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Case Definitions

Case Definitions. Dr.Vijay Yewale Convener, IAP Committee on Immunization 2009-11 Editor, Pediatric Infectious Disease. vnyewale@gmail.com. Diseases covered. Pneumonia (PNUC and PNUR) Acute Bacterial Meningitis (ABMP/ABMM/ABMH/ABMO/ABME) Diphtheria (DIPH) Pertussis (PERT)

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Case Definitions

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  1. Case Definitions Dr.VijayYewale Convener, IAP Committee on Immunization 2009-11 Editor, Pediatric Infectious Disease vnyewale@gmail.com

  2. Diseases covered • Pneumonia (PNUC and PNUR) • Acute Bacterial Meningitis (ABMP/ABMM/ABMH/ABMO/ABME) • Diphtheria (DIPH) • Pertussis (PERT) • Measles (MEAS) • Mumps (MUMP) • Chickenpox (CPOX) • Enteric fever (EFTY /EFPT) • Dengue fever (DENF /DENH /DENS) • Hepatitis (HEPA, HEPB, HEPE, HEPO, HEPN)

  3. PNEUMONIA • Clinical Pneumonia (PNUC) • High fever (> 38 Degree C) and • Tachypnea • > 60 breaths / min if aged < 2months • > 50 breaths / min if aged 2-11 • > 40 breaths / min if aged 12m to <60 months (Reasonably ruled out reactive airway disease) • Radiological Pneumonia (PNUR) • Abnormal chest radiograph suggestive of Pneumonia

  4. Microbiologic Diagnosis established • No • Yes • Culture • isolation of a bacterial pathogen from pleural fluid or blood • Antigen detection • identification of a bacterial antigen in pleural fluid by latex agglutination • Antibody detection • Other • Gram stained smear of pleural fluid

  5. Previous relevant vaccination • Not immunized (NI) : Not received any dose of Pertussis, Hib and Measles containing vaccine or conjugate pneumococcal vaccine • Partially immunized (PI) : Received either not all Pertussis, Hib and Measles containing vaccine and conjugate pneumococcal vaccine or not all age appropriate doses • Fully immunized (FI): Received all age appropriate doses of Pertussis, Hib and Measles containing vaccines and conjugate pneumococcal vaccine • Ineligible for Immunization (II): less than 6 weeks of age

  6. ACUTE BACTERIAL MENINGITIS • Acute onset of fever (usually > 38.5 °C rectal or 38.0 °C axillary and one of the following signs: Boggy fontanelle, seizures, neck stiffness, altered consciousness or other meningeal signs WITH • Abnormal CSF • Turbid appearance OR • Leucocytosis (>100 cells / mm3) OR • Leukocytosis (10 – 100 cells / mm3 ) with elevated prot >100mg% or CSF sugar <40 mg%

  7. Microbiologic Diagnosis established • No • Yes • Culture • isolation of a bacterial pathogen from a normally sterile clinical specimen such as CSF or blood • Antigen detection • identification of a bacterial antigen in CSF by latex agglutination • Antibody detection • Other • Gram stained smear

  8. ABMP • ABM with S.Pneumo • +ve Gram stain / Latex / CSF or Blood culture • ABMH • ABM with H.influenzae • +ve Gram stain / Latex / CSF or Blood culture • ABMM • ABM with N.Meningitides • +ve Gram stain / Latex / CSF or Blood culture • ABMO • ABM with organism other than P/H/N • ABME • ABM with no microbiological diagnosis

  9. Previous relevant vaccination(not applicable for ABMM and ABMN) • Not immunized (NI) : Not received any dose of conjugate Pneumococcal and Hib vaccines • Partially immunized (PI) : Received either not all of conjugate Pneumococcal and Hib vaccines or not all age appropriate doses • Fully immunized (FI): Received all age appropriate doses of conjugate Pneumococcal and Hib vaccines • Ineligible for Immunization (II) • Age less than 6 weeks

  10. CHICKENPOX(CPOX) • Vesicular rash starting on trunk and spreading to extremities in multiple stages of evolution

  11. Microbiologic Diagnosis established • No • Yes • Culture • Antigen detection • Antibody detection • Other

  12. Previous relevant vaccination • CPX vaccine • Not immunized (NI) • Not received any CPOX vaccine • Partially immunized (PI) • Received one dose of CPOX vaccine • Fully immunized (FI) • Received 2 doses of Chicken pox vaccine • Ineligible for Immunization (II) • Age less than 15 months

  13. ENTERIC FEVER • Compatible clinical picture AND • EITHER blood culture positive OR • Positive TUBE WIDAL ( both H/ A/B and O > 1: 160) done beyond day 5 of fever

  14. Microbiologic Diagnosis established • No • Yes • Culture • S. Typhi or S.Paratyphi on blood culture • Antigen detection • Antibody detection • WIDAL Test (both H/ A/B and O > 1: 160) • Other

  15. Previous relevant vaccination • TY vaccine • Not immunized (NI) • Above 2 years and not received any typhoid vaccine • Partially immunized (PI) • Time lapsed since last immunization > 3 years • Fully immunized (CI) • Received typhoid vaccine within last 3 years • Ineligible for Immunization (II) • Age less than 2 years

