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THE POWER OF HERD IMMUNITY

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Something I feel passionate about is the importance of vaccination especially childhood vaccine s which provide vital immunisation against major threatening diseases.

I have during my medical career witnessed the suffering and in many cases deaths relating to these infectious  diseases.

I have seen the terror in the eyes of people dying with tetanus, the demise of children with measles the congenital abnormality ( heart defects and delayed development) acquired as an effect of German Measles(Rubella) in the unborn child, infertility as are a result of mumps, the longstanding mobility handicaps following polio aswell as the agonising death from meningitis. I remember one of our patients, a fit healthy lady in early pregnancy contracting pneumococcal pneumonia and was on life- support machine for 5 weeks, fortunately with excellent medical care at Ealing Hospital she survived but sadly had a miscarriage.

We now provide immunisation for these infections. 

During the ‘swine flu’ epidemic the intensive care units of all the local hospitals each had several pregnant women fighting for their lives because they had contracted swine flu. This is why we which now offer vaccination to all pregnant women after

However, there will always be those around us who for one reason or another, they may be taking steroids or receiving chemotherapy or for some reason have poor immunity and need as many people around them to be vaccinated and become immunised against a specific infectious disease  so that they can be protected from the disease – herd immunity.

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The TED talk above given by Romina Libster albeit in Spanish with English subtitles is delivered with the same sentiment and echoes how I feel about the importance of vaccination.

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Posted by on March 25, 2015 in Training and Advice

 

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MEASLES CLOSE TO HOME

Watch out

                          THERE HAS BEEN AN OUTBREAK OF MEASLES IN

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If your child is not vaccinated  make an appointment as soon as possible  for a  MMR vaccination “to protect themselves, their loved ones, and the community at large.” The best protection against measles is a two dose regimen of the MMR vaccine, which is safe and more than 99% effective.

Complications of measles can include pneumonia, neurologic involvement, and death. It is well documented that about one in 1000 people with measles will develop meningitis and about one in 1000 will die. “Measles is not a trivial illness. Measles can be very serious, with devastating complications.”

A reader sent me this interesting article which gives food for thought  !!! 

https://medium.com/the-archipelago/im-autistic-and-believe-me-its-a-lot-better-than-measles-78cb039f4bea

 

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Don’t Believe In Vaccinations?

Two years ago I wrote a blog about the Measles epidemic in Swansea brought about because parents had declined to vaccinate their children. In USA there has been an outbreak of measles in 14 states and President Obama is urging parents to get their children vaccinated. At least 58 of those cases began in Disneyland in Dec. 2014, where large numbers of unvaccinated people made it easy for the virus to spread. Unvaccinated people are now being encouraged to avoid Disneyland parks altogether, lest the virus continues to spread. Last year alone the U.S. saw 644 confirmed cases of the measles, more than triple the number of cases in 2013.

   WHO            According to the WHO in November 2014

 * Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.

* In 2013, there were 145 700 measles deaths globally – about 400 deaths every day or 16 deaths every hour.

* Measles vaccination resulted in a 75% drop in measles deaths between 2000 and 2013 worldwide.

* In 2013, about 84% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.

* During 2000-2013, measles vaccination prevented an estimated 15.6 million deaths making measles vaccine one of the best buys in public health.m

27 years  ago Roald Dald wrote this moving letter to encourage parents to make sure they immunise their children: the message is still pertinent today.

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Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it.
Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.
“Are you feeling all right?” I asked her.
“I feel all sleepy,” she said.
In an hour, she was unconscious. In 12 hours she was dead.
The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.
That was 24 years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.
On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles.
I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.
It is not yet generally accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunised are putting the lives of those children at risk.
In America, where measles immunisation is compulsory, measles like smallpox, has been virtually wiped out.

Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunised, we still have a hundred thousand cases of measles every year.
Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die.
LET THAT SINK IN.
Every year around 20 children will die in Britain from measles.
So what about the risks that your children will run from being immunised?
They are almost non-existent. Listen to this. In a district of aroundu 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunisation! That is about a million to one chance.
I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunisation.
So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunised.
The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunisation should beg their parents to arrange for them to have one as soon as possible.
Incidentally, I dedicated two of my books to Olivia, the first was ‘James and the Giant Peach’. That was when she was still alive. The second was ‘The BFG’, dedicated to her memory after she had died from measles.
You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children.

