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Accordingly buy cheap synthroid on line stroke treatment 60 minutes, a nationwide study on the therapeutic efficacy of Sulfadoxine-Pyrimethamine for the treatment of uncomplicated falciparum malaria was conducted in 11 sentinel sites from October – December 2003 generic synthroid 125mcg medications to treat bipolar disorder. In-vivo therapeutic efficacy and safety baseline study on artemether-lumefantrine was also conducted in 4 sites by enrolling 213 subjects and after a follow-up period of 14 days buy synthroid 25mcg amex symptoms stomach flu, no treatment failure cases and drug side effects were reported i) Treatment of uncomplicated falciparum malaria: oral drugs are used can be used In most tropical countries since resistance to chloroquine and Sulfadoxine-pyrimethamine is well documented other drugs are recommended synthroid 100mcg for sale medications breastfeeding. Tablet containing 20 mg Artemether plus 120 mg Lumefantrine in a fixed dose combination. Dose: 15mg/kg followed by second dose of 10mg/kg after 8-12 hr Side Effects: Nausea, abdominal cramp, vertigo, insomnia, sometimes acute psychosis and convulsion d) Sulfadoxine-pyrimethamine (oral) e. Due to high prevalence of resistance to this combination, it is not recommended for treatment of P. Maintenance does: Twelve hours after the start of the loading dose, give quinine 10 mg salt/kg of body weight in dextrose saline over 4 hours. Quinine dihydrochloride 20 mg salt per kg loading dose intramuscularly divided in to two sites, anterior thigh). Avoid fluid overload Monitor blood glucose regularly Ensure adequate nutrition Chronic Complications of Malaria Tropical Splenomegaly Syndrome (Hyperreactive malarial Splenomegaly) It is a syndrome resulting from an abnormal immunologic response to repeated infection. General measures Mechanical Barriers/Methods • Draining water collections and swampy areas • Use of chemical impregnated mosquito nets around beds • Wire mesh across windows • Staying indoors at night • Use of long sleeved shirts and long trousers Insecticides or Chemicals • Use insecticide spray aerosols (permethrin, deltamethrin and chlorinated hydrocarbons) • Application of insect repellents to exposed skin. Drug prophylaxis It is indicated for • Pregnant women in endemic areas because of their increased risk of severe malaria • Children between 3 months and 4 years in endemic area (born to non-immune mother) 15 Internal Medicine • Travelers to malarious areas they should start taking drugs 1 week before traveling to these areas & for 4 weeks after the individual left the endemic area. Design appropriate methods of prevention and control of typhoid fever Definition: Typhoid fever is a systemic infection characterized by fever and abdominal pain caused by dissemination of Salmonella typhi and occasionally by S. Thus enteric fever is transmitted only thorough close contact with acutely infected individuals or chronic carriers through ingestion of contaminated food or water. Pathogenesis Following ingestion of the organism in contaminated food or drink, Salmonella typhi passes the gastric barrier and reach the upper small intestine where the bacilli invade the intestinal epithelium and they are engulfed by phagosoms which reside in the Peyer’s patches. At this stage the 17 Internal Medicine Salmonellae disseminate throughout the body in macrophages via lymphatic and colonize reticuloendothilial tissue (liver, spleen, lymph nodes, and bone marrow). Patients have relatively fewer or no signs and symptoms during this initial incubation period. Signs and symptoms, including fever and abdominal pain result when a critical number of bacteria have replicated. During weeks after initial colonization, further inflammation of the Peyer’s patches may result enlargement and necrosis which may result intestinal hemorrhage and perforation. The clinical phase of the disease depends on host defense and bacterial multiplication. The manifestation is dependent on inoculum size, state of host defense and the duration of the disease. The Severity of the illness may range from mild, brief illness to acute, severe disease with central nervous system involvement and death. First week st • Fever is high grade, with a daily increase in a step-ladder pattern for the 1 one week and then becomes persistent. In whites it appears as small, pale red, blanching macules commonly over chest & abdomen, lasting for 2-3 days. Fourth Week • Fever starts to decrease and the patient may deferveresce with resolution