CHN Bullets PDF

VISHNU SHARMA (M.Sc.
Nsg – CHN) ---------------------------- IMPORTANT CHN POINTS

( MO.- 7791925241)
Useful
KEY- POINTS
{For All Nursing Competitive Exams.)
BY- VISHNU SHARMA

M.SC. Nsg ( CHN)
1 WE4U NURSING CLASSES, GURJAR KI THADI, JAIPUR - 7742153220

VISHNU SHARMA (M.Sc. Nsg – CHN) ---------------------------- IMPORTANT CHN POINTS
( MO.- 7791925241)
IMPORTANT DAYS-----
9th jan. – cancer day

30th January - Anti-Leprosy Day
2nd feb. – cancer surviver day
12th Feb. – sexual reproductive health awareness day.
2nd Wednesday of March - No Smoking Day
6th – 12th march – world glaucoma week
8th March - International Women’s Day
9th march – anganwadi worker day.
15th March - World Disabled Day
16th march – world measles day.
22th march - water day
24th March - Anti-TB Day
7th April -World Health Day
11th april – National safe motherhood day

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17 April – Hemophilia day

25th April - World Malaria Day
8th May - World Red Cross Day
31st May - No Tobacco Day
5th June - World Environment Day
8th June – brain tumour day
14th June - World Blood Donor Day
21 june – international yoga day
26th June - international day of drug abuse
1st July - Doctors Day
11th July - World Population Day
28th July - World Hepatitis Day
1 aug – world breast feeding day
8th September- World Literacy Day
26 sept. – world heart day.
28th September- World Rabies Day
1st October - International Day for Older Persons
1st October - National Voluntary Blood Donation Day
2nd Wenesday of October- World Disaster Reduction Day
9th October - World Sight Day

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10th October - World Mental Health Day

24th October – World Polio Day
10th November - Universal Immunization Day
25th November- International Day for Elimination of Violence against Women
1st December - World AIDS Day
3rd December - International Day of Disabled Persons
10th December - Human Rights Day
Last Week of April - World Immunization Week
1–7th May - Anti–Malaria Week
1–30th June - Anti–Malaria Month
1–8th August - World Breast Feeding Week
25th August–8th September - Eye Donation Fortnight
15–21st November - Newborn Care Week
Important Instruments---
Ice Lined Refrigerator (ILR) - Cold chain temperature maintenance
Dial Thermometer - Cold chain temperature monitoring
Horrock’s Apparatus - Chlorine demand estimation in water
Chlorinator, Chloronome - Mixing/regulating the dose of chlorine in water

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Chloroscope - Measuring level of residual chlorine in drinking water

Salter’s scale - Field Instrument for Low Birth Weight (LBW)
Infantometer - Length of infants
Stadiometer -Height of adults
Shakir’s Tape - Mid-Arm Circumference (MAC)
Sound Level Meter - Measures intensity of sound
Band Frequency Analyzer - Characteristic of sound (pitch)
Audiometer - Hearing ability assessment
:-Communicable disease :- Key points by –Mr.VISHNU SHARMA

1:-Tetanus: CLOSTRIDIUM TETANI
2'-Meningococcemia: NEISSERIA MENINGITIDIS
3:-Rabies: RHABDOVIRUS ( LYSSA VIRUS TYPE-1)
4:-Poliomyelitis: LEGIO DEBILITANS (Type I Brunhilde);(Type II Lansing);
5:-Dengue Fever: ARBOVIRUSES (Chikunggunya); (Onyong-nyong); (West Nile); (Flaviviruses)
6:-Malaria: PLASMODIUM (protozoa) P. Falciparum (most fatal); P. Vivax P. Malariae; P.
Ovale
7:-Filariasis: WUCHERERIA BANCROFTI; BRUGIA MALAYI
8:-Leprosy: MYCOBACTERIUM LEPRAE

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9:-Measles: PARAMYXO VIRUS

10:-German measles: TOGA VIRUS
11:-Chicken pox: VARICELLA ZOSTER VIRUS
12:-Herpes zoster: HERPES ZOSTER VIRUS
13:-Scarlet fever: Group A HEMOLYTIC STREPTOCOCCUS
14'-Scabies: SARCOPTES SCABIEI (itch mite)
15:-Bubonic plague: YERSINIA PESTIS
16:-Diphtheria: KLEBS LOEFFLER
17:-Pertussis: BORDETELLA PERTUSSIS
18:-Tuberculosis: MYCOBACTERIUM TUBERCULOSIS
19:-Typhoid: SALMONELLA TYPHI
20'-Cholera: VIBRIO CHOLERA
21:-Amoebiasis: ENTAMOEBA HYSTOLITICA
22:-Leptospirosis: LEPTOSPIRA Spirochete
23'-Schistosomiasis: Schistosoma japonicum
24:-Gonorrhea: N. GONORRHEAE
25:-Syphilis: TREPONEMA PALLIDUM
26:-Chlamydia: C. trachomatis, T. vaginalis
27:-Genital herpes: HERPES SIMPLEX 2
28.Whooping cough—Bordetella pertusis

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Disease Mode(s) of transmission --
Chicken Pox. Droplet infection, droplet nuclei. Face to face transmission

Measles Droplet infection, droplet nuclei, 4 days before rash to 5 days later
through conjunctiva
Rubella Droplet infection, droplet nuclei vertical 1 week before rash to 1
week later
Mumps Droplet Droplet infection, direct contact
infection, direct
contact
Influenza Droplet infection, droplet nuclei
Diphtheria Droplet infection, direct contact fomite borne 95% transmission
from carriers
Whooping cough Droplet infection, direct contact, fomite
Meningococcal Droplet infection Carriers most important source of
infection
TB Droplet infection, droplet nuclei Not Fomite borne

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Poliomyelitis Faeco-oral, droplet infection

Hepatitis A Faeco-oral, parenteral, sexual
Hepatitis B Perinatal, parenteral, sexual

Hepatitis C Perinatal, parenteral, sexual
Hepatitis D Perinatal, parenteral, sexual Super-
infection/co-infection to HBV
Hepatitis E Feco-oral
Cholera Feco-oral, contaminated foods/drinks,
direct contact
Typhoid Feco-oral, urine-oral
Amoebiasis Feco-oral
Ascariasis Feco-oral
Ancylostomiasis Direct Transmission may be perennial
Dracunculiasis Consumption of water containing Water based disease
cyclops
Dengue Aedes bite Water breeding disease
Nipah virus Consumption of bats-eaten fruits
Person-to-person in India
Ebola virus Body fluids
Zika virus Aedes bite , vertical , sexual

