Water-borne diseases: classification and prevention/control. 2. Enumerate the diseases covered under National Vector Borne Diseases Control Programme. 3. Write strategies of prevention and control either for malaria or dengue fever.. Give me the answer of above three questions from the K Park standard book of PSM Community Medicine MBBS for my university exam to write in theory exam for the exam point of view.
Answers from K Park's Textbook of Preventive and Social Medicine (PSM)
Q.1 - Water-Borne Diseases: Classification and Prevention/Control
Definition
CLASSIFICATION OF WATER-RELATED DISEASES
A. Biological (Water-Borne Diseases)
| Category | Diseases |
|---|---|
| (a) Viral | Viral hepatitis A, Hepatitis E, Poliomyelitis, Rotavirus diarrhoea in infants |
| (b) Bacterial | Typhoid and paratyphoid fever, Bacillary dysentery, E. coli diarrhoea, Cholera |
| (c) Protozoal | Amoebiasis, Giardiasis |
| (d) Helminthic | Roundworm, Threadworm, Hydatid disease |
| (e) Leptospiral | Weil's disease |
| Host | Diseases |
|---|---|
| (a) Snail | Schistosomiasis |
| (b) Cyclops | Guineaworm, Fish tapeworm |
B. Chemical
- (a) Dental health: Fluoride at ~1 mg/litre protects against dental caries; high levels cause mottling of dental enamel (fluorosis)
- (b) Cyanosis in infants: High nitrate content causes methaemoglobinaemia
- (c) Cardiovascular diseases: Hardness of water appears to have a beneficial protective effect
C. Water-Washed Diseases (due to inadequate use/quantity of water)
- Shigellosis, Trachoma, Conjunctivitis, Ascariasis, Scabies
D. Water-Based/Water-Related Insect Vector Diseases
- Malaria, Filaria, Arboviruses (dengue, JE), Onchocerciasis, African trypanosomiasis - related to disease-carrying insects breeding in or near water
PREVENTION AND CONTROL OF WATER-BORNE DISEASES
- Purification of water on a large scale: sedimentation, filtration (slow sand/rapid sand filter), disinfection (chlorination)
- Residual chlorine: 0.5 mg/litre after 1 hour contact is standard
- Purification on small scale: boiling, chemical disinfection (bleaching powder, chlorine tablets), household filters
- Proper sanitation and sewage disposal to prevent faeco-oral contamination of water sources
- Preventing contamination of food and drinks through safe food handling practices
- Handwashing, safe storage of drinking water in the home
- Informing the community about safe water practices, hygiene, and disease transmission
- Monitoring outbreaks of water-borne diseases; investigating source of contamination promptly
- Water (Prevention and Control of Pollution) Act, 1974 in India provides for Central and State Water Boards with wide powers for controlling water pollution
- Source protection: prevention of contamination of water sources at origin
- Water conservation: rainwater harvesting, preventing wastage
Q.2 - Diseases Covered Under the National Vector Borne Diseases Control Programme (NVBDCP)
About NVBDCP
Diseases Covered Under NVBDCP
| S.No. | Disease | Vector |
|---|---|---|
| 1. | Malaria | Female Anopheles mosquito |
| 2. | Filariasis (Lymphatic filariasis) | Culex mosquito |
| 3. | Kala-azar (Visceral Leishmaniasis) | Sandfly (Phlebotomus) |
| 4. | Japanese Encephalitis (JE) | Culex mosquito |
| 5. | Dengue / Dengue Haemorrhagic Fever (DHF) | Aedes aegypti mosquito |
| 6. | Chikungunya | Aedes aegypti / Aedes albopictus |
Three-Pronged Strategy of NVBDCP
Q.3 - Strategies of Prevention and Control of Malaria
(a) Surveillance and Case Management
- Case detection - Both passive (patient presenting to health facility) and active case detection (house-to-house survey in endemic/epidemic areas)
- Early diagnosis and complete treatment:
- All fever cases diagnosed as malaria by microscopy or Rapid Diagnostic Test (RDT) should promptly be given effective treatment
- Aims at: complete cure; prevention of progression to severe disease; prevention of deaths; interruption of transmission; minimizing risk of drug resistance
- Sentinel surveillance - 521 sentinel surveillance hospitals with laboratory support identified in endemic states; 14 Apex Referral Laboratories linked with sentinel hospitals; IgM capture ELISA kits provided by National Institute of Virology, Pune
(b) Integrated Vector Management (IVM)
-
Indoor Residual Spray (IRS)
- Spraying of insecticides (DDT, Malathion, synthetic pyrethroids) on inner walls and ceilings of houses
- Effective in areas with endophilic (indoor-resting) vectors
-
Insecticide Treated Bed-Nets (ITNs) and Long Lasting Insecticidal Nets (LLINs)
- Mass distribution of LLINs in high-burden districts
- Provide personal protection and kill/repel mosquitoes
-
Anti-larval measures including source reduction
- Biological control: use of larvivorous fish (Gambusia, Lebistes) in water bodies
- Chemical larviciding: temephos (Abate)
- Source reduction: eliminating or draining mosquito breeding sites
- Environmental engineering: proper drainage, preventing stagnant water collection
(c) Epidemic Preparedness and Early Response
- Rapid response to outbreaks
- Epidemic action plans at district and state level
- Contingency grants to meet operational costs
- Media management during outbreaks
(d) Supportive Interventions
- Capacity building - Training health workers at all levels; ASHA (Accredited Social Health Activists) trained as Fever Treatment Depots (FTDs) for RDT and early treatment in villages
- Behavioural Change Communication (BCC) - IEC (Information, Education, Communication) activities; promoting use of bed-nets, early treatment-seeking, and environmental measures
- Inter-sectoral collaboration - Coordination with ministries of water resources, urban development, agriculture, etc.
