Childhood viral illnesses

Intended learning outcomes:<ul><li>Demonstrate an understanding of, and describe the pathogenicity, epidemiology, management and prevention of viral respiratory tract infections</li><li>Demonstrate an awareness and understanding of recent vaccine controversies</li><li>Demonstrate how viral infections are propagated</li></ul> Childhood viral infections:<img src="https://lh7-us.googleusercontent.com/uC0UwkL0elZhMFBIECvnTH9vFy-1L_IidBNES6tbkZc2sV4sofE4zmrElCCEBkZKWXqbh_ORRIUsGIOl9AExpy6-oInWSAmQey0khlhNFDuZml5BQ9ECMbfIjW03MffAH03jRLwFNpvFf5GPhqR8uCQ" alt="Childhood viral infections Skin manifestations Chickenpox Measles Rubella Hand, foot and mouth Congenital CMV Rubella vzv HIV Hepatitis Nervous system Viral meningitis HSV encephalitis vzv Gastrointestinal Rotavirus Enterovirus Respiratory infections Measles RSV influenza Rhinoviruses Adenoviruses Metapneumovirus Enteroviruses Mumps " width="602" height="339"> Chickenpox (varicella)Greenbook Chapter 34<a target="_blank" rel="noopener noreferrer nofollow" href="https://assets.publishing.service.gov.uk/media/6213ba8d8fa8f54915f43779/Green_Book_Chapter_34_v3_0.pdf"> https://assets.publishing.service.gov.uk/media/6213ba8d8fa8f54915f43779/Green_Book_Chapter_34_v3_0.pdf</a><ul><li>Varicella- zoster virus</li><li>After recovering virus goes dormant and could possibly be reactivated in later life as shingles</li><li>It is a DNA virus</li><li>Endemic to UK - consistently present but limited to region</li></ul> Pathogenesis of chickenpox:<ul><li>Takes 10-21 days to develop symptoms after being infected (incubation time)</li><li>Initial replication occurs in the upper respiratory tract, it is then transported in blood stream to skin</li><li>Vesicles contain live virus which when broken are infectious</li><li>Infectious period is typically 1-2 days before rash appeared until the rash dries</li></ul> Symptoms of chickenpox:<ul><li>Acute, non specific</li><li>Fever (typically lasts 1-2 days)</li><li>Vesicle development which dry and form granular scab (4 days post onset)</li><li>Infectious still scabs dry</li><li>Groups at risk:<ul><li>Pregnancy</li><li>Smokers</li><li>Immuno-compromised</li><li>Greater risk of people in these groups developing varicella pneumonia</li></ul></li></ul> Management of chickenpox<ul><li>Self limiting</li><li>Topical calamine lotion for itching</li><li>Antihistamines for itching</li><li>Paracetamol for pain and fever management</li><li>Acyclovir (antiviral inhibits DNA polymerase of virus ) for over 14 years, for those who have risk factors or severe symptoms</li><li>Advice:<ul><li>Maintain fluid intake to prevent dehydration</li><li>Wear smooth fabric</li><li>Keep nails short</li><li>Avoid contact with school or nursery</li><li>Do not scratch to prevent risk of infection</li></ul></li></ul> Chickenpox vaccination<ul><li>Not offered on NHS</li><li>Live attenuated vaccine</li><li>2 doses required<ul><li>Dose 1: over 12 months of age</li><li>Dose 2: 4-8 weeks after first dose</li></ul></li><li>Pre exposure to chickenpox:</li><li></li></ul><img src="https://lh7-us.googleusercontent.com/ajuK3qdSDN4SNacNhQP7Qeam2CWR7W6w_URbyeMfiipYAvJ5eEriydWya_nX0JFpn1PS-c6zeXu51Bvs2KPB8SqzViEAnAG2CB1sFRS2GPUFCtJl8CfeANXkS-rw-oXPrepfvqciowC5pku2VqqAeDE" alt="Definite history of VZ virus a Evaluate for VZ Info rmed v*Cination. adviQ to 'Negmncy and to FÉSt then to Oght patient Lmtil VOG if significmt to VZ No VZ compatibk rash: co md to in contut Figure 34.1 Procedure for vaccinating healthcare workers " width="579" height="800"><ul><li>Contraindications:</li><li> immunosuppressed patients.</li><li>women who are pregnant- Pregnancy should be avoided for one month following the last dose of varicella vaccine</li><li>a confirmed anaphylactic reaction to a previous dose of the vaccine</li></ul><ul><li>a confirmed anaphylactic reaction to any component of the vaccine, including neomycin or gelatin.