Vaccine Preventable Diseases

Ana H. Corona, MSN, FNP-CNursing Instructor

May 2008More presentations @: www.nurseana.com

Vaccine Preventable Diseases

• Bacteria and Viruses that cause vaccine preventable disease and death still exist and can be passed on to people who are not protected by vaccines.

• Convincing parents to adhere to childhood immunizations is not quite difficult as before.

Vaccines • A vaccine is a

medical preparation given to provide immunity from a disease.

• The development of vaccines against diseases is considered among one of the greatest accomplishments of medical science.

• Prior to the invention of vaccines infectious diseases swept through towns, villages, and cities with a horrifying vengeance.

• Vaccines have limited many of the life-threatening infectious diseases.

Smallpox

• Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus (an orthopoxvirus).

• The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting.

• A rash follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving a pitted scar.

Smallpox • Early results from

laboratory studies suggest that the drug cidofovir may fight against the smallpox virus;

• Treatment: supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

• The density of the rash is greater on the face than on the body.

• Man with smallpox. Public Health Images Library (PHIL) id# 131. Source: CDC/Barbra Rice

Smallpox lesions on skin of trunk. Picture taken in Bangladesh, 1973. Public

Health Images Library (PHIL) ID # 284. Source: CDC/James Hicks

Face lesions on boy with smallpox. Public Health Images

Library (PHIL) ID # 3. Source: CDC/Cheryl Tyron

The distribution of the smallpox rash is usually similar to that shown here. It is most dense on the face, arms and hands, legs

and feet. The trunk has fewer pocks than the extremities.

• After exposure, it takes between 7 and 17 days for symptoms of smallpox to appear (average incubation time is 12 to 14 days).

• The majority of patients with smallpox recover, but death may occur in up to 30% of cases. Many smallpox survivors have permanent scars over large areas of their body, especially their face. Some are left blind.

Pocks are usually present on the palms of the hands and on the soles of the feet.

• Smallpox normally spreads from contact with infected persons.

• Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects.

• Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains.

The smallpox virus dies within 24 hours. If an aerosol release of smallpox occurs, 90% of virus matter will be inactivated or dissipated in about 24 hours. Smallpox can be prevented through use of the smallpox vaccine. There is no proven treatment for smallpox, but research to evaluate new antiviral agents is ongoing.

A Woman with Smallpox

Early results from laboratory studies suggest that the drug cidofovir may fight against the smallpox virus; Treatment: supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

Smallpox vs Chickenpox

Smallpox Chickenpox

Rash

Distribution More pocks on arms and legs

More pocks on body

On palms and soles

Usually present

Usually absent

Differentiating Smallpox and Chickenpox

Smallpox chickenpox

Fever 2 – 4 days before rash

At time of rash

Rash

Appearance

Pocks in same stage Pocks in several stages

Development Slow Rapid

Distribution More pocks on arms and legs

More pocks on body

On palms and soles Usually present Usually absent

Death 1 in 10 die Very uncommon

Smallpox Vs Chickenpox: the relative density of rash on different parts of the body should be carefully observed. This diagram illustrates the differences that are usually seen.

Chickenpox

Chickenpox• Chickenpox is caused by a

virus, the varicella-zoster virus.

• Chickenpox spreads from person to person by direct contact or through the air by coughing or sneezing.

• It is highly contagious. • It can also be spread

through direct contact with the fluid from a blister of a person infected with chickenpox, or from direct contact with a sore from a person with shingles.

Chickenpox

• It takes from 10-21 days to develop symptoms after being exposed to a person infected with chickenpox. The usual time period is 14-16 days.

• The most common symptoms of chickenpox are rash, fever, coughing, fussiness, headache, and loss of appetite.

• The rash usually develops on the scalp and body, and then spreads to the face, arms, and legs.

• The rash usually forms 200-500 itchy blisters in several successive crops. The illness lasts about 5-10 days.

Chickenpox Complications

• The most common complication is bacterial infection of the skin or other parts of the body including the bones, lungs, joints, and blood. The virus can also lead to pneumonia or infection of the brain.

