childhood infections

1. Vaccine Preventable Diseases
(VPD)
Dr/ Eman M. Mortada
Associate professor
In public health and preventive medicine

2. Vaccines Routinely Recommended
for Children and Adolescents
1985 1995 2013
Measles
Rubella
Mumps
Diphtheria
Tetanus
Pertussis
Polio
Hib (infant)
Hepatitis B
Varicella
Pneumococcal disease
Influenza
Meningococcal disease
Hepatitis A
Rotavirus
HPV
Measles
Rubella
Mumps
Diphtheria
Tetanus
Pertussis
Polio
Hib (infant)
HepB
Varicella
Measles
Rubella
Mumps
Diphtheria
Tetanus
Pertussis
Polio
7
10
16

3. Measles

4. Measles
 Highly contagious viral illness
 Measles has high infectivity and pathogenicity
 Highest in susceptible infants younger than 12 months,
school-aged children, or young adults
 Measles often leads to severe complications that may be
fatal. Remains the leading cause of vaccine-
preventable death in children
 Immunity : -
 one attack of measles gives immunity for life.
 Infants acquire immunity transplacentally from
mothers who have had measles or measles immunization.
This immunity is usually completed for the first 4–6
months of life.

5. Highly contagious viral illness

6. Measles has high infectivity and
pathogenicity

7. one attack of measles gives immunity for life.

8. Infants acquire immunity transplacentally from
mothers who have had measles or measles
immunization.

9. Measles virus=
RNA virus
Man is only
reservoir
No carrier stage
exist
From the:
respiratory tract by
coughing and
sneezing
Indirect: Airborne
Respiratory tract
infants younger than
12 months,
school-aged children,
or young adults
IP=10 days

10. • Measles virus(paramyxovirus)= RNA virusAgent
•Man is only reservoir
• No carrier stage exist
Reservoir
• Indirect: AirborneTransmission
• 10 days
Incubation
Period
• Prodroma -kopliks spots and rah
Clinical
picture
• Diarrhea, Otitis media, Pneumonia,
Encephalitis, Death
Complications
The infectious cycle of measles

11. Measles Clinical manifestations
Prodroma
Stepwise increase in fever ,
cough,
coryza,
conjunctivitis (3-4 days)
Kopliks spots
2nd day
tiny bluish white spot
the pathognomonic sign
of measles
Rash
Time: the 3~5 days
Shape: maculopapular
Sequence: ( rash starts in
the face then the trunk
then on the periphery
)behind the ear→along
hairline→face→neck→ch
est→back→abdomen→li
mbs→hand and feet(palm
, sole)
Fades in order of
appearance

12. Measles Clinical manifestations:
 Prodroma Stepwise increase in fever , cough, coryza,
conjunctivitis (3-4 days)
 Koplik spots (2nd day tiny bluish white spot)
 Rash
 Time: the 3~5 days after fever ; but the 4th day is most common;
 Shape: maculopapular
 Sequence: ( rash starts in the face then the trunk then on the
periphery) behind the ear→along
hairline→face→neck→chest→back→abdomen→limbs→hand
and feet(palm , sole)
 Fades in order of appearance With desquamations

13. Koplik̓ s spot

14.  Measles rash

15. Serious disease as Per WHO.
Measles is the most serious of the common childhood illnesses.
More serious in the immuno-compromised, the undernourished,
and children with chronic debilitating diseases
1. Diarrhea, commonest cause of death
2. Otitis media
3. Pneumonia
4. Encephalitis
5. Death
Complications
Based on 1985-1992 surveillance data
It remains a leading cause of death among young children
globally, despite the availability of a safe and effective vaccine.
In developing countries, measles affects 30 million children a
year and causes 1 million deaths.

16. Rubella

17. Rubella (germen measles)
 The name is derived from the Latin, meaning little red.
 Also called as three-day measles/German measles
 The synonym "3-day measles" derives from the typical course
of rubella exanthema
 Rubella is also known as German measles because the disease
was first described by German physicians, Friedrich
Hoffmann, in the mid-eighteenth century.
 It's a generally mild disease in children; the primary medical
danger of rubella is the infection of pregnant women because
it can cause congenital rubella syndrome in developing babies.

