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8 Type of Communicable diseases and their prevention

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 8 Type of Communicable diseases and their prevention

  • Tuberculosis 
  • Diphtheria 
  • Pertussis
  • Tetanus
  • Measles
  • Hepatitis 
  • Typhoid Fever
  • Hepatitis-A

1-Tuberculosis 

Tuberculosis is a contagious infection caused by the bacterium Mycobacterium tuberculosis. It is one of the leading causes of death worldwide. Annually, between three and four million people die of disease, with 90 percent of these deaths occurring in developing countries. It is extremely common in Asia and Africa. Although it is most commonly associated with the lungs, it can affect other parts of the body, including the bones, joints, and brain.

Spreading Mode

Tuberculosis of the lungs is an airborne infection. When an infected person coughs, a large number of live tuberculosis bacteria are coughed into the air, where they remain suspended for a variable period of time depending on their size. Infection occurs when a person inhales air contaminated with tuberculosis bacteria. The risk of tuberculosis spreading is greater where people live in overcrowded conditions, when they do not seek appropriate care in a timely manner, and when a child is malnourished.
The risk of developing tuberculosis is greatest in children under the age of three. Individuals with weakened immune systems, such as those living with HIV/AIDS, are more likely to contract the diseases than individuals with healthy immune systems.
Period of Incubation: The time period between infection and the development of a positive tuberculin test is between 3 and 6 weeks, and the subsequent development of disease is dependent on
Contact distance and duration
  • The severity of disease in the index case 
  • Index case's sputum positivity status
  • Closeness and duration of contact 
  • The severity of the index case's disease 
  • Index case's sputum positivity status

Symptoms and Warning Signs

Tuberculosis is suspected when an ill child has a history of chronic illness with cough and fever lasting 3–4 weeks or longer, chest pain, and hemoptysis. These are considered cardinal features of the disease. Other characteristics include weight loss, an inability to regain normal health following measles or whooping cough, and a history of contact with an adult case of pulmonary tuberculosis.
Extrapulmonary disease is possible, with symptoms suggestive of tuberculosis in other organs such as the skeletal system, central nervous system, gastrointestinal tract, genito-urinary system, eyes, ear, heart, and skin.

Indeed, children are more likely than adults to develop the extrapulmonary disease. Multiple symptoms, such as malnutrition, lymphadenopathy, chest pain, hepatomegaly and/or splenomegaly, meningeal signs, and/or pleural effusion or ascites, may be present on examination.
Tubercular Meningitis (TBM), Miliary Tuberculosis, and Disseminated Tuberculosis are the most dangerous forms of tuberculosis. TBM is most frequently seen in children between the ages of six and four months and is characterized by meningeal irritation, convulsions, cranial nerve paralysis, and coma. Miliary Tuberculosis causes the appearance of small discrete millet seed-like shadows in all areas of the lungs. In Disseminated Tuberculosis, the bacteria spread via a lympho-hematogenous route to distant sites, where they may infect the liver, spleen, bones, and joints, among other organs.
Prevention Immunization with BCG vaccine is the best protection available for children against tuberculosis infection spread. Those diagnosed with tuberculosis should be treated promptly with appropriate antitubercular medications. Early diagnosis and treatment with RNTCP will, in the majority of cases, convert the patient to the non-infectious type within 48 hours and prevent the disease from spreading further in the community.

Vaccine BCG

Bacillus of Calmette and Guerin are denoted by the letters B, C, and G. The name "Bacillus" refers to the bacterium's shape. Calmette and Guerin are the surnames of the vaccine's developers. BCG vaccine is available in powder form. It must be reconstituted with the accompanying diluent prior to use (Normal Saline). The reconstituted vaccine is more heat-sensitive than the powdered vaccine. As a result, it must be used during the same session or within four hours of the previous session, whichever is earlier. Throughout the session, keep the vaccine in the shade or cover it with black paper to avoid exposure to sunlight.
The BCG vaccine protects infants and young children against tuberculosis in childhood.
Its role in preventing tuberculosis in children and tuberculous meningitis is well documented.