***If your child has not been immunised contact your surgery to make an appointment withe practice nurse.

 
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Posted by on February 3, 2015 in Training and Advice

 

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EBOLA

When anyone hears this name they immediately associate it with death and tradegy. It is not surprising that on several occasions I have seen a child in surgery with a fever and they have been unusually fearful because they are frightened they have contracted Ebola.
We can reassure, act appropriately and educate our children in so many ways:-

* Remind our children that we live in a country that has clean running water and an excellent sewage system which saves countless lives especially from infections. Did we not see the adverts on the TV at Christmas asking us to contribute to a provision of a pump in a bush village which had no running water?

* Educate our children to wash their hands before meals and after using the toilet and put our hands to our mouths or turn away when we have cough?

* Make sure you are up to date with immunisation and seek advice when travelling for recommended immunisations and health care with the practise nurse or local travel clinic

Travel clinichttp://www.globetrotterstravelclinics.com

* Encourage healthy living especially with regards diet and exercise.

* Appreciate and treasure our health service and not take it for granted that we have a service which is accessible, free and can offer a comprehensive range of treatments comparable to any country in the World.

Expectations are high – I can be sure that at least 50% of patients attending on Monday morning will have minor ailments which could be treated with Over The Counter remedies or just reassurance. If I sit in out of hours clinics the story is much the same!
Nevertheless, when I have had to admit or refer a patient with a serious illness for the most part I am pleased with the prompt response and standard of care. Moreover, if the outcomes are not satisfactory as a GP I have a voice to be able communicate dissatisfaction and facilitate change and as a patient there is also the same opportunity through PALS our Patient Liaison Service (details obtained at the surgery or on the website NHS choices)

More about Ebola
Nearly 40 years after Peter Piot was first dispatched to investigate a mysterious new virus.

Ebola
He was 27 and still in training, he had one of the greatest opportunities an aspiring microbiologist could dream of: the chance to discover a new virus, investigate its mode of transmission and stop the outbreak. It all started when his laboratory at the Institute of Tropical Medicine in Antwerp received a thermos from what was then called Zaire. It contained the blood of a Flemish nun who had died of what was thought to be yellow fever.

From that sample, however, his lab isolated a new virus, confirmed by the Centers for Disease Control in Atlanta and subsequently called Ebola, after a river about 100km north of Yambuku, the centre of the epidemic. It turned out to be one of the most deadly viruses known.

In early September 1976, Mabalo Lokela, the headmaster of the local school, had died with a high fever, intractable diarrhoea and bleeding. His death sent a shockwave through the small mission community. Soon the hospital was full of patients with a similar illness and nearly all died within a week.
There have been several outbreaks since that time but the present outbreak is the worst.

How is it transmitted?

It is believed that the virus originates in fruit bats. It circulates in populations of wild animals including gorillas, fruit bats, monkeys, antelopes and even porcupines.
It is transmitted through contact with bodily fluids. Eating fruit collected from the forest floor, that an infected fruit bat had bitten, could spread it. So could contact with the blood of an infected animal that had been butchered for bush meat.

Ebola

Monkeys, apes and antelopes are commonly eaten in the areas where the outbreak began. If someone were handling the raw meat and had an open cut on their hand, that could transmit the virus.

Once the virus is in human circulation, it becomes far harder to contain. Health care workers have been at particular risk because they have come into direct, close contact with victims.

Traditional burial ceremonies among many of the communities affected involve direct contact with the body of the dead, and this is believed to have been a major factor in the early spread of the virus, before public safety messages began to get through to people.

The virus can also be transmitted through sex. The WHO says that even men who have recovered from the virus can still transmit it through their semen for up to seven weeks after recovery.

Signs and Symtoms of Ebola

Fever
Severe headache
Muscle pain
Weakness
Fatigue
Diarrhea
Vomiting
Abdominal (stomach) pain
Unexplained hemorrhage (bleeding or bruising)
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.

The latest advise from NHS England is illustrated below:-

Ebola

 

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100 days of coughing after a 100 years

Eight months ago I wrote my 100th blog about a lady who had become a centenarian and how we had celebrated her birthday and since then she has followed my blogs and I have even introduced her to TED talks which she finds most interesting!

The telephone went yesterday to inform me that she was in hospital with what in some countries is known as
the 100 days’ cough or cough of 100 days.

The red dots are Bordatella pertussis bacteria, the cause of whooping cough.

We know it as whooping cough, or Pertussis..It is a highly contagious bacterial disease caused by Bordetella pertussis.

Although, in isolation and distressed by the severe coughing fits, which often produce the namesake high-pitched “whoop” sound when air is inhaled after coughing she has been in good spirits and no doubt full of questions due to her interminable curiosity.