- Monitoring and Evaluation - Periodic review, field visits, web-based Management Information System (MIS)
- Operational research - Studies on drug resistance and insecticide susceptibility
Drug Treatment Policy (Revised 2013)
| Species | Treatment |
|---|---|
| P. vivax | Chloroquine 25 mg/kg over 3 days + Primaquine 0.25 mg/kg/day for 14 days (to prevent relapse) |
| P. falciparum | ACT (Artesunate 3 days + Sulfadoxine-Pyrimethamine 1 day) + single dose Primaquine (0.75 mg/kg) on Day 2 |
| P. falciparum in North-East | Artemether-Lumefantrine (due to SP resistance) |
| Malaria in Pregnancy - 1st trimester | Quinine (for P. falciparum); Chloroquine (for P. vivax); Primaquine contraindicated |
| Malaria in Pregnancy - 2nd/3rd trimester | ACT for P. falciparum; Chloroquine for P. vivax |
Global Technical Strategy for Malaria (WHO, 2016-2030)
- Pillar 1: Ensure universal access to malaria prevention, diagnosis and treatment
- Pillar 2: Accelerate efforts towards elimination and attainment of malaria-free status
- Pillar 3: Transform malaria surveillance into a core intervention
Source: Park's Textbook of Preventive and Social Medicine, 25th Edition - Chapters on Water Supply & Sanitation, National Health Programmes (NVBDCP), and Communicable Diseases (Malaria, Dengue).
STYLE GOAL: Design the notes like premium handcrafted digital study notes on a clean A4 white page in portrait orientation. The page should look polished, minimal, neat, and easy to revise in one glance. Use a handwritten-but-very-legible academic note style, with strong visual hierarchy and lots of white space. The final output should feel like topper-style revision notes, not like a textbook page. VISUAL DESIGN: - Background: clean matte white paper, slightly warm white, smooth texture, no ruled lines. - Page format: A4 portrait, centered composition, equal margins on all sides. - Main title: very large uppercase deep royal blue heading, centered, bold, clean, marker-style handwritten look. - Subtitle strip: place a pale pastel yellow highlight bar below the main title; write a short exam-oriented subtitle in black uppercase text. - Section headings: use dark red or brick red color, numbered clearly (1., 2., 3., etc.), slightly larger than body text. - Body text: use neat black or very dark charcoal handwritten font, highly readable, medium-small size, consistent line spacing. - Keywords: highlight important terms in blue or underline them in blue. - Special emphasis: use red for critical labels, blue for keywords, black for explanations, pale yellow for highlight strips, and thin grey/red borders for boxes and tables. - Boxes: use thin rounded rectangular boxes for definitions, essential points, limitations, examples, and summary sections. - Tables: create clean ruled tables with thin lines, proper alignment, and enough spacing so they do not look cramped. - Overall aesthetic: elegant, tidy, minimal, academic, handwritten digital note design, no clutter, no excessive decoration. FONT DIRECTION: - Main title font style: marker-like uppercase handwritten font, similar to a clean medical revision poster heading. - Section heading font style: neat semi-bold handwritten uppercase or small caps. - Body font style: smooth monoline handwritten font, highly readable, similar to neat topper notes. - If exact fonts are needed, use close digital alternatives such as: - Title: Marker Felt / Balsamiq Sans Bold / Permanent Marker (clean version) - Section headings: Nunito Sans SemiBold / Kalam Bold / Patrick Hand Bold - Body text: Patrick Hand / Kalam Regular / Comic Neue / Segoe Print (clean and readable) - Do not use cursive calligraphy, fancy decorative fonts, or overly childish handwriting. LAYOUT STRUCTURE: For the given topic, convert the content into a highly structured revision page using sections such as: 1. Definition 2. Core concept / introduction 3. Important classifications or components 4. Essential requirements / criteria 5. Tables for comparison where useful 6. Applications / examples / case relevance 7. Limitations / exceptions / precautions 8. Importance / public health significance 9. Must write in exam 10. Key words / quick recall box CONTENT RULES: - Rewrite the SOURCE CONTENT into concise, accurate, exam-oriented notes for MBBS PSM. - Keep all medically important and university-relevant points. - Simplify long paragraphs into compact bullet points. - Convert dense theory into short definitions, subheadings, tables, arrows, and high-yield summary blocks. - Preserve factual accuracy; do not invent medical facts. - Keep standard textbook terminology where important. - Include national program