Case Definitions

Dr.Vijay YewaleConvener, IAP Committee on Immunization 2009-11 Editor, Pediatric Infectious Disease

vnyewale@gmail.com

Diseases covered• Pneumonia (PNUC and PNUR)• Acute Bacterial Meningitis

(ABMP/ABMM/ABMH/ABMO/ABME)• Diphtheria (DIPH)• Pertussis (PERT)• Measles (MEAS)• Mumps (MUMP)• Chickenpox (CPOX)• Enteric fever (EFTY /EFPT)• Dengue fever (DENF /DENH /DENS)• Hepatitis (HEPA, HEPB, HEPE, HEPO, HEPN)

PNEUMONIA• Clinical Pneumonia (PNUC)– High fever (> 38 Degree C) and – Tachypnea• > 60 breaths / min if aged < 2months• > 50 breaths / min if aged 2-11• > 40 breaths / min if aged 12m to <60 months

(Reasonably ruled out reactive airway disease)• Radiological Pneumonia (PNUR)– Abnormal chest radiograph suggestive of

Pneumonia

Microbiologic Diagnosis established

• No• Yes– Culture• isolation of a bacterial pathogen from pleural fluid or

blood

– Antigen detection• identification of a bacterial antigen in pleural fluid by

latex agglutination

– Antibody detection– Other • Gram stained smear of pleural fluid

Previous relevant vaccination • Not immunized (NI) : Not received any dose of

Pertussis, Hib and Measles containing vaccine or conjugate pneumococcal vaccine

• Partially immunized (PI) : Received either not all Pertussis, Hib and Measles containing vaccine and conjugate pneumococcal vaccine or not all age appropriate doses

• Fully immunized (FI): Received all age appropriate doses of Pertussis, Hib and Measles containing vaccines and conjugate pneumococcal vaccine

• Ineligible for Immunization (II): less than 6 weeks of age

ACUTE BACTERIAL MENINGITIS

• Acute onset of fever (usually > 38.5 °C rectal or 38.0 °C axillary and one of the following signs: Boggy fontanelle, seizures, neck stiffness, altered consciousness or other meningeal signs

WITH• Abnormal CSF– Turbid appearance OR– Leucocytosis (>100 cells / mm3) OR– Leukocytosis (10 – 100 cells / mm3 ) with elevated prot

>100mg% or CSF sugar <40 mg%

Microbiologic Diagnosis established • No• Yes– Culture• isolation of a bacterial pathogen from a normally sterile

clinical specimen such as CSF or blood

– Antigen detection• identification of a bacterial antigen in CSF by latex

agglutination

– Antibody detection– Other • Gram stained smear

• ABMP– ABM with S.Pneumo– +ve Gram stain / Latex / CSF or Blood culture

• ABMH– ABM with H.influenzae– +ve Gram stain / Latex / CSF or Blood culture

• ABMM– ABM with N.Meningitides– +ve Gram stain / Latex / CSF or Blood culture

• ABMO – ABM with organism other than P/H/N

• ABME– ABM with no microbiological diagnosis

Previous relevant vaccination(not applicable for ABMM and ABMN) • Not immunized (NI) : Not received any dose of

conjugate Pneumococcal and Hib vaccines• Partially immunized (PI) : Received either not

all of conjugate Pneumococcal and Hib vaccines or not all age appropriate doses

• Fully immunized (FI): Received all age appropriate doses of conjugate Pneumococcal and Hib vaccines

• Ineligible for Immunization (II) – Age less than 6 weeks

CHICKENPOX(CPOX)

• Vesicular rash starting on trunk and spreading to extremities in multiple stages of evolution

Microbiologic Diagnosis established

• No• Yes– Culture– Antigen detection– Antibody detection– Other

Previous relevant vaccination

• CPX vaccine – Not immunized (NI)• Not received any CPOX vaccine

– Partially immunized (PI) • Received one dose of CPOX vaccine

– Fully immunized (FI)• Received 2 doses of Chicken pox vaccine

– Ineligible for Immunization (II)• Age less than 15 months

ENTERIC FEVER

• Compatible clinical picture AND• EITHER blood culture positive OR• Positive TUBE WIDAL

( both H/ A/B and O > 1: 160) done beyond day 5 of fever

Microbiologic Diagnosis established

• No• Yes– Culture• S. Typhi or S.Paratyphi on blood culture

– Antigen detection – Antibody detection• WIDAL Test (both H/ A/B and O > 1: 160)

– Other

Previous relevant vaccination

• TY vaccine– Not immunized (NI)• Above 2 years and not received any typhoid

vaccine – Partially immunized (PI)• Time lapsed since last immunization > 3 years

