Vaccine Preventable Diseases

1. Vaccine Preventable Diseases Ana H. Corona, MSN, FNP-C Nursing Instructor May 2008 More presentations @: www.nurseana.com

2. Bacteria and Viruses that cause vaccine preventable disease and death still exist and can be passed on to people who are not protected by vaccines. Convincing parents to adhere to childhood immunizations is not quite difficult as before. Vaccine Preventable Diseases

3. A vaccine is a medical preparation given to provide immunity from a disease. The development of vaccines against diseases is considered among one of the greatest accomplishments of medical science. Prior to the invention of vaccines infectious diseases swept through towns, villages, and cities with a horrifying vengeance. Vaccines have limited many of the life-threatening infectious diseases. Vaccines

4. Smallpox • Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus (an orthopoxvirus). • The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting. • A rash follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving a pitted scar.

5. Early results from laboratory studies suggest that the drug cidofovir may fight against the smallpox virus; Treatment: supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur. The density of the rash is greater on the face than on the body. Smallpox

6. Man with smallpox. Public Health Images Library (PHIL) id# 131. Source: CDC/Barbra Rice

7. Smallpox lesions on skin of trunk. Picture taken in Bangladesh, 1973. Public Health Images Library (PHIL) ID # 284. Source: CDC/James Hicks

8. Face lesions on boy with smallpox. Public Health Images Library (PHIL) ID # 3. Source: CDC/Cheryl Tyron

9. After exposure, it takes between 7 and 17 days for symptoms of smallpox to appear (average incubation time is 12 to 14 days). The majority of patients with smallpox recover, but death may occur in up to 30% of cases. Many smallpox survivors have permanent scars over large areas of their body, especially their face. Some are left blind. The distribution of the smallpox rash is usually similar to that shown here. It is most dense on the face, arms and hands, legs and feet. The trunk has fewer pocks than the extremities.

10. Smallpox normally spreads from contact with infected persons. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Pocks are usually present on the palms of the hands and on the soles of the feet.

11. The smallpox virus dies within 24 hours. If an aerosol release of smallpox occurs, 90% of virus matter will be inactivated or dissipated in about 24 hours. Smallpox can be prevented through use of the smallpox vaccine. There is no proven treatment for smallpox, but research to evaluate new antiviral agents is ongoing.

12. A Woman with Smallpox

13. Early results from laboratory studies suggest that the drug cidofovir may fight against the smallpox virus; Treatment: supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

14. Smallpox vs Chickenpox

15. Differentiating Smallpox and Chickenpox

16. Smallpox Vs Chickenpox: the relative density of rash on different parts of the body should be carefully observed. This diagram illustrates the differences that are usually seen.

17. Chickenpox

18. Chickenpox is caused by a virus, the varicella-zoster virus. Chickenpox spreads from person to person by direct contact or through the air by coughing or sneezing. It is highly contagious. It can also be spread through direct contact with the fluid from a blister of a person infected with chickenpox, or from direct contact with a sore from a person with shingles. Chickenpox

19. Chickenpox • It takes from 10-21 days to develop symptoms after being exposed to a person infected with chickenpox. The usual time period is 14-16 days. • The most common symptoms of chickenpox are rash, fever, coughing, fussiness, headache, and loss of appetite. • The rash usually develops on the scalp and body, and then spreads to the face, arms, and legs. • The rash usually forms 200-500 itchy blisters in several successive crops. The illness lasts about 5-10 days.

20. Chickenpox Complications • The most common complication is bacterial infection of the skin or other parts of the body including the bones, lungs, joints, and blood. The virus can also lead to pneumonia or infection of the brain. • These complications are rare but serious. Complications are more common in infants, adults, and persons with weakened immune systems.

21. Infant with necrotizing fasciitis, a complication of varicella Newborn with chickenpox Chickenpox Complications

22. Chickenpox Treatment • Most cases of chickenpox in otherwise healthy children are treated with bed rest, fluids, and control of fever. • Children with chickenpox should NOT receive aspirin because of possible subsequent risk of Reye's syndrome. • Acetaminophen may be given for fever control. • Chickenpox may be treated with an antiviral drug in serious cases, depending on the patient's age and health, the extent of the infection, and the timing of the treatment.

