LO.2.

Assess, screen and manage common

communicable diseases

• Vaccine-Preventable Bacterial Diseases

1
 Introduction
• Vaccine-preventable diseases are communicable diseases that can
be prevented by immunization with vaccines.

• Vaccines are medical products prepared from whole or parts of

bacteria, virus, or the toxins (poisonous substances) that some bacteria
produce.

• Immunity refers to the ability of an individual to resist a

communicable disease.

• When a dead or weakened microorganism is given in the form of a

vaccine, this process is called vaccination or immunization. 2
 Overview of bacterial vaccine-preventable diseases

• Vaccine-preventable diseases are important causes of death

in children.
• Causes, transmission, symptoms, prevention and control
methods for common bacterial vaccine-preventable diseases.

3
………continued

4
 1.Tetanus
Tetanus is a neurological disorder, that is, a disorder of the
nervous system. Symptoms of tetanus are tight muscles that
are difficult to relax, and muscle spasms (muscle contractions
that occur without the person wanting them to). These
problems with the muscles are caused by a toxin (poison)
produced by the bacteria called Clostridium tetani.

Maternal tetanus is defined by the WHO as tetanus

occurring during pregnancy or within 6 weeks after the
conclusion of pregnancy (whether with birth, miscarriage, or
abortion). 5
• " Neonatal tetanus is defined as "an illness occurring
in a child who has the normal ability to suck and cry in
the first 2 days of life but who loses this ability between
days 3 and 28 of life and becomes rigid and has
spasms."

• Given the unique presentation of neonatal tetanus, the

history generally permits accurate classification of the
illness with a high degree of probability.(WHO)

6
 Tetanus cont’d…
• Reservoir: soil
• The incubation period: (time between the injury and first
symptom) of tetanus is about 7 – 10 days but it may range
from 1 day to 2 months.

• The period of onset: (time between the first symptom and

spasm) ranges 1 – 7 days.

7
Classification of tetanus

• Generalized Tetanus

• Localized tetanus

• Cephalic tetanus

• Neonatal tetanus

8
 Epidemiology
oTetanus occurs sporadically and almost always affects non-immunized
persons. Partially immunized persons or fully immunized individuals who
fail to maintain adequate immunity are also affected.

oTetanus is more common in rural areas where there is frequent contact

with soil.

oIt also occurs more frequently in warmer climates, during summer months
and in males.

oNeonates and young children are affected more in developing countries

where immunization programs are not comprehensive. 9
 Mode of transmission of tetanus
People can get tetanus through exposure to tetanus bacteria
(Clostridium tetani) which are always present in the soil.

The bacteria can be transmitted

• Directly from the soil, or

• Through dirty nails, dirty knives and tools, which contaminate

wounds or cuts.

10
Mode of transmission of tetanus cont’d…
A new born baby can become infected

 if the knife, razor, or other instrument used to cut its

umbilical cord is dirty

 if dirty material is used to dress the cord, or

 if the hands of the person delivering the baby are not clean.

11
• Unclean delivery is common when mothers give
birth at home in poor communities, but it can be
prevented by skilled birth attendants.

12
 Clinical features
 Dysphagia

 Neck stiffness

 Trismus, or lockjaw

 Contraction of facial muscles(rhesus sardonicus )

 Arched back (opisthotonos)

 Generalized muscle spasm triggered
by stimulus such as light or noise.

13
Poor prognostic factors in Tetanus

• Patients with higher grades

• Short incubation period and period of onset

• Cephalic tetanus and

• Patients with comorbidities have poor prognosis.

14
 Treatment, prevent and control of tetanus

• Once a person has tetanus, he or she will be treated by an

antibiotic drug. However, many people who have tetanus die
despite the treatment. Hence, prevention is the best strategy,
and vaccination is the best way to prevent tetanus.

15
Treatment, prevent and control of tetanus cont’d…

Tetanus toxoid (TT) vaccination

• The tetanus vaccine Tetanus toxoid vaccination is given

routinely to newborns and infants as part of the Penta valent
(fivefold) vaccine, which includes vaccines for diphtheria,
tetanus, pertussis, Hepatitis B, and a bacterium called
Haemophilus influenzae type B.
16
Treatment, prevent and control of tetanus cont’d…

• Neonatal tetanus can also be prevented by vaccinating

women of child bearing age with tetanus toxoid vaccine,
either during pregnancy or before pregnancy. This protects
the mother and enables anti-tetanus antibodies to be
transferred to the growing fetus in her uterus.

