Case Definitions Dr.Vijay Yewale Convener, IAP Committee on Immunization Editor, Pediatric Infectious Disease

Diseases covered Pneumonia (PNUC and PNUR) Acute Bacterial Meningitis (ABMP/ABMM/ABMH/ABMO/ABME) Diphtheria (DIPH) Pertussis (PERT) Measles (MEAS) Mumps (MUMP) Chickenpox (CPOX) Enteric fever (EFTY /EFPT) Dengue fever (DENF /DENH /DENS) Hepatitis (HEPA, HEPB, HEPE, HEPO, HEPN)

PNEUMONIA Clinical Pneumonia (PNUC) – High fever (> 38 Degree C) and – Tachypnea > 60 breaths / min if aged < 2months > 50 breaths / min if aged 2-11 > 40 breaths / min if aged 12m to <60 months (Reasonably ruled out reactive airway disease) Radiological Pneumonia (PNUR) – Abnormal chest radiograph suggestive of Pneumonia

Microbiologic Diagnosis established No Yes – Culture isolation of a bacterial pathogen from pleural fluid or blood – Antigen detection identification of a bacterial antigen in pleural fluid by latex agglutination – Antibody detection – Other Gram stained smear of pleural fluid

Previous relevant vaccination Not immunized (NI) : Not received any dose of Pertussis, Hib and Measles containing vaccine or conjugate pneumococcal vaccine Partially immunized (PI) : Received either not all Pertussis, Hib and Measles containing vaccine and conjugate pneumococcal vaccine or not all age appropriate doses Fully immunized (FI): Received all age appropriate doses of Pertussis, Hib and Measles containing vaccines and conjugate pneumococcal vaccine Ineligible for Immunization (II): less than 6 weeks of age

ACUTE BACTERIAL MENINGITIS Acute onset of fever (usually > 38.5 °C rectal or 38.0 °C axillary and one of the following signs: Boggy fontanelle, seizures, neck stiffness, altered consciousness or other meningeal signs WITH Abnormal CSF – Turbid appearance OR – Leucocytosis (>100 cells / mm 3 ) OR – Leukocytosis (10 – 100 cells / mm 3 ) with elevated prot >100mg% or CSF sugar <40 mg%

Microbiologic Diagnosis established No Yes – Culture isolation of a bacterial pathogen from a normally sterile clinical specimen such as CSF or blood – Antigen detection identification of a bacterial antigen in CSF by latex agglutination – Antibody detection – Other Gram stained smear

ABMP – ABM with S.Pneumo – +ve Gram stain / Latex / CSF or Blood culture ABMH – ABM with H.influenzae – +ve Gram stain / Latex / CSF or Blood culture ABMM – ABM with N.Meningitides – +ve Gram stain / Latex / CSF or Blood culture ABMO – ABM with organism other than P/H/N ABME – ABM with no microbiological diagnosis

Previous relevant vaccination (not applicable for ABMM and ABMN) Not immunized (NI) : Not received any dose of conjugate Pneumococcal and Hib vaccines Partially immunized (PI) : Received either not all of conjugate Pneumococcal and Hib vaccines or not all age appropriate doses Fully immunized (FI): Received all age appropriate doses of conjugate Pneumococcal and Hib vaccines Ineligible for Immunization (II) – Age less than 6 weeks

CHICKENPOX(CPOX) Vesicular rash starting on trunk and spreading to extremities in multiple stages of evolution

Microbiologic Diagnosis established No Yes – Culture – Antigen detection – Antibody detection – Other

Previous relevant vaccination CPX vaccine – Not immunized (NI) Not received any CPOX vaccine – Partially immunized (PI) Received one dose of CPOX vaccine – Fully immunized (FI) Received 2 doses of Chicken pox vaccine – Ineligible for Immunization (II) Age less than 15 months

ENTERIC FEVER Compatible clinical picture AND EITHER blood culture positive OR Positive TUBE WIDAL ( both H/ A/B and O > 1: 160) done beyond day 5 of fever

Microbiologic Diagnosis established No Yes – Culture S. Typhi or S.Paratyphi on blood culture – Antigen detection – Antibody detection WIDAL Test (both H/ A/B and O > 1: 160) – Other

Previous relevant vaccination TY vaccine – Not immunized (NI) Above 2 years and not received any typhoid vaccine – Partially immunized (PI) Time lapsed since last immunization > 3 years – Fully immunized (CI) Received typhoid vaccine within last 3 years – Ineligible for Immunization (II) Age less than 2 years

