Vaccine preventable diseases for babies after birth
Learning Objectives At the end of the unit, you should be able to:
●List diseases that are preventable by immunization under the Universal Immunization Programme (UIP).
●Describe their mode of spread and how they can be recognized and prevented.
Contents
●Diseases prevented by Immunization under UIP Programme.
●】Their mode of spread and how they can be recognized and prevented.
The following are the targeted vaccine preventable diseases under Universal Immunization Program:
1. Tuberculosis
2. Hepatitis B
3. Polio
4. Diphtheria
5. Pertussis
6. Tetanus
7. Haemophilus Influenzae Type B related
diseases (bacterial meningitis, pneumonia and others)
8. Pneumococcal disease
9. Diarrhoeas due to rotavirus
10. Measles
11. Rubella
12. Japanese Encephalitis
1. Tuberculosis (vaccine)
Tuberculosis (TB) is caused by the bacterium (Mycobacterium tuberculosis).
It usually attacks the lungs but can also affect other parts of the body including the bones, joints and brain.
TB can cause serious illness and death.
a) How to recognize the disease?
A child with fever and / or cough for more than 2 weeks, with loss of weight / no weight gain; AND History of contact with a suspected or diagnosed case of active TB disease within the last 2 years.
b) How is it spread?
TB is spread from one person to another through the air, often when an infected person coughs or sneezes. TB spreads rapidly, especially in areas where people are living in crowded conditions, have poor access to health care and/or are malnourished.
A person can contract bovine tuberculosis, another variety of TB by consuming raw milk from infected cattle.
c) How is the disease prevented?
Vaccination with Bacillus Calmette-Guerin (BCG) as per the schedule will prevent serious forms of childhood tuberculosis.
2. Hepatitis B (vaccine)
Hepatitis B is caused by a virus that affects the liver. Infants who get infected during birth or before one year of age, 90% develop chronic disease.
It is a highly infectious disase (50-100 times more infectious than HIV) and is the leading cause of jaundice, cirrhosis or liver cancer.
a) How to recognize the disease?
An acute illness typically including acute jaundice, dark urine, anorexia, malaise, extreme fatigue and right upper quadrant tenderness.
b) How is it spread?
The disease spreads through contact with infected blood or other body fluids in various situations:
a) from mother to child during birth;
b) during social interaction between children with cuts, scrapes, bites and/or scratches;
c) from person to person during sexual intercourse; and
d) through unsafe injections and/or transfusions, or needle stick accidents with infected blood.
c) How is the disease prevented?
By vaccinating children with HepB vaccine as per the Immunization schedule (contained in Pentavalent vaccine), we can prevent infection and its complications.
3. Poliomyelitis (vaccine)
Poliomyelitis, or polio, is a highly infectious disease caused by poloivirus types 1, 2 or 3. It mainly affects children of less than five years of age.
One in 200 infections causes irreversible paralysis when the virus attacks the spinal cord nerve cells that control the muscles.
India continues to be polio free since 2011. It is important that all polio vaccinations and immunization campaigns continue until the world is polio free.
a) How to recognize the disease?
Sudden onset of weakness and floppiness in any part of the body in a child less than 15 yrs of age or paralysis in a person of any age in whom polio is suspected.
b) How is it spread?
Polio is transmitted by the faecal-to-oral route. In areas with poor sanitation, it enters the body through the mouth when people eat food or drink water that is contaminated with faeces.
c) How is the disease prevented?
Vaccination with the oral polio vaccine (OPV) and inactivated polio vaccine (IPV) administered as per the immunization schedule will effectively prevent infection.
d) Why AFP should still be reported?
As the world is not yet polio free, it is important that all AFP cases be reported even though India is polio free. Surveillance for polio must continue to ensure that we will be able to detect cases if they occour.
4. Diphtheria (vaccine)
Diphtheria is caused by the bacterium (Corynebacterium diphtheriae). Diphtheria is an infectious disease that commonly affects the throat and the tonsils, forming a membrane that can lead to obstructed breathing and death.
a) How to recognize the disease?
