Download - Case Definitions
Case Definitions
Dr.Vijay YewaleConvener, IAP Committee on Immunization 2009-11 Editor, Pediatric Infectious Disease
Diseases covered• Pneumonia (PNUC and PNUR)• Acute Bacterial Meningitis
(ABMP/ABMM/ABMH/ABMO/ABME)• Diphtheria (DIPH)• Pertussis (PERT)• Measles (MEAS)• Mumps (MUMP)• Chickenpox (CPOX)• Enteric fever (EFTY /EFPT)• Dengue fever (DENF /DENH /DENS)• Hepatitis (HEPA, HEPB, HEPE, HEPO, HEPN)
PNEUMONIA• Clinical Pneumonia (PNUC)– High fever (> 38 Degree C) and – Tachypnea• > 60 breaths / min if aged < 2months• > 50 breaths / min if aged 2-11• > 40 breaths / min if aged 12m to <60 months
(Reasonably ruled out reactive airway disease)• Radiological Pneumonia (PNUR)– Abnormal chest radiograph suggestive of
Pneumonia
Microbiologic Diagnosis established
• No• Yes– Culture• isolation of a bacterial pathogen from pleural fluid or
blood
– Antigen detection• identification of a bacterial antigen in pleural fluid by
latex agglutination
– Antibody detection– Other • Gram stained smear of pleural fluid
Previous relevant vaccination • Not immunized (NI) : Not received any dose of
Pertussis, Hib and Measles containing vaccine or conjugate pneumococcal vaccine
• Partially immunized (PI) : Received either not all Pertussis, Hib and Measles containing vaccine and conjugate pneumococcal vaccine or not all age appropriate doses
• Fully immunized (FI): Received all age appropriate doses of Pertussis, Hib and Measles containing vaccines and conjugate pneumococcal vaccine
• Ineligible for Immunization (II): less than 6 weeks of age
ACUTE BACTERIAL MENINGITIS
• Acute onset of fever (usually > 38.5 °C rectal or 38.0 °C axillary and one of the following signs: Boggy fontanelle, seizures, neck stiffness, altered consciousness or other meningeal signs
WITH• Abnormal CSF– Turbid appearance OR– Leucocytosis (>100 cells / mm3) OR– Leukocytosis (10 – 100 cells / mm3 ) with elevated prot
>100mg% or CSF sugar <40 mg%
Microbiologic Diagnosis established • No• Yes– Culture• isolation of a bacterial pathogen from a normally sterile
clinical specimen such as CSF or blood
– Antigen detection• identification of a bacterial antigen in CSF by latex
agglutination
– Antibody detection– Other • Gram stained smear
• ABMP– ABM with S.Pneumo– +ve Gram stain / Latex / CSF or Blood culture
• ABMH– ABM with H.influenzae– +ve Gram stain / Latex / CSF or Blood culture
• ABMM– ABM with N.Meningitides– +ve Gram stain / Latex / CSF or Blood culture
• ABMO – ABM with organism other than P/H/N
• ABME– ABM with no microbiological diagnosis
Previous relevant vaccination(not applicable for ABMM and ABMN) • Not immunized (NI) : Not received any dose of
conjugate Pneumococcal and Hib vaccines• Partially immunized (PI) : Received either not
all of conjugate Pneumococcal and Hib vaccines or not all age appropriate doses
• Fully immunized (FI): Received all age appropriate doses of conjugate Pneumococcal and Hib vaccines
• Ineligible for Immunization (II) – Age less than 6 weeks
CHICKENPOX(CPOX)
• Vesicular rash starting on trunk and spreading to extremities in multiple stages of evolution
Microbiologic Diagnosis established
• No• Yes– Culture– Antigen detection– Antibody detection– Other
Previous relevant vaccination
• CPX vaccine – Not immunized (NI)• Not received any CPOX vaccine
– Partially immunized (PI) • Received one dose of CPOX vaccine
– Fully immunized (FI)• Received 2 doses of Chicken pox vaccine
– Ineligible for Immunization (II)• Age less than 15 months
ENTERIC FEVER
• Compatible clinical picture AND• EITHER blood culture positive OR• Positive TUBE WIDAL
( both H/ A/B and O > 1: 160) done beyond day 5 of fever
Microbiologic Diagnosis established
• No• Yes– Culture• S. Typhi or S.Paratyphi on blood culture
– Antigen detection – Antibody detection• WIDAL Test (both H/ A/B and O > 1: 160)
– Other
Previous relevant vaccination
• TY vaccine– Not immunized (NI)• Above 2 years and not received any typhoid
vaccine – Partially immunized (PI)• Time lapsed since last immunization > 3 years
– Fully immunized (CI)• Received typhoid vaccine within last 3 years
– Ineligible for Immunization (II)• Age less than 2 years
DIPTHERIA
• An illness characterised by laryngitis or pharyngitis or tonsillitis, and an adherent membrane of the tonsils, pharynx and/or nose
