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EPIDEMIOLOGY OF ARI
This document discusses the epidemiology of acute respiratory infections (ARI). It begins by defining ARI and describing how it is classified based on the site of infection, such as upper or lower respiratory tract. It then discusses the common microbial causes of ARI including various bacteria and viruses. Host factors and risk factors for ARI are described such as age, nutrition status, and environmental conditions. The document provides details on clinical assessment, classification, and treatment of ARI based on severity of symptoms. Treatment recommendations are given for pneumonia cases as well as prevention strategies with a focus on immunization.
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ARI involves respiratory tract infections categorized as upper or lower. Symptoms include cough, cold, and potential severe cases in children.
Numerous microbial agents cause ARI, including bacteria (e.g., Streptococcus pneumoniae) and viruses (e.g., Influenza, Coronavirus).
Children, especially infants and malnourished ones, face higher risks. Factors include socioeconomic status and environmental conditions.
ARI organisms transmit via airborne routes. Clinical assessments focus on symptoms like cough duration, feeding ability, and respiratory rate.
Classification of ARI into severe pneumonia and very severe disease based on symptoms such as inability to drink, convulsions, and stridor.
ARI classification includes severe pneumonia, non-severe pneumonia, and cough/cold. Treatment varies based on severity and includes antibiotics.
Treatment protocols for pneumonia, including antibiotics, dosage schedules, and monitoring for improvement or complications.
Immunization is crucial in preventing ARI. Vaccines include measles, HIB, and pneumococcal vaccines aimed at reducing pneumonia cases.
Details on pneumococcal vaccines including administration guidelines, effectiveness, and importance for children.
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EPIDEMIOLOGY OF ARI
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- 3. • Infection ofthe respiratory tract is called ARI. • ARI may cause inflammation of the respiratory tract anywhere from nose to alveoli with a range of combination of symptoms depending on the site of infection.
- 4. • ARI isoften classified by clinical syndromes depending on the site of infection. • ARI may be (AURI) – Acute Upper Respiratory Infection or (ALRI) – Acute Lower Respiratory Infection.
- 5. • The lowerrespiratory tract infections include epiglottitis, laryngintitis, laryngotracheitis, bronchitis, bronchiolitis and pneumonia. • The upper respiratory infection include common cold, pharyngitis and otitis media.
- 8. • Clinical featuresinclude running nose, cough, sore throat, difficult breathing and ear problem. • Fever is also common in acute ARI.
- 9. • Most childrenhave minor symptoms such as cold or cough. • However some children may have pneumonia which is a major cause of death.
- 10. • Some timesmeasles and whooping cough are important causes of severe respiratory tract infection.
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- 13. • The microbialagents' that cause ARI are numerous. • They could be classified as bacteria, virus and other agents.
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- 15. VIRUS ADENO VIRUS ENTEROVIRUSES INFLUENZA (A,B,C) MEASLES PARAINFLUENZA RESPIRATORY SYNCYTIAL VIRUS RHINO VIRUS CORONA VIRUS
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- 18. • Small childrensuccumb to the disease within a matter of days. • Case fatality rates are higher in young infants and malnourished children.
- 19. • Adults arealso affected and the symptoms tend to be more among females.
- 20. RISK FACTORS • Climaticconditions and housing are noted as a major risk factor. • Overcrowding, poor nutrition, Low Birth Weight and intense indoor smoke pollution underline the high rates.
- 21. • Children fromlow socioeconomic status tend to have more episodes of ARI. • The infection is common in preschool children attending day care centers.
- 22. • Infections tendto be more in urban communities than in rural communities. • Maternal smoking has been linked to increased occurrence of respiratory tract infections during the first year of life.
- 23. MODE OF TRANSMISSION •The organisms are transmitted by the airborne route. • The chain of infection is maintained by direct person to person contact.
- 24. CLINICAL ASSESSMENT • Historytaking and clinical assessment is very important in the management.
- 25. NOTE THE FOLLOWING •Age of the child. • Duration of cough. • Whether the child is able to drink (2-5 Mo). • has the young infant stopped feeding well (child less than 2 Mo)
- 26. • Any antecedentillness such as measles. • If the child is excessively drowsy or difficult to wake. • Did the child have convulsions. • Is there irregular breathing.
- 27. • Short periodsof apnoea. • History of child turning blue. • History of treatment during illness. • Fever if any.
