Measles is an acute infection and highly communicable viral disease of childhood. The virus is mixo-virus group. The clinical feature is characterized by prodromal catarrhal symptoms; fever, koplik’s spots on the buccal mucosa and typical dusky-red blotchy rash.
The typical maculo-papular rash develops first at the back of the ears and at the junction of the forehead and hairline and then whole of the face; within a few hours the rash spreads rapidly to involve the skin of the rest of the body. At first the rash is discrete but later it may become confluent and patchy especially in the face and neck.
Epidemiological Determinants:
Occurrence: It is endemic in most part of the world. The disease is universal.
Agent: It is caused by an RNA para-myxovirus. It is only one serotype. The virus cannot live outside the human body for any length of time.
Source of infection: The only source of infection is a case of measles carrier is not known to occur.
Infective Material: Secretions of nose, throat and respiratory tract of a case of measles during the prodromal period and the early stages rash.
Communicability: It is highly infectious during the prodromal period and at the time of eruption. Communicability declines rapidly after the appearance of the rash. The period of communicability is approximately 4 days before and 5 days after the appearance of the rash.
Host factor: Attacks everyone in infancy or childhood. In developing country the environmental condition is poor so 6 months to 3 years of children are more susceptible. Now it is declined due to vaccination.
Sex: Incidence is equal in both sexes.
Immunity: No age group is immune if there was no previous immunity. One attack of measles generally confers lifelong immunity. Second attack is rare. Infants are protected by maternal antibodies up to 9 months of age.
Nutrition: Measles tends to be very severe in the undernourished child. Mortality is very high in undernourished child then the well nourished child.
Environmental factor: It may occur in any season. Epidemic of measles is in winter season and early spring in our country (January & April). It is common in less socio-economic condition.
Transmission: It occurs directly from person to person mainly by droplet infection from 4 days before onset of rash until 5 days there thereafter. The portal of entry is the respiratory tract.
Incubation period: 10-14 days.
Clinical features: There are three stages in the natural history of measles. These are:
(1) Prodromal or Pre-eruptive stage:
o Begins 10 days after infection.
o Lasts until 14th day.
o Characterized by fever, coryza with sneezing with nasal discharge, cough redness of eyes, lacrimation and often photophobia.
o Vomiting and diarrhoea may be present.
o A day or two before the appearance of the rash, Kaplik’s spots appear on the buccal mucosa opposite the first and second upper molars. They are small, bluish-white spots on a red base, smaller than the head of a pin.
(2) Eruptive stage
o This stage is characterized by a typical, dusky-red, macular or maculo-papular rash which begins behind the ears and spreads rapidly in a few hours over the face and neck and extends down the body taking 2 to 3 days to progress to the lower extremities.
(3) Post-measles stage
o The child will remain weak for a few days and lose weight to a great extent.
o The child will become susceptible to suffer from other viral or bacterial infection.
o There may be growth retardation, diarrhoea, cancrum oris, pyogenic infections, candidosis, reactivation of pulmonary tuberculosis etc.
Prevention:
By vaccination. (EPI)
Complications: Complications with measles are relatively common. Some complications are:
Relatively mild and less serious diarrhea
Pneumonia
Encephalitis (sub-acute sclerosing panencephalitis)
Corneal ulceration leading to corneal scarring.
Complications are usually more severe amongst adults who catch the virus.
The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 %.
Vaccination can prevent this disease. So immunize your child against this as per schedule.
Friday, August 15, 2008
Sunday, August 10, 2008
Tetanus: Are you Immunized?
Tetanus is an acute disease caused by exo-toxin produced Clostridium tetani. It is characterized by painful muscular rigidity which persists throughout illness. The painful spasms of the muscles specially the Masseters resulting in Trismus or lock-jaw; muscle of the face resulting Risus Sardonicus; muscle of neck, back, abdomen and lower limbs resulting Opisthotomus. Case fatality rate is quite high; varying from 30 to 90%.
Agent Factors:
Agent Clostridium Tetani is a Gram-positive anaerobic, spore-bearing organism. The spores are terminal and give the organism a drum-stick appearance. The spores are highly resistant to a number of injurious agents; including boiling, phenol, cresol etc. It is destroyed by autoclaving for 20 minutes at 120°C & by irradiation. They germinate under anaerobic conditions & produce a potent exotoxin. It is one of the important causes of infant mortality. It produces potent neurotoxin which acts on nervous system. The spores remain viable for months in warm moist soil.
Period of communicability:
Not transmitted from person to person.
Reservoir of infection:
The natural habitat is many herbivorous animals e.g. cattle, sheep, horses, goats etc. They excrete it through their feces. The spores can survive for years in nature. The spores are blown through air with dust.
Host Factors:
The disease affects all ages and both sexes equally. The tetanus occurring in the new-born is known as “Tetanus Neonatum”.
The neonate typically contact with the disease at birth; because most of the delivery occurs or taken place in non-specific conditions i.e. unclean/ unsterilized space, untrained TBA, and specially when the umbilical cord is cut with unsterilized instruments or when the umbilical cord is stumped or dressed with ashes, soil or cow dung.
Sex:
Both sexes are affected. The males are more affected then the female. The males are more exposed to their occupation. Tetanus is common among agricultural workers, in neonate and in female during puerperal tetanus.
