Childhood Infectious Disease and Immunisation

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Childhood Infectious Disease and Immunisation

• Claire Jones

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Content

• Common Childhood Infectious Disease
• Presentations of Childhood Infectious Disease
• Immunisation Schedule
• MMR current evidence for discussion with parents

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Chickenpox

• Varicella zoster
• Fever and rash
• Incubation 14 21 days
• Infectious from a few days before rash appears
  until not more than 6 days after first spots
• Rash can be macular, papular or vesicular
• Vesicles dry and crust
• Can scar if scratched
• Symptomatic treatment
• Notifiable disease

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Measles

• RNA paramoxyovirus
• Airborne or droplet spread
• Incubation average 10 days (7-18) with further
  2-4 days before rash
• Infectious from prodromal period to four days
  after rash appears

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• Prodromal phase coryzal, conjunctivitis, fever,
  cough, Koplik spots, irritable, sometimes
  generalised lymphadenopathy
• Rash phase (after 2-4 days) Maculopapular rash,
  starts behind ears then spreads down body
  becoming confluent and then fades.

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Treatment of measles

• Isolation
• Analgesia
• Be aware of complications
• Rx of secondary bacterial infection
• Nutritional and fluid requirements
• Vaccinate un-vaccinated contacts
• Notifiable disease

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Mumps

• RNA paramyxovirus
• Mainly affects salivary glands
• Direct contact with infected saliva (?urine)
• Incubation 16-21 days
• Fever, malaise, enlargement of one or both
  parotid glands
• Swelling settle in 7-10 days
• Third of people no clinical illness
• No specific treatment

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Rubella

• Rubivirus (RNA togavirus)
• Usually mild but teratogenic during 1st trimester
  of pregnancy
• Incubation 14-21 days
• Prodromal symptoms fever, headache, malaise,
  upper respiratory symptoms
• Pink macular rash, starts on face then spreads to
  trunk and limbs, fades within four days
• Cervical lymphadenopathy, conjunctivitis

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Pertussis

• Bordetella pertussis
• Incubation 6-20 days
• Droplet transmission, most infectious during
  cararrhal stage
• Illness can last 2-3 months
• Starts with catarrhal stage, then irritating
  cough that becomes paroxysmal, the paroxysms are
  followed by the characteristic whoop
• Can be complicated by pneumonia, repeated
  vomiting and cerebral hypoxia

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Polio

• Viral illness affecting CNS
• Transmission from faeces or saliva of infected
  person
• Symptoms range from fever to meningitis to
  paralysis
• Often asymptomatic
• Rx acute stage, supportive and physio

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Tetanus

• Clostridium tetani which produces exotoxin that
  targets CNS. Once fixed it cant be neutralised
  with anti-toxin
• Incubation 24 hours to 24 days
• Muscle spasm, first at site of inoculation then
  facial muscles and muscles of neck and spine
• Trismus, fixed grin, arched body, hyper-extended
  neck, oesophageal spasm, autonomic dysfunction
• Death from aspiration, respiratory or cardiac
  failure

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Diphtheria

• Affects upper in respiratory tract and sometimes
  skin
• Incubation 2-6 days
• Membranous pharyngitis (bull neck) with fever and
  cervical lymphadenopathy
• Can result in respiratory obstruction
• Diphtheria toxin affects myocardium, nervous and
  adrenal tissues causing paralysis and cardiac
  failure

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School Exclusion

• DOH recommendations
• For five days from
• Rash onset in chicken pox, measles, rubella
• Starting antibiotics in pertussis and scarlet
  fever
• Onset of swollen glands - mumps

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Immunisation Schedule

• Two Months
• Three Months
• Four Months
• Twelve Months
• Thirteen Months
• Three years four months to five years
• Thirteen to eighteen years old

• 5 in 1 and PCV
• 5 in 1 and MenC
• 5 in 1 PCV Men C
• HibMenC
• MMR PCV
• Dip/tet/pertussis/polio MMR
• Tet/Dip/polio

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MMR discussion

• How serious are measles mumps and rubella?
• Safety and side effects of MMR vaccine
• Why two doses?
• Why not given separately
• Who cant have MMR
• The autism question.

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