2017 HCHB_digital

Childhood Diseases and Immunisation (continued)
Category Description Symptoms Refer to a doctor
HUMAN PAPILLOMA
VIRUS (HPV)
HPV viruses are a group of more than 200 related viruses.
At least 40 different types can be spread through sexual
contact and HPV infections are the most commonly
sexually transmitted infections.
As of January 2017, the HPV vaccine Gardasil 9 (protects
against HPV types 6, 11,16,18, 31, 33, 45, 52 and 58)
is funded on the NIS for both males and females from
age nine to 26. A two-dose schedule is recommended for
those aged 14 and under, and a three-dose schedule for
those aged 15 to 26. Any female who started a 3-dose
4-valent Gardasil regimen prior to the change-over is able
to complete their remaining doses in 2017. The vaccine is
licenced but unfunded for females aged 27 to 45 years.
HPV is very common with four out of five people
becoming infected with HPV during their lifetime.
In most people, the infection clears by itself
without causing any symptoms or long-lasting
health problems.
Low-risk HPVs 6 and 11 cause approximately 90%
of genital warts. Genital warts appear as a small
bump or cluster of bumps in the genital area. They
may be raised or flat, small or large, or shaped like
a cauliflower.
High-risk HPVs cause cancer, including cancer of
the cervix and anus and oropharyngeal cancer.
HPVs 16 and 18 are the most commonly implicated
viruses. Cancer often takes years to develop after a
person gets HPV.
If there is any suspicion of genital warts.
For any abnormal bleeding, pain, or
discharge in the genital area.
Women aged 20 to 70 should undergo
cervical screening at least every three years.
MEASLES
Measles is a highly contagious disease caused by a
paramyxovirus of the genus Morbillivirus. A vaccination
against measles is funded on the NIS and is given as a
combined measles, mumps and rubella vaccine (Priorix
replaces MMR-II from 1 July, 2017). Last reported
epidemic in New Zealand was 2011 (595+ cases).
Measles is endemic in many countries overseas and more
than a million children die from the virus each year.
First three days: high temperature, cough, cold,
runny nose, sore throat, swollen neck glands. Red,
sore, watery eyes and an inability to tolerate light.
Day three: Koplik’s spots may appear (small red
spots on inner surfaces of cheeks and soft palate).
These are transient and not seen in every case of
measles.
Days four and five: blotchy, flat red rash, first
appearing on the face then progressing down the
trunk and limbs, with or without itch.
If there is ear pain.
If the child is unwell after the rash subsides.
If the diagnosis is uncertain.
MENINGOCOCCAL
DISEASE
Meningococcal disease is a bacterial infection caused by
the bacterium Neisseria meningitidis, of which several
different groups exist (A, B, C, W-135, Y). Between 40
and 100 cases of meningococcal disease occur in New
Zealand each year, with most cases being caused by
group B bacteria. Group C is the next most common
cause. Humans are the only hosts of these bacteria.
Although there are a number of meningococcal vaccines
available, only Menactra and NeisVac-C are publicly
funded for certain groups of few people at high risk (ie,
those without a spleen, close contacts of meningococcal
cases). Customers may chose to purchase these privately.
NeisVac-C (only protects against Group C bacteria);
Menactra and Nimenrix (both protect against Groups
A, C, Y and W135) are conjugate vaccines and can be
used in children under two years. Conjugate vaccines are
considered superior to polysaccharide vaccines such as
Menomune.
Meningococcal B bacteria vaccines are difficult to develop
and none are currently commercially available in New
Zealand.
Symptoms can develop suddenly and include: a
high fever, headache, sleepiness, joint and muscle
pains. More specific symptoms include: a stiff neck,
photophobia (cannot tolerate light), vomiting,
crying, and a reddish-purple, pin-prick, spotty rash
or bruises that do not blanch (go white) when
pressed.
In babies and very young children, the signs may
be more subtle.
• Infants may refuse to feed.
• The child may be listless or strangely quiet,
irritable, or have a very high-pitched cry.
• The child may have a bulging or tight fontanelle
(top of the head).
• Neck stiffness may be absent in infants.
• Mothers are usually very instinctive about their
children and, if they believe there is “something
not quite right”, the child should be referred to
a doctor.
Be alert for the signs and symptoms of
meningococcal disease and seek urgent
medical treatment if it is suspected or cannot
be ruled out.
For more information go to the YourHealth
topics on the New Zealand Ministry of
Health’s website www.health.govt.nz (or
phone Healthline: 0800 611 116 or 111 if it
is an emergency).
If your customer has already seen a doctor
and been sent home but is still concerned,
advise them to call their doctor again, or
phone a different doctor, and insist on
further tests or observation.
MUMPS
Mumps (epidemic parotitis) is caused by a paramyxovirus
of the genus Paromyxovirus. Most reported cases are in
children aged five to nine years. Mumps is funded on
the NIS and is given as a combined measles, mumps
and rubella vaccine (Priorix replaces MMR-II from 1 July,
2017). Last reported epidemic in New Zealand was 1994
(188 cases); however, mumps cases are still occurring.
Some people do not experience any symptoms.
Both parotid (salivary) glands on the side of the
neck enlarge and become tender although one
usually swells one to two days before the other.
The glands become increasingly sore, especially
when swallowing, talking, chewing and drinking.
Dry mouth, fever, stiff neck, loss of appetite,
nausea, vomiting, tiredness and convulsions may
occur.
If customer is going through puberty.
If the customer has repeated vomiting,
headache and a stiff neck.
If the customer is an adult or adolescent
male with the disease.
If the diagnosis is uncertain.
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Page 28 HEALTHCARE HANDBOOK 2017-2018 Common Disorders