- 28. PHYSICAL EXAMINATION • Lookand listen to the following : • COUNT THE BREATHS IN ONE MINUTE….. • As the children get older their breathing rates slows down.
- 29. • Therefore thecutoff point used to determine if a child has fast breathing will depend on the age of the child.
- 30. • Count therespiratory rate one full minute using second’s hand of the watch looking at he abdominal movement or lower chest when the child is calm.
- 31. • The chestand the abdomen must be exposed for counting. • Increased respiratory rate (RR) is significant only if it persists.
- 32. FAST BREATHING IS PRESENTWHEN RR is
- 33. • 60 breaths/min or more in a child less than 2 Mo. • 50 breaths /min or more in a child aged 2 Mo up to 12 Mo. • 40 breaths /min or more in a child aged 12 Mo up to 5 years.
- 34. • Repeat thecount for a young infant (age less than 2 Mo) if the count is 60 breaths /min or more. • This is important because the breathing rate of young infant is often erratic.
- 35. • Occasionally younginfants stop breathing for a few seconds, and then breath very rapidly for a short period.
- 36. LOOK FOR CHEST INDRAWING •Look for chest indrawing when the child breaths IN.
- 37. • The childhas indrawing of the chest if the lower chest wall goes in while the child breaths in. • Chest in drawing occurs when the effort required to breath in, is much grater than normal.
- 38. LOOK AND LISTENFOR STRIDOR • A child with stridor makes a harsh noise when breathing IN.
- 39. • Stridor occurswhen there is narrowing of the larynx, trachea or epiglottis which interferes with the air entering the lungs. • These conditions are often called croup.
- 40. LOOK FOR WHEEZE •A child with wheeze makes a soft noise or shows signs that breathing OUT is difficult, wheezing is caused by narrowing of the air passage in the lungs. • The breathing-out phase takes longer than normal and requires effort.
- 41. • The breathing-outphase takes longer than normal and requires effort. • If the child has wheezing, ask the mother if her child had a previous episode of wheezing within the past year.
- 42. • If so,the child should be classified as having recurrent wheeze. • See if the child is abnormally sleepy or difficult to wake. An abnormally sleepy child is drowsy most of the time when he or she should be awake and alert.
- 43. • Feel forfever or low body temperature.
- 44. LOOK FOR SEVERE MALNUTRITION •Malnutrition when present is a high risk factor and case fatality rates are higher in such children.
- 45. • In severelymalnourished children with pneumonia, fast breathing and chest in drawing may not be as evident as in other children.
- 46. • A severelymalnourished child may have an impaired or absent response to hypoxia and a weak or absent cough reflex. • These children need careful evaluation for pneumonia as well as careful management.
- 47. • Cyanosis isa sign of hypoxia. • Cyanosis must be checked in good light.
- 48. CLASSIFICATION OF ARI 1.VERY SEVERE DISEASE. 2. SEVERE PNEUMONIA. 3. PNEUMONIA (Not Severe). 4. No pneumonia : cough or cold.
- 49. 1.VERY SEVERE DISEASE •The child presents the following manifestations: • NOT ABLE TO DRINK. • CONVULSIONS. • STRIDOR. • SEVERE MALNUTRITION.
- 50. NOT ABLE TODRINK • A child who is not able to drink could have severe pneumonia or bronchiolitis, septicaemia, throat abcess, meningitis or cerebral malaria.
- 51. CONVULSIONS • Convulsions, abnormallysleepy or difficult to wake : A child with these signs may have severe pneumonia resulting in hypoxia, sepsis, cerebral malaria or meningitis.
- 52. • Meningitis candevelop as a complications of pneumonia or it can occur on its own.
- 53. STRIDOR IN CALMCHILD • If a child has stridor when calm, the child may be in danger of life threatening obstruction of the airway from swelling of pharynx, trachea or epiglottis.
- 55. SEVERE MALNUTRITION • Aseverely malnourished child is at high risk of developing and dying from pneumonia. • In addition, the child may not show typical signs of the illness.
- 56. 2.SEVERE PNEUMONIA • Respiratoryrate is the most important sign to consider when assessing the child for pneumonia. • Presence of chest indrawing should also be noted.
- 59. • A childclassified under pneumonia has other signs such as: nasal flaring, when the nose widens as the child is breathing. • Grunting, the short sounds made with the voice when the child has difficulty in breathing.
