This document summarizes common infectious diseases among pediatric patients from a public health perspective using evidence-based methodology. It discusses major causes of childhood morbidity and mortality historically and currently in Saudi Arabia such as rotavirus, adenovirus, respiratory syncytial virus, influenza, and healthcare-associated infections. It also covers recent updates on management including vaccines, antibiotic practices, emerging pathogens like MERS, and infection control measures.

1. Some Common Infectious
diseases in pediatric from
public health perspective
Evidence Based Methodology
Prepared by
Mubarak M.
Medical Doctor
Master of Public Health (epidemiology- Griffith University, Australia)
Bachelor of Medical sciences (Griffith University, Australia)
Mubarak ALOsimi, M.D. 1

2. This presentation considers ……………..
• Starts in broad concept then becomes more specific.
• Looks briefly at historical sequence of infectious diseases.
• Focuses on KSA mainly.
• Highlights local health Stat on infectious diseases in pediatrics.
• Aims mainly to attract attention to updates with regard infectious
diseases in pediatrics.
• Employs evidence based data collection methodology.
Mubarak ALOsimi, M.D. 2

3. Evidence search methodology used in
this project…………..
Methods: This review was conducted using the databases pubmed,
Medline and Cochrane from January 2010 to May 2015. keywords
“pediatric, infections, management, control, HCAI and updates.
Mubarak ALOsimi, M.D. 3

4. The History of Pediatric Infectious
Diseases
• Major causes of childhood morbidity and mortality in Pediatrics.
• In 19th
and early 20th
Centuries, diphtheria, infant diarrheal illnesses, tuberculosis, streptococcal
infections and their complications.
• Most serious infection among kids, draw up scientific attention and resulted in golden era of
preventive vaccines From 1903 to 1916 then 2nd
golden era between 1932-1940 then ABX era
1941 -1951 then vaccine innovation 1955-1967.
• Remaining challenges: most notably HIV infection, tuberculosis and falciparum malaria and
Opportunistic infectious diseases that affect immunocompromised children.
• In the genomic era of medicine and the tools of molecular biology with DNA microarray analysis
and new proteonomics, there new insights into pathogenesis, diagnosis, and treatment of
infections.
 Shulman ST. The History of Pediatric Infectious Diseases. Pediatric Research (2004) 55, 163–176
 https://books.google.com.sa/books?id=9V6FbkkltrcC&pg=PA149&lpg=PA149&dq=golden+era+of+preventive+vaccines&source=bl&ots=dt5wjxfRMf&sig=PbJ-
l3eV6lMjl80fHDTO3lbOU1A&hl=en&sa=X&ei=Ay9aVZurLYmyUdeegbAJ&ved=0CDwQ6AEwBA#v=onepage&q=golden%20era%20of%20preventive%20vaccines&f=false
Mubarak ALOsimi, M.D. 4

5. Common Pediatric Infectious Diseases in
Saudi Arabia(1): by causative agents:
Rotavirus
(Reovirida)
Enteric
Adenovirus
(Adenovirid)
Astrovirus
(Astrovirida)
Calicivirus()
RNA, Groups A,B,C has 2
subgroups multiple serotypes
Classified on the basis of two
outer capsid proteins.
DNA, Enteric serotypes 40,
41, 31, and types 42-48
RNA,8 serotypes,
RNA, Two
genogroups:Norwalk-lik
viruses and, Sapporo-like
viruses
Clinical pattern: all viruses coz gastroenteritis
thro. person to person and contaminated water or
food. Characterized by severe watery diarrhea
leading to isotonic dehydration in infants and
young children (decreased intestinal absorption of sodium, glucose,
and water, and decreased levels of intestinal lactase, alkaline phosphatase, and
sucrase activity, and may lead to isotonic diarrhea )and accompanied
in some cases with nausea, vomiting, abdominal
cramps, headache and fever. Usually, 1st
occasion
is worst once.
Communicability : 2 days before to 10 days
after onset of symptoms.
Incubatory : hours to 2 days.
 Risk of epidemic outbreaks of waterborne
diarrheal disease among kids.
ELISA or latex agglutination available now to
detect antibodies. rapid detection of antigen.
Serous complication: Dehydration ; Electrolyte
imbalance; Metabolic acidosis.
• Tayeb HT. Molecular epidemiology of human astrovirus infections in
Saudi Arabia pediatric patients. J Med Virol. 2010 Dec;82(12):2038-42
• Tayeb HT, The Etiology of Viral Diarrhea in Children.
http://esciencecentral.org/ebooks/pediatric-infectious-
Mubarak ALOsimi, M.D. 5