• These complications are rare but serious. Complications are more common in infants, adults, and persons with weakened immune systems.

Chickenpox Complications

• Infant with necrotizing fasciitis, a complication of varicella

• Newborn with chickenpox

Chickenpox Treatment

• Most cases of chickenpox in otherwise healthy children are treated with bed rest, fluids, and control of fever.

• Children with chickenpox should NOT receive aspirin because of possible subsequent risk of Reye's syndrome.

• Acetaminophen may be given for fever control.• Chickenpox may be treated with an antiviral drug

in serious cases, depending on the patient's age and health, the extent of the infection, and the timing of the treatment.

Anthrax

Anthrax

• Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores.

• There are three types of anthrax:

• skin (cutaneous) • lungs (inhalation) • digestive

(gastrointestinal)

Anthrax

• Anthrax is not known to spread from one person to another.

• Humans can become infected with anthrax by handling products from infected animals or by breathing in anthrax spores from infected animal products (like wool, for example).

• Gastrointestinal anthrax - by eating undercooked meat from infected animals.

• Anthrax as a weapon. Anthrax also can be used as a weapon. This happened in the United States in 2001. Anthrax was deliberately spread through the postal system by sending letters with powder containing anthrax. This caused 22 cases of anthrax infection.

Anthrax: Signs/Symptoms

• Cutaneous: The first symptom is a small sore that develops into a blister.

• The blister then develops into a skin ulcer with a black area in the center.

• The sore, blister and ulcer do not hurt.

Anthrax : signs & symptoms

• Gastrointestinal: The first symptoms are nausea, loss of appetite, bloody diarrhea, and fever, followed by bad stomach pain.

• Inhalation: The first symptoms of inhalation anthrax are like cold or flu symptoms and can include a sore throat, mild fever and muscle aches. Later symptoms include cough, chest discomfort, shortness of breath, tiredness and muscle aches.

Anthrax • Incubation: Symptoms can appear within 7 days of

coming in contact with the bacterium for all three types of anthrax. For inhalation anthrax, symptoms can appear within a week or can take up to 42 days to appear.

• How Is Anthrax Treated?• Antibiotics are used to treat all three types of anthrax.

Early identification and treatment are important.• Prevention after exposure. Treatment is different for a

person who is exposed to anthrax, but is not yet sick. Health-care providers will use antibiotics (such as ciprofloxacin, levofloxacin, doxycycline, or penicillin) combined with the anthrax vaccine to prevent anthrax infection.

• Treatment after infection. Treatment is usually a 60-day course of antibiotics. Success depends on the type of anthrax and how soon treatment begins.

Anthrax Vaccine

• There is a vaccine to prevent anthrax, but it is not yet available for the general public.

• Anyone who may be exposed to anthrax, may get the vaccine.

• In the event of an attack using anthrax as a weapon, people exposed would get the vaccine.

Measles • Measles is caused by a virus.• It is spread through the air by

infectious droplets and is highly contagious.

• It takes an average of 10-12 days from exposure to the first symptom, which is usually fever.

• The measles rash doesn't usually appear until approximately 14 days after exposure, 2-3 days after the fever begins.

• Symptoms include fever, runny nose, cough, loss of appetite, "pink eye," and a rash. The rash usually lasts 5-6 days and begins at the hairline, moves to the face and upper neck, and proceeds down the body.

Measles (Rubeola)• Before measles immunization

was available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963.

• If Measles vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected.

• There is no treatment for measles.

• Bed rest, fluids, and control of fever. Patients with complications may need treatment specific to their problem.

Measles • Diarrhea is the most common

complication of measles (occurring in 8% of cases), especially in young children.

• Ear infections occur in 7% of reported cases. Pneumonia, occurring in 6% of reported cases, accounts for 60% of measles-related deaths.

• Approximately one out of one thousand cases will develop acute encephalitis, an inflammation of the brain.

• This serious complication can lead to permanent brain damage.

• Measles during pregnancy increases the risk of premature labor, miscarriage, and low-birth-weight infants, although birth defects have not been linked to measles exposure.

