Communicable Disease Update; Vol 9 (4), November 2010

Transcription

1 Communicable Disease Update; Vol 9 (4), November 2010 Item Type Newsletter Authors Health Service Executive (HSE) South (South East), Department of Public Health Publisher Health Service Executive (HSE) South (South East), Department of Public Health Download date 30/10/ :32:28 Link to Item Find this and similar works at -

2 Public Health Department, Health Service Executive South (SE) Volume 9 Issue 4, November 2010 In this Issue Page 1 In the News Page 2-4 Rashes in Childhood due to infectious diseases Ms Johanna Costigan Dr Catherine Lynch Dr Julie Heslin Page 5 Notified Infectious Diseases in the HSE South (SE) Page 6 Immunisation uptake Editorial Team Dr Orlaith O Reilly Director of Public Health Dr Julie Heslin Specialist in Public Health Medicine Ms Bernadette O Connor Surveillance Scientist Dr Colette O Hare Surveillance Scientist Administrator Siobhan O Rourke Disease Notifications can be sent to: Public Health Department HSE South (SE) Lacken, Dublin Rd, Kilkenny Tel Fax IN THE NEWS Malaria in Children of West African extraction A significant number of children, living in Ireland and travelling to malarious countries, develop malaria each year. The largest sub-group is children born in Ireland, who acquire their malaria when they travel to visit family in their parents country of origin. Analysis shows that a significant majority of these had not taken or not completed a course of antimalarial prophylaxis. HPSC have produced a leaflet and poster that highlights the issue of antimalarial prophylaxis, preventive measures regarding biting mosquitoes and provides simple advice on minimising the risk of malaria. This leaflet and poster is particularly for the attention of local GP surgeries and specialists in paediatrics, emergency medicine and staff in maternity hospitals. They have been posted in English and French on the HPSC website: hpsc/a-z/vectorborne/malaria/leafletsandposters Polio in Eastern Europe For the first time since it was certified polio-free in 2002, the WHO European Region has experienced the first importation of wild poliovirus, with the most recent case from Kazakhstan. It is worth considering acute poliomyelitis in the differential of acute flaccid paralysis. Tests include 2 stools 24 hours apart which need to go to National Virus reference laboratory. It is possible that an index case may have no travel history if he has had unknowing contact with someone who has recently returned from an area where wild poliovirus is circulating. ECDC spotlight: Chlamydia- High numbers, low awareness Chlamydia is the most common sexually transmitted disease in Europe and the number of cases is constantly increasing. However awareness is still very low and many cases are detected too late. There are 3 key messages: l Chlamydia is the most common sexually transmitted infection in Europe and particularly affects young people. l Chlamydia can have long-term consequences for sexual and reproductive health. l Chlamydia can be controlled through prevention, case finding and effective case management. For further info see Pages/index.aspx Zoonoses Conference Deferred The conference organising committee of the National Zoonoses Committee have regrettably made the decision to defer the Zoonoses conference planned on the 23rd and 24th of November 2010

3 Rashes in Childhood due to Infectious Diseases A rash is any change of the skin which affects its colour, appearance or texture. It can be caused by many things, including drug or other allergic reactions, eczema, local irritation or a bacterial or viral infection. It may be difficult to make a definitive diagnosis as many different agents can cause similar rashes. This is due to the fact that the skin has a limited number of responses. It is useful to consider associated history and symptoms, in addition to the rash, to enable the doctor to make a diagnosis. Insect bites, exposure to other ill children or adults, recent antibiotic use or environmental exposures are significant in the history of a recent rash. It is also important to elicit past immunisation history. Where fever is present, this generally means that the rash is due to an infection, although in some infections e.g. enterovirus infections, the fever may be mild or absent. There are 3 main types of rash: l Vesicular; l Maculopapular/Punctuate l Haemorrhagic. Vesicular rashes Chickenpox (Varicella zoster) The classic rash associated with a chickenpox infection includes red papules (bumps), vesicles (the spots that look like little blisters), which then become crusted scabs. It is very common to see all of the different stages of the chickenpox rash at the same time. Chickenpox typically starts on a child s trunk and then spreads to the rest of their body, including their arms, legs, and head. It is very itchy and very contagious. Recommended period of exclusion from school/crèche: 5 days from onset of rash Hand, foot and mouth disease Hand, foot, and mouth disease is caused by a coxsackie virus. It produces mouth ulcers and small blisters (vesicles) on the hands and feet. The vesicles often have a reddish border with a white or lighter coloured area in the centre. It often occurs in minor epidemics. Recommended period of exclusion from school/crèche: None required. However some benefit may be gained by excluding children who have blisters in their mouths and drool or who have weeping lesions on their hands. Impetigo Impetigo is a highly contagious disease caused by streptococcus or staphylococcus bacteria. It causes a superficial skin infection which appears red with yellow or golden crusts. It is seen frequently in children on the face, upper trunk, and arms. Recommended period of exclusion from school/crèche: Until lesions are crusted and healed or 48 hours after commencing antibiotic treatment. Molluscum contagiosum Molluscum contagiosum is a common condition where small warty bumps (mollusca) appear on the skin. It is caused by a virus that can be passed on by skin contact or from contaminated towels, flannels, soft toys, etc. It is not serious and usually clears within months without any treatment. Recommended period of exclusion from school/creche: None