18. The name is derived from the Latin, meaning
little red.

19. The synonym "3-day measles" derives from
the typical course of rubella exanthema

20. Rubella is also known as German measles because
the disease was first described by German
physicians

21. the primary medical danger of rubella is the
infection of pregnant women because it can cause
congenital rubella syndrome in developing babies.

22. IP= 2-3 WEEKS
Rubella–Togavirus=RNA
Cases &
incubatory
Carriers.
Congenitally
Infected infants
respiratory
secretion, blood,
urine, & stool
Direct:
Droplet and vertical transmission
Respiratory tract
Unvaccinated Infants,
children,
or young adults

23. • Rubella–Togavirus=RNAAgent
•Cases & incubatory Carriers. Congenitally
Infected infants act as reservoir for 1 year “in
respiratory secretion, blood, urine, & stool”
Reservoir
• Direct contact:
• Droplet and vertical transmission
Transmission
• I.P – 2-3 weeks average 18 days
Incubation
Period
• mild fever, and lymphadenopathy and
maculopapular rash
Clinical
picture
• congenital rubella syndromeComplications
The infectious cycle of rubella

24. Rubella Clinical manifestations
Prodroma
low-grade fever,
sore throat,
headache,
malaise,
anorexia
Lymphadenopathy
suboccipital,
postauricular &
anterior cervical lymph
nodes
Rash
Time: within 24 hours
Shape: maculopapular
Sequence: starts initially
on the face and neck and
spreads centrifugally to
the trunk and extremities
Fades: in order of
appearance by the end of
the third day without
desquamation

25.  Prodrome: low-grade fever, sore throat, headache, malaise,
anorexia
 Lymphadenopathy (suboccipital, postauricular & anterior
cervical lymph nodes)
 Rash:
 Time: within 24 hours
 Shape: maculopapular
 Sequence: starts initially on the face and neck and spreads
centrifugally to the trunk and extremities
 Fades: in order of appearance by the end of the third day
without desquamation
Measles
Rubella Clinical manifestations:

26.  Rubella rash  Cervical lymphadenopathy

27. Congenital rubella syndrome
 Arthralgia or arthritis (adult
females mainly)
 The disease is of major medical
importance because of congenital
rubella syndrome .
Classic Triad
 Cataract
 Cardiac abnormalities
 Deafness
Rubella Complications

28. Mumps

29. Mumps
 The name comes from the British word "to mump", that is
grimace or grin.
 The appearance of the patient as a result of parotid gland
swelling seems to be in grin
 It is usually disease of childhood, mumps may also affect
adults and in such cases there is a greater tendency for
complication to develop
 Before introduction of the vaccine in 1967:
• the peak incidence of the disease occurred in children 5-9 yr of
age
• * 85% of infections occurred in children younger than 15 yr of
age.
 Now most cases occur in young adults, producing outbreaks in
colleges or in the workplace

30. The name comes from the British word "to
mump", that is grimace or grin.

31. It is usually disease of childhood, mumps may also
affect adults and in such cases there is a greater
tendency for complication to develop

32. IP= 18 days
Mumps Virus
(Paramyxovirus-RNA)
Cases &
incubatory
Carriers.
respiratory
secretion
Disease is spread by coughing and sneezing,
sharing eating utensils.
Respiratory tract
Unvaccinated Infants,
children,
or young adults

33. The infectious cycle of mumps
• Mumps Virus (Paramyxovirus-RNA)Agent
•Cases & incubatory Carriers.Reservoir
• Disease is spread by coughing and sneezing,
sharing eating utensils.
Transmission
• 18 days
Incubation
Period
• Fever tenderness AND Swelling in salivary
glands
Clinical
picture
•orchitis (most common); oophoritis,
meningitis, encephalitits, pancreatitis
Complications

34. Mumps Clinical manifestations
Prodroma
low-grade fever,
sore throat,
headache,
malaise,
anorexia
Pain
Pain near the lobe of ear
and difficulty in chewing
within 24 hours of the
onset.
Salivary gland affection
Area behind the angle of
jaw appears full and
parotid swelling . Ear lobe
may appear to be pushed
upwards and outward
Submaxillary and
sublingual glands may
also be enlarged
Disease begins
unilaterally but involves
the other side also within
48 – 72 hours
Swelling disappears in 6
to 10 days.

