CHAPTER ONE: Immunization and Vaccination Overview

 History of vaccine development

 Definition of Terms
 Importance of immunization programmers
 Types of vaccine
 Types of immunization
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CHAPTER TWO: Vaccine-Preventable Disease
 Tuberculosis
 Polio
 Pertussis or whooping cough
 Tetanus
 Diphtheria
 Measles
 Meningitis
 Hepatitis
CHAPTER TREE: Vaccination schedule
 Under five children
 Immunization schedule of pregnant women

History of vaccine development

• Although inoculation against smallpox was practiced over 2000 years ago in China and
India, a British physician, Edward Jenner, is generally credited with ushering in the modern
concept of vaccination. In 1796 he used matter from cowpox pustules to inoculate patients
successfully against smallpox, which is caused by a related virus.
• By 1900, there were two human virus vaccines, against smallpox and rabies, and three
bacterial vaccines against typhoid, cholera, and plague.
• A worldwide case detection and vaccination programme against smallpox gathered pace
and, in 1979, the World Health Assembly officially declared smallpox eradicated — a feat
that remains one of history’s greatest public health triumphs or achievement.

• Smallpox has been declared eradicated in 1979.

. ❒. Eradication refers to the reduction to zero (or a very low defined target rate) of new cases
in a defined geographical area.
❒. Elimination refers to the complete and permanent worldwide reduction to zero new cases
of the disease through deliberate efforts.
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 • During the 20th century, other vaccines that protect against once commonly fatal infections
such as pertussis, diphtheria, tetanus, polio, measles, rubella, and several other
communicable diseases were developed.
• As these vaccines became available, high-income industrial nations began recommending
routine vaccination of their children. There are now over 20 vaccine-preventable diseases.

Definition of Terms
 Vaccination: The use of vaccines to stimulate your immune system to protect you
against infection or disease
 Immunization: The process of making you immune or resistant to an infectious
disease, typically via vaccination
 Immunity: Protection from an infectious disease. If you are immune to a disease, you
can be exposed to it without becoming infected.
 Vaccine: A preparation that is used to stimulate the body’s immune response against
diseases. Vaccines are usually administered through needle injections, but some can be
administered by mouth or sprayed into the nose.

 Overall Objective
 The primary objective for a given immunization program could be:
 to save lives,
 To prevent premature death and disability,
 To improve ability of children to learn,
 To reduce health sector costs for hospital care or economic loss to society.

 Aim of immunizations

• Immunizations protect us from serious diseases and also prevent the spread of those
diseases to others. Over the years immunizations have thwarted or prevent
epidemics of once common infectious diseases such as measles, mumps, and
whooping cough.
 Importance of immunization programmers
• Each year, vaccines prevent more than 2.5 million child deaths globally. An
additional 2 million child deaths could be prevented each year through
immunization with currently available vaccines.
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 Why are vaccines so special?
■ Vaccines promote health: unlike many other health interventions, they help
healthy people stay healthy, removing a major obstacle to human development.
■ Vaccines have an expansive reach: they protect individuals, communities, and
entire populations (the eradication of smallpox is a case in point).

■ Vaccines have rapid impact: the impact of most vaccines on communities and populations is
almost immediate. For example, between 2000 and 2008, vaccination reduced global deaths from
measles by 78% (from 750,000 deaths to 164,000 deaths per year).
■ Vaccines save lives and costs: recently, a panel of distinguished economists put expanded
immunization coverage for children in fourth place on a list of 30 cost-effective ways of advancing
global welfare

How the immune system works

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 •The immune system: defend against disease-causing microorganisms. Its goal is to
keep us healthy. The immune system is a vast and complex interconnected network
of many different organs, cells and proteins that work together to protect the body
from illness
• A healthy immune system can defeat invading disease-causing germs (or
pathogens), such as bacteria, viruses, parasites—as well as cancer cells—while
protecting healthy tissue.
• Understanding how the immune system works and how we can help protect our
bodies is essential to the fight against the COVID-19 pandemic.
 Vaccines reproduce a natural infection with less complications

 Expectations towards safety of vaccines

• Vaccines used in NIPs are safe and effective. However, like other pharmaceutical
products, vaccines are not completely risk-free and adverse events will occasionally
result from vaccination. Although most adverse events are minor (e.g. redness at
injection site, fever), more serious reactions (e.g. seizures, anaphylaxis) can occur
albeit at a very low frequency
• Although vaccines used in national immunization programmes (NIPs) are considered
safe and effective, vaccines are not risk-free and adverse events will occasionally occur
following vaccination. Public trust in vaccine safety is key to the success of vaccination
programmes.

