Acute Respiratory Infections / Pneumonia

At the end of the session, the students should be able to:
a)
b) list the types and clinical features of Acute Respiratory Infections (ARI)
c) explain the epidemiological determinants of ARI
d) classify the illness based on signs during clinical assessment describe the elements of management of ARI
e) enumerate various preventive measures for control of ARI

1. 21-02-2019 Dr Tanveer Rehman PSM JIPMER 1

2. Navin Paul Born – 01.01.2018 Died – 10.03.2018 21-02-2019 Dr Tanveer Rehman PSM JIPMER 2

3. ACUTE RESPIRATORY INFECTIONS (ARI) EPIDEMIOLOGY OF COMMUNICABLE DISEASES Dr Tanveer Rehman Junior Resident PSM, JIPMER

4. Specific Learning Objectives At the end of the session, the students will be able to: list the types and clinical features of Acute Respiratory infections (ARI) classify the illness based on signs during clinical assessment describe the elements of management of ARI explain the epidemiological determinants of ARI enumerate various preventive measures for control of ARI 21-02-2019 4 Dr Tanveer Rehman PSM JIPMER

5. Introduction 21-02-2019 5 I. Upper ARI (AURI) Common cold, pharyngitis, otitis media, epiglottitis, laryngitis II. Lower ARI (ALRI) Laryngotracheitis, bronchitis, bronchiolitis, pneumonia Clinical features : running nose, cough, sore throat, ear problem, fever, difficult breathing Dr Tanveer Rehman PSM JIPMER

6. Pneumonia 90% of ARI deaths Deadliest childhood disease Nearly one-fifth of childhood deaths worldwide In India – 18% of all ‘under five years’ deaths 6 Dr Tanveer Rehman PSM JIPMER 21-02-2019

7. Pneumonia 90% of ARI deaths Deadliest childhood disease Accounts for 15% of under 5 childhood deaths worldwide only one third of children with pneumonia receive the antibiotics they need In India – 18% of all ‘under five years’ deaths India had the second-highest number of deaths of children under the age of five in 2018 due to pneumonia Dr Tanveer Rehman PSM JIPMER 7 21-02-2019

8. Epidemiological determinants 21-02-2019 8 Dr Tanveer Rehman PSM JIPMER

9. Agent Bacteria Streptococcus pneumoniae Haemophilus influenzae type B Streptococcus pyogenes Staphylococcus pyogenes Klebsiella pneumonia Corynebacterium diphtheriae Virus Respiratory syncytial virus Pneumocystis jiroveci Adenovirus Influenza Measles Rhinovirus Coronavirus 21-02-2019 9 Dr Tanveer Rehman PSM JIPMER

10. Agent 21-02-2019 10 Others Chlamydia type B 2.Coxiella burnetti 3.Mycoplasma pneumoniae Dr Tanveer Rehman PSM JIPMER

11. Epidemiological determinants Host Infants and young children Elderly Adult women Nutritional status Low birth weight Environment Overcrowding Indoor air pollution Climate 21-02-2019 11 Dr Tanveer Rehman PSM JIPMER

12. Epidemiological determinants Transmission The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention. 21-02-2019 12 Dr Tanveer Rehman PSM JIPMER

13. Management of ARI 21-02-2019 13 Dr Tanveer Rehman PSM JIPMER

14. Clinical assessment His tory taking Physical examination Count the breaths in one minute Look for chest indrawing Look and listen for stridor and wheeze Check if abnormally sleepy or difficult to wake Check for severe malnutrition and fever/hypothermia 21-02-2019 14 Dr Tanveer Rehman PSM JIPMER

15. Integrated Management of Neonatal and Childhood Illness (IMNCI) Elements for management of a sick child Assess : danger signs, examine, checking nutrition and immunization status Classify : colour-coded triage Identify specific treatment Treatment instructions Counsel and follow up care 21-02-2019 15 Dr Tanveer Rehman PSM JIPMER

16. Classification A. Child aged 2 months – 5 years Very severe disease / Severe pneumonia Pneumonia No pneumonia: cough or cold B. Child aged less than 2 months Very severe disease / Severe pneumonia Local bacterial infection Severe disease or local infection Unlikely 21-02-2019 16 Dr Tanveer Rehman PSM JIPMER

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18. 21-02-2019 18 Dr Tanveer Rehman PSM JIPMER

19. Child aged 2 months – 5 years 21-02-2019 19 Dr Tanveer Rehman PSM JIPMER

20. Child aged 2 months – 5 years 21-02-2019 20 Dr Tanveer Rehman PSM JIPMER

21. Child aged 2 months – 5 years 21-02-2019 21 Dr Tanveer Rehman PSM JIPMER

22. Child aged less than 2 months 21-02-2019 22 Dr Tanveer Rehman PSM JIPMER

23. Child aged less than 2 months 21-02-2019 23 Dr Tanveer Rehman PSM JIPMER

24. Child aged less than 2 months 21-02-2019 24 Dr Tanveer Rehman PSM JIPMER

25. Prevention of ARI 1. Living conditions 2. Nutrition including EBF 3. Maternal and child care 4. Immunization a. Measles Rubella (MR) and Vitamin A vaccine b. Haemophilus influenza type B (Hib) vaccine & Pertussis c. Pneumococcal conjugate vaccine (PCV) 21-02-2019 25 Dr Tanveer Rehman PSM JIPMER

26. Global action plan for pneumonia and diarrhoea (GAPPD) The WHO and UNICEF integrated response protect  children from pneumonia including promoting exclusive breastfeeding and adequate complementary feeding; prevent  pneumonia with vaccinations, hand washing with soap, reducing household air pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed children; treat  pneumonia focusing on making sure that every sick child has access to the right kind of care -- either from a community-based health worker, or in a health facility if the disease is severe -- and can get the antibiotics and oxygen they need to get well; a 75% reduction in incidence of severe pneumonia and diarrhoea from 2010 levels among children under five, and the virtual elimination of deaths from both diseases in the same age-group. 21-02-2019 26 Dr Tanveer Rehman PSM JIPMER

27. Global action plan for pneumonia and diarrhoea (GAPPD) 21-02-2019 27 Dr Tanveer Rehman PSM JIPMER

28. Summary 21-02-2019 28 Dr Tanveer Rehman PSM JIPMER

29. THANK YOU 21-02-2019 29 Dr Tanveer Rehman PSM JIPMER