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Public Health

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Public Health

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    1. Public Health East Cumbria VTS March 2010

    3. Suggested Topics Health Protection Vacc & Imm Current Schedule MMR BCG / New Entrants HPV Incomplete Histories Travel Possible new vaccines Notifiable Diseases Exclusions Meningococcal Infection Clostridium difficile Sources of Advice and Information Questions

    4. Suggested Topics Health Protection Vacc & Imm Current Schedule MMR BCG / New Entrants HPV Incomplete Histories Travel Possible new vaccines Notifiable Diseases Exclusions Meningococcal Infection Clostridium difficile Sources of Advice and Information Questions

    5. Public Health Griffiths S, Jewell T, Donnelly P. Public Health;119(10):907-913 Oct 05. Public Health in Practice: the Three Domains of Public Health. Health Improvement Improving Services Health Protection

    6. Health Improvement Inequalities Education Housing Employment Family/community Lifestyles Surveillance and monitoring of specific diseases and risk factors

    7. Improving Services Clinical effectiveness Efficiency Service planning Audit and evaluation Clinical governance Equity

    8. Health Protection Infectious diseases Chemicals and poisons Radiation Emergency response Environmental health hazards

    9. NHS in Cumbria

    10. NHS in Cumbria

    11. Health Protection Agency

    12. Health Protection Agency

    13. Suggested Topics Health Protection Vacc & Imm Current Schedule MMR BCG / New Entrants HPV Incomplete Histories Travel Possible new vaccines Notifiable Diseases Exclusions Meningococcal Infection Clostridium difficile Sources of Advice and Information Questions

    14. Routine Immunisations

    15. Non Routine Immunisations

    16. MMR Vaccine

    17. BCG Vaccine 60% efficacy Lasts 10-12 years Boosters ineffective Side effects Universal BCG at 13 years NNT to prevent one (treatable) case = 20,000

    18. TB Control: Targeted Approach Most cases originate in high risk countries Port health BCG in infancy in high incidence communities Non infectious after 2 weeks treatment Effective treatment and contact tracing Some occupational groups still get BCG Healthcare workers Travel health

    19. HPV Immunisation Programme

    20. HPV Immunisation Programme Cervical Cancer 2nd most common female cancer in UK England: 2,200 cases and 800 deaths / yr Human Papilloma Virus 80% Sexually-active women infected at some time Mostly clears spontaneously in 6-12 months Mucosal infection: Pre-cancerous lesions Genital warts

    21. HPV Immunisation Programme 120 types of Human Papilloma Virus 35 linked to infections of genital tract 99.7% of cervical cancer caused by HPV Infection 70% caused by HPV Types 16 and 18 90% of genital warts caused by HPV Infection HPV Types 6 and 11

    22. HPV Immunisation Programme Vaccines Cervarix (GSK) HPV 16 & HPV 18 Gardasil (Sanofi Pasteur) HPV 6 & 11; HPV 16 & 18 Genetically-modified yeast High efficacy almost 100% 3 dose schedule

    23. Incomplete Vaccination Histories

    24. Travel Advice

    25. Travel Advice

    26. New Vaccines

    27. Shingles

    28. Rotavirus

    29. Suggested Topics Health Protection Vacc & Imm Current Schedule MMR BCG / New Entrants HPV Incomplete Histories Travel Possible new vaccines Notifiable Diseases Exclusions Meningococcal Infection Clostridium difficile Sources of Advice and Information Questions

    30. Notifiable Diseases

    31. Exclusions from School etc

    32. Suggested Topics Health Protection Vacc & Imm Current Schedule MMR BCG / New Entrants HPV Incomplete Histories Travel Possible new vaccines Notifiable Diseases Exclusions Meningococcal Infection Clostridium difficile Sources of Advice and Information Questions

    33. Meningococcal Infection

    34. Meningococcal Disease Notifications England & Wales 1912-2004

    35. Lab-confirmed Cases of Meningococcal Disease England & Wales 1997-2006

    36. Laboratory Confirmed Cases England & Wales 96/97to 04/05

    37. Case History You are working in a General Practice. A worried mother comes in saying that her child's best friend has been admitted to hospital in Glasgow with meningitis. Both children are 5 years old and attend a local primary school. She is concerned that her own family may be at risk. What would you do?

    38. Case History The head teacher at the school is a patient of yours and asks for advice. What would you tell them?

    39. Public Health Implications 98% cases in UK are sporadic Close contacts most at risk 0.5% chance if no antibiotics Household Contacts Overnight Contacts Equivalent Contacts Rifampicin Ciprofloxacin Ceftrioxone

    40. Contact Tracing

    42. Suggested Topics Health Protection Vacc & Imm Current Schedule MMR BCG / New Entrants HPV Incomplete Histories Travel Possible new vaccines Notifiable Diseases Exclusions Meningococcal Infection Clostridium difficile Sources of Advice and Information Questions

    44. Epidemiology (1) Healthy carriers: 3% of healthy adults 50 to 80% of healthy newborns 16 to 35% of hospitalized patients 5 to 30% of patients in chronic care settings Persistence in stools after infection: 10 to 40% of patients with CDAD

    45. Epidemiology (2) Persistence in the environment: Spores may persist for months!!! Floors from CDAD patient rooms heavily contaminated Commodes Bed frames Role of personnel with contaminated hands

    46. Epidemiology (3) Disinfection: lack of environmentally friendly sporicidal disinfectants: Hypochlorite 1:10 (5,000 ppm) Hydrogen peroxide vapour (unpractical)

    47. Clinical Picture Asymptomatic 3% of healthy adults 10 to 25% of hospitalized patients 5 to 70% of healthy neonates Mild diarrhoea Pseudomembranous colitis Complications: toxic megacolon, perforation, death

    48. PMC: Endoscopy

    49. Physiopathology

    50. Age Underlying disease Malnutrition Hypoalbuminaemia Chronic renal insufficiency HIV Infection Risk factors: Intrinsic

    51. Risk factors: Extrinsic Medication: Antibiotics Chemotherapy Antacids: proton pump inhibitors (???) Medical interventions Abdominal surgery Nasogastric tube Gastrostomia Other Duration of hospitalization Chronic care hospitalization < 1 year

    52. UHMB Cl difficile Age Breakdown

    53. Control & Prevention Antibiotic constraint (& ?PPIs) Hand hygiene/PPE Environmental hygiene Isolation

    54. Suggested Topics Health Protection Vacc & Imm Current Schedule MMR BCG / New Entrants HPV Incomplete Histories Travel Possible new vaccines Notifiable Diseases Exclusions Meningococcal Infection Clostridium difficile Sources of Advice and Information Questions

    55. Information and Advice Health Protection Agency www.hpa.org.uk 01257 246450 candlhpu@hpa.org.uk NHS Cumbria http://www.cumbria.nhs.uk 01768 245317

    56. Information and Advice Travax www.travax.scot.nhs.uk Fit For Travel www.fitfortravel.nhs.uk NHS Immunisation Website www.immunisation.nhs.uk

    57. Suggested Topics Health Protection Vacc & Imm Current Schedule MMR BCG / New Entrants HPV Incomplete Histories Travel Possible new vaccines Notifiable Diseases Exclusions Meningococcal Infection Clostridium difficile Sources of Advice and Information Questions

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