of symptoms. Complications of Typhoid fever • Gastrointestinal perforation and hemorrhage: are late complications that may occur in the 3rd or 4th week. These complications are life threatening and need immediate medical and surgical interventions • Other Less common complications Hepatitis Meningitis. Arthritis, osteomyelitis Parotitis and orchitis Nephritis Myocarditis Bronchitis and pneumonia N. B these complications can be prevented by prompt diagnosis and treatment Chronic Carriers • Approximately 1- 5 % of patient with Enteric fever become asymptomatic chronic carriers • They shed S. Diagnosis Can be suggested by the presence of Persistent fever Relative bradycardia, which was found to occur in 86% of Ethiopians. Widal test for O and H antigens • the O (somatic) antigen shows active infection whereas the H (flagellar) antigen could be indicative of past infection or immunization for typhoid. Limitations of Widal test • It is non specific and a positive test could be due to Infection by other salmonellae (as the antigen used for the test is also shared by other salmonellae) Recent vaccination for typhoid Past typhoid (already treated) • the demonstration of 4- fold rise in titer on paired sera is not useful for the treatment of acute cases, as this requires waiting for the convalescence phase of the disease and at this stage if the patient is lucky recovery will occur. These drugs can be given either orally or intravenous, depending on patient condition (able to take orally or not), severity of the disease. One should note that fever may persist for 4-6 days despite effective antibiotic treatment 20 Internal Medicine Oral drugs First Line Nowadays 4-amino quinolones are the drugs of choice because of their effectiveness on multidrug resistant typhoid, and low relapse and carrier rates. Dose should be reduced to 2g/d when fever starts to decrease (usually after 5 - 6 days), and continued to complete 2 weeks treatment. This is a drug of choice for patients that need parenteral therapy especially in Ethiopia (mainly for cost reason). Hence if resistance is suspected in an area, the preferred treatment would be with quinolones, azithromycin or third generation cephalosporins 21 Internal Medicine • Early use of antibiotics is associated with high rate of relapse (up to 20%) as compared to untreated cases (where the relapse rate is 5 - 10%). This is due to inhibition of adequate development of immune response by early therapy. Co-trimexazole (160/800mg twice a day) plus Rifampicin 600mg orally/d for 6 weeks.. Identify the different features of the two types of borrelia and their clinical manifestations 7. Design appropriate methods of prevention and control of relapsing fever Definition Relapsing fever is an acute febrile illness caused by Borrelia species, presenting with recurrence of characteristic febrile periods lasting for days alternating with afebrile periods. Borrelia demonstrates remarkable antigenic variation and strain heterogeneity which help the parasite to escape the immune response of the host and result in recurrence of febrile episodes. In Ethiopia the diseases affects mostly homeless men living crowded together in very unhygienic circumstances especially during rainy seasons. Pathophysiology In humans, borreliae after entering the body multiply in the blood and circulate in great number during febrile periods. They are also found in the spleen, liver, central nervous system, bone marrow, and may be sequestered in these organs during periods of remission. Severity is related to spirocheatal density in blood but systemic manifestations are related to release of various cytokines. The disease is characterized by sub capsular and parenchymal hemorrhage with infarcts of spleen, liver, heart and brain is seen. Thus, patients will have enlarged spleen and liver with variable edema and swelling of brain, lung and kidneys. Complications:- Life threatening complications are unusual in otherwise healthy persons if the disease is diagnosed and treated early. Epistaxis, blood streaked sputum other bleeding tendencies Neurologic manifestations like iridocyclitis, meningitis, coma, isolated cranial nerve palsies, Pneumonitis, Myocarditis Spleenic rupture of spleen etc. Without treatment, symptoms intensify over 2-7 days period and subside with spontaneous crisis during which borrelia disappear from the circulation. Such cycles of febrile periods alternating with afebrile periods may recur several times. Define rickettsial diseases with Special Emphasis on Epidemic and Endemic Typhus 2.
