This document discusses rotavirus prevention and control. It begins with an introduction stating that rotavirus is the leading cause of severe diarrhea in children under 5 globally, resulting in over 500,000 child deaths annually. The majority of these deaths occur in low-income countries.
It then covers the epidemiology and disease burden, describing rotavirus as the top cause of death in children under 5 worldwide. Clinical presentation is discussed, outlining the typical timeline and symptoms of rotavirus infection.
Prevention and control methods are summarized as infection control practices and vaccination. Two oral rotavirus vaccines currently available are described and their efficacy and safety are discussed. WHO recommendations for rotavirus vaccination through national immunization
This document discusses newer vaccines and an MR vaccination campaign. It provides background on vaccine history and types. Recent developments include vaccines for pneumococcal, influenza, meningococcal, HPV, and rotavirus. Future vaccines discussed include ones for HIV. The document also outlines the need for vaccination, recently added vaccines in India's national program, and details of vaccination schedules and target groups for campaigns like one for MR in 2017.
This study reviewed antibiotic use in the neonatal intensive care unit (NICU) of Misurata Medical Center from January to February 2018. It found that 97.3% of the 37 babies treated received penicillin alone or with gentamicin, for durations mostly between 3-7 days. Most treatment was based on clinical suspicion of infection rather than confirmed diagnosis, as only 2 cases underwent full sepsis workup. The main reasons for admission and initiating antibiotics empirically were preterm birth, caesarean delivery, low birth weight, and prolonged rupture of membranes - highlighting overuse and misuse of antibiotics without microbiological justification in the NICU.
There are four types of malaria parasites that infect humans. Plasmodium falciparum causes the most serious form of malaria. The parasites are transmitted via the bites of infected female Anopheles mosquitoes. Several anti-malarial drugs are discussed, including chloroquine, quinine, primaquine, artemisinin derivatives, mefloquine, and combinations of sulfadoxine and pyrimethamine. Treatment regimens vary depending on the parasite species and drug resistance patterns. Malaria prevention includes suppressive prophylaxis with drugs like chloroquine, mefloquine, or doxycycline.
Recent advances in management of tuberculosis finalVaibhav Watts
1) The document summarizes recent updates to WHO guidelines for the treatment and management of tuberculosis, including recommendations for shorter MDR-TB regimens, the use of bedaquiline and delamanid, and starting ART for all TB/HIV patients.
2) It also discusses changes to the Indian RNTCP guidelines in 2017, including implementing a daily drug regimen over intermittent dosing, modifications for TB/HIV coinfection treatment, and extending the continuation phase for certain TB types.
3) New drugs and regimens for both drug-susceptible and drug-resistant TB are highlighted, as well as the increased use of molecular diagnostic tests.
Antibiotics definition, Early and modern history, classification of antibiotics, Mechanism of antibacterial action, bacterial cell and drug targets, penicillins nomenclature, degradation reactions of penicillins, medical classification of penicillins, SAR of penicillins, Mechanism of penicillins, Betalactamase inhibitors, Therapeutic uses of penicillins, toxicity of penicillins, Side effects of penicillins.
Antibiotic resistance is a serious and growing public health problem. Overuse and misuse of antibiotics contributes to the development of resistant bacteria, making infections more difficult and sometimes impossible to treat. Key organizations warn that if antibiotic misuse continues, once treatable infections could become untreatable. Younger children and older adults are most at risk, as they use the most antibiotics. Improving antibiotic stewardship programs and developing new antibiotics are important to address this threat.
Antiviral drugs can be classified into several groups based on their mechanism of action and target virus. Anti-herpes drugs like acyclovir work by inhibiting viral DNA polymerase. Anti-retroviral drugs target HIV and include nucleoside reverse transcriptase inhibitors like AZT, non-nucleoside reverse transcriptase inhibitors like nevirapine, and protease inhibitors like ritonavir. These anti-HIV drugs are most effective when used in combination to suppress viral replication and improve immune function in patients. Common side effects of many antiviral drugs include bone marrow suppression, gastrointestinal issues, and peripheral neuropathy.
This document discusses newer vaccines and an MR vaccination campaign. It provides background on vaccine history and types. Recent developments include vaccines for pneumococcal, influenza, meningococcal, HPV, and rotavirus. Future vaccines discussed include ones for HIV. The document also outlines the need for vaccination, recently added vaccines in India's national program, and details of vaccination schedules and target groups for campaigns like one for MR in 2017.
This study reviewed antibiotic use in the neonatal intensive care unit (NICU) of Misurata Medical Center from January to February 2018. It found that 97.3% of the 37 babies treated received penicillin alone or with gentamicin, for durations mostly between 3-7 days. Most treatment was based on clinical suspicion of infection rather than confirmed diagnosis, as only 2 cases underwent full sepsis workup. The main reasons for admission and initiating antibiotics empirically were preterm birth, caesarean delivery, low birth weight, and prolonged rupture of membranes - highlighting overuse and misuse of antibiotics without microbiological justification in the NICU.
There are four types of malaria parasites that infect humans. Plasmodium falciparum causes the most serious form of malaria. The parasites are transmitted via the bites of infected female Anopheles mosquitoes. Several anti-malarial drugs are discussed, including chloroquine, quinine, primaquine, artemisinin derivatives, mefloquine, and combinations of sulfadoxine and pyrimethamine. Treatment regimens vary depending on the parasite species and drug resistance patterns. Malaria prevention includes suppressive prophylaxis with drugs like chloroquine, mefloquine, or doxycycline.
Recent advances in management of tuberculosis finalVaibhav Watts
1) The document summarizes recent updates to WHO guidelines for the treatment and management of tuberculosis, including recommendations for shorter MDR-TB regimens, the use of bedaquiline and delamanid, and starting ART for all TB/HIV patients.
2) It also discusses changes to the Indian RNTCP guidelines in 2017, including implementing a daily drug regimen over intermittent dosing, modifications for TB/HIV coinfection treatment, and extending the continuation phase for certain TB types.
3) New drugs and regimens for both drug-susceptible and drug-resistant TB are highlighted, as well as the increased use of molecular diagnostic tests.
Antibiotics definition, Early and modern history, classification of antibiotics, Mechanism of antibacterial action, bacterial cell and drug targets, penicillins nomenclature, degradation reactions of penicillins, medical classification of penicillins, SAR of penicillins, Mechanism of penicillins, Betalactamase inhibitors, Therapeutic uses of penicillins, toxicity of penicillins, Side effects of penicillins.
Antibiotic resistance is a serious and growing public health problem. Overuse and misuse of antibiotics contributes to the development of resistant bacteria, making infections more difficult and sometimes impossible to treat. Key organizations warn that if antibiotic misuse continues, once treatable infections could become untreatable. Younger children and older adults are most at risk, as they use the most antibiotics. Improving antibiotic stewardship programs and developing new antibiotics are important to address this threat.
Antiviral drugs can be classified into several groups based on their mechanism of action and target virus. Anti-herpes drugs like acyclovir work by inhibiting viral DNA polymerase. Anti-retroviral drugs target HIV and include nucleoside reverse transcriptase inhibitors like AZT, non-nucleoside reverse transcriptase inhibitors like nevirapine, and protease inhibitors like ritonavir. These anti-HIV drugs are most effective when used in combination to suppress viral replication and improve immune function in patients. Common side effects of many antiviral drugs include bone marrow suppression, gastrointestinal issues, and peripheral neuropathy.
This document discusses the antibiotic chloramphenicol, including its chemical and physical properties, mechanism of action, therapeutic uses, and side effects. Chloramphenicol is produced by Streptomyces venezuelae and inhibits bacterial protein synthesis. It has broad-spectrum antibacterial properties and is used to treat various bacterial infections in aquaculture like dropsy, furunculosis, and columnaris. The recommended dosages vary depending on the disease and species. While it can boost growth as an immunostimulant when combined with garlic, chloramphenicol also carries risks of hematopoietic toxicity at higher doses.
Severe Acute Respiratory Syndrome (SARS) Slide Share Health and MedicineSaira Yasmeen
This document provides information about Severe Acute Respiratory Syndrome (SARS). It defines SARS as a coronavirus that causes severe respiratory illness, sometimes progressing to pneumonia or respiratory failure. The SARS-CoV genome is large for a virus and codes for proteins involved in replication. SARS spreads through respiratory droplets and direct contact, with symptoms like high fever. Diagnosis involves virus detection through cell culture or antibody tests. Treatment includes antivirals and immunomodulators. Prevention relies on promptly detecting, isolating cases and tracing contacts to break transmission chains.