2-Diphtheria 

Diphtheria is a contagious disease that is caused by the bacterium Corynebacterium diphtheria. It is more prevalent during the colder months and in temperate climate zones. The bacteria produce a toxin that causes necrosis of local tissue. A greyish white pseudomembrane is formed by bacteria and necrotic cells that contain serofibrinous material. When attempts are made to dislodge it, it bleeds. The surrounding tissue is inflamed and oedematous. The toxin causes neuritis, myocarditis, and renal damage through its distal action. These complications have a significant impact on the health of those affected, most notably myocarditis, which can be fatal.

Spreading Mode

The respiratory tract is the most frequently used entry point. The source of infection is the secretions or discharge of an infected person/carrier. The disease is spread through droplet infection, direct contact, and fomites. Drying does not kill the bacteria.
Vulva, conjunctiva, skin wounds, and the internal ear are occasionally involved. Diphtheria is usually fatal within two to five days of infection. Individuals who are infected can spread the disease for up to four weeks. During outbreaks and epidemics, some children may carry the germ without exhibiting any symptoms, but they can still spread the disease to others (healthy carriers). Disease spread is facilitated by overcrowded and impoverished living conditions.

Symptoms and Warning Signs

When diphtheria affects the throat and tonsils, the first symptoms are sore throat, loss of appetite, mild fever, and cervical lymphadenitis. A bluish-white or grey membrane forms in the throat and tonsils within two to three days. If bleeding occurs, the membrane may become grayish-green or black in colour. It adheres to the soft palate of the throat and attempts to remove it may result in bleeding. The membrane may obstruct the airway in severe cases. At this point, the patient may recover or develop severe weakness and die within six to ten days. Patients with severe disease may not develop a high fever, but may develop neck swelling and airway obstruction, which can result in death if not treated properly.

Hoarseness of voice, croupy cough, inspiratory stridor with chest indrawing, subcostal, suprasternal recession are all symptoms of Laryngeal Diphtheria. Serosanguinous/purulent rhinitis is the hallmark of nasal diphtheria. It may be associated with shallow nasal and upper lip ulceration.
Lesions associated with cutaneous diphtheria may be painful, red, and swollen. Any chronic skin lesions are susceptible to diphtheria infection.

Complications that are frequently encountered include the following: 
  • Myocarditis 
  • Toxic Neuropathy 
  • Palatal Palsy 
  • Facial or Laryngeal Nerve Palsy 
  • Polyneuritis 
  • Diaphragmatic Paralysis

Prevention

Early detection and prompt treatment with antibiotics and anti-diphtheria serum (ADS) may save lives and halt disease spread. The most effective method of preventing diphtheria is to immunize the child aggressively with the DPT-containing "Pentavalent" Vaccine. Antibodies acquired transplacentally from the mother may protect the child for a brief period (about six months in the majority of cases).
Under the Universal Immunisation Programme, the pentavalent vaccine is administered at the ages of 6 weeks, 10 weeks, and 14 weeks, followed by a DPT booster dose (first dose) at 16 months (16-24 months) and a second booster dose at 5 years of age. The second dose should be administered at least four weeks after the first dose.

3-Pertussis

Bordetella pertussis is a highly contagious disease caused by the bacteria Bordetella pertussis and, on rare occasions, Bordetella parapertussis. Pertussis is a Latin term that translates as "intense cough" (per means "intense" and tussis means "cough"). It is most prevalent in children under the age of five. Children with pertussis experience bouts (paroxysms) of coughing spells, which are characterised by the characteristic whoop sound for which the disease is also known as Whooping Cough. Pertussis is preferred over whooping cough because the majority of infants do not have whoop.
Children who were not immunised were attacked more frequently. The incidence is higher in areas with low Pentavalent/DPT vaccine coverage. The disease is most dangerous in infants less than one year old and results in long-term respiratory disabilities.


Spreading Mode

The disease is spread through droplet infection, with an attack rate of nearly 100%. It spreads very easily from person to person via coughing or sneezing droplets. In many countries, the disease occurs in three- to five-year epidemic cycles.

Symptoms and Warning Signs

Typically, the disease progresses through three distinct phases: catarrhal, paraoxysmal, and convalescent.
  • Catarrhal phase
  • Runny nose 
  • Watery eyes 
  • Sneezing 
  • Fever
Two weeks is the duration of the catarrhal phase.

