CHNN 211 Midterms PDF

CHNN 211: COMMUNITY HEALTH more than 25 debilitating or life-threatening diseases, based toxin is rendered harmless (toxoid) and used as the including measles, polio,...

CHNN 211: COMMUNITY HEALTH more than 25 debilitating or life-threatening diseases, based toxin is rendered harmless (toxoid) and used as the including measles, polio, tetanus, diphtheria, meningitis, antigen in the vaccine to elicit immunity. NURSING - MIDTERMS influenza, tetanus, typhoid and cervical cancer. ▬ There are many types of vaccines, categorized by the TYPE OF VACCINE EXAMPLES STEVEN VALENCIA, SN LEVEL 2 - M10A antigen used in their preparation. Their formulations affect Live-attenuated BACTERIA: Tuberculosis (BCG) how they are used, how they are stored, and how they are VIRUS: Oral polio vaccine (OPV) MODULE 7: EXPANDED PROGRAMS ON administered. : Measles IMMUNIZATION : Rotavirus IMMUNIZATION TYPES OF VACCINES : Yellow fever ▬ Immunization is the process whereby a person is made 1. Live-attenuated vaccines (LAV) Inactivated BACTERIA: Whole-cell pertussis immune or resistant to an infectious disease, typically by the ▬ Available since the 1950s, live attenuated vaccines (LAV) (wP) administration of a vaccine. Vaccines stimulate the body’s are derived from disease- causing pathogens (virus or VIRUS: Inactivated polio virus own immune system to protect the person against bacteria) that have been weakened under laboratory (IPV) subsequent infection or disease. conditions. They will grow in a vaccinated individual, but Sub-unit BACTERIA: Acellular pertussis ▬ Immunization is a proven tool for controlling and because they are weak, they will cause no or very mild (aP) eliminating life-threatening infectious diseases and is disease. a. Protein-based VIRUS: Hepatitis B (HepB) estimated to avert between 2 and 3 million deaths each year. 2. Inactivated vaccines (killed antigen) b. Polysaccharide Pneumococcal, Meningococcal, It is one of the most cost-effective health investments, with ▬ Inactivated vaccines are made from microorganisms (viruses, c. Conjugate Salmonella typhi proven strategies that make it accessible to even the most bacteria, other) that have been killed through physical or hard-to-reach and vulnerable populations chemical processes. These killed organisms cannot cause Toxoid BACTERIA: Tetanus toxoid (TT) disease. : Diphtheria toxoid IMMUNITY 3. Subunit (purified antigen) ▬ Immunity is the condition of being secure against any a. Protein-based subunit vaccines particular disease. EXPANDED PROGRAM ON IMMUNIZATION (EPI) ▬ Protein based subunit vaccines present an antigen to the ▬ The Expanded Program on Immunization (EPI) was ▬ Immunity is the ability of the human body to tolerate the immune system without viral particles, using a specific, presence of material indigenous to the body, and to established in 1976 to ensure that infants/children and isolate protein of the pathogen. A weakness of this mothers have access to routinely recommended eliminate foreign material. This discriminatory ability technique is that isolated proteins, if denatured, may bind to provides protection from infectious disease, since most infant/childhood vaccines. Six vaccine preventable diseases different antibodies than the protein of the pathogen. were initially included in the EPI: TB, poliomyelitis, microbes are identified as foreign by the immune system. b. Polysaccharide vaccines Immunity to a microbe is usually indicated by the presence diphtheria, tetanus, pertussis, and measles. ▬ Some bacteria when infecting humans are often protected by of antibody to that organism. a polysaccharide (sugar) capsule that helps the organism ▬ There are two basic mechanisms for acquiring immunity, evade the human defense systems especially in infants and active and passive. young children. 1. Active immunity is protection that is produced by the ▬ Polysaccharide vaccines create a response against the person’s own immune system. This type of immunity molecules in the pathogen’s capsule. These molecules are usually lasts for many years, often during a lifetime. small, and often not very immunogenic. As a consequence, Active immunization is the induction of immunity they tend to: after exposure to an antigen. Antibodies are created by ▬ Not be effective in infants and young children (under 18–24 the recipient and may be stored permanently. months) 2. Passive immunity is protection by products produced ▬ Induce only short-term immunity by an animal or human and transferred to another c. Conjugate subunit vaccines human, usually by injection. Passive immunity often ▬ Conjugate subunit vaccines also create a response against provides effective protection, but this protection wanes the molecules in the pathogen’s capsule. In comparison to (disappears) with time, usually within a few weeks or plain polysaccharide vaccines, they benefit from a months. Passive immunization is the transfer of active technology that binds the polysaccharide to a carrier protein humoral immunity in the form of readymade ▬ The immunization coverage of children has improved (see that can induce a long-term protective response even in figure 1). The 2009 National Demographic and Health antibodies, from one individual to another. infants. Survey showed that 3 out of 4 births were protected against 4. Toxoid (inactivated toxins) neonatal tetanus, that is, women whose last birth was VACCINE ▬ Toxoid vaccines are based on the toxin produced by certain ▬ A vaccine helps the body’s immune system to recognize and protected against neonatal tetanus was 76%. The bacteria. The toxin invades the bloodstream and is largely differentials in protection against neonatal tetanus among fight pathogens like viruses or bacteria, which then keeps us responsible for the symptoms of the disease. The protein- safe from the diseases they cause. Vaccines protect against subgroups of women vary. Across regions, tetanus toxoid VALENCIA |PAGE 1  (TT) coverage ranged from 39% in ARMM to 88% in disease killed more than 3 million people in 1995. It usually ▬ Unfortunately, some people fail to take the medications as Central Visayas and Cagayan Valley. By level of education, attacks the lungs, but other parts of the body, including the prescribed or to complete their course of therapy, or they TT coverage was lowest for women with high school bones, joints and brain can also be affected.There is a may be given ineffective treatments (Non-compliance). education at 80% (NSO, 2009). difference between tuberculosis infection and disease. This may lead to multi-drug-resistant TB, which can be ▬ People with the infection only do not feel ill and have no spread to other people. Goals for the expanded program on immunization and symptoms. The infection may last for a lifetime and the  How is tuberculosis prevented? supporting legislation infected person may never develop the disease. Persons with ▬ The best protection available for children against ▬ To achieve the over-all EPI goal of reducing the morbidity the infection but not the disease cannot spread the infection tuberculosis infection is immunization with BCG vaccine. and mortality among children against the most common to others. In persons who have been thus immunized it is impossible vaccine-preventable diseases, the following laws have given ▬ People of all ages can contract tuberculosis. It spreads to determine whether a positive tuberculin skin test reaction the mandate of protecting children through immunization to rapidly, particularly where people are living in crowded is caused by the immunization or by infection with the TB the DOH and LGUs: conditions, have poor access to care, and are malnourished. bacterium. However, such individuals can be further  How is tuberculosis spread? examined to determine whether they are infected. ▬ RA. 10152, also known as Mandatory