Intervention 3: Infectious Disease Prevention
Infectious Diseases prevention: Tetanus toxoid (TT) immunisation, PMTCT of HIV; TB/STI Screening
Tetanus toxoid (TT) immunisation
Maternal and neonatal tetanus is easily preventable through the immunisation of women of child-bearing age and pregnant women. WHO recommends giving two properly spaced doses of TT in selected high-risk areas. Many countries routinely immunise pregnant women during ANC visits. For those women who were not vaccinated against tetanus earlier in life, or whose immunisation status is unknown, a total of five doses is recommended: two doses one month apart during the first pregnancy, and one in each subsequent pregnancy, or at relevant intervals, to a total of five doses. 7-11 programming will provide education and information for TT immunisation during pregnancy, encouraging pregnant women to seek appropriate ANC where immunisation services are provided.
DEFINITIONS:
- The Tetanus toxoid(TT) vaccine is given during pregnancy to prevent tetanus to the mother as well as her baby. Tetanus is a life-threatening bacterial disease that is caused by the toxin of a bacterium called Clostridium tetani. Tetanus bacteria enter the body through an open wound. Tetanus affects a person's nervous system and can be fatal if left untreated. It is preventable through immunisation.
Target Behaviours:
- Every pregnant woman receives the full schedule of TT following the national health standards of the Expanded Immunisation Program of the country
- Every pregnant woman should have a vaccine record card
PMTCT of HIV
To reduce the possibility of HIV transmission from mother to child, an HIV-positive pregnant woman must receive additional antenatal services. These include treatment with ARVs starting at 14 weeks of pregnancy to reduce her viral load and increase her ‘fighter’ cells; administration of drugs against opportunistic infections such as Tb; and nutrition counselling and support with particular regard to safe infant feeding practises. The HIV-exposed baby should be started on ARVs and cotrimoxazole prophylaxis until HIV infection is excluded. The baby should be tested for HIV at 4 to 6 weeks to enable prompt appropriate treatment if indicated. New evidence also shows that exclusive breast-feeding for six months, accompanied by continued ART for mother and child is effective in reducing HIVtransmission while giving the benefits of breastmilk. Countries with generalised HIV epidemics must implement the PMTCT actions. Without access to these services, mothers living with HIV will pass the virus to their babies in 30–45 per cent of cases. More than half of these infants will die before their second birthday, and up to 60 per cent will die by the age of 3. Comprehensive PMTCT using the new guidelines can actually reduce vertical transmission to 5 or even 1 per cent, virtually eliminating this threat to children.
Definitions:
- HIV(human immunodeficiency virus) is the virus that causes AIDS. This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person's broken skin or mucous membranes. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as thorugh breast feeding.
- The immmune system is the body's defense against disease and HIV, the human immuniodeficiency virus, causes the immune system to gradually deterioate, resulting in what is claled AIDS. AIDS is an acronym for Acquired Immunodeficiency Syndrome and refers to the most and advnaced severe state of HIV infection.
- When a woman is infected with HIV she can pass the virus to her infant during pregnancy, labor, delivery or breastfeeding. This is called mother to child transmission, or MTCT. The prevention of transission of HIV from the mother to her infant is called PMTCT. The current global effort is to revent new infections entirely in children and this is called the Elimination of Mother to Child Transmission of HIV(EMTCT).
Target Behaviours:
- Avoid risky sexual behavior. This includes multiple concurrent sexual partners, unprotected sex with an HIV-positive person
- Get tested for HIV. One can be infected without showing initial symptoms. Testing and getting treatment early(if found positive for HIV) can prolong quality life for the infected person.
- It is important for a pregnant woman to know her HIV status so she can prevent transmission to infant. All pregnant women should be tested for HIV.