Measles

• Measles (rubeola) pharyngitis in an adult showing striking inflammation

• Measles (rubeola) rash and conjunctivitis

Measles

• Koplik spots, blue-white spots on the inside of the mouth that occur 24-48 hours before the rash stage

Meningococcal Disease• Meningococcal disease is caused by the bacterium

Neisseria meningitidis. • The disease is spread person-to-person through the

exchange of respiratory and throat secretions • Meningococcal bacteria can't live for more than a few

minutes outside the body.

Meningococcal Disease

• Bacterial meningitis can be treated with antibiotics. It is critical to start treatment early.

• There are approximately 2,000-3,000 cases of meningococcal disease each year in the United States. An estimated 125 deaths from meningococcal disease occurred in the United States in 2004.

Septicemic rash

Meningococcemia

• The most common symptoms are high fever, chills, lethargy, and a rash.

• If meningitis is present, the symptoms will also include headache and neck stiffness (which may not be present in infants); seizures may also occur.

• Complications: shock, coma, and death can follow within several hours, even with appropriate medical treatment.

• About 9-12% of persons with meningococcal disease die. Of those who recover, up to 20% suffer from some serious after-effect, such as permanent hearing loss, limb loss, or brain damage.

Meningococcal Disease

• Four-month-old female with gangrene of hand and foot due to meningococcemia

• Rash from meningitis; spots change into purple bruises which don't blanch (lose their color) when pressed by glass

Hepatitis B Virus

• Hepatitis B is a liver disease caused by the hepatitis B virus (HBV).

• The spread of HBV occurs when blood from an HBV-infected person enters the body of a person who is not infected.

• This can occur through having sex with an HBV-infected person without using a condom.

• HBV is also easily spread by sharing drugs, needles, or "works" when "shooting" drugs.

• HBV is also spread through needlesticks or sharps exposures on the job

• From an infected mother to her baby during birth.

• Breastfeeding has not been associated with the spread of HBV.

• This woman is suffering from liver cancer caused by hepatitis B

Hepatitis B• The incubation period ranges from 45 to 160 days

(average 120.) • Signs and symptoms of hepatitis B might include nausea,

lack of appetite, tiredness, muscle, joint, or stomach pain, fever, diarrhea or vomiting, headache, dark urine, light-colored stools, and yellowing of the skin and whites of the eyes (jaundice).

• In the United States, an estimated 3,000-4,000 people die each year of HBV-related cirrhosis, and another 1,000-1,500 die each year of HBV-related liver cancer.

• There are several FDA-approved medications that might help a person who has chronic HBV infection.

• These medications cure, but they might decrease the chance of the infected person developing severe liver disease.

• There is no treatment (other than supportive care) for people with acute hepatitis B.

Pertussis (Whooping Cough)

• Nearly all children developed whooping cough, before pertussis immunizations were available.

• In the U.S., prior to pertussis immunization, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths. (CDC)

• Child with broken blood vessels in eyes and bruising on face due to pertussis coughing.

Pertussis

• Pertussis is caused by a bacterium, Bordetella pertussis.

• It is spread through the air by infectious droplets and is highly contagious.

• Incubation period is commonly seven to 10 days, with a range of 5-21 days.

• A photomicrograph of Bordetella (Haemophilus) pertussis bacteria

Pertussis disease can be divided into three stages:

• Catarrhal stage: can last 1-2 weeks and includes a runny nose, sneezing, low-grade fever, and a mild cough (all similar symptoms to the common cold).

• Paroxysmal stage: usually lasts 4-6 weeks, but can persist for up to 10 weeks. The characteristic symptom is a burst, or paroxysm, of numerous, rapid coughs. At the end of the paroxysm the patient suffers from a long inhaling effort that is characterized by a high-pitched whoop (hence the name, "whooping cough"). Infants and young children often appear very ill and distressed, and may turn blue and vomit.

• Convalescent stage: usually lasts 2-6 weeks, but may last for months.

Pertussis • Although the cough usually

disappears after 2-3 weeks, paroxysms may recur whenever the patient suffers any subsequent respiratory infection.

