Vaccine Preventable diseases

1. Vaccine Preventable diseases By Prof. Dr. Asmaa AbelAziz Dr. Alaa Hassan

2. Vaccine Preventable diseases • Measles • German Measles • Mumps • Poliomyelitis • Whooping Cough • Diphtheria • Tetanus • Chicken Pox

3. Measles (Rubeola) • Standard case definition: • A) Suspected case: • Any child suffering from the following symptoms • Fever (38.5 and lasting for >=3 days). • Maculopapular rash • Cough, Coryza (i.e. running nose) or • Conjunctivitis . • B) Confirmed Case : • A confirmed case is one in which suspected case is confirmed by laboratory( virus isolation or antibody elevation) .

4. Maculopapular Rash of Measles

5. Maculo Papular Rash

6. Complications: • Gastro-intestinal complications in the form of diarrhea. • Respiratory complications: Bronchitis, bronchiolitis and pneumonia. • Otitis media. • Encephalitis: occur in about 1 in 1000 case • Measles considered a major precipitating factor in the etiology of preventable blindness in the world by causing Vitamin A deficiency

7. Descriptive Epidemiology Person Place Time

8. Place : Countries in which measles vaccine is widely used are already experiencing a marked decrease in the incidence of the disease.

9. Time: The seasonal trend that is observed in winter months. Epidemic cyclic rhythm in the pre-vaccination era was 2-3 years according to accumulation of susceptibles.

10. Person: Age and sex: Measles is mainly a disease of children. The incidence is equal in both sex. Following the widespread use of measles vaccine, the disease is now seen in older age-groups and the incidence increases in adults Nutrition: Measles tends to be very severe in the malnourished child

11. Incubation period: 4 days before appearance of rash (range 8-16 days).

12. Cycle of infection

13. Cycle of infection: • Agent: • Measles virus. • Reservoir: • Man in the form of : • Cases: Mild cases are more frequent than before vaccination era . • Carriers are not known to occur . • The source of infection: • is the secretion of nose , throat, respiratory discharge • Exit: • Upper respiratory tract.

14. Measles Virus

15. Mode of transmission: • Measles is highly communicable diseases. • It can be transmitted by: • -Droplet spread • - Direct contact with nasal or throat • secretions of infected persons. • - Less commonly it is spread by air born • mode or indirect contact • Inlet: • Nose and mouth.

16. Susceptibility : • Practically all persons who have not had the disease or been immunized are susceptible. • Acquired natural immunity: is permanent. • Acquired passive immunity: Infants born to mothers who have had the disease are immune for the first 6-9 month or more depending on the amount of residual maternal antibody at the time of pregnancy. • Artificial passive immunization (Immunoglobulin) • Artificial active immunity( Vaccination)

17. Vaccination • The vaccine is presented as freeze-dried product. • It is stable, stored at refrigerator temperature (0-8C). • The vaccine is either monovalent or in combined form measles, rubella, and mumps – MMR – without loss of potency of any antigen. • Dosage: Single subcutaneous dose of 0.5ml of the reconstituted vaccine given into the arm. • According to the Schedule in KSA ,MMR is given in Two doses ( at 12th months & at 4-6th Years) • Immunity: Immunity develops eight days after vaccination. One dose of the vaccine appears to protect 95% of recipients. • Side effects: Mild fever (7 days after vaccine receiving)

18. Contraindications: • Measles vaccine should not be given to Children with impaired immune systems ( leukemia, lymphoma, generalized malignancy, immune deficiency diseases or immunosuppressive therapy.) • Pregnant women. • III. Person suffering from an acute illness and active T.B. • IV. Recipients of blood or blood products ( immune globulin, whole blood or packed red blood cells). They neutralize the measles vaccine. Administration of measles vaccine to blood recipients should be postponed 2-3 weeks after receiving the blood

19. Period of communicability: The period of communicability is four days before and four days after the appearance of the rash. The vaccine virus has not been shown to be communicable

20. Prevention: • Apply basic measures for prevention of respiratory tract infection . • 2. Vaccination. • 3. Immunoglobulin: The need for immunoglobulin is now much reduced because of the availability of an effective live attenuated vaccine. It is given to exposed children whom the vaccine is contraindicated • To be effective, passive immunity must be given within three days following an exposure, administration after three days is not effective Why?.

21. Control: • 1. Reporting to local health authority. • 2.Isolation: from school for 2 weeks after the onset of the disease. • 3.No specific treatment. • 4. Concurrent& terminal disinfections: Of no value • 5.Measures for contacts : • A-Put under observation for the incubation period • B-Previously immunized healthy contacts : nothing • C-Unimmunized healthy contacts : should receive • the vaccine within three days after exposure • D-Unimmunized contacts with contraindications to • immunization could receive immunoglobulin within • 3 days after exposure .

22. Measles elimination program: • Measles like small pox, has several favorable factors that make it a suitable candidate for eradication. • The virus exists in a single serotype that is of antigenicaly stable • Absence of nonhuman reservoir • The disease provides durable immunity., • Available effective live vaccine stable and produces durable immunity.

23. Characteristics of measles that makes the disease more resistant to eradication. I. Measles has very high secondary attack rate; (i.e. highly communicable ) .. It is necessary to maintain nearly 100% coverage with vaccine to prevent transmission. II. Measles is transmitted mainly by direct contact with infectious droplets or less commonly by air borne spread. Air borne transmission of measles increases the contact rate between the index case and susceptible. III. Because measles patients are contagious for 4 days before rash onset they transmit the infection before their discovery.

