is smear-negative at end of month 5.

Key definitions

Diagrams to know

• DOTS strategy 5-pillar flowchart showing feedback loops.
• TB treatment timeline: months 0–2 (intensive HRZE), months 2–6 (continuation HR), with sputum monitoring checkpoints.
• Category I vs. Category II regimen comparison.
• DSSM interpretation guide: 0 AFB, 1+ to 3+ grading.

Common values

Important facts

• Dengue 4 serotypes (DENV-1, DENV-2, DENV-3, DENV-4): only one active at a time in a given area (monotypic circulation) or multiple (endemic in Philippines).
• Vector characteristics:
• - Aedes aegypti: anthropophilic (prefers human blood), endophilic (inside homes), DAY-ACTIVE.
• - Aedes albopictus: found in rural/highland areas, also day-active, less urban-adapted.
• Breeding sites (source elimination):
• - Clean stagnant water: flower pots, water storage containers, vases, discarded tires, bottles, coconut shells, bird feeders.
• - NOT in dirty/flowing water (unlike malaria Anopheles).
• Transmission cycle:
• - Viremic person (especially days 1–5) → mosquito bloodmeal → viral replication in mosquito (extrinsic incubation 8–12 days) → mosquito becomes infectious → bites another person.
• - Vertical transmission (mosquito → eggs) is possible but uncommon.
• Clinical presentation:
• - Fever (38–40°C), headache, myalgia, arthralgia, rash (maculopapular, appears after defervescence).
• - Leucopenia, thrombocytopenia common.
• - Dengue hemorrhagic fever (DHF): plasma leakage (hemoconcentration, pleural effusion, ascites), bleeding manifestations, thrombocytopenia (<100,000), shock.
• Warning signs (must seek immediate care):
• - Severe abdominal pain.
• - Persistent vomiting.
• - Bleeding (any manifestation).
• - Lethargy/restlessness.
• - Sudden drop in platelet count.
• - Hematocrit rise (≥20%).
• DOH 4-S Strategy Implementation:
• - Search & Destroy: community mobilization, house-to-house inspection, elimination of water containers, clean gutters.
• - Self-Protection: use of insect repellent (DEET), long sleeves/pants, window screens, bed nets (though dengue is day-biter, nets prevent early morning bites).
• - Seek Early Consultation: educate public on fever >3 days; early detection allows isolation (patient is infectious 1 day before to 5 days after fever onset).
• - Support Fogging/Spraying: only during outbreaks in hotspot barangays; space spraying targets adult mosquitoes; must be repeated every 2–3 days for ≥1 week.
• Notification: dengue is weekly notifiable; outbreak cases reported immediately to trigger response.
• Immunity: primary infection → immunity to that serotype for life; secondary infection with different serotype carries DHF risk.
• No dengue vaccine widely available in Philippines yet (Dengvaxia use restricted to prior-infected persons due to dengue-antibody-dependent enhancement risk).

Key definitions

Diagrams to know

• Aedes aegypti life cycle (egg → larva → pupa → adult) with timeline.
• Dengue transmission cycle: person → mosquito → person, with incubation periods.
• DOH 4-S strategy implementation flowchart.
• Dengue vs. malaria vector comparison (day/night, breeding site, biting behavior, control focus).

