COMPREHENSIVE PAST PAPER 2024

QUESTIONS

SECTION A - MODULE: PARASITOLOGY

1. Describe in detail the factors that affect the parasite-host relationship.

2. Discuss the classification of parasites of medical importance, including their major

groups, characteristics, and examples. Explain the significance of understanding this
classification in the context of public health.

3. Discuss the transmission of malaria, including its causative agents, life cycle, clinical
manifestations, complications, and public health implications. Additionally, explain the
current control measures and strategies for malaria prevention.

SECTION B - MODULE: ENVIRONMENTAL MICROBIOLOGY

1. Describe 4 positive and 3 negative impacts of microorganisms.

2. Mention the four (4) flagella arrangements in bacteria.

3. As a public health expert who has been tasked with cleaning up plastic and other
pollutants in beaches around Freetown and has been given microorganisms to accomplish
the task, describe in general terms the process you would employ in your effort, stating
the factors that affect the process as well as the benefits and constraints of the process.

SECTION C - MODULE: EPIDEMIOLOGY

1. An unexplained sudden death of about 42 infants under 1 year of age in the Tonkolili
district from 1 January 2022 to 31 December 2022 were compared to 88 healthy infants
of the same age group and with similar characteristics at the same period. As an
epidemiologist, you are sent to investigate what may have caused the death among these
age groups.

a. Enumerate the appropriate study design you will use as an epidemiologist to

carry out your study and give 2 reasons for your answer.

b. State the exposure and outcome under study for this design.

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 c. Give the appropriate measure of the strength of association you will use to
make your inference.

d. Construct and complete a 2x2 contingency table and calculate the strength of
association with interpretation.

e. State the 3 analyses you would make in this study.

Q2. Define the following terms as used in epidemiology:

Morbidity, Mortality, Sporadic, Fatality, Endemic, Outbreak, Epidemic

b. Explain in detail the 4 differences between incidence and prevalence.

c. Highlight three (3) differences between incidence risk and incidence rate in epidemiology.

d. Define the following terms as used in epidemiology:

i. Attack rate

ii. Secondary attack rate

iii. Proportion

iv. Proportional mortality

v. Cumulative incidence

SECTION D - MODULE: PUBLIC HEALTH IMMUNOLOGY

1a Discuss the types of Immunity.

1b Define Autoimmune Deficiency Disease.

1c Compare and contrast Immunoglobulin and Immunogen.

1d Write short notes on three (3) temperature monitoring devices.

2a Discuss the differences between Innate Immunity and Adaptive Immunity.

2b List all cold chain equipment and write short notes on any three (3).

2c Write short notes on the following:

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 I. Clonal selection theory
II. Primary Lymphoid Organs
III. Secondary Lymphoid Organs

PAPER ONE

ANSWERS

SECTION A: PARASITOLOGY

Q1

Factors That Affect Parasite-Host Relationship

The parasite-host relationship is a complex and dynamic interaction that is influenced by a

multitude of factors. These factors can be broadly categorized into two main groups:

1. Intrinsic factors
2. Extrinsic factors.

Intrinsic factors

Intrinsic factors are those that are inherent to either the parasite or the host and influence their
ability to interact with each other. These factors are discussed further

Parasite Factors:

 Parasite Life Cycle: The complexity and stages of the parasite's life cycle can affect the
mode of transmission, host specificity, and severity of the infection.
 Parasite Virulence: The ability of the parasite to cause damage to the host is a key
determinant of the severity of the infection.
 Parasite Immune Evasion: The parasite's ability to evade the host's immune system
plays a crucial role in establishing and maintaining infection.
 Parasite Host Specificity: The degree to which the parasite is restricted to a particular
host species or group of hosts determines the potential for infection and transmission

Host Factors:

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  Host Age and Sex: The age and sex of the host can influence susceptibility to infection,
severity of disease, and immune response.
 Host Genetics: Genetic variation within host populations can determine individual
susceptibility to infection and the ability to clear infections.
 Host Immune System: The strength and efficiency of the host's immune system play a
critical role in controlling parasite growth and preventing disease.
 Host Nutritional Status: Nutritional deficiencies can weaken the host's immune system
and increase susceptibility to infection