What causes whooping cough

The bacterium infects the lining of the airways, mainly the windpipe (trachea) and the two airways that branch off from it to the lungs (the bronchi).
When the Bordetella pertussis bacterium comes into contact with the lining of these airways, it multiplies and causes a build-up of thick mucus. It is the mucus that causes the intense bouts of coughing as your body tries to expel it.
The bacterium also causes the airways to swell up, making them narrower than usual. As a result, breathing is made difficult, which causes the ‘whoop’ sound as you gasp for breath after a bout of coughing.

How whooping cough spreads

People with whooping cough are infectious from six days after exposure to the bacterium to three weeks after the ‘whooping’ cough begins.
The Bordetella pertussis bacterium is carried in droplets of moisture in the air. When someone with whooping cough sneezes or coughs, they propel hundreds of infected droplets into the air. If the droplets are breathed in by someone else, the bacterium will infect their airways.
This is why it is highly contagious. I remember in 1979 I was working as a paediatric doctor and there had been a whooping cough vaccination scare resulting in a sharp increase in cases. It was pitiful to see the numerous admissions of babies and young children with distressing bouts of coughing. It is clear how when a vaccination is introduced how the incidence of the disease falls so rapidly but rises again if vaccination uptake declines.
Whooping cough.

Treatment
If whooping cough is diagnosed during the first three weeks (21 days) of infection, a course of antibiotics may be prescribed. This is to prevent the infection being passed on to others.
It is important to take steps to avoid spreading the infection to others, particularly babies under six months of age.
Children with whooping cough should be kept away from school or nursery for five days from the time they start taking a prescribed course of antibiotics. The same advice applies to adults returning to work.
As a precaution, household members of someone with whooping cough may also be given antibiotics and a booster shot of the vaccine.
Antibiotics will not usually be prescribed in cases where whooping cough is not diagnosed until the later stages of infection (2-3 weeks after the onset of symptoms).
By this time, the Bordetella pertussis bacterium will have gone so you will no longer be infectious. It is also very unlikely that antibiotics will improve your symptoms at this stage.
Immunisation

Children are vaccinated against whooping cough with the 5-in-1 vaccine at two, three and four months of age, and again with the 4-in-1 pre-school booster before starting school at the age of about three years and four months.

Vaccination in pregnancy
In the UK, all pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant. Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

The immunity you get from the vaccine will pass to your baby through the placenta and provide passive protection for them until they are old enough to be routinely vaccinated against whooping cough at two months old.

Is the whooping cough vaccine safe in pregnancy?
It’s understandable that you might have concerns about the safety of having a vaccine during pregnancy, but there’s no evidence to suggest that the whooping cough vaccine is unsafe for you or your unborn baby.

Pertussis-containing vaccine has been used routinely in pregnant women since October 2012 and its safety has been carefully monitored by the Medicines and Healthcare Products Regulatory Agency (MHRA). The MHRA’s study of nearly 20,000 vaccinated women found no evidence of risks to pregnancy or babies.
To date, 50-60% of eligible pregnant women (over half a million) have received the whooping cough vaccine with no safety concerns being identified in the baby or mother.
Vaccination against whooping cough in pregnancy is also routinely recommended in the US and New Zealand.
The pregnancy vaccination programme has been very effective in protecting babies until they can have their first vaccine when they are two months old.
During 2012, 14 babies died from whooping cough, all of whom were born before the vaccination in pregnancy programme was introduced, and developed whooping cough before they could be vaccinated themselves. The number of infant deaths from whooping cough fell to three in 2013 – all three babies were too young to have been vaccinated themselves and none of their mothers had been vaccinated in pregnancy.

Further questions can be answered using the following link:-

http://www.nhs.uk/Conditions/Whooping-cough/Pages/Prevention.aspx

 
 

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DENGUE FEVER AND THE WORLD CUP

imageDengue is widespread in Brazil, which many travellers will visit this year for the football World Cup and in 2016 for the Olympic Games.Dengue fever

Dengue is a flavivirus infection transmitted by the bites of female mosquitoes, mainly of the species Aedes aegypti and Aedes albopictus, which are daytime biters. It is only the female mosquito that feeds off blood to provide protein for the eggs;the males feed off plant nectar.

Map dengue fever

From its origins in south-east Asia, it has spread to many parts of the tropical and sub-tropical world. Aedes mosqitoes are capable of breeding in small quantities of water, such as accumulated rainwater in oil drums and old tyres, as a consequence of which,
dengue often occurs in urban areas.