4 Scabies Scabies is an itchy rash caused by a little mite that burrows in the skin surface. It appears as tiny red intensely itchy bumps on the limbs and trunk, often seen initially between the fingers or in the armpits or groins. Recommended period of exclusion from school/creche: It is important to inform all close contacts as they will require treatment as well, even if they have no symptoms or itching child can return after first treatment. Maculopapular/Punctate rashes Slapped cheek disease (Parvovirus B19, Fifth Disease, Erythema infectiosum): Fifth disease is an acute viral disease characterized by mild symptoms and a blotchy rash beginning on the cheeks and spreading to the extremities and which may come and go, especially in the heat, and which may have a reticular pattern. Fever, if present, is mild. Recommended period of exclusion from school/crèche: None Rubella (German measles) Rubella is often a mild disease in children. The rash begins on the face and then spreads to the trunk and limbs. It can be a little itchy and is often more noticeable after a hot shower or bath. Unlike measles, children with rubella often do not have a fever and the rash is fainter than the rash of measles. Posterior occipital lymphoadenopathy can sometimes be found. For laboratory confirmation a buccal mucosa swab can be taken 7 days post onset of clinical symptoms. The swab is obtained by wiping the outer gum area above the teeth gently with the swab in order to sufficiently moisten it. The procedure should take no longer than 15 to 30 seconds. Recommended period of exclusion from school/crèche: For 6 days from onset of rash Measles Measles is an acute, highly-communicable viral disease with prodromal fever, conjunctivitis, coryza, cough, and Koplik spots on the buccal mucosa (aprox 4th day of illness). A characteristic red blotchy rash appears around the third day of illness, beginning on the face and becoming generalized, lasting 4-7 days and sometimes ends in desquamation. For laboratory confirmation A buccal mucosa swab can be taken 7 days post onset of clinical symptoms. The swab is obtained by wiping the outer gum area above the teeth gently with the swab in order to sufficiently moisten it. The procedure should take no longer than 15 to 30 seconds. Recommended period of exclusion from school/crèche: For 4 days from onset of rash. Scarlet fever Scarlet fever is an infection that is caused by Streptococcus species. The scarlet fever rash first appears as tiny red bumps on the chest and abdomen that may spread all over the body. Looking like sunburn, it feels like a rough piece of sandpaper, and lasts about 2-5 days. The child also has fever, sore throat, perioral pallor and a strawberrylooking tongue. Recommended period of exclusion from school/crèche: child can return 24 hours after commencing appropriate antibiotic treatment.

5 Roseola infantum Roseola is a viral illness of young children, usually marked by several days of high fever, followed by a distinctive rash (pinkish-red flat or raised, which appears on the trunk and spreads over the body) just as the fever breaks. Recommended period of exclusion from school/crèche: None Ringworm The photo of a child s leg shows a classical-appearing ringworm lesion with central clearing and a slightly raised red border. Recommended period of exclusion from school/crèche: Not usually required once child is on treatment. Haemorrhagic Most haemorrhagic rashes are not due to an infectious agent, the exception being meningococcal disease. Meningococcal disease can present in the early stages with a maculopapular rash. Rashes or contact with rash illness in pregnancy The greatest risk to pregnant women from rash illness comes from their own child/children, rather than the workplace. If a pregnant woman develops a rash, or is in direct contact with someone with a rash illness, this should be investigated by a doctor. l Chickenpox can affect the pregnancy if a woman has not already had the infection. If no history of chickenpox infection, report exposure to antenatal care giver, who will arrange a blood test to check for immunity. Shingles is caused by the same virus as chickenpox, so anyone who has not had chickenpox is potentially vulnerable to the infection if they have close contact with a case of shingles. l Rubella (German measles). If a pregnant woman comes into contact with German measles, she should inform her antenatal caregiver immediately to access medical advice. The infection may affect the developing baby if the woman is not immune and is exposed in early pregnancy. l Slapped cheek disease (parvovirus B19) can occasionally affect an unborn child. If exposed early in pregnancy (before 20 weeks), inform antenatal caregiver for medical advice. l Measles during pregnancy can result in early delivery or even loss of the baby. If a pregnant woman is exposed, she should immediately inform her antenatal care giver. l All female staff born after 1978 working with young children should have documented evidence of two doses of MMR vaccine. Immunisation Immunisation status should always be checked at school entry and at the time of any vaccination. Parents should be encouraged to have their child immunised and any immunisation missed or further catch-up doses required should be organized through the child s GP. For the most up-to-date immunisation advice

