virus

Influenza

Common Name: 
Flu
Parents & Caregivers
Introduction: 

Influenza, or flu for short, is a common illness caused by a virus. Most cases occur during the winter months. It is easily spread to others through talking, coughing and sneezing. People are always at risk for getting flu because the virus types or strains are always changing. Most people who get flu will recover, but some cases can lead to serious complications or even death. The very young, those 65 years and older, those with weakened immune systems, and women who are pregnant are at higher risk for flu complications.

The Fight Flu website provides also provides information and answers frequently asked questions about influenza.

A brief history: 

Epidemics and pandemics of respiratory disease, characteristic of influenza, have been documented since the 16th century. The bacteria Haemophilus influenzae was thought to be the cause until the influenza A virus was identified in 1933. Once the true cause of previous respiratory disease epidemics and pandemics had been identified work began on development and testing of the first influenza vaccines. Influenza vaccines were first used in the community in the late 1930 and the 1940s.

The current New Zealand situation: 

The New Zealand flu season includes the months between May and October.

  • In 2009 a pandemic influenza A H1N1 virus spread around the world. The influenza A virus had undergone an antigenic shift and many people less than 65 years of age did not have any protection from the virus.
  • Flu related hospitalisations are usually less than 500 per year, but in 2009 there were about 1,500 hospitalisations because of the A/H1N1 pandemic influenza strain.
  • Forty-nine (49) people died from pandemic influenza in 2009.
  • Flu related deaths are higher for Māori and Pacific peoples than New Zealand Europeans.
Symptoms: 

Influenza illness can include any or all of the following symptoms:

  • Fever. May last for 3-5 days.
  • Muscle or body aches. May last for 3-5 days.
  • Headache.
  • Lack of energy. May last for two or more weeks.
  • Dry cough.
  • Sore throat.
  • Runny nose.
  • Vomiting and/or diarrhoea. More common in children than in adults.
How do you get it?: 

People get influenza by breathing in droplets containing the influenza virus that have been talked, laughed, sneezed or coughed into the air by a person with the disease or by touching something that the droplets have landed on and then touching their mouth, nose or eyes.

What are the risks?: 

Influenza is not just a 'bad cold'. Although some of the symptoms are the same, influenza is usually much more severe.

  • Influenza can lead to serious complications, particularly in people with some existing medical conditions, such as heart or lung conditions, and pregnant women.
  • Complications include sinus infection, ear infection, bronchitis, pneumonia, heart failure, worsening asthma and miscarriage.
  • Influenza and/or complications from influenza can lead to death.
Who is most at risk?: 
  • Young children (this age group is not eligible to receive a free influenza vaccine unless they also have an 'eligible' medical condition).
  • Anyone aged 65 years or over.
  • Anyone aged 6 months to under 65 years with any of the following medical conditions:◦Chronic heart problems, excluding high cholesterol or high blood pressure if they have not caused problems with other organs.
    • Cerebrovascular disease.
    • Chronic breathing or lung problems, excluding asthma if regular preventive therapy is not required.
    • Diabetes.
    • Chronic kidney disease.
    • Cancer that is not in remission, excluding skin cancers if not invasive.
    • Other conditions (autoimmune disease, immune suppression, human immunodeficiency virus (HIV), transplant recipients, neuromuscular and central nervous system diseases, haemoglobinopathies and children on long term aspirin).
  • Pregnant women.
  • People who are obese (this group of people are not eligible to receive a free influenza vaccine unless they also have an 'eligible' medical condition).
Treating the symptoms: 

If identified early the illness can be treated with antiviral medication. This medication can shorten how long the illness last, make the symptoms less severe and/or prevent serious complications.

Symptoms can be managed using medications that relieve fever and pain may be useful however the role of paracetamol use with influenza is being studied to determine if, as well as relieving symptoms, paracetamol prolongs the illness.

Review by a Doctor is very important if the person has an existing medical condition, difficulty breathing, pain or pressure in the chest, dizziness, confusion, severe or prolonged vomiting, or if the person starts getting better then gets worse.

Preventing Disease Spread: 
  • Wash your hands or use hand sanitiser before touching your mouth, nose or eyes.
  • Keep a metre away from people who you know are sick.
  • Use disposable tissues. One blow and throw the tissue away, preferably into a rubbish bin with a lid or a plastic bag.
  • Cover coughs and sneezes with a disposable tissue or if no tissues are available cough or sneeze into the inside of your your elbow/arm.
  • Wash your hands with soap and water after blowing your nose or coughing and/or sneezing into a tissue. If it is not easy to get to a tap with water and soap use an alcohol-based hand sanitiser gel.
  • An effective hand wash uses soap and takes as long as it does to sing "Happy Birthday" AND drying your hands thoroughly.
  • Stay at home if you are sick.
  • Regularly clean flat surfaces, door handles, bathroom sinks and taps.
Health Professionals
Introduction (HP): 

The influenza case definition is "an acute respiratory tract infection characterised by an abrupt onset of two of the following: fever, chills, headache and myalgia".

Influenza viruses typically cause epidemics during the autumn and winter months. Occasionally an influenza virus can cause a pandemic.

The National Influenza Specialist Group (NISG) website (www.influenza.org.nz) also provides information on influenza and influenza immunisation and access to electronic copies of resource that relate to the current year's immunisation campaign.

Causative organism: 

There are three influenza types: influenza A, influenza B and influenza C. Influenza A is further defined into subtypes based on the structure of the haemagglutinin (H) and neuraminidase (N) surface antigens.

  • Influenza A: H1N1, H2N2, H2N3 (cause epidemics and pandemics)
  • Influenza B: widespread outbreaks and epidemics
  • Influenza C: sporadic cases of upper respiratory tract infection

Influenza A and B viruses typically undergo small antigenic changes year to year (drift). Occasionally a virus undergoes a major antigenic change (shift). The larger the antigenic change the more people affected, the more people hospitalised and an increase in the number of influenza deaths is observed.

Transfer of avian (bird) influenza to humans, and outbreaks of human avian influenza, have been reported since 1997.

Clinical signs, symptoms and complications: 

Incubation is 1-7 days but usually 1-3 days. The infectious period is from 1-2 days before symptoms develop to about day five of the illness in adults and for two weeks or longer in children. Influenza illness can include any or all of the following symptoms:

  • Fever. May last for 3-5 days.
  • Muscle or body aches. May last for 3-5 days.
  • Headache.
  • Lack of energy. May last for two or more weeks.
  • Dry cough.
  • Sore throat.
  • Runny nose.
  • Vomiting and/or diarrhoea. More common in children than in adults.
Method of transmission: 

Usually spread person to person by droplets from talking, laughing, sneezing and coughing. Infected droplets may be airborne or land on surfaces that are then touched and the virus is introduced by the person touching their mouth, nose or eyes.

In most avian influenza outbreaks infected people were in direct contact with infected birds. The outbreaks have remained in small clusters also suggesting limited transfer of avian influenza from person to person.

