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Case Definitions. Dr.Vijay Yewale Convener, IAP Committee on Immunization 2009-11 Editor, Pediatric Infectious Disease. vnyewale@gmail.com. Diseases covered. Pneumonia (PNUC and PNUR) Acute Bacterial Meningitis (ABMP/ABMM/ABMH/ABMO/ABME) Diphtheria (DIPH) Pertussis (PERT)
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Case Definitions Dr.VijayYewale Convener, IAP Committee on Immunization 2009-11 Editor, Pediatric Infectious Disease vnyewale@gmail.com
Diseases covered • Pneumonia (PNUC and PNUR) • Acute Bacterial Meningitis (ABMP/ABMM/ABMH/ABMO/ABME) • Diphtheria (DIPH) • Pertussis (PERT) • Measles (MEAS) • Mumps (MUMP) • Chickenpox (CPOX) • Enteric fever (EFTY /EFPT) • Dengue fever (DENF /DENH /DENS) • Hepatitis (HEPA, HEPB, HEPE, HEPO, HEPN)
PNEUMONIA • Clinical Pneumonia (PNUC) • High fever (> 38 Degree C) and • Tachypnea • > 60 breaths / min if aged < 2months • > 50 breaths / min if aged 2-11 • > 40 breaths / min if aged 12m to <60 months (Reasonably ruled out reactive airway disease) • Radiological Pneumonia (PNUR) • Abnormal chest radiograph suggestive of Pneumonia
Microbiologic Diagnosis established • No • Yes • Culture • isolation of a bacterial pathogen from pleural fluid or blood • Antigen detection • identification of a bacterial antigen in pleural fluid by latex agglutination • Antibody detection • Other • Gram stained smear of pleural fluid
Previous relevant vaccination • Not immunized (NI) : Not received any dose of Pertussis, Hib and Measles containing vaccine or conjugate pneumococcal vaccine • Partially immunized (PI) : Received either not all Pertussis, Hib and Measles containing vaccine and conjugate pneumococcal vaccine or not all age appropriate doses • Fully immunized (FI): Received all age appropriate doses of Pertussis, Hib and Measles containing vaccines and conjugate pneumococcal vaccine • Ineligible for Immunization (II): less than 6 weeks of age
ACUTE BACTERIAL MENINGITIS • Acute onset of fever (usually > 38.5 °C rectal or 38.0 °C axillary and one of the following signs: Boggy fontanelle, seizures, neck stiffness, altered consciousness or other meningeal signs WITH • Abnormal CSF • Turbid appearance OR • Leucocytosis (>100 cells / mm3) OR • Leukocytosis (10 – 100 cells / mm3 ) with elevated prot >100mg% or CSF sugar <40 mg%
Microbiologic Diagnosis established • No • Yes • Culture • isolation of a bacterial pathogen from a normally sterile clinical specimen such as CSF or blood • Antigen detection • identification of a bacterial antigen in CSF by latex agglutination • Antibody detection • Other • Gram stained smear
ABMP • ABM with S.Pneumo • +ve Gram stain / Latex / CSF or Blood culture • ABMH • ABM with H.influenzae • +ve Gram stain / Latex / CSF or Blood culture • ABMM • ABM with N.Meningitides • +ve Gram stain / Latex / CSF or Blood culture • ABMO • ABM with organism other than P/H/N • ABME • ABM with no microbiological diagnosis
Previous relevant vaccination(not applicable for ABMM and ABMN) • Not immunized (NI) : Not received any dose of conjugate Pneumococcal and Hib vaccines • Partially immunized (PI) : Received either not all of conjugate Pneumococcal and Hib vaccines or not all age appropriate doses • Fully immunized (FI): Received all age appropriate doses of conjugate Pneumococcal and Hib vaccines • Ineligible for Immunization (II) • Age less than 6 weeks
CHICKENPOX(CPOX) • Vesicular rash starting on trunk and spreading to extremities in multiple stages of evolution
Microbiologic Diagnosis established • No • Yes • Culture • Antigen detection • Antibody detection • Other
Previous relevant vaccination • CPX vaccine • Not immunized (NI) • Not received any CPOX vaccine • Partially immunized (PI) • Received one dose of CPOX vaccine • Fully immunized (FI) • Received 2 doses of Chicken pox vaccine • Ineligible for Immunization (II) • Age less than 15 months
ENTERIC FEVER • Compatible clinical picture AND • EITHER blood culture positive OR • Positive TUBE WIDAL ( both H/ A/B and O > 1: 160) done beyond day 5 of fever
Microbiologic Diagnosis established • No • Yes • Culture • S. Typhi or S.Paratyphi on blood culture • Antigen detection • Antibody detection • WIDAL Test (both H/ A/B and O > 1: 160) • Other
Previous relevant vaccination • TY vaccine • Not immunized (NI) • Above 2 years and not received any typhoid vaccine • Partially immunized (PI) • Time lapsed since last immunization > 3 years • Fully immunized (CI) • Received typhoid vaccine within last 3 years • Ineligible for Immunization (II) • Age less than 2 years
