Communicable Diseases 2012 Student Version

Communicable Disease

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.


of childhood include diseases with high transmission rates– Viruses are the leading cause of most

pediatric infections


• 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.

ImmunizationsImmunizationsImmunizationsImmunizations

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

local tendernesserythemaswelling at sitelow grade fever (possibly high

with activated)behavior 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.


• 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


• 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


• 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

True contraindications and precautions

Moderate-severe illness with or without fever

ImmunocompromisedPrior serious reaction (fever

105, seizure, anaphylatic)

AdministrationNursing

ConsiderationProper storageReconstitutionExpiration dateConsentDocumentation

(immunization record)

Atraumatic care

• Select needle of adequate length• Select proper site

– VL infants– Deltoid > 18 months

• Minimize pain– EMLA cream– Distraction

Communicable Communicable DiseasesDiseases

Communicable Communicable DiseasesDiseases

Nursing ResponsibilitiesAssessment: • 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. prevent spread-isolation2. reduce risk of cross

contamination3. prevent complications4. provide comfort

Viral InfectionsViral InfectionsViral InfectionsViral 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 B19)• No vaccine available• Transmitted by probable

respiratory secretions

• Easily Communicable up to 14 days after infection

Symptoms Classic rash of erythema on face

(cheeks), “slapped face appearance” High fever, lethargy, n/v, abd. Pain,

cervical lympadnopathy

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)

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 4-5 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 rash on face that spreads downward

• Discrete, then turns confluent on the third day

• Other symptoms persist


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 2nd “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 3rd day: parotitis (enlarged parotid

gland), unilateral or bilateral, pain, tenderness


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

throat


• Diagnosis by symptoms, serology available 1 month after infection

• Treatment– Antipyretics– Comfort measures

**Pregnant people must avoid infected child=fetal death

Bacterial InfectionsBacterial InfectionsBacterial InfectionsBacterial 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


• 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


• 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 4th or 5th 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 + TC, ASO titer• Management:

–respiratory isolation x 24 hours– full course of PCN/EES– analgesics for sore throat

• Lets Play a Game….

Practice Questions!Practice Questions!Practice Questions!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

a 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”

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. 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)

1.Diptheria2.Varicella3.Roseola4.Pertussis5.Rubella

Communicable Diseases 2012 Student Version

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