This document summarizes a seminar presentation on drug-resistant tuberculosis. It begins with an introduction defining tuberculosis and noting its status as a leading infectious cause of death worldwide, especially in India. It then covers topics like the transmission of TB, its pathogenesis, definitions of different types of drug-resistant TB (including MDR and XDR), factors that create drug resistance, and principles of treatment. The presentation includes sections on the epidemiology and mechanisms of drug resistance, as well as general treatment guidelines and specifics of regimens used in India's DOTS Plus program. It concludes with references cited.
This document discusses the appropriate and inappropriate use of antibiotics. It defines antibiotics and describes their history, including the discovery of penicillin. It notes that while antibiotics have saved many lives, their overuse and misuse has led to increased antibiotic resistance in bacteria. The document provides guidance on appropriate antibiotic prescribing for various conditions like sore throats, coughs, bronchitis, pneumonia, and properly switching from IV to oral antibiotics. It emphasizes that antibiotics should only be used when truly needed for bacterial infections, as their misuse fuels growing resistance.
Rotavirus vaccine presentation Rotateq 28 june 2013Gaurav Gupta
This document discusses rotavirus, a leading cause of severe diarrhea among children under 5 years old globally. It provides an overview of the disease burden in India, differences between the two available rotavirus vaccines (Rotarix and RotaTeq), challenges with vaccine serotype diversity and efficacy, and recommendations from WHO and IAPCOI to include rotavirus vaccination in national immunization programs in developing countries due to the potential for significant impact even with moderate vaccine efficacy.
Everything you should know about Influenza virus!ankitvkc
Influenza viruses belong to the Orthomyxoviridae family and have an enveloped structure containing proteins like hemagglutinin and neuraminidase. They contain a single-stranded RNA genome composed of 8 segments that encode 11 proteins. Influenza spreads through aerosols or contaminated surfaces and causes flu epidemics annually, as well as occasional pandemics arising from antigenic shift. The virus enters cells by binding hemagglutinin to sialic acid receptors and uncoating inside endosomes. Vaccination and antiviral drugs can help prevent and treat flu, while hand washing and masks can reduce transmission.
This document discusses methylcobalamin injection (vitamin B12). It begins by introducing vitamin B12 and its importance. It then describes the manufacturing process for methylcobalamin injection, including its active ingredients (methylcobalamin and D-mannitol) and water for injection. The document provides directions for administering methylcobalamin injection and discusses its mechanism of action, benefits, side effects, and good manufacturing practices. Throughout, it emphasizes the importance of vitamin B12 for the nervous system and treating deficiencies.
Rational use of antibiotics by Dr. Basil TumainiBasil Tumaini
Dr. Basil Tumaini presented a document on rational use of antibiotics. He discussed that antibiotics are commonly misused and overprescribed. Some key points included defining appropriate vs inappropriate antibiotic use, describing different antibiotic classes, and providing guidelines on rational prescribing like only using antibiotics for bacterial infections and avoiding unnecessary combinations. The document concluded with recommendations to only use antibiotics judiciously according to clinical guidelines and provide proper patient education.
Beta-Lactam Antibiotics Penicillins and cephalosporins.pptxsapnabohra2
TYB pharmacy
Pharmacology VI semester
Pharmacology notes
Beta-Lactam Antibiotics Penicillins and cephalosporins
antibiotics
Third year B pharmacy pharmacology notes
Pharmacology unit 3 notes
Penicillins and cephalosporins
Pharmacology VI semester notes
beta lactam antibiotics
- Swine flu, also known as H1N1, is caused by the influenza A H1N1 virus and causes respiratory illness. It was first detected in Mexico in 2009 and caused a global pandemic.
- In India, it has caused periodic outbreaks since 2009, killing over 1000 people annually. The worst affected states have been Gujarat and Rajasthan.
- The virus is transmitted through respiratory droplets from coughing and sneezing of infected individuals. It has an incubation period of 1-4 days. Symptoms include fever, cough, sore throat and body aches. Complications can include pneumonia.
Antibiotic resistance is a growing problem worldwide. The document discusses the causes of antibiotic resistance such as inappropriate antibiotic use, overuse in livestock, and misuse in hospitals. It emphasizes the need for prudent antibiotic use and antibiotic stewardship programs. The goals of an antibiotic policy are to reduce resistance, optimize antibiotic use, and prevent spread of resistant bacteria. Key participants in antibiotic committees and continual education are important to properly implement antibiotic policies.
This document discusses gastrointestinal reflux disease (GERD) and approaches to treating it. It begins by defining GERD and describing its typical clinical presentations. It notes that lifestyle factors like obesity have only weak evidence of aggravating GERD symptoms. Certain medications are also described as potentially aggravating GERD. The document then discusses the phenotypic classification of GERD and reviews the symptoms. It provides data on the prevalence of GERD worldwide and in particular countries and regions. Reasons for treatment failure with proton pump inhibitors are summarized. New therapies for GERD like vonoprazan, a potassium-competitive acid blocker, are introduced and its advantages over proton pump inhibitors are highlighted. Clinical evidence is presented demonstrating
This document provides an overview of antimicrobial resistance (AMR) and recent advances in combating it. It discusses the classification and mechanisms of drug resistance. The global scenario of increasing AMR is presented, along with the situation in Nepal. Recent strategies discussed include leveraging the role of the human microbiome, developing vaccines against resistant pathogens, interrupting bacterial conjugation through bioconjugation techniques, and interfering with quorum sensing pathways. The document also reviews Nepal's national policy and action plan related to AMR containment. Prevention strategies are proposed for individuals, policymakers, and health professionals.
1. The document provides guidelines for categorizing TB cases and treatment regimens under the Revised National Tuberculosis Control Programme (RNTCP) in India. It describes 5 categories of TB cases and their standard treatment regimens.
2. The document also summarizes various adverse drug reactions associated with anti-TB medications, their causative agents, clinical presentations, and management guidelines. It provides treatment guidelines for special groups including children, pregnant women, HIV patients, and those with comorbidities.
3. Guidelines are given for diagnosis and treatment of MDR-TB and XDR-TB cases. Standardized treatment regimens are recommended depending on drug susceptibility testing results and previous treatment history. Strict treatment
The document summarizes key information about penicillins including their structure, classification, mechanism of action, resistance, pharmacokinetics, adverse reactions, treatment of reactions, contraindications and drug interactions. It describes the core structure of penicillins including the thiazolidine and β-lactam rings. It classifies penicillins into natural, anti-staphylococcal, extended spectrum, and anti-pseudomonal categories. It explains their mechanism of inhibiting bacterial cell wall synthesis and common resistance mechanisms like β-lactamase production.
Influenza virus belongs to the orthomyxoviridae family and has four genera: influenza A, B, C, and thogotoviruses. Influenza A can infect various host species and cause pandemics in humans. Influenza viruses are spherical and contain 8 segments of single-stranded RNA. The RNA is surrounded by a lipid envelope containing hemagglutinin and neuraminidase proteins. Influenza A has the potential for antigenic shift and causes epidemics associated with changes in these surface proteins. Diagnosis involves virus isolation in cell culture and detection of viral antigens. Treatment options include amantadine and newer neuraminidase inhibitors.
This document discusses multi-drug resistant tuberculosis (MDR TB). It begins with an introduction to TB and definitions of key terms like MDR and XDR TB. It then describes first and second line anti-TB drugs, mechanisms of drug resistance, and factors contributing to acquired resistance. The document outlines methods for diagnosing drug resistance including genetic detection and drug sensitivity testing. It concludes with a brief overview of treatment approaches for MDR TB.
This document discusses rotavirus, a common cause of diarrhea in infants and young children. It provides information on signs and symptoms, risk factors, transmission, prevention and vaccines. The key points are:
- Rotavirus is highly contagious and usually causes fever, vomiting and watery diarrhea for 4-8 days. It is spread through fecal-oral transmission.
- Infants and children under 2 are most at risk, as they are more vulnerable to dehydration from rotavirus infection.
- Prevention strategies include handwashing, vaccination and oral rehydration solutions. There are three rotavirus vaccines available which provide protection from severe diarrhea.
The document summarizes future generation vaccines and their development. It discusses the need for vaccines against HIV, tuberculosis, malaria, dengue, and meningococcal diseases. For each disease, it outlines the disease burden, current vaccine development efforts including clinical trials, and the roles of organizations like WHO and PATH in accelerating vaccine development. The largest and most advanced vaccine clinical trials mentioned are for RTS,S malaria vaccine and Dengvaxia dengue vaccine.
