Infectious Diseases (Communicable diseases)

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?

Worldwide causes of death in children under 5 years old (WHO, 2011)

Today’s focus.... Meningitis Pneumococcal disease Measles Mumps Rubella Impetigo Varicella

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

3 main causes of meningitis in children (historically) Neisseria meningitidis (meningococcal) Haemophilus influenzae type B (Hib) Streptococcus pneunomaie (pneumococcal)

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

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

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

Meningococcal septicaemia

Impact of the introduction of Meningitis C vaccination (DH, 2010)

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

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

Symptoms of pneumococcal meningitis not the same as for meningococcal infection

Pneumococcal meningitis incidence rate per 100,000 population by age group, England and Wales, 1996-2005 (HPA)

Management Antibiotics – type depends on pathogen Commonly cephalosporin group (e.g. cefotaxime, ceftriaxone) Treatment of symptoms Anti-pyretics Analgesia

Measles, mumps and rubella All are viral infections All spread by airborne or droplet transmission Varying incubation periods Immunisation using MMR vaccine

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

Symptoms Early symptoms include: runny nose cough red and watery eyes and small white spots inside the cheeks (Koplik’s spots)

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

Measles

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

Mumps Acute viral illness caused by paramyxovirus Transmitted through the air when infected person coughs or sneezes Incubation period 14-25 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

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

Congenial rubella syndrome Risk for unprotected pregnant women Risk of foetal damage is estimated at: - 90% in first 10 weeks - 10-20% by 16 weeks - Rare after 20 weeks Defects include cardiac, auditory, ophthalmic, neurological problems

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

What are these?

Impetigo Highly contagious Bacterial localised Caused by staphlococcal or streptococcal skin infection Nasal carriage important Local and/or systemic antibiotic treatment

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

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

References/further reading Department of Health (2006) Immunisation against Infectious disease. London:TSO Health Protection Agency website http://www.hpa.org.uk/HPAwebHome/ Lissauer, T. & Clayden, G. (2012) Illustrated Textbook of Paediatrics 4th ed. Oxford:Elsevier