Unit  3     Health  Care    

Section  2     Childhood  diseases  and                 immunisation   In this section you will learn about childhood diseases. Childhood diseases are illnesses that mostly affect children. Once children have had a certain childhood disease, they will not get it again, because their bodies have become immune to that particular disease. This is also the reason why adults rarely get these diseases: if they were exposed in childhood they will usually not get it again as adults. Some of the childhood diseases you will learn about in this section may lead to serious complications. Immunisation can protect children from these complications. Exactly what immunisation is, and when and against which childhood diseases it is given, will also be discussed in this section. Let’s begin by looking at the different childhood diseases.

1. Childhood diseases Study the table below to find out about the different childhood diseases, their symptoms, how they are passed from one person to another, and complications that may arise due to the diseases. Disease Symptoms Modes of

transmission Complications

Polio First signs of illness are flu like symptoms; sore throat; fever; stomach problems (nausea, vomiting, stomach ache, constipation and diarrhoea); headache; pain in the neck, back, stomach and limbs (arms and legs); tiredness and irritability

Caused by a highly contagious virus which is transmitted via the faecal-oral route, or by ingesting contaminated water or food.

Meningitis, temporary or permanent paralysis, deformity of limbs, feet and spine; infection of the brain tissue (usually only occurs in babies); osteoporosis (brittle bones) and increased likelihood of bone fractures; death

Diphtheria Generally unwell, very sore throat, mild fever, swollen neck glands, problems in swallowing and breathing due to a thick coating in the nose, throat and airway. Children may also experience nausea, vomiting, and chills.

Bacterial disease transmitted through direct physical contact with an infected person or when an infected person coughs or sneezes

Heart failure, further chest infections, damage to the kidneys, nerve damage leading to paralysis of the eyes, neck, throat or respiratory (breathing) muscles (which may not be permanent), death in up to 10% of all cases (the 1-4 years age group is the most vulnerable)

Pertussis At first the symptoms are Caused by Convulsions or seizures due to

 

(Whooping Cough)

similar to those of a cold (coughing, sneezing, runny nose, sore throat, mild fever, poor appetite). After one to three weeks the cough changes: it becomes more persistent and severe, especially at night; it is now characterised by a “whoop” sound (caused when air is drawn into the lungs after the cough); there may be vomiting during coughing fits. Babies sometimes do not make the whooping sound when coughing but may stop breathing for a few seconds after coughing. Child feels generally well when not having a coughing attack. Coughing may continue for 2-3 months after infection has cleared

extremely contagious bacteria and spread through droplet infection (when infected child coughs, sneezes or talks)

lack of oxygen to the brain, hernias in the groin after severe coughing fit, pneumonia, lung damage, temporary and/or permanent brain damage, encephalitis (inflammation of the brain), death (especially in babies younger than 6 months)

Tetanus (Lockjaw)

Inability to open mouth (lockjaw), spasms in the jaw and neck muscles, difficulty in swallowing, stiffness of the neck, jaw and other muscles, irritability, painful contraction of other muscles (back, abdomen, arms and legs)

Tetanus bacteria, enter the body through a wound, often a cut or deep puncture wound

Illness usually passes without complications within three weeks, but death may occur in rare cases

Measles Fever (can be as high as 40ºC); dry cough; runny nose; red, watering eyes and a red rash, starting on the head and then spreading to cover the whole body

Caused by a very contagious virus which may be spread when an infected person coughs or sneezes

Complications vary from mild to serious: diarrhoea, middle ear infection, chest infections such as pneumonia and bronchitis, fever convulsions (fits), encephalitis (inflammation of the brain, which is very serious but rare), death (as high as 28% of patients in parts of the world where malnutrition is common and healthcare is poor)

Tuberculosis(TB)

Chronic cough (lasting more than 3 weeks), coughing up blood, fever, chills, night sweats, loss of appetite, weight loss, pallor (state of being pale), tiredness. Person may also be asymptomatic (i.e. show no symptoms).

Bacterial infection spread through the air when an infected person coughs, sneezes or spits. Very common; most people in our setting have been exposed to the bacterium. Illness usually occurs when the immune system is weak,

Tuberculous meningitis, permanent lung damage, disseminated TB (TB that spreads throughout the body), death (3 million deaths per year, making TB one of the most deadly infectious diseases in the world).

 

for example in HIV infected individuals.

Rubella (German Measles)

Rash (flat spots that may merge, may be itchy) which starts on the face and then spreads to the body and limbs (fades after 3 days), mild fever, swollen glands in the back of the neck, pain in the joints, headache and red eyes. Symptoms are generally mild, and tend to be worse the older the infected person is

Viral infection transmitted when an infected person coughs or sneezes. The urine, faeces and skin of an infected person can also contain the virus

Complications are extremely rare in children, but can occur in the unborn babies (foetuses) of pregnant women (baby may be born deaf, blind, with heart defects and learning disabilities)

Mumps Swelling at the angle of the jaw by the ear on one or both sides of the face due to enlargement of the salivary glands. Pain during swallowing and chewing, mild fever, headache, dry mouth, sometimes sore face and/or ears. It is also possible to be infected without showing any symptoms.

