WELCOME

ALL

E. P. I. TARGET DISEASES

(DPT POLIO HIB MR PCV)

Why immunisation?To stop U-5 deaths (mainly due to preventable ID)

Measles, polio-, DPT, Hib, S. pneumoniae, rotavirus, TB, etc. are killers. HBV and rubella are not U-5 killer

• 16k U-5 death/d or 5.9mln/y (50% in SS Africa; 30% in S. Asia) in 2015. >50% are preventable/treatable (simple, interventions). Children in SS Africa are >x14 more likely to die than .. in HICs

S. Asia has strong progress: >50% reduction since 1990; but in SS Africa it is 45%

Leading c/of U-5 death: preterm, pn., BA, D & malaria. 45% of all child deaths are linked to Mn.

World Distribn. of Deaths: U-5y: 2012

6.6million death: >50% preventable/Rx with simple, affordable interventions. 45% deaths linked to Mn.

World Disease Burden of Vax.-Preventable U-5 MR

Pertus-sis 13%

Hib* 13%

Measles 8%

Tetanus4%Pneumococcal

diseases*32%

Ro-tavirus*

30%

• 17% of global total death• 1.5million deaths in children

preventable through vaccination*WHO estimates

EPI target Ds in Bangladesh (10)

• TB• Diphtheria, Pertussis, Tetanus (DPT)• Poliomyelitis• HBV• HIB• Measles, Rubella (MR)• S pneumoniae

Other vax. available in Bangladesh • HPV• HAV• Varicella-zoster• Influenza• Typhoid• Cholera• Rota virus• Yellow fever• Meningococcus

Vaccines in pipeline

• Dengue• Malaria • HEV• Ebola (effective vax. In pipeline)• HIV• Improved BCG• Zica, etc.

Intracranial hge

Severe Cough

Very tenacious sticky sputum

Broken BV in eyes and face

What is the Dx?

‘Whooping’ Cough/100 days’ cough

• Highly contagious• ‘Killer’ in small infants

PERTUSSIS (persistent intense cough)

Pertussis: an ARI characterized by 3 stages:catarrhal, paroxysmal, & convalescence

Aetiology • B. pertussis (Classical)• Others:

– B. parapertussis, B. bronchiseptica– Adenovirus 1, 2, 3, 5– M. Pneumoniae; C. Trachomatis & pneumoniae

Epidemiologyfastidious, Gram-ve, pleomorphic rod. No growth on ordinary

media (lab to be informed beforehand !)• Does not survive in environment (P2P spread)• Human reservoir only70% cases in <1y age. Endemic every 3-5y• Mild/atypical in adults source for children• Highly contagious in stage- 1 (~100%)• Immunity is incomplete• I P: 7-10d. PI varies (-2 +6w of cough):

IP: incubation period. PI: period of infectivity

B pertussis aka Bordet-Gengou bacillus

Pathogenesis

• Basically bronchitis• Locally invasive; toxin mediated:

– severe inflam.: necrosis, infiltration: debris sticky scanty sputum severe cough

• May cause Br. Pn., bronchiectasis, collapse• Brain cortical atrophy from IC hge and anoxia

Pertussis toxins: pertactin, lymphocytotic factor, filamentous hemagglutinin, fimbrial proteins

agglutinogens)

Bronchiolar plugging and alveolar dilatation in pertussis in an infant

Clinical StagesCatarrhal stage: ~1-2 w. Mimics coryza: LGF, cough, red

watering eyes. Dx usually missed. ABT can abort

Paroxysmal stage: 2-4w/longer • Forceful cough of severity; 5-10 bouts/expn. whoop

and vomiting• Flushed/cyanosed face, bulging bloody watering eyes• Protruded tongue, dribbling, distended neck veins• F is absent/minimalSeverity: immune status, previous pertussis, ABT

Paroxysmal stage …• Paroxysmal cough 100%• Post-tussive emesis 80%• Prolonged dyspnoea (neonate) 80%• Whoop 70%• Convulsion 25%Mortality <4mo age 40%

Atypical presentation

• <6 mo age: apnea, no whoop. Severest in preterm • Older children and adults: milder-shorter, prolonged

cough ± paroxysms. No whoop in adults

S/he is apathetic, loses wt. rapidlyTriggers of paroxysms

– eating, drinking, sneezing, yawing, wind– laughing, playing, smoke– suggestion

PE: generally uninformative; May be no signs• Diffuse rales, and ronchi may be noted• Petechiae may be seen