 Vaccine-preventable diseases
Vaccines to prevent other diseases have become available since the introduction of EPI and are
recommended by the WHO for global use. They cover diseases such as hepatitis B disease,
diarrhoeal disease caused by rotaviruses, and pneumonia and other respiratory tract infections
caused by Haemophilus influenzae type B and pneumococcal bacteria. Others, such as the vaccine
against yellow fever, are recommended in countries where the disease burden is significant.
The main vaccine-preventable diseases targeted by the EPI and the associated vaccines
Tubercle bacillus---------Bacillus Calmett Guerin(BCG)
Poliovirus---------------Oral polio vaccine(OPV)vaccine Coryne bacterium diphtheria--Diphtheria
toxoid**vaccine
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Clostridium tetani (Tetanus)---Tetanus toxoid (TT)vaccine
Pertussis---------Whole-cell pertussis(wP)vaccine
Measles virus-----------------------Measles vaccine
Hepatitis B virus-----------------------Hepatitis B vaccine
Rotavirus----------------------------Rotavirus vaccine
Haemophilus influenza type B (Hib)--Hib conjugate vaccine
Streptococcus Pneumonia----------Pneumococcal vaccine
(Pneumococcal infection)

Types of vaccine
 Live attenuated (LAV): are closest to a natural infection. They contain a weakened
version of a living virus or bacteria. These types of vaccines teach your immune
system what the infection might look like without causing a severe illness. But
because these vaccines contain living pathogens, they can’t be given to people with
weak immune systems.
 Examples :
 MMR vaccine
 Chickenpox vaccine (special groups only)
 BCG vaccine against TB (special groups only)
 Inactivated vaccines
 Inactivated vaccines contain an inactivated or dead version of a virus or pathogen.
They are not as similar to a real infection as live, attenuated vaccines so often people
need multiple doses of this kind of vaccine to maintain immunity. These are safer for
people who are immunocompromised. The injectable flu vaccine is an inactivated
vaccine and polio.
 Subunit (purified antigen) Subunit vaccines contain only parts of a virus or bacteria
instead of a whole pathogen. This lets your immune system directly target the
important antigen of the pathogen and tends to have fewer side effects than
inactivated or live attenuated vaccines.
 Example
 whooping cough, or pertussis,
 Pneumococcal
 Hepatitis B (HepB)
 Tetanus toxoid (TT),
 Diphtheria toxoid
 Live travel vaccines used:
 Yellow fever vaccine
 Oral typhoid vaccine (not the injected vaccine)
 Types of immunization
 Active immunization involves stimulating the immune system to produce antibodies to
fight a disease. This is the form of immunization used in creating vaccines. Active
immunity can arise naturally, as when someone is exposed to a pathogen. For example, an
individual who recovers from a first case of the measles is immune to further infection…
 Passive immunization involves providing an antibody to the patient. It provides only
temporary protection against disease. For example, a fetus receives antibodies through the
placenta that provide temporary protection against certain illnesses during the newborn’s
initial months of life.
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 Vaccine-Preventable Disease

Tuberculosis:(TB)

 Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often

affect the lungs. Tuberculosis is curable and preventable.
 TB is spread from person to person through the air. When people with lung TB cough,
sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few
of these germs to become infected.

 Signs and symptoms of active TB

 Coughing for three or more weeks.
 Coughing up blood or mucus.
 Chest pain, or pain with breathing or coughing.
 Unintentional weight loss.
 Fatigue.
 Fever.
 Night sweats.
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 Chills.

Risk factors for TB

 Poverty
 HIV infection
 Homelessness
 Being in jail or prison (where close contact can spread infection)
 Substance abuse
 Taking medication that weakens the immune system
 Kidney disease and diabetes
 Working in healthcare
 Air pollution
 Cancer
 Smoking tobacco

Stages of Tuberculosis
 Latent TB. You have a TB infection, but the bacteria in your body are inactive and
cause no symptoms. Latent TB, also called inactive TB or TB infection, isn't
contagious. Latent TB can turn into active TB, so treatment is important.
 Active TB. Also called TB disease, this condition makes you sick and, in most cases,
can spread to others. It can occur weeks or years after infection with the TB bacteria.