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SOME IMPORTANT PROGRAMMES –
--National Family Planning Programme: 1951

__ National Malaria Control Programme (NMCP): 1953
__ Lymphatic Filariasis Control Programme: __..
__ National Leprosy Control Programme: 1955
__ National Malaria Eradication Programme (NMEP): 1958
__ National Tuberculosis Programme (NTP): 1962
__ National Goitre Control Programme (NGCP): 1962
__ National Trachoma Control Programme: 1963
__ Urban Malaria Scheme (UMS): 1971
__ Integrated Child Development Services (ICDS) Scheme: 1975.
__ National Cancer Control Programme: 1975-76
__ National Programme for Control of Blindness (NPCB):1976
__ Kala Azar Control Programme:1977
__ National Mental Health Programme: 1982
__ National Leprosy Eradication Programme (NLEP): 1983
__ National AIDS Control Programme (NACP): 1987
__ Baby Friendly Hospital Initiative (BFHI) :1991
__ _Revised National Tuberculosis Control Programme (RNTCP):1992
__ Child Survival and Safe Motherhood (CSSM) Programme:1992
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__ National AIDS Control Programme I (NACP I): 1992-97

__ Reproductive and Child Health Programme I:1997
__ _National Anti Malaria Programme (NAMP):1999
__ _National AIDS Control Programme II (NACP II):1999-2004

__ _National Vector Borne Disease Control Programme (NVBDCP):2003-04
__ _Integrated Disease Surveillance Project (IDSP): 2004-09
__ _Reproductive and Child Health Programme II:2004-09
_ National Rural Health Mission (NRHM):2005
_ Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), 2006
__ _National AIDS Control Programme III (NACP III): 2006-11
__ National Tobacco Control Programme (NTCP): 2007-08
__ National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke
(NPCDCS): 2008
__ National Program for Health Care of the Elderly (NPHCE): 2011
__ Pradhan Mantri Jan Dhan Yojana (PMJDY) – 2014
_ Pradhan mantra surksha yojna – 2015
- Pradhan mantra jeevan jyoti bima yojna - 2015
DIAGOSTIC TEST FOR C.D.

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1:-)Tetanus: WOUND CULTURE

2:-)Meningitis: LUMBAR PUNCTURE
3:-(Encephalitis: EEG
4:-)Polio: EMG; Muscle testing
5:-)Rabies: Brain biopsy (Negri bodies) Fluorescent rabies antibody test
6:-(Dengue: TOURNIQUET test (Rumpel lead)
7:-)Malaria: Malarial smear; QBC (Quantitative Buffy Coat)
8'-(Scarlet: DICK’S TEST; SCHULTZ-CHARLTON TEST
9:-(Diphtheria: SCHICK’S TEST; Moloney’s Test
10:-)Pertussis: Nasal swab; agar plate
11:-)Tuberculosis: MANTOUX test
12:-)Leprosy: SLIT SKIN SMEAR
13:-(Pinworm: SCOTCH TAPE SWAB
14:-Typhoid: WIDAL’S test
15:-HIV/AIDS: ELISA; WESTERN BLOT; PCT: Polymerase Chain Reaction Test
PHARMACOLOGY OF COMMUNICABLE DISEASE

:1:-Malaria- CHLOROQUINE
2:-Schistosomiasis: PRAZIQUANTEL

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3:-Scabies: EURAX/ CROTAMITON

4:-Chicken pox: ACYCLOVIR/ZOVIRAX
5:-Tuberculosis: R.I.P.E.S.
6:-Pneumonia: COTRIMOXAZOLE; Procaine Penicillin
7:-Helminths: MEBENDAZOLE; PYRANTEL PAMOATE
8. Typhoid -- chlormphenicol
9. Cholera - Tetracyclines
10. Whooping cough- erythromycin ( only 1st 5 days of illness)
SOME IMPORTANT COMMUNICABLE DISEASE---
DISEASE INCUBATION MODE OF PERIOD OF CONTROL PUBLIC

PERIOD TRANSMISSI COMMUNIC MEASURES HEALTH
ON ABILITY RESPONSE
AIDS/HIV* HIV Infection: Person-to- Persons with Education of Patient
14 person by HIV should be those who are interview by
days (1) sexual considered infected, and Public Health
AIDS (Stage 3 contact, infectious for those who are at (PH). Education

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HIV (2) exposure to life. Risk of risk of and counseling

Infection): 7 to blood, transmission becoming in conjunction
10 years (when (3) mother to may be higher infected about with HIV
HIV infection infant during in first months how to prevent testing. Referral
untreated) pregnancy or at after infection. transmission of of sexual and
time of birth, or HIV (i.e., safer needle sharing
via breast sexual partners for
feeding. practices, stop testing,
injecting drug counseling, and
use and needle treatment.
sharing, etc).
Chickenpox: 10-21 days, Person-to- As long as 5, Exclude from Recommend
Varicella average 14-16 person by but usually 1-2 school or child vaccination for
days droplet or days before care and avoid all appropriate
airborne spread onset of rash contact with susceptible
of respiratory until all blisters susceptible persons.
secretions; have crusted. persons until
direct contact blisters are
with drainage crusted.
from blisters or Exposed

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indirectly susceptible
through articles people eligible
contaminated for
by secretions immunization
from blisters. should receive
vaccine within
3-5 days to
protect from
their recent
exposure.
Chlamydia* 1-3 weeks; Contact with Duration of Examine and For higher
often infected person infection. treat all persons priority cases,
asymptomatic, through sexual Reinfection is with sexual patient
especially in activity; common if contact that interview with
females neonatal partners are not occurred within PH and
infections by treated in a the last 60 days, notification of
contact with timely manner. regardless of sexual contacts
birth canal. Without their test for referral to
treatment, results. Annual medical care.