Bilateral subconjunctival hge. in an infant with pertussis

Convalescence stage• Signs of improvement over weeks-months

• Resp. Tract can stay irritated for months-years: Paroxysms may occur with each RTI during this time

Complications• Respiratory:• CNS:• Alimentary system:• Others:

Complications: Respiratory Sys.• Pneumonia: primary, secondary• Reactivation of TB• Bronchiectasis• Collapse• Emphysema• Pneumothorax• AOM

4w-old: pertussis pn. with air trapping and collapse (segmental/lobar collapse not uncommon)

4-w. Died of pertussis pn. (2y S. aureus): air trap. He had SD hge.

Pertussis pn. in a 7-y. Obliteration

of cardiac borders is common

Complications: CNS• Hemorrhage, SD hematoma, brain atrophy• Seizures (Pertussis encephalopathy: hge+atrophy+seizures)

• SIADH

Complications: Alimentary Sys.• Frenulum ulceration

• Rectal prolapse, umbilical/inguinal hernia

• Intussusception, melena

• Malnutrition

SD hge in pertussis. Past: 36k died/y in US, most in first 6 mo of life

Mel

ena

Complications: Others

• Over exhaustion• Dehydration• Tetany• Hypoglycemia • Epistaxis, sub-conj. bleeds, purpura• Diaphragmatic rupture

Rupture of diaphragm: A. mimics loculated pneumothorax. B. NGT in herniated stomach

Prolonged QT

Tetany

Dx: mainly clinical• High index of suspicion in stage 1: immunity, contact,

neighborhood • Classical paroxysm is v. suggestive• Cough >2w with post-tussive emesis is an important clue

Lab. • CS: • CBC: absolute lymphocytosis (20-50K) is typical (not in B

parapertussis and immunized). It parallels the severity• CXR: perihilar infiltrates, Br.Pn., emphysema, etc.• PCR for rapid Dx

CS: should be done in all cases. Takes 10-14dNegative: after 4thw of illness, immunized, ABT• NP secretions (aspiration/Dacron/Ca alginate swab)• Media: Regan-Lowe (transport) and B.G.• Inform lab* beforehand

DD:• Other c/of bronchitis• Foreign body• Toxic damage to RT by gases• Lipoid/chemical pneumonia

*Inform lab as these media are not routinely available

• Erythromycin x14d is DoC– Aborts paroxysm in Stage 1– Shortens duration, reduces spread, prevents relapse– In Stage 2 ABT has no effect

• Azithromycin and clarithromycin are alternative• Resistance is rarePenicillins, cephalosporins ineffective

TREATMENT

Azithro.10–12mg/kg/d, max. 600mg/d x5dClarithro. 15–20 mg/kg/d, in 2 dd; max. 1 g/d x7d

Nursing is v. important– Avoid triggers, hydration, nutrition– suction clearance, O2

– Betamethasone, albuterol may severity No cough suppressants

Admission: Infants <6 mo– to manage apnea, hypoxia– feeding difficulties, dehydration– other complications– ICU

IMMUNISATION• 5 doses: 4th at 15-18mo; 5th at school entry• Immunity is not absolute/permanent• It may not prevent infection. Mild illness may not be recognized

and can spread• DPT vax.: requires booster/10y

Prognosis• Mortality ~40 % in infants <5mo

Death:• Anoxia, rapid dehydration• Malnutrition, hypoglycemia • Over exhaustion, encephalopathy

Points to Ponder• Pertussis is fatal in small babies• Severe damage to RT cilia RT is reactive for 1y• Causes innumerable complications

• Immunity is neither complete/permanent• Cl. Dx is essential• No growth on ordinary media

• Rx can abort the disease in coryzal stage• Can reactivate TB

This unvaccinated child has severe cough and vomiting. Answer the following:

1.What is the diagnosis?

2. What is the c/of such bleeding in this child?

3. What are other complications?

OSPE

MCQ

Classical pertussis

• causes neutrophilic leukocytosis• causes leukemoid reaction• is complicated by apnea in neonates• immunization confers excellent protection• causes death by septicemia• the bacteria grows in common media• makes blood culture positive

‘Bull neck’ (LAP and edema)

What is the Dx?

