Membership of the Faculty of Public Health (MFPH) Health Protection and Communicable Disease Control Syllabus

List the key principles of effective risk communication in an outbreak.

Be timely, transparent, and honest; acknowledge uncertainty; coordinate consistent messages across agencies; use trusted spokespeople; tailor to the audience; and provide actionable advice. Builds and maintains public trust.

Name the main outdoor air pollutants of public-health concern and a key effect of each.

$\text{PM}_{2.5}$ and $\text{PM}_{10}$ (cardiorespiratory disease, mortality), $\ce{NO2}$ (respiratory, traffic marker), $\ce{SO2}$ (respiratory irritation), ground-level ozone $\ce{O3}$ (respiratory), and carbon monoxide $\ce{CO}$ (hypoxia).

Why is $\text{PM}_{2.5}$ considered more harmful than $\text{PM}_{10}$?

Fine particulates with aerodynamic diameter $\leq 2.5\,\mu\text{m}$ penetrate deep into the alveoli and can enter the bloodstream, causing systemic cardiovascular and respiratory effects; $\text{PM}_{10}$ (coarse, $\leq 10\,\mu\text{m}$) is largely deposited in the upper airways.

What is the F-diagram in water and sanitation?

A model showing faecal–oral transmission routes from faeces to a new host via the five Fs: Fluids, Fingers, Flies, Fields/Floors (soil), and Food. Barriers (sanitation, handwashing, safe water, food hygiene) interrupt these pathways.

List the principles underpinning HACCP in food safety.

Hazard Analysis and Critical Control Points: (1) conduct hazard analysis, (2) identify critical control points, (3) set critical limits, (4) monitor CCPs, (5) establish corrective actions, (6) verification, (7) record-keeping. A systematic preventive approach to food safety.

Outline the immediate public-health priorities when responding to a chemical incident.

Identify the chemical and source, assess exposure routes and the population at risk, decontaminate and treat the exposed, control/contain the release (often led by fire service/HAZMAT), provide health advice (shelter or evacuate), and arrange longer-term health surveillance.

State the basic toxicology relationship governing chemical risk.

"The dose makes the poison" (Paracelsus). Risk depends on the dose–response relationship: $$\text{Risk}=f(\text{hazard}\times\text{exposure}).$$ Key thresholds include the NOAEL (no observed adverse effect level) and LOAEL; reference/acceptable daily intake derives from NOAEL divided by uncertainty factors.

Distinguish acute from chronic chemical toxicity.

Acute toxicity: adverse effects after a single or short-term high exposure (e.g. $\ce{CO}$ poisoning). Chronic toxicity: effects from repeated/low-level exposure over a long period (e.g. carcinogenesis, organ damage). Effects may be local or systemic, reversible or irreversible.

Differentiate ionising from non-ionising radiation with examples.

Ionising radiation has enough energy to remove electrons and damage DNA: alpha ($\alpha$), beta ($\beta$), gamma ($\gamma$), X-rays, neutrons. Non-ionising radiation lacks this energy: UV, visible light, infrared, microwaves, radio waves. UV is non-ionising but still carcinogenic to skin.

Define the SI units sievert (Sv) and gray (Gy) in radiation protection.

Gray ($\text{Gy}=\text{J kg}^{-1}$): absorbed dose of ionising radiation. Sievert (Sv): equivalent/effective dose, weighting absorbed dose for radiation type and tissue sensitivity to reflect biological harm: $$H_{T}=\sum_{R} w_{R}\,D_{T,R}.$$

State the three core principles of radiation protection (ICRP).

Justification (the benefit must outweigh the harm), Optimisation (keep exposures As Low As Reasonably Achievable — ALARP/ALARA), and Dose Limitation (individual doses must not exceed set limits). For external dose, reduce time, increase distance, and add shielding.

Compare deterministic and stochastic effects of ionising radiation.

Deterministic (tissue) effects have a threshold and severity rising with dose (e.g. skin burns, cataracts, acute radiation syndrome). Stochastic effects have no threshold and probability (not severity) rising with dose (e.g. cancer, heritable effects).

Distinguish climate change mitigation from adaptation in public health.

Mitigation: reducing greenhouse-gas emissions/drivers to limit the extent of climate change (e.g. decarbonisation, active travel). Adaptation: adjusting systems to reduce harm from changes already occurring (e.g. heatwave plans, flood defences). Many actions offer health co-benefits.

Name the major pathways by which climate change affects human health.

Direct: heatwaves, cold, floods, storms, wildfires. Ecosystem-mediated: changing vector-borne and water-borne disease ranges, air pollution/aeroallergens, food and water insecurity. Social: displacement, conflict, mental health impacts. Effects fall hardest on vulnerable groups (equity).

What does the Civil Contingencies Act 2004 require, and who are Category 1 responders?

It is the UK statutory framework for emergency preparedness. Category 1 responders (core: emergency services, NHS bodies, local authorities, Environment Agency) must assess risks, plan, maintain business continuity, warn/inform the public, and cooperate/share information. Category 2 (e.g. utilities, transport) must cooperate and share information.

What is a risk register (community risk register) and how are risks prioritised on it?

