Communicable Diseases 2012 Student Version

Communicable Disease

Communicable DiseasesAn illness that is transmitted by contact with body fluidsdirectly transmittedacquired from a person or vector (ticks, mosquitoes, or other animal) indirectly transmitted by contact with contaminated objects.

Communicable Diseasesof childhood include diseases with high transmission ratesViruses are the leading cause of most pediatric infections

Communicable DiseasesThe poor hygiene behaviors of young children promote the transmission of infectious diseases

The fecal-oral and respiratory routes are the most common sources of transmission in children.

Young children may not wash their hands after toileting unless closely supervised.

Immunizations

ImmunizationsPrevention of any illness is always better than treatment

Vaccines are the single best technique for prevention

Vaccines are the safer choice to getting the disease

Immunization Schedule

By 24 Months children should have:

4 Dtap, Hib, PCV

3 Hep B, IVP

1 MMR, varicella

ImmunizationsAre either inactivated or activated

Inactivated include Dtap, Hib, Hep

Activated (live) multiplies for days-weeks in body MMR, Varicella

ReactionsVaccines are very safe and have little chance for side effectsSide effects are minor and occur with in days of administrationReactions to live vaccines can occur 30-60 days post vaccine (usually in older children)

Reaction to Vaccines

local tendernesserythemaswelling at sitelow grade fever (possibly high with activated)behavior changes, irritability

Adverse EventsNational Law to provide care for those affected by a vaccines adverse eventLaw requires nurses toObtain consent prior to vaccine record lot #, manufacturer, exp. date of vaccine after administration

Barriers to ImmunizationComplexity of the health care systemExpenseInaccurate recordkeepingReluctance of health care workers to give more than two vaccines at a timeLack of public awareness of vaccinesParental misconceptions

Parental Misconceptions

Parents may understand the dangers inherent in some of these diseasessuffering, permanent disability, death

Unimmunized children are at a greater risk of getting the disease and of spreading it to pregnant women and to infants and children with serious medical conditions.

Parental MisconceptionsMisconception:

Vaccine-preventable diseases have been eliminatedCorrect Information

Travelers may reintroduce the disease Recent outbreaks of measles, mumps, and pertussis have been linked to groups of children not immunized

Parental MisconceptionsMisconception:

Immunization weakens the immune system.Fear of giving multiple vaccines.

Correct Information

Childs immune system is capable of several immunizations at once No effect on immune system

Parental MisconceptionsMisconception:

Vaccines may cause serious conditions, such as autism

Correct Information

Numerous studies have confirmed the lack of association between the measles vaccine and autism, as well as thimerosal in vaccines and autism

True contraindications and precautions

Moderate-severe illness with or without feverImmunocompromisedPrior serious reaction (fever 105, seizure, anaphylatic)

AdministrationNursing ConsiderationProper storageReconstitutionExpiration dateConsentDocumentation (immunization record)

Atraumatic care

Select needle of adequate lengthSelect proper siteVL infantsDeltoid > 18 monthsMinimize painEMLA creamDistraction

Communicable Diseases

Nursing ResponsibilitiesAssessment: Identify recent exposureIdentify prodromal symptomss/s occur early in diseaseLocate immunization historyConfirm history of having the disease

Nursing ResponsibilitiesImplementation:

prevent spread-isolationreduce risk of cross contaminationprevent complicationsprovide comfort

Viral Infections

Varicella (Chicken Pox)Varicella VirusVaccine availableTransmitted by respiratory secretions in contact and droplet, contaminated objects

Communicable 1 day before eruption of vesicles to 6 days after first crop of vesicles have formed

VaricellaBegins with slight fever, maliase, anorexiaIn 24 hours highly itchy rash primarily over trunkStarts as a macule which progresses into a papule and then a vesicle surrounded by erythema baseThe fluid becomes cloudy, breaks and crusts over

VaricellaThe Key to diagnosis is varying stages of rashRash starts on trunk and progresses to body including genitalia, mucous membranesAlso can detect presence of disease after 1 month through serum antibody testing

Management

Isolation at home until vesicles dry (2-3 weeks) and 1 week after lesions are goneVery young and immunocompromised may need isolation in hospitalRelief of itchingAntiviral agentsTreat secondary complications (bacterial infections from scratching)

Fifths DiseaseParvovirus (HPV B19)No vaccine availableTransmitted by probable respiratory secretions Easily Communicable up to 14 days after infection

SymptomsClassic rash of erythema on face (cheeks), slapped face appearanceHigh fever, lethargy, n/v, abd. Pain, cervical lympadnopathy

SymptomsFollowed with maculopapular red spots appear in 1 week, symmetrically on upper and lower extremities has a lace-like appearance

rash subsides, but reappears if skin is irritated (sun, heat, cold)

ManagementExplain the stages of rash development to parents.

