Chitsanu Pancharoen, MD Infectious Disease Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
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1 Hot Topics in Chitsanu Pancharoen, MD Infectious Disease Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
2 Outline I I. Community acquired pediatric infectious diseases 1. Disease outbreak Outbreak of RSV infection in small children Outbreak of RVGE in older children & adults Outbreak of influenza in older children Outbreak of rabies in dogs & humans 2. EID/RID Pertussis Zika infection TB & MDR TB
3 Outline II II. Vaccines to prevent pediatric infectious diseases 1. EPI vaccines: HB in HBV exposed infants 2. New EPI vaccines Bivalent HPV vaccine (2HPV) in girls Hib vaccine (Hib) Rotavirus vaccine (RV) 3. New optional vaccines Dengue vaccine (DV) Live attenuated hepatitis A vaccine (HAV) Nanovalent HPV vaccine (9HPV)
4 Design of Presentation I. Community acquired pediatric infectious diseases 1. Disease outbreak Outbreak of RSV infection in small children 2. EID/RID Pertussis II. Vaccines Outbreak of RVGE in older children & adults Outbreak of influenza in older children Outbreak of rabies in dogs & humans Zika infection TB & MDR TB From MEDIA to KNOWLEDGE & RESEARCH & PRACTICE 1. EPI vaccines HB in HBV exposed infants 2. New EPI vaccines Bivalent HPV vaccine (2HPV) in girls Hib vaccine (Hib) Rotavirus vaccine (RV) 3. New optional vaccines Dengue vaccine (DV) Live attenuated hepatitis A vaccine (HAV) Nanovalent HPV vaccine (9HPV)
5 Outbreak of RSV Infection ไวร ส RSV ระบาดหน าฝน โคราชเด กต ดเช อ โคราชเดกตดเชอ เข าไอซ ย! เขาไอซย!
6 Outbreak of RSV Infection Situation Large outbreak of RSV infection in children Presentation Viral pneumonia Investigation CXR: hyperaeration, perihilar interstitial infiltration Nasal swab for RSV (rapid test) Complications Acute: respiratory failure Long term: bronchial asthma Treatment Hydration, oxygenation, bronchodilator Antiviral agents (in the future) Prevention RSV vaccine (in the future)
7 Outbreak of RSV Infection FromRSV infection to From RSV infection to Asthma & other atopic diseases
8 Outbreak of Rotavirus Gastroenteritis น สบา ป วยร วง เต อนระว งหล งเช อโรต าไวร สระบาดหน ก แถมย งไม ม ยาร กษา!
9 Outbreak of Rotavirus Gastroenteritis Situation Large outbreak of RVGE in children & adults Presentation Investigation Acute gastroenteritis in children aged 0 5 yrs Stool exam no wbc, no rbc Stool for rotavirus antigen Complications Dhd Dehydration, metabolic tbli acidosis, i lactase dfii deficiency Treatment Diet therapy, ORS/IV fluid Prevention Breastfeeding, rotavirus vaccine
10 Outbreak of Rotavirus Gastroenteritis Reportsof RVGE Reports of RVGE in Thai adults
11 Outbreak of Rotavirus Gastroenteritis Slide อาจารย น ค Thai adults may not have Thai adults may not have immunity against certain RV.
