BCG
BCG, or bacilli Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. This vaccine is one of the first vaccines to be administered after birth or ideally before hospital discharge.
• A single dose of BCG vaccine is required to provide lifetime immunity.
• Booster doses of BCG vaccine are not recommended by WHO.
• BCG is preferably given at birth to provide protection in the early years when infection can often lead to diseases such as miliary tuberculosis or tubercular meningitis.
• Infants may receive the vaccine soon after birth or later, but preferably before exposure to persons with active tuberculosis.
Human TB has existed for thousands of years. No country is TB-free, and the disease is endemic in most poor countries of the world. It is estimated that about one-third of the current global population is infected asymptomatically withMycobacterium tuberculosis (Mtb), of whom 5-10% will develop clinical disease during their lifetime.
Human Papillomavirus (HPV)
Human Papilloma Virus (HPV) is the name of a group of viruses that includes more than 100 different types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva, or anus, and the lining of the vagina, cervix, or rectum. Some of these viruses are called "high-risk" types; they may cause abnormal Pap tests and can also lead to cancer of the Cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types; they may cause mild Pap test abnormalities or genital warts.
F.A.Q About the Disease and Vaccines
What is HPV?
Human Papilloma Virus (HPV) is the name of a group of viruses that includes more than 100 different types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva,
or anus, and the lining of the vagina, cervix, or rectum. Some of these viruses are called "high-risk" types; they may cause abnormal Pap tests and can also lead to cancer of the Cervix, vulva, vagina,
anus, or penis. Others are called "low-risk" types; they may cause mild Pap test abnormalities or genital warts.
How common is HPV Infection in India?
HPV is the most common sexually-transmitted infection in India. Sexually active men and women acquire genital HPV infection at some point in their lives.
How does HPV spread?
HPV is spread through sexual contact. Most infected persons have no symptoms and are unaware they are infected and can unintentionally transmit the virus to a sex partner. Rarely, a pregnant woman passes HPV to her baby during vaginal delivery.
How is HPV infection diagnosed?
Genital warts in men and women are diagnosed by visual inspection. Most women are diagnosed with HPV infection on the basis of abnormal Pap tests. Also, a specific test is available to detect HPV DNA in women. The test may be used in women with mild Pap
test abnormalities or in women more than age 30 years at the time of Pap testing. The results of HPV DNA testing can help healthcare providers decide if further tests or treatment are necessary. No HPV
tests are available for men.
Can genital HPV infection be cured?
There is no "cure" for HPV infection, although the infection usually goes away on its own. Approximately 90% of women with HPV infection become HPV-negative within two years. However, it is possible that the virus remains in a "sleeping" state and could
be reactivated years later. There are treatments for the health problems that HPV can cause, such as genital warts, cervical cell changes, and cancers of the cervix, vulva, vagina, and anus. Visible
genital warts can be removed by medications the patient applies, or by treatments performed by a healthcare provider. No one treatment is best. Warts might return, especially in the first 3 months after
treatment. It is not known whether treatment of genital warts will reduce the chance of passing the virus on to a sex partner. If left untreated, genital warts may go away, remain unchanged, or increase
in size or number.
How can people reduce their risk for acquiring genital HPV infection?
The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another individual. For people who are sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most
likely to prevent future genital HPV infections. However, it is difficult to determine whether a partner who has been sexually active in the past is currently infected. For those who are sexually active
and who are not in long-term mutually monogamous relationships, reducing the number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection.
Partners less likely to be infected include those who have had no or few prior sex partners. It is not known how much protection condoms provide against HPV, since areas that are not covered by a condom
can be exposed to the virus. However, condoms may reduce the risk of genital warts and cervical cancer.
What side effects have been reported from HPV vaccine?
Mild problems may occur with HPV vaccine, including pain, redness, swelling, and itching at the injection site. These problems do not last long and go away on their own. Fainting has been reported among adolescents who receive HPV vaccine (and other recommended
vaccines as well). It’s best for the patient to sit during vaccine administration and remain seated for 15–20 minutes after receiving the vaccine.
Can HPV vaccine cause HPV?
No. HPV vaccines are inactivated so they cannot cause disease-like symptoms or HPV disease.
What are the symptoms of HPV?
Most people who become infected with HPV have no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually
in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and
on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.
How serious is HPV?
Most HPV infections don't cause any symptoms and eventually go away, as the body's own defense system clears the virus. Women with temporary HPV infections may develop mild Pap test abnormalities that go away with time. About 10% of women infected with
HPV develop persistent HPV infection. Women with persistent high-risk HPV infections are at greatest risk for developing Cervical Cancer precursor lesions (abnormal cells on the lining of the cervix)
and cervical cancer. (See next question.)
What are possible complications from HPV?
Cervical cancer in women is the most serious possible complication from HPV infection. Persistent infection with high-risk types of HPV is associated with almost all cervical cancers. Worldwide, cervical cancer is the second most common cancer in women;
it is estimated to cause over 470,000 new cases and 233,000 deaths each year. Persistent infection with high-risk types of HPV is also associated with cancers of the vulva, vagina, penis, and anus. However,
these cancers are much less common than cervical cancer. The risk for anal cancer is 17 times higher among gay and bisexual men than among heterosexual men. The risk is also higher among men with compromised
immune systems, including those with HIV. Occasionally, low-risk HPV infections can be transmitted during birth, resulting in respiratory tract warts in infants and children.
Should individuals be screened before getting vaccinated?
No. Girls/women do not need to get an HPV test or Pap test to find out if they should get the vaccine. There are no routine HPV screening tests for men.
How effective are the HPV vaccines?
All three HPV vaccines are highly effective in preventing infection with types of HPV included in the vaccines. Studies have shown that all three vaccines prevent nearly 100 percent of the precancerous cervical cell changes caused by the types of HPV
included in the vaccine for more than 10 years after vaccination.
Do women still need to get a Pap test if they’ve been vaccinated against HPV?
Yes. Women should continue to receive regular cervical cancer screening for three reasons. First, the vaccine does not provide protection against all types of HPV that cause cervical cancer. Second, women may not receive the full benefits of the vaccine
if they do not complete. the vaccine series. Third, women may not receive the full benefits of the vaccine if they were infected with HPV before receiving the vaccine. In addition, vaccinated people
should continue to practice protective sexual behaviors since the vaccine will not prevent all cases of genital warts or other sexually transmitted infections.
Does the vaccine protect against all types of HPV?
No. Although there are more than 100 types of human papillomaviruses, only four (HPV 6, 11, 16, and 18) were included in Gardasil, 9 are included in Gardasil 9 (HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58) and only two (HPV 16 and 18) were included in Cervarix.
HPV 16 and 18 (included in all three vaccines) are responsible for 66% of cervical cancers.
What if a person doesn’t get all of the recommended doses?
It is not known how much protection people would get from receiving fewer than the recommended number of doses of the vaccine. For this reason, it is very important. to receive all recommended doses of the vaccine. If there is a gap in the schedule longer
than the recommended time, the series should be continued from where it left off – there is no need to restart the series.
Diphtheria
F.A.Q About the Disease and Vaccines
What causes diphtheria?
Diphtheria is caused by a bacterium, Corynebacterium Diphtheriae. The actual disease is caused when the bacteria release a toxin, or poison, into the person's body.
How does diphtheria spread?
Diphtheria bacteria live in the mouth, throat, and nose of an infected person and can be passed to others by coughing or sneezing. Occasionally, transmission occurs from skin sores or through articles soiled with discharge from sores of infected persons.
How long does it take to show signs of diphtheria after being exposed?
The incubation period is short: 2-5 days, with a range of 1-10 days.
What are the symptoms of diphtheria?
Early symptoms of diphtheria may mimic a cold with a sore throat, mild fever, and chills. Usually, the disease causes a thick coating at the back of the throat, which can make it difficult to breathe or swallow. Other body sites besides the throat can
also be affected, including the nose, larynx, eye, vagina, and skin.
How serious is diphtheria?
Diphtheria is a serious disease: 5%-10% of all persons with diphtheria die. Up to 20% of cases lead to death in certain age groups of individuals (e.g., children younger than age 5 years and adults older than age 40 years).
What are possible complications from diphtheria?
Most complications of diphtheria are due to the release of the toxin, or poison. The most common complications are inflammation of the heart, leading to abnormal heart rhythms, and inflammation of the nerves, which may cause temporary paralysis of some
muscles. If the paralysis affects the diaphragm (the major muscle for breathing), the patient may develop pneumonia or respiratory failure. The thick membrane coating at the back of the throat may cause
serious breathing problems, even suffocation.
How do I know if someone has diphtheria?
The diagnosis of diphtheria can only be confirmed after a physician takes a small sample of the infected material from the patient's throat (or other site) and has the sample tested in a laboratory. But because this disease progresses quickly, treatment
usually should begin based on the health professional's assessment of the patient.
Is there a treatment for diphtheria?
Diphtheria is treated with both antibiotics and with diphtheria antitoxin. Diphtheria antitoxin is produced in horses. Antitoxin does not get rid of toxin that is already attached to the body's tissues, but will neutralize any circulating poison and will
prevent the disease from getting worse. The patient should be tested for sensitivity to this antitoxin before it is given.
How long is a person with diphtheria contagious?
The disease usually becomes non-contagious 48 hours after antibiotics are started. However, some individuals continue to carry the diphtheria bacterium even after antibiotic therapy, and treatment should be continued until patients have two consecutive
negative cultures. People providing care for an individual with diphtheria should take standard contact precautions and make sure they have been adequately immunized against diphtheria.
Can you get diphtheria more than once?
Yes. Even individuals recovering from diphtheria should be immunized against the disease as soon as possible.
How are vaccines made that prevent diphtheria, tetanus and pertussis?
These vaccines are made by chemically treating the diphtheria, tetanus, and pertussis toxins to render them nontoxic yet still capable of eliciting an immune response in the vaccinated person. They are known as “inactivated” vaccines because they do not
contain live bacteria and cannot replicate themselves, which is why multiple doses are needed to produce immunity.
What’s the difference between all the vaccines containing diphtheria and tetanus toxoids and pertussis vaccine?
It’s like alphabet soup! Here is a listing of the various products:
• DTaP: Diphtheria and tetanus toxoids and acellular pertussis vaccine; given to infants and children ages 6 weeks through 6 years. In addition, four childhood combination vaccines include DTaP as a component.
• DTwP: Diphtheria and tetanus toxoids and whole cell pertussis vaccine; given to infants and children ages 6 weeks through 6 years. In addition, four childhood combination vaccines include DTwP as a component.
• Tdap: Tetanus and diphtheria toxoids with acellular pertussis vaccine; given to adolescents and adults. Pregnant women should receive Tdap during each pregnancy.
• DTaP: Diphtheria and tetanus toxoids and acellular pertussis vaccine; given to infants and children ages 6 weeks through 6 years. In addition, four childhood combination vaccines include DTaP as a component.
• DTwP: Diphtheria and tetanus toxoids and whole cell pertussis vaccine; given to infants and children ages 6 weeks through 6 years. In addition, four childhood combination vaccines include DTwP as a component.
• Tdap: Tetanus and diphtheria toxoids with acellular pertussis vaccine; given to adolescents and adults. Pregnant women should receive Tdap during each pregnancy.
How effective are these vaccines?
After a properly spaced primary series of DTaP or DTwp, approximately 95% of people will have protective levels of diphtheria antitoxin and 100% will have protective levels of tetanus antitoxin in their blood. However, antitoxin levels decrease with time
so routine boosters with Tdap are recommended every 10 years. Estimates of acellular pertussis vaccine efficacy range from 80% to 85%, but protection declines as the time since the dose increases.
