Some Common Infectious diseases in pediatric from public health perspective

Evidence Based MethodologyPrepared byMubarak M.

Medical DoctorMaster of Public Health (epidemiology- Griffith University, Australia)

Bachelor of Medical sciences (Griffith University, Australia)

Mubarak ALOsimi, M.D. 1

This presentation considers ……………..• Starts in broad concept then becomes more specific.• Looks briefly at historical sequence of infectious diseases.• Focuses on KSA mainly.• Highlights local health Stat on infectious diseases in pediatrics.• Aims mainly to attract attention to updates with regard infectious

diseases in pediatrics.• Employs evidence based data collection methodology.

Mubarak ALOsimi, M.D. 2

Evidence search methodology used in this project…………..

Methods: This review was conducted using the databases pubmed, Medline and Cochrane from January 2010 to May 2015. keywords

“pediatric, infections, management, control, HCAI and updates.

Mubarak ALOsimi, M.D. 3

The History of Pediatric Infectious Diseases• Major causes of childhood morbidity and mortality in Pediatrics.• In 19th and early 20th Centuries, diphtheria, infant diarrheal illnesses, tuberculosis, streptococcal

infections and their complications.• Most serious infection among kids, draw up scientific attention and resulted in golden era of

preventive vaccines From 1903 to 1916 then 2nd golden era between 1932-1940 then ABX era 1941 -1951 then vaccine innovation 1955-1967.

• Remaining challenges: most notably HIV infection, tuberculosis and falciparum malaria and Opportunistic infectious diseases that affect immunocompromised children.

• In the genomic era of medicine and the tools of molecular biology with DNA microarray analysis and new proteonomics, there new insights into pathogenesis, diagnosis, and treatment of infections.

Shulman ST. The History of Pediatric Infectious Diseases. Pediatric Research (2004) 55, 163–176

https://books.google.com.sa/books?id=9V6FbkkltrcC&pg=PA149&lpg=PA149&dq=golden+era+of+preventive+vaccines&source=bl&ots=dt5wjxfRMf&sig=PbJ-l3eV6lMjl80fHDTO3lbOU1A&hl=en&sa=X&ei=Ay9aVZurLYmyUdeegbAJ&ved=0CDwQ6AEwBA#v=onepage&q=golden%20era%20of%20preventive%20vaccines&f=false

Mubarak ALOsimi, M.D. 4

Common Pediatric Infectious Diseases in Saudi Arabia(1): by causative agents:

Rotavirus

(Reovirida)

Enteric Adenovirus (Adenovirid)

Astrovirus (Astrovirida)

Calicivirus()

RNA, Groups A,B,C has 2 subgroups multiple serotypes Classified on the basis of two outer capsid proteins.

DNA, Enteric serotypes 40, 41, 31, and types 42-48

RNA,8 serotypes,

RNA, Two genogroups:Norwalk-lik

viruses and, Sapporo-like viruses

Clinical pattern: all viruses coz gastroenteritis thro. person to person and contaminated water or food. Characterized by severe watery diarrhea leading to isotonic dehydration in infants and young children (decreased intestinal absorption of sodium, glucose, and water, and decreased levels of intestinal lactase, alkaline phosphatase, and

sucrase activity, and may lead to isotonic diarrhea )and accompanied in some cases with nausea, vomiting, abdominal cramps, headache and fever. Usually, 1st occasion is worst once.Communicability : 2 days before to 10 days after onset of symptoms.Incubatory : hours to 2 days. Risk of epidemic outbreaks of waterborne diarrheal disease among kids.ELISA or latex agglutination available now to detect antibodies. rapid detection of antigen.Serous complication: Dehydration ; Electrolyte imbalance; Metabolic acidosis.

• Tayeb HT. Molecular epidemiology of human astrovirus infections in Saudi Arabia pediatric patients. J Med Virol. 2010 Dec;82(12):2038-42

• Tayeb HT, The Etiology of Viral Diarrhea in Children. http://esciencecentral.org/ebooks/pediatric-infectious-diseases/pdf/etiology-of-viral-diarrhea-in-children.pdf

• CDC, 2014 REviews

Mubarak ALOsimi, M.D. 5

Common Pediatric Infectious Diseases in Saudi Arabia(2):by causative agents:

Respiratory

syncytial virus

Adenoviruses

influenza & Para-

influenza

Cornavirus including MERS and

SARS

RNA Virus, peak at 2-8 months

DNA virus, 52 serotypes predominantly 1, 2, 5, and 6; occasionally, 3 and 7.