(2–4 weeks) Paroxysmal Phase

The cough worsens gradually and is characterised by numerous bouts of rapid coughing. At the conclusion of these bouts, the child exhales a high-pitched whoop. During a coughing spell, a child may experience sub-conjunctival haemorrhage. The child may turn blue as a result of a lack of oxygen during prolonged coughing bouts. Vomiting and exhaustion frequently occur as a result of coughing attacks, which are more frequent at night. Physical examination findings between paroxysms may be normal. This stage typically lasts between one and six weeks, but may extend to ten weeks. With time, the attacks become milder.

Recuperation (2–4 weeks)

During this phase of recovery, the frequency, severity, and duration of attacks decreases until they cease.

Complications

Complications are most prevalent in newborns.
  •  Respiratory: The most common respiratory complications are pneumonia, apnoea, laryngospasm, pneumothorax, emphysema, and tuberculosis reactivation. The majority of deaths are caused by bacterial pneumonia.
  • Hemorrhage of the subconjunctival, epistaxis.
  • CNS: Hypoxia of the brain resulting in seizures. There have also been reports of intracranial hemorrhage.
  • Various others: Inadequate hydration, malnutrition, frenular ulcer, inguinal hernia, and rectal prolapse

Prevention

Whooping Cough or Pertussis is preventable through vaccination with a killed bacterial vaccine in combination with diphtheria and tetanus toxoid. Pertussis is prevented through primary immunisation with the Pentavalent/DPT vaccine and booster doses as recommended by the UIP. Though it is uncommon, it is worth noting that the DPT vaccine may cause convulsions due to the pertussis component. As a result, the child's attendant should be asked to wait approximately half an hour after the DPT vaccine is administered. Additionally, if a child develops convulsions following the first dose of pentavalent vaccine, the subsequent dose should be withheld.

4-Tetanus

It is a contagious disease caused by Clostridium tetani, an anaerobic organism. The organism is found in soil, dust, and the digestive tracts of a variety of animals.
The organism produces spores that are resistant to boiling but not to autoclaving. It produces the toxin tetanospasmin, which causes muscle spasms in affected individuals. The face and body assume an abnormal shape as a result of the spasms.
It can strike anyone at any age, but the disease, known as Neonatal Tetanus (NNT), is extremely lethal in newborns. Tetanus occurs as a result of soil and dirt contamination of the wound. A child with otitis media is also at risk of contracting tetanus. NNT can occur as a result of the cord being cut with an unsterilised blade or a dirty substance being applied to the umbilical stump of a newborn baby whose mother did not receive adequate tetanus vaccination during pregnancy.
Tetanus is a significant endemic disease in India.
The objective is to reduce NNT to less than one case per 10,000 live births in each district. To ensure that all deliveries are made by trained personnel

Spreading Mode

Tetanus is not contagious. If soil or dung enters a wound, a person may become infected. Tetanus germs are more likely to grow in puncture wounds caused by dirty nails, needles, barbed wire, thorns, wood splinters, or animal bites.
If the knife, razor, or other instrument used to cut the umbilical cord is dirty or rusted and contains germs, the newborn baby may become infected. Additionally, infection can occur if cow dung or ash is used to dress the cord or if soil enters the newborn's naval. Tetanus can also be transmitted to infants and children via contaminated instruments used for circumcision, scarification, and skin piercing, as well as through tattooing and when dirt, charcoal, or other unclean substances are rubbed into a wound.

Period of Incubation

The NNT typically manifests between three and twelve days after birth. The incubation period in older children and adults is typically between three and ten days but can last up to three weeks. The shorter the period of incubation, the more severe the disease and the greater the risk of death.
Infectivity It is not contagious.

Symptoms and Warning Signs

In older children, masseter spasm occurs, resulting in a locked jaw (trismus) and difficulty swallowing. Stiffness, difficulty chewing, dysphagia, salivary drooling, and neck muscle spasms ensue. There could be a fever. Muscle spasms are typically triggered by touch, light, or sound. Sensorium continues to function normally. A newborn with tetanus (NNT) appears normal at birth but is unable to sucking after three days. This is the introductory feature. They later develop the typical tetanus face (clenching of the jaw, laterally drawn lips, and raised brows) with lockjaw; even facial muscle contraction is visible. The entire body stiffens, severe muscle contractions and convulsions occur, the body is twisted backwards into a bow shape due to back muscle spasms, and death occurs in the majority of cases.