What are the main symptoms?

The incubation period is usually between two and five days, but may occasionally be longer. This is followed by fever, which may abate after a day or two, only to rise again. This is known as saddleback fever.

Common symptoms are severe arthralgia and myalgia, giving rise to the name breakbone fever, and headache.

Up to 50% of patients develop a maculopapular rash and there may be widespread lymphadenopathy. Recovery may be accompanied by prolonged fatigue and/or depression.

About 2% of patients may develop severe complications
of dengue such as haemorrhagic fever (DHF) or dengue shock
syndrome (DSS).
Warning signs for the rare dengue haemorrhagic fever include:
tiny bloods spots or large patches of blood under your skin, bleeding from the gums or nose, persistent vomiting and severe abdominal pain, vomiting blood or black, tarry stools. If you have any of these symptoms, you must seek immediate medical assistance.

Dengue fever

To establish if the rash is haemorrhagic use the glass or tumbler test as used in meningitis:-
Glass test

Can it be diagnosed by blood test?

Dengue fever can be diagnosed by isolating the virus in the blood during first five days. Also, on examining the blood there can be low white cell count and platelets and a raised alanine amino transferase (a liver enzyme) but this is not specific to Dengue Fever.
IgM antibodies may persist in the blood for two to three months
and a positive test may indicate recent or previous dengue
infection. If a traveller has had no previous exposure to dengue, a positive test is likely to be due to recent infection, but there is also cross-reactivity with other flaviviruses,

Is there a vaccine?
There is no vaccine

How can Dengue Fever be prevented?
It is a viral infection transmitted by mosquitos that bite in the day. It is important to wear clothing that covers as much of the skin as possible and use effective insect repellents such as diethyltoluamide (DEET) from dawn until dusk (in contrast to malaria prevention throughout the night from dusk until dawn)

How can it be treated?

There is no specific treatment for dengue. In most people symptoms can be managed by taking paracetamol (you should avoid aspirin, ibuprofen or other similar drugs), drinking plenty of fluids and resting.
Most people will recover within one to two weeks.

Before travelling it is advisable to attend a travel centre to obtain appropriate immunisations and advice.
Most immunisations can be given by our practise nurse or at one of the local travel clinics
http://www.globetrotterstravelclinics.com/
Travel advice for Brazil
http://www.mims.co.uk/TravelTables/882631/Brazil/

Having said this I had an amazing trip to Brazil several years ago to see my daughter who was studying there and absolutely loved Rio de Janeira, swimming on Copacabana beach, sky-diving on to the beach, dancing Salsa and even visited a Favela under escort. Then going on to explore the incredible Amazon river and Amazonian jungle and fortunately remained very well.
Rio

 

 
 

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SHINGLES VACCINE – ARRIVING SOON

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September 1st
  marks the arrival of a vaccine for people aged 70 years (routine cohort) and 79 years (catch-up cohort) to protect against shingles The efficacy of the vaccine declines with age and so it is not recommended for people aged 80 years or older.
The brand name of the shingles vaccine given in the UK is Zostavax

Unlike the flu jab, you’ll only need to have the vaccination once.
The vaccine is expected to reduce your risk of getting shingles. If you are unlucky enough to go on to have the disease, your symptoms may be milder and the illness shorter.
It’s difficult to be precise, but research to date suggests the shingles vaccine will protect you for at least three years, probably longer.
There is lots of evidence showing that the new shingles vaccine is very safe. It’s already been used in several countries, including the US and Canada, and no safety concerns have been raised. The vaccine also has few side effects.

What is Shingles?
Shingles or Herpes Zoster is a debilitating condition, which occurs more frequently and tends to be more severe in older people. It is estimated that around 250,000 people are affected in England and Wales each year, including 30,000 people in their 70s. Around one in 1,000 people over 70 who get shingles dies of the infection.

About 1 in 5 people have shingles at some time in their life. It can occur at any age, but it is most common in people over the age of 50. It is uncommon to have shingles more than once, but about 1 person in 50 has shingles two or more times in their life.

Most people have chickenpox ( varicella Zoster)in childhood, but after the illness has gone, the virus remains dormant (inactive) in the nervous system. The immune system (the body’s natural defence system) keeps the virus in check, but later in life it can be reactivated and cause shingles.
It is not known exactly why the shingles virus is reactivated at a later stage in life, but it may be due to having lowered immunity (protection against infections and diseases). This may be the result of:
being older
being stressed
a condition that affects your immune system, such as HIV and AIDS
Debilitation associated with cancer or medication affecting the immune system.

