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Communicable diseases in schools Dr Charmaine Gauci MD, MSc, PhD, FRSPH, FFPH Director, Health Promotion and Disease Prevention Directorate.

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Presentation on theme: "Communicable diseases in schools Dr Charmaine Gauci MD, MSc, PhD, FRSPH, FFPH Director, Health Promotion and Disease Prevention Directorate."— Presentation transcript:

1 Communicable diseases in schools Dr Charmaine Gauci MD, MSc, PhD, FRSPH, FFPH Director, Health Promotion and Disease Prevention Directorate

2 Children vulnerable group Low immunity Low immunity Most infectious diseases occur in children Most infectious diseases occur in children Close contact with other children Close contact with other children Long duration of contact Long duration of contact

3 Control of communicable diseases Making early diagnosis Making early diagnosis Risk assessment of the infectivity Risk assessment of the infectivity Isolation if infective Isolation if infective Prevention of infection of others Prevention of infection of others Elimination of infection Elimination of infection Educational and preventive measures Educational and preventive measures Corrective, sanitary and hygienic measures Corrective, sanitary and hygienic measures

4 Meningococcal Meningitis Serious infection caused by meningococcus Serious infection caused by meningococcus Meningococcus : commensal in 10% population Meningococcus : commensal in 10% population Usually harmless Usually harmless Occasionally overcome defense mechanisms and cause illness: in 2009 seven cases Occasionally overcome defense mechanisms and cause illness: in 2009 seven cases Different types: in Malta 25% Group B Different types: in Malta 25% Group B

5 Symptoms Sudden onset high fever Sudden onset high fever Severe headache Severe headache Photophobia Photophobia Vomiting Vomiting Petecchial rash Petecchial rash

6 Rash of Meningococcal Disease

7 How can you catch meningococcal disease? Not highly infectious Not highly infectious Passed by close prolonged contact Passed by close prolonged contact Bacteria do not survive outside body Bacteria do not survive outside body

8 How to prevent meningococcal infection? Vaccine available for type A,C,W,Y Vaccine available for type A,C,W,Y Not available for Group B (50% of cases in Malta) Not available for Group B (50% of cases in Malta) Infectious Disease Prevention and Control Unit Infectious Disease Prevention and Control Unit Risk assessment Risk assessment Antibiotics for close contacts Antibiotics for close contacts Household and kissing contacts Household and kissing contacts Close contacts in closed environment for long duration Close contacts in closed environment for long duration List of class mates required List of class mates required Teachers/facilitators for primary schools Teachers/facilitators for primary schools No need to exclude contacts from school if asymptomatic No need to exclude contacts from school if asymptomatic

9 Chicken pox

10

11 Caused by varicella virus Caused by varicella virus Spread via air or contact with fluid from blisters Spread via air or contact with fluid from blisters Virus does not survive outside body so objects do not transmit viruses Virus does not survive outside body so objects do not transmit viruses Infectious 5 days before rash onset and until vesicles have scabbed Infectious 5 days before rash onset and until vesicles have scabbed Vaccine exists in private market Vaccine exists in private market

12 Blood borne diseases Hepatitis B, C Hepatitis B, C HIV HIV Staff and children may be exposed: Staff and children may be exposed: Tending to bleeding nose Tending to bleeding nose Tending to wounds Tending to wounds Deep human bite Deep human bite No transmission from casual contact No transmission from casual contact Shaking hands Shaking hands Splattering blood on intact skin Splattering blood on intact skin

13 Increased number of cases Increased sexual activity Increased sexual activity Increased drug activity Increased drug activity Increase in children from highly prevalent countries Increase in children from highly prevalent countries

14 Prevention Hepatitis B vaccine Hepatitis B vaccine Offered to all children on national schedule Offered to all children on national schedule Universal precautions Universal precautions

15 Universal precautions Treat everyone the same Treat everyone the same Hand washing Hand washing Control of spread of infections Control of spread of infections Warm water, liquid soap, paper towels Warm water, liquid soap, paper towels Personal protective equipment Personal protective equipment Disposable gloves Disposable gloves Disposable plastic aprons Disposable plastic aprons Clinical waste Clinical waste Stored in pedal bins Stored in pedal bins Removed by clinical contractor Removed by clinical contractor

16 Use disinfectant for cleaning Use disinfectant for cleaning Discard soiled items Discard soiled items Vaccine for Hepatitis B Vaccine for Hepatitis B

