Control of Diphtheria, Pertussis, Tetanus, Haemophilus influenzae type b, and Hepatitis B FIELD GUIDE Scientific and Technical Publication No. 604 PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 525 Twenty-third Street, N.W. Washington, D.C. 20037 www.paho.org 2005 Also published in Spanish (2005) with the title: Control de la difteria, tos ferina, tétanos, Haemophilus influenzae tipo b y hepatitis B. Guía práctica. (ISBN 92 75 31604 X) PAHO HQ Library Cataloguing-in-Publication Data Pan American Health Organization Control of diphtheria, pertussis, tetanus, Haemophilus influenzae type b, and hepatitis B: field guide. Washington, D.C.: PAHO, © 2005. (Scientific and Technical Publication No. 604) ISBN 92 75 11604 0 I. Title II. Series 1. DIPHTHERIA - prevention & control 2. WHOOPING COUGH - prevention & control 3. TETANUS - prevention & control 4. HAEMOPHILUS INFLUENZAE TYPE B 5. HEPATITIS B - prevention & control 6. GUIDEBOOKS [PUBLICATION TYPE] NLM WC100 This guide was prepared by the Immunization Unit of the Pan American Health Organization. Cover photos: left, Stockbyte.com, © Stockbyte; center, courtesy of Ignacio Astorga; right, Stockbyte.com, © Stockbyte. The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Publications Program, Pan American Health Organization, Washington, D.C., U.S.A., which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization (2005) Publications of the Pan American Health Organization enjoy copyright protection in accor- dance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan Ameri- can Health Organization concerning the status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. CONTENTS About the immunization field guides . xi Preface . xiii Glossary . xv Acronyms . xix 1 DIPHTHERIA . 1 1.1 Introduction . 1 1.2 Epidemiology . 1 1.2.1 Infectious Agent . 1 1.2.2 Occurrence . 2 1.2.3 Transmission . 2 1.2.4 Reservoir . 2 1.2.5 Incubation . 2 1.2.6 Communicability . 2 1.2.7 Immunity . 3 1.2.8 Changing Epidemiology . 3 1.3 Clinical aspects . 4 1.3.1 Pathogenesis . 4 1.3.2 Clinical Features . 5 1.3.3 Laboratory Diagnosis . 6 1.3.4 Differential Diagnosis . 6 1.3.5 Complications . 7 1.3.6 Treatment . 7 1.3.7 Management of Contacts . 9 1.4 Vaccination activities . 9 1.4.1 Routine Immunization . 9 iii iv CONTROL OF DIPHTHERIA, PERTUSSIS, TETANUS, HAEMOPHILUS INFLUENZAE TYPE B, AND HEPATITIS B: FIELD GUIDE 1.4.2 Other Vaccination Activities . 10 1.4.3 Outbreak Control . 10 2 PERTUSSIS (WHOOPING COUGH) . 11 2.1 Introduction . 11 2.2 Epidemiology . 11 2.2.1 Infectious Agent . 11 2.2.2 Occurrence . 11 2.2.3 Transmission . 11 2.2.4 Reservoir . 12 2.2.5 Incubation . 12 2.2.6 Communicability . 12 2.2.7 Immunity . 12 2.2.8 Changing Epidemiology . 12 2.3 Clinical aspects . 13 2.3.1 Pathogenesis . 13 2.3.2 Clinical Features . 13 2.3.3 Laboratory Diagnosis . 14 2.3.4 Differential Diagnosis . 16 2.3.5 Complications . 16 2.3.6 Treatment . 17 2.3.7 Management of Contacts . 17 2.4 Vaccination activities . 18 2.4.1 Routine Immunization . 18 2.4.2 Outbreak Control . 18 3 TETANUS . 19 3.1 Introduction . 19 3.2 Epidemiology . 19 3.2.1 Infectious Agent . 19 3.2.2 Occurrence . 19 3.2.3 Transmission . 20 CONTENTS v 3.2.4 Reservoir . 20 3.2.5 Incubation . 20 3.2.6 Communicability . 20 3.2.7 Immunity . 20 3.2.8 Changing Epidemiology . 20 3.3 Clinical aspects . 21 3.3.1 Pathogenesis . 21 3.3.2 Clinical Features . 21 3.3.3 Laboratory Diagnosis . 22 3.3.4 Differential Diagnosis . 22 3.3.5 Complications . 22 3.3.6 Treatment . ..