Pharyngeal D: membranes covering tonsils and uvula in a 15y F

DIPHTHERIAa serious d. c/by only locally invasive C. diphtheriae

– fatal: local obstruction and– fatal: systemic toxicity

• Spreads P2P. Fate depends on:– strain (toxic/not), circulation, immunity

• Man only• Both non-/toxigenic cause obstruction• Only toxigenics cause toxemia• 50% mortality. Now rare

Common site: URT• Also skin, eye, ear, genitalia, wound• Exotoxin: degeneration/necrosis of heart, nerves (paralysis)

kidneys, adrenals– Interval: myocarditis 2w. neuritis 3-7w

Characteristic pseudomembrane• Necrosed tissue + exudate + bacteria• Tough-fibrinous; adherent• Gray to black (~bleed)• Attempt to remove it causes bleeding

Diphtheritic tracheobronchial

membranes

Conjunctival D.: membranous conj.: strep., pneumo., D; chemical, ligneous conj., adenovirus or HSV

Nasal diphtheria: 5y

Diphtheria in wound

Tonsilopharyngeal DInsidious: LGF, disproportionately toxic, malaise, sore

throat, irritable, dysphagia, bull neck, rapid pulse, ± respiratory and CV collapse

Very distinctive membrane: pharynx to palate. Palatal palsy: nasal voice +/-regurgitation. May die in 7–10d

Laryngeal DUsually extension from pharynx• Croup, severe chest retraction, hoarseness• Restless, but soon becomes weak, drowsy• A grave situation! Urgent tracheostomy/intubation

Diagnosis: Clinical Dx is urgent!• Extended membrane, disproportionately toxic; noisy

breaths, stridor, hoarseness, bull neck, palatal palsy• Serosanguinous nasal discharge• Confirmed by CS, FAB staining• Toxigenicity test by using guinea pigs

IMPORTANT!• Diphtheria like MO on smear does not establish Dx. CS is

essential. But Cl. Dx is enough to start Rx• Mortality is ~5%. Untreated ~50%

White Patch Over Tonsils

Follicular tonsillitis D i p h t h e r i a Inf. Mono. Agranucytosis Leukemias Candidiasis Herpangina

• Vincent’s angina• Post tonsillectomy

membrane• Ac. Toxoplasmosis• Ac. CMV

Herpangina

Oral thrush

Follicular tonsillitis

Inf. mononucleosis

TreatmentA. Neutralize toxin• Equine ADS for blood toxins (not fixed) after

desensitization if sensitive (5-20%)

Dose varies: site, circulation, toxicity, duration, LAP• Pharyngeal/laryngeal ≤48hr 20-40 th i.u.• Nasopharyngeal disease 40-60 ,,• Extensive for 3d/bull neck 80-120 ,,

B. ABT : Penicillin/erythromycin DoC x14d

C. Supportive: life support

ADS: antidiphtheric serum. ABT: antibiotic therapy

Complications

Obstruction: • Hypoxia, CV collapse• Bull neck, dysphagia • Pn., hemorrhagic pn.

Toxemia:Neuritis: paralysis of palate,

pharynx, eye, diaphragm, ciliary B, GBS

Myocarditis GastritisHepatitisNephritis, ATN

MCQIn diphtheria:

• most strains are toxigenic• natural infx. does not exclude vaccination• greatest obstruction occurs with pharyngeal D• antibiotic alone is curative

• positive Albert Stain is diagnostic• cardiac failure occurs due to toxic myocarditis• the pseudomembrane is easily separable

Wel

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Welcom

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POLIOMYELITIS• Enterovirus: damage AH cells: partial/full paralysis• Spreads: P2P, mucus/phlegm, feces• Enters gut and URT, multiplies in throat and gut, spread to

nerve by blood and lymph• IP: 5-35d. 3 patterns: subclinical (commonest)

nonparalytic, paralytic (1%)

• Massive vax.: practically eradicated it from most countries except a few Afro-Asian countries

AH: anterior horn

CF• Fever, myalgia, HA, abnormal reflexes, back stiffness, stiff

neck, ANS features• Tests: cultures from throat, stools, or CSF

Rx• Only supportive:

– moist heat for muscle pain and spasms– Analgesic (no narcotics)– Physiotherapy, orthopedic appliances and surgery

• If severe: lifesaving measures

Tripod sign

Complications• Paralysis, aspiration pn., pulmonary edema• Myocarditis, shock• Paralytic ileus, disability, deformity, urine retention, UTI

Prognosis• Depends on the clinical type and area affected• Most cases recover. • CNS involvement is a medical emergency• Disability is more common than death

Prevention: OPV (live) and IPV (inactive). No OPV in HIC• OPV: herd immunity. Pulse dosing in LICs

HIC: high income countries. LIC:

MCQ• Both OPV and IPV are live vax• OPV is used globally• Both polio vax. gives herd immunity• OPV pulse dosing is used in LICs only• Most polio cases are subclinical

• Polio paralysis is usually symmetrical• Bangladesh is polio free

What is the Dx?