17 Influenza A(H1N1)v Pandemic

18 How did it all start ?

19 Pandemics of influenza H7 H5 H9 * Recorded new avian influenzas H1N1 H2N Russian influenza H2N Asian influenza H2N2 H3N Hong Kong influenza H3N2 H3N Old Hong Kong influenza H3N Spanish influenza H1N Pandemic influenza H1N1 Recorded human pandemic influenza (early sub-types inferred) Reproduced and adapted (2009) with permission of Dr Masato Tashiro, Director, Center for Influenza Virus Research, National Institute of Infectious Diseases (NIID), Japan. Animated slide: Press space bar H1N1 Pandemic H1N1

20 Early cases - Mexico Although the exact time and location of the outbreak is unknown, it is believed to have been first detected when an influenza-like illness was reported by both health agencies and local news media in Mexico Although the exact time and location of the outbreak is unknown, it is believed to have been first detected when an influenza-like illness was reported by both health agencies and local news media in Mexico

21 Influenza A(H1N1)v H1N1 outbreak 2009 H1N1 outbreak epidemic spread of a new strain of influenza virus epidemic spread of a new strain of influenza virus clinically identified in April 2009 clinically identified in April 2009 new virus strain is a type of influenza A (H1N1)v virus, commonly called the swine flu new virus strain is a type of influenza A (H1N1)v virus, commonly called the swine flu also been called the H1N1 influenza, 2009 H1N1 flu, Mexican flu, or swine-origin influenza. also been called the H1N1 influenza, 2009 H1N1 flu, Mexican flu, or swine-origin influenza.

22 Pigs a Mixing vessel Pigs can catch human and avian or bird flu. When flu viruses from different species infect pigs, they can mix inside the pig and new, mixed viruses can emerge. Pigs can catch human and avian or bird flu. When flu viruses from different species infect pigs, they can mix inside the pig and new, mixed viruses can emerge.

23 A New Strain of Influenzae Virus The virus responsible was clinically identified as a new strain on April 24, 2009 The virus responsible was clinically identified as a new strain on April 24, 2009

24 Virologists Optimistic By late April, however, some virologists believed that this strain was unlikely to cause as many fatalities as earlier pandemics, and may not even be as damaging as a typical flu season. By late April, however, some virologists believed that this strain was unlikely to cause as many fatalities as earlier pandemics, and may not even be as damaging as a typical flu season.

25 WHO pandemic phases

26 WHO alerts it as Phase 6 WHO changed its pandemic alert phase to "Phase 6“ on 11 th June 2009 WHO changed its pandemic alert phase to "Phase 6“ on 11 th June 2009, which is defined as community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5, which is defined as community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5 Till now, May 2010 WE ARE STILL IN PANDEMIC ALERT PHASE 6 Till now, May 2010 WE ARE STILL IN PANDEMIC ALERT PHASE 6

27 What happened in Malta?

28 Reported Symptoms

29 Number of Influenza tests by Week, week 27, 2009 to week 9, 2010

30 Results of Influenza testing by week, week 27, 2009 to week 9, 2010

31 Consultation rate for Influenza-like illness among sentinel GPs,

32 Deaths in Malta 5 deaths occurred related to H1N1 in MALTA. 5 deaths occurred related to H1N1 in MALTA. 82 year old gentleman with chronic disease who died on the 12th of August. 82 year old gentleman with chronic disease who died on the 12th of August. 88 year old female with chronic disease who dead on the 18th of August. 88 year old female with chronic disease who dead on the 18th of August. healthy Spanish 32 year old female who dead on the 24th of August. healthy Spanish 32 year old female who dead on the 24th of August. healthy 32 year old male who dead on the 28th of December. healthy 32 year old male who dead on the 28th of December. 94 year old elderly male who dead on the 21st of January. 94 year old elderly male who dead on the 21st of January.