35. Mumps
 Mumps starts with Prodrome: moderate fever, malaise, pain on
chewing or swallowing, particularly acidic liquids.
 Pain near the lobe of ear and difficulty in chewing within 24
hours of the onset.
 Area behind the angle of jaw appears full and parotid swelling
 Ear lobe may appear to be pushed upwards and outward
 Submaxillary and sublingual glands may also be enlarged
 Disease begins unilaterally but involves the other side also
within 48 – 72 hours in 75 % of cases
 Fever and tenderness settle in 1 – 6 days
 Swelling disappears in 6 to 10 days.

36. Rare but Serious Complications
 Inflammation of the:
 Testicles
 Pancreas
 Ovaries
 Breast
 Encephalitis or Meningitis
 Deafness
 Male infertility
CDC
Mumps Complications

37. Combined Measles, Mumps, & Rubella (MMR) vaccine
 Nature: Live attenuated vaccine
 Dose: 0.5 ml
 Timing:
 Administration: subcutaneous injection
into the upper arm.
MMR vaccine
AgeVaccines
9 months (SINGLE DOSE)Measles
12 monthsMMR
18 monthsMMR
5 yearsMMR

38. Chickenpox

39. Chickenpox/Varicella
 Highly infectious
 Generally a benign, self-limiting disease
 Highly communicable disease of all ages
 Most common in children <10 years old

40. Varicella Zoster Virus .
Man only, cases
and carriers
respiratory
secretion, the fluid
from a blister of a
person infected
with chickenpox
airborne spread or
through direct contact with skin lesions
Respiratory tract
Unvaccinated Infants,
children,
or young adults

41. • Varicella Zoster Virus- DNA( HERPES
FAMILY) .
Agent
• Man only, casesReservoir
• Chickenpox spreads from person to person
by direct contact or through the air by
coughing or sneezing.
Transmission
• 2-3 weeks
Incubation
Period
• General symptoms and rash with Pruritus
Clinical
picture
• More in adultsComplications
The infectious cycle of chickenpox

42. Chickenpox Clinical manifestations
Prodroma
low-grade fever,
sore throat,
headache,
malaise,
anorexia
Purtic Rash
Time: 1-2 from prodroma
Shape: blister like rash,
initially as small red papules that
rapidly progress, the vesicles ulcerate,
crust, and heal.
Sequence: beginning on the trunk
followed by the head, the face, and, less
commonly, the extremities

43.  Prodromal symptoms: of fever, malaise, and anorexia
may precede the rash by 1 day.
 The characteristic blister-like rash appears initially as
small red papules that rapidly progress
 The fluid progresses from clear to cloudy, and the vesicles
ulcerate, crust, and heal.
 New crops appear for 3 to 4 days, usually beginning on the
trunk followed by the head, the face, and, less commonly, the
extremities. Vesicular spots appear often in crops most
commonly on trunk
 Pruritus is universal and marked.
 Clinical Manifestations
Chickenpox Clinical manifestations

44. Chicken pox

45.  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.
Chickenpox Complications

46.  Nature: live attenuated
 Dose: 0.5 ml
 Timing: Two doses are always recommended.
 1st at 18 months of age
 2nd dose at 4-6 years
 Administration: S.C.
Varicella vaccine
AgeVaccines
18 monthsVaricella
School entryVaricella

47. Diphtheria

48. Diphtheria
 An acute, toxin-mediated bacterial infection
 Affects all ages but serious in very old and very young
 Before vaccination introduced it was a leading cause of death
in children
 It was eliminated from much of the developed world by mass
vaccination in the mid-20th century.
 Recent outbreaks have occurred in the former Soviet Union
and continue to occur in South-east Asia.

