Pertussis Health Dictionary

Often called the TRIPLE VACCINE, the injections produce immunity against DIPHTHERIA, whooping cough (PERTUSSIS) and TETANUS. The vaccine is given as a course of three injections to infants around the ages of two, three and four months, together with haemophilus in?uenza B and meningococcal C vaccine as well as oral polio vaccine. A booster injection is given at school entry (see schedule in IMMUNISATION).... dpt vaccine

See pertussis.... whooping cough

Paediatrics is the branch of medicine which deals with diseases of children, but many paediatricians have a wider role, being employed largely outside acute hospitals and dealing with child health in general.

History Child health services were originally designed, before the NHS came into being, to ?nd or prevent physical illness by regular inspections. In the UK these were carried out by clinical medical o?cers (CMOs) working in infant welfare clinics (later, child health clinics) set up to ?ll the gap between general practice and hospital care. The services expanded greatly from the mid 1970s; ‘inspections’ have evolved into a regular screening and surveillance system by general practitioners and health visitors, while CMOs have mostly been replaced by consultant paediatricians in community child health (CPCCH).

Screening Screening begins at birth, when every baby is examined for congenital conditions such as dislocated hips, heart malformations, cataract and undescended testicles. Blood is taken to ?nd those babies with potentially brain-damaging conditions such as HYPOTHYROIDISM and PHENYLKETONURIA. Some NHS trusts screen for the life-threatening disease CYSTIC FIBROSIS, although in future it is more likely that ?nding this disease will be part of prenatal screening, along with DOWN’S (DOWN) SYNDROME and SPINA BIFIDA. A programme to detect hearing impairment in newborn babies has been piloted from 2001 in selected districts to ?nd out whether it would be a useful addition to the national screening programme. Children from ethnic groups at risk of inherited abnormalities of HAEMOGLOBIN (sickle cell disease; thalassaemia – see under ANAEMIA) have blood tested at some time between birth and six months of age.

Illness prevention At two months, GPs screen babies again for these abnormalities and start the process of primary IMMUNISATION. The routine immunisation programme has been dramatically successful in preventing illness, handicap and deaths: as such it is the cornerstone of the public health aspect of child health, with more potential vaccines being made available every year. Currently, infants are immunised against pertussis (see WHOOPING COUGH), DIPHTHERIA, TETANUS, POLIOMYELITIS, haemophilus (a cause of MENINGITIS, SEPTICAEMIA, ARTHRITIS and epiglottitis) and meningococcus C (SEPTICAEMIA and meningitis – see NEISSERIACEAE) at two, three and four months. Selected children from high-risk groups are o?ered BCG VACCINE against tuberculosis and hepatitis vaccine. At about 13 months all are o?ered MMR VACCINE (measles, mumps and rubella) and there are pre-school entry ‘boosters’ of diphtheria, tetanus, polio, meningococcus C and MMR. Pneumococcal vaccine is available for particular cases but is not yet part of the routine schedule.

Health promotion and education Throughout the UK, parents are given their child’s personal health record to keep with them. It contains advice on health promotion, including immunisation, developmental milestones (when did he or she ?rst smile, sit up, walk and so on), and graphs – called centile charts – on which to record height, weight and head circumference. There is space for midwives, doctors, practice nurses, health visitors and parents to make notes about the child.

Throughout at least the ?rst year of life, both parents and health-care providers set great store by regular weighing, designed to pick up children who are ‘failing to thrive’. Measuring length is not quite so easy, but height measurements are recommended from about two or three years of age in order to detect children with disorders such as growth-hormone de?ciency, malabsorption (e.g. COELIAC DISEASE) and psychosocial dwar?sm (see below).

All babies have their head circumference measured at birth, and again at the eight-week check. A too rapidly growing head implies that the infant might have HYDROCEPHALUS – excess ?uid in the hollow spaces within the brain. A too slowly growing head may mean failure of brain growth, which may go hand in hand with physically or intellectually delayed development.

At about eight months, babies receive a surveillance examination, usually by a health visitor. Parents are asked if they have any concerns about their child’s hearing, vision or physical ability. The examiner conducts a screening test for hearing impairment – the so-called distraction test; he or she stands behind the infant, who is on the mother’s lap, and activates a standardised sound at a set distance from each ear, noting whether or not the child turns his or her head or eyes towards the sound. If the child shows no reaction, the test is repeated a few weeks later; if still negative then referral is made to an audiologist for more formal testing.