Public health significance: 
  • Influenza is a disease of global public health importance because of the seasonal epidemic, and sometimes pandemic, nature of the virus.
  • During seasonal epidemics large numbers of people of all ages can be affected. Some of those infected will develop serious complications requiring time off school or work, medical care and hospitalisation. Some of those with complications will die.
  • During an influenza pandemic large numbers of people are infected, there is an increase in the number of people requiring medical care and/or hospitalisation and there is an increase in the number of people who die from a complication of influenza.
  • Lost productivity of a number of people sick with influenza and/or its complications during an epidemic or pandemic can affect a country's economy.
  • Avian influenza is a notifiable disease in New Zealand. More information about this process can be found on the Ministry of Health website (http://www.moh.govt.nz/influenza).
New Zealand epidemiology: 

For the third successive year the same three influenza viruses are expected to cause influenza in New Zealand:

  • A/California/7/2009 (H1N1)pdm09-like virus (the A/California/7/2009 (H1N1)-like virus from 2010 and 2011 has had ‘pdm09’ added to its name)
  • A/Perth/16/2009 (H3N2)-like virus
  • B/Brisbane/60/2008-like virus
Prevention: 
  • Wash your hands or use hand sanitiser before touching your mouth, nose or eyes.
  • Keep a metre away from people who you know are sick.
  • Use disposable tissues. One blow and throw the tissue away, preferably into a rubbish bin with a lid or a plastic bag.
  • Cover coughs and sneezes with a disposable tissue or if no tissues are available cough or sneeze into the inside of your your elbow/arm.
  • Wash your hands with soap and water after blowing your nose or coughing and/or sneezing into a tissue. If it is not easy to get to a tap with water and soap use an alcohol-based hand sanitiser gel.
  • An effective hand wash uses soap and takes as long as it does to sing "Happy Birthday" AND drying your hands thoroughly.
  • Stay at home if you are sick.

Regularly clean flat surfaces, door handles, bathroom sinks and taps.

Usually constant antigenic changes of the influenza A and B viruses, resulting in new strains, require annual changes to influenza vaccine antigen content.

It is rare that the influenza virus strains dominating the flu season remain constant for three years in a row, as they have done for 2009, 2010 and 2012.

An annual influenza vaccination is recommended because of naturally waning circulatory antibodies during the year after influenza vaccination.

Treatment: 

Antiviral medication may shorten the duration of illness, reduce the severity of symptoms and/or prevent complications.

  • Two classes of antiviral medication can be used to treat influenza IF they are prescribed within the first 48 hours of symptoms developing.◦The preferred antiviral class are the neuraminidase inhibitors, zanamivir (Relenza) and oseltamivir (Tamiflu). This class of antiviral medication is effective against both influenza A and B viruses and little viral resistance has been observed with widespread use.
    • The other class of antiviral medication are the admantanes, amantadine hydrochloride and rimantadine hydrochloride. This class of medication is only effective against influenza A. Widespread admantane resistance among influenza viruses has been observed.
  • Symptoms can be managed using medications that relieve fever and pain may be useful however the role of paracetamol use with influenza is being studied to determine if, as well as relieving symptoms, paracetamol prolongs the illness.
  • Review by a Doctor is very important if the person has an existing medical condition, difficulty breathing, pain or pressure in the chest, dizziness, confusion, severe or prolonged vomiting, or if the person starts getting better then gets worse.
Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Influenza is an acute viral respiratory tract infection characterised by an abrupt onset of two of the following: fever, chills, headache and myalgia.

Effects of disease: 
Sore throat, fever, chills, headache, muscle aches.
Myositis (muscle inflammation).
Croup and bronchiolitis in children.
Pneumonia and respiratory failure.
Encephalopathy (brain inflammation).
Myocarditis (heart inflammation) and pericarditis (inflammation of the layer around the heart).
Heart failure.
Make underlying chronic medical problems worse.
Secondary infections (infections that occur because the person has influenza or is being treated for influenza).
Sepsis.
Death.
Common side effects of vaccine: 
Soreness/pain, redness and/or swelling around the injection site.
Fever.
Malaise.
Muscle pain.
Reactions are more common in children not previously exposed to the vaccine or virus than adults.
Fever may be high in children.
Uncommon side effects of vaccine: 
In 2010 the Fluvax brand of influenza vaccine was associated with reports of young children experiencing high fevers and associated febrile convulsions. Whilst this brand stimulated an excellent immune response it is no longer recommended for children under the age of 9 years in New Zealand.
Rare/very rare side effects of vaccine: 
Anaphylaxis.
Guillain-Barré syndrome occurs less than once in one million doses, the same rate as the general population.

Hepatitis B

Common Name: 
Hep B or HBV
Parents & Caregivers
Introduction: 

Hepatitis is a viral disease that attacks the liver. There are several types of viral hepatitis, labeled A, B, C, D, and E. Hepatitis B virus or HBV is very infectious and is spread from person to person through bodily fluids including blood, semen, and vaginal fluids. People who are infected with hepatitis B can either develop an acute illness in which they become sick soon after infection or a chronic illness in which the illness does not begin to affect them for a longer period of time with more serious complications. People with chronic hepatitis B infection are likely to suffer from liver disease or liver cancer which can be life threatening. Infected infants and young children are at higher risk for developing chronic disease. Hepatitis B cannot be cured but can be prevented with a vaccine.

A brief history: 

Hepatitis was first described by Hippocrates over 2000 years ago with signs of jaundice or yellowing of the skin and eyes. Several outbreaks in the 19th and 20th Centuries are documented with global spread mainly a result of warfare. In recent history, cases in New Zealand peaked near 1984 but began declining with the introduction of the vaccine, first intended for infected mothers in 1985 and later for all children in 1988. For the last 10 years, New Zealand has maintained fewer than 100 new cases per year.

The current New Zealand situation: 

While estimates show that less than 1% of the New Zealand population are carriers of HBV, there are pockets of areas around the country with higher rates than others.

Symptoms: 

Symptoms of acute hepatitis B include nausea and vomiting, jaundice (yellow skin or eyes), dark urine (pee, mimi), pale faeces (poo, tutae), feeling unwell, lack of energy, loss of appetite, upset stomach or stomach pains, fever, and general aches and pains.

Chronic hepatitis B may be harder to detect as some infected people may not show signs or symptoms.

How do you get it?: 

Hepatitis B infection can be spread through open cuts or wounds, sexual contact, sharing drug needles, blood transfusion, and passed from infected mother to baby. Newborn babies of infected mothers can receive their first dose of hepatitis B vaccine within 24 hours of birth to prevent spread.

What are the risks?: 

Hepatitis B can be a life-long illness causing liver disease and liver cancer. Blood remains infective in those with a chronic hepatitis B infection and can infect others.

The Hepatitis Foundation of New Zealand provides a free Hepatitis B Follow-up Programme that provides information, support and regular blood tests that are vital in managing hepatitis B infection. We recommend a visit to their website (www.hepfoundation.org.nz) or you can phone them for free on 0800 332 010.

Who is most at risk?: 
  • People aged 25 years or over who are of Māori, Pacific Island or Asian ethnicity*
  • People born in Asia or the Pacific Islands*
  • Injection drug users
  • Heterosexuals with multiple partners
  • Men who have sex with men
  • Household contacts of infected persons
  • Health care and public safety workers who have exposure to blood in the workplace
  • Haemodialysis patients and blood transfusion patients

*Source: The Hepatitis B Foundation of New Zealand.

Treating the symptoms: 

There is no specific treatment for hepatitis B. Chronic hepatitis B infection can be treated with drugs like interferon and anti-viral medication. Patients with liver disease may be recommended for liver transplant. Liver cancer is almost always fatal.

The Hepatitis Foundation of New Zealand provides a free Hepatitis B Follow-up Programme that provides information, support and regular blood tests that are vital in managing hepatitis B infection. We recommend a visit to their website (www.hepfoundation.org.nz) or you can phone them for free on 0800 332 010.