  16. DIPTHERIA • An illness characterised by laryngitis or pharyngitis or tonsillitis, and an adherent membrane of the tonsils, pharynx and/or nose and Isolation of Corynebacterium diphtheriae from a clinical specimen

  17. Microbiologic Diagnosis established • No • Yes • Culture • Isolation of Corynebacteriumdiphtheriae from a clinical specimen OR • Antigen detection • Antibody detection • 4 fold or greater rise in serum antibodies • other • Gram stained smear

  18. Previous relevant vaccination • DPT vaccine (DTP) • Not immunized (NI) • Not received any dose of DTP • Partially immunized (PI) • Received less than the age appropriate doses • Fully immunized (FI) • Received all the age appropriate doses • Ineligible for Immunization (II) • Age less than 6 weeks

  19. PERTUSSIS • Cough lasting at least two weeks with at least one of the following symptoms: • Paroxysms (i.e. fits) of coughing • Inspiratory whooping • Post-tussive vomiting (i.e. vomiting immediately after coughing) without other apparent cause

  20. Microbiologic Diagnosis established • No • Yes • Culture • Isolation of Bordetellapertussis or +ve PCR • Antigen detection • Antibody detection • Other

  21. Previous relevant vaccination • DPT vaccine (DTP) • Not immunized (NI) • Not received any dose of DTP • Partially immunized (PI) • Received less than the age appropriate doses • Fully immunized (CI) • Received all the age appropriate doses • Ineligible for Immunization(II) • Age less than 6 weeks

  22. MEASLES Any child with fever and maculopapular rash (i.e. non-vesicular) and cough, coryza (i.e. runny nose) or conjunctivitis (i.e. red eyes)

  23. Microbiologic Diagnosis established • No • Yes • Culture • Antigen detection • Antibody detection • Presence of measles-specific IgM antibodies • Other

  24. Previous relevant vaccination • MEASLES vaccine • Not immunized (NI) • Partially immunized (PI) • Received only one dose of Measles containing vaccine • Fully immunized (FI) • Received 2 doses of Measles containing vaccine • Ineligible for Immunization(II) • Age less than 9 months

  25. Mumps • Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting two or more days and without other apparent cause

  26. Microbiologic Diagnosis established • No • Yes • Culture • Antigen detection • Antibody detection • Other Not applicable

  27. Previous relevant vaccination • MMR vaccine • Not immunized (NI) • Not received any Mumps containing vaccine • Partially immunized (PI) • Received at least 1 dose of Mumps containing vaccine • Fully immunized (FI) • Received 2 doses of Mumps containing vaccine • Ineligible for Immunization (II) • Age less than 15 months

  28. DENGUE • DENF • An acute febrile illness of 2-7 days duration with two or more of the following manifestations: • Headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations • DENH (Thrombocytopenia + evidence of capillary leak i.e. 20% increase in Hct or ple effusion or ascites) • DENS (DHF with evidence of shock)

  29. Microbiologic Diagnosis established • No • Yes • Culture • Antigen detection • NS1 Antigen test • Antibody detection • Positive Dengue serology IgG and IgM • Other • PCR

  30. Previous relevant vaccination Not applicable

  31. HEPATITIS • An acute illness typically including acute jaundice, dark urine, anorexia, malaise, extreme fatigue and right upper quadrant tenderness • Urine Bile pigments (urobilinogen) +ve • ALT(SGPT) >2.5 times the upper limit of normal • Malaria, leptospirosis, dengue and typhoid/paratyphoid

  32. HEPATITIS A (HEPA) • HEPATITIS B (HEPB) • HEPATITIS E (HEPE) • HEPATITIS O (HEPO) Hepatitis Other types • HEPATITIS N (HEPN) Hepatitis etiology not known

  33. Microbiologic Diagnosis established • No • Yes • Antibody detection • Positive IgM anti-HAV for HEPA • Positive HBsAg or IgM anti-HBc for HEPB • Positive IgM anti-HEV for HEPE • Positive IgM anti-HCV for HEPC • Other • PCR

  34. Previous relevant vaccinationHepatitis A • Hepatitis A vaccine • Fully Immunized (FI) • Taken 2 doses of Hepatitis A vaccine • Partially Immunized(PI) • Taken less than one doses of Hepatitis A vaccine • Not Immunized (NI) • Not taken any dose of Hepatitis A vaccine • Ineligible for immunization (II) • Less than 12 months of age

  35. Previous relevant vaccinationHepatitis B • Hepatitis B vaccine • Fully Immunized (FI) • Taken 3 doses of Hepatitis B vaccine • Partially Immunized (PI) • Not taken all 3 doses of Hepatitis B vaccine • Not Immunized (NI) • Not taken any dose of Hepatitis B vaccine • Ineligible for Immunization (II) • Less than 6 weeks

  36. HEPATITIS E , Other types, N (Etiology not known)Previous relevant vaccination Not applicable

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