ACUTE DIARRHOEAL DISEASES & CHOLERA.pptx

The detailed information about Acute Diarrhoeal Diseases is covered in the PPT, including definitions and causes of Cholera, its management, and vaccination for common diarrhoeal conditions.

1. Acute Diarrhoeal Diseases & Cholera Dr. Kishor Sochaliya Professor & Head Community Medicine Deptt ., CUSMC

2. Outline of Session Definition of ADD Burden (Global & National) Causes Management Vaccine Cholera IMNCI Validation in India Diarrhoea in Immunocompromised

3. Acute Diarrhoea Diseases

4. Diarrhoea is defined by WHO – “The passage of 3 or more loose or liquid stools per day or more frequently than is normal for the individual” Usually a symptom of gastrointestinal infection . It is the change in consistency rather than number of stool which is important . Definition

5. Types of Diarrhoea

6. Leading killer of children, accounting for 9% of all deaths among children under 5 years in 2015. Most deaths from diarrhoea occur among children < 2 years of age living South Asia and Sub-Saharan Africa. Even though the total annual number of deaths from diarrhoea among children under 5 years decreased by more than 50% in the past decade - Many more children could be saved through basic interventions. Global Burden

7. Global Burden

8. Steady progress in reducing deaths in children younger than 5 years - Total deaths declining from 2.5 million in 2001 to 1.5 million in 2012. Even though the deaths among children under 5 years have declined - The proportional mortality accounted by diarrhoeal disease still remains high . Third most common cause of death in under 5 children, responsible for 13% deaths in this age group. Burden in India

9. Burden in India

10. Causal Pathway

11. Agent factor

12. Four pathogens significantly associated with moderate to severe diarrhoea – Rotavirus, Cryptosporidium, Shigella & ST-ETEC. Rotavirus - Highest number of cases compared to any pathogens during infancy . Moderate to severe diarrhoea prevalence - Highest in India Moderate to severe diarrhoea - Common in paediatric populations, produced more than 20 episodes per 100 child years during each of the first 2 years of life . Cryptosporidium - Significant pathogen at all sites regardless of HIV prevalence. Agent Factor

13. Most common - Children 6 months to 2 years of age. Highest incidence – 6 to 11 months which is period of weaning . Low level of maternally acquired AB Lack of active immunity in Infant Introduction of contaminated food Direct contact to human & animal faeces when infant crawls Malnutrition Poverty Lack of personal & domestic hygiene Incorrect feeding practices Host Factor

14. Seasonal pattern: Tropical areas – Rotavirus throughout the year and Bacteria in summer Temperate areas – Bacteria in summer and Tropical in winters Mode of Transmission – Faeco oral route Environmental Factor

15. E.coli : Watery stools Vomiting is common Dehydration – Moderate to severe Fever- Often of moderate grade Abdominal pain – Mild Rotavirus : Insidious onset Prodromal symptoms – Fever, cough & vomiting precede diarrhoea Stools - Watery or semi-liquid, colour – Greening or yellowish, Typically looks like yogurt mixed in water Dehydration – Mild to moderate Fever – Moderate grade Clinical features

16. Shigellosis : Frequent passage of scanty amount of stools, mostly mixed with blood & mucus. Moderate to high grade fever Severe abdominal cramps Tenesmus – Pain around anus during defaecation Usually no dehydration Amoebiasis : Offensive and bulky stools containing mostly mucus and sometimes blood Lower abdominal pain Mild grade fever No dehydration Clinical features

17. Assessment of Dehydration

18. IMNCI Classification

19. Stool Microscopy Stoll Cultures ELISA for Rotavirus Immunoassays, Bioassays or DNA Probe test to identify E.coli strains Laboratory Diagnosis

20. Management

21. Dehydration - Major cause of death in 1829 pandemic of Cholera. I/V fluid - Major and standard line of therapy for rehydration. Robert A. Phillip - Create an effective ORT solution but his solution was extensively hypertonic . In early 1960s - Biochemist Robert K. Crane described the Sodium Glucose Co-transport mechanism and its role in intestinal glucose absorption . Oral Rehydration Salt Solution (ORS)

22. 1967-68 - Norbert Hirschhorn & Nathaniel F. Pierce showed that people with severe Cholera can absorb Glucose , Salt & Water . In 1968 - David. R. Nalin reported that in adults with Cholera, given an Oral Glucose-Electrolyte solution in volumes equal to that of the diarrhoea losses, reduced the need for I/V fluid therapy by 80%. In 1971 - During the Bangladesh Liberation War an epidemic of Cholera happened. Dr. Dilip Mahalanabis - A physician ordered use of ORS in refugees and it was seen that mortality rate was 3.6% in those who received ORS compared to 30% who receive I/V fluid therapy. Oral Rehydration Salt Solution (ORS)

23. The WHO in 1978 - Launched the Global Diarrhoeal Disease Control Program with ORS and a short term objective of reduced mortality due to diarrhoea. 1980s – UNICEF launched the ‘ Child Survival and Development Revolution’ concentrating its effort on four potent methods of saving children’s life – GOBI (Growth Monitoring, use of ORS, Breastfeeding & Immunization). The British Medical Journal, The Lancet - Described ORS as ‘ Potentially the most important medical advance of this century’. Oral Rehydration Salt Solution (ORS)

24. Composition of reduced osmolarity ORS

25. Treatment Plan A

26. Treatment Plan B

27. Treatment Plan C

28. ReSoMal (ORS for Severely Malnourished Children) - Used in patient centres for the treatment of children with Severe Acute Malnutrition (SAM). SAM children are deficient in Potassium and have very high level of Sodium (Normal ORS is dangerous for them). Also deficient in other minerals like Magnesium , Copper , Zinc etc. Children with SAM and who have some or severe dehydration but no shock should receive 5 ml/kg ReSoMal every 30 minute for first 2 hour. Then if the child is still dehydrated 5-10 ml/kg/h ReSoMal should be given in alternate hours with F-75 up to a maximum of 10 hour. ReSoMal

29. Zinc benefits children with diarrhoea because it is a vital micronutrient essential for , Protein synthesis Cell growth and differentiation Immune function and Intestinal transport of water and electrolyte Important for normal growth and development of children Zinc deficiency – Increased risk of GI infection, adverse effect on structure and function of the GI tract, impaired immune function. Dietary deficiency of zinc – Common in low-income countries due to lower intake of zinc rich food. Zinc Supplementation

30. Reduce the severity and duration of diarrhoea in children under 5 years of age. Recommended - 10-20 mg/day of zinc should be given for 10-14 days to all children. Reduce the risk of diarrhoea for 3-4 months Zinc Supplementation

31. The infant’s usual diet should be continued during diarrhoea and food should never be withheld. In case of breastfeeding child, BF should always be continue. When food is given, sufficient nutrients are usually absorbed to support continued growth and weight gain . It also speeds the recovery of normal intestinal function , including the ability to digest and absorb nutrients . Feeding

32. Diarrhoea reduces the absorption of Vitamin A . Problem – If diarrhoea occurs during or shortly after measles or in children who are already malnourished . Therapeutic treatment – Oral Vitamin A solution once in a day for 2 days (2,00,000 IU – 1 to 5 years of age, 1,00,000 IU – 6 to 12 months & 50,000 - < 6 months). Advise mothers to give Vitamin A rich food routinely . Vitamin A & Diarrhoea

33. Access to safe drinking water Use of improved sanitation Hand washing with soap Exclusive Breastfeeding for the first 6 months of life Good personal & food hygiene Health education about how infections spread Rotavirus vaccination Key Measures to Prevent Diarrhoea