Immunity:
No age group is immune if not immunized by vaccination or immunoglobulin. The immunity resulting from two doses of injections of Tetanus Toxoid is highly effective and lasts for several years. After recovery from tetanus, one should be actively immunized, because the amount of toxin that causes Tetanus is not enough to stimulate protective immunity in side the human body. This is a disease in which Herd Immunity does not protect the individual.
Environmental and Social Factor:
It is one of the environmental hazards. Its occurrence depends upon human’s physical & ecological surroundings; the soil, agriculture, animal and not on the presence or absence of infection in the population. Environmental factors are accompanied by social factor; such as unhygienic customs and habits, application of cow dung in wounds; unhygienic delivery practices; using of unsterilized instruments for cutting of umbilical cord. Ignorance is one of the most important causes in case of infection and lack of Primary Health Care services.
In UK, USA and Germany the incidence is reduced.
Mode of Transmission:
Infection is acquired by contamination of wounds with tetanus spores. The range of injuries and accidents which may lead to tetanus comprises a trivial pin prick, skin abrasion, puncture wounds, burns, human bite, animal bite, unsterile surgery, intrauterine death, bowel surgery, dental extracting, injections, unsterile division of umbilical cord, compound fracture, otitis media, chronic skin ulcers, eye infections, gangrenous limbs etc.
Incubation Period:
The incubation period is usually 6 to 10 days. It may be short like one day or as long as several months.
Types of Tetanus:
(1) Traumatic
(2) Puerperal
(3) Otogenic
(4) Idiopathic
(5) Tetanus Neonatum
Prevention:
(1) Active immunization in EPI: Scheduled administration of Tetanus Toxoid. All persons should be immunized regardless of age.
(2) Passive Immunization: By Anti-tetanus Serum (ATS)
Prevention of Tetanus after injury:
All wounds must be thoroughly cleaned soon after injury, removal of foreign body, soil, dust, necrotic tissue. In this way anaerobic condition is abolished.
ATS is given in divided doses.
Agent Factors:
Agent Clostridium Tetani is a Gram-positive anaerobic, spore-bearing organism. The spores are terminal and give the organism a drum-stick appearance. The spores are highly resistant to a number of injurious agents; including boiling, phenol, cresol etc. It is destroyed by autoclaving for 20 minutes at 120°C & by irradiation. They germinate under anaerobic conditions & produce a potent exotoxin. It is one of the important causes of infant mortality. It produces potent neurotoxin which acts on nervous system. The spores remain viable for months in warm moist soil.
Period of communicability:
Not transmitted from person to person.
Reservoir of infection:
The natural habitat is many herbivorous animals e.g. cattle, sheep, horses, goats etc. They excrete it through their feces. The spores can survive for years in nature. The spores are blown through air with dust.
Host Factors:
The disease affects all ages and both sexes equally. The tetanus occurring in the new-born is known as “Tetanus Neonatum”.
The neonate typically contact with the disease at birth; because most of the delivery occurs or taken place in non-specific conditions i.e. unclean/ unsterilized space, untrained TBA, and specially when the umbilical cord is cut with unsterilized instruments or when the umbilical cord is stumped or dressed with ashes, soil or cow dung.
Sex:
Both sexes are affected. The males are more affected then the female. The males are more exposed to their occupation. Tetanus is common among agricultural workers, in neonate and in female during puerperal tetanus.
Immunity:
No age group is immune if not immunized by vaccination or immunoglobulin. The immunity resulting from two doses of injections of Tetanus Toxoid is highly effective and lasts for several years. After recovery from tetanus, one should be actively immunized, because the amount of toxin that causes Tetanus is not enough to stimulate protective immunity in side the human body. This is a disease in which Herd Immunity does not protect the individual.
Environmental and Social Factor:
It is one of the environmental hazards. Its occurrence depends upon human’s physical & ecological surroundings; the soil, agriculture, animal and not on the presence or absence of infection in the population. Environmental factors are accompanied by social factor; such as unhygienic customs and habits, application of cow dung in wounds; unhygienic delivery practices; using of unsterilized instruments for cutting of umbilical cord. Ignorance is one of the most important causes in case of infection and lack of Primary Health Care services.
In UK, USA and Germany the incidence is reduced.
Mode of Transmission:
Infection is acquired by contamination of wounds with tetanus spores. The range of injuries and accidents which may lead to tetanus comprises a trivial pin prick, skin abrasion, puncture wounds, burns, human bite, animal bite, unsterile surgery, intrauterine death, bowel surgery, dental extracting, injections, unsterile division of umbilical cord, compound fracture, otitis media, chronic skin ulcers, eye infections, gangrenous limbs etc.
Incubation Period:
The incubation period is usually 6 to 10 days. It may be short like one day or as long as several months.
Types of Tetanus:
(1) Traumatic
(2) Puerperal
(3) Otogenic
(4) Idiopathic
(5) Tetanus Neonatum
Prevention:
(1) Active immunization in EPI: Scheduled administration of Tetanus Toxoid. All persons should be immunized regardless of age.
(2) Passive Immunization: By Anti-tetanus Serum (ATS)
Prevention of Tetanus after injury:
All wounds must be thoroughly cleaned soon after injury, removal of foreign body, soil, dust, necrotic tissue. In this way anaerobic condition is abolished.
ATS is given in divided doses.
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