Infants and ▬ Tuberculosis is spread through the air. When a person with Children Health Immunization Act of 2011, mandates the disease coughs or sneezes the germs enter the air. A B. DIPHTHERIA basic immunization covering the vaccine-preventable person inhaling air that contains TB germs may become  What is diphtheria? diseases. Added to the six immunizable diseases previously infected. TB can spread rapidly where people are living in ▬ Diphtheria is caused by a germ called Corynebacterium mentioned are hepatitis B, mumps, rubella, diseases caused crowded conditions, have difficulty in obtaining medical diphtheriae. Major epidemics have occurred in Eastern by Haemophilus influenzae type B (Hib), and other care, and are poorly nourished. In some areas it is possible Europe and Central Asia since the late 1980s. It tends to be a diseases as determined by the Secretary of Health in a to become infected from cattle with the disease, for instance disease of the colder months and of temperate climatic zones. department circular. It gives the directive to government by consuming unpasteurized milk. ▬ The germ produces a toxin that can harm or destroy human hospitals and health centers to provide for free mandatory ▬ The incubation period is 4-12 weeks but the infection may body tissues and organs. One type of the disease affects the basic immunization to infants and children up to 5 years of persist for months or years before the disease develops. A pharynx and other parts of the throat. Another type, age. person with the disease can infect others for several weeks commoner in the tropics, causes ulcers on the skin. after he or she begins treatment. The risk of developing TB ▬ Diphtheria affects people of all ages, but mostly non- ▬ R.A. 7846, AN ACT REQUIRING COMPULSORY is highest in children aged under 3 years and in very old immunized children under 15 years of age. IMMUNIZATION AGAINST HEPATITIS-B FOR people, although anyone may be affected. Persons with TB  How is diphtheria spread? INFANTS AND CHILDREN BELOW EIGHT (8) infection who have weakened immune systems, for instance ▬ The type of diphtheria that affects the throat is spread in YEARS OLD, AMENDING FOR THE PURPOSE people with HIV/AIDS, are more likely to develop the droplets and secretions from the nose, throat and eyes when PRESIDENTIAL DECREE NO. 996, AND disease than are those with normal immune systems. there is close contact between infected and uninfected APPROPRIATING FUNDS THEREFOR, provided for ▬ Concern about TB has been heightened recently because people. The other type is spread through contact with skin compulsory immunization against hepatitis B for infants some strains of the causative organism have developed ulcers. This form of the disease is often disseminated on and children below 8 years old. It also provided for hepatitis resistance to drugs. clothing and other articles that have been contaminated with B immunization within 24 hours after birth of babies of  What are the signs and symptoms? fluid from skin ulcers. women with hepatitis B. ▬ The symptoms of TB include general weakness, weight loss, ▬ Incubation period: become ill within two to four days, fever and night sweats. In TB of the lungs (pulmonary TB) although the symptoms may not appear until six days have ▬ The following are the specific goals of the program: the symptoms include persistent cough, the coughing up of elapsed. Infected individuals can usually spread the disease 1. To immunize all infants/children against the most blood, and chest pain. However, in young children the only to others for up to four weeks, although rarely this can common vaccine-preventable diseases. sign of pulmonary tuberculosis may be stunted growth or happen for up to six months. During outbreaks and 2. To sustain the polio-free status of the Philippines. failure to thrive. Other signs and symptoms depend on the epidemics some children may carry the germ without 3. To eliminate measles infection. part of the body that is affected. For instance, in TB of the showing any signs or symptoms but can still spread the 4. To eliminate maternal and neonatal tetanus. bones and joints there may be swelling, pain and crippling disease to other people. 5. To control diphtheria, pertussis, hepatitis B, and effects in the hips, knees or spine. ▬ The spread of the disease is favored in overcrowded and German measles.  What are the complications? poor living conditions. 6. To prevent extrapulmonary TB among children. ▬ TB weakens the body generally, increasing the likelihood  What are the signs and symptoms? that the affected person will contract other diseases or that ▬ When diphtheria affects the throat and tonsils, the early EPI DISEASES existing diseases will become more severe. symptoms are sore throat, loss of appetite and slight fever. A. TUBERCULOSIS (TB)  How is tuberculosis treated? Within two to three days a bluish-white or grey membrane  What is tuberculosis? ▬ People with TB must complete a course of curative forms in the throat and tonsils. If there is bleeding the ▬ Tuberculosis is caused by a bacterium (Mycobacterium therapy, which usually includes taking two or more anti- membrane may become greyish-green or black. It sticks to tuberculosis) that is carried by almost 2 billion people. The tuberculosis drugs for at least six months. the soft palate of the throat, and bleeding may occur if VALENCIA |PAGE 2  attempts are made to remove it. The patient may recover at seven to ten days before and seven to ten days after they  Polio is caused by a virus and can lead to severe, possibly this point or may develop severe weakness and die within first experience symptoms of the disease. Infected persons lifelong, paralysis. six to ten days. Patients with severe disease do not show who do not have symptoms can also spread  The disease is easily spread from person to person and from high fever but may develop swelling of the neck and hand to mouth, through eating food or drinking water that obstruction of the airway.  Many people who contract polio do not become seriously ill has been contaminated with feces from an infected ▬ In the type of diphtheria affecting the skin, the lesions may but may spread the disease to others who may become ill individual. be painful, reddened and swollen. Any chronic skin lesions  About 1 child in every 100 infected by the polio virus  The recommended method of prevention in children is to may become infected with diphtheria. develops paralysis immunize with oral polio vaccine (OPV).  What are the complications? ▬ Abnormal heart beats may occur during the early phase of D. MEASLES the illness or weeks later, and heart failure may result. There  What are the signs and symptoms? ▬ Measles kills more children than any other of the EPI target may be inflammation of the heart muscle and valves, ▬ People infected with the virus may not feel ill. Some may diseases. It is caused by a virus and is highly infectious, i.e., leading after many years to chronic heart disease and heart have influenza-like symptoms such as fever, loose stools, very easily spread. It is constantly present in some failure. Death occurs in 5-10% of cases. sore throat, stomach upset, headache or stomachache. populations and often occurs in epidemic proportions. In  How is diphtheria treated? Sometimes there may be pain or stiffness in the neck, back conditions of crowding and poverty where large numbers of ▬ Persons in whom diphtheria is suspected should be given and legs. non-immunized people are in close contact the stage is set diphtheria antitoxin and antibiotics such as erythromycin or ▬ The most serious form of the disease is paralytic polio. It for measles epidemics. The disease is more severe in infants penicillin, and should be isolated to avoid exposing others to begins with the milder forms but usually causes severe and adults than in children. the germs. Throat cultures should be obtained in order to muscle pain as well as the other symptoms. Paralysis usually  How is measles spread? secure correct diagnosis. Patients become non-infectious develops during the first week of illness. The use of one or ▬ Measles is spread by contact with nose and throat secretions about two days after the commencement of antibiotic both legs or arms may be lost, and breathing may be of infected people and in airborne droplets released when an treatment. impossible without the help of a respirator. The degree of infected person sneezes or coughs.  