The doctor or health visitor will also go through the child’s developmental progress (see above) noting any signi?cant deviation from normal which merits more detailed examination. Doctors are also recommended to examine infants developmentally at some time between 18 and 24 months. At this time they will be looking particularly for late walking or failure to develop appropriate language skills.... child health

The schedule laid down by most countries to recommend which routine immunizations should be given to children and the intervals at which boosters should be administered. Such routine immunizations usually include tetanus, diphtheria, pertussis, polio, Hepatitis B, Haemophilus influenzae type b (H.I.B.) and after one year of age, measles, rubella and mumps vaccines.... childhood immunization schedule

Also known as DPT vaccine, this is an injection that provides IMMUNITY against DIPHTHERIA, pertussis (whooping-cough) and TETANUS. It is given as a course of three injections at around the ages of two, three and four months. A booster dose of diphtheria and tetanus is given at primary-school age. Certain infants – those with a family history of EPILEPSY, or who have neurological disorders or who have reacted severely to the ?rst dose – should not have the pertussis element of DPT. (See MMR VACCINE; IMMUNISATION.)... triple vaccine

An antibiotic drug used to treat infections of the skin, chest, throat, and ears.

Erythromycin is useful in the treatment of pertussis and legionnaires’ disease.

Adverse effects include nausea, diarrhoea, and an itchy rash.... erythromycin

Linn. f.

Habitat: Native to China; now grown in Himachal Pradesh, Kumaon, the Nilgiris and West Bengal for edible fruits.

English: Japanese Persimmon.

Ayurvedic: Tinduka (var.).

Action: Hypotensive, hepatopro- tective, antidote to poisons and bacterial toxins. Calyx and peduncle of fruit—used in the treatment of cough and dyspnoea. Roasted seeds—used as a substitute for coffee.

The fruit, in addition to sugars, glucose, fructose, ascorbic acid, citric acid, contains (% of fresh weight) 0.20-1.41 tannins, 0.21-10.07 total pectins, 0.67 pentosans and 0.16-0.25 polyphenols. The fruit also contains 2.4 mg/100 g carotenoids; carotene expressed as vitamin A 2200-2600 IU. The carote- noids identified in the pulp include cryptoxanthine, zeaxanthin, antherax- anthin, lycopene and beta-carotene. (Many carotenoids originally present in the fruit decompose during ripening.

The fruit pulp is an antidote to bacterial toxins and is used in the preparation of a vaccine for pertussis.

Condensed tannins from the fruits effectively inhibited 2-nitrofluorene mutagen.

The immature leaves contain a ster- oidal saponin, lignin and phenolic compounds. Eugenol and dihydroac- tinidiolide are reported from fresh leaves.

The leaves are reported to exhibit hepatoprotective activity. Leaves also contain hypotensive principles. Astra- galin and isoquercitrin have been isolated from leaves.... diospyros kaki

See IMMUNITY.

Age Disease and mode of administration

3 days BCG (Bacille Calmette-Guerin) by injection if tuberculosis in family in past 6 months.

2 months Poliomyelitis (oral); adsorbed diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

3 months Poliomyelitis (oral); diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

4 months Poliomyelitis (oral); diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

12–18 months Measles, mumps, and rubella (German measles)4 (given together live by injection).

(SCHOOL ENTRY)

4–5 years Poliomyelitis (oral); adsorbed diphtheria and tetanus (given together by injection); give MMR vaccine if not already given at 12–18 months.

10–14 females Rubella (by injection) if they have missed MMR.

10–14 BCG (Bacille Calmette-Guerin) by injection to tuberculin-negative children to prevent tuberculosis.

15–18 Poliomyelitis single booster dose (oral); tetanus (by injection).

1 Pertussis may be excluded in certain susceptible individuals.

2 Known as DPT or triple vaccine.

3 Haemophilus in?uenzae immunisation (type B) is being introduced to be given at same time, but di?erent limb.

4 Known as MMR vaccine. (Some parents are asking to have their infants immunised with single-constituent vaccines because of controversy over possible side-effects – yet to be con?rmed scienti?cally – of the combined MMR vaccine.)

Recommended immunisation schedules in the United Kingdom... immune system

Linn.