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infection may screening for Education on

persist sexually active abstinence,
indefinitely, females aged < monogamy and
leading to 25 or at high use of barrier
infections of the risk. protection such
upper as latex
reproductive condoms.
tract and other
serious, long-
term
complications
in both females
and males.
Conjunctivitis, 24-72 hours Contact with During the Persons should Education of
with a fever discharges from course of active not attend family and
and behavioral the eyes, nose, infection. school or child classmates on
change, or throat of care during the prevention of
purulence or infected people, acute stage. spread by
hemorrhage from practicing good

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contaminated hand washing

fingers, and not sharing
clothing, and towels or other
other articles. items soiled
with discharge
from eyes or
nose.
Hepatitis A** 15-50 days, Person-to- Approximately Hand washing. Immediate
average 28-30 person spread 2 weeks before Exclude from patient
days by fecal-oral and 1 week high-risk interview and
route; ingestion after onset of situations (food assessment by
of contaminated jaundice. handling, child PH. Contact
food or water, care, and investigation.
or sharing of patient care) for Counseling. If
drug 1 week after case is in high-
paraphernalia. onset of risk situation,
jaundice. Give contact DPBH
household, immediately.
child care and Recommend
other intimate vaccination to

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contacts appropriate
immune susceptible
globulin (IG) persons.
0.02ml/kg body
weight and or
vaccine within
14 days of last
exposure.
Hepatitis B* 45-180 days, Sexual, IV drug Blood and other Follow Patient
average 60-90 use, close body fluids are Standard and interview and
days household infectious Blood Borne assessment by
contact, during late Pathogen PH. Contact
perinatal incubation Precautions. investigation.
mother-to- period, clinical Cover open cuts Counseling.
infant. Rarely disease, and for and sores. Wear Education on
occupational variable period gloves when in prevention of
percutaneous or after recovery contact with further spread
mucus (as long as blood or body and hepatitis B.
membrane HBsAg fluids. Screen all

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exposure to positive). Immediate women during

blood, saliva or Chronic carriers cleanup of each pregnancy.
semen are infectious objects Recommend
for life. contaminated vaccination to
with blood or appropriate
body fluid. For susceptible
blood or needle persons,
exposure to including all
known HBsAg infants.
positive
persons, and not
vaccinated,
hepatitis B
immune
globulin
(HBIG) 0.06
mg/kg body
weight within
24 hours (no
later than 72

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hours for
perinatal
exposure, 7
days for
percutaneous
exposure, or 14
days for sexual
exposure) and
HBV vaccine
given at 0,1,
and 6 months if
not previously
vaccinated.
Influenza (Flu) 1-4 days, Contact with One day before Vaccination. Education on
average 2 days droplets from symptoms Stay home prevention of
the nose and occur and up to while ill. Wash spread.
throat of an 7-10 days after hands often Recommend
infected person symptoms with soap and annual

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who is begin. water. Cover vaccination for

coughing or nose and mouth all appropriate
sneezing. with disposable persons.
tissue when Influenza that is
coughing and known or
sneezing or suspected to be
cough and of a viral strain
sneeze into that the Centers
your upper arm. for Disease
Avoid close Control and
contact with ill Prevention or
individuals. the World
Antiviral drugs, Health
as prescribed. Organization
has determined
poses a risk of a
national or
global
pandemic is
reportable

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immediately to
DPBH.
Measles:** About 10 days. Airborne by a 4 days before Exclude from Contact DPBH
Rubeola, Rash usually fine mist caused rash appears to school and immediately.
Hard measles, appears about when an 4 days after child care for 4 IgM is
Red measles 14 days after infectious onset of rash. days after necessary to
exposure but person coughs, appearance of confirm
can be as long sneezes or rash. Vaccinate diagnosis.
as 19-21 days. talks. This stays appropriate Patient
Fever onset, 7- suspended in susceptible interview and
18 days. the air for up to contacts as soon contact
3 hours. as possible but investigation by
within 72 hours PH. Institute
of last outbreak
exposure. IG control
for appropriate measures.
susceptible Recommend
contacts such as immunization
pregnant with MMR to

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women as soon all appropriate

as possible but susceptible
must be within persons.
6 days of last
exposure.
Mumps* 12-25 days, Droplet or 3 days before to Exclusion from Recommend

average 16-18 direct contact 4 days after day school and immunization
days with saliva and of symptom child care with MMR to
by airborne onset or until through 5 days all appropriate
droplet route. symptoms after onset or susceptible
resolve, until symptoms persons.
whichever is have resolved,
longer. whichever is
longer.
Vaccination is
indicated for
unimmunized
contacts but

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may not
provide
protection for
this exposure.
Rubella* * 14-21 days, Person-to- About 7 days Exclude IgM is
(German average 14-17 person by before and at children from necessary to
measles) days droplets and least 4 days school and confirm
discharges from after rash adults from diagnosis.
nose and throat appears. Infants work for 7 days Contact
and via articles with congenital after onset of investigation by
contaminated rubella rash. Pregnant PH.
by secretions. syndrome may contacts should Recommend
shed virus for be serologically immunization
months after tested for with MMR for
birth via urine susceptibility all appropriate
or pharyngeal and advised susceptible
secretions. according to persons.
results.
Salmonella* 6-72 hours, Ingestion of Variable: Exclude Patient
average 12-36 contaminated usually several symptomatic interview,

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hours. (Up to food days to several persons from assessment, and

16 days has (commonly weeks. A food handling, contact
been eggs, poultry, temporary patient care, investigation by
documented.) and meat); carrier state and child care PH. Education
contact with may continue until diarrhea on prevention
infected for months, has ceased. of spread.
animals or especially in Thorough hand Advise no
person-to- infants but washing by reptiles in
person spread transmission staff and child classrooms,
by fecal-oral from carriers is after bowel child care or in
route. very movements or homes with
uncommon. diapering, and children < 5
before eating or years of age or
preparing food. with immune
compromised
people.
Tuberculosis * 2-10 weeks Airborne Probably not If Patient
(TB) after exposure transmission of communicable communicable, interview and
(pulmonary for skin test tuberculosis after 2-4 weeks exclude from contact
and laryngeal) (PPD) bacteria in on effective school and investigation

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conversion. 5- droplet nuclei drug regimen. work until and follow-up

10% of persons from infectious Extra- patient meets by PH. Directly
with latent TB person. pulmonary TB criteria for non- observed
infection (+ Prolonged close is not infectiousness. therapy (DOT)
skin test but contact usually communicable. Evaluate by PH. PH give
clear chest x- needed for contacts with personnel
ray) go on to spread. significant recommendatio
develop disease exposure. ns on return to
in their lifetime. Prophylactic community.
therapy or Must still be
treatment as reported even if
indicated. suspect case.
Hepatitis C - Perinatal, parenteral, sexual

