Prevention of infectious diseases in school children

Tereza Kopřivová HerotováDagmar Schneidrová

Dept. of Child and Youth Health

Infectious diseases in the Czech Republic in 2011

(Institute of Health Statistics and Information, CR 2012)

• Structure and incidence of infectious diseases by age groups

(see p. 16 - ÚZIS infnem2012.pdf)

Antibiotic use: evolution of penicillin resistance of Staphylococcus aureus

Ferech, M. et al. JAC 2006 58:401-407

Total antibiotic use in European countries 2003

Antibiotic use: outpatient penicillin usage correlated with penicillin resistance, Europe, 2005

Source: Goossens et al. 2005

Prevalence of MRSA in Europe

Pneumococcus resistance to macrolides

Misunderstandings about antibiotics

0 20 40 60

% respondents with wrong answer % respondents don't know

Antibiotics work on most coughs & colds

Antibiotics can kill bacteria

Antibiotics can kill viruses

Antibiotics can kill bacteria that normally live on the skin and gut

Bacteria that normally live on the skin and in the gut are good for you

And 16-24 year olds are less knowledgeable

ATB SELF MEDICATION (Europe)

Survey on ATB use in CR( Dept. of Child Health, TH Bulovka, 2009)

• 18 % respondents used ATB without consulting a physician.• 3 % parents gave ATB to the child without consulting

a physician.• 15.7 % resp. have ATB at home.• 59 % of Prague resp. and 48 % of resp. outside Prague have

no ATB leftovers at home.• 55 % resp. expect ATB effect within 24 hours.• 24 % resp. would prefer having medicaments in drugstores,

9 % resp. in shops.• 10 % resp. would prefer PNC without prescription, 2 % resp.

all ATB without prescripton.• 88.5 % health profs. does not consider resistance a serious

problem.• 96.3 % resp. consider compulsory vaccination useful.

6 5,8

41,5

24,524,9

31,527,6

38,2

0

5

10

15

20

25

30

35

40

45

%

jen virům jen bakteriím virům ibakteriím

všemmikrobům

Otázka č. 21 - Praha x Ostatní

PRAHA OSTATNÍ

ATB are efficient against ?( Dept. of Child Health, TH Bulovka, 2009)

ATB are efficient against ?( Dept. of Child Health, TH Bulovka, 2009)

5,4 6

63,1

29,4

15,4

29,6

16,2

34,9

0

10

20

3040

50

6070

jen virům jen bakteriím virům ibakteriím

všemmikrobům

%

Otázka č. 21 - Zdravotník x Nezdravotník

Zdravotník Nezdravotník

The five key areas for prevention of antimicrobial resistance

Rational drug use and regulation

Research and development

Animal husbandry, agriculture, aquaculture

Surveillance

Infection prevention

Rational drug use and regulation• Reduce ATB use (↓ prescription)• Reduce spread of resistent strains (isolation)• Intervention (education) activities

focused on health profs in different fields focused on public

e-Bug the EU initiative for school children

Tereza Kopřivová HerotováNational coordinator

What is an e-Bug project

• e-Bug is a European wide antibiotic and hygiene teaching resource for junior (9-11 y.) and senior (12-15 y.) school children

• Funded by DG Sanco (EU Commission)• The project is lead by the Health Protection

Agency (HPA) Primary Care Unit in Gloucester, UK and involves a consortium of 18 partner EU countries: 10 associate and 8 collaborating

10 Associate Partners• Belgium• Czech Republic• Denmark• France• Greece• Italy• Poland• Portugal• Spain• Great Britain

8 Collaborating Partners

• Croatia• Finland• Hungary• Ireland• Latvia• Lithuania• Slovakia• Slovenia

e-BUG project 18 European countries → 62 % European population

• Great Britain• Czech Republic• France• Poland• Belgium• Denmark• Greece• Portugal• Italy• Spain• Lithuania• Latvia• Finland• Croatia• Hungary• Slovakia• Slovenia• Ireland

E-Bug project

Associate partners

• 46 % of European population

• 300 mil. people

• 62% of European Population

Collaborative partners

• 15% of European population

• 90 mil. people

The aims of e-Bug project• Increase awareness on benefits of compulsory and

elective vaccination • Increase awareness on microbial resistance• Increase compliance of patients related to ATB use• Improve personal hygiene of school children Teach:

– Prevention better than cure– Benefits of antibiotics– Overuse of antibiotics may have adverse

effect

DH SMACCommittee 1998:

Teaching about antibiotics should be included as part of the National Curriculum

Reducing infection rates should reduce antibiotic use in children!