• The disease is usually milder in adolescents and adults, consisting of a persistent cough similar to that found in other upper respiratory infections.

• These individuals are still able to transmit the disease to others, including unimmunized or incompletely immunized infants.

Pertussis • Pertussis can be a severe

illness, resulting in prolonged coughing spells that can last for many weeks.

• These spells can make it difficult for a child to eat, drink, and breathe.

• Because vomiting often occurs after a coughing spell, infants may lose weight and become dehydrated.

• In infants, it can also cause pneumonia and lead to brain damage, seizures, and mental retardation.

Pertussis Treatment

• Antibiotics may be helpful in treating pertussis. The drug of choice is erythromycin.

• This antibiotic should also be given for 14 days to all household and other close contacts of the patient to minimize transmission, regardless of age and vaccination status.

Poliomyelitis

• Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States.

• Polio left thousands of victims--mostly children--in braces, crutches, wheelchairs, and iron lungs. The effects were life-long.

Polio

• Patients whose respiratory muscles were affected were placed in an "iron lung" machine to enable them to breathe

Polio Ward

Polio Eradication

• 2,000 cases of polio in 17 countries were reported in 2006.

• Only four countries remain endemic (Afghanistan, India, Nigeria, Pakistan).

Poliomyelitis

• Polio is caused by a virus.• It is usually spread via the fecal-oral route (i.e.,

the virus is transmitted from the stool of an infected person to the mouth of another person from contaminated hands or such objects as eating utensils). Some cases may be spread directly via an oral to oral route.

• The incubation period of polio is commonly 6-20 days, with a range of 3-35 days.

• Surprisingly, 95% of all individuals infected with polio have no apparent symptoms.

Polio Signs and Symptoms• 95% of all individuals infected with polio have no

apparent symptoms.• 4%-8% of infected individuals have minor

symptoms such as sore throat and fever, nausea, vomiting, and other common symptoms of any viral illness.

• 1%-2% of infected individuals develop nonparalytic aseptic (viral) meningitis, with temporary stiffness of the neck, back, and/or legs.

• <1% of all polio infections result in the classic "flaccid paralysis," where the patient is left with permanent weakness or paralysis of legs, arms, or both.

Polio

• Diagnostic tests: a stool or throat sample is collected.

• Patients infected with the polio virus can pass the virus on for 7-10 days before the onset of disease.

• They can continue to shed the virus in their stool for 3-6 weeks.

• There is no "cure" for polio. Persons infected with polio need supportive therapy, such as bed rest and fluids.

Rotavirus

• Rotavirus disease is caused the rotavirus • The rotavirus enters the body through the mouth

and then infects the lining of the intestines. • Rotavirus is very contagious, spreading easily

from children who are already infected to other children and sometimes adults.

• The incubation period for rotavirus diarrhea is 1-3 days.

Rotavirus

• Rotavirus disease starts with fever, an upset stomach, and vomiting, followed by diarrhea.

• Children who have rotavirus disease develop vomiting and watery diarrhea that may last from three to eight days.

• May become dehydrated from loss of fluids.

• Children are typically treated by replacing lost body fluids through drinking products that contain water with sugar and minerals.

• Severe dehydration may lead to electrolyte imbalance, and metabolic acidosis.

• Treatment: IV fluid replacement for severe cases

Shingles (Herpes Zoster)• Both chickenpox and shingles are

caused by the same virus. • After a person has had

chickenpox, the virus rests in the body permanently, but silently.

• About 20% of all people who have been infected with chickenpox later develop the disease known as herpes zoster, or shingles.

• Symptoms of shingles are pain, itching, blisters, and loss of feeling along a nerve.

• Most cases occur in persons older than 50, and the risk of developing shingles increases with age.

Shingles • Shingles starts as a rash

with blisters that scab after 3 to 5 days.

• Symptoms: Rash and pain usually occur in a band on one side of the body, or clustered on one side of the face.

• The rash usually clears within 2 to 4 weeks.

• Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

Shingles Complications • Can lead to pneumonia, hearing

problems, blindness, scarring, brain inflammation (encephalitis), or death.

