Module 2 Introduction to

Community Health

Introduction

Community health is a major field of study within the medical and clinical sciences which
focuses on the maintenance, protection, and improvement of the health status of population
groups and communities. Each category focuses on a different level and approach towards the
community or population group.
In this module, you will learn the different underlying ideas about community health such
as the factors that improve its functionality, the role of epidemiology in public health. You will
also learn different communicable and non-communicable diseases that affect the people in a
community. And also you will learn the importance of immunization if conquering such viruses
that causes disease.

Learning Outcome
At the end of the module, the students will be able to:

 Define community health

 Identify the far-reaching impact of community health
 Distinguish the different factors that improve community health
 examine and discuss the role of epidemiology in public health
 recognize, examine and formulate the importance of immunization
 identify the major means of transmission for communicable diseases
 identify and examine immunizations in relationship to immunity
 differentiate the major classifications of communicable and non-communicable diseases

Learning Content

What Is Community Health and Why Is It Important?

The community you live in is part of who you are. Even if you don’t see your neighbours every
day, you recognize that the decisions you make impact those around you. You’re all in it
together, and you wouldn’t have it any other way!
Improving your community and helping others is often at the top of your mind. So when the
phrase “community health” crossed your radar, you had to know more. What is community
health? And how does it affect the lives of those in your area?

Community health is the intersection of healthcare, economics and social interaction.

Unfortunately, many people are unaware of the role this type of healthcare plays in their
everyday lives. Join us as we explore the impact of community health on your neighbourhood—
and what you can do to improve it.

What is community health?

Community health is a medical specialty that focuses on the physical and mental well-being of
the people in a specific geographic region. This important subsection of public health includes
initiatives to help community members maintain and improve their health, prevent the spread of
infectious diseases and prepare for natural disasters.

“Working at the community level promotes healthy living, helps prevent chronic diseases and
brings the greatest health benefits to the greatest number of people in need,” reports
the Centers for Disease Control and Prevention (CDC).

Strong community health requires residents to look beyond themselves and take “collective
responsibility,” says Caleb Backe, health and wellness expert at Maple Holistics. “It’s not just
about the healthcare system, but focuses on the importance of leading a generally healthy
lifestyle in order to protect the community as a whole.”

Community health is inextricably tied to individual wellness. “Good community health equates to
healthy people, as a community is the ecosystem or environment in which people live,” says
Thomas G. Bognanno, president and CEO of Community Health Charities. “It’s difficult to be
healthy personally if your community is unhealthy.”

The far-reaching impact of community health

Community health flips the script on the old adage, “You take care of you; I’ll take care of me.”
Instead, public health experts agree that the health of a community can have far-reaching—and
sometimes surprising—impacts on individual health and beyond.

“Community health impacts everything—educational achievement, safety and crime, people’s

ability to work and be financially healthy, life expectancy, happiness and more,” Bognanno says.
“Health impacts every other facet of life, from a child’s ability to learn to an adult’s ability to work,
so health is critical for education and financial well-being.”

The effect of health on quality of life can also impact the desire to participate in civic duties like
voting, social functions and leisure activities, according to Healthy People 2020, an initiative of
the Office of Disease Prevention and Health Promotion.

Communities that are attentive to public health can even reduce inequality among their
residents. “[Community health] also helps to reduce health gaps caused by differences in race
and ethnicity, location, social status, income and other factors that can affect health,” reports
the CDC.
The consequences of neglecting community health

A lack of focus on community health can lead to a range of complex problems that aren’t easy
to correct. For example, crime and safety issues that result from neglected community health
can quickly becoming a self-perpetuating cycle. “Repeated exposure to crime and violence may
be linked to an increase in negative health outcomes. Children exposed to violence may show
increased signs of aggression starting in upper-elementary school,” reports Healthy People
2020.

Chronic diseases, such as diabetes and heart disease, can also increase if a community’s
overall well-being is suffering. “An unhealthy community tends to be obese and struggle more
from chronic diseases and other health challenges,” Bognanno says.

Chronic diseases like these not only reduce life expectancy, they have a dramatic effect on the
economy. The CDC reports that 90 percent of the nation’s annual healthcare expenses are for
people with chronic health conditions.

Curbing the spread of infectious disease is also a priority of community health programs.
Without them, communities may find themselves battling outbreaks of illnesses that put
vulnerable populations like the elderly at higher risk.

“If a community has to recover from an emergency event, such as a natural disaster, reducing
the spread of disease becomes a crucial part of the recovery process,” Backe says.

Factors that improve community health

Improving community health is a huge undertaking that involves cooperation between public
health workers, local government, volunteers and average citizens alike—and the end products
of their work can take a lot of forms. “Communities benefit from walking trails and bike paths,
from access to healthy food and playgrounds, from accessible healthcare services, schools and
places of employment, as well as affordable housing,” Bognanno says.

Education also plays a large role in maintaining community health. Health fairs and advertising
campaigns that expose the dangers of risk factors like tobacco exposure, poor nutrition and
physical inactivity can raise awareness about the importance of choosing a healthy lifestyle.
The CDC has also focused on promoting nutrition guidelines in schools and increasing the
amount of physical education children receive.

Individuals can step up to the plate for their community’s health by volunteering at health fairs or
blood drives, petitioning local officials to develop more green space and walking trails and
maintaining their own health. “The collective responsibilities that individuals have for their
communal health can lead to positive interactions within the community as a whole,” Backe
says.

Introduction to Epidemiology

This background lesson provides several working definitions of epidemiology—the basic

science of public health; an introduction to the different categories of epidemiology and
types of epidemiological studies; and an overview of the disease transmission cycle.
First, to set the stage, consider the three incidents that follow, stepping into the shoes of
the public health officer who received the initial report and asking yourself the question,
“What do I do now?” Some of these examples made national news and may be familiar
to you.

Epidemiology Defined

A definition of epidemiology is “the study of the distribution and determinants of health-related

states in specified populations, and the application of this study to control health problems.” A
look at the key words will help illuminate the meaning:

 Epidemiology is the basic science of public health. It’s a highly quantitative discipline
based on principles of statistics and research methodologies.
 Distribution Epidemiologists study the distribution of frequencies and patterns of health
events within groups in a population. To do this, they use descriptive epidemiology, which
characterizes health events in terms of time, place, and person
 Determinant Epidemiologists also attempt to search for causes or factors that are
associated with increased risk or probability of disease. This type of epidemiology, where
we move from questions of “who,” “what,” “where,” and “when” and start trying to answer
“how” and “why,” is referred to as analytical epidemiology

A comparison between the practice of public health and the more familiar practice of health care
helps in describing epidemiology. First, where health care practitioners collect data on an
individual patient by taking a medical history and conducting a physical exam, epidemiologists
collect data about an entire population through surveillance systems or descriptive
epidemiological studies. The health care practitioner uses his or her data to make a differential
diagnosis. The epidemiologist’s data is used to generate hypotheses about the relationships
between exposure and disease. Both disciplines then test the hypotheses, the health care
practitioner by conducting additional diagnostic studies or tests, the epidemiologist by
conducting analytical studies such as cohort or case-control studies. The final step is to take
action. The health care practitioner prescribes medical treatment, and the epidemiologist, some
form of community intervention to end the health problem and prevent its recurrence.

Health Care Professional Epidemiologist

Collects data on an individual patient by Collects data about an entire population through
taking a medical history and conducting a surveillance systems or descriptive
physical exam epidemiological studies

Uses his or her data to make a differential Data is used to generate hypotheses about the
diagnosis relationships between exposure and disease
 Tests the hypothesis by conducting Tests the hypothesis by conducting analytical
additional diagnostic studies or tests studies such as cohort or case-control studies

Develops community intervention to end the

Prescribes medical treatment
health problem and prevent its recurrence

One way to sum up the task of epidemiologists is to say that they “count things.” Basically,
epidemiologists count cases of disease or injury, define the affected population, and then
compute rates of disease or injury in that population. Then they compare these rates with those
found in other populations and make inferences regarding the patterns of disease to determine
whether a problem exists.

