hot topics in pid infectious diseases… · disease outb ktbreak otb koutbreak of rsv if...

Hot Topics inHot Topics in

Pediatric Infectious DiseasesPediatric Infectious Diseases

Chitsanu Pancharoen, MDInfectious Disease Unit,Department of Pediatrics,Faculty of Medicine,Chulalongkorn University

Outline IOutline I

I Community acquired pediatric infectious diseasesI. Community‐acquired pediatric infectious diseases1. Disease outbreak

O tb k f RSV i f ti i ll hildOutbreak of RSV infection in small children Outbreak of RVGE in older children & adultsO b k f i fl i ld hildOutbreak of influenza in older childrenOutbreak of rabies in dogs & humans

2. EID/RIDPertussisZika infectionTB & MDR‐TB

Outline IIOutline II

II Vaccines to prevent pediatric infectious diseasesII. Vaccines to prevent pediatric infectious diseases 1. EPI vaccines: HB in HBV‐exposed infants2 New EPI vaccines2. New EPI vaccines

Bivalent HPV vaccine (2HPV) in girlsHib i (Hib)Hib vaccine (Hib)Rotavirus vaccine (RV)

l3. New optional vaccinesDengue vaccine (DV)Live attenuated hepatitis A vaccine (HAV)Nanovalent HPV vaccine (9HPV)

Design of PresentationDesign of Presentation I. Community‐acquired pediatric infectious diseases

1 Di tb k O tb k f RSV i f ti i ll hild1. Disease outbreak Outbreak of RSV infection in small children

Outbreak of RVGE in older children & adults

Outbreak of influenza in older children

Outbreak of rabies in dogs & humansOutbreak of rabies in dogs & humans

2. EID/RID Pertussis

Zika infection

TB & MDR‐TBF MEDIA tTB & MDR‐TB

II. Vaccines

1. EPI vaccines HB in HBV‐exposed infants

2 New EPI vaccines Bivalent HPV vaccine (2HPV) in girls

From MEDIA to…KNOWLEDGE & RESEARCH & PRACTICE

2. New EPI vaccines Bivalent HPV vaccine (2HPV) in girls

Hib vaccine (Hib)

Rotavirus vaccine (RV)

3. New optional vaccines Dengue vaccine (DV)p g ( )

Live attenuated hepatitis A vaccine (HAV)

Nanovalent HPV vaccine (9HPV)


Outbreak of RSV Infection

ไวรส RSV ระบาดหนาฝน

โคราชเดกตดเชอ เขาไอซย!โคราชเดกตดเชอ เขาไอซย!



Situation Large outbreak of RSV infection in children

Presentation Viral pneumoniaInvestigation CXR: hyperaeration, perihilar interstitial infiltration

Nasal swab for RSV (rapid test) Complications Acute: respiratory failure

Long term: bronchial asthmaTreatment Hydration, oxygenation, bronchodilator

Antiviral agents (in the future)Prevention RSV vaccine (in the future)



From RSV infection toFrom RSV infection to…Asthma & other atopic diseases


Outbreak of Rotavirus Gastroenteritis

“นสบา” ปวยรวง

เตอนระวงหลงเชอโรตาไวรสระบาดหนก

แถมยงไมมยารกษา!



Situation Large outbreak of RVGE in children & adultsSituation Large outbreak of RVGE in children & adults

Presentation Acute gastroenteritis in children aged 0‐5 yrsInvestigation Stool exam ‐ no wbc, no rbc

Stool for rotavirus antigen C li ti D h d ti t b li id i l t d fi iComplications Dehydration, metabolic acidosis, lactase deficiencyTreatment Diet therapy, ORS/IV fluid Prevention Breastfeeding rotavirus vaccinePrevention Breastfeeding, rotavirus vaccine



Reports of RVGEReports of RVGE in Thai adults



Slide อาจารยนค

Thai adults may not haveThai adults may not have immunity against certain RV.


Outbreak of Influenza

รร.กทม. 3‐4 แหง ปดเรยน!หนไขหวดใหญ



Situation Large outbreak of influenza in children who h i d i fl ihave received influenza vaccines

Presentation Infants: high fevergChildren: high fever, influenza‐like illness

Investigation Nasal swab for influenza virus (rapid test, PCR)Complications Pneumonia, encephalitisTreatment Oseltamivir if at risk population & complicationsPrevention Influenza vaccine (TIV, QIV), mask & hand washing



4 sites of MOPH training & research4 sites of MOPH training & research10‐04‐61, 11 ‐04‐61 Phuket18‐04‐61 19‐04‐61 Prachinburee18‐04‐61, 19‐04‐61 Prachinburee25‐04‐61, 26‐04‐61 Prae30 04 61 01 05 61 Amnartcharoen30‐04‐61, 01‐05‐61 Amnartcharoen

