Download Prevention of Communicable Diseases

Child and Communicable Diseases
Specific Objectives:
1. Define the most terminology used with communicable diseases.
2. Identify the most common communicable diseases which are
caused by viruses or bacteria in children .
3. Describe nursing care of such cases.
Definitions of Terms:
Communicable Disease: means a disease that may be transmitted directly or
indirectly from one individual to another.
Non-communicable Diseases: Those diseases or illnesses that cannot be
transmitted from an infected person to a susceptible, healthy one
A contagious disease is the one that is transmitted through contact. Examples
include scabies, trachoma, STD
Nosocomial (hospital acquired) infection is an infection originating in a
patient while in a hospital or another health care facility.
Airborne Pathogens: are defined as the transmission of infectious agents
through either airborne droplet nuclei (small-particle residue [five µm or smaller
in size] of evaporated droplets that may remain suspended in the air for long
periods of time) or dust particles containing infectious agents. These pathogens
include but are not limited to tuberculosis (TB), rubella (measles) and varicella
(chickenpox).
Direct Contact: means a disease that is spread through the exposure of blood
and/or body fluids to mucus membranes, open skin wounds, semen or
intravenous transfusion. Occurs through such acts as touching, biting, kissing,
sexual intercourse, or by direct projection (droplet spread) by coughing or
sneezing within a distance of one meter e g HIV/AIDS
Air-borne transmission -- transmission of microbial aerosols to a suitable port
of entry, usually the respiratory tract
Vehicle-borne transmission -- contaminated materials or objects (fomites)
serve as vehicles
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Vector-borne transmission -- disease transfer by a living organism, such as a
mosquito, fly, or tick
Incubational Period: Time that elapses between the invasion of microorganism
and the appearance of signs and symptoms of disease.
Prodromal period : the time during which a disease process has begun but is
not yet clinically manifest.
Communicability Period: Time during which the person stricken with the
disease and can transmit it to another person directly or indirectly.
Mode of transmission: Method of spread of disease to man.
Sources of infection
consist of man, animal, contaminated food or water, insects and environmental
factors, such as, dust and dirt.
Indirect Contac May be one of three types: air-borne, vehicle-borne, or vectorborne
Classification of Communicable Diseases according to type of transmission
 Contact diseases such as scabies, pediculosis, fungal skin infections,
trachoma, acute bacterial conjunctivitis.
 Sexually transmitted diseases and HIV/AIDS
 Vector borne diseases such as relapsing fever, bancroftian filariasis,
onchocerciasis, yellow fever, trypanosomiasis, plague, schistosomiasis,
dracunculosis, leishmaniasis and malaria.
 Diseases caused by Faecal – oral contamination such as acute gastroenteritis, bacillary dysentery, campylobacter jejuni, giadiasis, amoebiasis,
cholera, enteric fevers, food poisoning, poliomyelitis, viral hepatitis.
 Helmonthic diseases such as ascariasis, enterobiasis, trichuriasis,
hookworm, strongyloidiasis, taeniasis, hydatidosis.
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 Airborne diseases such as acute respiratory infections, meningitis
(bacterial and fungal) tuberculosis and leprosy.
 Zoonotic diseases (diseases of contact with animals or animal
products) such as anthrax, brucellosis, rabies, hydatidosis, tetanus.
The Epidemiologic Cycle
Agent
Vector
Host
Environment
The main transmission routes are;
 Direct contact, for example sexual contact
 Vectors such as mosquitoes
 Faecal-oral (ingesting contaminated food and water)
 Airborne
 Trans-placental (mother to foetus)
 Blood contact (transfusion, surgery, injection)
 Contact with animals or their products that are infected.
Factors Increase Communicable Disease such as:
 A lack of safe water, inadequate excreta disposal facilities, poor
hygiene, poor living conditions and unsafe food can all cause
diarrhoeal diseases. Immuno-suppressive illnesses such as AIDS
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 Climate can affect disease transmission in a variety of ways. The
distribution and population size of disease vectors can be heavily
affected by local climate.
 Crowding
 Malnutrition
 Natural disasters, particularly meteorologic events such as
cyclones, hurricanes, and flooding,
 Medication
Prevention of Communicable Diseases
A-Primary Prevention
For communicable disease this is the most common prevention method.