Preventing Disease Spread: 
  • There is an effective vaccine available to prevent hepatitis B.
  • Contacts and family members of infected persons should practice strict hygiene measures.
  • Avoid injection drug use.
  • Engage in safe sex practices including use of condoms.
Health Professionals
Introduction (HP): 

The hepatitis B virus (HBV) attacks the liver and can result in both acute and chronic disease. It is spread via blood and bodily fluids. The most common routes of infection are through sexual contact, injection drug use, and occupational hazards for health professionals. The age at which someone is infected is a good predictor of disease outcome and severity. Roughly 2 billion people worldwide have been infected with the majority of cases in developing countries. Hepatitis B is vaccine preventable and the vaccine is included in the New Zealand National Immunisation Schedule.

Causative organism: 

The hepatitis B virus is is a DNA-containing hepadnavirus. Hepatitis B is extremely virulent and is 50-100 times more infectious than the human immunodeficiency virus (HIV).

Clinical signs, symptoms and complications: 

Adults with acute hepatitis B infection may not display symptoms. The disease may only be detectable by liver function tests.

  • Acute hepatitis B can cause symptoms that include anorexia, abdominal discomfort, malaise and fatigue, nausea and vomiting, and jaundice.
  • Acute hepatitis B infection may cause an acute hepatic necrosis, requiring an emergency liver transplantation or causing death.
  • About 10% of adults with acute hepatitis B infection will develop chronic hepatitis B infection.
  • Chronic hepatitis B infection occurs in 90% of infected infants and 30-50% of infected children between 1-4 years of age.
  • Chronic hepatitis B infection may result in cirrhosis of the liver, which increases the risk of hepatocellular carcinoma.
Method of transmission: 
  • Sexual contact.
  • Injection drug use.
  • Perinatal transmission.
  • Occupational exposure for health care or public safety workers.
  • Exposure to blood transfusion or haemodialysis patients.
Public health significance: 
  • More than 2 billion people are infected worldwide.
  • There is a 70-90% vertical transmission rate from infected mother to newborn.
  • Roughly 90% of infected infants will become chronic hepatitis B infection carriers.
  • Hepatitis B related cirrhosis and liver cancer are almost always fatal.
New Zealand epidemiology: 

Some regions in New Zealand show a significantly higher rate of hepatitis carriage. In recent history, cases in New Zealand peaked near 1984 but began declining with the introduction of the vaccine, first intended for infected mothers in 1985 and later for all children in 1988. For the last 10 years, New Zealand has maintained fewer than 100 new cases per year.

Prevention: 
  • Strict hygiene measures.
  • Prophylactic immunisation for newborns to carrier mothers.
  • Safe sex practices.
  • Avoiding injection drug use or use of clean disposable needles.

An effective vaccine has been available in New Zealand to all children from 1988. The current hepatitis B vaccine is given with the primary series at 6 weeks, 3 months, and 5 months of age.

Treatment: 

There is no specific treatment for hepatitis B infection. Chronic disease may be treated with interferon or anti-virals but management revolves mostly around comfort and nutrition.

Health professionals are encouraged to refer patients who are hepatitis B positive to The Hepatitis Foundation of New Zealand (www.hepfoundation.org.nz) for enrolment in the Hepatitis B Programme. An online referral form is available or phone 0800 332 010 for more information.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Hepatitis B is one type of hepatitis virus that infects the liver and can cause ling term liver damage.

Effects of disease: 
Blood is infective whilst the person is acutely unwell and can infect others.
Approximately 2 in 10 adults with acute hepatitis B infection will not have symptoms.
Liver inflammation can cause abdominal discomfort, jaundice, anorexia, nausea and vomiting, malaise and fatigue: approximately 8 in 10.
Acute liver failure: 1 in 100, of who almost half will die or require an emergency liver transplantation.
People who become infected at birth or in early childhood usually develop a chronic hepatitis B infection. Which may lead to:
Cirrhosis of the liver, and an
Increased the risk of developing liver cancer.
Blood remains infective for life in those with a chronic hepatitis B infection and can infect others.
Common side effects of vaccine: 
Soreness/pain, redness and/or swelling around the injection site.
Fever over 38°C.
Decreased appetite, vomiting and/or diarrhoea.
Irritability, restlessness.
Unusual crying.
Fatigue.
Uncommon side effects of vaccine: 
Fever over 39°C.
Rare/very rare side effects of vaccine: 
Convulsion within 2 days of immunisation, less than 1 in 1.4 million doses.
Encephalopathy (brain inflammation), less than 1 in 1 million doses.
Anaphylaxis (severe allergic reaction), less than 1 in 1 million doses.
Urticaria (allergic skin reaction).
Hypotonic, hyporesponsive episode (HHE, a temporary period of decreased muscle tone and responsiveness) within 24 hours of immunisation, up to 47 times in 100,000 doses.
Persistent (> 3 hours) inconsolable screaming, up to 44 times in 100,000 doses.
Extensive swelling of vaccinated limb or one or both lower limbs.

Novel viral infection in the United Kingdom

Monday, 24 September 2012

A 49 year old Qatari national has been hospitalised in the UK with a laboratory confirmed novel coronavirus.

The Health Protection Agency of the UK conducted laboratory testing and compared the sequencing of the virus isolate from the 49 year old Qatari national with information on a virus sequenced previously and obtained from a 60 year-old Saudi national who died following infection with a novel coronavirus. This comparison indicated 99.5% identity, with one nucleotide mismatch over the regions compared.

Coronaviruses are a large family of viruses which includes viruses that cause the common cold and SARS. Given that this is a novel coronavirus the World Health Organization (WHO) is currently in the process of obtaining further information to determine the public health implications of these two confirmed cases.

With respect to these findings, WHO does not currently recommend any travel restrictions.

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Hepatitis A

Common Name: 
Hep A
Parents & Caregivers
Introduction: 

Hepatitis is a viral disease that attacks the liver. There are several types of viral hepatitis, labelled A, B, C, D, and E. Hepatitis A is transferred through the faecal-oral route either by contact with contaminated food and water with an infected person. The illness is self-limiting and does not cause a chronic infection.

A brief history: 

The earliest outbreaks of hepatitis A infection were likely in the 17th and 18th centuries however it was not until 1908 that McDonald suggested the disease may be caused by a virus. The first scientific evidence of the hepatitis A virus was from studies done during World War II.

The current New Zealand situation: 

Cases of hepatitis A are reported in New Zealand across all age groups. The majority, but not all, cases report overseas travel during the disease incubation period.

Symptoms: 

Young children may not have any symptoms of infection. Those with symptoms may have fever, tiredness, nausea, loss of appetite and/or stomach pains. The urine/mimi/wee may become dark and faeces/tuutae/poo become pale coloured. They rarely have jaundice (yellow colour of the skin and eyes).

Older children and adults usually have symptoms of fever, tiredness, nausea, loss of appetite and/or stomach pains. The urine/mimi/wee may become dark coloured and  faeces/tuutae/poo become pale coloured. They are likely to develop jaundice.

How do you get it?: 

The hepatitis A virus is transmitted through the faecal (tuutae)/oral route by:

  • Poor hygiene
  • Close contact with an infected person
  • Contaminated food, water or milk
What are the risks?: 

Symptoms usually last for several weeks but less than two months. For 1–2 people in 10 the symptoms will last or come and go for up to six months.

