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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 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 • • Discrete, then turns confluent on the third day Other respiratory symptoms persist 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 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 • • • • • • 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