Communicable Diseases - Sep - 2018 PDF

Communicable
Disease
Fariba Hossein Abadi (PhD)
Healthcare Awareness@FSSK.2018
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.
1
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.
2
Immunizations
“prevention is better than cure”
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
3
Immunization Schedule
– By 24 Months children should

have:
– B.C. G.
– 4 Dtap, Hib, PCV (Diphtheria, Tetanus,
pertussis)
– 3 Hep B, IVP
– 1 MMR, varicella (Measles, Rubella, Mumps)
Immunizations
• Are either inactivated or activated
• Inactivated include Dtap, Hib, Hep

(Haemophilus Influenza B)
• Activated (live) multiplies for days-

weeks in body MMR, Varicella
4
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 tenderness
erythema
swelling at site
low grade fever (possibly high with
activated)
behavior changes, irritability
5
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
6
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.
Correct Information
• Misconception:
• Travelers may
Vaccine-preventable reintroduce the
diseases have been disease
eliminated
• Recent outbreaks
of measles, mumps,
and pertussis have
been linked to
groups of children
not immunized
7
• Misconception: • Correct
Information
• Immunization
weakens the • Child’s immune
immune system. system is capable
• Fear of giving of several
multiple vaccines. immunizations at
once
• No effect on
immune system
• Misconception: • Correct
Information
• Vaccines may cause
serious conditions, • Numerous studies
such as autism have confirmed the
lack of association
between the measles
vaccine and autism, as
well as thimerosal in
vaccines and autism
8
True contraindications
and precautions
Moderate-severe illness with or

without fever
Immunocompromised
Prior serious reaction (fever
105, seizure, anaphylatic)
Administration
Nursing Consideration
Proper storage
Reconstitution
Expiration date
Consent
Documentation (immunization
record)
9
Atraumatic care
• Select needle of adequate length

• Select proper site
– VL infants
– Deltoid > 18 months
• Minimize pain
– EMLA cream
– Distraction
10
Nursing Responsibilities
Assessment:
• 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-isolation
2. reduce risk of cross contamination
3. prevent complications
4. provide comfort
11
Viral 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
12
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
13
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
14
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)
15
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
• 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
16
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
17
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
18
Diagnosis and
Management
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
19
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 and
Management
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
20
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
21
Diagnosis and
Management
• Diagnosis by symptoms, serology
available 1 month after infection
• Treatment
– Antipyretics
– Comfort measures
**Pregnant people must avoid infected
child=fetal death
Bacterial Infections
22
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
23
Diagnosis and Management
• 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
24
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
Diagnosis and Management

• 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)
25
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”
Scarlet fever
• Bacterial infection (strep),
often sequela to strep throat
• Transmission by direct
contact, droplet
• Communicable for 10 days to
2 weeks
26
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
27
Diagnosis and
Management
• Diagnosis + TC, ASO titer
• Management:
–respiratory isolation x 24
hours
– full course of PCN/EES
– analgesics for sore throat
• Lets Play a Game….
28
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”
29
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. Rubeola
2. Rubella
3. Roseola
4. Scarlet Fever
30
• 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
31

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Communicable

• The fecal-oral and respiratory routes are the

• Young children may not wash their hands after

“prevention is better than cure”

• Vaccines are the single best technique for

• Vaccines are the safer choice to getting

– By 24 Months children should

– 1 MMR, varicella (Measles, Rubella, Mumps)

• Inactivated include Dtap, Hib, Hep

• Activated (live) multiplies for days-

Moderate-severe illness with or

• Select needle of adequate length

Varicella (Chicken Pox)

Communicable 1 day before eruption

 rash subsides, but reappears if skin is irritated (sun, heat,

• The immune-competent child can

• Raised erythema rash rash on face that spreads

• Other symptoms persist

Diagnosis and Management

• By 4th or 5th day white coat sloughs off

• Lets Play a Game….

Which of the following statements indicates that a

• A mother brings her infant to the

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