Neonatal Tetanus can be prevented by immunizing pregnant women with two injections of Inj Tetanus Toxoid, administered four weeks apart — second dose/booster dose (if two doses were given during the previous pregnancy) given at least four weeks before delivery
• Training of Traditional Birth Attendants and delivery by trained personnel (TBA)
• Performing deliveries in accordance with the Five Cleans

Immunization in Passive Mode

  • Surgical wound cleaning/extraction of a foreign body or necrotic tissue should be performed under the supervision of an antibiotic and TIG.
  • In high-risk cases, 250–500 units of tetanus immunoglobulin (TIG) should be given intramuscularly (IM) prior to the onset of symptoms.
  • Immunization in Action
  • Active immunization with tetanus toxoid is the best way to prevent tetanus. • All pregnant women should receive two doses of tetanus toxoid. The first dose is administered immediately upon detection of pregnancy, followed by a second dose after a minimum of four weeks.
  • This safeguards both the mother and the infant against tetanus.
  • Routine immunization with pentavalent, DPT, and TT at the recommended ages (6,10, and 14 weeks, 16–24 months, 5–16 years) according to the UIP schedule protects the child against tetanus for life.

5- Measles

Rubeola is a word that means "red spots." Measles is an acute infectious disease of childhood caused by the Measles virus and characterised clinically by fever, cough, coryza, conjunctivitis, and Koplik's spots, which appear on the fourth day of the illness. It is a leading cause of morbidity and mortality in developing countries. Measles is a leading cause of morbidity and mortality among children in India. In hospitalised cases of measles alone, the case fatality rate is 4–8 percent. 

The case fatality rate in developing countries ranges from 200 to 1500, whereas it is less than 0.2 per 10,000 in developed countries. In some parts of the country, studies found measles prevalence in children under the age of five to be as high as 4–7 percent. It's a highly contagious illness. It spreads quickly, is always present in some populations, and frequently occurs in epidemic proportions. In conditions of overcrowding and poverty, where large numbers of unvaccinated people live in close quarters, outbreaks are common. The disease is more common between the ages of 9 months and 3 years. Maternal antibodies are transferred through the placenta to protect newborns and young infants. The only reservoirs are humans. Measles vaccine coverage is relatively low among UIP vaccines. Measles has a cyclical pattern. Malnutrition occurs after a Measles attack, and Measles is extremely dangerous if it occurs in a malnourished child.

Spreading Mode

Measles is an airborne disease spread through droplet infection. When a measles patient sneezes or coughs, a large number of airborne droplets are released into the air. Inhaling these droplets transmits disease to others. Airborne droplet transmission can occur even two hours after an infected person has left a room or closed area. The respiratory tract is the point of entry. The disease spreads quickly wherever infants and children congregate.

Symptoms and Warning Signs

The incubation period lasts ten days (ranges from 7 to 18 days). The first symptom of infection is a high fever that lasts one to seven days. During this time, you may experience a running nose, cough, red and watery eyes, and small white spots inside your cheeks (Koplik's spots). A slightly raised rash appears after a few days, usually on the fourth day, and spreads from the face and upper neck down to the body, then to the hands and feet over a three-day period. It lasts for five to six days and gradually fades from the same areas. Loss of appetite and loose stools are also possible, especially in infants.
Special Attention Is Required

The following points deserve special consideration:

  • Measles is notorious for its complications, which occur most frequently in children under the age of five.
  • Immediate post-measles complications include diarrhoea, pneumonia, malnutrition, and signs of vitamin A deficiency (acute deficiency can cause keratomalacia and blindness), otitis media, encephalitis, and death.
  • The most common cause of death associated with measles is pneumonia. This is typically due to the measles virus weakening the immune system. The pneumonia could be caused by the measles virus or by another germ. The neurological complications, which include febrile convulsions, encephalitis, and subacute sclerosing pan-encephalitis, are the most serious (SSPE).
  • A measles outbreak reactivates dormant tuberculosis.
  • Measles is a significant contributor to the prevalence of malnutrition. Measles is a leading cause of childhood blindness due to the development of an acute vitamin A deficiency during a Measles attack. Children who are malnourished are more likely to develop this complication.
  • Measles survivors are immune for the rest of their lives. Infants born to measles-infected mothers are usually immune for six to eight months.
  • If a parent brings their child in with any of the above-mentioned common complications, a history of measles within the last two months should be requested.
  • Management of a Case
  • There is no specific anti-viral medication available to combat the measles virus.
  • Patients are only treated symptomatically with supportive measures.
  • Vitamin A, two lakh international units for more than one year and one lakh international units for one year, reduces disease severity and prevents further deficiency of Vitamin A. This contributes to the prevention of blindness. As soon as a child is diagnosed with measles, he or she should receive vitamin A supplementation.
  • Feeding should be continued because there is a tendency to withhold food during and after a Measles attack.
  • Dehydration must be treated with an oral rehydration solution for diarrhoea.
  • Antibiotics may be required for pneumonia.