Hepatitis D - Perinatal, parenteral, sexual Super-infection/co-infection to HBV
Hepatitis E - Feco-oral
Cholera - Feco-oral, contaminated foods/drinks, direct contact
Typhoid - Feco-oral, urine-oral
Nipah virus - Consumption of bats-eaten fruits Person-to-person in India

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Ebola virus – Body fluids ( semean, vomits, tears, saliva etc.)
Discoveries, Inventions and Developments

• First vaccine develop : Small pox (Edward Jenner)
• Term ‘Vaccination’: Edward Jenner
• Term ‘Vaccine’: Louis Pasteur
• Vaccines- Anthrax, Rabies: Louis Pasteur
• First Polio Vaccine: Jonas Salk
• Penicillin (First antibiotic): Alexander Fleming
• Growth Chart: David Morley
• Homeopathy: Samuel Hahnemann
• Blood group types: Karl Landsteiner
• Citrus fruits in prevention of Scurvy: James Lind
• Transmission of Yellow fever: Walter Reed
• Life cycle of Plasmodium: Ronald Ross
First Country Honours

• First country to socialize medicine completely: Russia
• First country to introduce compulsory sickness insurance: Germany
• First country to start family planning programme: India
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• First country to start blindness control programme: India

• First country to establish finger printing bureau: India (Calcutta, 1897)
GOLDEN POINTS-
➢ Father of Medicine/First True Epidemiologist - Hippocrates

➢ Father of Public Health - Cholera
➢ First Country to Socialise Medicine completely - Russia
➢ Health as a “State of complete physical, social and mental = WHO
➢ HDI(Human Development Index) comprises - Knowledge (Literacy and Mean years of
schooling), Income and Longevity (Life Expectancy at Birth)
➢ Life Expectancy is a - Mortality Indicator (Positive Health Indicator)
➢ “Epidemiological Triad” comprises of - Agent, Host and Environment
➢ Extermination of organism is - Eradication
➢ Action taken prior to onset of disease is - Primary Prevention
➢ Early Diagnosis and Treatment are - Secondary Prevention
➢ Ivory Towers of Disease - Large Hospitals
➢ Prevalence is a - Proportion (Total=New + Old Cases)
➢ Total no. of deaths/Total no. of cases is - Case Fatality Rate
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➢ Observed Deaths/Expected Deaths is -Standardized Mortality Ratio (SMR)

➢ Prevalence/Duration is - Incidence
➢ Both exposure and outcome have occurred before study starts in - Case Control Study
➢ Cohort Study is - Forward Looking/Prospective Study
➢ Matching - Removes confounding, Ensures Comparability
➢ Relative Risk is - Incidence among Exposed/ Incidence among non-exposed
➢ Framingham Heart Study is a - Cohort Study
➢ Heart of a Control Trial is - Randomization
➢ Occurrence of a Disease Clearly in excess of normal expectancy - Epidemic
➢ Disease imported in a country where it doesn’t occur - Exotic
➢ First case to come to notice of investigator - Index Case
➢ Malaria parasite in Mosquito is - Cyclo-propagative Transmission
➢ Gap between Primary case and Secondary Case is - Serial Interval
➢ Yellow Fever/BCG/Measles are - Live Vaccines/ Lyophilised vaccines
➢ First Vaccine to be discovered - Smallpox Vaccine (Edward Jenner)
➢ Risk of Cold Chain failure is greatest at - Sub-centre and Village level
➢ Most effective sterilizing agent - Autoclaving (Steam under pressure)
➢ Beaching Powder contains - 33% available chlorine
➢ Small Pox was declared Eradicated on - 8 May, 1980
➢ Rash in Chickenpox is - Pleomorphic and Dew-drop like

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➢ Koplik Spots are diagnostic of - Measles (upper 2nd molar)

➢ Incubation Period for Measles is - 10-14 days
➢ Strain for Rubella Vaccine - RA 27/3
➢ Hundred Day Cough is - Pertussis (Whooping Cough)
➢ DOC for Chemoprophylaxis of Meningococcal Meningitis - Rifampicin
➢ Positive Schick Test indicates Susceptible to - Diphtheria
➢ SARS is caused by - Corona Virus
➢ WHO has recommended ‘DANISH 1331’ strain for - BCG Vaccine
➢ Polio stool samples are transported in - Reverse Cold Chain (+ 2° to + 8° C)
➢ ORS Solution should be used within - 24 Hours
➢ Enteric Fever includes - Typhoid and Para-typhoid Fevers
➢ MC arboviral disease is - Dengue
➢ Presumptive Treatment in Malaria - Chloroquine
➢ Main Vector for Yellow Fever is - Aedes aegypti
➢ Slims’ Disease is - AIDS
➢ Rule of Halves is seen in - Hypertension
➢ BMI is - Weight
➢ Under RCH Program, Kit A, B are kept at - Subcentre Level
➢ No. of Eligible Couples in India - 150–180 ECs/1000 population
➢ Conventional Contraceptives - Condoms/Spermicides

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➢ Progestasert (3rd gen IUD) releases 65 mcg/day Progesterone

➢ MC complaint of IUD insertion is - Bleeding
➢ Only Non-steroidal OCP - Centchroman (Saheli)
➢ MTP Act, 1971 was passed in - April 1972
➢ For sterilization, age of Husband should be - < 60 years
➢ 3 most important MCH problems - Malnutrition, Infection and Unregulated fertility
➢ MC disorder to be screened in neonates - Neonatal Hypothyroidism
➢ Low Birth Weight is Birth Weight - <2.5 Kg
➢ Most sensitive indicator of growth among children - Weight
➢ World’s greatest Public Health Tool is - Immunization
➢ MCC of MMR is - Hemorrhage
➢ Tocopherols are - Vitamin-E
➢ Amino acid converted in body to Niacin - Tryptophan
➢ Richest Source of Vitamin-C -Amla (Indian
➢ 1 PHC is for a population of – 20000- 30,000
➢ International Conference at Alma-Ata (1978) gave concept of - Primary Health Care
➢ MPW is located at - Subcentre level
➢ Greatest risk of Cold Chain failure is at - Subcentre and village level
➢ World Health Day - 7 April
➢ ‘O’ in GOBI Campaign (UNICEF) stands for - Oral Rehydration therapy

