Containment Strategies
Inhoudsopgave
College 1: Introduction to course and assignment theory...............................................................................1
College 3: control of infectious diseases......................................................................................................... 3
College 4 human rights.................................................................................................................................. 8
College 5: Containment of outbreaks of communicable diseases....................................................................8
College 6 vaccinations in NL......................................................................................................................... 11
College 7 antimicrobial resistance................................................................................................................ 14
College 8: ebola........................................................................................................................................... 16
College 9: cost-effectiveness and control strategies......................................................................................18
College 10: schistosomiasis.......................................................................................................................... 21
College 11: leishmaniasis............................................................................................................................. 24
College 12: Malaria...................................................................................................................................... 29
College 13: HIV/aids..................................................................................................................................... 31
College 14: Pandemics................................................................................................................................. 33
College 15: transfusion safety and blood-borne infections............................................................................35
College 16: TB containment and control....................................................................................................... 38
Selected diseases......................................................................................................................................... 39
College 1: Introduction to course and assignment theory
Example plaque: The difference between isolation and quarantine, quarantine is on basis of
the idea that you have the disease, so on speculation and within isolation we know that you
have the disease.
Example Spanish flue: the Spanish flue is called Spanish cause the news came first from
Spain.
Examples disease control:
Penicillin 1928 alexander Fleming and kills bacteria.
Vaccination cowpokes Jenner and Mr. Reinders first Dutch with vaccination ideas
We focus on strategies to control, eliminate, eradicate disease. We focus on the high/ middle-
and low-income countries from global to local. Because different diseases are more
interesting in different countries, STD is more interesting in high income countries and urban,
while ebola is not.
,Will lead to evidence informed decision making (EIDM), linking the problems to the solution.
Where evidence and context matters, we have to aknowledge our own role in it.
How would you approach designing an intervention within the context (precede/proceed)?
1. Social assessment
2. Epidemiological assessment
3. Behavioral and environmental assessment
4. Educational and organization assessment
5. Administration and policy assessment
6. Implementation
7. Process evaluation
8. Impact evaluation
9. Outcome evaluation
Known frameworks:
- Preceed/proceed: Precede is how we design an intervention(what are the problems)
and proceed is how to continue (what causes these problems).
- Intervention mapping: it is about mapping intervention tracks. Consists of 6 stepts.
They talk about clear objectives, what does the campaign has to achieve and what will
the impact be and what dou tou want to change.
- Behavior changes and communication model: theory planned behavior/ health belief
model. It is about understanding behavior and where It comes from, it is easier to
know what to change.
We use the 5 steps of Jenkins in health intervention.
1. What is the problem: is it a priority health problem? And focus on the social-economic
impact of the disease and for whom is it a priority problem? You need to know the
burden of the disease and the potential burden.
2. What factors cause the problem? Tools to identify the causes are the epi triangle and
problem tree. On the top is the problem in the problem tree and then you ask why
repeatedly.
3. How can these factors be changed: five basic strategies, removing agent/raise host
resistance/ modify environment/ separate agent from host/ interrupt transmission
(infected to non-infected).
Example:
Intervention Diarrhea Ischemic heart disease
Change the agent disinfection Promote low fat/salt
foods
Raise host resistance Proper nutrition Increase exercise
Modify the environment Enforcing sanitary Provide exercise
standards facilities social
reinforcement
Separate the agent from the Don’t let children play Keep fatty foods and
host among animals cigarettes out of home
interrupt transmission Special sanitary care for Screen for risk factors
the sick (isolating
cholera cases)
, Preventive programs deal with complex web of etiology, hence, why web of
interventions needed in many conditions.
- Primary prevention, before you get sick.
- Secondary prevention, screening and early detection together with treatment.
- Tertiary prevention, limiting and preventing further disability and death.
4. What overall intervention strategies are most appropriate and cost effective?
Intervention analysis, using research methods.
EIDM: evidence informed decision making, it is difficult to say where you have to go,
you can get an idea of where to go, but not necessarily a strict direction of where to
go. If you have evidence then you will make this decision where to go/what to do, it is
evidence based.
Using EIDM, for choosing the right intervention that can be implanted with limited
negative side effects.
- Medical-technical effectiveness: extent to which it controls disease, like a
condom for STD
- Organization feasibility: implementation of intervention (level of facilities,
skills of health workers), does it fit within the existing services
- Social cultural an political feasibility: acceptability of intervention to
community and leader, it is to ask the question: is it appropriate, is it
acceptable the intervention. For example registering every man that has sex
with man. Therefore you have to ask the person himself if he has, and that is
not appropriate in the Netherlands.
