Download COMMUNICABLE DISEASES

Communicable Disease
Communicable Diseases
• Diseases with high transmission rates transmitted by
contact with body fluids
• directly transmitted- acquired from a person or
vector
• indirectly transmitted- contact with contaminated
objects
• Viruses are the leading cause of most pediatric
communicable diseases
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
Why Immunize?
 We are a mobile society
 Diseases do not stop at geopolitical borders
 Children in the United States continue to get diseases that
are vaccine preventable
 There continues to be newly emerging and re-emerging
infectious diseases
 Healthy People 2020 goal to have 100% elimination of
vaccine preventable diseases
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
Advisory Committee
for Immunization Practices (ACIP)
 Sets the recommended schedule for immunizations
 Infants and Children 0-6
 Children and Adolescents 7-18
 Catch-up schedules (1 month behind)
 Schedule is reviewed yearly to reflect current
recommendations for licensed vaccines.
Children 0-23 months
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DTaP (4 doses)
Hib (4 doses)
PCV (4 doses)
Hep B (3 doses)
IPV ( 3 doses)
Hep A (2 doses)
Influenza (2 doses yearly)
MMR (1 dose)
Varicella (1 dose)
Up to 24 injections in 2 years
As many as 5 injections in a single visit
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)
Side Effects
 All vaccines could produce side effects
 CDC publishes Vaccine Information Sheets (VIS)
 Most side effects are minor and are related to the
administration, not the vaccine
 Soreness and swelling at injection site
 Low-grade fever
Contraindications
 Severe allergic reaction (anaphylaxis) after a previous
dose or to a vaccine component
 Encephalopathy not attributable to another identifiable
cause within 7 days of administration
 Pregnancy (live vaccines)
 Severe immunodeficiency (live vaccines)
Adverse Events
 Vaccine Adverse Event Reporting System (VAERS)
 Detect new, unusual, or rare vaccine adverse events
 Monitor increases in known adverse events
 Identify potential patient risk factors for particular types of adverse
events
 Identify vaccine lots with increased numbers or types of reported
adverse events
 Assess the safety of newly licensed vaccines
Vaccine Information Statements
(VIS)
 National Childhood Vaccine Injury Act of 1986
 Law states parents/legal guardians must be informed
about the benefits and risks of vaccines before
administration
 Legal mandate VIS must be offered electronically or
paper copy
 The law requires providers to use those developed by
CDC (do not change a VIS or make your own VIS)
Vaccine Information Statements
(VIS)
 National Childhood Vaccine Injury Act of 1986
 Law states parents/legal guardians must be informed
about the benefits and risks of vaccines before
administration
 Legal mandate VIS must be offered electronically or
paper copy
 The law requires providers to use those developed by
CDC (do not change a VIS or make your own VIS)
Informed Consent
 Parent or legal representative sign a separate “informed
consent” form if it is required by state
 VISs are not informed consent forms
Safe Storage and Handling
 Store vaccines at the recommended temperatures
according to the manufacturer’s guidelines IMMEDIATELY
upon arrival
 Vaccine shipments should be delivered when staff is
available to unpack and store the vaccine properly
 Store vaccine in storage units designated specifically for
biologics
 Post “Do Not Unplug” signs next electrical outlets
Safe Storage and Handling
 Prepare vaccines at the time the vaccine is administered
 Reconstitute immediately prior to injection
 Store diluent according to the manufacturer’s instructions
Atraumatic care
• Select needle of adequate length-longer needles
inserted at 90 degrees is best
• Select proper site
• VL infants
• Deltoid > 18 months
• Minimize pain
• EMLA cream
• Distraction
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
COMMUNICABLE
DISEASES
Communicable Disease
• Viral or Bacterial