names, definitions, formulas, indicators, epidemiological terms, and prevention levels whenever relevant. - If the topic contains comparisons, convert them into tables. - If the topic contains steps or hierarchy, convert them into flow-style bullet sequencing. - If the topic contains lists, cluster them into exam-friendly groups. - Add a “Must Write in Exam” section with the most scoring points. - Add a “Key Words” mini box for rapid last-minute revision. - Make it useful for fast revision before MBBS exams. - The notes should reduce reading load while still covering the chapter’s high-yield content. PSM-SPECIFIC PREFERENCES: - Prioritize definitions, epidemiology, concept clarity, indices, preventive measures, national health programs, screening, levels of prevention, risk factors, indicators, important acts/policies, and community application. - Use public health language appropriate for MBBS students. - Keep the tone academic but concise. - Where possible, organize content as: - definition - significance - causes / determinants - indicators / criteria - prevention / control - programmatic relevance - exam points QUALITY CONTROL: - Make the page visually balanced and not overcrowded. - Keep spacing even between sections. - Align boxes and tables neatly. - Ensure handwriting is very legible. - Make the result look clean enough to print or save as final revision notes. - Avoid messy strokes, uneven alignment, dark shadows, random doodles, or overcrowded text. - Avoid textbook screenshot appearance. - Avoid paragraph-heavy blocks. - Avoid too many colors; stay within blue, red, black, grey, and pale yellow pastel tones. OUTPUT INTENT: Generate final notes that look like premium handwritten digital revision notes made by a top MBBS student for Community Medicine / PSM exam preparation. TOPIC: [Dengue]
mkdir -p /home/daytona/workspace/dengue-notes && ls /home/daytona/workspace/dengue-notes/
~/dengue-notes/dengue_notes.html
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<div class="page">
<!-- ===== HEADER ===== -->
<div class="main-title">DENGUE FEVER</div>
<div class="subtitle-bar">
<span>Communicable Diseases | Community Medicine / PSM | MBBS Revision Notes</span>
</div>
<div class="source-tag">Source: K. Park — Textbook of Preventive & Social Medicine | NVBDCP Chapter</div>
<!-- ===== 1. DEFINITION ===== -->
<div class="section-heading"><span class="section-num">1</span> Definition & Introduction</div>
<div class="def-box">
<div class="def-label">Definition</div>
<div class="body-text"><span class="kw">Dengue</span> is an <span class="kw">arboviral</span> infection caused by <span class="kw">dengue virus</span> (genus <span class="kw">Flavivirus</span>), transmitted to humans by the bite of infected <span class="red">Aedes aegypti</span> (primary) and <span class="kw">Aedes albopictus</span> mosquitoes. Infection may be asymptomatic or present as classical dengue fever, dengue haemorrhagic fever (DHF), or dengue shock syndrome (DSS).</div>
</div>
<div class="two-col" style="margin-top:6px;">
<div class="col-box">
<div class="col-title">🌍 Global Burden</div>
<ul class="note-list">
<li><span class="kw">3.9 billion</span> people at risk in <span class="kw">128 countries</span></li>
<li><span class="kw">390 million</span> infections/year; <span class="kw">96 million</span> manifest clinically</li>
<li>Cases rose from <0.5M (2010) → <span class="kw">4.2M (2019)</span></li>
<li>90% hospitalizations: <span class="red">children <5 years</span></li>
<li>CFR during epidemics: <span class="red">~2.5%</span></li>
</ul>
</div>
<div class="col-box">
<div class="col-title">🇮🇳 India</div>
<ul class="note-list">
<li>Endemic in <span class="kw">35 states/UTs</span></li>
<li>2019: <span class="kw">157,996 cases</span>, <span class="red">253 deaths</span>; CFR = 0.1%</li>
<li><span class="kw">Serotypes</span> 1, 2, 3, 4 isolated; DENV-1 & DENV-2 widespread</li>
<li>Peak: <span class="kw">post-monsoon season</span></li>
<li>Southern states & Gujarat: <span class="kw">perennial transmission</span></li>
<li>India = <span class="hl">Category A</span> (WHO-SEARO)</li>
</ul>
</div>
</div>
<!-- ===== 2. EPIDEMIOLOGICAL DETERMINANTS ===== -->
<div class="section-heading"><span class="section-num">2</span> Epidemiological Determinants (Agent–Host–Environment)</div>
<table class="note-table">
<tr>
<th style="width:18%">Factor</th>
<th>Key Points</th>
</tr>
<tr>
<td class="td-red">Agent</td>
<td><span class="kw">Dengue virus</span> — genus Flavivirus, family Flaviviridae. <span class="kw">4 serotypes</span>: DENV-1, 2, 3, 4. RNA virus. Immunity is serotype-specific; secondary infection with different serotype → <span class="red">severe DHF/DSS</span>. DENV-1/DENV-2 sequence = <span class="red">500-fold</span> risk of DHF.</td>
