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 Neisseria meningitidis
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

15. Symptoms of pneumococcal meningitis not the same as for meningococcal infection

16. Pneumococcal meningitis incidence rate per 100,000 population by age group, England and Wales, (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. Complications Rare complications Encephalitis SSPE Death
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 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
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
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

26. Congenial rubella syndrome
Risk for unprotected pregnant women
Risk of foetal damage is estimated at:
- 90% in first 10 weeks
% 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
Lissauer, T. & Clayden, G. (2012) Illustrated Textbook of Paediatrics 4th ed. Oxford:Elsevier