Primary prevention targets the pre-pathogenesis period or the period before the
disease infects the individual. The interventions include:
 General measures such as health education, safety measures and healthy
behavior
 Specific measures such as vaccination or prophylaxis medication
B-Secondary Prevention
This mainly happens during the early stages of the disease process. The purpose
is to prevent further damage to the host cells and tissues and thus avoid disease
complications. Measures would include early diagnosis, screening and prompt
treatment.
C-Tertiary Prevention
This takes place during the advanced stages of the disease progression to
minimize the complications or reverse the effects. Main interventions are
rehabilitative in nature and include physical therapy, occupational therapy,
psychotherapy, corrective/rehabilitative surgery etc.
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Nursing responsibility:
1. Prevent spread-isolation
2. Reduce risk of cross contamination
3. Prevent complications
4. Provide comfort
Common Communicable Diseases Caused by Bacteria:
1. Diphtheria
Etiology:
Corynebacterium diphtheria (Diphtheria bacillus).
Incubational Period:
2-5 days or longer.
Communicability Period:
Several hours before onset of the disease until organism disappear from the
respiratory tract.
Mode of Transmission:
Droplet from respiratory tract of an infected person or a carrier directly or
indirectly.
Clinical features:
 Fever.
 Difficulty to swallow.
 Swelling of the neck.
 Hoarse or croupy cough and stridor.
 Purulent, bloody nasal discharge.
 The membrane can be seen on the nasal septum.
 Purulent conjunctivitis.
 Otitis media.
Nursing Consideration:
 Isolate the child (place him in isolating room, use medical aseptic
techniques).
 Bed rest
 oxygen on need
 check vital signs,
 Oral hygiene
 Observe signs and symptoms of paralysis.
 Observe signs and symptoms of complication
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Treatment:
 Bed rest.
 Antibiotics.
 Anti-toxins.
Prevention:
1. Active immunization: DPT vaccine.
2. Passive immunization: injection with
anti-toxins.
Complications;





Bronchopneumonia.
Kidney dysfunction.
Paralysis.
Myocarditis.
Cardiac failure.
2. Pertussis
(Whooping Cough)
Etiology:
Gram-negative bacillus.
Incubation Period:
5-14 days.
Communicability Period:
4-6 weeks from the onset of the disease.
Mode of Transmission:
Droplet (direct and indirect).
Clinical features:
Begins with cough which is worse at night. Symptoms may at first be very mild.
Characteristic "whooping" cough develops in about 2 weeks, and the spasm of
coughing sometimes ends with vomiting.
Nursing Consideration:
 Isolation
 Bed rest
 Oxygen with humidity to relief cyanosis (may use oxygen tent).
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





Mouth care
Small frequent feeding
Accurate intake and output must be kept.
Protect the child from secondary infection, keep him warm.
Observe: respiratory distress and convulsions.
Observe signs and symptoms of airway obstruction e.g.
restlessness, cyanosis, retraction.
Treatment:
 Symptomatic: sedatives and antispasmodics are important.
 Antibiotics
Prevention:
a- Active immunization: DPT vaccine.
b- Passive immunization: Gamma Globulin.
Complication:
 Otitis media.
 Bronchiectasis.
 Hemorrhage may occur.
 Marasmus.
 Encephalitis.
 Pneumonia.
3. Tetanus
(Lock Jaw)
Etiology:
Clostridium tetanti (tetanus bacillus).
Incubational Period:
3-21 days.
Communicability Period:
Not communicable from man to man, as the organism usually live in
animal’s intestinal tract.
Mode of Transmission:
Through a wound as organism is present in soil.
Clinical features:
 Convulsions are the first warning
symptoms in children.
 Excessive irritability and restlessness.
 Difficulty in swallowing.
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 Stiff neck.
 inability to open the mouth.
 Stiff arm and legs, then entire stiffness
of the body.
 Swallowing
usually
becomes
impossible.
 Dyspnea
Nursing Consideration:
1. Isolation.
2. Bed rest :Protect the child from any stimuli
(auditory or tactile stimuli
3. oxygen If dyspnea and cyanosis are present,
4. For tetanic spasm:
 Protect the child from falling.
 The nurse must be alert for number,
duration and frequency of convulsion
observe inability to swallow.
5. For inability to swallow:
 I.V. therapy
 Gavage feeding may be ordered.
