Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae.

[1] Signs and symptoms may vary

from mild to severe.[2] They usually start two to five days after exposure. [1] Symptoms often come on fairly gradually
beginning with a sore throat and fever.[2] In severe cases a grey or white patch develops in the throat. [1][2] This can
block the airway and create a barking cough as in croup.[2] The neck may swell in part due to large lymph nodes.[1] A
form of diphtheria that involves the skin, eyes, or genitals also exists. [1][2] Complications may
include myocarditis, inflammation of nerves, kidney problems, and bleeding problems due to low blood platelets.
Myocarditis may result in an abnormal heart rate and inflammation of the nerves may result in paralysis.[1]
Diphtheria is usually spread between people by direct contact or through the air.[1][3] It may also be spread by
contaminated objects. Some people carry the bacteria without having symptoms, but can still spread the disease to
others. There are three main types of C. diphtheriae causing different severities of disease.[1] The symptoms are due
to a toxin produced by the bacteria. Diagnosis can often be made based on the appearance of the throat with
confirmation by culture. Previous infection may not prevent against future infection.[2]
A vaccine, known as diphtheria toxoid, is effective for prevention and available in a number of formulations. Three or
four doses, given along with tetanus toxoid and acellular pertussis vaccine, are recommended during childhood.
Further doses are recommended every ten years. Protection can be verified by measuring the antitoxin level in the
blood. Treatment is with theantibiotic erythromycin or penicillin G. These antibiotics may also be used for prevention
in those who have been exposed to the infection. [1] A surgical procedure known as a tracheostomy is sometimes
needed to open the airway in severe cases.
Pertussis (also known as whooping cough or 100-day cough) is a highly contagious bacterial disease.[1][2] Initially,
symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough. This is then
followed by weeks of severe coughing fits. Following a fit of coughing, a high-pitched whoop sound or gasp may
occur as the person breathes in.[2] The coughing may last for 10 or more weeks, hence the phrase "100-day cough".
[3]
A person may cough so hard that they vomit, break ribs, or become very tired from the effort.[2][4] Children less than
one year old may have little or no cough and instead have periods where they do not breathe.[2] The time between
infection and the onset of symptoms is usually seven to ten days. [5] Disease may occur in those who have been
vaccinated, but symptoms are typically milder.[2]
Pertussis is caused by the bacterium Bordetella pertussis.[6] It is an airborne disease which spreads easily through
the coughs and sneezes of an infected person. [6][7] People are infectious to others from the start of symptoms until
about three weeks into the coughing fits. Those treated with antibiotics are no longer infectious after five days.
[8]
Diagnosis is by collecting a sample from the back of the nose and throat. This sample can then be tested by
either culture or by polymerase chain reaction.[9]
Prevention is mainly by vaccination with the pertussis vaccine.[10] Initial immunization is recommended between six
and eight weeks of age, with four doses to be given in the first two years of life. [11] The vaccine becomes less
effective over time, with additional doses often recommended for older children and adults. [12] Antibiotics may be
used to prevent the disease in those who have been exposed and are at risk of severe disease. [13] In those with the
disease, antibiotics are useful if started within three weeks of the initial symptoms, but otherwise have little effect in
most people. In children less than one year old and among those who are pregnant, they are recommended within
six
weeks
of
symptom
onset.
Antibiotics
used
includeerythromycin, azithromycin, clarithromycin,
or trimethoprim/sulfamethoxazole.[8] Evidence to support interventions, other than antibiotics, for the cough is poor.
[14]
Many children less than a year of age require hospitalization.
Tetanus, also known as lockjaw, is an infection characterized by muscle spasms. In the most common type, the
spasms begin in the jaw and then progress to the rest of the body. These spasms usually last a few minutes each
time and occur frequently for three to four weeks.[1] Spasms may be so severe that bone fractures may occur.[2] Other
symptoms may includefever, sweating, headache, trouble swallowing, high blood pressure, and a fast heart rate.[1]

Onset of symptoms is typically three to twenty-one days following infection. It may take months to recover. About
10% of those infected die.[1]
[2]