For example, in the hepatitis B example earlier, you might ask: Is the rate of disease among
people with no known risk factors greater than we would expect? Is the pattern or distribution of
the cases suspicious? Once a problem has been identified, the data are used to determine the
cause of the health problem; the modes of transmission; any factors that are related to
susceptibility, exposure, or risk; and any potential environmental determinants.

Epidemiological Studies

As mentioned earlier, epidemiologists used several different types of studies. Simply speaking,
these can be classified as either experimental, where the epidemiologists have control over the
circumstances from the start, or observational, where they do not. Vaccine efficacy trials are a
good example of experimental studies because investigators control who gets the vaccine and
who doesn’t. Observational studies can be further subdivided
into descriptive and analytical studies. In a descriptive study, the epidemiologist collects
information to characterize and summarize the health event or problem. In an analytical study,
the epidemiologist relies on comparisons between groups to determine the role of various risk
factors in causing the problem. Descriptive epidemiology is the most basic of these categories
and is fundamental to the work of an epidemiologists.

Another way of comparing descriptive and analytical epidemiology is to say that in the
descriptive process, we are concerned with “person” (Who was affected?), “place” (Where were
they affected?), and time (When were they affected?). Once we know the answers to these
questions, we can enter the realm of analytical epidemiology and ask how and why these
people were affected.

Disease Transmission

In talking about epidemiology, it is important to review how outbreaks occur. First, we’ll look at
three commonly used, and often misunderstood, terms: “epidemic,” “outbreak,” and “cluster.”
An epidemic is the occurrence of more cases of disease than would normally be expected in a
specific place or group of people over a given period of time. To an epidemiologist, “outbreak”
means basically the same thing. In the public’s mind, however, “epidemic” has a far more
serious connotation than “outbreak.” For this reason, “outbreak” is often used to avoid
sensationalism. The third term, “cluster,” is occasionally used, incorrectly, in place of “epidemic”
or “outbreak.” A cluster is a group of cases in a specific time and place that may or may not be
greater than the expected rate. Often the aim of investigating clusters is to determine the
baseline rate of disease for that time and place. Two other terms you will come across are
“endemic,” meaning a high background rate of disease, and “pandemic,” meaning very
widespread, often global, disease.

For an outbreak, or epidemic, to occur, the basic elements of disease causation and an
adequate chain of transmission must be present. Disease occurs when an
outside agent capable of causing the disease meets a host that is vulnerable to the agent in
an environment that allows the agent and host to interact. Then, given a chain of transmission
from one host to another and a suitable mode of spread, an outbreak can develop. These basic
concepts help guide the selection of public health strategies to prevent health problems.
Depending on which approach might be most effective, we might direct efforts at the specific
agent (e.g., guinea worm), host (e.g., immunization to prevent measles), or environment (e.g.,
sanitation improvements to prevent salmonella). We can also target a specific point in the chain
of transmission. This was the response in the E.coli outbreak in Washington State in the early
1990s, when health officials called for the thorough cooking of hamburgers to interrupt
transmission of the bacterium.
The host is the person, or in a more generic definition, the organism, that is susceptible to the
effect of the agent. The status of the host is quite important and is generally classifiable as
susceptible, immune, or infected. Finally, and also quite important, is that the host’s response to
exposure can vary widely, from showing no effect to manifesting illness.
The environment is the conditions or influences that are not part of either the agent or the host,
but that influence their interaction. A wide variety of factors, including physical, climatologic,
biologic, social, and economic conditions, can come into play. For instance, in a study of motor
vehicle injuries, the agent (mechanical energy) and the host (driver) could be affected by the
topography, the weather, and the actions of other drivers. In many infectious disease outbreaks,
social and economic conditions cause overcrowding and lead to high levels of exposure.
Agent, host, and environment alone are not sufficient to cause an epidemic; an adequate chain
of transmission must be present. This process requires a source for the agent, a portal of exit, a
mode of transmission, and a portal of entry. The first element, the source for the agent, is
often the place where the agent originates, where it lives, grows, and multiplies, but this is not
always the case. The agent that causes botulism (Clostridium botulinum), for example,
originates in soil, but the source of most botulism infections is improperly canned food
containing C. botulinum spores.
The second element, a portal of exit, is a pathway by which the agent can leave the source.
This pathway is usually related to the place where the agent is localized. For instance, the
agents causing tuberculosis and the flu are released through the respiratory tract, whereas
agents for many stomach ailments are released through the digestive tract. Agents found in the
blood, such as hepatitis B and HIV, can be released through cuts or needles.
Once the agent leaves the source, a mode of transmission, or means of carrying it to the host,
is needed. This can happen in a number of ways, some of which are direct and some
indirect. Direct transmission includes contact with soil or plants as well as contact between
people. In indirect transmission, the agent can be airborne, vector borne, or vehicle borne.
In airborne transmission, the agent is carried from the source to the host suspended in air
particles. Vector-borne diseases are transmitted indirectly by a live carrier, usually an arthropod,
such as mosquitos, fleas, or ticks. Vehicle-borne diseases are carried by inanimate objects,
such as food or water, blood, or items like handkerchiefs, bedding, and surgical instruments.
Finally, there must be a pathway into the host, a portal of entry, that gives the agent access to
tissue where it can multiply or act. Often the agent enters the host in the same way that it left
the source. This is the case with the flu virus, which leaves the source through the respiratory
tract and enters a new host through the respiratory tract.

The Chain of Infection Model

This model explains the spread of a communicable disease from one host (or person) to
another. The basic idea represented in the chain of infection is that individuals can break the
chain (reduce the risk) at any point, thus the spread of the disease can be stopped.

Table 1. Chain of infection.

Component of the
Definition Preventive measures
model

Pasteurization, chlorination,
Disease caused by an infectious
Communicable disease antibiotics, disinfectants, hand
agent
washing, etc.

Isolation, surveillance,
The human being who is
Human reservoir treatment with medications,
harbouring the infectious agent
etc.

The body part through which the

Utilization of handkerchiefs,
infectious agent is exiting from the
Portal of exit condoms, hair nets, insect
reservoir, for example the mouth
repellents, hand washing, etc.
or the anus

Isolation, hand washing,

The spread of the infectious agent mosquito control, sexual
Transmission
from the reservoir to the host abstinence, condom users,
etc.

The body part through which the

infectious agent will enter the new Condoms, hair nets, insect
Portal of entry
host, for example the skin after a repellents, hand washing, etc.
mosquito bite, the mouth

Establishment of The host develops signs and Immunizations, health

disease in new host symptoms of the new disease education, nutrition promotion;
(susceptible person) sexual abstinence, condom
Table 1. Chain of infection.

use, etc.

Now look at Table 1 carefully again. There are two sets of components that have some similar
preventive measures. As a way of helping yourself become familiar with this chart see if you can
spot which these are.

The portal of entry and exit both involve preventive measures such as hand washing, condoms,
hair nets and insect repellents, while the human reservoir and transmission measures both
involve isolation. Be sure you have a clear picture of the definition and prevention of each
element before you continue.

With the application of such information, health education can help to create programs that are
aimed at breaking the chain and reducing the risks of infection in other people.

THE COMMUNICABLE DISEASE MODEL

 The communicable disease model presents three elements; infectious agent, host and

environment, as the minimal requirements for the presence and spread of a
communicable disease in a population.
 The infectious agent is the element that must be present for the disease to occur and
spread. Bacteria, viruses and parasites are examples of infectious agents.
 The host is any susceptible organism. Plants, animals or humans can be invaded by the
infectious agent and become the host.
 The environment includes all other factors that either promote or prohibit disease
transmission.
Communicable disease transmission occurs when a susceptible host and an infectious agent
exist in an environment that allows disease transmission.

According to the communicable disease model, the role of health education and health
promotion in reducing the occurrence and transmission of diseases can be brought about by
specific actions.

Think of tuberculosis (TB), malaria and intestinal infections as examples, and then answer the
following questions:

1. Note one way to reduce the susceptibility of hosts.

2. Note one way to destroy infectious agents.
3. Note one way to reduce the contact between the host and the agent.
4. Note one way to modify the environment so that it is not conducive for disease
transmission.