Literature Survey Antibiotic ResistanceTuhin Samanta
Anti-toxin obstruction happens when microscopic organisms change in light of the utilization of these medications. Microscopic organisms, not people or creatures, become anti-toxin safe. These microorganisms may contaminate people and creatures, and the diseases they cause are more diligently to treat than those brought about by non-safe microscopic organisms.
Guidance for commissioners of perinatal mental health servicesJCP MH
This document provides guidance for commissioners on perinatal mental health services. It discusses:
1) The importance of perinatal mental health services for both mothers and infants, covering prevention, detection and management of mental health problems during pregnancy and the postpartum period.
2) What constitutes good perinatal mental health services, including specialized inpatient mother and baby units, outpatient perinatal mental health teams, and ensuring access to care across settings from primary to specialized care.
3) Key recommendations for commissioners around ensuring regional strategies, pathways for care, training, data collection, and collaboration across maternity, adult mental health, pediatric and primary care services to meet the mental health needs of
Diarrhea and it treatment. lactiviest and its benefits (1)Ashok Moses
Diarrhea is characterized by an increase in stool volume, frequency, or liquidity compared to normal. It can range from mild and self-limiting to severe and life-threatening if it leads to dehydration. The causes of diarrhea include infection, medications, inflammatory bowel disease, and lactose intolerance. Treatment focuses on rehydration and treating the underlying cause. Probiotics like Saccharomyces boulardii may help restore normal gut flora and shorten the duration of diarrhea.
This document discusses the antibiotic chloramphenicol, including its chemical and physical properties, mechanism of action, therapeutic uses, and side effects. Chloramphenicol is produced by Streptomyces venezuelae and inhibits bacterial protein synthesis. It has broad-spectrum antibacterial properties and is used to treat various bacterial infections in aquaculture like dropsy, furunculosis, and columnaris. The recommended dosages vary depending on the disease and species. While it can boost growth as an immunostimulant when combined with garlic, chloramphenicol also carries risks of hematopoietic toxicity at higher doses.
Severe Acute Respiratory Syndrome (SARS) Slide Share Health and MedicineSaira Yasmeen
This document provides information about Severe Acute Respiratory Syndrome (SARS). It defines SARS as a coronavirus that causes severe respiratory illness, sometimes progressing to pneumonia or respiratory failure. The SARS-CoV genome is large for a virus and codes for proteins involved in replication. SARS spreads through respiratory droplets and direct contact, with symptoms like high fever. Diagnosis involves virus detection through cell culture or antibody tests. Treatment includes antivirals and immunomodulators. Prevention relies on promptly detecting, isolating cases and tracing contacts to break transmission chains.
This document summarizes a seminar presentation on drug-resistant tuberculosis. It begins with an introduction defining tuberculosis and noting its status as a leading infectious cause of death worldwide, especially in India. It then covers topics like the transmission of TB, its pathogenesis, definitions of different types of drug-resistant TB (including MDR and XDR), factors that create drug resistance, and principles of treatment. The presentation includes sections on the epidemiology and mechanisms of drug resistance, as well as general treatment guidelines and specifics of regimens used in India's DOTS Plus program. It concludes with references cited.
This document discusses the appropriate and inappropriate use of antibiotics. It defines antibiotics and describes their history, including the discovery of penicillin. It notes that while antibiotics have saved many lives, their overuse and misuse has led to increased antibiotic resistance in bacteria. The document provides guidance on appropriate antibiotic prescribing for various conditions like sore throats, coughs, bronchitis, pneumonia, and properly switching from IV to oral antibiotics. It emphasizes that antibiotics should only be used when truly needed for bacterial infections, as their misuse fuels growing resistance.
Rotavirus vaccine presentation Rotateq 28 june 2013Gaurav Gupta
This document discusses rotavirus, a leading cause of severe diarrhea among children under 5 years old globally. It provides an overview of the disease burden in India, differences between the two available rotavirus vaccines (Rotarix and RotaTeq), challenges with vaccine serotype diversity and efficacy, and recommendations from WHO and IAPCOI to include rotavirus vaccination in national immunization programs in developing countries due to the potential for significant impact even with moderate vaccine efficacy.
Everything you should know about Influenza virus!ankitvkc
Influenza viruses belong to the Orthomyxoviridae family and have an enveloped structure containing proteins like hemagglutinin and neuraminidase. They contain a single-stranded RNA genome composed of 8 segments that encode 11 proteins. Influenza spreads through aerosols or contaminated surfaces and causes flu epidemics annually, as well as occasional pandemics arising from antigenic shift. The virus enters cells by binding hemagglutinin to sialic acid receptors and uncoating inside endosomes. Vaccination and antiviral drugs can help prevent and treat flu, while hand washing and masks can reduce transmission.
This document discusses methylcobalamin injection (vitamin B12). It begins by introducing vitamin B12 and its importance. It then describes the manufacturing process for methylcobalamin injection, including its active ingredients (methylcobalamin and D-mannitol) and water for injection. The document provides directions for administering methylcobalamin injection and discusses its mechanism of action, benefits, side effects, and good manufacturing practices. Throughout, it emphasizes the importance of vitamin B12 for the nervous system and treating deficiencies.
Rational use of antibiotics by Dr. Basil TumainiBasil Tumaini
Dr. Basil Tumaini presented a document on rational use of antibiotics. He discussed that antibiotics are commonly misused and overprescribed. Some key points included defining appropriate vs inappropriate antibiotic use, describing different antibiotic classes, and providing guidelines on rational prescribing like only using antibiotics for bacterial infections and avoiding unnecessary combinations. The document concluded with recommendations to only use antibiotics judiciously according to clinical guidelines and provide proper patient education.
Beta-Lactam Antibiotics Penicillins and cephalosporins.pptxsapnabohra2
TYB pharmacy
Pharmacology VI semester
Pharmacology notes
Beta-Lactam Antibiotics Penicillins and cephalosporins
antibiotics
Third year B pharmacy pharmacology notes
Pharmacology unit 3 notes
Penicillins and cephalosporins
Pharmacology VI semester notes
beta lactam antibiotics
- Swine flu, also known as H1N1, is caused by the influenza A H1N1 virus and causes respiratory illness. It was first detected in Mexico in 2009 and caused a global pandemic.
- In India, it has caused periodic outbreaks since 2009, killing over 1000 people annually. The worst affected states have been Gujarat and Rajasthan.
- The virus is transmitted through respiratory droplets from coughing and sneezing of infected individuals. It has an incubation period of 1-4 days. Symptoms include fever, cough, sore throat and body aches. Complications can include pneumonia.
Antibiotic resistance is a growing problem worldwide. The document discusses the causes of antibiotic resistance such as inappropriate antibiotic use, overuse in livestock, and misuse in hospitals. It emphasizes the need for prudent antibiotic use and antibiotic stewardship programs. The goals of an antibiotic policy are to reduce resistance, optimize antibiotic use, and prevent spread of resistant bacteria. Key participants in antibiotic committees and continual education are important to properly implement antibiotic policies.
This document discusses gastrointestinal reflux disease (GERD) and approaches to treating it. It begins by defining GERD and describing its typical clinical presentations. It notes that lifestyle factors like obesity have only weak evidence of aggravating GERD symptoms. Certain medications are also described as potentially aggravating GERD. The document then discusses the phenotypic classification of GERD and reviews the symptoms. It provides data on the prevalence of GERD worldwide and in particular countries and regions. Reasons for treatment failure with proton pump inhibitors are summarized. New therapies for GERD like vonoprazan, a potassium-competitive acid blocker, are introduced and its advantages over proton pump inhibitors are highlighted. Clinical evidence is presented demonstrating
This document provides an overview of antimicrobial resistance (AMR) and recent advances in combating it. It discusses the classification and mechanisms of drug resistance. The global scenario of increasing AMR is presented, along with the situation in Nepal. Recent strategies discussed include leveraging the role of the human microbiome, developing vaccines against resistant pathogens, interrupting bacterial conjugation through bioconjugation techniques, and interfering with quorum sensing pathways. The document also reviews Nepal's national policy and action plan related to AMR containment. Prevention strategies are proposed for individuals, policymakers, and health professionals.
1. The document provides guidelines for categorizing TB cases and treatment regimens under the Revised National Tuberculosis Control Programme (RNTCP) in India. It describes 5 categories of TB cases and their standard treatment regimens.