49. • Toxigenic strain of
Corynebacterium diphtheriaAgent
•Human reservoir( cases and
carriers)
Reservoir
• Direct droplet and indirect via
contaminated fomites
Transmissi
on
• 2 – 7 days
Incubatio
n Period
• sore throat, low fever, and an
adherent membrane on the
tonsils, bull neck
Clinical
picture
The infectious cycle of diphtheria

50. • Early signs: mild fever, malaise, sore throat,
difficulty in swallowing, hoarseness, anorexia,
malaise, cough, bull-neck appearance
• Within 2-3 days, adherent, gray
membrane on oral mucous membranes
• Extensive membrane - life-threatening airway
obstruction.
• Toxin – serious systemic complications including
myocarditis
• Death rate 5%-10%
Diphtheria Clinical manifestations

52. Tetanus

53. Tetanus
 Tetanus is usually a fatal disease, acquired through
environmental exposure to the spores of Clostridium tetani,
which are present in soil worldwide.
 The disease is caused by the action of a potent neurotoxin
produced by the bacterium in dead tissue (e.g. dirty wounds)..
• Not spread from person to person.
 Causes uncontrolled spasms of muscle.
 These spasms may cause bones to break and difficulty
breathing.
 Leads to death in about 10-20% of cases.

54. • Clostridium tetaniAgent
• soil, in the inanimate environment,
in animal feces,Reservoir
• Contamination of wounds with
spores of C. tetani
Transmissi
on
• 14 days
Incubation
Period
• characterized by increased muscle
tone and generalized spasms.
arched back d, Lock jaw
Clinical
picture
• Fatal
Complicati
ons:
The infectious cycle of tetanus (lock jaw)

55. • Initially: muscle stiffness of the jaw (“Lockjaw”) 50% cases
• 1-2 weeks after infection – progressive muscle tightening,
descending pattern
• Trismus (lockjaw)
• Neck stiffness
• Difficulty swallowing
• Abdominal muscle rigidity
Tetanus Clinical manifestations
Complications Include;
• Fractures
• Hypertension
• Laryngospasm
• Pulmonary embolism
• Aspiration
• Death

56. Pertussis (Whooping Cough)
100 days Cough

57. Pertussis (whooping cough)
• Known as the “100 Day Cough”
• It is one of the most common vaccine-
preventable diseases in
the United States and affects all age groups
from infants to adults.
Serious illness in children AND adults
• May be life threatening in infants
• Worldwide: 30-50 Million cases of Pertussis
and about 300,000 deaths annually

58. Known as the “100 Day Cough”

59. It is one of the most common VPD in
US and affects all age groups

60. May be life threatening in infants

61. Worldwide:
30-50 Million
cases
300,000
deaths
annually

62. • Bordetella pertussis-bacteriumAgent
• Human are only known reservoir
• Cases (Clinical + Subclinical)
Reservoir
• Spread easily from person-to-person in aersol droplets
produced by coughing or sneezing
Transmission
• 7 – 14 daysIncubation Period
• 3 stages (Catarrhal stage, Paroxysmal stage,
Convalescent stage)
• Gradually worsening cough by whoop
Clinical picture
• Major complications are most common among infants
and young children
Complications
The infectious cycle of pertussis

63. Catarrhal Stage
1-2 weeks
runny nose,
sneezing,
low fever, and
a mild cough (common
mistaken for cold)
Paroxysmal Stage
1-6 weeks
whooping cough,
which consists of
bursts or paroxysms of
numerous, rapid
coughs, severity of the
infection is at its
greatest.
Convalescent Stage
weeks-months
gradual recovery starts
Pertussis Clinical manifestations

64.  1st Stage- Catarrhal Stage 1-2 weeks
 runny nose, sneezing, low fever, and a mild cough (common
mistaken for cold)
 2nd Stage- Paroxysmal Stage 1-6 weeks
 whooping cough, which consists of bursts or paroxysms of
numerous, rapid coughs, severity of the infection is at its
greatest.
 3rd Stage- Convalescent Stage weeks-months
 gradual recovery starts
Pertussis Clinical manifestations

65. Pertussis Complications
 Major complications are most common among infants and young
children
 Due to increase intra abdominal pressure
 Hernias (inguinal / umbilical)
 Rectal prolapse
 Sub-conjuctival hemorrhage
 Secondary bacterial infections: DD, otitis media, Bronchopneumonia
 Neurological complications (due to the toxin or hypoxia or cerebral
hemorrhage)
 Malnutrition and weight loss and dehydration due to vomiting
 Sudden death - babies may stop breathing, apnoeic attacks