17
 Strategies to prevent and control tetanus
• Vaccinating a higher percentage of pregnant women against
tetanus with vaccines containing tetanus toxoid(TT).

• Vaccinating all females of child bearing age (approximately

15–45 years) with TT vaccine in high-risk areas where
vaccination coverage is currently low.

18
 Strategies to prevent and control tetanus cont’d…
• Outreach vaccination

• Promoting clean delivery and child care practices, through

better hygiene and care of the new born’s umbilicus.

• Improving surveillance and reporting of cases of neonatal

tetanus. The case finding and reporting will help us to give
appropriate treatment and vaccination to children.

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 2. Meningococcal meningitis
• Definition: Meningococcal meningitis is an infection of the
brain and spinal cord by the bacterium Neisseria meningitides
(also known as the meningococcus bacterium).The disease is
caused by several groups of meningococcus bacteria, which
are given distinguishing codes such as type A, B, C, Y and
W135.

• Infectious agent: Neisseria meningitides

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• Epidemiology Occurrence: Greatest incidence occurs
during winter and spring. Epidemics occur irregularly.
Common in children and young adults. It is also common in
crowded living conditions.

• Reservoir: Humans

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Mode of transmission
⑴ Respiratory tract : droplet infection
⑵ Close contact:

cough/sneeze kiss/breast-feed

22
Mode of transmission- Direct contact with respiratory droplets
from nose and throat of infected person.

Incubation period: 2-10 day, commonly 3-4 days.

Period of communicability- as long as the bacteria is present

in the discharge.

Susceptibility- Susceptibility is low and decreases with age

• 6 months to 2 years of age are highly susceptible.
23
 Risk Factors
Factors that can increase your risk of bacterial meningitis
include:
• Age
• Infants are at higher risk for bacterial meningitis than people
in other age groups.
• However, people of any age are at risk.
• Community setting
• Infectious diseases tend to spread more quickly where larger
groups of people gather together.
• College students living in dormitories and military personnel
are at increased risk for meningococcal meningitis.
24
 Risk Factors…..
• Certain medical conditions
• There are certain diseases, medications, and surgical
procedures that may weaken the immune system or
increase risk of meningitis in other ways.
• Working with meningitis-causing pathogens
• Microbiologists who are routinely exposed to meningitis-
causing pathogens are at increased risk.
• Travel
• Travelers to the meningitis belt in sub-Saharan Africa may
be at risk for meningococcal meningitis, particularly during
the dry season. 25
 Sign and symptoms
The classic clinical triad of meningitis is

• Fever

• Headache

• Nuchal rigidity (neck stiffness) , which are seen in > 90 % of

patients .

26
 Sign and symptoms cont’d…
• purpura

• stiffness of the neck

• lethargy (extreme lack of energy)

• coma (loss of consciousness)

• convulsions (uncontrollable

shaking, seizures)

• sensitivity to light(photophobia)
27
General and more specific signs of meningitis in infants
General signs of meningitis: More specific signs of meningitis:

• Drowsy . Convulsion(fits)

• Lethargic or unconscious . Bulging fontanelle in infants

• Reduced feeding

• Irritable

• High pitched cry

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More specific signs of meningitis in infants

• Convulsion(fits)

• Bulging fontanelle in infants

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30
 Diagnosis and treatment of meningitis
• Meningitis is diagnosed by physical examination of the person, and by
laboratory testing of the fluid from their spinal cord, where the
meningococcal bacteria can be found.
• In the hospital or health centre, the meningitis is treated using antibiotics
given intravenously (IV), that is, liquid antibiotics given directly into the
bloodstream through a vein.
• Tetanus and meningitis can both be manifested by fever and neck
stiffness, but there are other specific signs of each disease which help in
differentiation.
• For instance, people with tetanus may have tightness of the abdominal
muscles and may be unable to open their mouths.
• By contrast, the bulging fontanelle is a typical sign of meningitis in young
babies, which would not be found in cases of tetanus.
• However, these diseases are very difficult to distinguish on the basis of
clinical examination alone.
31
 Strategies to prevent and control meningitis
• Early identification and prompt treatment of cases in the health facility
and in the community.
• Education of people in the community on the symptoms of meningitis,
the mode of transmission and the treatment of the disease
• Reporting any cases of meningitis to the concerned Health authority
• avoiding close contact with the sick persons.
• Vaccination against meningococcus bacteria
• A mass immunization campaign that reaches at least 80% of the entire
population with meningococcus vaccines can prevent an epidemic.
A single case of meningitis could be a warning sign for the start of an
epidemic.
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3. Diphtheria

