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Medical Illnesses of School Health Importance Dr Thoon Koh Cheng Associate Consultant, ID Service
Epidemiology • From early infancy to toddler age, immune system is still constantly being challenged/ matured • May get ~6 infections/ year; double if exposed to secondhand smoke • Seasonal peaks occur, e.g. beginning of school, just after holidays, peak viral (e.g. flu) seasons
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What Causes Infection/ Infectious Diseases?
Viruses •Cause of many common childhood infections (e.g. common cold, gastric flu) •Antivirals may help but usually not required; Antibiotics don’t work Parasites •Uncommon cause of infections locally, but very common in developing nations (i.e. our neighbours!) (e.g. scabies, malaria) •Anti-parasitic drugs often required for treatment
“GERMS” Fungi •Uncommon cause of infections (e.g. oral thrush, skin infections “athlete’s foot”) •Anti-fungals usually required for treatment
Bacteria •Cause of many serious infections (e.g. bacterial pneumonia/ meningitis) •Antibiotics often required for treatment
• The GOOD NEWS is that most of these infections are mild and self-limiting!
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• The BAD NEWS is that some of these infections (and our reactions to them) can be deadly or chronic …
How can we tell them apart? When should we be worried?
Fever: Friend or Foe? • It is common to develop fever during an episode of infection • Fever is not a disease in itself – it is a sign that the body is mounting a response to fight infection (‘pyrogens’) • Fever in itself is not damaging to the child (even ‘high fever’) • But, fever may lead to fits (3%)
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General Warning Signs • Markedly reduced activity/ play (from extreme tiredness/ sleepiness) • Refusing to eat and drink; infrequent or not passing urine • Persistent vomiting or diarrhoea • Persistent irritability/ crying (or a weak cry) • Persistent pain
Specific Warning Signs Meningitis/ brain infections • Drowsy, difficult to rouse from sleep • Disoriented, doesn’t recognize parents, incoherent speech • Abnormal posture • Fits
Specific Warning Signs Chest Infections • Breathless • Noisy breathing (wheeze, stridor) • Marked in-drawing of the chest (retractions) • Blue at the lips
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Specific Warning Signs Bloodstream/ severe infections • Rashes • Pale/ mottled appearance • Cold, clammy hands and feet (normal colour fails to return after pressure)
Specific Warning Signs • When in doubt, seek help …
• The BEST NEWS is that many infectious diseases can be prevented by amazingly simple and inexpensive methods …
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Tips for Good Health • • • •
Wash your hands frequently Cover your mouth when you cough Try not to touch your eyes, nose, mouth Avoid close contact with people who are sick – stay at home if you’re sick • Watch what you eat • Get enough exercise and rest • Get the necessary vaccinations!
Prevention Strategies • Handwashing • Cleaning/ Disinfection • Food • Pets
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HANDWASHING • Frequent hand washing is one of the best ways to prevent the spread of infection. • One of the commonest ways to catch an infection (e.g. gastric flu) is to touch our eyes, rub our noses or lick our fingers (or bite our nails!) after touching a contaminated surface without having washed our hands.
HANDWASHING • When? • Before, during and after you prepare food • Before you eat, and after you use the toilet • After cleaning up children and handling their wastes • After handling animals or animal waste • When your hands are dirty • More often if someone else is sick at home • Remember: if you don’t do it, the children won’t
HANDWASHING • How?
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CLEANING/ DISINFECTION • Routine cleaning and disinfection of surfaces reduces the risk of infection. • Need to identify “hot zones” at school, for greater care and disinfection • Play/ Meal Areas • Bathroom/ Toilet • When cleaning, be sure to follow instructions on the cleaning product labels, wear gloves, wash hands after you’re done
FOOD
• Practise caution (and common sense!) when you: • Buy food • Store raw food • Prepare and cook food • Eat food • Store leftover food
FOOD
When in DOUBT, throw it OUT!
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PETS (ANIMALS) • Don’t get a pet unless the school is committed to caring for it! • Adopt or buy • Visit the Vet regularly • Give it a balanced diet • Don’t let it near the kitchen • Clean it and it’s living area regularly • Wash your hands more often
PETS (ANIMALS) • What if you get bitten or scratched by your pet (or any animal)? • Wash with soap and water • Apply antibacterial medication • Bandage the wound • Seek medical help (rabies, catscratch disease etc.) ØPregnant women/ toddlers
The Common Cold
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The Common Cold • Extremely common • Multiple types of viruses, each with multiple strains (“hundreds”) • Symptoms: fever, cough, runny nose, sore throat, sneezing, fatigue, poor appetite • Treatment: antipyretics, decongestants, antihistamines, antitussives, mucolytics • Usually self-limiting, but may lead to other complications (GE, bronchitis etc..)
Influenza
PB1, PB2, NS1, NS2 M1, M2
Seasonal Influenza • Common during outbreaks/ seasons (Northern vs Southern hemisphere) • Due to Influenza A and B viruses • Symptoms: similar to common cold, but less RN, more cough/ muscle aches • Treatment: symptomatic mainly; antivirals have to be given within 48h • Control: vaccinate, contact avoidance, personal hygiene
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Hand-Foot-Mouth Disease
HFMD • Endemic, but outbreak timing a/w speed of mutations and human susceptibility • >70 viral types (EV71- 2000, CA16- 2006) • Symptoms: fever, typical skin/ oral lesions, lethargy, vomiting/ diarrhoea • Treatment: symptomatic, hospitalisation for complications (fluids, heart, brain) • Control: personal hygiene, isolation 7-10d, PH measures when severe
Chickenpox “Let’s go for a chickenpox party!”
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Chickenpox • Extremely common, numbers ↑ recently • Symptoms: classic (2day prodrome followed by typical rash) vs atypical (esp. after vaccination; harder to diagnose) • Treatment: symptomatic ± antivirals (or vaccine/ immunoglobulin) given <72h • Commonly thought to be benign, but complications can be severe (brain, lung) • Control: isolation 7-10d, preventive vaccination, post-exposure measures
Seizures
Seizures • “(Brief) Period of unconsciousness which may be a/w muscles spasm, falls, frothing, loss of bladder/ bowel control or cessation of breathing” • Due to abnormal electrical activity of a part/ parts of the brain (“short-circuit”) • Always have a trigger: – Fever, salt disturbances (e.g. from dehydration), sleep deprivation, viral illness, flashing lights, smells etc..)
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Seizures – First Aid • STAY CALM! • (Time the seizure) • Turn the child to one (usually left) side (“recovery position”) • Remove dangerous objects from around the child • DO NOT insert anything in the mouth! • Call for help/ ambulance (esp. if >5 min)
Asthma/ Wheeze
Asthma • “Chronic, reversible, reactive airway inflammation” (vs bronchitis) • Increasing prevalence (1 in 5 children) • Interaction between genes/ environment • Triggers: house dust mite, viral illness, cool air, exercise, food (variable ++) • Symptoms: cough, runny nose, wheeze and breathlessness (may be fatal) • Treatment: inhalers, oxygen etc.. • Control: prevent attacks!
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Asthma – First Aid • • • •
STAY CALM! Give the (blue) rescue inhaler Sit upright If not better, call for ambulance – Keep giving the inhaler every 15 minutes till the ambulance arrives • (Take control! Prevent the next attack!)
Take Home Message • • • •
Infections Are Common Infections Are Preventable Fever Can Be A Good Sign Always remember first aid principles (“ABC”)
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