The immune-competent child can return to school or daycare once the body rash has appeared

RoseolaViral infectionNo vaccine availableTransmitted most likely by contact with salivaDisease of younger children, rarely affects children >3 years

Communicability unknown, but believed NOT to be communicable once rash appears

SymptomsPersistent high fever for 3-4 days in a child who appears wellThen drop in fever to normal => rash appearsrose-pink macules first on trunk, spread to neck, face, extremities, not itchy, lasts 1-2 days

Diagnosis and ManagementDiagnosis is made based on classis rash and symptoms, serum testing availableantipyretics, analgesics, isolation not necessaryMay result in fetal death if woman is infected during pregnancy.Since fever is very high can have febrile seizures

Rubeola (measles)

Viral infectionVaccine available M in MMRTransmitted by respiratory secretions, blood and urine of infected person

Communicable just before the rash appears to 4-5 days after rash appears=highly contagious

SymptomsFirst 24 hoursFever, malaise, cough, coryza, conjunctivitis

In 48 hoursKoplik spots (small, irregular, red spots with minute bluish-white center) first seen on buccal mucosa

Raised erythema rash rash on face that spreads downwardDiscrete, then turns confluent on the third day

Other symptoms persist

Diagnosis and ManagementDiagnosis made on symptoms, serology 1 month laterManagement:Isolation until rash disappearsBed rest AntipyreticsFluids and vaporizer for coughSkin care (itchy rash)Decrease lighting-photophobia may cause eye rubbing and corneal abrasion

MumpsViral infectionVaccine available 2nd M in MMRTransmitted by direct contact of saliva and respiratory droplet Communicable immediately before swelling begins

SymptomsFever, HA, M, Anorexia, x 24 hours, earache aggravated by chewing On 3rd day: parotitis (enlarged parotid gland), unilateral or bilateral, pain, tenderness

Diagnosis and ManagementDiagnosis by classic presentation, serum antibody testing 1 month after infectionTreatment:analgesics for painantipyreticsIsolationBed restSoft diet Cold compress to neck

Rubella(German measles)Viral InfectionVaccine Available R in MMRTransmitted by direct contact of nasopharyngeal secretions, feces, urine, or articles freshly contaminatedCommunicable 7 days before to 5 days after rash

SymptomsRash on face which rapidly spreads downward to neck, arms, trunk and legsby end of first day body is covered with pinkish-red maculopapulesRash disappears in same order as it appearedRash gone by 3rd dayalso low grade fever, HA, Malise, cough, sore throat

Diagnosis and ManagementDiagnosis by symptoms, serology available 1 month after infectionTreatmentAntipyreticsComfort measures

**Pregnant people must avoid infected child=fetal death

Bacterial Infections

DiphteriaBacterial infectionVaccine available D in DtapTransmitted by direct contact with respiratory secretions,droplet, contaminated objects

Communicable 2-4 weeks=highly contagious

Symptomsyellow nasal dischargemay have epitaxissore throathoarseness with coughenlarged lymph nodeslow grade feverincrease pulsemalaiselaryngeal involvement: potential airway obstruction=serious for the very young

Diagnosis and Management

Diagnosed by culture of discharge strict isolation abx (PCN)complete BRtrach if obstructed airwaysuctioning

Pertussis(whooping cough)

Bacterial infectionVaccine available P in DtapTransmitted by direct contact, dropletCommunicable for up to 4 weeks

SymptomsBegins with URI symptoms: dry, hacking cough that becomes severe, worse at night

**short, rapid coughs followed by sudden inspiration and whooping**Cheeks flush, eyes bulge, tongue protrudesThick secretions, often vomitsSick for 4-6 weekswww.whoopingcough.net for sound and video

Diagnosis and ManagementDiagnosed by classic presentationTreatment:hospitalization for infants or children who are dehydrated BR increase fluids abxSuctioningHumidifierObserve for airway obstruction (restlessness, retractions, cyanosis)

Scarlet feverBacterial infection (strep), often sequela to strep throatNo vaccine availableTransmission by direct contact, dropletCommunicable for 10 days to 2 weeks

SymptomsAbrupt high feverVery high pulse,Vomit, HA, Maliase, chills,abd. Pain tonsils enlarged: (edematous, red, covered with patches of white exudate).First 1-2 days tongue is coated with papules, is also red & swollen = white strawberry tongue

By 4th or 5th day white coat sloughs off leaving prominent papillae = red strawberry tongueRash: red, pin head sized lesions, rash is intense in folds and joints, flushed cheeks

Diagnosis and ManagementDiagnosis + TC, ASO titerManagement:respiratory isolation x 24 hours full course of PCN/EES analgesics for sore throat

Lets Play a Game.

Practice Questions!

Which of the following statements indicates that a parent understands the treatment for his/her child who has fifth? (Select All That Apply)1. I will give antibiotic for the full 10 days2. No antibiotic is needed, as this is a viral infection.3. I will apply antibiotic cream to her rash twice a day. 4. My child can go back to school when the body rash appears. 5. If my child had the vaccine, she wouldnt have gogotten sick

Fill in the BlankThe nurse is explaining the vaccine schedule to a parent of a newborn. The nurse evaluates parental understanding if the parent states the child will need _____ DPT vaccines by age 24 months.

A mother brings her infant to the pediatrician because the baby has had a high fever for 3 days and then developed a rash. The nurse examines the baby to find light pink macules on trunk, neck, face, and extremities. The nurse suspects the baby has:

1. Rubeola2. Rubella3. Roseola4. Scarlet Fever

If a 2 year old child was fully immunized or up to date, the child has a very low chance of getting which infection: (Select All that Apply)

DiptheriaVaricellaRoseolaPertussisRubella