Each spinal nerve supplies an area of skin called a dermatome. The virus lies dormant in a part of the spinal nerve called a ganglia and as each spinal nerve supplies a particular region of the skin the area of skin where the symptoms and rash appear will correspond to that dermatome.

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Signs & Symptoms,
Prodrome (1–4 days before the rash) — fever and myalgia, with burning, tingling, numbness, or intense itching in the affected skin.
Acute (painful rash lasting 7–10 days) — a rash starts with red flat lesions and then raised lesions and these develop into vesicular (blistery)lesions in a dermatomal distribution. These blister type lesions then burst, releasing varicella-zoster virus.
Healing (2–4 weeks) — the lesions crust over.

Most patients feel unwell and very often emotionally labile and many a time has a patient with shingles burst into tears during a consultation for no obvious reason.

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Treatment
An oral antiviral drug (such as aciclovir) should be started within 72 hours of rash onset for a certain group of people, such as people aged 50 years or older, people with non-truncal involvement (e.g. shingles affecting the neck, limbs, or perineum), and people with moderate or severe pain or rash.
If it is not possible to initiate treatment within 72 hours, antiviral treatment can be considered up to 1 week after rash onset, especially if the person is at higher risk of severe shingles or complications (e.g. continued vesicle formation, older age, immunocompromised, or severe pain).

Most people have shingles on the trunk or chest region and it is uncomplicated. However, some people are unfortunate in that they are infected in the facial area, develop a complication, are severely immunocompromised, or pregnant and may need urgent admission or a Specialist opinion.

Less urgent referral may be necessary if new vesicles are forming after 7 days of antiviral treatment, healing is delayed, or if pain is inadequately controlled by oral analgesia.

For further information:-
http://www.patient.co.uk/health/shingles-herpes-zoster
http://www.nhs.uk/Conditions/Shingles/Pages/Introduction.aspx

 
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Posted by on August 3, 2013 in Training and Advice

 

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WORLD HEPATITIS DAY – July 28th 2013

The date of July 28 was chosen for World Hepatitis Day in order to mark the birthday of Professor Baruch Blumberg, awarded the Nobel Prize for his work in discovering the hepatitis B virus.
See no evil,hear no evil,as represented by the three wise monkeys, an old proverb that is commonly used to highlight how people often deal with problems by refusing to acknowledge them. The monkeys have been chosen for the campaign to highlight that around the world hepatitis is still being largely ignored.
Hepatitis simply means inflammation of the liver and can be caused by a wide range of things. One of the most common causes of chronic (long-term) hepatitis is viral infection.
Five distinct hepatitis viruses have been identified: A, B, C, D and E. Hepatitis B and C, which can lead to chronic hepatitis, are particularly prevalent.
The five hepatitis viruses have different epidemiological profiles and also vary in terms of their impact and duration. The transmission route depends on the type of virus. Transmission routes that contribute greatly to the spread of hepatitis are exposure to infected blood via blood transfusion or unsafe injection practices, consumption of contaminated food and drinking water, and transmission from mother to child during pregnancy and delivery. Unsafe injection practices, including the use of unsterile needles and syringes, serve as a major pathway for the spread of hepatitis B and C, and reducing transmission of both diseases means changing these practices.
Hepatitis B and C are two such viruses and together kill approximately one million people a year. 500 million people around the world are currently infected with chronic hepatitis B or C and one in three people have been exposed to one or both viruses. Unlike hepatitis C, hepatitis B can be prevented through effective vaccination.

It is estimated that around 180,000 are affected by hepatitis B in the UK. Around 95 per cent of people with new chronic hepatitis B are migrants, most of whom acquired the infection in early childhood in their country of birth.
Hepatitis C is also a blood-borne viral infection that is transmitted through contact with infected blood. Around 216,000 people in the UK have chronic hepatitis C, and of these 87 per cent are current or past injection drug users. Almost half of the rest are from South Asian descent.

