Communicable Disease

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.
Communicable Diseases
of childhood include diseases with high
transmission rates
Viruses are the leading cause of most pediatric
infections

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
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
Immunization Schedule

By 24 Months children should
have:

4 Dtap, Hib, PCV

3 Hep B, IVP

1 MMR, varicella

Immunizations
Are either inactivated or activated

Inactivated include Dtap, Hib, Hep

Activated (live) multiplies for days-
weeks in body MMR, Varicella

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

Adverse Events
National Law to provide care for
those affected by a vaccines 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

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.
Parental Misconceptions
Misconception:

Vaccine-preventable
diseases have been
eliminated
Correct Information

Travelers may
reintroduce the
disease
Recent outbreaks
of measles, mumps,
and pertussis have
been linked to
groups of children
not immunized
Parental Misconceptions
Misconception:

Immunization
weakens the
immune system.
Fear of giving
multiple vaccines.

Correct
Information

Childs immune
system is capable
of several
immunizations at
once
No effect on
immune system



Parental Misconceptions
Misconception:

Vaccines may cause
serious conditions,
such as autism
Correct
Information

Numerous studies
have confirmed the
lack of association
between the measles
vaccine and autism, as
well as thimerosal in
vaccines and autism

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)
Atraumatic care

Select needle of adequate length
Select proper site
VL infants
Deltoid > 18 months
Minimize pain
EMLA cream
Distraction
Communicable Diseases
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

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

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
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)
Fifths Disease
Parvovirus (HPV B19)
No vaccine available
Transmitted by probable respiratory
secretions
Easily Communicable up
to 14 days after infection
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)


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
No vaccine available
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


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

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

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 2
nd
M in MMR
Transmitted by direct contact of
saliva and respiratory droplet
Communicable immediately before
swelling begins
Symptoms
Fever, HA, M, Anorexia, x 24 hours, earache
aggravated by chewing
On 3
rd
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

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 3
rd
day
also low grade fever, HA, Malise, cough, sore throat

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
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
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

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)
Scarlet fever
Bacterial infection (strep),
often sequela to strep throat
No vaccine available
Transmission by direct
contact, droplet
Communicable for 10 days to
2 weeks
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 4
th
or 5
th
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
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.
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 wouldnt 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 _____ 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


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