and
Isolation of Corynebacterium diphtheriae from a clinical specimen
Microbiologic Diagnosis established
• No• Yes– Culture• Isolation of Corynebacterium diphtheriae from a clinical
specimen OR
– Antigen detection– Antibody detection• 4 fold or greater rise in serum antibodies
– other• Gram stained smear
Previous relevant vaccination
• DPT vaccine (DTP)– Not immunized (NI)• Not received any dose of DTP
– Partially immunized (PI)• Received less than the age appropriate doses
– Fully immunized (FI)• Received all the age appropriate doses
– Ineligible for Immunization (II)• Age less than 6 weeks
PERTUSSIS
• Cough lasting at least two weeks with at least one of the following symptoms:– Paroxysms (i.e. fits) of coughing – Inspiratory whooping – Post-tussive vomiting (i.e. vomiting immediately
after coughing) without other apparent cause
Microbiologic Diagnosis established
• No• Yes– Culture• Isolation of Bordetella pertussis or +ve PCR
– Antigen detection– Antibody detection– Other
Previous relevant vaccination • DPT vaccine (DTP)– Not immunized (NI)• Not received any dose of DTP
– Partially immunized (PI)• Received less than the age appropriate doses
– Fully immunized (CI)• Received all the age appropriate doses
– Ineligible for Immunization (II)• Age less than 6 weeks
MEASLES
Any child with fever and maculopapular rash (i.e. non-vesicular) and cough, coryza (i.e. runny nose) or conjunctivitis (i.e. red eyes)
Microbiologic Diagnosis established
• No• Yes– Culture– Antigen detection– Antibody detection• Presence of measles-specific IgM antibodies
– Other
Previous relevant vaccination
• MEASLES vaccine– Not immunized (NI)– Partially immunized (PI)• Received only one dose of Measles containing
vaccine– Fully immunized (FI)• Received 2 doses of Measles containing vaccine
– Ineligible for Immunization (II)• Age less than 9 months
Mumps
• Acute onset of unilateral or bilateral tender,
self-limited swelling of the parotid or othersalivary gland, lasting two or more days and without other apparent cause
Microbiologic Diagnosis established
• No• Yes– Culture– Antigen detection– Antibody detection– Other Not a
pplicable
Previous relevant vaccination
• MMR vaccine– Not immunized (NI)• Not received any Mumps containing vaccine
– Partially immunized (PI)• Received at least 1 dose of Mumps containing
vaccine– Fully immunized (FI)• Received 2 doses of Mumps containing vaccine
– Ineligible for Immunization (II)• Age less than 15 months
DENGUE• DENF • An acute febrile illness of 2-7 days duration
with two or more of the following manifestations:– Headache, retro-orbital pain, myalgia, arthralgia,
rash, haemorrhagic manifestations• DENH (Thrombocytopenia + evidence of
capillary leak i.e. 20% increase in Hct or ple effusion or ascites)
• DENS (DHF with evidence of shock)
Microbiologic Diagnosis established
• No• Yes– Culture– Antigen detection• NS1 Antigen test
– Antibody detection• Positive Dengue serology IgG and IgM
– Other • PCR
HEPATITIS
• An acute illness typically including acute jaundice, dark urine, anorexia, malaise, extreme fatigue and right upper quadrant tenderness
• Urine Bile pigments (urobilinogen) +ve• ALT(SGPT) >2.5 times the upper limit of
normal• Malaria, leptospirosis, dengue and
typhoid/paratyphoid
• HEPATITIS A (HEPA)• HEPATITIS B (HEPB)• HEPATITIS E (HEPE)• HEPATITIS O (HEPO) Hepatitis Other types • HEPATITIS N (HEPN) Hepatitis etiology not known
Microbiologic Diagnosis established • No• Yes– Antibody detection• Positive IgM anti-HAV for HEPA• Positive HBsAg or IgM anti-HBc for HEPB• Positive IgM anti-HEV for HEPE• Positive IgM anti-HCV for HEPC
– Other • PCR
Previous relevant vaccinationHepatitis A
• Hepatitis A vaccine– Fully Immunized (FI) • Taken 2 doses of Hepatitis A vaccine
– Partially Immunized(PI)• Taken less than one doses of Hepatitis A vaccine
– Not Immunized (NI)• Not taken any dose of Hepatitis A vaccine
– Ineligible for immunization (II)• Less than 12 months of age
Previous relevant vaccinationHepatitis B
• Hepatitis B vaccine– Fully Immunized (FI) • Taken 3 doses of Hepatitis B vaccine
– Partially Immunized (PI)• Not taken all 3 doses of Hepatitis B vaccine
– Not Immunized (NI)• Not taken any dose of Hepatitis B vaccine
– Ineligible for Immunization (II)• Less than 6 weeks