Family: Compositae; Asteraceae.

Habitat: Waste places and fields throughout India, up to an altitude of 2,400 m.

English: Corn Sow Thistle.

Ayurvedic: Sahadevi (bigger var.). (Vernonia cinerea is equated with Sahadevi.)

Action: Plant—sedative, hypnotic, anodyne, expectorant, diuretic. Used for nervous debility. Seeds— used for asthma, bronchitis, cough, pertussis, fever; decoction in insomnia. Leaves—applied to swellings. Root—used for diseases of the respiratory tract.

The plant contains amino acids, lipids, polymeric hydrocarbons, polyphenols, protein; alpha- and beta- amyrins, lupeol, pseudotaraxasterol, taraxasterol. The latex contains manni- tol, alpha-and beta-lactucerols. Aerial parts and fruits contain ceryl alcohol, choline, palmitic, tartaric and stearic acids.... sonchus arvensis

Whooping-cough, or pertussis, is a respiratory-tract infection caused by Bordetella pertussis and spread by droplets. It may occur at all ages, but around 90 per cent of cases are children aged under ?ve. Most common during the winter months, it tends to occur in epidemics (see EPIDEMIC), with periods of increased prevalence occurring every three to four years. It is a noti?able disease (see NOTIFIABLE DISEASES). The routine vaccination of infants with TRIPLE VACCINE (see also VACCINE; IMMUNISATION), which includes the vaccine against whooping-cough, has drastically reduced the incidence of this potentially dangerous infection. In the 1990s over 90 per cent of children in England had been vaccinated against whooping-cough by their second birthday. In an epidemic of whooping-cough, which extended from the last quarter of 1977 to mid-1979, 102,500 cases of whooping-cough were noti?ed in the United Kingdom, with 36 deaths. This was the biggest outbreak since 1957 and its size was partly attributed to the fall in vaccination acceptance rates because of media reports suggesting that pertussis vaccination was potentially dangerous and ine?ective. In 2002, 105 cases were noti?ed in England.

Symptoms The ?rst, or catarrhal, stage is characterised by mild, but non-speci?c, symptoms of sneezing, conjunctivitis (see under EYE, DISORDERS OF), sore throat, mild fever and cough. Lasting 10–14 days, this stage is the most infectious; unfortunately it is almost impossible to make a de?nite clinical diagnosis, although analysis of a nasal swab may con?rm a suspected case. This is followed by the second, or paroxysmal, stage with irregular bouts of coughing, often prolonged, and typically more severe at night. Each paroxysm consists of a succession of short sharp coughs, increasing in speed and duration, and ending in a deep, crowing inspiration, often with a characteristic ‘whoop’. Vomiting is common after the last paroxysm of a series. Lasting 2–4 weeks, this stage is the most dangerous, with the greatest risk of complications. These may include PNEUMONIA and partial collapse of the lungs, and ?ts may be induced by cerebral ANOXIA. Less severe complications caused by the stress of coughing include minor bleeding around the eyes, ulceration under the tongue, HERNIA and PROLAPSE of the rectum. Mortality is greatest in the ?rst year of life, particularly among neonates – infants up to four weeks old. Nearly all patients with whooping-cough recover after a few weeks, with a lasting IMMUNITY. Very severe cases may leave structural changes in the lungs, such as EMPHYSEMA, with a permanent shortness of breath or liability to ASTHMA.

Treatment Antibiotics, such as ERYTHROMYCIN or TETRACYCLINES, may be helpful if given during the catarrhal stage – largely in preventing spread to brothers and sisters – but are of no use during the paroxysmal stage. Cough suppressants are not always helpful unless given in high (and therefore potentially narcotic) doses, and skilled nursing may be required to maintain nutrition, particularly if the disease is prolonged, with frequent vomiting.... whooping-cough

The study of all aspects of micro-organisms (microbes) – that is, organisms which individually are generally too small to be visible other than by microscopy. The term is applicable to viruses (see VIRUS), BACTERIA, and microscopic forms of fungi, algae, and PROTOZOA.