6 Statutory Notification of Infectious diseases The table below shows cases of infectious diseases notified in the HSE/SE area only under Infectious Disease (Amendment No.3) Regulations 2003 (S.I. No. 707 of 2003). With the exception of TB, data has been extracted from CIDR (Computerized Infectious Disease Reporting). Disease week week week Cases Cases Cases Acute infectious gastroenteritis Bacterial meningitis (not otherwise specified) Brucellosis Campylobacter infection Chlamydia trachomatis 3 NA Creutzfeldt Jacob disease Cryptosporidiosis Enterohaemorrhagic E. coli Giardiasis Gonorrhoea 3 NA Haemophilus influenzae disease (invasive) Hepatitis A Acute Hepatitis B Acute Hepatitis B Chronic Hepatitis C Herpes Simplex (gential) 3 NA Influenza (non-a/h1n1) Influenza (A H1N1) 4 NA 78 8 Legionellosis Leptospirosis Listeriosis Malaria Measles Meningococcal disease Mumps Noroviral infection Paratyphoid Pertussis Rubella Salmonellosis Shigellosis Streptococcus group A (invasive) Streptococcus pneumoniae (invasive) Syphilis 3 NA Tetanus Toxoplasmosis Trichomoniasis 3 NA 9 8 Tuberculosis Typhoid Viral encephalitis Viral Meningitis Total Provisional data 2 Since May 1st 2008 acute infectious gastroenteritis also now include Clostridium difficile cases 3 STI data shown is from laboratory only and does not contain data for ano-genital warts or non-specific urethritis. NA= Validated data not available prior to Influenza A/H1N1 was only notifiable in its own right from April 2009