TB Diagnosis
a) Blood tests
b) Imaging tests(chest X-ray )
c) Sputum tests
 TB treatment
 TB disease can be treated by taking several drugs for 6 to 9 months. the first-line
anti-TB agents that form the core of treatment regimens are:
 isoniazid (INH)
 rifampin (RIF)
 ethambutol (EMB)
 pyrazinamide (PZA

Drug-Resistant TB
 Sometimes drug-resistant TB occurs when bacteria become resistant to the drugs
used to treat TB. This means that the drug can no longer kill the TB bacteria.
 Drug-resistant TB (DR TB) is spread the same way that drug-susceptible TB is
spread. TB is spread through the air from one person to another.
Global impact of TB
 TB occurs in every part of the world. In 2020, the largest number of new TB cases
occurred in the WHO South-East Asian Region, with 43% of new cases, followed by
the WHO African Region, with 25% of new cases and the WHO Western Pacific with
18%.
 In 2020, 86% of new TB cases occurred in the 30 high TB burden countries. Eight
countries accounted for two thirds of the new TB cases: India, China, Indonesia, the
Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

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 TB Prevention
TB is preventable and, in most cases, treatable. Infection control practices can help reduce
the risk of TB transmission. Treatment of persons with latent TB infection can prevent the
subsequent development of active TB, and TB disease can usually be cured by available
anti-TB drugs.
 Complication of TB
o Lung damage.
o Infection or damage of your bones,
o Spinal cord, brain, or lymph nodes.
o Liver or kidney problems.
o Inflammation of the tissues around your heart

Diphtheria
Diphtheria is a serious bacterial infection that affects the mucous membranes of the throat
and nose. Although it spreads easily from one person to another, diphtheria can be
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 prevented through the use of vaccines.

Diphtheria spread
Diphtheria is transmitted from person to person through close contact with the discharge
from an infected person's eyes, nose, throat or skin.
Signs and symptoms?

. Symptoms of diphtheria include:

Difficulty Swallowing

 Sore throat (young children may cry when they try and swallow, or not want to eat)

 Fever (body feels warm)

 Hoarseness of voice

 Difficulty breathing

 Coughing or sneezing

 Swelling of neck

 Thick, grey coating formed in the nose, throat and tongue

Having throat pain

Becoming weak

Problems breathing due to tissues obstructing the nose and throat

Problems swallowing

An infected person typically shows signs of diphtheria around two to five days after exposure. The
length of time for symptoms to show can be anywhere from 1 to 10 days after exposure.

In addition, the toxin can harm the nerves, kidneys or heart if bacteria enter the bloodstream,

Complications

Complications of the infection include:

 Blockage of the air passages

 Injury to heart muscle
 Injury to nerves
 Sluggishness or lethargy

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  Paralysis (being unable to move)
 Lung infection or loss of lung function

Diphtheria treated
Antibiotics, such as penicillin or erythromycin, help kill bacteria in the body, clearing up
infections. Antibiotics lessen the time that someone with diphtheria is contagious. An antitoxin. If
a doctor suspects diphtheria, he or she will request a medication that counteracts the diphtheria
toxin in the body

Diphtheria prevented
The most effective way of preventing diphtheria is to maintain a high level of
immunization in the community. A mother can pass protective antibodies to herbaby but
this protection lasts only about six months.

In most countries, diphtheria toxoid vaccine is given together with pertussis vaccine and
tetanus toxoid. A combination of tetanus and diphtheria vaccine may be recommended as a
booster to maintain protection every ten years.

Polio
Polio is a contagious viral illness that in its most severe form causes nerve injury leading to
paralysis, difficulty breathing and sometimes dead.

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Causes
Poliovirus can be transmitted through direct contact with someone infected with the virus
or, less commonly, through contaminated food and water. People carrying the poliovirus
can spread the virus for weeks in their feces. People who have the virus but don't have
symptoms can pass the virus to others.

Polio spread
Poliovirus only infects people. It enters the body through the mouth and spreads
through: Contact with the feces (poop) of an infected person. Droplets from a
sneeze or cough of an infected person (less common).

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Signs and symptoms

Although polio can cause paralysis and death, the majority of people who are infected with the
virus don't get sick and aren't aware they've been infected.

Non paralytic polio

Some people who develop symptoms from the poliovirus contract a type of polio that doesn't lead
to paralysis (abortive polio). This usually causes the same mild, flu-like signs and symptoms
typical of other viral illnesses.