Prevention

Measles prevention entails immunization with measles vaccine. At the age of 9 months (9–12 months), children should receive one dose of the vaccine.

Vaccination Against Measles

It is a viral vaccine that has been live attenuated. Measles vaccine is available in powder form, along with a diluent. It must be reconstituted before it can be used. Measles vaccine that has been reconstituted must be used within four hours or discarded.
It should be noted that vitamin A is given at the same time as the measles vaccine.

How is it kept?

The measles vaccine should be stored at temperatures ranging from 2°C to +8°C. Freeze dried measles vaccine is not damaged by freezing, but it is damaged by temperatures that remain above 8°C for an extended period of time.

When does it occur?

Measles vaccine is typically administered as soon as the child reaches the age of nine months.
Maternal antibodies against measles have a longer duration of action than other antibodies. As a result, immunisation with measles vaccine is frequently ineffective before the age of 9 months.

Dose Count and Amount

A single dose of 0.5 mL vaccine is administered.

Where and how is it distributed?

The measles vaccine is injected into the skin's subcutaneous layer in the upper right arm (conventionally BCG is given in left arm).
Consequences A week after immunisation, a mild fever and rash lasting one to three days may occur.


6-Hepatitis

There are several types of Hepatitis viruses, including A, B, C, E, and delta Hepatitis.
The modes of transmission of these antigenically distinct viruses differ. The severity of complications and fatalities varies as well. Hepatitis B is one of the viruses that requires special attention. It is distinct from Hepatitis A and C.
  • A significant public health issue
  • 200 million people have been exposed globally; the WHO recommends the HB vaccine for all children worldwide.
  • Hepatitis B is distinct from Hepatitis A and Hepatitis C. 
  • Hepatitis B is transmitted in the same way that HIV is (via blood and sex), but it is 100 times more infectious.
  • Hepatitis B (also known as Serum Hepatitis) is an acute systemic infection caused by the Hepatitis B virus that causes significant pathology in the liver (HBV). The parenteral route is the most common mode of transmission. It is usually an acute self-limiting infection that can be sub-clinical or symptomatic. In about 5% to 15% of cases, HBV infection does not resolve, and the affected individuals become chronic carriers of the virus.
  • Persistent HBV infection can lead to chronic liver disease, such as active hepatitis and primary liver cancer.
  • Adults who become infected become ill, but rarely become chronic carriers (less than 15 percent )
  • Infected infants may not show symptoms, but they are at high risk of chronic carriage (more than 90%).
  • Chronic carriers are at a high risk of developing fatal liver disease later in life, including liver cancer.
  • In India, hepatitis B is a major public health issue. Hepatitis B accounts for 30–40% of the total viral hepatitis burden; however, because many cases go unreported or unrecognised, determining the actual number of Hepatitis B cases would be difficult.
  • In India, the chronic carrier rate ranges between 2 and 7 percent, with no seasonal pattern.

Mode of Spread

Hepatitis B is found in high concentrations in blood, serum, serous exudates, saliva, sperm, vaginal fluids, and the majority of other bodily fluids. However, it is typically transmitted through contact in the following ways:
  1. Perinatal transmission from mother to child.
  2. Ingestion of contaminated blood through cracked nipples of a carrier mother may aid in the spread of infection during feeding.
  3. The use of infected blood or blood products in transfusions.
  4. Hepatitis-B virus injections using unsterile needles or syringes from an infected person.
  5. Transmission of cuts, scrapes, and scratches between children during social contact.
  6. Transmission occurs during sexual contact with an infected person or a carrier.