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➢ Diseases under International Health Regulations - Cholera, Plague and Yellow fever (and
Smallpox, Wild Polio,Human influenza & SARS)
➢ MPW was given by - Kartar Singh Committee
➢ Father of Medicine/ First True Epidemiologist - Hippocrates
➢ Measles vaccine stored at - -5° to -15° C
➢ Rubella is Live vaccine and C/I in pregnancy
➢ Period of infectivity of measles 4 days before to 5 days after rash appearance
➢ Yellow fever Vaccine (17 D) Live Vaccine
➢ Lyophilized (freeze dried) Vaccines - BCG, Yellow Fever, Measles, MMR
➢ Cold Chain Temperature - + 2° to + 8° C
➢ Dysphagia, dysarthria and diplopia seen in - Clostridium botulinum food poisoning
➢ Reservoir in Chikungunya fever - Primates (monkeys)
➢ Typhoid diagnosed in 1st week by - Blood Culture
➢ 8th Day Disease - Tetanus neonatorum
➢ DOC Cholera (Pregnancy) - Furazolidone
➢ IP of yellow fever - 2–6 days
➢ The Factory Act and ESI Act were passed in - 1948
➢ Total osmolarity of WHO Reduced Osmolarity ORS - 245 mmol/L
➢ Routine surveillance is supplemented by - Sentinel surveillance
➢ Traditional lifestyles for CHD prevention - . Primordial level

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➢ One Urban-PHC is for population - 50,000

➢ Ambulatory patients in triage - Cat III (GREEN)
➢ Drug of choice for scabies - 5% Permethrin
➢ 1 PHC in tribal area for a population of - 20,000
➢ Dose of ORS for a child with weight 12 kg 900 ml
➢ Kit B is kept at. - Subcentres
➢ Richest source of Iron among nuts. - Pistachio
➢ Vaccine strain for swine flu vaccine in india - A7/California/2009
➢ Koplik spots are seen in – meseals
➢ Normal level of IQ is - 90–109 IQ points
➢ Extremely low birth weight is - <1000 grams
➢ Congenital rubella syndrome triad is - Cataract, Deafness, PDA
➢ Minimum number of Beds at CHC - 30 beds
➢ A subcentre in backward area is for - 3000 population
➢ Minimum duration of PEP for HIV - 4 weeks
➢ Food poisoning in less than 6 hours of food - Staphylococcal FP
➢ Health promotion is prevention level - Primary level
➢ First referral level is - Secondary level of care
➢ Lepromin test is strongly positive in - Tuberculoid leprosy
➢ Milk reduces absorption of - Iron

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➢ DDT mechanism of action - Contact poison

➢ Most essential fatty acid is - Linoleic acid
➢ Single drug treatment of trachoma - Azithromycin
➢ ICDS covered under - Ministry Women and Child Development
➢ Anganwadi worker covered under - Ministry Women and Child Development
➢ Integrated Child protection Scheme covered under - Ministry Women and Child Development
➢ Integrated Child Development Services (ICDS) launched in 1975
➢ National Rural Health Mission (ICDS) launched in 2005
➢ National Mental Health Program (NMHP) launched in 1982
➢ National Mental Health Act passed in year 1987
➢ Baby Friendly Hospital Initiative (BFHI) launched in 1991
➢ Child Survival Safe Motherhood (CSSM) launched in 1992
➢ First Disability Census in India 1881
➢ Immunize throw vaccine called vaccination.
➢ Vaccine coined by- Louis pasture
➢ Vaccination coined by- adward janner
➢ 1st Vaccine – Small pox (1798)
➢ Latest vaccine – 2009 Influenza (H1N1)
➢ Immunization is generally achieved with a single dose. (EXCEPT – OPV)
➢ 2 different live vaccines can be administred at different sites.

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LIVE VACCINE BACTERIAL -

➢ BCG – TYPHOID (ORAL)
VIRAL -
➢ ROTA VIRUS
➢ CHICKEN POX
➢ OPV ( SABIN 1957)
➢ YELLOW FEVER
➢ MMR
KILLED VACCINE
BACTERIAL –
➢ TYPHOID
➢ CHOLERA
➢ PLAGUE
➢ PERTUSIS-1923
VIRAL
➢ RABIES – 1885
➢ SALK POLIO -1954
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➢ INFLUENZA
➢ HEP. A -1982
➢ HEP. B
➢ JAPANESE ENCEPHELITIES
TOXOID
– DT , TT
➢ Monovalant – vaccine contain a single strain of a single antigen.
Eg. Measeles
➢ Polyvalent – vaccine contain two or more strains of the same specimen.
Eg. DPT.
IMMUNIZATION - WORLD – MAY 1974
EPI INDIA - JAN. 1978
➢ 3 Dose – DPT
Initaly in india -
1 Dose – BCG
2 Dose – TT for pregnant women
➢ Then in 1979 add – OPV
➢ In 1985 add - measeles
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➢ Total prevention against SIX killer Disease – DPT – MPT ( ACC. UPI-1985)
➢ Then EPI renamed as a UPI – 19 Nov. 1985 in India memory of late. Smt. Indira Gandhi.
➢ UPI becomes part of CSSM ( child survival & safe motherhood ) into 1992 & in RCH into
1997.
➢ Currently UPI under NRHM since 2005.
I. IPV – started part of global polio programme – 2013-18
-India launched IPV as a part of country National Immunization Programme on
oct. 2015.
ROTA VIRUS - March - 2016
Rajasthan – 23 march 2017
PENTAVELENT -
start in Dec.2011 kerla & tamilnaddu
Oct.2014 – 11 state – include rajasthan.
-: Aprail 2015 – All country.
II. JE – Japanese encephelities
➢ ADD – IMMUNIZATION SCH. 10 Nov. 2017 of ( world Immunity Day)

➢ PCV – 6-10-14 week ---0.5 ml / IM
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➢ JE – 9-12 month & 16-24 month – KILLED VACCINE. ( 1 ml – SC)

➢ MR- 9-12 & 16-24 – 0.5 ml /sc
MISSION INDRADHANUSH -
-: launched by – J.P. NADDA on 25 Dec. 2014.
-: coverage to all children across india by year 2020.
-: 7 VACCINE – MPT DPT H
-: In some selected state given – JE & Hib..
PULSE POLIO IMMUNIZATION –
➢ Comes in 1995.
➢ Duration - Dec. & Jan.
➢ First Dosage – 9 Dec. 1995
➢ Second Dosage. – 20 Jan. 1996
BCG –
➢ Used upto 4 hrs.
➢ Discard if at End of day if unused.
➢ Never mix with distill water because distill water cause irritation.
Measeles –
➢ Used up to – 4 hours.
➢ Discard after 4 hrs. then cause toxic shock syndrome.
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➢ Mainly used upto 1 hr. after dissolve.