It is rare for very severe liver problems to develop.

The risk of dying from complications related to a hepatitis A infection increases with advancing age and in those with pre-existing liver disease.

The hepatitis A virus does not cause a chronic infection.

Who is most at risk?: 
  • Children attending early childhood centres or play groups and members of their household.
  • People with developmental disabilities who attend residential and non-residential facilities and their carers.
  • Inmates of correctional facilities.
  • Men who have sex with men.
  • Injecting drug users.
  • People with chronic liver disease or who are at risk of developing chronic liver disease, e.g. people who are hepatitis B or hepatitis C positive, people who misuse alcohol.

Occupational groups exposed to faeces/tuutae, for example:

  • Employees of early childhood services
  • Health care workers, including cleaners, exposed to faeces
  • Sex industry workers
  • People who work with sewerage
  • Members of the armed forces
Treating the symptoms: 

There is no specific treatment for hepatitis A infection.

Contact your doctor for advice before using medication to relieve pain and/or fever.

Preventing Disease Spread: 
  • Thorough hand-washing using soap and water:
    • After using the toilet or changing nappies
    • Before and after preparing food
    • Before eating
  • Immunisation against hepatitis A.
Health Professionals
Causative organism: 

Hepatitis A is a single-stranded RNA virus in the Picornaviridae family.

Clinical signs, symptoms and complications: 
  • Incubation ranges from 15-50 days but averages 28-30 days.
  • Young children may not have any symptoms of infection. Those who do may have fever, tiredness, nausea, abdominal discomfort or pain, loss of appetite, dark coloured urine and pale coloured faeces or diarrhoea, runny nose, cough and joint pain. They rarely have jaundice.
  • Older children and adults usually have symptoms of fever, tiredness, nausea and loss of appetite, dark coloured urine and pale coloured faeces. They are likely to develop jaundice.
  • Elevated serum aminotransferase. Liver enzymes usually return to normal within six months of the illness
  • Although rare hepatitis A infection can cause fulminant hepatitis.
  • The risk of dying from complications related to a hepatitis A infection increases with advancing age and in those with pre-existing liver disease.
  • The hepatitis A virus does not cause a chronic infection.
Method of transmission: 

The hepatitis A virus is transmitted through the faecal-oral route by:

  • Poor hygiene
  • Close contact with an infected person, including sexual contact, sharing personal things like toothbrushes, face cloths and towels
  • Contaminated food, water or milk
Public health significance: 

Hepatitis A is notifiable on suspicion of the disease. Confirmation of disease is by a positive serum hepatitis A-specific IgM in the absence of recent vaccination.
Comprehensive information for identification and management of a suspected hepatitis A case and their contacts is provided in the Ministry of Health Communicable Disease Control Manual, 2012.
Administration of the hepatitis A vaccine to known contacts of hepatitis A cases has been shown to be effective in controlling outbreaks.

Normal human immunoglobulin (NHIG) may be considered for close contacts less than one year of age, where vaccination is contraindicated, the recipient is likely to have a reduced response to the vaccine or when the contact has high risk factors for severe disease.

When hepatitis A occurs at an early childhood centre all previously unimmunised staff and children at the service and those joining the centre during the six weeks after the last identified case, including identified cases in the households of attendees, may be advised to have vaccination and/or immunoglobulin if appropriate.

Prophylaxis may also be indicated when hepatitis A outbreaks occur in schools, residential care facilities and hospitals.

New Zealand epidemiology: 

Hepatitis A cases are reported in New Zealand. The majority, but not all, of cases report a history of overseas travel during the incubation period.

The number of cases reported each year between 2011 and mid-2013 has varied between 0.6 cases per 100,000 population in 2011, 1.6 cases/100,000 in 2012 and 1.0/100,000 population to mid-2013. The age range has been from toddler to older adult.

Prevention: 
  • Thorough hand-washing using soap and water:
    • After using the toilet or changing nappies
    • Before and after preparing food
    • Before eating
  • Cases are excluded from early childhood centres, school or work for one week after the start of symptoms or jaundice.
  • Vaccines are available to protect against hepatitis A.
    • Some vaccines only protect against hepatitis A, e.g. Avaxim® and Havrix® (adult and child vaccines).
    • Other vaccines combine hepatitis A protection with protection against hepatitis B, i.e. Twinrix®, or typhoid, i.e. Hepatyrix® and Vivaxim®.
    • All of the hepatitis A vaccines are available for purchase through general practice. The vaccine cost is based on whether the vaccine is for a child or adults or whether it protects against hepatitis A only or hepatitis A and another disease.  Extra practice fees for giving the vaccine may also apply.
Treatment: 

There is no specific treatment for hepatitis A infection.

Supportive care for symptom management can be provided.

Care should be taken when prescribing medicines that are metabolised by the liver for pain and/or fever.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Hepatitis A is a viral infection that affects the liver. The virus does not cause chronic infection.

Effects of disease: 
Liver inflammation that can result in dark coloured urine/mimi/wee and pale coloured faeces/tuutae/poos.
Fever.
Nausea.
Loss of appetite.
Although rare hepatitis A infection can cause severe hepatitis.
The risk of dying from complications related to a hepatitis A infection increases with advancing age and in those with pre-existing liver disease.
Common side effects of vaccine: 
Discomfort/pain and/or redness at the injection site.
Fatigue.
Irritability.
Nausea, vomiting, loss of appetite.
Headache.
Fever.
Uncommon side effects of vaccine: 
Rash.
Rare/very rare side effects of vaccine: 
Pruritis (itching).
Urticaria (hives).
Anaphylaxis (severe allergic reaction).
Vaccines: 

IPOL

IPV

IPOL is used for primary and booster vaccination of infants, children and adults to protect against infection with Type 1, Type 2 and Type 3 polioviruses causing poliomyelitis.

M-M-R® II

MMR

M-M-R® II is used for primary vaccination and revaccination of children and adults to protect against measles, mumps and rubella.

Gardasil®

Human papillomavirus (HPV)

Gardasil® is funded for use for primary immunisation of girls from 9 years of age and young women to protect them from four types of human papillomavirus infection, HIV positive individuals aged 9-26 years, and individuals who are pre- or post-solid organ transplantation. Gardasil® is not funded but can be used for primary immunisation of females who are not eligible for funded vaccine and within the age group of 9 through 45 years and males aged 9 through 26 years to protect them from four types of human papillomavirus infection.

The Institute of Environmental Science & Research Limited (ESR)Sexually transmitted infections in New Zealand 2011 Surveillance Report identified decreasing numbers of new genital warts cases between 2008 and 2011, most notable in 2010 and 2011 and in females aged 15-19 years, corresponding with commencement of the HPV immunisation programme. The Genital Warts pages from the full report are available here. The full ESR report is available from the ESR Public Health Surveillance website.

A short YouTube DVD, The Story of HPV (Human Papillomavirus), provides information for women, parents and caregivers, health workers and students planning to work in the health sector about the human papillomavirus, the Gardasil® vaccine that helps to protect against HPV, and the importance of cervical screening and practising safer sex in protecting women's health.

Rotavirus

Parents & Caregivers
Introduction: 

Rotavirus is a highly contagious virus that infects the intestine (gut) causing gastroenteritis (diarrhoea and vomiting) in infants and young children. Without immunisation almost all children in the world are infected by rotavirus before five years of age. Rotavirus is recognised as the most common cause of diarrhoea and dehydration in infants and young children in all countries. Adults can also become infected.