23. Anthrax

24. Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores. There are three types of anthrax: skin (cutaneous) lungs (inhalation) digestive (gastrointestinal) Anthrax

25. Anthrax • Anthrax is notknown to spread from one person to another. • Humans can become infected with anthrax by handling products from infected animals or by breathing in anthrax spores from infected animal products (like wool, for example). • Gastrointestinal anthrax - by eating undercooked meat from infected animals. • Anthrax as a weapon. Anthrax also can be used as a weapon. This happened in the United States in 2001. Anthrax was deliberately spread through the postal system by sending letters with powder containing anthrax. This caused 22 cases of anthrax infection.

26. Cutaneous: The first symptom is a small sore that develops into a blister. The blister then develops into a skin ulcer with a black area in the center. The sore, blister and ulcer do not hurt. Anthrax: Signs/Symptoms

27. Anthrax : signs & symptoms • Gastrointestinal: The first symptoms are nausea, loss of appetite, bloody diarrhea, and fever, followed by bad stomach pain. • Inhalation: The first symptoms of inhalation anthrax are like cold or flu symptoms and can include a sore throat, mild fever and muscle aches. Later symptoms include cough, chest discomfort, shortness of breath, tiredness and muscle aches.

28. Anthrax • Incubation: Symptoms can appear within 7 days of coming in contact with the bacterium for all three types of anthrax. For inhalation anthrax, symptoms can appear within a week or can take up to 42 days to appear. • How Is Anthrax Treated? • Antibiotics are used to treat all three types of anthrax. Early identification and treatment are important. • Prevention after exposure. Treatment is different for a person who is exposed to anthrax, but is not yet sick. Health-care providers will use antibiotics (such as ciprofloxacin, levofloxacin, doxycycline, or penicillin) combined with the anthrax vaccine to prevent anthrax infection. • Treatment after infection. Treatment is usually a 60-day course of antibiotics. Success depends on the type of anthrax and how soon treatment begins.

29. Anthrax Vaccine • There is a vaccine to prevent anthrax, but it is not yet available for the general public. • Anyone who may be exposed to anthrax, may get the vaccine. • In the event of an attack using anthrax as a weapon, people exposed would get the vaccine.

30. Measles is caused by a virus. It is spread through the air by infectious droplets and is highly contagious. It takes an average of 10-12 days from exposure to the first symptom, which is usually fever. The measles rash doesn't usually appear until approximately 14 days after exposure, 2-3 days after the fever begins. Symptoms include fever, runny nose, cough, loss of appetite, "pink eye," and a rash. The rash usually lasts 5-6 days and begins at the hairline, moves to the face and upper neck, and proceeds down the body. Measles

31. Before measles immunization was available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963. If Measles vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected. There is no treatment for measles. Bed rest, fluids, and control of fever. Patients with complications may need treatment specific to their problem. Measles (Rubeola)

32. Measles • Diarrhea is the most common complication of measles (occurring in 8% of cases), especially in young children. • Ear infections occur in 7% of reported cases. Pneumonia, occurring in 6% of reported cases, accounts for 60% of measles-related deaths. • Approximately one out of one thousand cases will develop acute encephalitis, an inflammation of the brain. • This serious complication can lead to permanent brain damage. • Measles during pregnancy increases the risk of premature labor, miscarriage, and low-birth-weight infants, although birth defects have not been linked to measles exposure.

33. Measles (rubeola) pharyngitis in an adult showing striking inflammation Measles (rubeola) rash and conjunctivitis Measles

34. Koplik spots, blue-white spots on the inside of the mouth that occur 24-48 hours before the rash stage Measles

35. Meningococcal Disease • Meningococcal disease is caused by the bacterium Neisseria meningitidis. • The disease is spread person-to-person through the exchange of respiratory and throat secretions • Meningococcal bacteria can't live for more than a few minutes outside the body.

36. Meningococcal Disease • Bacterial meningitis can be treated with antibiotics. It is critical to start treatment early. • There are approximately 2,000-3,000 cases of meningococcal disease each year in the United States. An estimated 125 deaths from meningococcal disease occurred in the United States in 2004. Septicemic rash

37. Meningococcemia • The most common symptoms are high fever, chills, lethargy, and a rash. • If meningitis is present, the symptoms will also include headache and neck stiffness (which may not be present in infants); seizures may also occur. • Complications: shock, coma, and death can follow within several hours, even with appropriate medical treatment. • About 9-12% of persons with meningococcal disease die. Of those who recover, up to 20% suffer from some serious after-effect, such as permanent hearing loss, limb loss, or brain damage.