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Together hepatitis B and C represent one of the major threats to global health. Hepatitis B and C are both ‘silent’ viruses, and because many people feel no symptoms, you could be infected for years without knowing it. If left untreated, both the hepatitis B and C viruses can lead to liver scarring (cirrhosis). If you have liver cirrhosis, you have a risk of life-threatening complications such as bleeding, ascites (accumulation of fluid in the abdominal cavity), coma, liver cancer, liver failure and death. In the case of chronic hepatitis B, liver cancer might even appear before you have developed cirrhosis.
Will Irving, Professor and Honorary Consultant in Virology, University of Nottingham and Nottingham University Hospitals NHS Trust, and member of the Programme Development Group, added: “It is estimated that around half of the individuals living in the UK with chronic hepatitis B or C infection are unaware of their diagnosis, but they are at risk of developing serious complications of their infection.

While there is a vaccine that protects against hepatitis B infection, there is no vaccine available for hepatitis C
Both viruses can be contracted though blood-to-blood contact
Hepatitis B is more infectious than hepatitis C and can also be spread through saliva, semen and vaginal fluid
In the case of hepatitis B, infection can occur through having unprotected sex with an infected person. Please note that this is much rarer in the case of hepatitis C
While unlikely, it is possible to contract hepatitis B through kissing. You cannot contract hepatitis C through kissing
Neither virus is easily spread through everyday contact. You cannot get infected with hepatitis B or C by shaking hands, coughing or sneezing, or by using the same toilet. There are different treatments for the two viruses. While treatment can control chronic hepatitis B, it can often cure hepatitis C
Even if treatment is not an option it is very important to maintain a healthy lifestyle. Alcohol, smoking, eating fatty foods, being overweight or extreme dieting (eating no food at all) may worsen liver disease.
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Hepatitis B

The World Health Organization (WHO) recognises that hepatitis B is one of the major diseases affecting mankind today. Hepatitis B is one of the most common viral infections in the world and the WHO estimates that two billion people have been infected with the hepatitis B virus and approximately 350 million people are living with chronic (lifelong) infections. 500,000 – 700,000 people die every year from hepatitis B.

It is part of our contract as doctors that we have to have been immunised for Hepatitis B and our immunity is checked by blood test. We also do the same for our nurse and phlebotomist.

The hepatitis B virus is highly infectious and about 50-100 times more infectious than HIV. In nine out of ten adults, acute hepatitis B infection will go away on its own in the first six months. However, if the virus becomes chronic, it may cause liver cirrhosis and liver cancer after up to 40 years, but in some cases as little as five years after diagnosis.

The hepatitis B virus is transmitted between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person.It arises primarily from injecting drug use, heterosexual contact with someone who is infected, travel to countries of intermediate or high endemicity, homosexual contact, and contact with someone in the same household who is a carrier and mother-to-child transmission. Although not all people will have any signs of the virus, those that do may experience the following symptoms:

Flu-like symptoms
Fatigue
Nausea
Jaundice (yellowing of the skin)
Stomach ache
Diarrhoea/dark urine/bright stools
Aching joints
Unlike hepatitis C, there is a vaccine that can prevent infection. If you think you are at risk, you should get vaccinated as soon as possible.

Hepatitis C

Hepatitis C is different from hepatitis B in that the virus more frequently stays in the body for longer than six months, and therefore becomes chronic. Four out of five people develop a chronic infection, which may cause cirrhosis and liver cancer after 15–30 years. There are approximately 170 million people chronically infected with hepatitis C worldwide. In 2000, the WHO estimated that between three and four million people are newly infected every year.

Hepatitis C is mainly spread through blood-to-blood contact and, similarly to hepatitis B, there are often no symptoms but if they are present can include:

Flu-like symptoms
Fatigue
Nausea
Aching muscles and joints
Anxiety and depression
Poor concentration
Stomach ache
Loss of appetite
Dark urine/bright stools

Although this is considered a global problem we must be aware that this is on our doorstep and now when so many people travel throughout the globe it is imperative that travel immunisation is considered if you wanting to travel or in a high risk occupation.
In 2011 there were 160 reports of acute hepatitis B in London, a 13% increase from 141 in 2010. This corresponds to an incidence rate of 2.06 per 100,000 population, which is nearly twice the national rate (England rate 1.13 per 100,000) and nearly double that seen in any other region. The highest rates of acute hepatitis B infection were in Islington, Brent, Newham, Lambeth, Hackney and Tower Hamlets.
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Do you have concerns?
If you have any concerns regarding Hepatitis this can be screened in the practise by an ordinary blood test or it is possible to attend a GUM clinic on Level 8 at Ealing Hospital

GUM stands for genito-urinary medicine. The clinic can help you with any concerns you have about sexually transmitted infections (STIs).

It provides a walk-in and limited appointments based service. To make an appointment call (020) 8967 5555 during clinic opening times only.