Signs and symptoms, which can last up to 10 days, include:

 Fever

 Sore throat

 Headache

 Vomiting

 Fatigue

 Back pain or stiffness

 Neck pain or stiffness

 Pain or stiffness in the arms or legs

Muscle weakness or tenderness

Paralytic syndrome

This most serious form of the disease is rare. Initial signs and symptoms of paralytic polio, such
as fever and headache, often mimic those of nonparalytic polio. Within a week, however, other
signs and symptoms appear, including:

 Loss of reflexes

 Severe muscle aches or weakness

 Loose and floppy limbs (flaccid paralysis)

Post-polio syndrome

Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people
years after having polio. Common signs and symptoms include:
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  Progressive muscle or joint weakness and pain

 Fatigue

 Muscle wasting (atrophy)

 Breathing or swallowing problems

 Sleep-related breathing disorders, such as sleep apnea

 Decreased tolerance of cold temperatures

Polio Diagnosis

Doctors often recognize polio by symptoms, such as neck and back stiffness, abnormal
reflexes, and difficulty swallowing and breathing. To confirm the diagnosis, a sample of
throat secretions, stool or a colorless fluid that surrounds your brain and spinal cord
(cerebrospinal fluid) is checked for poliovirus.

Complications and post-polio syndrome

Post-polio syndrome describes a cluster of symptoms that affect up to 64 percent of all polio
patients. It occurs several years after polio has passed. On average, post-polio syndrome occurs 35
years after the infection.

Signs and symptoms include:

 muscle and joint pain and weakness that slowly progresses

 muscle atrophy or shrinkage

 exhaustion for no reason

 swallowing and breathing difficulties

 suffering in colder temperatures

 sleep-related problems, such as apnea

 concentration and memory difficulties

 mood swings and depression

Polio treated
There is no cure for polio, only treatment to alleviate the symptoms. Heat and physical therapy is
used to stimulate the muscles and antispasmodic drugs are given to relax the muscles. While this
can improve mobility, it cannot reverse permanent polio paralysis. Polio can be prevented through
immunization.
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 Polio prevented

Vaccines are the main way to prevent polio.

However, other methods of limiting the spread of this potentially fatal disease include:

 avoiding food or beverages that may have been contaminated by a person with poliovirus

 checking with a medical professional that your vaccinations are current

 being sure to receive any required booster doses of the vaccine

 washing your hands frequently

 using hand sanitizer when soap is not available

 making sure you only touch the eyes, nose, or mouth with clean hands

 covering the mouth while sneezing or coughing

 avoiding close contact with people who are sick, including kissing, hugging, and sharing
utensils

Risk factors

As is the case with many other infectious diseases, people who get polio tend to be some of the
most vulnerable members of the population. This includes the very young, pregnant women, and
those with immune systems that are substantially weakened by other medical conditions.

Anyone who has not been immunized against polio is especially susceptible to contracting the
infection.

Additional risk factors for polio include:

 traveling to places where polio is endemic or widespread, especially Pakistan and

Afghanistan

 living with someone infected with polio

 having a weak immune system

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  pregnant women are more susceptible to polio, but it does not appear to affect the unborn
child

 working in a laboratory where live poliovirus is kept

Pertussis
Pertussis (also known as whooping cough) is a bacterial infection that gets into your nose and
throat. It spreads easily, but vaccines like DTaP (diphtheria, tetanus, and pertussis) and Tdap
(tetanus, diphtheria, and pertussis) can help prevent it in children and adults

Whooping Cough Symptoms

At first, whooping cough has the same symptoms as the average cold:

 Mild coughing
 Sneezing
 Runny nose
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  Low fever (below 102 F)
You may also have diarrhea early on.
After about 7-10 days, the cough turns into “coughing spells” that end with a whooping sound as
the person tries to breathe in air.
Because the cough is dry and doesn't produce mucus, these spells can last up to 1 minute.
Sometimes it can cause your face to briefly turn red or purple.
Most people with whooping cough have coughing spells, but not everyone does.
Infants may not make the whooping sound or even cough, but they might gasp for air or try to
catch their breath during these spells. Some may vomit.
Sometimes adults with the condition just have a cough that won’t go away.
Your health care provider may use many tools to

Diagnose whooping cough:

 A medical history, which includes asking about your symptoms

 A physical exam
 A lab test which involves taking a sample of mucus from the back of the throat through the nose.
This may be done with a swab or syringe filled with saline. The sample is tested for the bacteria
that causes whooping cough.
 Blood test
 Chest x-ray

Whooping Cough Complications

 Whooping cough is dangerous in babies, especially ones younger than 6 months old, because
it can keep them from getting the oxygen they need. This can cause:
 Brain damage or bleeding on the brain
 Pneumonia
 Seizures
 Apnea
 Convulsions

Pertussis spread

Pertussis is a very contagious disease only found in humans. Pertussis spreads from person to
person. People with pertussis usually spread the disease to another person by coughing or sneezing
or when spending a lot of time near one another where you share breathing space.

