YELLOW FEVER FOR DME in Midwifery .pptx

YELLOW FEVER FOR DME

1. BY NABBOLA STEPHEN CLINICAL INSTRUCTOR SALEM SCHOOL OF NURSING AND MIDWIFERY YELLOW FEVER FOR DME

2. Presentation outline Definition Causes Epidemiology Clinical picture Differential diagnosis Treatment Complication Prevention

3. Definition Is an acute viral heamorrhagic disease caused by yellow fever virus transmitted by an infected Aedes mosquitoes characterised bysudden onset of fever,chills,severe headache,back pain.

4. Epidmeiology is an illness of widely varying severity. It is confined to Africa (90% of cases)and South America between latitudes 15°N and 15°S. For poorly understood reasons, yellow fever has not been reported from Asia, despite the fact that climatic conditions are suitable and the vector, Aedes aegypti , is common.

5. Modes of transmission The infection is transmitted in the wild by Aades . africanus in Africa Extension of infection to humans (via the mosquito from monkeys ) leads to the occurrence of ‘ jungle’ yellow fever. Aades aegypti , a domestic mosquito which lives in close relationship to humans, is responsible for human-to-human transmission in urban areas (urban yellow fever). Once infected, a mosquito remains so for life.

6. Clinical presentation The incubation period is 3–6 days. Mild infection is indistinguishable from other viral fevers such as influenza or dengue. Three phases in the severe (classical) illness are recognized. Initially, the patient presents with a high fever of acute onset , usually 39–40°C, which then returns to normal in 4–5days During this time, headache is prominent. Retrobulbar pain(back of the eye), myalgia , arthralgia, a flushed face and conjunctivitisare common.

7. Clinical presentations continues Epigastric discomfort and vomiting are present when the illness is severe. Relative bradycardia ( Faget’s sign) is present from the second day of illness. The patient then makes an apparent recovery and feels well for several days. Following this ‘phase of calm’, the patient again develops increasing fever, deepening jaundice and hepatomegaly

8. Clinical presentations continues Ecchymosis , bleeding from the gums, haematemesis and melaena may occur. Coma, which is usually a result of uraemia or haemorrhagic shock, occurs for a few hours preceding death. The mortality rate is up to 40% in severe cases. The pathology of the liver shows mid-zone necrosis and eosinophilic degeneration of hepatocytes (Councilman bodies)

9. Diagnosis The diagnosis is established by a history of travel and vaccination status and by isolation of the virus (when possible) from blood during the first 3 days of illness. Serodiagnosis is possible , but in endemic areas cross-reactivity with other flaviviruses is a problem.

10. Treatment Treatment is supportive. Bed rest (under mosquito nets ), analgesics and maintenance of fluid and electrolyte balance are required.

11. Prevention and control Yellow fever is an internationally notifable disease . It is easily prevented using the attenuated 17D chick embryo vaccine but concerns over safety have arisen because of infection with the 17D virus. Vaccination is not recommended for children under 9 months or immunosuppressed patients, unless there are compelling reasons

12. Prevention continues For the purposes of international certification , immunization is valid for 10 years, but protection lasts much longer than this and probably for life. The WHO Expanded Programme of Immunization includes yellow fever vaccination in endemic areas.

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