</li></ul> RotavirusGreen book chapter 27b<a target="_blank" rel="noopener noreferrer nofollow" href="https://assets.publishing.service.gov.uk/media/5a80848aed915d74e622eea8/Green_Book_Chapter_27b_v3_0.pdf"> https://assets.publishing.service.gov.uk/media/5a80848aed915d74e622eea8/Green_Book_Chapter_27b_v3_0.pdf</a><ul><li>RNA in a protein capsule</li><li>It is environmentally stable contains 3 layer which protects it from the environment</li><li>Highly infectious:<ul><li>Faecal- oral route transmission is most common</li><li>Infectious dose - 10 virus particles</li><li>Respiratory transmission can also occur</li></ul></li><li>Replication occurs in the small intestine causing villi to flatten leading to activation of chloride channels.</li><li>The activation of chloride channels causes a increase in osmotic pressure in digestive system so there is a loss of water</li></ul><img src="https://lh7-us.googleusercontent.com/sheWV5IVUDoC-es3KPUkIoU-i-vgY7OSmPKqviS8GuneKaWyQ14WCABxbBvjlfKeYtwCCRhCn6QNouDzUQFb0clSjvzYmWl7So3ldUJy7x_02fcx8Tj5i7LJeATSsmdIJmYqVh2MEPpKkLYhsGfmYBY" alt="Rotavirus is a global problem No. of deaths per 100000 population 0-0.4 0.5-0.9 1-1.9 2-4.9 5-9.9 D 10-19.9 20-49.9 50-99.9 100-199.9 200-500 ATG DMA LCA VCT GRD TTO BRB MDV TLS COM MUS syc West Africa Persian Gulf E Med MIT SGP MHL SLB VIJT Caribbean KIR FSM WSM TON Balkan Peninsula Image Source: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2696431 " width="602" height="339"> Symptoms of rotavirus:<ul><li>Severe diarrhoea which lasts 3-8 days</li><li>Mild fever</li><li>Vomiting</li><li>Stomach cramps</li><li>Can cause dehydration</li></ul> NICE guidance for GI infections in under 5: <img src="https://lh7-us.googleusercontent.com/2Bk3NKuPCJjaorqz8EKsUY3Kb_cVEYD0S1i4IG2Ir7UaRyHE17Yr8MyGQ1TFDcPCUh-Zqanuy4MR5wnbFDGYGAx1D4-0JfV8ypoVmD1V0qAqPGifSgVn23pFuWYcjpnXRsvuSxnWoPGR-AhBpss4VZw" alt="NICE guidance: GI infections in under 5s • Dehydration risk (particularly < 12m yo) Reduced urine output

Altered responsiveness (red flag) Appears unwell or deteriorating (red flag)
Elevated heart rate/breathing (red flag) • Encourage fluid intake • ORS may be required • Appropriate handwashing • Avoid school/childcare facilities 48h post last symptom unicef@ NEW FORMULATION . LOW OSMOLARITY ORAL REHYDRATION SALTS Ip FOR FOR ANO NOUVELLE FORMULE . BASSE OSMOLARITÉ SELS DE RÉHYORATATION ORALE ENFANTS ET NUEVA FORMULA • OSMOLARIDAO BAJA SALES DE REHIDRATACION ORAL IP PARA EL LA CAOSAOA NICE National Institute for Health and Care Excellence https://www.nice.org.uk/guida nce/cg84/chapter/Recommendatio ns#diagnosis-2 " width="602" height="339"> Vaccination for rota virus:<ul><li>Offered on NHS since 2013</li><li>Live attenuated</li><li>Oral administration</li></ul><img src="https://lh7-us.googleusercontent.com/8P_vymT9565ogPFvdahNsct5awx9Rqeoj9rg5RSvDxs0hQzfeaYf24eFHxUytkV6UD7MYqCxzS9ynYDmSz6zjjSw7Qp9XdE3Z7EREdc4bJNySCnrpREGd45xXv3G1Oa9HfDGGDEG4KmPsG4Q6sGY0YU" alt="Instructions for administration Ofthe vaccine.' I Remove the protective 2. ms vaccine is for

DO not inject. tip cap from the oral applicator. oral administration only, The child should be seated in a rw•lining p€hition. Administer orally (i.e. into the child's mouth. towards the inner cheek) the entire content of the oral applicator. " width="421" height="339"><ul><li>2 doses required<ul><li>Dose 1: 8 weeks of age</li><li>Dose 2: 12 weeks of age</li><li>Vaccine should not be given to infants of 24 weeks or older</li></ul></li><li>Precautions:<ul><li>Vaccine strain is shed in faeces</li><li>Vaccine administered after severe combined immunodeficiency screening</li></ul> Pre vaccination<ul><li>Before vaccination scheme commenced was high social and economic impacts</li><li>Vaccine was commenced in 2013 and a significant drop in reports of rotavirus in under 5's was seen</li><li><img src="https://lh7-us.googleusercontent.com/R9mm44-LyRm52pdVkgHVQUAnQjz1h8lt5vqQzNq1pLJYCvr00Q1ZGlR6y_dxQ_v2CIR1rXlhk6Ce-OWhwkp8_Y27RuUcXArGZUZT5x2oG4gxa7c2MFvSyRBC95GeRTKkq-i7BU24lota29S2fc1RoJk" alt="Figure 8: Laboratory reports of rotavirus by week and age group 2009-2020 (England and Wales) Public Health England z 1600 1400 1200 1000 800 600 400 200 ä —Under 5 year olds —5 year olds and over ä ä ä ä " width="602" height="337"></li></ul> MeaslesGreen book chapter 21 (measles)<a target="_blank" rel="noopener noreferrer