Can a pregnant woman receive Tdap vaccine?
Yes. All pregnant women should receive Tdap during each pregnancy, preferably early in the time period between 27- and 36 - weeks’ gestation. Recent studies show that vaccination during pregnancy reduces a baby's risk of getting pertussis in early infancy
by 90 percent. Because infants are not adequately protected against pertussis until they have received at least 3 doses of DTaP / DTwP, it is especially important that all contacts (family members, caregivers)
of infants younger than age 12 months are vaccinated with Tdap if they haven't previously received Tdap. If a new mother hasn’t been vaccinated with Tdap, she should receive it before hospital discharge,
even if she is breastfeeding.
What side effects have been reported with these vaccines?
Local reactions, such as redness and swelling at the injection site, soreness and tenderness where the shot was given, as well as mild systemic reactions such as fever, are not uncommon in children and adults.
Hepatitis A
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HAV is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with HAV infection. This type of spread is called "fecal-oral." This can happen in a variety of ways, such as when an infected person who prepares or handles food doesn't wash his or her hands adequately after using the toilet and then touches other people's food. A person can also be infected by drinking water contaminated with HAV or drinking beverages chilled with contaminated ice. Contaminated food, water, and ice can be significant sources of infection for travelers to many areas of the world. For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed. Most infections in India result from contact with a household member or a sex partner who has hepatitis A; however the proportion of cases of hepatitis A among international travelers, illegal drug users, and men who have sex with men has been increasing. Casual contact, as in the usual office, factory, or school setting, does not spread the virus.
F.A.Q About the Disease and Vaccines
What causes hepatitis A?
Hepatitis A is a liver disease caused by Hepatitis A Virus (HAV).
How does HAV spread?
HAV is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with HAV infection. This type of spread is called "fecal-oral." This can happen in a variety of ways, such as when an infected
person who prepares or handles food doesn't wash his or her hands adequately after using the toilet and then touches other people's food. A person can also be infected by drinking water contaminated
with HAV or drinking beverages chilled with contaminated ice. Contaminated food, water, and ice can be significant sources of infection for travelers to many areas of the world. For this reason, the
virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed. Most infections in India result from contact with a household member or a
sex partner who has hepatitis A; however the proportion of cases of hepatitis A among international travelers, illegal drug users, and men who have sex with men has been increasing. Casual contact, as
in the usual office, factory, or school setting, does not spread the virus.
Can HAV be spread through sex?
Yes. Sex involves close, intimate contact (vaginal, anal, or oral sex) and increases the risk of exposure to HAV in the feces of an infected person.
What are the symptoms of hepatitis A?
People with hepatitis A can feel quite sick. If symptoms are present, they usually occur suddenly and can include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes).
How long does it take to show signs of illness after coming in close contact with a person who has HAV infection?
It can take 15-50 days to develop symptoms (average 28 days). People with HAV infection might not have any signs or symptoms of the disease. Adults are more likely to have symptoms than children. About 7 out of 10 adults have symptoms, while children
less than age 6 years usually have no symptoms. In some people, symptoms of hepatitis A recur in 6-9 months; this condition is called relapsing hepatitis A.
How long do symptoms last?
Symptoms usually last less than 2 months; however, a few people are ill for as long as 6 months.
How serious is hepatitis A?
Hepatitis A can be quite serious. Studies show that 33 out of 100 people with hepatitis A are hospitalized, with people over age 40 more likely to be hospitalized. Many days of work are missed due to hepatitis A, as well. Certain people, such as people
with chronic hepatitis C, can get very sick and die from hepatitis A. Death from hepatitis A is fairly rare in young people who are otherwise healthy.
Can people become chronically infected with HAV?
No. HAV only causes acute (recently acquired) infection, not chronic infection. Relapsing hepatitis A, as described above, goes away and is NOT a chronic HAV infection. (Both hepatitis B and hepatitis C viruses can cause chronic infection.)
How common is HAV infection throughout the world?
HAV infection occurs widely throughout the world. The infection is especially common in countries in Latin America, Africa, the Middle East, Asia, the Caribbean, and the Western Pacific. This means that people can become infected with HAV in many travel
destinations, even when using luxury tourist accommodations.
How does a person know if he or she is HAV infected?
To diagnose acute hepatitis A, a blood test called “IgM class antibody to HAV” (IgM anti-HAV) is needed. There is also a blood test available that shows if a person was infected with HAV in the past (total hepatitis A antibody [anti-HAV]). Talk to your
doctor or someone from your local health department if you suspect that you have been exposed to HAV or any type of hepatitis virus.
Is there a medicine to treat hepatitis A?
There is no medicine that will treat or "cure" hepatitis A. Supportive care includes bed rest, fluids, and fever-reducing medicines. Take fever-reducing medicine only if your physician recommends it.
How long can a person with HAV infection spread HAV?
The most likely time for an HAV-infected person to spread HAV to others is during the two weeks before the infected person develops symptoms. Clearly, if a person doesn't even know that they are infected, it makes it difficult to protect others from getting
the infection. The risk of spreading HAV becomes smaller over time and can still be present one week or longer after symptoms develop (e.g., yellowing of skin and eyes). Infants are more likely to be
capable of spreading HAV for longer periods of time.
If a person has had close personal contact with an HAV-infected person and hasn't been vaccinated, what should the person do?
If an unvaccinated person thinks that he or she might have been exposed, that person should call their healthcare professional immediately to schedule an appointment to determine whether a real exposure has occurred and whether hepatitis A vaccine should
be administered.
How does HAV differ from hepatitis B virus (HBV) and hepatitis C virus (HCV)?
• HAV, HBV, and HCV are three different viruses that attack and injure the liver and cause similar symptoms in people with acute (recently acquired) disease.
• HAV is spread by getting HAV-infected fecal matter into a person’s mouth who has never had hepatitis A (e.g., an HAV-infected person who doesn’t wash his or her hands after using the bathroom and then handles food for public consumption or an infected person who has sex with a person who has never had hepatitis A). HBV and HCV are spread when an infected person's blood or blood contaminated body fluids enter another person's bloodstream.
• HBV and HCV infections can cause lifelong (chronic) liver problems. HAV does not.
• There are vaccines that will protect people from HAV infection and HBV infection. Currently, there is no vaccine to protect people from HCV infection.
• There are medications that are approved by the Food and Drug Administration (FDA) for treatment of chronic HBV and HCV infections. • If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.
• HAV is spread by getting HAV-infected fecal matter into a person’s mouth who has never had hepatitis A (e.g., an HAV-infected person who doesn’t wash his or her hands after using the bathroom and then handles food for public consumption or an infected person who has sex with a person who has never had hepatitis A). HBV and HCV are spread when an infected person's blood or blood contaminated body fluids enter another person's bloodstream.
• HBV and HCV infections can cause lifelong (chronic) liver problems. HAV does not.
• There are vaccines that will protect people from HAV infection and HBV infection. Currently, there is no vaccine to protect people from HCV infection.
• There are medications that are approved by the Food and Drug Administration (FDA) for treatment of chronic HBV and HCV infections. • If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.
How effective is hepatitis A vaccine?
Hepatitis A vaccine is very effective. It appears that all adults, adolescents, and children become immune to hepatitis A virus infection after getting two doses. After one dose, at least 94 out of 100 people become immune for several years. It is important
to get the full two-dose series to ensure long-term protection.
What side effects have been reported with this vaccine?
The most common side effect is a sore arm, which happens to one out of two adults and one out of five children. Less common side effects include headache, loss of appetite, low-grade fever, or tiredness. When these problems happen, they usually start
3–5 days after vaccination and usually last for one or two days. A very rare but serious side effect is a severe allergic reaction. If this happens, it typically occurs within a few minutes to a few
hours following. the injection.
Hepatitis B
The spread of HBV occurs when blood from an HBV-infected person enters the body of a person who is not infected. This can occur through having sex with an HBV-infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce spread of HBV). HBV is also easily spread by sharing drugs, needles, or "works" when "shooting" drugs. The risk of HBV infection from HBV-contaminated needle sticks is much greater than the risk of spreading HIV by this method. Other types of percutaneous (through the skin) exposures, including tattooing and body piercing, have also been reported to result in the spread of HBV when good infection control practices have not been used. Unsafe injections
F.A.Q About the Disease and Vaccines
What causes Hepatitis B?
Hepatitis B is a liver disease caused by the hepatitis B Virus (HBV).
How does HBV spread?
The spread of HBV occurs when blood from an HBV-infected person enters the body of a person who is not infected. This can occur through having sex with an HBV-infected person without using a condom (the efficacy of latex condoms in preventing infection
with HBV is unknown, but their proper use may reduce spread of HBV).
HBV is also easily spread by sharing drugs, needles, or "works" when "shooting" drugs. The risk of HBV infection from HBV-contaminated needle sticks is much greater than the risk of spreading HIV by this method. Other types of percutaneous (through the skin) exposures, including tattooing and body piercing, have also been reported to result in the spread of HBV when good infection control practices have not been used. Unsafe injections in medical settings are a major source of HBV spread in many developing countries.
HBV is also spread through needle sticks or sharps exposures on the job and from an infected mother to her baby during birth. Breastfeeding has not been associated with the spread of HBV.
HBV can also be spread during childhood. Most early childhood spread occurs in households of people with chronic (life-long) HBV infection, but the spread of HBV has also been seen in daycare centers and schools. The most likely way that the spread of HBV occurs during early childhood involves contact between an infected person's body fluids (e.g., their blood or drainage from their wounds or skin lesions) and breaks in the child's skin. HBV can be spread also when an HBV-infected person bites another person who is not infected. HBV can be spread also by an infected person pre-chewing food for babies, and through contact with HBV from sharing personal-care items, such as razors or toothbrushes. The virus remains infectious and capable of spreading infection for at least seven days outside the body. Virus can be found on objects, even in the absence of visible blood. HBV is not spread through food or water, sharing eating utensils, hugging, kissing, coughing, and sneezing or by casual contact, such as in an office or factory setting. People with chronic HBV infection should not be excluded from work, school, play, childcare, or other settings.
HBV is also easily spread by sharing drugs, needles, or "works" when "shooting" drugs. The risk of HBV infection from HBV-contaminated needle sticks is much greater than the risk of spreading HIV by this method. Other types of percutaneous (through the skin) exposures, including tattooing and body piercing, have also been reported to result in the spread of HBV when good infection control practices have not been used. Unsafe injections in medical settings are a major source of HBV spread in many developing countries.
HBV is also spread through needle sticks or sharps exposures on the job and from an infected mother to her baby during birth. Breastfeeding has not been associated with the spread of HBV.
HBV can also be spread during childhood. Most early childhood spread occurs in households of people with chronic (life-long) HBV infection, but the spread of HBV has also been seen in daycare centers and schools. The most likely way that the spread of HBV occurs during early childhood involves contact between an infected person's body fluids (e.g., their blood or drainage from their wounds or skin lesions) and breaks in the child's skin. HBV can be spread also when an HBV-infected person bites another person who is not infected. HBV can be spread also by an infected person pre-chewing food for babies, and through contact with HBV from sharing personal-care items, such as razors or toothbrushes. The virus remains infectious and capable of spreading infection for at least seven days outside the body. Virus can be found on objects, even in the absence of visible blood. HBV is not spread through food or water, sharing eating utensils, hugging, kissing, coughing, and sneezing or by casual contact, such as in an office or factory setting. People with chronic HBV infection should not be excluded from work, school, play, childcare, or other settings.