Tetanus is caused by an infection with the bacterium Clostridium tetani,[1] which is commonly found in soil, dust, and
manure.[3] The bacteria generally enter through a break in the skin such as a cut or puncture wound by a
contaminated object.[3] They produce toxins that interfere with muscle contractions, resulting in the typical symptoms.
[4]
Diagnosis is based on the presenting signs and symptoms. The disease does not spread between people. [1]
Infection can be prevented by proper immunization with the tetanus vaccine. In those who have a significant wound
and less than three doses of the vaccine both immunization and tetanus immune globulin are recommended. In
those who are infected tetanus immune globulin or, if it is not available, intravenous immunoglobulin (IVIG) is used.
The wound should be cleaned and any dead tissue should be removed. [1] Muscle relaxants may be used to control
spasms. Mechanical ventilation may be required if a person's breathing is affected.
Bacillus CalmetteGurin (BCG) vaccine is a vaccine primarily used against tuberculosis.[1] In countries where
tuberculosis is common one dose is recommended in healthy babies as close to the time of birth as possible.
[1]
Babies with HIV/AIDS should not be vaccinated.[2] In areas where tuberculosis is not common, only babies at high
risk are typically immunized while suspected cases of tuberculosis are individually tested for and treated. Adults who
do not have tuberculosis and have not been previously immunized but are frequently exposed to drug resistant
tuberculosis may be immunized as well. [1] It is also often used as part of the treatment ofbladder cancer. Albert
Calmette, a French physician and bacteriologist, and his assistant and later colleague, Camille Gurin, a
veterinarian, were working at the Institut Pasteur de Lille (Lille, France) in 1908.
Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV) which affects the liver. It can cause both
acute andchronic infections. Many people have no symptoms during the initial infection. Some develop a rapid onset
of sickness with vomiting, yellowish skin, tiredness, dark urine and abdominal pain.[1] Often these symptoms last a
few weeks and rarely does the initial infection result in death. [1][2] It may take 30 to 180 days for symptoms to begin.
[1]
In those who get infected around the time of birth 90% develop chronic hepatitis B while less than 10% of those
infected after the age of five do. [3] Most of those with chronic disease have no symptoms; however, cirrhosis and liver
cancer may eventually develop.[4] These complications result in the death of 15 to 25% of those with chronic
disease.[1]
The virus is transmitted by exposure to infectious blood or body fluids. Infection around the time of birth or from
contact with other people's blood during childhood is the most frequent method by which hepatitis B is acquired in
areas where the disease is common. In areas where the disease is rare, intravenous drug use and sexual
intercourse are the most frequent routes of infection. [1] Other risk factors include working in healthcare, blood
transfusions, dialysis, living with an infected person, travel in countries where the infection rate is high, and living in
an institution.[1][3] Tattooing and acupuncture led to a significant number of cases in the 1980s; however, this has
become less common with improved sterility.[5] The hepatitis B viruses cannot be spread by holding hands, sharing
eating utensils, kissing, hugging, coughing, sneezing, or breastfeeding. [3] The infection can be diagnosed 30 to 60
days after exposure. Diagnosis is typically by testing the blood for parts of the virus and for antibodiesagainst the
virus.[1] It is one of five known hepatitis viruses: A, B, C, D, and E.
Haemophilus
influenzae (formerly
called Pfeiffer's
bacillus or Bacillus
influenzae)
is
a Gramnegative, coccobacillary, facultatively anaerobic pathogenic bacterium belonging to the Pasteurellaceae family. H.
influenzae was first described in 1892 by Richard Pfeifferduring an influenza pandemic.[1]
The bacterium was mistakenly considered to be the cause of influenza until 1933 when the viral cause
of influenza became apparent, and is still colloquially known as 'bacterial influenza'. H. influenzae is responsible for
a wide range of localized and invasive infections. This species was the first free-living organism to have its
entire genome sequenced.