An illness of the upper respiratory tract characterized by the following: laryngitis or pharyngitis or tonsillitis, AND adherent membranes of tonsils, pharynx and/or nose.
b) How is it spread?
The bacteria causing diphtheria inhabit the mouth, nose and throat of an infected person. It spreads from person to person by coughing and sneezing.
c) How is the disease prevented?
Giving DPT (contained in Pentavalent vaccine) and DPT boosters as per the immunization schedule is the most effective method of prevention.
5. Pertussis (whooping cough) (vaccine)
Pertussis or whooping cough, is a disease of the respiratory tract caused by Bordetella pertussis bacteria that live in mouth, nose and throat.
It is highly communicable disease characterized by repeated cough that may lead to pneumonia and other complications leading to death especially in infants and young children.
a) How to recognize the disease? A person with a cough lasting at least two weeks with at least one of the following:
a) paroxysms (i.e. fits) of coughing;
b) inspiratory whooping;
c) post-tussive vomiting (i.e. vomiting immediately after coughing);
d) without other apparent causes.
b) How is it spread? Pertussis spreads very easily from person to person in droplets produced by coughing or sneezing.
c) How is the disease prevented?
Giving DPT (contained in Pentavalent vaccine) and DPT boosters as per the immunization schedule will prevent pertussis.
6. Tetanus
Tetanus is caused by the bacterium Clostridium tetani, which is present in soil everywhere. Infection with this bacterium occurs when soil enters a wound or cut.
A toxin released by the bacterium causes severe, painful muscle spasms that can lead to death. Neonatal tetanus (in newborns) and maternal tetanus (in mothers) is a serious problem in areas where home deliveries conducted without sterile procedures are common.
a) How to recognize the disease?
Neonatal Tetanus: Any neonate with a normal ability to suck and cry during the first 2 days of life, and who thereafter cannot suck normally between 3 and 28 days of age and becomes stiff or has convulsions/spasms (jerking of the muscles), or both.
b) How is it spread?
Tetanus is not transmitted from person to person. In people of all ages, the bacterium can enter a wound or cut from items such as dirty nails, knives, tools, wood splinters, dirty tools used during childbirth, or deep puncture wounds from animal bites.
In newborn babies, infection can occur when delivery occurs on dirty mats or floors, a dirty tool is used to cut the umbilical cord, dirty material is used to dress the cord or when the hands of the person delivering the baby are not clean.
c) How is the disease prevented?
Vaccinating pregnant women with TT during pregnancy with the primary doses and booster doses wehre needed, prevents Matenal and Neonatal Tetanus.
All children must also receive TT/DPT (contained in Pentavalent Vaccine / DPT boosters) as per the immunization schedule to prevent tetanus in other age groups.
7. Haemophilus influenzae type b disease (vaccine)
Haemophilus influenzae is a bacterium found commonly in the nose and throat of children. There are six types of Haemophilus influenzae.
Out of these six types, Haemophilus influenzae type b, or Hib, causes 90% of all serious Haemophilus influenzae infections. Hib can lead to severe pneumonia and meningitis in children aged less than 5 years.
a) How to recognize the disease?
Clinical signs and symptoms of pneumonia include fever, chills, cough, rapid breathing and chest wall retractions. Children with meningitis can have fever, headache, sensitivity to light, neck stiff ness and sometimes confusion or altered consciousness.
b) How is it spread?
The disease spreads from person to person in droplets released when sneezing and coughing. Healthy children carrying the virus in their noses and throats can also infect others.
c) How is the disease prevented?
By vaccinating children with Hib vaccine (contained in Pentavalent vaccine) as per the Immunization schedule, we can prevent Hib infection and its complications.
8. Rotavirus gastroenteritis
Rotavirus gastroenteritis is a highly infectious diarrhoeal disease caused by rotavirus infecting the small intestines. It causes severe diarrhoea in infants and young children. Infants between three and 12 months of age may die due to severe dehydration.
a) How to recognize the disease?