RNA, typeA, B and C (hemagglutinin and the

neuraminidase), Eg H1N1or H5N1

RNA, alpha, beta, gamma, and delta. Human 229E, NL63, OC43, and HKU1

pluse SARS &MERS

Clinical pattern: all these viruses coz reparatory infections thro droplet or person to person contact (adeno); droplet/ close contac (RSV & C-OV); and contaminated water or food. Characterized by lower respiratory tract infections and accompanied in some cases with low-grade fever, Cough, Tachypnea, Coryza, Cyanosis, Retractions Wheezing & Rales. OM & dehydration may exist.Adno. protean{( Acute Resp., pharyngoconjunctival fever, keratoconjunctivitis or GE.

Communicability : 2 days to 7 days Incubatory : 2-5days (C-ov). Risk of multiorgan dysfunction : Respiratory failure and renal failure as in MERS with 30% fatality rate.PCR & Serology to detect antibodies. Also, rapid detection of antigen & culture.

Mubarak ALOsimi, M.D. 6

Common Health Care Associated infections in Saudi Arabia:by causative agents:

MRSA, Acinobacter, E. Faecalis

E.coli, Klebsiella, Enterococcus

Klebseilla, Enterobacter, Ecoli,

Acinetobacter , P.aeruginosa , GBS, Staph, C. albicans

At Invasive procedures via blood stream eg central

Line

Catheter-associated urinary tract infections

Healthcare Associated Infection in the NICU eg Ventilators(pneumonia)

Risk factors: Catheter hub or exit-site colonization or inserted in 1st wk of life; ELBW; >7 days.•candidemia in neonates: 5-minute Apgar scores< 5; H2 blocker; Intubation ; stay longer than 7 days; prematurity.•Pneumonia in pediatric:Reintubation; Genetic syndromes; Prior BSI; Immunodeficiency.•hospital-acquired UTI in pediatric: catheterization; Prior antibiotic; CP.The infection by the instrumentation:• Endotracheal tube: Sinusitis, tracheitis, pneumonia •Intravascular catheter: Phlebitis, line infection •Foley catheter: UTI PTwith pneumonia may have :Fever, cough, purulent sputum Abnormal chest auscultatory findings (eg, decreased breath sounds, crackles, wheezes) PT with UTI may have Fever or normal temperature Tenderness, suprapubic (cystitis) or costovertebral (pyelonephritis) Cloudy, foul-smelling urine Communicability : immanent, any time if no precaution.Incubatory : few hours- 1 day. Mubarak ALOsimi, M.D. 7

Vaccine Preventable infectious Diseases, statistics 2013

Neonatal Tetanus 0.03 per 1,000 live births)

Rubella (0.22 per 100,000

population)

Mumps (0.12 per 100,000 population)

Chickenpox (36.43 per 100,000

population)

C.Tetani, 4 to 14 days after birth, fatality rate 70%

RNA Virus,IP: 16-18days, C : 8x8 , droplets,

RNA Virus,IP: 16-18days, C : 2x5 , droplets,

VZV, DNA Virus, IP 1-3wks, IP: 14-16 C 2x5 , droplets and direct contact(resp

then macules then papules then pustule) Reye syndrome,

Hints: No cases of Whooping Cough, Diphtheria or Poliomylitis reported in this yr. immunization coverage DPT, HBV3 and OPV is 97.7%, while is 97.9% in year 2013.(Herd immunity)

Very few Meningitis by Meningococcal(2), Pneumococcal(3) H. influenzae(3), the rest (293) by others eg S epidermidis & Staph.