 Mouth care if he can open his mouth.
6. Check vital signs carefully.
7. If tracheostomy is performed; care of
tracheostomy. suction is done frequently.
Treatment:
 Antibiotics
 Antitoxin.
 Tranquilizers.
Prevention:
1. Active immunization: DPT vaccine.
2. Passive immunization: Injection of tetanus immuno-globulin
or antitoxin (a few hours after a wound occur).
Complication:
 Anoxia.
 Atelectasis.
 Pneumonia.
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Communicable Diseases Caused by Virus:
1.
Chicken Pox (Varicella)
This is a highly communicable disease in children.
Etiology:
Virus [Varicella- Zoster- Virus (VZV)].
Incubational Period:
10-21 days (2-3 weeks).
Communicability Period:
One day before and six days after the appearance of the first vesicle.
Mode of Transmission:
Droplet (direct or indirect). Dry scabs are not infectious.
Clinical Features
 fever.
 Headache.
 Rash: Successive crops of macules, papules, vesicles,
 Rash is itchy.
Nursing Consideration:
 Isolation:
 For rash (lesion):
 Cleaning the skin
 prevent skin infection.
 check vital signs and record it, especially
temperature.
 Observe for complications
Treatment:
 No specific treatment.
 To relieve itching, calamine lotion, antihistamine
 Antibiotics for secondary infection.
Prevention:
None
Complication:
 Abscess.
 Encephalitis.
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2. Measles (Rubeola)
Most cases occur before adolescent and it occurs more in spring months.
Etiology:
Virus RNA.
Incubational Period:
7-14 days (usually 10-20 days).
Communicability Period:
4 days before the appearance of rash to 5days after rash appearance.
Mode of Transmission:
Droplet (direct or indirect).
Clinical Features
 symptoms like common cold
 Sneezing.
 Fever
 Enlarged posterior cervical lymph nodes.
 Koplik’s Spots: Are pathogenic appear on day before rash.
Whitish spots resting on a reddish base appear on the inside of the
mouth.
 Rash: Rash appears on 2nd to 5th day and remain about a week.
Appears first on face, behind the ears, on the neck, forehead or
cheeks. Then, spread downwards
 photophobia
Nursing Consideration:
 Isolation.
 Bed rest
 For photophobia and conjunctivitis:
o ”Dark room”.
o Eye care with warm saline solution to remove
secretions or crust.
 Encourage fluids.
 Measure the temperature carefully
 For itchy rash: apply lotion or ointment
 Carry out the plan of care of complicated cases, such as, encephalitis
(convulsions),
Treatment:
 Symptomatic.
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Prevention:
a- Active immunization: live attenuated vaccine.
b- Passive immunization:Gamma-globulin.
Complication:
 Otitis media.
 Pneumonia.
 Encephalitis.
3. German Measles (Rubella)
Fetus may contact the disease in uterus if the mother develops the disease during
the pregnancy (1st trimester).
Etiology:
Virus.
Incubation Period:
14 to 21 days.
Communicable Period:
During Prodromal period and for 5 days after the rash.
Mode of Transmission:
1. Direct contact with nose and throat secretions of
infected persons.
2. Indirect via articles freshly contaminated with
nasopharyngeal secretion.
3. Trans-placenta congenital infection form
infected mother to the fetus.
Clinical Features
 Mild fever
 Running nose, sore throat.
 Rash :It is small pinpoint pink or pale red macules.“It
begins on face and hairline move to trunk then
extremities”.
 Swelling of posterior cervical and occipital lymph
nodes.
 No Koplik’s spots or photophobia.
Nursing Consideration:
1. Isolation especially form pregnant women.
2. Bed rest until fever subsided.
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Treatment:
 Symptomatic.
Prevention:
a- Active immunization; live attenuated rubella virus vaccine.
b- Passive immunization: Gamma- globulin.
Complication:
 Fetus damage if mother contacts the disease during pregnancy.
 Newborn may have congenital anomalies, such as deafness,
mirocephaly, mental retardation.
 Encephalitis.
Difference Between Measles and Rubella
1-German measles and measles are different viral infections.
2-German measles (rubella) is mild and a three day illness
3- measles is more serious and can last for many days.
4- Koplik’s Spots associated with measles.