- Mothers who are HIV positive should continue to take their medicine regularly, for life
TB and STI Screening
Routine screening for HIV together with other STIs both during pregnancy and as part of a broader maternal, newborn and child health programme is needed on an opt-out basis, especially since new STI cases – particularly HIV and syphilis – occur predominantly among the younger age group (15 to 24 years). HIV and syphilis are also the two STIs that most commonly affect newborns. Early screening for HIV should be done to ensure that HIV+ women can start a regime of prophylaxis by 14 weeks of pregnancy. Since an uninfected woman could sero-convert during pregnancy or breast-feeding, and since risk of vertical transmission is greater immediately following sero-conversion, women should consider re-testing close to delivery or during the post-partum period. If screening for syphilis is effectively done and prompt treatment is administered to the infected pregnant women, an estimated 492,000 stillbirths could be prevented. Unlike HIV, syphilis is curable with effective, inexpensive drugs. 7-11 programming makes all of this information known to households and will refer pregnant women to the health facilities where they can access the services needed.
Definition:
STIs/STDs are infections/diseases that are passed from one person to another through sexual contact. These include chlaymdia, gonorrhea, genital herpes, human papillomavirus(HPV), syphilis, and HIV. Many of these STDs do not show symptoms for a long time, but they can still be harmful and passed on during sexual relations. Some of the infections are caused by bacteria while others are caused by viruses or fungi. People who have STDs/STIs are more likely to have HIV than people who do not have STDs.
Target Behaviours:
- Avoid behaviors that can expose you to the risk of acquiring sexually transmitted infections
- Get regular screening, especially during pregancy
- Seek care and treatment early if you have symptoms related to sexually transmitted diseases
Tuberculosis
7-11 programming includes awareness-raising around Tb, with recommendations for early diagnosis and initiation of treatment. Some 7-11 programmes may choose to engage in community-based directly observed treatment short-course (DOTS) implementation; a rigorous approach normally needed to bring Tb levels under some control.
Definition:
- Tuberculosis or TB is a bacterial infection that most commonly affects the lungs. It is transmitted from person to person through droplets from the throat and lungs of people with the active lung disease. Sometimes it can spread to affect other part of the body to include the abdomen, the bones, and other internal organs. Tuberculosis is curable and preventable.
Target Behaviours:
- Pregnant women are tested for HIV and screened for Tuberculosis during antenatal care visit
- If you are HIV positive get screened for Tuberculosis and if you have tuberculosis get tested for HIV
- If you are infected with both HIV and Tuberculosis, go to the health facility for appropriate treatment for both conditions
- Take TB medicines as prescribed by the doctor or nurse, and finish the treatment
Read more about Infectious Disease and Prevention here
Questions:
What is Tetanus?
Tetanus is a life-threatening bacterial disease. The bacteria enters the body through an open wound. Tetanus affects a person’s nervous system and can be fatal if left untreated. It is preventable through immunisation. Tetanus is the only vaccine-preventable disease that is not transmitted from person to person. It is also the only vaccine-preventable disease that a person can get more than once.
How does a person contract Tetanus?
A person contracts Tetanus when bacteria from a contaminated source enter a break in the skin (a cut or puncture wound). The bacteria are commonly found in soil, dust and manure. In the case of the newborn, Tetanus usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. The disease does not spread between people.
What are the symptoms of Tetanus in a pregnant woman, and in a newborn?
The disease makes muscles rigid, causes muscle spasms and makes breathing difficult or impossible; it can completely shut down the nervous system. A newborn or infant with tetanus can generally suck normally for 2 days, then crying will increase, and the child will show an inability to suck, begin to have muscle spasms and grow rigid and stiff.
What are the consequences of Tetanus in a pregnant woman an in a newborn?
There is a great risk that a newborn with teatus will die.
Why is it important for a pregnant woman to be vaccinated with Tetanus Toxoid(TT)?
The Tetanus Toxoid (TT) vaccine causes the formation of antibodies that protect the mother against Tetanus. (You can think of antibodies like soldiers in the body).During pregnancy, the antibodies (or soldiers) are also passed on to the baby and protect him or her for a few months after birth. The vaccine also helps prevent early birth.
Is the TT safe?
Yes, the TT is safe.
Does TT have side effects?