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 Diphtheria
Definition:-An acute bacterial disease involving primarily tonsils, pharynx,
nose, occasionally other mucus membranes or skin and sometimes the
conjunctiva or genitalia.
• Diphtheria is caused by a bacteria called Corynebacterium diphtheriae.
• The germ produces a toxin that can harm or destroy human body tissues
and organs.
• One type of the disease affects the pharynx and other parts of the
throat.
• Another type, commoner in the tropics, causes ulcers on the skin.

• Diphtheria affects people of all ages, but mostly non-immunized children

under 15 years of age. 34
• Reservoir- Humans

• Incubation period- usually 2-5 days

• Period of communicability- variable, until virulent bacilli have

disappeared from discharges and lesion; usually 2 weeks or less

• Infected individuals can usually spread the disease to others for

up to four weeks, or longer.

• Susceptibility and resistance- Susceptibility is universal. Infants

borne to immune mothers are relatively immune, but protection is
passive 35
 Mode of transmission
How is diphtheria spread?
• The type of diphtheria that affects the throat is spread in droplets and
secretions from the nose, throat and eyes when there is close contact
between infected and uninfected people.
• The other type is spread through contact with skin ulcers. This form of
the disease is often disseminated on clothing and other articles that have
been contaminated with fluid from skin ulcers.
• The spread of the disease is favoured by overcrowding and poor living
conditions.
• During outbreaks and epidemics some infected persons may carry the
germ without showing any signs or symptoms (healthy carriers) but can
still spread the disease to other people.
• Any chronic skin lesions may become infected with diphtheria.
36
 Clinical Manifestation
• When diphtheria affects the throat and tonsils, the early
symptoms and signs are:
-Sore throat n(pharynges tonsillar diphtheria)

-Loss of appetite

-Slight fever within two to three days a bluish-white or grey

membrane forms in the throat and tonsils.

- If there is bleeding the membrane may become greyish-green or

black.
37
• It sticks to the soft palate of the throat, and bleeding may occur
if attempts are made to remove it.

• characteristic lesion marked by a patch or patches of an

adherent grayish membrane with a surrounding inflammation
(pseudo membrane).

• The patient may recover at this point or may develop severe

forms of the disease. 38
Patients with severe disease:
 Do not show high fever

 May develop severe weakness

 May develop swelling of the neck and obstruction of the airway

 Abnormal heart beat and heart failure may occur .

 swelling and edema of neck(in sever cases)

 Patients with severe disease or complications may die

39
 Treatment of diphtheria
• Persons in whom diphtheria is suspected should be given
diphtheria anti-toxin and erythromycin or penicillin.

• They should be isolated to avoid exposing others to the germs.

•
• Patients become non-infectious about two days after the
commencement of antibiotic treatment.

40
 Prevention and control
1. The most effective way of preventing diphtheria is to maintain a high
level of immunization in the community. Diphtheria toxoid vaccine is
given together with other vaccines (pentavalent)

2. A mother can pass protective antibodies to her baby, but this protection
lasts for only about six months after birth.

3. Educate the public, and particularly the parents of young children, of

the hazards of diphtheria and the necessity for active immunization.