‘The Severe’ Measles

(rubeola)

David Morley

Measles is a killer and blinding disease

specially for malnourished children

Measles is a viral ID of man. Spreads P2P

• Main sign: an itchy MPR (exanthem) and tiny white spots in mouth (enanthem). 3 stages: catarrhal, eruptive, convalescence

• F, cough, rhinitis, conjunctivitis. Rash on 4th day of F• Severely ill. Serious complications• Vax. prevents it• IP: 7-18d. But SSPE: ~10.8y; not contagious• PI:- -5 +5 d of rash

MPR: maculopapular rash

Pathology: • MPR: starts at hair line, behind ears; eyes, RT and GIT

Spreads ; stays 7–10d: post measles staining• Rash reaches feet: F goes!• Rash may bleed (black measles)• Mouth: Koplik spots; devastating ulcers

• Severe depletion of VA• RT: Pn., bronchiolitis; bronchitis, bronchiectasis, AOM• CNS: Encephalitis, SSPE• GIT: D, malabsorption

Pathology …Immune system• Immunoparesis (T&B cell)• DiarrheaAppendix • Lymphoid hyperplasia• Pathognomic Warthin-Finkeldey giant cell• Appendicectomy not neededEyes: VADX, Keratoconjunctivitis, KeratomalaciaNutrition: VADX, Enteritis

Post measles staining

Noma/ cancrum oris

SEQUELAE CAN BE RESTORED with APPROPIATE TECHNOLOGY

DIAGNOSIS Mainly clinical. Giant cells in nasal smear• Culture of virus (urine, blood, nasopharynx)• Sp. IgM

Rx: No sp. Rx. Only supportive: • Most important: Vitamin A

– 200k i.u. day1, d4 and d8. It MM• FEB, feeding, oral hygiene• Rx of complications. ABT only for 2y infx.• Ig may benefit in severe Mn

• VADX, blindness• AOM• Laryngotracheitis • Bronchitis• Bronchiectasis • Bronchiolitis• Giant Cell Pn.

• PM enteropathy• Mouth ulcers• Myocarditis• Encephalitis• SSPE (1/1000)

Complications: by virus itself

Eye damage (by virus and VADX)– Conjunctivitis, keratitis, keratomalacia. Was the

commonest nutritional blindness

Secondary infx• Unmasking of TB• Bronchitis, bronchiolitis, bronchiectasis • ALTB (croup), bacterial pneumonia• AOM, diarrhea

Pneumonia in measles: viral, giant cell (Hecht), bacterial, tuberculous

Complications: immunoparesis• Unmasking of TB, depressed CMI (Pseudo-ve MT)• Low response to vaccines • Diarrhea, malabsorption, 2y infx. (v. common) • If fever recurs suspect 2y infx.

Causes of death• Fulminant course, pn., diarrhea, severe Mn., VADX• Neurologic complications

Any non-accidental death within 1 mo of measles is measles related death

Subac. Sclerosing Panencephalitis (SSPE)• A rare, chr., progressive encephalitis in children and young

adults (?mutation of virus)• There is restricted expression of envelope proteins: no

infectious particles like the M protein produced: no immune response. No spread!

Progression• Stage 1: irritable, altered personality, dementia, MR• .. 2: fit, ataxia, more MR, speech problems, dysphagia• .. 3: steady decline in body function, blindness. Pt. is

likely to be mute and/or comatoseNo cure. Inosine pranobex, ribavirin, IF alpha/betaAka Dawson Disease, Dawson E or measles E

MRI at presentation (A, B) and 3mo later (C, D). A and C are T1; B and D T2. A B: focal abnormality in white m. of L frontal lobe, with hypointense signal on T1 and a hyperintense signal on T2. In the FU scan, this is less obvious , but advanced diffuse cortical atrophy is seen, (ventriculomegaly , markedly enlarged sulci (arrowheads in C)

MCQ

• Measles can deplete VA totally• MT can be negative after measles• Vaccines should not be deferred after measles• Noma is a recognized complication of measles

• 2 doses of measles vaccine are required• It is the commonest c/of nutritional blindness• SSPE is a slow virus infection

Severe muscular spasms with trismus from

contamination of umbilical stump

Risus sardonicus

Opisthotonos: back is bent backward with forward bowing

What is Dx?