It starts as blood stained purchase on line synthroid symptoms in children, but gradually becomes brown and then pale yellow order synthroid 200mcg with visa symptoms gluten intolerance, slowly disappearing over the next four to six weeks cheap 75 mcg synthroid otc treatment definition statistics. Initially it consists of blood buy discount synthroid 25 mcg online symptoms to pregnancy, amniotic fluid, lining of the uterus (endometrial tissue) and foetal skin cells, and has a rather unpleasant odour. After a couple of days the amount and odour reduces, and it consists mainly of mucus. If the baby is breech (sitting with the bottom down) or transverse in the uterus, a doctor may try by a series of pressure movements on the mother’s belly, to push the baby’s head around and down into the pelvis. It usually occurs if one of the many lobes in the breast does not adequately empty its milk, and may spread from a sore, cracked nipple. The breast becomes painful, very tender, red and sore, and the woman may become feverish, and quite unwell. Antibiotic tablets such as penicillin or a cephalosporin usually cure the infection rapidly and the woman can continue breastfeeding, but if an abscess forms, an operation to drain away the accumulated pus is necessary. In recurrent cases, bromocriptine may be used to stop or reduce breast milk production. The presence of meconium in the amniotic fluid surrounding the foetus before birth is a sign that the foetus is distressed and should be delivered as soon as possible. The vomiting and subsequent inhalation (breathing in) of meconium by the baby immediately after birth, can cause serious breathing problems for the baby including pneumonia or asphyxiation. Meconium ileus is a blockage of the small intestine caused by thick, sticky, dried meconium. The baby is unable to eat, develops abnormal biochemistry and the bowel may rupture. The blockage may resolve naturally, with the help of special fluids given by mouth and in a drip, or may need to be removed surgically. This complication most commonly occurs with the congenital condition cystic fibrosis. If pregnancy does not occur, the endometrium starts to deteriorate as the hormones that sustain it in peak condition alter. After a few days, the lining breaks down completely, sloughs off the wall of the uterus, and is washed away by the blood released from the arteries that supplied it in a process known as menstruation or the menses. The obvious causes for periods to stop are pregnancy and menopause, and every woman between 15 and 50 who misses a period should be considered pregnant until proved otherwise. There are also a number of medical conditions that may be responsible for amenorrhoea (a lack of menstruation) or oligomenorrhoea (infrequent menstruation). The oral contraceptive pill may cause menstrual periods to become lighter and lighter until they disappear completely. Some women take the pill constantly, without a monthly break off the pill or taking sugar tablets, and stop their periods for the sake of convenience. A miscarriage usually starts with a slight vaginal bleed, then period- type cramps low in the abdomen. A miscarriage occurs when a pregnancy fails to progress, due to the death of the foetus, or a developmental abnormality in the foetus or placenta. After 20 weeks, doctors consider it to be a premature birth, although the chances of the baby surviving if born before 28 weeks are very slim. Most miscarriages occur in the first twelve weeks of pregnancy, and many occur so early, that the woman may not even know that she has been pregnant and may dismiss the problem as an abnormal period. In more than half the cases, the miscarriage occurs because there is no baby developing. What develops in the womb can be considered to be just placenta, without the presence of a foetus (a blighted ovum is the technical term). There is obviously no point in continuing with this type of pregnancy, and the body rejects the growth in a miscarriage. Some women do not secrete sufficient hormones from their ovaries to sustain a pregnancy, and this can also result in a miscarriage. These women can be given additional hormones in subsequent pregnancies to prevent a recurrence of the problem. This problem may be surgically corrected to prevent the cervix from opening prematurely, or to remove fibrous growths that may be distorting the womb. There are dozens of other reasons for a miscarriage, including stress (both mental and physical), other diseases of the mother (eg. Up to 15 percent of diagnosed pregnancies, and possibly 50 percent of all pregnancies, fail to reach 20 weeks. There is virtually no treatment for a threatened miscarriage except strict rest, sedatives and pain relievers. If the body has decided to reject the foetus, medical science is normally helpless to prevent it. Once a miscarriage is inevitable, doctors usually perform a simple operation to clean out the womb, and ready it as soon as possible