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Vaccines and Vaccine Preventable Communicable Illness of Childhood

. Vaccines and Vaccine Preventable Communicable Illness of Childhood. Childhood Immunizations.

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Vaccines and Vaccine Preventable Communicable Illness of Childhood

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  1. . Vaccines and Vaccine Preventable Communicable Illness of Childhood

  2. Childhood Immunizations The introduction of vaccines against childhood diseases such as measles, mumps, rubella, polio, whooping cough (pertussis), diphtheria, small pox, haemophilus influenza, hepatitis b and varicella has greatly improved the quality of life for both children and adults. Vaccines need to be administered at specific ages and time intervals, timing for the first sets of immunizations is determined by the age in which transplacental immunity decreases or disappears, and the infant has the ability to make antibodies in response to the disease. The effectiveness of vaccines depends on proper storage and handling. Most vaccines need to be refrigerated and Varivax (for varicella) needs to be kept frozen. When involved in the administration of vaccine, the RN is responsible for both the proper storage and handling

  3. Types of Immunizations Live attenuated (live virus) MMR, Varivax Inactivated (killed virus vaccine) DTaP, Hib, IPV, Prevnar Recombinant (genetically rendered) Hep A, B Immunoglobulins (IVIG) Varicella , Measles, RSV, Rabies, Tetanus, Hepatitis A, B, C

  4. 2004 Immunization Schedule

  5. Securing a toddler

  6. Pediatric Nursing Responsibilities and Nursing Interventions in Immunizing children • Be prepared for life threating reaction when ever immunizing children. • At every visit/encounter child’s immunizations record should be reviewed. • Review child’s allergies (food and medicine) . • Review potential contraindications to each vaccines • Review past immunization history for past reactions • Assess child for anxiety and fear related to administration • Obtain informed consent. • In females of child bearing age (11-50) perform rapid urine HcG (pregnancy test) before administering Live vaccines (MMR/Varicella). • Parent and patient education about the need for specific vaccinations, risk of not getting vaccination and getting dieses and potential side effects of vaccine. • Record vaccines administered in patients chart and vaccine record (card) • Give patient and parent current VIS (vaccine information statement) in APPROPRIATE language before discharge. • Monitor child for 15 minutes post vaccination. • Report all vaccine related reactions using the federal VAERS (vaccine adverse reaction reporting system) and as per institution policy.

  7. DTaP VaccineDiphtheria, acellular pertussis and tetanus Ages: 2,4,6,15-18 months, 4-6 years with a separate Td (tetanus booster) at age 11-12 years, Td booster every 10 years for life. Total 5 childhood doses. Route: IM Dose: 0.5ml Common side effects: Redness, swelling, pain at injection site. T>100.9, drowsiness, anorexia. Serious side effects: Anaphylaxis, shock or collapse, fever > 102, persistent, inconsolable crying, seizures, encephalopathy. Contraindications: Occurrence of a serious side effect after previous dose, administration of IVIG within past 90 days.

  8. Nursing considerations DTaP vaccine • Use the same brand when ever possible. • Carefully question parents if they say the child had previous reaction to immunizations • Inform parents of increased risk of reaction to does 4 & 5 • If child had a serious adverse reaction to any previous dose, the next doses should be deferred.

  9. Diphtheria A bacterium that occurs in winter. Sx can be mild – severe with a gradual onset (1-2days). Low grade fever, malaise, anorexia, Rhinorrhea (with foul odor), hoarseness, stridor, cervical lymphadenitis, pharyngitis. There is a characteristic membrane that covers the tonsills, it is a membranous thick bluish white to grayish black in color, can spread to the soft & hard palates. Any attempt to remove the membrane results in significant bleeding. • Treatment: administration of IV antitoxin within 3 days of onset of sx. Also PCN G and surgical removal of membrane if occluding airway. • Maternal antibodies last as long as 6 months • Transmission: Contact with infectious nasal or eye discharge,unpasturized milk can also serve as a mode of transmission. • Incubation:2-7 days • Period of communicability: 2-4 weeks or until 4 days of abx therapy • Complications: produces an endotoxin that causes myocarditis, peripheral neuropathy and ascending paralysis (similar to Gulliiain-barre syndrome.