How long does it take to show signs of illness after coming in close contact with a person who has HBV infection?
The incubation period ranges from 45 to 160 days (average 120).
What are the signs and symptoms of Hepatitis B?
About 7 out of 10 adults with acute Hepatitis B have signs or symptoms when infected with HBV. Children under age 5 years who become infected rarely show any symptoms. Signs and symptoms of Hepatitis B might include nausea, lack of appetite, tiredness,
muscle, joint, or stomach pain, fever, diarrhea or vomiting, headache, dark urine, light-colored stools, and yellowing of the skin and whites of the eyes (jaundice). People who have such signs or symptoms
generally feel quite ill and might need to be hospitalized.
How serious is Hepatitis B?
Hepatitis B is very serious. About 9 out of 10 infants (who do not receive appropriate prophylaxis at birth), 30 out of 100 children younger than age 5, and about 2 of 100 adults who are infected with HBV are unable to clear HBV from their bodies and
become chronically infected. This serious condition is discussed below. Even though people might eventually recover from their acute infection, a feeling of tiredness and poor health might last for months.
What does it mean to have chronic HBV infection?
People with chronic HBV infection are infectious and can transmit HBV to others. Usually, chronically infected people do not feel sick and do not realize they are infected. They generally have HBV infection for their entire lives. They are also at high
risk of developing chronic liver disease, including cirrhosis (scarring of the liver), liver failure, and liver cancer.
What are the complications of chronic HBV infection?
An estimated 15-25 people out of 100 with chronic HBV infection eventually develop serious liver disease. Chronic HBV infection is responsible for most HBV-related sickness and death, including cirrhosis, liver failure, and liver cancer. When people are
infected at a very young age, these forms of liver disease do not appear usually until young adulthood or middle age.
Is HBV infection a serious problem in the world?
Worldwide, the medical consequences of chronic HBV infections are a huge problem. Approximately 350 million people around the world are chronically infected with HBV and approximately 1 million of these people die each year from cirrhosis leading to liver
failure or liver cancer. The medical literature states that Hepatitis B is the 10th leading cause of death worldwide.
How does a person know if she / he has HBV infection?
A blood test called IgM anti-HBc is needed to diagnose acute hepatitis B. There are additional blood tests for hepatitis B that determine other aspects of HBV infection.
Is there a medication to treat Hepatitis B?
There are several Food and Drug Administration (FDA)-approved medications that might help a person who has chronic HBV infection. These medications don't usually get rid of the virus, but they might decrease the chance of the infected person developing
severe liver disease. Not everyone is a candidate for these medications. Researchers continue to seek additional cures for Hepatitis B. There is no treatment (other than supportive care) for people with
acute Hepatitis B.
How long can a person with HBV infection spread HBV?
A person with acute or chronic HBV infection is contagious as long as they have the virus in their blood, which can only be determined by blood testing. In general, a person with acute Hepatitis B gets rid of the virus in their blood in six months. If
this does not happen, it is likely the person will become chronically infected with HBV for life.
What are some important Do's and Don'ts for people with chronic HBV infection?
DO's • Cover all cuts and open sores with a bandage.
• Discard used items such as bandages and menstrual pads carefully so no one is accidentally exposed to your blood.
• Wash hands well after touching your blood or infectious body fluids.
• Clean up blood spills; then clean the area again with a bleach solution (one part household chlorine bleach to 10 parts of water).
• Tell your sex partner(s) you have Hepatitis B so they can be tested and vaccinated (if not already infected or vaccinated). Partners should have their blood tested 1-2 months after three doses of vaccine are completed to be sure the vaccine worked.
• Use condoms (rubbers) during sex unless your sex partner has had hepatitis B or has been immunized and has had a blood test (as described above) demonstrating immunity to HBV infection. (Condoms might also protect you from other sexually transmitted diseases).
• Tell household members to see their doctors for testing and vaccination for hepatitis B.
• Tell your doctors that you are chronically infected with HBV.
• See your doctor every 6-12 months to check your liver for abnormalities, including cancer. • If you are pregnant, tell your doctor that you have HBV infection. It is critical that your baby is started on HBIg and hepatitis B shots within a few hours of birth.
DON'Ts • Don’t share chewing gum, toothbrushes, razors, washcloths, needles for ear or body piercing, or anything that might have come in contact with your blood or infectious body fluids.
• Don’t pre-chew food for babies.
• Don’t share syringes and needles. • Don’t donate blood, plasma, body organs, tissue, or sperm.
• Discard used items such as bandages and menstrual pads carefully so no one is accidentally exposed to your blood.
• Wash hands well after touching your blood or infectious body fluids.
• Clean up blood spills; then clean the area again with a bleach solution (one part household chlorine bleach to 10 parts of water).
• Tell your sex partner(s) you have Hepatitis B so they can be tested and vaccinated (if not already infected or vaccinated). Partners should have their blood tested 1-2 months after three doses of vaccine are completed to be sure the vaccine worked.
• Use condoms (rubbers) during sex unless your sex partner has had hepatitis B or has been immunized and has had a blood test (as described above) demonstrating immunity to HBV infection. (Condoms might also protect you from other sexually transmitted diseases).
• Tell household members to see their doctors for testing and vaccination for hepatitis B.
• Tell your doctors that you are chronically infected with HBV.
• See your doctor every 6-12 months to check your liver for abnormalities, including cancer. • If you are pregnant, tell your doctor that you have HBV infection. It is critical that your baby is started on HBIg and hepatitis B shots within a few hours of birth.
DON'Ts • Don’t share chewing gum, toothbrushes, razors, washcloths, needles for ear or body piercing, or anything that might have come in contact with your blood or infectious body fluids.
• Don’t pre-chew food for babies.
• Don’t share syringes and needles. • Don’t donate blood, plasma, body organs, tissue, or sperm.
What should you do if you have been exposed to HBV?
If you think you've been exposed to HBV, don't delay. Contact your doctor or clinic. If you have not been vaccinated, it is recommended that you receive treatment with Hepatitis B Immune globulin (HBIg). This is a blood product containing protective HBV
antibodies. You should also get the first dose of Hepatitis B vaccine as soon as possible, preferably at the same time as the HBIg is given, but at a different site on your body. Following this, you
will need to complete the full hepatitis B vaccine series (usually a total of three doses over a six-month period).
Can you get Hepatitis B more than once?
No. If you get an acute case of hepatitis B and recover, you should have protective antibodies in your blood that will prevent any further infection with HBV. The medical literature does report possible mutant strains of HBV infection, but these are rare
and would be highly unlikely to occur.
How does HBV differ from Hepatitis A Virus (HAV) and Hepatitis C Virus (HCV)?
HBV, HCV, and HAV are different viruses that attack and injure the liver, and can cause similar symptoms Usually people get HAV infection from close personal contact with an infected person or from ingesting fecally-contaminated food or water. HBV and
HCV are spread when an infected person's blood or blood contaminated body fluids enter another person's bloodstream. HBV and HCV infections can cause chronic liver problems. HAV does not. There are vaccines
that will protect people from HAV infection and HBV infection. Currently, there is no vaccine to protect people from HCV infection. There are medications that are approved by the FDA for treatment of
chronic HBV and HCV infections. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.
HIB
Hib disease is caused by a bacterium, Haemophilus influenzae. There are six different types of these bacteria (a through f). Type b organisms account for 95% of all strains that cause invasive disease, and this is the type against which the Hib vaccine protects.
F.A.Q About the Disease and Vaccines
What causes Hib disease?
Hib disease is caused by a bacterium, Haemophilus influenzae. There are six different types of these bacteria (a through f). Type b organisms account for 95% of all strains that cause invasive disease, and this is the type against which the Hib vaccine
protects.
How does Hib disease spread?
Hib disease is spread person-to-person by direct contact or through respiratory droplets. Usually the organism’s remains in the nose and throat, but occasionally the bacteria spread to the lungs or bloodstream and cause a serious infection in the individual.
How long does it take to show signs of Hib disease after being exposed?
The incubation period of Hib disease is not certain but could be as short as a few days.
What are the symptoms of Hib disease?
A person with invasive Hib disease can have different symptoms depending on what body systems are affected. (See next question.)
How serious is Hib disease?
Hib disease can be very serious. The most common type of invasive Hib disease is Meningitis, an infection of the membranes covering the brain (50%-65% of cases). Symptoms of Hib meningitis are fever, decreased mental status, and stiff neck. The mortality
rate is 2%-5%. In addition, 15%-30% of survivors suffer some permanent neurologic damage, including blindness, deafness, and mental retardation.Another 17% of invasive Hib cases include epiglottitis,
an infection and swelling in the throat that can cause life-threatening airway blockage. Other forms of invasive Hib disease include joint infection (8%), skin infection (6%), pneumonia (15%), and bone
infection (2%).
How do I know if my child has Hib disease?
The diagnosis of Hib disease is usually made based on one or more laboratory tests using a sample of infected body fluid, such as blood or spinal fluid.
Is there a treatment for Hib disease?
Hib disease is treated with antibiotics for 10 days. Most cases require hospitalization.Even with antibiotic treatment, up to 5% of all children with Hib meningitis die from the disease.
Can you get Hib disease more than once?
Yes. A child with Hib disease may not develop protective levels of antibodies. Children younger than age 24 months who have recovered from invasive Hib disease should be considered unprotected and receive the Hib vaccine as soon as possible.
Influenza
Viruses cause Influenza. There are two basic types, A and B. Their genetic material differentiates them. Influenza A can cause moderate to severe illness in all age groups and infects humans and other animals. Influenza B causes milder disease and affects only humans, primarily children. Subtypes of the type A Influenza virus are identified by two antigens (proteins involved in the immune reaction) on the surface of the virus. These antigens can change, or mutate, over time. When a "shift" (major change) or a "drift" (minor change) occurs, a new Influenza virus is born and an epidemic is likely among the unprotected population.
F.A.Q About the Disease and Vaccines
What causes Influenza (Flu)?
Viruses cause Influenza. There are two basic types, A and B. Their genetic material differentiates them. Influenza A can cause moderate to severe illness in all age groups and infects humans and other animals. Influenza B causes milder disease and affects
only humans, primarily children. Subtypes of the type A Influenza virus are identified by two antigens (proteins involved in the immune reaction) on the surface of the virus. These antigens can change,
or mutate, over time. When a "shift" (major change) or a "drift" (minor change) occurs, a new Influenza virus is born and an epidemic is likely among the unprotected population.
How does Influenza spread?
Influenza is transmitted through the air from the respiratory tract of an infected person. It can also be transmitted by direct contact with respiratory droplets.
How long does it take to develop symptoms of Influenza after being exposed?
The incubation period of influenza is usually two days but can range from one to five days.
What are the symptoms of Influenza?
Typical Influenza disease is characterized by abrupt onset of fever, aching muscles, sore throat, and non-productive cough. Additional symptoms may include runny nose, headache, a burning sensation in the chest, and eye pain and sensitivity to light.
Typical Influenza disease does not occur in every infected person. Someone who has been previously exposed to similar virus strains (through natural infection or vaccination) is less likely to develop
serious clinical illness.
Who should get influenza vaccine?
Annual influenza vaccination is recommended for all people ages 6 months and older who do not have a contraindication to the vaccine.
How often should this vaccine be given?
Influenza vaccine is given each year because immunity decreases after a year and because influenza vaccine viruses are updated almost every year. An annual vaccination is recommended even if the strains included in the vaccine are not changed from one
year to the next.
Should siblings of a healthy child who is younger than age 6 months be vaccinated?