Viral disease spread when an infected person coughs or sneezes. It can also be spread by sharing food or drinks, and through kissing

Complications are generally rare and include mild meningitis, encephalitis (inflammation of the brain), pancreatitis (inflammation of the pancreas) manifesting as abdominal pain and vomiting, deafness in one or both ears (sometimes permanent) in teenage boys and men infertility can occur (very rare)

Chickenpox Mild fever or headache before appearance of a rash, feeling generally unwell. Rash: at first, small, dark red spots on chest and back; quickly turn into very itchy fluid filled blisters which occur all over the body and face; blisters dry out and become scabs in 4-5 days.

Highly contagious virus spread through direct contact with fluid from broken chickenpox blisters or when the infected person coughs or sneezes

The most common complication is infection of the blisters; very rarely pneumonia, encephalitis (inflammation of the brain) or hepatitis (inflammation of the liver) can occur. Infection may be reactivated in adults causing shingles.

Your understanding of the infectious diseases of childhood will now be tested with a cross-word puzzle. Please try to complete the puzzle without looking at the table! When you are done, you can compare your answers with mine at the end of this unit before continuing with this section.

 

Self-Mark Activity 2

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ACROSS 2

Mumps, chickenpox, rubella, TB, measles, pertussis and dihtheria are spread when an infected person coughs or sneezes. This is called ... infection

4 Oral/polio is transmitted via this route 5 This illness causes a rash of very itchy

fluid-filled blisters 8 The bacteria which cause tetanus

usually enter the body through a ... 11 Polio, diphtheria, pertussis, tetanus,

measles and TB can all lead to ... 13 Illness which can cause paralysis and

deformity 14 One of the most deadly infectious

diseases in the world 15

Highly contagious viral infection which causes very high fever, cold-like symptoms and a rash which starts on

DOWN 1

Complications of rubella affect mainly the ... of a pregnant woman who gets infected

3 This disease is characterised by a rash of flat spots, which is sometimes itchy, and fades after three days

5 Complication which can arise in whooping cough due to a lack of oxygen in the brain

6 Rare complication of mumps seen in teenage boys and men who become infected

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First symptoms of this illness are similar to those of a cold, but later cough with distinctive whooping sound develops

9 Some of the symptoms of this illness are a very sore throat, mild fever, swollen neck glands, and difficulty in

 

the head

breathing and swallowing 10

This disease can lead to an inability to open the mouth due to muscle spasms in the jaw

12 The most prominent symptom of TB is a chronic ...

Many of the childhood diseases you have studied can lead to serious complications and even death. The sad thing is that the suffering and millions of deaths caused by these diseases every year could be prevented simply by taking children for their immunisations.

2. Immunisation

According to the World Health Organization immunisation has had a tremendous effect on health throughout the world (http://www.immunisation.nhs.uk/). In developed countries immunisation has led to the eradication of many childhood diseases. In developing countries thousands of lives can be saved if successful immunisation programmes are implemented. But what exactly is immunisation and how does it work?

  “Immunisation is the use of vaccines to protect people from disease.” (Meggitt,

2001: 64). Vaccines can be described as special medicines which stimulate the body’s immune system to make antibodies. Antibodies are special proteins in the blood which fight disease. If an immunised child comes into contact with a disease, the antibodies (which fight that particular disease) kill the organism which causes it, thus preventing the child form getting sick.

There are two different kinds of vaccines, namely live and inactivated vaccines:

• Live vaccines contain live organisms in a weakened form. These weakened organisms do not make the child sick. They only cause a mild infection which then triggers the immune system to produce antibodies. Live vaccines are very effective. They can give many years of protection, often from a single dose. Examples of live vaccines are oral polio, measles, BCG (against tuberculosis), mumps and rubella vaccines.

• Inactivated vaccines contain dead organisms or toxoids. Toxoids are

harmful substances which are made from the poisons of bacteria. When injected into the body they cause the immune system to produce antibodies. A single dose of inactivated vaccine is usually less effective than a single dose of live vaccine. Therefore several doses of inactivated vaccine are needed to give life-long immunity. Examples of inactivated vaccines are diphtheria, pertussis and tetanus vaccines.