  10. Membrane of Diphtheria

  11. Pertussis (aka: whooping cough) Most common in children under 6 mths of age Occurs frequently in medical workers and adults that are immunosuppressed, adults have mild illness but spread to unimmunized kids. Starts with runny nose followed by an irregular, non-productive cough, cough becomes severe at night and changes into spasms of paroxysmal coughing followed by inspiratory stridor or “whooping”. The whooping sound is produced by forceful inhalations and a narrowed glottis. In the infant sucking on a bottle can trigger the coughing spells. Is accompanied by flushing, cyanosis, vomiting, profuse drainage from eyes, nose, mouth. Dehydration may occur form decreased PO intake. Paroxysmal coughing may last up to 2 weeks. • Treatment: erythromycin • Mode of transmission: Resp droplets and direct contact with nasal/oral/eye drainage • Incubation: 7-21 days • Period of communicability: 1 week after exposure, and up to 5-7 days after abx tx is started. Is VERY contagious during paroxysmal coughing stage

  12. Cough of Pertussis

  13. Tetanus An acute, preventable and often fatal disease caused by an endotoxin produced by the anaerobic spore-forming, gram + bacillus called Clostridium tetani.

  14. Clincal manifestations of tetanus Characterized by painful muscular rigidity, usually of the masseter (mastoid bone) and neck muscles. Tetanus spore are found in soil, dust and the gut of humans and animals. Tetanus is not an invasive organism but enters a susceptible host through an opening in the skin, usually a puncture wound, burn or crushed injury. Tetanus spore can enter through a very minor, often unnoticed break in the skin. In the newborn, infection may occur through the umbilical cord (when child is delivered in an unsanitary way using a “dirty” instrument to cut the cord). Substance abusers are particularly susceptible through using contaminated injectable drug equipment. Organism multiples and grows rapidly in “unclean” wound and the endotoxin affects the CNS, there are several forms of Tetanus but the most common form is the most lethal. Initial sx: stiff neck, tenderness of the muscles in the jaw & neck, eventually all voluntary muscles are affected, complete recovery is possible Mortality is about 30%, infections in thenewborn are almost always fatal.

  15. Tetany

  16. Poliomyelitis 3 known types and a “wild-type”. Polio affects the CNS and causes paralytic disease. Causes fever, headache, decreased deep tendon reflexes, progressive weakness and paralysis. The paralysis results from damage to neurons, onset of paralysis may be sudden or gradual (3- 5 days) , is accompanied by respiratory difficulties leading to resp. distress and resp. failure. Pt will require intubation/tracheostomy and mechanical ventilation Less serious infection can be limited to fever, stiffness in neck/back, vomiting and sore throat. Still occurs world wide, primarily affects children although susceptible immunosuppressed adults can be infected in caring for infants who receive OPV. OPV: Oral polio vaccine, live virus vaccine. Virus is excreted in stool. Is no longer used in the US. Treatment: None, supportive only Mode of transmission: Fecal-oral possibly also respiratory. Incubation: 7 -10 days Period of Communicability: Unknown, pt believed to be infectious for several weeks before sx begin. Shed in pharyngeal secretions for a few days and in stool for several weeks Complications of Polio: Permanent motor paralysis, respiratory arrest, myocardial failure, aseptic meningitis.

  17. Polio Ward – Iron Lungs

  18. Polio Vaccine • OPV: Oral polio vaccine, live virus NO LONGER USED IN US. • IPV: Inactive Polio Vaccine, killed virus. Ages: 2,4, months, 6-18 months, booster at 4-6 years. Total 4 doses Route: SQ Dose: 0.5ml Common side effects: swelling and tenderness at injection site, irritability, tiredness. Serious side effects: Anaphylaxis Contraindications: Hypersensitivity to vaccine components, allergy to neomycin, streptomycin and polymyxin B.

