What is the management and treatment approach for communicable diseases?

Management and Treatment of Communicable Diseases

For highly pathogenic communicable diseases with human-to-human transmission capability, immediately admit patients to a High-Level Isolation Unit (HLIU) with strict airborne precautions, including negative pressure rooms and N95/FFP2 respirators for all healthcare workers. 1

Risk Stratification and Admission Criteria

Admit to HLIU if:

• Patient has unknown human-to-human transmittable or potentially transmittable epidemic febrile illness (native or imported) 1
• Patient has known infection caused by group 3 or 4 agents (group 4 agents cause serious disease with ready human-to-human transmission and lack effective treatment; group 3 agents cause serious disease but don't ordinarily spread person-to-person) 1
• Mortality exceeds 30% for the pathogen (e.g., extensively drug-resistant tuberculosis) 1

Infection Control Measures - The Foundation of Management

Standard precautions must include: 1

• Hand hygiene
• Personal protective equipment (gowns, gloves, eye protection)
• Prevention of needlestick injuries
• Environmental cleaning
• Appropriate waste handling

Upgrade to airborne precautions for suspected highly infectious diseases: 1

• Single monitored negative-pressure room with closed door
• N95 or FFP2 masks for all healthcare workers
• Surgical mask on patient if transport is essential (minimize movement)
• Maintain dedicated route with direct access in emergency departments

Critical caveat: Because modes of transmission are often underestimated (as seen with influenza), upgrade droplet precautions to airborne precautions whenever involvement of highly infectious agents is suspected. 1

Emergency Department Management

Implement these measures immediately: 1

• Apply standard precautions and respiratory etiquette systematically
• Designate at least one single isolation room with dedicated route
• Provide special training to emergency department teams
• Perform chest radiography separately from other patients
• Examine sputum for acid-fast bacteria when pneumonia is diagnosed to rule out tuberculosis
• Keep patient isolated until tuberculosis threat is eliminated

Laboratory Sampling and Testing

Follow strict biosafety protocols: 1

• Perform all sampling in the isolation room or HLIU
• Use point-of-care bedside tests when possible
• Conduct analyses in biosafety level 3/4 laboratory if point-of-care unavailable
• Once inactivated with formalin, samples can go to routine laboratory

Intensive Care Management for Severe Disease

When critical care is needed: 1

• Provide intensive care within the HLIU in collaboration with infectious disease team (HLIU should be pre-equipped for critical care) 1
• If ICU transfer necessary, subject the unit to negative pressure 1
• Minimize manual ventilation duration during resuscitation 1
• Use non-invasive positive pressure ventilation instead of facial mask aerosol therapy when possible 1
• Perform endotracheal intubation with rapid sequence induction by most skilled person available wearing full PPE 1
• Follow meticulous infection control during suctioning, tracheotomy, and bronchoscopy 1

Specific Disease Management

For influenza treatment and prophylaxis:

• Begin oseltamivir within 48 hours of symptom onset for treatment 2
• Use oseltamivir 75 mg once daily for post-exposure prophylaxis in household contacts for 7 days 2
• For pediatric patients 1-12 years: dose 30-60 mg once daily for 10 days prophylaxis 2

For Rift Valley Fever (high mortality 20-50% in severe disease): 3

• Manage in HLIU with negative pressure and full airborne precautions 3
• Provide intensive care within HLIU if possible 3
• Manage fluid and electrolyte imbalances carefully 3
• Consider early renal replacement therapy for acute kidney injury 3
• Poor prognostic factors include hypotension, shock, renal failure, severe hemorrhage, coma, and seizures 3

Pediatric Considerations

Special protocols for children: 1

• Admit all children suspected of HID to HLIU for infection control
• Minimize family participation during acute phase
• Ensure HLIU is prepared to provide age-appropriate nursing care

Public Health Reporting

Mandatory surveillance and reporting: 1, 3

• Report all suspected and confirmed cases to national public health authorities immediately
• Maintain prompt health-care personnel surveillance

Prevention Strategies

Primary prevention through vaccination: 1

• Implement immunization programs according to ACIP recommendations
• Maintain updated vaccination schedules for healthcare workers 1
• Note: Live attenuated influenza vaccine should not be given within 2 weeks before or 48 hours after oseltamivir administration 2

Workplace and community measures: 4

• Promote proper hand hygiene
• Clean and sanitize work areas
• Encourage sick individuals to stay home
• Implement social distancing when appropriate
• Use personal protective equipment

Common pitfall: Do not rely on publication of guidelines alone for behavior change - specific educational interventions and continuing medical education have greater probability of effectiveness. 1