Diphtheria General information Caused by the bacterium Corynebacterium diphtheria. Transmission is most often person-to-person spread via respiratorydroplets. The word diphtheria comes from Greek and means leather hide, a reference to the membrane that is characteristic of the disease. The disease was described in the 5th century BCE by Hippocrates. are based on the site of the infection. Infection may occur in the nose, throat, or larynx, the most common site is the throat. The bacterium releases a toxin which causes membrane formation at the site of the infection and tissue damage. The exudate spreads within 2 3 days and forms a membrane that may cause respiratory obstruction. Complications of diphtheria are 1), myocarditis, which causes abnormal cardiac rhythms and may be fatal and 2) neuritis which may cause localized paralysis but which usually resolves. In the 1920s, there were 100,000 200,000 cases of diphtheria in the United States that resulted in 13,000 15,000 deaths each year. Diphtheria was among the top four causes of death for children. Diphtheria continues to occur in other parts of the world. A major epidemic of diphtheria occurred in countries of the former Soviet Union beginning in 1990. By 1994, the epidemic had affected all 15 Newly Independent States. More than 157,000 cases that resulted in more than 5,000 deaths.
Chicken Pox Caused by the Varicella Zoster Virus. Transmission is most often person-toperson spread via respiratory droplets. Incubation period is 11-21 days after exposure. The disease is usually mild but can become complicated. The open lesions may develop serious bacterial infections that can lead to hospitalization or death. Herpes Zoster (shingles) is the reemergence of the virus in adults. Courtesy of Centers for Disease Control and Prevention Children begin with a rash and then fever. Children s first sign of the disease is a rash that progresses from macules to papules to vesicles before crusting. The lesions generally start on the head and then progress to the trunk. The majority of lesions are usually located on the trunk. The chicken pox infections may leave scars all over the body. Complications include secondary infections and encephalitis. Before the release of the vaccine in 1996, 11,000 people were hospitalized with varicella each year in the United States. In 1990-1996 there were 103 deaths each year from chicken pox, most in immunocompromised adults and children. After the vaccine was introduced, deaths from chickenpox dropped more than 90%.
Pertussis Caused by the bacterium Bordetella Pertussis. The bacteria attach to the cilia and produce toxins that paralyze the cilia. The toxins also cause inflammation and narrowing airways, because the cilia are paralyzed the person cannot clear the thick pulmonary secretions. It is a highly contagious respiratory infection. Transmission most commonly occurs via respiratory droplets. Also called whooping cough, the bacteria attach to the cilia and produce toxins that paralyze the cilia. The toxins also cause inflammation and narrowing airways, because the cilia are paralyzed the person cannot clear pulmonary secretions. Courtesy of Centers for Disease Control and Prevention An upper respiratory infection with a distinctive cough with an inspiratory whooping sound. The first stage is similar to a cold but after 1-2 weeks the cough becomes more severe. The severe cough may last from 1 10 weeks. Infants younger than 6 months may not have the strength to whoop at the end of the cough. Severe coughing attacks may cause the child to become cyanotic. The most common complication is a secondary bacterial pneumonia. Prior to the 1940 s when the vaccine became available, there were more than 200,000 cases of pertussis each year in the United States and the disease was a major cause of death in children. In 2004 through 2006, there were 82 deaths from pertussis reported in the United States. Children 3 months of age or younger accounted for 84% of these deaths.
Rotavirus Caused by the rotavirus; there are five different strains identified in the United States. Rotavirus is transmitted through the fecal-oral route and the virus is stable on environmental surfaces for long periods of time. This virus is commonly transmitted in schools, daycares and churches. Almost all children are infected by age 5. Reoccurrences of infection are common, but the severity of the illness is decreased. Most common cause of severe gastroenteritis in infants and young children. Courtesy of Centers for Disease Control and Prevention Rotavirus causes dehydration and possible death and can be prevented with a vaccine. The signs and symptoms of rotavirus are vomiting and watery diarrhea for 3-8 days, fever and abdominal pain. The rotavirus has a winter seasonal pattern. Most children are infected by two years of age. 2.5% of children who acquire the rotavirus will require hospitalization Before the vaccine about 50,000-70,000 children were hospitalized and between 20 60 children died because of rotavirus each year in the United States. Worldwide more than 500,000 children die as a result of rotavirus each year.
Tetanus The disease was described in the 5th century BCE by Hippocrates. The clinical manifestations of tetanus are caused by a potent neurotoxin produced by the bacterium Clostridium tetani. The spores are widely distributed in soil and found in domestic animal manure. Usually enters the body through an injury, such as a puncture from stepping on a nail. Tetanus is the only vaccine preventable disease that is not contagious from person to person. Commonly called lockjaw and often fatal. Courtesy of Centers for Disease Control and Prevention The disease usually presents with a descending pattern. The first sign is trismus or lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Muscle spasms may occur frequently and last for several minutes. Spasms continue for 3 4 weeks. Complete recovery may take months. Almost all reported cases of tetanus are in persons who have either never been vaccinated, or who have not had a booster in the preceding 10 years. Heroin users are at high risk for tetanus. In the late 1940s, before the tetanus toxoid was introduced into routine childhood immunization in the United States, 500 600 cases were reported per year and about 30% of those died. Recently, from 2000 through 2007 an average of 31 cases were reported per year and about 10% died. World-wide more than 250,000 infants die each year from neonatal tetanus caused by infection of unhealed umbilical stumps. This type of infection is very rare in the United States.