Symptoms and Warning Signs

  • Asymptomatic: People who are chronic carriers of HBV infections are frequently asymptomatic.
  • Viral Hepatitis Acute: Fever, abdominal discomfort, vomiting, passing of dark urine, pain in the abdomen, hepatomegaly, and other symptoms are similar to those seen in other types of viral hepatitis. Jaundice usually lasts longer than in other viral hepatitis (> 14 days).
  • Hepatitis A/B/C/D/E/F/G/E/F
  • Chronic Persistent Hepatitis: Enlargement of the liver and elevation of SGPT.
  • It has the potential to progress to Chronic Active Hepatitis. A liver biopsy confirms the diagnosis.
  • Chronic Active Hepatitis: A variety of constitutional symptoms, including fatigue, persistent or intermittent jaundice, arthralgia, arthritis, purpura, nephritis, and generalised vasculitis (polyarteritisnodosa). The SGPT level is elevated. The diagnosis, like Chronic Persistent Hepatitis, is confirmed by a liver biopsy.
  • Complications
  • Acute infection can have serious consequences. Only a small percentage of adults die. The majority of serious complications, such as chronic hepatitis, liver failure, and liver cancer, occur in people who have a chronic infection


Vaccine for Hepatitis B

The Hepatitis B vaccine comes in two varieties:
• Plasma-derived vaccines • Recombinant vaccines
It is administered as a birth dose and is also a component of the Pentavalent vaccine, which is administered in three doses at six, ten, and fourteen weeks of age. The Hepatitis B Vaccine is a cloudy liquid packaged in a ten-dose vial. If the Hepatitis B Vaccine is kept stationary for an extended period of time, it separates from the liquid and appears as fine sand particles at the bottom of the vial.
Temperature of Storage The Hepatitis B Vaccine should be stored at temperatures ranging from +2°C to +8°C. Hepatitis B vaccine is damaged by both heat and freezing. Use the shake test to see if it has frozen, as in the case of DPT and TT.

When does it occur?

At the moment, the Government of India adheres to this schedule.
• At 6 weeks, receive dose 1 of the pentavalent vaccine; at 10 weeks, receive dose 2 of the pentavalent vaccine; and at 14 weeks, receive dose 3 of the pentavalent vaccine.

Where and how is it distributed?

The Hepatitis B vaccine is administered via injection into the muscle on the antero-lateral side of the upper thigh.
Hepatitis B immunoglobulin (HBIG) is used for immediate protection for those who have been exposed to HBsAg-positive blood, such as (a) surgeons, nurses, or laboratory workers, (b) newborn infants of carrier mothers, (c) sexual contacts of acute hepatitis B patients, and so on. The HBIG should be administered as soon as possible after an unintentional inoculation (ideally within 6 hours and no later than 48 hours).

7-Typhoid fever

Typhoid fever is caused by a systemic infection with S. typhi, which is only found in humans.
The disease is clinically distinguished by a typical continuous fever lasting 3 to 4 weeks, relative bradycardia with lymphoid tissue involvement, and significant constitutional symptoms. Both typhoid and paratyphoid fevers are included in the term "enteric fever."

Typhoid fever is widespread in India. According to reported data for 2013, there were 1.53 million cases and 361 deaths. The most common cause of enteric fever is S. typhi. The infecting dose and the organism's virulence are two factors that influence the onset of typhoid fever in humans.
Man is the only known reservoir of infection, both as a case and as a carrier. The case could be mild, overlooked, or severe. The primary sources of infection are cases' or carriers' faeces and urine; secondary sources include contaminated water, food, fingers, and flies. No evidence suggests that typhoid bacilli are excreted in sputum or milk.

Spreading Mode

Typhoid fever is spread through the fecal–oral or urine–oral routes. This can happen directly through soiled hands contaminated with cases' or carriers' faeces or urine, or indirectly through ingestion of contaminated water, milk, and/or food, or through flies. Typically, the incubation period lasts 10–14 days. However, depending on the dose of bacilli consumed, it could be as short as three days or as long as three weeks.