• Severe pain can continue even after the rash clears up, a situation called post-herpetic neuralgia (PHN).

• Elderly are more likely to develop PHN, and it is more likely to be severe and long lasting.

• The pain may be sharp or throbbing, and it may extend beyond the area of the original rash.

• The skin may be unusually sensitive to touch and to changes in temperature.

• PHN can last for months, or even years.

Shingles Treatment

• Antiviral medicines can be used to treat shingles.

• These medications should be started as soon as possible after the rash appears.

• They can help shorten the length and severity of the episode.

• Pain medicine may also help with pain caused by shingles

• Diagnostic test: The test consists of a laboratory examination of cells taken from a skin lesion.

Tetanus

• Tetanus is a severe, often fatal disease.

• The bacteria that cause tetanus are distributed in soil and street dust, are found in the waste of many animals, and are very resistant to heat and germ-killing cleaners.

Tetanus • People with tetanus suffer from stiffness and spasms of the

muscles. • The larynx (throat) can close causing breathing and eating

difficulties, muscles spasms can cause fractures (breaks) of the spine and long bones, and some people go into a coma, and die.

• Approximately 20 percent of reported cases end in death.

Tetanus

• Child has painful muscle contractions from tetanus

• Tetanus is infectious, but not contagious

• A number of tetanus cases in younger persons has been observed recently in the U.S. among intravenous drug users, particularly heroin users.

• Worldwide, tetanus in newborn infants continues to be a huge problem.

• Every year tetanus kills 300,000 newborns and 30,000 birth mothers who were not properly vaccinated.

• Below: baby has neonatal tetanus with complete rigidity

Tetanus Treatment

• There is no treatment.• Supportive treatment and

management of complications.

• The best "treatment" is prevention through immunization.

• Diagnosis is not useful as the C. tetani bacteria often cannot be recovered from the wound of an individual who has tetanus.

Diphtheria

• Diphtheria is caused by a bacterium, Corynebacterium diphtheriae.

• The disease is caused when the bacteria release a toxin, or poison, into the person's body.

• This bacteria live in the mouth, throat, and nose of an infected person and can be passed to others by coughing or sneezing.

• Transmission occurs from skin sores or through articles soiled with discharge from sores of infected persons.

• The incubation period is short: 2-5 days, with a range of 1-10 days.

Diphtheria Symptoms

• Early symptoms of diphtheria may mimic a cold with a sore throat, mild fever, and chills.

• Usually, the disease causes a thick coating at the back of the throat, which can make it difficult to breathe or swallow.

• Other body sites besides the throat can also be affected, including the nose, larynx, eye, vagina, and skin.

• “Bull neck” appearance of diphtheritic cervical lymphadenopathy

Diphtheria Complications

• In 1921, a total of 206,000 diphtheria cases and 15,520 diphtheria related deaths were reported.

• Complications of diphtheria are due to the release of the toxin, or poison.

• The most common complications are inflammation of the heart and nerves, which may cause cardiac arrhythmias and temporary paralysis of some muscles.

• If the paralysis affects the diaphragm, the patient may develop pneumonia or respiratory failure.

• The thick membrane coating at the back of the throat may cause serious breathing problems, even suffocation. Child has diphtheria, thick gray

coating over back of throat

Diphtheria Diagnosis and Treatment

• Diphtheria can only be confirmed after a culture of the infected material from the patient's throat (or other site) is collected.

• Diphtheria progresses quickly, treatment usually should begin based on the health professional's assessment of the patient.

• Diphtheria is treated with both antibiotics and with diphtheria antitoxin

Child has "bullneck diphtheria"

Diphtheria

• After 48 hours of antibiotic treatment, the disease usually becomes non-contagious.

• Antibiotic treatment should be continued until the patient has three consecutive negative cultures.

• Some individuals may continue to carry bacteria even after treatment.

• Individuals can get diphtheria more than once.

• Individuals recovering from diphtheria should be immunized against the disease as soon as possible.