Monday 9-11:30am Male and female walk-in
Five male appointments available
4-6:30pm Male and female walk-in
Five female appointments available

Tuesday 4-6pm 19 and under female walk-in

Wednesday 9-11:30am Female walk-in
2-4:30pm Male and female walk-in

Thursday 2-4:30pm Male and female walk-in

Please be aware that waiting times may vary, so please allow a minimum of one and a half hours for your visit.

Your results: Ealing GU clinic operates a no news is good news policy. We only contact you within two weeks of having your initial tests, if a result is positive. You can also get your results from the results line which is ONLY available during 9am-12pm on a Tuesday morning. You must have your clinic number to get your results.
More details are available on the following website
http://www.level-8.org/index.html
You can use this website to learn more about safer sex, infections or the services offered by the young women’s clinic.
GUM clinics are provided throughout the UK to find a clinic near you simply click on the following

http://www.nhs.uk/Service-Search/Sexual%20health%20information%20and%20support/LocationSearch/734

If you are concerned you may have had or you could be in contact with
Hepatitis B. Immunisation is available at the surgery, travel clinic or GUM clinic.
Travel clinics

http://www.travelvaccination.co.uk/?gclid=CJKwmZzP0bgCFXTJtAod-zQA9w
Our local clinic in Hounslow and Southall
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http://www.globetrotterstravelclinics.com/

Globetrotters Travel Clinics are one stop shops for all of your Travel Health needs. They provide Travel Health advice and services, as well as premium Travel Health Products.

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What does hepatitis B immunisation involve?

For full protection, you will need three injections of hepatitis B vaccine over four to six months.
You will have a blood test taken one month after the third dose to check the vaccinations have worked.
You should then be immune (resistant to the virus) for at least five years. You can have a booster injection five years after the initial injection.

Hepatitis B vaccine on the NHS
GP surgeries and sexual health or GUM clinics usually provide the hepatitis B vaccination free of charge if you are in an at risk group.
GPs are not obliged to provide the hepatitis jab on the NHS if you’re not thought to be at extra risk.
GPs may charge for the vaccine if you want it as a travel vaccine, or they may refer you to a travel clinic so you can get vaccinated privately. The current cost of the vaccine (in 2013) is around £30 a dose.

How safe is the hepatitis B vaccine?
The hepatitis B vaccine is very safe and other than some redness and soreness at the site of the injection, side effects from it are rare.
Read more about vaccine safety and side effects.

Emergency hepatitis B vaccination
If you’ve been exposed to the hepatitis B virus and have not been vaccinated before, you should immediately have the hepatitis B vaccine plus an injection of antibodies called specific hepatitis B immunoglobulin (HBIG). This is because the vaccine doesn’t work straight away. The immunoglobulin works immediately, albeit temporarily, so you’re protected until the vaccine starts to work.
Immunoglobulin should ideally be given within 48 hours, but you can still have the jab up to a week after exposure.

Babies and hepatitis B vaccination
Babies born to mothers infected with hepatitis B can be given a dose of the hepatitis B vaccine after they are born. This is followed by another two doses (with a month in between each) and a booster dose 12 months later.
Some babies also have an injection of immunoglobulin after they are born to help prevent infection.

HEPATITIS EFFECTS EVERYONE EVERYWHERE: KNOW IT CONFRONT IT AND PROTECT YOURSELF

“see no evil, hear no evil, speak no evil”

 

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Rotavirus

Immunisation against rotavirus
 
There is an effective vaccine against rotavirus. The vaccine has been used in many countries and has been shown to be safe and effective.
 
In the UK it has now been decided to routinely vaccinate babies against rotavirus. From July 2013 babies will receive drops (by mouth) to help prevent rotavirus. These drops will be given at 2 and 3 months old. The vaccines will be given at the same time as their other routine vaccinations.
UK vaccination programme
The oral vaccine is expected to halve the number of cases of vomiting and diarrhoea caused by rotavirus and lead to 70% fewer hospital stays. 
The following sites will tell you more
 
 
 
What is rotavirus?image
Around 18,000 children are thought to be admitted to hospital each year in England and Wales because of rotavirus infection. Most children with rotavirus infection do not need admission to hospital. About 1 child in 10 who has rotavirus infection needs to be admitted to hospital.
Rotavirus is a viral infection that can cause gastroenteritis. Gastroenteritis is an infection of the gut (intestines) which usually causes symptoms of being sick (vomiting) and diarrhoea.  In most cases the infection clears within a few days, but sometimes takes longer. The main risk is a lack of fluid in the body (dehydration) and so the main treatment is to give your child lots to drink. It mainly affects young children, especially children between the ages of 6 months and 2 years.
With vomiting and diarrhoea, there is a risk of your child becoming lacking in fluid in their body (dehydrated). You should consult a doctor quickly if you suspect that your child is becoming dehydrated. Mild dehydration is common and is usually easily and quickly treated by drinking lots of fluids. Severe dehydration can be fatal unless quickly treated because the organs of the body need a certain amount of fluid to work normally.
 
