Portal of exit from reservoir – pathogen exits

from the body.

Communicable Disease
Modes of transmission

- Contact Transmission
- If it’s easily transferred from one person to - Vehicle/Route
another - Airborne Transmission – carried in the in the
- Illness due to an infectious agent which is atmosphere <5um
transmitted directly/indirectly from one person - Vector Transmission – animal/mosquito
to another
- Transmitted from one person to another Portal of entry into the body – cause bacteria to
- Applied to disease not transmitted by ordinary enter the body(nose, eye, ears, mucosa, open
contact and that which requires direct wound)
inoculation. Susceptible host
Communicable

- There is a causative agent. Factors Affecting of Entry of Infection to the Body

- Can be transferred from one person to another.
- Age, sex, genetic constitution
Infectious - Nutritional status, fitness, environmental factors
- Transmitted by ordinary contact - Absent of abnormal immunoglobulins
- General Physical, mental and emotional factors
Kissing’s Disease/Infectious mononucleosis - Status of hematopoietic system, efficacy of
Agent: Epstein-Barr virus reticuloendothelial system
- Presence of underlying disease
3 factors/Epidemiologic Triad - Patients with radiation, chemotherapy,
costiscosteroid/other immunosupressive
• Agent – infectious microorganism capable
agents
of invading and multiplying in the body of
host (the one causes the disease) Distribution of Disease
Carrier/Vector – carries the causative agent Sporadic – few isolated cases (irregular,
occasional; no pattern)
• Host – any organisms that supports the
nutritional and physical needs of the Endemic – contained in locality (continuous but not
causative agent for growth. high; every year but not low)
• Environment – condition that favors the
- Dystonia of panay
progression of the infection (most difficult to
- Malaria in palawan
change out of the three)
- Marberg in africa
Factors Responsible for Transmission of
Epidemic – sudden increase over a short period of
Infection
time (food poisoning)
Causative agent/etiologic agent
- Secular – long period (kawasaki disease)
Reservoir of infection – area where disease - Cyclical – seasoned (dengue)
grows and proliferate.
Pandemic – worldwide
Two types of reservoir
- HIV/Aids
- Human
- Animal
Herd immunity – immunity of population Doderleins bacillus – causes acidity in vagina

Immunity – when the body produces antibodies. E. Coli – found in the intestine/rectal (most
Vaccinated (ability of body to fight of the disease) common cause of UTI)

• B cells/humeral – create antibodies We don’t develop immunity to flu because the

• T cells/thymus – production of train changes ever year that’s why we need flu
immunoglobulin vaccine every year

Resistance – body withstand the disease. Strong 2nd line of defense

immune system ability of body to avoid the disease)
1. Inflammatory response (non-specific)
2. Cell mediated immunity (specific)
3. Human immunity
Classification of Immunoglobulin
Types of Immunity
IgG 75%
Active – developed by the body (lifelong)
- Present in majority of B cells
- Contains antiviral antitoxin and antibacterial 1. Natural – exposure to CD
- Ab 2. Artificial – vaccine
- Only IG that crosses placenta
Passive – other sources (6mnths-1yr)
- Responsible for protection of newborn
- Activates complement and binds to 1. Natural - breast milk, placenta
macrophages 2. Artificials – immunoglobulins (gamma)

IgA 15% Mother was injected tetanus toxoid to prevent

infection of the baby
- Predominant in body secretions such as saliva,
nasal and respiratory secretions, breastmilk Stages of Illness (IPAP)
- Protects mucus membrane
Incubation period – 1st exposure to appearance of
IgM 5% 1st S/S

- Forms natural antibody for blood type Prodrodromal Period – premonitory sign;
- Early immune response indicates impending attack.

IgE 0.004% - coryza (flu-like symptoms)

- Binds to mast cells and basophils Acne/Period of Illness – typical S/S (specific
- Involved in allergic and hypersensitivity symptoms)
reactions.
Period of Convalescence – road to recovery
IgD 0.2%

- Active not known.