</tr>
<tr>
<td class="td-blue">Vector</td>
<td><span class="kw">Aedes aegypti</span> (principal) + Aedes albopictus. Day-biting, breeds in <span class="kw">clean stagnant water</span> (containers, flower pots, tyres, overhead tanks). <span class="red">Incubation in mosquito (extrinsic): 8–10 days</span>. Feeds multiple times per gonotrophic cycle.</td>
</tr>
<tr>
<td class="td-red">Host</td>
<td>Humans are primary amplifying host. <span class="kw">Intrinsic incubation: 4–6 days</span> (range 3–14 days). High-risk groups: <span class="kw">infants, elderly, obese, pregnant, peptic ulcer, women in menstruation, haemolytic conditions, congenital deficiencies</span>. Only 2–4% develop severe disease on secondary infection.</td>
</tr>
<tr>
<td class="td-blue">Environment</td>
<td>Urban & semi-urban areas predominantly. Rapid urbanization, poor water storage = mosquito breeding proliferation. Tropical & subtropical regions. Seasonal — <span class="kw">monsoon and post-monsoon peak</span>.</td>
</tr>
</table>
<!-- ===== 3. CLASSIFICATION / CLINICAL SPECTRUM ===== -->
<div class="section-heading"><span class="section-num">3</span> Classification — Dengue Virus Infection (WHO)</div>
<div class="info-box">
<div class="info-label">Iceberg / Pyramid Phenomenon — DF/DHF/DSS</div>
<div class="body-text" style="text-align:center; font-size:13px;">
<span class="kw">Asymptomatic</span> (base — majority)
<span class="arrow">▲</span>
<span class="kw">Classical Dengue Fever (DF)</span>
<span class="arrow">▲</span>
<span class="red">DHF (Grade I–II)</span>
<span class="arrow">▲</span>
<span class="red">DSS (Grade III–IV)</span> (apex — minority)
</div>
</div>
<table class="note-table" style="margin-top:6px;">
<tr>
<th style="width:20%">Type</th>
<th>Features</th>
<th style="width:22%">Key Finding</th>
</tr>
<tr>
<td class="td-blue">1. Classical DF</td>
<td>Sudden high fever (39–40°C), severe headache, retro-orbital pain, myalgia, arthralgia ("break-bone fever"), maculopapular rash (80% cases), biphasic fever curve, self-limiting ~5–7 days</td>
<td>Rash on 3rd–4th day; low CFR</td>
</tr>
<tr>
<td class="td-red">2. DHF</td>
<td>Severe form. Three phases: <span class="kw">Febrile → Critical → Recovery</span>. Plasma leakage (haemoconcentration), thrombocytopenia (<100,000/cu.mm), haemorrhagic manifestations (positive tourniquet test), hepatomegaly</td>
<td><span class="red">Thrombocytopenia + Haemoconcentration</span> (≥20% rise in haematocrit)</td>
</tr>
<tr>
<td class="td-red">3. DSS</td>
<td>DHF + <span class="kw">circulatory failure</span> (cold clammy skin, rapid weak pulse, narrow pulse pressure <20 mmHg or hypotension, restlessness)</td>
<td>Most severe; highest CFR</td>
</tr>
<tr>
<td class="td-blue">4. Severe Dengue</td>
<td>Severe plasma leakage → shock; severe bleeding; severe organ impairment (liver, CNS, kidneys, heart)</td>
<td>WHO 2009 classification</td>
</tr>
</table>
<div class="two-col" style="margin-top:8px;">
<div class="col-box">
<div class="col-title">WHO Grading of DHF (Grades I–IV)</div>
<ul class="note-list">
<li><span class="kw">Grade I:</span> Fever + positive tourniquet test + thrombocytopenia</li>
<li><span class="kw">Grade II:</span> Grade I + spontaneous bleeding (skin/other sites)</li>
<li><span class="red">Grade III:</span> Circulatory failure — narrow pulse pressure, hypotension</li>
<li><span class="red">Grade IV (DSS):</span> Profound shock — undetectable BP and pulse</li>
</ul>
</div>
<div class="col-box">
<div class="col-title">Warning Signs (must recognise)</div>
<ul class="note-list">
<li>Severe abdominal pain</li>
<li>Persistent vomiting</li>
<li>Rapid breathing / respiratory distress</li>
<li>Bleeding from gums / nose</li>
<li>Blood in vomit / stools (black)</li>
<li>Fatigue, restlessness, cold extremities</li>
<li>No urine output for <span class="red">> 4–6 hours</span></li>
</ul>
</div>
</div>
<hr class="divider">
<!-- ===== 4. DIAGNOSIS ===== -->
<div class="section-heading"><span class="section-num">4</span> Diagnosis</div>
<table class="note-table">
<tr>
<th>Test</th>
<th>When Useful</th>
<th>Note</th>
</tr>
<tr>
<td class="td-blue">NS1 Antigen ELISA</td>
<td><span class="kw">Day 1 onwards</span> (early viraemia)</td>
<td>High sensitivity in first 3–5 days</td>
</tr>
<tr>
<td class="td-blue">IgM capture ELISA (MAC-ELISA)</td>
<td><span class="kw">After Day 5</span> of illness</td>
<td>Standard confirmatory test; kits provided by <span class="kw">NIV, Pune</span> free of cost</td>
</tr>
<tr>
<td class="td-red">Haematocrit</td>
<td>Serial monitoring from Day 3</td>
