Week 7 Detailed Lecture Notes

Welcome to Week 7; we are halfway through the course.
Reminder: Spring break is next week; no lecture or assignments are due.
Overview of today's topics: Childhood mortality and diseases commonly affecting children.

Childhood mortality has historically been high; approximately half of all children didn’t reach age 15.
This pattern has roots tracing back to hunter-gatherer societies.
Significant decline in mortality rates occurred between the years 1815 to 1900.
Reasons for high mortality rates include:
- Infectious diseases
- Birth complications
- Prematurity
- Malnutrition

Birth Complications:
- Dangerous conditions during childbirth for both mother and child.
- Cesarean sections (C-sections) were high-risk before advancement in surgical methods and antibiotics.
Prematurity:
- Clinically defined as delivery prior to 37 weeks gestation.
- Premature infants historically had low survival rates.
Malnutrition:
- Lack of access to proper food affecting health.
Infectious Diseases:
- Children are more susceptible due to immature immune systems. Common diseases include:
- Diarrheal diseases
- Measles
- Tuberculosis
- Typhoid

Neonatology Advances:
- Specialized pediatrics focusing on the care of newborns and infants, especially the sick and preterm.
Water Sanitation Improvements:
- Associated with declines in diarrheal diseases due to cleaner water.
Vaccination Initiatives:
- Vaccines for diseases (e.g., measles, polio) that previously caused high mortality.
Antibiotic Development:
- Revolutionized treatment for bacterial diseases.

Emerged as a distinct specialty in pediatrics around the 1960s.
Classified gestational age for preterm infants:
- Late preterm: 35-36 weeks
- Moderately preterm: 32-34 weeks
- Very preterm: 29-31 weeks
- Extremely preterm: <28 weeks
Neonatology innovations include:
- Ventilatory Support: Managing breathing in preterm infants through CPAP/BiPAP.
- Surfactant Treatments: Helps maintain alveoli open, crucial in preterm births as they lack sufficient natural surfactant.

Babies born very early face numerous challenges leading to intensive care needs.
Long-term effects include:
- Increased risk of cerebral palsy
- Cognitive delays
- Chronic diseases
Premature birth prevalence:
- Rising rates in recent years (~10%).
Factors contributing to increased prematurity:
- Reduced access to prenatal care, especially in rural areas.
- Increased use of IVF and multipara pregnancies which are more prone to preterm birth complications.

Importance of clean drinking water; reduces diarrheal diseases, particularly in children.
Role of Antibiotics: Help combat bacterial infections that disproportionately impact children.
Infographics highlight declines in mortality due to infectious diseases with antibiotic use.

Vaccines are pivotal in controlling childhood mortality:
- Estimated 500 million illnesses prevented, $2.7 trillion saved in healthcare costs in 30 years.
WHO efforts from 1974 include:
- Life-saving vaccines on a global scale.
- Significant impact on child mortality patterns: Over 154 million deaths prevented.
Timeline of vaccine requirements in the U.S. focusing on childhood vaccination laws leading to community immunity.

Children entering school or licensed daycare must provide proof of vaccinations or waivers.
Required vaccinations include:
- DTaP (diphtheria, tetanus, pertussis)
- Polio
- MMR (measles, mumps, rubella)
- Chickenpox
- Hepatitis B
Waiver options include medical, religious, and personal beliefs—varying by state.

Characterized by a rash, fever, and intense itching; typically mild and self-limiting.
Varicella Zoster Virus (VZV): The causative agent and a type of herpes virus.
Pre-vaccine era statistics show:
- 4 million cases annually, 10,000-13,000 hospitalizations, 100-150 deaths.
Introduction of the chickenpox vaccine in the 1990s led to a 97% reduction in cases and related healthcare savings.

Shingles reactivates the latent VZV in the body; occurs along nerve lines with painful rashes.
Lifetime risk of shingles is high: 1 in 3 adults, with post-herpetic neuralgia as a potential complication.
Shingrix vaccine recommended for adults over 50 to prevent shingles and associated complications.

Common viral illness in children, often self-limiting but can lead to rare complications.
Coxsackievirus as a primary cause; symptoms include rash on hands/feet/mouth, fever.
Currently no vaccines available; symptom management is the standard treatment.

Caused by Bordetella pertussis; characterized by severe coughing fits leading to possible respiratory failure in infants.
Vaccination via DTaP administered in several doses starting in early infancy.
Complications can include apnea and pneumonia, particularly hazardous for infants.

Streptococcus pyogenes causes scarlet fever, presenting with a characteristic rash and potential complications like abscesses.
Mortality significantly reduced with antibiotics; however, it historically affected childhood outcomes.

Commonly occur in children due to short eustachian tubes and immature immune systems.
Treatment can include antibiotics; severe cases might require ear tubes for fluid drainage.

Caused by the poliovirus; outcomes can range from mild symptoms to severe paralysis.
Preventive efforts led to the development of vaccines in the mid-20th century—significant reduction in cases.
Current status: Polio remains endemic in specific regions (e.g., Pakistan, Afghanistan).

Symptoms include high fever and a distinctive rash; complications can lead to pneumonia and encephalitis.
Importance of vaccination is critical; resurgence noted recently due to decreased vaccination rates and public hesitancy.
The MMR vaccine demonstrates a strong protective effect.

Should parents or guardians be mandated to vaccinate their children due to public health implications? Consider the balance between individual rights and community health.

A reminder that there will be no lecture or assignments during spring break.
Open invitation for students to reach out with questions or concerns about the course or topics discussed.