  1. The onset is usually gradual, but in children it can be sudden, with chills and a high fever. Symptoms of the prodromal stage include malaise, headache, cough, and sore throat, as well as abdominal pain and constipation.
  2. The fever rises in a step-by-step manner. After about 7–10 days, the fever settles and the patient appears toxic, exhausted, and often prostrated. (Note: Double-check it.)
  3. Constipation may be severe, especially in the early stages of "pea soup" diarrhoea.
  4. The rash (rose spots) usually appears during the second week of illness. The individual spot, which is mostly found on the trunk, is a pink papule 2–3 mm in diameter that fades with pressure. It vanishes in 3–4 days.
  5. Serious complications occur in up to 10% of typhoid fever patients, particularly those who have been sick for more than two weeks and have not received proper treatment. A sudden drop in temperature and signs of shock, followed by dark or fresh blood in the stool, are symptoms of intestinal haemorrhage.

Early detection and treatment of typhoid fever: This is critical because the early symptoms are non-specific.

Treatment

Fluoroquinolones are widely regarded as the preferred treatment for typhoid fever. They are less expensive, well tolerated, and more quickly and consistently effective than the previous first-line drugs, namely chloramphenicol, ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole.
Immunisation
While typhoid fever control must ultimately take the form of improved sanitation and domestic and personal hygiene, these are long-term goals in many developing countries. Immunization is a complementary approach to prevention because it is the only specific preventive measure that is likely to yield the greatest benefit for the least amount of money spent.

VACCINES AGAINST TYPHID

The previous parenteral killed whole-cell vaccine was effective but had severe side effects. Two vaccines that are both safe and effective are now licenced and available. The first is based on defined subunit antigens, while the second is based on whole-cell live attenuated bacteria.
The vaccine against Vi polysaccharide It is made up of purified Ty2 S Vi capsular polysaccharide. The vaccine is either subcutaneously or intramuscularly administered.
Schedule The vaccine is only approved for people over the age of two. There is only one dose required, and the vaccine provides protection 7 days after injection. Revaccination is recommended every three years to maintain protection.

Ty21a vaccination

This vaccine, which was first licenced in Europe in 1983 and in the United States in 1989, is an orally administered, live-attenuated Ty2 strain of S. Typhi in which multiple genes, including those responsible for vaccine production, are present. Schedule The vaccine is given every other day; on the first, third, and fifth days, a three-dose regimen is recommended. For people living in endemic areas, it is recommended that this series be repeated every three years.

8-The hepatitis A

The hepatitis A virus, which causes the disease, is an enterovirus. The virus's faecal shedding is at its peak during the late incubation period and the early acute phase of illness. There is only one serotype known. Low pH, heat, and chemicals have little effect on the virus. Formalin is said to be a powerful disinfectant. UV rays, as well as boiling for 5 minutes or autoclaving, inactivate the virus.
Infection Reservoir: Human cases are the only reservoirs of infection. The infections range from asymptomatic to life-threatening.

Transmission Modes

ORAL—FAECAL ROUTE: This is the primary transmission path. It can spread through direct (person-to-person) contact or indirectly through contaminated water, food, or milk.

INFECTIVE MATERIAL: Primarily human faeces. During the brief period of viraemia, blood, serum, and other fluids are infectious.
INFECTIOUS PERIOD:
From two weeks before to one week after the onset of jaundice, the risk of transmitting HAV is greatest. With the onset of jaundice, infectivity decreases rapidly. HAV infection is more common in children than in adults. However, people of all ages may become infected if they are susceptible.

Clinical Range

Gastrointestinal symptoms such as nausea, vomiting, anorexia, and mild fever are frequently associated with the onset of jaundice. Although jaundice can appear within a few days of the prodromal period, anicteric hepatitis is more common. Hepatitis A is completely cured in 98% of cases, but symptoms recur in 3–20% of cases.

Transmission Control

The most effective way to reduce the spread of infection is to promote simple personal and community hygiene measures, such as hand washing before eating and after using the restroom.
Vaccines: There are currently two types of hepatitis A vaccines in use around the world:
a) Formaldehyde-inactivated vaccines, which are manufactured in several countries and are widely used around the world.
b) Live attenuated vaccines, which are produced in China and are available in a number of countries.
Inactivated hepatitis A vaccines are approved for use in children as young as two and a half months old. The entire vaccination regimen consists of two doses administered into the deltoid muscle.
The time between the first (primary) and second (booster) doses is typically 6–12 months; however, the time between doses is flexible and can be extended to 18–36 months. It can be given in conjunction with other vaccines. The protective efficacy of the vaccine after two doses is approximately 94%.
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