• An Indonesian child with diphtheria kept alive by a throat operation

Diphtheria • Pharyngeal

diphtheria with membranes covering the tonsils and uvula

• Diphtheria, pseudomembrane

Hepatitis A (HAV)

• Man with jaundice (yellowing of the skin and eyes)

• Hepatitis A is a liver disease caused by hepatitis A virus (HAV).

• It is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with HAV infection.

• Contaminated food, water, and ice.

• A person can also be infected by drinking water contaminated with HAV or drinking beverages chilled with contaminated ice.

• Sex increases the risk of exposure to HAV in the feces of an infected person.

Hepatitis A

• It can take 15-50 days to become infected (average 28 days).

• People with HAV infection might not have any signs or symptoms of the disease.

• Adults are more likely to have symptoms than children.

• About 7 out of 10 adults have symptoms, while children less than age 6 years have no symptoms, usually.

• Some people have symptoms of hepatitis A recur for 6-9 months; this condition is called relapsing hepatitis A.

Hepatitis A Symptoms & Complications

• Symptoms usually occur suddenly and might include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes).

• This usually last less than 2 months; some people (10%-15%) are ill for as long as 6 months.

• Studies show that 11%-22% of people with hepatitis A are hospitalized. Infected adults who become ill lose an average of 15½ days of work if not hospitalized and 33¼ days of work, if hospitalized.

• Hepatitis A is a serious disease.

• Approximately 100 people die each year in the United States from HAV related causes.

• A blood test called IgM anti-HAV is needed to diagnose acute hepatitis A

• There is also a blood test available that shows if a person was infected with HAV in the past (hepatitis A antibody [anti-HAV]).

• There is no medicine that will treat or "cure" hepatitis A.

• Supportive care includes bed rest, fluids, and antipyretics.

HAV Incubation

• The most likely time for an HAV-infected person to spread HAV to others is during the two weeks before the infected person develops symptoms.

• The risk of spreading HAV becomes smaller over time and can still be present one week or longer after symptoms develop (e.g., yellowing of skin and eyes).

• Infants are more likely to be capable of spreading HAV for longer periods of time.

Infection with Haemophilus influenzae type b. (Hib)

• Hib meningitis once killed 600 children each year and left many survivors with deafness, seizures, or mental retardation.

• Since introduction of conjugate Hib vaccine in December 1987, the incidence of Hib has declined by 98 percent.

Child has swollen face due to Hib infection

Hib• Hib was the most

common cause of bacterial meningitis in U.S. infants and children before the Hib vaccine became available.

• Approximately two-thirds of the 20,000 reported Hib cases were meningitis, and one-third were other life-threatening invasive Hib diseases such as bacteria in the blood, pneumonia, or inflammation of the epiglottis.

Haemophilus influenzae type b. Cellulitis of the arm proven by blood culture

Hib Disease• Hib disease is caused by a

bacterium, Haemophilus influenzae.

• It contains six different types of these bacteria (a through f).

• Type b organisms account for 95% of all strains that cause invasive disease.

• Hib disease is spread person-to-person by direct contact or through respiratory droplets.

• The organisms remains in the nose and throat.

• The bacteria may spread to the lungs or bloodstream and cause a serious infection in the individual.

Haemophilus influenzae type b. Cellulitis of the foot proven by blood culture

Hib Complications• The incubation period of Hib

disease could be as short as a few days

• The most common type of invasive Hib disease is meningitis.

• Symptoms of Hib meningitis are fever, decreased mental status, and stiff neck.

• The mortality rate is 2%-5%. • 15%-30% of survivors suffer some

permanent neurologic damage, including blindness, deafness, and mental retardation.

• Another 17% of invasive Hib cases include epiglottitis, an infection and swelling in the throat that can cause life-threatening airway blockage.

• Other forms of invasive Hib disease include: joint infection (8%), skin infection (6%), pneumonia (15%), and bone infection (2%).

Periorbital cellulitis with purulent exudate from which Streptococcus pneumoniaeand Haemophilus influenzae type b

Hib Diagnosis and Treatment

• The diagnosis of Hib disease is usually made based on one or more laboratory tests using a sample of infected body fluid, such as blood or spinal fluid.

