In the UK we immunize against the following diseases.
Diphtheria is now very rare in developed countries. It is caused by the organism Corynebacterium diphtheriae. Infection occurs in the throat, forming a pharyngeal exudate, which leads to membrane formation and obstruction of the upper airways. An exotoxin released by the bacterium may cause myocarditis and neuritis with paralysis.
Tetanus is caused by an anaerobic organism, Clostridium tetani, found universally in the soil, which enters the body through open wounds. Progressive painful muscle spasms are caused by a neurotoxin produced by the organism. Involvement of the respiratory muscles results in asphyxia and death.
Pertussis (Whooping Cough)
Whooping cough is caused by the bacterium Bordetella pertussis. It lasts for 6–8 weeks, and has three stages: catarrhal, paroxysmal and convalescent. Paroxysms of coughing are followed by a whoop (a sudden inspiratory effort against a narrowed glottis), with vomiting, dyspnoea and sometimes seizures. Complications include bronchopneumonia, convulsions, apnoea and bronchiectasis. The diagnosis is clinical, and can be confirmed by nasopharyngeal culture. Erythromycin given early shortens the illness, but is ineffective by the time the whoop is heard. There is high morbidity and mortality in children under the age of 2 years.
Polio is caused by the poliomyelitis virus, which produces a mild febrile illness, progressing to meningitis in some children. Anterior horn cell damage leads to paralysis, pain and tenderness. It may also cause respiratory failure and bulbar paralysis. Residual paralysis is common in those who survive.
Haemophilus Influenzae B
Haemophilus influenzae type B (Hib) was the main cause of meningitis (Chapter 14) in young children before the vaccine was introduced. It led to severe neurological sequelae such as profound deafness, cerebral palsy and epilepsy in 10–15% of cases and death in 3%. The vaccine is only effective against type B infection.
Pneumococcal disease is caused by Streptococcus pneumoniae, which can produce serious invasive disease including septicaemia, meningitis and pneumonia.
Meningococcus C causes purulent meningitis in young children with a purpuric rash and septicaemic shock. Mortality is as high as 10% and morbidity includes hearing loss, seizures, brain damage, organ failure and tissue necrosis.
Measles is characterized by a maculopapular rash, fever, coryza, cough and conjunctivitis. Complications include encephalitis leading to neurological damage and a high mortality rate. In the UK there has been a recent reduction in vaccine uptake due to unfounded concerns about an association with autism and inflammatory bowel disease. These have now been disproven, but unfortunately there has been an associated increase in cases of measles.
Mumps causes a febrile illness with enlargement of the parotid glands. Complications include aseptic meningitis, sensorineural deafness and orchitis in adults. It is a possible cause of subfertility in men.
Rubella is a mild illness causing rash and fever. Its importance lies in the devastating effects it has on the fetus if infection occurs in the early stages of pregnancy. These include multiple congenital defects such as cataracts, deafness and congenital heart disease.
Tuberculosis (TB) remains a major problem in many countries and is re-emerging in eastern Europe. It affects the lungs, meninges, bones and joints. Most children with TB are identified because they are contacts of infected adults. Symptoms include cough, tiredness, weight loss, night sweats, haemoptysis and lymphadenopathy. Most individuals with TB have a positive reaction on Mantoux skin testing. Active TB requires treatment that must be continued over many months. Drug-resistant strains are now emerging. BCG is recommended at birth for babies born in communities where there is a high prevalence.
Hepatitis B is an important cause of acute and chronic liver disease. It can be transmitted perinatally from carrier mothers or through blood transfusion, needlestick injuries and biting insects. Children with HBV may be asymptomatic. Babies born to HBsAg +ve mothers receive vaccination at birth.
Infection with humanpapillomavirus (HPV) is common, with over 50% of sexually active women infected over the course of their lifetime. Two strains of HPV (16 and 18) are the cause of cervical cancer in over 70% of cases.
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