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Communicable diseases in schools

Communicable diseases in schools. Dr Charmaine Gauci MD, MSc, PhD, FRSPH, FFPH Director, Health Promotion and Disease Prevention Directorate. Children vulnerable group. Low immunity Most infectious diseases occur in children Close contact with other children Long duration of contact.

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Communicable diseases in schools

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  1. Communicable diseases in schools Dr Charmaine Gauci MD, MSc, PhD, FRSPH, FFPH Director, Health Promotion and Disease Prevention Directorate

  2. Children vulnerable group • Low immunity • Most infectious diseases occur in children • Close contact with other children • Long duration of contact

  3. Control of communicable diseases • Making early diagnosis • Risk assessment of the infectivity • Isolation if infective • Prevention of infection of others • Elimination of infection • Educational and preventive measures • Corrective, sanitary and hygienic measures

  4. Meningococcal Meningitis • Serious infection caused by meningococcus • Meningococcus : commensal in 10% population • Usually harmless • Occasionally overcome defense mechanisms and cause illness: in 2009 seven cases • Different types: in Malta 25% Group B

  5. Symptoms • Sudden onset high fever • Severe headache • Photophobia • Vomiting • Petecchial rash

  6. Rash of Meningococcal Disease

  7. How can you catch meningococcal disease? • Not highly infectious • Passed by close prolonged contact • Bacteria do not survive outside body

  8. How to prevent meningococcal infection? • Vaccine available for type A,C,W,Y • Not available for Group B (50% of cases in Malta) • Infectious Disease Prevention and Control Unit • Risk assessment • Antibiotics for close contacts • Household and kissing contacts • Close contacts in closed environment for long duration • List of class mates required • Teachers/facilitators for primary schools • No need to exclude contacts from school if asymptomatic

  9. Chicken pox

  10. Chicken pox • Caused by varicella virus • Spread via air or contact with fluid from blisters • Virus does not survive outside body so objects do not transmit viruses • Infectious 5 days before rash onset and until vesicles have scabbed • Vaccine exists in private market

  11. Blood borne diseases • Hepatitis B, C • HIV • Staff and children may be exposed: • Tending to bleeding nose • Tending to wounds • Deep human bite • No transmission from casual contact • Shaking hands • Splattering blood on intact skin

  12. Increased number of cases • Increased sexual activity • Increased drug activity • Increase in children from highly prevalent countries

  13. Prevention • Hepatitis B vaccine • Offered to all children on national schedule • Universal precautions

  14. Universal precautions • Treat everyone the same • Hand washing • Control of spread of infections • Warm water, liquid soap, paper towels • Personal protective equipment • Disposable gloves • Disposable plastic aprons • Clinical waste • Stored in pedal bins • Removed by clinical contractor

  15. Use disinfectant for cleaning • Discard soiled items • Vaccine for Hepatitis B

  16. Influenza A(H1N1)v Pandemic

  17. How did it all start ?

  18. H3N8 H2N2 H2N2 H1N1 PandemicH1N1 H3N2 2015 2010 1915 1925 1955 1965 1975 1985 1995 2005 1895 1905 H1N1 H9* Recorded new avian influenzas 1999 H5 1997 2003 H7 1980 1996 2002 1955 1965 1975 1985 1995 2005 Pandemics of influenza Recorded human pandemic influenza(early sub-types inferred) 2009 Pandemic influenza H1N1 1889 Russian influenza H2N2 1968 Hong Kong influenza H3N2 1918 Spanish influenza H1N1 1900 Old Hong Kong influenza H3N8 1957 Asian influenza H2N2 Animated slide: Press space bar Reproduced and adapted (2009) with permission of Dr Masato Tashiro, Director, Center for Influenza Virus Research, National Institute of Infectious Diseases (NIID), Japan.

  19. Early cases - Mexico • Although the exact time and location of the outbreak is unknown, it is believed to have been first detected when an influenza-like illness was reported by both health agencies and local news media in Mexico

  20. Influenza A(H1N1)v 2009 • 2009 H1N1 outbreak • epidemic spread of a new strain of influenza virus • clinically identified in April 2009 • new virus strain is a type of influenza A (H1N1)v virus, commonly called the swine flu • also been called the H1N1 influenza, 2009 H1N1 flu, Mexican flu, or swine-origin influenza.