Yes, it is especially important that all household contacts of children too young to be vaccinated against influenza (i.e., younger than age 6 months) receive annual influenza vaccination to protect the infant from serious infection. This is very important
because these infants are too young to be vaccinated and are most vulnerable to complications from influenza.
How safe is this vaccine?
Influenza vaccine is very safe. The most common side effects of the injectable (inactivated) influenza vaccine include soreness, redness, or swelling at the site of the injection. These reactions are temporary and occur in 15%–20% of recipients. Less
than 1% of vaccine recipients develop symptoms such as fever, chills, and muscle aches for 1 to 2 days following the vaccination. Experiencing these non-specific side effects does not mean that you are
getting influenza. Serious adverse reactions to influenza vaccine are very rare. Such reactions are most likely the result of an allergy to a vaccine component.
Can influenza vaccine cause influenza?
No. Neither the injectable (inactivated or recombinant) vaccine nor the live attenuated (nasal spray) vaccine can cause influenza. The inactivated injectable influenza vaccine contains only killed virus fragments and the recombinant vaccine contains only
a part of the influenza virus so neither type of vaccine can cause influenza. Fewer than 1% of people develop influenza-like symptoms, such as mild fever and muscle aches, after vaccination. These side
effects are not the same as having the actual disease.
Should siblings of a person with a chronic illness receive influenza vaccine even though the chronically ill person has been vaccinated?
Yes. Vaccination is recommended for all people ages 6 months and older, including contacts of people with chronic illnesses. It is important to vaccinate everyone who may have close contact with people at increased risk of severe influenza to better protect
them from influenza and its complications.
Is it safe for pregnant women to get influenza vaccine?
Yes. In fact, vaccination with the inactivated influenza vaccine is recommended for women who will be pregnant during the influenza season. Pregnant women are at increased risk for serious medical complications from influenza. Studies have shown that
influenza vaccination of pregnant women helps prevent influenza and its complications in both the mother and her newborn during the first 6 months of life.
How serious is Influenza?
Although many people think of Influenza as a type of cold, it is really a specific and serious disease. Disease complications and death are more common among young children, the elderly, and those with chronic illnesses.
Influenza viruses cause disease among persons of all ages. Rates of infection are highest among children, but the risks for complications, hospitalizations, and deaths from Influenza are higher among persons age 65 years or older, young children, and persons of any age who have medical conditions that place them at increased risk for complications from Influenza. Case reports and several epidemiologic studies also indicate that pregnancy can increase the risk for serious medical complications of Influenza.
In nursing homes, up to 60% of residents may be infected, with up to a 30% fatality rate in the infected. Risk for Influenza-associated death is highest among the oldest elderly persons age 85 years and older are 16 times more likely to die from an Influenza-associated illness than persons aged 65-69 years.
Children age two years and younger have hospitalization rates second only to people age 65 years and older. Children younger than age one year are the most likely to be hospitalized. Influenza-associated deaths are uncommon among children but represent a substantial proportion of vaccine-preventable deaths.
Influenza viruses cause disease among persons of all ages. Rates of infection are highest among children, but the risks for complications, hospitalizations, and deaths from Influenza are higher among persons age 65 years or older, young children, and persons of any age who have medical conditions that place them at increased risk for complications from Influenza. Case reports and several epidemiologic studies also indicate that pregnancy can increase the risk for serious medical complications of Influenza.
In nursing homes, up to 60% of residents may be infected, with up to a 30% fatality rate in the infected. Risk for Influenza-associated death is highest among the oldest elderly persons age 85 years and older are 16 times more likely to die from an Influenza-associated illness than persons aged 65-69 years.
Children age two years and younger have hospitalization rates second only to people age 65 years and older. Children younger than age one year are the most likely to be hospitalized. Influenza-associated deaths are uncommon among children but represent a substantial proportion of vaccine-preventable deaths.
What are possible complications from Influenza?
The most frequent complication of Influenza is bacterial pneumonia. Viral pneumonia is a less common complication but has a high fatality rate. Other complications include inflammation of the heart and worsening of such pulmonary diseases as bronchitis.
Reye's syndrome is a complication that occurs almost exclusively in children-patients suffer from severe vomiting and confusion, which may progress to coma because of swelling of the brain. To decrease
the chance of developing Reye's syndrome, infants, children, and teenagers should not be given aspirin for fever reduction or pain relief.
What is the best way to prevent Influenza?
The best way to prevent Influenza is with annual vaccination.
Is there an alternative to vaccination in preventing Influenza?
Vaccination is the principal means of preventing influenza and its complications. Here are some additional steps that may help prevent the spread of respiratory illnesses like Influenza
1. Cover your nose and mouth with your sleeve or a tissue when you cough or sneeze--throw the tissue away after you use it.
2. Wash your hands often with soap and water, especially after you cough or sneeze. If you are not near water, use an alcohol-based hand cleaner.
3. Stay away as much as you can from people who are sick.
4. If you get Influenza, stay home from work or school. If you are sick, don't go near other people to avoid infecting them.
5. Try not to touch your eyes, nose, or mouth. Germs often spread this way.
1. Cover your nose and mouth with your sleeve or a tissue when you cough or sneeze--throw the tissue away after you use it.
2. Wash your hands often with soap and water, especially after you cough or sneeze. If you are not near water, use an alcohol-based hand cleaner.
3. Stay away as much as you can from people who are sick.
4. If you get Influenza, stay home from work or school. If you are sick, don't go near other people to avoid infecting them.
5. Try not to touch your eyes, nose, or mouth. Germs often spread this way.
If I contract Influenza, what should I do?
Call your doctor to discuss your particular situation. You will need to get plenty of rest and to drink a lot of liquids. You can take medications to relieve the symptoms of Influenza (but never give aspirin to children or teenagers who have Influenza-like
symptoms, particularly fever). If you are at high risk from complications of Influenza, you should consult your doctor immediately if you develop Influenza-like symptoms. Those at high risk for complications
include people 65 years or older, people with chronic medical conditions, pregnant women, and young children. Your doctor may recommend use of an antiviral medication to help treat Influenza.
When is a person with Influenza contagious?
A person is most likely to pass on the virus during the period beginning one to two days before the onset of symptoms and ending four to five days after the onset.
Why can't we eradicate Influenza as we are doing with some other vaccine-preventable diseases (e.g., polio)?
It is difficult to completely eliminate Influenza for several reasons
1. Influenza viruses mutate frequently, making it very difficult to provide one influenza vaccination that will protect an individual for life.
2. Each year's Influenza vaccine is made up of three strains of the virus, based on an educated guess of which viruses will be most active during the upcoming influenza season. Occasionally, this projection may be wrong, and that year's vaccine will be less effective.
3. Influenza vaccine is not completely effective at preventing infection, especially with older individuals (although it does protect them from serious complications and death).
4. No attempt is made to vaccinate the entire population. Instead, Influenza vaccine is mainly recommended for certain groups such as people over 50, healthcare workers, people with chronic underlying illnesses, and others. Most recently the vaccine was recommended for use in infants and children age 6-59 months.
1. Influenza viruses mutate frequently, making it very difficult to provide one influenza vaccination that will protect an individual for life.
2. Each year's Influenza vaccine is made up of three strains of the virus, based on an educated guess of which viruses will be most active during the upcoming influenza season. Occasionally, this projection may be wrong, and that year's vaccine will be less effective.
3. Influenza vaccine is not completely effective at preventing infection, especially with older individuals (although it does protect them from serious complications and death).
4. No attempt is made to vaccinate the entire population. Instead, Influenza vaccine is mainly recommended for certain groups such as people over 50, healthcare workers, people with chronic underlying illnesses, and others. Most recently the vaccine was recommended for use in infants and children age 6-59 months.
Can you get Influenza more than once?
Yes. Influenza viruses change frequently and infection with one strain does not provide protection against all strains.
How are the vaccines made?
Every year, manufacturers develop and produce vaccine that contains virus strains that World Health Organization and, in the U.S., the FDA and CDC believe are most likely to circulate during the upcoming influenza season. Influenza vaccines contain both
type A and type B viruses. About six months are required to produce influenza vaccine each year.
How is the vaccine given?
The inactivated and recombinant vaccines are given as an intramuscular injection. The live attenuated vaccine is sprayed into the nose.
Measles
F.A.Q About the Disease and Vaccines
What causes measles?
Measles is caused by a virus.
How does measles spread?
Measles is spread through the air by infectious droplets and is highly contagious
How long does it take to show signs of measles after being exposed?
It takes an average of 10-12 days from exposure to the first symptom, which is usually fever. The measles rash doesn't usually appear until approximately 14 days after exposure, 2-3 days after the fever begins.
What are the symptoms of measles?
Symptoms include fever, runny nose, cough, loss of appetite, "pink eye," and a rash. The rash usually lasts 5-6 days and begins at the hairline, moves to the face and upper neck, and proceeds down the body.
How serious is measles?
Measles can be a serious disease, with reported cases experiencing one or more complications. Death from measles occurs in India. Complications from measles are more common among very young children (younger than five years of age) and adults (older than
20 years of age).
What are possible complications from measles?
Diarrhea is the most common complication of measles (occurring in 8% of cases), especially in young children. Ear infections occur in 7% of reported cases. Pneumonia, occurring in 6% of reported cases, accounts for 60% of measles-related deaths. Approximately
one out of one thousand cases will develop acute encephalitis, an inflammation of the brain. This serious complication can lead to permanent brain damage. Measles during pregnancy increases the risk
of premature labor, miscarriage, and low-birth-weight infants, although birth defects have not been linked to measles exposure. Measles can be especially severe in persons with compromised immune systems.
Measles is more severe in malnourished children, particularly those with vitamin A deficiency. In developing countries, the case-fatality rate may be as high as 25%.
How do I know if my child has measles?
Measles is diagnosed by a combination of the patient's symptoms.
Is there a treatment for measles?
There is no specific treatment for measles. People with measles need bed rest, fluids, and control of fever. Patients with complications may need treatment specific to their problem.
How long is a person with measles contagious?
Measles is highly contagious and can be transmitted from four days before the rash becomes visible to four days after the rash appears.
If I think my child has been exposed to measles, what should I do?
You should contact your doctor immediately if you believe you or your child has been exposed to measles. If your child has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure.
Can you get measles more than once?
No.
What kind of vaccine is it?
MMR vaccine contains live, attenuated (or weakened) strains of the measles, mumps, and rubella viruses.
At what age should the first dose of MMR be given?
The first dose of MMR should be given at or after 9 months age.
When should children get the second MMR dose?
The second dose is usually given at or 15 months age.
How effective is this vaccine?
The first dose of MMR produces immunity to measles and rubella in 90% to 95% of recipients. The second dose of MMR is intended to produce immunity in those who did not respond to the first dose, but a very small percentage of people may not be protected
even after a second dose.
How safe is this vaccine?
Hundreds of millions of doses of measles, mumps, and rubella vaccine prepared either as separate vaccines or as the combined MMR have been given in India, and its safety record is excellent.
What side effects have been reported with this vaccine?
Fever is the most common side effect, occurring in 5%–15% of vaccine recipients. About 5% of people develop a mild rash. When they occur, fever and rash usually appear 7–12 days after vaccination. About 25% of adult women receiving MMR vaccine develop
temporary joint pain, a symptom related to the rubella component of the combined vaccine. Joint pain only occurs in women who are not immune to rubella at the time of vaccination. MMR vaccine may cause
thrombocytopenia (low platelet count) at the rate of about 1 case per 30,000–40,000 vacci¬nated people. Cases are almost always temporary and not life-threatening. More severe reactions, including allergic
reactions, are rare.