Among the smallest and simplest microorganisms are the viruses. First described as ?lterable agents, and ranging in size from 20–30 nm to 300 nm, they may be directly visualised only by electron microscopy. They consist of a core of deoxyribonucleic or ribonucleic acid (DNA or RNA) within a protective protein coat, or capsid, whose subunits confer a geometric symmetry. Thus viruses are usually cubical (icosahedral) or helical; the larger viruses (pox-, herpes-, myxo-viruses) may also have an outer envelope. Their minimal structure dictates that viruses are all obligate parasites, relying on living cells to provide essential components for their replication. Apart from animal and plant cells, viruses may infect and replicate in bacteria (bacteriophages) or fungi (mycophages), which are damaged in the process.

Bacteria are larger (0·01–5,000 µm) and more complex. They have a subcellular organisation which generally includes DNA and RNA, a cell membrane, organelles such as ribosomes, and a complex and chemically variable cell envelope – but, unlike EUKARYOTES, no nucleus. Rickettsiae, chlamydia, and mycoplasmas, once thought of as viruses because of their small size and absence of a cell wall (mycoplasma) or major wall component (chlamydia), are now acknowledged as bacteria; rickettsiae and chlamydia are intracellular parasites of medical importance. Bacteria may also possess additional surface structures, such as capsules and organs of locomotion (?agella) and attachment (?mbriae and stalks). Individual bacterial cells may be spheres (cocci); straight (bacilli), curved (vibrio), or ?exuous (spirilla) rods; or oval cells (coccobacilli). On examination by light microscopy, bacteria may be visible in characteristic con?gurations (as pairs of cocci [diplococci], or chains [streptococci], or clusters); actinomycete bacteria grow as ?laments with externally produced spores. Bacteria grow essentially by increasing in cell size and dividing by ?ssion, a process which in ideal laboratory conditions some bacteria may achieve about once every 20 minutes. Under natural conditions, growth is usually much slower.

Eukaryotic micro-organisms comprise fungi, algae, and protozoa. These organisms are larger, and they have in common a well-developed internal compartmentation into subcellular organelles; they also have a nucleus. Algae additionally have chloroplasts, which contain photosynthetic pigments; fungi lack chloroplasts; and protozoa lack both a cell wall and chloroplasts but may have a contractile vacuole to regulate water uptake and, in some, structures for capturing and ingesting food. Fungi grow either as discrete cells (yeasts), multiplying by budding, ?ssion, or conjugation, or as thin ?laments (hyphae) which bear spores, although some may show both morphological forms during their life-cycle. Algae and protozoa generally grow as individual cells or colonies of individuals and multiply by ?ssion.

Micro-organisms of medical importance include representatives of the ?ve major microbial groups that obtain their essential nutrients at the expense of their hosts. Many bacteria and most fungi, however, are saprophytes (see SAPROPHYTE), being major contributors to the natural cycling of carbon in the environment and to biodeterioration; others are of ecological and economic importance because of the diseases they cause in agricultural or horticultural crops or because of their bene?cial relationships with higher organisms. Additionally, they may be of industrial or biotechnological importance. Fungal diseases of humans tend to be most important in tropical environments and in immuno-compromised subjects.

Pathogenic (that is, disease-causing) microorganisms have special characteristics, or virulence factors, that enable them to colonise their hosts and overcome or evade physical, biochemical, and immunological host defences. For example, the presence of capsules, as in the bacteria that cause anthrax (Bacillus anthracis), one form of pneumonia (Streptococcus pneumoniae), scarlet fever (S. pyogenes), bacterial meningitis (Neisseria meningitidis, Haemophilus in?uenzae) is directly related to the ability to cause disease because of their antiphagocytic properties. Fimbriae are related to virulence, enabling tissue attachment – for example, in gonorrhoea (N. gonorrhoeae) and cholera (Vibrio cholerae). Many bacteria excrete extracellular virulence factors; these include enzymes and other agents that impair the host’s physiological and immunological functions. Some bacteria produce powerful toxins (excreted exotoxins or endogenous endotoxins), which may cause local tissue destruction and allow colonisation by the pathogen or whose speci?c action may explain the disease mechanism. In Staphylococcus aureus, exfoliative toxin produces the staphylococcal scalded-skin syndrome, TSS toxin-1 toxic-shock syndrome, and enterotoxin food poisoning. The pertussis exotoxin of Bordetella pertussis, the cause of whooping cough, blocks immunological defences and mediates attachment to tracheal cells, and the exotoxin produced by Corynebacterium diphtheriae causes local damage resulting in a pronounced exudate in the trachea.