• Spread of infection is mainly via sneezing/coughing and contaminated hands

• Handwashing interventions reduce illnesses and absenteeism in schools

3 key topics

1. Microorganisms

• Useful and dangerous microbes• Viruses vs. Bacteria vs. Fungi• ATB have no effect against viral and

fungal infections • Compulsory and elective vaccination • Natural microflora and its importance

3 key topics

2. Personal hygiene

• 80% common infections are spread via dirty hands

• Hand washing = effective prevention of infections of upper and lower respiratory tract and GIT (alimentary infections)

• Timing and technique of hand washing

3 key topics

3. Antibiotic resistance

• Misuse and overuse of ATB• Mechanism of developing

resistance• Risks of resistance • Prevention of resistance• Negative effects of ATB on health

Developing e-Bug style & content

Brainstorming sessions with teachers & partners:

• Suit range of teaching styles

• Have IT links

• Be student friendly

• MUST link closely to National Curriculums

Development of Junior and Senior Characters

Clothing

Hair styles

‘Girly look’

Amy and Harry

Development of bug characters

Good Bugs Bad Bugs

Junior bugs Senior bugs

Bacteria

Fungus

Viruses

e-Bug Lesson Plan for Junior Schoolchildren1. Introduction to microbes They are found everywhere even though you can’t see them. There are three types of micro-organisms.

2. Good Microbes Good bacteria keep us healthy. Bacteria can be put to good use.

3. Bad Microbes Sometimes microbes can make us sick.

4. Prevention of Infection Prevention when possible is better than cure. Keep your bad microbes to yourself. Our body helps defend against microbes.

Hand hygiene

How, When and Why to wash your hands

Respiratory hygiene

Cover your coughs and sneezes

Vaccines

Vaccines are important to prevent a range of infections (including the flu).

There are not vaccines for ALL infections.

5. Treatment of Infection Most common infections get better on their own through time, bed rest, liquid intake

and healthy living. Antibiotics : If you have antibiotics, finish the course!

Junior Microbe activity

Respiratory Hygiene activity

Best part: sneezing

because you get to use the snot

gun

Holding a tissue in front of your nose

spreads less germs

Junior antibiotic activity

It really hurts and I think

I’m getting a cough.

Don’t you have any antibiotics at home you

can take? Reading the comic

Not to use someone elses

antibiotics

Best part: What we learnt:

All antibiotics are different

e-Bug Lesson Plan for Senior Schoolchildren1. Introduction to microbes There are three different types of microorganisms (bacteria, viruses, fungi). They are found everywhere even though you can’t see them. They are found in your body.

2. Good Microbes Good bacteria can help keep us healthy. Most microbes are good for us. They can be put to good use. We need bacterial colonisation to live a healthy life (normal flora). Protect your flora.

3. Spread and Prevention of Infection Sometimes microbes can make us sick. Prevention where possible is better than cure. Don’t spread your bad microbes to others. Our body helps defend against microbes. Different routes of infection are hands, water, air, blood.

1. Hand hygiene - How, When and Why to wash your hands.

2. Respiratory hygiene - Cover your coughs and sneezes .How and why this is important.

3. Vaccines - Vaccines help prevent a range of bacterial and viral infections .Previously common infections are rare due to vaccines .There are not vaccines for all infections. Most common infections are not prevented by vaccines.

4. Sexually transmitted infections

4. Treatment of Infection Most common infections get better on their own through time, bed rest, liquid intake and healthy living.

Antibiotics - If you have antibiotics, finish the course. Do not use leftover or other people antibiotics. Overuse of antibiotics can damage our normal / good bacteria. Bacteria are becoming resistant to antibiotics due to overuse.