The side effects are related to a sore arm, swelling at the site of injection, and itching.
Can the vaccine cause the disease?
No, it cannot cause the disease.
When should a pregnant woman receive TT?
During antenatal care visits, the health care provider must check the immunization status of the pregnant woman (either by history or by card), regardless of whether the woman intends to continue the pregnancy. If the woman qualifies for it, the provider should administer TT:
- If the pregnant woman has not previously been vaccinated, or if her immunization status is unknown, she should receive two doses of TT one month apart before delivery, and further doses as per the country schedule
- If the woman has had 1–4 doses of tetanus toxoid in the past, she should receive one dose of TT before delivery
- A total of 5 doses protects a woman throughout her childbearing years
Are there any reasons a pregnant woman should not receive TT?
No, in general it is safe for a pregnant woman and her baby to receive the recommended TT schedule
Why is it important to keep a vaccine record card?
The pregnant woman must keep a vaccination record card and have it with her when vising the antenatal care service and when she is ready to deliver the baby as having record of vaccines will be helpful for future health records.
The pregnant woman should make sure the health care provider completes the vaccination record car when she receives TT doses
Questions: HIV and Prevention of Mother to Child Transmission of HIV
How is HIV transmitted?
HIV can be transmitted from one person to another in several ways; the most common of which is sexual transmission. This can include heterosexual or homosexual (e.g. men who have sex with men) transmission Other ways of HIV transmission include:
Transmission from a mother to her infant during pregnancy, labor, delivery or breastfeeding, blood from HIV-contaminated needles, syringes or other sharp instruments, and from transfusion with HIVcontaminated blood. HIV is not transmitted through casual contact, sharing food, or mosquito bites.
What is the difference between HIV and AIDS?
HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immunodeficiency syndrome). AIDS is the late stage of HIV infection. People who have AIDS grow weaker because their bodies lose the ability to fight off illness. Without treatment, people with AIDS will eventually die, usually of opportunistic infections. With appropriate treatment, however, HIV can be managed and infected persons can live long and productive lives.
How quickly does a person infected with HIV develop AIDS?
The length of time can vary widely between individuals. Left without treatment, the majority of people infected with HIV will develop signs of HIV-related illness within 5–10 years, although this can be shorter. The time between acquiring HIV and an AIDS diagnosis is usually between 10–15 years. Antiretroviral therapy (ART) can slow the disease progression by preventing the virus replicating and therefore decreasing the amount of virus in an infected person’s blood (known as the ‘viral load’).
What is the benefit of an HIV test?
Knowing your HIV status can have 2 important benefits:
If you learn that you are HIV positive, you can take steps before symptoms appear to access treatment, care and support, thereby potentially prolonging your life and preventing health complications for many years. If you know that you are infected, you can take precautions to prevent the spread of HIV to others.
Is there a cure for HIV?
No, there is no cure for HIV. But with good and continued adherence to antiretroviral therapy, the progression of HIV in the body can be slowed to a near halt. Increasingly, people living with HIV can remain well and productive for extended periods of time.
What are antiretroviral drugs?
Antiretroviral drugs are used in the treatment and prevention of HIV infection. They fight HIV by stopping or interfering with the reproduction of the virus in the body, reducing the amount of virus in the body.
What is the most common life-threatening opportunistic infection affecting people living with HIV or AIDS?
Tuberculosis (TB) kills nearly 360,000 people living with HIV each year. It is the number one cause of death among HIV-infected people in Africa, and a leading cause of death in this population worldwide.
Does male circumcision prevent HIV transmission?
No, it does not prevent it altogether, but male circumcision reduces the risk of female-to-male sexual transmission of HIV by around 60%. WHO and UNAIDS have recommended voluntary medical male circumcision as an additional strategy for HIV prevention in settings with high HIV prevalence and low levels of male circumcision. A one-time intervention, medical male circumcision provides life-long partial protection against HIV as well as other sexually transmitted infections. It should always be considered as part of a comprehensive HIV prevention package and should never replace other known methods of prevention, such as female and male condoms.