Treatment for pertussis

the treatment for whooping cough is usually antibiotics. Early treatment is very
important.it may make your infection less serious and can also help prevent spreading
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 the disease to others. Treatment after you have been sick for 3 weeks or longer may not
help
 Pertussis prevented
vaccine are the best way to prevent whooping cough. There are two vaccines in the wold that can
help prevent whooping cough: DTaP and Tdap. These vaccines also provide protection
against tetanus and diphtheria
 You may also help prevent the spread of whooping cough (and other respiratory diseases)
by:

 Washing your hands often with soap and water. You can use an alcohol-based hand rub if soap
and water are not available.
 Avoiding touching your face with unwashed hands
 Cleaning and disinfecting surfaces that you frequently touch, including toys
 Covering coughs and sneezes with a tissue or upper shirt sleeve, not hands
 Staying home when sick
 Avoiding close contact with people who are sick
.

Tetanus

Tetanus is a serious disease of the nervous system caused by a toxin-producing

bacterium. The disease causes muscle contractions, particularly of your jaw and neck
muscles. Tetanus is commonly known as lockjaw.

Causes

The bacterium that causes tetanus is called Clostridium tetani. The bacterium can survive in a
dormant state in soil and animal feces. It's essentially shut down until it discovers a place to thrive.

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 When the dormant bacteria enter a wound — a condition good for growth — the cells are
"awakened." As they are growing and dividing, they release a toxin called tetanospasmin. The
toxin impairs the nerves in the body that control muscles.

 Signs and symptoms

 Jaw cramping.
 Sudden, involuntary muscle tightening (muscle spasms) – often in the stomach.
 Painful muscle stiffness all over the body.
 Trouble swallowing.
 Jerking or staring (seizures)
 Headache.
 Fever and sweating.
 Changes in blood pressure and fast heart rate.
Tetanus spread

The spores can get into the body through broken skin, usually through injuries from contaminated
objects. Tetanus bacteria are more likely to infect certain breaks in the skin. These include:

 Wounds contaminated with dirt, poop (feces), or spit (saliva)

 Wounds caused by an object puncturing the skin (puncture wounds), like a nail or needle
 Burns
 Crush injuries
 Injuries with dead tissue

Other Ways Tetanus Gets Into Your Body

Tetanus bacteria can also infect the body through breaks in the skin caused by:

 Surgical procedures
 Insect bites
 Dental infections
 Compound fractures (a break in the bone where it is exposed)
 Chronic sores and infections
 Intravenous (IV) drug use
 Intramuscular injections (shots given in a muscle)

Incubation period

The incubation period — time from exposure to illness — is usually between 3 and 21 days
(average 10 days). However, it may range from one day to several months, depending on the kind
of wound. Most cases occur within 14 days. In general, doctors see shorter incubation periods
with:

 More heavily contaminated wound

 More serious disease
 A worse outcome (prognosis)

Complications
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Severe muscle spasms as a result of tetanus can also cause serious health complications

 breathing problems due to spasms of the vocal cords (laryngospasm) and spasms of the
muscles that control breathing

 pneumonia (an infection of the lungs)

 brain damage due to lack of oxygen

 abnormal heart rhythm

 bone fractures and fractures of the spine due to muscle spasms and convulsions

 secondary infections due to prolonged hospital stays

Treatment for tetanus

Tetanus is a medical emergency requiring:

 care in the hospital

 immediate treatment with medicine called human tetanus immune globulin (TIG)
 aggressive wound care
 drugs to control muscle spasms
 antibiotics
 Tetanus vaccination.

Tetanus prevented

• The major contribution the physician can make to reduction of morbidity and mortality
from tetanus is prevention of the disease. Fortunately, it is completely preventable through
adequate immunization and proper wound care. Tetanus occurs only in patients who have
not had adequate primary immunization or who have not received adequate immunization
boosters since.
Measles
Measles, is A highly contagious viral infection that involves the respiratory system, including the
lungs and breathing tubes. infection that starts in the respiratory system. It still remains a
significant cause of death worldwide
There were about 110,000 global deaths related to measles in 2017, most of them in children under
the age of 5, according to the World Health Organization (WHO).