Increasing influenza vaccine acceptance among pregnant women & small children



Have you vaccinated 2018 influenza vaccines?... TIV vs QIV


Outbreak of Rabies

พษสนขบา... ระบาดแลว

4 อาเภอใน จ.ตรง พบผปวยโคมา! ประกาศเปนพนทสเหลอง

ตรงพบชาย “เสยชวต”

จากโรคพษสนขบา P

Pediatric Infectious Diseases

Outbreak of Rabies

Situation Large outbreak of animal & human rabies

Presentation Prodome: fever, headache, neurologic symptomsNeurologic phase: 1. Encephalitic rabies

2 P l ti bi2. Paralytic rabiesComa: inspiratory spasm, hypoventilation, hypotensionDead: 100%Dead: 100%

Investigation Antigen & antibody detection, viral cultureTreatment No specific treatmentTreatment No specific treatmentPrevention Rabies vaccination in dogs & cats

Pre‐exposure rabies vaccination, 2‐3 doses


Outbreak of Rabies

Rabies exposures are common in children.Bites on face are common in children.

P


Outbreak of Rabies

Pre‐exposure 2‐dose rabies is as good as 3‐dose rabies.

P


EID/RID: Pertussis/

หวงเดกไทยปวย “โรคไอกรน” มากขน หวงเดกไทยปวย โรคไอกรน มากขน

แนะควรรบวคซนตามนด


EID/RID: Pertussis/

Situation Emergence of pertussis in infantsSituation Emergence of pertussis in infantsPresentation Prolonged and severe cough

Contact with index case Investigation CBC: lymphocytosis

ESR: lowPCR for B. pertussisPCR for B. pertussis

Treatment MacrolidesPrevention DTP in children

Tdap/TdaP in adults including pregnant womenTdap/TdaP in adults including pregnant women


EID/RID: Pertussis/

Pertussis in Thai adults and childrenThai adults and children


EID/RID: Pertussis/

ไ ใ ขอมลไอกรนในเดก

Pertussis in Thai neonates


EID/RID: Pertussis/

Tdap in pregnant Thai womenpregnant Thai women


EID/RID: Zika Infection /

ไวรสซการะบาดในบราซล ขนฉกเฉน

“ทารกศรษะเลก” เพมไมหยด



Situation Outbreak of Zika infection in severalSituation Outbreak of Zika infection in several countries

P t ti F ith h th l iPresentation Fever with rash, arthalgiaInvestigation PCR, Zika IgM & IgGComplications Microcephaly in neonatesComplications Microcephaly in neonatesTreatment Symptomatic treatmentPrevention Control mosquito & larvae surveillancePrevention Control mosquito & larvae, surveillance



Zika virus infection in pregnant women &

Risk of microcephaly in neonates


EID/RID: TB & MDR‐TB /

“ปวยวณโรคดอยาหลายขนาน” พง! กรมควบคมโรคเดนหนา กรมควบคมโรคเดนหนา

5 มาตรการลดปญหา



Situation Increasing rate of MDR‐TB in adults & childrenSituation Increasing rate of MDR TB in adults & children

Presentation Children: prolonged fever, weight lossAdults: chronic cough, bloody sputum, weight loss

Investigation Tuberculin test, CXR, sputum for AFB & cultureC li ti Si il t d iti TBComplications Similar to drug‐sensitive TBTreatment Anti‐TB drugs, DOTSPrevention BCG index case contact cases maskPrevention BCG, index case, contact cases, mask



KCMH Siriraj QSNICH 4 Provinces

Year 2006‐2015 2008‐2011 2001‐2010 2004‐2006ea 006 0 5 008 0 00 0 0 00 006

DST done (%) 53 53 78 33

DR‐TB (%) 34.3 34.0 28.2 ‐

MDR‐TB (%) 5.8 5.7 3.8 3.0

Pre‐XDR TB (%) 2.9 0 0 ‐

Mono‐H (%) 4.5 11.3 ‐ ‐

Mono‐R (%) 1.5 0 ‐ ‐

PMono‐S (%) 1.5 3.8 ‐ ‐ Increasing rate of MDR‐TB

In Thai children

EPI VaccinesEPI Vaccines

HB in HBV‐exposed infants

จลดคนไทยตดเชอไวรสตบอกเสบ

EPI Vaccines


Situation Global elimination of hepatitis B by 2030

PastHBV screening in pregnant women HBsAg, HBeAgHBV prevention in HBV‐exposed HBIG, HBx3

PresentHBV infection in infants <1% HBV infection in HBV‐exposed 2%

FutureTenofovir in HBeAg +ve pregnant 0% HBV infection in infants

EPI Vaccines


Tenofovir prevents perinataltransmission of hepatitis B.p

New EPI VaccinesNew EPI Vaccines

HPV Vaccine (2HPV)

หมอยน ป.5 แนนอกหลงฉด

วคซน HPV เปนอปาทานหมวคซน HPV เปนอปาทานหม

New EPI Vaccines

HPV Vaccine (2HPV)

Situation Cervical cancer prevention

Past Cervical cancer screening Pap smear, VIA

PresentCervical cancer screening Thin prep, PCR for HPV HPV vaccine (4HPV, 2HPV) Optional vaccine2HPV for grade 5 girls EPI vaccine

FutureNew HPV vaccine (9HPV) Available soon


HPV Vaccine (2HPV)

Situation 2HPV for grade 5 girls

HPV infection & cervical cancerBurden Cervical cancer is a common female cancer. Severity Cervical cancer is severe and life‐threatening.