How is diphtheria prevented? recovery varies from person to person. ▬ Transmission by airborne droplets can occur even two hours ▬ The most effective way of preventing diphtheria is to ▬ In childhood polio there is initially a slight fever. Within after an infected person has left a room or other closed area. maintain a high level of immunization in the community. A three to five days the child develops a headache, stiff neck, ▬ An infected person can infect others a few days before and mother can pass protective antibodies to her baby but this and muscle pain, and the fever then increases. After a for several days after he or she develops symptoms. The protection lasts only about six months. further period of one to three days the child becomes disease spreads easily wherever infants and children gather ▬ In most countries, diphtheria toxoid vaccine is given paralyzed in the legs, arms, face or chest. together. together with pertussis vaccine and tetanus toxoid. A ▬ The incubation period ranges from 3 to 35 days. Laboratory  What are the signs and symptoms? combination of tetanus and diphtheria vaccine may be testing of the stools or throat secretions is used to confirm ▬ The incubation period ranges from 7 to 18 days. The first recommended as a booster to maintain protection every ten cases of polio. sign of infection is a high fever lasting one to seven days. years.  What are the complications? During this period there may be a runny nose, cough, red ▬ About 1% of infected children become paralyzed, and a and watery eyes, and small white spots inside the cheeks. C. POLIOMYLITIS (POLIO) larger percentage of these children have some permanent After several days a slightly raised rash develops, spreading  What is polio? paralysis. Death may occur if the muscles used for breathing from the face and upper neck to the body and then to the ▬ Polio is caused by a virus. It is a crippling disease that can are paralyzed and no respirator is available. hands and feet over a period of about three days. It lasts for occur in adults but it is much commoner in children.  How is polio treated? five to six days and fades successively from the same areas.  How is polio spread? ▬ There is no treatment but the symptoms can be relieved There may also be loss of appetite and loose stools, ▬ The virus enters the body through the mouth when people somewhat. Sometimes the patient has to use a respirator in especially in infants. eat food or drink water contaminated by feces carrying it. order for breathing to continue.  What are the complications? Consequently, the disease is most likely to spread in areas of  How is polio prevented? ▬ Complications occur particularly in children aged under 5 poor sanitation. The virus enters the bloodstream and may ▬ Polio prevention involves immunization with oral polio years and in adults aged over 20 years. Severe diarrhea may invade certain types of nerve cell, which it can damage or vaccine (OPV). Antibodies from the mother provide be a problem, especially in infants, possibly causing destroy. protection to the infant for two to three months after birth. dehydration. In children there may be inflammation of the ▬ It also occurs in throat secretions, and is sometimes spread Infected people who recover can develop natural immunity middle ear, respiratory tract infections and croup. in airborne droplets through close contact with persons that protects them against future infection. ▬ Pneumonia is the commonest cause of death associated with carrying the infection who are sneezing or coughing, or ▬ OPV is recommended by EPI for the eradication of polio. It measles. This is usually because the measles virus weakens through exposure to throat and nose secretions in other ways. is cheap, easy to give, highly effective and safe. The EPI the immune system. The pneumonia may be caused by the ▬ The disease is very easily spread. Nearly all children living schedule comprises four doses, starting at birth and ending measles virus itself or by other germs. Encephalitis, a in households where someone is infected themselves at 14 weeks age dangerous swelling of the brain, may also develop. become infected. Persons are most likley to spread the virus VALENCIA |PAGE 3 ▬ Children aged under 12 months, if not immunized, are the E. PERTUSSIS  What is the treatment for pertussis? most likely to acquire measles infection. Severe measles is ▬ Pertussis, or whooping cough, is a disease of the respiratory ▬ Treatment with an antibiotic, usually erythromycin, may particularly likely in poorly nourished children, especially tract caused by a germ called Bordetella pertussis which make the illness less severe. The use of antibiotics also those not receiving sufficient vitamin A, in children living in lives in the mouth, nose and throat. Many children with reduces the ability of the patient to infect others because the crowded conditions, and in those with immune systems that pertussis have coughing spells lasting four to eight weeks. medicaments kill germs in the nose and throat. Plenty of have been weakened by AIDS or other diseases. Measles is The disease is common in non-immunized children fluids should be given to prevent dehydration. Sometimes a major cause of blindness among children in Africa. everywhere. It has become increasingly so in recent years people in the same household as a patient are given ▬ People who recover from measles are immune for the rest of and severe epidemics have occurred in countries where antibiotics to reduce the probability of infection. their lives, and infants born to mothers who have had immunization coverage has declined. The disease is most  How is pertussis prevented? measles are usually immune for six to eight months. dangerous in children aged under 1 year. ▬ Prevention involves immunization with pertussis vaccine,  What is the treatment for measles?  How is pertussis spread? which is usually given in combination with diphtheria and ▬ The treatment of children suffering complications of ▬ Pertussis spreads very easily from person to person in tetanus vaccines. Newborns and infants are not protected measles can save their lives. Vitamin A administration can droplets produced by coughing or sneezing. Most persons against pertussis by maternal antibodies. A person infected help to avoid the complications of eye damage and blindness. exposed to the germs become infected. In many countries with pertussis usually acquires lifelong immunity. All children with severe measles, and all children in the disease occurs in regular epidemic cycles of three to five developing countries with measles, should receive vitamin years. The most susceptible people are the youngest non-  Pertussis is a bacterial infection spread from person to A supplementation as soon as they are seen at a health immunized children. person by sneezing and coughing. facility, and a second dose should be given the next day. General nutritional support and the treatment of  The disease is extremely contagious, especially where dehydration with oral rehydration solution may be necessary.  