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Immunisations and Infections

Immunisations and Infections. Helen Toyne , GP Toby Angstmann , O&G Ashley Watson, Infectious Diseases. Case 1: Mrs A: Planning her first pregnancy. 29 years of age Never been pregnant Works as primary school teacher Thinks she had childhood immunisations, no physical record

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Immunisations and Infections

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  1. Immunisations and Infections Helen Toyne, GP Toby Angstmann, O&G Ashley Watson, Infectious Diseases

  2. Case 1: Mrs A: Planning her first pregnancy • 29 years of age • Never been pregnant • Works as primary school teacher • Thinks she had childhood immunisations, no physical record • No known history of varicella infection • Several tattoos acquired in Bali 5 years previously

  3. Case 1 Mrs A: Routine care, individualised care • Syphillis, Rubella, Hep B Antigen, HIV, varicella IgG, UMCS • Other possibilities: • Hep B sAntibody (if immune, no more tests!) • Hep C • chlamydia • Parvovirus B19 ?? Not routinely screened • Measles antibody – may be relevant in some people, outbreak at present • Bacterial vaginosis HVS – not antenatal, not first preg.

  4. Parvovirus B19: • Also known as fifth disease, slapped cheek syndrome, erythema infectiousum • 50% women immune pre-pregnancy • If infected during pregnancy, less than 5% have miscarriage/anaemia • Serology availability and indications? • When/ if to stay away from work (kids infectious 48 hours before symptoms)

  5. Toby’s video here • Severe consequences possible • 4 cases TCH past 12 months

  6. Pre-pregnancy immunisations • Influenza • MMR (live virus) • DTPa • Varicella (live virus) • What about early pregnancy – fever??

  7. Whooping cough outbreak from 2009

  8. Influenza in the ACT – per CHO • Influenza in neonates: ACT Data • In 2012, there were 17 cases of influenza in infants aged 12 months or less. • Of those, 6 were aged 3 months or less, one was aged 4 weeks

  9. National FluCan data – pregnant women • Between 4 April to 12 October 2012, • 39 pregnant women hospitalised with influenza, accounting for • 3.5% of all hospitalisations due to influenza. • 2 were in ICU.

  10. Case 2 - Antenatal • Mrs H, 26 weeks pregnant, 2nd baby • Immunised 3 year old son has mild varicella illness • She does not recall having chicken pox or immunisation • Which test • How to get ZIG • What if child 18months with vaccine associated varicella?

  11. Case 3 - Antenatal • Mrs C, 36 weeks pregnant • Copious white vaginal discharge, perineal itch • History of recurrent candida • Swab • Treat ?? • Oral fluconazole?? • GBS – current practice

  12. Case 4 Antenatal • Mrs D • 16 weeks pregnant • Nasal congestion, coloured nasal discharge, frontal headache, 5 days. Temp 37.9 aural • 2 year old has streaming nose and moist cough • Mrs D desperate, can’t sleep, miserable +++

  13. Options – limited guidelines • “Safe” remedies: saline • Unclassified but low risk remedies, eg topical decongestants (xymetolazone) • Nasal steroids –mometasone, fluticasone lowest systemic bioavailability, listed as B3, budesonide cat A • Antibiotics – amoxycillin, erythromycin cat A

  14. A, B, C, D, X – NOT hierarchical • Human data are lacking or inadequate for drugs in the B1, B2 and B3 categories • Subcategorisation of the B category is based on animal data • The allocation of a B category does not imply greater safety than a C category • Medicines in category D are not absolutely contraindicated during pregnancy (e.g.anticonvulsants)

  15. Case 5: Post partum • Nikki, with 3 day old Arthur calls from home • NVD, early discharge • Increasing “period pain” feeling hot and cold, moderate PV bleeding, light headed and tired • Midwife already visited for the day • Issues for GP: • ?how urgent • How to fit in to schedule • Who to call and how if concerned

  16. Cont. • Nikki attends the surgery as an urgent “fit in.” • Delivery record indicates placenta complete • O/E temp 38.2, uterus 3cm above pubic bone, mildly tender. BP normal, HR 85 • Empirical treatment • Investigation – swab • When to US? • When to send back to hospital?

  17. Summary - Immunisation • Immunise prepregnancy where possible • Live vaccines given in pregnancy are unlikely to be harmful • Influenza vaccine is routinely recommended for all pregnant women • dTpa is recommended pre-pregnancy, elsewhere used during pregnancy. • WATCH THIS SPACE • Hep B • Consider measles

  18. Summary - screening • New guidelines – HIV, hep B, syphillis, rubella, bacteriuria, chlamydia in <25s, Hep C if high risk, varicella if no history • Effective interventions available for all except Hep C • Parvovirus - case by case • GBS ???

  19. Summary - infections • Diagnosis and treatment of non pregnancy related illness generally similar to non pregnant • Symptomatic treatments often safe and highly significant to women • Antibiotics category A first line if required

  20. Referral pathways • Pre-conception or early pregnancy • Antenatal • Post partum • Infectious diseases

  21. THANK YOU

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