Standard Precaution
- May affect cell maturation.
- Strategy to reduce risk and control nosocomial
infections
Host Defense - Have replaced universal precautions

1st line of defense Applies to:

1. Chemical substance - Injured skin

2. Cilia - Non-intact mucus membrane
3. Normal flora - Blood
- Body fluids except sweat 8. Reverse Isolation – protect patient from
acquiring other disease because of lowered
Hospital Precautions
resistance. (Immunocompromised patients)
Standard precaution: Hand washing – 20sec
Sharps should be put in RED punctured proof
containers

Transmission based precaution Prevent the spread of the communicable

disease through:
1. Airborne -measles, TB, varicella, <5um, 6ft
- Reduce risk of airborne transmission of - Health Education
infectious agent through air. - Immunization: BCG after birth, hepa B
- Requires protective measures in addition to - Environmental Sanitation: Presidential
standard precaution Decree (PD) 856
Recommendation: - Supervision in the preparation of food:
- Private room (negative air pressure)
Return demonstration - Proof of understanding the
- Co-habitation
health teaching
- Limit contact with susceptible clients
- Limit movement inside room Asking questions – patient is ready to learn
2. Droplet – rubella, mumps, diphtheria >5um
Earliest immunization
3ft
- Does not remain suspended in the air BCG – given at birth
Recommendation:
Hepa B – 24hrs after birth
- Private room
- Co-habitation PD856 (promulgating code on sanitation) – legal
- Wear mask within 3ft from the client bases of having a sanitation officer
3. Contact – direct/indirect
- Skin, GI, wound infections, diphtheria, herpes, Control Measures
simplex virus, scabies 1. Isolation – separates a person with
Recommendation: communicable disease from other people
- Private room (with specific S/S)
- Co-habitation 2. Quarantine – incubation period to exposure
- Wear gloves and gowns of the disease
- Limit movement inside the room 3. Reverse Isolation- patient needs to be
4. Enteric – prevent spread of disease that protected
can be transmitted through direct contact 4. Disinfection – limit/destroy number of
with infected person microorganisms (spores/egg left)
5. Respiratory Isolation – prevent omission ➢ Concurrent – done in presence of
of organism by means of droplets that are infection
coughed, sneezed and breath into the ➢ Terminal – after discharge
environment
6. Strict Isolation – protect medical staff and Medical Asepsis
other persons - Gowning – protects inner parts of the body
7. Wound and skin – prevent infection of - Mask – filters the microorganism
personnel and patients from infections
transmitted by direct contact with wounds N95 airborne
and other condition resulting to skin
Surgical droplet
secretions and heavily particles
- Medical hand washing – most effective way
of reducing transmission
- Placarding – placing reminders in patients communities in collaboration with LGU and other
room partners

Targets:

TUBERCULOSIS Cure atleast 95%of sputum smear positive TB

patient discovered
- Socioeconomic disease/opportunistic infection
- 2wks treatment not contagious Detect at least 80%-100% of the estimated new
sputum smear positive TB cases
S/S: cough (>2wks), fever low grade 38-38.5 (late
afternoon), chest/back pain, hemoptysis (blood
streak sputum), significant weight loss. Sweating,
(DSSM) direct sputum smear microscopy – primary
fatigue, body malaise, and SOB.
diagnostic tool in NTP case finding
High protein, vitamin C, and enough sleep will not
All symptomatic people must undergo DSSM
effect TB
Hemoptysis – only contraindication to direct sputum
MOT:
smear microscopy
- airborne droplet
DSSM>GS/CS – best confirmatory test
- direct invasion
DSSM – best test for TB
Period of communicability
Upper lobe TB infiltration
- depends on number of bacilli
- Discharged Lower lobe cochs tumor for pneumonia
- The virulence
- Adequacy of ventilation
Purulent discharge- hallmark sign of pneumonia
Too young, too old
Cattle, carabaos, horses (mycobacterium Bovis)
Preferred precautions
Bovine TB – unpasteurized milk. Eating improper
- Airborne precautions
cooked meals from carabaos and cattles
- Negative pressure room
- Isolation/private room Mycobacterium marinaro – TB from water
Methods of Control Treatment partner – make sure patient take their
meds in the morning before breakfast to increase
- Prompt diagnosis and treatment
its potency (if there’s none, it could be the brgy.
- BCG vaccination
Health worker)
- Health education
- Improve social conditions such as RA 7160 – LGU
overcrowding
- Make available medical activities DOTS strategy
- Provide public health nursing and outreach o recording and reporting
services for home supervision o Uninterrupted supply of quality assured
drugs
National TB control program o Standardized acc for all TB cases
o Access to quality assured sputum
Vision: country where TB is no longer a public
microscopy
health program o Sustained political commitment
Mission: ensure that TB DOTS services are
available, accessible, and affordable to Who can perform DSSM
 o Smearing Healthy (+) - 10mm
o Fixing Immuno - 5mm
o Staining When is Mantoux test usually performed - usually
o Recording and interpreting dont on a tuesday to be read on Thursday or Friday