  19. Measles/ Rubeola • Caused by mobillivirus. (member of the paramyxovirus family). • Occurs primarily in children, late winter early spring. Occurs in unvaccinated children or children whose immunity is declining (the teenager or school age child who only rec’d 1 dose). • Many cases are reported from children who immigrate to the US from countries which do not require vaccination (even though it is a INS regulation that all who enter the US be immunized) or received mishandled vaccines (poor response) • Vaccination provides life long immunity in 95% of persons vaccinated • Measles is a cause of significant cause of infant and child morbidity in developing countries • Maternal antibodies begin to disappear in the infant at 12-15 months.

  20. Clincal manifestations of Measles

  21. Clincal Manifestations Measles Children are quite ill during prodromal phase with: • High fever • Conjunctivitis • Cough • Anorexia • Small, irregular, bluish-white spots on buccal mucosa know as “Koplik’s spots” • Characteristic red, blotchy maculorpapular rash appears 2-4 days after prodromal phase, rash begins on face and then spreads to trunk and extremities, Sx subside in 2-4 days

  22. Koplik’s Spots - Measles

  23. Measles Treatment: None, supportive only, abx used for secondary bacterial infections (which are very common) Mode of transmission: airborne (resp droplets) Incubation: 8-12 days Period of communicability: during prodromal phase, ends 2- 4 days after rash appears. Complications of Measles: diarrhea, OM, bronchopneumonia, laryngealtracheobronchitis, encephalitis

  24. Mumps/ Parotitis • A paramyxovirus that occurs world wide in unvaccinated children., most often in late winter/early spring. • Both infection and vaccination provide life long immunity. • Maternal antibodies begin to disappear in the infant 12-15 months.

  25. Clinical manifestations of Mumps • Malaise • Low grade fever • Decrease appetite • Decreased activity level • Unilateral parotid swelling, swelling peaks around day 3. • Meningeal signs: stiff neck, headache, photophobia (in about 15% of pts)

  26. Unilateral Parotid swelling - Mumps

  27. Mumps Treatment: none ,supportive only Mode of transmission: saliva droplets and direct contact with secretions Incubation: 12-25 days Period of communicability: 7 days before swelling till 9 days after swelling subsides (can be as long as 2-3 weeks) Complications of Mumps: Orchitis (inflammation of the epidydimis which produces pain on testicular palpations and unilateral scrotal swelling). • Sterlity is a rare occurrence Oophoritis, pancreatitis, aseptic meningitis and unilateral deafness (permanent)

  28. Rubella/ German Measles German measles is a mild disease with a characteristic pink, nonconfluent, maculorpapular rash that appears on the face, neck, trunk, legs and disappears in the same order.

  29. Clincal manifestations Rubella • Prodromal sx begin 1-5 days before rash • Low grade fever • headache • Malaise • Sore throat • Anorexia • Generalized lymphadenopathy involving the postaricular, suboccipital and posterior cervical lymph nodes, common up to 7 days before rash begins. German Measles is a self limiting disease in children with very rare side effects. Danger is pregnant women.

  30. Rubella/German Measles Treatment: None, supportive only Mode of transmission: Droplets, direst contact with infected persons, or contact with articles soiled by nasal secretions Incubation: 14-21 days Period of communicability: 7 days before rash until about 4 days after. Infants with CRS shed virus for months and should not be cared to by susceptible persons, strict isolation from pregnant women (or potentially pregnant women) is required. Complications of Rubella: Rare but includes arthritis in the adolescent. Encephalitis. By far the most common and serious complication is CRS.