<td>≥20% rise → plasma leakage (DHF); Done daily till fever-free for 1–2 days</td>
</tr>
<tr>
<td>Platelet count</td>
<td>Daily in suspected DHF</td>
<td><100,000 = DHF; Transfuse prophylactically at <10,000; or if massive bleeding</td>
</tr>
<tr>
<td>Tourniquet test</td>
<td>Grade I DHF</td>
<td>≥10–20 petechiae per 2.5 cm² = positive <span class="badge">Grade I criteria</span></td>
</tr>
</table>
<div class="info-box" style="margin-top:6px;">
<div class="info-label">Sentinel Surveillance Infrastructure (India)</div>
<ul class="note-list">
<li><span class="kw">521 Sentinel Surveillance Hospitals</span> with lab support in endemic states</li>
<li><span class="kw">14 Apex Referral Laboratories</span> linked to sentinel hospitals</li>
<li>IgM capture ELISA kits provided by <span class="kw">National Institute of Virology (NIV), Pune</span> — free</li>
<li>Contingency grants provided for operational costs</li>
</ul>
</div>
<hr class="divider">
<!-- ===== 5. TREATMENT ===== -->
<div class="section-heading"><span class="section-num">5</span> Management (Supportive — No Specific Antiviral)</div>
<div class="two-col">
<div class="col-box">
<div class="col-title">Dengue Fever (DF)</div>
<ul class="note-list">
<li><span class="kw">Oral fluids</span> — ORS, fruit juice, electrolytes</li>
<li><span class="kw">Paracetamol</span> for fever — interval ≥ 6 hrs</li>
<li><span class="red">Avoid: Aspirin, Ibuprofen, NSAIDs</span> (↑ gastritis, bleeding, Reye's syndrome)</li>
<li>Monitor: urine output, fever, platelet, haematocrit</li>
<li>Discharge if: afebrile ≥24h, appetite returns, platelet >50,000, good urine output</li>
</ul>
</div>
<div class="col-box">
<div class="col-title">DHF / DSS</div>
<ul class="note-list">
<li>Febrile phase: same as DF + IV fluids if vomiting</li>
<li><span class="kw">Critical phase:</span> IV fluid resuscitation (Ringer's Lactate/NS) based on haematocrit</li>
<li>Treat shock: rapid fluid replacement algorithms (Grade III/IV)</li>
<li>Platelet transfusion: <10,000/cu.mm or active bleeding</li>
<li><span class="red">NO steroids, NO antibiotics routinely</span></li>
</ul>
</div>
</div>
<hr class="divider">
<!-- ===== 6. PREVENTION AND CONTROL ===== -->
<div class="section-heading"><span class="section-num">6</span> Prevention & Control (GOI Mid-Term Plan 2011)</div>
<div class="three-col">
<div class="col-box">
<div class="col-title" style="color:#b52b1e;">(a) Surveillance</div>
<ul class="note-list">
<li>Disease surveillance (case reporting)</li>
<li>Entomological surveillance (Breteau Index, House Index)</li>
<li>Outbreak identification & demarcation</li>
</ul>
</div>
<div class="col-box">
<div class="col-title" style="color:#b52b1e;">(b) Case Management</div>
<ul class="note-list">
<li>Lab diagnosis (NS1, IgM ELISA)</li>
<li>Clinical management per GOI guidelines</li>
<li>Early referral; hospital preparedness</li>
</ul>
</div>
<div class="col-box">
<div class="col-title" style="color:#b52b1e;">(c) Vector Management</div>
<ul class="note-list">
<li>Environmental (source reduction)</li>
<li>Chemical control (larviciding)</li>
<li>Personal protection</li>
<li>Legislation</li>
</ul>
</div>
</div>
<div class="three-col" style="margin-top:8px;">
<div class="col-box">
<div class="col-title" style="color:#1a3a8c;">(d) Outbreak Response</div>
<ul class="note-list">
<li>Epidemic preparedness</li>
<li>Rapid response teams</li>
<li>Media management</li>
</ul>
</div>
<div class="col-box">
<div class="col-title" style="color:#1a3a8c;">(e) Capacity Building</div>
<ul class="note-list">
<li>Training of health workers</li>
<li>Strengthening HR</li>
<li>Operational research</li>
</ul>
</div>
<div class="col-box">
<div class="col-title" style="color:#1a3a8c;">(f) BCC & IEC</div>
<ul class="note-list">
<li>Social mobilization</li>
<li>IEC activities (do's & don'ts)</li>
<li>Inter-sectoral coordination</li>
</ul>
</div>
</div>
<!-- Vector Control Box -->
<div class="info-box" style="margin-top:8px;">
<div class="info-label">Vector Control Measures (Aedes aegypti)</div>
<div class="two-col" style="margin-top:4px; gap:8px;">
<div>
<div class="body-text" style="font-size:12.5px;"><span class="red">Anti-larval (Source Reduction):</span></div>
<ul class="note-list">
<li>Weekly dry day — empty, clean & dry all water containers</li>
<li>Cover overhead tanks, water storage</li>
<li>Proper disposal of tyres, flower pots, coconut shells</li>
<li>Abatization (Temephos in water containers)</li>
<li>Biological: <span class="kw">Gambusia / Lebistes</span> fish</li>
</ul>
</div>
<div>
<div class="body-text" style="font-size:12.5px;"><span class="red">Anti-adult & Personal Protection:</span></div>
<ul class="note-list">