Who can perform in a far flung community:

• BHW trained and supervised by the NTP med
techs LEPROSY
- causative agent - oldest disease. mycobacterium Leprae
2 formulation of anti TB drugs - Pangolins/armadillos
- Fixed dose - 1 tab
- Single drug combination 2wks treatment not contagious

Drugs: S/S: Early

Intensive: INH, RIG, PYRAZINAMIDE
Continuation: INH, RIF - Change in skin color = reddish/white
Extrapulmonary PTB - Loss of sensation on skin lesions
Drugs: - Decrease/loss of sweating
INH, RIF, PYRAZINAMIDE, ETHAMBUTOL OR - Thickened and painful nerves
STREP - Muscle weakness and paralysis of extremities
Continuation: INH, RIF
- Pain and redness of the eyes
Tuberculosis of the Bone - Potts disease. Presence
of bone pain - Nasal obstruction and bleeding
Laboratory test to take for tb before taking RIPES - - Ulcers that do not heal
Liver function tests because the medications are
hepatotoxic Late signs

- Madarosis
RIPES
- Lagopthalmos
Rifampicin - body fluid discoloration. Permanent
discoloration of contact lens - Clawing of finger and toes
Isoniazid - Peripheral neuropathy. Hallmark sign: - Contractures
tingling sensation on legs = Vit b6; pyridoxine, - Sinking of the nosebridge
green leafy vegetables - Gynecomastia
Pyrazinamide: Gouty arthritis/ Hyperurecemia - - Chronic ulcers
increase fluid intake of atleast 6-8 glasses of water
Ethambutol: Optic neuritis: inability to recognize MOT: prolong skin-to-skin contact
green and blue. Eye pain Mgt: Stop taking meds.
You cannot take ethambutol for more than 2 No need for hospital admission for treatment
months.
Streptomycin - damage to Cn8. Nephrotoxic dont Who are the most susceptible
take more than 2 months o Children below 12 years of age because of
If there is tinnitus: turn on the music the fragility of their skin
Tuberculin test = exposure o Older persons CANNOT get leprosy
o Mantaoux test - read or interpreted after 72 Prevention
hours; single screening. Exposed to tb BUT o avoidance of prolonged skin to skin contact
doesnt mean you have TB. o BCG vaccination = acid fast bacillus
o Most Filipinos are positive for mantoux o Good personal hygiene
because we are exposed to BCG o Adequate nutrition
o Tine test = mass screening; 48 hours o Health education
0-4mm - insignificant Dapsone, Clofazomine + Rifampicin
5mm or more - significant - HIV or impaired • watch out for skin discoloration
immunity **How long do you treat leprosy - 1 year to 2 years
10 mm or greater - significant with normal immunity If lesions are severe - 2 years - 2 years 1/2
Gold standard test for TB: Quantiferon alpha testing What are the 2 types of leprosy - pau basilliary <5
PPD - purified protein derivation lesions, Multibasilliary >5 lesions
BCG - Bacillum of Calmelle Gurin WHO leprosy classification
Paubacillary (tuberculoid and intermediate o Prevent exposure to contaminated water =
infectious type) - non infectious wear boots
Duration: 6-9 months o Treat patient in endemic areas to prevent
Rifampicin and Dapsone disease progression
HT: Dapsone: Itchiness o Apply 70% of alcohol to skin immediately
MultiBacillary (Lepromatous and borderline) Drinking water: Allow water to stand 48-72 hours
Clofazimine - s/e = dryness or flakiness of the skin before use
Self administered Dapsone and Lamprene What is the treatment?
Diagnostic test Drug: Praziquantel (Biltricide) - helminthicide
SSS = Slit Skin SMear Test = determines the o Oxamniquin for mansoni
presence of M. Leprae o Metrifonate for Hematobacterium
Lepromin test - susceptibility to leprosy Most common cause of death: Hepatic complication
Treatment: RA 4073 - advocates for home Vector: snail (Oncomelania Quadrasi)
treatment of Leprosy **Missing** Dont need to bring What infects the snail - Miracida
patient to hospital What infects the human host - Cercariae
MDT (Multi drug therapy) Capillariesis
o reduces communicablity period of leprosy in Ca: Capillaria
4-6 weeks Philippinesis
o It prevents development of resistance to Eating of freshwater fish
drugs Blood fluke
o It shortens the duration of treatment Pragomiasis
Ca: Paragominus westermani
Eating fresh water crabs and shrimps
Schistosomiasis Lung fluke
Drug of choice: Praziquantel
(Snail Fever)/Bilhariasis/Katayama Fever