  31. CRS: Congenital Rubella Syndrome If a mother is infected in the first trimester of pregnancy, the fetus can be severely affected • spontaneous abortion • Still birth • Fetal death are all common • 10% of infected fetuses die after birth Multiple congenital anomalies are common, these congenital anomalies are known as Congenital Rubella syndrome.: • Severe congenital heart dieses (pulmonary atresia-PA, tricuspid atresia, hypoplastic left heart syndrome-HLHS) • IUGR • Ear defects (causing deafness • Eye defects (causing congenital cataracts) Caused by mother not being immunized as a child, rates of CRS are on the rise. Mostly seen in Hispanic immigrant populations (immigrant being the key)

  32. Congenital Rubella Syndrome

  33. MMR Vaccine (measles/mumps & rubella) A combination LIVE vaccine Ages: 12- 15 months, 4-6 years (Total 2 doses) Route: SQ Dose: 0.5ml Common side effects: Elevated temperatures 1-2 weeks after immunization, redness/pain at injection site, joint pain. Serious side effects: anaphylaxis, encephalopathy, thrombocytopenia, purpura, chronic arthritis. Contraindications: • Allergy to neomycin or gelatin • Severely impaired immune system (HIV/AIDS, cancer tx) or other immunosuppressant medications or treatments • MMR cannot be given to any child with a history of cancer (accept order for MMR only from a Pediatric Hematologist/Oncologist) • Children with HIV can get MMR. • Cannot be given within 3 months of blood or blood product transfusion • Cannot be given to pregnant women Nursing Considerations before administration: • Allergy status • Urine HcG for all women capable of being pregnant • Question pt/parents about immunosuppression • Vaccine is a powder that must be mixed with diluting solution before administration – becomes clear yellow solution.

  34. Haemophilus Influenza Type B A bacteria which has several serotypes. Occurs in spring and summer. Most commonly affects infants and children in day care settings, LBW children, children with chronic illnesses. Invasive HiB disease was a major source of mortality and morbidity before routine vaccination was implemented (1987).

  35. Clincal manifestations of HiB disease HiB starts as a viral URI, the organism can pass though out the nasal mucosa to directly invade the blood stream, It causes several sever invasive illnesses: • Meningitis • Epiglottis it • Pneumonia • Septic arthritis • Om • Bronchitis • Pericarditis HiB disease is a leading cause of sepsis in the newborn. Treatment is ampicillin, however 1/3 of strains are resistant. Rifampin may be given to unimmunized contacts.

  36. HiB Disease Mode of transmission: Direct person to person contact or droplet inhalation, frequently colonized in nasal secretions. Incubation: unknown. Period of communicability: 3 days from the onset of symptoms

  37. Haemophilus Influenza Type B vaccine (HiB) Ages: 2, 4, 6, 12- 15 months (4 doses total) Route: IM Dose: 0.5 ml Common side effects: pain, redness or swelling at injection site Serious side effects: anaphylaxis Nursing considerations: • prior reaction to HiB vaccine • Use same preparation/manufacturer (if possible)

  38. Hepatitis B Hep A, B, C, D , E and G. Hep A – HBV Most contagious form, fecal-oral route Hep B – HCV blood and blood products Hep C – HCV blood and blood products, sexual transmission Hep D- HDV only present with Hep B most common in IVDU/hemophiliacs Hep E – HEV non A non B fecal-oral route Hep G- HGV transfusions and organ transplants Hepatitis is an acute inflammation of the liver. Acute viral Hepatitis (A,B,C,D,E,G) is the most common cause of hepatitis. . Hepatitis can also be caused by drugs (`including alcohol) chemicals and autoimmune liver disease . It is a significant cause of morbidity and mortality in world wide. The changes in the liver tissue results in varying degrees of swelling, infiltration of the liver cells by mononuclear cells with subsequent degeneration, necrosis and fibrosis of the liver. Hepatitis can be self limiting and complete regeneration of liver cells can occur but it is unknown which case of Hepatitis will do so.