• Most are transmitted by respiratory secretions in early
prodromal period
• Communicable disease can cause serious complications
and death
• Infected children can transmit disease to pregnant women
and cause fetal disease, disability
• Many are Diseases are Vaccine Preventable
Nursing Responsibilities
Assessment
• Identify recent exposure
• Identify prodromal symptoms
• symptoms that occur early in disease
• Locate immunization history
• Confirm history of having the disease
Nursing Responsibilities
Implementation
• prevent spread-isolation
• reduce risk of cross contamination
• prevent complications
• provide comfort
VIRAL INFECTIONS
Viral Infections
Non- Preventable Viral Disease
Vaccine Preventable Viral Disease
• Fifth’s Disease
• Varicella
• Roseola
• Ruebola
• Mumps
• Rubella
FIFTH’S DISEASE
Parvovirus
Fifth’s Disease
• Affects any age child, usually preschool or early school
age
• Common disease as no vaccine is available
• Believed once had disease will not acquire again
• Moderately uncomfortable symptoms
Symptoms
• No prodromal symptoms
• Begins with rash of
erythema on cheeks
“slapped face
appearance”-classic for
fifth disease
• Next 24 hrs high fever,
lethargy, n/v, abd. pain,
cervical lympadnopathy
Symptoms
• Within the week,
maculopapular red spots
appear
• Symmetrically on upper and
lower extremities has a lacelike appearance
• Rash subsides in a few days
but reappears if skin is
irritated (sun, heat, cold)
Management
• Management of other symptoms (fever, pain,
nausea, vomiting)
• Explain the stages of rash development to
parents
• Isolation during facial rash stage
• The immune-competent child can return to
school or daycare once the body rash has
appeared
ROSEOLA
Roseola
• Disease of younger children
• Common disease as no vaccine is available
• Rarely affects children >3 years
• Believed once had disease will not acquire again
• No uncomfortable symptoms except for high fever
Symptoms
• Prodromal Symptoms of
persistent high fever for
3-4 days in a child who
appears well
• Then drop in fever to
normal and rash appears
that identifies roseola
• Rash is a rose-pink
macules first on trunk,
spread to neck, face,
extremities, not itchy,
lasts 1-2 days
Management
• Antipyretics, analgesics
• Isolation not necessary once rash appears
• Since fever is very high can have febrile seizures
VARICELLA
(Chicken Pox)
Varicella
• Affects unvaccinated child of any age
• Vaccine available for children age 12 months and older
• Extremely uncomfortable disease that lasts for weeks
• Death is rare but can be caused by blockage of GI track,
especially in infants and immunocompromised children
Symptoms
• Prodromal period slight fever, malaise, anorexia
• Next 24 hours highly itchy rash primarily over trunk can
spread all over skin and mucus membranes, GI track,
genitalia
• The key to diagnosis is varying stages of rash
Symptoms
• Rash starts as a macule
which progresses into a
papule and then a
vesicle surrounded by
erythema base
vesicle
macule
• The fluid becomes
cloudy, breaks and
crusts over
papule
Management
• Communicable 1 day before eruption of vesicles to 6 days after first
crop of vesicles have formed
• 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, skin care (extremely itchy rash)
• Treat secondary complications (bacterial infections from scratching)
RUBEOLA
Measles
Rubeola
• Affects unvaccinated children of any age
• Vaccine available for children age 12 months and older
(First “M” in MMR)
• Extremely uncomfortable disease that lasts for weeks
• Death is common especially in infants and immune-
compromised children as many cases spread to brain and
cause encephalitis
Symptoms
• Prodromal period in first 24
hours
• Fever, malaise, cough,
coryza, conjunctivitis
• Next 48 hours first ‘rash’
that identifies rubeola
• “Koplik spots” (small,
irregular, red spots with
minute bluish-white
center) first seen on
buccal mucosa
Symptoms
• Raised erythema rash on
face that spreads
downward
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Discrete, then turns confluent
on the third day
Other respiratory symptoms