- 60. • Cyanosis, adark bluish or purplish colouration of the skin caused by hypoxia. • Some children with chest in drawing also have wheezing.
- 61. 3.PNEUMONIA (NOT SEVERE) •A child who has fast breathing but no chest in drawing is classified as having pneumonia (not severe). • Most children are classified under this category if they are brought early for treatment.
- 62. 4.NO PNEUMONIA :COUGH ORCOLD • Most children with a cough or difficult breathing do not have any danger signs of pneumonia (chest indrawing/ fast breathing).
- 63. • These childrenhave simple cough/cold. • They do not need any antibiotic. The child gets better in 1-2 weeks.
- 64. EACH DISEASE CLASSIFICATION HASA CORRESPONDING TREATMENT PLAN
- 65. CLASSIFICATION SEVERE PNEUMONIA, COUGH,COLD SIGNS CHEST INDRAWING, WITH OR WITHOUT WHEEZE TREATMENT 1.TREAT FEVER IF PRESENT. 2.TREAT WHEEZING. 3.IF REFERAL IS NOT AVAILBALE TREAT WITH ANTIBIOTICS AND FOLLOW CLOSELY.
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- 67. SIGNS CHEST INDRAWING, WITHOR WITHOUT WHEEZE
- 68. TREATMENT • REFER URGENTLYTO HOSPITAL & GIVE FIRST DOSE OF ANTIBITIC. • TREAT FEVER IF PRESENT. • TREAT WHEEZING. • IF REFERAL IS NOT AVAILBALE TREAT WITH ANTIBIOTICS AND FOLLOW CLOSELY.
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- 70. SIGNS • NO CHESTIN DRAWING AND FAST BREATHING. • (50/min or MORE if child 2 months up to 12 months; 40 per min or more if child 12 months up to 5 years)
- 71. TREATMENT • ADVISE MOTHERTO GIVE HOME CARE. • ADMINSTER ANTIBIOTIC. • TREAT FEVER IF PRESENT.
- 72. • TREAT WHEEZINGIF PRESENT. • ADVISE MOTHER TO RETURN WITH CHILD IN 2 days for reassessment or earliest if the child is getting WORSE.
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- 74. SIGNS • NO CHESTIN DRAWING. • NO FAST BREATHING (LESS THAN 50/min if child 2 Mo up to 12 Mo; Less than 40 per min if child is 12 Mo up to 5 years).
- 75. TREATMENT • Assess andtreat ear problem or sore throat of present. • Assess and treat other problems.
- 76. • Advise motherto give home care. • Treat fever, if present. • Treat wheezing if present.
- 77. RE - ASSESSMENT •Re-assess in 2 days a child who is taking an antibiotic for pneumonia.
- 78. RE ASSESSMENT PARAMETER WORSETHE SAME IMPROVING SIGNS Not able to drink. Has chest indrawing. Has other danger signs. ------- ------- ------ -------- Breathing slower. Less Fever. Eating better. TREATMENT Refer URGENTLY to hospital Change antibiotic or refer Finish 5 days of antibiotics
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- 80. TREATMENT - INDIA •Co-trimoxazole is the drug of choice for the treatment of pneumonia. • Co-trimoxazole is less expensive with few side effects.
