Communicable Disease

1. Communicable Disease

2. Communicable Diseases • An illness that is transmitted by contact with body fluids • directly transmitted • acquired from a person or vector (ticks, mosquitoes, or other animal) • indirectly transmitted • by contact with contaminated objects.

3. Communicable Diseases of childhood include diseases with high transmission rates • Viruses are the leading cause of most pediatric infections

4. Communicable Diseases • The 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.

5. Immunizations

6. Immunizations • Prevention 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

7. Immunization Schedule • By 24 Months children should have: • 4 Dtap, Hib, PCV • 3 Hep B, IVP • 1 MMR, varicella

8. Immunizations • Are either inactivated or activated • Inactivated include Dtap, Hib, Hep • Activated (live) multiplies for days-weeks in body MMR, Varicella

9. Reactions • Vaccines are very safe and have little chance for side effects • Side effects are minor and occur with in days of administration • Reactions to live vaccines can occur 30-60 days post vaccine (usually in older children)

10. Reaction to Vaccines • local tenderness • erythema • swelling at site • low grade fever (possibly high with activated) • behavior changes, irritability

11. Adverse Events • National Law to provide care for those affected by a vaccine’s adverse event • Law requires nurses to • Obtain consent prior to vaccine • record lot #, manufacturer, exp. date of vaccine after administration

12. Barriers to Immunization • Complexity of the health care system • Expense • Inaccurate recordkeeping • Reluctance of health care workers to give more than two vaccines at a time • Lack of public awareness of vaccines • Parental misconceptions

13. Parental Misconceptions • Parents may understand the dangers inherent in some of these diseases • suffering, 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.

14. Parental Misconceptions • Misconception: Vaccine-preventable diseases have been eliminated Correct Information • Travelers may reintroduce the disease • Recent outbreaks of measles, mumps, and pertussis have been linked to groups of children not immunized

15. Parental Misconceptions • Misconception: • Immunization weakens the immune system. • Fear of giving multiple vaccines. • Correct Information • Child’s immune system is capable of several immunizations at once • No effect on immune system

16. Parental Misconceptions • Misconception: • 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

17. True contraindications and precautions • Moderate-severe illness with or without fever • Immunocompromised • Prior serious reaction (fever 105, seizure, anaphylatic)

18. AdministrationNursing Consideration • Proper storage • Reconstitution • Expiration date • Consent • Documentation (immunization record)

19. Atraumatic care • Select needle of adequate length • Select proper site • VL infants • Deltoid > 18 months • Minimize pain • EMLA cream • Distraction

20. Communicable Diseases

21. Nursing Responsibilities Assessment: • Identify recent exposure • Identify prodromal symptoms • s/s occur early in disease • Locate immunization history • Confirm history of having the disease

22. Nursing Responsibilities Implementation: • prevent spread-isolation • reduce risk of cross contamination • prevent complications • provide comfort

23. Viral Infections

24. Varicella (Chicken Pox) • Varicella Virus • Vaccine available • Transmitted 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

25. Varicella • Begins with slight fever, maliase, anorexia • In 24 hours highly itchy rash primarily over trunk • Starts as a macule which progresses into a papule and then a vesicle surrounded by erythema base • The fluid becomes cloudy, breaks and crusts over

26. Varicella • The Key to diagnosis is varying stages of rash • Rash starts on trunk and progresses to body including genitalia, mucous membranes • Also can detect presence of disease after 1 month through serum antibody testing

27. Management • Isolation at home until vesicles dry (2-3 weeks) and 1 week after lesions are gone • Very young and immunocompromised may need isolation in hospital • Relief of itching • Antiviral agents • Treat secondary complications (bacterial infections from scratching)

28. Fifth’s Disease • Parvovirus (HPV B19) • No vaccine available • Transmitted by probable respiratory secretions • Easily Communicable up to 14 days after infection

29. Symptoms • Classic rash of erythema on face (cheeks), “slapped face appearance” • High fever, lethargy, n/v, abd. Pain, cervical lympadnopathy