4. Mumps (infectious Parotitis)
Mumps is common in children 5-10 years. It is affects the salivary glands
(mainly parotids glands).
Etiology:
Virus.
Incubational Period:
14-21 days.
Communicability Period:
One to six days before the first symptoms appears until the swelling
disappears.
Mode of Transmission:
Direct or indirect contact with salivary secretion of infected person.
Clinical Features
 fever.
 Vomiting.
 Pain in or behind ears and pain on swallowing or chewing.
 Swelling mainly parotids glands
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Nursing Consideration:
1. Isolation.
2. Bed rest until swelling disappears.
3. For fever: Encourage fluids and antipyretics.
4. For glands:
 Mouth care and gargle frequently.
5. Apply hot or cold compresses for the swelling.
6. For Mastitis: Breast support, use cold compresses.
Treatment:
 Symptomatic.
Prevention:
a- Active immunization: Live attenuated vaccine.
b- Passive immunization: Gamma- globulin.
Complication:
 Sterility
 Ovaritis,
 Deafness.
5. Poliomyelitis (infantile Paralysis)
It attacks the brain stem and spinal cord.
Etiology:
Virus. The disease is caused by any one of 3 polioviruses:
c- Type 1 (Brunhilde).
d- Type 2 (Lansing).
e- Type 3 (Leon).
Incubational Period:
5-14 days.
Communicability Period:
Latter period of incubational period till the first week of acute illness.
Mode of Transmission:
Oral contamination by intestinal and pharyngeal secretions of infected
person.
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Clinical features:
 clinical signs of paralysis to complete paralysis.
 Initial symptoms of upper respiratory tract infection: fever,
headache, vomiting…etc.
 Stiffness of neck, back and limbs.
 Spinal: paralysis appear
 Paralysis of limbs is the most common affected muscles.
 stool incontinent and urinary incontinent may occur.
 inability to swallow
 Convulsion.
 Personality disturbances.
Nursing Considerations:
1. Isolation and bed rest.
2. In acute stage:
 Put the child under close observation.
 Notify the degree and progress of the
paralysis
 Observe rate and type of respiration and signs
of respiratory distress
 Oxygen therapy when cyanosis occurs.
 If tracheostomy is done in case of
diaphragmatic paralysis, care of tracheostomy.
3. For paralysis:
 Change
position
frequently.
Careful
positioning for affected limbs each time he is
turned or moved.
 To minimize the degree of deformity, correct
body alignment and optimum position must be
maintained.
 Use footboard to prevent foot drop when
child is on back. If the child is on abdomen,
pull the mattress away from foot of bed and
letting feet protrude over the edge to prevent
pressure on toes.
 Application of heat to affected muscles to
relax them.
4. Suction of the pharynx and postural drainage to prevent
aspiration of secretions.
5. For swallowing difficulties:
 Soft diet if they can swallow with difficulty.
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 If swallowing is difficult, use gavage
feeding.
6. For incontinent:
 Skin care and perineal region is padded to
provide absorption for excretions. Catheter
may be done.
Treatment:
 Symptomatic.
 Physiotherapy.
Prevention:
a- Active immunization: (OPV).
b- Passive immunization: Gamma- globulin.
Complication:
 Emotional disturbance.
 Gastric dilatation.
 Hypertension.
Others communicable diseases in children
Influenza:
commonly called “flu”, is a respiratory infection caused by several groups of
viruses. Symptoms include high fever, fatigue, muscle and joint aches. It is
spread through direct contact with infected people and water droplets in the air
from coughs and sneezes.
Treatment includes rest, liquids, and over the counter medications.
Prevention includes avoiding contact with infected persons and vaccines.
Hepatitis B
Hepatitis B is a serious disease caused by a virus that attacks the liver. The
virus, which is called hepatitis B virus (HBV), can cause lifelong infection,
cirrhosis (scarring) of the liver, liver cancer, liver failure, and death
Transmission (how do you get it??)
 Contact with the body fluids of an infected person
 Sexual contact
 Blood to Blood contact
Symptoms:
• Jaundice (yellowing of eyes and skin)
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• Tiredness and weakness
• Weight loss, loss of appetite
• Abdominal pain
Treatment
Bed rest, medications, do not drink alcohol
Prevention:
vaccine, do not share needles, abstinence (no sex or drugs!)
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