Infectious Diseases (Communicable diseases)

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Infectious Diseases (Communicable diseases). Start with an activity. What does infectious mean? How many infectious diseases in children can you list? How are they transmitted (passed on)? Are the diseases you have named preventable through vaccination?. - PowerPoint PPT Presentation

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  • Infectious Diseases(Communicable diseases)

  • Start with an activity

    What does infectious mean?How many infectious diseases in children can you list?How are they transmitted (passed on)?Are the diseases you have named preventable through vaccination?

  • Worldwide causes of death in children under 5 years old (WHO, 2011)

    Chart1

    0.02

    0.14

    0.14

    0.03

    0.08

    0.12

    0.29

    0.17

    0.01

    Worldwide causes of death in children

  • Todays focus....MeningitisPneumococcal disease

    MeaslesMumpsRubella

    ImpetigoVaricella

  • Remember...Meningitis is like a symptom caused by a pathogen (virus or bacteria)Any vaccines developed have to be aimed at the pathogen There is not one vaccine which protects against all causes of meningitis

  • 3 main causes of meningitis in children (historically)

    Neisseria meningitidis (meningococcal)Haemophilus influenzae type B (Hib)Streptococcus pneunomaie (pneumococcal)

  • PresentationHeadacheFever Cold hands and feetStiff neckPhotophobiaLethargyDrowsinessLoss of consciousnessShock tachycardia, tachyapnoeaPurpuric /petechial rash (meningococcal disease only)

    These are not in any particular order and you must remember that the age of the child will impact on the assessment

  • Meningococcal disease (HPA,2012)Caused by infection with Bacteria Neisseria meningitidisGram negative diplococci, divided into 13 serogroups-Groups B and C are most common in the UK-Less common serogroups include A, Y, W135, and ZHealthy individuals carry the bacteria in their nose and throat without symptomsTransmission occurs through frequent and prolonged contact with respiratory secretions of a carrier from coughing, sneezing, kissing

  • Most common presentation of meningococcal disease is meningitis and septicaemia Disease onset is sudden1 in 8 people who recover are left with long term complicationsCase fatality rate is high but varies with age, serogroup, clinical presentation and prompt treatment

  • Meningococcal septicaemia

  • Impact of the introduction of Meningitis C vaccination (DH, 2010)

  • Prognosis & Complications10% mortality in UKHigher in cases with septicaemia25% of survivors experience reduced QOL10-20% permanent sequelaeCommon are skin scars, hearing loss, limb amputations, seizures and brain damage

  • Pneumococcal disease (HPA)Caused by infection with bacteria Streptococcus pneumoniaeThis bacterium (also called the pneumococcus) is responsible for causing pneumococcal diseaseThe bacteria are carried in the nose and throatTransmitted through infected droplets through coughing, sneezing & close contactAsymptomatic carriage possibleWhether infection develops or not depends on immune system and on virulence of serotype acquiredOver 90 serotypes identified (based on differences in polysaccharides in outer coating)Not all 90 serotypes cause disease about 80% invasive infections in UK children caused by just 8-10 of these types

  • Invasive PneumococcalDisease (bacteramia)

    Soft Tissue Infection (rare)

    Arthritis (rare)

    Sinusitis (common)

    Otitis Media

    Pneumonia

    Peritonitis (rare)

    Spectrum of pneumococcal infection

    Meningitis

  • Pneumococcal meningitis incidence rate per 100,000 population by age group, England and Wales, 1996-2005 (HPA)

  • ManagementAntibiotics type depends on pathogenCommonly cephalosporin group (e.g. cefotaxime, ceftriaxone)Treatment of symptomsAnti-pyreticsAnalgesia

  • Measles, mumps and rubellaAll are viral infections

    All spread by airborne or droplet transmission

    Varying incubation periods

    Immunisation using MMR vaccine

  • MeaslesExtremely contagious viral illness caused by MorbillivirusMost common in 1-4 year oldsSpread by contact with nose and throat secretions and in airborne droplets released when an infected person sneezes or coughsTransmission period is from beginning of first symptoms to 4 days after appearance of the rash Incubation period ranges from 7 to 18 days

  • SymptomsEarly symptoms include: runny nose cough red and watery eyes and small white spots inside the cheeks (Kopliks spots)

  • More symptomsFollowed by:- A slightly raised rash develops, spreading from the face and upper neck to the body and then to the hands and feet over a period of three days- Rash lasts 5-6 days- Loss of appetite and loose stools

  • Measles

  • ComplicationsCommon complicationsOtitis mediaPneumoniaDiarrhoeaConvulsions

    In 2008, nobody died from measles in the UKIn India there were over 81,000 deaths in children under 5 years (Black et al. 2010)Rare complicationsEncephalitisSSPEDeath

  • MumpsAcute viral illness caused by paramyxovirusTransmitted through the air when infected person coughs or sneezesIncubation period 14-25 daysTransmissible for several days before the parotid swelling to several days after it appears

    SymptomsHeadache and fever Parotid swelling which may be unilateral or bilateral Photophobia, neck stiffness (meningism) can develop

    At least 30% of cases in children have no symptomsMost severe in adults

  • Rubella German measlesCaused by Toga virusTransmitted through direct or droplet contact with nasopharyngeal secretionsIncubation period is 14 21 daysInfectivity period from 1 week before until 5-7 days after the onset of rashThe peak incidence of infection is late winter and early spring

    Often a mild illnessMay begin with swollen lymph glands, low grade fever, malaise & conjunctivitisMaculo-papular discreet rash develops on face, neck and body Swollen joints and joint pain common in adults

  • Congenial rubella syndromeRisk for unprotected pregnant womenRisk of foetal damage is estimated at:- 90% in first 10 weeks- 10-20% by 16 weeks- Rare after 20 weeksDefects include cardiac, auditory, ophthalmic, neurological problems

  • How do we treat these infections?There are no treatments for these infectionsThe symptoms are treatedPrevention is immunisation

    Remember: Measles is a major cause of child death in developing countries

  • What are these?

  • ImpetigoHighly contagiousBacterial localisedCaused by staphlococcal or streptococcal skin infectionNasal carriage importantLocal and/or systemic antibiotic treatment

  • Varicella chicken poxCaused by the varicella zoster virusVesicles are infectious until they are dryInfectious prior to vesicles appearingContact or droplet spread (virus in nasopharynx)Danger in pregnancySo common in childhood that 90% of adults are immuneVaccine availableCan be complications especially in adultsThe shingles connection

  • There are many infectious diseases some more or less common in childrenWe will come across more tomorrow when we look at vaccinationThere are global variationsNursing care means considering transmission to othersSome children may be more susceptible to infections

  • References/further readingDepartment of Health (2006) Immunisation against Infectious disease. London:TSOHealth Protection Agency website http://www.hpa.org.uk/HPAwebHome/ Lissauer, T. & Clayden, G. (2012) Illustrated Textbook of Paediatrics 4th ed. Oxford:Elsevier

    Symptoms of pneumococcal meningitis not the same as for meningococcal infection*