<li>Space spraying (pyrethrum/malathion) during outbreaks</li>
<li>Full sleeves clothing, repellents (DEET creams/coils)</li>
<li>Bed-nets during daytime for infants</li>
<li>Isolation under bed-net during viraemia</li>
<li>Detection & elimination of roof-tops, sunshade stagnation</li>
</ul>
</div>
</div>
</div>
<!-- ===== 7. VACCINE ===== -->
<div class="section-heading"><span class="section-num">7</span> Vaccine</div>
<div class="hl-box">
<div class="hl-label">CYD-TDV (Dengvaxia) — Sanofi Pasteur, 2015</div>
<ul class="note-list">
<li>Tetravalent, live attenuated recombinant vaccine</li>
<li>Schedule: <span class="kw">3 doses × 0.5 mL at 0, 6, 12 months</span></li>
<li>Approved for ages <span class="kw">9–45 years</span> in endemic countries</li>
<li><span class="red">Contraindicated:</span> immunocompromised, pregnancy/breastfeeding, moderate-severe acute febrile illness</li>
<li><span class="red">WHO Caution (2018):</span> Recommended only in <span class="kw">seropositive individuals</span> (prior dengue infection confirmed) — risk of severe dengue in seronegatives</li>
</ul>
</div>
<!-- ===== 8. GLOBAL STRATEGY ===== -->
<div class="section-heading"><span class="section-num">8</span> Global Strategy for Dengue Prevention & Control (WHO 2012–2020)</div>
<div class="two-col">
<div class="col-box">
<div class="col-title">Goals by 2020</div>
<ul class="note-list">
<li>Reduce dengue <span class="kw">mortality by ≥50%</span></li>
<li>Reduce dengue <span class="kw">morbidity by ≥25%</span></li>
<li>Estimate true burden of disease by 2015</li>
</ul>
</div>
<div class="col-box">
<div class="col-title">Strategy — 5 Pillars</div>
<ul class="note-list">
<li>Diagnosis & case management</li>
<li>Integrated surveillance & outbreak response</li>
<li>Sustainable vector control</li>
<li>Implementation of future vaccines</li>
<li>Basic, operational & implementation research</li>
</ul>
</div>
</div>
<!-- ===== MUST WRITE IN EXAM ===== -->
<div class="exam-box">
<div class="exam-label">Must Write in Exam</div>
<ul class="note-list">
<li><span class="kw">Agent:</span> Dengue virus, Flavivirus genus, <span class="kw">4 serotypes (DENV 1–4)</span>, immunity serotype-specific</li>
<li><span class="kw">Vector:</span> Aedes aegypti — day-biting, breeds in clean stagnant water, urban vector</li>
<li><span class="kw">Incubation period:</span> Intrinsic 4–6 days (3–14 days); Extrinsic (mosquito) 8–10 days</li>
<li><span class="kw">Classification:</span> Classical DF / DHF (Grade I–IV) / DSS — Iceberg phenomenon</li>
<li><span class="kw">DHF triad:</span> Fever + Haemorrhage + Thrombocytopenia + Plasma leakage (haemoconcentration)</li>
<li><span class="kw">Diagnosis:</span> NS1 antigen (Day 1+), IgM ELISA (after Day 5), Serial haematocrit</li>
<li><span class="red">Aspirin and NSAIDs are contraindicated</span> in dengue — risk of Reye's and bleeding</li>
<li><span class="kw">Source reduction (weekly dry day)</span> — most important vector control measure</li>
<li><span class="kw">India:</span> 521 sentinel hospitals + 14 apex labs; NIV Pune provides ELISA kits free</li>
<li><span class="kw">GOI Mid-Term Plan 2011</span> — 8 components (Surveillance, Case Mgmt, Vector Control, BCC, Capacity Building, Inter-sectoral, Outbreak Response, M&E)</li>
<li><span class="kw">Dengue under NVBDCP</span> — one of 6 vector-borne diseases</li>
</ul>
</div>
<!-- ===== KEYWORDS ===== -->
<div class="kw-box">
<div class="kw-label">⚡ Key Words — Quick Recall</div>
<div class="kw-chips">
<span class="kw-chip">Flavivirus</span>
<span class="kw-chip">Aedes aegypti</span>
<span class="kw-chip">4 Serotypes</span>
<span class="kw-chip">Thrombocytopenia</span>
<span class="kw-chip">Haemoconcentration</span>
<span class="kw-chip">Plasma Leakage</span>
<span class="kw-chip">NS1 Antigen</span>
<span class="kw-chip">IgM ELISA (Day 5+)</span>
<span class="kw-chip">Iceberg Phenomenon</span>
<span class="kw-chip">DHF Grades I–IV</span>
<span class="kw-chip">Weekly Dry Day</span>
<span class="kw-chip">No Aspirin</span>
<span class="kw-chip">Dengvaxia (CYD-TDV)</span>
<span class="kw-chip">NVBDCP</span>
<span class="kw-chip">NIV Pune</span>
<span class="kw-chip">521 Sentinel Hospitals</span>
<span class="kw-chip">Mid-Term Plan 2011</span>
<span class="kw-chip">Biphasic Fever</span>
<span class="kw-chip">Break-Bone Fever</span>
<span class="kw-chip">Day-biting Vector</span>
</div>
</div>
<div class="footer">
K. Park — Textbook of Preventive & Social Medicine | Community Medicine / PSM | MBBS Exam Notes
</div>
</div>
</body>
</html>
