Pedia: Vaccine Preventable Communicable Diseases

1 VACCINE PREVENTABLE COMMUNICABLE DISEASES By Dr. Co (Pedia2 Module4/ Lecture Date: June 22, 2006)

Conjugate polysaccharide •

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Koch’s Postulates Established that a different microbe causes each communicable disease 1. 2. 3. 4.

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Chain of infection must exist for disease to be communicable Pathogen of Elimination through causation cleaning, sterilizing & disinfecting Reservoir or place Elimination or minimizing of where pathogen breeding places of vectors lives Method of Surgical marks & gloves, transmission quarantine, control of vectors Susceptible host Immunization

IMMUNITY AND IMMUNIZATION •

Innate Immunity Individual has been resistant to a specific organism. • Acquired Immunity o Active • The active exposure to an organism; artificiallyinduced; requires the competent immune response to the antigen exposure; long-term o Passive • Temporary; achieved through the transmission of maternal antibody or through administration of immunoglobulin or antitoxin to a susceptible host • Herd Additional form of protection achieved through active immunization of a significant proportion of the population (70-80%) at risk, by increasing the people that can’t contact and can’t transmit a disease

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Toxoids Inactivated bacterial toxin that is modified in vaccine production and combined with an agent that prolongs its absorption to enhance antigenicity. o Toxoid stimulates antitoxins formation in the recipient. o Do not induce lifelong immunity therefore, required to be boosted periodically. e.g. tetanus VACCINE TYPE Live attenuated

Live bacterial Killed inactivated Killed bacteria

Subunits

Toxoid Polysaccharide (ineffective in children)

EXAMPLE MMR OPV Varicella Yellow Fever BCG Oral typhoid HepA Polio Rabies Cholera Pertussis Plague Typhoid Acellular pertussis HepaB influenza typhoid lyme Tetanus Diphtheria Meningococcal disease Pneumococcal disease

Monoclonal Antibody Sera prepared from lymphocytes Contains antibody against one microorganism Least complex

Contraindication & precautions to Live vs. Killed vaccines under various circumstances LIVE VACCINE CI CI CI Use with caution

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KILLED VACCINE CI No CI/ precautions No CI/ precautions No CI/ precautions No CI/ precautions

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Immunization doses by age for infants & children

VACCINE (4 to 6 years old) DTP Polio MMR Hepa A

Made from infecting organism (viral/bacterial) Killed or attenuated

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 Equine (antitoxin) sources  more side effects Confer temporary passive immunity (~6-12 weeks)

VACCINE (BIRTH TO 2 years old) BCG ** Hepa B DTP Hib Polio Pneumococcal conjugate MMR Measles Varicella

Vaccines

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Sterile solutions containing preformed antibody derived from:  Human (Ig) or

CIRCUMSTANCE Allergy to vaccine Pregnancy Immunosuppression Severe illness Recent administration of blood products

IMMUNOBIOLOGIC AGENTS •

Immune Sera

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COMMUNICABLE DISEASES

Hib Pneumococcal disease

Number of doses 1 3 4 4 4** (3 in USA) 4 1 1 1 Number of doses 1 1 1 2

Safety concerns related to immunization VACCINE MMR MMR Hepa B Hib Multiple vaccine with thimerosal DTP Pertussis Multiple vaccines Rotavirus Influenza Oral polio

Safety Concerns Autism Inflammatory bowel disease Autoimmune diseases, multiple sclerosis, rheumatoid arthritis Diabetes Autism SIDS Acute encephalopathy Overwhelming the immune system Intussusception Guillan-Barre syndrome Paralysis (VAPP)

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Characteristics of Vaccine Preventable Disease DISEASE

Diphtheria

Hib

HepB

TYPE OF ORGANISM

MODE OF TRANSMISSION Person to person, direct contact with

Gram (+)

Gram (-)

Virus

Person to person, Direct contact or airborne droplets Exposure to infected blood or body fluids. In children, primarily prenatally spread

Person to person contact or droplet Measles

Mumps

Pertussis

Pneumococcus

Polio

Rubella

Tetanus

Varicella

Virus

Virus

Person to person contact or droplet. Communicable the day before to 9 days after swelling. Most often occurs in children Person to person contact. Very contagious

Gram (-)

Gram (+)

Person to person contact or droplets. Many people are colonized in the Upper Respiratory Tract Direct contact of virus with mouth

Virus

Virus

Neurotoxin produced by anaerobe Gram (+)

Virus

Influenza

Virus type A or B

Rotavirus

Virus

HPV

Virus

SYMPTOMS Bullneck, Sorethroat, Fever, yellow-white to grayish membrane tonsils Otitis media, Sinusitis, Epiglotitis, Upper Respiratory Tract Infection Generally flu-like symptoms (may be asymptomatic). Liver may be enlarged, dark urine, light stool, jaundice. Symptoms last 4-6 wks Flu-like symptoms, high fever, cough, conjunctivitis, rash cephalocaudal. (+) Koplik’s spots Low-grade fever, headache, carache. Pain & swelling of parotid glands lasting about a week

respiratory distress, myocarditis

Non-productive cough with quick expiratory phase followed by inspiratory whoop. Scleral or conjunctival hemorrhage due to coughing. Otitis media, Sinusitis, Invasive bacterial infections

Pneumonia, fever, ear infections

Low-grade fever & sore throat (most cases are asymptomatic

Muscle weakness progressing to paralysis 0.1 – 2% of the cases. May affect any muscle group Severe complications in early fetal development may result in congenital malformation & death. Vaccine is live so it must not be given to pregnant women

Person to person or direct contact. Communicable 4 days before to 4 days after rash appears. Highly contagious

Mild in adults & young children. Macular rash on scalp, trunk & limbs lasting 1-3 days

Exposure of wound to the bacterium. Deep puncture woulnds are at greatest risk. Neonatal tetanus results from contamination of the umbilical stump Person to person, contact with airborne droplets. Very contagious. Communicable 2 days before to 6 days after vesicles appear. Primarily affects children

Severe generalized muscle spasms

Person to person, contact with airborne droplets

Fecal-oral route, usually from contaminated water Sexually transmitted especially among

COMPLICATIONS

Low-grade fever, listlessness. Lesions appear 2-4 days. Rash has 3 phases: raised spots, fluid-filled vesicles, scabs. Rash is highly pruritic and generalized Fever, myalgia, headache (flu-like symptoms) are prominent in older children & adults. Younger children asymptomatic. Watery diarrhea. Child <2 years old have more episodes due to absence of antibodies

Bacterial meningitis. Most invasive disease occur in children 3mos to 3 y/o Chronic hepatitis, Cirrhosis, Liver cancer

Pneumonia, encephalitis. For persons allergic to eggs can have severe reaction to the vaccine Orchitis in males who have reached puberty but sterility is rare. Infrequent complications are encephalitis & meningitis

Pneumonia, Meningitis

Grandparents should avoid caring for infected children, because they can develop advanced varicella if they haven’t had varicella in their lifetime. Herpes-Zoster. The very young & old are high risk of pneumonia.

severe dehydration, metabolic imbalance, malnutrition, intussusception Cervical cancer

ADDITIONAL NOTES

3 promiscuous adolescents /3na/secb‘08