If a child develops a rash after getting the MMR vaccine, is he contagious?
Transmission of the vaccine viruses does not occur from a vaccinated person, including those who develop a rash. No special precautions (e.g., exclusion from school or work) need be taken.
Can the live virus in the vaccine cause measles, mumps, and/or rubella?
Because the measles, mumps, and rubella viruses in the MMR vaccine are weak versions of the disease viruses, they may cause a very mild case of the disease they were designed to prevent; however, it is usually much milder than the natural disease and
is referred to as an adverse reaction to the vaccine.
What if a pregnant woman inadvertently got the MMR vaccine?
Women are advised not to receive any live virus vaccine during pregnancy as a safety precaution based on the theoretical possibility of a live vaccine causing disease (e.g., rubella virus leading to congenital rubella syndrome [CRS]).
Meningococcal
F.A.Q About the Disease and Vaccines
What causes meningococcal disease?
Meningococcal disease is caused by the bacterium Neisseria Meningitidis. This bacterium has at least 13 different subtypes. Five of these subtypes, A, B, C, Y, and W-135, cause almost all invasive disease. The relative importance of these five subgroups
depends on geographic location and other factors.
How does meningococcal disease spread?
The disease is spread person-to-person through the exchange of respiratory and throat secretions (e.g., by coughing, kissing, or sharing eating utensils). Meningococcal bacteria can't live for more than a few minutes outside the body, so the disease is
not spread as easily as the common cold or influenza.
How long does it take to show signs of meningococcal disease after being exposed?
Meningococcal bacteria can make a person extremely ill by infecting the blood (septicemia) or by infecting the fluid of the spinal cord and around the brain (meningitis). Symptoms of either can develop in just a few hours or they may take one to two days.
Because this disease progresses quickly, it is important to be diagnosed and start treatment as soon as possible.
What are the symptoms of meningococcal disease?
The most common symptoms are high fever, chills, lethargy, and a rash. If meningitis is present, the symptoms will also include headache and neck stiffness (which may not be present in infants); seizures may also occur. In overwhelming meningococcal infections,
shock, coma, and death can follow within several hours, even with appropriate medical treatment.
How serious is meningococcal disease?
Meningococcal disease is very serious. About 9-12% of persons with meningococcal disease die. Of those who recover, up to 20% suffer from some serious after-effect, such as permanent hearing loss, limb loss, or brain damage.
How is meningococcal disease diagnosed?
The diagnosis is made by taking samples of blood and spinal fluid from a person who is possibly infected. The spinal fluid is obtained by performing a spinal tap, where a needle is inserted into the lower back. Any bacteria found in the blood or spinal
fluid is grown in a medical laboratory and identified.
Can't meningitis be caused by a virus too?
Yes, the word "meningitis" refers to inflammation of the tissues covering the brain and spinal cord. This inflammation can be caused by viruses and fungi, as well as bacteria. Viral meningitis is the most common type: it has no specific treatment but
is usually not as serious as meningitis caused by bacteria.
Is there a treatment for meningococcal disease?
Bacterial meningitis can be treated with antibiotics. It is critical to start treatment early.
What persons are at special risk for meningococcal disease?
Persons at risk include infants, travelers to places where meningococcal disease is common (e.g., certain countries in Africa and Saudi Arabia), people with damaged or missing spleens, and people with certain blood diseases.
Other factors make it more likely an individual will develop meningococcal disease, including having a previous viral infection, living in a crowded household, having an underlying chronic illness, and being exposed to cigarette smoke (either directly or second-hand).
Studies have also shown that college freshmen who live in dormitories are at an increased risk of meningococcal disease compared with others their age.
Other factors make it more likely an individual will develop meningococcal disease, including having a previous viral infection, living in a crowded household, having an underlying chronic illness, and being exposed to cigarette smoke (either directly or second-hand).
Studies have also shown that college freshmen who live in dormitories are at an increased risk of meningococcal disease compared with others their age.
How common is meningococcal disease in the world?
Meningococcal disease is common in certain parts of the world, especially the area of Africa which is known as the "meningitis belt." An estimated 700,000 cases of meningococcal disease occurred in this area over a recent 10-year period; about 10% of
the cases died. Subtype A is responsible for most of the meningococcal disease in sub-Saharan Africa.
Can you get meningitis more than once?
Yes. Meningitis can be caused by different subtypes of the meningococcal bacterium, by other bacteria such as Streptococcus and Haemophilus, as well as by viruses and fungi. Even being vaccinated against Neisseria meningitidis or having had the disease
will not protect you against these other sources of infection.
If a child is diagnosed with meningococcal disease, can anything be done to protect the other children with whom he has contact?
Individuals who have been exposed to a person with bacterial meningitis can be protected by being started on a course of antibiotics immediately (ideally within 24 hours of the patient being diagnosed). This is usually recommended for household contacts
and children attending the same day care or nursery school. Older children (e.g., who are attending the same school or high school) aren't usually considered exposed unless they have had very close contact
with the infected person (e.g., kissing or sharing a glass).
In addition to the antibiotic treatment, vaccination may be recommended for people two years of age and older if the person's infection is caused by meningococcus type A, C, Y, or W-135, all of which are contained in the meningococcal vaccine.
In addition to the antibiotic treatment, vaccination may be recommended for people two years of age and older if the person's infection is caused by meningococcus type A, C, Y, or W-135, all of which are contained in the meningococcal vaccine.
What people are at special risk for meningococcal disease?
Risk factors for meningococcal disease include having a recent viral infection, household crowding, and cigarette smoke exposure (direct or second-hand smoke). In addition, certain people are at higher risk than other people their age for meningococcal
disease caused by any serogroup. These include people with a damaged or missing spleen, those with persistent complement component deficiency (an immune system disorder).
What are the side effects of these vaccines?
Up to about half of people who get MenACWY vaccines have mild side effects, such as redness or pain where the shot was given. These symptoms usually last for one or two days. A small percentage of people who receive the vaccine develop a fever. Severe
reactions, such as a serious allergic reaction, are very rare.
Mumps
F.A.Q About the Disease and Vaccines
What causes mumps?
Mumps is caused by a virus.
How does mumps spread?
Mumps spreads from person to person through the air. It is less contagious than measles or chickenpox.
How long does it take to show signs of mumps after being exposed?
The incubation period of mumps is 14-18 days, but can range from 14-25 days.
What are the symptoms of mumps?
Individuals with mumps usually first feel sick with such nonspecific symptoms as headache, loss of appetite, and low-grade fever.
The most well-known sign of mumps is "parotitis," the swelling of the salivary glands, or parotid glands, below the ear. Parotitis occurs only in 30%-40% of individuals infected with mumps.
Up to 20% of persons with mumps have no symptoms of disease, and another 40%-50% have only nonspecific or respiratory symptoms.
The most well-known sign of mumps is "parotitis," the swelling of the salivary glands, or parotid glands, below the ear. Parotitis occurs only in 30%-40% of individuals infected with mumps.
Up to 20% of persons with mumps have no symptoms of disease, and another 40%-50% have only nonspecific or respiratory symptoms.
How serious is mumps?
In children, mumps is usually a mild disease. Adults may have more serious disease and more complications.
What are possible complications from mumps?
Central nervous system involvement (meningitis) is common, but is usually not serious. Meningitis (with headache, stiff neck) occurs in up to 15% of people with mumps, but usually resolves without any permanent damage. Up to 50% of postpubertal males
experience "orchitis," or testicular inflammation, as a complication of mumps. This may involve pain, swelling, nausea, vomiting, and fever, with tenderness of the area possibly lasting for weeks. Sterility
is a rare complication, however. An increase in spontaneous abortion (miscarriage) has been found among women who developed mumps during the first trimester of pregnancy; however, there is no evidence
that mumps causes birth defects. Deafness, in one or both ears, can occur in approximately one per 20,000 reported cases of mumps.
Is there a treatment for mumps?
There is no "cure" for mumps, only supportive treatment (bed rest, fluids, and fever reduction).
How do I know if my child has mumps?
Mumps is diagnosed by a combination of symptoms and physical signs and laboratory confirmation of the virus, as not all cases develop characteristic parotitis and not all cases of parotitis are caused by mumps.
How long is a person with mumps contagious?
The infectious period is considered to be three days before symptoms begin to the ninth day following the onset of symptoms.
If I think my child has been exposed to mumps, what should I do?
If your child has not been vaccinated against mumps, receiving the vaccine after exposure to the virus will not help prevent disease if the child has already been infected. However, if the child did not become infected after this particular exposure,
the vaccine will help protect him or her against future exposure to mumps.
Can you get mumps more than once?
No.
Pertussis
F.A.Q About the Disease and Vaccines
What causes pertussis?
Pertussis is caused by a bacterium, Bordetella pertussis.
How does pertussis spread?
Pertussis is spread through the air by infectious droplets and is highly contagious.
How long does it take to show signs of pertussis after being exposed?
The incubation period of pertussis is commonly seven to 10 days, with a range of 5-21 days.
What are the symptoms of pertussis?
Pertussis disease can be divided into three stages:
Catarrhal stage: can last 1-2 weeks and includes a runny nose, sneezing, low-grade fever, and a mild cough (all similar symptoms to the common cold).
Paroxysmal stage: usually lasts 4-6 weeks, but can persist for up to 10 weeks. The characteristic symptom is a burst, or paroxysm, of numerous, rapid coughs. At the end of the paroxysm the patient suffers from a long inhaling effort that is characterized by a high-pitched whoop (hence the name, "whooping cough"). Infants and young children often appear very ill and distressed, and may turn blue and vomit.
Convalescent stage: usually lasts 2-6 weeks, but may last for months. Although the cough usually disappears after 2-3 weeks, paroxysms may recur whenever the patient suffers any subsequent respiratory infection. The disease is usually milder in adolescents and adults, consisting of a persistent cough similar to that found in other upper respiratory infections. However, these individuals are still able to transmit the disease to others, including unimmunized or incompletely immunized infants.
Catarrhal stage: can last 1-2 weeks and includes a runny nose, sneezing, low-grade fever, and a mild cough (all similar symptoms to the common cold).
Paroxysmal stage: usually lasts 4-6 weeks, but can persist for up to 10 weeks. The characteristic symptom is a burst, or paroxysm, of numerous, rapid coughs. At the end of the paroxysm the patient suffers from a long inhaling effort that is characterized by a high-pitched whoop (hence the name, "whooping cough"). Infants and young children often appear very ill and distressed, and may turn blue and vomit.
Convalescent stage: usually lasts 2-6 weeks, but may last for months. Although the cough usually disappears after 2-3 weeks, paroxysms may recur whenever the patient suffers any subsequent respiratory infection. The disease is usually milder in adolescents and adults, consisting of a persistent cough similar to that found in other upper respiratory infections. However, these individuals are still able to transmit the disease to others, including unimmunized or incompletely immunized infants.
How serious is pertussis?
Pertussis can be a very serious disease, especially for infants. Rates of hospitalization and complications increase with decreasing age. The breathing difficulties associated with this disease can be very distressing and scary for the patient and his
or her family.
Although adults are less likely than infants to become seriously ill with pertussis, most make repeated visits for medical care and miss work, especially when pertussis is not initially considered as a reason for their long-term cough. In addition, adults with pertussis infection have been shown to be an important source of infection to infants with whom they have close contact.
Although adults are less likely than infants to become seriously ill with pertussis, most make repeated visits for medical care and miss work, especially when pertussis is not initially considered as a reason for their long-term cough. In addition, adults with pertussis infection have been shown to be an important source of infection to infants with whom they have close contact.
How do I know if my child has pertussis?