which chromium-browser || which chromium || which google-chrome || which google-chrome-stable || which puppeteer 2>/dev/null; which wkhtmltoimage 2>/dev/null; python3 -c "import imgkit; print('imgkit ok')" 2>/dev/null; python3 -c "from playwright.sync_api import sync_playwright; print('playwright ok')" 2>/dev/null; node -e "require('puppeteer'); console.log('puppeteer ok')" 2>/dev/null
cd /home/daytona/workspace/dengue-notes && /usr/bin/chromium --headless --disable-gpu --no-sandbox --screenshot=dengue_notes.png --window-size=900,1400 "file:///home/daytona/workspace/dengue-notes/dengue_notes.html" 2>&1; ls -lh dengue_notes.png 2>/dev/null
cd /home/daytona/workspace/dengue-notes && python3 -c " from PIL import Image img = Image.open('dengue_notes.png') print('Size:', img.size) print('Mode:', img.mode) " 2>/dev/null || echo "PIL not available" # Try full-page capture with chromium print-to-pdf approach /usr/bin/chromium --headless --disable-gpu --no-sandbox \ --print-to-pdf=/home/daytona/workspace/dengue-notes/dengue_notes.pdf \ --print-to-pdf-no-header \ "file:///home/daytona/workspace/dengue-notes/dengue_notes.html" 2>&1 | tail -3 ls -lh /home/daytona/workspace/dengue-notes/
cd /home/daytona/workspace/dengue-notes && /usr/bin/chromium --headless --disable-gpu --no-sandbox --screenshot=dengue_notes_full.png --window-size=900,3200 "file:///home/daytona/workspace/dengue-notes/dengue_notes.html" 2>&1 | tail -2 && ls -lh dengue_notes_full.png
📋 Dengue — PSM Revision Notes (K. Park)
| Format | Download |
|---|---|
| 🖼️ Full-page PNG (printable) | dengue notes full Image · PNG |
| 📄 PDF (A4, print-ready) | dengue notes PDF Document · PDF |
| 🌐 HTML (editable source) | dengue notes HTML File · HTML |
What's covered in the notes (8 structured sections):
- Definition & Introduction - with global burden stats (390M infections/year, 3.9B at risk) and India-specific data
- Epidemiological Determinants - Agent / Vector / Host / Environment table
- Classification - Iceberg phenomenon, Dengue Fever / DHF / DSS / Severe Dengue, WHO Grades I-IV, Warning Signs table
- Diagnosis - NS1 antigen (Day 1+), IgM ELISA (Day 5+), haematocrit, tourniquet test; 521 sentinel hospitals + 14 apex labs
- Management - DF vs DHF/DSS columns; contraindications (Aspirin/NSAIDs) prominently highlighted
- Prevention & Control - GOI Mid-Term Plan 2011 in 3-column layout; vector control (source reduction, weekly dry day, larviciding, personal protection)
- Vaccine - CYD-TDV (Dengvaxia) details + WHO seropositive-only caution
- Global Strategy - WHO 2012-2020 goals
I am unable to open these files and if I open these files, they are blank and saying error message. Please give me another source of download or give me any other source or in the image form.
Premium handcrafted digital study notes on clean A4 white page portrait orientation. Topic: DENGUE FEVER - PSM Community Medicine MBBS Revision Notes from K. Park textbook. Design: warm white matte paper background, no ruled lines. Main title "DENGUE FEVER" in very large bold deep royal blue uppercase centered at top. Below title a pale yellow highlight strip with subtitle "Communicable Diseases | PSM / Community Medicine | MBBS Revision Notes". Small grey text below: "Source: K. Park — Textbook of Preventive & Social Medicine" Section 1 heading in dark red bold: "1. DEFINITION & INTRODUCTION" Blue-bordered rounded box: "Dengue = Arboviral infection caused by Dengue Virus (genus Flavivirus), 4 serotypes (DENV 1-4), transmitted by Aedes aegypti (day-biting mosquito). Infection: Asymptomatic / Classical DF / DHF / DSS" Two side-by-side light grey rounded boxes: Left box title in blue: "GLOBAL BURDEN" with bullet points: • 3.9 billion at risk in 128 countries • 390 million infections/year • 96 million manifest clinically • Cases: <0.5M (2010) → 4.2M (2019) • 90% hospitalizations: children <5 yrs Right box title in blue: "INDIA" with bullets: • Endemic in 35 states/UTs • 2019: 1,57,996 cases; 253 deaths; CFR = 0.1% • DENV-1 & DENV-2 widespread • Peak: post-monsoon • India = Category A (WHO-SEARO) Section 2 heading in dark red bold: "2. EPIDEMIOLOGICAL DETERMINANTS" Clean ruled table with blue header row (white text): Headers: FACTOR | KEY POINTS Row 1: Agent (red text) | Flavivirus; 4 serotypes; RNA virus; immunity serotype-specific; secondary infection → severe DHF; DENV-1/DENV-2 sequence = 500x risk DHF Row 2: Vector (blue) | Aedes aegypti (principal) + Ae. albopictus; day-biting; breeds in clean stagnant water; extrinsic incubation 8-10 days Row 3: Host (red) | Incubation: 4-6 days (3-14 days); High risk: infants, elderly, obese, pregnant; 2-4% develop severe disease on secondary infection Row 4: Environment | Urban/semi-urban; monsoon peak; poor water storage; tropical regions Section 