Infectious Diseases (Communicable diseases)

1. Infectious Diseases(Communicable diseases)

2. 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?

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

5. Today’s focus.... • Meningitis • Pneumococcal disease • Measles • Mumps • Rubella • Impetigo • Varicella

6. 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

7. 3 main causes of meningitis in children (historically) • Neisseria meningitidis (meningococcal) • Haemophilus influenzae type B (Hib) • Streptococcus pneunomaie (pneumococcal)

8. Presentation • Headache • Fever • Cold hands and feet • Stiff neck • Photophobia • Lethargy • Drowsiness • Loss of consciousness • Shock – tachycardia, tachyapnoea • Purpuric /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

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

10. Most common presentation of meningococcal disease is meningitis and septicaemia • Disease onset is sudden • 1 in 8 people who recover are left with long term complications • Case fatality rate is high but varies with age, serogroup, clinical presentation and prompt treatment

11. Meningococcal septicaemia

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

13. Prognosis & Complications • 10% mortality in UK • Higher in cases with septicaemia • 25% of survivors experience reduced QOL • 10-20% permanent sequelae • Common are skin scars, hearing loss, limb amputations, seizures and brain damage

14. Pneumococcal disease (HPA) • Caused by infection with bacteria Streptococcus pneumoniae • This bacterium (also called the pneumococcus) is responsible for causing pneumococcal disease • The bacteria are carried in the nose and throat • Transmitted through infected droplets through coughing, sneezing & close contact • Asymptomatic carriage possible • Whether infection develops or not depends on immune system and on virulence of serotype acquired • Over 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

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

17. Management • Antibiotics – type depends on pathogen • Commonly cephalosporin group (e.g. cefotaxime, ceftriaxone) • Treatment of symptoms • Anti-pyretics • Analgesia

18. Measles, mumps and rubella • All are viral infections • All spread by airborne or droplet transmission • Varying incubation periods • Immunisation using MMR vaccine

19. Measles • Extremely contagious viral illness caused by Morbillivirus • Most common in 1-4 year olds • Spread by contact with nose and throat secretions and in airborne droplets released when an infected person sneezes or coughs • Transmission period is from beginning of first symptoms to 4 days after appearance of the rash • Incubation period ranges from 7 to 18 days

20. Symptoms • Early symptoms include: • runny nose • cough • red and watery eyes and • small white spots inside the cheeks (Koplik’s spots)

21. More symptoms • Followed 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

22. Measles

23. Rare complications Complications • Common complications • Otitis media • Pneumonia • Diarrhoea • Convulsions • In 2008, nobody died from measles in the UK • In India there were over 81,000 deaths in children under 5 years (Black et al. 2010) Encephalitis SSPE Death

24. Mumps • Acute viral illness caused by paramyxovirus • Transmitted through the air when infected person coughs or sneezes • Incubation period 14-25 days • Transmissible for several days before the parotid swelling to several days after it appears Symptoms • Headache 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 symptoms • Most severe in adults

25. Rubella – German measles • Caused by Toga virus • Transmitted through direct or droplet contact with nasopharyngeal secretions • Incubation period is 14 – 21 days • Infectivity period from 1 week before until 5-7 days after the onset of rash • The peak incidence of infection is late winter and early spring • Often a mild illness • May begin with swollen lymph glands, low grade fever, malaise & conjunctivitis • Maculo-papular discreet rash develops on face, neck and body • Swollen joints and joint pain common in adults

26. Congenial rubella syndrome • Risk for unprotected pregnant women • Risk of foetal damage is estimated at: • - 90% in first 10 weeks • - 10-20% by 16 weeks • - Rare after 20 weeks • Defects include cardiac, auditory, ophthalmic, neurological problems

27. How do we treat these infections? • There are no treatments for these infections • The symptoms are treated • Prevention is immunisation • Remember: Measles is a major cause of child death in developing countries

28. What are these?

29. Impetigo • Highly contagious • Bacterial • localised • Caused by staphlococcal or streptococcal skin infection • Nasal carriage important • Local and/or systemic antibiotic treatment

30. Varicella – chicken pox • Caused by the varicella zoster virus • Vesicles are infectious until they are ‘dry’ • Infectious prior to vesicles appearing • Contact or droplet spread (virus in nasopharynx) • Danger in pregnancy • So common in childhood that 90% of adults are immune • Vaccine available • Can be complications especially in adults • The shingles connection

31. There are many infectious diseases some more or less common in children • We will come across more tomorrow when we look at vaccination • There are global variations • Nursing care means considering transmission to others • Some children may be more susceptible to infections

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