The diagnosis of pertussis is usually made based on its characteristic history and physical examination. A laboratory test may be done, which involves taking a specimen from the back of the patient's throat (through the nose).
What are possible complications from pertussis?
Again, younger patients have a greater chance of complications from pertussis than older patients. The most common complication is secondary bacterial infection, which is the cause of most pertussis-related deaths. Pneumonia occurs in one out of 20 cases.
Infants are also more likely to suffer from such neurologic complications as seizures and encephalopathy, probably due to the reduction of oxygen supply to the brain.
Infants are also more likely to suffer from such neurologic complications as seizures and encephalopathy, probably due to the reduction of oxygen supply to the brain.
Is there a treatment for pertussis?
Antibiotics are somewhat helpful in treating pertussis. The drug of choice is usually erythromycin. This antibiotic should also be given for 14 days to all household and other close contacts of the patient to minimize transmission, regardless of age and
vaccination status.
All close contacts younger than seven years of age should complete their DTaP vaccine series if they have not already done so. If they have completed their primary four dose series, but have not had a dose within the last three years, they should be given a booster dose.
Patients also need supportive therapy such as bed rest, fluids, and control of fever.
All close contacts younger than seven years of age should complete their DTaP vaccine series if they have not already done so. If they have completed their primary four dose series, but have not had a dose within the last three years, they should be given a booster dose.
Patients also need supportive therapy such as bed rest, fluids, and control of fever.
How long is a person with pertussis contagious?
Persons with pertussis are most infectious during the catarrhal period and during the first two weeks after onset of the cough (approximately 21 days).
Can you get pertussis more than once?
Reinfection appears to be uncommon but does occur. With natural infection, immunity to pertussis will likely wane as soon as seven years following disease; reinfection may present as a persistent cough, rather than typical pertussis. Unfortunately, it
is difficult to verify pertussis infection with existing laboratory methods.
If someone has a recent culture-documented case of pertussis, he or she may not need immediate immunization against pertussis; however, a vaccine containing pertussis antigen will not be harmful, and they should continue on the routine immunization schedule for future protection against tetanus, diphtheria, and pertussis. If culture is lacking, even with a history of pertussis, do NOT withhold a dose of pertussis vaccine, if it is recommended per the routine schedule.
If someone has a recent culture-documented case of pertussis, he or she may not need immediate immunization against pertussis; however, a vaccine containing pertussis antigen will not be harmful, and they should continue on the routine immunization schedule for future protection against tetanus, diphtheria, and pertussis. If culture is lacking, even with a history of pertussis, do NOT withhold a dose of pertussis vaccine, if it is recommended per the routine schedule.
Pneumococcal
F.A.Q About the Disease and Vaccines
What causes pneumococcal disease?
Pneumococcal disease is caused by Streptococcus pneumoniae, a bacterium. There are more than 90 subtypes. Most subtypes can cause disease, but only a few produce the majority of invasive pneumococcal infections. The 10 most common subtypes cause 62% of
invasive disease worldwide.
How does pneumococcal disease spread?
The disease is spread from person to person by droplets in the air. The pneumococci bacteria are common inhabitants of the human respiratory tract. They may be isolated from the nasopharnyx of 5%-70% of normal, healthy adults.
How long does it take to show signs of pneumococcal disease after being exposed?
As noted above, many people carry the bacteria in their nose and throat without ever developing invasive disease. The incubation period for specific diseases caused by an invasive pneumococcal infection is noted below.
What diseases can pneumococci bacteria cause?
There are three major conditions caused by invasive pneumococcal disease: pneumonia, bacteremia, and meningitis. They are all caused by infection with the same bacteria, but have different symptoms.
Pneumococcal pneumonia (lung disease) is the most common disease caused by pneumococcal bacteria. The incubation period is short (1-3 days). Symptoms include abrupt onset of fever, shaking chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weakness. The fatality rate is 5%-7% and may be much higher in the elderly.
Pneumococcal bacteremia (blood infection) occurs in about 25%-30% of patients with pneumococcal pneumonia. Bacteremia is the most common clinical presentation among children younger than age two years, accounting for 70% of invasive disease in this group.
Pneumococcal meningitis symptoms may include headache, tiredness, vomiting, irritability, fever, seizures, and coma. Children younger than age one year have the highest rate of pneumococcal meningitis.
Pneumococci are also a common cause of acute otitis media (middle ear infection). Middle ear infections are the most frequent reason for pediatric clinic visits in India.
Pneumococcal pneumonia (lung disease) is the most common disease caused by pneumococcal bacteria. The incubation period is short (1-3 days). Symptoms include abrupt onset of fever, shaking chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weakness. The fatality rate is 5%-7% and may be much higher in the elderly.
Pneumococcal bacteremia (blood infection) occurs in about 25%-30% of patients with pneumococcal pneumonia. Bacteremia is the most common clinical presentation among children younger than age two years, accounting for 70% of invasive disease in this group.
Pneumococcal meningitis symptoms may include headache, tiredness, vomiting, irritability, fever, seizures, and coma. Children younger than age one year have the highest rate of pneumococcal meningitis.
Pneumococci are also a common cause of acute otitis media (middle ear infection). Middle ear infections are the most frequent reason for pediatric clinic visits in India.
How serious is pneumococcal disease?
Pneumococcal disease is a serious disease that causes much sickness and death. More than half of these cases occurred in adults for whom pneumococcal polysaccharide vaccine was recommended. Young children and the elderly (individuals younger than age
five years as well as those older than age 65 years) have the highest incidence of serious disease.
Case-fatality rates are highest for meningitis and bacteremia, and the highest mortality occurs among the elderly and patients who have underlying medical conditions. Despite appropriate antimicrobial therapy and intensive medical care, the overall case-fatality rate for pneumococcal bacteremia is about 20% among adults. Among elderly patients, this rate may be as high as 60%.
Before a vaccine was available in India, pneumococcal disease caused serious disease in children younger than age five years. Children younger than age two years are at the highest risk for serious pneumococcal disease.
Case-fatality rates are highest for meningitis and bacteremia, and the highest mortality occurs among the elderly and patients who have underlying medical conditions. Despite appropriate antimicrobial therapy and intensive medical care, the overall case-fatality rate for pneumococcal bacteremia is about 20% among adults. Among elderly patients, this rate may be as high as 60%.
Before a vaccine was available in India, pneumococcal disease caused serious disease in children younger than age five years. Children younger than age two years are at the highest risk for serious pneumococcal disease.
Is there a treatment for pneumococcal disease?
Penicillin is the drug of choice for treatment of pneumococcal disease; however, resistance to penicillin and other antibiotics has been on the rise. Treating patients infected with resistant organisms requires expensive alternative antimicrobial agents
and may result in prolonged hospital stays. The increased difficulty of treating this serious bacterial infection makes prevention through vaccination even more important.
How long is a person with pneumococcal disease contagious?
The exact period of communicability is not known. It appears that transmission can occur as long as the organism remains in respiratory secretions.
Can you get pneumococcal disease more than once?
Yes. There are more than 90 known subtypes of pneumococcus bacteria, with 23 subtypes included in the current pneumococcal polysaccharide (adult) vaccine and 7 subtypes included in the current conjugate (child) vaccine. Having been infected with one type
does not always make the patient immune to other types. Even if an individual has had one or more episodes of invasive pneumococcal disease, he or she needs to be vaccinated.
Types of pneumococcal vaccines available for vaccination?
There are two types of pneumococcal vaccine – pneumococcal polysaccharide vaccine and pneumococcal conjugate vaccine.
Both pneumococcal vaccines are made from inactivated (killed) bacteria. The pneumococcal conjugate vaccine (PCV) includes purified capsular polysaccharides from the bacteria that are “conjugated” (or joined) to a protein (a harmless variety of diphtheria toxin). The resultant conjugate vaccine is able to produce an immune response in infants and antibody booster response to multiple doses of vaccine.
The pneumococcal polysaccharide vaccine (PPSV23) contains long chains of polysaccharide (sugar) molecules that make up the surface capsule of the bacteria. Generally speaking, pure polysaccharide vaccines do not work well in children younger than 2 years, induce only short-term immunity, and multiple doses do not provide a “boost” to immunity.
Both pneumococcal vaccines are made from inactivated (killed) bacteria. The pneumococcal conjugate vaccine (PCV) includes purified capsular polysaccharides from the bacteria that are “conjugated” (or joined) to a protein (a harmless variety of diphtheria toxin). The resultant conjugate vaccine is able to produce an immune response in infants and antibody booster response to multiple doses of vaccine.
The pneumococcal polysaccharide vaccine (PPSV23) contains long chains of polysaccharide (sugar) molecules that make up the surface capsule of the bacteria. Generally speaking, pure polysaccharide vaccines do not work well in children younger than 2 years, induce only short-term immunity, and multiple doses do not provide a “boost” to immunity.
Which adults are recommended to receive a dose of PCV13?
Pneumococcal conjugate vaccine (PCV13, Prevnar 13, (Pfizer) is recommended for all adults without a prior PCV13 vaccination who have certain high-risk conditions, including immunocompromising conditions, cerebrospinal fluid (CSF) leak, and cochlear implant.
Immunocompromising conditions include chronic renal failure, nephrotic syndrome, congenital or acquired immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease, or other hemoglobinopathies.
PCV13 can be given to adults age 65 years and older without these high-risk conditions based on shared clinical decision-making.
Immunocompromising conditions include chronic renal failure, nephrotic syndrome, congenital or acquired immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease, or other hemoglobinopathies.
PCV13 can be given to adults age 65 years and older without these high-risk conditions based on shared clinical decision-making.
Do some children need to get both PCV13 and PPSV23?
Yes, children at high risk of invasive pneumococcal disease should receive PCV13 and then also receive PPSV23 when age two years or older. PPSV23 is not given routinely to healthy children.
If I have already received at dose of PPSV23 at age 65 years should I still receive PCV13?
All people with certain medical conditions, including immunocompromising conditions, CSF leak, asplenia, and having a cochlear implant, are recommended to be vaccinated with PCV13. Adults age 65 years and older may receive PCV13 based on shared clinical
decision making between the patient and their healthcare providers.
Polio
F.A.Q About the Disease and Vaccines
What causes polio?
Polio is caused by a virus.
How does polio spread?
Polio is usually spread via the fecal-oral route (i.e., the virus is transmitted from the stool of an infected person to the mouth of another person from contaminated hands or such objects as eating utensils). Some cases may be spread directly via an
oral to oral route.
How long does it take to show signs of polio after being exposed?
The incubation period of polio is commonly 6-20 days, with a range of 3-35 days.
What are the symptoms of polio?
Surprisingly, 95% of all individuals infected with polio have no apparent symptoms.
Another 4%-8% of infected individuals have symptoms of a minor, non-specific nature, such as sore throat and fever, nausea, vomiting, and other common symptoms of any viral illness.
About 1%-2% of infected individuals develop nonparalytic aseptic (viral) meningitis, with temporary stiffness of the neck, back, and/or legs. Less than 1% of all polio infections result in the classic "flaccid paralysis," where the patient is left with permanent weakness or paralysis of legs, arms, or both.
Another 4%-8% of infected individuals have symptoms of a minor, non-specific nature, such as sore throat and fever, nausea, vomiting, and other common symptoms of any viral illness.
About 1%-2% of infected individuals develop nonparalytic aseptic (viral) meningitis, with temporary stiffness of the neck, back, and/or legs. Less than 1% of all polio infections result in the classic "flaccid paralysis," where the patient is left with permanent weakness or paralysis of legs, arms, or both.