Measles symptoms

• Symptoms of measles generally first appear within 10 to 12 days of exposure to the

virus. They include:
 Cough
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  Fever
 runny nose
 red eyes
 sore throat
white spots inside the mouth
 A widespread skin rash is a classic sign of measles. This rash can last up to 7 days and
generally appears within 14 days of exposure to the virus. It commonly develops on
the head and slowly spreads to other parts of the body.

 Measles airborne
• Measles can be spread through the air from respiratory droplets and small aerosol
particles. An infected person can release the virus into the air when they cough or
sneeze.
• The measles virus can live outside of the body for longer than you may think. In fact,
it can remain infectious in the air .

• Diagnosing measles
Doctors can confirm measles by
 Examining your skin rash and checking for symptoms that are characteristic of the
disease, such as white spots in the mouth, fever, cough, and sore throat.
 Measles based on your history and observation, your doctor will order a blood test to
check for the measles virus.
Treatment for measles
There's no specific treatment for measles. Unlike bacterial infections, viral infections aren't
sensitive to antibiotics. The virus and symptoms typically disappear in about two or three weeks

Your doctor may recommend the following to help you recover

 acetaminophen (Tylenol) or ibuprofen (Advil) to reduce fever

 rest to help boost your immune system
 plenty of fluids
 a humidifier to ease a cough and sore throat
 vitamin A supplement

Incubation period for measles

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 • The incubation period of an infectious disease is the time that passes between exposure
and when symptoms develop. The incubation period for measles is between 10 and 14
days.
Measles prevention
• Vaccination
• Some groups shouldn’t receive a vaccination against measles. These groups include:
• people who’ve had a previous life-threatening reaction to the measles vaccine or its
components
• pregnant women
• immunocompromised individuals, which can include people with HIV or AIDS,
people undergoing cancer treatment, or people on medications that suppress the
immune system

• Measles prognosis
• Measles has a low death rate in healthy children and adults, and most people who contract
the measles virus recover fully.
 complications is higher in the following groups:
A. children under 5 years old
B. adults over 20 years old
C. pregnant women
D. people with a weakened immune system
E. individuals who are malnourished
F. people with a vitamin A deficiency
Other complications associated with measles may include:
 Otitis media( ear infection )
 Malnutrition
 Encephalitis
 Eye problems and blindness (abscised with Vitamin A deficiency)
 Pneumonia
 severe diarrhea
 blindness
 pregnancy complications, such as miscarriage or preterm labor

Hepatitis B

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people,
hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic
hepatitis B increases your risk of developing liver failure, liver cancer or cirrhosis — a condition
that permanently scars of the liver.

Sign and Symptoms

Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to
four months after you've been infected, although you could see them as early as two weeks post-
infection. Some people, usually young children, may not have any symptoms.

Hepatitis B signs and symptoms may include:

 Abdominal pain

 Dark urine

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  Fever

 Joint pain

 Loss of appetite

 Nausea and vomiting

 Weakness and fatigue

 Yellowing of your skin and the whites of your eyes (jaundice)

Causes

Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from
person to person through blood, semen or other body fluids. It does not spread by sneezing
or coughing.

 Hepatitis B spread

 Sexual contact. You may get hepatitis B if you have unprotected sex with someone who is
infected. The virus can pass to you if the person's blood, saliva, semen or vaginal secretions
enter your body.

 Sharing of needles. HBV easily spreads through needles and syringes contaminated with
infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B.

 Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else
who comes in contact with human blood.
Mother to child. Pregnant women infected with HBV can pass the virus to their babies during
childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases.
Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become
pregnant.

Acute vs. chronic hepatitis B

Hepatitis B infection may be either short-lived (acute) or long lasting (chronic).

 Acute hepatitis B infection lasts less than six months. Your immune system likely can clear
acute hepatitis B from your body, and you should recover completely within a few months.
Most people who get hepatitis B as adults have an acute infection, but it can lead to chronic
infection.

 Chronic hepatitis B infection lasts six months or longer. It lingers because your immune
system can't fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly
leading to serious illnesses such as cirrhosis and liver cancer.
The younger you are when you get hepatitis B — particularly newborns or children
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 younger than 5 — the higher your risk of the infection becoming chronic. Chronic
infection may go undetected for decades until a person becomes seriously ill from
liver disease.