TETANUS • Fatal! Neurotoxin from vegetative form of anerobic

spore forming G+ve C. tetani. IP: 3d–3w-months (~14d)• Ubiquitous; soil, dust, dung; grows in deep wound: dead

tissues; no tissue damage nor inflam.• contamination shorter IP severer disease • Painful generalized myospasm. Death is usually from

suffocation. Subsides over weeks if recovers

• Brain not affected. Mentally clear• NT: 5-14 d (8 days disease)

NT: neonatal tetanus

LT secondary to parent’s attempt to drain a boil with a contaminated thorn

TREATMENTMedical emergency. Must hospitalize• Supportive: control spasm, FEB, nutrition• Control of ANS instability if any:

– ventilator SOS:• Wound management:Control of spasms is most important• Anticonvulsant: best survival is achieved by flaccid

paralysis and mechanical ventilation• TIG 3000-6000iu im for all. No local infiltration (cannot

neutralize fixed toxin)• IVIG can be considered

Anticonvulsants• Diazepam, Midazolam, Chlorpromazine• Baclofen and other muscle relaxants

ANS instabilities• Temp. instability, Cardiac arrhythmias• Unstable BP, Excessive secretions

Temperature instabilityHGF in tetanus: Spasms, Sympathetic over-stimulation,

Infection, Dehydration

TETANUS PRONE WOUND• Containing dirt, feces, soil, or saliva• Has necrotic or gangrenous tissue

Aggressive care is essential: part of preventionAim: eradication of the MO• Remove dead tissue and FB• No extensive débridement for punctures• No wide excision of cord stump

WOUND MANAGEMENT

Past Doses Clean, Minor Tetanus prone

Td TIG Td TIG<3 or unknown Y2 N Y Y3

    34 No5 No No6 No2 Children <7 y, DTaP. DT if pertussis is CI. 7 y: Td

3 Equine ATS used when TIG is NA

4 If only 3 doses a 4th is given

5 Yes, if >10 y since last dose

6 Yes, if >5 y since last dose

TT in Wound Management

ABT• Metronidazole is the DoC. Pen. G is alternative• Duration: 10-14d

TIG• Give TIG in HIV, regardless of h/of TT• Child 7y: use Td; <7y: DTaP/DTP/DT• Separate sites for TT and TIG• TIG does not preclude immunization• TIG does not impair immunogenesis

PO/IV metronidazole (30 mg/kg/d/6-h. Pen. G (100 000 U/kg/d/4-6h; max. 12 million U/day) IM

COMPLICATIONS

• Aspiration pn.• Dysphagia• Dyspnea, apnea • Secondary infx.

• IC Hge• Fractures, soft tissue injury• Hyperpyrexia• Hypoglycemia• Hyperglycemia

CAUSES OF DEATH

•Over-exhaustion, Aspiration pn., Hypoglycemia• IC Hge, Dehydration

Immunization• TT is toxoid; better as Td• Very stable: months at room temp• Very effective. May be given with other vax. • Given as DTP/DTaP, DT, Td ( diphtheria content)

– TT for pregnant and women of CBA• Children 6w-7 y: x5 TT and diphtheria toxoid• 5th before school entry. Then each 10y• For wilderness expeditions: 1 booster if not taken in 5y

HIB conjugate vx. containing TT (PRP-T) are not substitutes for TT vx

POINTS TO PONDER

• Non-communicable• Completely preventable • Non-inflammatory toxic response• Disease does not confer immunity • Spasm control is the mainstay of Rx

MCQ

Tetanus • is commonly focal• is a communicable disease• Dx mainly clinically• The vaccine is highly effective

• is more common in elderly people• Pt. stays mentally clear• can cause hyperpyrexia

Hemophilus influenzae type b (Hib/HIB)

• Severe sepsis, particularly among infants• During late 19C was believed to cause flu• Aerobic G-ve. Has polysaccharide capsule • 6 different serotypes (a - f)• 95% inf. is c/by type b (Hib)• Colonizes nasopharynx: affects local and distant sites• Antecedent URTI may be a contributing factor