2HPV vaccineEfficacy 80%, similar protection with 4HPV Safety Few side effectsRecom 2 doses in 9‐15 yr, 3 doses in > 15 yr


HPV Vaccine (2HPV)

HPV vaccine 2 doses is adequate for girls aged 9 15 yrsfor girls aged 9‐15 yrs.


HPV Vaccine (2HPV)

Physicians should be more proactive in discussing and recommending HPV vaccination.


Hib Vaccine (Hib)

วคซนฮบคออะไร

ทาไมเดกไทยไมไดฉดฟร


Hib Vaccine (Hib)

Situation DTwP‐Hib‐HB… to replace DTwP‐HB

Hib infectionBurden May be underestimatedBurden May be underestimated Severity Invasive Hib esp. meningitis is severe.

Hib vaccineHib vaccineEfficacy Good Safety Few side effects y

Recom DTwP‐Hib‐HB 3‐4 doses in 2, 4, 6 and (18) mo


Rotavirus Vaccine (RV)

กรมควบคมโรคเตรยมเรงผลกดนวคซนโรตากรมควบคมโรคเตรยมเรงผลกดนวคซนโรตา

เขาสแผนภมคมกนโรค ภายในป 2561 ฟร



Situation RV… the next EPI vaccine

Rotavirus gastroenteritis (RVGE)Burden RVGE is the most common cause of

childhood diarrhea 0‐5 yr of age. Severity RVGE is not a simple diarrhea.

Rotavirus vaccine (RV)Efficacy RV helps decrease disease severity. Safety IntussusceptionRecom 2‐3 doses PO, 1st before 4 mo, last before 8 mo



RVGE is common in Thai children aged 0‐5 yrs.Rotavirus vaccine: From evidence to policy.

New Optional VaccinesNew Optional Vaccines

Dengue Vaccine (DV)

ฟลปปนสระงบ “วคซนไขเลอดออก”ฟลปปนสระงบ วคซนไขเลอดออก

หลงพบผลขางเคยง


Dengue Vaccine (DV)

Situation DV causes severe dengue in seronegativesg g

Dengue virus infectionB d D i i t i l t iBurden Dengue is common in tropical countries.Severity Dengue may be severe.

Dengue vaccineDengue vaccineEfficacy <70%, at least decrease severity Safety Beware in dengue seronegativesSafety Beware in dengue seronegativesRecom 9‐45 yr, more efficacy & safe in seropositives


Dengue Vaccine (DV)

Slide อ ฉอSlide อ.ฉอ

Barrier affecting DV acceptance P

is the cost of vaccine.


Dengue Vaccine (DV)

P


Live Attenuated Hepatitis A Vaccine (HAV)

Situation Live HAV… A better vaccineSituation Live HAV… A better vaccine

Hepatitis A infectionB d M b kBurden May cause outbreaks Severity Not as severe as HBV infection

HAV vaccineHAV vaccineEfficacy Excellent Safety Very safeSafety Very safe Recom >1 yr, single dose in children and adults


Live Attenuated Hepatitis A Vaccine (HAV)

New live attenuated HAV...single dose, good protection, less expensive


Nanovalent HPV Vaccine (9HPV)

Situation 9HPV… more protection

HPV infection & cervical cancerBurden Cervical cancer is a common female cancer.Burden Cervical cancer is a common female cancer. Severity Cervical cancer is severe and life‐threatening.

9HPV vaccineEfficacy More efficacious than 2HPV & 4HPV Safety Few side effects Recom Same as 2HPV & 4HPV


Nanovalent HPV Vaccine (9HPV)

New nanovalent HPV vaccine...Broader protection against cervical cancer

Hot Topics inp

Pediatric Infectious DiseasesLesson learnt1 Outbreak & emergence of vaccine preventable1. Outbreak & emergence of vaccine preventable

infectious diseases2 Vaccines to prevent infectious diseases2. Vaccines to prevent infectious diseases

EPI vaccinesN EPI iNew EPI vaccinesOptional vaccines

h iResearch vaccines3. Media‐knowledge‐research‐practice

hot topics in pid infectious diseases… · disease outb ktbreak otb koutbreak of rsv if...

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