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Vaccine Preventable Diseases
Terms in this set (45)
What are the 7 vaccine preventable diseases
¥ Measles, Mumps, Rubella
¥ Hepatitis B and A
¥ Hib (Haemophilus influenzae type B)
Subacute sclerosing panencephalitis
Subacute sclerosing panencephalitis (SSPE) is a progressive, debilitating, and deadly brain disorder related to measles (rubeola) infection.
o Rare, seen when measles acquired at young age
o Personality changes, mental deterioration
Presentation of measles
¥ Fever, rhinorrhea, cough, conjunctivitis, malaise, Koplik's spots (2-3 days), rash (3-5 days)
¥ Rash: facial at hairline and descending
¥ Ear infection, pneumonia, diarrhea, encephalitis, deafness, MR
How long does the measles rash last?
When are you contagious with measles? How is it spread?
Contagious 4 days before and after rash
¥ Transmitted by respiratory droplet
¥ Highly virulent, an exposed un-immunized child will most likely contract disease
If a pt has the measles, MMR vaccine can also be given to...
members who have contact with immunosuppressed patient
¥ Salivary and parotid gland swelling, meningitis, orchitis
¥ Sterile rare after orchitis
**95% parotid swelling, tender, not warm or erythematous, start unilateral and can go bilateral
low-grade fever, malaise, headache, myalgias and anorexia.
¥ Mild facial rash
¥ Swelling to post-auricular lymph nodes
TORCH infection: deafness, blindness, heart defects, mental retardation
Why vaccinate for Rubella
¥ million infected in US asymptomatic and can pass by casual contact, sharing toothbrushes, razors, washclothes
¥ Fulminant hepatitis
¥ Hepatocellular carcinoma
¥ Chronic infection occurs more likely in young children
¥ 90% of newborns infected during perinatal period develop chronic infection
¥ If infected in first 5 years, 15-25% risk for premature death
Hep B presentation
¥ Most children under 5 may be asymptomatic
¥ Older children have fever, fatigue, anorexia, nausea/emesis, abdominal pain, dark urine, clay colored stool, myalgia, jaundice
**One third of chronic hepatitis B infections occur in infants and young children
Hep B vaccination is at birth... when do you give it more specifically?
¥ If HBsAg positive, give HBIG and hepB vaccine within 12 hours of birth
¥ If HBsAg unknown, give hepB vaccine within 12 hours of birth, while testing mother
¥ If HBsAg negative, give hepB vaccine before hospital discharge
¥ If not immunized before discharge, single antigen vaccine to be given within 1 month of birth
Hep A presentation and how it can be transmitted
¥ Nausea/emesis, anorexia, fever, malaise, abdominal pain, jaundice
¥ Asymptomatic in children less than 6 years (70%)
¥ Food-borne illness, close personal contact
Which diseases does Pneumococcal present in
¥ Pneumonia - Most common
¥ Ear infection
¥ Sinus infection
Children at risk for pneumococcal infection
¥ Decreased immune function from disease or drugs
¥ Functional or anatomic asplenia (SS, HIV)
¥ Chronic heart, pulmonary (including asthma), liver, or renal disease
¥ Smoking cigarettes
¥ Cerebrospinal fluid leak, cochlear implants
¥ Direct person-to-person contact via respiratory droplets and by autoinoculation in persons carrying the bacteria in their upper respiratory tract.
¥ The spread may be influenced by crowding, winter/spring season, and the presence of upper respiratory infections or pneumococcal disease such as pneumonia or otitis media.
DAYCARE CENTERS MAKE IT WORSE
Disorders with Haemophilus Influenza Type B infection
¥ Meningitis - Most common before vaccine
¥ Infectious arthritis
¥ Purulent pericarditis
¥ Endocarditis and osteomyelitis
Complications of Hib
¥ 3%-6% of Hib cases in children are fatal
¥ Up to 20% of patients who survived Hib meningitis have permanent hearing loss or other long-term neurological sequelae
In non-invasive cases of bronchitis or otitis media, complications are rare and typically not severe
Children at risk
¥ Sickle cell disease
¥ HIV infection
¥ Antibody and complement deficiency syndromes
¥ Malignant neoplasms
¥ Unimmunized children younger than 4 years of age
¥ Household contacts and day-care classmates of a person with Hib disease
¥ Increased risk for disease among close contacts of patients with non-b or nontypeable Haemophilus influenzae has not been identified.
Transmission of Hib
Direct contact with respiratory droplets from nasopharyngeal carrier or case patient. Neonates can acquire infection by aspiration of amniotic fluid or contact with genital tract secretions containing the bacteria.
MC presentation of tetanus
Presentation of tetanus
¥ "Lock jaw" muscle spasms of jaw are most common
¥ Abdominal rigidity
¥ Painful muscle stiffness and spasms all over the body
¥ Primarily jaw and neck muscles, secondarily trunk and back
¥ Full body spasms appearing like seizure activity
¥ Difficulty swallowing
¥ Fever and sweating
¥ Hypertension and tachycardia
¥ Pulmonary embolism
¥ Aspiration pneumonia
3 main forms of tetanus
*Generalized tetanus: most common, >80% of cases.
*Localized tetanus: spasms confined to the area around the injury, usually occurs in people with partial immunity. Can progress to generalized.