nofollow" href="https://assets.publishing.service.gov.uk/media/5e021b9140f0b6665e80187b/Greenbook_chapter_21_Measles_December_2019.pdf">https://assets.publishing.service.gov.uk/media/5e021b9140f0b6665e80187b/Greenbook_chapter_21_Measles_December_2019.pdf</a><ul><li>Airborne or droplet transmission</li><li>Leads to acute viral respiratory illness</li><li>RNA virus</li><li>Highly infectious - for every one person who has measles they will infect 18 people</li><li>Can result in pneumonia or very rare brain infection</li><li>Paper published claiming the MMR vaccine causes autism lead to a drop in vaccination rates leading to measles becoming endemic again until 2014</li><li></li></ul><img src="https://lh7-us.googleusercontent.com/qKR_RIb4fVG-iDUabsgKZ_ItznK51ay9tU_9ua13tfkMFtS6lfFrp2aN4lY94OmmunGMHX5lLTN2j6b223JHVL00eAorKkTYoWUveWpAJXwJQWh9-RfEQf0wQoJDA2rQhzuks2Mgheu6QTdQYY8JDvY" alt="Figure 4. Imported, import-related and endemic measles cases in the UK from 2001 to 2017 2200 Imo 1000 400 200 WHO elimination targets definitions not yet introduced • related E mjemic transmission • Imported Intevwupted endemic t ransmission Measles eliminate 2014 Public Health England " width="602" height="339"> Symptoms of measles:<ul><li>10 day incubation period</li><li>Fever</li><li>Malaise</li><li>Cough</li><li>Conjunctivitis </li><li>3-4 post infection: rash</li><li>Complications:<ul><li>Hospitalisation</li><li>Sub acute sclerosing pan encephalitis</li><li>Pneumonia</li></ul></li></ul> Measles management:<ul><li>Typically self limiting but must notify government if have measles</li><li>Control via vaccination</li><li>Contact health and protection team is have measles and:<ul><li>Pregnant</li><li>Less then 1 year old</li><li>Immunocompromised</li></ul></li><li>Advice:<ul><li>Drink adequate fluid</li><li>Paracetamol/ ibuprofen for pain</li><li>Avoid contact with schools</li><li>Avoid susceptible individuals</li><li>If signs of complication seek urgent medical help</li></ul></li></ul></li></ul>Mumps and rubellaGreen book chapter 23 (Mumps)<a target="_blank" rel="noopener noreferrer nofollow" href="https://assets.publishing.service.gov.uk/media/5a7a446ded915d1fb3cd6a43/Green-Book-Chapter-23-v2_0.pdf">https://assets.publishing.service.gov.uk/media/5a7a446ded915d1fb3cd6a43/Green-Book-Chapter-23-v2_0.pdf</a>Green book chapter 28 (rubella )<a target="_blank" rel="noopener noreferrer nofollow" href="https://assets.publishing.service.gov.uk/media/5a7a446ded915d1fb3cd6a43/Green-Book-Chapter-23-v2_0.pdf">https://assets.publishing.service.gov.uk/media/5a7b362bed915d3ed9062e5f/Green-Book-Chapter-28-v2_0.pdf</a> Mumps:<ul><li>Spread via airborne or droplet transmission</li><li>Incubation period is about 17 days (ranges from 14-25)</li><li>Patients are infectious for several days before swelling appears</li></ul> Rubella:<ul><li>Spread through droplet transmission</li><li>Many individuals develop rash 14-17 days after exposure</li><li>Individuals are infectious for 1 week before symptoms and up to 4 days after rash onset</li><li>Maternal rubella infection in pregnancy may result in foetal loss or in congenital rubella syndrome (CRS).</li><li>CRS presents with one or more of the following:<ul><li>cataracts and other eye defects</li><li>Deafness</li><li>cardiac abnormalities</li><li>Microcephaly</li><li>retardation of intra-uterine growth</li><li>inflammatory lesions of brain, liver, lungs and bone marrow.</li></ul></li></ul> rubella and mumps symptoms:Both notifiable infections so government should be informedRubella:<ul><li>Mild</li><li>Rash which appears 2-3 post infection</li><li>Slight fever</li><li>Sore throat</li></ul> Mumps:<ul><li>12-25 incubation period</li><li>Swelling of parotid glad</li><li>Joint pain</li><li>Headache</li><li>1/6 cases are asymptomatic</li></ul> MMR vaccination:<ul><li>Provided under NHS</li><li>Live attenuated vaccine</li><li>2 doses at appropriate intervals<ul><li>Dose 1: age 1</li><li>Dose 2: 3 years and 4 months of age</li></ul></li><li>Provides 99% efficacy</li><li>Contraindications:<ul><li>those who are immunosuppressed</li><li>those who have had a confirmed anaphylactic reaction to a previous dose of a measles-, mumps- or rubella-containing vaccine</li><li>those who have had a confirmed anaphylactic reaction to neomycin or gelatine</li><li>pregnant women</li></ul></li></ul>