2. The document also summarizes various adverse drug reactions associated with anti-TB medications, their causative agents, clinical presentations, and management guidelines. It provides treatment guidelines for special groups including children, pregnant women, HIV patients, and those with comorbidities.
3. Guidelines are given for diagnosis and treatment of MDR-TB and XDR-TB cases. Standardized treatment regimens are recommended depending on drug susceptibility testing results and previous treatment history. Strict treatment
The document summarizes key information about penicillins including their structure, classification, mechanism of action, resistance, pharmacokinetics, adverse reactions, treatment of reactions, contraindications and drug interactions. It describes the core structure of penicillins including the thiazolidine and β-lactam rings. It classifies penicillins into natural, anti-staphylococcal, extended spectrum, and anti-pseudomonal categories. It explains their mechanism of inhibiting bacterial cell wall synthesis and common resistance mechanisms like β-lactamase production.
Influenza virus belongs to the orthomyxoviridae family and has four genera: influenza A, B, C, and thogotoviruses. Influenza A can infect various host species and cause pandemics in humans. Influenza viruses are spherical and contain 8 segments of single-stranded RNA. The RNA is surrounded by a lipid envelope containing hemagglutinin and neuraminidase proteins. Influenza A has the potential for antigenic shift and causes epidemics associated with changes in these surface proteins. Diagnosis involves virus isolation in cell culture and detection of viral antigens. Treatment options include amantadine and newer neuraminidase inhibitors.
This document discusses multi-drug resistant tuberculosis (MDR TB). It begins with an introduction to TB and definitions of key terms like MDR and XDR TB. It then describes first and second line anti-TB drugs, mechanisms of drug resistance, and factors contributing to acquired resistance. The document outlines methods for diagnosing drug resistance including genetic detection and drug sensitivity testing. It concludes with a brief overview of treatment approaches for MDR TB.
This document discusses rotavirus, a common cause of diarrhea in infants and young children. It provides information on signs and symptoms, risk factors, transmission, prevention and vaccines. The key points are:
- Rotavirus is highly contagious and usually causes fever, vomiting and watery diarrhea for 4-8 days. It is spread through fecal-oral transmission.
- Infants and children under 2 are most at risk, as they are more vulnerable to dehydration from rotavirus infection.
- Prevention strategies include handwashing, vaccination and oral rehydration solutions. There are three rotavirus vaccines available which provide protection from severe diarrhea.
The document summarizes future generation vaccines and their development. It discusses the need for vaccines against HIV, tuberculosis, malaria, dengue, and meningococcal diseases. For each disease, it outlines the disease burden, current vaccine development efforts including clinical trials, and the roles of organizations like WHO and PATH in accelerating vaccine development. The largest and most advanced vaccine clinical trials mentioned are for RTS,S malaria vaccine and Dengvaxia dengue vaccine.
Literature Survey Antibiotic ResistanceTuhin Samanta
Anti-toxin obstruction happens when microscopic organisms change in light of the utilization of these medications. Microscopic organisms, not people or creatures, become anti-toxin safe. These microorganisms may contaminate people and creatures, and the diseases they cause are more diligently to treat than those brought about by non-safe microscopic organisms.
Guidance for commissioners of perinatal mental health servicesJCP MH
This document provides guidance for commissioners on perinatal mental health services. It discusses:
1) The importance of perinatal mental health services for both mothers and infants, covering prevention, detection and management of mental health problems during pregnancy and the postpartum period.
2) What constitutes good perinatal mental health services, including specialized inpatient mother and baby units, outpatient perinatal mental health teams, and ensuring access to care across settings from primary to specialized care.
3) Key recommendations for commissioners around ensuring regional strategies, pathways for care, training, data collection, and collaboration across maternity, adult mental health, pediatric and primary care services to meet the mental health needs of
Diarrhea and it treatment. lactiviest and its benefits (1)Ashok Moses
Diarrhea is characterized by an increase in stool volume, frequency, or liquidity compared to normal. It can range from mild and self-limiting to severe and life-threatening if it leads to dehydration. The causes of diarrhea include infection, medications, inflammatory bowel disease, and lactose intolerance. Treatment focuses on rehydration and treating the underlying cause. Probiotics like Saccharomyces boulardii may help restore normal gut flora and shorten the duration of diarrhea.
Rotavirus is the leading cause of severe diarrhea in children worldwide. In India, it results in 100,000-150,000 child deaths per year. The virus is highly prevalent in India and symptoms include non-bloody diarrhea, vomiting, and dehydration. It is spread through the fecal-oral route. While the infection itself is self-limiting, treatment focuses on fluid replacement to prevent dehydration. Handwashing and vaccination are important for control and prevention.
El rotavirus es una enfermedad viral que causa diarrea y vómitos en bebés y niños pequeños, pudiendo causar deshidratación. Se transmite a través de las heces fecales de personas infectadas por contacto directo o a través de superficies u objetos contaminados. Sus síntomas principales son diarrea que puede venir acompañada de fiebre y vómitos, y su tratamiento consiste en mantener la hidratación a través de la alimentación y la preparación de suero oral en casa.
Rotavirus is a major cause of diarrhea in infants and young children worldwide. It spreads easily between people through contaminated food or surfaces. The virus causes infection and inflammation of the intestinal tract, leading to diarrhea and dehydration. Diagnosis involves detecting the virus in stool samples using tests like ELISA or electron microscopy. Treatment focuses on rehydration through oral rehydration therapy. Handwashing and sanitation can help prevent transmission. Two live, oral rotavirus vaccines provide protection against severe diarrhea from the most common strains.
Este documento describe el rotavirus, el cual causa diarrea infantil en todo el mundo. Pertenece a la familia Reoviridae y al género Rotavirus, con siete grupos. Es un virus esférico de doble capa proteica que contiene 11 segmentos de ARN bicatenario. Se transmite por la vía fecal-oral y causa diarrea y deshidratación al replicarse en el intestino delgado. Existen vacunas que ayudan a prevenir la infección y sus síntomas graves.
Los rotavirus son la causa principal de diarrea grave en niños pequeños a nivel mundial. Se transmiten por vía fecal-oral y sobreviven en el ambiente. La infección causa deshidratación grave por la pérdida de líquidos y electrolitos en la diarrea y los vómitos. Las vacunas orales actuales como Rotarix y RotaTeq han demostrado ser seguras y efectivas para prevenir la enfermedad causada por los rotavirus.
Rotavirus is a common cause of diarrhea in infants and children worldwide. It is spread through fecal-oral transmission and causes gastroenteritis. Nearly all children have been infected by rotavirus by age 5. The virus attaches to and damages cells lining the intestines, causing watery diarrhea that can lead to dehydration. Replacing lost fluids and electrolytes is the primary treatment for rotavirus diarrhea. Vaccines are available to help prevent rotavirus infection in children.
This document discusses rotavirus prevention and control. It provides an overview of rotavirus epidemiology, transmission, clinical presentation, diagnosis and treatment. It discusses infection control measures including handwashing and vaccination. Two oral rotavirus vaccines are described and their efficacy, safety and use in HIV-infected infants is summarized. Surveillance efforts in South Africa and Africa are outlined. WHO recommendations for rotavirus vaccination through routine immunization programs are also mentioned.
Rotavirus RV is a disease that is extremely spreadable in children whose age ranges between 3'5 years. Rotavirus vaccination RVV is an effective method for combating the diarrhoea disease as rotavirus is the leading cause of diarrhoea worldwide. For fulfilling the aim of reducing the burden of RV caused in children under 5 years for diarrhoea mortality. World Health Organization WHO recommends introducing RVVs worldwide. Globally three RVVs are licensed for local use two monovalent vaccines Rotarix, and Rotavac and a pentavalent vaccine RotaTeq. Safety and efficacy of these vaccines have been proved, however, they require cold chain storage at or below 2oto 8oC before use. In this article, a detailed profile of Rotarix vaccine is being emphasized. Rotavirus Vaccines are in high demand for introduction by many low income countries, but limitations such as price, poor supply and insufficient cold chain capacity at distant delivery points, have restricted their introduction. A. A Bhosale | Dr. V. U Barge "Illustrative Review on Rotavirus Vaccines" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-1 , December 2019, URL: https://www.ijtsrd.com/papers/ijtsrd29552.pdfPaper URL: https://www.ijtsrd.com/biological-science/biotechnology/29552/illustrative-review-on-rotavirus-vaccines/a-a-bhosale
Rotavirus is a major cause of diarrhea in infants worldwide. It spreads easily through fecal-oral transmission, especially in settings like daycares where children are in close contact. The virus infects and destroys cells in the small intestine, causing diarrhea, fluid loss, and dehydration. Diagnosis involves detecting the virus in stool samples using tests like ELISA. Treatment focuses on oral rehydration therapy. Two live, oral rotavirus vaccines provide protection against the most common strains causing severe childhood rotavirus diarrhea.