Viruses cause disease by cellular destruction arising from their intracellular parasitic existence. Attachment to particular cells is often mediated by speci?c viral surface proteins; mechanisms for evading immunological defences include latency, change in viral antigenic structure, or incapacitation of the immune system – for example, destruction of CD 4 lymphocytes by the human immunode?ciency virus.... microbiology

n. a genus of tiny Gram-negative aerobic bacteria. B. pertussis causes *whooping cough, and all the other species are able to break down red blood cells and cause diseases resembling whooping cough.... bordetella

(dTaP/IPV) a booster vaccine given to children between 3 years 4 months and 5 years of age. It tops up protection against diphtheria, tetanus, pertussis (whooping cough), and polio.... dtap/ipv

a primary *immunization given to infants typically at 2, 3, and 4 months of age. It protects against six diseases: diphtheria (D), tetanus (T), pertussis (whooping cough) acellular component (aP), polio (inactivated polio vaccine) IPV, Haemophilus influenzae type b infection (Hib) (see Hib vaccine), and Hepatitis B (HepB).... dtap/ipv/hib/hepb

The name applied generally to dead or attenuated living infectious material introduced into the body, with the object of increasing its power to resist or to get rid of a disease. (See also IMMUNITY.)

Healthy people are inoculated with vaccine as a protection against a particular disease; this produces ANTIBODIES which will confer immunity against a subsequent attack of the disease. (See IMMUNISATION for programme of immunisation during childhood.)

Vaccines may be divided into two classes: stock vaccines, prepared from micro-organisms known to cause a particular disease and kept in readiness for use against that disease; and autogenous vaccines, prepared from microorganisms which are already in the patient’s body and to which the disease is due. Vaccines intended to protect against the onset of disease are of the former variety.

Autogenous vaccines are prepared by cultivating bacteria found in SPUTUM, URINE and FAECES, and in areas of in?ammation such as BOILS (FURUNCULOSIS). This type of vaccine was introduced by Wright about 1903.

Anthrax vaccine was introduced in 1882 for the protection of sheep and cattle against this disease. A safe and e?ective vaccine for use in human beings has now been evolved. (See ANTHRAX.)

BCG vaccine is used to provide protection against TUBERCULOSIS. (See also separate entry on BCG VACCINE.)

Cholera vaccine was introduced in India about 1894. Two injections are given at an interval of at least a week; this gives a varying degree of immunity for six months. (See CHOLERA.)

Diphtheria vaccine is available in several forms. It is usually given along with tetanus and pertussis vaccine (see below) in what is known as TRIPLE VACCINE. This is given in three doses: the ?rst at the age of two months; the second at three months; and the third at four months, with a booster dose at the age of ?ve years. (See DIPHTHERIA.)

Hay fever vaccine is a vaccine prepared from the pollen of various grasses. It is used in gradually increasing doses for prevention of HAY FEVER in those susceptible to this condition.

In?uenza vaccine A vaccine is now available for protection against INFLUENZA due to the in?uenza viruses A and B. Its use in Britain is customarily based on advice from the health departments according to the type of in?uenza expected in a particular year.

Measles, mumps and rubella (MMR) vaccines are given in combination early in the second year of life. A booster dose may prove necessary, as there is some interference between this vaccine and the most recent form of pertussis vaccine (see below) o?ered to children. Uptake has declined a little because of media reports suggesting a link with AUTISM – for which no reliable medical evidence (and much to the contrary) has been found by investigating epidemiologists. (See also separate entry for each disease, and for MMR VACCINE.)

Pertussis (whooping-cough) vaccine is prepared from Bordetella pertussis, and is usually given along with diphtheria and tetanus in what is known as triple vaccine. (See also WHOOPING-COUGH.)

Plague vaccine was introduced by Ha?kine, and appears to give useful protection, but the duration of protection is relatively short: from two to 20 months. Two injections are given at an interval of four weeks. A reinforcing dose should be given annually to anyone exposed to PLAGUE.

Poliomyelitis vaccine gives a high degree of protection against the disease. This is given in the form of attenuated Sabin vaccine which is taken by mouth – a few drops on a lump of sugar. Reinforcing doses of polio vaccine are recommended on school entry, on leaving school, and on travel abroad to countries where POLIOMYELITIS is ENDEMIC.