persist
Management
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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
Mumps
• Affects unvaccinated children of any age
• Vaccine available for children age 12 months and older
(Second “M” in MMR)
• Moderately uncomfortable disease
• Death is not common however swelling causes extreme
difficulty to swallow, leads to dehydration
Mumps
• Prodromal symptoms
of fever, headache,
maliase, anorexia, and
earache aggravated by
chewing
• On 3rd day classic
symptoms of parotitis
(enlarged parotid
gland), unilateral or
bilateral, pain,
tenderness
• No rash
Management
• Analgesics for pain
• Antipyretics
• Isolation until swelling resolves
• Bed rest
• Soft diet
• Cold compress to neck
RUBELLA
German Measles
Rubella
• Affects unvaccinated children of any age
• Vaccine available for children age 12 months and
older
(“R” in MMR)
• Mildly uncomfortable disease
• Death is not common
Symptoms
• Prodromal symptoms of
low grade fever, HA,
malaise, cough, sore
throat
• Identifiable rash begins on
face which rapidly spreads
downward to neck, arms,
trunk and legs
• By end of first day body is
covered with pinkish-red
maculopapules
• Slightly itchy
• Rash disappears in same
order as it appeared gone
by 3rd day
Management
• Antipyretics
• Comfort measures-slight itchy rash
• Isolation until rash disappears
• Avoid contact with pregnant women
BACTERIAL
INFECTIONS
Bacterial Infections
Vaccine Preventable Bacterial
Disease
• Diphtheria
• Pertussis
Vaccine Preventable Bacterial
Disease
• Scarlet Fever
DIPHTHERIA
Diphtheria
• Affects unvaccinated children of any age
• Vaccine available for children age 2 months and older
(“D” in Dtap)
• Serious respiratory involvement
• Death is common due to airway obstruction from
laryngeal swelling
Symptoms
• yellow nasal discharge
• may have epistaxis
• sore throat
• hoarseness with cough
• enlarged lymph nodes
• low grade fever
• increase pulse
• malaise
Management
• Diagnosed by culture of discharge
• strict isolation
• antibiotics-penicillin
• complete bed rest
• trach if obstructed airway
• suctioning
PERTUSSIS
Whooping Cough
Pertussis
• Affects unvaccinated children of any age
• Vaccine available for children age 2 months and
older
(“P” in Dtap)
• Serious respiratory involvement
• Death is common due to airway obstruction
Symptoms
• Prodromal symptoms begins with cough
and congestion
•
• Progresses into a dry, hacking cough that
becomes severe, worse at night
• Cough is short and rapid followed by
sudden inspiration and whooping
Symptoms
• Cheeks flush, eyes bulge, tongue protrudes
• Thick secretions, often vomits
• Sick for 4-6 weeks
• www.whoopingcough.net for sound and
video
Management
• Hospitalization for infants or children who are
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dehydrated
Bed rest
Increase fluids
Antibiotics-macrolides
Suctioning
Humidifier
Observe for airway obstruction (restlessness,
retractions, cyanosis)
SCARLET FEVER
Scarlet fever
• Bacterial infection (strep), often sequela to strep throat
• Affects mainly schoolage children and adolescents
age 5-15 who are susceptible to strep throat
• Isolation not necessary after 24 hours on antibiotics
• No vaccine
• Moderately uncomfortable symptoms
Symptoms
• Prodromal symptoms of
abrupt high fever, high pulse,
vomit, headache, Malaise,
chills, abdominal pain
• Followed by
• 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”
Symptoms
• By 4th or 5th day
white coat sloughs
off leaving prominent
papillae = “red
strawberry tongue”
• Rash appears of red,
pin head sized
lesions, rash is
intense in folds and
joints, flushed
cheeks
Management
• Diagnosis made by positive throat
culture and ASO titer
• respiratory isolation x 24 hours
• 7-10 days of penicillin
• analgesics for sore throat
PRACTICE QUESTIONS!
Which of the following statements indicates that a
parent understands the treatment for his/her child who
has fifth disease? (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
_____ DTaP 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