Extrinsic Factors

Extrinsic factors are those that are external to the parasite and host and can influence the

dynamics of their interaction. These factors include:

 Environmental Factors: Environmental conditions, such as temperature, humidity, and

availability of resources, can affect parasite survival, transmission, and virulence.
 Habitat and Geographic Distribution: The overlap of habitat and geographic range
between parasites and hosts determines the potential for contact and infection.
 Population Density: The density of host populations can influence the rate of parasite
transmission and the prevalence of infection.
 Human Intervention: Human activities, such as deforestation, urbanization, and
livestock farming, can alter ecological landscapes and increase the risk of parasite-host
interactions.
 Competition and Coinfection: The presence of competing parasites or co infections can
influence the outcome of individual infections and the overall dynamics of host-parasite
interactions.

Q2

Classification of Parasites of Medical Importance

Parasites are classified into TWO major groups based on their morphology and life cycles:

1. PARASITIC PROTOZOANS

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 o Characteristics: Single-celled organisms, capable of asexual and sexual
reproduction, motile via cilia, flagella, or pseudopodia.

Sub group

Parasitic Protozoans are classified into four subdivision base on their abilities to move. These
include;

1. Flagellated Protozoans 3. Sporozoans

Examples Examples

▪ Trypanosoma Toxoplasma

▪ Leishmania Plasmodium

2. Amoeboid Protozoans 4. Ciliated Protozoans

Entamoeba Example

Naegleria Balantidium

Public Health Significance: Protozoan infections like malaria, giardiasis, and amoebiasis are
significant causes of morbidity and mortality in tropical and subtropical regions.

2. HELMINTHS

Characteristics: Multicellular worms with complex life cycles, often requiring intermediate
hosts.

Subdivision

Helminths are divided in to two categories these include

1. Nemathehelminthes

Nematoda

(Round worms)

2. Platyhelminthes

Cestoda (Tapeworms)

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Trematoda (Flukes)

Examples:

 Ascaris lumbricoides (roundworm)

 Schistosoma spp. (blood flukes)

Public Health Significance: Helminth infections, such as soil-transmitted helminths and

schistosomiasis, are major public health concerns in many developing countries due to poor
sanitation.

Q3

Transmission of Malaria

 Causative Agents: Malaria is caused by Plasmodium species, primarily P. falciparum,

P. vivax, P. malariae, and P. ovale.

 Life Cycle:

1. Infective Stage: Sporozoites from infected Anopheles mosquitoes enter the

human bloodstream during a mosquito bite.

2. Liver Stage: Sporozoites infect liver cells, multiply, and develop into merozoites.

3. Blood Stage: Merozoites infect red blood cells (RBCs), multiply, and cause RBC
rupture, leading to clinical symptoms.

4. Gametocyte Stage: Some merozoites develop into gametocytes, which are taken
up by another mosquito during a blood meal, continuing the cycle.

 Clinical Manifestations: Symptoms include fever, chills, headache, anemia, and in

severe cases, complications like cerebral malaria, organ failure, and death.

 Complications: Severe anemia, acute respiratory distress syndrome (ARDS), cerebral

malaria, kidney failure.

 Public Health Implications: Malaria is a major public health burden, especially in sub-
Saharan Africa. It contributes to high morbidity and mortality, particularly in children
under five years and pregnant women.

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  Current Control Measures:

o Insecticide-treated nets (ITNs)

o Indoor residual spraying (IRS)

o Antimalarial drugs (e.g., Artemisinin-based combination therapies)

o Vaccination (e.g., RTS,S/AS01 vaccine)

o Vector control and environmental management

SECTION B: ENVIRONMENTAL MICROBIOLOGY

Q1a

Positive Impacts of Microorganisms

 Nutrient Cycling: Microorganisms decompose organic matter, recycling essential

nutrients like nitrogen and phosphorus back into the ecosystem.

 Food Production (photosynthesis): Microorganisms such as bacteria and yeast play a

critical role in food production processes like fermentation (e.g., in bread, yogurt, and
cheese production).

 Bioremediation: Microorganisms are used to break down pollutants in the environment,

such as oil spills, sewage, and toxic waste.

 Medical Applications: Microorganisms are used in the production of antibiotics,

vaccines, and other therapeutic products.