How effective are condoms in preventing HIV?
When used properly during every sexual intercourse, condoms are a proven means of preventing HIV infection in women and men. However, apart from abstinence, no protective method is 100% effective.
How can HIV infection be prevented?
Prevention of HIV transmission is through avoidance of situations in which exposure to the virus occurs or by taking medications to prevent transmission, such as ARV prophylaxis through prevention or elimination of mother to child transmission of HIV (PMTCT/EMTCT) programs or post-exposure prophylaxis (PEP) after rape or an occupational exposure.
Some of the general approaches to HIV prevention include:
- Abstaining from sex
- Practicing mutual faithfulness after determining HIV status of both partners
- Consistent and correct use of condoms
- Screening blood before transfusion
- Adhering to infection control measures
- Post exposure prophylaxis (PEP)
- Prevention of mother to child transmission of HIV through ARV prophylaxis, modifying delivery practices to reduce transmission and ensuring safe infant feeding practices.
Now that I am infected with HIV, what should I do?
Infection with HIV is no longer a death sentence as there is treatment available to keep people alive. Now that you know your status, in addition to the prevention measures listed above you should also take note of the following:
- Maintain safer sexual practices and behavior
- Use condoms for high-risk sexual behaviors
- Be faithful to your partner
- Maintain one sexual partner
- Visit the health facility for examination and initiation of treatment for HIV infection
- Adhering completely to the HIV medication regimen your doctor or nurse has prescribed for you
- Attend your clinic appointments regularly
- Request for any additional needs to help you stay on treatment
- Join a support group to learn from other HIV positive people
- Encourage other members of your family to get tested for HIV
- Disclose, tell another person of your HIV status so that they can support you as you are on treatment.
How is HIV transmitted from mother to child?
HIV-positive women can transmit HIV to their infants during pregnancy, birth, or while breast feeding. This occurs when there is a mixing of blood between the mother and child (during pregnancy when the virus can cross the placenta from mother to child), or the mixing of body fluids (during delivery as the baby passes through the birth canal), or through breastfeeding when the virus may be transmitted to the child.
When is HIV transmitted from the mother to the child?
During pregnancy, labor and delivery, the risk of HIV transmission from mother to child is between 20– 50% (without treatment such as ART). In other words 20 to 50 children born to 100 HIV positive women will be infected by the virus. Different periods of pregnancy have different risks which are as follows: 5–10% during pregnancy; 10–20% during labor and delivery; 5–20% during breast feeding. The virus can be transmitted at any time the newborn has contact with the blood or bodily fluids of the HIV positive mother.
How can we prevent the transmission of HIV from mother to child?
Prevention of transmission of HIV infection from HIV positive women to their infants during pregnancy, labor, and delivery and post-natal through breastfeeding. This is often through the use of antiretroviral drugs during pregnancy and after delivery for mother and child, which is why it is so important for an HIV-positive women to delivery in a health facility – to ensure that she and her baby receive the drug regimen that they need.
Questions: Sexually-Transmitted Infections/Diseases (STI/STD)
How are STDs spread?
You can get an STI/STD by having sex (vaginal, anal or oral) with someone who has an STD. Anyone who is sexually active can get an STD. Some STDs, like herpes and HPV, can also be spread by skin-to-skin contact.
How will I know if I have an STI/STD?
Many STDs don’t cause any noticeable symptoms. STDs can be transmitted through sexual relations with someone with no symptoms. As such, the only way to know for sure if you have an STD is to get tested.
Can STDs be treated?
Your doctor can prescribe medicines to cure some STDs, like chlamydia and gonorrhea. Other STDs, like herpes, cannot be cured, but you can take medicine to help with the symptoms. If you receive treatment for an STD, be sure to finish all of your medicine, even if you feel better before you finish it all. Ask the doctor or nurse about testing and treatment for your partner, too. You and your partner should avoid having sex until you’ve both finished treatment. Otherwise, you may continue to pass the STD back and forth. It is possible to get an STD again (after you’ve been treated), if you have sex with someone who has an STD.