 

One could say that both live and inactivated vaccines trick the body into making antibodies without the child having been infected with a disease. In other words, they give artificial immunity. There are two kinds of artificial immunity, namely active and passive immunity:

• Active immunity is when a vaccine causes the body to make antibodies against the disease. When an immunised person comes into contact with the disease the body’s immune system recognises it and immediately produces antibodies to fight it. Active immunity gives long-lasting (sometimes even life-long) protection against disease. This type of immunity is given by live and inactivated vaccines and was discussed above. A child only becomes immune about two weeks after vaccination. Yet sometimes it is necessary to make a child immune immediately. Read about passive immunity to find out how that can be done.

• Passive immunity is provided when the body is given antibodies directly, instead of having to produce them. The child who is given antibodies is immune immediately. This is necessary in certain situations. For example, if a child has a wound which might be contaminated with tetanus bacteria, giving him/her immediate immunity is very important. New born babies have passive immunity against several diseases (e.g. measles, mumps and rubella) because the antibodies were passed to them from the mother through the placenta. Passive immunity only lasts for a few weeks or months, which is why children have to be immunised once the passive immunity has worn off.

Besides having artificial active immunity, children can also have natural active immunity. How does this come about? When a child gets a contagious childhood disease, the body starts making antibodies to fight it. The antibodies against that particular disease will be produced by the body for the rest of the child’s life. Therefore, once the child has been infected with a particular childhood disease, he/she will not get the same disease again. For example, a child only gets chickenpox once. He/she does not get chickenpox again because he/she is immune because of the antibodies in his/her body. In addition to offering protection from disease, immunisation has two further benefits:

• If enough people are immunised against a disease, major outbreaks of that disease are prevented.

• Immunisation can lead to the total eradication of diseases. An example of a deadly disease which has been eradicated through immunisation is smallpox.

 

This sub-section on immunisation contains a lot of information! Have a look at the diagram which summarises the most important points discussed so far:

                   contagious  childhood  disease  

     

contagious  childhood  disease  

                       

In Namibia children are immunised according to an immunisation schedule, which is included in the child’s health passport. An immunisation schedule tells parents/primary caregivers at what age children should receive the different vaccines in order to be protected against various diseases. Here is what this schedule looks like:

Age Vaccine New born Polio 0

BCG 6 weeks Polio 1

DPT 1 10 weeks Polio 2

DPT 2 14 weeks Polio 3

DPT 3 9 months Measles 5 years DT

Polio 10 years DT

Polio BCG

 vaccines  

     Immunisation          =  the  giving  of      

Stimulate  body  to  make  

Child  becomes  immune  

Live  vaccines  Contain  live  but  weakened  organisms;  life-­‐long  protection  from  single  dose  

Inactivated  vaccines  Contain  dead  organisms  or  toxoids;  several  doses  needed  for  life-­‐long  immunity  

Special  proteins  in  the  blood  which  fight  

 

(BCG is a vaccine against tuberculosis. It does not actually prevent the disease from occuring, but reduces the likelihood of more severe forms of the disease. DPT is a vaccine which gives immunity against three diseases, namely diphtheria, pertussis (whooping cough) and tetanus. DT is a vaccine against diphtheria and tetanus.) Vaccines against other childhood diseases like mumps and rubella are also available but they are not routinely given to children by the Namibian health care system. If parents want to immunise their children against these diseases they have to so privately (at a private doctor’s practice or a private clinic) You have learned that immunisation is a way to protect children against serious diseases. Children who are immunised can fight the infectious childhood diseases when they come in contact with them; those who are not immunised are at risk of catching the diseases. Now it’s time for another self-mark activity. Answer the following questions in your notebook.

 

Self-mark activity 3

 

 

 

 

 

 

 

 

 

 

I hope that was not too difficult! If you had problems answering the questions revise the relevant parts of the section before comparing your answers with mine at the end of the unit. Once you have done that continue by studying the next section where you will learn about parasites which can cause illness in humans.

 

1. Briefly explain immunisation using your own words as far as possible. In your explanation make use of the words “vaccine”, “antibodies” and “live and inactivated vaccines”.

2. Make a diagram which explains immunity. Distinguish between natural and

artificial immunity. Also remember that there are two kinds of artificial immunity.

3. Give three reasons why children should be immunised.

For the next questions choose the correct answer:

4. Polio and DPT vaccines are given (during the same immunisation) to babies at a) 9 months b) 6, 10 and 14 weeks c) 6 and 9 months

5. At nine months the baby receives

a) the measles vaccine b) the vaccine against diphtheria, pertussis and tetanus c) the vaccine against polio

6. DPT is a vaccine against

a) diphtheria, pertussis and tuberculosis b) diphtheria, whooping cough and tetanus c) tuberculosis

7. Newborn babies are given

a) the polio and DPT vaccines b) no vaccines c) vaccines against polio and tuberculosis

8. DT, polio and BCG vaccines are given (during the same immunisation) at

a) 5 years b) 14 weeks c) 10 years