 Decomposers: Many microbes break down dead and decaying matter and recycle
nutrients that can be used by other organisms.

Negative Impacts of Microorganisms

 Disease Causation: Pathogenic microorganisms cause infectious diseases in humans,

animals, and plants (e.g., tuberculosis, cholera, HIV).

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  Food Spoilage: Microorganisms cause the decomposition and spoilage of food products,
leading to significant economic losses.

 Biodeterioration: Microorganisms can degrade materials like wood, plastics, and metals,
causing structural damage to buildings and infrastructure.

2. Four Flagella Arrangements in Bacteria

1. Monotrichous: A single flagellum at one end (e.g., Vibrio cholerae).

2. Lophotrichous: A cluster of flagella at one or both ends (e.g., Helicobacter pylori).

3. Amphitrichous: A single flagellum at each end (e.g., Spirillum volutans).

4. Peritrichous: Flagella distributed all over the surface (e.g., Escherichia coli).

Q3

General Process of Bioremediation

1. Site Assessment and Pollutant Identification:

Conduct a thorough assessment of the beaches to determine the types and extent
of pollution (plastics, chemical pollutants, etc.).

Identify the most suitable microorganisms that can degrade these specific
pollutants. For example, certain bacteria like Pseudomonas and Ralstonia can
break down plastics, while other microbes degrade hydrocarbons or heavy metals.

2. Microbial Selection and Introduction:

Based on the pollutants identified, select or genetically engineer microorganisms

known to degrade these substances.

Introduce these microorganisms to the polluted areas, ensuring that the

environmental conditions (pH, temperature, oxygen levels, and nutrients) are
favorable for microbial growth and activity.

3. Monitoring and Optimization:

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 Monitor the effectiveness of the microorganisms in breaking down the pollutants
over time. This involves testing the water, sand, and soil to track the reduction of
contaminants.

Adjust environmental factors (e.g., aeration, nutrient supply) to enhance microbial

degradation rates.

4. Natural Attenuation vs. Bioaugmentation:

In cases where indigenous microorganisms are already present and active, I would
employ natural attenuation, allowing them to break down pollutants at their
natural pace.

If the indigenous microbes are insufficient or ineffective, bioaugmentation would

involve adding externally sourced or engineered microorganisms to speed up the
process.

Factors Affecting the Bioremediation Process

1. Pollutant Type: Different pollutants require different types of microorganisms. Plastics,

for instance, are more difficult to degrade compared to organic pollutants like oils.

2. Microbial Species: The success of the process depends on the metabolic capabilities of
the microorganisms selected. Some may degrade pollutants faster than others.

3. Environmental Conditions: Factors like temperature, moisture, pH, and the presence of
oxygen (aerobic vs. anaerobic conditions) can significantly influence the activity of
microorganisms. For example, high temperatures and proper aeration are often required
for optimal degradation of plastic waste.

4. Nutrient Availability: Microorganisms require nutrients like nitrogen and phosphorus to

thrive. In environments lacking these, the addition of nutrients (biostimulation) may be
necessary.

5. Time: Bioremediation is a relatively slow process, and complete degradation of

pollutants like plastics can take months or even years.

Benefits of the Process

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 1. Eco-friendly: Bioremediation is a natural, non-toxic process that reduces the need for
chemical or physical clean-up methods, minimizing further environmental damage.

2. Cost-effective: Compared to traditional clean-up methods, bioremediation can be less

expensive since it utilizes natural processes and requires minimal infrastructure.

3. Targeted and Efficient: Microorganisms can be engineered or selected to target specific

pollutants, ensuring more efficient degradation.

4. Minimal Disruption: Since microorganisms work at a molecular level, they cause less
disruption to the local ecosystem compared to mechanical clean-up processes.

Constraints of the Process

1. Slow Degradation Rates: Microbial degradation of plastics, in particular, is a slow

process that might take years for full remediation. This may not meet immediate clean-up
requirements.

2. Environmental Variability: Factors such as extreme weather (heavy rains, high tides) or
fluctuating temperatures can impact the efficacy of microorganisms, making it
challenging to maintain optimal conditions.