Young infants are the most likely to contract pertussis and people live in crowded conditions and nutrition is poor. It is very important to encourage children with measles to the most likely to develop bacterial pneumonia, a life-  Infants and very young children are the people most likely eat and drink. threatening complication. to be infected, to have serious complications, and to die  How is measles prevented? from the disease. ▬ The prevention of measles involves immunization with  The most effective way to prevent pertussis is to immunize measles vaccine. Children should receive one dose before ▬ The disease is most readily transmitted as from seven days after a person has been exposed to the germs until three all children aged under 1 year. the age of 1 year. In some countries, measles vaccine is combined with vaccines against the mumps and rubella weeks after the start of coughing. The incubation period can be up to 21 days. F. TETANUS viruses. Two doses of measles vaccine are recommended in  What are the signs and symptoms?  What is tetanus? some instances, as in refugee camps where there is a high ▬ There are usually three stages in the illness. Initially a child ▬ In tetanus or lockjaw, the affected person's muscles all probability of exposure to the disease. appears to have a common cold, with runny nose, watery contract, making the body stiff. The disease is particularly ▬ Children should be immunized against measles on eyes, sneezing, fever and a mild cough. The cough gradually common and serious in newborn babies, when it is called admission to hospital because of the danger of infection. If worsens and the second stage involves numerous bursts of neonatal tetanus. they are aged 6-9 months the initial dose should be followed rapid coughing. At the end of these bursts the child takes in ▬ Tetanus is caused by the germ Clostridium tetani, which by a second as soon as possible after the age of 9 months. air with a high-pitched whoop. The child may turn blue grows in dead tissue, for instance in a wound or in a baby's Children admitted to hospital with measles should be because of a lack of oxygen during a long burst of coughing. umbilical cord. The germ is common in the environment, isolated for at least four days after the skin rash appears. Vomiting and exhaustion often follow the coughing attacks, often occurring in soil containing manure. The bacteria form Malnourished children with measles should be isolated for which are particularly frequent at night. This stage usually spores that can survive in the environment for years. The the duration of the illness. lasts one to six weeks but may go on for up to ten weeks. toxin they produce poisons the nerves that control the ▬ Some 124 million children under 5 years of age suffer The attacks become milder with the passage of time. muscles, and this causes stiffness. vitamin A deficiency. In areas known to be deficient in ▬ In the third stage, when recovery takes place, the coughing ▬ People of all ages can catch tetanus. Neonatal tetanus kills vitamin A it can be given at the same time as measles gradually becomes less intense and stops in two to three between 500 000 and 1 million babies every year. Almost all vaccine or any other recommended EPI vaccine. weeks. There is not usually a high fever during the illness. babies who catch the disease die. It is particularly common  What are the complications? in rural areas and tropical lowlands.  Measles is a highly infectious viral disease that is spread ▬ Complications are most probable in young infants. The from person to person through sneezing, coughing and close commonest and the cause of most deaths is bacterial personal contact. pneumonia. Convulsions and seizures may occur, these  How is tetanus spread?  All children should receive measles vaccine before the age complications arising because of the reduced oxygen supply ▬ Tetanus is not transmitted from person to person. A person of 1 year. to the brain during coughing attacks or because of the toxins may become infected if soil or dung enters a wound or cut.  Severe complications of measles can be avoided if proper released by the pertussis germs. Less serious complications This may happen, for example, if a wound is made with a treatment is given. include loss of appetite, inflammation of the middle ear, and dirty tool. Tetanus germs are likely to grow in deep puncture dehydration. VALENCIA |PAGE 4  wounds caused by dirty nails, needles, barbed wire, thorns, protected against the disease at birth. Clean practices during wood splinters and animal bites. delivery and clean wound care are also very important in G. HEPATITIS B ▬ A newborn baby may become infected if the knife, razor or preventing tetanus.  What is hepatitis B? other instrument used to cut the umbilical cord is dirty.  What are the signs and symptoms? ▬ This disease, caused by the hepatitis B virus, affects the Infection may also occur if cow dung or ash is used to dress ▬ In newborn babies the symptoms usually appear 4-14 days liver. People usually recover, but some continue to carry the the cord, or if soil enters the baby's navel. If the hands of the after birth. The incubation period is usually between three virus for many years and can spread the infection to others person delivering are not clean the baby may become and ten days but may be as long as three weeks. The shorter throughout the time that they are chronic carriers. infected. Infants and children may also contract tetanus the incubation period, the higher is the risk of death.  How is hepatitis B spread? when dirty instruments are used for circumcision, ▬ Muscular stiffness in the jaw is a common first sign. This is ▬ The hepatitis B virus is carried in the blood, saliva, semen, scarification and skin-piercing, and when dirt, charcoal or followed by stiffness of the neck, difficulty in swallowing, vaginal fluids and most other body fluids. However, it is other unclean substances are rubbed into a wound. stiffness of the stomach muscles, muscle usually spread by contact with blood in the following ways: spasms, sweating and fever.  Injection with unsterilized needles or syringes  Neonatal tetanus remains a serious problem in countries ▬ Newborn babies with tetanus appear normal at birth but stop containing hepatitis B virus from an infected person, with poor immunization coverage and unclean practices sucking three to ten days later. At 5-13 days they are still not for instance another patient or a needle-user. associated with childbirth. breast-feeding, the whole body becomes stiff, severe muscle  Transmission of hepatitis B virus by mothers to their  If untreated, tetanus is a very serious disease at any age. contractions and convulsions occur, and death follows in babies during the birth process, when contact with Almost every person contracting tetanus dies. most cases. blood always occurs.  What are the signs and symptoms?  What are the complications?  Transmission between children during social contact ▬ In newborn babies the symptoms usually appear 4-14 days ▬ Fractures of the spine or other bones may occur as a result through cuts, scrapes and scratches. after birth. The incubation period is usually between three of muscle spasms and convulsions. Abnormal heartbeat,  Transmission during sexual intercourse through contact and ten days but may be as long as three weeks. The shorter coma, pneumonia and other infections may also occur. with blood or other body fluids. the incubation period, the higher is the risk of death. Death is particularly likely in very young and old age groups. ▬ Muscular stiffness in the jaw is a common first sign. This is  What is the treatment for tetanus? ▬ The virus does not occur in an infected person's stools followed by stiffness of the neck, difficulty in swallowing, ▬ Wounds should be thoroughly cleaned and dead tissue unless they contain blood. It does occur in the milk of stiffness of the stomach muscles, muscle should be removed. For persons with wounds that are infected mothers but in such small amounts that nursing can spasms, sweating and fever. neither clean nor minor and who are not fully protected proceed. ▬ Newborn babies with tetanus appear normal at birth but stop against tetanus, tetanus immune globulin should be given. ▬ The disease occurs all over the world and can affect all age sucking three to ten days later. At 5-13 days they are still not ▬ Antibiotics may also be used. groups. Most chronic carriers are in China, South-East Asia, breast-feeding, the whole body becomes stiff, severe muscle ▬ Persons who recover from tetanus do not have natural and Africa. contractions and convulsions occur, and death follows in immunity. ▬ The incubation period averages six weeks but may be as most cases.  