o usually in Bicol region, Davao and Romblon Filariasis

o Usually attacks liver and intestine. Blood
rich organs Agent: Wuchereria bancrofti
S/S:
- Brugia malayi
- Diarrhea - B. Timori
- Bloody stool
- Enlargement of abdomen Nematodes
- Spleenomegaly Attacks lymph nodes (swelling/enlarge/destroy)
- Weakness
- Anemia MOT:
- Inflamed liver
- Bites of female mosquito
Agent: Japonicum (commonly in Philippines), - Aedes poecillus (primary), mostly found in
Mansoni, Haematobium, Malayanensi areas with abaca
- Aedes flavivostris (secondary)
Liver (blood reach organ), lives in blood vessels of
intestine and liver. Incubation period: 8-16 mnths

Dx: COPT(cercum ova precipitin test) Peak biting time: 10pm-12 midnight

• If COPT is not available then STOOL exam is the Malaria peak biting time - 9-3pm
next best thing Asymptomatic stage
Preventive measures o Characterized by the presence of
o Health education - Toilet facilities, avoid microfilarae in the blood
waiting in floody waters, molocyte o No clinical signs
o Proper disposal of feces and urine o Asypmtomatic for years
o Improve irrigation and agricultural practices o Other progress to acute and chronic stages
o Teat snail breeding sites with molluscides Acute stage
- Lymphadenitis - Plasmodium Malariae
- Lymphangitis
- In some cases, male genitalia is affected -> MOT
o Bite of female mosquito
orchitis
o Blood transfusion
Chronic S/S o Sharing of IV needles
o Transplacental
- Hydrocoele
- Lymphedema Early Diagnosis
- Elephantiasis
Clinical method - signs and symptoms had you
Dx: been on a malaria endemic areas? Do you live in a
malaria endemic area
- Physical exam
- History taking Microscope method - blood smear
- Observation of S/S
QBC = quantitative Buffy coat = fastest
- Finger prick test = giemsa stain = microfilariae
Malarial smear = best time; high fever
Laboratory examinations
o Nocturnal blood examinations - after 8pm Drug of choice for chemoprophylaxis
o Immunochromatographic test - Chloroquine - given at weekly intervals
o Rapid assessment method; anytime of the - 1-2 weeks before entering endemic area
day Pregnant: For the entire duration of pregnancy

Treatment
Drug of choice: o Blood schizonticides
o Quinine - cinchonism - ototoxycity
- Diethylcarbamazine citrate (Hetrazan) o Chloroquine; s/e: itchiness - normal
- Albendazole and ivermectin o Primaquine
- Doxycycline (elephantiasis) o Fansidar - pyrimethamine and sulfadoxine

