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Preventing RHD
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Preventing RHD

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Preventing rheumatic heart disease

Preventing rheumatic heart disease

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Preventing RHD Preventing RHD Presentation Transcript

  • Preventing RHD g Dr Christine ConnorsNT Department Health & Families MSHR
  • Primary preventionGAS vaccinesReducing throat carriage GASReducing skin carriage GAS
  • GAS vaccinesIdeal vaccine Contains epitope seen in all GAS strains Highly immunogenic Does not cross react with human tissue Induces serum IgG and mucosal IgA Prevents severe GAS disease Well tolerated
  • Vaccine historyHuman vaccine trials began 1920 s, 1920’scontinued till late 1970’sOne GAS vaccine in clinical trials in last 30yyearsOne approved for clinical trials to start soonNoN successful l f l large efficacy trials ffi ti l
  • ChallengesM protein type specific vaccines p yp p Multiple strains g greater diversity in developing countries y p g New emm types emerge frequentlyM protein major contributor to cross reactivity p j ybetween GAS and human tissueOther potential epitopes p p p Cell wall carbohydrate, surface protein, exotoxins New antigens identified by proteomics (bacterial proteins)
  • Reducing GAS throat carriageTemperate climates p 15-30% children have GAS in throat Sore throat 70/100 person y p years GAS pharyngitis 14/100 person yearsTropical climates p 4-17% throat carriage 3% in NT Sore throat 8/100 person years No cases GAS pharyngitis
  • Reducing GAS skin infectionHigh rates 12 70% 12-70%Often associated with scabiesPossibly “iP ibl “immunise” against throat carriage and i ” i t th t i dinfectionPossible cause of “priming” of immune system Recurrent, low level immune reactionsReducing skin GAS will reduce overall burden
  • East Arnhem Healthy Skin ProgramAim: Reduce the prevalence of scabies and skin sores as a primary prevention strategy to reduce circulation of GAS Program Components: - VET II certificate in Healthy Skin - Annual scabies treatment day - Education and screening children 0- <15 years - Chart audit for clinic presentations - Cohort study for scabies treatment y uptake
  • Scabies Prevalence By Age Group 25% 22.8% Sep 04 Feb 06 04-Feb 22.6% Mar 06-Aug 07 20%Average monthly prevalence 15% 13.7% 13 7% p 13.0% 10% 9.4% e 6.3% 5% 0% <3 yrs 3-8 yrs 9-14 yrs Age group
  • School Age Scabies Prevalence 14% Sep 04-Feb 06 Mar 06-Aug 07 12.0% 12% 10% evalence 8% 7.7% 7 7%Average monthly pre 6% e 4% 3.7% 2% 1.5% 0% scabies Infected scabies School Age Children 3-14 years
  • Skin Sore Prevalence By Age Group 60% Sep 04-Feb 06 Mar 06-Aug 07 51.1% 50% 41.7% 41 7% 41.3% 41 3%Avera monthly prevalence e 40% 31.6% 30.0% 30 0% y 30% age 19.7% 20% 10% 0% <3 yrs 3-8 3 8 yrs 9-14 9 14 yrs Age group
  • Treatment of skin sores, 3-14 years 20% Sep 04-Feb 06 18% Mar 06-Aug 07 17.2% 16% 14% revalence 12%Averag monthly pr 10% 8% ge 7.3% 6% 3.8% % 3.9% 4% 2% 0% 5 or more sores crusted/purulent sores Treatment for Skin Sores
  • Chart Audit – Reason for Clinic ese o Presentation 35 33.1 32.4 30 25 tions 20% of presentat 15.1 14.9 15 13.1 11.9 11 9 10 5 0 Non-infectious URTI Ear Skin LRTI Diarrhoea Health Problem
  • Age at 1st presentation 60 First Scabies Infestation 70% % Scabies (cumulative) 60% 50 50% 40 % h de ( u u tv ) Ci r n c ml i e u br f h r n Nme o Ci de a 40% l 30 30% l 20 20% 10 10% 0 0% 0 1 2 3 4 5 6 7 8 9 10 11 Age in Months 70 First Skin Sores 80% % Skin Sores (cumulative) 70% 60 60% 50 S in oe c mlaiv ) % k s r s( u u t e 50% u br f h r nN me o C ilde 40 40% 30 30% 20 20% 10 10% 0 0% 0 1 2 3 4 5 6 7 8 9 10 11 Age in Months
  • Where to from here?•Ivermectin for uncomplicated scabies and their contacts•Short course oral antibiotics for skin sores Short•Lowering the thresh-hold for the treatment of skin sores