66.  Nature: killed acellular pertussis vaccine combined to Diphtheria and
tetanus toxoids
 Dose: 0.5 ml
 Timing: 5 doses are always recommended.
 at 2, 4, 6 months of age
 18 months of age
 A dose at 4-6 years
 Administration: IM
DTaP vaccine
AgeVaccines
9 monthsDTaP
12 monthsDTaP
18 monthsDTaP
School entryDTaP

67. Birth
2 mo
4 mo
6 mo
9 mo
12 mo
18 mo
24 mo
School
entry
BCG
DTaP1
DTaP2
DTaP3
Measles1(mono)
M2MR1
DTaPB1
HepAV2
DTaPB2
HepBV1
HibV1
HibV2
HibV3
OPV4
HibVB
OPVB2
IPV1
IPV2
IPV/OPV3
OPVB1
M4MR3Varicella2
HepBV2
HepBV3
HepBV4
HepAV1
PCV1
PCV2
PCV3
PCVB
/Td
Rota
Rota
MCV4
MCV4
Varicella1 M3MR2
vaccineinformation.org
Childhood Immunization Schedule in KSA

68. Pneumococcal Disease
Invasive Pneumococcal
Disease (bacteramia)
Soft Tissue Infection (rare)
Arthritis (rare)
Sinusitis
(common)
Otitis Media
Pneumonia
Peritonitis (rare)
Spectrum of pneumococcal infection
Meningitis

69. Pneumococcal disease
 The most common cause of vaccine preventable death
 Risk is highest during the first year of life and in the winter
months
 Boys are at greater risk than girls
 Factors such as attendance at day care and lack of breast feeding
are associated with a higher risk of pneumococcal disease

70. • Bacterium - Streptococcus pneumoniaeAgent
• Asymptomatic carriage possibleReservoir
• Transmitted through infected droplets
through coughing, sneezing & close contact.
Transmission
• 1-4 days
Incubation
Period
• Bacteraemia – most common presentation
Clinical
picture
• Complications of meningitisComplications
The infectious cycle of Pneumococcal
disease

71. Pharynx
Larynx
Nasopharynx
Eustachian
tube
Nasal cavity
Trachea
Primary
bronchi
Lungs
Lower
respiratory
tract
infections
Upper
respiratory
tract
infections
Meningitis
Sinusitis
Otitis media
Pneumonia
Parapneumonic
empyema
Bacteraemia/
septicaemia
Invasive
disease
Pneumococcal bacteria cause disease when
they spread beyond the nasopharynx
S. pneumoniae

72. Streptococcus pneumoniae causes a spectrum of
invasive and non-invasive disease
Invasive
Pneumococcal
Disease
Vaccination drivers
Severity
Deaths
Hospitalisation
Costs
Volume of cases
Economic costs
Antibiotic use and
resistance
Adapted from Melegaro et al. J Infection 2006, 52(1):37–48. Silfverdal et al. Vaccine 2009; 27: 1601–1608. WHO. The global burden of
disease. 2008. O’Brien et al. Lancet 2009;374:893–902.

73.  May present as bacteraemia,
meningitis or pneumonia
 Common cause of acute Otitis media
 Bacteremia: most common and life-
threatening form in children.
 Complications:
 can cause septicaemia which can
lead to organ damage and carries a
high mortality rate
Pneumococcal Clinical manifestations
Invasive Pneumococcal
Disease (bacteramia)
Soft Tissue Infection (rare)
Arthritis (rare)
Sinusitis
(common)
Otitis Media
Pneumonia
Peritonitis (rare)
Spectrum of pneumococcal infection
Meningitis

74.  Nature: Conjugate vaccines,
 Dose: 0.5 ml
 Timing: 2, 4, 6, months of age,
 booster dose at 12 months of age.
 Administration: IM
PCV7 vaccines
AgeVaccines
2 monthsPCV7
4 monthsPCV7
6 monthsPCV7
12 monthsPCV7