How is tetanus prevented? long as six months.  What are the complications? ▬ The prevention of neonatal tetanus requires women of  What are the signs and symptoms? ▬ Fractures of the spine or other bones may occur as a result childbearing age to receive tetanus toxoid. This results in the ▬ The younger a person is when infected the more likely it is of muscle spasms and convulsions. Abnormal heartbeat, protection of mothers and in tetanus antibodies being that he or she will show no signs or symptoms. A person coma, pneumonia and other infections may also occur. transferred from them to their fetuses. Infants are thus with no symptoms may remain infected for many years and Death is particularly likely in very young and old age groups. protected against the disease at birth. Clean practices during can spread the infection to others. Such a person is more  What is the treatment for tetanus? delivery and clean wound care are also very important in likely than one showing symptoms to suffer complications ▬ Wounds should be thoroughly cleaned and dead tissue preventing tetanus. caused by liver damage in the long term. should be removed. For persons with wounds that are ▬ Infected people may feel weak and may experience stomach neither clean nor minor and who are not fully protected  All children should be immunized against tetanus because upsets and other influenza-like symptoms. They may also against tetanus, tetanus immune globulin should be given. antibodies transferred from the mother before birth last for have very dark urine or very pale stools. Jaundice may ▬ Antibiotics may also be used. only a few months. appear as yellow skin or a yellow color in the whites of the ▬ Persons who recover from tetanus do not have natural  Tetanus is caused by a germ found in the natural eyes. The symptoms may last several weeks. General immunity. environment. weakness and fatigue may continue for months. A  Infection occurs when unclean objects puncture or cut the laboratory blood test is required to determine with certainty skin and umbilical cord and during unclean delivery whether a person has hepatitis B virus or disease.  How is tetanus prevented? practices. ▬ Most acute infections in adults are followed by complete ▬ The prevention of neonatal tetanus requires women of  Nearly all newborns with tetanus die. recovery, and the affected people rarely become chronic childbearing age to receive tetanus toxoid. This results in the  The most important way to achieve prevention is to carriers. However, many children, even though they are not protection of mothers and in tetanus antibodies being immunize women of childbearing age and to ensure clean acutely ill as a rule, do become chronic carriers, and many transferred from them to their fetuses. Infants are thus delivery practices. develop severe complications. VALENCIA |PAGE 5   What are the complications?  Most people are infected by non-symptomatic carriers of the ▬ The disease is prevented by immunization with yellow fever ▬ Infected persons who recover and do not become carriers disease, and many children are infected by mothers who are vaccine, which is given to children in a single dose, usually possess antibodies and are protected throughout their lives. carriers. when they are aged 9 months and at the same time as ▬ The consequences of acute infection can be severe. Death measles vaccine. The vaccine is very safe and effective, occurs in a small percentage of adults. Most serious H. YELLOW FEVER producing antibodies against yellow fever which can last for complications, including chronic hepatitis, cirrhosis, liver  What is yellow fever? 30 years or longer. failure and liver cancer, occur in persons with chronic ▬ Yellow fever, an acute disease of short duration, is caused ▬ Prevention should also involve the elimination of the infection. by a virus. It occurs in tropical and subtropical areas, mainly accumulations of stagnant water in which the vector in sub-Saharan Africa and Central and South America, and mosquitoes breed.  Most babies born to mothers who are carriers also become affects people of all ages. carriers.  How is yellow fever spread?  Yellow fever is caused by a virus that is transmitted by  About 25% of untreated babies who are infected with ▬ The yellow fever virus is spread by mosquitos when they mosquitos. hepatitis B virus subsequently develop severe chronic liver bite humans. It is not spread directly from person to person.  It is an acute disease from which patients either recover disease or even liver cancer. The mosquitos act as hosts for the infection and deliver it to completely or die. people, and are said to be vectors of the disease. They breed  There is a safe and effective vaccine against the disease for  What is the treatment for hepatitis B? in small accumulations of stagnant water. Once infected, children. ▬ There is no treatment for the acute condition. In chronic mosquitos carry the virus for life. infection the disease can sometimes be stopped by certain ▬ Mosquitos may acquire the virus by biting either infected Immunization schedule for infants and young children medications. monkeys or infected humans, and they can subsequently ▬ Immunization is an essential health intervention for eligible  How is hepatitis B prevented? spread it to humans. children and women, and this service is available in all ▬ Safe and effective hepatitis B vaccine is available. EPI health facilities and institutions providing health services for recommends that children receive three doses during the  What are the signs and symptoms? women and children nationwide. Wednesday is the first year of life, the first dose being administered either at ▬ The illness may be so mild that it is not noticed or diagnosed. immunization day in government health facilities unless birth or at about six weeks of age on the occasion of the first It can be confused with malaria, hepatitis and other diseases. otherwise revised by local traditions, customs, and other clinic visit, and the third at 14 weeks. If possible, all Three to six days after a person has been infected by a exceptions. pregnant women should be tested to determine whether they mosquito, he or she suddenly develops fever, chills, ▬ Infants are given this service according to the schedule and carry the virus in their blood. Babies of mothers who are headache, backache, general muscle pain. upset stomach and manner prescribed by the DOH. The schedule and manner carriers should then receive an injection of hepatitis B vomiting. When the disease progresses, the person becomes of administration of infant immunizations are shown on antibodies (hepatitis B immune globulin) together with the slow and weak and there is bleeding of the gums and blood Table 1 first dose of vaccine at birth. in the urine. There may be jaundice and black vomiting. ▬ In some countries the hepatitis B vaccine is offered to or  What are the complications? recommended for adolescents and young adults, since the ▬ The disease usually lasts two weeks, after which the patient virus is sexually transmitted and is also easily spread either recovers or dies. Death may follow convulsions and through needle-sharing. coma. In areas where the disease is endemic about 5% of ▬ Persons with hepatitis B virus should not donate blood and infected persons die from the disease. In epidemics, when should not allow other persons to come into contact with large numbers of people are infected during a short period, their blood or other body fluids. They should use barrier up to 50% of infected people may die. methods when having sex and should not share eating ▬ Yellow fever is diagnosed by performing a laboratory blood utensils, toothbrushes, needles or razors with other people. test. Persons recovering from yellow fever have lifelong ▬ Health care workers should use all necessary precautions immunity. with all patients because patients who are carriers of the virus can spread the infection to them quite easily through  Yellow fever causes about 30 000 deaths annually. blood contact.  