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11. Name at least two ways to control the spread of infectious disease?

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  1. Sanitation
  2. Education and behavior change
  3. Vaccination
  4. Treatment and quarantine

Method of disease transmission, virulence, numbers affected, cost, and feasibility affect when which of these (or a combination thereof) is a better approach.

A pregnant mother in Cambodia watches while her child is vaccinated. Conservation International and CARE-Cambodia opened the first clinic in Thma Bang in 2004. Previously, the nearest health services were a day's walk away.
© 2005 Carol Boender, Courtesy of Photoshare.


  1. Sanitation
    Sanitation is a primary, preventive measure. It removes infectious disease agents from the enviroment, and therefore, prevents community exposure to these agents. Provision of clean water and removal of waste are two common, population-based measures.

    A girl washes her hands at a village in Guna district of Madhya Pradesh, India.
    © 2006 Anil Gulati, Courtesy of Photoshare

  2. Education and behavior change
    Health education to acheive behavior change is another primary, preventive measure. For example, respiratory infection and diarrhoea are the primary cause of death in one-third of all children who die before age five. Education that produces behavior change can alter that outcome. A recent randomized controlled trial that included instruction on handwashing and provision of plain soap reduced the incidence of diarrhoea and pneumonia by 50% (Luby et al. 2005).

    Insufficient calorie and micronutrient intake (undernutrition) play a role in one-third of all child deaths. While access to nutrition (affordablity and availability) is a factor, undernutrition is also amenable to education and behavior change.

    Similarly, appropriately-targeted, effective education on safe sex practices reduces incidence of sexually-transmitted infections. (Education that leads to behavior change can also produce lower rates of chronic diseases such as diabetes and cardiovascular diseases.)

    © 2008 Amy Joyce

  3. Vaccination
    Vaccination is another preventive measure aimed at controlling infectious diseases, one with profound impact on population health. The World Health Organization (WHO) estimates that their 1998-2003 Global Polio Eradication Initiative saw infections fall by 99%, preventing infection in about five million. Measles vaccines produced a 78% drop in the incidence of measles from 2000 to 2008.

    Nevertheless, 164,000 still died as the result of measles infections during 2008; 95% of these deaths were in low-income countries where people had poor access to vaccines. In sum, WHO estimates that 2.1 million people died of vaccine preventable diseases in 2002, showing that much work remains in this area. This applies not just to the creation of vaccines for widespread infectious diseases still without a vaccine but to the need for increased distribution of vaccines already proven to be effective. Thus, GAVI (the Global Alliance for Vaccines and Immunisation) has as its current goals to accelerate the uptake and use of underused and new vaccines; to contribute to strengthening the capacity of integrated health systems to deliver immunisation; to increase the predictability of global financing and improve the sustainability of national financing for immunisation; and to shape vaccine markets.

    A young Yemeni midwife vaccinates an infant against polio at a clinic in Sanaa, Yemen.
    © 2006 Ben Barber, Courtesy of Photoshare

  4. Treatment and quarantine
    Of the four infectious disease control measures described here, only treatment for the disease, and if necessary, quarantine of those with an infectious disease, come after outbreak of infection. Examples of infectious diseases with widespread prevalence not fully contained by prevention measures include tuberculosis, malaria and HIV. Transmission is reduced, or halted, by effectively-administered treatment. While treatment of infectious diseases helps to reduce transmission, control of infectious diseases is cheaper and more effective with prevention. That said, once an outbreak of infectious disease is present, treatment and/or quarantine is critical to controlling spread.

The resources below offer more on understanding the cost-effectiveness and efficacy of the different approaches—the methods used to determine which is the best approach and when.



John Snow (1855). On the Mode of Communication of Cholera. London.

JB McKinlay & SM McKinlay (1977). The questionable contribution of medical measures to the decline of mortality in the United States in the Twentieth Century. The Milbank Memorial Fund Quarterly. Health and Society 55.3. (Summer, 1977): 405-428.

SA Esrey, RG Feachem & JM Hughes (1985). Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities. Bulletin of the World Health Organization 63.4 (1985): 757-772.

SA Esrey, JB Potash, L Roberts & C Shiff (1991). Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bulletin of the World Health Organization 69.5 (1991): 609-621.

A Prüss, D Kay, L Fewtrell & J Bartram (2002). Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environmental Health Perspectives 110.5 (May 2002): 537-542.

V Curtis & S Cairncross (2003) Effect of washing hands with soap on diarrhoea risk in the community: A systematic review. The Lancet Infectious Diseases 3.5 (May 2003): 275-281.

L Fewtrell, RB Kaufmann, D Kay, W Enanoria, L Haller & M Colford (2005). Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis. The Lancet Infectious Diseases 5.1 (January 2005): 42 - 52.

Education and behavior change

FD Butterfoss, RM Goodman & A.Wandersman (1993). Community coalitions for prevention and health promotion. Health Education 8.3 (1993): 316-330.

A Oakley, D Fullerton, J Holland, S Arnold, M France-Dawson, P Kelley & S McGrellis (1995). Sexual health education interventions for young people: a methodological review. BMJ 310.6973 (21 January 1995): 158-162.

D Nutbeam. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 15.3 (September 2000): 259-267.


TA Lieu, SL Cochi, SB Black, ME Halloran, HR Shinefield, SJ Holmes, M Wharton & AE Washington (1994). Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 271.5 (2 February 1994): 375-381.

KL Nichol, KL Margolis, J Wuorenma, and T Von Sternberg (1994). The efficacy and cost cffectiveness of vaccination against influenza among elderly persons living in the community. New England Journal of Medicine 331.12 (22 September 1994): 778-784.

GD Sanders & AV Tair (2003). Cost Effectiveness of a potential vaccine for human papillomavirus. Emerging Infectious Diseases 9.1 (January 2003): 37–48.

SA Harper, K Fukuda, TM Uyeki, NJ Cox & CB Bridges (2004) Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 53.RR06 (28 May 2004): 1-40.

Treatment and quarantine

R Carter, KN Mendis, & D Roberts (2002). Spatial targeting of interventions against malaria. Bulletin of the World Health Organization 78.12 (2002): 1401-1411.

T Day, A Park, N Madras, A Gumel & J Wu (2005). When is quarantine a useful control strategy for emerging infectious diseases? American Journal of Epidemiology 163.5: 479-485.

D Donnell, JM Baeten, J Kiarie, KK Thomas, W Stevens, CR Cohen, J McIntyre, JR Lingappa & C Celum (2010). Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: A prospective cohort analysis. The Lancet 375.9731 (12 June 2010): 2092 - 2098.

C Dye, CJ Watt, DM Bleed. SM Hosseini & MC Raviglione (2005). Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence, and deaths globally. JAMA 93.22 (2005): 2767-2775.

NR Gandhi, A Moll, AW Sturm, R Pawinski, T Govender, U Lalloo, K Zeller, J Andrews & Gerald Friedland (2006). Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. The Lancet 368.9547 (4 November 2006): 1575-80.

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