  21. Pigs a Mixing vessel • Pigs can catch human and avian or bird flu. When flu viruses from different species infect pigs, they can mix inside the pig and new, mixed viruses can emerge.

  22. A New Strain of Influenzae Virus • The virus responsible was clinically identified as a new strain on April 24, 2009

  23. Virologists Optimistic • By late April, however, some virologists believed that this strain was unlikely to cause as many fatalities as earlier pandemics, and may not even be as damaging as a typical flu season.

  24. WHO pandemic phases

  25. WHO alerts it as Phase6 • WHO changed its pandemic alert phase to "Phase 6“ on 11th June 2009 • , which is defined as community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5 • Till now , May 2010 WE ARE STILL IN PANDEMIC ALERT PHASE 6

  26. What happened in Malta?

  27. Reported Symptoms

  28. Number of Influenza tests by Week, week 27, 2009 to week 9, 2010

  29. Results of Influenza testing by week, week 27, 2009 to week 9, 2010

  30. Consultation rate for Influenza-like illness among sentinel GPs, 2007-2010.

  31. Deaths in Malta • 5 deaths occurred related to H1N1 in MALTA. • 82 year old gentleman with chronic disease who died on the 12th of August. • 88 year old female with chronic disease who dead on the 18th of August. • healthy Spanish 32 year old female who dead on the 24th of August. • healthy 32 year old male who dead on the 28th of December. • 94 year old elderly male who dead on the 21st of January.

  32. H1N1 vaccine • 29 of December 2009 • for health care workers • 2ND January 2010 • chronic disease • pregnant women • 14th January 2010 • children form 6 months to 5 years • 28th January 2010 • rest of the population were offered the vaccine

  33. What is H1N1 illness?

  34. Symptoms To Look For

  35. The Spread of Influenza • Person to person through droplets • Cough • Sneeze • Contaminated Surface

  36. When a Family Member is Sick Rest away from others Keep personal items separate Disinfect items & surfaces One person as caregiver Frequent handwashing

  37. Prevention measures

  38. Wash hands often Hand sanitizer available Cover coughs & sneezes Hands away from face Disinfect common surfaces Stay home when sick Get the flu shot Prevent the Flu

  39. Simple Measures Help • By touching something contaminated with flu viruses • touching one's mouth or nose • through coughing or sneezing • One of the most effective prevention measures is regular hand washing.

  40. Eating Pork Safe? • People cannot catch swine flu from eating pork or pork products • Cooking pork to an internal temperature of 71 degrees Celsius kills the swine flu virus along with other bacteria and viruses

  41. Prevention is best option • Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

  42. Clean Hands – Safe Hands • Washing your hands often with soap and water, especially after you cough or sneeze • You can also use alcohol-based hand cleaners.

  43. Avoid Unnecessary Actions • Avoiding touching your eyes, nose or mouth. Germs spread this way • Trying to avoid close contact with sick people.

  44. Staying at home if sick • Staying home from work or school if you are sick

  45. Prompt to seek Medical Attention • seek medical attention if they develop any symptoms of influenza-like illness

  46. Spread the Message of Flu to Everyone

  47. How pandemics differ —and why they can be difficult

  48. For any future pandemic virus – what can and cannot be assumed? What probably can be assumed: Known knowns • Modes of transmission (droplet, direct and indirect contact) • Broad incubation period and serial interval • At what stage a person is infectious • Broad clinical presentation and case definition (what influenza looks like) • The general effectiveness of personal hygiene measures (frequent hand washing, using tissues properly, staying at home when you get ill) • That in temperate zones transmission will be lower in the spring and summer than in the autumn and winter

  49. What cannot be assumed:Known unknowns • Antigenic type and phenotype • Susceptibility/resistance to antivirals • Age-groups and clinical groups most affected • Age-groups with most transmission • Clinical attack rates • Pathogenicity (case-fatality rates) • ‘Severity’ of the pandemic • Precise parameters needed for modelling and forecasting (serial interval, Ro)

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