DIPTHERIA An illness characterised by laryngitis or pharyngitis or tonsillitis, and an adherent membrane of the tonsils, pharynx and/or nose and Isolation of Corynebacterium diphtheriae from a clinical specimen

Microbiologic Diagnosis established No Yes – Culture Isolation of Corynebacterium diphtheriae from a clinical specimen OR – Antigen detection – Antibody detection 4 fold or greater rise in serum antibodies – other Gram stained smear

Previous relevant vaccination DPT vaccine (DTP) – Not immunized (NI) Not received any dose of DTP – Partially immunized (PI) Received less than the age appropriate doses – Fully immunized (FI) Received all the age appropriate doses – Ineligible for Immunization (II) Age less than 6 weeks

PERTUSSIS Cough lasting at least two weeks with at least one of the following symptoms: – Paroxysms (i.e. fits) of coughing – Inspiratory whooping – Post-tussive vomiting (i.e. vomiting immediately after coughing) without other apparent cause

Microbiologic Diagnosis established No Yes – Culture Isolation of Bordetella pertussis or +ve PCR – Antigen detection – Antibody detection – Other

Previous relevant vaccination DPT vaccine (DTP) – Not immunized (NI) Not received any dose of DTP – Partially immunized (PI) Received less than the age appropriate doses – Fully immunized (CI) Received all the age appropriate doses – Ineligible for Immunization (II) Age less than 6 weeks

MEASLES Any child with fever and maculopapular rash (i.e. non-vesicular) and cough, coryza (i.e. runny nose) or conjunctivitis (i.e. red eyes)

Microbiologic Diagnosis established No Yes – Culture – Antigen detection – Antibody detection Presence of measles-specific IgM antibodies – Other

Previous relevant vaccination MEASLES vaccine – Not immunized (NI) – Partially immunized (PI) Received only one dose of Measles containing vaccine – Fully immunized (FI) Received 2 doses of Measles containing vaccine – Ineligible for Immunization (II) Age less than 9 months

Mumps Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting two or more days and without other apparent cause

Microbiologic Diagnosis established No Yes – Culture – Antigen detection – Antibody detection – Other

Previous relevant vaccination MMR vaccine – Not immunized (NI) Not received any Mumps containing vaccine – Partially immunized (PI) Received at least 1 dose of Mumps containing vaccine – Fully immunized (FI) Received 2 doses of Mumps containing vaccine – Ineligible for Immunization (II) Age less than 15 months

DENGUE DENF An acute febrile illness of 2-7 days duration with two or more of the following manifestations: – Headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations DENH (Thrombocytopenia + evidence of capillary leak i.e. 20% increase in Hct or ple effusion or ascites) DENS (DHF with evidence of shock)

Microbiologic Diagnosis established No Yes – Culture – Antigen detection NS1 Antigen test – Antibody detection Positive Dengue serology IgG and IgM – Other PCR

Previous relevant vaccination

HEPATITIS An acute illness typically including acute jaundice, dark urine, anorexia, malaise, extreme fatigue and right upper quadrant tenderness Urine Bile pigments (urobilinogen) +ve ALT(SGPT) >2.5 times the upper limit of normal Malaria, leptospirosis, dengue and typhoid/paratyphoid

HEPATITIS A (HEPA) HEPATITIS B (HEPB) HEPATITIS E (HEPE) HEPATITIS O (HEPO) Hepatitis Other types HEPATITIS N (HEPN) Hepatitis etiology not known

Microbiologic Diagnosis established No Yes – Antibody detection Positive IgM anti-HAV for HEPA Positive HBsAg or IgM anti-HBc for HEPB Positive IgM anti-HEV for HEPE Positive IgM anti-HCV for HEPC – Other PCR

Previous relevant vaccination Hepatitis A Hepatitis A vaccine – Fully Immunized (FI) Taken 2 doses of Hepatitis A vaccine – Partially Immunized(PI) Taken less than one doses of Hepatitis A vaccine – Not Immunized (NI) Not taken any dose of Hepatitis A vaccine – Ineligible for immunization (II) Less than 12 months of age

Previous relevant vaccination Hepatitis B Hepatitis B vaccine – Fully Immunized (FI) Taken 3 doses of Hepatitis B vaccine – Partially Immunized (PI) Not taken all 3 doses of Hepatitis B vaccine – Not Immunized (NI) Not taken any dose of Hepatitis B vaccine – Ineligible for Immunization (II) Less than 6 weeks

HEPATITIS E, Other types, N (Etiology not known) Previous relevant vaccination