MEASLES – RUBELLA (MR) VACCINE –
➢ MR vaccination campaign – dose given to child age 9 month – 15 years.

➢ Routine administration – MR vaccine to be included under national immunization schedule
after the completion of MR compaign.
➢ 2 dose under NIS- MR-1 at 9 month age , MR-2 at 16-24 month of age.
➢ Delayed immunization – if a child missed this dose , MR vaccine can be given till 5 years of
age.
POLIOMYELITIES VACCINES –
OPV (Sabin) IPV (Salk)
Type of vaccine Live attenuated vaccine Killed
MOT Oral SC /IM
Type of immunity Humoral + intestinal Humoral
Prevention of Paralysis + intestinal re- Paralysis
infection
Manufacture Easy Difficult
Cost Cheaper expensive
Inactivated (Salk) poli vaccine (IPV) –

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• Is a type of killed vaccine.

• Schedule- 1st 3 dose at 1-2 month interval each & 4th dose after 6-12 month of last dose.
Advantages of IPV-
• Safe in immunodeficiency disorders.
• Useful in those over 50 years age.
• Safe during pregnancy.
• No risk of vaccine associated paralytic polio.
IPV vs Fractional Dose IPV –

IPV f- IPV
Dose 0.5 ml 0.1 ml
Route IM ID
Site Thigh Upper arm
No. of dose 1 2
Schedule 14 weeks 6 , 14 weeks

( MO.- 7791925241)
Oral (sabin) polio vaccine –

• Is a live attenuated vaccine.
• Schedule –
Dose Age
OPV – 0 At birth
OPV- 1 6 week
OPV -2 10 week
OPV – 3 14 week
OPV-B 16-24 month
“SWITCH”- Replacing Trivalent OPV with Bivalent OPV-

• Introduce IPV Replace Topv with bOPV with Draw OPV
2014-15 april 2016 2019-20
National “SWITCH” –
➢ National switch Date – 25 april 2016.
➢ National Validation Day – may 09,2016 ( india to be decleared free of tOPV).

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✓ Heat sensitive vaccine – OPV-MEASELES-MMR-BCG-ROTA VIRUS.

✓ Most heat sensitive vaccine – OPV
✓ Freezer sensitive vaccine- “T – SERIES” – TT,DPT,HEP-B, HEP-A,.
✓ Most freeze sensitive – DPT.
CATCH –UP VACCINATION FOR MISSON DOSE-

➢ BCG – missed dose must given till 12 month of age.
➢ Age 1-7 year = all vaccine given except BCG.
➢ Age > 7 year = mmr( 10 & 16 year )typhoid every 3 yar till 16 year.
➢ Hep.-B birth dose should be ricive as soon as possible.
➢ ROTA VIRUS - max. age of first dose is 14 week & 6 days never given after 15 weeks.
➢ Max. age for the final dose is 8 month.
➢ After 2 ear not beneficial.
➢ IPV – catch up within 6 month of age.
➢ PCV.- 4 month to 18 year.
➢ After 7 year pertusis not required.
➢ Mostly measles vaccine cause TSS ( toxic shock syndrome).
➢ Complication of tetanus is brachial neuritis ( pain in shoulder & arm.)

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➢ Complication of rubella MMR is arthralgia ( joint pain)

➢ Complication of BCG is lymphadenitis (enlargement of lymph node) & osteomyelitis.
➢ Scar forming vaccine is BCG –
✓ Papule within 2-3 week.
✓ Papule increased 4 -8 mm within 5 week.
✓ Permanent scar after 5 week.
➢ Mg cl use for stabilizing OPV.
➢ BCG given by tuberculin syringe ( 26 gauge)
➢ Measles given at 9 month because before that maternal antibody present.
➢ MMR or Rubella vaccine contraindicated in pregnancy due “ CRS’ ( congenital rubella
syndrome” .
• Deafness
• PDA( patent ductus arteriosus)
• Cataract
➢ TT not provide HERD immunity.
➢ Measles provide max. herd immunity.
➢ HPV ( HUMAN PAPILLOMA VIRUS) given at age of 9 year. ( no given in pregnancy)
➢ First antigen vaccine for human use is hep. B vaccine ,which is discovered in 1986.
➢ MMR is given at ( 12-15 month). Then known by MR-II
➢ If DPT vaccine is frozen that should be discard.

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➢ Measles vaccine cause small papule because that vaccine administered S.C. route , so more
vaccine diffuse from inner skin layer .
• Papule form after 5-10 days of measles vaccination.
• Antibody produce after 11-12 days of vaccination.
➢ IPV contraindicated in case of neomycin & streptomycin.
➢ Varicella zoster vaccine avoid in case of aspirin containing products because of risk of Reye’s
syndrome.
➢ Meningococcal meningitis vaccine provide immunity for 3 year.
➢ PCV must given after spleenectomy.
➢ Small pox vaccine is live viral vaccine.
➢ Unused BCG vaccine discard at the end of the day.
➢ Maternal immunity present in children upto 3 month.
➢ Age of primary immunization of DPT , measles , & T.B. is 0 – 9 month.
➢ Inoculation means injecting of an antigen ,antiserum , or antitoxin into an individual to produce
immunity a specific disease.
➢ Side effect of Hib vaccine is low grade fever.
➢ Reverse cold chain means carrying stool samples from pt. S.C. to lab. At 2-8 degree c or
alkaline PH.
➢ In typhoid ,polio & cholera used reverse cold chain.
➢ Typhoid vaccine not included in revised immunization schedule.

( MO.- 7791925241)
➢ Measles used within 1 hr. after preparation .