DIPTHERIA • An illness characterised by laryngitis or pharyngitis or tonsillitis, and an adherent membrane of the tonsils, pharynx and/or nose and Isolation of Corynebacterium diphtheriae from a clinical specimen
Microbiologic Diagnosis established • No • Yes • Culture • Isolation of Corynebacteriumdiphtheriae from a clinical specimen OR • Antigen detection • Antibody detection • 4 fold or greater rise in serum antibodies • other • Gram stained smear
Previous relevant vaccination • DPT vaccine (DTP) • Not immunized (NI) • Not received any dose of DTP • Partially immunized (PI) • Received less than the age appropriate doses • Fully immunized (FI) • Received all the age appropriate doses • Ineligible for Immunization (II) • Age less than 6 weeks
PERTUSSIS • Cough lasting at least two weeks with at least one of the following symptoms: • Paroxysms (i.e. fits) of coughing • Inspiratory whooping • Post-tussive vomiting (i.e. vomiting immediately after coughing) without other apparent cause
Microbiologic Diagnosis established • No • Yes • Culture • Isolation of Bordetellapertussis or +ve PCR • Antigen detection • Antibody detection • Other
Previous relevant vaccination • DPT vaccine (DTP) • Not immunized (NI) • Not received any dose of DTP • Partially immunized (PI) • Received less than the age appropriate doses • Fully immunized (CI) • Received all the age appropriate doses • Ineligible for Immunization(II) • Age less than 6 weeks
MEASLES Any child with fever and maculopapular rash (i.e. non-vesicular) and cough, coryza (i.e. runny nose) or conjunctivitis (i.e. red eyes)
Microbiologic Diagnosis established • No • Yes • Culture • Antigen detection • Antibody detection • Presence of measles-specific IgM antibodies • Other
Previous relevant vaccination • MEASLES vaccine • Not immunized (NI) • Partially immunized (PI) • Received only one dose of Measles containing vaccine • Fully immunized (FI) • Received 2 doses of Measles containing vaccine • Ineligible for Immunization(II) • Age less than 9 months
Mumps • Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting two or more days and without other apparent cause
Microbiologic Diagnosis established • No • Yes • Culture • Antigen detection • Antibody detection • Other Not applicable
Previous relevant vaccination • MMR vaccine • Not immunized (NI) • Not received any Mumps containing vaccine • Partially immunized (PI) • Received at least 1 dose of Mumps containing vaccine • Fully immunized (FI) • Received 2 doses of Mumps containing vaccine • Ineligible for Immunization (II) • Age less than 15 months
DENGUE • DENF • An acute febrile illness of 2-7 days duration with two or more of the following manifestations: • Headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations • DENH (Thrombocytopenia + evidence of capillary leak i.e. 20% increase in Hct or ple effusion or ascites) • DENS (DHF with evidence of shock)
Microbiologic Diagnosis established • No • Yes • Culture • Antigen detection • NS1 Antigen test • Antibody detection • Positive Dengue serology IgG and IgM • Other • PCR
Previous relevant vaccination Not applicable
HEPATITIS • An acute illness typically including acute jaundice, dark urine, anorexia, malaise, extreme fatigue and right upper quadrant tenderness • Urine Bile pigments (urobilinogen) +ve • ALT(SGPT) >2.5 times the upper limit of normal • Malaria, leptospirosis, dengue and typhoid/paratyphoid
HEPATITIS A (HEPA) • HEPATITIS B (HEPB) • HEPATITIS E (HEPE) • HEPATITIS O (HEPO) Hepatitis Other types • HEPATITIS N (HEPN) Hepatitis etiology not known
Microbiologic Diagnosis established • No • Yes • Antibody detection • Positive IgM anti-HAV for HEPA • Positive HBsAg or IgM anti-HBc for HEPB • Positive IgM anti-HEV for HEPE • Positive IgM anti-HCV for HEPC • Other • PCR
Previous relevant vaccinationHepatitis A • Hepatitis A vaccine • Fully Immunized (FI) • Taken 2 doses of Hepatitis A vaccine • Partially Immunized(PI) • Taken less than one doses of Hepatitis A vaccine • Not Immunized (NI) • Not taken any dose of Hepatitis A vaccine • Ineligible for immunization (II) • Less than 12 months of age
Previous relevant vaccinationHepatitis B • Hepatitis B vaccine • Fully Immunized (FI) • Taken 3 doses of Hepatitis B vaccine • Partially Immunized (PI) • Not taken all 3 doses of Hepatitis B vaccine • Not Immunized (NI) • Not taken any dose of Hepatitis B vaccine • Ineligible for Immunization (II) • Less than 6 weeks
HEPATITIS E , Other types, N (Etiology not known)Previous relevant vaccination Not applicable