• Hib disease is treated with antibiotics for 10 days. Most cases require hospitalization.

• Even with antibiotic treatment, up to 5% of all children with Hib meningitis die from the disease.

Mumps

• Child very swollen under the jaw and in the cheeks due to mumps

• Mumps is highly communicable and it only takes a few unvaccinated Individuals to initiate transmission.

• Mumps was a major cause of deafness in children, occurring in approximately 1 in 20,000 reported cases.

Mumps

• Mumps is usually a mild viral disease.

• Rare conditions such as swelling of the brain, nerves and spinal cord can lead to serious side effects such as paralysis, seizures, and fluid in the brain.

• An increase in miscarriages has been found among women who develop mumps during the first trimester of pregnancy.

Mumps • Serious side effects of

mumps are more common among adults than children.

• Swelling of the testes is the most common side effect in males past the age of puberty, occurring in up to 20 percent to 50 percent of men who contract mumps.

Pneumococcal Disease

• Before pneumococcal conjugate vaccine became available for children, pneumococcus caused 63,000 cases of invasive pneumococcal disease and 6,100 deaths in the U.S. each year.

• Many children who developed pneumococcal meningitis also developed long-term complications such as deafness or seizures.

• Brain of a person who died from pneumococcal brain infection

Pneumococcal Disease

• Pneumococcal disease is caused by Streptococcus pneumoniae, a bacterium.

• The disease is spread from person to person by droplets in the air.

• There are three major conditions caused by invasive pneumococcal disease: pneumonia, bacteremia, and meningitis. They are all caused by infection with the same bacteria, but have different symptoms.

Signs and Symptoms• Pneumococcal

pneumonia: abrupt onset of fever, shaking chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weakness.

• Pneumococcal bacteremia: (blood infection) occurs in about 25%-30% of patients with pneumococcal pneumonia.

• Pneumococci bacterial meningitis: Symptoms may include headache, tiredness, vomiting, irritability, fever, seizures, and coma.

• Pneumococci are also a common cause of acute otitis media (middle ear infection).

Treatment • Penicillin is the drug of choice

for treatment of pneumococcal disease.

• Resistance to penicillin and other antibiotics has been on the rise.

• Studies indicate that in some areas of the United States up to 40% of invasive pneumococci are resistant to common antibiotics.

• Treating patients infected with resistant organisms requires expensive alternative antimicrobial agents and may result in prolonged hospital stays.

Child with pneumococcal disease

Rubella (German Measles)• Rubella is caused by a

virus.• It spreads from person to

person through the air. • Rubella is contagious.• The incubation period

varies from 12 to 23 days (average, 14 days).

• Symptoms are often mild and may be unapparent up to half of the time.

Rubella Signs and Symptoms• Symptoms: usually first break

out in a rash, which starts on the face and progresses down the body.

• Older children and adults usually first suffer from low-grade fever, swollen glands in the neck or behind the ears, and upper respiratory infection before they develop a rash.

• Adult women often develop pain and stiffness in their finger, wrist, and knee joints, which may last up to a month.

• Up to half of people infected with rubella virus have no symptoms at all.

Characteristic maculopapular rash indicative of rubella

Rubella Diagnosis & Treatment• There is no "cure" for

rubella, only supportive treatment (e.g., bed rest, fluids, and fever reduction).

• Because the rubella rash looks similar to other rashes, the only sure way to diagnose rubella is by a laboratory test

• The disease is most contagious when the rash is erupting, but the virus can be spread from seven days before, to 5-7 days after the rash begins.

Characteristic maculopapular rash indicative of rubella

Rubella Complications

• 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop congenital rubella syndrome (CRS), resulting in heart defects, cataracts, mental retardation, and deafness.

Infant with congenital rubella syndrome

Cataracts caused by congenital rubella syndrome

References & Sources

• Immunization Action Coalition

• The World Health Organization

• Center for Disease Control and Prevention

• Los Angeles County Department of Health Services

• J.L. Bezzant, MD, Clinical Professor, Department of DermatologyUniversity of Utah School of Medicine