4. Concurrent and terminal disinfection of articles in contact with patient

and soiled by discharges of patient. 41
 4. Pertussis (Whooping Cough)
Definition: Pertussis, or whooping cough, is an acute disease of
the respiratory tract caused by bacteria called Bordetella
pertussis.
• The germ lives in the mouth, nose and throat.
• The disease is common in non-immunized children all over the
world.
• Severe epidemics can occur where immunization coverage is
low.
• The disease is most dangerous in children less than 12 months
old.
Reservoir: Humans 42
 Mode of transmission:

Primarily by direct contact with discharges from respiratory

mucus membranes of infected persons by airborne route,
probably by droplets.
Pertussis spreads very easily from person to person through
droplets produced by coughing or sneezing.
Indirectly by handling objects freshly solid with
nasopharyngeal secretions
Most unprotected persons exposed to the germs become
infected
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Incubation period: 1-3 weeks
Susceptibility and resistance- The most susceptible people are the
youngest non-immunized children. One attack usually confers prolonged
immunity but may not be lifelong.
Period of communicability- Highly communicable in early catarrhal
stage before the paroxysmal cough stage

• The disease is most readily transmitted as from seven days after a person
has been exposed to the germs until three weeks after the start of
coughing.
-When treated with erythromycin, infectiousness is usually 5 days or less
after onset of therapy.
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Epidemiology Occurrence- An endemic disease common to
children especially young children everywhere in the world.

A marked decline has occurred in incidence and mortality rates

during the past four decades

Outbreaks occur periodically

Endemic in developing world and 90% of attacks occur in

children under 6 years of age.

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 Clinical manifestation
The disease has insidious onset and 3 phases:
1. Stage 1 (Catarrhal phase lasts 1-2 weeks)
• Initially a child appears to have a common cold-like illness.
• cough & Rhinorrhea
2. Stage 2 (Paroxysmal phase: 2-6 weeks)
• The cough worsens.
• The child has numerous bouts of rapid, Explosive, repetitive and
prolonged coughing.
• At the end of these bouts the child takes in air with a high-pitched
whoop.
• The child may turn blue because of a lack of oxygen during a long bout
of coughing.
46
 Contd….
• Vomiting and exhaustion often follow the coughing attacks,
which are particularly frequent at night.

• Child looks healthy between paroxysms

• This stage usually lasts one to six weeks but may go on for up
to ten weeks. The attacks become milder with the passage of
time.
47
3. Convalescent phase: begins after 4-6 weeks

• The cough may diminish slowly or may last long time. After
improvement the disease may recur.

• The coughing gradually becomes less intense and stops in

two to three weeks.

• Recovery takes place.

• Note: Usually there is no high fever during the illness.

48
 Diagnosis
It is difficult to distinguish it from other upper respiratory tract
infection

History and physical examination at phase two (paroxysmal

phase) ensure the diagnosis

• Infants <3 months of age may have apnea, cyanosis, or an

acute life-threatening event
• choke, gasp, gag, and flail extremities, with face reddened
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Complications of pertussis
• Complications are most probable in young infants.
• Convulsions
• Other bacterial pneumonia
• Middle ear infection
• Dehydration
• Malnutrition

What is the treatment for pertussis?

• Erythromycin helps the patient only if it is given early in the first stage
of the illness. But treatment with antibiotics, usually erythromycin,
helps to reduce the ability of the patient to infect others.
• Plenty of fluids should be given to prevent dehydration.
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 Prevention and control
1. Educate the public about the dangers of whooping cough and
the advantages of initiating immunization at 6 weeks of age.
2. Consider protection of health workers at high risk of exposure
by using erythromycin for 14 days.
3. Isolation
4. Immunization with pertussis vaccine, which is usually given in
combination with other vaccine preventable diseases
(pentavalent).
• A person infected with pertussis usually acquires lifelong
immunity.
51
 Remember
 Pertussis a bacterial infection spread from person to person by
sneezing and coughing.
 The disease is highly infectious, especially under crowded
conditions.
 New born infants are not protected against pertussis by
maternal anti body.
 Infants and young children are the people most likely to be
infected, have a serious complication, and dies from the disease.
 The most effective way to prevent pertussis is immunization of
all children those aged less than 1year.

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 5. Haemophilus influenza type b (Hib)
• Haemophilus influenzae type b(Hib) is one of the six sero types
of haemophilus bacteria
• It causes about 95% of morbidity and mortality among under
five children
• This bacteria causes majority of the serious childhood illnesses
like pneumonia, bacterial meningitis, parotitis, and septicemia.
How is haemophilus influnzae spread?
• It spread from person to person through droplets while
coughing and sneezing
• Sometimes infected children may carry Hib without showing any
signs and symptoms of illness but they can still infect others.
• It usually infects children between six months and two years of
age. 53
 What are the signs and symptoms of Hib?