You may have answered with the following examples:

 1. Good nutrition will build a person’s defenses against infection and reduce their risk of
developing TB.
2. Cooking food properly destroys infectious agents that could cause intestinal infections.
3. Wearing a mask or holding your hand in front of your mouth while coughing will reduce
the contact between the agent that causes TB, and other human beings.
4. Drying swampy and marshy areas will make the environment less easy for mosquitoes
to breed in and therefore reduce the incidence of malaria.

Health risk reduction for non-communicable diseases

Both the chain of infection and communicable disease models are helpful in trying to prevent
disease caused by an infectious agent. However, these models are not applicable to non-
communicable diseases, which include many of the chronic diseases such as heart disease and
cancers. Most of these diseases become apparent in people over a period of time and are not
caused by a single factor, but by a combination of factors. The concept of ‘caused by many
factors’ is often called the multi causation disease model. For example, it is known that heart
disease is most likely to be a problem for individuals who are older, who smoke, who do not
exercise, who are overweight, who have high blood pressure, who have high blood cholesterol
and who have a family history of heart disease.

Note that within the list of factors you have just read there are both modifiable and non-
modifiable risk factors.

Non-communicable Diseases and Disorders

Diseases are classified as either communicable or non-communicable. Communicable diseases

are spread to other people and they are caused by viral, bacterial, parasitic, or fungal infection.
Non-communicable diseases, also known as non-infectious diseases, are not transferred and
are typically caused by heredity, deficiencies in nutrition or factors involving the environment.
Some non-communicable diseases include

 Respiratory disorders
 Diabetes
 Headaches
 Arthritis
 Skin disorders
 Neurological disorders
 Cancer
 Cardiovascular Diseases and Disorders
Respiratory Disorders

Chronic Obstructive Pulmonary Disease

 COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a progressive

disease that makes it hard to breathe. “Progressive” means the disease gets worse over
time.
 COPD can cause coughing that produces large amounts of mucus (a slimy substance),
wheezing, shortness of breath, chest tightness, and other symptoms.
 Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke
or used to smoke. Long-term exposure to other lung irritants, such as air pollution,
chemical fumes, or dust, also may contribute to COPD.
 COPD, or chronic obstructive pulmonary disease, is a major cause of disability and the
third leading cause of death in the United States. More than 12 million people are
currently diagnosed with COPD. An additional 12 million likely have the disease and don’t
even know it.

To understand COPD, it helps to understand how the lungs work. The air that you breathe goes
down your windpipe into tubes in your lungs called bronchial tubes or airways.

The airways and air sacs are elastic (stretchy). When you breathe in, each air sac fills up with
air like a small balloon. When you breathe out, the air sacs deflate and the air goes out.

In COPD, less air flows in and out of the airways because of one or more of the following:

 The airways and air sacs lose their elastic quality.

 The walls between many of the air sacs are destroyed.
 The walls of the airways become thick and inflamed.
 The airways make more mucus than usual, which tends to clog them.

In the United States, the term “COPD” includes two main conditions—emphysema and chronic
bronchitis.

In emphysema, the walls between many of the air sacs are damaged, causing them to lose their
shape and become floppy. This damage also can destroy the walls of the air sacs, leading to
fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas
exchange in the lungs is reduced.

In chronic bronchitis, the lining of the airways is constantly irritated and inflamed. This causes
the lining to thicken. Lots of thick mucus forms in the airways, making it hard to breathe. Most
people who have COPD have both emphysema and chronic obstructive bronchitis. Thus, the
general term “COPD” is more accurate.
Outlook

 COPD is a major cause of disability, and it’s the third leading cause of death in the
United States. More than 12 million people are currently diagnosed with COPD. Many
more people may have the disease and not even know it.
 COPD develops slowly. Symptoms often worsen over time and can limit your ability to
do routine activities. Severe COPD may prevent you from doing even basic activities like
walking, cooking, or taking care of yourself.
 Most of the time, COPD is diagnosed in middle-aged or older people. The disease isn’t
passed from person to person—you can’t catch it from someone else.
 COPD has no cure yet, and doctors don’t know how to reverse the damage to the
airways and lungs. However, treatments and lifestyle changes can help you feel better,
stay more active, and slow the progress of the disease.

How Can COPD Be Prevented?

You can take steps to prevent COPD before it starts. If you already have COPD, you can take
steps to prevent complications and slow the progress of the disease.

Prevent COPD Before It Starts

The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the
leading cause of COPD.

Chronic Bronchitis

Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It
causes a cough that often brings up mucus, as well as shortness of breath, wheezing, and chest
tightness. There are two main types of bronchitis: acute and chronic.

Chronic bronchitis is one type of COPD (chronic obstructive pulmonary disease). The inflamed
bronchi produce a lot of mucus. This leads to cough and difficulty getting air in and out of the
lungs. Cigarette smoking is the most common cause. Breathing in other fumes and dusts over a
long period of time may also cause chronic bronchitis. Treatment will help your symptoms, but
chronic bronchitis is a long-term condition that keeps coming back or never goes away
completely.

Emphysema

Emphysema is a type of chronic obstructive pulmonary disease (COPD) involving damage to

the air sacs (alveoli) in the lungs. As a result, your body does not get the oxygen it needs.
Emphysema makes it hard to catch your breath. You may also have a chronic cough and have
trouble breathing during exercise.

The most common cause is cigarette smoking. If you smoke, quitting can help prevent you from
getting the disease. If you already have emphysema, not smoking might keep it from getting
worse. Treatment is based on whether your symptoms are mild, moderate or severe.
Treatments include inhalers, oxygen, medications and sometimes surgery to relieve symptoms
and prevent complications.

Asthma

Asthma is a chronic lung disease that inflames and narrows the airways, making it hard to
breathe. The disease affects people of all ages, but it most often starts in childhood. People who
have asthma may wheeze, cough, feel short of breath, or have chest tightness.

Asthma can’t be cured, but it can be controlled. People who have asthma, or those who have
children with asthma, can take an active role in their treatment. For example, they can work with
their health care providers to create an asthma action plan. This plan gives guidance on taking
medicines properly, avoiding asthma triggers, tracking levels of asthma control, responding to
worsening symptoms, and seeking emergency care when needed. When asthma is well
controlled, most people who have the disease are able to live normal, active lives.

Diabetes

Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes
from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give
them energy. With Type 1 diabetes, your body does not make insulin. With Type 2 diabetes, the
more common type, your body does not make or use insulin well. Without enough insulin, the
glucose stays in your blood.

Over time, having too much glucose in your blood can cause serious problems. It can damage
your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the
need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.

A blood test can show if you have diabetes. Exercise, weight control and sticking to your meal
plan can help control your diabetes. You should also monitor your glucose level and take
medicine if prescribed.

Diabetes means your blood glucose, or blood sugar, is too high. With Type 1 diabetes, your
pancreas does not make insulin. Insulin is a hormone that helps glucose get into your cells to
give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood
glucose can lead to serious problems with your heart, eyes, kidneys, nerves, and gums and
teeth.

Type 1 diabetes happens most often in children and young adults but can appear at any age.
Symptoms may include

 Being very thirsty

 Urinating often
 Feeling very hungry or tired
 Losing weight without trying
 Having sores that heal slowly
  Having dry, itchy skin
 Losing the feeling in your feet or having tingling in your feet
 Having blurry eyesight

What are the most important things to do to prevent diabetes?

The Diabetes Prevention Program (DPP), a major federally funded study of 3,234 people at high
risk for diabetes, showed that people can delay and possibly prevent the disease by losing a
small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical
activity 5 days a week and healthier eating.

What are the risk factors which increase the likelihood of developing diabetes?

 Being overweight or obese.

 Having a parent, brother, or sister with diabetes.
 Being African American, American Indian, Asian American, Pacific Islander, or Hispanic
American/Latino heritage.
 Having a prior history of gestational diabetes or birth of at least one baby weighing more
than 9 pounds.
 Having high blood pressure measuring 140/90 or higher.
 Having abnormal cholesterol with HDL (“good”) cholesterol is 35 or lower, or triglyceride
level is 250 or higher.
 Being physically inactive—exercising fewer than three times a week.

