COMMUNICABLE DISEASE Dr Ampily J S Communicable Diseases

COMMUNICABLE DISEASE Dr. Ampily J S

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.

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

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.

Immunizations

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

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

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

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)

Reaction to Vaccines Ølocal tenderness Øerythema Øswelling at site Ølow grade fever (possibly high with activated) Øbehavior changes, irritability

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

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

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.

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

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

Parental Misconceptions Misconception: Correct Information Vaccines may cause Numerous studies have serious conditions, such as autism confirmed the lack of association between the measles vaccine and autism, as well as thimerosal in vaccines and autism

True contraindications and precautions ØModerate-severe illness with or without fever ØImmunocompromised ØPrior serious reaction (fever 105, seizure, anaphylatic)

Administration Nursing Consideration ØProper storage ØReconstitution ØExpiration date ØConsent ØDocumentation (immunization record)

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

Communicable Diseases

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

Nursing Responsibilities Implementation: 1. 2. 3. 4. prevent spread-isolation reduce risk of cross contamination prevent complications provide comfort

Viral Infections

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

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

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

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)

Fifth’s Disease Parvovirus (HPV B 19) No vaccine available Transmitted by probable respiratory secretions Easily Communicable up to 14 days after infection

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

Symptoms Ø Followed with maculopapular red spots appear in 1 week, symmetrically on upper and lower extremities has a lace-like appearance Ø rash subsides, but reappears if skin is irritated (sun, heat, cold)

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

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

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

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

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 45 days after rash appears=highly contagious

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 on face that spreads downward Discrete, then turns confluent on the third day • Other symptoms persist

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

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

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

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

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

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 3 rd day also low grade fever, HA, Malise, cough, sore throat

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

Bacterial Infections

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

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

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

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

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

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)

Scarlet fever Bacterial infection (strep), often sequela to strep throat No vaccine available Transmission by direct contact, droplet Communicable for 10 days to 2 weeks

Symptoms Abrupt high fever Very 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 4 th or 5 th day white coat sloughs off leaving prominent papillae = “red strawberry tongue” Rash: red, pin head sized lesions, rash is intense in folds and joints, flushed cheeks

Diagnosis and Management Diagnosis + TC, ASO titer Management: 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 days” 2. “No antibiotic is needed, as this is a viral infection. ” 3. “I will apply antibiotic cream to her rash twice day. ” 4. “My child can go back to school when the body rash appears”. 5. “If my child had the vaccine, she wouldn’t have go gotten sick” a

Fill in the Blank The 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. Rubeola 2. Rubella 3. Roseola 4. 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) 1. Diptheria 2. Varicella 3. Roseola 4. Pertussis 5. Rubella