Food hygiene activitySeeing the

microbes was really cool

It was a different type

of lesson

I never knew bacteria were

alive

It was really hard to keep the

bacteria off the salad

Germs can spread very

easily

Always wash hands when dealing with

food

Hand hygiene activity

There are loads of bacteria on your

body

I learnt how to stop microbes

spreading

I learnt to wash my hands all the

time

Proper handwashing10 teps

1. Water your hands in pouring warm water.

2. Soap all your hands.

3. Soap your palms.

4. Soap between fingers.

5. Soap back of your hands

6. Soap your nails and under nails.

7. Soap your wrists.

8. Water your hands and dry them with a paper towel.

9. Close the water tap with the towel.

10. Open the door with the paper towel and throw it to the basket!

Senior antibiotic activity

That’s amazing – this bug’s

killed by all of them

Development of Websitewww.e-Bug.eu

– All pack content– Teacher presentations to aid lesson plans– Games for classroom or home play– Revision sections for students

e-Bug Time-lines1-3m Jun 06 - Aug 06 appoint UK staff

3-12m Sep 06 - May 07 research across Europe

13-21m Jun 07 - Feb 08 pack and website in England

22-27m Mar 08 - Aug 08 translation in 9 AP countries

27-39m Aug 08 - Aug 09 dissemination in AP countries

22-39m Mar 08 - Aug 09 evaluation in 3 AP countries

36m May 09 presentation to collaborating countries

2010 final version translated to all

European languages and distributed

Pack Evaluation

• France, Czech Republic and England

• Control and Intervention schools– 86 schools and 6290 students (52% senior)

– Questionnaires pre and 2-4 weeks post activities

• Significant increase in knowledge in all activity areas

Where e-Bug fits into the Curriculum

ScienceScienceScienceScienceSpainSpain

ScienceScienceScienceSciencePortugalPortugal

ReligionReligion

PerioPerio

ScienceScienceScienceSciencePolandPoland

ScienceScienceScienceScienceItalyItaly

ScienceScienceScienceScienceGreeceGreece

PSHEPSHE

BiologyBiologyScienceScienceScienceScienceGreat BritainGreat Britain

ScienceScienceScienceScienceFranceFrance

ScienceScienceScienceScienceDenmarkDenmark

Homeland studyHomeland study

ChemistryChemistry

BiologyBiologyScienceScienceScienceScience**Czech RepublicCzech Republic

ScienceScienceScienceScienceBelgiumBelgium

PrimaryPrimary SecondarySecondary

* And in Slovenia, Slovakia and Latvia science (natural and social) account for the largest portion of time in the curriculum.

e-Bug in the Czech RepublicImplementation• Review - adaptation to the CR school system• Translation - pack and website (available Sept. 09)

• Promotion - Teachers fairs and science fairs (2008 - 2010).

− Links in packs to related websites and vice versa.− Information letter to all primary and secondary schools (August ’09).− Teachers magazines and websites − Science teachers networks

• Endorsement - Project supported by Ministries of Health and Education and Johnson&Johnson

• Printing – All Czech primary and secondary schools received a free printed copy (4,000 primary and 3,600 secondary schools)

Prevention of InfectionsRole of the Public Health Officer (CR

– Hygiene of Children and Youth)

Law No.258/2000 on public health protection•Regular assessment of school environment according to hygienic standards and regulations (microclimate – temperature, ventilation, cleanliness of the facility, etc.)•Consultant or coordinator of school health promotion programmes

Construction, technical and microclimatic conditions

• Law No.183/2006 on district planning and construction regulations

• Directive No.268/2009 on general technical requirements on buildings

• CSN 73 4108 – cloakrooms, washrooms and toilets

Hygiene of school facilitiesMoH Directives No. 410/2005, No. 343/2009 on hygienic requirements on facilities and regimen of educational facilities for children and youth:- incl. requirements on hygienic facilities (toilets, washrooms – e.g. 1 washbasin/20 children, soap container, hand dryer or paper towels)

Ambient temperature

Direct. No. 343/2009 •defines requirements on ventilation and parameters of microclimatic conditions (temperature, circulation velocity, relative moisture of air)•defines measures in higher values (ventilation, heating regulation) and lower values in the classroom (3 days below 18oC or 1 day below 16oC – school attendance is stopped)

Air quality

Directive No. 268/2009 •max. concentration of CO2 acceptable for ambient environment – 1000 ppm. •regular ventilation recommended

www.e-Bug.eu