Children in 33 African countries are at highest risk for the disease.  The hepatitis B virus is spread through contact between  The disease is of short duration and can be fatal. people's blood and other body fluids.  The disease occurs in both acute and chronic forms.  What is the treatment for yellow fever?  The younger a person is on becoming infected, the less ▬ There is no specific treatment. Patients may require fluids to probable it is that symptoms will occur but the more compensate for dehydration. probable it is that he or she will become a carrier of the  How is yellow fever prevented? disease and develop a severe liver condition later. VALENCIA |PAGE 6  the Philippines, at least 30% of diarrhea-related is given only to infants aged 10 weeks up to a hospitalizations are caused by Rotavirus. maximum of 32 weeks. ▬ Hib is a bacterium responsible for serious illness, such  Administer the entire dose of the Rotavirus vaccine as meningitis and pneumonia, with almost all cases slowly down one side of the mouth (between the cheek and gum) with the tip of the applicator directed toward younger than 5 years, with those between 4 and 18 the back of the infant’s mouth. To prevent spitting or months of age especially vulnerable. failed swallowing, stimulate the rooting or sucking ▬ The following are important considerations related reflex of the young infant. For infants aged 5 months or to the schedule and manner of administering infant older, lightly stroke the throat in a downward motion to immunizations: stimulate swallowing.  Use only sterile syringe and needle per client  There is no need to restart a vaccination series EPI Vaccines regardless of the time that has elapsed between doses. ▬ Preparations used in EPI are either inactivated (killed)  All the EPI antigens are safe and effective when microorganisms, attenuated microorganisms, fragments administered simultaneously, that is, during the same from microorganisms like hepatitis B vaccine, or toxoids. immunization session but at different sites. It is not Attenuated vaccines are live microorganisms that have recommended, however, to mix different vaccines in been altered so that they are no longer pathogenic, but are one syringe before injection, or to use a fluid vaccine still antigenic. Toxoids are inactivated or altered bacterial for reconstitution of a freeze-dried vaccine. When a exotoxins. vaccine is administered to an infant at the same time with another injectable vaccine, the vaccines should be TABLE 2 EPI VACCINES, CONTENTS AND FORMS administered on different sites. However, if more than Vaccine Contents Form one injection has to be given on the same limb, the BCG (Bacillus Live, attenuated Freeze-dried, injection sites should be 2.5-5cm apart to prevent Calmette-Guerin) bacteria reconstituted with a overlapping of local reactions. special diluent  The recommended sequence of the coadministration of Hepatitis B RNA-recombinant, Cloudy, liquid, in vaccines is OPV first followed by Rotavirus vaccine, vaccine using Hepatitis B an auto-disable then other appropriate vaccines. surface antigen injection syringe if  OPV is administered by putting drops of vaccine (HBs Ag) available straight from the dropper onto the child’s tongue. Do DPT-HepB-Hib Diphtheria toxoid, Liquid, in an auto- not let the dropper touch the tongue. (Pentavalent inactivated disable injection  Only monovalent hepatitis B vaccine must be used for vaccine) pertussis bacteria, syringe the birth dose. Pentavalent vaccine must not be used for tetanus toxoid, the birth dose because DPT and Hib vaccine should not recombinant DNA be given at birth. A monovalent vaccine is one that surface antigen, and contains an antigen against a single disease. Pentavalent synthetic conjugate vaccines contain antigens against five diseases: of Haemophilus diphtheria, pertussis, tetanus, hepatitis B, and influenzae B bacilli ▬ Receiving the antigens at the earliest possible age Hemophilus influenzae B. Oral polio vaccine Live, attenuated Clear, pinkish  Children who have not received AMV1 as scheduled virus (trivalent) liquid reduces the chance of the child getting infected or sick and children whose parents or caregivers do not know of the immunizable diseases. Administration of the Anti-measles Live, attenuated Freeze-dried, whether they have received AMV1 shall be given vaccine (AMV1) virus reconstituted with a hepatitis B vaccine at birth reduces the chance of the AMV1 as soon as possible, then AMV2 one month special diluent child becoming a carrier. Studies also show that after the AMV1 dose. Measles-mumps- Live, attenuated Freeze-dried, measles vaccine is 85% effective.  All children entering day care centers/ preschool and rubella vaccine viruses reconstituted with a ▬ In 2012, two new vaccines were introduced as part of Grade I shall be screened for measles immunization. (AMV2) special diluent EPI: Rotavirus vaccine and Hib vaccine. Rotavirus Those without the immunization shall be referred to the Rotavirus vaccine Live, attenuated Clear, colorless infects the large intestine. It is the most common nearest health facility for immunization. virus liquid, in a cause of severe diarrhea I infants and children.  The first dose of Rotavirus vaccine is administered only container with an to infants aged 6 weeks to 15 weeks. The second dose oral applicator Children between the ages of 6 and 24 months are at great risk of developing severe Rotavirus infection. In Tetanus toxoid Weakened toxin Sometimes slightly VALENCIA |PAGE 7  turbid in refrigerator. Do not stock vaccines at the refrigerator  The vaccine has not been contaminated. appearance: Clear, door shelves.  The vials have been stored under appropriate cold chain colorless liquid;  Hepatitis B vaccine, Pentavalent vaccine, Rotavirus conditions. sometimes slightly vaccine, and TT are damaged by freezing, so they should  The vaccine vial septum has not been submerged in turbid… not be stored in the freezer. Wrap the containers of these water. vaccines with paper before putting them in the vaccine  The VVM on the vial, if attached, has not reached the Target setting and vaccine requirements bag with cold packs. discard point. ▬ The first specific goal of EPI in the Philippines indicates a  Keep diluents cold by storing them in the refrigerator in  Reconstitute freeze-dried vaccines such as BCG, AMV, target of 100% immunization of infants/children against the the lower or door shelves. and MMR only with the diluents supplied with them. most common vaccine-preventable diseases. At the  Discard reconstituted freeze-dried vaccines 6 hours after RHU/health center level, the public health nurse is  Other considerations to maintain potency reconstitution of at the end of the immunization session, responsible for preparing vaccine requirements and ▬ Observe the first expiry-first out (FEFO) policy. whichever comes sooner. overseeing