How serious is polio?
Although most cases of polio are mild, the 1% of cases resulting in flaccid paralysis have made polio a feared disease for hundreds of years. Of persons with paralytic polio, about 2%-5% of children die and up to 15%-30% of adults die.
How is polio diagnosed?
If a person is suspected of being infected, a sample from their stool or throat should be tested for the poliomyelitis virus.
How long is a person with polio contagious?
Patients infected with the polio virus can pass the virus on for 7-10 days before the onset of disease. In addition, they can continue to shed the virus in their stool for 3-6 weeks.
Is there a treatment for polio?
There is no "cure" for polio. Persons infected with polio need supportive therapy, such as bed rest and fluids. Standard precautions should be taken to avoid passing on the virus through any contamination from the patient's stool.
How common is polio in the world?
In 1988, the World Health Organization (WHO) adopted the goal of global polio eradication. Although the initial target date of 2000 was not met, substantial progress has been made. In 1988, there were estimated to be 350,000 reported cases of polio in
the world; in 2001, just 480 cases were reported in only 10 countries. Unfortunately, rumors about the safety of polio vaccine in 2003, and subsequent refusal of vaccine by many parents in Nigeria, led
to an increase in cases and spread of the virus to nearby countries that had previously been polio free. In 2003, there were 784 reported cases; in 2004, there were 1,258 reported cases. Polio currently
exists only in Asia (Afghanistan, India, and Pakistan) and Africa (primarily Nigeria). In 2006, there were 1,906 cases of polio in 16 countries, according to the Global Polio Eradication Initiative.
Many organizations have been working hard toward eradicating polio including WHO, the United Nations Children's Fund (UNICEF), the Centers for Disease Control and Prevention (CDC), Rotary International,
and many other international and national groups. Strategies include house-to-house vaccination and National Immunization Days.
Why should I vaccinate my child against polio if this disease has been eliminated from India, since 2014 by the WHO?
Polio still exists in parts of Africa and Asia and can easily be imported. When poliovirus is eliminated from the world, polio vaccine will become part of history. But we are not to that point yet.
How is the vaccine administered?
• IPV is given as a shot in the arm or leg.
• OPV is given as an oral liquid.
• OPV is given as an oral liquid.
How effective is this vaccine?
IPV is very effective in preventing polio, but only when all recommended doses are completed. A single dose of IPV produces little or no immunity, but 99% of recipients are immune after three doses.
How safe is this vaccine?
The IPV vaccine is very safe; no serious adverse reactions to IPV have been documented.
Rabies
F.A.Q About the Disease and Vaccines
What causes rabies?
Rabies is caused by a virus. The virus invades the central nervous system and disrupts its functioning.
How does rabies spread?
The rabies virus is transmitted in the saliva of infected animals. People usually become infected with the virus by being bitten by an infected animal, but any contact with the saliva of an infected animal (alive or dead) can potentially lead to infection
if the person has an opening in the skin or the saliva gets into their eyes, nose, or mouth.
You cannot get rabies from the blood, urine, or feces of a rabid animal, or from just touching or petting an animal.
You cannot get rabies from the blood, urine, or feces of a rabid animal, or from just touching or petting an animal.
How long does it take to show signs of rabies after being exposed?
For rabies, the incubation period is more variable than with other infections. Usually symptoms appear anywhere from 10-60 days following exposure to the virus, but they can occur as early as a few days after exposure or as long as a year later.
What are the symptoms of rabies?
The rabies virus attacks the nervous system (brain and spinal cord). The first symptoms of rabies are similar to a flu-like illness--fever, headache, and general discomfort. Within days, the disease can progress to symptoms such as anxiety, confusion,
agitation, abnormal behavior, delirium, and hallucinations.
Once symptoms appear, the disease is almost always fatal. Therefore, any person who has been bitten, scratched, or somehow exposed to the saliva of a potentially rabid animal should see a physician as soon as possible for postexposure treatment.
Once symptoms appear, the disease is almost always fatal. Therefore, any person who has been bitten, scratched, or somehow exposed to the saliva of a potentially rabid animal should see a physician as soon as possible for postexposure treatment.
How serious is rabies?
Rabies is an extremely painful and deadly disease. As mentioned above, if prompt and appropriate post-exposure treatment is not received, the disease is fatal. Each year rabies kills approximately 50,000 people around the world.
What should I do if a neighborhood dog bites my child?
You should get medical attention for any animal bite. If the pet appeared healthy at the time your child was bitten, it can be confined for 10 days and observed; at least three doses of Anti Rabies Vaccine (ARV) need to be given to your child. If the
pet appeared ill at the time it bit your child, it should be evaluated by a veterinarian for signs of rabies. Your physician will be able to give you more specific advice for your situation.
I've been bitten by a Dog / Cat --what should I do?
If you've been bitten or scratched by any animal, you should
1. Clean the area immediately with soap and water for at least five minutes.
2. Immediately take a Tetanus Toxoid Vaccine short.
3. See a doctor/physician as soon as possible, ideally within 24-48 hours
1. Clean the area immediately with soap and water for at least five minutes.
2. Immediately take a Tetanus Toxoid Vaccine short.
3. See a doctor/physician as soon as possible, ideally within 24-48 hours
How is rabies diagnosed?
Rabies can be very difficult to diagnose. Laboratory tests can find rabies virus in the saliva, skin, or brain tissue of a patient; unfortunately, this is not possible until late in the disease when it is too late for treatment. Therefore, the physician
or other health professional will most likely make a diagnosis based on the details of contact with a potentially infected animal and the likelihood of rabies infection in that species in that geographical
location. Obviously, diagnosis is easier if the animal involved is available for testing.
Can you get rabies from another person?
In theory, infected humans could transmit rabies through a bite or other exposure.
How common is rabies in the world?
The rabies virus can be found everywhere except a few Caribbean islands, England, Ireland, Japan, Taiwan, Spain, and Portugal.
Rabies is a big problem in Asia, Africa, and Central and South America. Each year rabies kills more than 50,000 people and millions of animals worldwide.
Exposure to rabid dogs is the cause of over 90% of human rabies cases and over 99% of human deaths from rabies worldwide. Although vaccination of dogs and elimination of strays has been shown to effectively prevent most cases of human rabies, the cost of such a control program is beyond the reach of most developing countries.
Rabies is a big problem in Asia, Africa, and Central and South America. Each year rabies kills more than 50,000 people and millions of animals worldwide.
Exposure to rabid dogs is the cause of over 90% of human rabies cases and over 99% of human deaths from rabies worldwide. Although vaccination of dogs and elimination of strays has been shown to effectively prevent most cases of human rabies, the cost of such a control program is beyond the reach of most developing countries.
How can I help prevent rabies in my pet and myself?
1. Vaccinate your pets (dogs, cats) and livestock (sheep, cattle, horses) against rabies. Don't let your pets wander unsupervised. Spay or neuter your pets; pets that are fixed are less likely to leave home and become strays.
2. Contact animal control to remove stray animals or animals acting sick or strange in your neighborhood.
3. Never touch or approach unfamiliar animals, domestic or wild. Don't touch dead animals. Teach your children the same.
4. Seal openings into your home to prevent wild animals from gaining entrance.
5. If you do get bitten by an animal, wash the wound with soap and water for at least five minutes and then seek medical care.
2. Contact animal control to remove stray animals or animals acting sick or strange in your neighborhood.
3. Never touch or approach unfamiliar animals, domestic or wild. Don't touch dead animals. Teach your children the same.
4. Seal openings into your home to prevent wild animals from gaining entrance.
5. If you do get bitten by an animal, wash the wound with soap and water for at least five minutes and then seek medical care.
Rotavirus
F.A.Q About the Disease and Vaccines
What causes rotavirus disease?
Rotavirus disease is caused by a virus, the rotavirus. The name rotavirus is derived from the Latin rota, meaning "wheel," because the rotavirus has a wheel-like appearance when viewed by an electron microscope.
How does rotavirus spread?
The rotavirus enters the body through the mouth and then infects the lining of the intestines. Rotavirus is very contagious, spreading easily from children who are already infected to other children and sometimes adults. Large amounts of rotavirus are
shed in the stool of infected persons and the virus can be easily spread via contaminated hands and objects, such as toys. Children can spread rotavirus both before and after they become sick with diarrhea.
Rotavirus is very stable and may remain viable in the environment for months if not disinfected.
Rotavirus is very stable and may remain viable in the environment for months if not disinfected.
How long does it take to show signs of rotavirus after being exposed?
The incubation period for rotavirus diarrhea is 1-3 days. Symptoms of infection vary and depend on whether it is the first infection or reinfection.
What are the symptoms of rotavirus?
Rotavirus disease usually starts with fever, an upset stomach, and vomiting, followed by diarrhea. Children who have rotavirus disease develop vomiting and watery diarrhea that may last from three to seven days. They may lose interest in eating and drinking
and become dehydrated from loss of fluids.
How serious is rotavirus?
All three symptoms of rotavirus disease (fever, vomiting, and diarrhea) cause children to lose fluids. Vomiting is especially dangerous because it's difficult to replace fluids in children who are vomiting persistently. Rotavirus infection is even more
problematic in the developing world because children with rotavirus disease are less likely to receive the medical intervention necessary to prevent death from dehydration. In developing countries, rotavirus
causes more than 500,000 deaths each year in children younger than age five years.
What are possible complications from rotavirus?
Rotavirus infection in infants and young children can lead to severe diarrhea, dehydration, electrolyte imbalance, and metabolic acidosis. Immunodeficient children may have more severe or persistent disease.
How do I know if my child has rotavirus?
Rotavirus disease is difficult to differentiate from illness caused by other pathogens. As a result, laboratory testing of the stool is needed to confirm a diarrheal illness as rotavirus.
Are children more likely to become infected at certain times of the year?
In tropical climates, the disease occurs year round.
Is there a treatment for rotavirus?
Children are typically treated by replacing lost body fluids through drinking products that contain water with sugar and minerals. In severe cases, body fluids are replaced with fluids given directly through the veins using an intravenous line in the
hospital.
How long is a person with rotavirus contagious?
Infected persons shed large quantities of virus in their stool beginning 2 days before the onset of diarrhea and for up to 10 days after onset of symptoms. Rotavirus may be detected in the stool of persons with immune deficiency for more than 30 days
after infection.
Can you get rotavirus more than once?
A person may develop rotavirus disease more than once because there are many different rotavirus types, but second infections tend to be less severe than the original infections. After a single natural infection, 40% of children are protected against
any subsequent rotavirus infection. Recurrent rotavirus infections affect persons of all ages.
Wouldn't good hygiene be enough to prevent rotavirus disease?
Better hygiene and sanitation have not been very effective in reducing rotavirus disease. This is illustrated by the fact that virtually everyone in the world is infected by rotavirus disease by age five years, despite differences in sanitation between
countries.
How effective is rotavirus vaccine?
Rotavirus vaccine is very effective against rotavirus disease. Studies show the vaccine to be highly effec¬tive (85% to 98%) against severe rotavirus disease and effective against rotavirus disease of any sever¬ity (74% to 87%) through approximately the
first rotavirus season after vaccination. Chances that children will need to be hospitalized for rotavirus disease are also greatly decreased (96%) by the vac¬cine. Neither vaccine will prevent diarrhea
or vomit¬ing caused by other germs.
How is this vaccine given?
Rotavirus vaccine is given orally to babies.
What is the recommended schedule for getting this vaccine?
