1.
THE IMMUNIZABLE DISEASES
I
Whooping Cough, Diphtheria
ANN MURIITHI-MUGO
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2.
OBJECTIVES
1. To know the disease entities that constitute the immunizable
diseases.
2. To understand the clinical presentation, diagnosis, management
and prevention of each of the immunizable diseases.
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3.
Immunizable diseases
The six childhood immunizable diseases targeted by KEPI are:
1. Tuberculosis (TB)
2. Poliomyelitis (Polio)
3. Diphtheria
4. Pertussis (Whooping cough)
5. Tetanus
6. Measles
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4.
Reasons these are target diseases:
1. The vaccines for their immunization are available, cheap and
effective and give long term immunity.
2. These diseases are among the highest cause of mortality and
morbidity among the under-five children.
3. The diseases are immunizable and it is cheaper to immunise
children than to treat them.
4. The diseases are highly contagious among children hence
leading to epidemics. But if many are vaccinated a community
may develop herd immunity thus reducing the spread of
diseases.
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5.
Target groups for KEPI
1. Infants (under one year)
2. Children 1 - 9 years
3. Women of child bearing age (19-49)
4. Pregnant mothers
NB: It is now routine practice to immunise against Hepatitis B and
haemophilus Influenzae type B in Kenya.
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6.
WHOOPING COUGH
Whooping cough is which is also known as pertussis, is
an acute respiratory tract infection caused by a
bacterium called Bordetella pertussis.
-Mode of transmission is by droplet inhalation.
-The incubation period is 7-10 days.
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7.
Clinical presentation
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8.
Clinical presentation cont..
• The signs and symptoms of whooping cough vary with the age
of the child.
• If a child is under 6 months of age, he/she will present with:
-Fever
-A cough that does not end with a whoop and lasts more than
three weeks.
• If a child is six months of age or more, he/she will present
with:
-Fever
-Sneezing, watering of eyes and irritation of the throat.
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9.
Clinical presentation cont..
-Paroxysms of coughing followed by a whooping
sound at the end of long coughing spell. The spell
may end in vomiting and gasp for breath.
-Talking, coughing or crying can precipitate the
paroxysms of cough.
-The under side of the tongue may become sore
and ulcerate.
-Attacks are more frequent at night and the cough
can last several weeks.
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10.
DIAGNOSIS
•Diagnosis is done clinically in most cases.
•Culture of the organism from pharyngeal
secretions.
•PCR on the secretions.
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11.
COMPLICATIONS
• Pneumonia
• Convulsions
• Encephalopathy with brain damage
• Malnutrition due to vomiting and loss of appetite
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12.
MANAGEMENT
1. Supportive:
-Encourage the mother to give nutritious food to prevent
malnutrition.
-Encourage breastfeeding or the drinking of plenty of oral fluids
immediately after a coughing attack to prevent dehydration.
-Avoid giving sedatives or cough suppressants because they
may make the illness worse.
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13.
Management cont..
2. Definitive treatment:
-Antibiotics: Macrolides- Erythromycin, clarithromycin or
Azithromycin or trimethoprim and sulphamethoxazole.
-IV fluids
-Antipyretics
NB: Refer the child to hospital immediately for further
management and anticipate complications.
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14.
PREVENTION
• Whooping cough is vaccine preventable using the Pentavalent
vaccine.
• Isolation of those suffering from whooping cough.
• Sending all suspected cases of whooping cough for treatment in the
hospital.
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15.
DIPHTHERIA
• Diphtheria is an acute infectious disease of the throat and
tonsils, caused by bacteria known as Corynebacterium
Diphtheriae, a facultative anaerobic Gram-positive
bacterium.
• These bacteria produce typical lesions on the mucous
membrane of the upper respiratory tract.
• A milder form of diphtheria can be restricted to the skin.
• Toxins released from the lesions are responsible for severe
general symptoms and can cause damage to the heart and
peripheral nerves.
• The incubation period is 2 - 9 days.
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16.
Mode of Transmission:
–Droplet inhalation.
–Ingestion of contaminated milk.
–Skin to skin contact.
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17.
Clinical presentation
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18.
Bull neck
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19.
Skin lesion
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20.
Clinical presentation cont…
•The child has fever and is acutely sick and toxic.
•The neck is enormously swollen –Bullneck.
•Sore throat with hoarseness and difficulty in
swallowing.
•Grey membrane at the back of the throat that spreads
past the tonsils. The membrane looks like small piece
of a dirty cloth stuck to the child's throat and may
suffocate the child to death.
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21.
Complications
• Myocarditis - the local lesion’s toxins attack the heart
muscle, causing signs of cardiac failure.
• Respiratory paralysis.
• Peripheral neuropathy, causing paralysis of the limbs.
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22.
Diagnosis
• Through the isolation of the bacteria from pharyngeal
specimen.
• Through clinical criteria:
-URTI with sore throat,
-Low grade fever,
-Adherent pseudomembrane on the throat, pharynx
and, or nasal cavity.
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23.
Management
Supportive treatment:
- Intubation or a tracheotomy with mechanical ventilation for those
with features of upper airway obstruction
- Arrhythmias can occur early in the course of the illness or weeks
later, and can lead to heart failure. Thus monitor and treat.
- Diphtheria antitoxin given early in the course of the illness to
prevent paralysis in the eye, neck, throat, or respiratory muscles.
NB: antitoxin does not neutralize toxin that is already bound to
tissues, delaying its administration is associated with an increase in
mortality risk.
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24.
Management cont…
Definitive Treatment:
• Empirical treatment should be started in a patient in whom suspicion of
diphtheria is high. Drugs recommended are:
-Metronidazole
-Erythromycin (orally or by injection) for 14 days (40 mg/kg)
-Procaine penicillin G given intramuscular for 14 days
• Patients with allergies to penicillin G or erythromycin can use
Rifampicin or Clindamycin.
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25.
Prevention
Diphtheria can be prevented by Immunisation
using the Pentavalent vaccine.
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