Risk factors

Hepatitis B spreads through contact with blood, semen or other body fluids from an infected
person. Your risk of hepatitis B infection increases if you:

 Have unprotected sex with multiple sex partners or with someone who's infected
with HBV
 Share needles during IV drug use
 Are a man who has sex with other men
 Live with someone who has a chronic HBV infection
 Are an infant born to an infected mother
 Have a job that exposes you to human blood
 Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands,
Africa and Eastern Europe
Complications

Having a chronic HBV infection can lead to serious complications, such as:

 Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection can
lead to extensive liver scarring (cirrhosis), which may impair the liver's ability to function.

 Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer.

 Liver failure. Acute liver failure is a condition in which the vital functions of the liver shut
down. When that occurs, a liver transplant is necessary to sustain life.

 Other conditions. People with chronic hepatitis B may develop kidney disease or
inflammation of blood vessels
Prevention

The hepatitis B vaccine is typically given as three or four injections over six months. You can't
get hepatitis B from the vaccine.

The hepatitis B vaccine is recommended for:

 Newborns

 Children and adolescents not vaccinated at birth

 Those who work or live in a center for people who are developmentally disabled
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  People who live with someone who has hepatitis B

 Health care workers, emergency workers and other people who come into contact with blood

 Anyone who has a sexually transmitted infection, including HIV

 Men who have sex with men

 People who have multiple sexual partners

 Sexual partners of someone who has hepatitis B

 People who inject illegal drugs or share needles and syringes

 People with chronic liver disease

 People with end-stage kidney disease

 Travelers planning to go to an area of the world with a high hepatitis B infection rate

Meningitis
Meningitis is a rare infection that affects the delicate membranes -- called meninges -- that cover
the brain and spinal cord. You or your children can catch it.

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Causes of Meningitis
Meningitis almost always results from a bacterial or viral infection that begins somewhere else in your
body, like your ears, sinuses, or throat.
Less common causes of meningitis include:

 Autoimmune disorders
 Cancer medications
 Syphilis
 Tuberculosis

Meningitis Symptoms
Meningitis symptoms can develop within hours or days and may include:

 Confusion
 Fever
 Headache
 Numbness in your face
 Sensitivity to light
 Stiff neck so that you can’t lower your chin to your chest
 Severe headache with nausea or vomiting
 Seizures
 Sleepiness or a hard time waking up
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  Lack of appetite
 Lack of thirst
 Skin rash (with meningococcal meningitis)

Symptoms of meningitis in infants

In infants, meningitis symptoms may include:

 High fever
 Crying that’s constant and gets louder when you hold the baby
 Baby seems overly sleepy, or inactive
 Stiff neck or body
 Bulge on the soft area on the top of the baby’s head
 Poor ability to feed
 Crankiness

Risk Factors for Meningitis

Anyone can get meningitis, but research shows that it's more common in these age groups:

 Children under 5
 Teenagers and young adults ages 16-25
 Adults over 55

Meningitis is more of a danger for people with certain medical conditions, such as a damaged or
missing spleen, long-term disease, or immune system disorders.
Because certain germs that cause meningitis can spread easily, outbreaks are most likely to happen
in places where people live close to each other. College students in dorms or military recruits in
barracks can be more likely to catch the disease. So are people who travel to areas where
meningitis is more common, such as parts of Africa

Types of Meningitis

Bacterial meningitis
It's an extremely serious illness. You or your child will need to get medical help right away. It can be
life-threatening or lead to brain damage unless you get quick treatment.
Several kinds of bacteria can cause bacterial meningitis. The most common ones in the in the world
are:

 Streptococcus pneumoniae (pneumococcus)

 Neisseria meningitidis (meningococcus)
 Listeria monocytogenes (in older people, pregnant women, or those with immune
system problems)