3. Incomplete Degradation: Some pollutants, especially certain types of plastics or

chemically resistant substances, may not be completely degraded. Partial breakdown
products could still be harmful.

4. Monitoring Challenges: Continuous monitoring and adjusting environmental conditions

require resources and expertise, which could be costly and time-consuming.

SECTION C: EPIDEMIOLOGY

Q1

a) State the appropriate study design you will use as an epidemiologist to carry out your
study and state 2 reasons for your answer.

 Appropriate study design: Case-control study.

 Reasons:

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 1. It allows for the comparison of exposures (e.g., source of drinking water) between
cases (infants who died) and controls (healthy infants).

2. Compare the exposure in case and control

b) State the exposure and outcome under study for this design.

 Exposure: Source of drinking water.

 Outcome: Sudden death of infants under 1 year of age.

c) What appropriate measure of the strength of association will you use to make your
inference?

 Measure of association: Odds Ratio (OR).

d) Construct and complete a 2x2 contingency table and calculate the strength of association
with interpretation.

Diseased (case) Healthy (control) total

Expose (Well water) 23 15 38

Unexposed 46 28 74

Total 69 43 112

Odds Ratio = ad/bc

Odds Ratio (OR): (23*28) / (15*46)

= 644 / 690

= 0.93

 Interpretation: An OR of 0.93 suggests a weak association between well water and the
sudden deaths.

e) State the 3 analyses you would make in this study.

1. Correctness and integrity of the data

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 2. Descriptive analysis

3. Association analysis

Q2

a) Definitions:

I. Morbidity: Refers to the presence of illness or disease within a population.

II. Mortality: Refers to the occurrence of death within a population.
III. Sporadic: Occurs occasionally and irregularly without a predictable pattern.
IV. Fatality: The death rate or the proportion of deaths among the diagnosed cases of
a disease.
V. Endemic: A disease regularly found in a particular area or population.
VI. Outbreak: A sudden increase in the number of disease cases in a particular area
or population.
VII. Epidemic: A widespread occurrence of an infectious disease in a community at a
particular time.

b) Four Differences between Incidence and Prevalence:

Incidence Incidence
1 Incidence refers to new cases during a prevalence measures all existing cases
specific time period (both new and old) at a given time.
2 Incidence provides information on the prevalence indicates how widespread the
risk of contracting a disease disease is.

3 Incidence is a rate (cases per unit time), prevalence is a proportion (total cases over
the population).

4 Incidence is more useful for studying the prevalence is useful for understanding the
causes of diseases disease burden.

c) Three Differences between Incidence Risk and Incidence Rate:

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 Incidence Risk Incidence Rate
1 Incidence Risk is the probability that a Incidence Rate measures the number of
person without the disease will develop it new cases per unit of person-time.
within a specific time period
2 Incidence Risk is a proportion Incidence Rate is a rate.
3 Incidence Risk applies to closed populations Incidence Rate can be applied to open
populations where individuals may enter
or leave.

d) Definitions of Epidemiological Terms:

1. Attack Rate: The proportion of people exposed to a specific agent who develop the
disease, often used in outbreak investigations.

2. Secondary Attack Rate: The proportion of susceptible individuals who become infected
after being exposed to a primary case.

3. Proportion: A type of ratio where the numerator is part of the denominator (e.g., number
of disease cases in a population).

4. Proportional Mortality: The percentage of deaths due to a specific cause out of the total
number of deaths in a population.

5. Cumulative Incidence: The proportion of a population that develops a condition over a

specified period.

SECTION D: IMMUNOLOGY

Answers

1a) Types of Immunity

1. INNATE IMMUNITY

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2. ADAPTIVE IMMUNITY

a. Natural adaptive immunity

 Passive (maternal)
 Active (infection)
a. Artificial adaptive immunity
 Passive (Antibodies transfer)
 Active (immunization)

INNATE IMMUNITY:

This is the body's first line of defense and is present from birth. It provides a non-specific
response to pathogens and includes physical barriers (skin, mucous membranes), chemical
barriers (stomach acid, enzymes), and cellular defenses (phagocytes, natural killer cells).