 Pneumonia and meningitis are the most important diseases

caused by Hib bacteria

 Pneumonia is the common disease caused by Hib than

meningitis

 In children showing signs and symptoms of pneumonia and

meningitis should have to be suspected for Hib infection.

54
 Pneumococcal Disease
• Pneumococcal (also known as Streptococcus pneumoniae) is a
bacterium that causes a group of diseases called Pneumococcal
disease.
• These include severe diseases such as pneumonia, meningitis,
bacteraemia, and milder diseases such as middle ear infection
(otitis media), sinusitis and bronchitis.
• Different serotypes also have differing potential to cause
different diseases (e.g. meningitis, pneumonia) in various age
groups.
• In Ethiopia, an estimated 1 in every 4 deaths among children
under-five years of age is caused by pneumonia every year.
• The introduction of pneumococcal conjugate vaccine (PCV) in Ethiopia
will prevent an estimated 35,000 deaths in over five years period. 55
 Mode of transmission

• Droplet spread or contact with surfaces contaminated with the

secretions.

• Any time a patient or a healthy carrier coughs or sneezes;

she/he releases droplets into the air.

• Direct contact with respiratory secretions from patients or

healthy carriers, who may carry pneumococci in their nose or
throat and transmit it on fingers, cloths (handkerchiefs) and
objects (e.g. cups).
56
 Sign and symptoms
• The sign and symptoms of pneumococcal infections are depends on the
types of infection the patient have like pneumonia, ear infection, sinusitis
and bronchitis and even meningitis.

Treatment
• Pneumococcal disease, being bacterial, can be treated with antibiotics
especially penicillins (e.g. amoxicillin) or co-trimoxazole.

• Treatment should follow the national guidelines. However, in many

countries including Ethiopia, strains of pneumococcus are becoming
resistant to these antibiotics.

57
 Prevention Methods
• Safe and effective vaccines now exist to protect against many (but not
all) strains of pneumococcal disease.

• Vaccines are the most cost- effective way for preventing pneumococcal
diseases. Pneumococcal diseases will occur less frequently in immunized
children.

• However, in order to maximize protection of children, additional disease

control measures should be reinforced such as hand washing, nutrition
and breast feeding.

58
 Summary
• Vaccine-preventable diseases are communicable diseases that
can be prevented by immunization with vaccines containing
weakened or killed infectious organisms or their toxins.

• Vaccination increases the level of immunity in the body to the

infectious agents that were used to make the harmless vaccine.

• The common bacterial vaccine preventable diseases include,

tetanus, diphtheria, pertussis, meningitis, pneumonia and
tuberculosis
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 4. VIRAL VACCINE
PREVENTABLE DISEASE
Arba Minch College Of Health Science Department of HEX,
December 2019

60
 objectives
When you have studied this session, you should be able to:
• Define and use correctly all of the key words printed in bold.

• Describe what causes the common viral vaccine-preventable

diseases, how the infectious agents are transmitted ,and the
characteristic signs and symptoms of an affected person.

• Describe the treatment in the community of children who have

measles.

• Describe how measles, polio and hepatitis B can be controlled

and prevented in rural communities.
61
 Overview of viral vaccine-preventable diseases
• viruses are microscopic infectious agents that do not have the
structure of a cell they are more like tiny boxes or particles.

• They are much smaller than bacteria and can only be seen
with the most powerful microscopes.

• Some of the diseases caused by viruses can be prevented by

vaccination, as you will learn in this study session.

62
 Overview of viral vaccine-preventable diseases…
• Vaccine-preventable diseases are important causes of death in
children

• The causes, infectious agents, modes of transmission,

symptoms, and methods of prevention, treatment and control
of the most important viral vaccine preventable diseases are
summarized in Table below.

