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A Practical Guide to Immunisation
Clinical features
The characteristic symptoms of mumps is
swelling of one of more of the salivary glands
most commonly the parotid gland.
Early symptoms also include headache
and fever. Photohobia and neck stiffness
(meningism) can also develop.
At least 30% of cases in children have no
symptoms.
Most severe in adults.
Photo courtesy of CDC
The complications of mumps include
• Pancreatitis (affects 1 in 25)
• Oophoritis (ovarian inflammation)
(affects 1 in 20 )
• Orchitis (Testicular inflammation)
(affects 25%-40% of post pubertal men)
• Meningitis (affects up to 15% of cases)
• Encephalitis
(0.02-0.3% of the cases)
• Deafness (affects 1 in 20,000 patients)
• Nephritis, cardiac abnormalities and (rarely) death have been reported.
Vaccine schedule in Ireland
Mumps immunisation with the combined MMR vaccine is recommended for all children at 12
months as part of the primary childhood immunisation programme. A booster dose MMR is
recommended at 4-5 years. Single vaccines are not recommended.
4.2.7 Pertussis
Epidemiology of disease and impact of vaccination
Pertussis, also known as whooping cough, is a highly infectious bacterial disease involving the
respiratory tract caused by the bacterium Bordetella pertussis, which is found in the mouth, nose
and throat of an infected person. Pertussis can occur at any age. Although most reported cases
occur in children less than five years, cases are reported amongst adolescents and adults every year.
It is most dangerous in children under one and most severe in young infants. In Ireland, as in most
European countries, the number of pertussis cases reported each year has decreased because of
childhood immunisation (Figure 4.7). Cases when they do occur are usually amongst non-vaccinated
or incompletely vaccinated children.
Transmission
Pertussis is spread from person-to-person by droplet infection produced by coughing or sneezing.
Incubation period
The average incubation period is 7-10 days with a range of 4-21 days.
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A Practical Guide to Immunisation
6000
DT P introduced, 1952/53
Number of Notifications
5000
4000
3000
P ertus s is va ccine s ca re
mid 1970s
2000
1000
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
1974
1972
1970
1968
1966
1964
1962
1960
1958
1956
1954
1952
1950
1948
0
Year
Figure 4.7: Pertussis cases notified in Ireland 1948-2006.
Source: Health Protection Surveillance Centre
Period of infectivity
An individual can be infectious from six days after exposure (before they even realise that they are
sdfsdfsfdsfdsdfsdfsfds
ill) to three weeks after onset of
cough.
Clinical features
The illness progresses through three stages:
1. The catarrhal stage (characterized by
mild symptoms such as runny nose, sneezing
and mild temperature) typically lasts for 1-2
weeks.
2. The paroxysmal stage (paroxysms of
coughing followed by an inspiratory whoop),
lasts 1 to 6 weeks
3. The convalescent stage with gradual
recovery, over 2-3 weeks. The duration of
illness can be from two weeks to longer than
three months
Photo courtesy of CDC
Up to 20% of cases may require hospitalisation for complications of the illness. These
include pneumonia (1 in 20), middle ear infection, loss of appetite, dehydration, seizures and
encephalopathy (approximately 1% and 0.1% respectively), apnoeic episodes (brief cessation of
breathing) and death (0.2%).
Vaccine schedule in Ireland
Pertussis vaccine is administered at 2 , 4 and 6 months with diphtheria, tetanus, hepatitis B, Hib and
IPV vaccines (referred to as the “6-in-1” vaccine). Booster vaccine doses are given at 4-5 years of
age and again between 11-14 years of age.
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A Practical Guide to Immunisation
Whole cell pertussis vaccines were used in Ireland and were associated with the development of
local side effects. Vaccine development led to the production of acellular Pertussis vaccines which
are less immunogenic and produce fewer side effects. All pertussis containing vaccines currently
used in Ireland are acellular pertussis vaccines.
4.2.8 Pneumococcal infection
Epidemiology of disease and impact of vaccination
Pneumococcal infection is a bacterial infection caused by members the Streptococcus Pneumoniae
family of which there are more than 90 serotypes. The organism is frequently found in the upper
respiratory tract of healthy individuals world-wide. Carriage of the bacteria may range from 10% of
adults to 50% of children attending day care facilities.
Invasive pneumococcal disease became notifiable on 1st January 2004 in Ireland (Figure 4.8). The
very young, the elderly and those in “at risk” groups as laid down in the National Immunisation
Guidelines are at increased risk of infection.
Age-specific incidence Invasive Pneumococcal Disease (IPD), 2004-2006, by age group
Age specific incidence rates (/100,000)
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
3-4
1-2
0.0
<1
5.0
Age group (years)
2004
2005
2006
Figure 4.8: Age-specific incidence of Invasive Pneumococcal disease 2004-2006.
Source: Health Protection Surveillance Centre
Transmission
Transmission requires close contact with cases or carriers and is via droplet infection.
Person-to-person transmission of the organism is common, but illness among casual contacts and
attendants is infrequent.
Incubation period
The incubation period is difficult to determine but can be as short as 1-3 days.
Period of infectivity
The patient is infectious as long as viable pneumoccal organisms are present in nasal, oral or
respiratory secretions. Treatment with antibiotics such as penicillin renders patients with susceptible
organisms non-infectious within 48 hours.
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