ADAPTIVE IMMUNITY:

This is a specific response developed after exposure to antigens. It involves lymphocytes (T cells
and B cells) and provides long-term protection through memory cells

This type of immunity has memory, meaning that once the body has encountered a pathogen, it
"remembers" it and can respond more efficiently upon subsequent exposures. Adaptive immunity
can be classified into two broad categories: Natural and Artificial, each of which has active and
passive subtypes.

A. Natural Adaptive Immunity

Natural adaptive immunity is acquired through natural exposure to pathogens or maternal

transfer of antibodies. It is divided into two subtypes:

1. Natural Active Immunity (Infection-induced Immunity)

This type of immunity develops when a person is exposed to a pathogen, such as a virus,
bacterium, or other infectious agents, through natural processes. The immune system responds
by recognizing the pathogen as foreign, producing specific antibodies and activating T cells to
fight off the infection.

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  Example:

When you contract and recover from diseases like chickenpox or measles, your body creates
memory B and T cells that "remember" the pathogen. If you encounter the pathogen again, your
immune system mounts a faster and more effective response, preventing reinfection or reducing
its severity.

2. Natural Passive Immunity (Maternal Immunity)

This type of immunity is passed from mother to child naturally, either through the placenta
during pregnancy or through breast milk. The mother’s antibodies (immunoglobulins) are
transferred to the baby, providing immediate, but temporary protection against infections.

 Examples:

Placental transfer: During pregnancy, a mother passes her antibodies to the fetus through the
placenta, especially immunoglobulin G (IgG), which provides protection to the newborn for
several months after birth.

Breastfeeding: After birth, breastfeeding passes more antibodies to the infant, especially
immunoglobulin A (IgA), which helps protect the baby’s mucosal surfaces (e.g., gastrointestinal
tract).

B. Artificial Adaptive Immunity

Artificial adaptive immunity is acquired through medical interventions, such as vaccination or

antibody transfer through the introduction of killed, weakened forms of the diseased organism. It
is divided into two subtypes:

1. Artificial Active Immunity (Vaccination/Immunization)

Artificial active immunity is induced by vaccines, which contain weakened, dead, or inactivated
pathogens, or parts of the pathogen (such as proteins). These vaccines stimulate the immune
system to produce antibodies and memory cells without causing the disease. This prepares the
immune system to respond more effectively if it encounters the actual pathogen in the future.

 Examples:

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MMR vaccine: The measles, mumps, and rubella (MMR) vaccine contains live, attenuated
viruses that stimulate the body to develop immunity without causing the diseases.

Tetanus toxoid

2. Artificial Passive Immunity (Antibody Transfer or Immunoglobulin Therapy)

In artificial passive immunity, antibodies (immunoglobulins) are directly administered to an

individual through medical treatments. This provides immediate protection, especially in cases
where a person is already exposed to a pathogen or is at high risk for infection, but does not have
time to develop their own immune response.

 Examples:

Rabies post-exposure prophylaxis: After a person is bitten by a rabid animal, rabies

immunoglobulin is administered to provide immediate protection while the vaccine helps the
person develop their own immunity.

Tetanus serum

Q1b

Autoimmune Deficiency Disease

Autoimmune deficiency diseases occur when the immune system fails to distinguish between
self and non-self, attacking the body’s own tissues. This leads to various conditions such as
Systemic Lupus Erythematosus (SLE), Type 1 Diabetes, and Rheumatoid Arthritis.

Q1c

Similarities between Immunoglobulin and Immunogen

 Both immunoglobulins and immunogens play central roles in the immune response.
Immunogens trigger an immune response, while immunoglobulins (antibodies) are
produced as part of the immune defense against the antigen.
 Both can interact with antigens: immunogens stimulate the production of antibodies by
the immune system, and immunoglobulins bind specifically to antigens as part of the
immune system’s response.

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  Both are biologically significant in terms of recognizing and defending against
pathogens. Immunogens activate the immune system, while immunoglobulins serve to
neutralize, opsonize, or mark pathogens for destruction by other immune cells.
 Vaccination strategies often involve both: an immunogen (a weakened or inactivated
form of a pathogen) is introduced to stimulate the immune system, leading to the
production of immunoglobulins (antibodies) for future protection.