75. Meningococcal disease

76. Meningococcal disease
• Severe acute bacterial infection
• Colonises nasopharynx, may invade bloodstream
• Populations affected – young children & adults,
immunocompromised

77. • Bacteria: Neisseria meningitidis – type B &
C most common
Agent
• Asymptomatic carriage,5-11% adults and
25% adolescents carry the bacteria in their
nose and throat without symptoms
Reservoir
• Transmission occurs through aerosol, droplet
or direct contact with respiratory secretions.
Transmission
• 3-4 days
Incubation
Period
• Meningitis: Inflammation around the brain or
spinal cord
Clinical
picture
• Very serious, can be deadly. Death can occur
in a few hours
Complications
The infectious cycle of Meningococcal
disease

78.  Meningitis is the most common presentation - fever,
headache, neck stiffness, photophobia
 Petechiae, hypotension, circulatory collapse, coma, multi-
organ failure
 10% will die, 15% of survivors will have long-term
sequelae – deafness, mental retardation, limb loss
Meningococcal Clinical manifestations

79.  Nature: Conjugate vaccines, protects against A, C, Y, W-135
 Dose: 0.5
 Timing:
 Administration: SC
Meningococcal (MCV4) vaccines
AgeVaccines
9 monthsMCV4
12 monthsMCV4

80. Haemophilus influenza B (Hib)

81. Haemophilus influenza B (Hib)
 Severe bacterial infection
 6 different serotypes – type b most common
 Colonizes nasopharynx and Can invade bloodstream
 Most likely to affect young children and immunocompromised
 Prior to vaccine, Hib was leading cause of childhood
1. Bacterial meningitis
2. Epiglottitis
3. Pneumonia
4. Empyema
5. Pericarditis
6. Septic arthritis

82. • Haemophilus influenza bacteriaAgent
• Healthy individuals can carry Hib bacteria in
their nose and throat without symptomsReservoir
• Transmitted via resp droplets
• Transmission occurs from coughing,
sneezing, close contact with infected person.
Transmission
• 1-4 days
Incubation
Period
• Meningitis is the most common presentation
Clinical
picture
• Complications of Hib meningitisComplications
The infectious cycle of Haemophilus

83.  Meningitis common – fever, vomiting, lethargy, meningeal
irritation
 Other presentations – Epiglottitis, pneumonia, septic
arthritis, cellulitis, pericarditis, empyema, osteomyelitis
Haemophilus Clinical manifestations
•Complications of Hib meningitis
•Deafness
•Convulsions
•Intellectual impairment
•Case fatality rate 2-5% in spite of effective antimicrobial therapy

84.  Nature:capsular polysaccharide antigen
 Dose: 0.5 ml
 Timing: Recommended at
 2, 4, and 6 month;
 booster at 18 month of age
 Administration:. IM
Hib vaccine
AgeVaccines
2 monthsHib
4 monthsHib
6 monthsHib
18 monthsHib

85. Tuberculosis

86. Tuberculosis
 In the 19th century, the disease was often referred to as
“consumption”.– “wasting disease”, “White Plague”.
 Tuberculosis is among the top 10 causes of global mortality, and
nearly one-third of the world's population is infected with the
tuberculosis bacillus.
 Of these cases, more than 9 million develop TB disease when
their immune system is weakened and 3 million die each year.

87. In the 19th century, the disease was often
referred to as “consumption”.– “wasting
disease”, “White Plague”.

88. Tuberculosis is among the top 10 causes of
global mortality,

89. nearly one-third of the world's population is
infected with the tuberculosis bacillus.