A brief history: 

Rotavirus was first identified in 1973. It is named rotavirus because of its wheel-like appearance.

The current New Zealand situation: 

Rotavirus occurs in every country in the world, including New Zealand. By the age of three years 90% of New Zealand children will have contracted rotavirus.

Death from rotavirus infection in New Zealand is very rare.

Symptoms: 

The illness begins with the sudden onset of vomiting and watery diarrhoea which can last from three to seven days.

Fever and abdominal pain may also occur.

How do you get it?: 

Rotavirus is spread by the faecal-oral route and generally occurs in winter and early spring. Spread of infection within families and institutions is common as large amounts of rotavirus are present in the faeces/poos/tütae of infected individuals. Contamination of hands, hard surfaces, toys, utensils and other objects is relatively easy.

What are the risks?: 

The major risk is dehydration from vomiting and diarrhoea.

  • Death from rotavirus infection is extremely rare in New Zealand.
  • Adult symptoms are usually mild.
Who is most at risk?: 

Most infections occur in infants and children between 6-24 months of age.

Treating the symptoms: 

There is no specific treatment for a rotavirus infection. Replacing fluid loss from vomiting and diarrhoea is very important to prevent dehydration.

Continue breast feeding if appropriate. Alternatively, offer small frequent drinks of either clear fluids or a rehydration preparation such as Gastrolyte or Pedialyte – offering from a small cup or spoon or syringe sometimes helps.

The disease can cause a rapid and severe deterioration. Signs of dehydration include:

  • Dry mouth and tongue
  • No wet nappies
  • No tears when crying
  • Sunken fontanelle
  • Sunken eyes
  • Reduced skin turgor - Gently pinched skin remains ‘pinched’
  • Lethargic or irritable

Many children will require medical intervention and hospitalisation for dehydration.

Children can start eating solids whenever they feel ready. Bland foods e.g. toast, dry biscuits, are a good to start with.

Preventing Disease Spread: 

The spread of rotavirus can be minimised by thorough hand washing after changing nappies or cleaning up vomit, after using the bathroom, before preparing food and before eating.

Children with diarrhoea or vomiting should not attend school or childcare centres until they have not had any loose poos/ tütae or vomiting for 24 hours.

Purifying water supplies and improving hygiene alone are unlikely to substantially reduce the incidence of this disease.

Health Professionals
Introduction (HP): 

Rotavirus infects the intestinal mucosa, altering the function of the intestinal epithelium resulting in malabsorptive diarrhoea. It has also been found in extra-intestinal sites including blood, lungs, and liver. Immunity after infection is incomplete but first infections are generally more severe than subsequent infections.

The incidence of rotavirus gastroenteritis typically peaks during winter in temperate climates whereas in tropical settings it occurs year round.

Causative organism: 

A segmented, double stranded RNA virus of the Reoviridae family.

The mature virus is a triple shelled capsid consisting of the outer, intermediate, and inner layers. The outer capsid contains two proteins. A binary classification is used to designate their neutralisation specificity, G and P.

Seven groups of rotavirus have been identified (named A-G); most strains affecting humans belong to group A but outbreaks of groups B and C rotaviruses have been identified. In 2007, 5 serotype combinations caused approximately 90% of all human rotavirus infections.

No correlation between rotavirus serotypes and  disease severity has been demonstrated.

Clinical signs, symptoms and complications: 

Incubation is approximately 1-3 days.

Vomiting and watery diarrhoea for 3 - 7 days, frequently with fever and abdominal pain.

For individuals with healthy immune systems, rotavirus gastroenteritis is a self-limited illness, lasting for only a few days.

The most serious complication of rotavirus is dehydration, with an associated weight loss.

Severe dehydration can lead to death.

Method of transmission: 

Transmission is primarily by the faecal–oral route; person to person or via contaminated fomites, as rotaviruses are shed in large numbers for many days in vomit and diarrhoea.

Public health significance: 

Rotavirus is highly infectious, it can survive on hands for at least four hours and on hard surfaces for weeks.

New Zealand epidemiology: 

Ninety percent (90%) of New Zealand children will contract rotavirus by the age of 3 years. In a survey undertaken of children under 3 years of age with acute diarrhea admitted to eight NZ hospitals, rotavirus was detected in 42.6% of stool samples and varied significantly by age (26.8% for 0-5 months; 42.5% for 6-11 months; and 52.1% for 12-35 months; p<0.001) and by season (51.2% in winter/spring vs 24.5% in summer/autumn; p<0.001).

It has been estimated, in NZ, that the annual burden of rotavirus is 1506 hospitalisations (476 per 100,000), 3086 emergency department presentations not requiring hospitalization, plus 10,120 cases of rotavirus managed solely in primary care.

Prevention: 

The spread of rotavirus can be minimised by thorough hand washing after changing nappies or cleaning up vomit, after using the bathroom, before preparing food and before eating.

Children with diarrhoea or vomiting should not attend school or childcare centres until they have not had any loose poos/ tütae or vomiting for 24 hours.

The oral rotavirus vaccine RotaTeq® was added to the National Immunisation Schedule on 1 July 2014.

Treatment: 

There is no specific treatment for rotavirus infection.

Oral rehydration is very important, to hydrate the child and replace fluid lost through vomiting and diarrhoea. Mothers can continue to breastfeed, alternatively clear fluids or a rehydration fluid such as Gastrolyte or Pedialyte can be offered frequently using a small cup or spoon.

Parents need advice on early signs and symptoms of dehydration (dry mouth and tongue, no wet nappies, no tears when crying, sunken fontanelle, sunken eyes, reduced skin turgor, lethargic or irritable), and to be aware that a sudden deterioration may occur after a large, watery bowel motion.

Children can start solids as soon as they feel ready. It is recommended they start with bland foods such as toast or dry biscuits.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Rotavirus is a highly contagious virus that infects the intestine (gut) causing gastroenteritis (diarrhoea and vomiting).

Effects of disease: 
Vomiting.
Diarrhoea.
Abdominal pain.
Fever.
Dehydration.
Dehydration can lead to death.
Common side effects of vaccine: 
Mild, temporary diarrhoea and/or vomiting within 7 days after the vaccine.
Fever.
Fussiness.
Crying.
Uncommon side effects of vaccine: 
Flatulence.
Abdominal pain.
Rare/very rare side effects of vaccine: 
Anaphylaxis.
Intussusception.
Blood in faeces/poos/tūtae.

Poliomyelitis

Common Name: 
Polio
Parents & Caregivers
Introduction: 

Poliomyelitis is a highly contagious viral disease caused by three types of poliovirus (types 1, 2 and 3).  Prior to the development of polio vaccines nearly every person became infected, with the highest disease rate being in infants and young children. Infection can result in irreversible paralysis, usually of the leg muscles but for 5-10% of acute flaccid paralysis cases the breathing muscles are paralysed and the person may die.

The World Health Organization is a partner in the Global Polio Eradication Initiative with Rotary International, the United States Centers for Disease Control and Prevention and UNICEF.  The goal of the Initiative is to reach every last child with polio vaccine and ensure a polio-free world for future generations. Since 1988 polio case numbers have reduced by 99%.

There are just four countries in the world that have (endemic) polio Afghanistan, India, Nigeria and Pakistan. Polio can travel from these four countries to any other “polio free” country in the world and infect people who have not had the disease or been immunised. In 2009-2010, 23 previously polio-free countries were re-infected due to imports of the virus.

