Vaccinations and childhood infections

Question 1

Answer 1

varicella zoster virus (VZV)

Incubation: 1 to 3 weeks from the time you were exposed to chickenpox for the spots to start appearing.

Tx: aciclovir who presents within 24 hours of rash onset (immunocompromised px only)

Infectious period: from 2 days before the spots appear to until they’ve crusted over, usually 5 days after they first appeared

Question 2

Notifiable disease

Answer 2

Organism: Rubella virus

Incubation period: 2-3 weeks

Typically a red-pink colour rash. It consists of a number of small spots, which may be slightly itchy.

The rash usually starts behind the ears before spreading around the head and neck. It may then spread to the chest and tummy (the trunk), and legs and arms. In most cases the rash disappears by itself within three to five days.

Enlarged lymph nodes: ears, occiput, neck. In some cases this swelling can be painful.

As well as a rash and swollen lymph glands, people with rubella may also develop other symptoms, including:

a high temperature (fever) – it is usually mild.

cold-like symptoms

slightly sore and red eyes (conjunctivitis)

aching and painful joints

loss of appetite

tiredness

Mx: Advise the person (or their carer) that rubella is usually a mild, self-limiting condition. The rash and fever will typically resolve within 5 days, although swollen lymph glands may take a week or more to improve. Keep the child away from school for four days after the rash appears.

Tx: Rest, drink adequate fluids, and take paracetamol or ibuprofen for symptomatic relief

Question 3

Answer 3

Haemophilus influenzae

Rare due to Hib vaccine

Presentation: young children, signs of sepsis and inability to swallow or talk.

Refer as examination of throat can precipitate complete airway obstruction

Question 4

Rotavirus

Answer 4

Rotavirus is the most common cause of diarrhoeal disease among infants and young children.

Transmission: the faecal-oral route.

infect enterocytes of the villi of the small intestine, leading to structural and functional changes of the epithelium.

Question 5

Human papilloma virus

A group of viruses that affect skin and mucous membranes.

Regions include include:

cervix

anus

mouth and throat

Answer 5

What can HPV infection do?

genital warts – which is the second most common STI in England.

abnormal tissue growth and other changes to cells within your cervix

Girls aged 12-13 are offered a vaccination against HPV to help protect them against types of HPV that can cause cervical cancer.

Other types of HPV infection ; skin warts and verrucas.

Question 6

MMR

Answer 6

Measles, mumps, and rubella — MMR (MMRVaxPRO® or Priorix®).

Two vaccinations

• at 12 months
• at 3 years and four months

Question 7

The 6-in-1 vaccine

given at 8, 12 and 16 weeks old.

Answer 7

Question 8

Which vaccinations are given at 8 weeks?

Answer 8

Question 9

Which vaccinations are given at 12 weeks?

Answer 9

Question 10

Which vaccinations are given at 16 weeks?

Answer 10

Question 11

Which vaccinations are given at one year?

Answer 11

Question 12

Which vaccinations are given at 3 years and four months?

Answer 12

Question 13

Whooping cough (pertussis)

Three phases of symptoms

• Catarrhal phase; one week. Dry unproductive cough.
• Paroxysmal phase; can last a month or more; coughing fits, whooping, post-tussive vomiting.
• Convalescent phase - 2 months, gradual improvement.

Answer 13

bacterium: Bordetella pertussis

Spread by droplets during coughing.

Incubation: 7 days

Infectious period 3 weeks after the onset of symptoms.

Notifiable disease

tx: macrolide; erythromycin or clarithromycin

Question 14

What is the causative agent for croup?

Answer 14

parainfluenza viruses (HPIVs) -80% of cases

can also be RSV, adenoviruses, rhinoviruses, enterviruses, measles

laryngotracheobronchitis (croup), which is a viral disease of the upper airway and is mainly problematic in children aged 6 months to 3 years of age.

Question 15

Facts about croup

Answer 15

• upper airway infection , 80% cases parainfluenza virus. Other viruses included RSV.
• affects children 6 months to 3 years.
• prevalent in autumn and spring.

Question 16

Symptoms and management of croup

Answer 16

• Starts with coryzal symptoms, then proceeds to stridor, barking cough, classically worse at night.
• child usually has a hoarse cry.
• usually self-limiting but can be severe. Keep child calm; crying increases oxygen demands.
• Severe: >> respiratory work, cyanosis, drowsiness

tx: control symptoms; paracetomal, NSAIDs

Hospital: oxygen (>94% sats) , systemic dexamethasone and nebulised budesonide (since viral infection)

Lasts typically 3-7 days

Question 17

Facts about acute epiglottis

Answer 17

causative organism: haemophilus influenzae

rare now due to Hib vaccine.

Signs of sepsis, and an inability to swallow or talk.

Mx: transfer immediately for intubation if suspected.

Question 18

What is human Respiratory Syncytial Virus (RSV) ?

Answer 18

a syncytial virus that causes respiratory tract infections. (pneumonia)

It is a major cause of lower respiratory tract infections and hospital visits during infancy and childhood

NB> syncytium is a multinucleated cell that can result from multiple cell fusions of uninuclear cells

Question 19

Facts: acute otitis media

Answer 19

• streptococcus pneumoniae, haemophilus influenzae and viruses
• Symptoms; fever, deafness, pain in the ear.
• Examination; red, inflammed bulging tympanic membrane with loss of light reflex.
  *

Question 20

Measles

Answer 20

Incubation period; 10-12 days and infectivity last from four days before, until four days after the rash appears.

coryza, maculopapular rash, fever, cough, conjunctivitis

Koplik’s spots are pathognomonic (They occur in 60-70% of patients during the prodrome and for up to 2-3 days after the rash disappears)

Complications; include otitis media, gastroenteritis, bacterial pneumonia, bronchitis.

Question 21

Bronchiolitis

• acute lower respiratory tract.

Occurs in very young, most commonly infants between 2 and 6 months old.

Common cause of acute respiratory failure

MCQ late sequalae: possible asthma (although not understood why)

Answer 21

Respiratory syncytial virus (RSV) usually.

>> production of mucus + cell debris + oedema

= narrowing and obstruction of small airways.

Begins as an upper respiratory tract infection (URTI) that evolves with signs of respiratory distress, cough, wheeze, air trapping and bilateral crepitations

NB. widespread fine inspiratory crackles are a key finding

Mx: usually mild, self-limiting. Refer if: poor feeding, respiratory problems

Question 22

What’s this?

Answer 22

Nematode infection - enterobius vermicularis

Female is larger and may be seen at night emerging from the anus to lay eggs.

The eggs are accompanied by an irritant mucus,; intense pruritus and scratching. Cycle: eggs(anus) - hands - mouth - re-infect.

The presenting feature is often pruritus ani or pruritus vulvae, especially at night.

Tx: hygiene, or Mebendazole (single oral dose)