Rabies vaccine was introduced by Pasteur in 1885 for administration, during the long incubation period, to people bitten by a mad dog, in order to prevent the disease from developing. (See RABIES.)

Rubella vaccine, usually given with mumps and measles vaccine in one dose – called MMR VACCINE, see also above – now provides protection against RUBELLA (German measles). It also provides immunity for adolescent girls who have not had the disease in childhood and so ensures that they will not acquire the disease during any subsequent pregnancy – thus reducing the number of congenitally abnormal children whose abnormality is the result of their being infected with rubella via their mothers before they were born.

Smallpox vaccine was the ?rst introduced. As a result of the World Health Organisation’s successful smallpox eradication campaign – it declared the disease eradicated in 1980 – there is now no medical justi?cation for smallpox vaccination. Recently, however, there has been increased interest in the subject because of the potential threat from bioterrorism. (See also VACCINATION.)

Tetanus vaccine is given in two forms: (1) In the so-called triple vaccine, combined with diphtheria and pertussis (whooping-cough) vaccine for the routine immunisation of children (see above). (2) By itself to adults who have not been immunised in childhood and who are particularly exposed to the risk of TETANUS, such as soldiers and agricultural workers.

Typhoid vaccine was introduced by Wright and Semple for the protection of troops in the South African War and in India. TAB vaccine, containing Salmonella typhi (the causative organism of typhoid fever – see ENTERIC FEVER) and Salmonella paratyphi A and B (the organisms of paratyphoid fever – see ENTERIC FEVER) has now been replaced by typhoid monovalent vaccine, containing only S. typhi. The change has been made because the monovalent vaccine is less likely to produce painful arms and general malaise, and there is no evidence that the TAB vaccine gave any protection against paratyphoid fever. Two doses are given at an interval of 4–6 weeks, and give protection for 1–3 years.... vaccine

chick embryos injected with the living, attenuated strain (17D) of pantropic virus. Only one injection is required, and immunity persists for many years. Re-inoculation, however, is desirable every ten years. (See YELLOW FEVER.)

Haemophilus vaccine (HiB) This vaccine was introduced in the UK in 1994 to deal with the annual incidence of about 1,500 cases and 100 deaths from haemophilus MENINGITIS, SEPTICAEMIA and EPIGLOTTITIS, mostly in pre-school children. It has been remarkably successful when given as part of the primary vaccination programme at two, three and four months of age – reducing the incidence by over 95 per cent. A few cases still occur, either due to other subgroups of the organism for which the vaccine is not designed, or because of inadequate response by the child, possibly related to interference from the newer forms of pertussis vaccine (see above) given at the same time.

Meningococcal C vaccine Used in the UK from 1998, this has dramatically reduced the incidence of meningitis and septicaemia due to this organism. Used as part of the primary programme in early infancy, it does not protect against other types of meningococci.

Varicella vaccine This vaccine, used to protect against varicella (CHICKENPOX) is used in a number of countries including the United States and Japan. It has not been introduced into the UK, largely because of concerns that use in infancy would result in an upsurge in cases in adult life, when the disease may be more severe.

Pneumococcal vaccine The pneumococcus is responsible for severe and sometimes fatal childhood diseases including meningitis and septicaemia, as well as PNEUMONIA and other respiratory infections. Vaccines are available but do not protect against all strains and are reserved for special situations – such as for patients without a SPLEEN or those who are immunode?cient.... yellow fever vaccine is prepared from

A lung disorder in which 1 or more bronchi (the air passages leading from the trachea) are abnormally widened, distorted, and have damaged linings.

Bronchiectasis most often develops during childhood and was once commonly associated with infections such as measles and pertussis (whooping cough).

The condition is also a complication of cystic fibrosis.

It results in pockets of long-term infection within the airways and the continuous production of large volumes of green or yellow sputum (phlegm).

Extensive bronchiectasis causes shortness of breath.

The symptoms are usually controlled with antibiotic drugs and postural drainage.

If the condition is confined to one area of the lung, surgical removal of the damaged area may be recommended.... bronchiectasis

Also known as triple vaccine, an injection that provides immunity against diphtheria, pertussis (whooping cough), and tetanus; The vaccine causes the body to produce antibodies against these infections. It is given as a course of 3 injections at 2, 3, and 4 months, followed by a preschool booster dose. Before leaving school, a further diphtheria and tetanus booster is given. The vaccine does not provide complete immunity to diphtheria or pertussis but reduces risk of serious illness.