7 Immunisation Immunisation uptake uptake in in the the HSE-SE HSE-SE and and in in Ireland Ireland Immunisation uptake rates for children at 12 months and 24 months of age. Immunisation uptake rates for children at 12 months and 24 months of age. p g Immunisation uptake rates for children % Uptake at 12 months at 12 months and 24 of months age of age. BCG D 3 P 3 % Uptake T 3 Hib at 3 12 months Polio 3 HepB of age 3 MenC 3 MenC 2 PCV 2 HSE SE Q4 BCG D 3 90 P 3 90 T 3 90 Hib 3 90 Polio 3 90 HepB 3 NA MenC 3 90 MenC 2 90 PCV 2 HSE 2009 SE Q TS 2010 CW/KK NA WD CW/KK TS NA WX TS WD NA National WD WX Q1 WX National NA 91 NA 91 NA 91 NA 91 NA 91 NA 91 NA - NA 91 NA 91 NA HSE National Q4 SE 2009 Q Q1 HSE 2010 SE Q NA 89 NA NA HSE 2008 SE Q NA Not available at time of going to print % Uptake at 24 months of age DD 3 3 PP 3 3 T 3 3 Hib 33 Hib b b Pol 3 MenC 3 MMR 1 HSE SE SE Q1 Q CW/KK TS TS WD WD WX WX National 94 NA 94 NA 94 NA 93 NA 87 NA 94 NA 94 NA 90 NA Q1 Q HSE SE SE Q1 Q * * Hib Hib b b figure for for months does not include those who have had a Hib dose >12 months as part of 5IN1/6IN1 The new primary immunisation schedule commenced in September 2008 for children born on or after July 1 st, 2008 (see for complete details). The immunisation uptake rates presented in this report for children at 12 months of age in Quarter are children born between 31/10/2008 and 31/12/2008 and who have been immunized according to the new schedule. They have received three doses of vaccines against diphtheria (D3), pertussis (P3), tetanus (T3), Haemophilus influenzae type b (Hib3), polio (Polio3), hepatitis B (HepB3), two doses of meningococcal serogroup C conjugate vaccine (MenC2), two doses of pneumococcal The new primary immunisation schedule commenced in September 2008 for children born on or after July 1st, 2008 (see The new primary immunisation schedule commenced in September 2008 for children born on or after July 1 st for complete details). The immunisation uptake rates presented in this, 2008 (see for complete details). The immunisation uptake rates report for children at 12 months of age in Quarter are children born between 01/01/2009 and 31/03/2009 and who have presented in this report for children at 12 months of age in Quarter are children born been between immunized 01/01/2009 according to and the 31/03/2009 new schedule. and They who have received have been three immunized doses of vaccines according against to diphtheria the new (D3), pertussis (P3), schedule. tetanus (T3), They Haemophilus have received influenzae three type doses b (Hib3), of polio vaccines (Polio3), against hepatitis diphtheria B (HepB3), (Dtwo 3 ), doses pertussis of meningococcal (P 3 ), serogroup tetanus C (Tconjugate 3 ), Haemophilus vaccine (MenC2), influenzae two doses type of b pneumococcal (Hib 3 ), polio conjugate (Polio 3 vaccine ), hepatitis (PCV2) B and (HepB one dose 3 ), two of BCG doses vaccine. of Uptake meningococcal of immunisations serogroup in the South C conjugate East 12 months vaccine of (MenC age increased 2 ), two by doses between of 3-4% pneumococcal compared with conjugate the same period in conjugate vaccine (PCV2) and one dose of BCG vaccine vaccine For children (PCV 2 ) aged and 24 one months dose of of age BCG in the vaccine. South East in Q1 2010, immunisation uptake rates increased by between 5-7% compared Uptake with of immunisations Q1, The target in the uptake South rate East of 95% at was 12 months achieved by of all age LHOs increased for BCG at by 12 between months and 3-4% for D3, P3, T3 Hib3, compared Hibb and with Pol3 the in Carlow/Kilkenny same period at in months. For Hibb children uptake aged was 95% 24 at months 24 months of age in Waterford in the and South an uptake East in rate Q1 of > 2010, 95% was immunisation achieved for D3, uptake P3, T3 rates Hibb, increased Pol3 and MMR1 by between in Wexford 5-7% at 24 months compared in Q with Q1, The target uptake at 12 months rate of and for 95% D3, was P3, T3, achieved Hib3, Pol3 by and all MenC3 LHOs in for Wexford BCG at at 1224 months and in Q4 for D 3, P 3, T 3 Hib 3, Hib b and Pol 3 in Carlow/Kilkenny at 24 months. Hib b uptake was 95% at 24 months in Waterford and an uptake rate of > 95% was achieved for D 3, P 3, T 3 Hib b, Pol 3 and MMR 1 Wexford at 24 months in Infectious Disease Notification: contact information Q Uptake of immunisations in the South East at 12 months of age increased by 1% compared with the same period in For children aged 24 months of age in the South East in Q4-2009, immunisation uptake rates increased by between 1-2% compared with Q4, The target uptake rate of 95% was achieved by all LHOs for BCG Medical practitioners and Clinical directors of diagnostic laboratories are required to transmit a written or electronic notification of a notifiable infectious disease to a Medical Officer of Health (the Infectious Diseases (Amendment) Regulations, 2000 (S.I. No 151 of 2000)). Printed copies of Case Definitions for Notifiable diseases which include a booklet of standard notification forms are available from regional public health department offices, to which notifications should be returned. Notifications can be phoned: , faxed: or posted to: Public Health Department, HSE South (SE), St Canice s Hospital, Lacken, Dublin Road, Kilkenny This report is is produced with the data provided by the Edited by: Dr. Orlaith O Reilly, Director of of Public Health Senior Medical Officers, Environmental Health Officers, Waterford Regional Hospital Laboratory, Hospital Clinicians, Regional STI Clinics and General Practitioners. Compiled by: Dr. Julie Heslin, Consultant in in Public Health Medicine Ms. Bernadette O Connor, Surveillance Scientist Dr. Colette O Hare, Surveillance Scientist Public Health Department, HSE South (SE), Lacken, Dublin Road, Kilkenny. Tel: cc Nov Aug 2010 Health Service Executive South Eastern Area Published by the Communications Department. Reference Number