Symptoms of dehydration – associated with any cause of gastroenteritis
In children symptoms include passing little urine, a dry mouth, a dry tongue and lips, fewer tears when crying, sunken eyes, weakness, being irritable or having no energy.
Symptoms also include drowsiness, pale or mottled skin, cold hands or feet, very few wet nappies, and fast (but often shallow) breathing. This is a medical emergency and immediate medical attention.
 
Fluids to prevent dehydration
You should encourage your child to drink plenty. The aim is to prevent dehydration. The fluid lost in what they bring up (their vomit) and/or their diarrhoea needs to be replaced. Your child should continue with their normal diet and usual drinks. In addition, they should also be encouraged to drink extra fluids. However, avoid fruit juices or fizzy drinks, as these can make diarrhoea worse.
If your child is mildly dehydrated, this may be treated by giving them rehydration drinks. Your doctor or nurse will advise about how to make up the drinks and about how much to give. This can depend on the age and the weight of your child. If you are breast-feeding, you should continue with this during this time. Otherwise, don’t give your child any other drinks unless the doctor or nurse has said that this is OK. It is important that your child is rehydrated before they have any solid food.
 
Babies under 6 months old are at increased risk of dehydration. You should seek medical advice if they develop gastroenteritis. Breast or bottle feeds should be encouraged as normal. You may find that your baby’s demand for feeds increases. You may also be advised to give extra fluids (either water or rehydration drinks) in between feeds.
 
Rehydration drinks may be advised by a healthcare professional for children not drinking enough or with severe diarrhoea and vomiting; especially if they have passed six or more very loose stools (faeces) or vomited three or more times in the previous 24 hours. They are made from sachets available from pharmacies and on prescription. You should be given instructions about how much to give. Rehydration drinks provide a perfect balance of water, salts, and sugar. The small amount of sugar and salt helps water to be absorbed better from the gut (intestines) into the body. Do not use home-made salt/sugar drinks, as the quantity of salt and sugar has to be exact.
 
If your child vomits, wait 5-10 minutes and then start giving drinks again, but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger children who may not be able to take sips.
 
Note: if you suspect that your child is dehydrated, or is becoming dehydrated, you should seek medical advice urgently.
 
Sometimes a child may need to be admitted to hospital for treatment if they are dehydrated. Treatment in hospital usually involves giving rehydration solution via a special tube called a nasogastric tube. This tube passes through your child’s nose, down their throat and directly into their stomach. An alternative treatment is with fluids given directly into a vein (intravenous fluids).
 
Eat as normally as possible once any dehydration has been treated
Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, then encourage your child to have their normal diet. Do not ‘starve’ a child with rotavirus infection. This used to be advised but is now known to be wrong. 
 
Breast-fed babies should continue to be breast-fed if they will take it. This will usually be in addition to extra rehydration drinks (described above).
Bottle-fed babies should be fed with their normal full-strength feeds if they will take it. Again, this will usually be in addition to extra rehydration drinks (described above).
Older children – offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important, and food can wait until the appetite returns.
Medication is not usually needed
You should not give medicines to stop diarrhoea to children under 12 years old. They are unsafe to give to children, due to possible serious complications. However, you can give paracetamol or ibuprofen to ease a high temperature (fever) or headache.
 
How is rotavirus spread?
Rotavirus is present in the gut (intestines) of an infected person and can pass out in their diarrhoea. It is easily spread from an infected person to another by close contact. This is often because the virus is on the infected person’s hands after they have been to the toilet. For smaller children who wear nappies, it may be spread by the hands of the person changing the infected child’s nappy. Surfaces or objects touched by the infected person can also allow the virus to spread. The virus can be passed on if the infected person prepares food. Outbreaks of rotavirus that affect many people can occur – for example, in nurseries or schools.
 
NB Although this is advise in a case of Rotavirus  the same advice should be followed in all cases of gastroenteritis. 
 
 

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