Protection against pertussis and tetanus gradually wanes. In adults, pertussis is mild but can be transmitted to children. Since tetanus is serious at any age, boosters are recommended at the time of any dirty, penetrating injury if there has not been a vaccination in the past 10 years.

Reactions to the diphtheria and tetanus parts of the vaccine are rare.

The pertussis vaccine often causes slight fever and irritability for a day or so.

More serious reactions are extremely rare and include seizures and an allergic reaction, which may lead to sudden breathing difficulty and shock.

Permanent damage from the vaccine is even rarer.

Doctors are now agreed that for most children, the benefits of outweigh the minimal risk from the vaccine.

The pertussis element of the vaccine should not be given to children who have reacted severely to a preceding dose of the vaccine, or who have a progressing brain abnormality.... dpt vaccination

The process of inducing immunity as a preventive measure against infectious diseases. Immunization may be active or passive. In the passive form,antibodies are injected into the blood to provide immediate but short-lived protection against specific bacteria, viruses, or toxins. Active immunization, also called vaccination, primes the body to make its own antibodies and confers longer-lasting immunity.

Routine childhood immunization programmes exist for diseases such as diphtheria, pertussis, and tetanus (see DPT vaccination), haemophilus influenza (Hib), measles, mumps, and rubella (see MMR vaccination), meningitis C, and poliomyelitis. Additional immunizations before foreign travel may also be necessary (see travel immunization).

Most immunizations are given by injection, and usually have no after effects. However, some vaccines cause pain and swelling at the injection site and may produce a slight fever or flu-like symptoms. Some may produce a mild form of the disease. Very rarely, severe reactions occur due, for example, to an allergy to 1 of the vaccine’s components. Not all vaccines provide complete protection. Cholera and typhoid fever vaccinations, in particular, give only partial protection.

People with immunodeficiency disorders, widespread cancer, those taking corticosteroid drugs, or those who have previously had a severe reaction to a vaccine should not be immunized. Some vaccines should not be given to young children or during pregnancy.... immunization

Medical conditions that must be reported to the local health authorities. Notification of certain potentially harmful infectious diseases enables health officers to monitor and control the spread of infection.

Examples of notifiable infectious diseases are food poisoning, hepatitis, measles, malaria, tetanus, tuberculosis, and pertussis (whooping cough).

Some categories of diseases other than infections must also be reported. These include certain birth defects and forms of learning difficulties. Cancers are registered nationally, and cancer data is now pooled in an international registry. Certain types of occupational disease are also reportable; examples include lead poisoning, mercury poisoning, cadmium poisoning, and anthrax. (See also prescribed diseases.)... notifiable diseases

Thymus vulgaris

FAMILY: Lamiaceae (Labiatae)

SYNONYMS: T. aestivus, T. ilerdensis, T. webbianus, T. valentianus, French thyme, garden thyme, red thyme (oil), white thyme (oil).

GENERAL DESCRIPTION: A perennial evergreen subshrub up to 45 cms high with a woody root and much-branched upright stem. It has small, grey-green, oval, aromatic leaves and pale purple or white flowers.

DISTRIBUTION: Native to Spain and the Mediterranean region; now found throughout Asia Minor, Algeria, Turkey, Tunisia, Israel, the USA, Russia, China and central Europe. The oil is mainly produced in Spain but also in France, Israel, Greece, Morocco, Algeria, Germany and the USA.

OTHER SPECIES: There are numerous varieties of thyme – the common thyme is believed to have derived from the wild thyme or mother-of-thyme (T. serpyllum), which is also used to produce an essential oil called serpolet, similar in effect to the common thyme oil.

Another species used for the production of the so-called red thyme oil is particularly the Spanish sauce thyme (T. zygis), a highly penetrating oil good for cellulitis, sports injuries, etc. (although, like the common thyme, it is a skin irritant). Other species used for essential oil production include lemon thyme (T. citriodorus), a fresh scented oil good for asthma and other respiratory conditions, safe for children. Spanish marjoram (T. Mastichina) is actually botanically classified as a variety of thyme, with which it shares many common properties, despite its common name. Spanish marjoram contains mainly 1,8-cineole (up to 75 per cent) and linalool (up to 20 per cent), so therapeutically has much in common with eucalyptus, being well suited to treating viral and bacterial respiratory infections. See also Botanical Classification section.