for the next pregnancy. Heavy bleeding, that may lead to anaemia, infections in the uterus, and the retention of some tissue in the uterus are the most common complications. In most cases, there is no reason why a subsequent pregnancy should not be successful. It is only if a woman has two miscarriages in succession that doctors become concerned, and investigate the situation further. Its severity varies markedly, with about one third of pregnant women having no morning sickness, one half having it badly enough to vomit at least once, and in 5% the condition is serious enough result in prolonged bed rest or even hospitalisation, when it is called hyperemesis gravidarum. Although it usually ceases after about three months, it may persist for far longer in some unlucky women. Severe cases may be associated with twins, and it is usually worse in the first pregnancy. Because morning sickness is a self-limiting condition, treatment is usually given only when absolutely necessary. Supplements of vitamin B6 and ginger (either as pieces or capsules) have also been shown to help. Only in severe cases, and with some reluctance, will doctors prescribe more potent medications. In rare cases, fluids given by a drip into a vein are necessary for a woman hospitalised because of continued vomiting. There is a canal through the centre of the cervix that is normally only a couple of millimetres in diameter. During pregnancy this canal is filled with a mucous plug to protect the growing foetus from anything entering the uterus through the vagina. As the cervix starts to dilate in the early stages of labour, this mucous plug becomes dislodged, and may be noticed as a slightly blood stained vaginal discharge (a show) by the mother. Provided medical care is readily available, it is probably the perfect solution to childbirth for both mother and child, but because critical problems can arise very rapidly during childbirth (eg. The mother may also require pain relief, particularly in a first birth, and the baby may require resuscitation. Birthing rooms, which have a homely ambience, but are attached to a maternity hospital, are ideal. Home births can be very risky, as even with a woman who has had no problems in previous births, unexpected problems may occur.
Pregnant women should eat foods rich in protein (eggs buy genuine synthroid medicine vending machine, milk and milk products order generic synthroid canada medications known to cause seizures, Soya bean buy synthroid 25 mcg with amex treatment 4 pink eye, beans and lean meats) order synthroid 50mcg with mastercard medicine 8 discogs, Calcium (dairy products, green leafy vegetables, fish), iron and folic acid (lean meat, legumes, green leafy vegetables, egg yolk). However, women with certain medical conditions, high-risk pregnancies, or other complications may need to decrease working hours or discontinue working altogether. As long as the job is safe, and does not cause any stress and exhaustion, low-risk pregnant women can continue to work. Job requirements may be modified to allow for less physical workload, frequent breaks, elevation of legs, and frequent position changes. Reduced hours may be allowed in the third trimester as the demands of pregnancy increase. Working pregnant women should learn about their organizations maternity benefits and leave plans, as well as related local and national laws. Travel during pregnancy Pregnant women can safely travel until close to their due date. Some guidelines to follow include: ♦ Select the fastest mode of travel, if possible. Women at risk for miscarriage or premature labor should abstain from intercourse and breast stimulation. In addition, pregnant women should continue to use condoms with partners that have Sexually Transmitted Infections. Types of labor • False labor: False labor is labor that is not true especially felt by women with first pregnancy. With false labor, there is no feeling of pushing, no wetting (discharge) and opening of the cervix, In order to know the opening of the cervix, there is a need to do vaginal examination. During true labor, contraction and relaxation of the uterus starts and a force of pushing down is felt by the mother. Pushing down (contraction of the uterus) comes and goes frequently and later stays longer. The volume of discharge increases, placental fluid starts to flow out and small haemorrhage starts. The health extension worker must know the two types of labor and must be able to provide the necessary delivery assistance when she knows it is true labor. Stages of labor • First stage labor This is labor which lasts from the beginning of a strong contraction of the uterus until the baby drops into the birth canal. First stage labor lasts 10 - 20 hours for women with first birth, 7 - 10 hours for mothers with more than one births. Therefore, the health extension worker should take into account these stages of labor and if the labor at each stage is more than the expected