*Cephalic tetanus: rarest form, usually occurs with lesions on head or face. Has been associated with otitis media. Incubation period is usually 1-2 days. Disease results in flaccid cranial nerve palsies rather than spasm. Spasm of the jaw muscles may also be present. Can progress to generalized.
When do symptoms typically occur with tetanus in neonatal peeps?
symptoms usually appear from 4 to 14 days after birth, averaging about 7 days.
Why vaccinate for tetanus? Treatment if you get it?
Site of entry (wound) may not always be apparent
Wounds can be contaminated by dirt, feces, soil, or saliva
Treatment is largely supportive care
o Human tetanus immune globulin (TIG) and tetanus toxoid booster
o Supportive care includes muscle relaxants, tracheostomy, mechanical ventilations, aggressive wound care and antibiotics may be needed
Varicella prodromal phase...
1-2 days prior to rash:
o Decreased appetite
Progressive, itchy rash: 250-500 lesions typical
In vaccinated people, breakthrough wild-type varicella usually presents > 42 days after vaccination, with less than 50 lesions, usually maculopapular instead of vesicular lesions and with low or no fever
Diagnosis of Varicella
VZV PCR with vesicular fluid (preferred)
o Can be used to distinguish wild type from vaccine strain
PCR assay of saliva or buccal swab in acute phase
Describe varicella rash
three or more successive crops that progress usually within 24 hours from macules to papules to vesicles and then crust over.
Different stages of rash will be seen all over the body. Rash typically starts on face/trunk and then spreads to extremities.
How long are peeps contagious with varicella? Incubation time? How long does the illness last?
* Infected individuals are contagious for 1-2 days prior to outbreak of rash and then until all lesions have crusted over; about 4-7 days.
*About 1 in 1,000 children will develop severe complications including pneumonia, encephalitis or bacterial super infections
*Average incubation period for varicella is 14 to 16 days (range 10-21 days) after exposure to a varicella or a herpes zoster rash, with a range of 10 to 21 days.
*Illness typically lasts 5-10 days
¥ Supportive care including antihistamines, oatmeal baths, calamine lotion, and Tylenol
¥ IV Acyclovir in immunocompromised people
¥ Oral acyclovir
Who should receive oral acyclovir?
o Healthy persons older than 12 years of age
o Persons with chronic cutaneous or pulmonary disorders
o Persons receiving long-term salicylate therapy
o Persons receiving short, intermittent, or aerosolized courses of corticosteroids
Not recommended in healthy children. Has poor GI absorption
If treatment is used, children at moderate or high risk of developing severe infection can use oral acyclovir. If the child has a high risk of developing severe infections, IV Acyclovir should be used.
Classic varicella rash description
dewdrops on a rose petal
About 1 in 50 women who contract chickenpox during their pregnancy will...
deliver children with birth defects
Varicella infection has a higher case-fatality rate in infants when the mother develops varicella...
from 5 days before to 2 days after delivery, because there is little opportunity for development and transfer of antibody from mother to infant and the infant's cellular immune system is immature.
Complications of Varicella
¥ Bacterial skin infections (cellulitis, necrotizing fasciitis)
¥ Encephalitis or acute cerebellar ataxia
¥ Fetal infection
Fetal infection after maternal varicella during the first or early second trimester of pregnancy occasionally results in fetal death or varicella embryopathy, characterized by limb hypoplasia, cutaneous scarring, eye abnormalities and CNS abnormalities.
Presentation of Bordatella Pertussis
¥ Paroxysmal ("sudden attack") coughing followed by forced inspiratory effort causing a "whoop" however most children who are infected do not have this typical constellation of symptoms
¥ CDC Case Definition: A cough illness lasting at least 2 weeks with one of the following: paroxysms of coughing, inspiratory "whoop," or post-tussive vomiting, and without other apparent cause
Incubation period/progression of pertussis
Incubation period after exposure: 7-10 days
Catarrhal: "common" cold with mild cough and coryza, fever uncommon, cough gets worse over time
Paroxysmal: coughing persists and severity increases, paroxysm can lead to gagging and cyanosis, post-tussive emesis occurs frequently. Testing during this period can be inconclusive. This stage lasts 2-6 weeks and complications are most likely during this stage.
Convalescent: Cough subsides and cough continues to decrease gradually over several weeks to months.
Cough of 100 Days in China
Infant presentation of pertussis
¥ Catarrhal stage is often very short or absent
¥ Early symptoms include feeding difficulties, tachypnea, and cough, paroxysms of cough can lead to gagging, apnea, cyanosis, and bradycardia
¥ Appear well between episodes of coughing and may not exhibit characteristic whoop, in one series only 9 out of 24 infants with pertussis in a PICU had a whoop
¥ Typically the source of infection in most infants is a household contact
Who is most at risk for complications of Pertussis
6mo and younger
¥ Apnea, in infants thought to be due to vagal stimulation
¥ Pneumonia is the most frequent complication which can lead to pulmonary hypertension from acute pulmonary vasoconstriction and extreme leukocytosis
¥ Vomiting which happens in 50% of children less than 12 months of age
¥ Seizures that are of new onset occurred in 1-2% of children less than 6 months of age
¥ Death frequently occurs in infants younger than 6 months of age
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