12 Outbreak of Influenza รร.กทม. 3 4 แห ง ป ดเร ยน! หน ไข หว ดใหญ
13 Outbreak of Influenza Situation Large outbreak of influenza in children who have received dinfluenza vaccines Presentation Investigation Infants: high fever Children: high fever, influenza like illness Nasal swab for influenza virus (rapid test, PCR) Complications Pneumonia, encephalitis Treatment Oseltamivir if at risk population & complications Prevention Influenza vaccine (TIV, QIV), mask & hand washing
14 Outbreak of Influenza 4 sites of MOPH training & research , Phuket , Prachinburee , Prae , Amnartcharoen Increasing influenza vaccine acceptance among pregnant women & small children
15 Outbreak of Influenza Have you vaccinated 2018 influenza vaccines?... TIV vs QIV
16 Outbreak of Rabies P พ ษส น ขบ า... ระบาดแล ว 4 อ าเภอใน จ.ตร ง พบผ ป วยโคม า! ประกาศเป นพ นท ส เหล อง ตร งพบชาย เส ยช ว ต จากโรคพ ษส น ขบ า
17 Outbreak of Rabies Situation Presentation Investigation Treatment Prevention Large outbreak of animal & human rabies Prodome: fever, headache, neurologic symptoms Neurologic phase: 1. Encephalitic rabies 2. Paralytic rabies Coma: inspiratory spasm, hypoventilation, hypotension Dead: 100% Antigen & antibody detection, viral culture No specific treatment Rabies vaccination in dogs & cats Pre exposure rabies vaccination, 2 3 doses
18 Outbreak of Rabies Rabies exposures are common in children. Bites on face are common in children. P
19 Outbreak of Rabies Pre exposure 2 dose rabies is as good as 3 dose rabies. P
20 EID/RID: Pertussis ห วงเด กไทยป หวงเดกไทยปวย วย โรคไอกรน มากข น มากขน แนะควรร บว คซ นตามน ด
21 EID/RID: Pertussis Situation Presentation Investigation Treatment Prevention Emergence of pertussisininfants in infants Prolonged and severe cough Contact with index case CBC: lymphocytosis ESR: low PCR for B. pertussis Macrolides DTP in children Tdap/TdaP in adults includingpregnant women
22 EID/RID: Pertussis Pertussis in Thai adults and children
23 EID/RID: Pertussis ข อม ลไอกรนในเด ก Pertussis in Thai neonates
24 EID/RID: Pertussis Tdap in pregnant Thai women
25 EID/RID: Zika Infection ไวร สซ การะบาดในบราซ ล ข นฉกเฉ น ทารกศ รษะเล ก เพ มไม หย ด
26 EID/RID: Zika Infection Situation Outbreakof Zika infectioninseveral countries Presentation ti Fever with rash, arthalgia Investigation PCR, Zika IgM & IgG Complications Microcephaly in neonates Treatment Prevention Symptomatic treatment Control mosquito & larvae, surveillance
27 EID/RID: Zika Infection Zika virus infection in pregnant women & Risk of microcephaly in neonates
28 EID/RID: TB & MDR TB ป วยว ณโรคด อยาหลายขนาน พ ง! กรมควบคมโรคเด นหน า กรมควบค มโรคเดนหนา 5 มาตรการลดป ญหา
29 EID/RID: TB & MDR TB Situation Increasing rate of MDR TB in adults & children Presentation Investigation Children: prolonged fever, weight loss Adults: chronic cough, bloody sputum, weight loss Tuberculin test, CXR, sputum for AFB & culture Complications Similar il to drug sensitive TB Treatment Prevention Anti TB drugs, DOTS BCG, index case, contact cases, mask
30 EID/RID: TB & MDR TB KCMH Siriraj QSNICH 4 Provinces Year DST done (%) DR TB (%) MDR TB (%) Pre XDR TB (%) Mono H (%) Mono R (%) P Mono S (%) Increasing rate of MDR TB In Thai children
31 EPI Vaccines HB in HBV exposed infants จ ลดคนไทยต ดเช อไวร สต บอ กเสบ
32 EPI Vaccines HB in HBV exposed infants Situation Global elimination of hepatitis B by 2030 Past HBV screening in pregnant women HBsAg, HBeAg HBV prevention in HBV exposed HBIG, HBx3 Present HBV infection in infants <1% HBV infection in HBV exposed 2% Future Tenofovir in HBeAg +ve pregnant 0% HBV infection in infants
33 EPI Vaccines HB in HBV exposed infants Tenofovir prevents perinatal transmission of hepatitis B.
34 New EPI Vaccines HPV Vaccine (2HPV) หมอย น ป.5 แน นอกหล งฉ ด ว คซ น วคซน HPV เป เปนอ ปาทานหม นอปาทานหม
35 New EPI Vaccines HPV Vaccine (2HPV) Situation Cervical cancer prevention Past Cervical cancer screening Present Cervical cancer screening HPV vaccine (4HPV, 2HPV) 2HPV for grade 5 girls Future New HPV vaccine (9HPV) Pap smear, VIA Thin prep, PCR for HPV Optional vaccine EPI vaccine Available soon
36 New EPI Vaccines HPV Vaccine (2HPV) Situation 2HPV for grade 5 girls HPV infection & cervical cancer Burden Cervical cancer is a common female cancer. Severity Cervical cancer is severe and life threatening. 2HPV vaccine Efficacy 80%, similar protection with 4HPV Safety Few side effects Recom 2 doses in 9 15 yr, 3 doses in > 15 yr