time, she should take her to the next health facility with supervision and assistance. Preparations of the woman for delivery To keep personal hygiene of pregnant women: water, soap and clean cloth should be prepared for washing the legs, the pelvic and genital areas. Care during intense labor • Since labor entails tiredness, the woman on labor should be made to get simple food on occasional basis. After one of the shoulders comes out, it should be raised up to allow for the body also to come out. As traditionally done, painting it with cow dung, mud, butter or 24 Family Health another thing is dangerous to the baby. The health extension workers should make follow up and a feedback should be received from the health facility. Expulsion of the placenta • the mother will feel some labor after she has delivered. This is known by seeing that there is no cut in its soft side and that there is no cut on its sheath. If there is tear, put cotton pad or clean cloth and advice for urgent referral to the next health facility. Postpartum Care Definition: postpartum care is the period from completion of third stage of labor to the return to the normal non-pregnant, or pre- pregnant state, usually six weeks later. Lactation may continue after this period, menstruation may not recommence yet, or sexual activity is resumed. Overall it is a care given within the first 24 hours of delivery up to six weeks to: ♦ Prevent complications ♦ Restore to normal health ♦ Check to adequacy of breast-feeding ♦ Provide Family Planning service ♦ Give basic health information Complications during Postnatal period ♦ Puerperal sepsis/general infection ♦ Thrombo-phlebitis ♦ Secondary Haemorrhage ♦ Breast problems – engorgement, infection ♦ Incontinence – stool or urine 27 Family Health Care to the mother during postnatal period. Breastfeeding Breast milk is: a perfect nutrient, easily digested, can be efficiently used and protects against infection. Disadvantages of Bottle Feeding Formula milk is expensive Formula needs to be accurately mixed for adequate nutrition Takes time for preparation Baby more susceptible to diseases and infection 30 Family Health Fuel is needed for heating water to mix the formula More than one bottle is needed Demonstration on getting sunlight for the baby. Supplementary Feeding • Wash hands before the preparation of child’s food • Start supplementary feeding when the baby reaches 6 months of age. As the baby grows older feed thin and non- spiced pulses sauce mixed with injera (shiro). It is a means of promoting the health of the women and families and part of a strategy to reduce the high maternal, infant and child morbidity and mortality. Objectives: General: Is to reduce morbidity and mortality of mothers and children by spacing child bearing, preventing unplanned and unwanted pregnancy. Specific: • To increase awareness, knowledge and skills of the community to utilize family planning services, • To increase utilisation of family planning services by households, • To prevent mothers from having too many pregnancies and children • To avert population growth rate, 33 Family Health • Prevent unwanted pregnancies and high risk abortions, • Promote active participation of males in family planning activities. Traditional family planning methods Breast-feeding method: When a mother breast-feeds her baby, the message concerning the feeding goes from the nipple to the vagus nerve and proceeds to the front-part of the pituitary gland in the brain. Then the pituitary gland 35 Family Health initiates the production of prolactin hormone to activate the milk producing glands in the breasts. The prolactin hormone again reduces the secretion of luteinizing hormone which initiates the normal menstrual cycle. The calendar method: If a woman has a regular cycle of 27 days, it is possible to know by subtracting from 27-18 and 27-11 the first and last days of ovulation respectively. Based on this calculation, the woman should avoid sexual intercourse between day 9 and day 19 of the menstrual cycle in order to prevent pregnancy. By the same token, women who have regular menstrual cycles of 28 days, to 30 days should avoid sexual intercourse between 10-17 days and 12-19 days respectively; this time they are safe to do sexual intercourse during the remaining 36 Family Health respective days. Is Abstinence method: This refers to stopping temporarily or permanently sexual intercourse. Using this natural / traditional method requires a strong discipline, thrust and good understanding between husband and wife or sexual partners. Withdrawal Method: This method uses the withdrawal or the pulling out of the male genital (penis) from the vagina, interrupting sexual intercourse just before ejaculation so that sperm does not enter the vagina. The ejaculation must be far away from the genital areas to make sure that no sperm enter the vagina. The effect of this method is weak and unreliable because of the following reasons.