Humans are the only host for polioviruses. Polio can be eradicated through immunisation. If every person is immune the polioviruses have no one to infect and will die out. Type 2 wild poliovirus was eradicated in 1999.

A brief history: 

Poliomyelitis was recorded on an Egyptian stele as far back as 1580-1350BC, in the image of a man with flaccid paralysis of a leg. It was described later by Michael Underwood in 1789. Epidemics and major outbreaks occurred over the 19th century.

A weakened (attenuated) live oral polio vaccine is used by the World Health Organization’s Expanded Programme on Immunization. There is a small risk that the weakened poliovirus in the vaccine can cause vaccine associated paralytic poliomyelitis (VAPP) in someone who is not immune to polio and is exposed to the vaccine virus.

An inactivated poliomyelitis vaccine, licensed for use in the US in the mid-90s, it is primarily used in countries that have eradicated polio. There is no risk of VAPP from the inactivated polio vaccine.
New Zealand started immunising against polio in 1961 using the oral polio vaccine. The inactivated polio vaccine was introduced in 2002 to reduce the risk of VAPP.

The current New Zealand situation: 

Until polio is eradicated worldwide there remains a risk of polio returning to “polio free countries”, including New Zealand.

Since 1962 there have been seven cases of polio reported in New Zealand, the most recent was in 1998. Four cases were laboratory confirmed as vaccine associated and two were classified as probably vaccine related, before New Zealand changed from the oral polio vaccine to the inactviated polio vaccine in 2002. One case was wild polio (not vaccine related), acquired in Tonga and imported into New Zealand.

Symptoms: 

The majority of cases (approximately 95 in 100) have no symptoms.

  • Between 4-8 in 100 cases have symptoms of a minor non-specific illness including a low grade fever, fatigue, headache, vomiting, neck stiffness, sore throat and/or muscle pain.
  • In about 1-5 in 100 cases the person develops aseptic meningitis a few days after they have recovered from their non-specific illness. They usually recover fully.
  • Up to 2 in 100 cases have a rapid onset of acute flaccid paralysis without normal reflexes in the affected areas.
How do you get it?: 

Humans are the only host for polioviruses. People infected with a poliovirus excrete the virus in their saliva and faeces whether they have symptoms of the disease or not. Poor hygiene then spreads the virus to others.

Polioviruses are passed from person-to-person through the oral-faecal or oral-oral route. Occasionally the viruses may be passed on through contaminated water, milk or food.

The incubation period is usually 3-6 days in a person with no symptoms or for a person to develop non-specific symptoms.  The incubation period between exposure and development of paralytic disease is usually 7-21 days but could be as short as 3 days or as long as 35 days.

What are the risks?: 

Most people fully recover from polio.

The complications from polio depend on what part or parts of the body have been affected by the poliovirus.
People may experience permanent muscle weakness or paralysis, difficulty passing urine and urinary tract infections, uneven limb growth (the affected leg does not grow and the unaffected leg continues to grow normally), bone deformities, heart problems, breathing problems, cranial nerve damage, brain damage and death.

People who have had polio may experience significant muscle pain and weakness 15-40 years after recovering from polio. This is called post-polio syndrome. It is thought to be related to the aging of muscles and nerves that are compensating for the original damage. The person does not have the disease again.

Who is most at risk?: 

In countries where polio remains endemic infection is more common in children less than 5 years of age. When most children have acquired protection against all three types of polio by 5 years of age and therefore are protected as they grow into adulthood the risk of acute flaccid paralysis is highest in children less than 3 years of age.

In countries that are polio free people who have not had polio or been immunised against polio are at risk of getting polio when it is imported/introduced into the country b y a traveller. In this situation adults are more likely to develop acute flaccid paralysis than children. In 1993 the Netherlands experienced a polio outbreak in a community who had chosen not to immunise against polio.

Treating the symptoms: 

Polio is incurable.

During the acute illness only supportive care can be provided to reduce complications associated with paralysis.

After the person has recovered rehabilitation can prevent or reduce post-polio deformities and increase independence.

Preventing Disease Spread: 

Polio can only be prevented through immunisation.

Household contacts of a person with polio are usually infected before the polio has been diagnosed in the first case so isolation of the person with polio in the home environment after diagnosis is not useful.

Health Professionals
Causative organism: 

Polioviruses are enteroviruses and belong to the family Picornaviridae. There are three antigenic types (serotypes 1, 2 and 3).

Type 1 appears to be the most neurovirulent of the three serotypes. Most cases are caused by type 1. Type 2 was eradicted in 1999.

The viruses are resistant to inactivation by many common detergents and disinfectants, including soaps, non-ionic detergents and lipid solvents such as ethanol, ether, and chloroform. They are rapidly inactivated by 0.3% formaldehyde or 0.5 ppm free residual chlorine, by desiccation, low humidity or by exposure to ultraviolet light.

Clinical signs, symptoms and complications: 

The incubation period is usually 3-6 days in a person with no symptoms or for a person to develop non-specific symptoms. The incubation period between exposure and development of paralytic disease is usually 7-21 days but could be as short as 3 days or as long as 35 days.

After infection the poliovirus initially incubates in the gastrointestinal tract. Polio has four possible presentations:

1. The majority of poliovirus infections (about 95%) are subclinical, inapparent infection without symptoms.

2. About 4-8% of cases only develop a minor non-specific illness. Symptoms may include low grade fever, fatigue, malaise, drowsiness, headache, vomiting, constipation, neck stiffness, sore throat and/or muscle pain.

3. About 1-5% of cases are nonparalytic poliomyelitis. Initial symptoms are non-specific (fever, malaise, vomiting, sore throat). One to two days later symptoms of meningeal irritation from aseptic meningitis develop. Recovery is usually complete however nonparalytic poliomyelitis can progress to the paralytic form of the disease.

4. Between 0.1-2% of cases are paralytic poliomyelitis. The paralytic form of the disease occurs when the poliovirus spreads to the motor neurons of the anterior horn cells in the spinal cord (spinal poliomyelitis) and/or brain stem (bulbar paralysis). The cranial nerves may also be affected by polioviruses. The area paralysed depends on the anatomic location of the motor neuron damage. Although the motor neurons do not recover and are not replaced it is possible for other muscles to compensate for the paralysis, resulting in partial or complete recovery from paralytic poliomyelitis for some people.

In polio-free countries with pockets of non-immune/unimmunised communities adults are more likely to present with paralytic poliomyelitis. In countries with endemic polio children less than 3 years are more likely to develop paralytic polio.

The person initially experiences symptoms of a minor non-specific illness, becomes symptom free, then one to three day later develops fever with a rapid onset of descending acute flaccid paralysis. Adolescents and adults may not experience the minor illness symptoms but develop more severe pain in the affected extremities. The progression of paralysis usually stops once the fever abates. Paralysis is usually asymmetrical with reduced or absent deep tendon reflexes. The sensory nerves are not affected.
The diagnosis of paralytic poliomyelitis is based on the clinical course, isolation of poliovirus in two stool samples and the presence of a neurologic deficit 60 days after symptom onset. Neurologic deficit may be complete or partial flaccid paralysis or weakness.
The two stool samples must be taken at least 24 hours apart in the first 14 days after the onset of paralysis are required to diagnose paralytic poliomyelitis. The laboratory must be notified before sending the specimen. Isolation of the virus in stool samples is important to determine if the virus is wild-type or vaccine related.