33 H1N1 vaccine 29 of December of December 2009 for health care workers for health care workers 2 ND January ND January 2010 chronic disease chronic disease pregnant women pregnant women 14 th January th January 2010 children form 6 months to 5 years children form 6 months to 5 years 28th January th January 2010 rest of the population were offered the vaccine rest of the population were offered the vaccine

34 What is H1N1 illness?

35 SYMPTOM COMMON COLD INFLUENZAFeverRare Sudden Onset (lasts 3-4 days) HeadacheRareFrequent Aches & Pains SlightUsual (often quite severe) WeaknessRare/Mild Moderate to Extreme Bed Ridden RareFrequent (may last 5-10 days) SnifflesCommonSometimes SneezingUsualSometimes Sore Throat CommonSometimes CoughSometimes (Mild to Moderate) Usual (can become severe)

36 Person to person through droplets Person to person through droplets Cough Cough Sneeze Sneeze Contaminated Surface Contaminated Surface

37 Rest away from others Rest away from others Keep personal items separate Keep personal items separate Disinfect items & surfaces Disinfect items & surfaces One person as caregiver One person as caregiver Frequent handwashing Frequent handwashing

38 Prevention measures

39 Wash hands often Wash hands often Hand sanitizer available Hand sanitizer available Cover coughs & sneezes Cover coughs & sneezes Hands away from face Hands away from face Disinfect common surfaces Disinfect common surfaces Stay home when sick Stay home when sick Get the flu shot Get the flu shot

40 Simple Measures Help By touching something contaminated with flu viruses By touching something contaminated with flu viruses touching one's mouth or nose touching one's mouth or nose through coughing or sneezing through coughing or sneezing One of the most effective prevention measures is regular hand washing. One of the most effective prevention measures is regular hand washing.

41 Eating Pork Safe? People cannot catch swine flu from eating pork or pork products People cannot catch swine flu from eating pork or pork products Cooking pork to an internal temperature of 71 degrees Celsius kills the swine flu virus along with other bacteria and viruses Cooking pork to an internal temperature of 71 degrees Celsius kills the swine flu virus along with other bacteria and viruses

42 Prevention is best option Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

43 Clean Hands – Safe Hands Washing your hands often with soap and water, especially after you cough or sneeze Washing your hands often with soap and water, especially after you cough or sneeze You can also use alcohol-based hand cleaners. You can also use alcohol-based hand cleaners.

44 Avoid Unnecessary Actions Avoiding touching your eyes, nose or mouth. Germs spread this way Avoiding touching your eyes, nose or mouth. Germs spread this way Trying to avoid close contact with sick people. Trying to avoid close contact with sick people.

45 Staying at home if sick Staying home from work or school if you are sick Staying home from work or school if you are sick

46 Prompt to seek Medical Attention seek medical attention if they develop any symptoms of influenza-like illness seek medical attention if they develop any symptoms of influenza-like illness

47 Spread the Message of Flu to Everyone

48 How pandemics differ — and why they can be difficult How pandemics differ — and why they can be difficult

49 For any future pandemic virus – what can and cannot be assumed? What probably can be assumed: Known knowns Modes of transmission (droplet, direct and indirect contact) Modes of transmission (droplet, direct and indirect contact) Broad incubation period and serial interval Broad incubation period and serial interval At what stage a person is infectious At what stage a person is infectious Broad clinical presentation and case definition (what influenza looks like) Broad clinical presentation and case definition (what influenza looks like) The general effectiveness of personal hygiene measures (frequent hand washing, using tissues properly, staying at home when you get ill) The general effectiveness of personal hygiene measures (frequent hand washing, using tissues properly, staying at home when you get ill) That in temperate zones transmission will be lower in the spring and summer than in the autumn and winter That in temperate zones transmission will be lower in the spring and summer than in the autumn and winter

50 What cannot be assumed: Known unknowns Antigenic type and phenotype Antigenic type and phenotype Susceptibility/resistance to antivirals Susceptibility/resistance to antivirals Age-groups and clinical groups most affected Age-groups and clinical groups most affected Age-groups with most transmission Age-groups with most transmission Clinical attack rates Clinical attack rates Pathogenicity (case-fatality rates) Pathogenicity (case-fatality rates) ‘Severity’ of the pandemic ‘Severity’ of the pandemic Precise parameters needed for modelling and forecasting (serial interval, R o ) Precise parameters needed for modelling and forecasting (serial interval, R o )

51 Precise clinical case definition Precise clinical case definition The duration, shape, number and tempo of the waves of infection The duration, shape, number and tempo of the waves of infection Will new virus dominate over seasonal type A influenza? Will new virus dominate over seasonal type A influenza? Complicating conditions (super-infections) Complicating conditions (super-infections) The effectiveness of interventions and counter-measures including pharmaceuticals The effectiveness of interventions and counter-measures including pharmaceuticals The safety of pharmaceutical interventions The safety of pharmaceutical interventions