- The health care provider will move the probe around the area to see the pelvic organs.
- Exercise for 30 minutes a day if you are not overweight, and for 60 - 90 minutes a day if you are overweight. Talk to your doctor before starting a new exercise plan, especially if you have been diagnosed with heart disease or you have ever had a heart attack.
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After reconstitution buy synthroid with a visa treatment 4 letter word, all the vaccine should be drawn up into the syringe and used ® immediately buy synthroid 200mcg otc medications related to the lymphatic system, but Menveo may be held at or below 25°C for up to eight hours generic 25 mcg synthroid with mastercard treatment jones fracture, and chemical and physical in-use stability has been demonstrated for 24 hours ® at 30°C for Nimenrix Dosage and schedule Routine MenC schedule See Tables 22 buy cheap synthroid 25 mcg online stroke treatment 60 minutes. Administration All meningococcal-containing vaccines are given intramuscularly into the upper arm or anterolateral thigh. This is to reduce the risk of localised reactions, which are more common when the vaccine is given subcutaneously (Mark et al. However, for individuals with a bleeding disorder, vaccines should be given by deep subcutaneous injection to reduce the risk of bleeding. The site at which each vaccine is given should be noted in the child’s clinical record. Disposal Equipment used for vaccination, including used vials, ampoules, or partially discharged vaccines should be disposed of at the end of a session by sealing in a proper, puncture-resistant ‘sharps’ box according to local authority regulations and guidance in the technical memorandum 07-01 (Department of Health, 2006). Recommendations for the routine use of the MenC conjugate vaccines the objective of the routine immunisation programme is to protect those under 25 years of age and individuals outside this age range who may be at increased risk from meningococcal C disease. Immunisation schedule the routine immunisation schedule, as revised in 2013, is set out in Table 22. The response at this age is very good even where no infant doses have been received. These children should still receive the teenage booster when they reach the target age. Children who reach the target age for the teenage booster who were vaccinated according to the previous vaccine schedules (without a toddler booster) should be offered a single dose. Children above the age of ten years who have not received any MenC may receive the teenage booster early (See Table 22. Children and adults with asplenia, splenic dysfunction or complement deficiency Children and adults with asplenia or splenic dysfunction may be at increased risk of invasive meningococcal infection. Such individuals, irrespective of age or interval from splenectomy, may have a sub-optimal response to the vaccine (Balmer et al. Given the increased risk, additional vaccinations against meningococcal disease are advised for individuals with asplenia or splenic dysfunction or when complement deficiency is diagnosed depending on age and vaccination history. Those who had received polysaccharide vaccines in the past should be vaccinated with conjugate vaccine as above. Individuals who are travelling or going to reside abroad All travellers should undergo a careful risk assessment that takes into account their itinerary, duration of stay and planned activities. Individuals who are particularly at risk are visitors who live or travel ‘rough’, such as backpackers, and those living or working with local people. Large epidemics of both Green Book Chapter 22 v2_3 247 Meningococcal serogroup A and W meningococcal infection have occurred in association with Hajj pilgrimages, and proof of vaccination against A, C, W and Y serogroups is now a visa entry requirement for pilgrims and seasonal workers travelling to Saudi Arabia. Epidemics, mainly of serogroup A and more recently serogroup W infections, occur unpredictably throughout tropical Africa but particularly in the savannah during the dry season (December to June). Immunisation is recommended for long-stay or high-risk visitors to