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In order to be protected against these three diseases, infants must receive three injections of the combined DTP (diphtheria, tetanus, pertussis) vaccine by the age of six months. The first injection is given at two months, followed by two more administered every other month. The child must receive a booster shot of CDT (combined diphtheria and tetanus toxoid) at age 18 to 24 months and another CDT shot at the age of four to six years. Thereafter, a booster of diphtheria-tetanus vaccine is necessary every ten years for life.

Diphtheria. Diphtheria is a bacterial disease that is frequently fatal. It causes infection of the nose, throat, tonsils, and lymph nodes of the neck. The bacterium responsible can produce a toxin (poison) that causes heart damage and paralysis. Cases of diphtheria are now rare in Western countries. For every case reported there are many other persons who are carriers of diphtheria. (A carried is a person who harbors the disease without getting sick him- or herself, and who can transmit it to other people.)

Before the diphtheria vaccine came into general use 40 years ago, many adults were immune to diphtheria because they had had some form of the illness in childhood. This situation no longer exists, so adults should receive booster shots of diphtheria vaccine every ten years. Serious ractions to the diphtheria vaccine, which is a dead vaccine, are rare.

Tetanus. Tetanus, or lockjaw, is a disease of the nervous system that can enter the body through a wound – even a minor wound like a scratch or an insect bite. Tetanus cases still occur throughout Australia. Although the vaccine is thoroughly safe and effective, its protection weakens over the years and booster shots are required. It is generally thought that after the age of four to six a child should receive a booster every ten years. However, some people are likely to have more frequent contact with tetanus germs and need to have a booster shot every five years. In general, clean wounds, such as those from kitchen utensils, require boosters every ten years; dirty wounds, such as those from rusty nails, barbed wire, and others that happen outdoors, require boosters every five years. For example, if your child has a wound from a rusty nail, check to see if he or she has received a booster within the last five years. Adults should receive boosters at least every ten years.

Whooping cough. Whooping cough is more common than many parents (and doctors) realize. It is a highly contagious infection of the respiratory tract, and it gets its name from the severe, strangling cough that develops as the disease progresses. Whooping cough vaccine is the most uncertain of the three components of the DTP vaccine, and it does not always give complete immunity. There have been extremely rare instances of brain damage following its use, but in some of these cases the damage was caused by faulty administration of the vaccine rather than by the vaccine itself. The vaccine may also cause a brief reaction of fever. For these reasons, routine boosters are not recommended after the child is eighteen months old. However, the mortality rate among infants under age one who contract whooping cough and the possibility of complications in older children are high enough to exceed by far the minimal risk of the vaccine.

In England, serious reactions to the vaccine were sufficiently frequent at one point to persuade the medical profession to suspend its use. However, because of the increasing incidence of whooping cough and its severe complications, immunization has now been reinstituted in England.

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Appendicitis is an inflammation (infection) of the appendix. The appendix is a hollow tube about the size of your little finger that forms a blind pouch where the small intestine joins the large intestine. In 99 percent of all children, the appendix lies in the lower right quarter of the child’s abdomen.

Appendicitis can occur at any age. If the appendix is not surgically removed, the infection worsens until the appendix bursts. Then the infection spreads throughout the abdomen. An infected appendix may perforate (rupture) within hours of the initial pain or may not rupture for a day or two. A ruptured appendix can lead to death.

Signs and symptoms

Persistent abdominal pain in your child should be considered a symptom of appendicitis until proven otherwise. Typically, the pain of appendicitis is constant; it does not come and go as does the pain from cramps. Once it starts, it grows continually worse. The pain may start in the pit of the stomach, but it usually soon moves to the lower right quarter of the abdomen. The pain is made worse by walking or just moving about. The abdomen is tender to a gentle pressure in the lower right quarter, more tender than in other areas. There may be nausea and vomiting, but these symptoms usually start only after the pain has started.

Generally, there is a low-grade fever (37.8°C, oral; 38.3°C, rectal), but the temperature may range anywhere from normal to 40°C. Bowel movements are usually normal, but there may be diarrhea. Diagnosis is difficult because all of these signs may not be present. Because diagnosis is so difficult and the condition is so serious, call your doctor if you have any reason to suspect appendicitis.

Home care

Try applying gentle heat, as with a heating pad turned to “low.” If pain gets worse, it is probably appendicitis. Never apply cold; this can mask the symptoms of appendicitis.

Do not give pain killers such as paregoric or codeine. Acetaminophen is safe but useless. Aspirin can affect the blood’s ability to clot, so it should not be given in case the child needs surgery. Allow only clear liquids by mouth. However, once you suspect that there is a strong possibility of appendicitis, do not give your child any food or drink until you consult your physician. Never give a laxative or enema.

Precaution

If pain persists in the lower right quarter of the abdomen, despite home treatment measures, call your doctor.

Medical treatment

The only acceptable treatment for appendicitis is surgical removal of the appendix (an appendectomy). Therefore, your doctor must be reasonably sure of the diagnosis. In addition to the abdomen, your child’s chest and throat will be examined because a throat infection and pneumonia can cause symptoms of appendicitis. A rectal examination will also be performed and a blood count and a urinalysis done. (These last two tests do not prove or disprove appendicitis, however.) An X ray may be called for.

Once tests are complete, your doctor may operate or admit your child to a hospital to watch the child for a few hours until the diagnosis becomes more certain. Unnecessary surgery is to be avoided, but the rule of safety is to operate on a child who may have appendicitis rather than postpone surgery until the appendix ruptures.

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Will there be difficulties in getting a job?

Almost certainly not. Almost all careers and jobs are open to persons with diabetes. Some jobs are clearly unsuitable for people with diabetes and it would be unwise to attempt to do them. Examples include being a commercial airline pilot or joining the armed services. In some jobs it would be difficult to keep in good diabetic control and an example of this is taxi driving or long distance truck driving, where it might be impossible to have regular meals.

On the other hand, you may encounter employers who are prejudiced against any kind of medical disorder and in such cases if you really wish to obtain a job there, you must convince your employer that diabetes will not interfere with your efficiency in the job. Perhaps Diabetes Australia can help you in this situation, and your doctor could provide you with a certificate.

Whether you volunteer that you have diabetes to any potential employer or not is largely up to you. By doing so, you are keeping faith with your prospective employer and it makes it easier for him to accept the occasional time off for a medical check-up or illness. At all events it is necessary for someone working with you to know about it in case you need help.

Often there is no problem at all, but you should discuss with your doctor if you are in any doubt. A youth employment officer (vocational guidance officer) may be of help, as he will know a wide range of employment agencies that can be approached if diabetes does seem to have created difficulties with employment.

In general, and except in certain categories of employment, people with diabetes do not have trouble in getting a good job but you should not be discouraged if one or two employers should turn you down because of your diabetes.

When I apply for a job, must I tell my prospective employer that I have diabetes?

It is difficult to generalize about this except to say that you must be truthful at all times if you wish to hold a secure and a good job. For some occupations you will be asked to provide a medical certificate. If you have to fill in a form or if your doctor has to fill in a form for you, then it is clear that you must state the fact of diabetes. You can ask your doctor to give a certificate to go with this form, making a statement about your health and whether it is likely to interfere with your ability to carry out the job. If you are asked if you have any physical or medical complaints then clearly you must say that you have diabetes. You can qualify this by saying that you are perfectly well, that you have not missed school because of it and that you are prepared to get a medical certificate about it.

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