vaccine allocation. Vaccine requirement is ▬ Comply with the recommended duration of storage and  Protect BCG from sunlight and Rotavirus vaccine from calculated based on eligible population. The nurse uses the transport. At the health center/RHU with a refrigerator, the light. following formulas to estimate eligible population: duration of storage should not exceed one month. Using transport boxes, vaccines can be kept only up to maximum SIDE EFFECTS OF ADVERSE REACTIONS OF Estimated number of infants = total population x 2.7% of 5 days. IMMUNIZATION ▬ Take note if the vaccine container has a vaccine vial monitor ▬ Vaccine recipients or their parents/guardians should be Estimated number of 12 to 59 month old children = total (VVM) and act accordingly. The VVM is a round disc of informed of side effects or adverse reactions of vaccine(s) to population x 10.8% heat-sensitive material placed on a vaccine vial to register be given. Adverse events should be monitored closely. cumulative heat exposure. A direct relationship exists ▬ BCG injection results in the formation of a wheal that Estimated number of pregnant women = total population x 3,6% between rate of color change and temperature: the lower the disappears within 30 minutes. After about 2 weeks, a small temperature, the slower the color change; the higher the red tender swelling appears at the injection site, which may MAINTAINING THE POTENCY OF EPI VACCINES temperature, the faster the color change. develop into a small abscess which ulcerates. The ulcer ▬ Vaccines confer immunity only when they are potent, and to heals by itself and leaves a scar. The whole course from retain the potency, vaccines must be properly stored, vaccination to the formation of a scar takes about 12 weeks. handled, and transported. The following points are important This is an expected response and does not require any considerations to maintain the potency of EPI vaccines. management.  Maintain the COLD CHAIN TABLE 3 SIDE EFFECTS OF VACCINATION AND THEIR ▬ The cold chain is a system for ensuring the potency of a MANAGEMENT vaccine from the time of manufacture to the time it is given VACCINES SIDE EFFECTS MANAGEMENT to an eligible client. BCG Koch’s No management is ▬ The person directly responsible for cold chain management phenomenon: an needed at each level is called the Cold Chain Officer. At the acute inflammatory RHU/health center, the public health nurse acts as the Cold reaction within 2-4 Chain Officer. This means that the nurse is in charge of days after maintaining the cold chain equipment and supplies, such as vaccination; usually the freezer/refrigerator, transport box, vaccine bags/carriers, indicates previous cold chain monitors, thermometers, and cold packs. The exposure to nurse implements an emergency plan in the event an tuberculosis electrical breakdown or power failure. ▬ Abide by the open-vial policy of the DOH. A multidose vial ▬ EPI vaccines and the special diluents have the following may be opened for one or two clients if the health worker Deep abscess at Refer to the cold chain requirements: feels that a client cannot come back for the scheduled vaccination site; physician for  OPV: -15 to 25⁰C. OPV has to be stored in the freezer. immunization session. Multidose liquid vaccines, such as almost invariably incision and In the vaccine bag, OPV is placed in contact with cold OPV, Pentavalent vaccine, hepatitis B vaccine, and TT from due to drainage packs. which one or more doses have been taken following subcutaneous or  All other vaccines, including measles vaccine, MMR, standard sterile procedures, may be used in the next deeper injection and Rotavirus vaccine, have to be stored in the immunization sessions for up to maximum of 4 weeks, refrigerator at a temperature of +2 to +8⁰C. These provided that all the following conditions are met: Indolent ulceration: Treat with INH vaccines should be stocked neatly on the shelves of the  The expiry date has not passed. an ulcer which powder VALENCIA |PAGE 8  persists after 12 some children the child EPI RECORDING AND REPORTING weeks from Rotavirus vaccine Some children Reassure parents ▬ EPI recording and reporting are accomplished using the vaccination date develop mild and instruct them to FHSIS. vomiting and give antipyretic and  Fully Immunized Children (FIC) Glandular If suppuration diarrhea, fever, and Oresol to the child ▬ Are those who were given BCG, three doses of OPV, three enlargement: occurs, treat as irritability doses of DPT and hepatitis B vaccine or three doses of enlargement of deep abscess Tetanus toxoid Local soreness at Apply cold Pentavalent vaccine, and one dose of anti-measles vaccine lymph glands the injection site compress at the before reaching one year of age. draining the site. No other  Completely immunized child injection site treatment is needed ▬ Refers to children who completed their immunization Hepatitis B Local soreness at No treatment is schedule at the age of 12-23 months. vaccine the injection site necessary CONTRAINDICATION TO IMMUNIZATION  Child protected at birth (CPAB) DPT-HepB-Hib Fever that usually Advise parents to ▬ In general, there are no contraindications to immunization of ▬ Is a term used to describe a child whose mother has received (Pentavalent lasts for only 1 day. give antipyretic a sick child if the child is well enough to go home. Sending a. Two doses of TT during this pregnancy, provided that vaccine) Fever beyond 24 children away and telling mothers to bring them back for the second dose was given at least a month prior to hours is not due to immunization when they are well enough is a bad practice delivery; or the vaccine but to because it delays the immunization. Bring the child back to b. At least three doses of TT anytime prior to pregnancy other causes the RHU/health center for immunization at another time with this child. may not be easy for the mother, leaving the child at risk of Local soreness at Reassure parents getting sick if an immunizable disease. the injection site that soreness will disappear after 3-4 ▬ There are few absolute contraindications to the EPI days vaccines. Do not give:  Pentavalent vaccine/DPT to children over 5 years of age. Abscess after a Incision and  Pentavalent vaccine/DPT to a child with recurrent week or more drainage may be convulsions or another active neurological disease of the usually indicates necessary central nervous system. that the injection  Pentavalent vaccine 2 or 3/DPT 2 or 3 to a child who was not deep has had convulsions or shock within 3 days of the most enough or the recent dose. needle was not  Rotavirus vaccine when the child has a history of sterile hypersensitivity to a previous dose of the vaccine, intussusceptions or intestinal malformation, or acute Convulsions: Proper management gastroenteritis; and although very rare, of convulsions;  BCG to a child who has signs and symptoms of AIDS or may occur in pertussis vaccine other immune deficiency conditions or who are children older than should not be given immunosuppressed. 