- 81. DOSAGE SCHEDULE AGE/WEIGHT PAEDIATRIC TABLET:SULPHAM ETHOXAZOLE100 mg & TRIMETHOPRIM 20 mg. PAEDIATRIC SYRUP: each spoon (5ml) : TABLET:SULPHAM ETHOXAZOLE 200 mg & TRIMETHOPRIM 40 mg. < 2 Mo Wt. 3-5 Kg. ONE TABLET TWICE DAILY HALF SPOON (2.5 ml TWICE A DAY)
- 82. DOSAGE SCHEDULE AGE/WEIGHT PAEDIATRIC TABLET:SULPHAM ETHOXAZOLE100 mg & TRIMETHOPRIM 20 mg. PAEDIATRIC SYRUP: each spoon (5ml) : TABLET:SULPHAM ETHOXAZOLE 200 mg & TRIMETHOPRIM 40 mg. 2 -12 Mo Wt. 6-9 Kg. TWO TABLETS TWICE DAILY ONE SPOON (5 ml TWICE A DAY)
- 83. DOSAGE SCHEDULE AGE/WEIGHT PAEDIATRIC TABLET:SULPHAM ETHOXAZOLE100 mg & TRIMETHOPRIM 20 mg. PAEDIATRIC SYRUP: each spoon (5ml) : TABLET:SULPHAM ETHOXAZOLE 200 mg & TRIMETHOPRIM 40 mg. 1-5 YRS. Wt. 10-19 Kg. THREE TABLETS TWICE DAILY ONE & HALF SPOON (7.5 ml TWICE A DAY)
- 84. TREATMENT OF SEVERE PNEUMONIA (2Mo -5Yrs)
- 85. (A) ANTIBIOTICS DOSE INTERVALMODE First 48 hrs Benzyl penicillin (OR) Ampicillin (OR) Chloramphenicol 50,000 IU /kg/dose 50mg/kg/dose 25mg/kg/dose 6 hourly 6 hourly 6 hourly IM IM IM
- 86. IF CONDITIONS IMPROVES,then for the next 3 days give: (B) ANTIBIOTICS DOSE INTERVA L MODE PROCAINE PENICILLIN (OR) AMPICILLIN (OR) CHLORAMPHENICOL 50,000 IU /kg/dose max 4 lac IU 50mg/kg/dose 25mg/kg/dose ONCE. 6 HOURLY 6 HOURLY IM Oral Oral
- 87. IF NO IMPROVEMENT;then for the next 48 hrs CHANGE THE ANTIBIOTIC (B) • If ampicillin is used change to chloramphenicol. (IM) Cont….
- 88. • If chloramphenicolis used, change to Cloxacillin 25 mg/kg/dose, every 6 hours along with gentamycin 2.5 mg/kg/dose/8 hrs. • If condition improves continue treatment orally.
- 89. THE DOSES CANBE ROUNDED OFF TO NEAREST ADMINISTRABLE DOSE • C - PROVIDE SYMPATOMATIC TREATMENT FOR FEVER & WHEEZING, IF REQUIRED. • D -MONITOR FOOD & FLUID INTAKE. • E - ADVISE MOTHER ON HOME MANAGEMENT ON DISCHARGE.
- 90. TREATMENT OF PNEUMONIA INCHILDREN AGED LESS THAN 2 MONTHS
- 91. ANTIBIOTIC DOSE AGE, 7 DAYS AGE , 7 DAYS to 2 Mo Inj BENZYL PENICILLIN OR Inj AMPICILLIN AND Inj Gentamycin 50,000 IU/kg/dose 50 mg/kg/dose 2,5 mg/kg/dose 12 hourly 12 hourly 12 hourly 6 hourly 8 hourly 8 hourly
- 92. MANAGEMENT OF CHILDREN WITHNO PNEUMONIA • Symptomatic treatment is given. • DO NOT ADMINISTER ANTIBIOTICS
- 93. PREVENTION OF ARI •Immunization is an important measure to reduce the incidence of ARI. • Health promotional activities should be undertaken .
- 94. IMMUNIZATION • Vaccine holdpromise of saving millions of children dying of pneumonia. • Three vaccines have potential of reducing deaths from pneumonia.
- 95. THEY ARE : 1.MEASELES VACCINE. 2. HIB VACCINE. 3.PNEUMOCOCCAL PNEUMONIA VACCINE.
- 96. MEASLES VACCINE • InIndia MMR – a trivalent vaccine is administered to infants on completing 9 months of age. • Pl refer Epidemiology of measles.
- 97. HIB VACCINE • Haemophilusinfluenza B (HIB) is an important cause of pneumonia and meningitis among children. • It’s high cost has posed obstacle to its utilization in the developing countries.
- 99. • The vaccineis often given as a combined preparation with DPT. And polio vaccine. • Three or four doses are given depending the type of manufacturers. (6,10,14 weeks and booster dose at 14 months)
- 100. • The vaccineis not offered to children aged more than 24 months. • No serious side effects have been recorded .
- 101. PNEUMOCOCCAL PNEUMONIA VACCINE • PPV23,a polysaccharide non conjugate vaccine containing capsular antigens of 23 serotypes against this infection is available.
- 104. • A doseof 0.5ml of PPV23 contains 25 micrograms of purified capsular antigen. • PPV23 is administered as a single IM dose preferably in the deltoid muscle.
- 105. • Protective capsulartype specific antibody generally develop by the third week following vaccination.
- 106. • Two conjugatevaccines are available since 2009 (PCV10 & PCV13). • The recommended storage temperature is between 2 & 8 degree Celsius.
- 107.