➢ Influenza vaccine may given by nasal spray.
➢ After swelling due to DPT used ICE packs.
➢ ORS guideline -
AGE WEIGHT QUANTITY
Under 4 month Less then 5kg 200-400ml
4-11 month 5-7.9kg 400-600ml
1-2 yrs 8-10.9 kg 600-800ml
2-4 Yrs 11-15.9 kg 800-1200 ml
5-14 Yrs 16.29.9 kg 1200-2200 ml
Greater than More then 30 2200-4000 ml
15kg kg
➢
➢ India was the 1st country in the world to launch the new ORS formula since June 2004.
➢ Old formula contains sodium biocarbonate at a place of sodium citrate.
➢ Rule of Ten is used for CLEFT LIP.
➢ 3Cs (three clean) during Home delivery- clean hands ,clean surface, clean cord care.
➢ Honeymoon Contraception – oral pills.
➢ Salpingography – x-ray study of the fallopian tube.
➢ Fertilization done in F.T.(ampulla)

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➢ Total weight gain – 11 kg

➢ ( 1st trimstar – 1Kg)
➢ ( 2nd trimester – 5kg)
➢ (3rd trimester – 5kg)
➢ Chills, headache, nausea and vomiting are all signs of transfusion reactions.
➢ Digoxin is also used to treat atrial Fibrillation.
➢ Iron is needed in the formation of hemoglobin.
➢ Hemiplegia is paralysis of one side of body.
➢ The 3 “C’s”—coryza, cough, conjunctivitis
➢ Koplik’s spots: Small red spots with a bluish white center and a red base; located on the buccal
mucosa and last 3 days
➢ A vaccine is contraindicated if the child experienced an anaphylactic reaction to a previously
administered vaccine or a component in the vaccine.
➢ Live virus vaccines generallyare not administered to individuals with severely deficient
immune systems, individuals with a severe sensitivity to gelatin, or pregnant women.
➢ Parenteral vaccines are given in separate syringes in different injection sites.
➢ Vaccines administered intramuscularly are given in the vastus lateralis muscle (best site) or
ventro gluteal muscle (the deltoid can be used for children 36 months of age and older).

( MO.- 7791925241)
➢ Adequate needle length and gauge are as follows: intramuscular,1 inch, 23–25 gauge;
subcutaneous, ⅝ inch, 25 gauge (needle length may vary depending on the child’s size).
➢ For painful or red injection sites, advise the parent to apply cool compresses for the first 24
hours, and then use warm or cold compresses as long as needed.
➢ Human papillomavirus vaccine (HPV)-
1. Dependingon the type of vaccine used (HPV2 or HPV4), the HPV vaccine guards against
diseases that are caused by HPV types 6, 11, 16, and 18, such as cervical cancer, cervical
abnormalities that can lead to cervical cancer, and genital warts.
2. The vaccine is most effective for boys and girls if administered before exposure to human
papillomavirus through sexual contact.
3. The vaccine is administered as 3 injections over 6 months—first dose to girls at age 11 to 12
years, the second dose 2 months after the first dose, and the third dose 6 months after the first dose.
4. A 3-dose series may be administered to boys 9 to 18 years old to reduce their likelihood of
acquiring genital warts.
5. The vaccine can cause pain, swelling, itching, and redness at the injection site; fever; nausea; and
dizziness.
6. The vaccine is contraindicated in individuals with a reaction to a previous injection and in
pregnant women.
➢ Prevalence of suicides in India 36 per 1 Lac population.

( MO.- 7791925241)
➢ MDG related to water supply 20 litres/ day < 1km radius.

➢ Number of vaccine vials in Day carrier box 6–8 vials.
➢ Number of vaccine vials in Vaccine carrier 16–20 vials.
➢ MC blood group in Indian population Blood group ‘O’
➢ Jai Vigyan Mission is for control of Rheumatic fever/ RHD.
➢ Ujjwala scheme is related to child trafficking.
➢ Most common cause of neonatel mortality in india – prematurity & LBW
➢ 0-7 Days – prematurity
➢ 7-28 days – sepsis
➢ 28 days – 1year – Diarrhoea, respiratory infection .
➢ “BULL – NECK “ appearance In – Diphtheria
➢ White plague – T.B.
➢ Slim’s disease - AIDS
➢ Dengue virus has – 4 serotypes.
➢ AYUSH is important component is – NRHM
➢ Major cause of blindness in india – CATARACT
➢ First country to statrt FPP & Blindness Control programme at national level- India
➢ Bleaching powder is also known as chlorinated lime.
➢ Rashes appears firstly on trunk in Chikenpox & on face ,head in smallpox.
➢ Rabies also known as Hydrophobia.

( MO.- 7791925241)
STRAINS OF COMMONLY USED VACCINES –
VACCINE STRAINS
BCG Danish -1331strain (WHO recommended)
OPV/IPV P1, P2, P3 strains (Monovalent or Trivalent)
MUMPS Jeryll lynn strain.
Rubella vaccine RA 27/3
Yellow Fever vaccine 17D strain
Varicella vaccine OKA strain
JE vaccine Nakayama strain

Beijing P3 strain
SA 14-14-2 (Used in India)
Swine Flu Vaccine A7/ California/ 2009
(killed)

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Malaria vaccine SPf 66 strain (Lytic Coktail)

Pf 25 strain
HIV vaccines mVA (modified Vaccinia Ankara) strain
rAAV (recombinant Adeno associated viral
vaccine)
strain
CTL (Cytotoxic T- lymphocytic ) strain
AIDSVAX strain
Subunit Vaccine strain
VACCINE VIAL MONITOR-

➢ if vaccine is potent at the time of administration
➢ VVM is a label containing a heat-sensitive material which is placed on a vaccine vial to
register cumulative heat exposure over time.
➢ VVM indicates efficiency of cold chainQ (temperature maintenance)
➢ VVM is a mark on OPV vial consisting of:
– An outer circle
– An inner square (made of heat sensitive material)
➢ WHO grading of VVM in OPV:
– Is based on colour changes in VVM: ONLY INNER SQUARE CHANGES COLOUR, circle
always remain blue
– Based on VVM, OPV is usable upto Grade IIQ
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WHO Grade Outer circle Inner circle Inference