The differential diagnoses for acute flaccid paralysis include infection by other enteroviruses, other viruses (e.g., Epstein-Barr virus, human immunodeficiency virus, mumps virus), campylobacter jejuni, hypokalaemia, antibiotic reaction (aminoglycosides, tetracyclines, polymixin B), chemical poisoning, cephalic tetanus, fungal-mycotoxins, wasp venom, Guillain-Barre Syndrome, Bell’s Palsy, transverse myelitis.

The complications from polio depend on the anatomic location of the motor neuron damage. People may experience permanent muscle weakness or paralysis, difficulty passing urine and urinary tract infections, uneven limb growth (the affected leg does not grow and the unaffected leg continues to grow normally), bone deformities, heart problems, breathing problems, cranial nerve damage, brain damage and death.

The fatality rate from poliomyelitis varies depending on the presentation. For paralytic spinal poliomyelitis 2-5% of child cases and 15-30% of adult cases may result in death. Up to 75% of cases with bulbar poliomyelitis will die.
People who are immunocompromised are more likely to experience complications and a fatal outcome from poliomyelitis.

Post-polio syndrome occurs 15-40 years after a person has recovered from paralytic poliomyelitis. It is characterised by exacerbation of existing weakness, development of new weakness or paralysis and/or increased muscle pain. Increasing length of time since the acute infection, presence of residual impairment form the acute illness and being female are risk factors for post-polio syndrome. The pathogenesis of post-polio syndrome does not involve ongoing or recurrent poliovirus infection. It is thought to be related to the aging of muscles and nerves that are compensating for the original damage.

Method of transmission: 

Humans are the only host for polioviruses.

Polioviruses are transmitted person to person via the oral-faecal or oral-oral route. They have occasionally been transmitted through contaminated water, milk or food.
All infected people shed the virus in their stool, including those with subclinical/inapparent infection.
The person is most infectious immediately before to 1-2 weeks after the onset of symptoms. However the virus is excreted in saliva for approximately two weeks and in faeces for three to six weeks and sometimes longer.

People who are immunocompromised may excrete the virus for years (chronic excretor).

Public health significance: 

All cases of acute flaccid paralysis in New Zealand must be investigated as suspected poliomyelitis and notified to the Medical Officer of Health immediately.

Acute flaccid paralysis in persons aged less than 15 years should also be reported to the New Zealand Paediatric Surveillance Unit (NZPSU) based at the University of Otago. The NZPSU will send case investigation and follow up forms to clinicians, continue to monitor that New Zealand has eradicated polio and provide information to the World Health Organization.

Any confirmed case of poliomyelitis in New Zealand constitutes a Public Health Emergency of International Concern (PHEIC). The Director of Public Health at the Ministry of Health should be contacted urgently. The New Zealand National Poliomyelitis Response Plan outlines the actual response and is published on the Ministry of Health website. (http://www.health.govt.nz).

The infection rate of non-immune household or institutional contacts is as high as 90-100%.
Both a live oral polio vaccine (OPV) and an inactive polio vaccine (IPV) are effective at preventing disease from polioviruses because inhibition of poliovirus replication in and dissemination from the gastrointestinal tract (OPV) and/or inhibiting viraemia (IPV) following infection prevents disease.

As humans are the only host polioviruses can be eradicated through immunisation. In developed countries with high sanitation and hygiene standards immunisation coverage of 66-80% can prevent outbreaks of polio. In developing countries with lower sanitation and hygiene standards immunisation coverage needs to be much higher with 94-97% of the population having completed a primary course of three doses of polio vaccine.

Until polio is eradicated worldwide there remains a risk of polio returning to “polio free countries”, including New Zealand.

New Zealand epidemiology: 

Polio became a notifiable disease in New Zealand in 1908. Since then epidemics (about 1000 cases) were recorded in 1916, 1925, 1937, 1948/49, 1952/53 and 1955/56. Use of the Salk inactivated polio vaccine began in 1956 for older children and extended to all those aged 6 months to 29 years in 1956. The use of this vaccine delayed the next polio epidemic to 1961.

The Sabin oral vaccine was introduced to New Zealand in 1961 for children less than 12 months of age. Its use was extended to school aged children, and all adolescents and adults in 1962. There have not been any cases of locally acquired wild-type polio in New Zealand since 1962.

Since 1962 there have been seven cases of polio reported in New Zealand, the most recent was in 1998. Four cases were laboratory confirmed as vaccine associated (two vaccine recipients and two unimmunised contacts of vaccine recipients). Two were classified as probably vaccine related. In 1976 an infant was diagnosed with wild-type polio acquired in Tonga and imported into New Zealand.

New Zealand changed from using the live oral polio vaccine to the inactivated injectable polio vaccines in 2002.

Until polio is eradicated worldwide there remains a risk of polio returning to “polio free countries”, including New Zealand.

Prevention: 

High standards of public sanitation and hygiene will contribute to reducing the spread of poliovirus.

Immunisation is the only way to prevent the disease.

The inactivated polio vaccine (IPV) is used in New Zealand to provide individual protection and herd immunity against polio without the risk of vaccine associated paralytic poliomyelitis (VAPP) that is associated with use of the live oral polio vaccine. IPV can also be safely administered to people who are immunocompromised and close contacts of people who are immunocompromised.

A combination of oral and inactive injected polio vaccines are acceptable to provide a primary course and booster dose of polio vaccines.

Occupational vaccination and travel:
There is no evidence that routine IPV boosters are required however they are currently recommended to reduce any possible risk form waning immunity when there is an increased risk of exposure to poliovirus.

If more than 10 years has elapsed since completing a primary course of three polio containing vaccines or polio containing booster vaccine a booster dose of IPV is recommended (but not funded) for:

  • Travellers to countries where poliomyelitis remains endemic.
  • Individuals at particular risk of exposure (e.g., sewerage workers, laboratory workers routinely handling faecal specimens which may contain wild or vaccine-derived polioviruses).
  • Healthcare workers in direct contact with a case of poliomyelitis.
Treatment: 

Polio is incurable.

During the acute illness only supportive care can be provided to reduce complications associated with paralysis.

After the person has recovered physical rehabilitation can prevent or reduce post-polio deformities and increase independence.

 

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Poliomyelitis is a highly contagious viral disease caused by three types of poliovirus (types 1, 2 and 3).

 

 

 

Effects of disease: 
The majority of cases (approximately 95 in 100) have no symptoms.
Between 4-8 in 100 cases have symptoms of a minor non-specific illness including a low grade fever, fatigue, headache, vomiting, neck stiffness, sore throat and/or muscle pain.
In about 1-5 in 100 cases the person develops aseptic meningitis a few days after they have recovered from their non-specific illness.
The majority of people fully recover from polio.
Up to 2 in 100 cases have a rapid onset of acute flaccid paralysis without normal reflexes in the affected areas.
The complications from polio depend on what part or parts of the body have been affected by the poliovirus.
People may experience permanent muscle weakness or paralysis, difficulty passing urine and urinary tract infections, uneven limb growth (the affected leg does not grow and the unaffected leg continues to grow normally), bone deformities, heart problems, breathing problems, cranial nerve damage, brain damage and death.
People who have had polio may experience significant muscle pain and weakness 15-40 years after recovering from polio. This is called post-polio syndrome.
Common side effects of vaccine: 
Soreness/pain, redness and/or swelling around the injection site.
Fever over 38°C.
Decreased appetite, vomiting and/or diarrhoea.
Irritability, restlessness.
Unusual crying.
Fatigue.
Uncommon side effects of vaccine: 
Fever over 39.5°C.
Induration (area of hard inflammation).
Swelling involving the entire thigh or upper arm occurs in 2–3 percent of children after administration of the fourth and fifth doses of acellular pertussis vaccine. It resolves spontaneously without long term consequences.
Rare/very rare side effects of vaccine: 
Anaphylaxis.
Urticaria.
Idiopathic thrombocytopenic purpura.
Persistent (> 3 hours) inconsolable screaming.
Hypotonic, hyporesponsive episode (HHE) with 24 hours of immunisation.
Convulsion within 2 days of immunisation.
Inflammation of the nerve in the arm causing muscle weakness and pain (brachial neuritis) occurs within four weeks of immunisation, 1- 2 times per 200,000 doses
Encephalopathy less than once in one million doses.