52 0% 10% 20% 30% 40% 50% 60% Age (midpoint of age class) % with clinical disease 1918 New York State 1918 Manchester 1918 Leicester 1918 Warrington & Wigan 1957 SE London 1957 S Wales 1957 Kansas City 1968 Kansas City With thanks to Peter Grove, Department of Health, London, UK Age-specific clinical attack rate in previous pandemics Animated slide: Press space bar

53 Different age-specific excess deaths in pandemics Age group Excess deaths < Age group Excess deaths Excess deaths, second wave, 1918 epidemic Excess deaths second wave 1969 pandemic, England and Wales Source: Department of Health, UK

54 1918/1919 pandemic: A(H1N1) influenza deaths, England and Wales 1918/19: ‘Influenza deaths’, England and Wales. The pandemic affected young adults, the very young and older age groups. R o = 2-3 (US) Mills, Robins, Lipsitch (Nature 2004) R o = (UK) Gani et al (EID 2005) R o = (UK) Hall et al (Epidemiol. Infect. 2006) R o = (Geneva) Chowell et al (Vaccine 2006) Courtesy of the Health Protection Agency, UK Transmissibility: estimated Basic Reproductive Number (R o )

55 Estimated additional deaths in Europe if a 1918/19 pandemic occurred now – a published worst case scenario Estimated additional deaths in Europe if a 1918/19 pandemic occurred now – a published worst case scenario EU total: 1.1 million deathsAustria13,000Latvia13,800Netherlands23,100Belgium14,900Lithuania18,800Poland155,200 Bulgaria47,100Germany116,400Portugal25,100 Czech Rep 34,100Greece27,400Romania149,900 Cyprus 1, 900 Hungary37,700Slovenia5,000 Denmark7,300Ireland6,700Slovakia20,600 Estonia6,100Italy95,200Spain87,100 Finland8,100 Luxembour g 500Sweden13,300 France89,600Malta1,100UK93,000 Iceland420Norway5,800 Murray CJL, Lopez AD, Chin B, Feehan D, Hill KH. Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918–20 pandemic: a quantitative analysis. Lancet. 2006;368:

56 Seasonal influenza compared to pandemic — proportions of types of cases Asymptomatic Clinical symptoms Deaths Requiring hospitalisation Seasonal influenza Pandemic Asymptomatic Clinical symptoms Deaths Requiring hospitalisation

57 A good health preparedness Possible Option in Prevention

58 Getting Vaccinated Every Year Is The Best Flu Prevention! To provide protection from seasonal flu one vaccination is needed. To provide protection against H1N1 influenza will need only one vaccination. Probably a combined vaccine is needed Like the seasonal influenza shot, there will be some time needed for the body to build immunity to H1N1. Flu vaccines do not protect against flu-like illnesses caused by non-influenza viruses.

59 Hand Washing: Simple Yet Serious Prevention! Wash hands with soap & warm water for 20 seconds. Dry hands with a paper towel or with an air hand dryer. If soap & water are unavailable, use wipes or alcohol-based gel or foam. Rub the product all over hands and fingers until dry.

60 Studies Show… Flu viruses remain viable and can infect a person for 2 to 8 hours after being deposited on surfaces. Wiping or spraying surfaces with a household disinfectant* will help prevent spread of flu viruses. *(chlorine, hydrogen peroxide, soap, and alcohols)

61 Flu In Schools Students & staff can get sick with flu and schools may act as a point of spread Students & staff with flu-like symptoms stay home for at least 24 hours after fever is gone Set up a separate room for sick students until they can be sent home

62 What Teachers Can Do Send sick students to school or health office for evaluation Emphasize covering mouth when coughing & sneezing Emphasize hand washing after blowing nose, coughing & sneezing Prepare “take home” lessons for students recovering at home Regularly clean surfaces in classrooms

63 Communicate Steps Parents Can Take To Protect Family Against Flu Keep a sick child home Cover coughs & sneezes Clean hands Keep sick household member in separate room Clean surfaces Monitor health of sick child

64 Wizu

65 Handwashing

66 Effect of microbes on hands

67 4 principles cleaning hands

68 T zone

69 Spread the message

70 Wisu song..educational campaign for children in schools..join along !!

71 Thank you


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