3 heading in dark red bold: "3. CLASSIFICATION — DENGUE VIRUS INFECTION" Blue info box: "ICEBERG PHENOMENON: Asymptomatic (base-majority) ▲ Classical DF ▲ DHF Grade I-II ▲ DSS Grade III-IV (apex-minority)" Small ruled table: Headers: TYPE | FEATURES | KEY FINDING Row 1: Classical DF | Fever 39-40°C, headache, retro-orbital pain, myalgia, maculopapular rash (80%), biphasic fever, self-limiting 5-7 days | Break-bone fever; low CFR Row 2: DHF | Plasma leakage, thrombocytopenia (<1 lakh), haemoconcentration (≥20% rise Hct), haemorrhage; 3 phases: Febrile→Critical→Recovery | Thrombocytopenia + Haemoconcentration Row 3: DSS | DHF + circulatory failure; cold clammy skin, narrow pulse pressure <20 mmHg | Most severe; highest CFR WHO Grading box in two columns: Left: Grade I: Fever + positive tourniquet test | Grade II: Grade I + spontaneous bleeding | Grade III: Circulatory failure | Grade IV (DSS): Undetectable BP/pulse Right "WARNING SIGNS" (red): Severe abdominal pain • Persistent vomiting • Bleeding (gums/nose/black stools) • Cold extremities • No urine >4-6 hrs • Restlessness Section 4 heading in dark red: "4. DIAGNOSIS" Table: TEST | TIMING | NOTE NS1 Antigen ELISA | Day 1 onwards | Early viraemia detection IgM Capture ELISA | After Day 5 | NIV Pune provides free; confirmatory Serial Haematocrit | From Day 3 daily | ≥20% rise = plasma leakage (DHF) Platelet Count | Daily in DHF | <1 lakh = DHF; transfuse at <10,000 Tourniquet Test | Grade I | ≥10 petechiae/2.5cm² = positive Blue box: "INDIA INFRASTRUCTURE: 521 Sentinel Surveillance Hospitals + 14 Apex Referral Labs | IgM ELISA kits FREE from NIV Pune" Section 5 heading in dark red: "5. MANAGEMENT (Supportive — No Specific Antiviral)" Two boxes side by side: Left "DENGUE FEVER": ORS/oral fluids • Paracetamol (interval ≥6hrs) • ❌ NO Aspirin/NSAIDs/Ibuprofen (Reye's syndrome risk) • Monitor platelet + Hct daily • Discharge: afebrile ≥24h, platelet >50,000 Right "DHF/DSS": IV fluids (Ringer's Lactate) based on haematocrit • Rapid fluid resuscitation in shock • Platelet transfusion <10,000 or active bleeding • NO steroids routinely Section 6 heading in dark red: "6. PREVENTION & CONTROL (GOI Mid-Term Plan 2011)" Six small boxes in 2 rows of 3: (a) Surveillance: Disease + entomological surveillance; outbreak identification (b) Case Management: Lab diagnosis (NS1/IgM); clinical management; early referral (c) Vector Management: Source reduction; chemical control; personal protection; legislation (d) Outbreak Response: Epidemic preparedness; rapid response; media management (e) Capacity Building: Training health workers; operational research (f) BCC & IEC: Social mobilization; inter-sectoral coordination Blue box "VECTOR CONTROL MEASURES": Anti-larval: Weekly Dry Day (empty/clean/dry all containers) • Cover overhead tanks • Abatization (Temephos) • Gambusia fish • Dispose tyres/flower pots Anti-adult & Personal: Space spraying (pyrethrum) during outbreaks • Full sleeves clothing • Repellents (DEET) • Bed-nets for infants (daytime) Section 7 heading in dark red: "7. VACCINE — CYD-TDV (Dengvaxia, Sanofi 2015)" Yellow box: Tetravalent live attenuated • 3 doses × 0.5mL at 0, 6, 12 months • Ages 9-45 years • ⚠️ WHO 2018: Only for SEROPOSITIVE individuals — risk of severe dengue in seronegatives • Contraindicated: immunocompromised, pregnancy Red-bordered starred box "★ MUST WRITE IN EXAM": • Agent: Dengue virus, Flavivirus, 4 serotypes, serotype-specific immunity • Vector: Aedes aegypti — day-biting, breeds in CLEAN stagnant water • IP: Intrinsic 4-6 days; Extrinsic (mosquito) 8-10 days • DHF Triad: Fever + Haemorrhage + Thrombocytopenia + Plasma Leakage (haemoconcentration ≥20%) • NO Aspirin/NSAIDs in dengue (Reye's syndrome + bleeding risk) • Weekly Dry Day = most important source reduction measure • 521 sentinel hospitals + 14 apex labs; NIV Pune = free ELISA kits • GOI Mid-Term Plan 2011 = 8 components Blue-bordered box "⚡ KEY WORDS": Blue rounded pill chips: Flavivirus • Aedes aegypti • 4 Serotypes • Thrombocytopenia • Haemoconcentration • Plasma Leakage • NS1 Antigen • IgM ELISA (Day 5+) • Iceberg Phenomenon • DHF Grades I-IV • Weekly Dry Day • No Aspirin • Dengvaxia • NVBDCP • NIV Pune • Break-bone Fever • Day-biting Vector • Biphasic Fever Footer in light grey: "K. Park — Textbook of Preventive & Social Medicine | Community Medicine / PSM | MBBS Exam Notes" Overall aesthetic: clean, elegant, minimal, handwritten-but-legible academic digital notes style. Colors: deep royal blue, dark red/brick red, black, pale yellow highlights, light grey boxes. No clutter, lots of white space, very neat alignment. Like premium topper-style digital study notes.