30. Symptoms • Followed 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)

31. Management • Explain the stages of rash development to parents. • The immune-competent child can return to school or daycare once the body rash has appeared

32. Roseola • Viral infection • No vaccine available • Transmitted most likely by contact with saliva • Disease of younger children, rarely affects children >3 years Communicability unknown, but believed NOT to be communicable once rash appears

33. Symptoms • Persistent high fever for 3-4 days in a child who appears well • Then drop in fever to normal => rash appears • rose-pink macules first on trunk, spread to neck, face, extremities, not itchy, lasts 1-2 days

34. Diagnosis and Management • Diagnosis is made based on classis rash and symptoms, serum testing available • antipyretics, analgesics, isolation not necessary • May result in fetal death if woman is infected during pregnancy. • Since fever is very high can have febrile seizures

35. Rubeola (measles) • Viral infection • Vaccine available “M” in MMR • Transmitted by respiratory secretions, blood and urine of infected person Communicable just before the rash appears to 4-5 days after rash appears=highly contagious

36. Symptoms • First 24 hours • Fever, malaise, cough, coryza, conjunctivitis • In 48 hours • “Koplik spots” (small, irregular, red spots with minute bluish-white center) first seen on buccal mucosa • Raised erythema rash rash on face that spreads downward • Discrete, then turns confluent on the third day • Other symptoms persist

37. Diagnosis and Management Diagnosis made on symptoms, serology 1 month later Management: • Isolation until rash disappears • Bed rest • Antipyretics • Fluids and vaporizer for cough • Skin care (itchy rash) • Decrease lighting-photophobia may cause eye rubbing and corneal abrasion

38. Mumps • Viral infection • Vaccine available 2nd “M” in MMR • Transmitted by direct contact of saliva and respiratory droplet • Communicable immediately before swelling begins

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

40. Diagnosis and Management Diagnosis by classic presentation, serum antibody testing 1 month after infection Treatment: • analgesics for pain • antipyretics • Isolation • Bed rest • Soft diet • Cold compress to neck

41. Rubella(German measles) • Viral Infection • Vaccine Available “R” in MMR • Transmitted by direct contact of nasopharyngeal secretions, feces, urine, or articles freshly contaminated • Communicable 7 days before to 5 days after rash

42. Symptoms • Rash on face which rapidly spreads downward to neck, arms, trunk and legs • by end of first day body is covered with pinkish-red maculopapules • Rash disappears in same order as it appeared • Rash gone by 3rd day • also low grade fever, HA, Malise, cough, sore throat

43. Diagnosis and Management • Diagnosis by symptoms, serology available 1 month after infection • Treatment • Antipyretics • Comfort measures **Pregnant people must avoid infected child=fetal death

44. Bacterial Infections

45. Diphteria • Bacterial infection • Vaccine available “D” in Dtap • Transmitted by direct contact with respiratory secretions,droplet, contaminated objects Communicable 2-4 weeks=highly contagious

46. Symptoms • yellow nasal discharge • may have epitaxis • sore throat • hoarseness with cough • enlarged lymph nodes • low grade fever • increase pulse • malaise • laryngeal involvement: potential airway obstruction=serious for the very young

47. Diagnosis and Management • Diagnosed by culture of discharge • strict isolation • abx (PCN) • complete BR • trach if obstructed airway • suctioning

48. Pertussis(whooping cough) • Bacterial infection • Vaccine available “P” in Dtap • Transmitted by direct contact, droplet • Communicable for up to 4 weeks

49. Symptoms • Begins 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 protrudes • Thick secretions, often vomits • Sick for 4-6 weeks • www.whoopingcough.net for sound and video

50. Diagnosis and Management • Diagnosed by classic presentation • Treatment: • hospitalization for infants or children who are dehydrated • BR • increase fluids • abx • Suctioning • Humidifier • Observe for airway obstruction (restlessness, retractions, cyanosis)