Rotavirus is a leading cause of severe diarrhea in children under 5 globally. Two rotavirus vaccines, Rotarix and RotaTeq, have proven safe and effective in reducing severe rotavirus disease and deaths. Based on evidence from trials in developing countries showing significant public health impact, WHO now strongly recommends that rotavirus vaccines be included in all national immunization programs worldwide. The first dose should be given between 6-15 weeks of age.
This document discusses several viruses that cause gastroenteritis in humans. Rotavirus is identified as the leading cause of severe diarrhea in children under 5 years old worldwide. Latex agglutination testing is described as a rapid method for detecting rotavirus in stool samples. The study found a higher prevalence of rotavirus infection in HIV-positive patients compared to HIV-negative patients presenting with diarrhea. Enteric adenoviruses, norovirus, and sapovirus are also discussed as important causes of viral gastroenteritis. Electron microscopy, enzyme immunoassays, and PCR-based methods are described for laboratory diagnosis of these viruses from stool specimens.
Rotavirus is the most common cause of severe diarrhea in children under 5 globally. It results in over 500,000 child deaths annually, mostly in developing countries. Two live, oral rotavirus vaccines have been developed and recommended by WHO for inclusion in national immunization programs worldwide due to their safety and efficacy in trials. Vaccination has significantly reduced the burden of severe rotavirus diarrhea in countries that have adopted routine childhood immunization against rotavirus. Further research is still needed to optimize vaccine benefits in developing countries where the impact could be greatest.
This document summarizes information about rotavirus, which is a leading cause of severe diarrhea in young children worldwide. It discusses the disease burden of rotavirus, describing it as responsible for over 600,000 childhood deaths annually, especially in low-income countries like India. The document also reviews rotavirus virology, epidemiology, clinical manifestations, preventive measures, challenges, and two available oral vaccines - Rotarix and RotaTeq. It emphasizes that while improvements in hygiene and sanitation can help reduce transmission, vaccination is needed to significantly reduce the mortality and morbidity caused by rotavirus diarrhea.
Rotavirus is a common virus that causes severe diarrhea in infants and young children. It infects the intestines and causes inflammation of the stomach and bowels. The main symptoms are watery diarrhea, vomiting, fever and dehydration. It is transmitted through the fecal-oral route. Diagnosis involves detecting the virus or its proteins in stool samples. Treatment focuses on preventing dehydration through oral rehydration. Vaccines have been developed to help prevent rotavirus infection and reduce its global impact.
Prevention of rotavirus in india is vaccination the only strategy.Dr. Dharmendra Gahwai
Rotavirus is a major cause of diarrhea in young children in India, resulting in approximately 300,000 deaths per year. While oral rehydration solution can treat dehydration, rotavirus infection has no specific treatment. Rotavirus vaccines have been shown to significantly reduce rotavirus disease and deaths in other countries. For India, introducing an affordable rotavirus vaccine into its national immunization program could cost-effectively prevent thousands of rotavirus-related deaths annually, though overall immunization coverage would need to increase to maximize its impact.
This document discusses rotavirus, which is the leading cause of severe diarrhea among children under 5 years old globally. It covers the virology of rotavirus, including that it is resistant to destruction and has multiple serotypes. However, natural infection protects against future infections regardless of serotype. The document also reviews scary statistics about rotavirus' impact, being responsible for 5% of child deaths and over 100,000 deaths annually in India alone. It discusses how rotavirus diarrhea can be clinically diagnosed and the importance of vaccination to prevent rotavirus, given hand washing and sanitation are ineffective due to its resistant nature. Two available vaccines, Rotarix and RotaTeq, provide strong efficacy against severe rotavirus disease.
Rotavirus is a major cause of diarrhea in infants and young children worldwide. It spreads easily between people through the fecal-oral route. Diagnosis is made through enzyme immunoassays detecting the virus in stool samples. Treatment focuses on fluid replacement through oral rehydration therapy. Two oral rotavirus vaccines provide protection against the most common strains causing infection. Development of an indigenous rotavirus vaccine called Rotavac could help reduce the 100,000 annual child deaths from rotavirus in India.
Rotavirus is the leading cause of severe diarrhea in infants and young children worldwide. Two oral rotavirus vaccines, Rotarix and RotaTeq, were licensed in the 2000s and introduced in national immunization programs. Rotarix is a live-attenuated monovalent G1P[8] human strain, while RotaTeq is a pentavalent human-bovine reassortant vaccine. Both vaccines have shown high efficacy rates against severe rotavirus gastroenteritis in clinical trials. Efforts are ongoing to develop more affordable rotavirus vaccines, such as the Indian vaccine Rotavac, which is currently in phase III trials.
Rotavirus is a major cause of childhood diarrhea and mortality globally, disproportionately affecting children in developing countries. While two vaccines are available, they have shown reduced effectiveness in developing countries possibly due to differences in strain diversity, malnutrition, and breastfeeding practices. New vaccine candidates targeting regional strains are in development. A holistic approach considering economic constraints, alternative interventions, and long-term solutions like infrastructure and nutrition improvements may maximize the public health impact of rotavirus prevention efforts.
Rotavirus vaccines: recent developments and future considerations discusses two new rotavirus vaccines that have been shown to be safe and effective in protecting young children against severe rotavirus gastroenteritis. While both vaccines are now marketed worldwide, there is still room for improvement. The review addresses recent advances in rotavirus research that could help improve existing vaccines or develop new ones, with a focus on the immune response induced by the current vaccines and mechanisms of protection.
This study analyzed 103 stool samples from infants under 12 months old with diarrhea in Iraq. Rapid immunochromatography tests found that 52 samples (50.5%) were positive for rotavirus, 30 (29.1%) for norovirus, and 21 (20.4%) for adenovirus. The most affected age group was 1-4 months. Rural infants had higher rates of viral diarrhea than urban infants. Mixed feeding was associated with more cases than breastfeeding alone. Common symptoms included watery stool, fever, weakness, abdominal pain, and vomiting. The major causes of infantile diarrhea in the study area were identified as rotavirus, followed by norovirus and adenovirus.
This document discusses human parasite vaccines. It begins by explaining what vaccines do in stimulating the host's protective immune response. Developing effective parasite vaccines faces challenges including not fully understanding the parasite's life cycle and which stages elicit a protective immune response. Effective vaccines must produce long-lasting protection without boosting and be low-cost, stable, and safe. Progress has been limited for parasite vaccines due to parasites' ability to evade the immune system, uncertainty regarding which antigens stimulate protection, and differences between animal models and human immune responses. Major human parasitic diseases discussed include malaria, African sleeping sickness, Chagas disease, leishmaniasis, intestinal protozoa, schistosomiasis, onchocerciasis
This document discusses viruses that cause diarrhea. It focuses on rotavirus as the most common cause of diarrhea in children. Rotavirus is a double-stranded RNA virus that infects and destroys cells lining the small intestine. It is classified into groups based on antigenic variation and currently globally common strains include G1P[8]. The virus is transmitted through the fecal-oral route. Clinical features include vomiting and watery diarrhea. Treatment involves oral rehydration and prevention centers around vaccination and improved hygiene. The document also briefly outlines other viruses like norovirus, adenovirus, astrovirus and their roles in viral gastroenteritis.
Rotavirus is a virus that causes gastroenteritis in infants and young children. It is estimated that nearly all children will be infected with rotavirus by age 5. Rotavirus causes about half of all cases of gastroenteritis in children under 5. India will soon have a locally manufactured low-cost rotavirus vaccine as part of its universal immunization program. The vaccine from Bharat Biotech is expected to be available at almost one-fifteenth the current market price and could be launched in 2015. Recent research has studied rotavirus infections and strains in small ruminants and the potential for interspecies transmission.
Diarrea aguda infecciosa en pediatria, epidemiologia, prevencion y tratamientofranklinaranda
This document discusses acute diarrheal disease in children. It notes that diarrhea is a leading cause of morbidity and mortality in children worldwide, responsible for 2-3 million deaths per year. In the US, acute diarrhea accounts for 9% of pediatric hospitalizations. The causes of acute diarrhea vary but include viruses like rotavirus and norovirus, as well as bacterial and parasitic pathogens. Treatment focuses on fluid replacement and management, while prevention efforts include vaccination against rotavirus.