– Fully immunized (CI)• Received typhoid vaccine within last 3 years

– Ineligible for Immunization (II)• Age less than 2 years

DIPTHERIA

• An illness characterised by laryngitis or pharyngitis or tonsillitis, and an adherent membrane of the tonsils, pharynx and/or nose

and

Isolation of Corynebacterium diphtheriae from a clinical specimen

Microbiologic Diagnosis established

• No• Yes– Culture• Isolation of Corynebacterium diphtheriae from a clinical

specimen OR

– Antigen detection– Antibody detection• 4 fold or greater rise in serum antibodies

– other• Gram stained smear

Previous relevant vaccination

• DPT vaccine (DTP)– Not immunized (NI)• Not received any dose of DTP

– Partially immunized (PI)• Received less than the age appropriate doses

– Fully immunized (FI)• Received all the age appropriate doses

– Ineligible for Immunization (II)• Age less than 6 weeks

PERTUSSIS

• Cough lasting at least two weeks with at least one of the following symptoms:– Paroxysms (i.e. fits) of coughing – Inspiratory whooping – Post-tussive vomiting (i.e. vomiting immediately

after coughing) without other apparent cause

Microbiologic Diagnosis established

• No• Yes– Culture• Isolation of Bordetella pertussis or +ve PCR

– Antigen detection– Antibody detection– Other

Previous relevant vaccination • DPT vaccine (DTP)– Not immunized (NI)• Not received any dose of DTP

– Partially immunized (PI)• Received less than the age appropriate doses

– Fully immunized (CI)• Received all the age appropriate doses

– Ineligible for Immunization (II)• Age less than 6 weeks

MEASLES

Any child with fever and maculopapular rash (i.e. non-vesicular) and cough, coryza (i.e. runny nose) or conjunctivitis (i.e. red eyes)

Microbiologic Diagnosis established

• No• Yes– Culture– Antigen detection– Antibody detection• Presence of measles-specific IgM antibodies

– Other

Previous relevant vaccination

• MEASLES vaccine– Not immunized (NI)– Partially immunized (PI)• Received only one dose of Measles containing

vaccine– Fully immunized (FI)• Received 2 doses of Measles containing vaccine

– Ineligible for Immunization (II)• Age less than 9 months

Mumps

 • Acute onset of unilateral or bilateral tender,

self-limited swelling of the parotid or othersalivary gland, lasting two or more days and without other apparent cause

Microbiologic Diagnosis established

• No• Yes– Culture– Antigen detection– Antibody detection– Other Not a

pplicable

Previous relevant vaccination

• MMR vaccine– Not immunized (NI)• Not received any Mumps containing vaccine

– Partially immunized (PI)• Received at least 1 dose of Mumps containing

vaccine– Fully immunized (FI)• Received 2 doses of Mumps containing vaccine

– Ineligible for Immunization (II)• Age less than 15 months

DENGUE• DENF • An acute febrile illness of 2-7 days duration

with two or more of the following manifestations:– Headache, retro-orbital pain, myalgia, arthralgia,

rash, haemorrhagic manifestations• DENH (Thrombocytopenia + evidence of

capillary leak i.e. 20% increase in Hct or ple effusion or ascites)

• DENS (DHF with evidence of shock) 

Microbiologic Diagnosis established

• No• Yes– Culture– Antigen detection• NS1 Antigen test

– Antibody detection• Positive Dengue serology IgG and IgM

– Other • PCR

Previous relevant vaccination

Not applicable

HEPATITIS

• An acute illness typically including acute jaundice, dark urine, anorexia, malaise, extreme fatigue and right upper quadrant tenderness

• Urine Bile pigments (urobilinogen) +ve• ALT(SGPT) >2.5 times the upper limit of

normal• Malaria, leptospirosis, dengue and

typhoid/paratyphoid

• HEPATITIS A (HEPA)• HEPATITIS B (HEPB)• HEPATITIS E (HEPE)• HEPATITIS O (HEPO) Hepatitis Other types • HEPATITIS N (HEPN) Hepatitis etiology not known

Microbiologic Diagnosis established • No• Yes– Antibody detection• Positive IgM anti-HAV for HEPA• Positive HBsAg or IgM anti-HBc for HEPB• Positive IgM anti-HEV for HEPE• Positive IgM anti-HCV for HEPC

– Other • PCR

Previous relevant vaccinationHepatitis A

• Hepatitis A vaccine– Fully Immunized (FI) • Taken 2 doses of Hepatitis A vaccine

– Partially Immunized(PI)• Taken less than one doses of Hepatitis A vaccine

– Not Immunized (NI)• Not taken any dose of Hepatitis A vaccine

– Ineligible for immunization (II)• Less than 12 months of age

Previous relevant vaccinationHepatitis B

• Hepatitis B vaccine– Fully Immunized (FI) • Taken 3 doses of Hepatitis B vaccine

– Partially Immunized (PI)• Not taken all 3 doses of Hepatitis B vaccine

– Not Immunized (NI)• Not taken any dose of Hepatitis B vaccine

– Ineligible for Immunization (II)• Less than 6 weeks

HEPATITIS E , Other types, N (Etiology not known)

Previous relevant vaccination

Not applicable