Childhood Diseases and Immunisation (continued) Category Description Symptoms Refer to a doctor CHICKENPOX Chickenpox is a common, contagious disease caused by the varicella zoster virus. From 1 July, 2017, varicella vaccine (Varilrix) is funded on the NIS for all children at 15 months old, and a catch-up dose for previously unvaccinated children at 11 years old. The vaccine is also funded for children and adults with reduced immunity or at very high risk of contracting the disease (two doses recommended). Approximately 50,000 cases of chickenpox occur in New Zealand each year. People who have had chickenpox are also at risk of developing shingles later in life (see Shingles). Initially, fever, headache, tiredness or sore throat for up to three days before the rash appears (adults may develop a flu-like illness). The rash begins as red itchy spots, usually in crops of three to five that eventually become blisters. Most commonly begin on the head and neck before moving to the trunk and limbs. May also appear inside the mouth or on the genitals. Blisters crust over after three to five days and are extremely itchy. Number of blisters can range from a few to several hundred. Secondary bacterial infection is common. If the blisters become infected. If there are spots in the eyes, ears, or mouth. If the child has another illness affecting their immune system. If the child seems particularly unwell. If the diagnosis is uncertain. DIPHTHERIA Diphtheria is a serious, often fatal disease caused by Corynebacterium diphtheriae. Diphtheria is included in the NIS as part of the Infanrix-hexa (diphtheria, tetanus, pertussis, polio, hepatitis B, Haemophilus influenzae type b) vaccine. It is also a component of some other vaccines (ie, Boostrix, ADT booster, Infanrix-IPV). Diphtheria is extremely rare in New Zealand but is endemic in many developing countries. The bacteria cause mucous membrane inflammation so the most common symptom is a sore throat, hoarseness, painful swallowing and the development of a bluish-greyish membrane that covers the inside of the throat and tonsils. Other symptoms include a nasal discharge, fever and chills. Some people have no symptoms. Anybody with suspected diphtheria as the diphtheria toxin can affect the lungs, heart, peripheral nerves, and kidneys. Fatality rate is 2%–10%. HAEMOPHILUS INFLUENZAE TYPE B Haemophilus influenzae type b (Hib) is caused by a bacterium. Humans are the only hosts of these bacteria and children less than five years are especially at risk. Hib (Hiberix replaces Act-Hib from 1 July, 2017) is funded on the NIS for all children aged less than five years. Before immunisation, most common presentations were meningitis and epiglottitis. Meningitis tends to occur in younger children aged less than three years. Symptoms include fever, loss of appetite, vomiting, bulging fontanelle (babies), drowsiness, light sensitivity. Epiglottitis usually occurs in children aged two to four years. Symptoms include difficulty breathing and swallowing and drooling. May extend neck and stick tongue out. Rapid onset. Anybody with suspected Hib infection. Hospitalisation may be required. HEPATITIS A Hepatitis A is a virus that is more common in areas with low living standards, poor hygiene and high population density. In countries where the disease is endemic, almost all adults are immune. Several cases of hepatitis A infection were reported in New Zealand in 2015 linked to imported frozen berries. Havrix and Havrix Junior are funded on the NIS for transplant patients, children with chronic liver disease, and close contacts of known hepatitis A carriers. In infants and preschool children most infections are either asymptomatic or cause mild non-specific symptoms without jaundice. Adults typically develop symptomatic disease (eg, jaundice, weight loss, abdominal discomfort, dark urine), the severity of which increases with age. Anybody with suspected hepatitis A infection. HEPATITIS B Hepatitis B is a very infectious viral disease that infects liver cells. It is the host’s immune response that leads to the death of the infected liver cell. Two strengths of HBvaxPRO are funded on the NIS for people meeting certain criteria. Symptoms of acute hepatitis B include nausea and vomiting, jaundice, dark urine, pale faeces, tiredness, anorexia, stomach and muscle aches and fever. Some people are infected with the virus but do not show symptoms for a long time (chronic hepatitis). Anybody with suspected hepatitis B. Significant learning opportunity: Wound care Your new Group 3 CPD project Page 26 HEALTHCARE HANDBOOK 2017-2018 Common Disorders
