hot topics in pid infectious diseases… · disease outb ktbreak otb koutbreak of rsv if...
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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)
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of RSV Infection
ไวรส RSV ระบาดหนาฝน
โคราชเดกตดเชอ เขาไอซย!โคราชเดกตดเชอ เขาไอซย!
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of RSV Infection
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)
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of RSV Infection
From RSV infection toFrom RSV infection to…Asthma & other atopic diseases
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Rotavirus Gastroenteritis
“นสบา” ปวยรวง
เตอนระวงหลงเชอโรตาไวรสระบาดหนก
แถมยงไมมยารกษา!
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Rotavirus Gastroenteritis
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
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Rotavirus Gastroenteritis
Reports of RVGEReports of RVGE in Thai adults
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Rotavirus Gastroenteritis
Slide อาจารยนค
Thai adults may not haveThai adults may not have immunity against certain RV.
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Influenza
รร.กทม. 3‐4 แหง ปดเรยน!หนไขหวดใหญ
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Influenza
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
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Influenza
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
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Influenza
Have you vaccinated 2018 influenza vaccines?... TIV vs QIV
Pediatric Infectious DiseasesPediatric Infectious Diseases
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
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Rabies
Rabies exposures are common in children.Bites on face are common in children.
P
Pediatric Infectious DiseasesPediatric Infectious Diseases
Outbreak of Rabies
Pre‐exposure 2‐dose rabies is as good as 3‐dose rabies.
P
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: Pertussis/
หวงเดกไทยปวย “โรคไอกรน” มากขน หวงเดกไทยปวย โรคไอกรน มากขน
แนะควรรบวคซนตามนด
Pediatric Infectious DiseasesPediatric Infectious Diseases
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
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: Pertussis/
Pertussis in Thai adults and childrenThai adults and children
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: Pertussis/
ไ ใ ขอมลไอกรนในเดก
Pertussis in Thai neonates
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: Pertussis/
Tdap in pregnant Thai womenpregnant Thai women
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: Zika Infection /
ไวรสซการะบาดในบราซล ขนฉกเฉน
“ทารกศรษะเลก” เพมไมหยด
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: Zika Infection /
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
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: Zika Infection /
Zika virus infection in pregnant women &
Risk of microcephaly in neonates
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: TB & MDR‐TB /
“ปวยวณโรคดอยาหลายขนาน” พง! กรมควบคมโรคเดนหนา กรมควบคมโรคเดนหนา
5 มาตรการลดปญหา
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: TB & MDR‐TB /
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
Pediatric Infectious DiseasesPediatric Infectious Diseases
EID/RID: TB & MDR‐TB /
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
HB in HBV‐exposed infants
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
HB in HBV‐exposed infants
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
New EPI VaccinesNew EPI Vaccines
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
New EPI VaccinesNew EPI Vaccines
HPV Vaccine (2HPV)
HPV vaccine 2 doses is adequate for girls aged 9 15 yrsfor girls aged 9‐15 yrs.
New EPI VaccinesNew EPI Vaccines
HPV Vaccine (2HPV)
Physicians should be more proactive in discussing and recommending HPV vaccination.
New EPI VaccinesNew EPI Vaccines
Hib Vaccine (Hib)
วคซนฮบคออะไร
ทาไมเดกไทยไมไดฉดฟร
New EPI VaccinesNew EPI Vaccines
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
New EPI VaccinesNew EPI Vaccines
Rotavirus Vaccine (RV)
กรมควบคมโรคเตรยมเรงผลกดนวคซนโรตากรมควบคมโรคเตรยมเรงผลกดนวคซนโรตา
เขาสแผนภมคมกนโรค ภายในป 2561 ฟร
New EPI VaccinesNew EPI Vaccines
Rotavirus Vaccine (RV)
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
New EPI VaccinesNew EPI Vaccines
Rotavirus Vaccine (RV)
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
New Optional VaccinesNew Optional Vaccines
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
New Optional VaccinesNew Optional Vaccines
Dengue Vaccine (DV)
Slide อ ฉอSlide อ.ฉอ
Barrier affecting DV acceptance P
is the cost of vaccine.
New Optional VaccinesNew Optional Vaccines
Dengue Vaccine (DV)
P
New Optional VaccinesNew Optional Vaccines
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
New Optional VaccinesNew Optional Vaccines
Live Attenuated Hepatitis A Vaccine (HAV)
New live attenuated HAV...single dose, good protection, less expensive
New Optional VaccinesNew Optional Vaccines
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
New Optional VaccinesNew Optional Vaccines
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