Vector control measures

o Insecticide treatment of mosquito net
Malaria o House spraying
o On stream seeding - bio ponds; larvaviruos
Agent: plasmodium
fishes - 2-4 fishes/sq.m: 200-400 fish per
Vector: Female mosquito
area
Exoerethrocytic phase - outside of the RBC
o On stream clearing - cutting the vegetation
Acts upon those rich in BC such as liver and blood
overhanging along the stream banks
vessels
Japanese encephalitis - inflammation of the brain
Recommended antimalarial drugs
due to mosquito bites
o Choroquine sulfate
Erethrocytic phase - destruction of RBC
o Sulfadoxine
o Quinine sulfate
S/S
o Quinine hvdrochloride
o recurrent chills
o Quinidine Sulfate
o Fever
o Quinidine Glucate
o Profuse sweating
Public health nursing responsibilities
o Anemia
Participate in the implementation of the following:
o Body malaise - due to infection
o Treatment policies
o Hepatomegaly - exoerethrocytic phase
o Provision of drugs
o Spleenomegaly
o Laboratory confirmation diagnosis
o Training of BHW on diagnosis and
Infectious agents
treatment
- Plasmodium Falciparum = most fatal
o Supervision of malaria control activities
- Plasmodium vivax
- Plasmodium Ovale – rarest
 o Collection analysis and submission of No drug of choice
reports
o Recognition of early signs and symptoms Mx: Rehydration and paracetamol
o Health education
o Availability of anti malarial drugs and H-fever classification
chemophrophylaxis drugs - Severe, frank type
o Chemically related mosquito nets
- Moderate
o Larva eating fish - tilapia etc.
o Environmental sanitation - Mild
o anti mosquito soap
Chikungunya virus
o Neem tree (eucalyptus)
o Zooprophylaxis - pigs getting bit instead of MOT:
people
Period of communicability; first week of illness;
virus is present in the blood
Dengue (Hemorrhagic fever)
Peak aged 5-9 yrs old
Megakaryocytes – responsible for platelet
production Dx:
Pathophysio Torniquet test/rumped leads test/capillary fragility
test = presumptive
Viral=bone marrow=attacks immature platelet
megakaryocyte =>20 petechia (hermans sign)

Bleeding = +torniquet test

Dengue bites 9am-3pm Confirmatory: platelet count normal: 150-

409x10^3/ml
S/S
Mx:
First 4 days
- Paracetamol, analgesic
- High fever
- Rapid placement of body fluids
- Abdominal pain and headache
- Includes intensive monitoring and follow up
- Flushing accompanied by vomiting
- Give ORS to replace fluid
- Conjunctival infection
- Epistaxis

4th – 7th days Control measures (best thing to do wala lamok)

Hemorrhagic Eliminate vector by:

Hypo-tachy-tachy - Changing water and scrubbing sides of lower

vases once a week
- Lowering of temperature
- Destroy bleeding places of mosquito
- Severe abdominal oain
- Proper disposal of rubber tires, empty bottles
- Vomiting and frequent bleeding
and cans
- Unstable BO and narrow pulse
- Keep water containers covered
- Change water after 2-3 days

7th-10th day (convalescent/recovery)

- Generalized flushing with interventing areas of Measles&german measles

flushing
S/S
- Appetite regained
- Stable BP - Fever
- Rashes - Teach, guide, supervise adequate nursing care
- Symptoms referable to upper respiratory tract as indicated
- Infection - Check corrections of mediation and treatment
- Koplik spot prescribed by the physician

Measles: filterable virus of measles

Measles German Outstanding sign: Kopliks (enanthem)

(Rubeola) measles
(Rubella) Exanthem: rashes
Koplik spot Forscheimer
Signs of rash: facial rash
spot
Buccal Palate Stimson’s line: bilateral red line on the lower
mucosa conjunctiva
Measles MMR
vaccine Prevent: penumonia, diarrhea, malnutrition
(AMV1)
9mnths or as 1yr
early as
6mnths Chicken Pox
Stimson Line
Agent: herpes zoster virus type 3

MOT:
S/S:
Period of communicability
Slight fever
Incubation period
Maculo-papular rash for a few hrs/vesicular (fluid
10days = fever
filled)
14 days = rashes (8-13 days)
Vesicular for 3-4 days = scarring = pneumonia
9 mnths of vaccine protection 83%
Incubation: 2-3 wks commonly 13-17days
1 yr 9
Period of Communicability
Method of Prevention and control
Presence of scabs: fluid in lesions
- Avoid exposing children to any person with
Second attack are rare: shingles
catarhhal symptoms
- Isolation of cases from diagnosis until 5-7 days Outstanding: pain = nerve endings
after onset of rash
Method of prevention and control
- Disinfection of articles soiled with infected
secretions - Case over 15yrs of age should be investigated
- Administration of measles immune globulin to to eliminate the possibility of small pox
susceptible infants - Isolation
- Current disinfection of throat and nose
- Discharges
Nursing Care - Avoid contact with susceptible

- Protect eyes from glare (vitamin A/6mnths

repeated every 6mnths until child reach 3yrs of
Mumps
age)
- Keep patient in adequately ventilated room Agent: paramyxovirus
Salivary gland = parotitis DPT 10 years