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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2. Outline of Presentation
Introduction
Epidemiology and Disease Burden
The Rotavirus
Clinical Presentation
Prevention and Control
Vaccination
Surveillance
WHO Recommendations
3. Introduction
Rotavirus (RV) is the commonest cause of severe
diarrhoeal disease in infants and young children
globally
527 000 children die each year
Children under 5 most vulnerable
Majority in low-income countries (85%)
Country-specific data show 80-90 children die every
day in Nigeria from the disease, 50-60 deaths occur
daily in Cameroon, and 10-12 in South Africa
Estimated cost to healthcare system: USD 264 to 318
4. Epidemiology and Disease Burden
Causes of Death in Children Under 5 Worldwide, 2008
15% = 1.3 million deaths annually !
Black RE, Lancet 2010; 375:1969-1987
7. Transmission
Primary mode of transmission is feacal to oral
Highly communicable and transmissible
Close person-to-person contact and environmental
surfaces are common vectors of transmission
Incubation period is 1 – 3 days
8. Transmission
Large quantities of virus are shed in stool from just
prior to onset of symptoms until about 10 days after
onset
Amount of virus shed in stool:
10-100 billion virions/gram of stool !
Amount of ingested virus required to cause infection:
As few as 10 infective virions !
9. The Rotavirus
First recognized in 1973, rotavirus belongs
to the viral family Reoviridae
Its wheel-like shape under an electron
microscope earned it the name of “rota”
virus
The rotavirus genome consists of 11
double-stranded RNA segments, each
encoding one viral protein
A triple-layered capsule surrounds the RNA
Scientists have described seven rotavirus
groups (A to G)
Only groups A, B, and C infect humans
Group A, which has multiple strains,
causes the majority of childhood infections
Vaccine candidates are designed to protect
against Group A rotaviruses
10. The Rotavirus
The G-type and P-type define the serotype
They are critical to vaccine development
because they are the vaccine targets for
stimulating a protective immune response
SEROTYPES
Source : WWW.ROTAPICTURES/BU/EDU
G1P[8] is the most common serotype worldwide and accounts for over two
thirds of rotavirus infections worldwide
Infections with G1, G2, G3, G4, and G9 together comprise almost 95% of
rotavirus serotypes observed
Because the 2 gene segments that encode these proteins can segregate
independently, a typing system consisting of both G and P types is used. i.e.
G1P[8], G2P[4], G3P[8], G4P[8], G9P[8], and G9P[6]
13. Clinical Presentation
Pathogenesis
The virus causes diarrhoea by three principle mechanisms:
infection of villus epithelial cells causes cell destruction,
decreased absorption of salt and water, and decreased
disaccharidase activity, increasing the osmotic load in the gut
lumen
stimulation of the enteric nervous system, leading to increased
fluid secretion
direct enterotoxin effects of nonstructural protein 4 (NSP4), the
first viral enterotoxin to be described
The osmotic load in the gut and increased fluid secretion lead to
diarrhoea and, if unchecked and without fluid replacement, can
ultimately lead to dehydration and acidosis
14. Clinical Presentation
Complications
•
The major complication is the dehydration, which can lead to
acidosis and eventually to circulatory collapse.
Also been associated with
aseptic meningitis, necrotizing enterocolitis, acute
myositis, hepatic abscess, pneumonia, Kawasaki disease,
SIDS and Crohn's disease
Rotavirus induced gastroenteritis in children with
immunodeficiency may cause persistent infection lasting
weeks or months
Self-limited illness in immunocompetant
15. Clinical Presentation
Diagnosis
Mostly clinical
Rapid antigen detection by ELISA of rotavirus in stool
specimens.
Isolates may be further characterized by reverse-
transcriptase polymerase chain reaction
16. Clinical Presentation
In infants, natural rotavirus infection confers protection against subsequent
infection
By the age of 2 years, nearly every child in a cohort of children in Mexico had
experienced at least one rotavirus infection
These children had greater protection against severe diarrhoea with subsequent
infections
Two natural infections were required for 100% protection against moderate-to-
severe diarrhoea
The first exposure to rotavirus also protected 87% (95% CI, 54%, 96%) of children
from having severe disease from the second infection
The protection rates observed with one natural infection are similar to those
observed with vaccine-induced protection
Vaccination protects 84% to 98% of children against severe outcomes of a second
rotavirus infection
Source: Velazquez, FRet al. N Engl J Med. 1996;335:1022-1028
17. Clinical Presentation
Probability of RV Infection by Age
Cumulative Probability of First and Subsequent Natural Rotavirus Infections during
the First Two Years of life (Source: Velazquez, FRet al. N Engl J Med. 1996;335:1022-
1028.)
18. Treatment
Therapy for rotavirus-induced diarrhoea involves replacement of fluids and
electrolytes lost during infection.
Priorities
feeding (breast milk or diluted formula in infants and lactose free
carbohydrate rich foods in older children) within 24 hours after
onset of illness
the use of oral rehydration therapy in children with mild or
moderate dehydration.
Fruit juices and soft drinks are not recommended due to their high glucose
content, low sodium content and high osmolarity.
Antibiotics, antisecretory drugs, antimotility drugs, absorbents and
antiemetics do not ameliorate acute infection, prevent reinfection or reduce
fluid losses during rotavirus induced gastroenteritis, and therefore do not
play a role in treatment.
Children with immunodeficiency disorders may be treated with rotavirus-
specific immunoglobolin preparation. Administer orally to decrease shedding
and ameliorate disease .
20. Infection Control
In the Home and Day-Care Facilities
Hand-washing areas
Food-preparation areas
Diaper-changing surfaces
Diaper disposal containers
Toys
In Hospital Areas and Clinics
Hand-washing areas
Medication-preparation areas
22. Rotavirus Vaccines
Two oral, live, attenuated rotavirus vaccines
Rotarix (GlaxoSmithKline Biologicals,Rixensart, Belgium)
RotaTeq (Merck & Co. Inc., West Point, PA, USA)
Available internationally
Both vaccines are considered safe and effective
WHO now recommends that infants worldwide be vaccinated
against Rotavirus
Vaccines differ in composition and dosing schedule
Rotarix (RV1) is a monovalent vaccine given in a 2-dose
schedule
23. Rotavirus Vaccines
RotaTeq Rotarix
Manufacturer Merk & Co. GSK
Genetic framework Bovine Rotavirus – WC3 Human Rotavirus-89-12
Composition 5 Human, Bovine reassortant Single Human rotavirus
Genotypes G1, 2, 3, 4 and [P8] G1 [P8]
Dosage Schedule 3 doses at 2, 4 and 6 months 2 doses at 2 and 4 months
Route oral oral
Presentation liquid Lysophilized-reconstituted
Efficacy against severe 85% 95%
disease
Virus shedding Up to 13 % 17 % - 27%
25. Vaccine Efficacy
Rotavirus Efficacy in Clinical Trials in Africa and Asia
Vaccine Region Country Efficacy
RV1 (Rotarix) Africa South Africa, 62% (44% - 73%)
Malawi
RV5 (RotaTeq) Asia Bangladesh, 51% (13% - 73%)
Vietnam
RV5 (RotaTeq) Africa Ghana, Kenya, 64% (40% - 79%)
Malawi
Madhi SA, et al. N Engl J Med 2010;362:289-298
Armah GE, et al. Lancet 2010;376:606-614
Zaman K, et al. Lancet 2010;376:615-623
26. Vaccine Efficacy
Efficacy of Rotavirus Vaccines by Mortality Stratum and Country
Mortality rate RV vaccine Countries were studies were
defined by WHO efficacy performed
estimates
HIGH 50 – 64 % Ghana, Kenya, Malawi, Mali
46 – 72 % Bangladesh, South Africa
INTERMEDIATE
72 – 85 % Vietnam, the Americas
85 – 100 % The Americas, Western Pacific
and Europe
Adapted from WHO. Wkly Epidemiol Rec 2009;84:533-40
27. Rotavirus Surveillance in South Africa
In the first year, coverage was less than 50%; data from early
2010 indicated uptake of 50-75%
Rotavirus in South Africa is a very seasonal disease, usually
peaking in May, with a second smaller peak a few months later
In summer months there is little rotavirus but quite a bit of
other diarrheal disease
Data collected from the sentinel sites through June 2010
showed a major decline in RV-positive stool samples in the 2010
rotavirus season, the first following the vaccine’s introduction
In vaccinated children, rotavirus was detected in 11% of stool
samples during the surveillance period, while in the
unvaccinated children the rate was 20%
28. Rotavirus Surveillance in South Africa
Cumulative number of specimens tested rotavirus positive and total number of
samples collected by hospital - Reporting period: 04/01/2010 to 30/12/2010.