90. Of these cases, more than 9 million develop TB disease
when their immune system is weakened and 1.5 million
die each year.
one-third
3million

91. TB resurgence
 At 1990 there is TB resurgence in both developed and developing
countries (U shaped curve), WHO declared in 1993 that TB is a
global emergency.
Causes of TB recurrence
 HIV pandemic (reactivation of TB)
 Inadequate treatment (Drug resistance) MDR
 Substance abuse
 Unemployment, malnourishment
 Negligence in control measures (false belief)
 Stress, fatigue, bad housing, low income
 Occupational: silica workers, medical, farmers

92. At 1990 there is TB resurgence in both developed
and developing countries

93. WHO declared in 1993 that TB is a global
emergency.

94. • Mycobacterium tuberculosisAgent
•Infected person(cases)Reservoir
• Air borne droplet nuclei
Transmissio
n
• 3-12 weeks
Incubation
Period
• Generally: night fever and night
sweats
• Lungs: cough, hemoptysis, chest pain
Clinical
picture
• lung fibrosis, spread of infection&
fatality
Complicatio
ns
The infectious cycle of TB

95. TB Clinical manifestations
 Generally: anorexia, malaise, fatigue,weight loss, night fever and
night sweats
 Lungs – cough, hemoptysis, chest pain
 In young children, the only sign may be stunted growth or failure
to thrive
 Complications:
 1- lung fibrosis
 2- spread of infection to other body parts
( CNS, kidney)
 3- fatality: resulting from respiratory failure

96.  Nature: live Attenuated strain
 Dose: 0.1 ml, one dose
 Timing: All babies, at or soon after birth
 Administration:. intradermal
BCG vaccine
AgeVaccines
Shortly after birthBCG

97. Rotavirus

98. Rotavirus infection
• Highly contagious Viral infection – most
common cause of severe diarrhoeal
disease in children
• Still a major cause of death in children in
developing countries
• Rotavirus disease is a diarrheal disease
caused by a virus called rotavirus
• The name rotavirus comes from the wheel-
like appearance of the virus
under the microscope

99. • RotavirusAgent
• Faecal-oral routeTransmission
• 1-3 daysIncubation Period
• Causes gastroenteritisClinical picture
• which can lead to complications associated with
dehydration
Complications
The infectious cycle of rotavirus

100.  Three main symptoms of rotavirus infection:
 Fever
 Vomiting
 Watery diarrhea
 Abdominal pain may also occur
 Diarrhea usually stops after 3 to 7 days
• Complications:
 Severe diarrhea
 Dehydration
 Electrolyte imbalance
Rota Clinical manifestations

101.  Infants after the age of
3 months
 Low to no immunity
 Vulnerable to dehydration
 Older children if they are
immunocompromised
Who is most at risk in the population?
Baby
> 3 months
Riskofdisease
Immuno-
compromised
Children
Adults Older
people
Population

102.  Nature:Live attenuated vaccine
 Dose AND Timing: 2 x doses at 2 & 4 months
 Administration:. given orally
ROTA vaccine
AgeVaccines
2 monthsRota
4 monthsRota

103. Poliomyelitis (Polio)

104. Polio
 Polio is a crippling and potentially fatal infectious disease.
 There is no cure, but there are safe and effective vaccines.
 Therefore, the strategy to eradicate polio is based on preventing
infection by immunizing every child to stop transmission and
ultimately make the world polio free.
 In 1988, the World Health Assembly adopted a resolution for the
worldwide eradication of polio.
 Today, polio continues to circulate in three countries:
Afghanistan, Pakistan, and Nigeria.

105. • Poliovirus: belongs to “Picorna” viruses
which are small RNA-containing viruses.
Agent
• Human are only known reservoir
• Cases (Clinical + Subclinical) and carriers
Reservoir
• Fecal-oral route – developing countries
• Droplet infection – developed countries
Transmission
• 7 – 14 days
Incubation
Period
• Predominant sign – Asymmetrical flaccid
paralysis (AFP)
Clinical
picture
The infectious cycle of Polio

106. Often asymptomatic (>95% cases)
 May have mild influenza type symptoms
Sore throat, Fever, Nausea, Headache
Paralytic polio
 <1% have paralysis from virus attacking motor neurons
• Predominant sign – Asymmetrical flaccid paralysis (AFP)
 Asymmetrical with fever at onset(reach max. extent within 3-4
days)
 Legs are affected more than arms
Polio Clinical manifestations

107.  Nature: inactivated polio vaccine (IPV), trivalent: type 1,2 & 3
 Dose & Timing:
 2, 4, 6 months
 Administration: IM
Salk vaccine
AgeVaccines
2 monthsIPV
4 monthsIPV
6 monthsIPV