How does body weight affect the likelihood of developing diabetes?

Being overweight or obese is a leading risk factor for type 2 diabetes. Being overweight can
keep your body from making and using insulin properly, and can also cause high blood
pressure. The Diabetes Prevention Program (DPP), a major federally funded study of 3,234
people at high risk for diabetes, showed that moderate diet and exercise of about 30 minutes or
more, 5 or more days per week, or of 150 or more minutes per week, resulting in a 5% to 7%
weight loss can delay and possibly prevent type 2 diabetes.

Headache

Oh my aching head! Nearly everyone has had a headache. The most common type of
headache is a tension headache. Tension headaches are due to tight muscles in your
shoulders, neck, scalp and jaw. They are often related to stress, depression or anxiety. You are
more likely to get tension headaches if you work too much, don’t get enough sleep, miss meals
or use alcohol.
Other common types of headaches include migraines, cluster headaches and sinus headaches.
Most people can feel much better by making lifestyle changes, learning ways to relax and taking
pain relievers.

Headaches can have many causes, but serious causes of headaches are rare. Sometimes
headaches warn of a more serious disorder. Let your health care provider know if you have
sudden, severe headaches. Get medical help right away if you have a headache after a blow to
your head, or if you have a headache along with a stiff neck, fever, confusion, loss of
consciousness or pain in the eye or ear.

A migraine is a very painful type of headache. People who get migraines often describe the pain
as pulsing or throbbing in one area of the head. During migraines, people are very sensitive to
light and sound. They may also become nauseated and vomit.

Migraine is three times more common in women than in men. Some people can tell when they
are about to have a migraine because they see flashing lights or zigzag lines or they temporarily
lose their vision.

Many things can trigger a migraine. These include

 Stress
 Lack of food or sleep
 Exposure to light
 Hormonal changes (in women)

Doctors used to believe migraines were linked to the opening and narrowing of blood vessels in
the head. Now they believe the cause is related to genes that control the activity of some brain
cells. Medicines can help prevent migraine attacks or help relieve symptoms of attacks when
they happen. For many people, treatments to relieve stress can also help.

Arthritis

If you feel pain and stiffness in your body or have trouble moving around, you might have
arthritis. Most kinds of arthritis cause pain and swelling in your joints. Joints are places where
two bones meet, such as your elbow or knee. Over time, a swollen joint can become severely
damaged. Some kinds of arthritis can also cause problems in your organs, such as your eyes or
skin.

One type of arthritis, osteoarthritis, is often related to aging or to an injury. Other types occur
when your immune system, which normally protects your body from infection, attacks your
body’s own tissues. Rheumatoid arthritis is the most common form of this kind of arthritis.
Juvenile rheumatoid arthritis is a form of the disease that happens in children. Infectious arthritis
is an infection that has spread from another part of the body to the joint.

Osteoarthritis is the most common form of arthritis. It causes pain, swelling and reduced motion
in your joints. It can occur in any joint, but usually it affects your hands, knees, hips or spine.
Osteoarthritis breaks down the cartilage in your joints. Cartilage is the slippery tissue that covers
the ends of bones in a joint. Healthy cartilage absorbs the shock of movement. When you lose
cartilage, your bones rub together. Over time, this rubbing can permanently damage the joint.
Factors that may cause osteoarthritis include

 Being overweight
 Getting older
 Injuring a joint

Therapies that manage osteoarthritis pain and improve function include exercise, weight control,
rest, pain relief, alternative therapies, and surgery.

Skin Disorders

Did you know that your skin is the largest organ of your body? It is, in terms of both weight,
between 6 and 9 pounds, and surface area, about 2 square yards. Your skin separates the
inside of your body from the outside world. Skin:

 Protects you from bacteria and viruses that can cause infections
 Helps you sense the outside world, such as whether it is hot or cold, wet or dry
 Regulates your body temperature

Conditions that irritate, clog or inflame your skin can cause symptoms such as redness,
swelling, burning and itching. Allergies, irritants, your genetic makeup and certain diseases and
immune system problems can cause dermatitis, hives and other skin conditions. Many skin
problems, such as acne, also affect your appearance.

Dermatitis

A rash is an area of irritated or swollen skin. It might be red and itchy, bumpy, scaly, crusty or
blistered. Rashes are a symptom of many different medical conditions. Things that can cause a
rash include other diseases, irritating substances, allergies, and your genetic makeup.

Contact dermatitis is a common cause of rashes. It causes redness, itching and burning where
you have touched an irritant, such as a chemical, or something you are allergic to, like poison
ivy.

Some rashes develop immediately. Others form over several days. If you scratch your rash, it
might take longer to heal. The treatment for a rash usually depends on its cause. Options
include moisturizers, lotions, baths, cortisone creams that relieve swelling, and antihistamines,
which relieve itching.
Hives

Hives are red and sometimes itchy bumps on your skin. An allergic reaction to a drug or food
usually causes them. Allergic reactions cause your body to release chemicals that can make
your skin swell up in hives. People who have other allergies are more likely to get hives than
other people. Other causes include infections and stress.

Hives are very common. They usually go away on their own, but if you have a serious case, you
might need medicine or a shot. In rare cases, allergic reactions can cause a dangerous swelling
in your airways, making it hard to breathe – which is a medical emergency.

Acne

Acne is a common skin disease that causes pimples. Pimples form when hair follicles under
your skin clog up. Most pimples form on the face, neck, back, chest and shoulders. Anyone can
get acne, but it is common in teenagers and young adults. It is not serious, but it can cause
scars.

No one knows exactly what causes acne. Hormone changes, such as those during the teenage
years and pregnancy, probably play a role. There are many myths about what causes acne.
Chocolate and greasy foods are often blamed, but there is little evidence that foods have much
effect on acne in most people. Another common myth is that dirty skin causes acne; however,
blackheads and pimples are not caused by dirt. Stress doesn’t cause acne, but stress can make
it worse.

If you have acne

 Clean your skin gently

 Try not to touch your skin
 Avoid the sun

Treatments for acne include medicines and creams.

Scabies

Scabies is an itchy skin condition caused by the microscopic mite Sarcoptes scabei. It is

common all over the world, and it affects people of all races and social classes. Scabies
spreads quickly in crowded conditions where there is frequent skin-to-skin contact between
people. Hospitals, child-care centers and nursing homes are examples. Scabies can easily
infect sex partners and other household members. Sharing clothes, towels, and bedding can
also spread scabies. You cannot get scabies from a pet. Pets get a different mite infection
called mange.

Symptoms are

 Pimple-like irritations or a rash

  Intense itching, especially at night
 Sores caused by scratching

Several lotions are available to treat scabies. The infected person’s clothes, bedding and towels
should be washed in hot water and dried in a hot dryer.

Psoriasis

Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery
scales. You usually get them on your elbows, knees, scalp, back, face, palms and feet, but they
can show up on other parts of your body. A problem with your immune system causes psoriasis.
In a process called cell turnover, skin cells that grow deep in your skin rise to the surface.
Normally, this takes a month. In psoriasis, it happens in just days because your cells rise too
fast.

Psoriasis can last a long time, even a lifetime. Symptoms come and go. Things that make them
worse include

 Infections
 Stress
 Dry skin
 Certain medicines

Psoriasis usually occurs in adults. It sometimes runs in families. Treatments include creams,
medications and light therapy.

Neurological Disorders

Neurological disorders include:

 Diseases caused by faulty genes, such as Huntington’s disease and muscular dystrophy
 Problems with the way the nervous system develops, such as spina bifida
 Degenerative diseases, where nerve cells are damaged or die, such as Parkinson’s
disease and Alzheimer’s disease
 Injuries to the spinal cord and brain
 Seizure disorders, such as epilepsy
 Cancer, such as brain tumors
 Meningitis

Huntington’s Disease

Huntington’s disease (HD) is an inherited disease that causes certain nerve cells in the brain to
waste away. People are born with the defective gene, but symptoms usually don’t appear until
middle age. Early symptoms of HD may include uncontrolled movements, clumsiness or
balance problems. Later, HD can take away the ability to walk, talk or swallow. Some people
stop recognizing family members. Others are aware of their environment and are able to
express emotions. If one of your parents has Huntington’s disease, you have a 50-50 chance of
getting it. A blood test can tell if you have the HD gene and will develop the disease. Genetic
counselling can help you weigh the risks and benefits of taking the test. There is no cure.
Medicines can help manage some of the symptoms, but cannot slow down or stop the disease.