24. The strategies recommended for achieving measles elimination and mortality reduction include: • 1-Maintain high vaccination coverage rate • for measles vaccine • 2-Enhancing measles surveillance • systems. • 3-Improve management of complicated • cases of measles. • 4-Provide Vit. A supplementation

25. German Measles (Rubella) Standard case definition: a) Suspected case : Any patient with the following : 1.Fever (>37.2C) 2.Generalized maculopapular rash. 3.Lymphadenopathy. b) Confirmed case : A confirmed case is one in which the suspected case is confirmed by laboratory (virus isolation or antibody elevation ) or epidemiological.

26. Complications: • In rare instances, encephalitis, thrombocytopenic purpura and neuritis may occur. • Joint involvement (arthralgia and arthritis) is a common complication in young adults, particularly women. • Congenital rubella syndrome:

27. Manifestations of congenital rubella Ear :Deafness Eyes : cataracts, glaucoma, retinopathy and microophthalmia Heart : patent ductus arteriosus, ventricular septal defect, pulmonary stenosis Neurologic : microcephaly and mental retardation Others: bone lesions, splenomegaly, hepatitis, and thrombocytopenia with purpura may occur. These congenital malformations and even fetal death may occur following either clinically manifest or inapparent rubella infection during early pregnancy.

28. Congenital Rubella Syndrome

29. Mental retardation

30. Descriptive Epidemiology: • Place : • Worldwide, universally endemic • Time: • The disease is prevalent in winter and spring. • Person: • Age and sex: • In unvaccinated population, rubella is primarily a disease of childhood and young adults. • In communities where children are well immunized, adolescent infection become more important. • Both sexes are susceptible.

31. Incubation period: On average 18 days.

32. Cycle of infection Agent: Rubella virus. Reservoir: Man in the form of clinical and subclinical cases. Source of infection: Nasopharyngeal secretions of infected persons Exit: Nose , mouth and placenta.

33. Mode of transmission: • Droplet spread. • Direct contact with patients. • Indirect contact with articles freshly soiled with discharges from nose and throat, • Air borne transmission • -Transplacental. • Inlet: • Nose and mouth.

34. Susceptibility : 1. Infants borne to immune mothers are protected for 6-9 months. 2. Active immunity acquired by natural infection is permanent 3. Immunity after vaccination: A single dose of live attenuated rubella virus vaccine elicits a significant antibody response. According to the Schedule in KSA ,MMR is given in Two doses ( at 12th months & at 4-6th Years) Duration of immunity: Rubella antibody persists for a long period after vaccination.

35. Vaccine and pregnancy: Because vaccine virus theoretically might infect the fetus and cause congenital defects if given to susceptible women early in pregnancy, immunization of women known to be pregnant is contraindicated.Pregnancy is to be avoided for 3 month after vaccination. 4 - Immunoglobulin: is given to women exposed during early pregnancy

36. Period of communicability: For about one week before and four days after onset of rash. Infants with congenital rubella may shed virus for months after birth.

37. Prevention: 1-Apply basic measures for prevention of respiratory tract infection 2-Immunization: In KSA, 2 doses of rubella vaccine is given in combination with measles and mumps vaccines (MMR) in the 12th & at 4-6 years of age The single rubella live attenuated vaccine is recommended for susceptible women in the post partum period for teachers, nurses, doctors are exposed to rubella patients.

38. Control: • Measures for cases : • Reporting to local health authority: • Isolation: to protect non-immune women during pregnancy. • Specific treatment: None. • Measures for contact : • 1. Pregnant contact : • Put under observation for the incubation period . • Laboratory investigation :Rising IgM or a IgG , indicates recent infection. Given either immunoglobulin or abortion is done . • 2. Children contacts : • Put under observation . • Active or passive immunization is not recommended

39. Mumps Salivary Glands Standard case definition: A) Suspected case : An acute illness of unilateral or bilateral tender self limited swelling of parotid or other salivary glands. B) Confirmed case : All of the above and isolation of the virus from salivary secretion of the case or by serological testing for mumps specific antibodies. Parotid Swelling

40. Typical Onset of Mumps

42. Complications : The complications occur more in teenage children and adults than in infants and young children. These include: • Orchitis: sterility is rare because the condition is unilateral • Oophoritis , mastitis and myocarditis, Pancreatitis • Neurological : meningitis and meningoencephalitis. • Congenital anomalies involving the heart if the infection occurs during pregnancy.

43. Descriptive Epidemiology: • Place : Mumps is rarely an endemic disease . Outbreaks are associated with overcrowding . • Time: Winter is the season of greatest incidence. • Person: Age: It affects any age if there is no previous immunity. The disease tends to be more severe in adults than in children, with more frequent complications.

44. Incubation period: Usually 18 days.

45. Cycle of infection: • Agent: Mumps virus. • Reservoir: Man in the form of clinical and sub clinical infection. The source of infection is the saliva of infected person. • Exit: Mouth. • Mode of transmission: • Droplet contact. • Direct contact with saliva of an infected person. • Indirect contact with articles soiled with nose& throat discharge • Inlet: Nose and mouth.

46. Mumps Virus

47. Susceptibility : • Susceptibility is general . • Post infection immunity is generally life long and develops after subclinical as well as clinical attacks.. • Vaccination: Live attenuated vaccine in combination with Measles & german measles vaccine (MMR)

48. Period of communicability: The virus has been isolated from saliva from six days before the appearance of the swelling of the parotid up to nine days after.

49. Prevention: 1-Apply basic measures for prevention of respiratory tract infection 2-Vaccination: live attenuated vaccine The vaccine is available as combined vaccine (combined measles – mumps – rubella vaccine) MMR. In KSA, 2 doses of MMR are given in the 12th & at 4-6 years of age.

50. Control: • Report to local health authority. • Isolation: Invalid because the maximum infectiousness occurs before onset of illness, • Concurrent and terminal disinfection: Of articles soiled with patient’s secretions. • Contacts: Put under surveillance . • No specific treatment,