Measles Measles is an acute viral infectious disease. It is spread by personal contact via respiratory droplets. Measles is still a common disease worldwide. The virus remains active for 2 hours in the air. Courtesy of Centers for Disease Control and Prevention Measles begins with the upper respiratory symptoms of coughing, sneezing, red, watery eyes, runny nose, and a high fever. After 5-7 days a macularpapular rash becomes visible. The rash starts at the hairline and moves down the face to the body. An assessment finding that is sometimes seen with measles is blue-white spots on the inside of the cheeks called Koplick spots. About 30% of those with measles have complications. Complications include diarrhea, otitis media, pneumonia, and the severe complication of encephalitis. Measles outbreaks continue to occur in the United States. Most outbreaks occur when a measles case is imported from another country to a community with low vaccination coverage rates. In 2006, the WHO estimated there were 20 million cases from measles and 242, 000 deaths worldwide. Measles is the leading cause of preventable death in the world. In 2008, there were 132 measles cases reported in the United States; 92% were unvaccinated persons.
Pneumococcal Pneumococcal disease is a leading cause of serious illness in children and adults. Children less than 2 years of age and adults over 65 are most at risk. The bacteria, Streptococcus pneumococcus, can cause infection in different parts of the body and result in different types of disease. Pneumococcal infection in the lungs can result in pneumococcal pneumonia (most common presentation in adults). Pneumococcal infection in the bloodstream can result in bacteremia (most common presentation in children less than 2 years). The pneumococcus bacteria can also cause meningitis, otitis media (common in children) and sinusitis. Transmission occurs through direct person-to-person contact via respiratory droplets. Antibiotic resistant strains of pneumococcal bacteria have emerged. Pneumococcal pneumonia symptoms include fever, shortness of breath, cough, and chest pain. Meningitis symptoms include all of the symptoms listed and stiff neck, photophobia, and altered level of conscientiousness. Bacteremia is a blood infection and may have joint pain as a symptom. Otitis media symptoms are painful ear, swollen eardrum and irritability. Pneumococcal infections can cause long term complications that include hearing loss, brain damage and loss of limbs. Before the vaccine, an estimated 200 children died every year as a result of invasive pneumococcal disease. Although not considered invasive disease, an estimated 5 million cases of acute otitis media occurred each year among children younger than 5 years of age. Bacteremia without a known site of infection is the most common invasive clinical presentation of pneumococcal infection among children 2 years of age and younger.
Rubella Rubella (German Measles) is a viral infection that causes a fever and a rash. Transmission occurs through personal contact via respiratory droplets. Incubation is 12 23 days. Rubella symptoms are a macularpapular rash, swollen lymph nodes and a fever for two to three days. Infections are often mild and up to half of infections may not be visible. If a pregnant woman gets rubella it can cause serious birth defects in the fetus, called congenital rubella syndrome (CRS). Congenital infection with rubella virus can affect virtually all organ systems, although deafness is the most common. In 1964-65, before the vaccine, there were 12.5 million cases of rubella that resulted in 20,000 children born with CRS. Rubella rarely causes death. Courtesy of Centers for Disease Control and Prevention
Polio Polio (Poliomyelitis) is a virus that infects the nervous system and it is highly contagious. The virus enters through the mouth and multiplies in the pharynx, gastrointestinal track and lymph system. Polio is highly contagious and spread by oralfecal and oral-oral route. Last case of Polio in the US was in 1979. Courtesy of World Health Organization Most polio infections have no symptoms, some have non-specific symptoms, but 1% of the polio cases result in complete paralysis of the lower limbs. Polio can cause complete paralysis of the lower limbs and possible death. There have been no deaths from polio in the recent past because the vaccine is available worldwide. Nations are considered polio free after 3 years without any cases of polio reported. In 2008, there were about 1,600 cases of polio in 4 countries. The goal is to eliminate polio worldwide in the next decade.
Mumps Mumps is caused by a virus and transmitted by respiratory droplets. Incubation is 14-18 days. In 2009, there were over 6,000 mumps cases in the United States. Mumps symptoms are nonspecific flu like symptoms and tenderness and swelling in salivary glands and parotid glands. Courtesy of Centers for Disease Control and Prevention Orchitis, painful inflammation of the testicles, occurs in about 50 % of post pubertal boys. Meningitis may also be a complication of mumps. Sterility is rare. Pancreatitis and deafness occur infrequently. Mumps rarely causes death.
Haemophilus influenzae type B Haemophilus influenza type B is an aerobic gram negative bacteria. Haemophilus influenzae type B causes many infections including meningitis, pneumonia, epiglottitis, occult febrile bacteremia, septic arthritis, cellitus, otitis media, purulent pericarditis, endocarditis and osteomyelitis and other infections. The incidence of Hib has decreased by 99% to fewer than 1 of 100,000 children fewer than 5 years of age since 1990. Courtesy of American Academy of Pediatrics and Neal Halsey, M.D. will vary depending on the site of the infection. of meningitis include: fever, change in mental status, and stiff neck of epiglottis include: swelling in the throat and airway blockage, wheezing, coughing, etc. Joints are affected in 8% of cases, skin infections in 6%, pneumonia 16% and bone infection in 2%. Hearing impairment and neurologic changes occurs in 15 30 % of survivors. Before the vaccine, about 1,000 children died each year in the United States related to Hib disease. In 2009, only 2 children died that were attributed to Hib disease.