Rotavirus vaccines require multiple doses. Different vac¬cine are given in a 3-dose or 2 dose series with doses at ages either at 10 weeks and 14 weeks or 6, 10, and 14 weeks of age. The first dose of either vaccine can be given as early as age 6 weeks
or as late as age 14 weeks, 6 days. There must be at least 4 weeks between doses and all doses must be given by age 8 months. Rotavirus vaccine may be given at the same time as other childhood vaccines.
Should an infant who has already been infected with rotavirus still be vaccinated?
Yes. Infants who have recovered from a rotavirus infection may not be immune to all of the virus types present in the vaccine. So infants who have previ¬ously had rotavirus disease should still complete the vaccine series if they can do so by age 8 months.
Rubella
F.A.Q About the Disease and Vaccines
What causes rubella (German Measles)?
Rubella is caused by a virus.
How does rubella spread?
Rubella spreads from person to person through the air. Rubella is contagious but less so than measles and chickenpox.
How long does it take to show signs of rubella after being exposed?
The incubation period varies from 12 to 23 days (average, 14 days). Symptoms are often mild and may be inapparent up to half of the time.
What are the symptoms of rubella?
Children with rubella usually first break out in a rash, which starts on the face and progresses down the body. Older children and adults usually first suffer from low-grade fever, swollen glands in the neck or behind the ears, and upper respiratory infection
before they develop a rash. Adult women often develop pain and stiffness in their finger, wrist, and knee joints, which may last up to a month. Up to half of people infected with rubella virus have no
symptoms at all.
How serious is rubella?
Rubella is usually a mild disease in children; adults tend to have more complications. The main concern with rubella disease, however, is the effect it has on an infected pregnant woman. Rubella infection in the first trimester of pregnancy can lead to
fetal death, premature delivery, and serious birth defects.
What are possible complications from rubella?
Encephalitis (brain infection) occurs in one in 6,000 cases, usually in adults. Temporary blood problems, including low platelet levels and hemorrhage, also occur rarely. Up to 70% of adult women with rubella have pain and/or swelling of the joints, which
is usually temporary.
The most serious complication of rubella infection is Congenital Rubella Syndrome (CRS), the result when the rubella virus attacks a developing fetus. Up to 85% of infants infected during the first trimester of pregnancy will be born with some type of birth defect, including deafness, eye defects, heart defects, mental retardation, and more. Infection early in the pregnancy (less than 12 weeks gestation) is the most dangerous; defects are rare when infection occurs after 20 weeks gestation.
The most serious complication of rubella infection is Congenital Rubella Syndrome (CRS), the result when the rubella virus attacks a developing fetus. Up to 85% of infants infected during the first trimester of pregnancy will be born with some type of birth defect, including deafness, eye defects, heart defects, mental retardation, and more. Infection early in the pregnancy (less than 12 weeks gestation) is the most dangerous; defects are rare when infection occurs after 20 weeks gestation.
Is there a treatment for rubella?
There is no "cure" for rubella, only supportive treatment (e.g., bed rest, fluids, and fever reduction).
How do I know if my child has rubella?
Because the rubella rash looks similar to other rashes, the only sure way to diagnose rubella is by a laboratory test.
How long is a person with rubella contagious?
The disease is most contagious when the rash is erupting, but the virus can be spread from seven days before, to 5-7 days after the rash begins.
If I think my child has been exposed to rubella, what should I do?
If your child has not been vaccinated against rubella, receiving the vaccine after exposure to the virus will not help prevent disease if the child has already been infected. However, if the child did not become infected after this particular exposure,
the vaccine will help protect him or her against future exposure to rubella.
Can you get rubella more than once?
Second cases of rubella are believed to be very rare.
Why do people call rubella "German Measles"?
Rubella was first described as a separate disease in the German medical literature in 1814.
Tetanus
F.A.Q About the Disease and Vaccines
What causes tetanus?
Tetanus is caused by a toxin (poison) produced by thebacterium Clostridium tetani. The C. tetani bacteriacannot grow in the presence of oxygen. They producespores that are very difficult to kill as they are resistantto heat and many chemical agents.
How does tetanus spread?
C. tetani spores can be found in the soil and in theintestines and feces of many household and farmanimals and humans. The bacteria usually enter thehuman body through a puncture (in the presence ofanaerobic [low oxygen] conditions, the spores will germinate).
Tetanus is not spread from person to person.
How long does it take to show signs of tetanusafter being exposed?
The incubation period varies from 3–21 days, with anaverage of eight days. The further the injury site is fromthe central nervous system, the longer the incubationperiod. The shorter the incubation period, the higherthe risk of death.
What are the symptoms of tetanus?
The symptoms of tetanus are caused by the tetanustoxin acting on the central nervous system. In the mostcommon form of tetanus, the first sign is spasm of thejaw muscles, followed by stiffness of the neck, difficultyin swallowing, and stiffness of the
abdominal muscles.Other signs include fever, sweating, elevated bloodpressure, and rapid heart rate. Spasms often occur,which may last for several minutes and continue for3–4 weeks. Complete recovery,
if it occurs, may takemonths.
How serious is tetanus?
Tetanus has a high fatality rate. In recent years, tetanushas been fatal in about 10% to 20% of reported cases.
What are possible complications from tetanus?
Laryngospasm (spasm of the vocal cords) is a complicationthat can lead to interference with breathing.Patients can also break their spine or long bones fromconvulsions. Other Possible complications includehypertension, abnormal heart rhythm, and secondaryinfections,
which are common because of prolongedhospital stays.Obviously, the high probability of death is a majorcomplication.
How is tetanus diagnosed?
The diagnosis of tetanus is based on the clinical signsand symptoms only. Laboratory diagnosis is not usefulas the C. tetani bacteria usually cannot be recoveredfrom the wound of an individual who has tetanus, andconversely, can be isolated from the skin
of an individualwho does not have tetanus.
What kind of injuries might allow tetanus to enterthe body?
Tetanus bacilli live in the soil, so the most dangerouskind of injury involves possible contamination withdirt, animal feces, and manure. Although we have traditionally worried about deep puncture wounds, in realitymany types of injuries can allow tetanus
bacilli to enterthe body. In recent years, a higher proportion of caseshad minor wounds than had major ones, probablybecause severe wounds were more likely to be properly managed. People can also get
tetanus from splinters,self-piercing, and self-tattooing. Injecting drug usersare also at risk for tetanus.
I stepped on a rusted nail. What should I do?
Any wound that may involve contamination with tetanusbacilli should be attended to as soon as possible.Treatment depends on your vaccination status and thenature of the wound. In all cases, the wound should bethoroughly cleaned. Seek medical treatment
immediatelyand bring your immunization record with you. With wounds that involve the possibility of tetanuscontamination, a patient with an unknown or incompletehistory of tetanus vaccination needs a
tetanusanddiphtheria-containing shot (Td or Tdap) and a doseof tetanus immune globulin (TIG) as soon as possible.
Varicella (Chickenpox)
F.A.Q About the Disease and Vaccines
What causes chickenpox?
Chickenpox is caused by a virus, the Varicella-Zoster Virus.
How does tetanus spread?
C. tetani spores can be found in the soil and in theintestines and feces of many household and farmanimals and humans. The bacteria usually enter thehuman body through a puncture (in the presence ofanaerobic [low oxygen] conditions, the spores will germinate).
Tetanus is not spread from person to person.
How does chickenpox spread?
Chickenpox spreads from person to person by direct contact or through the air by coughing or sneezing. It is highly contagious. It can also be spread through direct contact with the fluid from a blister of a person infected with chickenpox, or from direct
contact with a sore from a person with shingles.
How long does it take to show signs of chickenpox after being exposed?
It takes from 10-21 days to develop symptoms after being exposed to a person infected with chickenpox. The usual time period is 14-16 days.
What are the symptoms of chickenpox?
The most common symptoms of chickenpox are rash, fever, coughing, fussiness, headache, and loss of appetite. The rash usually develops on the scalp and body, and then spreads to the face, arms, and legs. The rash usually forms 200-500 itchy blisters in
several successive crops. The illness lasts about 5-10 days.
How serious is chickenpox?
Many cases of chickenpox are mild, but deaths from this disease can occur. Before the development of a vaccine, people use to die every year in India from chickenpox. Most of these people were previously healthy. Even children with average cases of chickenpox
are uncomfortable and need to be kept out of daycare or school for a week or more.
What are possible complications from chickenpox?
The most common complication is bacterial infection of the skin or other parts of the body including the bones, lungs, joints, and blood. The virus can also lead to pneumonia or infection of the brain. These complications are rare but serious. Complications
are more common in infants, adults, and persons with weakened immune systems.
How do I know if my child has chickenpox?
Usually chickenpox can be diagnosed by disease history and appearance alone. Adults who need to know if they've had chickenpox in the past can have this determined by a laboratory test.
How long is a person with chickenpox contagious?
Patients with chickenpox are contagious for 1-2 days before the rash appears and continue to be contagious through the first 4-5 days or until all the blisters are crusted over.
Is there a treatment for chickenpox?
Most cases of chickenpox in otherwise healthy children are treated with bed rest, fluids, and control of fever. Children with chickenpox should NOT receive aspirin because of possible subsequent risk of Reye's syndrome. Acetaminophen may be given for
fever control. Chickenpox may be treated with an antiviral drug in serious cases, depending on the patient's age and health, the extent of the infection, and the timing of the treatment.
How common is chickenpox in India?
Because it is so easy to catch chickenpox, almost adults in India have been infected. Until a vaccine became available.
Can you get chickenpox more than once?
Most people are immune to chickenpox after having the disease. However, although it is not common, second cases of chickenpox can occur, particularly in immunocompromised persons.
If I think my child has been exposed to chickenpox, what should I do?
If the child has had chickenpox or has been vaccinated, nothing needs to be done. It is recommended that a susceptible person (one who has never had chickenpox) receive the chickenpox vaccine as soon as possible after being exposed to the virus. There
is evidence that the vaccine may prevent illness or reduce the seriousness of the disease, if given within 3 to 5 days following exposure. Even if the person was not infected with the chickenpox virus
from the exposure, receiving the vaccination will prevent future disease.
What kind of vaccine is it?
The chickenpox vaccine is a live attenuated vaccine. This means the live, disease-producing virus was modified, or weakened, in the laboratory to produce an organism that can grow and produce immunity in the body without causing illness.
How effective is this vaccine?
Almost all (more than 99%) children develop immu¬nity to the disease after two doses of vaccine. For older children and adults, an average of 78% develop immunity after one dose and 99% develop immunity after the recommended two doses.
Although some vaccinated children (about 2%) will still get chickenpox, they generally will have a much milder form of the disease, with fewer blisters (typi¬cally fewer than 50), lower fever, and a more rapid recovery.
The vaccine almost always prevents against severe disease. Getting chickenpox vaccine is much safer than getting chickenpox disease.
Although some vaccinated children (about 2%) will still get chickenpox, they generally will have a much milder form of the disease, with fewer blisters (typi¬cally fewer than 50), lower fever, and a more rapid recovery.
The vaccine almost always prevents against severe disease. Getting chickenpox vaccine is much safer than getting chickenpox disease.
What side effects have been reported with this vaccine?
Possible side effects are generally mild and include redness, stiffness, and soreness at the injection site; such localized reactions occur in 19% of children immunized and 24% of adolescents and adults (slightly more following the second dose). A small
percentage of people develop a mild rash, usually around the spot where the shot was given.
Can the vaccine cause chickenpox?
Because this vaccine is made from a live, but weak¬ened, virus, about 1% of recipients develop a mild form of the disease, consisting of a limited rash, most often with only 5–6 blisters. Usually there is no fever. These people are then safe from the
more serious, naturally occurring form of the virus.
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