Clinical symptoms and signs range from mild loose stools to severe watery diarrhoea and vomiting leading to dehydration.
b) How is it spread?
The disease spreads by the faecal-to-oral route. It is stable in the environment and can spread via contaminated food, water and objects.
c) How is the disease prevented?
By vaccinating children with rotavirus vaccine as per the Immunization schedule, we can prevent infection and its complications. Remember to give ORS during any diarrhoea.
9. Pneumococcal disease (vaccine)
a) What is pneumococcal disease?
Pneumococcal disease is a group of diseases caused by a bacterium Streptococcus pneumoniae (also known as pneumococcus).
The most serious of these diseases are pneumonia, meningitis, and blood stream infections.
Streptococcus pneumoniae is the leading cause of bacterial pneumonia in children under 5 years of age.
b) What diseases does pneumococcus cause?
Diseases that are often caused by pneumococci include:
●Pneumonia
●Bacteraemia, sepsis: bloodstream infection,
●Bacterial meningitis: infection of the membranes and fluid that covers and protects the spinal cord and brain
●Middle ear infection (otitis media)
●Sinusitis, Bronchitis
c) How is pneumococcal disease spread?
Pneumococcus spreads from person to person (coughing, sneezing or close contact).
Many people have pneumococcus in their nasopharynx for days or weeks at a time.
In most cases the pneumococcus disappears from the nasopharynx without causing any symptoms, but sometimes disease develops.
d) Who is at increased risk of pneumococcal disease?
●Young children and elderly individuals are most at risk.
● The children most at risk of pneumococcal disease are:
● Children under 5 years of age, especially those under 2 years of age z Immunocompromised children
●Those with influenza or other respiratory virus infections can get a second infection with pneumococcus.
●Malnutrition, lack of breastfeeding, exposure to indoor smoke and crowded living conditions.
●Poor and marginalized populations with poor access to health care.
e) How is the disease prevented?
These diseases can be prevented by administering PCV in three doses – 2 primary doses and at 6 & 14 weeks and 1 booster dose at 9 months of age along with MR first dose.
10. Measles/Rubella
Measles is a highly infectious disease caused by a virus. It is an important cause of death among children who are poorly nourished and live in crowded conditions.
Complications include dehydration due to severe diarrhoea, malnutrition, inflammation of middle ear, pneumonia, blindness and encephalitis (brain infection).
Rubella is generally a mild disease in children but when infection occurs in early pregnancy, it has the potential to cause spontaneous abortions, fetal deaths, still births and serious congenital defects (congenital rubella syndrome – CRS) in the child causing lifelong disabilities.
a) How to recognize the disease?
Any person with fever and maculopapular rash, i.e. non-vesicular AND cough, coryza (runny nose), or conjunctivitis (red eyes)
b) How is it spread?
The virus is spread through nose and throat secretions of infected people and in airborne droplets released when an infected person sneezes or coughs.
c) How is the disease prevented?
The Measles/Rubella containing vaccine (MR) is effective in preventing measles and should be given according to the immunization schedule.
11. Japanese Encephalitis (vaccine)
Japanese encephalitis (JE) is an infection of the brain caused by a virus. It is prevalent in certain geographical areas in some of the states.
JE is fatal in 20-30% of cases, with young children (less than 10 years) having a greater risk of severe disease and death.
a) How to recognize the disease?
A person of any age, at any time of the year with acute onset of fever and change in mental status (including symptoms as confusion, disorientation, coma or inability to talk) AND/OR new onset of seizures (excluding simple febrile seizures).
b) How is it spread?
JE virus is spread by mosquitoes. The virus normally infects birds and domestic animals, especially pigs, which serve as its reservoirs. Humans may contract the disease when a mosquito that has bitten an infected animal then bites a person.
c) How is the disease prevented?
Following the campaigns targeting all children in the age group of 1-15 years in the high risk districts, the vaccine is integrated into the UIP of the district. Children between 9 months – 2 years are targeted for two doses of JE.