Incubation period: 6-12 days - Cause by neuro toxinx

When is mump dangerous: puberty –

sterility/infertility
Agent: clostridium tetani
Before 9yrs of age/before puberty
Method of prevention and control
S/S:
- Pregnant women should be actively immunized
- Painful swelling in front of the ear, angle of in region where tetanus neonaturum is
jaws and down the neck prevalent
- Fever
- Malaise
- Loss of appetite Influenza (common flu/ABC)
- Swelling of one or both testicles = orchitis;
excessive temperature S/S
Ice packs and prevent scrotum from hanging - Abrupt onset of fever
Treatment - Chilly sensations/chills
- Aches/pains in back
Prophylactic: vaccine/immunization against the - Respiratory symptoms include: coryza, sore
disease throat and cough
Active treatment: average case First sign
Diptheria Drug of choice: Penicillin
Hallmark: Grayish/Sodo membrane

Pertussis Pneumonia
Hallmark: Whooping cough

Direct contact/overcrowding Cholera

S/S

- Ordinary cold which becomes increasingly Typhoid fever

severe
- Paroxysms of cough 5F’s: Finger, food, feces, flies and fomites
- Vomiting may follow spasm Fecal oral
-
S/S:
Period of Communicability
- Fever (ladderlike/steplike fever)
Catarhhal stage

Drug of choice
Bacillary Dysentery
- Erythromycin
S/S:
Tetanus

Initial sign abdominal rigidity

Hepa A, B
Panthomonic signs Trismus
Paralytic Shellfish Poisoning (red tides)
Agent: red diniflagellates Vector: Itch mite

MOT: seafoods S/S:

Incubation Period: 30mins to several hrs - Itching

- When secondarily infected, the skin may feel
S/S:
hot and burning with minor discomfort
- Numbness of the face especially around the
Anthrax
mouth
- Vomiting and dizziness Agent: bacillus anthracis
- Headache
Cutaneous form
- Tingling sensation, paresthesia and eventual
paralysis of hands and feet - Exposed part of skin begins to itch and papule
- Rapid pulse appears in inoculation site.
- Difficulty of speech and difficulty swallowing - Papule became vesicle and then evolve into
- Total muscle paralysis with respiratory arrest depressed eschars
and death in several cases
Pulmonary form
Patients who survive 12hrs = has greater chances
of survival - Onset resembles as that upper respiratory tract
infection
- After 3-5 days infection becomes acute, with
fever, shock and death

Gastrointestinal Anthrax
Leptospirosis
- Violent gastrointeritis with vomiting and bloody
Agent: spirochete bacterium leptospira
stools
Tetracycline high tendency for resistance
Methods of Control

- Immunize the high risk person with cell free

Rabies vaccine
- Educate employees handling potentially
Lysa virus
contaminated articles about mode of
RA 9482 - act elimination rabies among humans transmission
(Responsible pet ownership) - Control dusts and proper ventilation in
hazardous industries especially those that
handle raw animal materials
MOT:

- Bite of a rabid animal Sexually Transmitted Disease (STD)

- Human to human transmission possible
- Incubation period: 2-8 wks Infection S/S
- Period of communicability: 3-10 days Chlamydia – C. Discharge - Tetracycline
trachomatis whitish Erythromycin
Monitor dog for 10-14 days Gonorrhea – Burning/Tulo Ceftriaxone
Neisseria Doxycycline
If dog is dead cut off the head and bring it to gonorrhea Amoxicillin
Department of Agriculture Syphilis – Chancre – Benzanthine
treponema painless penicillin
pallidum lesion
Scabies Genital herpes Painful Acyclovir
– type 2 blisters
 Bathing with
dilute
NaHCO3
Analgesics
Trichomoniasis Avocado like Metronidazole
– trichomonas discharge
vaginalis
Candidadiasis Cottage Nystatin –
– candida cheeselike swish and
albicans swallow
Fluconazole
Pubic lice Nits Permethrin
Lindane
Genital warts Couliflower Sitz bath
like Yearly
papsmear

HIV/AIDS

Zidovudine – pregnant women with HIV

Below 200 CD4 progress to aids

Meningococcemia

Hallmark: hemorrhagic rash (maplike purpura)

Bird flu (italy)

Drug of choice: tamiflu (oseltamivur)

SARS COVID-19 MERS-COV

Coronavirus
Respiratory
system
Guangdong Wuhan Middle east
Bats Bats Camel
N95