primary, secondary, tertiary prevention
- related: General Medicine
- tags: #literature #pulmonary
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- primary: prevent disease from occuring
- secondary: soften impact of disease that already occurred
- tertiary: soften impact of longterm effect, e.g. cardiac rehab after NSTEMI
Primary prevention is defined as the action taken to avoid or remove the cause of a health problem in an individual or a population before it arises. Primary prevention for influenza focuses on the reduction of new influenza cases; by reducing exposure rates and increasing resistance, the number of new cases can be reduced. The target population for primary prevention include those who are most likely to be exposed and/or could increase their resistance. Activities related to primary prevention related to influenza include removal or reduction of sources that increase the risk of influenza infection, introduction of educational programs regarding appropriate behavioral changes to reduce exposure in a community and promotion to improve general health of the population. In addition, recommendations to prevent influenza among health-care providers by seasonal influenza immunization programs are related to primary prevention (choice A is incorrect).
Among the different categories of prevention, secondary prevention relates to “actions taken to detect a health problem at an early stage in an individual or a population, thereby facilitating a cure or reducing or preventing it spreading or long-term effects.” Secondary prevention relates to the administration of anti-influenza chemoprophylaxis as soon as possible to all exposed patients and health-care providers in an ICU at risk to develop the disease (choice B is correct). The three classic categories of prevention include primary, secondary, and tertiary prevention, respectively. The goal of secondary prevention focuses on reducing the severity of a disease (reducing morbidity) and new cases (incidence) of influenza in patients or health-care providers at risk. This may apply to influenza cases (reducing severity of symptoms or duration of illness), and the community (reduce severity of the influenza outbreak or spread of the disease and shorten the length of time the outbreak exists). Early detection of a disease-causing exposure or identifying influenza in its early state can lead to early treatment to either stop the progression of the disease or reduce its severity, which will reduce influenza-related complications, respectively. Identification of those who have the disease and are ill can also aid in reducing the spread of the disease to others in the community. For instance, screening for respiratory symptoms, fever and altered mentation can lead to the identification of patients who require postexposure prophylaxis. Therefore, the target population for secondary prevention includes individuals who are at risk of exposure or risk of disease after exposure or those who present with early disease.
Despite the limited data on clinical effectiveness of antiviral chemoprophylaxis for controlling influenza outbreaks in hospitals, the clinical practice guidelines recommend the use of chemoprophylaxis to all exposed patients or health-care providers who do not have suspected or laboratory-confirmed influenza, regardless of influenza vaccination history. In addition to chemoprophylaxis, the guidelines emphasize the implementation of all other recommended influenza outbreak control measures, when an influenza outbreak has been identified in a hospital. Data on the effectiveness of antiviral chemoprophylaxis for controlling influenza in hospitals are limited. The use of oseltamivir or zanamivir chemoprophylaxis for exposed patients has been described in neonates, older children, and adults in conjunction with other interventions to control nosocomial influenza outbreaks. As mentioned, decisions about antiviral chemoprophylaxis should consider the anticipated severity of illness, risk of complications, and mortality associated with influenza in the population at risk and on the ability to implement control measures, including isolation and spatial separation of susceptible individuals from each other. Influenza vaccine should be administered to all health-care personnel each season, as vaccine is more likely to be immunogenic in health-care personnel compared with residents from long-term facilities (primary prevention).
Tertiary prevention refers to the action taken to reduce the chronic effects of a health problem in an individual or a population by minimizing the functional impairment consequent to the acute or chronic health problem. The goal of tertiary prevention in influenza is to reduce the risk of disease-related premature mortality or long-term morbidity and increasing the likelihood of returning to a state of health. The rationale of tertiary prevention is that once disease (eg, influenza) occurs, tertiary prevention will focus on controlling cardiac-related complications or premature death. The novel concept of quaternary prevention is not fully adopted but is defined as the action taken to identify patients at risk of overmedication/polypharmacy, to protect individuals from new medical interventions, and to suggest interventions that are ethically acceptable. Therefore, quaternary prevention related to influenza has not been fully addressed (choice D is incorrect).1