Common values

Important facts

• MALARIA:
• - Endemic in Mindanao and Visayas; not endemic in Metro Manila, Luzon.
• - Vector: Anopheles mosquito (NIGHT-BITER) — bites 8 PM–6 AM.
• - Transmission: blood transfusion, needle-sharing (rare in Philippines).
• - Control: insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), artemisinin-based combination therapy (ACT) for treatment.
• - Clinical: fever, chills, headache, myalgia; can progress to severe malaria (cerebral, renal failure, pulmonary edema).
• SCHISTOSOMIASIS:
• - Endemic in Leyte, Samar, and parts of Mindanao (Agusan del Sur).
• - Parasite: Schistosoma japonicum; intermediate host: Oncomelania snail.
• - Transmission: exposure to freshwater (swimming, wading, bathing) contaminated with cercariae.
• - Pathology: eggs deposit in organs → chronic inflammation, fibrosis, cirrhosis (if liver involved).
• - Control: snail control, water sanitation, mass treatment, health education (avoid infested water).
• FILARIASIS:
• - Endemic in parts of Mindanao, Visayas, and coastal regions.
• - Vectors: Anopheles, Culex, Aedes mosquitoes.
• - Causative agent: Wuchereria bancrofti (lymphatic filariasis).
• - Manifestations: asymptomatic microfilaremia, lymphangitis, lymphadenitis, elephantiasis of limbs/genitalia.
• - Control: Mass Drug Administration (MDA) with albendazole + diethylcarbamazine (DEC) for 5–6 years in endemic areas.
• HANSEN'S DISEASE (LEPROSY):
• - Causative agent: Mycobacterium leprae; chronic, slowly progressive; curable.
• - Transmission: respiratory droplets (prolonged close contact); NOT highly infectious (70–95% of exposed persons are immune).
• - Clinical forms: tuberculoid (few lesions, high immunity), lepromatous (many lesions, low immunity), borderline.
• - Diagnosis: slit-skin smear microscopy (acid-fast bacilli) or clinical features.
• - Treatment: Multidrug Therapy (MDT) for 6–12 months (paucibacillary = 6 months; multibacillary = 12 months).
• - Control: case detection, early treatment, contact screening, DOH Leprosy Program.
• - Complications: reversal reactions, Type 1 & Type 2 reaction (manage with corticosteroids).
• RABIES:
• - Viral disease; ALWAYS FATAL if symptomatic (99.9% fatality rate post-symptom onset).
• - Transmission: saliva of infected animal via bite, scratch, or mucous membrane exposure.
• - Incubation: variable (2 weeks–3 months, rarely up to 1 year); depends on wound location, viral load.
• - Prevention: Post-Exposure Prophylaxis (PEP) with rabies vaccine (PVRV or ERIG + PVRV) MUST be given within 24 hours, ideally within hours of exposure.
• - First aid: wash wound thoroughly with soap & water immediately (removes virus).
• - Animal control: suspect animal observation for 10 days; if animal dies/shows symptoms → confirm rabies.
• - DOH rabies program includes vaccination of high-risk groups (veterinarians, animal handlers).
• DOH ELIMINATION/CONTROL PROGRAMS:
• - Malaria: case management, vector control (ITNs, IRS), surveillance in endemic areas.
• - Schistosomiasis: snail survey & control, sanitation, mass treatment in endemic provinces.
• - Filariasis: MDA programs, surveillance, elimination targets.
• - Leprosy: case detection, MDT provision, disability prevention.
• - Rabies: PEP provision, animal control, vaccination of risk groups.

Key definitions

Diagrams to know

• Endemic areas map for malaria, schistosomiasis, filariasis in Philippines.
• Vector-parasite-host relationships for each disease (transmission cycle).
• Rabies post-exposure prophylaxis decision flowchart (animal type, observation status, PEP urgency).
• Hansen's disease classification (tuberculoid vs. lepromatous) based on bacillary load & immunity.

Important facts

• PRIMARY PREVENTION — specific examples:
• - Immunization (vaccination) is the CLASSIC primary prevention-specific protection (active immunity induced).
• - Health education: hand-washing, food safety, sexual health, tobacco/alcohol cessation.
• - Environmental: clean water, sanitation, vector control (bed nets, IRS for malaria), food storage.
• - Nutrition: malnutrition ↑ TB risk; supplementation improves immunity.
• - Workplace safety: PPE for healthcare workers, needle-stick prevention.
• SECONDARY PREVENTION — examples:
• - Case-finding: sputum screening for TB (smear microscopy, Xpert), dengue surveillance, contact tracing.
• - Screening: TST (tuberculin skin test) for TB infection, blood smear for malaria, stool exam for schistosomiasis.
• - Isolation/quarantine: TB patient during infectious period (first 2 weeks of treatment); close contacts of measles/mumps watched.
• - Contact tracing: find and test contacts of TB, dengue, rabies-exposed persons.
• - Early treatment: DOTS initiation, dengue fluids/transfusion, rabies PEP.
• TERTIARY PREVENTION — examples:
• - TB: monitor treatment response, manage drug side effects (optic neuritis from ethambutol), prevent MDR-TB via adherence.
• - Dengue DHF: aggressive fluid resuscitation, transfusion for hemorrhage, prevent shock.
• - Hansen's disease: MDT adherence, eye care (blindness prevention), physiotherapy (contracture prevention).
• - Malaria: manage severe anemia, cerebral malaria, acute renal failure.
• - Rabies: supportive care only (palliative; always fatal post-symptom) — emphasis is on PEP (secondary prevention).
• VACCINATION IS PRIMARY PREVENTION—SPECIFIC PROTECTION (active immunity).
• PRIMARY PREVENTION INTERRUPTS THE DISEASE CHAIN BEFORE PATHOGEN ENTERS HOST (e.g., immunization, vector control, sanitation).
• SECONDARY PREVENTION DETECTS & TREATS EARLY (e.g., DOTS, case-finding, contact tracing) TO PREVENT TRANSMISSION & PROGRESSION.

Key definitions

Diagrams to know

• Three levels of prevention applied to one disease (e.g., TB: vaccination → case-finding via Xpert → DOTS/drug side effect monitoring).
• Disease progression timeline showing where each prevention level intervenes.
• Disease chain and prevention lever (agent, host, environment, prevention points).