Muscular Dystrophy

Muscular dystrophy (MD) refers to a group of more than 30 inherited diseases that cause
muscle weakness and muscle loss. Some forms of MD appear in infancy or childhood, while
others may not appear until middle age or later. The different muscular dystrophies vary in who
they affect and the symptoms. All forms of MD grow worse as the person’s muscles get weaker.
Most people with MD eventually lose the ability to walk.
There is no cure for muscular dystrophy. Treatments include physical and speech therapy,
orthopedic devices, surgery and medications. Some people with muscular dystrophy have mild
cases that worsen slowly. Other cases are disabling and severe.

Spina Bifida

Spina bifida is the most common disabling birth defect in the United States. It is a type of neural
tube defect, which is a problem with the spinal cord or its coverings. It happens if the fetal spinal
column doesn’t close completely during the first month of pregnancy. There is usually nerve
damage that causes at least some paralysis of the legs. Many people with spina bifida will need
assistive devices such as braces, crutches or wheelchairs. They may have learning difficulties,
urinary and bowel problems or hydrocephalus, a build-up of fluid in the brain.

There is no cure. Treatments focus on the complications, and can include surgery, medicine
and physiotherapy. Taking folic acid can reduce the risk of having a baby with spina bifida. It’s in
most multivitamins. Women who could become pregnant should take it daily.

Parkinson’s Disease

Parkinson’s disease is a disorder that affects nerve cells, or neurons, in a part of the brain that
controls muscle movement. In Parkinson’s, neurons that make a chemical called dopamine die
or do not work properly. Dopamine normally sends signals that help coordinate your
movements. No one knows what damages these cells. Symptoms of Parkinson’s disease may
include

 Trembling of hands, arms, legs, jaw and face

 Stiffness of the arms, legs and trunk
 Slowness of movement
 Poor balance and coordination
As symptoms get worse, people with the disease may have trouble walking, talking or doing
simple tasks. They may also have problems such as depression, sleep problems or trouble
chewing, swallowing or speaking.
Parkinson’s usually begins around age 60, but it can start earlier. It is more common in men
than in women. There is no cure for Parkinson’s disease. A variety of medicines sometimes help
symptoms dramatically.

Alzheimer’s Disease

Alzheimer’s disease (AD) is the most common form of dementia among older people. Dementia
is a brain disorder that seriously affects a person’s ability to carry out daily activities.

AD begins slowly. It first involves the parts of the brain that control thought, memory and
language. People with AD may have trouble remembering things that happened recently or
names of people they know. A related problem, mild cognitive impairment(MCI), causes more
memory problems than normal for people of the same age. Many, but not all, people with MCI
will develop AD.

In AD, over time, symptoms get worse. People may not recognize family members or have
trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair.
Later on, they may become anxious or aggressive, or wander away from home. Eventually, they
need total care. This can cause great stress for family members who must care for them.

AD usually begins after age 60. The risk goes up as you get older. Your risk is also higher if a
family member has had the disease.

No treatment can stop the disease. However, some drugs may help keep symptoms from
getting worse for a limited time.

Spinal Cord Injury

Your spinal cord is the part of your nervous system that relays messages to and from your
brain. It is housed inside your vertebrae, which are the bone disks that make up your spine.
Normally, your vertebrae protect your spinal cord. If they don’t, you can sustain a spinal cord
injury. Besides injuries, the spinal cord can develop

 Tumors
 Infections such as meningitis and poliomyelitis
 Inflammatory diseases
 Autoimmune diseases
 Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy

Symptoms vary but might include pain, numbness, loss of sensation and muscle weakness.
These symptoms can occur around the spinal cord, and also in other areas such as your arms
and legs. Treatments vary but often include medicines and surgery.
Epilepsy

Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen
when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may
have strange sensations and emotions or behave strangely. They may have violent muscle
spasms or lose consciousness.

Epilepsy has many possible causes, including illness, brain injury and abnormal brain
development. In many cases, the cause is unknown.

Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment
right away. There is no cure for epilepsy, but medicines can control seizures for most people.
When medicines are not working well, surgery or implanted devices such as vagus nerve
stimulators may help. Special diets can help some children with epilepsy.

Meningitis

Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord, called the
meninges. There are several types of meningitis. The most common is viral meningitis, which
you get when a virus enters the body through the nose or mouth and travels to the brain.
Bacterial meningitis is rare, but can be deadly. It usually starts with bacteria that cause a cold-
like infection. It can block blood vessels in the brain and lead to stroke and brain damage. It can
also harm other organs. Pneumococcal infections and meningococcal infections can cause
bacterial meningitis.

Anyone can get meningitis, but it is more common in people whose bodies have trouble fighting
infections. Meningitis can progress rapidly. You should seek medical care quickly if you have

 A sudden fever
 A severe headache
 A stiff neck

Early treatment can help prevent serious problems, including death. Vaccines can prevent some of the
bacterial infections that cause meningitis. Parents of adolescents and students living in college dorms
should talk to a doctor about the vaccination.

Communicable (Infectious) Diseases

Infectious diseases kill more people worldwide than any other single cause. Infectious
diseases are caused by germs. Germs are tiny living things that are found everywhere
—in air, soil, and water. You can get infected by touching germs.

There are four main kinds of germs:

 Bacteria—one-celled germs that multiply quickly and may release chemicals which can
make you sick
  Viruses—capsules that contain genetic material, and use your own cells to multiply
 Fungi—primitive vegetables, like mushrooms or mildew
 Protozoa—one-celled animals that use other living things for food and a place to live

Bacteria
Bacteria are living things that have only one cell. Under a microscope, they look like balls, rods,
or spirals. They are so small that a line of 1,000 could fit across a pencil eraser. Most bacteria
won’t hurt you—less than 1 percent makes people sick. Many are helpful. Some bacteria help to
digest food, destroy disease-causing cells and give the body needed vitamins. Bacteria are also
used in making healthy foods like yogurt and cheese.
But infectious bacteria can make you ill. They reproduce quickly in your body. Many give off
chemicals called toxins, which can damage tissue and make you sick. Examples of bacteria that
cause infections include Streptococcus, Staphylococcus, and E. coli.

Antibiotics are the usual treatment. When you take antibiotics, follow the directions carefully.
Each time you take antibiotics, you increase the chances that bacteria in your body will learn to
resist them. Later, you could get or spread an infection that those antibiotics cannot cure.

Strep Throat

Streptococcal infections (strep for short) cause a variety of health problems. There are two
types: group A and group B. Antibiotics are used to treat both.

Group A strep causes

 Strep throat—a sore, red throat, sometimes with white spots on the tonsils
 Scarlet fever—red rash on the body
 Impetigo—a skin infection
 Toxic shock syndrome
 Cellulitis and necrotizing fasciitis (flesh-eating disease)

Group B strep can cause blood infections, pneumonia and meningitis in newborns. A screening
test during pregnancy can tell if you have it. If you do, I.V. antibiotics during labor can save your
baby’s life. Adults can also get group B strep infections, especially if they are elderly or already
have health problems. Strep B can cause urinary tract infections, blood infections, skin
infections and pneumonia in adults.

Tuberculosis (TB)

In developed countries, such as the United States, many people think TB is a disease of the
past. TB, however, is still a leading killer of young adults worldwide. Some 2 billion people—
one-third of the world’s population—are thought to be infected with TB bacteria, Mycobacterium
tuberculosis (Mtb).
TB is a chronic bacterial infection. It is spread through the air and usually infects the lungs,
although other organs and parts of the body can be involved as well. Most people who are
infected with Mtb harbor the bacterium without symptoms (have latent TB), but some will
develop active TB disease. According to World Health Organization estimates, each year 8
million people worldwide develop active TB and nearly 2 million die.