37 New EPI Vaccines HPV Vaccine (2HPV) HPV vaccine 2 doses is adequate for girls aged 9 15 yrs.
38 New EPI Vaccines HPV Vaccine (2HPV) Physicians should be more proactive in discussing and recommending HPV vaccination.
39 New EPI Vaccines Hib Vaccine (Hib) ว คซ นฮ บค ออะไร ท าไมเด กไทยไม ได ฉ ดฟร
40 New EPI Vaccines Hib Vaccine (Hib) Situation Hib infection Burden Severity Hib vaccine Efficacy Safety Recom DTwP Hib HB to replace DTwP HB May be underestimated Invasive Hib esp. meningitis is severe. Good Few side effects DTwP Hib HB 3 4 doses in 2, 4, 6 and (18) mo
41 New EPI Vaccines Rotavirus Vaccine (RV) กรมควบคมโรคเตร ยมเร งผล กด นว คซ นโรต า กรมควบค มโรคเตรยมเรงผลกดนวคซนโรตา เข าส แผนภ ม ค มก นโรค ภายในป 2561 ฟร
42 New EPI Vaccines Rotavirus Vaccine (RV) Situation RV the next EPI vaccine Rotavirus gastroenteritis (RVGE) Burden RVGE is the most common cause of childhood diarrhea 0 5 yr of age. Severity RVGE is not a simple diarrhea. Rotavirus vaccine (RV) Efficacy RV helps decrease disease severity. Safety Intussusception Recom 2 3 doses PO, 1 st before 4 mo, last before 8 mo
43 New EPI Vaccines Rotavirus Vaccine (RV) RVGE is common in Thai children aged 0 5 yrs. Rotavirus vaccine: From evidence to policy.
44 New Optional Vaccines Dengue Vaccine (DV) ฟ ล ปป นส ระง บ ว คซ นไข เล อดออก ฟลปปนสระงบ วคซนไขเลอดออก หล งพบผลข างเค ยง
45 New Optional Vaccines Dengue Vaccine (DV) Situation DV causes severe dengue in seronegatives Dengue virus infection Burden Dengue is common in tropical countries. ti Severity Dengue may be severe. Dengue vaccine Efficacy Safety Recom <70%, at least decrease severity Beware in dengue seronegatives 9 45 yr, more efficacy & safe in seropositives
46 New Optional Vaccines Dengue Vaccine (DV) Slide อ.ฉอ P Barrier affecting DV acceptance is the cost of vaccine.
47 New Optional Vaccines Dengue Vaccine (DV) P
48 New Optional Vaccines Live Attenuated Hepatitis A Vaccine (HAV) Situation Live HAV A better vaccine Hepatitis A infection Burden May cause outbreaks Severity Not as severe as HBV infection HAV vaccine Efficacy Safety Recom Excellent Very safe >1 yr, single dose in children and adults
49 New Optional Vaccines Live Attenuated Hepatitis A Vaccine (HAV) New live attenuated HAV... single dose, good protection, less expensive
50 New Optional Vaccines Nanovalent HPV Vaccine (9HPV) Situation 9HPV more protection HPV infection & cervical cancer Burden Cervicalcancer cancer isa commonfemale cancer. Severity Cervical cancer is severe and life threatening. 9HPV vaccine Efficacy More efficacious than 2HPV & 4HPV Safety Few side effects Recom Same as 2HPV & 4HPV
51 New Optional Vaccines Nanovalent HPV Vaccine (9HPV) New nanovalent HPV vaccine... Broader protection against cervical cancer
52 Lesson learnt Hot Topics in 1. Outbreak & emergence of vaccine preventable infectious diseases 2. Vaccines to prevent infectious diseases EPI vaccines New EPI vaccines Optional vaccines Research vaccines 3. Media knowledge research practice
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