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The clinical features due to various causative agents may overlap and may even be atypical
Following is a list of commonly seen clinical features associated with different agents.
Also, the general principles of diarrhea management are similar for most causative agents.
CLINICAL FEATURES: CHOLERA
• Rice-watery stool
• Marked dehydration
• Projectile vomiting
• No fever or abdominal pain
• Muscle cramps
• Hypovolemic shock
• Scanty urine
CLINICAL FEATURES: E. COLI (ETEC) DIARRHEA

Reference:
K. Park, 2019. Epidemiology of Communicable Diseases, In: Park’s Textbook of Preventive and Social Medicine, 25th ed. Jabalpur, 2019

• Major killer of under 5 children, even though the toll has reduced considerably
– 10% of under-5 deaths in India
– Reduction of mortality mainly due to rehydration tech including ORS
• Under 5 children are estimated to have 3 episodes per year
– Incidence hasn’t changed much but mortality is reduced considerably
– Loss of considerable number of DALYs
• Leading cause of death during disasters and emergencies

As on 23rd March 2020
When to use a mask
• If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.
• Wear a mask if you are coughing or sneezing.
• Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
• If you wear a mask, then you must know how to use it and dispose of it properly.

As on 22nd March 22, 2020
COVID-19 virus can be transmitted in areas with hot and humid climates

Mission Indradhanush
The percentage of children, who are fully immunized (FIC), was found to be only 65% in 2013-14. This was despite the Universal Immunization Program (UIP) running since 1985 and Expanded Program on immunization (EPI) since 1978.
Mission Indradhanush was launched in December 2014 to:
• Actively achieve full immunization of 90 percent by 2020 and
• Simultaneously to boost the Routine Immunization (RI) infrastructure in the country

A student is often tempted to quickly move on to examination after listening to the presenting complaints.
Clinical history taking should not be taken lightly.
A logically taken history will give rise to a list of probable diagnoses in your mind by identifying patterns of symptoms even before you proceed on to the examination.
Systematically taken history will guide you to:
• Look especially for signs for confirming or ruling out certain disorders upon physical examination and

Rat control measures:
1. Sanitation
2. Trapping: Bait is used. Causes temporary reduction in numbers.
Captured rats must be killed as they become “trap-wise” and avoid traps later

1. Mechanical: infectious agent is mechanically transported through soiling of vector’s feet or proboscis or by passage through its gastrointestinal tract. for example spread of e coli by housefly
2. Biological:
a. Propogative: infectious agent merely multiplies inside the vector e.g. plague in rat flea
b. Cyclo-propogative: agent changes in number and also in form e.g. malaria parasites in mosquito
c. Cyclo-developmental : the disease agent undergoes only development but no multiplication e.g. microfilaria in mosquito

Reference:
K. Park, 2019. Environment and Health, In: Park’s Textbook of Preventive and Social Medicine, 25th ed. Jabalpur, 2019