- Financial feasibility: costs for personal and materials, et: economic appraisal
and sustainability
5. What needs to be done to reach the goals? With what population shall we work:
anticipate barriers to implementation.
College 3: control of infectious diseases
Transmission:
Direct Indirect
Skin-skin (herpes type 1) Food-borne (salmonella)
Blood/mucous-mucous (STI’s) Water-borne (HepA)
Across placenta (toxoplasmosis) Vector-Borne (malaria)
Through breats milk (HIV) Air-borne (chickenpox)
Sneeze cough (Influenza)
Exposure = a relevant contact, depends on the agent (skin, seksual intercourse, water contact,
etc.)
Four relevant branches epidemiology:
1. Disease etiology
2. Outbreak investigation
3. Disease screening
4. Comparisons of treatment and effect
, - Latent period: is the period that you are exposed but not infectious, so you can’t pass it on
- Non-infectious period: you still have the disease but not infectious anymore.
- Incubation: time you are infected but there are non-symptoms yet and afterward you get a
start of your symptoms being clinical or sub-clinical
In the picture above:
- Upper stream: can you spread or not
- Lower stream: are you sick or not
Terms used in dynamics of infectious diseases:
- Index case: the first case identified
- Primary: the case that brings the infection into a populaton
- Secondary: infected by a primary case
- Tertiary: infected by a secondary case
Reproductive rate: how many people you infect.
- Virulent component
- Contact moment
- Resistance of the person (how many are already immune)
1. Point source:
there was one source in moment of time and per day more people become infected
until the maximum incubation period is over, could be for example food poisoning.
2. Continuing source:
If the line is almost stable, so we then think it is not human transmission but
continuing source outbreak. So, one source that consistently gives the agent, so water-
borne diseases like cholera
Disseminated outbreak originating from an index case with propagated spread: Human to
human transmission you expect waves and it goes op exponentially.
Geographical data: city based
Deographical data: what did they do
Yes (outcome) No (outcome)
Yes (predictor) 42 5
No (predictor) 16 53
Inhoudsopgave
College 1: Introduction to course and assignment theory...............................................................................1
College 3: control of infectious diseases......................................................................................................... 3
College 4 human rights.................................................................................................................................. 8
College 5: Containment of outbreaks of communicable diseases....................................................................8
College 6 vaccinations in NL......................................................................................................................... 11
College 7 antimicrobial resistance................................................................................................................ 14
College 8: ebola........................................................................................................................................... 16
College 9: cost-effectiveness and control strategies......................................................................................18
College 10: schistosomiasis.......................................................................................................................... 21
College 11: leishmaniasis............................................................................................................................. 24
College 12: Malaria...................................................................................................................................... 29
College 13: HIV/aids..................................................................................................................................... 31
College 14: Pandemics................................................................................................................................. 33
College 15: transfusion safety and blood-borne infections............................................................................35
College 16: TB containment and control....................................................................................................... 38
Selected diseases......................................................................................................................................... 39
College 1: Introduction to course and assignment theory
Example plaque: The difference between isolation and quarantine, quarantine is on basis of
the idea that you have the disease, so on speculation and within isolation we know that you
have the disease.
Example Spanish flue: the Spanish flue is called Spanish cause the news came first from
Spain.
Examples disease control:
Penicillin 1928 alexander Fleming and kills bacteria.
Vaccination cowpokes Jenner and Mr. Reinders first Dutch with vaccination ideas
We focus on strategies to control, eliminate, eradicate disease. We focus on the high/ middle-
and low-income countries from global to local. Because different diseases are more
interesting in different countries, STD is more interesting in high income countries and urban,
while ebola is not.
,Will lead to evidence informed decision making (EIDM), linking the problems to the solution.
Where evidence and context matters, we have to aknowledge our own role in it.
How would you approach designing an intervention within the context (precede/proceed)?
1. Social assessment
2. Epidemiological assessment
3. Behavioral and environmental assessment
4. Educational and organization assessment
5. Administration and policy assessment
6. Implementation
7. Process evaluation
8. Impact evaluation
9. Outcome evaluation
Known frameworks:
- Preceed/proceed: Precede is how we design an intervention(what are the problems)
and proceed is how to continue (what causes these problems).