  39. Hepatitis - acuity levels Fulminate Hepatitis: severe, acute disease with massive destruction of the liver which results in rapid liver failure followed by death 1-2 weeks after infection, usually caused by Hep B accompanied by Hep D. Most common cause is toxic reactions to drugs. Sub acute or chronic hepatitis: progressive destruction of liver cells, can be present for years as an asymptomatic infection but will eventually result in cirrhosis and liver failure. Liver tumors after ~ 20 years.

  40. Hepatitis - Jaundice and Ascites

  41. Hepatitis Most hepatitis B infections are acquired in childhood either from the mother (Perinatal) or as an adolescent (sexual transmission and IV drug use), Route of transmission from mom-fetus - if the mother is a carrier or has an active infections, the virus will cross the placental barrier late in pregnancy or during labor, when the child ingests amniotic fluid or via breast milk. Most women who pass Hep B to their fetus are unaware of their status. The infection can lie dormant for 2-3 decades and in their 30’s or 40’s the hepatitis can become active and can lead to cirrhosis, liver failure, and liver cancer. Hepatitis B is the number one cause of liver failure in the world, number one reason for liver transplants in the US, and number one cause of liver tumors in young adults.

  42. Clincal Manifestations of HepB • Insidious onset • Jaundice • Anorexia • Malaise • Nausea • Abnormalities in LFT’s (SGOT/SGPT/Bilirubin) • Prodromal sx’s: rash, arthritis, “aches & pains”

  43. Treatment Treatment for Hep B: No specific treatment, supportive • Rest • Hydration • Nutritional support (high calorie, high protein, high carbohydrate, low fat diet ) • Vitamin supplementation • No Alcohol or drugs metabolized by the liver Hospitalization when sx are severe or clotting factors are altered More importantly treatment involves early detection, monitoring, recognition of chronic liver disease and the prevention of spread. Treatment with Monolclonal antibodies ,a-interferon, antiviral agents: Ribavirin have shown some success.

  44. Hepatitis B Vaccine Ages: birth- 2months, 2 - 4months, 6 – 18 months Route: IM Dose: 0.5ml Total doses - 3 Common side effects: Pain/redness at injection site, headache, photophobia, altered LFT’s Serious side effects: Anaphylaxis, glean – Barrie type illness with progressive muscle weakness. Nursing considerations: all pregnant women should be screened before birth (or immediately following birth), if mom is HbsAG+, vaccine must be given to infant within 12 hours, followed by HBIG to prevent transmissions to infant. Prevents liver cancer caused by Hep B.

  45. Varicella (chicken pox) Cause by varicella- zoster virus, a herpes virus-6. Occurs in late fall, winter and spring. Maternal antibodies disappear 2-3 months after birth. The onset of symptoms is acute, mild fever, malaise, and irritability occur before rash. Rash begins as a maculae on a erythematosus base and progresses to a papule, then a clear filled vesicle. Lesions of all stages can be present at one time.

  46. Treatment of Varicella None, care is supportive. Oral and IV acyclovir (retroviral) is used for immunocompromised children ONLY. Most children with varicella recover fully with only supportive care (prevention of dehydration, reduction of fever, prevention of secondary bacterial skin infections). In an immunosuppressed child, prompt recognition and aggressive treatment with VZIG must begin immediately to prevent varicella pneumonia. Children infected prenatal or postnatal have a very poor prognosis

  47. Varicella lesions

  48. Varicella lesions

  49. Varicella Mode of transmission: Direct contact with lesions, airborne spread of secretions Incubation: 14-21 days Period of communicability: up to 5 days before the onset of rash and until ALL lesions are crusted over. The incubation period may be extended in immunocompromised children. Complications of Varicella: In the healthy immune competent child complications are rare but can include: secondary bacterial infections, hepatitis, pneumonia thrombocytopenia, Glomerulonephritis, Reye syndrome, encephalitis In the immunosuppressed child the results can be catastrophic

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