One in 10 people who are infected with Mtb may develop active TB at some time in their lives.
The risk of developing active disease is greatest in the first year after infection, but active
disease often does not occur until many years later.

TB in the United States

In 2006, the Centers for Disease Control and Prevention (CDC) reported 13,799 cases of active
TB. While the overall rate of new TB cases continues to decline in the United States since
national reporting began in 1953, the annual decrease in TB cases has slowed from an average
of 7.1 percent (1993–2000) to the current average of 3.8 percent (2001–2005), according to
CDC. In addition to those with active TB, an estimated 10 to 15 million people in the United
States have latent TB.

Minorities are affected disproportionately by TB, which occurs among foreign-born individuals
nearly nine times as frequently as among people born in the United States. This is partially
because they were often exposed to Mtb in their country of origin before moving to the United
States. In 2004, a very high percentage of Asians (95 percent) and Hispanics (75 percent) who
were born outside the United States were reported to have TB.

Tuberculosis (TB) is a bacterial infection caused by a germ called Mycobacterium tuberculosis.

The bacteria usually attack the lungs, but they can also damage other parts of the body. TB
spreads through the air when a person with TB of the lungs or throat coughs, sneezes or talks.
If you have been exposed, you should go to your doctor for tests. You are more likely to get TB
if you have a weak immune system.

Symptoms of TB in the lungs may include

 A bad cough that lasts 3 weeks or longer

 Weight loss
 Coughing up blood or mucus
 Weakness or fatigue
 Fever and chills
 Night sweats

If not treated properly, TB can be deadly. You can usually cure active TB by taking several
medicines for a long period of time. People with latent TB can take medicine so that they do not
develop active TB.
Viral Infections
Viruses are capsules with genetic material inside. They are very tiny, much smaller than
bacteria. Viruses cause familiar infectious diseases such as the common cold, flu and warts.
They also cause severe illnesses such as HIV/AIDS, smallpox and hemorrhagic fevers.

Viruses are like hijackers. They invade living, normal cells and use those cells to multiply and
produce other viruses like themselves. This eventually kills the cells, which can make you sick.

Viral infections are hard to treat because viruses live inside your body’s cells. They are
“protected” from medicines, which usually move through your bloodstream. Antibiotics do not
work for viral infections. There are a few antiviral medicines available. Vaccines can help
prevent you from getting many viral diseases.

Influenza

Flu is a respiratory infection caused by a number of viruses. The viruses pass through the air
and enter your body through your nose or mouth. Between 5% and 20% of people in the U.S.
get the flu each year. The flu can be serious or even deadly for elderly people, newborn babies
and people with certain chronic illnesses.

Symptoms of the flu come on suddenly and are worse than those of the common cold. They
may include

 Body or muscle aches

 Chills
 Cough
 Fever
 Headache
 Sore throat

Is it a cold or the flu? Colds rarely cause a fever or headaches. Flu almost never causes an
upset stomach. And “stomach flu” isn’t really flu at all, but gastroenteritis.

The main way to keep from getting the flu is to get a yearly flu vaccine. If you get the flu, your
health care provider may prescribe medicine to help your body fight the infection and lessen
symptoms.

Common Cold

Sneezing, sore throat, a stuffy nose, coughing—everyone knows the symptoms of the common
cold. It is probably the most common illness. In the course of a year, people in the United States
suffer 1 billion colds.

You can get a cold by touching your eyes or nose after you touch surfaces with cold germs on
them. You can also inhale the germs. Symptoms usually begin 2 or 3 days after infection and
last 2 to 14 days. Washing your hands and staying away from people with colds will help you
avoid colds.However, do not give aspirin to children. And do not give cough medicine to children
under four.

There is no cure for the common cold. For relief, try

 Getting plenty of rest

 Drinking fluids
 Gargling with warm salt water
 Using cough drops or throat sprays
 Taking over-the-counter pain or cold medicines

Hepatitis B

Hepatitis B is one type of hepatitis—a liver disease—caused by the hepatitis B virus (HBV).
Hepatitis B spreads by contact with an infected person’s blood, semen or other body fluid. An
infected woman can give hepatitis B to her baby at birth.

If you get HBV, you may feel as if you have the flu, or you may have no symptoms at all. A
blood test can tell if you have it. HBV usually gets better on its own after a few months. If it does
not get better, it is called chronic HBV, which lasts a lifetime. Chronic HBV can lead to scarring
of the liver, liver failure or liver cancer.

There is a vaccine for HBV. It requires three shots. All babies should get the vaccine, but older
children and adults can get it too. If you travel to countries where Hepatitis B is common, you
should get the vaccine.

Infectious mononucleosis

Infectious mononucleosis, or “mono,” is an infection caused by the Epstein-Barr virus. The virus
spreads through saliva, which is why it’s sometimes called “kissing disease.” Mono occurs most
often in 15- to 17-year-olds. However, you can get it at any age. Symptoms of mono include

 Fever
 Sore throat
 Swollen lymph glands

Sometimes you may also have a swollen spleen. Serious problems are rare.

A blood test can show if you have mono. Most people get better in two to four weeks. However,
you may feel tired for a few months afterward. Treatment focuses on helping symptoms and
includes medicines for pain and fever, warm salt water gargles and plenty of rest and fluids.
Fungi
If you have ever had athlete’s foot or a yeast infection, you can blame a fungus. A fungus is
actually a primitive vegetable. Mushrooms, mold and mildew are examples. Fungi live in air, in
soil, on plants and in water. Some live in the human body. Only about half of all types of fungi
are harmful.

Some fungi reproduce through tiny spores in the air. You can inhale the spores or they can land
on you. As a result, fungal infections often start in the lungs or on the skin. You are more likely
to get a fungal infection if you have a weakened immune system or take antibiotics.

Fungi can be difficult to kill. For skin and nail infections, you can apply medicine directly to the
infected area. Oral antifungal medicines are also available for serious infections.

Yeast Infections (or Candida)

Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in
your body. Usually, your immune system keeps yeast under control. If you are sick or taking
antibiotics, it can multiply and cause an infection.

Yeast infections affect different parts of the body in different ways:

 Thrush is a yeast infection that causes white patches in your mouth

 Esophagitis is thrush that spreads to your esophagus, the tube that takes food from your mouth to
your stomach. Esophagitis can make it hard or painful to swallow
 Women can get vaginal yeast infections, causing itchiness, pain and discharge
 Yeast infections of the skin cause itching and rashes
 Yeast infections in your bloodstream can be life-threatening

Antifungal medicines eliminate yeast infections in most people. If you have a weak immune
system, treatment might be more difficult.

Parasitic Diseases

Parasites are living things that use other living things—like your body—for food and a place to
live. You can get them from contaminated food or water, a bug bite, or sexual contact. Parasitic
diseases can cause mild discomfort or be deadly.

Parasites range in size from tiny, one-celled organisms called protozoa to worms that can be
seen with the naked eye. Some parasitic diseases happen in the United States. Contaminated
water supplies can lead to Giardia infections. Cats can transmit toxoplasmosis, which is
dangerous for pregnant women. Others, like malaria, are common in other parts of the world.

If you are traveling, it’s important to drink only water you know is safe. Prevention is especially
important. There are no vaccines for parasitic diseases. Some medicines are available to treat
parasitic infections.
Pneumonia

Pneumonia is an inflammation of the lung, usually caused by an infection. Three common

causes are bacteria, viruses and fungi. You can also get pneumonia by accidentally inhaling a
liquid or chemical. People most at risk are older than 65 or younger than 2 years of age, or
already have health problems.

If you have pneumonia, you may have difficulty breathing and have a cough and a fever. A
physical exam and history can help determine if you have pneumonia. Chest x-rays and blood
tests can help determine what is wrong. Treatment depends on what made you sick. If bacteria
are the cause, antibiotics should help. Viral pneumonia may get better with rest and drinking
liquids.

Preventing pneumonia is always better than treating it. The best preventive measures include
washing your hands frequently, not smoking, and wearing a mask when cleaning dusty or moldy
areas. There is a vaccine for pneumococcal pneumonia, a bacterial infection which accounts for
up to a quarter of all pneumonias.