Cellulitis6%

Arthritis8% Bacteremia

2%

Meningitis50%

Epiglottitis17%

Pneumonia15%

Osteomyelitis2%

HIB: Clinical Features*

*prevaccination era

Hib Meningitis

• 50-65% of meningitis in the prevaccine era• Deafness or neurologic sequelae in 15-30%• CFR: 2-5% despite of effective ABT

Rx: 3G cephalosporin, or chloramphenicol plus ampicillin. Ampicillin-resistance is now common

• Reservoir: human; asymptomatic carriers• Droplets• Incidence has fallen 99% since prevaccine era

CFR: case-fatality rate

0

5

10

15

20

25

1990 1992 1994 1996 1998 2000 2002 2004

Inci

denc

eIncidence*of Invasive Hib Disease, 1990-2004

*Rate per 100,000 children <5 years of ageYear

020406080

100120140160180200

0-1 12-13 24-25 36-37 48-49 60Age group (mos)

Inci

denc

eHaemophilus influenzae type b, 1986

Incidence* by Age Group

*Rate per 100,000 population, prevaccine era

Polysaccharide Conjugate Vax.

• Enhanced Ab. production. Given with other vax.• 3 primary from 6w; 2 boosters• Generally not for >59mo of age• Consider for high-risk: asplenia, immunodeficiency, HIV,

HSCT: 1 pediatric dose

Pneumococcal Disease• Gram-positive S. pneumoniae (Pasteur in 1881)• Reservoir: human; spread: droplets• 90 serotypes• Polysaccharide capsule is important virulence factor• Type-specific Ab is protective

Pneumonia, Bacteremia, Meningitis, AOM

• 2005: 1.6 million died; (0.7-1million U-5), mostly in LICs• In HICs, <2y and the elderly mostly affected• Immunodeficiencies greatly increase the risk• Increasing ABR underlines urgent need for vax.

Pneumococcal Disease in Children• Sepsis without focus is the commonest presentation• Leading c/of bacterial meningitis among U-5; highest

among infants• Most common c/of AOM (5million/y)

Pneumonia: 36% of adult CAP and 50% of HAPAc. onset: F, Shaking chills, pleuritic chest p., moist cough, SoB, tachypnea, hypoxia. 175k adm. In US/y. Common bacterial complication of flu and measles

CAP: community-acquired pn. HAP: hospital-acquired pn. AOM: acute otitis media

Pn. Sepsis• >50,000/y in the USA• More among elderly and very young• CFR: ~20%; 60% among the elderly

Pn. Meningitis• 3k-6k/y in the USA• CFR: ~30%; 80% in the elderly• Neurologic sequelae common

Children at more Risk of IPD

• Functional/anatomic asplenia, especially SCD• Overcrowding, poor clothing, malnutrition • HIV• Cochlear implant• Out-of-home group child care• USA: Afro-American, Alaskan Native, American Indian in

Alaska, Arizona, or N Mexico• Navaho children in Colorado and Utah

Outbreaks not common: generally occur in crowdingIPD often has underlying illness and may have high fatality

SCD: sickle cell disease

Invasive Pn. D. (IPD): Incidence by Age

0

50

100

150

200

250

<1 1 2 3 4 5-17 18-34 35-49 50-64 65+Age Group (Yrs)

Rat

e*

*Rate per 100,000 population Source: Active Bacterial Core surveillance/EIP Network

Pneumococcal Vax.• Growing ABR: urgent need for vax. • Vax. is most effective for Px

– 3 doses of pn. conjugate vax. (PCV) covering 7, 10 & 13 serotypes (PCV7, 10, 13)

– 1 unconjugated polysaccharide vax. covering 23 strains (PPV23)

• WHO recommends PCV

ABR: antibiotic resistance

Rubella

• Ac., contagious viral inf. that occurs most often in children and young adults

• Rubella in pregnancy may cause fetal death or cong. defects known as cong. rubella syn. (CRS: blindness, deafness, heart defects)

• 110k babies are born with CRS/y• Immunization

– Single dose of vax.: >95% immunity; 2nd dose 100%– Usually combined with Measles, Mumps, and/or Varicella vaccine

MCQ

• Pneumococcus is a capsulated bacteria• Rubella can cause deafness in adolescents• Hib is a common c/of epiglottitis• Pneumococcal vax. covers all strains• AOM can cause meningitis

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