Serotypes[edit]
In 1930, two major categories of H. influenzae were defined: the unencapsulated strains and the encapsulated
strains. Encapsulated strains were classified on the basis of their distinct capsular antigens. There are six generally
recognized types of encapsulated H. influenzae: a, b, c, d, e, and f. [3] Genetic diversity among unencapsulated
strains is greater than within the encapsulated group. Unencapsulated strains are termed nontypable (NTHi)
because they lack capsular serotypes; however, they can be classified by multilocus sequence typing.
The pathogenesis of H. influenzae infections is not completely understood, although the presence of the capsule in
encapsulated type b (Hib), a serotype causing conditions such as epiglottitis, is known to be a major factor in
virulence. Their capsule allows them to resist phagocytosis and complement-mediated lysis in the nonimmune host.
The unencapsulated strains are almost always less invasive; they can, however, produce an inflammatory response
in humans, which can lead to many symptoms. Vaccination with Hib conjugate vaccine is effective in preventing Hib
infection, but does not prevent infection with NTHi strains.[4]

Diseases[edit]
Most strains of H. influenzae are opportunistic pathogens; that is, they usually live in their host without causing
disease, but cause problems only when other factors (such as a viral infection, reduced immune function or
chronically inflamed tissues, e.g. from allergies) create an opportunity. They infect the host by sticking to the host
cell using trimeric autotransporter adhesins.
Naturally acquired disease caused by H. influenzae seems to occur in humans only. In infants and young
children, H. influenzae type b (Hib) causes bacteremia, pneumonia, epiglottitis and acute bacterial meningitis. On
occasion, it causes cellulitis, osteomyelitis, andinfectious arthritis.
Due to routine use of the Hib conjugate vaccine in the U.S. since 1990, the incidence of invasive Hib disease has
decreased to 1.3/100,000 in children. However, Hib remains a major cause of lower respiratory tract infections in
infants and children in developing countries where the vaccine is not widely used. Unencapsulated H.
influenzae strains are unaffected by the Hib vaccine and cause ear infections (otitis media), eye infections
(conjunctivitis), and sinusitis in children, and are associated with pneumonia.
Poliomyelitis, often called polio or infantile paralysis, is an infectious disease caused by the poliovirus. In about
0.5% of cases there is muscle weakness resulting in an inability to move.[1] This can occur over a few hours to few
days.[1][2] The weakness most often involves the legs but may less commonly involve the muscles of the head, neck
and diaphragm. Many but not all people fully recover. In those with muscle weakness about 2% to 5% of children
and 15% to 30% of adults die.[1]Another 25% of people have minor symptoms such as fever and a sore throat and
up to 5% have headache, neck stiffness and pains in the arms and legs.[1][2] These people are usually back to normal
within one or two weeks. In up to 70% of infections there are no symptoms.[1] Years after recovery post-polio
syndrome may occur, with a slow development of muscle weakness similar to that which the person had during the
initial infection.[3]
Poliovirus is usually spread from person to person through infected fecal matter entering the mouth.[1] It may also be
spread by food or water containing human feces and less commonly from infected saliva.[1][2] Those who are infected
may spread the disease for up to six weeks even if no symptoms are present. The disease may be diagnosed by
finding the virus in the fecesor detecting antibodies against it in the blood. The disease only occurs naturally in
humans.[1]
The disease is preventable with the polio vaccine; however, a number of doses are required for it to be effective.
[2]
The USCenters for Disease Control and Prevention recommends polio vaccination boosters for travelers and
those who live in countries where the disease is occurring.[4] Once infected there is no specific treatment.[2] In 2015
polio affected less than 100 people, down from 350,000 cases in 1988. [2][5] In 2014 the disease was only spreading
between people in Afghanistan,Nigeria, and Pakistan.[2] In 2015 Nigeria had stopped the spread of wild poliovirus but
it reoccurred in 2016.[6][7]
Poliomyelitis has existed for thousands of years, with depictions of the disease in ancient art. [1] The disease was first
recognized as a distinct condition by Michael Underwood in 1789[1] and the virus that causes it was first identified in

1908 byKarl Landsteiner.[8] Major outbreaks started to occur in the late 19th century in Europe and the United States.
[1]
In the 20th century it became one of the most worrying childhood diseases in these areas.[9] The first polio vaccine
was developed in the 1950s by Jonas Salk.[10] It is hoped that vaccination efforts and early detection of cases will
result in global eradication of the disease by 2018.