CONTINUING OTC EDUCATION Infectious period and transmission Transmitted either by droplet inhalation (through the infectious person coughing or sneezing) or by direct contact with the blister exudate (fluid). Incubation is 10–20 days. Contagious period is one to two days before the rash appears and until all the blisters have formed scabs – may take between five and 10 days. Keep children away from school or childcare facilities throughout this contagious period. Immunocompromised people can develop the disease more than once. Transmission is by respiratory droplets or by direct contact with skin lesions or articles soiled by infected individuals. Diphtheria can be spread through contaminated food, such as milk. Untreated people are infectious for up to a month. Once appropriately treated the contagious period can be limited to four days. Incubation period: two to five days. Spread by infectious droplets through coughing and sneezing. Incubation period: unknown, probably two to four days. Complications and other management Scarring as a result of chickenpox infection occurs in approximately 19% of children with an average of three scars per child, often on the face. Secondary bacterial infection as a result of scratching is common. Antibiotics may be needed. People with asthma may get a worsening of their asthma symptoms or develop a viral pneumonia. Dehydration can also occur, especially if sores are located inside the mouth and drinking is painful. Other more severe complications (eg, encephalitis, Guillain-Barré syndrome, Reye’s syndrome) are rare and more likely in immunocompromised and adult chickenpox cases. Foetal abnormalities, premature labour and delivery and, rarely, maternal or neonatal death (2%–5% risk) can occur if a pregnant woman contracts chickenpox at eight to 20 weeks' gestation. Newborns are at risk of serious disease if their mother contracts chickenpox between the 5th day before delivery and the 2nd day after the baby is born. Other cases of chickenpox acquired in utero may cause no symptoms in the foetus but may present later as shingles at a young age. Other management: Avoid NSAIDs in chickenpox due to the rare possibility of complications. Consider aciclovir in immunocompromised people or people at risk of severe varicella infections. Varicella-zoster immune globulin given within 96 hours of initial contact can also reduce disease severity. Treatment is with diphtheria antitoxin and antibiotics. Booster doses should be considered by adults every 10 years particularly if travelling overseas to developing countries (usually given as a combined tetanus and diphtheria vaccine). ADT booster is also funded on the NIS for adults aged 45 and 65 years old. The infection is treated with antibiotics and additional treatments may be required for associated illnesses. Before the introduction of the Hib vaccine in 1994, Hib disease was the most common cause of life-threatening bacterial infection in children less than five years. Since 1994 hospitalisations due to Hib have decreased by approximately 90%. Avoid overcrowded conditions and sharing food and utensils. Practice good hygiene measures. Can survive outside the body for prolonged periods in food and water. Incubation period: 15–50 days. Transmitted either through person-to-person contact or through food or drink contaminated with faeces from an infected person. Signs and symptoms usually last less than two months, although can last up to six. Thoroughly wash hands before and after using the toilet, before preparing and serving food, and after changing nappies. The number of notified cases has steadily decreased since 1980; however, outbreaks frequently occur, most notably in the Ashburton district in 2013 with over 28 confirmed cases reported, and more recently nationwide in 2015 linked to frozen berries. Complications of hepatitis A are rare but can include cholestasis (a build-up of bile inside the liver) and liver failure which is potentially fatal. Usually transmitted through contact with infected blood or body fluids during childbirth, contact with broken skin in childhood, or during sexual intercourse or intravenous drug use. Hepatitis B virus in desiccated blood remains infective for at least one week. Incubation period: six weeks to six months. No specific treatment. Chronic hepatitis B infection can be treated with interferon and anti-viral medication. Contacts and family members of infected persons should be vaccinated against hepatitis B and practise strict hygiene measures. As there is no cure, preventing infection with the disease through vaccination, not sharing needles and practising safe sex using condoms is recommended. People with chronic hepatitis B are at higher risk for liver disease or liver cancer. Visit ELearning to start your project www.pharmacytoday.co.nz Facilitated by Dr Alesha Smith Page 27
According to Stéphane Rossini, incoming Chairman of the Agency Council, the culture of collaboration will remain a factor in ensuring that Switzerland is successful in retaining a high-quality medicines control system: “A globalised economy and the international consumption of therapeutic products entail synergies and collaboration.”
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