sub-Saharan Africa, for example, those who will be living or working closely with local people, or those who are backpacking. From time to time, outbreaks of meningococcal infection may be reported from other parts of the world, including the Indian sub-continent and other parts of Asia www. Country-specific recommendations and information on the global epidemiology of meningococcal disease can be found on the following websites: www. Children aged one year Menveo® or Nimenrix® ● ● Not recommended to four years ● ● Single dose of 0. Children aged five Menveo® or Nimenrix® ● ● Single dose of years to ten years (either preferred to 0. Individuals aged 11 Menveo® or Nimenrix® ● ● Single dose of years and older (either preferred to 0. Green Book Chapter 22 v2_3 249 Meningococcal Contraindications There are very few individuals who cannot receive meningococcal vaccines. When there is doubt, appropriate advice should be sought from a consultant paediatrician, immunisation co-ordinator or consultant in communicable disease control, rather than withhold immunisation. The vaccines should not be given to those who have had: ● a confirmed anaphylactic reaction to a previous dose of the vaccine, or ● a confirmed anaphylactic reaction to any constituent or excipient of the vaccine. Precautions Minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation. If an individual is acutely unwell, immunisation may be postponed until they have recovered fully. This is to avoid confusing the differential diagnosis of any acute illness by wrongly attributing any signs or symptoms to the adverse effects of the vaccine. Pregnancy and breast-feeding Meningococcal vaccines may be given to pregnant women when clinically indicated. There is no evidence of risk from vaccinating pregnant women or those who are breast-feeding with inactivated virus or bacterial vaccines or toxoids (Granoff et al. In cases where meningococcal immunisation has been inadvertently given in pregnancy, there has been no evidence of fetal problems. Premature infants It is important that premature infants have their immunisations at the appropriate chronological age, according to the schedule. The occurrence of apnoea following vaccination is especially increased in infants who were born very prematurely. Very premature infants (born ≤ 28 weeks of gestation) who are in hospital should have respiratory monitoring for 48-72 hrs when given their first immunisation, particularly those with a previous history of respiratory immaturity. If the child has apnoea, bradycardia or desaturations after the first immunisation, the second immunisation should also be given in hospital, with respiratory monitoring for 48-72 hrs (Ohlsson et al. Green Book Chapter 22 v2_3 250 Meningococcal As the benefit of immunisation is high in this group of infants, immunisation should not be withheld or delayed. Re-immunisation should be considered after treatment is finished and recovery has occurred. Further guidance is provided by the Royal College of Paediatrics and Child Health (www. Adverse reactions MenC conjugate vaccine Pain, tenderness, swelling or redness at the injection site and mild fevers are common in all age groups. In infants and toddlers, crying, irritability, drowsiness, impaired sleep, reduced eating, diarrhoea and vomiting are commonly seen. Neurological reactions such as dizziness, febrile/afebrile seizures, faints, numbness and hypotonia following MenC conjugate vaccination are very rare. Hib/MenC conjugate Mild side effects such as irritability, loss of appetite, pain, swelling or redness at the site of the injection and slightly raised temperature commonly occur. Less commonly crying, diarrhoea, vomiting, atopic dermatitis, malaise and fever over 39. Reports of all adverse reactions can be found in the Summary of Product Characteristics for Menveo® (Novartis, 2010). Green Book Chapter 22 v2_3 251 Meningococcal For Nimenrix®, very common or common reported reactions included injection site reactions including pain, erythema, and swelling. Other very common or common reactions include irritability, drowsiness, headache, nausea, and loss of appetite.
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