2017 HCHB_digital

CONTINUING OTC EDUCATION
Infectious period and
transmission
Spread by inhalation of infected droplets from a
cough or sneeze.
Incubation period: six to 20 days.
Highly infectious and around 90% of nonimmune
household contacts will contract it.
Infectious period: seven days after exposure
until three weeks after the cough begins.
Children should stay away from school or
childcare facilities throughout this contagious
period.
Pneumococcal bacteria are carried in the nose
and throat of healthy adults and children.
Transmitted through infected droplets released
into the air by coughing or sneezing.
Incubation period: varies, may be as short as
one to three days.
Complications and other management
Babies aged less than six months are most at risk (75% require hospitalisation). Almost no maternal protection against pertussis is
passed to the newborn from the mother. Children under 12 months who are ill enough to be admitted to hospital have a one in 200
chance of dying of whooping cough. In one to three per 1000 children whooping cough leads to permanent brain damage, paralysis,
deafness or blindness (mortality rate of approximately 1%). Adolescents and adults may just present with a persistent cough similar
to that found in other upper respiratory infections (but still infectious).
Other management: Antibiotics do not cure pertussis, but may be given to reduce spread of infection to others. Cough medicines
provide little relief and should never be used in children under six. A mist vaporiser may soothe dry, irritated airways. Keep the room
free of irritants such as dust and smoke. Maintain a good fluid intake – keep meals small and more frequent. Ensure sick children get
plenty of bedrest.
Additional notes: Pertussis immunity wanes over time; both following natural disease and vaccination (immunity lasts five to 10
years). Pertussis is estimated to be responsible for up to 20% of severe coughs in adults lasting one to three months. These could be
a significant reservoir of infection. Reinfection may present as a persistent cough, rather than typical pertussis. Currently available
vaccines prevent disease much better than they prevent infection, so outbreaks still occur in countries with widespread vaccination
although mortality and morbidity is greatly reduced.
Pneumococcal disease is more common in autumn and winter and is the leading cause of bacterial pneumonia in young children
and adults older than 65. Maori and Pacific children are affected by pneumococcal disease more than other ethnicities in New
Zealand. Since introduction of a vaccine in 2008, the number of hospitalisations and recorded carriers of the bacteria has reduced.
Combination antibiotic treatment is usually required, although resistance can be a problem. Supportive care may also be needed.
Transmitted by the faecal-oral route or
by ingestion of pharyngeal secretions.
Asymptomatic people will shed the virus in their
stool and through poor hygiene will spread the
infection to others.
Incubation period: three to 21 days.
Virus persists in the pharynx for approximately
one week and in the faeces for three to six
weeks.
Highly contagious. Virus is able to survive a
long time on surfaces such as taps, bench
tops and toys. Main route of infection is
contamination of hands, utensils and other
objects with faeces from an infected person.
Incubation period: 24–72 hours.
Transmission is through direct or droplet
contact with infected nasopharyngeal secretions
(through a cough or sneeze). Infants with
congenital rubella shed virus in their pharyngeal
secretions and urine for months after birth and
should be considered infectious until they are
12 months old.
Incubation period: 14–21 days.
Humans are the only source of rubella infection.
Soil is the most common source of Clostridium
tetani spores and bacilli. Animals also carry the
bacilli and spores in their intestine and release
it in their faeces. Entry can be gained into the
body through a relatively minor cut, graze or
puncture wound.
Incubation period: three to 21 days.
A person with tetanus is not infectious to
others.
The disease is incurable. While the person is acutely unwell only supportive care can be provided to reduce complications associated
with paralysis. Once recovered, rehabilitation can prevent or reduce post-polio deformities and increase independence.
The Global Polio Eradication Initiative aims to immunise every last child on the globe with polio vaccine and ensure a polio-free world
for future generations. Until eradication throughout the world is confirmed, there is a risk of polio returning to New Zealand. New
Zealand started immunising against polio in 1961 using the oral polio vaccine, which was replaced in 2002 by the inactivated polio
vaccine. Worldwide rates of polio have decreased by 99% since 1988. Polio is still endemic in Afghanistan, Nigeria and Pakistan.
Most years, several previously polio-free countries are reinfected due to imports of the virus from endemic countries infecting nonimmune
people.
Strict hygiene is vital in preventing transmission. Hands should be thoroughly washed after changing nappies or cleaning up
diarrhoea or vomit. Vaccination with the oral rotavirus vaccine is the most effective way to prevent infection.
There is no specific treatment for rotavirus infection. The most important thing is to prevent dehydration by replacing fluid lost
through diarrhoea and vomiting.
Rubella is usually a mild disease in children; adults tend to have more complications. The most serious complication of rubella
infection is Congenital Rubella Syndrome (CRS), which results when the rubella virus attacks a developing foetus. When infection
occurs during the first trimester of pregnancy, up to 85% of infants will be born with some type of birth defect, including deafness,
eye defects, heart defects, mental retardation and more. Defects are rare when infection occurs after 20 weeks’ gestation.
Rubella vaccine, as contained in the combined measles, mumps, and rubella vaccine, is 95%–96% effective at preventing disease.
Those who are not protected after the first dose almost always develop protection after the second dose.
The last rubella outbreak in New Zealand was 1995/96 where 306 cases were notified (mostly involving young men).
Intensive care treatment is required and recovery can take months.
Almost all of the recent cases of tetanus reported in New Zealand occurred in individuals who had not received their primary
immunisation course of a tetanus-containing vaccine. In 2010, seven cases of tetanus were notified, the highest number since 1992
and one person died. One case had received a primary course of tetanus vaccines but had not received a booster dose for 15 years.
Most years between zero and two cases are notified.
Booster doses should also be given to people travelling overseas if it has been more than 10 years since their last dose.
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