What happens if I don't treat an STD?
Some curable STDs can be dangerous if they aren’t treated. For example, if left untreated, chlamydia and gonorrhea can make it difficult or even impossible for a woman to get pregnant. You also increase your chances of becoming infected with HIV if you have an untreated STD. Some STDs, in particular HIV, can be fatal if left untreated.
What can I do to protect myself?
The surest way to protect yourself against STDs is to not have sex (“abstinence”). It is okay to say “no” if you do not want to have sex. If you do decide to have sex, you and your partner should get tested beforehand.
Are some STDs associated with HIV?
Yes. People can get syphilis, gonorrhea, and herpes (shingles) in addition to HIV infection. People with these STDs are at higher risk of contracting HIV.
Why does having an STD put me more at risk for becoming infected with HIV?
If you get an STD you are more likely to get HIV than someone who is STD-free. This is because the same behaviors and circumstances that may put you at risk for getting an STD can also put you at greater risk for getting HIV. In addition, having a sore or break in the skin from an STD may allow HIV to more easily enter your body.
If I already have HIV, and then I get an STD, does that put my sexual partner(s) at an increased risk for getting HIV?
It can. If you already have HIV, and then get another STD, it can put your HIV-negative partner at greater risk of getting HIV from you. Your sexual partner is less likely to become infected with HIV from you if you:
- Use antiretroviral therapy (ART). ART reduces the amount of virus (viral load) in your blood and body fluids. ART can keep you healthy for many years, and greatly reduce your chance of transmitting HIV to sex partners, if taken consistently.
- Choose less risky sexual behaviors.
- Use condoms consistently and correctly. The risk of getting HIV may also be reduced if your partner takes pre-exposure prophylaxis, or PrEP, after discussing this option with his or her healthcare provider and determining whether it is appropriate.
Will treating STDs prevent me from getting HIV?
No. If you get treated for an STD, this will help to prevent its complications, and prevent spreading STDs to your sexual partner(s). Treatment for an STD other than HIV does not prevent the spread of HIV. If you are diagnosed with an STD, talk to your doctor about ways to protect yourself and your partner(s) from getting reinfected with the same STD, or getting HIV.
What is Syphilis?
Syphilis is a sexually transmitted infection which can pass from the infected mother to the unborn child. The infection can be hard to recognize. It causes significant illness and death and is especially dangerous to the newborn baby. It is estimated that globally more than 1.5 million pregnant women are infected with syphilis2 and that more than half a million adverse events occur in their babies.
The most common problems which result from syphilis infection are stillbirths, preterm labour and newborn infection leading to death. Syphilis can also cause deformities in the baby such as blindness or deafness and cause babies to be born very small, called low birth weight. When a newborn baby or young infant shows signs of syphilis infection this is called “congenital syphilis” meaning acquired from its mother.
Is syphilis curable?
Yes, adult women and men can be cured of syphilis using a very strong antibiotic which is given as an injection a number of times to ensure the infection is cured. If the patient does not receive treatment the infection will eventually lead to serious illness and death. This antibiotic can safely be given to a pregnant woman during pregnancy and will protect the unborn baby and can also be given to a newborn baby or an infant or child suspected of having congenital syphilis.
Can congenital syphilis be prevented?
Yes. As the infection may have no symptoms it is best that all pregnant women are tested. If a pregnant woman is tested early in her pregnancy and found to have a positive result she can be treated quickly and this can prevent complications and also protect the unborn baby from acquiring congenital syphilis. At this time her sexual partner should be contacted and also treated so that he will not pass the infection onto the pregnant woman and unborn child again.
What can be done to prevent congenital syphilis?
Early diagnosis and treatment during pregnancy is the best way to prevent the complications to the newborn baby. All pregnant women should be encouraged to attend their first antenatal visit as early as possible in the pregnancy in order for the syphilis screening test to be done and the mother and her partner to be treated if needed.