HERBAL/FOLK TRADITION: One of the earliest medicinal plants employed throughout the Mediterranean region, well known to both Hippocrates and Dioscorides. It was used by the ancient Egyptians in the embalming process, and by the ancient Greeks to fumigate against infectious illness; the name derives from the Greek thymos meaning ‘to perfume’. It is also a long-established culinary herb, especially used for the preservation of meat.

It has a wide range of uses, though in Western herbal medicine its main areas of application are respiratory problems, digestive complaints and the prevention and treatment of infection. In the British Herbal Pharmacopoeia it is indicated for dyspepsia, chronic gastritis, bronchitis, pertussis, asthma, children’s diarrhoea, laryngitis, tonsillitis and enuresis in children.

ACTIONS: Anthelmintic, antimicrobial, antioxidant, antiputrescent, antirheumatic, antiseptic (intestinal, pulmonary, genito-urinary), antispasmodic, antitussive, antitoxic, aperitif, astringent, aphrodisiac, bactericidal, balsamic, carminative, cicatrisant, diuretic, emmenagogue, expectorant, fungicidal, hypertensive, nervine, revulsive, rubefacient, parasiticide, stimulant (immune system, circulation), sudorific, tonic, vermifuge.

EXTRACTION: Essential oil by water or steam distillation from the fresh or partially dried leaves and flowering tops. 1. ‘Red thyme oil’ is the crude distillate. 2. ‘White thyme oil’ is produced by further redistillation or rectification. (An absolute is also produced in France by solvent extraction for perfumery use.)

CHARACTERISTICS: 1. A red, brown or orange liquid with a warm, spicy-herbaceous, powerful odour. 2. A clear, pale yellow liquid with a sweet, green-fresh, milder scent. It blends well with bergamot, lemon, rosemary, melissa, lavender, lavandin, marjoram, Peru balsam, pine, etc.

PRINCIPAL CONSTITUENTS: Thymol and carvacrol (up to 60 per cent), cymene, terpinene, camphene, borneol, linalol; depending on the source it can also contain geraniol, citral and thuyanol, etc.

There are many chemotypes of thyme oil: notably the ‘thymol’ and ‘carvacrol’ types (warming and active); the ‘thuyanol’ type (penetrating and antiviral); and the milder ‘linalol’ or ‘citral’ types (sweet-scented, non-irritant).

SAFETY DATA: Red thyme oil, serpolet (from wild thyme), ‘thymol’ and ‘carvacrol’ type oils all contain quite large amounts of toxic phenols (carvacrol and thymol). They can irritate mucous membranes, cause dermal irritation and may cause sensitization in some individuals. Use in moderation, in low dilution only. They are best avoided during pregnancy.

White thyme is not a ‘complete’ oil and is often adulterated. Lemon thyme and ‘linalol’types are in general less toxic, non-irritant, with less possibility of sensitization – safe for use on the skin and with children.

AROMATHERAPY/HOME: USE

Skin care: Abscess, acne, bruises, burns, cuts, dermatitis, eczema, insect bites, lice, gum infections, oily skin, scabies.

Circulation muscles and joints: Arthritis, cellulitis, gout, muscular aches and pains, obesity, oedema, poor circulation, rheumatism, sprains, sports injuries.

Respiratory system: Asthma, bronchitis, catarrh, coughs, laryngitis, sinusitis, sore throat, tonsillitis.

Digestive system: Diarrhoea, dyspepsia, flatulence.

Genito-urinary system: Cystitis, urethritis.

Immune system: Chills, colds, ’flu, infectious diseases.

Nervous system: Headaches, insomnia, nervous debility and stress-related complaints – ‘helps to revive and strengthen both body and mind’..

OTHER USES: The oil is used in mouthwashes, gargles, toothpastes and cough lozenges. ‘Thymol’ is isolated for pharmaceutical use in surgical dressings, disinfectants etc. Used as a fragrance component in soaps, toiletries, aftershaves, perfumes, colognes, etc. Extensively employed by the food and drink industry, especially in meat products.... thyme, common