63
64
 1. Measles (Rubella)
Definition
• An acute highly communicable viral disease
Infectious agent
• Measles virus
Epidemiology
• In Ethiopia, it is one of the major cause of child mortality .
• It has many name in indigenous language ,such as “ankelis” or
“shinfto”
Reservoir
-Humans
65
 Mode of transmission
• Airborne by droplet spread,
• direct contact with nasal or throat secretions of infected persons and
• less commonly by articles freshly soiled with nose and throat secretion
Incubation period
 7-18 days from exposure to onset of fever
All those who are non vaccinated or have not had the disease are
susceptible
 Permanent immunity is acquired after natural infection or immunization.
Infectious period
(time during which an infected person can infect others)
From 24 hours before the onset of symptoms to four days after the
appearance of the rash.
66
 Clinical Manifestation
• Fever,
• Runny nose
• Conjunctivitis (Inflamed eyes)
• cough and
• Koplik spots on the buccal mucosa(Tiny white spots with
bluish-white centers on a red background found inside the
mouth on the inner lining of the cheek).
• maculopapular generalize rash, beginning on the face,
gradually becoming generalized.
• Leucopoenia is common.
67
 Prevention
1. Educate the public about measles immunization.
2. Immunization of all children (less than 5 years of age)
3. Provision of measles vaccine at nine months of age.

68
2. Poliomyelitis(polio)
Definition
• Poliomyelitis (usually called polio)is a viral disease that causes
paralysis (weakness or inability to use the muscles) of the legs,
arms or hands
cause
• Polio is caused by three types of viruses, namely, polio virus
types 1, 2 or 3
• The Ethiopian government has a plan to eradicate the disease
in the near future
• As a result of a continuing vaccination programme, polio is
fortunately becoming a rare disease in Ethiopia
69
 2. Poliomyelitis(polio)…

• However, there are sometimes cases among people who come

to Ethiopia from neighbouring countries such as Sudan

Mode of transmission
• Polioviruses are transmitted when people drink water or eat
food contaminated by faeces (stools) which carry the virus
(faeco-oral transmission)

70
 2. Poliomyelitis(polio)…
Clinical manifestations
Most children who get a poliovirus infection without symptoms
develop immunity and have lifelong protection against polio
A few children may develop a kind of paralysis called acute
flaccid paralysis (AFP)
Which is characterized by acute (rapidly developing, severe)loss
of movement or weakness of the legs, arms or hands
Paralytic polio begins with mild symptoms and fever, followed by
severe muscle pain and paralysis
Some patients may not be able to breathe because of the
paralysis of respiratory muscles in the chest, which can lead to
death 71
 2. Poliomyelitis(polio)…
Diagnosis
 A diagnosis of polio is confirmed by laboratory testing of stool
samples
Treatment
 The initial symptoms of a--cute polio such as muscle pain and
fever can be relieved
There is no treatment that can cure the weakness and paralysis
if AFP develops
Prevention
1. Educate the public about polio immunization
2. Vaccination is the best method to eradicate the disease
72
 3. Hepatitis B(HBV)
Definition
• Hepatitis is a term referring to a serious inflammation of the
liver

Causes
• Several viruses can cause hepatitis, but the hepatitis B virus(or
HBV) is the most important one
• Hepatitis B disease is a major global health problem and the
most serious type of viral hepatitis.

73
 3. Hepatitis B…
Mode of transmission
 Injury or injection
From a pregnant mother to her baby
Unprotected sexual intercourse

Clinical manifestations
 Feel weak and experience stomach upsets
 ther flu-like symptoms, which may last several weeks or months
 The pt may also have very dark urine
 Very pale stools
 Jaundice, which presents with yellowing of the skin or a yellow colour in
the whites of the eyes 74
 3. Hepatitis B…
Incubation period
The incubation period of hepatitis B averages six weeks, but may be as
long as six months
Young children who are infected (usually at birth)often show no
symptoms
Also, a larger proportion of children become chronic carriers of HBV,
compared with infected adults
Treatment
There is no curative treatment for acute hepatitis B disease
Advise patients or the parents of affected children to try to keep eating
and drinking
 Replacement of fluids lost through vomiting or diarrhoea is essential, and
giving ORS is recommended if dehydration is a concern 75
 3. Hepatitis B…
Prevention

1. Educate community about how hepatitis B is transmitted

2. Educate how transmission can be avoided

3. Give the pentavalent vaccine to infants

76