Grade I Blue White OPV can be used
Grade II Blue Light blue OPV can be used
Grade III Blue Blue OPV can’t be used
Grade IV Blue Purple /black OPV can’t be used
€ (Grade III is Discard point)
Cold Chain-
➢ Cold chain: Is a system of storage and transportation of vaccines from the point of manufacture
to the point of administration (actual vaccination site)
➢ Cold chain temperature of vaccines available in India:
➢ OPV (Sabin):
( MO.- 7791925241)
– Routine storage: +2° C to +8° C

– Long term storage: –20° C to –40° C
➢ Yellow fever vaccine: –30° C to +5° C
➢ All other vaccines: +2° C to +8° C (Also known as the ‘cold chain temperature of vaccines in
IndiaQ’)
➢ Diluents: Can be stored in +2° C to +8° C OR can be kept outside cold chain (a room
temperature)
➢ Vitamin A: Is stored outside cold chain (at room temperature)
➢ +2° C to +8° C ‘cold chain temperature of vaccines inIndia’)
Cold Chain Components (equipments) & Levels in India-

➢
Level Component Temp. Storage
duration
State/ regional level
Walk in cold room(WIC) +2°c to +8°c 3 month
Walk in freezers (WIF) -15°c to -25°c
District level Large ILR +2°c to +8°c 1month
Large DF -15°c to -25°c
PHC Level Small ILR +2°c to +8°c 1 month
Small DF -15°c to -25°c
Sub- center level Vaccine carrier +2°c to +8°c 48-72 hours
Day carrier
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Session level Fully frozen icepack +2°c to +8°c 1-3 hours

➢
LATEST UPDATES-
➢ Hon’ble cabinet minister – Dr. Harsh vardhan
➢ Hon’ble Minister of state – Ashwini kumar chobey
➢ Launch of dedicated website for National Tobacco Control Programme (NTCP) on World
No Tobacco Day 2019.
➢ Nipah – zoonotic disease.
- 1st out break in malesia & singapure from 1998-1999.
- In india – 2001-07
- NIPAH virus RNA identified by PCR from respiratory secretions, urine,CSF.
- Isolation of NIPAH virus from respiratory secretions, urine or CSF.
- NIPAH = BSL -4 agent & sample collection within 4-5 days onset of illness.
➢ Birth & Death Registration = 21 Days.
➢ Nsg. & midwifery portal is an initative of MHFW .mission of this online resource center is to
provide a platform that connects the nurses. Is launched by – Smt. Anuradha gupta – 14
feb.2013.
➢ Total ASHA –
- In India – 882068 – under NRHM
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55039 - NUHM TOTAL - 937107

- In Rajasthan 47693 – NRHM
4636 - NUHM TOTAL – 52329
IFA – SUPPLIMENTATION -- ACC. To ANEMIA MUKT BHARAT ( 2018-2022)
➢ 6-59 month children – 20mg + 100mcg – Biweekly – bottle – 50ml

➢ 5-9 years children - 45 mg + 400 mcg – weekly – pink colour tablet
➢ 10-19 years adolescent - 60 mg + 500mcg – weekly – blue colour tab.
➢ 20-49 years women ( non-preg) – 60 mg + 500 mcg – weekly – red colour tab
➢ Preg. ,lactating mothers - 60 mg + 500 mcg – Daily – red colour tab
Smallpox Eradication
• Last case of smallpox in world: 26th October 1977 (Somalia)
• WHO declared global eradication of smallpox: 8th May 1980
• Last indigenous case of smallpox in India: 17th May 1975 (Bihar)
• Last known case of smallpox in India: 24th May 1975 (Importation from Bangladesh)
• India declared smallpox free: April 1977
Few Important Diseases in Public Health

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• Father of Public Health: Cholera

• Barometer of Social Welfare: Tuberculosis
• Slims’ Disease: HIV/AIDS
• Black Sickness: Kala Azar (Leishmaniasis)
• Black Death: Plague
• Cerebrospinal fever: Meningococcal meningitis
• Break-bone fever: Dengue
• Monkey fever/ disease: KFD (Kyasanur Forest Disease)
• 5-day fever: Trench fever
• 8th day disease: Tetanus neonatorum
• 100-day cough: Pertussis (Whooping cough)
• Koch’s Phenomenon: Tuberculosis
• Hansen’s disease: Leprosy
• Rubeola: Measles
• Rubella: German measles
• Rubula: Mumps

( MO.- 7791925241)

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VISHNU SHARMA (M.Sc.

Nsg – CHN) ---------------------------- IMPORTANT CHN POINTS

BY- VISHNU SHARMA

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9th jan. – cancer day

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17 April – Hemophilia day

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10th October - World Mental Health Day

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Chloroscope - Measuring level of residual chlorine in drinking water

:-Communicable disease :- Key points by –Mr.VISHNU SHARMA

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9:-Measles: PARAMYXO VIRUS

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Disease Mode(s) of transmission --

Chicken Pox. Droplet infection, droplet nuclei. Face to face transmission

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Poliomyelitis Faeco-oral, droplet infection

Hepatitis B Perinatal, parenteral, sexual

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SOME IMPORTANT PROGRAMMES –

--National Family Planning Programme: 1951

__ National AIDS Control Programme I (NACP I): 1992-97

__ _National AIDS Control Programme II (NACP II):1999-2004

DIAGOSTIC TEST FOR C.D.

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1:-)Tetanus: WOUND CULTURE

PHARMACOLOGY OF COMMUNICABLE DISEASE

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3:-Scabies: EURAX/ CROTAMITON

SOME IMPORTANT COMMUNICABLE DISEASE---

DISEASE INCUBATION MODE OF PERIOD OF CONTROL PUBLIC

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HIV (2) exposure to life. Risk of risk of and counseling

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infection may screening for Education on

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contaminated hand washing

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17 WE4U NURSING CLASSES, GURJAR KI THADI, JAIPUR - 7742153220

exposure to positive). Immediate women during

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19 WE4U NURSING CLASSES, GURJAR KI THADI, JAIPUR - 7742153220

who is begin. water. Cover vaccination for

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women as soon all appropriate

Mumps* 12-25 days, Droplet or 3 days before to Exclusion from Recommend

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hours. (Up to food days to several persons from assessment, and

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conversion. 5- droplet nuclei drug regimen. work until and follow-up

Hepatitis C - Perinatal, parenteral, sexual

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Ebola virus – Body fluids ( semean, vomits, tears, saliva etc.)