- Intervention mapping: it is about mapping intervention tracks. Consists of 6 stepts.
They talk about clear objectives, what does the campaign has to achieve and what will
the impact be and what dou tou want to change.
- Behavior changes and communication model: theory planned behavior/ health belief
model. It is about understanding behavior and where It comes from, it is easier to
know what to change.
We use the 5 steps of Jenkins in health intervention.
1. What is the problem: is it a priority health problem? And focus on the social-economic
impact of the disease and for whom is it a priority problem? You need to know the
burden of the disease and the potential burden.
2. What factors cause the problem? Tools to identify the causes are the epi triangle and
problem tree. On the top is the problem in the problem tree and then you ask why
repeatedly.
3. How can these factors be changed: five basic strategies, removing agent/raise host
resistance/ modify environment/ separate agent from host/ interrupt transmission
(infected to non-infected).
Example:
Intervention Diarrhea Ischemic heart disease
Change the agent disinfection Promote low fat/salt
foods
Raise host resistance Proper nutrition Increase exercise
Modify the environment Enforcing sanitary Provide exercise
standards facilities social
reinforcement
Separate the agent from the Don’t let children play Keep fatty foods and
host among animals cigarettes out of home
interrupt transmission Special sanitary care for Screen for risk factors
the sick (isolating
cholera cases)
, Preventive programs deal with complex web of etiology, hence, why web of
interventions needed in many conditions.
- Primary prevention, before you get sick.
- Secondary prevention, screening and early detection together with treatment.
- Tertiary prevention, limiting and preventing further disability and death.
4. What overall intervention strategies are most appropriate and cost effective?
Intervention analysis, using research methods.
EIDM: evidence informed decision making, it is difficult to say where you have to go,
you can get an idea of where to go, but not necessarily a strict direction of where to
go. If you have evidence then you will make this decision where to go/what to do, it is
evidence based.
Using EIDM, for choosing the right intervention that can be implanted with limited
negative side effects.
- Medical-technical effectiveness: extent to which it controls disease, like a
condom for STD
- Organization feasibility: implementation of intervention (level of facilities,
skills of health workers), does it fit within the existing services
- Social cultural an political feasibility: acceptability of intervention to
community and leader, it is to ask the question: is it appropriate, is it
acceptable the intervention. For example registering every man that has sex
with man. Therefore you have to ask the person himself if he has, and that is
not appropriate in the Netherlands.
- Financial feasibility: costs for personal and materials, et: economic appraisal
and sustainability
5. What needs to be done to reach the goals? With what population shall we work:
anticipate barriers to implementation.
College 3: control of infectious diseases
Transmission:
Direct Indirect
Skin-skin (herpes type 1) Food-borne (salmonella)
Blood/mucous-mucous (STI’s) Water-borne (HepA)
Across placenta (toxoplasmosis) Vector-Borne (malaria)
Through breats milk (HIV) Air-borne (chickenpox)
Sneeze cough (Influenza)
Exposure = a relevant contact, depends on the agent (skin, seksual intercourse, water contact,
etc.)
Four relevant branches epidemiology:
1. Disease etiology
2. Outbreak investigation
3. Disease screening
4. Comparisons of treatment and effect
, - Latent period: is the period that you are exposed but not infectious, so you can’t pass it on
- Non-infectious period: you still have the disease but not infectious anymore.
- Incubation: time you are infected but there are non-symptoms yet and afterward you get a
start of your symptoms being clinical or sub-clinical
In the picture above:
- Upper stream: can you spread or not
- Lower stream: are you sick or not
Terms used in dynamics of infectious diseases:
- Index case: the first case identified
- Primary: the case that brings the infection into a populaton
- Secondary: infected by a primary case
- Tertiary: infected by a secondary case
Reproductive rate: how many people you infect.
- Virulent component
- Contact moment
- Resistance of the person (how many are already immune)
1. Point source:
there was one source in moment of time and per day more people become infected
until the maximum incubation period is over, could be for example food poisoning.
2. Continuing source:
If the line is almost stable, so we then think it is not human transmission but
continuing source outbreak. So, one source that consistently gives the agent, so water-
borne diseases like cholera
Disseminated outbreak originating from an index case with propagated spread: Human to
human transmission you expect waves and it goes op exponentially.
Geographical data: city based
Deographical data: what did they do
Yes (outcome) No (outcome)
Yes (predictor) 42 5
No (predictor) 16 53