Measles (0.92 per 100,000 population)

RNA virus (Morbillivirus), Droplets, IP 10- 2days, (Non specific,K.spots,generlised maculop), Acute encephalitis,OM. C 4X4:Mubarak ALOsimi, M.D. 8

Genetic & immunologic defects predisposition to infections- Not Idiopathic any more……• Neisseria- Invasive disease (immunologic defects ) MAC deficiency & Properdin deficiency

(Gen) C5-9 deficiency.• Mycobacteria (immunologic defects ) IL-12,-23,IFN-γdeficiency (Gen) IFNGR1&2.• Streptococcuspneumoniae (immunologic defects ) IRAK-4 and MyD88 deficiency (Gen)

IRAK4 & MYD88.• EBV X-linked lymphoproliferative disease (immunologic defects ) SAP and XIAP deficiency

(Gen) SAP & XIAP.• HSV-1 Encephalitis (immunologic defects ) Impaired production of antiviral IFNs (Gen)

UNC93B TLR3.

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Classical show (1)…………….

Mubarak ALOsimi, M.D. 10

Classical show (2)…………….crater

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Control and Management (Updates and Evidence) Vaccins and prophlaxis:• Rota Virus (RotaTeq and Rotarix- phase 3 WHO, recommended to minimize

burden of 40% of all diarrhea hospitalizations and deaths in children under 5 Yrs. Intussusception is contaIN.

• Antimonoclonal antibodies “ palivizumab” as prophylaxis for RSV, should be limited to infants <29 weeks or with chronic illness such as congenital heart disease or chronic lung disease. in the first year of life no more than five monthly doses of palivizumab (15 mg/kg per dose) during the RSV season only. Also, for < 24 months if immunocompromised during the RSV season. NB: pneumococcal colonization can enhance subsequent HRSV infection, thus control pneumococcal colonization may prevent HRSV.

• Continuous warn against live vaccine admin. with Pt had Cortisol in ex 1moth or immunodeficient Pt except…….

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Control and Management (Updates and Evidence)- problematic attitude:• Refusal LP, patients’ attitudes LP improved Significantly, through

structural education on indications, benefits, and risks. • If still refusal, antibiotic should provide coverage for the 3 most

common pathogens: S pneumoniae, N meningitidis, and H influenza and administered IV. N meningitidis - 7 days, H influenzae - 7 days, S pneumoniae - 10-14 days, S agalactiae (GBS) - 14-21 days, L monocytogenes - 21 days or longer. However, 5 trials involving children aged 3 weeks to 16 years show No differences between short-course (4-7 days) and long-course (7-14 days) treatment with IV ceftriaxone were demonstrated with respect to end-of-therapy clinical success.

•

Mubarak ALOsimi, M.D. 13

Control and Management (Updates and Evidence)- Antibiotic Practice:Susceptibilities of the most likely pathogen, rather important than

evidence of the superiority of one antibiotic over another.Antibiotic exposure before 6 months of age, or repeatedly during

infancy, was associated with increased body mass and obesity.A new class of antibiotic to fight drug-resistant infections such as

MRSA and TB ….such as Teixobactin , inhibits cell wall synthesis by binding to a highly conserved motif of lipid II (precursor of peptidoglycan) and lipid III (precursor of cell wall teichoic acid).

Mubarak ALOsimi, M.D. 14

Control and Management (Updates and Evidence)- emerging pathogens:• Cov MERS- case study:• A 35-year-old male from Khamis Mushait city developed symptoms on 27 April and was admitted to hospital on 29 April. The patient has

comorbidities. He has no history of direct contact with camels or consumption of raw camel products; however, his house is adjacent to a camel market. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical condition in ICU. Contact tracing of household and healthcare contacts is ongoing for this case.

• WHO advice: Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS CoV infection. Therefore, these people should avoid close contact with animals, particularly ‐camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to.Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

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Control and Management (Updates and Evidence)- HCAI:Hand washing is the single most important; RSV and parainfluenza viruses –

gown and gloves (ie, contact precautions);Mask within 3 feet (ie, droplet precautions) for Influenza virus, group A

streptococcus (for the first 24 hours of treatment), methicillin-susceptible S. aureus, Bordetella pertussis (until patient has received five days of effective therapy), and Mycoplasma pneumoniae.

Adenovirus – contact and droplet precautions.Methicillin-resistant S. aureus and other multidrug resistant organisms – special

organism precautions; contact and droplet precautions and dedicated patient equipment.

Urinary catheters only when justified, if so The choice of anti-infective catheters.

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