Differences between Immunoglobulin and Immunogen

Feature Immunoglobulin (Antibody) immunogen

Definition Immunoglobulins are glycoproteins Immunogens are any substances (often
produced by B cells that bind to specific proteins or polysaccharides) capable
antigens of eliciting an immune response.
Function They neutralize pathogens, assist in Their main function is to stimulate the
opsonization, and trigger immune cell immune system to produce a response,
functions. particularly the production of
antibodies
Origin Produced by plasma cells (activated B Any foreign substance or pathogen
cells) in response to an antigen. (e.g., bacteria, viruses, toxins)
introduced to the body.
Nature Immunoglobulins are proteins made by Immunogens are antigens that can be
the immune system proteins, lipids, polysaccharides, or
nucleic acids
Types There are five types of Immunogens are typically pathogens
immunoglobulins (IgG, IgA, IgM, IgE, (e.g., viruses, bacteria) or their
IgD). components (e.g., proteins,
polysaccharides).
Response Immunoglobulins respond to antigens Immunogens stimulate the production
by binding and neutralizing them of immunoglobulins and other
immune responses

1d) Three Temperature Monitoring Devices

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1. Vaccine Vial Monitor (VVM):

VVM are small indicator that adhere to vaccine vials and change color as the vaccine is expose
to cumulative heat letting the health worker know weather the vaccine has exceeded a preset
limit beyond which the vaccine should not be used. The VVM is labeled on the cap or neck of
the vials. VVM has a square box located in the circle (purple label). VVM has four stages, one
and two are recommended for used and stage three and four should not be used/ discarded.

These stages involved

2. Freeze Tag:

Freeze tag is a temperature monitoring device used to monitor the temperature of a vaccine in a
refrigerator. Freeze tag has a memory that last for 30 days. This means that when the cold chain
attendance is not around, he/she can still read and record the temperature for about 30 days.
Freeze tag alarms for temperature outside +2℃ to +8 ℃. It alarms for freeze (freeze alarm), if
the temperature is less than +2℃. It also alarms for heat (heat alarm), if the temperature is above
+8℃. Freeze tag does not only alarm for temperature (freeze or heat alarm) but also gives the
duration and time of exposure of the vaccine. Freeze tag is often effective for two years. After
that they need rerun or are changed completely. Records/ Readings are done twice a day, that is
immediately you get to work and before you leave for work. If it did not alarm it shows OK.

3. Thermometer:

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A thermometer is a common device used to measure and monitor temperature in vaccine
storage equipment like refrigerators, freezers, and cold boxes. Digital thermometers are preferred
for their accuracy and ease of reading. In cold chain management, thermometers help ensure that
vaccines are stored within their required temperature range (usually 2°C to 8°C for many
vaccines). Some thermometers come with alarms that alert users when temperatures fall outside
the safe range.

2a) Differences Between Innate and Adaptive Immunity

 Innate Immunity:

o Present at birth and provides non-specific defense.

o Rapid response within hours.

o No memory; response is the same each time.

o Involves physical barriers, phagocytes, and natural killer cells.

 Adaptive Immunity:

o Develops after exposure to pathogens (acquired).

o Slower initial response, but specific to the pathogen.

o Has memory; response is stronger and faster on subsequent exposures.

o Involves T cells and B cells, and the production of antibodies.

2b) Cold Chain Equipment (Any Three)

1. Refrigerators: Used to store vaccines at recommended temperatures (usually between

2°C and 8°C).

2. Cold Boxes: Insulated containers used to transport vaccines while maintaining their
required temperature.

3. Ice Packs: Used in cold boxes and vaccine carriers to keep vaccines cool during
transport.

2c) Short Notes on the Following:

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 Clonal Selection Theory: This theory explains how the immune system responds to
specific antigens. Each B or T lymphocyte has a specific receptor for an antigen. When
an antigen binds to the receptor, the lymphocyte is activated and clones itself, producing
more cells with the same receptor to combat the antigen.

 Primary Lymphoid Organs: These are the organs where lymphocytes (B cells and T
cells) mature. The primary lymphoid organs include the bone marrow (where B cells
mature) and the thymus (where T cells mature).

 Secondary Lymphoid Organs: These are the organs where immune responses are
initiated and where mature lymphocytes become activated. They include the spleen,
lymph nodes, and Mucosa-Associated Lymphoid Tissue (MALT).

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