Defining Health Disparities

Despite prevention efforts, some groups of people are affected by HIV/AIDS, viral hepatitis,
STDs, and TB more than other groups of people. The occurrence of these diseases at greater
levels among certain population groups more than among others is often referred to as a health
disparity. Differences may occur by gender, race or ethnicity, education, income, disability,
geographic location and sexual orientation among others. Social determinants of health like
poverty, unequal access to health care, lack of education, stigma, and racism are linked to
health disparities.

Immunity and Immunizations

Shots may hurt a little… but the diseases they can prevent can hurt a lot more! Immunization
shots, or vaccinations, are essential. They protect against things like measles, mumps, rubella,
hepatitis B, polio, diphtheria, tetanus and pertussis (whooping cough). Immunizations are
important for adults as well as for children. Here’s why.

Your immune system helps your body fight germs by producing substances to combat them.
Once it does, the immune system “remembers” the germ and can fight it again. Vaccines
contain germs that have been killed or weakened. When given to a healthy person, the vaccine
triggers the immune system to respond and thus build immunity.

Before vaccines, people became immune only by actually getting a disease and surviving it.
Immunizations are an easier and less risky way to become immune.

Vaccines

Vaccines are the best defence we have against serious, preventable, and sometimes deadly
contagious diseases. Vaccines are some of the safest medical products available, but like any
other medical product, there may be risks. Accurate information about the value of vaccines as
well as their possible side-effects helps people to make informed decisions about vaccination.

Federal law requires that Vaccine Information Statements explaining vaccine benefits and risks
be handed out whenever (before each dose) certain vaccinations are given. Vaccine Information
Statements are available in Spanish and many different languages. In addition, more detailed
information describing the benefits and risks of a particular vaccine is available in the
Prescribing Information from the Food and Drug Administration.

The following sections answer common questions asked about vaccines and how vaccines are
tested and monitored to ensure they are safe and effective. These sections are currently
available in English only.

Vaccines are held to the highest standard of safety. The United States currently has the safest,
most effective vaccine supply in history. Vaccines undergo a rigorous and extensive evaluation
program to determine a product’s safety and effectiveness. If a vaccine does receive approval, it
is continuously monitored for safety and effectiveness.

Many partners work together to make sure vaccines are safe. Government health scientists
work with manufacturers, health care providers, academia, and global health groups such as the
World Health Organization to build a comprehensive vaccine safety system. At the Department
of Health and Human Services, primarily three agencies work on vaccine safety:

 Centers for Disease Control and Prevention (CDC)

 National Institutes of Health (NIH)
 Food and Drug Administration (FDA)

Vaccines undergo rigorous and extensive testing to determine their safety and effectiveness
prior to approval. Following approval, FDA carefully monitors the quality of vaccines—all
manufactured lots must pass tests before they can be used. Vaccine manufacturers also must
follow strict manufacturing standards, and FDA conducts routine inspections of manufacturing
sites.

Scientists from FDA and CDC work closely to monitor reports of vaccine side effects (adverse
events) after they are approved and used widely. FDA and CDC take all reports seriously, and
work together to evaluate and address any potential problems.

Potential Side Effects

Vaccines, like all medical products, may cause side effects in some people. Most of these side
effects are minor, such as redness or swelling at the injection site. Read further to learn about
possible side effects from vaccines.

Any vaccine can cause side effects. For the most part these are minor (for example, a sore arm
or low-grade fever) and go away within a few days.

Remember, vaccines are continually monitored for safety, and like any medication, vaccines
can cause side effects. However, a decision not to immunize a child also involves risk and could
put the child and others who come into contact with him or her at risk of contracting a potentially
deadly disease.

How Well Do Vaccines Work?

Vaccines work really well. No medicine is perfect, of course, but most childhood vaccines
produce immunity about 90–100% of the time.

What about the argument made by some people that vaccines don’t work that well . . . that
diseases would be going away on their own because of better hygiene or sanitation, even if
there were no vaccines?

That simply isn’t true. Certainly better hygiene and sanitation can help prevent the spread of
disease, but the germs that cause disease will still be around, and as long as they are they will
continue to make people sick.

All vaccines must be licensed (approved) by the Food and Drug Administration (FDA) before
being used in the United States, and a vaccine must go through extensive testing to show that it
works and that it is safe before the FDA will approve it. Among these tests are clinical trials,
which compare groups of people who get a vaccine with groups of people who get a control. A
vaccine is approved only if FDA makes the determination that it is safe and effective for its
intended use.

If you look at the history of any vaccine-preventable disease, you will virtually always see that
the number of cases of disease starts to drop when a vaccine is licensed. Vaccines are the
most effective tool we have to prevent infectious diseases.

Prevention

Vaccines help the body’s immune system prepare for future attacks. Vaccines consist of killed
or modified microbes, parts of microbes, or microbial DNA that trick the body into thinking an
infection has occurred. A vaccinated person’s immune system attacks the harmless vaccine and
prepares for invasions against the kind of microbe the vaccine contained. In this way, the
person becomes immunized against the microbe: if re-exposure to the infectious microbe
occurs, the immune system will quickly recognize how to stop the infection.

This section explains more in detail about how your immune system works to prevent you from
getting sick. Knowing how your immune system works may help you understand how vaccines
work with your immune system to protect you.

What is the Immune System?

The immune system is a network of cells, tissues, and organs that work together to defend the
body against attacks by “foreign” invaders. These are primarily microbes—tiny organisms such
as bacteria, parasites, and fungi that can cause infections. Viruses also cause infections, but
are too primitive to be classified as living organisms. The human body provides an ideal
environment for many microbes. It is the immune system’s job to keep them out or, failing that,
to seek out and destroy them.

When the immune system hits the wrong target, however, it can unleash a torrent of disorders,
including allergic diseases, arthritis, and a form of diabetes. If the immune system is crippled,
other kinds of diseases result.

The immune system is amazingly complex. It can recognize and remember millions of different
enemies, and it can produce secretions (release of fluids) and cells to match up with and wipe
out nearly all of them.

The secret to its success is an elaborate and dynamic communications network. Millions and
millions of cells, organized into sets and subsets, gather like clouds of bees swarming around a
hive and pass information back and forth in response to an infection. Once immune cells receive
the alarm, they become activated and begin to produce powerful chemicals. These substances
allow the cells to regulate their own growth and behaviour, enlist other immune cells, and direct
the new recruits to trouble spots.

In addition, scientists are rapidly unravelling the genetic blueprints that direct the human
immune response, as well as those that dictate the biology of bacteria, viruses, and parasites.
The combination of new technology and expanded genetic information will no doubt reveal even
more about how the body protects itself from disease.

Mounting an Immune Response

Infections are the most common cause of human disease. They range from the common cold to
debilitating conditions like chronic hepatitis to life-threatening diseases such as AIDS. Disease-
causing microbes (pathogens) attempting to get into the body must first move past the body’s
external armour, usually the skin or cells lining the body’s internal passageways.

The skin provides an imposing barrier to invading microbes. It is generally penetrable only
through cuts or tiny abrasions. The digestive and respiratory tracts—both portals of entry for a
number of microbes—also have their own levels of protection. Microbes entering the nose often
cause the nasal surfaces to secrete more protective mucus, and attempts to enter the nose or
lungs can trigger a sneeze or cough reflex to force microbial invaders out of the respiratory
passageways. The stomach contains a strong acid that destroys many pathogens that are
swallowed with food.

If microbes survive the body’s front-line defences, they still have to find a way through the walls
of the digestive, respiratory, or urogenital passageways to the underlying cells. These
passageways are lined with tightly packed epithelial cells covered in a layer of mucus,
effectively blocking the transport of many pathogens into deeper cell layers.

Mucosal surfaces also secrete a special class of antibody called IgA, which in many cases is the
first type of antibody to encounter an invading microbe. Underneath the epithelial layer a variety
of immune cells, including macrophages, B cells, and T cells, lie in wait for any microbe that
might bypass the barriers at the surface.
Next, invaders must escape a series of general defences of the innate immune system, which
are ready to attack without regard for specific antigen markers. These include patrolling
phagocytes, natural killer T cells, and complement.

