Acute respiratory infection control and prevention

1. Ari control and prevention nikita johanna soans 32

2. ARI control Improving the primary medical care services and developing better methods for early detection , treatment and prevention of acute respiratory infection is the best way to control ARI mortality rate due to pneumonia is reduced if treated correctly Education of mothers about pneumonia because compliance with treatment and seeking proper care when child suffers determine outcome of the disease

3. WHO recommendation for management of ARI Clinical assesment History taking and management are very important Note :1)age 2)feeding habits 3)fever 4)convulsions 5)irregular breathing 6)history of treatment during the illness 7)activity

4. Physical examination 1:count the breaths in one minute Breathing count depends on the age of the child Count respiratory rate for a minute Fast breathing is present when RR is -60 breaths /min or more in a child less than two months of age -50/min or more in child aged 2months upto 12 months -40 breaths/min or more in a child aged 12 months upto 5 years

5. Chest indrawing Look for chest indrawing when child breaths IN Child has indrawing if the lower chest wall goes in when the child breaths IN Occurs when the effort required to breath in ,is much greater than normal Stridor Harsh noise while breathing IN is stridor Occurs due to narrowing of trachea ,larynx or epiglottis These conditions often called croup

6. Wheeze A child with wheeze makes a soft whistling noise OR shows signs that breathing OUT is difficult This is due to narrowing of the air passages Fever Check for body temperature Cyanosis Sign of hypoxia

7. Malnutrition If malnutrition is present its high risk and case fatality rates are higher In severely malnourished: 1) children with pneumonia, fast breathing and chest indrawing may not be evident 2)Impaired or absent response to hypoxia and a weak or absent cough reflex 3)Careful evaluation and mangement

8. ARI control programmes ARI control in children ARI is an episode of acute symptoms & signs resulting from infection of any part of respiratory tract & related structures Constitutes 22-66% of outpatients & 12-45% of inpatients In India: 10-50 children die per 10,000 episodes of ARI

9. ARI control programmes Crux of the program is to identify children with ARI at the community level by training the field workers to recognize easily & reliably identifiable clinical signs of ARI & early reference WHO protocol comprises 3 steps: Case finding & Assessment Case Classification Institution of appropriate therapy

10. Step 1: Case finding & Assessment Cough & difficult breathing in children < 5 years age Fever is not an efficient criteria

11. Step 2: Case Classification Children grouped into 2: Infants < 2months & Older children Specific signs to be looked: In younger children like feeding difficulty, lethargy, hypothermia, convulsions

12. In infants < 2 months Pneumonia is diagnosed if RR 60/min with other clinical signs All should be hospitalized All should receive IV medications Minimum duration of 10 days Combination of Ampicillin & Gentamicin

13. step 3:Institution of appropriate therapy Antibiotics

14. P revention of ARI Breastfeeding infants exclusively (no other food or drinks, not even water) for the first six months breast milk has excellent nutritional value and it contains the mother’s antibodies which help to protect the infant from infection.

15. Avoiding irritation of the respiratory tract by indoor air pollution, such as smoke from cooking fires; avoid the use of dried cow dung as fuel for indoor fires. Immunization of all children with the routine Expanded Programme on Immunization Feeding children with adequate amounts of varied and nutritious food to keep their immune system strong.

16. control the spread of respiratory bacteria by educating parents to avoid contact as much as possible between their children and patients who have ARIs. people with ARIs should cough or sneeze away from others, hold a cloth to the nose and mouth to catch the airborne droplets when coughing or sneezing Immunization also increases control, by reducing the reservoir of infection in the community and increasing the level of herd immunity

17. immunization

18. measles vaccine Pneumonia is a serious complication of measles Reducing the incidence of measles helps reduce death from pneumonia Live attenuated vaccine Freeze dried product 0.5ml dose subcutaneously also effective intramuscularly Schedule :9 th month

19. HIB vaccine Haemophilus influenza B most important cause of death due to meningitis and pneumonia in developing countries Available for more than a decade Expensive Included in the IAP immunization schedule combined preparation with DPT and poliomyelitis Three or four doses are given dependin on type of vaccine Schedule : 6 ,10, 14 weeks booster dose 12-18 months Vaccine is not offered to children more than 24 months

20. Pneumococcal vaccine A)ppv23: polysaccharide non conjugate vaccine containing capsular antigen of 23 serotypes against this infection Children under two years and immunocompromised do not respond well to this vaccine Select groups –sickle cell disease ,chronic heart disease , DM, organ transplants etc Dose -0.5ml Administration – intramuscular in the deltoid

21. Pcv-7: pneumococcal conjugate vaccine New vaccine suitable for infants and toddlers It is included in the IAP immunization schedule Induces a t- cell dependent immune response Prevents pneumococcal pneumonia and meningitis moderately effective against otitis media dose- 1)6,10,14 weeks ,booster after 12 months OR 2)2, 4,6 months and booster after 12 months administration-intramuscular

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