Mumps

Parents & Caregivers
Introduction: 

Mumps is a viral illness. It is often recognised by swelling and tenderness of one or more parotid (salivary) glands although some people with mumps have no symptoms and others may only have symptoms in other organs e.g., meningitis or one or both testicles inflamed.

A brief history: 

Mumps was first recognised in the fifth century BC by Hippocrates. Mumps was described as an illness accompanied by swelling of the ear and painful enlargement of the testes, either unilaterally or bilaterally. It was not recognised as an infectious disease until the 19th century. The first safe and immunogenic attenuated mumps virus vaccine became available in 1967. The origin of the word mumps is obscure but may be related to the old English verb, which means ‘grimace, grin, or mumble.’

In the years before the introduction of mumps vaccine the disease was most commonly reported among young school-age children.

The current New Zealand situation: 

The last mumps epidemic was in 1994, when there were 188 hospitalisations. However, mumps cases are still occurring in New Zealand.

Symptoms: 

Most children under two years of age have no symptoms when they get mumps. Those who get mumps as adults are more likely to experience severe disease.

When symptoms are present they usually include fever, headache, malaise, muscle aches, poor appetite, swelling, and tenderness of one or more salivary glands (just below the ear lobe).

However, some people may have no involvement of salivary glands and have symptoms from other organ involvement.

On average fever usually lasts 1-6 days, but salivary gland swelling can last for 10 days or longer.

It usually takes between 6-18 days from exposure to the first symptom but could also range from 12-25 days.

How do you get it?: 

Mumps is spread by infected droplets in the air from breathing, coughing and sneezing, and also by direct contact with infected saliva.

A person with mumps may be infectious from seven days before the salivary glands swell until nine days after. The most infectious period is between two days before illness and four days afterwards. People without symptoms are also infectious.

What are the risks?: 

Adults are more likely to experience severe mumps disease.

Viral meningitis occurs in up to 15% of mumps cases (almost always without long term consequences),
Temporary deafness to high frequency sounds is more common, occurring in 4 in 100 cases.
Orchitis (inflamed testicle), usually one sided, occurs in 20-25% of post-pubertal males. Oophoritis (inflamed ovary) occurs in 5% of post-pubertal females. Sterility occurs rarely.
Encephalitis (brain inflammation) occurs in 1 in 6,000 cases, and 1 in 100 of those with encephalitis die.
Profound and permanent deafness, usually on one side, occurs in 1 in 15,000 cases.
Overall the case fatality rate from mumps is about 1.8 per 10,000 cases.
Pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis may also occur.
Mumps in the first trimester of pregnancy may increase the rate of miscarriage, but there is no evidence that it causes fetal abnormalities.

Who is most at risk?: 

Unvaccinated adolescents and adults are most at risk.

Pregnant women who get mumps during the first 3 months of pregnancy have an increased risk of miscarriage.

Treating the symptoms: 

There is no treatment for the mumps infection. Treatment of symptoms is aimed at improving comfort.

Preventing Disease Spread: 

Immunisation given on time is the best method of preventing mumps. The measles, mumps, rubella vaccine (MMR) is given as part of the standard immunisation schedule at 15 months and 4-5 years of age. In New Zealand there is no single mumps vaccine available.

People with mumps are excluded from early childhood education, school and work until nine days after the appearance of swollen salivary glands.
Contacts of mumps cases, who are not immune to mumps e.g., those who are unimmunised, are excluded from early childhood education, school and work until 26 days after the appearance of swollen glands in the last case they were in contact with.

Health Professionals
Causative organism: 

Mumps virus is a member of the genus Rubulavirus in the family Paramyxoviridae.

Humans are the only known natural hosts.

Clinical signs, symptoms and complications: 

The diagnosis of mumps is usually made on the presence parotitis. However, infection from other viruses e.g., coxsackieviruses and Epstein–Barr virus, can infrequently cause parotitis.

Method of transmission: 

Mumps is spread by infected droplets in the air from breathing, coughing and sneezing, and also by direct contact with infected saliva. Viraemia leads to organ involvement including the kidneys, meninges, joints and particularly the parotid (salivary) glands or respiratory tract involvement.

Public health significance: 

Mumps is notifiable to the Medical Officer of Health immediately on suspicion of the disease.

New Zealand epidemiology: 

The last mumps epidemic was in 1994, when there were 188 hospitalisations. However, mumps cases are still occurring in New Zealand. In 2010 41 cases of mumps were notified and of these 16 were laboratory confirmed. Most cases occurred in children aged 15 months-3 years and those over 20 years. One person was hospitalised and no one died.

Prevention: 

Some infants may have passive immunity from transplacental transfer of maternal mumps antibodies during the later weeks of pregnancy. This passive protection dependent on maternal immunity to mumps and wanes by 6-12 months of age in most infants.

Treatment: 

There is no treatment for the mumps infection. Treatment is symptomatic and aimed at improving comfort.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

A highly contagious viral infection spread by droplets in the air and saliva. It is typically recognised by fever and swollen, tender salivary glands.

Effects of disease: 
Adults are more likely to experience severe mumps disease.
Fever, headache, and swelling and tenderness of one or more parotid (salivary) glands.
Viral meningitis: Up to 15 in 100, usually followed by full recovery.
Temporary deafness to high frequency sounds is more common, occurring in 4 in 100 cases.
Orchitis (inflammation of the testicle): 20-25 in 100 post pubertal males, usually only one testicle is affected. Sterility occurs rarely.
Oophoritis (inflammation of the ovaries): 5 in 100 post pubertal females.
Encephalitis: 1 in 6000, and 1 in 100 of those with encephalitis die.
Profound and permanent deafness, usually on one side, occurs in 1 in 15,000 cases.
Overall case fatality rate of 1.8 in 100,000.
Pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis may also occur.
Mumps contracted during the first trimester of pregnancy increases the risk of miscarriage. There is no evidence it causes fetal abnormalities.
Common side effects of vaccine: 
Measles component:
Fever over 39.5˚C and/or rash 6–12 days after immunisation.
Mumps component:
Parotid and/or submaxillary swelling 10–14 days after immunisation.
Rubella component:
Mild rash, fever and/or lymphadenopathy between two and four weeks after immunisation.
Joint symptoms may occur after the vaccine, the incidence of which is age related. More adult women than children get joint symptoms about two to four weeks after immunisation.
Rare/very rare side effects of vaccine: 
Anaphylaxis.
Temporary thrombocytopenia.
Encephalitis occurs once in one million doses. There may be some long-term effects from this.
Aseptic mumps meningitis.
Convulsion associated with fever.
Vaccines: 

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