Hospital Rotavirus Positive Total Samples
Chris Hani Baragwanath 128 541
Edendale 16 84
George Mukhari 46 232
Mapulaneng 10 67
Matikwane 41 218
Total 241 1142
Rotavirus also has a distinct seasonality with peaks in the winter months in
temperate climates
serotype G1 accounts for approximately 50% of infections in South Africa.
Other serotypes causing infection in South Africa include G2, G8, G9 and G12
Data courtesy of NICD Epidemiologic Report; ROTA Surveillance, 2011.
29. Rotavirus Surveillance in Africa
25-40% of African children hospitalized with
diarrheal illness are infected with rotavirus
By 18 months of age, 83% of children will have
contracted the virus
G1 is most prevalent strain in Africa, estimated
50% of cases, followed by G3 at 30%
G2 strain occurs in “waves” every 3 to 4 years
G4 and G8 strains occur in sporadic isolation
G9 is emerging in countries across the
continent
Mixed serotypes are increasingly common
Of the P genotypes, P6 is the most common,
accounting for 50-60% of cases, followed by P8
(35-40% of cases).
An unusual VP4 serotype has also been
detected
African Rotavirus Surveillance Network (AFRSN) – www.afro.who.int/en
31. Other Effects of Rotavirus Vaccination
Health Impact
decrease in all-cause diarrhoea
Herd Immunity
protection extends to the unvaccinated
Age specific incidence of disease
change in age of exposure
Season specific incidence of disease
shift in onset of epidemics. Helps guide surveillance systems
Long-term interaction of rotavirus vaccination and strain
ecology
33. Rotavirus Vaccine Safety
Intussuseption
Currently NO data supports hypothesis of increased risk of
intussuseption with RV vaccines
Rotavirus vaccines are safe
•
Reviewed safety data from phase III efficacy studies of
Rotarix and RotaTeq, as well as postmarketing safety data
from Australia, Latin America and the United States
•
Previous association with the now withdrawn vaccine,
RotaShield
34. Rotavirus Vaccine Safety
Contraindications
Severe Combined Immunodeficiency Syndrome
History of:
severe allergic reaction to a prior dose of RV
Severe allergic reaction to latex
Intussuseption
Some congenital GI malformations e.g. Meckel diverticulum
Vaccine-vaccine interactions
RV vaccines have been found not to interfere significantly with the immunogenicity
or safety of other childhood vaccines
35. WHO - EPI Recommendations
RV vaccine should be included in all national immunization programmes
In countries where diarrhoeal deaths account for ≥10% of mortality among children
aged <5 years, the introduction of the vaccine is strongly recommended
WHO recommends that the first dose of either RotaTeq or Rotarix be administered at
age 6–15 weeks
The maximum age for administering the last dose of either vaccine should be 32
weeks.
It is recommended that 2 doses of Rotarix be administered with the first and second
doses of DTP rather than with the second and third doses
This ensures maximum immunization coverage and reduces the potential for late
administration beyond the approved age window
This schedule will be reviewed as new data become available
6 and 14 weeks in RSA EPI schedule
36. Conclusions
Rotavirus vaccines are not the solution to controlling this disease
Disease Control involves an integrated approach
Zinc treatment
Improved oral rehydration solution (ORS)
Exclusive breastfeeding
Improved nutrition
Community education
Safe water, adequate sanitation and hygiene
These can complement the impact of vaccines and together have a huge impact in
reducing the burden of diarrhoea – one of the largest killer of young children.
37. References
•
WHO Weekly Epidemiological Record 2008; 83 (47), 27 November 2008
•
Global networks for surveillance of rotavirus gastroenteritis, 2001-2008. Wkly Epidemiol Rec 2008;83:421-428.
•
Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global illness and deaths caused by rotavirus disease in children. Emerg Infect
Dis 2003;9:565-72.
•
Chin, J. (Ed.). (2000). Control of Communicable Disease Manual. Wash. DC: American Public Health Association.
•
American Academy of Pediatrics. (1997). Rotavirus. In Red book: Report of the committee on infectious diseases. (24th ed., pp.454 - 456).
Elk Grove Village, IL:Author.
•
Velazquez F, Matson DO, Calya JJ, et al. Rotavirus infections in infants as protection against subsequent infections. N Engl J Med.
1996;335:1022-1028.
•
Offit, P. A. & Clark, M. F. (2000). In G. L. Mandell, J. E. Bennett, & R. Dolin (Eds)., Principles and practice of infectious diseases. (5th ed.,
pp.1696 -1703). Philadelphia, PA: Churchill Livingstone
•
Estes M. Rotaviruses and their replication. In: Howley PM, ed. Fields Virology. 3rd ed. Vol. 2. Philadelphia, PA: Lippincott-Raven; 1996:1625-
55.
•
Estes MK, Cohen J. Rotavirus gene structure and function. Microbiological Reviews 1989;53:410-49.
•
Glass RI, Bhan MK, Ray P, et al. Development of candidate rotavirus vaccines derived from neonatal strains in India. J Infect Dis
2005;192(Suppl):S30-S5.
•
Ward RL, Bernstein DI. Lack of correlation between serum rotavirus antibody titers and protection following vaccination with reassortant
Rotavirus strains are serotyped according to the neutralization of one of the two proteins present in the outer capsid: VP7, a glycoprotein, is neutralized in G types, and VP4, a protease-cleaved hemagglutinin, is neutralized in P types. G types 1, 2, 3, and 4 are responsible for most infections in children. Rotavirus was given its name when scientists observed its wheel-like appearance; it was named after rota , the Latin word for wheel . The inner hub of the rotavirus (yellow on the slide) is usually referred to as the G-type, and the spokes coming off of the inner hub (red on the slide) are usually referred to as the P-type. The G-type and P-type define the serotype of the virus and are critical to vaccine development because they are the vaccine targets for stimulating a protective immune response.
Two surface rotavirus proteins, VP7 (a glycoprotein—G protein) and VP4 (a protease-cleaved protein—P protein), induce homotypic and heterotypic neutralizing antibody responses that are suspected to partly provide protective immunity after natural infection and vaccination
Before symptoms of rotavirus infection appear, feacal shedding occurs. Fever and vomiting precede diarrhoea, and hospitalization for dehydration usually occurs between days 2 and 6 after infection Fever and vomiting are usually the first symptoms, followed quickly by diarrhoea. Oftentimes the vomiting is a rate-limiting factor in attempts to provide oral rehydration. When hospitalization for dehydration does occur, it is usually 2 to 6 days into the illness, and intravenous fluid therapy is necessary.
The diarrhoea is usually non-bloody, profuse, and lasts for up to 3-8 days. Compared with children with non-rotavirus-related diarrhoea, rotavirus-infected children experience more vomiting and have a greater number of diarrhoea episodes per day, which explains why dehydration is so common with this illness.[13] Dehydration is commonly isotonic. Diarrhoea is watery without blood or mucous. Although coryza and cough may precede GI symptoms, replication of rotavirus in the upper respiratory tract is not important in the spread of the virus (4). Neurologic symptoms may occur in severe cases as a result of electrolyte imbalance or direct viral infection of the central nervous system (1).
Cause of disease Rotavirus replicates in certain cells that line the inside of the small intestine. This replication decreases the ability of the intestine to absorb salts and water. Rotavirus has never been detected consistently in the blood or in other sites far from the intestine.
Cause of disease Rotavirus replicates in certain cells that line the inside of the small intestine. This replication decreases the ability of the intestine to absorb salts and water. Rotavirus has never been detected consistently in the blood or in other sites far from the intestine.
In a cohort of Mexican children, nearly every child had a rotavirus infection by the age of 2 years. Rotavirus vaccination mimics the protection rates of one natural infection. The failure of a primary natural rotavirus infection to protect completely against subsequent infection may indicate the need for multiple vaccinations or for the administration of a polyvalent vaccine that can elicit full protection against all prevalent serotypes. It is encouraging that the degree of protection conferred by asymptomatic infection was similar to that afforded by symptomatic infection. The occurrence of two rotavirus infections, whether symptomatic or asymptomatic, resulted in complete protection against moderate-to-severe illness. This finding implies that an attenuated vaccine that caused asymptomatic infection could induce protective immunity. That two natural infections were required for complete protection against moderate-to-severe illness implies that more doses of an attenuated vaccine will be required to achieve efficacy similar to that from exposure to a wild-type strain adapted to the human intestine.
