What are some ethical dilemmas surrounding childhood vaccination?
- Issue of safeguarding - is it wrong for parents to not get their kids immunised as it puts them at risk of serious harm
- We need people to be vaccinated for herd immunity
- Are vaccines maleficent? - SEs of the vaccine + the vaccine offers no benefit to the child who likely won’t get the infection (unnecessary pain - needle)
Who do you contact if there is a notifiable disease?
Local health protection agency - medical officer (PHE)
Should you contact the health protection agency on confirmation of the disease?
NO!!!
Contact on suspicion
Give some examples of notifiable diseases
MMR, Diptheria, Whooping cough, leprosy, meningitis, meningococcal septicaemia, rabies, tetanus, TB, Scarlett fever, neonatal conjunctivitis…etc
What is included in the NICE traffic light system for an unwell child?
Colour Activity Respiratory system Hydration + circulation Other (E.G. temp, rash...)
What are the 3 outcomes of the NICE traffic light system?
Green (low risk)
Amber (intermediate risk)
Red (high risk)
What age group is the NICE traffic light system for?
<5yo
If a child has a red traffic light system score what should you do?
Urgent paediatric review (<2hrs)
If a child has a amber traffic light system score what should you do?
Either - Mx at home w/ safety net
Or - arrange to see again in few hours
Or - Refer to paeds for further Ix
If a child has a green traffic light system score what should you do?
Mx at home + safety net
What does safety netting involve
A management plan in case of deterioration
Giving written/verbal advise to the parent about worrying signs to look out for that warrants the child needing medical review (A+E)
Arrange follow-up
Lisa with other health professionals
What ages to febrile convulsions occur?
6mths-5yrs
if occurs outside this time suggests other cause to seizure
What is the risk of having another febrile convulsion after having one?
30%
What is the risk of developing epilepsy after having a febrile convulsion?
2%
What are some worrying signs in a febrile convulsion?
> 5mins
features of meningism: neck stiff, photophobia
Rash (non-blanching)…
ACTUAL: >15mins, recurrence/>1 episode 24hrs, focal seizure
What is the criteria for Kawasaki disease
Fever for 5+ days and 4/5 of:
(1) Polymorphorous rash
(2) Lymphadenopathy (>1.5cm + cervical)
(3) Changes in extremities
- Early: erythema + oedema
- Later: peeling
(4) Changes to mucous membranes (e.g. strawberry tongue)
(5) Bilateral conjunctival infection
What investigations are important in Kawasaki’s?
ECHO + ECG
What is significant about the blood tests in kawasaki’s?
^ ESR used to monitor treatment
What is the traffic light for a child <3mths with temp 38+?
Red
What is the traffic light for a child 3-6mths with temp 39+?
Amber