Microbes cross the general barriers then confront specific weapons of the adaptive immune
system tailored just for them. These specific weapons, which include both antibodies and T
cells, are equipped with singular receptor structures that allow them to recognize and interact
with their designated targets.

Immunity
Long ago, physicians realized that people who had recovered from the plague would never get it
again—they had acquired immunity. This is because some of the activated T and B cells had
become memory cells. Memory cells ensure that the next time a person meets up with the same
antigen, the immune system is already set to demolish it.

Immunity can be strong or weak, short-lived or long-lasting, depending on the type of antigen it
encounters, the amount of antigen, and the route by which the antigen enters the body.
Immunity can also be influenced by inherited genes. When faced with the same antigen, some
individuals will respond forcefully, others feebly, and some not at all.

An immune response can be sparked not only by infection but also by immunization with
vaccines. Some vaccines contain microorganisms—or parts of microorganisms— that have
been treated so they can provoke an immune response but not full-blown disease.

Immunity can also be transferred from one individual to another by injections of serum rich in
antibodies against a particular microbe (antiserum). For example, antiserum is sometimes given
to protect travellers to countries where hepatitis A is widespread. The antiserum induces
passive immunity against the hepatitis A virus. Passive immunity typically lasts only a few
weeks or months.

Vaccines

For many years, healthcare providers have used vaccination to help the body’s immune system
prepare for future attacks. Vaccines consist of killed or modified microbes, parts of microbes, or
microbial DNA that trick the body into thinking an infection has occurred.

A vaccinated person’s immune system attacks the harmless vaccine and prepares for invasions
against the kind of microbe the vaccine contained. In this way, the person becomes immunized
against the microbe. Vaccination remains one of the best ways to prevent infectious diseases,
and vaccines have an excellent safety record. Previously devastating diseases such as
smallpox, polio, and whooping cough (pertussis) have been greatly controlled or eliminated
through worldwide vaccination programs.
Recommended Vaccines for Young Adults

The transition to adulthood is an exciting time in a young person’s life. Starting a career, getting
an apartment, entering college, or joining the armed forces all offer unique rewards and
challenges.

Yet young adults may not know that some vaccines can make this transitional time a healthier
one.

Vaccines recommended for young adults ages 19–24 include:

 Meningococcal conjugate vaccine, which helps prevent meningococcal disease

 Tdap vaccine, which protects against tetanus, diphtheria, and pertussis (also known as
whooping cough)
 HPV vaccine, which protects against the viruses that cause most cervical cancers, anal
cancer, and genital warts
 Seasonal flu vaccine

There may be other vaccines recommended for young adults because their health, job, or
lifestyle may put them at higher risk for certain diseases. Young adults should talk to a doctor or
nurse to find out if there are other vaccines that they may need.

Teaching and Learning Activities

ACTIVITY 1

Watch a video: How Pandemics Spread and answer this question.

 Why are epidemics and pandemics a relatively recent phenomenon in human history?
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 ACTIVITY 2

1. Identify 10 Leading Causes of Death in the Philippines

I. _____________________________________________________________
II. _____________________________________________________________
III. _____________________________________________________________
IV. _____________________________________________________________
V. _____________________________________________________________
VI. _____________________________________________________________
VII. _____________________________________________________________
VIII. _____________________________________________________________
IX. _____________________________________________________________
X. _____________________________________________________________
.
2. Identify 10 Leading Causes of Injury

I. _____________________________________________________________
II. _____________________________________________________________
III. _____________________________________________________________
IV. _____________________________________________________________
V. _____________________________________________________________
VI. _____________________________________________________________
VII. _____________________________________________________________
VIII. _____________________________________________________________
IX. _____________________________________________________________
X. _____________________________________________________________
.

ACTIVITY 3

1. Test your knowledge about the causes and symptoms of COPD (Chronic Obstructive
Pulmonary Disease). Learn how the disease affects the lungs and how you can prevent its
complications.

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Recommended Learning Materials and Resources for
Supplementary Reading

 To learn more about how public health workers are improving the health of people
across the nation, take a look at these “6 Invaluable Ways Community Health
Workers Improve Our Lives.”

 Watch this video titled Living With and Managing Asthma.

This video—presented by the National Heart, Lung, and Blood Institute, part of the
National Institutes of Health—describes asthma, its signs and symptoms, and ways
to manage the disease.
 For more information about infectious diseases, see or listen to: What You Need to
Know About Infectious Diseases.

Flexible Teaching Learning Modality (FTLM)

adopted
Online (synchronous)
FB Messenger, google classroom, google meet
Remote (asynchronous)
Module

Assessment Task
 References

Source: Centers for Disease

Control, EXCITE, http://www.cdc.gov/excite/classroom/intro_epi.htm
The Chain of Infection Model: Health Education, Advocacy and Community Mobilization
Chapter, CC-BY-NC-SA, http://labspace.open.ac.uk/mod/oucontent/view.php?
id=452835&printable=1
Chronic Bronchitis: NIH, National Heart, Lung, and Blood Institute via MedlinePlus.gov
Emphysema: NIH, National Heart, Lung, and Blood Institute via MedlinePlus.gov
Diabetes: NIH: National Institute of Diabetes and Digestive and Kidney Diseases via
MedlinePlus
What are the most important things to do to prevent diabetes?: Prevent Diabetes, Centers
for Disease Control, http://www.cdc.gov/diabetes/consumer/prevent.htm
Headache: NIH: National Institute of Neurological Disorders and Stroke via MedlinePlus.gov
Arthritis: NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases via
MedlinePlus.gov
Skin Disorders: Skin Disorders, National Institute of Arthritis and Musculoskeletal and Skin
Disease, NIH, http://www.nlm.nih.gov/medlineplus/skinconditions.html
Neurological Disorders: Neurological Disorders, NLM,
NIH, http://www.nlm.nih.gov/medlineplus/neurologicdiseases.html
Huntington’s Disease: Huntington’s Disease, NIH, National Institute of Neurological
Disorders and Stroke, http://www.nlm.nih.gov/medlineplus/huntingtonsdisease.html
Muscular Dystrophy: NIH: National Institute of Neurological Disorders and Stroke via
MedlinePlus.gov
Spina Bifida: NIH: National Institute of Neurological Disorders and Stroke via MedlinePlus.gov
Parkinson’s Disease: MedlinePlus.gov
Spinal Cord Injury: MedlinePlus.gov
Epilepsy: NIH: National Institute of Neurological Disorders and Stroke via MedlinePlus.gov
Meningitis: NIH: National Institute of Neurological Disorders and Stroke via MedlinePlus.gov
Introduction: NIH: National Institute of Allergy and Infectious Diseases,
MedlinePlus, http://www.nlm.nih.gov/medlineplus/infectiousdiseases.html
Strep Throat: NIH: National Institute of Allergy and Infectious Diseases via MedlinePlus.gov
Viral Infections: NLM, NIH via MedlinePlus.gov
Influenza: NIH: National Institute of Allergy and Infectious Diseases via MedlinePlus.gov
Hepatitis B: NIH: National Institute of Diabetes and Digestive and Kidney Diseases via
MedlinePlus.gov
Infectious mononucleosis: MedlinePlus.gov
Fungi: MedlinePlus.gov
Yeast Infections (or Candida): MedlinePlus.gov
Parasitic Diseases: National Library of Medicine, National Institutes for Health via
MedlinePlus.gov
Pneumonia: MedlinePlus.gov
Defining Health Disparities: Centers for Disease Control and
Prevention, http://www.cdc.gov/nchhstp/healthdisparities/
Source: OpenStax College, Introduction to Health and Medicine, Connexions, May 18,
2012. http://cnx.org/content/m43019/1.2/
Immunity and Immunizations: National Institute of Allergy and Infectious Diseases via
MedlinePlus.gov
Vaccines: Vaccines, US Dept. of Health and Human Services, http://www.vaccines.gov
Vaccines: National Institute of Allergy Infectious Diseases
Recommended Vaccines for Young Adults: College,
CDC, http://www.cdc.gov/vaccines/spec-grps/college.htm