3 months; caused anymore by pertussis vaccine ▬ Some conditions are considered false contraindications. If they are seen in children, the health worker may continue with the appropriate immunizations. These are:  Malnutrition, which should be considered as an OPV None indication that the child especially needs the protection Anti-measles Fever 5-7 days after Reassure parents conferred by immunization; vaccine vaccination in some and instruct them to  Low-grade fever; children; give antipyretic to  Mild respiratory infection; and sometimes, there is the child  Diarrhea. Children with diarrhea who are due for OPV a mild rash should receive a dose of OPV during the visit. MMR Local soreness, Reassure parents However, the dose is not counted. The child should fever, irritability, and instruct them to return when the next dose of OPV is due. and malaise in give antipyretic to VALENCIA |PAGE 9 CHNN 211: COMMUNITY HEALTH children and know which problems are most important to treat. Therefore, effective case management needs to NURSING - MIDTERMS consider all of a child’s symptoms. STEVEN VALENCIA, SN LEVEL 2 - M10A  Objectives of IMCI ▬ To reduce significantly global morbidity and mortality MODULE 8: ILLUSTRATED MANAGEMENT OF associated with the major causes of illnesses in children CHILDHOOD ILLNESS ▬ To contribute to healthy growth and development of INTRODUCTION children. ▬ The WHO/UNICEF guidelines for Integrated Management of Childhood Illness (IMCI) offer simple CASE MANAGAMENT PROCESS and effective methods to prevent and manage the leading The CASE MANAGEMENT PROCESS is used to assess and causes of serious illness and mortality in young children. classify two age groups: The clinical guidelines promote evidence-based assessment  Age 1 week up to 2 months and treatment, using a syndromic approach that supports the  Age 2 months up to 5 years rational, effective and affordable use of drugs. The And how to use the process shown on the chart will help us to guidelines include methods for checking a child’s identify signs of serious disease such pneumonia, diarrhea, FIGURE 1: DISTRIBUTION OF 11.6 MILLION DEATHS immunization and nutrition status; teaching parents how to malaria, measles, DHF, meningitis, malnutrition and anemia. AMONG CHILDREN LESS THAN 5 YEARS OLD IN ALL give treatments at home; assessing a child’s feeding and DEVELOPING COUNTRIES, 1995 counselling to solve feeding problems; and advising parents  The Case Management Process ▬ 5% Malaria about when to return to a health facility. The approach is ▬ The charts describes the following steps; ▬ 7% Measles designed for use in outpatient clinical settings with limited 1. Assess the child or young infant ▬ 19% Diarrhoea diagnostic tools, limited medications and limited 2. Classify the illness ▬ 19% Acute respiratory infections (ARI) opportunities to practice complicated clinical procedures. 3. Identify the treatment ▬ 18% Perinatal ▬ 32% other 4. Treat the child  In each country, the IMCI clinical guidelines are 5. Counsel the mother ▬ 54 % Malnutrition adapted: 6. Give follow up care  Approximately 70% of all childhood deaths are ▬ To cover the most serious childhood illnesses typically seen associated with one or more these 5 conditions at first-level health facilities  The Classification Table ▬ To make the guidelines consistent with national treatment ▬ The classification tables on the assess and classify have 3 INTERGRATED MANAGEMENT OF CHILDHOOD guidelines and other policies Rows. ILLNESS ▬ To make the guidelines feasible to implement through the ▬ Color of the row helps to identify rapidly whether the child ▬ A strategy for reducing mortality and morbidity associated health system and by families caring for their children at has a serious disease requiring urgent attention. with major causes of childhood illness home. ▬ Each row is colored either – ▬ A joint WHO/UNICEF initiative since 1992 ▬ Currently focused on first level health facilities  Pink – means the child has a severe classification and FOREWORD needs urgent attention and referral or admission for ▬ Comes as a generic guidelines for management which been ▬ Since the 1970s, the estimated annual number of deaths inpatient care. adapted to each country. among children less than 5 years old has decreased by  Yellow – means the child needs a spec eds a specific almost a third. This reduction, however, has been very medical treatment such as an appropriate antibiotic, an  Pneumonia, diarrhea, dengue hemorrhagic fever, uneven. And in some countries rates of childhood mortality oral anti-malarial or other treat other treatment; also malaria, measles and malnutrition cause more than are increasing. In 1998, more than 50 countries still had teaches the mother how to give oral drugs l drugs or to 70% of the deaths in children under 5 years of age. All childhood mortality rates of over 100 per 1000 live births.1 treat local infections at home. The health worker these are preventable diseases in which when managed Altogether more than 10 million children die each year in teaches the mother how to care for her child at home and treated early could have prevented these deaths. developing countries before they reach their fifth birthday. and when she should return. There are feasible and effective ways that health Seven in ten of these deaths are due to acute respiratory Green– not given a specific medical treatment such as worker in health centers can care for children with  infections (mostly pneumonia), diarrhoea, measles, malaria, antibiotics or treatments. The health worker h worker these illnesses and prevent most of these deaths. WHO or malnutrition—and often to a combination of these teaches the mother how her how to care for her child at and UNICEF used updated technical findings to conditions (figure 1). home. describe management of these illnesses in a set of integrated guidelines for each illness. They then ▬ Always start at the top of the classification table. If the child developed this protocol to teach the integrated case has signs from more than 1 row always select the more management process to health worker who see sick serious classification. VALENCIA |PAGE 10   Why not use the process for children age 5 years or 3. Referral, treatment or counseling of the child’s caretaker more? (depending on the classification identified) ▬ The case he case management process is designed for 4. Follow-up care children < 5yrs of age, although. Much of the advise on treatment of pneumonia, diarrhea, malaria, measles and  Referral Health Facility malnutrition, is also applicable to older children, the 1. Emergency triage assessment and treatment ASSESSMENT AND CLASSIF D CLASSIFICATION of 2. Diagnosis, treatment and monitoring of patient’s older children would differ. For example, the cut off rate for progress determining fast breathing would be d would be different because normal breathing rates are slower in older chi older children. Chest indrawing is no indrawing is not a reliable sign of severe pneumonia as children get older and the bones of the chest become more firm. ▬ In addition, certain treatment recommendations or advice to mothers on hers on feeding would differ for >5yrs r >5yrs old. The drug dosing he drug dosing tables only apply to chi ply to children up to 5yrs old. The feeding advice for older children may differ and they may have ay have different feeding problems. ▬ Because of differences in the clinical signs of older and younger children who have th ldren who have these illnesses, the assessment and classification process using these clinical signs is not recommended for older children.  Why not use this process for young infants age < 1 week old? ▬ The process on young infant chart is designed for infants age 1 week up to 2 months. It greatly differs from older infants and young children. In the first week of life, newborn infants are often sick from conditions related to labor and delivery. Their conditions require special treatment.  Identification and provision of treatment ▬ Curative component adapted to address the most common life-threatening conditions in each country ▬ Rehydration (diarrhea, DHF) ▬ Antibiotics (pneumonia, “severe disease”) ▬ Antimalarial treatment ▬ Vitamin A (measles, severe malnutrition)  Promotive and preventive elements ▬ Reducing missed opportunities for immunization (vaccination given if needed) ▬ Breastfeeding and other nutritional counseling ▬ Vitamin A and iron supplementation ▬ Treatment of helminth infection THE INTEGRATED CASE MANAGEMENT PROCESS Overall Case Management Process  Outpatient 1. Assessment 2. Classification and identification of treatment VALENCIA |