In a cohort of Mexican children, nearly every child had a rotavirus infection by the age of 2 years. Rotavirus vaccination mimics the protection rates of one natural infection. The failure of a primary natural rotavirus infection to protect completely against subsequent infection may indicate the need for multiple vaccinations or for the administration of a polyvalent vaccine that can elicit full protection against all prevalent serotypes. It is encouraging that the degree of protection conferred by asymptomatic infection was similar to that afforded by symptomatic infection. The occurrence of two rotavirus infections, whether symptomatic or asymptomatic, resulted in complete protection against moderate-to-severe illness. This finding implies that an attenuated vaccine that caused asymptomatic infection could induce protective immunity. That two natural infections were required for complete protection against moderate-to-severe illness implies that more doses of an attenuated vaccine will be required to achieve efficacy similar to that from exposure to a wild-type strain adapted to the human intestine.
Deaths also result from treatment. Hypotonic solution given in a large volume can create cerebral oedema. It is important to remember that the range of sodium excretion of rotavirus diarrhoea is around 30 to 60 mL equivalents per liter. Rehydration with fluid less than one-third normal saline causes total body sodium loss. The brain cannot correct fluid imbalance as quickly by moving solute as it can by moving water; patients who have been given too much free water may develop brain oedema and die.
Where is RV found ? Parents cannot prevent their children from getting a rotavirus infection. The primary mode of rotavirus transmission is fecal to oral. Rotavirus is highly communicable and transmissible. Close person-to-person contact and environmental surfaces are common vectors of transmission. It is impossible to keep contaminated fingers and objects from going into children's mouths. Even if a child is not cared for in a daycare setting, he or she is likely to have contact with other children or objects that other children have touched. Rotavirus is an extremely hardy pathogen. The incubation period is 1-3 days and large quantities of virus are shed in stool from just prior to onset of symptoms until about 10 days after onset. Rotavirus is highly transmissible. Under experimental conditions, almost 50% of rotavirus remains viable on contaminated hands for 60 minutes
Where is RV found ? Parents cannot prevent their children from getting a rotavirus infection. The primary mode of rotavirus transmission is fecal to oral. Rotavirus is highly communicable and transmissible. Close person-to-person contact and environmental surfaces are common vectors of transmission. It is impossible to keep contaminated fingers and objects from going into children's mouths. Even if a child is not cared for in a daycare setting, he or she is likely to have contact with other children or objects that other children have touched. Rotavirus is an extremely hardy pathogen. The incubation period is 1-3 days and large quantities of virus are shed in stool from just prior to onset of symptoms until about 10 days after onset. Rotavirus is highly transmissible. Under experimental conditions, almost 50% of rotavirus remains viable on contaminated hands for 60 minutes
RV1, the live-attenuated human rotavirus vaccine, was approved by the FDA in 2008 and contains one strain of live-attenuated human rotavirus, a G1 P[8] strain. RV1 shares neutralizing identity with G1, G3, G4, and G9 through the P[8] VP4 protein. RV1 does not share neutralizing identity with G2 P[4] strains, and a major concern with the RV1 strain is efficacy against G2 P[4] strains. RV5 The RV5 vaccine contains five reassortant viruses developed from human and bovine parent rotavirus strains and shares neutralizing identity with G1, G2, G3, G4, and P[8], the same P serotype as many of the G9 strains observed in the US. Phase 3 trials included more than 70,000 infants in 11 countries.2 The vaccine demonstrated 74% overall efficacy and 98% efficacy for severe rotavirus disease. In a cohort of infants for which data from clinic and ED visits were collected, there was an 86% reduction in the need for a physician visit for diarrhea and a 96% reduction in hospitalization.2 RV5 was effective against all the G serotypes tested
Defination of attenuated vaccine, monovalent, pentavalent
Do the rapid immunoassays detect vaccine-strain virus? Yes, the threshold for detection is on the order of 105 or 106 for the enzyme immunoassay. There is a low rate of shedding with the RV5 vaccine, while the rate of shedding is higher for the RV1 vaccine. Shedding is higher for the monovalent vaccine in part because it is better adapted to the host for replication.
Defination of attenuated vaccine, monovalent, pentavalent
After 1 year of follow up, the efficacy of Rotarix in preventing severe rotavirus gastroenteritis was 61.2% (95% CI, 44–73%) in the combined study populations, 76.9% (95% CI, 56–88%) in South Africa and 49.5% (95% CI, 19–68%) in Malawi Despite its lower efficacy in Malawi, the number of episodes of severe gastroenteritis prevented by vaccination was higher (3.9/100 vaccinees) than in South Africa (2.5/100 vaccinees) because of the higher incidence of severe rotavirus gastroenteritis in young infants in Malawi.
Rotavirus vaccination is effective and is now affecting epidemiology. Most severe infections occur during the first year of life, and it appears as though vaccination is affecting exposure, which means that a person’s age of first exposure might be delayed. A change in the age distribution of severe infection is likely to be seen. The concern when measles vaccination was introduced was that if all children were immunized, the epidemiology of the disease would shift and older children and adults, when infected, would experience more severe disease since they lack previous natural exposure. In fact, there was a temporary shift toward older individuals getting infected, but the overall absolute number of cases declined drastically, and as you know, endemic measles transmission was eliminated in the U.S. in 2000 (despite recent outbreaks related to importations and pockets of undervaccination).
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SLIDE SHOWS REDUCTION OF rv CASES AFTER INTRODUCTION rv VACCINE IN THE usa
Routine immunization occurs in real-world conditions different from ideal clinical trial settings. Thus, monitoring postlicensure impact on rotavirus disease is crucial for ensuring that appropriate gains in terms of expected vaccination benefits are attained. Changes in the epidemiology of rotavirus disease might occur in the postlicensure era, such as shifts in average age at infection, seasonality of disease, and serotype distribution after vaccination or appearance of unusual genetic variants ensuring that protection is conferred through the first and second years of life when most severe disease and mortality from rotavirus occur will be crucial for the success of a rotavirus vaccination program. Finally, assessing whether vaccination has an affect on rotavirus transmission in the community, thus providing benefits to unvaccinated groups, is important. Monitoring impact with focus on these public health considerations will not only allow assessment of the effectiveness of rotavirus vaccines in routine use, but also generate the necessary evidence to inform public health policy decision-making and continued investment in rotavirus vaccines.
Herd immunity is when a vaccine protects even subjects not vaccinated This study confirms on a national scale that the 2008 rotavirus season among children aged <5 years was dramatically reduced compared to pre-RV5 seasons. … Based on the observed decrease during the 2008 season, we estimated that ~55,000 acute gastroenteritis hospitalizations were prevented during the 2008 rotavirus season in the United States. A decrease of this magnitude would translate into the elimination of 1 in every 20 hospitalizations among US children aged <5 years. Interestingly, the reduction in gastroenteritis wasn’t only in vaccinated children: In 2008, acute gastroenteritis hospitalization rates decreased for all children aged <5 years, including those who were either too young or too old to be eligible for RV5 vaccination . …These findings … raise the possibility that vaccination of a proportion of the population could be conferring indirect benefits (ie, herd immunity) to nonvaccinated individuals through reduced viral transmission in the community
In December 2008, GACVS reviewed safety data from phase III efficacy studies of Rotarix and RotaTeq, as well as postmarketing safety data from Australia, Latin America and the United States. GACVS concluded that these vaccines are safe and that a risk of intussusception of the order associated with the previously marketed, but now withdrawn, tetravalent reassortant rotavirus vaccine (RotaShield, Wyeth Lederle, Philadelphia, PA, USA) can be ruled out with confidence. In June 2009, GACVS stated that no data directly support a hypothesis that administration of rotavirus vaccine even outside of the age range 6–15 weeks for the first dose and 32 weeks for the second dose is associated with an increased risk of intussusception..
In various settings, rotavirus vaccines have been found not to interfere significantly with the immunogenicity or safety of OPV or other childhood vaccines. OPV, however, appears to have an inhibitory effect on the immune response to the first dose of rotavirus vaccine, although this interference does not persist after administration of subsequent doses.