108.  Nature:live attenuated poliovirus trivalent: type 1,2 & 3
 Dose:0.5 ML
 Timing:
 Administration: ORAL
Oral polio vaccine
OPV is still the primary vaccine for eradication
AgeVaccines
6 monthsOPV
12 monthsOPV
18 monthsOPV
School EntryOPV

109. Hepatitis A

110. Hepatitis A
 Hepatitis A is a frequent virus of childhood and is not
considered a deadly and serious infection.
 Usually mild self limited infection, acute infection with no
chronic infection
 Also known as infectious hepatitis
 It is endemic in KSA

111. • HAV/ RNA virusAgent
• Cases and incubatory carriersReservoir
• Faecal oral transmission, through
contaminated food
Transmissi
on
• 15-50 days (average 4 weeks)
Incubation
Period
• Prodroma: fever, anorexia/ nausea
• Acute jaundice, dark urine and
pale stool
Clinical
picture
The infectious cycle of Hepatitis A

112.  Nature: inactivated
 Dose: 0.5 ml
 Timing:
2 doses
 1st is 18
 then at 24 months
 Administration: IM
HAV vaccine
AgeVaccines
18 monthsHAV
24 monthsHAV

113. Hepatitis B

114. Hepatitis B
 Also known as serum hepatitis
 The most common chronic viral infection
 1/3 of world’s population has been infected
 240 million with chronic disease
 15-25% of these die due to liver related diseases
1million deaths annually 4 million new infections

115. • HBV/ DNA virus found in blood,
tissue, body fluids
Agent
• Human are only known reservoir
• Cases and carriersReservoir
• Parenteral - IV drug abusers
• Sexual - homosexuals
• Perinatal: mother →infant. (Vertical)
Transmissio
n
• 1-6 months(average 90 days)
Incubation
Period
• Acute symptoms as HA
• Chronic infection complications
Clinical
picture
• Liver cirrhosis and cancer
Complicatio
ns
The infectious cycle of Hepatitis B

116. • 6% of people
infected over
the age of 5
become
chronically
infected
Perinatal
• 90% of
infected
infants
become
chronically
infected
Perinatal transmission Horizontal transmission
Transmission of HBV
CDC. Available at: http://www.cdc.gov/hepatitis. Accessed December2006.
Lee WM. N Engl J Med. 1997;337:1733-1745.
Lavanchy D. J Viral Hepat. 2004;11:97-107.
HostMother
Infant
Recipient
•Child-to-child,50%NOT due to
MTC
•Contaminated needles
•Sexual contacts
•Healthcare worker
•Blood transfusion

117.  Acute infection similar to Hepatitis A - may be
more prolonged or severe
 5-10% with acute Hepatitis B become
chronically infected
 25% of chronically infected develop liver
cirrhosis - premature death in 50%,
 5% of cirrhotics develop liver cancer
Hepatitis B Clinical manifestations
HBV Infection
15-40%
Chronic Hepatitis
Cirrhosis
HCC

118.  Nature: Recombinant DNA vaccine
 Dose: 0.5ml
 Timing:
4 doses
1st is given shortly after birth
then at 2,4,6 months
 Administration: IM
HBV vaccine
AgeVaccines
At birthHBV
2 monthsHBV
4 monthsHBV
6 monthsHBV

119. Routine immunization schedule
Polio 0 – at birth
Polio 1 – 6 weeks
Polio 2– 10 weeks
Polio 3– 14 weeks
Vitamin A after 6
months
Rota 1 – 6 weeks
Rota 2 – 10 weeks
BCG – At birth
Right side Left side
Measles – 9 mos
PCV 1 – 6 weeks
PCV 2– 10 weeks
PCV 3– 14 weeks
Source: Ethiopian National Immunization Coverage Survey, 2012 (updated)
Penta 1 – 6 weeks
Penta 2– 10 weeks
Penta 3– 14 weeks
IPV – 14 weeks
ADC Campaigns/special
•HPV demo: Adolescents x2
•Men A: 1 dose; 1-29yr
•Polio Eradication: <5 years,
repeated
•Measles: <5 or <15