38. Meningococcal Disease • Four-month-old female with gangrene of hand and foot due to meningococcemia • Rash from meningitis; spots change into purple bruises which don't blanch (lose their color) when pressed by glass

39. Hepatitis B is a liver disease caused by the hepatitis B virus (HBV). The spread of HBV occurs when blood from an HBV-infected person enters the body of a person who is not infected. This can occur through having sex with an HBV-infected person without using a condom. HBV is also easily spread by sharing drugs, needles, or "works" when "shooting" drugs. HBV is also spread through needlesticks or sharps exposures on the job From an infected mother to her baby during birth. Breastfeeding has not been associated with the spread of HBV. This woman is suffering from liver cancer caused by hepatitis B Hepatitis B Virus

40. Hepatitis B • The incubation period ranges from 45 to 160 days (average 120.) • Signs and symptoms of hepatitis B might include nausea, lack of appetite, tiredness, muscle, joint, or stomach pain, fever, diarrhea or vomiting, headache, dark urine, light-colored stools, and yellowing of the skin and whites of the eyes (jaundice). • In the United States, an estimated 3,000-4,000 people die each year of HBV-related cirrhosis, and another 1,000-1,500 die each year of HBV-related liver cancer. • There are several FDA-approved medications that might help a person who has chronic HBV infection. • These medications cure, but they might decrease the chance of the infected person developing severe liver disease. • There is no treatment (other than supportive care) for people with acute hepatitis B.

41. Pertussis (Whooping Cough) • Nearly all children developed whooping cough, before pertussis immunizations were available. • In the U.S., prior to pertussis immunization, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths. (CDC) • Child with broken blood vessels in eyes and bruising on face due to pertussis coughing.

42. Pertussis • Pertussis is caused by a bacterium, Bordetella pertussis. • It is spread through the air by infectious droplets and is highly contagious. • Incubation period is commonly seven to 10 days, with a range of 5-21 days. • A photomicrograph of Bordetella (Haemophilus) pertussis bacteria

43. Pertussis disease can be divided into three stages: • Catarrhal stage: can last 1-2 weeks and includes a runny nose, sneezing, low-grade fever, and a mild cough (all similar symptoms to the common cold). • Paroxysmal stage: usually lasts 4-6 weeks, but can persist for up to 10 weeks. The characteristic symptom is a burst, or paroxysm, of numerous, rapid coughs. At the end of the paroxysm the patient suffers from a long inhaling effort that is characterized by a high-pitched whoop (hence the name, "whooping cough"). Infants and young children often appear very ill and distressed, and may turn blue and vomit. • Convalescent stage: usually lasts 2-6 weeks, but may last for months.

44. Pertussis • Although the cough usually disappears after 2-3 weeks, paroxysms may recur whenever the patient suffers any subsequent respiratory infection. • The disease is usually milder in adolescents and adults, consisting of a persistent cough similar to that found in other upper respiratory infections. • These individuals are still able to transmit the disease to others, including unimmunized or incompletely immunized infants.

45. Pertussis • Pertussis can be a severe illness, resulting in prolonged coughing spells that can last for many weeks. • These spells can make it difficult for a child to eat, drink, and breathe. • Because vomiting often occurs after a coughing spell, infants may lose weight and become dehydrated. • In infants, it can also cause pneumonia and lead to brain damage, seizures, and mental retardation.

46. Pertussis Treatment • Antibiotics may be helpful in treating pertussis. The drug of choice is erythromycin. • This antibiotic should also be given for 14 days to all household and other close contacts of the patient to minimize transmission, regardless of age and vaccination status.

47. Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. Polio left thousands of victims--mostly children--in braces, crutches, wheelchairs, and iron lungs. The effects were life-long. Poliomyelitis

48. Patients whose respiratory muscles were affected were placed in an "iron lung" machine to enable them to breathe Polio

49. Polio Ward

50. 2,000 cases of polio in 17 countries were reported in 2006. Only four countries remain endemic (Afghanistan, India, Nigeria, Pakistan). Polio Eradication