A tool used by Local Resilience Forums to list hazards/threats, assessed by likelihood and impact. Risks are plotted on a likelihood$\times$impact risk matrix to prioritise planning. Underpins the National Risk Register.

Define the UK emergency command structure: gold, silver, and bronze.

Gold (strategic): sets overall strategy and policy, off-site. Silver (tactical): coordinates and translates strategy into actions, manages resources. Bronze (operational): delivers tasks on the ground at the scene. This is the tiered command framework for major incidents.

What is the standard mnemonic for major-incident scene management by emergency services?

CSCATTT: Command and control, Safety, Communication, Assessment, Triage, Treatment, Transport. The first three (CSC) are the structural priorities; the latter (TTT) are the medical priorities.

Define a major incident.

An event or situation with a range of serious consequences requiring special arrangements to be implemented, typically beyond the scope of business-as-usual; it overwhelms or threatens to overwhelm normal resources and requires coordinated multi-agency response.

What is the purpose of triage in a major incident, and what does the triage sieve assess?

To prioritise casualties by clinical urgency so resources do the greatest good for the greatest number. The triage sieve rapidly categorises using mobility, airway, respiratory rate, and circulation (capillary refill/pulse) into priorities P1 (immediate), P2 (urgent), P3 (delayed), and dead.

List the core elements of a pandemic preparedness plan.

Surveillance and early detection, risk assessment, governance/command structures, healthcare surge capacity, antiviral/vaccine stockpiles and deployment, non-pharmaceutical interventions, communications, business continuity, ethical frameworks, and testing through exercises. Aligns with WHO pandemic phases.

Name the strategic non-pharmaceutical intervention phases often used in pandemic response.

Containment (case-finding, contact tracing, isolation to stop spread early), Delay (slow spread to protect health services / flatten the curve), Research/mitigation, and Recovery. "Flattening the curve" lowers and spreads the peak to stay within healthcare capacity.

What is a business continuity plan (BCP) and what is the difference between an MTPD and an RTO?

A BCP ensures critical functions continue or quickly resume after disruption. The Maximum Tolerable Period of Disruption (MTPD) is the longest a function can be unavailable before unacceptable harm; the Recovery Time Objective (RTO) is the target time to restore it, which must be shorter than the MTPD.

Outline the standard risk assessment process.

Identify hazards, assess who/what may be harmed and how, evaluate the risk by likelihood $\times$ consequence (often a risk matrix), decide on and implement control measures (hierarchy of control), and review/record. Aims to reduce risk to ALARP.

What is mass prophylaxis and when might mass chemoprophylaxis be used?

Rapid delivery of preventive medical countermeasures (vaccines or antibiotics/antivirals) to a large population to prevent disease after exposure. Mass chemoprophylaxis is used in events such as a meningococcal cluster, anthrax release, or pandemic, requiring countermeasure stockpiles and rapid distribution points (PODs).

Distinguish pre-exposure prophylaxis (PrEP) from post-exposure prophylaxis (PEP).

PrEP: medication/vaccine given before exposure to prevent infection in those at ongoing risk (e.g. HIV PrEP, travel vaccination). PEP: intervention given soon after a known/suspected exposure to prevent disease (e.g. HIV PEP, rabies PEP, meningococcal antibiotics).

Define antimicrobial stewardship and state its core aims.

A coordinated programme to optimise antimicrobial use — right drug, dose, route, and duration — to improve outcomes, reduce toxicity and cost, and slow the emergence of resistance. Embodied in "Start Smart, Then Focus": prompt appropriate empirical therapy, then review and de-escalate at 48–72 hours.

List the main mechanisms by which bacteria become resistant to antimicrobials.

(1) Enzymatic inactivation of the drug (e.g. $\beta$-lactamases), (2) altered/modified target site, (3) reduced uptake/decreased permeability, (4) active efflux pumps, and (5) bypass of the metabolic pathway. Resistance genes spread by mutation and by horizontal transfer (plasmids, transposons).

What is the difference between intrinsic and acquired antimicrobial resistance, and how is resistance surveilled?

Intrinsic: a species is naturally resistant (inherent feature). Acquired: resistance gained by mutation or horizontal gene transfer. Surveillance combines laboratory antimicrobial susceptibility testing (e.g. MIC, breakpoints) with reference systems such as national AMR/antibiotic-use reporting (e.g. ESPAUR) to track trends and alert mechanisms.

Define a healthcare-associated infection (HCAI) and name common examples and key prevention measures.

An infection acquired as a result of healthcare, not present/incubating on admission (typically appearing $\geq 48$ hours after admission). Examples: MRSA bacteraemia, Clostridioides difficile, catheter-associated UTI, surgical site infection, ventilator-associated pneumonia. Prevention: hand hygiene, aseptic technique, care bundles, environmental cleaning, antimicrobial stewardship, and surveillance.

What is the "One Health" approach?

A collaborative, multisectoral framework recognising that human, animal, and environmental (ecosystem) health are interconnected. It guides work on zoonoses, antimicrobial resistance, food safety, and emerging infections by integrating human medicine, veterinary, and environmental sectors.