6. Common Pediatric Infectious Diseases in
Saudi Arabia(2):
by causative agents:
Respiratory
syncytial
virus
Adenoviruses
influenza &
Para-
influenza
Cornavirus
including
MERS and
SARS
RNA Virus, peak at 2-8
months
DNA virus, 52 serotypes
predominantly 1, 2, 5, and
6; occasionally, 3 and 7.
RNA, typeA, B and C
(hemagglutinin and the
neuraminidase), Eg
H1N1or H5N1
RNA, alpha, beta, gamma,
and delta. Human 229E,
NL63, OC43, and HKU1
pluse SARS &MERS
Clinical pattern: all these viruses coz reparatory
infections thro droplet or person to person contact
(adeno); droplet/ close contac (RSV & C-OV); and
contaminated water or food. Characterized by lower
respiratory tract infections and accompanied in some
cases with low-grade fever, Cough, Tachypnea, Coryza,
Cyanosis, Retractions Wheezing & Rales. OM &
dehydration may exist.
Adno. protean{( Acute Resp., pharyngoconjunctival
fever, keratoconjunctivitis or GE.
Communicability : 2 days to 7 days
Incubatory : 2-5days (C-ov).
 Risk of multiorgan dysfunction : Respiratory
failure and renal failure as in MERS with 30%
fatality rate.
PCR & Serology to detect antibodies. Also, rapid
detection of antigen & culture.
Mubarak ALOsimi, M.D. 6

7. Common Health Care Associated infections in Saudi
Arabia:
by causative agents:
MRSA,
Acinobacter
, E. Faecalis
E.coli, Klebsiella,
Enterococcus
Klebseilla,
Enterobacter, Ecoli,
Acinetobacter ,
P.aeruginosa , GBS,
Staph, C. albicans
At Invasive procedures via
blood stream eg central
Line
Catheter-associated
urinary tract infections
Healthcare Associated
Infection in the NICU eg
Ventilators(pneumonia)
Risk factors: Catheter hub or exit-site colonization or
inserted in 1st
wk of life; ELBW; >7 days.
•candidemia in neonates: 5-minute Apgar scores< 5; H2
blocker; Intubation ; stay longer than 7 days;
prematurity.
•Pneumonia in pediatric:Reintubation; Genetic
syndromes; Prior BSI; Immunodeficiency.
•hospital-acquired UTI in pediatric: catheterization; Prior
antibiotic; CP.
The infection by the instrumentation:
• Endotracheal tube: Sinusitis, tracheitis, pneumonia
•Intravascular catheter: Phlebitis, line infection
•Foley catheter: UTI
PTwith pneumonia may have :Fever, cough, purulent
sputum Abnormal chest auscultatory findings (eg,
decreased breath sounds, crackles, wheezes)
PT with UTI may have Fever or normal temperature
Tenderness, suprapubic (cystitis) or costovertebral
(pyelonephritis) Cloudy, foul-smelling urine
Communicability : immanent, any time if no
precaution.
Incubatory : few hours- 1 day.
Mubarak ALOsimi, M.D. 7

8. Vaccine Preventable infectious Diseases, statistics
2013
Neonatal Tetanus
0.03 per 1,000 live
births)
Rubella (0.22 per
100,000
population)
Mumps (0.12 per
100,000
population)
Chickenpox
(36.43 per
100,000
population)
C.Tetani, 4 to 14 days after birth,
fatality rate 70%
RNA Virus,IP: 16-18days, C : 8x8 ,
droplets,
RNA Virus,IP: 16-18days, C : 2x5 ,
droplets,
VZV, DNA Virus, IP 1-3wks, IP: 14-16 C
2x5 , droplets and direct contact(resp
then macules then papules then
pustule) Reye syndrome,
Hints:
No cases of Whooping Cough,
Diphtheria or Poliomylitis reported in
this yr. immunization coverage DPT,
HBV3 and OPV is 97.7%, while is
97.9% in year 2013.(Herd immunity)
Very few Meningitis by
Meningococcal(2), Pneumococcal(3)
H. influenzae(3), the rest (293) by
others eg S epidermidis & Staph.
Measles (0.92
per 100,000
population)
RNA virus (Morbillivirus), Droplets, IP 10-
2days, (Non specific,K.spots,generlised
maculop), Acute encephalitis,OM. C 4X4:Mubarak ALOsimi, M.D. 8

9. Genetic & immunologic defects predisposition
to infections- Not Idiopathic any more……
• Neisseria- Invasive disease (immunologic defects ) MAC deficiency & Properdin deficiency
(Gen) C5-9 deficiency.
• Mycobacteria (immunologic defects ) IL-12,-23,IFN-γdeficiency (Gen) IFNGR1&2.
• Streptococcuspneumoniae (immunologic defects ) IRAK-4 and MyD88 deficiency (Gen)
IRAK4 & MYD88.
• EBV X-linked lymphoproliferative disease (immunologic defects ) SAP and XIAP deficiency
(Gen) SAP & XIAP.
• HSV-1 Encephalitis (immunologic defects ) Impaired production of antiviral IFNs (Gen)
UNC93B TLR3.
Mubarak ALOsimi, M.D. 9