A bacteria called Haemophilus influenzae type b (Hib) was a common cause of meningitis in babies
and young children until the Hib vaccine became available for infants. There are also vaccines
for Neisseria meningitidis and Streptococcus pneumoniae. Experts recommend that all children get
them, as well as all adults who are at a higher risk for the disease.
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In many cases, bacterial meningitis starts when bacteria get into your bloodstream from
your sinuses, ears, or throat. The bacteria travel through your bloodstream to your brain.
The bacteria that cause meningitis can spread when people who are infected cough or sneeze.
Viral meningitis
 Viral meningitis is more common than the bacterial form and generally -- but not always --
less serious.
 A number of viruses can trigger the disease, including several that can cause diarrhea.
 Fungal meningitis
 Fungal meningitis is much less common than the bacterial or viral forms. Healthy people rarely
get it. You’re more likely to get this form of meningitis if you have a problem with your
immune system, like AIDS.
 Parasitic meningitis
Parasitic meningitis is also rare. It’s caused by parasites that usually affect animals. You can get it from
eating animals like snails, slugs, snakes, fish, or poultry that are infected by parasites or their eggs, or
produce that contains parasite eggs. The risk is higher with raw or undercooked foods.
Amoebic meningitis
Amoebic meningitis is a rare, usually fatal infection by a single-celled bug called Naegleria fowleri.
This amoeba lives in soil or warm, fresh water, but not salt water. People typically get it
from swimming in water where the amoeba lives, not drinking it. Amoebic meningitis isn’t
contagious.

Non-infectious meningitis
Non-infectious meningitis is caused by diseases like lupus or cancer, or if you’ve had a head injury,
brain surgery, or take certain medications. It isn’t contagious.

Chronic meningitis
Chronic meningitis has similar symptoms as acute meningitis, but develops over a couple of weeks. It
results from infections with a fungus or the mycobacteria that cause tuberculosis. These organisms get
into the tissue and fluid surrounding your brain to cause meningitis.

Meningitis Diagnosis
Your doctor will ask about your medical history and do a physical exam, including checking your
neck for stiffness and looking for a skin rash that might suggest a bacterial infection. They will
also need to do tests that can include:

 Blood tests to find bacteria

 CT or MRI scans of your head to find swelling or inflammation
 Spinal tap, in which a health care worker uses a needle to take fluid from around your
spinal cord. It can tell what’s causing your meningitis.
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Treatment for Meningitis
Your treatment will depend on the type of meningitis you have.
Bacterial meningitis needs treatment with antibiotics right away. The doctor might give you a
general, or broad-spectrum, antibiotic even before they’ve found the exact bacteria that caused
your illness. Once they do, they’ll change to a drug that targets the specific bacteria they find. You
might also get corticosteroids to ease inflammationViral meningitis usually goes away on its own
without treatment. Your doctor might tell you to stay in bed, drink plenty of fluids, and take over-the-
counter pain medicines if you have a fever or aches. If a virus like herpes or influenza caused your
illness, you might take antiviral medication.
Antifungal medications can treat fungal meningitis.

Complications of Meningitis
Meningitis can cause severe complications in adults and children, especially if you delay treatment.
Possible complications include:

 Seizures
 Brain damage
 Loss of hearing
 Memory problems
 Learning problems
 A hard time walking
 Kidney failure
 Shock
 Death

Prevention of Meningitis
You may be able to prevent meningitis by avoiding infection with the viruses or bacteria that cause it.
These infections are passed to others when you cough, sneeze, kiss, or share toothbrushes or eating
utensils. Take these steps to prevent infections:

 Wash hands often. Rinse well. Teach your kids to wash their hands often too, especially after
eating, using the toilet, or when you’re in public places.
 Don’t share items like toothbrushes, eating utensils, or lipstick.
 Don’t share foods or drinks with other people.
 Cover your mouth and nose when you cough or sneeze.
 Stay healthy. Eat a healthy diet, get plenty of exercise, and rest at night.
 If you’re pregnant, eat food that’s well-cooked. Avoid foods made from unpasteurized milk.
 Get immunized. Follow your doctor’s advice on getting immunization shots for diseases that
may cause bacterial meningitis, including flu and pneumonia vaccines.

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 Table 1:Routine immunization schedule for infant,0-15months

Age Vaccines Site

At Birth(up to 2week) BCG OPV0 under the skin (in the
left upper arm)
6week(42 days) DPT-HepB+Hib1 OPV1 Intramuscular route.

(subcutaneous)
10 weeks DPT-HepB+Hib2 OPV2
14 weeks DPT-HepB+Hib3 OPV3
14 weeks IPV1 intramuscularly
9 month Measles (MCV1) subcutaneous
injection
9 month IPV2 intramuscularly

Table2: Routine Immunization Schedule for Pregnant Women(15-49Years)

Dose Time for administration Duration of protection
Td1 At first contact OR as early as None
possible during pregnancy
Td2 At least 4 weeks after Td1 1-3yrs
Td3 At least 6 months after Td2 5years
Td4 At least 1 year after Td3 10 years
Td5 At least 1 year after Td4 For all childbearing age years
and possibly longer

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