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Chapter 14 Communicable and Infectious Disease Risks Copyright © 2016 by Elsevier Inc. Objectives Describe the natural history of human immunodeficiency virus (HIV) infection and appropriate client education at each stage. Explain the clinical signs of selected communicable diseases. Evaluate the trends in incidence of HIV, STDs, hepatitis, and tuberculosis, and identify groups that are at greatest risk. Copyright © 2016 by Elsevier Inc. 2 Objectives (Cont.) Analyze behaviors that place people at risk of contracting selected communicable diseases. Evaluate nursing activities to prevent and control selected communicable diseases. Explain the various roles of nurses in providing care for those with selected communicable diseases. Copyright © 2016 by Elsevier Inc. 3 Human Immunodeficiency Virus Infection Natural history of HIV Transmission Epidemiology of HIV/AIDS HIV surveillance HIV testing Perinatal and pediatric HIV infection AIDS in the community Resources Copyright © 2016 by Elsevier Inc. 4 Natural History of HIV Three stages: Primary infection (within about 1 month of contracting virus) Clinical latency (when body shows no symptoms) • Use of highly active antiretroviral therapy (HAART) has greatly increased survival time of persons with HIV/AIDS Symptomatic disease (AIDS) • CD4 T-lymphocyte count less than 200/mL with documented HIV infection • AIDS-related opportunistic infections Copyright © 2016 by Elsevier Inc. 5 Transmission Transmitted through exposure to blood, semen, transplanted organs, vaginal secretions, and breast milk Those who have had blood, sexual, or needle-sharing exposure with an HIV-infected person are at risk for contracting the virus. NOT transmitted through casual contact (touching or hugging someone) or through mosquitoes or other insects Copyright © 2016 by Elsevier Inc. 6 Epidemiology of HIV/AIDS First cases of AIDS identified in 1981 Worldwide 35.3 million people live with HIV infection Sub-Saharan Africa accounts for more than 70% of all HIV infections Epidemic also growing in central Asia, the Middle East, and Eastern Europe Treatment for HIV infection has been given higher priority Prevalence of AIDS has increased Copyright © 2016 by Elsevier Inc. 7 HIV Surveillance 2008: confidential reporting of HIV-positive status by name required in all 50 states and the District of Columbia Copyright © 2016 by Elsevier Inc. 8 HIV Testing HIV antibody test Indicates the presence of the antibody to HIV Enzyme-linked immunosorbent assay (EIA) • Screens blood and other donor products Western blot Does not reveal whether individual has symptomatic AIDS, nor does it isolate the virus Confirmatory test minimizes false-positive results Routine testing and voluntary screening Copyright © 2016 by Elsevier Inc. 9 Perinatal and Pediatric HIV Infection Perinatal transmission Recommendation Accounts for nearly all HIV infection in children and can occur during pregnancy, labor and delivery, or breastfeeding Make HIV testing routine part of prenatal care. Pediatric infection Despite having an HIV-infected mother, many children do not acquire HIV/AIDS. However, one or both parents may die, thus indirectly affecting the health of the child. Copyright © 2016 by Elsevier Inc. 10 HIV Stage 3 (AIDS) in the Community Chronic disease Much care is provided in the home. Nurses provide teaching to clients and families. Adherence to HAART: critical Americans with Disabilities Act of 1990 Mental health issues HIV-infected children Should attend school Impaired immunity to childhood diseases Copyright © 2016 by Elsevier Inc. 11 Quick Recall What is the greatest challenge raised by allowing children infected with HIV to attend school? A. These children are at higher risk for sports injuries. B. Other children are put at risk of acquiring HIV infection. C. These children are more likely to develop complications from childhood diseases. D. Other children can tell they are different, which may lead to social isolation. Copyright © 2016 by Elsevier Inc. 12 How’d You Do? HIV-infected children should attend school; no case of HIV infection in the United States has been transmitted in a school setting. Instead, because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious sequelae. Copyright © 2016 by Elsevier Inc. 13 Resources Service organizations Voluntary Faith-based Toll-free numbers and websites Federal Other Copyright © 2016 by Elsevier Inc. 14 Sexually Transmitted Diseases Gonorrhea Syphilis Chlamydia Genital herpes Human papillomavirus infection Copyright © 2016 by Elsevier Inc. 15 Gonorrhea Bacterium Transmission Genital-genital contact, oral-genital contact, and anal-genital contact Uncomplicated versus complicated Highest incidence in United States Infects mucous membranes of the genitourinary tract, rectum, and pharynx African Americans, persons in the South, and women 15 to 24 years of age Number of antibiotic-resistant cases rising Copyright © 2016 by Elsevier Inc. 16 Syphilis Treponemal spirochetes Direct contact Men having sex with men (MSM); recently, number of infected women has increased Clinical signs Sexual contact or mother-to-fetus Blood transfusion (early-stage donor) Highest rates Infect moist mucous/cutaneous membranes Primary, secondary, tertiary Congenital syphilis Copyright © 2016 by Elsevier Inc. 17 Chlamydia Bacterium Transmission Infects genitourinary tract and rectum of adults Causes conjunctivitis and pneumonia in neonates Mucous membrane contact with mucopurulent discharge from infected site Most common reportable infectious disease Copyright © 2016 by Elsevier Inc. 18 Genital Herpes Herpes simplex viruses 1 and 2 No cure Transmission Majority of cases caused by HSV-2 Increasing number of cases caused by HSV-1 Direct exposure; infects genitalia and skin HSV-2 occurrence 16.2% of American adolescents Of particular concern to women and children Linked with development of cervical cancer Increased risk of fatal newborn infection Copyright © 2016 by Elsevier Inc. 19 Human Papillomavirus Infection HPV genital warts Transmission Direct contact with HPV-associated warts FDA-licensed vaccines Mouth, genitals, and anus Bivalent Quadrivalent Complications Link to cervical cancer Other cancers: vaginal, anal, and oropharyngeal Copyright © 2016 by Elsevier Inc. 20 Hepatitis Hepatitis A virus Hepatitis B virus Hepatitis C virus Non-ABC hepatitis Copyright © 2016 by Elsevier Inc. 21 Hepatitis A Virus (HAV) Most common transmission Vaccine available since 1995 Fecal-oral route Sources: water, food, feces, or sexual contact Found worldwide Incidence has declined 92% Makes HAV completely preventable High-risk groups Copyright © 2016 by Elsevier Inc. 22 Hepatitis B Virus (HBV) Spread through blood and body fluids Remains alive outside body For at least 1 week High-risk groups Acute or chronic infections Vaccine available Occupational Safety and Health Administration (OSHA) regulations Copyright © 2016 by Elsevier Inc. 23 Hepatitis C Virus (HCV) Most common chronic bloodborne infection in United States Transmission Blood or body fluids of an infected person enter an uninfected person High-risk groups Spread rapidly during 1980s Chronic liver disease from HCV 12th leading cause of death in adults in United States Most common reason for liver transplant Copyright © 2016 by Elsevier Inc. 24 Non-ABC Hepatitis Very uncommon in the United States Hepatitis D (HDV): chronic or acute, only occurs in those already infected with HBV; no vaccine Hepatitis E (HEV): acute infection transmitted by fecal-oral route; no chronic carriers; no vaccine Hepatitis G (GB virus C): does not cause acute or chronic hepatitis; virus has been isolated in patients with posttransfusion hepatitis Copyright © 2016 by Elsevier Inc. 25 Tuberculosis (TB) Transmission Common symptoms Cough, fever, fatigue, hemoptysis, chest pains, weight loss Epidemiology Airborne droplets WHO reports 12 million cases in 2012 and 1.3 million deaths due to TB (WHO, 2013) Drug-resistant TB Multidrug-resistant TB (MDRTB) Extremely drug-resistant TB (XDRTB) Copyright © 2016 by Elsevier Inc. 26 TB: Diagnosis and Treatment Tuberculin skin test (TST) Previously, purified protein derivative (PPD) test Used for initial screening Followed by chest x-ray for persons with positive skin reaction and pulmonary symptoms Prompt treatment with multiple antimicrobial drugs Treatment failure may be due to lack of client adherence, which can result in drug resistance. Copyright © 2016 by Elsevier Inc. 27 Nurse’s Role in Providing Preventive Care for Communicable Diseases Primary prevention Secondary prevention Testing and counseling for HIV Posttest counseling Partner notification and contact tracing Tertiary prevention Education on how to avoid infection Directly observed therapy Standard precautions Copyright © 2016 by Elsevier Inc. 28