10. Classical show (1)…………….
Mubarak ALOsimi, M.D. 10

11. Classical show (2)…………….crater
Mubarak ALOsimi, M.D. 11

12. Control and Management (Updates and
Evidence) Vaccins and prophlaxis:
• Rota Virus (RotaTeq and Rotarix- phase 3 WHO, recommended to minimize
burden of 40% of all diarrhea hospitalizations and deaths in children under 5 Yrs.
Intussusception is contaIN.
• Antimonoclonal antibodies “ palivizumab” as prophylaxis for RSV, should be
limited to infants <29 weeks or with chronic illness such as congenital heart
disease or chronic lung disease. in the first year of life no more than five monthly
doses of palivizumab (15 mg/kg per dose) during the RSV season only. Also, for <
24 months if immunocompromised during the RSV season. NB: pneumococcal
colonization can enhance subsequent HRSV infection, thus control pneumococcal
colonization may prevent HRSV.
• Continuous warn against live vaccine admin. with Pt had Cortisol in ex 1moth or
immunodeficient Pt except…….
Mubarak ALOsimi, M.D. 12

13. Control and Management (Updates and
Evidence)- problematic attitude:
• Refusal LP, patients’ attitudes LP improved Significantly, through
structural education on indications, benefits, and risks.
• If still refusal, antibiotic should provide coverage for the 3 most
common pathogens: S pneumoniae, N meningitidis, and H influenza
and administered IV. N meningitidis - 7 days, H influenzae - 7 days,
S pneumoniae - 10-14 days, S agalactiae (GBS) - 14-21 days, L
monocytogenes - 21 days or longer. However, 5 trials involving
children aged 3 weeks to 16 years show No differences between
short-course (4-7 days) and long-course (7-14 days) treatment with
IV ceftriaxone were demonstrated with respect to end-of-therapy
clinical success.
•
Mubarak ALOsimi, M.D. 13

14. Control and Management (Updates and
Evidence)- Antibiotic Practice:
Susceptibilities of the most likely pathogen, rather important than
evidence of the superiority of one antibiotic over another.
Antibiotic exposure before 6 months of age, or repeatedly during
infancy, was associated with increased body mass and obesity.
A new class of antibiotic to fight drug-resistant infections such as
MRSA and TB ….such as Teixobactin , inhibits cell wall synthesis by
binding to a highly conserved motif of lipid II (precursor of
peptidoglycan) and lipid III (precursor of cell wall teichoic acid).
Mubarak ALOsimi, M.D. 14

15. Control and Management (Updates and
Evidence)- emerging pathogens:
• Cov MERS- case study:
• A 35-year-old male from Khamis Mushait city developed symptoms on 27 April and was admitted to hospital on 29 April. The patient has
comorbidities. He has no history of direct contact with camels or consumption of raw camel products; however, his house is adjacent to a camel
market. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical
condition in ICU. Contact tracing of household and healthcare contacts is ongoing for this case.
• WHO advice: Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute
respiratory infections and to carefully review any unusual patterns.
Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to
identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-
care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be
added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye
protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when
performing aerosol generating procedures.
Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are
considered to be at high risk of severe disease from MERS-CoV infection. Therefore, these people should avoid close contact with animals, particularly
camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular
hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.
Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly
cooked.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or
trade restrictions.
Mubarak ALOsimi, M.D. 15

16. Control and Management (Updates and
Evidence)- HCAI:
Hand washing is the single most important; RSV and parainfluenza viruses –
gown and gloves (ie, contact precautions);
Mask within 3 feet (ie, droplet precautions) for Influenza virus, group A
streptococcus (for the first 24 hours of treatment), methicillin-susceptible S.
aureus, Bordetella pertussis (until patient has received five days of effective
therapy), and Mycoplasma pneumoniae.
Adenovirus – contact and droplet precautions.
Methicillin-resistant S. aureus and other multidrug resistant organisms – special
organism precautions; contact and droplet precautions and dedicated patient
equipment.
Urinary catheters only when justified, if so The choice of anti-infective catheters.
Mubarak ALOsimi, M.D. 16

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• SatyenP. Urinary tract infections in the critical care unit: A brief review. Crit Care Med. 2013 Nov-Dec; 17(6): 370–374.
• Barclay L. Healthcare-acquired infections fall in critically ill kids. Medscape Medical News [serial online]. September 8, 2014;Accessed September 8, 2014. Available at http://www.medscape.com/viewarticle/831295.
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